MCCEE May 2003 1. Threshold of a screening test is increased. How it will affect sensitivity and specificity? a) Sensitivity increase & specificity decrease b) Sensitivity decrease and specificity increase answer:b 2. A child has ingested overdose of iron tablets- first symptom? a) Nausea and abdominal pain b) Hyperventilation c) Seizure answer :a “Acute iron intoxication” :seen exclusively in young children, in them small numbers of any available preparation ,even 10 tablets can be « fatal ».Symptms:Sx of ”necrotizing gasteroenteritis”,vomiting,abdominal pain,bloody diarrhea=>shock,lethargy,dyspnea,severe metabolic acidosis. Tx:Whole bowel irrigation to remove unabsorbed tablets Deferoxamine t remove absorbed tablets Notice:activated charcoal can’t bind to iron,so will have no benefit “chronic iron intoxication”(hemochromatosis):excess of iron deposits in heart,liver,pancreas,etc.It’s seen in patient with multiple transfusions of RBC products over time,or in those who have inherited hemochromatosis,not in normal individuals ‘cause normal gut doesn’t absorb excess iron intake,unless there is really overingestion of iron in long period,can’t be overcome by normal mechanisms esp. in those who have anemia of chronic dis. Or hemolytic anemia. Tx:phlebotomy-Deferoxamine 3. Rheumatoid arthritis patient develops tinnitus. Cause? a) Due to ASA Adverse effects of ASA: 1-gastric upset(advise patients to have it with meal and enough water,and may be antiacids);2-PUD;3-erosive gastritis;4-like other NSAIDS it can cause elevation in liver enzymes(rarely hepatitis);5-rash;6-aggreviates asthma;7-may interfer to renal function;8-antiplatelet activity;9-Reye syn.;and 10-“salicylism” What is Salicylism?”vomiting,tinnitus,decreased hearing,vertigo” with higher amounts of ASA. Also,ASA in high doses results in hyperpnea,respiratory alkalosis,then,when acidic components accumulate,a meabolic acidosis more complicates cases. 4. WHO conference in 1978 in Alma Mata, Russia- declaration on “Health-for-all” by 2000,….the individuals,families,and community are the basis of health system,and the primary health worker,as the first agent of health care system,dealed with by community,is the central health force. 5.Rheumatoid arthritis patient develops swelling left calf and ankle. Thigh normal. Cause? a) DVT b) Rupture of popliteal cyst This is an old trick!When a RA patient has Sx of DVT,always consider a ruptured popliteal cyst(Baker’s cyst). 6. Child 3years with swelling of scrotum. Testis can be palpated through the swelling Fluctuant, painless. Observed for few months. Translucent. Definitive Management? a) examine regularly b) aspirate only c) surgery d)injecting sclerosant answer:c …….Dx:Hydrocele,Tx:according to the case,if it’s well tolerated & there is no complication,nothing ;however, drinage+ injection of a sclerosing agent indicates for complicated cases or in order to prevent recurrence.The last Tx modality is surgery. According to Smith’s urology textbook,if a hydrocele remains beyond 1 year old,surgery should be performed. 7. Question on probability- probability of finding one disease is A and other is B. (Independent). Probability on finding the 2 diseases in one pt. a) AX B b) A+B c) AXB- A+B ??? answer:a …..P[A and B]=P[A]xP[B],”multiplication rule”,but when both A and B cann’t occur together,they are referred to as being”mutually exclusive”,means P[A and B]=0 8. Most common occupational disease in Canada. a) silicosis b) dermatitis c) asthma d) asbestosis answer:b(?) 9. Most common cancer in Canada/ a) lung b) breast c) prostate e) brain answer:a….Lung cancer ,most common cancer,most common cause of cancer death in male & females(Toronto notes,R34) 10. 23 year old lady presented with cramping abdominal pain and heavy bleeding. Pregnancy test positive. Bleeding stopped today morning. Pregnancy symptoms disappeared one week ago. USG shows empty uterus and 3 cm mass in adnexa. Diagnosis? a) ectopic pregnancy b) complete abortion with corpus luteal cyst c) ves. Mole with corpus luteum d) twin gestation- one aborted and one ectopic answer:b …….Firstly,as pregnancy symptoms disappeared,so this woman can not be pregnant now,so choice d is easily ommitable. Then,this patient showed Sx of miscarriage,and now uterus is empty,then we can think to these options: A complete abortion….not given in choices A complete abortion with a luteal cyst An abnormal aborted pregnancy with luteal cyst But which one?Did she have Sx of a molar pregnancy?no,not high titers of bHCG ,no excessive vomiting,etc.,so answer c seems incorrect. ……..but if “pregnancy test”is + now=>then patient has an EP.I personally think there is a mistake in typing this question,and the betaHCG is not + now ‘caz if it were so,why they emphasized on disappeared Sx of pregnancy? 11. Child with inguinal hernia. Presentation a) scrotal swelling b) thickening of spermatic cord answer:a……inguinal hernia:Testis is separated from hernia,spermatic cord is not palpable above the swelling(unlike Hydrocele or Spermatocele,in which spermatic cord is palpable),negative transillumination 12. A mother brought to her son to your clinic with red spots around eye. You confirmed it as petechiae. What other finding is of concern to you a) petechiae all over body b) subconjunctival hemorrhage c) he developed vomiting after few hours 13. A lady 50 years with swelling medial to femoral pulse. Firm and smooth. Diagnosis? a) femoral hernia b) inguinal hernia c) saphena varix answer:a.....An old lady,with hernia medial to femoral pulse=femoral hernia,which has risk of incarceration;however,the most common hernia in female population is inguinal hernia.Tx for both is surgery. 14. galactorrhoea . cause? a) pituitary infarction b) hyperthyroidism c) danazol d) thoracic nerve stimulation e)dopamine agonist my answer:d hypothyroidism,estrogenic drugs,antiandrogens(not danazol that is antiestrogenic),dopamine antagonists,prolactinoma(not infarction of pituitary!)=>galactorrhea any stimulation in chest wall( textbooks of Endocrinology)=>galactorrhea 15. Mechanism of action typical antipsychotics a) + dopamine receptors “Typical neuroleptics”:blockade of D2 receptors(dopamine),they treat Possitive symptoms like hallucination or delusions…..like haldol “Atypical neuroleptics”:blockade of D2 &/or D1,5HT receptors(dopamine+ serotonin),they treat both pos. and neg. symptoms……like clozapine 16.a patient on antipsychotics, cannot sit still…… a] akathisia Akathisia is an unpleasant physical restlessness which results to unabillity to keep still,it usually occurs in the first 2 weeks of treatment.The symptoms don’t respond to antiparkinsonian drugs,but will disappear by diminished doses. 