Mccee Sae 2 Answers

Section: 1 Question: 1 A 30-year-old man presents with severe pruritus that is worse at night and reports similar symptoms among other family members. Upon examination, areas of excoriated papules are observed in the interdigital areas. Which one of the following is the most likely diagnosis? dermatitis herpetiformis cutaneous larva migrans contact dermatitis scabies pinworm infestation Question: 2 A 33-year-old woman who is 29 weeks pregnant with her fourth child presents to the obstetric unit with onset of painless vaginal bleeding two hours ago, accompanied by passage of significant blood and clots. Fetal heart rate is regular at 150 beats/minute. She is having no uterine contractions. Which one of the following is the most likely diagnosis? placenta praevia abruptio placentae vasa praevia bloody show disseminated intravascular coagulation

Question: 3 A 3-year-old boy presents to the emergency room following

a 40 second generalized tonic-clonic seizure. The infant has been ill with a high fever for 24 hours. His history is unremarkable, and physical examination is normal, CBC and urinalysis are normal. Which one of the following would be the best initial step? Arrange to have an EEG performed urgently. Admit to hospital for an immediate CT scan of the head. Carry out blood cultures. Reassure the mother and recommend close observation. Perform a lumbar puncture.

Question: 4 Throughout the winter months, about 18% of 1000 people working in a modern office building complain of headache, eye irritation and sore throat. These symptoms develop each day about noon and persist through the afternoon. The most likely explanation for this phenomenon is allergic rhinitis. occupational stress. mass psychogenic illness. sick building syndrome (indoor air pollution). endemic transmission of rhinovirus. Question: 5 A 15-year-old boy presents with a history of repeated fire setting. He collects lighters and enjoys watching fires in the neighborhood. His mother and teachers describe his temper as explosive and he is known to fight, lie and steal. With his mother, he is frequently argumentative and disobedient. Which one of the following diagnoses is most likely?

conduct disorder oppositional defiant disorder intermittent explosive disorder attention deficit hyperactivity disorder (ADHD) pyromania

Question: 6 A 30-year-old male presents with a three month history of weight loss, fatigue and night sweats. He has palpable lymph nodes in his neck and mild hepatosplenomegaly. A chest x-ray shows a large mediastinal mass. What would be the most appropriate method of obtaining tissue for pathologic diagnosis in this patient? neck lymph node biopsy under local anesthetic biopsy of mediastinal mass under general anesthetic liver biopsy under local anesthetic liver biopsy under general anesthetic needle biopsy of the spleen under local anesthetic

Question: 7 For a 52-year-old sedentary, normotensive, non-smoking white male who is not overweight, drinks 60 mL of whiskey per day and plays golf occasionally, which one of the following conditions is most likely to cause death within the next 10 years? motor vehicle accident cerebrovascular disease

suicide cirrhosis of the liver ischemic heart disease Question: 8 A 26-year-old pregnant woman delivers a male infant at 40 weeks, with a birthweight of 2.0 kg. His head circumference is 34 cm and there are no dysmorphic features. Antenatal ultrasounds have been normal until 32 weeks, when intrauterine growth restriction has been diagnosed. Which one of the following is the most likely cause of the low birth weight? congenital intrauterine infection chromosomal or genetic abnormality placental insufficiency congenital hydrocephalus maternal age

Question: 9 A previously normal 65-year-old African-American man presents with a urinary tract infection. He is treated with sulfamethoxazole-trimethoprim. One week later, routine laboratory testing reveals a new normocytic anemia with hemoglobin 89 g/L. Which one of the following is the most likely diagnosis? Glucose-6-phosphate dehydrogenase (G6PD) hemolysis thalassemia trait occult blood loss from renal carcinoma sickle cell trait favism

Question: 10 A 27-year-old man is brought to the emergency room after trying to smash a computer in the library. He says the computer is being used to control his thoughts and that he has a good idea that the government is behind this. This patient is exhibiting which one of the following? auditory hallucinations delusions visual hallucinations obsessions ruminations

