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Home › Health Officer COC › Medicine COC Exam Questions and Answers Pdf

Medicine COC Exam Questions and

Answers Pdf
 AYENEW  POSTED ON AUGUST 16, 2022   POSTED IN HEALTH OFFICER COC, MEDICINE COC   2
COMMENTS

Medicine COC Exam Questions and Answers Pdf

Medicine COC Exam Questions and Answers Pdf

1. A 26 year-old female presented with two months of excessive menses and gum
bleeding. Physical examination revealed pale conjunctiva, petechiae’ and ecchymosis.
Which of the following is the most likely diagnosis?

A. Hemophilia

B. Idiopathic thrombocytopenic purpura

C. Scurvy

D. Vitamin K deficiency

2. A 21 year-old woman presented with fatigue and light headedness. Physical

examination showed marked conjunctival and palmar pallor. Which of the following
physical findings is most likely to be seen in this patient?

A. Apical diastolic murmur

B. Ejection systolic murmur

C. Narrow pulse pressure Tachyca

D. Rumbling mid diastolic murmur

3. A health officer was evaluating an anemia patient. Laboratory test revealed: Hgb 7
g/dl, MCV-7711, WBC – 5400/ul, Platelet – 650,000/µl. Which of the following is the
most likely diagnosis?

A. Acute myelogenous leukemia

B. Aplastic anemia

C. Iron-deficiency anemia

D. Megaloblastic anemia

4. A 45 year-old woman presented with fatigue and orthostatic dizziness of two months
duration. She has conjunctival pallor. Complete blood count revealed: Hgb= 8 g/dl,
WBC = 4200/µl and platelet 170,000/μl. Which of the following co-morbidities is LEAST
likely?

A. Chronic kidney disease

B. Chronic obstructive lung disease

C. Colorectal cancer

D. Disseminated tuberculosis

5. A 57 year-old man is admitted to the Medical Ward with hemorrhagic stroke. After a
week the patient suddenly developed plueritic chest pain and shortness of breath
Physical examination revealed signs of respiratory distress and a swelling involving his
right calf and thigh.

What is the most likely cause for his deterioration?

A. Acute myocardial infarction

B. Aspiration paeumonia
C. Fat embolism

D. Pulmonary embolism

6. A 26 year-old man with rheumatic heart disease came for follow-up. He has active
precordium and rumbling mid-diastolic murmur. What valvular lesion is most likely in
this patient?

A. Aortic regurgitation

B. Mitral regurgitation

C. Mitral stenosis

D. Tricuspid regurgitation

7. A 65 year-old male with type 2 diabetes mellitus presents to the Emergency

Department with a squeezing, retrosternal chest pain of one hour duration. He has
vague discomfort in his right arm and shoulder. The physical examination is notable for
diaphoresis and mild tachycardia.

Which of the following is the most likely diagnosis?

A. Acute coronary syndrome

B. Acute pericarditis

C. Aortic dissection

D. Pulmonary embolism

8. Which of the following is a major criteria for the diagnosis of rheumatic fever?

A. Elevated ESR

B. Fever

C. Prolonged PR segment

D. Polyarthralgia
9. A 29 year-old woman came to the OPD with shortness of breath and body swelling of
three weeks. On physical examination she has raised JVP, accentuated P2 and grade IV
diastolic murmur at the apex.

Which of the following drug delays disease progression?

A. Frusemide

B. Penicillin

D. Digoxin

10. A 45 year-old male with heart failure is comfortable at rest. He develops dyspnea
and fatigue to walk to a nearby shop and is forced to rest for five minutes before
symptoms improved.

What is the stage and functional status of this patient?

A. Stage A. Class II

B. Stage B, Class III

C. Sage C, Class IV

D. Stage C, Class III

11. A 30 year-old man was found to have a BP-170/100, He has a history of asthma.
Which one is the most appropriate drug of choice?

A. Atenolol

B. Enalapril

C. Hydralazine

D. Furosemide

12. A 40 year-old man presented with fever, shaking chills of three days duration. He
also has non-productive cough and right-sided pleuritic chest pain. He has no significant
past medical history. Physical examination revealed crepitation on the posterior right
lower chest.

Which one is the best initial investigation to confirm the diagnosis?

A. Chest X-ray

B. Culture of sputum

C. Gram stain of sputum

D. White blood cell count

13. A 25 year-old woman who was diagnosed with pulmonary tuberculosis and started
anti- tuberculosis treatment two weeks ago is found to be HIV positive on screening On
physical examination, she has pale conjunctiva and laboratory investigation shows CD4
count of 100cells/μl.

Which one is the most appropriate first line antiretroviral regimen for this patient?

A. ABC/3TC/NVP

B. TDF/3TC/EFY

C. AZT/3TC/EFV

D. D4T/3TC/NVP

14. A 24 year-old man has generalized lymphadenopathy, aphthous ulcers, and gray-
white plaques around his scrotum. Dark field microscopic examination demonstrates
spirochetes. Which of the following is the treatment of choice?

A. Ceftriaxone

B. Erythromycin

C. Penicillin

D. Tetracycline
15. A 30 year-old prisoner presents with intermittent fever and headache of two days
duration. He claims that three of his roommates had similar symptoms and were
treated in the prison. Blood film examination showed a spirochete.

Which one of the following is the most appropriate antibiotic choice for this patient?

