A 73 year old woman has become progressively kyphotic over the last 3 years. Her past history includes Ca Colon & hysterectomy at age 26 for fibroids. She now presents with acute back pain & localised mid-thoracic tenderness. CXR & lateral spine X-rays are shown (interpreted as osteopaenia with wedge compression # in mid-thoracic vertebrae with no lytic or sclerotic lesions seen). The most likely diagnosis is:
Multiple myeloma
Bone metastases
Osteoarthritis
Osteoporosis
Hyperparathyroidism
Answer
An 84 year old woman, previously well, presents with stress incontinence. An Ultrasound shows an 80ml residual volume. Examination shows a 2cm cystocoele. What is the best management?
Reassure
Vaginal pessary
Referral to gynaecology to fix cystocoele
Pelvic floor exercises & bladder retraining
Oxybutynin
Answer
A 78 year old woman describes passing small amounts of urine on coughing. There is no dysuria, nor any systemic symptoms. The best therapeutic intervention is:
Pelvic floor exercises
Intermittent self catheterisation
Anticholinergic agents
Voluntary micturition every 4 hours
Fluid restriction
Answer
An elderly patient has dysphagia. The patient is at high risk of aspiration with which of the following?
A. Refusal to eat
B. Absent gag reflex bilaterally
C. Dysarthria
D. Facial weakness & drooling
E. Weak cough & decreased voice strength
Answer
Recognised associations with hypermesis gravidarum include:
- Hydatidiform mole
- Age More than 30 years
- Smoking
- Primiparous women under 20 years of age
- Pre-eclampsia
Answer
Characteristic features of overdosage with tricyclic antidepressants include all except :
A. Hesitancy of micturition
B. Tachycardia
C. Constriction of pupils
D. Postural hypotension
E. Hyper-reflexia
Answer
One of the following statements is incorrect about Jaundiced patients
A. non A - non B hepatitis can be transmitted by drinking contaminated water.
B. hepatitis B is associated with the development of hepatocelllular carcinoma.
C. acute cholangitis carries a mortality of about 40%.
D. hepatitis A typically produces a carrier state following the acute infection.
Answer
The following would indicate a diagnosis of stress incontinence in females
Except
A. nocturia occurring three times nightly.
B. dribbling after passing water.
C. leaking small amounts of urine.
D. having to "rush" to get to the toilet on time.
Answer
Significant interactions have been known to occur between the following drugs if given concurrently
except A. terfenidine and erythromycin
B. ciprofloxacin and theophyline.
C. cimetidine and warfarin
D. omeprazpole and alginate preparations.
Answer
When considering symptoms due to carcinoma of the colon at the time of presentation , all are true
except A. pain occurs in the majority of patients with a right sided lesion.
B. a palpable mass is present in the majority of those with a lesion in the left colon.
C. change in bowel habit is present with the majority of rectal lesions.
D. the majority of rectal lesions bleed.
Answer
A recently born baby has been diagnosed to have hemiplegia due to Cerebral Palsy. When counselling the parents subsequently the doctorhas to be aware that the prognosis might include all
except A. the mean IQ. is about 80
B. the majority of children have speech problems.
C. the incidence of specific learning defects has been shown to be greater that for the general population.
D. those with persistent spasticity have a better prognosis than those who develop hypotonia.
E. for children with an IQ. greater than 70, education should be in the normal system.
Answer
OWNING DOGS HAS BEEN SHOWN TO BE ASSOCIATED WITH ALL EXCEPT A. a decrease in presentation of minor health problems to the general practitioner.
B. an increase in one year survival following a myocardial infarction.
C. a lower blood pressure when matched with the average population.
D. lower lipid levels when matched with the average population.
E. increase in gastrointestinal infections.
Answer
When following up patiets with breast cancer:
A. fixed regimes of long term follow up (5 year) by hospital have been shown to lead to a more favourable outcome.
B. treatment with tamoxifen has been shown to improve prognosis in post menopausal patients.
C. cancer in the opposite breast is no greater than the incidence of breast cancer for women as a whole.
D. hormone manipulation has a greater response rate than chemotherapy in the management of advanced disease.
Answer
SUB - ARACHNOID HAEMORRHAGE
A. the majority of patients will die without warning.
B. peak age range is in the under 35 year old.
C. the majority of patients who have surgery achieve their previous quality of life.
D. the risk of epilepsy is increased following a haemorrhage.
Answer
Tags: MCQ, Neurology, Sub Arachnoid, Hemorrhage
Regarding chlamydial Infection all are true Except
A. typically causes a vaginitis.
B. is symptomatic in the majority of women.
C. is the commonest cause of chronic prostatitis.
D. if discovered in pregnancy is best left untreated until after delivery.
E. urethritis is typically associated with a dysuria combined with a negative midstream urine culture.
Answer
Tags: MCQ, Infection, STD, Chlamydia
A 32 year old female presents with acute onset of neck pain of musculo-skeletal origin. At this age it has been shown that
A. Only a few patients are pain free after one month.
B. the majority of patients will have recurrence of pain within 2 years.
C. soft cervical collars are of proven benefit in reducing the duration of symptoms.
D. non steroidal anti inflammatory drugs have been shown to be of benefit in reducing the duration of symptoms.
E. manipulative techniques (e.g. Cyriax) have been shown to be of no additional benefit.
Answer
A 42 year old man presents witha depressive illness. the following factors would support an unfavourable prognosis
Except A. loss of mother prior to 12 years of age.
