ANESTHESIA
1. Which of the following is the proper positioning for
intubation?
a) extension of the lower C-spine and extension of the
atlanto-occipital joint
b) flexion of the lower C-spine and extension of the
atlanto-occipital joint
c) flexion of the lower C-spine and flexion of the
atlanto-occipital joint
d) open the mouth only half way to get a good look at
the cords
e) have the patient’s head on a high pillow to facilitate
intubation
2. Which of the following is NOT part of rapid sequence
induction?
a) patient breathes 100% O2 for 3-5 minutes prior to
induction
b) the patient receives bag ventilation immediately
following induction
c) the Sellick manoeuvre
d) pressure placed on the cricroid cartilage
e) muscle relaxant given
3. Which of the following methods is sufficient to
determine if the EET has passed through the cords?
a) chest movement
b) absence of abdominal distension
c) condensation of water vapour in the EET tube
during expiration
d) CO2 in exhaled gas as measured by capnogragh
e) refilling of reservoir during exhalation
4. Which of the following is CORRECT?
a) extracellular fluid volume (ECF) equals 2/3 of total
body water
b) ECF volume deficit will cause hypotension and
bradycardia
c) ECF volume expansion will cause increased JVP
and S3
d) moderate dehydration means 10% of the ECF
volume is lost
e) [Na+] determines ECF volume
5. Which of the following is NOT a transfusion reaction?
a) fever
b) hypercalcemia
c) anaphylaxis
d) intravascular hemolysis
e) extravascular hemolysis
6. Which of the following is NOT a side-effect of opioid
analgesics?
a) diarrhea
b) constipation
c) nausea
d) biliary spasm
e) respiratory depression
7. Opioid analgesics:
a) Prevent the release of inflammatory/pain mediators
at the site of injury
b) Block synaptic transmission along the pain pathway
c) Stimulate respiration and increase blood pressure
d) Are rarely associated with tolerance
e) Cause papillary dilation
8. The most potent inhalation induction agent that is
commonly used is:
a) enfluane
b) isoflurane
c) sevoflurane
d) nitrous oxide (N2O)
e) halothane
9. Contraindications to thiopental include all following
EXCEPT:
a) cardiac failure
b) porphyria
c) bowel obstruction
d) potential difficult intubation
e) status asthmaticus
10. The following is a depolarizing muscle relaxant?
a) Rocuronium
b) Mivacurium
c) Succinylcholine
d) Tubocurarine
e) Pancuronium
11. Which of the following is FALSE? Epidural analgesia:
a) causes uterine relaxation
b) controls blood pressure in preeclampsia
c) can cause urinary retention
d) can contribute to the effect of caval compression
e) can cause itching
12. All but one of the following increases the likelihood of
regurgitation at the time of induction:
a) obesity
b) anxiety
c) upper airway obstruction
d) increased esophageal sphincter pressure
e) hiccups
13. Which of the following is used in the treatment of
malignant hypertension:
a) succinylcholine
b) ketamine
c) dantrolene
d) tubocurarinee
e) neostigmine
14. Regarding pre-operative investigations, all of the following
are true EXCEPT:
a) EKG recommended for those > 40 year old
b) pulmonary function test (PFT’s) for those with COPD
c) Hb and urinanalysis are required for every surgical
patient as indicated in the Public Health Act
d) hospital policy dictate the indications for tests such as
CXR
MCCQE 2002 Review Notes Sample Questions – 3
CARDIAC AND VASCULAR SURGERY
1. Intermittent Claudication is:
a) a reproducible discomfort in exercising muscle
groups
b) secondary to occlusive arterial disease
c) a relatively benign condition when treated with risk
factor modification and exercise
d) may be life-style limiting
e) all of the above
2. Ischemic rest pain is:
a) unremitting pain in the most distal portion of the
affected extremity
b) a precursor to gangrene and limb-loss
c) associated with pallor on elevation and rubor on
dependency
d) should be treated with aggressive revascularization
surgery
e) all of the above
3. An arterial ulcer can be described as:
a) red granulating base. Located over a weight bearing
area. Non-painful
b) red granulating base. Heaped up border with
venous engorgement. Located in the gaiter
distribution
c) whitish, necrotic base. “Punched out” appearance.
No evidence of healing, painful. Located usually on
the distal parts of the extremity
d) all of the above
e) none of the above
4. An aneurysm can be defined as:
a) an artery greater than 5 cm in diameter
b) a localized enlargement of a vessel greater than
1.5X its expected diameter
c) an artery greater than 3 cm in diameter
d) a blood vessel greater than 1.5X its expected
diameter
e) an out-pouching of the aorta
5. The clinical findings of a ruptured abdominal aortic
aneurysm include:
a) pulsatile abdominal mass
b) hypotension
c) back pain
d) hematemesis
e) A, B, and C
f) all of the above
4 – Sample Questions MCCQE 2002 Review Notes
CARDIOLOGY
1. All of the following regarding the management of
heart failure are true EXCEPT:
a) digitalis is indicated in atrial fibrillation
resulting in heart failure
b) the use of ß-blockers in acute CHF has been
shown to reduce mortality
c) calcium channel blockers add no proven survival
benefit in patients with CHF
d) oral inotropes have a detrimental effect on survival.
e) ACE inhibitors improve survival in
asymptomatic patients with LVEF < 35%
2. Regarding pericardial disease, which of the following is
INCORRECT?
a) the ECG changes of acute pericarditis include PR
segment depression and ST segment elevation
b) autoimmune pericarditis is not associated with
acute MI
c) a prominent “x” descent might be expected in the
JVP waveform of a patient with a pericardial effusion
d) tamponade may result in hypotension, elevated
central venous pressure, and pulsus paradoxus
e) a relatively small pericardial effusion may result in
tamponade if it develops rapidly
3. Regarding syncope:
a) the etiology of as many as 50% of cases is never
identified
b) vasovagal syncope (the common faint) results from a
combination of peripheral vasodilatation and relative
bradycardia
c) a common cause of syncope is a cortical stroke
d) the final common pathway of most causes of
syncope is usually generalized cerebral
hypoperfusion
e) cough, micturition, and defecation syncope all result
in part from impaired venous return to the heart
4. Which of the following statements is INCORRECT?
a) chronic sympathetic nervous system activation
causes long-term changes in the myocardium in
heart failure
b) the development of heart failure requires an
initiating myocardial insult
c) dilated cardiomyopathy is a common cause of CHF
d) poor ventricular compliance results in an S3
e) Cheyne-Stokes breathing is frequently seen in
patients with CHF
5. Which of the following statements about valvular cardiac
disease is CORRECT:
a) pulmonary valve disease is a leading cause of
morbidity and mortality
b) rheumatic heart diseases is a minor cause of mitral
stenosis
c) mitral regurgitation leads to LV dilatation
d) radiation of a systolic murmur to the clavicle is not
commonly seen in aortic stenosis
e) mitral valve prolapse leads to a lower JVP
6. Which of the following provides symptomatic relief but
has not ben shown to increase longevity in the context of
CHF:
a) ACE inhibitors
b) loop diuretics
c) beta-blockers
d) spironolactone
e) hydralazine and nitrates
7. The least serious contraindication to Thrombolytic
Therapy in acute myocardial infarction is:
a) cerebral hemorrhage
b) active bleeding
c) acute pericarditis
d) chronic liver disease
e) aortic dissection
8. Which of these is NOT a peripheral sign of infective
endocarditis:
a) Osler's nodes
b) splinter hemorrhages
c) Janeway lesions
d) clubbing
e) palmar erythema
9. Which of the following is not one of the major Jone’s
criteria:
a) pancarditis
b) subcutaneous nodules
c) polyarthritis
d) Huntington’s chorea
e) erythema margination
10. Which of the following is TRUE regarding the JVP:
a) 3rd degree heart block is associated with cannon
a waves
b) a positive Kussmaul sign is not correlated with
constrictive pericarditis
c) C-V waves are seen in tricuspid stenosis
d) atrial fibrillatoin does not affect the JVP waveform
e) the “y” decent occurs during ventricular systole
MCCQE 2002 Review Notes Sample Questions – 5
COMMUNITY HEALTH
1. One rationale for universal hepatitis B vaccination in
infants is that:
a) the vaccine is not effective in preventing infection in
high-risk adults
b) no risk factors can be identified in 25% of hepatitis B
cases
c) hepatitis B infections occur commonly in children
d) the HBV vaccine is contraindicated in at-risk
pregnant women
e) most chronic carriers contract hepatitis B during early
childhood
2. Polyvalent pneumococcal vaccine is NOT
RECOMMENDED in patients:
a) with sickle cell anemia
b) with HIV infection
c) who take prophylactic penicillin
d) under 2 years of age
e) who are pregnant or considering pregnancy in the
next three months
3. Which one of the following is caused by chronic tobacco
smoking?
a) increased throat pain during streptococcal infection
b) increased ciliary action
c) increased anti-protease activity
d) hyperplasia of respiratory epithelium
e) increased risk of ulcerative colitis and endometrial
carcinoma
4. You are director of occupational health for a corporation
that has many employees aged over 45 who smoke one
or more packs of cigarettes daily and are at increased
risk for lung cancer. What strategy for the early detection
of lung cancer in asymptomatic individuals would you
recommend?
a) no strategy has been shown to be effective in
reducing mortality
b) chest x-ray and sputum cytology every 6 months for
high-risk employees
c) annual chest x-ray and sputum cytology for high-risk
employees
d) annual chest x-rayand sputum cytology for all
employees
e) annual chest x-ray for all employees
5. Regarding obesity:
a) exercise, diet and behavioural therapy result in
sustained weight loss in 50% of patients
b) obesity is the leading cause of preventable death in
industrialized countries
c) the periodic health exam recommends routine diet
counselling and measuring BMI for all individuals
d) even a small weight loss is associated with benefit
e) switching from soft drinks sweetened with sugar to
those with artificial sweetners results in fewer
calories consumed and sustained weight loss for
most patients
6. Regarding cocaine abuse:
a) cocaine abuse is primarily confined to lower social
classes, and is often associated with opiate abuse
b) cocaine is well absorbed via the oral route
c) physical dependence is common, and physical
withdrawal symptoms are severe
d) cocaine may cause toxic psychosis and hypertension
e) cocaine has no current medical indications
7. Pneumonia:
a) is the third most common infective cause of death in
the developed world
b) is very rarely caused by Gram-negative organisms in
elderly patients
c) is treated at home in less than 50% of patients
d) pleuritic pain is a poor prognostic sign
e) a poor white cell response is an ominous sign
8. A case control study is designed to analyse a suspected
hypothetical association between the development of
mania and migraine treatment. This study:
a) can derive and estimate of the risk of an individual
developing the mania as a consequence of migraine
treatment
b) will demonstrate that any association found is likely
to be causal
c) will need controls who are chosen at random from the
general population
d) will necessitate careful follow-up of a group of patient
receiving migraine treatment, and a not treated
control group
e) will not give biased results if all the patients have
been carefully assessed by a senior clinician
9. A double blind trial is planned to compare the utility of
glyburide and metformin in the treatment of diabetes
mellitus. The main reasons for randomising patients are:
a) so that the number of subjects in each group will be
identical
b) so that the two patient groups will have similar
prognostic features
c) so that the statistian will not analyse the data in a
biased fashion
d) so that the investigator does no know in advance
what therapy which patient will receive
e) to prevent the clinician knowing which drug the
patient is taking
10. Which statement is TRUE?
a) the assignment of a gender is a nominal variable
b) histogram is a useful way of showing how a particular
variable is changing in respect to time
c) the mean of a sample of positive numbers is
invariably greater than the median value
d) the mean of a large sample will always increase in
size as the size of the sample increase
e) approximately 70% of data points are both within one
standard deviation of the mean and larger than the
mean of a normally distributed data set
6 – Sample Questions MCCQE 2002 Review Notes
COMMUNITY HEALTH . . . CONT.
