Medical Council of Canada’s Part I

1.A 32-year-old psychiatric patient is seen in the Emergency Department after having cut her left wrist with a razor blade. Local bleeding was controlled by compression, and the wound was sutured. On examination of the hand, the patient has paresthesia and decreased sensation to the fifth digit, decreased adduction, abduction of the fingers and inability to adduct the thumb. Which one of the following structures was injured?

Median nerve.
Anterior interosseus nerve.
Ulnar nerve.
Posterior interosseus nerve.
Radial nerve.

2.A 58-year-old woman was admitted to hospital and diagnosed with metastatic hepatocellular carcinoma. During the second week of her hospitalization, she became jaundiced. She uncharacteristically showed little concern for this and wished to be discharged because she believed there were cats in her room. Mini Mental Status Examination reveals a score of 14/30. Which one of the following is the most likely etiology for her behavioral change?

Alcohol withdrawal with perceptual disturbances
Hepatic encephalopathy
Cerebral metastases
Intracerebral bleed
Alcohol-induced psychotic disorder

3.A 68-year-old man has been diagnosed with moderate chronic obstructive pulmonary disease (COPD) (FEV1: 56% of predicted.) He has been taking his salbutamol and ipratropium bromide inhalers 4 times daily as directed. He now returns to clinic with complaints lack of improvement in his shortness of breath. Which one of the following is most important to enquire about before adding or changing his present medications?

Use of an aerochamber with his inhalers
Presence of a cat in the house
Level of exercise tolerance
Taking his medications at regular times
Production of sputum

4.A 3-year-old child is brought by her mother to see you because of recurrent pruritic and erythematous plaques in the popliteal and antecubital fossae. As an infant, she had similar patches on her cheeks and scalp. These signs are most suggestive of which one of the following diagnoses?

Folliculitis.
Atopic dermatitis.
Tinea corporis.
Seborrheic dermatitis.
Photodermatitis.