B. previous depressive illness.
C. involvement with local charitable organisations.
D. obsessional personality.
E. a wife house bound with multiple sclerosis.
Answer
FEBRILE CONVULSIONS
A. Have a prevalence of between 2 - 5%.
B. Are typically associated with fevers due to bacterial infections.
C. Post ictally are typically associated with transient neurological deficits.
D. In a 3 year old child which fail to respond to 5 mgs rectal diazepam. The dose cannot be repeated in one hour.
E. Have a weaker family history than idiopathic epilepsy.
Answer
Tags:
MCQ, Pediatrics, Febrile Convulsions, Febrile Seizures
WHEN INITIATING TREATMENT WITH A PROGESTERONE ONLY CONTRACEPTIVE, THE FOLLOWING POINTS ARE TRUE.
A. Extra contraceptive precautions should be used if started on day 1 of the cycle.
B. They should not be taken for 4 weeks prior to surgery.
C. If switching from a combined oral contraceptive, they should be commenced after the 7 day break.
D. Post abortion they should be started on the day after the operation.
E. They are secreted in significant amounts in breast milk.
Answer
Following a bereavement the following are shown to be true
except
A. Approximately 20% of widowers die in the first year.
B. Mortality is greater for women than for men.
C. Mortality is still greater than expected at 2 years post bereavement.
Answer
Nocturnal Cramps have been shown to be caused by all except
A. Cirrhosis of the liver.
B. Peripheral arterial disease
C. L5 / S1 disc compression.
D. Salbutamol administration.
Answer
When considering whether to give a patient with a sore throat antibiotics, the following are true
A. Approximately 30% of throat swabs grow beta haemolytic streptococcus.
B. About 20% grow haemophilus influenza.
C. The decrease in the incidence of rheumatic fever commenced at the time of the introduction of antibiotics.
D. Tonsillar exudate in an under 15 year old is typically associated with glandular fever.
E. Enlarged tonsillar glands are typically associated with bacterial infection.
Answer
WHEN CONSIDERING THE ORGANISATION OF CARE FOR THOSE WITH GOUT.
A. Allopurinol is contra-indicated in the presence of renal calculi.
B. The majority of patients with gout will have co-existing hypertension.
C. Lipid levels are higher in those with gout than in the general population.
D. Alcohol increases the real urate clearance.
E. The majority of those with gout will have a positive family history.
Answer
When considering the diagnosis of Phimosis all are true EXCEPT
A. By 6 months of age approximately 50% of boys have a retractable foreskin.
B. Circumcision is not associated with a higher complication rate than other childhood operative procedures.
C. Inability to clean under the foreskin is associated with the development of cancer of the penis in adulthood.
D. If untreated has been shown to lead to problems with sexual function in later life.
Answer
BREAST FEEDING
A. Mastitis is typically caused by streptococcus
B. Typically takes longer than bottle feeding.
C. Causes babies to be obese with the same frequency as bottle feeding.
D. Weaning onto cows milk should take place at 6 months of age.
Answer
WHEN CONSIDERING THE DRUG TREATMENT OF ASTHMA WITH INHALER DEVICES
A. The incidence of oral candidiasis is increased by the use of spacer devices.
B. Salmeterol is indicated for p.r.n. usage.
C. Intermittent terbutalin has been shown to lead to long term worsening of asthma.
D. Steroid dosage of 600 mcg daily has been shown to be associated with adrenal suppression in adults.
E. Sodium cromoglycate is of no proven value in treating acute asthmatic attacks.
Answer
SICKLE CELL DISEASE IS ASSOCIATED WITH ALL EXCEPT
1. Priapism.
2. Impaired fertility in women.
3. An increased incidence of stroke.
4. Gall stones in the majority of patients.
5. An enlarged spleen in the first decade of life.
Answer
Which one of the following is indicated in the diagnostic workup for attention-deficit/hyperactivity disorder (ADHD)?
