Procedure followed for Medical Registration Exam

MMDC LICENCE EXAMINATION

7.11.2017

All medical graduates who wish to register as general medical practitioners with the Maldivian Medical and Dental Council (MMDC), are required to pass MMDC’s Licensing Examination.

The Licensing Examination is a screening examination that assesses the basic medical knowledge and problem solving of a candidate at a level comparable to a minimally competent medical student completing his or her medical education.

1. PATTERN OF QUESTIONS:

It is a three hour computer based exam, and includes a total of 150 multiple-choice questions with a single best answer; covering both basic medical sciences and clinical subjects

The exam is divided in to 2 parts: -        .

Part 1: consists of 45 questions from basic sciences (Anatomy, Physiology, Biochemistry, Pathology, Microbiology, Pharmacology, Forensic Medicine, Preventive and social medicine and medical ethics and medico-legal)

Part 2: consists of 105 questions from clinical subjects (Medicine , Surgery, Pediatrics, Obstetrics & Gynecology, Orthopedics, Emergency medicine, ENT, Ophthalmology, Skin & Venereal diseases, Psychiatry, Radiology and Anesthesiology)          ,

Duration of the exam: – a) Part 1(Basic Sciences):    50 minutes; and

b) Part 2(clinical subjects):  2 hours

Marks Allocated: – Each question is of 1 mark, so a total of 150 marks

Pass Mark: -         50% i.e.75 marks

The examination is held at Central Administration of Maldives National University (MNU), in Male’. The examination is conducted and the result issued by MNU.

Eligible Candidates:- Candidates who fulfill the criteria for registration at MMDC; holding MBBS or equivalent degree from a MMDC recognized medical college followed by at least 52 weeks of rotatory internship in a MMDC recognized center

2. PROCEDURE OF APPLICATION

  1. Application form for MMDC licensure Examination  can be downloaded from the council website: www.mmc.gov.mv
  2. Application form after completion, has to be submitted at the reception of Ministry of Health.
  3. Each applicant has to submit a copy of the Provisional Medical Registration certificate issued to them by MMDC and the ID/Passport with the completed application form
  4. After the candidate submits the application form, each candidate shall receive an e-mail from MMDC confirming the venue, date, time of examination and the date to collect the “statement of entry slip” for licensure exam by MMDC.
  5. Candidates must acknowledge the receipt of e-mail by MMDC
  6. The “statement of entry slip” must be collected from MMDC; within the time frame indicated in the e-mail
  7. Once the candidate receives the “statement of entry slip”, a payment of MVR 3000.00 as exam fees, shall be paid to Central Administration, Maldives National University.
  8. Candidates shall be present at the examination hall, 30 minutes before the scheduled exam time
  9. Result of the examination will be issued by MNU
  10. After clearing the exam, Permanent Medical Registration and Temporary Registration will be issued to the local doctors and expatriates respectively once the candidate applies for the above with the exam results
  11. Unsuccessful applicants should Re-sit and clear the Licensure Examination before their provisional license expires in order to continue medical practice in the Maldives

3. GUIDANCE TO HELP CANDIDATES PREPARE FOR MMDC LICENSURE EXAMINATION

MMDC Licensure Examination assesses  whether  a  candidate  can  approach  medical  practice  with  the  appropriate  intellectual  skills ,  clinical  reasoning,  critical  thinking  and  decision  making;  possessing  sufficient  knowledge  of  the  basic  and  clinical sciences and  the  ability  to  create  a  differential  diagnosis  and  treatment  plan  for  common clinical conditions. Candidates should:-

1)      Have knowledge of signs and symptoms of disease, be able to take good history, conduct an examination of the patient, order the relevant investigations, arrive at a differential diagnosis and know the non-pharmacological and pharmacological management of common disease conditions

2)      Know to manage medical emergencies.

3)      Demonstrate good communication skills including breaking bad news, informing relatives of results of investigations and informing them of the patient’s condition.

