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01.03.2012

By: Alhag Abu Anzeh Muhammad (baghdats@yahoo.com)

Part A:

1- A 25 y.o female at 41 wk gestation is noted to change her cervical dilatation from -! cm within 2 ho"rs .

#here of the following most diagnosis is $

A. %ormal la&or 'rogress

(. 'rolonget latent 'hase

).'rotracted active 'hase

*.arest active 'hase

+.arest of descent

2. #hich %,%-o&stetrical s"rgical 'roced"re is most commonly 'erformed in the 2-end trimester of 'regnancy $

A. a''endectomy

(. cholecystectomy

).ovarian cyestectomy

*.tensillectomy

+.s'lenectomy

3.*"ring what 'eriod of gestation does high dos ioniing radiation e'os"re 'ose the most risk of mental

retardation in the fet"s $

A.4-/

(.-10

).20-2

*.2-3/

4. +val"ation of "ncom'licated long standing chronic hy'ertension early in 'regnancy incl"des all ++P+ which

of the following $

A.eachocardiogra'hy

(.ser"m creatinine level

). o'htalmological eval"ation

*."rinary catecolamine

+. "antitive "rinary 'rotein analysis

5. (-&lockers "se in 'regnancy in 'artic"lar Atenolol is associated with which of the following 'erinatal

mor&idities $

A. 'reterm &irth

(. neonatal hy'erglycemia

) fetal growth restriction

*. infantile res'iratory distress syndrome

+. neonatal 'olycythemia

.which of the following actions im'roves oygenation thro"gh the 'lacenta in cases of fetal heart rate

deceleration $

A. left lateral rec"m&ent 'osition

(. e'id"ral anesthesia

) mor'hine s"l'hate administration

*. oytocin

+. atro'ine

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/."m&ilical cord 'rola'se is most likely to occ"r with which of the following $

A. face 'resentation

(. transverse lie

).frank &reech 'resentation

*.com'lete &reech 'resentation

+. &rew 'resentation

. a m"lti'ara with 'revio"s ma6or throm&oem&olic event is on hea'arin treatment from the &eginning of

'regnancy7 long-term hea'arin thera'y may lead to which of the following com'lications $

A.oste'orosis

(.throm&o'hilia

). fetal intracranial hemorrhage

*.dia&etes mellit"s

+. he'arin ind"ced thromocyto'enia

!. which of the folloeing is &est management of an 1 year old 'rimigravida at 2 weeks gestation with (P

108110 7 elevated liver f"nction tests and 'latelet of 070008mml $

A.e'ectant management and oral antihy'ertensive thera'y

(. 'latelet transf"sion and liver f"nction monitoring

). magnesi"m s"lfat thera'y and 'rom't delivery

*. imm"noglo&"lin thera'y

+. 'lasma'haresis

10. what lower limit level for the 50 g gl"cose screen wo"ld im'rove its sensitivity to 9!0 for detection of

gestational dia&etes:

A.130

(.135

).140

*.145

+.150

11; A 20 year old woman n"ll'ari"s 'atient was fo"nd to &e sereonegative for )

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13; a re'eated grad"al 20 &eats 'er mint dee' smooth deceleration of the fetal heart rate that start after the

'eak of each c-indication descri&es which of the following fetal heart &eat 'atterns :

A; early deceleration .

(; late deceleration .

); varia&le deceleration .

*; 'rolonged deceleration .

+; sin"soidal 'attern .

14; yo"r 'atient 30 weeks gestational e'erience 'remat"re of '-'rom c"rrent recommended for the

management of 'rom incl"de which of the following $

A; &road s'ectr" 'ro'hylactic 'arenteral antimicro&ial thera'y.

(; cesarian section if s'ontan la&or occ"rs &efore 35 weeks .

); gelatin s'onge '"lgging of the cervi.

*; second "ltraso"nd meas"rements of the e'ansion of the cervi +; daily washing of the vagina with a

sol"tion of iodine or )hlorheidine

15; which of the following incorrect regarding semen analysis $

A; se"al interco"rse sho"ld &e avoided - days 'rior the semen.

(; semen e6ac"laion sho"ld &e "' to an ho"r 'rior to analysis.

); there is high varia&le in the same male 'atient analysis .

*; diagnostic of an anomaly will never &e given &ased on a single sam'le.

+; mor'hology of the s'erm has the highest correlation with fertility

1. #hat of the following is not a significant detail in the anamnesis of the male infertility$

A. in&orn defects

(.no omission of the testis

c. fre="ency of se

*. fre="ency of >having+. fre="ency of cons"m'tion of fatty foods

1/; a female 'atient "ndergoes follicle sonograra'hic follow "' for the eval"ation of 'rimary infertility on cycle

day 14 a single follicle 22mm in diameter is identified7 what is the significance of the finding:

a-normal finding 'rior to ov"lation

&-cor'"s l"te"m

c-f"nctional ovarian cyst

d-&enign ovarian t"mor

e-normal finding following ov"lation

1; what is the main hormone that effects the cervical m"c"s after ov"lation

a-'rogesteron

&-estrogen

c-cortisol

d-?@

e->@

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1!; following a 'rimary infertility eval"ation of a 41 years old co"'le the female 'artner was fo"nd to have

menses every 3 day 'rogesterone level 2ng8ml on cycle day 30 and a normal "terine cavity with normal contrast

dye 'assage to the 'elvis on hysterosal'ingogra'hy the male semen analysis was: concentration 22 milion8ml

55moyility and 30normal mor'hology what is the etiology of the infertility in this case:

a-l"teal 'hase infertility

&-male factor infertility

c-"terine factor infertility

d-idio'atic infertility

e-age related and ov"lation disorder

20-A which of the following is correct regarding females with m"llerian dysgenesis$

a-a&sence of the inferior third of vagaina

&-"ter"s eistence

c- 4 karyoty'e

d-com'lete vaginal and "ter"s a&sence

e-menses a''earance following estrogen and 'rogesterone test

21-which of the following characteried the female athletic triad syndrome$

A-

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25-which of the following is a test for ovarian reserve$

A->@ level on 'eriod day 3.

(-estradiol level on 'eriod day .

)-'rogesterone level following ov"lation.

*-?@ level &efore ov"lation.

+- inhi&in A level.

2- what are the acce'ted indications for systemic estrogen treatment for 'ost-meno'a"sal women$

A-osteo'orosis 'revention7 coronary artery disease 'revention7 treatment of vaginal and v"lvar atro'hy.

(-osteo'orosis 'revention7 treatment of vasomotor sym'toms7 treatment of vaginal and v"lvar atro'hy.

)-coronary artery disease 'revention7 mood im'rovement7 'revention of AlheimerEs disease.

*-mood im'rovement7 treatment of vasomotor sym'toms7 'revention of AlheimerEs disease.

+-coronary artery disease 'revention7 treatment of vaginal and v"lvar atro'hy7 'revention of AlheimerEs

disease.

2/-what are the contraindication of systemic estrogen treatment as a re'lacement thera'y for 'ost-meno'a"sal

woman$

A-osteo'orosis

(-"ndiagnosed vaginal &leeding

)-o&esity

*-dia&etes

+-hy'ertension

2-a 30 year old female 7 B5P47 is 10 weeks 'regnantDintra"terine 'regnancy; in the 'resence of an intra"terine

device D*;. >he is interested in contin"ing the 'regnancy. he F* wire is visi&le at the cervical os.

#hich of the following is the a''ro'riate management $

A-leave the F* in 'lace with no f"rther treatment.

(-leave the F* in 'lace and treat with anti&iotics.

)-remove the F* now7 followed &y e'ectant management.

*-terminate the 'regnancy d"e to the increased infection risk.

+-'erform a la'arosco'y to ecl"de heteroto'ic 'regnancy.

2!-which of the following is an a&sol"te contraindication for oral contrace'tive administration$

A-lower etremity varics.

(-tension headaches.

)-sei"re disorder.

*-smoking over the age of 35 .

+-mild hy'ertension.

30-which of the following is correct regarding "terine leiomyomas$

A-50 of the 'atients will s"ffer from a&normal "terine &leeding.

(-there is a strong association &etween leiomyomas and infertility.)-leiomyomas diminish and are mostly asym'tomatic d"ring 'regnancy.

*-anemia is the most common com'lication of leiomyomas.

+-there is no rec"rrence following the resection of leiomyomas.

