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 ioni-ing radiation e.'os"re 'ose the most risk of mental
retardation in the fet"s $

A.4-/
(.0-10
).20-2
*.20-3/


4. +val"ation of "ncom'licated long standing chronic hy'ertension early in 'regnancy incl"des all +1+P+2 which
of the following $

A.eachocardiogra'hy
(.ser"m creatinine level
). o'htalmological eval"ation
*."rinary catecolamine
+. 3"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 o.ygenation 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
*. 45 o.ytocin
+. 45 atro'ine
/."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


0. 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 10 year old 'rimigravida at 20 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
*. 45 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 )<5 yo" co"nsel yo"r 'atient
that the most effective 'revention for maternal )<5 infection d"ring 'regnancy involves which of the following :


A; 're 'regnancy inactivated vir"s vaccine administration.
(; good hygiene and hand washing.
); )<5 4g given with /2h of viral e.'os"re.
*; ganciclovir administration within /2h of e.'os"re.
+; "n ho"se isolation the entire 'regnancy.


12; how many weeks after delivery does menstr"ation normally ret"rn in a non &reast feeding woman$

A; 4- weeks .
(; -0 weeks .
); 14-1 weeks .
*; 1-10 weeks .






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 )hlorhe.idine



15; which of the following incorrect regarding semen analysis $

A; se."al interco"rse sho"ld &e avoided -0 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



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

a-'rogesteron
&-estrogen
c-cortisol
d-?@
e-A>@


1!; following a 'rimary infertility eval"ation of a 41 years old co"'le the female 'artner was fo"nd to have
menses every 30 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
55:moyility and 30:normal 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 e.istence
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 characteri-ed the female athletic triad syndrome$

A-<enstr"al &leeding following estrogen and 'rogesterone administration .
(-4ncrease in over 10: in ideal m"scle mass.
)-@ighly increased gonadotro'ins.
*-(one mass increase only in the 'resence of m"scle mass increase.
+-@irs"tism and menses a''earance following administration of 'rogesterone only.


22-which of the following com&ination is acce'ted for the treatment of hirs"tism$

A-Progesterone7 BnC@ antagonist7 com&ined oral contrace'tives.
(-Progesterone7com&ined oral contrace'tives7BnC@ agonist.
)-BnC@ agonist7 cy'roterone acetate7 >>C4.
*-BnC@ antagonist 7 cy'roterone acetate7 fl"tamide.
+-BnC@ agonist7 cy'roterone acetate7 com&ined oral contrace'tives.


23-4n vitro fertili-ation is the only acce'ta&le sol"tion for achieving self ov"m 'regnancy in women with:

A-an o&str"cted fallo'ian t"&e following P4*D'elvic inflammatory disease; and a normal another fallo'ian t"&e .
(-an o&str"cted fallo'ian t"&e following P4* and another fallo'ian t"&e following 'regnancy and sal'ingostomy.
)-a single fallo'ian t"&e following sal'ingectomy and male 'artner s'erm co"nt of cells8ml.
*-male s'erm co"nt ofcells8ml and an o&str"cted fallo'ian t"&e following P4*.
+-a fallo'ian t"&e with hydrosal'in. and normal contrast media 'assage to the 'elvis and another normal
fallo'ian t"&e.


24- all of the following are indications for 45A treatment e.ce't:

A-&ilateral t"&al o&str"ction .
(-severe oligoterato-oos'ermia.
)-decreased ovarian reserve.
*-re'eated a&ortions d"ring the first trimester.
+-genetic disorder that re="ires 're-gestational diagnosisDPB*;.






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

A-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 Al-heimerEs disease.
*-mood im'rovement7 treatment of vasomotor sym'toms7 'revention of Al-heimerEs disease.
+-coronary artery disease 'revention7 treatment of vaginal and v"lvar atro'hy7 'revention of Al-heimerEs
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


20-a 30 year old female 7 B5P47 is 10 weeks 'regnantDintra"terine 'regnancy; in the 'resence of an intra"terine
device D4*;. >he is interested in contin"ing the 'regnancy. 2he 4F* wire is visi&le at the cervical os.
#hich of the following is the a''ro'riate management $

A-leave the 4F* in 'lace with no f"rther treatment.
(-leave the 4F* in 'lace and treat with anti&iotics.
)-remove the 4F* now7 followed &y e.'ectant management.
*-terminate the 'regnancy d"e to the increased infection risk.
+-'erform a la'arosco'y to e.cl"de heteroto'ic 'regnancy.


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

A-lower e.tremity 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.







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 <C4


32. woman with @B>4? on 'a' smear 'ositive 3.ne.t management

a. histerosco'y a&domen
&. col'osco'y and &io'sy
c. @P5 va.in
d- tracheletomy


33. 1/yo girl with 'ain in a&domen after "ltraso"nd 1cm ovarian adne.al 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 lisino'ril G statin G A)+ inh&itorP:

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


3. <ale 45 years old com'lained of non'rod"ctive co"gh for the 'ast months.4n addition7 he is healthy7 a
history of hy'ertension7 hy'erli'idemia. @e takeslisino'ril7 atorvastatin. 4n addition7 he has no sym'toms.
A"sc"ltatory chistyes lighton &oth sides. #hich of the following is the most a''ro'riate ne.t ste' in the cond"ct
of this 'atient$

A. immediately transferred to the treatment of AC(s 2 H AC( H
(. &eca"se the co"gh ind"ced &y angiotensin-converting en-yme "s"ally occ"rswithin one month from the
&eginning of acce'tance sho"ld contin"e to takelisino'ril and &e screened for other ca"ses of co"gh.
). sho"ld not take lisino'ril 40 ho"rs and see whether the host-co"gh.
*. has to take lisino'ril and assign a cromolyn7 will see whether the co"gh.




