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uestons
TO 1 jBascj
D UUyCJiOU HJH i8 C\JUJICU iH IHC CHCi_CHCy UCJiIHCHI
Oi CH8iUCU CHC8I JiH IHJI DC_JH JI iC8I J8ICU Oi 1b HiH
UIC8 JHU HJ8 8iHCC iC8O\CU. D 8iHiJi Ci8OUC OCCUiiCU JI iC8I
yC8ICiUJy. CiIiHCHI HCUiCJ Hi8IOiy iHCUUC8 H_CiICH8iOH
JHU IyC Z UiJDCIC8 HCiIU8. lUiiCHI HCUiCJIiOH8 JiC
JOUiiHC _yDUiiUC JHU J8iiiH.
\H Hy8iCJ CXJHHJIiOH DOOU iC88UiC i8 1ZbyUb HH _
HCJiI iJIC i8 yHH JHU iC8iiJIOiy iJIC i8 1ZyHiH. 8Ii
HJICU CCHIiJ \CHOU8 iC88UiC i8 U CH _l CJiOIiU U8IiOKC
i8 HOiHJ IHCiC JiC HO CJiGJC HUiHUi8 JHU IHC UH_ BCU8
JiC CCJi.
DOiJIOiy BHUiH_8 iDCUUC JH CC\JICU 8CiUH IiOOHiH C\C.
CCIiOCJiUO_iJH i8 8HOWH. lHC8I iJUO_iJH i8 HOiHJ.
Wch ot thc toIIowg s thc most IcIy dagoss
[D} lHiOHC 8IJDC JH_iHJ
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lH8IJDC JH_iHJ
1||m 1
TO Z jBascj
D UyCJiOU WOHJH i8 JUHiIICU IO IHC HO8iIJ ViIH CU-
iiIiC CHC8I JiH UiJHOiC8i8 JHU Uy8HCJ O 1 HOUi8 UUiJ
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Ji \CHOU8 iC88UiC i8 HOiHJl JHU HO CHHCiJ CUCHJ i8 HOICU.
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Wch ot thc toIIowg s thc most IkcIy dagoss
[D} DCUIC HyOCJiUiJ iDJiCIiOH
DCUIC CHCJiGiIi8
[l} DOiIiC Ui88CCIiOH
UHOHJiy CHDOi8H
Z CrCOvscUr NeCcOe
TO jbaslc]
A 78ycarold man is cvaluatcd B thc cmcrgcncy dcpartmcnt
lor ncwonsct chcst pain. Hc dcscribcs a crushing pain that is
locatcd B thc lcn substcrnal arca and has bccn prcscnt lor I0
hours. Hc has had no pnor cpisodcs ol chcst pain. His mcd
ical history is notablc lor hypcrtcnsion and hypcrlipidcmia.
urrcnt mcdications arc aspirin, hydrochlorothiazidc, and
atorvastatin.
n physical cxanination, blood prcssurc is I00,70 mm Hg
in both arms, pulsc is I00,min, and rcspiration ratc is
I,min. 1hcrc is no jugular vcnous distcnnon and no cardiac
murmurs or rubs. 1hc lungs arc clcar.
Iaboratory rcsults arc notablc lor clcvatcd lcvcls ol scrum crc
atinc kinasc and troponin I. 1hc initial clcctrocardiogram is
shown. hcst radiograph is normal.
Wch ot thc tollowng s thc bcst managcmcnt tor ths
pancnt
A) hcst 1 with contrast
I) chocardiogram
) Icrcutancous coronary intcrvcntion
1hrombolytic thcrapy
1||.
TO jbaslcj
A 50ycarold man is cvaluatcd lor a 2-hour cpisodc ol cpi-
gastnc discomlort and dyspnca dunng cxcrcisc that is rclicvcd
by rcst. Hc is now pain hcc. 1hc pancnt statcs a similar cpisodc
occurrcd on thrcc prcvious occasions, but hc did not scck
mcdical advicc. Hc has bccn using antacids lor thc past
wccks vith partial rclicl Hc rcports no lcvcr, chills, nausca,
vomiting, diaphorcsis, or postprandial abdominal pain. Hc
has a I5ycar history ol hypcrtcnsion and hypcrlipidcmia; his
only mcdication is chlorthalidonc.
n physical cxamination, hc is alcbrilc, blood prcssurc is
I50,85 mm Hg, pulsc ratc is 88,min, and rcspiration ratc is
I4,min. IMI is 28. stimatcd ccntral vcnous prcssurc is nor
mal. ardiac cxamination rcvcals a rcgular rhythm. 1hc b_ is
normal, and an b_ is hcard at thc apcx; no murmurs or othcr
cxtracardiac sounds arc hcard. 1hc lungs arc clcar to auscul
tation. 1hc abdomcn is not tcndcr to palpation.
omplctc blood count and troponin lcvcl arc normal as arc
thc clcctrocardiogram and chcst radiograph.
Wch ot thc tollowng s thc most lkcly dagoss
A) Acutc pcricarditis
I) Aortic disscction
) Ischcmic hcart discasc
Icptic ulccr discasc
TD Advanced]
A 52yca:oId vonan Is cvaIuacd In Lc cnc:cn, dca:
ncn Io: onoIn suIsc:naI cLcs :cssu:c assocIacd wIL
nausca dIaLo:csIs and IILLcadcdncss. Ic: synons
Ican 3 Lou:s ao. SLc Las Lyc:cnsIon and Lc:cLoIcs
c:oIcnIa. Ic: ncdIcaIons a:c Lyd:ocLIo:olIaZIdc :avas
aIn and asInn.
On LysIcaI cxanInaIon Lc: IIood :cssu:c Is 8+/2 nn
I uIsc Is 8/nIn and :csI:aIon :ac Is 20/nIn. Ca:dIac
auscuIaIon :cvcaIs dIsan Lca: sounds wL an S_. TLc Iuns
a:c cIca: IIIac:aIIy csInacd ccn:aI vcnous :cssu:c Is cIc
vacd a JJ cn IC.
IIcc:oca:dIo:an Il nL-sIdcd :cco:dIaI Icads Is sLovn.
Icads NL:ouL N_a:c :cco:dcd hon Lc :IL sIdc oI Lc
cLcs.}
Wichotheohowngshoudbegvennextu theueat-
mentothispauent:
A} IoIuanInc In:avcnousIy
I} Mco:oIoI In:avcnousIy
C} I:oIyccn suIIInuaIIy
I} 0. saIInc In:avcnous IoIus
CaIOlOvascuIaI MeOlclne 3
TD b Basic]
A 58yca:oId vonan Is cvaIuacd In Lc cnc:cncy dca:-
ncn to: suIsc:naI cLcs aIn oI !8 Lou:s' du:aIon. SLc
dcsc:IIcs lc aIn as a ILcnIn Ia Is no assocIacd vIL
caIn o: cxc:Ion and La :adIacs o Lc nccl. TLc aIn Is
no acconanIcd Iy dysnca nausca o: dIaLo:csIs and Is
no assocIacd IL cxc:Ion. SLc aIso :co:s synons oI
occasIonaI Lca:Iu:n and acId :cu:IaIon. SLc Lad a sInI
Ia: cIsodc oI suIsc:naI cLcs aIn ! nonl ao and an cxc:
cIsc s:css cs La acLIcvcd 0 Lc: :cdIccd naxInaI Lca:
:ac sLovcd no IscLcnIa. TLc aIcn's ncdIcaI LIso:y Is oL
c:Isc un:cna:laIIc.
On LysIcaI cxanInaIon cnc:au:c Is 37.2C .0I}
IIood :cssu:c Is !30/7+ nn I uIsc :ac Is 88/nIn and
:csI:aIon :ac Is !/nIn IMI Is 32. TLc ca:dIouInona:y
cxanInaIon Is no:naI. IIcc:oca:dIo:aLy sLovs nonsc-
cInc STscncn and Tvavc aIno:naIIIcs vLIcL a:c
uncLancd hon scvc:aI :cvIous cxanInaIons.
Whichotheohowgisthemostappropriatemanage-
menttorthispauent:
A} AnIuIao:y csoLacaI I nonIo:In
I} Co:ona:y anIo:aLy
C} IsoLaoas:oduodcnoscoy
I} O:aI :oon un InLIIIo: Lc:ay
I} Rcca cxc:cIsc s:css cs
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4 CardCvascuar Medlcne
TH 7 jAOvanCCO|
1 ZZyCuiOU HuH 8 C\uuuICU UuiiH_ IHC HOHIH O_uHC H
IHC CHCi_CHCy UCjuiIHCHI !Oi HICiHiIICHI jujIuIiOH8 uHU
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Uy8jHCu Oi OiLOjHCu. C Hu8 HO jiOi HCUCu H8IOiy uHU
8 HCJLy JHU JCU\C. C iCjOiI8 DCH_ ! IO o WCCK8 J_O WL
C\Ci uI_uC Hyu_u uHU u _iJUuuy CXjuHGH_ HJI Ciy-
IHCHuIOu8 iu8H OH H8 uDUOHCH HCu8uHH_ u HH O
CH uI VUC8I jOiHL. C WOiK8 u8 u OiC8LCi H u88uCHu8CII8
uHU Hu8 HOI Iiu\CCU OuI O IHC uiCu iCCCHIy.
\H jHy8Cu CXuHHuIOH H8 LCHjCiuLuiC 8 HOiHu DOOU
jiC88uiC 8 7/ HH _ uHU ju8C 8 +/HiH. HCiC uiC
CuHHOH Wu\C8 H IHC ]u_uui ju8uIOH. HCiC 8 HO iJ8H uHU
iC8uI8 O CuiUuC uHU juHOHuiy uu8CuIJIOH uiC HOiHJ.
HC CCCIiOCuiUO_iuH 8 8HOWH.
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[1} i8IUC_iCC uIiO\CHIiCuui DOCK
I) ODIZ [jC 1 uIDO\CHIiCuJi DOCK
,C) ODLZ I_C 11 uIiO\CHLiCuui DOCK
[1} HiUUC_iCC uIiO\CHIiCuui HCJiI DOCK
J/|1
lTH jBasC]
1 +!yCuiOU HuH 8 C\uuuICU Oi uH oyCui H8IOiy O
Cj8OUC CHC8I jJH u88OCuICU WIH Uy8jHCu IuCHyCuiUu
UJjHOiC88 uHU UZZHC88 IHuI OCCui8 8C\CiJ UHC8 CJCH WCCK.
HC 8yHjIOH8 UC\COj 8uUUCHy uiC OHCH 8O 8C\CiC IHuI HC
CC8 LJI HC 8 _OH_ LO UC JHU HjiO\C 8_HCJHLy VIHJH
7 IO o HHuIC8. HC juICHI UOC8 HOI KHOW WHJL jiCCj-
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DCILCi Oi WOi8C.
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IuKC8 HO HCUCuLOH8. HUH_8 OH jHy8Cu CXuHHJIOH uiC
uHiCHuiKuDC. CUCu iCCOiU8 iC\CJ LHuI UuiH_ IHC8C
Cj8OUC8 HyjCiICH8OH Oi IuCHyCuiUJ Hu\C HC\Ci DCCH UOCu
HCHICU.
[1} 1CuIC COiOHuiy 8yHUiOHC
I) uHC U8OiUCi
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[1} HCuHOIHOiuX
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D ODyCJiOU WOHJH S HOSjIaZCU Oi CHCSI jJH SCCOHUJiy
IO JH JCHIC COiOHJiy SyHUiOHC. Ci HHCUJIC IiCJIHCHI
COHSSIS O HCIOjiOO HCjJiH HIiO_yCCiH JHU JSjiH
WHCH iCSHIS H HHCUJIC iCC O HCi CHCSI USCOHOiI. D
iHyIHH SIij S SHOWH.
Y1Ch O tDC OOWD_ IS tDC DOSt HCy CCCDOCatUIO
_aQDIC UIa_OSIS:
[D} |ISIUC_iCC JIiOVCHIiCHJi DOCK
[1} ODIZ IyjC SCCOHUUC_iCC JIIOVCHIiCHJi DOCK
[\} ODIZ IyC SCCOHUUC_iCC JIiOVCHIiCHJi DOCK
[1} JHiUUC_iCC JIIOVCHIiCHJi DOCK [COHjCIC HCJiI
DOCK}
1||m '
TH 30 jAdvanced]
D ODyCJiOU HJH S CVJHJICU UHiH_ J iOHIHC OOWHj
CXJHHJIOH Oi COiOHJiy JiICiy USCJSC. C WJS UJ_HOSCU
WIH J HyOCJiUJ HJiCIOH D yCJiS J_O JHU WJS SIJiICU OH
JSjiH HCIOjiOO JIOiVJSIJIH SHOji JHU SHDH_HJ
HIIiO_yCCi|H. C WJS JSyHjIOHJHC HHH HOHIHS J_O WHCH
HC HOICU CXCiIOHJ JH_HJ JHCi WaKH_ IVO DOCKS. C HOW
HSCS SHDhH_HJ HIiO_yCCiH OH J UJy DJSS. C HJS HOI HJU
JHy CjSOUCS O jJH JI iCSI Oi jiOOH_CU CHCSI jJH IHJI WCiC
HOI iCCVCU Dy SHDH_HJ HIiO_yCCiH.
\H jHySCJ CXJHHJIOH DOOU jiCSSHiC S 1O,V HH _
JHU HCJiI iJIC S o ,HH. \JiOIU HjSIiOKCS JiC HOiHJ WIH
HO DiHIS. \JiUJC CXJHHJIOH S HOiHJ. JHC HH_S JiC CCJi.
S CCCIiOCJiGO_iJH S HHCHJH_CU SHCC IHC JSI VSI WIH
HO CVUCHCC O JCHIC CHJH_CS.
aUUDOD tO aUU_ a OD_aCDD_ DIDatC WDICD O tDC
OOWD_ IS tDC DOSt aQQtOQtIatC DaDa_CmCDt Ot tDIS
QaDCDt:
[D} DUU iJHOJZHC
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[1} HCiCJSC HCIOjiOO
CarOiOvascuar NeOicine S
TH 33 jAdvanced]
D oyCJiOU WOHJH S CVJHJICU H IHC CHCi_CHCy UCjJiI-
HCHI HOHiS JHCi IHC SHUUCH OHSCI O CCHIiJ JHICHOi CHCSI
jJH JHU UySjHCJ. JHCiC S COHSIJHI CHCSI jiCSSHiC I_HIHCSS
JHU UySjHCJ. bHC S HOI OH JHy HCUCJIOHS.
\H jHySCJ CXJHHJIOH IHC jJICHI S JCDiC. 1OOU jiCS
SHiC S 1,O HH _ DJICiJy jHSC S 11o,HH JHU iCS-
jiJIOH iJIC S 1o,HH. SIHJICU CCHIiJ VCHOHS jiCSSHiC S
1D CH _\. JHCiC JiC HO HHiHHiS iHDS Oi _aOjS OH CJi-
UJC JHSCHIJIOH. Ci HH_S JiC CCJi. JHCiC S HU jCUJ JHU
OWCi C_ CUCHJ IHJI S HOiC jiOHOHHCCU OH IHC H_HI SUC.
JHC CCCIiOCJiUO_iJH SHOWS bJSC_HCHI UCjiCSSOH H IHC
JICiJ CJUS. JHC CHCSI iJUO_iJjH S HOiHJ. JHUHCU
CCHOCJiUO_iJjHy SHOWS J SHah HyjCiUyHJHC CH VCHIiCC
WIH HOiHJ iC_OHJ WJ HOIOH.
YCD O tDC OOw_ tCStS SDOuU DC QCtOtDCU DCXt:
[D} \J jHHOHJiy JH_O_iJjHy
[\} JUOHHCUC jCiSOH HJ_H_
[1} JiJHSCSOjHJ_CJ CCHOCJiUO_iJjHy
TO 32 j8asc]
D OoyCJiOU WOHJH S CVJHJICU Oi CHCSI jJH O HOHIHS
UHiJIOH. bHC UCSCiDCS IHC jJH JS J CHSUCU DHiHH_ IHJI
OCCHiS DOIH JI iCSI JHU WHCH SHC CXCiCSCS. I JSIS Oi JDOHI
1U HHHICS JHU S iCCVCU Dy CJIH_ JHU Dy iCSI. bHC HJS
HyjCiICHSOH Oi WHCH SHC IJKCS HyUiOCHOiOIHJZUC. bHC
HJS JSIHHJ Oi WHCH SHC IJKCS HHJCU COiICOSICiOUS JHU
HHJCU JDHICiO JS HCCUCU. SHC jiCIiCJIS HCiSC WIH IHC
HHJCU DiOHCHOUJIOi SHC CJH WJK OH_ USIJHCCS JI J DiSK
jJCC WIHOHI UySjHCJ. bHC COHIHHCS IO SHOKC C_JiCIICS JHU
HJS SHOKCU 1 jJCK jCi UJy Oi U yCJiS.
\H jHySCJ CXJHHJIOH SHC S JCDiC. 1OOU jiCSSHiC S
1o,o HH _ jHSC S O,HH JHU iCSjiJIOH iJIC S
1o,HH. \JiUOjHHOHJiy CXJHHJIOH S HOiHJ. JHC
iCSHIS O JH CCCIiOCJiUO_iJH JiC HOiHJ.
YDICD O tDC OOWID_ IS tDC DOSt aQQtOQtIatC UIa_OS
DC tCSt Ot tDIS QaDCDt:
[D} DUCHOSHC HHCCJi jCiSOH SIiCSS ICSI
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b LIdOV5cUI MedcHe
TO 1 jBascj
D b+yCJiOU HJH 8 C\JHJICU Oi Z UJy8 O JI_HC JHU Uy8
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8 J8QiH.
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HOiHJ b JHU b_ JHU HO HHiHHi8 Oi _JOQ8. HH_8 JiC CCJi
IO JH8CHIJIOH.
HC CCCIiOCJiUO_iJH 8 8HOWH.
Wch ot thc toIIowng s thc most IkcIy dagoss
[D} DIDa BDiJIOH
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1|tm 1J
TO 1 jBascj
D byCJiOU HJH VIH CHiOHC 8IJDC JH_HJ 8 C\JHJICU
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C OHy _CI8 CHC8I QJH VIH 8_HHCJHI CXCiIOH I_CJy
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iHD8. HH_8 JiC CCJi IO JH8CHIJIOH. HC iCHJHUCi O IC
CXJHHJIOH 8 HOiHa.
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Wch ot thc toIIowng s thc bcst managcmcnt tor ths
pancnt
[D} DUU COQUO_iC
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TO 1 [baslc]
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Oi Uy8[HCa. C Ha8 HO [iiOi [Ci8OHa Oi aHiy Hi8IOiy O Cai-
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|P} PIia BDDaIiOH
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TO 1 jbaslc]
P +yCaiOU HaH i8 C\aUaICU aCi a COWOiKCi HaU a HyOCJi
Gia iHaiCIiOH, HC i8 WOiiCU aDOUI Ha\H_ a HCaiI aIIaCK. C
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aiICiy Gi8Ca8C.
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/ 2-yCaiOU HHi8C i8 C\aHaICU iH IHC CHCi_CHCy UCjaiIHCHI
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/ 2yCaiOU HaH WiIH COiOHaiy aiICiy Ui8Ca8C i8 C\aHaICU
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/ 2yCai OU HaH WIH a H8IOiy O a HyOCaiUa HaiCIOH i
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HCUiCaHOH8 aiC i8iHOjH Cai\CUiO Ui_OXH aHU BiO8CHiUC.
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aHU jH8C iaIC i8 U/HiH. |H_Hai \CiH8 aiC HOI Ui8ICHUCU aHU
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. 1yCaiOU WOHaH WiIH aOiIiC 8ICHO8i8 i8 C\aHaICU Oi
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HCUiCa jiODCH8 aHU IaKC8 HO HCUiCaIiOH8.
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D byCaiOU HaH i8 C\auaICU Oi iHCiCa8CU 8HOiIHC88 O
DiCaIH O o WCCK8 UuiaIiOH. C Ha8 Uy8jHCa OH CXCiIiOH
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jiO8IHCIC \a\C iCjaCCHCHI Oi DCu8jU \a\C aOiIC 8ICHO-
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8CaIICiCU CiaCKC8 CaH DC HCaiU aI IHC uH_ Da8C8. Ò jCiijH-
Cia CUCHa 8 jiC8CHI.
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[D} DOiIC iC_ui_IaIOH
[1} DIia 8CjIa UCCCI
[\} \OaiCIaIOH O IHC aOiIa
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Item R j8aslc]
D 0byCaiOU WOHaH i8 C\auaICU a8 a HCW jaICHI UuiH_ a
iOuIHC OHCC \I8iI. bHC 8 HCaIHy aHU aCI\C aHU 8WIH8 aj8
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Item 45 jAOvancCO]
D oU-yCaiOU WOHaH 8 C\auaICU IH IHC CHCi_CHCy UCjaiI-
HCHI Oi 8HOiIHC88 O DiCaIH jajIaIOH8 aHU jCUa CUCHa.
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DiCaIHC. 1OOU jiC88uiC i8 11Z/oU HH _ aHU ju8C i8
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WHC 8IIiH_ uji_HI. \aiUaC au8CuIaIOH UCHOH8IiaIC8 aH
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OOWCU Dy a OWjiICHCU Ua8IOC HuiHui HCaiU DC8I aI IHC
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1 1oyCaiOU WOHaH i8 C\auaICU UuiiH_ a iOuIiHC CXaHi
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aHU ju8C 8 7U/D. b aHU b_ aiC HOiHa aHU IHCiC i8 aH b_
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iaUiaIC IO IHC CaiOIIU aiICiiC8. D Na8a\a HaHCu\Ci iHCiCa8C8
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Item 47 j8aslc]
D ZbyCaiOU a8yHjIOHaIC HaH i8 C\auaICU UuiH_ a iOu-
IHC CXaHHaIOH. i8 DOOU jiC88uiC i8 1bU/U _ aHU
H8 HCaiI iaIC i8 VU/D. 8IHaICU CCHIia \CHOu8 jiC88uiC i8
HOiHa. HC CaiOIiU uj8IiOKC i8 Di8K aHU COaj8C8 QuCKy.
HC ajCa Hju8C 8 U8jaCCU. D _iaUC o/0 H_HjiICHCU
UCCiC8CCHUO Ua8IOC HuiHui i8 HCaiU aI IHC 8CCOHU ii_HI
iHICiCO8Ia 8jaCC WIH iaUiaIOH UOWH IHC CH 8ICiHa DOiUCi.
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aHU iH CHU-CXjiaIOH. HCiC 8 C\UCHCC O Hai DCU ju8aIOH.
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CHaH_C iH IHC HuiHui WiIH H8jiaIOH.
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Item 1 Answer:
Educatonal Objectve. !aqnerc nen-S7clcvaten
myecardal nfarcten.
HC HOSL ikCy Uia_HOSiS iS a HOHbCC\aLiOH HyOCaiUia
HiCHOH [b}. HSjaHCHLHaS HaUCHCSLjaH aLiCSL
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HCHLiCaUS`_LHiOu_`_.HCSCCaLuiCSHUCaLCab.
aaCuLCCOiOHaiyUiOHCODSLiuCHOHLOCOiOHaiyDOOU
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HyOCaiUia iSCHCHia. bCC\aLiOH HyOCaiUia iHaiCLiOH
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LiOCaiUiO_iajHCC\iUCHCCO bSC_HCHLCC\aHOH.1LHOu_H
HOSLjaHCHLSWLHb1HHHaLCyUC\COj_Va\CSOHCCC
LiOCaiUiO_iaH SOHCCXHiDiLUa_HOSLiC bSC_HCHLCC\aLOH
aHUCaiUiaC CHZyHCCC\aLOHSWLOuL _Va\CS.
aHCHLSVHOjiCSCHLVLiSCHCHiCCHCSLjaiHDuLWLHOuLUia_
HOSHCbSC_CHL CC\aHOH aiCCaLC_OHZCU Ha\_ uSLDC
a_HaOib.+HCSCIWOCOHUHOHSaiCCOSCyiCaLCUaHU
Ha\CSiHiaijaLOjHyiOO_yaUCliUCajiCSCHLaHOHSDuLLCy
Uu Ci iH LC SC\CHIy O LC HyOCaiUia iSCHCHla. aHCHLSWL
CiLHCiCOHUiHOH IyjiCmyjiCSCHLWLH aH_Ha aL iCSL HOVC\Ci
SOHC jaHCHLS UCSCHDC a jaLLCiH O HCVOHSCL Oi iHCiCaSiH_
a_a.biSCHCHaiSSC\CiCaHUiCSuISHaUCLCCLDC
iCCaSC O DiOHaikCn O HyOCaiUaHHyHOuIS aHCiUCOHSCL
OiSCCHCCHCSLjaiHOSLCOuHOHyCaiUiaCHOjOmH HO
jOHH aULC CO CiCaUHCKaSC. uHSLaDC
a_HaLCiCiSHOUCLCCLaDCHCiCaSCiLCSC CHZyHCS.
\iOHiC SLaDC aH_Ha iCCiS LO a COiOHaiy aiLCiy SyHUiOHC
LHaL iS CHaiaCLCiiZCU Dy CHCSL UiSCOHOiL LHaL OCCuiS jiC-
UCLaDy aHU iCjiOUuCiDy aL a CCiLaiH C\C O CXCiLiOH aHU iS
iCiC\CUViL iCSL Oi HiLiO_yCCiiH. SCHCHiC jaiH LHaL OCCuiS
ViLH iCSL iS HOLCOHjaLiDC VLH LHC Uia_HOSiS O CHiOHiC SLa-
DCaH_iHaaHULCjiCSCHCCOjOSiLi\CSCiuHDiOHaikCiSOi
HyOCaiUia HCCiOSiS aSO CXCuUCS LiS Uia_HOSiS.

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Item Z Answer.
Educatonal Objectve: !aqnerc acun crcardtr
HCHOSLlkCyUia_HOSiSiSaCuLCjCHCaiUiHS. \HCSLjaiHOH
aCuLCjCiiCaiUHSiSSHaqaHUjCuHHCaHUVOiSCHCUDyaSSuH-
H_ a SujHC jOSiLOH. 1CuLC jCHCaiUiLS iS Ga_HOSCU Dy LHC
jiCSCHCC O aL CaSLLWOO LC LHiCC CaSSiC CaLuiCS: 1) jCu-
iiLiC CHCSL jaiH ,2) iCLiOH iuD aHU [} UiHSC COHCOiUaHL
bSC_HCHL CC\aLiOH OH CCCLiOCaiUiO_iajHy OHCH ViLH
UCjiCSSiOHOLCSC_HCHL. HC CaSSiC jCHCaiUa iCLOH
iuDHaSLHiCCCOHjOHCHLS[HOLaCOHjOHCHLSHayDCHCaiU}
iCaLCULOCaiUiaCHOLiOHaHUOCCuiSUuHH_aLHaSySLOC\CH-
LDCuaiCOHLiaCHOHaHUiajiU\CHLHCuaiB_.HCSOuHUO
LHC iuDCaH DC SQuC8 SCiaLCHy aHU H_HjiLCHCU.
aLiCHLSWLHaHaCuLCaOiHCUiSSCCHOHjiCSCHLWLLHCaDiujL
OHSCL O SC\CiC jaiH HLHC LOiaX. OOU jiCSSuiCiS \aiiaDC.
aiHUCSCiiDCUaSiijjiH_ OiLCaiH_ OCCuiSHOHyaDOuL
aU O jaLiCHLS. HC jHySiCa HHUiH_ O a juSC UCHCiL iS
uHCOHHOH.1LCaSLOHCLHiUOjaLiCHLSHa\CHOCCCLiOCai-
UiO_iajHiC aDHOiHai] aHU aL CaSL +U O jaLiCHLS aCk
WUCHH_OUHCUaSHOHjaHCHCSLiaUiO_iajH.OV
C\Ci jCuiiLiC CHCSLjaiHjCiiCaiUia iCLiOH iuD aU G SC
b CC\aLiOHSaiC HOLCOHjaLiDCViLH aOiHC UiSSCCLiOH.
HCjaiHOaHaCuLCHyOCaiUiaiHaiCHOHiSuSuaLyiCLiOSLCi-
HaiH OCaLiOHHayiaUiaLCLOLHCSHOuUCiSOiaiHSaHUHay
DCaSSOCiaLCUVLHauSCaaHU\OHiLiH_UiajHOiCSiSOiSHOiL-
HCSSO DiCaLH. 1LOu_HLCiHHaCCCLiOCaiUiO_iaHiSHOH
Ga_OSHCHujLOaU OjaHCHLSCOHjaHDCCHaH_CSVOuU
iHCuUCOCabCC\aHOHSWLHiCCijiOCabUCjiCSSiOHaSSO
CiaLCU VLHCC\aHOHOCaiUaCDiOHaikCiSSuCH aSLiOjOHiH.
aHCHLSVLHjuHOHaiyCHDOiSHHayjiCSCHLWLLCCaS-
SiCSyHjLOHSOUySjHCaCHCSLjaiHHCHOjLySiSOiSyHCOjC
DuLLHCjiCSCHLaLiOHiSOHCHHOiCSuDLC.1LHHCSOHyHOH
SjCCibCiCSjiiaLOiyOiHCHOUyaHiCHaHiCSLaHOHSHayOCCui.
uHOHaiyCHDOiSHiS HOL aSSOCiaLCUViLH a jCiiCaiUiaiC-
LOH iuDOiUiHSC bSC_HCHL CHa_CS.

g0SS 0 CU lCl0S S m0 0 lSC 0 S
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ajyOiHO8LjaLiCHL8WiLHb1iDCCaH8CiLi8a88OCiaLCUWLH
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LO LHiOHDOyLiC LHCiajy aHU iH jaLiCHL8 WiLH CaiUiO_CHiC
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Educational Dbjective: rt| ttP|6n my6tr
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CO!!CaLCO VLh VI> L!CaLDCnL may UC a!O!|aLC aLhOu_h
many aL|CnL> !C>OnO VCu LO >|mC !Ca>>u!anCC. |!>L-|nC
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CaC|um ChannC UOCkC! >uCh a> \C!al. OVC\C! aDL|a!-
lhyLm|C U!u_ LhC!ay |> a>>OC|aLCU WLh >|OC-CHCCL> >O L!CaL-
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anO UCnCL>. POO|L|Ona |D\C>L|_aL|On |n Lh|> a>ymLOmaL|C
yOun_ aDO hCaLhy aL|CnL |> uL|kCly LO ChaD_C H|> maLa_C
JU CIdOv8cuI NedcHe
HCHI. HCiCOiC CCHOCJiUO_iJjHy JiiHyJ HOHiIODH_
JHU CXCiCiSC SIiCSS ICSIiH_ iS HOI HUiCJICU.
E I __________
ImduI VICudI C0IdC0S d IS Sg 0 d SIuC
uId 0Imd dI ddI 0 0 dSS0Cd0 W 0 0
CIdS0 ISk 0 CdI00VdSCudI VS, dICudI dS
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bOUCBIOHB D0CIV0. 1It0l g0ltH 0l Ik j0I H0
mH m0l Bl 0H mg0Hl00t t0I00PtIIm0I0l
HC HOSI JjjiOjDJIC IiCJIHCHI Oi IHS jJIiCHI iS JH \i.
bUSIJHCU VCHIHCUJi IJCHyCJiUiJ [ } OCCUiS HOSI COHHOHy
H jJUCHIS VIH jiCViOUS HyOCJiUiJ HaiCUOH JHU iI iS IHC SCJi
OiHCU Dy IHC iHaiCIiOH IHJI jiOViUCS IHC aHJIOHiC SUDSIiJIC
Oi iCCHIiy. 1iCJS O BDiOSiS iHICiSjCiSCU VIH \JDC HyOCJi-
Uia IiSSUC JiC jiCSCHI iH IHC DOiUCi ZOHC O UCHSC SCJi IiSSUC
JHU iHjJiI IHC iCqUICU COHUUCIiOH UCJy CDIiCa IO IHC CSIJD
iSHHCHI O iCCHIiy CiiCUIS. byHjIOHS UCjCHU OH IHC UHUCi-
\iH_ SIJIC O IHC jJIiCHI JHU SOHC jJIiCHIS CJH DC JSyHjIO-
HJIiC jJiIiCUJiy i IHC iJIC iS SOW. H _CHCia HCUiCJ
IHCiJjy [ JHiOUJiOHC jiOCJiHJHiUC HCCJiHiUC} UOCS HOI
iHjiOVC SUiVIVJ iH jJIiCHIS WiIH JHU SIiUCIHiJ HCJiI UiS-
CJSC IHUS HOSI jJIiCHIS JiC CJHUiUJICS Oi \i jJCCHCHI.
Ji_C CiHiCJ IiiJS HJVC UCHOHSIiJICU \i IHCiJjy iHjiOVCS
SUiViVJ iJICS iH jJIiCHIS VIH HCHOUyHJHiCJy UHSIJDC
JHCi CJiUiJC JiiCSI WHO HJVC iSCHCHiC Oi HOHiSCHCHiC CJi-
UiOHyOjJIHy JHU CCCIiOH UJCIiOHS CSS IHaH o7. H jJIiCHIS
VIH CH VCHIHCUJi UySHCIOH H IHC JDSCHCC O \i
iHjJHIJIiOH HJS JSO DCCH SHOWH IO iHjiOVC SUiViVJ. HC
jDHaiy CH_iDiHIy CiiICiiOH Oi \i iHjaHIJIiOH Oi jDHJiy
jiCVCHIiOH O SUUUCH CJiUiJC UCJIH iH IHC SCIIiH_ O HCJiI J-
UiC iS CH VCHIiiCUJi CCCIiOH UJCIiOH CSS IHJH o7, iC_JiU-
CSS O IHC jiCSCHCC Oi JDSCHCC O! COiOHJiy UiSCJSC Oi IHC
OCCUiiCHCC O JiiHyHiJ.
E PT
1 ImdI g0 CII0 0I mdd0 CdI00VII00
Id0I mdd0 0I ImdI IV0 0 Su00 CdI0dC
0d Sg 0 dI duI S VICudI [C0 IdC
0 SS d JbV.
DO_aQDy
\C\u \, u_CH! , CiCZNCiU|J P,1|SH I.iOQHyJCDC |HQJH!JDOH
O! CJiU|OVCi!Ci UChDi|J!OiS m |UOQJ!H|C HOH|SCHCH|C CJiU|OHyOQJ!Hy
!Oi !HC Qi|HJiy QiCVCH!|OH O! UCJ!H. J HJiiJ!IVC iCV|CW. \|H \JiU|O.
Z1[O}.ZO+. i. ZO1
lI0D dd HSW0f.
bOUCBIOHB D0CIV0. 0n0gt 0 ]0ltHl Bl PtH
DtH0I 0I0l0H 0IItl H lt tllHg 0j 0tH m)0t0I
00 Hj0Itl0H.
HC DCSI OjIiOH Oi IHC jJUCHI JI IHiS IiHC iS IO COHUHUC HCU
iCJ HJHJ_CHCHI. NCHIDCUJi IJCHyJiiHyIHHiJS JiC COHHOH
iH IHC SCIIH_ O JCUIC HyOCJiUia HJiCIiOH OCCUiiH_ iH Uj
IO Z7 O jJIiCHIS. iCSjiIC J SiXOU iHCiCJSC H iHHOSjiIJ
HOiIJiIy IHC OVCiJ HOiIJiIy JI i yCJi iS HOI iHCiCJSCU iH
jJIiCHIS WiU VCHIiiCUai BDiiJIiOH IHJI OCCUiS Caiy iH IHiS
SCIIiH_. HCiCOiC UHKC SUUUCH CJiUiJC UCJIH OCCUiDH_ iH
OIHCi SCIUH_S CaiUiJC JiiCSI OCCUiHH_ ViIHH IHC hiSI +o HOUiS
O IiJHSHUiJ JCUIC HyOCJiUia iHJiCIiOH UOCS HOI iCqUiiC
UCBDiiJIOi jJCCHCHI.
DHJiy VCHIiCUJi BDiiJIiOH SHOUU DC UiSIH_UiSHCU UOH
VCHIDCUJi BDDJIiOH IHJI OCCUiS JICi iH IHC COUiSC USUJy
JS J iCSUI O HCJiI iUiC. 1COiC IHC JUVCHI O IHC iHjaHIJDC
CJiUiOVCiICiUCBDHJIOi VCHIiiCuJi BDHJIiOH OCCUiDH_ JIC
iH IHC HOSjiIJ COUiSC WJS JSSOCiJICU ViIH JH oo7 iyCJi HOi-
IJiIy iJIC. 1 jJICHIS CVCH IHOSC WHO HJVC HOI SUCiCU
JiiHyIHHiJ UUHH_ HyOCJiUiJ iHJiCIiOH SHOUU DC iCCVJU-
JICU JHCi HyOCJiUJ iHJiCIiOH Dy IiJHSIHOiJCiC CCHOCJiUiO
_iJH IO iIHCi SIiJIi] DSK. IHC CCCIiOH UJCIiOH iS OUHU IO
DC iCUUCCU <o7 } IHC jJIiCHI HJy DC J CJHUiUJIC Oi UCBD-
DJIOi jJCCHCHI.
1OUaiOHC HJS HOI DCCH SHOVH IO iHjiOVC OVCiJ HOiIa
iIy OOViH_ HyOCJiUiJ iHJiCIiOH. H IHC _CHCiJ jOjUJIiOH
O CJiUiJC aiiCSI SUiViVOiS mOUJiOHC UOCS HOI iHjiOVC HOi-
IJiIy.
HjJHIJDC CaiUiOVCiICiUChDH1JIOi jJCCHCHI iS HOI iHUi-
CJICU Oi jJIiCHIS WHO CXjCDCHCC VCHIiiCUJi JiiHyIHHJS CSS
-
IHJH +o HOUiS JHCi JH JCUIC bCCVJIiOH HyOCJiUiJ iHJiC-
IiOH. HjJHIJDC CJiUiOVCiICiUCBDiiJIOiS HJVC UCHOH
SIiJICU J HOiIJHIy DCHChI Oi CSSCHIiJy J OIHCi _iOUjS O
CJiUiJC JiiCSI SUiViVOiS.
HC IyQiCJ iHUCJIOHS Oi J jJCCHJRCi iHCUUC SyjIOHJIiC
SiHOJIiiJ HOUC UySHCIiOH [ SiHUS DiJUyCJiUiJ iHIiJ JIiiJ
DOCK CXiI DOCK} JHU SyHjIOHJIiC DiJUyCJiUiJ UUC IO
JUVJHCCU SCCOHU Oi IHiiUUC_iCC HCJiI DOCK. HiS JSyHjIO-
HJIiC HJH ViIH HO C\UCHCC O DiJUyCJiUiJ Oi JUVJHCCU HCJiI
DOCK OH HiS CCCIiOCJiUiO_iJH HJS HO iHUCJIiOH Oi J jJCC-
HJRCi. JCCHJKCi jJCCHCHI UOCS HOI jiCVCHI SUUUCH UCJIH
UUC IO VCHIiCUJi IJCHyJiiHyIHHiJS.
PT
LdI0dC dIIS 0CCuIIg W IS 4b0uIS 0 d dCu, IdS~
muId m0CdI0d dIC0 00S 0 IquI SC00dI IV0
Id 0I d Sd0dI0 0Sm0CdI0d dIC0 CdI.
DO_aQDy
uSuHO!O 1. PCOHQiCHCHS|VC JQQiOJCH U HJHJ_CHCH! O! VCH!i|CuJi
JiiHyH|JS. \JiO|O \|H. ZoZ[}.+o1+V, v. i. 1oOo1VZ
Item dR Answer: L
Educational Objective: !oqnarc]omlollanq@l
ryn4ramc.
JHSQaUCHLHOSLKCyHaSOH__JSyHUtOHC_Jb}.lai-
UaCCVCHLSHQaUCHLSWLH_JbHCuUCSy HCOQCaHUCaiUaC
atiCSLUuCLOLOiSaUCUCQOHLCSVCHLHCuatLaCHyCaiUa._Jb
HayDCCLHCiCOH_CHLaOiaCQutCU.JHSQaUCHLQiODaDyHaS
COH_CHLa _Jb, Su__CSLCU Dy iCCuiiCHL SynCOQC LH__CiCU
Dy aCL\Ly aHUa aHyHSLOiyO Caty SuUUCH UCaLH COuSH
UiOVHH_}.CiHOLHCiSQiODaDyaHCCLCUaSVC.1SKaC-
LOiS Oi aCQuiCU _Jb HCuUC CHaC SCX, HyQOKaCHa,
HyQOHa_HCSCma,SLtuCLuiaHCaiLUSCaSC,QiC\OuS_J-HLCi
Va QiOOH_aLOH, aHU a HSLOiy O Uiu_-HUuCCU atiHyLHHa.
,^ CXLCHSVC SL O OCHUH_ a_CHLS CaH DC OuHU aL
.aZCCiL.Oi_y HCUCa-QiOSyUiu_-SLSy Uiu_-SLS.CH.}
\LHCiCaiUaCCauSCSOSyHCOQCaHU SuUUCHUCaLHHyOuH_
QaLCHLSHCuUCHyQCiLiOQHC CaiUOHyOQaLHy aHU aiiHyLH-
HO_CHCi_HL VCHLtCuaiUySQaSa.
CH DuHUC DiaHCH DOCK } aHU i_HL DuHUC DiaHCH
DOCK 1}aiC CCCLiOCaiUO_iaQHC QaLLCiHSLHaLHCiCaSC
H BCQuCHCy WLH a_C. HOSL OHCH OCCuiS H QaLCHLS
WLHuHUCiyH_HCaiLUSCaSC.iHOUCiQaLCHLS,SaSSO-
CaLCUVLHHCiCaSCUHOiLaLy.iHyOuH_CiQaLCHLS,HOVCVCi,
SHOLaSSOCaLCUWLHSyHCOQCOiSuUUCHUCaLHaHULHC
QiO_HOSS S _CHCiay CXCCCHL. 1 S SHaiy aSSOCaLCU
WLHHCiCaSCUHOiLaLy HOUCiQaUCHL>WLHuHUCtyH_HCatL
USCaSC. YHCH I S HOL aSSOCaLCU WLH uHUCiyH_ Cai-
UaC USCaSC, QaLCHL OuLCOHCS aiC _CHCiay CXCCCHL, aHU
1 S aH uHKCyCauSC OLHSQaLCHL`SSyHQLOHS.
iSL-UC_iCCaLiOVCHLHCuaiDOCKSCHaiaCLCiZCUDyQiOOH-
_aLOH O LHC HLCiVa LO OH_Ci LHaH .Z SCC; L uSuay S
HOLaSSOCaLCUWLHaLCiaLOHSHHCaiLiaLCaHUHaSHOaSSOC-
aLOHWLHSyHCOQC OiSuUUCHUCaLH.

LldC8v8htShpt8htSWth0hg Syhdl0m8hCud8SyhC0p8
hdCldCll8Stdu8t0t0lSd8d8p0ht8Sv8htlCultChyCld.
bC_agHy
Go.J:i0:: |, Z+::0+ W, Moss |. !oi Q1 s,iJ:om:. Ca:: I:o0.
C+:J.o.. 200B,33II):02909+. IM|D: IBB35+00|
Item d Answer: A
Educational Objective: lrcor^ Tar|1corrHrra-
roranrlorr1Vhcorr]olurcwrh4qaxn.
_OXH S LHC HOSL aQQiOQiaLC LHCiaQy LO HLaLC H LHS
QaLCHL. JHC iOC O U_OXH H LiCaLH_ HCaiL auiC QaLCHLS
H SHuS iHyLHH SQiHaiy Oi SyHQLOH COHLiO iaLHCiLHaH
HQiOVH_ SuiVVa. JiCaLHCHL VLH U_OXH HaS HOL DCCH
SHOVHLOaHCCLHOiLaLy DuLHaSDCCHSHOVHLOiCUuCCHOS
QLaZaUOHS._OXHCaHDCaUUCULOOLHCiHCiaQyHQaUCHLS
WLHICVAOiK CaiL/SSOCaLOHCaSSiiiOiHCaiLauiC
Oi SyHQLOH COHLiO. aHLaHH_ OVCi SCiuH COHCCHLia-
LOHS O U_OXH S aS CHCCLVC aSHaHLaHH_H_HCi COHCCH-
CarOOvascuIar MeOcne J1
LraLOHS, aHU QOLCHLa LOxCLCS arC aVOdCU. _Cr d_OxH
CVCS a 1.2 H_yH 1.C HHOy_ VCiSuS .C. H_yH
.C1.HHOy_}aQQCaiLODCaSSOCaLCUWLHH_HCiHOi-
LaHLy H QaLCHLS WLH SySLOC HCaiL auiC. JHC QiHaiy iCa-
SOHLOuSCaHaHgOLCHSHiCCCQLOiDOCCiP1}HSLCaUOaH
aH_OLCHSH-COHVCiLH_ CHZyHC Pl1} HHDLOi, SuCH aS
SHOQH,SLOaVOULHCSUCCHCCLOCOu_H.lOHDHCULiCaL-
HCHLWLHaHPl1HDLOiaHUaHP1 S_CHCiayHOLiCC-
OHHCHUCU, DCCauSC COHCuiiCHL LHCiaQy S S_HCaHLyaSSO-
CaLCU WLH HCiCaSCU iSK O HCUCaLOH HOHaUHCiCHCC aHU
aUVCiSCCHCCLS,HCuUH_VOiSCHH_iCHaHCUOHaHUSyHQ
LOHaLCHyQOLCHSOH,VHCiCaSLHCaUUUOHaDCHChLOuSH_
LHCSC LVO HCUCaLOHSLO_CLHCiS HOL VC CSLaDSHCU. Pl1
HHDLOiSatCCuiiCHLyQiCCiiCUOVCiP1SOiHOSLQaUCHLS,
DCCauSCLHCiC SHOiC CHCaCXQCiCHCC VLH LHCSC a_CHLS.
JHCiC S HO iOC OiLHC iOuLHC aHUCOa_uaLOH O HCaiL a-
uiC QaLCHLS VLH VaiaiH Oi aSQiH} DCCauSC LHCiC S HO
aQQaiCHL DCHCBL aHU aH HCiCaSCU iSK O DCCUH_. a|Oi
_uUCHCS_CHCiaya_iCCLHaLVaiaiHSHOuUDCCOHSUCiCU
H a QaLCHL VLH a HCaiL auiC aHU a QiCVOuS LHiOHDOLC
CVCHL Oi CXaHQC, SLiOKC Oi QuHOHaiy CHDOSH} aHU H
QaLCHLSWLHaHuHUCiyH_aLiahDiaLOH HCaiLiHyLHH.

Ug0kh8vt8SSympt0mShdd8Cl8S8Sh0Spt2t0hS, Dutt
pl0vd8S h0Sulvv D8h8th pt8htS Wth h8lt ul8.
bC_agHy
Go.J0:: !R. !:+:: l+..a::. îi |i:::i M:J. 20I0,I52I1):|iC0I
I5, ga./ |1C0I0. IM|D: 205I3B25|
Item d Answer:
Educational Objective: !oqnarchcorr]olurc 4uc
rapcrporrumror4amyaporhy.
JHS QaLCHL HOSL KCy HaS HCatL auiC UuC LO QCiQatU
CaiUOHyOQaLHy. CiQaiLuH CaiUOHyOQaLHy S UChHCU aS
HCaiL aHuiCWLH a CH VCHLiCuai C|CCUOHBaCLOHCSS LHaH
C7LHaLSUa_HOSCUDClCCHHOHLHSDCOiCaHUCHOHLHS
aHCiUCVCiyHLCaDSCHCCOaHUCHLhaDCCauSC.iLSuSu-
ayUa_nOSCUUuHH_LHCbiSLHOHLHQOSqaiLuH.JHSQaUCHL
HaS CHCa CaLuiCS COHSSLCHL VLH HCaiL auiC QiO_iCSSVC
UySQHCa}, C\UCHCC O CH VCHLiCuai UySHCLOH LaCHyCai-
Ua,CCVaLCUCCHLtaVCHOuSQiCSSuiC,b_aHUb_,USQaCCUaHU
UH SCaQCaHQuSC,HLtaiC_uigLaHLHuiHui,QuHOHaiy
CiaCKCS}, aHU COHBiHaLOiy CHCSL iaUO_iaQHy QCuia CH-
SOHS aHUHLCiSLLaHmLtaLCS}.
PCuLCHyOCaiUaHaiCLOHHayOCCuiUuiH_QiC_HaHCyaHU
HLHCQOSLjaiLuHQCiOU.iLHayDCiCaLCULOaLHCiOSCCiOUC
COiOHaiyaiLCiyUSCaSCOiCOiOHaiyatLCiyUSSCCLOHaHUVaS-
CuLS aHU CaiHCS a _H iSK O HaLCiHa HOiLa|aHU HOi
DULy.JHSQaLCHL`SQiCSCHLaLOH,HOVCVCi,UOCSHOLSu__CSL
aHaCuLC COiOHaiySyHUiOHC, gVCHLHCaDSCHCCO CHCSLQaH
OiCCCLiOCaiUO_iaQCCHaH_CS.
J2 CrOOvscu!r MeOcHe
/OiIiC Ui88CCIiOH HJy OCCui H IHC jCiijJiIuH Oi jO8IJiLuH
jCiOU JHU i8 J jJiIiCuJi COHCCiH iH jJIiCHI8 WiIH JOiIOjJIHy
iCJICU IO JiJH 8yHUiOHC JHiiJ IHOiJCiC JOiIiC JHCuiy8-
HJ Ui8CJ8C Oi DiCu8jiU JOiHC \J\CiCJICU JOiIOjJIHy. OW-
C\Ci IHC CuiiCHI jiC8CHIJIiOH UOC8 HOI 8u__C8I JOiIiC Ui88CC
IiOH _\CH IHC JD8CHCC O CHC8I jJiH IHC jiC8CHCC O CquJ JHU
HOiHJ DOOU jiC88uiC8 iH IHC ujjCi CXItCHIiC8 JHU IHC jiC8
CHCC O HOiHJ OWCi CXItCHiIy ju8C8. /UUiHOHJhy JOiHC Ui8
8CCHOH i8 u8uJy J88OCiJICU WIH JH JDHOiHJ CHC8I iJUiO_iJjH
[WUCHCU HCUiJ8IiHuH JDHOiHJ JOiIiC COHIOui} JHU IHC
JD8CHCC O IHC8C BHUiH_8 Ji_uC8 8IiOH_y J_JiH8I IHC UJ_HO-
8i8. /OiIiC Ui88CCIiOH CJHHOI CXjJiH IHC jJIiCHI8 BHUiH_8 O J
UiJICU CH \CHIHCC JHU 8i_H8 O HCJiI JuiC.
\OJiCIJIOH O IHC JOiIJ HJy iJiCy jiC8CHI iHiIiJy J8 H_Ci-
ICH8iOH UuiiH_ jiC_HJHCy. OWC\Ci IHC jJIiCHI8 CuiiCHI
jHy8iCJ CXJHiHJIiOH BHUiH_8 O CJ8iy jJjJDC OWCi CXIiCH-
iIy ju8C8 WiIHOuI UCJy JHU IHC JD8CHCC O HyjCiICH8iOH Ji_uC
J_JiH8I COJiCIJIiOH. H JUUiIiOH iiD HOICHiH_ i8 HOI iCjOiICU
OH IHC CHC8I iJUiO_iJjH.
1
1h ISBC 0 Vd0 CBId VB0uS ISSuI, um0BdI
CIdCkS, VBICudI gd0S [5 0I 5_), dB CdI0dC muImuI, dB0
0WI XIm 0md d BCIdS h kh000 0 hdI duI.
DlO_agHy
Goldbcrg F. carI furc. ^nn InIcrn Mcd. 200,S2(11):IJC1-
1S, quiz IJC. IMII: 20S382S]
lIBD d7 MDSWBt. M
bOUCBIODB DgBCIVB. 1PJuJh J [JItnI Ib nt
0ntI btJrI jJurt Ib tJrdJt Jng0grJ[by.
HC HO8I JjjiOjiiJIC UiJ_HO8IiC IC8I Oi IHi8 jJIiCHI i8 J CJi
UiJC JH_iO_iJjHy. Hi8 jJIiCHI HJ8 ]jiCJ JH_iHJ [8uD8ICiHJ
CHC8I jJiH jiCCijiIJICU Dy CXCiIiOH JHU iCiC\CU Dy iC8I} JHU
HCWOH8CI HCJiI JiuiC CviUCHCCU Dy 8yHjIOH8 [ CXCiHOHJ
Uy8jHCJ JnU OiIHOjHCJ} CXJHiHJHOH BI1UiH_8 [CC\JICU u_u-
Ji \CHOu8 jiC88uiC juHOHJiy CiJCKC8 JHU JH b_ JHU b_}
JHU CCHOCJiUiO_iJH WiIH J 8uDHOiHJ CCCIiOH iJCIiOH.
lCBHiIi\C IC8IH_ Oi COiOHJiy JiICiy Ui8CJ8C [\Pl} Dy CJi-
UiJC CJIHCICDZJIiOH i8 WJiiJHICU. HC jiiHJiy JiH O JH C\J-
uJHOH Oi \Pl i8 IO iUCHIi| jO88iDC IJi_CI8 Oi iC\J8CuJi-
iZJIiOH [jCiCuIJHCOu8 Oi 8ui_CJ} WiIH IHC _OJ8 O iCUuCiH_
JH_HJ iHjiOVH_ 8y8IOiC HHCHOH iCUuCiH_ IHC ii8K O HCJiI
JiuiC jiO_iC88iOH aHU iHjiO\iH_ 8uivi\J.
Oi jJHCHI8 WiIH JH iHICiHCUiJIC CiHOOU O \Pl WHO HJ\C
HO CJIuiC8 O uH8IJDC aH_HJ 8IiC88 IC8IiH_ i8 IHC jiCCiiCU
JjjiOJCH WHCH J88C88iH_ Oi \Pl. / CXCiCi8C 8IiC88 IC8I i8
iCCOHHCHUCU iH J jJIiCHI WiIH JH HICiHCUiJIC jiODJDii]
O Ui8CJ8C JHU J HOiHJ iC8IiH_ CCCIiOCJiUiO_iJH [1\L}.
HuCCJi HCUiCiHC 8IiC88 IC8I i8 HCjH i IHC iC8IiH_ 1\L i8
JDHOiHJ. H IHi8 jJIiCHI HOWC\Ci IHC jiCIC8I jiODJDiiIy Oi
\Pl i8 Hi_H DJ8CU OH Hi8 J_C 8CX JHU IHC jiC8CHCC O ]ji
CJ JH_iHJ 8yHjIOH8. 1CCJu8C J HC_JIi\C iC8uI OH 8IiC88 IC8I
iH_ iH J jJICHI WIH J H_H jiCIC8I jiODJDiiIy O \Pl WOuU
HJ\C J Hi_H iKCHOOU OJCH_ J J8C HC_JH\C CJHCICDZJHOH
WOuU 8Ii DC HCCUCU Oi J UCBiIi\C UiJ_HO8i8 J8 WC J8 Oi
jM_ IHCiJjy.
/ iJUiOHuCiUC \CHIiiCuO_iJH CJH DC u8CH iH COHBiHiH_
IHC CCCIiOH hJCIiOH i CJiBCJIiOH i8 HCCUCU. H IH8 jJIiCHI
HOWC\Ci IHC CCCIiOH iJCIiOH \JuC i8 jiO\iUCU Dy IHC
CCHOCJiUiO_JH. uiIHCiHOiC J iJUiOHuCiUC \CHIDCuO_iJm
WOuU HOI J88i8I iH UCICiHiHiH_ IHC CJu8C O IHC HCWOH8CI
HCJiI JiuiC.
1
dBS Wh BW0BS hdI duI dB0 dBgBd Sh0u0 0 Vdu
d0 Wh CdI0dC CdhIZd0B dB0 dBg0gIdh h dI 0S
S0 CdB00dS 0I IVdSCudIZd0B.
DlO_agHy
Goldbcrg F. carI furc. A InIcrn Mcd. 200,S2(11):IJC1-
1S, quiz IJC. IMII: 20S382Sj
IBD d MDSWBt.
bOUCBIODB DgBCIVB. 1PJuJh nt0ntI btJrI
jJurt Ib ttb0tJrd0grJ[by.
/ CCHOCJiUiO_iJH 8HOuU DC ODIJiHCU iH J jJIiCHI8 WiIH
HCWy UiJ_HO8CU Oi 8u8jCCICU HCJiI JiuiC IO UCICiHiHC
WHCIHCi IHC HCJiI JiuiC i8 8y8IOiC Oi UiJ8IOiC JHU WHCIHCi
IHCiC JiC JHy 8IiuCIuia Oi HHCIiOHJ JDHOiHJiIiC8 IHJI HJy
DC CJu8iH_ IHC HCJiI JiuiC [8uCH J8 iC_iOHJ WJ JDHOiHJi-
IC8 jCDCJiUiJ Ui8CJ8C Oi \J\uJi JDHOiHJiIy}. O IHC8C
i88uC8 HJy HJ\C J 8i_mCJHI iHjJCI OH HJHJ_CHCHI JHU jiO_-
HO8i8.
1|jC HJIiiuiCIC jCjIiUC [1} i8 J HOiHOHC 8yHIHC8iZCU Dy
IHC CJiUiJC \CHIDCC8 iH iC8jOH8C IO iHCiCJ8CU WJ 8IiC88 UuC
IO jiC88uiC Oi \OuHC O\CiOJU. 1 J88Jy8 HJ\C DCCOHC J
u8CH IOO iH IHC GJ_HO8i8 O JCuIC HCJiI JuiC JHU UiHCi
CHIJHH_ iI hOH HOHCJiUiJC CJu8C8 O Uy8jHCJ. / jJIiCHI WiIH
J 1 COHCCHIiJIOH DCOW I j_/H i8 uHKCy IO HJ\C
JCuIC HCJiI JiuiC WHCiCJ8 J jJIiCHI WiIH J COHCCHIiJIiOH
Hi_HCi IHJH o j_/H HJ8 J Hi_H iKCHOOU O HJviH_ HCJiI
JiuiC. 1 C\C V iKCy DC CC\JICU H IHi8 jJIiCHI COH-
BiHiH_ IHC jiC8CHCC O \OuHC O\CiOJU. HC jHy8iCJ CXJH-
iHJIiOH Hi8IOiy JHU CHC8I iJUiO_iJjH COHCOiUJHIy 8u__C8I
\OuHC O\CiOJU JHU HCJiI JiuiC JHU J 1 C\C COHBiH
iH_ IHi8 WOuU HOI DC HCjH.
/ iJUiOHuCiUC \CHIiiCuO_iJH WOuU JCCuiJICy J88C88 \CH-
IiiCuJi CCCIiOH hJCIiOH DuI WOuU HOI jiOviUC OIHCi CJiUiJC
8IiuCIuiJ Oi HHCIiOHJ iHOiHJIiOH IHJI HJy iHjJCI HJH
J_CHCHI. / iJUiOHuCiUC \CHLHCuO_iJH IHCiCOiC i8 HOI IHC
HO8I JjjiOjiiJIC HCXI IC8I.
8CHCHJ i8 J HJOi CJu8C O CH \CHIHCuJi Uy8BHCIiOH. Li\CH
IHC jOICHIiJ 8i_mCJHI DCHCBI8 O iC\J8CuJiiZJIiOH iH JjjiO-
jiiJIC CJHUiUJIC8 iHCuUiH_ iHjiO\CU \CHIHCuJi BHCHOH JHU
iCUuCCU HOiDiUiIy JHU HOiIJiIy Uii_CHI C\JuJIOH Oi COiO
HJiy JiLCiy USCJSC SHOHU DC HHUCiLJKCH Oi HOSL QJLCHLS
VLH HCJiL JHiC. D SIiCSS LCSL WOHU DC JQQiOQiJLC H LHS
QJHCHL BLHCiC WCiC J H_HCi CHCJ SHSQCOH Oi COiOHJiy US
CJSC Oi SCHCHJ CJHSH_ HCWOHSCL HCJiL JHiC. OWCVCi
_VCH LHC JCK O JH_HJ SyHQLOHS IHC QJLCHLS iCJIVCy
yOHH_ J_C JHU JCK O iSK JCLOiS CHCJ SHSQCOH JL LHS
QOHL S OW. HJy JHU HQOiLJHIy JH CXCiCSC SLiCSS LCSL S
COHLiJHUCJLCU H J QJLCHL VLH UCCOHQCHSJLCU HCJiL JHiC
SHCH JS LHS QJLCHL.
KEY PO1T
B 6CR0Cl0l0glm SR0U0 06 00lB60 lB l6BS WlR B6W
0lgB0S60 0l SUS6C60 R6l lUl6.
1DC_aQHy
/DlJJH | /DlJJH . C lOC O CCOCJlGiO_lJQy mCHOGyHJHiC
JSSCSSHCH! mCJl!JJlC. CJl! aC.ZVb(Z]:JVJ-Zb. 1:
JVZ+VObbq
Item d Answer:
Educational Objective: 1I|0l ^|H J0Ik 1|0Il 70
tt0lt0H t0 0I ytt h|0Il j0tuI| Htlh 0 ~00tk|l
iCJLHCHL WLH JH JH_OLCHSHCOHVCiIH_ CHZyHC [DI1)
nHDLOi [SHCH SHOQH) JHU J DOCKCi [SHCH JS CJiVCUO)
S HUCJLCU Oi J QJLCHLS VLH SySLOC HCJiL JHiC iC_JiUCSS
O SyHQLOHS Oi HCIOHJ SLJLuS HCHUH_ JSyHQLOHJIC Oi
VCiy HCIOHJ QJLCHLS. HC COHDHJLOH O LHCSC LWO CJSSCS
O HCUCJHOHS HJS JUULVC DCHCBLS WLH iC_JiU LO HOiDULy
JHU HOiLJLy H SySLOC HCJiL JHHiC. HS QJLCHL S JiCJUy
LJKH_ JH DI1 HHDLOi SO J DOCKCi SHCH JS CJiVCUO
SHOHU DC JUUCU. 1OCKCiS SHOHU HOL UC HLJLCU Oi
HCiCJSCU UHiH_ UCCOHQCHSJLCU SLJLCS SHCH JS VOHHC OVCi
OJU Oi H_OLCHSOH DCCJHSC LHC LiJHSCHL UCCHC H CJiUJC
OHqHL HJy WOiSCH J UCCOHQCHSJLCU SLJLC.
POUQHC S LHC OHy CJCHH CHJHHC DOCKCi UCHOHSLiJLCU
LO HJVC J HCHLiJ [iJLHCi LHJH UCLiHCHLJ) CHCCL OH HOiDU
Ly JHU HOiLJLy H HCJiL HiC. HHS L S JH JCCCQLJDC J_CHL
LO HSC Oi JH_HJ Oi HyQCiLCHSOH LHJL S HOL JUCqHJLCy COH-
LiOCU WLH DI1 HHDLOiS Oi DOCKCiS. OWCVCi LHS
QJHCHL HJS HCIHCi JH_HJ HOi HHCOHIiOCU HyCiLCHSOH JHU
JOUQHC S HOL HUCJLCU.
_OXH S HUCJLCU Oi QJLCHLS WLH HOUCiJLCy LO SCVCiCy
SyHQLOHJLC HCJiL JHiC [CW 1OiK CJiL DSSOCJLOH
] CJSS I!I-I) Oi Oi iJLC COHLiO H QJLCHLS WLH JLiJ
BDiJHOH. _OXH HQiOVCS SyHQLOHS JHU iCUHCCS HOSQ-
LJZJLOHS DHL L UOCS HOL JHCCL SHiVVJ. bQiOHOJCLOHC S
HUCJLCU OHy Oi LiCJIHCHL O CJSS III Oi I HCJiL
JHiC H LHS SCLHH_ LS HSC S JSSOCJLCU VLH J o7 iCUHC
LOH H HOiLJLy. HS QJLCHL HOWCVCi S OHy HHHJy
SyHQLOHJIC CJSS II); IiCJLHCHL WLH CLHCi U_OXH
Oi SQiOHOJCLOHC S HOL HUCJLCU.
HCiC JiC CHiiCHLy HO iODHSL UJLJ LO SHQQOiL JUUHOH O JH
JH_OLCHSH iCCCQLOi DOCKCi [D1) SHCH JS OSJiLJH LO DI1
nDLOi LHCiJQy Oi IiCJLHCHL O SySLOC HCJiL JHiC. O
CarOOvascuIar NeOcne 33
UCHHLVC HQiOVCHCHL H SHiVVJ HJS DCCH UCHOHSLiJLCU
HSH_ LHC COHDHJHOH O LHCSC LWO J_CHLS. Db1S JiC CHiiCHLy
iCCOHHCHUCU OHy Oi QJLCHLS WHO JiC HLOCiJHL O DI1
HHDLOiS QiHJHy OVH_ LO DI1 HHDLOiHUHCCU COH_H.

1l6m6B WlR B Bgl06BSlBC0BV6llBg 6BZm6 lBRl0l0l B0
00Ck6l lS lB0lC60 0l l6BS WlR SS0lC R6l lUl6
l6gl06SS 0 Sm0mS 0l UBCl0B SUS, lBCU0lBg Sm0
mlC 0l V6l UBCl0B l6BS.
1DC_aQHy
LOGDCl_ !K. CJi! iHlC. P 1H!ClH CG. ZJJbZ(11]:1IOJ-
Jb QHiZ 1IOJO. 1. ZbJbZbq
ltemA Answer:
Educational Objective: 1I|0l 0 ]0lt|Hl Htlh h|0Il
j0tuI| Htlh 0 ~00tk|I 0Hd 0H 0Hgt0HtH~t0HV|IltHg
|HUym| tHht0tl
HS QJHCHL SHOHU DC SLJiLCU OH SHOQi H JUU!HOH LO HCLO
QiOO. DH_OLCHSHCOHVCiLH_ CHZyHC [DI1) HHDLOiS
SHCH JS SHOQi JiC !HUCJLCU Oi LiCJLHCHL O J CW 1OiK
CJiL SSOCJHOH ) HCLOHJ CJSSCS O SySLOC HCJiL
JHiC HCHUH_ JSyHQLOHJHC CJSS I) QJHCHLS. DI1
HHDLOiS iCUHCC HOiLJIy JHU HOiDULy H JSyHQLOHJHC
JHU SyLQLOHJIC QJLCHLS JHU UCJy LHC OHSCL O CnCJ HCJiL
JHiC H QJLCHLS VLH JSyHQLOHJLC CH VCHLiCHJi UySHC-
LOH. \VCiJ DI1 HHDLOi LHCiJQy iCUHCCS HOiLJ] Dy
JDOHL Z7iSK Oi HyOCJiUJ HJiCLOH Dy JDOHL Z7 JHU
HOSQLJHZJLOH Oi HCJiL JHHiC Dy o7LO +7.
Oi QJLCHLS HLOCiJHL O DI1 HHDLOiS OWH_ LO HyQCi-
KJCHJ Oi iCHJ HSHHCCHCy LHC COHDHJHOH O HyUiJJZHC
JHU J HLiJLC S J SHLJDC JLCHJHVC VLH HCHOUyHJHC CHCCIS
O VJSOUJLOH JHU JHCiOJU iCUHCLOH. iCJIHCHL VLH LHS
COHDHJLOH S JSO JSSOCJLCU WIH J iCUHCLOH H HOiLJ|
JLHOH_H LO J CSSCi UC_iCC LHJH S SCCH VIH DI1 H!DLOiS
JHU LHS COHDHJLOH UOCS HOL HJVC LHC SJHC QOSLVC HQJCL
OH qHJIy O C JS JH DI1 nHDLOi.
HC iOC O U_OXH L IiCJLH_ HCJiL JHHiC QJLCHLS H SHHS
iHyIHH S QDHJiy Oi SyHQLOH COHLiO iJLHCi LHJH HQiOV
H_ SHiVVJ. iCJIHCHL WLH U_OXH HJS HOL DCCH SHOWH LO
JHCCL HOiLJLy DHL HJS DCCH SHOWH LO iCUHCC HOSQLJ|ZJHOHS.
_OXH CJH DC JUUCU LO OLHCi IHCiJQy H QJHCHLS VIH I
CJSS III Oi I HCJiL JHiC Oi SyHQLOH COHLiO. JHLJHH_
OWCi SCiHH COHCCHIiJLOHS O U_OXH S JS CHCCLVC JS HJH
LJHH_ H_HCi COHCCHLiJIOHS JHU QOLCHLJ LOXCLCS JiC
JVOUCU.
1QCiCHOHC S J SCCCHVC JUOSLCiOHC DOCKCi LHJL S CHiiCHLy
JQQiOVCU Oi IiCJLHCHL O HyQCiLCHSOH JHU Oi CH VCHLiCH-
Ji UySHCI!OH JHCi HyOCJiUJ HJiCIOH. QCiCHOHC S J
SHLJDC JLCiHJLVC LO SQiOHOJCLOHC L IiCJLHCHL O SCVCiC
HCJiL HiC CJSS Oi I) _yHCCOHJSIJ UCVCOQS
JS J SUC CHCCL O SQiOHOJCLOHC IiCJLHCHL.
34 LiCOv$CUIi N6CCD6
Hi8 JIiCHI HJ8I CJ88 HCJiIJuuiC(8yHIOH8 WiIH
HOGCiJIC CXCiIiOH} JHG GOC8 HOI HCCI IHC CiiICDJ Oi IiCJI
HCHIWiIHGi_OXiH OiJH JGO8ICiOHCJ_OHi8I.

