MCCEE 2

Photos


A picture of a small boy opening his mouth, indicating that his vaccination is not complete, presented with fever, drooling, what is the diagnosis?

Diphtheria croup

Epiglotitis

Laryngotracheobronchitis





A photo of the inguinal region with brown rash that covers the inguinal region including the scrotum, what is the best treatment?

Nystatin oint

Amphotericin B systemic

Griseophulvin





ECG of right bundle branch block with left axis deviation





A photo of a hand with big nodules, all are true except:

a. Urethritis

b. Treatment with allopurinol

A photo of the side of a young man found on the street and when moved, they found these patches (red well demarcated on the side of the body and upper limbs), which of the following carries serious concerns

Necrosis of muscle under these patches.

Myoglobinuria

Fever

Compartment Syndrome





A female with term pregnancy, came with labor pain, suddenly developed profuse painless bleeding, what is your diagnosis

Placenta previa

Abruptio placenta

Uterine rupture





A female with term pregnancy, came with labor pain, she had a history of lower uterine segment C/S, suddenly developed profuse vaginal bleeding, what is your next step in management

Pelvic exam

U/S

Send he home

Keep her waiting until bleeding stop





What is the definitive treatment for dysmenorrhea

Bilateral oophorectomy

OCP

NSAID













What is the best treatment of condylomata acuminata in pregnancy

Cryotherapy

Podophylin

Surgical removal

Intralesional interferon





Which of the following is the most common gynecological problem

Endometrial polyp

Endometrial ca

Cervical cancer

Ovarian cancer





What is the most common cause of postmenopausal bleeding

Endometrial ca

Endometrial polyp

Atrophic vaginitis





Evista® is mainly effective in

Relieve hot flashes

Coronary artery disease prevention

Endometrial ca prevention

Decrease osteoporosis





What is the absolute contraindication for HRT

History of breast ca

Uncontrolled hypertension

Migraine headache

Acute liver disease





What is the most common finding in dysmenorrhea

normal pelvic exam

retroverted uterus

cul du sac nodularity





Where is the most common site of ectopic pregnancy

Ampula

Uterus

Ovary

Cervix





A lady came with lower abdominal pain, bleeding, cervical motion tenderness, and adnexal mass. U/s show empty uterus, what is your diagnosis

Ectopic pregnancy

Complete abortion with luteal cyst

Salpangitis





A lady came with 5 wks missed period with lower abdominal pain, cervical motion tenderness, fever, and bleeding, diagnosis

Ectopic

Salpangitis c. complete abortion





A female with malodorous vaginal discharge, absence of vaginal irritation, all is true except:

a. Clue cells

b. Positive whiff test

c. Hyphae on wet mount KOH

d. No WBC



TSS, all is true except

Caused by S. Aureus exotoxins

tampon use

post partum infection

desquamations of the skin

necrosis of fascia





A female post C/S developed fever on 5th post op day, U/S is negative , , given triple antibiotics with no response, what is the diagnosis

Pelvic abscess

Subdiaphramtic abscess

Pelvic thrombophlebitis





What is the most common gynecological malignancy

Endometrial ca

Ovarian Ca

Cervical Ca





All of the following are risk factors for Ca cervix except

HPV infection

Smoking

Multiple partners

Late menarche





Question about abnormal pap smear in pregnancy





Hydatiform mole, what is the best treatment

Hysterectomy

Suction D & C with sharp curettage + oxytocin

No treatment

Initial prenatal visit include all except,

Blood group and Rh Ab

Infection screening

Urine C&S

General stool exam





Question on prenatal screening, all are true except

10-12 wk: CVS

14-18 wk: quickening

16 wk maternal serum screen

24 wks: 75 2hr GTT





In Pregnancy. Induced Hypertension, all are used except

hydralazine

labetolol

ACEI

Nifedipine





In pregnancy and diabetes, you give all except

Insulin

Dietary control

Oral hypoglycemic





Full term lady, active labor, transverse lie infant, your management

internal version

external version

C/S





What is the most common cause of perinatal mortality in multiple gestations

IUGR

Prematurity

Anemia

Congenital anomalies





IUGR is associated with all except

DM

Smoking

Alcohol

Hypertension

Prior history of IUGR





Labor is defined as

Answer: progressive dilatation and effacement of cervix, with descent of presenting part



Early deceleration is due to vagal response to head compression





Variable deceleration is due to cord compression





The most common cause of late post partum bleeding is

uterine atony

retained placenta

cervical laceration

vaginal hematoma





A man reading a newspaper, the man sitting next to him got injured by the edge of the news paper, what is most probably the diagnosis

corneal erosion

uveitis

iritis





In iritis, all are true, except

Discharge



A young child came with fever, painful red eye, proptosis, diagnosis is

periorbiatl cellulites

retrobulbar cellulites

iritis d. uveitis

What is the most common cause of mercury poisoning in Canada

Shellfish



What is the most common occupational disease in Canada

skin disease





What is the likely hood of a woman who is a carrier of a recessive gene to have her tow daughters carrying the disease

