COMMUNITY AND PUBLIC HEALTH . . . .2
MEDICINE . . . .6
OBSTETRICS AND GYNECOLOGY . . . .11
PEDIATRICS . . . .14
PSYCHIATRY . . . .20
SURGERY . . . .24
ANSWERS TO SAMPLE QUESTIONS . . . .29
KEY FEATURE QUESTIONS . . . .31
KEY FEATURE SCORING GUIDE . . . .36
A
Toronto Notes 2005 Sample Questions 1Sample Questions
A Collective Arrangement by the Chapter Editors, Associate Editors,
and CD-ROM Editor of 2005
2 Sample Questions Community and Public Health Toronto Notes 2005
Community and Public Health
1) Which one of the following is not a typical feature of asbestosis? a) increased risk of cancer
b) pleural thickening and calcification c) interstitial fibrosis
d) obstructive pattern on pulmonary function tests e) none of the above
2) The following statements regarding contact dermatitis are true EXCEPT:
a) phototoxic dermatitis following topical application of creosote requires UV light
b) photoallergic contact dermatitis requires UV light to be manifested
c) contact eczema involves a type IV delayed hypersensitivity reaction
d) contact urticaria or hives is a common form of dermatitis e) chemical burns by HCl and KOH may result in an irritant
contact dermatitis
3) The following statements regarding noise are true EXCEPT: a) temporary threshold shift recovers following cessation of
noise exposure
b) permanent threshold shift is characterized by a progressive pattern of hearing loss
c) most cases of permanent threshold shift are surgically treatable d) higher frequency noise is more damaging than low frequency
noise
e) none of the above
4) The frequencies most necessary for the understanding of speech extend from about:
a) 20-20 000 Hz b) 400-4 000 Hz c) 250-8 000 Hz d) 100-5 000 Hz e) none of the above
5) Lead exposure typically results in: a) chronic dermatitis
b) resting and intention tremor c) extensor muscle weakness d) arrhythmias
e) cerebellar ataxia
6) Which of the following statements concerning the Worker’s Compensation Act is true?
a) the worker reserves the right to sue the employer for negligence b) funding is provided by the provincial government
c) the worker is guaranteed payment from the first day of injury/illness if it is deemed to be work-related
d) the Worker’s Compensation Board is an independent, private agency
e) none of the above
7) Which of following statements regarding radiation is false? a) natural background radiation accounts for about half of a
typical person’s exposure
b) ionizing radiation causes intestinal villi to become denuded c) exposure to non-ionizing radiation may result in cataracts d) ionizing radiation results in an increased incidence of
neoplasia such as lung and thyroid e) none of the above
8) Which statement concerning vibration induced white finger disease is false?
a) early symptoms include tingling and numbness of the fingers when at rest
b) swelling of the fingers over knuckles may be an early feature
c) cold, damp conditions may precipitate symptoms d) the affected area eventually spreads to involve all fingers e) none of the above
9) In a cohort study of disease “X” in people with risk factor “Y” versus those who are without risk factor “Y”, the following results were obtained:
X no X total
Y 80 20 100
no Y 50 50 100
The relative risk of developing “X” in “Y” versus no “Y” is: a) 80 x 50 = 4 c) 50 x 80 = 4
50 x 20 20 x 50
b) 50 _ 20 = 0.3 d) 80/100 = 1.6
100 100 50/100
e) it is not possible to calculate risk in a cohort study 10) The attributable risk of factor “Y” to disease “X” would be:
a) 80/100 = 1.6 c) 80 x 50 = 4
50/100 50 x 20
b) 80 _ 50 = 0.3 d) 50 x 20 = 0.25
100 100 80 x 50
e) it is not possible to calculate atrributable risk in a cohort study
11) A group of 50 people are exposed to virus “A”. Of those 50 people, 9 develop a mild infection, 10 become seriously ill, and 3 die. The attack rate of virus “A” in the population would be: a) 22/50
b) 9/50 c) 10/50 d) 19/50 e) 13/50
12) The following indicate the results of screening test “Q” in screening for disease “Z”:
Disease Z
+ –
+ 40 10 50
Screen Q – 30 120 150 70 130 200 The specificity of test “Q” would be:
a) 40/70 b) 120/130 c) 40/50 d) 120/150 e) 40/130
13) The positive predictive value would be: a) 40/70
b) 120/130 c) 40/50 d) 120/150 e) 70/200
14) To determine an odds ratio one would have to perform which of the following studies?
a) a cross sectional/prevalence study b) a randomized controlled trial c) a cohort study
d) a case study e) a case control study
Toronto Notes 2005 Community and Public Health Sample Questions 3
15) Examples of secondary prevention would include all of the following EXCEPT:
a) Pap smear for cervical cancer
b) chemoprophylaxis in a recent TB converter c) proctoscopy for rectal cancer
d) immunization for Haemophilus influenzae B e) mammography for breast cancer
16) Alpha error is:
a) the probability of declaring a difference to be absent when it in fact is present
b) the probability of declaring a difference to be present when it is not
c) the probability of declaring a difference to be absent when it is indeed absent
d) the probability of declaring a difference to be present when it does exist
17) Which one of the following descriptors of a diagnostic test is influenced by the prevalence of the disease being tested for: a) specificity
b) sensitivity c) accuracy
d) positive predictive value e) reliability
18) Which of the following statements regarding the measurement of health and disease in a population is true?
a) a rate is the number of times an event has occured during a certain time interval divided by the number of persons at risk during the same interval
b) when calculating a ratio, the numerator is a portion of the denominator
c) a ratio is the number of times an event has occurred during a certain time interval multiplied by the number of times an event has occurred during the same interval d) when calculating a rate, the numerator is not a portion of
the denominator e) none of the above
19) In 1990, which country spent the least on health care as a percentage of GDP (gross domestic product):
a) Canada b) France c) Sweden d) UK e) USA
20) The component of Canada's health care system that receives the highest percentage of the health care budget is: a) hospitals
b) physician fees c) drug benefit plans d) laboratory services e) administration
21) The British North America Act (BNA):
a) was mainly concerned with health care legislation b) granted exclusive powers over health care to the
provinces, including powers over marine hospitals c) replaced the Canada Health Act
d) applied to British Columbia only e) none of the above
22) Regarding health expenditure and health outcomes: a) the U.S. has the greatest health expenditure and the
lowest infant mortality rates
b) there is a positive association between national expenditure on health and GDP
c) increased national health expenditure always increases health status of a country
d) all of the above e) none of the above
23) Which of the following is the most important justification for population screening programs for a specific disease? a) early detection of the disease of interest is achieved b) the specificity of the screening test is high
c) the natural history of the disease is favourably altered by early detection
d) effective treatment is available e) the screening technology is available
24) Regarding the regulation of health professionals, provincial colleges of physicians and surgeons:
a) have the advancement of the public interest as their primary goal
b) protect the public from incompetent or unfit MDs c) act as licensing bodies for MDs
d) do not advance the professional and political interests of MDs e) all of the above
25) Active immunization was important in control of each of the following childhood communicable diseases EXCEPT: a) diphtheria
b) polio c) measles d) scarlet fever e) pertussis
26) All of the following statements are true EXCEPT:
a) one indirect measure of a population’s health status is the percentage of low birth weight neonates
b) accidents are the largest cause of potential years of life lost in Canada
c) the Canadian population is steadily undergoing rectangularization of mortality
d) morbidity is defined as all health outcomes excluding death e) the neonatal mortality rate is the number of infant deaths
divided by the number of live births multiplied by 1000 27) All of the following statements are true EXCEPT:
a) the data collected on a death certificate is uniform and in conformity with WHO guidelines
b) Section 7 of the Coroner’s Act states that the coroner’s office must be notified if a patient dies after some mishap such as leaving an instrument in the body at surgery c) diseases which must be reported to the local medical
officer of health include AIDS, food poisoning, influenza and gonorrhea
d) a tuberculin reaction greater than 5 mm is considered positive in all individuals
e) all of the above
28) In describing the leading causes of death in Canada, two very different lists emerge, depending on whether proportional mortality rates or person-years of life lost (PYLL) are used. This is because:
