RECALL MCQ JULY 2006

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    RECALL MCQ JULY 2006
    ADELAIDE

    14. Man. Knee injury. Has sharp pain, knee effusion. He was playing soccer 1 month ago. He paused for a month amd started to play again. Now he is presented with pain in the knee that is often locked, gives away and he can’t extend his leg
    A-rupture of ACL
    B-Med meniscus problem
    1. Picture of a brown discolored lesion with red borders on the nostril. Diagnosis?
    a) SCC
    b) BCC
    c) Melanoma
    d) Actinic Keratosis
    we can’t answer without picture, but it is either SCC OR BCC
    2. A middle aged man with acute onset of jaundice and fever. In examination you can feel a mass in RUQ which moves up and down with breathing, what's the most probable cause?
    a) CBD stone I AGREE
    b) Liver abscess
    c) Gallstone in gallbladder

    3. Man with retinal detachment. What is initial management?
    a) Nurse with head lying back
    b) IV dexamethasone******************
    c) Atropine eyedrops
    d) Pilocarpine eyedrops

    4. Patient with history of ulcerative colitis for many years. Now jaundiced and getting worse.
    a) Sclerosing colangitis ( with raised alkaline phosphatise)
    b) Crohn's disease
    c) HCC

    5. New born baby with 1 week history of yellow discharge from umbilical stump. A red fleshy lump can be seen on examination. What is the treatment?
    a) Reassure parent
    b) Povidone iodine (Betadine)
    c) Silver nitrate
    d) Ultrasound
    e) Surgical removal I THINK ******************
    FOR PREVENTION; USE:
    o Povidone-iodine applied daily until cord separation
    o Silver sulfadiazine applied daily until cord separation
    o Bacitracin ointment applied daily until cord separation
    FOR TREATMENT ANTISTAPH + AMINOGLUCOSIDE OR SURGERY

    6. A middle aged man has undergone post AMI angiography, ballooning and stenting. He is on clopidogrel. 2 days post OP he has a growing pulsating mass in the femoral region. What is the best management?
    a) Stop clopidogrel
    b) Operate on femoral artery********************
    c) Direct compression of the region

    7. A man suffers trauma to his head and presents with a wound in the right temporal area, his right pupil is dilated and fixed. The most likely DX?
    a) Epidural hemorrhage I AGREE
    b) SAB
    c) Cerebral tumor

    8. A patient with head trauma, on painful stimulus he opens his eyes, localizes pain and mumbles incomprehensible sounds. What is the Glasgow Coma Scale?
    a) 6
    b) 8
    c) 10
    d) 12
    the answer is 9 (5+2+2)

    9. A patient with head trauma, on painful stimulus he opens his eyes, withdraws his arm and moans. What is the Glasgow Coma Scale?
    a) 7
    b) 8
    c) 9**************
    d) 10

    10. A middle aged woman comes to your clinic with sudden attack of unilateral pain in the eye and light flashes. What's the best INITIAL management?
    a) Nurse with head lying back
    b) IV dexamethasone
    c) Atropine eyedrops
    d) Pilocarpine eyedrops*********************(GLAUCOMA)

    11. A patient with sudden onset of nystagmus, ataxia, dyplopia, vertigo, lack of sensation on right side of his face. Most likely DX?
    a) Posterior cerebral artery infarct
    b) Vertebral artery insufficiency I agree
    c) Carotid artery infarct

    12. A baby is born at term with meconium stained amniotic fluid, after an hour he becomes cyanosed, tachypneic and hypotonic. What do you do as the initial treatment?
    a) Oxygen
    b) Suction I agree
    c) Intubation
    d) IV antibiotics

    13. A 14 year old pregnant girl, who has been abandoned by her boyfriend and she doesn't live with her parents, asks you for abortion. What do you do?
    a) Call her parents
    b) Call the child protective service I agree
    c) Call the police
    d) Refer to gynecologist for abortion

    14. A woman 2 days after a normal vaginal delivery suddenly passes a clot and then bleeds fresh blood, in examination the uterus is floppy and felt 2cm above the umbilicus, no fever.
    a) Inject ergometrin inside uterus muscle I AGREE
    b) D & C
    c) Antibiotics (IV)
    d) Vaginal prostaglandin F2-alpha

    15. Full term lady in labor, 4 cm dilated, no progression after 4 hours. What is the best next step?
    a) Induce with oxytocin
    b) Vaginal prostaglandin
    c) Rupture of membranes****
    d) Wait

    16. Treatment of Group B Streptococcus in pregnancy is of value because:
    a) It prevents premature births. I agree
    b) It prevents the recurrence of still birth.
    c) Is of no value, because patient is asymptomatic.