17.best way to prevent benzodiazepine dependence a) use the one with short half-life b) use for short duration c) use at nighttime only d) answer:b short half-life=>more dependency 18. Most common gynecological infection in Canada a) candidiasis b) bacterial vaginosis c) gonorrhea d) answer:b……Keys:clue cells-grey,thin,diffuse discharge-fishy odour….,it needs no Tx if patient is assymptomatic,non pregnant,not anticipating a pelvic surgery ,otherwise treat with oral metronidazole or tpical clinda……….in pregnancy treat with Amoxi. 19. Most common cause for premenstrual itching (cyclical itching) a) candidiasis b) bacterial vaginosis b) non specific vaginitis answer:nonspecific vaginitis d) 20. Most specific site to collect swab for gonococci a) vulva b) vagina c) cervix c) endometrium answer:cervix......in Gonorrhea swabs from cervix,rectum,throat 21. Pap smear swab collected from a) endo cervical and ectocervix b) endocervical and endometrial d) endo cervical answer:a…..Pap smear:endocervical & exocervical cell sampling(+TZ) 22. A patient presented with an ulcer near medial malleolus. Cause a) ischemia b) perforator incompetence c) answer:b leg ulcer esp. Over the medial malleolus=>venous ulcer secondary to venous stasis especially in the presence of perfoator incompet ence Tx:reducing edema of leg+treating ulcers,if large ulcers,debridement+graft 23. A patient with chronic bronchitis PaO2 60 mmHg. What advise you will give EXCEPT a) no need for continuous O2 therapy b) maintain healthy food hygiene c) annual influenza vaccination d) no need for prophylactic antibiotics e) avoid hypnotics or sedatives answer:a indications of LTOT(long term oxygen therapy)from Harrison’s textbook:1-Pao2= or < 55mmHg or o2 sat= or <88%;2-[Pao2:56-59 and o2 sat= or < 89%] And [Hct=55% or corpulmonale or pulmonary HTN];3-Paco2= or <60 mmHg and o2sat= or >90% indications for oxygen therapy according to Toronto Notes:Pao2= or <55 mmHg;o2 sat= or <89% with rest,exercise,or sleep Annual inf. Vaccination should be done in COPD cases,but prophylactic antibiotics are not recommended. In COPD cases hypnotics or other drugs with depressant effects on respiratory centers in CNS should be avoided. 24. HIV positive patient, CD4 count 250 Presented with cold. What will you do a) start multiple drug antiretroviral treatment b) TMP+ Sulpha When should we start antiretroviral drugs in HIV+? -symptomaic patients with any CD4 count(including wasting,unexplained fever>2 weeks,Thrush,other opportunistic infections) -asymptomatic patients with CD4<200 -asymptomatic patients with Cd4:200-350,or HIV RNA>55000 -asymptomatic patients with CD4>350 and HIV RNA<55000 CD4<200…….prophilaxy for PCP with cotri CD4<100……prophilaxy for TOXO with cotri CD4<50…….prophilaxy for MAC with Rifabutin or Azithromycin Cd4<50…….prophilaxy for CMV My answer:a…..according to Harrison’s textbook CD4<350 =>initiate antiretroviral drugs c) 25. Full term child. Birth weight 3000. Develops respiratory distress. Xray shows air bronchogram. Diagnosis a) Transient tachypnoea of newborn 26. Baby 8 hours after birth, staring and severe Cyanosis. Hypotonia of muscles. What investigation you will do? a) CK b) Echocardiogram c) EEG Answer:b 27. A child had headache, vomiting, and abdominal pain. Then he sleeps. What is your diagnosis? a) migraine e) temporal lobe epilepsy answer:a..a typical case of migraine in a young child,which relieves by rest “temporal lobe Epi.”:or Complex partial seizure,Petit mal seizure....associated with altered memory,mood,perception in older children,young adults.it can have “Aura”,after aura,patient stares,and looks unresponsiveness or”distant” from environment.Then recovery comes with headache & confusion.IT DOES NOT RELIEVE BY REST. 28. A child 3 years presented with abdominal pain and Bleeding PR for 12 hours. What is your diagnosis? a) meckel’s diverticulum b) intussusception answer:b…..both a & b are possible causes of GIB in children,but in most cases of Meckel’s div. There is a painless bleeding from rectum,and only in small proportion child shows severe pain. Certainly,there were some clues in main question referring to answer b,but unfortunately we don’t have complete question. 29.elderly –sensorineural hearing loss. Most common Cause a) presbyacusis b) 30. Occupational deafness. Usually caused by a) high frequency loss f) low frequency loss answer:a……..”OLD WORKERS DO NOT HEAR THEIR WIVES’ SOUND”! c) 31. A passenger in bus got an injury in his eye with the newspaper of the neighboring person. Diagnosis a) corneal abrasion b) 32. Benzodiazepam. Cross-tolerance with which drug a) chlorpromazine b) alcohol c) tricyclics answer:b….BDZs have additive or synergistic effects with other central depressants such as alcohol,barbiturates,and antihistamines. 33. A child has ingested 30 tablets of imipramine. What should be done mean while contacting the toxicology center. a) forced diuresis b) give ipecac syrup g) drug to prevent convulsions. Answer:b….imipramine,a TCA,is extremely dangerous when taken in overdose quantities=>metabolic acidosis,coma,sudden apnea,respiratory suppression,hyperpyrexia,seizure,conduction defects & arrythmias. Tx: monitoring of heart in ICU Sodium bicarbonate to overcome acidosis,and conduction block Maybe antiarrythmic drugs Supportive cares like:giving ipecac syrup,or gastric lavage,inducing emesis d) 34. A child has ingested an overdose of imipramine. Pt. is stable. What investigation is done to monitor sign of toxicity. a) ECG b) EEG d) Blood level of drug Answer:a……ECG 35. Which combination should not be used? a) tranyl cypramine-sertraline 36. A child with tic disorder- what is the first thing in management a) benzodiazepine b) family psychotherapy answer:b……Tx in Tic disorders:Haldol,Pimozide,psychotherapy…..in general apart from in nightmares &somnambulism,BDZ are not prescribed in childhood 37. Behavior therapy least useful a) hallucination b) depression with strong suicidal ideation c) generalized anxiety answer:a….indications:anxiety disordes,paraphilia,substance abuse 38. Anti depressant drugs most useful in which of the following conditions? a) 39. Which of the following is the most common condition in Canada? a) cervical malignancy b) endometrial malignancy c) endometrial polyp c) septulum uterus answer:b ….endometrial cancer is the most common gynecological malignancy in Canada 40. Toxic shock syndrome. Not true a) exo toxin b) tampons c) skin necrosis d) fever e) rash answer:c ……Toxic shock syndrome:a life threatening condition due to exoproteins from S.aureus,but a clinical infection with S.aureus is not necessary for Dx……symptoms:fever,hypotension,rash,end organ damage,scaling……risk factors:mens.,tampons,contraception devices. 