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31. woman with mat"re cystic &enign teratoma . which of the following is correct:

a.10 of the &enign t"mors

&. more related with meno'a"se

c. associated with 'ain and ascites

d. com'osed of the 3 em&ryonic layers

e. make diagnosis with ? on 'a' smear 'ositive 3.net management

a. histerosco'y a&domen

&. col'osco'y and &io'sy

c. @P vain

d- tracheletomy

33. 1/yo girl with 'ain in a&domen after "ltraso"nd 1cm ovarian adneal mass:

a.gonado&lastoma

&. linfoma

c. (renner

d7 disgerminoma

e. sero"s e'ithel carcinoma

34- anatomy in6"ry to "reter smallest chance in gynecologic 'roced"re:

a- "ter"s artery

&. cardinal ligament

c.&ilateral vaginal fornices

d.

e.ovarian ligament

35. /0 yo women with watery vaginal discharge:

a-metastatic "terine cancer&-e'itel ovaric cancer

c-e'itel fallo'ian carcinoma

d-&enign ovaric cancer

e- mt colon cancer

3. 45yo non 'rod"ctive co"gh with hy'ertension with lis ino'ril G statin G A)+ inh&itorP:

a. change A)+ ini&itor to angiotensin 2 ini&itor

3.

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3/. /0yo with lisino'ril amlodi'ine 7(lood Press"re 138/48 weight 72 kg creatinie 2.57

BC 2. what stage$

a.

& .

c.

d.

3. 0 yo stage )I* with increase creatinin7 (P 1208/07 creatinin .37 IG 4.7 @),3 207 net ste' $

a change fistola

& dialysis

c &io'sy

d 24h "rine 'rotein collection

3!. 50 yo man with diff"se &one 'ain for wk now . dialysis for 15 year:

a. amiloidosis

&. renal osteodistro'hy

c. mieloma m"lti'le

d. osteoarthritis

40. woman 2!yo wk with morning stiffness 7 swelling hands 3th and 4th metacar'al 7small nod"les . diagnosis

test:

a. anti cc' Danti-cyclic citr"llinated 'rotein anti&odie;

&. rhe"matoid factor

c. cA%)A J cito'lasmatic Anti-ne"tro'hil cyto'lasmic anti&odie

d. 'A%)A J'erin"clear Anti-ne"tro'hil cyto'lasmic anti&odie

41;5 year old man with achalasia and hy'ertention is eval"ated for worsening dys'nea and 10-'o"nds weight

loss over the 'ast weeks.he has 50 'ack Hyear sm'king historyand cons"mes 2 li=o"r drinks 'er day .'hysical

eamination is "nreveling s"&se="ent eso'hagogastrodo"denosco'y reveals "lcerating lesion in the 'roimal

eso'hag"s&io'sy of the mass shows s="am"s cell carcinoma which of the following are risk factor fordevelo'ment s="am"s cell carcinoma$

a;to&acco

&;alcohol

c;achalasia

d;all the a&ove

42; A4/ year old man is eval"ated &eca"se of 4 months history of fatig"e 7na"sea7 and mild e'igastric 'ain 7

"''er endosco'y shows thickened nod"lar forms in the distal stomach . &io'sy s'ecimen revelas h.'ylori

organism and low grade gastric m"cosa associated lym'hoid tiss"e lym'homa .ct scan of the a&domen shows no

evedance of metastasis or lymnodes involvment which of the following is the most a''ro'riate treatment for this

'atient $

a;chemothera'y 7radiation 7s"rgical resection

&;total gastrectomyc;radiation

d;ome'raol7clarithromycin .amoicillin

43;which of the following a&o"t angina 'ectoris is tr"e$

a; ty'ically lasts 1-2 h

&; it may associated with e'igastric 'ain

c; it ca"ses 'erdicta&le +)B changes

d; it ty'ically associated with chest wall tenderness

e; rarely radiates to neck 6aw or sho"lder

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44;1 year old women 'resent for eval"ation of facial and lower etremity edema 2weeks ago 7she was

diagnosed with "''er res'iratory tract infection that has since resolved with s"''"rative treatment on 'hysical

eamination (HP 150H100 cardiac normal 7&ilateral lower 'itting edema la& test : creatinine 1./ al&"min 3.5 lower

ser"m com'lement "rinealysis 1G 'rotiens dysmor'hic r&cs with casts which of the following is most likely

diagnosis $

a;ga gl"mer"lone'hritis

&;wegner disease

c;>?+

d;'ost stre't gl"mer"lone'hritis

45;52 year old man com'lain of dys'nea for weekshe has minimal 'rior medical care notes no 'rior medical

'ro&lems and denies any medication "se he admits to have smoked a'ack of ciggarets daily for 30 years .he is

c"rrently sta&le and 'hysical eaminattion is remarka&le for 'rolonged e'iratory 'hase and diminished

&raething so"nds &ilaterally in which of the following most likely ca"se for chronic dys'nea $

a;'"lmonary em&olism

&;co'd

c;dia&etes

d;myocardial infarction

4;20 year old man 'resent with hemat"ria he has noticed &lood in his "rine twice in the 'ast months &oth

occation 3-5 days after "''er res'iratory infect ion 7 his 'hysical e is "nremarka&le 7 la& normal craetinine

"rinelysis :trace 'rotin"ria 2G &lood 10-15 r&cs ...most likely diagnosis$

a;good'ast"re

&;henoch schenloin '"r'ra

c;'ost infection gl"mer"lone'hritis

d;ga ne'hro'athy

4/;5 year old women with 'rosthetic mechanical mitral valve 'resent of 1 week history of fever "' to 3!.57

maliase diff"se myalgia 7 &lood c"lt"re ret"rn 'ositive for coag"lase negative sta'h which of the following is

indicated for this 'atient$

a.transthoracicecho&.trans eso'hgeal echo

c.m"lti slice ct

d.24 ho"r holter

4;5 year old woman 'revio"s history of infective endocarditis 'resent for advice regarding anti&iotic

'ro'hylais 'rior to dental 'roseds"re it will involve significant gingival mani'"lation she has no allergy .

which A( is indicated $

a;levofloacin

&;clarithromycin

c;no anti&iotic

d;amoicillin

4!; 32 year old man history of iv dr"g "se 'resent with 3 days history of intermitten fever "' to 3.3 and maliase

on eamination :3.3 (HP 130H5 heart rate !4 CC:1! he has new 2H systolic m"rm"r at left sternal chest

radiogra'h normal "rinelysis 5-10r&cs for this 'atient which more likely etiology of fever$

a;coag"lase neg sta'h

&;stre't

);mecthillin resistance sta'h

d;gram negative enteric &acteria

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50;/2 y+ar old woman with history of hy'ertention and to&acco 'resent with chest 'ain for 2 weeks she discri&es

'ain as 'ress"re like with radiation to left arm it incrase &y eertion and relived &y rest there is no association

she deniy chest 'ain history 'hysical eamination "nrevealed +)B shows ?@ .la&s cardiac enymes are normal

which of the following is most likely diagnosis $

a;non st segment elevation myocardial infarction

&;'ericarditis

c;"nsta&le anginal

d;sta&le anginal

51. a 3 year old male 'resents with 'rod"ctive co"gh. he 'tient re'orts feeling well "ntil he develo'ed

dys'nea and a 'rod"ctive co"gh of green s'"t"m 2 days ago. @is sym'toms have 'rogressed and now he also

re'orts fever and chills. ,n eamination: *ecreased &reath so"nds associated with rhonchi and increased

fremit"s in his right l"ng &ase. A chest -ray reveals consiladation in the right lower lo&e.

#hich of the following is the most common organism identified in s"ch ad"lt 'atients:

a. @. nfl"ena.

&. stre'. Pne"monia.

c.

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54. a 40 year old female with a histroy of coronary artery disease7 stat"s 'ost-'erc"taneo"s coronry intervention

with a dr"g-el"ting stent 1 year ago7 'resents to the emergency de'artment with fever and right "''er ="adrent

'ain for 1 day. An a&dominal sonogram reveals gallstones with likely cholecystitis and no &iliary d"ctal dilation.

>he is admitted for anti&iotics and a geeral s"rgery cons"ltation7 the s"rgeon is concerned &eca"se the 'atient is

on clo'idogeral for a dr"g-el"ting stent. f 'ossi&le7 how long sho"ld s"rgery &e delayed after sto''ing the

'atients clo'idogeral:

a. 1 day.

&. / days.

c. 1 month.

d. 1 year.

55. a ro"tine eamination in a / year old woman revelaed le"kocytois. >he denies fever7 night sweats or weight

loss. @er'hysical eamination is normal7 in 'artic"lar she has no lym'hadeno'athy or he'atos'lenomegaly.

A re'eat &lood cell co"nt shows le"kocytosis with an a&sol"te lym'hocyte co"nt of /.510!8?. @er hemaglo&in

and 'latelet co"nt are normal. low cytometry reveals a monoclonal ( cell 'o'"lation.

#hich of the following is the most likely diagnosis for this 'atient:

a. Ac"te myelogeno"s le"kemia.

&. ac"te lym'hocytic le"kemia.

c. chronic myelogeno"s le"kemia.

d. chronic lym'hocytic lekemia D)??;.

e. ?ym'ho&lastic lym'homa.