    17. A 13 year old quadriplegic retarded girl is brought to you by her parents, who are asking you about hysterectomy. What will you do?
    a) Tell them that it's illegal
    b) Contact the supreme guardian court I agree
    c) Refer to gynecologist for procedure

    18. A 9 month old child is brought to the hospital by his parents, complaining of noisy breathing. In examination there is mild inspiratory stridor and no other specific findings. He is not in distress and vital signs are normal. What is the most likely cause:
    a) Tracheomalacia I don’t agree cause it induce expiratory crackles mainly
    b) Asthma***************this is the answer.
    c) Bronchiolitis

    19. A 2 month old baby with jaundice. He is feeding and thriving well. He has dark urine and pale stool. Total Bil: 200, conjugated Bil is 130.
    Most likely diagnosis?
    a) Breast milk jaundice
    b) Gilbert's syndrome
    c) Billiary atresia
    d) Hypothyroidism**********
    e) Spherocytosis

    20. Which one is the best diagnostic method for congenital pyloric stenosis?
    a) Barium meal in supine and erect position
    b) Abdominal xray
    c) Palpate the abdomen during a breast feed I agree

    21. X-ray of supracondylar humerus fracture. What is most likely to be damaged?
    a) Brachialis artery this is the most common complication

    22. A 20 year old female with a lump in anterior aspect of sternocleidomastoid muscle, at the border of lower and middle third. What's the best management?
    a) Total excision
    b) Aspiration
    c) CT imaging
    I don’t know, I will leave it to check it
    23. A patient presents with fever and chills, an hour after urethral catheterization. What's the most likely cause?
    a) Bladder rupture I don’t agree
    b) Gram negative septicaemia ****** which commonly happen after catherization

    24. Patient with a lump in suprasternal notch, which moves up and down with swallowing. What is the diagnosis?
    a) Thyroid nodule I don’t agree, cause it could me not isible
    b) Thyroglossal cyst******** is the answer,and On examination, the cyst rises as the patient swallows or protrudes their tongue because of its attachment to the tongue via the tract of thyroid descent
    c) Branchial cyst

    25. Picture of a lump in neck of an old man. His cousin had tonsilitis a week ago. Which one the following examinations will most likely reveal the cause?
    a) Submandibular examination
    b) Anterior triangle examination
    c) Examination of the mouth floor
    WE MUST HAVE THE PITURE

    26. In mid-shaft humerus fracture, which of the following is most probably damaged?
    a) Radial nerve I agree
    b) Ulnar nerve
    c) Median nerve

    27. Which one gives the best view of the bile duct:
    a) ERCP**** IS THE BEST TO DIAGNOSE THE BILE DUCT.
    b) DIDA scan
    c) OCG
    d) US I DON’T AGREE, IT IS THE FIRST TEST TO BE DONE BUT NOT THE BEST

    28. A man with shoulder dislocation presents in ED within an hour. You want to reduce the joint in ED. Which drugs do you use?
    a) Fentanyl and midazolam
    b) Suxamethonium and pethidine I AGRE
    c) Rectal paracetamol
    d) Morphine


    29. A middle aged lady who works in the hospital as a cleaning lady, comes to you with elbow pain. In examination she has tenderness on the upper head of radius. What's the most likely diagnosis?
    a) Stress fracture of radius
    b) Injury to the head of brachioradialis
    THE ANSWER MUST BE Tennis elbow is caused by inflammation of the common extensor origin, at the lateral epicondyle of the humerus. There may also be concommittant rupture of aponeuritic fibres. It is a frequent cause of elbow pain.

    30. An 80 kg male patient with burns on 15% of his body surface. What is the best fluid regime for his first 24 hours?
    a) 3L Hartmann + 2L 5% dextrose I AGREE
    b) 3L N/S + 2L 5% D/W
    c) 3L Hartmann + 2 L blood

    31. A middle aged diabetic man has undergone abdominal surgery. 5 days later he develops fever and wound infection followed by removing of two of his staples. 2 days later the wound is dehiscened totally. The complete lab data is given. What is the most likely cause of his wound dehiscence?
    a) Low albumin
    b) Infection I AGREE
    c) Low platelets

    32. Commonest cause of claudication in the lower extremities?
    a) Superficial femoral artery I AGREE
    b) Popliteal artery
    c) Posterior tibial artery
    d) Deep femoral artery

    33. A middle aged man presents with recurrent renal colics. In investigations he is found to have a 2.5 cm stone in the left calyce with no obstruction. What is the next step?
    a) ESWL LITHOTRIPSY**** IS DONE FOR STONE MORE THAN 1 CM
    b) Reassurance
    c) Antibiotics and increase fluid intake
    d) Percutaneous lithotomy

    34. Patient with history of nephrolithiasis, on Xray a calculi is found in the union of the urether and bladder. The bladder is distended. Management?
    a) Surgical removal of calculi
    b) Reassurance
    c) Antibiotics and increase fluid intake
    d) Percutaneous lithotomy
    EITHER A OR D, BUT I THINK A.

