AMC RECALL PAPER: MCQ EXAM SERIES B, OCT 1999 Medicine Type ‘A’ questions CARDIOVASCULAR DISEASE 1. A patient with acute myocardial infarction used heparin; which of the following methods is used for monitoring: a. BT b. PT c. ARTT d. INR e. Fibrinogen 2. A patient has a mitral valve stenosis – all of the following signs are correct EXCEPT: a. AF b. S 1 increased c. Palpitation increased S 2 in apex d. S 3 e. Presystolic murmur 3. In a patient with myocardial infarction was found a new systolic murmur on examination. Cardiac ejection fraction was 55%. Which of the following is MOST probable cause: a. Aortic regurgitation b. Papillary muscle dysfunction c. Mitral valve stenosis d. Papillary muscle rupture e. Tricuspid valve regurgitation 4. A young woman has hypertension with fibrosing stenosis of renal artery (60%) which of the following is the MOST appropriate treatment: a. Renal artery angioplasty b. ACE Inhibitors c. Antihypertensives d. Diuretics e. Arteries dilation drugs 5. An obese patient with diabetes mellitus is under anti-hypertension treatment. His blood pressure is 160/100mmBg on examination. Which of the following is your INITIAL consideration for this patient: a. Decreased protein in his diet b. Concurrent hypertensive therapy c. Give diuretics d. Control sugar intake in the diet e. Ideal weight 6. At which level of cholesteral you consider to give lipid-lowering statins (eg, simvastatin, pravastatin) a. 6 mmol/l b. 5.5 mmol/l c. 5 mmol/l d. 4.5 mmol/l e. 4 mmol/l 7. Patient with coronary heart disease and xanthoma along the Achilles tendons. Which of the following is THE MOST LIKELY diagnosis: a. Familial hypercholesterolaemia b. Familial combined hyperlipidaemia c. Remnant removal disease d. Hypolipoproteinaemia 8. Which of the following examination supports the diagnosis of pulmonary thromboembolism: a. Chest PA X-rays b. Pulmonary Doppler c. Blood gas d. Pulmonary ventilation perfusion mismatched on pulmonary scan e. Lung function measurement Contagious diseases 9. Which of the following is the MOST COMMON characteristic of pleura effusion of TB: a. Glucose decreased or absent b. Monocyte c. Blood stained d. Protein <2g e. Find TB bacillus 10. Which following group is the MOST at RISK OF HIV infection: a. Heterosexual b. Homosexual c. Intravenous drug user d. Blood transfusion e. Haemophilias 11. Which of the following group is LEAST LIKE of infection of HIV: a. Heterosexual b. Blood Transfusion c. Homosexual d. Haemodialysis e. Haemophiliacs 13. A farmer has suddenly had undulant fever for 2-3 days with abruptly headache severe myalgia, jaundice and petechial rash on the skin; liver and spleen enlargement. Which of the following is the diagnosis: a. Brucellosis b. Yellow fever c. Leptospirosis d. Malaria e. Anthrax 14. Dengue fever, all followings are correct EXCEPT: a. Arbovirus b. Mosquito transmission c. Children get least severe illness d. There is no specific treatment e. Air droplet infection 15. A patient with mycobacteria infection which of the following is most appropriate treatment a. cotrimoxazole b. tetracycline c. Amoxycilline d. Metronidazole e. Erithromycin Emergencies 16. What is compatible with critical illness: a. Increased cortisol , increased TSH b. Both cortisol and TSH decreased c. Increased cortisol, decreased TSH d. Decreased cortisol, increased TSH e. Normal cortisol, increased TSH ENDOCRIN DISEASE 17. A 65 year old man has ‘bulk” diarrhoea with “oil”. He drinks alcohol for many years . Which of the following is your investigation a IV pancreagraph b Endoscopy pancreagraph c. Abdominal X-ray d Ultrasound e Enema 18.For an elderly man, which above following blood sugar level need further investigation a. 5 mmol/l b. 5.5 mmol/l c. 6 mmol/l d. 6.5 mmol/l e. 7 mmol/l 19.Side effective of corticosteroids including all the following EXCEPT a Lymphocytosis b. Lymphopenia c. Hirsutism d. Osteoporosis e. Weight gain 20. A patient has headache, prominent supraorbital ridge prognathism teeth spacing increased,thick spade-like hands and seborrhoea and coarse oily skin. Which of the following is BEST investigation to establish diagnosis: a. Insulin-glucose b. X-ray of pituitary test c. Cranial CT scan or MRI scan d. SERUM T4+PRL+growth hormone level e. Oral glucose tolerance test (OGTT) 21.Which following patient is LEAST LIKELY to suffer primary hypothyroidism: a. 65 year old female with goitre b. 35 year old female with depression c. 28 year old female with 3 years menorrhagia d. 18 year old boy with relative less age e. 32 year female with anaemia unresponsive to iron, B 12and folate 22 Patient has a single lump on one side of the thyroid, all following situation s suggest malignant EXCEPT a. Single nodule b. US showed a solid nodule c. Thyroid scan show “HOT’ lump e. Associated with increased serum thyroglobulin f. Associated with hoarseness DESEASE INVOLVING EYE 23. Uveitis is MOST COMMONLY found in which of th e following diseases: a. Reiter’s disease b. Rheumatoid arthritis c. Ankylosing spondylitis d. Sjogren’s syndrome e. Psorisis 24._____________________ a. An infection of frontal sinuses b. Thyrotoxicosis c. Neoplastic lesion in lamina cribrosa d. Nasopharyngeal tumour invading the orbit e. Glaucoma GASTROINTESTINAL DISEASE 25. Eradication of HELICOBACTER PYLORI for duodenal ulcer: a. Increase ulcer healing rate b. Influence relapse rate c. Decrease rate of gastric lymphoma d. Decrease local gastritis e. Decrease cimetidine dosage 26 A young patient comes from overseas with diarrhoea, no blood. Temperature 37.9C, stool examination showed few Salmonellas. What is your management: a. Observation and repeat stool examination 3 days later b. Broad spectrum antibiotic