\ ;:e= = L s

5
c
D. Carcmotd ,yndrome
E. Salmonella mfection
F. Crohn' s disease
G. Divcrticuliris
H. Giardiasis
I. Irritable bowel syndrome
J. Ischaemic col itis
K. Coeliac disease
L. Pseudomembranous colitis
M. Ulcerative colitis
From the options above, select the diagnosis most appropriate for each clinical
vignette. Each option may be used once, more than once or not at all.
3.
4.
:!'L:= .,. e.>c.u. !l..o'--::lg a sudden onset of vomiting and severe
- o arrhoea t\\ o previously. The vomiting has settled but her diarrhoea
persistS. A stool specimen taken at the time was negative for bacterial organisms.
A 40-ycar old man presents with a three-year history of weight loss, lassitude and
passage of bulky stools that are offensive and difficult to nosh away. His sister is
known to have type I di abetes mellitus.
A 73-year old woman develops intractable diarrhoea after leaving hospital where
she had been rreated for pneumonia.
' 30-ya:; oid :na:1 of se-ere diarrhoea. up to 12 times in the past 24
aJO..c.. "I1r:te bcf;n be bad attended a wedding reception. He tells you that
;:x:su c..n-e SimiW symptomS.
I 200812909
.... I,_;,,,. _; . .. .. I I. ,.,.,,.., ' .....
l!.o-:-------
4
THEME: SEIZURES IN A CHILD
OPTIONS:
A. Simple febri le
B. Complex febri le
C. P}ridoxine dependency
D. Hypocalcaemic
Hypoglycaemic
F. Hypematracmic
G. Petit mal
H. Bacterial meningitis
I. !infantile spasms
J. Generalized tonic-donie
K. Simple partial
L. Complex partial
M . Post traumatic
For each of the following clinical presentations seled from the list above the most
appropriate diagnosis. Each opt ion may be used once, more than once or not at all.
6. A nine-month old presenting with seizure that was preceded by the sudden onset of
a of high temperature. The seizure was predominantly on the lefl side, lasting 2-3
minutes. On examination the child looked well, but was ~ t i l l febrile.
7. The teacher of an eight-year-old complains that the child is frequently "spaced
out" and inattentive
8. fifteen-month old child presents with high grade fever for 4 days that started with
S)lDptoms of upper respiratory tract infection. There was a history of seizure
lasting 20 mimnes about 2 hours ago. On examination he looks lethargic and iII,
has a sixth nerve palsy. The fundus was normal, but his blood pressure was low for
his age.
9. A two-year-old who had diarrhoea and occasional vomiting for a few days, presents
with ev;dence of dehydration. His mother was reducing his fluid intake to prevent
vomiting. His cry was high pitched and his abdomen felt doughy.
I 0. A teenage girl delivered her baby at term in a rural hospital. On discharge she
start::<! the baby on full cream milk because she cannot afford the expensive baby
formula. The baby presents to the emergency room at 8-days of age with a
generalized convulsion
Stmtstt' I 200812009
OPTIO:'\ -
"' C ... v;ClC
B. C..rwac Iailure
C. Xephrotic syndrome
D. Acute glomerulonephritis
E. Chronic renal failure
F. Elephantiasis
G. Hypothyroidism
H. Postural oedema
I. Malabsorption
J. Pelvic lymphatic obstruction
For each patient with oedema, select the most likely diagnosis. Each option may be
as.ed eott. more than once or not at all.
00,0 tth ;eoemized oedema. periorbital puffiness and proteinuria
....... B.lcoi! lS
prostate. bas pallor, 'half and
-.i v6ose fe =ylai:ls dw his breath is "fishy''. He was admitted
...U. n;ue pam. \Ommng and bloody diarrhoea and oedema.
13. A 66- year -old hypenensive lady of20 years with poor appetite and vomiting,
presents with elevated JVP, tender hepatomegaly, oedema and fundi showing grade
n hypertensive changes. Urinalysis shows proteinuria. Blood count is normal.
14. A 66- year- old lady with non-pitting bilateral oedema, constipation and weight
gain. ECG shows low voltage complexes, sinus rhythm and rate of 56/min. She
underwent hysterectomy 30 years earlier.
!5. A SO- old alcoholic male with a history of recurrent severe abdominal pain,
i:;;.e- = and chronic diarrhoea associated with cachexia.
S!!mgstor I 2008/2009

6
THEME: RHEUMATOLOGY
OPTIONS:
A. Antipbospholipid syndrome
B synerome
c
"
L
J
lupus erythematosus
L. Takayasu's arteritis
From the options above, select the diagnosis most appropriate for each clinical
vignette. Each option may be used once, more than once or not at all.
16. A 52-year old woman complains of a four-month history of swelling and tightness
in the skin over the finger of each hand. For the last three weeks she has become
bneathless when walking to the bus slop.
17. A 22-year old woman complains of loss of appetite, low-grade fever, shoulder and
lr.:u.ock !)aiD. and severe cramps in her arms and hands during exercise. On
=r;mjnn her pulse is weak in both arms. her blood pressure is 75155 mmHg in
e-" =::... - HJ; - doe rigl;l =and 115 75 mmHg in both legs.
a or>"''CG c; !Us e,oes. and dry mouth. He
l:::cS z:iC knees. On eumination. there are
ee
A::-:=.. a ;"'15'- c:; -..s pcru.s. p3:n m the left heel and right-
g,;b;! s::t es; :co: -erbed. upoo wakl;;;m !he morning. T\\O weeks earlier,
.:;e !:1 dilll tboea.
20. A 73-year old man presenos with malaise, anorexia, pain in the shoulders and hips,
and loss of 10 kg over the last 10 weeks. On examination, there is mild painful
Limitation of hip and shoulder mot1on and muscle tenderness but not weakness.
haemoglobin 13.5 gldL, white blood cell count 25 .0 g x\0
9
/ L. platelet 210 x 10
9
/L,
ESR = 90mmlh.
Stmgs!er I 2098/2009
7
STRlcn'RAL HEART L510:'\S
OPTIO:'\S:
A. Aomc regurg!WlOn
B. Aortic Stenosis
C Atrial septal defect
D Hypemophic cardiomyopathy
E Mitral regurgitation
F Mitral stenosis
G Pulmonary regurgitation
H Pulmonary stenosis
I Tricuspid regurgitation
J Ventricular septal defect
For each of the following auscultatory findings, select the MOST likely cardiac
lesion. Each may me used once, more than once or not at all.
21. Loud first heart sound followed by a low-pitched mid-diastolic mummr.
Soft second sound followed by high-pitched early diastolic murmur loudest in
apumoo
ra=: p. r=c;...t brief e:rrly diastolic murmur loudest in
I *
- - FL'ed -nng oithe second heart sound and an eject ion systolic murmur best heard
m insptrauon.
25. Soft second heart sound followed by an ejection systolic murmur loudest at the left
sternal edge in expiration and radiating to the neck.
Semester 1 2008/2009
-
8
THEME: DISORDERS OF THOUGHT
OPTIONS:

ia.:"'
-

-=-zznd=z>t;;,t;

L De ..s..:r-.., of thoughts being read
Del;;siOJlS of control
K. Erotomanic delusions
For each of the following patients, choose the single most appropriate option fr om the
list a bove. Each can be used once, mor e than once, or not at aU.
26. A 20-year old man reported that he strongly believes that his mother is putting
poison in his food. He stated that she wanted to kill him so that she could claim on a
secret insur ance policy which she took out on his life.
27. A 45-year old man who is euphoric, speaking loudly and engaging in risky
beha"loio!!r. complains to his doctor that images and ideas are flashing through his
m:x..
A - - . '::11: = cc:oes to Tery btcause be feels that the
t.i bcai bld. tl:.:: = ;;ea; them.
.:00. A , --:ear old complams to her family doctor that she is having problems
focusing as she experiences regular episodes of her thoughts stopping suddenly,
quite unexpectedly while they arc freely flowing. She further states that she is not
experiencing anxiety at the times when this phenomenon occurs.
Stmnte' I 200812009
9
THDU:: Dl EASE PR\t::'.TJO:-.

A. Prim3l) pn:,enuon
B. Secondary prevention
C. Tertiary prevention
0. Primary and secondary prevention
E. Primary, secondary and tertiary prevention
F. Health sector reform
G. Natural history
H. Quarantine
I. Sanitation
J. Investigation
K. Healthy public pol icy
L. Creating supportive environment
Select the word or phrase above which best fits each of the following scenarios.
Each option may be used once, more than once or not at aiL

--
..
34.
35.
P10wp uee '1 "'"'J' of a case of gonorrhoea v.-itb appropriate antibiotics.
Go\ no smoking in public buildings.
ior breast cancer using mammograms.
Physiotherapy for stroke patients.
Providing green spaces for individuals to exercise.
Semesler I 2008/2009
THEME: CHEST PAIN
OPTIO:\S:
b::;:csZc5:1=.-

- f\: I I I c:=s.:'e ;x::o
G. i'k
H l?cx:rdit,
l P..:lmOIW) embolism
1. Pneumothorax
K. Hyperventilation
10
For each of the following pre.sentations, select from the list above, the most likely
option. Each option may be used once, more than once or not at all.
36. A 64-year old lady who smoked for 15 years developed severe tearing chest pain
wbile in her garden. The pain radiated to her back. At the emergency room, she was
hypotensive and the radial pulses could not be felt. There was an early
- c = ::r lle"" ""l.!!e left stcmal edge (3nl space) and the heart sounds were
r!:s
wbch oc:c .ed only v. hen he bent
He has been on
p:::SOU:Z .:- a;:,d :::.est ;-n in-e 6ys after ha:\ing an
a:= !:ft'Cf S!u:pcorn.s.. He has a cough producthe of
. "'""'n . .;pumm.
39. A 55-year old man had severe central chest pain while climbing a flight of steps. He
was short of breath and diaphoretic. The pain lasted for 1 hour and was aborted by
medication given in the Emergency Room.
40. A 45-year old woman had severe chest pain which radiated to the back and both arms.
It was aggravated by inspiration, coughing and changes of body position. She gets
relief by siniog up and leaning forward.
I 200812009
I I
SECTION: B
Tilli section cornp:ises one hundred 100) Multiple Choice Questions of the
single ~ t response type. Each question carries one (I) mark.
Negative marking does not apply
Semester I 2008/2909
12
1. You arc asked to sec a 47 year old male who was hospitalized because he developed
proximal deep venous thrombosis following a 4 -hour airplane fl ight. What is the
most appropriate duration and intensity should this patient be treated with oral
anticoagulant therapy?
-
a 6 months. international normalized ratio (fNR) of 2 to 3
b 6 11=ks. c-:R of:! to 3
- != ;:: k 15 ca::cp e t.'le rncaDo!JC s:.ximme. \\ llich of the
ta:il:s-=:; - :-a;uired so e the dia;nosis?
::1
c.
d_
e.
8 _ yressure oi 150 9:! mm Hg
..!>t circumference greater that 40 inches (I 05 em
Fasting glucose of 12 mmol/L (normal 4.2 - 6.4mol L)
Reduced plasma HDL concentration
Low homocysteine levels
3. A 49 year old male presents with a history of2 episodes ofleft precordial chest
discomfort over the past month while walking up a hill. Physical examination
showed an overweight male with BP 150/ 112 rum Hg. There were no other
abnonnalities. The next most appropriate step in management is?
a.
b.
Admission to hospital
Ecbocardiography
=s ltSling
0 . _.:.....=.)
. - -
1;:11; a:::r.:I5e :ress =ng
='==
a.e 10,
A:"Q)S0m21 Poly:::-s:ac Dbease
"il Chrocic clei"SttlUl oeplmos
c. Otabetes
d. Acute Glomerulonephritis
e. Nephrotic Syndrome
5. A 63 year old man is found to have a left homonymous hemianopia. The most
like!) structure damaged is the?
:
Left occipital lobe
Ri;ht occipital lobe
Left lz:e:2J ge::x::hne oudeos
Semestfr I 200812009