3/. /0yo with lisino'ril amlodi'ine 7(lood Press"re 1308/48 weight 72 kg creatinie 2.57
BAC 20. what stage$

a. 4
& .444
c. 45
d. 5


30. 0 yo 5 stage )I* with increase creatinin7 (P 1208/07 creatinin .37 IG 4.07 @),3 207 ne.t 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
e.amination is "nreveling s"&se="ent eso'hagogastrodo"denosco'y reveals "lcerating lesion in the 'ro.imal
eso'hag"s&io'sy of the mass shows s="am"s cell carcinoma which of the following are risk factor for
develo'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 gastrectomy
c;radiation
d;ome'ra-ol7clarithromycin .amo.icillin

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
44;10 year old women 'resent for eval"ation of facial and lower e.tremity edema 2weeks ago 7she was
diagnosed with "''er res'iratory tract infection that has since resolved with s"''"rative treatment on 'hysical
e.amination (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;4ga 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 0 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 e.aminattion 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 infection 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;4ga 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


40;50 year old woman 'revio"s history of infective endocarditis 'resent for advice regarding anti&iotic
'ro'hyla.is 'rior to dental 'roseds"re it will involve significant gingival mani'"lation she has no allergy .
which A( is indicated $

a;levoflo.acin
&;clarithromycin
c;no anti&iotic
d;amo.icillin


4!; 32 year old man history of iv dr"g "se 'resent with 3 days history of intermitten fever "' to 30.3 and maliase
on e.amination 2:30.3 (HP 130H05 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


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 e.ertion and relived &y rest there is no association
she deniy chest 'ain history 'hysical e.amination "nrevealed +)B shows ?5@ .la&s cardiac en-ymes 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. 2he '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 e.amination: *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. @. 4nfl"en-a.
&. stre'. Pne"monia.
c. <oraella catarrhalis.
d. Pse"domonas aerginosa.
e. ?egionella 'ne"mo'hilia.


52. a / year old man com'lains of 'rogressively worsening fatig"e over the 'receding months. @e has
diffic"lty walking 2 &locks &eca"se of this. @e also has a 'oor a'etite and has lost 15 'o"nds.
Physical e.amination reveals'ale con6"nctiva. 2he l"ngs are clear to a"sc"ltation &ilaterally.
2he hert rhythm is reg"lar an the rate is ! &'m. 2here are no heart m"rm"rs. 2he )() shows hemoglo&in of
/g: with a decreased <)5. 2he total iron-&inding ca'acity is incresed and the ferritin level is low.
2his 'atients anemia is most likely secondary to:


a. thalassemia.
&. anemia of chronic disease.
c. folate deficiency.
d. (12 deficiency.
e. iron deficiency anemia.


53. a 0 y old female with a history of coronary artery disease 'resents with chest 'ain for 1 ho"r. @er 'ain is
similar t'o the sym'toms that she e.Kerienced last year when she was diagnosed with a non->2 elevati'on <4.
>he has &een taking her medictions as instr"cted. 2he nearest catheteri-ed la&oratory is 3 ho"rs away.
#hich of the following is the most a''ro'riate ne.t ste' in the management of this 'atient:

a. 2ransfer the 'atient for P)4.
&. cons"lt cardiovas"lar s"rgery for coronary &y'ass s"rgery.
c. adminster throm&olytic is there is no contraindication.
d. medical management.












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. 4f '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 e.amination in a / year old woman revelaed le"kocytois. >he denies fever7 night sweats or weight
loss. @er'hysical e.amination 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 /.5110!8?. @er hemaglo&in
and 'latelet co"nt are normal. Alow 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 <acro?.
,n 'hysical e.amination: Afe&rile and hemodynamically sta&le7 no evidence of &leeding.
>he is tranf"sed 1 "nit of 'ooled 'latelets.
Ce'eat la&oratory testing 1 ho"r 'ost transf"sion shows a 'latelet co"nt of 100008<acro?.
#hich of the following is the most a''ro'riate ne.t ste' in management of this 'atient:


a. transf"se 1 "nit of 'ooled 'latelets now.
&. transf"se 1 "nit of 'latelets and 1 "nit of 'acked C() now.
c. %o trans"f"ssion t this time7 initiate 'latelet cross match 'rior to ne.t transf"sion &eca"se of ina''ro'riate
res'onse to transf"sion.
d. %o tranf"ssion at this time7 no f"rther testing is re="ired 'rior to ne.t transf"sion &eca"se res'onse was
a''ro'riate.


5/. a 40 y old man with a history of 45 dr"g a&"se 'resents with fever and chills for 1 week. @is e.amination
reveals a new holosystolic m"rm"r at the left lower sternal &order that increase with ins'iration. @e is fe&rile at
30.!). Lo" 'lan to admit him for work "' and treatment of infective endocarditis.
what d"ration of 45 anti&iotics is necessary for this 'atients illness.


a. 4 to weeks.
&. / to 10 days.
c. 3 monhts.
d. 1 year.









50. 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 ne.t ste' in the management for this 'atients angina:

a. Add mor'hine to the 'atients regimen.
&. )oronary angiogra'hy7
c. ?ifestyle modification incl"ding e.ercise.
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.
&. Aamily histroy of cancer.
c. 2o&acco a&"se.
d. Philadel'hia chromosome DPh;.


0. a 0 year old woman has 6"st had the diagnosis of )<? confined. >he is com'letely asym'tomatic and is very
active. @er la&oratory e.amination: #()-301108!8?7 hematocrit-3:7 'latelet co"nt- 4350008<acro?. #hich of
the following wo"ld &e the most a''ro'riatetreatment at this time:

a. <onitor the 'atient closely and initiate treatment when she is sym'tomatic.
&. Admint the 'atient to the oncology ward and initiate /G3 Dcytar&ine and da"nor&icin;.
c. >tart the tyrosine kinase inhi&itor D2I4; imatini&.
d. (egin interferon alfa and hydro.y "rea.
e. (egin testing the family and searching data &ases for stem cell donor.


18 /yrs woman 'resent with 'ainf"l &"rning of hand accom'ained &y erythema and new heat 7 on e.am:
o&vio"s erythema of &oth hands7 the ti' of s'leen 'al'a&le 7 la&: 'latlet 1500007 w&cs 120007 haemoticret 40:
m"tation of 6ak2 is detected 7 which of following is well doc"mented com'lications associated with this disorder:

a- &iddi-chiari syndrome
&- hy'ertension
c- myo'athy
*-interstitial l"ng disease


28 0 yrs male with history aortic valve reg"r 7 'resent with 3 days history of intermittent fever 30.3 7 &.'.
130805 7 h.r. !4 7 CC 1! 7 @+AC2 >,F%* AC+ )C4>P M ty'ical of A5C 7 most likely aetiology of fever a- methicillin
sensetive co-ag"lase -ve stre'&- methicillin resistance co-ag"lase -ve stre'c- methicillin sensitive sta'h a"reo"s
d- gm -ve enteric &acteria38 which regarding eno.a'arin tr"e..

.a-its "se not cost effective in o"t 't clinic ..
.&- not need monitoring...