like amoxicillin c. Trimethoprine plus sulphasalazine d. Cotrimoxazole plus trimethoprim e. Reassure 27. Which of the following is MOST RELATED to adenoma/carcinoma of the colon: a. Aspirin can caused b. Low fibre diet c. Saturated fat more than the unsaturated fat in the diet d. Alcohol f. Smoking 28. A 28-year-old policeman on sulphasalazin therapy for ulcerative colitis, Right hypochondrial pain. SGPT and alk, phosphatase increased, bilirubin mild increased, SGOT normal and liver aminotransferase enzymes normal (?) which of the following is THE MOST LIKELY diagnosis: a. Primary biliary cirrhosis b. Side effect of sulphasalazin c. Sclerosing cholangitis d. Cholangitis e. Acute viral hepatitis 29. Patient with supposed hepatoma. Which of the following questions is MOST helpful for diagnosis: a. Present liver cirrhosis b. Alcohol liver disease c. Acute hepatitis d. Cholangitis e. Family history of liver hepatoma 30. Ascitis a. _______ b. Bilateral abdominal varicosis c. Peri-oral teleangiectasia d. Jaundice and palmar erythema e. Dupytren’s contracture HAEMATOLOGICAL DISEASE 31. In anaemia patent with increased transferrin. All of the following is correct EXCEPT: a. Increased serum ferritin b. Decreased serum ferritin c. Increased total iron binding capacity d. Increased transferrin e. Decreased serum iron 32. An anaemic patient with increased transferrin. All following are correct EXCEPT: a. Thalassemia major b. Chronic disease c. Iron deficiency d. Sideroblastic anaemia e. Haemolysis 33. Which of the following is typically occurring in heparin – induced thrombocytopenia: a. Joint bleeding b. Petechial purpura on the skin c. Thrombosis d. Haematuria e. Ecchymosis 34. In haemolytic anaemia, all is correct EXCEPT: a. Increased urobilinogen b. Serum urobilin c. Erythrocyte count d. Decreased MCV e. Increased serum iron 35. A 67 year-old alcoholic man has backache, ESR 120mm/h. Which of the following is MOST LIKELY diagnosis: a. Multiple sclerosis b. Acute lymphatic leukaemia c. Hodgkin disease d. Non-Hodgkin disease e. Multiple myeloma 36. A patient with splenomegaly 12cm below ribs. There was no lymph node enlargement. Leucocytes 33000, decrease in erythrocytes, leukocytosis. What is the diagnosis: a. Chronic granulitic (?) leukaemia b. Myelofibrosis c. Hodgkin disease d. Non-Hodgkin disease e. Acute lymphoma 37. A 67 year-old patient with long standing alcoholism. Lab: HB 9.8; ESR 120: leukocytes 10000 and left shift. Which of the following is diagnosis: a. Viral hepatitis b. Multiple myeloma c. Iron deficiency anaemia d. Fatty liver 38. A 28 year-old female with long standing alcoholism, history of bowel irritation. Lab: HB 9.8; MCV 110. Which is the MOST LIKELY diagnosis: a. Whipple’s disease b. Colorectal carcinoma c. Coeliac disease d. Irritative bowel syndrome e. Ulcerative colitis IMMUNOLOGICAL DISEASE 39. A 74 year-old women have polymyalgia rheumatica. What is CHARACTERISTIC: a. Distal limb muscle aching b. Increased muscle CPK c. There is fatigue, fever and depression d. ESR normal e. Giant cell arthritis NEUROLOGICAL DISEASES 40. Left homonymous hemianopia. Where is the lesion: a. Right temporal lobe b. Left optic nerve c. Optic chiasm d. Right optic radiation e. Right occipital cortex f. 41. A 64 year-old patient suddenly had face, arm and leg weakness on the same side of the body. No sensory loss or loss of consciousness, where is lesion: a. Middle cerebral artery b. Carotid artery occlusion c. Hypertensive disease local in the internal capsule d. Infarction in the putamen e. Aneurism of the sinus cavernosum 42. All following signs are present in Parkinson disease EXCEPT: a. Loss of postural reflexes b. Myoclonus c. Decreased reflexes d. Muscle weakness e. Broad wide gait 43. Upper motor neuron damage – all can occur EXCEPT: a. Hyperreflexia in arm b. Spasticity of the extensor muscles of the leg c. Proximal muscle weakness d. Absent abdominal reflexes e. Ankle clonus 44. A 35 year-old female with facial pain, associated sensory delicate, no trigger zone. What is the diagnosis: a. Trigeminal neuralgia b. Ramsay – Hunt syndrome c. Bell’s palsy d. Multiple sclerosis e. Tolosa – Hunt syndrome 45. These are all phenytoin side effects EXCEPT: a. Nystagmus b. Osteomalacia c. Stimulate osteoporosis d. Lymphoma e. Deafness 46. Patient 64 year-old, suddenly occurred hemiparesis and paralysis of soft palate and Horner’s syndrome on the same side of the body. Where is the lesion: a. Middle cerebral artery b. Carotid artery occlusion c. Vertebro-basilar artery d. Giant cell arteritis e. Subclavian steal syndrome RESPIRATORY DISEASES 47. A 55 year-old patient has blood pressure 200/130mmHg. His left kidney is small and urine tests and kidney functions are normal. What is your NEXT investigation: a. Intravenous pyelography b. Retrograde c. Renal CT scan d. Renal scan 48. _________ and O2 _______was given___O2 therapy 4 hour later_______ showed PO2 68 mmHg, and PCO 2 40 mmHg. What is your next therapy: a. Reduce O2 concentration and do blood gas analysis after 30min b. Give bronchodilators c. Hydrocortisone d. Intubation and ventilation e. Antibiotics injection 49. Patient has sudden dyspnea. Physical examination found left upper chest respiratory movements increased. In left lower part percussion dullness and decreased respiratory sounds. What is the diagnosis: a. Atelectasis b. Pneumonia c. Pleural effusion d. Pulmonary thrombosis e. Pneumothorax 50. Which of the following is the MOST consistent with the diagnosis: a. Oat cell carcinoma-blubbing b. Pneumonia-hyperresonance + decreased chest wall movements c. Emphysema-bilateral alveolitis + clubbing d. Fibrosing alveolitis-widespread respiratory