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Student’s Name: ______________________________ Number: _________________
Department of Family and Community Medicine
Final Examination
COMM-421 (Females) (First batch)
Tuesday: 27.3.1427 (25.4.2006)
Time: 8:30-11:00 Am
Part A
Multiple Choice Questions (MCQs)
ONE SINGLE BEST ANSWER.
15 Marks
1.
Asthma control means all of the following EXCEPT:
a. Minimal chronic symptoms.
b. Minimal or no adverse reactions from medications.
c. Almost normal PEF (Peak Expiratory Flow).
d. Moderate need for PRN B2-agonists medications.
e. PEF variability < 15%.
2.
The following are true regarding bronchial asthma EXCEPT:
a. Aminophyllines can cause palpitation, GIT irritation and tremors.
b. Cromolyn sodium inhibitis the degeneration of mast cells.
c. Ipratrobium bromide is better to be avoided in chronic asthma because of its
anticholinergic side effects.
d. Corticosteroids are very useful in severe asthma.
e. A peak flow rate of less than 50% of predicted implies severe attack.
3.
The following behavioral strategies are useful to improve compliance with
the prescribed medical regimen EXCEPT:
a. Tailoring to specific patients characteristics.
b. Forcing.
c. Contracting.
d. Self-monitoring.
e. Support of other family members and friends.
4.
Lack of patients compliance with instructions to take certain medication
is:
a. Nearly always the fault of the patient.
b. Always associated with socioeconomic status of the patient.
c. Affected by knowledge of the illness.
d. Related to patient's educational level.
e. Related to the absence of symptoms.
5.
These statements are true EXCEPT:
a. Resources are manpower, materials, money, time and information.
b. Generic prescribing is one type of substitution of resources.
c. Never do yourself what another can do for you as well as you would.
d. The leader is not responsible for the team's failures and successes.
e. People use authority to do the work for which they are responsible.
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Student’s Name: ______________________________ Number: ________________
ONE SINGLE CORRECT ANSWER.
6.
Prescribing is affected by the following factors EXCEPT:
a. Symptomatic relief.
b. Clinical convenience.
c. Social factors.
d. The total number of prescriptions issued annually.
e. Patient's compliance.
7.
Factors increasing prescribing include all EXCEPT:
a. The presence of pharmaceutical advertising.
b. Wednesday afternoon antibiotic.
c. Admitting uncertainty during consultation.
d. Placebo prescribing.
e. To avoid confrontation of patient.
8.
According to White et al., out of the approximately 750 adults of 1000 who
get ill or become injured during a given month, a primary care physician
will see ____ of them as outpatients, ____ will be admitted to a hospital,
and ___ will be admitted to university teaching hospital.
a. 500, 20,5.
b. 250, 9,1.
c. 150, 15,7.
d. 450, 9,5.
9.
The difference between PHC and the hospital is:a. Continuity of care is less in PHC than in hospitals.
b. PHC is less accessible.
c. Contact in PHC is usually initiated by the doctor rather than by the patient.
d. PHC involves extended diagnosis and care.
e. Preventive care for the patient and family is less feasible than in the hospital.
10.
How many hypotheses should you consider at one time while formulating
a diagnostic possibilities (hypotheses) during a patient encounter?
a. Only one - more than that is too confusing.
b. Three or four - a nice number that attending usually ask.
c. More than five - the more the better.
d. Being a medical student, you should keep all of the possible hypotheses in mind
all of the time.
11.
Good communication (mark the false statement);
a. Is the basis of history taking.
b. Is an alternative to history taking in the primary care setting.
c. Favorably influences the quality of doctor-patient relationship.
d. Is sensitive to the needs of patients and relatives.
e. Is the basis for better doctor practice in primary care.
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Student’s Name: ______________________________ Number: ________________
ONE SINGLE CORRECT ANSWER.
12.
Which of the following is the most appropriate study design to assess the
efficacy of a new drug.
a. Randomized clinical trial.
b. Cohort study.
c. Case-control study.
d. Cross-sectional study.
e. Descriptive study.
13.
In managing an obese person:a. Secondary causes should be ruled out in the initial assessment by requesting
appropriate investigations.
b. The loss of around 3 kg/week should be the goal.
c. Anorectic drugs (eg amphetamines) are better avoided.
d. Surgery has no place in the management of massive obesity.
e. Exercise has a limited value as it reduces the basal metabolic rate.
