Québec Médecin Examen d’aptitude à
l’exercice
1. A 65-year-old patient presents with sudden onset unilateral
weakness and aphasia that resolved within 30 minutes. The most
likely diagnosis is:
A. Migraine with aura
B. Transient ischemic attack
C. Intracerebral hemorrhage
D. Focal seizure
Answer: B
Rationale: Transient focal neurological deficits resolving within 24
hours are characteristic of a transient ischemic attack.
2. Which investigation is most appropriate as the first-line test for
suspected pulmonary embolism in a hemodynamically stable
patient with high clinical probability?
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. Ventilation–perfusion scan
Answer: C
Rationale: In patients with high clinical probability, CT pulmonary
angiography is the preferred diagnostic test.
3. A newborn has jaundice within the first 24 hours of life. The most
likely cause is:
A. Physiological jaundice
B. Breast milk jaundice
, C. Hemolytic disease
D. Gilbert syndrome
Answer: C
Rationale: Jaundice appearing within the first 24 hours is
pathological and commonly due to hemolysis.
4. Which medication is contraindicated in pregnancy due to
teratogenicity?
A. Acetaminophen
B. Amoxicillin
C. Isotretinoin
D. Insulin
Answer: C
Rationale: Isotretinoin is highly teratogenic and strictly
contraindicated in pregnancy.
5. A patient with diabetes presents with polyuria, polydipsia,
abdominal pain, and Kussmaul respirations. The most likely
diagnosis is:
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Lactic acidosis
D. Acute renal failure
Answer: B
Rationale: Kussmaul respirations and abdominal pain are classic
features of diabetic ketoacidosis.
6. Which heart murmur is best heard at the apex and radiates to the
axilla?
A. Aortic stenosis
, B. Mitral regurgitation
C. Tricuspid regurgitation
D. Mitral stenosis
Answer: B
Rationale: Mitral regurgitation produces a holosystolic murmur at
the apex radiating to the axilla.
7. The most common cause of community-acquired pneumonia in
adults is:
A. Staphylococcus aureus
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Legionella pneumophila
Answer: C
Rationale: Streptococcus pneumoniae remains the leading cause
of community-acquired pneumonia.
8. Which electrolyte abnormality is most likely in a patient with
prolonged vomiting?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Answer: B
Rationale: Loss of gastric contents leads to hypokalemia and
metabolic alkalosis.
9. A 30-year-old woman presents with heat intolerance, weight loss,
and palpitations. The most likely diagnosis is:
A. Hypothyroidism
, B. Subacute thyroiditis
C. Hyperthyroidism
D. Cushing syndrome
Answer: C
Rationale: Heat intolerance and weight loss are hallmark signs of
hyperthyroidism.
10. Which imaging modality is preferred for suspected acute
appendicitis in a pregnant patient?
A. CT scan
B. MRI
C. Plain abdominal X-ray
D. Ultrasound only after CT
Answer: B
Rationale: MRI avoids ionizing radiation and is preferred in
pregnancy when ultrasound is inconclusive.
11. A patient presents with fever, neck stiffness, and altered
mental status. The next best step is:
A. Start antibiotics after lumbar puncture
B. CT scan then lumbar puncture
C. Immediate lumbar puncture without imaging
D. Start empiric antibiotics immediately
Answer: D
Rationale: Empiric antibiotics should not be delayed in suspected
bacterial meningitis.
12. Which condition is associated with a positive Murphy sign?
A. Acute pancreatitis
B. Acute cholecystitis
l’exercice
1. A 65-year-old patient presents with sudden onset unilateral
weakness and aphasia that resolved within 30 minutes. The most
likely diagnosis is:
A. Migraine with aura
B. Transient ischemic attack
C. Intracerebral hemorrhage
D. Focal seizure
Answer: B
Rationale: Transient focal neurological deficits resolving within 24
hours are characteristic of a transient ischemic attack.
2. Which investigation is most appropriate as the first-line test for
suspected pulmonary embolism in a hemodynamically stable
patient with high clinical probability?
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography
D. Ventilation–perfusion scan
Answer: C
Rationale: In patients with high clinical probability, CT pulmonary
angiography is the preferred diagnostic test.
3. A newborn has jaundice within the first 24 hours of life. The most
likely cause is:
A. Physiological jaundice
B. Breast milk jaundice
, C. Hemolytic disease
D. Gilbert syndrome
Answer: C
Rationale: Jaundice appearing within the first 24 hours is
pathological and commonly due to hemolysis.
4. Which medication is contraindicated in pregnancy due to
teratogenicity?
A. Acetaminophen
B. Amoxicillin
C. Isotretinoin
D. Insulin
Answer: C
Rationale: Isotretinoin is highly teratogenic and strictly
contraindicated in pregnancy.
5. A patient with diabetes presents with polyuria, polydipsia,
abdominal pain, and Kussmaul respirations. The most likely
diagnosis is:
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Lactic acidosis
D. Acute renal failure
Answer: B
Rationale: Kussmaul respirations and abdominal pain are classic
features of diabetic ketoacidosis.
6. Which heart murmur is best heard at the apex and radiates to the
axilla?
A. Aortic stenosis
, B. Mitral regurgitation
C. Tricuspid regurgitation
D. Mitral stenosis
Answer: B
Rationale: Mitral regurgitation produces a holosystolic murmur at
the apex radiating to the axilla.
7. The most common cause of community-acquired pneumonia in
adults is:
A. Staphylococcus aureus
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Legionella pneumophila
Answer: C
Rationale: Streptococcus pneumoniae remains the leading cause
of community-acquired pneumonia.
8. Which electrolyte abnormality is most likely in a patient with
prolonged vomiting?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Answer: B
Rationale: Loss of gastric contents leads to hypokalemia and
metabolic alkalosis.
9. A 30-year-old woman presents with heat intolerance, weight loss,
and palpitations. The most likely diagnosis is:
A. Hypothyroidism
, B. Subacute thyroiditis
C. Hyperthyroidism
D. Cushing syndrome
Answer: C
Rationale: Heat intolerance and weight loss are hallmark signs of
hyperthyroidism.
10. Which imaging modality is preferred for suspected acute
appendicitis in a pregnant patient?
A. CT scan
B. MRI
C. Plain abdominal X-ray
D. Ultrasound only after CT
Answer: B
Rationale: MRI avoids ionizing radiation and is preferred in
pregnancy when ultrasound is inconclusive.
11. A patient presents with fever, neck stiffness, and altered
mental status. The next best step is:
A. Start antibiotics after lumbar puncture
B. CT scan then lumbar puncture
C. Immediate lumbar puncture without imaging
D. Start empiric antibiotics immediately
Answer: D
Rationale: Empiric antibiotics should not be delayed in suspected
bacterial meningitis.
12. Which condition is associated with a positive Murphy sign?
A. Acute pancreatitis
B. Acute cholecystitis