a) one measure uses a calendar year and the other a fiscal year to calculate annual experience
b) one measure includes morbidity as well as mortality experience
c) both rates exclude deaths occurring over the age of 70 d) different definitions of “cause of death” are used e) one measure gives greater weight to deaths occurring in
younger age groups
29) Differentiation between a point-source epidemic and a progressive (propagated) epidemic is made by: a) considering the characteristics of the infectious agent b) determining the level of immunity in the community c) determining the number of persons infected and
calculating the attack rate
d) plotting the distribution of cases by time onset e) none of the above
38) In 1981, the crude birth rate in Ontario was approximately 14 per 1000 and the crude death rate was 7 per 1000. The estimated rate of net migration was –1 per 1000. The growth rate of the province, per 1000 population was:
a) 6 b) 7 c) 8 d) 20 e) 22
39) All of the following statements about environmental health are true EXCEPT:
a) levels of toxic agents measured in the environment may not reflect internal organ levels
b) the federal government monitors the quality and types of industrial emissions and toxic waste disposal
c) sick building syndrome is associated with Pontiac fever and Legionnaire’s disease
d) all humans have detectable levels of PCBs e) none of the above is true
40) The effectiveness of a preventative measure is assessed in terms of: a) the effect in people to whom the measure is offered
b) the effect in people who comply with the measure c) availability with the optimal use of resources
d) the cost in dollars versus the benefits in improved health status e) all of the above
41) All of the following statements about the Canada Health Act (1984) are true EXCEPT:
a) it did not define all medically necessary hospital and physician services
b) the CHA replaced the Hospital Insurance and Diagnostic
Services Act of 1957
c) the CHA banned all forms of extra billing
d) according to the CHA, provinces must meet all the terms and conditions of Medicare to qualify for federal transfer payments
e) none of the above
42) Each of the following is an example of primary prevention EXCEPT: a) genetic counselling of parents with one retarded child b) nutritional supplements in pregnancy
c) immunization against tetanus
d) chemoprophylaxis in a recent tuberculin converter e) speed limits on highways
43) The classical “epidemiological triad” of disease causation consists of factors which fall into which of the following categories:
a) host, reservoir, environment b) host, vector, environment c) host, agent, environment d) reservoir, agent, vector e) host, age, environment
44) Of the five items listed below, the one which provides the strongest evidence for causality in an observed association between exposure and disease is:
a) a large attributable risk b) a large relative risk c) a small p-value
d) a positive result from a cohort study e) a case report
45) The difference between a common point source outbreak and a propagated outbreak of illness is that:
a) all cases in a common point source outbreak occur within one incubation period of the exposure
b) the attack rates in propagated outbreaks are higher c) person-to-person transmission is a feature of common
source outbreaks
d) case fatality rates in common source outbreaks are generally higher
e) the source of infection in propagated outbreaks is more easily contained than in common source outbreaks 30) The occurrence of an illness at a rate of above that expected is
called: a) hyperendemic b) epidemic c) endemic d) enzootic e) pandemic
31) Each of the following statements applies to case control studies EXCEPT:
a) starts with disease b) suitable for rare diseases c) relatively inexpensive d) prolonged follow-up required
e) there may be a problem in selecting and matching controls 32) A clinician who has been examining the patterns of mortality in
your community says that the rates for heart disease and lung cancer are higher in this community than in an adjacent
community. Which of the following questions should you ask first? a) how did the clinician choose the comparison community? b) have the rates been standardized for age?
c) are tobacco sales significantly different in the two communities? d) are the facilities to treat these diseases comparable in the
two areas?
e) are the numbers of deaths comparable in each area? 33) The purpose of randomization is to:
a) make sure that there are equal numbers of men and women in test and control groups
b) increase the chances of getting a statistically significant difference c) ensure that the numbers of cases and controls are equal d) limit bias
e) all of the above
34) Which of the following types of studies usually provides only a measure of prevalence?
a) descriptive b) cross-sectional
c) randomized controlled trial d) cohort
e) none of the above
35) The major advantage of cohort studies over case-control studies is that:
a) they take less time and are less costly
b) they can utilize a more representative population
c) it is easier to obtain controls who are not exposed to the factor d) they permit estimation of risk of disease in those exposed
to the factor
e) they can be done on a “double-blind” basis 36) All of the following statements concerning occupational
health are true EXCEPT:
a) disorders of reproduction are among the top 10 work-related diseases and injuries
b) most workers are covered by both federal and provincial legislation with respect to workplace health and safety c) skin problems and hearing problems together are
responsible for half of WCB claims
d) a complete occupational medical history includes investigation of the temporal relationship between symptoms and exposure
37) Which of the following statements concerning exposure to solvents in the workplace is true?
a) each solvent compound has a specific antidote that can be used to treat exposure
b) a prominent symptom of solvent exposure is memory loss c) some solvents can cause skin dryness and loss of
subcutaneous adipose tissue d) solvents do not affect the bone marrow e) all of the above
Toronto Notes 2005 Community and Public Health Sample Questions 5
46) Which of the following are strategies for control of disease: a) population immunization
b) contact tracing to offer treatment to all who could be infected c) monitoring increases in the population of certain disease vectors d) having physicians report curable, potentially serious diseases e) all of the above are true
47) During a clinical trial, the difference in the success rates of two drugs was not statistically significant. This means that: a) there is no difference in drug effectiveness
b) there is a sizable probability that the demonstrated difference in the drugs’ effectiveness could occur due to chance alone c) the demonstrated difference in the drugs’ effectiveness is
too small to be clinically meaningful
d) the two samples of patients on which the drugs were tested came from the same population
e) none of the above are true
48) The incidence of a particular disease is greater in men than in women, but the prevalence shows no sex difference. The most probable explanation is that:
a) the mortality rate is greater in women b) the case fatality rate is higher in women c) the duration of the disease is longer in women d) women receive less adequate medical care for the disease e) this diagnosis is more often missed in women
49) All of the following statements about statistical tests are true EXCEPT:
a) linear regression is used to describe the relationship between two continuous variables
b) a confidence interval is a range of values giving information about the precision of a measurement
c) ANOVA tables are used to make comparisons among the means of 3 or more groups simultaneously
d) in a normal distribution, the mean, median and mode are equal e) the chi-square test evaluates the statistical significance of 2
or more percentages of categorical outcomes
50) All of the following are responsibilities of local public health units in Canada EXCEPT:
a) communicable disease control b) health education
c) investigation of sudden death d) immunization
e) health promotion
51) Who is ultimately responsible for the quality of care in a hospital? a) chief executive officer
b) board of trustees c) medical director d) chief of staff e) attending physicians
52) Which of the following is not one of the 5 Terms and Conditions of Medicare? a) portability b) flexibility c) universality d) comprehensive coverage e) accessibility
53) You are given this data pertaining to an outbreak of diarrhea in a daycare:
Age Number of Children Number of Diarrhea
1 20 17 2 19 15 3 39 13 4 39 4 5 38 5 6+ 18 1
What is the attack rate of this illness? a) 25% d) 40%
b) 30% e) 50% c) 32%
6 Sample Questions Medicine Toronto Notes 2005