¼

1/16

1/24





If the probability of event A is P= #m and the probability of event B is P= #, then the probability of both events A and B occurring is

A+B

A*B

A/B





What will happen at the cut edge of the test to the specificity and the sensitivity

Sensitivity will increase and specificity will decrease

Sensitivity will decrease an specificity will increase

Both sensitivity and specificity will increase

Both will decrease





Incidence is defined as the number of new cases of a disease in a population per

the total number of population at the beginning

the total number of population at the mid

the total number of population at the end





The most important cause of Years of Life Loss below the age of 30 is

Suicide

Accidents

Cancer





A man came wondering about the possibility that he might get a prostate cancer cause his father had it, his SPA is normal, but on PR you find a firm prostate nodule, what is your management

assure the patient

do biopsy under trasrectal US

reassess in three months

reassess in six months





A man came to the emergency after a car accident, in a state of shock from bleeding, he carries with him a card of Jehovah witness, his wife is insisting that he should be receiving what ever necessary to save his life, your management is

give him blood

give him fluids only even if this might lead to his death

consult someone else to verify his membership in Jehovah witness





A 13 years old boy brought by his mother because of an ugly looking sebaceous cyst in his neck, the mother insisted on that this should be removed while the boy refused any kind of medical intervention, what is your management

respect the boy wish

respect the mothers’ wish

refer him to a child Abuse society





What is the most common Ca of thyroid gland

Answer: papillary



A patient with medial malleolar ulcer, what is most likely the cause

Acute DVT

Arterial insufficiency

Incompetent perforator vein





New born with cyanosis unresponsive to oxygen, diagnosis

TGA

Tetralogy of Fallot

Hypoplastic left heart syndrome

VSD





All of the following is itchy eruption in children, except

Urticaria

Contact dermatitis

Scabies

Seborrheic dermatitis





Child presented with bloody diarrhea, fever, vomiting, you do all except

fluids

loperamide

Metronidazole

Stool C&S





Treatment of VWD





Treatment of Hemophilia





Child with fever, vomiting, negative culture of CSF, increased proteins, decrease sugar, cause

Meningococcal meningitis

S. Pneumonia

L. monocytogens

Viral





A child brought with moderate dehydration, what is the initial management

20ml Normal saline boulus

glucose water

blood









Full term newborn with tachypnea, mild retraction, grunting, diagnosis

RDS

TTN

Pneumonia





Newborn, you suspect diaphragmatic hernia, you do all except

Bag



Necrotizing enterocolitis, all are true except

pneumatosis intestinales

abdominal distension

calcification





The cause of HUS is E.coli O157 :H7 toxin





Nephrotic syndrome, all are true except

severe proteinuria

hypoalbumeninemia

edema

low C3





A child with headache, vomiting, then go to sleep, what is the diagnosis

Migraine



Mallet finger(DIP flexion with loss of active extension)





Boxer’s fracture,(volar displacement of the head, apex dorsal)





After penetrating injury of the hand, a man came with pain on passive extension, swelling of the digit, point tenderness along the tendon sheath, diagnosis

felon

acute suppurative tenosynovitis





A 55yr woman with loss of interest, loss of memory, poor concentration, but intact cognitive function, diagnosis

Schizophrenia

Dementia

Pseudo dementia





A case of posttraumatic stress disorder, treatment

Behavioral therapy

Psychotherapy

Psychoanalysis





A case of drug intoxication with tachycardia, hypertension, loss of painful stimulus, ataxia, nystagmus, the drug is

cocaine

cannabis

PCP

Amphetamines

A man presented with multiple complaints, you find multiple abdominal scars of previous operations, medical work up is negative, he insist that he has a serious medical condition, diagnosis

somatization

somatiform

hypochondriasis

factitious disorders





A person with gender identity disorder had:

Answer: cross dressing in childhood



Definition of mood:





Delirium can be due to which situation, except:

post surgery

alcohol

brain tumor





A child with TIC, what would you do

a. observe more

b. refer to children psychiatry

c. medication



A child with ADHD, what not to give:

a. metilphenidate

b. D-amphetamine



A child 5yo previously normal that after moving to another city and started on kinder garden, develops enuresis





Somatoform Disorders





Sleep Apnea





How to avoid lead poisoning:

a. washing hands



Pharmacotherapies for Psychiatry that are contraindicated to be used together.





