Set Assesment Exam (MCCQEI-May 205) uestion: A 65-year-old woman is prescribed tamoxifen therapy following surgery for breast cancer. Which one of the following best describes the mode of action of this drug on reducing the patient’ risk of recurrent disease? 1) thas progestational activity that limits the growth-promoting effects of estragens, 2) It decreases secretion of follicle-stimulating hormones (FSH). 3) It enhances biliary excretion of estrogens 74) Itblocks the binding of estrogen to estrogen receptors 5) Ithas direct cytotoxic effects ee She is unresponsive and restless. Her breathing ie aboured. Hr family indicates that she has alustesy of confusion and dementi. ‘They slo indjste tat se ingested "an-feeze" fom the sarge Blod ga reuse: 7.09{ECOB) mtg, PO2 13 mmie( HOON mmoV/L, 02 saturation 97 24. Pease interpre the blood gas satus LePl) primary metabolic acidosis with respitatory compensation B primary metabolic seidais with no compensation 3 ) primary respiratory acidosis with no metabolic compensation ) primary respiratory acidosis with metabolic compensation {S) primary metabolic alkalosis with respiratory compensation Question: 10 ‘A 45-year-old woman presents tothe Emergency Room with difficulty in breathing and decreased lave! of consciousness, I is impossible fo ge any Farther history. An arterial blood g3865 is immediately done. Which one othe following clinical scenarios is most Jikely to give these results? pH 7.26 PO2 76 mmilg PCO2 68 mmblg biearbonate 30 mmol. F102 0.21 ia 1). diabetic ketoacidosis 2) acute renal failure 2/3) chronic obstructive pulmonary disease with acute infection “s) acute pulmonary embolus : 5) methanol toxicity | --_cfebube <2, Gacstion: 1D SX, As€yearolifwoman receiving chemotherapy for widespread metastatic breast cancer is SN2 admitted to hospital with increasing drowsiness, confusion and constipation. She is XO Found tobe hypercaleemie. Which one ofthe fllowig reatmen scenes sefeecents ‘he best inital management of her hypercalcemia? 1). Change the chemotherapy regimen 2) Administer a bisphosphonate dup intravenously $C} Give normal saline solution and a dive logethe. Lngo8) Give nonna saline solution 5) Give dextoea Sin wate solution me bele oe we 58‘Sa Asesment Exam (MCCQEL-May 2005) Question: 12 A35-year-old epileptic presents to your office complaining of a fuzzy feeling in the head Examination shows bidirectional horizontal nystagmus, ‘The most likely eause ofthis finding is 1) pocrly controlled epilepsy. qedrow 2) vitamin B12 deficiency. ee he oer 3) alcoholism, ey Get 4) phenytoin excess sed 5) subdural hematoma estion:13 Reena man reseed wih poss, myosi an anys on thee side. Which once te llowing ithe mow il ena oh conn? 1) amon induced exopiines 2) fourth cranial ervey 2 spel pulmonary earioea ‘)enge yo land 5) thomsen vena tation Question: 14 ‘You sce a 49-year-old man in the emergency room with a 20a history af alenhol abuse, Heis agitated and flordly psychotic, with visual hllucnations and persecutory ‘delusiogs. On examination his blood pressure, hear rate and respiratory rate ar all increased. He is disoriented, sweaty, and has abdominal cramps. What isthe most likely diagn fa 1) subdural nematoma alcoe\ raw THIS 2) alcohol intoxication fe 3) hepatic encephalopathy a oT aves 44) delicium tremens a= Walcingdn 5)_paranoid schizophrenia ‘ Si ean | eens Ca S = somueck Pam (IY) Tifeasuring the blood pressure in an adult patent with suspected hypertension. 4 Which one ofthe following is recommended for an accurate measurement? 1) Use a mercury manometer with the column a atrial level 2) Choose a cuff with bladder width about 40% of arm circumference 3) Increase cuff pressure rapidly until KorotkofT sounds disappear then release for measurement 4)Therate of drop of mercury should be 2 mm per second 455) Record die pressure at which the radial every pulse Gist sppeais (systolic pressune Question: 16 A patient who is evaluated 1 week afte the death of her father describes many memories ‘of her father and says tht she is tearful occasionally and having some rouble falling asleep. She returned to work 4 days afte her fathers death. Proper treatment for this patient should consist of which ofthe following?Saf Assesment Exam (MCCQEI-M ay 2008) 1) administration of antidepressant agents 2). Jong-term psychotherapy 3) referral for further psychiatric evaluation 4) a longer period of time away from work © 5) conservative, supportive treatment Question: 17 On physical examination of @ 3-month-old child you detect a thrill and a machinery-type ‘murmur atthe let upper sternal border. A widened systemic pulse pressure and bounding peripheral pulses are also noted. Based on these findings, which one of the following is the most likely diagnosis? 1) familial hypercholesterolemia > 2) patent ductus arteriosus 3) tetralogy of Fallot 4) Marfan's syndrome 5)_aortic stenosis Question: 18 Which one ofthe following statements about hemorrhagic disease of the newborn is true? 1) Itis mote common in bottle-fed infants. 2) It requires therapy with fresh frozen plasma 3) It becomes evident in the first 24 hours of life +4) It results from a deficiency of vitamin K. 5) Itis more common in females. 219 ‘A 9-year-old boy has been referred to you for evaluation of bedwetting. He is dry during the day but wets every night. His physical examination and urinalysis are normal. Which one of the following is the mgst appropriate method for managing this child? 1) ” psychiatric counseling +2) desmopressin (DDAVP®) ESS 3) waking at night Naren 4) nightly diapers 5) limitation of fluid intake Question: 20 A 14-year-old boy is referred with blood pressure of 130/70 mmHg, There is family history of essential hypertension. His general physical examination and urinal normal. Llome blood pressure readings are consistently between 1000-110 ml systolic and 70-80 mmHg diastolic. Which one of the following is the mos likely cause of his hypertension? 21). "white coat” hypertension 2) essential hypertension 3) reflux nephropathy 4) pheochromocytoma x 5) renovascular hypertensionSelf Assessment Exam (MCCQEL-M ay 2005) Question: 21 [A 3-year-old boy, known to have sickle cell anemia, presents fo the emergency room with sudden onset of severe pallor. Clinical examination reveals massive splenomegaly. On. an earlier clinic visit 2 weeks before this boy had splenomegaly of only 2 em. Which one of the following is the most likely explanation for this acute deterioration? 1) hemolysis 2) malaria 3) hemangioma 4) folate deficiency 5) sequestration ‘Question: 22 A patient has episodes of pain associated with menstrual periods. Following appropriate investigations, you diagnose endometriosis. Which one of the following is the most common pelvic site? 1) posterior cul-de-sac 2) broad ligament of the uterus 3) bladder 94) ovary 5) rectosigmoid colon Question: 23, ‘Afier stepping on a rusty nail, a S-year-old comes to the emergency room. History reveals that he had his DPTP vaccinations at 2, 4, 6 months and 18 months of age and a booster DTpolio vaccination one year ago. Which ofthe following would you recommend? 