1. A 42-year-old woman has a12-year history of ulcerative colitis that has responded well to mesalamine and occasional corticosteroid enemas. Recent surveillance colonoscopy with biopsies showed low-grade dysplasia. Which of the
following would be the most appropriate next step in the management of this lady?
A) No intervention, repeat colonoscopy in 6 months
B) No intervention, repeat colonoscopy in 1 year
C) Administer continuous corticosteroid enemas
to the surgeon for colectomy
E) Administer a high-dose corticosteroid intravenously
2. A 28-year-old man undergoes an endoscopic transthoracic sympathectomy for palmar hyperhidrosis. Postoperatively,
he has developed ptosis of his eye. This is due to iatrogenic damage to which one of the following nerves?
A) 8th cervical nerve
B) 1st thoracic nerve
C) Lower cord of brachial plexus
D) 2nd thoracic ganglion
E) 7th cervical nerve
3. A 51-year-old woman undergoes a successful bone marrow transplant from a matched unrelated donor for refractory Hodgkin’s disease. She is discharged from the hospital on no medications and is feeling well.
At an appointment 6 months posttransplant, she is well with no evidence of malignancy. Three weeks later, she travels to Florida with her family. She is cautious of the sun but develops sunburn on her face, despite wearing sunscreen and a protective hat. When
she returns from her trip 5 days later, she presents with persistent erythema of her face. She also states that her wrists and hands have been sore for the past 2–3 weeks. On examination, her face is mildly tender to touch, and a rash is present. Her
hands are diffusely swollen. She is afebrile, and the remainder of her physical examination is benign. What is the most likely diagnosis?
A) Graft-versus-host disease
B) Hypersensitivity to sunlight due to the patient’s antirejection regimen
C) New-onset systemic lupus erythematosus
E) Staphylococcal skin infection acquired during travel
4. A 35-year-old woman arrives on the floor after an uneventful hysteroscopy to evaluate
her long history of uterine fibroids. About 30 minutes after her arrival, she begins to complain of nausea and has two episodes of vomiting. The physician administers 0.625 mg of droperidol and 400 mg of acetaminophen by mouth. On follow-up evaluation, the
patient's neck is involuntarily flexed to one side. She is alert, oriented, and conversant and has an otherwise normal neurologic examination. Which of the following is the most likely diagnosis?
A) Cerebral vascular accident
C) Dystonic reaction to droperidol
D) Munchausen syndrome
5. A 50-year-old woman with diabetes mellitus presents with backache and inability to walk unaided. This came on suddenly,
while she was trying to lift her shopping bag from the car boot. Which of the following is most suggestive of a lesion of the sciatic nerve?
A) Absent knee tendon jerk
B) Foot drop
C) Inability to flex the hip
D) Decreased sensation on
the anterior thigh and medial leg
E) Intervertebral disc prolapse at L2/L3 level
6. A 59-year-old man has a body mass index (BMI) of 42. As might be expected, his fasting blood glucose level is high, 210 mg/dL,
as was his HbA1c level, 9.8%. In addition, he suffers from hypertension and dyslipidemia. His physician advised him to lose weight both for his general well-being and to help control his diabetes. Consequently, for the past 4 years, he has desperately tried
to lose weight. He worked his way through an alphabet of popular and fad diets, from the Atkins diet to the Weight Watchers diet. If he lost a few pounds while on a particular diet, he gained back the pounds lost, plus a few more within a few months of
terminating the diet. Finally, he and his physician decided he should try bariatric surgery, the Roux-en-Y gastric bypass procedure. A week after leaving the hospital, his fasting blood glucose level was 100 mg/dL. Three months later, it was 96 mg/dL and his
HbA1c was 6.0%. Which of the following choices is most likely to explain this remarkable improvement is his diabetes?
A) The reduction in level of his circulating glucagonlike peptide-1 (GLP-1)
B) The reduction in level of his circulating peptide
C) The reduction in his mass of adipose tissue
D) The reduction in the level of his circulating ghrelin
E) The reduction in the level of his circulating leptin
7. A 51-year-old man has recurrent
bouts of lightheadedness and mild confusion. Episodes of hypoglycemia were recently documented that are improved with ingestion of food. The patient has no headache, blurred vision, or double vision. He has gained approximately 4.5 kg (10 lb) in the past 2
months. Medical and family histories are noncontributory. Physical examination is normal. The following laboratory data are obtained after an overnight fast: plasma glucose 30 mg/dL (1.67 mmol/L), serum insulin 30 mlU/L (215.25 pmol/L), and an elevated serum
C-peptide level. Screening for sulfonylurea is negative and CT scan of the abdomen is normal.