Hemochromatosis, 2 questions: one for diagnoses ( clinical case ) and the other for lab ( transferrin saturation )





Consent is not valid if the patient has mental disability and the consent is given by phone by his brother under alcohol effects.





Patient went to hospital to a minor surgery and she wants to also take out the birth mark she has. Consent:

a. is valid because she signed an admission paper when got into the hospital

b. is not valid because she expressed her wish after 1 hour of pre-anesthetic drugs



A man is at the ER unconscious, his Hb is 5.0g, you have done everything for him to recover but he needs more procedures. You find inside his pocket one card of active membership of Jehovah Witness. What will you do:

a. give just hydration/ volume but do not transfuse blood

b. give him the blood transfusion without worrying about the card

c. go look for information with other relatives

d. give him the blood transfusion if his wife signs the authorization



Husband and wife come to you complaining they’re having marriage problems. He talks to you alone and says he has no attraction for his wife, but he has morning erections and when he reads “magazines”. He’s taking propanolol for 5 years. What will you do?

a. order fasting glucose



Husband and wife having marriage problems. She says their marriage was always happy up to now when he complains he wants to separate from her. What will you do:

a. refer them to couple counseling

b. listen to their reasons before any action



Postmenopausal woman with complains of vaginal pruritus and dyspareunia. At the exam you find atrophic vaginitis. What do you give:

a. corticoid cream

b. E + P oral

c. refer to colposcopy

d. perform vulvae biopsy



Best method to be used as contraception and as protection against ovarian cancer:

a. BCP

b. IUD

c. Condom



A pregnant woman comes for the first visit at 27 weeks. You perform the measurement and the uterine fundus is at 16 weeks. Which is your next step:

a. Amniocentesis

b. CVS

c. U/S



Most common complication of gemelar pregnancy:

a. prematurity







In which situation would you perform MSS:

a. Routinely to all pregnant

b. Routinely to pregnant after 35 yo

c. Routinely at 16 weeks



Pregnant woman at 20 weeks, I gesta, with diabetes, what would you say:

a. refer to terminate the pregnancy right now

b. start oral hypoglycemic medication

c. close control of her glycemia



How to avoid the complications of prematurity in gemelar pregnancy?

a. Close control + corticoid when time to delivery



Contraindication of tocolysis:

a. Antepartum hemorrhage



Patient gesta I, the first baby came with oNTD and she wants to get pregnant in 6 months, what would you do:

a. give her folic acid



NST with the result = no acceleration, indicates:

a. Fetal distress



Pregnant woman with 36 weeks, edema in ankles and hypertension, which drug is contraindicated:

a. labetalol

b. metildopa

c. hydralazine

d. magnesium sulphate



Placenta previa, first step:

a. U/S



Previous C/S, during labor develops lost of lots of blood:

a. uterine rupture



Breech presentation, what to do?

a. Maneuvers

b. C/S



100. Shoulder dystocia, first step:

a. McRobert’s maneuver



101. One cause of nasal cancer can be:

a. Nickel



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MCC Qualifying Exam Part I – 2003 – May – From Dr. Salma



Pictures:



1. A picture of nails with splinter hemorrhage:

Ans: infective endocarditis



2. A picture of newborn female with vaginal bleeding:

Ans: reassurance



3. A picture of swollen painful blue colored extern hemorrhoids and H/O constipation and painful defecation:

Ans: thrombosed external hemorrhoids



4. A picture of a basal body temperature from day 1 to day 28 of menstrual cycle. The temperature is rising from luteal phase to menstruation

Ans: ovulatory cycle



5. A picture of cardiotocography external fetal heart monitoring NST. The graphic is normal showing increase of 15 beats for 15 seconds after every 15-20 min and at the base line

Ans: fetus is not hypoxic



Part B – Questions



This part consists of 53 cases. Each case has one or two or three questions. Time- 4 hours.



1. A case of Bat bite



Q. What is the initial management when a mother calls you and says she had found a dead bat on her son’s bed when he woke up in the morning? Select three options:



a. you report the public health authority

b. ask the mother to find out the mark of the bite at her son’s body

c. you give anti-rabies

Others I do not remember, research for the more possibilities



2. A case of 16 yo girl with acne vulgaris of 2nd and 3rd stages.



Q. What is the management?



Q. Which foods are restricted for the options?

a. chocolate b. coke and soda c. nuts d. cheese e. ice cream f. none



3. A case of MVA of a 28 weeks pregnant woman who came in emergency and delivered premature baby. Police came and asked questions about baby’s condition. You are the attending physician, what will you do:

a. give all the information

b. don’t say anything respecting privacy

MCCQ may 7 03



1. MVA Jehovah's witness, had valid card in his pocket. Hb 5.0g, hypotension, wife ask you try as much as you can to save his life. how can you do?

a. blood transfusion

b. do as much as you can but blood transfusion



2. child with leukemia, family ask you to keep the secret. the child may ask you the diagnosis.what can you do?

a. tell the child the truth

b. do as the family required and tell the child a begnine diagnosis

c. ethic consultation before you see the child.