41. A lady 50 years, 2 years nocturnal cough. Now develops fever sweats weight loss purulent sputum. X-ray shows consolidation apex of lower lobe. Diagnosis a) tuberculosis 42. Asian 53 years. Weight 93 kg. Arthritis. Now c/o head ache. Striae on abdomen, thinning of skin. What investigation to be done? A) CT scan head B) Random plasma cortisol C) Enalapril enhanced renal angiogram Answer:a ……what is the most probable Dx?Cushing Dis.,an adenoma in pituitary,producesACTH => symptoms of Cushing syndrome + compressive Sx of a space occupying lesion in brain(headache)=>perform a CT of head Other choices are nonsense…..a random plasma cortical is not a good test for Dx. Cushing syn. ‘cause it has great diurnal variations,and except in a few cases with very low early moning plasma cortisol (see Harrison’s textbook)it has no benefit. 43. Commonest cause of broncheolitis RSV 44. Which of the following diseases can be prevented by a live attenuated vaccine except? a) typhoid b) measles c) polio d) rubella f) diphtheria answer:f,…….Typhoid vaccine(salmonella type)is not contraindicated in pregnancy ….tetanus vaccine:toxoid;pneumococcal vaccine(pneumovax):polysaccharide;BCG vaccine:attenuated M.Bovis ;meningococcal vaccine:polysaccharide;measles vaccine:attenuated virus;rubella vaccine:attenuated vaccine;polio:two types IPV(inactivated poliovirus vaccine) & OPV(oral-attenuated virus);diphtheria vaccine:toxoid in DTP (Diphtheria,Tetanus,Pertusis) 44. If a child develops diphtheria now the mortality is almost the same as it was 50 years ago. But now the disease is not so common because a) incidence decreased b) prevalence decreased d) effective antibiotics developed answer:a……incidence of diphtheria has been in significant decrease for routine immunization. d) 45. CAD is more in men compared to women. Which of the following is true? a) MI investigation and treatment more effective in men b) Chest pain in women is less frequently attributed to non cardiac causes c) Awareness about MI is same in men and women e) Hypertension is a strong risk factor in men compared to women Answer:e….HTN 46. Which of following is the most important risk factor for CVA a) systolic hypertension b) smoking f) elevated serum cholestrol answer:a …. 47. A child with proptosis, swelling and redness around eye, movement of eye painful. Diagnosis a) orbital cellulites b) preorbital cellulites answer:a….Tx:admit,IV antibiotics,B/C,orbital CT,surgical drinage of abscess,follow closely 48. Elderly people a) prefer to live alone and like their children to visit them b) live alone because of geographical distribution children have to live away d) like to live alone and don’t like visitors answer:a 49. A man 65 years labile mood, depression forgetful for 2 years. He has long standing hypertension. O/E Cognitive functions partial impairment, absent ankle jerk. Diagnosis a) alzhiemer’s b) pseudo dementia f) multiinfarct dementia answer:c…..pseudodementia (depression in elderly resembling dementia) does not give absent ankle jerk….alzheimer’s dementia has specific criteria,not fulfilled by this patient.Also,it has no focal neurologic sign like an absent ankle jerk. In the presense of a long standing HTN and focal neurologic sign=>multi-infarct dementia seems more approproate. 50. A man presented with injury of hand after a fight in beer parlor. Most likely injury a) dorsal dislocation of 5th metacarpal b) palmar dislocation of 5th metacarpal c) radial dislocation of 5th metacarpal d) ulnar dislocation of 5th metacarpal e) 51. Which of the following antipsychotic has got least extrapyramidal side effects a) chlorpromazine b) haloperiodol c) resperidone d) clozapine g) loxapine answer:d ......each antipsychotic drug which has strong neuroleptic effect(like Halopridole),has greater extrapyramidal side effect,but smaller anticholinergic side effects.In contrast,chlorpromazine with strong anticholinergic side effects,has smaller extrapyramidal disadvantages. Clozapine,an atypical antipsychotic,has no extrapyramidal effect. 52. Which of the following antipsychotic produce extrapyramidal SE in therapeutic dose? a)chlorpromazine b) haloperiodol c)resperidone d)clozapine e)loxapine answer:b 53. A lady 33 years had a pregnancy with anencephaly and undergone abortion at 15 weeks. She wants to conceive in 6 months. What advise you will give a) start folic acid now b) she has to do amniocentesis at 16 weeks c) neural tube defects are unlikely to recur in subsequent pregnancies answer:b……:Hx of NTD=>higher risk of NTD in future pregnancies comparing to normal population……every pregnant woman should take 0.4 mg/day Folic acid PO for 1-3 months preconceptually & throughout T1,so it’s soon to start Folic acid for this woman. Amniocentesis should be done for every woman with Hx of having a child with birth defect,in 15-16 weeks of gestation. d) 54. Diabetic lady advice regarding risk of congenital anomalies. a) risk is same for gestational diabetes and other diabetes b) risk can be reduced to that of general population if strict control of sugar is maintained through out the pregnancy. c) Sacral agenesis is the most common anomaly d) USS for congenital anomaly is done at 32 weeks Answer:d……in a diabetic lady=>increased risk for GDM compared to normal population,with tight glycemic control preconception this risk decreases,but not to measures for normal population. Sacral agenesis is an uncommon complication in infants of diabetic mothers. US+amniocentesis are used to evaluate fetal situation in 37-38 weeks(for programming delivery according to lung maturation). Also,OCT in 32 weeks ……..GDM can not cause congenital defects ‘cause it starts after organogenesis! 