4)      Demonstrate knowledge of medical ethics, Understand the concepts of patient confidentiality, and when  to  breach  patient  confidentiality;  the  importance  of  informed  consent and  concept of medical negligence; and

5)      Be able to educate patients and public health promotion and disease prevention.

3.1. MEDICINE         

The knowledge expected of candidates in the subject of Medicine:- candidates   should   be   able   to   diagnose, suggest   management for common medical conditions .These include:-

  1. Cardiovascular Diseases: Hypertension,  ischemic  heart  disease, ECG changes in IHD, rheumatic  fever,  heart  failure,  bacterial endocarditis, pericardial diseases, pulmonary edema, valvular heart diseases, congenital heart disease and arrhythmias
  2. Respiratory conditions:- Bronchial    asthma,  COPD,  TB,  Bronchiectasis, pneumonia,   Interstitial lung disease, bronchial carcinoma, PFT, ABG
  3. Neurological conditions:- Headache, stroke, epilepsy, meningitis, myasthenia gravis, Parkinsonism, vertigo, Glasgow coma scale, CSF, Cranial nerves
  4. Gastrointestinal conditions: Splenomegaly, Viral Hepatitis, pancreatitis, cirrhosis, Upper  gastrointestinal  bleeding,  GERD, peptic  ulcer  disease,  Diarrhoea
  5. Hematology: anaemia, haemoglobinopathies, thrombocytopenia, leukaemias, DVT , haemophilia and other coagulation disorders.
  6. Electrolyte imbalance: hyperkalemia, hyponatremia
  7. Nephrology conditions: -pyuria, proteinuria, hematuria, glomerulonephritis, renal failure.
  8. Endocrine disorder: Thyroid   disorders, diabetes mellitus. Cushing’s syndrome,
  9. Rheumatology:.  Rheumatoid arthritis, SLE, Gout, ankylosing spondylitis
  10. Infectious diseases:-    typhoid,  worm infestation, measles, tetanus, varicella  , leptospirosis, scrub typhus, dengue fever, HIV, malaria, septic arthritis

Recommended reading for Medicine

  1. Davidson’s  Principles  and  Practice  of  Medicine  by  Nicholas  A  Boon,  Nicki R  College, Brian R Walker & John AA Hunter
  2. Clinical Medicine by Parveen Kumar & Michael Clark
  3. McLeod’s Clinical Examination by  John F  Munro  &  Ian  W  Campbell

3.2. OBSTETRICS AND GYNAECOLOGY 

OBSTETRICS: Candidatesshould be able to recognize, diagnose and manage normal and abnormal pregnancy, labour and puerperium. This includes:-

  1. Normal Pregnancy: anatomy  & physiology of the female reproductive system, physiological changes in pregnancy , diagnosis  &  duration  of  the  normal  pregnancy,  placenta  &  fetus ,  normal labour & delivery
  2. Pregnancy complicated by:-miscarriage, abortion, gestational  trophoblastic   disease,   ectopic   pregnancy,   antepartum haemorrhage   (placenta   praevia, abruptio placentae, vasa praevia ), multiple pregnancy, malpresentations,   premature labour
  3. Labour complicated by:  prolonged   labour, obstructed   labour, breech   presentation,  shoulder  presentation, cephalopelvic disproportion, postpartum haemorrhage and retained placenta.
  4. Puerperium complicated by:  obstetric  shock,  infections,  thrombophlebitis, DIC
  5. Prenatal infections
  6. Medical disorders:  pregnancy   induced   hypertension,   gestational   diabetes   mellitus,   anaemia   and   Rhesus isoimmunization
  7. Operative and diagnostic procedures:  Caesarean  section, instrumental deliveries

GYNAECOLOGY:- The candidate  should be able recognize, diagnose and manage common gynaecological problems and diseases:-

