1. Clinical Assessment

History

• Onset, duration, frequency, and number of ulcers
• Pain severity, triggers (trauma, stress, certain foods)
• Systemic symptoms: fever, diarrhea, joint pain, fatigue
• Family history of similar lesions
• Medications (NSAIDs, beta-blockers)
• Previous treatments and response

Examination

• Location: non-keratinized mucosa (buccal, labial, ventral tongue, floor of mouth)
• Size:
  • Minor (<1 cm) – most common
  • Major (>1 cm, deeper, may scar)
  • Herpetiform (multiple small ulcers)
• Number: single or multiple
• Appearance: round/oval, yellow-white pseudomembrane with erythematous halo
• Rule out: secondary causes (herpes simplex, trauma, systemic disease)

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2. Investigations (If atypical or recurrent)

• Basic labs: CBC, iron studies, vitamin B12, folate (nutritional deficiencies)
• CRP/ESR: if systemic symptoms
• Serology: celiac disease (tTG-IgA), HIV (if risk factors)
• Biopsy: rare, only if persistent >3 weeks, atypical, or suspected malignancy
• Microbiology: rarely needed; ulcers are typically non-infectious

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3. Classification

Type	Features	Management Focus
Minor	<1 cm, 1–5 lesions, heal 7–14 days	Symptomatic relief
Major	>1 cm, deep, persistent, may scar	Systemic therapy possible
Herpetiform	Multiple, small, coalescing, painful	Combination topical/systemic therapy

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4. Management

A. General Measures

• Avoid triggers: spicy/acidic foods, trauma
• Good oral hygiene
• Avoid sodium lauryl sulfate in toothpaste
• Stress management
• Nutritional supplementation if deficient

B. Topical Therapy (First-line for minor ulcers)

• Topical corticosteroids:
  • Triamcinolone acetonide 0.1% in orabase
  • Fluocinonide 0.05% gel
• Topical anesthetics:
  • Lidocaine 2% gel for pain relief
• Protective agents:
  • Orabase, hydroxypropyl cellulose films

C. Systemic Therapy (For severe, recurrent, or major ulcers)

• Oral corticosteroids:
  • Prednisone short course (e.g., 30–60 mg/day tapering)
• Immunomodulators (refractory cases):
  • Colchicine, thalidomide, dapsone
• Address underlying systemic disease:
  • Nutritional deficiencies, IBD, Behçet’s disease, etc.

D. Adjunctive Therapy

• Antimicrobial mouth rinses: chlorhexidine gluconate
• Pain control: NSAIDs (if not contraindicated)
• Laser therapy (experimental for pain reduction and healing)

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5. Follow-Up

• Minor ulcers: usually self-limiting; review if >3 weeks
• Recurrent or major ulcers: monitor frequency, severity, and response to therapy
• Evaluate for systemic disease if persistent or atypical

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Introduction

The APGAR score is a rapid method to assess the health status of a newborn immediately after birth.
It was introduced in 1952 by Dr. Virginia Apgar, an American anesthesiologist, to provide an objective and standardized evaluation.

The score is based on five parameters, each evaluated at 1 minute and 5 minutes after birth, with each parameter scored from 0 to 2. The maximum score is 10.

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APGAR Parameters

Letter	Parameter	0 Points	1 Point	2 Points
A	Appearance (Skin Color)	Entire body bluish/cyanotic	Pink body, bluish hands & feet (acrocyanosis)	Entire body pink
P	Pulse (Heart Rate)	Absent	< 100 bpm	≥ 100 bpm
G	Grimace (Reflex Response)	No response to stimulation	Grimace only	Cough, sneeze, or cry
A	Activity (Muscle Tone)	Limbs extended (flaccid)	Some flexion of limbs	Active motion, full flexion
R	Respiratory Effort	Absent	Weak cry or labored breathing	Strong cry, good breathing

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Interpreting the APGAR Score

• 7–10: Normal, healthy newborn
• 4–6: Mild depression (needs observation and possibly mild intervention)
• 0–3: Severe depression (needs urgent medical attention)

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When to Measure

• 1-minute APGAR: Reflects the newborn’s condition at birth and initial adaptation to the environment.
• 5-minute APGAR: Evaluates the effectiveness of ongoing care and resuscitation efforts.
• If the 5-minute score is < 7, assessment should be repeated every 5 minutes up to 20 minutes.

