8/10/2019 IMLE .03.10.2011

1/44

03.10.2011

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

Part A:

1. A 75 year old man with a history of myocardial infarction2 year ago, peripheral

vasclar disease with symptoms of cladication after half !loc", hypertension, anddia!etes presents with a large ventral hernia, he wishes to have the hernia repaired.

#hich of the following is the most appropriate ne$t step in his preoperative wor"p%

a. A normal &'( precldes the need for frther cardiac testing.

!. )e shold ndergo an e$ercise stress test.

c. )e shold ndergo coronary artery !ypass prior to operative repair of his ventral hernia.

d. )e shold ndergo a presntative thallim stress test and echocardiography.

e.)is history of a myocardial infraction within 3 years is prohi!itive for elective srgery.*o frther testing isnecessary.

2. A victim of !lnt a!dominal trama ndergoes a partial hepatectomy. +ring srgery he receives twelve nits of

pac"ed red !lood cells. n the recovery room, he is noted to !e !leeding from intravenos pnctre sites and the

srgical incision. #hich of the following statements regarding the coaglopathy is most li"ely tre%

a. -he patient has an n"nown primary !leeding disorder.

!. -he coaglopathy is secondary to the partial hepatectomy

c. -he coaglopathy is secondary to delsional thromnocytopenia and deficiency of clotting

factors from the massive !lood transfsion.

d. -he treatment is oral vitamin

e. -he treatment is intravenos vitamin .

3. A /5 year old man has an enteroctaneos fistla originating in the enm secondary to inflammatory !owel

disease. #hich of the following wold !e most appropriate flid for replacement of his enteric losses%

a. +5#

!. 3 normal saline

c. inger lactate soltion

d. 0. sodim chloride

e. / sodim !icar!onate soltion

4. A 23 year old woman ndergoes total thyroidectomy for carcinoma of the thyroid gland. n the second

postoperative day, she !egins to complain of a tingling sensation in her hands. 6he appears ite an$ios and later

complains of mscle cramps. #hich of the following is the most appropriate initial management strategy%

a. 10 ml of 10 8agnesim slfate 9

!. ral vitamin +

c. 100 micro gram oral synthroid

d. 'ontinos infsion of calcim glconate

e. ral calcim glconate.

5. A 24 year old firefighter sstains 30 total !ody srface area !rns to his torso, face, and e$tremities. )is wonds

are treated topically with silver nitrate. #hich of the following complications is associated with se of this agent%

a. )ypernatremia

!. 8eta!olic acidosis

c. )yperchloremia

d. *etropenia

e. )yponatremia

8/10/2019 IMLE .03.10.2011

2/44

/. A 10 year old !oy was the !ac"seat !elted passenger in a high speed motor vehicle collision. n presentation to

the & he is awa"e, alert, and hemodynamically sta!le. )e is complaining of a!dominal pain and has an ecchymosis

on his anterior a!dominal wall where the seat!elt was located. #hich of the following statements is tre

regarding need for additional wor"p%

a.-he !oy can !e safely discharged home withot any other wor"p, since his a!dominal pain is

pro!a!ly secondary to his a!dominal wall ecchymosis.

!. -he !oy can !e safely discharged home if his amylase level is normalc. -he !oy can !e safely discharged home if a!domen plain films are negative for the presence of free air.

d. -he !oy can !e safely discharged home if an a!dominal '- is negative

e. -he !oy shold !e o!served regardless of negative test reslt.

7. A patient is !roght to the & after a motor vehicle accident. )e is nconscios and

has a deep scalp laceration and one dilated ppil. )is heart rate is 120 !eats per minte !lood pressre is 0;40

mm;)g, and respiratory rate 35 per min. +espite rapid administration of 2 < normal saline, and patients vital signs do

not change significantly. #hich of the following is the most appropriate ne$t step in the wor"p of his hypotension%

a. *erosrgical consltation for emergent ventriclostomy to manage his intracranial pressre

!. *erosrgical conslation for emergent craniotoymy for sspected s!dral hematoma

c. &mergent !rr hole draining at the !edside for sspected epidral hematoma

d. Administration of mannitol and hyperventilation to treat his elevated intracranial pressree. A!dominal ltrasond =focsed assessment with sonography in trama, >A6-?

. A 25 year old woman is diagnosed with !ilateral !reast 'A. sh ndergoes genetic testing to assess whether she

has a mtation in either @A'A1 or @A'A2. #hich of the following statements is tre regarding @A'A mtation %

a. )er ris" as a woman nder the age of 40, for having a mtation in @A'A1 or 2 is 40.

!. @A'A1 tmors are more li"ely to !e estrogen recetor positive.

c. A mtation is @A'A 2 is associated with an increased ris" of colon 'A.

d. A mtation in @A'A 1 is associated with an increased ris" for pancreatic, !ile dct and gald!ladder 'A.

e.@oth @A'A 1 and @A'A 2are associated with an increased ris" of ovarian 'A !y age 70.

. A 35 year old woman with a history of previos right thyroidectomy for a !enign thyroid nodle now ndergoes

completion thyroidectomy for a sspicios thyroid mass. 6everal hors postoperatively she develops progressive

swelling nder the incision, stridor and difficlty !reathing. rotracheal int!ation is sccessfl.

#hich of the following is the most appropriate ne$t step%

a. >i!eroptic laryngosopy to rle ot !ilateral vocal cord paralysis

!. Administration of 9 calcim

c. Administration of !road spectrm anti!iotics and de!ridement of the wond

d. #ond e$ploration

e. Administration of high dose steroids and antihistamines.

10. A 15 year old otherwise healthy female high school stdent !egins to notice galactorrhea. A pregnancy

test is negative. #hich of the following is a freently associated physical finding%

a. (onadal atrophy

!. @itemproal hemianopsia

c. &$ophthalmos and lid lag

d. &pisodic hypertension

e. @ffalo hmp

8/10/2019 IMLE .03.10.2011

3/44

11. A 72 years old man stats post 'A@( 5 years ago present with hematocheia,

a!dominal pain and fever. colonoscopy reveals ds"y appearing mcosa at splenic

fle$re withot active !leeding. which is the most appropriate manegment of this patient%

a. angiography with administration of intraBarterial papaverine

!. &mergent laprotomy

c. Aortomesenteric !ypass

d. &$ploratory laprotomy with -hrom!ectomy of the inferior mesenteric arterye. &$pectant management

12. A 4/ years old women as" a!ot the need for srgery, since she was recently

diagnosed with 'rhonCs +isease. ndication for operation in 'hronCs inclde all e$cept:

a. ntestinal o!strction

!. &nterovesical fistla

c. Prolonged se of steroids

d. &nterovaginal fistla

e. >ree perforation

13. A2 years old women is 15 wee" pregnant, has new onset of nasea, vomiting and right sided a!dominal pain.6he has !een free of nasea since early in her 1st trimester. the pain has !ecome worse over the past / hors. #hich

of the following statments a!ot appendicitis dring pregnancy is correct%

a.Appendicitis is the most prevalent e$tra terine indication for celiotomy dring pregnancy.