A= Saxa
piC : ......
c , . ;oerdefxcancn
e. Sptder nac:' i
7. A 58-year-old woman with type 2 diabetes mellitus , presents with a history over the
past 2 months with a history of nausea and bloating with intermittent vomiting . There
is no pain. Symptoms are most prominent following a meal. Which of the following is
the most likely diagnosis for this patient?
a. Gastro-esophageal reflux
b. Gastroparesis
c. Gastric ulcer
d. Duodenal ulcer
e. Pancreatitis
_, o!' dysphagia in a 50 year old man would not
L
--'V: .al e"'3:Ul -.nion
1..'pper GI endoscopy
d. Serum gastrin
c. Chest X-ray
9. A 72 year old woman with history of osteoarthritis after taldng a week of Ibuprofen
developed fever, malaise and a generalized rash. Her peripheral blood count showed
an eosinophilia and urine analysis showed proteinuria and haematuria. What is the
most likely diagnosis?
:
syndrome
5)..-.drome


. .....- -

Semester 1 200812009
14
JO. A 55 year old man who has been on bed rest for the past 10 days, complains of
shortness of breath and chest pain. The chest X ray is normal. The next most
important specific investigation should be?
a. Pulmonary ventilation perfusion scan
b. Pllmomu; arteriography
11. A 65-year-old vegetarian is ataxic .,.,;th a stamping gait. and he must keep his eyes
on his feet as he walks. Romberg's test is positive. The most likely cause of his
problem is?
a. Parkinson s disease
b. Multiple sclerosis
c. Alcoholic cerebellar degeneration
d. Subacute combined degeneration of the cord
e. Charcot-Marie-Tooth disease
U. \\'b!eb of the following is unlikely to be a cause of Peptic Ulcer disease?
13. \\..,_ ~ of t:!le foiJo...-u:.g reg.a:rlJng t;pper gas;roinrestinal bleeding is most correct?
a. M o ~ t frequently due to gastric carcinoma
b. Naso-gastric apirate is usually negative
c. Postural symptoms usually indicate mild bleeding
d. Mortality is increased in patients with concomitant cardio-pulmonary
disease
e. Antacid therapy usually stops bleeding
Semwer 1 209812099
15
14. A 25- year old woman presents with a history of malaise. anorexia and mild right
upper abdominal discomfon for the past se\en days. She also had mid anhralgia of
the hands. She "'"lb not on any medications. Physical examination revealed mild
J
"aundice T'1e 'tt s;JJOOth and non tender. Blood
- 6
_ the f"ol.kr-,;;_;: Hh l <L. WBC I 2.0 X I 0 L. Total
....::-= :;o - u JOI'L (m omoll.1. AST (SGPD 400 ru (normal 0-35
n: -\. Ph.;.-s '' fi. 130-1 :o JL r. GGTP 90 JU (normal 1-94 IU). albumin
33g L normal 35-55 g L). Hepatis B surface antigen and hepatitis C antibody were
negative. A. f was positive.
Which of the following is the most likely diagnosis?
a. Autoimmune hepatitis
b. Helicobacter pylori gastritis
c. Chronic pancreati tis
d. Acute viral hepatitis
e. Hepatic adenoma
15. Wl1ich of the fol lowing clinical features of hepatic cirrhosis is unlikely to be
detected on examination in a 45 year old banender?
...
Caput medusae



PenrbenJ cya.oos1s
16. A Characteristic clinical features of a spontaneous pneumothorax is?
a. Gradual onset of chest pain
b. Bilateral chest pain
c. Displacement of trachea to the affected side
d. Reduced or absent breath sounds on the affected side
c. Increased vocal resonance on the affected side
17. \Vhich of the following result most likely support the diagnosis of multiple
myel01113?
!!. Ek\-:u.ed ,;eru:n GGTP (gamma gh;tamylll"lUlSpeptidase)
b lnc:reased

el of normal immunoglobulin
c. Microalbuminuria
d. Translucencies in skull radiograph
e. normal ESR
r ............. r........,
Somottor t 2008/2909
?n I I
16
18. A 53 year old female presented to a primary care physician with complaints of facial
feature changes, enlargement of her hands and having to increase her shoe size three
times within the past three years. She was recently diagnosed with diabetes mellims
and had complaints consistent with carpal ronnel syndrome. The most likely diagnosis
is?
Pancreatic tumour
r.-
=
---"'-...,., pcllie (1\'P) v.hich of the is most likely
a.. lliaYe b pronounced in atrial fibrillation
:- a v.a\e ts pronounced in pulmonary regurgitation
c v wave represents atrial filling against a closed tricuspid valve
d. range is-s to+ 10 mmHg
e. Right external jugular vein is the most reliable for assessing the NP
20. Which of the following is most correct regarding the third hean sound?
a. Is normal at any age
b. May occur with mitral regurgitation
c. May occur with mitral stenosis
d. Is d""" to decreased filling of the ventricle
e occur if ania1 septal defect is present
- ==::so! ..-:;e lefi emricular failure. There is
ECG a>-1055 the precordial leads
... ..,......,....., \:-\"' \\ZXil stile diagnosis?
!L ...... = s
:; .=:sn.e
S:Jcr rn :vau dial mfa.rction
d. O.asto!Jc dysfunction typical of a diabetic bean
Pericarditis e.
22 Which of the following is most correct for atrial fibrillation?
a. Is associated with a slow atrial rate
b. Is associa1ed v.ith a regular irregular pulse
c. Is almost always symptom2:tic
C. Is a faaor for scoke
e May 0.: ;:a;; e-..eC. lil .aial by electi' e DC cardioversion
Semm!! I 2008/2009
-,...-...
17
23. Which of the following may be a feature of acme rheumatic fever?
a. E'idence ofa mfection
b Sc:iz::t es
-
-! C=:!Ul"
e. Rennins
24. The most common anterior mediastinal tumour in adults is?
,-
-=>.
a. Thymoma
b. Lymphoma
c. Mesothelioma
d. Myoma
e. Fibroma
A 45-ycar old female who underwent mastectomy with axillary clearance 2 years
ago now presents with excessive thirst and polyuria. Investigations show:

ser=:J

s.en.xm
serum urea
serum creatinine
urine osmolality
The most likely diagnosis is:
150 mmoFL {normal 136-145 mmoJ/L)
3 S x:=ol1.. {norma1 3.5-5.0 mmoJIL)
2.8 mmoll. (normal 2.2-2.6 mmoJ/L)
9 mmoL'L (normal fasting 4.2 -6.4mol/L )
6 mmoliL (normal 3.6-7.1 mmol!L)
100 umoJIL (normal <133 umoJIL)
150 mmol/kg (normal 300-900 mmol!kg)
a. Psychogenic polydipsia
b. SlADH
c. Diabetes Insipidus
d. Hypercalcaemia
e. Diabetes mellitus
:: 5.. In dl3betic oept.'"OpZ!hy. v. hich of the following would not be of value in
p!'e\'mUD5 decline m renal function?
a. Angiotensin converting enzyme inhibitors
b. Angiotensi n receptor blockade
c. Iligh protein diet
d. Treatment of hypercholesterolaemia
e. Avoidance of non-steroidal anti-inflammatory drugs
sorogstor 1 2008/2009
The Universkv of tho West Indios
18
27. A 75-year old chronic smoker is experiencing rapid weight loss,
hypcrpigmcntation and muscle weakness associated with marked hypokalaemia. The
most likely cause oftbe clinical presentation is:
a. Metastatic disease to the brain
b. Metastatic disease to kidney causing potassium wasting
c Superimposed tuberculosis
b:.-
:1.. I.. rate cyrstals
b. Elevated peripheral white blood cell count
c. Positive gram stain on joint aspirate
d_ Elevated ESR
e. Decrease glucose in joint aspirate
29. A 73-year-old man presents following several episodes ofhematemcsis.
Examination shows s igns of orthostatic hypotension and melena. What is the fi rst
priority in caring for this patient?
:1.. tube placement and gastric lavage
:t. Resnsciwion ,.;th adequate rv access and appropriate fluid and blood
;ztl4:x:t j;;fi:sUXJ
c w swp the bleeding
c..
A r-z femk 1S ad ia=- ofwei;!:t loss fur 6 months. On
en::: =mea S:Je LS 11o"'Wed. pulse I().! mm.. T = 3-.3C. BP 90 60 mm Hg. chest clear,
pansystolic murmur at the apex_ Urinalysis reveals haemaruria.
Of the following what is the most appr opriate early investigation to diagnose her
condition?
a. Chest radiograph
b. Ultrasound scan of kidneys, ureters and bladder
c. Repeated blood cultures
d. Electrocardiogram
e. Cardiac catheterization
Semester I 200812009
r-.- --
' '

19
3 I . A 35- y...a.- oli s;:hool teat:bcr ce-.elops a sihery rash on both her elbows.
This xromp3:1lied by arthritis affecting the small joints of her hand.
On closer ex.a:::imrio:: she bas p1tting of the nails and onycholysis. What is the most