Which of the following diagnostic studies should be done next?
A) Endoscopic retrograde pancreatography.
B) Transabdominal (Endoscopic) ultrasonography.
C) MRI of the abdomen.
D) Positron emission tomography.
E) Somatostatin receptor scintigraphy.
8. A 23-year-old married woman comes to the office after recent exposure to a person with active
hepatitis A. She has a long history of recurrent sinopulmonary infections and bronchial asthma. In addition, after her last pregnancy, she received a blood transfusion for severe postpartum hemorrhage. After receiving an intramuscular
dose of immune serum globulin as prophylaxis against hepatitis A, she develops an anaphylactic reaction. Which of the following is the most likely cause of this patient’s reaction?
A) Immunoglobulin A (IgA) deficiency with anti-IgA antibodies
B) A hemolytic transfusion reaction
C) Contaminated immune serum globulin
D) A type IV hypersensitivity reaction against a protein in the immune serum globulin
E) A febrile reaction
9. A 47-year-old
man recently consulted a physician about developing weakness, particularly in his right hand. Upon providing a history, the man explained that he does house repair and has been working on a neighborhood rehabilitation project for the past
several months. In doing this, he sandblasts and sands and scrapes by hand to remove the old paint. These
homes were first constructed in the 1920s and since have been covered with several layers of paint. He also revealed that he
habitually ate his lunch at the work site, which he described as being dusted with old paint particles. In addition to the weakness in his arm, he admitted to sporadic stomachaches, constipation, and said his wife had complained that he
is always irritable. He also states that, until recently, he had been in good health. Upon examination, he was found to be 6 feet (19.7 m) tall and to weigh 170 lb (77.1 kg). His heart, lungs, and abdomen were normal, as were most
analytical values, but he did show signs of right wristdrop consistent with radial nerve palsy and his complete blood count (CBC) showed a microcytic anemia; his serum iron levels were found to be normal. Which of the following diagnostic
tests would provide the most useful information regarding the appropriate treatment?
A) Nerve conduction velocity (NCV) study of the right arm
B) Radiography of the right arm and wrist
C) Magnetic resonance imaging (MRI) scans
of the right arm and wrist
D) Urine screen for heavy metals (lead, mercury, arsenic)
E) Screening for diabetes mellitus.
10. Which of the following clinical findings is least likely in a patient
with infarction in the distribution of the left anterior choroidal artery?
A) Right hemiparesis
B) Right hemi-sensory loss
C) Right hemianopia
11. A 76-year-old man presenting
with dysphagia was found to have inoperable esophageal adenocarcinoma. He has an endoscopically placed esophageal stent for palliation of his symptoms, but unfortunately found it very painful, and it was removed a few days later. There is no perforation. He
asks whether there are any other treatment options to help with his symptoms. Which of the following modalities is an appropriate first-line treatment option to discuss?
A) Band ligation
B) Botulinum toxin injection
Local ethanol injection
E) Photodynamic therapy.
12. An AIDS patient develops symptoms suggestive of a severe, persistent pneumonia with cough, fever, chills, chest pain, weakness, and weight loss. The patient
does not respond to penicillin therapy, but goes on to develop very severe headaches. The presence of focal neurologic abnormalities leads the clinician to order a CT scan of the head. This demonstrates several metastatic brain abscesses. Biopsy of one of
these lesions demonstrates beaded, branching, filamentous gram-positive bacteria that are weakly acid fast. Which of the following is the most likely causative organism?
13. You are a hospitalist called to admit a 70-year-old man to the ICU. His wife states that he was sitting at the table eating breakfast with her when he dropped his fork and had difficulty speaking.
Within a couple of minutes he was unable to move his right side. She called the paramedics, who brought him to the hospital. Now in the ICU, his vital signs are as follows: BP 200/98 mm Hg, HR 100, RR 10, O2 saturation 94% on room air. He is afebrile. On physical
examination he is lethargic and unable to speak. His pupils are equal and round but sluggish. He has flaccid paralysis of the right arm and leg with a Babinski sign present on the right. His heart is irregularly irregular, and an ECG confirms atrial fibrillation.