11. Which clinical picture most likely corresponds to a
patient who has ingested “two bottles of aspirin”?
a) arterial thrombosis and hypothermia
b) hyperpnea, tinnitus, and respiratory alkalosis
c) metabolic acidosis, hypokalemia, hyperglycemia
d) weakness, ataxia, drowsiness
e) facial pallor followed later by hepatic tenderness
12. Who should be screened for lead poisoning in Canada?
a) all children with developmental delay
b) all children living in housing built before 1960
c) all children living in housing in high-risk districts
d) children with unexplained symptom complex of
abdominal pain, anorexia, anemia, ataxia, and
slurred speech
e) none of the above
13. Each of the following patients has a 5-mm reaction to a
5TU PPD skin test. Who should receive therapy for
tuberculosis?
a) an intravenous drug user known to be
HIV-seronegative
b) a Vietnamese refugee
c) a 30-year-old long-term resident of a mental
institution
d) a 40-year-old with diabetes mellitus
e) a 40-year-old female with known HIV infection
14. A 54-year-old white female who is new to your practice
presents with a viral upper respiratory infection. She
insists that three days of penicillin is the only thing that
ever cures it. You explain your reasons for not using an
antibiotic, but she continues to insist. You should:
a) treat her symptomatically but do not give antibiotics
b) refer her to a physician in your community who has
a reputation for frequently using antibiotics
c) have the patient sign a medical release before
giving her a script for gentamycin
d) tell her that if she is not better in three days you will
give her an antibiotic as a compromise
15. Fetal infection with Hepatitis B is most likely during the:
a) first trimester
b) second trimester
c) third trimester
d) throughout pregnancy
e) Hepatitis B is not vertically transmitted
16. Appropriate treatment of a neonate born to a Hepatitis
B positive mother is:
a) hepatitis b immune globulin (HBIG) at birth
b) HBIG at birth and Hepatitis B vaccine at 2, 4, and 6
months of age
c) HBIG and Hepatitis B vaccine at birth, 1, 6 months of
age
d) HBIG at birth and Hepatitis B vaccine at birth, 1 and
6 months of age
e) hepatitis B vaccine at 2, 4, and 6 months of age
17. With regards to the vertical transmission of Hepatitis B:
a) there is a less than 1% risk if the mother is
asymptomatic and HBsAG+
b) can be transmitted through the placenta and
through breast milk only
c) risk of vertical transmission is greater than 80% if
mother is HBsAg+ and HBcAg+
d) chronic active hepatitis B has no effect on prematurity
e) hepatitis B vaccine should not be given to a pregnant
woman
18. Vertical transmission of HIV can be reduced by giving AZT:
a) during pregnancy
b) during labour
c) at the delivery
d) to the neonate
e) all of the above
MCCQE 2002 Review Notes Sample Questions – 7
DERMATOLOGY
1. All of the following have been implicated in the
pathogenesis of acne vulgaris EXCEPT:
a) androgen stimulated production of sebum
b) Propionibacterium acnes
c) consumption of sugars, fats and oils
d) hyperkeratinization of follicle lining
2. Which of the following medications is not indicated for
the treatment of acne vulgaris?
a) benzoyl peroxide
b) topical erythromycin
c) adapalene
d) tazarotene
e) metronidazole
3. Which of the following is not a feature of perioral
dermatitis?
a) papules and inflammatory plaques
b) rim of sparing round vermillion border of lips
c) predominantly males
d) teenagers to mid-adulthood
a) treated with topical metronidazole
4. You have been referred a 2 month old with atopic
dermatitis. Where are the most likely sites of the
dermatitic eruptions in an infant of this age?
a) peripheral fingers and toes
b) flexural creases of elbows and wrists
c) face and extensor surfaces of limbs
d) diaper distribution
5. You have been referred an 80 year old man with a
history of venous insufficiency, who complains of a
constant irritation of his lower legs of 6 months
duration. The most likely diagnosis is:
a) seborrheic dermatitis
b) stasis dermatitis
c) atopic dermatitis
d) allergic contact dermatitis
6. The cause of “cradle cap” in infants is most commonly:
a) atopic dermatitis
b) seborrheic dermatitis
c) pityriasis rosea
d) alopecia areata
7. The most common causative agents of Impetigo
Vulgaris are:
a) pseudomonas and streptococcus
b) fungi
c) GABHS and Staphylococcus aureus
d) GABHS and Group B Streptococcus
e) Mycoplasmae
8. Staph aureus group II exfoliating toxin is associated with
a) bullous impetigo in axillae and groin folds
b) psoriatic knee patches
c) facial atopic dermatitis
d) vitiligo
9. Which of the following is NOT a true difference between
erysipelas and cellulitis?
Erisypelas Cellulitis
a) Upper dermis Lower dermis
and subcutaneous fat
b) Well demarcated Poorly demarcated
c) Group A Strep as Dermatophyte
causative agent as causative agent
d) commonly on face commonly on extremities
10. Primary syphilis is described by the following EXCEPT:
a) excruciatingly painful buttonlike papule
b) regional non-tender lymphadenopathy
c) VDRL negative initially
d) Treated with 2.4 million units benzathine penicillin
G given intramuscularly
11. Hand-Foot-and-Mouth Disease is:
a) common in the elderly
b) caused by staphylococcus aureus
c) caused by Coxsackie A16 virus
d) chronic
e) treated with antibiotic medications
12. Which of the following is not associated with a
dermatophytic infection?
a) Tinea capitis
a) Tinea Corporis
a) Condylomata acuminata
a) Onychomycosis
13. Which of the following typically presents after acute
streptococcal pharyngitis?
a) atopic dermatitis
b) guttate psoriasis
c) pityriasis rosea
d) plaque psoriasis
14. Which of the following is associated with gluten
intolerance?
a) Bullous pemphigoid
b) Pemphigus vulgaris
c) Dermatitis herpetiformis
d) Porphyria cutanea tarda
15. Which is not a feature of lichen planus?
a) purple
b) polygonal
c) pruritic
d) purulent discharge
e) peripheral distribution
16. All of the following are characteristics of basal cell
carcinoma EXCEPT:
a) associated with UV radiation
b) pearly nodule with telangiectasia
c) located on body surfaces not exposed to sunlight
d) spread by local invasion
e) age of onset >4 0
8 – Sample Questions MCCQE 2002 Review Notes
DERMATOLOGY . . . CONT.
17. Which is NOT a feature of a cutaneous drug eruption?
a) toxic epidermal necrolysis
b) angioedema
c) phototoxicity
d) hypopigmentation
e) anaphylaxis
18. Which is NOT a feature of vitiligo and its management?
a) associated with thryoid disease and diabetes
mellitus
b) more common in blacks than whites
c) treatment options include PUVA therapy
d) destruction of melanocytes
e) well-demarcated white macules
19. All of the following are skin diseases associated with
diabetes mellitus EXCEPT:
a) eruptive xanthomas
b) tinea pedis
c) acanthosis nigricans
d) necrobiosis lipoidica
e) pruritis
20. Malignant melanoma involving the papillary dermis is
Clark Level:
a) I
b) II
c) III
d) IV
e) V
21. All of the following are treatments for non-scarring
alopecia EXCEPT:
a) spironolactone
b) minoxidil
c) hair transplantation
d) intralesional triamcinalone
e) finasteride
MCCQE 2002 Review Notes Sample Questions – 9
EMERGENCY MEDICINE
1. A patient presents with a puncture wound to the hand
that occurred 12 hours ago. He is not certain if he has
been vaccinated for tetanus. Which of the following is the
proper management of this patient with respect to
tetanus prophylaxis?
a) tetanus toxoid
b) tetanus immune globulin
c) both tetanus toixoid and tetanus immune globulin
d) no prohylaxis required
2. A 34 year-old otherwise healthy woman presents in the
trauma room after being involved in a motor vehicle
collision. She is strongly suspected to have internal
bleeding. Her heart rate is 130, blood pressure 85/50,
and respiratory rate is 40. Which of the following are
likely TRUE?
a) she has lost < 1,000 cc of blood
b) she will have normal urine output
c) fluid replacement should consist of crystalloid and
blood
d) she has lost > 40% of her blood volume
3. A patient presents to the emergency department. On
examination he requires a sternal rub to open his eyes.
He is muttering incomprehensively and withdraws his
hand when a painful stimulus is applied. His Glascow
Coma Scale score is:
a) 7
b) 8
c) 9
d) 10
4. With respect to question 3, the most appropriate
management of this patient’s airway is:
a) none
b) oropharyngeal airway
c) nasopharyngeal airway
d) endotracheal intubation
e) cricothyroidotomy
5. The anticholinergic and sympathomimetic toxidromes
shareall of the following features EXCEPT:
a) hyperthermia
b) maydriasis
c) tachycardia
d) diaphoresis
6. Which of the following is NOT true regarding the
management of asthma patients in the emergency room:
a) patients unable to speak with an O2 sat < 90%
should be intubated
b) peak flow meters are the best way to assess
response to therapy
c) patient education about the proper use of puffers
is an important aspect of treatment
d) anti-cholinegics are the first line agents in the
treatment of mild asthma
e) a silent chest on auscultaton indicates an
emergency and requires immediate treatment
7. Which of the following is TRUE regarding hypertensive
emergencies?
a) there is evidence of end organ damage
b) renal failure can be both a cause and an effect of
hypertensive emergencies
c) the goal of treatment is to lower the blood pressure
to normal within 30-60 minutes
d) fundoscopic findings may include papilledema and
hemorrhages
e) all of the above
8. In a head trauma patient the most important feature on
history is:
a) seizure
b) loss of consciousness
c) headache
d) nausea and vomiting
9. According the Ottawa Ankle Rules, an ankle radiographic
series is required in all of the following situation EXCEPT:
a) bony tenderness to palpation along the posterior
edge of the lateral maleolus
b) bony tenderness to palpation along the posterior
edge of the medial malleolus
c) bruising over either malleolus
d) inability to weight bear both immediately
following the injury and in the emergency
department
10. Which of the following is NOT true with respect to
hypothermia?
a) chest compressions should be deferred up to
1 minute until it is certain that the patient is
pulseless as they can precipitate ventricular
tachycardia
b) pupils become fixed and dilated at core body
temperature below 25ºC
c) ventricular fibrillation becomes a risk at core
body temperatures < 30ºC
d) the patient should be rewarmed slowly to
avoid an afterdrop
11. Which of the following is FALSE regarding adult patients
presenting to the emergency department following a
sexual assault?
a) they will often present with chief complaints other
than sexual assault
b) physicians are legally obligated to report the
assault to the police even if the victim does not
wish it reported
c) the patient should have folllow up with an MD at
a rape crisis centre within 24 hours
d) pregnancy and sexually transmitted disease
prophylaxis should be offered if appropriate
10 – Sample Questions MCCQE 2002 Review Notes
EMERGENCY MEDICINE . . . CONT.