1) recombinant human anti-tetanus toxin 2) metronidazole 3) vaccination with tetanus and diphtheria toxoids 4) intramuscular immunoglobulin 5) no further immunizations are required Question: 24 ‘The occurrence of malignant mesothelioma has been correlated with industrial exposure to 1) asbestos 2) beryllium 3) coal dust 4) nitrogen dioxide 5) silicaSelf Assessment Exam (MCCQEI-May 2005) Question: 1 ‘A.20-year-old white man was stabbed in the chest in a bar fight and arrived at the ‘emergency room within 30 minutes. You noticed that the trachea is deviated away from the side of the chest that suffered the puncture. Which one of the following would you find upon physical examination of the traumatized side? 1) increased fremitus 2) increased breath sounds 2 3). dullness to percussion £—+4) hyperresonant percussion” 5) wheezing and stridor uestion: 2 'Siyenoldehovals Witness man i schduld for emerysnsywmgey flowing ‘motor vehicle accident in which he sustained pelvic fractures. The patient is competent and lucid before the surgery and refuses the administration of blood products. Which course of action is most appropriate in the event of significant intra-operative blood loss? 1) administration of packed red celis in the recovery 2) use of a cell saver £3) administration of hydroxyethyl starch 4) administration of packed cells after obtaining consent 5) intra-operative autologous blood donation Question: 3 A 58-year-old man presents to your office with a history of having an episode of sudden visual loss in his right eye. ‘The patient describes the loss of vision as similar to someone pulling a cover over his right eye. Vision returned to the right eye after 10 minutes. This visual-field defect is secondary to which one of the following? 1) scotoma (£2) amaurosis fugax 3) strabismus 4) esotropia 5) night biindness Question: 4 Two hours after application of the plaster cast for supracondylar fracture, a patient comes ‘ack to emergency room with a complaint of severe pain in the hand. Examination revealed swelling of the fingers and cyanosis. Which one of the following is the best management? 1) to abserve the patient 2) to administer vasodilators 3) to administer analgesies 4) cut open the plaster near the fingers 9 5) cut open the entire plaster cast immediately 62agane b> excesiond « bret) Sel Assessment Exam (MCCQE1-May 2005) “wig tg Question: 5 ‘A 40-year-old woman presents with a selfdetected hard breast mass. Which one of the following isthe procedure of choice for confirming the diagnosis? 1) mammography 2). thermography 3) ultrasonography Be -4) aspiration cytology © 5)_ incisional biopsy histology C Question: 6 > ear-01d man complains of a 6-month history of shortness of breath and cough, Physical examination reveals clubbing with coarse crackles in both lung bases. Which ‘one of the following is the most likely diagnosis? 1) asthma 2) reflux-induced cough 3) chronic bronchitis +4) idiopathic pulmonary fibrosis 5) sarcoidosis Question: 7 Within minutes of a bee sting, a 23-year-old woman develops generalized pruritus and hyperemia of the skin, followed shortly by swelling of the face and eyelids, dyspnea, and laryngeal edema. This reaction is mediated by which one of the following? 1) antigen-antibody complexes 2). cytotoxic T cells 3). IgA antibodies #4) IgF antibodies 5) IgG antibodies Question: 8 seq A 10-year-old woman presents to your office with a lump inher breast. Which one ofthe Roe #£€X following is the greatest risk factor for cancer? 1) muliparity bonne 2) postive fami history te mB 3) Theor linn replaces heapy 25% Lasts 4) early menarche © 5) advanced age Question: 9 A 35-year-old woman is brought to the Emergency Department in severe distress. She hhas had the "flu" for three days. Past history reveals a six month history of fatigue and ‘malaise. Physical exam reveals BP 120/65 mm Hg supine, 90/58 mm Hg standing, and darkened areas of skin on the knuckles, creases of the palm, elbows and on an abdominal scar. Laboratory values are Na 122 mmol/L, K 5.8 mmoV/L, C1 95 mmol/L, CO2 18, mmol/L. Which one of the following laboratory tests is most likely £0 assist in confirming your diagnosis? 63Sal Assessment Exam (MCCQEL-M ay 2005) 1) Plasma follcte-stimulating hormone (FSH) and luteinizing hormone (LH) 2) 24}our urine metanephrines and vanillylmundelic acid (VMA) 3) Plasma catecholamines, total and fractionated 4) Plasma cortisol and adrenocorticotropic hormone (ACTH) 5) Plasma 170H progesterone Question: 10 A 24-year-old man is brought to the emergency room after being found unresponsive in a city park. Physical examination reveals pinpoint pupils unresponsive to light and a respiratory rate of 7 breaths per minute, Which one of the following is the most likely cause? 1) tricvelic antidepressant overdose 2) morphine overdose 3) arsenic poisoning 4) lead intoxication 5) alcohol intoxication Question: 11 A 21-year-old man presents with a recent suicide attempt. You are asked to assess him in the energeney 19ut. Which one of the following statements concerning the suicide assessment of this patient is TRUE? 1) Discussing suicide with persons suspected of feeling suicidal may increase their risk of suicide. 2) Persons with a recent suicide attempt are at less risk for eventually killing themselves, 3) Depressed persons who commit suidide can do so as they begin to improve. 4) Persons with schizophrenia are at less risk for suicide. 5) Persons with schizophrenia do not usually communicatE their intentions. « Question: 12 A patient is convinced that an intravenous (IV) injection he received has made him immortal. This is an example of which one of the following? 1) anillusion 2) adelusion 3) a hallucination 4) a perseveration 5) a projection Question: 13 A 4l-year-old man reports that he washes his hands 50 times a day. In the evening, he will check the doors, windows, and stove at least a dozen times before retiring for the night. Which one of the following is the most likely diagnosis? 1) paranoid disorder 2), paranoid schizophrenia 3) schizotypal personality disorder 4) obsessive-compulsive disorder 5) _presenile dementia 64Set Asesment Exam (MCCQE! Question: 14 ‘A mother brings her 10-year-old son to your office because he lost consciousness the day before while running, She says that he had had similar episodes in the past, but has never been seen by a dactor She also sates that he does not seem to be able to play as long as most of his friends, On physical examination you detect a systolic ejection murmur and find that the apical impulse is lateral to the mid clavicular line, Which one of the following is the most likely diagnosis? 1) mitral valve stenosis © 2) aortic stenosis 3) coarctation of the aorta 4). aortic insufficiency 5) patent ductus arterioaus Question: 15 ‘A healthy 4-year-old giel presents with the following symptoms: rapidly progressing respixatory distress, high fever, muffled voice, and drooling. Which one ofthe following ‘measures is most appropriate in the initial management of this problem? 8 1) endotracheal intubation 2) ribavirin aerosol 5) bronchodilators 4) racemic epinephrine aerosol 5) high doses of intravenous steroids Question: 16 ‘A 3eyear-old girl has had a low-grade fever, "raspy" cough, and clear rhinorthea for 3 days. She is brought to the emergency room when she begins to develop difficulty breathing. On physical examination her vital signs include a temperature of 39.7°C, a pulse of 160 beats per minute, and respirations of 36 breaths per minute, Auscultation reveals bilateral honchi, wheezing, and some mild stridor. Which one of the following is the most likely diagnosis? 