A CT of the head shows a large bleed in the left frontoparietal area with mass effect and midline shift. You decide to intubate the patient to protect his airway. What is the next most appropriate step in the treatment of this patient while you are awaiting
your urgent neurosurgical consult?
A) Hyperventilate the patient to a goal pCO2 of 20 mm Hg
B) Give a bolus of IV mannitol
C) Give a bolus of IV dexamethasone
D) Give sublingual nifedipine to decrease the BP
E) Anticoagulate with IV
heparin because of the atrial fibrillation.
14. A 73-year-old woman is brought in by paramedics after fainting in the mall and hitting her face. She does not remember any preceding symptoms, and she did not lose
control of her bowel or bladder. Witnesses at the scene say that she was down for less than a minute, then woke up and was fairly alert. She was bleeding from a laceration on her chin and paramedics were called. When she arrived at the hospital, her initial
values were normal and an EEG did not show epileptiform activity. She is placed on a cardiac monitor. The following day, she becomes lightheaded and loses consciousness while lying in bed, and her monitor shows tachycardia with the QRS complexes
being uniformly longer than 120 ms.
What is the most common cause of this rhythm disturbance?
A) Uncontrolled hypertension
B) Distention of the pulmonary veins
C) Accessory pathway
D) Ischemic heart disease.
47-year-old woman presents at night to the Emergency Department with chest pain. She states that the pain started that evening and has progressively been getting worse. She is concerned that she is having a heart attack. The pain is described as a burning
sensation associated with a sour taste in her mouth, and it started shortly after she ate dinner; it has occurred on previous occasions, but never as bad as it is now.
Previously, she used calcium carbonate tablets that were effective for the pain. She
has no history of heart disease or other medical problems, and she takes no regular medications. She does not smoke cigarettes or use cocaine. Her vitals are normal, and her physical examination is unremarkable. Initial laboratory tests and an ECG are normal.
Which of the following is the most likely cause of this patient’s chest pain?
A) Unstable angina
C) Pulmonary embolism
D) Gastroesophageal reflux disease
28-year-old patient with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) for two months presents with fever, abdominal pain and cloudy dialysis fluid. There is no diarrhea or vomiting and the pain has been present for about
12 hours. The patient has ESRD secondary to chronic glomerulonephritis, there is no history of diabetes, urinary infections or antibiotic use. Examination reveals a temperature of 38.9 C (102 F), and blood pressure of 110/70 mm Hg. The throat is clear, as
are the lungs. Cardiac examination reveals a grade 2/6 systolic murmur. Abdominal examination reveals decreased bowel sounds with diffuse tenderness. There is mild rebound. There is no edema or skin rash. A complete blood count shows a leukocyte count of 14,200/mm3,
hemoglobin is 12.5 g/dL. Peritoneal fluid is cloudy with 1,000 white blood cells, 85% of which are polymorphonuclear leukocytes. Gram's stain of fluid is negative. Cultures of blood and peritoneal dialysis fluid are taken. Which of the following is the most
appropriate initial step in management?
B) Immediate removal of dialysis catheter.
C) Intravenous vancomycin
D) Intravenous gentamicin
E) Oral ciprofloxacin
lady is admitted with a 30 minute history of heavy central chest pain associated with nausea and sweating. Her ECG shows ST elevation in leads V1, V2, V3 and V4.
Which of the following coronary arteries is most likely to be occluded?
B) Left anterior descending artery
C) Obtuse marginal artery
D) Posterior descending artery
E) Right coronary artery
18. A family physician cares for a family consisting of a 45-year
old husband, 43-year-old wife and a 12-year-old daughter. The family reports that recently the 77-year-old maternal grandmother who lived with them died after a prolonged respiratory infection. Autopsy subsequently confirms that she had active pulmonary tuberculosis
at the time of death. The organism tested sensitive to all anti-tuberculosis drugs. In responding to the grandmother's illness, which of the following is the most appropriate step in management?
A) Obtain leukocyte counts on all family members
B)Obtain sputum cultures for acid fast bacilli
C)Obtain chest computerized tomograms on all members
D)Place protein purified derivative (PPD) test on all members
E)Schedule bronchoscopy lavage for the adults.