A) A TSH level
B) An EEG
C) A blood lead level
D) Continuous performance testing
E) Home- and school-specific ADHD rating scales
Answer
A 17-year-old white female is brought in by her parents because of concern about her recent weight loss. Her past medical history is unremarkable. Physical examination is notable for a body mass index of 23, bilateral parotid gland enlargement, dental erosions on the lingual surfaces of her teeth, submandibular lymphadenopathy, and elongated abrasions on the dorsal surface of her right hand.
The most likely diagnosis is:
A) hyperthyroidism.
B) Sjogren's syndrome.
C) sarcoidosis.
D) bulimia nervosa.
E) HIV infection.
Answer
Of the following antidepressants, which one is LEAST likely to cause drug interactions?
A) Citalopram (Celexa)
B) Fluoxetine (Prozac)
C) Paroxetine (Paxil)
D) Mirtazapine (Remeron)
E) Imipramine (Tofranil)
Answer
Which one of the following is a common early side effect of fluoxetine (Prozac)?
A) Constipation
B) Loss of appetite
C) Orthostatic hypotension
D) Atrioventricular block
E) Skin rash
Answer
You diagnose attention-deficit/hyperactivity disorder in a 10-year-old male, and the parents ask about medication treatment.
Which one of the following would you tell the parents with regard to potential side effects of medication treatment?
A) Methylphenidate (Ritalin) may precipitate seizures.
B) Although anorexia may occur, it will not lead to substantial short term weight loss.
C) Methylphenidate has significantly fewer side effects than dextroamphetamine (Dexedrine).
D) The effect on eventual adult height is minimal in patients treated with methylphenidate or dextroamphetamine.
E) Children treated with stimulants have an increased risk of developing addiction to illegal drugs in adolescence.
Answer
A patient with bipolar disorder is being treated with lithium. Of the following, which one is the most likely side effect of this therapy?
A) Hypoparathyroidism
B) SIADH
C) Hypothyroidism
D) Diabetes insipidus
E) Hypoaldosteronism
Answer
An 18-year-old female visits you because she is having difficulty sleeping, cannot concentrate, and is more irritable. She also says that people around her remark on how overly alert and wary she seems to be and how easy it is to startle her. With gentle probing you discover that 6 months ago she was driving a car that was involved in an accident in which a close friend was killed. Since that time she avoids driving and always tries to avoid the intersection where the accident occurred. In spite of trying to put it out of her mind, she still dreams about the event, and even during the day may relive the accident. Her mother is concerned because she has begun to withdraw from participation in school and church activities and just broke off a relationship with her long-term boyfriend.
The most probable PRIMARY diagnosis in this patient is which one of the following?
A) Acute stress disorder
B) Adjustment reaction with depressed mood
C) Major depression
D) Generalized anxiety disorder
E) Post-traumatic stress disorder
Answer
An 18-year-old female complains of generalized headache, dizziness (characterized as lightheadedness), and generally not feeling well for 3 days. This started at the same time as her menses and coincided with a major examination in a college class she is taking. Her review of symptoms is otherwise negative. Her past medical history includes a recent acute onset of low back pain related to lifting and a recent depressive episode which responded well to medication. Her current medications include an oral contraceptive, which she has taken for 2 years, a corticosteroid nasal spray, and ibuprofen for the past 2 weeks. She was on paroxetine (Paxil), 30 mg/day, for 7 months, but this was stopped 5 days ago because of sexual dysfunction. Because of her symptoms she has not taken any medications for the past 2 days. Since then the headache has eased substantially, but the feeling of lightheadedness has remained. A physical examination is unremarkable.
Which one of the following is the most likely cause of her symptoms?
A) Allergic rhinitis
B) Paroxetine withdrawal
C) Serotonin syndrome
D) Viral infection
E) Stress
Answer
The predominant symptom associated with dysthymic disorder is:
A) incoherence.
B) loosening of associations.
C) delusions.
D) depression.
E) trichotillomania.
Answer
Which one of the following is characteristic of drug-seeking behavior in patients who abuse prescription drugs?
A) They refuse non-narcotic alternatives.
B) They rarely report drug allergies.
C) They request that other modalities be tried first before narcotics are used.
D) They minimize their symptoms.
E) They frequently only see one physician.
Answer
You diagnose depression in a 17-year-old white male and prescribe bupropion (Wellbutrin XL). He returns for a follow-up visit 4 weeks later. He now reports less despondency, but says he has developed severe insomnia. He also tells you that his mind "races" all the time, and that he has received two speeding tickets in the past 2 weeks.
Which one of the following would be appropriate now?
A) Substitute sertraline (Zoloft) for the bupropion
B) Add valproate (Depakote)
C) Add alprazolam (Xanax)
D) Add imipramine (Tofranil) at bedtime
E) Add haloperidol (Haldol)
Answer
Which one of the following statements would be the most accurate advice to give to an adolescent beginning light therapy for seasonal affective disorder?