14.
A 50-year-old male is being treated for hypertension with a low-salt diet,
hydrochlorothiazide 25 mg/day, and propranolol 120 mg bid. His blood
pressure at present is 180/100 mg Hg.
Which of the following would be a reasonable third-ling agent for the
treatment of this patient's blood pressure?
a. Atenolol.
b. Metoprolol.
c. Labetalol.
d. Furosemide.
e. Enalapril.
15.
Failure of reassurance usually appears in the following manner EXCEPT:
a. The patient fails to look reassured, at the end of the interview.
b. The patient stop asking questions, even when the doctor is ready to answer him.
c. The patient brings a relative to the consultation.
d. The doctor fails to terminate the consultation.
e. The patient asks for different investigations from the ones already done.
16.
The following are the indications to refer the depressed patient to a
psychiatric EXCEPT:
a. Lack of response to treatment which may need ECT.
b. Delusional symptoms.
c. Moderate to high suicidal risk.
d. Unipolar major depression.
e. Lack of family support for observation or care.
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Student’s Name: ______________________________ Number: ________________
ONE SINGLE CORRECT ANSWER.
17.
Differential diagnosis of anxiety disorders include the following EXCEPT:
a. Hyperthyroidism.
b. Proxysmal atrial tachycardia.
c. Hypoglycaemia.
d. Hyperglycaemia.
e. Phaeochromocytoma.
18.
A 62-year-old man, lost his wife 3 months ago presents with low mood,
loss of appetite and social isolation.
You diagnosed him as a case of depression, which of the following
drugs could be given safely for this patient.
a. Clomipramine.
b. Chlorpromazine.
c. Diazepam.
d. Paroxetine.
e. Propranolol.
19.
All of the following changes may occur in patients being treated with
orlistat (Xenical) EXCEPT:a. Decrease in total serum cholesterol level.
b. Decrease in LDL cholesterol level.
c. Decrease in fat soluble vitamin level.
d. Changes in coagulation parameters in patients also taking warfarin by increasing
vitamin K absorption.
e. Steatorrhea, flatus, fecal incontinence and oily spotting.
20.
In simple obesity, there is increased risk of all the following EXCEPT:
a. Ischaemic heart disease.
b. Diabetes mellitus.
c. Osteoarthritis.
d. Recurrent urinary tract infections.
e. Sleep apnea.
21.
According to Saudi hypertension management group for management of
hypertension, the following are true EXCEPT:
a. The normal blood pressure is considered to be < 120/80.
b. Persons with blood pressure 150/95 are considered stage 1.
c. Most of the hypertensive patients require two or more drugs to control the blood
pressure.
d. The optimal goal is blood pressure < 125/70.
e. Thiazide diuretics are to be considered in management of hypertension even in
those with diabetes.
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Student’s Name: ______________________________ Number: ________________
ONE SINGLE CORRECT ANSWER.
22.
Obesity is generally defined as:
a. An increase in the desirable body weight of 20% above normal.
b. A increase in the desirable body weight of 30% below normal.
c. An increase in the body mass index of 20% above normal.
d. An increase in body mass index of 30% above normal.
e. Body mass index of 31%, in an adult healthy person.
23.
In breaking bad news the following are true EXCEPT:
a. The doctor needs to be empathetic and sensitive.
b. The doctor should use language that is clear and simple.
c. The doctor may need to involve the family.
d. The doctor may not need to identify patient's main concerns.
e. The doctor should offer continuing support to the patient.
24. A 49-year-old postmenopausal obese woman with type 2 diabetes
mellitus. She brings in a list of blood pressures taken by the school nurse
over the past 3 months. The blood pressure readings average 136/86.
Your approach to this clinical case problem could include:
a. Recommend lifestyle changes and a return visit in 3 months.
b. Prescribe lisinopril, when her blood pressure is unchanged in 3 months.
c. Prescribe metoprolol, when her blood pressure is unchanged in 3 months.
d. a and b
e. a and c
25.
The following target groups are subjected to screening for diabetes
EXCEPT:
a. Those with impaired GTT.
b. Women with history of multiple pregnancies.
c. Those with BMI > 30.
d. Those above age of 45 years.
e. Those with history of hypertension.
26.