19. Which of the following extraintestinal manifestations is associated with Crohn disease but not ulcerative colitis?
A) Ankylosing spondylitis
B) Erythema nodosum
20. A 30 year old woman presents with unprovoked left popliteal deep vein thrombosis. Her family history is negative for venous thromboembolism. She has a history of
SLE and takes prednisone 10mg daily, hydroxychloroquine and supplements of calcium and vitamin D. She has one child but has had two miscarriages. An aPTT test performed before starting anticoagulation in this patient is prolonged, but her PT is normal.
Which statement is most likely to be correct?
A) Because her APTT is increased already, Heparin should be withheld and warfarin treatment initiated at INR 2.5 to 3.5, perhaps forever
B) The patient should be encouraged to use oral contraceptive
to prevent pregnancy during the time she is anticoagulated
C) She will need Heparin and then anticoagulation with Warfarin at INR 2 to 3, perhaps indefinitely
D) Start anti-coagulation with Heparin and then Warfarin at INR 2.5 to 3.5 for 3 to 6 months
E) She will need lifelong new oral anticoagulants.
21. A 65-year-old man has been stable on the general medical ward following an admission with acute coronary syndrome several days previously. His drug history
consists of aspirin, enalapril and glyceryl trinitrate (GTN) spray. He has developed dyspnea over the last few hours. On examination he has a raised jugular venous pressure (JVP) and crackles to his mid zones. His electrocardiogram (ECG) shows a rate of 140
beats per minute in atrial fibrillation. Which of the following is the most appropriate management?
A) Intravenous amiodarone
B) Intravenous digoxin
C) Intravenous flecainide
D) Observe and screen for MI
22. A 48-year-old man is admitted through the ER with a possible left lower extremity cellulitis. The patient says that he has been having fever, swelling, and redness of his left lower extremities
that comes and goes spontaneously over the past couple of months. He also tells you about an episode in which he lost vision in his left eye for several minutes a couple of weeks ago, but the vision returned without incident. He had a urologic evaluation for
penile trauma 3 months ago. On physical examination, his BP is 125/80, HR 70, RR 14, and he is currently afebrile. His examination is significant for a 3/6 systolic murmur heard at the left lower sternal border without radiation while lying supine. Blood
cultures return positive results for Enterococcus species, and an echocardiogram reveals large mitral vegetation. You review treatment for enterococcal endocarditis. Which of the following antibiotics always misses enterococcal infections?
23. A 70-year-old woman with a history of type2 DM and CAD with a known left bundle branch block on ECG is admitted to the ICU with sepsis
from a urinary source. She is fluid resuscitated, and empiric broad-spectrum antibiotics are begun after the appropriate cultures are obtained. Despite what appears to be adequate resuscitative efforts with volume replacement, the patient has had minimal urine
output over the past couple of hours. You decide to place a pulmonary artery catheter to help to determine the patient’s hemodynamic situation. Which of the following complications of pulmonary artery catheter placement is the patient at increased risk
for because of her past medical history?
A) Pulmonary artery perforation
B) Pulmonary infarction
C) Complete heart block
E) Ventricular tachycardia.
24. The first four tests
that should be ordered in the initial evaluation of patients with a suspected coagulopathy are all of the following except
A) Platelets count
B) Bleeding time
C) Platelet aggregation studies
of the following is not true about tetanus?
A) The toxin affects inhibitory GABA and glycine receptors, leading to unopposed contraction and spasm of skeletal muscle.
B) It is characterized by acute onset of skeletal muscle rigidity and convulsive
C) Initial symptoms involve lockjaw and risus sardonicus.
D) Fractures, dislocations, and rhabdomyolysis may occur due to forceful sustained muscle
E) Tetanus disease usually leads to long-lasting immunity.
26. A 55-year-old woman, who has never smoked, presents to you on the ward with a history of weight loss, decreased appetite and finger clubbing. You are told that her chest x-ray revealed opacity in the hilar region of the right
lung suggesting a bronchogenic carcinoma. She is currently awaiting a CT-chest with bronchoscopy to follow. From the list below, select the most likely diagnosis:
A) Squamous cell carcinoma of the lung
B) Adenocarcinoma of the lung
C) Small cell carcinoma of the lung
D) Large cell carcinoma of lung
E) Carcinoid tumour of the lung.
27. A 68-year-old woman recently diagnosed with multiple myeloma presents to her GP with
progressively increasing breathlessness, exercise intolerance and ankle swelling. On examination, there is bilateral pitting leg edema to her thighs, ascites and raised JVP. The apical impulse is impalpable. An ECG shows diffusely diminished voltage. Chest
X-ray is normal and the echocardiogram shows small thick ventricles and dilated atria with a thickened interatrial septum. The ventricular myocardium has a granular sparkling texture on echo, and minimal fluid in the pericardial space is noted. What is
the most likely diagnosis?
