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1. A 16 years old girl with type 1 DM brought to the physician bcz of 10kg(22-Ib s) weight loss in last 6 months.

The patient reports that she is feeling fine an d doesn t think anything is wrong. She said she is happy to have lost the weight a nd would love to loss more weight. She said her diabetes is in good control and she Is unaware of any insulin reaction. She is 165 cm (5 ft 5 in) and weight 46 kg ( 102 ibs). BMI is 17 kg/m2. Physical shows no other abnormalities and lab sh ows HbA1c of 8.5% which was 5.8 %. Which of the following patient behavior have contributed her weight loss. A. Decreasing the amount of self administer insulin dose. B. Overuse of laxatives C. Restricting calories consumption. (Wrong) D. Self induced vomiting after meal E. Stating a intense aerobic exercise program 2. 21 years old man comes to the emergency department in the winter bcz of heada che , nausea, vomit and dizziness. He has no fever chill or shortness of breath. He has no major medical history. He lives in a basement apartment in a three st ory house, no one else in the house has the similar symptom. He smokes 2 packs o f cig daily . physical showed no other abnormalities. Which of the following pat hophysiologic process best explain patients symptoms. A. Acidosis causing the oxyhemoglobing dissociation curve to shift to the right. (Wrong) B. Activation of nicotinic receptors in locus ceareleus C. Cerebral arterial constriction caused by increased co2 conc in blood. D. Competitive inhibition of oxyhemoglobin formation. E. Inactivation of cytochrome oxidase by cyanide.

3. A 3 years boy is brought to the physician by his mother bcz she is concern th at he doesn t speak in sentence. He has a vocabulary of about 20 words and she sai d that he points to the object he wants instead of asking. He is at 5oth percent ile for height and weight. Physical shows no abnormality. During the examination the patient sits on a table looking at a reflex hammer and appears indifferent to his mothers presence. Which of the following is the most appropriate action b y the physician. A. Reassure the mother that the patients language development are within range o f normal development. (wrong) B. Advise the mother to enroll the child preschool early. C. Inform the mother that the patient has mental retardation and would need spec ial education D. Recommend farther evaluation to find the cause of language delay E. Order an MRI of brain

4. A 79 years old women with osteoarthritis comes to the physician for an initia l examaniton. She is otherwise healthy and lives alone. When the physician enter s the examination room he detects a slight odour suggestive of urine, it is most appropriate for the physician to approach the topics of urinary incontinence wi th this patient with which of the following way. a. Are u having any problem that u may be too embarrassed to talk about? Would u be willing to talk about them today. (wrong) b. I couldn t help but noticed a odor when I entered the room. Are u having any di fficulties in having holding ur urine. c. I understand this can difficult to talk about but do u also finds urself havi

ng fecal incontinence in addition to urinary incontinence. d. I know this can be an embarrassing topics but ppl sometimes have difficulties in holding their urine as they get older. Is this ever a problem for u. e. It is not surprising that some1 at ur age having difficulties holding urine. How many accidents u have in a day.

5. A 59 years old women dx with unresectable pancreatic cancer. Physician thorou ghly discussed the dx and Rx with her. She doesn t have a mood disorder. One week later she presents to the physician and said she decided to decline palliative c hemotherapy which could prolong her life only 6 months. She said I would like to d ie by cancer now rather than be tortured by chemo and die later. Which of the fo llowing response by physician is appro[riate A. Have u consulted ur clergy before choosing such a path. (wrong) B. I respect ur choice and I will make u as comfortable as possible. C. I think u are making a bad decision. Why would u chose to die sooner. D. I think u are making a unwise descision. You never know wt kind of new treatm ent comes to the corner. E. I would like to involve ur family in the descision.

6. 33 yrs old women comes to the physician with 3 months history of headache. 2w ks ago she moved to women shelter area bcz her husband had been hitting her. She takes no medication on physical multiple bruise in different stages of healing present over face, neck, and trunk. There is circumferential bruise on both side s of neck. Which of the following is most appropriate to gather pertinent inform ation from this patient. A. B. C. D. E. Did u bring ur record from the emergency room with u. I see some bruise in ur neck. How did that happened. Plz demonstrate to me how this neck bruise occurred. (Wrong) This looks like u were chocked. Is that true. What sort of device did ur husband used in ur neck.