9) Hemolytic anemia is characterized by all of the following EXCEPT: a) increased LDH
b) increased reticulocytosis c) increased unconjugated bilirubin d) increased haptoglobin e) lead poisoning
10) A patient complains of a non-tender mass over the thyroid region on the left side of her neck. Concerned about a thyroid disorder, you order the appropriate investigations. The results are as follows:
TSH: 6.0 Free T4: 20.2
Thyroid antibodies: none RAIU: No “hot” spots seen
The next investigation(s) you choose to do are: a) watch and wait for 3-6 months
b) FNA c) surgical biopsy
d) trial of L-thyroxine therapy for 6 months e) none of the above
11) An 8 year-old boy is brought to the office because his mother is concerned he is entering puberty already. You examine him and note the beginnings of facial hair, axillary hair and Tanner stage 2 external genitalia. Choose the set of investigations you initially want to do:
a) CBC, lytes, testosterone, bone age, CT head b) FSH, LH, testosterone, lytes, bone age, DHEA-S
c) FSH, LH, testosterone, cortisol, DHEA-S, 11-OH progesterone, bone age
d) lytes, testosterone, DHEA-S, 17-OH progesterone, cortisol, bone age
12) The subendothelium is the most vulnerable segment of the heart from an ischemic standpoint. The major reason for this is: a) the highest oxygen utilization is in the subendocardium b) coronary flow to the subendocardium occurs almost completely
during diastole whereas other regions receive some flow during systole as well
c) the subendocardium has a diminished aerobic capacity d) there is less potential for collateralization to the
subendocardium
e) the ratio of capillary to myocyte is less in the subendocardium than in other regions
13) 18 year-old female with initial onset of pruritic rash characterized by excoriations, scaling and crusting and distributed on the extremities, neck and eyelids. Past medical history is significant for asthma and hayfever. The most likely diagnosis is:
a) scabies b) atopic dermatitis c) contact dermatitis d) shingles
e) dyshydrotic eczema
14) 8 year-old black male comes in with an asymptomatic
erythematous eruption characterized by oval patches with collarette scaling. It is distributed as a "Christmas tree" pattern on the back. Father states that there was originally one lesion on the abdomen a few weeks prior. What is the most likely diagnosis:
a) pityriasis rosea b) tinea corporis c) lichen planus d) psoriasis e) none of the above
Medicine
1) Which of the following is a feature of secretory diarrhea? a) small stool volume (< 1L/day)
b) increased stool osmotic gap c) persistent diarrhea despite fasting d) blood and/or pus in stools e) malodorous, often floating stools
2) Each of the following are risk factors for colon cancer EXCEPT: a) low fiber diet
b) severe diverticular disease c) familial adenomatous polyposis d) ulcerative colitis
e) high fat diet
3) Intestinal complications more common to Crohn’s disease than ulcerative colitis include each of the following EXCEPT: a) fistula formation
b) perianal disease c) intestinal obstruction d) toxic megacolon e) post-surgical recurrence
4) A 21 year-old bisexual man has a 4 week history of intermittent diarrhea, urethral discharge, and pain in the right knee and left second toe. He has several oral ulcers, a clear urethral discharge, a scaly papular rash on palms and soles, onycholysis, sausage-like swelling of the left second toe, and heat and swelling of the right knee. The results of Gram stains and cultures of urethral discharge are negative. Rheumatoid factor is not present. The most likely diagnosis is:
a) Reiter’s syndrome b) gonococcal arthritis c) Behcet disease
d) acquired immune deficiency syndrome e) psoriatic arthritis
5) A 53 year-old presents to your office with pain and stiffness in both hands and knees of 6 months duration. Which of the following findings on your physical examination may help with a diagnosis:
a) joint tenderness/effusions b) maculopapular rash c) iridocyclitis d) hepatosplenomegaly e) all of the above
6) Radiographic features of osteoarthritis of the knee include which of the following:
a) marginal erosions
b) juxta-articular osteopenia (demineralization)
c) loss of articular cartilage with narrowing of the radiologic joint space
d) osteonecrosis (avascular necrosis) of the medial femoral condyle
e) high riding patella (patella alta)
7) An elevated level of hemoglobin A2 in a patient with mild microcytic anemia suggests the diagnosis of:
a) alpha-thalassemia b) sickle trait c) beta-thalassemia d) hereditary spherocytosis
e) hereditary persistence of fetal hemoglobin
8) It is unlikely to see macrocytosis in a patient with anemia in which of the following? a) reticulocytosis b) vitamin B12deficiency c) folate deficiency d) myelodysplastic syndrome e) sideroblastic anemia
Toronto Notes 2005 Medicine Sample Questions 7
15) 30 year-old female comes in with a soft smooth erythematous nodule on her lower lip. She states that a few weeks prior she had some chapped lips with occasional bleeding. Now, the lips have healed but this lesion arose suddenly in its place. It is occasionally tender on pressure. The most likely diagnosis is:
a) HSV1
b) cherry hemangioma c) pyogenic granuloma d) dermal nevus e) none of the above
16) A 65 year-old male with back pain, nephrotic syndrome and anemiapresent to the ER. Ultrasound shows normal kidney size. His creatinine is 500. Which diagnosis best fits the scenario? a) polycystic kidney disease
b) chronic GN c) multiple myeloma d) diabetic nephropathy e) analgesic abuse
17) Which of the following are indications for dialysis in ARF? a) severe alkalosis unresponsive to medical therapy. b) severe acidosis unresponsive to medical therapy. c) severe hypokalemia unresponsive to medical therapy. d) severe hypercalcemia unresponsive to medical therapy. e) b and d
18) Which of the following is true with respect to diabetes and kidney disease?
a) primarily affects the tubules. b) earliest sign is decreased GFR.
c) microalbuminuria is a late sign of DM nephropathy. d) threshold for dialysis is same as other CRF patients. e) BP control slows progression of DM nephropathy.
19) The various species of Campylobacter can cause diseases ranging from acute enteritis to bacteremia. Which of the following modes of transmission does NOT apply to Campylobacter?
a) contact with infected animals b) contaminated food and water c) improperly cooked poultry d) aerolized droplets
e) person to person spread via fecal-oral route
20) Which of the following is NOT a common infectious cause of acute diarrhea? a) Escherichia coli b) Shigella c) Norwalk virus d) Vibrio cholerae e) Helicobacter pylori
21) Impaired coronary flow reserve is associated with each of the following conditions EXCEPT:
a) severe aortic stenosis
b) severe systemic hypertension with left ventricular hypertrophy c) severe mitral stenosis in the presence of atrial fibrillation d) a totally occluded coronary artery but with excellent collateral
supply from the contralateral (i.e. opposite) coronary artery e) an isolated 30% diameter stenosis of a coronary artery 22) Which of the following pulmonary function tests most
reliably discriminates “pure” chronic bronchitis from emphysema?
a) total lung capacity b) functional residual capacity c) residual volume
d) single breath diffusing capacity e) flow at 50% vital capacity
23) Which of the following would NOT be part of your plan for the treatment of acute ventricular fibrillation?
a) electrical defibrillation b) lidocaine
c) epinephrine d) bretylium e) manganese
24) Which of the following is not an aggravating factor of congestive heart failure? a) hypertension b) thyrotoxicosis c) alcohol d) inactivity e) arrhythmia
25) In the course of DKA, serum potassium levels: a) remain unaffected
b) can appear normal but total body potassium may actually be low
c) can appear normal but total body potassium may actually be high
d) will naturally be corrected by insulin administration e) none of the above
26) A 2 month-old boy has a Ca of 1.80 (corrected) after an assessment for FTT. Mother informs you she has been consistently
breastfeeding without trouble as corroborated by a visiting nurse. What is at the top of your differential?
a) malabsorption
b) pseudohypoparathyroidism
c) mother didn’t supplement with DiVisol (Vit D supplement) d) DiGeorge syndrome
27) A virus that is not inactivated by mild detergents that solubilize phospholipid membranes is:
a) poliovirus b) variola virus c) cowpox virus d) vaccina virus
28) All the following are true statements about viruses EXCEPT: a) they are obligate intracellular parasites
b) they are filterable agents c) they are simply organized d) they are devoid of enzymes
e) they may contain double stranded DNA
29) A viral genome that does not replicate in the cytoplasm of the infected cell is:
a) poliovirus b) rabies virus c) cytomegalovirus d) rubella virus e) mumps virus
30) Which of the following is true about congenital heart block in neonatal lupus erythematosus?
