Medicine Colloquium Exam - First Session 2015 PDF

## Ministry of Education and Higher Learning Medicine Colloquium Exam - First Session 2015 ### IMPORTANT INSTRUCTIONS Each candidate should read this page before answering the questions. The candidate should follow the directions below: 1. Write clearly your FIRST and FAMILY NAME and APPLICANT NU...

## Ministry of Education and Higher Learning Medicine Colloquium Exam - First Session 2015 ### IMPORTANT INSTRUCTIONS Each candidate should read this page before answering the questions. The candidate should follow the directions below: 1. Write clearly your FIRST and FAMILY NAME and APPLICANT NUMBER with ink (pen) in the designated space (colored square). 2. Please use the pencil ONLY. 3. Do not use any pen (like bic) or ink. 4. Completely Fill the answer squares using pencil only. 5. Only ONE answer is allowed to each question. 6. Avoid erasing as much as you can. 7. When needed, do erase the cancelled answer COMPLETELY. 8. You may use the question bookle as scratch, and make sure to return it with the answer sheet at the end of the exam. 9. On the answer sheet, you should fill up the square corresponding to the right answer, in pencil only. No writing allowed at all. 10. Keep your answer sheet clean and tidy, do not fold or tear it. 11. The duration of the exam is THREE HOURS. 12. The composition consists of 180 QUESTIONS. ### Important Note: Any square filled up with a pen or ink cannot be read by the machine. It reads answers filled up in PENCIL only. Thank You & Good Luck S.A. ## Ministère de l'Education et de l'Enseignement Supérieur Examen Colloquium Medecine - Première Session 2015 ### INSTRUCTIONS IMPORTANTES Le Candidat doit lire ces instructions avant de commencer à répondre aux questions et devra observer les directives suivantes : 1. Ecrire son PRENOM et NOM et son NUMERO D'EXAMEN à l'encre et de façon lisible à l'endroit indiqué (coin en couleur) 2. Utiliser UNIQUEMENT un crayon mine. 3. Ne pas utiliser de stylo à encre ou à bille (encre sèche). 4. Remplir, sur la fiche de réponse, tout le carré au complet, sans sortir de lignes. 5. Chaque question qui comporte PLUS D'UNE réponse, est annulée. 6. Essayer d'éviter, autant que possible, d'effacer. 7. Dans des cas particulier, il faut TRES BIEN effacer la réponse que vous voulez changer. 8. Pour éviter les erreurs, vous pouvez utiliser la feuille de questions comme brouillon, bien que vous devez la rendre, à la fin de l'épreuve. 9. Interdiction formelle d'écrire quoique ce soit sur la feuille de réponse en dehors des carrés. 10. Bien conserver la feuille de réponse; elle ne doit pas être froissée. 11. La durée de l'examen est de TROIS HEURES. 12. La composition comprend 180 QUESTIONS. ### Remarque : Chaque carré rempli d'encre ou de toute couleur autre que la mine, ne sera pas compté car la machine qui lit les réponses ne peut capter que le signal envoyé par le carré rempli de MINE. Merci & Bonne Chance ## وزارة التربية والتعليم العالي إمتحانات الكولوكيوم ### تنبيه هام يرجى إلى الموظفين المساعدين للجان الفاحصة في الدورة الثانية - كولوكيوم ٢٠١٥ التقييد بما يلي: 1. الحضور في الموعد المعين إلى مركز الإمتحان والتوقيع على سجل الدوام عند الوصول والخروج. 2. يحظر جلب أو إستعمال الأجهزة الخليوية في المبنى. 3. عدم مغادرة المبنى بتاتا وإعلام المسؤول في حال الضرورة القصوى. 4. التقيد التام بالأنظمة والقوانين المرعية الإجراء والخاصة بسرية الإمتحانات. 5. يمنع منعاً باتاً التدخين للجميع في قاعات الإمتحانات. 6. يمنع على المراقبين الخروج من قاعات الإمتحان أو التكلم بصوت مرتفع مع بعضهم البعض. 7. يسمح فقط للمسؤولين عن الإمتحانات في اللجان الفاحصة بالتجول في الطوابق والغرف نقدر جهودكم وتعاونكم المخلص ومع الشكر سلفا". المسؤول عن تنظيم الكولوكيوم عبد المولى شهاب الدين ## وزارة التربية والتعليم العالي إمتحانات كولوكيوم طب عام - الدورة الأولى ٢٠١٥ ### تعليمات هامة على المرشح قراءة هذه الصفحة قبل البدء بالإجابة على الأسئلة والتقيد بالإرشادات التالية: 1. كتابة إسمه و شهرته و رقم الإمتحان بالحبر وبطريقة واضحة في المكان المخصص لذلك المربع الملون). 