Ang|otens|n-convert|ng entyme |nh|b|tors are |nd|cated lor treat
ment ol aII New York Heart Assoc|at|on [NYHA) lunct|onaI cIasses
ol systoI|c heart la|Iure, |ncIud|ng asymtomat|c [NYHA cIass
at|ents.
DO_agDy
Goldbcrg LI. Icari
_
urc. P Inicrn Mcd. 200;52():IJC-
5; quiz IJC. IMII: 2053825]
Item A1 Answer:
Educational Objectve: 7rcat a patcnt wtb Ncw
Tcr| !cart rccatcn ]nctcnal clarr cr 1bcart
falurc wtb rprcnclacmnc.
HC HO8I JiOiiJIC JGGiIiOH IO IHi8 JIiCHI8 IiCJIHCHI i8
8iiOHOJCIOHC.bHCHJ88yHIOH8COH8i8ICHIWiIHCWAOiK
CJiI88OCiJIiOH I) CJ88hHCIiOHJ 8IJIu8(8yH
IOH8GC\COWiIHHGJCIi\iIy}JHG8HCGOC8HOIJCJi\O
uHCO\CiOJGCGOHCXJHiHJHOH (HOiHJCCHIiJ\CHOu8iC8
8UiCJHGHOb_uHOHaiyCiJCKC8OiCGCHJ}.biiOHOJCIOHC
i8 iHGiCJICG Oi IiCJIHCHI O 8C\CiC I hHCIiOHJ CJ88
OiI) 8y8IOiCHCJiIJiuiCiHJGGiIiOHIO8IJHGJiGIHCiJy
WiIH JH JH_iOICH8iHCOH\CiIiH_ CHZyHC(P\1} HHDiIOi
DOCKCiJHGUuiCHCJ8HCCGCG.biiOHOJCIOHChiIHCiDOCK8
IHCJCIiOH8OJGO8ICiOHCWHiCHi8HOICOHCICy8uiC88CG
Dy CHiOHiC P\1 iHHiDiIOi IHCiJy JGO8ICiOHC HJ8 JG\Ci8C
CHCCI8 O 8OGiuH iCICHIiOH OIJ88iuH WJ8IiH_ JHGHyOCJi-
GiJBDiO8i8.HCJGGiIiOHO8iiOHOJCIOHCi8J88OCiJICGWiIH
J o7iCJIi\C iCGuCIiOHiHHOiIJiIy.
bCiuHCiCJIiHHCJHGOIJ88iuHC\C88HOuGDC8CiiJyHOH
iIOiCGiHJIiCHI8IJKiH_8iIOHOJCIOHC.\OHIiJiHGiCJHOH8IO
8iiOHOJCIOHCIHCiJyiHCuGCJ8CiuHCiCJHHCC\C_iCJICi
IHJH 2.OH_/G(221 11 O/1}BHCHOi2.H_/G1(10.
O/1}iHWOHCHOiJOIJ88iuHC\C_iCJICiIHJHOHCq/1
(O HHOy1}.
Ii8_CHCiJy HOIiCCOHHCHGCGIOJGGJH_iOICH8HiCCCIOi
DOCKCi IHCiJy 8uCH J8 O8JiIJH IO P\1 iHHiDiIOi IHCiJy
DCCJu8C IHC ii8K O JG\Ci8C 8iGC CHCCI8 8uCH J8 H_CiKJCHiJ
JHGH_OICH8iOH i8iHCiCJ8CG.
HC JGGiIiOH O HCIOJZOHC IO OO GuiCIiC IHCiJy CJH DC
u8ChIOiHCiCJ8CGiuiCIiCCHCCIi\CHC88.OWC\CiIHi8JIiCHI
JCJi8 Cu\OCHiC OH HCi CuiiCHI GiuiCIiC iC_iHCH 8O
CHHJHCCGGiuiC8i8i8 HOI HCCGCG.
ii8I_CHCiJIiOHCJCiH1CHaHHCDOCKCi8(8uCHJ8HiCGiHC}
HJ\C DCCH 8HOWH IO iHCiCJ8C IHC ii8K O HCJiI JiuiC GCCOH
CH8JIiOHJHGHO8iIaiZJIiOH.PHOGiHCJHGCOGiiHCaiC
IHCOHyCJCiuHCHJHHCDOCKCi8WIHGCHOH8IiJICGHCuIiJ
CHCCI8OHHOiIJiIy iHJHCHI8WiIHHCJiIJuuiC.HC8CJ_CHI8
CJHDCu8CGiH JIiCHI8WIHHCJiIaiuiCOiIHCHJHJ_CHCHI
O HyCiICH8iOH Oi JH_iHJ HOI JGCquJICy COHIiOCG WiIH
OIHCi J_CHI88uCHJ8P\1iHHiDiIOi8 Oi DOCKCi8.
Ang|otens|n-convert|ng entyme |nh|b|tors, pbIockers, and s|rono
Iactone reduce mortaI|ty |n at|ents w|th New York Heart Assoc|a
t|on cIass or heart la|Iure.
DO_agDy
Goldbcrg LI. Icari fiIurc. P Inicrn Mcd. 200;52():IJC-
5; quiz IJC. IMII: 20513825j
ItemAZ Answer: A
Educational Objective: !aqncrc anal ]brllatcn
ar tbc caurc cf clncal dnrcratcn n a patcnt wtb
acrtc rnncrr.
CW-OH8CI JIiiJ BDiiJIiOH 8 IHC HO8I iKCy CJu8C O IHC
JIiCHI8HCW8yHIOH8.POiHC\J\C8CCiO8i8Oi\J\CIHiCK
CHiH_ WiIHOuI OuIBOW OD8IiuCIiOH i8 iC8CHI iH HOiC IHJH
2O7 O Ci8OH8 OGCi IHJH 0O yCJi8. JIiCHI8 JiC OHCH GiJ_
HO8CG WHCH JH J8yHIOHJIiC HuiHui i8 Ju8CuIJICG Oi O
OWiH_ JH iHCiGCHIJ CCHOCJiGiO_iJHiC HGiH_. HC iO
_iC88iOHOHJOiHC8CCiO8i8IO8ICHO8i8i88OWJHGCWCiIHJH
27 O JIiCHI8 GC\CO \J\C OD8IiuCIiOH O\Ci IHC HCXI 1
yCJi8. YHCH HiG 8ICHO8i8 i8 iC8CHI HOWC\Ci iO_iC88i\C
\J\C8ICHO8i8iOCCCG8HOiCiJiGy.\J88iCHJHC8IJIiOH8O
JOiIiC 8ICHO8i8 JiC JH_iHJ 8yHCOC JHG HCJiIJiuiC. HCJiy
8IJ_C8 JOiIiC 8ICHO8i8 HJy iC8CHI 8uDIy WIH Gy8HCJ Oi J
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a_cDcHl SlcQ:
[} DGOHiHJ lJ 8CJH
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[1} CIJiOGODCHZy_HJHiGiHC [11L} 8CaH
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CyCJiOG WOHJH i8 CVJHJICG Oi J oWCCK Hi8IOiy O
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IOH OH8CI 8HC HJG JCHIC DiOHCHiIi8 WiIH jiOGHCIiVC COH_H
JHG CVCi. JHC jJIiCHI HJ8 J 2yCJi Hi8IOiy O O8ICOJiIHiiIi8 O
IHC KHCC8 IHJI iCQHiC8 iHIiJJiIiCHJi COiIiCO8ICiOiG iHCCIiOH8
CVCiy o IO HOHIH8 HCi J8I iHCCIiOH WJ8 o HOHIH8 J_O. Ci
OHy OIHCi HCGiCJIiOH i8 JCCIJHiHOjHCH.
\H jHy8iCJ CXJHHJHOH IHC JHCHI OOK8 IiiCG. CHjCiJIHiC
i8 o.Cl [VV.C1} DOOG jiC88HiC i8 112yC HH _ jH8C
iJIC i8 V2yHiH iC8jiiJIiOH iJIC i8 1 yHiH JHG 11 i8 o2.
JHC jJIiCHI HJ8 CH8HiH_OiG CJIHiC8 JHG CCHIiJ ODC8iIy. JHCiC
JiC HHIjC CCCHyHO8C8 OH IHC HjjCi JHG OWCi CXIiCHiIiC8.
CCiCJ8CG JXiJiy JHG jHDiC HJii i8 HOICG. HCiC i8 DOHy
HyjCiIiOjHy JHG 8HJ CH8iOH8 O IHC KHCC8 DiJICiJy DHI HO
CViGCHCC O WJiHIH Oi CiyIHCHJ.
GiCHOCOiIiCOIiOjiC HOiHOHC iOW HOiHJ
lOiIi8O [
1HiIiJ HCJ8HiCHCHI iOW
HCi CO8yHIiOjiH 8IiHHJIiOH iOW HOiHa
YDICD O lDc OOWIH_ IS lDc DOSl IKcy CaUSc O lDIS
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[} GiCHJ JGCHOHJ
[1} 1XO_CHOH8 COiIiCO8ICiOiG8
[l} iIHiIJiy HiCiOJGCHOHJ
[} iiHJiy JGiCHJ iH8HDCiCHCy
TH Z7 j8aslC]
+ yCJiOG WOHJH i8 HO8jiIJiZCG Oi jyCOHCjHiiIi8. JHC
jJIiCHI HJ8 J yCJi Hi8IOiy O jDHJiy JGiCHJ iH8HHCiCHCy
JHG HJ8 DCCH GOiH_ WC OH IHCiJjy VIH OiJ HyGiOCOiIi8OHC
JHG HHGiOCOiIi8OHC. bHC iCjOiI8 Hi88iH_ IWO GO8C8 O IHC
HyGiOCOiIi8OHC IOGJy DCCJH8C O HJH8CJ. bHC i8 8IJiICG OH
iJjiG iHIiJVCHOH8 iHH8iOH O HOiHJ 8JiHC JHG CCHiiJXOHC.
\H jHy8iCJ CXJHiHJIiOH ICHjCiJIHiC i8 o.Vl [12.1}
DOOG jiC88HiC i8 V2yC HH _ 8HjiHC JHG yC HH _
8iIIiH_ jH8C iJIC i8 VyHiH 8HjiHC JHG 112yHiH 8iIIiH_ JHG
iC8jiiJIiOH iJIC i8 1V yHiH.
C8HI8 O JDOiJIOiy 8IHGiC8 iCVCJ J 8CiHH 8OGiuH CVC O
12C HCQyi [12C HHOyi} JHG J 8CiHH jOIJ88iHH CVC O
C.C HCQyi [C.C HHOyi}.
YDICD O lDc OOWIH_ SDOUU Dc aUDIDISlctcU HcXl:
[} 1HH8iOH O o7 8JhHC
[1} bIiC88 GO8J_C O iHIiJVCHOH8 HyGiOCOiU8OHC
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[1} 8HJ GO8J_C O OiJ HyGiOCOiH8OHC JOHC
TH Z j8asC]
yCJiOG WOHJH i8 OHHG IO HJVC J8COiC O 2. JI HCi
Hij OOWiH_ J iOHIiHC 8CiCCHiH_ GHJ CHCi_y XiJy JD8OQ-
IiOHCIiy [12} 8CJH. HC jJIiCHI i8 OIHCiWi8C HCJIHy HJ8
HO ODViOH8 ii8K JCIOi8 Oi O8ICOjOiO8i8 JHG IJKC8 HO HCGi-
CiHC8.
lJCiHH
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2 j_yHi [2 H_yi}
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[} GG C8IiO_CH iCjJCCHCHI IHCiJjy
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TH Z jAOvnCeO]
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HyjCiICHSiOH. bHC HJS HO SyHjIOHS JHU iS HOHO_JHOHS ViLH
HCi HHSDJHU O b yCJiS. Ci OHy HCUiCJLiOH iS
HyUiOCHOiOLHiJZiUC. bHC iCCCi\CU JH iHhHCHZJ \JCCiHJLiOH
HOHIHS J_O JHU J HCQCS ZOSICi \JCCHJIiOH 1 yCJi J_O. Ci
JSI Jj SHCJi WJS 1+ HOHIHS J_O JHU iCSHIS WCiC HOiHJ
JS WCiC iCSHIS O LHC jiC\iOHS IHiCC JHHHJ Jj SHCJiS.
\H jHySiCJ CXJHiHJIiOH DOOU jiCSSHiC iS 1yZ HH _
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HJLiOH HUiH_S JiC HOiHJ.
HC IOIJ CHOCSICiO C\C iS 1 H_yUi [+.V HHOyi} JHU
IHC iCHOCSICiO C\C iS b+ H_yUi [1.+ HHOyi}.
YDICD O tDc OOWID_ I8 tDc DO8t aQQIOQIIatc DcatD
DaIDtcDaDCc IDtcIVcDDOD OI tDI8 QaDcDt:
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Item1 Answer:
Educational Ob]ectve: 10gH0t _t Z d00t mt
lB.
1hspaticnthastypc2diabctcsmchtus.1hcdiagnosisoldia-
bctcsmchtuscanbccstab|ishcdbyalastingp|asmag|ucosc
|cvc|olat|cast2mg/d!Z.0mmo|/!),arandomp|asma
g|ucosc |cvc| ol at |cast 200 mg/d! . mmo|/!) and
symptomsolhypcrg|yccmialorcxamp|c,po|yuria,po|ydip-
sia,orb|urrcdvision),ora2-hourora|g|ucoscto|crancctcst
CGJ) rcsu|t ol at |cast 200 mg/d! . mmo|/!). !n
200,thc^mcricanIiabctcs^ssociationcndorscdahcmo-
g|obin1_ va|ucol.5olgrcatcrasdiagnosticoldiabctcs.
!mpaircdlastingg|ucosc,impaircdg|ucoscto|crancc,orboth
markthctransitionhomnorma|g|ucoscto|crancctotypc2
diabctcsmc||itus.!mpaircdlastingg|ucoscisdiagnoscdwhcn
thclastingp|asmag|ucosc|cvc|isinthcrangcol00to25
mg/d! 5. to .9mmo|/!), and impaircd g|ucosc to|cr-
ancc-anana|ogousprcdiabcticstatc-isdiagnoscdwhcnthc
p|asmag|ucosc|cvc|atthc2-hourmarkolanCG11is10
to99mg/d!Z.8to.0mmo|/!).
Ioradiagnosisolthcmctabohcsyndromctobcmadc,inlor-
mation about thc paticnt's b|ood prcssurc 2 30/85 mm
!g), |ipid |cvc|s trig|yccridc |cvc| 2 50 mg/d! .Z
mmo|/!|; !I!-cho|cstcro| <10 mg/d! in mcn .0
mmo|/!j),lasting p|asma g|ucosc |cvc| mg/d! .
mmo|/!j), andwaist circumlcrcncc >10in >02 cm| in
mcn)isncccssary!nsuhcicntdatahavcbccnprovidcdlorths
diagnosis.
1y6 Z 0d066S m6lluS S 0dgB0S60 W6B 6 dSBg ldSmd
gluC0S6 l6V6l S 1Zb mg/0L (1 . mm0/L] 0I gI6d6I, 6 IdB00m
ldSmd gluC0S6 l6V6l S Z mg/0L (11.1 mm0/L] 0I gI6d6I 6
ldSmd gluC0S6 l6V6l S Z mg/0L (11.1 mm0/L] 0I gI6d6I d6I d
Z0uI 0Idl gluC0S6 0l6IdBC6 6S 0I 6 V6B0uS 6m0gl00B
"r
Vdlu6 S b.b% 0I gI6d6I.
DO@agDy
/CDCJH 1iJDCICS 1SSOCiJUOH. bIJHGJiGS O! HCGiCJ CJiC mGiJDCICS
21. 1iJDCICS \JiC. 21 bH1.bJJOJ. i1. 2+22[
4b
Item2 Answer: E
Educatonal Ob]ective: 1rt0l ]rtd00t Hl0 dtl
0Hd tXrtt.
1hc most appropriatc trcatmcntlorthis paticnt is dict and
cxcrcisc.Shchasimpaircdlasungg|ucosc!IG),dchncdasa
lasungp|asmag|ucosc|cvc|inthcrangcol to25mg/d!
5.to.9 mmo|/!), andshou|dbcgnaprogram olmtcn-
sivc hlcsty|c changc, inc|uding 30 minutcs olcxcrcisc most
daysolthcwcckandaca|onc-rcstrictcddict,toachicvcwcight
rcductiononthcordcrol Zolbodywcight.
Iictandcxcrciscisthcrccommcndcdapproachlorpaticnts
withcithcr!IGorimpaircdg|ucoscto|crancc!G1),thcprc
diabcucstatcs.1hcrc|auvcriskrcductionI )inthcinci-
dcnccoldiabctcsinpaticntswith!G1associatcdvithintcn-
sivc|ilcsty|cchangcis58.
!harmaco|ogic thcrapy with g|ucosc-|owcrmg drugs is not
indicatcdlorthspaticntwithiso|atcd!IG.!npharmaco|ogic
studics ol diabctcs prcvcntion, acarbosc thcrapy rcsu|tcd in
on|ya25K,whchisinlcriortothatobtaincdvthdict
andcxcrcisc.
Mcuorminthcrapyisassociatcdvthan ol3,whichis
a|soinlcriortothc58I obtaincdvthdctandcxcrcisc.
Mcuormin thcrapy maybcconsidcrcdin paucntswith both
!IGand!G1,whoconsututcahighcrriskgroup.1hispaucnt
docsnothavc! G1lasmgp|asmag|ucosc|cvc|ol10to99
mg/d! Z.Zto.0mmo|/!|atthc2-hourmarkolanora|
g|ucoscto|crancctcst)andsoshou|dnotrcccivcmcuormin.
Modulatorsolthcrcnn -angotcnsinaxis,suchasrpri|and
othcrangotcnsin-convcrtingcnzymcinhibitors,donotcon-
tributctodabctcsprcvcntion.
Kosig|itazoncandpiog|itazonchavcbccnassociatcdvith2
and81rcspccuvc|y,inthcincidcnccoldiabctcs.1hcsc
agcnts, howcvcr,arcnotcndorscdlorroutincpharmaco|ogic
usc in paticnts with prcdiabctcs bccausc ol thcir costs and
advcrsc cllccts, inc|uding cdcma, incrcascd lracturcriskin
womcn,andpossib|cincrcascdcardiovascularmorbidity.

d6BS W I60d066S S0ul0 06 d0VS60 0 d00 d I0gIdm 0
l6Syl6 CdBg6 0 I6V6B I0gI6SS0B 0 y6 Z 0d066S m6lluS.
DO@agDy
NiJH b. yC 2 GiJDCICS. 1HH HICiH CG. 211O2(O}.\11O.
i1. 21V+21[
lIOH DSWOt.
LOUCBIODB DjOCIVO. Jngn0tt ttt0nmry dntt
rtnd tbr0nt nntrtnllt.
Jhispaticnt has sccondary diabctcs rclatcd to chronic pan-
crcautis.OiabctcsmcllitusisgcncrallycatcgorizcdastypcJ
typc2,gcstational,andsccondarydiabctcs.Jhispaucnt'sdia-
bctcsisthc last gc, whichconsists ol agroupolunrclatcd
conditions that arc associatcd with hypcrglyccmia through
chcctsoncithcrinsulinavailabilityorinsulinscnsitivity.Jhcsc
includc various cndocrinc disordcrs, suchas Cushing syn-
dromcandacromcgaly,scvcralpancrcaticconditions,suchas
acutc and chronic pancrcatitis andpancrcatic canccr, drug-
induccdhypcrglyccmia,andscvcralgcncticsyndromcs.Jhis
paticnt has a historyol alcoholabusc, a historyolrccurrcnt
pancrcatius,andpancrcauccalcihcauonsonanabdominalCJ
scan,whichcollccuvclyconhmthcdiagnosisolchromcpan-
crcatitis.
Somcoldcrpaucntsprcviouslydagnoscdwithppc2diabctcs
mcllitus havc autoimmunc bcta-ccll dcstruction, albcit ol a
morcgraduallyprogrcssivcnaturctcrmcdlatcntautoimmunc
diabctcsoladulthood).Suchpaticntsdcvclopabsolutcinsulin
dchcicncyovcrumc.Ltc-onsctautoimmuncdiabctcsoladut-
hoodisapossibilityinthispaticnt,gvcnhsagc5ycars),his
lcanbodyhabius,andthcinsidiousonsctoldiabctcs.Iow-
cvcr,itwouldbcmuchlcsscommonthansccondarydiabctcs
inthismanwithconmmcdchronicpancrcatitis.
Jhis paticnt's clinical prcscntationis atypical lorgcJ dia-
bctcs,whchusuallyhasanacutcorsubacutconsctandischar-
actcrizcd bypolyuria, polydipsia, polyphagia, kctoncmia or
kctonuria,andwcightloss.
Mostpaucntswithtypc2diabctcsarcobcscoratlcasthavc
abdominalobcsiphighwaist-tohipratio).Jhispaticntisol
normal bodywcight,and his scaphoid-appcaringabdomcn
makcstypc2diabctcscvcnlcsslikcly.
O1M3
>8C0hdIyCuS8S0db8t8Sm8tuSmyI8Sut|0mdS8S8S0
th88X0CIh8phC|8S,8hd0CIh0pth8S,g8h8tCSyhdI0m8S,hd
dIugS0ICh8mCS.
1bO
[
aQDy
ìaH 5. JyjC Z OiaCLCs. ^HH 1HLCrH ^CU. Z11Z(]:1J\11.
^1: Z1V+Z1[
lIOH R DSWOt. L
LOUCBIODB DjOCIVO. 1rtnl _t Z dntt mtlur
ulb mtQ0rmn.
Jhc most appropnatc trcatmcntlor thispaticnt is tobcgin
mcuormin.Variousoralandinjcctablcagcntsarcavailablclor
thc initial managcmcnt ol typc 2 diabctcs, most ol which
rcducchypcrglyccmia to asimardcgrcc.Bccauscolitslow
cost, cl.ccuvcncss, goodtolcrability, rclauvcsalcty,lavorablc
chcctsonbodywcight,andabscnccolhypoglyccmiaasasidc
LnCOcrInOOQy anC MetabOIsm 41
chcct, mcuormin rcmains thc bcst hrst-hnc agcnt availablc.
Mctlormin iscontraindicatcd inpaticnts with rcnal insuu-
cicncyscruncrcatininclcvcl>.+mg/d! 23.8 ol/!j
lorwomcnand>.5mg/d!32.mol/!jlormcn).!or
thispaticnt,ongoingattcmptsatlilcstylcchangcarcunlikcly
to rcducc hcrblood glucosc lcvcl mrthcr. Jhcrclorc, iniua-
tion ol mctlormin thcrapy is most likcly to improvc hcr
glyccmiccontrol.
!xcnaudc,anin|cctablcagcnt,isonlyapprovcdloruscincom-
binauonrcgmcnsvthoralagcntsandisinappropriatcmmost
circumstanccs monothcrapy.Glimcpiridccouldbcuscdbut
is associatcd with wcight gainand thc riskolhypoglyccmia.
Cvcrall,itrcmainsalcssatuacuvcchoiccthanmcuormininmost
paticnts, including this onc. !ioglitazonc isalso availablc lor
monothcrapy,butitssidcchccuolwcightgain,cdcma,incrcascd
pcnphcralbonchacturcratcsinwomcn,andhighcostmakcit
lcssattracnvcthanmcuormin ahrst-|incthcrapy.
O1MX
M8t0ImhSI8C0mm8hd8dSth8ht phImC00gClh8Ipy
0Im0Slpt8htSWthtyp8 db8t8Sm8tuS.
1bO
[
aQDy
IaLHaH ^, 1usC |1, aviUsOn ^1, CL a. ^CUiCa maHa_CmCHL O!
HyjCr_yCCmia iH LyjC Z UaCLCs: a COnsCHsus al_OHLm !Or LHC iHiUaUOn
aHU aUusLmCHL O! LHCrajy: a COnsCHsus sLaLCmCHL O! LHC CriCaH
iaCLCs ^ssOCiaLiOH aHU LHC urOjCaH ^ssOCiaLiOH !Or LHC 5LuOy O!
iaCLCs. iaCLCs \arC. ZVZ(1]:1V-Z. ^1: 1cV+VZ[
lIOH DSWOt.
LOUCBIODB DjOCIVO. nnngt b_trgyttmn n n
b0tmGd nltnl ulb ntn nnd rtrnndn ntuHt.
Jhcmost appropriatc trcatmcntlorthis paticntisbasal and
prcprandialinsulinadministration.Ic hasuncontrollcddia-
bctcsmcllitusduringhospitalization.Fcccnt guidclincs rcc-
ommcndattcmpht+gtoimprovcglyccmccontrolinallhos-
pitalizcdpaucnts1+0to200mg/d!.8toJJ.Jmmol/!).
Jhus,abasal-bolus insulinrcgimcnconsistingolalong-act-
inginsu|inandarapid-actinginsulinanalogucbclorcmcalsis
rccommcndcdlorthishospitalizcdpaticnt.Suchanapproach
allowsloramorccasilyutratablcrcgmcnandcanconvcnicntly
bchcld during diagnostic tcsungor proccdurcs whcnnutri-
tionalintakcisintcrruptcd.
Conunuousinsulininmsionsarcd culttoadmstcroutsidc
thcintcnsivccarcunitinmosthospitals.Jhcrclorc,initiating
oncisnotthcbcsttrcatmcntlorthspaticntandmaynotcvcn
bcncccssarytoobtaingoodglyccmiccontrol.
1 rcgimcn ol ncutral protaminc Iagcdorn ^!I) insulin
twiccdailyV likclyimprovcglyccmiccontrolbutisnotas
casilytitratablcasabasal-boluscorrcctionanddocsnotprc-
vcntpostprandialglucoscspikcs.
Slidingscalcrcgularinsulinhasbccnassociatcdwithincrcascd
hypcrglyccmic and hypoglyccmic cxcursions and has bccn
louhdtorcsultininlcnorglyccmiccontrolcomparcdwltha
4b LnCOC|lnOOQyanC Me!aOOIsm
Da8aDOH8 COiiCCIOH iC_HCH H HO8jIaZCG jaICHI8. HI
aIH_ IH8 aQQiOaCH 8 IHCiCOiC HaQjiOjiaIC.
AbS-bUuShSuhf8gm8hCUhSSlhgUlUhgClhghSuh
hdfpdClhghSuhhUgu8b8lUf8m8SSf8CUmm8hd8d
lUfhUSpl28dpl8hlSWlhuhCUhlfU8ddb8l8S.
DC_aghy
\mjCIICz CI,5mCy 1, Zsman P,CL a. anUOmzCU sIuUy OI Dasa
DOus nsun LhCIajy mLhC njaHCnL mana_CmCnL OI jaLCnLs WLh LyjC
2 UaDCLCs (J 2 LIa}. 1aDCLCs LaIC. 2;(V}:21o1-21o.
j1N1:1b1o
IOH DSWOf
bOUCBIODB DgOCIVO 0H0gr d00rlt rrlH0[0lby
0Hd m0tH0r rmm0 Blb [0H rrlH0 [b0t00gH0l0H.
amCUa jHOIOCOa_HaIOH 8 IHC HO8I ajQiOjiaIC HCXI 8ICj
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jJICHI8 WHO JiC OGHC 8HHCCHI CJH DC J88OCJICUWIH CJI-
J8liOjmCiC8HI88HCHJ8JlCIJ_OICi[jHJiHJCOO_CJHOHHI
OlOUHC DOCK8 iCCJ8C O LHyiOU HOiHOHC}. 1CCJH8C 8_H-
LnCOC|nOOQy anC Me!abO>m b3
CJHIOOHCUChCCHCyHIHC\HICObIJIC88iJrCOOHCIHCi-
Jjy HjiC_HJHI\.b. WOHCH8HOI HGCJICU.
CJ8HiCHCHIOLHCBCCLH OUOHyiOHiHC[_}C\C8HOIH8C-
HIHC C\JHJIOH OlHyjOlHyiOU8H DCCJH8C_ C\C8Lyj-
CJy iCHJH VIHH IHC iClCiCHCC iJH_C HHI IHC jOHI O
8C\CiCHyjOI|iOG8H.H8jJIlCH8HHJICiCUDyjiC_HJHCy.
LOHIHHH_IHCCHiiCHIHJHJ_CHCHI8HJjjiOjHJICDCCJH8C
HHUCiIiCJIHCHIOlHJICiHJHyjOlHyiOG8HCJHHJ\CJjOICH-
IJyHC_JI\CCHCCIOH CIJ HCHiOCO_HI\C UC\COjHCHI.

L8vUthyfUkh8f8quf8m8htSmyhCf8S8JVtU bV dufhgth8
lfSttfm8St8fUlpf8ghhCy.
VDO_aQHy
NccrmoII NJ. In Ihc clinic. !ypoIhyroidism. ^nn InIcrn Ncd.
2009;ibi):IJC. lMI: i9949i40|
lIOH 1 DSWOf
bOUCBIODB DOCIVO! 1rr0l Lr0PrJ 0tJr0Ir Btl0
0hH00 0H0 mrl0tm030r.
HC HO8I JjjiOjiJIC HCUCJ iC_HCH lOi IH8 jJICHI VIH
LiJ\C8 U8CJ8C 8 JICHOO JHU HCHHJZOC. LiJ\C8 U8CJ8C
CJH jiC8CHI WIH CIHCi 8HDCHCJ Oi O\CiI IHyiOIOXCO88.
Hy8CJ CXJHHJIOH HJyiC\CJIJCHyCJiUJ JHCC\JICU8y8-
IOCDOOUjiC88HiCVLHJWUCHCUjU8CjiC88HiCJjJjJDC
_OICiWHCH8CJ88CJy8HOOIHJIHyiOIOXC8IJiCUHCIOU
iCIiJCIOH jiOjIO88 JHU HiCqHCHIy JH HHIiJl\C UCi-
HOjJIHy. O COHIiO HCi IJCHyCJiUJ J DOCKCi 8HCH J8
JICHOO8HUCJICU.L\CHIHC CHCJJHU JDOiJIOiyHHU-
H_8lH8jJICHI8J8OHOUCiJICyHyjCiIHyiOU.OLiCJIHCi
HyjCilHyiOG8H CIHCiHCIHHJZOCOijiOjyIHOHiJCCJH
DC H8CU. CLHHJZOC WHCH _CHCiJyHJ8 lCWCi8UC CHCCI8
JHUiC8HL8HqHCKCiJCHC\CHCHIOlIHCCHIHyiOU8IJIClHJH
jiOjyHOHiJC 8 jiClCiiCU H HO8I jJICHI8. 1CCJH8C O J
jiC8HHCU HHHHOHOUHJIOiy CCCI JHIlHyiOUJ UiH_8
iC8HIHUiH_BCCiCH88OHiJIC8ODClWCCH7 JHUD7 H
jJICHI8VIH \iJ\C8 U8CJ8CWHO JiC liCJICU Oi 1 yCJi.
1ICHOO JOHC WOHU OHy JUUiC88 IHi8 jJLCHI9 JUiCHCi_C
8yHjIOH8 JHU HOI iCUHCC HCi IHyiOU HOiHOHC C\C8 JHU
HCIHHJZOCJOHCWOHUHOIHHCUJICyJUUiC88HCiIJCHy-
CJiUJ.
UOJCL\C OGiHC LHCiJjy jiCCCUCU Oi OOWCU Dy JUHHC-
U\C lHCiJjyVLH JHJHLIHyiOUJ UiH_8OCCJ8OHJy H8CU IO
IiCJILiJ\C8U8CJ8C.HCGiH_8_\CHHJHJIlCHjIIOUCCiCJ8C
lHCi8KOJliJH8CHIWOi8CHH_OlHCLHyiOIOXCO88JHCiLHy-
iOU JDJUOH. 1CCJH8C JHIIHyiOUJ UiH_8 iCHUCi LHC HyiOU
iJUOiC88IJHI IHCy HH8I DC 8IOjjCU Oi 8C\CiJ UJy8 DCOiC
JHUJHCi_VH_LHCiJUOJCU\COUHC.1IHOH_HJHOCCJ8OHJ
jJICHI DCCOHC8 CHLHyiOU JHCi iJUOJCI\C OUHC JUHH8-
IiJIOHIHCCXjCCICU OHICOHC 8HyjOIHyiOU8HWHCH L_-
CJyOCCHiVLHH2 IO HOHlH8OHCiJjyJIWHCHUHCLHy-
iOUHOiHOHCiCjJCCHCHI IHCiJjy8DC_HH.
b4 LnOOC|InOOQynO Me!bOIm

M6md206 dS 6W6I S06 66CS d0 I6SuS quCk6I dC6V6
m6 0 6 6uI00 Sd6 d 006S I00uIdC d6S
W 6II00Sm.
DlO_agHy
àkamura , `ch |, Itch I, Iukata S, Nyauch P, amada `.
cmparscn cl mcthmazc|c and prcpy|thcurac| mpatcnts vth hycr
thyrcdsm causcd Iy Lravcs' dscasc. | |n ndccrnc| NctaI.
2007;v2():21b7212. 1NIO: 173v70+
Item Answer:
Educatonal Ob]ectve: !apnarc tbc batbyrad
rtapc af partpartum tbyradtr.
JCUCsIHCXInana_CnCHIsICjsrCjCaInCasurCnCHIClIhC
IyrCO-sUnuaIH_CrnCHC [J5}aHOhCCIyrCXHC[J_}
CVCs. CsIjarIunIhyrCOIsVmCCCCursHajjrCXnaICy
Cl VCnCH H IC \HICO 5IaICs WImH a lCV nCHIs Cl
OCVCry s a VaHaHI Cl jaHCss IyrCOIs. PI jrCsCHIaICH
jaICHIs nay aVC IraHsCHI IyrCICXCCss aCHC IraHsCHI
yjCIyrCOsn aCHC Cr IyrCICXCCss IhaI s lCCVCO Uy
yjCIyCOsnaHOIhCHUyrCCCVCrJsjaUCHInCsIkCy
as jCsIjarIun IyrCOIs IaI s HCV H IC yjCIyrCO
jasCahCrajCHCOCl IraHsCHIIyrCICXlCCss. JCyjCIy-
rCOsn CaH UC CCHBrnCO Uy rCnCasuHH_ Cr J5 anOhCC
J_CVCs.
H ImsjaIlCHIIC aUsCHCC Cl a _CICraHOCyC OsCasC jCHIs
aVayhCn LraVCsOlsCasC asOCCsICrCCCHIOCVCCjnCHICl
synjICnsassCCaICOVlIhyjCIyrCOsn.
NCImaZCCICrajysHajjrCjraIClCrIsjaICHIUCCausC
sC nCsI kCy as yjCIhyrCOsn HCI yjCrIhyrCOsn. l
IransCHI yjCIhyrCOsn sCCHhrnCO Uy a _ J5 CVC
aHO CV lrCC J_CVC IyrCO CrnCHC rCjaCCnCHI HCI
nCImaZCCCaHUCCCHsOCrCOlCrUCICrsCnCsynjICns.
YI jCsIjarIun IyrCOIs rCsuIs Cl IyrCO sCaHs aHO
raOCaCIVC COlnC ujIakC ICsIs V UC CV Ourln_ IhC IhyC-
ICXC jasC aHO ICH UCCCnC CCVaICO OurH_ IhC _CIhy-
rCO jasC as IC IyrCO _aHO rCCCVCrs aHO UCCCnCs VCry
aVOlCr COHC as sICrCs atCrCjCICO. ClCrCsuCICsIH_CaH
UC aOVsCO CVCVCr IC rCsuIs Cl CurrCHI IyrCO HCICH
ICsIsarCrCQulrCOIC assCssIhCjaICHIsIhyrCOCrnCHCsIa-
Ius aHO OCICrmHC l sCaH rCsuIs su__CsI LraVCs OsCasC Cr
VaIsnCrC Cy rCCCVCry IyrCOIs.
\IrasCuHO Cl IC IyrCO _aHO CaH UC usCO IC OsUH_us
IhC_hVasCuarBCVClLraVCsOsCasChCnIhCCV-BCVjaI-
ICrH Cl auICnnuHC IyrCOIs. P nCrC OrCCI ICsI Cl Is
jaICHIs IyrCO HCIlCH CVCVCr s nCasurCnCHI Cl IC
J5 aHO hCC J_CVCs VC CaH QuaHI|IyrCOHCICH
anO jrCvOCa UasCHCVIVCICCCnjarCIurCIyrCO
HCICHICsIrCsuIs.
0SdIum I00S Cd CduS6 0SdIum I00XC0SS,

0I00Sm, 0I d 6I00 0 00.
DlO_agHy
NcOcrmctt N1. In thc c|nc. Iypcthyrcdsm. Pnn Intcrn Ncd.
200v;1b1(11):I11. 1NIO: 1vv+v1+0[
Item Answer: L
Educatonal Objectve: !apnarc cutbyrad rrk ryn-
dramc.
JsjaICHIsCuOaVCrCjCaIIyrCOHCIlCHICsIsH O IC
o VCCks. YIs sICry ClarCCCHIsCVCrC lHCss IhC rCsuIs
ClsIhytCOmHCUCHICsIs[CVIhyrCOsUnuaUH_CrnCHC
J5[aHOhCCIm COCIyrCHHCJ_jCVCsaHOaCV-HCrna
hCC IhyrCXHC J_ CVC} arC nCsI CCHssICHI VI CaH_Cs
hCn a HCHIyrCOa HCss [CCCCIVCy kHCVn as CuIhyrCO
sCk syHOrCnC}. JC CassC jaIICrH CCHssIsCl CV J5aHO
hCCJ_CVCsVIhahCCJ_CVCHICHCrnaICCV-HCrna
ran_C [CrCVCHhaHkyCVVIhajrCCH_COlnCss}. CVCrsC
J_CVCsarCCCVaICOn nCasurCO}UuIUCCausCrCsuIsClIhs
nCasurCnCHIIyjCayIakCsCVCraVCCksICCUIaHrCVCrsCJ_
CVCrCsuIsarCsCOCnusCOCHCay. JCUCsIHCXIsICjsIC
aCVICjaICHIIC rCCCVCr lCr IC o VCCksaHOICH rCjCaI
IC IyrCO CICHICsIs. lrCsuIsClIhCsCICsIsarCHCIHCr-
na ahCrrCCCVCry rICr VCrkujCaH CCnnCHCC.
ralH sHCIajjrCjHaIClCrIhsjaICHIUCCausC HCCln-
Ca hHOH_ su__CsIs jIuIary OysHCIlCH. urICrnCrC l
CVauaUCH Cl IhC jIuIary _anO VCrC rCQulrCO NV Cl IhC
sCaIurCCaVCuOUCnCsIajjrCjHaIC.
JCrCarCHCOaIasCVH_IhaIJ _ rCjaCCnCHIIhCrajysUCH-
ChCalCrHCHIyCOanCss. JCrClCrC HUaUCHCl CVCIy-
rCXHC sHCIajjrCjHaIC.
JyrCOuIrasCHC_rajyOCCsHCICjOCICrnHCCaH_CsH
IhyrCOHCICH aHOIhussHCIusClCrIms jaICHI.

b6V6I6 6SS Cd CduS6 6uI00 SCk S0I0m6, WC S dSS0C
d60 W d00Imd I6SuS 0 I00 uC0 6SS d 06
0Imd26 d6I I6C0V6I.
DlO_agHy
Pd|cr SN, Wartctky !. 1hc ncn thyrcda ||ncss syndrcmc. ndccrnc|
NctaI |n `crth A. 2007;3(3):b772, v. 1NIO: 1773123
Item Answer: L
Educatonal Ob]ectve: tvaluan an nrdntally dr-
ravcrcd adrcnal adnama.
asna-hCC nCIaHCjrlHC CVCs aHO CVCrH_I OCXanCIha-
sCHCsujjrCssCHICsIsCuOUCOCHCHCXI.JCHCrCasH_usC
Clma_H_sIuOCsasrCVCaCOnaHyjrCvCusyunrCCC_n7CO
ChCHasynjICnaICaOrCHanassCs[aOrCHaHCOCHIaCnas }.
HIa assCssnCHI sCuO HCuOC a CarC sICryaHO jys-
CaCXaaICHICBHOaHysu__CsIlCHClna_HaHIOsCasCCr
CHCa CVOCHCC Cl CrnCHC yjCrsCCrCICH. NCsI jaICHIs
VIhnCIasIaICCaHCCrCl IhCaOrCHa_aHOsaVC CmCa CV-
OCHCCClOsCasCCsCVCrC. na_H_CaraCICrsUCsClIhCnass
[sZC !J aIICLuauOL \asCum[) CaL rO\OC mOrIaHI CuCs.
JC rs OI rmmy Or mCIasIaUC CaLCCr s HCary 2" IOr IumOrs
Css IaL 4 Cm L OamCICr UuI HCrCasCs IO 25" IOr IumOrs
Cm Or arCr. NCLasIaIC CsOHs IO IC aOrCHa aLUs ICHO IO
a\C a !J aIICLuaIOL >20 1Ou1shCO u1LIs) aLO arC
OCL UaICra. rmary aUrCLOCOrICa CarCLOma ICHOs IO UC
arC VI rrCuar UOrOCrs aHO may HCuOC arCas OI LCCrO-
ss. COCrOmOIOma aUrCLa CarCLOma aLO mCIasIaIC
UsCasC IO LC aOrCHa aLOs arC OCH \asCuar VCrCas UCHH
aOrCLa aOCLOmas arC HOI y \asCuar.
CCausC O\CrI CLCa maHuCsIaUOHs arC I_Cay sCaHI sCrCCH-
L ICsIs arC OCH HCCCssary IO OCHH OICHIay HCIOH-
H aOrCHa HCUCHIaOmas sCCrCIH COrIsO aOOsICrOHC Or
CaICCOamHCs. 5uUCHCa !usH syHUrOmC s IC mOsI
COmmOH aULOrmaLy assOCaICO VI aOrCLa HCOCHIaOmas.
CCausC ICsC aLCHIs a\C HO symIOms Or ysCa hHOHs
OI !usmH syLOrOmC IC OssUIy OI auIOHOmOus yCr-
sCCrCIOH OI uCOCOrICOOs sOuO UC C\auaICO WI aL
O\CrHI OCXamCIasOHC surCssOL ICsI. PUOUOHay mCa-
surCmCLIs OI asma CaICCOamHCs arC rCasOHaUC sCrCCLH
ICsIs IO ruC OuI COCrOmOOma WC CaH UC asymIO-
maIC Or assOCaICO WI HICrmIICHI symIOms.
PUrCLa HCOCHIaOmas arC uCy IO sCCrCIC aUOsICrOLC
UuI aICHIs sOuO UC sCrCCLCU IOr IaI OssULy I ICy a\C
yCrICHsOH Or yOaCma UOL OI VC arC aUsCLI H Is
aICHI. 5nIary CXCCss aOrCLa aHOrOCH rOOuCIOH s rarC
CXCCI VCL IC mass rCrCsCLIs aOrCLa CaHCCr aHO sCrCCH-
H s HOI rOuUHCy CrIOrmCO L IC aUsCHCC OI CmCa sHs
Or symIOms OI ICmHZaIOH H mCH Or yCraLOrOCHsm H
VOmCH VC s asO aUsCLI H Is aLCHI.
l _ ______
Hypersecret|oo of g|ucocort|co|ds aod catecho|am|oes shou|d be
eva|uated |o a|| pat|eots, |oc|ud|og asymptomat|c pat|eots, w|th
|oc|deota||y d|scovered adreoa| adeooma.
bO_aQDy
CH8H L /jjiO8CH !O !HC j8!CH! W!H 8H 8GiCH8 HCGCH!8OH8. |
\HH HGOCiUO C!8D. Z1,Vb[V).+11. 1. ZoZ+_
Item Zd Answer:
Educatonal Objectve: !oqnosc hqcroldosnronsm
wrh mcosurcmcnr of rhc scrum oldsnronc hplosmo
rcnn orrvp roro.
JC mOsI arOHaIC HCXI OaLOsIC ICsI s OCICrmLaIOH OI
IC sCrum aOOsICrOLC IO asma rCHH aCI\Iy raIO. Js
aICLI as Oru-rCssIaLI yCrICLsOL [uHCOLIrOCU _Cr-
ICHsOH OL IrCC Orus HCuOH a OurCIC) uLrO\OCO
yOaCma aLO rOUaUC mCIaUOC aaOss; C asO as aH
LarOHaICy urHC OIassuDC\C. L Is sCIIH_ r-
mary _CraOOsICrOLsm s a \Cry Cy CausC OI s yCr-
ICHsOL aLO yOaCma CsCCay \CH ms aC. C UCsI
sCrCCLH ICsI IOr rmary _CraOOsICrOLsm s a OCICrmHa-
UOH OI IC raLO OI sCruD aOOsICrOHC [H H/ O) IO asma
LnCOC|InOOQynC Ne!OOI>m 55
rCLH aCIVIy [H H/m/mH). P raIO rCaICr IhaL 20, ar-
UCuary VCH LC sCruD aOOsICrOLC C\C s rCaICr LaL 15
L/ O 414 mO/ ), s COHssICHI WL IC OaLOss OI r-
mary yCraOOsICrOLsm.
1Cr UOCCmCa COHHrmaIOH OI yCraOOsICrOLsm OCa-
ZaUOH rOCCOurCs arC arOHaIC IO UHCrCHUaIC aOOsICrOHC-
rOOuCL aOCLOmas VC arC amCLaUC IO sur_Ca rCsCC-
IOL BOm UaICra yCQasa VC s mCUCay IrCaICU.
L\CL IhC HCOCHCC OI HCOCLIa aOrCHa CsOHs OV-
C\Cr ma_H sUOCs suC as !J OI IC aOrCHa aLUs sOuU
HOI UC CrIOrmCO UCIOrC UOCCmCa ICsIH IaI COHhrms
IC rCsCLCC OI yCraOOsICrOmsm.
Js aICLI OOCs LOI hI IC OCmOraC Or CmCa rOhC OI
a aICHI VI rCLO\asCuar _CrICHsOH aHO Ius C\auaUH
IC rCHa arICrCs VI OIa suUIraCIOH rCHa aH_Oray s
HOI HOCaICO. CHO\asCuar yCrICHsOH OuC IO hUrOmus-
Cuar OsCasC OI IC rCLa arICrCs usuauy rCsCHIs L aUCLIs
yOuHCr IaH 35 yCars aHU aZOICma s rarCy rCsCLI. PICr-
OsCCrOIC rCHO\asCuar yCrICHsOL s mOrC COmmOH L
aICLIs OOCr IaH 55 yCars aHO s BCquCHIy assOCaICO WI
\asCuar OsCasC L OICr \CssCs; aZOICma s OCH rCsCHI.
|ICr IaL susIaLCO yCrICHsOH Is aICHI OO LOI a\C
aHy OI OICr symIOms Or sHs suCsI\C OI a COCrOmO-
CyIOma aIaIOHs CaOaCC IrCmOr UaOrCss). JCrC-
IOrC sCrCCmH IOr a COCrOmOCyIOma VI mCasurCmCHI
OI IC asma mCIaHChmC aHO HOrmCIaLCrLC C\Cs s Css
BCy IO UC C IaL s sCrCCLH IOr yjCraUOsICrOLsm.
Jhe best screeo|og test for pr|mary hypera|dosteroo|sm |s a deter-
m|oat|oo of the rat|o of serum a|dosterooe to p|asma reo|o act|v|ty.
bO_aQDy
uHGCi |,\8iCy 1 8iGC8 \ C! 8, HGOCiHC bOCC!y. \88C GC!CC-
!OH G8_HO88 8HG !iC8!HCH! Ol j8HCH!8 W!H jiU8iy 8GO8!CiOH8H. 8H
HGOCiHC bOCC!y CHC8 ji8C!CC _uGCHC. | \H HGOCiHO C!8D.
Zo,V[V).ZZo1. 1. 1obbZZoo[
Item Z Answer:
Educatonal Objectve: tvoluon o porcnr wrh sus-
pcrnd Cnhnq dscosc wrh prumry .
JC mOsI arOraIC HCXI OaLOsUC ICsI IOr Ls aICHI s
IuIary . 5C as UOCCmCa ICaIurCs OI aUrCHOCOrU-
COIrOC OrmOLC [P!J1)UCCLOCHI !usH syLOrOmC
[yCrCOrIsOsm aLO CC\aICO P!J1). JC CausC OI IC
P!J1 yCrsCCrCIOH s CICr a IuIary aOCLOma Or aL
CCIOC sOurCC suC as a CarCHOO IumOr. H Is aICHI ar-
Ia surCssOH Vas aCC\CO WI -OOsC OCXamCIasOHC
VC suCsIs aH P!J1 -sCCrCIH IuIary mCrOaOCHOma.
1-OOsC OCXamCIasOHC s usuay HOI suCCCss H su-
rCssH P!J1 rOUuCIOL BOm aL CCIOC sOurCC. 1OW-
C\Cr ICrC arC CXCCLOHs sO CauIOH musI UC CXCrCsCO H
HICrrCIaLOH. H suC HsIaHCCs CXCrI COHsuIaUOH s my
rCCOmmCLUCO.
S6 LnOOCrInOOQy anO MetabOIsm
/UiCHaiHa_iH_i8iHUiCaICUiIHCHyjCiCOiIi8Oi8Hi8/L
iHUCjCHUCHI [HyjCiCOiIi8Oi8H aHU HOiHa Oi OW /L
C\C}. 1HjaIiCHI8WiU1 HyCiCOiIi8Oi8Ha88OCiaICUWiIH 8Uj
jiC88CU/L8CCiCHOH,a L8CaHOIHCaUiCHa_aHU8OhCH
8HOW8 a IUHOi [aUCHOHa Oi CaiCiHOHa}. OWC\Ci, IHi8
jaIiCHI8/LC\CWa8CC\aICUaHUaUiCHaiHa_iH_i8HOI
iHUiCaICUVIHCiIHCi a LOi118CaH.
HC CO8yHIiOjiH 8IiHUaIiOH IC8I i8 U8CU IO UCICiHiHC IHC
aUiCHa iC8Ci\C DyHCa8UUH_IHCiC8jOH8CIOa8IaHUaiU UO8C
O8yHIHCHCaUiCHOCOiIiCOIiOjiCHOiHOHC. HCIC8IUOC8HOI
UCICCI LU8HiH_ 8yHUiOHC DHI, iaIHCi, aUiCHa iH8UHCiCHCy
aHU i8IHCiCOiCHOIiHUCaICUOiIHi8 jaIiCHI.
KTN FO1NT
0I6B0C0IC0I0C 0Im0B6 [L1H)066B06B 6IC0IS0lSm
S m0S C0mm0Bl CduS60 0 d udI um0I 0I dB 6C0C L1H
S0uIC6, SuC dS d CdICB00 um0I.
DC_aQHy
iHGiH_ |\ aHi. \HSHiH_`S SyHGiOHC. iHOi!aH! iSSHCS iH Gia_HOSiS
aHG HaHa_CHCH!. | \iH HGOCiiHO C!aD. ZV1(1}.+b.
_11. 1b_
lI0H Zb P5W0t. P
bUULBIOB1 ODj0LIV0. Jdgn0rt bt0rbr0m0rymd
Ib dud0mnd L1 rrdn.
JHC HO8I ajjiOjiiaIC HCXI HaHa_CHCHI 8ICj Oi IHi8jaIiCHI
i8 aH aDUOHiHa L 8CaH. bHC Ha8 IHC Ca88iC 8yHjIOH8 O
jHCOCHiOHOCyIOHajajiIaIiOH8,8WCaIiH_,HCaUaCHC8,aHU
HyjCiICH8iOH. 1UUiIiOHay, DiOCHCHiCa IC8IiH_ iC\CaCU
iHCiCa8CU ja8Ha C\C8 O CaICCHOaHiHC8. O8I jHCOCHiO
HOIOHa8aiCOCaICUiHIHCaUiCHaHCUUa,aIHOU_H8OHC
aiCCXIia-aUiCHaiHOii_. LJHa88CH8iIniIiC8O Vo7IO i7
iH UCICCIiH_ aUiCHa jHCOCHiOHOCyIOHa aHU ajjiOXiHaICy
V7iHUCICCIiH_CXIia-aUiCHaCaICCHOaHiHC-8CCiCIiH_jaia
_aH_iOHa8. 11 i8 a8 8CH8iIi\C a8 L iH UCICCIiH_ aUiCHa
jHCOCHiOHOCyIOHa8 aHU 8UjCiiOi IO LiH UCICCIiH_ CXIia
aUiCHaCaICCHOaHiHC-8CCiCIiH_jaia_aH_iOHa8.
1 aUiCHaCCIOHy i8 ajjiOjiiaIC OHy WHCH a IUHOi i8 COH
BiHCU.1 aUiCHaCCIOHyWOUUHOIDCiHUiCaICUiIHC8OUiCC
OIHCCaICCHOaH1iHC8 WCiC COHHiHCU IO DCCXIia-aUiCHa.
1aHaDUOHinaLJ8HOW8HOHa88C8,IHCHCXIDC8IOCaiZiH_
8IUUy WOUU DC a HCIaiOUODCHZy_HaHiUiHC [1L} 8CaH.
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Item3 Answer:
Educational Objective: !auarcruprurcda0dam-
ualaarrraucuryrm.
HC jaICHIS CimCa jiCSCHIaIiOHSC\CiC aDUOHiHa Oi DaCK
ja!H WiIH SyHCOjC OhOWCU Dy aDUOHHa UiSCOHOiIiS Iyj
iCa Oi a iHjIHiCU aDUOH!Ha aOiIiC aHCHiySH ^ )IHaI HaS
DCCH OCay COHIJiHCU jiC\CHIiH_ HS iHHCGiaIC UCaIH. HC
SCHHHC C\CHI O SC\CiC SHUUCH aDUOH!Ha aHU DaCK jaiH aSSO-
CiaICU WiIH OSS O COHSCiOHSHCSS HaiKS IHC OCCHiiCHCC O iHj
IHiC. CHKOCyIOSiS aHU aHCHia aiC COHHOH. / \ SCaH
SHOHU DC jCiOiHCU Oi Uia_HOSiS aHU IHC JHCHiySH SHOHU
DC iCjaiiCU CHCi_CHIly.
\OHIaHCU iHjIHiC O ^ WHCH HiSUia_HOSCU iS HOSI OHCH
HiSIaKCH Oi iCHa COC aCHIC HyOCaiUia iHaiCIiOH Oi Ui\Ci-
IiCHiIiS. CHa COiC Hay jiOUHCC SC\CiC jaiH iH IHC OWCi
DaCK Hm Oi _iOiH. _iCay IHC jaiH WaXCS aHU WaHCS. iI
iS HHiKCy IHaI iCHa COC WOHU jiCSCHI WiIH SyHCOjC aHU IHC
HOiHa HiiHaySiS aSO HaKCS IHiS Uia_HOSiS HHKCy.
/CHIC HyOCaiUa iHaiCIiOH CaH DC aSSOCiaICU VIH SyHCOjC
aHU IHC CCCIiOCaiUiO_iaH iS HOI aWayS Uia_HOSIiC jaiIiCH
aiy i IHCiC aiC hHUiH_S SHCH aS CH \CHIiiCHai HyjCiUOjHy
WHiCH Hay ODSCHiC SHDIC aDHOiHaiIiCS. OWC\Ci IHC jiCS-
CHCC O aDUOHHa aHU OWCi DaCK jaH iaIHCi IHaH CHCSI jaiH
HaKCS IHiS Uia_HOSiS CSS iKCy.
i\CiIiCHiIiS WOHU jiCSCHI VIH C\Ci aHU CiaHjy aDUOHi-
Ha jaiH HOSI COHHOHy iH IHC CH OWCi qHaUiaHI aHU OHCH
aSSOCiaICU WiIH a CHaH_C iH DOWC HaDiIS. CHKOCyIOSiS Hay
DC jiCSCHI. yHCOjC aSSOCiaICU WiIH IHC OHSCI O jaiH WOHU
DC a \Ciy HHHSHa jiCSCHIaIiOH Oi IHiS CHIiIy.
NT
000m , 0Ck , 0 SC0 0 I0 000m
0IC uISm IuuI.
bC_aQhy
CUCiC 11. H lHC CiHiC. 1DUOHiHJ! JOiliC JHCHiySH. PHlCiH CU.
ZVJO(V}:IO-J-JO QHiZ IOJ. j11. JV+J+oO_
ItemA Answer:
Educational Objective: !auarcaudncarraurrpa-
nau-prcdamuaurrrra0lc0aclryudramc.
HC HOSI ajjiOjiiaIC HCXI SICj iH IHC HaHa_CHCHI O IHiS
jaIiCHI iS iCaSSHiaHCC aHU jOyCIHyCHC _yCO. HiS jaIiCHI
HaS iiiiIaDC DOWC SyHUiOHC. 1a yOHH_ WOHaH SHC BIS IHC
UCHO_iajHiC jiOhC aHU SHC HCCIS IHC OHC iii CiiICiia
WiIH aDUOHiHa jaiH iCHC\CU Dy UCCCaIiOH aHU a CHaH_C iH
DOWC HaDiIS. HC HOSI iCCCHI Uia_HOSIiC CiiICDa iCqHiiC IHC
jiCSCHCC O aI CaSI IWO O IHiCC SyHjIOHS OCCHiiiH_ Oi
HOHIHS [HOI HCCCSSaiiy COHSCCHIi\C} UHiiH_ a 17-HOHIH
jCiiOU. +HCSC SyHjIOHS iHCHUC jaiH iCiC\CU WiIH UCCCa
IiOH OHSCI aSSOCiaICU WiIH CHaH_C iH SIOO CqHCHCy Oi OHSCI
aSSOCiaICU VIH CHaH_C iH IHC COHSiSICHCy O IHC SIOO. iH CiH-
iCa jiaCICC IHCSC CiiICDa Ha\C a jOSiI\C jiCUiCI\C \aHC O
V7. iHjOiIaHIly SHC HaS HO JaiH iHUiCaIOiS iHCHUiH_ OUCi
a_C HaC SCX HOCIHiHa aWaKCH!H_ iCCIa DCCUiH_ WCi_HI
OSS Oi aHiy HSIOiy O COOH CaHCCi. iH IHC aDSCHCC O aaiH
SyHjIOHS aUUiIiOHa ICSIS Ha\C a Uia_HOSIiC yiCU O 77 Oi
CSS. HiIHCiHOiC aDOiaIOiy SIHUiCS iHUiCaIC HO aHCHia Oi
IHyiOiU UChCiCHCy. iiiiIaDC DOWC SyHUiOHC iS a CimCa Uia_-
HOSiS aHU IHCiC aiC HO aDOiaIOiy iaUiO_iajHiC Oi CHUOSCOjiC
hHUiH_S IHaI aiU !H Ua_HOSiS. /UUHOHa C\alHaHOH iS HOI OHy
HHHCCCSSaiy aHU CXjCHSi\C DHI aSO jOICHIiay HaiH CSjC-
Ciay WHCH iH\aSi\C jiOCCUHiCS aiC OiUCiCU. HC jaIiCHI
SHOHU DC iCaSSHiCU IHaI aIHOH_H IHiS jiODCH iS aHOyiH_
JHU iHCOH\CHCHI iI iS HOI iCIHiCaICHiH_. 1CCaHSC hDCi SHj-
jCHCHIaIiOH HaS HOI DCCH HCj a HOHaDSOiDCU OSHOIiC
aXaI\C SHCH aS jOyCIHyCHC _yCO WiKCy jiO\iUC HCi Si_
HCaHI iCC
HCiC iS HO HUiCaIOH Oi IHC jaIiCHI IO HHUCi_O a \ SCaH
Oi COOHOSCOjy. \ia COHIiaCCjIi\CS aiC HOI I_iCay aSSOCi
a ICU WiIH IHC SyHUiOHC aHU SHC DC_aH IaKH_ IHC HCUiCaIiOH
aHCi IHC OHSCI O HCi SyHjIOHS.

|II0 00W S0I0m S CC 0g0SS C 0 m0
C00 W S m h0m |ll CII 0 00 00
V Im 0C0IS.
bC_aQhy
YiSOH |1. H lHC CiHiC. iiilJDC DOWC SyHUiOHC. P HlCiH CU.
ZJ+(J}.I-J-IJ. j11. JVO+_
Item5 Answer: L
Educational Objective: !auarcrrhcmrralrr.
+HiS jaIiCHI iKCy HaS iSCHCHiC COHHS IHC HOSI CqHCHI OiH
O iSCHCHa O IHC _aSIiOiHICSIiHa IiaCI. HiS IyjC O iSCHCHia
HSHay aHCCIS IHC CUCiy WiIH aIHCiOSCCiOIiC UiSCaSC aHU iH
HOSI CaSCS iS IiaHSiCHI aHU iCSO\CS WiIH COHSCi\aIi\C HaH
a_CHCHI. aICHIS WiIH aCHIC COOHiC iSCHCHa HSHay jiCSCHI
WiIH iajiU OHSCI O aDUOHiHa jaiH aHU ICHUCiHCSS O\Ci IHC
aCCICU DOWC. CCIa DCCUiH_ Oi DOOUy UiaiiHCa HSHay
UC\COjS WiIHiH 7+ HOHiS O IHC OHSCI O aDUOHiHa jaiH. +HC
IyjiCa hHUiH_ OH \ SCaH iS IHCKCHiH_ O IHC DOWC Wa !H
a SC_HCHIa jaIICiH WHCH iS HOI SjCCiBC Oi iSCHCHia aHU CaH
DC SCCH iH iHCCIOHS COiIS aHU \iOHH USCaSC. HC hHUiH_ O
jaICHy SC_HCHIa HCCiaIiOHS OH COOHOSCOjy H a jaHCHI WiIH
a COHjaIiDC HiSIOiy CSIaDiSHCS IHC Ua_HOSiS. \OOHiC SIiiC
IHiCS aiC a iaiC COHjHCaIiOH.
HC jaIiCHIS aCHIC OHSCI O SyHjIOHS VIH DOOUy UiaiiHCa
iS HOI COHSiSICHI WiIH \iOHH UiSCaSC. aHCHIS WiIH \iOHH US-
CaSC COHHOHy jiCSCHI WiIH a CHiOHiC HiSIOiy O aDUOHHJ
jaiH UiaiiHCa aHU WCi_HI OSS. CjIC HCCi USCaSC COHU jiC-
SCHI WiIH Dii_HI iCU iCCIa DCCUiH_ DHI OHy iH IHC SCIIH_ O
a ai_C aHU iajiU DCCU aHU COHU HOI CXjaiH IHC hHUH_S OH
IHC \ SCaH. iiDIaDC DOWC SyHUiOHC iS a Uia_HOSiS O CXCH-
SiOH aHU UOCS HOI jiCSCHI WiIH iCCIa DCCUiH_ aHU IHC CHaH_CS
HOICU OH IHC \ SCaH.
PO1T
|SCmC C0S ISS m0S C0mm0 0I S W
I0SCI0C VSCuI 0SS W CIm 000m 0
0000 S00, m0S CSS S Sm0.
bC_aQhy
biCCHJiJSiHHJiJH |. 1iJ_HOSiS JHU HJHJ_CHCHl O iSCHCHiC COiliS. IHii
LJSliOCHlCiO Cj. ZO(O}.+ZJ+Z. j11. JJZ+Z_
lIBD< HSWBf. L
bOUCBIOHB DgBCIVB. JP0u0 dPtrltul: Hlb
L1:t0n.
HC HO8I ajjiOjiiaIC HCXI 8ICj H IC C\auaUOH O HjaUCHI
i8 a COHIia8I-CLHaHCCU \ 8CaH O IHC aDUOHCH aHU jC\i8.
H8 jaIiCHI`8 CH OWCi quaUiaHI jaiH C\Ci aHU CC\aICU
CuKOCyC COuHI aiC Ca88iC 8yHjIOH8 aHU 8i_H8 O Ui\CiIiC-
uhIi8. HC HO8I 8CH8iIi\C iHa_H_ HOUaiIy IO COHHiH IHi8
Uia_HO8i8 a8 WC a8 C\auaIC Oi aHy COHjCaIiOH8 8uCH a8 jCi-
OiaIiOH aD8CC88 OD8IiuCIiOH aHU H8Iua 8 a COHIia8I-
CHHaHCCU \ 8CaH O IHC aDUOHCH aHU jC\i8. 1 HuHDCi O
jiO8jCCI\C iH\C8Ii_aIiOH8 Ha\C iCjOiICU a 8CH8iIi\iIy O V7
IO Vb7 aHU 8jCCBCiIy O b7 IO 17 Oi \ 8CaH iH aCuIC
U\CiICuIi8. HC jiC8CHCC O 8C\CiC Ui8Ca8C OuHU OH \ 8CaH
Wa8 jiO_HO8IiCaHy \Ciy u8C Dy aCCuiaICy jiCUiCIiL_ aiuiC
O HCUiCa IiCaIHCHI aHU ii8K O 8CCOHUaiy COHjCaIiOH8.
\OOHO8COjy i8 _CHCiay a\OiUCU UuiiH_ aH Cji8OUC O aCuIC
UI\CiIiCuIi8 Oi COHCCiH O iHCiCa8CU ii8K O jCiOiaIiOH WiI
aii iH8uHaIiOH iIHCiHOiC COOHO8COjy WOuU Hi88 IHC
CXIiauHiHa COHjCaUOH8 8uCH a8 aD8CC88 OiHaUOH. 1 8Ha-
DOWC 8CiC8 C\auaIC8 IHC 8Ha HIC8IiHC WHCH i8 HOI aHCCICU
BUi\CiIiCuIi8. COiC IC a\aHaDiiIy O \ 8CamiH_ DaiiuH
CHCHa Wa8 u8CU IO Uia_HO8C Ui\CiIiCuIi8 DuI KC
COOHO8COjy jiC8CHI8 a ii8K Oi jCiOiaIiOH aHU i8 HOI 8CH8i-
Ii\C IO IHC jiC8CHCC O CXIiauHiHa COHjiCaIOH8.
O11
1h DS mdgBg m00dl 0 C0BIm SUSC0 0VICUlS dB0
VdlUd 0I XIdUmBdl C0mlCd0BS S d C0BIdSBhdBC0 L1
SCdB.
DO_aQHy
bHC!H P iOH_O WOCH 1. 1VCI!CHaI U8Ca8C aHU UVCI!CHD8.
^} La8!IOCH!CIO. Z,1[}.1OOJOO. i11. 1+V+V
lIBD HSWBf.
bOUCBIOHB DgBCIVB. 10gn0:t tbr0nt ]0ntrt0l
l: t0nrmtd 0y ]0ntrt0lt t0tt0l0n.
HC Uia_HO8i8 O CHiOHiC jaHCiCaIiIi8 8HOuU DC 8IiOH_y COH-
8UCiCU iH IHC ajjiOjiiaIC CiHiCa 8CIIiH_ 8uCH a8 a jaIiCHI
WiI a Hi8IOiy O aCOHOi8H WHO jiC8CHI8 WiIH CHiOHiC ujjCi
aDUOHiHa jaiH iaUiaIiH_ IO IHC DaCK UiaDCIC8 aHU 8ICaIOi
iHCa. buCH jaICHI8 Hay HOI HCCU aUUiIiOHa IC8IiH_. OW-
C\Ci HO8I jaICHI8 Ha\C OHy HOH8jCCiBC aDUOHiHa jaiH aHU
CC\aICU jaHCiCaIiC CHZyHC C\C8 aHU iCquiiC Uia_HO8IiC iaU-
O_iajHiC iHa_iH_ 8IuUiC8. HC jiC8CHCC O jaHCiCaIiC CaCiH-
CaIiOH8 OH jaiH i18 Oi \ 8CaH COHBiH8 IC Uia_HO8i8. aiH
!H8 O IHC aDUOHCH Wi 8HOW jaHCiCaIiC CaCiHCaIiOH8 iH
8OHC jaIiCHI8 a8 iI UiU iH Ii8 jaIiCHI. O8I jaUCHI8 HOWC\Ci
iCquiiC aDUOHiHa \ 8CaH8 IO UCICCI IC CaCiBCaIiOH8 aHU
IO CXCuUC OIHCi Cau8C8 O jaH.
1CuIC CHOaH_iI8 i8 a88OCiaICU WiIH Diiaiy OD8IiuCIiOH aHU i8
CHaiaCICiZCU Dy IHC IiiaU O jaiH C\Ci aHU auHUCC WHiCH
aiC aD8CHI B IH8 jaIiCHI. Diiaiy OD8IiuCUOH iH\O\C8 IC
jaHCiCaIC UuCI a8 WC jaHCiC?IiC CHZyHC8 Hay DC CC\aICU.
1CuIC CHOaH_iIi8 i8 HOI COHjaIiDC WIH aH iHC88 a8IiH_ J
yCai.
i\CiUCHiU8 i8 aLOICi aCuIC iHC88 CHaiaCICHZCU Dy CH OWCi
quaUiaHI jaH C\Ci aHU OCaZCU aDUOHiHa ICHUCHC88. Ci
Gas!rCen!erCICQyanC Hepa!CICQy 75
IHCi aCHIC CHOaH_iIi8 HOi Ui\CiICuiI8 8 a88OCiaICU WIH jaH-
CiCaIiC CaCiBCaIOH8. 1CuIC Ui\CiIiCuiI8 i8 HOI a88OCaICU WIH
jaHCiCaIiC CHZyHC CC\aIiOH8.
aiH a88OCiaICU WiI jCjIiC uCCi Ui8Ca8C i8 KCy IO DC Cji_a8-
IiiC i8 H8uay UC8CiiDCU a8 DuiHiH_ Oi _HaWH_ aHU ICHU8 IO
OCCui UHiiH_ a8IH_ Oi aI Hi_HI. I i8 HOI a88OCiaICU WIH CC
\aICU jaHCiCaIC CHZyHC C\C8 Oi jaHCiCaIiC CaCiBCaIiOH8.
KEX PO1MT
1h 0dgB0SS 0 ChI0BC pdBCIdS Sh0Ul0 D SI0Bgl C0BS0
I0 B dBS Wh d hS0I 0 dlC0h0lSm ISBBg Wh
ChI0BC UI dD00mBdl dB |d0dBg 0 h DdCk, 0dDS,
Sd0IIhd, dB0 dBCIdC CdlCCd0BS 0B dD00mBd Id0
0gIdhS.
DO_aQHy
\OHWC 1i Bai. \HIOHC QaHCICaD!8. \HII \QH La8!IOCH!CIO.
Z,Z+[O}.O-OV. i11. 1V1ZZ+VV
lIBH% HSWBf.
bOUCBIOHB DgBCIVB. 10gn0:t btm0ylt urtmt
:yndr0mt.
HC HO8I ajjiOjiiaIC HCXI HaHa_CHCHI 8ICj i8 a jCHjHCia
DOOU 8HCai. Hi8 jaIiCHI iKCy Ha8 HCHOyIiC uiCHiC 8yH-
UiOHC [ib} WHiCH i8 CHaiaCICiiZCU Dy IHiOHDOCyIOjCHa
aHU IHiOHDOIiC HiCiOaH_iOjaIHy. HiOHDOIiC HiCiOaH
_iOjaIHy i8 a CiHiCa 8yHUiOHC IaI aHCCI8 HuIjC Oi_aH 8y8-
ICH8 DuI i8 aWay8 CHaiaCICiiZCU Dy IHiOHDOCyIOjCHia aHU
HiCiOaH_iOjaIHiC HCHOyIiC aHCHia [8CH8IOCyIC8 OH IHC
jCiijHCia DOOU 8HCai CC\aICU iCIiCuOCyIC COuHI aLU CC-
\aICU aCIaIC UCHyUiO_CHa8C C\C}. HiOHDOIiC HiCiOaH-
_OjaIHy Hay HaHiC8I a8 IHiOHDOIC IHiOHDOCyIOjCHiC jui-
juia Oi ib. ib i8 u8uay Cau8CU Dy HCIOH WIH bHi_a
IOXiHjiOUuCiH_ 1tbtI!tb!2 t0/! [\Jb.} OHCH iCaICU
IO iH_C8IOH O COHIaHiHaICU uHUCiCOOKCU DCC Oi Dy COH-
jCHCHI Uy8iC_uaIiOH Cau8CU Dy _CHCIiC HuIaIiOH8. 1UU-
IiOHa HaHiC8IaIOH8 Oib Hay HCuUC aCuIC KULCy Huiy
aHU HCuiOO_iC BHUH_8 [Oi CXaHjC HCaUaCHC COH8iOH}
DuI IHC OHy Uia_HO8IiC CiiICia aiC IHiOHDOCyIOjCHa aHU
HiCiOaH_OjaIHiC HCHOyIiC aHCHia iH IHC aD8CHCC O aHy
OIHCi jOICHIa Cau8C.
1HIiDiOIC8 aiC HOI iCCOHHCHUCU iH IC IiCaIHCHI Oib.
bIuUiC8 iH CHiUiCH Ha\C 8HOWH CiICi HO DCHCHI Oi HCiCa8CU
COHjCaIiOH8 WHCH aHIiDiOIiC8 aiC u8CU. HC HaiH8Iay O
IiCaIHCHI 8 8ujjOiU\C WI aUCquaIC H uiU8 aHU CO8C HOH
iIOiH_ O CCCIiOyIC8 aHU DOOU COuHI8 Uiay8i8 Hay DC
iCquiiCU Oi aCHIC iCHa auiC. iaH88iOH O jaCKCU iCU
DOOU CC8 Hay DC HUiCaICU i aHCHia WOi8CH8 DuI jaICCI
IiaH88iOH 8 COHIiO\Ci8ia DCCau8C iI Hay WOi8CH IHC IiOH
DOIiC jiOCC88 aHU i8 [jCay u8CU OHy WHCH DCCUiH_ i8 8i_-
HiBCaHI.
OuIiHC 8IOO CuIuiC8 OHy IC8I Oi 8aHOHCa 8Hi_Ca aHU
CaHjyODaCICi. HCiCOiC H jaIiCHI8 WiI DOOUy UaiiHCa
8IOO 8HOuU a8O DC 8CHI 8jCCiBCay Oi 1. t0/! \Jb. IC8I-
iH_. CCa CuKOCyIC IC8IiH_ Ha8 jOOi 8CH8I\Iy aHG 8jCCiBCIy
BIC Uia_HO8i8 O HCUOu8 UiaiiHCa W HOI 8jCCmCay Uia_-
HO8C ib aHU V HOI aUU u8C Ua_HO8IiC iHOiHaIiOH.
7b Ga>!rCCn!CrCCQyanC HCpa!CCQy