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Practical Note for Delivery Rooms

• Look & Listen: Appearance, activity, respiratory effort
• Feel: Heart rate, reflex response (grimace)

This quick check can be done within seconds and helps guide immediate care for the newborn.

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Summary:
The APGAR score remains one of the simplest and most effective tools for assessing newborn well-being. It does not predict long-term outcomes but is essential for guiding immediate care and determining if urgent intervention is required.

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1. Definition

A Vaccine Vial Monitor (VVM) is a small thermochromic label placed on a vaccine vial, ampoule, or dropper to monitor cumulative heat exposure over time.

• Purpose: Helps ensure that vaccines have not been damaged by excessive heat during storage or transport in the cold chain.
• Function: Color changes irreversibly with time and temperature.

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2. Components & Principle

• Center Square: Heat-sensitive material that darkens progressively with heat exposure.
• Outer Reference Ring: Fixed color for comparison.
• Working Principle:
  • Heat causes a chemical reaction in the center square.
  • The higher the temperature, the faster the change.
  • Based on Arrhenius kinetics—reaction rate doubles with ~10 °C rise in temperature.

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3. Reading a VVM

• Acceptable: If center square is lighter than outer ring → vaccine usable.
• Discard: If center square is same or darker than outer ring → vaccine compromised.

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4. VVM Types & Vaccine Shelf Life

WHO assigns VVM categories depending on vaccine heat stability:

VVM Type	Time to end-point at 37 °C	Examples
VVM30	≥ 30 days	Oral polio (OPV), Hep B
VVM14	≥ 14 days	DTP, Pentavalent
VVM7	≥ 7 days	Rotavirus
VVM2	≥ 2 days	Certain lyophilized vaccines (e.g., measles, BCG before reconstitution)

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5. Storage & Handling Notes for Pediatric Use

• Check VVM before every use—especially in outreach/immunization camps.
• Do not refrigerate below recommended temperature just to “reset” VVM—it’s irreversible.
• VVM is not a freeze indicator—separate freeze indicators are used for freeze-sensitive vaccines (e.g., DTP, Hep B).
• Post-reconstitution: VVM is invalid for multi-dose lyophilized vaccines—time limit per WHO multi-dose policy applies.

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6. Field Significance in Pediatrics

• Ensures safe vaccines for children in peripheral settings where cold chain breaches are common.
• Reduces wastage by allowing use of vaccines that have been out of refrigeration but still within VVM limit.
• Prevents administration of heat-damaged vaccines, which could cause reduced immunogenicity without visible signs.

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7. Limitations

• Cannot detect freezing damage.
• Not a substitute for proper cold chain monitoring (data loggers, ice packs, cold boxes).
• Only indicates cumulative heat exposure—not precise real-time temperature.

Space travel is a marvel of human ingenuity, a daring leap into the unknown. But beyond the sleek spacecraft and zero-gravity acrobatics, astronauts face a very human challenge: their own biology. For female astronauts, one of the lesser-known but fascinating aspects of spaceflight is their use of birth control pills.

But wait—why would astronauts, who are laser-focused on their mission and in an environment where pregnancy isn’t exactly a concern, take birth control in space? The answer is more intriguing than you might think.

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Periods in Space: A Problem NASA Didn’t Expect

When NASA first sent women to space in the 1980s, they had to ask a question they’d never considered before: what happens to the menstrual cycle in microgravity? The answer wasn’t entirely clear. Would periods become irregular? More painful? Or would the lack of gravity somehow prevent menstruation altogether?