5. a 44 y old woman with ac"te myelogeno"s le"kemia7 c"rrently "ndergoing ind"ction chemother'y7 was

noted to hve a 'latelet co"nt of !0008

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5. a /0 year old man with a history of hy'ertension and dia&etes 'resents to the management of chronic angina

for the 'ast year. @is chest 'ain now occ"rs one or 3 times 'er month7 ty'ically last 5 min"tes7 and are relieved

&y rest and s"&ling"inal nitroglycerin. A recent 'harmacologic stress test showed a reversi&le 'erf"sion defect.

#hat is the most a''ro'riate net ste' in the management for this 'atients angina:

a. Add mor'hine to the 'atients regimen.

&. )oronary angiogra'hy7

c. ?ifestyle modification incl"ding eercise.

d. )ontin"e with the c"rrent management.

5!. which of the following is the most likely factor contri&"ting to chronic myeloid le"kemia:

a. +'os"re to radiation.

&. amily histroy of cancer.

c. o&acco a&"se.

d. Philadel'hia chromosome DPh;.

0. a 0 year old woman has 6"st had the diagnosis of )

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4. #hich of the following is the most a''ro'riate net ste' in the eamination of 'atients with endocarditis7 the

ca"sative agent is >tre'tococc"s &ovis:

A. )om'lete eamination of the teeth to 'revent a 'ossi&le a&scessed tooth

(. I?A and liver f"nction tests every months

). I?A and liver f"nction tests every months7 eye eamination every year

*. ?iver f"nction tests every esyatsev7 eye eamination every yeaC.

5. Patient 44 years old7 s"ffering from rhe"matoid arthritis 2 years7 "ndergoing tests on the com'laints

of aggravated symmetrical 'ain in the 6oints of hands and feet 2 weeks. em'erat"re 3/.3. P>-!0 min7 &lood

'ress"re7 1328!07 heart and l"ngs are normal7 marked he'atos'lenomegaly7 active synovitis

fingermetacar'o'halangeal 6oints of the hands. @emoglo&in 12 g 8 l7 le"kocytes 1./ N 10 ! degrees7 'latelets 15

000. he total meta&olic rate analysis.

#hat is the most likely diagnosis of this 'atient$

A. ?"'"s erythematos"s7 dr"g ind"ced

(. )indrom elty

). +vans >yndrome

*. nfection with 'arvovir">.

; 35 year old man was diagnosed with 'ancreatitis a weak ago7 right "''er ="adrant sonogram showed the

evidence of cholelithiasis7 his sym'tom resolved with conservative treatment7 management after 2 days of

hos'ital,n 'hysical e...amination raised way a''earance yellowish colo"red skin lesion on the etensor

s"rgace of &ilateral arm7 having had this for many years.A li'id 'anel revealed total cholesterol 217 @*? J 427

?*? J 127 riglycerides J 140.

#hat is the most a''ro'riate net ste'$

a; %o f"rther work"'

&; Prescri&e gemfi&roi

lc; Prescri&e atorvastatin

d; Cefer to cholecystectomy

e; Prescri&e niacin

/; 35 year old female came for a ro"tine visit her 'ast medical history is significant for 'oorly controlled ty'e

*ia&etes mellit"s last @( A1c is ./ has o&str"ctive slee' a'nea7 o&esity and hy'ertension7 dysli'idemia.@ermedication metformin7 ins"lin7 hydrochlorothiaide7 and atorvastatin7 on 'hysical eamination (

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!; a 34 year old man 'resents for a ro"tine visit7 he has no com'lain today7 he has history of o&esity D(ym'toms have coincided with diffic"lty slee'ing and

generaliead walars.and lethargy7 on eamination she has a hy'er'igmented malar rash 7 moderate synovitis of

the hands7 and 'ale con6"ctiva7

#hich of the following is the most likely diagnosis for this 'atient$

a.re"matoid aritritis

&.systemic l"'"s

c.fi'romyalOigia

d.'olymialgia

e.hy'othiroidism

1.A 4/ y old man is com'laining of fatig"e 7lethargy and 4.5kg wheight gain for last 2 months .his 'ast medical

history consists of hy'ertension and hy'erli'idemia for which is take lis ino'ril7 simvastin7on eamination7&lood

'ress"re 1308/ and heart rate 54 &eats 7 mild non'iting edema in his &ilateral lower etrimties 7dee' tendon

refles and delayed the rest of his eamination in "nmarka&le7 which of the following is the &est screening testingfor this 'atient$

a.4

&.>@

).3

*.4G3

2.A43 years old man 'resents whith 'al'itation an shortness of &reath7on eamination &lood 'ress"re 12480

h.rate 12 &8min irreg"lar and 3.c 7moderate &ilateral eo'htalmos 7a 'al'a&le goiter7a 28 systolic flow

m"rm"r and mildweakness in &ilateral lower etremities.An +)B confirm atrial fi&rillation with ra'id7ventric"lar

res'onse and tsh at 0.003mm8ml los-4./mm8ml D0.5-4./mm8ml; which of the follwing is the most a''ro'riate

treatment for A. n @+ PA+%$

a.'ro'ylthio"racil

&.iodide

c.'ro'ranolo

d.'rendison

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3.a 5/ years old com'laining of a mass in the neck she has not had any systimacly sym'toms and has not &een

losing weight . &lood 'ress"re 7 heart rate normal. >he does not have 'al'a&le nod"le in the left 'ole of the

thyroid gland. >he has no cervical or s"'raclavic"lar lym'hoadeno'athy. >@ levels are whith normal limits 7and a

sonogram of the thyroid confirms 1. cm cystic nod"le in the left 'ole for this 'atient.

#hich of the following is the &est net ste'$

a.fna

&.radion"clide "'take imaging

c.ct of the neck

d. ser"m thyroglo&"lin assay

4.a 41 years old &"siness ec"tive 'resents to yo"r office and com'laints of 'al'itation and shortness &reath 7

after f"rther ="estioning 7he admits to heavy alcohol cons"m'tion the 'revio"s evening 7on eamination he is

fo"nd to have an irreg"lar heart &eat of 130 &8min7 the most likely diagnosis is$

a.entric"lar tachycardia

&.ventric"lar fi&rillation

'remat"re 7 contractions

c.atrial fi&relation

d.wPw syndrom

5; a healthy 2 yrs. ,ld man 'resented with a&dominal cram'ing7 fever for 2 days and diarrhea7 10 stools in the

last 24h with &lood and #()s. he most likely diagnosis is:

a- sta'hylococcal food 'oisoing

&- rotavir"s

c- chrons disease

d. shigellosis

e- (>

; 5! yrs. ,ld female with a history of a heart m"rm"r &"t no other sym'toms or rihomatic fever. he m"rm"r

is 28 crescendo decrescendo that radiates to the carotid artery. he m"rm"r decreases with valsalva mane"ver

and on standing7 the most likely diagnosis is:

a. aortic stenosis

&- tric"s'id reg"rgitation

c- mitral reg"rgitation

d- hy'ertro'hy o&str"ctive cardiomyo'athy

/; a 'revio"s healthy 15 yrs. ,ld &oy was at a 'arty. he 'resented to the emergency room after a s"dden onset

of anger7 agitation and 'aranoia. @e clam that a government agent is s'ying on him. he first thing to do is:

a- ++B

&- gl"cose rolerance test

c- P+ for the head

d- thyroid f"nction test

e. "rine toicology screen

; flo"etines most common adverse effect:

a- hy'otension

&- liver toicity

c. na"sea

d- sedation

e- weight gain

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!; a''ro'riate medication for o"rette disorder:

a- &"'ro'ione

&. clonidine

c. halo'eridol

d- 'aroetine

e- venlafaine

!0. #hich of the following is the most common adverse effect of methyl'henidate $

A. @y'otension.

(. nsomia.

). ?iver toicity.

*. remor

+. #eight gain.

!1. #hich of the following ="alities wo"ld &e most commonly associated with a more favora&le 'rognosis of

a"tistic disorder$

A. +asy toilet training.

(. nterested in mechanical toys.

). ,rganied 'lay.

*. Ceci'rocal conversion.

+. Ceciting songs and 'oems from memory.

!2. #hich of the following la&oratory a&normalities are most likely to &e fo"nd in a 'atient with anoreia

nervosa$

A. @y'ercholesterolemia.

(. @y'erkalemia.

). @y'ocarotenemia.

*. ncreased thyroid stim"lating hormone D>@;.

+. ?e"kocytosis.

!3. #hich of the following disorders is rarely conf"sed with aniety that stems 'rimarily from medical disorder$

A. Panic disorder

(. >'ecific 'ho&ia

). ,&sessive com'"lsive disorder.