A) The 10,000-lux fixture is more effective and less time consuming than the 2500-lux fixture.
B) Sunscreen must be avoided for maximal benefit from therapy.
C) Light treatment is most effective when given in one daily session.
D) Patching the eyes during therapy is optional.
E) If clinical response is not demonstrable after 7 days of therapy, alternative therapy is indicated.
Answer
Which one of the following is true regarding attention-deficit/hyperactivity disorder (ADHD)?
A) It frequently coexists with specific learning disabilities/cognitive deficits
B) It is more prevalent in girls
C) Megavitamins have proved helpful in the treatment of ADHD
D) It rarely coexists with psychiatric behavioral disorders
E) Antisocial personality disorders are unusual in adults who had ADHD as children
Answer
A 7-year-old is brought in by his parents for evaluation of possible attention-deficit/hyperactivity disorder (ADHD). You review the history carefully and perform a thorough physical examination, including visual and hearing evaluations. You conclude that the problem is more likely due to ineffective discipline than to ADHD.
Which one of the following would be a strong clue that your interpretation is correct?
A) The child has frequent motor and vocal tics
B) The child acts as if he is in "another world" when playing
C) If a sibling is present, the child will play alongside, rather than with, the sibling
D) There is a clear pattern of varying sleep cycles, varying from periods when the child needs little sleep and is euphoric, t to periods of excessive sleep and a depressed mood
E) The parents react extremely emotionally when the child misbehaves during the office visit
Answer
An 18-year-old white female is considered a difficult patient. She is hostile and exceedingly demanding, often requests specific medications, and once asked you to bring her back a souvenir from your vacation. She seems accident-prone and has frequently gotten into minor trouble as a teenager. She has multiple somatic complaints and has been diagnosed as having chronic fatigue syndrome by another physician.
Of the following, the most likely diagnosis is:
A) chronic mononucleosis.
B) dysthymia.
C) depression.
D) borderline personality disorder.
E) antisocial personality disorder.
Answer
Which one of the following statements concerning suicide is correct?
A) Elderly grandparents have the lowest rate of suicide.
B) Adolescent males are much less likely than adolescent females to commit suicide.
C) Firearms are the most common method for committing suicide.
D) Youth suicides are rarely related to media reports of suicides.
E) Homosexual adolescent and heterosexual adolescent suicides are of equal incidence.
Answer
In evaluating an 8-year-old boy for attention deficit hyperactivity disorder you would especially want to know:
A) the results of an electroencephalogram.
B) the result of a trial of antidepressants.
C) the result of an enhanced CT scan of the head.
D) the results of psychometric tests.
E) your receptionist’s assessment of the child’s behavior in the waiting room.
Answer
A mother brings her 18-year-old daughter to you because of excessive showering and dressing rituals, which have been present for 3 years. You suspect, and a psychiatric consultant concurs, that the daughter has obsessive-compulsive disorder (OCD).
Which one of the following statements about this patient is true?
A) Obsessive-compulsive disorder (OCD) is a rare psychiatric diagnosis in adolescence.
B) Her disease is likely to remit spontaneously.
C) Unlike a schizophrenic patient, she would consider her rituals irrational.
D) If behavior therapy fails, treatment with any tricyclic antidepressant will be effective in controlling her symptoms.
E) If clomipramine (Anafranil) is used for drug therapy, blurred vision and dry mouth would be very uncommon side effects.
Answer
A 19-year-old female comes to your office accompanied by her boyfriend. In the last 9 months she has withdrawn from college and has requested a leave of absence from her part-time job. She no longer will accept social engagements. Though she was formerly active in church and teaching Sunday school, she has also withdrawn from theses activities. Her relationship with her boyfriend remains strong, she sleeps well, and she continues independent running and cycling.
Which one of the following would be appropriate as initial treatment?
A.Lithium (Eskalith)
B.Paroxetine (Paxil)
C.Haloperidol (Haldol)
D.Alprazolam (Xanax)
E.Trazodone (Desyrel)
Answer
Which one of the following is true regarding dysthymic disorder?
A) Depressive symptoms are severe and of duration <2 years.
B) The onset is typically abrupt following and identifiable life stress.
C) There is a strong association with other psychiatric and medical conditions.
D) The prognosis for eventual spontaneous remission is generally excellent.
E) Antidepressant medications (e.g., selective serotonin reuptake inhibitors [SSRIs])are not helpful in the management of this problem.
Answer
A 10-year-old male comes in for follow-up of his attention deficit hyperactivity disorder (ADHD). At the time of his last visit 1 month ago he was taking methylphenidate (Ritalin) each morning. At the time his mother reported that he did extremely well in class during the morning, but by the end of the day he was having problems with inattentiveness. This carried over into difficulties concentrating on homework after school. These problems were affecting his grades and causing distress to him and his mother. The child expressed a desire not to take medicine during the school day. You switched his medicine at that visit to a long-acting form of methylphenidate (e.g., Concerta).
