MCCQE1 ques and CASES with answers

PEDIATRICS . . . CONT.


51. Turner syndrome is associated with the following clinical features

EXCEPT:

a) major learning difficulties

b) short stature

c) primary amenorrhea

d) broad chest

e) wide carrying angle at elbows

52. Which statement concerning delayed puberty is false?

a) defined absence of pubertal development by age 13 in girls

and age 14 in boys

b) the most common cause is constitutional delay

c) chronic disease may cause growth delay

d) delayed puberty in males is more suggestive of pathology than

delayed puberty in females

e) bone age is an important investigation in determining the

cause of delayed puberty in both males and females

53. A 3 year old Asian girl presents with a fever of 6 days, red lips and

tongue, bilateral nonpurulent conjunctivitis, cervical

lymphadenopathy and a polymorphic rash.

The most likely diagnosis is:

a) Streptococcal pharyngitis

b) Kawasaki’s disease

c) infectious mononucleosis

d) adenoviral infection

e) none of the above

54. Which of the followng statements concerning minimal lesion

glomerulonephritis is correct?

a) it is a common cause of nephrotic syndrome in children, but it

is a very rare cause of nephrotic syndrome in adulthood

b) glomerular filtration rate is usually preserved

c) it is usually unresponsive to treatment such as prednisone and

cyclophosphamide

d) it is most often accompanied by severe hypertension

e) the urine typically shows red blood cell casts (suggestive of

proliferative glomerulonephritis)

55. A 1100 gram infant born at 36 weeks gestation develops respiratory

distress syndrom and requires supplemental oxygen until 4 months

of age. A CXR then shows hyperinflation of both lungs and cystic

changes in the bases. The most likely diagnosis is:

a) bronchopulmonary dysplasia

b) cor pulmonale

c) presistant pulmonary hypertension

d) pneumonia

e) cystic adenomatoid malformation of the lung

56. Breat feeding is a contraindication to which of the following

vaccinations?

a) diptheria

b) influenza

c) MMR

d) hepatitis B

e) none of the above

57. A 6 month old infant presents in the winter with fever, cough,

wheezing, tachypnea and decreased appetite. A CXR shows

hyperaeration and streaky perihilar infiltrates bilaterally. You diag

nose bronchopneumonia. Which organism whould likely be causing

this child’s infection?

a) chlamydia pneumonia

b) mycoplasma pneumonia

c) streptococcus pneumonia

d) haemophilus influenza

e) respiratory syncitial virus

58. Prostaglandin E1 infusion can be used for the initial management in

each of the following neonatal heart lesions EXCEPT:

a) pulmonary atresia

b) coarctation of the aorta

c) Tetralogy of Fallot

d) patent ductus arteriosus

e) hypoplastic left heart syndrome

38 – Sample Questions MCCQE 2002 Review Notes

PHARMACOLOGY

1. The first pass effect refers to:

a) the first time the drug reaches its site of action

b) passage of the drug from the skin into the body

c) metabolism of the drug by the liver

d) passage of the drug from the lung into the systemic

circulation

e) metabolism of the drug by kidneys

2. A patient with hypoalbuminemia requires:

a) a higher dose of a highly protein bound drug

b) the same dose of drug protein binding doesn’t

matter

c) a lower dose of a highly protein bound drug

d) no drug at all its just too dangerous

3. Compared to water soluble drugs lipid soluble drugs:

a) are larger molecules

b) have higher ionizations

c) diffuse more easily through membranes

d) more easily absorbed if given IV

4. The primary site of absorption of most drugs is the:

a) mouth

b) skin

c) stomach

d) small intestine

e) lungs

5. The primary site of biotransformation of most drugs

is the:

a) liver

b) lung

c) small intestine

d) skin

e) kidneys

6. The main route of excretion for most drugs is the:

a) liver

b) lung

c) small intestine

d) skin

e) kidneys

7. Regarding phase I drug reactions which is NOT correct:

a) they are oxidation, reduction or hydrolysis reactions

b) they involve conjugation with polar endogenous

substrates

c) they increase the water solubility of the drug

d) they include the P450 mediated reactions

8. Regarding first order kinetics for drug metabolism which

is NOT true:

a) a constant fraction of drug is eliminated per unit

of time

b) elimination is based on drug concentration

c) drugs may go from zero to first order kinetics when

the receptor is saturated

d) it is a non-linear relation

9. A drug with a half life of 24 hours will take ____ to reach

steady state:

a) 12 hours

b) 24 hours

c) 48 hours

d) 96 hours

e) 120 hours

10. Regarding the figure below

a) Drug A is less potent than drug B

b) Drug A is less efficacious than drug B

c) Drug A is more efficacious than drug C

d) Drug A is equally efficacious to drug C

e) Drug A is equally potent to drug C

11. A drug with a narrow therapeutic index:

a) never requires therapeutic drug monitoring

b) always require therapeutic drug monitoring

c) can be given over a wide dose range with little worry

about toxicity

d) has a TD50 at a lower concentration than the ED50

e) has an ED50 that is very close to the TD50

12. The following is TRUE regarding type A adverse drug

reactions

a) they account for 80% of all adverse drug reactions

b) they are an extension of the drugs pharmacological

effect

c) they are predictable

d) they require discontinuation of the drug

e) they require a dose reduction of the drug

Response e.g. % of

receptors blocked

Log Dose

C

B

Potency

A > B > C

Efficacy

A = C > B

A

100%

60%

50%

25%

MCCQE 2002 Review Notes Sample Questions – 39

PLASTIC SURGERY

1. A 23 year-old male was involved in a snowmobile

accident and sustained a closed displaced humeral shaft

fracture. His neurovascular status is normal. You realign

the fracture and place him in a splint. Prior to discharge

he states he has numbness over the dorsum of this hand

and he is unable to extend his metacarpophalangeal

joints. Which of the following would you suspect to be

the cause?

a) ulnar nerve was damaged at the time of the fracture

b) radial nerve was damaged at the time of the fracture

c) radial nerve is trapped in the fracture site

d) ulnar nerve is compressed by hematoma

e) median nerve is trapped in fracture site

2. A 55 year old female complains of numbness and

discomfort in her right hand, which is awakening her from

sleep. Similar symptoms occur while steering the car

or writing. You suspect carpal tunnel syndrome.

Which of the following would lead you to consider

alternative diagnoses?

a) absence of sensory loss on testing with pinprick

b) absence of thenar muscle wasting

c) absence of weakness of abductor pollicis brevis

d) presence of rheumatoid arthritic changes in the

hands

e) wasting of the thenar, hypothenar and interosseous

muscles of the right hand

3. Which antibiotic is the first line drug of choice for an

otherwise uncomplicated human bite infection of the

hand?

a) Gentamicin

b) Penicillin

c) Flagyl

d) Cephalexin

e) Erythromycin

4. Which of the following is correct regarding

hemangiomas?

a) they usually will require surgery

b) most present in the teenage years

c) they usually resolve on their own

d) most are found on the extremities

e) they are composed mostly of dilated veins

5. All the following are common conditions seen with a

rheumatoid hand EXCEPT:

a) synovitis

b) radial drift

c) thumb deformity

d) Swan neck deformity

e) Boutonniere deformity

6. A 23 year old man is involved in a house fire, sustaining

second and third degree burns to his face, anterior chest

and trunk, entire left arm, groin, and both legs

circumferentially. What is the estimated TBSA involved in

the burn?