A. Ceftriaxone

B. Procaine penicillin

D. Vancomycin

B. Ciproflocacillin

16. A 20 year-old male patient presents with abdominal swelling of three weeks
duration She lives in a rural village where the water source used is river water.
Ultrasound examination reveals peri-portul fibrosis.

Which one of the following is most likely cause for the patient’s condition?

A. Leishmaniasis

B. River blindness

C. Ascariasis

D. Schistosomiasis

17. A 22 year-old HIV positive patient who presented with shortness of breath was
suspected to have Pneumocystis jiroveci pneumonia but he has no signs of respiratory
distress and his CD4 count is 150/μl. Which of the following drugs is recommended for
this patient?

A. Co-trimoxazole

B. Prednisolone

C. Fluconazole

D. Pyrimethamine
18. A 60 year-old male had cough for five years with clear sputum production and
shortness of breath. He has smoked a pack of cigarettes per day for 20 years.
Laboratory examination reveals haemoglobin of 19 g/dl. X-ray of the chest shows
hyperinflation without infiltrates.

Which of the following is the most likely diagnosis?

A. Bronchial asthma

B. Chronic obstructive pulmonary disease

C. Interstitial lung disease

D. Pulmonary Tuberculosis

19. A 40 year-old alcoholic develops productive cough and fever. Chest x-ray shows an
air-fluid level in the superior segment of the right lower lobe. Which of the following is
the most appropriate pharmacotherapy?

A. Ceftazidime and ciprofloxacillin?

B. Ceftriaxone and gentamycin

C. Metronidazole and crystalline penicillin

D. Vancomycin and chloramphenicol

20. A 25 year-old man presents with abdominal pain, headache and fever of five days
duration.The Health officer suspected the diagnosis of typhoid fever.

Which of the following investigations confirms the diagnosis?

A. Stool examination

B. Blood culture

C. Weil-Felix titer

D Widal test
21. A 27 year-old man complains of fever, rigors, productive cough with rusty-coloured
sputum and pleuritic chest pain. Chest examination revealed increased tactile fremitus
and dullness to percussion in the right lower lung field.

What is the most likely diagnosis

A. Lobar pneumonia

B. Bronchopneumonia

C. Lung abscess?

D. Pleural effusion

22. A 35 year-old woman presented with trismus for a day. She also has shoulder and
back pain.

She reported that she sustained a puncture over the left foot a week ago. She is fully
conscious.

Which of the following is the most appropriate pharmacotherapy?

A. Carbamazepine

B. Diazepam

C. Phenobarbital

D. Phenytoin

23. A 30 year-old man presented with epistaxis, easy fatigability and intermittent fever
for one month. Physical examination revealed hepatosplenomegaly.

Which of the following is the best investigation to confirm the diagnosis?

A. Blood culture

B. Bone marrow aspiration

C. Stool examination
D. Ultrasound of abdomen

24. A 60 year-old man presented with sudden onset of right sided weakness on both
upper and lower extremities before a day. The weakness is maximal at onset and during
sleep. He is hypertensive but does not take medications.

What is the most likely diagnosis?

A. Hemorrhagic stroke

C. Subarachnoid hemorrhage

D. Transient ischemic attack

25. Which of the following is the most common cause of hemorrhagic stroke in
Ethiopia?

A. Aneurysm

B. Anticoagulation

C. Brain tumor

D. Hypertension

26. A 24 year-old HIV positive woman presents with fever and skin rash over the left
chest two days ago. The rash is vesicular and follows dermatomes (T4-5). She is
confused and meningeal signs are positive. Which of the following is the most likely
diagnosis?

A. Fungal meningitis

B. Pyogenic meningitis

C. Tuberculos meningitis

D. Viral Meningoencephalitis
27. A 30 year-old male presented with headache, fever and progressive weakness on the
left side of his body two weeks ago. He has right ear discharge since two months. On
physical examination BP-140/80 mmHg, PR-102/min, T-39°C. He is mentally alert and
power on the left upper and lower extremities is 3/5. What is the most likely diagnosis?

A. Brain abscess

B. Brain tumor

C. Ischemic stroke

D. Subdural hematoma

28. A 60 year-old alcoholic patient presented with fever, headache and neck pain of two
day duration. On examination body T-39°C and has neck stiffness. Bacterial meningitis
suspected but lumbar puncture was deferred because he has papilledema.

Which of following is the best empiric therapy for this patient in addition to Ampicillin?

A. Vancomycin and Cholramphenicol

B. Ceftriaxone and Vancomycin

C. Ceftriaxone and Chloramphenicol

D. Cloxacillin and Ciprofloxacin

29. A 36-year-old male presented with fatigue and tea-colored urine for five days.
Physical examination revealed jaundice and tender Hepatomegaly. Laboratory
investigation reveal Aspartate aminotransferase (AST) = 2400 U/L, Alanine
aminotransferase (ALT)-2500 U, Alkaline phosphatase-210 U/L and total bilirubin-8.6
mg/dl.

Which of the following is the LEAST likely cause for the patient’s condition?

A. Acetaminophen poisoning

B. Acute Viral hepatitis

C. Alcoholic liver disease

D. Ischemic liver injury

30. A 56 year-old man presented with progressive abdominal distension and leg swelling
of two months duration. He is a known patient with cirrhosis for the past one year on
follow up not on medication. On examination, he was not in distress and has moderate
ascites a bilateral leg swelling. Which of the following is the best initial management?