a. Rhemnato1d arthritis
b. Osteoarthritis
c. Discoid lupus
b. Psoriatic arthropathy
e. Sclerodenna
32. Which of the following is not a risk factor for coronary artery disease ?
a.. A family history of premature coronary artery disease
b. An increased low-density lipoprotein fraction
c. Diabetes mellitus
d. An increased high-density lipoprotein fraction
e. Systemic hypertension
33. \Vhich of the following need not be avoided in a patient with a c reatinine
clearance of I 5 mls?
a_ HyC:rox:-:rrea
b. Frosemide
c.
d. Pethidine
e. Sucralfate
34. Which of the following is most likely c.orrect in type 2 diabetes mellitus?
a. Has a HLA- linkcd genetic predisposition
b. Is likely to be triggered by viral infect ion
c. Has a strong autoimmune aetiology
d. Has a higher prevalence in thin people
e. Is associated with resistance to insulin in the target tissue
A female v.;m a hisrory of frequent asthma exacerbations si nce childhood
presents to the physician s office with wheezing. shortness of breath and a dry cough
for the last 2 days that was not alle,iated with inhaled bronchodilators. She did not
have a fe ver. Besides inhaled bronchodilators, which of the following treatment
options is most appropriate?
a. Antibiotics
b. Oral theophylline
c. Inhaled steroids
d. Anti -cholinergic inhaler
e. Oxygen
S-oter I ;lOOS/2009
,, .. ;. _ _ .... ,.,f4... ... , .....
.. ....,_ ____
"' I I
20
36. A 30-year-old woman presents to the emergency room with three weeks of
galactorrhea. She is otherwise healthy and is not taking any medications. On
physical examination, sbe has a slight decrease in vision in her temporal fields
bilaterally. Otherwise, physical examination is without abnormalities. Her urine
hCG is negative.
The most likely pathologic etiology of the patient's symptoms is
.eS I *5
37 A healthy 38-year-old woman presents to your office for a routine check-up.
She denies any complaints and is not on any medications. Her physical
examination is unremarkable. Screening laboratory tests reveal a slightly
elevated hypercalcaemia at 10.8 mg/dl. The most likely diagnosis causing her
hypercalcaemia is?
a. Sarcoidosis.
b. Hypercalcaemia of malignancy.
c. Primary hyperparathyroidism.
d. Iatrogenic.
e. Addisons disease
e::;::.u r..:::1iil5
L.t::zx::s ~
e . Hepmns
39. Of the following, the most su.itable treatment for Clostridium difficile is?
a. Metronidazole
b. Amoxicillin
c. Gentamicin
d Cimetidine
e. Tetracycline
Semester I 2008/2009
-
--------
......__#"'" __
?1'1 J I
- - --
21
40. With regards to H
1
:-;
1
influenza, the best response is?
a. It is an influenza B virus
b. It is a:1 :n.'luenza C virus
c It.., a combi:J.ation of human and bird v-h"USes
d. Mortality is above 80% in infected persons
e. It is an influenza A virus
41. Proximal myopathy is most Likely found in which of the following?
a. Phaechromocytoma
b. Thyrotoxicosis
c. Medullary carcinoma of the thyroid
d. Alkaptonuria
e. Glucagonoma
42. On a routine check-up, a 65-year-old woman with recently diagnosed
adenocarcinoma of the lung is found to have drooping of the right eyelid. Pupillary
e:u.minatioo reveals anisocoria with the right pupil smaller than ihe left. Upon
fmther questioning she reveals that after exerting' herself she has to mop the sweat
oifofher left brov.. but does not notice any sweat on her right side. Which of the
follov.ing is the most likely etiology of the patient s symptoms?
a. Apical lung tumor
b. Graves' disease
c. Myasthenia gratis
d. Paraneoplastic endocrine hormone production
e. Superior vena cave obstruction
43. Causes oftransudative pleural effusion most likely include which of the following?
a. Bacterial pneumonia
b. Cardiac failure
c. Bronchial carcinoma
d.
e. Rheumatoid arthritis
Semootor I 200812009
.,... ' t
22
44. A woman who is 31 weeks pregnant comes to the emergency department with
symptoms of preeclampsia. The presence of which of the following signs would
change this initial diagnosis?
a. Edema
b. Hyperreflexia
c. Hypertension
~ ~
c.
- ~ A - ' 5 - ~ o l d u die .. il:i dmical feanrres of cirrhosis and portal
. r ;,o=r'S1QC l:.ss '&neeal bieed. He has ascites. \\'hat single test best provides
~ ..,r, nn.suon about the possible presence of ascitic fluid infection?
a. Ascitic fluid neutrophil count
b. Gram stain of ascitic fluid
c. Bacterial culture of ascitic fluid
d. Aascitic fluid pH
e. Ascitic fluid protein
46. A 40-year old woman presents with increased lethargy and diminishing exercise
tolerance over six months. She was treated for Graves' disease in the past with
radio-iodine. She is pale and haemogratn shows:
Haemoglobin 6.0 gldl
Mean COTpUSCU!ar Volume 115fl (normal 86-98 fl)
'Qi'C2 Blood Cell Coa:n 2A X Hf'L
det 50 X 10 1.
I. f\. O::iCS w t
;; Anm-:2 c!ae 10 :::ac:uoo, ~
e R achl()Q-iJJdtred bone.....!. .,.... disease
d. Autoun:nune haemolytic anaemia
e. Iron deficiency anaemia
47. The most common aetiology of hypothyroidism is?
a. Thyroidectomy
b. Radioactive iodine ablation for hyperthyroidism
c. Congenital dyshormonogenesis
d. Hashimoto s thyroiditis
e. Iodine deficiency
s.mosw 1 2008/200i
"'"' , ,
48.
--
.
a. H;!S in - ...,..,., 3 .,.,.-,,_,
b. 1.5 ;;-=m--' "'! cfcctxm
c ?ro'u s ::x-s: Sa':l oo the scalp
.:.. x .:=J:?!=Ied b10 infection
e. Is =ted "uh t hydrocortisone
49. Of the following, the roost likely cause of localized non-scarring alopecia is?
a. Lichen planus
b. Tinea capitis
c. Alopecia arcata
d. Radiodennatitis
c. Carbuncle
50. or the following drugs, the one roost likely to cause ototoxicity is?
a.
Gentamicin
b.
Ampicillin
c. Iron
....
.t;:.-_,.....,;!:11
::
P":-.--.:sc::a.:o;.e