At this visit the mother reports that her son is now doing well through the entire school day and is able to get his homework done. However, she notes that his appetite at dinner has decreased and that he has lost 2 lbs. She also reports that it is somewhat more difficult for him to fall asleep.
What is the most appropriate management at this point?
A.Discontinue the Concerta.
B.Have him take the medication at bedtime.
C.Reassure the mother and reevaluate in 1 month.
D.Add a dose of tricyclic antidepressant such as nortriptyline (Pamelor) to be taken with the evening meal.
E.Switch him to a selective serotonin reuptake inhibitor (SSRI) such as paroxetine (Paxil).
Answer
The physician counseling a 4-year-old child about the death of a loved one should keep in mind that children in this age group:
A.often feel no sense of loss.
B.often believe that they are somehow responsible for the death.
C.should not attend a funeral.
D.should usually be told the loved one is having a long sleep.
E.usually accept the finality of death with little question.
Answer
In a 19-year-old college student taking a selective serotonin reuptake inhibitor (SSRI), addition of bupropion (Wellbutrin) should be considered if the patient develops which one of the following side effects?
A.Dystonia
B.Nausea
C.Headache
D.Sexual dysfunction
E.Desire for cigarettes
Answer
An 18-year-old white male is having rapid mood changes, and his speech is pressured and difficult to interpret. These findings suggest a/an:
A.obsessive-compulsive disorder.
B.manic episode.
C.paranoid schizophrenia.
D.borderline personality.
E.antisocial personality.
Answer
An adolescent reports difficulty sleeping. Which one of the following statements concerning insomnia is correct?
A.Getting up at the same time every day can increase the restfulness of sleep.
B.Daytime drowsiness, excessive snoring, and confusion if awakened from sleep are associated with restless legs syndrome.
C.Insomnia rarely occurs in the elderly.
D.There is little correlation between insomnia and depression.
E.Patients must take hypnotic drugs for a prolonged period to cure insomnia.
Answer
You see an 18-year-old obstetric patient late in her third trimester for mild dysuria and urinary urgency. Microscopic examination of the urinary sediment is notable for bacteria and you make a presumptive diagnosis of cystitis.
Which one of the following antibiotics would be CONTRAINDICATED?
A) Nitrofurantoin (Macrodantin)
B) Trimethoprim/sulfamethoxazole (Bactrim, Septra)
C) Amoxicillin/clavulanate (Augmentin)
D) Cephalexin (Keflex)
E) Amoxicillin (Amoxil)
Answer
5. Which one of the following is the most reliable clinical symptom of uterine rupture?
A) Sudden, tearing uterine pain
B) Vaginal bleeding
C) Loss of uterine tone
D) Fetal distress
E) Maternal bradycardia
Answer
Treating preterm labor with beta-adrenergic agonists has been shown to decrease the rate of which one of the following?
A.Perinatal deaths
B.Preterm delivery
C.Low birth weight infants
D.Delivery within 48 hours of treatment
Answer
You are called to attend the delivery of a 24-year-old primiparous female. After a prolonged 18-hour labor requiring oxytocin (Pitocin) agumentation, she delivered a 4200 gm (9lb 4 oz) male infant. A vacuum-assisted delivery was performed because of maternal exhaustion, and the mother required repair of a third degree perineal laceration. Thirty minutes after you leave the delivery room, there are no other physicians in the hospital, and the delivery nurse urgently reports to you that the mother’s blood pressure is 80 mmHg systolic and her bed is soaked with blood.
The most likely cause of this problem is:
A.occult cervical lacerations.
B.hematoma.
C.uterine atony.
D.uterine rupture.
E.disseminated intravascular coagulopathy (DIC).
Answer
A 16-year-old G1 P2 has just delivered the head of her infant, which appears to be macrosomic. Further pushing fails to complete delivery, and you suspect shoulder dystocia. Immediate management should include
A) starting O2 at 6 L/min.
B) establishing a generous episiotomy.
C) acutely flexing the mother’s legs against her abdomen with her feet removed from the stirrups.
D)rotating the infant’s posterior shoulder out of the sacrum and then delivering it below the symphysis
E) having an assistant apply suprapubic pressure to the anterior shoulder.
Answer
Which one of the following is true regarding cesarean deliveries?
A) A previous cesarean delivery mandates a repeat cesarean delivery.
B) Only women with a single previous cesarean delivery should undergo a trial of labor.
C) Two-thirds of women with multiple cesarean deliveries can deliver vaginally.
D) The likelihood of uterine rupture triples after multiple previous deliveries.