2. إستعمال قلم الرصاص فقط للإجابة على قسيمة الأجوبة. 3. عدم إستعمال أي قلم حبر. 4. ملء المربع الصغير بكامله بالرصاص عند الإجابة. 5. تجنب المحو قدر المستطاع. 6. كل سؤال يتضمن أكثر من إجابة واحدة يعتبر لاغيا". 7. في الحالات الإستثنائية إمح جيدا الجواب الذي تريد أن تغيره. 8. لتجنب الوقوع في الخطأ يمكنك إستعمال ورقة الأسئلة كمسودة على أن ترد عند إنتهاء الإمتحان. 9. عدم الكتابة على ورقة الأجوبة إلا في داخل المربعات. 10. المحافظة جيدا" على ورقة الأجوبة والإنتباه ألا تتمزق. 11. مدة الإمتحان ثلاث ساعات. 12. المسابقة تتضمن ١٨٠ سؤالا". ### ملاحظة هامة : كل مربع مملوء بالحبر أو بأي لون غير الرصاص لن يحسب لأن آلة التصحيح لا تقرأ سوى المربع المملؤ بالرصاص. شكراً وبالتوفيق ## Ministry of Education and Higher Learning Medicine Colloquium Exam - First Session 2015 ### IMPORTANT INSTRUCTIONS Each candidate should read this page before answering the questions. The candidate should follow the directions below: 1. Write clearly your FIRST and FAMILY NAME and APPLICANT NUMBER with ink (pen) in the designated space (colored square). 2. Please use the pencil ONLY. 3. Do not use any pen (like bic) or ink. 4. Completely Fill the answer squares using pencil only. 5. Only ONE answer is allowed to each question. 6. Avoid erasing as much as you can. 7. When needed, do erase the cancelled answer COMPLETELY. 8. You may use the question bookle as scratch, and make sure to return it with the answer sheet at the end of the exam. 9. On the answer sheet, you should fill up the square corresponding to the right answer, in pencil only. No writing allowed at all. 10. Keep your answer sheet clean and tidy, do not fold or tear it. 11. The duration of the exam is THREE HOURS. 12. The composition consists of 180 QUESTIONS. ### Important Note: Any square filled up with a pen or ink cannot be read by the machine. It reads answers filled up in PENCIL only. Thank You & Good Luck S.A. ## Ministère de l'Education et de l'Enseignement Supérieur Examen Colloquium Medecine - Première Session 2015 ### INSTRUCTIONS IMPORTANTES Le Candidat doit lire ces instructions avant de commencer à répondre aux questions et devra observer les directives suivantes : 1. Ecrire son PRENOM et NOM et son NUMERO D'EXAMEN à l'encre et de façon lisible à l'endroit indiqué (coin en couleur) 2. Utiliser UNIQUEMENT un crayon mine. 3. Ne pas utiliser de stylo à encre ou à bille (encre sèche). 4. Remplir, sur la fiche de réponse, tout le carré au complet, sans sortir de lignes. 5. Chaque question qui comporte PLUS D'UNE réponse, est annulée. 6. Essayer d'éviter, autant que possible, d'effacer. 7. Dans des cas particulier, il faut TRES BIEN effacer la réponse que vous voulez changer. 8. Pour éviter les erreurs, vous pouvez utiliser la feuille de questions comme brouillon, bien que vous devez la rendre, à la fin de l'épreuve. 9. Interdiction formelle d'écrire quoique ce soit sur la feuille de réponse en dehors des carrés. 10. Bien conserver la feuille de réponse; elle ne doit pas être froissée. 11. La durée de l'examen est de TROIS HEURES. 12. La composition comprend 180 QUESTIONS. ### Remarque : Chaque carré rempli d'encre ou de toute couleur autre que la mine, ne sera pas compté car la machine qui lit les réponses ne peut capter que le signal envoyé par le carré rempli de MINE. Merci & Bonne Chance ## وزارة التربية والتعليم العالي إمتحانات الكولوكيوم ### تنبيه هام يرجى إلى الموظفين المساعدين للجان الفاحصة في الدورة الثانية - كولوكيوم ٢٠١٥ التقييد بما يلي: 1. الحضور في الموعد المعين إلى مركز الإمتحان والتوقيع على سجل الدوام عند الوصول والخروج. 2. يحظر جلب أو إستعمال الأجهزة الخليوية في المبنى. 3. عدم مغادرة المبنى بتاتا وإعلام المسؤول في حال الضرورة القصوى. 4. التقيد التام بالأنظمة والقوانين المرعية الإجراء والخاصة بسرية الإمتحانات. 5. يمنع منعاً باتاً التدخين للجميع في قاعات الإمتحانات. 6. يمنع على المراقبين الخروج من قاعات الإمتحان أو التكلم بصوت مرتفع مع بعضهم البعض. 