e. Asthma-prolonged expiration with wheeze RENAL DISEASES 51. A young patient has haematuria and proteinuria with respiratory infection. There is no hypertension. He has similar situation before. The diagnosis is: a. Nephrotic syndrome b. Streptococcal glomerulonephritis c. IgA nephropathy d. Acute pyelonephritis e. Membranous nephropathy 52. Post-operative third day serum Na 165mmol/l and urine Osmo is 250 (normal 50 – 1000). The MOST LIKELY cause is: a. Thiazide diuretic dose is too high b. Diabetes mellitus c. Diabetes insipidus d. SIADH e. Acute renal failure 53. Staghorn calculi can be found in the entire following situation EXCEPT: a. Recurrent pyelonephritis b. Immobilisation c. Idiopathic hypercalciuria d. Primary hyperparathyroidism AMC 23RD OCTOBER 1999 MCQ PAPER I PAEDIATRICS p.s : the following is a reconstruction of the essence only of the question and answer ( stem and answer options) . The great majority of the actual exam questions were very much longer in the form detailed clinical case histories. R.?/? = repeated questions and when R.T = repeated topic only R.AMCQ = repeated question from “Annotated MCQ’ book 35Type ‘A”question: Behavioural problem 1 A 7 yr with enuresis . What is the most likely cause? a. UTI b. Family disorder c. O.M d. Vesico -ureteric reflux e. Ectopic ureters CVS: 2 A 6 yr boy found to have a systolic murmur on the left sternal border. His weight is on the 3rd centile. What is your advice to h is parents? a. That he has Atrial Septal Defect b. That he has Ventricular Septal Defect c. That he should be referred to a cardiologist d. That the murmur will remit spontaneously e. That surgery is essential to correct his condition Emergencies: 3 WOF is the most likely cause of meningitis in the 4 y.o child? a. E.coli b. Haemophilus influence c. Adeno-virus d. N. Meningitidis e. Strep. Pneumoniae 4 A 3 y.o child ingested washing detergent . What is the most appropriated initial action a. Give the child milk to drink b. Urgent endoscopy c. Induce vomiting by ipecac d. Gastric lavage e. Induce osmotic diarrhoea by mannitol GIT 5 Jaundice 5 days after birth is most likely due to a. Physiological deficiency of glucoronyl transferase b. Physiological excessive destruction of the RBCs c. Iso-immunization d. Biliary duct atresia e. Breast milk jaundice 6 A 2 y.o presented with chronic constipation. AXR shower heavy faecal loading of the colon . P/R was uneventful. What is the most appropriated next step? a. Double contract barium enema b. Rectal biopsy c. Anal dilation d. AXR e. Laxatives 7A child brought in by his mother b/o vomiting. His weight is within normal centiles for his age. WOF is the most PPROPRIATE? a. Urine microscopy and culture b. Advise the mother to make the milk formula thicker c. Dilute his milk with water d. Give him less milk e. Check the strength of the milk formula 8 WOF is most likely cause of mouth ulcers in children? a. Aphthous ulcer b. Behcet’s syndrome c. Herpes simplex d. Herpes Zoster e. Self inflicted Haemo 9 A young boy presents with widespread petechial rash . Otherwise well Blood film shows the following : Hb 10w , WCC 10w, Platelets 50x109 (150-400x 109) WOF is the most likely cause? a. TIP b. Salicylate overdose c. Anaphylactoid purpura d. Heamophilia e. Von willebrand’s Disease Malignancies: 10 5 yo presented with a mass in the left lower abdominal quarant. Otherwise , he is well. What is the most likely cause? a. Neuroblastoma b. Acute leukaemia c. Nephroblastoma (Wilm’s tumour) d. Hodgkin’s disease e. Non-hodgkin lymphoma 11A child discovered a lump in the lower posterior triangle of the neck . O/E the lump fluctuated and transilluminated. Its consistency was soft. What is the most likely cause? a. Branchial cyst b. Carotid body tumour c. Enlarge lymphnode d. Thyroglossal cyst e. Cystic hygroma Meonatology: 12 A full term neonate was born at 30/4, 1500 g was noticed to be cyanosed on the hands and feet . O/E the infant was responsive and jittery on handing. The respiratory rate is 40/ min and lung and heart are clinically normal . WOF is correct? a. The infant most probably has a convulsion b. O-2-- should be given c. Blood sugar level should be checked d. Blood calcium level should be checked e. The infant’s rectal temperature should be checked Neurology: 13All the following are true about cerebral palsy except: a. Epilepsy occurs in less than 50% of the patients b. Feeding difficulties are common c. Majority develop mental handicap (IQ less than 70%) d. Spastic diplegia is the most common type e. Is associated with intellectual disability Resp: 14. A 1 year-old boy was brought to you c/o fever. O/E. you find his temp. to be 37.5oCwith widespread bilateral wheezing on chest auscultation. Two family members just recovered from upper respiratory tract infection. The MOST LIKELY cause is: a. Acute bronchiolitis b. Croup. c. Asthma d. Pneumonia e. Inhaled foreign body AMC EXAM 25 OCTOBER 1999 MCQ PAPER II OBS & GYN P.S.: The following is a re-construction of the essence only of the questions and answers (stems B options). The vast majority of the actual exam questions were very much longer than that in the form of clinical case histories. R.7/7 = Repeated question & when R, T = Repeated Topic R. AMCQ = Repeated questions from “ Annotated MCQ” book 30 Type ‘A’ Questions: OBSTETRICS Antenatal Care: 1. All the following may be reason fro admitting a pregnant woman EXCEPT: a. Show (bleeding) b. Headache, visual disturbances and abdominal pain c. Rupture of membranes d. Painful contractions e. Contractions at intervals of 1/5 – 6 minutes Bleeding in Pregnancy: 2. A woman presented with vaginal bleeding at 8/40 of her pregnancy. Blood loss was estimated as 