Class of 2025
MDSC 3313 FINAL EXAM - 07/03/2023
1. Which of the following sites is associated with pheochromocytoma?
a) Parathyroid gland
b) Islet cells of the pancreas
c) Testis
d) Adrenal medulla
2. Well known complications of Paget’s disease of the bone include the
following EXCEPT:
a) Fractures
b) Osteomyelitis
c) Osteosarcoma
d) High output cardiac failure
3. An embolus to the brain most likely didn't emerge from which of the following
Locations?
a) Mural thrombus of left atrium
b) Carotid artery
c) Abdominal Aortic Artery
d) Vegetation of mitral valve
4. The 16 year old had a positive Kernig’s sign and other symptoms of meningitis. On
doing CSF culture, gram -ve diplococci was seen. Which of the following is the
most likely cause?
a) S. aureus
b) N. meningitidis
c) Streptococcus pneumoniae
d) N. gonorrhoeae
5. She was found to have a rash, features of DIC, adrenal gland failure and hypotension
[Waterhouse–Friderichsen syndrome (WFS)]. What organism is the cause of
this?
a) N. gonorrhoeae
b) E. Coli
c) S. aureus
d) N. Meningitidis
6.Patient has anxiety. Which of the following drugs would produce the LEAST
sedative/hypnotic effect:
A) Phenobarbital
B) Buspirone
C) Diazepam
D) Zolpidem
7.This organism is responsible for causing hydatid cysts in liver. Which one?
a) Echinococcus Granulosus
b) Taenia Solium
c) Trichinella Spiralis
d) Strongyloides stercoralis
8.Which carcinoma has capsular and vascular invasion?
a) Medullary
b) Follicular
c) Papillary
9.Which of the following is not a clinical feature of hypercalcaemia:
a) Polyuria
b) Polyphagia
c) Polydipsia
d) Weight loss
10. Which of the following is a benign fibrous cartilaginous tumor commonly
found in the hands and feet of adults?
a) Enchondroma
b) Osteosarcoma
c) Chondroblastoma
d) Chondromyxoid fibroma
11. What is the most common type of brain parenchymal tumour?
a) Meningioma
b) Oligodendroglioma
c) Neurofibromatosis
d) Astrocytoma
12In which case if meningitis is the level of glucose normal.
a) Viral
b) Bacterial
c) Tuberculosis
d) Fungus
13Man presented with pain in big toe, no previous history of trauma. Neutrophils and Negative
birefringent needle- shaped crystals present:
a) Gout
b) Pseudogout
c) Arthritis
14 Which of the following fractures are slowest to heal and develop non-union?
a) Intracapsular femoral neck in an elderly patient
b) Lower 1⁄3 of the tibia in a teenager
c) Proximal humerus in a middle aged person
d) Distal femur at any age
15 A man was being prepared for some kind of organ transplant so they treated him
with something which compromised his immune system, soon after he developed rash etc,
causative agent was herpes zoster virus. What could have caused this
a. Primary infection of chickenpox
b. Reactivation of latent varicella-zoster virus from childhood
c. From blood transfusion
16. 16 year old boy presented with diarrhea, fever, pain. Admitted to eating homemade canned
tomatoes. Which organism causes this?
a. Clostridium botulinum
b. Staphylococcus aureus
c. Clostridium perfringens
d. Listeria monocytogens
17 Radial immunodiffusion used to detect
a. IL 4
b. TNF
c. Component C4
d. Component C1
18.64 year old came to your practice complaining of slow movement and
unstable gait . He has been diagnosed with parkinson’s disease . He was given
pramipexole . This drug -
a. Stimulates the dopamine receptor
b. Inhibits dopamine transporter
c. Increases bioavailability of dopamine
d. Is an antimuscarinc drug
19. Patient had headaches and seizures. He had high blood pressure.He also had a history
of valvular heart disease and had splinter haemorrhages. What was his most likely
diagnosis?
A. Cerebral abscess
B. Meningitis I think
C. Subdural hematoma
D. Subarachnoid Hemorrhage
20. A 58 year old male presented to ICU with acute onset of severe headache, sudden collapse
and loss of consciousness. His blood pressure was mildly elevated and they suspected
intracranial hemorrhage. He had no history of head trauma. Which is the most appropriate?
a. Investigate suspected history of alcoholism abuse
b. He had a ruptured Berry aneurysm
c. CSF exam is not recommended
d. Arteriovenous malformations are common at this age
21. A 32 year old man with a 7cm mass in the epiphysis of the distal femoral region. A biopsy
was taken which showed mononuclear cells and multinuclear giant cells. The diagnosis is:
A. osteosarcoma
B. chondrosarcoma
C. giant cell tumour
D. osteoid osteoma
22. 65 year old male presented with a suspected intracranial hemorrhage. He is a known
hypertensive. Which is CORRECT?