7. يسمح فقط للمسؤولين عن الإمتحانات في اللجان الفاحصة بالتجول في الطوابق والغرف نقدر جهودكم وتعاونكم المخلص ومع الشكر سلفا". المسؤول عن تنظيم الكولوكيوم عبد المولى شهاب الدين ## وزارة التربية والتعليم العالي إمتحانات كولوكيوم طب عام - الدورة الأولى ٢٠١٥ ### تعليمات هامة على المرشح قراءة هذه الصفحة قبل البدء بالإجابة على الأسئلة والتقيد بالإرشادات التالية: 1. كتابة إسمه و شهرته و رقم الإمتحان بالحبر وبطريقة واضحة في المكان المخصص لذلك المربع الملون). 2. إستعمال قلم الرصاص فقط للإجابة على قسيمة الأجوبة. 3. عدم إستعمال أي قلم حبر. 4. ملء المربع الصغير بكامله بالرصاص عند الإجابة. 5. تجنب المحو قدر المستطاع. 6. كل سؤال يتضمن أكثر من إجابة واحدة يعتبر لاغيا". 7. في الحالات الإستثنائية إمح جيدا الجواب الذي تريد أن تغيره. 8. لتجنب الوقوع في الخطأ يمكنك إستعمال ورقة الأسئلة كمسودة على أن ترد عند إنتهاء الإمتحان. 9. عدم الكتابة على ورقة الأجوبة إلا في داخل المربعات. 10. المحافظة جيدا" على ورقة الأجوبة والإنتباه ألا تتمزق. 11. مدة الإمتحان ثلاث ساعات. 12. المسابقة تتضمن ١٨٠ سؤالا". ### ملاحظة هامة : كل مربع مملوء بالحبر أو بأي لون غير الرصاص لن يحسب لأن آلة التصحيح لا تقرأ سوى المربع المملؤ بالرصاص. شكراً وبالتوفيق ## Multiple Choice Questions **1.** A 85-year-old woman presents with a 6 hours history of severe sudden onset central abdominal pain. Her heart rate is 110 beats per minute and irregularly irregular. Her blood pressure is 132/94mmHg and temperature is 38.1°C. Abdominal examination reveals a generally soft but distended and tender abdomen with no audible bowel sounds. Per rectal examination reveals guaiac-positive stool. What is the most likely diagnosis? a. Abdominal aortic aneurysm b. Acute pancreatitis c. Mesenteric Ischemia d. Myocardial infarction e. Peptic ulcer disease **2.** A 21-year-old previously healthy male arts student presents with a 2-day history of lower abdominal pain and loss of appetite. He is pyrexial and has a tender palpable mass in his right iliac fossa. Haematology reveals a pyogenic leukocytosis and a CT demonstrates a 13x15cm walled-off abscess adjacent to a large complex inflammatory mass involving and inflamed appendix? what is the most appropriate management plan? a. Conservative management (analgesia, intravenous fluid and antibiotics) b. Conservative management, followed by interval appendicetomy at 6-8 weeks c. Lasparoscopy and washout d. Laparoscopic appendicectomy e. Percutaneous drainage of the abscess and intravenous antibiotics **3.** A 43-year-old previously well woman presents with pain, swelling and erythema in the anorectal area. What is the most appropriate management? a. CT of abdomen and pelvis b. Erxamination under anaesthesia and drainage of pus c. Flexible sigmoidoscopy d. Intravenous antibiotics e. MRI of perineum **4.** An 84-year-old man presents repeatedly with abdominal distension due to a sigmoid volvulus. Which one of the following statements does not apply to the management of sigmoid volvulus? a. Following detorsion, volvulus recurs in 50-90% of cases b. Following sigmoid resection, volvulus recurs in 0% of cases c. Sigmoidoscopic decompression successfully reduces volvulus in 70-80% of cases d. Spontaneous detorsion of volvulus is common e. Therapeutic barium enema can successfully reduce a volvulus **5.** A 27-year-old woman sustains multiple rib fractures in a road traffic accident. When is an urgent thoracotomy not indicated? a. Cardiac tamponade b. Chest drainage of 300mL blood in the first hour and 250mL/h in the next few hours c. Flail chest with evidence of haemothorax d. Immediate chest drainage of > 1500mL of blood e. Widening of the mediastinum to > 8cm **6.** ABO compatibility is advisable for the transfusion of blood products. Which of the following products does not require ABO compatibility? a. Cryoprecipitate b. Fresh frozen plasma c. Haemoglobin solution d. Packed red cells e. Platelets **7.** A 72-year-old man presents with fresh rectal bleeding. He undergoes CT angiography, which fails to localize the bleeding source and continues to bleed. What is the most appropriate investigation? a. Barium enema b. CT of chest, abdomen and pelvis c. Colonoscopy d. Flexible sigmoidoscopy e. Upper gastrointestinal endoscopy and proctoscopy **8.