A. Furosemide

B. Furosemide and Spironolactone

C. Hydrochlorothiazide

D. Paracontesis and Frusemide

31. Which of the following is the most common complication of Peptic ulcer disease?

A. Hemorrhage

B. Gastric outlet obstruction

C. Malignancy

D. Perforation

32: A 50 year-old woman presented with fever, cough and chest pain for two days.
Chest X- ray showed pleural effusion. Pleural fluid analysis showed: WBC neutrophils,
PH=7.2, blood culture was positive for streptococcus pneumonia,

What is the next best step in management of this patient besides antibiotics?

A. Dexamethasone

B. Chest CT scan

C. Chest tube insertion

D. Lung function test

33. A 46 year-old man is brought to the Emergency Department because he was
vomiting fresh blood. He reports that he has no abdominal pain or nausea: On
physical examination, BP-70/40 mmHg. PR-118/min, RR= 24/min. He also has
gynecomastia, dilated abdominal veins and ascites. Which of the following is the
most likely cause of the bleeding?

A. Esophageal cancer

B. Esophageal varices

C. Mallory Weiss

D. Reflux esophagitis

34. A 47 year-old man comes to a Hospital complaining of epigastric pain that is

exacerbated by eating. Antigenic test for Helicobacter pylori is positive. Endoscopic
examination reveals a duodenal ulcer.

Which of the following is the most appropriate therapy?

A. Amoxicillin, clarithromycin and omeprazole

B. Amoxicillin, metronidazole and anti-acid

C. Omeprazole and anti-acid

D. Ranitidine, amoxicillin and metronidazole

35. A 29 year-old man with HIV infection presents with chronic diarrhea associated
with anorexia, abdominal cramps and significant weight loss. His recent CD4 count -
20 cells/mm3. A modified acid-fast stain of a stool specimen shows 4-6 um oocytes.

Which of the following is the most likely cause?

A. Cryptosporidium parvum

B. Microsporidia

C. Mycobacterium avium complex?

D. Pneumocystis jiroveci
36. Which of the following is the best early indicator for diabetic nephropathy?

A. Rising blood urea nitrogen?

B. Alburainuria

C. Hypertension

D. Rising creatinine level

37. A 35 year-old man presents with generalized body swelling of two months.
Physical examination reveals BP-120/70mmHg, ascites and +3 pretibial edema.
Protein = 4.5g/24hour urine collection. Which of the following is the most likely
diagnosis?

A. Chronic liver disease

B. Heart failure

C. Nephrotic syndrome

D. Glomerulonephritis

38. A 55 year-old man comes to the Emergency OPD because of excruciating pain
in his right big toe. He was diagnosed to have gouty arthritis. Which of the following
is the most appropriate pharmacotherapy?

A. Allopurinol

B. Ceftriaxone

C. Indomethacin

D. Morphine

39. A 28 year-old lactating woman presented to the emergency OPD with a

complaint of right breast pain of five days duration. On examination body T-38°C with
right breast tenderness but no fluctuation. What is the most likely diagnosis?

A. Breast Abscess
B. Breast Cancer

C. Fibroadenoma

D. Fibrocystic Change

40. A 32 year-old man presented to the surgical OPD with complaint of neck mass of
one year duration. On examination he l as a hoarse voice and a solitary 2cm x 2cm
thyroid mass on the right side which has firm consistency and fixed to underlying
structures. There was no lymphadenopathy. What is th: most likely diagnosis?

A. Thyroid adenoma

B. Thyroid cancer

C. Thyroiditis

D. Toxic Nodule

Medical Doctor’s COC Exam In Ethiopia

Medical Doctor’s COC Exam In Ethiopia

41. A 35 year-old man with a chronic peptic ulcer disease presented with features of
acute abdomen and chest x-ray revealed pneumo-peritoneum. His symptoms lasted
for six hours and his vital signs were stable af er infusion of one liter of Normal
Saline solution.

What should be the next step in the managenent of this case?

A. Barium meal study

B. Endoscopy

C. Triple therapy

D. Laparotomy

42. A 50 year-old woman brought an ultrasound imaging result which showed Gall
Bladder Stone.

She has no abdominal pa n and no known medical illness. Which of the following
is the recommended management?
A. Cholecystectomy

B. Extracorporal Shockwave Lithotripsy (ESWL)

C. Reassurance

D. Ursodeoxycholic acid

43. A 68 year-old man is admitted to a Hospital with complaint of intermittent lower

abdominal pain, bowel habit change and rectal bleeding of one month duration. He
has tenesmus and incomplete sense of defecation and had lost weight. What is the
most likely diagnosis?

A. Amebic dysentery

B) Colorectal cancer

C. Sigmoid Volvulus

D. Ulcerative colitis

44, A 55 year-old man presented to the surgical OPD with a complaint of rectal
bleeding of one month duration. He has no protruding mass per rectum and digital
rectal examination was non- revealing. What is the investigation of choice?

A. Abdominal CT-Scan

B. Barium Enema

C. Colonoscopy

D. Upper GI Endoscopy

45. A 30 yeur-old man was seen at the Emergency surgical OPD with perianal pain
of two days duration. He has fever and chills. He has left perianal induration with
tenderness but no fluctuation. What is the most likely diagnosis?

