†‡§¦ SLE september 2006

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SLE September 2006

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SLE September 2006a) b) c) d) e) a) b) c) d) e) 1. Management of choice for breach pregnancy presented at 34 weeks: External Cephalic Version (ECV) Caesarean section ECV + tocolytics Induction of labor Observe for 2 weeks. 2. Not correct during management of labor: Intensity of uterine contraction can be monitored manually Maternal vital signs can vary relative to uterine contraction Food and oral fluids should be withheld ( )during active labor Advisable to administer enema upon admission I.V fluid should be administered upon admission 3. 33-year-old woman para 5 underwent repeated elective C-section. On 6th day post op. patient reported her clothes stained by copious serosangeous drainage from abdominal wound. Most likely diagnosis is: Vesicocutaneous fistula Enterocutaneous fistula Hematoma Stitch abscess Wound dehiscence 4. 22 days 25 days 28 days 35 days 38 days Average length of menstrual cycle is:

a) b) c) d) e) a) b) c) d) e)

a) b) c) d) e)

5. 32-year-old-woman has malodorous discharge and itching. Her partner has also slight discharge. PV examination showed strawberry spots on the cervix. Most appropriate treatment is: Metronidazole Estrogen cream Progesterone cream Vinegar douche Salphonamide cream 6. (long unnecessary details about) 70-year-old man fell ( )on outstretched hand. On examination intact both radial and ulnar pulses, dinner fork deformity. Tender radial head. Diagnosis is: Colles fracture fracture of distal ulna & displacement of radial head. Fracture of scaphoid? Fracture of shaft of radius with displacement of head of ulna.

a) b) c) d)

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SLE September 2006

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a) b) c) d) e)

7. 12-year-old girl with malaise, fatigue, sore throat and fever. On examination: petechial rash on palate, large tonsils with follicles, cervical lymphadenopathy and hepatosplenomagaly. All are complications EXCEPT: Aplastic anemia Encephalitis Transverse myelitis Splenic rupture Chronic active hepatitis 8. 6-month-old baby presented to clinic with 2-days history of gastroenteritis. On examination: decreased skin turgor, depressed anterior fontanel and sunken eyes. Best estimate of degree of dehydration: 3% 5% 10% 15% 25% 9. 3 days 5 days 7 days 10 days 14 days Total duration of treatment for group A streptococcal infection:

a) b) c) d) e) a) b) c) d) e)

a) b) c) d)

10. 8-month-old came with dehaydartion, fever, depressed anterior fontanel, vomiting, crying but no neck stiffness. No similar symptoms in her sisters. What is important investigation you want to do?: Blood culture CBC and differential CSF examination Chest x-ray

11. Female patient developed lesions on the cheek and nose and diagnosed as rosacia. Treatment is: a) Amoxicillin b) Tetracycline (according to Rona Mackie textbook) 12. (story of) patient presented to ER with low blood pressure, distended jugular veins, muffled heart sounds, bruises over the sternal area..etc. diagnosis is: a) Cardiac tamponade (remember Becks triad in cardiac tamponade: hypotension,increased JVP and muffled heart sounds)

a) b) c) d)

13. Pregnant woman, U/S showed anterior lateral placenta. Examiner finger can not reach placenta. This placenta is: Low lying Marginal placenta previa Partial placenta previa Lateral placenta previa

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SLE September 2006

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a) b) c) d) e)

14. Pregnant teacher at (16 or 20 weeks of gestation) reported 2 of her students developed meningitis. Prophylactic treatment: Observe for signs of meningitis meningitis polysaccharide vaccine. Ceftriaxone (I dont remember the dose and duration) Cefuroxime (I dont remember the dose and duration) rifampicin 600 mg BID for 2 days.

15. Mother brought her infant 18 month to ER with a history of URTI for the last 2 days with mild respiratory distress this evening the infant started to have hard barking cough with respiratory distress on examination RR 40\min , associated with nasal flaring suprasternal retraction and intercostal retraction. What is the most likely diagnosis: a) viral pneumonia b) bacterial pneumonia c) bronchiolitis d) acute epiglotitis e) trachobronchiolitis 51 . 16. A women came to antenatal clinic at 8 weeks gestation Diagnosed as a case of Cervical incompetence, which of the following is the appropriate management : a) insert a suture in the same week b) insert a suture at 14 to 16 weeks gestation c) confirm the Diagnosis By inserting Hegar s dilator d) admit the patient throughout the pregnancy time in the hospital for observation. e) give beta-mimetic agent (Ritodrine) 61 . 17. A 45 year-old-man came to the ER with sudden headache, blurred vision, excruciating eye pain, frequent vomiting. The most likely diagnosis: a) Acute conjunctivitis b) Acute iritis c) Acute glaucoma d) Episcleritis e) Corneal ulceration 71 . 18. Patient presented to ER with dyspnea, right-sided chest pain, engorged neck veins and weak heart sounds. Stethoscope over right lung showed no air entry. Plan of treatment for this patient: a) I.V fluid, pain killer, O2 b) aspiration of pericardium c) respiratory stimulus d) intubaion e) immediate needle aspiration, chest tube 81 . 19. Which of the following physical findings in boys is the earliest indication that puberty has begun:

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SLE September 2006 a) b) c) d) e) Increasing prostate size Appearance of the upper lip hair Increasing penis size Increasing testicular size appearance of pubic hair

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a) b) c) d) e) a) b) c) d) e)

20. A 48-hour-old newborn infant is in critical care unit with respiratory distress and jaundice. Hemoglobin is 9 gram/dl, and reticulocyte is 4%. Maternal history of previous normal-term-pregnancy without transfusion. Blood types shows heterospecificity type between mother and child. Indirect Coomb's test positive. The MOST probable diagnosis is: Thalassemia Maternal - Fetal blood group incompatibility Sickle cell Septicemia Hereditary red cell enzymatic defect 21. Perinatal mortality: Includes all stillbirths after the 20th week of pregnancy Includes all neonatal deaths in the 1st 8 weeks of life Includes all stillbirths and first week neonatal deaths Specifically ..... neonatal deaths Is usually ...... as death per 10,000 live births 22. An 18 months old baby brought by his mother, she complains that her child says only mama & baba. Otherwise the baby is completely normal. First step to evaluate this patient is: physical examination Chromosomal analysis Hearing evaluation Developmental testing CT scan of the head (I am not sure if there was reassurance or not) 23. A full-term infant brought by his mother to your office weighing 3800 grams developed jaundice on the 2nd day of life. The infant appears healthy and breast-feeding well. The infant's hemoglobin is 180 g/L. The direct and indirect Coomb's tests are negative. The infant's total bilirubin is 189 umoL/L (11 mg/dl) and the indirect bilirubin is 184 umoL/L. The MOST likely diagnosis in this infant is: Undiagnosed neonatal sepsis Breast milk jaundice Physiological jaundice Jaundice due to a minor antigen blood group incompatibility ABO blood group incompatibility

a) b) c) d) e)

a) b) c) d) e)

24. A 5-day-old baby vomited dark red blood twice over the past 4 hours. He is active and feeding well by breast. The MOST likely cause is: a) Esophagitis

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SLE September 2006 b) c) d) e) Esophageal varices Gastritis Duodenal ulcer Cracked maternal nipples

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a) b) c) d) e)

25. A 5-year-old patient was seen at ER with history of fever and sore throat. Which of the following findings will suggest a viral etiology for his complaint? Presence of a thin membrane over the tonsils A palpable tender cervical lymph node Petechial rash at hard or soft palate Absence of cough Rhinorrhea of clear colorless secretions 26. An 80-year-old woman presented to your office with a 6-month history of stiffness in her hands bilaterally. This stiffness is worse in the morning and quickly subsides as the patient begins her daily activities. She has no other significant medical problems. On examination, the patient has bony swelling at the margins of the distal interphalangeal joints on the second to the fifth digits on both hands. No other abnormalities are found on physical examination. These swellings represent: Heberden's nodes Bouchar's nodes Synovial thickenings Subcutaneous nodules Sesamoids 27. Which of the following radiological features is a characteristic of miliary tuberculosis: Sparing of the lung apices Pleural effusion Septal lines Absence of glandular enlargement Presence of small cavity 28. A 70-year-old woman presented with a 3-day history of perforated duodenal ulcer...She was febrile, semi comatose and dehydrated on admission. The BEST treatment is: Transfuse with blood, re-hydrate and perform vagotomy and drainage urgently Insert a nasogastric tube and connect to suction, hydrate the patient, give systemic antibiotics and observe Insert a nasogastric tube and connect to suction, hydrate the patient, give systemic antibiotics and perform plication of the perforation Hydrate the patient, give blood, give systemic antibiotics and perform hemigastrectomy None of the above

a) b) c) d) e)

a) b) c) d) e)

a) b) c) d) e)

29. The following are complications of laparoscopic cholecystectomy EXCEPT: a) Bile leak

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SLE September 2006 b) c) d) e) a) b) c) d) e) Persistent pneumoperitoneum Shoulder tip pain Ascites Supraumbilical incisional hernia 30. Fissure-in-ano MOST commonly occurs: Posteriorly Anteriorly Laterally In men In cases of diarrhea

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a) b) c) d) e)

31. A 20-year-old man involved in Road Traffi