  1. Abnormalities in the genital tract, disorders of sexual development.
  2. Menstrual disorders:-  Menstrual cycle, Primary  and  secondary  amenorrhoea,  dysfunctional   uterine   bleeding,   postmenopausal   bleeding , dysmenorrhoea.
  3. Genital  tract  Infections:-  vulvitis, vaginal discharge,vaginitis, cervicitis, pelvic inflammatory disease
  4. Benign and malignant conditions: -endometriosis, adenomyosis, cervical intraepithelial    neoplasia, gestational trophoblastic tumours, CA cervix, ovary and uterus.
  5. Contraception
  6. Endocrine disorders: – hyperprolactinaemia, polycystic ovarian disease, hirsutism, menopause.
  7. Operative and diagnostic procedures: – Dilatation and curettage, biopsy, cauterization, abdominal and vaginal hysterectomy, tubal surgery, hysterosalpingography, ultrasonography, cervical smear.

Recommended Reading for Obstetrics and Gynaecology

  1. Philip N Baker (editor). Obstetrics by Ten Teachers. London, Hodder Arnold
  2. Ash Monga (editor). Gynaecology by Ten Teachers. London, Hodder Arnold
  3. Hiralal Konar (editor). Textbook of Obstetrics by DC Dutta. Calcutta, New Central Book Agency
  4. Hiralal  Konar  (editor). Textbook of Gynaecology by DC  Dutta  Calcutta, New Central Book Agency
  5. Michael Swash (editor).  Hutchison’s Clinical Methods.  Edinburgh, Elsevier Science
  6.  Arulkumaran,I   Symands, A   Fowlie   (editors). Oxford   Handbook   of   Obstetrics & Gynaecology  Oxford, Oxford University Press
  7. DK Edmonds (editor). Dewhurst’s Textbook of Obs & Gynecology. Oxford, Blackwell Publishing

3.3. PAEDIATRICS         

Candidates should be able to describe the normal development of the fetus, and factors that affect fetal growth:-

  1. Normal   pattern   of   growth   and   development  and management   of   abnormalities – such as failure to thrive , short and tall stature
  2. Breast  feeding
  3. Management of neonatal problems:- low birth weight, preterm births, respiratory distress, jaundice,   hypothermia, hypoglycaemia, hypocalcaemia, seizures
  4. Resuscitation  of  newborn
  5. Common renal, endocrine  and metabolic disorders:- hypothyroidism, diabetes mellitus  and inborn errors of metabolism, nephrotic/ nephritic syndrome
  6. Common  haematological  conditions:-  Anaemia,    Thalassaemia  , G6PD deficiency,  immune   thrombocytopenic  purpura, haemophilia, and haematological malignancies
  7. Common   dermatological   conditions   in   childhood:-  eczema, scabies,  impetigo,Steven Johnson syndrome
  8. Presentations of  child abuse 
  9. Common infections : Neonatal sepsis, ophthalmia neonatorum, chiken pox, bronchiolitis, pneumonia, meningitis, UTI, , dengue, acute rheumatic fever, , mumps, rubella, pertussis, TB,HIV, Diarrhoea, pertussis
  10. Common pediatric conditions :- Bronchial asthma, Seizures, acute flaccid paralysis, Enuresis, Autism, stridor, dehydration , malnutrition
  11. Cardiac conditions:  congenital heart disease, arrhythmias, cardiac failure,  Pulmonary hypertension, kawasakis disease, infective endocarditis
  12. Transporting neonates

Recommended Reading for  Paediatrics

  1. Nelson’s Textbook of Paediatrics. RM Kliegman et al
  2. A Neonatal Vade Mecum. B Spiedel (ed), 1998
  3. A Paediatric Vade Mecum. TG Barrett, AD Lander, V Diwakar
  4. Illustrated Paediatrics by Tom Lissauer, Graham Clayden