1) asthma 2). epiglottis » 3). laryngotracheobronchitis 4) tonsilitis 5) pneumonia Question: 17 A few hours after eating a dinner of stuffed turkey, a previously well 7-year-old boy and his parents develop vomiting, abdominal cramps, and diarrhea. Differential diagnosis of the cause ofthese gastrointestinal symptoms should include which one of the following? 1) Clostridium difficile pe Campylobacter Ef 3) pinwomns, Sp 4) Stophylococaus aureus exotoxin 5) Clostridium hotulinur 65= & x ‘Self Assesrment Exam (MCCQEI-May 2005) Question: 18 ‘A 30-year-old woman presents with a long standing history of irregular menstrual periods ‘which are often associated with severe pelvic pain and menorrhagia She has also been experiencing dysparunia and pain during defecation. Which one of the following is most likely to assist you in dingnosing this patient's condition? 1) clinical history © 2) laparoscopy 3) pelvic examination 4) hysteroselpingogram (HSG) 5) culdocentesis during menses Question: 19 ‘A 28-year-old woman has a 3-year history of primary infertfity. She presents with increasing symptoms of steady, aching lower abdominal pain atthe time of menses. The pain persists throughout menstruation and often after, and radiates into the rectum. Tender nodules in the uterosacral ligaments are noted on pelvic examination. Which one of the following would be the most contributory investigation? 1) posteoital test #2) diagnostic Laparoscopy 3) _hysterosalpingogram on day 9 of her cycle 4) endometrial biopsy on day 26 of her eycle 5) basal body temperature charting Question: 20 ‘A 72-year-old woman complains of a lump protruding through the vagina with local pressure symptoms, On examination, there is a visible uterine prolapse. All of the following may be etiologic factors, EXCEPT 1) multiparity. 2) chronic smoking, 3). history of large babies. 2 4) stress urinary incontinence. 5) postmenopausal status. S. pine physicians are deliberating over whether the patient they have examined is exhibiting the auscultatory signs of mitral valve prolapse or not. Assuming that there ‘would be agreement by chance of 50%, but, in fact, four ofthe five physicians actually agree on the findings, what isthe choice-corrected agreement (kappa) for the clinical findings? 1) 08 2) 0.75 3) 06 4) 07 5) 05 66oy Sal Assessment Exam (MCCQEI-May 2005) Fa 2, neon 22 Several studies have indicated that, in large urban areas there is a higher prevalence of schizophrenia inthe lower socioeconomic class. Epidemiologic studies tend o support the hypothesis that 1) unsatisfactory social circumstances "breed” an excess incidence of schizophrenia, 2) the fathers of schizophrenics also tend to come from a lower socioeconomic class £43) people with schizophrenia tend to "drift" down the social scale, because of their ‘lines. 4). both intelligence and schizophrenia are negatively associated with social class 5) schizophrenia "runs" in families and is primarily an inherited disorder. < uestion: 23 ‘To qualify for federal contributions, provincial heath insurance plans must gusrantee al of the following, EXCEPT 1) benefits include all necessary hospital care and physicians’ services, 2) universal coverage on uniform terms and conditions. 3) portability of coverage from province to province. © 4) benefits include all necessary out-of-hospital drugs, dental care and prostheses. 5) administration on a non-profit basis. Question: 24 A 68-year-old mas develops acute renal failure afler surgery for ruptured worte aneurysm. He refuses dialysis. Psychiatric consultation reveals him tobe fully alert and oriented, cognitively intact, and not psychotic or clinically depressed. He says he is refusing dialysis because he has "lived full life" and does not want to be "ted to a ‘machine, even if this means TMI die." The psychiatrist should tel the man’s internist that the man 1) is temporarily incompetent to decide on treatment, so treatment should be started 2) is competent to decide on treatment, but his refusal should be overruled because of the existence of a medical emergency © 5) his refusal of dialysis must be respected because he is competent to decide on treatment 4) is behaving in a self-destructive manner, so he should be committed for treatment ‘against his will 5) shows no evidence of a major psychiatric illness but assessment of competency is required Section: 2 Question: 1 ‘A 28-year-old pregnant woman develops sudden onset of dyspnea and tachycardia, ‘Which one of the following is the most likely explanation? 1) acute mitral valve regurgitation © 2) pulmonary embolism 3) myocardial infarction 4) acute respiratory distre 5) lobar pneumonia syndromexe a ‘Seif Assessment Exam (MCCQEI-May 2065) Question: 2 [A 50-year-old man comes to the emergency room with a history of vomiting for three days’ duration. His past history reveals that for approximately 20 year, he has been getting cpigastric pain, lasting Zor two to three woeks. He remenbes getting relief from pain by taking milk and antacids, Physical examination showed fullness inthe epigastric area with visible peristalsis, absence of tendemess and normal e=tive bowel sounds Which one of the following is the most likely diegnosis? 1) gastric outlet obstruction 2) small bowel obstruction 3) volvulus of the colon 4) inesreerated umbilical hernia 5) cholecystitis Question: 3 A40-year-old man complains to his doctor of impotence. Which one ofthe following medication could be implicated? 1) ranitidine, 2) sertraline 3) clarithromycin 4) enslapril 5) hydrochlorthiazide Question: 4 A 34-year-old female keyboard operator develops pain and numbvess in he: hands that radiates up her arms, Which of the following is most likely to have been injured? 1) axillary nerve 2) median nerve 3) alnarnerve 4) racial nerve 5) brachial plexus/ tricape muscle Question: 5 ‘A 60-year-old man presents with a small lesion on his nose, On examination ofthe lesion ‘you note the following: the lesion is 3-mm in diameter, slightly eleveted with a waxy appearance, and has a slight vascular pattem on top. This lesion is most characteristic of which one of the following? 1) basal cell carcinoma 2) squamous cell carcinoma Sy 5) vida x VO Fe, 4) = ~ 5) actinic keratosis. gee A 68* 5 an 76 7 —>— 5) glomerular subendothelial immune complex deposition ‘Sat Asessment Exam (MCCQEI-May 2005) Question: 6 ‘A 30-year-old woman presents with a headache, gradual development ofa partial biter ianopia, and a history of cessation of menses several years ago. Which Oe of the following is the most likely cause? 1) dilated third ventricle 2). craniopharyngioma 3) saccular aneurysm of the circle of Willis 4). pituitary adenoma 5) meningioma of the tuberculum sellae Question: 7 ‘A 30-year-old man has a history of recurrent pneumonias and chronic cough dating from eaily childhood. ‘The cough, which is worse in dhe moxning ad on lying down, is productive of foul-smelling purulent sputum which is occasionally bloody-tinged. ‘The patient is chronically ill and has clubbed fingers. Rales are heard over the lung bases posteriorly. Which one of the folloWing isthe most likely diagnosis? 1) chronic bronchitis 2). pulmonary aspergillosis 3) pulmonary neoplasm 4) chronic obstructive emphysema 5) bronchiectasis Question: 8 A 22-year-old woman presents with fever, malaise, generalized arthralgias, and a skin rash, over the nose and malar eminences. ‘Which one of the following possible findings hhas the greatest relative significance in the overall prognosis for the patient? 