a) it is associated with maternal anti-Ku autoantibodies b) it is transient
c) the majority of patients will require a pacemaker d) there is no increased risk of connective tissue disease in
adulthood
e) the risk of mortality is small
31) Which of the following is true about serologic testing in SLE? a) Aapositive ANA is specific for SLE
b) ds-DNA level correlates with disease activity in SLE
c) anti-histone antibodies are seldom positive in non-drug induced SLE
d) the majority of patients with SLE have anti-Sm antibodies e) anti-Ro antibody is specific for SLE
32) The treatment of choice for thrombotic events in the antiphospholipid antibody syndrome is:
a) intravenous steroids
b) high-dose oral steroids with a rapid taper c) penicillamine
d) aspirin e) warfarin
41) Which of the following pair of CNS lesions and corresponding visual field defects is incorrect?
a) temporal lobe tumour – superior quadrantanopia b) frontal lobe tumour – altitudinal field defect c) pituitary tumour – bitemporal hemianopsia d) occipital lobe tumour – homonomous hemianopsia e) Multiple Sclerosis – central scotoma
42) The “triple bolus” test of pituitary function works by a rapid succession of IV constituents as follows:
a) insulin – hypoglycemia mediated rise in GH and ACTH GHRH – rise in LH and FSH
TRH – rise in TSH and PRL b) CRH – rise in GH and ACTH
GHRH – rise in LH and FSH TRH – rise in TSH and PRL
c) estrogen – rise in LH, drop in FSH and PRL insulin – rise in GH and ACTH
TRH – TSH
d) cortrosyn – rise in GH and ACTH GHRH – rise in LH and FSH TRH – rise in TSH and PRL
43) A 58 year-old man with a past history of a parathyroidectomy for primary hyperparathyroidism is now in your office complaining of headaches worse in the AM (made worse by a small MVA he credits to a loss of peripheral vision). You plan to:
a) send to the Emergency Department for an immediate CT head b) check his calcium to ensure there’s no remaining parathyroid
tissue
c) check for a pheochromocytoma (which you know causes H/As) because you are concerned he has MEN I syndrome d) check for a homonymous hemianopia because you are
worried about a pituitary tumor
e) check for a bitemporal hemianopia because you are worried about a pituitary tumor
44) A 30 year-old patient with asthma complains of daily wheezing and occasional waking at night with cough and chest tightness for three weeks. His usual medication is salbutamol two puffs tid-qid. The next step in management is:
a) add long-term theophylline b) increase salbutamol to two puffs q4h c) add ipratropium bromide two puffs qid d) add beclomethasone two puffs qid
e) discontinue salbutamol and begin prednisone 50 mg od and taper over 2 weeks
45) Which is not a feature of asbestosis? a) Increased risk of cancer. b) Pleural thickening and effusion. c) Interstitial fibrosis.
d) Obstructive pattern on pulmonary function tests. e) All of the above are features of asbestosis. 46) A 63 year-old woman develops intermittent dizziness.
Examination discloses diminished corneal light reflex and mild hearing loss in theright ear. The most likely diagnosis is: a) cerebellopontine angle tumour
b) benign paroxysmal positional vertigo c) lateral medullary syndrome d) Méniére disease
e) none of the above
47) A 25 year-old man is admitted with a history suggesting seizures. Which of the following would not support this diagnosis? a) urinary incontinence
b) the sound of voices preceding events c) drowsiness and weakness following the event d) rarely occur when recumbent
e) none of the above
48) Which of the following would not be expected in a right-sided Brown-Séquard syndrome?
a) right-sided hemi-paresis
b) right-sided decreased proprioception c) left-sided decreased sensitivity to pinprick d) left-sided decreased vibration sense e) none of the above
8 Sample Questions Medicine Toronto Notes 2005
33) Highly infective chronic hepatitis B is suggested by: a) elevated liver enzymes, HBeAg+, anti-HBc IgM+ b) normal liver enzymes, HBeAg+, anti-HBc IgG+ c) normal liver enzymes, HBeAg-, anti-HBc IgG+ d) elevated liver enzymes, HBeAg+, anti-HBc IgG+
34) Which is more often associated with hospital acquired pneumonia than community acquired pneumonia?
a) Streptococcus pneumoniae b) Hemophilus influenza c) Legionella
d) Chlamydia pneumoniae e) Mycoplasma pneumoniae
35) Which of the following is least likely to contribute to myeloma? a) hypercalcemia
b) amyloidosis
c) infiltration of the kidney by myeloma cells d) hyperuricemia
e) intratubular light chain deposition
36) All of the following are vitamin-K dependent proteins EXCEPT: a) protein C
b) antithrombin III c) factor IX d) factor II e) factor VII
37) An 11 year-old male comes in with erythematous pustules, inflamed nodules and cysts with some scaring distributed on the face predominantly. Diagnosis of acne vulgaris was given. Topical erythromycin was used for 2 weeks, several months ago, with no response. What treatment would you prescribe now? a) accutane immediately
b) topical tretinoin c) topical benzoyl peroxide
d) topical antibiotic other than erythromycin e) oral antibiotic
f) oral antibiotic and topical tretinoin
38) A 40 year-old woman develops recurrent papules and pustules in a symmetrical pattern on her cheeks, nose, chin and forehead. She blushes easily, especially when consuming hot liquids, alcohol, or spicy foods. The most likely diagnosis is:
a) acne vulgaris b) perioral dermatitis c) acne rosacea d) seborrheic dermatitis e) carcinoid syndrome
39) A 27 year-old man is brought into the ER after a bicycling accident. A car door suddenly opened in front of him, of which he smashed into and was thrown 15 feet. On examination, he is drowsy and confused. He opens his eyes when his name is called. He mumbles words that you understand but the sentences do not make sense. He moves all four limbs but does not respond to any commands. He is able to pull both hands away when pinched and squirms when his sternum is rubbed, making no effort to stop you. What is his Glasgow COMA Scale score?
a) 10 b) 11 c) 9 d) 8 e) 7
40) A 74 year-old, right-handed man presents with a past medical history of hypertension and dyslipidemia for 30 years. He is a retired banker who recently has had trouble calculating his restaurant bill. He also notices that his writing has deteriorated. On physical exam, he has difficulty naming his fingers and is confused with distinguishing left from right. The lesion is most likely in which part of the brain?
a) right parietal b) left parietal c) left temporal d) right temporal e) frontal
Toronto Notes 2005 Medicine Sample Questions 9
49) Endocarditis in an I.V. drug user:
a) is equally prevalent to that of the normal population b) is commonly located in the mitral valve
c) is typically caused by S. pneumoniae d) is typically found on the tricuspid valve
e) is typically found on the aortic valve, producing a systolic ejection murmur
50) A 55 year-old man with a history compatible with chronic bronchitis presents to your office with shortness of breath on exam. In the history, all of the following would be anticipated EXCEPT: a) A 20-year history of smoking
b) worsening of symptoms with exposure to smog c) worsening of symptoms with acute respiratory infections d) recurrent episodes of pleurisy
e) increased incidence of chronic respiratory disease in family members
51) Which of the following are not consistent with primary (spontaneous) bacterial peritonitis?
a) abdominal discomfort and fever
b) ascitic fluid neutrophil count of> 250x106 cells/L c) ascitic fluid WBC count of >500x106 cells /L
d) multiple organisms on culture and sensitivity of ascitic fluid 52) Which finding is NOT frequently found in Chronic Myelogenous
Leukemia (CML)? a) elevated WBCs b) elevated vitamin B12level c) elevated LDH
d) translocation between chromosomes 9 and 14 e) increased uric acid level
53) Schistocytes on blood film examination are UNLIKELY to be seen in which of the following:
a) thrombotic thrombocytopenia purpura (TTP) b) thalassemia
c) vasculitis
d) disseminated intravascular coagulation (DIC) e) glomerulonephritis
54) All of the following can INHIBIT the absorption of ingested non-heme iron EXCEPT:
a) alcohol b) achlorhydria
c) phosphate (i.e. as found in milk) d) phytates (i.e. as found in cereals) e) antacids
55) Which of the following is true of Myasthenia Gravis? a) in patients older than 60, thymic hyperplasia is a common
etiology
b) often associated with thyroid disease
c) antibodies that are produced against acetylcholinesterase d) associated with small cell lung carcinoma
56) Which of the following is true with respect to proteinuria? a) all proteinuria is secondary to glomerular disease
> 2 g/24 h = nephrotic syndrome
b) is always abnormal and indicative of serious renal disease c) it may be normal for an individual to have <150 mg per day of
proteinuria
d) if a patient has 1.5 g of protein in 24 h they must have tubular-interstitial disease.