56. Prostate cancer; most important in diagnosis a) PSA b) DRE c)CT Answer:b ….important?from what point of view??PSA is specific to prostate,but not specific for Prostate cancer.DRE just shows an enlargement or a nodule,so isn’t specific,but it’s done as a routine PH.E. 59. Soldier returning from peacekeeping force. He has nightmares anxiety. Etc. what is the initial step in management a) psychoanalysis b) benzodiazepine for 1year c) a trial of behavior therapy for s assort period answer :d……why (d) and not (a)?…..Psychanalysis: it’s a long Tx modality(3-5 years,4-5 times every week),esp. used to improve patient’s insight ,and emphasizes on early childhood events,so I don’t think it’s appropriate Tx for this acute illness. Then, short-term/brief psychotherapy is used for “acute crisis”(like this case) or particular emotional problems.Number of sessions agreed at outset(6-20 times) 60. A 23 year old girl develops watery diarrhea after a picnic, 2 days later she develops purpuric rashes, oliguria, what is most likely a) 2 other picnic mates developed rashes the next day b) they made lemonade using water from a near by pond c) many of the picnic people developed bite marks bitten by mosquito d) few of the picnic people were returning from usa answer:b? …..my first guess was HUS,but…..watery diarrhea after picnic=>2 days later Sx of low plt.,oliguria;all in a “23 y/o” girl?!!!….it can’t be simply a HUS,neither course of dis. ,nor age of patient do not match to HUS…..;however,none of other common causes of food poisoning(esp. those related to contaminated water) can cause all of these symptoms together,not a V.cholorea(rice water stool,no purpura),not S.aureus,etc…..so I guess it’s an atypic case of HUS(still unsatisfied with Dx!) due to shigatoxin or E.coliO157:H7…..then, answer (b) seems correct.What is your idea? e) 61. Toddler’s diarrhea what seen a) indigested food particles b) fecal occult blood c) vomiting answer:a d) 62. hirshsprung’s most imp. Inv a) Barium enema b) Colonic transit time with radio opaque markers c) X ray answer:a ….. some abnormal findings in barium enema,as a”dilated sigmoid colon” before a”narrower segment” as “transition to dilated colon”,and then a “normal caliber aganglionic rectum” distally,summing up means,abnormal aganglionic segment has normal caliber,but former segment is dilated. BUT Dx in HIRSHPRUNG dis. IS BY BIOPSY. 63. hirshsprung .diff from constipation a) from birth b) fecal soiling answer:a….:Sx of hirshprung in first 24 hours of life,unless there is a very small aganglionic segment,showing itself in later childhood with constipation and maybe overflow incontinence ……in barium enema,functional constipation shows dilated rectum & colon,but in hirshprung’s dis. Just colon is dilated. 64. Male pain left lower quad. Mass. Neutrophilia. Inv? a) rigid sigmoidoscopy b) barium. Enema c) colonoscopy d) X-ray answer:d…..Dx:Diverticulosis(left-sides appendicitis)=>Do not perform barium enema or sigmoidoscpy/colonoscopy during an acute attack! The optimal method of investigation is CT scan,if not available Hypaque enema(water soluble) is SAFEshows”sawtooth appearance” US may be useful for following up an abscess. Tx in Diverticulitis: admit+NPO+fluid+IV antibiotics that cover B.Fragillis(Ciprofluxacin,metronidazole) Surgery if: 1-Hinchey stages 3 or 4(purulent or feculent peritonitis) 2-after 1 attack if: a)less than 50 years old,b)immunocompromized , c)abscess needing percutaneous drinage 3-after 2 attacks in others 4-cmplications: bleeding,fistula,obstruction 5-R/O colon cancer, or refractory medical management SURGERY WITH HARTMANN PROCEDURE 65. Child ingested cleaning liquid with Iye. Lips & mouth corroded what is least useful a) oeso.scopy b) X ray chest answer:a…..a CXR is necessary to investigate perforation and free gas in mediastinum,and although esophagoscopy is our most important investigation,it’s done after primary resusciation,usually in the first 12 hours of admition. 66. Tension pneumothorax. All are features except a) hyper translucent b) mediastinal shift c) inspiratory stridor d) subcutaneous crunchy sound d) decreased breath sounds answer:c… ..trachea away from pneumothorax,distended neck veins,respiratory distress,cyanosis,asymmetry,hyperresonance on percussion,absent breath sounds,unilaterally…..NO RADIOGRAPHIC Dx,a CLINICAL Dx. 67. What is the first management of tension pneumothorax? a) needle thoracotomy b) needle thoracostomy c) chest tube answer:b 68. Epiglottitis with mild stridor. all are true except a) intubation b) ABG to monitor prognosis Answer:b c) 69. Child with sore throat red tongue lymphadenopathy. How to differentiate viral etiology a) throat swab, b) white cell count answer:a……why not (b)?In your clinic,do you perform a WBC count to differentiate a bacterial pharyngitis from a viral ? ……then a “WBC diff” can differentiate between these two, not simply a “WBC count”. 70. Man with gonorrhea. Treated with cef. Still symptoms. Urine microscopy no organism, cause a) chlamydia ALWAYS treat a patient with Gonorrhea both for Gonorrhea and Clamydia! Tx for Gon. :Ceftriaxone 125 mg IM single dose Tx for Cla.: Doxy. 100 mg Bid for 7 days or Azithr. 1 go orally as a single dose If your patient is pregnant, for bth diseases you can give Amoxi. Or Erythro. Both diseases should be reported on the next working day to health system ,and in the case of presence of any of them=>treat partner! Screen high risk ppulation for Gon. And Clamydia! 71. Gonococci a) intracellular diplococci b) extra cellular diplococci answer:a……a gr negative diplococci,intracellular 72. RTA- blood at urinary meatus, what to do next? a) urethrogram b) catheterize answer:a…a retrograde urethrogram …..DON’T PLACE A CATHETER BEFORE R/O OF URETHRAL INJURY! 73. Child h/o fall. Pain lumbar region with ecchymoses, gross hematuria. Renal CT shows peri renal hematoma. Child stable renal pedicle normal. Management? a) surgical repair b) close monitoring in ICU c) catheterize and rest for 7-10 days c) send home answer:c …renal trauma with laceration/hemaoma=>minor trauma=> seldom surgical repair renal trauma with laceration,extending to medulla and collecting system,major renal vascular injury,shattered kidney=>major trauma microscopic hematuria+minor trauma+stable=>no admition gross hematuria+contusion/minor trauma=>admit+bedrest+repeat CT if bleeding persists hemorrhage & hemodinamicly unstable=>surgery 74. Man 56 years. Father died of prostate ca. o/e a small nodule right lobe. PSA 2.2. What advice a) follow up in 6 months DRE and PSA b) foloow up in 3 months PSA c) uss guided Biopsy now answer:c…..a nodule on DRE=>check PSA,TURP ,and perform Bx 75. Post menopausal bleeding. What inv. a) endometrial biopsy post-menopausal bleeding=endometrial cancer until proven otherwise. 