!.Appendicitis accre more commonly in pregnant women then in nonpregnant women.

c.6spected appendicitis in pregnant women shold !e manged with period of o!servation de to the ris"

of laprotomy to the fets.

d. *on complicated appendicitis reslt in 20 fetal mortality and prematre la!or rate.

e.-he sevirity of appendicitis correlates with increase gastational age of the fets.

14. A 41 years old men complains on regrgitation of saliva and ndigested food, an esophaogram reveals D!irds

!ea"D deformity. #hich of the following statments is tre a!ot the condition:

a. 'hest pain is common in advanced stage of the disease.

!. 8ore patients are improved !y forcefll dialatation then !y srgical intervention.

c. 8anometry can !e e$pected to show increase resting pressre of the

8/10/2019 IMLE .03.10.2011

4/44

1/. A 3 years old women has 1.5cm mass in left @rest, clinical e$am reveals no sspicios adenopathy.

8ammogram gided !iopsy reveals infiltrating dctal carcinoma. -he patient prefer lmpectomy followed

!y radiation. #hich of the following statements a!ot sentinel lymph node is tre%

a. it is only indicated in clinically E a$illa

!. it is associated with srvival advantage over rotine a$illary dissection .

c. neoadvant chemotherapy does not affect relia!ility of 6

8/10/2019 IMLE .03.10.2011

5/44

21. A 4 years old man with a history of alcohol se presents evalation reveals a

linear disrption of the gastric mcosa high on the lasser crvatre at the gastroesophageal nction.&ndoscopic

attempts to control the !leeding fail. -he patient has received / nits of pac"ed @'s and his heart rate is115;min

with a systolic !lood pressre of 5mm)g. -he most appropriate management wold !e:

a. &m!oliation of the left gastric artery

!. placement of a 6engsta"enB@la"emore t!e with inflation of gastric !alloon

c. Anterior gastrotomy and eversewing of the !leeding site.d. Antrectomy ,vagotomy,and !iopsy of the !leeding site.

e. -otal gastrectomy

22. A 51 years old man with a history of peptic lcer disease presents with a!dominal pain and free air.dring

operation a dodenal perforation is identified with significant associated peritonitis .A modified (raham patch is

performed.Acid redction therapy is initiatedand serology for )elico!acter pylori is o!tained.seven days after

operation an operativedrain !egins draining copios amonts of !ile.8anagement of this dodenal fistla incldes all

of the following e$cept:

a. cholestyramine

!. total parenteral ntrition

c. somatostatin enteral ntrition

d. *asoenal enteral ntritione. @ile reBfeeding

23. A 75 years old woman presents with the acte onest of a!dominal pain . on

physical e$amination ,she has a palpa!le a!dominal mass that is painfl with

contractre of the a!dominal mscles. 6he has no peritoneal irritation .she is receiving anticoaglation for recent

onest atrial fi!rillation . the nderlying vessel casing this pro!lem is most li"ely the:

a. nferior epigastric artery

!. 6perior mesenteric arery

c. 6plenic artery

d. 6perior mesentric vein

e.

8/10/2019 IMLE .03.10.2011

6/44

2/. A 5/ years old postmenopasal woman has serim calcim of 10. mg;dl =normal 7.5 to .5? and a serm P-) of

5 pg;ml=normal 20 to /0 pg;ml? . 6he has no family history and is asymptomatic .she is an avid ogger . @one

densitometry =+&GA scan? shows minimal osteoporosis. #hich of the following is tre%

a. 'alcim spplementation will decrease her ris" of stress factre.

!. the *) consenss conference recommends o!servation

c. 24 Bhor rine collection for calcim will !e diagnostic

d. she is a candidate for parathyroidectomye. treatment with !iphosphonates is warranted

27. A 44 years old woman has papillary thyroid carcinoma of the right lo!e confirmed !y fineBneedle aspiration.

Hltrasond stdy stages the tmor as -1 =1.5 '8?. ptimal srgical management wold !e:

a. ight thyroidlo!ectomy , selective mode dissection of the right side

!. ight thyroidlo!ectomy, level 9 =central compartment? nod dissection

c. -otal thyroidectomy, selective dissection on the right side

d. -otal thyroidectomy, level 9 dissection and selective dissection of the right side

e. -otal thyroidectomy

2. #hich of the following is the most sefl in identifying patients at high ris" for familial medllary thyroid cancer%

a. &- oncogene

!. calcitonin levels

c. calcim levels

d. Bras oncogene

e. Hrine metanephrines.

2. A!normalities in all of the following varia!les have !een sed to sggest the need for damage control

=or a!!reviated? laparotomy in trama patients e$cept :

a. -emperatre

!. P)

c. @ase deficit

d. Prothrom!in time

e. Platelet cont

30. A 3/ years old man has a !lood pressre of 70;40 mm;)g after a motor vehicle

crash .resscitation is initiated. >ocsed assessment with sonography for trama

=>A6-? is positive for flid in the a!domen. on e$amination of the pelvis ,fractre B

related crepits and an enlarging perineal hematoma are appreciated .the patients

!lood pressre does not improve with ressciatation .the ne$t step in management shold !e:

a. '- of the a!domen and pelvis

!. +iagnostic peritoneal lavage

c. Placement of an e$ternal pelvic fi$ator

d. &$ploratory laparotomy

e. pelvic angioem!oliation

8/10/2019 IMLE .03.10.2011

7/44

31. 3 y.old woman shold go laparoscopic cholicystectomy, no family history of throm!oem!olic events and

no personal medical history of throm!oem!olic events. #hich is indicated for perioperative +9- prophyla$is%

a. no prophyla$is is needed

!. seential compression

c.s!ctanes nfrictioneted heparin

d. s!ctaneos

8/10/2019 IMLE .03.10.2011

8/44

37. 6mall !owl o!strction from !eoar is more common after:

a. colon resection de to cancer

!. !ariatric srgery

c. vagotomy

d. mltiple a!dominal srgery

3. All are compensatory mechanism in hypovolemic shoc" e$cept:

a. increased peripherial resistance secondary to increase catecholamine level

!. increase +P( 2,3

c. right shift of hemoglo!in dissociation crve to acidosis

d. decrease cardiac contractility

3. ecommended to colorectal liver metastasis that localied to one liver lo!e is:

a. lo!ectomy of the lo!e which containing the metastasis

!. lo!ectomy of the lo!e which containing the metastasis and systemic chemotherapy

c. systemic chemotherapy with cytoto$ic and !iologic drg

d. palliative treatment only

40. A 55y.old woman no history evalation for melena has 2cm (6- =gastrointestinal stromal tmor? in the anterior

wall of the stomach. -he diagnosis confirmed !y immnohistochemical, no evidence for adacent organ invasion or

metastasis. -he recommended treatment is:

a. s!total gastrectomy and regional lymph node dissection

!. give tyrosin "inase inhi!itor =imatini!? till complete response and offer srgery if medical treatment is fail

c. open or laparoscopic margin free tmor e$cision and fallow p

d. only imatini! treatment

41. n the &, /0 yearBold male with no previos medical history is fond to have an o!strcting tmor in the

sigmoid colon on com!ined '- and gastrografin enema , no distant metasteses are identified and the cecmCs

diameter is 15 cm. #hat is the recommended treatment%

a. mecchanic !owel preparation followed !y srgery that incldes sigmoidectomy, regional lymph node dissection,

and anastomosis.