h6m0C UI6mC S0I0m6 0dg0SS S 0dS60 0 h6 I6S6C6 0
mCI0dg0dhC h6m0C d6md d0 hI0m00C06d.
DlO_aQHy
aZZaQ 5. tCHOyIIC HICHIC 8yHGIOHC. aH CHCI_IH_ HCaIH II8K. /H
aH Hy8ICIaH. Z/+(}.VV1. i1. 1/Z+[
Item Answer:
Educatonal Ob]ectve: Jgn0rt rdI0n r0tIIr.
CXiDC 8i_HOiGO8COjy i8 IHC HO8I ajjiOjiiaIC HCXI Gia_-
HO8IiC IC8I. JHC HO8I iKCy CaH8C O GiaiiHCa iH IHi8 jaIiCHI i8
iaUiaIiOH jiOCIiIi8 ViCH OCCHi8 COHHOHy iH jaIiCHI8 iCCCi\-
iH_ jC\iC iaGiaIiOH. 1CHIC iaGiaIiOH jiOCIiIi8 H8Hay HaHi-
C8I8 WIHiH OWCCK8 O IHCiajy ViIH 8yHjIOH8 O GiJiHCa aHG
ICHC8HH8. JHC jiOCIiIi8 i8 GHC IO GiiCCI iaGiaIiOH iHHiy IO IHC
iCCIa HHCO8a aHG H8Hahy iC8O\C8 8OOH aHCi iaGiaIiOH i8 Gi8-
COHIiHHCG. \HiOHiC jiOCIiIi8 CaH OCCHi HOHIH8 IO yCai8 aHCi
IiCaIHCHI aHG i8 a88OCiaICG WiIH a WOi8C jiO_HO8i8. ia_HO-
8i8 i8 C8IaDi8HCG Dy CHGO8COjiC HGiH_8 O HHCO8a ICaH_-
iCCIa8ia WiIH DiOj8y 8HOWiH_ 8HDHHCO8a HDiO8i8 aHG aiICii-
OC CHGaiICiiIi8.
JHC ICHjOia iCaIiOH8Hij DCIWCCH IHC jaIiCHI8 iaGiaIiOH
IHCiajy aHG OH8CI O HCi UiaiiHCa 8yHjIOH8 WiIHH O WCCK8
HO8I 8IlOH_y 8H__C8I8 iaGiaIiOH jiOCIiIi8. \JHaIiOH Oi JH
iHCCIiOH8 CaH8C O UiaiiHCa i8 uHiKCy IO C8IaDi8H a Gia_HO-
8i8 DCCaH8C IHC jiCIC8I jiODaDiiIy O aH iHCCIiOH8 CaH8C O
GiJiiHCa i8 OW. 1DGOHiHa/jC\iC \J 8CJH V HOI DC HCj-
m, DCCaH8C HO 8jCCiHC iaGiOO_iC CaIHiC8 GCHHC iaGiaIiOH
jiOCIiIi8, IHC Gia_HO8i8 i8 C8IaDiSHCG Dy GiCCI \i8HaiZaIiOH O
IHC aCCICG HHCO8a.
Ca8HHH_ 8IOO O8HOaiIy Hay OCCa8iOHay DC HCjH H Gi8-
IiH_Hi8HH_ O8HOIiC GiaiiHCa HOH 8CCiCIOiy GiaiiHCa aHG iH
IHO8C CW jaIiCHI8 8H8jCCICG O Ha\iH_ aCIiIiOH8 GiaiiHCa [OW
8IOO O8HOaiIy}. JHi8 IC8I VHOI DC HCjH iH a jaUCHI ViIH
a H8IOiy COHjaIiDC WiIH iaGiaIiOH jiOCIiIi8.
CU6 Id0d0 I0CS Cd CdUS6 0dIIh6d d0 6B6SmUS Wh b
W66KS 0 h6Id.
DhO_aQHy
CI[CI OIII8 ^.ICaIHCHI O IaGIaIIOH [iOCIIU8. |IH \H CO I |O
aGIO}. Z/1V(V}./Z+V. i1. 1//Zo1Z[
Item Answer:
Educational Ob]ectve: Jgn0rt tbr0nt ntrtI-
Ir wIb d0mn L1rtn.
JHC IC8I HO8I iKCy IO C8IaDi8H IHC Gia_HO8i8 i8 \J 8CaH O
IHC aDGOHCH. JHi8 jaIiCHI Ha8 CHiOHiC jaHCiCaIiIi8 8CCOHGaiy
IO aCOHO aDH8C WHiCH Ha8 iC8HICG iH HaaD8OQIiOH. JHC
IHiCC Ca88iC HHGiH_8 iH CHiOHiC jaHCiCaIiIi8 aiC aDGOHiHa
jaiH IHaI i8 H8HJy HiGCji_a8IiiC jO8IjiaHGia GiaiiHCa aHG
GiaDCIC8 HCLIH8 8CCOHGaiy IO jaHCiCaDC CHGOCiiHC iH8HH-
CiCHCy. aaD8OijIiOH OCCHi8 iH jaIiCHIS WiIH CHiOHiC jaH-
CiCaIiIi8 WHCH ajjiOXiHaICy 80" O IHC jaHCiCa8 i8 GC8IiOyCG.
aaD8OQIiOH jiC8CHI8 WIH GJiHCa aHG 8ICaIOiiHCa WCi_HI
O88 aHG GCHCiCHCiC8 O aI-8OHDC \iIaHiH8 DCCaH8C IHC GaH-
a_CG jaHCiCaIiC _aHG i8 HO OH_Ci jiOGHCiH_ IHC jaHCiCaIiC
CXOCHHC CHZyHC8 IO aD8OiD OOG. 1GGiUOHJ CHC8 IO IHC Gia_-
HO8i8 iHCHGC CC\aICG jaHCiCaIiC CHZyHC C\C8 aHG i\Ci
CHCHi8Iiy IC8I8. aIiCHI8 WIH a IyjiCa jiC8CHIaIiOH Hay HOI
HCCG aGGiIiOHa IC8IiH_. OWC\Ci HO8I jaIiCHI8 WiIH CHiOHC
jaHCiCaIiIi8 Ha\C OHy HOH8jCCiHC aDGOHiHa jaiH [aHG HOi-
Ha jaHCiCaIiC CHZyHC COHCCHIiaIiOH8} aHG iCQHiiC Gia_HO8-
IiC iaGiO_iajHiC iHa_iH_ 8IHGiC8. JHC jiC8CHCC O jaHCiCaIiC
CaCiHCaIiOH8 OH iaGiO_iajH8 COHHiH8 IHC Gia_HO8i8. aiH
HH8 O IHC aDGOHCH Wi 8HOW jaHCiCaIiC CaCiHCaIiOH8 iH
ajjiOXiHaICy 30" O jaIiCHI8. O8I jaIiCHI8 HOWC\Ci
iCQHiiC aDGOHiHa \J 8CaH8 WHiCH aiC aDC IO GCICCI jaH-
CiCaIiC CaCiHCaIiOH H Hj IO 90" O jaIiCHI8. \J 8CaHHiH_ CJH
a8O CXCHGC OIHCi CaH8C8 O jaiH.
1HIiCHGOHy8ia aHIiDOGiC8 aiC a HaiKCi Oi CCiaC Gi8Ca8C
WHiCH i8 HHiKCy iH IHi8 jaIiCHI WIH aH CVGCHI Hi8IOiy O jaH-
CiCaIiC HaaD8OQIiOH. 1IHOH_H COOHO8COjy i8 iHGiCaICG a8
a 8CiCCHH_ IOO Oi a\Cia_C ii8K a8yHjIOHaIiC jaIiCHI8 DC_iH-
HH_ aI IHC a_C O 50 yCai8 aHG Oi jaIiCHI8 VIH a CHaH_C iH
DOWC HaDiI8 aHG WCi_HI O88 IHi8 jaIiCHI8 Hi8IOiy 8H__C8I8
jaHCiCaIiC HaaD8OQIiOH aHG COOHO8COjy i8 C88 iKCy IHJH
aDGOHiHa \J 8CaH IO COHHiH IHC Ga_HO8i8. CIOO 8IHGiC8
aiC ajjiOjiiaIC Oi GCICiHiHiH_ IHC CaH8C O aH aCHIC iHCC
IiOH8 GiaiiHCa DHI IHi8 jaIiCHI Ha8 HaG GiaiiHCa Oi b HOHIH8
JHG iHCCIiOH8 GiaiiHCa i8 HOI H8Hay a88OCiaICG WiIH 8HCH a
GC_iCC O WCi_HI O88 Oi CC\aIiOH O jaHCiCaIiC CHZyHC8.
d6S Wh ChI0C dBCI6dS I6S6B Wh d000mBd d dB0,
m0I6 S6V6I6 CdS6S, mdd0S0I0B dB0 6B00CI6 BSUlC6C.
DlO_aQHy
YIII t /[IC V CIH VYI8OH |5. |HIOHIC [aHCICaIIII8. CHaCH_C8
aHG aGVaHCC8 IH [aIHO_CHC8I8 _CHCIIC8 GIa_HO8I8 aHG IHCIa[y.
La8IIOCHICIOO_y. Z/1Z(+}.1bb/1b/. i1.1/+7++[
Item Answer:
Educatonal Ob]ectve: Jgn0rt nd tI dr
rbtrtd0mnnI rrIt 0wt ryndr0mt.
JHC HO8I ajjiOjiiaIC HaHa_CHCHI Oi IHi8 jaUCHI i8 8yHjIOH
COHIiO. 1iiiIaDC DOWC 8yHUfOHC [11C} i8 IHC HO8I COHHOH
_a8IiOiHIC8UHJ COHGiUOH Gia_HO8CG H IHC 1HiICG CIaIC8. JHi8
jaUCHI jiC8CHI8 VIH 8yHjIOH8 IHaI HCCI IHC OHC 111 CiiIC-
Ha Oi 11C. JHC OHC CiiICiia WCiC GC\COjCG IO C8IaDi8H COH-
8CH8H8 _HiGCiHC8 Oi Gia_HO8i8 O HHCUOHa DOWC Ui8OiGCl8.
\HICiia Oi 11C aiC 8yHjIOH8 O iCCHfiCHI aDGOHHa jaiH Oi
Gi8COHOiI aHG a HaiKCG CHaH_C H DOWC HaDiI Oi aI Ca8I O
HOHIH8 VIH 8yHjIOH8 CXjCHCHCCG OH aI Ca8I 3 Gay8 a HOHIH
Oi aI Ca8I 3 HOHIH8. JWO Oi HOiC O IHC OOV_ HH8I a8O
ajjy. 1) jaiH i8 iCiC\CG Dy a DOWC HO\CHCHI 2) OH8CI O
jaH i8 iCaICG IO a CHaH_C iH HCQHCHCy O 8IOO aHG/Oi 3)
OH8CI O jaiH i8 iCaICG IO a CHJH_C iH IHC ajjCaiaHCC O 8IOO.
1H IHi8 OIHCiVi8C HCaIHy yOHH_ WOHaH iCa88HiaHCC IHaI 8HC
Ha8 a CHfOHiC DHI HOI a iC-IHiCaICHiH_ Gi8CaSC WIH iCCOH-
HCHGaUOH O a Hi_H-HDCi GiCI 8HOHG DC IHC iHiUa IHCiajy.
\J CHICiO8COjy Oi COOHO8COjy WOHG DC jiCHaIHiC aI IHi8
jOiHI _\CH IHC aD8CHCC O aaiH 8yHjIOH8. C\Ci WCi_HI O88
DOOG iH 8IOO aDHOiHJ jHy8iCa CXaHiHaIiOH aHiy Hi8IOiy
O+aHHaIOiy DOWC Gi8Ca8C Oi COOH CaHCCi Oi jaiH Oi Uiai-
iHCa IHaI aWaKCH8/iHICiCiC8 WiIH 8CCj.
Jhispaucntdocsnothavccvidcnccolmalabsorpuon,ancmia,
orwcightlosstosuggcstadiagnosisolccliacdiscasc, thcrc-
lorc,ancmpiricglutcn-hccdctwouldbcinappropriatc.1
cmpiric glutcn-lrcc dict is ncvcr appropriatc without hrst
cstablishingthchistologicaldiagnosisolccliacdiscascwitha
small-bowclbiopsy.
KEN O1NT
II0l 00Wl SB0I0m S CBCl 0gB0SS 0 XCUS0B B0, B
R 0SBC 0 lIm Sm0mS, BVSV W0IKU S B0 BCSSI.
DO_aQHy
\iSOH |. H !HC CiHiC. IIi!dDC DOVC SHUIOHC. lHH H!CIH CU.
Z1+(1]:Jl-1-Jl-1. 1: 1V
p
+[
Item 12 Answer. A
Educational Objectve. Oiaqncscapaticntwitb
scvcrcLOSDUU O CHc inftticn.
JhispaucntmostlikclyhasscvcrcC/cnridiumd;:i/cinlcc-
tion CI). CI typically prcscnts with watcry diarrhca,
althoughthcrangcolsymptomsspananasymptomaticcar-
ricr statc toscvcrcmantcolitiswith toxic mcgacolon.
!aticntswithCIandassociatcdcolitistypicallyhavcdiarrhca
upto0or5timcsdady,lowcrabdominalpain,cramping,
lcvcr,andlcukocytosisthatohcncxcccds5,000,! 5x
0',!).CIvthcolitisismostcommonlyassociatcdwith
prioranubioticadministration.Jhccolitisisproduccdbytwo
toxins,/and8.Jhcschavcdillcrcntmcchanismsolaction,
butbotharchighlypotcntandcausccytotoxicityatcxtrcmcly
low conccntrauons. Jhctoxinscanbcdctcctcdinthcclini-
cal laboratory andthcprcscnccolcithcrtoxinconnrmsthc
diagnosis. Jrcatmcnt ol scvcrcCI with colitis consistsol
oralvancomycinandintravcnousmctronidazolc.
Jhctypicalprcscntationol Crohndiscascisabdominalpain,
diarrhca,andwcightlossthatoccursovcrapcriodolmonths,
Hnotycars.Jhispaucnt`sscvcrcandrapidlyprogrcssivccoursc
isnotconsistcntwithCrohndiscasc.
!aticnts with uncomplicatcd divcrticulitis prcscnt with
abdominalpainandlcvcr. !hysicalcxaminationdiscloscslch
lowcr quadrant abdominaltcndcrncss. !cukocytosis is prc
scnt,andurinalysismayshowstcrilcpyriaductoinUamma-
tionclosctothcbladdcr.Jhcpaticnt`s2daymstoryolscvcrc
diarrhcais not consistcnt with divcrticulitis. ivcrticulosis
consistsolthcprcscnccoldivcrticulainthccolon.ivcrtic-
ulosis is common in agingWcstcrn populations and is not
associatcdwithpainordiarrhca.
Ischcmiccoliussymptomsincludclchlowcrquadrantabdom-
inal pain and bloody diarrhca, which arc ohcnscll-limitcd.
JrcatmcntissupportivcandincludcsintravcnousUuidsand
bowcl rcst. Most symptoms rcsolvc within+8 hours. Jhis
paucnt`sprogrcssivcsymptomsarcnotconsistcntwithadag-
nosisolischcmiccolitis.
BS WR IV0US X0SUI 0 B00CS m 0V0
L/05lt|J|umJ|h|C|/CBC0B B0 SS0C0 C0lS, WRCR S CRI
CIZ0 0 0IIR U 0 10I 1b mS 0l, l0WI 000mBl
B, CImBg, VI, B0 lUK0C0SS.
Gs!rOC!CrOIOQyO HCp!OIOQy 77
DO_aQHy
dI!C!! |L LCIUiH_ . liHiCd ICCO_Hi!iOH dHU Uid_HOSiS O!
lOS!IiUiUH Ui!1CIC iH!CC!iOH. liH H!CC! iS. Z+:b1Z-b1.
1: 11Z1[
Item 1 Answer.
Educational Objective. Manaqcb3HOHcH3 qas-
nccnnritis.
Jhispaticnthas Sa/mcnc//agastrocntcntis, buthcdocsnot
rcquirctrcatmcntatthistimc. 8ccausc Sa/mcnc//agastrocn-
tcriusisusuallyscll-limitcd,antibiotictrcatmcntisgcncrally
notrcquircdlormosthcalthypcrsons. Ilthcdiarrhcawors-
cnstothcpointthathccannotrcplacclostUuidsorHhcshows
cvidcncc oltoxicity pcrsistcnt highlcvcr, dcclimng mcnta
uon,cnd-organdysmnction)orlikclybactcrcmia,hcV nccd
morcaggrcssivcintcrvcntion.
Jrcatmcntisrccommcndcdomylor)immunocompctcnt
paucnuyoungcrthan2ycarsoroldcrthan50ycarstoavoidthc
incrcascd incidcnccol complicauons mthcsc agc groups, 2)
immunocompctcntpaucntswithscvcrcillncssrcquinnghospi-
ta|izauon,3)immunocompctcntpaucntswthknownorsus-
pcctcdathcrosclcroucplaqucsorcndovascularorboncpros-
thcscsbccauscolsccdingolsalmoncJactothcscarcasduringa
bloodstrcaminlccuon,and+)immunocompromcdpaucnts,
suchaspaucnuwithunconuollcdinlccuonorthoscrcquir-
ingcorucostcroidsandothcrimmunosupprcssivcagcnts.
Jhcrcisagcattcmptauontoucatpaucntsvthdocumcntcd
orsuspcctcdbactcrialdiarrhca.^lthoughthcrciscvdcnccthat
anubactcrialucatmcntolS|pc/|oruavclcrs`diarrhcacauscd
byccrtaintoxin-producingsnolI:|cri:|ia:c/i)mighthas
tcn rccovcry,thcbcnchtsolcarly trcatmcnt arcmodcst and
dhwithumc.Jhcucatmcntolprcsumcdordocumcntcd
Sa/mcnc/|diarrhcaiscvcnmorcproblcmauc.!ormostpaucnu
withsalmoncllosis,rccovcryoccurscquaylastwithorwithout
anubioucs. addiuon,thcrcmaybcadclayinclcanngthcsal-
moncllachomthcstoololanubiouc-trcatcdpaucnts,andthc
cucctsolthcanubioucs indcpcndcntlyconmbutctotoxic-
ity,incluJingC/midiumdq :i/ctoxin-mcJiatcddim hca.
lthcantibiotics thatmightbcuscmlintrcatingsalmoncl
losis,ciproUoxacinwouldbcrcasonablyhkclytobcchcctivc
invitro,althoughrcsistancctothcUuoroquinoloncsisincrcas
inginmanypartsolthcworld.
MctronidazolcwouldnothavcanybcncntlorSa/mcnc//aor
anyothcr bactcrial diarrhca. Jhc uscol antidarrhcal agcnts
suchaslopcrdcisprobablysalclorindividualswithtrav-
clcrs`Jiarrhcabutisnotrccommcndcdlorpotcntiallyinva-
sivcpathogcnssuchasSa/mcnc//a.Inaddition,paticntswith
lcvcr,bloodystools,orsignsolsystcmictoxicipshouldnot
bcgvcnbowclparalyticsbccauscthcscagcntscanworscnthc
acutcdiscasccoursc.
O1MY
bCUS J/m0BC#gSI0BIS S USUll Sllm0, B0
0C ImB S gBI B0 IqUI0 0I m0S RlR IS0BS.
DO_aQHy
1dVOVSi b\ \dIICH ll LUCIIdH! id_HOSiS dHU UCd!HCH! O! dCU!C
OI QCISiS!CH! UidIIHCd. LdS!IOCH!CIOO_y. ZV1o( ]: 1+-1.
_1: 1V+p+1[
1 Gas!rOC!CrOOgyaO HCpa!OOgy
Item Answer:
Educatonal Ob]ectve: !anorr hrpancrllular
njury pamrn on laboranry urrn.
JHi8jaIiCHIHa8aCHICHCjaIOCCHaiUaHa_Ca88OCiaICUViIH
mUH_CiDHHDiHCHiaIHaICOHUDCCaH8CUDyaCHICHCjaH-
Ii8.CjaIOCCHaiiHHiyHO8IOHCHiC8HI8iHaHCC\aIiOHO
8CiHHJJiHCaHiHOIiaH8Cia8C [DJ}aHU a8jaiIaIC aHiHO-
IiaH8Cia8C [DJ} COHCCHIiaIiOH8 WHiCH iCHCCI iCCa8C O
iHIiaCCHai CHZyHC8 HOH iHHiCU HCjaIOIC8. 1bJ i8 a8O
iCCa8CUHOHOIHCiI88HC88HCHa8IHCHCaiIaHU8KCCIaHH8-
CC. JHCiCOiC CC\aIiOH8 O DJ WHiCH i8 HiHiHay jiO-
UHCCUiHHOHHCjaIiCIi88HC8 aiCHOiC8jCCiBCOiUia_HO8iH_
i\CiUi8Ca8C.CjaIOCyICUy8HCIiOHi8OHCH a88OCiaICUWIH
COHH_aICU H_CiDiiiHDiHCHia iH WHiCH IHC UiiCCI DiiiHDiH
HaCIiOH i8 _iCaICiIHaH 50.
\HOC8IaIiC iHHiy [ CHOC8Ia8i8} WHiCHCOH8i8I8 OaaCK OOi
aHaDHOiHaiIyiHIHCBOWODHCi8iHUiCaICUjiiHaiiyDyaH
CC\aIiOH O 8CiHH aKaiHC jHO8jHaIa8C aHU iCaIi\Cy HiHi
HaCC\aIiOH8O1JaHU1J.\HOC8Ia8i8HayOCCHiViIH
OHI aHHUiCC DCCaH8C O IHC CajaCiIy O IHC i\Ci IO COHIiHHC
IO 8CCiCIC DiC 8HUCiCHIy HHIH IHC iHHiy IO IHC DiC UHCI8 i8
8i_HiBCaHI.iiOOHHU Ui8iHjIiOHOIHCDiC 8CCiCIOiy HCCHa
Hi8H8i8iKCyIOiC8HIiHCOHH_aICUHyjCiDiiiHDiHCHiaVIH
CC\aIiOH O IHC UiiCCI HaCIiOH O 8CiHH DiiiHDiH. JHC Bi8I
C\aHaIi\C8ICjiHajaIiCHIVIHaCHOC8IaIiCjaIICiHOiHHiy
i8 IO ODIaiHaHHIia8OHHU8IHUy IO UCICiHiHCi iHIiaHCjaIiC
Oi CXIiaHCjaIiC DiiaiyOD8IiHCIiOH i8jiC8CHI.
i\CiUi8OiUCi8 CaH a8OjiC8CHIVIHa HiXCU jaIICiHOi\Ci
iHHiy IHaI i8 CHaiaCICiiZCU Dy HOUCiaIC IO 8C\CiC CC\aIiOH8
O aHiHOIiaH8Cia8C aKaiHC jHO8jHaIa8C aHU DiiiHDiH C\-
C8. CjaIiIi8 aHU \ aiC CXaHjC8 O COHUiIiOH8 IHaI CaH
OCCa8iOHayjiC8CHIWiIH a HiXCUi\CiiHHiyjaIICiH.
JHi8 jaIiCHI8 jiCUOHiHaHIy CC\aICU aHiHOIiaH8Cia8C C\-
C8 WiIH HiUy CC\aICU aKaiHC jHO8jHaIa8C COHCCHIiaIOH
aHUUiiCCI DiiiHDiHHaCIiOHCCaiyjOiHI8IO aHCjaIOCCHai
iHHiy jaIICiH. D HOHHCjaIiC HHiy jaIICiH 8HCH a8 HH8CC
iHHiy WOHU DC a88OCiaICU WIH 8H_ CC\aIiOH8 O DJ
C88Ci CC\aIiOH8 O DJ aHU WOHU HOI DC a88OCiaICU ViIH
CC\aIOH8 O COHH_aICU DiiiHDiH.
PO1WT
d0ClUlI [UIy m0S 0 ISUS V0 0 SIUm
m0ISIS [L) 0 SI m0ISIS
[b1) C0CI0S 0 0 S SS0C0 W 0IC yI
0IU0m.
DO_agHy
u|KC . |\C| HDtl|OD. lCl C|Ctl|OD JDd |DlCQ|ClJl|OD O |Cu|l.
|LJU Cd. ZUUZZZZ).oU. i. 1Z1oJJ00j
Item Answer:
Educatonal Objectve: !anorr Glbrrr ryn4romr.
JHi8jaIiCHIHa8HUiiCCI[HHCOHH_aICU}HyjCiDHiiHDiHCHia
WHCHiHaHa8yHjIOHaIiCjaIiCHIWIHaHOiHaHCHO_ODiH
C\C aHUOIHCiVi8CHOiHa i\Ci IC8I8 i8 8H__C8Ii\CO LiDCiI
8yHUiOHC. iiiHDiH i8 HCa8HiCU a8 COHH_aICU [UiiCCI} aHU
HHCOHH_aICU [iHUiiCCI} HaCIOH8. H jaHCHI8 ViIH CHOC8Ia-
IiC Ui8Ca8C8 CaUiH_ IO aHHUiCC ajjiOXiHaICy Ha O IHC
DiiiHDiH i8 HCa8HiCU a8 IHC COHH_aICU HaCIOH. iiCUOHi-
HaHCCOIHCHHCOHH_aICUHaCIiOHiHUiCaIC8CiIHCiHCO\Ci
jiOUHCIiOH O DiiiHDiH [a8 OCCHi8 iH HCHOy8i8} Oi iHjaii
HCHI O DiiiHDiH COHH_aIiOH. JHC aIICi i8 iCaIi\Cy COH-
HOH _i\CH IHC 5 jiC\aCHCC O LiDCiI 8yHUiOHC iH IHC
_CHCia jOjHaIiOH. JHi8 DCHi_H 8yHUiOHC a8O KHOWH a8
COH8IiIHIiOHaHCjaIiCUy8HCIiOHaHUa aHOHHCHOyHC
aHHUiCCi8CHaiaCICDZCUUyIOIaDiiiHDiHCOHCCHIiaIiOH8Hj
IO o. H_yU 51.3 HHOy} iC8HIiH_ iOH a iCUHCCU
CXjiC88iOH O IHC CHZyHC IHaI COHH_aIC8 DHiiHDiH. LiDCiI
8yHUiOHC i8 IHC HO8I COHHOH iHHCiiICU Ui8OiUCi O DiiiH-
DiHHCIaDOi8H.HaUHISiIi8aDCHi_HUi8OiUCiaHUHOaUUi
IOHa Uia_HO8IC 8IHUC8OiIHCiajy i8 iCqHiiCU aI IHi8 IiHC.
\HOC8Ia8i8UHCIOaHOiaCOHIiaCCjIi\Ca_CHIVCaH8CCOH-
H_aICU [UiiCCI} HyjCiDiiiHDiHCHia aHU aH CC\aICU 8CiHH
aKaiHC jHO8jHaIa8C C\C HCiIHCi O WHiCH IHi8 jaIiCHI Ha8.
iaIiCHI8ViIHHCHOy8i88i_HBCaHICHOH_HIOCaH8CHHCOHH-
_aICU HyjCiDiiiHDiHCHia _CHCiay Ha\C a OW HCHO_ODiH
C\CaHUaDHOiHa\aHC8OiHCaHCOqH8CHai\OHHC[OW}
aHU iCU CC Ui8IiiDHIiOH WiUIH [Hi_H}. DDUOHiHa HIia-
8OHO_iajHy Hay DC a HCj 8IHUy Oi jaIiCHI8 WiIH UiiCCI
HyQCiDHiiHDiHCHiaWHiCHi8H8Haya88OCiaICUViIHi\CiUi8-
Ca8C DHI i8 HOI iHUiCaICU iH IHi8 jaIiCHI WHO Ha8 iHUiiCCI
H_CiDiiiHDiHCHia HO C\iUCHCCOi\CiUi8Ca8C.
P
1 C0 0g 0 0IC [UC0[Ug0) yI0IU0
m Sym0mC W 0Im m0g00 V
0 0IWS 0Iml VI SS S 0CV 0 0I Sy0I0m.
DHO_agHy
1||C| 1|DHCd 1. HC JymQlOmJl|t OuQJUCDl vm JUDO|mJl l|\C|
HDtUOD lCl. |m|\C| |. ZUU1oZ).101. _i. 1JJZ1Zj
Item Answer: A
Educatonal Objectve: Manaqr rympnmarc all-
rnnr 4rrarr.
JHCDC8IHaHa_CHCHIOiU8jaICHIi8CCCIi\CCHOCCy8ICC-
IOHyDCOiCHO8jiIaUi8CHai_C.O8IjaIiCHI8ViIHa8yHjIO-
HaIiC 8IOHC8 aiC HaHa_CU COH8Ci\aIi\Cy. DDOHI 70 O
jaICHI8 VIH _a8IOHC8 aHU 8iH_COi iHHCqHCHI Cji8OUC8 O
jaiHHa\CaiaICO Diiaiy COHjiCaIiOH8 O I IO2 jCiyCai.
iaIiCHI8VIHaHCji8OUCOCOHjiCaICU DHiaiy Ui8Ca8C [aCHIC
CHOCCy8IiIi8 Oi _a8IOHC jaHCiCaIiIi8} Ha\C a o7 CHaHCC O
Ha\iH_ a iCCHiiCHCC O COHjiCaICU U8Ca8CWiIHiH3 HOHIH8.
JHi8 jaIiCHI Ha8 HaU iCCHiiCHI Cji8OUC8 O Diiaiy COiC aHU
CHOCCy8IiIi8aHUi8aIii8KOiCOHjiCaICU_aDaUUCiUi8Ca8C.
HHHCOHjCaICU_aDaUUCiUi8Ca8CajaiO8COjiCCHOCCy8-
ICCIOHyi8jiCCiiCUIOOjCHajaiOIOHyDCCaH8CiIiC8HI8iH
8HOiICi HO8jiIa 8Iay8 C88 jaiH aHU a HOiC iajiU iCCO\Ciy.
\iWiIH8jHiHCICiOIOHyi8iHUiCaICUOijaIiCHI8WiIHDi-
iaiy OD8IiHCIiOH UHC IOCHOCUOCHOiIHia8i8. IHa8 HO iOC iH
iCHO\iH_ HOHOD8IiHCIiH_ 8IOHC8 HOHIHC _aDaUUCi.
DIHOH_H Hi8OUCOXyCHOiC aCiU Hay UCCiCa8C IHC ii8K Oi
IHiC8IOHCOiHaIOHiH8OHCjaIiCHI8iIi8C88CHCCH\CHaH
CHOCCy8ICCIOHy H jaICHI8 VIH CX8IiH_ 8IOHC8 aHU iI8 H8
i8 iHiICU IO jaIiCHI8 WHO aiC HHaDC IO HHUCi_O 8Hi_Ciy.
iCIaiy CHaH_C8 aHU WCi_HI O88 Hay DC H8C Oi jiC\CHI-
iH_UC\COjHCHIO_a8IOHC8DHIUOHOIIiCaI8IOHC8IHaIaiC
aiCaUy jiC8CHI.

L0CSC0m I0V0S 0BV Id 0I dBS W
Sm0mdC gdS0B 0SdS.
DO_aQHy
5andcrs \ IinysncrIh P. \asIcncs. bN|. 2UU/;ooo/i1):29o9.
lNII: i/9Uo/U|
lIOH 1 DSWOf.
bOUCBIODB DgOCIVO. 10QH0t]Im0IythI0HQ
tb00HQl.
Jhispancntlikclyhaspnmarysclcrosingcholangus,achronic
cholcstanc|ivcrdiscascassociatcdvithinhammatorybowcldis
cascandcharactcnzcdbynbrosis,inhammanon,andstncmg
olthcbiliaryucc.\pto85olahcctcdpancntshavcundcrly
ingimammatorybowcldiscasc,butlcssthan5olpancntsvth
imdatorybowcldiscaschavcpnmarysc|crosingcholang
ns.Cho|cstauclivcrdiscascspnmamycauscclcvanonolscrum
alsalincphosphatascvalucsandminorclcvanonsolthcamino
translcrasclcvcls.Jhcdisordcrismorccommoninpancntsvith
u|ccranvcco|insthanvithCrohndiscasc.Mostpancntsarcdiag
noscdwhi|casymptomancvithabnormalrcsu|tsonlivcrbio
chcmistrytcsts,butjaundiccandprutuscanoccurinpancnts
vithadvanccddiscasc.Jhcdiagnosisisusua|lymadcbycndo
scopicrcuogadccholangopancrcatogaphy,whichiscspccial|y
uscminadvanccddiscascwhcrchisto|ogcsaqlcscanbctascn
toru|coutcholangocarcinomaandstcntscanbcplaccdHthcrc
isadominantstticturc.Magcncrcsonancccho|angopancrc
atographycanalsobcuscd.
Gi|bcrtsyndromcisacommondisordcrassociatcdwithindi
rccthypcrbilirubincmia. !aticntsviththissyndromcgcncr
allyhavcascrumtotalbilirubinlcvclol lcssthan3.0mg,dL
5.3 ol,L),whcrcasthcscrumdircctbi|irubinlcvclislcss
than orcqualto0.3mg,dL 5. ol,L).Aprcsumptivc
diagnosisol Gilbcrtsyndromccanbcmadcinanothcrvisc
hcalthypaticntwhohasindirccthcrbi|irubincmia,normal
livcrcnzymcvalucs,andanormalhcmoglobinconccntration
whichcxcludcshcmolysis).Jhispaticntdocs noth thc
critcrialorGilbcrtsyndromc.
!aticntsvthacutchcpatitisCarcusuahyasymptomaticand
thcrclorcrarclyprcscntclinical|y,but0to85olpcrsons
whoacquircacutchcpatitisCdcvclopchromcinlcction.Jhc
cholcstaticpicturcinthcabscnccolothcrsignsoladvanccd
livcrdiscascisinconsistcntvithchronichcpatitisC.!aticnts
vithacutchcpantisAohcnhavclatiguc,nausca,milduppcr
abdominalpain, andjaundicc.Scrumaspartatcaminotrans
lcrascandalanincammotranslcrascvalucsarcusuallygrcatcr
than500\,L.HcpatitisAdocsnotprcscntvithacho|csta
ticbiochcmicalpron|cassccninthispaticnt.

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a Muqhy sign clicitcd on cxamination, lcvcr, lcukocytosis,
mildbi|irubinandaminotranslcrascclcvation,gallstoncsand
pcricholccystic huid, and thickcning ol thc gallbladdcr wall
onultrasonography.Whcnultrasonographyrcvcalsgallstoncs
andaposinvcu|trasonographicMhysign,thcposiuvcprc
dictivc valuc loracutc cholccystitisis2. Muqhy sign is
intcrruption ol dccp inspiration whcn prcssurc is app|icd
bcncaththcrightcostalarch.Whcnthcpaticnthasthcaddi
tionalnndingsolgallstoncs andgallbladdcrwallthickcning
>3mm),thcpositivcprcdictivcvalucis5loracutccholc
cystitis.Surgicalcholccystcctomyisadvsab|conccgallstoncs
lcadtosuchcomp|icationsasacutccholccystitis.
Acutc cho|angitis isassociatcdvith biliary obstruction and
thcsubscqucntdcvclopmcntolasuppurauvcinlccnonvthin
thcbiliarytrcc.bstructionismostohcnductogallstoncs.
Charcot triad pain, lcvcr, and jaundicc) occurs in most
paticntsvithcholangitis.Jhcabscnccol biliarytractobstruc
tiononultrasonographyrulcsoutacutccholangitis.
Although thc prcscntation ol pancrcatitis varics, thc most
commonsigns andsymptomsarcthcsuddcn onsctolcon
stant,scvcrcuppcrabdomina|painassociatcdvthnauscaand
vomiting. Jhc hallmark ol diagnosis is thc prcscncc ol
markcdlyincrcascdlcvclsolcirculatingpancrcaticcnzymcs,
whicharcnotloundinthispaticnt.
Gal|bladdcrdyskincsia,charactcrizcdbyarcduccdratcolgall
bladdcrcmptying, iscontrovcrsial as a causc ol right uppcr
quadrantpain.Somcpaticntshavclcaturcsthatovcr|apvth
thosc ol mnctional bowc| discasc. !t isnot associatcd with
lcvcr, a positivc Murphy sign, hypcrbilirubincmia, or gall-
stoncs.

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antibiotics to covcr acrobic and anacrobic gramncgativc
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scopic rctrogradc cholangiopancrcatography with sphinc
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uCCf S DOjSy. iOjSCS O a _aSIfC uCCfS SHOuU DC jCf-
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Hay HafDOf Ha_HaHCy. 1H DCHi_H uCCfS DOjSCS CaH aSO
jfO\UC C\UCHCC Of UC jfCSCHCC O J/!t0u0tl|I ]}/0I! iHCC-
IiOH aHU _uUC ajjfOjfaIC UCfajy.
BZ GastrCCntCrCCQyanO HCpatCCQy
C8IiH_ Oi J ]}/0I! i8 iHGCaICG iH jaIiCHI8 VIH aCIi\C jCj
IiC HCCi Gi8Ca8C [GHOGCHa Oi _a8IiiC} aHG iH jaIiCHI8 VIH a
Hi8IOiy O jCjIiC HCCi Gi8Ca8C WHO Ha\C HOI DCCH jiC\iOH8y
IiCaICG Oi 1. ]}l0I! iHCCIiOH. HC HO8I COHHOHy H8CG
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DC iCGHCCG Dy a8 HHCH a8 ZD7 iH jaIiCHI8 WHO Ha\C IaKCH a
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WCCK8 Oi Di8HHIH Oi aHIiDiOIiC IHCiajy VIHiH + WCCK8 O IHC
CHGO8COjy, IHCiCOiC DiOj8y OOWCG Dy Hi8IOO_C C\aHaHOH
Oi C\iGCHCC O 1. ]}l0I! iHCCIiOH i8 IHC CHGO8COjiC IC8I O
CHOiCC Oi IHi8 jaIiCHI. HC 8CH8iIi\iIy O HiCa DiCaIH IC8IiH_
iKC IHaI O IHC iajiG HiCa8C IC8I i8 iCGHCCG Dy HCGiCaIiOH8
IHaI aCCI HiCa8C jiOGHCIiOH 8HCH a8 a 111.
iCaIHCHI Oi jCjIiC HCCi Ui8Ca8C i8 _HiGCG Dy IHC DiOj8y aHG
jiC8CHCC O 1. ]}l0I! iHCCHOH. 1H IHC jiC8CHCC O GOCHHCHICG
iHCCIiOH IiijC IHCiajy COH8i8IiH_ O a 111 aHOXiCiiH aHG
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iijC IHCiajy i8 HOI iHGiCaICG iH IHC aD8CHCC O GOCHHCHICG
iHCCIiOH. 1H IHi8 jaIiCHI IiijC IHCiajy 8HOHG DC WiIHHCG
jCHGiH_ GOCHHCHIaIiOH O iHCCIiOH.
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IHCCOHHICi iDHjiOCH, HaHy jaIiCHI8 WHO IaKC 8HCH HOH
jiC8CiijIiOH HCGiCaIiOH8 aiC HHaWaiC IHaI IHCy aiC IaKiH_ aH
l1i IHaI CaH CaH8C HCCi G8Ca8C.
J ]}l0I! iHCCIiOH Ha8 DCCH iHCG OHI iH IH8 jaIiCHI Dy IHC
HC_aIi\C Hi8IOO_y Oi IHC Oi_aHi8H a8 WC a8 HC_aIi\C 8CiHH
aHIiDOGy IC8IiH_, IHCiCOiC HO iIHCi IC8IiH_ Oi 1. ]}l0I! i8
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a8 a _a8IiiHOHa [ZOiH_Cii8OH 8yHGiOHC} CHCa CaIuiC8
O WHiCH iHCHGC HHHjC jCjIiC HCCi8 HCCi8 iH HHH8Ha OCa
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IHi8 jaIiCHI Ha8.
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OWC\Ci IHi8 jaIiCHI Ha8 a GHOGCHa HCCi WHCH i8 HHCH
C88 iKCy IO iCjiC8CHI a Hai_HaH aHG DiOj8y O IHC HCCi
Oi OOWHj CHGO8COjy IO a88C88 Oi HCaiH_ i8 HOI HCCGCG.
lCHGiOHaIC IHCiajy Oi O8ICOjOiO8i8 Ha8 DCCH a88OCiaICG VIH
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jiiaIC aI IH8 IiHC.
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8ICj. l1i8 aiC IHC GiH_8 HO8I HCQHCHIy a88OCiaICG WiIH
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HOH CaH8C8 O Gy8jCj8ia 8HCH a8 l1i H8C.
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aHG HHCCC88aiy IiCaIHCHI uIHC jaIiCHI8 Gy8jCj8ia iHjiO\C8.
1 8yHjIOH8 COHIiHHC aHCi 8IOjjiH_ IHC l1i IC8IiH_ Oi
J ]}l0I! i8 WaiiaHICG.
laiH CaIHiC8 8HCH a8 HHCXjaiHCG iiOH GCHCiCHCy aHCHia
HHiHICHIiOHa WCi_HI O88 Gy8jHa_ia OGyHOjHa_ia jajaDC
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HjjCi CHGO8COjy. CCaH8C IHC iHCiGCHCC O HJ_HaH i8 8i_
HiHCaHIy _iCaICi iH jaIiCHI8 OGCi UaH DD yCai8 HjjCi
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HCWOH8CI Gy8jCj8ia C\CH ViIHOHI aaiH CaIuiC8. Hi8 jaIiCHI
Ha8 HO iHGiCaHOH Oi HjjCi CHGO8COjy.
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Item Z Answer:
Educational Ob]ective: tmprrally ncat [nrtanal
dyspcpsa wth a prann pump nhbnr
HC HOSI ajjiOjiiaIC HaHa_CHCHI Oi IHiS jaIiCHI iS aH
CHjiiiC Iiia WIH a jiOIOH jHHj iHHiDiIOi [11}. HHCIiOHa
GySjCjSia iS GCLCG aS CHiOHiC Oi iCCHiiCHI GiSCOHOiI iH IHC
Cji_aSIiiHH WiIH HO Oi_aHiC CaHSC GCICiHiHCG. ljjCi
CHGOSCOjy iS HCCCSSaiy IO iHC OHI Oi_aHiC CaHSCS aHG OHy
aHCi IHiS iS jCiOiHCG CaH IHC Gia_HOSiS O HHCIiOHa GyS-
jCjSia DC GiSIiH_HiSHCG HOH Oi_aHiC GySjCjSia [C._. GySjCj
Sia CaHSCG Dy jCjIiC HCCi GiSCaSC iCHHX CSOjHa_iIiS Hai_
HaHCy}. CCaHSC IHiS jaIiCHIS HHCIiOHa GySjCjSia SyHjIOHS
aiC HCCi-iKC aH CHjiiC Iiia O a 11 iS IHC iCCOHHCHGCG
IiCaIHCHI.
1HDHaIOiy CSOjHa_Ca j1 HOHiIOiiH_ WHiCH COHSiSIS O
iHSCiIiH_ a j1 HOHiIOi iH IHC UiSIa CSOjHa_HS aHG iCCOiGiH_
IHC iCSHIS O\Ci a jCiiOG O Z HOHiS iS IHC HOSI aCCHiaIC
HCaHS IO COHHiH IHC Gia_HOSiS O _aSIiOCSOjHa_Ca iCUH UiS-
CaSC GIF }. HC ICCHHiQHC aSO aOWS GCICiHHaIiOH O aH
aSSOCiaIiOH DCIWCCH SyHjIOHS aHG IHC aHOHHI aHG jaIICiH
O CSOjHa_Ca aCiG CXjOSUiC. HiS jiOCCGHiC Hay DC HCjH
WHCH IHC Gia_HOSiS O GIF iS iH GOHDI Oi ajjiOjiiaIC
GIF IHCiajy iS HOHSHCCCSSH. HiS jaIiCHIS SyHjIOHS aiC
HOI COHjaIiDC ViIH GIF aHG aHDHaIOiy j1 HOHiIOiiH_
iS HOI iHGiCaICG.
HHCIiOHa GySjCjSia GOCS HOI Ha\C aH ajjaiCHI Oi_aHiC CaHSC
IHaI iCQHuCS SHi_Ciy. HCiCOiC SHi_iCa COHSHIaIiOH iS HOI
iHGiCaICG. YiIH HO OIHCi Si_HS Oi SyHjIOHS IO SH__CSI a jSy-
CHiaIiiC iHCSS jSyCHiaIiiC COHSHIaIOH S HOI WaiiaHICG.
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| IiH L8SLiOCHLiO. ZUUb.V( b SUjj}.bZ11bZ1. 11. 1bVo+o[
Item Z Answer:
Educational Ob]ective: !apnasc pasnannstnal
blccdnp af absrurc rausc.
HC HCXI SICj iH IHC HaHa_CHCHI O IHiS jaICHI iS IO iCjCaI
IHC HjjCi CHGOSCOjy. HiIia CHGOSCOjy Hay HiSS CSiOHS IHaI
aiC GiHCHI IO SCC Oi DCCG iHICiHiIICHIy. CIWCCH OHC IHiG
aHG DO IHiiGS O SOHiCCS O _aSIiOiHICSIiHa DCCGiH_ O
ODSCHiC CIiOO_y aiC OHHG WiIHiH IHC iCaCH O HjjCi
CHUOSCOjy WHiCH iS IyjCay IHC HCXI jiOCCGHiC jCiOiHCG
OOW_ HOHGia_HOSUC HjjCi aHG OWCi CHGOSCOjy. CjCaI
HjjCi CHGOSCOjy iS jaiIiCHaiy ajjCaiH_ iH IHiS jaIiCHI ViIH
a HiaIa HCiHia DCCaHSC O IHC jOSSiDiiIy O \aHCiOH CSiOHS.
\aHCiOH CSiOHS aiC iHCai _aSIiiC HCCiS Oi CiOSiOHS iH IHC
HiaIa HCiHia SaC. \aHCiOH CSiOHS aiC HSHay aH iHCiGCHIa
HHGiH_ aHG aiC SCCH iH D7O [aIiCHIS VIH HiaIa HCiHiaS WHO
HHGCi_O CHGOSCOjiC CXaHaIOH DHI IHCy CaH CaHSC CHiOHiC
Oi CSS OHCH aCHIC DOOG OSS.
iCjCaI HjjCi CHGOSCOjy iS HC_aIi\C COHSiGCiaIiOH CaH DC
_\CH IO iCjCaI COOHOSCOjy Oi CajSHC CHGOSCOjy. H ViiC
CSS CajSHC CHGOSCOjy a jaIiCHI SWaOWS a \iGCO CajSHC IHaI
Dy iHICSIiHa HOIiiIy jaSSCS UOH_H IHC SIOHaCH aHG iHIO
Gas!rCen!erCCQy anO Hepa!CCQy 83
IHC SHa HICSIiHC. HC \iGCO CajSHC IiaHSHiIS iHa_CS IO a
iCCOiU_ GC\iCC WOH Dy IHC jaHCHI. HiS jiOCCGHiC HaS DCCH
SHOWH IO GCICCI SOHiCCS O DCCGiH_ iH 7O jaIiCHIS aHG iS
COHSiGCiCG IHC ICSI O CHOiCC OOWiH_ HjjCi aHG OWCi
CHGOSCOjy SIHGiCS.
aDu1 SWaOW HaS a OW SCHSiU\Iy aHG SjCCiBCiIy iH IHC Ua_-
HOSiS O _aSIiOiHICSIiHa DCCGiH_ COHjaICG WiIH HjjCi
CHGOSCOjy aHG CaH iHICiCiC WiIH SHDSCQHCHI CHGOSCOjiC
SIHGiCS. HC GOHDC DaOOH CHGOSCOjC iS a SySICH IHaI HSCS
DO aICX DaOOHS OHC HOHHICG OH IHC CHGOSCOjC aHG a SCC
OHG DaOOH OH IHC O\CiIHDC WHiCH aiC SHCCCSSi\Cy iHHaICG
aHG GCHaICG IO jCaI IHC DOWC O\Ci IHC CHGOSCOjC aHG
aCHiC\C GCCj iHIHDaIiOH O IHC SHa iHICSIiHC. OHDC Da
OOH CHGOSCOjy Hay DC jCiOiHCG IHiOH_H aH Oia Oi a
IiaHSaHa iOHIC aHG HaS iCjaCCG iHIiaOjCiaU\C CHICiOSCOjy H
HaHy CaSCS. HC iOC Oi GOHDC DaOOH CHGOSCOjy iS IO C\a-
HaIC Oi IiCaI BHGiH_S SCCH OH CajSHC CHGOSCOjy Oi C\aHa-
IiOH O OH_OiH_ DCCGiH_ WHCH DCCGiH_ iS DiiSK CHOH_H IHaI
IHC HCCG Oi CHGOSCOjiC HCHOSIaSiS iS CXjCCICG aHG aS a COH-
jCHCHIaiy ICSI WHCH a SHa-DOWC SOHiCC O DCCGiH_
iCHaiHS a COHCCiH GCSjiIC a HOHGia_HOSIiC CajSHC CHGOSCOjy.

|B gSl0BSB 00Bg 0 00SCUl 0lgB, l Ul
B00SC0 W 0B 00Bg S0UlC B SgBCB l00I
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b1. _11. i+Z+1[
Item d Answer:
Educational Ob]ective: !apnasc srhcmr ralts.
HC HOSI iKCy Gia_HOSiS iS iSCHCHiC COiIiS. 1IHOH_H aH
HHGCiyiH_ CaHSC iS OHCH HOI iGCHImCG COOHiC iSCHCHia CaH
OCCHi H aSSOCiaIiOH ViIH COOHiC HyjOjCiHSiOH iH IHC SCIIiH_
O aOiIiC Oi CaiGiaC DyjaSS SHi_Ciy, jiOOH_CG jHySiCa CXCi-
IOH [Oi CXaHjC OH_-GiSIaHCC iHHHiH_} aHG aHy CaiGiO
\aSCHai C\CHI aCCOHjaHiCG Dy HyjOICHSiOH. CGiCaIiOHS
SHCH aS Oia COHIiaCCjIi\CS GiH_S SHCH aS COCaiHC \aSCHiIiGCS
aHG HyjCiCOa_HaDC SIaICS Ha\C aSO DCCH iGCHUCG aS iiSK
aCIOiS. OSI jaICHIS ViIH COOHiC iSCHCHia aiC OGCi IHaH O
yCaiS aHG HSHay jiCSCHI ViIH CH OWCi QHaGiaHI jaiH Hi_CHI
GCCCaIiOH aHG iCG Oi HaiOOH iCCIa DCCGH_ IHaI UOCS HOI
iCQHiiC IiaHSHSiOH. 1aIiCHIS Hay Ha\C HiU ICHGCiHCSS O\Ci
IHC HVO\CG SC_HCHI O COOH, HyjO\OCHia aHG jCiiIOHiIiS
aiC iaiC. \OOHOSCOjiC HHGiH_S aiC _CHCiay SC_HCHIa aHG
iHCHGC HCHOiiHa_C HOGHCS iHCai aHG CiiCHHCiCHUa HCCi
aIiOH aHG _aH_iCHC. HCiajy HCHGCS iHIia\CHOHS HiGS aHG
aHIiDiOIiCS IO CO\Ci aHaCiODCS aHG _iaHHC_aIi\C DaCICiia
aIHOH_H GaIa IO SHjjOiI IHiS aIICi jiaCIiCC aiC WCaK.
OSI jaIiCHIS VIH aCHIC HCSCHICiiC iSCHCHia aiC OGCi IHaH
D yCaiS. bC\CiC aDGOHiHa jaiH iS aHOSI iH\aiiaDy jiCSCHI
DHI Caiy jHySiCa CXaHiHaIiOH BHGiH_S aiC HiHiHa HSIiaI-
iH_ IHC CaSSiC ICaCHiH_ OjaiH OHI O jiOjOiUOH IO CXaHi-
HaIiOH. 1IHOH_H OCCHI DOOGjOSiIi\C SIOO iS COHHOH
O\CiI DCCGiH_ iS iaiC. aIC Si_HS aHG SyHjIOHS iHCUGC HaH-
SCa \OHUH_ C\Ci HCHaICHCSiS ODSIiHCIiOH DaCK jaiH aHG
SHOCK.
b4 Gs!tOCn!CtOOQynU HC!OOQy
i\CiIiCuJi Ui8CJ8C CHCOHjJ88C8 DOIH Ui\CiIiCuJi HCHOi-
iHJ_C JHU Ui\CiIiCuiIi8. i\CiIiCuO8i8 i8 JH iHjOiIJHI CJu8C
O HJ88i\C jJiHC88 OWCi _J8IiOiHIC8IiHJ DCCUiH_ iH OUCi
jJIiCHI8. i\CiIiCuiIi8 iC8uI8 HOH OD8IiuCIiOH JI IHC Ui\Ci-
IiCuuH HCCK Dy CCJ HJIICi CJUiH_ IO HuCu8 JHU DJCICHJ
O\Ci_iOWIH. CCJu8C 85" O Ui\CiIiCuiIi8 OCCui8 iH IHC 8i_
HOiU Oi CH COOH CH OWCi quJUiJHI jJiH i8 IHC HO8I COH
HOH CuHiCJ HJHC8IJIiOH OHCH JCCOHjJHCU Dy C\Ci JHU
CuKOCyIO8i8 O\CiI iCCIJ DCCUiH_ i8 IyjiCJy HOI 8CCH. H
jJIiCHI8 WiIH 8u8jCCICU Ui\CiIiCuuIi8 COOHO8COjy i8 HOI jCi-
OiHCU DCCJu8C O IHC H8K O COOHC jCiOiJIiOH.
M0Stpt|8htSWthC00hCSCh8mI80d8Ithhby8IShd
uSuypI8S8htWth8t0W8IqudIhtph,uIg8htd88Ct0h,
hdI8d0ImI00hI8Ctb88d|hgthtd08Sh0tI8quI8tIhSuS0h.
D:O_aQHy
1CHCi8!8G! i8HG! !|. \OOH 8CHCH8. iCCCH! H8_H!8 8HG 8Gv8HCC8.
\Hii L88!iOCH!CiO CQ. ZJJZ(b].V. 111. ZVb[
Item d3 Answer: A
Educational Objective: 1tt0gHI& lIR 0j lt0ht4IHg
IH 0 ]0lItHl HIlb H@tl g0H0IHlIH0 0tt4IHg.
\jjCi CHUO8COjy 8HOuU DC jCiOiHCU JI IHC IiHC O JH
ujjCi _J8IiOiHIC8IiHJ DCCU JHCi JjjiOjiiJIC \OuHC iC8u8-
CiIJHOH IO jiOVUC J UiJ_HO8i8 J8 IO IHC CJu8C O DCCUH_ jiO-
ViUC J jiO_HO8i8 JHU jCiOiH CHUO8COjiC _uiUCU IHCiJjy i
iCquiiCU. Oi CXJHjC JH uCCi VIH J Vi8iDC \C88C HJ8 JH
JjjiOXiHJICy 50" ii8K O iCDCCUiH_ i HOI IiCJICU CHUO
8COjiCJy. HC8C uCCi8 CJH DC CHCCIi\Cy IiCJICU WiIH iHjCC-
IiOH IHCiJjy IHCiHa COJ_uJIiOH \J CHUO8COjiC jiODC8 Oi
HCCHJHiCJ HOUJuIiC8 8uCH J8 CHUOCij8. \CJHDJ8CU uCCi8
iCDCCU iH C88 IHJH 5" O CJ8C8 JHU UO HOI iCquiiC CHUO8COjiC
IHCiJjy.
HCiC i8 J 5" IO 0" iCDCCUiH_ iJIC Oi CHUO8COjiC HCHO
8IJ8i8. H IHC8C jJIiCHI8 CHUO8COjiC IHCiJjy HJy DC iCjCJICU
i IHC jJIiCHI iCHJiH8 HCHOUyHJHiCJy 8IJDC. iCjCJI
CHUO8COjy i8 uH8uCCC88H Oi IHC DCCUiH_ \C88C i8 iHJCCC88i
DC Oi IOO Ji_C 8ui_iCJ COH8uIJIiOH 8HOuU DC ODIJiHCU.
OWC\Ci CHUO8COjiC iHICi\CHIiOH i8 IHC Hi8I HJHJ_CHCHI
CHOiCC Oi ujjCi _J8IiOiHIC8IiHJ DCCUiH_.
HIiJ\CHOu8 OHCjiJZOC HJ8 DCCH 8HOVH IO iCUuCC IHC H8K O
iCCuiiCHI ujjCi _J8IiOiHIC8IiHJ DCCUiH_ H jCjIiC uCCi8 JHCi
CHUO8COjiC HCHO8IJ8i8. \iJ OHCjiJZOC J8O HJy UCCiCJ8C
iCDCCUH_. 1 HCIJJHJy8i8 8HOWCU IHJI JUju\JHI Hi_HUO8C
jiOIOH juHj HiDiIOi IHCiJjy OhOWH_ CHUO8COjiC HCHO-
8IJ8i8 Oi uCCi8 JI Hi_H ii8K O iCDCCUiH_ iCUuCC8 iCDCCUiH_
8ui_Ciy JHU HOiIJiIy. \CIiCOIiUC HJy HJ\C J HJi_iDJ DCHC
BI Dy UCCiCJ8iH_ IHC iJIC O HOH\JiiCCJ DCCUiH_ DuI i8 iHC
iiOi IO iHIiJ\CHOu8 jiOIOH juHj iHHiDiIOi8. bHUiHC J H8-
IJHiHC _ DOCKCi i8 iHCHOi IO jiOIOH juHj iHHiDiIOi8 J8 JH
JUjuHCI IO CHUO8COjiC IHCiJjy JHU IHCiC i8 HO DCHCHI O JUUiH_
J Hi8IJHlHC _ DOCKCi IO jiOIOH juHj iHHiDiIOi IHCiJjy.

Upp8I8hd0SC0pySh0udb8p8I0Im8dtth8tm80hupp8I
gStI0ht8Sthb88dt8IppI0pIt8v0um8 I8SuSCtt0h t0
pI0v|d8 dgh0SS St0th8 CuS8 0b88dhg, pI0vd8pI0gh0-
SS,hdp8I0Im8hd0SC0pCgud8d th8IpyI8quI8d.
D:O_aQHy
\8QQC 1b 1DCGC 1. 1H!8 H8H8_CHCH! O 8CH!C HQQCi _88!iOH!C8-
UH8 DCCGH_. OH H!8 Cv8H8UOH HQ !O _88!iOH!C8!H8 CHGO8COQy.
1CG \H Oi!H A ZVZ(].+VJ-bV x. 111. J+[
Item dZ Answer:
Educatonal Objectve: 0H0gt H@tl g0O0IH~
lIH0 0tt4IHg HIlb ltHl0lI0H 0j lbt IHO0V0tH0l V0~
Hmt.
HC Hi8I 8ICj iH IHC HJHJ_CHCHI O JCuIC \JiiCCJ HCHOi
iHJ_C i8 IHC iC8IOiJIiOH O IHC iHIiJ\J8CuJi \OuHC u8iH_ J
Ji_C DOiC jCHjHCia iHIiJ\CHOu8 uHC Oi J CCHIiJ iHC. JCKCU
CiyIHiOCy1C8 JiC u8CU J8 HCCUCU IO iCjJCC DOOU O88 aHU COI
IiH_ JCIOi8 JiC iCjJCCU J8 HCCUCU. JICCI IiJH8H8iOH8 HJy
DC iHUCJICU i \JuC8 J DCOW 50,000/I 50 0" /I).
OOWiH_ iC8IOiJIiOH O IHC iHIiJ\J8CuJi \OuHC U8 jJHCHI
8HOuU uHUCi_O ui_CHI C8OjHJ_O_J8IiOUuOUCHO8COjy JHU
DJHU i_JIiOH O C8OjHJ_CJ \JiiCC8. JHU _JIiOH HJ8 DCCH
8HOWH IO DC J8 CHCCIi\C J8 8CCiOIHCiJjy Oi jiC\CHIiH_ CJiy
iCDCCUiH_. HCiJjy 8HOuU J8O DC 8IJiICU WiIH iHIiJ\CHOu8
OCIiCOHUC WHCH iCUuCC8 jOiIJ \CHOu8 DOOU iHBOW UiOu_H
iHHiDiIiOH O IHC iCCJ8C O \J8OUiJIOiy HOiHOHC8 JHU i8 HOiC
CHCCIi\C Oi COHIiOiH_ DCCUiH_ IHJH jJCCDO HOWC\Ci iI8
uIiHJIC CCCI OH 8uiV\a i8 uHKHOWH.
/iICHO_iJjHy i8 HOI Bi8I-iHC IHCiJjy iH jJHCHI8 VIH J \JHCCJ
DCCU HOH \CHOu8 jOiIa HyjCiICH8iOH JHU HO iHICi\CHIiOH
8HOuU IJKC jiCCCUCHCC O\Ci iC8IOiJHOH O IHC iHIiJ\J8CuJi
\OuHC. /iICiiO_iJjHy i8 iC8Ci\CU Oi jJIiCHI8 WiIH J jiC-
8uHCU JiICHJ 8OuiCC O DCCUiH_ J8 CJH DC 8CCH iH jCjHC uCCi
Ui8CJ8C Oi IuHOi8 JHyWHCiC JOH_ IHC _J8IiOiHIC8IiHJ IiJCI.
H 8uCH CJ8C8 JiICiiO_iJjHy CJH DC u8CU IO iUCHIiJ JHU
CHDOZC IHC 8jCCiHC \C88C iH\O\CU. Hi8 HCIHOU i8 u8uJHy
iC8Ci\CU Oi CJ8C8 iH WHiCH IHC jJIiCHI i8 JCIi\Cy DCCUiH_ JHU
CiIHCi CHUO8COjiC IHCiJjy HJ8 JiCU IO 8IOj IHC DCCUiH_ Oi
IHC jiC8CHCC O JCIi\C DCCUiH_ iHICiCiC8 WiIH iUCHIiBCJIiOH
O IHC DCCUiH_ 8iIC JHU IHC jJIiCHI i8 uH8IJDC.
HIiJ\CHOu8 HJUOO i8 HOI JjjiOjHJIC DCCJu8C IH8 jJIiCHI i8
HyOICH8i\C JHU HCCU8 \OuHC iCjJCCHCHI JHU CHUO8COjiC
iHICi\CHIiOH iJIHCi IHJH HCUiCJ IHCiJjy. 1 HOH8CCCIi\C -
DOCKCi i8 u8CH iH IHC jiiHJiy JHU 8CCOHUJiy jiC\CHIiOH O
\JiiCCJ DCCUiH_ DuI HOI J8 JCuIC IHCiJjy.
V0um8I8St0It0hSpI0Itymhg8m8htht8Iv8ht0h0I
gStI0ht8Sthb88dhgh h8m0dyhmCy uhStb8pt8htS.
DlO_aQHy
\8QQC 1b 1iCGC 1. H!8 H8H8_CHCH! O 8CH!C HQQCi _88!iOH!C8
!H8 DCCGH_. OH H!8 Cv8H8UOH HQ !O _88!iOH!C8!H8 CHGO8COQy.
1CG \H Oi!H A ZVZ(].+VJbV x. 111. J+[
Item dd Answer: L
Educational Objectve. 1I0gH0t 4IVtllItH0I 0l
V0tH0l ttmI0 0 lbt m0l Ikty t0Ht 0j ]0IHt 0Htl
g0O0IHlIH0 0tt4IHg.
HC HO8I iKCy 8OuiCC8 O jJiHC88 OWCi _J8IiOiHIC8IiHJ
DCCUiH_ JiC Ui\CiIiCuO8i8 JHU \J8CuJi CCIJ8iJ. /Ci HCHO
UyHJHiC 8IJDiiZJIiOH IHC HCXI 8ICj i8 IO Ui8IiH_ui8H ujjCi
BJD |Jwc|_1||J|M|c||M1| U|ccd|M_. JMc |ccMcc J| U|JJd
J| cJ||cc_|JuMd||Kc D1|c||1| JM _1|||c |1\1_c |Md|c1|c
JM_J|M_ J| |cccM| uc| _1||J|M|c||M1| U|ccd|M_ 1Md |Mc
Mccd |J| uc| cMdJcJy. `c_1||\cM1J_1|||c |uUc |1\1_c
||c||1U|c|M|u||M_Ju|uc|_1||J|M|c||M1|U|ccd|M_JM|y||
|Mc 1||1|c cJM|1|M U||c [1 yc||Jw J| _|ccM hu|d |M1| |c|
J|||\c |J| U||c w||M 1 u||Mc d|||cK) |Md|c1||M_ 11_c J|
|Mc |uUc UcyJMd |Mc y|J|u |M|J |Mc duJdcMuD.
JMcDJ|cJDDJMc1ucJ|1cu|c c\c|c |Jwc|_1||J|M|c
||M1|U|ccd|M_1|ccJ|JM|cd|\c|||cu|1 1M_|cc|1|1[1|JKMJwM
1 1M_|Jdy|1|1) cJl||| [|J| c1M|c |Mh1DM1|J|y UJwc|
d|c1c |M|cc||JM |cMcD|1 J| |1d|1||JM) 1Md cJ|JM|c McJ
|1|1. |ccd|M_BJD1cJ|JM|cd|\c|Ucu|uD1Md\1cu|1|cc|1
|1 | |y|c1||y 1cu|c 1Md 1|M|c. cMcD|c cJ|||| |y|c1||y
Jccu||MJ|dc||Md|\|du1|w||M|_M|Dc1M|c1|d|1caMdc||M
c|1| \1cu|1| d|c1c wMJ |ccM| w||M 1UdJD|M1| 1|M 1Md
JM|y1D1||1DJuH|J| U|ccd|M_. 1||cM|w||MH 1|J|y
UJwc| d|c1c 1Md U|ccd|M_ uu1||y |1\c 1M c|1U||Mcd M|
|J|yJ||Mh1DD1|J|yUJwc|d|c1caMd1UdJD|M1|1|M. JMc
1||cM||cccM|cJ|JMJcJy1Md|1|_c\J|uDcU|ccd|M_D1Kc
1 McJ|1D uD|1Kc|y.
PO1MT
1h8 m0St k8y S0ufC8S 0l ph8SS 0W8f gStf0ht8Sth b88dhg
f8 dv8ftCu0SS hd vSCuf 8CtS.
1DlO_aQHy
ZHCCaiO L. QGCHOO_y O OWCi _a8IiOHIC8IHa UCCGiH_. C8I iiaCI
C8 IH La8IiOCHICiO. ZoZZ(Z}.ZZOZZ. _i1i. Jo+o_
Item dR Answer: A
Educatonal Objectve: !aqna:c anal [::urc a: a
tau:c af panl bcmantbcca.
JM|1||cM|DJ|l|Kc|yM11M1M1|Du|c|M1||c1u|M_|cc
|1|Ju||c|U|ccd|M_1Md1|MV||Mdc|cc1||JM1Md|M1|||JU
1U|y duc|JMc||cccM|cJM||1||JM.1 1M1|Du|c|1|c1||M
|Mc||M|M_J||Mc1D1|c1M1|.\1|c0||cc|1|cM1UJMUy_cM
|ly |c1d|M_ ||1c Uu||JcK 11|| D1y |c\c1| ||c Du|c Uu|
UDDd|M_D1yMJ|1|w1yUc|ccM|. JMc1||cM|D1yM1\c
|JJDucM1|M|J1l|Jwd|g|1l|cc|1lcM1uJMJ|1MJcJy.
\M|JM|c Du|c1|cJUcM1ccJD1M|cdUyc|c|M1l K|M |1_
1ccM|M|||1ucM|. ccu||cM|J|MJMMc1m_Du|cMJu|d
|1|c cJMcc|M|J|uMdc||y|M_ d|c1c 1|||cu|1||y \|J|M d|
c1c.
cc|1|c1Mcc|1MdcJ|JMc1Mcc|Du|1|w1yUc cJM|dc|cd |M
JDcJMc w||M McwJMc| |cc|1| Ju||c| U|ccd|M_. Jwc\c|
|||1||cM|uMdc|wcM|cJ|JMJcJy|c||1M 1 yc1|1_J 1Md
|cu||wc|c MJ|D1|. \cM|||M|1||cM|M1dcJ|JM|cU\c|||c
u|1 |Mc |1c| |M1| Mc| U|ccd|M_ Jccu|V||M l dc|cc1||JM
1MdM1 UccM |ccM| J\c|1 oDJM|Mc||Jd| MJ| |yQ|c1|J|
d|\c|||cu|1| U|ccd|M_ wM|cM |cMd |J c1uc |_M|Dc1M| 1cu|c
1|M|c McD1|JcMc2|1 |M1| JUcM |J JM|1McJu|y.
O1MX
Ah lSSuf8S g8h8Iy CuS8 f8Ct 0ut8t b88dhg hd ph Wth
d8l8Ct0h.
1DlO_aQHy
IHOH_ ib aiIOO iI. CHOiiHOG8 aHG 88HiC H aHO. La8IiOCHICiO
IiH OiIH P. Zo/(}.Z/++ b. _i1i. Jo/V+_
Gas!rOe!erOOQy aO Hepa!OOQy bb
Item d Answer:
Educatonal ObjeOve: Strccn far bcpantcllular tar-
tnama n a parcnr wrb bcparr: 1.
JMc DJ| 1|J||1|c c|ccM|M_ ||1|c_y |J| Mc1|Jcc||u|1|
c1|c|MJD1|M|M|1||cM||||\c|u|||1JMJ_|1My. c1|Jcc|
|u|1| c1|c|MJD1 | |Mc DJ| cJDDJM ||D1|y |M||1Mc1||c
|uDJ| 1Md ||c |1|c|_|Jw|M_c1uc J| c1Mcc||c|1|cd dc1|M
|M DcM |M |Mc \M||cd|1|c. JMc c1|cc| uu1||ydc\c|J|M
1||cM|w||hc|||MJ|. JMcDJ|cJDDJMc1ucJ|c|||MJ|
|c1d|M_ |J Mc1|Jcc||u|1| c1|c|MJD1 1|c cM|JM|c Mc1||||
1MdMc1u||\V|1||M|ccUJM1Md1lcJMJl|c\c|d|c1cMJw
c\c| 1||cM|V|||cM|JM|cMc1|||||M|cc||JM|M|Mc1UcMcc
J| c|||MJ| M1y dc\c|J Mc1|Jcc||u|1| c1|c|MJD1. 1||cM|
w||M1cJD1UU|cu|||1JuHd|D1_|M_|udy1Md1uUcQucM|
c|uM 0|c|J|J|c|M |c\c| _|c1|c| ||1M 500 M_/D 500
|!_/)c1MUcd|1_MJcdV||MMc1|Jcc||u|1|c1|c|MJD1w|||
Ju|1U|Jy. JMcJ||D1l||Dc|J|m||1|c1c|ccM|M_|J_|1D
1Md || |dc1|BcQucM 1|c uMKMJwM.
\JDU|Mcd uc J| 0|c|J|J|c|M Dc1u|cDcM| 1Md u|||1
JMJ_|1My|Mc|c1c |Mc cM|||\||y J| dc|cc||JM Uu| 1| |Mc
ccMc J| |Mc|c1cd |1|cJ|||\c |cu||. 0c|J|J|c|M |
MJ| cc|Dc |J| Mc1|Jcc||u|1| c1|c|MJD11Md MJu|d MJ| Uc
ucd 1|JMc 1 1 c|ccM|M_ |c| uI1c u|||1JuMd | MJ| 1\1||
1U|c. |\c| \J c1MD|M_ cJc |Mc 1||cM| |J H ccc1|y
|1d|1||JM1|||cu|1||y||c|ccM|M_| c||J|DcdBcQucM|ly.
|t8htS Wth Chf0hC h8pttS b hl8Ct0h h th8 bS8hC8 0l Cffh0-
SS my d8v80p h8pt0C8uf CfCh0m hd Sh0ud uhd8fg0
p8f0dC SCf88hhg.
1DlO_aQHy
H bL OHaHHCG 1HCH , 1aO |. iiCvCHUOH O HCQaIOCC
Hai CaiCiHOHa iH HCQaUU8 viH8 HCCIOH. | La8IiOCHICiO CQaIO.
ZVZ+(o}.JOZ/. _i1i. JV/ZV_
Item d Answer: A
Educatonal Objectve: !aqna:c bcparr: .
JM|1||cM|DJ|Kc|yM11cu|cMc1||||1. JMc1||cM|M1
c||M|c1| yD|JD 1Md |1UJ|1|J|y DMd|M_ cJM||cM| w||M
1cu|c Mc1||||[|1||_uc [1uMd|cc JJ||1M|c|1c cJMccM
||1||JM>000 \/). J|c D1[J| |Ju|cJ| ||1MD||JM 1|c
|M_c||JMJ|cJM|M1|cd|JJdJ|w1|c|1MdcJM|1c|w||MaM
|M|cc|cdc|JM. \|Ju1|1|||cu|1||yM|_M||K|Mc|udccJ
|c||\0_|MJ|||1\cl|M_|Judc|dc\c|JcdcJuM|||ccM||d|cM
|Md1yc1|cccM|c| DcMwMJM1\ccw||MDcM 1Mdc||1
cJ|c wMJ|M_c| |1w Mc||DM. 1||MJu_M1My J| |Mc Mc1||
|| \||uc c1M c1uc yD|JD1||c 1cu|c Mc1|||| Mc1||||1
| |Mc DJ| ||Kc|y |M|cc||JM |M 1 ||1\c|c| |J 1M uMdc\c|Jcd
cJuM||yW||Ju|J|Mc|||K|1c|J|.c1uU1|1|DJ|1|w1y
1c||||D||cd|M|cc||JM 1||MJu_M1cu|cMc1||U1D1y|1|c|y
|ccM| 1 H|D|M1M| Mc1|||| |M1| D1y |cQu||c ||\c| ||1M
|1M|1||JM. JMc c||M|c1| cJu|c D1y |Mc|udc 1 |J|JM_cd
cMJ|c|1||c M1ccM1|1c|c||2cd Uyc|||cMcc J|[1uMd|cc|J|
u|J DJM||. J|c1|DcM|J|1cu|c|c1||||1|uJ|||\c.
c|uD|N11uMc_|JUu||MMJu|dUc1dD|M||c|cd|J1l|MJuc
MJ|d 1Md |M||D1|c cJM|1c| w||M|M 2 wccK J| cJu|c.
c1||||1 \||u\1cc|McMJu|dUc JUc|cd|J ||1\c|c| wMJ
_J|JuMdc|dc\c|JcdcJuM|||c DcMwMJM1\ccW|MDcM
|M[cc||JM d|u_ uc| 1Dd 1||cM| w||M cM|JM|c ||\c| d|c1c.
8b G>!rCC!CrCCQyO HCp!CCQy
Icparirls I, \and arc lcss likcly vlrhour a hisrory ol par-
cnrcral cxposurc. Icpariris virus I\ or dclra agcnr,
dcpcnds upon rhc prcscncc ol IIsAg lor irs rcplicatlon and,
rhcrclorc, cannor survlvc on irs own. !n a paucnr inlccrcd vlrh
hcpariris I, IV inlcrlon may prcscnr as an acurc hcpariris
in which casc ir is a co inlccrion, or an cxaccrbauon ol prc-
cxisring chronic hcpariris in which casc ir is a supcrinlccrion,.
!arlcnrs wirh a hisrory ol injccrlon drug usc arc ar grcarcsr
risk lor acquirlng I\ inlccrlon. !inally, acurc hcpariris \
rarcly causcs symproms.
dl0S Wl dCU0 0dllS g00Id dv0 dlgU0, dUS0d, v0m
llg, [dU0lC0, d0 dml0IdS0IdS0 vdU0S gI0d0I d 1 UlL.
DO_aQDy
I|uDdlgc bI I||Zl|||.K ^. cl||||s . A lm 1hys|.|lD.
JJOo.iOiOo. 1i. iOo+oJoj
IOD d7 HSWOt.
bOUCBIOHB DgOCIVO. 1I0gH0t 0t0b0It btQ0lIlI.
Jhis paricnr has scvcrc alcoholic hcparlris. xccssivc alcohol
inrakc may causc livcr discasc dirccrly or may incrcasc rhc risk
ol an unlavorablc ourcomc in paricnrs virh prccxlsring livcr
discasc. Jhis parlcnr wirh chronic alcohol abusc has many ol
rhc characrcrlsric hndings ol alcoholic hcpatltis: a hlsrory ol
rcccnr hcavy alcohol usc, clcvarcd scrum asparrarc amino-
rranslcrasc ASJ, and alanlnc aminorranslcrasc AIJ, valucs
usually lcss rhan 500 I,I and lrcqucnrIy lcss rhan 300
I,I,, ASJ ro AIJ rarlo grcarcr u 2 ro , clcvarcd alka-
linc phospharasc conccnrrarion, jaundicc, coaguloparhy, and
cnccphaloparhy. Morcovcr, orlcr major causcs ol acurc and
chronlc livcr dlscasc havc bccn cxcludcd.
Jhc parlcnr`s scrolog rcsrs comrm pasr inlccuon vlrh hcpau-
rls I virus and currcnr imumry posirlvc hcparlrls I surlacc
antigcn anrlbody,. Simllarly, rhc scrologlc rcsrs lor hcpatlris A
arc compariblc vlrh pasr inlccrion and currcnr lmmuniry pos-
irlvc !gG hcparlris A anrlbody,. Jhc ncgarivc hcparlris \anrl-
body scrology rulcs our chronic hcparlris \virus inlccrlon.
Auroimmunc hcpariris is an inammarory condirlon ol rhc
livcr ol umown causc. !r primarlly dcvclops in pcrsons 20 ro
40 ycars ol agc, bur all agc groups and mosr crhnlc groups arc
ahccrcd. Womcn dcvclop auroimmunc hcparirls morc olcn
rhan mcn. Mosr parlcnrs prcscnr vrh lcaturcs ol chronic livcr
discasc. Anrinuclcar anribody, anri-smoorh-musclc anribody,
or anrlbody ro livcr,kldncy microsomc tyc anti-IIM,
is prcscnr in 87 ol parlcnrs and hclps ro supporr a dlagnosis
ol aurolmmunc hcparirls. !inally, auroimmunc hcparlris docs
nor causc a larry livcr.
1
l0S Wl dC00lC 0dllS dv0 d lS0I 0 I0C0 0dv dC0
0 US0, 00vd00 S0IUm dSdOd0 dml0IdS0IdS0 [b) d0 dd
l0 dml0fdS0IdS0 [L) C0C0Idl0S, d b'L Idl0 gI0d0I
d 0 1,d0 00vd00 dkdl0 0SddS0 C0C0Idl0.
DO_aQDy
Lu.cy l|hu||D 1 O|glD J.|.OhO||. hcl||Us. ^Dg| |cd.
JJoOJO}.boO. 1i. ibboO+j
IOD d HSWOt.
bOUCBIOHB DgOCIVO. 1I0gH0t 0DImmDHt
btQ0lIlI.
Jhis paricnr has auroimmunc hcparlris, a disordcr rlar occurs
mosr commonly in glrls and young womcn. Iikc rhis paricnr
wirh hyporhyroidism, many allccrcd paricnrs havc orhcr
auroimmunc disordcrs and a lamlly hisrory ol auroimmuniry.
Jhcsc parlcnrs usually prcscnr vrh vaguc symproms. !arlguc,
which occurs in 85 ol paricnrs, is rhc mosr common prc-
scnring symprom, lollowcd by jaundicc 46,, anorcxia
30,, myalgias 30,, and diarrhca. n physical cxamina-
rion, mosr parlcnrs havc an cnlargcd livcr. !aricnrs can havc
aminorranslcrasc conccnrrarlons inro rhc rhousands bur ry-
ically lcss rhan 500 !I ar prcscnrarion,, clcvarcd bilirubin,
olcn ncar-normal alkalinc phospharasc, and hycrgamma-
globulincmia. Auroimmunc scrologic rcsrs, spccihcally anrl-
nuclcar anribodlcs, anrl-smoorh musclc anrlbodlcs, and anrl-
body ro livcr,kidncy microsomc ryc anri-IIM,, may
bc posirivc bur arc nor dcrccrcd in up to 25 ol paricnrs.
!rimary biliary cirrhosis is a chronic progrcssivc cholcsraric
livcr discasc ol unknown causc. !r is an auroimmunc disordcr
rhar occurs prcdominanrly ln womcn 80 ro 0 ol cascs,
bcrwccn 40 and 60 ycars ol agc. Jhc diagnosric rriad associ-
arcd wirh pnmary biliary clrrhosis includcs a cholcsrarlc livcr
promc, posirlvc anrimirochondral anrlbody rircrs, and com-
pariblc hisrologic nndings on livcr biopsy. Scrum alkalinc
phospharasc lcvcl is usually clcvarcd 0 rlmcs or morc abovc
normal. Jhc parlcnr`s ncar-normal alkalinc phospharasc con-
ccnrrarion and ncgarivc anrimirochondrlal anribody csscn-
rially rulc our primary biliary cirrhosis.
Although drug-induccd livcr in|ury can causc simllar livcr rcsr
abnormahrlcs, rlc paricnr has nor rakcn any ncw mcdlcarlons
rcccnrly, making rhis diagnosis unlikcly, and lcvorhyroxinc
would bc a vcry unusual causc ol drug-induccd hcpariris.
Addirionally, druginduccd hcpariris is nor associarcd wirh
posirivc anrl-smoorh musclc anribody hndings. Shc has no
paln ro suggcsr acurc cholccysrlrls.

