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MCQs Techniques

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MCQs Techniques

  1. 1. Fayza Rayes MBBCh. MSc. MRCGP Consultant Family Physician Joint Program of Family & Community Medicine, Jeddah www.fayzarayes.com
  2. 2. Objectives: 1. Improving your out come from studding 2. Improving your technique in answering MCQs
  3. 3. Introduction: 1. Do you follow any techniques while studying from MCQ book 2. Do you follow any techniques while answering MCQs questions
  4. 4. Contents:  10 tips in studying for MCQs exam  10 tips in answering MCQs  Answering 45 MCQs
  5. 5. 10 Tips in studying MCQs: 1. Write your studying plan 2. Study in a group 3. Answering one MCQ is an opportunity to review lots of knowledge . Make sure to get the maximum from every single MCQ . Read the explanation and review the related topic 4. Write a short abstract about each important topic 5. Write table to compare between similar diseases 6. Be specific in your information and extra specific
  6. 6. How can you benefit from this information ?
  7. 7. 10 Tips in studying MCQs: 7. Concentrate on important topics in family medicine e.g.:  Children growth and development  Vaccination  Presentation of common diseases special patients. e.g. appendicitis in very young and in very elderly patients  Prescribing skills of antibiotics and psychotropic medications
  8. 8. 10 Tips in studying MCQs: 8. To improve your mental fitness, periodically take mock exam, start by 10 questions then increase it gradually till you take full mock exam (100-150 MCQs in 2-3 hours continuously) 9. Revise your mistake periodically (some mistakes are false believes… like delusion very difficult to correct ) 10. Just before the exam, you need at least 2-3 weeks for revision (revise your mistakes , read your personal abstracts )
  9. 9. Correction of false believes: Do you have any strategy?? 1. Writing summaries 2. Teaching others the new information 3. Reminding cards 4. …….
  10. 10. How to write your valuable summery 1. Typical presentation of the disease 2. Pathognomonic features 3. Areas of similarity and areas of difference from other differential diagnosis (to make the question difficult) 4. Initial investigation (cost effectiveness and sensitivity) 5. Diagnostic test (more specific) 6. Initial management (non-pharmacological + or -) 7. Most effective management (It could be costly , it could have more side effect) 8. New update ??!!
  11. 11. 10 Tips in answering MCQs: 1. Pay attention to the key words 2. When you chose an answer make sure the stem of the MCQ and the answer you have chosen are grammatically correct If you are not sure of the answer make intelligent guising: 3. Find your correct answer by process of exclusion:  First delete the apparently incorrect answer  Any answer partially incorrect delete it from your choices  If two choices are similar both are incorrect  If two choices are opposite to each other , one of them is the correct answer  If one choice is different from the rest, consider it the right answer
  12. 12. 10 Tips in answering MCQs: 4. Some MCQs ask about number . Learn how to deal with numbers  Arrange the answers in order – lowest->> highest  Eliminate the lowest and highest number  Go with the general theme of family medicine practice  Chose the meaningful number 5. In general, respect your logical thinking & your clinical experience
  13. 13. 10 Tips in answering MCQs: Examples logical thinking:  Smoking is a risk factors of nearly any health problem  Old medications have more side effects than new medications  In general drug with less side effect are with weaker effect, and the vise versa  To change to any new intervention (drug, procedure, investigation or vaccine …) the effect of the new intervention must be the same or better effects and with less side effects
  14. 14. 10 Tips in answering MCQs: 6. In controversial issues, respect what you can remember from your MCQs reference books 7. Don’t postponed writing in the answer sheet till near the end of the exam time 8. Don’t hand over your paper early . Use your time fully 9. Near the end of exam time, you need 5-10 minutes for revision to avoid stupid mistake 10. Do not change any answer unless you are 100% sure that your first choice was wrong
  15. 15. A 6-month-old infant is brought into your office by his mother. She presents with 2-day history of wheezing, a mild fever (38.5°C), and rhinorrhea. The child has no known allergies but there is a history of allergies in the family. On examination, the child’s respiratory rate is 60/minute. There is rhonchi and moist rales heard throughout the chest. The chest x-ray shows evidence of hyperaeration. The most likely diagnosis in the child is: A. Mycoplasma pneumoniae infection B. Allergic bronchitis C. Viral tracheitis D. Bacterial tracheitis E. Bronchiolitis .1
  16. 16. Key words: A 6-month-old infant is brought into your office by his mother. She presents with 2-day history of wheezing, a mild fever (38.5°C), and rhinorrhea. The child has no known allergies but there is a history of allergies in the family. On examination, the child’s respiratory rate is 60/minute. There is rhonchi and moist rales heard throughout the chest. The chest x- ray shows evidence of hyperaeration.