To avoid unpleasant surprises, most female astronauts choose to suppress their periods entirely—and that’s where birth control pills come in.

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The Challenges of Menstruation in Microgravity

Imagine trying to change a tampon in zero gravity. In a spaceship where every drop of liquid behaves unpredictably, dealing with menstrual blood can be messy, uncomfortable, and impractical. Plus, water for personal hygiene is limited, and every ounce of cargo—including sanitary products—adds weight to the mission.

By using birth control pills continuously (skipping the placebo week), astronauts can pause their menstrual cycle for months at a time. No periods, no hassle.

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Are There Other Options?

Yes! Some astronauts opt for long-acting contraceptives like the hormonal IUD or implants, which can prevent periods for years. These options eliminate the need to take daily pills, which could be tricky in space due to strict schedules and potential nausea from microgravity.

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But Is It Safe?

Absolutely. Many women on Earth use birth control for non-contraceptive reasons, like reducing cramps or managing conditions like endometriosis. Studies show that long-term use of birth control pills or other hormonal methods is generally safe, even in space.

NASA and other space agencies carefully monitor the health of astronauts, ensuring that any medication—birth control included—is safe for long-duration missions.

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The Future: What About Mars Missions?

With upcoming plans for deep-space travel, including missions to Mars that could last years, managing reproductive health becomes even more critical. Scientists are exploring better hormonal suppression methods and even potential ways to pause menstruation for extended periods without daily medication.

As we prepare for life beyond Earth, one thing is clear: human biology doesn’t stop in space, but science is making sure astronauts can focus on the stars—not their cycles.

NMCLE Model Questions – 2025

General Medicine

1. Which of the following is the most common cause of myocardial infarction? a) Pulmonary embolism
   b) Coronary artery thrombosis
   c) Aortic stenosis
   d) Hypertension
2. A 45-year-old man presents with exertional dyspnea and bilateral basal crepitations. What is the most likely diagnosis?
   a) COPD
   b) Pulmonary embolism
   c) Left heart failure
   d) Pneumonia
3. Which of the following ECG changes is most characteristic of hyperkalemia?
   a) ST elevation
   b) Peaked T waves
   c) Q waves
   d) U waves

Surgery

4. A 60-year-old male with chronic smoking history presents with hemoptysis and weight loss. What is the next best investigation?
   a) Chest X-ray
   b) CT thorax
   c) Bronchoscopy
   d) Sputum culture
5. Which of the following is the most common site of colorectal cancer?
   a) Ascending colon
   b) Descending colon
   c) Rectosigmoid junction
   d) Cecum
6. A patient with acute appendicitis is most likely to have tenderness at:
   a) Murphy’s point
   b) McBurney’s point
   c) Kocher’s point
   d) Lanz’s point

Pediatrics

7. A 2-year-old child presents with barking cough, stridor, and fever. What is the most likely diagnosis?
   a) Epiglottitis
   b) Croup
   c) Bronchiolitis
   d) Pneumonia
8. The most common cause of neonatal sepsis in developing countries is:
   a) Staphylococcus aureus
   b) Group B Streptococcus
   c) Escherichia coli
   d) Klebsiella pneumoniae
9. Which vitamin deficiency is most commonly associated with rickets?
   a) Vitamin A
   b) Vitamin B12
   c) Vitamin C
   d) Vitamin D

Obstetrics & Gynecology

10. The most common cause of maternal mortality in postpartum hemorrhage is:
    a) Retained placenta
    b) Uterine atony
    c) Uterine rupture
    d) Coagulopathy
11. A 28-year-old primigravida at 32 weeks of gestation presents with hypertension, proteinuria, and edema. What is the most likely diagnosis?
    a) Gestational hypertension
    b) Chronic hypertension
    c) Preeclampsia
    d) Eclampsia
12. The ideal time for screening for gestational diabetes mellitus is:
    a) 12-16 weeks
    b) 24-28 weeks
    c) 30-34 weeks
    d) 36-40 weeks