1
Ld00Id0I l0lgS l dl0S Wl dU0lmmU0 0dllS lCU00
00vd00 S0IUm dml0IdS0IdS0 vdU0S, 0Igdmmdg00Ul0
mld, ml0 0I0llIU0l0mld, ml0 00vd00 S0IUm dkdl0 0S
ddS0 vdU0S, d0 0 I0S0C0 0 dU0dl000l0S.
DhO_aQDy
|lw||| L. I||m.l| |cl|u|cs lDd mlDlgcmcD| O| lu|O|mmuDc hclUUs.
YO||d | Lls||OcD|c|O|. JJo1+i}.ooJiooJb. 1i. 1oboj
IOD d HSWOt.
bOUCBIOHB DgOCIVO. 1I0gH0t 0tD btQ0lIlI 1.
Jhc markcdly clcvarcd amnorranslcrasc lcvcls, posiuvc hcpau-
rls I surlacc anrigcn, and !gM anrlbody ro hcparirls I corc
anrigcn csrablish uc dlagnosis ol acurc hcpariris I inlccrion.
!aricnrs ar grcarcsr risk lor cxposurc ro hcparirls I vlrus inlcc-
rion arc rhosc vlrh a hisrory ol mulrlplc scxual partncrs and
injccrion drug uscrs. Mosr adulr parlcnrs Vclcar rhcir inlcc-
rion alcr a lcw monrhs. Iowcvcr, abour 5 paricnrs dcvclop
acurc progrcssivc hcparirls I wirh hcparlc dccompcnsarion
and nccd urgcnr livcr rransplanrarion, as docs rhis paricnr.
1HC8C jJIiCHI8 ICHG IO HJ\C JH CC\JICG 1JHG J ii8iH_
DiiiHDiHC\CJHG HJy GC\COjCHCCjHJOjJIHy JHJiKCiO
HiHJHI HCjJIiC JiHiC.
JIiCHI8ViIHCHiOHCHCjJIiIi81HJ\CjO8iIi\CHCjJIiIi818Hi
JCC JHIi_CH JHG jO8iIi\C _L JHIiDOGy IO HCjJIiIi8 1 COiC
JHIi_CH_JHIiDOGy IOHCjJIiIi81COiCJHIi_CHi8HC_JIi\C.
H JGGIiOHIH8jJIiCHI8HJHI COHi8Ci8HOI COHjJIiDC
ViIHCHiOHC HCjJIIi8 1iHCCIiOH.
DCHIC HCjJIiIi8 D i8 GiJ_HO8CG Dy IHC jiC8CHCC O_ JHIi-
DOGy IO HCjJIiIi8 D \iiH8 [_ JHIi1DV} VHCH JjjCJi8 JI
IHCOH8CIOIHCJCHICjHJ8COIHCiHC88JHGDCCOHC8HHGC-
ICCIJDC iH 3 IO o HOHIH8. _L JHIi1DV J8O DCCOHC8 jO8-
iIi\C GHiiH_ IHC JCHIC jHJ8C DUI jCi8i8I8 Oi GCCJGC8 JHG i8 J
HJiKCiOiHHHHiIy IOiIHCiiHCCIiOH. DjCi8OHVIHJjO8-
iIi\C _L JHIi1DV IiICi DHI J HC_JIi\C IICi Oi _ JHIi-
1DV HJ8 HJG HCjJIIIi8D iH IHC iCHOIC jJ8I Oi HJ8 iCCCi\CG
HCjJIiIi8 D \JCCiHC.
JIiCHI8ViIH JCHIC HCjJILi8 LJiCH8HJy J8yHjIOHJIiC JHG
IHCiCOiC iJiCy jiC8CHI CHHiCJy DHI o0" IO 85" OjCi8OH8
VHO JCQHiiC JCHIC HCjJIiIi8 L GC\COj CHiOHiC iHCCIiOH.
DIHOH_H GCICiHiHJIiOH O JHIiDOGy IO HCjJIiIi8 L \iiH8
[1LV}i8JiCiJDCJHGHCXjCH8i\CIC8IOiGJ_HO8iH_HCjJIi
Ii8LIHCGiJ_HO8IiC _OG8IJHGJiG i8IHCjiC8CHCCO 1LV
DiH 8CiHH1.
PO1T
0SV6 6dS bSuldC6 dg6 d0 |gN dD00y 0 6dS b
C0l6 dg6 6SdDS 6 0dg0SS 0 dCu6 6dS b6C0.
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_ ``. _1| _
Item R Answer: L
Educational Objective: Oaqnorc rhronr hcpattr L
vrur nfcrton.
1Hi8 jJIiCHI HO8I iKCy HJ8 CHiOHiC HCjJIiI8 L iHCCIiOH.
1CjJIiIi8 L\iiH8 [1LV} i8 IHC HO8I COHHOH DOOGDOiHC
iH!CIiOH iH IHC \HiICG bIJIC8. DIHOH_H 8CiCCHH_ O DOOG
jiOGHCI8 JHG iCGHCCG IiJH8Hi88iOH JHOH_ iHCCIiOH GiH_
H8Ci8HJ\CiC8HICGiHJGCCiCJ8iH_HHHDCiOHCV1LViHCC-
IiOH8IHCHHHDCiOGCJIH8i8iHCiCJ8IH_DCCJH8COIHCDJCK
O_ O CHiOHiC iHCCIiOH8 JHG IHC OH_ GHiJIiOH O CHiOHiC
IHCCHOHDCOiCCHiHO8i8GC\COj8.JIiCHI8VIHJCHICHCjJH
I8 L JiC H8HJy J8yHjIOHJIiC JHG IHCiCOiC iJiCy jiC8CHI
CiHCJyDHIo0" IO85" OjCi8OH8VHOJCQHiiCJCHICHCjJH
Ii8 LGC\COjCHiOHiCiHCCIiOH. 1HCJHIi1LVJHIiDOGy IC8I
i8IHC8CiCCHH_IC8IOiJIii8KjCi8OH8JjO8iIi\CIC8IiHJjCi
8OHWIHOHCOIHCii8KJCIOi8COHBH8CXjO8UiCIOIHCViH8.
1HC1LVDIC8Ii8iCQHiiCGIOGCICiHiHCJCIi\CiHCCIiOH
iJIHCiIHJH H8I CXjO8HiC IO IHC \iiH8.
1CjJIIi8DGOC8HOICJH8CCHiOHiCi\CiGi8CJ8C. 1HCjJIiCHI8
8CiOO_y i8COHjJIiDCViIHCiIHCiJjJ8IiHCCIOHViIHHCjJIi-
Ii8 D \iiH8 OiiHHHZJLOH VIH HCjJLIII8D \JCCIHC.
1CjJIiIi81\iiH8 [11V}CJH8C820" IO 30" OCJ8C8OJCHIC
\iiJHCjJIiIi8JHG 5" OCJ8C8OCHiOHiC\iiJHCjJIiIi8iHIHC
\HiICGbIJIC8. HHjC8CXjJiIHCi8JHGiHCCHOHGiH_H8CJiC
IHC HJOi ii8K JCIOi8 Oi Gi8CJ8C JCQHi8iIOH iH IH8 COHHIiy.
Gas!rOen!erOIOQyanO Hepa!OIOQy B7
1Hi8 jJIiCHI i8 HC_JIi\C Oi HCjJIiIi8 1 8HiJCC JHIi_CH JHG
IHCiCOiCGOC8 HOI HJ\C CHiOHC HCjJIiIi8 1iHCCIiOH.
1CjJIIIi8\iiH8[1VOiIHCGCIJJ_CHI}i8JGCCCH\CViiH8
IHJI iCQHiiC8 IHC jiC8CHCC O 118D_ IO iCjiCJIC. H IHC
\HiICG bIJIC8 iHCCIiOH GiH_ H8Ci8 WIH HCjJIIi8 1 JiC IHC
_iOHj JI Hi_HC8I ii8K OiJCQHiiiH_ HCjJIiIi8 .
PO1WT
16 d~6dS LVluS dD00y 6S S 6 SCl66g 6S 0l d
lSk 6lS0S, d 0SV6 6S d 6lS0 W 06 0 6 lSk dC0lS
C0lS 6X0Sul6 0 6 VluS.
DlO_aQDy
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j_ |1I!|1I!! . _1| _
Item R3 Answer:
Educational Objective: Oaqnorc nonalroholr rnam-
hcpattr ar thc raurc of rrrhorr.
1HC HO8I iKCy CJH8C O IH8 jJIiCHI8 H\Ci Gi8CJ8C i8 HOHJ-
COHOiC8ICJIOHCjJIiIi8 [Db1}. ^8CiIC8JHGCC\JICGJHHO-
IiJH8CiJ8C JHG DiiiHDiH C\C8 8H__C8I jOiIJ H_CiICH8iOH
CJH8CGDy CiiiHO8i8. OHJCOHOiCJIIy \CiGi8CJ8C[D}
COH8i8I8O\JDJDCGC_iCC8O JIJCCHHHJHOHiHHJ JIiOH
JHG DiO8i8 iHIHCJD8CHCCO8i_HCJHI JCOHO iHIJKC. JIIy
H\CiG8CJ8CiHIHCJD8CHCCOiHHJHHJIiOH i8HOiCCOHHOH
iH VOHCH IHJH IHHCH JHG OCCHi8 iH o0" O ODC8C jJICHI8.
^b1 i8 J 8HDCJIC_Oiy O D GCHHCG J8 IHC jiC8CHCC
OiHHJIiOHOCCHiiiH_iH JDOHI20" OODC8CjJIiCHI8 O
VHiCH 2" IO 3" V GC\COj CiiiHO8i8. Db1 i8 HO8I COH-
HOHy 8CCHiHjJIiCHI8ViIHHHGCIyiH_COH8CQHCHCC8OODC-
8iIyiHCHGiH_H8HiHiC8i8IJHCCHyjCiICH8iOHJHGH_Ciiji-
GCHiJ [HCIJDOiC 8yHGiOHC}. D i8 H8HJy GJ_HO8CG
VHCHjJIiCHI8ViIHCHJiJCICii8IiCCiCJD8KJCIOi8JiCOHHG
IOHJ\CHiGy IOHOGCiJICy CC\JICG8CiHHJH1iHOIiJH8CiJ8C
COHCCHIiJIiOH8. HJ_iH_ViIH HIiJ8OHO_iJjHy L1 Oi
CJH COHHiH IHC jiC8CHCC O 8ICJIO8i8. i\Ci DiOj8y i8 8OHC
IiHC8 HCCC88Jiy IO C8IJDi8HIHC GiJ_HO8i8 ODb1.
DCOHO JHG COHiC HCjJHH8 L iHCCHOH JiC IHC HO8I COH
HOH CJH8C8 O CiiiHO8i8 iH IHC \HICG bIJIC8 HOVC\Ci IH8
jJHCHI GOC8 HOI HJ\C C\iGCHCC O HCjJHIi8 LuCCHOH [HC_J-
I\C JHHHCjJHH8 LJHHDOGy} HOi GOC8 8HC COH8HHC JCOHO
H 8HHCiCHI QHJHIIy IO CJH8C CHiHO8i8 o JCOHOiC jCi
GJy OiHCH JHG 3 JCOHOiC jCi GJy Oi VOHCH Oi 10
yCJi8}. DIHOH_HCHiOHiC HCjJHH8 1 uCCHOH CJH CJG IO CIi-
iHO8i8Hi8jJHCHI88CiOO_C8HGCJICH HiIy IOHCjJHH81
[HC_JH\C HCjJHH8 1 8HiJCC JHH_CH jO8iH\C JHHHCjJHH8 1
8HiJCCJHHDOGy} HOICHiOHiCHCjJHH81uCCHOH. ÎHOH_H
jiiHJiy DiiJiy CiiiHO8i8i8HOiCCOHHOHIHVOHCHIHJHHCH
iI i8 CHJiJCICiiZCG Dy HJiKCG CC\JIiOH8 O IHC JKJHC jHO8
jHJIJ8C [CHOC8IJHCi\CiGi8CJ8C} HOI8CCHIHIHi8 jJHCHI.
PO1
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0dD66S, d0 y6l06d d0 S d 06d CduS6 0 Cll0SS.
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GH Z MDSWGt.
bOUCBODB DgGCIVG. !aqnarc prmary rrhrarnq
rbalanqtr.
HI8Qa!ICH!Ha8COC8!a!ICBVCIUI8Ca8CCHaIaC!CII2CUDy8!IIK-
H_CCVa!IOH8O!!CaKaIHCQHO8QHa!a8CCVCaHUOHyHOU
C8! CCVa!IOH8 O! !C aHIHO!IaH8!CIa8CCVC8. HC HO8! BCy
UIa_HO8I8 I8 QIIHaIy 8CCIO8IH_ CHOaH_I!I8.C HO8! COH-
HOH8yQ!OH8O!QIIHaIy8CCIO8IH_CHOaH_I!I8aICQIuII!u8
aHU !a!I_uC a8 !HC UI8Ca8C QIO_IC88C8 HO8! Qa!ICH!8 UCVCOQ
auHUICC. iIIHaIy 8CCIO8IH_ CHOaH_I!I8 I8 a CHIOHIC COHUI
IIOH IHa!u8uayQIC8CH!8IH IHC !OuI!HOI UCCaUC O!I!C
I! I8 HOIC COHHOH H HCH !HaH IH WOHCH aHU I8 CaIaC!CI-
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aHU u!IHa!Cy HDIO8I8 O! !HC IH!IaHCQa!IC aHU CX!IaCQaIIC
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uHKHOWHDu! a 8!iOH_a88OCIa!IOHCXI8!8WI!H uCCIa!IVC CO-
ID8 WHICH I8 QIC8CH! IH HOIC !HaH d7 O! Qa!ICH!8 WI!H QII-
HaIy 8CCIO8IH_ CHOaH_I!I8. 1OWCVCI !C 8CVCII!y O! uCCIa-
!IVC COI!I8 UOC8 HO! COIICa!C WI! !HC 8CVCII!y O! QIIHaIy
8CCIO8IH_COaH_I!I8aHU!ICa!HCH!O!uCCIa!IVCCOI!I8UOC8
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8OWy QIO_IC88IVC au!OIHHuHC UI8Ca8C !Ha! HaIH!y aHCC!8
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VIOu8CXQO8uIC aHUIHHuHI!y!O !HC VIIu8. \H!IKCCQa!ID8
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raurc af arrnr.
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iCHJ \J8OCOH8IDCIOH CJU8 IO J 8yHUiOHC O! JCUIC KGHCy
Uy8HCIiOH CHJiJCICiZCU Dy HCiCJ8CU iCHJ 8OUUH J\UIy
J iCJI\Cy HOiHJ UiHC 8CUHCHI JHU O_UiiJ iH 8OHC
JICHI8. Hi8 COHUIOH 8 UJ_HO8CU JHCi OIHCi CJU8C8 O!
JCUIC KUHCy HjUiy 8UCH J8 iCiCHJ JZOICHJ iCHJ JiCHCHy-
HJ Ui8CJ8C Oi OD8IiUCIOH HJ\C DCCH CXCUUCU. bOHIJHCOU8
DJCICiiJ CiIOHI8 \_OiOU8 UUiCIC IHCiJy JiJCCHIC88
WiIHOUI \OUHC CXJH8iOH JHU _J8IiOiHIC8IHJ UCCUiH_ J8O
HJy iCCiIJIC HCJIOiCHJ 8yHUiOHC. HC HO8I C!!CCI\C
IiCJIHCHI !Oi HCJIOiCHJ 8yHUiOHC 8 \Ci IiJH8JHIJIOH.
.IHOU_H JIiCHI8 WiIH COHCIC OD8IiUCIiOH HJ\C 8_HB
CJHIy UCCiCJ8CU UiHC OUIUI IHO8C WIH JiIJ OD8IiUCIOH
HJy HJ\C OyUiiJ CJU8CU Dy O88 O! IUDUJi HCIOH Oi CXCiC-
HOH O! CXCC88 iCIJHCU 8OUIC. iUHCy UIiJ8OHO_iJHy H HO8I
JICHI8 WiIH OD8IiUCIOH iC\CJ8 HyUiOHCHiO88 JHU WJ8
JD8CHI H IHi8 JICHI.
Hi8 JICHI HJU HO 8_H8 O! Hy[O\OCHJ 8UCH J8 Hy[OICH8OH
Oi IJCHyCJiUJ JHU Hi8 KUHCy Uy8HCIOH UiG HOI HiO\C
JHCi U8COHIHUJIiOH O! UUiCIC8 JHU JUHH8IiJIOH O! \O-
UHC iCJCCHCHI WIH HOiHJ 8JiHC JDUHH. 8 HJKC8 iC-
iCHJ JZOICHJ JH UHKCy UJ_HO88.
HC GiJ_HO8i8 O! iCHJ JiICiy 8ICHO88 J8 IHC CJU8C O! IH8 JCUIC
KiUHCy iHjUiy i8 ULKCy COH8UCDH_ H8 CHU-8IJ_C CiiHO88 HO
C\UCHCC O! Hy[CiICH8OH JHU HO 8_H8 O! UH8C \J8CUJi U8-
CJ8C.
W P1
1h h0IBl SB0I0m lS 0B0 S 0V0mB 0 k0B
0SUBCl0B B lBS Wh 0I hIBSl0B I XCUS0B 0
II0 Z0ml, IB IBChml 0SS, 0I 0DSIUC0B.
DO_aQHy
/rrCyC ' ICrnanOCZ |, L|DCs . athC_CnCsls anO trCaImCnI CI hCa
ICrCna synOrCmC. >Cmln !lv Cr ls 2o;2o:o1-Vb. : 1o2V2V[
lIBDb HSWBt.
bOUCBIOHB D[BCIVB. 1t0gH0Jt tlyIbtm0 H0mJHm
0JJ0tI0h0 HtIb tHmm0I0ly 00Ht 0tJt0Jt.
HC HO8I KCy UJ_HO88 i8 CiyIHCHJ HOUO8UH. XIiJiH-
IC8IHJ HJH8IJIiOH8 OCCUi H JiOXHJICy IO O!
JICHI8 WI\ HHJHHJIOiy DOWC Ui8CJ8C JI 8OHC IHC H IHC
s\IOCH\CIOOQy HU HC\OOQy b9
COUi8C O! IHCi U8CJ8C. iyHCHJ HOUO8UH WHCH HJH!C8I8
J8 8HJ CXqU8ICy ICHUCi HOUUC8 OH IHC JiICiOi IDJ 8Ui-
!JCC i8 IHC HO8I COHHOH CUIJHCOU8 HJH!C8IJIOH O!+JH-
HJIOiy DOWC Ui8CJ8C JHU OCCUi8 HOiC COHHOHy iH \iOHH
U8CJ8C WHCiCJ8 yOUCiHJ _JH_iCHO8UH 8 HOiC COHHOH
H UCCiJI\C COI8. HC Iy[CJ CHCJ iC8CHIJIOH O! Ciy
IHCHJ HOUO8UH 8 IHC 8UUUCH OH8CI O! OHC Oi HOiC ICHUCi
CiyIHCHJIOU8 HOUUC8 OH IHC JHICiOi C_8 IHJI JiC HOiC CJ8-
iy JJICU IHJH \8UJZCU. HC CiUIOH 8 OHCH iCCCUCU
Dy J iOUiOHC O! !C\Ci HJJ8C JHU JiIHiJ_J. / iC8UUJ
CCCHyHOIC JCJiJHCC i8 COHHOH J8 IHC C8OH8 J_C. H
JICHI8 WiIH iHHJHHJIOiy DOWC U8CJ8C IiCJIH_ IHC UHUCi-
yiH_ DOWC U8CJ8C U8UJy iC8UI8 H iCH88OH O! CiyHCHJ
HOUO8UH.
CiHJII8 HCiCIi!OiH8 8 CHJiJCICiiZCU Dy _iOUCU iU-
iIC CiyUCHJIOU8 JUO\C8CC8 OH IHC CXICH8Oi 8Ui!JCC8 O!
IHC JiH8 C_8 CCHIiJ DJCK DUIIOCK8 JHU 8CJ. / _CHCIC
iCUi8O8IiOH 8 HKCU IO IHC 8JHC _CHC8 J88OCiJICU WIH
CCJC Ui8CJ8C. ìIUJy J JICHI8 WIH UCiHaII8 HCiCIi-
!OiH8 HJ\C CCJC U8CJ8C DUI _J8IiOHIC8IiHJ 8yHIOH8 OCCUi
H OHy JDOUI O! JICHI8.
yOUCiHJ _JH_iCHO8UH OCCUi8 iH JiOXHJICy O!
JICHI8 WIH UCCiJI\C COiI8. yOUCiHJ _JH_iCHO8UH 8 JH
UHCOHHOH HCUIiOHiC UCCiJIi\C 8KH Ui8CJ8C. C8OH8 ICHU
IO DC HUIC JHU IO JCJi OH IHC OWCi CXIiCHiIC8. HCy
DC_iH J8 ICHUCi QJUC8 U8IUC8 Oi \C8CC8 IHJI 8OHIJ-
HCOU8y UCCiJIC JHU iO_iC88 IO JH UCCi8 WIH J UiU-
CHI DJ8C JHU UHUCiHHCU iJ__CU \OJCCOU8 DOiUCi8.
HCUHJIOiU HOUUC8 JiC IHC HO8I COHHOH CUIJHCOU8 HJH-
!C8IJIOH O! iHCUHJIOU JiIHiiI8. HCy HJy DC J8yHIOHJIiC
Oi J JHU HICi!CiC WIH HCIOH. HCUHJIOiU HOUUC8
JiC UCqUCHIy !OUHU iH IHC 8UDCUIJHCOU8 L88UC jU8I U8IJ IO
IHC CDOW OH IHC CXICH8Oi 8Ui!JCC O! IHC !OiCJiH. OUUC8
J8O HJy DC !OUHU OH IHC CXICH8Oi 8Ui!JCC O! IHC HJHU JHU
O\Ci UC /CHC8 ICHUOH8. HCUHJIOU HOUUC8 JHU HHJH-
HJIOiy DOWC G8CJ8C JiC HOI HKCU.
bIhm B000SUm, WhCh mBSS S Sm, XqUS B0I
B00US 0B h BI0I Dll SUIC, S h m0S C0mm0B CU
B0US mBS0B 0 lBmm0I D0W 0lSS.
DO_aQHy
CquCna !, ùs >. rythCma nCOCsuH. CrmaIC |ln. 2o;2(+]:
+2b-o, v. : 1oVV+[
lIBD HSWBt. L
LOUCBIODB D[BCIVB. 1t0gH0Jt Httl0ItPt t0tItJ.
H8 JHCHI HJ8 HU IO HOUCiJIC CH8iUCU UCCiJI\C COI8
DJ8CU OH H8 CHiCJ iC8CHIJIOH JHU CHUO8COC JHU H8IO-
O_C mUiH_8. i8 CX 8HOKH_ 8IJIU8 HiCiOCyHC JHCHiJ JHU
IHC iC8CHCC O! JiIHDI8 WHCH 8 I1C HO8I COHHOH CXIiJH-
IC8IHJ HJH!C8IJIOH O!d JIOiy DOWC U8CJ8C iIHCi
8UOiI IHC UiJ_HO8i8. CCiJH\C COiIi8 IyiCJy iH\O\C8 UC
iCCIUH JHG CXICHG8 iOXHJuy VIH COHIi_UOU8 iHHJHHJ-
IOH I\JI 8 _CHCiJy HICU IO IHC HUCO8J O! IHC COOH JHG
iCCIUH. JIiCHI8 U8UJy iC8CHI WIH DOOUy UJiiHCJ J88OC-
JICU WIH iCCIJ Ui8COH!OiI !CCJ Ui_CHCy JHU CiJH8.
/IHOU_H HO8I JICHI8 HJ\C DOOUy UJiiHCJ IHO8C WiIH
iOCII8 CJH iC8CHI W|IH COH8IiJIOH.
JU !IOCH!CIOOQyHO HC!OIOQy
/IHOu_H HaHy COi IiUC8 CaH Ha\C O\CiajjiH_ CiHiCa CHUO-
8COjiC aHU C\CH H8IOO_iC CaIuiC8 IHCiC aiC iHjOiIaHI U-
CiCHCC8 IO COH8iUCi. iCiO8COjiC COiI8 jiC8CHI8 WIH HOH-
DOOUy UiaiiHCa aHU COOHO8COjy 8HOW8 HOiHa HuCO8a
HaCiO8COjiCay aHU Hi8IOO_y 8HOW8 CiIHCi HCiCa8CU iHIiaCj
iIHCia yHjHOCyIC8 yHjHOCyIC COiI8} Oi aH iHCiCa8CU 8HD
HuCO8a COa_CH ayCi COa_CHOu8 COiI8}. CCUiH_ 8 C88
OHCH a CaIHiC O \iOHH COiIi8 aHU CHUO8COjiC HHaHHa-
IOiy CHaH_C8 aiC jaICHy aHU _CHCiay 8jaiC IHC iCCIuH DHI
CaH CXICHU IHiOH_HOuI IHC CHIiC _a8IiOHIC8IiHa IiaCI Hi8-
IOO_C CaIuiC8 HOWC\Ci Hay DC HUi8HH_ui8HaDC hOH IHO8C
O HCCiaI\C COI8. HCCIOH8 COI8 H8Hay jiC8CHI8 WIH
HOiC aCuIC 8yHjIOH8 aHU CHiOHiC CHaH_C8 8HCH a8 CiyjI
aiCHiICCIuiC Ui8IOiIiOH aiC aD8CHI. 8CHCHiC COiIi8 a8O _CH-
Ciay Ha8 a HOiC aCHIC COHi8C aHU 8jaiC8 IHC iCCIHH DCCau8C
O IHC UHa DOOU 8ujjy IO IHi8 iC_OH aHU 8 OHCH a88OCiaICU
WIH OIHCi C\iUCHCC O aIHCiO8CCiOHC \a8CHai Ui8Ca8C.

UlC6ldV6 C0lS Cdll BV0lV6S 6 l6Cum dB0 6X6B0S l0X-
mdll W C0Bgu0uS Bldmmd0B d S g6B6ldll lm60 0
6 muC0Sd 0 6 C0l0B dB0 l6Cum.
DO_agHy
dHD_diI 1! bdHGDOiH W HHdDDdIOij DOWC GiSCdSC. C!iHiCd!
dSQCCIS dHG CSIdD!iSHCG dHG CvO_ IHCidQiCS. dHCCI. Z7 oV(Vb7o}.
1+11b7. 11.17+VV_
ItemA8 Answer:
Educational Objective: 1ItJl HttIJlPt t0li.
HC HO8I ajjiOjiaIC IiCaIHCHI i8 HC8aaHiHC. Hi8 jaICHI
Ha8 HiU CH8iUCU HCCiaI\C COiIi8 Da8CU OH Hi8 CiHiCa jiC
8CHIaIiOH CHUO8COjiC aHU Hi8IOO_C BHUiH_8. OjiCa IHCi-
ajy i8 ajjiOjiiaIC Oi Ui8Ia U8Ca8C. \jIiOH8 iHCHUC COiI8OHC
OaH anU HC8aamC Oi COiIiCO8ICiOiU 8HjjO8IOiC8 Oi jiOC
IiIi8 aHU HyUiOCOiI8OHC Oi HC8aaHiHC CHCHa8 Oi CH-8UCU
COIi8. \ia a-aHHO8aiCyaIC8 iHCHUH_ 8Ha8aaZiHC
HC8aaHHC Da8aaZiUC aHU O8aaZiHC aiC ajjiOjiiaIC Oi
Ui8Ia Ui8Ca8C IHaI UOC8 HOI iC8jOHU IO IOjCa IHCiajy Oi Oi
HiU IO HOUCiaIC jaHCOiIi8.
\ia jiCUH8OHC i8 u8CU WHCH 8yHjIOH8 UO HOI iC8jOHU IO
a-aHiHO8aiCyaIC8. CCau8C jiCUH8OHC aHU OIHCi COiIiCO-
8ICiOiU8 Ha\C HaHy aCHIC aHU CHiOHiC IOXC CCCI8 IHaI aiC
UO8C- aHU UHiaIiOH-UCjCHUCHI IHC OWC8I CCCIi\C UO8C
8HOHU DC _i\CH Oi IHC 8HOiIC8I IHC. /ZaIHiOjiHC Â)Oi
C-HCiCajIOjuDHC C-} Hay DC u8CU Oi jaICHI8 WHO Ha\C
iHCOHjCIC Ui8Ca8C iCH88iOH WHiC OH COiICO8ICiOiU8. OW-
C\Ci DCCaH8C DOIH a_CHI8 Ha\C UCayCU OH8CI O aCIiOH COH
COHIaHI aUHiHi8IiaHOH O CiIHCi ÂOi C- IO_CIHCi WIH
a o IO +-HOHIH COHi8C O jiCUH8OHC 8 OHCH HCCC88aiy.
/HIiDiOIC8 iHCuUH_ DOIH HCIiOHiUaZOC aHU CijiOHOXaCH
Ha\C HOI DCCH 8HOWH IO DC CCCIi\C H HCCiaI\C COiI8.
aD 8 a CHHCDC aHIDOUy a_aH8I IHHOi HCCiO8i8 aC-
IOi D H jaIiCHI8 WIH 8C\CiC Ui8Ca8C Oi WHO UO HOI iC8jOHU
IO COiIiCO8ICiOU IHCiajy Oi iCH88OH HHXiHaD Hay DC
CCCIi\C DuI iI WOHU HOI DC aH ajjiOjiiaIC Bi8I-iHC HCU-
iCaIOH Oi HiU uCCiaIi\C COiIi8.
1
lSlB6 6ld 0l B0uC0B dB0 mdB6BdBC6 0 l6mSS0B B
ml0 0 m006ld6 ulC6ldV6 C0lS S m6SdldmB6 0l dB06l b
dmB0SdlCld6 dg6B.
DO_agHy
_ b! IN.HCidQCHIiC SIidIC_iCS !Oi IHC HdHd_CDCHI O! HCCi
dIivC COiIiS. HHdDD OWC! 1iS. ZV1b(}.Vob-Vb. 11.
1oVob71_
ItemR Answer: L
Educational Objective: 1Jg0it mtI0it0[t t0li.
Hi8 jaICHI HO8I KCy Ha8 HiCiO8COjC COiIi8 WHiCH 8 CHai-
aCICDZCU Dy CHiOHiC WaICiy UaiiHCa WIHOHI DCCUiH_. HCiC
aiC IWO IyjC8 O HiCiO8COjiC COiI8. COa_CHOH8 COiI8 aHU
yHjHOCyIC COiIi8. HC a\Cia_C a_C O OH8CI Oi COa_CHOU8
COiI8 8 H IHC 8XIH UCCaUC O iC aHU iI ICHU8 IO aHCCI HOiC
WOHCH IHaH HCH. HC a\Cia_C a_C O OH8CI Oi yHjHOCyiC
COiI8 i8 iH IHC 8C\CHIH UCCaUC O iC aHU WOHCH 8CCH IO DC
aCCICU 8i_HIy HOiC OHCH IHaH HCH. HC CaH8C O HiCiO
8COjiC COiIi8 8 HHKHOWH. \HC IHCOiy i8 IHaI IHC H8C O
`bl18 Hay COHIiiDHIC IO IHC UC\COjHCHI O IHC Ui8OiUCi.
/HOIHCi IHCOiy i8 IHaI iI i8 Cau8CU Dy aH auIOHHHHC
iC8jOH8C. \OOHO8COjy H aCCICU jaIiCHI8 i8 _iO88y HOiHa
IO HaKC a Ua_HO8i8 8C\Cia DiOj8C8 Hu8I DC IaKCH hOH IHC
COOH. H COa_CHOH8 COiIi8 DiOj8y 8jCCiHCH8 8HOW HOiC
IHaH HOiHa aHOHHI8 O COa_CH DCHCaIH IHC iHiH_ O IHC
COOH. H yHjHOCyIiC COI8 IHC 8jCCiHCH Hay a8O 8HOW aH
iHCiCa8CU HHHDCi O yHjHOCyIC8. OjCiJUC UijHCHOXy
aIC aHU Di8HHIH 8HD8aiCyaIC CIHCi aOHC Oi iH COHDiHaHOH
aiC CHCCIi\C aHU WC IOCiaICU WHCH H8CU a8 iHiIa IHCiajy.
lCCiaI\C COiH8 i8 CHaiaCICDZCU Dy DOOUy UiaiiHCa a88OCiaICU
VIH iCCIa U8COHOiI WHiCH H jaHCHI UOC8 HOI Ha\C. 1C\Ci
WC_HI O88 IaCHyCaiUa UCHyUiaIOH aHU 8i_HiBCaHI aDUOH-
Ha ICHUCiHC88 Oi iCDOuHU iHUiCaIC8 HOiC 8C\CiC U8Ca8C.
1HUO8COjiC B11UiH_8 CaH DC 8uDIC H jaIiCHI8 WiIH HiU HCCi
aIi\C COI8 aHU CXaHHaIOH Hay 8HOW OHy HHCO8a CUCHa
aHU CiyICHa. HCiCa8CU uaHHaIiOH Cau8C8 haDiiIy HCCi
aIOH aHU DCCUiH_. aIiCHI8 WIH \iOHH Ui8Ca8C COHHOHy
jiC8CHI WIH aDUOHHa jaiH UiaiiHCa aHU WC_HI O88. 1i8-
Ca8C iH\O\iH_ IHC 8Ha iHIC8HHC OHCH CaH8C8 HOHDOOUy Uiai-
iHCa WHCiCa8 HCHaIOCHCZia i8 HOiC iKCy WHCH IHC COOH i8
iH\O\CU. 1HUO8COjC CXaHiHaIOH Hay 8HOW ajHIHOH8 HCCi8
Oi ai_C uCCi8 IHaI CaH COaC8CC aHU Cau8C a CODDC8IOHC
ajjCaiaHCC. HC jaHCHI Ha8 HOI IaKCH aHy aHHDiOHC8 aHU UOC8
HOI Ha\C OIHCi C8IaD8HCU D8K aCIOi8 Oi C/nrtdtumdq
ct/:COiH8 iHCHUH_ iCCCHI HO8jIaiZaIOH aU\aHCCU a_C aHU
8C\CiC iHC88. \OOHO8COjy Wi 8HOW j8CHUOHCHDiaHC8
ajjCaDH_ a8 iai8CU yCOW Oi OH-WHiIC jaQuC8 8CaIICiCU O\Ci
IHC COOiCCIa HHCO8a. bHC Ha8 HOI Iia\CCU OHI O IC COHH-
Iiy iCCCHIy aHU IHCiCOiC i8 HOI aI i8K Oi IiOjiCa 8jiHC.
1
MCl0SC0C C0lS S CdldC6lZ60 b Cl0BC Wd6l 0dll6d
W0u bl660Bg, 6 0dgB0SS muS b6 md06 b S0l0gC 6Xdm
d0B 0 C0l00SC0C b0S S6Cm6BS.
DlO_agHy
jSK ! OHi |,jHiH YiCKDOH P,iiKSSOH b. 1id_HOSiS dHG DdH
d_CDCHI O! DiCiOSCOQiC COiIiS. YOi!G | LdSIiOCHICiO. Zo1+(+o}.
7Zo7Zoo. 11. 1V1Vo1_
bCCIOO
LOOIB1 HIOtOB NG1C1DO
Questons
TBH 1 jBaslC]
A ncv rcsr ro sciccn oi piosrarc cancci has Lccn dcvclopcd
and rhc icsulrs aic compaicd vu rhc icsulrs o nccdlc Liopsy
o rhc piosrarc gland. A riial asscssing rhc icsulrs o rhc ncv
rcsr againsr Liopsy icsulrs is summaiizcd Lclov.
dIO>y dIO>y dIO>y
dIO>y
.
1C>\
.
C>\ 1C>\ 1C>\
.
|\ICn\> Z0 1 b0
YD8t 8tc tDc ScDSDVty 8DU SQcCCty Ot tDS DcW tcSt:
,A) Scnsiriviry, 0.25; spccinciry, 0.75
I) Scnsiriviry, 0.33; spccinciry, 0.7
,C) Scnsirivry, 0.8; spccihci(, 0.8
I) Scnsiriviry, 0.; spccihciry, 0.
TBH Z jBaslC]
A ncv diagnosric rcsr is dcvclopcd and rcsrcd in an cxpcn-
mcnral scrring. Thc rcsr`s scnsiriviry and spccinciry aic 0.80.
In rhc popularion o paricnrs in vhich rhc rcsr vas uscd, rhc
posirivc and ncgarivc picdicrivc valucs vcic 0.57 and 0.2,
icspccrivcly. Thc picvaIcncc o discasc in rLc rcsr popularion
vas 0.25. Thc usual picvalcncc o rhis discasc in rhc commu-
niry is 0.025.
YDcD UScU D tDc CODDUDty WDCD O tDc OOWD_
Dc8SucS S DOSt Kcy tO UcCtc8Sc:
,A) Scnsiriviry
I) Spccihciry
,C) Iosirivc picdicrivc valuc
I) Mcgarivc picdicuvc valuc
,I) Iosirivc likcmood iario
TBH d jAOvanCeO]
A 54ycaiold voman is cvaluarcd duiing an insuiancc cxam
inauon rLar icquiics human immunodcncicncy vnus ,II\)
rcsring. Shc has no symproms oI\ discasc. Shc has had a
monogamous scxual iclarionship virh hci husLand o 24
ycais, uscs no iccicauonal diugs, and has had onc Llood rians-
msion Lccausc o riauma hom a moroi vchiclc accidcnr in
70. Rcsulrs o rhc physical cxannnarion aic noimal.
91
Rcsulrs iom an cnzymcIinkcd immunosoiLcnr assay
,IIISA) aic posirivc, virh a rcsr scnsiriviry and spccinciry o
8. Jhc picvaIcncc o II\ posiriviry in similai paricnrs is
appioximarcly in 0,000.
YD8t S tDc QtOD8Dty tD8t tDS Q8DcDt D8S DcC
DOD:
,A) 8
I) 0
,C) 0
I) 0.5
TBH R jAOvanCeO]
A -ycaiold voman is cvaluafcd ih rhc cmcigcncy dcpair-
mcnr oi iighr lovciquadianr aLdominal pain and cvci o 3
houis` duiarion. Jhc paricnr is nor scxually acrivc.
n physical cxaminarion, rLc aLdomcn is rcndci ro palparion
in rhc nghr lovci quadianr Lur virhour cvidcncc o guaid-
ing oi icLound rcndcncss. Iclvc cxaminauon is noimal vrh-
our ccivical morion rcndcincss oi iighr adcncxal pain. !ol-
Ioving clinical cxaminarion, rhc pioLaLiIiry o acurc
appcndiciris is csrimarcd ro Lc 50. / aLdominal appcn-
diccal CT scan is oidcicd. / appcndiccal CT scan shoving
inFammarion and a rhickcncd appcndiccal vaIl is associarcd
vrh a likcHood iauo o3.3 oi rhc diagnosis o acurc appcn-
diciris.
M tDc L SC8D S DtctQtctcU 8S QOSDVc Ot 8QQcDUCDS
WD8t S tDc QOSttcSt QtOD8Dty tD8t Uc Q8DcDt D8S 8QQcD
UCDS:
,A) 50
I) 5
,C) 80
I) 5
92 GCnCra |n!Crna MCCICInC
TH b jAOvanceO]
8CiiC8 O + HCW IC8I8 [ \ aHG } aiC GCVCOCG IO Gia_
HO8C HCHaCHiOHaIO8i8. HC OCiaIiH_ CHaiaCICii8IiC8 Oi a
VaiiCIy O GiCiCHI CHI OiHI8 Oi CaCH O IHC OHi IC8I8 aiC
OIICG OH a iCCCiVCi OCiaIiH_ CHaiaCICii8IiC [1\\} CHiVC.
Recelver Opera!Cr Charac!erls!lc (ROC) Curve
.
.
.

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6
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0
.
o_
L
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L
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.
. .Z .D . .D . .J . . .
J Specificity
(|alsepos|:|ve a:e)
YCD O tDc OllOw_ tcStS DaS tDc DcSt OVctall aCCDaCy:
[}
[}
[\} |
[}
TH AOvanceO]
yCaiOG HaH i8 CVaHaICG GUiiH_ a iOHIiHC Hy8iCa
CXaHiHaIiOH. i8 HCGiCa Hi8IOiy i8 iCHaiKaDC Oi HyCiICH
8iOH aHG HyQCiiiGCHia. C Ha8 a Z QaCK yCai Hi8IOiy O Ci_
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JXiCIy. OWC\Ci 8IuUiC8 HJ\C DCCH iHCOHCu8i\C OH iL8 CH-
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CHZOGiaZCjiHC8 8uCH a8 GiaZCjaH CaH DC u8CG IO IiCaI
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iaUiHOHa IHCiajy Oi CyaHiGC jOi8OHiH_ iHCuGC8 iHHaaIiOH
O aHy HiIHIC OOWCG Dy IHC aGHiHi8IiaIOH O iHIia\CHOu8
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iC8uI8 BOH HHaaIiOH O _a8COu8 HyGiO_CH CyaHiGC Oi IHC
H_C8IiOH O jOIa88iuH Oi 8OGiuH CyaHiGC. yGiO_CH CyaHiGC
jOi8OHiH_ i8 a8O COHHOH a8 a iC8uI O 8HOKC iHHaaIiOH BOH
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jaIDC VIH CyaHiGC jOi8OHiH_.
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bOUCBIODB DgOCIVO. trttn J [JItnI j6r Jlt6b6l
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HC LPL1 quC8IiOHHaiiC i8 IHC DC8I CHOiCC IO 8CiCCH Oi aCO
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L a\C yOu C\Ci CI DaG Oi _uIy aDOuI yOui G_:
1 1yC OjCHCi. a\C yOu C\Ci HaG a Bi8I IHiH_ iH IHC
HOD_ IO 8ICaGy yOui HCi\C8 Oi IO _CI iiG O a HaH_O\Ci:
YiIH a CuIOH O IVO jO8iH\C aH8WCi8 IHC LPL1 quC8HOHaiiC
i8 ' IO +' 8CH8iIi\C aHG ' IO ' 8jCCiBC Oi GCICCIiH_
aCOHO aDu8C Oi GCjCHGCHCC iH jHHaiy CaiC 8CIHH_8 aHG iHUi-
CaIC8 IHaI iIHCi a88C88HCHI i8 WaiiaHICG. PCOHO aDu8C Hay
DC UiHCUI IO Gia_HO8C. 1aIiCHI8 OCH jiC8CHI WiIH COHjaiHI8
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CH8. \IHCi jOICHIia CuC8 IO aCOHO Hi8u8C aiC iCCuiiCHI
C_a Oi HaiiIa jiODCH8 aD8CHICCi8H Oi O88 O CHjOyHCHI
aHG COHHiIIm_ Oi DCiH_ IHC viCHH O viOCHCC. JHC 1.b. 1iC-
\CHIi\C bCiviCC8 a8K OiCC [1b1bJ} iCCOHHCHG8 iOuHHC
8CiCCHH_ O aGuI8 VIH CiIHCi UiiCCICG quC8IiOHiH_ Oi u8C O
a 8IaHGaiGiZCG IOO IO iGCHIi] jCi8OH8 WHO8C aCOHO u8C juI8
IHCH aI ii8K. OiC iKCy IO DC aI ii8K aiC IHO8C ViIH jiiOi aCO
HO jiODCH8 yOuH_ aGuI8 aHG 8HOKCi8. HC 1b1bJ OuHG
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VIH OOWuj jiOGuCC 8Ha IO HOGCiaIC iCGuCIiOH8 iH aCO
HO COH8uHjIOH IHaI aiC 8u8IaiHCG O\Ci IO lHOHIH jCii-
OG8 Oi OH_Ci.
1IHOu_H IHC OjIiHa iHICi\a Oi 8CiCCHiH_ i8 HOI KHOWH
8CiCCHiH_ aI IHC IiHC O aH iHiIia \i8iI i8 CCaiy iHjOiIaHI.
JHCiC aiC HuIijC 8CiCCHiH_ iH8IiuHCHI8 IHC LPL1 quC8-
IiOHHaiiC i8 OHC O IHC HO8I WiGCy u8CG. JWO jO8iIi\C
iC8jOH8C8 iHGiCaIC IHaI iIHCi a88C88HCHI Oi aCOHO Hi8u8C
i8 WaiiaHICG.
HC LPL1 quC8HOHHaiC Ha8 a iCjOiICG 8CH8iHviIy iaH_H_
BOH +o' IO +' aHG 8jCCiBCiIy iaH_iH_ BOH U' IO '.
aDOiaIOiy IC8I8 8uCH a8 aH CC\aICG HCaH COQu8Cuai \OuHC
[8CH8iIi\iIy o' 8jCCiBCiIy +o'} aHG aH CC\aICG a8jaiIaIC
aHiHOIiaH8Cia8CyaaHiHC aHiHOIiaH8Cia8C iaIiO [8CH8iIiViIy
l' 8jCCiBCiIy l'} CaH DC 8u__C8I\C DuI aiC HOI Uia_HO8-
IiC O aCOHO aDu8C aHG GCjCHGCHCC. HCii iCaIi\Cy OW 8CH
8iIviIiC8 HaKC IHCH uH8uiICG Oi 8CiCCHiH_.
CCau8C O IHC 8HOiI Ha-iC O CIHaHO a iaHGOH CIHaHO
C\C 8HOuG HOI DC u8CG IO 8CiCCH Oi aCOHO8H.
JJB GeerI |ter MeCIcne
bClBBg BSIlUmBIS SUC dS I LAUL QUSI0BBdl dl HC
IV 0l dC00 mSUS SClBBg B I lmdl Cdl SIIBg.
DlO_aQ
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y
b8IIZ !. \iHiC8 Qi8CIICC. HHCJIHy 8COHO H8C. ^ 1H_ |CG. Zb
obZ(}.bV-. _11.Jbo+Z+
ltem Z Answer:
Educational Objective: Trcat lum0ar rpnal rnnorr
wtb rurqcry.
aCjaHaLUHCuiOO_CHjaiHCHLBOHSjHaSLCHOSSHay
DC LiCaLCU Dy Sui_Ciy. H COHSUCiH_ Sui_Ca LiCaLHCHL Oi
jaLCHLSWLHDaCjaHBOHiaUCuOjaLyOi SjHaSLCHOSS
_uUCHCSiCCOHHCHUiCCiHH_ jaLCHLSaHCia HHHuHO
o HOHLS LO 2 yCaiS OaCU HOHSui_C1 HLCi\CHLOHS. a
uiCSUCh1CUaSjiO_iCSS\CHCuiOO_CUChCLSaHUSC\CiCjaH
LHaL SHOLiCSOHS\C LO COHSCi\aL\C LiCaLHCHL. JHS jaLCHL
HaSLiCUCOHSCi\aL\CLCiajyWLHhiSL-HCHCUCaLOHLiCaL-
HCHL[5P15aLUaCCLaHHOjHCH}aLUjHySCaLCiajyyCL
HCiSyHjLOHSHa\CjiO_iCSSCU. JHCiCOiC SHCSW _ LO
COHSUCiSui_CaLiCaLHCHLLHCH LHC HCXL ajjiOjiaLC SLCj S
LO iCCi LHC jaLCHL Oi Sui_Ca COHSUCiaLOH. 5ui_Ca LiCaL
HCHL O SjHaSLCHOSSSuSuayCCCL\C.
CCLiOHyO_iajHy aHU HCi\C COHUuCLOH SLuUCS aiC HOL
iCquiCU Oi LHC Ua_HOSS O uHDai SjHa SLCHOSS DuL Hay
DC HCj H jaLCHLS WLH aL_Ca SyHjLOHS aHU WHCH LHC
jOSSD| O aH aLCiHaL\C Ua_HOSS SuCH aS jCHjHCia HCu-
iOjaLHy S COHSUCiCU. JHCiC S CuiiCHLy \Ciy LLC C\UCHCC
LOSujjOiLLHCuSCOCOiLCOSLCiOUHjCCLOHSHLHCLiCaLHCHL
OSjHaSLCHOSS. 5jHaLiaCUOHSLHCajjCaLOHOCOHSLaHL
OiHLCiHLLCHLjuH_OiCC ajjCULOLHCSjHCLO_iaUuay
SLiCLCH LHC SjHC. \OHUHuOuS Oi HLCiHLLCHL SjHa LiaCLOH
HaSHOLDCCHSHOWH LODCCHCCL\CHjaLCHLSWLHSCaLCaOi
SjHa SLCHOSS.

bdCk dB dB0 BUl00gC mdlmBI l0m SBd SIB0SS md D
IldI0 D SUlgl.
DlO_aQ
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y
YI8OH |. H IHC CiHiC. IwD8CK Q8iH. P HICiH CG. ZJ+(V}.
\b-J-\b-J. _11. 1+bZb
ltem Z Answer: L
Educational Objective: !aqnorc vcrn0ral
ornomycltr.
JHCHOSLajjiOjHaLCHaLa_CHCHLSui_CHLSjHC. !CU
Ba_SHLSjaLCHLSjiCSCHLaLOHSu__CSUH_aSySLCHCLCSS
LCCauSCO DaC[1HHCuUCOCaZCUjaHHSLOiyOHLi1
\CHOuSUiu_uSCC\CiaLUCC\aLCUCiOCyLCSCUHCHLaUOH
iaLC. JHCSC HHUH_S SLiOH_y Su__CSL LHC jOSSDLy O \CiLC-
DiaOSLCOHyCLSHCCLOuSUSLSOiSjHaCjUuiaaDSCCSS.
OSL jaLCHLSWLH \CiLCDia OSLCOHyCLS Ha\C DaC Oi HCC
jaHLHaL_iaUuayWOiSCHSO\CiWCCSOiHOHLHSC\CiSjiC
SCHLHOHy50 OjaUCHLSaHUCuOCyLOSSSLyjCayaDSCHL
DuL LHC CiyLHiOCyLC SCUHCHLaLOH iaLC S OHCH _iCaLCi LHaL
i00 Hu)H.JCHUCHCSSLOjajaUOHO\CiLCH\O\CUjOiUOH
OLCSjHCSCOHHOH. CiLCDia OSLCOHyCLS SHOSLOHCH
USSCHHaICUHCHaLO_CHOuSy. 5C_HCHLaaiLCHCSSujjlyDOOU
LO LC \CiLCDiaCWL DiCaLH_ aiLCHCS Sujjy_ DOOU LO
LC HCHOi Hai_H O OHC CHU jaLC aHU LHC SujCHOi Hai_H
OLCaUjaCCHLCHUjaLC.\OHSCquCHLyWHCHHCCUOHOCCuiS
L_CHCiayOOWSLHS\aSCuai jaLLCHiH\O\H_DOHCHLVO
aUjaCCHL\CiLCDi1DOUCSWLHH\aSOHHLOLHCiHLCi\CiLCDia
US[USUS}.OLCHUaSOuiCCSO HCHaLO_CHOuSOSLCOHyCUS
HCuUCSH[HCCLOHUiu_uSCiS}uHaiyLiaCLOiiCSjiaLOiy
LiaCL HCCLOH CHUOCaiULS Oi HLia\aSCuai CaLHCLCiiCaLCU
HCCLOH. aLCHLSWLH HCCLOuS USLS aiC aL HS OiSjHa
CjUuia aDSCCSS. CCauSC DOOU CuLuiCS aiC jOSL\C Luj LO
5 O jaLCHLS WLH \CiLCDia OSLCOHyCLS LCy SHOuU DC
ODLaHCU Oi ah jaUCHLS HWHOH LHS COHULOH S SuSjCCLCU.
H jaLCHLS WLH SuSjCCLCU \CiLCDia OSLCOHyCLS USUS Oi
SjHaCjUuiaaDSCCSSui_CHLC\auaLOHWLHa_H_SWai-
iaHLCU. SLHCjiCCiiCUHa_H_HOUaLy DCCauSCSCaHS
SHOW CHaH_CS O aCuLC OSLCOHyCUSWLHH UayS O HCCLOH
aHUaiCSujCiOiLOaLUHOiCSCHSU\C0) aHUSjCCHC80)
LaHjaH hHS aHU \JSCaHS CaL UCLCCLSOHLSSuC aDSCCSSCS
aHUCjUuiajaia\CiLCDiaOijSOaSaDSCCSSCSjOSSDyiCqui
H_ Sui_Ca UiaHa_C aHU CaH UCHCaLC aHaLOHy UCOiC
Sui_Ciy. OHCLCCSS aSC-jOSL\C1iCSuLSHayOCCuiH
jaLCHLS WLH HOHHCCLOuS COHULOHS SuCH aS iaCLuiCS
LuHOiSaLUHCaCUOSLCOHyCLS.
.LDOLC LHCiajy WLH Oi WLHOuL Sui_Ciy S LyjCay
iCquiCULOLiCaLSjHCaHUiCaLCUSOHLSSuCHCCLOH. OW
C\Ci aHLDOLCLHCiajySHOuUDC_uUCUWHCHC\CijOSSDC
Dy DOOU CuLuiC iCSuLS CHjiC aHLDOLiC LHCiajy WLHOuL
aH aLLCHjL LO COHhiH LHC uHUCIy_ CauSC O LHC jaLCHLS
jaH aHUSOuiCC OHCCLOH SHajjiOjiaLC.
MKI S I lll0 mdgBg m00dI 0l SUSCI0 VlIDld
0SI0mIS, DCdUS SCBS S0W CdBgS 0 dCUI 0SI0mIS
WIB 0dS 0 BCI0B dB0 dl SUl0l I0 dB mS dB0 L1
SCdBS.
DlO_aQ
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y
Yi8OH |I. H IHC CiHiC. Iw D8CK Q8iH. ^ HICiH CG. ZJ+.
\b-J-\b-1. _11. J+bZb
ltem d Answer: A
Educational Objective: Manaqc arun nonrpcrr low
0ark pan wtb arcmmnopbcn.
JHC DCSL iHLa HaHa_CHCHL OjLOH Oi LHS jaLCHL S aCCLa
HHOjHCH.JHSjaUCHLHaSaCuLCOWDaC[1HiCSuUH_BOH
aiCCCHLH]uiy. CHaSHOS_HSOHCuiOO_CCOHjiOHSCOi
jOLCHLay SCiOuS uHUCiyH_ COHULOHS. LuUCHCS juD-
SHCUDyLHCPHCiCaH \OC_CO HySCaHSaHULHC PHCH-
CaH aH 5OCCLy iCCOHHCHU aCCLaHHOjHCH Oi5D1S Oi
BiSIiHCIiCJIHCHIOJCHICHOHS[CCiHCOWDJCK[JiH.1O[i
OiG JHJ_CSiC Oi IiJHJGO iS 8H O[IiOH WHCH HSCG jHGiCiOHSy
iH [JIiCHIS WiIH SCVCiC GiSJDiH_ JCHIC OW DJCK [JiH IHJI iS
HOI COHIiOCG [Oi iS HHiKCy IO DC COHIiOCG} WiIH JCCIJ-
HiHO[HCHOi ^11S. JIiCHISSHOHG DCiHOiHCGIHJIIHC
[iO_HOSiSOiJCHICOW DJCK [JiH iS_CHCiJy _OOG JHG IHJI
HOSI[JIiCHISiH[iOVCWiIHiH HOHIH.
JHC[JHCHIHJSHOSi_HSOHCHiOO_CCOH[iOHiSCOiCJIuiCS
SH__CSLiH_ J [OICHIiJy SCiiOHS COHGiIiOH IHCiCOiC 1
WOuGHOI DCHCCCSSJiy. VCHuIHCiCWCiCSi_HSO USKHCiHi
JHOH[J[OSiHVCSLiJi_HIC_iJiSiH_ICSI}JH1WOHGHOIDC
HCCCHHCSSIHC[JHCHIHJGC\iGCHCCOHOIOiiH[JiiHCHI
HJGHOIiCS[OHGCG IO IHCiJ[y Oi H[IOHS WCiCiHCiCJSH_.
HHDJi[JiHiJUO_iJ[HSJiC_CHCiJy HOIiCCOHHCHGCGiH
IHC CVJHJHOH O OW DJCK [JiH DCCJHSC IHCiC iS HO C\iGCHCC
IHJIiOHHHC[JiHiJGiO_iJ[Hy iH[JHCHISVIHHOHS[CCiBCOW
DJCK[JiHiS JSSOCiJICG WiIH J _iCJICi iH[iOVCHCHIiH[JIiCHI
OHICOHCSIHJHSCCCHVCiHJ_iH_. 8iHiJGiO_iJ[HSWOHGDC
J[[iO[iiJIC i J VCiICDiJ COH[iCSSiOH HJCIHiC iS SHS[CCICG.
IHGiCSHJVCHOIGCHOHSIiJICGIHJIDCGiCSIiSHC[HiHJCHIC
OWDJCK [JiH JHG iIHJy iH[8iiiCCOVCiy IiHC.