12. Which of the following is NOT true regarding allergy and
anaphylaxis?
a) they are IgE mediated immune response to
antigens
b) epinephrine is the first line agent for the treatment
of minor skin eruptions to topical agents
c) signs and symptoms of an allergic reaction vary
from minor cutaneous eruptions to cardiovascular
collapse, bronchospasm and laryngeal edema
d) the ABC’s are the first step in the treatment of
any allergic reaction
13. Which of the following is FALSE with respect to chest
pain?
a) all patients presenting with chest pain should
receive an ECG
b) a normal ECG and normal cardiac enzymes rule
an ischemic event
c) a careful history is essential in determining the
etiology of the chest pain
d) reproducible chest pain on palpation of the chest
wall does not rule out an acute MI
14. Which of the following toxins is NOT a cause of an
increased anion gap metabolic acidosis?
a) methanol
b) ethylene glycol
c) salicylates
d) iron
d) benzodiazepines
15. Which of the following toxins is NOT matched to its
specific treatment?
a) acetaminophen - N-acetylcysteine
b) carbon monoxide - hyperbaric oxygen
c) heroin - naloxone
d) diazepam - bicarbonate
e) methanol - ethanol
MCCQE 2002 Review Notes Sample Questions – 11
ENDOCRINOLOGY
1. 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
2. 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
3. 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
4. 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
LHRH – rise in LH and FSH
TRH – rise in TSH and PRL
b) CRH – rise in GH and ACTH
LHRH – 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 – rise in TSH
d) cosyntropin – rise in GH and ACTH
GHRH – rise in LH and FSH
TRH – rise in TSH and PRL
5. 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 headaches) because you are concerned he
has MEN I syndrome
d) check for a homonymous hemianopia because you
are worried about a pituitary tumour
e) check for a bitemporal hemianopia because you are
worried about a pituitary tumour
6. Which of the following is not associated with thyroid
disease?
a) dermatitis herpetiformis
b) urticaria
c) porphyria cutanea tarda
d) vitiligo
e) alopecia areata
7. 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 DM, 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
8. Secondary causes of hyperlipidemia include all of the
following EXCEPT:
a) obesity
b) hyperthyroidism
c) diabetes
d) nephritic syndrome
e) glucocorticoids
9. A 63-year-old woman has had a gradually enlarging goiter
for at least 10 years. She has no symptoms of
hyperthyroidism. On physical examination, both thyroid
lobes are irregular, firm and nontender. Her serum
thyroxine (T4) level is 120 nmol/L (normal range is
0.51 - 142 nmol/L) and triiodothyronine (T3) -resin uptake
is normal at 30%. The patient is treated with 50 ug of T3
daily in an attempt to decrease the size of the goiter.
Several weeks later she develops weakness,
palpitations, insomnia, and a tremor; she has lost 2.3 kg
(5 lb). The size of the thyroid gland is unchanged; her
serum T4 level is now 115 nmol/L. These findings
indicate that the patient:
a) has developed Graves' disease
b) has painless thyroiditis
c) has autonomous endogenous thyroid function
d) is taking more T3 than was prescribed
e) has had a hemorrhage into a thyroid nodule
12 – Sample Questions MCCQE 2002 Review Notes
ENDOCRINOLOGY . . . CONT.
10. In deciding upon the ideal dosage of replacement
therapy for hypothyroidism, each of the following factors
is considered EXCEPT:
a) subjective patient response
b) findings on physical examination
c) response of the radioactive iodine uptake
d) plasma TSH level
e) level of free thyroid hormone measured in the serum
11. An asymptomatic postmenopausal 54-year-old woman
sustained a slight concussion in an automobile accident.
X-rays of the skull show an enlarged sella turcica.
Computed tomography (CT scan) of the skull shows no
density within the sella turcica. This patient most likely
has:
a) A familial syndrome associated with hypercalcemia
and pheochromocytoma
b) Pigmentation of skin, buccal mucosa, and pressure
areas
c) Elevated serum calcitonin levels
d) Normal endocrine function
e) Hypogonadism with hyposomnia
12. A 32-year-old diabetic did not take his usual dose of
30 units of lente insulin and 5 units of regular insulin
because he had an "upset stomach with vomiting". The
next day he was admitted to hospital. His plasma
glucose was 29.9 mmol/L and the urine was strongly
positive for ketones. The serum bicarbonate was
6 mEq/L, arterial pH was 7.05 and serum potassium was
5.4 mEq/L. Which one the following statements is most
likely to be TRUE?
a) The predominant ketone body in the serum is
acetoacetate
b) The elevated serum potassium level reflects total
body potassium in this patient
c) The plasma glucagon level will be increased
d) The serum phosphate concentration will rise during
insulin therapy
e) The patient followed the correct course by
withholding insulin in the absence of food intake
For 13, 14, and 15.
A 32-year-old woman visits her physician because of agitation,
weight loss, and inability to sleep. When questioned
further, she reveals an increased appetite, and an increased
frequency of bowel movements. Previously, she had regular
menstrual periods, but now they are less frequent and
irregular. During the physical examination, the physician
notes that her skin is warm and moist and that she has a fine
tremor of the fingers, hyperreflexia, and lid lag. The woman
has moderately severe exophthalmos, and her upward gaze
seems weak and uncoordinated.
13. Which one of the following disease processes is most
likely manifesting itself?
a) A thyroid adenoma that is secreting thyroxine
b) Inappropriate hypothalamic secretion of TRH
c) Graves’ disease
d) Hashimoto’s disease
e) Sick euthyroid syndrome
14. All of the following statements correctly pair a useful
medication with its mechanisms of action EXCEPT
a) Propylthiouracil (PTU) blocks the coupling reaction in
T4 synthesis
b) Methimazole (MMU) reduces peripheral conversion of
T4 to T3
c) Radioactive iodine destroys follicular cells in the
thyroid
d) Propranolol blocks the sympathetic components of
thyrotoxicosis
e) Prednisone may relieve the mechanical exophthalmos
and opthalmoplegia by reducing inflammation.
15. All of the following laboratory test results are consistent
with the clinical picture EXCEPT:
a) decreased T3 resin uptake
b) decreased TSH response to a TRH challenge
c) decreased serum TSH
d) increased serum T4 concentration
e) positive test for circulating antibodies against the
TSH receptor
16. Which of the following disorders is NOT associated with
osteoporosis?
a) pheochromocytoma
b) prolactinoma
c) Cushing’s syndrome
d) Kleinfelter’s syndrome
e) Graves’ disease.
17. A 41-year-old man has been diagnosed with
panhypopituitarism. Which of the following is not part of
the appropriate management of this patient?
a) L-thyroxine
b) hydrocortisone
c) fludrocortisone
d) testosterone
e) Medic Alert bracelet
18. While not always the presenting complaint, the earliest
symptom/sign of a pituitary tumour is usually:
a) visual disturbance (e.g. bitemporal hemianopsia)
b) gonadal insufficiency
c) headache
d) extraocular muscle paresis
e) diabetes insipidus
19. An elderly diabetic woman with mild renal insufficiency
presents to the emergency room with confusion. Blood
glucose was 1.5 mmol/L. She is treated with glucose IV
for 24 hours, discharged and instructed not to take any
medications. 6 hours after discharge, she is brought back
to the emergency department in a coma. Blood glucose
is now 1 mmol/L. Which of the following hypoglycemic
agents is the patient most likely using?
a) repaglinide
b) acarbose
c) metformin
d) rosiglitazone
e) glyburide
MCCQE 2002 Review Notes Sample Questions – 13
ENDOCRINOLOGY . . . CONT.
20. A 47-year-old man is admitted to hospital to be
evaluated for hypertension and hypokalemia. After the
patient has been restricted to a 120 mEq/day Na diet for
1 week, his plasma aldosterone twice the normal level.
Which is the next MOST appropriate step?
a) fludrocortisone suppression test
b) cosyntropin (ACTH) stimulation test
c) measurement of plasma renin activity
d) CT adrenals
e) treat with spironolactone
21. Which of the following is considered diagnostic of
diabetes:
a) random plasma glucose level of 10 mmol/L
b) fasting plasma glucose level of 6.8 mmol/L
c) on OGTT, 1 hour plasma glucose level > 11.1
d) on OGTT, 2 hour plasma glucose level > 7.8
e) presence of polyuria and polydipsia and plasma
glucose level of 12 mmol/L
22. A 35-year-old man gives a history of paroxysmal
hypertension, headache, diaphoresis and palpitations.
His father has hypertension and hypercalcemia and a
paternal aunt died from a thyroid cancer. The physician
would be most likely to measure serum levels of:
a) calcitonin, calcium, and glucose
b) glucagon, insulin, and cholesterol
c) thyroid hormone, adrenomedullin, and phosphorus
d) CRH, gastrin, and renin
14 – Sample Questions MCCQE 2002 Review Notes
FAMILY MEDICINE
1. A 28 year old sexually active woman in a stable
relationship for 2 years comes to your office for an
annual check-up. Which of the following is NOT a
recommended screening tool in the Periodic Health
Exam?
a) counseling re: sun exposure
b) pap smear
c) breast self examination
d) counseling re: folic acid supplementation
e) counseling re: bicycle helmet use
2. A 26 year old woman reports suffering from moderately
severe unilateral headaches approximately twice a
month for the past year. The headaches are pulsating in
quality with associated nausea and photophobia.
Physical examination is normal. Which of the following is
NOT appropriate abortive treatment for an acute attack?
a) NSAIDS
b) sumatriptan
c) DHE
d) amitryptiline
e) ergotamine
3. A 63 year old man with a 10 year history of type 2
diabetes is screened for microalbuminuria.
Albumin:creatinine ratio is 2.6. Which of the following is
the appropriate first step in management?
a) repeat albumin:creatinine in one year
b) repeat albumin:creatinine test twice over the next
3 months and if abnormal, get 24 hour urine for
creatinine clearance
c) referral to nephrologist
d) adjust dosages of oral hypoglycemic medications
e) reduce dietary protein
4. A 38 year old businesswoman and mother of two children
presents with a 3 month history of fatigue. Past medical
history is remarkable for GDM in her last pregnancy.
Pallor noted, otherwise normal physical exam. Which of
the following investigations is NOT indicated at this time?
a) appropriate assessment for anxiety and depression
b) appropriate assessment of current life stressors,
past trauma and abuse
c) CBC
d) serum glucose
e) BUN, creatinine
5. The target LDL-C for a very high risk patient (10 year risk
CAD > 30%, history of cardiovascular disease, or
diabetes) is:
a) < 2.5 mmol/L
b) < 3.0 mmol/L
c) < 3.5 mmol/L
d) < 4.0 mmol/L
e) < 5.0 mmol/L
6. A 65 year-old newly-diagnosed hypertensive male is
about to begin anti-hypertensive medication. Which of
the following should you NOT prescribe as first-line
therapy:
a) angiotensin-converting enzyme inhibitor
b) long acting dihydropyridine
c) beta-adrenergic antagonist
d) low dose thiazide diuretic
e) high dose hydrochlorothiazide
7. A 32 year old man presents with a 2 week history of
persistent cough and generally feeling unwell. On
examination, T= 37.7 , HR= 80, BP = 120/70, RR = 16.
Which of the following is INAPPROPRIATE treatment?
a) symptomatic antipyretics
b) antitussives
c) bronchodilator bid
d) tetracycline 250 mg qid
e) rest and fluids
8. A 40 year old smoker presents with a 3 day history of
rhinorrhea, cough, and headache. No vital sign
abnormalities present. Which of the following is the
best management?
a) educate patient about duration of symptoms, suggest
hydration, analgesics and dextromethorphan prn
b) educate patient about duration of symptoms and
have her return to clinic in 2 days
c) order CXR
d) order sputum culture
e) educate patient about smoke exposure and risk of
URTI and prescribe erythromycin x 10 days
9. Which of the following is CORRECT regarding depression?
a) The lifetime risk of major depressive disorder is 55%
for women
b) Early treatment of major depressive disorder does
not improve outcomes
c) Risk of recurrence after 3 episodes of major
depressive disorder is 90%
d) Most patients will need at least two years of
pharmacological treatment
e) Most primary care patients with depression should
be referred for psychiatric consultation
10. When prescribing the oral contraceptive pill (OCP), which
of the following should be done:
a) Inform patients that the OCP protects against STDs
b) Perform breast, abdominal and pelvic exams and
assess blood pressure
c) Warn patients that their risk of dysmenorrhea is
increased
d) Perform a complete physical exam after taking a
thorough sexual history
e) Perform a Beta-HCG test prior to prescribing OCP
MCCQE 2002 Review Notes Sample Questions – 15
FAMILY MEDICINE . . . CONT.
