MCCEE January 2004 1. Wrist drop, which nerve is affected?

a) median nerve b) radial nerve c) ulnar nerve answer: b 2. Characteristic of borderline personality disorder is: Answer: splitting 3. Femur fracture with angulation, lower leg is pale, pulseless and cold, whats the first management? a) straighten the leg and traction b) immediate operation 4. In designing a community prevention program, which one should be undertaken first? a) obtain guarantee of funding b) estimate the cost-benefit of intervention c) quantify objectives d) carry out a community needs assessment e) formulate possible strategies of screening answer: d 5. All can cause depression except: a) cimetidine b) corticosteroids c) cephalosporines answer: c 6. cricothyroidectomy is indicated for a) foreign body in the trachea b) severe facial injuries c) C5-C6 spine injuries 7. child with yellow skin, which one is indication of carotenemia? a) no discoloration of the sclera 8. patient said his boss let him come to see u because he always cannot keep good relationship with his colleagues, he thinks his boss is harassing him, whats the probable diagnosis? a) borderline personality discorder b) dependent personality discorder c) schizotypal personality discorder 9. young lady with sudden onset right lower quadrant pain, pregnancy test is negative. Pelvic examination reveals 6cm severe tender right adnexal mass, diagnosis? a) adnexal torsion b) ruptured ovarian cyst c) ectopic pregnancy 10. old patient referred by his dentist with white lesion in his mouth, management? Answer: biopsy 11. old patient with whitish thickening lip, management? a) biopsy 12. child bitten by some kind of insect came with symptoms of anaphylactic shock, management?

Answer: SC epinephrine 13. picture shown whitish lesions on the tongue (oral thrush) of an old woman after taking antibiotics for 10 days. Management? a) mycostatin gurgle b) coticosteroids c) amphotericin answer: a 14. all drugs r teratogenic except: answer: heparin 15. typical senario of trigeminus neuralgia, what do u give? Answer: carbamazepine 16. all of the following is true about incidence except: a) estimate the risk of acquiring the disease in community b) useful for etiology analysis for both acute and chronic diseases answer: b 17. most common irritant for child asthma at home: a) rugs b) pets c) plants d) smoking 18. best diagnosis of chronic pancreatitis: a) CT b) ERCP c) serum amylase answer: b 19. common symptom of cardial tamponade and pneumothorax: a) hypotension b) bradycardia c) decreased venous pressure answer: a 20. which of the folloing most suggests a pneumothorax? a) deviation of trachea b) paradoxical respiration 21. 30 y.o. female patient, her father has huntinton chorea, how big is the chance that she also has the disease? Answer: 50% 22. patient after big operation develops suddenly dyspnea, chest pain (probably PE), the most likely finding on chest x-ray is: answer: normal 23. patient with obstructive pulmonary disease, which of the following ABG finding suggests oxygen therapy may be dangerous: a) pH=7.34, pCO2=60, bicarbonate=30 b) pH=7.4, pCO2=40, bicarbonate=24 c) pH=7.19, pCO2=25, bicarbonate=forgotten answer: a (primary respiratory acidosis and compensation with metabolic alkalosis)

24. imperforated hymen is associated with all of the following except: a) abdominal mass b) limb paralysis c) obstruction of venous return d) hydronephrosis 25. police took a man who sexually assaulted a boy. When u asked him how many legs does the horse have, he answered 5. Dignosis? Answer: factitious disorder 26. followings r characteristics of psychoanalysis except: a) contertransference b) resistance c) rehearsal 27. 18 y.o. freshman came to u asking about the best way to prevent HIV transmission, your best answer is: a) combination use of condom and spermacide b) sexual abstinence c) judicious use of condom d) HIV test of partners 28. patient taking many drugs including ACEI, TCA and complaints of impotence, which drug is most likely to cause this symptom? a) ACEI b) TCA 29. female patients presents with palpitation, EKG shows occasional premature ventricular beats, management? Answer: reassurance 30. young lady complaints of hopelessness, decreased in concentration especially at the end of the day. management? a) time off work b) antidepressant c) psychosocial support and return visit d) psychosocial support and lorazepam 31. young female patient with genital herpes, what do u suggest? a) she can not conceive in the future b) she can conceive but she should tell her obstetrics about her herpes history answer: b 32. newborn with hart rate 40/min, irregular respiration, some flexion of the extremities, grimace to nasal catheter. He is pale and blue. Apgar score is? a) 2 b) 3 c) 4 d) 5 e) 6 33. newborn with congestive heart failure, is acyanotic, most likely cause? a) TOF b) ASD c) aoteric stenosis