A 24-year-old woman patient develops wheezing and shortness of
breath when exposed to cold air or when exercising. These symptoms
are getting worse.
Which of the following is the prophylactic agent of choice for the
treatment of asthma in these circumstances?
a. Inhaled beta2 agonists.
b. Oral aminophylline.
c. Inhaled anticholinergics.
d. Inhaled sodium cromoglycate.
e. Oral corticosteroids.
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Student’s Name: ______________________________ Number: ________________
ONE SINGLE CORRECT ANSWER.
27.
A 51-year-old male presents with 6 month history of chest pain. His past
medical history is unremarkable. Family history, his brother had coronary artery
bypass graft at age of 45 and the same for his father at age of 62.
On examination: Nothing significant
Lipid profile:
Normal
Chest X-Ray and resting ECG: Normal
The most appropriate next step in management is:
a. Immediate referral to cardiologist.
b. Coronary catheterization.
c. Reassurance and discharge.
d. Stress exercise ECG test.
e. Cardiac enzymes.
28.
β-blockers (β-adrenergic agents) are used in the treatment of angina
because they have one of the following properties?
a. Increase the coronary blood flow.
b. Increase the left atrial volume and pressure.
c. Increase the peripheral vascular resistance.
d. Decrease the heart rate and myocardial contractility.
e. Increase the venous return to the heart.
29.
Hypercholesterolaemia, the following are true EXCEPT:
a. When screening, first check a total cholesterol level.
b. Non-pharmacologic methods alone are not recommended.
c. The first choice drugs are now clearly the statins.
d. Aggressive lowering of cholesterol is recommended in patients with CHD.
e. The aim of treatment is to lower LDL and increase HDL.
30.
A 38-year-old female comes to your office with a 1-year history of lower
abdominal pain associated with constipation (one hard bowel movement every
3 days) and the passage of mucus per rectum on a regular basis. She has never
passed blood per rectum to her knowledge. She describes no fever, chills,
weight loss, jaundice, or any other symptoms. There is no relationship between
the abdominal pain and food intake.
On physical examination, the abdomen is scaphoid, and no hepatosplenomegaly or other
masses are palpated. There is a very mild generalized abdominal tenderness, but it does
not localize.
Which of the following has to be considered in the differential diagnosis of the condition
described?
a.
b.
c.
d.
e.
Colonic adenocarcinoma.
Fecal impaction.
Lactase deficiency.
Endometriosis.
All of the above.
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Student’s Name: ______________________________ Number: ________________
ONE SINGLE CORRECT ANSWER.
31.
A 34-year-old female presents with a 3-day history of hematuria, dysuria,
increased urinary frequency, and nocturia. She has had no fever, no chills, and no
back pain.
On examination, she does not look ill. Her temperature is 37.50C. Her abdomen is
nontender.
What is the most likely diagnosis?
a. Berger's disease (immunoglobulin A nephropathy).
b. Acute hemorrhagic cystitis.
c. Acute hemorrhagic urethritis.
d. Acute glomerulonephritis.
e. Acute cystitis with concomitant coagulation disorder.
32.
A 61-year-old postmenopausal woman comes to your office for a routine
health examination. She has a history of osteoarthritis and smokes one
pack of cigarettes per day. Her blood pressure is 120/80, her height is
160 cm, and her weight is 52 kg. The rest of her physical examination is
normal. Her diet is low in calcium-rich foods, and she is not currently
taking a calcium supplement.
You feel she is at risk for osteoporosis. You initially recommend that she:
a. Obtain a central dual-energy x-ray absorptiometry (DXA) scan.
b. Start taking a bisphosphonate immediately.
c. Order serum calcium, thyroid stimulating hormone (TSH), 25-hydroxyvitamin D.
d. Obtain a lateral spine x-ray.
e. Obtain a quantitative computed tomography (QCT) scan.
33.
All of the following may cause falsely high blood pressure EXCEPT:
a. If the cuff is leaking.
b. If the cuff is too loose.
c. If the arm is held below the heart level.
d. If the patient is not relaxing his arm.
e. If the cuff is too big.
34.
The mandate that the physician shall not divulge information about the
patient within the constraints of the law is known as the principle of:
a. Informed consent.
b. Noncompliance.
c. Confidentiality.
d. Gate keeping.
35.