11. Which of the following statements regarding pharyngitis
is/are TRUE:
a) The most common etiologic agent is viral
b) Bacterial causes for sore throats occur predominately
in pre-school aged children
c) Delaying treatment for Group A ß-hemolytic
Streptococcal pharyngitis by 48 hours does not
increase the risk of rheumatic fever
d) a) and c)
e) all of the above
12. In the context of low back pain, x-ray imaging should be
ordered in these cases except:
a) 25-year-old male i.v. drug user with 3 week history of
low back pain
b) 64-year old female with 48-hour history of back pain
and numbness in the right leg extending to the knee
c) Previously healthy 37-year-old male with 3 month
history of low back pain
d) 56-year-old woman with well controlled hypertension
and 4 week history of low back pain
e) 18-year-old construction worker with 1 week history
of low back pain
13. Acceptable methods of assessing for obesity include the
following but:
a) BMI
b) daily calorie intake
c) waist-hip ratio
d) percent body fat
14. Which of the following is characteristic of alcohol
dependence:
a) 23-year-old male college student who consumes an
average of 23 drinks per week and exhibits no
withdrawal symptoms
b) 65-year-old recently retired engineer who binge
drinks two times a month
c) 43-year-old married female, recently fired, and who
has been in 2 MVAs involving alcohol this past year
d) 35-year-old male former AA member who has not
drunk in 10 years
16 – Sample Questions MCCQE 2002 Review Notes
GASTROENTEROLOGY
1. Pseudomembranous colitis is usually caused by toxins of
which organism?
a) Staph aureus
b) Clostridium difficile
c) Clostridium perfringens
d) Clostridium botulinum
e) Bacteroides fragilis
2. A 13 year old presents with increased serum bilirubin
and vague nonspecific complaints. Labs show increase in
unconjugated bilirubin with normal liver function tests
and negative hepatitis screens. There is no evidence of
liver abnormality or hemolysis. The most likely diagnosis
is?
a) Gilbert’s syndrome
b) biliary atresia
c) hepatoma
d) cholecystitis
e) cholangiocarcinoma
3. After noticing his wife avidly eats clay, starch, and ice, her
husband brings her to the ER. History reveals she is a
vegetarian, and in her second trimester of pregnancy.
The most likely disease afflicting this woman is?
a) megaloblastic anemia
b) hepatolenticular disease
c) gastric carcinoma
d) pica
e) hypermethioninemia
4. The ecchymosis of the flank seen in patients with acute
pancreatitis is named after?
a) Trousseau
b) Goodpasture
c) Grey-Turner
d) Cullen
e) Wernicke-Korsakoff
5. The best test for a massive lover GI bleed is?
a) colonoscopy
b) angiography
c) radiolabelled RBC scan
d) barium enema
e) fecal occult blood
6. An elderly woman presents with blood per rectum with a
3 day history of severe ab pain, anemia, hypotension
and CAD. The most likely diagnosis is?
a) ulcerative colitis
b) crohn’s disease
c) irritable bowel disease
d) ischemic bowel (colitis)
e) infectious diarrhea
7. All are causes of splenomegaly EXCEPT:
a) infectious mononucleosis
b) thalassemia minor
c) congestive heart failure
d) sarcoidosis
e) diabetes
8. A diagnosis of Irritable bowel sydrome is based on:
a) Rome criteria which emphasizes negative features of
the disease
b) Rome criteria which emphasizes positvie features of
the disease
c) a diagnosis of not an exclusion
d) all of the above
9. Diagnosis of celiac sprue includes all of the following
EXCEPT:
a) evidence of malabsorption
b) abnormal small bowel biopsy
c) improvement in sign and symptoms with a
gluten- containing diet.
d) positive anti-endomysial antibody.
10. You suspect a patient with a fat malabsorption syndrome.
Which symptom would you NOT expect?
a) night blindness
b) metabolic bone disease
c) bleeding disorder
d) lactose intolerance
11. A 12-year-old boy is jaundiced and has an enlarged liver
on palpation. Lab values show increased ALT,
increased AST, increased conjugated bilirubin.
Kayser-Fleisher rings are noticed on the slit-lamp.
A diagnosis of Wilson’s disease is made. All of the
following are true EXCEPT:
a) the primary defect is a mutation in ceruloplasmin
b) the patient likely has increased levels of serum free
copper and liver copper and increased urinary copper
with penicillamine challenge
c) Wilson’s disease is inherited in an autosomal recessive
pattern
d) patients can demonstrate increased serum
ceruloplasmin
e) in normal patients, more than 90% of serum copper
circulates bound to ceruloplasmin
12. All of the following can be causes of conjugated
hyperbilirubinemia EXCEPT:
a) Wilson’s disease
a) Criggler-Najjar syndrome I
a) primary biliary cirrhosis
a) gallstones
a) viral hepatitis
13. The most common cause of a significant
upper GI bleed is:
a) Mallory Weiss tear
a) angiodysplasia
a) peptic ulcer
a) dieulafoy lesion
a) antritis
14. The medical treatment to be of most benefit in the
therapy of both variceal and non-variceal
upper GI bleed is:
a) octreotide
b) omprazole
c) ice water lavage
d) vasopressin
e) ranitidine
MCCQE 2002 Review Notes Sample Questions – 17
GASTROENTEROLOGY . . . CONT.
15. A 50 year old man was admitted for a bleeding duodenal
ulcer 2 months ago. He was discharged from hospital
with an appropriate course of H. Pylori eradication
treatment. He has since completed the therapy and is
currently asymptomatic. Which of the following is the
BEST non-invasive test to confirm eradition of H. Pylori:
a) urea breath test
b) endoscopy and histology
c) IgG serology
d) skin testing
16. Which one of the following statements regarding liver
failure is TRUE?
a) a liver biopsy is a not required with a good history of
alcoholism
b) encephalopathy may be reversible
c) SBP (spontaneous bacterial peritonitis) is usually a
result of blunt abdominal trauma
d) coagulopathy is a result of poor diet in most patients
with cirrhosis
e) the size a varix is proportional to the degree of
portal hypertension
18 – Sample Questions MCCQE 2002 Review Notes
GERIATRIC MEDICINE
1. Which of the following is NOT a cause of urinary
incontinence?
a) diabetes
b) coagulopathies
c) restricted mobility
d) UTIs
e) prostatic disease
2. Which of the following physiological changes affect
pharmacokinetics in the elderly?
a) increased body albumin
b) decreased body fat
c) increased GFR
d) decreased hepatic blood flow
e) increased hepatic phase I reactions
3. Which of the following statements is TRUE:
a) The ratio of males to females over 85 in Canada
is 2:1
b) Accidents are the most common cause of death in
Canadians over 65
c) During normal bereavement, symptoms of
depression should last for up to one year
d) all of the above
e) none of the above
4. The functional assessment of IADLs in the elderly
include all of the following EXCEPT:
a) food preparation
b) ability to climb stairs
c) driving
d) managing finances
e) shopping
5. Which of the following is NOT a cause of failure to thrive in
the elderly:
a) alopecia
b) poor dentition
c) depression
d) neglect
e) dementia
MCCQE 2002 Review Notes Sample Questions – 19
GYNECOLOGY
1. Which of the following is not consistent with PCOD?
a) high testosterone
b) low LH
c) average age of presentation 15-35 years
d) low or normal FSH
e) hirsutism
2. Which of the following is the most common site of
occurrence for endometriosis?
a) broad ligament
b) uterosacral ligaments
c) ovary
d) rectosigmoid colon
e) appendix
f) lung
3. Which of the following are diagnostic characteristics of
endometriosis? (Multiple answers)
a) constant pelvic pain
b) chocolate cysts
c) deep dyspareunia
d) blueberry spots
e) cyclic dysmenorrhea
f) infertility
g) bladder symptoms
h) bowel symptoms
i) powder burn lesions
4. Which of the following are considered risk factors for
ectopic pregnancy? (Multiple answers)
a) alcohol consumption
b) previous PID
c) use of IUD
d) appendectomy
e) previous ectopic pregnancy
f) use of assisted reproductive techniques
g) grand multiparity
h) endometriosis
5. Which of the following are considered predisposing
factors for candidiasis? (Multiple answers)
a) diabetes
b) pregnancy
c) HIV
d) organ transplant recipient
e) BCP
f) use of a diaphragm
g) antibiotic therapy
h) hypertention
i) cigarette smoking
6. Regarding condylomata/genital warts which of the
following is/are TRUE? (Multiple answers)
a) spread can be prevented using condoms
b) infection can be latent, only detectable with DNA
hybridization
c) some viral serotypes are associated with an
increased incidence of cervical CA
d) removal of lesions is proven to decrease recurrence
e) lesions present during pregnancy is an absolute
indication for C/S
f) treatment is through either physical or chemical
modalities
7. Which of the following is correct regarding the presentation
and treatment of genital herpes? (Multiple answers)
a) inguinal lymphadenopathy is present with first
infection
b) recurrent infections are usually less severe and less
frequent
c) presentation is four to six months after exposure
d) initial presentation is as a painless chancre on vulva
e) diagnosis is made on viral culture
f) treatment with acyclovir is curative
g) outbreak is usually preceded by a tingling, burning
prodrome
8. Which of the following are absolutely necessary for the
diagnosis of PID? (Multiple answers)
a) temperature > 39.0 C
b) adnexal tenderness
c) cervical motion tenderness
d) elevated white count
e) positive culture for N. gonorrhea, or C. Trachomatis
f) elevated ESR
g) lower abdominal pain
9. Regarding PAP smear screening protocol, which of the
following are recommended? (Multiple answers)
a) should be performed yearly from onset of sexual
activity until age 69
b) requires only an endocervical cell sampling
c) is equally effective in identifying both SCC and
adenocarcinoma
d) a patient can be released from screening after two
consecutive negative tests
e) after three negative tests, screening intervals can be
increased up to 3 years
f) an inadequate sample requires a repeat PAP within
3 months
20 – Sample Questions MCCQE 2002 Review Notes
GYNECOLOGY . . . CONT.
10. Which of the following are consistent with the clinical
presentation of fibroids? (Multiple answers)
a) menorrhagia
b) abnormal bleeding pattern
c) abdominal heaviness
d) increased abdominal girth
e) amenorrhea
f) infertility
g) abdominal pain
h) difficulty emptying bladder
i) difficulty defecating
11. Non-contraceptive benefits of oral contraception pills
include:
a) Reduced benign breast disease and ovarian cysts
b) Reduced dysmenorrhea
c) Reduced anemia
d) Reduced risk of ovarian carcinoma
e) All of the above
12. Regarding infertility:
a) It is defined as failure to conceive after one year of
regular unprotected intercourse
b) It occurs in approximately 50-60% of couples
c) Most cases are due to unknown factors
d) A normal sperm count from semen analysis is
> 5 million sperm/mL
e) A hysterosalpingogram plays no role in potential
evaluation of infertility
13. A 20 year old G0 woman presents to your office with a
4-month history of amenorrhea. She had previously
normal and regular cycles since age 12 years. Your initial
evaluation of this problem includes:
a) Thorough history and physical examination
b) A beta-hCG test
c) TSH and prolactin levels
d) All of the above
e) none of the above
14. Absolute contraindications to HRT include:
a) undiagnosed vaginal bleeding
b) known or suspected cancer of the ovary
c) acute renal disease
d) obesity
e) none of the above
15. Which of the following condition(s) are associated with
Polycystic Ovarian Syndrome?
