Pneumaturia is most commonly the result of

1) neoplasm of the bladder.

2) neoplasm of the rectum.
3) diverticular disease of the colon.
4) gas-forming organisms in the urine.
5) Crohn disease.

A 7-year-old child is seen at the Emergency Department for a left acute ear and
periauricular throbbing pain persisting for the last 3 days with otorrhea, fever and
progressive hearing loss. She had an earache with an upper respiratory tract infection 2
weeks ago which resolved spontaneously. On physical examination, the child looks ill
with an oral temperature of 39.5°C. There is a profuse creamy discharge from her left ear
canal with tenderness, redness and edema on her left retroauricular region. Her right ear,
chest and throat are normal. Which one of the following diagnoses is the most likely?

1) acute otitis media

2) peritonsillar abscess
3) external otitis
4) acute mastoiditis
5) suppurative tympanitis

Which one of the following features is characteristic of central retinal artery occlusion?

1) painful phenomenon
2) progressive loss of vision
3) bilateral blindness
4) semi dilation of both pupils with poor response to direct light
5) brisk constriction of pupil when the other eye is illuminated

23-year-old man complains of pain and swelling on the radial side of the wrist after a
fall. There are no definite clinical findings apart from point tenderness, and the x-ray
reveals no fracture. Which one of the following treatments is the most appropriate?

1) plaster immobilization for 2 weeks and re-x-ray

2) compression bandage for 2 weeks and re-x-ray
3) compression bandage for a few days and early active exercise
4) plaster immobilization for 6 weeks and reassess
 5) reassurance and analgesics

You are asked to assess a 65-year-old man with retrosternal chest pain. On examination,
he is diaphoretic and has mottled extremities. His systolic blood pressure is 60 mm Hg
with a pulse rate of 140/minute. His jugular venous pressure is 6 cm above the sternal
angle, and his heart sounds are very faint. Which one of the following describes this
patient's condition?

1) increased systemic vascular resistance, decreased cardiac output

2) decreased systemic vascular resistance, decreased cardiac output
3) decreased systemic vascular resistance, increased cardiac output
4) increased systemic vascular resistance, increased cardiac output
5) normal systemic vascular resistance, decreased cardiac output

A 25-year-old right-handed woman has recurrent spells during which she seems to be
"out of contact" for about 30 seconds. These are associated with a feeling of fear and
recollection of memories from the past.; For a few minutes following an attack, she has
trouble finding words to express herself. The most likely site of origin for these attacks is

1) the right temporal lobe.

2) the left parietal lobe.
3) the left frontal lobe.
4) the left temporal lobe.
5) both frontal lobes.

For the past 3 days, a 73-year-old woman has been complaining of dizziness, nausea and
vomiting. There is no associated tinnitus. These symptoms are induced by rapid changes
in position. Examination of the eyes shows nystagmus and arcus senilis. Which one of
the following is the most likely cause of this problem?

1) brain tumor
2) transient ischemic attacks
3) Meniere disease
4) labyrinthitis
5) acoustic neuroma

A 60-year-old man with a history of alcohol abuse presents with the new onset of ascites.
Which one of the following statements is FALSE?
 1) Salt restriction is the most important initial treatment measure.
2) Abdominal paracentesis is indicated for diagnostic purposes.
3) Bed rest may help in initiating a diuresis.
4) Lasix is the diuretic of choice.
5) Bacterial peritonitis may be present in the absence of abdominal pain,
tenderness or fever.

What is the most common comorbid psychiatric diagnosis in patients with chronic pain?

1) anxiety disorder
2) depressive disorder
3) substance abuse disorder
4) somatization disorder
5) conversion disorder

Which one of the following drugs can be safely administered to patients taking
phenelzine?

1) methyldopa
2) lithium carbonate
3) pseudoephedrine
4) methylphenidate
5) meperidine
Loosening of associations is most often found in

1) depression.
2) schizophrenia.
3) bipolar disorder.
4) drug-induced delirium.
5) transient global amnesia.

Schizotypal personality is characterized by which one of the following symptoms?