A) Chronic pericardial effusion with tamponade
B) Chronic pericardial effusion without tamponade
C) Constrictive pericarditis
D) Restrictive cardiomyopathy
E) Congestive heart
28.A 65-year-old male patient is admitted with renal failure and is diagnosed with acute tubular necrosis. Which of the following is least likely to be the cause of acute tubular necrosis?
B) Paracetamol poisoning
E) Corticosteroid therapy
29. A 65-year-old woman with long-standing diabetes mellitus visits your clinic for follow-up 2 weeks after the
initial visit. Her fasting home glucose monitoring shows elevated blood sugar levels ranging between 200-250 mg/dl. Two weeks ago, her HbA1c was 7.2% and the fasting plasma glucose was 212 mg/dl. You recommend the following to evaluate the discrepancy between
the fasting values and the HbA1c:
A) Order a CBC
B) Prescribe a new glucometer
C) Order a fructosamine
D) Repeat the HbA1c
E) Repeat the fasting plasma glucose.
30. A 43-year-old
man presents to the clinic with complaints of fever, night sweats, anorexia, cough, and chest pain. The chest x-ray reveals infiltrates in both the lower and upper lobes, with possible cavitations in the apices. A presumptive diagnosis of tuberculosis is made
on the basis of finding acid-fast bacilli (AFB) on microscopic examination of sputum. The patient is started initially on isoniazid, rifampin, pyrazinamide, and ethambutol.
What is the best way to monitor this patient?
A) Sputum acid-fast
stains every month for 6 months
B) Sputum cultures every month until cultures become negative
C) Serial chest x-rays
D) Blood testing for drug toxicity
E) Observe for clinical deterioration.
49-year-old man with untreated hepatitis C infection develops persistent proteinuria. Which of the following diagnoses is not typically associated with hepatitis C?
A) Membranous nephropathy
B) Focal segmental glomerulosclerosis
E) Polyarteritis nodosa
32. A 59-year-old woman is admitted with central abdominal pain. Serum amylase is 1800 IU/L. Her initial Glasgow Coma Scale score is 4. You are asked to review her the next day as the nurses have noticed that her urine output has
been just 15 mL in the past 3 hours. The rest of her observations are as follows:
• Blood pressure = 105/45 mmHg
• Pulse = 113 beats/min
• Respiratory rate = 28 breaths/min
• Saturation 93% on 8 L of oxygen
On auscultation of her chest you hear widespread crepitations. What is the most appropriate next course of action?
A) Fluid restriction
B) Colloid bolus
D) Transthoracic echocardiogram
E) Central line insertion
33. Features of type 1 renal tubular acidosis include all of the following EXCEPT:
A) Normal AG
C) Ca phosphate stone formation
D) Urine pH decrease below 4, following oral ammonium chloride loading test
E) Raised serum PTH hormone
35. All of the following statements regarding non-alcoholic steatohepatitis
(NASH) are correct EXCEPT:
A) Liver biopsy is the only means of accurately diagnosing NASH.
B) Weight loss has been shown to result in improvement of elevated liver enzymes.
C) Patients with NASH can develop
D) Histologically it is characterized by severe portal or peri-portal inflammation.
E) Laboratory studies cannot identify patients at risk of progression.
36. A 30-year-old male patient complains
of fever and sore throat for several days. T he patient presents to you today with additional complaints of hoarseness, difficulty breathing, and drooling. On examination, the patient is febrile and has inspiratory stridor. Which of the following is the best
course of action?
A) Begin outpatient treatment with ampicillin.
B) Culture throat for β-hemolytic streptococci.
C) Admit to intensive care unit and obtain otolaryngology consultation.
D) Schedule for chest x-ray.
E) Obtain Epstein-Barr serology.
37. Regarding management of an episode
of hypoglycaemia in a 65-year-old who is on sulfonylurea therapy, which ONE of the following is TRUE?