*. Post tra"matic stress disorder

+. Beneralied aniety disorder

!4.a 2 year old female was diagnosed to have D'ost stress disorder; P>* after she was assa"lted and ra'ed

months ago. ,ver the net2 years7 des'ite etensive thera'y and 'harmacological treatment7 the res'onse was

s"&o'timal. >he was later diagnosed to have ma6or de'ressive disorder and s"&stance a&"se 'ro&lems. #hich of

the following is the most common comor&id condition in women with P>*$

A. >"&stance a&"se

(. *e'ression

). ,&sessive com'"lsive disorder

*. Psychotic disorder

+. +ating disorder

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!5. #hich of the following is the most common somatoform disorder$

A. )onversion disorder

(. >omatiation disorder

). Pain disorder

*. @y'ochondriasis

+. (ody dismor'hic disorder

!. #hich of the following hel's in disting"ishing malingering and factitio"s disorder$

A. Age

(. >econdary gain

). *eli&erate 'rod"ction of sym'toms

*. )o"rse of illness

+. Ces'onse to conformation

!/. A 4 year old women is fr"strated and angry with her ne"rologist &eca"se he recommended a 'sychiatric

eval"ation for what she descri&es as Qmedical 'ro&lemsR. >he com'lains of dines7 na"sea7 'al'itations7

a&dominal 'ain and sweating 7 &"t no one is a&le to give her the right ttreatment. >he was seen &y an ear

s'ecialist 7 cardiologist 7 and a gastroenterologist 7 &"t nothing a&normal was detected. >he was ho'ing that a

ne"rologist wo"ld find a ca"se for her sym'toms. >he also states that these sym'toms occ"r with sym'toms

witho"t any 'reci'itating factors7 last for 20 to 30 min"tes7 and she feels as if she is Qa&o"t to dieR. he most

'ro&a&le diagnosis in this women is:

A. BA*.

(.

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10/. #hich of the following medical disorder is associated with the highest risk of s"icide$

A. +'ili'sy.

(. @"ntingtons disease.

). A*>.

*. )ancer.

+. (rain in6"ry.

10. cortisol has a significant im'act on mood and c"shingEs syndrome is often associated with 'sychiatric

dist"r&ance. #hat is the most common 'sychiatric manifestation in 'atient with c"shings syndrome$

A. >CEs are contraindicated in liver disease.

*. Paroetine ca"ses minimal inhi&ition of he'atic enymes.

+. @alf lives of dr"gs are red"ced in liver disease.

110. #hich of the following statements is tr"e a&o"t s"icide in medically ill 'atients $

A.

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Part (:

1; in disting"ishing schio'hrenia from am'hetamine ind"ced toic 'sychosis the 'resence of which of the

following in the most hel'f"l$

a- tectile or vis"al hall"cination

&- 'aranoid del"sion

c-intact orientation

d- clear conscio"snes

e- a"ditory hall"cination

2; which of the following electrolyte a&normality is associated with &"l"mic 'atient $

a- meta&loic acidosis

&- res'iratory acidosis

c-meta&loic alkalosis

d- res'iratory alkalosis

e-normal

3; P>* differs from ac"te stress disorderDA>*;:

a- A>* occ"rs more commonly than P>*

&- P>* is associated with at least 3 dissociative sym'toms

c- ree'ercing the tra"ma is not fo"nd in A>*

d- avoidance of stim"li is associated with the tra"ma is only fo"nd in P>*

e- P>* lasts less than 1 month after tra"ma

4; do"&le de'ression:

a- 2 family mem&ers with de'ressive disorder conc"rrently

&-rec"rrent ma6or de'ressive disorder with c"rrent sym'toms twice as disa&iling

c- two e'isodes of ma6or de'ressive disoder at month

d-s"'erim'osed &i'olar 2 disorder with aty'ical de'ression

e- rec"rrent ma6or de'ression disorder s"'erim'osed with dysthmic disorder

5; cloa'ine:

a. s associated with few7 if any7 etra'eramidal side effects.

&- is &elieved to eert its thera'e"tic effect mainly &y &locking the do'amine rece'tors.

c- ca"ses significant increase in 'rolactin level

d- is associated with 10-20 incidence of agranolocytosis

e- re="ires monthly monitoring of &lood chemistry

; late onset schio'hrenia:

a- is more common in men

&. is associated with a 're'onderance of 'aranoid sym'toms

c- is clinically disting"ished from early onset schio'hrenia d- res"lts in

'oorer res'onse to anti'sychotic medicatione- has an onset after 0 years of age.

/; minor signs and sym'toms of discontin"ation on &enodiae'ine:

a- hy'er'yreia

&- grand mal sei"re

c- 'sychosis

d. nightmares.

e- death

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; which of the following com'lications wo"ld &e the &est indication for admitting 'atient with anoreia

nervoasa to the hos'ital:

a- anemia

&. arrhythmia

c- &radycardia

d- hy'otention

e- lan"go

!; #hich of the following wo"ld &e the most a''ro'riate treatment for 'anic disorder:

a- ari'i'raole

&- car&amae'ine

c- res'eridone

d. sertraline

e- val'oric acid

10; in &i'olar disorder7 which tests sho"ld &e done &efore treatment with lithi"m$

a-thyroid

f"nction test7 creatinine7 'regnancy test

&-thyroid f"nction test7 creatinine7 liver

c-thyroid f"nction test7 creatinine7 com'lete &lood co"nt

d- thyroid f"nction test7 liver f"nction test 'regnancy test

11. Lo" are seeing a 4 week infant who a''ears 6a"ndiced he is growing well witho"t any

'ro&lem and is ecl"sively &reastfed 7his 'hysical eamination is nota&le only for some

scleral icter"s and 6a"ndice to the a''ear chest yo"r net co"rse of act ion wo"ld &e$

a. a&dominal "ltra so"nd eamination

&. fractionated ser"m &ilir"&in

c. o&servation with follow "' a''ointment in 1 month

d. liver f"nction tests "rine c"lt"re

12. what wo"ld &e the &est first line management in 'reventing eacer&ations in 'atient with chronic

asthma$

a. inhaled al&"terol Dventolin;

&. le"kotriene inhi&itors

c.antiimm"nogglo&"lin +

d. inhaled corticosteroids

e. cromolyn sodi"m

13. Lo" are seeing a 12 year old female with h fever arthritis oral "lcers malar rash and

'hoto sensi&ility yo" s"s'ect she may have an imm"nologic disease7 which of the following tests wo"ld &e

most s'ecific for her disease:

a. antiendomesial anti&ody

&. anti do"&le sranded *%Ac. anti stre'olysin anti&ody

d. ser"m imm"nogo&"lines levels

14. #hich of the following co mor&idity com'lications is associate with overweight in adolescents$

a. sli''ed ca'ital femoral e'i'hysis

&. hy'oglycemia

c. angina

d. osteomalasia

e. fat necrosis

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15. nasal 'oly's in children:

a. may ca"se sero"s otitis

&. are common in early infancy

c. may ca"se s"ffocation or a'nea

d. are associate with cystic fi&rosis

e. are most often cancero"s

1. #hich of the following ca"ses of congenital infection is associate with cats$

a. cytomegalovir"s

&. r"&ella

c. too'lasma gondi

d. sy'hilis

e. 'arvovir"s (1!

1/. Patient who sho"ld receive 'ro'hylais for 'ne"mocystis carini 'ne"monia mor than others incl"de

those with:

a. linked agammaglo&"linemia

&. @ infection

c. chronic gran"lomato"s disease

d. sickle cell disease

e. congenital ne"tro'enia

1. A worried mother calls into re'ort that her 2 days old new&orn is &leeding from her &ottom7 her

'renatal and &irth history were "nremarka&le. ,n 'hysical eamination yo" noticed a &loody

serosang"io"s fl"id ooing from the vagina. here is no &r"ising or

'atechia. he most likely diagnosis is:

a. hemo'hilia A

&. child a&"se

c. &irth tra"ma

d. hemangioma of the v"lva

e. withdrawal &leeding

1!. A 10 years old white female 'resents with 'ain and swelling of the right el&ow7

accom'anied with fever of 3! c7 she re'orts that 3 days ago she had 'ainf"l swelling of the left ankle the

s"&side this morning. 2 weeks ago she had sore throat. ?a&oratory res"lts reveal elevated sediment rate7 a

negative antin"clear anti&ody7 and an elevated anti

stre'tolysine. he most likely diagnosis is:

a. >?+

&. 6"venile idio'athic arthritis

c. ac"te ra"matic fever

d. gonoccocal arthritis

e. se'tic arthritis

20. A 12 months old &oy is eamined &eca"se of ref"sal to walk. @e started to walk at 10

month and has &een doing well "ntil this 'oint. ,n 'hysical eamination he is moderately ill child with

fever of 3!.2 c 7 eternally rotated left hi' with limit to 'assive and active motion. he )CP level is high.

he most likely diagnosis is:

a. osteomyelitis of the left fem"r

&. se'tic arthritis of the left knee

c. legge 'erthes disease

d. se'tic arthritis of left hi'

e. ewing sarcoma of the left fem"r.