1L. O/E her BP is 90/60, pulse is 130/1’. The fetus is dead. All the following is relevant to her treatment EXCEPT: a. Resuscitate her with I/V fluids under CVP control b. Do U/S to check ectopic pregnancy c. Order a coagulation profile d. Do U/S to check placenta praevia e. Insect a urinary catheter 3. You were called to the maternity wing for a 34 yrs old woman G5 P4 who has delivered earlier in the same day. She was bleeding bright red blood from her vagina. The uterus was small and contracted and the placenta and membranes were intact. The MOST LIKELY cause of her bleeding is: a. Uterine atony b. Retained products of conception c. Laceration of the genital tract (uterus, cervix and vagina) d. Coagulopathy e. Uterine rupture CIG: 4. WOF is true about CIG Genetic Counselling: 5. A woman has a child with Spina Bifida. She is pregnant again and asks your advice about this pregnancy. You may advise her to do all the following EXCEPT: (R.T. 3/98) a. Amniocentesis at 16-18 weeks b. U/S at 16 weeks to detect any fetal malformation c. U/S at 12 weeks for anencephaly d. U/S at 11-12weeks to measure the Nuchal Fold e. Triple or quadruple test at 16 weeks Malpresentation: 6. A 33y.o woman is seen during routine antenatal visit. O/E she is 156cm tall, at 31/40 weeks with breech presentation. WOF is MOST appropriate? a. Ask her to return again after 2 weeks b. Order X-ray pelvimetry c. Arrange for external cephalic version at 34-36/40 d. Prepare the patient and do external cephalic version after 30min PIN: 7. A 34y.o, G2 P1 presents at term with mild pre-eclampsia and a Bishop score of 4. WOF is INCORRECT in her management? a. Rupture the membranes b. Rupture the membranes then put up Syntocinon infusion c. Put up Syntocinon infusion in Hartman’s solution d. Apply prostaglandin PE2 -intra-vaginally e. Apply prostaglandin PE-2 intra-vaginally Pregnancy Plus: 8. A 28y.o, G2 P1 is Rh-ve is currently 8 weeks pregnant, She didn’t have any problem wither 1st child because he was also Rh-ve. However, the baby needed phototherapy because of liver immaturity. WOF is MOST APPROPRIATE in the management of her present pregnancy? a. indirect coomb’s test b. Amniocentesis at 36-37 weeks of gestation to determine fetal bilirubin level c. Delivery at 34-37/40 d. U/S at 20-30/40 to look for hydrops fetalis 9 A 30 yrs pregnant woman also suffer from asthma . WOF is true? a. Should not be treated by b-agonists in the 3rd trimester b/c their tocolytic effects b. Should not be treated by corticosteroids c. Does not get more frequent bronchospasm d. Will need caesarean section at 36-37 wks of gestation e. May need more frequent b-agonists during the pregnancy than before 10 A 8 wks pregnant woman comes into contact with a child who was recently diagnosed with Rubella. All of the following is true EXCEPT a. Give her anti-rubella specific IG b. If infection occurs the fetus may suffer from microcephaly, hearing loss and cardiac abnormalities c. Order IgG and IgM antibodies d. Repeat testing for IgG and IgM at 14-16/40 even if initial test was (-) e. Vaccinate her against rubella 11 WOF is the most likely cause of painless jaundice in pregnancy? a. Cholestasis b. Fatty liver of pregnancy c. Hyperemesis gravidarum d. Acute hepatitis e. Cholelithiasis GYNAECOLOGY Bleeding in non-pregnant 12 a 42 yo woman on O/C come to see you b/o mid-cycle spot bleeding. What is the most likely cause? a. Reduced oestrogen level b. Cervical ectropion(erosion) c. Cervical intra-epithelial neoplasia d. Endocervical cancer e. Atrophic vaginitis Cervix 13 WOF is the best treatment for cervical cancer stage 11B a. Cone biopsy b. Total hysterectomy c. Total hysterectomy followed by chemotherapy d. Chemotherapy alone e. Radiotherapy Contraception 14 A 32 yrs woman falls pregnant despite using an IUD, She consult you . WOF is correct? a. Copper cause congenital malformations b. The pregnancy should be terminated because copper is very harmful to mother and fetus c. IUD is associated with 405-50% increased incidence of ectopic pregnant d. IUD cause pelvic inflammatory disease e. Vaginal examination should be conducted and the IUD removed under U/S guidance if the thread is found Hormones: 15 A 50 yr woman has been on tamoxifen fro 5 yrs breast cancer . Present with mid –cycle vaginal bleeding . What is the most likely cause? a. Metastases from the breast b. Endometrial cancer c. Endometrial hyperplasia d. Endometrial hypoplasia because of tamoxifen e. Decreased oestrogen level because of tamoxifen 16 The OCP has all the following effects EXCEPT a. Reduce iron deficiency anaemia b. Improve serum lipids profile c. Reduce the incidence of endometriosis d. Reduce benign breast e. Reduce the incidence of ectopic pregnancy 17 All of the following are true about Depo-provera EXCEPT a. decrease the incidence of thrombo-embolism b. Decrease the incidence of ectopic pregnancy c. May delay pregnancy after depo-provera is ceased d. May cause weight gain e. They do not affect glycaemic control in diabetics 18 AbsoluteC/I to OCP a. Smoking b. Migraine with hemiplegic aura c. Diabetes mellitus d. Gall bladder disease e. Hypertension HRT: 19 A 55 yrs woman presented 3 yrs . after menopause asking your advice about HRT. She was not symptomatic and O?E her vagina was well oestrogenised. What is the most likely cause ? a. Ectopic progesterone secretion b. Oestrogen producing tumour c. The time lag since her menopause is too short for symptoms to occur d. Peripheral conversion of androstenedion to oestrogen e. Peripheral conversion of Di-Hydro- Epi- Androsterone(DHEAS) to oestrogen 20 Progestion against athorosclerosis mediated by HRT. May be due to all the following EXCEPT a. Decrease