A. Anal fissure

B. Perianal Abscess
C. Perianal fistula

D. Thrombosed Hemorrhoids

46. A 20 year-old man was seen at the emergency department following road traffic
accident of one hour duration. He has sustained trauma to the abdomen. On
examination; Vital signs: BP 80/50 mmHg and PR-120/min. He has tire marks on the
abdomen and it was tender. The patient is started on 1V fluids.

What is the next step in the management?

A. Abdominal CT-scan

B. Exploratory laparotomy

C. Observation

D. Plain abdominal x-ray

47. A 50 year- old man came complaining of fatigue and dyspepsia of three months
duration Physical examination revealed a pale conjunctiva with a palpable mass at
the epigastrium that moves with respiration. What is the gold standard diagnostic
modality?

A. Abdominal Ultra sound

B. CUpper GI Endoscopy

C. Plain abdominal film

D. CT scan of the abdomen

48. A man was stabbed to the abdomen and presented to the Health Center with
eviscerated small bowel which was getting dark. Which of the following is the correct
initial measure before referral?

A. Cover the intestine with salinc gauze

B. Refer to a nearby hospital without intervention

C. Replace the intestine back into the peritoneal Cavity

D. Widen is stab wound under local anesthesia

49. A2 year-old farmer presented to the OPD with abdominal pain and frequent
vomiting of one day duration. On examination the abdomen is slightly distended and
has visible peristalsis. Plain abdominal x-ray showed step ladder pattem air-fluid
level.

Which of the following is the most likely diagnosis?

A. Caecal Volvulus

C. Sigmoid Volvulus

D. Small bowel Volvulus

B. Compound Volvulus

50. A 65 year-old man was seen at the Emergency OPD with abdominal pain,
distension and failure to pass feces and flatus of two days duration. He had two
similar attacks in the last three years and was successfully treated with rectal tube
deflation. On Examination BP-90/60 mmHg and PR=110/min. The abdomen was
tender and bowel sounds were absent.

Which of the following measures is to be avoided?

A. Analgesics

B. Antibiotics

C. IV fluid

D. Rectal tube deflation

Medical Doctor’s COC Exam In Ethiopia 

Medical Doctor’s COC Exam In Ethiopia

51. A 45 year-old housewife presented with progressive submandibular swelling of

two days duration. She visited a dentist and undergone tooth extraction a day prior to
the start of her symptoms. Examination showed tense, shiny bilateral submandibular
swelling with no area of fluctuation. She also has drooling of the saliva and protruded
tongue. What is the diagnosis of this patient?

A. Ludwig’s angina

B. Periodontal abscess

C. Submandibular cellulites

D. Submental abscess

52. A 20 year-old man presented to the OPD forty minutes after he sustained stab
injury to his left posterior chest. He has shortness of breathing. He is acutely sick
looking; BP= 110/60 mmHg. PR-90/min, RR-26/min. He has decreased air entry on
the lower left chest with visible air rush through the stab wound. What is the best first
step in the management of this patient?

A. Apply airtight dressing

B. Apply triangular dressing

C. Suture the wound

D. Take chest X-ray

53. A 35 year-old male patient came to emergency OPD 12 hours after he started to
have sudden onset of epigastric pain. He has long standing history of dyspepsia for
which he has been taking anti-acids repeatedly. Examination revealed tachycardia,
rigid and tender abdomen. What is the appropriate imaging study to reach a
definitive diagnosis?

A. Barium follow through

B. Barium meal

C. chest X-ray

D. Plain abdominal X-ray

54. A 27 year-old patient was involved in a road traffic accident. He was brought to
the Hospital by the driver. He is agitated; PR-140/min and feeble, BP-80/40 mmHg.
He has pale conjunctiva and his chest is clear with good air entry. He has an
ecchymosis over his left flank area. Abdominal Ultrasonography showed a significant
collection of fluid in his abdomen.

What is the most likely diagnosis?

A. Cardiogenic shock

B. Hemorrhagic shock

C. Neurogenic shock

D. Septic shock

55. A 64 year-old male patient presented to the Emergency OPD after he failed to
pass urine for a day. He had difficulty of urination for the last one year. The previous
night he took seven bottles of beer with friends. On examination he is acutely sick
looking and in pain. Bladder is palpable 10 cm above the pubic bone and tender.
What is the most likely cause for acute urinary retention?

A. Benign Prostatic Hyperplasia

B. Bladder cancer

C. Bladder stone

D. Urethral Stricture

56. An 18 years old male presented with right scrotal swelling of 1 day duration. He
also has associated pain and it started while he was asleep, it woke him up. He also
has fever and pain during urination. On examination right testis is tender, hot to
touch, swollen, and the testicular cord is not thickened. What is the most likely
diagnosis?

A. Testicular torsion

B. Epididymo-orchitis

C. Infected hydrocele

D. Testicular tumor
57. A 36 year-old male patient came with difficulty of urination for the last two years.
He had previous history of whitish urethral discharge for which he was treated with
tablets and injections. What is the most likely diagnosis?

A. Benign prostatic hyperplasia

B. Prostatic Cancer

C. Sexually transmitted disease

D. Urethral Stricture

58. A 43 year-old male patient came to the Emergency OPD after being involved in a
road traffic accident before a day. He has failed to urinate since the incident and is
unable to move his right lower limb. On examination his vital signs are normal, there
is right pubic tenderness and blood on the penile meatus. What should be the next
step in management?