a) 68.5%

b) 67.5%

c) 46%

d) 55%

7. All of the following burns require extra fluid

administration EXCEPT:

a) burns greater than 70% TBSA

b) electrical burn

c) inhalation injury

d) pediatric burns

e) 4º burns

8. All of the following are complications of breast implants

EXCEPT:

a) capsular contraction

b) increased risk of infection

c) breast asymmetry

d) systemic inflammatory reaction

9. All of the following statements are true concerning a

hypertrophic scar EXCEPT:

a) it frequently improves with corrective surgery

and/or pressure

b) it is more common in blacks

c) it does not outgrow its border

d) it occurs soon after surgery and usually

subsides with time

10. Regarding fractures of the mandible, all of the following

are correct, EXCEPT:

a) they frequently are compound

b) they produce numbness of the lip

c) deformity and malocclusion are the usual

presenting features

d) the muscles of mastication keep fragments

from displacement

e) the majority can be treated by dental fixation

11. All of the following are true statements regarding wound

contractures EXCEPT:

a) contracture is due to dehydration of coagulum and is

not an active, energy-dependent process

b) contracture begins at about the fourth or fifth post

wound day

c) myofibroblasts move surrounding dermis inward

d) contraction may be inhibited by cytotoxic drugs

e) contracture occurs in an inflammatory milieu

12. During wound healing, collagen is laid down by:

a) the endothelial cell

b) the fibroblast

c) the wandering macrophage

d) the surrounding epithelium

e) none of the above

40 – Sample Questions MCCQE 2002 Review Notes

PSYCHIATRY

1. Monoamine oxidase inhibitor drugs are used in the

treatment of depression because they increase synaptic

levels of:

a) gamma-aminobutyric acid (GABA)

b) histamine

c) acetylcholine

d) norepinephrine

e) somatostatin

2. Neuropsychological effects of hallucinogens may include

all of the following EXCEPT:

a) miosis

b) tremor

c) hyper-reflexia

d) incoordination

e) blurred vision

3. Cocaine withdrawal can include all of the following

EXCEPT:

a) “Crash” sleep

b) anergia

c) anhedonia

d) euphoria

e) continued craving

4. Alcohol withdrawal includes all of the following EXCEPT:

a) autonomic hyperactivity

b) tremor

c) starts within 2-4 hours after prolonged drinking

d) nausea

e) irritability

5. Which would not be considered a risk factor for suicide in

patients presenting with suicidal ideation:

a) substance abuse

b) male gender

c) lack of social supports

d) unsuccessful attempt at suicide in the past

e) childless marriage

6. A 54 year-old man has become forgetful, preoccupied,

withdrawn, irritable and disheveled. His physical

examination was normal. The patient had been with his

company for twenty-two years and was considered an

excellent employee. Which of the following is the most

likely diagnosis:

a) multi-infarct dementia

b) hypothyroidism

c) schizophrenia

d) alcoholism

e) major depression

7. Which of the following is correct about depression in

children:

a) family therapy should be avoided because it

scape goats a child who is already vulnerable

b) symptoms may manifest as antisocial behaviour

c) antidepressants generally are not effective in

children

d) the suicide rate in children aged 8-13 is higher than

it is in older adolescents

e) depression in children has been shown to be a

prodrome to the later development of

schizophrenia

8. All of the following are classified as paraphilias EXCEPT:

a) fetishism

b) homosexuality

c) exhibitionism

d) sexual sadism

e) transvestism

9. A 32 year old engineer has been uncharacteristically

active for several weeks. He spends most of his time at

work and gets little sleep. He has told another engineer

that he is involved “in a research project that will earn

me the Nobel Prize”. Expensive research equipment

keeps arriving at his office. The engineer is irritable, and

it is hard to hold his attention. A classmate from

graduate school recalls that the patient behaved in a

similar twice during stressful periods at school.

Long-term drug therapy for this patient would likely

include:

a) haloperidol

b) valproic acid

c) clozapine

d) ascorbic acid

e) chlordiazepoxide

10. Elderly male depressives typically present with all of

the following EXCEPT:

a) importuning

b) anxiety

c) weight loss

d) little suicide risk

e) insomnia

11. From among the drugs listed below, which would be the

cause for most concern in an overdose:

a) paroxetine (SSRI)

b) amitriptyline (tricyclic)

c) diazepam (benzodiazepine)

d) chlorpromazine (phenothiazine)

e) fluoxetine (SSRI)

12. Which of the follow statements about schizophrenia

is false?

a) male schizophrenics to experience their first

psychotic episode at a younger age than women

b) male schizophrenics are more frequently

hospitalized than female schizophrenics

c) compared to young female schizophrenics, young

male schizophrenics are at increased risk of

movement disorders secondary to neuroleptics

d) in women, the symptoms of schizophrenia tend to

worsen after menopause

e) all of the above statements are true

13. A 29 year old school teacher who lives alone is brought to

the emergency room because she has become

increasingly suspicious, hyperactive, and anorexic over the

past two days. She believes that “people in the

neighbourhood are out to get me”. She has not slept

in 2 nights. She reports seeing snakes crawling on the wall.

Based on this information, the most likely diagnosis of the

woman’s problem is:

a) anorexia nervosa

b) cocaine withdrawal

c) paranoid personality

d) psychostimulant abuse

e) shared paranoid disorder

MCCQE 2002 Review Notes Sample Questions – 41

PSYCHIATRY . . . CONT.

14. Anti-α-1-adrenergic blockade causes:

a) nausea

b) constipation

c) orthostatic hypotension

d) dry mouth

e) drowsiness

15. The following are common side effects of SSRIs EXCEPT:

a) headache

b) sexual dysfunction

c) vomiting

d) anorexia

e) orthostatic hypotension

16. Clozapine is the neuroleptic of choice for

schizophrenia when:

a) the patient shows no evidence of tardive dyskinesia

b) the patient has not improved with adequate

dosages for 6 weeks of 3 other antipsychotics

c) the patient is under fifteen years of age

d) the patient has a WBC count of >10 000

e) the patient is very sensitive to anticholinergic

side effects

17. Frequent conditions appearing comorbidly with ADHD

include:

1) oppositional defiant and conduct disorders

2) anxiety disorder

3) learning disabilities

4) tic disorders

5) language disorders

Which are correct:

a) only 1 is correct

b) 1, 2, and 3 are correct

c) 2 and 4 are correct

d) all are true

18. A 35 year old man presents to the emergency room with

suicidal ideation. He describes significant stress due to

recent job loss and financial hardship. Further inquiry

reveals a history of repeated job loss, fraud charges, and

frequent arm slashing to decrease stress. The man was

not disruptive as a child. The most likely diagnosis is:

a) borderline personality disorder

b) antisocial personality disorder

c) adjustment disorder

d) dysthymic disorder

e) schizophrenia

19. Which of the following statements concerning childhood

abuse and neglect is false:

a) the abuser is commonly a friend or a relative

b) physical indicators of sexual abuse include bruising

or pain in the genital region

c) children who have been abused often present with

aggressive or anxious behaviors

d) Mmentally retarded or physically handicapped

children may be at increased risk of abuse

e) local child welfare authorities must be notified in

cases of suspected child abuse, however there is no

duty to report child neglect

20. Which of the following statements concerning anorexia

nervosa and bulimia nervosa is false:

a) patients with either of these eating disorders are

preoccupied with weight, food, and body shape

b) bulimia nervosa is more prevalent than is anorexia

nervosa

c) both of these eating disorders are more common in

females than in males

d) bulimia nervosa often presents earlier in

adolescence than does anorexia nervosa

e) bulimic symptoms may occur in both bulimia

nervosa and anorexia nervosa

21. A pattern of unstable but intense interpersonal

relationships, impulsivity, inappropriately intense anger,

identity disturbance, affective instability, and problems

with being alone suggest a diagnosis of:

a) antisocial personality disorder

b) narcissistic personality disorder

c) histrionic personality disorder

d) schizoid personality disorder

e) borderline personality disorder

22. The criteria for diagnosis of a factitious disorder include:

a) intentional production or feigning of physical signs or

symptoms

b) absence of secondary gain

c) possibility of economic gain

d) (a) and (b)

e) (a) and (c)