total cholesterol level b. Decrease LDL level c. Decrease HDL level d. Decrease total triglycerides levels e. Protective effect on vascular wall endothelium 21 A 53yrs woman non-symptomatic woman presented asking your advice about HRT fro prevention of osteoporosis because of positive family history. She has had hysterectomy 2 yrs. Earlier. Which of the following would you prescribe her a. Ethinly oestradiol 0.01-0.05mg b. Conjugated oestrogen 0.675mg c. Oestradiol valerate 1-2 mg d. Piperazine oestrone 0.625 mg e. Oestriol 1 mg Incontinence: 22 Management of urge incontinence includes all the following EXCEPT a. Anti-cholinergic drugs b. Pelvic floor muscles exercises c. Dilatation of the bladder sphincter d. HRI e. Baldder retraining (Bladder drill) Infertility 23 After ejaculation which of the following is the site were MOST of the sperms are lost a. The vagina b. The cervix c. The uterine cavity d. The ampulla e. The isthmus 24 A 28 yo woman with 18/12 h/o post pill amenorrhoea [resents b/o infertility .All of the following investigations may need to be carried out EXCEPT a. S. Prolactin b. CT scan even if the prolactin level is normal c. S. oestrogen d. FSH e. Laparoscopy for PCO Ovaries 25. A young woman presents b/o acute pelvic pain after 8 wks of amenorrhoea .B_hcg is (-) and on U/S . She is found to have an 1.8cm cyst, what is the most appropriated action a. Ask too see her again after 3 wks b. Refer her fro laparoscopy c. Refer her for surgical remove of the cyst d. Prescribe oral contraceptive pill e. Prescribe her clomiphene Pelvic pain 26. A 24 yrs woman presents b/o acute pelvic pain and spotting after 8 wks of amenorrhoea . B-HCG is +, In the past she has had appendicectomy and cholecystectomy . what is the least likely cause of her pain a. Ectopic pregnancy b. Red degeneration of a fibroid c. Tortes ovarian cyst d. Pelvic abscess e. Inevitable abortion Procedures: 27 A woman is being investigation for infertility . Her gynaecologist advised laparoscopy and she asks your opinion about the procedure . you may tell her all the following EXCEPT a. Visceral damage is possible but unlikely to happen b. Vena caval or aortic rupture can cause cardiac arrest and death c. Laparoscopy is diagnostic of PCO d. Shoulder pain is common after the procedure e. Serious heart or lung disease usual, do not contraindicate the procedure SURGERY Integument/dermatology Head and neck /eye/ENT 1. A young man complains of a misty vision when he is reading books, the eye vision test showed 5/60 on both eyes. When he wears glasses the vision test showed 40/60 on left eye and 35/60 on the right eye. Which of the following is the most likely basis on his complains? a. Diabetic retinopathy b. Cataract c. Myopia d. Chronic simple glaucoma e. Nervous system /Neurology 2. Which of the following lesion can cause the wrist drop? a. Radial nerve b. Ulnar nerve c. Median nerve d. Brachial plexus nerve e. 3. A young man with bilateral weakness and wasting of thenar, hypothenar and interossei of hand , which of the following is the most possible cause a. Bilateral ulnar nerve palsies b. Bilateral median nerve palsies c. Multiple sclerosis d. Brain stem infarction e. Musculoskeletal Orthopaedics and rheumatology 4. Which of the following is the management for the large necrosis of limb? a. High dose of steroids b. Antibiotics c. Cytotoxic drug d. Tetanus toxoid e. 5. Picture of a palm fascia thickening and fibrosis with skin puckering associated with the ring finger and litter finger flexion (Dupuytren’s contracture) . Which of the following is the most common cause? a. Farm worker b. Chronic infection alcoholism c. Vibrating tool damage d. Smoker e. 6. Which of the following situation is the most common complication of an intra-epiphysial fracture in a long bone in an adolescent? a. Mal-union or non-union b. Increase spurt of growth in long bone c. Premature cessation of growth d. Stiffness e. Deformity Circulation system /heart/vessels 7. A 60 year-old male patient presents a sudden abdominal pain which is severe pain and radiates to the back , there are 120/min of pulse, 90/60 mmHg of blood pressure, which of the following is the most likely diagnosis? a. Acute pancreatitis b. Leaking aneurysm c. Perforation of duodenum d. Acute cholecystitis e. Most characteristic feature of fat embolism 8. Which of the following is the most likely characteristic of fatty embolism after lower limb trauma? a. Petechiae usually occur in the upper body b. Never involve the CNS c. Petechiae usually occur in the lower body d. Dyspnoea and tachypnoea e. 9. A lady presents an engorged long saphenous veins and engorged tributaries in the calf and thigh , which of the following is the management? a. Ligation of saphenous vein b. Ligation of stripping vein c. Amputate the leg if varices are severe d. Sclerotherapy e. Remove varices vein under local anaesthesia 10. Management of bedridden in a patient include all of the followings EXCEPT: a. Keep dry the pressure area b. Use a water bed c. Use sheep skin on the bed d. Keep ventilation on both sides of feet e. Constant movement by turning the patient 11. A 53 yrs man has a sudden blindness on the one eye, Which of the following is common cause? a. Block of proximal part of subclavian artery b. Temporal arteritis c. Block entire carotid artery d. Block of vertebral artery Respiratory system /lung /chest 12. A female patient developed tachycardia and fever(T38C) at 24 hrs after elective cholecystectomy. She was , otherwise , well before operation , apart from biliary pain. She was reluctant to cough, but produced a small amount of white sputum. Which of the following is the most likely explanation of her