57) In which of the following conditions would one not expect a Trans-Tubular Potassium Gradient greater than 4? a) primary hypoaldosteronism
b) acute vomiting c) renin-secreting tumour d) unilateral renal artery stenosis e) Gordon syndrome
58) The most significant cause of morbidity in the elderly: a) arthritis
b) dementia c) heart disease d) stroke
e) hearing impairment
59) Which of the following is NOT an age-related change? a) impaired myocardial diastolic dysfunction b) increased gastric acid secretion c) decreased drug clearance
d) increased nocturnal sodium and fluid excretion e) decreased baroreflex sensitivity
60) Regarding the elderly patient, which of the following apply? a) vague symptoms
b) atypical presentations c) loss of function d) polypharmacy e) all of the above
61) Which of the following is not associated with thyroid disease? a) dermatitis herpetiformis
b) urticaria
c) porphyria cutanea tarda d) vitiligo
e) alopecia areata
62) All of the following are treatments for non-scarring alopecia except: a) spironolactone
b) minoxidil c) hair transplantation d) intralesional triamcinalone e) finasteride
63) A 70 year-old woman presents with acute knee arthritis. Radiographs show meniscal calcification (chondrocalcinosis). Analysis of the synovial fluid reveals weakly positive birefringent rhomboid-shaped crystals. The crystals are most likely:
a) monosodium urate b) calcium hydroxyapatite c) cholesterol
d) calcium pyrophosphate dihydrate e) dicalcium phosphate dihydrate (Brushite) 64) Entamoeba histolytica is transmitted to humans by:
a) ingestion of infective eggs b) ingestion of cysts
c) ingestion of animal tissue that contains the larva d) penetration of the skin by infective larva e) ingestion of adult form
65) Strongyloides spp. is transmitted to humans by: a) ingestion of infective eggs
b) ingestion of cysts
c) ingestion of animal tissue that contains the larva d) penetration of the skin by infective larva e) ingestion of adult form
66) The biosynthesis of fungal ergosterol is inhibited by: a) amphotericin B
b) griseofulvin c) flucytosine d) nystatin e) ketoconazole
67) A 55 year-old woman with asthma is on systemic steroids for one year. She develops a recent right-sided pleural effusion. She feels unwell and tires easily. Aspiration reveals a turbid fluid, a high lymphocyte count, high LDH, low glucose, and a pH of 7.4. The most compatible diagnosis is:
a) pulmonary embolism b) empyema
c) tuberculosis d) subphrenic abscess e) pancreatitis
74) Nitroglycerin administered sublingually may contribute to the relief of myocardial ischemic pain by each of the following mechanisms EXCEPT:
a) coronary vasodilation
b) decreased venous pooling resulting in increased cardiac preload
c) reduced systemic vascular resistance d) reduced ventricular volume
75) At what CD4 count are HIV patients at increased risk of developing PCP?
a) CD4 count >500x106 b) CD4 count 200-499x106 c) CD4 count <200x106 d) CD4 count < 500x106 e) none of the above
76) An 80 year-old female with a 25% reduction in her GFR requires which of the following adjustments for a drug that is
predominantly cleared by the kidneys? 1. 25% decrease in individual doses 2. 25% increase in dosing intervals 3. increase overall fluid intake 4. decrease length of therapy by 25% a) all of the above
b) 1 and 3 c) 2 and 4 d) 2,3, and 4 e) 1 and 2
77) Consequences of immobility include which ONE of the following: a) diarrhea
b) maintenance of muscle mass c) urinary retention
d) pneumonia
e) hastened wound healing
78) Which of the following is FALSE in terms of falls in the elderly? a) they are the most common cause of mortality due to injury b) environment plays a significant role
c) fractures most commonly involve the humerus d) age-related sensory changes make the elderly more
susceptible
e) fear of falling contributes to self-protection immobility
10 Sample Questions Medicine Toronto Notes 2005
68) Diagnosis of acute symptomatic pulmonary embolism can be excluded when which of the following is normal?
a) chest x-ray
b) ventilation-perfusion lung scan c) bilateral leg venograms d) PaO2and A-a O2gradient e) CT scan of the pulmonary arteries
69) In acute pyelonephritis, which of the following is most commonly associated with bacteremic spread from a distant focus? a) Escherichia coli
b) Proteus sp.
c) Staphylococcus aureus d) Serratia sp.
e) Enterococcus sp.
70) A patient presents with a decreased level of consciousness and visual difficulties. Bloodwork reveals an anion gap of 22 and an osmolar gap of 24. Which of the following is most likely responsible?
a) ethanol b) salicylates
c) renal tubular acidosis type I d) methanol
e) diabetic ketoacidosis
71) In the treatment of Type I Diabetes, which of the following is true? a) sulfonylureas are useful as an adjunctive therapy to insulin b) most patients are adequately controlled with one type of
insulin (non-mixed) only
c) once diagnosed with Type I, patients must immediately be assessed for retinopathy
d) during periods of illness or infection, patients may require additional insulin
e) the most common initial presentation is visual disturbance 72) Which of the following is associated with thyroid disease?
a) neurofibromatosis b) vitiligo
c) erythema nodosum d) pemphigus vulgaris e) icthyosis vulgaris
73) Each of the following is a correct statement about COPD EXCEPT: a) the type of emphysema associated with smoking is usually
centriacinar
b) clubbing is not a clinical feature c) long-term oral steroids should be avoided d) smoking cessation does not lead to improvement of
pulmonary function
e) the aim of supplemental O2 therapy is to provide relief of shortness of breath
Toronto Notes 2005 Obstetrics and Gynecology Sample Questions 11
Obstetrics and Gynecology
1) A 26 year-old primigravida presents at 40 weeks in active labour with contractions every 2 minutes. She is diagnosed as having a transverse lie with the back up. Which of the following would be the most appropriate next step?
a) start isoxuprine (Vasodilan) b) perform an external version c) prepare for an immediate C-section
d) rupture membranes and then perform an internal version e) none of the above
2) A 25 year-old primigravida at 34 weeks gestation is thought to be small for dates by her physician and is sent for a sonographic evaluation. The ultrasound shows the biparietal diameter to be appropriate for 34 weeks gestation. The abdominal circumference is appropriate for 30 weeks gestation. The head:abdominal circumference ratio is < 1. The estimated fetal weight is <10th percentile for 34 weeks gestation. The amniotic fluid is decreased. Which of the following is the most likely diagnosis?
a) symmetrical IUGR b) asymmetrical IUGR c) congenital anomaly d) congenital infection e) unknown gestational age
3) A 32 year-old G5P4 presents with an 8 week history of amenorrhea andsuggestive symptoms of pregnancy. Physical examination reveals an irregular, enlarged uterus of 16 weeks size. Ultrasound confirms thepresence of an 8 week viable pregnancy and a multiple fibroid uterus. The correct management for this patient is: a) termination of the pregnancy with elective myomectomy
2 months later
b) termination of the pregnancy with concomitant myomectomy c) prudent observation with elective C-section at term d) prudent observation anticipating probable vaginal delivery e) myomectomy and follow pregnancy in usual way
4) An infant is born. At one minute the heart rate is 120 per minute, respiratory effort is a good strong cry, muscle tone is active, reflex irritability is absent, colour is pink with blue extremities. What is the one minute Apgar score?