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21-3 years -old &oy 'resents to an "rgent care "nit with 3 days history of a&dominal 'ain and diffic"lty

walking. A&dominal findings incl"d &lood 'ress"re of 12080 mm @g 7 diff"se a&dominal tenderness7

'"r'"ric rash of hands and ankles7 and diff"se 'eriartic"lar tenderness and swelling of the ankles.the mos likele

diagnosis is:

a. >ystemic l"'"s erythematos"s

&. Iawasaki desease

c. S"venile rhe"mathidarthritis

d. @enoch ->chonlein '"r'"ra

e. >tevens T Sohnson syndrome

22-A 10 years-old &oy 'resent to clinic ro"tine 're'artici'ation s'orts 'hysical. @e re'orts no recent illness

or "n"s"al syntoms.on eamination yo" hear a distinct short systolic eyection m"rm"r. t is l o"dest at the left

lower sternal &order and is low 'itched and somewhat m"sical nat"re. #hen the 'atient sits "'right the m"rm"r

is less intense.#hich of the following is the most likely diagnosis$

a-Aortic valve reg"rgiatation

&- ventric"lo se'tal defect

c-Atrial se'tal defect

d- '"lmonary valve stenosis

e-vi&ratory innocent m"rm"r

23-risonomy 21 is m ost commonly associated with:

a-malrotacion

&-atrioventric"lar canal

c-cleft 'alat

d-renal fail"re

e-sensory ne"ral hearing loss

24- #hat is the most significant serio"s com'lication arising from kawasaky desease$

a-coronary ane"risms

&- kidney fail"re

c- gall&ladder stonesd- gastrointestinal &leeding

e-hy'ertension

25- a 20 months-old toddler is seen in the emergency de'artment &eca"se of an ho"rs

history of diffic"lt &reathing. Previo"sly he had &een 'erfectely well. *"ring s"''er he &egan having

'aroysmal co"ghing and wheeing. @e has not hat any 'revio"s similar e'isodes .

@e has moderately increaded work of &reathing. ,n a"sc"ltacion the wheeing is heard only over his right

chest. @is vital s igns are: tem'erat"re 3/)7 '"lse 137 res'itarory rate 0. he most lakely diagnosis is:

A. Asthma

(. )ystic fi&rosis

). Pne"monia

*. Poreign &ody as'iration

+. Pean"t allergy with ana'hylais

2-A 10 months-old infant has 'oor weight gain and 'ersistent co"gh. he mother descri&es t he child as

having very large 7 fo"l smelling stools for months . #hich of the following diagnostic modalities is lakely to res"lt

in correct diagnosis of the child$

a-) eamination of the chest

&-ser"m inm"noglo&"lins

c- PP*. >kin test

d-ins'iratory and e'iratory chest -ray

e->weat chloride test

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2/- 15 years -old girl with short stat"re 7neck we&&ing and se"al infantilism is fo"nd to have heart

m"rm"r 7 and weak femoral '"lse. #hich of the following is the most likely diagnosis$

a-Achondro'lasia

&-"rner >yndrome

c- *i Beorge >yndrome

d- congenital hi'otiroidism

e-)eliac desease

2-a year- old is hos'italied for o&servation &eca"se of short 'eriod of "nconscio"sness after fall from

'la"gro"nd swing. @e had develo'ed "nilateral 'a'illary dilatat ion 7 focal sei"res7 rec"rrence of de'ressed

conscioness and hemi'legia. #hich of the following is the most a''ro'riate meas"re at this time$

a-s'inal ta'

&- ) scan of the head

c-ra'id fl"id hydratation

d-naloone

e-&ilateral &"rr holes

2!- year- old &oy 'resent with the s"dden set of ataia which of the following is the most likely ca"se$

a-dr"g intoication

&- agenesis of cor'"s callos"s c-

ataia telangiectasia

d-m"sc"lar dystro'hy

e-riedrich Ataia

30-a 3 year- old &oy 'arentEs com'lain that their child has diffic"lt walking ha child 'erfomed ade="ately "ntil a

few months ago when the family notical an increased inward c"rvat"re of the lower s'ine as he walks and gait

&ecame wadding ,n eamination he has anlargedcalves. #hich of the following is the most likely diagnosis$

a-s'ina &ifida oc"lta

&-m"sc"lar dystro'hy

c-&rain t"mord-B"illain (arre syndrome

e-(ot"lism

31- A 14-year-old girl awakens with a m ild sore throat7 low-grade fever7 and a diff"se

mac"lo'a'"lar rash. *"ring the net few ho"rs7 she develo's tender swelling of her wrists and redness of

her eyes. ,n eamination there is marked swelling with mild tenderness of her 'osterior cervical and

occi'ital lym'h nodes. o"r ho"rs later the rash has vanished.

#hich of the following is the most likely diagnosis$

a. ignificantly elevated #() co"nt consistent with &acteremia )orrect

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33- 2 weeks ago7 2 year old &oy develo'ed diarrhea7 which has 'ersist to the 'resent time

des'ite dietary management. @is stools have &een watery7 'ale and frothy witho"t traces of

&lood. @e has &een fe&rile. +amination of his stool is likely to reveal which of the following$

a. >almonella sonnei

&. +ntero&i"s vermic"laris

c. )ry'tos'oridi"m 6e6"ni

d. oo'lasma gondii

e. Cotavir"s

34- An 1 month child 'resents with a &rief7 generalied tonic-clonic sei"re. @e is now

'ostictal and has a tem'erat"re of 40U). *"ring the l"m&ar '"nct"re Dwhich "ltimately

'roves to &e normal;7 he has a large7 watery stool that has &oth &lood and m"c"s in it.

#hich of the following is the most likely diagnosis in this 'atient$

a. >almonella

&. +nterovir"s

c. >higella

d. )am'ylo&acter

e. Cotavir"s

35- 12 years old ashkenay 6ewish girl has mild anemia 7 le"ko'enia and throm'ocyto'enia . 'fysic

eaminations revealsan enlarged s'leen. An -ray of the fem"r is descri&ed as a''earing to &e Q +rlenmeyer

flaskR. (one marrow eamination shows a&normal cells. #hich of the following the most likely diagnosis$

a. ay-sachs disease

&. Ba"cher disease

c.

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3!- An infant &orn 35 weeks gestation to a mother with no 'arental care is noted to &e

6ittery and irrita&le and having diffic"lty feeding. Lo" note coarse tremors on eamination with high

'itched cry. *iarrhea and en"resis. Lo" s"s'ect the infant is withdrawing from which of the following$

a.Alcohol

&.

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45 - a 3 month old infant 'resents for a well child eval"ation. #hich of the following wo"ld &e a

ca"se for concern in the infant$

a - reg"rgitation of 15-30 ml of form"la 3 times a day

&- one &owel movement every other day

c - 3 &owel movements 'er day

d - liver s'an of 5 cm

e - hemocc"lt-'ositive stool

4 - d"ring ro"tine screening )()7 a 1 year old is noted to have 'rono"nced eosini'hilia.

#hich of the following is the most likely e'lanation$

a - &acterial infections

& - chronic allergic rhinitis

c - f"ngal infections

d - helminth infestation

e - t"&erc"losis

4/ - an 1/ year old male is seen in the st"dent c linic for "rinary fre="ency7 dys"ria and "retheral

discharge. #hich of the following is not likely to e'lain this condition$

a - her'es sim'le

& - +scherichia coli F

c - chlamydial "rethritis

d - sy'hilis

e - @ infection

4 - a week old &a&y 'resents to the office. @is weight is still near his &irth weight. @e

had a normal gestation and delivery and has not had any signs of illness. he 'hysical

eamination is normal. A diagnosis of fail"re to thrive D; is made. #hich of the following is indicated$

a - immediate hos'italiation and etensive la&oratory tests.

& - increasing the caloric content of form"la and fre="ent weight meas"rements

c - starting solid foods since form"la is not res"lting in good growth.

d - re'ort the child to the health services and immediate 'lacement in foster caree - switching form"la to a different cows &ased form"la

4! - yo" are eval"ating a 5 year old for the first time. @is height 6"st &elow the 5th

'ercentile. Previo"s growth chart reveals that since ! months his weight and height are 6"st &elow the 5th

'ercentile. @is mother height is 155cm and his fathers height is 13. @istory and 'hysical eamination is

otherwise normal. #hat is the most likely diagnosis$

a - constit"tional growth delay

& - growth hormone deficiency

c - noonan syndrome

d - familial short stat"re

e - hy'othyroidism

50 - a 15 month old male is &ro"ght to the 'ediatrician &eca"se he seems m"ch smaller

than his two older &rothers were at that age. @e has &een generally healthy ea't for 2

e'isodes of otitis media and occasional WcoldsW. @e &egan walking at 11 months and can now say WmamaW

WdadaW and names of his &rothers. #hat is the most a''ro'riate net ste'$

a - 'erform a denver develo'ment screening test.