fever? a. Leakage of bile b. Wound infection c. Thrombophlebitis d. Pulmonary atelectasis e. Bronchopneumonia 13. Which of the following is the most serious condition requiring immediate intervention? a. Tension pneumothorax b. Pneumohaemothorax c. Open pneumothorax d. Subcutaneous emphysema e. Flail chest 14. A 70 yrs man has history of heavy smoking and haemoptysis, there are pleural plaques on the chest x-ray . Which of the following is next management? a. Bronchoscopy to look for asbestos bodies b. Percutaneous biopsy for mesothelioma c. Open chest biopsy d. Give antibiotics e. Thoracoscopy and. Gastrointestinal system /abdomen/abdominal wall 15. A woman presents sudden onset of abdominal pain, vomiting for 8 hrs. O/E: there were irregular pulse , terderness of abdomen, bowel sound absent and bloody discharge from rectum . Which of the following is the most likely diagnosis? a. Ulceration colitis b. Colon cancer c. Diverticulitis d. Mesenteric disease e. Crohn ‘s disease 16. Five days after appendectomy , a patient develops 39C of fever, Which of the following is the most likely cause of the fever? a. Appendix abscess b. Wound infection c. Thrombophlebitis d. Pulmonary atelectasis e. Bronchopneumonia 17. Which of the following is the characteristic of fistula? a. Communication with two side epithelium b. A kind of ulcer c. Always leads to granuloma d. Sinus e. Communication with one end epithelium cavity 18 Lithogenesis of bile is increase by all of the following EXCEPT: a. Age b. Weight loss c. Malabsorption d. Crohn’s disease e. Hyperlipidaemia 19. Which of the following is the most common hiatus hernia? a. Sliding oesophageal hernia b. Rolling hernia c. Pare oesophageal hernia d. Mixed hernia 20. A man, middle age, complains that there was a mild abdominal pain with an abdominal distension , which was relied by passing flatus, There was semiformal stool motion . Which of the following is the most possible diagnosis? a. Irritable bowel syndrome b. Cancer of colon c. Coeliac disease d. Diverticular disease 21. Picture of CT scan of the abdomen shows a huge localised swelling in the abdominal cavity. Which of the following is the least likely cause ? a. Pancreatic pseudocysts b. Ascites c. Splenic cyst d. Pancreatic cancer Breast/endocrine system 22. Which of the following is the most common cause for bloody discharge from the nipples? a. Intra-ductal carcinoma b. Intra-ductal papilloma c. Paget’s disease of the nipples d. Fibroadenoma e. Mammary duct ectasia 23. Which of the following is the best time for self breast examination ? a. Before menstruation b. During menstruation c. After menstruation d. Just before ovulation e. Just after ovulation Reproductive system 24. An enlarged , red and painful testes in a 10 yrs boy, which of the following is your management? a. Reassure b. surgical exploration of scrotum c. urine analysis d. urine analysis and send him home e. send him to out-patient urology Haematopoietic system 25. In a patient with spherocytosis, all of the following may happen after splenectomy EXCEPT a. Life span of RBC will become normal b. Reduce the rate of haemolysis c. Increase risk of infection d. Increase platelet e. Increase staphylococcus infection 26. Regarding DIC, all of the followings are true EXCEPT: a. Fibrinogen decreased b. Fibrinogen degradation products decreased c. Prolong APTT and INR d. Antithrombin III decreased e. Thrombocytopenia Renal system Nutrition /metabolism 27. In third day after head surgery , a patient has reduced levels of serum Na+ k + and cl -, the urine osmolality is normal, but blood osmolality is low, which of the following is the most likely cause? a. Water intoxication b. Inappropriate ADH syndrome c. Acute renal failure d. Choric renal failure e. Diabetic insipidus Infection disease: 28. Which of the following is the most likely site detected anaerobic infection: a. Brain abscess b. Hip prothesis c. Lung abscess d. Long bone osteomyelitis e. Pleural effusion Clinical Oncology 29. Regarding cancer of the thyroid all of the followings are true EXCEPT: a. Commonest finding was a solitary nodule b. Hot nodule on isotope scanning c. Hoarseness is one of the symptoms d. Difficulty in swallowing e. More in males 30. A female patient presents a tinnitus, sensorineural hearing loss and absence of corneal reflex. Which of the following is the MOST LIKELY cause: a. Brainstem glioma b. Acoustic neuroma c. Meniere’s disease d. Vestibular labyrinthitis e. Ear wax 31. Picture: Which of the following is INITIAL management for a woman with a lump in the breast: a. Needle aspiration b. Needle core biopsy c. Excision d. Radiotherapy e. Radical mastectomy 32. All of the following statements regarding cancer of lip are true EXCEPT: a. It accounts fro 30% of head and neck cancers b. It usually occurs on upper lip c. It most is squamous cell carcinoma d. Occur equally in males and female e. ? 