1) immune complexes at the dermal-epidermal junction in skin 2) pleuritis 3) atypical verrucous vegetations of the mitral valve 4) perivascular fibrosis inthe spleen Question: 9 re me hear A 38-year-old woman presents to you convinced that she has chronic fatigue syndrome. The history reveals no evidence of fever or swollen glands, and no other symptoms other than fatigue and difficulty sleeping. Her physical examination is completely normal. She nas a high thyroid-stimulating hormone level. You would then suspect and subsequently confirm 1) hyperthyroidism secondary to pituitary adenoma. 2) hypothyroidism, 3) Grave disease. 4) thyroiditis 5) chronic fatigue syndromewcas the fol 6 depen tT yf eines te pre er She Ke he ettpmartl hed Pooh wry con tne Br pote par TENE foarte pad vo ect bee fli i) ‘Se ante Est CCQEL-May 2088) ~ a7 Grestion: 25nd qudiplepic woman (who is mental inc) is shied ind every 2 pours fo vent presi (ects) lear The cca examines er athe end of 2 four neg ses Shei feng wel na coughing nde fe. Examination eng oes ules anos eT ae te mgt ng A, Which one te llowing ithe mow resonable inepeaton of cate? 1) ale secondary to mics hgsing PF 2) pulmonary edema, which has localized due to gravitational forces oe 3) compressive atelectasis 284) aspiration pneamonitis '5)_ehronie pulmonary fibrosis \who was¥oused one morning with dfficlty‘ind appeared confused. Which of the following drug orders is most likely associated with this episode?” 1) timethoprim-sulfamethoxazole (Septra®) D.S. x 2 daily 2) hydrochlorothazide 50 mg once daily 3) lorazepam 30 mg hs 44) theophylline 200 mg x2 daily 53) senna (Senokot®) 1-2 tables as required X Question: 12 QGO ra ttyercit gt nas besome markedly withdrawn daring the ps mons and hes ‘complained of persisting abdominal pain and constipation, for which no organic cause hhas been found. Which one of the following isthe most likely diagnosis? 1). depressive disorder 2). schizophrenia 3). conduct disorder 4) attention deficit hyperactivity disorder 5) infeotile autism Question: 13. ‘A 30-year-old woman complains of episodic faintness, tingling sensation in her hands, shortness of breath, and severe anxiety. Thorough medical workup reveals no pathologie ‘condition. During an episnde of theoe symptoms, chemical analyte nf the enim wall prabebly reveal which one ofthe following? 1) decreased chloride 2) increased urea (BUN) 3) decreased protein 4) increased serum amylase © 5) increased pit 70Sa Assesment Exam (MCCQEL-May 2005) ‘man is suspicious of others, superstitious, believes he possesses telepathic ‘powers, and has no friends. Which one of the following is most likely to be associated With this clinical description? 1) pascivesaggresive personality disorder 2) histrionic personality disorder 1.3) schizotypal personality disorder 4). avoidant personality disorder 5) compulsive personality disorder Question: 15 ‘A 2-year-old boy with visible abdominal distention is found to have a large left-sided flank mass. Which one of the following is the most likely diagnosis? 1) renal cell carcinoma @ 2) polycystic kidney rmoedy 3) transitional cell carcinoma a ah) Win tmo S sy 5) hydronephrosis Question: 16 A 3-year-old with a history of asthma is brought to the Emergency Department in acute respiratory distress. His mother relates that she stopped his twice daily sodium cromoglycate 1 week ago. Physical examination reveals a distressed child with a harsh cough, On auscultation of the chest, there are areas of reduced air entry and diffuse expiratory wheezes. Which one of the following is the most appropriate initial management? 1) aerosolized ipratropium bromide by nebulization 2) aerosolized sodium cromoglycate by nebulization 3) aerosolized budesonide 4) subcutaneous epinephrine, 1:1000 dilution * 5) aerosolized salbutamol by nebulization Question: 17 A 13-year-old boy states that he is growing breasts and that they hurt. He has been growing taller this past year. He has no other complaints. On physical examination you note some acne on his face, his testes and phgllus are appropriate for age, and he has fine sparse pubic hair. Which one of the following is the most likely diagnosis? #1) normal puberty 2) Klinefelter’s syndrome 3) pituitary tumor 4) adrenal tumor 5) gonadal tumorSelf Assessment Exam (MCCQEI-May 2005) Question: 18 A full-term infant presents to your office at 7 days of age with bilateral purulent ‘conjunctive discharge, erythema and swelling at the medial aspect ofthe eyes. Which one of the following is the most likely diagnosis? £1) Neisseria gonorthocae infection ‘ 2). hemes simple infeson 3) nasolacrimal duct inflammation due to Staphylococcus aureus | eens oes ej store Reseda dee 5) chlamydia infection ee enon in peonte. 2-3 +yf5 stic ‘A 30-year-old primigravida presents at 34 weeks gestational age with blood pressure of 160/90 mg headache epgar pin vial sbnormaliee nd 3 protemera, Biopbysial fof of the i i Which one oft allowing ite ben course of are 1) Induce labour and attempt vaginal delivery. 2) Start magnesium sulfate intravenously. 3) Perform an emergency C-section. 4) Give betactomethasone to induce fetal lung maturity. oi psne as case eee aia ea matty Oca oy Ai te flowing ar considered posible nication for esarean section, EXCEPT glacier 2) Fetal distress. 3) genital herpes. #4) carcinoma in situ of the cervix. 5) prior urethropexy. ‘Question: 21 at ‘The statistical measure of the degree of relationship between two sets of numbers is 1) theaverage 2) the standard deviation 3) the normal distribution 4) the standardized scores 5) the correlation coefficient oes hen interpreting a diagnostic tes, the term "gold standard” refers to a definitive diagnosis obtained by some independent means. All ofthe following would be examples of gold standards useful in clinical practice, EXCEPT, coronary angiography in evaluating a cardiac stress test. bacteriologic culture in testing a rapid diagnostic kit for gonorrhea, bronchoscopy with biopsy in evaluating sputum cytology. autopsy results in evaluating electrocardiography. results of long-term follow-up in a test for early rheumatoid arthritis. 72Sf Aasenment Exam (MCCOEL-May 2005) 3 Question: 23 [A new screening test fora type of cancer is carried out on 10,000 subjects. One hundred and sixty have a positive result, of whom eight are determined to actully have the disease. These eight subjects survive longer than other persons suffering from the same lype of enicer dixgnosed by other means, Which one oF the flowing, statements is correct? 1) The sensitivity ofthis test is 98.4% (10,000-160)/10,00. 2) The incidence ofthe disease in this population is 80 per 100,000. 3) Early detection by this test improves survival 4) The predictive value of positive testis 3% (8/160). 5) The predictive value of a negative testis 95% (152/160) Question: 24 Anactive 75-year-old woman relocates to your town. She has hypertension, arthritis, and Giabetes. Her medication regimen includes hydrochlorothiazide, potassium elixir, 4iltiazem, acetaminophen, ibuprofen and glyburide. Which factor is most related to compliance withthe medialOn BNE ok yf Alen Camplin age 2) number of drugs in the regimen ONE of Mectiaatran 3) gener edhe 4) number of comorbid diseases @ teers frequency 5) sseof tablets versus use ofetixis ©) laboc ling y ington’ 7 Combuner Lass . D@ Rsk SP non Comptines mane, Cone inteal Section: 3 mectteamen fucters “Hom & age Question: 1 A ginshot won tothe upper arm eansing shack-wave damage to the median nerve may’ leave the patient with which one af the following? 