a) obesity
b) hirsutism
c) insulin resistance
d) acanthosis nigricans
e) All of the above
MCCQE 2002 Review Notes Sample Questions – 21
HEMATOLOGY
1. You would expect to find an increased bleeding time in
all of the following conditions EXCEPT:
a) Osler-Weber-Rendu
b) HSP
c) ITP
d) Celiac disease
e) Splenomegaly
2. All of the following characterize chronic ITP EXCEPT:
a) onset usually following recent viral infection
b) spontaneous remission uncommon
c) peak age of onset 20-40 years
d) occurs more frequently in women
e) insidious onset of bleed
3. Which of the following coagulation factors is NOT
effected by chronic liver disease
a) factor VII
b) factor V
c) fibrinogen
d) factor VIII
e) factor IX
4. What disorder results in prolonged bleeding time and
decreased factor VIII coagulation activity?
a) Hemophilia A
b) Hemophilia B
c) von Willebrand’s disease
d) Vitamin K deficiency
e) None of the above
5. A young girl with thalassemia is undergoing a blood
transfusion and suddenly develops back pain, fever and
becomes tachypneic. The likely diagnosis is:
a) Delayed hemolytic transfusion reaction
b) Febrile non-hemolytic transfusion recaction
c) Acute hemolytic transfusion reaction
d) Circulatory overload
e) Graft vs. host disease
6. Which of the following is not accurate for iron stores:
a) Serum Fe
b) Transferrin
c) Ferritin
d) Hemosiderin
e) TIBC
7. The most common cause of cold antibodies other than
idiopathic is:
a) Drug induced
b) Routine detection
c) Secondary to infection
d) Secondary to lymphoproliferative disorder
e) Autoimmune disease
8. Which of the following blood smear results are most
likely to indicate G6PD deficiency?
a) Rouleaux
b) Howell-Jolly bodies
c) Basophilic stipling
d) Heinz bodies
e) Tear drop cells
9. All of the following may be seen in aplastic anemia
EXCEPT:
a) Anemia
b) Thrombocytopenia
c) Leukopenia
d) Splenomegaly
e) increase frequency of infections
10. The cause of beta thalasemia minor is:
a) Increase HbA2 production
b) Reduced B chain production
c) Increased HbF production
d) No B chain production
e) Increased B chain production
11. Metabolic disturbances that may be seen in acute
myelogenous leukemia include:
a) high uric acid, high calcium, high magnesium
b) high uric acid, low calcium, low magnesium
c) high uric acid, high calcium, high phosphate
d) high uric acid, low calcium, low phosphate
e) low uric acid, high calcium, high phosphate
12. Clinical features of chronic myelogenous leukemia include
all EXCEPT:
a) left upper quadrant pain and fullness
b) pruritus
c) peptic ulcers
d) priapism
e) jaundice
13. The MOST COMMON presentation of essential
thrombocythemia is:
a) weight loss, fever
b) bleeding
c) thrombosis
d) asymptomatic
e) splenomegaly
14. A 22-year old male student presents with enlarged cervical
lymph nodes that become painful after alcohol
consumption. The only remarkable feature on history is an
8 lb weight loss over 2 months. The most likely diagnosis
would be:
a) ALL
b) Hodgkin’s lymphoma
c) Non-Hodgkin’s lymphoma
d) CLL
e) multiple myeloma
15. Possible treatments for multiple myeloma or its
complications include all EXCEPT:
a) corticosteroids
b) bisphosphonates
c) radiation therapy for bone lesions
d) renal transplant
e) plasmapheresis
22 – Sample Questions MCCQE 2002 Review Notes
INFECTIOUS DISEASES
1. Group A Strep is least likely to cause which of the
following complications:
a) scarlet fever
b) necrotizing faciitis
c) impetigo
d) subacute bacterial endocarditis
e) glomerulonephritis
2. Septra is used in AIDS patients to prevent which
opportunistic organism?
a) Pneumocystis carinii
b) M. tuberculosis
c) S. pneumoniae
d) CMV
e) Cryptococcus
3. Severe bloody, afebrile diarrhea is associated with what
bacterial infection?
a) Salmonella infection
b) Enteroinvasive E.coli infection
c) Enterohemorrhagic E. coli infection
d) Enterotoxigenic E. coli infection
e) Giardiasis
4. Human Herpes Virus 6 is associated with what disease?
a) Infectious mononucleosis
b) CMV infection
c) Herpes Simplex infection
d) Roseola
e) Chicken Pox
5. Cat’s scratch disease is caused by what organism?
a) Leishmania spp.
b) Bartonella henselae
c) Treponema pallidum
d) Toxoplasmosa gondii
e) Ancylostoma braziliensei
6. Predictors of HIV progression include the following
EXCEPT:
a) CD4 cell count
b) plasma HIV RNA levels at set point
c) onset of HIV related symptoms
d) age at initial infection
e) method of transmission (i.e. anal intercourse versus
vaginal intercourse)
7. Protozoa are associated with all of the following except
a) unicellular organism
b) produce larvae
c) do not cause eosinophilia
d) indefinite lifespan
e) mulitply within host
8. Inwhich disease would Donovan bodies be present?
a) genital warts
b) lymphogranuloma venereum
c) syphilis
d) granuloma inguinale
e) chancroid
9. Which disease is NOT caused by Chlamydia sp.?
a) lymphogranuloma venereum
b) pelvic inflammatory disease
c) granuloma inguinale
d) inclusion conjunctivitis
e) nongonococcal urethritis
10. If a patient comes to your office complaining of chest pain
and a cough producing a current jelly-like sputum, which
organism would be the most likely cause of his/her
pneumonia?
a) Streptococcus pneumoniae
b) Haemophilus influenzae
c) Pseudomons aeruginosa
d) Influenza virus
e) Klebsiella pneumoniae
11. Which organ in the human body is the most sensitive to
disseminated intravascular coagulation in a case of
meningitis?
a) thyroid
b) adrenal
c) lateral ventricle of the brain
d) spleen
e) aorta
12. The Negri body is a pathogonomiic sign of:
a) acute bacterial meningitis
b) arbovirus encephalitis
c) rabies
d) polio
e) chronic meningitis
13. If untreated, this infection can lead to cholangiocarcinoma.
a) Schistosomiasis
b) Clonorchis sinesis
c) Strongyloidosis
d) Trypanosoma
e) E. coli
14. A 10 year old girl from El Salvador is brought to the
pediatric outpatient clinic. On the growth charts, she is
< 1 percentile. A CBC reveals a profound anemia. She has
moderate edema of the lower extremities and face. Stool
is sent for ova and parasites (O&P), and the lab reports the
presence of helminth eggs. The most likely parasite
compatible with her clinical presentation is?
a) hookworm
b) Strongyloidosis
c) pinworm
d) pork tapeworm
15. A 48 year old make who received a bone marrow
transplant 6 months previously for chronic myelogenous
leukemia is admitted with wedge-shaped infiltrates on
chest x-ray. He is experiencing severe respiratory difficulty
and is coughing up blood. Despite aggressive treatment,
he dies shortly after admission. At autopsy, pulmonary
infarcts are found. The pulmonary vessels contain fungal
hyphae with acute angle branching. The most likely
diagnosis in infection with:
a) Asperigillus spp.
b) Candida spp.
c) Blastomycosis
d) Pneumocystis carinii
MCCQE 2002 Review Notes Sample Questions – 23
NEPHROLOGY
1. A 63 year old woman with a long history of chronic renal
failure is seen because of fatigue. She gets tired after
walking 4 blocks, but is comfortable at rest. Her only
medication is a calcium channel blocker for
hypertension. There is no history suggestive of bleeding.
Her physical examination reveals pallor but no other
abnormalities. Lab investigations reveal that a
Hgb = 85 g/L, MCV = 88 fL, ferritin = 210 ug/L,
vitamin B12 = 210 pmol/L, a normal RBC folate, and
serum creatinine of 379 umol/L. Two months ago, her
Hgb level was 90 g/L. The MOST APPROPRIATE
THERAPY for her anemia AT THIS POINT is:
a) administration of erythropoietin
b) dialysis
c) renal transplantation
d) vitamin B12 injections
e) oral iron
2. A 22 year old woman with a history of type 1 diabetes
mellitus is brought to the emergency room in coma.
Blood tests indicate a wide anion gap metabolic
acidosis. If her metabolic acidosis is due solely to
diabetic ketoacidosis, which of the following findings is
NOT consistent:
a) blood glucose increased
b) serum ketones increased
c) serum osmolar gap increased
d) extracellular fluid volume reduced
e) urine dip positive for ketones
3. A patient in acute renal failure comes to the emergency
room. His serum potassium value is 8.0 mM. Of the
following ECG changes listed below, which ONE is NOT
consistent with hyperkalemia?
a) wide QRS complexes
b) peaked T waves
c) peaked P waves
d) ventricular fibrillation
e) prolonged PR interval
4. A chronic dialysis patient who passes no urine has missed
3 hemodialysis treatments in the last week and comes into
the emergency room with a serum potassium value of
8.5 mmol/L. An ECG shows cardiac changes consistent with
severe hyperkalemia. Blood glucose is 4.5 mmol/L. Which
ONE of the following would be the best action to take:
a) Give the patient a prescription for an oral potassium
exchange resin and arrange dialysis within 24 hours
b) Give insulin and glucose intravenously
c) Give insulin and calcium gluconate intravenously and
inhaled salbutamol
d) Give insulin, calcium gluconate and glucose
intravenously and arrange for urgent dialysis
e) Give inhaled salbutamol and larger doses of
intravenous furosemide
5. Which of the following is the LEAST APPROPRIATE
indication for dialysis in the setting of acute renal failure?
a) extracellular fluid volume overload unresponsive to
diuretics
b) hyperkalemia unresponsive to medical attempts to
lower the plasma potassium level
c) plasma creatinine greater than 300 umol/L
in an otherwise asymptomatic patient
d) uremic pericarditis
e) uremic encephalopathy with seizures
6. The COMMONEST cause of acute renal failure in
hospitalized patients is:
a) acute crescentic glomerulonephritis
b) acute tubular necrosis (ATN)
c) cyclosporine nephropathy
d) HIV nephropathy
e) obstructive uropathy
7. The COMMONEST cause of death in dialysis and renal
transplant patients is:
a) cardiovascular disease
b) HIV-associated complications from repeated
infusions of blood products
c) infection
d) neoplasia
e) suicide
8. A 21 year old woman is referred for edema of the ankles
that developed 3 weeks earlier. Physical examination
shows moderate bilateral ankle edema. The chest was
clear and heart sounds were normal. Jugular venous
pressure was 1 cm above the sternal angle. Urinalysis
shows 3+ protein and occasional red and white blood
cells. Plasma creatinine was normal and plasma albumin
was reduced at 36 g/L.
Which of the following is the LEAST likely renal
diagnosis?
a) acute tubular necrosis (ATN)
b) membranous glomerulonephritis
c) minimal change glomerulonephritis
d) lupus nephritis
e) post-infectious glomerulonephritis
9. A 66 year old man is referred to you for hypertension
which was not noted until this year, despite yearly
physical examinations for many years. Apart from recent
headaches he has no complaints and was not taking any
medications. Blood pressure in your office was
175/100 mm Hg with a pulse of 80/min. Examination of
the optic fundi showed arteriolar narrowing. Bilateral
femoral bruits were present. Urinalysis showed 1+
protein and granular casts. Plasma creatinine was
210 umol/L. The MOST LIKELY diagnosis is:
a) atheromatous emboli
b) bilateral renal artery stenosis
c) essential hypertension
d) pheochromocytoma
e) proliferative glomerulonephritis
24 – Sample Questions MCCQE 2002 Review Notes
NEPHROLOGY . . . CONT.
10. A 36 year old man presents with ankle edema and an
elevated jugular venous pressure. Plasma creatinine is
350 umol/L. Past history reveals a polyarthritis for
6 months treated with ibuprofen and allergic rhinitis.
Physical exam reveals several active joints in both hands
and an itchy skin rash over the trunk. BP = 170/100 mm Hg
and he has moderate peripheral edema. Urinalysis shows
a trace of protein, trace blood and on microscopy many
white blood cells and white blood cell casts are seen.