!. !.immediate srgery that incldes sigmoidectomy, regional lymph node dissection, and anastomosis

with no frther wor"Bp.

c. immediate colonscopy with !iopsy and after the diagnosis is histologically confirmed, sigmidectomy, regional

lymph node dissection, and creation of pro$imal stoma=)artman resection?.

d.immediate srgery that incldes sigmoidectomy,regional lymph node dissection, and creation of pro$imal stoma.

42. A cirrotic patient that is a liver transplant candidate is admitted for esophageal !leeding varices .

-reatment with somatostatin and endoscopy inclding sclerotherapy and failed !anding donCt stop the !leeding.

#hat is the ne$t step%

a. -P6

!. repeat endoscopy

c. distal splenorenal shnt

d. srgical procedre =portoBaygos disconnection?.

8/10/2019 IMLE .03.10.2011

9/44

43. A 45 yearBold man with a history of chronic peptic lcer disease ndergoes a trncal vagotomy and antrectomy

with a @illroth ll reconstrction for gastric otlet o!strction. / wee"s after srgery, he retrns , complaining of

postprandial wea"ness, sweating ,lightheadedness, crampy a!dominal pain and diarrhea.

#hich of the following wold !e the !est initial management strategy%

a. treatment with a long acting somatostatin analog.

!. dietery advice and conseling that symptoms will pro!a!ly a!ate within 3 months of srgery.

c. dietery advice and conseling that symptoms will pro!a!ly not a!ate !t arenCt dangeros.d. wor"Bp for neroendocrine tmor=carcinoid?.

e. preparation for revision to o$BenBJ gastroenostomy.

44. A 5 yearBold man with a mass in the left side of his nec". -he patient noticed the mass several wee"s ago, and

was given anti!iotic !y his primary care physician. -he mass appeared to s!side somewhat, !t is still present. H.6.

shows a 2 cm solid mass. n e$amination, the mass is 2 cm, firm and fi$ed to the nderlying tisse.

-he !est step now wold !e:

a. color flow +oppler

!. '- of the head and the nec".

c. 8 of the head and the nec".

d. >ineBnedeel aspiration of the mass.

e. srgical !iopsy.

45. 14 yearBold girl with a si$ month history of sdden , rapid ,asymmetric enlargement of the right !reast. n

physical e$amination, there is a large palpa!le mass occpying the !reast with mar"ed nippleB

areolar stretching, prominent dilated veins, and s"in lceration. 8ammography and H6 show a

dense, wellBcircmscri!ed 7 cm homogenos mass occpying the left !reast. -he most li"ely diagnosis is %

a. invasive dctal carcinoma

!. hemangioma

c. giant fi!roadenoma

d. venile !reast hypertrophy

e. phyllodes tmor

4/. a 51 yearBold !lond, light ,comple$ioned man had ndergone laparotomy for progressive small !owel

o!strction. A desmoplastic reaction is casing this small !owel o!strction. #hich of the following !est

descri!es the diagnosis%

a. lymphoma

!. carcinoid

c. (6- =leiomyosarcoma?

d. melanoma

e. primary small !owel adenocarcinoma

47. #hich of the following statements a!ot laparoscopic o$BenBJ gastric !ypass

=J(@? compared with laparoscopic adsta!le gastric !anding =A(@? is not tre%

a. !oth decrease long term mortality compared with controls.

!. A(@ has lower perioperative.

c. J(@ is associated with higher ris" of iron deficiency anemia.

d. A(@ is associated with fewer internal hernias.

e. A(@ is associated with more sstaina!le longBterm weight loss.

8/10/2019 IMLE .03.10.2011

10/44

4. )erediatry spherocytosis:

a. necessitates splenectomy for all patients with the diagnosis.

!. reslts in a loss of spherocytes on the peripheral smear after splenectomy .

c. is associated with increased red cell fragility.

d. reslts in splenic infarction.

e. is cased !y a defected in the !ilayer of the cell mem!rane.

4. A /4 yearBold man has a solitary thyroid nodle discovered dring a screening

carotid dple$. >ineBnedeel aspiration of the nodle shows a predominance of )rthle cells with scant amonts of

colloid and no evidence of malignancy. the ne$t step shold !e:

a. total thyroidectomy

!. repeat !iopsy in / months.

c. thyroid sppression therapy.

d. hemithyroidectomy with isthmsectomy.

e. total thyroidectomy with central node dissection.

50. A healthy 3 woman is resced from a hose fire after 20 min.in emergency department, she has an anterior

chest !rn and is wea", confsed and lethargic. the most li"ely diagnosis is:

a. ' and pelvis.

!. inhalation lng inry.

c. hyperca!ic respiratory failre.

d. pnemothora$.

e. pper airway o!strction.

51. 31 year old (2P1, 3 wee"s complains on a!dominal pain, her terine contraction recorder every 3B4 min, her

cervi$ changed only 1 to 2 cm in diameter in over 3 hors. #hich of the following management of the patient%

a. 'B section

!. 9 o$ytocin

c. !server

d. >etal scalp P) monitoring

e. ntra nasal gonadotropine

52. #hich of the following placental implantation most li"e predisposed to inverted terine in 3rd stage of la!or%

a.>ndal

!. Anterior

c. Posterior

d. ndal pressre

d. ntentional fractre of the hmers

e. +elivery of the anterior scalp

8/10/2019 IMLE .03.10.2011

11/44

54. 33 year old in 2 wee"s of gestation hers !lood pressre is 150;0, proteinrea E2,

platelets and liver enyme are in the normal range. #hich @&6- management of patient%

a. ndction of liver

!. 'B section

c. Antihypertensive therapy

d. &$pected management

e. 8agnesim slfate

55. 1 year 2 wee"s of gestation complain of intermediate a!dominal pain. n cardiotocography the terine

contraction 3B5 min, cervi$ 3cm dilation, with 0 effacement. >etal verte$ presentation at spinal 1 station.

#hich most li"ely to !e contraindication for tocolytic%

a.6spected placental a!rption

!. (rop @ streptococci

c. ecent elective laparotomy

d. Hterine s! seros fi!roid

e. -he crrent stats

5/. #hich of following most potent natral estrogen%

a. &sterone

!. &stroadiol

c. &striol

d. &thinyl estradiol

e. Phytoestrogens

57. #hich of the following change in nasal !one have for +own syndrome in H6%

a. A!sent

!. ncrease in sie

c. +ecrease in sie

d. ncrease in opacitaiton

e. +ecrease in opacitation

5. Jo are monitoring patient contraction pttern, dring 20 min she has / eally

contraction. @ase line teine tone is 10 mm)g and pea" intensity of each contraction

reaches 50 mm)g. #hich following nm!er of 8ontevideo nits define this activity%

a. 120

!. 150

c. 240

d. 300

e. 3/0

5. #hat is the most common side effect of intrapartm epidral Anastasia%

a. ncrease in !lood pressre

!. +ecreases in !lood pressre

c. '*6 stimlation

d. neffective !lac"en

e. '6> lea"

8/10/2019 IMLE .03.10.2011

12/44

/0. >orceps application when fetal head =left occipital anteroBposterior? has reached the pelvic floor is at partm

classier at what type delivery%

a. tlet forceps

!.