76. severe premenstrual syndrome. Definitive management a) b/l oopherectomy b) hysterectomy c) prog d) oes d) NSAID Answer:b........Tx in PMS:1-symptomatic,according to main chief complain,if pain:NSAIDS,if edema:diuretics,etc.;2-psychological support;3-diet;4-regular exercise So prog. And NSAIDS could be correct answers provided that what exactly had been asked in exam. In a severe & refractory dysmenorrhea,after all conservative Tx,if patient doesn’t want to have a child in future,do hysterectomy. 77. Girl 5 years. H/o vomiting since birth. Now complaints of dysphagia for solids. Cause a) esophagitis b) bazoar c) hiatus hernia e) duo ulcer answer:c 78. A man with tertiary syphilis. Which of the following is going to alter his management plan? a) AIDS AIDS + Syphilis(esp. Neurosyphilis)=>higher rate of recurrence of infection,or higher rate of resistance to usual Tx…..In syphilis+AIDS ,CSF should be inspected by LP. 79. A man presented with contracture of PIP. He cannot flex Dip. Which s the pathology a) flexor digitorum b) extensor pollicis c) extensor carpi answer:a…….FLEXION in hand:Flexor Policis Longus=>felex IP joint of thumb;Flexor Digitorum Profundus(FDP)=>flex DIP of fingers;Flexor Digitorum Superficialis(FDS)=>flex PIP;Flexor Carpi Ulnaris(FCU),Flexor Carpi Radialis(FCR),Policis Longus(PL)=>flex wrist & oppose thumb to small finger 80. Case control study useful in a) study of rare disease. 81. Ethics- a man suspects to be having probable gonorrhea. His wife works in lab. He doesn’t want her to know his specimen. What to do. a) ask him to tell his wife b) put a code no. on the sample, not his name. c) Don’t listen to him c) Send him to the public sexually transmitted disease clinic Answer:a …gonnorhea should be reported to local public ealth unit,it’s a STD and communicable,so partner should know about it, ask your patient to tell his wife about his ailment. 82. A couple comes to you. Husband wants to end the relation what the wife thinks to be a happy marriage. She is crying. What to next? a) spend one and a half hours to each of them to psychotherapy b) try to find out what made the crisis c) send to lawyer answer:b 83. For which of the following is behavior modification is best? a) phobic anxiety b) generalized anxiety c) affective disorder d) bipolar disorder answer:a…….Behaviour Therapy is beneficial in: anxiety disorders, substance abuse, paraphilis Cognitive therapy is more useful in: depression, anxiety disorder, self-esteem problems. In Behavioural therapy we try to change patient’s internal or external responses that precipitate or maintain emotional distress,while in Cognitive therapy we change patient’s thoughts. Why not (b)?isn’t it an anxiety disorder? Yes!it is,but we use CBT in treating with GAD.Then, Behaviour therapy is the most useful Tx in Phobias. 84. A man 50 years hp 156/95 sweating, palpitation, one of his relative had thyroid ca. what inv. To be done? a) urine catecholamine b) urine VMA d) CT adrenal Answer:a…for screening pheocromocytoma.(This patient is a probable case of MEN-II.) 85. A man 10 days after pancreatitis complains of abdominal pain, firm swelling a) pseudocyst, b) a/c hepatitis c) cholangitis answer :a….complications of acute pancreatitis :abscess, pseudocyst d) 86. Peptic ulcer patient complaints of pain radiating to back. Diagnosis a) perforation b) penetration answer:b……complications of PUDs:1-perforated ulcer(ant. Surface) with sudden onset of the pain,a chemical peritonitis followed by bacterial peritonintis;2-posterior penetration(post. Surface), maybe to pancreas=>increased amylase-pain=>radiating to back,unrelated to meals;3-hemorrhage(post. Surface),bleeding from Gasterodudenal artery;4-GOO 87. Gastric ulcer patient. Treated for12 weeks. Asymptomatic now. When gastroscopy done ulcer is still present. Negative for malignancy and H.pylori. What to do? a) treat for 8 more weeks b) life long H2 receptor blocker c) follow up only c) partial gastrectomy with excision of ulcer answer:b…..life-long H2 agonist or PPI to decrease the risk of recurrence……in refractory cases, ZES should be R/Out. 88. Known MI patient now presents with palpitation. He says he is on quinide, propranolol and digoxin 0.125 mg. O/e- PR-96,irregularly irregular. What should be done to prevent any complications? a) increase the dose of digoxin b) anti coagulant for long time c) give digoxin and quinide togather 89. All are true about carbamazepine except a) starting dose 200mg b) causes leucocytosis answer:b ….Carbamazepine:a tricyclic compound,effective in Tx. Of bipolar disorders as a mood stablizer,also used to treat trigeminal neuralgia,epilepsy.It has only oral forms,useful in children too.Its fatal toxic effect is “Agranolucytosis”,esp. in elderly patients with trigeminal neuralgia.Other adverse effects include:mild LEUKOPENIA ,skin rashes. Dosage:750-3000mg/day,tid-Theraputic range:350-700 micromol/liter 90. Mitral stenosis patient goes to a dentist for some procedure. He is asking for prophylactic antibiotics. Which of the following decides which to given? a) type of procedure b) c) presence of atrial fibrillation presence of cardiac failure d)type of procedure answer:a …..Mitral valve prolapse or MR or MS –all prosthetic heart valves-HX of bacterial endocarditis-PDACo of Aorta-surgical shunts- VSD-hypertrophic cardiomyopathy,and some other cases need prophylactic antibiotic before some dental,respiratory,GI,GUT procedures.Among dental procedures those need prophylactic Ab are: distraction,periodontal procedures(leading to gum bleeding),implant, root canal,orthodontic Tx(not brackets),intraligamantal anaesthetic injections,so we must ask what procedure will be done for patient. 91. Bier block (regional IV anesthesia). Which is true? a) bupivacaine is better b) effect lasts longer even after the procedure , giving adequate post op analgesia c) suitable for all procedures in hand answer:?b?……I’m not sure about my answer,but as IV reginal block is used for procedures up to 1.5 hours, (b) seems right. IV regional block is used for both upper & lower exteremity procedures,more commonly used in UE.It’s simple,reliable and with few absolute contraindications. Blockades, in general, are more suitable for upper exteremity procedures.Intercostal blockade is suitable for after-surgery pain. Peripheral nerve blockades(especially Bier’s blockade),often used for procedures,done on superficial structures in exteremities. 