51. Of the following, !he first manifestation of sickle cell disease in infancy is
usually?
a. Osteomyelitis
b. Acute chest syndrome
c. Stroke
d. Renal failure
e. Dactylitis
52. Maternal rubella in the first trimester of pregnancy is most likely 10 cause which of !he
follov.:ing in the fetUS?
a. s=osis
b. Atrial septal defect
c. Aonic dissection
d. Coarctation of the aorta
e. Pulmonary stenosis
Semuter 1 2008/2009
buk seh vsd though
24
53. Which of the following is not a recognized complications of bacterial meningitis?
a. Deafness
b. Bell's palsy
c. Hydrocephalus
d. Altered mental state
e. Epilepsy
Oe foDaori::..:; 15 - likely 10 ae associated \\;!h bloody diarrhea?
1
- \ uus
c lococcal enteritis
d. Cholera
e. Brucellosis
55. Which of !he following is most correct regarding tetanus?
a. Is not a noti fi able disease
b. Is uncommon now due to a vaccination programme
c. Is associated with no mortality
d. Produces lifelong immunity on recovery from an attack
c. Is more common in the elderly
56.. old girlts broug.t:t w. by her mother. The molher states !hat her daughter is
s:::ff=; f::m:: - ;;::a.a. cs a=-d ;;;;:;;ores. S"!le b3s a histo:ry of recurrent ear infections.
bs D2$a.l speech. The most likely
1.. A'ftW!rl
- Sloe::: .. F 1Xa
.-.S!'!m:'
d :--; 3S3I polyp:.
e. Gastro-oesophageal reflux disease.
57. A 2 year old boy presents with a two day history of fever and earache. He attends a
daycare center, and has no significant past medical history. He looks ill and is assessed
to have an acute otitis media.
The most appropriate management at this time is?
a. \\ atchful wailing
b. Swt high dose Amoxcillin orally
c. Swt AsplllD
d. G;.. e .-.=en! Ceftri.axo;,e
e Refc- :o c E.'\ fur-.ber
S..moster I 2008/2009
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25
58 The best rime 10 add maintenance potassium to intravenous fluids in children who
present ...,-Jtb St' ere is?
a. \\'ben urme ou-:put is assured
b. \\'be:! t:l.U3\ enoos f:uids are Started
c. When ..ex= potlSSIWD falls below 4.0 mmol'L
d. \\ 1lcn all deficits are replaced
e. \\ nen oral fluids are commenced
59. A 14 -year -old female is overweight, has acanthosis nigricans and elevated blood
sugar without ketonuria. Her mother had developed gestational diabetes during the
pregnancy and is now frankly diabetic. The most likely diagnosis in the teenager
is?
a. Type 1 diabetes mellitus
b. Type 2 diabetes mellitus
c. Renal glycosuria
d. Diabetes due to the transfer of maternal autoantibodies to the child.
e. MODY
The oo>t of exclusiYe breastfeeding is to?
a. Protect against nappy rash
b. Reduce incidence and severity of infantile colic
c. Protect against otitis media
d. Interfere with immune response to oral polio vaccine
e. Increase the risk of allergy
/}l{tt: <j /oiif
61 A two year old is admitted with a febrile seizure and developmental delay. /
Laboratory evaluation reveals Hb 6.2 gm/dl, with hypochromia, macrocytosi s and
basophilic stippling on a peripheral smear. Of the following, the most likely
di3gnosis is?
a.. Iron deficiency
b. Lead poisoning
c. Zinc deficiency
d. Sickle cell disease
c. Anaemia of chronic disease
Semester 1 2008/2009
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26
62. An eleven- month old boy is brought to Casualty with a two- day history of high
fever. He has a one- day history of clear rhinorrhoea and cough. On examination,
the only significant findings are temperature 40C, and a bulging, hyperaemie left
tympanic membrane. Shortly after completion of the examination he has a
generalized tonic clonic seizure.
Tbe labor-aiOr) in' estigation that would most likely influence your initial

53. Of 1M followmg, the most likely lnle statement regarding failure to thrive is?
a. The diagnosis is only established when the Z score is -3
b Careful dietary assessment helps in the diagnosis
c. Most have an organic cause
d. Hospitalization is indicated in most cases
e. Faecal fat estimation is needed to rule out malabsorption
64. A previously well 7-year-old girl had onset of fever, pain and swelling of her right
ankle, three weeks ago; this seemed to respond to acetaminophen. One week ago
the left knee became swollen and painful; today she presents to Accident &
E:::;,c gea-: m t:oess of breath and complaining of chest pain.
65. Of the following, the most likely correct answer in relation to systemic onset
juvenile rheumatoid arthritis (Still's Disease) is?
a. Is characterized by asyrmnetric joint involvement
b. Presents with splenomegaly
c. Is commoner in females
d. Manifests as uveitis
e. May present as a pseudoparesis
--------
Stmtsm< J 2908/2002
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jra
27
66. Which of !he following statements about urinary tract infection in infancy
is moSt coma?
(a 1 The diapl()Sb LS omfumed by urineanalysis
(b) lc>t icla:lt,; present with urinary symptoms
( ~ It rs a CESe of j&..-xiice in lhe neonatal period
d lniants ",th a characteristic history may be gi,en antibiotics
"ithout urinal) culture
(c) Radiological examination of the urinary track is not recommended
67. A I 0-year-old boy recovers from a bout of viral gastroenteritis. However, he
continues to have persistent postprandial diarrhea. What is the most likely cause for
his diarrhea?
a.. Relapse of his viral gastroenteritis
b. Decreased intesti nal sucrase activity
c. Decreased intestinal lactase activity
d. Missed infection due to Shigella
e. Persistent vi llus atrophy of the small bowel
6S. The most likely true statement concerning immunization is?
~ ! > ~ .... --c-t:X ts comraindi.Qted in a child with a family history of febrile
co= -uh""lOUS
b. \.P..fR 'accine should be given to all HJV -infected chi ldren
c . BCG is a live attenuated vaccine
d. Hepatius B vaccine is a polysaccharide- protein conjugate
e. Vaccine-associated paralysis is a complication of IPV
69. Of the following, the most common cause of cancer in children aged less than five
years is?
a. Acute lymphoblastic leukaemia
b. Brain tumours
c. Renal tumours
d. Acute myeloid leukaemia
e. Ewing's sarcoma
o A 15-year old girl presents to the emergency room with a history of recent
acetammophen ingestion. The most significant morbidity associated with thi s
ingestion is?
a. Cardiac arrhythmias
b. Malignant hypertension
c. Seizures
d. Hepatotoxicity
c . Haemolytic anaemia
Semester I 2008/2009
28
71. Which of the following statements about sudden infant death syndrome is most
likely to be true?
a. Postmortem studies show that respiratory infection is the
commonest cause
b. lr is the commonest cause of death of infants between I month
:C . - t!-.e Cvibbean