The MOST LIKELY diagnosis is:
a) atheromatous emboli
b) interstitial nephritis
c) lupus nephritis
d) membranous glomerulonephritis
e) renal artery stenosis
11. Acute diffuse proliferative glomerulonephritis is usually
accompanied by each of the following findings EXCEPT:
a) red blood cell casts on microscopic urinalysis
b) proteinuria
c) pigmented casts on microscopic urinalysis
d) blood clots in the urine
e) none of the above
12. The anion gap is increased in metabolic acidosis
associated with each of the following EXCEPT:
a) diabetic ketoacidosis
b) renal tubular acidosis
c) acute tubular necrosis
d) ethylene glycol intoxication
e) lactic acidosis
13. Treatment of hypertension caused by bilateral renal
artery stenosis should NOT include which of the
following?
a) weight reduction if obese
b) drug therapy with angiotensin-converting enzyme
inhibitors
c) percutaneous transluminal renal angioplasty
d) surgical renal revascularization
e) sodium restriction
14. Hyperkalemia is reduced by each of the following
EXCEPT:
a) administration of calcium gluconate intravenously
b) administration of glucose, insulin and sodium
bicarbonate intravenously
c) oral administration of potassium-exchange resins
with sorbitol
d) hemodialysis with low potassium dialysate
15. The anemia of chronic renal failure is usually due to which
of the following?
a) malabsorption of iron
b) vitamin B12 deficiency
c) blood loss
d) decreased erythropoietin production
e) associated inflammatory conditions
NEUROLOGY
1. 32 year old woman with right-hand pain waking her up at
night. Physical exam reveals mild weakness of right
thumb adduction and some thenar wasting. What is the
most likely diagnosis?
a) cervical radiculopathy
b) carpal tunnel syndrome
c) tendinits
d) syringomyelia
2. 35 year old woman with one week history of bilateral leg
weakness. Physical exam reveals moderate leg weakness,
mild arm weakness, and decreased reflexes. What is the
most likely diagnosis?
a) Lyme disease
b) Parkinson's disease
c) Multiple Sclerosis (MS)
d) Guillian-Barré syndrome
3. Patient with mild left-sided hearing loss and absent left
corneal reflex. Where is the lesion?
a) left cerebellar pontine angle
b) lateral medulla
c) left CN V
d) left cochlea
4. 75 year old man with sudden onset of severe leg
weakness. Physical exam reveals bilateral leg weakness,
loss of pain and temperature sensation with intact
vibration and positon sense in both legs. What is the
likely diagnosis?
a) anterior cerebral artery territory stroke
b) lumbar radiculopathy
c) anterior spinal artery occlusion
d) diabetic polyneuropathy
5. Which of the following is NOT consistent with
amyotrophic lateral sclerosis (ALS)?
a) distal arm and leg weakness
b) coexistence of both upper and motor neuron signs
c) slowed motor nerve conduction velocities
d) fasciculations
6. 52 year old woman with incontinence and “dizzy spells.”
Physical exam reveals rigidity, bradykinesia, postural
instability, mild ataxia, and postural hypotension. What is
the likely diagnosis?
a) vitamin B12 deficiency
b) Parkinson’s disease
c) normal pressure hydrocephalus
d) multiple systems atrophy
7. Patient with dizziness, left arm and leg weakness, loss of
pain and temperature senasation in the left face and
right extremeties. What is the likely diagnosis?
a) lateral medullary syndrome
b) migraine with aura
c) middle cerebellar artery territory stroke
d) benign paroxysmal positional vertigo (BPPV)
8. Choose the ONE CORRECT statement. A lesion of the left
cerebellum could cause?
a) akinesia
b) right arm and leg ataxia
c) left arm and leg weakness
d) spasticity of the right arm and leg
e) dysmetria on finger to nose testing of the left arm
9. The following statements concerning the pathophysiology
of Parkinson’s disease are correct, EXCEPT:
a) symptoms appear after there has been a substantial
loss of the pigmented neurons of the substantia nigra
b) the internal segment of the globus is the major outflow
center of the basal ganglia
c) the globus pallidus interna is normally excitatory
to the thalamus
d) a pallidotomy, a surgical lesion placed in the globus
pallidus is helpful in some patients with Parkinson’s
disease
e) dopaminergic neurons of the substantia nigra project
to the putamen
10. Choose the ONE CORRECT statement regarding Wernicke’s
aphasia:
a) patients with Wernicke’s aphasia have dysprosodic
speech
b) weakness of the face and arm are commonly found in
patients with Wernicke’s aphasia
c) the speech of patients with Wernicke’s aphasia is fluent
with normal or slightly increased speed
d) patients with Wernicke’s aphasia almost universally
fail to understand the commance “take off your
glasses”
e) patients with Wernicke’s aphasia cannot write but
they are still able to read
11. All of the following statements regarding aphasia are
correct, EXCEPT:
a) the left hemisphere is dominant for language even in
many left handed patients
b) patients with Broca’s aphasia often have upper motor
weakness of the right arm and face
c) patients with Broca’s Conduction, and Wernicke’s
aphasias all have difficulty with repetition
d) both Wernicke’s and Broca’s areas are supplied by the
middle cerebral artery
e) patients with transcortical type aphasias have a lesion
which damages both Wernicke’s and Broca’s cortical
areas
12. A patient who is unable to use a comb but has no muscle
weakness is likely to have a lesion in which part of the
central nervous system?
a) the hand area of the motor cortex
b) the vermis of the cerebellum
c) Broca’s area
d) part of the premotor or prefrontal cortex
e) posterior parietal cortex
MCCQE 2002 Review Notes Sample Questions – 25
26 – Sample Questions MCCQE 2002 Review Notes
NEUROSURGERY
1. Which of the following is FALSE regarding intracranial
dynamics?
a) normal intracranial pressure is 6-15 mmHg
(8-18 cm H2O)
b) the relationship between an expanding intracranial
mass and the resultant rise in intracranial pressure
is linear
c) cerebral blood flow depends on cerebral perfusion
pressure and cerebral vascular resistance
d) lumbar puncture is contraindicated in patients with
known or suspected intracranial mass lesions
2. Which of the following is NOT a classic finding in
someone with raised intracranial pressure?
a) headache with nausea and vomiting
b) respiratory changes
c) increased blood pressure
d) tachycardia
3. An obsese 30 year-old woman presents with headache
and nausea, and a bilateral decrease in visual acuity.
She has no recent history of trauma and is otherwise
well, but takes tetracycline for acne. CT and MRI scans of
her head with and without contrast are normal. Of the
following options, what is the most likely diagnosis?
a) normal pressure hydrocephalus
b) benign intracranial hypertension
c) meningioma
d) acute subdural hematoma
4. What is the most common type of primary brain tumour
in adults?
a) astrocytoma
b) medulloblastoma
c) meningioma
d) vestibular schwannoma
5. Which of the following is NOT a characteristic CT feature
of a brain abscess?
a) perilesional hypodensity
b) central hypodensity
c) homogenous contrast enhancement
d) ring enhancement with contrast
6. A 45 year-old man presents with headache. On
examination, you notice that he has a large chin and
brow, as well as large clammy hands. MRI of his head
reveals a large midline suprasellar mass. What visual
deficit might you expect in this gentleman?
a) right monocular blindness
b) amaurosis fugax
c) left homonymous hemiaopia
d) bitemporal hemianopia
7. What is the most appropriat initial investigation in the
diagnosis of subarachnoid hemorrhage?
a) lumbar puncture
b) CT without contrast
c) MRI
d) CT with contrast
8. Which of the following is NOT part of the management
of vasopasm following subarachnoid hemorrhage?
a) maintaining blood pressure at or below 120/80
b) nimodipine
c) IV solutions to decrease hematocrit levels
d) angioplasty
9. A 70 year-old man complains of trouble walking. On
examination, you find that he has left leg weakness and
hyperreflexia, but relatively normal power and reflexes in
his right leg. Furthermore he has decreased position and
vibration sense in his left leg relative to his right, but
decreased pin prick sensation in his right leg relative to
his left. MRI of his lumbar spine reveals a tumour
compressing the man’s spinal cord. Where is the tumour?
a) lateral to the right side of the lumbar spinal cord
b) lateral to the left side of the lumbar spinal cord
c) within the centre of the lumbar spinal cord
d) anterior and central to the lumbar spinal cord
10. A 29 year-old bodybuilder presents complaining of right
arm pain and weakness. Examination reveals a
decreased triceps reflex on the right and decreased
sensation on the right middle finger. MRI shows a right
posterolateral intervertebral disc hernation. Where is the
herniation ?
a) C4-5 interspace
b) C5-6 interspace
c) C6-7 interspace
d) C7-T1 interspace
11. What is the most common cause of an epidural
hematoma?
a) ruptured middle cerebral atery
b) ruptured anterior cerebral artery
c) ruptured posterior communicating artery
d) ruptured middle meningeal arter
12. What is the typical appearance of an acute subdural
hematoma on noncontrast CT?
a) diffuse intraparenchymal hypodense mass
b) hyperdense biconvex mass
c) hypodense intraventricular mass
d) hyperdense concave mass
13. Which of the following is NOT a classic finding in someone
with carpal tunnel syndrome?
a) positive Tinel’s syndrome
b) hand pain sometimes awakening patient at night
c) hypothenar muscle wasting
d) positive Phalen’s sign
14. What is the most common location for pediatric brain
tumours?
a) anterior cranial fossa
b) posterior cranial fossa
c) middle cranial fossa
d) sella turcica
15. What is the term for the group of hindbrain abnormalities
involving some degree of cerebellar hernation or
hypoplasia?
a) Chiari malformation
b) Dandy-Walker malformation
c) craniosynostosis
d) myelomeningocele
MCCQE 2002 Review Notes Sample Questions – 27
OBSTETRICS
1. Polyhydramnios is associated with all of these EXCEPT:
a) premature labour
b) cord prolapse
c) postpartum hemorrhage
d) Potter’s syndrome
e) trisomy 18
2. With regard to thromboembolism and pregnancy all of
the following are true EXCEPT:
a) Risk increases with maternal age
b) Warfarin is teratogenic
c) There is an increase in factors I, VII, VIII, IX, X, XII
d) Heparin crosses the placenta
e) The uterus compresses veins contributing the
venous stasis
3. Which of the following are TRUE with regard to normal
labour:
a) Labour commences with onset of regular painful
contractions in the presence of a dilated cervix
b) Retraction of the head during the second stage
suggests an undiagnosed malposition
c) The average time for the second stage is one hour in
the multiparous woman
d) The second stage includes both a latent and active
stage
e) Signs of placental separation include a gush of bright
red placental blood
4. Which of the following is associated with profuse painless
vaginal bleeding in the third trimester?
a) abruptio placenta
b) umbilical cord prolapse
c) degenerating fibroid
d) placental insufficiency
e) placenta previa
5. Which of the following is NOT a prerequisite to the use of
forceps in obstetrical delivery?
a) patient must be fully dilated
b) full bladder
c) adequate anaesthesia
d) position of fetus known
e) ruptured membranes
6. The most common cause of postpartum hemorrhage is:
a) retained placenta
b) uterine atony
c) vaginal lacerations
d) cervical lacerations
e) uterine fibroids
7. Which of the following is NOT associated with severe
preeclampsia?
a) elevated liver transaminases
b) thrombocytopenia
c) blood pressure greater than 160/110
d) oliguria
e) hematemesis
8. A 28 year old G1P0 woman at 35 weeks presents to the
labour floor with painless vaginal bleeding. Which of the
following should NOT be done?
a) vaginal examination
b) complete blood count
c) crossmatch blood
d) ultrasound
e) fetal heart rate monitor
9. Which of the following is TRUE regarding malpresentation
of a fetus?