  17. 17. A 6-month-old infant is brought into your office by his mother. She presents with 2-day history of wheezing, a mild fever (38.5°C), and rhinorrhea. The child has no known allergies but there is a history of allergies in the family. On examination, the child’s respiratory rate is 60/minute. There is rhonchi and moist rales heard throughout the chest. The chest x-ray shows evidence of hyperaeration. The most likely diagnosis in the child is: A. Mycoplasma pneumoniae infection B. Allergic bronchitis C. Viral tracheitis D. Bacterial tracheitis E. Bronchiolitis
  18. 18.  Bronchiolitis (RSV) In most “typical” kids, this virus is what most parents consider “just a cold,” but it has the potential to become serious, so here’s what you should know  Symptoms: Runny nose, fever, cough, wheezing with breathing, irritability, & loss of appetite.  Treatment  Mild symptoms are treated with rest, fluids, and a cool air humidifier.  Babies who are struggling to breath may hospitalized and given supplemental humidified oxygen. Their breathing will be monitored and if necessary fluids will be given intravenously to prevent dehydration.  Occasionally infants need mechanical ventilation to fill and empty the lungs until the airways open. 1. Example of Quick Revision Bronchiolitis in infants
  19. 19. 2. Example of Quicker Revision
  20. 20. 1. Infants 2. Wheezing 3. Rhonchi and moist rales 4. Respiratory syncytial virus 5. Cold, humidified, oxygen 3. Example of Abstracts Bronchiolitis in infants
  21. 21. A 5-year-old child is brought to the ER with his mother. The mother tells you that for the past 24 hours the child bas been “talking strangely” and drooling. He has had no appetite and has not been drinking. Based on this history, what is the diagnosis of major concern? A. Viral pneumonia B. Acute epiglottis C. Bronchiolitis D. Croup E. Bacterial pneumonia .2
  22. 22. A 5-year-old child is brought to the ER with his mother. The mother tells you that for the past 24 hours the child bas been “talking strangely” and drooling. He has had no appetite and has not been drinking. Based on this history, what is the diagnosis of major concern? A. Viral pneumonia B. Acute epiglottis C. Bronchiolitis D. Croup E. Bacterial pneumonia
  23. 23. 1. Example of Quick Revision
  24. 24. 2. Example of Quicker Revision
  25. 25. Epiglottitis:
  26. 26. 1. ER 2. Delusion “talking strangely” 3. Drooling 4. A lateral x-ray of the neck 5. IV/IM ceftriaxone Epiglottitis: 3. Example of Abstracts
  27. 27. An 18-month-old infant is brought to the ER by his mother. He developed an upper respirator tract infection 2 days ago and suddenly this evening developed a harsh, barky cough and difficulty breathing. On examination the child is coughing. His respiratory rate is 40/minute and he is in some respiratory distress. The breath sounds that are heard appear to be transmitted from the upper airway. There are nasal flaring and suprasternal, infrasternal, and intercostals retractions. The child’s temperature is 38.5°C.
  28. 28. What is the most likely diagnosis in this child? A. Viral pneumonia B. Acute epiglottis C. Bronchiolitis D. Croup E. Bacterial pneumonia .3
  29. 29. What is the most likely diagnosis in this child? A. Viral pneumonia - LRTI B. Acute epiglottis - LRTI C. Bronchiolitis - LRTI D. Croup - URTI E. Bacterial pneumonia - LRTI
  30. 30. Acute Larynotracheitis (Viral Croup) Differential Diagnosis: The differential diagnosis of viral croup includes epiglottitis, foreign body, and angioneurotic edema. Symptoms: Barking cough – especially at night; high pitched whistling noise with inhalation (stridor); runny nose; fever. Management: Most children with croup do not require hospitalization. Treatment at home consists of air humidification, avoidance of agitation, and reduction of fever If signs of severe obstruction develop, treatment with an aerosol of racemic epinephrine (2.25%), nebulized with 100% oxygen, frequently provides relief. Frequent aerosol treatments may be needed for the first few hours. A single parenteral dose of dexamethasone, 0.6 mg/kg, is effective in decreasing the length and severity of respiratory symptoms that are associated with viral croup. Inhaled corticosteroid therapy has also been used with some success, but parenteral dexamethasone is somewhat easier. Intubation or tracheostomy rarely is necessary. 1. Example of Quick Revision
  31. 31. A systematic review of clinical trials confirmed the observations that nebulised adrenaline produces immediate and often dramatic improvements in reducing the signs of airway obstruction in severe croup. Acute Larynotracheitis (Viral Croup) 2. Update & EBM
  32. 32. 1. Early childhood 2. ER 3. Harsh, barky cough 4. Respiratory distress 5. Parainfluenza virus 6. Aerosolized steroids 7. Nebulised adrenaline Acute Larynotracheitis (Viral Croup) 3. Example of Abstracts
  33. 33. Tips in studying MCQs:  Answering one MCQ is an opportunity to review lots of knowledge . Make sure to get the maximum from every single MCQ . Read the explanation and review the related topic  Write a short abstract about each important topic A. Write pathognomonic features B. Write Update information C. Write controversial issues AND stick to your NOTES  To master clear differentiation make comparisons between similar issues
  34. 34. A 25-year-old college student presents with a 3-week history of fatigue, malaise, fever, chills, and sore throat. On physical examination, the patient has a temperature of 39°C. There is pharyngeal hyperemia and edema and marked exudates are seen in both tonsillar areas. There is significant cervical lymphadenopathy present. You suspect infectious mononucleosis. Of the following clinical features of acute infectious mononucleosis, the least common is: A. Splenomegaly B. Hepatomegaly C. Fever D. Exudative tonsillitis E. Generalized lymphadenopathy .4
  35. 35. Key words A 25-year-old college student presents with a 3-week history of fatigue, malaise, fever, chills, and sore throat. On physical examination, the patient has a temperature of 39°C. There is pharyngeal hyperemia and edema and marked exudates are seen in both tonsillar areas. There is significant cervical lymphadenopathy present. You suspect infectious mononucleosis. Of the following clinical features of acute infectious mononucleosis, the least common is: A. Splenomegaly – (30-45%) B. Hepatomegaly – (Impaired LFTs --30% of the patients) C. Fever - 85% D. Exudative tonsillitis – 60% E. Generalized lymphadenopathy – 85%
  36. 36. Breast Cancer A 41-year-old woman comes to your office after finding a breast lump during a routine self-examination. She has been examining her breasts regularly for the past 5 years; this is the first lump she has found. On examination, there is a lump located in the right breast. The lump’s anatomic location is in the upper outer quadrant. It is approximately 3 cm in diameter and is not fixed to skin or muscle. It has a hard consistency. There are three axillary nodes present on the right side; each node is approximately 1 cm in diameter. No lymph nodes are present on the left. At this time, what would you do? A. tell the patient that she has fibrocystic breast disease; ask her to return in 1 month, preferably 10 days after the next period, for a recheck B tell the patient to come back for a breast examination in 6 months C. order mammogram D. order an ultrasound examination of the area E. arrange for urgent fine-needle biopsy .5