A) Initial oral or intravenous glucose therapy can be omitted because it is likely to fail
B) Octreotide should be considered
for recurrent or persistent hypoglycaemia
C) Hypoglycaemia in a stable diabetic on a regular sulfonylurea dose is not usually due to a precipitating event
D) There is a more sustained response to intravenous glucose therapy
in sulfonylurea-induced hypoglycaemia than in insulin-induced hypoglycaemia
38. A 59-year-old man presents to the ED with left-sided chest pain and shortness of breath that began 2 hours prior to arrival. He states the pain is pressure-like and radiates down his left arm. He is diaphoretic. His BP is 160/80 mm
Hg, HR 86 beats per minute, and RR 15 breaths per minute. ECG reveals 2-mm ST-segment elevation
in leads I, aVL, V3 to V6. Which of the following is an absolute contraindication to receiving thrombolytic therapy?
A) Systolic BP greater than 180 mm Hg
B) Patient on Coumadin and aspirin
C) Total hip replacement
3 months ago
D) Peptic ulcer disease
E) Previous hemorrhagic stroke
39. The best pharmacologic treatment for hypotension related to the spinal anesthetic is
40. An ischemic stroke involving the right side of the pons could lead to which of the following patterns of weakness?
A) Left facial
weakness and right body weakness
B) Right facial weakness and left body weakness
C) Right facial weakness and right body weakness
D) Left arm weakness and right leg weakness
E) Right arm weakness and left leg weakness
41. A 49-year-old man who smokes two packs of cigarettes a day presents with a lung mass on x-ray and recent weight gain. Laboratory examination shows hyponatremia with hyperosmolar urine. The patient probably has
B) Pituitary failure
C) Conn’s syndrome
D) Cardiac failure
42. A 75-year-old woman is referred for assessment of her mental state. Her carer states that she noticed general decline in her physical and mental
state. She is more forgetful and her concentration is poor. Sometimes her speech is incoherent. She trips frequently and had many falls. On rare occasions she has imagined seeing people sitting in her room. Each of the following features would help to distinguish
between organic and functional disorders, except
B) Visual hallucinations
C) Poor performance of the
serial sevens test
43. A 40-year-old
man with occasional dysphagia and who otherwise feels well undergoes esophageal motility studies that show an LES amplitude of approximately 60 mmHg. The esophagus relaxes completely when he swallows. The most likely diagnosis is
GERD (gastroesophageal reflux disease)
C) Hypertensive LES
D) Barrett’s esophagus
E) Esophageal spasm
60-year-old accountant complains of recurrent attacks of exquisite pain and swelling in the left big toe. Each of the following conditions is likely to be associated with this disorder, except
A) Chronic alcoholism
C) Rheumatoid arthritis
D) Diabetes mellitus
E) Diuretic therapy
45. A 60-year-old man was referred for further assessment of a cardiac murmur. On
examination it was noted that he has a weak and slow-rising carotid pulse. The most likely underlying cardiac abnormality is
A) Aortic regurgitation
C) Dissecting aneurysm
D) Hypertrophic obstructive cardiomyopathy (HOCM)
E) Aortic stenosis
46. A 50-year-old
woman has a history of gastrinoma and pituitary tumour. She reports increasing lethargy, drowsiness and constipation. The laboratory studies include raised calcium (2.9 mmol/I), low phosphate and raised PTH levels. The most likely diagnosis is?
A) Carcinoma of the bronchus
E) Multiple endocrine neoplasia syndrome (MEN I)
47. A 60-year-old
teacher is being investigated for increasing shortness of breath and diffuse fibrotic changes found on plain chest X-rays. He was taking diuretics and anti-arrhythmic treatment. The 12-lead ECG shows a prolonged QT interval. Each of the following clinical
situations could be responsible for this ECG abnormality, except
A) Heart failure
E) Amiodarone therapy
48. A 30-year-old mechanic presented with central chest pain, worse on lying flat. He claims that he has had a flu-like illness for a week. Which
one of the following ECG changes is most characteristic of this disorder?
A) PR prolongation
B) ST depression
Peaked, tall T wave
D) Prominent U wave
E) PR-segment depression
49. A 16-year-old male treated for acute lymphocytic
leukemia develops severe lumbar and abdominal pain. His serum amylase is markedly elevated. Which of the following agents most likely caused these findings?
50. A 58-year-old
man was admitted with a three-weeks history of shortness of breath. The chest X-ray demonstrates a right pleural effusion. Pleural fluid analysis shows 6600 mm3 WBC,40% eosinophils. The condition least likely to be responsible this clinical presentation is
C) Pulmonary infarction
D) Benign asbestos
E) Tuberculous pleural effusion
33-year-old woman presents for evaluation of chronic hepatitis C virus (HCV) infection discovered during a life insurance physical examination. Her risk factor for HCV infection was a blood transfusion after a motor vehicle accident at the age of nine years.