E) Obstetric complications occur frequently during a trial of labor in women with two or more previous cesarean deliveries.
Answer
Which one of the following intravenous agents given to the mother during labor is the drug of choice for prophylaxis of neonatal group B streptococcal disease?
A) Clindamycin (Cleocin)
B) Erythromycin
C) Gentamicin (Garamycin)
D) Metronidazole (Flagyl)
E) Penicillin G
Answer
A 25-year-old male has a dental infection associated with facial swelling and lymphadenopathy. Which one of the following is the most appropriate antibiotic?
A) Cephalexin (Keflex)
B) Tetracycline
C) Penicillin
D) Ciprofloxacin (Cipro)
E) Azithromycin (Zithromax)
Answer
Which one of the following is the most common cause of infectious enteritis in children in temperate climates?
A) Parvo-like virus (e.g., Norwalk)
B) Cytomegalovirus
C) Campylabacter jejuni
D) Pathogenic Escherichia coli
E) Human rotavirus
Answer
A 17-year-old white male with current immunizations is seen in your office with a history of sudden painful swelling of the right parotid gland. The patient has a temperature of 38.2° C (100.8° F). The parotid gland is tender on examination.
Which one of the following would be most appropriate at this point?
A) Observation only
B) Asking about pets in the household
C) Tuberculin testing
D) A CT scan
E) Antibiotics
Answer
A 17-year-old white male comes to your office with severe pain, fluctuance, erythema, and tenderness localized over the pad of the distal long finger.
The most likely diagnosis is:
A) a paronychia.
B) a felon (whitlow).
C) an eponychial abscess.
D) bacterial tenosynovitis.
E) digital cellulites.
Answer
A 16-year-old white female in her first trimester of pregnancy presents with low-grade fever, myalgias, headache, and a rash consistent with erythema migrans. Ten days ago she was hiking in an area where deer ticks are present. She remembers being bitten by a tick which she discovered and removed 2 days after her hike.
Which one of the following is the most appropriate treatment option?
A) Amoxicillin
B) Azithromycin (Zithromax)
C) Doxycycline
D) Erythromycjn
E) Acyclovir
Answer
Your office nurse reports an accidental needlestick with a used venipuncture needle. She had drawn blood from a 18-year-old white male, who is a new patient undergoing evaluation for hypertension and hyperlipidemia. He has no evidence of other health problems and no risk factors for HIV. Both the nurse and the patient are found to be HIV negative.
Which one of the following would be the most appropriate advice?
A) No further testing for HIV is necessary.
B) She should have repeat HIV testing at 6, 12, 24, and 52 weeks after the exposure.
C) She should begin treatment with prophylactic antiretroviral therapy within the next 48 hours.
D) She should refrain from patient contact, unless she wears gloves, until another negative test 12 weeks after the exposure.
E) She should refrain from unprotected sexual contact with her husband until another negative test 6 weeks after the exposure.
Answer
Which one of the following patients should be screened for hepatitis C virus (HCV) infection?
A) A 15-year-old who received a blood transfusion in 1996 subsequent to a serious motor vehicle accident.
B) An 18-year-old nurse finishing her first year of work in a dialysis unit.
C) A 17-year-old day-care worker after a 1-year-old child in her room was diagnosed with hepatitis C.
D) A 9-month-old born to a mother positive for HCV.
E) An 18 year old presenting to an STD clinic with penile discharge.
Answer
Your community recently experienced an outbreak of infectious diarrheal illness due to the protozoan Cryptosporidium, a chlorine-resistant organism. A reporter from the local newspaper asks you if there are other chlorine-resistant fecal organisms that could contaminate public drinking water.
You would tell the reporter that such organisms include:
A) Escherichia coli.
B) Vibrio cholerae.
C) Campylobacter jejuni.
D) Giardia lamblia.
E) Rotavirus.
Answer
A 2-year-old child has had four episodes of otitis media within the last 6 months, all of which completely cleared after 10 days of appropriate antimicrobial therapy. You see him in your office following his most recent episode. A physical examination is completely normal at this time. You decide to attempt to reduce the number of recurrences.
Of the following, the best INITIAL intervention is to:
A) schedule myringotomy and insertion of ventilating tubes.
B) schedule adenoidectomy.
C) perform an allergy survey and consider allergy hyposensitization injections.
D) prescribe a single daily dose of amoxicillin or sulfisoxazole, especially during winter months.
E) prescribe a course of oral steroids to decrease swelling of the eustachian tube mucosa.
Answer
Which one of the following is true regarding drug-resistant Streptococcus pneumoniae as a cause of otitis media in children?
A) Rates of pneumococcal resistance to the macrolides are significantly lower than rates of resistance to penicillin.
B) Cefaclor (Ceclor) and loracarbef (Lorabid) have greater activity than amoxicillin against S. pneumoniae.