23. A patient with a fear of heights is brought to the top of a

tall building and required to remain there as long as

necessary for the anxiety to dissipate. This is an

example of:

a) graded exposure

b) participant modeling

c) positive reinforcement

d) flooding

e) relationship therapy

24. Hypnosis has been used successfully in all of the following

conditions EXCEPT:

a) pain

b) phobia

c) paranoia

d) anxiety

e) smoking

25. Cognitive therapy helps to correct which of the following

cognitive distortions:

a) depersonalization

b) psychotic thinking

c) over-generalizations

d) selective inference

e) hallucinations

26. The most frequently reported side effect of tricyclic

antidepressants is:

a) peripheral neuropathy

b) photosensitivity

c) agranulocytosis

d) jaundice

e) dry mouth

PSYCHIATRY . . . CONT.

27. A high risk of suicide is associated with which one of the

following factors:

a) female aged less than 30 years

b) married male less than 30 years

c) public setting

d) secondary gain from attempt

e) single male aged more than 60 years

28. A fixed unalterable belief that is false in its content and

in its social and cultural setting is called:

a) an illusion

b) a hallucination

c) a delusion

d) agnosia

e) paranoia

29. Criteria for involuntary hospitalization of a suicidal

patient include:

a) assessment done less than 72 hours prior to

completion of Form 1

b) presence of a mental disorder

c) acute risk of harm to themselves

d) (a), (b), and (c)

e) (b) and (c)

30. Each of the following statements about affective

disorders is true EXCEPT:

a) patients with bipolar disorder show roughly the

same frequency of positive family history as do

patients with unipolar disorder

b) major depressive illness is more common in women

than in men

c) bipolar affective disorder is far less common than

unipolar affective disorder

d) there is a different response to lithium in unipolar

and bipolar disorder

e) imipramine is more likely to produce hypomania in

bipolar patients than in unipolar patients

31. A major depressive disorder is diagnosed only when the

affective disturbance has existed for at least :

a) two weeks

b) four weeks

c) six weeks

d) eight weeks

e) twelve weeks

32. A 30 year-old man presents in emergency with right

lower quadrant abdominal pain. His wife reports that he

had been drinking heavily in response to marital

problems and had never had such pain before.

Appendicitis was diagnosed and an appendectomy was

successfully performed. Four days later the patient was

anxious, restless, unable to sleep and claimed his wife

was a stranger trying to harass him. The likeliest

diagnosis is:

a) paranoid reaction

b) delirium tremens

c) mania

d) schizophreniform reaction

e) post-operative delirium

33. Which of the following symptoms of schizophrenia

responds best to anti-psychotic medication:

a) asocial behavior

b) flat affect

c) paranoid delusions

d) lack of motivation

e) all of the above

34. A 53 year-old housewife presents with depression

marked by early morning wakening, diminished energy

and poor concentration. She is treated with supportive

psychotherapy and imipramine 100 mg qhs.

After four weeks she is no better. You would next:

a) reassure her that antidepressants take 5-6 weeks to

be effective

b) begin intensive psychotherapy

c) switch to a serotonin reuptake inhibitor

d) increase the dose to 150 mg qhs

e) add lithium carbonate 1200 mg daily

35. Hypertensive encephalopathy is a serious complication of

treatment with:

a) phenothiazines

b) tricyclic antidepressants

c) lithium carbonate

d) MAOI antidepressants

e) benzodiazepines

36. Electroconvulsive therapy (ECT) is a first line treatment in

which one of the following conditions?

a) obsessive compulsive disorder

b) paranoid schizophrenia

c) generalized anxiety disorder

d) acute mania

e) major depression with acute suicidal ideation

37. Tardive dyskinesia is:

a) an acute extrapyramidal side effect of phenothiazines

b) an acute anticholinergic side effect of tricyclic

antidepressants

c) a type of Parkinson’s disease

d) a side effect of excessive ECT treatments

e) a long term complication of chronic phenothiazine

administration

38. Which of the following symptoms is most commonly found

in schizophrenia?

a) depressed mood

b) flight of ideas

c) elevated mood

d) delusional fears

e) thought insertion

39. Patients with conversion disorders will show each of the

following EXCEPT:

a) “La belle indifference”

b) severe depression

c) loss of special sense function

d) secondary gains

e) paralysis of voluntary muscles

42 – Sample Questions MCCQE 2002 Review Notes

MCCQE 2002 Review Notes Sample Questions – 43

PSYCHIATRY . . . CONT.

40. The syndrome of delirium tremens is associated with

each of the following EXCEPT:

a) rapidly fluctuating level of consciousness

b) dehydration

c) visual hallucinations

d) renal failure

e) polyneuropathy

41. Which of the following is best treated with high dose

benzodiazepines:

a) schizophrenia, catatonic type

b) major depression

c) generalized anxiety disorder

d) delirium tremens

e) psychogenic amnesia

42. Personality types predisposed to depression include

which one of the following:

a) dependent

b) antisocial

c) schizoid

d) paranoid

e) schizotypal

43. Which of the following neurological symptoms can be

produced by antipsychotic drugs?

a) akathesia

b) shuffling gait

c) oculogyric crisis

d) tremor at rest

e) all of the above

44. Absolute contraindications to ECT include:

a) pregnancy

b) recent myocardial infarction

c) fractured pelvis

d) brain tumor

e) all of the above

45. In the elderly delirium may be produced by the use of:

a) neuroleptics

b) tricyclic antidepressants

c) antiparkinsonian agents

d) minor tranquilizers

e) all of the above

46. Which of the following statements about simple phobia

is correct?

a) it responds well to simple reassurance

b) it responds well to individual psychotherapy

c) it responds well to benzodiazepines

d) it responds well to relaxation and desensitization

e) all of the above

47. Toxicity due to lithium carbonate is associated with all

of the following EXCEPT:

a) nausea

b) serum lithium level of 0.1 mEq/L

c) tremulousness

d) convulsions

48. Which of the following investigations need not be

performed before starting treatment with lithium

carbonate?

a) serum creatinine

b) serum electrolytes

c) thyroid function studies

d) serum bilirubin

e) all of the above

49. All of the following are common side effects of tricyclic

antidepressants EXCEPT:

a) dry mouth

b) constipation

c) parkinsonian tremor

d) tachycardia

50. The Theory of Behavioral Therapy employs which of the

following concepts:

a) reaction formation

b) reinforcement

c) imprinting

d) autosuggestion

e) sublimation

51. Which of the following represents a contraindication for

psychoanalysis?

a) the existence of transference feeling toward the

analyst

b) the existence of countertransference feeling in the

analyst

c) the resistance to change by the patient

d) preoccupation with resolving a crisis situation

e) the existence of an underlying neurotic style of

behaviour

52. Which of the following is least helpful in treating

depression?

a) phenelzine

b) imipramine

c) lithium carbonate

d) lorazepam

e) all of the above

53. A young mother is very focused on the health of her

16 month-old. She keeps her house immaculate for fear

that dirt will harm her baby, she checks the lock on the

door at least ten times before retiring to bed, and she has

to get up and check that her child is still breathing at least

3 times every night. She knows that her fears are irrational

but persists with these behaviors. The most likely

diagnosis is:

a) paranoid delusions not otherwise specified

b) post-partum depression

c) obsessive compulsive disorder

d) generalized anxiety disorder

e) paranoid personality disorder

54. A thorough assessment for the presence/absence of

alcohol withdrawal should include questions about all of

the following EXCEPT:

a) nausea and vomiting

b) mood

c) difficulty walking (ataxic gait)

d) visual disturbances

e) tremulousness

44 – Sample Questions MCCQE 2002 Review Notes

PSYCHIATRY . . . CONT.