33. A patient comes to see you and shows a lump on left arm, which of the following is the MOST IMPORTANT information you should ask: a. What kind of pain is it? b. How long have you been found the lump? c. How do you feel? d. Which part of arm is the location of the lump? 34. Which of the following metastatic carcinoma have the WOST prognosis: a. Prostate b. Breast c. Stomach d. Uterus e. Colon 35. A patient has single lump on one side of thyroid. All following situations suggest malignant EXCEPT: a. Single nodule b. Ultrasound showed a solid nodule c. Thyroid scan showed a ‘hot’ lump d. Associated with serum thyroglobulin increased e. Associated with hoarseness Clinical Immunology: 36. A young man with an accident on his motorcycle and presented with 3cm of bone protruding through the skin on the leg. What is the next management? AMC EXAM MONDAY 25TH OCTOBER 1999 MCQ PAPER II PSCHIATRY P.S.: The following is a re-construction of the essence only of the questions and answers (stems B options). The vast majority of the actual exam questions were very much longer than that in the form of clinical case histories. R.7/7 = Repeated question & when R, T = Repeated Topic R. AMCQ = Repeated questions from “ Annotated MCQ” book 20 TYPE ‘A’ QUESTION: ADOCSMENT DISORDER: 1. What is CORRECT in normal Grief? a. Affective reactivity is preserved b. Suicidal risk is increased c. Progression to pathological grief is common d. May precipitate schizophrenia e. May precipitate delusional disorder COMMUNITY & LIAISON PSHCIATRY 2. You were called fro a young patient of yours who has stopped taking his medication and was very agitated and waiving a sword. What is the BEST COURSE OF action? a. Talk to him in a calm voice to convince him to give you the sword and conduct a mental examination b. Talk to him firmly that he should lay down his sword c. Withdraw from the situation and call the police to help you transfer him to hospital Recall Paper AMC MCQ EXAM OCT 1999 Surgery 1. A young patient present with a lump in the arm. You are unsure about its nature. What do you ask to help to establish your diagnosis? Choice what is the best response? A. Is it painful? B. Is there any lump in other side of the body? C. Is there any change of bowel habit? D. What do you think cause of the lump? E. How long it present? 2. What is the common cause of bone tumour in the pelvis of young adult? A. Metastatic Tumor B. Osteoma C. Osteosarcoma D. Chondroma E. 3. What is the common cause amaurosis fugax (transient mononuclear vision)? A. Stenosis of internal carotic artery? B. Giant cell arteritis C. Vertebral artery occlusion D. Embolism to middle cerebral artery. E. 4. A women developed tinnitus and sensory neural deafness decreased sensation in trigeminal area. What is the most likely cause? A. Acoustic neuroma. B. Brain stem infarction. C. Vestibular neuritis. D. Vasculitis. E. Meningioma. 5. What is true about carcinoma of lip? A. Usually in upper lip. B. Usually squamous cell in origin. C. Metastasis to cervical lymph node. D. Exclusively occur in men. E. 6. A patient developed pain in right eye then developed blindness, what is the most likely cause? A. Closure angle glaucoma. B. Chronic glaucoma. C. Conjuctivitis. D. Corneal FB. E. Uveitis. 7. A diabetic patient developed a deep ulcer in 3rd metatarsal head. What is the cause? A. Neuropathy. B. Atherosclerosis. C. Micro-vascular disease. D. Infection. E. Uncontrolled DM. 8. A boy can not see the black board in the class but can read his book. On examination Right eye vision 6/36. left eye vision 6/18. What is the most likely cause? A. Myopia. B. Hypermetropia. C. Amblyopia D. Cataract. E. Presbyopia. 9. Photo of CT scan of abdomen (looks like cystic lesion) What is the least likely cause? A. Acute gastric dilatation. B. Ascites. C. Mesenteric cysts. D. Splenic cyst. E. Pancreatic pseudocyst. 10. photo of Dupuytren’s contracture. What is the most likely cause : A. work with vibratory tools B. alcoholic C. ulnar nerve palsy D. median nerve palsy E. work with fire arm 11. photo of mammogram & ultrasound of breast showing very large cystic mass. What is the next plan of management A. true cut biopsy B. aspiration (fine needle) C. mastectomy D. radiotherapy E. d 12. what is the least likely cause of thyroid carcinoma A. being male B. hot nodule in thyroid scan C. radiation to the neck D. history of hoarseness 13. a man has thyroidectomy due carcinoma. He developed fever tachycardia after 10 days. What is the most likely cause ? A. sepsis B. thyroid storm C. hypothyroidism D. d E. d 14. photo of a obese lady in operative table. What is the most likely cause : A. dermatitis artefacta B. herpes zoster C. d D. d E. d 15. a woman developed sudden oset of abdominal pain. On examination pulse irregular, abdomen diffusely distended, positive rebound tenderness. Rectal examination showed dark stained stool. What is the likely cause A. mesenteric artery occlusion B. perforated diverticulitis C. . D. . E. . 16. an obese woman developed low thoracic pain radiates to lower abdomen, epigastrium. Right femoral pulse is weak and epigastric tenderness present. This lady has past history of appedicectomy & long standing hypertension. Now BP 170/100 Pulse 100. chest X ray showed widened mediastinum. What is the most important cause you going to exclude ? A. rupture aortic aneurysm B. diverticulitis C. inferior myocard infarction D. diaphragmatica hernia E. 17. what is fistula A. d B. d C. d D. d E. d 18. a man has varicose veins of long saphenous vein A. saphenous vein ligation B. stripping up the tribularis C. phenol injection D. . E. . 19. a young man fell from tractor sustained a .. in the leg. After debridement of the wound you ask about his previous tetanus immunization status. He said “ I think I have shot 5 years ago rather I don’t remember” what is your treatment plan ? A. tetanus toxoid B. tetanus immunoglobulin & toxoid C. tetanus immunoglulin IM & toxoid & penicillin D. ., E. . 20. 42 years old lady has right nephrectomy few years ago for phosphate stone. She now presents with severe hypertension due to localized renal artery stenosis due to fibromuscular hyperplasia. What is the best management ? A. hypotensive agent B. renal artery angioplasty with surgical back up C. renal artery reconstruction surgery D. . E. . 21. a young hypotensive man has reduced CVP & reduced pulmonary artery wedge pressure. What is the most likely cause ? A. hypovolemia B. hypervolaemia C. pulmonary embolism D. pneumathorax E. . 