& - ask the mother to com'lete a 3 day diary of all the food that the child has eaten.

c - send &lood for e="antitative imm"noglo&"lins

d - 'lot his height and weight on growth chart and com'are to 'revio"s charts.

e - o&tain a sweat chloride test.

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51 . a 4 year old 'resents with a dry scaling rash wish rec"rs intermittently. he family history is 'ositive for

asthma 7allergy and ecma. reatment of his ecma incl"des which of the following$.

a . kee'ing the skin scr"'"lo"sly clean with &aths twice daily

& . allergy testing and allergy shots

c . a strict elimination diet

d . steroid cream and moist"riing lotion

e . oral steroid

52 . a teenager who gets st"ng &y a &ee develo's "riticaria within 30 min"tes of the sting this reaction is

most likely mideted &y $

a . com'lement )3

& . g+ anti&odies

c . ne"tro'hilis

d . cells

e . g A

53 . a 1 month female is eamined &eca"se she s'its "' a&o"t a ta&les'oon of milk-like

material after each feed .it does not come o"t forcef"lly and contains no &lood or &ile . she

takes 50 cc of form"la every 2-3 ho"rs the s'itting "' often occ"rs after she is 'laced on her &ack in the cri&

the 'hysical eamination and growth 'ercentiles are normal .the most likely diagnosis is $

a . 'yloric stenosis

& . volv"l"s

c . gastroeso'hageal refl"

d . gastroenteritis

e . tracheoeso'hageal fist"la

54. malrotation with volv"l"s is most likely to &e 'resent in which of the following 'atients$

a . 15 months old with severe 'aroysmal a&dominal 'ain and vomiting

& . 15 year old se"ally act ive girl with lower a&dominal 'ainc . 3 day old term infant with &ilio"s emesis .lethargy and a&dominal distention

d . 4 day old 'remat"re D 33 w ; &a&y who 6"st started nasogastric feedings he has a&dominal

distention &loody stools and throm&ocyto'enia

e . / year old girl with a&dominal 'ain vomiting fever diarrhea )orrect

55 . in female which of which of the following events signifies the onset of '"&erty $

a . menarche

& . growth s'"rt D height ;

c . '"&ic hair

d . thelarche

e . voice dranges

5 . a f"ll term neonate is noted to have circ"moral cynosis and twitching of his left hand at 12 ho"rs of ageon 'hysical eamination he is fo"nd to have an a&sent '"'illary res'onse to light and a small 'enis

which of the following is the most likely diagnosis:

a .hy'ocalcemia

& . hy'oglycemia

c . congenital hy'othyroidism

d . congenital heart disease

e . idio'athic e'ile'sy

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5/ . a 14 year old adolescent female has ins"lin de'endent dia&etes mellit"s for the 'ast / year she now

has a hemoglo&in A1) of 14.! this la&oratory test indicates which of the following $

a . her gl"cose control is 'oor

& . she does not have ins"lin de'endent dia&etes mellit"s

c . she has entered the honey-moon 'hase of her dia&etes

d . she has an "nderlying infection

e . she is demonstrating the somogy 'henomenon )orrect

5 . a new&orn infant has mild cyanosis 7 dia'horesis 7'oor 'eri'heral '"lses7 he'atomegaly and

cardiomegaly . res'iratory rate is 0 &reaths 'er min"te and heart rate is 250 &m' the child most likely has

congestive heart fail"re ca"sed &y which of the following $

a . a large atrial se'tal defect and valv"lar '"lmonic stenosis

& . trans'osition of great vessels and ventric"lar se'tal defect

c . total anomalo"s '"lmonary veno"s ret"rn

d . @hy'o'lastic left heart syndrome

e . 'aroysmal atrial tachycardia

5! . a year old girl "nderwent removal of a cranio'haryngioma 3 mo. Previo"sly she is on a thyroid

re'lacement regimen &"t her mother re'orts she is very fatig"ed the net ste' wo"ld &e to $

a . increase the dose of her thyroid medication

& .sched"le a growth hormone stim"lation test

c . meas"re A)@ and cortisol

d . o&tain an

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2; A 33 year old man who had &een mor&idly o&ese "nderwent s"ccessf"l Co"-en-L

gastric &y'ass 33 month earlier. @owever7 recently he has &een having dist"r&ing

sym'toms. hese incl"de insomnia7 sensory dist"r&ances7 s"ch as n"m&ness and tingling in

his hands and feet7 as well as inflamed tong"e7 diiness7 'oor coordination and &alance. n

addition he develo'ed strange way of walking7 a stom'ing gait striking first heavily with his

heel. he deficiency that wo"ld most likely ca"se sym'toms descri&ed is which one of the following$

a. ron

&. itamin (12

c. olate

d. Xinc

e. )o''er

3; A 5 year old man with long history of )oronary artery disease and recent history of

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.A grossly "nderweight 52 y8o women with chronic maln"trition is d"e to "ndergo ma6or s"rgery . it

decide to start total 'arental n"trition DP%;nas 'art of intial thera'y . while introd"cing a central veno"s

catheter into right s"&clavian vein she develo' s"dden dysnea . #hat is the most diagnosis $

a. Air em&olism

&. '"lmonary em&olism

c. fat em&olism

d. ac"te aniety

e. 'ne"mothora

/./2 y8o female is seen in emergency de'artment with a history of s"dden sever colick

mida&dominal 'ain and na"sea and vomiting over the 'ast 3 ho"rs . d"ring eamination she throw "' a &ile-

stained vomits . 'hysical eamination reveal generalied a&dominal tenderness with decreased &owel so"nd 7

radiogra'hy of a&domen show radioo'a=e mass in distal small &owel on right side with dilated loo's 'roimally .

no free air is noted "nder dia'hragm &"t air is 'resent in &iliary tree . #hat is mostly diagnosis $

a. lym'homa for small &owel

&. ac"te 'ancreatitis

c. ac"te a''endicitis with radio'a="e fecalith

d. gallstone ile"s

e. int"ss"sce'tion

. A 35 y8o fire man was &adly &"rned when the roof of ho"se colla'sed on him .

@e had second-degree &"rn involving 15 of his &ody s"rface and third degree &"rn

involvig 20 of &ody s"rface . he was r"shed to the nearest emergency de'artment and

then transferred to &"rn "nit . a week later he develo' fever 7 &lack 'atches are noted in the &"rn wo"nd .

(io'sy and c"lt"re of one of wo"nd site wo"ld most likely reveal which of the organisms $

a. sta'h a"re"s

&. 'se"domonas a"rgensa

c. candida al&icans

d. gro"' a stre'tococc"s

e. stre'tococc"s 'ne"monia

!. A 55 y8o alcoholic man with chronic 'ancreatitis has rec"rrent attack of a&dominal 'ain that radiate to &ack

. 'ain is controlled with medical thera'y 7 he lost 30 & in 'ast 3 months &eca"se of chronic diarrhea .

eamination of a&dominal show no masses 7 ) shoe m"lti'le calcification &"t no mass lesion 7 ser"m gl"cose

normal 7 ="alitive stool test for fat normal 7 antiglidian anti&ody are not 'resent 7 m ost a''ro'riate treatment is $

a. total 'ancreatectomy

&. &road s'ectr"m thera'y

c. gl"ten free diet

d. oral 'ancreatic enyme &efore 7 d"ring 7 and after meals

e. administration of lact"lose

/0. A 55 y8o man 'resent to emergency with massive hematemessis . 'hysical eaminasion reveal a&dominal

distension 7 shifting d"llness on 'erc"ssion and s'iderangiomato over the faceand "''er chest 7 an emergentendosco'e reveal &loody ra'idly filling distal eso'hag"s . @ematemessis is most likely d"e to $

a. 'yloric stenosis

&. r"'t"red eso'hageal varices

c. gastric "lcer

d. eso'hageal carcinoma

e. d"odenal "lcer

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/1; a years old man with intermittent cram'ing a&dominal 'ain 7 also have diffic"lty

defecating 7 he is managing &owel movement every third or fo"rth day only 7 with grait YYY of straining and

then only 'ass small hard feces with lot of m"c"s and sometimes fresh &lood . his 'hysician s"s'ects o&sti'ation

and orders a &ari"m enema that reveals massively dilated sigmoid

colon with col"mn of &ari"m resem&les a &eards 'eak . what is the most likely diagnosis$

a- int"sse'tion

&- volv"l"s of sigmoid colon

c- toic mega colon

d- ogilvie syndrome

e- im'acted stool

/2; a 1 years old woman 'resents to the emergency de'artment with a history of severe

retrosternal chest 'ain that is aggravated &y swallowing and dee' &reathing . the 'atient

a''ears anio"s 7 she is afe&rile 7 has sin"s tachycardia7 slightly elevated &lood 'ress"re and tachy'nea 7

mild 'allor is noted 7 &"t she seems well hydrated and has no icter"s .