Question: 11 What would be the best test to confirm the diagnosis of hereditary spherocytosis? Coombs test bone marrow aspiration osmotic fragility studies red blood cell enzyme studies human leukocyte antigens (HLA) studies

Question: 12 The son of a 79-year-old woman wants a psychiatric evaluation for his mother because she has been more

confused and lethargic during the past 6 months. She takes several medications daily, although her son doesn't know what they are. Mental status examination shows the woman to be dishevelled, mildly agitated, and delirious. Which one of the following is the most useful next step in this woman's evaluation? identifying her medications eliciting a family history ordering serum electrolytes obtaining a CT scan of the head prescribing haloperidol for agitation

Question: 13 A first-born male child develops vomiting at the age of five weeks. The vomit is free of bile. The child remains hungry and vomits after taking feedings. Examination reveals visible peristalsis in the upper abdomen. Which one of the following is the most likely diagnosis? esophageal atresia hypertrophic pyloric stenosis duodenal web midgut volvulus incarcerated inguinal hernia

Question: 14 International comparisons suggest that the health status of a population is most influenced by the presence of a national health insurance plan.

physician/population ratio. range of social and welfare programs. method of paying the physicians. number of hospital beds.

Question: 15 A patient with delirium tremens manifests all of the following, EXCEPT clouded consciousness. hypothermia. coarse tremor. tachypnea. hyperhidrosis.

Question: 16 A 4-year-old girl presents with areas of bluish discoloration of the lower extremities, buttocks and upper trunk. She has a low-grade fever but otherwise well looking. The complete blood count reveals the following results: hemoglobin, 120 g/L; white blood cell, 8.2x109/L and platelets 170 x109/L. Which one of the following is the most likely diagnosis? henoch-Schönlein purpura hemophilia A meningococcemia idiopathic thrombocytopenic purpura acute leukemia

Question: 17

A 28-year-old pregnant woman develops sudden onset of dyspnea and tachycardia. Which one of the following is the most likely explanation? acute mitral valve regurgitation pulmonary embolism myocardial infarction acute respiratory distress syndrome lobar pneumonia

Question: 18 A 10-year-old boy complains of headaches and stomach aches each morning before school and has missed most of the last 2 weeks of school. He has no history of vomiting, change in stool patterns, weight loss or visual disturbances. His physical examination is negative. The most appropriate course of action is propranolol prophylaxis for migraines. referral back to school with reassurance to parents. computed tomography scan of the head. Maalox® before meals. suggest withdrawal of privileges to deal with truancy. Question: 19 A 55-year-old overweight, non-smoking woman, recently separated from her husband, complains of severe chest pains radiating to both arms. During the attacks, which are provoked by drinking cold liquids, she is nauseated and may experience difficulty in swallowing. The most likely diagnosis is

ischemic heart disease. peptic ulcer disease. panic disorder. esophageal spasm. biliary colic.

Question: 20 A 4-year-old boy has a history of easy bruising, nosebleeds, and a similar history among male and female family members. Laboratory investigations show normal INR and prolonged APTT. Which one of the following is the most likely cause of this boy's tendency? hemophilia A Christmas disease factor XIII deficiency von Willebrand's disease familial platelet function disorder

Question: 21 A 45-year-old business executive with advanced cirrhosis of the liver and a history of alcohol abuse says that he drinks only because of the constant nagging of his wife. This is an example of which of the following defense mechanisms? rationalization repression sublimation

reaction formation intellectualization

Question: 22 A 3-year-old boy presents with a swelling in the right scrotum. On examination the swelling is irreducible, it is possible to get above it and it is translucent. Which one of the following is the most likely diagnosis? indirect inguinal hernia varicosity of testicular veins torsion of the testis acute epididymo-orchitis primary hydrocele

Question: 23 To estimate survival from a follow-up study, "time zero" must be defined precisely for each patient. This is best ensured by "back dating" the entrance to the date of onset of the first symptoms, as obtained from the history. enrolling all patients on the same calendar date. measuring from the first instance when each patient's symptoms met certain criteria for severity. measuring from the time the disease is detected by a screening program. selecting all patients at clinically comparable

points in the course of their disease.