a) It is associated with an increased risk of congenital
anomaly
b) Compound presentation precludes a vaginal delivery
c) It commonly occurs in association with an anthropoid
pelvis
d) It may be corrected during labour by intravenous
oxytocic agents
e) It should be treated by immediate stabilizing
induction if the membranes rupture
10. All of the following are true about the renal system in
pregnancy EXCEPT:
a) The GFR is 60% greater than normal by 12 weeks
b) There is a link between UTI and low birth weight
c) Acute glomerulonephritis is a rare condition and is
usually diagnosed as preeclampsia
d) Asymptomatic bacteriuria has a frequency of 5%
e) The creatinine and urea decrease in the normal
woman compared with non-pregnant values
11. The diagnosis of pregnancy is related to which of the
following?
a) May be delayed as there is commonly a small
amount of blood loss at the time of the first missed
period
b) Nausea and vomiting usually precede amenorrhea
c) Portable doppler machine may detect a fetal heart at
6 weeks
d) In the absence of biophysical and biochemical
diagnostic aids a bimanual examination to detect
Hegar’s sign should be performed
e) The beta subunit of HCG is similar to corresponding
units on LH,FSH and TSH giving false positive results
on immunosorbent assays
12. All of the following are prerequisites for labour
suppression (tocolysis) EXCEPT:
a) intact membranes
b) live fetus
c) absence of fetal distress
d) no dilatation
e) necessary personnel if tocolysis fails
13. With regards to fetal heart monitoring, which of the
following is TRUE:
a) Early decelerations are related to a vagal response
to head compression
b) An acceleration is defined as an increase of at least
20 bpm lasting at least 20 seconds
c) Normal range is 100-180 bpm
d) A variable deceleration is the least common change
seen during labour
e) A late deceleration peaks at the same time as the
uterine contraction
14. Which of the following is NOT true:
a) With rubella infection, the greatest risk to the fetus
occurs in the first trimester
b) Genital herpes lesions is an indication for a caesarean
section
c) AZT decreases the incidence of vertical transmission
of HIV
d) Varicella vaccine is safe during pregnancy
e) All women should be screened for Hepatitis B
15. Which of the following is TRUE:
a) The puerperium refers to the first 2 weeks after
delivery
b) The uterus should reach the non-pregnant state with
in 1-2 weeks
c) Foul smelling lochia suggests endometritis
d) Lochia changes in time from lochia rubra to lochia
serosa to lochia alba
e) Postpartum blues are rare
OPHTHALMOLOGY
1. Which of the following is NOT a contraindication to pupil
dilation:
a) narrow anterior chamber
b) iritis
c) neurologic abnormality requiring pupillary
evaluation
d) iris supported anterior chamber lens implant
2. In myopics, the eyeball is:
a) too long
b) too short
c) non-spherical
d) crooked
3. The most common cause of exophthalmos in children is:
a) hyperthyroidism
b) orbital cellulitis
c) orbital tumours
d) orbital hemorrhage
4. Eversion of the lower lid margins is termed:
a) trichiasis
b) entropion
c) ectropion
d) chalazion
5. The most common type of lid carcinoma is:
a) adenocarcinoma
b) squamous cell carcinoma
c) sebaceous cell carcinoma
d) basal cell carcinoma
6. Which conjunctivitis typically begins as unilateral and
progresses to the opposite eye:
a) bacterial
b) viral
c) allergic
d) chlamydial
7. Which of the following is associated with contact lens
wear:
a) vernal conjunctivitis
b) iritis
c) scleromalacia perforans
d) giant papillary conjunctivitis
8. Which of the following should never be given for corneal
abrasions:
a) topical analgesics
b) topical antibiotics
c) pressure patch
d) topical cycloplegics
9. Dendritic lesions are characteristic of:
a) herpes zoster keratitis
b) arcus senilus
c) herpes simplex keratitis
d) scleritis
10. Severe photophobia is most characteristic of:
a) acute glaucoma
b) cataracts
c) iritis
d) corneal abrasion
11. Which is NOT a management step in iritis:
a) pressure patch
b) pupil dilation
c) systemic analgesics
d) medical work-up to determine etiology
12. Cataracts can be due to all of the following but:
a) aging
b) diabetes mellitus
c) increased lipids
d) uveitis
13. Which of the following require the most urgent attention:
a) central retinal vein occlusion
b) cataracts
c) scleritis
d) central retinal artery occlusion
14. Management for primary angle closure galucoma
includes all of the following except:
a) laser iridotomy
b) mydriatic drops
c) topical beta-blockers
d) IV hypertonic mannitol
e) systemic carbonic anhydrase inhibitors
15. Which of the following is NOT associated with primary
angle closure glaucoma:
a) steroid use
b) nausea and vomiting
c) hyperopia
d) painful red eye
e) opacified cornea
16. Which of the following is NOT a cause of a relative
afferent pupillary defect:
a) multiple sclerosis
b) optic neuritis
c) dense cataract
d) large retinal detachment
e) central retinal vein occlusion
17. Which of the following is associated with impaired pupil
dilation:
a) sympathetic stimulation
b) Adie’s tonic pupil
c) parasympathetic understimulation
d) Horner’s syndrome
18. The most common ocular infection in HIV is:
a) herples simplex
b) pnuemocystis carinni
c) cytomegalovirus
d) candida
e) toxoplasmosis
28 – Sample Questions MCCQE 2002 Review Notes
MCCQE 2002 Review Notes Sample Questions – 29
OPHTHALMOLOGY . . . CONT.
19. In a newly diagnosed patient with type 2 diabetes,
appropriate screening for retinopathy should involve:
a) begin screening five years after diagnosis
b) repeat in four years and thereafter annually
c) begin screening three years after diagnosis, then
repeat annually
d) begin screening after age 50; earlier if poor glycemic
control
20. Non-proliferative changes in diabetic retinopathy include
all of the following EXCEPT:
a) microaneurysms
b) retinal edema
c) intraretinal microvascular anomalies
d) retinal edema
e) dot and blot hemorrhages
21. Grade 5 involvement in graves disease refers to:
a) corneal involvement
b) soft tissue involvement
c) sight loss due to optic neuropathy
d) proptosis
22. Which of the following tests for a phoria:
a) Hirschberg test
b) cover test
c) cover-uncover test
d) holler test
e) accomadation reflex
23. The following are true in the management of chemical
burns to the eye EXCEPT:
a) alkali burns have a worse prognosis than acid burns
b) an alkali burn should be neutralized immediately
c) an IV drip with water should be set-up for irrigation in
the emergency room
d) cyclopegic drops should be administered
24. In differentiating the causes of red eye, photphobia is
most characteristic of:
a) cataract
b) conjunctivitis
c) angle closure keratitis
d) acute glaucoma
e) acute iritis
ORTHOPEDICS
1. A 35 year old male manual labourer sustained a
displaced subcapital hip fracture after falling at work.
The fracture was reduced and fixed with 3 cannulated
screws. Five months after the operation, he presents to
your clinic with worsening hip pain. What is the most
likely diagnosis?
a) Nonunion
b) Osteonecrosis
c) Loosening of the cannulated screws
d) Malunion
e) Osteomyelitis
2. A 25 year old professional basket ball player lands on his
right foot while it is in a pronated and externally rotated
position. He hears a “snap” and is unable to weight bear
on his right foot. An ankle X-ray reveals significant talar
shift without a visible fibular fracture. The most
appropriate next step is:
a) Closed reduction of the ankle mortise followed by
application of a cast
b) Bedrest for 4 weeks followed by intense
physiotherapy
c) X-ray the right knee to rule out a Maisonneuve
fracture
d) Open reduction with internal fixation of the right
ankle
e) Splint ankle and encourage weight bearing
3. A 75 year old lady slips on a throw rug in her living room
and falls. An X-ray reveals a displaced subcapital hip
fracture. Prior to her fall, the patient lived alone,
per formed all ADLs independently and enjoyed golfing.
The most appropriate management of this fracture is:
a) Moore’s unipolar hemiarthroplasty
b) Bedrest for 6 weeks
c) Reduction with internal fixation using 3 cannulated
screws
d) Bipolar hemiarthroplasty
e) Total hip replacement
4. A 21 year old presents to your office after injuring her
knee in a soccer game. She states that the knee clicks
when she walks and has “locked” on several occasions.
On exam there is an effusion and the knee is grossly
stable. The most likely diagnosis is:
a) Anterior cruciate ligament tear
b) Meniscal tear
c) Osteoarthritis
d) Bursitis
e) Medial collateral ligament tear
5. All of the following regarding Achilles tendon rupture are
true, EXCEPT:
a) Positive Thompson’s test
b) Palpable gap over Achilles tendon
c) Weak plantar flexion
d) May occur secondary to steroid injection
e) Treat by casting foot in dorsiflexion
30 – Sample Questions MCCQE 2002 Review Notes
MCCQE 2002 Review Notes Sample Questions – 31
OTOLARYNGOLOGY
1. Regarding laryngeal cancer, which of the following is
FALSE?
a) hoarseness appears early
b) involved nodes are not palpable in 35% of cases
c) distant metastasis appears early
d) direct extension is common
e) it is 90% five-year curable when limited to one cord
2. All of the following are removed in radical neck
dissection EXCEPT:
a) sternocleidomastoid muscle
b) external carotid artery
c) internal jugular vein
d) spinal accessory nerve
e) submaxillary gland
3. Which of the following factors is NOT associated with
squamous cell carcinoma of the larynx?
a) male sex
b) age in fifth and sixth decades
c) history of woodworking
d) large ethanol intake
e) tobacco smoking
4. In LeFort I fractures, the fragment consists of all of the
following EXCEPT:
a) upper teeth and palate
b) lower portions of the pterygoid processes
c) portions of the walls of both maxillary antra
d) nasal spine
e) bridge of the nose
5. In general, traumatic perforations of the tympanic
membrane:
a) are a surgical emergency
b) will heal spontaneously in most cases
c) usually require operative repair
d) require microsurgical repair
e) require a graft for repair
6. The MOST common organism in acute otitis media of
older children and adults is:
a) Staphylococcus
b) Streptococcus
c) Hemophilus influenzae
d) Klebsiella pneumoniae
e) Pseudomonas
7. A 65-year-old white male who has been smoking pipes
since early adulthood notes a small patch of white on the
lateral anterior portion of the tongue. The patch is not
painful for the first month, but gradually becomes more
painful as it begins to enlarge and ulcerate. The MOST
likely diagnosis is?
a) benign nonspecific ulceration
b) leukoplakia (benign)
c) epulis
d) carcinoma of the tongue
e) ranula of the tongue
8. The diagnosis in question 7 may be confirmed by:
a) a positive Wasserman test
b) a positive lupus erythematosus (LE) preparation
c) a biopsy of the lesion
d) diagnostic mandibular and maxillary x-rays
e) observation of further progression of the disease
9. A cholesteatoma is:
a) an atherosclerotic lesion
b) a dermal collection of cholesterol salts
c) epithelial debris in the middle ear
d) a yellow papule beneath the oral tongue
e) retained cerumen
10. Small, malignant tumours of the larynx that are intrinsic in
origin and have not spread beyond the larynx are BEST
treated by:
a) irradiation
b) laryngofissure
c) total laryngectomy
d) total laryngectomy and radical neck dissection
e) radium needle implants
11. Clinical features of facial fractures frequently include all of
the following EXCEPT:
a) deformity
b) facial nerve paralysis
c) anesthesia over areas of trigeminal branch
distribution
d) ocular disparity
e) malocclusion of the teeth
12. The MOST sensitive test for nasal fracture is:
a) history
b) physical diagnosis
c) plain x-ray studies
d) magnetic resonance imaging
e) computed tomography (CT) scanning
13. Mixed tumours of the salivary gland:
a) are most common in the submaxillary gland
b) are usually malignant
c) are most common in the parotid gland
d) usually cause facial paralysis
e) are associated with calculi
14. In epistaxis, what percentage of the cases will respond to
ten minutes of direct pressure?
a) 10%
b) 30%
c) 70%
d) 90%
e) 0%
15. Which of the following is NOT a cause for conductive
hearing loss?
a) otitis media
b) otosclerosis
c) noise-induced hearing loss
d) perforation of the tympanic membrane
e) ossicular chain disruption
32 – Sample Questions MCCQE 2002 Review Notes
OTOLARYNGOLOGY . . . CONT.