92. Elderly lady, pain on hand and upper arm. Wasting of thenar eminence. Severe pain at night. Cannot carry shopping bag. Diagnosis a) carpal tunnel syndrome b) cervical spondylosis answer:a 93. 75 year old man, sudden onset of back pain, severe pain right buttock, hamstrings, micturition problem. He was having UTI 2 weeks back Cause a) multiple myeloma involving spinal cord b) lung ca with metastasis c) archnoiditis answer:a…..I run for this answer because the patient has”pain”,is “ old ”,and has had UT problems.There is nothing supporting a suspection to lung cancer(xcept for being an old man),no Hx of smoking,no cough,etc. What is Arachnoiditis?chronic arachnoiditis, inflammatory in its nature,but sometimes occurs after SAH,meningitis,intraspinal injection of penicillin, contrast media,trauma,and surgery.The initial symptom is usually a radicular pain,but LMN symptoms can be seen.In last stages,an ataxic spastic paraparesis and dysfunction in sphincters will appear.There is high protein level in CSF,with increased WBC(in LP).MRI can be helpful in Dx. Myelography shows contrast fragmentation into some saccular lesions in spinal cord…Tx:NSAIDS or steroids,surgery in localized spinal involvement.(Aminoff neurology,1999) 94. A baby with birth wt.3.5kg now 4 weeks weighs 3.6 kg. Mother worried not drinking enough milk. What will you advise? a) Tell her that nothing to worry, as some kids don’t gain much weight in the first month b) start formula feeding c) investigate the kid answer:c…. in the first month baby should gain 20-30 gr/day,not gained by this child(only 100 gr weight gain during the first month!)=>investigate the child 95. A lady 33 weeks of gestation, admitted with uterine cramps and moderate bleeding. Nurse started IV line and blood taken for grouping and cross matching. What to do next? a) start another IV line b) arrange for CS c) start tocolysis d) examine for cervical dialtaton d) USS Answer:USS ……..bleeding in third trimester:FIRSTLY DO AN USS to R/O placenta previa ……why do you run for (a) Dr9_9_9?there is no severe hemorrhage,nedding two large bores,eh? 96. Triple screening done in the antenatal period. Which is true? a) should be only offered to women who are willing for termination if any abnormality is found b) should be offered only if proper pre test counseling is given answer:b 97. Regarding HRt, a lady ha h/o migraine and strong family history of osteoporosis what should be done/ a) offer oes-prog.HRT b) progesterone only c) biphosphonate only d)oes only answer:c ……migraine is a relative contraindication of HRT,so a is not a good drug for her.We can give her bisphosphonates 98. Raloxifine, which is true a) contraindicated in peptic ulcer b) effective for hot flushes c) effective for osteoporosis d)breast ca increased risk answer:c …raloxifene(SERMs) maybe protective against breast cancer,DOES NOT RELIEVE HOTFLASHES(MAY MAKE THEM WORSE) OR OTHER MENOPAUSAL SYMPTOMS. 99. Infertility with c/c salpingitis. Which is not done? a) laparoscopy b) laparotomy c) hysteroscopy answer:b????? 100. Ophthalmoplegia with pupillary sparing. Cause? a) diabetes b) canernous aneurysum answer:a......pupils spared in DM. c) 101.herpes simplex corneal ulcer. What is not done? a) patching b) corticosteroids use answer:b 102. Otosclerosis. normal ear drum 103. A child with sinusitis and otitis media. Treated with antibiotics. Serous effusion still present in middle ear. What to do? a) another course of antibiotics b) myringostmy with tube c) myringoplasty answer:a…a failure in therapy by Amoxicillinn=>double dose Amoxi. Or give Amoxi-clav……..patient has none of indications of myringotomy & tympanoplasty(Toronto Notes,otolaryngology,34) 104. A lady gave birth to a cleft palate baby. You are going to send her home after counseling. For what reason she is going to come to your office more often? a) feeding problem b) recurrent otitis media c) teeth problem answer:a..if untreated,the baby will have feeding problems,speech pathologies,and recurrent infections, but in the first months feeding problem have greater importance=>surgical repair in 6-9 months 105. You gave a new drug to your patients with dementia. Those suffering from multi infarct dementia improved while those with Alzheimer’s not.. What should you do before prescribing this to your patient 106. What type of trial is this? 107. In the Er you are planning to do a new trial on pts with retrosternal chest pain 108. A lady for laparoscopic tubal ligation on the way to theater asks for removal of a mole on her forearm while she is under GA. What you will tell? 109. Jehovah witness signed card 110. hemophilia A Xlinked recessive 111. A carrier lady for an X linked recessive disease marries a normal man. They have 2 daughters. What is the probability of each of them to become carrier? a) 1in 4 b) 1 in 8 c) 1 in 16 d) 1in 64 answer:a…..a X’X marries a XY=>X’X - X’Y - XX - XY=>1/4 carrier girl 112. Which is not a cause for occupational asthma. vinyl chloride 113. Which causes nasal sinus ca? a) nickel b) 114. condyloma accuminata, pregnant lady what is used a) podophyllin b) flurouracil c) trichloracetic acid d) imiquimod answer:c?….condyloma should be treated early during pregnancy,if not =>do C/S ……condyloma cann’t be prevented by condom……In pharmacological textbooks a 6% systemic absorption is considered after dermatologic application of 5FU cream,which is not enough to induce syatemic adverse effects.I’m not sure about answer©,but as I remember trichloroacetic acid is safe in pregnancy. 115. Picture of tinea cruris. Treatment. a) topical steroids b) amphoterecin b c) tolnaftate e) grieseofulvin answer:c(tolnaftate) ..topical clotrimazole or terbinafine ,not oral drugs for Tinea capitis or cruris or pedis(interdigital type),among choices only tolnaftate is topical…..using topical teroids before Dx of any typpe of Tines results in Tinea incognito. 