3.4. SURGERY

The candidate should be able to diagnose and describe management of:-

  1. Hernias : inguinal, femoral, Para umbilical, umbilical, epigastric & incisional
  2. Acute appendicitis, appendicular mass & abscess
  3. Breast lumps:-  fibroadenomas, fibroadenosis & carcinomas
  4. Neck lumps:- goiters, thyroglossal cyst, carotid body tumour,CA thyroid
  5. Gastrosurgical conditions:- haematemesis and oesophageal varices, peptic ulcers and gastric cancers, pancreatitis, CA pancreas, cholecystitis, biliary calculous disease and obstructive jaundice, dysphagia (achalasia and oesophageal cancer), liver cysts, tumours and abscess, , rectal bleeding, colorectal and anal cancer, intestinal obstruction, Peritonitis, inflammatory bowel disease, diverticular disease, fissure/ fistula in ano, ischiorectal abscess, haemorrhoids
  6. Urosurgical conditions:- bladder outflow obstruction, benign hypertrophy of prostrate and CA prostate, renal tumours, haematuria, urinary tract calculi, hydronephrosis, hydrocoeles and varicocele
  7. varicose veins
  8. Vascular :- limb ischaemia, DVT and pulmonary embolism, abdominal aortic aneurysm, A-V malformations and A-V fistulas, lymphoedema and other lymphatic disorders
  9. Skin conditions:- skin infections (abscess, cellulitis, erysipelas, carbuncles, gas gangrene), wound management and healing  including diabetic wounds
  10. raised intracranial pressure and space occupying lesions
  11. Cases of trauma (mass disaster, triage, according to ATLS guidelines):-  head injury, chest injury, abdominal injury; splenic rupture, injury to major blood vessels, spinal injuries and  Burns
  12. pre-operative assessment and preparation

 Recommended Reading for Surgery

RCN Williamson & BP Waxman. Scott: An Aid to Clinical Surgery

GR McLatchie & DJ Leaper. Oxford Handbook of Clinical Surgery  2002

A Clain (editor). Hamilton Bailey’s Demonstration of Physical Signs in Clinical Surgery

RCG Russell et al (editors). Bailey & Love’s Short Practice of Surgery

PJ Morris & WC Wood (editors). Oxford Textbook of Surgery Volumes 1, 2 & 3 (2nded). 2000

3.5. EMERGENCY   MEDICINE         

Candidates  should  deal  effectively  with  medical and surgical  emergencies  at  different  levels  including  resuscitation  and should be  able to manage the following:-

  1. Cardiac conditions:- Acute  MI, angina, syncope, acute  pulmonary  oedema,  congestive  cardiac  failure,  cardiac  arrhythmias,   cardiac   arrest,   cardiogenic  shock,  hypertensive  encephalopathy,  massive pulmonary embolism, cardiac tamponade
  2. Respiratory conditions:-Acute  respiratory  failure,  acute  severe  asthma,  tension  pneumothorax,  massive  pulmonary collapse, acute laryngeal obstruction, epistaxis, stridor, near drowning
  3. Gastroenterology conditions:-Upper   gastro-intestinal   bleeding,   hepatic   encephalopathy,   acute abdomen, pancreatitis, typhoid perforation, severe diarrhoea and dehydration electrolyte imbalance
  4. Neurological conditions:-Unconsciousness,  status   epilepticus, meningitis,   viral   encephalitis,   stroke,   subarchnoid  haemorrhage,  intracranial  hypertension,  bulbar  paralysis,  respiratory  muscle paralysis, myasthenia gravis, Guillain Barre syndrome,
  5. Acute renal failure
  6.  Acute   disseminated   intravascular   coagulation,   acute   massive   intravascular   haemolysis.
  7. Endocrine and metabolic conditions:- Diabetic keto-acidosis, hypoglycaemic coma, thyrotoxic crisis, myxoedema coma, acute  adrenal  Insufficiency,  acute  hypopituitarism,  tetany,  acute  hypercalcaemia,  acute water intoxication, hypothermia, heat stroke, electric shock, ,  electrolyte imbalance
  8. Acute poisoning
  9. Shock:- hypovolaemic shockdengue shock syndrome , septic shock
  10. Injuries:- ENT, maxillofacial injuries, eye injuries, retinal detachment and head injuries.