A. Decompress with percutanous needle puncture

B. Do image-guided catheterization

C. Inset a folley catheter to decompress the bladder

D. Perform emergency suprapubic cystostomy

59. A 24 year-old man came to the Emergency OPD with severe pain originating in
the flank, radiating inferiorly and anteriorly. He also has nausea and vomiting. His
vital signs are within normal limies. Abdominal examination showed marked
costovertebral angle tenderness.

Urinalysis showed microscopic hematuria. What is the most likely diagnosis?

A. Cystitis

B. Pyelonephritis

C. Pyonephrosis

D. Ureteric colic
60. A 60 year-old female patient presented with right sided flank pain and hematuria
of one month duration. She also has significant weight loss, night sweats and
malaise. On physical examination, she is chronically sick looking with normal vital
signs, a bimanually palpable mass on the right flank. What is the most likely
diagnosis?

A. Chronic pyelonephritis

B. Neuroblastoma

C Renal cell cancer

D. Wilm’s tumor

81, A 25 year old gravida2 para1mother comes to your clinic for a quest of transfer to
other hospital for  delivery. She is currently 36 weeks. She was diagnosed to have
HIV at first screening and was put on HAART since then. Her pregnancy otherwise
was uncomplicated. A recent viral Load was 2000 copies/ml. What is the most likely
method and timing of delivery to reduce the risk of mother to child transmission is?

Cesarean delivery at 38 week

Vaginal delivery at 37 weeks

Vaginal delivery at 39 weeks

Cesarean delivery at 39 week

82, A 25yrs old para2 gravida 1 mother  whose GA is 36wk  fromelnmp  comes to
emergency opdwith compliant of pain full vaginal bleeding of 2hr duration at
presentation her  Bp =80/40 PR=128  with paper white conjuctia & 34 WK sized
uterus FHB=184 for 10 min ultrasound shows fundal placenta with hypoechoic mass
at retroplacental area what will the diagnosis of thise patient?

Grade1 abruptio placenta

Grade2 abruptio placenta

Grade3A abruptio placenta

Grade3B abruptio placenta

83, What should be the definitive management for the above patient?

Resuscitation &termination of pregnancy with induction

Resuscitation & continue with conservative  management

Resuscitation with fluid & prepare cross match blood then c/s at 39 WK

Correcting the shock with fluid &blood transfusion then emergency c/s

Answer question 84&85 based on the given scenario

84, A 23-year-old G1P0 presents to labor and delivery at 39 weeks complaining of

irregular uterine contractions for the past several hours, some of which are painful.
The discomfort is located primarily in her lower abdomen. She reports good fetal
movement and denies any vaginal bleeding or leakage of fluid. The nurses place the
patient on an external fetal monitor. The monitor indicates that she is contracting
every 2 to 10 min, and the nurses tell you that the contractions are mild to palpation.
Cervical
exam is 50/1–2/−1, vertex. This exam is unchanged from that in the office 1 week
ago. The fetal heart rate is reactive without any decelerations. The patient is tired of
being pregnant and wants to deliver as soon as possible.

What is this patient’s most likely diagnosis?

Active labor

Latent labor

False labor

Stage 1 of labor

85,  What is the most appropriate next step in the management of this
patient?

Send her home

Admit her for an epidural for pain control

Do artificial rupture of membrane

Administer terbutaline

86, A 69-year-old postmenopausal woman is being admitted for surgical treatment of

endometrial cancer. She has no health insurance and would like to know which is the
most important preoperative screening test to look for metastasis?

chest X-ray

hysterosalpingogram

pelvic ultrasound

intravenous pyelogram (IVP)

87, Which one of the following FALSE about augmentation of labour?

It is a means of correcting obstructed labour by using oxytocin                  

Its indication is poor progress of labour due insufficient uterine actions

When there is gross CPD labour should not be augmented

None of the above

88, Which one is an absolute contraindication for induction of labour?

Grand multiparity

One upper uterine  segment  scare

Twin pregnancy

One lower uterine segment scar

89, A 21 year old woman has presented for first prenatal visit. Her LNMP  was 12
wks ago, which she was certain about.  Upon abdominal examination you noted
bilaterally enlarged adnexae and the uterus is about 20 wks sized. Abdominal
Ultrasound depicted a snowstorm pattern in the uterus. What is the specific next
step management?

Admit and prepare x-matched blood

Put her on oxytocin

Evacuate the content

Primary hysterectomy

90, With typical use, which of the following contraceptive methods has the highest
failure rate within the first year of use?

Withdrawal

Spermicides

Male condom

Progestin-only pills

91, Surgical infection that is erythematous and edematous with shiny skin, sever
pain and fever but has no sharply circumscribed border/edge is most characteristic
of:

Cellulitis

Abscess

Boils (Furuncle)

Carbuncle

92, One of the following is NOT included in post operative infections:

Pancratitis

Parotitis

Ludwig angina
Septic thrombophilebitis

93, Dead bone in patients with chronic osteomylities  is called————

Osteomalacia      

Involucrum          

Sequestrum     

Cloaca

94, Which of the following is not true about acute osteomyelitis

Its common in pediatrics age group

The commonest causative organism in neonates is Staph. aures only

It is usually caused by a single organism

Bone scan can be useful in early phase

95, which one of the following is the most common cause of small bowl obstraction

Hernia

Post op adhesion

Intussesuption

Volvules

96, the definative diagnosis of BOO is made through

history and physical examination

ultrasound

pressur -flow studies

based on PSA level

97, Which one of the follwing is different from  others

Poor flow

Hesitency

Frequency

Dribbling

98, Most accurate method of diagnosing achalasia?