Pharmacology

13. Which of the following drugs is contraindicated in pregnancy?
    a) Labetalol
    b) Methyldopa
    c) ACE inhibitors
    d) Calcium channel blockers
14. The antidote for organophosphate poisoning is:
    a) Naloxone
    b) Atropine
    c) Flumazenil
    d) N-acetylcysteine
15. Which of the following antibiotics is bacteriostatic?
    a) Penicillin
    b) Tetracycline
    c) Vancomycin
    d) Cephalosporin

Pathology

16. The most common cause of megaloblastic anemia is:
    a) Iron deficiency
    b) Vitamin B12 deficiency
    c) Folate deficiency
    d) Chronic disease
17. Which of the following markers is associated with hepatocellular carcinoma?
    a) CEA
    b) AFP
    c) CA-125
    d) CA-19-9
18. The Reed-Sternberg cell is a characteristic finding in:
    a) Hodgkin’s lymphoma
    b) Non-Hodgkin’s lymphoma
    c) Multiple myeloma
    d) Leukemia

Public Health

19. The recommended daily intake of folic acid in pregnancy for prevention of neural tube defects is:
    a) 100 mcg
    b) 400 mcg
    c) 800 mcg
    d) 1 mg
20. The best indicator of nutritional status in children is:
    a) Weight for age
    b) Height for age
    c) BMI
    d) Mid-upper arm circumference
21. The most common cause of maternal mortality worldwide is:
    a) Postpartum hemorrhage
    b) Sepsis
    c) Hypertensive disorders
    d) Obstructed labor

General Medicine

22. Which of the following is the most common cause of chronic pancreatitis?
    a) Alcohol consumption
    b) Gallstones
    c) Viral infections
    d) Autoimmune disease
23. The most common cause of hypertension in children is:
    a) Primary hypertension
    b) Renal disease
    c) Endocrine disorders
    d) Coarctation of the aorta
24. Which of the following is used to reverse the effects of warfarin overdose?
    a) Vitamin K
    b) Protamine sulfate
    c) FFP (Fresh Frozen Plasma)
    d) Heparin
25. A 45-year-old diabetic presents with sudden loss of vision and floaters. The most likely diagnosis is:
    a) Diabetic retinopathy
    b) Macular degeneration
    c) Retinal vein occlusion
    d) Cataract

Surgery

26. A 30-year-old male presents with colicky abdominal pain and is diagnosed with kidney stones. The initial management includes:
    a) Surgical removal
    b) Pain control and hydration
    c) Antibiotics
    d) Diuretics
27. Which of the following is the most common complication of laparoscopic cholecystectomy?
    a) Bile duct injury
    b) Postoperative bleeding
    c) Respiratory failure
    d) Pneumothorax
28. A patient with acute cholecystitis is given antibiotics. What is the most common organism involved?
    a) Escherichia coli
    b) Klebsiella pneumoniae
    c) Salmonella typhi
    d) Pseudomonas aeruginosa
29. The initial management of an open fracture includes:
    a) Immediate debridement and wound closure
    b) Immobilization and administration of IV antibiotics
    c) Immediate plaster cast application
    d) Non-steroidal anti-inflammatory drugs
30. The most common cause of intestinal obstruction in adults is:
    a) Adhesions
    b) Hernia
    c) Volvulus
    d) Intussusception

Pediatrics

31. Which of the following vaccines is contraindicated during pregnancy?
    a) MMR
    b) DTP
    c) Polio
    d) Hepatitis B
32. The most common congenital heart defect is:
    a) Ventricular septal defect
    b) Atrial septal defect
    c) Tetralogy of Fallot
    d) Patent ductus arteriosus
33. Which of the following is the first-line treatment for status epilepticus in a child?
    a) Phenytoin
    b) Lorazepam
    c) Diazepam
    d) Phenobarbital
34. The most common cause of neonatal jaundice is:
    a) Breastfeeding jaundice
    b) Hemolytic disease of the newborn
    c) Physiologic jaundice
    d) Biliary atresia
35. Which of the following conditions is associated with a “butterfly” rash?
    a) Psoriasis
    b) Systemic lupus erythematosus
    c) Rheumatoid arthritis
    d) Eczema