Question: 24 A 45-year-old female presents with a history of a direct blow over the shaft of her left humerus. Her x-ray shows a spiral fracture of the distal third of the humerus. On examination of her hand, sensation is intact on the palmar side but absent on the dorsum of her hand. Which one of the following nerves is most likely injured? axillary nerve musculocutaneous nerve median nerve radial nerve ulnar nerve

SECTION 2 Section: 2 Question: 1 A 24-year-old man is brought to the emergency room after being found unresponsive in a city park. Physical examination reveals pinpoint pupils unresponsive to light and a respiratory rate of 7 breaths per

minute. Which one of the following is the most likely cause? tricyclic antidepressant overdose morphine overdose arsenic poisoning lead intoxication alcohol intoxication Question: 2 The following laboratory values were obtained during investigation of a 45-year-old man: Hemoglobin

90 g/L

Mean corpuscular volume

82 fL

Mean corpuscular hemoglobin concentration

300 g/L (N = 310360 g/L)

Serum iron

7 µmol/L (N = 13-27 µmol/L)

Total iron binding capacity

36 µmol/L (N = 5472 µmol/L)

Sideroblasts in the bone marrow

0.25 (N = 0.300.50)

Bone marrow iron

Normal

These results could be due to all the following conditions, EXCEPT iron deficiency anemia. alcoholism. chronic infection. malignant disease.

rheumatoid arthritis. Question: 3 The incidence of a particular disease is greater in men than in women, but the prevalence shows no sex difference. The most probable explanation is that the mortality rate is higher in women. the case fatality rate is higher in women. the duration of the disease is longer in women. women receive less adequate medical care for the disease. this diagnosis is more often missed in women.

Question: 4 A 50-year-old woman has a 2 cm carcinoma in the upper outer quadrant of her left breast, with no palpable axillary nodes. Which one of the following is the most appropriate treatment? lumpectomy and tamoxifen lumpectomy and axillary dissection modified radical mastectomy lumpectomy, axillary dissection and radiotherapy lumpectomy followed by radiotherapy

Question: 5 A 16-year-old boy presents in the emergency room with a history of a football injury to the left flank earlier that day. He reports that at the time of injury he only had the wind knocked out of him and recovered in a

few minutes. About 1 hour later he began to experience pain in the left upper quadrant and left shoulder and light-headedness on standing. Which one of the following is the most likely diagnosis? dislocation of the left shoulder broken rib on the left side left-sided pneumothorax contusion of the left kidney ruptured spleen

Question: 6 A 6-month-old girl presents with vomiting and diarrhea of acute onset. Her systolic blood pressure is 40 mm Hg, pulse is 160/minute, she has poor peripheral circulation and is very lethargic. Her serum sodium concentration is 158 mmol/L. Which one of the following is the best initial management? intravenous 5% dextrose in 0.9% saline, 20 mL/kg over 60 minutes intravenous 5% dextrose in water at 80 mL/kg/24 hours oral solution containing 50 mmol sodium per liter septic workup hydrocortisone 200 mg intravenously Question: 7 A 28-year-old woman has a 3-year history of primary infertility. She presents with increasing symptoms of steady, aching lower abdominal pain at the time of menses. The pain persists throughout menstruation and often after, and radiates into the rectum. Tender nodules in the uterosacral ligaments are noted on

pelvic examination. Which one of the following would be the most contributory investigation? postcoital test diagnostic laparoscopy hysterosalpingogram on day 9 of her cycle endometrial biopsy on day 26 of her cycle basal body temperature charting

Question: 8 A 54-year-old man presents with extreme pain and swelling of the left middle finger. Four days earlier, he suffered a small puncture wound to the volar aspect of the finger at the level of the distal flexor crease. Passive extension of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints severely aggravates his symptoms. Which one of the following is the most likely diagnosis? pulp space infection cellulitis mid-palmar space infection septic tenosynovitis septic arthritis distal interphalangeal (DIP) joint

Question: 9 A 52-year-old patient is complaining of hot flushes, sweating, and sleep disturbance. After discussion she feels hormone replacement therapy would not be suitable for her. She wants to discuss herbal remedies for menopause. Which one of the following natural

products is most likely to help her symptoms? Kava Ginseng coenzyme Q10 Evening primrose oil Bilberry