eamination of the cardiovasc"lar system had normal findings ece't for sin"s tachycardia 7 the a&domen is

scha'hoid and no tenderness7masses or organomegaly is noted. her wight is less than the norm for her age

and hight . the 'atient however feels that she is o&ese and has taken to &inge eating followed &y self ind"ced

vomiting . which of the following is the most 'ro&a&le ca"se of her 'ro&lem $

a- gasrorefl" desease

&- &oerhave syndrome

c- tension 'ne"mothora

d- gastric "lcer desease

e- eso'hegeal cancer

/3; a 5 years old woman 'resents to the emergency de'artment with diff"se a&dominal

'ain and vomiting 7 she has not had a &owel movement in the 'ast 3 days 7 'hysical eam

reveals hy'er 'eristalsis 7 tym'any to 'erc"ssion 7 and no re&o"nd tenderness 7 her

tem'erat"re is 3 c D100.4f;. an a&dominal -ray film reveals distended loo's of small &owel with a ste'

ladder 'attern of differential air-fl"id levels. which of the following is the mechanism that most likely

'rod"ce these sym'toms$

a-divertic"losis

&- adhesions from 'revio"s s"rgery

c- torsion of the &owel aro"nd the mesenteric root

d- int"ss"si'tion of the terminal ili"m into cec"m

e- ischemia secondary to throm&osis of the s"'erior mesenteric artery )orrect

/4; a 35 years old man with a long history of dys'e'sia7 e'eriences s"dden onset of sever e'gastric distress

with associated 'ain in the right sho"lder . 'hysical eam reveals a 'atient who a''ears ill and has rigid7 ="it

a&domen with re&o"nd tenderness. which of the following is the most a''ro'riate first ste' in the management

of this 'atient$

a- order a &ari"m st"dy of the "''er B

&- order "'right and s"'ine a&dominal films

c- 'erform a 'eritoneal lavaged- administer anti-acids

e- do an e'loratory la'aratomy

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/5; 20 years old man is sta''ed in the left side of his chest7 medial to the ni''le . "'on

eamination his &lood 'ress"re is !080 mm@g 7 and his '"lse is 1308min 7 his 6"g"lar

veno"s '"lse increases on ins'iration 7 whereas his 'eri'heral '"lse and &lood 'ress"re

decreases on ins'iration . &reath so"nds are normal &ilaterally . the 'atients chest -ray film is "nremarka&le

. after receiving 2? of isotonic saline 7 his &lood 'ress"re remains low 7

whereas his central veno"s 'ress"re rises to 32 cm @2, .

which of the following is the most a''ro'riate net ste' in the managing of this 'atient $

a- insert a chest t"&e into the left 'le"ral cavity

&- increase 'arenteral fl"ids "ntil the &lood 'ress"re increases

c- order an echocardiogram

d- decrease veno"s 'ress"re &y administering ventilator

e- decrease veno"s 'ress"re &y administering loo' di"retics

/. A 50 years old womam arrived at the +.* &ro"ght &y his s"n 7tell to the triage n"rse that after

cons"ming a hearty thankgiving meal felt ill 7'ain and sym'toms grew worse d"ring

the night and early morning and have 2-3 e'isodes of gall&ladder tro"&le 'ain &"t non so

severe 7tN102f 7(P !0842 7sever right c"adrant 'ain 76a"ndice 7'ro&lems with answer

="estion and &a&&le incoherent 7mild he'atomegaly .PC1258min 7#() 137Y10-3 D%47-

107;&illir"&ina total 7mg8l 7tran'e'tidase activity rate is 105 7alcline 'hos'hatase val"e 1/"mts8l 7"rine

analysis is normal.

a-ame&ic liver a&sces

&-ac"te he'atitis.

c-ac"te 'ancreatitis

d-ascending colangitis.

e-sclerosis 'ericolangitis.

//- / y. old woman with 'elvic 'ain 7ct shows mass near her right 'elvic wall 7ct g"idede &io'sy

revealed s'idle ty'e with few mitotic cell 7 at e'lor. 7a 2cmZ 'ed"nc"lated mass is noted on the

anteromesenteric &order of the mild ile"m 7a''ro'iate thera'y...

a-ligated of the mass at the 'ed"nc"lated stak.

&-widge ecision of the mass .

c-widge ecision 7regional lym'h nodes disection.

d-widge ecision 7imatini&

e-wide ecision regional ltm'h nodes disection 7imatini&.

/- refeedind in s"rgery related to:

@y'o'hos'hatemia

/; #@A is the hallmark &iochemical feat"re of the res"m'tion

of feeding syndromeDre-feeding syndrome;7 associated with increased mortality$

A; hy'okalemia

(; hy'o'hos'hatemia

); gi'omagneemiya

*; hy'oglycaemia

+; hy'ocalcemia

/!-a 'atient with c"taneo"s melanoma in the right leg 7irreg"lar with discoloration 7&"t not "lceration 7right

ing"inal region witho"t 'al'le nodes 7'"nch &io&sy of the lesion reveal3[1mm thick lesion . 2cm[local ecision of

the 'rimary lesion 7net ste'\

a-o&servation .

&-sentenel lym'h node &io'sy .

c-elective lym'hadeno'athy .

d.CDradiothera'y;.

e-isolated lym'h 'erf"sion.

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0- 50 y.old 'atient has a 3cm villo"s a''earing t"mor at cmZ of the an"s net ste'\

a-o&serve thelesion of sign of malignancy .

&-res"re the 'atient that this are not 'remalignant lesio

c-f"lg"rate the lesion.

d-locally irradiate of the lesion .

e-s"rgically resect the lesion.

1- A 0 years old man7 'resents with 6a"ndice for 2 weeks7 there is no history of a&dominal 'ain7 ("t there

is a markedly distended gall&lader seen on "ltraso"nd. what is the most likely diagnosis :

a. )ommon &ile d"ct o&str"ction from a stone

&. )ommon &ile d"ct o&str"ction from 'ancreatitis

c. )ommon &ile d"ct o&str"ction from 'ancreatic carcinoma of the head of the 'ancreas

d. ac"te cholecystitis

e. alcoholic he'atitis

2- A 2! years old man with a history of crohnEs disease involving the terminal ile"m develo's 'ne"mat"ria and

fecal"ria. #itch of the following com'lications of crohnEs disease this 'atient have $

a. ileodo"denal fist"la

&. ileosigmoid fist"la

c. rec"rrent disease involving a 'revio"s ileocolon anasromosis

d. colovescical fist"la

e. ac"te cystits

3- A 5 years old man remains in the )F for 1 month after coronary artery &y'ass grafting D)A(B;7 he

has &een treated for 2 e'isode of 'ne"monia and contin"es to re="ire ventilatory s"''ort. @e develo's a

watery diarrhea and a&dominal distension7 stool sent for )lostridi"m difficile is 'ositive and oral

metronidaole is initiated. 5 days later the 'atient develo's hy'otension7 re="iring vaso'ressors7 and renal

fail"re7 #()J 30008mm3. #hich of the following is the most a''ro'riate management $

a. intraveno"s vancomycin

&. vancomycin enemasc. cecostomy t"&e 'lacment

d. diverting transverse loo' colostomy

e. total a&dominal colectomy and ileostomy

4- >mall &owl 'erforation in &l"nt tra"ma is detected &y:

a. ) a&dominal scan

&. oc"sed Assessment with >onogra'hy for ra"ma DA>;

c. *iagnostic 'eritoneal lavage D*P?;

d. 'hysical eamination

e. none of the a&ove

5 - 23 years old 'atient carries a total thyroidectomy on carcinoma of t he thyroid gland. ,n the 2nd dayafter s"rgery7 she &egan to com'lain of feeling in the &ones of the hands 'okalivaniya. t looks 'retty ecited7 and

then &egins to com'lain of m"scle cram's. #hich of the following is most correct$

A. 10 ml810 of magnesi"m s"lfate 8 in.

(. itamin * orally

). ?evomiroksina 100mcg orally. $$$

*. )ontin"o"s inf"sion of calci"m gl"conate.

+. Bly"kanat calci"m gloc"nate orally.