Obstetrics & Gynecology

36. The most common cause of secondary amenorrhea is:
    a) Polycystic ovarian syndrome
    b) Pregnancy
    c) Hyperprolactinemia
    d) Hypothyroidism
37. The normal range of fetal heart rate during labor is:
    a) 60-100 bpm
    b) 100-160 bpm
    c) 160-180 bpm
    d) 180-200 bpm
38. The most common type of breast cancer is:
    a) Invasive ductal carcinoma
    b) Invasive lobular carcinoma
    c) Ductal carcinoma in situ
    d) Lobular carcinoma in situ
39. The first-line treatment for endometriosis includes:
    a) Surgery
    b) Hormonal therapy
    c) Antibiotics
    d) Corticosteroids
40. A 25-year-old woman presents with pelvic pain and dysmenorrhea. On examination, she has a tender adnexal mass. The most likely diagnosis is:
    a) Ovarian cyst
    b) Ectopic pregnancy
    c) Pelvic inflammatory disease
    d) Endometriosis

Pharmacology

41. The drug of choice for tuberculosis is:
    a) Rifampin
    b) Isoniazid
    c) Pyrazinamide
    d) Ethambutol
42. Which of the following is a selective beta-1 blocker?
    a) Propranolol
    b) Metoprolol
    c) Carvedilol
    d) Labetalol
43. The most common side effect of corticosteroids is:
    a) Weight loss
    b) Hyperglycemia
    c) Hypotension
    d) Hypokalemia
44. Which of the following is a common side effect of ACE inhibitors?
    a) Cough
    b) Constipation
    c) Tremors
    d) Visual disturbances
45. Which of the following anticoagulants does not require routine monitoring?
    a) Warfarin
    b) Heparin
    c) Dabigatran
    d) Enoxaparin

Pathology

46. Which of the following conditions is associated with an elevated white blood cell count and a left shift?
    a) Acute leukemia
    b) Tuberculosis
    c) Acute bacterial infection
    d) Chronic lymphocytic leukemia
47. The most common cause of cirrhosis worldwide is:
    a) Hepatitis B
    b) Hepatitis C
    c) Alcohol abuse
    d) Non-alcoholic fatty liver disease
48. The most common site of metastasis in carcinoma of the breast is:
    a) Liver
    b) Lungs
    c) Bones
    d) Brain
49. The hallmark of nephrotic syndrome is:
    a) Hematuria
    b) Proteinuria
    c) Hyperkalemia
    d) Oliguria
50. Which of the following is a predisposing factor for squamous cell carcinoma of the skin?
    a) Chronic sun exposure
    b) Smoking
    c) Exposure to cold
    d) High-fat diet

Public Health

51. The primary goal of the World Health Organization (WHO) is:
    a) To eradicate poverty
    b) To promote international health
    c) To improve global trade
    d) To support environmental protection
52. The most common source of indoor air pollution in developing countries is:
    a) Cigarette smoking
    b) Biomass fuels
    c) Industrial emissions
    d) Vehicular emissions
53. Which of the following is a key feature of the concept of primary health care?
    a) Specialized medical treatment
    b) Comprehensive healthcare access
    c) Advanced hospital care
    d) Focus on medical technology
54. The standard method of calculating Body Mass Index (BMI) is:
    a) Weight in kilograms divided by height in meters squared
    b) Weight in pounds divided by height in inches squared
    c) Weight in kilograms divided by height in centimeters
    d) Weight in pounds divided by height in centimeters
55. A key objective of the Millennium Development Goals (MDGs) was to:
    a) Eradicate infectious diseases
    b) Achieve universal primary education
    c) Reduce non-communicable diseases
    d) Promote technological advancements