3. percentage of physician's expenditures in 1995

a. 52, b. 25% c. 14% d. 5%



4. patient tell you he'll kill his wife after he go home what can you do?

a.involuntary hospitalization

b. write a letter to inform the wife

c. call the police



5.ECG atrial flutter + RBBB



6. sawmill worker, what kind of lab you want to check before he start his job?



7. scenario, basal cell carcinoma, surgery.

a. excision 1 cm margin, b. 2 cm margin



8. man watch TV suddenly dyspnea. BP(shock), jugular vein 7 cm. no trauma history.

a. pneumothorax

b. hemothorax

c. intracranial bleeding



9.patient with AST( ALT?) 5000, diagnosis

a. hepatitis

b. cholethiasis

c. pbs



10. many right upper abdominal pain questions



11. postpartum hemorrhage, management



13. enuresis. 5 year old boy



14. scenario, hirschsprung's disease, diagnosis

a. barium enema

b. barium upper G.I. Serieas

c. Colon scopy



15. all are kawasaki's disease except

a congestion of conjunctiva

b. strawbwrry tongue

c. universal lymphadenpathy

d. polymorphouse rash



16. 7 year old male. lower extrmities purpura. upper respiratory infection 1 week ago. diagnosis

a. henoch-schonlein purpura



17. stone in kidney 0.7 cm treatment

a. ESWL

b. expected treatment

c. drink a lot of water and wash out

d. surgery



18. which of the following incontinence is the best indication for surgery?

a. stress

b. urge

c. overflow



19.testicle torsion



20. tesicular tumor markera.

a.beta-hCG



21.treatment of scrotum varicocele

a. surgical ligation



22. 8 yo, inteligence was previously normal. have lots of spelling mistakes, physical exam is normal. management

a. psychiatric consultation

b. punishment

c. home work everyday.



23. a boy was normal in kindergarden and just start school. spelling mistakes diagnosis

a. learning disability

b. teacher-student problems



24. put chloride to swiming pool, what kind of method regarding disease control?

a. environment

b. environment + vector

c. vector



25. (B) medical student was thorn, there is blood in the needle. what do you test the blood?

student: HIV, HB, HC

patient:



26. old woman, syncope, current drugs: anti-HTN, anti-parkinson, diuretics. which drug is the cause?



27.Auto-dominant disease, parents has no disease, uncle has. the child's propobility to get the disease



28.new infant, abdominal mass, most possible diagnosis

a. hydronephrosis

b. wilm's tumor

c. neuroblastoma



29. duodenal atresia



30. Pregnant 2nd stage of labour, suddenly dyspnea, vaginal bleeding, shock. Diagnosis

a. Amniotic embolus

b. Brain aneurysm rupture

c.pulmonary embolism



31.(B) neighbor find walked in the back yard, no memory. Diagnosis.

a. Night walking,



32. After party, agressive behavior, tachycardia. what is the possible substance?

a. Cocaine.

b. Pcp.

c. LSD



33.a physician in a bar, somebody has disease. what can you do?

a. if you feel like your judgement was affected, don't come out.

b. as a doctor, you should come out

c. you have no responsibility.



34. 16 yo girl ask for OCP. what do you do?

a. ask for parents' consent

b. explain the benefit and complication and give her



35. (B) regular period, LMP 2 weeks ago, ask for OCP. what should you do?

a. parents' consent

b. ABC

c. Pregnancy test.

d. liver, kidney function

e. STD

f. annual physical exam

g. pap smear



36. acne management.

a. avoid chocolate

b. avoid fat

c.fiber

d. wash face, keep sanita

e. food is not affective



37. (B) dementia, delirium differenciation



38.picture, teenager, valva lichen, examination and management.



39. (B) post operation, lower limb pain. diagnosis



40 (B) lower limb malleolus ulcer, big area, diagnosis.



41. play game, should pain where at 90-120 degree abduction, diagnosis.



42. (B) skiing, "pop" sound, knee pain, swelen. unstable, feel like the knee drop of. diagnosis.



43. family doctor, holiday, how to take care of the patients

a. leave the patients to other doctors

b. keep resposibility

c. find replacement

d. responsibility depend on the community



44. antipsychotic drugs administration for several months showed twich on face, diagnosis

a. akathisia

b. dystonia

c. parkinsonism