3. #hich of the following 'ro'osals for eno.a'arin is tr"e:

A. 4t is 'roved that its "se in am&"latory 'atients determines the cost
&. 2he "se of this dr"g does not re="ire 'eriodic testing
c. 2he fre="ency of throm&ocyto'enia7 s"ch as the "se of he'arin
*. (e assigned to intraveno"s
+. 4ts "se in 'atients with renal fail"re is safe






4. #hich of the following is the most a''ro'riate ne.t ste' in the e.amination of 'atients with endocarditis7 the
ca"sative agent is >tre'tococc"s &ovis:

A. )om'lete e.amination 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 e.amination every year
*. ?iver f"nction tests every esyatsev7 eye e.amination 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. 2em'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 105
000. 2he total meta&olic rate analysis.
#hat is the most likely diagnosis of this 'atient$

A. ?"'"s erythematos"s7 dr"g ind"ced
(. )indrom Aelty
). +vans >yndrome
*. 4nfection 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 wa.y a''earance yellowish colo"red skin lesion on the e.tensor
s"rgace of &ilateral arm7 having had this for many years.A li'id 'anel revealed total cholesterol 2107 @*? J 427
?*? J 1207 2riglycerides J 1040.
#hat is the most a''ro'riate ne.t ste'$

a; %o f"rther work"'
&; Prescri&e gemfi&ro-i
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 44
*ia&etes mellit"s last @( A1c is 0./: has o&str"ctive slee' a'nea7 o&esity and hy'ertension7 dysli'idemia.@er
medication metformin7 ins"lin7 hydrochlorothia-ide7 and atorvastatin7 on 'hysical e.amination (<4 42 kg8m and
&lood 'ress"re 14080!7 treatment which of the following "nderlying condition 4s 'rimary a''roach$

a; @y'erglycemia
&; @y'erli'idemia
c; @y'ertension
d; 4nflammatory cytokines
e; ,&esity


0; 0 year old man 'resend with witnessed ac"te onset of right sided weakness and sl"rred s'eech o f 30
min"te 'rior to 'resentation he has a history of hy'ertension7 ty'e 44 dia&etes mellit"s and hy'erli'idemia. ,n
e.amination &lood 'ress"re 200811 mmhg7 heart rate !0 &eat8min his s'eech is sl"rred and he has 3H5 strength
on the right7 )2 scan shows ischemic stroke7 a &asis meta&olic 'anel7 )() and coag"lation test are all normal7 the
'atient has no history of stroke7 and intracere&ral &leeding7 head tra"ma or recent s"rgery.
#hat is the ne.t immediate ste':

a; 45 la&etalol to lower the (P to &elow 105H110 mmhg and then throm&olytic thera'y
&; immediate throm&olytic thera'y
c; 'ermissive hy'ertension7 as'irin7 statin and close monitor
d; 45 la&etalol to lower (lood 'ress"re &y 25:7 as'irin7 statin M close monitor




!; a 34 year old man 'resents for a ro"tine visit7 he has no com'lain today7 he has history of o&esity D(<4 J 34;
hy'erli'idemia and to&acco "se7 only medication is statin7 &lood 'ress"re 13H07 la& e.amination reveal
creatinine of 1.0 mg and @g A1c of 5./:7 what is the ne.t a''ro'riate action to control &lood 'ress"re$

a; order 24 hr am&ylatory &lood 'ress"re monitoring
&; )o"ncil 'atient on life style modification
c; start hydrochlorothia-ide 25 mg daily
d; order genetic st"dies to determine the 'atients risk of hy'ertension


/0; 35 year old white man is admitted for an "n'rovoked *52 of the left femoral vein he has 1st degree relative
of "n'rovoked *52 he is started on low molec"lar weight he'arin and warfarin7 he is interested in "nderstanding
the ca"se or any 'reci'itating factors for *527 for this 'atient7 what is the most a''ro'riate$

a; anti-throm&in f"nctional assay
&; 'rotein ) f"nctional assay
c; factor 5 leiden genetic testing
d; 'rotein > f"nctional assay
e; none of the a&ove


00.A 2 y women re'orts e.'eriencing generali-ed 'ain 7which &ecome 'rogress7 worse over the 'ast several
months7 her 'ains s'ecifically worse in the 6oints. >ym'toms have coincided with diffic"lty slee'ing and
generalie-ad walars.and lethargy7 on e.amination 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


01.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 lisino'ril7 simvastin7on e.amination7&lood
'ress"re 1308/0 and heart rate 54 &eats 7 mild non'iting edema in his &ilateral lower e.trimties 7dee' tendon
refle.s and delayed the rest of his e.amination in "nmarka&le7 which of the following is the &est screening testing
for this 'atient$

a.24
&.2>@
).23
*.24G23


02.A43 years old man 'resents whith 'al'itation an shortness of &reath7on e.amination &lood 'ress"re 124800
h.rate 120 &8min irreg"lar and 23.c 7moderate &ilateral e.o'htalmos 7a 'al'a&le goiter7a 28 systolic flow
m"rm"r and mildweakness in &ilateral lower e.tremities.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 AA. 4n 2@+ PA24+%2$


a.'ro'ylthio"racil
&.iodide
c.'ro'ranolo
d.'rendison





03.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 2 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. 2>@ levels are whith normal limits 7and a
sonogram of the thyroid confirms 1.0 cm cystic nod"le in the left 'ole for this 'atient.
#hich of the following is the &est ne.t ste'$


a.fna
&.radion"clide "'take imaging
c.ct of the neck
d. ser"m thyroglo&"lin assay



04.a 41 years old &"siness e.c"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 e.amination he is
fo"nd to have an irreg"lar heart &eat of 130 &8min7 the most likely diagnosis is$

a.5entric"lar tachycardia
&.ventric"lar fi&rillation
'remat"re 57 contractions
c.atrial fi&relation
d.wPw syndrom


05; 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. 2he most likely diagnosis is:

a- sta'hylococcal food 'oisoing
&- rotavir"s
c- chronPs disease
d. shigellosis
e- 4(>


0; 5! yrs. ,ld female with a history of a heart m"rm"r &"t no other sym'toms or rihomatic fever. 2he m"rm"r
is 28 crescendo decrescendo that radiates to the carotid artery. 2he 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


0/; 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. 2he first thing to do is:

a- ++B
&- gl"cose rolerance test
c- P+2 for the head
d- thyroid f"nction test
e. "rine to.icology screen


00; flo".etinePs most common adverse effect:

a- hy'otension
&- liver to.icity
c. na"sea
d- sedation
e- weight gain

0!; a''ro'riate medication for 2o"rette disorder:

a- &"'ro'ione
&. clonidine
c. halo'eridol
d- 'aro.etine
e- venlafa.ine


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

A. @y'otension.
(. 4nsomia.
). ?iver to.icity.
*. 2remor
+. #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.
(. 4nterested in mechanical toys.
). ,rgani-ed '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 anore.ia
nervosa$

A. @y'ercholesterolemia.
(. @y'erkalemia.
). @y'ocarotenemia.
*. 4ncreased thyroid stim"lating hormone D2>@;.
+. ?e"kocytosis.