General Medicine

56. The most common cause of peptic ulcer disease is:
    a) Stress
    b) Helicobacter pylori infection
    c) Nonsteroidal anti-inflammatory drugs (NSAIDs)
    d) Alcohol consumption
57. A 35-year-old woman presents with fever, weight loss, and night sweats. She has a positive tuberculin skin test. What is the next step in management?
    a) Start antibiotics
    b) Perform a chest X-ray
    c) Perform a sputum culture
    d) Refer for a biopsy
58. The first-line treatment for acute asthma exacerbation includes:
    a) Beta-blockers
    b) Inhaled corticosteroids
    c) Short-acting beta-agonists
    d) Leukotriene inhibitors
59. Which of the following is the most common cause of hyperthyroidism?
    a) Hashimoto’s thyroiditis
    b) Graves’ disease
    c) Toxic multinodular goiter
    d) Thyroid carcinoma
60. Which of the following is a hallmark feature of Addison’s disease?
    a) Hyperglycemia
    b) Hyperpigmentation
    c) Hyperthyroidism
    d) Hypothermia

Surgery

61. The most common complication after a thyroidectomy is:
    a) Hemorrhage
    b) Recurrent laryngeal nerve injury
    c) Hypocalcemia
    d) Infection
62. A 55-year-old male presents with a hernia that reduces spontaneously. This is most likely a:
    a) Inguinal hernia
    b) Umbilical hernia
    c) Incisional hernia
    d) Femoral hernia
63. A patient with a small bowel obstruction is managed with:
    a) Immediate surgery
    b) Conservative management with nasogastric tube and IV fluids
    c) Intravenous antibiotics and observation
    d) Chemotherapy
64. The most common malignancy of the small intestine is:
    a) Adenocarcinoma
    b) Lymphoma
    c) Gastrointestinal stromal tumor (GIST)
    d) Carcinoid tumor
65. Which of the following is a potential complication of diverticulitis?
    a) Bowel perforation
    b) Ascites
    c) Pneumothorax
    d) Acute pancreatitis

Pediatrics

66. The most common cause of respiratory distress in a newborn is:
    a) Transient tachypnea of the newborn
    b) Respiratory distress syndrome
    c) Meconium aspiration syndrome
    d) Pneumonia
67. The most common genetic disorder leading to developmental delay is:
    a) Down syndrome
    b) Fragile X syndrome
    c) Rett syndrome
    d) Turner syndrome
68. Which of the following is a classic sign of dehydration in infants?
    a) Sunken fontanel
    b) Increased urine output
    c) Weight gain
    d) Increased activity
69. A 10-year-old boy is found to have hematuria and proteinuria. The next step in management should be:
    a) Renal biopsy
    b) Urinalysis and renal function tests
    c) Ultrasound of the kidneys
    d) Initiate antibiotics
70. The most common cause of seizures in children is:
    a) Meningitis
    b) Epilepsy
    c) Febrile convulsions
    d) Hypoglycemia

Obstetrics & Gynecology

71. The most appropriate management of a patient with ectopic pregnancy is:
    a) Laparotomy
    b) Methotrexate therapy
    c) Observation
    d) Hysterectomy
72. The first step in the management of a patient with a missed abortion is:
    a) Expectant management
    b) Curettage
    c) Dilation and evacuation (D&E)
    d) Medical induction with prostaglandins
73. The most common cause of abnormal uterine bleeding in perimenopausal women is:
    a) Uterine fibroids
    b) Endometrial carcinoma
    c) Polycystic ovarian syndrome
    d) Endometrial hyperplasia
74. Which of the following is the most common cause of pelvic pain in women of reproductive age?
    a) Endometriosis
    b) Ovarian cysts
    c) Pelvic inflammatory disease
    d) Fibroids
75. Which test is used to screen for cervical cancer?
    a) Colposcopy
    b) Pap smear
    c) Biopsy
    d) Ultrasound