Barium swallow

CT scan

Manometry

MRI Scan

99,  A 55 years old male presents with progressive dysphagia which is more for
solids, weight  loss and he is alcoholic  since the age of 15. Examination entirely
normal. Diagnosis is?

Esophageal stricture

Achalasia

Diffuse esophageal spasm

Esophageal Cancer

100. 65 years old male patient presented with compliant failure to urinate of a day
duration during DRE he has smooth convex and elastic prostate with mobile rectal
mucosa .Which diagnosis go with DRE finding

Prostatic ca

BPH
Prostatic caliculi

Prostatitis

101. Among the blood products one can be used beyond 5 years

Whole blood   

Cryoprecipitate 

Fresh frozen plazma

Platelet

102. On arrival at E-OPD of MVA, You observe a significant bruising on the

chest/seat belt sign. You suspected the patient has a pericardial tamponade. Which
of the following is not a sign of Beck triad?

Hyperresonant chest sounds

Hypotension

Jugular vein distention

Muffled heart tones

103. True about nodular goiter

There is persistent stimulation of TSH

 Nodules may be cystic or solid

More single nodule than multiple

Cyst is common complication lead to  calcification

104. Diffuse toxic goiter (graves’ disease) NOT characterized by

Thyroid enlargement
Overproduction of TSH

Exophthalmos

105. Which of the following is true about shock?

Anaphylactic shock is a type of Obstructive shock.

Multiorgan failure is expected in compensated stage of shock.

In cardiogenic shock pulmonary capillary wadge pressure decrease.

A and C

None of the above

106. A 25 years old male patient presented 1hrs after he sustained a road traffic
accident. At presentation the vital signs were BP: 80/40mmHg PR:108b/m RR:26
Temp:36.7. He has no site of bleeding but has a bilateral femoral shaft deformity. He
has no other site of injury. What should be your first step in Emergency management
of this patient ?

Send him for X-ray

Secure double IV line and start resuscitation

Splint the extremity to prevent further injury

Follow the ATLS protocol

107. Not true about appendix and acute appendicites

peak age of acute appendicites is b/n 2nd  and 3rd decade of life

appendicites is poly microbial infection

pelvic appendixe is most common position of appendix

all are  true

108. Which one of the following is NOT a clinical indication for laparatomy in
management of Abdominal injury?

Hemodynamic stability

Clear and persistent signs of peritoneal irritation

Radiologic evidence of pneumoperitonium

Evisceration

109. Which one of the following combination is TRUE about Abdominal trauma?

Blunt abdominal trauma —–  Organs with largest surface area are prone to injury

Penetrating abdominal trauma —– Mostly inelastic tissues injured

Blunt abdominal trauma —–  Adjacent structures are commonly injured

Penetrating abdominal trauma —– Damage localized to the path of an object

110. A single most practical method of assessing adequacy of fluid resuscitation in

trauma patient is:

Blood pressure

Pulse rate

Urine output

Daily weight monitoring

111.A victim of road traffic accident is brought to emergency room unconscious and
with blood pressure of 80/60 mmHg. The first step in management of this patient is:

 IV fluid resuscitation

Skull x-ray

To establish adequate airway

Neurologic evaluation

112. the most common immediate cause of death in a major trauma includes:

Bleeding in the chest and abdomen

Lethal injury to brain, heart & major blood vessels

Extensive fractures and increased intracranial injuries

Sepsis and organ failure

113. Alemitu is 18  years old female patient who was admitted in the surgical ward
with a diagnosis of severe anemia secondary to acute blood loss secondary to
unstable pelvic fracture.she was investigated with CBC and her hgb was 2mg/dl and
her platelet count was 80,000.you were the one who manage her in the emergency,
what is your first choice to treat the severe anemia?

Whole blood 

Plasma  

Platlet 

 Ringer lactate

114. Based on the above case, What is your next choice?

Whole blood

 Platelet   

Normal saline

Albumin

115. If you want to give platelet to Alemitu, how many units do you want to transfuse
her to attain the lowest normal level of platelet count?

5 units  
7 units   

8 units  

4 units

116. Which one of the following is H type spectrum of EA and TEF?

 Isolated atresia

Blind end proximal limb and distal fistula

Fistula without atresia

All

117. Neck x-ray finding of patient with goiter can be?

Lateral view –tracheal shift

AP view- tracheal compretion

Calcification

118. Which of the following is not predisposing factor for adenocarcinoma of the
esophagus?

Barrett’s esophagus

Esophageal web?

Obesity

Smoking

119. While performing an assessment on a patient involved in MVA, you observe

decreased breath sounds, and upon percussion of the chest, you note hyper
resonance and has no any additional finding.  What will be the diagnosis?