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

A. Panic disorder
(. >'ecific 'ho&ia
). ,&sessive com'"lsive disorder.
*. Post tra"matic stress disorder
+. Benerali-ed an.iety disorder


!4.a 20 year old female was diagnosed to have D'ost stress disorder; P2>* after she was assa"lted and ra'ed
months ago. ,ver the ne.t2 years7 des'ite e.tensive 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 P2>*$


A. >"&stance a&"se
(. *e'ression
). ,&sessive com'"lsive disorder
*. Psychotic disorder
+. +ating disorder





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

A. )onversion disorder
(. >omati-ation 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 di--nes7 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. 2he most
'ro&a&le diagnosis in this women is:

A. BA*.
(. <a6or de'ressive disorder.
). <5P.
*. Panic disorder.
+. <eniereEs disease.


!0. A / year old male 'atient is admitted to an ac"te 'sychiatric "nit for severe s"icidal ideation. @e admits to
feeling ho'eless and ref"ses to contract for safety. @e has a history of noncom'liance with treatment and is
ref"sing to take any medications. @e has severe 'sychomotor retardation and sto's eating and drinking. A
reasona&le choice of treatment in this 'atient wo"ld &e:

A. Pers"ade the 'atient to take antide'ressant.
(. #ait and watch for the 'atient to change his mind.
). )onsider feeding against his well.
*. +lectroconv"lsive treatment D+)2;.
+. 4ntensive 'sychothera'y.


!!. ,ne of the criteria for the diagnosis of ma6or de'ressive disorder is weight loss that is "nintentional. 2he
criteria for weight loss s'ecify that:

A. ?oss of any amo"ntof weight is significant.
(. ?oss of 5: or more of the &ody weight in the 'ast one month.
). ?oss of 10: or more of the &ody weight in the 'ast one month.
*. ?oss of 10: of &ody weight in the 'ast 2 weeks.
+. ?oss of 5: of &ody weight in the 'ast 2 weeks.


100. <ania can &e associated with all of the following feat"res e.ce't:

A. >ometimes associated with de'ression sym'toms.
(. )an &e triggered &y antide'ressants.
). 4rrita&ility is a recogni-ed sym'tom.
*. 4s always followed &y de'ression.
+. )an occ"r d"ring &ereavement.

101. #hich of the following illicit dr"gs can lead to a f"ll range of sym'toms similar to that seen in 'atients with
schi-o'hrenia$

A. +cstasy.
(. Alcohol.
). <ari6"ana.
*. Phencyclidine.
+. ,'iates.


102. A 4 year old male is sta&le on low dose halo'eridol for chronic schi-o'hrenia. Cecently he was diagnosed to
have comor&id de'ression and was started on fl".etine 20mg. he calls the 'hysician with com'lains of stiffness
in his arms and legs. #hat is 'ossi&le ca"se of these sym'toms$

A. <alingering7 the 'atient wo"ld like to sto' taking antide'ressant medicine.
(. 4ncrease level of halo'eridol &eca"se of fl".etine.
). Al".etine is ca"sing e.tra'yramidal side effect sym'toms.
*. *ecrease levels of halo'eridol are ca"seing e.tra'yramidal side effects.
+. 4ncrease level of fl".etine &eca"se of halo'eridol.


103. #hat is the characteristic feat"re of chronic mari6"ana a&"se$

A. <otivational syndrome.
(. >ei-"re.
). #ernickEs ence'halo'athy .
*. @PP*.
+. >troke.


104. A 52 year old male is admitted to medical "nit for an "lcer on his foot. 2 days after admission7 he was fo"nd
to tolerate the 4ntraveno"s anti&iotics well and has no fever. @owever he &ecomes restless and a''ears slightly
conf"sed. @e also com'lains of insomnia and the n"rse noticed he is dia'horetic with an increase heart rate and
&lood 'ress"re7 'hysical e.amination reveals a co"rse tremor of the "''er e.tremities and his refle.es are
descri&ed as &risk 7 what is the most likely diagnosis$

A. Alcohol withdrawal.
(. ,'iate withdrawal.
). <etham'hetamine withdrawal.
*. %icotine withdrawal.
+. <ari6"ana withdrawal.


105. #hich of the following is considered to &e a 'oor 'rognostic factor with 'atient with anore.ia nervosa$

A. ?ate age of onset.
(. Aamily mem&ers o'en to 'artici'ate in 'atient care.
). +arly age onset.
*. %o s"icidal &ehavior.
+. %o 'revio"s hos'itali-ation.


10. #hich of the following is the most significant risk factor for s"icide$

A. Psychiatric disorder.
(. *eath of a loved one.
). ?oss of 6o&.
*. ?ack of home.
+. )onflict at work




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

A. +'ili'sy.
(. @"ntingtons disease.
). A4*>.
*. )ancer.
+. (rain in6"ry.


100. 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. <ania.
(. Psychosis.
). An.iety.
*. Panic attack.
+. *e'ression.


10!. A ma6ority of the 'sychotro'ic medications are meta&oli-ed in the liver. #hich of the following statements
is tr"e regarding the treatment of de'ression in he'atic disease$


A. Al".etine is not cleared &y he'atic en-ymes.
(. ?ithi"m is the mood sta&ili-er of choice in the 'resence of he'atic fail"re.
). >>C4Es are contraindicated in liver disease.
*. Paro.etine ca"ses minimal inhi&ition of he'atic en-ymes.
+. @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. <ost terminally ill 'atients develo' a 'sychiatric disorder.
(. <ost terminally ill 'atients are at risk of s"icide.
). Anger is an im'ortant factor in s"icide.
*. <edical illness is not common in 'atients who commit s"icide.
+. s"icide in medically ill 'atients is not 'reventa&le.


