116. A man presented with headache, photophobia, menigism. CSF_ cells increased, neutrophils 95% What is the most common cause a) menigococci b) s.pneumoniae d) viral answer:b 117. Viral meningitis. Which is not true? a) sugar normal b) protein elevated c) chloride high answer:c 118. A man with dark skin, liver 20 cm. Cirrhosis. Diagnosis a) hemochormatosis 119. What inv. In the above patient a) transferrin saturation 120. A child with necrotizing enterocolitis. All are true except a) air in portal vein b) pneumoperitonium e) peritoneal calcification answer:a & b are true 121. a man presented with a mass right to his rectus below umbilicus while standing and straining. Disappears while lying down. Diagnosis a) Richter’s hernia b) spigelian hernia c)desmoid’s tumor answer:b 122. Which of the following is toxic in overdose? a) vit.A b) vit.E c) vit.K d) vit.C f) vit.B12 answer:a 123. c/f of congenital hypertrophic pyloric stenosis. Diagnosis.(2 questions) 124. A lady 50 years presented with mild hypercalcemia X-ray chest normal. Diagnosis. a) sarcoidosis 125. A child had a/c sinusitis and you treated with a course of penicillin. His blood inv shows- TC increase, s.ca decrease others normal. You supplement with ca, what inv. To be done a) s PTH b) X-rays of hands Answer:b…..as our friend Dr9_9_9 says,we must r/o rickets=>X-ray f hands 126. A man presented with pain in flanks radiating to groin. He had similar episodes 2 times previously. And was diagnosed to have hyper calciuria. What should be done? a) thiazides b) allopurinol c) reduce dietary calcium answer:a 127.post appendicectmy pt develop s-subphrenic abscess 128.which of the following is most likely to be a drug reaction a) IMN patient treated with pencillin produces rash b) Sulpha d) patient with sore throat treated with pen. Has rash answer:a 129. Intoxication. –Which one causes oliguria? a) ethylene glycol b) cannabis c) cocaine e) LSD Answer :a 130. Intoxication- dry skin. Pupil sluggish reacting. Agitated. Paranoid a) cannabis b) cocaine c) LSD answer:b 131. Child electrocuted. What is the cause of death? a) cardiac arrest 132. A child has features of meningitis. Which is poor prognostic factor? a) temp.38.5 b) generalized seizure c) localizing sign d) neck stiffness answer:b 134. Neonatal sepsis.a feature a) hypothermia 135. A man complaints of severe headache for the last 12 hours. Vomiting + photophobia. Diagnosis a) subarchnoid hemorrhage 136. A child had a fall and he was drowsy. While waiting in the ER he becomes more and more drowsy .one pupil dilated diagnosis a) extradural hematoma b) subdural hematoma answer:b 137. A man with a swelling in the right scrotum. O/e- tender mass above testis. skin of scrotum red and inflamed. Prostate enlarged He has pyuria. What is the diagnosis? a) epididymitis b) epididymitis and prostatitis c) gonococcal urethritis answer:b….this patient surely has an epididymitis, but is there any prostatitis in conjunction?….the cause of his epididymitis can be gnorrhea or clamydia(<35y/o),or GI organisms esp. E.coli(>35y/o) 138. How to look for clue cells. a) vaginal secretion with KOH and cover b) vaginal secretion with saline and cover c) d) cervical secretion with saline and cover cervical secretion with KOH and cover d) vaginal secretion with KOH and dry answer:a…..for Dx. Of bacterial vaginosis,we should add KOH 10% on vaginal secretion=>fishy odor , clue cells……why do you choose N/S?where have you seen it?I think we should add KOH(?) 139. Multiple pregnancy-cause of perinatal mortality a) prematurity 140. Tocolysis contraindicated in all except a) twins at 33 weeks b) cervix 4 cm c) chorioamnionitis answer:b….. contraindications of tocolysis:bleeding(placenta previa or abruption),maternal HTN,maternal DM,maternal heart disease,eclampsia or pre-eclampcia,chorioamnionitis,errythroblastosis fetalis,severe congenital anomalies,fetal distress/demise,IUGR,multiple gestation(relative) 141. Persistent bradycardia in fetus due to a) head compression b) AV block Answer:b…….causes of fetal bradycardia:maternal beta-blocker therapy,hypothermia,hypoglycemia,hypothyroidism,or fetal cardiac conduction defect(like AV block due to CMV infection,or anti-SS-A antibodies) 142. Which is true about congenital anomalies? a) congenital anomalies rarely affect growth b) if symmetrical IUGR is detected look for congenital anomalies c) trisomy 13&18 will not cause growth retardation answer:b 143. A child 3 years has BP 138/95. He has a systolic murmur right 2nd space, femoral pulse not palpable. Diagnosis ? a)coarctation 144. apgar score 145. A pregnant lady with GCT 10.3 mmol/l, what is most imp. Strict maintenance of euglycemia through out the pregnancy 146. A lady prepared for hysterectomy. What will you tell her regarding risk of thromboembolism a) risk is highest after 72 hours b) thromboembolism mostly originate from pelvic veins answer:a…thromboembolism mostly originates from calf veins,mostly shows itself POD5+(7-10) …….even in the cases undertaken a surgery like hysterectomy,TE arises from calf veins,and also from ileofemoral veins. 147. A lady post partum develops DVT. What is the management? a) warfarin for 3 months b) heparin IV for 1 week and warfarin for 3 months d) heparin IV for 1 week and low molecular wt. Heparin for 3 months answer:d 148. A pregnant lady 20 weeks. Uterus 26 weeks. Beta HCG 30000.what is the management a) suction curettage 149. Which of the following is not poor prognosis in melanoma) a) color change b) spreading c) bleeding d) tuft of hair e) irregular surface answer:d 150. C/f of thrombosed external pile. Diagnosis? 151. Same scenario. Management 152. c/f ischiorectal abscess . management incision & drinage+/- antibiotics 153. A girl c/o continuous pain in the vulva for the last 8 hours. O/e a red tender swelling is seen on the post 1/3 of lab minora. What is the diagnosis? a) bartholin’s cyst b) bartholin’s duct abscess d) skene’s gland abscess answer:b 154. A group of people returning from Rocky Mountains developed diarrhea. Cause a) Rocky mountain spotted fever b) giardiasis answer:a…..….you are right!they like to trick us as foreign MDs! This is Giardiosis,with waterborne transmission(especially in the Rockies) and fecal-oral transmission of infective cysts…treat patients with metronidazole…..and diarrhea is not seen in RMSF! 155.esophageal atresia with tracheo esophageal fistula at the lower end. What is true? a) gastric aspiration common b) gastric air shadow not seen answer:a c) 156. A man sustained a stab wound on the thigh anteriorly. He is bleeding profusely. What is the first thing to do? a) apply tourniquet above the wound b) press femoral artery c) direct pressure d) on wound e) fill the wound with clothes answer:c…..we never “FILL” wounds with clothes,even with clean clothes 157. A child with 15% burns On face and chest. What is done? a) oral midazoalm and i/v morphine b) i/v midazolam and burn dressing c) i/v cef.and morphine answer:b?