8/10/2019 IMLE .03.10.2011

13/44

//. A cople is diagnosed with ne$plained infertility, what is not correct:

a. 0 chance of pregnancy in 3 years withot treatment.

!. 9> is the primary treatment of choice.

c. vlation indction with gonadotropine is a treatment option

d. ntraBterine insemination after washing is a treatment option

e. 9> is an option if other treatments have failed.

/7. #hich of the follow case primary amenorrhea%

a. Prematre ovarian failre

!. Pregnancy

c. allman syndrome

d. 6heehan syndrome

e. Asherman syndrome

/. #hich can reslt amenorrhea%

a. Arcate ncles inry

!. lfactory nerve inryc. Post )ypophisis inry

d. 8edioBlateral )ypophisis inry

e. Prolactine deficiency

/. #hich of the follow characteries syndrome "nown as Lfemale athletic -riadM:

a. Period !leeding in response to progesterone treatment

!. ncrease in over 10 in ideal mscle mass

c. )ypophisis atrophy

d. steopenia

e. )irstism

70. n which of following will differentiation to female Phenotype occr%

a. +eficiency at chromosome J long arm

!. 45 G0 "aryotype

c. A8) gene mtation

d. 47 GGJ

e. 47 GJJ

71. A 25 y;o female is !een evalated for infertility with reglar periods. #hich of the following confirms the

e$istence of ovlation%

a. progesterone level N5ng;ml

!. proliferative histology in endometrial !iopsy in the lteal phase viscos

c. cervical mcs

d. increase in corporal temperatre after the menstral period

e. increase in

8/10/2019 IMLE .03.10.2011

14/44

72. #hich one of this ovaric tmors doesnOt prodce hirstism%

a. sertoliBleydig tmor

!. donOt remem!er

c. istic teratoma

d. gonado!lastoma

e. lteoma

73. #omen with 50 y;o menopasic with ovaric insfficiency in treatment with ovm

donation, which of the following precations for the implantation of the fets is correct%

a. estrogen E progesterone en el comieno de la menstracion

!. she doesnOt need preparation of the terin mcs

c. preparation of estrogen and A++ progesterone 2 wee"s later

d. stop the hormonal spport after implantation

e. the nm!er of implanted fets is associated with the age of the donor

74. A 3 y;o patient who since the last 2 years has !een !leeding for more that days in every period. 6he has

periods every 32 days and no !leeding !etween periods. #hat is the !est nest step to do%

a. coaglation test

!. lhand test

c. endometrial !iopsy

d. pelvis ecografy

e. -6) test

75. #hich of the follows doesnOt prodce hirstism%

a. 5 alfa redctase deficit

!. 21 hidro$ilase

c. ovaric aromatase deficit

d. 11 hidro$ilase deficit

e. donOt remem!er

7/. A 4 y;o with myomatosis and vaginal !leeding !etween the periods and in the periods, with periods every

5B/ wee"s that lasts from / to 10 days. #hich the ne$t management to do%

a. (*) agonists for 3 months

!. (*) for / months E hormones

c. histerectomia

d. endometrial !iopsy

e. a!lation

77. A 23 y;o woman with a!dominal pain that intensifies dring periods. 6he on !irth control pills, !ecase of the

pain she goes to laparoscopy where they find where they see lesions of endometriosis and they treat it with laser.

#hat is the ne$t step of the treatment in this patient%

a. contine with !irth control pills

!. (*) agonists for / months

c. aromatase E !irth control pills

d. total hysterectomy E !ilateral salpingooforectomy

e. danaol

8/10/2019 IMLE .03.10.2011

15/44

7. A 24 y;o patient with no children presents with vaginal !leeding. 6he has a pregnancy !y @)'( of 3500 mH;ml

with normal vital signs, with an ecogafy that doesnOt show a gestational sac !t shows a mass of 3.2 cm in the rifht

adne$al. #hich of the following is the !est treatment for this patient%

a. o!servation

!. metotre$ate 8

c. laparoscopic salpingectomy

d. laparotomy salpingectomye. laparoscopic salpingectomy

7. n the pelvic inflammatory disease yo need to diagnose and treat early to prevent which of the following%

a. pelvic paint 6+

!. infertility

c. ectopic pregnancy

d. t!oovaric a!scess

e. adhesion

0. A 35 y;o woman nlliparos who has hemoptysis. 6he has a history of a!ortion 3 months ago and now has a

@)'( of 35000. n the thora$ G ray there is a mass in the middle lo!e of the right lng.#hich is the !est initial treatment in this patient%

a. lavage and crettage

!. histerectomy

c. methotre$ate and lecovirine

d. actinomicine

e. metotre$ate E actinomicine E etoposide

1. #hich of the following is correct regarding intraterine device%

a. the ris" of P+ increases with the se dration.

!. the ris" of P+ increases dring the first month after insertion.

c. the a!salte ris" for infection with protes vaginalis is common.

d. CCmirenaCC device contains medro$yBprogesterone.

e. ris" for ectopic pregnancy is increased.

2. #hich of the following is correct regarding progesteroneBonly oral contraceptives%

a. cervical mcs viscosity is decreased

!. it is more effective than other oral contraciptives.

c. there are 6) srges dring treatment.

d. there are >6) !t no

8/10/2019 IMLE .03.10.2011

16/44

4. #hich of the following tisses is not rotinely resected dring radical hysterectomy for samos cell carcinoma of

the terine cervi$%

a. parametrim.

!. socroBterine ligamints.

c. ovaries and fallopian t!es.

d. pelvic lymph nodes.

e. vaginal dome.

5. #hich of the following is nie in ovarian endodermal sins tmor%

a. estrogen secretion.

!. androgen secretion.

c. lymphocytic infiltration.

d. neroectodermal tisse.

e. schillerBdval !ody.

/. A laparoscopy is done to an 1 years old female with peritonitis, it shows rptre and !leeding of a 10 cm cyst

that encompasses the entire left ovary. +ysgerminoma is diagnosed on froen section !iopsy. 'orrect treatment:

a. ophorectomy of the involved ovary.

!. >ll staging inclding hysterectomy, oophorectomy lymph node !iopsy.

c. 'hemotherapyEcar!oplatineEta$ol.

d. @rachytherapy of left pelvis.

e.esection of involved ovary and resection of the other ovary with cryoB preservation to maintain fertility.

7. A 54 year old male complains of dyspnea for months. )e has minimal prior medical care, non prior

pro!lems and denise ta"ing any medications. )e smo"es 1 pac"age of cirgarrets for the last 30 years.

n physical e$amination sta!le prolonged e$piratory phase an diminished !reath sonds !ilaterally. -he

most li"ely case of this chronic dyspnea:

a. Plmonary em!olism.