Part (:

1; in disting"ishing schi-o'hrenia from am'hetamine ind"ced to.ic '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; P2>* differs from ac"te stress disorderDA>*;:

a- A>* occ"rs more commonly than P2>*
&- P2>* 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 P2>*
e- P2>* 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; clo-a'ine:

a. 4s associated with few7 if any7 e.tra'eramidal side effects.
&- is &elieved to e.ert 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 schi-o'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 schi-o'hrenia d- res"lts in
'oorer res'onse to anti'sychotic medication
e- has an onset after 0 years of age.


/; minor signs and sym'toms of discontin"ation on &en-odia-e'ine:

a- hy'er'yre.ia
&- grand mal sei-"re
c- 'sychosis
d. nightmares.
e- death
0; which of the following com'lications wo"ld &e the &est indication for admitting 'atient with anore.ia
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'ra-ole
&- car&ama-e'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 e.cl"sively &reastfed 7his 'hysical e.amination is nota&le only for some
scleral icter"s and 6a"ndice to the a''ear chest yo"r ne.t co"rse of action wo"ld &e$

a. a&dominal "ltra so"nd e.amination
&. 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 e.acer&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 *%A
c. 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
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. to.o'lasma gondi
d. sy'hilis
e. 'arvovir"s (1!


1/. Patient who sho"ld receive 'ro'hyla.is for 'ne"mocystis carini 'ne"monia mor than others incl"de
those with:

a. 1 linked agammaglo&"linemia
&. @45 infection
c. chronic gran"lomato"s disease
d. sickle cell disease
e. congenital ne"tro'enia


10. 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 e.amination yo" noticed a &loody
serosang"io"s fl"id oo-ing from the vagina. 2here is no &r"ising or
'atechia. 2he 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. 2he 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 e.amined &eca"se of ref"sal to walk. @e started to walk at 10
month and has &een doing well "ntil this 'oint. ,n 'hysical e.amination he is moderately ill child with
fever of 3!.2 c 7 e.ternally rotated left hi' with limit to 'assive and active motion. 2he )CP level is high.
2he 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.
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 120800 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 e.amination yo" hear a distinct short systolic eyection m"rm"r. 4t 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


23-2risonomy 21 is most 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 stones
d- gastrointestinal &leeding
e-hy'ertension

25- a 20 months-old toddler is seen in the emergency de'artment &eca"se of an 0 ho"rs
history of diffic"lt &reathing. Previo"sly he had &een 'erfectely well. *"ring s"''er he &egan having
'aro.ysmal co"ghing and whee-ing. @e has not hat any 'revio"s similar e'isodes .
@e has moderately increaded work of &reathing. ,n a"sc"ltacion the whee-ing is heard only over his right
chest. @is vital signs are: tem'erat"re 3/)7 '"lse 137 res'itarory rate 0. 2he most lakely diagnosis is:

A. Asthma
(. )ystic fi&rosis
). Pne"monia
*. Poreign &ody as'iration
+. Pean"t allergy with ana'hyla.is

2-A 10 months-old infant has 'oor weight gain and 'ersistent co"gh. 2he mother descri&es the 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-)2 e.amination of the chest
&-ser"m inm"noglo&"lins
c- PP*. >kin test
d-ins'iratory and e.'iratory chest 1-ray
e->weat chloride test

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
&-2"rner >yndrome
c- *i Beorge >yndrome
d- congenital hi'otiroidism
e-)eliac desease


20-a year- old is hos'itali-ed 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 dilatation 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'
&- )2 scan of the head
c-ra'id fl"id hydratation
d-nalo.one
e-&ilateral &"rr holes


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

a-dr"g into.ication
&- agenesis of cor'"s callos"s c-
ata.ia telangiectasia
d-m"sc"lar dystro'hy
e-Ariedrich Ata.ia


30-a 3 year- old &oy 'arentEs com'lain that their child has diffic"lt walking 2ha 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 e.amination 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"mor
d-B"illain (arre syndrome
e-(ot"lism


31- A 14-year-old girl awakens with a mild sore throat7 low-grade fever7 and a diff"se
mac"lo'a'"lar rash. *"ring the ne.t few ho"rs7 she develo's tender swelling of her wrists and redness of
her eyes. ,n e.amination there is marked swelling with mild tenderness of her 'osterior cervical and
occi'ital lym'h nodes. Ao"r ho"rs later the rash has vanished.
#hich of the following is the most likely diagnosis$

a. <easles
&. Coseola
c. +rythema m"ltiforme
d. C"&ella
e. +rythema infectios"m


32- #hich of the following conditions is contraindicated to a diagnostic l"m&ar '"nct"re$

a. 2hrom&ocyto'enia
&. ("lging fontanelle
c. ?"m&ar '"nct"re 2 days &efore
d. <arked "ncoo'erativeness on the 'art of the 'atient
e. >ignificantly elevated #() co"nt consistent with &acteremia )orrect

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. 2o.o'lasma gondii
e. Cotavir"s


34- An 10 month child 'resents with a &rief7 generali-ed 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 ashkena-y 6ewish girl has mild anemia 7 le"ko'enia and throm'ocyto'enia . 'fysic
e.aminations revealsan enlarged s'leen. An .-ray of the fem"r is descri&ed as a''earing to &e Q +rlenmeyer
flaskR. (one marrow e.amination shows a&normal cells. #hich of the following the most likely diagnosis$


a. 2ay-sachs disease
&. Ba"cher disease
c. <"co'olysaccharidosis
d. )anavan disease
e. Blycogen storage disease


3- #hich of the following cancer has the highest incidence in yo"ng children DV/ years;$

a. +wing sarcoma
&. @odgkin disease
c. 2estic"lar cancer
d. Cetino&lastoma
e. ,steosarcoma


3/- A12 month-old female infant with fail"re to thrive is &ro"ght to the office. @er 'arents
note that she is very f"ssy and often s'its "' after feeding. she also has two loose fo"l- smelling stool each day.
#hich of the following foods can she eat safely witho"t aggravating her sym'toms$

A; Cice
(; #heat
); ,ats
*; (arley
+; Cye









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

a.Alcohol
&.<ari6"ana
c.@eroin
d.)ocaine
e.2o&acco


40- A 'rimi'aro"s woman whose &lood ty'e is , 'ositive gives &irth at term to an infant who has A-'ositive
&lood and a hematocrit of 55:. A total ser"m &ilir"&in level o&tained at 3 ho"rs of age is 12 mg8d?. #hich
of the following additional la&oratory findings wo"ld &e characteristic of A(, hemolytic disease in this infant$


a. A normal retic"locyte co"nt
&. A 'ositive direct )oom&s test
c. )rescent-sha'ed red &lood cells in the &lood smear
d. +levated hemoglo&in
e. Petechiae