A) A common site of hemorrhage in these patients is the occipital lobe
B) Charcot-boucad occur in the circle of willis
C) Hyaline arteriosclerosis is the common cause for rupture
D) A common site of hemorrhage in these patients is subdural
23. 39 year old woman had a space occupying lesion that produced wavy nuclei and spindle
shaped cells on histo. The lesion was at the cerebellopontine angle. What was her most likely
diagnosis?
A. Ependymoma
B. Schwannoma
C. Medulloblastoma
D. Pilocytic astrocytoma
24. Woman (was in her 30s or 40s) had symptoms of hyperthyroidism- increased bowel
movement and weight loss etc. Which of the following is her most likely diagnosis?
A. Follicular adenoma
B. Multinodular goitre
C. Graves disease
D. Follicular carcinoma
25. 80 yr old tanty who never really physically active but woke up one morning and fell off
the bed i think and fractured the head of her femur. It was also found that she had
compression at T10. She had normal levels of calcium, phosphates and ALP. What is the most
likely diagnosis?
a) Osteogenesis imperfecta
b) Osteoporosis
c) Vitamin D deficiency
d) Acute osteomyelitis
26. Fanconi's anemia. Which of the the following features are not consistent with fanconi's
anemia.
A. Cafe au lait spots
B. ADAMTS13 mutation
C. Abnormal chromosome breakage
D. Radial hypoplasia
27. An ill patient’s blood film is shown. Known risk factors for this condition include all of the
following EXCEPT:
A. Severe aplastic anemia
B. Down syndrome
C. HTLV1
D. radiation
28. Patient was diagnosed with severe aplastic anaemia based on their reticulocyte count.
According to Camitta’s criteria, what could have been their reticulocyte count?
A. 0.3%
B. 25%
C. 3%
D. 10%
29. Another patient had AML and they gave a flow cytometry graph and asked which if the
following would be expected in this patient?
A. CD4/CD45
B. CD 3/CD8
C. CD13/CD33
D. CD10/CD
30. Treatment of hypercalcemia involves all of the following except:
A. Steroids
B. Hydroxyurea
C. Iv fluids
D. Bisphosphonates
31. Which of the following can be used to measure serum IL2 conc?
A. Elisa
B. Radiolabelled antibody test
C. Flow cytometry
D. ?
32. A pregnant woman came with cervical lymphadenopathy. Her baby now had intracerebral
calcifications. What is the causative agent?
a. ZIKA
b. Toxoplasma Gondii
c. CMV
d. Treponema pallium
33. Which micro-organism shows drumstick appearance?
A. Clostridium tetani
B. Clostridium difficile
C. Clostridium perfringens
D. Clostridium jejuni
34. 6 yo girl presents with pyrexia, nausea, diarrhoea. Which of the following viruses?
A) measles
B) rota virus
C) mumps virus
D)
35. A Coma patient is brought into the emergency department with suspected poisoning,
there was no history available, but morphine poisoning was suggested. Which one of the
following WOULD NOT be seen in this patient.
A) Mydriasis
B) Markedly depressed respiratory rate
C) Cyanosis
D) Decrease in blood pressure
36. A severe case of herpes zoster (shingles) occurs on the face of a renal transplant recipient
while in the hospital for immunosuppressive therapy to prevent rejection. The MOST LIKELY
source of the patient's infection is:
a.Reactivation of latent varicella-zoster virus acquired during childhood
b.Primary infection from a nurse working despite a mild episode of shingles
c.Primary infection from exposure to a child with chickenpox a few days prior to hospitalization
d.Transmission of the virus from a blood transfusion given during the patient's hospital stay
37. Which of the following is used to detect CSF in nasal fluid specimen:
A. Alpha 2- macroglobulin
B. Alpha 1 antitrypsin
C. Beta 2 transferrin *** (but was this an option? Wasn’t it given as beta 1 ?)
D. Beta 2 microglobulin
38. What are the findings in Ambiguous genitalia?
A. Cortisol
B. Testosterone
C. 17-Hydroxyprogesterone
D. Pregnenolone?
39. 25 hydroxyvitamin D3 is converted to 1,25-Dihydroxyvitamin D3 in the:
A. Intestine
B. Parathyroid gland
C. Liver
D. Kidney tubule
40. Most common cause of Actinomycosis?
A. Actinomyces Israeli
B. Actinomyces odontolyticus
C. Actinomyces naeslundii
D. Actinomyces graevenitzii
41. Question with … I think it was regarding causative agent of aseptic meningitis. Spoke of
normal glucose and high protein … I think !