16. Conductive hearing losses are usually reversible. Which
of the following conditions is reversible by surgical
treatment?
a) otosclerosis
b) presbycusis
c) sudden hearing loss
d) ototoxicity
e) meningitis
17. What is the BEST treatment for most cases of
sensorineural hearing loss associated with
aging (presbycusis)?
a) nothing
b) hearing aid
c) ear trumpet
d) diuretic therapy
e) labyrinthectomy
18. The MOST common benign lesion of the external
ear is:
a) melanoma
b) chondrodermatitis nodularis chronicus helicus
c) cerumenoma
d) actinic keratosis
e) exostosis of the canal
19. MOST of the infectious and/or inflammatory diseases
involving the middle ear space are secondary to:
a) ciliary dyskinesia
b) resistant pathogens
c) eutstachian tube dysfunction
d) tobacco abuse
e) allergic diathesis
20. Acute otitis is:
a) a rare condition
b) the most common reason ill children visit the doctor
c) usually not accompanied by pain and fever
d) caused by coliform bacteria
e) treated by placing ventilating tubes
21. All of the following ar indications for tonsillectomy
EXCEPT:
a) six to seven episodes of tonsillitis in 1 year
b) airway obstruction secondary to tonsillar
hypertrophy
c) repeat ear and sinus infections
d) recurrent peritonsillar abscess
e) very large asymmetric tonsil in an adult
22. The MOST common cause for infant stridor, accounting
or 60% of the cases, is:
a) subglottic hemangioma
b) vocal cord paralysis
c) laryngomalacia
d) congenital webs
e) laryngeal cleft
23. What is the MOST common cause of acquired subglottic
stenosis?
a) motor vehicle trauma
b) prolonged endotracheal intubation
c) chronic bronchitis
d) tracheoesophageal fistula
e) previous tracheal surgery
24. A 5-year-old child has persistent serous effusions in both
ears for 6 months after a routine acute infection. He has a
40-dB condutive heraring loss in both ears and has been
having trouble in school. What would be the BEST
treatment for this child?
a) observe the child for another 3 months
b) prescribe amoxicillin for 10 days
c) recommend hearing aids
d) place ventilating tubes
e) prescribe prophylactic antibiotics for 3 months
25. A 3-year-old child has has eight episodes of acute otitis
media in 6 months and has difficulty resolving the
effusions between infections. What should be done to
effectively eliminate the infections?
a) continuing treating each infection as it arises
b) place ventilating tubes
c) prescribe prophylactic antibiotics for 6 months
d) remove the tonsils
e) give IV antibiotics for 4 weeks after infectious
disease consultation
26. The following clinical entities are common causes for
tinnitus EXCEPT:
a) high-frequency hearing loss
b) Ménière’s disease
c) ototoxic drugs
d) loud noise exposure
e) acute otitis media
27. Vertigo is very common in all of the following conditions
EXCEPT:
a) vestibular neuritis
b) Ménière’s disease
c) presbycusis
d) viral labyrinthitis
e) benign paroxysmal positional vertigo
28. The fastest, safest means of establishing a surgical
airway is:
a) endoscopic intubation
b) tracheotomy under local anesthesia
c) tracheotomy under general anesthesia
d) cricothyrotomy
e) puncture through the thyroid membrane
MCCQE 2002 Review Notes Sample Questions – 33
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 cases is most suggestive of child abuse?
a) a child who clings to her parent but shies away from the
emergency physician.
b) a parent who refuses to leave his/her child alone with the
physician, despite the physician’s repeated requests.
c) a parent who claims that his child broke her arm after falling off
her bike.
d) a child with recurrent urinary tract infections despite antibiotic
prophylaxis.
e) a child with old-looking bruises on both elbows and shins.
5) 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) benign abdominal mass compressing her duodenum
b) diaphragmatic hernia
c) functional abdominal pain
d) gastroesophageal reflux disease
e) early peptic ulcer disease
6. Which of the following investigations is most helpful in the
assessment of a child presenting with an acute asthma attack, who
responds poorly to treatment?
a) white cell count and differential
b) arterial blood gases
c) chest x-ray
d) pulmonary function tests
e) sweat chloride test
7. 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
8. 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
9. 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
10. 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) choledochal cyst
c) Hirschsprung disease
d) tracheoesophageal fistula
e) volvulus
11. 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
PEDIATRICS . . . CONT.
12. 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
13. Which of the following is a contraindication to breast feeding
in Canada:
a) allergic disease in the family
b) infantile diarrhea
c) marijuana smoking
d) HIV infection
e) maternal use of ibuprofen
14. 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
15. 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
16. 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
17. 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
routinely 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
18. Which of the is more characteristic of platelet abnormalities and
not coagulation defects?
a) hematomas
b) hemarthrosis
c) petechiae
d) minimal bleeding from small cuts
e) positive family history
19. 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
20. 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
21. 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
22. 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
23. 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
24. 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
incest
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
34 – Sample Questions MCCQE 2002 Review Notes
MCCQE 2002 Review Notes Sample Questions – 35
PEDIATRICS . . . CONT.
25. 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
26. 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
27. All infants less than 3 months of age who have fever and no
localizing signs should have all of the following evaluations
EXCEPT:
a) blood cultures
b) careful history and physical exam
c) chest x-ray
d) CBC (with differential)
e) urine culture
28. All the following statements regarding transient tachypnea of the
newborn (TTN) is true EXCEPT:
a) infants born by C-section are at increased risk for
developing TTN
b) residual pulmonary function disability is common among
infants who have TTN
c) the incidence of TTN is higher than Respiratory Distress
Syndrome (RDS) among term infants
d) TTN shows marked improvement with 12-24 hrs
29. Antibiotic prophylaxis against infective endocarditis is required for
all of the following EXCEPT:
a) rheumatic valve lesions
b) prosthetic heart valves
c) isolated secundum atrial septal defect
d) pacemaker leads
e) patent ductus arteriosus
30. Causes of microcytic anemia include all of the following EXCEPT:
a) excessive cow's milk intake
b) iron deficiency
c) folic acid deficiency
d) thalassemias
e) lead poisoning
31. The latest time after the onset of group A ß hemolytic
Streptococcus pharyngitis that initiation of penicillin therapy can be
expected to prevent acute rheumatic fever is:
a) 24 hrs
b) 48 hrs
c) 96 hrs
d) 9 days
e) 2 weeks
32. A 16 year-old male has a 4 day illness of abrupt onset consisting of
fever, sore throat, rhinorrhea, cough and mild abdominal pain. He
has a red tonsillopharyngeal area, a whitish exudate on the tonsils
and tender anterior cervical nodes. The most likely cause of his
infection is:
a) adenovirus
b) Group A beta-hemolytic Streptococcus
c) Epstein-Barr Virus
d) Neisseria gonorrhea
e) Staphylococcus
33. A 13 month-old infant boy has chronic diarrhea, poor appetite,
irritability and growth failure. He had been well previously,
developing 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’s disease
d) cystic fibrosis
e) none of the above
34. Which of the following is most likely to provide the basis for
making the correct diagnosis in an infant or child who has failure to
thrive (FTT)?
a) blood chemistries
b) cultures
c) history and physical
d) radiograph studies
e) none of the above
35. A 8 year-old boy has had paroxysmal abdominal pain since his
parents separated 6 months ago. Which of the following symptoms
would support an organic basis for his disease?
a) headaches accompanies the pain
b) pain located in the periumbilical region
c) pain awakens child at night
d) symptoms last < 1hr
e) none of the above
36. The most common cause of chronic diarrhea in a
6 month - 36 month old child is:
a) chronic non-specific diarrhea
b) disaccharidase deficiency
c) enteric infection
d) malabsorption
e) protein intolerance
37. Which of the following is NOT required for a diagnosis of juvenile
rheumatoid arthritis?
a) arthritis in at least one joint
b) arthritis lasting for at least 6 weeks
c) positive rheumatoid factor
d) onset before the age of 16
e) other causes of arthritis excluded
PEDIATRICS . . . CONT.
38. A child presents with bilateral shin pain. Which of the following
suggests that this is NOT growing pains?
a) pain is poorly localized
b) pain awakens the child at night
c) no fever or rash
d) pain abates with reassurance and massage
e) child may limp in the morning from stiffness
39. Which of the following steps is NOT indicated in the management
of croup?
a) keeping the child calm
b) hydration
c) antipyretics
d) antibiotics
e) humidified oxygen
40. Which of the following pairs shows the CORRECT stage of normal
development?
a) 6 months - pulls to stand
b) 12 months - pincer grasp
c) 18 months - handedness
d) 2 years - draws a cross
e) 3 years - tells a story
41. Which of the following is NOT characteristic of a functional
murmur?
a) pansystolic murmur
b) murmur varies with position
c) variably split S2
d) murmur becomes louder with fever
e) no extra clicks
42. Which of the following is the most common congenital heart lesion
in children?
a) atrial septal defect
b) ventricular septal defect
c) patent ductus arteriosus
d) Tetralogy of Fallot
e) coarctation of the aorta
43. Choose the INCORRECT statement about breastfeeding:
a) for healthy term babies, breastfeeding is recommended over
formula feeding
b) breastmilk contains more amino acids than cow’s milk.
c) exclusively breastfed babies should be supplemented with
iron after 6 months of age
d) assessment of adequate intake can be done by counting
the number of wet diapers in a day
e) an HIV-positive mother should not breastfeed
44. All of the following are characteristics of a child with Pervasive
Developmental Disorder (PDD) EXCEPT:
a) abnormal speech pattern
b) stereotypic behaviours, such as head-banging or hand-flapping
c) abnormal cognitive function
d) consuming interest in one topic or activity
e) tendency to reciprocate in peer interactions
45. All of the following are appropriate in the initial assessment of a
child with failure to thrive EXCEPT:
a) diet history
b) social history
c) measurement of height, weight and head circumference
d) growth hormone levels
e) bone age x-ray
46. Which of the following statements about a child with short stature
is CORRECT?
a) the bone age is delayed in a child with constitutional growth
delay
b) height crosses a major percentile line on the child’s growth
chart
c) weight is more affected than height in a child with an
endocrine deficiency
d) karyotyping part of the routine investigation of all children with
short stature
e) growth hormone replacement is helpful in a child with familial
growth delay
47. Which of the following developmental milestones in not a cause for
concern?
a) 15 month old not walking
b) 12 month old not talking
c) 12 month old who does not search for hidden objects
d) 3 year old unable to stand on one foot momentarily
e) 6 month old with a persistent grasp reflex
48. All of the following immunizations should be administered to a
7 year-old child who is a recent immigrant, with unknown
vaccination status EXCEPT:
a) tetanus
b) MMR
c) diptheria
d) pertussis
e) polio
49. A 3 year old girl has a 2 month history of left knee swelling and
morning stiffness. There is no history of fever or rash. The child
appears very healthy. The most likely tentative diagnosis is:
a) pauciarticular juvenile rheumatoid arthritis (JRA)
b) systemic lupus erythematosus (SLE)
c) rheumatic fever
d) Kawasaki’s disease
e) Henoch-Schonlein purpura
50. An 8 year old boy has had 2 episodes of loss of awareness. These
last 5 seconds and consist of eyes and head turning to one side.
EEG reveals 3Hz spike and wave activity. First line therapy would
include:
a) ACTH
b) phenytoin
c) carbamazepine
d) ethosuximide
e) phenobarbital
36
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