Recall the Friday tutorial case of the 24-year-old male presenting with

abdominal pain since the previous night:

1. All of the following positive signs suggest the diagnosis of appendicitis
EXCEPT:
a. Obturator sign
b. Murphys sign*
c. Psoas sign
d. Rebound tenderness
e. Rovsings sign
2. Which of the following signs is MOST useful for ruling in appendicitis?
a. Abdominal rigidity
b. Migration of pain from the periumbilical area to the right lower
abdominal quadrant
c. Fever
d. Pain located in the right lower abdominal quadrant*
e. Anorexia
3. In a patient presenting with abdominal pain in the right lower quadrant, the
following differentials should be considered:
i. Nephrolithiasis
ii. Cholecystitis
iii. Appendicitis
iv. Diverticulitis
v. Aortic dissection
vi. Inflammatory bowel disease
vii. Myocardial infarction
viii.
Pancreatitis
a.
b.
c.
d.
e.

i, ii, iii, iv
iii, iv, vi, viii
ii, iii, v, vi
iii, vi, vii, viii
i, iii, iv, vi*

Recall the Friday tutorial case of the 21-year-old woman presenting with
diarrhea for the past week:
1. All of the following statements regarding irritable bowel syndrome are correct
EXCEPT:
a. A positive family history for the condition increases an individuals risk
of IBS.
b. Peak prevalence of IBS is between the ages of 20 to 39 years of age.
c. IBS is clinically defined as abdominal discomfort or pain associated
with altered bowel habits for at least 7 days per month in the previous
month.*
d. A history of infectious gastroenteritis is a risk factor for IBS.
e. Exercise, peppermint oil, and probiotics can improve the symptoms of
IBS.
2. Evaluation of suspected IBS should include the following EXCEPT:
a. Evaluation of the patients stool consistency using the Bristol Stool
Chart
b. Hydrogen breath testing to assess for small intestinal bacterial
overgrowth*
c. Assessment of whether the patients presentation meets the Rome III
criteria
d. Routine testing for celiac disease
e. Assessment of the severity of the patients symptoms using the IBS
severity score
3. All of the following are considered alarm features and should prompt
investigation for diseases others than IBS EXCEPT:
a. Family history of colorectal cancer, IBD, or celiac disease
b. Weight loss
c. Nocturnal diarrhea
d. Mucus in the stool*
e. Blood in the stool

Recall the Friday tutorial case of the 28-year-old woman presenting with
right-sided headache:
1. The BEST individual question to ask your patient to rule out migraine would
be:
a. Do you feel nauseous?*
b. Are you sensitive to light or sound?
c. Does eating chocolate trigger your headache?
d. Does eating cheese trigger your headache?
e. Does physical activity aggravate your headache?
2. Which of the following statements regarding the diagnosis and management
of headache is INCORRECT?
a. The presence of photophobia, nausea or vomiting and disabling
intensity strongly increase the likelihood of migraine.
b. Imaging and lumbar puncture should be performed in a patient
presenting with a thunderclap headache.
c. Headache aggravated by the Valsalva maneuver is a red flag and
prompts further investigation.
d. In a patient presenting with a new-onset headache, imaging is not
recommended unless there are abnormal neurologic exam findings.*
3. Which of the following conditions are considered primary headaches?
i. Meningitis
ii. Tension-type headache
iii. Encephalitis
iv. Temporal arteritis
v. Migraine without aura
vi. Migraine with aura
vii. Subarachnoid hemorrhage
viii.
Cluster headache
a.
b.
c.
d.
e.

ii, iii, vi, viii

ii, v, vi, viii*
i, ii, v, viii
ii, v, vi, vii
I, ii, iii, viii

Recall the Friday tutorial case of the 72-year-old man presenting at the
clinic with his wife. She was concerned about his memory loss:
1. All of the following are quick screening tests for cognitive impairment that
can be administered during the first visit EXCEPT:
a. Sweet 16
b. Verbal fluency test
c. GDS-15*
d. Mini-Cog
2. Match the key findings on history and physical
suspected diagnosis:
Key Findings on History and Physical
Examination
i. Peripheral neuropathy, history of highrisk sexual behaviour or drug use
ii. Fluctuating behavioural changes,
inattention, altered level of
consciousness
iii. Recent head trauma, seizures,
papilledema
iv. Flat affect, anhedonia
a.
b.
c.
d.

examination with the

Suspected Diagnosis
A. Subdural hematoma
B. HIV-associated dementia

C. Delirium
D. Depression

i-C, ii-B, iii-A, iv-D

i-B, ii-C, iii-A, iv-D*
i-C, ii-A, iii-B, iv-D
i-B, ii-D, iii-A, iv-C

3. Which of the following statements is INCORRECT?

a. The majority of patients with dementia have Alzheimer disease.
b. Mild cognitive impairment is the transitional state between normal
cognition and early Alzheimer disease.
c. Increasing age is the greatest risk factor for dementia.
d. Chronic anticholinergic use decreases the risk of dementia.*
e. The presence of the apolipoprotein E4 genotype increases the risk of
dementia.

Recall the Friday tutorial case of the 22-year-old man presenting with dull
right shoulder pain:
1. All of the following statements are correct EXCEPT:
a. Common symptoms of rotator cuff impingement syndrome include
pain, weakness and loss of motion.
b. Age and repetitive use of the shoulder increase the risk of rotator cuff
injury.
c. The presence of shoulder pain is useful for ruling in a rotator cuff tear.*
d. The presence of infraspinatus muscle atrophy increases the likelihood
of rotator cuff disease.
2. Which of the following tests is LEAST useful for diagnosing rotator cuff
disease?
a. Neer test*
b. Drop arm test
c. Painful arc test
d. Internal rotation lag test
e. External rotation lag test
3. In a patient presenting with shoulder pain, other causes of joint pain may be
considered. Match the laboratory tests with the suspected diagnosis:
Laboratory Investigation
Suspected Diagnosis
i. Serum uric acid
A. Septic arthritis
ii. Antinuclear antibody
B. Systemic lupus
erythematosus
iii. HLA B27
C. Spondyloarthropathy
iv. White blood cell count, culture and
D. Gout
Gram stain
a.
b.
c.
d.

i-D, ii-C, iii-B, iv-A

i-C, ii-B, iii-D, iv-A
i-D, ii-B, iii-C, iv-A*
i-B, ii-C, iii-A, iv-D

Recall the Friday tutorial case of the 37-year-old man presenting with low
back pain for the past 24 hours:
1. A positive patient history of illicit intravenous drug use would INCREASE your
suspicion for which of the following conditions?
a. Ankylosing spondylitis
b. Spinal malignant neoplasm
c. Spondylolisthesis
d. Spinal osteomyelitis*
2. A positive patient history of chronic corticosteroid use would INCREASE your
suspicion for which of the following conditions?
a. Ankylosing spondylitis
b. Compression fracture*
c. Spinal stenosis
d. Spondylolisthesis
3. Which of the following statements regarding the diagnosis and management
of acute low back pain is INCORRECT?
a. Saddle anesthesia suggests cauda equina syndrome, which requires
immediate referral.
b. A straight leg raise test is positive for L4-S1 nerve root pain if it
radiates below the knee.
c. Bed rest is recommended for patients with acute low back pain as it is
effective at reducing pain and improving function.*
d. Without clinical signs of serious pathology, diagnostic imaging and
laboratory testing often are not required.