  37. 37. Breast Cancer A 41-year-old woman comes to your office after finding a breast lump during a routine self-examination. She has been examining her breasts regularly for the past 5 years; this is the first lump she has found. On examination, there is a lump located in the right breast. The lump’s anatomic location is in the upper outer quadrant. It is approximately 3 cm in diameter and is not fixed to skin or muscle. It has a hard consistency. There are three axillary nodes present on the right side; each node is approximately 1 cm in diameter. No lymph nodes are present on the left. At this time, what would you do? A. tell the patient that she has fibrocystic breast disease; ask her to return in 1 month, preferably 10 days after the next period, for a recheck B tell the patient to come back for a breast examination in 6 months C. order mammogram D. order an ultrasound examination of the area E. arrange for urgent fine-needle biopsy
  38. 38. What do we mean by being specific?! General information X Detailed information
  39. 39. What do we mean by being specific?! General information X Detailed information This is general information
  40. 40. What do we mean by being specific?! General information X Detailed information This is detailed information
  41. 41. Tips in studying MCQs:  Be specific in your information  And be extra specific and meticulous
  42. 42. Immune-deficient Child Which one of the following vaccine must not be given to a household contact of an immune-deficient child? A. Mumps, measles and rubella. B. BCG C. Influenza vaccine D. Oral polio vaccine E. Hepatitis B vaccine .6
  43. 43. Immune-deficient Child Which one of the following vaccine must not be given to a household contact of an immune-deficient child? A. Mumps, measles and rubella. B. BCG C. Influenza vaccine D. Oral polio vaccine E. Hepatitis B vaccine
  44. 44. Breast Feeding Which of the following statements about breast-feeding is true? A) The infant should feed on each side for 8 to 15 minutes every 2 to 3 hours after birth. B) Colostrum is excreted 7 to 10 days after delivery and contains important antibodies, high calories, and other nutrients. C) The mother should weigh infants before and after feeding to quantify the amount consumed. D) Breast-feeding usually provides adequate nutrition for 2 to 4 months—supplementation should begin at that point. E) Breast-feeding should be based on timed intervals rather than on demand. .7
  45. 45. Breast Feeding Which of the following statements about breast-feeding is true? A) The infant should feed on each side for 8 to 15 minutes every 2 to 3 hours after birth. B) Colostrum is excreted 7 to 10 days after delivery and contains important antibodies, high calories, and other nutrients. C) The mother should weigh infants before and after feeding to quantify the amount consumed. D) Breast-feeding usually provides adequate nutrition for 2 to 4 months—supplementation should begin at that point. E) Breast-feeding should be based on timed intervals rather than on demand. The answer is A. Breast-feeding is encouraged for all mothers . Currently, as many as 50% of mothers.
  46. 46. Growth & Development An 8-month-old infant is brought to the emergency department by his mother for an assessment of an upper respiratory tract infection. He has been coughing for the past 3 days and has had a runny nose. On examination, his temperature is 37.5°C. His weight is below the 3rd percentile for his age, his length is at the 25th percentile, and his head circumference is at the 50th percentile. He appears malnourished and has thin extremities, a narrow face, prominent ribs, and wasted buttocks. He has a prominent diaper rash, unwashed skin, a skin rash that resembles the skin infection impetigo contagious on his face, uncut fingernails, and dirty clothing.  What is the most likely cause of this child’s condition?  a. maternal deprivation  b. cystic fibrosis  c. constitutionally small for age  d. infantile autism  e. congenital bilateral sensorineural hearing loss .8
  47. 47. Growth & Development An 8-month-old infant is brought to the emergency department by his mother for an assessment of an upper respiratory tract infection. He has been coughing for the past 3 days and has had a runny nose. On examination, his temperature is 37.5°C. His weight is below the 3rd percentile for his age, his length is at the 25th percentile, and his head circumference is at the 50th percentile. He appears malnourished and has thin extremities, a narrow face, prominent ribs, and wasted buttocks. He has a prominent diaper rash, unwashed skin, a skin rash that resembles the skin infection impetigo contagiosum on his face, uncut fingernails, and dirty clothing.  What is the most likely cause of this child’s condition?  a. maternal deprivation  b. cystic fibrosis  c. constitutionally small for age  d. infantile autism  e. congenital bilateral sensorineural hearing loss
  48. 48. Growth & Development Bone age can sometimes be used to differentiate certain causes of short stature in children. With respect to bone age, which of the following statements is true? A. bone age is normal in both familial short stature and constitutional delay of growth B. bone age is normal in familial short stature and delayed in constitutional delay of growth C. bone age is normal in constitutional delay of growth and delayed in growth hormone deficiency D. bone age is delayed in both familial short stature and short stature caused by hypothyroidism E. bone age is variable and cannot be used to differentiate familial short stature and constitutional delay .9
  49. 49. Growth & Development Bone age can sometimes be used to differentiate certain causes of short stature in children. With respect to bone age, which of the following statements is true? A. bone age is normal in both familial short stature and constitutional delay of growth B. bone age is normal in familial short stature and delayed in constitutional delay of growth C. bone age is normal in constitutional delay of growth and delayed in growth hormone deficiency D. bone age is delayed in both familial short stature and short stature caused by hypothyroidism E. bone age is variable and cannot be used to differentiate familial short stature and constitutional delay
  50. 50. Teeth Eruption A 9-month-old boy brought by his mother to see you in the clinic. Her main concern that her son did not have teeth eruption till now. He is developmentally normal. His height and weight are normal. What will be your advice to her? A. Tell her don't worry except after 1 month. B. It is not unusual for the first deciduous teeth to erupt before 12 months. C. Investigate for hypothyroidism. D. Do roentgenogram for mandible and maxillary X ray. E. Tell her that because her son have a nails, so he will also have teeth eruption. .10
  51. 51. Teeth Eruption A 9-month-old boy brought by his mother to see you in the clinic. Her main concern that her son did not have teeth eruption till now. He is developmentally normal. His height and weight are normal. What will be your advice to her? A. Tell her don't worry except after 1 month. B. It is not unusual for the first deciduous teeth to erupt before 12 months. C. Investigate for hypothyroidism. D. Do roentgenogram for mandible and maxillary X ray. E. Tell her that because her son have a nails, so he will also have teeth eruption.