55. Which of the following will be least helpful with respect

to distinguishing delirium from dementia:

a) disorientation at night

b) duration of disorientation

c) fluctuating level of consciousness

d) mini mental status examination

e) presence of visual hallucinations

56. Onset of schizophrenia is typically in an affected

individual’s:

a) early teens

b) late teens/early 20s

c) late 20s/early 30s

d) late 30s/early 40s

e) late 40s/early 50s

57. Which of the following is an example of a negative

symptom of schizophrenia:

a) nihilistic delusion

b) flat affect

c) auditory hallucinations

d) catatonic behaviour

e) all of the above

58. Helpful treatments for post-traumatic stress disorder

symptoms include the following except:

a) SSRIs

b) relaxation techniques

c) exposure therapy

d) cognitive restructuring

e) all of the above may be helpful

59. The primary difference between factitious disorder and

malingering is:

a) factitious disorder involves the feigning of

symptoms for external rewards (e.g. economic gain)

b) factitious disorder involves the unintentional

production of symptoms

c) there is an absence of primary gain in factitious

disorder

d) factitious disorder can involve only psychological

symptoms

e) there is an absence of secondary gain in factitious

disorder

60. The following features tend to differentiate atypical

antipsychotics from typical/conventional antipsychotics

EXCEPT:

a) atypicals are serotonin-dopamine antagonists

b) atypicals tend to result in more specific dopamine

blockade

c) atypicals tend to result in lower levels of prolactin

d) atypicals tend to cause fewer extrapyramidal side

effects

e) atypicals tend to be more effective for the

treatment of negative symptoms

61. Which of the following statements is true about sexual

dysfunction:

a) it is secondary to physical factors alone

b) it occurs only in females

c) the commonest cause is medications

d) psychological factors account for 10% in women

e) none of the above

62. Which of the following statements is true about

premature ejaculation:

a) most common male sexual dysfunction

b) usually secondary to performance anxiety

c) has a 90% success rate with regards to treatment

d) treatment includes: excercises to focus on

experience vs performance, increasing stimulation

and control exercises

e) all of the above

63. Which of the following statements is true about paraphilias:

a) almost never diagnosed in women

b) treated with androgen drugs

c) includes: exhibitionism, fetishm, voyeurism,

pedophilia

d) a and b

e) a and d

64. All of the following statements are correct EXCEPT:

a) female orgasmic disorder can be caused by

denervation of the lumbosacral spine

a) having a rigid, conservative sexual upbringing can

result in delayed ejaculation in men

a) phenothiazines are used to treat delayed ejaculation

disorder in males

a) most delayed ejaculation is situational

a) most orgasmic disorders in women are psychological.

65. Major Depressive Disorder with melancholic features is

most likely accompanied by:

a) echololia and /or echopraxia

b) hypersomnia

c) severe anhedonia

d) weight gain

e) inappropriate posturing

66. Long acting antipsychotic medications:

a) are available in both typical and atypical preparations

b) are administered IM or SC

c) are first line treatment for severe schizophrenia

d) are less likely to cause EPS compared to the oral form

e) should be ideally started after the patient has had

exposure to the oral form

67. A 55-year-old man with chronic schizophrenia is brought to

the E.R. He is diaphoretic, pale and has a temperature of

41ºC, blood pressure of 170/100, and heart rate of 120. He

also exhibits muscle rigidity and a fluctuating level of

consciousness. The most diagnosis is:

a) acute dystonic reaction

b) tardive dyskinesia

c) neuroleptic malignant syndrome

d) psychosis secondary to a general medical condition

e) substance-induced psychosis

68. Obsessive-compulsive disorder is most consistent with:

a) perfectionism, meticulous organization and

cleanliness

a) the persistent need to shower because of the belief

that aliens are contaminating one’s body

b) recurrent and intrusive thoughts that are inserted into

one’s mind by others

c) a persistent preoccupation with food and one’s

appearance accompanied by bingeing, purging and/or

restricting behaviours

d) compulsively avoiding cracks in the side walk for fear

that if one does not, a relative might be subject to

harm

69. Bipolar disorder may be characterized by:

a) rapid cycling: at least one episode (manic or

depressed) every 4 weeks

b) an increased risk in females

c) a lower risk in higher socioeconomic groups due to

decreased psychosocial stressors

d) hypomanic episodes without depressed episodes, as

in Bipolar II disorder

e) none of the above

MCCQE 2002 Review Notes Sample Questions – 45

RESPIROLOGY

1. which of the following is an incorrect statement regarding

transudative pleural effusions?

a) pleural LDH/serum LDH is > 0.6

b) pleural protein/serum protein is < 0.5

c) pelural LDH <2/3 upper limit of normal serum LDH

d) all of the above

e) none of the above

2. Which of the following organisms causes

“walking pneumonia”?

a) S. aureus

b) S. pneumoniae

c) H. fluenzae

d) Mycoplasma

e) Legionella

3. Which of the following is considered a positive tb skin

test?

a) induration of > 5 mm in close contact with an

HIV positive individual

b) induration of < 5 mm in an adult with no risk factors

c) induration of < 5 mm in a person with silicosis

d) induration of > 5 mm in a person with known TB

exposure

4. The following are typical chest x-ray findings of a

malignant solitary nodule:

a) > 3 cm

b) ill-defined margins

c) “popcorn” pattern of calcification

d) associated pleural effusions

e) cavitation with thick wall

5. All of the following but one are indicative of poorly

controlled asthma:

a) night time awakenings

b) use of a beta-agonist 2x/week

c) mild limitation of activities

d) chronic dry cough

6. All of the following but one are typical chest x-ray

findings in a person with COPD:

a) hyperinflation

b) flat hemidiaphragm

c) increased AP diameter

d) increased retrosternal air space

e) increased peripheral markings

7. Which of the following is NOT an indication of home

O2 in a person with COPD?

a) PaO2 < 55 mmHg

b) PaO2 < 60 mmHg with erythrocytosis

or cor pulmonale

c) persistant hypoxemia after 3 weeks of

maximal therapy

d) PaO2 maintained > 80 mmHg during wakeful res

increased by 250 ml during exercise or sleep

8. Which of the following are associated with upper

lobe fibrosis?

a) farmer’s lung

b) silicosis

c) sarcoid

d) histiocytosis

e) X asbestos

9. The differential diagnosis of obstructive lung disease

includes:

a) COPD

b) asthma

c) bronchiectasis

d) CF

e) chest wall disease

10. Which is NOT a feature of adenocarcinoma of the lung?

a) solitary peripheral pulmonary nodule

b) may appear as an alveolar infiltrate simulating

pneumonia

c) frequently unilateral

d) metastasizes early

46 – Sample Questions MCCQE 2002 Review Notes

RHEUMATOLOGY

1. 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) Behçet’s disease

d) acquired immune deficiency syndrome

e) psoriatic arthritis

2. 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

3. 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)