34. patient on warfarin for phlebitis presents with spontaneous bruises and petechiae. INR is also increased. Management? a) reduce warfarin b) stop warfarin c) stop warfarin + vitamin K d) stop warfarin + fresh frozen plasma 35. scenario of endometriosis, definitive diagnostic method? Answer: laparoscopy 36. female patient presents with right lower quadrant pain. Now she also complains of epigastric and left abdominal pain. On examination, she has tenderness on epigastrium and left abdomen. Fever 38C, labor: your management within 30 min includes all of the following except: a) repeat abdominal examination b) check BP and pulse on standing c) pelvic examination d) requisition of ultrasound which is scheduled in next week 37. one disease family tree, ask what inheritance type a) autosomal recessive b) autosomal dominant c) X linked recessive d) X linked dominant e) multifactorial 38. patient on lithium presents with fatigue, weight gain and constipation. Investigation? a) serum electrolytes b) serum lithium level c) TSH answer: c 39. black woman, nullipara, jogs 30 minutes three times a week. She smokes for 20 years. Height 150cm, weight 50kg. which of the factors increase the osteoporosis? a) her race b) her BMI c) exercise d) smoking e) nullipara answer: d 40. an evidence of decreasing osteoporosis in post-menopausal woman who are taking calcium supplement can be strongest obtained from a) a randomized control trial of giving calcium tablets and follow up for fractures for 10 years b) comparison of fracture incidence in postmenopausal women who are living in high and low diary products available answer: a 41. the most common cause of absence from work is answer: back strain 42. most important bias factor in cohort study is a) follow up b) recall answer: a

43. patient presents with hematuria and albuminuria. Which test can confirm the diagnosis of acute glomerolonephritis? a) abdomen US b) ASO titre 44. all of the following are associated with posterior hip dislocation except: a) avascular necrosis of femoral hear b) sciatic nerve injury c) femoral nerve injury 45. your colleague was preparing to do a surgery. You found out his gait is abnormal and you got smell from him. You let him not to do the surgery but he said it was not your business. What should you do? a) inform the chief of staff on the next morning b) inform the CEO immediately c) let another colleague help to talk to him 46. patient on clozapine, important side effect of this drug: answer: agranulocytosis 47. pap smear is a) primary prevention b) sencondary prevention c) tertiary prevention answer: b 48. scenario of acute pyelonephritis, the most common cause is: a) staphylococcus aureas b) E. coli c) Chlamydia trachomatis answer: b 49. woman with breast cancer was treated with radiotherapy. She was responding well but developed depression. Then, she got pneumonia and died. What is the cause u should write on her death certificate? a) pneumonia b) depression c) brest cancer answer: a 50. your neighbor called u because their child was choking during eating. U should do: answer: put the child facing down and give blows on the back at the interscapular area 51. best treatment of bullous impetigo: a) penicillin b) amoxicillin c) cloxacillin 52. patient with lower back pain, x-ray: anterior osteophytes at L4-L5 and subchondral sclerosis, diagnosis: a) degenerative spondylitis 53. middle aged female patient with gastroesophageal reflux complaints of dysphagia for liquid and solid food. Cause? a) barrett esophagus b) squamous cell carcinoma of esophagus

c) adnocarcinoma of esophagus d) peptic stricture 54. picture shown 6-month-old infant with umbilical hernia. Your management? Answer: reassurance and recheck at 1 year of age 55. in postoperative period, a patient demanded for morphine for relief of his pain every 4 hours. The attending nurse thought that this patient was lying and told you that the patient should be treated with placebo. What will u do? a) give placebo b) not give placebo c) tell the patients relatives for consent to give placebo 56. U are family physician of a lab technician. He always drinks. U will report all the conditions except: a) you know that a lab technician disturbs his lab works b) he drives car during drunk c) he occasionally drives his private airplane during drunk d) has sexual relationship with his 14-year-of daughter 57. patient presents with recurrent gouty arthritis attack, urinary uric acid is increased, you will prescribe: a) colchicine b) allupurinol + colchicines c) benzbromaron 58. patient post-MI, develops bradycardia with pulse 32/min, the best management a) atropine b) pacemaker answer: b 59. scenario of neuroleptic malignant syndrome, treatment? a) benzodiazepine b) bromocriptine c) benztropine d) buspirone answer: b 60. which neurotransmitter in schizophrenia? Answer: dopamine 61. definition of ergonomics? Answer: concerned with human factors in the design and operations of machines and the physical environment 62. patient postoperative presented with heavy wound bleeding, she also gave a history of massive bleeding when she had a tooth extraction. Blooding time is increased. You will give: a) DDAVP b) factor XIII c) fresh frozen plasma answer: a 63. KOH is used to diagnose: a) candidiasis b) bacterial vaginosis c) thichomoniasis