A. Culex
B. Aedes
C. Ioxides
D. Coquillettidia
41. What is related to cell mediated response?
A. Mast cells
B. B cell
C. T cell
D. Basophils
42.Question with dog bite, no erythema around the area. Shallow bite. Child is fully vaccinated
with last tetanus shot 5 yrs ago. What family will cause this… something like that.
Options were
A. Rhabdoviridae
B. Bunnyaviridae
C. Myxoviridiae
43. A 67year old male patient was diagnosed with multiple myeloma. Cytogenetic analysis was
done to investigate for prognostic features. Which one of the following would confer very poor
prognosis in myeloma?
A. t(15,17)
B. t(8,14)
C. Del 13q
D. t(9;22)
44. Diagnosis of ALL, what makes it a poor prognosis
A. Girl
B. 8 years of age
C. CD 10, 19
9
D. WBC of 54 x 10 /L
45. Pregnant woman, she had a long history of syphilis which they recognised and treated at the
start of her pregnancy. Mother had a history of substance abuse and domestic violence.
Amniotic fluid was malodorous. Baby died, and the autopsy showed cerebral necrosis and
calcifications. Baby also came out with a rash on right face. What was the cause
A. Treponema pallidum
B. Toxoplasma
C. CMV
D. HSV
46. Baby came out with red/purple nodules, and upper right quadrant fullness? Or enlargement..
(it was the blue muffin nodules). How would this have been transmitted?
A. Via sexual transmission to mother then to baby via bloodstream
B. Mother gets it via inhaled droplets then passes to fetus via bloodstream
C. Spontaneous mutation
D.
47. Most sensitive test used for detection of HIV
A. Elisa
B. Immunofixation
C. Electrophoresis
D. PCR
48. Question with mononucleosis, Burkitt’s lymphoma, nasopharyngeal carcinoma, glandular
fever. What organism responsible
A. Epstein Barr Virus
B. CMV
C. HSV
49. Repeat question on phenytoin (1st order and zero order)
50. Question with thyroid levels
TBG 250 (normal), Total T4 normal, Free T3 - 5, TSH 6 (i think)
A. Hypothyroidism
B. Hyperthyroidism
C. Secondary hyperthyroidism
D. Euthyroid sick syndrome
51. Sjorgen’s syndrome test
A. Anti rho
B. Anti ss DNA
C. Anti scl
D. Anti histone
52. Another thyroid question. Patient in ICU
TSH high
Total T3 , Total T4 was low
Free T3 was high, T4 was high and reverse T3 was high
(Please correct me if you remember)
53. Question about cannabis. All of the following are true about cannabinoid EXCEPT:
A. Broken down to cannabinol
B. Prefer CB1 receptors
C. Something with presynaptic G-coupled receptors
D. Receptors increased in the brainstem
54. Question on Weed, man tried to stop smoking weed, he became agitated during that time,
panicky?, basically all over the place and he began smoking again to suppress it.
The man would have the following side effects EXCEPT
A. Increase in aggression
B. Decreased coordination
C. Increase in heart rate
D. Decrease in short-term cognition
HAEM CASE 1
Questions 55 and 55 related to a case on Polycythaemia Rubra Vera, Hb count 18.5.
55. Hemoglobin count of 18.5 mg/dL. Diagnosis of Polycythaemia Rubra Vera. Findings include
all EXCEPT:
A. Splenomegaly
B. Pruritus after a bath
C. Increased platelets and wbc count
D. Increased Erythropoietin
56. Complications of Polycythaemia Vera include all of the following EXCEPT?
A. Deep vein thrombosis
B. Myelofibrosis
C. AML
D. Kidney tumor from excess erythropoietin
57. In a patient with Hb 18, all of the following are reasons for this except:
A. Post renal transplant patient
B. . Smoking
C. Fibroid uterus
D. JAK2 mutation
58. Question with BCR-abl fusion gene
A. Chronic myeloid leukemia
B. Chronic lymphoid leukemia
C. Primary polycythaemia
D. Myelofibrosis
59. Woman, hands feeling warm, bowel movements, weight loss (i believe this is a repeat)
A. Graves disease
B. Goitre
C. Thyroiditis
60. Best test for detection of pheochromocytoma
A. Plasma Metanephrine
B. Plasma epinephrine
C. Urinary metanephrine
D. Urinary metanephrine
(They didn't include URINARY VMA as an option)
61. Question on Ann Arbor staging - she had generalized lymphadenopathy, night chills, severe
weight loss (I think 50kg to 30kg in a rell short time). Believe the lady had swelling of the neck.