Hemothorax
Open pneumothorax

Simple pneumothorax

Tension pneumothorax

120. 22years old male patient presented  with abdomenal pain of a day duration wich
was intially around periumbalical region later on shifted to RLQ and has associated
anorexia during physical examinatin he has pain on right lower quadrat during
palpation of LLQ…..which sign is posetive  in this patient

Rovsing sign

psoas sign

obturater sign

Pointing sign

41, A 5 year old female child presented with generalized body swelling of 1wk
duration. She has history of skin rash a month back. And has hx of cola colored urine
of 3 days duration.  On P/E- V/S:  PR: 110, RR: 28, T-37, BP: 140/80 and Urine
analysis reveals full of RBC.

            The most likely diagnosis of this patient is:

Nephrotic syndrome

post streptococcal glomerulonephritis

disseminated TB

none         

43, Which of the following is complication of nephrotic syndrome?

Thrombosis

Spontaneous bacterial peritonitis

sepsis
All

44, Which one of the following statement is not true about childhood asthma?

Parent asthma is one of the minor criteria of asthma predictive index in children

Asthma predictive index is useful to assess future risk

 genetic predisposition has role

A & C     

 none

45, Most common route of transmission of UTI in children is

Sexual abuse

Ascending infection

Hematogenous spread

None

46, A developmental disorder starting at or soon after birth and occurring most
frequently in infants with immature lungs is?

Meconium aspiration syndrome

Transient tacypenia of newborn

Hyaline membrane disease

Congenital pneumonia

47, If you encounter a neonate with a scaphoid abdomen, having respiratory distress
and upon auscultation there is bowel sound heard on the left side of the chest. What
could be the possible diagnosis for this neonate?

Chonal atresia
Diaphragmatic hernia

Tracheoesophageal fistula

None of the above

48, Among the different vaccine which is available in our country which vaccine is
protective and has a good efficiency in preventing tuberculosis?

PCV

BCG

OPV

Pentavalent

49, Which of the following is not a contraindication to do lumbar puncture in patient

you suspected neonatal meningitis?

Bulging  fontanel

Focal neurologic deficit

Thrombocytopenia

Infection at the site of LP

None of the above

50, Which could not be possible causes of neonatal conjunctivitis?

N. Gonrrehea

C. Tracomatis

S. Aures

None
All

51, Which one is not a poor prognostic sign of SAM among the following?

Jaundice

Low serum Na level

Age < 6 month

None

All

52, Which one of the following is NOT a disease of URTI (upper respiratory tract
infections)?

Croup

Common cold

Epiglottitis

None

53, Which one of the following is NOT true about croup disease?

Preceding URTI is common to present

The commonest age of presentation is 5 mo to 5yr

Bacterial etiology is the known cause

Barking cough, hoarseness of voice, inspiratory stridor is common presentation

54, For a patient having typical clinical manifestation of congestive heart failure, what
investigation can we send to support our diagnosis?

CXR
Echocardiography

ECG

All of the above

55, A 7 yrs old male patient presented to you at pediatric emergency OPD
complaining of generalized body swelling of week duration. Additionally, he has
history low grade fever and decreased urine amount, severe headache and one
episode of abnormal body movement but, he denies of having urine color change.
Two weeks back he had history of sore throat at which it resolved out spontaneously
without treatment.

On P/Ex he has puffy face, V/S:   BP 150/100mmHg PR: 110 bpm     RR: 28   T:
37.6

He has grade II bilateral pitting edema

On U/A there is microscopic hematuria (dysmorphic RBCs)

56, Which one is the most likely diagnosis and it’s feared complication for this
patient?

Nephrotic syndrome- uremic encephalopathy

Severe acute malnutrition- hypoglycemia

Nephtitic syndrome- hypertensive encephalopathy

Acute rheumatic fever- rheumatic heart disease

57, A 10 years old female known asthmatic patient whom on follow up presented to
emergency OPD with dyspnea, cough but no fever. On examination v/s: PR: 110
RR: 50 T: 37.4 oC and the pulse oximetry reads 88% of O2 saturation in room air.
She has sign of distress and diffuse wheezing over the whole chest and no other
pertinent finding.

What would be your next best stepyou should follow in the of management this
patient?

Send her immediately for CXR

Put on her Oxygen therapy and start salbutamol challenge

Hold on any treatment and call for anesthesiologist for endotracheal intubation

Provide her IV antibiotics

58, At which stage of growth and developmental child would normally develop an
emotion of fearing darkness?

Infancy age

Preschool age

School age

Adolescent age

59, What is  the risk of goat milk if initiated at 4 month of age

B12deficiency 

B iron deficiency anemia

C folic acid deficiency

D hemolytic anemia

60, one of the following is not diagnostic investigation  of  HIV for  8 month infant

DNA PCR

RNA PCR

Antibody test

All are diagnostic

61, one of the following is absolute contraindication of  LP for meningitis

 cardiorespiratory distress
bulged fontanel

 LP site infection

 thrombocytopenia 

62, one of the following is not true about  CSF  finding in normal child

CSF glucose < 75% of blood glucose?

CSF protein 20-45g/dl

cell count 0-5/microlitter

 opening pressure of  50-85mmhg

63, Which of the following is NOT a risk factor for ovarian cancer?

Nulliparity

Infertility

Combination oral contraceptive pill use

Hereditary nonpolyposis colon cancer (HNPCC)

64, Which one of the following is a criteria for low forceps?