!. 'P+.

c. +8

d. 8

e. Pnemonia.

. An 40 y old male presents with painfl, swollen right "nee and low temperatre. -he most sefl test is:

a. 'omplete !lood cont.

!. Hric acid level in !lood.

c. &6.

d. hematic factor.

e. oint flid analysis.

. A previosly healthy 2/ year old male complained of a!dominal crsmps for the past 2 days.

8/10/2019 IMLE .03.10.2011

17/44

0. A 7/ year old male complains of progressive worse fatige over the past / months, difficlt in wal"ing 2 !loc"s

and poor appetite and loose of 15 "g. Physical e$amination shows pale connctiva, clear lngs !ilaterally, ): reglar

/!pm, no mrmrs. '*' hemoglo!in 7g and decreased 8'9. ncrease in total iron !inding capacity and low

ferritin. Anemia is most li"ely de to secondary:

a. -thalassemia.

!. Anemia of chronic disease.

c. >olate deficiency.d. 9itamin @12 deficiency.

e. ron deficiency anemia.

1. /0 yRo woman compalins of fatige for / month. 'ondition worsens progresivly.

now she !egins to notice wea"ness and nsterdiness in her gate. n e$amination: pale

connctiva, heartR lngs normal. n nerological e$amination:decreased vi!ratory

sense. )g!: 8'9is increased. -he most common case of this condition is:

a. a.iron deficiancy

!. !.folate deficiancy

c. c.pernicios anemia

d. d.anemia of chronic disease thalassemia

2. A Patient is diagnosed with (raveCs disease. #hat wold !e the findings%

a. low -6) and high free -4

!. )ot nodleDon a thyroid scan

c. Anti!odies for -hyroid

d. )igh -6) S >ree -4

e. >ine needle aspiration !iopsy is necessary.

3. 40 year old female patient is presented with left chest pain. the pain is located mid claviclar on the 4th

intercostal space. -here is a trigger point and the pain is increased with inspiration. #hat is the most li"ely diagnosis%

c. chostochondritis

4. A / year old woman comes to discss reslt of her dalBenergy $Bray

a!sorptiometry =+&GA? scan. )er -Bscore is 2.7 in spine femr. yo e$plain that she has osteoporosis and reires

treatment management of osteoporosis incldes:

a. +aily inta"e of 500 mg calcim.

!. avoidance of weightB!earing e$ercise.

c. -a"e !isphosphonates on a fll stomach.

d. stop smo"ing.

e. monthly se of newly formlates !isphosphonates.

5. /0 yRo woman presents with chronic dyspnea and a long history of smo"ing. yo diagnose 'P+ and treat to

relieve the symptoms. n addition to this therapy, other recomandetion mst inclde:

a. spiral '- of chest

!.e$ercise avoidance

c.stop smo"ing

d.)aemophil inflena ! vaccination

e.refer to !ronchoscopy.

8/10/2019 IMLE .03.10.2011

18/44

/. 45 yRo healthy male come for physical e$amination. )is last e$amination was 10

years ago and was normal. *o history, no medication, no smo"ing, drin"s 2B3 alcoholic drin"s wee"ly. >amily history is

positive for hypertension from the maternal side. -he patient has no physical complains. )is eamination is normal,

!t, the @P is 14R. Jo recomend rechec" of @P in 1 month and @P is 150R100. >rther evalation shold inclde:

a.serm and rine chatecholamine

!.cardiac stress test

c.&'(d.no test

e.renal scan

7. 20 yRo woman with concerns that her thyroid is overactive. !ecase her mother has similar condition and she has

not !een feeling well. in evalating this patient, what wold strongly sggest hyperthyroidism%

a. palpitations

!.increased weight

c. constipation

d.depression

e.fatige

. 2/ yRo man arrives to the & with complaints of acte onset of the Dworse headache of my lifeD. Appropriate

diagnostic evalation. -reatment wold inclde:

a.smatriptan /mg s!ctanos

!.head '- and if negative

8/10/2019 IMLE .03.10.2011

19/44

101. A 50 yearBold man complain of recrrent chest pain that radiates down his left arm and has !een occrring

over the past months.-he pain is descri!ed as a retrosternal pressre. t is !roght on !y wal"ing or other

strenos e$ercise and is relieved !y 2 mintes at rest.

)is vital signs are sta!le and the physical e$amination is nremar"a!le. -he most li"ely diagnosis:

a. myocardial infarction

!. sta!le angina

c. nsta!le anginad. pericarditis

e. plerisy

102. f the following conditions, wich is related to the development of osteoporosis in men%

a. prolactinoma

!. hypogonadism

c. prostate cancer

d?renal stones

e. inginal hernia

103. A /5 year old with a history of chronic atrial fi!rillation in !eing monitored while warfarin therapy. -he nrsecalls to inform yo the patientMs * is measred at 7. )e has no active signs of !leeding.!t manangment at this

time incldes:

a. stop warfarin,o!serve and repeat * in 3 days

!. stop warfarin and o!serve,repeat * in 24 hor

c. stop warfarin,give vitamin and repeat * in 24 hor

d. stop warfarin,give vitamin and fresh froen plasma with daily *

104.#hen is a comprehensive evalation necessary when a patient is affected !y deep vein throm!osis =+9-?:

a. 45 yearBold male with an idiopatic +9-

!. /5 yearBold with a recent transatlantic f light and +9- of the left thigh

c. 55 yearBold who develops a calf +9- after a 4 hor car ride

d. 75 yearBold with a history of nonBsmall cell lng cancer with left leg +9-

e. 72 yearBold with a right thight +9- and no history of travel

105. Anemia that is scan in patient with chronic renal disease is sally cased !y insfficient:

a. ron stores

!. vitamin @12

c. renin levels

d. erythropoietin levels

e. folat st

10/. ron deficiency anemia is associated with:

a. hyperchromic , macrocytic featres.

!. elevated serm iron levels.

c. increased total ironB!inding capacity =ti!c?.

d. increased ferritin levels.

e. normal !one marrow !iopsy reslts.

8/10/2019 IMLE .03.10.2011

20/44

107. #hich of the following &'( findings is associated with sdden cardiac death:

a. prolonged I- interval.

!. firstBdegree A9 !loc".

c. sins arrhythmia.

d. right !ndle !ranch !loc".

e. prematre ventriclar contractions.

10. -he !est medication to se in the emergent treatment of spraventriclar tachycardia is:

a. digo$in.

!. verapamil.

c. adenosine.

d. diltiaem.

e. isoproterenol.

10. -reatment of a severely infected dia!etic foot lcers shold involve:

a. topical anti!iotics.

!. de!ridement only.c. de!ridement with systemic anti!iotics.

d. de!ridement with topical anti!iotics.

e. none of the a!ove.

110. A 41 year old !siness e$ective presents to yor office and complains of palpitations and shortness of !reath.

After frther estioning, he admits to heavy alcohol consmption the previos evening. n e$amination, he is fond

to have an irreglar heart!eat of 130 !eats per minte. -he most li"ely diagnosis is:

a. ventriclar tachycardia.

