Monday, June 9, 2008

Family Medicine MCQ (Single Best Answer)

1. A 35-year-old school teacher who is asymptomatic consults his family doctor for the following blood tests. He had Hepatitis B vaccination 10 years ago.

Hepatitis B surface antigen NEGATIVE
Hepatitis B “core” antigen NEGATIVE
Hepatitis B antibody POSITIVE ( Titer: 8 i.u./L)

Which of the following statement is correct?

A. He has good immunity against hepatitis B infection
B. He has chronic hepatitis B
C. He has acute hepatitis B infection.
D. He acquired hepatitis B from vertical transmission.
E. He should be advised for booster dose of hepatitis

2. A 30 year-old housewife presents with chronic persistent diarrheas for 6 weeks. Which of the following symptoms would MOST suggestive of a pathological cause of her diarrhea?

A. More than 3 episodes of diarrhea per day.
B. Having a sensation of active bowel movement
C. Nocturnal diarrhea with 2-3 episodes after sleep.
D. Abdominal pain
E. Similar episodes 2 years ago

3. A 20 year old college student was treated for bronchopneumonia two weeks ago. On follow up, his blood test shows the following results:

Haemoglobin 10.3 (13-14 g/d L)
White blood count 8,000 (4,000-11,000/dL)

Platelets 160,000 (150,000-400,000/dL)
Reticulocytes 10%
Agglunitation POSITIVE

The above results are consistent with:

A. Drug induced hemolysis
B. Acute Infectious mononucleosis
C. Partially treated pneumonia
D. Mycoplasma induced hemolysis
E. Aplastic anemia

4. A 75-year-old Right-handed patient suffers a thrombotic stroke. He understands what is being said to him but he has difficulty in finding words to speak. He is also confused about left and right. The lesion in his brain is MOST likely situated at:

A. Left frontal lobe
B. Right frontal lobe
C. Left parietal lobe
D. Left temporal lobe
E. Right temporal lobe


5. A 50 year old man with history of diabetes mellitus presents to his family doctor with a complaint of itchiness at both the armpits. On examination, both his axilla regions are erythematous, shinny and satellites lesions are seen.
The MOST likely diagnosis is:

A. Pityriasis versicolour
B. Necrobiosis lipodica diabeticurum
C. Impetigo
D. Cutaneous candidiasis
E. Atopic eczema

6. A 20 year old college student presents with nocturnal cough and chest tightness. Occasionally he also complains of audible wheeze after exercise.
Which of the following will BEST confirm your clinical diagnosis?

A. Chest radiograph
B. Peak flow monitoring for diurnal variability
C. Trial of inhaled beta-2 agonist
D. Trial of inhaled steroid
E. Spirometry

7. A 30-year-old man presents with a 12-month history of headaches. He describes it as severe and sudden onset around his right supraorbital and temporal region associated with watery eyes and a blocked nose. The attacks last about 1-2 hours, occurring daily for a week. He experiences this phenomenon every 3-4 months. In between the attacks he is asymptomatic.
The history of this patient suggest a diagnosis of:

A. Tension headache
B. Chronic glaucoma
C. Migraine
D. Trigeminal neuralgia
E. Cluster headache

8. A 30-year-old asymptomatic worker visits his family doctor for pre-employment assessment. He has a sister who is diagnosed with chronic anemia. This is his blood test results.

Hemoglobin 9.5 (13-18 g/d L)
White cell count 5,000 (4,000-11,000 /dL)
Platelets 160,000 (150,000-400,000 /dL))
Serum Ferritin 35 (12-200 µg/L)

Periphral Blood film: Hypochromic, microcytic, anisocytosis with some target cells.

The MOST appropriate next line of investigation is:

A. Request for Serum Iron level
B. Request for Serum Folate level
C. Hemoglobin electrophoresis
D. Upper GIT endoscopy
E. Lower GIT endoscopy


9. A 25 year old primigravida at 20 weeks of her pregnancy is found to have Bacteriuria caused by E.coli on urine test. She is asymptomatic. Which of these is the most appropriate plan of management.

A. Reassurance without treatment.
B. Repeat urine test at term
C. Commence with antibiotic treatment
D. Delay treatment until after delivery
E. Ultrasonography of her kidneys


10. A 25-year-old female presents with generalize malaise, lethargy and intermittent low grade fever for 6 month duration. On examination she is pale and erythematous rash is presence on her face and neck. The following are some tests done at the clinic:

Urine analysis:
Protein ++ Red blood cell: ++ White blood cell: +

ESR 110 (<20 mm/hr )
Creatinine 250 (60-130 umol/L)

Na: 140 (135-145 mmol/L)
K: 5.5 (3.5-4.5mmol/L)

What is the MOST likely cause of her problems?

A. Renal calculi
B. Infective endocarditis
C. Chronic pyelonephritis
D. Systemic lupus erythematosus
E. Chronic rheumatic heart disease

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Answer: 1(E) 2(C) 3(D) 4(C) 5(D) 6(B) 7(E) 8(C) 9(C) 10(D)







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2 comments:

PAFP said...

hi, thank you
if you have more please send it to : (( familyphysician.ps@gmail.com ))

Learner said...

Does SLE have a high ESR ?