\\loch of t::e foUov.ing is most correct for gastro-oesophageal renux in the
fust oflife?
a. Is extremely rare
b. Usually requires elective surgical treatment
c. May cause aspiration pneumonia
d. May cause vitamin B 12 anaemia
e. May be alleviated by thinning the feeds
73. Which of the following statement is most correct as to contraindications to
pertUSSis immunization?
A 3-=a='>->!C: ts ro ux CUkl#JIC!" afttr his parents
stool. The} swe ,..,.,be dJC. not zppear disu-es:.ed at the time,
he nov. displays some tenderness to abdominal pressure. Other than this
tenderness. there were no significant ftndings on physical examination. After
performing radionuclide imaging 99mTc pertecbnctate, the doctor makes a
d1agnosis and recommends surgery to correct the problem. What is the most likely
source of this child's condition?
a. Blocking of the intestine due to folding of the distal ileum into the proximal
colon
b. Breakdo\l<"ll of the stomach mucosal barrier with erosion of the underlying
lll1JCOSa
c im=ge 10 !be unestinal epithelium due to ingestion of coins
.:.. m a teeters divetrirul=
e " , er-:xnrd IJhhc. :=:c; c !he superior mesenteric

Sp !!f!!! I 200812009
19
-s A 3 old deli' crcc! iollov.-ing prolonged labor with an Apgar score of 3 at
1 3 81 m-e == :mC .! 81 10 rr:inmes She is noted to have abdominal
di.trrSioom day 3 oflife. The a"ylo:::;-:.1 X-ray isshom1 below. Which of the
follow, 1::!: ES l:..e - t rrob'e::l?
a. Duodenal atresia
:: ! a::'CSia
c.
ecronsing enteroCOlitis
d.
Hirshsprungs disease
e. Oesophageal stenosis
76. A physician is asked to evaluate a 5-year-old girl who has developed a mass in her
neck. During the interview, he learns that the mass appeared within the past few
months and has been enlarging; however, it causes no pain or discomfort. The mass
is in the midline of the neck just below the hyoid bone. Laboratory tests reveal a
triiodothyronine level of 150 ng/ d.L, (normal 70- 190 ng/dl), a thyroxine level of 8.0
ug d.L (nonnal 5-12 ug. dl) and a thyroid-stimulating hormone level of I J!UimL.
(normal 0.4-5 ut.: ml). ACT scan of the neck is performed and the doctor
recommends surgery. Y.'hat is the most likely diagnosis?
a. Branchial cleft cyst
b. Dermoid cyst
c. Ectopic thyroid gland
d. Lipoma
e. Thyroglossal duct cyst
Semester I 2008/2009
30
77. Which of the foUowing statements about childhood asthma is most correct ?
a. It affects about 0.5% of all children
b. Nocturnal cough excludes the diagnosis
c. An inhaler with spacer cannot be used for a 5 year old child
d. A 3 year old child can use a peak flow meter
e. It occurs more commonly in those whose parents smoke in
lilt 1lol::se
- f"'::s:::=s C;.e yaedi'Cl..-u;; fur a TOCii:ne check-up. His mother reports
f::l:::be :u home. wa'es bye-bye. and will say .. dada". He cannot
tur.t He seemed somewhat apprehensive when the physician
er.te.o:i the room. He can lift his head when lying on his stomach, sit unassisted,
and stand with help. He has a positive Babinski's reflex. lf this infant has mel all his
developmental milestones appropriately, how old is be most likely to be?
a. 4-5 months
b. 7-11 months
c. 12-15 months
d. 18 months
e. 24 months
79. A three- year old presents with an enlarged cervical lymph node for which he was
prescn"bed antibiotics with no response. The Mantoux test was 8 mm. The next best
- of aetiou is?
.. :.: ... w eo: tbe code
- IS3 C:e;:_
- c :y::;-.x,te W=rr<t I" K'G 'ESR
- a:% & :ks: X-=!
e. - =--"- J. Corr.- !:p BiJPO"=.l
80. A 15-year-old boy of normal height and weight for age has gyoaccomastia. He is on
no medication. The most likely cause is?
a. Cirrhosis of the liver
b. Klinefelter's syndrome
c. ThyTOtoxicosis
d. Pubertal
e. Androgen insensitivity
Stlnestrr I 200812009
__ ..... __ _
r __ ,.._
1. -yer old :--' ..-n!l f:"\":r. 3Ddo!::lhcl vomiting for two
<r- :Tr==...,....,. iX -as ;xr.-,..21 cx=ept fcrr the re;nperarure of 39.5C. Her total
::rO xto' L. ofw'-.ici; were neutrophils. Urineanalysis
CIII =-t il.'te ;:u h;;.'l 5eld. Urine culture from a clean
:--::: _e::aCClll(I,OCO &:ld 100.000 colonies of Escherichia coli per mi. The most

a.
Inflamed retrocaecal appendix
b. Acute pyelonephritis
Mesenteric adenitis
c.
d. Acute gastroenteritis
e.
Renal abccss
82. Which is the most abused substance in the Caribbean?
a.
Alcohol
b.
Nicotine
c.
Cannabis
d.
Cocaine
e.
Heroin
3 1 ts rrierred from the school counsellor to the Child Guidance Clinic
oi cs.UiJU' e beha,,ocr during the past eight months. He has been
in :Se'er.li fights wl!h the use of weapon and bas been verbally abusing the
teae!:.ers. This w-as a previously well behaved 'A' student, who is now refusing to
complete assignments and participate in activities. His mother has also reported a
notable change in his behaviour at home.
Of the following, the most likely diagnosis for this patient is?
a. Academic under.1chievcment
b. Adjustment disorder
c. Attention deficit hyperactivity disorder
d. Conduct disorder
e. Oppositional defiant disorder
A sccrct3lJ bas been e,'(periencing anxiety associated with having to take
ele'\-:mr. to her office. She reportS ha''ing palpitations, diaphoresis and a feeling of
impendmg doom while in the elevator. This continues on leaving the eleva10r, peaking
in imensiry after about ten minutes and dissipating shortly thereafter. Regarding this
young lady, which of the following is most correct?
a. Her prognosis is poor
b. She has agoraphobia
c. She has a bipolar disorder
d. She should be treated with a mood stabilizer
e. She should receive systematic desensitization
Semester I 2008/2009
. . ... . ..
> 6/12, vs
authority, violent
32
85 Which of the following is the most appropriate indicator of poor prognosis in
schizophrenia?
a. Acute onset of the illness
b. Late age of onset
c. Schiz.optypal premorbid personality
c c;eoce o'" '"'"'00<! "j mpma:lS