Physical exam revealed multiple lymph nodes in the groin. Further tests showed lymph node
processes in the bone marrow
Which stage
A. Stage 3A
B. Stage 3B
C. Stage 4A
D. Stage 4B
62. Question with Man had rash on skin over pacemaker and spread over shoulder. Gram
staining was positive for clusters of cocci which are known to be resistant to multiple antibiotics,
including beta-lactams. Which organism?
A. Methicillin resistant Staph
B. Ampicillin resistant pneumococcus
C. Penicillin resistant strep
D. Vancomycin resistant Enterococcus
63. Schizophrenic patient. They are on risperidone/paliperidone. Which of the following
symptoms least likely to occur?
A. Blurred vision
B. Constipation
C. Akathisia
D. Hyperglycemia
64. Patient develops hyperprolactinemia (galactorrhoea, amenorrhoea, etc was listed) from an
antipsychotic. Which of the following can be used as a replacement aka would least likely
produce hyperprolactinemia?
A. Aripriprazole
B. .
C. .
D. .
65. This patient is on an antiepileptic that made them develop anorexia, weight loss, joint pain
and lymphadenopathy. Which is the most likely drug that caused the lymphadenopathy?
A. Carbamazepine
B. Phenytoin
C. Valproic acid
D. .
66. Parkinson’s treatment with levodopa/carbidopa. Which symptoms are most likely to still
occur despite adding carbidopa ?
A. Nausea & vomiting
B. Agitation/ Anxiety
C. .
D. .
67. Which of the following can you treat by administering immunoglobulins?
A. DiGeorge Syndrome
B. Selective IgG deficiency
C. RAG1 deficiency
D. .
68. All of the following are true about the Rubella vaccine EXCEPT:
A. It is a killed vaccine
B. .
C. .
D. .
69. All of the following are true about the Rabies vaccine EXCEPT:
A. It is a live attenuated vaccine
B. When giving the vaccine post-exposure, give it with rabies immunoglobulin
C. If someone is bitten by a wild animal, give them the vaccine
D. .
70. A 55 year-old TY was diagnosed with a brain tumour. Her CBC showed: Hb- 12g/dL,
Platelets - 197 x 10°L, Wbc - 7.1 × 10°L. She was given chemotherapy. Repeat CBC showed
Hb- 10g/dL, Platelets - 77 x 10°/L, Wbc - 1.7 x 10°/L, lymphocytes-85%, myelocytes-10%
neutrophils-5%. She was noted to be febrile. Together with the appropriate treatment for the
MOST LIKELY infection , she should also be given:
A. Whole blood transfusion
B. Anti-lymphocyte globulin
C. Filgrastim
D. White blood cell transfusion
71. PSA question in which the patient had a DRE done. PSA was like 5.6 μg/L. DRE was
negative for cancer i believe. After like a month PSA was 5.4 μg/L. Percentage free PSA
was 29%. What can be inferred ?
A. High chance of cancer
B. Low chance of cancer
C. BPH
D. Prostatitis
72. Most useful biomarker for post-operative monitoring of colorectal carcinoma
A. CA125
B. Carcinoembryonic antigen
C. PSA
D. Alpha fetoprotein test
73. A 60-year-old male with chronic renal failure develops hypercalcemia and subsequently has
surgery to remove lumps from the neck. What is the histology on these likely to show?
A. Hyperplasia of the parathyroid gland
B. A medullary carcinoma of the thyroid
C. Carcinoma of the parathyroid glands
D. A parathyroid adenoma
74. A 65-year-old man’ results are shown: Hb- 9g/dL, Platelets – 77 x 109/L, Wbc – 3.1 x 109/L.
Blood film shows rouleaux formation. ESR-99mm/hr. He was also noted to have renal failure.