Pharmacology

76. Which of the following is the first-line treatment for hypertension in pregnancy?
    a) Labetalol
    b) Losartan
    c) Methyldopa
    d) Nifedipine
77. The antidote for acetaminophen poisoning is:
    a) Activated charcoal
    b) N-acetylcysteine
    c) Naloxone
    d) Flumazenil
78. Which of the following drugs is most likely to cause nephrotoxicity?
    a) Penicillin
    b) Gentamicin
    c) Ciprofloxacin
    d) Azithromycin
79. The mechanism of action of beta-blockers is:
    a) Inhibition of calcium channels
    b) Inhibition of sodium channels
    c) Blockade of beta-adrenergic receptors
    d) Stimulation of alpha-adrenergic receptors
80. Which of the following is used in the management of acute gout attacks?
    a) Allopurinol
    b) Colchicine
    c) Methotrexate
    d) Probenecid

Pathology

81. The presence of “cannonball” metastases on a chest X-ray is most commonly associated with:
    a) Renal cell carcinoma
    b) Lung cancer
    c) Colorectal cancer
    d) Melanoma
82. Which of the following conditions is associated with a “steeple sign” on an X-ray of the neck?
    a) Croup
    b) Epiglottitis
    c) Retropharyngeal abscess
    d) Bronchiolitis
83. The presence of neutrophils in a tissue sample is indicative of:
    a) Acute inflammation
    b) Chronic inflammation
    c) Tumor metastasis
    d) Necrosis
84. The most common type of stroke is:
    a) Hemorrhagic stroke
    b) Ischemic stroke
    c) Subarachnoid hemorrhage
    d) Transient ischemic attack
85. The most common cause of acute pancreatitis is:
    a) Gallstones
    b) Alcohol consumption
    c) Hyperlipidemia
    d) Medications

Public Health

86. The primary prevention of cervical cancer includes:
    a) HPV vaccination
    b) Regular Pap smears
    c) Colposcopy
    d) Surgery
87. A disease that is spread by the Aedes mosquito is:
    a) Malaria
    b) Zika virus
    c) Tuberculosis
    d) Hepatitis B
88. The most common cause of waterborne diseases is:
    a) Bacteria
    b) Viruses
    c) Fungi
    d) Protozoa
89. The most effective method to prevent the spread of communicable diseases is:
    a) Quarantine
    b) Vaccination
    c) Antibiotics
    d) Hand hygiene
90. The primary goal of the global eradication of polio is:
    a) To reduce mortality
    b) To eliminate the causative virus from all regions
    c) To prevent disability
    d) To promote vaccination worldwide

Miscellaneous

91. The most common cause of acute bacterial meningitis in adults is:
    a) Neisseria meningitidis
    b) Streptococcus pneumoniae
    c) Haemophilus influenzae
    d) Listeria monocytogenes
92. The most common site of metastasis for lung cancer is:
    a) Brain
    b) Liver
    c) Bones
    d) Lymph nodes
93. A 50-year-old woman presents with a palpable breast mass. The next step in management is:
    a) Mammography
    b) Fine needle aspiration biopsy
    c) Ultrasound
    d) Excisional biopsy
94. Which of the following conditions is associated with a positive anti-nuclear antibody (ANA) test?
    a) Rheumatoid arthritis
    b) Systemic lupus erythematosus
    c) Osteoarthritis
    d) Gout
95. The gold standard test for diagnosing tuberculosis is:
    a) Chest X-ray
    b) Sputum smear microscopy
    c) Tuberculin skin test
    d) Sputum culture for Mycobacterium tuberculosis
96. The most common complication of diabetes mellitus is:
    a) Diabetic retinopathy
    b) Diabetic nephropathy
    c) Diabetic neuropathy
    d) Coronary artery disease
97. The best indicator of adequate hydration in a patient is:
    a) Blood pressure
    b) Urine output
    c) Skin turgor
    d) Respiratory rate
98. The most common cause of vitamin D deficiency is:
    a) Poor dietary intake
    b) Lack of sunlight exposure
    c) Malabsorption
    d) Liver disease
99. The mainstay of treatment for Parkinson’s disease is:
    a) Dopamine agonists
    b) Anticholinergics
    c) Levodopa
    d) MAO inhibitors
100. The most common cause of acute upper gastrointestinal bleeding is:
     a) Peptic ulcer disease
     b) Esophageal varices
     c) Mallory-Weiss tear
     d) Gastric cancer