    35. Retroorbital pain plus rhinnorhea:
    a) Cluster headache I AGREE
    b) Temporal arteritis

    36. A lady with infertility, her LH is increased, FSH increased, Oestradiol decreased. Management:
    a) Clomiphen citrate
    b) Oestrogen daily I AGREE
    c) IVF

    37. Middle aged man comes with history of recurrent attack of abdominal pain that radiates to back. During the attack he is hypotensive but returns to normotensive after 6-8 hrs time. Diagnosis?
    a) Acute pancreatitis
    b) Leaking aneurism I AGREE , NUT NOT SURE
    c) Mesenteric artery occlusion
    d) Mesenteric adenitis
    e) Renal calculi

    38. Patient comes to you with decreased breathing sounds on the right middle lobe, consolidation and dullness on percussion. What is the most likely diagnosis?
    a) Bronchiactasis
    b) Pleural effusion
    c) Pulmonary collapse I AGREE
    d) Pneumothorax

    39. A lady complains of hot flushes and dry vagina. What will you prescribe her as a method to reduce vaginal bleeding?
    a) C ombined OCP throughout the cycle I WOULD CHOSE THIS BECAUSE I WANT TO DCREASE THE VAGINAL BLEEDING
    b) Oestrogen in the beginning and progesterone for the last 12 days

    40. A patient with dilatation of the urether, urinary bladder and kidney. Most probable cause?
    a) S tricture urethra I AGREE
    b) Hypoplasia of kidney
    c) Vesicoureteric stenosis

    41. Which one is chronic?
    a) HBV
    b) HCV I AGREE
    c) HAV
    d) HDV

    42. A women had a baby with cleft lip/palate, became pregnant again. What is true about her 2 nd baby having cleft palate?
    a) 10% chance
    b) 2-4% chance****
    c) Same as general population

    43. Most common cause of small bowel obstruction in Australians who didn't have a previous abdominal operation?
    a) Adhesions
    b) Groin hernia I AGREE
    c) Hiatus hernia
    d) Intussusception
    e) Adhesions

    44. Picture of Xray of small bowel obstruction in anthology book.
    a) Adhesions

    45. A couple are both 26y old. They have not been able to conceive for 2y. She is having regular periods with 28day cycles. There is no history of previous illness or surgery. Which of the following is NOT necessary at this stage?
    a) Check for impotence and ejaculation problems
    b) Karyotyping I AGREE
    c) Check progesterone levels at 21days
    d) Semen analysis
    e) Laparoscopy and hysterosalpingography

    46. The following are associated with anal pathology as opposed to rectal pathology. Except:
    a) Perianal pain
    b) Blood dripping on toilet bowl
    c) Mucous discharge I AGREE
    d) Pruritus ani
    e) Bulging mass
    47- An 87 year old man that you are going to do a colonic operation on. His daughter has had a 3 hour meeting with the anesthetist and she is very anxious and agitated about the operation. Now she wants to see you to discuss her father's surgery. What do you do?
    a) Speak to her I AGREE
    b) Choose not to see her
    c) See her only if she has power of attorney
    d) See her only with her father present

    48. A 40 year old nurse threatening suicide. Has had a previous episode but no associated risk of crisis. States she has a syringe with potassium chloride in her bag and will kill herself. What is the diagnosis?
    a) Depression
    b) Bipolar disorder
    c) Borderline personality disorder I AGREE
    d) Schizophrenia

    49. Which of the drugs cannot be prescribed together?
    a) Lithium carbonate & Carbamezum (INCREASE TOXICITY)
    b) Lithium carbonate & Sertreline
    c) Lithium carbonate & Clonazepine

    50. In a diabetic ketoacidotic patient which of the following is a cause for hyperkalaemia?
    a) Acute renal failure
    b) Lack of insulin
    c) Acidosis I AGREE
    d) Infection
    e) Lack of glucose

    51. A middle aged man has flashes of light and shimmering. It resolves without any significance. After 4 days symptoms returned and he completely lost his vision in one eye over a period of 6 hours. What could be the diagnosis?
    a) Retinal artery thrombosis
    b) Macular degeneration
    c) Carotid artery disease
    d) Retinal & macular detachment I AGREE
    e) Vertebro-basilar artery insufficiency