a) 5 b) 6 c) 7 d) 8 e) 9
5) Which of the following is the easiest and most reliable way of detecting a retained succenturiate placental lobe?
a) palpation of the uterus
b) inspection of the maternal side of the placenta c) visualization of the cervix on speculum exam d) inspection of the fetal side of the placenta e) pelvic ultrasound
6) Choose the correct statement regarding operative obstetrics: a) a first degree tear involves skin and vaginal mucosa as well as
underlying fascia and muscle
b) delivery aided by vacuum extraction is typically of shorter duration than if forceps are used
c) one absolute prerequisite for the use of forceps is that the baby’s presenting part must be below the ischial spines d) a third degree tear extends through the anal sphincter e) none of the above
7) A 36 year-old female presents with a mucopurulent vaginal discharge. Gram stain of a cervical swab shows gram negative diploccocci. Which of the following is correct?
a) if untreated this condition will likely resolve spontaneously b) the most likely diagnosis is Strep group B
c) appropriate treatment is Metronidazole vaginal cream d) appropriate treatment is a single I.M. dose of 250 mg
of Ceftriaxone
e) Public Health will most likely need to be notified
8) A one year-old female presents with vaginal bleeding. Vaginal inspection reveals the presence of a multicystic grape-like lesion. The most likely diagnosis is?
a) sexual abuse b) DES syndrome c) sarcoma botyroides d) clear cell adenocarcinoma e) exposure to exogenous estrogen
9) A 24 year-old G1P0 is seen in the Emergency Department. Her LMP was 8 weeks ago. She is experiencing lower abdominal cramping and heavy vaginal bleeding with clots. Examination reveals a soft abdomen with mild lower abdominal tenderness. On pelvic exam, the vagina is filled with blood and clots. The cervical os is opened and tissue is protruding. The uterus is enlarged to a 6 week size. Which of the following is the most likely diagnosis?
a) ectopic pregnancy b) threatened abortion c) degenerating fibroid d) placenta previa e) incomplete abortion
10) A 24 year-old female G1P0 is admitted to hospital at 34 weeks gestation. The patient describes passing a large volume of clear fluid per vagina for 36 hours. Examination reveals the following: temp 38.5C, no uterine contractions, vague lower abdominal tenderness, fetal heart rate 185 bpm. Lab investigations reveal: Hb 120, WBC 19.0, + nitrazine test of vaginal fluid, + ferning of vaginal fluid. Which of the following is the most likely diagnosis?
a) premature rupture of membranes
b) premature rupture of membranes and chorioamnionitis c) premature labour
d) acute pyelonephritis e) acute vaginitis of pregnancy
11) A 24 year-old female presents with abdominal pain. ß-HCG is negative. Pelvic ultrasound shows a 5 cm right ovarian cyst. You would:
a) perform immediate laporotomy b) perform immediate laproscopy
c) aspirate the cyst under ultrasonographic guidance d) order a CBC and a CA125
e) expectant management with repeat ultrasound in 8 weeks 12) The pathology report following a therapeutic abortion shows
Arias-Stella phenomenon (decidualization). The most appropriate next step in the management of this patient would be?
a) repeat a pregnancy test b) laporoscopy c) reassure the patient d) prescribe oral contraception e) repeat the D&C
13) In a patient whose blood type is O-Rh negative and whose husband has O-Rh positive blood, Rh immune globulin (Rhogam) should be given after all the following EXCEPT:
a) artificial rupture of membranes
b) full term delivery of a baby with O-Rh positive blood type c) amniocentesis
d) spontaneous abortion e) therapeutic abortion
14) Risk factors for shoulder dystocia include all the following EXCEPT: a) maternal obesity
b) macrosomia c) maternal diabetes
d) prolonged second stage of labour e) outlet forceps delivery
25) A 55 year-old woman comes to the office to discuss menopause. You tell her all of the following are a part of this stage EXCEPT: a) hot flushes
b) vaginal dryness c) mood swings d) insomnia e) decreased libido
26) All of the following features have been described in women with androgen insensitivity syndrome EXCEPT:
a) mammary aplasia b) female phenotype
c) absence of wolffian duct structures d) short vagina
e) absence of mullerian duct structures 27) The commonest indication for amniocentesis is:
a) chromosome anomaly of the mother b) teenage pregnancy
c) advanced maternal age d) family history of Down syndrome e) family history of cystic fibrosis 28) On colposcopy, the transformation zone:
a) contains columnar epithelium
b) is the area between original squamous epithelium and columnar epithelium
c) contains metaplastic epithelium d) contains atypical blood vessels
29) Complications of cesarean section include each of the following EXCEPT:
a) hemorrhage b) infection
c) laceration of the fetus
d) subsequent rupture of the uterine scar e) inversion of the uterus
30) Regarding laparoscopy:
a) it is contraindicated in patients who are menstruating. b) patients with intestinal obstruction are still able to undergo
laparoscopy
c) the most common indication for therapeutic laparoscopy is tubal sterilization
d) all of the above are incorrect 31) Causes of secondary amenorrhea include:
a) Turner syndrome b) anorexia
c) androgen insensitivity syndrome d) gonadal dysgenesis
e) imperforate hymen
32) Risk factors for cervical carcinoma includes all of the following EXCEPT:
a) human papilloma virus type 16 and 18 b) early age at first intercourse
c) smoking d) nulliparity
e) multiple sexual partners
33) A 35 year-old G0P0 has severe pain during menses which radiates into the anal region. On bimanual exam, she has a small, retroverted uterus and tender nodules can be felt on palpation of the uterosacral ligaments. Which of the following conditions does she most likely have: a) chronic PID b) adenomyosis c) fibroids d) endometriosis e) uterine carcinoma
34) Which of the following statements is correct?
a) cervical carcinoma is the most common gynecological malignancy in Canada
b) lichen sclerosis is treated with estrogen cream c) colposcopy is required after a finding of mild cervical
dysplasia on a routine Pap smear
d) follicular cysts typically regress with the following cycle e) leiomyomata are malignant tumours
12 Sample Questions Obstetrics and Gynecology Toronto Notes 2005
15) Fetal exposure to lithium in the first trimester has been strongly associated with:
a) alopecia b) cleft lip and palate c) congenital heart defects e) limb defects
d) mental retardation
16) The commonest type of bleeding encountered with uterine leiomyomata is: a) post-coital spotting b) mid-cycle bleeding c) hypermenorrhea d) oligomenorrhea e) post-coital staining
17) Which of the following statements about estrogen therapy in postmenopausal women is correct?
a) it is a major risk factor for breast cancer b) it decreases hepatic triglyceride production c) it produces hypertension
d) it protects against vertebral compression fractures
e) it directly stimulates the proliferation of vascular endothelium 18) Which event is matched with the correct timing?