C) Third-generation cephalosporins should be used when other beta-lactam antibiotics have failed in suspected pneumococcal otitis.
D) Drug-resistant strains of S. pneumoniae are increasingly common in otitis media.
Answer
A worried mother calls to tell you that when she went in to check on her crying 6-month-old infant after his nap she noticed a bat in the room. She contacted animal control and an officer captured the bat. The mother wants to know what to do next.
Which one of the following is the best advice?
A) Arrange to have the bat tested for rabies; initiate postexposure prophylaxis for the child only if positive.
B) Initiate postexposure prophylaxis for the child while testing the bat for rabies; discontinue the shots if negative.
C) Initiate postexposure prophylaxis for the child and dispose of the bat.
D) Examine the child for bites or scratches; reassure the mother if none is found, and dispose of the bat.
E) Tell the mother not to worry because bats do not carry rabies.
Answer
A 4-year-old white male has radiographically proven osteomyelitis following a cat bite to the finger. A Gram stain reveals pleomorphic gram-negative rods.
The most likely diagnosis would be:
A) Bartonella henselae.
B) Francisella tularensis.
C) Pasteurella multocida.
D) Haemophilus influenzae.
E) Bacteroides fragilis.
Answer
Which of the following antibiotics is relatively contraindicated for use in children under 12 years of age:
A) Clindamycin (Cleocin)
B) Chloramphenicol (Chloromycetin)
C) Erythromycin estolate (Ilosone)
D) Ciprofloxacin (Cipro)
E) Tobramycin (Nebcin)
AnswerTags:
MCQ, Pediatrics, Drug dosage
The incidence of institutional pediatric Staphylococcus aureus infection can be reduced most effectively by:
A) treatment of all culture-positive patients with vancomycin (Vancocin).
B) meticulous hand washing before and after contact with patients.
C) mask and gown use with each suspected patient.
D) avoidance of flowering houseplants in patient rooms.
E) routine quarantine of culture positive patients.
Answer
Which one of the following is indicated for treatment of chlamydial urethritis during pregnancy?
A) Amoxicillin (Amoxil)
B) Ciprofloxacin (Cipro)
C) Erythromycin base
D) Doxycycline (Monodox)
E) Ofloxacin (Floxin)
Answer
Until the results of bacterial cultures are known children ill with presumed bacterial lymphadenitis should be given
A) dicloxacillin.
B) amoxicillin.
C) erythomycin.
D) sulfisoxazole.
E) trimethoprim-sulfamethoxazole.
Answer
A 17-year-old white male comes to your office worried about Lyme disease. He recently returned from a camp in the Upper Peninsula of Michigan where he went hiking in the woods. He recalls no tick bite, but about 1 week after returning home he developed a low-grade fever, myalgias, and fatigue. He has had these symptoms for 1 week when he comes in to see you. A physical examination is completely normal.
The single most important diagnostic clue in establishing the diagnosis of Lyme disease is:
A) new-onset bundle-branch block.
B) nuchal rigidity compatible with meningitis.
C) high, spiking fevers.
D) erythema migrans.
E) acute arthritis of a large joint.
Answer
A 6-year-old white male is brought to your office with a 2 month history of persistent, painless swelling in his left groin. Neither the child nor his parents can remember any illness or injury associated with the onset of this condition. The only significant medical history is a diagnosis of attention-deficit/hyperactivity disorder, treated with methylphenidate (Ritalin). Findings are normal on physical examination, except for enlarged lymph nodes in the left inguinal area. You note one node which is about 3 cm x 3 cm and two which are approximately 1 cm x 2 cm. The left leg appears normal.
Which one of the following is the most likely diagnosis?
A) Cat-scratch disease
B) Hodgkin’s disease
C) Sarcoidosis
D) Lymphogranuloma venereum
E) Tularemia
Answer
A young girl is bitten on the finger by her pet kitten. Within 8 hours the finger is red and indurated, and a seropurulent discharge can be expressed from the wound. A Gram stain reveals many polymorphonuclear leukocytes and small gram-negative coccobacilli with bipolar staining.
The responsible organism is most likely:
A) Staphylococcus aureus.
B) Streptococcus pneumoniae.
C) Yersinia pestis.
D) Pasteurella multocida.
E) Bartonella henselae
Answer
Cutaneous larva migrans is transmitted via:
A.Contaminated food.
B.Contaminated drinking water.
C.Aerosol inhalation.
D.Skin contact with soil.
E.Mosquitoes.
Answer
Which one of the following single-dose regimens is effective for treatment of uncomplicated urethral or cervical infection caused by Chlamydia trachomatis.