341 - a 3 year old &oy is eval"ated &eca"se of 'allor and weakness. ?a&oratory tests reveal microcytic and
hy'ochromic anemy. 2he ferritin level is low. #hich of the following is the most likely diagnosis$

a - folate deficiency
& - thalassemia minor
c - a'lastic anemia
d - iron deficiency
e - vitamin (12 deficiency


342 - a year old &oy is e.amined &eca"se of nighty &edwetting. 2he &oy has never had a 'rolonged
'eriod of nighttime dryness and never has WaccidentsW while awake. @e has no dys"ria and his "rinary
steam is normal. #hat is the most common ca"se of his 'rimary noct"rnal en"resis$


a - "rinary tract infection
& - vesico"reteral refl".
c - 'sychological 'ro&lem
d - normal develo'mental variant
e - "nsta&le &ladder


343 - a 5 year old &oy 'resents with a history of grossly &loody "rine7 '"ffy eyes and
headache for a 1 day. @e has &een a well child &"t did have a fever and sore throat 10 days ago7 which
resolved witho"t treatment. 2he most likely diagnosis is:

a - ac"te cystitis
& - 4g A ne'hro'aty
c - ac"te 'yelone'hritis
d - 'ostinfectio"s glomer"lone'hritis
e - &enign hemat"ria

344 - which of the following is regarded as a known com'lication of treatment with total 'arenteral
n"trition D2P%;$

a - se'sis
& - renal fail"re
c - chronic diarrhes
d - vitamin A deficiency
e - irreversi&le athro'y of the m"cosa of the small intestine )orrect
3 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


34 - 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


34/ - an 1/ year old male is seen in the st"dent clinic 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 F24
c - chlamydial "rethritis
d - sy'hilis
e - @45 infection


340 - 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. 2he 'hysical
e.amination is normal. A diagnosis of fail"re to thrive DA22; is made. #hich of the following is indicated$

a - immediate hos'itali-ation and e.tensive 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 care
e - switching form"la to a different cowPs &ased form"la


34! - 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 fatherPs height is 13. @istory and 'hysical e.amination 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


350 - 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 e.a'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 ne.t 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.
51 . a 4 year old 'resents with a dry scaling rash wish rec"rs intermittently. 2he family history is 'ositive for
asthma 7allergy and ec-ma. 2reatment of his ec-ma 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"ri-ing 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
& . 4g+ anti&odies
c . ne"tro'hilis
d . 2 cells
e . 4g A


53 . a 1 month female is e.amined &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 e.amination 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 'aro.ysmal a&dominal 'ain and vomiting
& . 15 year old se."ally active girl with lower a&dominal 'ain
c . 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 age
on 'hysical e.amination 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


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


50 . 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 . 'aro.ysmal 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 ne.t 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)2@ and cortisol
d . o&tain an <.C.4 st"dy of her hand
e . meas"re 4BA-1 and 4BA(P-3


0 . a 20 mo.old child has fever irrita&ility and ref"sal to move his right lower e.tremity 'hysical e.amination
reveals a swollen and tender right knee that resists 'assive motion which of the following is the most
im'ortant test to confirm the im'ression of se'tic arthritis$

a . e.amination of 6oint fl"id
& . . - ray of the knee
c . erythrocyte sedimentation rate
d . com'lete &lood co"nt
e . &lood c"lt"re

1; A 2/ year old man 'resents to the +mergency room after a high s'eed motor vehicle collision7 with
chest 'ain and marked res'iratory distress. Physical e.amination7 he is hy'otensive with distended
neck veins and a&sence of &reath so"nds in left chest. #hich of the following is 'ro'er initial treatment$


a. 4nt"&ation
&. )hest 1-ray
c. Pericardiocentesis
d. )hest decom'ression with needle
e. +mergent thoracotomy












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. 2hese 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 di--iness7 'oor coordination and &alance. 4n
addition he develo'ed strange way of walking7 a stom'ing gait striking first heavily with his
heel. 2he deficiency that wo"ld most likely ca"se sym'toms descri&ed is which one of the following$


a. 4ron
&. 5itamin (12
c. Aolate
d. Xinc
e. )o''er


3; A 5 year old man with long history of )oronary artery disease and recent history of
<yocardial infarction is seen in +mergency room with history of s"dden onset of 'ain in right leg. 2he
'atient also com'lains of n"m&ness in the leg. Physical e.amination revealed 'allor of right leg7 the skin was
cool to to"ch7 and the 'atient has diffic"lty in moving his toes.
Caising his leg increase the 'allor and dorsalis 'edis '"lse co"ld not &e felt.
2hese sym'toms most likely re'resent which of the following a&normalities$

a. >"'erficial throm&o'hle&itis
&. @erniation of a l"m&ar disk
c. Arterial occl"sion
d. *ee' veno"s ins"fficiency
e. @y'ovolemic shock


4; A 30 year old man was taken on an +mergency room after his car skidded on the free way and st"ck
a 'illar. @is vital signs were as follows: '"lse- 008min.7 res'iratory rate -208min.7 &lood 'ress"re- 1008/0 mm@g.
Physical e.amination revealed non 'rominent 6"g"lar neck veins7 no indication of cyanosis and systemic &reath
so"nds. A 'osterioranterior chest 1-ray film reveals a widened mediastin"m. #hich of the following choices is
most likely diagnosis$

a. C"'t"red Aortic Ane"rysm
&. )ardiac tem'onade
c. *issection of the thoracic aorta
d. <yocardial cont"sion
e. P"lmonary cont"sion


5; A 0 year old man 'resents at the +mergency de'artment &eca"se of s"ch severe
a&dominal 'ain that he Q S"st co"ld not stand it any longer Q . @e tells the triage n"rse that
he had not &een feeling well for the 'ast co"'le of months7 'rimarily &eca"se he had &een
having a&dominal 'ain a&o"t 30 min"tes after eating and as a conse="ence lost almost 10
'o"nds7 &"t last night he s"ddenly develo'ed Q a stomach ache from hell Q. @e also has &een
vomiting and has had several e'isodes of &loody diarrhea. F'on 'hysical e.amination the
'hysician notes hy'otension and notices a&dominal distention. (owel so"nds are a&sent7
and there is no re&o"nd tenderness 'resent or other relevant findings "'on a&dominal
e.amination. ?a&oratory data reveal an a&sol"te ne"tro'hilic le"kocytosis and mild left shift 'l"s lactic
acidosis7 and elevation of the ser"m amylase level. #hich of the following is the most likely diagnosis$


a. Ac"te "lcerative colitis
&. @emorrhagic 'ancreatitis
c. Aortoenteric fist"la
d. Ac"te small &owel infarction
e. 2o.ic megacolon