a) maternal serum screening test: 20-22 weeks b) post-partum visit: 6 weeks
c) chorionic villus sampling: 4-6 weeks d) oral glucose challenge test: 14-16 weeks e) Rhogam to Rh negative women: 12-14 weeks
19) Routine blood work during the first antenatal visit include all of the following EXCEPT:
a) CBC b) HIV c) rubella titre d) blood group and type e) Rh antibodies
20) All of the following are cardiovascular adaptations to pregnancy EXCEPT:
a) cardiac output increases 33-45% b) stroke volume increases 10-30%
c) heart rate decreases 12-18 beats per minute d) systolic blood pressure decreases 4-5 mmHg e) diastolic blood pressure decreases 8-15 mmHg 21) A couple are unable to conceive after 1 year. Of the following
statistics regarding infertility, which are correct: a) 10-15% of couples are infertile
b) only 40% of couples achieve pregnancy within 6 months of trying
c) only 20% achieve pregnancy within 1 year of trying d) male factors are responsible for over half of infertility causes e) infertility is labelled after failure to conceive within 2 years of
trying
22) Vaginal discharge which is fishy in odor and associated with >20% clue cells on microscopy will not be associated with which of the following:
a) be due to gardnerella vaginalis overgrowth b) can be treated with metronidazole or clindamycin c) with the addition of KOH may see hyphae or spores d) must be treated in all pregnant women, including
asymptomatic
e) is rarely associated with inflamed or itchy vulva
23) In the treatment of an ectopic pregnancy with methotrexate all of the following are true EXCEPT:
a) the pregnancy must not have ruptured b) it must be less than 5cm in size c) patient should be clinically stable d) compliance and f/u are ensured e) no fetal heart activity has been noted
24) Which of the following is associated with breech presentations? a) fetal heart sounds heard best in the upper abdomen b) brachial plexus injury
c) prolapse of the umbilical cord d) increased fetal mortality e) all of the above
Toronto Notes 2005 Obstetrics and Gynecology Sample Questions 13
35) If a mother nurses her child, the time of reappearance of her menses is uncertain but usually occurs after her delivery by: a) 1-2 months
b) 2-3 months c) 3-4 months d) 4-5 months e) > 5 months
36) Which of the following statements regarding malignant cervical lesions is true?
a) 95% are squamous cell carcinoma
b) CA-125 levels to monitor treatment effectiveness are indicated c) the majority of lesions arise outside the transformation zone of
the cervix
d) they are not associated with HPV infection
e) treatment for stage 4 disease radical hysterectomy with chemotherapy
37) In endometriosis, the most common location for disease is: a) broad ligament
b) cul-de-sac c) ovaries d) appendix
e) uterosacral ligament
38) All of the following increase the risk of developing ovarian cancer EXCEPT: a) family history b) BCP c) nulliparity d) late menopause e) caucasian
39) In the first 100 days of pregnancy, human chorionic gonadotropin titre doubles: a) every day b) every week c) every 2 days d) every month e) every 2 weeks
40) A young female enters your office wanting to start oral contraceptive pills. You remind yourself of the reasons she may not start the pill which are:
a) impaired liver function
b) undiagnosed abnormal uterine bleeding c) congenital hyperlipidemia
d) past history thrombophlebitis e) all of the above.
41) Which of the following statements regarding endometriosis is incorrect?
a) theories proposed to explain the histogenesis of endometriosis include retrograde menstruation and coelemic metaplasia b) CA-125 is often useful in making the diagnosis of
endometriosis
c) symptoms of endometriosis may include urinary frequency and diarrhea
d) the differential diagnosis of endometriomas include hemorrhagic
corpus luteum cysts as well as neoplasms
e) the risk of endometriosis is several fold greater if there is a first degree relative with this condition
42) A 55 year-old female presents with a "period-like" vaginal bleeding for 5 days that stopped spontaneously. Your approach to the problem would be to:
a) reassure the patient and manage expectantly b) administer provera 10 mg od for 15 days c) administer cyclic estrogen plus progesterone d) obtain endometrial tissue
e) perform a pap smear plus endocervical curretage
43) The appropriate next step in a woman found to have 1 abnormal Pap smear showing mild dysplasia (CIN1) is:
a) repeat in 1 year's time
b) repeat in 4-6 months time with colposcopy if abnormal c) send patient directly for colposcopy and LEEP excision d) send for colposcopy after 1 abnormal Pap
e) repeat Pap immediately and treat for HPV infection 44) The commonest cause of disseminated intravascular
coagulation during pregnancy is: a) amniotic fluid embolism b) abruptio placentae c) placenta previa d) missed abortion e) chorioamnionitis
45) Contraindications to vaginal delivery include each of the following EXCEPT:
a) previous classical cesarean section b) squamous cell carcinoma in situ of the cervix c) total placenta previa
d) transverse lie with ruptured membranes
e) primigravida breech with cephalo-pelvic disproportion 46) In a differential diagnosis of third trimester bleed, which of the
following should not be included: a) placenta previa
b) vasa previa c) abruptio placentae d) threatened abortion e) marginal sinus hemorrhage
47) A 41 year-old woman presents with obesity, hirsutism and oligomenorrhea, which of the following tests will give the least useful information?
a) FSH b) LH c) testosterone d) TSH
e) urine free cortisol
48) With respect to androgen insensitivity syndrome, which of the following is true?
a) genotype is XY
b) breast development and uterus are absent c) serum testosterone is below normal male range d) secondary sex characteristics are male e) the condition is autosomal recessive
49) The new selective estrogen receptor modulators have all of the following benefits EXCEPT:
a) no agonistic effect on breasts b) provides estrogenic benefit on bone
c) mimics estrogenic effect on cardiovascular status d) no agonistic effect on uterine tissue
e) provides relief of hot flushes associated with menopause 50) Regarding birth control, which of the following is false?
a) it is contraindicated in women over age 35 who are smokers b) its efficacy may be decreased when taking antibiotics c) reduces the risk of ovarian carcinoma
d) is associated with only a 10% failure rate
7) Which of the following investigations is most helpful in the assessment of a child presenting with an acute asthma attack? a) white cell count and differential
b) arterial blood gases c) chest x-ray
d) pulmonary function tests e) O2 sat. monitoring
8) A 6 year-old boy is brought to emergency with a 5 day history of fever, cough, and poor appetite, but no vomiting. On exam, he appears unwell, is febrile, and has crusty nasal discharge and a wet-sounding cough. Chest x-ray reveals a pulmonary infiltrate in the right middle lobe. He is admitted to hospital for pneumonia. What is the best management for this child?
a) observe for 24 hours with IV fluids only
b) observe for 24 hours with IV fluids and acetaminophen c) give oral amoxicillin and acetaminophen
d) give IV ampicillin and oral acetaminophen e) give oral erythromycin and acetaminophen
9) Side effects of methylphenidate (Ritalin) therapy for hyperactivity include each of the following EXCEPT:
a) anorexia b) insomnia c) tachycardia
d) dependence (addiction) e) growth suppression
10) In comparing breast milk and formula, which of the following statements is NOT correct:
a) breast milk has a higher percentage of protein b) breast milk has whey:casein ratio of 60:40
c) breast milk contains leukocytes, complement and lysozymes d) breast milk has a lower concentration of iron than iron
fortified formulae
e) breast milk has an optimal calcium:phosphorus ratio of 2:1 11) Most umbilical hernias in children:
a) need strapping b) resolve spontaneously c) require elective surgery d) require immediate surgery
e) are associated with a higher incidence of inguinal hernias 12) A newborn male spits up his first feeding and develops bilious
emesis with subsequent feedings. On physical exam he appears ill, has a scaphoid abdomen and absent bowel sounds. Abdominal x-ray shows air in the proximal small bowel, but a paucity of air in the distal digestive tract. The most likely cause for this infant's vomiting and clinical finding is:
a) antral web b) choldochal cyst c) Hirschsprung disease d) tracheoesophageal fistula e) volvulus
13) Breastfeeding is contraindicated if the mother has: a) acute EBV infection
b) acute HepA infection c) chronic HepB infection d) asymptomatic HIV infection e) none of the above
14) A 10 month-old child develops low-grade fever and sunburn-like erythema over much of the body, but most prominently in the intertriginous areas. Within 36 hours, sheet-like desquamation is noted in the flexures and around the mouth. The mucous membranes are spared. Which of the following is the most likely diagnosis:
a) Kawasaki disease
b) staphylococcal scalded skin syndrome c) Stevens-Johnson syndrome
d) toxic epidermal necrolysis e) toxic shock syndrome
14 Sample Questions Pediatrics Toronto Notes 2005
Pediatrics
1) A 6 month-old infant presents in the winter with fever, cough, wheezing, tachypnea and decreased appetite. A chest radiograph shows hyperaeration and streaky perihilar infiltrates bilaterally. You diagnose bronchopneumonia. Which organism would most likely be causing this child's infection?
a) Chlamydia pneumoniae b) Mycoplasma pneumoniae c) Streptococcus pneumoniae d) Haemophilus influenzae e) Respiratory syncytial virus
The following case pertains to questions 2 and 3:
A 12 month-old girl is brought to the emergency department for the second time in 2 days for vomiting and passage of 8 to 10 watery stools per day.