** A 39-year-old woman presents to the breast outpatient clinic complaining of persistent nipple discharge. Examination reveals no mass lesion in either breast but bloodstained discharge from a single duct. What is the most appropriate initial investigation? a. CT of chest, abdomen and pelvis b. Ductography c. Mammogram d. Nothing else required e. Ultrasound of the breasts **9.** A 67-year-old woman presents with a creamy discharge from left nipple which has a slit like appearance. There is no associated underlying mass. What is the most likely diagnosis? a. Duct ectasia b. Ductal papilloma c. Periductal mastitis d. Phyllodes tumor e. Physiological **10.** A 75-year-old man, 2 years postradiation therapy for prostate cancer, presents to the outpatient clinic with anemia and tenesmus. Flexible sigmoidoscopy reveals mucosal pallor and vascular telanglectasia. What is the most likely diagnosis? a. Campylobacter enteritis b. Chlamydia trachomatis infection c. Ischemic colitis d. Radiation proctitis e. Ulcerative colitis **11.** Appropriate therapy for metastatic prostate cancer: a. Hormone therapy b. Chemotherapy c. Radical radiation therapy with boost doses to the prostate gland d. Radical prostatectomy or radiation therapy e. Observation **12.** Which of the following procedures is the first test the physician should order to establish the diagnosis of deep venous thrombosis? a. Computed tomography (CT) scan b. Doppler c. Lung ventilation and perfusion scans d. Contrast Venography e. Cardiac catheterization **13.** An 80 year-old woman with a history of congestive heart failure develops angina pectoris. Her medications are adjusted to include furosemide, digoxin, nitroglycerine, and potassium supplements. Shortly thereafter, she develops intermittent frontal throbbing headaches. Which of the following should the physician do first: a. Perform a temporal artery biopsy b. Begin propranolol c. Obtain a brain computed tomography scan d. Discontinue nitroglycerin e. Begin sublingual ergotamine **14.** If present, which of the following features distinguishes upper tract(kidney) from lower tract(bladder) infection in women: a. Pubic tenderness b. Fever 38.50C c. Burning on urination d. Colony count > 10 5/mL e. White blood cells in urinalysis **15.** A 65 year old man reads in the Newspapaer that prostatic specific antigen (PSA) is a good screening for cancer and asks his internist to have this drawn. The test reveals midly elevated PSA 10.4 ng/mL. digital rectal examination indicates a normal sized prostate, but ultrasound reveals a small hypoechoic area measuring 5x7mm in the right lobe. Which of the following measures is the next appropriate step: a. Perform a bone scan b. Repeat assays for PSA in three months to check for further elevation c. Begin leuprolide depot therapy d. Perform a computed tomography scan of the retroperitoneum, pelvis and prostate e. Perform a transrectal biopsy of the abnormal area revealed by ultrasound **16.** A 46 year old woman has been diagnosed with metastatic renal cell carcinoma, metastatic to the lungs and several ribs. She is experiencing flank pain and occasional hematuria. The initial treatment at this point is: a. Resection of primary tumor b. Supportive care c. Chemotherapy d. Resection of all metastatic lesions e. Radiation **17.** Eosinophilia is most likely to be found in which of the following settings: a. Pnumococcal pneumonia b. Schistosomiasis c. Influenza d. Corticosteroid therapy e. Diarrhea caused by Giardia Lamblia **18.** A 35 year-old woman with a history of Crohn's disease develops a painful nodule on her lower leg that soon ulcerates. Examination shows an extremely tender, deep, 8x10cm ulceration with a purulent base and erythematous undermined borders. The most likely diagnosis is: a. Calciphylaxis b. Vasculitis c. Stasis dermatitis d. Erythema nodosum e. Pyoderma gangrenosum **19.