.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 D2P%;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 an.iety
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 e.amination she throw "' a &ile-
stained vomits . 'hysical e.amination reveal generali-ed 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 'ro.imally .
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


0. 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 4& in 'ast 3 months &eca"se of chronic diarrhea .
e.amination of a&dominal show no masses 7 )2 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 most a''ro'riate treatment is $


a. total 'ancreatectomy
&. &road s'ectr"m thera'y
c. gl"ten free diet
d. oral 'ancreatic en-yme &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 e.aminasion reveal a&dominal
distension 7 shifting d"llness on 'erc"ssion and s'iderangiomato over the faceand "''er chest 7 an emergent
endosco'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



/1; a 0 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- to.ic mega colon
d- ogilvie syndrome
e- im'acted stool


/2; a 10 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 an.io"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 .
e.amination of the cardiovasc"lar system had normal findings e.ce'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 e.am
reveals hy'er 'eristalsis 7 tym'any to 'erc"ssion 7 and no re&o"nd tenderness 7 her
tem'erat"re is 30 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 e.am 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 B4
&- order "'right and s"'ine a&dominal films
c- 'erform a 'eritoneal lavage
d- administer anti-acids
e- do an e.'loratory la'aratomy








/5; 20 years old man is sta''ed in the left side of his chest7 medial to the ni''le . "'on
e.amination 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 'atientPs 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 ne.t 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%470-
1070;&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 e.cision of the mass .
c-widge e.cision 7regional lym'h nodes disection.
d-widge e.cision 7imatini&
e-wide e.cision regional ltm'h nodes disection 7imatini&.


/0- refeedind in s"rgery related to:

@y'o'hos'hatemia


/0; #@A2 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'omagne-emiya
*; 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 e.cision of
the 'rimary lesion 7ne.t ste'\

a-o&servation .
&-sentenel lym'h node &io'sy .
c-elective lym'hadeno'athy .
d.C2Dradiothera'y;.
e-isolated lym'h 'erf"sion.
00- 50 y.old 'atient has a 3cm villo"s a''earing t"mor at cmZ of the an"s ne.t 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.


01- 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


02- 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


03- A 5 years old man remains in the 4)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
metronida-ole 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 enemas
c. cecostomy t"&e 'lacment
d. diverting transverse loo' colostomy
e. total a&dominal colectomy and ileostomy


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

a. )2 a&dominal scan
&. Aoc"sed Assessment with >onogra'hy for 2ra"ma DAA>2;
c. *iagnostic 'eritoneal lavage D*P?;
d. 'hysical e.amination
e. none of the a&ove


05 - 23 years old 'atient carries a total thyroidectomy on carcinoma of the thyroid gland. ,n the 2nd day
after s"rgery7 she &egan to com'lain of feeling in the &ones of the hands 'okalivaniya. 4t looks 'retty e.cited7 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.
(. 5itamin * orally
). ?evomiroksina 100mcg orally. $$$
*. )ontin"o"s inf"sion of calci"m gl"conate.
+. Bly"kanat calci"m gloc"nate orally.


0-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 ecch-mosis 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 ecch-mosis
&-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 )2 is negative
e-the &oy sho"ld &e o&served regardless of negative test res"lt )orrect


0/- a 35 year old with a history of 'revio"s right th-roidectomy for a &enign thyroid nod"ls
now 7 "ndergoes com'letion thyroidectomy for a s"s'icio"s th-roid 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 ne.t ste'$

A-fi&ero'tic laryngosco'y to r"le o"t &ilateral vocal cord 'aralysis
(-administration of 45 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


00- 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
)-e.o'hthalmos and lid leg
*-e'isodic hy'ertension
+-&"ffalo h"m'


0!- 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 e.ce'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









!1. A 55 years old man 'resents with his first e'isode of *ivertic"litis. @e is hemodynamical sta&le and
im'roves within 40 ho"rs. @e gets anti&iotica. )2 reveals stranding of sigmoid mesentery7 no free air and
no a&scess. 2he ne.t >te' in treatment sho"ld &e:

a. Cesection and anastomosis.
&. Cesection and colostomy.
c. *ischarge and elective colectomy.
d. *ischarge7 oral anti&iotica and o&servation.
e. )olnosco'ic intral"minal stent.


!2. A 44 years old woman has 'a'illary thyroid carcinom of the right lo&e confirmed &y fine-needle as'iration.
Fltraso"ndst"dy stages the t"mor as 21 D175 cm;. #hat scho"ld &et he s"rgical 'roced"re$


a. Cight thyroid lo&ectomy7 selective node dissection of the right side.
&. Cight thyroid lo&ectomy7 level node disscection.
c. 2otal thyroidectomy7 selective node dissection of the right side.
d. 2otal thyroidectomy7 level dissection and selective dissection of the right side.
e. 2otal thyroidectomy.


!3. A 3 years old man has a &lood 'res"re of /080 mm@g after a motor vehicle crash.
Ces"scitation is initiates. Aoc"sed Assessment with >onogra'hy for 2ra"ma DAA>2; was
'ositive for fl"id in the a&domen. ,n e.amination of the 'elvic7 fract"re-related- cer'it"s and an enlarging
'erinal hematoma are a''reciated. 2he &lood ores"re dose not im'rove with res"scitation.
#hat is the ne.t ste'$


a. )2 of the a&domen and 'elvic.
&. *iagnostic 'eritoneal lavage.
c. Placement of e.ternal 'elvic fi.ator.
d. +.'lorative la'arotomy.
e. Pelvic angioemo&ili-ation.