1) easily provoked pain in the hand 2) weakness on wrist extension 3) atrophy in the first dorsal interosseous muscle 4) numbness over the fith digit 5) radial deviation of the hand Question: A 9-year-old boy is brought fo the hospital with 4 history of having fallen from his bike He fainted and is now complaining of abdominal pain and thirst. There is general vorninal tendemess and rebound tendemess. Approximately 4 hous after the accident, the white blood count is 20x 109/L and dhe hemoglobin is 80 g/L. Wha i the most likely diagnosis? 1) renal contusion 2) acute pancreatitis 5) ruptured spleen 4) retroperitoneal hematoma 5) ruptured bowel 73Self Assessment Exam (MCCQEI-M ay 2005) Question: 3 ‘A 50-year-old man presents to the emergency room with severe epigastric pain, low- grade fever, tachycardia, and mild hypotension. ‘The patient relates a history of moderate to heavy social drinking. The chief resident suspects acute pancreatitis. Which one of the following is the single most important laboratory finding to confirm the diagnosis of pancreatitis? 1) hyperlipidemia 2) hyperbilirubinemia 3) elevated serum amylase 4) elevated serum phospholipase A 5) elevated serum alkaline phosphatase Question: 4 A 22-year-old male, working as a waiter in a nightclub, noticed a gradual hearing loss. He admitted thatthe noise level in his jab ia very high and that he was not advieed to wear ear defenders, Which one of the following does he most likely suffer from? 1) sensory hearing loss and vertigo 2). both sensory and conductive hearing loss 3) conductive hearing loss and ataxia 4) sensory hearing loss and tinnitus 5) conductive hearing loss and nystagmus Question: 5 A.68-yeat~old man presents with « chief complaint that solid food gets stuck in the middle of his chest. In addition, he admits to a 11 kg weight loss over the last 3 months. Which one of the following is the most likely diagnosis? 1) esophagitis 2) lower esophageal ring 3) esophageal carcinoma 4) cerebrovascular accident 5) myocardial infarction Question: 6 ‘A 52-year-old man with a long history of alcohol use comes to the emergency room of a «general hospital. He is confused and on examination is noted to have palsies of conjugate gaze, horizontal nystagmus, and ataxia. Which one of the following is the most likely diagno: 1) conversion reaction 2) alcohol intoxication 3) alcohol hallucinosis, 4) delirium tremens 5) Wernicke's encephalopathy Question: 7 A 71-year-old woman with a history of coronary artery disease presents to her family physician for a routine check-up. The physician notices that she has lost 10 kg since her 74Sal Assessment Exam (MCCQEI-May 2005) last visit 6 months ago. When questioned, she gives a history of intermittent periumbilical pain that always begins 30 minutes after eating and lasts about 2 hours. ‘She claims that the pain is worse after large meals and so she has begun to eat less out of, fear of pain. Which one of the following is the most likely diagnosis? 1) pancreatitis 2). cholecystitis 3) small bowel obstruction 4) intestinal ischemia 5) peptic uleer disease Question: 8 I a woman under 40 years of age, which one of the following breast abnormalities would have the highest predictive value for malignancy? 1) painful, moveable mass 2). painless, moveable mass 3) blood nipple discharge 4) clear nipple discharge 45) breast skin edema with dimpling Question: 9 A 68-year-old man presents with cardiac arrest due to ventricular rupture. Which one of the following myocardial changes is the most frequent cause? 1) Abscess formation and tissue destruction due to infective endocarditis. 2). Fatty change due to interaction of diphtheria exotoxin and camitine 3) _Aschoff bodies associated with rheumatic fever. 4) Inflammation due to coxsackie B infection © 6.5}. Nectors due to coronary artery obstion Question: 10 ‘A49-year-old man who smokes two packs of cigarettes @ day presents with a lung mass ‘on x-ray and recent weight gain. Laboratory examination shows hyponatremia with hyperosmolar urine. The patient probably has which one of the following diagnoses? 1) renal failure 2) pituitary feture 3) Conn's syndrome 4) cardiac failure 5). inappropriate ADH (secretion) Question: 11 Which one of the following types of hallucination is normal? PD hymagoeergceme bv wekefilines ~ Sleep ( rereoles lillputien Sy ecg 2 fect ov gers werble) waciile TECH ow Fe~so7] matene? 4) olfactory adew ein 5) auditory tapi ey Sos 8 temtly in ho sims grat. path ie tote ee2 Salt Assessment Exam (MCCOEI-M ay 2005) Question: 12 ‘A 20-year-old college student presents to you with 2 history of intermittent chest pain for about 6 months, He states thatthe pain can occur at any time, but often occurs late inthe day. The pain can be sharp, dul, or aching and may last for hour. He is physically active land is carrying a full academic load. The pain is unrelated to exercise and does not restrict his activities. His father and paternal uncle have both had myocardial infarctions ‘within the past year. Physical examination is normal, although the patient appears restless and has a heart rate of 100/min, Which one ofthe following i the most ikely diagnosis? 1), fefiux esophagitis +2) generalized anxiety disorder 3) transient myocardial ischemia 44) myocantial infaretion 5) costochondrtis Question: 13 A 25-year-old man is hospitalized after weeks of worsening psychosis. He is given. thiothixene, an antipsychotic medication. Five days later, he develops a fever of 39.8 °C, becomes delirious and lies stiffly in his bed. His family reports that he had been physically well prior to his admission. Which of the following diagnosis is of most immediate concern? 1) tardive dyskinesia 2) viral meningitis +3) neuroleptic malignant syndrome 4) ruptured cerebral aneurysm 5) unsuspected opioid dependence Question: 14 ‘A 3]-year-old man is shy, socially withdrawn, low in self-esteem, yet eager to please when called on by persons in authority. Which one of the following personality disorders is mast likely to be associated with this clinical description? 1) _passive-aggressive personality disorder 2) histrionie personality disorder 3) schizotypal personality disorder +4) avoidant personality disorder 5) _compulsive personality disorder Question: 15 “ArSyear-UlT Gl is admitted to the Children's Hospital after swallowing an undisctosed number of her mother’s ASA tablets, She is hypotensive, flushed and tachypneie. Which of the following acid-base disturbances would be most likely? aaa 1) pH low ; HCO3 low ; pCO? high 2) pH normal ; HCO high; pCO2 low balers 3) pH low; HCO3 low; pCO2 high Opesp pel 4) pH low, HCO3 high; pCO2 low CB) envaoe WOO 5) pH high; HCOS high; pCO? high =‘ = NX Se Sal Assesment Exam (MCCQEI-May 2005) Question: 16 A S-year-old patient has axillary freckling, several firm subcutaneous masses on both. arms and seven light-brown macules on his trunk which are greater than 1.5 em. Which ‘one of the following is the most likely diagnosis? 1) Peutz-Jeghers syndrome 2) tuberous sclerosis pe feae 3) Sturge-Weber syndrome 4) Albright's disease 5) neurofibromatosis Question: 17 A 13-year-old girl sustains « minor injury to the left side of her back in a school basketball game, On examination litte is found except for asymmetric shoulder levels While she bends over, the right posterior chest is elevated. Which of the following are these findings most readily suggestive of? 1) an accessory rib 2) an ifiopsoas muscle spasm 3) thabdomyosarcoma 4) scoliosis 5) hematoma Question: 18 Abe year-old woman is seen because of high fever, fostaion, vomiting and diarhes Her pulse is rapid and thready, and her blood pressure is recorded at 60/40 mmHg. A. Giffae generalized macular as s noted. Following stabilization with fhid and vasoactive medications, culture of which of the following specimens will most likely lead to the correct diagnosis? 