4. Which of the following is true about serologic testing in

SLE?

a) A positive 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

5. 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

6. 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)

7. Which of the following is not a disease modifying agent for

rheumatoid arthritis?

a) infliximab

b) gold

c) high dose corticosteroid

d) methotrexate

e) hydroxychloroquine

8. A 25-year-old male presents to the emergency room with a

6-week history of progressive weakness. On questioning,

the man has difficulty combing his hair, brushing his teeth,

and climbing stairs. Night sweats, fever and malaise are

present. He has noticed a purplish swelling around his

eyes. Bloodwork shows a high AST and ALT. ALP is

normal. High on your differential diagnosis is:

a) rheumatoid arthritis

b) trauma-related back pain

c) inflammatory myopathy

d) polyarteritis nodosa

e) polymyalgia rheumatica

9. A 39-year-old female presents to your office with an

insidious onset of right knee pain. The differential

diagnosis includes:

a) synovitis

b) degenerative arthritis

c) ligament derangement

d) bursitis

e) all of the above

10. Systemic lupus erythematosus may be characterized by all

of the following EXCEPT:

a) hemolytic anemia

b) discoid rash

c) serositis

d) erosive arthritis

e) psychosis

11. Physical examination manoeuvres specific to inflammatory

spondyloarthropathies include all of the following EXCEPT:

a) straight leg raising

b) occiput-wall distance

c) chest expansion

d) Schöeber’s test

MCCQE 2002 Review Notes Sample Questions – 47

RHEUMATOLOGY . . . CONT.

12. Cautions and contraindications of NSAIDs include:

a) a creatinine of 180 mmol/L

b) peptic ulcer disease

c) warfarin use

d) cirrhosis

e) all of the above

13. Small vessel vasculitides include all of the following

EXCEPT:

a) Wegener’s granulomatosis

b) Churg-Strauss syndrome

c) essential cryoglobulinemia vasculitis

d) Kawasaki’s disease

e) predominantly cutaneous vasculitis

14. A 30-year-old male presents with a history of mild upper

respiratory tract infection progressing to a severe cough

and hemoptysis. Upon examination, you note a

nasoseptal perforation. Tests you should order include:

a) chest x-ray

b) urine routine and microscopy

c) CBC

d) c-ANCA

e) all of the above

15. A 50-year-old female presents with headache, scalp

tenderness and painless loss of vision in her right eye.

Your initial management is:

a) temporal artery biopsy

b) prednisone 1mg/kg

c) infliximab infusion

d) cyclophsophamide 2mg/kg

e) consult to Ophthalmology

16. Psoriatic arthritis may be characterized by:

a) subungual hyperkeratosis

b) DIP involvement

c) conjunctivitis

d) dactylitis

e) all of the above

17. All of the following statements about septic arthritis are

true EXCEPT:

a) permanent joint damage can quickly occur

b) N. gonorrhea accounts for 75% of cases in young

adults

c) Salmonella species characteristically infect those

with idiopathic thrombocytopenic purpura

d) predisposing factors include prior antibiotic use

e) IV antibiotics should be started empirically

18. Cauda equina syndrome is characterized by the following

EXCEPT:

a) saddle anesthesia

b) urinary retention

c) weak plantar flexion

d) decreased anal sphincter tone

e) posterior thigh pain

19. First line pharmacologic treatment for osteoarthritis is:

a) acetaminophen 1000 mg po QID

b) celecoxib 200 mg po BID

c) glucosamine 500 mg po QID

d) ibuprofen 400 mg po TID

e) depo-medrol 20 mg intra-articularly

20. Which of the following medications is not associated with

drug-induced lupus syndrome?

a) isoniazid

b) propranolol

c) hydralazine

d) cyclosporine

d) carbamazepine

21. A 30-year-old woman comes to your office with a 1-day

history of right knee pain and swelling. She has never had

joint pain. She spent the day before working in her

garden, and was kneeling for most of the time. She has no

other associated symptoms, but has had several sexual

partners within the last year. You aspirate her knee

because you are worried about septic arthritis and send

requisitions for cell counts, microscopy, stat Gram stain,

glucose, LDH and culture. The lab phones you back in the

next hour with the following results:

WBC 40,000

% PMN 35%

Stat Gram stain negative

Crystals negative

Glucose 1.1mmol/L

What is your next step?

a) Send the patient home and advise her to take extrastrength

acetaminophen - this is probably traumatic

b) Advise her to go to the emergency room with a letter

instructing the emergency staff to draw blood cultures

and start antibiotics

c) Give the patient intra-articular steroids

d) Send the patient home and ask her to return to your

office tomorrow

e) Refer her to a rheumatologist

48 – Sample Questions MCCQE 2002 Review Notes

UROLOGY

1. An 84 year old man presents to your office complaining

of a five day history of passing terminal bright red

bloody

urine. He reports marked urgency and frequency but is

otherwise well and afebrile. In retrospect, he remembers

being quite ill with an infection in the recent past.

Analysis of a voided specimen shows 3 smooth and

rounded RBCs/hpf. Which of the following is NOT

included in your differential diagnosis?

a) benign prostatic hpertrophy (BPH)

b) post-streptococcal glomerulonephritis

c) a stone lodged at the vesico-ureteric junction

d) a superficial bladder tumour

e) a coliform positive UTI

2. Of the following conditions, which is not considered a

urological emergency?

a) paraphimosis

b) priapism

c) orchitis

d) testicular torsion

e) autonomic dysreflexia

3. A normal semen analysi includes all of the following

EXCEPT:

a) pH between 7.5-8.1

b) a sperm count > 20 million sperm/ml

c) WBC < 10/hpf

d) motility > 50%

e) > 60% normal morphological forms

4. A mother brings her toilet-trained, 5 year old daughter

to see you with a 3 day history of dysuria, increased

frequency, and urgency incontinence. Her past medical

history is significant for a bag-specimen positive UTI

charaterized by high fever and vomiting at 2 years of age.

At the time, she was lost to follow up. Which of the

followin would be appropriate for your initial

management of this patient?

a) voiding cystourethrogram (VCUG)

b) a mid stream urine specimen

c) nuclear cystogram

d) DMSA renal scan

e) abdominal ultrasound

5. A 55 year old man reluctantly admits to difficulty in

maintaining an erection sufficient for sexual intercourse

for the past two years. He reports being healthy,

however, he has not seen a physician in 10 years. Which

of the following would not suggest a potential cause for

his erectile dysfunction?

a) elevated blood pressure

b) galactorhea

c) acanthosis nigracans

d) varicocele

e) eruptive xanthoma

6. A 50 year old man presents with a 2 month history of

irritative voiding symptoms and a fever. He initially saw

his family doctor who treated him for cystitis with

ciprofloxacin for 5 days. He now presents to you because

his symptoms have returned soon after he finished his

course of antibiotics. All of the following are likely

TRUE except:

a) he never had a UTI

b) he might have complained of discomfort when

riding a bicycle

c) he might have also experienced back pain

d) this patient does not need to be investigated

e) he could of had prostatitis and should have been

treated at least 3 weeks

MCCQE 2002 Review Notes Sample Questions – 49

ANSWERS TO SAMPLE QUESTIONS

ANESTHESIA

1. B 2. B 3. D 4. C 5. B 6. A 7. B 8. E 9. C 10. C

11. A 12.D 13. C 14. C

CARDIAC AND VASCULAR SURGERY

1. 2. 3. 4. 5.