  52. 52. Visual Screening Which statement regarding visual screening in children is correct? A. Visual screening is not indicated until age 5. B. Visual acuity can be assessed by the Random Dot E test. C. Stereopsis can be measured by the Tumbling E test. D. Strabismus can be assessed with the cover test during the first year of life. E. Visual screening can be reliably assessed at age 2. .11
  53. 53. Visual Screening Which statement regarding visual screening in children is correct? A. Visual screening is not indicated until age 5. B. Visual acuity can be assessed by the Random Dot E test. C. Stereopsis can be measured by the Tumbling E test. D. Strabismus can be assessed with the cover test during the first year of life. E. Visual screening can be reliably assessed at age 2.
  54. 54. Influenza Vaccination Which one of the following patients should not receive an influenza vaccination? A. A 36-year-old pregnant woman at 12 weeks' gestation. B. A 65-year-old man with diabetes mellitus. C. A 28-year-old man with HIV infection. D. A 54-year-old woman who is allergic to eggs. E. A six-year-old girl who lives with a grandmother who has terminal cancer. .12
  55. 55. Influenza Vaccination Which one of the following patients should not receive an influenza vaccination? A. A 36-year-old pregnant woman at 12 weeks' gestation. B. A 65-year-old man with diabetes mellitus. C. A 28-year-old man with HIV infection. D. A 54-year-old woman who is allergic to eggs. E. A six-year-old girl who lives with a grandmother who has terminal cancer. Chose the different
  56. 56. Knowledge of Vaccination A 68-year-old patient is seen for a general examination. Current recommendations for immunizations include A. tetanus booster every 5 years B. influenza vaccination yearly C. pneumococcal vaccination yearly D. hepatitis booster every 5 years E. meningococcal vaccination .13
  57. 57. Knowledge of Vaccination A 68-year-old patient is seen for a general examination. Current recommendations for immunizations include A. tetanus booster every 5 years B. influenza vaccination yearly C. pneumococcal vaccination yearly D. hepatitis booster every 5 years E. meningococcal vaccination
  58. 58. Tips in studying MCQs:  Concentrate on important topics in family medicine e.g.:  Children growth and development  Breast feeding  Vaccination  Presentation of common diseases special patients. e.g. appendicitis in very young and in very elderly patients You will be asked in this topics in any FM exam
  59. 59. Forgetfulness A 57-year-old male has become forgetful, preoccupied, withdrawn and suspicious. His physical examination was normal. The patient has been with his company for 22 years and was considered an excellent employee. Which of the following is most likely diagnosis? A. Multi-infarct dementia. B. Depression. C. Vascular dementia D. Alcoholism. E. Alzheimer .14
  60. 60. Forgetfulness A 57-year-old male has become forgetful, preoccupied, withdrawn and suspicious. His physical examination was normal. The patient has been with his company for 22 years and was considered an excellent employee. Which of the following is most likely diagnosis? A. Multi-infarct dementia. B. Depression. C. Vascular dementia D. Alcoholism. E. Alzheimer
  61. 61. Tips in answering MCQs: If you are not sure of the answer make inelegant guising: Find your correct answer by process of exclusion:  First delete the apparently incorrect newer  If two choices are similar both are incorrect
  62. 62. Post MI Medications Which of the following improve survival after myocardial infarction in hypertensive patient? A. Nitrate. B. Morphine. C. ACE inhibitors. D. Calcium channel blockers. E. Aspirin. .15
  63. 63. Post MI Medications Which of the following improve survival after myocardial infarction in hypertensive patient? A. Nitrate. B. Morphine. C. ACE inhibitors. D. Calcium channel blockers. E. Aspirin.
  64. 64. H. Pylori Testing .16 Which of the following types of H. pylori testing is not useful to confirm eradication? A. stool antigen test B. urea breath test C. enzyme-linked immunosorbent assay (ELISA) D. Serology culture E. Steiner stain of gastric biopsy specimen
  65. 65. H. Pylori Testing Which of the following types of H. pylori testing is not useful to confirm eradication? A. stool antigen test B. urea breath test C. enzyme-linked immunosorbent assay (ELISA) D. Serology culture E. Steiner stain of gastric biopsy specimen
  66. 66. Gout Which one of these drug is not associated with gout? A. Diuretics B. Digoxin C. Niacin (vitamin B3) D. Aspirin E. Cyclosporine (Immunosuppressive) .17
  67. 67. Gout Which one of these drug is not associated with gout? A. Diuretics B. Digoxin C. Niacin (vitamin B3) D. Aspirin E. Cyclosporine (Immunosuppressive)
  68. 68. Vague Chest Pain  A 35-year-old male consults you about vague chest pain he developed while sitting at his desk earlier in the day. The pain is right-sided and was sharp for a brief time when it began, but it rapidly subsided. There was no hemoptysis and the pain does not seem pleuritic. His physical examination, EKG, and oxygen saturation are unremarkable. A chest film shows a 10% right pneumothorax. Which one of the following should you do next? A. Admit the patient to the hospital for observation. B. Admit the patient to the hospital for chest tube placement. C. Obtain a repeat chest radiograph in 24–48 hours. D. Obtain an expiratory chest radiograph. E. Reassure the patient and do nothing .18