1) sputum 2) urine 3) stool 4) cervicovaginal secretions 5) cerebrospinal fluid Question: 19 aes Which one of the following hormones is responsible forthe proliferation of the milk ducts during pregnancy? 1) human chorionie gonadotropin 2) progesterone . 3) prolactin 4) estrogen 5) human placental lactogen Question: 20 Amniocentesis is used in the diagnosis of all of the following conditions, 1) trisomy 21 (Down syndrome). 2) metabolic errors, CEPTp a ‘Seif Assessment Exam (MCCQEL-M ay 2005) 3) neural tube defects. © 4) genitourinary anomalies. 5) trisomy 18. Question: 21 of From information reenrced at school Ait was found that, out of a total of 400 missed ‘person days' during November, 100 were due to measles; 200 to "flu"; and the rest to various other causes. At school B in the same neighbothood, during the same period of time, a total of 75 children were absent for | or more days. Of these, 25 had suffered from measles; 25 from “fhu" and the rest from various other causes. It can be concluded that 1) the incidence of measles was greater in school "B" than in school "A". 2) the incidence of "flu" was greater in school "A" than in school "B". 3) the overall morbidity rate was higher in school "A" than in school "B" 4) the incidence of “other causes" was greater is school "A han in school “B" « 5) none of the above conclusions can be reached with the data provided. “ai “Question: 22 Exposure to lead can cause all of the following, EXCEPT 1) anemia. #2) citthosis of the liver. 3) paresis. 4) abdominal pain. 3) porphyninune. Question: 23 ‘A case control study was conducted in which 50 cases and 50 controls were interviewed to inquire about their history of exposure to substance ‘X’. The following 2 X 2 table resulted: Cases Controls Totals Exposed 4020 60 Not exposed 10 30 x 40 RR Totals, 50 50 100, crest ‘The ‘odds ratio’ (estimate of the relative risk) is Ag J 1) 07 Dele F 2) 1.50 3) 2.00 4) 300 > 5) 6.00 Question: 24 4 Under certain circumstances, it may be legitimate to detain individuals in an institution against their wishes, for their own good and to protect others. This situation may arise when 1) a person has bizarre fantasies and actions 2) _petsons are mentally incompetent and unable to manage their own affairs 78‘Sa Assesment Exam (MCCQEI-May 2005) 3) a close relative submits a petition that an individual is actually and presently insane #4) the individual's continued liberty poses a danger 3) person has visual and aural hallucinations Se cium: 4 uestion: 1 Aap yeareld centr ropped his circular saw and severed his lower eg. Which one of the following would be indicative of a severed tibial nerve? #1) paralysis ofthe plantarflexors ofthe foot 2) paralysis of all the muscles in the pasterior compartment of the leg 43) anesthesia of most of the sole of the foot 4) paralysis of the muscles in the lateral crural compartment 5) anesthesia to the medial aspect of the lower leg Question: 2 A middle-aged woman is admitted unconscious to the Emergency Department following ‘ahead injury in a car accident. There is bruising over the upper abdomen. Blood pressure is 80 mm Hg systolic, pulse 120/minute. What is the most important initial step 'm the management of this patient? 1) xray (three views) of abdomen + 2). immediate laparotomy 3) draw blood sample and start TV fluids 4) perform emergency burtholes 5) diagnostic peritoneal lavage mos OM aR sesame 3 cc Question: 4 A 78-year-uld man complains of 3 months of fatigue and a 10 kg weight loss, Physical examination reveals jaundice without abdominal tendemess or organomegaly. Which one of the following is the most likely diagnosis? 1) cholecystitis 2) pancreatitis 3) hemochromatosis 4) hepatic vein thrombosis © 5) pancreatic carcinoma 79Sa Assessment Exam (MCCQEI-May 2005) Question: 5 A 55-year-old man presents to the hospital with the complaint of severe intermittent pain in his right lower back that radiates around his trunk into his lower quadrant and upper right thigh. Which one of the following is the most likely diagnosis? 1) hepatitis 2) appendicitis +3) aureteral stone 4) pyelonephritis 3) biliary obstruction Question: 6 ‘T_ You are pertorming pulmonary function tests on a 80-year-old male with persistent cough * Which one of the following would occur normally with age? 1)“ in vita capacity 2) fallin FEVI/FVC bh eotic recosl 3). fallin arterial p02 Bae 4). increase in arterial pCO2 Pim. Fimahon nese 5) decrease in arterial pH Question: 7 A 26-year-old man developed hemoptysis and dyspnea over the course of 3 months. His physician suspected tuberculosis and started him on triple therapy with isoniazid, rifampin, and ethambutol. After 2 months, the patient complained of pins-and-needles sensations in his feet. Neurologic examination was otherwise unremarkable. Strength was good in all limbs. Which one of the following nutritional deficiencies is most likely responsible? 1) vitamin B12 deficiency # 2) vitamin B6 (pyridoxine) deficiency 3) vitamin B (alphatocopherol) deficiency 4) vitamin D deficiency 5) vitamin BI (thiamine) deficiency Question: 8 56-year-old patient presents with polycythemia. He is found to have low ox: “4 saturation, increased red blood cells mass, normal plasma volume and inereased erythropoietin levels. Which one of the following is the most likely diagnosis? 1) polycythemia rubra vera 34-7) chronic obstructive pulmonary disease (COPD) 3) stress polycythemia 4) renal adenocarcinoma 5) congenital spherocytosis Question: 9 While being investigated for long-standing hypertension, a 53-year-old woman is found to have the following serum laboratory test values: normal creatinine, total protein, 80Seif Assessment Exam (MCCQEI-May 2005) albumin, and globulin; increased calcium and alkaline phosphatase; and decreased phosphorus. Which of the following do these findings suggest the presence of? 1) carcinoma metastatic to bone 2) excessive dietary calcium intake 3) multiple myeloma © 4) parathyroid adenoma 5) sarcoidosis Question: 10 ‘A 40-year-old woman presents with painful swelling ofthe joints of her fingers, excessive fatigue and a malar rash. Which one of the following diseases is is most likely? 1) psoriasis 2) pseudogout © 3) systemuc lupus erythematosus (SLE) 2 eemaaela ete serum sickness to are Jocal store. These have been getting more frequent and she is finding it increasingly difficult to leave her home. Which one of the following should form part of her treatment? 1) psychodynamic therapy 2). interpersonal psychotherapy 3) family therapy 4) supportive psychotherapy { 5) cognitive behavioral therapy ~ go year-old woman tells her physician that for several months she has been experiencing palpitations, dizziness, shortness of breath, a feeling of impending doom and a fear of dying, Which of the following would be the most appropriate initial step in managing this patient? 1). offer psychotherapy 2) prescribe benzodiazepines 3)" perform a physical examination 4)_refer the patient to a psychiatrist > 5) teach relaxation techniques Question: 13 A patient reports that, on his way to your office he saw a man feeding two squirrels in the park, He says that this means that his future will be decided within 2 weeks. Which one Of the following terms best describes this mode of thinking? 