3.6. PATHOLOGY 

  1. Causative agents and predisposing factors of disease.
  2. Mechanisms of disease production:- cellular injury, Inflammation, cellular and vascular response, chemical mediators and cells in chronic granulomatous and immune-mediated inflammation
  3. Abnormalities of the blood and vascular system:- Hemorrhage, thrombosis, embolism, oedema
  4. Adaptive response of tissue to injury:-hypertrophy, hyperplasia, atrophy, metaplasia and dysplasia
  5. Healing of tissue following injury –primary and secondary wound healing and factors that impair healing
  6. Neoplasia:-benign and malignant tumours, spread of tumours, paraneoplastic syndromes, grading and staging,
  7. Haemato-oncology : Pathology of Acute leukaemia ,Myeloproliferative disorders, Lymphoproliferative disorders , Multiple Myeloma, Aplastic anaemias, Myelodysplastic syndromes, carcinoid tumors, Anemia
  8. Haemostasis :-coagulopathies, Platelet function disorders, thrombocytopaenias , thrombophilia
  9.  blood transfusion blood grouping, cross matching and  haemolytic disease of the new born
  10. Parenchymal and interstitial responses and biochemical abnormalities – pigmentation, calcification and acid-base balance disturbances
  11. Link the basic mechanisms of Pathology to specific diseases of the cardiovascular. respiratory, gastro-intestinal, genitor-urinary, neurological, and lympho-proliferative systems in order to explain their pathogenesis, clinical features, complications and effects.

Recommended Reading for Pathology

  1. Basic Pathology  by Stanley L Robbins
  2. Consise Pathology by Parakrama Chandrasoma . 3rd Edition
  3. Pathalogical basis of Disease by Stanley L Robbins.
  4. Essential Haematology by Hoffbrand and Petit (latest Edition)

3.7. PSYCHIATRY         

The candidate should be able to describe the common psychiatric conditions: _

  1. Psychotic  illnesses  :-schizophrenia,  Affective disorders,  delusional  disorders,  brief  psychotic episodes
  2. Organic psychiatric illness :- delirium, dementia, epilepsy related psychiatric disorders
  3. Deliberate self-harm
  4. Neurotic  stress  related  disorders :- anxiety  disorders,  phobia,  obsessive  compulsive  Disorder and dissociative disorder
  5. Depression 
  6. Eating disorders: – anorexia nervosa, bulimia
  7. Grief reaction
  8. Common psychiatric emergencies:- acute dystonic reactions, panic attacks, neuroleptic malignant syndrome, lithium toxicity, seizures, depressive stupor, intoxication and withdrawal due to alcohol and drugs, mania, violent and homicidal behaviour

Recommended Reading for Psychiatry

  1. Shorter Oxford Textbook of Psychiatry by  Michael  Gelder, Richard Mayou & Philip Cowen
  2. Concise Texbook of Clinical Psychiatry by Benjamin J Sadock & Virginia A Sadock
  3. Oxford Handbook of Psychiatry by Semple, Smyth, Burns, Darjee, McIntosh

3.8. PREVENTIVE AND SOCIAL MEDICINE       

The candidate should be able to explain  the  concept  of  Primary  Health  Care  and  describe  its  application  in  healthcare programmes in Maldives. The candidate should be able to:-

  1. National Immunization Program
  2. National disease control programmes:- Epidemiology , prevention and control of dengue, injury surveillance, National TB program, National HIV/AIDS program,, ANC program, Smoking cessation.
  3. Epidemiological surveillance of diseases:- Epidemiology,   surveillance, methods  of  data  collection ,incidence, prevalence
  4. Disease Transmission
  5. Infection control:  Hand hygiene, Sterilization and disinfection , herd immunity, Universal precautions
  6. Vaccination
  7. Injuries: falls,  occupational injuries, Road traffic accidents
  8. Common  nutritional  deficiencies  :  malnutrition,  iron  and  folic  acid deficiency, vitamin A deficiency, iodine deficiency
  9. Non communicable disease: risk factors, prevention
  10. Family planning:- contraception, sterilization