  69. 69. Vague Chest Pain  A 35-year-old male consults you about vague chest pain he developed while sitting at his desk earlier in the day. The pain is right-sided and was sharp for a brief time when it began, but it rapidly subsided. There was no hemoptysis and the pain does not seem pleuritic. His physical examination, EKG, and oxygen saturation are unremarkable. A chest film shows a 10% right pneumothorax. Which one of the following should you do next? A. Admit the patient to the hospital for observation. B. Admit the patient to the hospital for chest tube placement. C. Obtain a repeat chest radiograph in 24–48 hours. D. Obtain an expiratory chest radiograph. E. Reassure the patient and do nothing
  70. 70. Fatigue and Weakness A 60-year-old man is being evaluated for fatigue, weakness, and exercise intolerance. Laboratory assessment reveals: Hemoglobin: 9.1 mg/dL (L) Serum iron: 46 μg/dL (L) Ferritin: 9 ng/mL (L) Total iron binding capacity (TIBC): 626 μg/dL (H) Mean corpuscular volume (MCV): 76 fL (L) What is the most common cause of this condition? A. Blood loss B. Poor nutrition C. Inadequate absorption of iron D. Chronic disease E. Folic acid deficiency .19
  71. 71. Fatigue and Weakness A 60-year-old man is being evaluated for fatigue, weakness, and exercise intolerance. Laboratory assessment reveals: Hemoglobin: 9.1 mg/dL (L) Serum iron: 46 μg/dL (L) Ferritin: 9 ng/mL (L) Total iron binding capacity (TIBC): 626 μg/dL (H) Mean corpuscular volume (MCV): 76 fL (L) What is the most common cause of this condition? A. Blood loss B. b. Poor nutrition C. c. Inadequate absorption of iron D. d. Chronic disease E. e. Folic acid deficiency
  72. 72. Liver Disease with Cirrhosis  You are seeing a patient who has end-stage liver disease with cirrhosis due to hepatitis C. What will be her most likely cause of death? A. Liver failure. B. Myocardial infarction. C. Bleeding varices. D. Hepatocellular carcinoma. E. Renal failure. .20
  73. 73. Liver Disease with Cirrhosis  You are seeing a patient who has end-stage liver disease with cirrhosis due to hepatitis C. What will be her most likely cause of death? A. Liver failure. B. Myocardial infarction. C. Bleeding varices. D. Hepatocellular carcinoma. E. Renal failure. The main causes of 436 deaths among 532 patients with cirrhosis followed up for up to 16 years constituted liver failure (24%), liver failure with gastrointestinal bleeding (13%), gastrointestinal bleeding (14%) i.e. bleeding ±hepatic failure (27%), primary liver cell carcinoma (4%), other liver-related causes (2%), infections (7%), cardiovascular diseases (22%), extra hepatic malignancies (9%), and other non-liver-related causes (5%). Totally, 57% died of liver-related causes .20
  74. 74. Liver Disease with Cirrhosis  You are seeing a patient who has end-stage liver disease with cirrhosis due to hepatitis C. What will be her most likely cause of death? A. Liver failure. B. Myocardial infarction. C. Bleeding varices. D. Hepatocellular carcinoma. E. Renal failure. The main causes of 436 deaths among 532 patients with cirrhosis followed up for up to 16 years constituted liver failure (24%), liver failure with gastrointestinal bleeding (13%), gastrointestinal bleeding (14%) i.e. bleeding ±hepatic failure (27%), primary liver cell carcinoma (4%), other liver-related causes (2%), infections (7%), cardiovascular diseases (22%), extra hepatic malignancies (9%), and other non-liver-related causes (5%). Totally, 57% died of liver-related causes
  75. 75. Prostate Cancer The best management of localized, well-differentiated prostate cancer in men older than 65 is: A. Radiation implants. B. External beam radiation therapy. C. Watchful waiting. D. Primary androgen deprivation therapy. E. Robot-assisted prostatectomy. .21
  76. 76. Prostate Cancer The best management of localized, well-differentiated prostate cancer in men older than 65 is: A. Radiation implants. B. External beam radiation therapy. C. Watchful waiting. D. Primary androgen deprivation therapy. E. Robot-assisted prostatectomy.
  77. 77. Tips in studying MCQs:  Be specific in your information  And be extra specific and meticulous
  78. 78. AAA Which one of the following is the greatest risk factor for abdominal aortic aneurysm (AAA)? A. Cigarette smoking. B. Diabetes mellitus. C. Hypertension. D. African-American race. E. Female gender. .22
  79. 79. AAA Which one of the following is the greatest risk factor for abdominal aortic aneurysm (AAA)? A. Cigarette smoking. B. Diabetes mellitus. C. Hypertension. D. African-American race. E. Female gender.
  80. 80. Abdominal Aortic Aneurysm (AAA)  In the UK the rate of Abdominal Aortic Aneurism (AAA) in Caucasian men older than 65 years is about 4.7%  The peak incidence is among males around 70 years of age, the prevalence among males over 60 years totals 2- 6%.  In the U.S. the incidence of AAA is 2-4% in the adult population.  AAA is 4-6 times more common in male siblings of known patients, with a risk of 20-30%.  Rupture of the AAA occurs in 1-3% of men aged 65 or more, the mortality is 70-95%.