!4. A 1! years old man7 who fell while 'laying &asket&all fract"red the shaft of the right radi"s and "lna
s"&se="ently "nderwent closed red"ction and a''lication of a cylindrical cast. @e now 'resents with
com'laints of 'ain in the right inde. finger. 2hereis no tingling sensation. )linical e.amination reveals no
dimin"tion in ca'illary refill time7 no hy'oesthesia7 cyanosis ist a&sent. Passive movements of the finger elicits
'ain. )ast is intact. #hat sho"ld &e yo"r ne.t ste'$

a. Ceass"re the 'atient.
&. Prescri&e analgesis.
c. Prescri&e corticosteroids.
d. )leave the cast.
e. ?eave the cast intact and raise the arm for 24 ho"rs. )orrect


!5. A 14 years old &oy come to the office &eca"se his &reasts have recently &ecome tender and slighty
swollen. F'on e.amination a tender7 2 cm mass is fo"nd to &e 'al'a&le in the s"&areola region of &oth
&reasts. #hat sho"ld &e yo"r ne.t ste'$

a. +.cise the masses &y 'erformig a s"&c"taneo"s mastectomy.
&. 4ncise and drain the mass
c. 2reatment with steroids.
d. As'irate the mass for c"lt"re and cytology.
e. ?eave alone.





!.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'hyla.is was &eg"n.
#hich of the following is the &est test to monitor he'arin thera'y$

A.throm&in timeD22;.
(.'rothrom&in timeDP2;.
).'rothrom&in and 'roconvertin test.
*.activated 'artial throm&o'lastin.
+.&leeding time. )orrect


!0.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@4AA 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'ra-ole 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 'rimarily &eer and only at social occasion.

A.diff"se eso'hageal s'asm.
(.achalasia.
).&engin eso'hageal strict"re.
*.-enkerPs divertic"l"m.
+.eso'hageal carcinoma.





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 slightly '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 that 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.2he 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 to make a
to"chdown. 2he 'atient com'lains on severe 'ain in his right arm. @is vital signs are: (P
1408007 PC !0 reg"lar7 2em' 3/) and CC 228min reg"lar. 2he right arm is swollen and
ang"lated in the mid arm area7 itPs tender to to"ch and movement is 'ainf"l. 2he 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. 1-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. A.iliary nerve
&. <edian nerve
c. Flnar nerve
d. Cadial nerve
e. (rachial nerve )orrect


102. #hile riding his &icycle ! year old &oy loss control and falls d"ring the 'rocess. @is
a&dominal strikes the handle &ar. @is 'arents &ring him to the +mergency Coom &eca"se he has a vag"e
mid-a&dominal 'ain and some &r"ising of the anterior a&dominal wall. @is vital signs are sta&le and there
are no other visi&le in6"ries.
#hich of the following is the most likely in6"ry:

a. C"'t"red >'leen
&. C"'t"red ?iver
c. C"'t"red Pancreas
d. @ematoma of the Cect"s <"scle

103. 40 year old o&ese woman was admitted to the hos'ital with "''er right ="adrant 'ain and vomiting.
>he has no diarrhea and no consti'ation. )linical e.amination reveals
tenderness and a''ro'riate investigation demonstrate a 'resence of stone in the )ommon (ile *"ct
D)(*;. Attem't to dislodge the stone endosco'ically 'roved f"tiled7 so she
"nderwent )(* e.'loration. days 'ost o'eration7 the 'atient develo'ed fever of 30]). #hich of the
following is most likely the ca"se of fever:

a. Acc"m"lation of &lood from the 'eritone"m
&. +ndoto.ic shock
c. #o"nd infection
d. Cenal fail"re

104. #hat is the ca"se for rise the rise in lactate levels d"ring stress$

a. <"scle 'rotein degradation
&. Anaero&ic cell res'iration
c. 4ncrease A2P degradation
d. 4ncrease gl"coneogenesis

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

a. (leeding time
&. aP22
c. 4%C
d. <edical history taking


10; d"ring her visit to a 'rimary care 'hysician7 3! years old woman relates that she has
recently had &o"ts of hoarsenes aften associated with diffic"lty in swallowing and
&reathing. F'on taking a history the 'hysician also determines that she emigrated with her
'arents from the Fkraine in 1!00 at the age of 1/ year. F'on e.amination the 'hysician discovers a firm nod"le
near her AdamEs a''le. 2he ne.t ste' in o&taining a diagnosis is which of the following$

a; analy-ing the res"lts of an "ltraso"nd and scan.
(; doing a fine needle as'iration &io'sy
c; a thyroid n"clear scan "sing 1234
d; determining the thyroid ser"m level
e; a formal s"rgical &io'sy.


100; 5 years old man was sean &y his family 'hysician with a month history of
consti'ation and recent history of 'ain in the left lower ="adrant of his a&domen. 2he
'atient com'lained of tenderness and fever as well. Physical e.amination revealed a
moderately o&ese man7 &lood 'ress"re 1308!07 '"lse /7 res'iration 18min7 tem'erat"re
3/70 U). his cardiovasc"lar and res'iratory system was normal7 e.amination of the a&domen
revealed tenderness in the left lower ="adrant with a 'ositive re&o"nd. 4n addition a tender
mass was felt on rectal a.amination. A com'lete &lood co"nt revealed ne"tro'hylic
le"cocytosis and the stool g"aiac test res"lts was negative. <ost likely diagnosis$

a; "lcerative colitis
&; irrita&le &owel syndrome
); ac"te divertic"litis
d; carcinoma colon
e; aschemic colitis




























10!; 5 years old women went &icycling into the co"ntry near lake 2ahoe8 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
e.amination of the chest. 2here is no 6"g"lar veno"s dilation. 2he rest of her e.amination
findings are "nremarka&le. A"rther e.amination 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 30 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''ro.imately one week 'revio"sly. >he doesnEt
smoke7 drinks wine on social occasions7 and takes &irth control 'ills. 2here is no family
history of &reast cancer. Physical e.amination reveals a rather stocky women with
'end"lo"s &reasts. >he has a moderated si-ed7 nontender7 irreg"lar l"m' in the lower o"ter
="adrant of her left &reast. 2he overlying skin a''ears thickened. %o ni''le discharge is
'resent7 and she has no a.illary lym'hadeno'athy. 2he right &reast and a.illa are normal.
<ammogra'hy reveals increased density in the affected region. Fltraso"nd g"ided fine
needle as'iration DA%A(; was 'erformed. 2he 'athology re'ort was consistent with a
diagnoses of fat necrosis.
#hich of the following is the most a''ro'riate ne.t ste' in the management of this 'atient$

a. +.cise the mass.
&. Ce'eat fine needle as'iration &io'sy after one month.
c. Ce'eat mammogra'hy in a month.
d. Ceass"re the 'atient and follow "' in a few weeks. )orrect
































01.03.2012
Part A:
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