...... ..Jo olbe fa!:loa"q S)o::;;:=s lS wp!!;dy;.:. z ;::muent with generalized

a. T elblon headaches
b. Hallucinations
c. Palpitations
d. Breathlessness
c. Excessive inappropriate worries about possible future accidents
87. Cyclothymic Disorder is best characterized by?
a.
b.
c

Some symptoms of Major Depression
Symptoms lasting for at least 2 years
Scn->e of Mania
wd Er..sodes
.-.,.,.......,:n,. a{ affect
A _ o:::=:o G ,:,a;;; t:caeC: a mle psydliatriSl for depression stemming
divorce. Recentlj. the pauent ha;; been coming to her appointments
dressed up and weanng expensive perfumes. She bas started to flirt with the doctor.
The patient's demeanor and appearance had initially reminded the psychiatrist of his
aunt. He is uncomfortable with the patient's new behavior panems and tells her so. She
becomes very angry and storms out of the office, canceling all remaining appointments
on her way out. Which of the following behaviors is an example of negative
transference?
a. The doctor seeing the patient as his aunt
b. The doctor telling the patient he is uncomfortable
c. The patient being angry with the doctor
d. The patient dressing up for appointments
e. The paueut flirung v."Itb the doctor
Semester I 2008/2009
-
"4 pmnary care physician because of depression and
e;e =xr:'=s T;;e states that she feels bad about herself
A of the p;!tirnt's hiStory shows that she has had frequent
ai headaches. and fatigue for the past 2
'i\- would suppon a diagnosis of major
rzrher cyst!:y:nic disorder in this patient?
a. Changes m appetite
b. Changes in sleep patterns
c. Depressed mood
d. Fatiguc:Jlack of energy
e. Remittance and recurrence
90. A 35- year old man rep<>rts that while fishing. he is bothered by persistent and intntsivc
thoughts to leap over the protective railing. He denies any desire to commit this act
but fears that one day he will be unable to resist the thoughts. He is most likely
experiencing?
a. A compulsion
b. A delusion
c. An obsession
ci An illusion
e .\ h3llucination
91. A man presents to a marriage counselor at his wife's prompting. He has
been married for 10 years and believes that his wife has been unfaithful for the entire
marriage, despite her protests to the contrary. He says that everyone is always betraying
him, and he has a litany of slights, insults, and injuries that have been perpetrated
against him. He is very defensive with the counselor and reads an attack in almost
every statement. This patient most likely has which oftbe following personality
disorders?
a. Antisocial
b. Avoidant
c. Obsessive-compulsive
d. Paranoid
e. Schizoid
92 A new office screening test for haemaruria claims to be 95 percent sensitive and a
100 percent specific. ln using the test in an average clinic population, there would
be most likely?
a. Few false positives
b. Many false positives
c. No false positives
d. No false negatives
e. Many false negatives
Sgmestor I 2008/2909
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34
93. An investigation of food poisoning arising from a church picnic showed !hat !he
median time for eating potato salad and having symptoms of diarrhoea and vomiting
was 14 hours. With respect to the causative agent, this time interval is most likely an
esri=e of the?
0.: ,. u l!le mest apprwpri:lne the mcidence of a
-Lew:: ==s.m,.a t:l.! j)OpUlatioo.,
a.. Prolonging the li\'es of persons "'-ith the disease
b. Decreasing the case-fatality rate for the disease
c. Improving the treatment of the disease once it has been diagnosed
d. Primary prevention
e. Secondary prevention
95. The Aedes egypti is of public health significance because it?
a. Is !he vector of malaria
..., :.S :be of .fil.ari.asis
-= :3.--=:ls ; !DII"5IIy ..._.
f! !S w=- f.:.er
e. Is tz "= (:r 4:::::;;a:
!1.
=
c. A measure of central tendency
d. The standard dl:'o;ation
e. The median
97 A statistical report states that in a certain country, approximately 3 people die from
strokes for every 100,000 persons estimated to be alive. This statistic most likely
represents?
a. The case fatality from strokes
b. The sl2ndardized mortality rate for Strokes
c. Th-: crude mor.alll} rate fer molo:es
d. T!le = sptn5c lODUlsy rate fer s:rotes
e :be ;-..s;. ..:Ja o.: dea:la na
5e 5 *5 I ?MII?!'!99
35
9S. I:mneduuely af'4 a hu:n.::me mlhe ith an effective management team on site
\'linch of the >WemeDl is DIGSt cornet'!
a. A doc-s best rok ts 10 do lri&ge oi affected persons
b. The risk oi dY..-t.oea is s-ea= m the fits< hours
c. \ . olunteers from oumde of the seaor := hardly required
d. The risk of non-typhoid salmonella infections is !ugh
e. The probability of an outbreak of measles in temporary shelters is hgher than
usual
99. Which of the following disease is not recognized to be usuatly associated with
improper excreta management?
a. Hepatitis A
b. Typhoid fever
e. Giardiasis
d. Hepatitis B
e. Ancylostomiasis
100.. tift CJ Uuibbean has increased substantially over the past decades.
The most calbe of !.his is a change in the incidence of?
a. Malignant conditions
b. Cerebrovascular diseases
c. Maternal mortality
d. Cardiovascular diseases
e. Tradirional iofecrious diseases
END OF QUESTJON PAPER
Somestor I 2008/2009