A) Azithromycin (Zithromax), 1 g orally
B) Doxycycline (Vibramycin), 200 mg orally
C) Amoxicillin, 2 g orally
D) Cefixime (Amoxil) (Suprax), 400 mg orally
E) Metronidazole (Flagyl), 2 g orally
Answer
All of the cases listed below should receive rabies prophylaxis EXCEPT:
A.A rat bit occurring in the patient’s basement.
B.A bat bite sustained on a hiking trip.
C.A raccoon bite occurring on a hunting trip.
D.A dog bite from an unprovoked cocker spaniel not found for observation.
E.A feral cat who ran away.
Answer
A 13-year-old male is found to have hypertrophic cardiomyopathy. His father also had hypertrophic cardiomyopathy, and died suddenly at age 38 following a game of tennis. The boy's mother asks you for advice regarding his condition.
A) He may participate in no contact sports.
B) He should receive lifelong treatment with β-blockers.
C) His condition usually decreases lifespan.
D) His hypertrophy will regress with age.
E) His siblings should undergo echocardiography.
Answer
You perform a health maintenance examination on a 2-year-old white male. He is asymptomatic and is meeting all developmental milestones. The only significant finding is a grade 3/6 diastolic murmur heard at the right upper sternal border.
Which one of the following would be most appropriate at this time?
A) No further evaluation
B) Order a stat EKG
C) Reevaluation in 6 months
D) Maintenance doses of digoxin
E) Referral to a pediatric cardiologist
Answer
Evidence of cardiomegaly on a chest film is found early in which one of the following?
A) Transposition of the great vessels
B) Tricuspid atresia
C) Tetralogy of Fallot
D) Pulmonic stenosis
E) Coarctation of the aorta
Answer
A 17-year-old white female has a history of intermittently recurring cardiac arrhythmias. She comes to the emergency department with a 1-hour history of weakness and rapid heart beat. Her lungs are clear and she denies chest pain. Her blood pressure is 110/60. Her EKG is shown below.
Of the following, the most appropriate immediate management would be:
A) cardioversion.
B) cardiac pacing.
C) adenosine (Adenocard).
D) bretylium (Bretylol).
E) lidocaine (Xylocaine).
Answer
Traveler’s diarrhea in a group of high school students on Spring Break can be effectively treated in the great majority of cases by a 3-day course of:
A.Erythromycin.
B.Penicillin V.
C.Sulfacetamide.
D.Ciprofloxacin.
E.Metronidazole.
Answer
In the Day Care Center for which you are the medical consultant, two children develop systemic Haemophilus influenzae type b infections within the same month. You recommend prophylaxis for all children and staff in the classroom with which one of the following?
A.Ceftriaxone (Rocephin)
B.Chloramphenicol (Chloromycetin)
C.Trimethoprim/sulfamethoxazole (Bactrim, Septra)
D.Cefaclor (Ceclor)
E.Rifampin (Rifadin)
Answer
Of the following childhood diseases, which one has a morbidity and mortality that can be attributed largely to cardiac involvement?
A) Rubeola
B) Lead poisoning
C) Kawasaki disease (mucocutaneous lymph node syndrome)
D) Systemic lupus erythematosus
E) Congenital syphilis
Answer
1. A low maternal serum α-fetoprotein level is associated with which one of the following?
A) Neural tube defects
B) Fetal edema
C) Down syndrome
D) Twin pregnancy
E) Fetal demise
Answer
1. During a checkup at 6 weeks of age, an infant whose examination was normal in the nursery is found to have a harsh, widely transmitted, grade 4/6 holosystolic murmur over the left parasternal area. The infant is notably acyanotic and appears well.
Which one of the following is the most likely diagnosis?
A) Ventricular septal defect
B) Tetralogy of Fallot
C) Transposition of the great vessels
D) Tricuspid atresia with a hypoplastic right ventricle
E) Severe pulmonary stenosis with an intact ventricular septum (intra-atrial shunt)
Answer
1. Which of the following children should be kept out of day care?
A) A 6-month-old with mouth ulcerations associated with drooling.
B) A 2-year-old with nonpurulent conjunctivitis.
C) A 3-year-old with a rash but no fever or behavioral change.
D) A 4-year-old with non-bloody diarrhea who is otherwise asymptomatic.
E) A 5-year-old who was diagnosed with head lice and treated two days ago.
Answer
1. In coping with breath-holding spells in young children, parents should:
A) ignore the behavior when it occurs.
B) attempt to reason with the child regarding the harm that could result from this behavior.
D) seek help from a psychologist to avoid serious problem in the future.
C) enlist the help of an older sibling.
E) slap the child’s face gently to break the episode
Answer
Regarding Gonorrhoea which is incorrect:
a. Is caused by a bacterium
b. Can only be treated with penicillin
c. If untreated, can occasionally lead to infertility
d. Is frequently asymptomatic in women
Answer