Her husband of seven years tests negative for anti-HCV antibody. The couple wishes to conceive a child. Which of the following recommendations is most appropriate?
A) Avoid breast-feeding the baby.
B) Plan delivery of the baby by cesarean section.
C) Administer HCV immunoglobulin to the infant at
the time of delivery.
D) Test the infant for HCV after the age of 18 months.
E) Use latex condoms.
52. A general practitioner is in a dilemma over a case he has referred to you. He says that the referred 31-year-old man has no myocardial infarction or ischaemic heart disease, but his 12-lead-ECG shows many Q waves. Which one of the
following is not responsible for this man’s ECG Q wave?
B) Hypertrophic cardiomyopathy
D) Limb lead reversal
E) True posterior wall myocardial infarction
53. A 55-year-old
man presents with gross haematuria. He has recurrent urinary bladder stones. Rapid bedside ultrasound examination fails to demonstrate any stone, but there is a fungating bladder mass. What type of bladder cancer is likely?
Transitional cell cancer
B) Clear cell cancer
C) Squamous cell cancer
E) Bladder lymphoma
54. A 45-year-old woman is found to have gallstones on abdominal ultrasonography that forms part of a pre-medical insurance examination. She is
reasonably well and healthy and denies abdominal symptoms. She neither smokes nor drinks alcohol and there is no family history of note. Which of the following statements is true regarding this woman’s gallbladder disease?
Emergency open cholecystectomy is required
B) Prophylactic laparoscopic gallbladder removal should be considered
C) Advise against cholecystectomy
D) Evaluate for
E) Refer to ERCP
22-year-old man develops a severe attack of acute intermittent porphyria, two days after starting a medication prescribed by his GP. Which one of the following medications has not been prescribed by his GP?
D) Valproic acid
56. A 48-year-old man with acute leukaemia develops fever, chills, headache, flushing,
tachycardia and chest tightness one hour after starting blood transfusion because of anaemia. He reports ‘similar things’ whenever he receives blood transfusion. What is the best action now?
B) Call the resuscitation team
C) Stop the transfusion
D) Give paracetamol
E) Epinephrine (adrenaline) injection
57. A 59-year-old man with long-standing Type 2
diabetes presents for his annual check-up. Fundoscopy reveals scattered dot haemorrhages and a few hard exudates in the macular area. He states that his vision is not that good but he is coping with it and that his eye glasses are not helpful. Which one of
the following is true?
A) He has proliferative retinopathy
B) He has pre-proliferative retinopathy
C) He should be referred
to the ophthalmologist
D) He should be referred for pars plana vitrectomy
E) Reassure and ask him to return next year
58. A 50-year-old man with septicaemia develops
severe shortness of breath, cough and irritability. Which one of the following is inconsistent with the diagnosis of adult respiratory distress syndrome?
A) PaO2/FiO2 150 mmHg
Reduced lung compliance
C) Bilateral interstitial infiltrate
D) Bilateral alveolar infiltrate
E) Pulmonary artery capillary
tracing of 25 mmHg
59. A 60 year old male is brought to casualty in the early hours of the morning after being found unconscious
in the street. On examination, he was drowsy but localised to painful stimuli. There was no evidence of head injury or meningism. Investigations revealed:
sodium 134 mmol/L (137-144)
potassium 4.0 mmol/L (3.5-4.9)
urea 4.0 mmol/L (2.5-7.5)
creatinine 80 micromol/L(60-110)
glucose 4.5 mmol/L (3.0-6.0)
chloride 100 mmol/L (95 - 107)
bicarbonate 25 mmol/L (20 - 28)
plasma osmolality 385
mosmol/Kg (278 - 305)
What is the most likely explanation for his presentation
A ) diazepam poisoning
B ) ethanol poisoning
C ) methanol poisoning
D ) phenobarbitone poisoning
E ) Phenytoin poisoning
60. A 46-year-old male was seen for an insurance
medical examination. He was entirely asymptomatic, but his serum urate concentration was noted to be 0.5 mmol/L (0.23 - 0.46). What is the most appropriate management for this patient?
A ) Allopurinol
B ) Colchicine
C ) Ibuprofen
D ) Lifestyle intervention
E ) Sulphinpyrazone