….. firstly admit patient(face burn),then suppress pain with appropriate analgesic ang give prophylactic antibiotic if there is deep second or third degree burn wound 158. 2 year old child. burns 15% calculate fluid replacement Parkland formula=> fluid in the first 24 hours=TBSA x weight(Kg) x 4cc….1/2 of this fluid in first 8 hours,the other ½ in the next 16 hours 159. A lady brings her son to you saying that he is alcoholic who denies that . what question is least relevant a) do you need an eye opener in the morning b) do you hate criticism c) do you drink only on social occasions answer:c….a & b are two questions of CAGE questionnaire C:ever felt need to Cut down on drinking? A:ever felt Annoyed at criticism of your drinking? G:ever felt Guilty about your drinking? E:ever need a drink first thing in morning?”Eye opener” 160. Features of anaphylaxis-treatment a) epinephrine 161. Laryngeal nodule- not a risk factormedication 162. A man 64 years c/o hoarseness. What is the first thing to be done? a) chest X ray b) laryngoscopy answer:b 163. Uncomplicated intestinal obstruction. All are seen except a) increased bowel sounds b) distension c) guarding d)tympanitic answer:c 164. Idiopathic thrombocytopenia 165. Most common cause of syncope in a young man a) vasovagal b) hypoglycemia answer:a 166. A man presented to Er after a party. Intoxicated. Blood values- HCO3 very low. All others normal. What other inv a) urine osmolality b) serum osmolaity answer:b 167. Mallory weis – what inv. a) senstaken tube b) OG scopy c) balloon answer:b 168. Clinical features suggestive of intestinal ischemia 169. Crohn’s. C/f given. Diagnosis? 170. Right upper quadrant pain, fever, jaundice. Diagnosis a) a/c cholecystitis b) cholangitis c) hepatitis answer :b 171. A/c cholecystis. Cause. a) obstruction of cystic artery b) onstruction of CBD c) obstruction of GB by stone answer:c 172. post op 36 hours. Cause of fever, a) atelectasis b) UTI c)Wound infection answer:a 173. Most common cause of incontinence in women a) stress incontinence b) urge incontinence d) detrusor instability answer:stress incontinence 174. Dementia patient. Treatment of which of the following could have prevented a) Alzheimer’s b) pernicious anemia answer:b 175. Another question on dementia. 176. What is the most imp. Thing to differentiate Alzheimer’s from pseudo dementia a) Short duration b) mental status examination answer:b……a patient with pseudodementia is not cooperative during interview,unless we can encourage him/her.an Alzheimer patient in contrast shows interest to interview but makes mistakes in answering our questions. 177. Treatment for seasonal rhinitis a) nonsedative antihistamines b) oral steroids answer:a 178. Picture of a child. Mouth open. a) adenoid hypertrophy. 179. Couple comes to you. Husband hypertensive says impotence 6 months but erection occurs in the morning and while reading the magazine. What should you do? a) counseling this patient has non-organic impotence=>counselling 180. Cause for recurrent UTI in child a) VU reflux 181. Treatment of nephritic syndrome. All except a) diuretics b) salt restriction c) fluid restriction d) prednisolone e) protein restriction answerc? …..I searched for answer in Cecil,Harrison,Toronto Notes,Kumar, Furtunately there is a brief explanation regarding this issue in Kumar,fifth edition,page 607:dietary protein restriction only in severe cases,but salt restriction always necessary.Diuretics and corticosteroids are used in Tx, so fluid restriction (c) seems to be the answer?it’s obvious that we should monitor body volume by daily weighting too,so there should be a careful observation for fluid excess,especially when we remember there is always a risk of pulmonary edema in the presence of an impaired kidney. 182. Elderly lady fecal occult blood. All are true except. 183. Case of DUB. 184. All the following can be given to improve sexual function. Except a) sildenafil b) estrogen c) testosterone d) gonadotrophin analogues answer:b..if we are asked for Tx of male sexual dysfunction,estrogen will be correct answer. 185. ADHD 186. A lady with previous h/o cs for footling breech is kept for trial. During labor she develops bleeding PV, fetal tachycardia. …. Diagnosis a) rupture uterus. 187.a lady at 41 weeks of gestation likes to wait for spontaneous onset of labor. Which of the following require immediate delivery? a) oligohydramnios b) macrosomia b) glycosuria answer:a 188.CPS a) interest of public is most 189. Which of the following is the most effective way to prevent dental caries in children? a) fluoridation of water b) dental flossing answer:a 190. Periodic health examination not true a) detection of chronic diseases b) behaviour change and hygiene c) more focused annual physical examination answer:c……..Toronto Notes,family medicine,page3:most notable recommendation is the abolition of the annual physical exam,replaced by the periodic health examination(PHE) 191. ECG a) LBBB b) RBBB with RAD c) RVH d) WPW 192. Picture of a hand with a lump on the dorsal surface MCP jt. a) h/o renal calculi 193. A lady develops dry cough. Treated with ampicillin few days later Develops rash, elevated liver enzymes. Cause a) mycoplasma b) 194. Bacterial vaginosis. All true except a) PHb) Flagellated organism Answer:b….ph in bacterial vaginosis is acidic(5->5.5),Gardenella is a small gr negative bacillus. 195. Malaria treated. Recurrence after 1 year a) dormant liver schizhont 196. Features of meningitis. What inv. a) lumbar puncture 197. Features of multiple sclerosis all except a) dysphagia b) anosmia answer: neither dysphagia, nor anosmia 198. Horner’s with dysphagia. a) PICA b) ACA Answer:PICA 199. Paranoid schizhoprenia- features given, 200. Psychotherapy 201. Elderly wife abusing husband who is suffering from arthritis what is not done a) send hem to daycare b) support to wife answer:b….elder abuse is a criminal offence under the Criminal Code 202. Status asthmaticus a) hydration, inhaled beta agonist, IV steroid 203. Strawberry angiomas. Treatment. a) spontaneous regression b) excision c) injection of sclerosant. Answer:a 204. Ocd treatment a) fluoxamine 205. Abruption placenta. Cause of DIC a) fribrinolysis.
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