    52. A man has undergone treatment for carcinoma of lungs. Now he presents with pain along side his left arm and hand. What could be the cause?
    a) Paraneoplastic neuropathy I DON’T AGREE
    b) Ca involving brachial plexus I THINK THIS IS THE ANSWER (PANCOAST TUMOR)
    c) Multiple sclerosis
    d) Disc prolapse
    e) Motor neuron disease

    53. A 40 year old lady developed pain in the abdomen around the umbilicus, nausea and vomiting. On examination there was generalized tenderness, more marked in the right iliac region. What will be your next management?
    a) Admit in the hospital for further development
    b) Give antibiotics
    c) Do blood tests for leucocytosis
    d) USG
    e) Give analgesic and arrange for appendectomy , GENERALIZED TENDERNESS IS AN EMERGENCY FOR OPOERATION
    54. A lady in labor proceeding satisfactorily with a healthy foetus without any complication. How will you monitor foetal heat rate?
    a) Computerized charting of foetal heart rate
    b) Continuous cardiotocography I AGREE
    c) Intermittent auscultation

    55. Which of the following is the most important source of receiving ionising radiation per capita?
    a) Nuclear fallout
    b) Medical X-rays
    c) Natural background radiation
    d) Home electronics
    e) Conventional war
    http://www.uic.com.au/ral.htm
    56. A man visiting from Malaysia now presenting with fever, headache and rigors. He received prophylactic Chloroquine. What will you do now?
    a) Thick & thin film I AGREE
    b) Blood culture
    c) HIV test
    d) Urine analysis
    e) Antibiotic

    57. A man complaining of repeated blurring of vision for a few weeks. Now he complains that blurring of vision feels like a curtain coming down over his vision. Which of the following can be the cause?
    a) Amaurosis Fugax I DON’T AGREE
    b) Retinal detachment IT IS ACTING LIKE CURTAIN WHEN IT HAPPENS
    c) Carotid artery occlusion
    d) Central vein thrombosis

    58. A 1year old girl presented with fever and rigor. Her bag urine analysis showed leukocytes 56x 10^5. Urine culture showed mixed growth with E. coli > 10^5 what will you decide?
    a) Infection proven
    b) Bacteriuria without infection
    c) Equivocal nothing can be decided
    d) Collect catheter urine for analysis

    59. Most common site of endometriosis:
    a) Umbilical
    b) Ovaries
    c) Lungs
    d) Peritoneal

    60. A primigravida came for first antenatal visit. On examination, her uterus is found to be 20weeks height, but her LMP suggest only 12 weeks of pregnancy. What may be the cause of disparity between two dates?
    a) Hydatiform mole
    b) Hydrops foetalis
    c) Incorrect estimation of LMP
    d) Polyhydramnios
    e) Twin foetus

    61. A patient received a human bite on his arm, on presenting to you ordered a blood test for Hepatitis B. The next morning biter's doctor called you and asked whether you have ordered a blood test for Hepatitis C & HIV because some of the victim's blood has entered to biter's mouth. The victim is unwilling to give consent for testing his Hepatitis C and HIV. What you will do next?
    a) Get the public health unit force victim to give her consent
    b) Ask the doctor to treat biter's prophylacticaly
    c) Ask the biter's to contact the victim request and convince him to give consent for testing.
    d) Order laboratory to perform the test without patient's knowledge
    e) Do nothing, assuming victim is not caring Hepatitis C and HIV virus.

    62. A one-month-old infant was brought by his mother to the hospital, complaining of difficulty in breathing during feeding, lethargy and not gaining on weight. While the neonate was examined in the nursery at the 2nd day of life there were no abnormalities, mother took him home with no doubt of any problem. On examination, there is a systolic murmur on the left lower sternal border. What is the problem?
    a) If the defect is on the muscular part it is not detected
    b) If defect is on the membranous part it appears afterwards
    c) During early infancy increased heart rate and respiratory noise could mask the murmur
    d) Increased pulmonary vasculature resistance delays the left to right shunt
    e) Defect is a flap valve so it is not easy to recognize

    63. A 6 year old boy presented with red, hot and tender swollen right knee. He can't walk properly and doesn't allow you to examine his knee. Which of the following is most likely?
    a) Tenosynovitis
    b) Osteomyelitis
    c) Septic arthritis
    d) Perthe's disease
    e) Patellar fracture
    64. A lady who was treated for left breast cancer now complains of pain in the right thigh. You diagnosed secondary metastasis to the right femur. Which of the following will you give her to relive the pain?
    a) NSAIDS
    b) Tamoxifen
    c) Subcutaneous Morphine
    d) Radiation
    e) Chemotherapy