22. what is true about rash in fat embolism A. usually occur in the face B. usually in the upper part of the body] C. lower part of the body D. in lower legs 23. a man developed abdominal pain & vomiting for 8 hours. Examination Hb 18.7 g what fluid is the best : A. Hartman solution 2000 ml during surgery B. Hartman solution 2000 ml before surgery C. 4 % Dextrose 1/5 NS 2000 ml before surgery D. 4 % Dextrose 1/5 NS 2000 ml after surgery 24. what is the life threatening condition ? A. tension pneumothorax B. haemothorax C. aortic aneurysm 25. a woman presents with unilateral exophthalmos. What is the most likely cause : A. carcionoma of maxillary antrum B. thyrotoxicosis C. sinusitis D. cellulites of the orbital 26. About antibiotic uses : A. It is always best to give antibiotic before any operation B. It is best practice to give two or three antibiotic together to have maximum benefit C. Always try to give single antibiotic to minimize cross reaction D. E. . 27. When is the best time for self examination of breast ? A. immediately before menstruation B. immediately after menstruation C. during midcycle D. at the end of the period E. Paediatric 1. 2 year old boy previously well, presents with buccal ulceration including some noted on the tongue which in most likely cause: A. Herpes type I B. Adenovirus C. ECHO virus E. Coxackie virus E. 2. 17 month old boy ingested some corrosive. He has drooling from mouth, otherwise well. What would be next of management? A. Reassure mother B. Admit for observation and possible endoscopy C. Give ipecac D. Give nasogastric activated charcoal 3. 2 year old well child noted to have some petichiae and purpura on the trunk for one week. No other abnormality detected. Which is the correct? A. Child has haemophilia A B. Child probably has low platelet count C. D. E. 4. 2 year old presents with cut in hand with minimally contaminated wound. This child has no past history of immunization. Which of the following is most appropriate? A. Tetanus immunoglobulin B. Tetanus toxoid C. Penicillin D. DPT (triple antigen) E. Combined Diptheria Tetanus 5. One year old child developed cough, running nose. Two other family members have sneezing, coughing. The child developed moderate respiratory difficulty with nasal flaring, chest hyper inflated by the time present to hospital. What is the most likely diagnosis? A. Asthma B. Bronchiolitis C. Vital croup D. Diptheria E. 6. What is the significant of epiphyseal growth fracture? A. Malunion B. Ununion C. arrested growth D. E. 7. A mother noted a mass during bathing in a 22 month old child. On examination she said the child has irritable, pale. The mass noted on left lower quadrant, which is non tender and also bilateral noted periorbital echymosis. Which of the following is most likely diagnosis? A. Refer for child abuse B. Neuroblastoma C. Wilms tumor D. Advise mother its no important finding. 8. 9 year old boy with life long history of enuresis and not wet during the day. WOF is associate with the correct statement regarding this child in which > 20% cases are correct? A. Either parent has history of enuresis B. Reflux uropathy C. Small capacity bladder D. Spina bifida occulta E. Small kidney 9. 8 year old boy obese, weigh 48 kg (>98 percentile) height 137 cm (90th percentile). WOF is correct in relation to this boy? A. Advanced bone age B. Elevated fasting blood sugar C. Increase urinary free cortisol D. Primary parathyroid E. Increase Thyroid hormone 10. 22 month old child presents with mild jaundice. On examination splenomegaly and found with past history of prolong neonatal jaundice and family history of gall stone. WOF you will find in peripheral blood film? A. Microcytosis B. Target cells and basophilic stippling C. Spherocytes D. Megaloblastic E. Inclusion bodies. 11. Child presents with acute attack of asthma the best side measure to assess the severity is: A. Severity of the wheezing B. Response to inhaler C. Degree of dyspnoea D. PEF E. Pulmonary function test. 12. One week baby presents with sign of severity chest infection. WOF shall be included in the management? (X-ray reveals pneumatocele) A. Ampicillin B. Gentamycin C. Fluxacillin D. Cephalosporin E. 13. An infant presents with recurrent attack of bullous vomiting and screaming which of the following is used in the assessment of his condition? A. Reassurance B. Endoscopy C. CT scan D. US E. 14. Child presented immediately to ED after swallowed acoustic soda. Fist step is? A. Endoscopy B. Milk C. Water D. Charcoal E. 15. Child presents with fever for 2 days and then rash after fever disappear. What is the Diagnosis? A. Roseola infantum B. Measles C. Scarlet fever D. Herpes simplex type I E. 13. One year child with fully breast milk feeding presents with pale, anaemia, lethargic. WOF is the correct response? A. Iron deficiency B. Thalassaemia C. Change to bottle milk D. E. 14. 6 moth old baby with recurrent unilateral eye infection. Previously treated with antibiotic. WOF is the correct response? A. Repeat the antibiotic B. Lacrimal duct obstruction C. Refer to Ophtalmologist. D. E. 15. Case at Amblyopia? A. All children should be screen at 6 year old B. Loss of central vision – unless corrected C. Cover the affected eye. D. E. 16. Diabetes Mellitus usually: A. Presented within 1 month of case B. 50% have history of DM monozygote twin C. Could be react with oral hypoglycemia D. E. 17. All of the following could be a cause of deafness in newborn except (apgar score 8 at 1 minute): A. Phenytoin B. Kernicterus C. 1500 gram weigh at birth D. E. 18. Most common micro organism in child with meningitis? A. Echo virus B. Herpes virus C. TB D. Staphylococcus. E.