Considering the MOST LIKELY diagnosis, possible associated causes for the renal failure could
be ALL of the following EXCEPT
A. Amyloidosis
B. Hypercalcemia
C. Pancytopenia
D. Immunoglobulin deposition
75. Combined immunodeficiency disease. Which component would you check for that will fight
off extracellular antigen
A. CD4+
B. Immunoglobulin qualitification
C. Anti-nuclear antibodies
D. NK cells
76. Viral infection. What is involved?
A. Cytotoxic T cells
B. NK cells
C. High antibody titre
D. .
77. A 65-vear-old who had complained of severe backache for 4 months presented to the clinic
with progressive leg weakness. An urgent MRI showed a plasmacytoma at T-9. He should be
treated urgently to prevent spinal cord compression and paralysis by:
A. anti-lymphocyte globulin
B. radiation therapy
C. intravenous immunoglobulin
D. surgical excision
78. A 45-year-old man had a lymph node biopsy which revealed a diagnosis of CD 20
lymphoma. These are all types of treatment drug used EXCEPT:
A. Hydroxyurea
B. Cyclophosphamide
C. Rituximab
D. Prednisolone
79. The skin-prick test is most suitable for diagnosis of:
A. Contact dermatitis
B. Food allergy
C. Tuberculosis
D. SLE
80. What type of vaccine uses plasmid from the virus inserted into a cell (Something so)
A. Nucleotide vaccine
B. Recombinant vaccine
C. DNA vaccine
D. Protein vaccine
81. Boy has sickle cell anemia based on hemoglobin Electrophoresis result. Was at steady state
hb of 8mg/dl, normal Platelets and wbc count. He returns to hospital a month later, hemoglobin
fell to 5.5mg/dl, he's now febrile and feeling ill, all cell counts low ( wbc and platelets)
Reticulocyte count was kinda high like 54%. Platelets were 78 (aka it’s not SAA) . Which is the
complication he is experiencing?
A. Parvovirus
B. Severe Aplastic anemia
C. A haemolytic crisis
D. .
82. A 30-year-old married lady is suspected to have an infection during her pre-natal visit. Her
pet cat could act as a reservoir for which of the following congenital infections?
A. Treponema pallidium
B. Herpes simplex virus
C. Toxoplasma gondi
D. Zika virus
83. Patient has hyperthyroidism. They developed jaundice, hepatosplenomegaly. ALT,
AST, etc were all high after treatment. Most likely drug used?
A. Propanolol
B. Propylthiouracil
C. Potassium iodide
D. Radioactive iodine
84. What is true about hypercalcemia in primary hyperparathyroidism?
A. Rapid serum calcium increase
B. Plasma intact PTH low
C. Renal calculi common
D. Hypercalcemia occurs when >3.5 mmol/L
85.. A 65 year old lady came to the clinic with left sided weakness and slurred speech.
An MRI was done, which revealed a lesion in the right frontal-parietal region. Histology
studies showed tumour with pattern below. Which brain tumour is the histologic finding
consistent with?
A. Meningioma
B. Oligodendroglioma
C. Ependymoma
D. Glioblastoma Multiforme
86. Patient has a SLE. To detect such antibodies, one would mix serum from the patient
with latex beads coated with:
A. Human IgG
B. Horse Ab to Human IgG
C. Human DNA
D. Horse Ab to Human DNA
87. Hybridomas arise from:
A. T cells and myeloma cells
B. B cells and myeloma cells
C. Memory B cells and myeloma cells
D. Helper T and myeloma cells
88. Something about immunotherapies and all are beneficial EXCEPT:
A. Complete immunosuppression
B. Selective immunosuppression
C. Replicate immune reaction
D. Activate immune reaction
89. Which of the following describes the best use of tumor markers?
A. Monitoring the disease
B. Making a diagnosis
C. .screening
D. .
90. Lady was warded in the hospital for 1 day for chest pains. She had an MI. She had diarrhea.
Stool tested positive for salmonella. Which best describes the situation?
A. Hospital acquired
B. Nosocomial
C. Iatrogenic
D. Community acquired
91. Woman diagnosed with simple partial seizures developed an erythematous skin rash. Which
drug is most likely to have this side effect?
A. Carbamazepine
B. Ethosuximide
C. Lamotrigine
D. .
92. What is the MAIN purpose of passive immunity?
A. It gives mainly IgM
B. .
C. Antibodies more readily available
D. .
93. A venezuelan woman works with horses and mules.. Cant remember the rest but she got
some disease. What was most likely the mode of transmission?
A. Arthropods transmitted infection from horse
B. Tick transmitted infection from deer
C. Drinking Contaminated water
D.
94. Pharm question about which anxiolytic drug does not affect REM sleep
A. Zolpidem
B. .
C. .
D. .