CARDIOLOGY

1. B 2. B 3. C 4. D 5. C 6. B 7. D 8. E 9. D 10. A

COMMUNITY HEALTH

1. B 2. D 3. D 4. A 5. D 6. D 7. E 8. A 9. B 10. A

11. B 12.E 13.E 14. A 15. C 16. D 17. C 18.E

DERMATOLOGY

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

21. D

EMERGENCY MEDICINE

1. C 2. C 3. B 4. D 5. D 6. E 7. E 8. B 9. C 10. B

11. B 12.B 13.B 14. E 15. D

ENDOCRINOLOGY

1. B 2. D 3. C 4. A 5. E 6. C 7. B 8. B 9. C 10. C

11. D 12.C 13.C 14. A 15. B 16. B 17. C 18.B 19. E 20. B

21. E 22.A

FAMILY MEDICINE

1. C 2. D 3. B 4. E 5. A 6. C 7. D 8. A 9. C 10. B

11. D 12.E 13. B 14. C

GASTROENTEROLOGY

1. B 2. A 3. D 4. C 5. B 6. C 7. E 8. B 9. C 10. D

11. A 12.B 13.C 14. A 15. A 16. B

50 – Sample Questions MCCQE 2002 Review Notes

ANSWERS TO SAMPLE QUESTIONS . . . CONT.

GERIATRIC MEDICINE

1. B 2. D 3. E 4. B 5. A

GYNECOLOGY

1. B 2. C 3. B, C, E, F, G, H, I 4. B, C, D, E, F, G, H 5. 1, B, C, D, E, G 6. B, C, F

7. A, B, E, G 8. B, C, G 9. A, E, F 10. A, B, C, D, F, G, H, I 11. E 12. A

13. D 14. E 15.E

HEMATOLOGY

1. B 2. D 3. E 4. B 5. A

INFECTIOUS DISEASES

1. D 2. A 3. C 4. D 5. B 6. E 7. B 8. D 9. C 10. E

11. B 12.C 13.B 14. A 15A

NEPHROLOGY

1. A 2. C 3. C 4. D 5. C 6. B 7. A 8. A 9. B 10. B

11. D 12.B 13.B 14. A 15. D

NEUROLOGY

1. B 2. D 3. A 4. C 5. C 6. D 7. A 8. E 9. C 10. C

11. E 12.D

NEUROSURGERY

1. B 2. D 3. B 4. A 5. C 6. D 7. B 8. A 9. B 10. C

11. D 12.D 13.C 14. B 15. A

OBSTETRICS

1. D 2. D 3. E 4. E 5. B 6. E 7. A 8. A 9. A 10. A

11. A 12.D 13.A 14. D 15. D

OPHTHALMOLOGY

1. B 2. A 3. B 4. C 5. D 6. B 7. D 8. A 9. C 10. C

11. A 12.C 13.D 14.B 15.A 16.C 17.D 18.C 19.B 20.C

21.A 22.C 23.B 24.E

ORTHOPEDICS

1. B 2. C 3. D 4. B 5. E

MCCQE 2002 Review Notes Sample Questions – 51

ANSWERS TO SAMPLE QUESTIONS . . . CONT.

OTOLARYNGOLOGY

1. C 2. B 3. C 4. E 5. B 6. B 7. D 8. C 9. C 10. A

11. B 12.B 13.C 14. D 15. C 16. A 17. B 18.D 19. C 20. B

21. C 22.C 23.B 24. D 25. B 26. E 27. C 28.D

PEDIATRICS

1. E 2. A 3. A 4. B 5. C 6. B 7. E 8. A 9. B 10. E

11. D 12.B 13.D 14. B 15. B 16. B 17. B 18.C 19. A 20. A

21. E 22.B 23.D 24. C 25. B 26. C 27. C 28.B 29. C 30. C

31. D 32.B 33.A 34. C 35. C 36. A 37. C 38.E 39. D 40. C

41. A 42.B 43.B 44. E 45. D 46. A 47. B 48.D 49. A 50. D

51. A 52.D 53.B 54.B 55. A 56. E 57. E 58.D

PHARMACOLOGY

1. C 2. C 3. C 4. D 5. C 6. E 7. B 8. D 9. E 10. D

11. 12.D

PLASTIC SURGERY

1. C 2. E 3. B 4. C 5. B 6. A 7. A 8. D 9. B 10. D

11. A 12.B

PSYCHIATRY

1. D 2. A 3. D 4. C 5. E 6. E 7. B 8. B 9. C 10. D

11. B 12.E 13.D 14. C 15. E 16. B 17. D 18.A 19. E 20. D

21. E 22.E 23.D 24. C 25. E 26. E 27. E 28.C 29. E 30. A

31. A 32.B 33. C 34. D 35. D 36. E 37. E 38.D 39. B 40. D

41. D 42.A 43.E 44. D 45. E 46. D 47. B 48.D 49. C 50. B

51. D 52.D 53.C 54. C 55. A 56. B 57. B 58.E 59. C 60. B

61. C 62.E 63.A 64. C 65. C 66. E 67. C 68.E 69. E

RESPIROLOGY

1. A 2. D 3. A 4. C 5. B 6. E 7. D 8. E 9. E 10. C

RHEUMATOLOGY

1. A 2. E 3. C 4. B 5. E 6. D 7. C 8. C 9. E 10. D

11. A 12.E 13.D 14. A 15. B 16. E 17. C 18.E 19. A 20. D

21. B

UROLOGY

1. B 2. C 3. A 4. A 5. D 6. D

52 – Sample Questions MCCQE 2002 Review Notes

KEY FEATURE QUESTIONS

Instructions for Examinees

“Key Feature” questions can pertain to solutions of clinical cases that involve data-gathering (e.g., history taking, physical examination, laboratory investigations),

diagnosis or treatment.

The Key Feature questions will ask for your answers in different ways: you may be asked to (i) select the correct response(s) from a menu of options, or

(ii) print the correct answer(s) on a blank line.

Please note the following guidelines before proceeding:

1. After reading the description of the case, read the question carefully. Take note as to whether you are told the maximum number of answers to

provide. If you exceed this number, you will receive no credit for the question. If you select or list fewer answers, you will still receive credit

for any of your answers which are correct.

2. If you are asked to select your answers from a menu:

a. Read the complete menu of options before recording your answers.

b. Make certain that the number of answers you record is not greater than the number you have been asked to select.

3. If you are asked to list your answers below the question:

a. Ensure that you print each answer legibly.

b. Record each answer on a separate blank line.

c. Do not record more than the maximum number you are asked to list.

CASE1

A 30 year-old homeless male presents with a 4 week history of feeling

generally unwell with anorexia, weight loss and intermittent fever. He

lives primarily on the streets or occasionally in a men’s shelter. He admits

to regular use of intravenous heroin for the last seven years and often

shares needles.

QUESTION 1 (CASE 1)

Given this history, which of the following diagnoses would you consider?

Select up to five.

1. Acute pancreatitis

2. AIDS related complex

3. Aspergillosis

4. Bacterial endocarditis

5. Chronic pancreatitis

6. Delirium tremens

7. Diabetes mellitus

8. Hepatitis B

9. Hepatocellular carcinoma

10. Histoplasmosis

11. Leukemia

12. Lymphoma

13. Osteomyelitis

14. Peptic ulcer disease

15. Pericarditis

16. Pyelonephritis

17. Renal failure

18. Secondary syphilis

19. Talc pneumonitis

20. Tuberculosis

QUESTION 2 (CASE 1)

A mitral regurgitant murmur is auscultated in this patient.