answer: a 64. young male patient with painless scrotal mass, transilumination ive, management? Answer: refer to surgery 65. hepatitis B can be transmitted through the following ways except: answer: fecal-oral 66. the best screening test of primary hyperaldosteronism in hypertension: answer: serum rennin activity level 67. male patient had problem at work. Now he complains of back pain. Physical exam shows no pathological finding but he obsessed with it. Diagnosis? Answer: malingering 68. patient with deceitfulness, impulsivity and lack of remorse. Diagnosis? a) antisocial PD b) borderline PD 69. boy fell from a tree, presented with abdominal pain and hematuria. U will do: a) renal scan b) CT note: there were no option like IVP so I chose CT 70. central tendency: mean systolic pressure: 115mmHg with standard deviation of 15mmHg, ask 95% of the population will have SP of: Answer: 85-145mmHg 71. incidence of a disease in the exposure group is 137, in the non-exposure group is 8, ask 137/8 is called: Answer: relative risk 72. decreased mortality rate of stroke is due to: a) better control of blood pressure b) regular use of aspirin c) improvement of surgery process 73. patient treated with amoxicillin for 10 days developed diarrhea, how to confirm your diagnosis? a) stool culture for clostridium dificile b) coloscopy c) test of clostridium dificile toxin 74. newborn needs: a) 75 kcal/kg/day b) 115 kcal/kg/day c) 200 kcal/kg/day answer: b 75. female with adenomyosis is likely to present with Answer: bulky uterus 76. scenario of angle closure glaucoma, your first management: a) miotic eye drop b) mydriatic eye drop Answer: a

77. 75 years old man presented with bilateral loss of vision, he gave history of herpes zoster. What is the most likely cause of his visual loss a) bilateral corneal opacity due to herpes zoster b) macular degeneration c) glaucoma Answer: b 78. post trauma, which of the following signs enforces you to admit the patient? a) corneal abrasion b) conjunctival tear c) soft eye answer: c 79. shock baby syndrome answer: you may find intraocular hemorrhage 80. picture shown clubbing fingers, which is NOT the cause? a) lung cancer b) chronic bronchitis c) infective endocarditis 81. child with 2 years history of tourettes syndrome, now developed obsessive compulsive disorder, what would your give? a) haloperidol b) fluvoxamine 82. which cancer can caused by vinyl chloride? Answer: liver CA 83. which one is not a symptom of lead poisoning? Answer: liver cirrosis 84. which of the following trauma must be treated first? Answer: pneumathorax 85. picture of female newborn shown vaginal bleeding, management? Answer: reassurance 86. patient with anxiety, dysphoria, muscle pain, accasionally convulsion, these are the withdrawal symptoms of which of the followings? a) benzodiazepine b) cocain c) cannabis 87. the difference between male and female sexuality is: Answer: female has shorter refractory period 88. most common source of silicosis exposure is: Answer: sandblasting 89. 12 months infant only with breast feeding till now is most on risk of what deficiency? a) vitamin D b) iron c) folic acid 90. child with knee pain, swelling and redness of the knee joint, management?

Answer: knee aspiration 91. Downs syndrome is associated with the followings except: Answer: rocker bottom foot 92. patient had barbecue, developed muscle pain, diarrhea, eosinophelia. Best investigation to confirm the diagnosis? Answer: muscle biopsy 93. scenario of vaginal candidiasis and groin skin candidiasis, the patient probably has: Answer: DM 94. patient presented with inability to dorsiflex the foot and loss of sensation over the dorsum of the foot, diagnosis? a) peripheral neuropathy b) disc compression Answer: b 95. conversion disorder, all are true except: a) la belle indifference b) unconsciousness of the symptoms c) defence mechanism of projection and intellectualization 96. female vaginal lubrication during sexual excitement period is due to secretion of: a) cervical glands b) vaginal glands c) vaginal transudat