1) peculiarities of ideation, appearance, and behavior

2) exaggerated expression of emotion
3) grandiosity, lack of empathy, and hypersensitivity
 4) irresponsible and antisocial behavior
5) instability of mood, interpersonal relationships, and self-image

A chest x-ray in a 4-year-old shows a posterior mediastinum mass. Which one of the
following is the most probable diagnosis?

1) teratoma
2) lymphoma
3) thymic hyperplasia
4) neuroblastoma
5) bronchogenic cyst

Coryza in a 3-week-old infant may lead to upper airway obstruction when the baby
sleeps, but not when awake and crying because

1) there is inflammation and edema of the larynx and trachea.

2) the extrathoracic trachea is floppy and collapses easily on quiet inspiration.
3) an infant is an obligate nose-breather.
4) the tongue falls back into the posterior oropharynx.
5) the tonsils become enlarged and obstruct the airflow in and out of the larynx.

A 13-year-old boy complains of having six loose bowel movements with blood associated
with abdominal cramps on a daily basis for the past 3 months. He has one bowel
movement during the night. Which one of the following is the most likely diagnosis?

1) ulcerative colitis
2) salmonella gastroenteritis
3) giardiasis
4) colonic polyp
5) campylobacter gastroenteritis

In a child with a febrile seizure, which one of the following is predictive of the
development of epilepsy?

1) history of febrile seizures in a first-degree relative

2) previous history of febrile seizures
3) recurrence of febrile seizure on phenobarbital therapy
 4) non-specific electroencephalogram findings
5) history of afebrile seizures in a first-degree relative

At 20 weeks' gestation in a normal, singleton pregnancy, the fundus of the uterus is

usually

1) between the symphysis pubis and the umbilicus.

2) just above the symphysis pubis.
3) not palpable.
4) at or near the umbilicus.
5) 4 to 6 cm above the umbilicus.

The karyotype of a hydrocephalic infant would likely show

1) mosaicism.
2) nondisjunction.
3) polyploidy.
4) translocation.
5) euploidy.

25-year-old woman with a 5-cm unilateral asymptomatic cystic ovarian mass should

1) undergo immediate laparotomy.

2) return in 6 weeks for a repeat examination.
3) return in 6 months for a repeat examination.
4) be highly suspected of having ovarian cancer.
5) be scheduled for laparoscopy.

Three weeks following pelvic surgery, a patient notes continuous, painless loss of urine.
Which one of the following tests is LEAST helpful in diagnosing a urinary fistula?

1) instillation of methylene blue into the bladder

2) oral phenazopyridine (Pyridium®)
3) intravenous pyelogram
4) ultrasound
5) cystoscopy
If, for a particular year, the mean length of stay of persons discharged from a hospital is 8
days, it follows that

1) one half of the patients stay longer and the other half fewer than 8 days.
2) the frequency distribution of discharges by length of stay is symmetrical
about a center of 8 days.
3) the total number of days of hospitalization provided during the year, divided
by the number of discharges, is 8 days.
4) the average length of stay of hospitalized patients on any given day in that
year will center around 8 days.
5) the greatest proportion of patients discharged stayed in the hospital 8 days.

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?

1) motor vehicle accident

2) cerebrovascular disease
3) suicide
4) cirrhosis of the liver
5) ischemic heart disease

The "potential years of life lost" method is a useful way of looking at mortality for all of
the following reasons, EXCEPT

1) it estimates the average time a person would have lived if he or she had not
died prematurely.
2) it compares the effect on society of untimely death from specific causes.
3) it identifies health care needs of the elderly.
4) it focuses on the social and economic loss from death and emphasizes deaths
of younger persons.
5) it helps evaluate competing claims for the allocation of health care resources.

Which one of the following statements regarding Hepatitis B infection is true?

1) The presence of e antigen (HBeAg) in addition to Hepatitis B surface antigen

(HBsAg) indicates higher infectivity.
2) In Canada, serologic evidence of previous infection of Hepatitis B (anti-HBs)
is approximately the same in all socioeconomic classes.
3) Hepatitis B infection antigen is found in over 5% of the American
population.
 4) After infection, anti-Hepatitis B surface antigen (anti-HBsAg) appears within
2 weeks.
5) Hepatitis B surface antigen (HBsAg) has not been found in semen.