CEmB0hEB 0l NblS lE lSBE hEl 0l CUE B0BSE~
CC 0W bCk B.
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J!b-J-J!b-J. _11: J+b2b[
lIBH d3 DSWBf. L
bOUCBIODB DgBCIVB. J0gn0t [n0 t0r t0m~
[rtu0n ut h00nt mtml0t Blh t0n.
JHCHCXIGiJ_HOSHCSIHGy SHOHGDCJH1SCJHOIHCIHO
iJCOHHDJiS[HC.JHiS[JHCHIHOSIiKCy HJSS[iHJCOiGCOH-
[iCSSiOHGHCIODOHC HCIJSIJSCS HOH iCCHiiCHI [iOSIJIC CJH-
CCi. JHC IHiCC HOSI COHHOH HJi_HJHCiCS iCS[OHSiDC Oi
S[iHJ COiG COH[iCSSiOH JiC [iOSIJIC DiCJSI JHGHH_CJHCCi.
iSSi_HSJHGSy H[IOHSJiC COHSiSICHI VIHS[iHJCOiGCOH
[iCSSiOH. JHC iHiHJSyH[IOHiH[JLiCHLS WiIH C[iGHiJS[iHJ
COiG COH[iCSSiOH GHC IO IHHOi HSHJy iS S[iHJ Oi iJGiCHJi
[JiH IHJI HJy [iCCCGC IHC OHSCI O HCHiOO_iC Sy H[IOHS
WHiCHHJy iHCHGCWCJKHCSSHHHDHCSS OiS[HHCICiGiSIHi-
D8HCCS. [iHJ COiG COH[iCSSiOH iS JH OHCOO_C CHCi_CHCy
JHGOIHCIHOiJCOHHDJiS[iHCiSHCCGCGIOCOHHiHIHC
GiJ_HOSiS JHG JSSiSI iH IiCJIHCHI [JHHiH_. IiHiCiJHS SHOHG
HJVCJOWIHiCSHOGOSHS[iCiOHOiS[iHJCOiGCOH[iCSSiOH
iH J [JIiCHI WiIH KHOWH CJHCCi Oi J iiSK Oi iCCHiiCHI CJHCCi.
JHCJDSCHCCOHCHiOO_C HHGiH_S SHOHGHOIJICiIHJISIiJI-
C_y. JHCHISWHOSCCOiGCOH[iCSSiOHiSGiSCOVCiCGJHCiGCVC-
O[iH_ HCHiOO_C GCHCiIS JiC HOiC iKCy IO iCH8iH HHCIiOH-
Jy iH[JiiCG JHCi iHICiVCHIiOH.
GCHCII lH!CIHI MCdc|HC JJS
1JGiOHHCiGC DOHC SCJHHiH_ iS VCiy SCHSiIiVC Oi GCICCIiH_
DOHCHCIJSIJSCSJHGHJSIHCJGVJHIJ_CO\iSHJiZiH_IHCCHHiC
SKCCIOH DHI iI HJS J Hi_HJSC[OSiIiVCiJIC JHG [iOVGCS HO
iHOiHJIiOH JDOHI IHCCJ SJC COH[iCSSiOH. CCJHSC J DOHC
SCJH CJHHOI COHHiH J GiJ_HOSiS O S[iHJ COiG COH[iCSSiOH
iIiS JH iHJ[[iO[iiJICGiJ_HOSHC ICSI iHIHS CHCi_CHI SCIIiH_.
JHC CiHiCJ CJIHiC O DiJICiJ OWCi CXIiCHiIy WCJKHCSS
JCCOH[JHCGDy Hy[CiiCLCXiJOCJiZCSIHC[iOCCSSIOHCS[iHJ
COiG.1 OIHCDiJiHWOHGIHCiCOiCDCJHiHJ[[iO[ii-
JIC GiJ_HOSIiC ICSI.
JiH iJGiO_iJ[HS JiC HSCG IO GiJ_HOSC COH[iCSSiOH HJCIHiCS
O IHC IHOiJCiC S[iHC DHI C8 OI GCCIy VSHJiZC S[iHJ COiG
COH[iCSSiOH. 1J[JHCHISHCHJSHHJjOiVCiICDiJlDOGy CO
J[SC Oi [CGiCC CiOSiOH iS J[[iOXiHJICy o7 [iCGiCIiVC O
S[iHJCOiG COH[iCSSiOH DHI J JSCHC_JHVCiCSHIOCCHiS iH
HCJiy27O[JHCHISWiIHS[iHJCOiGCOH[iCSSiOH. JHCiCOiC
[JiHiJUO_iJ[Hy iSHOIIHCDCSIGiJ_HOSHCICSIOiIHiS[JHCHI.
1hE l0 0 bCk B, mUSCE WEkBESS, B0 0SS 0 b0WE 0l

b00El C0Bl0 S SUggESVE 0 SB C0l0 C0mlESS0B.
DlO_aQHy
!OC |b 1JlCHC .ClJSlJHC CUuiJ SHJ COiU COHiCSSOH. CCl
CuiO. 2(b}:+bV-. _11: J+2JbV[
lIBH d DSWBf. b
bOUCBIODB DgBCIVB. J0gn0t t0ughP0r0nl
0lhm0 Blh 0 H0 0j nh0t 00ur0.
1 IiiJl O iHHJCG JDHICiO COHG HC[ COHIiO IHC [JIiCHIS
SyH[IOHSJHGCOHBHIHCGiJ_HOSiSOCOH_HVJHJHIJSIHHJ.
JHCHOSICOHHOHCJHSCSOCHiOHiCCOH_HJiCJSIHHJ[OSI
HJSJ Gii[ SyHGiOHC [CHiOHC SiHHSiIiSiHiHIiS} JHG _JSIiO-
CSO[HJ_CJ iCHHX GiSCJSC [L11}. iOHCHOSCO[y JHG CHCSI
IJ[JyHOiOCiHGiJ_HOSH_COH_HGHCIOIHCSCIHiCCCJHSCS.
JHC GiJ_HOSiS O COH_HVJiiJHI JSIHHJ iS SH__CSICG Dy IHC
[iCSCHCC O JiiWJy H_CiiCS[OHSiVCHCSS JHGCOHBiHCG WHCH
COH_H iCSOVCS WiIH JSIHHJ IHCiJ[y.
JHC[JHCHIGOCSHOIHJVC[OSIHJSJGD[[uiHCHIHJSJSCCiC-
IiOHS SiHHS COH_CSIiOH Oi OIHCi Sy H[IOHS SH__CSIiVC O
CHiOHiCOiiCCHiiCHI SHHSiHS JHGHJS HOIiCS[OHGCG IO IiCJI-
HCHI. JHCiCOiC IJ O IHC SiHHSCS iS HOI HCCCSSJiy. 1 IHC
[JIiCHIGOCSHOIiCS[OHGIOJDHICiOCOSiHO[HCDiOHCHiHS
SHOHGDCCOHSiGCiCGJSIHCCJHSCOCHiOHiCCOH_HJHGDiOH
CHOSCO[y WiIH DiO[Sy SHOHG DC [CiOiHCG IO COHBiH IHJI
GiJ_HOSiS. \IHCiWiSC DiOHCHOSCO[y iS HOI J BiSIiHC GiJ_
HOSHCICSI iH US [JIICHI.
JHCiCiSBILCJDOHIIHCCHJiJCICiJHGHHiH_OCHiOHiCCOH_H
GHC IO L11 IHJI GiSIiH_HiSHCS iI HOH OIHCi COHGiIiOHS iH
JGGiHOHiIOHCHCJHDCSiCHIHOHJ_JSIiOiHICSHHJSIJHG
[OHI.OWCVCiIHC[JIiCHIGiGHOIDCHCBIHOHo HOHIHSO
CH[iiiC _JSIHC JCiG SH[[iCSSiOH IHCiJ[y Oi L11. JHCiC
120 GCnCraI |n!Crna MCdclnC
OiC iI iS iCaSOHaDC IO iUC OUI COU_HvaiiaHI aSIHHa DCOiC
[HiSUiH_ 2+HOUi CSO[Ha_Ca [1 HOHiIOHH_.
1h6 0gB0SS 0 C0ughVIB Shm S Sugg6S60 0 h6 I6S
6BC6 0 IW h6II6S0BSV6B6SS B0 C0BIm60 Wh6B C0ugh
I6S0V6S Wh I 0 Bh60 0u6I0.
DhC_aQHy
1DOHZ_HCiD Y 1iJllCi JillCi J. \OH_H JHG JSlHHJ. \Hii \QiH
1HH CG. 21o(1}.++-+. _1l. 11oo12+]
Item dd Answer: A
Educational Ob]ective: !ntan cmprr manaqc-
mcnt [cr rbrcnr rcuqb wtb antbrtamnc/drcnqcrtant
rcmbnatcn.
HC HOSI a[[iO[iiaIC IiCaIHCHI Oi IHiS [aIiCHI iS a Iiia O
aH aHIiHiSIaHiHCyGCCOH_CSIaHI COHDiHaIiOH. HC iHiIia
a[[iOaCH iH [aIiCHIS WiIH CHiOHiC COU_H >8 WCCKS iH GUia
IiOH} iS IO COHGUCI a HiSIOiy aHG [HySiCa CXaHiHaIiOH OOK
iH_ Oi iGCHIiHaDC CaUSCS GCICiHiHC WHCIHCi IHC [aIiCHI iS
IaKiH_ aH aH_iOICHSiHCOHvCiIiH_ CHZyHC [D\1} iHHiDiIOi
aHG ODIaiH a CHCSI iaGiO_ia[H. H IHC [O[UaIiOH O [aIiCHIS
WHO GO HOI SHOKC GO HOI IaKC aH D\1 iHHiDiIOi aHG HavC
a HOiHa CHCSI iaGiO_ia[H U[[Ci aiiWay COU_H SyHGiOHC
[iD\} [[iCviOUSy ICiHCG ostnasal dri), aSIHHa aHG
_aSIiOCSO[Ha_Ca iCHUX GiSCaSC [L1V} aiC iCS[OHSiDC Oi
a[[iOXiHaICy VV7 O CaSCS O CHiOHiC COU_H. YHCH IHC
CaUSC O a CHiOHiC COU_H iS UHCCai IHC DHCiiCaH \OC_C
O \HCSI HySiCiaHS iCCOHHCHGS iHiIia IiCaIHCHI WiIH a
HiSI_CHCiaIiOH aHIiHiSIaHiHCy GCCOH_CSIaHI COHDiHaIiOH
IO IiCaI iD\. HiS iS IiUC CvCH iH IHC aDSCHCC O CviGCHCC
O a [OSIHaSa Gii[. HC Gia_HOSiS O CHiOHiC COU_H iS OHCH
DaSCG U[OH IHC [aIiCHIS iCS[OHSC IO CH[iiiC IHCia[y aHG
iI Hay IaKC WCCKS Oi CvCH HOHIHS Oi IHC COH_H IO iCSOvC
WiIH a[[iO[iiaIC IHCia[y.
H a HOHSHOKiH_ [aIiCHI ViIH a HOiHJ CHCSI iaUiO_ia[H aHG
HO SySICHiC SyH[IOHS \ SCaH O IHC CHCSI iS HOI iHGiCaICG.
1SIHHa iS a COHHOH CaUSC Oi a CHiOHiC COU_H aHG Hay [iC
SCHI OHy VIH a COU_H [COU_HvaiiaHI aSIHHa}. 1OWCvCi [Ui
SUiH_ [UHOHaiy HHCIiOH ICSIiH_ Oi iHiIiaIiH_ CH[iHC a_O
HiSI IHCia[y Oi aH iHHaCG COiIiCOSICiOiG SUCH aS HUIiCaSOHC
Oi aSIHHa iS [iCHaIUIC UHCSS IHC [aIiCHI JiS IO iCS[OHG IO
CH[iiiC IiCaIHCHI O iD\.
H IHC aDSCHCC O L1V SyH[IOHS [iOIOH[UH[ iHHiDiIOiS
SHOUG DC iCSCivCG Oi [aIiCHIS ViIH CHiOHiC COU_H WHO HavC
a HOiHa CHCSI iaGiO_ia[H aiC HOI IMH_ aH D\1 iHHiDiIOi
GO HOI SHOKC JHG WHO HavC aiCG IO iH[iOvC VIH IiCaIHCHI
Oi iD\ aSIHHa aHG HOHaCi_iC COSiHO[HiiC DiOHCHiIiS.
H [aIiCHIS WiIH CHiOHiC COU_H WHO HavC HOiHJ CHCSI iaGiO
_ia[H hHGiH_S HOiHa S[iiOHCIiy aHG a HC_aIivC HCIHa
CHOiHC CHaCH_C ICSI IHC Gia_HOSiS O HOHaSIHHaIiC
COSiHO[HiC DiOHCHiIiS IAI) SHOUG DC COHSiGCiCG. HiS
Gia_HOSiS iS OHCH COHSiGCiCG aHCi [aIiCHIS ai IO iCS[OHG IO
IiCaIHCHIS GiiCCICG aI iD\ L1V aHG aSIHHa. 1IHOU_H
COHhiHaIiOH O IAI iCQUiiCS a DiOHCHia DiO[Sy IHC
iCS[OHSC IO CH[iiiCJy aGHiHiSICiCG iHHaCG COiIiCOSICiOiGS iS
OHCH USCG IO CSIaDiSH IHC Gia_HOSiS.

mIC I6m6B 0 ChI0BC C0ugh B B0BSm0KBg 6B B0
KBg B Bg06BSBC0BV6IBg 6BZm6 Bh00I Wh0 hS B0I
m Ch6S I00gIh 06gBS Wh B BhSmB6/06C0Bg6SB
C0m0B0B.
DC_aQHy
1JVOiG l \HHH_ I. JHJ_CHCHl O! CHiOHiC COH_H. JHCCl.
2o1(V21 }.1oC-1o+. _1l.1+2+o2_
|tem d Answer: A
Educational Ob]ective: !aqncrc anqcnnrn-rcn-
vcrtnq cnsymc nbbnr rbrcnr rcuqb.
HC HOSI a[[iO[iiaIC HaHa_CHCHI O[UOH Oi IHiS [aUCHI iS IO
GiSCOHIiHUC IHC aH_iOICHSiHCOHvCiIiH_ CHZyHC [D\1}
iHHiDiIOi BSiHO[H. HiS [aUCHI [iCSCHL ViIH a COU_H O OH_Ci
IHaH 8 WCCKS GUiaIiOH aHG IHUS HCCIS IHC GCHHiIiOH Oi
CHiOHiC COU_H. DCCOiUiH_ IO DHCiiCJH \OC_C O \HCSI HySi
CiJHS _UiGCiHCS IHC iHiIia CvaUaIiOH iHCUGCS a HiSIOiy aHG
[HySiCa CXaHiHaIiOH IO GCICiHiHC iKCy CIiOO_CS OOWCG
Dy a CHCSI iaGiO_ia[H IO iGCHH OD\iOUS aDHOiHahUCS. IHC
CHCSI iaGiO_ia[H iS HOiHa OHC SHOHG iCCOHHCHG UiSCOH
HHUiH_ D\1 iHHiDiIOiS aHG SHOiH_ i IHCSC aCIOiS aiC iGCH
IihCG iH IHC HiSIOiy Oi [UiSUC CH[iiiC HaHa_CHCHI O CHiOHC
COU_H IHC [aIiCHI iS a HOHSHOKCi JHG iS HOI IaiH_ aH D\1
iHHiDiIOi. H SOHC CSUHaICS U[ IO 27 O [aIiCHIS IMH_ aH
D\1 imDiIOi GCvCO[ a CHiOHiC COU_H. HCiC Hay DC HO OD\i
OUS ICH[Oia iCaIiOHSHi[ DCIWCCH IHC iHiIiaIiOH O D\1
iHHiDiIOi IHCia[y JHG IHC OHSCI O COU_H. HC HCGiaH IiHC IO
iCSOUUOH iS 2 GayS BOH WIHGIaWa O IHC D\1 iHHiDiIOi.
H [aIiCHIS WiIH CHiOHiC COU_H aHG a HOiHa CHCSI iaGiO
_ia[H a CHCSI \ iS OHy iHGiCaICG Oi IHOSC aI Hi_H iiSK Oi
UH_ CaHCCi.
i[[Ci aiiWay COU_H SyHGiOHC [iD\} iS a COHHOH CaUSC
O CHiOHiC COH_H. D Iiia O a HiSI_CHCiaIiOH aHIiHiSIa
HiHCyGCCOH_CSIaHI COHDiHaIiOH Oi SCvCia WCCKS iS a[[iO
[iiaIC IiCaIHCHI Oi iD\. H a HOHSHOKiH_ [aIiCHI WHO iS
IaiH_ aH D\1 HiDiIOi HOWCvCi IHC D\1 iHHiDiIOi SHOUG
DC GiSCOHIiHUCG Oi SCvCia WCCS DCOiC IiCaIiH_ Oi iD\.
1SIHHa aHG HOHaCi_C COSiHO[HiiC DiOHCHiIiS Hay [iCSCHI
WiIHOUI aHy SyH[IOHS OIHCi IHaH COU_H. [iiOHCIiy WOUG
DC iHUiCaICG iH IHC CvJUaIiOH O CHiOHC COU_H IHaI HaS HOI
iCSOvCG aHCi IHC iHiIia HaHa_CHCHI HCaSUiCS [HiSIOiy [HyS
iCJ CXJHiHaUOH CHCSI iaUiO_Ia[H CCSSaIiOH O D\1 HDiIOi
IiCaIHCHI Oi U[[Ci aiiWay COU_H SyHGiOHC}.
1IHOU_H CH[iiiC IHCia[y Oi _aSIiOCSO[Ha_Ca iCHUX GiSCaSC
[ L1V} iS a[[iO[iiaIC i [iOHiHCHI SyH[IOHS O L1V
aCCOHjJHy IHC COH_ Oi mIa HaHa_CHCHI HCa8HiC8 a
G8COHIHHH_ IHC 1l1 HHDIOi aWay8 8HOHG jiCCCGC
CHjiC IHCiajy Oi L1J.
1
|B dBS dKBg dB dBg0BSBC0BVIBg BZm B00I W0
ISB W d CI0BC C0Ug dB0 d B0Imdl CS Id00gId, 0S
C0BBUBg dBg0BSBC0BVIBg BZm B00I md 0
00 0dgB0SC dB0 IdUC.
DO_aQHy
1IWH K JuHJHH O8CI iL CL a; DHCDCJH LO!C_C O! LHC8L
iHy8CJH8 (DLL1}. iJ_O88 JHG HJHJ_CHCHL O! COU_H CXCCuLVC 8uH
HJIy. DLLi CVGCHCCDJ8CG CHCJ! QIJCLCC _uGC!HC8. LHC8L.
Z1ZV(1 8uQQ}.1bZb. _i1i.1+Z_
IH d DSWf.
bOUCBIODB DgCIV. Lit thtil L tP0u0 0
0lttnl Btlh htm0(iti j0l ung t0nttr
HC HO8I ajjiOjiaIC HCXI 8ICj H IHC HaHa_CHCHI O IH8
jaICHI 8 CHC8I l. HC HO8I COHHOHy CHCOHHICiCG CaH8C8
O HCHOjIy88 H aHDHaIOiy jaIlCHI8 aiC iHCCIiOH [DiOHCH
I8 Oi jHCHHOHla} aHG Ha_HaHCy. 1 jaICHI8 WIH HCHOjI
y88 8HOHG HaVC a CHC8I iaGO_iajH. 8K aCIOi8 IHaI HCiCa8C
IHC i8K O Ha_HaHCy HCHGC HaC 8CX a_C OGCi IHaH +
yCai8 a 8HOKH_ H8IOiy O HOiC IHaH + jaCKyCai8 aHG
8yjIOH8 a8HH_ Oi HOiC IHaH WCCK. HC8C jaHCHL8 8HOHG
DC iCCiiCG Oi CHC8I l aHG HDCiOjIC DiOHCHO8COjy CVCH
IHC CHC8I iaGO_iajH 8 HOiHa.
bjHIUH CyIOO_y CXaHHaIOH aOHC 8 HOI CHCCIVC H Caiy
Ga_HO88 O HH_ CaHCCi DCCaH8C O OW 8CH8HVIy. IHOH_H
jHHOHaiy HCIOH IC8IH_ CaH GCICiHHC IHC jaIICHI Ha8
CHiOmC OD8IiHCHVC jHHOHaiy G8Ca8C aHG WHCIHCi IHC jaHCHI
8 a 8Hi_Ca CaHGGaIC I 8 HOI iHGCaICG IO C8IaD8H a Ga_HO
88 O HH_ CJHCCi. OOW Hj H HOHIH8 8 HOI aH aG\8aDC
8I!aIC_y Oi a jaHCHI aI H_H D8K Oi HH_ CaHCCi 8HCH a8 IH8
jaHCHI GCayCG Ga_HO88 Hay iC8HI H 8HDOjHHa OHICOHC.

ll dBS W hm0SS S0Ul0 dV d CS Id00gId,
dBS d g ISK 0I lUBg CdBCI S0Ul0 0 III0 0I CS
L1dB0 0I0C 0I0BC0SC0 VB CS Id00gId S
B0Imdl.
DO_aQHy
iuGHJ CHIHJH b DIOHOW Yb 1O8J |. CHOQLy88. GJ_HO88 JHG
LICJLHCHL. LOHQI HCI. ZVb(+}.1V-+V. _i1i. Z+V_
lIH d DSWf. b
bOUCBIODB DgCIV. lt0l 0tu 0l0nthtlti Btlh
iymm0ltt mt0iulti.
HC DC8I HaHa_CHCHI Oi IH8 jaICHI 8 8yHjIOHaIC IiCaI
HCHI. iCaIHCHI O aCHIC DiOHCHIII8 8 H8Hay 8yHjIOHaIIC.
HCiC 8 HO CVGCHCC IO 8HjjOiI IHC H8C O HO8I OVCiIHC
COHHICi aHG jiC8CDjIOH aHIIH88VC HCGCaIOH8. OWCVCi
Geer l!er MeCce 121
8OHC 8IHGC8 HaVC 8HOVH IHaI `bJ8 VIH Oi WIHOHI aH
aHIH8IaHHC GCCiCa8C COH_H 8CVCiIy. 1 Iia O DHjiOCH
Hay DC iCa8OHaDC Oi IH8 jaHCHI jiOVGCG IHCiC aiC HO COH
IiaHGCaIIOH8.
DHICiO H a HCICiCGGO8C HHaCi Hay HCj IO GCCiCa8C
COH_H 8CVCiIy aHG GHiaIOH H aGHI8 VIH aCHIC DiOHCHI8
WHCH IHCiC 8 CVGCHCC O WHCCZH_. OWCVCi a_OHi8I
HHaCi8 HaVC HOI DCCH 8HOWH IO DC HCj H IHC aD8CHCC O
WHCCZH_ aHG IHCiCOiC jiODaDy WOHG HOI DCHCHI IH8
jaIiCHI.
1jjiOXHaICy o7 O jaICHI8 WIH aCHIC DiOHCHIi8 HaVC
jHiHCHI 8jHIHH DHI IH8 8 HOI a iCaDC jiCGCIOi O DaCIC
ia IHCCIOH. O8I 8IUGC8 a IO 8HOW IHaI aGHH8IiaHOH O
aHIDOIC8 8HCH a8 aZIHiOHyCiH 8_HCaHIy HjiOVC8 OHI
COHC8 HCHGH_ 8yHjIOH iC8OHIOH aHG Caiy iCIHiH IO
WOiK H jaICHI8 VIH aCHIC DiOHCHI8. H jaICHI8 WIH aH
aCHIC CXaCCiDaIOH O CHiOHC OD8IiHCIVC jHHOHaiy G8Ca8C
aHIDOHC IHCiajy 8 HO8I KCy IO DC HCj H IHO8C WIH aI
Ca8I IWO O IHC OOWH_: HCiCa8CG 8jHIHH jHiHCHCC
[CHaH_C H 8jHIHH COOi} HCiCa8CG 8jHIHH VOHHC Oi
HCiCa8CG Gy8jHCa. 1HDOHC8 aiC ajjiOjDaIC Oi jaHCHI8 WIH
jCiIU888 H OiGCi IO GCCiCa8C G8Ca8C IiaH8H88OH aIHOH_H
IHC8C a_CHI8 HaVC a HICG CCCI OH 8yHjIOH8. CiIH888
8HOHG DC 8H8jCCICG WHCH a COHHHHIy OHIDiCaK Ha8 DCCH
iCjOiICG. byHjIOH8 Hay HCHGC COH_HH_ jaiOy8H8 aHG
jO8IIU88VC VOHiHH_ DHI aiC HOI iCaDC HGCaIOi8 O iHCCHOH.
1 CHC8I iaGO_iajH 8 HOI HGCaICG H a jaICHI VIH aCHIC
DiOHCHI8 WHO GOC8 HOI HaVC 8_H8 Oi 8yHjIOH8 O jHCHHO
Ha 8HCH a8 CVCi Gy8jHCa aHG jCHDIC CHC8I jaH. lOH_H
IHaI jCi88I8 Oi HOiC IHaH o WCCK8 8 aI_Ca Oi aCHIC DiOH
CHI8 aHG a CHC8I iaGO_iajH 8 _CHCiay HGCaICG a8 IHC iH
Ia Ga_HO8IIC IC8I.
HBHCHZa ViIH8 CHIUiC 8 HOI HCCGCG H a jaHCHI WIHOHI CVCi
Hya_a Oi Haa8C DCCaH8C IHC jiODaDiHIy O HHHCHZa ViH8
HCCIOH 8 VCiy OW.
B00CS dI B0 0BCdl 0I dBS W dCU 0I0BCS.
DO_aQHy
YCHZC I,1OW!CI ÎG. LHCJ! iIJCLCC. DCULC DIOHCHU8. ^ H_|
|CG. Zbb(Z}.Z1ZbZ1. _i1i.1J++_
IH d7 DSWf.
bOUCBIODB DgCIV. lt0l thl0ntt 00iDutltPt u
m0n0ly dtit0it Btlh im0ktng ttii0lt0n.
bHOKH_ CC88aHOH 8 IHC 8H_C HO8I CHCCIVC HICiVCHHOH IO
iCGHCC IHC D8K O GCVCOjH_ CHiOHiC OD8I!HCIVC jHHOHaiy
Gi8Ca8C aHG IO 8IOj LS jiO_iC88OH. OHOiIICiH IODaCCO GCjCH
GCHCC IiCaIHCHI 8 CHCCIIVC aHG CVCiy IODaCCO H8Ci 8HOHG DC
OCiCG COHH8CH_ aHG HCOIHC iCjaCCHCHI [jaICH _HH
HaCi aHG Ha8J 8jiay} aI CVCiy V8I. lOHH8CH_ 8HOHG OCH8
OH C8IaD8HH_ a QHI GaIC CHjHa8ZH_ aD8IIHCHCC H8H_
122 GCnCrI lntCrnI MCdcnC
OIHCi JHiy HCHDCi8 JHG J\OiGiH_ JCOHO JHG OIHCi GiH_8.
bC\CiJ CHCCIi\C [HJiHJCOIHCiJ[iC8 Oi IODJCCO GC[CHGCHCy
JiC J\JiJDC JHG JI CJ8I OHC O IHC8C HCGiCJIiOH8 8HOHG DC
JGGCG IO COHH8CiH_ HHC88 COHIiJiHGiCJICG. 1JIJ UOH IHC
^JHOHJ 1H8HIuIC8 OCJIH 1HH_ CJIH bIuGy iC\CJCG IHJI
HOiC [JiIiCi[JHI8 iH IHC 8HOKiH_ iHICi\CHIiOH _iOH[ QHiI
COH[JiCG WiIH H8HJ JHG CH8IOHJiy IHCiJ[y [yCJi 1. +.+7 \8.
V.7 yCJi .+7 \8. Z1.V7}. HC JHHHJ iJIC O GCCiHC iH
1` O\Ci + yCJi8 Oi QHiIICi8 WJ8 HJ IHJI Oi COHIiHHiH_
8HOKCi8.
Hi8 [JIiCHI i8 JiCJGy OH IHCiJ[CHIiC GO8C8 O J OH_JCIiH_
DiOHCHOGiJIOi JH iHHJCG COiIiCO8ICiOiG i[iJIiO[iHH JHG J
8HOiIJCIiH_ J_OHi8I JHG 8HC GOC8 HOI CXHiDiI OXyHCHO
_ODiH GC8JIHiJIiOH ViIH CXCiIiOH. HCiCOiC 8HC GOC8 HOI
HCCG JHy CHJH_C8 iH HCi iHHJCG HCGiCJIiOH8 Oi iCQHiiC 8H[-
[CHCHIJ O\_CH IHCiJ[y.
1
bm0KBg CSS0B S h SBgl m0S CV BfVB0B 0
f0uC h ISK 0 0Vl0Bg ChI0BC 0DSIuCV ulm0BI 0S
S B0 0 S0 S f0gISS0B.
DC_agHy
Yi8OH |. H IC CiHiC. bHOKiH_ CC88aIiOH. ^ HICIH CU. 21+.
JI2-1-IJ2-1. 1. 12oo+b
Item d Answer: A
Educational Ob]ective: Knew tbc cgcrn ef rmeknq
rcnaten en lunq ]nrten.
Hi8 [JIiCHI iKCy HJ8 CHiOHiC OD8IiHCIi\C [HHOHJiy Gi8CJ8C
[ L\11 } DJ8CG OH HCi CiHiCJ HHGiH_8 JHG [HHOHJiy HHC-
IiOH iC8HI8 [1` <7 JHG 1`yL` <.}. H IHC 1HH_
CJIH bIuGy 8HOKCi8 WiIH HiG IO HOGCiJIC L\11
WCiC iJHGOHiZCG IO iCCCi\C 8HOKiH_ iHICi\CHIiOH [H8 i[iJI-
iO[iHH DiOHiGC 8HOKiH_ iHICi\CHIiOH [H8 [JCCDO Oi HO
iHICi\CHIiOH. 1HH_ HHCIiOH WJ8 HOHiIOiCG Oi yCJi8. HC
8HOKiH_ iHICi\CHIiOH JiH8 WCiC DOIH J88OCiJICG WiIH J
GCCiCJ8CG iJIC O GCCiHC B HH_ HHCIiOH. HC H8C O J DiOH
CHOGJIOi HJG J 8HJ DCHCHCiJ CHCCI OH HH_ HHCIiOH. HC
DCHCHI GiG HOI [Ci8i8I JHCi [JIiCHI8 8IO[[CG H8iH_ IHC DiOH-
CHOGiJIOi. H J 8HD8CQHCHI 8IuGy IHC 1HH_ CJIH bIHGy
iHHJCG COiIiCO8ICiOiG8 GiG HOI iH[iO\C IHC iJIC O GCCiHC iH
HH_ HHCHOH.
1HOH_ IHO8C WHO QHiI 8HOK_ HH_ HHCHOH iH[iO\CG GHi-
iH_ IHC Hi8I yCJi Dy JH J\CiJ_C O Z7. YOHCH WHO 8HCCC88-
Hy QHiI 8HOK_ iH[iO\CG Dy .7 COH[JiCG WiIH HCH
WHO iH[iO\CG Dy 1.7. H IHC 8HOKiH_ iHICi\CHIiOH _iOH[
JHOH_ IHO8C WHO QHiI 8HOKiH_ IHC 8HD8CQHCHI iJIC O GCCiHC
iH HH_ HHCIiOH WJ8 J H1 [Ci yCJi J HOiHJ \JHC COH
[JiCG WiIH COHIiHUiH_ 8HOKCi8 WHO8C HH_ HHCIiOH GCCiHCG
JI J iJIC O H1 [Ci yCJi.
1
bm0KBg CSS0B S SS0C0 Wh 0CIS0 I 0 0ClB
B luBg uBC0B.
DC_agHy
Yi8OH |. H IC CiHiC. bJOKiH_ CC88aIiOH. PHH HICIH CU. 2
1+(o}.JI2-1-IJ2-1. 1. 12oo+b[
Item d Answer:
Educational Ob]ective: Ceunrcl tbc atcnt en rmek-
nq rcrraten h rcdurc tbc rrk ef rardevarrular drcarc.
bHOKiH_ CC88JIiOH V HJ\C IHC _iCJIC8I iH[JCI OH iCGHCiH_
IHi8 [JHCHI8 H8K O HIHiC CJiGiO\J8CHJi Gi8CJ8C. H8 WOHJH
HJ8 8C\CiJ ii8K JCIOi8 Oi CJiGiO\J8CHJi Gi8CJ8C iHCHGiH_
ODC8iIy [1 >} HCi JHiy Hi8IOiy HCi 8CGCHIJiy iC8IyC
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HHIi[C iHICi\CHIiOH8 Oi CJiGiO\J8CHJi Gi8CJ8C ii8K JCIOi
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JGGiC88 IHC H8K JCIOi8 JHG iHICi\CHIiOH8 8CQHCHIiJy. OW
C\Ci IHCiC JiC J8O GJIJ IO 8H__C8I IHJI JGGiC88iH_ HHIi[C
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HIuiC CJiGiO\J8CHJi G8CJ8C. [I GOC8 HOWC\Ci COiiCJIC WiIH
ii8K O 8HOKiH_iCJICG CJHCCi8 JHG HH_ Gi8CJ8C.} H JGGiIiOH
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Hi8I yCJi8 JHCi 8IO[[iH_. HCiCOiC JIHOH_H IHi8 [JIiCHI
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DC 7 O\Ci IHC HCXI 1 yCJi8 [OW ii8K} COH[JiCG WiIH C88
IHJH 17 i 8HC WCiC J HOH8HOKCi.
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Ci8C J HCJIHy GCI JHG HJiHIJiHiH_ J HCJIHy WCi_HI. YiC
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Hy[CiICH8iOH JHG GiJDCIC8 IHCy HJ\C HOI COHCH8i\Cy DCCH
8HOWH IO iCGHCC IHC H8K O CJiGiO\J8CHJi C\CHI8.
1h ISK 0 CI00VSCulI VB S f0uC0 I0l [WhB b
IS} 0 Sm0KBg CSS0B B W0mB.
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CHDCU bP bIaHj|CI | 1O8HCI DP IOUiIZ LP. bHOKiH_ aHU
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HC HO8I ajjiOjiiaIC jHaiHaCOO_iC IHCiajy Oi Ii8 jaIiCHI
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12 WCCK8 iHCiCa8CU IHC OUU8 O OH_ICiH 8HOKiH_ CC88aIOH
ajjiOXiHaICy IHCCOU COHjaiCU ViU jaCCDO. YCH COH-
jaiCU UiiCCIy WiI DujiOjiOH \aiCHiCiHC Wa8 IC HOiC CUCC-
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iCquHCU DOXCU WaiHiH_8 OH \aiCHiCHC aHU DujiOjiOH HOI-
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>UIgC I6dm6B SR0U0 06 C0BS06I60 0I d6BS WI bMI 0
Jb0I gI6d6I d00 S6I0US 006SI6d60 m60Cdl C0m0I006S 0I
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DlO_aQHy
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iH_ DOOU _uCO8C ijiU jaHC aHU 8CiuH CiCaHHiHC C\aua-
IiOH. PDHOiHa Wai8I CiiCuHCiCHCC [ >i2 CH _ + H] Oi
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ODC8i[ a 8uiiO_aIC C8IHaIC Oi \i8CCia aI. ì8CCia aI i8 a
HOiC HCIaDOCay aCI\C aI IaI iCCa8C8 BCC aH aCU8 iHIO
IC jOiIa 8y8ICH WHCH COHIDDuIC8 IO HyjCiijiUCHia HyjCi
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!24 GCCrI |ICI MCdICIC
gastrocsophagcal rclux, and ccrtain typcs ol canccr c.g.,
brcast, cndomctrium, prostatc, colon, kidncy, and gallblad
dcr). In adults with a 8MI ol 5 to 34., an abnormal waist
circumlcrcncc is associatcd with a grcatcr nsk than that dctcr
mincd by 8MI alonc. Iaticnts idcntihcd as ovcrwcight 8MI,
5-. ), obcsc 8MI, 30 ), or having an abnormal waist cir
cumlcrcncc arc asscsscd lor obcsity-associatcd condiuons such
as hypcrtcnsion, mctabolic syndromc, cndocrinopathics i.c.,
h_othyroidism, diabctcs, and Cushng syndromc), and rcpro-
ducuvc disordcrs such as polycysuc ovary discasc. In a|l paucnts
with a 8MI grcatcr than 25, obtain a blood glucosc lcvcl,
scrum crcatininc lcvcl, and lasting hpid prohlc HIL cholcs
tcrol, tnglyccridcs, and LIL cholcstcrol) to asscss lor comor
bidtics.
Scrccning asymptomatic paticnts with complctc blood count
and scrum clcctrolytcs in thc abscncc ol conditions known to
altcr clcctrolytcs) docs not providc mcasurcablc hcalth carc
bcnchts. Scrccning clcctrocardiograms arc not rccommcndcd
in asymptomatic paticnts bccausc abnormalitics ol thc rcsting
clcctrocardiogram arc rarc, arc not spccihc lor coronary artcry
discasc, and do not prcdict subscqucnt mortality lrom coro
nary discasc. Similarly, scrccning chcst x-rays arc not hclpml
in asymptomatic pcrsons. A slccp study may bc indicatcd to
conhrm slccp apnca in paticnts with daytimc latiguc, somno
lcncc, hypcrtcnsion, or history ol snoring, but this paticnt is
asymptomatic and docs not rcquirc a slccp study or pulsc
oximctry to dctcrminc oxygcn saturation.

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DO_aQDy
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lI0Hd HSW0t.
bOUCBIOHB D0CIV0. 1rt0| 00t:( |0 0r/:m|.
1hc bcst managcmcnt opuon lor this paucnt is to add a wcight
loss mcdication such as orlistat with mcals, with continucd
cncouragcmcnt ol dict and cxcrcisc. A mcta-analysis ol orlis
tat trials dcmonstratcd an avcragc wcight loss ol . kg o.4
lb) comparcd with placcbo. Rcpcatcd attcmpts at dictary mod-
ihcation and cxcrcisc havc lailcd to trcat this paticnt`s obcsity,
which is likcly a contributing lactor to hcr hypcrlipidcmia,
hypcrtcnsion, and typc diabctcs mcllitus. According to thc
Amcncan Collcgc ol Ihysicians clinical guidclinc, drug thcr
apy can bc ollcrcd to obcsc paticnts who havc lailcd to achicvc
thcir wcight loss goals through dict and cxcrcisc alonc. 8clorc
initiating drug thcrapy, it is important to havc a nank discus
sion vth thc paticnt rcgarding thc drugs` sidc chccts, salcty
data, and thc tcmporary naturc ol thc wcight loss achicvcd
with mcdications.
Sibutraminc is a sympathomimctic agcnt that supprcsscs
appctitc and lood intakc. Likc orlistat, it is an cllcctivc drug
lor wcight loss. Howcvcr, sibutraminc incrcascs systolic
blood prcssurc and pulsc. It is also associatcd with in incrcasc
in nonlatal myocardial inlarction and strokc in paticnts with
prccxisting cardiac discasc. In ctobcr 00, sibutraminc
was voluntarily withdrawn nom thc \.S. and Canadian mar-
kcts lor salcty conccrns.
Mcdications arc a common contnbunng lactor to obcsity, and
sullonylurcas such as glipizidc havc bccn associatcd with
wcight gain. !owcvcr, insulin is also associatcd with wcight
gain, and switching thc paticnt`s mcdication nom gipizidc to
insulin is unlikcly to bc ol bcncht.
Rclcrring thc paticnt lor banatric surgcry is not indicatcd, as
thc paticnt docs not mcct commonly cstablishcd rclcrral
guidclincs 8MI 40 or 8MI 35 with mcdical comorbiditics
such as slccp apnca, obcsity-rclatcd cardiomyopathy, scvcrc
arthritis, hypcrlipidcmia, diabctcs, or glucosc intolcrancc).

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1hc paticnt should undcrgo uppcr cndoscopy to rulc out a
complication lrom hcr rcccnt laparoscopic gastric bypass
surgcry, cspccia|ly stomal stcnosis a stricturc at thc anasto-
mosis ol thc gastric pouch and |c|unum) or marginal ulccra-
tions or crosions. Il a stricturc is diagnoscd at thc timc ol
cndoscopy, dilauon ol thc stncmrc cndoscopically ohcn rcsults
in rclicl ol symptoms vthout thc nccd lor rcpcat surgcry.
Stomal stcnosis typically prcscnts with symptoms ol nausca,
vomiting, and inabihty to cat. ithcr barium swallow or uppcr
cndoscopy can cstablish thc diagnosis. ndoscopy may bc
morc appropriatc than banum swallow in this paticnt bccausc
ol thc possibility ol stomal crosion, which is morc dimcult to
diagnosc with barium radiography. 8ccausc thc paticnt has
not had othcr signs ol uppcr gastrointcstinal blccding or anc
mia with hcr pcrsistcnt symptoms, stricturc is morc likcly.
Howcvcr, thc paticnt takcs naproxcn, and thcrclorc, mccra
tion at thc anastomotic sitc should also bc cxcludcd.
Marginal crosions or ulccrations can bc trcatcd vth proton
pump inhibitors, such as omcprazolc, and ccssation ol thc
SA!I in most paticnts. Howcvcr, this thcrapy is not ind-
catcd until a diagnosis is cstablishcd.
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UCiaSIHCCauSC.JHiSjiOjOiHOHHayDCaS_HaS aHOH_
HuiSiH_ HOHC iCSiUCnIS. JHS jaHCHIS OSS O iHICiCSI iH HS
jiC\iOuS aCIi\iIiCS iCjiCSCHIS aHHCUOHia, IHiS jaiiCU VIH HS
SCCj UiHCu| iH IHC SCIIu_ O a HajOi iC SItCSSOi [uHCH-
jOyHCHI}HayDCaSi_nOHajOiUCjiCSSiOHaHUWaiiaHIHi-
IHCi C\auaIiOH. 1HCXjaiHCU WCi_HI OSS O Oi HOiC iH 1
HOHIH iS OHC O IHC Uia_HOSIiC CHICiia Oi HajOi UCjiCSSiOH
aIHOu_H SOHC jaIiCHIS jiCSCHI WiIH WCi_HI _aiH UuC IO a
UCCiHCiHjHySiCa aCIi\Iy aHU iHCiCaSC iH ajjCIiIC.
lIHOu_H jiOSIaIC CaHCCi CaH iaiCy CauSC WCi_HI OSS iH IHC
aDSCHCC OOIHCiSyHjIOHS iI iS aHuCH CSS iKCy CauSCIHaH
iSUCjiCSSiOHjaiHCuaiyiHajaHCHIWiIHamCUOHiJJHUSCCj
UiSIuiDaHCC.JHiSjaHCHIUOCSHOIHa\CjOyaOijOyUijSia
IOSu__CSIaUa_HOSiSOIyjC GaDCICSaHUIHCaSUH_DOOU
_uCOSC C\C iS HOiHa. 1_C-ajjiOjiiaIC CaHCCi SCiCCHH_
WHiCHWOUUiHCuUCaCOOHOSCOjyiLIHiSa_C_OujWaSHOi-
Ha HOHIHS a_O HaKiH_COOHCaHCCi uHKCy aS WC.

|SyChtIC dSUId8IS I8CUmmUhCuS8SUhvUuhtIy W8ght
USSmUhg pt8htS WhUdUhUthv8phySC CuS8UIW8ght
USS.
blO_aQHy
NJHGCiSCHUCiCH b LCCHS 1 HOCKJCi! 1ODDJCiS !.HC GiJ_HOSHC
S[CC!iUm O UHiH!CHHOHJ WCi_H! OSS. 1Ui | H!CiH CG. 2OJ.J
J+. . JOVo2V
lI0H H5W0t.
bOUCBIOHB Dg0CIV0. unugt nntnnlt0nu
Bttgbl 0 0y @tng 0nr0t0n.
JHC HOSI ajjiOjiiaIC HCXI SICj iH IHC HaHa_CHCHI O IHS
jaIiCHISuHiHICHUCU WCi_HI OSS iS IO SIOjDujiOjiOH. aHy
HCUiCiHCS CaH CauSC iH\OuHIaiy WCi_HI OSS Dy iHUuCiH_
aHOiCXia UyS_CuSia _aSItOiHICSHHa SyHjIOHS Uiy HOuIH
COHHSiOH Oi iHaIICHIiOH Oi a HO\CHCHI UiSOiUCi. JHC
jaHCHISHCUCaHOHiSISHOuUDCiC\CWCUVIHSjCCiaaIICH-
IiOH IO IHCjiCSCHCCO aHIiCHOiHCi_Ca_CHIS aHIijaiKiHSOH-
iaH a_CHIS Ui_OXiH iiOH aHU jOIaSSiuH SujjCHCHIS aSjiDH
JHUbl1SOjiaICSCCiIaiHaHIiUCjiCSSaHIS[DujiOjiOHaHU
HuOXCHHC } IHyiOiU HOiHOHC SujjCHCHIaIiOH aHU CCiIaiH
HyjO_yCCHiC a_CHIS [HCIOiHiH aHU CXCHaIiUC}. 1H IHiS
jaIiCHI IHCiC iS a jOSSiDC ICHjOia iCaHOHSHij DCIWCCH IHC
iHiIiaHOHO DujiOjiOH aHUIHC OHSCIOaHOiCXiaaHU WCi_HI
OSS. CCauSC SHC HaS HO OIHCi HHUiH_S IO Su__CSI aHOIHCi
CauSC O WCi_HI OSS SIOjjiH_ IHC DujiOjiOH aHU CaiCHy
ODSCi\iH_ IHC jaIiCHI iS IHC HOSI iCaSOHaDC OjIiOH. OSI
CXjCiISiCCOHHCHUHaiHICHaHCCVIHaHaHHUCjiCSSaHIUiu_
!2o GCnCr |n!Crn MCUICInC
Oi + LO V mOHLS JHCi iCmSSOH O SymLOmS. 1HS JlCHL
HJS DCCH L!CJLCU Oi mOHLHS SO L S HOL uHiCJSOHJDC LO US
COHLHuC LHCiJy VLH CJ!C OhOW u.
1OUy mJ_H_ O LC LOiJX JHU JDUOmCH Wl !1 Oi 1
iH LHC JDSCHCC O HSLO!CJ HOimJLOH Oi HySCJ CXJmHJ
lOH hHUH_S OHLH_ LO LHC LHOiJX Oi JDUOmCH HJS HOL DCCH
SHOWH LO HC UCLCiH!HC LC CJuSC O H\OuHLJiy WC_HL OSS.
H SLuUCS H WHCH J CJuSC O H\OuHLJiy WC_HL OSS WJS
J__iCSS\Cy uiSuCU J LHOiOu_H HSLOiy JHU HySCa CXJm
HJLOH JHU DJSC JDOiJLOiy LCSLH_ iJLHCi LHJH JU\JHCCU
mJ_H_ iO\UCU LHC UJ_HOSS H HCJiy a JLCHLS. bH
Jiy H LHC JDSCHCC O SymLOmS uCi CHUOSCOy S uHKCy
LO iC\CJ J CJuSC O uHHLCHlOHJ WC_HL OSS JHU S HOl HU-
CJLCU.
1CLLC SLmuJHL LCiJy Oi H\OuHLJiy WC_HL OSS WL
mC_CSLiO JCCLJLC Oi SmJi J_CHLS HJS DCCH SLUUCU mJHy H
JLCHLS Vl /b Oi CJHCCi CJCHCXJ. H LCSC JlCHLS CCi
lJH J_CHLS HJ\C DCCH SHOWH LO iOmOlC WC_HL _JH HOW
C\Ci J Sui\\J JU\JHLJ_C HJS HOL DCCH SHOWH. uilHCimOiC
lHC uSC O JH JCLlC SUmuJLC UOCS HOL JUUiCSS LHC uHUCry-
H_ CJuSC O WC_HL OSS.
M8dCtUhSChb8CuS8UhvUuhtIyW8ghtUSSh8d8Iy
pt8htS.
DC_aQHy
1lDal b LiCCHVOOU \ iayCllC I.PaQQiOaC lO lC HaHa_CHCHl
O uH|D!CHllOHa VCl_l O88 mCUCiy QCOQC. \/|. ZoJZ( }.o-
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lI0HAb HSW0t. L
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]Hmnrj d:t:t : tH:t j tgbl ::.
bC\CiC CHiOHC ODSL!uCL\C umOHJiy USCJSC [!) CJH
CJuSC SySLCmC CHCCLS HCuUH_ uHCJHCU WC_L OSS SKCC-
LJ muSCC UySHCLOH HCiCJSCU CJ!UO\JSCuJi mOiDULy aHU
mOiLJLy HCiCJSCU iSK Oi LyC 2 UJDCLCS mCluS OSLCO-
OiOSS HJCLuiCS JHU UCiCSSOH. lHCXJHCU WC_HL OSS
OCCuiS H JiOXmJLCy HJ O LHC JUCHlS WLH SC\CiC !
mOSly DCCJuSC O LC OSS O SKCCLJ muSCC mJSS. lHCXaHCU
WC_HL OSS CJiiCS J OOi iO_HOSS H ! HUCCHUCHL O
OIHCi HUCJLOiS SuCH JS 1N Oi CO_. 1HC mCCHJHSmS
uHUCr|H_ LHCSC SySLCmC CHCCLS JiC uHCCai DuL J!C iODJDy
HLCiiCJLCU JHU mulJCLOiJ HCuUH_ HJCL\Ly SySLCmC
H JLOH USSuC HyOXJ JHU OXUJL\C SL!CSS. HCiCJSCS H
COHCCHL!JLOHS O H JlOiy mCUJLOiS HUCJLH_ CiH-
CiJ DOOU CC JCL\JUOH JSO HJ\C DCCH OuHU LHiOu_HOuL lC
DOUy JHU mJy mCUJLC SOmC O LCSC SySLCmC CCCLS.
/lHOu_H LHC WC_HL OSS O mJ_HJHCy S J OSSDLy H L|S
JLCHL LHC JDSCHCC O _JSLiOHLCSLHJ SymlOmS Oi OLHCi
OCJZH_ SymLOmS LHC HOima CJHCCi SCiCCHH_ LCSL iCSuLS
WLHH LHC JSL yCJi JHU LC JLCHLS HSLOiy O SC\CiC !
maKC LC CJCHCXJ O! HOl CJHCCi LHC mOSl KCy CJuSC
H LHS JLCHL. 1HC JLCHLS SiOmCLiy HUCJLCS SC\CiC
! JHU J__iCSS\C mJHJ_CmCHL O ! S HCCCSSJiy.
1\JuJLOH Oi UCiCSSOH S JSO HUCJLCU.

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88CtS,hCudhguhht8htUhW8ghtUSS,Sk88tmuSC8dyS-
uhCtUh,hdhCI8S8dISkUCIdUvSCuIdS8S8,USt8UpUIU-
SS,hdd8pI8SSUh.
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ng lb r mtdrrgt:hrnt.
1HC mOSL JiOHJLC HCXL mJHJ_CmCHL SLC S OiJ mCUiOX
_iO_CSLCiOHC JCCLJlC. H JLCHLS WHO iCSCHL WLH mCHOi-
iHJ_J [ HCJ\y mCHSLiuJ DCCUH_) WL J KHOWH CLOO_y SC\-
CiJ LHCiJCulC J_CHLS CJH UCCiCJSC DCCUH_. Oi mOUCiJlC
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CSlJLOHJ J_CHL SuCH JS mCUiOXyiO_CSLCiOHC JCCLJLC CJH DC
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SLJDZC LHC CHUOmCl!um JHU SLO uLCHHC DOOU HOW. /lCi
HJL\Cy J mOHOHJSC OiJ COHL!JCCL\C mJy DC UOSCU Oui
lmCS J UJy Oi D LO UJyS JHU SuDSCquCHLy iCUuCCU LO Uay
UOSH_ Oi WCCKS OOWCU Dy WLUiJWJ DCCUH_.
ÒHSlCiOUJ JHLHHJmmJlOiy Uiu_S JCL Dy HHDLH_
iOSLJ_JHUH SyHLHCSS JHU mJy UCCiCJSC mU DCCUH_ Dy
JiOXmJLCy ". HCC UJy OiJ COHL!JCCL\CS JiC CHCC
L\C H UCCiCJSH_ mCHSLiuJ DOOU OSS Dy D" HOWC\Ci H
DCCUH_ LHJL S JS HCJ\y JS lHS CJSC HClCi O LHCSC mCUCJ-
LOHS WOuU DC JS CHCCL\C JS mCUiOiO_CSLCiOHC.
LHC JLCHL WCiC OiLOSLJLC Oi UZZy HOm DOOU OSS Hl!J-
\CHOuS CSL!O_CH WOuU DC JiOiJlC. JiCHLCiJ COHu_JLCU
CSLiO_CHS JiC JiOXmJLCy " CCCL\C H SLOH_ LHC
DCCUH_ CHLiCy. umOHJiy CmDOSm JHU \CHOuS liOm
DOSS J!C COmCJLOHS O HLiJ\CHOuS CSLiO_CH LHCiJy.
bui_Ca OUOHS JiC iCSCi\CU Oi CJSCS WHCH mCUCJ L!CJlmCHL
JuS DuL L S KCy H lS CJSC LJl mCUCJ L!CJLmCHL CaH iO
VUC J DiU_C uHU HCi SCHCUuCU Sui_CJ iOCCUuiC. OLLOi-
H_ HCi Oi J WCCK VHOL DC HC DCCJuSC L S kCy SHC V
SuSlJH J _iCJL UCJ O JUULOHJ DOOU OSS UuHH_ LHS UmC.

M8dIUkypIUg8St8IUh8C8tt8UI1tU 1 dySS88Ctv8tI8t-
m8htUImUd8It8m8hStIub88dhg.
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aZlO b1 blQ A. /DHOiHa ulCilHC DCCUlH_. bOul CU |.
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Item b Answer: L
Educational Objective: 0gH0t [0]t]It 0V0l] ]H
dl0mt.
HI8 jaIICHI Ha8 Ca88IC jOyCy8IIC OVaIy 8yHUIOHC [1l\.
1l\aHCCI80"OWOHCHOCHU-DCaH_a_CaHUIyjICaBy
jIC8CHI8 VIH OI_OHCHOIIHCa aHU 8I_H8 O aHUIO_CH CXCC88
[HII8uII8HaCHCaHUOCCa8IOHayaOjCCIa.H8uIHIC8I8IaHCC
I8aHaOICaIuICOIHC UI8OIUCI a8aIC OVCIWCI_HIaHUODC-
8IIyaIHOu_HOHy"OaHCCICUWOHCHaICODC8C._ICay
IHCIC I8 a HIU CCVaIIOH IH IC8IO8ICIOHC aHU UCHy-
UIOCjIaHUIO8ICIOHC 8uaICCVC8aHU a uICIHIZIH_ HOIHOHC
IOOICC8HHuaH_HOIHOHCIaHOO_ICaICIIHaH2.1.Ia_-
HO8I8 ICQuIIC8 IWO O IHC IHICC OOWIH_ CaIuIC8. I, OVua-
IOIyUy8HHCHOH [2aDOIaIOIyOICIHiCaC\IUCHCCO HyjCI-
aHUIO_CH8HaHU[3) uIIa8OHO_IajHICCVIUCHCCOjOyCy8IIC
OVaDC8.HI8jaHCHIHa8OVuaIOIyUy8HHCHOHaHUCHCaC\I-
UCHCC O HyjCIaHUIO_CH8H.
HI8 jaIICHI8 IOIa IC8IO8ICIOHC CVC 84 H_yU1 _2.V
HHOy1 aIHOu_H 8OHCWHaI HI_H I8 HOI HI_H CHOu_H IO
IaI8CCOHCCIH8aDOuIaIuHOI.yjICay IHC8CIuHIC8IO8ICIOHC
CVC IH jaIICHI8 WIIH 1l\ IaICy CXCCCU8 1 H_yU1 [.2
HHOy1 HI_HCICVC8WaIIaHIa8CJICHOIJHaUICHaOIOVJI-
IaHIuHOI.HaUUIHOHIHCjaHCHIaCK8aHy8I_H8OV8HIHaI
I8 COHHOHy a88OCIaICUVIH aHUIO_CH 8CCICIIH_ IuHOI8 8uCH
a8 8uUUCH OH8CI O HCH8IIua IIIC_uaIIIy HII8uII8H aCHC
UCCjCHiH_OIHCVOICCUOHIa[OICIOWHDaUIH_IHCICa8CU
Hu8CC Ha88 OICIIOIOHC_ay.
HC aD8CHCC O _aaCIOIIHCa aHU HOIHajIOaCIIHCVCCIH-
IHaIC8 a jIIuIIaIy jIOaCIIHOHa a8 IHC Cau8C O IHC jaIICHI8
OI_OHCHOIIHCa. 1UUIIIOHay HyjCQIOaCIIHCHIa UOC8 HOI
Cau8C HII8uII8H.

|oyCyStCovfySyhdfom8typCypf8S8htSWthogom8hoffh8
hdSghSolhdfog8h8kC8SShCudhg hfSutSm, Ch8,hdoCC
Sohyop8C.
DlO_gHy
WIscn |I. Jhc pclycystc cvary syndrcmc. Pnn Intcrn Ncd. 2U11;
1o+(3):IJC21. INII: 21282v2[
Item b3 Answer:
Educational Objective: 1lt0I [tlmtH0[0H0 ]m[
hm HIb tH0gtH lt[0ttmtHI Ibtl0[].
HC HO8I ajjIOjHaIC IICaIHCHI OI IHI8 jaIICHI I8 C8IIO_CH
ICjaCCHCHI IHCIajy [1. 1 jIOVIUC8 8I_HIHCaHI ICIC
OI HOI Bu8HC8 a88OCIaICU WIIH HCHOjau8C IH " IO V" O
jaIICHI8.HCICI8HOCCaIDCHCBIOOHCC8IIO_CH-COHIaIHIH_
jIOUuCI OVCI aHOIHCI. CIC O HOI Hu8HC8 I8 IHC jIIHaIy
[aI_uaDy IHC OHy IHUICaIIOH OI 1 aIHOu_H II a8O
ICUuCC8IHCIaICO jO8IHCHOjau8aDOHCUCH8IIy O88. OW-
CVCI IHCDCHCB I8O 1 Hu8I DC WCI_HCUa_aIH8IIHC H8K8
WHCHIHCuUCjOICHHaIHCICa8CUIaIC8O DICa8ICaHCCIIHOH-
DOCHDOIC CVCHI8 aHUCaIUIaC CVCHI8.
Gener |n!ern Medcne 127
lOHIIaIHUICaIIOH8IOC8IIO_CHu8CIHCuUCuHUIa_HO8CUVa_-
Ha DCCUIH_ DICa8I CaHCCI OIHCI C8IIO_CH-8CH8IHVC CaHCCI8
CuIICHI OI jICVIOu8 HI8IOIy O VCHOu8 OI aIICIIa IHIOHDO8I8
aHU IVCI Uy8HHCIIOH OI UI8Ca8C. HC \.. OOU aHU Iu_
1UHIHI8IIaIIOHICCOHHCHU8u8COIHC8HaC8ICHCCIIVCUO8C
O HOIHOHC ICjaCCHCHI IHCIajy OI IHC 8HOIIC8I UuIaIIOH
jO88IDCIO IICaIHCHOjau8a8yHjIOH8.
1IHOu_H 8OHC 8IuUIC8 HaVC ICjOIICU jO8IIIVC IC8uI8 WIIH
DaCKCOHO8HICjOII8HaVCDCCHIHCOH8I8ICHIaHUIHCHCIHOU-
OO_Cay 8IIOH_C8I 8IuUIC8 HaVC OuHU HO CUCHCC O DCHC-
BI. lOHCu8IVC C\IUCHCC I8 8IHIaIy aCKIH_ OI OIHCI aICIHa-
IIVC HCUICIHC8 8uCHa88Oy jIOICIH8 aHUICU COVCI.
1IC8CII|IIOH IICaIHCHI8 OI WHICH IHCIC I8 8OHC CUCHCC O
DCHCHIIH jaIICHI8WIIHHOI Bu8HC8 IHCuUC IHC8CCCIIVC 8CIO-
IOHIHaHUHOICjIHCjHHCICujIaKCIHHIDIIOI8VCHaaXIHCaHU
8CCCIIVC 8CIOIOHIH ICujIaKC IHHIDIIOI8 8uCH a8 CIIaOjIaH
jaIOXCIIHC HuVOXaHiHC aHU BuOXCIIHC. HC8C CaH DC COH-
8IUCICU a8 8CCOHU-IHC a_CHI8 C8jCCIay IH WOHCH WHO a8O
HaVC 8OHC 8yHjIOH8 O HOOU OI aHXICIy UI8OIUCI8. I I8
H_OIHC8IZCUIHaIHOIHu8HC8aICjaIHOjHy8IOO_ICaya88OCI-
aICUWIIHIHCICa8CUHOIaUICHCI_ICaCHVIIy aHUUCCICa8CU8CIO-
IOHCI_IC aCII\IIy 8O II I8 iKCy IHaI IHC DOCKa_C O 8CIOIOHiH
ICujIaKC I8 IC8jOH8IDC OI IHC DCHCHI8 WIIH IHC8C a_CHI8.
\IHCIa_CHI8IHaIHayICICVCHOIHu8HC8IHCuUCHiIIaZajIHC
aHU_aDajCHIIH.
aOXICHC I8 a 8CCCIIVC C8IIO_CH ICCCjIOI HOUuaIOI IHaI I8
ajjIOVCU OI IHC jICVCHIIOH O jO8IHCHOjau8a DOHC Ha88
O88 DuI II UOC8 HOI HCj WIIH HOI Hu8HC8 OI OIHCI jO8I-
HCHOjau8a8yHjIOH8 aHU HayCVCHWOI8CH IHCH.

cStfog8hf8pC8m8htth8fpypfovd8S8ll8Ctv8f88lolhot
luSh8S, 0uttSuS8muSt08W8gh8dghStth8pot8htdv8fS8
8ll8CtS.
DlO_gHy
Ccl I IarLcld I, IwanWhytc C, Nllcr !. In thc clnc.
Ncncpausc. A Intcrn Ncd. 2UUv;1oU():IJC+11o; guz IJC+1.
jINII: 1v3+v28]
Item bZ Answer:
Educational Objective: 1V0H0H tt0Hd0l] 0mtH0l
lbt0 HIb 0 [l0gtIH HIbdl0H0 tb0tHgt.
HCHCXI8ICjIHIHCCVauaIIOHOIHI8jaIICHIWIIH8CCOHUaIy
aHCHOIIHCaaHCI8IOjjIH_HCIOIaCOHIIaCCjHVCjII8ajIO_-
C8IIHWIIHUIaWaCHaCH_C.H8jaIICHIHa8aHuHICHaIKaDC
jCI8OHaaHUaHHyHCUICaHI8IOIyJHUHOC\IUCHCCOaHUIO-
_CHCXCC88. C8uIO HCI8CICCHiH_aDOIaIOIy8IuUIC8aICHC_
aIIVC OI IHyIOIU UI8OIUCI8 OVaIIaH Uy8HHCIIOH aHU HyjCI-
jIOaCIIHCHIa. \IVCH IHC8C UaIa IHC G CICHIIa GIa_HO8I8 O
IH8jaHCHI88CCOHUaIy aHCHOIIHCaHCuUC8aHaIOHICUCCCI8
aHU CHIOHiC aHOVuaIIOH WIIH OIVIHOuI C8IIO_CH. HC UI-
CICHIIa UIa_HO8I8 CaH DC HaIIOWCU HO8I CCCIIVCy WIIH a
jIO_C8IIH WIIHUIaWa CHaCH_C. CH8C8 aHCI CHaCH_C
T2b GCnCt |n\Ctn NCUCnC
CXCHGC8 aHaIOHiC GCCCI8 aHG CHiOHiC aHOvHaIiOH WIHOHI
C8IiO_CH. HCiCOiC a [iO_C8IiH WiIHGiaWl CHaCH_C i8 IHC
HO8I a[[iO[iiaIC HCXI 8IC[.
iOyCy8IiC Ovaiy 8yHGiOHC [i\\b} aHCCI8 7 O WOHCH O
CHiGDCaiiH_ a_C aHG Iy[iCay [iC8CHI8 WiIH Oi_OHCHOiiHCa
aHG 8i_H8 O aHGiO_CH CXCC88 [Hii8HI8H aCHC aHG OCCa8iOH
ay aO[CCia}. H8HiH iC8i8IaHCC i8 a HaOi CaIHiC O IHC Gi8
OiGCi a8 i8 OvCiWCi_HI aHG ODC8iIy [aIHOH_H OHy 50" O
WOHCH ViIH i\\b aiC ODC8C}. y[iCay IC8IO8ICiOHC aHG
GCHyGiOC[iaHGiO8ICiOHC 8HaIC CvC8 aiC HiGy CCvaICG aHG
IHC HICiHiZiH_ HOiHOHC IO OiCC8IiHHaIiH_ HOiHOHC iaIiO
i8 _iCaICi IHaH 2: . Ca8HiCHCHI O GCHyGiOC[iaHGiO8ICiOHC
8HaIC i8 iaiCy CmiCay H8C.
iO8iIivC WIHGiaWa DCCGiH_ aHCi IHC [iO_C8IiH WiIHGiaWa
CHaCH_C 8H__C8I8 aH C8IiaGiO CvC O _iCaICi IHaH 40 [_yHi
, I4.8 [HOyi} aHG IHH8 ODviaIC8 IHC HCCG Oi HCa8HiCHCHI
O 8CiHH C8IiaGiO CvC8.
1 1 O IHC [iIHiIaiy _aHG i8 HHHCCC88aiy aI IHi8 [OiHI
DCCaH8C HCi OiCC8IiHHaIH_ HOiHOHC [iOaCID aHG IHy
iOiG CvC8 aiC a HOiHa.
M8hStfu oW oh fog8Sth WthdfW hdCt8S f8tv8y hof
m 8Stfog8h foduCtoh hd t8ht outoW tfCt, WhCh mtS
th8 d8f8ht dghoSS o S8Cohdfy m8hoffh8 to ChfohC
hovutoh Wth 8Stfog8h f8S8ht.
DO_agDy
1IJCUCC IOHHHCC O! !HC 1HCICJH bOCC!y !OI CQIOGuCUVC CGCHC.
IuIICH! CVJ!uJ!OH O! JHCHOIIHCJ. CI!! b!CI!. Zb( b buQQ!
1].b1+b-b1bb. 11i.1bbb1Z[
Item b Answer:
Educational Objective: tvaluan rcrcndary amcncr-
rbca wtb mcarurcmcnt cf rcrum fcllrlc rtmulatnq bcr-
mcnc and prclartn lcvclr.
Hi8 [aIiCHI8 8CiHH OiCC8IiHHaHH_ HOiHOHC [1b1} aHG
[iOaCHH CvC8 8HOHG DC HCa8HiCG. bCCOHGaiy aHCHOiiHCa i8
GCHCG Dy IHC aD8CHCC O HCH8C8 Oi 3 Oi HOiC COH8CCHHvC
HOHIH8 iH a WOHaH WHO Ha8 HCH8IiHaICG [iC\iOH8y. CH
8IiHa aiHiC CaH DC COH[CIC aHCHOiiHCa Oi vaiyiH_ GC_iCC8
O Oi_OHCHOiiHCa IHC aIICi DCiH_ HHCH HOiC COHHOH.
iiC_HaHCy 8HOHG DC CXCHGCG iH a [aIiCHI8 [iiOi IO OIHCi
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Educational ObjeOive: Tr:s1 smg: Z q:runs/:n
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b!ccding disordcr
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mCHLs ahCr Oa_HCss CI aH OCaLmC umCHary CmCism
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amy sLCry HCuOCs a maLCrHa _raHOmCLCr a mCLCr
aHO aH COCr rCLCr WL a sLCry CI OCC VCHCus LrCm-
Css VC Vas Oa_HCsCO H LhrCC rCaLVCs CICrC LCy
VCrC a_CO o yCars. JC aLCHL LaKCs HC Cra CCHLraCCLVCs
Cr CLCr mCOCaLCHs aHO s CLCrVsC CaLy. JC CCmCLC
CCO CCuHL s HCrma aHO LC I1 s ..
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u tDc cValuaUOD O tDI8 gaUcDt:
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5C as HC CLCr mCOCa rCCms.
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LCH CI LC r_L CVCr CXLrCmty sCVs mO CryLCma
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CaI. IarOCumCHary aHO aOCmHa CXamHaLCH hHOH_s
arC HCrma.
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CarOChH aHHCOy CVCl anO LC rCsCHCC CI a uus HLCr
CH CCa_uaLCH LCsLH_.
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P yCarCO VCmaH VC as CCH LryH_ LC CCCmC rC_-
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VCKCO VCHCus LrCmCCmCsm 16 mCHLs a_C. Cr asL
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aOCmHa CXamHaLCH arC HCrma.
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mm _ usC raLC s 6 / mH rCsraLCH raLC s Z / mD aHO
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sVCy VCrsCHH_ IaL_uC ICr_CUHCss CCHsHauCH CXCCssVC
LmsL aHO HCrCasCO urHaLCH. C as HC aH. s CHy s_-
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mCma OuC LC Sr|:ptororrupn:umonn: mCHLs a_C.
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aDC. JCmjCiaIuiC s .1 I [Vo.o DOOU jiCssuiC s
11/ mm _ jusC iaIC s 12/mH aHU iCsjiaIOH iaIC
s 1 /mH. JC Oia muCOsa s Uiy aHU IC COHuHCI\aC aiC
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CCs.
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mOHaiy jaiCHCyma HIiaICs aiC sCCH.
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HOH WI HOima saHC. JC iCsuIs OI a DOHC maiiOV asjia-
HOH aiC sOVH [aIC 1V.
[P PCuIC myCOU CuKCma
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uIjC myCOma
Item Z [AOvanceO]
P +-yCai-OU VOmaH s C\auaICU aHCi a _ sCium IOIa
jiOICH C\C Vas IOuHU UuiH_ iOuIHC aDOiaIOiy ICsIH_.
CUCa sIOiy s HOHCOHIiDuIOiy.
|H jysCa CXamHaIOH \Ia s_Hs aiC HOima aHU CXam-
HaIOH BHUm_s aiC uHrCmaiKaDC VI HO Oi_aHOmC_ay Oi
ymjHaUCHOjaIy.
CmO_ODH
CuKOCyIC COuHI
aICCI COuHI
IaCum
IiCaIHHC
iOICH
JOIa
PDumH
1.b _/U [1b _/
bb/ [b.b 1 /
2/|I [2 1 /
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1. m_/U [oo.+ mO/
1.1 _/U [11 _/
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bCium jiOICH CCCIiOjOiCss sOVs a mOHOCOHa sjKC OI
1.o _/U [1o _/ VC s iICi UCHIHCU as _L-t Dy
sCium muHOhaIOH. P DOHC maiiOV asjiaIC iC\Cas 7
jasma CCs. P sKCCIa sui\Cy UOCs HOI sOV aHy yIC CsOHs.
Hem8lCCQy TAb
Wch ot thc tollowg s thc most IkcIy dagoss
[P 1 [_I CaH amyOUOss
ymjOjasmaC ymjOma [\aUCHsIim
maCiO_ODuHCma
[I OHOCOHa _ammOjaIy OI uHUCICimCU s_HB-
CaHCC [L1b}
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Item Z [8aslc]
P -yCaiOU maH COmCs IO IC OHCC IOi IOOVuj C\aua-
IOH 1 mOHI aHCi DCH_ sCCH IOi symjIOms OI aH ujjCi iCs-
jiaIOiy IiaCI HICCIOH. ysCa CXamHaIOH HHUm_s aI s
HIa \sI VCiC HOima aDOiaIOiy sIuUy iCsuIs sOVCU a
CuKOCyIC COuHI OIo/ [1o 1 / WI 7 ym-
jOCyCs. JC jaHCHIs ujjCi iCsjiaIOiy IiaCI HICCHOH syj-
IOms a\C sHCC iCsO\CU COmjCICy aHU C HOICs HO OICi
mCUCa jiODCms Oi symjIOms.
ysCa CXamHaIOH HHUH_s UuiH_ Is \sI aiC a_aH HOi-
ma WI HO C\UCHCC OI ymjaUCHOjaIy Oi sjCHOmC_ay.
JC iCjCaICU CuKOCyC COuHI iCmaHs IC samC aHU IC COm-
jiCCHs\C mCIaDOC jiOBC aHU aCIaIC UCyUiO_CHasC COH-
CCHIiaIOH aiC HOima. CijCia DOOU smCai iC\Cas mOi-
jOO_Cay maIuiCajjCaiH_ ymjOCyICs.
Wch ot thc toIIowg s thc most Ikcly dagoss
[P PCuIC ymjOCyIC CuKCma
PCuIC myCOU CuKCma
[I IiOHC ymjOCyIC CuKCma
IiOHC myCOU CuKCma
Item J0 8aslcj
P b-yCaiOU VOmaH s C\auaICU H IC CmCi_CHCy UCjaiI-
mCHI IOi IC\Ci aHU saKH_ Cs OI o HOuis UuiaIOH. JC
jaICHI as a 1yCai sIOiy OI myCOUysjasIC syHUiOmC
IiCaICU VI azaCIUHC.
|H jysCa CXamHaIOH ICmjCiaIuiC s V.2I [12.
DOOU jiCssuiC s 1/ mm _ jusC iaIC s 11/mH
aHU iCsjiaIOH iaIC s 2/mH. ysCa CXamHaIOH BHUH_s
aiC OICiWsC uHiCmaiKaDC VI HO ias ymjaUCHOjaIy
COsIO\CiICDia aH_C ICHUCiHCss aDUOmHa ICHUCiHCss Oi
sjCHOmC_ay.
CmO_ODH
CuKOCyC COuHI
aICCI COuHI
1iHayss
1. _/U [1 _/
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oo/ [oo 1 /
IOima
P CCsI iaUO_iaj s HOima.
P jCHjHCia DOOU smCai s sOVH [aIC 2.
[P PCuIC ymjODasIC CuKCma
PCuIC myCOU CuKCma
[I PCuIC jiO myCOCyHC CuKCma
IiOHC myCOU CuKCma
TAb HemalOlOQy
TH d3 [AOvancCO|
l O-yCJi-OU HJH i8 CVJuJICU IOi iHCiCJ8iH_ IJIi_uC OI Z
HOHLH8` UuiJLiOH. C HJ8 HO OLHCi HCUiCJ iODCH8 JHU i8
HOI IJKiH_ JHy HCUiCJIiOH8.
\H Hy8iCJ CXJHiHJIiOH VIJ 8i_H8 JiC HOiHJ. HCiC i8 HO
yHHJUCHOJIHy Oi CHHCiJ CUCHJ. HC 8CCH i8 JJ-
DC CH DCOW IHC CH CO8IJ HJi_iH.
CHO_ODiH 1Z.1 _/U [1Z1 _/}
CuKOCyIC COHHI OOZ/| [OO.Z 1 /}
JICCI COuHI 1O/| [1O 1 /}
l CiiHCiJ DOOU 8HCJi 8HOW8 JH iHCiCJ8CU HuHDCi OI _iJH-
uOCyIiC CC8 iH J HJ8C8 OI UCVCOHCHI DuI ViIH J HJiKCU
CH 8HiH JHU HO luCi iOU8 iH IHC DJ8I8. OHC HJiiOW CXJH-
iHJIiOH 8HOW8 HyCiCCuJi HJiiOW [7 CCuJii]} WiIH
HJiKCU _iJHuOCyIiC HyCQJ8iJ J CH 8HiH iH IHC _iJHuO-
CyIC8 JHU 7 nyCODJ8I8. IyIO_CHCIiC IC8IiH_ iCVCJ8 J
!CK, 71IiJH8OCJIiOH.
Wch ot Uc toBowg s Uc most mcy dagoss
[l} lCuIC yHHODJ8IiC CuKCHiJ
[} lCuIC HyCOiU CuKCHiJ
[I} lCuIC iOHyCOCyIiC CuKCHIJ
IHIOHiC HyCOiU CuKCHiJ
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HOHB1OIO@
DSWfS BDO LfltlQUS
Item 1 Answer:
Educational Objective: !apnatc ran d]rcnry n
tbc tcttnp aj nmmamry ancma.
HiSjaUCHIHaSaHCHiaO imaHHaUOHaHUiIOHUChCiCHCy.bHC
HaS IHCUHaIOiU aIIHIiIiS a CaUSC O iHaHHaIOIy aHCHa.
m aIOIy CyIOiHCSDOC iIOH UUaUOHUCCICaSCIIaHS-
[aHU IOIa iIOH-DiHUiH_ CajaCiIy i\_} C\CS aHU
HCICaSC CIIiU C\CS.HCOHIIaSI IHC jHySiOO_C ICSjOHSCIO
iIOH UCCiCHCy iS IO iHCICaSC UaHSCIH [aHU i\} C\CS aHU
UCCICaSC CIIiU C\CS. YHCH |HH aIiOH aCCOHjJmCSmOH
UCCiCHCy|HHanaIOIy CyIO|HCSaWay8COHOuU!HCCxjCCICU
jaIICIHOSCIUHmOHCHCHSIIiCS OImOH UChCiCHCy aOHC.
HiS jaIiCHIS iHiIia SCIUH iIOH CHCHiSIIiCS UCHOHSIIaIC a
SCIUH iIOH-IO-i\ IaIiO O JZ7. CjCaI SCIUH iIOH
CHCHiSIIiCSbHOHIHSaICISHOWJHC\CHOWCIiIOH-IO-i\
IaIiOO+.7aHUHCICIHIiHC\CiSOW-HOIHa. \iIIUay a
jaIiCHISWIHSCIUHCIIiIiHC\CSOWCIIHaHJIOJbH_/H
[J-JbI_/}aICiIOH UChCiCHI, HOWC\CIZb7OHCHSIIUaI-
iH_WOHCHWiIHaDSCHISIaHaDCDOHCHaiIOWiiOHHa\CCI-
IiIH C\CS Hi_HCI IHaH 1b H_/H [Jb jI_/}. 1SSUHiH_
aDSCHCCO iHaIiOHHi_HCICIHIiHCUIO iHiISO oIO
+J H_/H [o-+J_/}iHjIO\C IHC CHCiCHCy OUia_HOS-
iH_iIOHUChCiCHCyiHWOHCHUUIiH_ICiIICjIOUUCI\CyCaIS.
iCCaUSC IHiS jaIiCHI aSO HaS IHCUHaIOiU aIIHIiI|S SCIUH CI-
HIiHC\CSaICCXjCCICUIOIiSC[DyaSHUCHaSIHICCOU}OWH_
IO IHC CCCIS O iHaHHaIOIy CyIOiHCS. HCICOIC IHiS
jaIiCHIS SCIUH CIIiIiH C\C O o H_/H [o I_/} SUj-
jOIIS a Uia_HOSiS OiIOH UCCiCHCy jaIIiCUJIyiH!HCSCIIiH_
O HCIiHaH1HaIOIyiHCSS.1SaIUCO IHUH1DSCIUHCIIiIiH
C\CS OWCI IHaH J IO JZ H_/H [J-1Z I_/} Hay
ICCCI iIOH UCCiCHCyiHjaIiCHISWiIH iHaHHaIOIySIaICS.
.IHOU_HHOHIyjHySiOO_CDOOUOSSWIHCHSUUaUOHiS
IHCHOSIiCyCaUSCOmOHUChCiCHCy iHH jaUCHISHCSHOUU
Ha\C a_C-ajjIOjHaIC CaHCCI SCICCHiH_ WiIH COOHOSCOjy [aI a
H|HHUH}IOCXCUUC_aSUO|HICSUHaCau8CSOOCCU|IDOOUOSS.
CIHOIICXaIC iS aH aHIiHCIaDOHIC IHaI iHHiDiIS UiHyUIOOaIC
ICUUCIaSCaHUCaUSCSHC_JODaSHCHaIUIaUOH,HOWC\CIOW-
UOSCHCIHOIICXaICiSUHiCyIOCaUSCSi_HihCaHIHC_aODaS-
IiCaHCHa WHCICaSHi_HCIUOSCSHayUOSOWiIaSi_HiBCaHI
IiSCiHHCaHCOIjUSCUaI\OUHC[\\}.HiSjaIiCHIS\\
iS UHCHaH_CU WiIH OW-UOSC HCIHOIICXaIC. CHCC HC_a-
ODaSIiCaHCHiaUUC IOHCIHOIICXaICiSHOIaiCyCOHIIiDU-
IOIIO IHS jaIiCHIS aHCHia.
TAJ
>6IUm 6IIB l6V6lS l0W6I B 1 0 1Z Bg/mL [11Z g/L)
my I66C I0B 06C6BCy B 6BS W Blmm0Iy S6S.
DO_aQDy
Wcrss G, Goodhough L1. ^ncmra ol chronic drscasc. ` ngl | ^cd.
2005;352(10):1011-23. Î: 1558012j
Item Z Answer: A
Educational Objective: !apnatc aplattr ancma.
HiS jaIiCHI HaS ajaSIiC aHCHa. aIiCHIS WiIH IHiS UiSOIUCI
Ha\CjaHCyIOjCHia aOW ICIiCUOCyCCOUHI JHUaH_OjaS-
IiCDOHCHaIIOW[<Z7CCUaHIy }WiIHHOIHaHaIUIaIiOHO
aCCiHCS.1jaSUCaHCHiaiSaaIaGiSOIUCIiHWHCHHyClOiU
jIO_CHiIOI CCS aHU SICH CCS aIC SC\CICy UiHiHiSHCU OI
aDSCHIiHIHCDOHCHaIIOWDCCaUSCOCiICIaHiHIIiHSiCUCCCI
O IHC SICH CCS OI iHHUHCHCUiaICU SICH CC UCSIIUCIiOH
WHiCH CaUS IO IIaHS!SiOH-UCjCHUCHI aHCHia IHIOHDOCy-
IOjCmaaHUSC\CICHCUIIOjCHia. HajjIOXiH1aICyb7OCaSCS
OajaSIiCJHCHaLCICiSHOOD\OUSCaUSC,CHCHiCaSUIU_S
\iIa iHCCIiOHS COa_CH \aSCUaI UiSCaSCS aHU IHyHOHa CaH
DC iH1jiCaICU iH IHC ICHaiHiH_ CaSCS. HICICIOH-aCIi\aICU
yHjHOCyICSaICiH\Ol\CUiHaUIOiHHUHCUCSIIUCIiOHOSICH
CCSiHaSi_HCaHIjIOjOIIiOHOjaIiCHISWiIHIHCiUiOjaIHiC
OI !HC aCQUiICU OIH O IHC UiSCaSC, UIS aCI CXjaiHS WHy
iHHUHOSUjjICSSi\C IHCIajyiSCHCCIi\CiH SOHCjaIiCHIS. Hi-
Iia HaHa_CHCHI iH\O\CS Wi!HUIaWa O aHy jOICHIiay
CaUSaIi\Ca_CHISaHUa \SCaHOIHCCHCSIIOIUCOUIaHaSSO-
CiaICU IHyHOHa.
aIiCHISWiIHiHHUHCIHOHDOCyIOjCHiC jUQUIa[}Ha\C
jCICCHiaCaHUCCCHyHOSCSDUIUOHOIHa\CaUCCICaSCUCUO-
Cy!C COUHI.OSI jaUCHIS WiL UO HOI Ha\C aHCHia DUI
SOHCOIHCHHayHa\CJHaSSOCiaICUaUIOiHHUHCHCHOyIiC
aHCHia OIiIOH UChCiCHCy aHCHia UUC IO DCCUiH_. OWC\CI
IHS jaIiCHISUiICCIaHIi_ODUHH [\OOHDS}ICSIWaS HC_aIi\C
aHUSHCHaUaOWICIiCUOCy ICCOUHIWHCHIO_CIHCIIUCOUI
HCHOlyHCaHCHia.iHayHSjaHCHIUOCSHOIHa\CaCHHiCa
LSIOIyO DCCUiH_aHUHCI|iOHSIOICSaICHOIHaWHiCHSU_-
_CSISIHaIDOOUOSSaHUiIOHUCCiCHCyiSHOIIHCCaUSCOHCI
aHCHa.
KEN PO1M1
6BS W lSC B6m V6 Cy06, 0W I6CUl0
Cy6 C0UB, B0 y0lSC 00B6 mII0W.
!Ad HemalOOQy
DlO_aQHy
Ouny `S Schcnbcry ! faadO I1. Ppastc ancma. furr Cpn
IcmatOl. 200;15(3):12-1. !II: 13v177v]
Item3 Answer:
Educational Objectve: Trcar ran mtcnty ancma
wrh aral ran.
HC HO8I J[[iO[iiJIC IiCJIHCHI Oi IHi8 [JIiCHI i8 OiJ iiOH.
Hi8 [JICHI HJ8 iiOH GCHCiCHCy JHCHiJ J8 COHHiHCG Dy IHC
OW HCJH COi[H8CHJi \OHHC OW 8CiHH iiOH C\C CC\JICG
IOIJ iiOH-DiHGiH_ CJ[JCiIy [11\} JHG OW IiJH8CiDH 8JIH
iJIiOH [iiOH/11\}. 1iOH GCHCiCHCy i8 DC8I IiCJICG Dy H8H_
OiJ iiOH 8JI8, CiiOH8 8HJIC 325 H_ IHiCC IiHC8 GJiy i8 IHC
CJ8I CX[CH8i\C [iC[JiJIiOH. DIHOH_H IHCiC JiC JICiHJIi\C
[iC[JiJIiOH8 O OiJ iiOH HOHC HJ8 COHCH8i\Cy DCCH 8HOWH
IO HCiCJ8C OiJ IOCiJDHIy JHG IHCy GCi\Ci C88 CCHCHIJ iiOH.
1iOH IHCiJ[y i8 Iy[iCJy COHIiHHCG 8C\CiJ HOHIH8 JHCi HOi
HJiZJIiOH O IHC HCHO_ODiH C\C. 1JIiCHI8 WHO JiC HHJDC
IO JD8OiD iiOH OiJy [Oi CXJH[C [JHCHI8 WIH \iOHH Ui8CJ8C
CCiJC Gi8CJ8C Oi 8HJ DOWC iC8CCIOH} iH8ICJG HJy iCCCi\C
[JiCHICiJ iiOH.
1CCJH8C IhC [JHCHI i8 HCHOGyHJHiCJy 8IJDC IHCiC i8 HO iHGi
CJIOH Oi J DOOG IiJH8H8iOH. H8 [JIiCHI8 8i_H8 8yH[IOH8
JHG JDOiJIOiy BHGiH_8 JiC HOI 8H__C8Ii\C O iCHJ 08CJ8C
WHiCH HJy CJH8C J OW CiyIHiO[OiCIiH C\C Oi O J DOHC HJi
iOW Gi8OiGCi WHiCH WOHG iCQHiiC JGHH8IiJIiOH O 8H[iJ
[Hy8iOO_C C\C8 O CiyIHiO[OiCHH. OiCO\Ci CiyIHO[OiCHH
IHCiJ[y WOHG DC iHCCCIi\C iH IHi8 [JIiCHI HHIi iiOH HJ8
DCCOHC J\JJDC Oi CiyIHiOCyIC [iOGHCHOH. Hi8 [JIiCHI HJ8
HO C\iGCHCC O HJJD8OQIiOH IHJI WOHG iCQHiiC [JiCHICiJ
JGHHi8IiJIiOH O iiOH.
W 1
8I6IS WI I0 06C6Cy 86m8 I6quI6 0I8 I0 I68C6m6I
I6I8y.
DlO_aQHy
Ilp S Bcnnctt |^ fhambcrs I. IrOn dchccncy ancma. P Iam
! hyscan. 200;b[b):i. !ÎI: i3bbi3j
ltem Answer: A
Educational Objectve: !aqnarc qlutarc o-pharphan
mhydraqcnarc mtcnty.
Hi8 [JHCHI HJ8 _HCO8C [HO8[HJIC GCHyUiO_CHJ8C [ L1}
GCHCiCHCy. L1 GCBCiCHCy i8 IHC HO8I COHHOH Gi8OiGCi O
CiyIHiOCyIC HCIJDOi8H. L1 i8 HCCC88Jiy Oi _CHCiJIH_
JGCQHJIC HiCOIiHJHiGC JGCHHC GiHHCCOHGC [HO8[HJICXi-
GJ8C [D1} IO [iC\CHI OXiGJHI 8IiC88. L1 i8 OHHG OH
IHC 2-CHiOHO8OHC JHG IHCiCOiC GCbCiCHCy iJiCy OCCHi8
iH WOHCH. HC JCHIC OH8CI O 8yH[IOH8 JHG HHGiH_8 iH
[JHCHI8 WiIH HGCBCiCHCy CJH DC [iCCi[iIJICG Dy GiH_8 HCC
HOH Oi GiJDCIiC KCIOJCiGO8i8. 1H IHi8 [JHCHI HCHOy8i8 WJ8
iKCy [iCCi[iIJICG Dy IiiHCIHO[iiH8HJHCIHOXJZOC.
DI 2 IO 4 GJy8 JHCi iHIiOGHCIiOH O IHC OXiGJIi\C 8IiC88 H
[JICHI8 WIH L1 GCBCCHCy OH8CI O JHHGiCC JHG GJiK
HiiHC OCCHi8 WiIH Oi WIHOHI JDGOHiHJ JHG DJCK [JiH. HC
HCHO_ODiH C\C GCCiCJ8C8 Dy 3 IO 4 _/G1 30 IO 40 _/1}
JHG IHCiC i8 JH J[[iO[iiJIC iHCiCJ8C iH iCIiCHOCyIC8. HC
HCHOy8i8 8[OHIJHCOH8y iC8O\C8 iH J[[iOXiHJICy 1 WCCK J8
IHC OGCi CHZyHCGC[CICG CC8 JiC iC[JCCG Dy HCW CC8 WIH
8HHCiCHI L1 IO [iC\CHI HiIHCi HCHOy8i8. DGGiHOHJ JD
OiJIOiy BHGiH_8 iH [JIiCHI8 WiIH L1 GCBCiCHCy iHCHGC J
HC_JH\C UiiCCI JHG iHGiiCCI JHIi_ODHiH [\OOHD8} IC8I JHG
IHC [iC8CHCC O`DiIC Oi `Di8ICi CC8 [iOGHCCG WHCH JCCH
HHJICG OXiGiZCG HCHO_ODiH iCHJiH8 JGHCiCHI IO IHC Ciy
IHiOCyIC HCHDiJHC WIH JH JGJCCHI HCHDiJHC-DOHHG CCJi
ZOHC. bHCH CC8 JiC Vi8iDC OH IHi8 [JIiCHI8 [CD[HCiJ DOOG
8HCJi. 1CCJH8C iCICHOCyIC8 CJH HJ\C HOiHJ L1 C\C8
HCJ8HDH_ L1 C\C8 GHDH_ JH JCHIC C[i8OGC HJy [iOGHCC
J J8CHC_JIi\C iC8HI.
1JHCHI8 WiIH HCiCUiIJiy 8[HCiOCyIO8i8 HJ\C 8[HCiOCyC8 OH IHC
[Cii[HCiJ DOOG 8HCJi J8 GO [JIiCHI8 WiIH WJiH JHIi
DOGyHCGiJICG HCHOy8i8. HC UiiCCI JHI_ODHiH IC8I i8 [O8
iIi\C iH [JICHI8 WIH WJiH JHHDOGy~HCGiJICG HCHOy8i8 JHG
HC_JIi\C iH [JICHI8 WiIH HCiCGiIJiy 8[HCiOCyIO8i8. 1JICHI8
WIH J HiCiOJH_iO[JIHy HJ\C 8CHi8IOCyIC8 OH IHC [Cii[HCiJ
DOOG 8HCJi JHG IyiCJy J OW [JICCI COHHI. CiIHCi O
IHC8C B11GiH_8 i8 [iC8CHI iH IHC [Cii[HCiJ DOOG 8HCJi 8HOWH.