Question: 10 On physical examination of a 21-year-old woman, you auscultate at the apex of her heart a low-pitched midto-late diastolic murmur with accentuation of S1. Upon careful listening you notice a clicking sound just after S2 and immediately preceding the rumbling murmur. Which one of the following is the most likely condition? aortic insufficiency atrial myxoma mitral valve prolapse mitral valve stenosis patent foramen ovale

Question: 11 A 21-year-old primigravida at 20 weeks' gestation is diagnosed as having herpes genitalis. Your suggestion to her for her future care include which one of the following? Pap smears every 3 months cesarean section if active lesions at the time of

delivery termination of this pregnancy refraining from sexual activity amniocentesis to see if fetus is infected

Question: 12 The lupus patient you are following suddenly develops a fever and notes that her urine is dark in color. Analysis of her urine reveals the presence of red cells. She has had some joint aching and been feeling unwell for a few days. Her malar rash is about the same as usual for her. Which one of the following suggests she is experiencing an exacerbation of her disease? C3 and C4 are both normal. C3 is low and C4 is normal. CH50, C3 and C4 are normal. C3 and C4 are low. terminal complement components are absent.

Question: 13 A 9-year-old boy is brought to the hospital with a history of having fallen from his bike. He fainted and is now complaining of abdominal pain and thirst. There is general abdominal tenderness and rebound tenderness. Approximately 4 hours after the accident, the white blood count is 20 x 109/L and the hemoglobin is 80 g/L. What is the most likely diagnosis?

renal contusion acute pancreatitis ruptured spleen retroperitoneal hematoma ruptured bowel

Question: 14 A 40-year-old woman has a history of osteoporosis in her family and seeks counseling. Which of the following statements is true regarding an increased risk of osteoporosis? black women with a late menopause white women with larger bone mass women with regular physical exercise women with history of cigarette smoking white women with a late menopause

Question: 15 A 27-year-old woman seeks evaluation for her "depression" in an out-patient clinic. She reports episodic feelings of sadness since adolescence. Occasionally she feels good, but these periods seldom last more than 2 weeks. She is able to work but thinks she is not doing as well as she should. In describing her problems she seems to focus more on repeated disappointments in her life and her low opinion of herself than on discrete depressive symptoms. In your differential diagnosis at this point,which one of the following is the most likely

diagnosis? major depression with melancholia adjustment disorder with depressed mood cyclothymia childhood depression dysthymia

Question: 16 Extrinsic allergic alveolitis may be acquired by breathing air contaminated by which one of the following substances? urea formaldehyde foam insulation fine silicaceous dust chlorine gas fungal spores degreasing solvent

Question: 17 Following a car accident, a patient presents with bruising of the eyelid and clear fluid is observed leaking from his nose. Which one of the following is the most likely cause? linear fracture of the vault of skull anterior cranial fossa fracture petrous bone fracture

foramen magnum fracture squamous temporal bone fracture

Question: 18 A infant girl presents with a webbed neck, shield chest, coarctation of the aorta, and edema of the hands and feet . Which one of the following conditions is she likely to manifest? kyphoscoliosis deafness cataracts amenorrhea renal failure

Question: 19 Between 1901 and 1981, the total mortality rate in developed countries showed a dramatic decline. Which one of the following factors accounted for the greatest proportion of the decrease in mortality during this time? improvement in the geographic distribution of health care professionals increase in the number of health care professionals development of antibiotics improvements in general living standards improvements in diagnostic techniques

Question: 20

You see a cyanotic 1-day-old baby boy, born by difficult delivery at 37 weeks' gestation. After administration of 100% oxygen, there is no significant change in the arterial PaO2. Based on this finding, the most likely primary diagnosis is pulmonary disorder. central nervous system damage. congenital heart disease. sepsis. metabolic disorder.

Question: 21 Two medical students poll a random sample of classmates concerning their choices for residency training and find that the percentage of women who plan to train in primary care is significantly higher than the percentage of men (p