    65. A 40 year old man was playing squash. He received a blowout injury on his right eye. Which of the following can occur?
    a) Enophtalmus
    b) Anterior hyphema
    c) Zygomatic depression
    d) Diplopia
    e) Conjunctival suffusion

    66. Which of the following can be used in the treatment of mania?
    a) Fluxetine
    b) TCA
    c) Benzodiazepines
    d) Na-Valproate
    e) Fluphenazine

    67. In hydroponic grown marijuana Tetrahydrocannabinol ( THC) the active ingredient as opposed to field grown marijuana is:
    a) THC concentration is lower of that not grown hydroponicaly.
    b) THC concentration in not affected.
    c) THC concentration is higher in hydroponic grown.

    68. A 72 year old man had a trans-urethral prostate resection. Histology revealed 5% undifferentiated carcinoma cells in the specimen. Which of the following is the best management for his condition?
    a) Do nothing
    b) Radiation
    c) Radical prostratectomy
    d) Complete trans-urethral resection
    e) Chemotherapy

    69. Patient presents with chest pain. Dullness in the area of left lower lobe and breath sounds decrease. Above that bronchial sound was heard. What is the diagnosis?
    a) Pleural effusion
    b) Pneumonia
    c) Consolidation of lower left lobe
    d) Lung cancer
    e) TB

    70. Median forceps delivery, baby cannot move one arm post delivery. What is the most likely diagnosis?
    a) Erb's palsy
    b) Fracture of humerus

    71. Which of the following movement is first lost in degenerative disease of the hip?
    a) Flexion
    b) Extension
    c) Rotation
    d) Abduction
    e) Adduction

    72. Retrograde blood flow into the left vertebral artery can be due to obstruction of:
    a) Internal carotid artery
    b) Proximal subclavian artery
    c) Distal subclavian artery

    73. A seven week old baby is brought to you by his mother. She complains that the baby had been vomiting intermittently since birth. On examination you find no abnormalities except for some weight loss. What is your probable diagnosis?
    a) UTI
    b) Pyloric stenosis
    c) Phenylketonuria
    d) DI
    e) GORD

    74. A 12 month old child can do all of the following except?
    a) Transfer object from one hand to the other
    b) Can grasp object with thumb and index finger
    c) Can walk without support
    d) Can sit without support

    75. A 15 month old child can do which of the following?
    a) Hop on one leg
    b) Draw a triangle
    c) Can say a complete sentence
    d) Draw 4 parts of human body
    e) Can climb stairs

    76. A 13 year old boy is below the 3rd percentile for height (his height is equal to 50 th percentile for 9 year old). Which of the following is the best prognostic sign for him to reach the normal adult height?
    a) Bone age equal to 13 years
    b) Bone age equal to 9 years
    c) Bone age equal to 15 years
    d) Weight more than 5th percentile for his age
    e) Weight equal to the 90th percentile for his age

    77. A young woman present with antenatal bleeding. What is the indication of placenta previea?
    a) Abdominal pain with bleeding
    b) Tender uterus
    c) Smaller bleedings before

    78. Dislocation of the shoulder, what is the most common nerve that will be affected?
    a) Ulnar
    b) Median
    c) Axillary
    d) Medial
    e) Musculocutaneous
    f) Brachial

    79. A 12y old boy with height and weight on the 90 th percentile was brought in by his mother with pain in the hip associated with a limp:
    a) Slipped femoral epiphysis
    b) Osteomyelitis
    c) Perthes disease
    d) Transient synovitis

    80. In a still born baby, who had normal CTG until last 30min of labor. Labor progress was good, no maternal and fetal distress .Which of the following is the least beneficial to know the cause of death?
    a) Coombs test
    b) Kleinhauer count
    c) Anti-cardiolipin antibody
    d) Anti Rh antibody
    e) Mother's karyotype


    81. A previously well 18 months old infant noticed by his parents to have a very fast heart rate for the last 20 minutes. Heart rate was about 250-300/min. What is the appropriate management?
    a) Reassure the parents
    b) Beta-blocker
    c) Digoxin
    d) Verapamil
    e) Cold water stimulation

    82. You are the intern in the surgical ward and the next morning you are going to see a postop hemicolectomy patient. During the surgery hepatic metastasis were found and a liver resection was performed as well. You?
    a) Tell the patient that it all went well and don't inform him of the new findings.
    b) Tell the patient that the consultant will speak to him during the week.
    c) Tell him nothing.
    d) Tell him about the procedure and explain the new findings.

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