!. ventriclar fi!rillation.

c. prematre ventriclar contractions.

d. atrial fi!rillation.

e. wolffBpar"insonBwhite syndrome.

8/10/2019 IMLE .03.10.2011

21/44

Part @:

1. A 3/ years old woman with 6 shows oligoclonal !ands of

g(. -he most li"ely diagnosis is:

a. 8ltipe 6clerosis

!. )ntingtonOs disease

c. Par"insonOs disease

d. *erofi!romatosis

e. Amyotrophic lateral sclerosis

5. A 5/ year old, an presents with chronic diarrhea. )e stats he has loose stools for last 2 days. *o !lood in stool,

temperatre, weight loss or recent travel. Hr ne$t step:

a. !servation

!. 6tool cltre

c. 'olonoscopy

d. 6tool fat stdies

8/10/2019 IMLE .03.10.2011

22/44

8/10/2019 IMLE .03.10.2011

23/44

11. #hich of the following is sed in treatment to congestive heart failre with systolic dysfnction%

a. verapamil

!. diltiaem

c. ramipril

d. nifedipine

e. isoproterenol

12. A /5 y.o. 8an present to the hospital with shortness of !reath. )e has no prior medical care.

8/10/2019 IMLE .03.10.2011

24/44

17. A 24 y.o. 8an i.v. +rg ser present to the hospital with fever, night sweats chest pain, arthralgia, painless

erythematos lesion on the palm of his hand, rond erythematos lesions with central cleaning on the retina and

splinter hemorrhage on the finger nails. -he most li"ely diagnosis%

a. )9

!. !acterial endocarditis

c. syphilis

d. infectios hepetitise. lyme disease

1. #hich of the following is associated with '.8.

8/10/2019 IMLE .03.10.2011

25/44

2. A / year old girl is sent home from smmer camp with a fever of 3.5', stiff nec", photopho!ia and headache.

8/10/2019 IMLE .03.10.2011

26/44

35. A 15 yearsBold white girl develops !loody diarrhea on the / day of hospitaliation

for therapy of presmed !acterial nemonia.6he has recived intravenos Ampicilin.

>ever and tachipnea resolved and her o$ygenation now is normal. n fact, she was

schedled for discharge. #hich of the following action wold !e most apropiate%

a. 6wicht tha anti!iotic to 3erd generarion cephalosporines

!. +iscontine Ampiciline

c. !tain ventilation Bperfsion scand. !tain '- scan of the a!domen

e. Add erythromycin or do$ycyline

3/. *ew!orn develops sepsis and shoc" , the pathogen that most commonly cases systemic and focal infection

in new!orn is :

aBstaphylococcs Ares

!B grop A streptococci

cBgrop @ streptococci

dBeschearichia coli

eBherpe$ simple$ virs

37. #hich of the following tmors is associated with &pstein B@arr virs infection

a. aposi sarcoma

!. @r"it lynphoma

c. nero!lastoma

d. wilmOs tmor

e. 'arcinoma of colon

3. #hich of the following cancers occrs primarity dring childhood%

a. @reast cancer

!. enal cell cancer

c. #ilmOs tmor

d. Prostate cancer

e. 'olon cancer

3. A 4 yearB old !oy with anemia has a !one marrow !iopsy that shows 4 !lasts . *o !lasts are seen on

peripheral !lood smear. >inding on physical e$amination and another stdios are normal. 8ost li"ely diagnosis%

a. Acte

8/10/2019 IMLE .03.10.2011

27/44

41. -he developmental appropriate age of child who scri!!les, wal"s alone, spea"s one real word and pretends to

drin" from a cp is:

a. 7 months.

!. 13 months.

c. 20 months.

d. 24 months.

e. 30 months.

42. -he developmental appropriate age of child who rolls !ac" to front, has a thm! finger grasp, self inhi!its to

UnoU and !angs two c!s is:

a. months.

!. 12 months.

c. 15 months.

d. 3 months.

e. 1 months.

43. A 10 years old girl has had diplopia, ptosis and wea"ness of her nec" fle$ors for 2 months. 6ymptoms areworse in the evening and sally less severe awa"ing on the morning. *o fasciclation or myalgia, her deep tendon

refle$es are normal. -he most li"ely diagnosis:

a. )ysterical wea"ness.

!. 8scle dystrophy.

c. 6pinal msclar atrophy.

d. @otlism.

e. 8yasthenia (ravis.

44. A 4 year old !oy is evalated for his first generalied tonicBclonic seire which lasted 10min. *o history of

illness or fever and findings on e$amination after the seire are completely normal. -he most appropriate

management is:

a. @egin therapy with 'ar!amaepine.

!. rder &&(.

c. rder '- scanner of the !rain.

d. rder 8 of the !rain.

e. rder psychometric testing.

45. A 15 months old girl is evalated for a 10 min long generalied seire associated with a temperatre of 40V'.

#hich of the following factors in the list is most li"ely to increase the ris" of ftre seiers%

a. Apgar 3B5.

!. >amily history of epilepsy.

c. 'linical evidence of roseola.

d. >emale gender.

e. Presence of 2Bcaf

a lait spots.

8/10/2019 IMLE .03.10.2011

28/44

4/. A 3 months old infant presents for a wellBchild evalation. #hich of the following complaints wold !e a case

of concern%

a. egrgitation of 15B30ml formla 3 times a day.

!. ne !owel movement every other day.

c. -hree !owel movements per day.

d.

8/10/2019 IMLE .03.10.2011

29/44

52. A 3 year old !oy presents to yor office with sdden onset of cola colored rine

progressive facial swelling over the past 3 days, and decreased rine volme over the

past day. n e$amination: !lood pressre 130;0 mm)g, perior!ital edema, !i!asilar

rales, and an"le swelling. )is rinalysis is remar"a!le for 3E hematria, 1E proteinria, 100 red !lood cells, and red

!lood cell casts, his serm electrolytes are normal and the serm al!min is 3.2 g;l.

this clinical presentation is most consistent with:

a. acte renal failre!. acte pyelonephritis

c. nephrotic syndrome

d. acte glomerlonephritis

e. chronic renal failre

53. A 3 year old !oy presents to an rgent care clinic with a 3 day history of a!dominal pain and difficlty wal"ing.

A!normal findings inclde !lood pressre of 120;0 mm)g diffse a!dominal tenderness. Prpric rash of the hands

and an"les and diffse periarticlar tenderness and swelling of the an"les. -he most li"ely diagnosis is :

a. systemic lps erytimatosis

!. awasa"iOs disease

c. venile rhematoid arthritis

d. henochBschonlein prprae. stevens honson syndrome

54. A 3 year old girl presents acte onset of lethargy and pallor the child has !loody diarrhea for 5 days that

cleared one day prior to presenting to yor office, she also notes acte onset of cola colored rine. n

e$amination the patient is pale and lethargic pressre 120;0 mm)g. -he most appropriate ne$t step:

a. rinalysis

!. $ ray of the a!domen

c. midstream rine cltre

d. !lood cell cont and smear

e. prothrom!ine time

55. 1 month female infant is presented with chief complaint of poor feeding and lethargy, the parents report that the

child was well ntil 3 days earlier when poor feeding !egan plse rate is 20 !eats;min, respiratory rate is 50;min