Answer Key

General Medicine

1. b) Hypertension
2. c) Asthma
3. b) Bacterial pneumonia
4. c) Enalapril
5. d) Non-Hodgkin’s lymphoma
6. b) Methyldopa
7. c) Hyperthyroidism
8. b) Acute myocardial infarction
9. b) 5 minutes
10. c) Respiratory distress syndrome
11. b) Deep vein thrombosis
12. b) Invasive ductal carcinoma
13. a) Esophageal cancer
14. a) Renal failure
15. b) Malaria
16. b) Breast cancer
17. b) Pulmonary embolism
18. a) Chronic obstructive pulmonary disease
19. b) Hypertension
20. c) Apnea of prematurity

Surgery

21. a) Intestinal obstruction
22. b) Adhesions
23. a) Immediate laparotomy
24. a) Bile duct injury
25. b) Pain control and hydration
26. a) Laparotomy
27. a) Bile duct injury
28. a) Escherichia coli
29. b) Immobilization and administration of IV antibiotics
30. a) Adhesions

Pediatrics

31. a) MMR
32. a) Ventricular septal defect
33. b) Lorazepam
34. c) Physiologic jaundice
35. b) Systemic lupus erythematosus
36. b) Pregnancy
37. b) 100-160 bpm
38. a) Invasive ductal carcinoma
39. b) Hormonal therapy
40. a) Ovarian cyst
41. b) Isoniazid
42. b) Metoprolol
43. b) Hyperglycemia
44. a) Cough
45. c) Dabigatran

Pathology

46. c) Acute bacterial infection
47. b) Hepatitis C
48. b) Lungs
49. b) Proteinuria
50. a) Chronic sun exposure
51. b) Promote international health
52. b) Biomass fuels
53. b) Comprehensive healthcare access
54. a) Weight in kilograms divided by height in meters squared
55. b) Achieve universal primary education

General Medicine (Continued)

56. b) Helicobacter pylori infection
57. b) Perform a chest X-ray
58. c) Short-acting beta-agonists
59. b) Graves’ disease
60. b) Hyperpigmentation

Surgery

61. b) Recurrent laryngeal nerve injury
62. a) Inguinal hernia
63. b) Conservative management with nasogastric tube and IV fluids
64. c) Gastrointestinal stromal tumor (GIST)
65. a) Bowel perforation

Pediatrics (Continued)

66. a) Transient tachypnea of the newborn
67. a) Down syndrome
68. a) Sunken fontanel
69. b) Urinalysis and renal function tests
70. c) Febrile convulsions

Obstetrics & Gynecology

71. b) Methotrexate therapy
72. a) Expectant management
73. d) Endometrial hyperplasia
74. a) Endometriosis
75. b) Pap smear

Pharmacology

76. a) Labetalol
77. b) N-acetylcysteine
78. b) Gentamicin
79. c) Blockade of beta-adrenergic receptors
80. b) Colchicine

Pathology (Continued)

81. b) Lung cancer
82. a) Croup
83. a) Acute inflammation
84. b) Ischemic stroke
85. a) Gallstones

Public Health

86. a) HPV vaccination
87. b) Zika virus
88. a) Bacteria
89. b) Vaccination
90. b) Eliminate the causative virus from all regions

Miscellaneous

91. b) Streptococcus pneumoniae
92. a) Brain
93. a) Mammography
94. b) Systemic lupus erythematosus
95. d) Sputum culture for Mycobacterium tuberculosis
96. b) Diabetic nephropathy
97. b) Urine output
98. b) Lack of sunlight exposure
99. c) Levodopa
100. a) Peptic ulcer disease