| guC0S6b0S8I6 06y0l0g68S6 06C6Cy, bI6 0I bS
I6I C6S 8I6 I00uC60 W6 8CCumu8I60 0X0260 6m0g0b
I6m8S 806I6I I0 I6 6IyII0CyI6 m6mbI86, WC CI68I6S 8
80j8C6I m6mbI86b0u0 C68I 206.
DlO_aQHy
fappcn I IOrcl L. LucOsc--phOsphatc dchydrOycnasc dch
ccn !ancct. 200;31:+-+. !II: 1ij
|tem5 Answer:
Educational Objectve: !aqnarc rhalarrcma mnar
an rhc barr af a pcrphcral blaad rmcar
JHC HO8I iKCy GiJ_HO8i8 i8 IHJJ88CHiJ HiHOi. 1JIiCHI8 WiIH
IHJJ88CHJ HJ\C J OW HCJH CCHJi \OHHC JHG IJi_CI CC8
OH IHC [Cii[HCiJ 8HCJi. Ji_CI CC8 JiC CHJiJCICiiZCG Dy J
CCHIiJ GCH8C GC[O8iI O HCHO_ODiH 8HiiOHHGCG Dy J HJO O
[JOi. JHi8 _\C8 IHC CiyIHiOCyIC8 J `DH8CyC J[[CJiJHCC.
H HOiHJ CiyIHiOCyIC8 IHCiC i8 OHy CCHIiJ [JOi. 1H IHJ
J88CHiJ IHC CiyIHiOCyIC COHHI i8 H8HJy HOiHJ Oi C\CH
8i_HHy CC\JICG. 1iOH 8IHUiC8 JiC |[iCJy HOiHJ HHC88 IHCiC
i8 J COCXi8IiH_ iiOH GCHCiCHCy JHCHiJ. HC GC_iCC O [OKO
CyIO8i8 JHG JHi8OCyIO8i8 i8 OHy HOGC8I DHI IHC Hy[OCHiOHiJ
i8 8U_ JHG HC[8 GiHCiCHIiJIC IHJJ88CHJ UOH iiOH GCH
CiCHCy JHCHiJ.
CiCGiIJiy 8[HCiOCyIO8i8 i8 CHJiJCICDZCG Dy HHiOiHy 8HJ
8[HCiOCyIC8 IHJI JCK IHC |[iCJ CCHIiJ [JOi O HOiHJ Ciy
IHiOCyC8 JHG 8iCKC CC JHCHiJ i8 CHJiJCICDZCG Dy 8iCKCG CC8
[CrCsCCHI- Or sjHUC-sajCU CCs} OH IC jCrjCra OOU
smCar. CsC BHCHs arC asCHI H Is jaICHI`s jCrjCra
OOUsmCar.rOHUCBCCHCyaHCmasu \CHICHOr-
ma rCsuIs OI LC rOH sIuUCs. /UUIOHay, a mOrC sH
\araIOH H rCU OOU CC szC aHU sajC VOuU CCXjCCICU
VIIsUCrCCOIyjOCrOmaHrOHUCBCCHCyaHCma.
Pa!Ien!s w|!h !haIassemIa have a I0w mean ceIIuIar v0Iume and
!arge! ceIIs 0n !he perIpheraI bI00d smear and have n0rmaI resuI!s
0n Ir0n s!udIes.
DlO_aQDy
HHU aCHHiCWI!2 . C!a!HaaSSCHia. H_! | CG. Zb
b(JJ}.JJbJJ+O. _1. JOJOZ+
IBHM DSWBf' L
LOUCBODB DgBCIVB' J0gn0t t0000mn m)
ttnty n 0 [0ItnI Ib 0 0n0rm0 PI0mn 1_1Pt
Ib mtIbym00nt 0td 0nd b0m0tyhnt mt0urtmtnh.
CmOsIajjrOjraICHCXIUaHOsICICsIsmCasurCmCHIOI
sCrum mCHmaOHC aCU aHU OmOCysICLC. s jaICHI`s
BHUHs OI maCrOCyIC aHCma, IrOmOCyIOjCHa, CC\aICU
aCIaICUCyUrOCHasCC\C, aHUHCurOO_CBHUHsarC\Cry
suCsI\C OI VIamH _UCBCCHCy UCsjIC IhC OV-HOrma
_C\C. C\Cs OI mCIymaOHC aCU aHU OmOCysICHC
CCOmCCC\aICUHjaLCHIsVI\IamH _ UCBCCHCyCIOrC
sCrum\IamH_C\CsUCCrCasCCOVICHOrmaraHC. H
COHIrasI, OHy OmOCysICHC s CC\aICU H IOuIC UCBCCHCy.
5uCHCa\IamH _UCBCCHCy HjaICHIsVIsuICsHs
aHU symjIOms OI \Iamm _UCBCCHCy CaH C UCICCICU y
UCHIBCaIOH OI CC\aICU mCIymaOHC aCU C\Cs. s s
jarICuaryIruC IOrjaICHIsVOsC\IamH _C\CsH IhC
OVHOrma raHC, asIsjaICHI`ss.
/IOu OHC marrOV Ojsy CaH C suCsI\C OI \IamH
_UCBCCHCy, I s HOI a sjCCBC ICsI IOr COHmmH Is Us-
OrUCrCCausCUCrCarCOICrjOICHIaCausCsOImCaOas-
ICmarrOV, HCuUHmyCOUysjasa.
ryLrOCyC IOaIC C\Cs a\C CCH IOuICU as a CILCr HUCa-
LOH OI IOaIC sIOrCs IhaH sCrumIOaICC\Cs arC, uI ICy arC
suCCI IO jrOCms OI UCBDH HOrma \auCs aHU may HOI
C IaI CjCLCay. ryrOCyIC IOaICC\Cs CaH asO C
UCjrCssCU H jaICHIs WIh \Iamm _UCBCCHCy. /UUIOH
ay, IOaIC UCBCCHCy VOuU HOI CausC I1C HCurOOC symj-
IOmsjrCsCHIHIhs jaLCHI.
arCIaCCaHLOUCsarCCC\aICULjaICHIsWIjCrHCOus
anCmauImayHOICCC\aICUHjaICHIsVOsCVIamH_
UCBCCHCy s UuC IO maasOqIOH, VC s a \Cry COmmOH
CausCOIUCBCCHCy m I1C CUCly.
&` 1
Me!hyImaI0nIc acId IeveIs bec0me eIeva!ed bel0re vI!amIn
,_
IeveIs decrease beI0w !he n0rmaI range In pa!Ien!s wI!h vI!amIn
,_
delIcIency.
HCma\OOQy 1A9
UDlO_aQDy
\ia\CHS aSHCS| |, \H \. \iHCa IHQHiiiCS. OW UO WC C\a-
Ha!C a Hai_iHay OW _1C\C: |aH 1iaC!. ZbO(J }.OZ-O. _1:
JZJVZ
IBH DSWBf' L
LOUCBODB DgBCIVB' J0gn0t [r0IbtIt P0Pt
btm0yIt 0ntm0.
CmOsICyCausCOIIhsjaLCHI`saHCmasCmOyCaHC-
ma UuC IO mCCaHCa UCsIruCLOH y IC jrOsICLC CarI
\a\C.. jaICHIsWICmOyCaHCmaa\CCOmmOHBHU-
Hs,VCHCuUCaHHCrCasCUsCrUmaCIaICUCyUrOCHasC
C\C, a UCCrCasCU sCrum ajIOOH C\C, aHU rCLCuOCyO-
ss. XamHaIOH OIIhCjCrjCraOOU smCar s OBCH Cj-
HUCHUICCausCOI IC CmOyLCaHCma.
s jaICHI`s OOU smCar sOVs sCsIOCyICs [hamCHICU
OOU CCs}, VC arC IOuHU H jaICHIs WI mCrOaHO-
jaICCmOyICaHCma [IOrCXamjC,IrOmOLCLrOmO-
CyIOjCLCjurjura,CmOyICurCmCsyHUrOmC,aHUUssCm-
HaICU HIra\asCuar COauaIOH} aHU VI mCCaHCa
UCsIruCIOH UuC IOjrOsICIC CarI\a\Cs. CrOaHOjaIhC
CmOyIC aHCma s aH uHCy UaHOss IOr a jaICHI VO
ajjCarsVC,asHOC\UCHCCOIOranUysHCIOH,aHUasa
HOrma jaICCI COuHI. aICHIs WI1 auIOH1uHC CmOyIC
aHCma a\C mCrOsjCrOCyICs OH IhCr jCrjCra smCar H
aUUIOH IO aH HCrCasCUrCICuOCyICCOuHI, sCsIOCyICs arC
HOIay asCHI.
UCmOyICmCmasCOmmOHHjaICHIsVIjrOsICIC
CarI\a\Cs,uILCaLCmaCaH CmOrCsC\CrCmujIOZU7
OI jaICHIs. 5ymjIOmaIC CmOyIC aHCma CaH usuay C
IrCaICUWIOrarOHaHUOaICrCjaCCmCHI,aLOumOrC
sC\CrCCasCs may VarraHIOOU IraHssOH Or rCCOmHaHI
umaHCryIrOjOCIH.IrCy,jaLCHIsVrCqurC\a\CrCOj-
CraIOH I CmOyss s UuC IO sHBCaHI \a\C UysHCLOH Or
jrOrCss\Cjara\a\uarrCurIaIOH.
kTN PO1M1
5chIs!0cy!es [lragmen!ed bI00d ceIIs) are ass0cIa!ed wI!h mIcr0an-
gI0pa!hIc hem0Iy!Ic anemIa [!hr0mb0!Ic !hr0mb0cy!0penIc pur
pura, hem0Iy!Ic uremIc syndr0me, and dIssemIna!ed In!ravascuIar
c0aguIa!I0n) and wI!h mechanIcaI des!ruc!t0n due !0 pr0s!he!Ic
hear! vaIves.
DlO_aQDy
bHaQiia ,Na!Hii ba_iC ^. CHOySiS aSSOCia!CG Wi!H QiOS!HCUC HCai!
\a\CS. a iC\iCW. \aiGiO C\. ZVJ(}.JZJJZ+. _1: JV+b
IBH DSWBf'
LOUCBODB DgBCVB' J0gn0t r0n m)ttnty
0ntm0 0n Ibt 00i 0j 0 [tr[btr0 000d mt0r
C BI1UHs OH IhC jCrjCra OOUsmCar arCsuCsL\COI
rOH UCBCCHCy aHCma. C CryIrOCyICs sOV yjOCrOma,
aHsOOss [CaHCs m szC}, aHU jOOCyIOss [CaHCs H
sajC}anUarCasOuCyIOCmCrOCyC.IaCOHBmaIOryICsI
T50 Hem\OOQy
lorcxamplc,scrumlcrriundctcrminauon)supportsthcdiag-
nosis oliron dcncicn ancmia, a sourcc ol gastrointcstinal
bloodlossshoudbcsought,rcgardlcssolwhcthcrthcstoolis
posiuvcorncgauvcloroccultblood.Agastrointcsunallcsion,
suchascoloncanccrorgastnus,islarmorclikclythandictary
nadcquacicsormalabsoquoninanothcrvschcalthyadult.
Hcrcditary sphcrocytosis, anothcr causc ol microcytosis,is
associatcdvthsphcrocytcssmallccllsvithlossol thcnor-
mal ccntral pallor) and an cnlargcd splccn, and would bc
unlikclyto prcscnt in a 5-ycar-old man. Sicklc ccll ancmia
would bc associatcdvith sicklcd cclls spindlc- or crcsccnt-
shapcd cchs) on thc pcriphcral blood smcar, which arc not
prcscnt. Although thc thalasscmias arc associatcd with
hypochromic,microcyucc(cytcs,thcdiagnosisisunlikcly
inapaucntwhohadanormal hcmoglobin lcvclycarago.
!naddition,crythrocytcsinthalasscmiashowlcsshypochro-
mia,ansocytosis,andpoikilocytosisandmorctargctcclls.1ar-
gctcclls arccharactcrizcdbyaconccntrationoldcnschcmo-
globininthcccntcrolthcccllsurroundcdbyaD olpallor
crcatingabull's-cyc"appcarancc.ormalcrythrocytcshavc
anarcaolccntralpallor.

PerIpherabOOdsmearlIndIngssuggestIve OlIrOndelIcIencyane
mIaIncudemIcrOcytOsIs,hypOchrOmIa,anIsOcytOsIs(changesIn
sIze),andpOIkIOcytOsIs(changesInshape).
DO_aQDy
IaIK b. IOH GCHC|CHCy aHCH|a. G|a_HO8|8 aHG HaHa_CHCH!. IuII IQ|H
La8!IOCH!CIO. ZV,Zb(Z}.1ZZ1Z. 11. 1VZZZ
Item Answer: A
Educatonal Objectve: !aqnarc aummmunc
hcmalytr ancma.
1hispaucnthasautoinununchcmolycancmia^). 1hc
hcmolycancmiasarccharictcnzcdbyincrcascddcstrucuonol
cryocytcsassociatcdvthrcuculocytosis.Llcvatcdlcvclsol
uncon|ugatcdbilnubin,lactatcdchydrogcnasc,andunc acid
anddcprcsscdlcvclsol haptoglobinarccharactcnsucol hcmol-
ysis.^!HAmaybc idiopathic orrcsultnomdrugs,lypho-
prolilcrauvcdisordcrs,collagcnvasculardscascs,ormalignan-
cics.\arm antibody-mcdatcd hcmolytic ancmia, thc most
commontypcolA!HA,isdiagnoscdbythcdncctanuglobu-
H Coombs)tcst,whichdctccu!gGorcomplcmcntonthc
ccllsurlcc,andthcprcscnccolsphcrocytcsonthcpcnphcr
bloodsmcar.!nuscondiuon,!gGanubodicsbindtoK-typc
anugcnsonthccrythrocytcsurlaccat.0C98.I).
Hcrcditary sphcrocytosis is a congcnital hcmolytic ancmia
causcdby abnormaliticsin crythrocytc mcmbranc protcins
andischaractcrizcdbysphcrocyuccjcytcsvthincrcascd
osmoucnagductothcnlargcvolumc,surlaccarcarauo.
!twouldbc vcry unusualloracongcntialhcmolytic ancmia
tobchrstdiagnoscdatthispaticnt'sagc.Additionally,hcrcd-
itarysphcrocytosisisnotassociatcdvthpositivcrcsultsona
Coombstcst.Sphcrocytcsarcsmallroundccllsthatlackthc
typicalccntralpallorolnormalcryocytcs.
Microangiopathic hcmolytic ancmia is a nonimmunc
hcmolycancmia.1vithothcrhcmolycancmias,itischar-
actcrizcd by rcticulocytosis, clcvatcd lcvcls ol uncon|ugatcd
bihubin,lactatcdchydrogcnasc,anddcprcsscdlcvclsolhap-
toglobin.Microangiopathichcmolysismaybcassociatcdvth
thrombotopcma. Anothcr distinguishing charactcristic ol
mcroangiopathchcmolyticancmiaisthcprcscnccolschis-
tocytcsonthcpcriphcralbloodsmcar.1hisnndingwaslack-
ingonthispaticnt'spcnphcralbloodsmcar.
o-1halasscmiaisacongcnitalhcmolyticancmia.!aticntswith
atwo-o-gcncdclccthavctargctccllsandanabscnccolsphc-
rocytcsonthcpcriphcralbloodsmcaranddonothavcposi-
tivcrcsultsonadircctantiglobulintcst.

WarmantIbOdy-medIatedhemOytIcanemIa,acOmmOncOmpIca
tIOnOlymphOIdmaIgnancIes,IscharacterIzedbyspherOcytesOn
theperIpherabOOd smear
DO_aQDy
au8W|I!H /\ bKIaD8 I bCH!Z|H_CI I La|_CI / CC!1CI , |J_CI \.
/u!O|HUWHC HCHOy!|C aHCH|a8 VaH8 8yHGIOHC8 aHG QuIC ICG CC
aQa8|a |H HOH-OG_K|H yHQHOHa8. CuK yHQHOHa. Z,+(}.
11V11+V. 11.1b
Item 1 Answer: A
Educatonal ObjeOve: !aqnarc an arqurcd raaqu-
latan [armr m]rcnry.
1hcpaucntmostlikclyhasanacquircdcoaguauonlactordch-
cicncy./ coagulationlactorsarcsynthcsizcdinthclivcr,and
scvcrchcpaticimpairmcntlcadstovanouslactordchcicncics,
andvitamndchcicnmaymrthcrincrcascthcrisklordcn-
cicntcoagulationlactors.!aticntsvthhvcrdiscasc,cspccially
cirrhosis,havcancnlargcdsplccn andamodcratcrcducuon
in thc platclct count 50,000 to 100,000,I 50-100
10',I|) causcd by splcnic scqucstration hypcrsplcnism),
whichmayincrcascthcrisklorblccding.!naddition,cirrho-
sisisoncnassociatcdvthcsophagcalvanccs,whichalsocausc
gastrointcstinal blccding. Coagulation usually docs not
bccomcimpaircduntilthccirrhosisisadvanccd,andthcpro-
thrombin timc, activatcdpartialthromboplastin timc,and
thrombintimcarc prolongcdasinthispaucnt).!lrcsults
olanyolthcscassaysarcprolongcdandthcdiagosisrcmams
in doubt, an inhibitor mixing study should bc donc. 1his
involvcsrcpcanngthcabnormalassayvtha mturcolthc
paticnt's plasma andnormalplasmatodctcctcithcralactor
dchcicncyorthcprcscnccolaninbitorthatis,anantibody
dircctcdagainstalactor).1hcrcsultsolthcmixingstudyV
normalizcinapaucntvthalactordcncicncyasthcydidin
thispaucnt)butVrcmainabnormalHaninhibitorisprcscnt.
1hcpaticnt's platclctcountisnotlowcnoughto causc sig-
ncant blccding. Acquircd qualitativc platclct disordcrs arc
nOst cOnnOny causCU y Uru_s CsCciaIy asirin anU
b/S. \LHCl aHlaLCCL a_CHLS uSCULOLlCaL CalUO\aSCu-
atUSCaSCHayalSOCauSCaLCCLUSOlUClS[OlCXaHCaDCX-
HaD CHDaLUC COUO_lC}. !lCHa S aHOLHCl COHHOH
CauSC O a QuaLaL!\C aLCCLUSOlUCl. JHC aLCCL UCCCL H
ulCHa HaS DCCH aLLlDuLCU LO HalCU aLCCL\CSSC Va
aUHCSOH. JHCaLCHLSLaKH_HOHCUCaLOHS aHULHCSCluH
ClCaLHHC S .S H_yU1 32.6 HHOy1} HaKH_ aH
aCQuHCUaLCCLHHCLOH USOlUCluH1Cy.
KEX
C0dgUd0B dC0fS df SBhSZ0 B h Vf, dB0 SVf
hdC mdfmB d0S 0 Vdf0US dC0f 0CBCS.
DhC_aQDy
IaGWC b1 baHya P|. IOa_UaUOH GiSOiGCiS aHG DCCGiH_ mivCi GiS-
CaSC: H!UiC GiiCC!iOHS. IiH ivCi 1iS. ZV1(1}:1DD7.
11: 1V1D1V
Item Answer: A
Educational Ob]ecive: 0QH0t 4tmH04
HO0V0tD0t t00QD0l0H.
JHC HOSL KCyUa_HOSSS USSCHHaLCU HLla\aSCual COa_u-
aUOH[\}. \SLHClCSuLO\UCSlCaUaCU\aUOHOCOa_-
uaUOH LHaL CaUS LO OlHaUOH O BDH COLS. bOHC aUCHLS
Ha\C a LHtOHDOUC USOlUCl DuL H HOSL aUCHLS SCCOHUaly
BDlHOySSUSSO\CSLHCBDHHCOLaHUCOHSuHUOHOaLCCLS
JCOa_uaUOHaCLOlSCauSCSHiOHDOCyLOCHaCOLU_C-
LOl UCBCCHCCS DCCUH_ aHU \aSCual Hul!CS. 1l\iOCyLC
COHSuHLOH S HaHCSLCU Dy a HClOaH_OaLHC HCHOyC
aHCHa VLH Ha_HCHLCU ClyLHlOCyLCS SCCH OH a ClHCla
DOOU SHCal.\ HOSL COHHOHy OCCulS H aLCHLS VLH
HCCUOHSCaHCCl aHU ODSLCLi!Ca COHCaUOHS. LlaHHC_a-
U\CSCSSSLHCHOSLCOHHOHHCCUOHaSSOCaLCUWLH \.
JHC Ua_HOSS O\ S DaSCU OH a lOOH_CU lOlHlOHDH
HCaCU\aLCUalUalLHlOHDOaSUHHCaHULHlOHDHUHC
a H_HUHCl L!LCl a lCUuCCU SCluH BDlHO_CH C\C aHU
aLCCL COuHL aHU HClOaH_OalHCHCHOyC aHCHa. JHC
UC_lCC O LHCSC aDHOlHaUCS UCCHUS OH LC CXLCHL O COH-
SuHUOHOaLCCLSaHUCOa_uaUOHaCLOlSaHULHCaD!LyO
LHC aUCHL LOCOHCHSaLC Ol LHCSC BHUH_S.
JVOLHlOHDOUCHClOaH_OaLH!CSHLHCG ClCHUalUa_HO-
SS O\ alC LlOHDOUCLHlOHDOCyLOCHCutula [J}
aHU HCHOyC ulCHC SyHUlOHC [1!b}. JHCLWOSyHUlOHCS
O\Cia aHU L S OHCH UHCuL LO USH_uSH DCLWCCH LHCH.
JHC CHLaU O J HCuUCS LOHDOCyOCHa HClOaH_O-
aLHCHCHOyCaHCHaHCulOO_CUCBCLSlCHalHa|tHCHL
aHU C\Cl. 1 B\C BHUH_S UO HOL HCCU LO DC lCSCHL Ol LHC
Ua_HOSS LO DC CSLaDSHCU. 1!b S a COHUUOH iHaiy O
CH1UlCH aHU HaHyaHCCLS LHCKGCyS aS alCSuL O HllatCHa
aLCCL-BDlH UOHD. CLHCl HOl 1!b S aSSOCaLCU
WLH CC\aUOHS O LHC lOLHlOHDH Ol alUal LHlOHDOaSU
UHCOlLHC U|HClOlUClCSSOHOLHCBDHHO_CHC\C.
Hem\CCQy 11
1HHuHC LHlOHDOCyLOQCHC QulQula [1J} Hay DC auLOH-
HuHC HCUaLCU Ol Ulu_ !HUuCCU. JHC Ua_HOSS S DaSCU OH
CXCuO_ OLHCl CauSCS O lHlOHDOCyLOCHa OLHCl SySLCHC
!uCSSCSaHUHCUCaUOHS. JHCOHyaDOlaLOiy USOlUClaSSO-
CaLCUWLH JSLHlOHDOCyLOCH!a.
1h 0dgB0SS 0 0SSmBd0 BfdVdSCUdf C0dgUd0B S 0dS0
0B d f00Bg0 f0hf0m0B m, dCVd0 dfd hf0m00dS
B m, dB0 hf0m0B m, d hgh 0mf f, d f0UC0 SfUm
0fB0gB V dB0 d C0UB, dB0 mCf0dBg0dhC
hm0C dBmd.
DC_aQDy
Cvi OD I1 DaCHi | Ya!SOH 1L. LUiGCiHCS IOi !DC Gia_HOSlS
aHG HaHa_CHCH! OI GiSSCHiHa!CG iH!iavaSCUai COa_Ua!iOH. ii!iSD
IOHHi!!CC IOi b!aHGaiGS iH 1aCHa!OO_y. i | 1aCHa!O.
ZV1+D(1}:Z+. 11: 1VZZZ+77
Item Answer:
Educational Ob]ective: 0QH0t V0H Wt0t0H4
4t0t.
JHCHOSLuCyUa_HOSSS\OHY|CDlaHUU!SCaSC.JHSaUCHL
HaSaDHOlHaDCCO_OHLOOLHCXLlaCUOHaHSLOiySu__CSU\C
OaDCCO_LCHUCHCyaHUaaHyHSLOlyOaOLCHUJDCCU
H_ lODCH. 1S aDOiaLOly SLuUCS SuOlL DOLH a QuaLaU\C
aLCCL UCCCL [lOOH_CU DCCUH_ UHC} aHU a HU COa_u-
OaLHy [DOlUClHC CC\aLCU aCU\aLCU alUa LHlOHDOaSUH
UHC aJ aLUOVCLOlNC\C}. JHCSCBJ1UH_SatCSu_
_CSL\C O LHC HOSL COHHOH HHClLCU HCHOSLaUC USOlUCl
HaHCy \OHY|CDlaHUUSCaSC. \OHY|1CDlaHUUC S OHC
OLHCCVHCHOSLaUCU!SOlUClSCHalaCLCHZCUDyDOLHaaLCCL
aHUCOa_uaUOHUCCCLUuCLOalCUuCUOHOlUCCCLH\OHY|C-
DlaHU CLOl [\\} VHCH SuOlLS aLCCL aUCSOH aHU aSO
SCl\CS aS a CallCllOLCH Ol aCLOlN. JHC Ua_OSS SCOH-
BlHCUDy HCaSuH_LHC\\aHU_CHC\CJUaCUv[.
1CHOHa/ [aCLOlN UCBCCHCy}S HOL aSSOCaLCUWLH a
lOOH_CUDCCUH_HHCHOlSLHaHSHLLCUOHLHClLOSOH
[2-mCU HHCHC}. JHClCSCHCCOauuSUDLOlS_CH
ClayaSSOCaLCUWLHaLHiOHDOUCHOLaDCCUH_USOlUClS
aHaCQUHCU U!SOlUCl UOCSHOLlOOH_ LHCDCCUH_ UHC aHU
S HOL aSSOCaLCU \LH UCClCaSCU C\CS O aCLOl. LamH
UCBCCHCy CaH OCCul H aLCHLS lCCCvH_ LOLa alCHLCla
HuLHUOH Ol OH_LClH JHUDOUCS aHU H LHOSC VHO alC Ha
HOuHSHCUalUCualyHLHCSCLU_OWaULlaUOH.
JHS COHULOH S CHalaCLClZCU Dy a lO_lCSS\Cy lOOH_CU
lOLlOHDHHHCI) aHUaJ[\LHLHCI lOOlUOHaLCy
HOlClOOH_CU LHaHLHCaJ}aHUaHOlHaUOHDHUHC
BUH_SHOL COHSSLCHL \LH LHOSC H H aUCHL.
KEY
V0B W0fdB0 0SdS S dB dU0S0md 00mBdB 0S0f0f ChdfdC
fZ0 0 d fS0Bd dB0 dm hS0f 0 d 00Bg B0BC, d
f00Bg0 00Bg m, d 00f0fBVd0 dCVd0 dfd
hf0m00dSB m, dB0 d 0W dC0f VV.
162 HemalOIOQy
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1CSSCi I. iia_HOSiS aHU !iCaHCH! O! VOH \1CDiaHU UISCaSC. HCW
pcrspcctivcs and nuanccs crratun in IacnopIa. 2008,14(3):66P].
aCHO[Hi!ia. Z/1 bU[[b.-1+. _1i. 1/VZ
Item 1 Answer: A
Educational Objective: tlttH j0l 0tt4tHg 4tJ0lml
Htlb 0 ttHtt0 btJHl].
HC DC8L 8CfCCHH_ JfOJCH LO UCLCCL DCCUH_ U8OfUCf8 8 Dy
LJK_ J LOfOu_H CHCJ H8LOfy. HC ChHICJ H8LOfy 8HOuU
OCu8 OH LHC fC8CHCC O JHy 8y8LCHC HC88C8 JHU fC\Ou8
DCCUH_. DCCUH_ 8 fCOfLCU L8 8C\CfLy 8HOuU DC UCLCf
n1HCU J8 8HOuU WHCLHCf LC DCCUH_ 8 8OHLJHCOu8 Of 8 JH
CXCC88\C fC8OH8C LO HOfHJ DCCGH_ JHCf Hjufy 8uf_Cfy Of
UCHLJ fOCCUufC8 WHCLHCf LC DCCUH_ JLLCfH 8 COH_ Of
fCCCHLy JCQufCU JHU WHCLHCf LC DCCUu_ 8u__C8L8 J JLCCL
Of J COJ_uJLOH UCCCL. JLCCL-fCJLCU DCCUH_ LCHU8 LO
OCCuf HHCUJLCy JHCf Hjufy JHU OHCH JCCL8 LHC HuCOu8
HCHDfJHC8 Of LHC 8u H LHC OfH O CLCCHJC. \OJ_uJLOH
fCJLCU DCCUH_ HJy DC UCJyCU H OH8CL 8 HJ8LCU HOfC
Dy UCC L88uC Dfu8C8 [CCCHyHO8C8} JHU HJy fOUuCC
HCHJfLfO8C8 H JLCHL8 WLH COH_CHLJ UCBCCHCC8. YOHCH
8HOuU DC J8CU JDOuL LHC JLLCfH O HCH8LfuJ DCCUH_ Of
O8LHCHOJu8J JDOuL WHCLHCf JJDHOfHJ DCCUH_ HJ8
OCCuffCU. \DLJHH_ J UCLJCU HCUCJLOH H8LOfy JHU J JH
y H8LOfy O JDCCUH_ U8OfUCf8 8 HCfJL\C.
H LHC JD8CHCC O J Cf8OHJ Of y H8LOfy O JDHOfHJ DCCU
H_ \Cf U8CJ8C 8_mCJHL JCOHO u8C HJJD8OqUOH Of JU
COJ_uJUOH LHCfJy LC CHOOU O J DCCUH_ U8OfUCf 8 OW
JHU HO RfLHCf fCOCfJU\C LC8H_ 8 fCQuiCU. JUCHL8 WLH
JO L1C8C D8 CLOf8 8HOUU DC 8CfCCCU RfLHCf Dy ODLJH
H_ J fOL1fOHDH UHC I y} JH JCU\JLCU JfUJ L1iOH
DOJ8LH UHC JHU J JLCCL COuHL. JUUUOH J8HJ BD
fHO_CH HCJ8ufCHCHL JHU \OH YlC DiJHU JCLOf LC8UH_ 8HOuU
DC COH8UCfCU H JUCHL8 WL J H8LOfy O DCCUH_ fODCH8.
1
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lRg, lVI 0lSS, SlgRllCR C0h0 US, m0S0Il0R, 0I RlC0
gUl0R hI, h lklh000 0 00lRg 0lS0I0I lS 0W, R0
R0 UIhI I0IlV SlRg lS IqUlI0.
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bHC!aHa L\ aC[HCiSOH ib. HC CaSC a_aIHS! iOU!IHC [iCO[Cia!iVC
aDOia!Oiy !CS!iH_. CU IiH Oi!H ^ Z/(1}./-+. _1i.
1Zb/bZ
Item 1R Answer:
Educational Objective: 1t0gH0Jt [0lV0VtlH 11V
tHjttlt0H 0J lbt t0Ht 0j 0[0Jltt tltJtJ tH Jttkt tt 4tJt0Jt.
fJH8CHL JJ8LC Cf88 H J JLCHL WLH CHiOHC HCHOyLC
JHCHJ 8 u8uJy UuC LO JCuLC HCCLOH WLH Jf\O\fu8 JV
J 8H_C8LfJHUCU D Vfu8. HC fOCH8Ly O LH8 \fu8 LO
HCL DOHC HJffOW CfyLHfOU fO_CHLOf CC8 CJH CJu8C fO
OuHU JHCn1J H 8OHCOHC WHO 8 UCCHUCHL OH fJU Cfy
L1fOCyLC fOUuCLOH. DCuLC HCCLOH CJH DC UJ_HO8CU Dy
mGH_ 8CfuH _ JHLDOUC8 J_JH8L Jf\O\fu8 iV. CCO\
Cfy u8uJy OCCuf8 8OHLJHCOu8y H UJy8 LO WCC8.
Jf\O\fu8 JV HCCLOH J8O CJu8C8 CfyUCHJ HCCLO8uH
m U8CJ8C} J COHHOH CHUHOOU HC88 CHJfJCLCfzCU Dy J
8JCUCHCC JCJfJHCC O LHC JCC OlOWCU Dy J JCy fCU
fJ8H OH LHC LfuH JHU HD8. H8 \fu8 CJH J8O CJu8C O
yJfLHfL8 H JUuL8 [OHCH JHCf CXO8ufC LO J CHU WL Cfy
LHCHJ HCCLO8uH } HyUfO8 CLJ8 !HCL!OH OCCuf8 CJiy
UufH_ fC_HJHCy JHU CHfOHC HCCLOH H HHuHOCOHfO
n18CU Cf8OH8 HCuG_ JLCHL8 HCCLCU VLH .
DLOu_H CuCmJ HJy CJu8C 8C\CfC JHCn1!J OLHCf HCHJLOO
CUC HCJ_C8 JiC J8O OHCH H\O\CU WHCH WJ8 HOL C\UCHL H
LL8 JUCHL. D DCCUH_ uCCf 8HOulU 8UHulJLC C[CyLC fO
UuCUOH JHU HOL UCfC88 fCUCuOCyLC fOUuCUOH JHU HO8L Cy
WOuU DC J88OCJLCU WLH HCCHJ Of 8LOO 8JHC8 O8U\C Of
OCCuL DOOU. 8LCHJH Vu8 CCUOH 8 uHCy LO CJu8C fCU
CCl JJ8J. H8 VfJl HCCUOH HJy DC J88OCJLCU WLH HCHOyC
JHCHJ JHU fCLCuOCyLO88 yHHJUCHOJLHy 8CHOHC_Jy
HCJUU8 JHU J \JfCLy O yHHOfOCfJU\C U8OfUCf8.
1
1IRSlR SlC CIlSlS lR lRS Wlh ChI0RlC hm0lC Rml
lS USU 0U 0 CU lRCl0R Wlh IV0VlIUS b15.
DC_aQHy
bCiVCy | CaHy DN OU_C |. IiHiCa [iCSCH!aUOHS O! [aiVOViiUS D1V
IH!CCUOH. Î1HySICIaH. Z//b(}.//. _1i. 1/+V]
Item 1 Answer:
Educational Objective: 1t0gH0Jt [Hm0H0l] b_tl~
hHJt0H tH 0 [0lttHl Htlb Jttkt tt 0Htmt0.
HC HO8L Cy UJ_HO88 8 uHOHJfy HyCfLCH8OH. u
HOHJfy H_CfLCHSOH 8 J HCWy fCCO_HzCU CJu8C O HOfDU
Ly JHU HOfLJ| H JLCHL8 WLH HOHOzy_Ou8 8CKC CC U8
CJ8C. NJfOu8 8LuUC8 8u__C8L J fC\JCHCC OU7 LO U7. HC
fC8CHLJLOH O uHOHJfy HyCfLCH8OH 8 CHJfJCLCfzCU Dy
f_HL8UCU HCJfL JufC WU CfHCfJ CUCHJ JDHOfHJ
\CHOu8 WJ\COfH8 BXCU 8LLH_ O`_ OuU Of JJDC u
HOHC \J\C CO8ufC LfCu8U fC_uf_LJLOH J f_HL \CHLfCu
Jf HCJ\C JHU CCJf uH_8. H8 JLCHL8 CCHOCJfUO_fJHC
fC8uL8 JfC COH88LCHL WU uHOHJfy HyCfLCH8OH.
HC CJfUHJ 8yHLOH8 O JOfLC 8LCHO88 JfC JH_HJ 8yHCOC
JHU Uy8HCJ. HC HufHuf O JOfLC 8LCHO88 8 J HU8y8LOC
CfC8CCHUOUCCfC8CCHUO HufHuf HCJfU DC8L JL UC 8CCOHU
D_L HLCfCO8LJ 8JCC UC HufHui fJUJLC8 LOWJfU LC CJfOUU
JfLCfC8. HC HufHuf UOC8 HOL \Jfy WU fC8fJLOH JHU 8
HOL J88OCJLCU WLH BXCU 8IUH_ O`_ H JOfUC 8LCHO88 8L
LH_ 8 OHCH JD8CHL Of fC\Cf8CU [HCJfU UufH_ CXHJJLOH HOL
H8fJLOH}.
O8L JLCHL8 WU HyCfLfOHC CJfUOHyOJLHy JiC fCJU\Cy
J8yHLOHJLC HOWC\Cf 8OHC HJy UC\CO 8yHLOH8 O u
HOHaiy COH_CSIOH [ CXCiIOHa UySjHCa OiIHOjHCa aHU
jaiOXySHJ HOCIUiHa UySjHCJ} CHCSI jJH JI_UC jajIa-
IOHS UZZHCSS aHU SyHCOjC. H aCCICU jaICHIS jHySCa
CXaHiHaHOH H IC jiCSCHCC O CH \CHIiCUai OUHOW ODSI!UC-
IOH SHOWS a \aiJDC aHU UyHaHC SySIOC HUiHUi IHJI S
HCiCaSCU Dy IHC NaSa\a HaHCU\Ci. HCiC S HO CHaH_C H IHC
HUiHUi WIH iCSjiaIOH. CHOCaiUiO_iajHy H jaICHIS WIH
HyjCiIiOjHC Ca!UOHyOjaIHy UCHCaICS a jaIICiH O CH \CH-
IiCUai Oi SCjIa HyQCiIiOjHy WHCH S aDSCHI H IHS jaLCHI.
SCHCHC HCJiI USCaSC CJH CaUSC CH \CHIiCUai UySHuCIOH
aHU S_HS O HCaiI aUiC WIHOUI CHCSI jJH. OWC\Ci IHS
jaICHIS HUH_S aiC HOSI COHjaIDC WIH i_HI-SUCU HCaiI
aUiC [jCijHCia CUCHa aHU CCai UH_S} UUC IO jUHOHaiy
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CCHOCaiUO_iaH SHOWS HOiHa CH \CHIiCUai HCIOH.
PO1M1
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dy d6S W SCk6 C6 0S6dS6.
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LJGWH J NCHHSKy . 1HHOHJiy COHjCJHOHS O SCKC CC GSCJSC.
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I!aHSSOHS JiC jCiOiHCU IO HCiCJSC IHC HCHO_ODH / C\C
IO aI CaSI o"aHU IHCiCDy UCCiCaSC LHC jCiCCHIa_C O aDHOi-
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SCKH_. H aUOCSCCHIS aHU aUUIS jUHOHaiy CiSCS USUay
SIaiI WIH HiCHOHS IHaI HJy DCCOHC SCCOHUaiy HCCICU.
YIH IHC HUIjC HJiCIOHS jiCUOHaIC JHU jUHOHaiy
COH_CSIOH aHU HIiajUHOHaiy SHUHIH_ UC\COj aHU CaU IO
HOiC H_OXJ aU SCKhH_.
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qUCHCy O jJ CiSCS aHU aCUIC CHCSI SyHUiOHC DUI S HOI
USCU H IHC aCUIC IiCaIHCHI O IHC SCKH_ jiOCCSS. HC UiU_
WOiKS Dy HCiCaSH_ HCHO_ODH jiOUUCIOH WHCH HCjS
jiC\CHI HCHO_ODH ` jOyHCiZaIOH aHU SCKhH_. CCJUSC
O IHC HCiCJSCU DOOU \OUHC iCSUIH_ HOH iCU DOOU CC
I!aHSSOHS I S HOI jOSSDC IO HCiCaSC IHC HCHO_ODH /
IO HOiC IHaH o"VIHOUI HUUCH_ \OUHC O\CiOaU IHCiC-
OiC CXCHaH_C LiaHSSOHS aiC iCqUiCU.
HemalCCQy !3
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d6S W SCk6 C6 0S6dS6, dCu6 C6S Sy0I0m6 S0u0
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bOUCBIODB DOCIVO Jtugn0t 00nttr0t 0j lt
tp Btl .
HC DCSI ICSI IO C\aUaIC IHC jaICHIS Hj jaH S HS
jaICHI HOSI KCy HaS OSICOHCCiOSS O IHC Hj. \SICOHCCiO-
SS [jiC\OUSy CaCU a\aSCUai HCCiOSS} O IHC CHOiJ HCaU H
JUUIS S OHCH JSSOCaICU VIH IiaUHa SCKC CC USCaSC JCO-
HO aDUSC _OUI COiICOSICiOU USC JHU HyjCiCOa_UaDC
SIJICS I CaH aSO DC UOjaIHC. aH S IHC HOSI COHHOH
SyHjIOH aHU S USUay OCaICU H IHC _iOH IH_H aHU DUI-
IOCK jaH S aSO COHHOH. 8H H iaUiO_iajHy S OHCH IHC
HIa Ua_HOSIC ICSI JHU Caiy HHUH_S Hay HCUUC HCiCaSCU
UCHSIy iCHCCIH_ HaiiOW HaiCIOH aHU CaCBCaIOH. OW
C\Ci CHaH_CS OH jaH HH iJUO_iajHy Hay IaKC WCCKS IO
HOHIHS IO JjjCai aHU iaUO_iajHy S HSCHSI\C H IHC Ua_-
HOSS O Caiy OSICOHCCiOSS. HaS a iCjOiICU SCHSI\Iy Oi
OSICOHCCiOSS IHJI CXCCCUS V" aHU S jOSI\C WHCH OIHCi
SHUCS aiC HC_aI\C. I S IHC jiCCiiCU HJ_H_ HOUJhIy ja!-
ICUa!y HIa jJH iaUO_iajHS JiC HOiHJ.
`CjIC JiIHHIS SHOUU aVayS DC COHSUCiCU H J jaICHI WIH
aCUIC HOHOJiICUai aiIiIS. OWC\Ci H IHC aDSCHCC O jiC-
VOUS Hj USCaSC Oi QiOSIHCSS SCjIC a!IHiIS O IHC Hj S iC
aH\Cy iaiC. /aiIH!OCCHICSS S IHUS HOI HUCaICU JI IHS HHC.
CaZCU OSICOjOiOSS Hay OCCUi H jaICHIS VIH HUiCS aHU
S a jiOHHCHI CaIUiC O COHjCX iC_OHa jaH SyHUiOHC
[iCBCX SyHjaIHCIC UySI!OjHy} WHCH S CHaiaCICiZCU Dy jaH
H IHC CXIiCHICS JSSOCaICU VIH SWCH_ HICU iaH_C O
HOIOH \JSOHOIOi HSIaDHIy aHU SH CHaH_CS. OHC UCH-
SIOHCIiy S HOI HUCaICU L IHS jaHCHI DCCaUSC SHC HaS HO HS
IOiy O HUiy aHU HOHC O IHC SyHjIOHS CHaiJCICHSUC O COH-
jCX iC_OHa jJH SyHUiOHC.
/ iaUOHUCUC DOHC SCaH S HOiC SCHSI\C IHaH jaH iaU-
O_iajHS DUI HOI JS SCHSI\C aS H IHC Ua_HOSS O
OSICOHCCiOSS. / iaUOHUCUC DOHC SCaH S IyQCay iCSCi\CU
Oi jJICHIS WHO Ha\C a COHIiaHUCJIOH Oi [Oi CXaH-
jC HCIa HjaHIS}.
MK S m0I6 d 9VS6SV6 6 0dg0SS 0 0S606CI0SS
d0 S 6 I66II60 mdgg I0C60uI6 W6 d Id00gIdS
dI6 0Imdl.
DC_aQHy
|OHCS I HH_CiOiG 1b. !SlCOHCCiOSS. CUOO_y GJ_HOSS JHG liCJl-
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CC OsCasC anO as aO CCCusCn CI a maCr VCssC n IC Os-
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CCs}. aICnIs WI sCKC CC OsCasC CCmmCny aVC Iar_CI
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aLIijHOSjHOijiU aHIiDOUy SyHUiOHC iCquiiCS a HiSIOiy O a
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ujuS aHIiCOa_uaHIS Oi CC\aICU C\CS O aHIijHOSjHOijiU
aHUDOUiCSaiChCquCHIyjiCSCHIiHjaUCHISWIIHSySICHiCujuS
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HuIaUOH,jiOIHiOHDiLaHU_CHaHU aCU\iIyHCaSuiCHCHISaiC
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lHOH_ uHSCCCICU WHiIC jaIiCHIS jiCSCHIiH_ WIIH aH iHiIia
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aiCHCICiOZy_OuSOiIHCaCIOiN CiUCHHuIaUOHaLUC7HCI-
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UOHS. CiI1CiIHCCIOiN CiUCHHuIaUOHHOiIHCjiOIHiOH-
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iHCuUiH_jHHaiiyUiCIaiyiHIaKCO OiCaCiU,\lIan1_,J
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SHOWHIOiCUuCCU HSK O iCCuiiCHI \aSCuaiC\CHIS. yjCi-
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0 Ibt t0Ht 6j rtn0 j0tHrt, 0ntmt0, 6B0nt6n g0, 0nd
bytrt0ttmt0.
HC UCCiCaSCU aHiOH _aj iHUC jiCSCHCC OaHCHia, jiOICH-
uiia, HyjCiCaCCHia, aHU iCHa aiuiC Su__CSIS HuIijC
HyCOHa.lCuICKiUHCyHuiyiS IHCiHiIiajiCSCHIaIiOHiHaS
HaHy aS OHC HaO jaIiCHIS WiIHHuIijCHyCOHa. XCCjI
HemalOOQy T7
iH HuIijC HyCOHa, HyjCiCaCCHia H IHCjiCSCHCC OaCuIC
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HOCCaCiCiODOIHaCIIOjiCUiSjOSCIOHyjOCaCCHia.yjCi-
CaCCHiaHayCauSCiCHaiHSuHCiCHCyIHiOu_HSC\CiaHCCH-
aHiSHS, iHCuUiH_ HCHOUyHaHiC CCCIS O \aSOCOHSIiiCIiOH
IHaI HCUiaIC iCHa SOUiuH aHU WaICi iCICHIiOH, aHU UiiCCI
CHCCISOHiCHaIuDuaiSOUiuHaHUWaICiHaHUiH_,iCSuUH_
iH jiCiCHa aZOICHia SCCOHUaiy IO \OuHC UCjCIiOH. Oi-
Hay, IHC aHiOH _aj iSajjiOXiHaICy 1Z ZHCqy[1Z Z
HHOy}. OSI uHHCaSuiCU aHiOHS COHSiSI O aDuHiH.
HCiCOiC, IHC jiCSCHCC O CiIHCi a OW aDH C\C Oi aH
uHHCaSuiCU CaIiOHiC i_HI CHaiH, WHiCH OCCuiS iH HuIijC
HyCOHa,iCSuISiH aOWaHiOH_aj.
1IHOu_HHyUiOCHOiOIHiaZiUCIOXiCiIyCaHjiCSCHIWIH \O-
uHCUCjCIiOHaLUjiCiCHaaZOICHia,IHCjiCSCHCCO HCHa-
IOOCaHUHCIaDOiCCOHjHCaIiOHSHaKCSIHSCSSiKCyaSa
H_ Uia_HOSiS. HC HyjCiCaCCHia IHaI CHaiaCICHZCS IHC
HiK-aKai SyHUiOHC iS HOI aSSOCiaICU WiIH aHCHia Oi jiO-
ICHuiiaaHUiSuSuJyaSSOCiaICUWIIHHCIaDOiCaKaOSiS.ii-
Haiy HyjCijaiaIHyiOiUiSH SHOuU DC aSSOCiaICU WiIH
HyjOjHOSjHaICHiaaHU HOIaHCHiaOijiOICiHuiia.
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y6lCdC6d, d0 l6d dUl6 SUgg6SIS UI6 y60d.
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HIIC HyCOHu. uHtCI. ZVo+:oZ+ooV. 11: JV+Jo+_
lI0H Z7 HSW0t.
bOUCBIOHB D0CIV0. 1t0gn6t mHItt myt6m0
tn 0 0IttnI BtIb b_trt0ttmt0.
HiS jaIiCHI HaS HyjCiCaCCHia, UiHSC OSICOjCHia, aHCHia,
CuKOjCHia, iCHa iHSuHCiCHCy, aHU a HiSIOiy O CHCajSuaICU
Oi_aHiSHiCaICU jHCuHOHia, WHCH iS a CHaiaCICiiSIiC jiC-
SCHIaIiOHOHuIijCHyCOHa.HCUia_HOSiSiSSujjOiICUDy
IHCDOHCHaiiOWaSjiiaIC,WHiCHSHOWSCuSICiSOjaSHaCCS.
HCSC CCS CaH CaSiy DC UiSIiH_uiSHCU hOH HC_aODaSIOiU
CiyIHiOCyICS DyIHCii UiSjCiSCU CHiOHaIH jaIICiH aHU jCiH-
uCCai haO [LO_i ajjaiaIuS}.
lCuICHyCOiUCuKCHiaiaiCyCauSCSHyjCiCaCCHia. HaUUi-
IiOH,HOiCSC\CiCDOHCHJiiOW|uiCaHUaUCCiCaSCUjaICCI
COuHI WOuU DC iKCy, aHU IHC DOHC HaiiOW aSjiiaIC WOuU
SHOW CuKCHiC DaSIS. !HiOHiC yHjHOCyIiC CuKCHia [!}
OHy iaiCy CauSCS HyjCiCaCCHia aHU iCHa iHSuHCiCHCy aH
CC\aICU CuKOCyIC COmI iS I_iCa. OiCO\Ci, IHC iHCiCaSCU
HuHDCi O jaSHa CCS iH IHC DOHC HaiiOW aSjiiaIC iH IHiS
jaUCHIiuCSOuIaUia_HOSiSO !.CIaSIaUCSHaCCuH_
CaHCCi iH IHC DOHC HaiiOW Hay CauSC CyIOjCHia aHU HyjCi-
CaCCHia. OWC\Ci, IHC jCiijHCia DOOU SHCai WOuU SHOW
CuKOCiyIHiODaSIiC CaIuiCS WiIH ICaiUiOj CiyIHiOCyICS aHU
in1aIuiCHyCOiUaHUCiyIHiOiUCCS.uiIHCiHOiC,IHCHOi-
Tb HemlOOgy
CC_CmOn_sCItCCnCmarrCVasratCnts auCnt
VCsCVsarCICrauCnCIasmaCChssnCCnsstCntVt
mCtastasshCm anyCtCrCanCCr.
Mu m0md S SuggS0 0 ISC 0 ICdCmd,
0S0d, dmd, uK0d, d0 Id SuCC.
DO_agDy
JJD C 1OUJi , iC!KiCu!Z CHJiU8OH 1L 1HUCi8OH \.
uHC HyCOHJ. JHCC!. 2Vo+(V}.o2+ooV. HD 2V |uH
2J. _1L. JVD+Jo+q
Item Z Answer: L
Educational Objectve: Oaqnarc manarlanal qam-
mqathy aj undurmncd rqnranrc.
JmsauCntasmCnCCCna_ CatyCIunOCtCrmnCOs_-
mCanCC [NL\5}VCsCaraCtCnZCOytCrCsCnCCCI a
CV sCrummCnCCCnarCtCn[N-rCtCn}CVC [<. _/O1
_/1}Csstan 1 7asmaCCsntCCnCmarrCVanO
tCasCnCCCI yCCnCCsCnsanCmayCrCaCCmaCrrCna
nsumCCn assCCatCO Vt a asma CC rCICrauVC rCCCss
CrrCatCO-CCJymCrCLICrauVCOsCrOCr.JCHCOCnCCCI
NL\5 nCrCasCsWt a_C anO mCrCtanb7CI CrsCnsCOCr
tanyCatsmayCahCCtCO.ICsCCHCuCatmCntsrCgutCO
CYCCt ICr CCsC ICCV-u tC OCnm rC_rCssCn tC myCCma
CrCtCrOsCrOCrsanOCnCOCmCasutCmCntCIsCrumN-rC-
tCn CVCs. JC nsk CI rC_tCssCn CCrrCatCs Cst Vt tC N
tCtCnCVC:tC_CrtCCVCtCCatCrtCnsk.
P1 [_t-Can} amyCOCss s a mCnCCCna asma CC
OysCrasan VC sCCrCtCO mmunC_Cun s OCCstCO as
hrs n kOnCys Cart anO CrCra nCrVCs tCrCy rC
OuCn_ rC_rCssVC Cr_an OyshnCtCn. \CmmCn symtCms
nCuOCIau_uCVC_tCssanOCasyrusn_.OnCyHVCVC-
mCnt rCOuCCs nCrCtC synOrCmC Wt ar_C amCunts CI
nCn-_t-CanrCtCnura;aZCtCmaOCVCCsatCntCOs
CasCCCursC.\arOaCnVCVCmCntCanCOCtCCtCOas tmCkCn-
n_CI tC sCtum anO CaOstCCartIaurC anO arrytmas.
5CnsCrmCtCr nCurCaty s tC manICstatCn CI CrCra
nCrVC nVCVCmCnt. CtCCtCn CI mCnCCCna mmunC_C
unnsCrum CCO Cr tssuCsO CrCntatCsP1 amyCOCss
hCmCtCrICrms CI amyCOCss.
1ymCasmaCyCymCmakusuayaatCOWtamCn
CCCnasCrumatarCtCnCI mmunC_|CunN [\aOCn
strOms maCrC_CunCma} nCt _L as sCCn n ts auCnt.
NCst atCnts aVC CnC marrCV ym nCOC anO sCnC
HVCVCmCntanOsCmCmayOCVCCyCrVsCCstysynOrCmC.
Na|CrOa_nCsuCCntCnaICrmuuCmyCCmanCuOCtCIC
CVH_:tCHnOn_CIaasmaCyCmaCnussuCCsy;_rCatCr
tan 7 CCna asma CCs n tC CnC marrCV; m_ N-
rCtCnCVCs [_L >.b_/O1 b _/1anO_P>Z._/O1
Z_/1};anOCnCC|CnCsrCtCnuna[urnCrCtCnCYCrC
tCn >1._/Z+}. NnCrCrtCranCuOC17tC7 asma
CCsntCCnCmarrCV;N-rCtCnCVCCsstan.b _/O1
[b _/1}; ytC CnC CsCns; anO OsCO CVCs CI nCn
mCnCCCnarCtCns.POagCsssCstasCOVtCnCma|Cr
anO CnC mnCrCrtCHCn CrtrCCmnCrCHtCna.
M00C0d gdmm0d 0 u0Im0 SgCdC S CdIdC
I0 0 d SIum m00C0d I0 V SS d g/0L
g/L] W0u 0VI CCd duIS 0 m0md d0 SS d
1 dSmd CS 00 mdII0W.
DO_agDy
JUC | O8HO \DCiJ UC JiiCJ \. 1J!HO_CHC88 JHU iO
_iC88OH O HOHOCOHJ _JHHOJ!Hy O uHUC!CiHHCU 8_HHCJHCC.
CuKCHJ. 222(V}.JDJJD. uD 2 |u oJ. 1L.
JJoJ_
Item Z Answer: L
Educational Objective: Oaqnarc rhranr lympharytr
lcukcma.
JC mCst kCy Oa_nCss ICr ts atCnt s CrCnC ymC
CytC CukCma [\11} VC s CaraCtCrZCO y anCrma
aCCumuatCnCImCQCC_CaymaturC-aCarn_ymC
tCsVtaCaraCtCrstCmmunCCnCt_C[\b'\Z'
anO\Z' CCs}n tCCCOCnCmarrCVCrymatC
ussuCs. JC Oa_nCss ChCn s CstasCO y BCV CytCmCtry
tCaVCOtCnCCOICrCnCmarrCVasrauCnCrCsy.\1
CCCursnatCntsahCra_C+yCarsVtnCrCasn_hCguCnCy
n suCCCssVC OCCaOCs CI IC. JC OsCasC s ChCn ICunO nC-
OCntayCnrCutnCCCOVCrkuasaymCCytCssVtCut
CtCr CVOCnt OsCasC. Cn_ CnCOs CI staty Cr VCry sCV
rC_rCssCnCI OsCasCmayCCCurCVCrmanyyCars.
PCutCymCastC CukCma [P11} san CYtrCmCya__rCs-
sVC OsCasC CI rCCursCr J Cr CCs tat s usuay CI CYC-
sVC CnsCt. IaOy rsn_ CVCs ast CCs n tC CCO anO
CnCmarrCV u|ymaOCnCaty[CsCCayntCmCO
astnum}ayCun_Cra_CatCnsCt anOCytCCnasCCCnOarytC
CnC marrCV nVCVCmCnt arC tC usua rCsCntn_ CnCa
ICaturCsCIP1.
PCutCmyCCOCukCma A) tyCm yrCsCntsVtsCVCrC
anCytCCna anO CrCuatn_ myCCO asts. nICCtCn anO
CCOn_ arC CCmmCn rCsCntn_ rCCms CI atCntsVt
P1.
\rCnC myCCO CukCma [\N1} s rCCC_nZCO y an CC-
VatCOCukCCytCCCuntanOnCrCasCOnumCrsCI_ranuCCytC
CCs n a asCs CI OCVCCmCnt Cn tC CrCra CCO
smCar.`CrymmaturCCChsCrastsrCrCsCnt 17tCb7CItC
_ranuCCytCs Vt nCrCasn_ numCrs CI rCmyCCCytCs
myCCCytCs anO mCtamyCCCytCs. \N s OsCCVCrCO nC
OCntahynmanyatCnts.