His temperature is 39.0ºC.

Which of the following other findings may be found on physical examination

given the diagnoses being considered?

Select up to five.

1. Ascites

2. Campbell De Morgan spots

3. Cannon “a” waves

4. Cyanosis

5. Erythema nodosum

6. Follicular keratosis

7. Gynecomastia

8. Hepatomegaly

9. Janeway lesions

10. Jaundice

11. Koilonychia

12. Livedo reticularis

13. Osler nodes

14. Pallor

15. Palmar erythema

16. Papilledema

17. Purpura

18. Roth spots

19. Spider nevi

20. Splenomegaly

MCCQE 2002 Review Notes Sample Questions – 53

KEY FEATURE QUESTIONS . . . CONT.

CASE 2

A babysitter brings a 14-month-old to emergency because of inconsolable

crying. The child appears well cared for and healthy but a

"bruise" is noted on the left humerus and a well-circumscribed small

fresh burn is noted on the other shoulder.

QUESTION 3 (CASE 2)

List four well recognized risk factors for child abuse:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

4. _____________________________________________________________

QUESTION 4 (CASE 2)

Which of these physical findings are most suggestive of child abuse?

Select up to four.

1. Alopecia

2. Blue sclera

3. Bruises on shins and elbows

4. Buttocks wasting

5. Caput medusa

6. Clubbing

7. Condylomata acuminata

8. Eczema

9. Full fontanelle

10. Healed laceration on chin

11. Hutchison teeth

12. Impetigo

13. Large purple macular lesion on buttock

14. Limp

15. Oral thrush

16. Petechiae

17. Pitted finger nails

18. Proptosis

19. Retinal hemorrhage

20. Seborrhea

QUESTION 5 (CASE 2)

You suspect this is a case of child abuse. Which of the following are

appropriate steps in the initial management. Select up to four.

1. Abdominal ultrasound

2. Ascorbic acid level

3. Bone density studies

4. CBC

5. Chest x-ray

6. Coagulation studies

7. Creatinine

8. Dietary history

9. ECG

10. Factor VIII assay

11. Liver/spleen scan

12. MRI

13. Notify CAS (Children’s Aid Society)

14. Notify police

15. Notify public health nurse

16. Ophthalmology consult

17. Psychiatry consult

18. Serum calcium, phosphorus and alkaline phosphorus

19. Skeletal survey

20. Urinalysis

CASE 3

An 84 year-old female is brought to the Emergency Department by her

daughter who states that her mother has not been herself over the past

three days. Further questioning reveals that the mother has been less

attentive than usual and more withdrawn, her conversation is often

rambling and she has not been sleeping well. Prior to this, she functioned

very well.

QUESTION 6 (CASE 3)

What diagnoses would you consider at this time? List up to two.

1. _____________________________________________________________

2. _____________________________________________________________

QUESTION 7 (CASE 3)

What additional aspects of history would be most important to know?

Select up to four.

1. Alcohol use

2. Complete psychiatric history

3. Family history of Alzheimer’s disease

4. Financial status

5. History of fever

6. History of incontinence

7. History of osteoarthritis

8. History of Parkinson’s disease

9. History of previous CVA

10. Immunization status

11. Marital status

12. Medication history

13. Occupational history

14. Pattern of symptoms over the course of the day, e.g. fluctuations

15. Presence of hallucinations

16. Previous history of depression

17. Previous seizure disorder

18. Previous surgery

19. Recent travel

20. Smoking history

QUESTION 8 (CASE 3)

The interview confirms the daughter's description of the mother. Physical

exam reveals: BP 120/80 supine and 100/70 sitting, RR=22, P=104,

T=38.7ºC. JVP is at the sternal angle. Respiratory exam reveals dullness,

increased tactile fremitus, crackles and bronchial breath sounds all in the

left base. Heart sounds are normal. The abdominal exam is normal. CNS

exam does not reveal any focal findings. What would you include in your

initial investigations? Select up to four.

1. ALT

2. AST

3. Blood cultures

4. B12

5. CBC

6. Chest x-ray

7. CPK

8. CT scan of head

9. Drug screen

10. EEG

11. Electrolytes

12. HIV test

13. MRI of head

14. Protein electrophoresis

15. PT and PTT

16. RBC folate

17. SPECT scan

18. TSH

19. Urea and creatinine

20. VDRL

54 – Sample Questions MCCQE 2002 Review Notes

KEY FEATURE QUESTIONS . . . CONT.

CASE 4

A 57 year-old man presents to the Emergency Department with a 12 hour

history of left flank pain.

QUESTION 9 (CASE 4)

What diagnoses would you consider at this time?

Select up to four.

1. Ruptured abdominal aortic aneurysm

2. Bowel obstruction

3. Appendicitis

4. Pyelonephritis

5. Diverticulitis

6. Renal calculi

7. Biliary colic

8. Renal cell carcinoma

9. Pneumonia

QUESTION 10 (CASE 4)

On history and physical exam, what symptoms and signs might aid in

diagnosis? Choose up to seven.

1. Fever/chills

2. Weight loss

3. Rebound tenderness

4. Costovertebral angle tenderness

5. Urgency and frequency

6. Pruritus

7. Hypotension

8. Pulsatile abdominal mass

9 Nausea and vomiting

10. Left flank mass

11. Productive cough

12. Abdominal guarding

13. Pale stools and dark urine

14. Hematuria

QUESTION 11 (CASE 4)

What tests might be necessary to confirm your diagnosis?

Choose up to six.

1. ESR

2. Serum amylase

3. Urine R&M

4. Chest x-ray

5. Abdominal/pelvic ultrasound

6. 3 views of the abdomen

7. Urine C&S

8. Abdominal CT

9. IVP

10. Total bilirubin

11. Electrolytes

12. 24 hour creatinine clearance

13. KUB

14. Serum Mg

15. Serum alkaline phosphatase

16. Barium enema

17. Serum Ca

18. CBC

CASE 5

A 30 year-old woman comes to your office with a 3 day history of vulvar

and vaginal pruritus.

QUESTION 12 (CASE 5)

What diagnosis would you consider at this time? List up to three.

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

QUESTION 13 (CASE 5)

What features on the history would you inquire about to make a diagnosis?

Choose up to seven.

1. Date of last menstrual period

2. Sexual history

3. Vaginal discharge

4. Vulvar erythema

5. Vaginal odor

6. Recent antibiotic therapy

7. Diabetes

8. Macular rash

9. Psychiatric history

10. Headache

11. Allergies

12. Dysuria

13. Use of douches

14. Sore throat

15. Previous history of STDs

QUESTION 14 (CASE 5)

What tests would you do to confirm the diagnosis? Choose up to four.

1. Urine C&S

2. Wet prep of vaginal discharge for microscopy

3. Urinalysis

4. CBC

5. ESR

6. Culture for gonorrhea

7. Culture for chlamydia

8. Abdominal CT

9. Pelvic ultrasound

10. Culture for Trichomonas vaginalis

CASE 6

A 65 year-old man in the emergency department has RUQ pain. He is

otherwise healthy.

QUESTION 15 (CASE 6)

List three diagnoses you should consider in this patient.

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

MCCQE 2002 Review Notes Sample Questions – 55

KEY FEATURE QUESTIONS . . . CONT.