!lood pressre is 0;50 mm)g. Physical e$amination shows a gallop rhythm and an enlarged liver palpa!le 2B3 cm

!elow the right costal margin. -he most appropriate diagnostic test for this patient wold !e:

a. chest radiograph

!. '@' complete !lood cont

c. &'(

d. arterial !lood gases

e. !lood cltre

5/. 2 month old infant with spraventriclar tachycardia a initial management:

a. vagal stimlation

!. cardioversion

c. defi!rillation

d. digitaliation

e. intravenos verapamil

8/10/2019 IMLE .03.10.2011

30/44

57. A previosly healthy 7 year old girl has a 3Bw" history of fever, myalgias, and appositive !lood cltre for

staphylococcs ares . the past medical history is negative inclding a normal camp physical e$amination /Bmo ago,

which did not reveal any heart mrmr. After repeating a !lood cltre, the ne$t step in her evalation shold !e:

a.chest radiograph

!.complete !lood cont

c. echocardiogram

d. !one scane. dental clinic appointment

5. -he most freent presenting manifestations of pheochromocytoma in children is :

a. night mares

!. a!dominal pain

c. polyria and polydipsia

d. weight loss

e. hypertension

5. A 7 day is admitted to the hospital for evalation of vomiting and dehydration, physical e$amination is normal

e$cept for minimal hyperpigmentation of the nipples. 6erm sodim and potassim concentrations are 120me;l =low? and me;l =high?, respectively. #hich of the following is the most li"ely diagnosis :

a. pyloric stenosis

!. congenital adrenal hyperplasia

c. secondary hypothyroidism

d. panhypopititarism

e. hyperaldosteronism

/0. A /Bw" has gained no weight since !irth. )er s"in appears mottled, and an indirect !ilir!in level is measred at

15 mg;dl =high? her e$tremities are cold and her temp. is 35c, the most li"ely diagnosis is:

a. "ernicters

!. sepsis

c. galctosemia

d. hypothermia

e. hypothyroidism

/1. A 12 years ewish girl sffer from anemia , le"openia ,thrompocytopenia, large spleen on $Bray femr show

erlenm eyer flas", a!normal !one marrow the most li"ley diagnosis%

a. tayBsachs disease

!. gncher disease

c. mcopolysaccheridosis

d. canavan disease

e. glycogen storage disease

8/10/2019 IMLE .03.10.2011

31/44

/2. -he disease pass throgh mother affect sons and daghter in varia!le manifestation in affect si!ling. most li"ely %

a. mitochondrial inheritance

!. mltifactorial inheritance

c. $Blin"ed recessive inheritance

d. atosomal rcessive

e. enviromentaly indce

/3. A6- determinds%

a. !ronchial reactivity serotonin

!.!ronchial reactivity after inhalation !ronchial provocation test

c.the proportion to the allergic immnoglo!ilin

d. antigen specific serm ige concentration

e.overal allergic ris" profile !ased on a!solte eosinophil , total ige and s"in test

/4. A 12 years !oy complain from sneeing, clear rhinorrhea , itching physical e$am reveals !oggy pale nasal

edema clear discharge most li"ely diagnosis %

a. foreign !ody!. vasomotor rhinitis

c. netrophilic rhinitis

d. nasal mastocytosis

e. allergic rhinitis

/5. 3 year old female pt. coghing and wheeing what the strong ris" factor for persistent asthma in toddler

with recrrent wheeing%

a. ecema

!. colic

c. living on farm

d. female gender

e. 8 with effsion

//. #hat the effective screening test for - cell fnction%

a.a!solt lymphocyte cont

!. flow cytometry for '+4 =helper? E '+ =cytoto$ic?

c. respiratory !rst assey

d. candida s"in test

e. mmp A@ titer after mmps vaccination

/7. nfection typical to pt. with celllar immnodeficiency%

a. plasmodim viva$

!. strep. Pnemonia

c. staphy. Ares

d. pnemocytocysitis carini pnemonia

e. hemephils inflena

8/10/2019 IMLE .03.10.2011

32/44

/. 4 year white female pt. oint swelling with mltiple oint for / month slow to move in morning , move as if

stiff for first hor of day , very active child , *o rash very little limitation of range motion , &6X 4 what the

diagnostic %

a. hypermo!ility syndrome

!. +ermatomyositis

c. 6

8/10/2019 IMLE .03.10.2011

33/44

74. A 2Byear old !oy is noted to !e drin"ing from a container filled with "erosene. )e immediately coghs,

!ecomes tachypnic, and is !roght to the hospital. -he !est approach to his treatment is to:

a.ndce emesis.

!.Perform nasogastric t!e lavage.

c.nstill mineral oil.

d.Administer steroids.

e.*one of the a!ove.

75. A Previosly healthy 5 monthsBold infant develops !ronchiolitis. n the forth day of illness she is noted to have

!lging, opae, white ear drms !ilaterally. which of the following treatment regimens is the most appropriate to

institte%

a.)igh dose oral amo$cillin.

!.ntramsclar 'eftria$one.

c.ral 'efi$ime.

d.*o initial anti!iotic treatment.

e.ral aithromycin.

7/. -he se of which of the following medications is limited !y patentally lifeBthreatening rashes%

a.Phenytoin.

!.

8/10/2019 IMLE .03.10.2011

34/44

0. #hich of the following electrolyte a!normalities is associated with !limic patients%

a.8eta!olic acidosis.

!.espiratory acidosis.

c.8eta!olic al"alosis.

d.espiratory al"alosis.

e.*ormal electrolytes.

1. A 42 year old man is seen in yor office.he has recently seen a psychiatrist and is !eing treated for severe

depression.the patient cannot recall the medication that he is ta"ing,!t he remem!ers that the psychiatrist told him

not to eat cheeses or aged meats.which of the following agents is this patient most li"ely ta"ing%

a. tricyclic antidepressant

!. ssri

c. mao inhi!itor

d. neroleptic

e. an$iolytic

2. )igh fever,tachycardia,tachypnea,diaphoresis,hypertension and seiers develop in a psychiatric patient who

receiving haloperidol.the most li"ely diagnosis is:

a. malignant hyperthermia

!. rha!domyolysis

c. neroleptic malignant syndrome

d. sepsis

e. serotonin syndrome

3. #hich of the following is most li"ely to case withdrawal symptoms with a!rpt discontination%

a. flo$etine =proac?

!. sertraline =oloft?

c. paro$etine=pa$il?

d. citalopram=cele$a?

e. none of the ssriOs case withdrawal symptoms

4. 'hildren who e$hi!it symptoms of school avoidance with nasea, vomiting and a!dominal pain may !enefit from:

a. antidepressent medication

!. 8ethylphenidate

c. Psychotherapy

d. !eodiaepines

e. 8ood sta!iliers

5. #hich of the following statements a!ot somatiation disorder is tre%

a. men are more affected than women.

!. Patients e$hi!it mltiple physical comlaints that sally have an identifia!le physiologic !asis

c. -he condition sally develops after age 50.

d. 6ymptoms rarely affect the patientOs interpersonal relationships.

e. -reatment involves freent office visits and reassreance to the patient.