LI0C m0CC uKmd S CdIdCI0 0 d00Imd dCCu
mud0 0 m0I00gCd mduI~ddIg m0CS W
d CdIdCISC mmu00 0000, 00 mdII0W, 0I
mdC SSuS.
DO_aQHy
ACC I,\iICH b. \HlOHIc yHQHOcyc CHKCHIl. UIl_HOSIS adLlClL-
HCHL. lyO \IH YlOc. Z1(}:11b11ZV. _Yii. 1V1b[
Item Answer:
Educational Objective: !aqnarc acun myc/ad
/cukcma an thc barr aj a pcrphcra/ b/aad rmcar
HC HOSI KCy UJ_HOSS S JCHIC HyCOU CHKCHJ ^).
yCOUySjJSIC SyHUiOHCS JiC COHJ USOiUCiS O IHC
HCHJIOjOCIC SICH CCS H jJICHIS OUCi IHJH D yCJiS JHU
JiC CHJiJCICiZCU Dy HCHCCI\C HCHJIOjOCSS JHU jCijHCiJ
CyOjCHJ. /IHOu_H IHC HJIHiJ HSIOiy O USIHCI SHDIyjCS O
HyCOUySjJSJ iJH_CS BOH HUOCHI CHiOHC JHCHJ IO iJjU
UCJIH BOH jiO_CSSOH IO JCuIC CuKCHiJ HOSI jJUCHIS C\CH-
IuJy jiO_iCSS IO CHKCUC SyHUiOHCS Oi UC BOH COHjHCJ-
UOHS O DOHC HJiiOW JHiC. JICHIS WIH HyCOUySjJSHC
SyHUiOHC IiCJICU WIH JZJCIUHC HJ\C S_HCJHIy UCJyCU
IiJHSOiHJIOH IO CHKCHJ JHU HjiO\CU QHJIy O C.
CSjIC IiCJIHCHI WIH JZJCIUiHC IHiS jJICHI HJS P JS
HUCJICU Dy IHC jCijHCiJ DOOU SHCJi SHOWiH_ J HyCODJSI
WIH PHCi iOUS. PHCi iOUS JiC CuHjS O JZuiOjHC HCCUC-
SHJjCU CiySIJS HJUC BOH jiHJiy CyOjJSHC _iJHHCS. HCy
OCCHi HOSI OHCH H jJHCHIS WIH ^ JHU iJiCy H jJHCHIS
WIH HyCOUySjJSJ. C\Ci H jJICHIS VIH P S JHOSI
JWJyS iCJICU IO HCCIOH IHCiCOiC IHS jJICHI HHSI DC
qHCKy JHU IHOiOH_Hy C\JHJICU Oi J SOHiCC O HRCIOH JHU
IICJICU CHjiCJhy WIH DiOJUSjCCIiHH JHIDOUCS.
PCHIC yHjHODJSIC CHKCHJ (P} S JH CXIiCHCy J__iCS-
S\C USCJSC O jiCCHiSOi Oi CCS HSHJy O CXjOS\C OHSCI.
1JjUy iSH_ DJSI CCS H IHC DOOU JHU DOHC HJiiOW Du|
yHjHJUCHOjJIHy (CSjCCJy H IHC HCUJSUHHH} JHU CyIOjC-
HJ SCCOHUJiy IO DOHC HJiiOW H\O\CHCHI JiC I1C HSHJ jiC-
SCHIH_ ChCJ CJIuiCS. PHCi iOUS UO HOI OCCui H jJICHIS
WIH P.
PCHIC jiOHyCOCyC CUKCUJ ( P} S J SHDIyjC O ^ IHJI
JCCOHHIS Oi 17 O jJUCHIS WiIH /.HC USOiUCi S CXQHS
ICy SCHSI\C IO JHIHiJCyCHHC CyOIOXC IHCiJjy. HC JUUIOH
O J!|JHiCIHOCJCU JHU JiSCHC IiOXUC IO IHC IHCiJjy
HJS iCSHICU H H_H CHiC JHU SJ\J_C iJICS. JICHIS WiIH P
HJy HJ\C CiCHJIH_ DJSIS DuI IHC jiCUOHHJHI CC S J Ji_C
HDJIHiC _iJHHOCyIC WIH HHIjC _iJHuCS O\CiyH_ IHC
CyIOjJSH JHU HHCCHS.
yjCJy CHiOHC HyCOU CuKCHJ ( \} S UJ_HOSCU JS J
iCSHI O J iOuIHC DOOU COHHI IHJI SHOWS CHKOCyIOSS WiIH
CiCHJIH_ HyCOU jiCCHiSOiS H J SIJ_CS O UC\COjHCHI.
JICHIS WIH \ HJy HJ\C CiCHJIH_ DJSIS DHI JSO V
HJ\C HOiC HJIHiC _iJHHOCyICS JHU V HOI HJ\C PHCi iOUS.
A erhera| b|ood smear showng mye|ob|asts that contan Auer
rods s dagnostc ot acute mye|od |eukema.
HemalOIOQy T69
DO_aQHy
\iOHHC 1 /QQCDlHH 1 \OHLlC b1 CL l. /cHLC HyCOIU
CHKCHIl. | lL \OHQl \lHt CLW. Z(1}:VZVV. _Yii:
1V171V[
Item 3 Answer:
Educational Objective: !aqnarc chranc myc/ad
/cukcma.
HS jJICHI HJS CHiOHC HyCOU CHKCHJ (\}. HC jiO-
IO|jC O IHC HyCOjiOCiJU\C SyHUiOHCS \ iCSHIS BOH
J DJJHCCU IiJHSOCJIOH DCIWCCH CHiOHOSOHCS V JHU 22
_I(V22} IHC HJUCjHJ CHiOHOSOHCq WHCH CiCJICS J
uHqHC _CHC UCS_HJICU 1CIH1, IHS _CHC COUCS J 21
KJ jiOICH (j21} IHJI HCUOHS JS IyOSHC KHJSC. P I(V22}
S HOI OHy UJ_HOSIC O \ DuI S JSO IHC CJHSJI\C _CHCUC
C\CHI JHU J IHCiJjCHIC IJi_CI. HC UJ_HOSS O \ H IHS
jJICHI S DJSCU OH IHC jiCSCHCC O IHC 1CI H1 OHCO_CHC
jCijHCiJ DOOU SHCJi HUH_S SHOWiH_ HCiCJSCU _iJHHO-
ICS WIH J HJiKCU CH SHH JHU H_CiCCHJi DOHC HJiiOW
WIH HJiKCU HyCOU jiOHCiJIOH.
JICHIS WIH JCHIC yHjHODJSIC CuKCHJ (P} IyjCJy
HJ\C yHjHOCyIOSS HCHIiOjCHJ JHCHJ IHiOHDOCyOjCHJ
yHjHJUCHOjJIHy JHU HCjJIOSjCHOHC_Jy JI jiCSCHIJHOH.
1HCiCJSCU HHHDCi O yHjHODJSIS OuHU OH DOHC HJiiOW
CXJH1JHJUOH JiC SuSjCOuS Oi IHC UJ_HOSS. HHHHOjHCHO-
I_H_ S HCCCSSJiy IO COHiH IHC UJ_HOSS O ^ JHU UCICi-
HHC IHC yHjHOCyICS JIC CCS CCS Oi DjHCHOI_C
CCS WIH HJiKCiS O DOIH yHjHOU JHU HyCOU CCS.
PCHIC HyCOU CHKCHJ (P} SHOHU DC COHSUCiCU WHCH
CiCHJIH_ DJSIS JiC jiCSCHI H IHC jCijHCiJ DOOU SHCJi.
HC UJ_HOSS O P S COHiHCU Dy J DOHC HJIiOW JS j-
iJIC SHOWH_ HyjCiCCuJi HJiiOW COHIJHH_ _iCJICi IHJH
27 IO o7 HyCODJSIS. \HCC IHC UJ_HOSS O JCHIC CHKCHJ
S CSIJDSHCU IHC CJSSCJIOH S DJSCU OH IHC HOHOO_y O
IHC HHJIHiC CCS. HC jiCSCHCC O PHCi iOUS COHiHS IHC
HyCOU HJIHIC O IHC CHKCHJ.
PCuIC jiOHyCOCyIC CHKCHJ (D1} S J SHDIyjC O P
IHJI JCCOH1IS Oi 17 O CJSCS. JICHIS WIH P HJy HJ\C
CICHJIH_ DJSIS DHI IHC jiCUOHHJHI CC S J Ji_C H1HJ-
IHiC _IJHuOCyIC WIH HHIjC _iJHHCS O\CIyH_ IHC CyIO-
jJSH JHU HHCCHS.
O1T
The dagnoss ot chronc mye|od |eukema s based on the res
ence ot the bLh/4bLoncogene, erhera| b|ood smear tndngs
showng ncreased granu|ocytes wth a marked |ett shtt, and
hyerce||u|ar bone marrow wth marked mye|od ro|teraton.
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YDCD O tDc OOWD_ S tDc OQDua Ua@OSDC tcSt:
!J 8CJHO IHC uHDJi8iHC
[1] 1 O IHC uHDJi8iHC
[!] JiHiJUiO_iJH OIHC uHDJi8iHC
[i] JHiCCHJ8C DOHC 8CiHIi_iJHy
TH b3 jAOvanCCO]
+yCJiOUWOHJHi8HO8iIJiZCUDCCJu8COJHOHJ
UiJiHiH_uCCiOH IHC JHIJiJ8CCIOIHCCHOOI.bHCHJ8J
J yCJiHi8IOiyOI_C2UiJDCIC8HCIU8.JHCuCCii8CiOHiC
JHU HOHHCJiH_ DuI O\Ci IHC J8I o UJy8 HJ8 DC_uH UiJiHiH_
Ou8HCiH_ HJICiiJ.AC8ICiUJyIHCJIiCHIUC\COCUC\Ci
JHU IHC JiCJ JiOuHU IHC uCCi DCCJHC CiyIHCHJIOu8. CU
iCJIiOH8 iHCuUC HCUOiHiH JHU iO_IJZOHC.
\H jHy8iCa CXaHiHaIOH 8HC UOC8 HOI ajjCai m . CHjCia-
IuiC i8 .l [J1.1} OICi \Ia 8i_H8 aiC HOiHa. ^ -
CH Dy Z-CH UCCj jaHIai uCCi IHaI i8 UiaiHiH_ a juiuCHI
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C CHHC !OOI i8 WaiH CiICHaIOu8 aHU CUCHaIOu8. u8C8
iH IHC !OOI aiC jajaDC. O DOHC i8 \i8iDC Oi UCICCICU WiIH a
HCIa jiODC. ^ jaH iaUiO_iaj O! IC !OOI 8HOW8 OHy 8OH
Ii88uC 8WCiH_.
Which ol thc lodowg imagng studcs ol thc loot shomd
bc pcrlormcd ncxt?
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!C\Ci.
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OIHCi \iIa 8i_H8 aiC HOiHa. LCHCia CXaHiHaIOH iHCuUiH_
HCuiOO_iC CXaHiHaIOH i8 HOiHa. O! IC 8jHC 8HOW8
CHHaHCCHCHI O! IC -CHU jaIC8 aHU H aHOH O! IHC
Ui8K 8jaCC. O CjiUuia CHHaHCCHCHI Oi jaia\CiICDia COhCC
IiOH8 aiC 8CCH. HC jaIiCHI i8 O8jiIaiZCU.
Which ol thc lohowg is thc most appropratc ncxt man-
agcmcnt stcp?
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D5Wf5 BDO LflIlQU5
Item 1 Answer:
Educatonal Ob]ectve: !aqncrc Bcrky Mcuntan
rpcmd [cvcr
HiS aIiCHI HOSI iKCy HaS OCKy OHHIaiH S[OIICU C\Ci
[b}. C iCSCHIS WiIH a HH-iKC HCSS UHHH_ IHC SHH-
HCi.CCaHSCOIHCHOHSCCihCHaIHiCOilSSyHIOHSb
SHOHUDCSIiOH_yCOHSiUCiCUiHaIiCHISSHCHaSIHiSOHCWIH
a HOHSCCiBC CDiiC iHCSS WIHIH 8 WCCKS O OICHIa ICK
CXOSHiC aHU iHHCUiaICIICaIHCHIWlIHUOXyCSHOHU
DC _i\CH CHU_iCSHISO Uia_HOSIC SIHUiCS,aHy COC
WiIHIiCK-DOiHCiHCCIiOHUOHOIiCCa aSCCiBCIiCK DiIC. \
IO0" OlaUCHISC\CHIuayUC\COIHCCHaiaCICHSUCUJ\CH-
H_CiyIHCHaIOHSHaCuCSOCaICUaiOHHUIHCWHSISaHUaHKlCS
IHaISiCaU CCHIHCIay. HCHOSI COHHOHya\aiaDCUia_-
HOSIiCICSI Oi biS aCOH\alCSCCHI SCiOO_y.
aDCSiOSiS iS CaHSCU Dy 1uu|J!u m!tl0l! aH iHIiaCCHai iO-
IOZOaH JiaSiIC. aDCSiOSiS iS IiaHSHiIICU IO HUHaHS Dy IiCKS
aHUOCCHiSiiHaiiyiHIHCHOiIHCaSICiH\HiICUbIaICSWiIHaH
CiCCHICi iH \aC \OU aSSaCHHSCIIS aHU IHC aSSOCiaICU
iSaHUS.OSIiHCUOHSaiCSHDCHiCJDHIaHOHSCCihCCDHC
iHCSS CaH OCCHi. aDCSiOSiS SHOHU DC COHSiUCiCU iH aIiCHIS
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1lIHOH_H IHiS aIiCHIS iCSCHIaIiOH iS COHaIiDC W!H
iHHHCHZa IHiS UiSCaSC UOCS HOI _CHCiay OCCHi iH ICHCiaIC
iC_OHSO IHC WOiUUHHH_IHC SHHHCi.
OSI Caiy OCaliZCUyHC UiSCaSC OCCHiS iH IHC SLCi aHU
a aHU iS CHaiaCICiiZCU Dy IHC CiyIHCHa Hi_iaHS iaSH aH
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dES Wh d 0SECC EDIE ESS Wh J WEEKS 0 0E
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Item2 Answer: A
Educatonal Ob]ectve: !aqncrc [arttcur [cvcr
HiS [aIiCHI HOSI iKCy HaS aCIiIOHS C\Ci. aCIiIiOHS C\Ci
WaS IHC Uia_HOSiS iH " O a aIiOHa HSIiIHIC O CaIH
COHOiIO8+8 iCCiiaSOiC\aHaIOHO C\CiOHHKHOWHOH
_iH [a H_Hy SCCCICU OHaIiOH}. aCIiIiOHS C\CiHSHayiS
Uia_HOSCU iH yOHH_ WOHCH _CHCiay SHOWS HHHSHa C\Ci
aIICDS SHCH aS \CiyH_H OiDiiC SiKCS aHU iaiU UCCi\CS-
CCHCC VIHOHI CHiS aHUUiaHOiCSiS.1 C\Ci UiaiyW Iyi-
CayUCHOHSIiaICa aCKOHOiHaUiHiHaICHCiaIHiC\aIia-
IiOH. iKC IHiS aIiCHI Hy8iCa aHU aDOiaIOiy BHUiH_S O
iHCIOHOiiHH daIOHaiCaCKiH_UHm_IHCCDiCihCSS.
a a CUICiiaHCaH C\CiiS aH aHIOSOHa iCCCSSi\C UiSOi-
UCiiC\aCHIHCOCO CWiSHHiKiSH1iaDiCaHU1iH CH-
iaHHCiiIa_C. OSIaICHISHa\CIHCOHSCIOiHCSSDCOiCa_C
!0 yCaiS 5" DCOiC IHC a_C OJ yCaiS. HC KCy CaIuiC iS
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aiC aSO COHHOH. LiSOUCS O C\Ci aiC aCCOHaHiCU Dy CC
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IHiOCylC SCUiHCHIaUOH iaIC.
LHUOCaiUiIS SHOHU DC SHS[CCICU i aH aDHOiHa HHiHHi iS
HCaUOHCXaHHaUOHaiUCUaIyiHaUCHISViIHaCOHCiH_
HiSIOiyOiL HIC\Ci. LHUOCaiUUSiSHHliKCyHHaUCHI
VIH HOiHal HySiCaBG_aHU HC_aU\C UOOUCHIuiCS.
1iOXiHaICy 80" O aICHIS WIH SySICHC HHS CiyIHC-
HaIOSHS[bL}Ha\CCHIaHCOHSH\O\CHCHIaISOHCOiHIiH
IHCiiUiSCaSCCOHiSC.OSIiaSHCSaSSOCiaICUWIHbLOCCHiH
aiCaSCXOSCUIOIHCSHH. OiCIHaH0" OaUCHISViIHbL
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IiCHai Oi OyaiIiCHai Oi aSyHHCIiiC Oi SyHHCIiiC. OiC
IHaH " O HHIiCaICU aIiCHIS ViIH bL Ha\C H_H IICiS O
aHIiHHCCai aHIiDOUiCS a HC_aIi\C aHIiHHCCai aHIiDOUy ICSI
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HCIaDOiC 8IaIC jiCCijiIaICU Dy CXjO8HiC IO \OaHC iHHaaHOHal
aHC8IHCIiC8 [HaOIHaHC i8OHHiaHC CHHHiaHC UC8HHiaHC
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IHC UiH_ DHI CaH OCCHi 8C\Cia HOHi8 aHCi IHC iHiHa CXjO8HiC
aHU CaH UC\COj iH jaHCHI8 WHO WCiC jiC\OH8y CXjO8CU IO IHC
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HyjCiIHCiHia IaCHyjHCa aHU CaiUiaC aiiHyIHHia8. aD-
UOHyOy8i8 [CC\aICU CiCaIHC KiHa8C} aHU aCHIC iCHa IHiC
CaH UC\COj. ai_HaHI HyjCiIHCiHia 8HOHU DC 8H8jCCICU iH
jaHCHI8 WiIH a aHiy H8IOiy O jiODCH8 UHHH_ aHC8IHC8ia.
HC HCHiOCjIiC Ha_HaHI 8yHUiOHC i8 a hCUCaICHiH_ Ui8-
OiUCi CaH8CU Dy aH iUiO8yHCiaHC iCaCIiOH IO HCHiOCjIiC IiaH-
qHiiZCi8 [UOjaHiHC _iCCCjIOi aHIa_OHi8I8} aHU 8OHC
aHIij8yCHOIiC UiH_8. HC HO8I COHHOH OHCHUiH_ HCHiOCj
IiC a_CHI8 aiC HaOjCiiUO aHU HHjHCHaZiHC. HC 8yHUiOHC
OCCHi8 WiIH a UiH_8 IHaI CaH8C CCHIia UOjaHiHC iCCCjIOi
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IHCiajy. O8I jaIiCHI8 ViIH IHC 8yHUiOHC UC\COj HH8CC
ii_UiIy HyjCiIHCiHa CO_HIi\C CHaH_C8 aHIOHOHiC H8IaDi
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IH8 jaIiCHI UiU HOI iCCCi\C a HCHiOCjIiC a_CHI HCHiOCjIiC
Hah_HaHI 8yHUiOHC i8 UHiKCy.
1iKC IHC HCHiOCjHC Hai_HaHI 8yHUiOHC IHC 8CiOIOHiH 8yH
UiOHC jiC8CHI8 WiIH Hi_H C\Ci HH8CC ii_iUiIy aHU CO_HIi\C
CHaH_C8. iHUiH_8 HHiqHC IO IHC 8CiOIOH 8yHUiOHC aiC 8Hi\-
CH_ HyjCiiCBCXia HyOCOHH8 aHU aIaXia. HC 8CiOIOHiH 8yH-
UiOHC i8 CaH8CU Dy IHC H8C O 8CCCIi\C 8CiOIOHiH iCHjIaKC
iHHiDiIOi8 a CaIC_Oiy O UiH_ IHaI U8 jaHCHI Ha8 HOI DCCH
CXjO8CU IO.
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jaIiCHI iCCCiV_ aUCqHaIC IiCaIHCHI Oi HyjCiIHyiOiUi8H.
& P1
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ChfCt8f28dbyhyp8fm8tb0CStt8pf8Cptt8dby8kp0Suf8t0
v0t8hht0hh8Sth8tCShdd8p0f2hgmuSC8f8khtS.
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HOH 8OHiCC COHIiO iHCHUiH_ IHC iCHO\a O 8OHiCC8 O iHCC-
IiOH 8HCH a8 HUWCiH_ CaIHCICi8 UiaiHa_C O aD8CC88C8 aHU
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UHCCICU IHCiajy a BHiU CHaCH_C ai8 IO aCHiC\C a HCaH aiIC-
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SIJiH UOCS HOI iUC OUI _OHOiiHCJ DCCaUSC iI iS ODSCi\CU H
OHy b7 O WOHCH ViH I1S iHCCIiOH.
H J WOHJH WIH J Hi_H jiCICSI jiODJDiiIy Oi CCiVClIiS WHO
HJy CJSiy DC OSI IO OlOW-Uj iI iS DCSI IO IiCJI CHjiiiCJy
Oi _OHOiiHCJ JHU CHJLyUiJ iJLHCi HJH WJI Oi SjCClBC ICSI
iH_ IO iCIUiH. \CHiiJXOHC WiIH CiIHCi UOXyCyCiHC Oi
JZiIHiOHyCiH iS JH JjjiOjiiJIC iC_H1CH. H HC jiCSCHCC O J
UOCUHCHICU _OHOiiHCJ iHCCIiOH Dy HUCCiC JCiU Oi CUIUIC
1B0 |nCc!lOUs DlsCasC MCOlclnC
CHaHyUa S aWayS IfCaICG C\CH H IHC aDSCHCC O jOSI\C ICSI
fCSuIS Of C|!aHyUa HCCIOH.
[11} HCuGCS a SjCCIfuH O USOfGCfS O IHC CHJC ujjCf
_CHIJ IfaCI iHOuUH_ CHGOHCIfiIS SJjH_IS IuDOO\afJH
aDSCCSS aHG jC\C jCfIOHIS. 1a_HOSS S CSIaDbSHCG CHi-
Cay VIIH Su__CSI\C LHUH_S HOuUH_ CCf\CJ HOIOH ICH
GCfHCSS uICfHC ICHGCfHCSS Of aGHCXa ICHGCfHCSS OH jC\C
CXaHHaIOH.
aCIClJ \a_iHOSS S HOI a SCXuJLy IfJHSHIICG UiSCaSC aHG
GOCS HOI CauSC CCf\CiIiS. \H \a_iHJ CXJHiHaIiOH iHBaHHa-
IOH iS HOI C\UCHI DuI a HOHO_CHCOuS WHIC HOHiHHaH-
HaIOfy USCHaf_C COaIS IHC \a_iHJ WaS. HC \a_HJ j1 iS
H_HCf IHaH +.D IHC WHH ICSI S jOSiI\C [a LSHy OGOf iS jfC-
SCHI WHCH jOIaSSiuH HyUfOXGC iS aGGCG IO \a_HJ SCCfCHOHS}
aG CuC CCS [SquaHOuS CjIHCa CCS CO\CfCG WIH DaC-
ICfa ODSCufH_ IHC CG_CS O IHC CjIHCia CCS} afC OuHG OH
WCI HOUHI.
B P1
L8fvCtS S d8h8d 0y 8th8f th8 pf8S8hC8 U muCUpufu8ht C8f-
vC dSChfg8 Uf 8hdUC8fvC 088dhg hd S CuS8d 0y Chmy-
d | hd/Uf gUhUCUCC h8CtUh.
DlC_aQHy
Yi|scn |I. In thc c|inic. \iginitis ind ccr vicitis. Pnn Intcrn Ncd.
2UUV;151(5}:I131I1315; Quiz I13-1. INIO: 1V721U1]
lIOD Z3 DSWOt!
LOUCBIODB D[OCIVO! 1rt0I 0rrtmn0h0 g0n0t0t
t0 njttI0n.
HS jaICHI HOSI mCy HaS USSCHHaICG _OHOCOCCJ HCC-
IOH [1L} aHG HIia IfCaIHCHI SHOuG iHCuGC jafCHICfa
IHCfajy WIH CCHlaXOHC Of a COHjafaDC IHfG_CHCfaIiOH
CCjHaOSjOfiH.
1L Hay CauSC SCjIC Of SICfiC iHHuHCHCUiaICG afIHDIS
JHG ICHOSyHO\IS aHG HCquCHIy H\O\CS IHC KHCCS jS JHG
WfiSIS DuI HOI IHC SjiHC. 1CfHaIIS aSSOCaICG WIH SjafSC
jCljHCfa HCCfOIiC juSIUCS JSO iS COHHOH. / CHJfaCICDSIC
jfOGfOHC O Hi_faIOfy JfIHJ_a aHG ICHOSyHO\iIS Hay jfC-
CCGC IHC SCIIH_ O IHC SyHO\IS H OHC Of SC\CfJ ]OHIS.
LCHIOufiHafy SyHjIOHS aSSOCiaICG WiIH 1L uSuay afC
aDSCHI H WOHCH JHG _CHIJ iHCCIiOH iH WOHCH Hay Ha\C
OCCuffCG OH_ DCOfC SySICHC USSCHiHaIOH. 1aICHIS VIIH
fCCIJ aHG jHafyH_Ca COOHi7aIOH O ^t!::tr!0 _0H0rr00t0t
iH IHC SCIIiH_ O 1L afC COHHOHy aSyHjIOHaIC. H a
jaICHIS iH WHOH 1L iS CHCaLy SuSjCCICG fOuIHC CuIufC
O I1C fCCIuH JHG jHJfyHX aS WCL aS IHC DOOG aHG IHC ]OiHIS
iS HGiCaICG.
\H Gia_HOSiS O 1L jfOHjI C\JuaIiOH Of aGGiIOHJ SCXu-
Jy IfaHSHiIICG USCaSCS iHOuUiH_ SyQHibS JHG 11N iS iHU-
CaICG. HjfiC IfCaIHCHI Of I0/0U)0!0 lr0t00U0l!: HCC-
IiOH WiIH GOXyCyCHC aSO SHOuG DC COHSGCfCG DCCauSC
COHCCIOH WIH ^._0H0rr00t0t JHG I. lr0t00U0l!: iS COH
HOH. 1aHCHIS ViIH 1L JfC HCquCHIy aSyHjIOHaHC aG IHS
COHUIOH CaH CauSC HCfIIy i uHIfCaICG. CXua jafIHCfS O
jaIiCHIS VlIH 1L JSO SHOuG DC IfCaICG.
/CyCO\if S JH CHCCI\C IfCaIHCHI Of HCQCS SiHjCX iHCC
IOH. 1OWC\Cf HCQCS SHjCX S HOSI mCy IO CauSC jaH
\CSCuJf aHG CfOS\C USCaSC O IHC _CHIaa HOI jajuCS aHG
HCCfOIC juSIuCS OH IHC CuIaHCOuS SufaCCS aHG HCQCS SH-
jCX S HOI aSSOCaICG VIH a n_faIOfy afIHfIS.
uOfOquHOOHCS SuCH aS CjfOBOXaCH JfC HO OH_Cf fCCOH
HCHGCG Dy IHC \CHICfS Of 1SCaSC \OHIfO aHG 1fC\CHIOH
Of IHC IlCaIHCHI O _OHOffHCa DCCauSC O IHC H_H fCSSIJHCC
faIC. LCHIaHCH iS HOI HUCaICG DCCauSC ^ _0H0rr00t0t S
HOI COHSSICHIy SuSCCjIDC IO IHS a_CHI.
1
SS8mht8d gUhUCUCC h8CtUh my CuS8 fthftS hd
t8hUSyhUvtS hd S Ut8h SSUCt8d Wth SpfS8 p8fph8f
h8CfUtC puStu8S.
DlC_aQHy
cntcrs lcr Oiscisc cntrc| ind Ircvcnticn Ycrkcwski !, Lcrmin
5N. 5cxui||y trinsmittcd dsciscs trcitmcnt guidc|incs 2UU. N
i:ccmm Kcp. 2UU;55(iK11}. INIO: 188812]
lIOH ZZ DSWOt!
LOUCBIODB D[OCIVO! 10gn0rt gtnI0 bttr rm
]tx PrHr njttI0n.
HiS jaICHI HaS IHC CaSSC LHUH_S O jfH1afy _CHiIJ HCfjCS
SHjCX \fuS [1N} iHCCIOH. 1NJ Of 1N2 Hay CauSC
I1C HCCIOH DuI 1N2 S I1C HOfC COHHOH jaIHO_CH.
LCHiIa HCQCS CSiOHS I_CJy DC_H aS \CSCCS IHaI uCCfaIC
aHG JfC quIC ja. HC HIa HCCIOH S OHCH IHC HOSI
SC\CfC aG CaH DC aCCOHjJHCG Dy OCJ yHjHaGCHOjaIHy aHG
SySICHC SyHjIOHS. CCuffCHCCS \afy iH HCquCHCy aHG afC
IyQCay CSS SC\CfC IHaH IHC HIa CjSOGC. aHy fCCuffCHCCS
JfC SuDCHCa DuI afC HOHCIHCCSS COHIa_iOuS. HC Ua_HOSS
O _CHIJ HCQCS S OHCH SuSjCCICG OH CHCa _fOuHGS DuI
Hay DC COHLfHCG Dy \fa CuIufC Of SCfOO_C ICSIH_ IHC
Uia_HOSS S iH GOuDI. Nifa CuIufC Of 1NJ JHG 1N2 S a
fajG ICSI WIH fCSuIS OHCH a\aaDC Dy IHC HCXI Gay. HC
SjCCBCiIy O \fa CuIufC ajjfOaCHCS J7 DuI IHC SCHSH\-
Iy \afCS WIH IHC quaIy O SjCCiHCH HaHGH_ aHG UC a_C O
IHC CSOH [OGCf CfuSICG CSOHS Ha\C OWCf \CG}.
\HaHCfOG iS a fCaH\Cy uHCOHHOH SCXuay IfaHSHIICG OIS-
CaSC CauSCG Dy 10tU0[0!/n: 0ntrt)!. HCCHOH S CHafaCICf7CG
Dy IHC jfCSCHCCS O fa__CG juluCHI ja uCCfS aSSOCiaICG
VIH ICHGCf yHjH HOGCS IHaI Hay SujjufaIC. HC SujCfLCiJ
\CSCCS aHG CfOSOHS O HCfjCS SHjCX VifuS HCCHOH JfC HOI
CaSiy HiSIaKCH Of IHC GCCj fa__CG uCCfS O CHJHCfOG.
HC jDHaly uCCfaH\C CSOH [CHaHCfC} lH jaUCHIS VIH S_|S
GC\COjS ajjfOXHaICy WCC| ahCf HCCUOH OCCufS HaS a CCaH
ajjCafJHCC VlIH HCajCGuj DOfGCn aHG S uSuay jaHCSS aHG
OhCH uHfCCOgi7CG jafUCuafy H WOHCH. uUjC SHa jm
\CSCCS aHG CfOSOHS al_uC SuOH_y a_aiHSI IS Ua_OSiS.
byHj!OH8OVUVOVa_HaCaHUIUia8I8IHCHUCjIHII!H8CX!CDa
aHU IH!CDa CIy!HCHa aHU HOHOUOIOH8 WHI!C CHIUmC Gi8-
CHaI_C.OOjIH|I!u8HaKC8VHVOVagaCaHUIUIa8I8C88HCy
aHUCaHUIUaiHCCHOHUOC8HO!CaH8Cjm_CHI!aHCCI8.
k1Y PO13
ImIy g8hI 8I8S Sm8X vIuS h8CI0h S CICI8I28d by
8v8I, 8dC8, hd hu, uC8II8d, v8SCuI 8S0hS.
DO_aQDy
ICIHIK I LuHu 1IOUC J. JHC !ICu!HCH! O HCIjCS SHjCX HCC
!OHS. uH CVUCHCCUuSCU ICVCV. /ICH 1H!CIH CU. Zo,1o(11].117
11++. 1. 1ob+JoZ
Item Zd Answer:
Educatonal Objectve: Trcat a patcnt wtb pclvr
nmmamry dscasc wtb rcaxcnc and dcxyryrlnc.
Hi8jaHCH!8CHiCaBHGiH_8aICCOHjaHDCW!HjCCHaH-
Ha!OIy Gi8Ca8C [i } aHU 8HC 8HOHU ICCCIVC IH!IaHH8CUaIy
UCIVCICUCCRaXOHCaHUOIaUO C.iI8 aQOyHICIO-
DIaHCHOHO!HCCHUOHC!IIHHOjIaH!uDC8aHUOVaIiC8
UIa_HO8I8 I8 Da8CU OH !HC jIC8CHCC O aDUOHIHa Gi8COHOI!
H!CIIHC OI aUHCXa !CHUCDC88 OI CCIVICa HOHOH !CHUCDC88.
\!HCI UIa_HO8!IC CII!CIIa IHCHUC !CHjCIa!HIC HI_HCI !HaH
^b.^Ì[11.`}CCI\ICaOIVa_HaHHCOQHIHCH!U8CHaI_C
CHKOCyC8IHVa_IHa 8CCICHOH8 aHUUOCHHCH!aHOH O _OHOI
IHCaOICHaHyUIaIHCCHOH.iI8HO8!mCy!OOCCHIW!HIH
Uay8 O!HC OH8C! O HCH8C8. . WOHCH WI!H 8H8jCC!CU i
8HOHUDC!C8!CUOI_OHOIIHCaCHaHyUIaaHUiHCCHOH
aHUu1UCI_OjIC_HaHCy!C8HH_.H8CVCICCa8C8IHa_H_8HOHU
DC jCIOIHCU !O CXCHUC a !HDOO aD8CC88. /HDHa!OIy
jaHCH!8 aIC HCa!CU WI!H CCHaXOHC aHU UOXyCyCIHC W!H OI
WI!HOH! HC!IOHIUaZOC. HIa!IOH O !ICa!HCH! I8 + Uay8.
iaHCH!8W!Hi8HOHUDCHO8jI!aIZCUH!HCICI8 i) HOCiH-
ICaiHjIOVCHCH!aHCI+b!O2HOHOaHHDIOHC8[ 2}aHIHaDi-
I!y!O!OCIa!COIaaHHDIOHC8[ ^}8CVCICmCW!HHaH8CaVOH-
IHH_ OI HI_H CVCI [ +} 8H8jCC!CU IH!Ia aDUOHiHa aD8CC88 [ D}
jIC_HaHCyOI 6) HOHCOHjIaHCCW!H OHqaHCH!!HCIajy.
/UjICIIHaHU_CH!aHICIHUOHO!ICiaDy!ICa!_OHOIIHCaaHU
CHaHyUaIHCC!iOHaHU!HCICOICaICHO!aUCQHa!CaH!iDIO!IC
!HCIajyOIaQaHCH!Wi!Hi./ZI!HIOHyCIHaOHCI88HHCICH!
!ICa!HCH! OI CHaHyUIa IHCC!IOH DH! I8 HO OH_CI ICCOH-
HCHUCUa8IHi!Ia!ICa!HCH!OI_OHOIIHCaiH!C!IOHOWH_!O
!HC HI_H jICVaCHCC O _OHOIIHCa8!IaiH8WI!HUCCICa8CU8H8-
CCj!IDII!y. ICOXI!IH aOHC I8 IH8HHCICH! !ICa!HCH! OI i
aHUCOHDIHa!IOHWI!HOIaUO\CI8ICCOHHCHUCU.
kY PO17
18 II8Im8hI 0I mbuI0Iy I8hIS WI 8vC hmmI0Iy
dS8S8 S hIImuSCuI C8IIX0h8 hd 0I d0XyCyCh8.
DO_aQDy
ICH!CIS OI SCuSC IOH!IO uHU ICVCH!OH (II]. \jUu!C !O II`S
SCXUuy lIuHSH!!CU USCuSCS !ICu!HCH! _UIUCHCS Z. UOIO
QuHOOHCS HO OH_CI ICCOHHCHUCU OI !ICu!HCH! O _OHOCOCCu HCC
HOHS. YOID OI!u Yy Cj. Z7,b(1+].Z. 1.
17+17o
|n!Cc!Ou> O>C>C MCUcnC 11
Item Z Answer:
Educatonal Objectve: Trcat 1DCuOsDs|uOVCCu
pncumcna wtb nmctbcprm-sugamctbcxaclc plus
rcrtrcsnrcds.
HCDC8!IHIHa!ICa!HCH!IC_IHCHOI!H8ja!ICH!I8!IIHC!HO-
jIIH8HaHC!HOXaZOC QH8 COI!ICO8!CIOIU8. 1uruU0t)J/!J
tI0Prt!!jHCu1OHIaICHaIH8!HCHO8!COHHOH.bUC!H-
IH_iHC88aHUCaH8COUCa!HIHja!ICH!8WI!H/b.HCUia_
HO8I8 8HOHU DC COH8IUCICU IH aHy ja!ICH! WI!H a I+ CC
COHH!O C88!HaH2yWHOQIC8CH!8WI!HCVCIUyCOH_H
aHUUy8jHCaUCVCOjIH_OVCI8CVCIaUay8OIWCCK8.HCCHC8!
IaUiO_IajH !yQICay 8HOW8 DIa!CIa IH!CI8!I!Ia IH!J!Ia!C8 DH!
BHUIH_8 CaH VaIy IOH a HOIHa BH !O COH8OIUa!IOH OI a
jHCHHO!HOIaX. HC UIa_HO8I8 I8 C8!aDI8HCU Dy 8IVCI 8!aIH
CXaHiHa!IOH O IHUHCCU 8jH!HH OI a DIOHCHO8COjIC 8aHjC
8HOWIH_CHaIaC!CII8HCCy8!8.1^WCCKCOHI8CO!IiHC!HOjDH-
8HaHC!HOXaZOC I8 !HC 8!aHUaIU !ICa!HCH!. IOI!ICO8!CIOIU8
aICICQHIICUOIjaHCH!8WI!HCViUCHCCO HyQOXIa[aI!CDa1O_
< _ V.^KiaOIaHaVCOaIaI!CIIa_IaGiCH! >^D
_ +. Kia_} aHU8HOHUDCCOH!IHHCUOI!HCCH!iIC COHI8C
O !ICa!HCH!.
aQ8OHC CaH DC aH aUHHC!IVC !ICa!HCH! !O !IIHC!HOjIIH IH
aCH!C 1uruU0t)J/!JtI0Prt!! aHU CaH DC H8CU aOHC a8 a jIO-
QHyaC!iC a_CH! OI Qa!ICH!8 WI!H a I+ COHH! lC88 !HaH
2y IH ja!ICH!8 WHO aIC IH!OCIaH! O !IiHC!HOQIIH-8H-
C!HOXaZOCDH!I!I8HO!ICCOHHCHUCUa88IH_CUIH_!HCI-
aQy OI 1uruU0t)J/!JtI0Prt!!jHCHHOHia.
PO1M3
1Im8I0ImSum8I0X208 uS C0IIC0SI8I0dS S I8 I8
8II8d hI II8Im8hI 0I F8um0Ql|]r0v8O|h8um0h hd
y0X [II8I D_ <1mm dg [9.Jk] 0I h v80III8I
gId8hI >Jbmm dg [4.1k]).
DO_aQDy
Iu!HCIHO! 1 uH!CIHCI , 1OU_HOUX 1 CCu! IOUUCIC |
OI!HOuIy |. nrumcr)s/tsrcvrrttjHCHHOHIu. 1HCC! S IiH OI!H
P. Z1,Z+(1].17o. 1. Z171b+o
Item Z Answer: A
Educatonal Objectve: Prcvd agrcpran prcpby-
lartr tbcrag fcr a patcnt wtb Vnfcrtcn.
HI8 ja!ICH! 8HOHU ICCCIVC !IiHC!HOjIiH8HaHC!HOXaZOC.
CVCIa UIH_8 HaVC DCCH 8HOWH !O jIO\iUC CHCCHVC jIOQHy
aXI8 a_aIH8! OjjOI!HHI8!IC IHCC!IOH8 IH ja!iCH!8 WI!H
iHCC!IOH aHU !O QIOOH_ IC IH 8OHC Qa!iCH!8. HC I+ CC
COHH!I8aHiHUICa!OIO IHHU1CCOHjC!CHCC. CCOHHCHUa-
HOH8IC_mUIH_WHCH!OiHIHa!CjIOjHydI8aICDa8CUOHI+
CC COHH! CVC8. HC !HIC8HOU OI 1uruU0t)J/!J aHU !OXO
Qa8HO8I8 QIOQHyaXI8 I8 2y aHU y IC8QCC!iVCy.
HCjaHCH!8I+CCCOHH!I8 yaHU8HC8HOUUICCCIVC
jIOQHyaXI8OI1uruU0t)J/!J2|UOI!OXOja8HO8I8I HCIaHH-
DOUy !I!CI I8 jO8I!IVC [GCHOH8!Ia!IH_ QICVIOH8 IHCC!IOH DH!
HO! u|}. HHC!HOQIIH8HaHCUOXaZOC I8 !HC BIS!-
iHC a_CH! OIDO!H.
!bZ |n!Cc!lOus OlsCsC MCUlclnC
DZiIHiOHyCiH iS HSCU !Oi jiOjHyaXiS a_aiHSI }(0u0(ltr!HU
0I!HU COHjCX iH jaIiCHIS WIH a l1+ CC COHHI CSS IHaH
Dy. HiS jaIiCHIS \1+ CC COHHI iS HOI aI IHiS IHiCSHOU
aHU IHCiC!OiC jiOjHyaCIiC aZiIHiOHyCiH IHCiajy iS HOI iCC
OHHCHUCU. HCOHaZOC iS HOI iCCOHHCHUCU !Oi IHC jiiHaiy
jiOjHyaXiS O! |0nu!u0 iH!CCIiOHS UCSjiIC iIS CHCCIi\CHCSS iH
IHiS iOC. HC jOICHIia !Oi UiH_ iCSiSIaHCC HHHCiOHS jOICH
Iia UiH_-UiH_ iHICiaCIiOHS IHC CaSC aHU CHCCI\CHCSS O! IiCaI
iH_ iH!CCIiOH VHCH iI UOCS OCCHi aHU aCK O! SHi\i\a DCHCBI
ai_HC a_aiHSI jiOjHyaCIiC HSC. 1SOHiuZiU VOHU DC iHUiCaICU
i! IHC jaIiCHI VCiC hHHU IO Ha\C a jOSiIi\C IHDCiCHiH SKiH ICSI
_iCaICi IHaH D HH aHU a HC_aIi\C CHCSI X-iay CXCHUiH_ aCIi\C
IHDCiCHOSiS. HCiC iS HO iCaSOH IO jiO\iUC jiOjHyaCIiC iSO-
HiaZiU IHCiajy !Oi jaIiCHIS VHO Ha\C HOI DCCH CXjOSCU IO
}(0u0(ltrIHU lHutr(Hl0\!\. DIHOH_H \a_aHCiCO\ii iS CHCC-
H\C iH jiC\CHIiH_ CyIOHC_aO\iiHS [l`} iH!CCIiOH UCCi-
SiOHS iC_aiUiH_ jiOjHyaXiS aiC COHjCX. Na_aHCiCO\ii iS
CXjCHSi\C a IHCOiCIiCa COHCCiH aDOHI IHC UC\COjHCHI O!
UiH_ iCSiSIaHCC CXiSIS iI iS IOXiC IO IHC DOHC HaiiOV aHU IiCaI-
HCHI O! Caiy iH!CCIiOH iS \Ciy CHCCIi\C. iHay HO jiO\CH SHi-
\i\a DCHCBI iS aSSOCiaICU ViIH \` jiOjHyJXiS.
lh 1Ph15 W1h hlV hPL10h, I0h!L1L 1hPI 0I 0um0
Q5l|5,10X0!5m055, h0 MyC00Cl0l|umv|umL0m!PX IP
0P1PImhP0 1hP L4LP!! L0uh1.
DlO_aQDy
fCt_ |f aQan |J man ,JmmanuC fnUCtSOn |J, ÌOnC \,
\CSkC |` LuttCt |` LaaHI |J, I`CUCnC fSSOCaIOn Ol IC
1nlCCIOuS lSCaSCS ÒCCly Ol fmCtCa. 1maty CatC _uUCnCS lOt IC
mana_CmCnI Ol [CtSOnS nlCCICU Wlh uman mmunOUChCCnCy vtuS:
ZV uQUaIC y IC ImCUCHC fSSOCalOn Ol IC 1nlCCIOuS SCaSCS
ÒCCly Ol fmCtCa. LH 1nlCCI S. ZV,+V(}:C1-b1. `1:
1VC+ZZq
lIOH Z DSWOf. b
bOUCBIODB DgOCIVO. LHm|I0Hd Ibt 0ii0tt0It0H
0tttH lttulltHI bt[ti Z0ihl tHjttIt0H 0Hd 1VtHt
It0H.
HIS jaIiCHI HOSI iKCy HaS 1N iH!CCIiOH. CijCS ZOSICi
iH!CCIiOH iS IHC iCaCIi\aIiOH O! IHC \aiiCCa \iiHS iH a SiH_C
CHIaHCOHS HCi\C. CCHiiCHCC O! HCijCS ZOSICi iH!CCIiOH iH IHC
iHHHHOCOHjCICHI HOSI iS HHCOHHOH DHI UOCS OCCHi. YHCH
iCCHiiCHI UiSCaSC iS jiCSCHI IHC HHUCiyiH_ CaHSC iS O\Ci-
VHCHiH_y 1` iH!CCIiOH. 1H I1S jaICHI IHCiC iS a DaHU O!
CiHSIS aHU DiSICiS OH aH CiyIHCHaIOHS DaSC aOH_ a UCi-
HaIOHa UiSIiiDHIiOH OH IHC CH IHOiaX. HCiC iS C\iUCHCC O!
SCaiiiH_ iH a UCiHaIOHC SC\Cia CCHIiHCICiS aDO\C IHC CHi-
iCHIy iH\O\CU SiIC iCjiCSCHUH_ a jiC\OHS HCijCS ZOSICi iHCC-
IiOH. DIHOSI Ha! O! a HCijCS ZOSICi CjiSOUCS Uia_HOSCU iH
jaHCHIS ViH 1` aiC iCCHiiCHCCS. HC aU\CHI O! Hi_Hy aCI\C
aHIiiCIiO\iia IHCiajy HaS HOI CSSCHCU IHC iHCiUCHCC O! iCCHi-
iCHI HCQCS ZOSICi iH!CCIOH iH jaIiCHIS ViIH 1N iH!CCIiOH.
aIiCHIS OH CHCHOIHCiajy aHU jaIiCHIS VHO Ha\C HHUCi_OHC
Oi_aH IiaHSjaHI Hay aSO UC\COj iCCHiiCHI HCQCS ZOSICi.
/ jaICHIS VIH 1` iH!CCIiOH aHU HCQCS ZOSICi iH!CCIiOH aiC
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CSiOHS. OSI jaIiCHIS WU 1 iH!CCIiOH CaH DC IiCaICU ViH
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HiS jaIiCHIS JCOHOiSH iS a iiSK !aCIOi !Oi CiiiHOSiS DHI HOI !Oi
iCCHiiCHI HCQCS ZOSICi iH!CCHOH. D jaHCHI VIH IHCXjaiHCU
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CaSC SHCH UiaDCICS HCiIHS DHI UiaDCICS iS HOI JSSOCiaICU VIH
iCCHiiCHI HCijCS ZOSICi. 1CCaHSC O! H1iS jaHCHIS iHCCHOH UiH_
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iH!CCHOHS iS aSSOCiaICU ViIH iCCHiiCHI HCQCS ZOSICi.
KPLuIIPh1 hPIP5 Z051PI hPL10h 5h0u!0 1IggPI 1P51hg 0I 055
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bOUCBIODB DgOCIVO. 1t0gH0it 0tuh 1VtHjtt
It0H BtIb 1V1^Z vtl0 00d mt0iultmtHI.
HC HOSI ajjiOjiiaIC aUUiHOHa ICSI iS aH 1` DVia OaU
aHU 1` aHIiDOUy HCaSHiCHCHI. HiS jaIiCHIS jiOOH_CU
!CDiiC SyHUiOHC iH IHC SCIIiH_ O!1N DS !aCIOiS SHOHU iaiSC
COHCCiHS !Oi iCCCHI iH!CCIiOH ViIH 1N. 1CICCIiOH O! 1N
D iS IHC HOSI SCHSiIi\C ICSI !Oi UCICCIiH_ 1N iH!CCIiOH
UHiH_ IC aCHIC SyHjIOHaIiC jHaSC. CSIS !Oi 1NSjCCiBC
aHIi_CHS SHCH aS jZ+ CaH aSO UCICCI IHC jiCSCHCC O! \iiHS iH
IHC aCHIC SCIIiH_. DHIiDOUiCS IO 1` UO HOI COHHOHy OCCHi
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ViIH aCHIC 1N iH!CCIiOH OH IHC DaSiS O! aH 1` \iia OaU
HCaSHiCHCHI SHOHU Ha\C COHHiHaIOiy SCiOO_iC aHIiDOUy
ICSHH_ jCi!OiHCU aI a SHDSCQHCHI jOiHI u IiHC.
1H aUUiIiOH IO IHC aCHIC iCIiO\iia SyHUiOHC UiS jaIiCHI HHSI
DC C\aHaICU !Oi SCCOHUaiy SyjHiiS HSiH_ IHC iajiU jaSHa iCa-
_iH ICSI. bCCOHUaiy SyjHiiS aHU aCHIC iCIiO\iia SyHUiOHC
SHOHU aVayS DC COHSiUCiCU iH SCXHay aCIi\C jaIiCHIS ViIH
iaSH !C\Ci aHU _CHCiaiZCU yHjHaUCHOjaIHy. \IHCi CaHSCS O!
a HOHOHHCCOSiS SyHUiOHC [!Oi CXaHjC 1D8ICiH-1aii ViHS
aHU CyIOHC_aO\iiHS iH!CCIiOHS} SHOHU aSO DC COHSiUCiCU i!
IHCSC ICSIS aiC iHCOHCHSi\C.
HC \1+ CC COHHI Hay DC jiO!OHHUy UCjiCSSCU iH jaIiCHIS
ViIH aCHIC 1N iH!CCHOH DuI IC l1+ CC COHHI CaH DC DOIH
iHSCHSiH\C iH IHC Uia_HOSiS O! aCHIC iH!CCIiOH aHU UCjiCSSCU
Dy \aiiOHS OIHCi HOH~1`-1 iH!CCIiOHS a_CHIS.
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IjC iiSK aCIOiS Oi 1N iHCCIiOH. HiIHCiHOiC aCHIC
iHCCIOH WOHG DC GCICCICG WiIH aH CC\aICG 1_ aHIiDOGy
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SjCCiBC aHG iS HOI HSC iH Gia_HOSiS, IHCiCOiC a SKiH DiOjSy
iS HOI iHGiCaICG.
PD IW ________
1RE mEdSUlEmEB 0 NV hNP Vld 0d0 S RE m0S SEBSVE ES
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jyDHCIHaHiHC aHG OHiC aCiG aiC _i\CH iHiIiay. OOWHj
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ajCHIC iCSjOHSC aHCi 1+ GayS SICiCOIaCIC DiaiH DiOjSy iS iCC-
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Iial HCi\OHS SySICH yHjHOHa.
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_iIiS iH jaIiCHIS WiIH D11 WHO IyjiCay jiCSCHI WIH SyHj
IOHS SHCH aS HCaGaCHC iii|IaDiiIy aHG HaHSCa IHaI CaH HiHiC
OIHCi GiSOiGCiS. OSI jaHCHIS Ha\C a \1+ CC COHHI O CSS
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COCCa aHI_CH iH IHC CCiCDiOSjiHa HHiG Oi CHIHiC O Cr)l
tttn n:jrm0n iH IHC CCiCDiOSjiHa HHiG. \iyjIOCOCCa
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aHG a \1+ CC COuI O CSS IHaH D/. yHjIOHS iHCHGC
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LuUCnCS IOt tCvCnIOH anU ItCaImCnI OI OOtIunSIIC IHICCIIOnS n
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lIOH Z D$WOt.
bOUCBIODB DgOCIVO. 1rtPtnl t0lbtr0::0t0d
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JHC HOSI CHCCIi\C Way IO jiC\CHI CaIHCICiaSSOCiaICG HiiHaiy
IiaCI iHCCIiOHS [1JS} iS IO GCCiCaSC CaIHCICi HSC. 1C\iCCS
SHOHG DC HSCG Oi SjCCiBC iHGCaIOHS HOI Oi COH\CHiCHCC
aHG SHOHG DC iCHO\CG aS SOOH aS jOSSiDC. XaHjCS O
ajjiOjiiaIC HSC iHCHGC Gia_HOSiH_ jaIHOO_C BHGiH_S iH IHC
OWCi HiiHaiy IiaCI Oi IHC CaHSC O HiiHaiy iCICHIiOH HOHi-
IOiiH_ HHiG SIaIHS iH aCHICy i jaIiCHIS WHCH IHiS GiiCCIy
iHjaCIS HCGiCa IiCaIHCHI aHG HaHa_H_ jaIiCHIS WiIH SIa_C
o Oi + jiCSSHiC HCCiS OH IHC DHIIOCKS. OWC\Ci HiiHaiy
CaIHCICiS OHCH aiC HSCG Oi COH\CHCHCC WHCH Si_HCaH!y
iHCiCaSCS IHC iiSK Oi 1JS. 1 IHC CaIHCICi iS HCCGCG HCaSHiCS
aiC iCQHiiCG IO GCCiCaSC IHC HSK O DaCICiHia aHG SHDSCQHCHI
iH!CIiOH. JHCSC iHCHGC HaHGWaSHiH_ HSiH_ aH aSCjIC ICCH-
HiQHC aHG SICDC CQHijHCHI Oi CaIHCICi HSCiIiOH aHG CaiC
SCCHHH_ !HC CaIHCICi jiOjCiy HaiHIaiHiH_ HHODSI!HCICG HDHC
HOW aHG COSCG SICiiC GiaiHa_C aHG COHSiGCiiH_ HSC O
aHIiDaCICiiaCOaICG CaIHCICiS. aHijHaIiOH aHG iiii_aIiOH
SHOHG DC HiHiHiZCG. jCCiHCHS SHOHG DC COCCICG HSiH_
!HC GiaHa_C Da_ \a\C. DHIDiOICS SHOHG HOI DC HSCG aS jiO
jHyJS Oi !HC jiC\CHHOH O 1JS DCCaHSC SHCH HSC jiOHOICS
aHHDiOIC iCSiSIaHCC.
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aICU uHHat\ ItaCI HICCIOnS n aCuIC CatC OSIaS. iHICCI \OHI!O IOS
UCmO. zo;zV[Su):5+1D. ii1: 1oo+oo
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Item d Answer:
Educational Ob]ective: 1ltPtHl PtHlt0l00tt0d
[HtDm0Ht0 Htlb tmttlttl [0tlt0HtHg.
bCHCiCCIjO8IOHV HO8IiKCyiCUHCCIHCi8KO\CHIa
IOia88OCaICUjHCHHOHa \A).\CHWHCHaCHHCUIHDC8
H jaCCDaCICiaBOH IHC 8IOHaCH CaH iCaCH IHC HH_8 aHU
CaH8CjHCHHOHa.bCHCiCCIjO8IOHH_HDCUaI+b`8H8C
DCCaH8CIiCUHCC8IHCiI8KOCXCHi8OHODaCICDaBOHIHC
8IOHaCHHIO IHCHjjCiaiWay8.
\HaH_H_CHUOIiaCHCaIHDC88CCH8O_CaDHIiCHIUDaIOH
8 a88OCaICU WIH CCiIaH i8K8 |Oi CXaHjC HIHDaIH_ IHC
C8OjHa_H8 Oi jiCCjIaIH_ HyjOXa UHiH_ IHC jiOCCUHiC}.
CHIHDaIOH Hay a8OHCiCa8CIHC i8K OHO8OCOHa jHCH-
HOHa.\aiCH8jCCIOHaHUHaHa_CHCHIOIHCIUDH_CaH
HCj iCUUCC HCCIIOH8 8_HIy. CCaH8C IHC IHDH_ Ha8 a ICH-
UCHCy IO COCCIWaICi CaiC UiaHa_C O aCCHHHaICU COH
UCH8aICHIOjaICHI8jCCCUIaHa_CCOHIaIHCi88aU\OCaICU.
\iajaCCHCHIOCHUOIiaCHCaIUDC88CHiiCHIyDCC\CUIO
DC8HjCiOiIOHa8ajaCCHCHIDCCaH8CHa8O_a8IiC aHUHa8O-
IiaCHCa IHDC8 CaH8C 8OHC UC_iCC O OD8IIHCIOH O IHC O8Ia
H IHC HO8C WHCH CaH jiCU8jO8C IO HO8OCOHa 8HH8I8.
YHCIHCi Ha8a IHDC8 8HOHU DC iCjaCCU Dy Oia IUDC8 8
HHCCaI. OWC\CiHODCHCBIVDC_aHCUDyCHaH_H_BOH
aHOiOIiaCHCaIHDCIOaHa8OIiaCHCaIHDCIOjiC\CHIaCa8CO
HCaIHCaiCa88OCaICUjHCHHOHa.
CUHCH_ IHC UCH8Iy O _a8IiC DaCICia Dy H8C O jiOjHyaC
IC aHIIDOIC8 8 ICHjIH_. OWC\Ci IH8 ajjiOaCH 8HCHCC
I\C aHU 8Ci\C8 IO8CCCIOiiC88IaHI 8IiaH8.

b8m-8f8cIp0SI0hhgf8duc8SIh8fSk0lv8hII0fSS0cI8d
ph8um0h.
Bibliogaphy
aiSaHI YOCIC !.HlCCIiOH iCvCHIOH mIC HICHSvC CaiC uHiI.
HlCCI S H OiI ^. ZVZ(}.Zb. i. 1VbV1]
Item d3 Answer:
Educational Objectve: Lt 00llttl [ltt0Dlt0H 0H0
00[ 0H0 H0Hl j0l b0H0 bygt0Ht [ltP0Hl lbt [l000 0j
CIosnidimdimciIctHjttlt0H.
HCHO8ICHCCII\CDHHUCUHCa8HiC8IOjiC\CHIIHC8jiCaUO
C/osntdtumdg tt/:HCCIOHaiCDaiiCijiCCaHIOH8aHU8Oaj
aHU WaICi Oi HaHU CCaHH_. H\iOHHCHIa COHIaHHaIOH
WI1 \C_CIaII\C C. dg tt/:aHU C. dt[tt/:8jOiC8 BCqHCHIy
OCCHi8. C.dg tt/:8IiaH8HIICUIOOIHCijaICHI8IHiOH_HIHC
HaHU8 aHUCOIHC8 O HCaIH CaiC WOiKCi8 aHU BOH COHHOH
CqHjHCHI IHaI 8H8CUOH jaICHI8 WIHOHICCaHH_. 1COH-
DHaIOH O HICi\CHIOH8 DHHUCU IO_CIHCi Ha\C DCCH
8HOWH IO DC CCCI\C aI iCUHCH_ HaHy HO8jIaaCqHiCU
HCCIOH8. HC H8C O a C. dtgtt/:DHHUCCOH88IIH_ O Dai
iCi jiCCaHIOH8 CHHaHCCUCCaHH_ WIH DCaCH aHU IiaU
UOHa8OajaHUWaICiHaHUHy_CHC8H8CHjiC\CHIH_IHC
8jiCaU O C. d;[tt/:. bOaj aHU WaICi aIC HOI 8jOiCUa DHI
IHC HCCHaHC8 O HaHU Wa8HH_ CHCCI\Cy iCHO\C8 8jOiC8.
/COHODa8CUHaHU Hy_CHCjiOUHCI8UO HOI K 8jOiC8 aHU
aiCHCHCCI\CaI iCHOVH_IHCHBOHHaHU8.
aiiCi jiCCaHIOH8 8HCH a8 WCaiH_ HOH8ICiC _O\C8 aHU a
_OWH aHU H8H_ UCUCaICU CqHjHCHI Ha\C DCCH iCCOH
HCHUCU Oi C. dt[tt/:COHIiO Dy IHC \CHICi8 Oi 8Ca8C
\OHIiOaHUiC\CHIIOHaHUHa\CDCCH8HOWHIODCCHCCI\C.
1IiDOiHC jiCCaHIOH8 aiC iCCOHHCHUCU Oi jaICHI8 WIH
KHOWHOi8H8jCCICUH HC88C8IIaH8HIICUDy aiDOiHC UiOjCI
HHCC8HCHa8IUDCiCHO88HCa8C8\aiCCaOiU88CHHaICU
\aiCCa ZO8ICi \IH8 HCCIOH. aICHI8 HH8I DC 8OaICU H a
ji\aICiOOHWIHHC_aI\CaijiC88HiCIHCUOOiHH8IiCHaH
CO8CU aHU CHICiH_ jCi8OH8 HH8I WCai Ha8K8 WIH a B
ICiH_CajaCIyOb7.iaH8jOiICUjaUCHI8HH8IWCaiHa8K8.
iOjCI jiCCaHIOH8 aiC iCCOHHCHUCU Oi jaICHI8 WIH
KHOWH Oi 8H8jCCICU HC88C8 IiaH8HIICU Dy ai_CjaiICC
UiOjCI8 8HCH a8 N:tss:rta m:ntntttdts HCCIOH8 aHU
HH HCHZa.aICHI8aiC8OaICUHji\aICiOOH8aHUHO8jIa
jCi8OCWCaIaCCHa8K8WHCH WI1H o CCI OIHC jaUCHI.
L/05lt/0/0m 0//O/8buhd8c0hSSIhg0lbff8fpf8cuI0hS,
8hhhc8dc8hhgWIhb8ch,hdIfdI0hS0phdWI8f
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Bibliogaphy
1CSSCH J. H IHC CHiC. OSIiUuH UHCC HICCIOH. P HICiH
CU. Z11b(}.J+1-1b Qu2 J+1. i. ZVZ1b+]
Item d Answer: A
Educatonal Objectve: 1HltlD tHjttlt0Ht0H0
mt0Dlt tH 0 [0lttHl Htlb Ncisscriamcmgndis
mtHtHgtlt.
HCHO8IajjiOjDaICHCXI8ICj8IHCH8COaaCCHa8K. H8
jaICHI Ha8 N:tss:rta m:ntntttdtsHCHH_I8. iOjCI jiC
CaHIOH8 8HOHU DC HUaICU WHCH IH8 Ua_HO88 8 8H8jCCICU
aHUiCqHiCIHaIHCaIHCaiCWOiKCi8WIHHCIO iCCIOIHC
HUCXjaICHIWCaIaaCCHa8K.1jjiOjiaICHCCIIOH COHIIO
HCa8HiC8 Oi jaIICHI8 HCHUC HaHU Hy_CHC aHU 8IaHUaiU
jiCCaHIIOH8.
HC HHHaH Ha8OjHaiyHX 8 IHC OHy KHOWH iC8Ci\Oi Oi
HCm_OCOCCaHCHH_II8.CHH_OCOCCaiC8jiCaUBOHjCi
8OH IO jCi8OH Dy iC8jiaIOiy UiOjCI8 O HCCICU Ha8OjHai\H
_Ca 8CCiCUOH8. Ci8OH8WIH8CaHI CXjO8HiC IO IHC iHUCX
jaUCHI| 8aL1CHOH8CHOUUayCaiCCCHICiOiaHyOHCWIHUiCCI
COHIaCI WIHajaUCHI8Oia8CCiCUOH8}8HOHUiCCC\CCHCHO
jiOjHyaX8WIHajjiOjiaICaHUDOUC8. b_mCaHIHCaIHCaiC
CXjO8HiCHCUUC8jCi8OmCWIHjOICHUaOiHUHaICCOHIaCI
|WIHH o CCI}O IHCjaUCHI8 iC8jiaIOiy 8CCiCUOH8.
Oi HCCIIOH 8jiCaU Dy UiCCI COHIaCI WIH IHC jaICHI |Oi
CXaHjC \aHCOHyCHiC88IaHI CHICiOCOCC} aUUUOHa HRC
UOH COHIiOHCa8HiC8iHCHUCjaUCHIjaCCHCHIHIOaji\aIC
iOOHOiWiIHIHO8CWHOHJ\CJ8iHiJiHCCHOHJHGIHCH8CO
HOH8ICiiC _O\C8 JHG _OWH8 OiGiiCCI COHIJCIVIH IHCjJHCHI
Oi JHy iHCCIi\C HJICiiJ. /iiDOiHC iHCCIiOH jiCCJHIiOH8 aiC
JjjiOjiiJICOiiHC88C8IiJH8HIICGDyJiiDODCGiOjCIHHCCi
[Oi CXaHjC IHDCiCuO8i8 HCJ8C8 JHG \JHCCJ}. 1GGiHOHJ
iHCCIiOH COHIiO HCJ8HiC8 iHCHGC jJCCHCHI iHIO J jii\JIC
iOOHIyQiCJyHJjiC88HiCHC_JH\CiOOHJHG8jCCiJHJ8K8
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lC8mSklUfCUS8CUhICIWIhhl8CIUuSpI8hIShddUhIh8
mSkUhfUUm8hIfy,f8hdCI8dWh8hm8hhgUCUCCm8hhgIS
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HC HO8I iHjOiIJHIiHCCIiOH COHIiO HCJ8HiC i8 IHC iH8IiIH-
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iHGHiJIiOHHOI IHC CiyIHCHJiC8HIiH_ WiIHiH IO /2
HOHi8i8IHCHHCJ8HiCG.NJHOH8CHIOH \JHC8 JiC H8CGDJ8CG
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IHjCCIiOHGiH_H8Ci8iC8iGCHI8OiCHjOyCC8OHi_Hii8KCOH
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HOHIH8 O IHiCC IO OHiGiH_ IHCiJjy [i8OHiJZiG iiJHjiH
jyiJZiHJHGCJHG CIHJHDHIO}. Hi8IHCiJjyWOHGDCiHJj
jiOjiiJICi IHC jJIiCHIHJ8 J HOiHJCHC8I iJGiO_iJjHaHGHO
8yHjIOH8O JCIi\C iHCCIiOH.
iCJIHCHIO JICHIIHDCiCHO8i8iHCCHOH 8HD8IJHHJyiCGHCC8
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Item d Answer: A
Educational Ob]ective: Jgn0:t hnI Iu0trtu0::
n ItnI nb0 rtttPtd 0tt fmtHLutrn
(DfL) PttnI0n.
HiS jaIiCHI SHOUU iCCCi\C a CHCSI iaUiO_iajH. bHC iCCCi\CU
DaCiC LaHCIIC-LUCiiH |LL} \aCCiHaIiOH iH /iCa HOiC
IHaH20 yCaiSa_O. CCCijIOIHiS\aCCiHaIiOHSHOUUHOIiHBU-
CHCC iHICqiCIaIiOH O IHC IUDCiCuiH SKiH ICSI. LL \aCCiHa-
UOHiSUSCUiHHaHyCOUHHiCSWiIHaHi_HjiC\aCHCCOIUDCi-
CUOSiS IO jiC\CHI CHiUHOOU IUDCiCUOUS HCHiH_iIiS aHU
HiiaiyUlSCaSC. UDCiCUiHiCaCIi\IyCaUSCUDyLL\aCCiHa-
LiOH VaHCS ViLH IHC jaSSa_C O IiHC aHU iS u IO jCiSiSI
HOiC IHaH 10 yCaiS aHCi \aCCiHaIiOH iH IHC aDSCHCC O
)t0uut|t/IHU |Hut/tH/0:I:iHCCIiOH IHCiCOiC IUDCiCUiH
SKiHICSIiH_iCaCIiOHSiH jCiSOHS\aCCiHaICUViIHLLSHOUU
DC iHICqiCICU USiH_ IHC SaHC CiiICiia aS USCU iH IHOSC VHO
Ha\C HOI iCCCi\CU IHC \aCCiHC. HS jaIiCHIS IUDCiCUhH SKiH
ICSIiH_iCSUISHOUUDC iHICijiCICU aSjOSiIi\C 1 HH} aHU
iS iHUiCaIi\C O aICHI Oi aCIi\CIUDCiCUOSiSIHCCIiOH. LOHSC-
qUCHIySHC SHOUU iCCCi\C a CHCSI iaUiO_iajHIO CXCUUC IHC
jiCSCHCCO aCIi\CIUDCiCuOUSUiSCaSC. iaUiO_iajHiCiCSUIS
aiC HC_aIi\C IiCaIHCHI Oi aICHI IUDCiCUOSiS iHCCIiOH COH-
SiSIiH_ O iSOHiaZiU IHCiajy SHOUU DC ii1IiaICU. ìIaHii1 _
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OjaIiCHLSLiCaICU ViIHiSOHaZiUV UC\COjjCiijHCiaHCU-
iOjaIHyIHaIiSjiC\CHIaDCWiIHSUjjCHCHIajyiiUOXHCIHCi-
ajy. bUjjCHCHIajyUOXi!1CiSCSjCCiayiHjOiIaHLii1jaUCHIS
aIHi_HiiSKOiHCUiOjaIHy |IHOSCWiIHUiaDCICS UiCHiaaCO-
HOiSH HaHUIiiIiOH ` iHCCIiOH jiC_HaH Oi SCiZUiC
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CUOSiS iS HOI iHUiCaICU iH IHiS jaIiCHI.
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IHC iiSK IHaI IUDCiCUOSiS iH!CCIiOH V jiO_iCSS IO aCU\C UiS-
CaSC IHCiCOiC jiO\iUil1_ HO aUUiIiOHa C\aUaIiOHOiIHCiajy
VOUUHOIDCajjiOjiiaIC. aIiCHISCXjOSCUIOIUDCiCUOSiSiH
IHC UiSIaHI jaSI Hay Ha\C aH iHiIia HC_aIi\C SKiH ICSI jCi-
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ICSIiH_OHCH DOOSIS a HC_aIi\CICSI iCSUI IOjOSiLi\CaS IHC
iHHUHCSySICHiCCaSiISjiC\iOUSCXjOSUiC IHUSUi\U_iH_a
I!UC-jOSiU\CiCSUI.VO-SICjICSIiH_HayDCjaiIiCUaiyHCj-
ii1OUCijCiSOHSaHUiHUiSIiH_UiS_HCVOHOUCXjO-
SUiCS iH aHHUa CHjOyCC-ICSIiH_ jiO_iaHS. CCaUSC IHiS
jaIiCHIHaSajOSiIi\CIUDCiCul1SKiHICSIiCjCaIiH_l1CIUDCi-
CUl1SK ICSIiS UHCCCSSaiy aHUV HOI aICiHaHa_CHCHI.

1u0ICu Sk ISIg IdCI0S l IS0S W0 ICVd I
0dC LdmIIuI [bL] VdCC S0ud 0 IIIId uSg
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2V1O(JJ}:i1-1+ QUiZ iJ1. iialHn m:P iHlciH TcG.
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Item d Answer: L
Educational Ob]ective: 1|r0ITyCOD8CIctU
IDDctCuOSS njttI0n nIb j0urdrug Ibtry.
HC uiIia IiCaIHCHI O IHiS jaIiCHI ViIH aCIi\C IUDCiCUOSiS
HUSIii1UUCOUiaHIiIUDCiCUOUS UiU_S. CCaUSCO iHCiCaS-
i1_COHCCiHSOUiU_iCSiSIaHCC ajaIiCHISWiIHSUSjCCICUOi
COHtHCUIUDCiCUOSiSaiCI!CaICUVI1Oui-U!U_IHCiajyVIH
IHC iSI-iHC a_CHIS iSOHIaZiU iiaHjiH jyiaZiHaHiUC aHU
CIHaHDUIOOi2 HOHIHSOOVCUDyUC-CSCaaUOHOaHHi-
CiODia IHCiajy OHCC UiU_ SUSCCjIiDiiIy O iSOHiaZiU aHU
iiaHjiHiSCSIaDiSHCU. HCSCa_CHISaiCIHCHCOHIiHUCUOi7
HOHIHS IOIJ_ aV-HOHIHIiCaIHCHICOUiSC.
aICHIIUDCiCUOSiS|jOSiIi\CHDCiCUJ1SKiHICSIiCSUIDUIHO
C\iUCHCC O aCIi\C UiSCaSC} CaH DC IiCaICU ViIH a VHOHIH
COUiSC OiSOHiaZiU. OVC\Ci IHiS jaIiCHI HaS SyHjIOHS aH
aDHOiHa CHCSI iaUO_iajH aHU a jOSiIi\C SjUIUH SIaiH Oi
aCiU-aSIOi_aHiSHSCXCUUiH_aICHIIUDCiCuOSiS.HiCC-UU_
I1CiajyViIHiSOHiaZiUjyiaZiHaHiUCaHUCIHaH1DUIOiSiHSU-
BCiCHIIHCtajyOijOICHUayUiU_-iCSiSImIHDCiCuOSiS.HCi-
ajy CaHHOI DC UCayCU UHIi a UC1Ii\C Uia_HOSiS OIUDCiCU-
OSiS iS HaUC DCCaUSC IHiS Hay IaKC VCCKS aHU IHC iHCIiOH
COUU VOiSCHOi SjiCaUIOOI1CijCiSOHS iH IHC iHICiiH.