  81. 81. Smoking & AAA
  82. 82. Cervical Cancer Which of the following statements regarding cervical cancer screening is true? A. The death rate from cervical cancer continues to increase despite Pap smear screening. B. Immunosuppression has not been identified as a risk factor for cervical cancer. C. Human papillomavirus (HPV) types 1 and 3 are most closely linked to cervical cancer. D. Smoking has been linked to the development of cervical cancer. E. Most cases of cervical cancer occur between the ages of 20 and 30 years. .23
  83. 83. Cervical Cancer Which of the following statements regarding cervical cancer screening is true? A. The death rate from cervical cancer continues to increase despite Pap smear screening. B. Immunosuppression has not been identified as a risk factor for cervical cancer. C. Human papillomavirus (HPV) types 1 and 3 are most closely linked to cervical cancer. D. Smoking has been linked to the development of cervical cancer. E. Most cases of cervical cancer occur between the ages of 20 and 30 years.  The answer is D.  Tip: Smoking always the first to blame
  84. 84. Tips in answering MCQs: Examples logical thinking: Smoking is the first to blame … Smoking is “ criminal ”
  85. 85. Smoking Risks
  86. 86.  In the British Journal of Psychiatry, the researchers wrote, “The best-fitting causal model was one in which nicotine dependence led to increased risk of depression.” They suggest two possible routes, one involving common risk factors, and the second a direct causal link.  According to the researchers, “this evidence is consistent with the conclusion that there is a cause and effect relationship between smoking and depression in which cigarette smoking increases the risk of symptoms of depression.”  http://psychcentral.com/lib/can-smoking-cause-depression/0007153 Smoking and Depression
  87. 87. Smoking Which of the following conditions is NOT associated with smoking? A. Peptic ulcer disease B. Depression C. Children of smokers are at increased risk for otitis media D. Osteoporosis E. Cervical cancer .24
  88. 88. Smoking Which of the following conditions is NOT associated with smoking? A. Peptic ulcer disease B. Depression C. Children of smokers are at increased risk for otitis media D. Osteoporosis E. Cervical cancer
  89. 89. Tips in answering MCQs:  In general, respect your clinical experience  In controversial issues, respect what you can remember from your MCQs reference books
  90. 90. Hepatitis C & Brest Milk Which of the following statements is correct concerning hepatitis C virus (HCV)? A. There is no risk to infants if the mother is affected. B. There is no risk associated with sexual intercourse with an individual with hepatitis C. C. Cesarean section should be performed on mothers who test positive for hepatitis C to prevent transmission to the newborn. D. Hepatitis C can be spread by contaminated water supplies. E. Hepatitis C does not appear to be transmitted in breast milk. .25
  91. 91. Hepatitis C & Brest Milk Which of the following statements is correct concerning hepatitis C virus (HCV)? A. There is no risk to infants if the mother is affected. B. There is no risk associated with sexual intercourse with an individual with hepatitis C. C. Cesarean section should be performed on mothers who test positive for hepatitis C to prevent transmission to the newborn. D. Hepatitis C can be spread by contaminated water supplies. E. Hepatitis C does not appear to be transmitted in breast milk.
  92. 92. 1. Learn to write very clear message to correct any false believes in your MCQs Knowledge 2. It is more helpful if you add new relevant information to maximize your benefit from MCQs studying
  93. 93. Tips in studying MCQs:  Answering one MCQ is an opportunity to review lots of knowledge . Make sure to get the maximum from every single MCQ . Read the explanation and review the related topic  Write a short abstract about each important topic
  94. 94. Headache Red Flags Each of the following is a solid indication for neuroimaging in a patient with headache except: A. Onset of headaches over the age of 50 years B. Seizures associated C. Prolonged aura D. Nausea and vomiting E. Headache worsening with movement .26
  95. 95. Headache Red Flags Each of the following is a solid indication for neuroimaging in a patient with headache except: A. Onset of headaches over the age of 50 years B. Seizures associated C. Prolonged aura D. Nausea and vomiting E. Headache worsening with movement
  96. 96. Head Lice Which of the following is true regarding management of head lice? A. Children should be kept out of school until no visible evidence of nits is noted. B. Household members should only be treated if live lice or eggs are noted within 1 cm of the scalp. C. Head lice programs have had a significant impact on lowering the incidence of head lice. D. Cleaning of bedding has little impact on lice eradication. E. The health of those exposed is more important than the confidentiality of the child affected. .27
  97. 97. Head Lice Which of the following is true regarding management of head lice? A. Children should be kept out of school until no visible evidence of nits is noted. B. Household members should only be treated if live lice or eggs are noted within 1 cm of the scalp. C. Head lice programs have had a significant impact on lowering the incidence of head lice. D. Cleaning of bedding has little impact on lice eradication. E. The health of those exposed is more important than the confidentiality of the child affected. The answer is B. Practice guidelines published by the American Academy of Pediatrics (AAP) state that if a case of head lice is identified, all household members should be checked, and only those with live lice or eggs within 1 cm of the scalp should be treated. It is recommended to treat family members who share a bed with the person who is infected
  98. 98. Tips in answering MCQs:  In general, respect your clinical experience  If your clinical practice is different than MCQ correct answer according to the reference book . Go with the book
  99. 99. Number Technique Before the diagnosis of post-traumatic stress disorder (PTSD) is made, symptoms should be present for at least A. 1 year B. 6 months C. 3 months D. 1 month E. 1 week .28
  100. 100. Number Technique Before the diagnosis of post-traumatic stress disorder (PTSD) is made, symptoms should be present for at least A. 1 year B. 6 months C. 3 months D. 1 month E. 1 week
  101. 101. Number /Anorexia Nervosa In young women with an eating disorder, at what point would you expect her menstrual periods to resume? A. 75% of ideal body weight B. 80% of ideal body weight C. 90% of ideal body weight D. 100% of body weight E. It is unusual for menstrual cycles to resume with any weight gain. .29
  102. 102. Number /Anorexia Nervosa In young women with an eating disorder, at what point would you expect her menstrual periods to resume? A. 75% of ideal body weight B. 80% of ideal body weight C. 90% of ideal body weight D. 100% of body weight E. It is unusual for menstrual cycles to resume with any weight gain.
  103. 103. In a healthy patient, what is the appropriate age to administer Pneumococcal vaccine? A. 50 years B. 5 years C. 75 years D. 16 years E. 65 years .30
  104. 104. In a healthy patient, what is the appropriate age to administer Pneumococcal vaccine? A. 5 years B. 16 years C. 50 years D. 65 years E. 75 years
  105. 105. Tips in answering MCQs: Some MCQs ask about number . Learn how to deal with numbers  Arrange the answers in order – lowest->> highest  Eliminate the lowest and highest number  Go with the general theme of family medicine practice  Chose the meaningful number
  106. 106. Use of Antibiotics Which one of the following is appropriate and effective treatment for genitourinary gonorrhea in a 20-year-old male with a purulent urethral discharge? A. Amoxicillin, 3.5 g orally once. B. Ciprofloxacin, 500 mg orally once. C. Ceftriaxone, 125 mg intramuscularly once. D. Doxycycline, 100 mg 2 times daily for 3 days. E. Erythromycin, 500 mg 4 times daily for 7 days. .31
  107. 107. Use of Antibiotics Which one of the following is appropriate and effective treatment for genitourinary gonorrhea in a 20-year-old male with a purulent urethral discharge? A. Amoxicillin, 3.5 g orally once. B. Ciprofloxacin, 500 mg orally once. C. Ceftriaxone, 125 mg intramuscularly once. D. Doxycycline, 100 mg 2 times daily for 3 days. E. Erythromycin, 500 mg 4 times daily for 7 days.