The following are high risk factors for osteoporosis EXCEPT:
a. Late menarche.
b. Early menopause.
c. Null parity.
d. Steroid excess.
e. High salt consumption.
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Student’s Name: ______________________________ Number: ________________
ONE SINGLE CORRECT ANSWER.
36.
In deciding how to care for a dying patient, the physician's primary
responsibility is to:
a. Himself or herself.
b. The spouse.
c. The children.
d. The patient.
37.
PHC was totally implemented in Saudi Arabia on:
a. 1980.
b. 1978.
c. 1983.
d. 1985.
e. 1982.
38.
All of the following are considered as part of PHC elements EXCEPT:
a. Immunization.
b. Treatment of simple injuries.
c. Antenatal care.
d. Treatment of preeclampsia.
e. Management of IHD risk factors.
39.
A 28-year-old female with chronic headaches comes to your office for
the specific purpose of seeking referral to a neurologist. She has seen
five neurologists already but is not satisfied with what any of them have
told her.
What is the most appropriate action for you to take at this time?
a. Agree to refer her to another neurologist and get out of the room as quickly as
possible.
b. Refuse to refer the patient to another neurologist.
c. Ask the patient to come back in a few weeks; you have to think carefully about
this request.
d. Tell the patient that although you will refer her to another neurologist, this is a
complete waste of everyone's time and money; there is obviously nothing wrong
with her.
e. None of the above.
40.
Which of the following settings is not acceptable for the delivery
of bad news?
a. A physician's office.
b. A quiet room in a hospital setting.
c. The patient's home.
d. A private hospital room.
e. A multibed hospital room.
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Student’s Name: ______________________________ Number: _________________
Department of Family and Community Medicine
Final Examination
COMM-421 (Females) (First batch)
Tuesday: 27.3.1427 (25.4.2006)
Modified Essay Questions
(MEQs)
Part B
15 Marks
Case 1
A mother of 5-month-old- infant comes to your clinic because the child has a cold.
There is no fever and chest is clear. There is no other abnormal finding. What is
your management?
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Student’s Name: ______________________________ Number: _________________
Case 2
A 14-year-old boy comes to see you with his parents, he has just been discharged
from hospital after having an epileptic seizure for the first time.
What issues would you aim to cover and what would be your management
aims?
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Student’s Name: ______________________________ Number: ________________
Case 3
Mrs. Nouf is a 32-years-old school-teacher who got married 7 years
ago. You saw her 3 months ago at the primary care center with URTI.
You congratulated her for being pregnant for the first time. The
gestational age during that visit was 7-8 weeks. Nouf was very happy
because she and her husband had suffered a lot to have a baby.
She comes to you today to complain about your colleague Dr. Soad
who apparently had misdiagnosed her and, as a result, Nouf has lost
her 'precious' baby 2 weeks ago. Nouf has presented to Dr. Soad
about 3 weeks ago complaining of epigastric and right loin pain,
dysuria and vomiting. Dr. Soad did not bother to examine her and just
asked for a urine test. She told her that she most probably had a
urinary tract infection and gave her an antibiotic. She asked her to
come back in 2 days to see the result of the urine culture.
The pain improved for a while but then it recurred and it was much
worse. Two days later the pain became very severe and she was
highly febrile. Nouf had to visit the A&E and she was admitted
immediately for surgery. The surgeon told her that the pain was due to
appendicitis. Unfortunately, her appendix perforated and she
developed peritonitis. The surgeon 'cleaned' her abdomen and
removed a large amount of pus but, in the middle of all this, she had
mid trimester abortion and she lost her baby!
Nouf was hysterically crying. "How could she miss my appendicitis,
Dr?" Nouf said, "she destroyed my life. The surgeon told me that this
could have been prevented. He also told me that I might have
developed some adhesions because of the pus which was flooding my
abdomen. I might never get pregnant again".
What are the issues raised by this consultation?
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Student’s Name: ______________________________ Number: ________________
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Student’s Name: ______________________________ Number: ________________
Case 4
Salma a 42-year-old lady newly diagnosed as hypertensive with an average blood
pressure reading of 148/98. Her physical examination and routine investigations
were normal. Her cardiovascular risk assessment was low. Her BMI = 27 Kg/m2 she
is non-smoker and works as a Secretary in a school.
Enumerate how would you proceed in educating this patient about nonpharmacological treatment?
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