** A 45 year-old woman complains of nervousness, palpitation, and a 7Kg weight loss. Her thyroid gland is enlarged twofold, and her heart rate is 108 beats/minute. Free T4 is 3.6 ng/dL(high), and TSH is undetectable. You recommand radioidine therapy, and the patient asks you about possible complications. What is the most common complication of radioiodine therapy? a. Subacute thyroiditis b. Leukemia c. Thyroid cancer d. Thyroid storm e. Hypothyroidism **20.** In the treatment of acute cholecystitis, most patients are Best served with a. Early cholecystectomy b. IV antibiotics and late cholecystectomy c. Percutaneous drainage of the gallbladder d. Endoscopic sphincterotomy e. Cholecystostomy **21.** A 61-year-old man comes in because of colicky abdominal pain and vomiting of 3 days duration. On physical examination, he is moderately distended and has high pitched hyperactive bowel sounds and a 5-cm tender groin mass. On direct questioning, he explains that he has had that bulge for many years, but has always been able to "push it back in" when he lies down. For the past 3 days, however, he has been unable to do so. He has a temperature of 38.9 C (102 F) and a white blood cell count of 12,500/mm3. Which of the following is the most appropriate management at this time? a. A sonogram of the mass b. A trial of nasogastric suction and IV fluids for a few days c. Insertion of a long rectal tube via sigmoidoscopy d. Manual reduction of the hernia, followed by a period of observation e. Urgent surgical intervention **22.** A 22-year-old woman is brought to the emergency department after an automobile accident and is unconscious, nor breathing, and bleeding profusely with unstable vital signs. What is the first appropriate step in the management of this patient? a. Obtain a full medical history from family members b. Perform a thorough physical examination c. Establish an airway and institute mechanical ventilation d. Blood type and crossmatch, then transfuse 2 units of packed red blood cells e. Establish intravenous access, and administer a fluid challenge with Ringer's lactate **23.** A newborn with a HR 80/min, no respiratory effort, no response to nasal catheter, central cyanosis, has an APGAR of: a. 1 b. 2 c. 3 d. 4 e. 5 **24.** A 2 yr. old patient presented to the out patient department for 1 day history of acute ear pain and discharge from right ear. You examined him and diagnosed an acute otitis media (OM) with a perforated ear drum on right. The most probable cause would be: a. Virus b. Mycoplasmapneumonia c. Streptococcus pneumoniae d. Staphylococcus aureus **25.** Which of the followings is onset of symptoms in newborn with hypoglycemia? a. Episodes of cyanosis b. Convulsions c. Apathy d. All of the above e. None of the above **26.** In small infants, symptoms due to esophagitis may include: a. Feeding problems b. Anemia c. Hematemesis d. Irritability e. All of the above **27.** SSPE (subacutesclerosingpanencephalitis) is associated with: a. Mumps b. Chickenpox c. Herpes d. Measles e. All of the above **28.** In acute post-infectious glomerulonephritis, all of these elements are present except one: a. Previous infection (1 to 3 weeks) b. Hematuria c. Oliguria d. Low C4 complement e. Good prognosis **29.** In hemolytic uremic syndrome, cardiac failure is due to all these factors except one: a. Myocardial lesions b. Hypervolemia c. Low platelet count d. Acute renal failure e. Anemia **30.** In the evaluation of the child who has short stature, the most important diagnostic information is determined from the: a. Bone age b. Extended family growth history c. Growth curve d. Growth hormone levels e. Serum T4 and thyroid stimulating hormone **31.** In which disease there is risk of obstruction and death by triggering a laryngeal spasm: a. Acute epiglottitis b. Acute pharyngitis c. The abscess of the tonsil d. The retro pharyngeal abscess **32.