  108. 108. Use of Antibiotics Of the following antibiotics, which one would be acceptable to use when treating penicillin-resistant S. pneumoniae otitis media? A. Azithromycin B. Clarithromycin C. Cefuroxime D. Cefaclor E. Cephalexin .32
  109. 109. Use of Antibiotics Of the following antibiotics, which one would be acceptable to use when treating penicillin-resistant S. pneumoniae otitis media? A. Azithromycin B. Clarithromycin C. Cefuroxime D. Cefaclor E. Cephalexin Only five antibiotics—high-dose amoxicillin (80 mg/kg/day), amoxicillin–clavulanate (Augmentin), cefuroxime (Ceftin), cefprozil (Cefzil), and ceftriaxone (Rocephin)—have demonstrated a modest degree (60% to 80%) of clinical efficacy in the treatment of acute otitis media caused by penicillin-resistant S. pneumoniae.
  110. 110. Antibiotics An 18-year-old woman presents with swelling, warmth, and spreading redness at the upper part of her ear, where she recently underwent an ear piercing. Appropriate antibiotic coverage includes A. cephalexin B. ciprofloxacin C. azithromycin D. penicillin E. tetracycline .33
  111. 111. Antibiotics An 18-year-old woman presents with swelling, warmth, and spreading redness at the upper part of her ear, where she recently underwent an ear piercing. Appropriate antibiotic coverage includes A. cephalexin B. ciprofloxacin C. azithromycin D. penicillin E. tetracycline
  112. 112. Depression A 14-year-old girl is diagnosed with major depressive disorder. It is her first episode and the clinical assessment is that it is mild depression. Which one of the following treatment choices is appropriate? A. Tricyclic antidepressant.. B. SSRI. C. St. John's wart. D. Cognitive-behavioral therapy. E. Lithium. .34
  113. 113. Depression A 14-year-old girl is diagnosed with major depressive disorder. It is her first episode and the clinical assessment is that it is mild depression. Which one of the following treatment choices is appropriate? A. Tricyclic antidepressant.. B. SSRI. C. St. John's wart. D. Cognitive-behavioral therapy. E. Lithium.
  114. 114. Alcoholism management  A 56-year-old business executive with a history of alcoholism and associated liver disease presents to your office and would like to stop drinking. In order to prevent alcohol withdrawal, you select which of the following medications? A. Lorazepam B. Clonazepam C. Diazepam D. Flurazepam E. Buspirone .35
  115. 115. Alcoholism management  A 56-year-old business executive with a history of alcoholism and associated liver disease presents to your office and would like to stop drinking. In order to prevent alcohol withdrawal, you select which of the following medications? A. Lorazepam B. Clonazepam C. Diazepam D. Flurazepam E. Buspirone
  116. 116. Anti depressant Medications Which of the following medications is least likely to cause sexual side effects? A. Fluoxetine (Prozac) B. Sertraline (Zoloft) C. Venlafaxine (Effexor) D. Citalopram (Celexa) E. Bupropion (Wellbutrin) .36
  117. 117. Anti depressant Medications Which of the following medications is least likely to cause sexual side effects? A. Fluoxetine (Prozac) B. Sertraline (Zoloft) C.Venlafaxine (Effexor) D. Citalopram (Celexa) E. Bupropion (Wellbutrin)
  118. 118. Antidepressant About how many patients in the total treated population respond only partially or don't respond at all to antidepressant monotherapy? A. 5 to 20 percent. B. 10 to 30 percent. C. 20 to 40 percent. D. 30 to 50 percent. E. 40 to 60 percent. .37
  119. 119. Antidepressant About how many patients in the total treated population respond only partially or don't respond at all to antidepressant monotherapy? A. 5 to 20 percent. B. 10 to 30 percent. C. 20 to 40 percent. D. 30 to 50 percent. E. 40 to 60 percent. Placebo effect is up to 60%
  120. 120. About how many patients in the total treated population respond only partially or don't respond at all to antidepressant monotherapy? A. 5 to 20 percent. B. 10 to 30 percent. C. 20 to 40 percent. D. 30 to 50 percent. E. 40 to 60 percent. Placebo effect is up to 60% Antidepressant
  121. 121. Tips in studying MCQs: Concentrate on important topics in family medicine e.g.: Important Medications • Antibiotics • Antidepressant • Other psychotropic medications • Anti epilepsy medications • Anti TB • Anti ulcer medications • Antihypertensive medications • Hypoglycemic medications • Asthma medications
  122. 122. Hepatitis C Infection Which one of the following is the approximate risk that a health care worker will contract hepatitis C infection following a needle stick injury contaminated by blood from a patient testing positive for hepatitis C by polymerase chain reaction? A. 0.6 percent. B. 50 percent. C. 6.1 percent. D. 16 percent. E. 26 percent. .38
  123. 123. Hepatitis C Infection Which one of the following is the approximate risk that a health care worker will contract hepatitis C infection following a needle stick injury contaminated by blood from a patient testing positive for hepatitis C by polymerase chain reaction? A. 0.6 percent. B. 50 percent. C. 6.1 percent. D. 16 percent. E. 26 percent.