Recommended reading for Community medicine

  1. Park  JE,  Park  K,  Park’s  Textbook  of  Preventive  and  Social  Medicine
  2. National guidelines for management of TB, Health protection Agency,  Maldives
  3. National Expanded Immunization Schedule, Health protection Agency,  Maldives

3.9. FORENSIC MEDICINE  

  1. Death: – Causes, Changes  after  death,  hypostasis,  rigor  mortis,  putrefaction,  mummification, estimation  of  time since death
  2. Injuries:-  abrasions,  contusions,  lacerations,  stabs,  fractures,  effects  of  injury and cause of death, circumstances of injury (accident /suicide / homicide),burns, electrocution, fire arm injuries
  3. injury patterns:- defense, self-inflicted and fabricated injuries,  ante-mortem  and  postmortem injuries
  4.   Injury or death from explosives:   injury patterns,  post  mortem  examination
  5. Criminal abortion  and Infanticide
  6. Autopsy
  7. Sexual  offences:- sexual abuse,  child sexual abuse, unnatural offences
  8. Child abuse and Sudden Infant Death Syndrome
  9. Torture and battering:  modes  of  presentation, child/ wife battery, abuse of domestic servants,
  10. Drowning and immersion in water 
  11. Identification  of  the  living  and  dead :- medico-legal  importance,  general  and specific  methods  of  identification eg: scars, tattoos,  disease, skeletal  remains,  forensic  odontology,  exhumation
  12. Asphyxia
  13. Common Poisoning  :  organophosphorous   compounds,  Corrosive poisons: acids, alkali, Alcohol,  Plant poisons (atropine, strychnine), carbon monoxide, Metal poisons(lead, arsenic, mercury, copper), Narcotics(heroin, opium, cannabis, medicines(Barbiturates, paracetamol, benzodiazepam)

Recommended reading for Forensic Medicine.

Keith Simpson’s Forensic Medicine (edited by Bernard Knight)

Clinical Forensic Medicine edited by W.D.S. Mc Lay 

4. SAMPLE QUESTIONS:    (MCQs with single best answer)

4.1 Emergency Medicine

1) A 50-year-old man presents in emergency ward with central chest pain. On examination, his blood pressure is 90/60 mmHg and pulse is 106/min. He is pale and sweating profusely. The most likely diagnosis is:

  1. Esophagitis
  2. Myocardial infarction
  3. Pericarditis
  4. Pleural effusion
  5. Pneumothorax

2) Findings suggestive of pure left-sided heart failure include all of the following except:

a)      Dyspnea

b)      Hepatomegaly

c)      Orthopnea

d)     Paroxysmal nocturnal dyspnea

e)      none of the above

3) The three areas measured with the Glasgow Coma Scale are:

a)      Eye opening, verbal response, and motor response

b)      Vital signs, eye opening and pupil reaction

c)      Level of consciousness, vital signs and respiratory pattern

d)     Open wounds, peripheral pulses and motor response

e)      Pupil reaction, muscle power and reflexes

4.2 Pediatrics

4) Management of pneumonia at home

a)      Only those with mild pneumonia are treated at home

b)      Tachypneic patients are treated at home

c)      Chest in drawing is a mild symptom

d)     Antibiotics are given intravenously

e)      No need to follow up in 2-3 days

   5) Signs of severe dehydration include

a.normal pulse

b.decreased fluid intake

c. very delayed capillary refill with mottled skin

d.thirsty

e.normal physical examination

4.3 Anatomy

6) Regarding the spinal cord, all are correct EXCEPT:

a.  The spinal cord is the continuation of the medulla oblongata.

b.  The spinal cord ends at the level of L3 in the adult.

c.  In the adult, the dura mater ends at the level of S2 vertebra.

d.  The ventral 2/3 are supplied by the anterior spinal artery.