The fetal head leading point should be above +2

Rotation is less than 45 degree

The fetal head is on the pelvic floor

The fetal head leading point should be below +2

67, A 25yrs old G3P2 mother with GA of 35wks + 2D present with compliant of gush
of fluid per vagina of 1days duration, on sterile speculum examination there is
pooling of posterior vaginal fornix. Which of the following is NOT appropriate
management:-
Strict Bed rest

Corticosteroid

Prophylactic antibiotics

Kick chart

68, A 30yrs old nulliparous women presents with compliant of inability to conceive of
3yrs duration on pelvic US she has Four submucosal myomas, Hematocrit is 27%.
What is the appropriate management?

Transfusion & Hysterectomy

Hysterectomy without transfusion

Transfusion & Myomectomy

Myomectomy without transfusion

69, A 25yrs old laboring multiparous mother is on second stage of labor for 2hrs, she
has two moderate contractions and station is +2. What is the next appropriate
management?

Do cesarean section

Forceps delivery

Vacuum delivery

Waite for vaginal delivery

70, Which one of the following is the least commonest degenerative change of
myoma

Sarcomatous degeneration

Red degeneration

Hyaline degeneration
Septic degeneration

71, A primipara is in labor and an episiotomy is about to be cut. Compared with a

midline episiotomy, an advantage of mediolateral episiotomy is

Ease of repair

Less extension of the incision

Less blood loss

Less dyspareunia

72, Multiparous patient who has received no prenatal care presents to Labor and
Delivery with a complaint of vaginal bleeding. Her fundal height is 24 cm. Which of
the following laboratory tests supports the diagnosis of preeclampsia?

Creatinine 1.5 mg/dL

Platelet count 103,000/μL

Hct 40%

Total protein of 258 mg in a 24-hour urine collection

73, A 23 yrs old primigravida lady with GA of 28wk presented at antenatal care clinic
and her blood group is A- and her husband blood group is B+ so what should be
done next for  this patient?

 Administration of anti D

 Appoint her at 36 wks of gestation        

Indirect  coomb’s test

Direct coomb’s test

74, Which of the following is not an admission criterion for PID?

Failure to respond for outpatient treatment

PID with uncertain diagnosis

PID with TOA

Older Age

75, A woman who is currently pregnant presents to your office for antenatal care.
She had two abortions, one ectopic pregnancy, fetal death at 36weeks of gestation
and three live births. How are you going to describe her obstetric history?

G7 P3 A3 E1

G7 P4 A3 E1

G8 P4 A2 E1

G8 P3 A3 E1

76, One of the following IS NOT among the classic clinical triad of ectopic
pregnancy?

Amenorrhea

Foul Smelling Vaginal Discharge

Abdominal Pain

Vaginal Bleeding

77, Assume you are responsible physician at ANC clinic and a 45 year old known
hypertensive pregnant mother comes to you for first evaluation. Under which WHO
follow up category do you put her for next follow up?

Specialized care

Basic component

Can be reclassified in basic component follow-up, if her blood pressure one’s well
controlled

must be referred to territory hospital

78, You are at emergency OPD and a mother with profuse vaginal bleeding of 5 hrs
is brought to you by her family after she gave birth vaginal. On physical examination
she is unconscious and pale. How do you proceed with the management of this
particular patient?

You have to secure double IV line and resuscitate with crystalloid

You have to take sample for cross mach

Call for help

You have to do bimanual compression

79, The diagnosis of post partum hemorrhage is considered if;

 Estimated blood loss is greater than 1000ml after vaginal delivery

10%  drop  in hematocrit as we compare with health adult women hematocrit

There is vital signs derangement with hypovolemia

Estimated blood loss  greater than 1000ml after  abdominal hysterectomy

80, A 35 year old G3P2 mother who claims to be amenorrhic for the last 8 months
present to emergency OPD with vaginal bleeding of 06hr duration. She has history of
1 previous C/S scare and you proceed with P/E. Which one of the following is true
for this case scenario?

Abdominal examination should be avoided.

Digital vaginal examination is contraindicated.

Double set-up examination should be done first

External genital examination should be avoided

77,  Which one of the following is True about abnormal uterine bleeding?

Pregnancy must be considered in any reproductive age group mother who present
with vaginal bleeding.
It can be caused by wide variety of local and systemic disease or drugs

Most common cause of AUB is anovulatory

All

78, You are with your family on vacation, and one of your cousins need advise after
she missed four pills of companied oral contraceptive in row in the first week of her
normal menstrual cycle. She has no history of sexual contact in the last 5 days. What
will be your best advice?

To take her pills as soon as possible, but no problem  for missed pills

To take her pills as soon as possible, and to use condom for the next 7 days

To stop the pills as pregnancy is more likely and as it is teratogenic

All

79, A 19 year-old female patient presents with recurrent non-foul smelling curd like
whitish vaginal discharge. Her current episode started a week back. She never had
any sexual intercourse. She has no other oral, hair nail or skin lesions. What is the
most likely diagnosis?

Gonorrhea

Vaginal candidiasis

Chlamydia

Primary syphilis

80, A 37 year-old female HIV patient with presents with a persistent painful ulcer
involving the genital area and the inter-gluteal cleft of two years duration. She recalls
that the initial lesions were vesicles which easily ruptured. What is the most likely
diagnosis?

Pressure ulcer

Herpes simplex

Herpes zoster
Aphthous ulcer