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Medical Doctor’s COC Exam In Ethiopia

Medical Doctor’s COC Exam In Ethiopia

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

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Medical Doctor’s COC Exam In Ethiopia


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