e.  The conus medullaris is fixed to the coccyx by the filum terminale

7)  Regarding the abdominal aorta, all are correct EXCEPT:

a.          It enters the abdomen opposite the 12th thoracic vertebra

b.          It bifurcates into 2 common iliac arteries opposite the 5th lumbar vertebra

c.          It lies on the left side of the inferior vena cava

d.          The branches that supply the gut arise from its anterior surface

e.          The thoracic duct passes through the aortic opening of the diaphragm

4.4 Pharmacology

8) What term is used to describe a gradual decrease in responsiveness to a drug, taking days or weeks to develop?

a. Refractoriness

b.Cumulative effect

c.Tolerance

d.Tachyphylaxis

e.Addiction

9) A 20 year old female presents with a six weeks history of galactorrhoea. She has no other symptoms but takes medication for contraception, dyspepsia and migraine. Examination reveals slight galactorrhoea with expression from both breasts but is otherwise normal.Investigation shows: Prolactin 915 mU/L. Which of the following drugs may be responsible?

a.         Codeine phosphate

b.         Metoclopramide

c.         Antiacid

d.         Oral contraceptive pill

e.         Sumatriptan

4.5 Ophthalmology

10) A 59-year-old with bilateral glaucoma is treated with drops of the parasympathetic agent pilocarpine. Cholinergic stimulation of the pupil causes which of the following?

a.  Absence of the papillary response to light

b.  Inequality of pupil size

c.  Papillary constriction (miosis)

d.  Papillary dilation (mydriasis)

e.  Tonic pupil (slow re-dilation after exposure to light)

4.6 Preventive Medicine

11) What kind of risk factor is High blood pressure for cardiovascular disease?

a.   Modifiable risk factor

b.   Static risk factor

c.   Non modifiable risk factor

d.   Hereditary risk factor

e.   Gender independent risk factor

4.7 Medical ethics

12) Your 36-year-old patient has just tested positive for HIV. He asks that you not inform his wife of the results and claims he is not ready to tell her yet.

What would you say to your patient?

a.  Encourage the patient to share the information with his wife on his own, giving him a bit more time if necessary.

b.  Tell the patient that his wife is at serious risk for being infected with HIV, and that you have a duty to ensure that she knows of the risk.

c.   Tell the patient that it requires reporting both the patient and any known sexual partners to local health protection agency

d.   All the above.

e.   None of the above.

4.8 Forensic Medicine

13)  Which of the following regarding autopsy is NOT correct

a.  Autopsy is often useful in determining the cause of death

b.  A decomposing body does not require autopsy as often no information can be obtained

c.  Autopsy is sometimes conducted to retain relevant organs and tissues as evidence

d.  The ‘I’ incision extends from the chin straight down to the symphysis pubis

e.  The stomach and its contents are preserved in suspected poisoning cases

4.9 Microbiology

14) The causative agent of tetanus is

a.  Clostridium botulinum

b.  Cl. tetani

c.  Cl. welchii

d.  Cl. Perfringens

e.  Diphtheria toxin

15)   Gram-positive cocci include:

a. Staphylococcus sp.

b. Escherichia sp.

c. Meningococcus sp.

d. Haemophilus sp.

e. Moraxella sp

4.10 Biochemistry

16) Glycosylated hemoglobin is related to  glucose content in blood over

a. 1 month

b. 2 months

c. 3 months

d.  4 months

e. None of the above

 17)  Vitamin K deficiency cause

a. keratomalacia leading to blindness

b. faulty epiphyseal bone formation

c.defective tooth enamel

d. keratinization of mucous membranes and skin

e. Hemorrhagic disease of newborn

4.11 Surgery

18) A 38-year-old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to the groin. It is associated with nausea, perspiration and frequent urination. He is restless, tossing in bed, but has no abnormal findings. The most likely diagnosis is:

a. Herpes zoster

b. Left ureteral calculus

c. Sigmoid diverticulitis

d.Torsion of the left testicle

e. Retroperitoneal hemorrhage

 

19) Meckel’s diverticulum most commonly presents as:

a.       Gastrointestinal bleeding

b.       Obstruction

c.       Diverticulitis

d.       Intermittent abdominal pain

e.       Fever