** A 6-year-old complains of headaches on arising in the morning before school for 2 months. In addition, for the past 2 days the patient has demonstrated head tilt. Physical examination reveals difficulty in performing rapid alternating hand movements. The fundi are difficult to visualize. The next part of the evaluation should be: a. An EEG b. A visit to the school psychologist c. A brain CT scan d. Lumbar puncture e. A vision test **33.** Overpassing term pregnancy is defined as a. term+one month b. term+10 days c. term+15 days d. term+21 days **34.** A forty year old woman gives history of fever for last three weeks accompanied by dry cough, night sweats and weight loss. Chest examination is normal. Abdominal examination reveals hepatosplenomegaly. Chest X-ray shows symmetrically distributed fine nodules. The most likely diagnosis is: a. Miliary tuberculosis. b. Chronic liver disease. c. Malaria. d. Pneumonia. e. Typhoid. **35.** A fifteen year old girl presents with history of fever, bleeding from gums and pallor for last fifteen days. Her peripheral blood film shows pancytopenia. The most important investigation is: a. Bone marrow examination. b. Coomb's test. c. Reticulocyte count. d. Serum folic acid level. e. Serum iron level. **36.** In a patient with thalessemia peripheral blood film for red cell morphology shows: a. Hypochromic microcytic cells. b. Normochromic normocytic cells. c. Macrocytosis. d. Sickle cells. e. Spherocytes. **37.** In a patient with history of shortness of breath, which of the following sign indicates left heart failure: a. Ascites. b. Basal crepitations. c. Dependant edema. d. Engorged neck veins. e. Fourth heart sound. **38.** A patient presents with history of intermittent fever, abdominal pain and headache. Abdominal examination shows tenderness and hepatosplenomegaly. His blood culture is positive for salmonella typhi. The antibiotic of choice for this patient is: a. Ciprofloxacin. b. Gentamycin. c. Metronidazole. d. Tetracycline. e. Vancomycin. **39.** The most common side effect of quinine is: a. Coma. b. Deafness. c. Headache. d. Respiratory depression. e. Tremors. **40.** Renal calcification is an unlikely complication in: a. medullary cystic kidney disease b. renal tuberculosis c. sarcoidosis d. secondary hyperparathyroidism **41.** Which of the following statements about post-traumatic epilepsy is correct? a. it usually follows head trauma within a month b. the CT reveals the causative abnormalities c. it requires surgical therapy in most cases d. it responds poorly to standard anticonvulsive therapy e. the EEG reveals its characteristic changes **42.** In the nephrotic syndrome: a. the prognosis is better in males than in female patients b. a generalized edema is present c. an intermittent microscopic hematuria suggests advanced parenchymal damage d. the administration of steroids is always ineffective **43.** Anticardiolipin antibodies are associated with increased incidence of: a. Peripheral neuropathy b. Migraine c. Epilepsy d. Myopathy e. Chronic meningitis **44.** Which of the following is the most sensitive test for diagnosing diabetic nephropathy? a. Creatinine clearance measurement b. Glucose tolerance measurement c. Serum creatinine measurement d. Ultrasonography of the kidneys e. Urine albumin measurement **45.** A 30-year-old woman presents with small wounds on the sides of her mouth for the past 2 weeks. She recently adopted a strict vegetarian diet. On examination, she has pale conjunctivae, a magenta tongue, and macerated lips in addition to the angular stomatitis. What is the most likely diagnosis? a. Thiamine deficiency b. Riboflavin deficiency c. Vitamin K deficiency d. Vitamin D deficiency e. Iron deficiency **46.** The herpes zoster vaccine is made from which of the following components? a. Inactivated virus b. Live attenuated virus c. Polysaccharides d. Toxoid **47.** In addition to motor and verbal responsiveness, which of the following needs to be assessed in order to determine the patient's Glascow Coma Score? a. Appearance (skin color) b. Eye response c. Reflex response d. Pulse **48.