  124. 124. Which one of the following is the approximate risk that a health care worker will contract hepatitis C infection following a needle stick injury contaminated by blood from a patient testing positive for hepatitis C by polymerase chain reaction? A. 0.6 percent. B. 50 percent. C. 6.1 percent. D. 16 percent. E. 26 percent. Hepatitis C Infection
  125. 125. Urinary Tract Infections Which one of the following is the most sensitive laboratory indicator for urinary tract infections? A. Pyuria. B. Bacteriuria. C. Leukocyte esterase. D. Increased vaginal pH. E. Urine nitrite. .39
  126. 126. Urinary Tract Infections Which one of the following is the most sensitive laboratory indicator for urinary tract infections? A. Pyuria. B. Bacteriuria. C. Leukocyte esterase. D. Increased vaginal pH. E. Urine nitrite. Respect your practical experience
  127. 127. HIV In which one of the following situations should a health care worker be offered antiretroviral prophylaxis after an occupational exposure to a patient known to be infected with human immunodeficiency virus? A. Urine with no visible blood in it splashed into the worker's eyes. B. Needle-stick injury when recapping a clean needle. C. Intact skin contact with patient's tears. D. Accidental cut from a used sharp instrument. E. Urine with no visible blood in it splashed onto exposed skin. .40
  128. 128. HIV In which one of the following situations should a health care worker be offered antiretroviral prophylaxis after an occupational exposure to a patient known to be infected with human immunodeficiency virus? A. Urine with no visible blood in it splashed into the worker's eyes. B. Needle-stick injury when recapping a clean needle. C. Intact skin contact with patient's tears. D. Accidental cut from a used sharp instrument. E. Urine with no visible blood in it splashed onto exposed skin. Common sense
  129. 129. HIV Infection What is the approximate risk of (HIV) seroconversion after a needle-stick injury when the source patient has documented HIV infection? A. 0.01 to 0.05 percent. B. 0.3 to 0.5 percent. C. 1.0 to 5.0 percent. D. 25 to 30 percent. E. Nearly 100 percent. .41
  130. 130. HIV Infection What is the approximate risk of (HIV) seroconversion after a needle-stick injury when the source patient has documented HIV infection? A. 0.01 to 0.05 percent. B. 0.3 to 0.5 percent. C. 1.0 to 5.0 percent. D. 25 to 30 percent. E. Nearly 100 percent.
  131. 131. Needle Stick injury & Risk to the Health Care Worker  HIV  Hepatitis C  Hepatitis B  0.3 to 0.5 percent  6.1 percent  ….
  132. 132. Tips in studying MCQs: Concentrate on important topics in family medicine e.g.: Important infections  TB  Hepatitis B & C  HIV  Any current epidemic disease TB
  133. 133. Falls In The Elderly Which of the following is responsible for the largest proportion of falls in the elderly? A. Extrinsic (environmental) factors. B. Postural changes. C. Dizziness. D. Gait problems. E. Impaired vision. .42
  134. 134. Falls In The Elderly Which of the following is responsible for the largest proportion of falls in the elderly? A. Extrinsic (environmental) factors. B. Postural changes. C. Dizziness. D. Gait problems. E. Impaired vision. Different
  135. 135. Asymptomatic Bacteriuria Of the following outcomes, which one is associated with antibiotic treatment of asymptomatic bacteriuria in elderly women? A. Prevention of pyelonephritis. B. Prevention of hypertension. C. Sterilization of the urinary tract. D. Emergence of drug-resistant bacterial strains. E. Overall reduction in mortality. .43
  136. 136. Asymptomatic Bacteriuria Of the following outcomes, which one is associated with antibiotic treatment of asymptomatic bacteriuria in elderly women? A. Prevention of pyelonephritis. B. Prevention of hypertension. C. Sterilization of the urinary tract. D. Emergence of drug-resistant bacterial strains. E. Overall reduction in mortality. Different
  137. 137. Tips in answering MCQs: and the answer you have chosen are grammatically correct If you are not sure of the answer make intelligent guising:  If one choice is different from the rest, consider it the right answer
  138. 138. Acellular Pertussis Vaccine Which one of the following statements about the acellular pertussis vaccine is true? A. It is about as effective as the whole-cell vaccine with fewer side effects. B. It is a little less effective than the whole-cell vaccine with fewer side effects. C. It is as effective as the whole-cell vaccine but does not show an appreciable difference in side effects. D. It is less effective than the whole-cell vaccine with no significant difference in side effects. E. It is less effective than the whole-cell vaccine with more side effects. .44
  139. 139. Which one of the following statements about the acellular pertussis vaccine is true? A. It is about as effective as the whole-cell vaccine with fewer side effects. B. It is a little less effective than the whole-cell vaccine with fewer side effects. C. It is as effective as the whole-cell vaccine but does not show an appreciable difference in side effects. D. It is less effective than the whole-cell vaccine with no significant difference in side effects. E. It is less effective than the whole-cell vaccine with more side effects. New vaccine has same or better effects and less side effects
  140. 140. Tips in answering MCQs: Examples logical thinking:  To change to any new intervention (drug, procedure, investigation or vaccine …) the effect of the new intervention must be the same or better effects and with less side effects
  141. 141. Thrombocytopenic Purpura The following statement about thrombocytopenic purpura is correct? A. They present most often with nosebleeds or bleeding gums. B. They tend to be girls. C. They remit spontaneously in up to 90 percent of cases. D. They have a slightly higher risk of intracerebral hemorrhage than adults. E. They show poikilocytosis and nucleated red cells on the peripheral smear. .45
  142. 142. Thrombocytopenic Purpura The following statement about thrombocytopenic purpura is correct? A. They present most often with nosebleeds or bleeding gums. B. They tend to be girls. C. They remit spontaneously in up to 90 percent of cases. D. They have a slightly higher risk of intracerebral hemorrhage than adults. E. They show poikilocytosis and nucleated red cells on the peripheral smear.
  143. 143. Tips in answering MCQs: Respect your logical thinking & your clinical experience
  144. 144. Thank yo

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