2) Of the following, which provides the best estimate of the patient’s volume deficit:
a) weight change since the beginning of the illness b) hydration of mucous membranes, skin turgor, and
level of consciousness
c) pulse, blood pressure, and peripheral capillary filling time d) serum electrolytes
e) serum urea nitrogen and creatinine levels
3) The patient has lost 0.6 kg. She is moderately lethargic and has dry mucous membranes and reduced skin turgor. Blood pressure is 80/40 mm Hg, and pulse is 120 per minute; capillary refill is reasonably brisk. Lab studies reveal: sodium 131, potassium 4.8, chloride 101, bicarbonate 16 mEq/L, urea nitrogen 24 mg/dL and creatinine 0.6 mg/dL. The best strategy for managing this child is to:
a) hospitalize for administration of IV fluid therapy b) administer an oral rehydrating solution while the
child is under medical supervision for 4-6 hours c) instruct the parents about oral rehydration at home d) hospitalize after giving 20 mL/kg of 0.9% saline IV e) instruct parents on use of soy formula
4) Which of the following statements about Attention Deficit and Hyperactivity Disorders (ADHD) is INCORRECT?
a) ADHD is more commonly seen in boys than girls b) deafness and seizure disorders must be excluded before
the diagnosis of ADHD is made
c) three characteristic features of ADHD are inattention, hyperactivity, and mental retardation
d) ritalin is effective in the treatment of about 70% of cases of ADHD
e) side effects of Ritalin include poor growth, insomnia, and tics 5) A 6 year-old child is brought into the Emergency with his father because of a fractured arm. Although his father states that the child fell off his bike, the fracture does not seem consistent with this story. On inspection, you discover that the child seems to have a number of old bruises on his back and on his legs, some of which seem reminiscent of finger markings. Which of the following steps is not appropriate in this circumstance? a) let the child go home with his father since you cannot really
prove anything
b) document the injuries that you saw with possible photographs
c) call the CAS and inform them d) try to interview the child alone
e) do additional investigations (e.g. skeletal survey)
6) A 14 year-old girl has refused to go to school 3 times in the past 4 months. She says, "My tummy hurts," but she cannot point to where it bothers her. Her appetite is good, her bowel movements are normal, and she is sleeping well at night. She is a
healthy-looking girl with no abnormal findings on physical exam. What is the most likely diagnosis?
a) a benign abdominal mass compressing her duodenum b) diaphragmatic hernia
c) somatoform disorder d) gastroesophageal reflux disease e) early peptic ulcer disease
Toronto Notes 2005 Pediatrics Sample Questions 15
15) By one year of age, a child is able to have all of the following foods except: a) breast milk b) peeled fruits c) cheese d) peanuts e) eggs
16) Central cyanosis in the newborn infant is most often caused by: a) congenital heart disease
b) lung disease
c) central nervous system disease d) methemoglobinemia e) hypoglycemia
17) In a premature infant who is suspected of having necrotizing enterocolitis (NEC), each of the following is correct EXCEPT: a) Septicemia is associated with an increased risk of NEC b) NEC is thought to be caused by systemic hypertension c) the finding of air in the portal vein indicates severe illness d) respiratory distress increases the risk of NEC
e) apgar scores inversely correlate with the risk of NEC 18) Which of the following is the most significant risk factor for the
development of childhood asthma: a) family social background b) parental asthma c) stress in the family d) parental smoking
e) presence of pets in the house
19) Which of the following statements about sickle cell disease is true? a) all patients with sickle cell disease have a homozygous HbSS
genotype
b) sickle cell disease causes a severe chronic anemia that is not r outinely transfusion dependent
c) patients have increased susceptibility to infection by nonencapsulated organisms
d) patients usually present with sickle cell crises within one month of age
e) splenic dysfunction usually does not occur until the child enters his/her teens
20) Which of the following is false about physiological jaundice? a) it rarely presents before the age of 24 hours
b) it may cause kernicterus
c) in premature infants it may persist for 3-4 weeks
d) it is mainly due to temporarily impaired hepatic clearance of bilirubin
e) it does not always require treatment with phototherapy 21) Which of the following statements is true?
a) cancer is the second most common cause of death in children b) Hodgkin's lymphoma is the most common childhood cancer c) hyperploidy in leukemic cells is a poor prognostic indicator d) Wilm's tumor is rarely associated with other congenital
abnormalities
e) neuroblastomas usually occur in late adolescence 22) A 5 year-old girl with hypogammaglobulinemia and absent
immunoglobulin A (IgA) receives infusions of immune globulin monthly. Shortly after her most recent infusion began, she developed hypotension, wheezing, and several urticarial lesions. Which of the following best explains her reaction?
a) anaphylactic reaction due to IgE anti-IgA antibodies b) Gram-negative sepsis due to contaminated immune globulin c) idiosyncratic reaction due to rapid infusion of immune
globulin
d) serum sickness reaction from foreign serum in the immune globulin
e) transfusion reaction due to ABO incompatibility
23) When prophylactic antibiotic therapy is used for tooth extraction in a patient with a ventricular septal defect: a) therapy is started 24 hours prior to the procedure b) a throat swab should be taken prior to the procedure c) a second generation cephalosporin (cefuroxime) is the
therapy of choice
d) therapy is given for one week following the extraction e) erythromycin is the drug of choice for those allergic to
penicillin
24) Which of the following statements about stuttering in a 4 year-old is incorrect:
a) it is characterized by intermittent difficulty in producing a smooth flow of speech
b) it is more than 3 times more frequent in girls than in boys c) it is exacerbated by anxiety
d) more than 30% of children who stutter recover spontaneously
e) none of the above
25) A woman who is positive for hepatitis B surface antigen (HBsAg), but negative for hepatitis B antigen (HBeAg), delivers at term. What would be the best management for this woman's infant?
a) administer gamma globulin intramuscularly immediately and at 1 month of age
b) administer hepatitis B (HB) vaccine immediately and at 1 month and 6 months of age
c) administer hepatitis B immune globulin (HBIG) if cord blood is positive for HbsAg
d) administer HBIG and HB vaccine immediately, and HB vaccine again at 1 month and 6 months of age e) advise mother that breastfeeding is contraindicated 26) Regarding sexual abuse of children, each of the following
statements is true EXCEPT:
a) no genital injury is found in the majority of patients b) father-daughter incest is more common than brother-sister c) most assailants are unknown to the victim
d) laboratory findings usually show no presence of sperm e) half of the abused children come from single parent
families
27) The viral infection most likely to cause CNS involvement and focal neurological findings is :
a) coxsackievirus b) herpes simplex c) enterovirus d) rabies e) rhinovirus
28) Which of the following predisposes infants to chronic otitis media? a) bottle-feeding in upright position
b) abnormal tympanic membrane formation
c) environmental factors such as daycare and passive smoking d) allergies
e) none of the above
29) A 13 month-old infant boy has chronic diarrhea, poor appetite, irritability and growth failure. He had been well previously, developing normally until diarrhea began at 3 months of age. Findings include weight loss less than 5th percentile and length at 25th percentile, cachectic appearance, wasted extremities and protuberant abdomen. His labs are: albumin 23, protein 40. Stool positive for reducing sugars and negative for enteric pathogens and ova and parasites. These findings are most consistent with:
a) celiac disease b) cow milk allergy c) Crohn disease d) Cystic Fibrosis e) none of the above
