MCQs Techniques

Fayza Rayes
MBBCh. MSc. MRCGP
Consultant Family Physician
Joint Program of Family & Community Medicine, Jeddah
www.fayzarayes.com

Objectives:
1. Improving your out come from studding
2. Improving your technique in answering MCQs

Introduction:
1. Do you follow any techniques while studying from
MCQ book
2. Do you follow any techniques while answering
MCQs questions

Contents:
 10 tips in studying for MCQs exam
 10 tips in answering MCQs
 Answering 45 MCQs

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

How can you benefit from this information ?

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. 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 )

Correction of false believes:
Do you have any strategy??
1. Writing summaries
2. Teaching others the new information
3. Reminding cards
4. …….

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 ??!!

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

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

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

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

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

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.

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

 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

2. Example of Quicker Revision

1. Infants
2. Wheezing
3. Rhonchi and moist rales
4. Respiratory syncytial virus
5. Cold, humidified, oxygen
3. Example of Abstracts
Bronchiolitis in infants

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

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

1. ER
2. Delusion “talking strangely”
3. Drooling
4. A lateral x-ray of the neck
5. IV/IM ceftriaxone
Epiglottitis:

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.

What is the most likely diagnosis in this child?
A. Viral pneumonia
B. Acute epiglottis
C. Bronchiolitis
D. Croup
.3

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

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

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.
2. Update & EBM

1. Early childhood
2. ER
3. Harsh, barky cough
4. Respiratory distress
5. Parainfluenza virus
6. Aerosolized steroids
7. Nebulised adrenaline

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

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

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%

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

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

What do we mean by being specific?!
General information X Detailed information

This is
general information

This is
detailed information

 Be specific in your information
 And be extra specific and meticulous

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

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

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

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.

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

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

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

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

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

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.

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

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.

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

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

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

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

 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

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

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

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

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

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.

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

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

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

Gout
Which one of these drug is not associated with gout?
A. Diuretics
B. Digoxin
C. Niacin (vitamin B3)
D. Aspirin
E. Cyclosporine (Immunosuppressive)

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

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

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

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

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

A. Liver failure.
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

A. Liver failure.
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

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

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.

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

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.

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%.

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

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

Smoking is the first to blame …
Smoking is “ criminal ”

 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

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

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

 In general, respect your clinical experience
 In controversial issues, respect what you can
remember from your MCQs reference books

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

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.

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

 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

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

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

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

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

 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

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

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

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

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.

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

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

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

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

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.

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

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.

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

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

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

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.

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

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

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

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)

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

Antidepressant
A. 5 to 20 percent.
Placebo effect is up to 60%

A. 5 to 20 percent.
Placebo effect is up to 60%
Antidepressant

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

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

chain reaction?
A. 0.6 percent.
B. 50 percent.
C. 6.1 percent.
D. 16 percent.
E. 26 percent.

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

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

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

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

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.
E. Nearly 100 percent.
.41

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.
E. Nearly 100 percent.

Needle Stick injury &
Risk to the Health Care Worker
 HIV
 Hepatitis C
 Hepatitis B
 0.3 to 0.5 percent
 6.1 percent
 ….

Concentrate on important topics in family
medicine e.g.: Important infections
 TB
 Hepatitis B & C
 HIV
 Any current epidemic disease TB

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

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

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

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

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

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

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

 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

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

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.

Respect your logical thinking & your clinical experience

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