** Which of the following can precipitate a gout attack? a. Administration of fluids during surgery b. Immobilization of a joint c. Initiation of hormone replacement therapy d. Prolonged exposure to warm temperatures **49.** A 53-year-old man has had malaise for the past 3 months. He is afebrile. His heart sounds are distant and he has a friction rub. An echocardiogram shows a pericardial fluid collection. A pericardiocentesis yields 10 mL of bloody fluid. Which of the following conditions is most likely to give rise to these findings? a. Autoimmune disease b. Chronic renal failure c. Rheumatic fever d. Metastatic carcinoma e. Acute myocardial infarction **50.** Which of the following diagnostic studies should be obtained initially for a patient who presents to the ED with an acute asthma exacerbation? a. Arterial blood gas b. Chest radiography c. Complete blood count d. No initial laboratory studies are required **51.** An infant has the following findings at 5 minutes of life: pulse 130 bpm, cyanotic hands and feet, good muscle tone, and a strong cry and grimace. This infant APGAR score is: a. 6 b. 7 c. 8 d. 9 e. 10 **52.** A 10-yr-old girl has had diplopia and ptosis and weakness of her neck flexors for 2 months. Symptoms are worse in the evening and are usually less severe on awakening in the morning. She has no fasciculations or myalgias. The most likely diagnosis is: a. Hysterical weakness b. Muscular dystrophy c. Poliomyelitis d. Botulism e. Myasthenia gravis **53.** An 18-year-old man shot once in the left chest has a blood pressure of 80/50 mm Hg, a heart rate of 130 beats per minute and distended neck veins. Immediate treatment might include: a. Administration of antibiotics b. Subxiphoid pericardiotomy. c. Needle decompression of the left chest in the second intercostal space. d. Emergency thoracotomy to cross-clamp the aorta. **54.** What is the first diagnosis to discuss for a bowel obstruction in a baby of 6 months? a. Intestinal Atresia b. Aganglionose colonic c. Intestinal malrotation d. Meconium ileus e. Acute intestinal invagination **55.** A 16year-old boy patient presented for a painless midline neck mass that he noticed few months ago. On physical examination, the mass is painless, 2cm in diameter inferior to the hyoid bone and ascend with tongue protrusion. What is the next step? a. Surgical excision b. Order an FNA c. Observation d. Order a neck Ultrasound e. 10 days course of oral antibiotics **56.** A 35 year-old woman with a history of Crohn's disease develops a painful nodule on her lower leg that soon ulcerates. Examination shows an extremely tender, deep, 8x10cm ulceration with a purulent base and erythematous undermined borders. The most likely diagnosis is: a. Calciphylaxis b. Vasculitis c. Stasis dermatitis d. Erythema nodosum e. Pyoderma gangrenosum **57.** In the treatment of acute cholecystitis, most patients are Best served with a. Early cholecystectomy b. IV antibiotics and late cholecystectomy c. Percutaneous drainage of the gallbladder d. Endoscopic sphincterotomy e. Cholecystostomy **58.** Which of the following infertility factors is the most frequent? a. Ovulatory factor b. Pelvic factor c. Male factor d. Cervical factor e. Unexplained factor **59.** Which fetal malformation can be prevented by folic acid intake? a. Cardiac abnormalities b. Abnormalities of the neural tube c. Trisomy 21 d. Turner's syndrome e. Intrauterine growth retardation **60.** All of the followings are true concerning the amniotic fluid except: a. It is mainly derived from the fetal urine b. It protects against the compression of the umbilical cord c. It contains pulmonary surfactant d. It is mainly derived from the gastrointestinal secretions e. It provides a space for fetal movements **61.** What is the most frequent complication of an abnormal involution of the placenta a. Development of fibromes b. Delayed hemorrhage c. Infection d. Infertility e. Adenomyosis **62.** What is the most frequent cause post partum hemorrhage? a. Uterine atony b. Retention of placentary debris c. Perineal lacerations d. Uterine rupture