1) illusion 2) hallucination we ~~ aSaif Assessment Exam (MCCQE1-May 2008) 3) delusion 4) loose association 5) neologism 2) calcium (total) 1.66 mmol/L. 3) white blood cell count 18 x 109/L. 4) aspartate aminotransferase 100 UL. L—5) slucose 2.2 mmol/L. awn, Question: 21 ‘The incidence of a particular disease is greater in men than in women, but the prevalence shows no sex difference. The most probable explanation is that 1) the mortality rate is higher in women. 2) the case fatality rate is higher in wornen, #3) the duration of the disease is longer in women. 4) women receive less adequate medical care for the disease. 5) this diagnosis is more often missed in women. 83Seif Assessment Exam (MCCQEI-May 2005) Question: 22 All of the following are responsibilities of local public health units in Canada, EXCEPT. 1) communicable disease control 2) health education +3) investigation of sudden death. 4) immunization. 5) health promotion. (Question: 237 OF the following are characteristics of provincial voluntary health organizations, EXCEPT 4—1) provincial governments contribute to their funding in proportion to the number of members. 2). they are governed by volunteers rather than by professionals 3) they often carry out programs of education for the public, patients, their families, or health professionals. Se-4) they may provide direct services to patients. \'5) they may conduct research or provide funds to others for researc (wv Question: 24 OY The causative organism of cholera, Vibrio cholerae, has been recognized for 100 years. Outbreaks of cholera often reach epidemic proportions; the history af xeven pandemics can now be traced. ‘The most recent only just now appears to be subsiding. Which one of the following is the spread of ths infection, enhanced by modem transportation? 1) fomites 2) mosquitoes +3) contaminated food sources 4) person-to-person 5) domestic flies Section: 1 Question: 1 A 49-year-old man is diagnosed with a non-small cell lung cancer. Staging investigations suggest that the disease is confined to the lef ing. Which OME T the following is the most appropriate initial treatment for this patient? 1) combination chemotherapy >) combined chemotherapy and radiation +5) surgical resection 4) radiotherapy 5) brachytherapy Question: 2 at-old boy presents with a swelling in the right scrotum. On examination the swelling is irreducible, itis possible to get above it and itis translucent. Which one of the following is the most likely diagnosis?Sal Assessment Exam (MCCQEI-May 2005) 1) indirect inguinal hernia 2) varicosity of testicular veins 3) torsion of the testis 4) acute epididymo-orchitis #5). primary hydrocele Question: 3 : A.49-year-old man with alcoholic cirshosis presents with an acute upper gastrointestinal bleed. Which one of the following tests will be most useful in localizing the site of bleeding? 1) angiography 2) magnetic resonance imaging (MRI) 73) gastroscopy 4) small bowel follow through 5) technetium red cell scan Question: 4 ‘A.40-year-old man presents with dysphagia, which appears to be much worse for cold food as compared to warm food and worse for liquids than for solids. He has also experienced regurgitation of food, especially at night. Esophagrams showed smooth narrowing of the cardioesophagcal junction and dilation of the esophagus proximal to the area of narrowing. Which one of the following is the most likely diagnosis? 1), carcinoma ofthe esophagus 2) peptic esophagitis #3) achalasia 4) diffuse spasm of the esophagus, 5) benign esophageal stricture Question: 5 A.35-year-old woman complains of fatigue, nausea and low-grade fever, since dental root canal surgery four weeks previously. You suspect endocarditis. What is the most likely organism? 1). Streptococcus pneumoniae 2). Straphylococcus aureus 3) Haemophilus infiuenza #4) Viridans streptococcus 3) escherichia coli A right handed elderly man has sudden onsets of weakness of the right hand and arm, with less severe weakness of the right leg. ‘There is no aphasia, anqa0 sensory br visual symptoms. His symptoms resolve in over one week's time. Recovery is full. Which of the following is the most likely diagnosis? 1) subdural hematoma = weisy 6C 2) carotid occlusion (thrombosis) tensa 3) hypertensive encephalopathy pee Secbory | (itm seg bee bysetu Ate © he ie 85Set Assessment Exam (MCCQEL-May 2005) SL 4) tacunar infarction 5) cerebral hemorthage Question: 1 ‘A 3-year-old child presents to the Emergency Department complaining of headache, purulent nasal discharge, fever, earache, and nasal congestion for the last 5 days. An ‘ray of the sinus reveals thickening of the maxillary sinus of more than 9 mm. Which one of the following findings suggests a complication of the sinusitis? 1) purulent conjunctivitis 2). cervical adenitis 3) serous otitis #4) periorbital cellulitis 5) purulent tonsilltis Question: 2 A 16-year-old man presents with a sublingual mass. Itis bluish, beneath the tongue in the anterior floor of the oral cavity on the right side. Itis soft and ‘uctuant, but not painful. Which one of the following diagnoses is the most likely? +1) ranula 2) dentigerous eyst 3) branchial cyst 4) torus palatinus 5) radicular eyst Question: 3 A 20-year-old man has been involved in a motor vehicle collision, He has obvious blunt chest and abdominal injuries, but the striking feature is his marked restlessness, Which ‘one of the following is the most important initial step to take? #1) Check for causes of hypoxia, 2) Give him morphine. 3) Check him for head injury. 4) Give him a sedative. 5) Catheterize his bladder Question: 4 ‘Which type of colonic polyp is most likely to become malignant? 1) hyperplastic polyp 2) tubular adenoma oK aderordor’s peyr £3) villous adenoma - 44) Peutz-Jeghers polyp Pali colar ;2etg PS 5) juvenile polyp ( Petgpasis aly 1b caedne syd. Tor & jremjonahey ee ee 86Setf Assessment Exam (MCCQEI-May 2005) Question: 5 In differentiating between systemic lupus erythematosus and rheumatoid arthritis, which cone of the following symptoms would make systemic lupus erythematosus the more likely diagnosis? 1) ulnar drift at the metacarpophalangeal joints 6 2) absence of synovial thickening in symptomatic joints 3) symmetrical tenderness of small joints 4) asymptomatic effusions in both knees, 5) _periarticular nodules 3 Question: 6 ‘A 62-year-old alcoholic presents with complaints of poor balance, requiring a cane to keep from falling. He has a high stepping gait and cannot stand with his eyes closed. He has normal finger-nose testing and normal cranial nerve examination. His problem is most likely due to 1) alcoholic cerebellar disease. 2) chronic subdural hematoma. #3) alcoholic peripheral neuropathy. 4) Wemicke encephalopathy. 5) vitamin B12 deficiency. Question: 7 ‘A 62-yeat-old man presents with a 4-week history of pruritus and steadily deepening jaundice. He has taken no drugs. The only significant positive findings are jaundice, dark urine and clay-colored stools on rectal examination. Preliminary biochemical test results include: alkaline phosphatase four times normal; aspartate aminotransferase slightly elevated. Which one of the following tests should you do next? 1) upper gastrointestinal barium contrast x-ray — +2) ultrasound examination of the upper abdomen Bi 3) endoscopic retrograde cholangiopancreatography Woe 4) measurement of serum HBs-antigen, anti-HBc and anti-HAV a 5) percutaneous transhepatic cholangiography ‘Question Gorm to comment, to an interest group, conceming prognosis in human immunodeficiency virus (HIV) infected individuals. Of the following, which one has had the most significant impact on prognosis for HIV infected individuals? 