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-A 10 years old &oy was the &ackseat &elled 'assenger in a high s'eed motor vehicle

collision . on 'resentation to the +C he is awake 7 alert7and hemodynamically sta&le. @e is

com'laining of a&dominal 'ain and has an ecchmosis on his anterior a&dominal wall where the seat&elt

was located. #hich of the following statements is tr"e regarding need for additional work"'$

a-the &oy can &e safely discharged home witho"t any other work"' 7 since his a&dominal 'ain is

'ro&a&ly secondary to his a&dominal wall ecchmosis

&-the &oy can &e safely discharged home if his amylase level is normal

c- the &oy can &e safel discharged home if a&domen 'lain films are negative for the 'resence of free air

d-the &oy can &e safel discharged home if an ) is negative

e-the &oy sho"ld &e o&served regardless of negative test res"lt )orrect

/- a 35 year old with a history of 'revio"s right throidectomy for a &enign thyroid nod"ls

now 7 "ndergoes com'letion thyroidectomy for a s"s'icio"s throid mass several ho"rs

'osto'eratively7 she develo's 'rogressive swelling "nder the incision7 stridor and diffic"lty &reathing

.orotracheal int"&ation is s"ccessf"l -which of the following is the most a''ro'riate net ste'$

A-fi&ero'tic laryngosco'y to r"le o"t &ilateral vocal cord 'aralysis

(-administration of caci"m

)-administration of &road s'ectr"m anti&iotics and de&ridment of the wo"nd

*-wo"nd e'loration

+-administration of high dose steroids and antihistamines )orrect

- a15 yaer old otherwise healthy female high school st"dent &egins to notice galactorrhea A 'regnancy test

is negative . which of the following is fre="ently associated 'hysical finding:

A-gonadal atro'hy

(-&item'oral hemian'osia

)-eo'hthalmos and lid leg

*-e'isodic hy'ertension

+-&"ffalo h"m'

!- A 4 years old woman ask a&o"t the need for s"rgery 7since she was recently diagnosed with crohns

disease .indication for o'eration in crohns incl"de all ece't$

A-intestinal o&str"ction

(-enterovesical fist"la

)-'rolonged "se of steroids

*-enterovaginal fist"la

+-free 'erforation

!0- A 41 years old com'lains on reg"rgitation of saliva and "ndigested food 7an

eso'haogram reveals &irds &eak deformity. #hich of the following statements is tr"e a&o"t the condition$

A-chest 'ain is common in advanced stage of the disease

(-more 'atients are im'roved &y forcef"l dialation then &y s"rgical intervention

)- manometry can &e e'ected to show increase resting 'ress"re of the ?+>

*-initial s"rgical treatment consist 'rimarily of resection of the distal eso'hag"s with reanastomosis

of the stoma a&ove the dia'hragm+-'atients with this disease are at no increased risc for the devol'ment of carcinoma )orrect

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!.A /5 y.o. man was to the emergency room of local hos'ital after having colla'sed at home.

the 'atients sa'o"se related that he had com'laned of sadden sever 'ain over the left flank. he informed the

'hysician that he had &een com'laning of &ack itch for few years.

'hysical e. revealed a conscions male 7ac"te distress7 with definit signs of hy'otention

7tachycardia7tachy'nea and hy'othermia.he had m"cosal 'allor &"t no cyanosis.the

a&domen was tender to 'al'itations7and a '"lsatile s"'ra"m&ilical mass was 'resent.&owel so"nds were

diminished and 'eri'heral '"lses were e="al and moderately strong.the 'atient was given 100 ,2 &y

mask7at 10? 'er min"te. the cardiac minotor showed sin"s

tachycardia with mild ischemia.

#hich of the following mechanisims is most likely involved in the 'athogenesis of this 'atient clinical disorders$

A.cystic medial degeneration.

(.defect in collagen.

).defect in fi&rillin.

*.an imm"nologic reaction.

+.athrosclerosis.

!/.A 5 y.o. women had a 5 years history of 'ain in the right hi' that had =rad"ally gotten worse.she had

reached a 'oint where she ho&&led with the hel' of a cane.nonsteroidal

analgetics did not hel' her very m"ch.she finaly agreed to "ndergo s"rgery.an -ray film of the right hi'

confirmed severe osteoarthritis.the ortho'edic s"rgean recomended hi'

arthro'lasty.she was considered at hish rist for dee' veno"s throm&osis and he'arin

'ro'hylais was &eg"n.

#hich of the following is the &est test to monitor he'arin thera'y$

A.throm&in timeD;.

(.'rothrom&in timeDP;.

).'rothrom&in and 'roconvertin test.

*.activated 'artial throm&o'lastin.

+.&leeding time. )orrect

!.A 5 y.o. women com'lans of diarrhea and weight loss for several months.on 'hysical e. she is noted to

&e slim with evidence of recent weight loss and a systolic heart m"rmar can &e heard to the right sternal

&order in the 4th intercostal margin.la&oratory findings incl"de "rinary collection for 5@AA increased to 4

fold the "''er normal limit7and chromogranin A level of the 1000ng8m lDnV!2 ng8ml;.

#hich of the folloing is the initial recomended managment of thes 'atient$

A.s"rgical resection of the &owel t"mor.

(.chemothera'y d"e to metastatic t"mor.

).somatostatin analog.

*.interferon alfa.

+.administration of s'ecific chromogranin anti&odies.

!!.A /4 y.o ca"casan man recently made an a''ointment to see his 'hysician &eco"se he

had diffic"lty in swallowing his 'ills .it took 2 weeks to get an a''ointment .&y the time his

'ro&lem had 'rogressed to the 'oint where he was having 'ro&lem with solids in general &"t

no'ro&lem with li=ids.in the 'ast he had also a longstanding history of B+C* wich was

treated with ome'raole starting last year. at 'resent he doesnot smoke &"t he had started

smoking at the age 14 and ="ite some 10 y ago.he did drink 7&"t 'r imarily &eer and only at social occasion.

A.diff"se eso'hageal s'asm.

(.achalasia.

).&engin eso'hageal strict"re.

*.enkers divertic"l"m.

+.eso'hageal carcinoma.

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100.A /3 y.o man with scandinavian ancestors was "ndergoing a ro"tin 'hysical e. ehen his

'hysician noted a ro"nedish s'ot a&o"t mm in diameter that was s lightly 'inker that the

remainder of the man face.when he ran his finger across it7 he also noted that was dry and

ro"gh.the 'atient informed him that something had &een going on with that s'ot for a year

or so its a''erance seemed to wa and wane7 essentially disa''earing once in a while &"t

then retarning7sometimes covered with white scales t hat then dro''ed of.the 'atient

admitted that as a &oy and a yo"ng man he s'ent co"ntless ho"res at athe &each.the

'hysician ca"terited the lesion with li="id nitrogen within 2 weeks the area &ecame cr"sted 7shrank and fell

off.2 weeks therefore7the ro"gh s'ot reterned and after a month 7the 'atient develo'ed an o'en sore at the

same location that wo"ld not heal.he sore is most likely to &e wich of the following$

A.actinic keratosis.

(.&asal cell carcinoma.

).s="amo"s cell carcinoma.

*.nod"lar melanoma.

+.her'es melanoma.

101- A 24 year old male 'laying foot&all fell on his o"tstretched hand ho'ing t o make a

to"chdown. he 'atient com'lains on severe 'ain in his right arm. @is vital signs are: (P

140807 PC ! reg"lar7 em' 3/) and CC 228min reg"lar. he right arm is swollen and

ang"lated in the mid arm area7 its tender to to"ch and movement is 'ainf"l. he h"meral

a''ear to &e fract"red7 ca'illary circ"lation in the nail &ed is normal. @owever7 there is a

clinical evidence of nerve damage. -ray imaging confirms fract"re of the h"meral shaft with some

ang"lated dis'lacement. #hich of the following is the nerve in6"ry associated with this fract"re:

a. Ailiary nerve

&. 'leen

&. C"'t"red ?iver

c. C"'t"red Pancreas

d. @ematoma of the Cect"s

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105. #hich of the following is the most im'ortant to eval"ate the risk for intra-o'erative &leeding$

a. (leeding time

&. aP

c. %C

d.

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10!; 5 years old women went &icycling into the co"ntry near lake ahoe8 the front wheel

str"ck a 'athole and she fell to the gro"nd. #hile doing so7 her chest str"ck the handle&ar.

>he was immediately r"shed to the local hos'ital7 on arrival she is conscio"s and a''ears to

&e in moderate distress . &lood 'ress"re 1408!5 mm@g7 '"lse !7 res'iration are shallow

and ra'id at 228min7 &r"ising over the left anterior hemithora is o&served "'on

eamination of the chest. here is no 6"g"lar veno"s dilation. he rest of her eamination

findings are "nremarka&le. "rther eamination wo"ld most likely yield which of the following$

a; increased &reath so"nds of the chest.

&; ego'hony on the left

); increased hy'erresonace

d; increased width of intercostals on the left

e; mediastinal str"ct"res shifted to the left.

110. A 3 year old woman visits her family 'hysician &eca"se of her concern a&o"t a l"m' in

her left &reast which she noticed after a fall a''roimately one week 'revio"sly. >he doesnEt

smoke7 drinks wine on social occasions7 and takes &irth control 'ills. here is no family

history of &reast cancer. Physical eamination reveals a rather stocky women with

'end"lo"s &reasts. >he has a moderated sied7 nontender7 irreg"lar l"m' in the lower o"ter

="adrant of her left &reast. he overlying skin a''ears thickened. %o ni''le discharge is

'resent7 and she has no aillary lym'hadeno'athy. he right &reast and ailla are normal.

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01.03.2012

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8/10/2019 IMLE .01.03.2012

43/45

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