QUESTION 16 (CASE 6)

What are the most important questions to ask about on history?

Choose up to seven.

1. Pruritus

2. Pale stools

3. Fever/chills

4. Hematuria

5. Jaundice

6. Anorexia

7. Dark urine

8. Weight loss

9. Back pain

10. Diarrhea

11. Alcohol/drug history

12. Nausea and vomiting

13. Fatigue

14. Cold intolerance

CASE 7

A 60 year-old woman comes to your office because she has seen bright

red blood in the toilet bowl after bowel movements for the past month.

She is otherwise healthy.

QUESTION 17 (CASE 7)

What are three common diagnoses you should consider?

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

QUESTION 18 (CASE 7)

What questions would you ask on history to help determine the cause of

the bleeding? Choose up to five.

1. Family history of inflammatory bowel disease

2. Hematemesis

3. Recent weight loss

4. Nausea and vomiting

5. Change in bowel habits

6. Abdominal pain

7. Fever/chills

8. Family history of colo-rectal cancer

9. Blood mixed with stool or coating the surface

10. Past history of hemorrhoids

11. Dietary history

12. Smoking history

13. Pain on defecation

14. Allergies

CASE 8

You are called to the nursery to assess a 2 hour old term newborn with

respiratory distress. The only information the nurse gives you over the

phone is that the baby was born this morning, had good Apgars and

arrived in the nursery pink on room air and in no distress.

QUESTION 19 (CASE 8)

What are the most common diagnoses that would be in your differential

for this infant? List up to three.

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

QUESTION 20 (CASE 8)

With respect to the diagnosis, which elements of the history and physical

will be most important in determining the etiology of this baby’s distress?

Select up to four.

1. Delivery mode (C-section, vaginal)

2. Feeding pattern

3. Grunting

4. Head circumference

5. Heart sounds

6. History of maternal diabetes

7. Indrawing

8. Maternal temperature

9. Meconium stained amniotic fluid

10. Oxygen requirement

11. Presence of bruising

12. Presenting part (breech, vertex)

13. Previous obstetric history

14. Tachypnea

15. Vital signs

CASE 9

A 45 year-old migrant farm worker comes to see you with sudden onset

of severe pain in his back and right leg after lifting some bales of hay.

The pain radiates into the lateral aspect of the right foot and is associated

with numbness along the lateral aspect of the foot. He has had a 5

year history of lower back pain with a similar episode of pain 1 year ago

which was concentrated at the posterolateral aspect of the right calf

and lateral aspect of the right foot. It became progressively worse,

then resolved over a 3 week period.

QUESTION 21 (CASE 9)

What elements of the history would you ask about in order to formulate

your diagnosis? Choose up to five.

1. Diffuse muscle cramps

2. Alcohol intake

3. Effect of NSAIDs

4. Family history of back problems

5. Previous history of back injury

6. Shoulder pain

7. Weakness in right leg

8. Allergies

9. Knee problems

10. Urinary incontinence

11. Skin rashes

12. Previous effective physiotherapy

13. Headaches

14. Nocturia

QUESTION 22 (CASE 9)

What elements of the physical exam would you focus on?

Choose up to four.

1. Examination of skin

2. Range of motion of lumbar spine

3. Blood pressure

4. Inspection of muscle bulk in lower extremities

5. Sensory exam of arms

6. Peripheral pulses

7. Reflexes in lower extremities

8. Motor testing of legs

9. Motor testing of arms

10. Sensory exam of legs

11. Bowstring sign

12. Respiratory rate

13. Temperature

14. Straight leg raise test

15. Abdominal exam

16. Rectal exam

17. Pulse

18. Range of motion of knee

19. Auscultation of chest

20. Romberg test

56 – Sample Questions MCCQE 2002 Review Notes

KEY FEATURE SCORING GUIDE

QUESTION 1, CASE 1

1. Maximum Number to be selected: = 5

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 5 correct answers: 2, 4, 8, 13, 20

5. Number of correct answers you selected: = ___

QUESTION 2, CASE 1

1. Maximum Number to be selected: = 5

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 5 correct answers: 9, 13, 14, 18, 20

5. Number of correct answers you selected: = ___

QUESTION 3, CASE 2

1. Maximum Number to be listed: = 4

2. The Number you listed (L): = ___

3. Is “L” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 8 correct answers:

1. Prematurity

2. Difficult child

3. History of parental child abuse

4. History of substance abuse

5. Social isolation

6. Developmental delay

7. Poverty

8. Parental character/personality disorder

5. Number of correct answers you listed: = ___

QUESTION 4, CASE 2

1. Maximum Number to be selected: = 4

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 4 correct answers: 7, 9, 14, 19

5. Number of correct answers you selected: = ___

QUESTION 5, CASE 2

1. Maximum Number to be selected: = 4

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 4 correct answers: 6, 13, 16, 19

5. Number of correct answers you selected: = ___

QUESTION 6, CASE 3

1. Maximum Number to be listed: = 2

2. The Number you listed (L): = ___

3. Is “L” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 2 correct answers:

1. Delirium

2. Acute Confusional State

5. Number of correct answers you listed: = ___

QUESTION 7, CASE 3

1. Maximum Number to be selected: = 4

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 5 correct answers: 1, 5, 12, 14, 15

5. Number of correct answers you selected: = ___

QUESTION 8, CASE 3

1. Maximum Number to be selected: = 4

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 5 correct answers: 3, 5, 6, 11, 19

5. Number of correct answers you selected: = ___

MCCQE 2002 Review Notes Sample Questions – 57

KEY FEATURE SCORING GUIDE . . . CONT.

QUESTION 9, CASE 4

1. Maximum Number to be selected: = 4

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 4 correct answers: 1, 4, 6, 8

5. Number of correct answers you selected: = ___

QUESTION 10, CASE 4

1. Maximum Number to be selected: = 7

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 8 correct answers: 1, 2, 4, 5, 7, 8,

10, 14

5. Number of correct answers you selected: = ___

QUESTION 11, CASE 4

1. Maximum Number to be selected: = 6

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 7 correct answers: 3, 5, 7, 8, 9, 13,

18

5. Number of correct answers you selected: = ___

QUESTION 12, CASE 5

1. Maximum number to be selected = 3

2. The number you listed (L): = ___

3. Is “L” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 4 possible answers:

1. Bacterial vaginosis

2. Vaginal/vulvar candidiasis

3. Trichomonas vaginalis

4. Chemical vaginitis

5. Number of correct answers you listed: = ___

QUESTION 13, CASE 5

1. Maximum Number to be selected: = 7

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 8 correct answers: 2, 3, 5, 6, 7, 12,

13, 15

5. Number of correct answers you selected: = ___

QUESTION 14, CASE 5

1. Maximum Number to be selected: = 4

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 4 correct answers: 2, 6, 7, 10

5. Number of correct answers you listed: = ___

QUESTION 15, CASE 6

1. Maximum Number to be listed: = 3

2. The Number you listed (L): = ___

3. Is “L” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 3 correct answers:

1. Biliary colic

2. Acute cholecystitis

3. Bile duct carcinoma

5. Number of correct answers you listed: = ___

QUESTION 16, CASE 6

1. Maximum Number to be selected: = 7

2. The Number you selected (S): = ___

3. Is “S” greater than the Maximum? YES Your Score = 0.

NO Continue.

4. There are 7 correct answers: 1, 2, 3, 5, 6, 7, 8

5. Number of correct answers you selected: = ___

58 – Sample Questions MCCQE 2002 Review Notes