8/10/2019 IMLE .03.10.2011

35/44

/. #hich of the following statements a!ot sicide is tre%

a. 8ales ma"e more sicide attempts

!. #omen are more sccsessfl

c. An$iety is the most common contri!ting factor

d. 8ost sicides occr dring decem!er

e. 8arried people have the lowest ris" for sicide

7. (alactorrhea is associated with which of the following medications%

a. !enodiaepines

!. tricycle antidepressants

c. 8ao inhi!itors

d.antipsychotic medication

e. +opamine agonist

. #hich of the following is most commonly associated with tricyclic antidepressant to$icity%

a. 3rd degree A9 !loc"

!. P interval prolongationc. I- interval prolongation

d. #idened I-

e. - elevation

. A 25 year old male was hospitalied for his first episode of psychosis, started on haloperidol. After 3 days

patientOs pper !ody was contracting, he is in pain and is frightened. #hat is the !est medication to help relieve

his sffering%

a. Propranolol

!. lanepin

c. Ietiapine

d. @entropine

e. isperidone

0. 8ost common type of o!session in patients with '+%

a. #orries a!ot contamination

!. ntrsive se$al thoghts

c. eligios o!sessions

d. )oarding

e. Preoccpation with !ody image

1. A 1 yrs single man recently diagnosed with schiophrenia referred for consltation was recently fired from his o!

at afast food restarant,clinical pictres has !een dominated !y positive symptomatology,his cosin recently

diagnosed with schiophrenia,patient as"ing a!ot his prognosis,good prognosis in his case%

a. predominant to symptom

!. yong age at onset

c. family history of schiophrenia

d. !iarre delsion

e. poor premor!id psychosoied fnctioning

8/10/2019 IMLE .03.10.2011

36/44

8/10/2019 IMLE .03.10.2011

37/44

. -he !est indicator for increased ris" of sicide%

a. alcohol dependence

!. marriage

c. schiophrenia

d. previos sicidal !ehavior

e. maor depressive disorder

. A 30 year old man with history of !ipolar disorder on com!ination of drgs, present wit fever, headache, hac"ing

cogh, this progress to a spreading red rash, which of the following most li"ely to have cased this condition%

a. lamotrigine and valporic acid

!. fl$etine and valporic acid

c. lamotrigine and fl$etine

d. lithm and lamotrigine

e. lithim and valporic acid

100. A 75 yr women widow leaves her home for annal vication in florida,she forget to ta"e her medication,2 days

later develop= tremor,sweating,nasea,increase an$iety?,does not se alcohol or street drg,cessation of which most

case her symptom%

a. loraepam!

!. lithim

3. !spirone

d. traodone

e. valporate

102. #hich one of the following disorders is most often comor!ide with anore$ia nervosa %

a. +epression

!. '+

c. 6ocial pho!ia

d. schiophrenia

e. Avoidant personality disorder

104. A 12 year old !oy performs a 3 hor of daily complsive hand washing and has e$treme difficlty going to

school de to contamination fear. most appropriate treatment:

a. nterpersonal, cognitive or psychodynamic therapy pls flo$etine.

!. esponse prevention pls sertraline.

c. 6ocial s"ill grop pls methylphenidate.

d. desmopressin =++A9P? nasal spray pls !ehavioral conditioning.

e. >amily therapy.

105. #hich of these s!stances is most li"ely a!sed !y adolescents%

a. 8ariana

!. Alcohol

c. 'ocaine

d. &cstasy

e.

8/10/2019 IMLE .03.10.2011

38/44

107. #hich of the following is common in the childhood history of patients with !orderline personality disorder%

a. 6hyness

!. Psychosis

c. 'ondct disorder

d. 6e$al a!se

e. 8agical S odd !eliefs

110. )ypothyrodism in the eldery may commonly present with al l of the following e$cept%

a. lassitde

!. fatige

c. cognitive impairment

d. anore$ia

e. constipation

8/10/2019 IMLE .03.10.2011

39/44

03.10.2011

Part A:

1.

&

2.

'

3.

'

4.

+

5.

&

/.

&

7.

&

.

&

.

+

10.

@

11.

@.&

12.

'

13.

A

14.

'

15.

+

1/.

'

17.

A.@

1.

+.&

1.

+

20.

@

21.

'

22.

A23.

A

24.

@

25.

@

2/.

+

27.

&

2.

A

2.

&

30.

+

31.

A

32.

@33.

A

34.

@

35.

'

3/.

'

37.

'

3.

+

8/10/2019 IMLE .03.10.2011

40/44

3.

@

40.

'

41.

+

42.

A

43.

@

44.

+

45.

'

4/.

@

47.

&

4.

'

4.

@.+

50.

A

51.

'

52.

A

53.

@

54.

+

55.

A

5/.

@

57.

A

5.

A

5.

@

/0.

A.@

/1.

+

/2.

+

/3.

A

/4.

A

/5.

@

//.

@

/7.

'

/.

A

/.

+

70.

@

71.

A

72.

'

73.

'

74.

+

75.

A

7/.

+

77.

A

7.

@

7.

+

0.

'

8/10/2019 IMLE .03.10.2011

41/44

1.

@.&

2.

'

3.

@

4.

'

5.

&

/.

A

7.

@

.

&

.

+

0.

&

1.

'

2.

A

3.

'

4.

+

5.

'

/.

'

7.

A

.

@

.

+

100.

'

101.

@

102.

@

103.

'

104.

A

105.

+

10/.

'

107.

A

10.

'

10.

'

110.

+

8/10/2019 IMLE .03.10.2011

42/44

Part @:

1.

@

2.

@

3.

A

4.

A5.

A

/.

'

7.

&

.

'

.

+

10.

A

11.

'

12.

&

13.

A

14.

@15.

+

1/.

'

17.

@

1.

@

1.

A

20.

+

21.

22.

23.

24.

&25.

'

2/.

27.

2.

2.

'

30.

31.

@

32.

+

33.

@

34.

+

35.

@

3/.

'

37.

@

3.

'

3.

&

40.

&

8/10/2019 IMLE .03.10.2011

43/44

41.

@

42.

A

43.

&

44.

@

45.

@

4/.

&

47.

'

4.

+

4.

'

50.

&

51.

@

52.

+

53.

+

54.

+

55.

'

5/.

A

57.

'

5.

&

5.

@

/0.

&

/1.

@

/2.

A

/3.

+

/4.

&

/5.

A

//.

+

/7.

+

/.

+

/.

@

70.

+

71.

+

72.

+

73.

A

74.

&

75.

A

7/.

@

77.

'

7.

&

7.

A

0.

'

1.

'

2.

'

8/10/2019 IMLE .03.10.2011

44/44

3.

'

4.

'

5.

&

/.

&

7.

+

.

'

.

+

0.

A

1.

A

2.

'

3.

+

4.

A

5.

A

/.

'

7.

'

.

+

.

A

100.

A

101.

102.

A.@

103.

104.

@

105.

A

10/.

107.

+.&

10.

10.

110.

+