1) prophylaxis for Mycobacterium avium #2) combination antiviral therapies 3) pneumococcal vaccination 4) antiviral therapy for Kaposi sarcoma 5) antifungal prophylaxisos Setf Assessment Exam (MCCQEI- Question: 9 A 5-year-old child is brought to you because his parents find him overactive, easily distracted, restless, disorganized in hs play, and often in conflict with other children his age, In addition to working with the family and with his teacher, you decide upon a trial of medications. Which one of the following medications is the most appropriate? 1) diazepam 2) phenytoin 3) methylphenidate 4) lithium carbonate 5) cimetidine Question: 10 All of the following statements about postpartum psychosis are true, 1) it should be treated as a psychiatric emergency. 2) residual symptoms are common. 3) lithium carbonate is useful for manic symptoms. 4) psychotherapy is beneficial fier the period of acute psychosis, 5) use of neuroleptics is often necessary Question: 11 A |4-year-old gitl is being assessed for weight loss. Which one of the following features from the history would suggest ast organic cause for the patient’s problem? 1) Her dentist had to fit two crowns because of dental erosion. 2) She is unconcemed about her weight loss, 3) She complains of constant fatigue 4) She is on the school athletic team. 5) Her mother and sister have been treated for depression Question: 12 The most effective treatment for eyelothymie disorder is 1) fluoxetine 2) lithium carbonate. 3) individual supportive psychotherapy, 4) psychodynamic psychotherapy. 5) amitriptyline. Ges) Etter datos aaelyahebanic een oa shal ee init, The white blood cell count is 15 x 109/L. Platelet count is 80 x 109/L. ‘The liver and spleen are barely palpable, Which one of the following factors should concern you the most regarding the child's prognosis? 1) white blood cell count 2) platelet count 3) child's age 4) mild hepatosplenomegaly 5) child's genderSeif Assessment Exam (MCCQEI-May 2005) Question: 14 ‘An 8-year-old boy has had the following symptoms for the last 3 months: profuse watery thinorchea, nasal obstruction, itching tearing of the eyes, and mouth breathing. Which ‘one of the following is the most probable diagnosis? 1) sinusitis, 2) tonsilitis #3) allergic rhinitis 4) nasal polyposis 5) hypertrophy of adenoids Question: 15 Cyanosis in the newbom is typical of 1) left-to-right cardiac shunt, 2) patent ductus arteriosis. 3) aortic stenosis. 44) transposition of the great vessels 5) coarctation of the aorta. Question: 16 Ina S-year-old girl with leg edema and apparent congestive heart failure, which one of the following would be most effective in inducing rapid therapeutic diuresis? 1) digoxin #2) furosemide 3). thiazides 4) spironolactone 3) mannitol Question: 17 Plasma levels of pituitary gonadotropins are characteristically elevated in each of the following cases, EXCEPT 1) Tumer syndrome. 2) menopause. 3) following bilateral oophorectomy, 94) bilateral dermoid cysts. 5) following radiation therapy for carcinoma of the cervix, Question: 18 ‘A 5-cm in diameter right ovarian cyst is found incidentally during the first prenatal ‘examination of an otherwise healthy 22-year-old primigravida at 12 weeks' gestation. The most likely diasmosis is 1) a dermoid cyst 2) a mucinous cystadenoma. 3) an endometrioma. 4) a follicular eyst +5) a corpus luteum eyst 89* & Q Sa Assessment Exam (MCCQEL-May 2005) In FereEhing for cervical neoplasia, which one of the following statements about the Papanicolaou testis correct? #1) Iris not necessary following hysterectomy. 2) Ithas a low false negative rate, +3) Itshould always include an endocervical component. 4) It should not cause cervical bleeding. 5) It is best done in the premenstrual phase of the cycle Question: 20 The female menopause may be associated with all of the following, EXCEPT + 1) increase in appetite 2) osteoporos 3) vasomotor syimptoms. i) atrophy of the vaginal mucosa. 5) atrophy of the urethral mucosa ‘Question: 21 ‘The impact of cigarette smoking on the health of the population of a Canadian province has been studied. The following statistics are found: Death rate from lung cancer in smokers = 1/1000/year Death rate from lung cancer in non-smokers = 0.05/1000/year Prevalence of cigarette smoking = 50% Total death rate from lung cancer = 0.525/1000/year ‘The relative risk of lung cancer due to smoking is, 1) 1/1000/year -0.05/1000/year = 0.95/1000/year. 2) 0.525/1000/year ~ 0.05/1000/year = 10.5. © 3) 1/1000/year ~ 0.05/1000/year = 20. 4) 1/1000/year + 0.05/1000/year x 50% = 10. 5) U/1000/year + 0.525/1000/year x 50% = 0.98. cf Question: 22 ut ‘The annual rate of natural increase of the population in a given area is 1) the birthrate plus the immigration rate into the area for each year. 22). the birthrate minus the death rate, minus the immigration rate, for each year. 3) the birthrate minus the death rate. plus the immigration rate, for each year 4) the binrate minus the death rate for each year 5) none of the above data is sufficient to calculate the rate of natural increase. Question: 23 One of the effects of screening for hypertension is that those who have an elevated blood. pressure may be “labeled.” The most likely consequence of labeling these patients is 1) they tend to take on sick-role behavior. 62) they realize the seriousness of the diagnosis and tend to be very compliant patients 3) they believe that details of their illness are known to other people. 90b _ “Gy ype SO 8 ntact 0 (BD 3. 4) they are characterized by unusual denial. 5)_they are at risk for associated depression ust fepression is lower in a woman 1) who has three or more children under 6 years of age, 2), of lower socioeconomic status. 3) with multiple sclerosis. + 4) whose parents died when she was a child. 5) who has never married, Section: 1 Question: 1 A'S6-yearold man wit a 3-week history of fatigue, intermittent fever and cough, presents tothe emergency department complaining of increasing shortness of breath, The patient's temperature is 38.4 °C. The white blood cell count is 16.5 x109/L. A chest x-ray shows a right-sided pleural effusion filling the lower two thirds of the hemithorax. AL this point, which one ofthe following is the best investigation to conduct? 1) sputum culture 22) thoracentesis 3) CT of the chest 4) bronchoscopy 5) lung sean Questios A 35-year-old female presents to your oflice with a one week history of hemorthoids that slightly prolapse and bleed with some bowel movements. She finds them increasingly itchy. Which one of the following is the most likely treatment you would recommend for this patient? ))hemorrhoidectomy 2) hemorrhoid banding 3) acetaminophen suppositories 4) stool softeners and high fibre diet 5) laxatives Question: 3 ‘A.65-year-old man is on his second postoperative day after colon resection for carcinoma. He ison intravenous fads snd nasogastric suction, Which one ofthe following would be the most reliable in assessing the state of his hydration? 1) turgor of skin 2) body weight 3) urine output “9 amount of thirst. 5) moisiness of his tongue o