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uSd Id.
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8CaaHlc i. iH lHc CiHiC. HDciCUO8i8. DHH iHlciH TcG.
2V1O:i1-1+ QUiZ iN1. iialUn iH: ^ iHlciH TcG.
2V1O1:2V2. _iTi: 1V+_
Item d Answer: A
Educational Ob]ective: 1rtI hnI Iu0trtu0:: n
n mmun0:u_rt::td ItnI.
SOHiaZiU IHCiajy Oi V HOHIHS iS iCCOHHCHUCU Oi IHiS
jaIiCHI aHU jyiiUOXii1C |\iIam _} iS I_iCay aUUCU IO jiC-
\CHIiSOHaZiUiHUUCCUjCiijHCiaHCUiOjaIHy. HiSjaHCHIVaS
SCiCCHCU Oi IUDCiCUOSiS DCCaUSC O COHCCiHS iC_aiUiH_
iHHHHOSUjjiCSSiOH UUC IO HCi UiSCaSC aHU HCi iHjCHUiH_
IHCiajy ViIH jiCUHiSOHC. aHUIiiIiOH iHHUHOSUjjiCSSCU
8IaIC8 aHU 8IiC88 aiC i8K aCIOi8 Oi jiHaiy jiO_iC88OH Oi
iCaCI\aIOH O qUC8CCHI IUDCiCUO8i8. NaiOU8 CUIO \aUC8
aiCU8CUDa8CUOHIHCaHCHI8i8K8IaIU8IOHCiCa8CIHC8jCCi-
BCiIyOIUDCiCUiH8HIC8IiC8UI8.HiCCCUI-OHI8Ha\CDCCH
UCBHCUOiaO8iI\C IUDCiCUiH iCaCIiOH:HH1!HHaHU
1HHO iHUUiaIOH./HUUiaIOHOHHOiHOiC8COH-
8UCiCUO8I\CHCi8OH8aIH_HC8Iii8KOUC\COiH_aCIi\C
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aIiCHI8 Ci8OH8 WIH CO8C COHIaCI VIHaHyOHCWiIH aCI\C
IuDCiCUO88OiIHO8CWiIHaCHC8IiaUO_iaHCOH8i8ICHIWIH
jiiOi IUDCiCUO88}. Hi8 jaIiCHI 8 HHUHO8UjjiC88CU aHU
IHC-HH IHiC8HOUOiiHIaIH_ IHCiay OiaICHI IUDCiCU-
O88 aC8 IOHCi. iH aUUIiOH IHC1HCiiCaHHOiaCiCbOCi-
CIy iCCOHHCHU8 IHaI aICHI8 WHO U8C iCUH8OHC [21
H_/ U}OiaHyOIHCiiHHUHO8UiC88i\Ca_CHIaHUWHOHa\C
a HHOiai_CiaiCaOHUUiaIiOHOHIuDCiCUiH8KHIC8IH_
DC_iH jiOjHyaCIC IHCiajy WiIH8OHiaZiU.
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8OH8WHOHa\CiHH_iaICUIOIHC\HICUbIaIC8BOHHi_HH8K
COUHIHC8 WIHH IHC a8I yCai8, HCCIOH UiU_ U8Ci8, ji8-
OHCi8,HCaIHCaiCWOiKCi8,aHUaICHI8WiIHSiCO88UiaDCIC8
HCiIU8 CHiOHC iCHa aUiC CUKCHa Oi yHHOHa CaiCi-
HOHa O IHC HCaU Oi HCCK Oi UH_ iCCCHI 8_HiBCaHI WCi_HI
O88OiaH8IOiyO_a8IiCCIOHyOiCUHOCaDya88.1CaIHy
aUOC8CCHI8WHOaiC CXO8CU IO aUUI8iHHi_H-H8KCaIC_OiiC8
8HOUU a8O DC 8CiCCHCU U8H_ IHi8 1!-HH CUI-OI 1 CUI-OH
jOiHI O1HH8 U8CUOiJ OW-ii8KjCi8OH8.
CCaU8C IHi8 jaIiCHI Ha8 HO C\UCHCC O aCIi\C IUDCiCUO88
OUi-UiU_ IiCaIHCHI Oi 1 yCai 8 HOI HCCUCU. HC U8C O
HaHjHOiIHCIiCaIHCHIO aICHIIUDCiCUO88Ha8 HOIDCCH
CXICH8\Cy 8IUUCU. iaHH Oi o HOHIH8 8CCH8 IO DC a8
CCCI\C a8 OH_Ci IiCaIHCHI WiIH 8OHiaZiU, OHC HOHIH O
DjH IHCiajy 8 iH8UDCCHI. IO aHIIUDCiCUOU8 IHCiajy
jaCC8 IHC jaIiCHI aI i8K OiiCaCI\aIOHIuDCiCUO88 DCCaU8C
O HCiHHUHO8UiC88CU8IaICaHUWOUUHOIDCaiOHaIC.
PO1WT
l0ydCIC S0d20 I6ldy S 066Cd dI6IS W0 uS6
l60S06 [<1b mg/0] 0l dy 0I6l mmu0Sul6SSV6 dg6I d0
W0 dV6 b mm 0l m0l6 0 0uldI0 0 Iu06lCu Sk I6SIg.
bhO_aQHy
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ZVJb.\J-J+ qUiZ NJ. !!!J!UH iH. /HH H!C!H CU.
ZVJbJ.ZVZ. _1. JV+oo
|tem Answer:
ducationaI objective: 1rtJI JhnI Iutrtu0rr uIb
r0nJzd ]r0r Ibt JdmnrJI0n 0j J Ium0r nttr0rr
jJtr U (1} nbr
HCHO8I ajjiOjHaICHCXI8ICHIH8aICHI8HaHa_CHCHI
8IOHiIaIC8OHiaZiU. bCiCCHiH_OiaICHIIUDCiCUO8i88HU-
CaICU H jaHCHI8 jHOi IO 8OU Oi_aH IiJH8aHI HiIiaIOH O
CHeHOIHCiayOiIUHOiHCCiO88aCIOiU[`1 -U}HHDiIOi8
Oi IHCiC8cHCCOOIHCiHaOiiUuUHOCOHiOui8iH_COH
|nIec!Ous Dsease Nedcne 187
UHOH8. 1U\Ci8C CHCCI8 O I-U HHDIOi8 HCUUC IHC H8K
Oi8CiOU8HCCIOH. imaDaUaH1H1 aDJHUCIaHCiCCI
aiC a88OCiaICU WIH aH HCiCaSCU HCUCHCC O iCaCI\aIOH
IUDCiCUO8i8aiHCUaiyCXIiajUHOHaiyIuDCiCUO8i8.HCiC-
OiC a jaIiCHI8 DCH_ COH8UCiCU Oi 8UCH IHCiajy 8HOUU
UHUCi_O 8CiCCHH_ Oi aICHI IUDCiCUO8i8 iHCCIiOH WHiCH
HCUUC8a HCUiCaHi8IOiyHy8iCaCXaUiHaHOHaHUIuDCi-
CUiH8KiHIC8IiH_ WiIH UiiBCU iOICH UCi\aI\C [1} OiaH
iHICiCiOH[iCCa8Ca88ay. i 8CiCCHiH_ i8 jO8iI\C ajjiOiaIC
IiCaIHCHIOiaICHIIUDCiCUO8i8i8iHUiCaICUDCOiCDC__
IHCiayWIHa`-UiHHiDiIOi. Hc\cHICiSOi1i8CJ8C\OH-
IiO aHUiC\CHIOHiCCOHHCHUIiCaIHCHIO aICHI IUDCiCU-
O8i8 iHCCIiOH Oi a aIiCHI8 aHHH_ IO IaKC a I1-U
iHHiDIOiWHOHa\Ca1iC8UIOHHOi HOiCOH UUia-
HOHOi ajO8H\CHICiCiOH-[iCCa8Ca88ay. HCiCOiCIHCHO8I
aiOHaICIiCaIHCHIOiHjaHCHIi8i8OHaZiUOiVHOHIH8.
1IHOU_H IHC HO8I aiOiiaIC UUiaIOH O IiCaIHCHI WiIH
i8OHiaZiU DCOiC DC_iHHiH_ iHXiHaD 8 UHKHOWH HO8I
CXCiI8 iCCOHHCHU aI Ca8I HOHIH8 O i8OHaZU IHCiay
DCOiCHiIiaIiH_ a`1-U iHHiDiIOi.
1OUi-UiU_ aHIiIUDCiCUOU8 IHCiajy i8 iHUiCaICU Oi aCIi\C
IUDCiCUO88WHCHajaHCHI8UiU_iC88IaHCC8IaIU8i8UHKHOWH
DUI8HOI aiOiaICOiIH8aICHIWHOHa8HOC\iUCHCCO
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bCjIC juHOHaiy CHDO afC COHHOH H IfCuSjU CHUO-
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IHM DSWt.
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/SO SujjOfIH_ IHC Ua_HOSS afC IHC jfCSCHCC O a DCuSjU
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H IHC JDSCHCC O jCHCiiH JCi_y OI jCHiCiiH iCSiSIJHCC \JH
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SCHiSyHIHCIiC jCHiCiiHS SHCH JS OXJCiiH Oi IO IHC
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iGCHH IHC CJHSJIi\C GCCjDOHC jJIHO_CHS HJy CJG IO SjiCJG
O iHCCIiOH IO JGJCCHI DOHCS Oi SOH IiSSHCS JHG IHC HCCG Oi
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HiS jJIiCHI JjjCJiS WC CHOH_H IO WJiI Oi IHC DOHC DiOjSy
IO DC COHjCICG DCOiC SIJiU_ CHjiiiC JHHDiOHC IHCiJjy JHG
JGHSHH_ IC JHHDiOHCS DJSCG OH CHIUiC iCSHIS. HjuC IHCi-
Jjy SHOHG iHCHGC JCI\iIy J_JuSI SIiCjIOCOCCi HCIHCiiH-
iCSiSIJHI. 1nr|n{iP), JCiODiC _iJHHC_JH\C DJCii JHG
JHJCiODCS. HCiJjy ViIH iHjCHCH JOHC W HOI JGCQUJICy
CO\Ci iP, \JHCOHyCH JHG CCHJZGiHC WHOI JGCQUJICy
CO\Ci JHJCiODiC DJCICiJ JHG \JHCOHyCiH JHG HCIiOHiGJZOC
W HOI JGCQHJICy CO\Ci _iJHHC_JIi\C Oi_JHiSHS.

LUIUIS 0DI0 I0m SuS IICI 0I UCI DS 0I 00 0I
ICI I DCII I00gy 0 U0Iyg 0SI0myIS, D0
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Item b Answer:
Educational Objective: tvaluau a patcnt wtb vcr-
ubral crucmycltr wtb a rpnc .
HC nCXIHJJ_CHCnISICjk O lC UmDJiSjinC.NCiIC-
DiJOSICOHyCiUS iS J iUCCUOn O IC SjiC IJI HUSI DC COn-
SiUCiCUiJyjJUCnIWilnCV-OnSCIDJCkjJ|nJUC\Ci.JUCnL
VIJCuICCHJIO_CnOuSOSICOHyCiUSJiCmOiC|kCyIOjiCSCnI
WiI JCUIC jin JnU !C\Ci IJn JiC jJUCnIS VI CHiOniC COn-
Ii_UOUS OSICOHyC|!IiS [Oi CXJHjC OOI UCCiJSSOCiJICU
OSICOmyCliU}.nJUULCHJIO_COuSOSICOHyC|iUSHOSIOHCn
in\O\CSHCinICiVCilCDiJUiSkSjJCCJUIvOJU|JCCnI\CilCDiJC.
OICnUJ SOuCCS O HCHJIO_CnOUS |HCCUOn inCUUC IC _Cni-
IOUHnJiy IiJCI [jJiUCUJiy OOWin_ inSIiUHCnIJIiOn} Skin
[|H|CCUOnUiu_\) HCICU |nUJ\JSCuJiUC\iCCS[OiCXHjC
JCCnUJ\CnOUSCJlCICi}JUCnUOCJiU|USDUIOHCnICSOUiCC
OICiCCUOnCJ|LOIDCiUCnmCU. HjJUCnISWiICmJIO_C-
nOUS OSICOHyC|US IC CUKOCyIC COmIiS |jiCJy nOiHJ DUI
lCCiiOCyIC SCUiHCnIJUOn iJIC iSCC\JICUi IO O
jJUCnISJUiSOHCn_CJICiIJ Hm/.
iS lC HOSI JjjiOjiiJICiHJ_n_ SIuUy Oi jJIiCnIS WiIH
SUSjCCICU\CiICDiJOSICOHyCiliSJnUiSJHOiCSCnSiIi\CSlUUy
IHJn SCJnS Oi jJin iJUiO_iJjHS. n JUUiIiOn CJn
UCICCI JnCjiUUiJ JDSCCSS Oi J jJiJ\CiICDiJ Oi jSOJS JDSCCSS
IHJI HJy iCQUiiC SUi_iCJ UiJinJ_C. CJnnOI DC jCi-
OiHCU [Oi CXJHjC in jJIiCnIS ViIH jJCCHJkCiS Oi HCIJ
jiOSIHCIiC UC\iCCS} Oi i iCSUIS JiC inCOnCUSi\C J _JiUH
nUCCJiSIUUy iS \CiySCnSiIi\CJnU SjCCmCinliSSCIIin_.
HiCC-jHJSCDOnC SCinI_iJjHyUSin_ JDCCU ICCHnCIiUH CJn
OCCJSiOnJy DC Cj! in UiJ_nOSin_ OSICOHyCiIiS DUI iI iS
JSSOCiJICU ViIH JSC-jOSiIi\C iCSUIS in jJIiCnIS ViI OIHCi
CJUSCS O DJCk jJ|HinCUUin_ HJCIuiC JS VC JS JSC-nC_J
li\C iCSUIS i IHC inCCI|OniSCJiy. HiCC-jHJSC DOnC SCinli_-
iJjHyiSJninRiiOiUiJ_nOSIiCICSICOHjJiCUIOSCJnH!n_
DUI mJy DC JjjiOjiiJIC VHC IHC U!IiJ iHJ_n_ iCSUI
iS inUCICiH|HJIC.
F1
1h8dgh0SS0lv8ft8bf0St80my8tSmuStb8C0hSd8f8dhhy
pt8htWh0pf8S8htSWthh8W-0hS8tbCkphhdl8v8f.
VDO_aQHy
Z|mmcI| W. I|H|CJ QIJC!|Cc. NcI!cDIJ OS!cOmyc|!|S. H_ ] cG.
2Jo2(JJ}:J22V. 11: 22o7o+q
Item b3 Answer: L
Educational Objective: tvaluau pcrrblc
crucmycltr wtb .
iS lC jiCCiiCU iHJ_in_ SIUUy Oi jJIiCnIS SUCH JS IiS
OnCViIOOIin!CCIiOn.1OOIinCCIiOnSJiCJSi_niBCJnICJUSC
O! HOiDiUiIy in jJIiCnIS ViIH UiJDCICS HCiIUS JnU i
UnIiCJICU CJn jiO_iCSS IO OSICOHyCiIiS IHJI HJy iCQUiiC
JHjUIJIiOnOiCUiC.jjiOjiiJICJSSCSSHCnIOUiJDCliCOOI
inCCIiOnS iS IHCiCOiC CSSCnIiJ. nCSSDOnCiS \iSiDC jHySi
CJ CXJHinJUOn bnUin_S JiC OHCn inCOnCUSi\C Oi UiJ_nOS-
in_ OSICOHyCiIiS. Jin iJUiO_iJjHS JiC |nSCnSiIiVC JnU HJy
SOV SOH IiSSUC SVChn_ DUI nO DOny JDnOiHJiIiCS Oi Z Oi
HOiC VCCkS JHCi inCCIiOn HJS UC\COjCU. n JUUiIiOn IHiS
QJIiCnI HJU J nC_JIi\C HCIJ-jiODC ICSI [J jOSiIi\C ICSI HJS J
jiCUiCIi\C \JUC O Oi UiJ_nOSin_ OSICOHyCiIiS}.
IHOU_HHCi UCCi iS iHiICU IO IC jJnIJiSUi!JCC IC CC-
UiIiSiS HOiCU C VHiCimjiCSJ HOiC CXICnSi\CjiOCCSS
iCQUHn_iJjiU JSSCSSHCnI JU IiCJIHCnI.
SCJniSnCiIHCiJSSCnSiIi\CnOiSjCCibCJSJnUiSinUi-
CJICU Ony VHCn CJnOI DC jCiOiHCU [Oi CXJHjC in
jJUCnISVIjJCCHJkCiSOiHCIJjiOSIHCUCUC\iCCS}.nUiUm
JDCCU CUkOCyIC SCJnJnUIiijC-jHJSCICCHnCIiUHDOnCSCJn
JiC\CiySCnSiIi\CDUInOISjCCibCOiUiJ_nOSin_OSICOHyCiIiS
JnUJiCJSSOCiJICUWiIHH|_JSC-jOS|U\CiJICSCSjCCiJ|yVHCn
JnO\Cr|n_ CCUiIiSOiSOH l|SSUCinCCIiOniS jiCSCnI.
PO1T
MK Sth8m0StS8hStv8hdSp8ClCStudyl0fdgh0Shgl00t
hl8Ct0hSS0Ct8d0St80my8tS.
VDO_aQHy
u!J|J b 1JGJ Nl bJI_cJH! ] 1c!S| P,OuIJG |.1OcS !|S QJUcH!
W|! G|JDc!cS JVc OS!cOmyc|!|S O! !c OWcI cX!Icm|!y: ]ll.
22VV(7}:Jo. 11: J2ooV2q
Item bZ Answer: L
Educational Objective: !aqncrc tbc rauc cf vcru-
bral crucmycltr wtb blccd rulturcr.
OOU OCS JiC ICHOSI JjjiOjHJIC nCXISICj. H JjJUCnI
WiI SUSjCCICU \CiICDiJ OSICOHyCiUS JHiCiODiOO_C UiJgO
SiS HUSI DC CSIJDiSHCU IO _mUC JUDiOUC ICDjy. CCJuSC HC
inCCUOn iS OHCn HCHJIO_CnOUS DOOU CUIuiCS SHOUU DC
ODIJiCU|niUJyinJjJUCnIS. UImCSJ|CjOSiU\CHUjIO
O jJUCnlSJU iUCnmCJUOn O S/cp|tottus curus, ViC iS
IC mOSI HCQUCnICJUSCO\CiICDiJOSICOHyCiUS HJy ODVJIC
ICnCCUOiJDOnCDiOjSy.OVC\CiHICiHJ__SIuUiCSSU_-
_CSI \CiICDiJOSICOHyCiUS DUI HCDOOU CuIuiCS JiC nC_JU\C
-_mUCU jCiCUIJnCOUS nCCUC DiOjSy SHOuU DC jCiOiHCU.
CCJUSC H jiOCCUUiC iS Ony JDOUI SCnSiU\C JUDiOUCS
SHOUUDCVIHCUUnUJHiCiODiOO_CUiJ_OSiSkHJUC.
1HjiiiC CCHiiJXOnC V jiOVUC JUCQUJIC CO\CiJ_C Oi HOSI
_nC_JU\CJUSIiCjIOCOCCJOi_JniSHSiCSjOnSiDCOi\Ci-
ICDiJ OSICOmyCiIiS DUI V jiOVUC nO CO\CiJ_C Oi HCIH-
Ciin-iCSiSIJnI S. curus [b}. bIJiIin_ CHjiiiC nJCiin
VOUU DC J _OOU CHOiCCi IHCinCCIi\COi_JniSHVCiC J SUS-
CCjIiDCSIJjyOCOCCUSHOVC\CinJCiinV nOIJUCQUJICy
CO\CiinCCUOnSCJUSCUDyOi_iJH-nC_JU\COi_JiSmS.
PO1T
b00dCutuf8Sf8p0Stv8hbV0lpt8htSWthv8ft8bf
0St80my8IS.
VDO_aQHy
Z|mmcI| W I|H|CJ QIJC!|Cc. NcI!cDIJ OS!cOHyc|!|S. H_ ] cG.
2Jo2(JJ}:J22-V. 11: 22o7o+q
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b. H_yU _J.V HHO/}
.+ H_yU _2.J HHO/}
j_yH _ H_y}
oo \y
Wch ot thc tollowng s thc most lkcly causc ot ths
pancnt's bonc dscasc
_P} PUyHJHC DOHC U8CJ8C
_1} \8ICOHCCiO88
_\} \8ICOjOiO88
bCCOHUJiy HyjCijJiJIHyiOU8H
TH 1R AOvanceO|
P bbyCJ!OU WOHJH 8 OHHU HJH JCyWJy Dy jJiJHCUC8.
bHC 8 ODIHHUCU HyjOICH8i\C JHU IJCHyCJiUC. Ci DiCJIH
8HC8 O JCOHO.
1CCI!OyIC8
bOUHH
\HOiUC
OIJ88HH
\JiDOH UOXUC
1OOU _J8C8
j
C_
Job HCq/ _Job HHO/}
V2 HCqy _V2 HHO/}
o. HCqy _o. HHO/}
J2 HCqy_J2 HHO/}
.
+2 HH _ _b. KJ}
Wch ot thc tollowng acd-basc dsordcrs s most lkcly
prcscnt
_P} CIJDOC JCUO88 HCIJDOC JKJO88 JHU iC8jiJIOiy
JCUO88
_1} CIJDOC JCUO88 JHU iC8iJIOiy JKJO88
_\} CIJDOC JKJO88 JHU iC8jiJIOiy JCUO88
C8jiJIOiy JCUO8i8 JHU HCIJDOC JCiUO88
_1} bHjC HCIJDOiC JCUO88
TH 1 jAOvanCeO]
A 40ycaroIu vonan is cvaIuacu in Lc LosiaI o: ncaIoIic
aciuosis.
A:c:iaI IIoou yascs
I
Icc
!Icc:oIycs
Souiun
Ioassiun
LIoriuc
a:Ion uioxiuc
\:inc cIcc:oIycs
Souiun
Ioassiun
LIo:iuc
7.30
36 nn Iy 4.8 IIa}
140 ncq/I 140 nnoI/I}
3.0 ncq/I 3 nnoI/I}
113 ncq/I 113 mmoI/I}
17 ncq/I 17 nnoI/I}
40 ncq/I 40 nnoI/I}
10 ncq/I 10 nnoI/I}
30 ncq/I 30 nnoI/I}
YDCD O tDc OOWH_ S tDc DOSt Kcy C8USc O tDS
g8DcHtS 8CUD8Sc USOtUct:
A} IiaIcic Icoaciuosis
I} RcnaI uIuIa: aciuosis
} Iaxaivc aIusc
I} \i:aI yasrocnc:iis
TH 1 jBasC]
A 61yca:oIu nan is cvaIuacu in Lc cnc:ycncy uca:ncn
Iccausc o a 3uay Liso:y o couyL :ouucivc o ycIIov su-
D. Ic Las cL:onic oIs:ucivc uInona:y uiscasc anu Lc
:ouincIy uscs suIcncnaI oxyycn, 2 I/nin. Ic sacs La
Lc is nov sLo: o I:caL a :cs.
ILysicaI cxaninaion sLovs La Lc is usiny acccsso:y nuscIcs
o :csirauon unu u:scu -Iicu I:caLiny. Ic Las :oIonycu
cxi:ao:yo-insi:ao:y Lasc on cxLaIaion anu scac:cu
vLcczcs. Ic Las acLyca:uia anu IiIac:aI iiny cucna o
Lc cx:cniics.
Iis oxyycn sau:aion is 91 on suIcncnaI oxyycn. Lcs
:auioy:aL sLovs cLanycs consiscn viL cnLyscna, Iu is
oLc:visc uncLanycu non IascIinc. Iis a:c:iaI IIoou yas
vaIucs arc Ic, 59 nn Iy 7.8 IIa} Icc, 64 nn Hy 8.5
IIa} anu I, 7.32. Ic: c:uncn IaIo:ao:y vaIucs incIuuc
souiun, 140 ncq/I 140 nnoI/I} cLo:iuc, 100 ncq/I
100 nnoI/I} oassiun, 3.5 ncq/I 3.5 nnoI/I} anu
Iica:Ionac, 32 ncq/I 32 nnoI/I}.
YDCD O tDc OOWH_ 8CUD8Sc USOtUctS S DOSt Kcy
gtcScHt:
A} McaIoIic aciuosis
I} Rcsi:ao:y aciuosis
} Rcsi:ao:y aciuosis anu ncaIoIic aciuosis
I} Rcsi:ao:y aIIaIosis
TH 1 jBasC]
A 28yca:oIu nan is I:ouyL o Ic cnc:ycncy uca:ncn
viL Lc suuucn onsc o uysnca oIIoviny a s:cssI inc:-
vicv a vo:I.
n LysicaI cxaninauon, cnc:au:c is 36.7 98I}, Lcar
:ac is 99 /nin, :csirauon rac is 32/nin, anu IIoou :cssu:c
NeprCCQy T97
is 15/80 Hy. Hc is vcak unu in nouc:ac :csi:uory dis-
rcss. aruiovascuIar anu uInona:y cxaminauons a:c no:naI.
Souiun 140 ncq/I 140 nnoI/I}
Ioassiun 4.9 ncq/I 4.9 nnoI/I}
Lo:iuc 110 ncq/I 110 nnoI/I}
Iica:Ionac 22 ncq/I 22 nnoI/I}
A:c:iaI IIoou yas suuics on anIicn
I 7.49
Ico 30 nn Iy 4.0 IIa}
Io 99 nn Iy 13.2 IIa}
YDCD O tDc OOWH_ DcSt CD8t8CtctZcS tDc g8DcHtS
8CUD8Sc OSOtUct:
Mixcu union ya ncaIoLc aciuosis anu :csi:ao:y
aIIaIosis
I} Mcu ncaIoIic uIIaIosis anu :csi:ao:y aIIaIosis
} Rcsi:ao:y aciuosis
I} Rcsi:ao:y aIIaIosis
TH 1 [BasC]
A 56yca: oIu nan viL a mso:y o aIcoLoIisn is ounu Iyiny
on Lc s:cc. n a:vaI a Lc cnc:ycncy uca:mcn, Lc is
conscu.
n LysicaI cxaninaion, cnc:au:c is 36.1 \ 97.0I},
IIoou :cssu:c is 126/80 nn Iy, anu uIsc :ac is 70/nin.
Iunuuscoic cxaninaion sLovs no aiIIcucna. a:uiac,
uInona:y, anu aIuominuI cxuninaions a:c no:naI.
GIucosc asiny} 86 ny/uI 4.8 nnoI/I}
IIoou u:ca ni:oycn 45 ny/uI 16.1 nnoI/I}
Sc:un c:caininc 2.8 ny/uI 247.5 oI/I}
Souiun 138 ncq/I 138 nnoI/I}
Ioassiun 5.4 ncq/I 5.4 nnoI/1}
LIo:iuc 98 ncq/I 98 nnoI/I}
Iica:Ionac 14 ncq/I 14 nnoI/I}
IIasna osnoIuIiy 336 nosn/Iy 336 ;inoI/Iy}
\:inaIysis aIciun oxaIac c:ysaIs
A:c:iaI IIoou yas suuics viL Lc aicn I:caLiny
anIicn
I 7.32
Icc 29 nn Iy 3.9 IIa}
Ic 80 nn Iy 10.6 ka}
YCD O tDc OOWIH_ S tDc DOSt Kcy U8_OSS:
AIcoLoIic Icoaciuosis
I} IiaIcic Icoaciuosis
} LyIcnc yIycoI oisonny
I} Iacic aciuosis
TH 1 jAOvanCeO]
A 39-yca:oIu nan is cvaIuacu in Lc cnc:ycncy uca:ncn
Iccausc o scvc:c Ic ua ain anu Lcnau:ia ac: Iayiny
soIaII. 1Lc ain is sLaq anu :auiacs o Lc y:oin. Ic von-
icu ciyL imcs Ico:c :cscnaion. Ic Las a nonoIs:uc-
iny, caIciunconaininy Iiuncy sonc a Lc u:cc:ocIvic
]uncion on Lc Ic siuc.
TBd NeICCQy
\H HIJ C\JuJIOH H8 DOOG iC88uiC VJ8 1/V HH _
iC8iJIOiy iJIC VJ8 /HH JHG u8C iJIC VJ8 11/HH.
bCiuH 8OUuH
bCiuH OIJ88uH
bCiuH CHOiGC
bCiUH DCJiDOHJIC
PiICiJ DOOG _J8C8
1+1 HCq/i [1+1 HHO/i}
+. HCq/i [+. HHO/i}
1 HCq/i [ 1 HHO/i}
+ HCq/i [ + nO/i}
. CO_ HH _ [+.b
KJ}
YDCD O tDc OllOV_ DcSt UcSCrDcS tDS QaDcDtS aCU
DaSc USOrUcr:
[P} CIJDOC JCGO88 JHG iC8iJIOiy JKJO88
[} CIJDObC JKJO88
[\} CIJDOC JKJO88 JHG iC8iJIOiy JCGO88
[} CIJDOC JHG iC8iJIOiy JKJO88
[1} C8iJIOiy JKJO88
TEO Z0 jBasC]
P -yCJi OG HJH 8 C\JuJICG H IHC CHCi_CHCy GCJiIHCHI
Oi J -VCCK H8IOiy O Gy8HCJ OH CXCiIOH JHG J -GJy H8-
IOiy O OiIHOHCJ. C iCOiI8 HO CHC8I JH Oi JIJIOH8.
C HJ8 J +b-JCKyCJi H8IOiy O C_JiCIIC 8HOKH_. C IJKC8
HO HCGCJIOH8.
\H Hy8CJ CXJHHJIOH ICHCiJIuiC8 8 .Z\ [VV.}
DOOG iC88uiC 8 1b/V HH _ u8C iJIC 8 1b/IHm
JHG iC8iJIOH iJIC 8 Z/HH. \Xy_CH 8JIuiJIOH Dy H8C
OXHCIiy 8 bb7 OH JHDCHI Ji. HC JICHI HJ8 ]u_uJi
\CHOu8 G8ICHIOH IO IHC JH_C O IHC ]JV VHCH 8IIH_ ui_HI.
P iOHHCHI b_ JHG DDJ8Ji CiJCKC8 JiC HCJiG OH Ju8CuIJ-
IOH O IHC uH_8 JHG IIH_ CGCHJ IO IHC KHCC8 8 iC8CHI.
OOG uiCJ HIiO_CH
\iCJIHHC
1CCIiOyIC8
bOGuH
OIJ88uH
\HOiGC
\JiDOH UOXGC
LuCO8C
b H_/Gi [Z HHO/i}
1. H_/Gi [1b. HO/i}
Z HCq/i [1Z HHO/i}
b. HCq/i [b. HHO/i}
1 HCq/i [ HHO/i}
ZZ HCq/i [ZZ HHO/i}
1b H_/Gi [.b HHO/i}
YDCD O tDc OllOWD_ DcSt UcSODcS tDS QaDcDtS QlaSDa
tODCty aDU ScrU SOUDD StatDS:
[P} _CiO8HOJi HyOHJIiCHJ
[} yO8HOJi HyOHJIiCHJ
[\} OiHJ O8HOJi HyCiHJIiCHJ
[} OiHJ O8HOJi HyOHJIiCHJ
[1} OiHJ O8HOJi 8CuGOHyOHJItCHJ
TEO Z1 jAOvanCeO]
P -yCJi-OG VOHJH 8 DiOu_HI IO IHC CHCi_CHCy GCJiI-
HCHI JHCi JH_ JI HOHC. Ci JHy 8IJIC8 IHJI 8HC HJ8 DCCH
\Ciy COH8CG JHG G8OiCHICG O\Ci IHC J8I Z GJy8 JHG IHJI
8HC DC_JH IHCiJy VIH J HCV HCUCJIOH + GJy8 J_O. bHC HJ8
I_C Z GJDCIC8 HCIu8 HyCiICH8OH JHG _JuCOHJ. P DJ_
COHIJHH_ IHC JICHI8 HCGCJIOH8 HCuGC8 _yDuiGC H1CI-
OiHH HyGiOCHOiOIHJZGC JCCIJZOJHGC JHG CHJJiH.
\H Hy8CJ CXJHHJIOH ICHCiJIuiC 8 \ [Vb.} HCJiI
iJIC 8 b/HH iC8iJHOH iJIC 8 1Z/HH JHG DOOG iC88uiC
l8 11b/b HH _. bHC 8 COHH8CG JHG uHJDC IO JH8VCi
quC8IOH8 JiOiJICy. \JiGJC CXJHHJIOH 8 HOiHJ. HC
uH_8 JiC CCJi. HCiC 8 HO CGCHJ.
OOG HiCJ HIiO_CH
\iCJIHHC
bOGuH
OIJ88uH
\HOiGC
CJiDOHJIC
1 H_/Gi [.1 HHO/i}
1.1 H_/Gi [V.Z HO/i}
1 nCq/i [1 HHO/i}
.V HCq/i [.V HHO/i}
HCq/i [ HHO/i}
Z+ HCq/i [Z+ HHO/i}
YDCD O tDc OllOWD_ UrD_S S DOSt lkcly rcSQODSDlc
Or tDc QaDcDtS OD_S:
[P} PCCIJZOJHGC
[} LyDuiGC
[\} yGiOCHOiOIHJZGC
[} CIOiHH
TEO ZZ jAOvanCeO]
P bb-yCJi-OG HJH 8 8CCH GuIH_ J iOuIHC C\JuJIOH. C
VJ8 GJ_HO8CG VIH IyC Z GJDCIC8 HCbIu8 1b yCJi8 J_O. C
J8O HJ8 HyCiICH8OH JHG J 1yCJi H8IOiy O i_HI KHCC
O8ICOJiIHiI8 IHJI 8 VC COHIiOCG VIH HJXHJ-GO8C
DuiOCH. 8 OIHCi HCGCJIOH8 JiC O8JiIJH HCIOiHH
JHG iJ\J8IJIH.
\H Hy8CJ CXJHHJIOH ICHCiJIuiC 8 .Z\ [Vb.V}
DOOG iC88uiC 8 1+/VZ HH _ u8C iJIC 8 / HH JHG
iC8iJIOH iJIC 8 1+/HH. \JiUOuHOHJiy CXJHHJIOH 8
HOiHJ. HCiC 8 DJICiJ OVCi-CXIiCHIy CGCHJ IO IHC HG
8HH.
LuCO8C [HOHJ8IH_}
bOGuH
OIJ88uH
\HOiGC
CJiDOHJIC
bCiuH CiCJIHHC
\iHC iOICH
CiCJIHHC iJIO
\iHJy88
Z H_/Gi [1Z.b HHO/i}
1+Z HCq/i [1+Z HHO/i}
b.V HCq/i [b.V HHO/i}
1b HCq/i [ 1b HHO/i}
1b HCq/i [1b HHO/i}
Z.b H_/Gi [ZZ1 HO/i}
.+ H_/H_
bCCBC _iJVIy 1.1b + iOICH
Z+ _luCO8C HO CJ8I8
YCD O tDc OllOVD_ S tDc DOSt aQQrOQratc DDal
DaDa_cDcDt StcQ:
[P} C_H HyGiOCHOiOIHJZGC
[} C_H 8iOHOJCIOHC
[\} 8COHIHuC DuiOCH JHG DC_H HiO8CHGC
[} buD8IIuIC 8HOi Oi O8JiIJH
TH Zd jBasc]
P yCarOU maH WI IyjC 1 UaCICs mCLus aHU CrOmC
UHCy UsCasC [sCrum CrCaIHHC b. m/ U +6.b
mO/]} s CVauaICU H LC CmCrCHCy UCjarImCHI Or a Z
Uay sIOry O musCC VCanCss aHU rCCCHI OHsCI O I CaU
CUHCss. D CCCIrOCarUOram IaCH H IC CmCrCHCy UCjarI
mCHI s sOVH.
- , [.,,l ..
.. ! }: . : .
l'
/] . ' - ) !
````/ ` ll^
_ .1.:` '| - . . . ..|
::` : ` `` ' `. i
_ ` ].

,
YUCU O tUc OllOWD_ S tUc DcSt uucUatc DcaUcDt
OQDOD:
[P} IaCum uCOHaIC HIraVCHOusy
[} b7 uCOsC HIraVCHOusy
[I} CmOUayss
[} 5OUum jOysIyrCHC suOHaIC H sOrIO rCCIay
TH Z jAdvanced]
P 1-yCarOU r s CVauaICU Or VCaHCss. |H jysCa
CXamHaIOH IC OOU jrCssurC s 1Z+/+ mm WIH HO
OrIOsIaIC CaHCs jusC raIC Z/mH aHU rCsjraIOH raIC
1b/mH. 1 s 16. JC rCsI O IC jysCa CXamHaIOH s
umCmaraC.
5OUum
OIassum
IOHUC
CarOHaIC
1+ mCq/ [1+ mmO/}
Z.6 mCq/ [Z.6 mmO/}
11 mCq/ [11 mmO/}
21 mCq/ [Z1 mmO/}
OOU urCa HIrOCH aHU sCrum CrCaIHHC arC HOrma. P sjOI
uHHC jOIassum COHCCHIraIOH s 6 mCq/ [6 mmO/}.
YUCU O Uc OllOW_ S tUc uOSt lKcly Ua@OSS:
[P} aXaIVC ausC
[} rmary _CraUOsICrOHsm
[I} rmary yjOaUOsICrOHsm
[} 5urrCjIIOus UurCIC usC
NephrOOQy !99
TH Z jBasc]
P ++yCarOU maH COmCs IO IC CmCrCHCy UCjarImCHI WI
jOyura aHU jOyUjsa. |VCr IC jasI Uays C as HOICU
HCrCasCU urHaIOH WI HCary COHsIaHI IrsI.
ysCa CXamHaIOH s HOrma. PUmssOH aOraIOry rCsuIs
HCuUCU sCrum sOUum O 1bb mCq/ [1bb mmO/}
jasma uCOsC O 1b m/U [6. mmO/} aHU urHC
OsmOaIy O 11 mOsm/ [11 mO/}. C as sH-
CaHI HCrCasC H urHC OsmOaIy [rCaICr IaH b7} VIH 1
IO Z Ours aHCr HCCIOH O armC VasOjrCssH.
YUat S tUc uOSt lKcly CaDSc O tUc UyQcIaDcua:
[P} ICHIra UaCICs HsjUus
[} aCICs mCIus
[I} ICjrOCHC UaCICs HsjUus
[} rmary jOyUjsa
TH Z jAdvanced]
P bbyCarOU VOmaH s CVauaICU H IC CmCrCHCy UCjarI-
mCHI Or a Z-Uay sIOry O sCVCrC mUCjasIrC jaH raUaI-
H IrOu IO Cr aC aHU O HausCa WI VOmIH. COrC
Is sC Vas VC aHU aU HO mCUCa jrOCms, sC UOCs HOI
IaC aHy mCUCaIOHs Or U aCOO.
|H CXamHaIOH sC s m UsIrCss hOm jaH. JCmjCraIurC s
.6I [V6.V} OOU jrCssurC s 1bb/V mm aHU
jusC raIC s 1+/mH. 1 s ZV. UCjasIrC ICHUCrHCss
IO jajaIOH s marCU.
D aUOmHa uIrasOuHU rCVCas a UaICU COmmOH C UuCI
aHU muIjC asIOHCs. aOraIOry CVauaIOH rCVCas CC-
VaICU aaHC jOsjaIasC amyasC aHU jasC CVCs, IOIa Ca-
Cum CVC s .6 m/U [1. mmO/}.
YHat O tUc OllOWD_ S tUc uOSt lKcly CaDSc O tUc
U_OCalCcua:
[P} 1ZbUyUrOXy VIamH UCBCCHCy
[} PuIOmmuHC yjOjaraIyrOUsm
[I} IaCum CCaIOH WI hCC aIIy aCUs
[} araIyrOU aHU Hury
TH Z7 jAdvancedj
P +byCarOU naH WI sIaC 1 jumOHary sarCOUOss [mar
ymjaUCHOjaIy} s CVauaICU Or aUOmHa jaH aHU Us
ICHUOH. C as CrOHC COHsUjaUOH aHU s asI OVC mOVC
mCHI Vas Uays aO.
|H jysCa CXamHaIOH ICmjCraIurC s .6I [V6.Z}
OOU jrCssurC s 1bZ/6 mm jusC raIC s 6/mH aHU
rCsjraIOH raIC s 1Z/mH. OVC sOuHUs arC jrCsCHI uI
UmHsCU. JCHUCrHCss IO jajaIOH s jrCsCHI aHU mOsI
jrOmHCHI H IC CH OVCr quaUraHI WIOuI uarUH. CC
Ia CXamHaIOH rCVCas Irm sIOO uI HO massCs.
5Crum CaCum CVC s 11. m/U [Z.V mmO/}, IC
rCmHUCr O IC aOraIOry CVauaIOH s HOrma HCuUH
IyrOUsImuaIH OrmOHC CVC aHU hCC IyrOXHC. P jaH
m O IC aUOmCH sOVs marCU COOHC UsICHIOH WI
sIOO uI HO rCC ar uHUCr IC Uajram Or CVUCHCC O
mCCaHCa OVC OsIruCIOH. tHCmas aHU aXaIVCs arC jrC-
sCrCU.
Z00 NeprCICQy
YCD O tDc OllOWD_ S tDc uOSt aggIOgIatc aUUUODal
DcaUcDt OI tDS gaUcDt:
[D} !iHaCaCCI
[1} 1yUiOCHOiOIHiaZiUC
[!} 1HIIa\CHOH8 HOiHa 8aiHC
iCUHi8OHC
TH Z 8asc]
D +byCaiOU HaH i8 C\aHaICU Oi a HOHIH Hi8IOiy O
!aIi_HC COH8IijaIiOH aHU jOya. 1C a8O Ha8 a byCai Hi8
IOiy O HyjCiICH8iOH. !HiiCHI HCUiCaIiOH8 aiC O8aiIaH aHU
UiIiaZCH.
Hy8iCa CXaHiHaIiOH I1UiH_8 iHCHUiH_ \iIa 8i_H8 aiC HOi
Ha.
!aCiHH
!iCaIiHiHC
LHCO8C a8IiH_
HO8jHOiH8
HyiOiU8IiHHaIiH_
HOiHOHC
11.+ H_/U [2.V HHOy}
1.1 H_/U [V.2 HOy}
H_/U [+.V HHO/}
2.2 H_/U1 [.1 HHOy}
1.2 I1/H [1.2 H1/}
caSuIcucDt O WDCD O tDc OllOWD_ lcVclS SDOulU Dc
UODc DcXt:
[D} !aCiIOHiH
[1} 2b1yUiOXyiIaHiH
[!} aiaIHyiOiU HOiHOHC
aiaIHiOiU HOiHOHCiCaICU jiOICiH
lTH Z AOvanceO]
D +yCaiOU HaH WIH a OH_8IaHCH_ Hi8IOiy O aCOHOi8H
i8 HO8jiIaiZCU Oi aCHIC jaHCiCaIiIi8. 1i8 a8I U Wa8 Uay8
a_O. 1C Ha8 O8I ajjiOXiHaICy 17 O Hi8 DOUy WCi_HI O\Ci
IHC ja8I + HOHIH8 UHC IO U_ aCOHO aHU HOI CaIiH_.
\H jHy8iCa CXaHiHaIiOH HC i8 CaCHCCIiC. NiIa 8i_H8 aiC HOi
Ha. 11 i8 1. 1C i8 HOI COHH8CU Oi IiCHHOH8. HCiC i8
HiUCji_a8IHC ICHUCDC88 WiIHOHI iCDOHHU. ^CHiOO_C CXaH
iHaIiOH i8 HOiHa.
bOUiHH
OIa88iHH
!HOiiUC
1iCaiDOHaIC
HO8jHOiH8
!aCiHH
1 HCQ/ [1 HHO/1}
.+ HCQ/ [.+ HHOy}
V HCQ/ [V HHO/}
2 HCQ/ [2 HHOy}
.b H_/U [1.1 HHOy}
V. H_/U1 [2.2 HHOy}
HC jaIiCHI iCCCi\C8 IHiaHiHC iCjaCCHCHI OiC aCiU 8HjjC
HCHIaIiOH aHU a HHIi\iIaHiH OOWCU Dy \i_OiOH8 iHIia
\CHOH8 UHiU iCjaCCHCHI ViIH b7 UCXIiO8C aHU HOiHa 8aiHC
aHU jOIa88iHH CHOiiUC. OijHiHC i8 H8CU IO COHIiO jaiH.
1i_HICCH HOHi8 aICi IHC jaIiCHI8 aDUOHiHa jaiH Ha8
iHjiO\CU DHI HC DCCOHC8 iC8IC88 a_iIaICU aHU CXIiCHCy
WCaK aHU i8 DaiCy aDC IO iai8C H8 CXIiCHiIiC8 a_aiH8I _ia\iIy.
YCD O tDc OllOWD_ S Uc uOSt lucly Ua_OSS:
[D} 1yjCiCaCCHia
[1} 1_OKaCHia
[!} 1yjOHaIiCHia
1yjOjHO8jHaICHia
>CC\O
OQrOO@g
DSWfS BDO LflIlQUS
Item 1 Answer:
Educational Ob]ective: 1t0gH0t 0llb0l0ltt ]l0htH
PlI0.
JHC HO8I JjjiOjHJIC HCXI UiJ_HO8IiC IC8I i8 IO C\JHJIC IHC
jJIiCHI Oi OiIHO8IJIiC jiOICiHHiiJ. JHi8 i8 UOHC Dy ODIJiHiH_
8CjJiJIC Hjii_HI [UJyIiHC} JHU 8HjiHC [O\CiHi_HI} HiHC CO
CCIiOH8 Oi jiOICiH qHJHIiIJIiOH. \iIHO8IJIiC jiOICiHHiiJ i8
UCBHCUDyJHiHCiCJ8CiHHiiHJiyjiOICiHCXCiCIiOHOHy!HIHC
Hjii_HI jO8iIiOH, WHCH 8HjiHC IHC HiiHJiy jiOICiH CXCiCIiOH
iJICi8HOiHJ[<oH_/bH}.JHCCOHUiHOHi88CCHHO8ICOH
HOHy iH CH!UiCH Oi yOHH_ JUHI8. JHC IOIJ HiiHC jiOICiH
CXCiCIiOH iJICi8H8HJyC88IHJH _/2HJHUIHCHiiHJy8i8
i8 OIHCiWi8C HOiHJ. JHC CIiOO_y O IHC COHGIiOH i8 HHCCi-
IJiH, iH 8OHC CJ8C8 HiU JICiJIiOH8 !H _OHCiHJi Hi8IOO_
HJ\C DCCHiCjOiICU.1J88OCiJIiOHOOiIHO8IJIiCjiOICiHHiiJ
WiIH CHIiJjHCHI O IHC CH iCHJ \CH DCIWCCHICJOiIJ JHU
IHC 8HjCiiOiHC8CHICiiCJiICiy[HHICiJCKCi8yHUiOHC} J8O
HJ8 DCCH iCjOiICU. JHC COHGI!OH i8 DCHi_H, iI OHCH iC8O\C8
8jOHIJHCOH8y JHU OH_ICiH OOW-Hj 8IHUiC8 iH JCCICU
jJHCHI8HJ\C 8HOWHiCHJ!HCIiOHiCHJiH8HOiHJ.
1 KiUHCy DiOj8yi8 HOI IHC HO8I JjjiOjiiJIC HCXI 8ICj iH IHi8
jJHCHI8 HJHJ_CHCHI. i8 HCUiCJ Hi8IOiy jiO\iUC8 HO C\i
UCHCC O 8i_HiHCJHI jJ8I Oi jiC8CHI iHC88 JHU Hi8 jHy8iCJ
CXJH!HJI!OHJHUiHiIiJJDOiJIOiy8IHUiC8UOHOI8H__C8I8Cii-
OH8 KiUHCy Ui8CJ8C. bjCCiBCay HC i8 HOiHOICH8i\C JHU HOI
CUCHJIOH8,IHC8CiHHCiCJHHiHCaDHmIHJHUCHOC8ICiOJiC
HOiHJ, JHU IHCHHHJy8i8i8 HOiHJ.
18iH_C2HOHiHiiHCCOCCIiOHWOHUHO8IiKCyOHyCOH
BiHIHC8HDHCjHiOHCiJICOHHHJiyjiOICiHCXCiCIiOHWHCH
i8JiCJUyCViUCHIhOHIHC8jOIuHHCjiOICiHiCJIHiHCiJIiO
O .bH_/H_.OiCiHjOiIJHIy J8iH_C2HOHiHiiHCCO-
CCIiOH WOHU Ji IO UiCiCHIiJIC IHC iJIC8 O Hjii_HI \Ci8H8
8HjiHCjiOICHHi!JWHiCHi8C88CHIiJiHUi8H_ui8HiH_ OiIHO-
8IJIiC hOH jCi8i8ICHI jiOICiHHHJ.
L!\CH IHC jJHCHI8 J_C HOiHJ HCHO_ODiH JHU 8CiHH jiO-
IC!HJUy8jiOICiHCmiJi8\CiyuH!KCyJHU8CiHHJHUHHHCjiO
ICiHCCCIiOjHOiC8i88IuUiC8JiC HOIHCCUCU.bHOHUIHCjJHCHI
jiO\CIOHJ\CjCii8ICHIjiOICiHHHJHHCjiOICiHCCCUOjOiC8i8
JHU iHHuHOHXJLiOH 8IHUiC8 HJy DC H8C! iH UCICiHiHiH_
WHCIHCiIHCjiOIC!HHHJiCuCCI8_OHCiHJiOiIuDHJiU!8CJ8C.
IthOSttC pIOt8huI S d8h8d 0y h hCI8S8 h uIhIy pIOt8h
8kCI8tOh Ohy h th8 upIght pOStOh.
Z01
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!h|DK Cr!hCs!a!|c hrs!. \|D iCC|a!r. 211;b(:1V-12. iN11:
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Item2 Answer: A
Educational Ob]ective: 1t0gH0t 0tPh tHhlltlt0
Ht]bltlt.
JHC HO8I iKCy UiJ_HO8i8 i8 JCHIC iHICi8IiIiJ HCjHiiIi8. JHi8
jJHCHIHJ8JCHICKiUCyiHHiyA), J8C\UCHCCUDyIHC8HU
UCHOH8CIOOi_HiiJJHU JH!HCiCJ8CiH HCi DOOU uiCJ HiIiO-
_CH [11} JHU 8CiHH CiCJIiHiHC \JHC8. Ci HiiHC [HOiHJ
HjOHJO iOH}i8jO8iH\COiCHOCyC8JHUCUKOCyCCJ8I8
DHI IHC CHIuiCi8 HC_JH\C [8ICiiCjyuJ}. JHi8 CuCJjiCIuiC
i8 HO8I COH8i8ICHI WiIHIHDHOiHICi8HHJudJHOH CJH8CU
DyJCHICiHICDHHJHCjHHH8.iH_8jJ!HOJiyJCIJHJHHDi-
OHC8aiCIHCHO8ICOHHOHCHOO_yOJCHICiHICi8HHJHCjHii
H.JHCHI8HJyJ8OHJ\CC\Ciia8HJHUCO8!HOjH!iJJIHOH_H
OHyJHiHOiiIyO jJHCHI8WHJ\CJ IHiCC CJIHiC8.
1CHIC IuDHJi HCCiO8i8 [J} i8 IHC HO8I COHHOH OiH O
HIiaiCHJ Ui8CJ8C IHJI CJH8C8 JCHIC KiUHCy iHHiy iHHO8jiIJ
iZCUjJHCHI8.\H8CIOIH8COHUiHOHH8HJyOCCHi8JCiJ8H8
IJiHCU jCiiOU Oi8CHCHJOiCXjO8HiCIO HCjHiOIOX!CJ_CHI8.
1iiHJy8i8 iH JjjiOXiHJICy o7 O jJIiCHI8 WiIH JCHIC IuDH-
JiHCCiO8i8iC\CJ8HHUUyDiOWHCJ8I8,CHKOCyC8JHUCHKO-
CyICCJ8I8 JiCHOIJ88OCiJICUWiIH1J.
\HOC8ICiO Ciy8IJ CHDOuZJHOH HJy CJH8C A iH jJIiCHI8
WiIHJOiHCJIHCiO8CCiOIiCjJqHC8.JHi8COHUiIiOHHJyOCCHi
8jOHIJHCOH8yDHIHO8IOHCHUC\COj8JHCiCOiOHJiyOiKiU-
HCy JH_O_iJjHy Oi JOiIiC 8Hi_Ciy. iUHCy iHHiy iH jJHCHIS
WiIH CHOC8ICiO Ciy8IJ CHDOiZJIiOH H8HJy HJ8 J 8HDJCHIC
OH8CIWiIH J 8IHIIC!iH_ COHi8CO\Ci 8C\CiJ WCCK8. \HIJHCOH8
HJHiC8IJIiOH8 UC\COj iH JjjiOXiHJICy 17 IO 1o7 O!
jJHCHI8JHUHJyiHCHUCu\CUOiCHCHJH88K!HHCCiJHOHJHU
HOUHC8. JHCHI8 WiIH CHOC8ICiO Ciy8IJ CHDOiZJHOH I_i
CJy HJ\C J DJHU HiHC 8CUiHCHI DHI HJy HJ\C Uy8HOQHiC
HCHJIHiiJ JHU CiyIHiOCyIC CJ8I8.
JHCJD8CHCCOOiIHO8IJHCHyjOICH8iOH IJCHyCJiGJJHUIHC
HOiHJ 11CiCJIiHiHC iJIiO O JjjiOXiHJICy 1.1 Ji_uC
J_JiH8I jiCiCHJJZOICHiJ J8IHC CJH8CO/.
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St8I8 pyuI, hd 8ukOCyt8 CStS.
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â! CV ^C[HiO. Z1(b].+1-. 111. Zb1ZV
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LOUCBOHB
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gOCVO. 1V0P0 [tlHl tm0
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C HOSL ajjiOjHaLC HCXL SLCj S CySLOSCOjy. S jaLCHI aS
jCiSSLCHL CHaLuia UCHCU aS LC jiCSCHCC O LiCC Oi HOiC
CiyLiOCyLCS/j H LC uiHC UCLCCLCU OH LVO Oi HOiC SaH-
jCS. CCUH_ H jaLCHLS WL jCiSSLCHL CHaLuia Hay Oi_-
HaLC aHyCiC aOH_ LC _CnlLOuiHaiy LiaCL aHU UHCiCHU-
aLH_ DCLCCH _OHCiuai aHU HOH_OHCiUai CHaLuHa CjS
LO _uUC HaHa_CHCHL. lS jaLCHLS HOiHa-ajjCaiH_ Ciy-
LiOCyLCS iCVCaCU OH uiHC HCiOSCOjy aHU aDSCHCC O Ci-
LiOCyLC CaLS aHU jiOLCH H LC uHHC aiC COHSSLCHL WL HOH-
_OHCiuai CHaLuia.
\HC jOSSDC CauSC O jCiSSLCHL HOH_OHCiuai CHaLuia S
_CHLOuiHaiy LiaCL Ha_HaHCy. S aCLOiS Oi LCSC HaH_-
HaHCCS HCuUC HaC SCX a_C _iCaLCi LaH D yCaiS LODaCCO
uSC aHU CXjOSuiC LO Uiu_S SuC aS CyCOjOSjaHUC aHU
DCHZCHC aHU iaUaUOH. CCJuSC LlS jaUCHL aS SCVCia HS aC-
LOiS CySLOSCOjy S HUCaLCU LO CXCuUC a Ha_HaHCy.
CHaLuia Hay UCVCOj H jaLCHLS LaH_ IP1S Oi aHU-
COa_uaHLS DuL SOuU HOL auLOHaUCay DC aLLiDuLCU LO LCSC
a_CHLS ajjiOjiaLC CVauaLOH Oi _OHCiuai Oi HOH-
_OHCiuai USOiUCiS SOuU SL DC jCiOiHCU H LS SCLUH_.
H aUULOH USCOHLHuaLOH O VaiaiH Hay jaCC HaL iS
Oi iLCi LiOHDOCHDOHC USOiUCiS.
S jaLCHLS S_Ly HCiCaSCU SCiuH CiCaLHHC CVC S Su_-
_CSLVC O _OHCiuai USCaSC VC OHCH HaHCSLS aS a
UCCiCaSC H UHCy HCLOH. OVCVCi _OHCiuai CHaLuia
S COHHOHy aSSOCaLCU WL UySHOQC C[CyCS aHU Ciy-
LiOCyLC CaSLS. \OHCiuai USCaSC aSO S uHCy H LC
aDSCHCC O jiOLCH OH uiHaySS. CiCOiC UHCy DOjSy
VC S OHCH uSCU LO CVauaLC jaLCHLS V!L _OHCiuai US-
CaSC VOuU HOL DC ajjiOjiaLC Oi LlS jaLCHL.
H a jaLCHL VL jCiSSLCHL CHaLuia aHU aL l_ iS Oi _CH-
LOuiHaiy LiaCL Ha_HaHCy iCjCaLH_ L\C uiHaySS H
HOHL\S juLS LC jaLCHL aL iS Oi jiO_iCSS\C SjiCaU O CaH-
CCi aHU S HOL aH ajjiOjiaLC HaHa_CHCHL OjLOH.
KEY F 0 I `
| dES Wh 0g0mElUdl hEmdUld, K0E UldS00gldh
d0 CS0SC0 dlE 0CdE0 0 EXCU0E d gE0Uldl ldC
mdgdC 0V0UdS Wh lSK dC0lS 0l hS C000.
1DlO_aQDy
\OHCH iOWH S. CiO8CO[iC HCHa!Uiia. ^ 1H_ | CG. Z+b
(Z].Z-Zb. 11.1ZbbVVb
lOHM HSWOt.
bOUCBOHB
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gOCVO. J0QH0t l00d0my0y tt
0Hd0ly h H0lt0lt 0Vtld0t.
S jaLCHL HOSL Cy aS iaDUOHyOySS VC S CauSCU
Dy SCCLa HuSCC UaHa_C LaL CaUS LO iCCaSC O HLiaCCuai
COHjOHCHLS HLO LC CiCuaUOH. C SyHUiOHC VaS iSL UCH-
LCU H jaLCHLS WL LiauHaLC CiuS HuiCS DuL LCiC aiC
HOHLiauHaLC CauSCS SuC aS aCOO [UuC LO yjOjOS-
jaLCHa] Uiu_ uSC HCLaDOC USOiUCiS aHU HCCLOHS. C
CaSSC LHaU O HUH_S HCuUCS HuSCC jaH VCaHCSS aHU
Uai uHHC. C Ola_HOSS S DaSCU OH CmCa m_S aHU a S-
LOiy O jiCUSjOSH_ aCLOiS [SuC aS jiOOH_CU n\HODlZa-
LOH Oi Uiu_ LOXCLy] aHU COHB|HCU Dy LC jiCSCLCC O HyO-
_ODHuia aH HCiCaSCU SCiuH CiCaLHC HaSC CVC aHU H
SOHC CaSCS yjCiaCHa. P jOSLVC HUjSLC Oi DOOU
H LC aDSCHCC O CiyLiOCyLCS aSO Su__CSLS iaDUOHyOySS.
C USOiUCi uSuay iCSOVCS VLD UayS LO VCCS. |CaLHCHL
COHSSLS O a__iCSSVC HuU iCSuSCLaLOH huUS SOuU DC
aUuSLCU LO HaHLaH LC Ouiy uiHC OuLjuL aL CaSL H
HHHLC uiHC S HC_aLVC Oi HyO_ODH. PCuLC UHCy 1uiy
iCSuLH_ bOH aCuLC LuDuai HCCiOSS OCCuiS H ajjiOXHaLCy
OHC LiU O jaLCHLS. 1aySS S SOHCLHCS HCCCSSaiy.
PLOu_ aHL CjaLC auiC Hay iCSuL H COHa Uai
HiHC aHU iCHa auiC OLCi LCSLS O SyHLCLC VCi uCLOH
H LS jaLCHL aiC HOiHa. CHOyLC aHCHa VOuU HOL
CXjaH LC jaLCHLS CCVaLCU CiCaLHC HaSC CVC aHU uSuahy
UOCS HOL CauSC iCHa auiC. CHOyC uiCHC SyHOiOHC S HOL
COHSSLCHL W!L LC HOiHa COHjCLC DOOU COuHL CnCa BHU-
H_S O jOySuDSLaHCC OVCiUOSC Oi LC aDOiaLOiy BHUH_ O
LC CCVaLCU SCiuH CiCaLHC HaSC CVC.

KhdD00m0SS S dSS0CdE0 Wh mUSCE d, WEdKESS, d0
0dlK UlE, dD0ld0l 0gS CU0E d EEVdE0 SElUm ClEdE
KdSE EVE d0 0SVE UlE 0SCK 0l D000 hE dDSECE 0
Elhl0CES.
1DlO_aQDy
aaiC 1aOHaHG . .DGOaHi C! a. aDGOHyOy8l8 aHOH_
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111. 1bb+Vbb
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LO CVauaLC Oi uHaiy ODSLiuCLOH. C jaLCHL aS OVCi ui-
Haiy LiaCL SyHjLOHS VL UHCu[ VOUH_ aHU SujiajuDC
HCSS. S S COHSSLCHL VL DaUUCi OuLCL ODSLiuCLOH
bOH jiOSLaLC _CiLiOjy. \DSLiuCLOH CaH CauSC HLiaiCHa
VaSOCOHSLiCLOH SCCHC LuDuai Huiy mHLCiSLLa DiO-
SS LaL Hay CaU LO CHU-SLa_C UHCy USCaSC uHCOiiCCLCU.
/LOu_ jaUCHLS WL COHjCLC ODSLiuCUOH aVC S_HHCaHL[
UCCiCaSCU uiHC OuLjuL L\OSC VL jaiLa ODSLiuCLOH Hay
Ha\C jOyHiia CaH8CU Dy O88 O IHDHai HCHOH Oi CXCiCIiOH
O CXCC88 iCIaiHCU 8OHIC. iUHCyHIia8OHHU iH HO8I jaIiCHI8
WiIH OD8IiHCIiOH iC\Ca8 HyUiOHCjHiO8i8. aIiCHI8 WiI aCHIC
KiUHCyHHiy ^) CaH8CUDy HiiHaiy IiaCI OD8IiHCIiOHHa\C
a a\OiaDC jiO_HO8i8 WHCH OD8IiHCIiOH i8 iCiC\CU WiIHiH 1
WCCKOOH8CI. DKiUHCyHIia8OHHUWOHU iC\Caa Ui8ICHUCU
DaUUCi aHU jO88iDC HyUiOHCjHiO8i8. 1H8CiIiOH O a OCy
CaIHCICi i8 iHiHaIiCaIHCHI.
iUHCy DiOj8y 8HOHU DC COH8iUCiCU WHCH IC Uia_HO8i8 O
^ iCHaiH8 U1CCai aHCi CXCHUiH_ jiCiCHa aHU jO8IiCHa
Ui8Ca8C. 1iOj8y 8 WaiiaHICUIOHCj_HiUCIHCiajy Oi jiO\iUC
jiO_HO8HCiHiHaHOH.1Iia8OHHUUHjCXaiICDO_iajHy\J
aiICiiO_iajHy Y1 aHU aH_iOICH8iH-COH\CiIiH_ CH2yHC
iHHiDiIOiiCHO_iajHyaiCH8CUIOC\aHaICiCHa\a8CHaIHiCiH
IHCjiC8CHCCOUi8iHjICUaiICiiaOi\CHOH8DOOUBOW.1HIi8
jaIiCHIWiIH\OiUiH_8yHjIOH8aHU8HjiajHDiCHC88HOH-
iHa8i\CKiUHCy HIia8OHHUy i8 IHC Uia_HO8IiC IC8I O CHOiCC.
1DHHiH i8 IHC OHy jiOICiH UCICCICU OH Uij8IiCK HiiHay8i8
aHUHOIHiH_iHIHCjaIiCHI8jiC8CHIaIiOH8H__C8I8HCHa8ajii
Haiy _OHCiHai Ui8Ca8C CaH8iH_ D1 Uij8LiCK C\aHaIiOH
WOHU aUU iIIC IO IHi8 Ca8C. _HaHIiIaIi\C HCa8HiCHCDI8
iaIHCiIHaHUj8HCKHCIOUOO_yaiCiCCOHHCHUCUIOUCICCI
aDH1 CXCiCIiOH C88IHaH o H_/2+ H.
0 1
60 ulIlS0u0 S 0CI0 0l ll IIS WIh CuI k0
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siJncy nja:y cp::n C.n l:+... !008;i04):.!8-.!04. lM|:
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ItemB Answer: L
Educational Objective: Oapnerc hcmelytr urcmr
ryndremc.
JHC HO8I iKCy Uia_HO8i8 i8 HCHOyIiC HiCHiC 8yHUiOHC
[11}. 11 COHHOHy HaHiC8I8 a8 aCHIC KiUHCy iHHiy
[D1} aCCOHjaHiCU Dy IHOHDOCyIOjCHa aHU HiCiOaH_iO-
jaIHiC HCHOyIiC aHCHia [8CHi8IOCyIC8 OH jCiijHCia DOOU
8HCai}. JHCIWOHO8ICOHHOHCaH8C8aiCii1CCIiOHDyHi_a
IOXiHjiOUHCiH_Tt/crit/ia to/i T. to/i \1D .1aHUOIHCi
8CiOI_C8}aHUa aUCCiCHCyO aCIOi1. JHCIOXiHCaHSC8
DOOUy UiaiiHCa aHU CHICi8 IHC CiiCHaIiOH aHU DiHU8 IO
jaICCI8_OHCiHaiCajuaiyCHUOICiJCC8HC8aH_aCC8
aHU _OHCiHai aHUIHDHaiCjiIHCaCC8. Hi_aIOXiH DiHU8
IO jaICCI8 Dy HCaH8 O _ODOIiiaO8yCCiaHiUC iCCCjIOi8
WHiCHCaU8IOjaICCIa__iC_aIiOH.Hi_aIOXiHHaya8O8HH-
HaIC CHUOIHCia CC8 IO iCCa8C ai_C \OHYuCDiaHU aCIOi
HHIiHCi8 WHiCH CaH iIHCi CHHaHCC jaICCI a__iC_aIiOH.
aCIOi1ajiOICiHiHICCOHjCHCHIjaIWayHOiHayjiO-
ICCI8 CC8 hOH UaH1a_C DyIHC aICiHaIi\C COHjCHCHI jaI-
Way. DUCBCiCHCyO aCIOi1 aOW8 \o IOjOICHIiaICaHIOaH-
IDOUy-HCUiaICU Oi iHHHHC COHjCXHCUiaICU iHHiy IO
NeprCCQy ` Z03
_OHCiHaiCC8 CaUH_IOCXjO8HiCO 8HDCHUOIHCiHHaHU
aCIi\aIiOH ODOIH jaICCI8 aHUCOa_HaIiOH.
DCHIC iHICi8IiIia HCjHiiIi8 [D} i8 HO8I COHHOHy CaH8CU
Dy a HyjCi8CH8iIi\iIy iCaCIiOH IO a HCUiCaIiOH Oi Dy CCiIaiH
iHCCIiOH8 Oi aHIOiH1HHHC COHUiHOH8. 1iiHay8i8 BHUiH_8 iH
jaHCHL8HayiHCHUCCHKOCyCCa8I8aHUCO8iHOjHi8./ UOC8
HOICaH8C HCHOyIiC aHCHa OiIHiOHDOCyIOjCHia.
DCHICIHDHaiHCCiO8i8 [DJ}H8HayOCCHi8 aHCi a8H8IaiHCU
jCiiOU O i8CHCHia Oi CXjO8HiC IO HCjHiOIOXiC a_CHI8. DJ
HayiC8O\CiH 1 IO o WCCK8OiiC8HIiHjCiHaHCHICHU-8Ia_C
KiUHCyUi8Ca8CUCjCHUiH_OHIHCUHiaIiOHaHU8C\CDIy OIHC
i8CHCHiC Oi HCjHiOIOXiC iH8HI. 1iiHay8i8 H8Hay iC\Ca8
HHUUy DiOWH Ca8I8 aHU i8 HOI a88OCiaICU WiIH HiCiOaH_iO-
jaIiCHCHOyIiC aHCHia OiIHiOHDOOjCHa.
YHaDUOHyOy8i8 UC\COj8 WHCH HH8CC iHHiy CaU8 IO IHC
iCCa8C O HyO_ODiH aHU OICiiHIiaCCHaiHH8CC COHICHI8
iHIO IC CiiCHaIiOH. yO_ODiH i8 KHOWH IO CaH8C HCjHiO-
IOXiCiIy DyiHUHCIiOHOKiUHCyi8CHCHiaaHUIHDHaiOD8IiHC
IiOH. YHaDUOHyOy8i8 HO8I COHHOHy UC\COj8 aCi CXjO-
8HiC IO HyOIOXiC UiH_8 iHCCIiOH CXCC88i\C CXCiIiOH Oi
jiOOH_CU iHHODii2aIiOH. D Uia_HO8i8 O iHaDUOHyOy8i8
8HOHUDCCOH8iUCiCUiHjaIiCHI8WiIHa8CiHHCiCaIHCKiHa8C
C\C_iCaICiIHaHD 1/WHOUCHOH8IiaICHCHCjO8iIi\-
i|OHHiiHC Uij8IiCK IC8IiH_iHIHC aD8CHCCO HCHaIHDa.
kY O1w7
hm0lIC ulmC S0l0m C0mm0l mSIS S CuI k0
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cp::.gy C+:..n). !00;ii3):!i3-8. lM|: i534|
Item? Answer:
Educational Objective: Oapnerc arun tubular
ncrrerr-arrerand arun kdncy nry.
JHi8 jaIiCHI8 CC\aICU 8CiHH CiCaIHHC C\C HiHiHa jiO
ICiHHDa aHU HHUUy DiOWH Ca8I8 OH HDHay8i8 aiC HO8I COH
8i8ICHI WiIH aCHIC IHDHai HCCiO8i8. JHi8 COHUiIiOH H8Hay
UC\CO8 aHCi a 8H8IaiHCU jCiiOU O i8CHCHia Oi CXjO8HiC IO
HCjHiOIOXiC a_CHI8 8HCH a8 Ci8jaIiH iHIia\CHOH8 J O_y-
CO8iUC8 OiiaUiOCOHIia8I.
DCHIC iHICi8IiIia HCjHiiIi8 HO8I COHHOHy UC\COj8 aHCi
CXjO8HiC IO CCiIaiH HCUiCaIiOH8 iHCHUiH_ IiiHCIHOjiiH.
JHi!C8IaIiOH8 O U8COHUiIiOH Hay iHCHUC ia8H jiHiiIH8
CO8iHOjHiia aHU C\Ci. 1iiHC 8CUiHCHI HUiH_8 iHCHUC
jyHiia CHKOCyIC Ca8I8 HiCiO8COjiC HCHaIHiia aHU IHDHai-
iaH_CjiOICiHHDJ. JHCSC CaIHiC8 aiC aD8CHI iH U8jJHCHI.
aHiC8IaIiOH8 O IHCIHiOHDOHCHiCiOaH_iOjaIHiC8 iHCHU
iH_IiOHDOIiCIiOHDOCyIOjCHiCjHqHiaHayiHCHUCaCHIC
KiUHCyiHHiyIaIi8H8HayaCCOHjaHiCUDyHiCiOaH_OjaIHiC
HCHOyCaHCHiaaHUIiOHDOCyIOjCHia./jiOXiHaICyD7
ZU4 NCprCCQy
O jaIiCHI8 Ha\C OW C3 C\C8. HC HiiHC 8CUiHCHI H8Hay
8HOW8 HiHiHa Oi HO aDHOiHaiIiC8 aHU i8 HOHUia_HO8IiC
iaiCy CiHiOCyIC Oi HHUUy DiOWH Ca8I8 Hay DC 8CCH. Hi8
jaHCHI8 HOiHa HCHO_ODH COHCCHIiaHOH aHU jaICCI COHHI
CXCHUC a IHiOHDOIiC HiCiOaH_iOjaIHy a8 IHC CaH8C O IHC
aCHIC KiUHCy iHHiy.
UHCy HIia8OHO_iajHy iH HO8I jaIiCHI8 WIH OD8IiHCIiOH
iC\Ca8 HyUiOHCjHiO8i8 WHiCH i8 aD8CHI iH IHi8 jaIiCHI. Hi-
IHCiHOiC IHC HiiHJy8i8 iH jaIiCHI8 WiIH OD8IiHCIiOH i8 DCH_H
aHU i8 HOI a88OCiaICU WLH IHC HHUUy UiOWH Ca8I8 OHHU iH
IHi8 jaIiCHI8 HiUC.
KTN O1M1
ACut8tubufh8CfoSSuSuyd8v8opSlt8fSuSth8dp8fodol
SCh8mof 8kpoSuf8toh8phfotokCg8htShdSSSoCt8dWth
muddybfoWhCStSohufhySS.
DlO_aQhy
Choudhury , Ahmcd Z.rug-associatcd rcnal dyshmchon and injury.
at Clin Iract cphrol. 200,2(2):80-i. IMI:i323]
ltemB Answer:
Educational Objective: 1I0gH0t 0H4 Dt0l [ItItH0
0Z0mI0 BIlb V0Hmt It[0ttmtHl.
Hi8 jaIiCHI HO8I iKCy Ha8 jiCiCHa aZOICHia aHU IHC HO8I
ajjiOjiiaIC HCXI 8ICj iH HaHa_CHCHI i8 i8OIOHC 8aiHC. DCHIC
KiUHCy iHHiy iH jaICHI8 WiIH Hai_HaHCy i8 OHCH UHC IO jiC-
iCHa Ui8Ca8C OD8IiHCIiOH Oi H8C O HCjHiOIOXiC a_CHI8. HC
jiC8CHCC O HyjOICH8iOH HyjOHaIiCHia aHU a UCCiCa8CU HiiHC
8OUiHH CXCiCIiOH aCCOHjaHiCU Dy a DaHU HiiHC 8CUiHCHI
iai8C8 8H8jiCiOH Oi jiCiCHa aZOICma.
iJy8i8 WOHU DC iHUiCaICU i IHC aZOICHia jCi8i8ICU Oi WOi8-
CHCU aHCi COiiCCIOH O IHC HyjO\OCHia jaiICHaiy i OIHCi
HiCHiC COHjCaIiOH8 8HCH a8 CHCCjHaOjaIHy Oi iCUaCIOiy
H_CiKaCma WCiC jiC8CHI. iJy8i8 i8 HOI UUiCaICU DCOiC U
jaHCHI Ha8 HHUCi_OHC a I!ia O aUCqHaIC \OHHC iCjaCCHCHI.
HCiajy WiIH HiUOUiiHC aHU OCIiCOIiUC Hay DC CHCCIi\C aHU
8aC Oi IHC IiCaIHCHI O HCjaIOiCHa 8yHUiOHC iH 8OHC
jaHCHI8. OWC\Ci IHC aD8CHCC O a8CiIC8 Oi OIHCi 8i_H8 O jOi-
Ia HyjCiICH8iOH aiC HOI COH8i8ICHI WiIH HCjaIOiCHa 8yH-
UiOHC.
HHOi y8i8 8yHUiOHC Hay HaHiC8I a8 H_CiKaCHia HyjCi-
jHO8jHaICHia aHU HyjCiHiiCCHia. HHOi y8i8 8yHUiOHC
HO8I KCy OCCHi8 U jaIiCHI8 VIH CXIiCHCy iajiUy jiO_iC8-
8i\C yHjHOiU HCOja8H8 aHU iH IHO8C WHO Ha\C DH| yH-
jHOiU HCOja8H8 IHaI iC8jOHU iajiUy IO IiCaIHCHI. 8DHii-
Ca8C CaH DC H8CU IO I!CaI Ha_HaHCyiCaICU HyjCiHiCCHa iH
OiUCi IO jiC\CHI IHHOi y8i8 8yHUiOHC iH Hi_Hi8K jaIiCHI8 Oi
a8 a COHjOHCHI O IHCiajy Oi C8IaDi8HCU IHHOi y8i8 8yH-
UiOHC aHU a88OCiaICU HyjCiHiiCCHia. OWC\Ci IHi8 jaIiCHI8
8CiHH CCCIiOyIC jHO8jHOiH8 aHU H!iC aCiU C\C aDHOiHa-
iHC8 aiC HO8I iKCy a iC8HI O HyjO\OCHia aHU a88OCiaICU KiU
HCy Uy8IHCHOH aHU 8HOHU iHjiO\C WiIH \OHHC iCjCIiOH
IHCiCOiC ia8DHiiCa8C IHCiajy WOHU HOI DC WaiiaHICU.
1
1h8pf8S8hC8olhypot8hSoh,hypohtf8m,hdd8Cf8S8dufh8
Sodum8kCf8tohCComph8dbybhdufh8S8dm8htShoud
fS8SuSpCohlofpf8f8h2ot8m.
DlO_aQhy
armon M, Ciroldi M, Jhicry C, Schlcmmcr B, Azoulay I. Clinical
rcvicw: spccinc aspccts of acutc rcnal lilurc in canccr pahcnts. Crit Carc
200,i0:2ii. IMI:i+i3]
ItemS Answer: L
Educational Objective: 1I0gH0t [ItItH0 0DmI0
IH 0 [0lItHl BIlb tbI0HIt RI4Hty 4It0t.
HC HO8I iKCy CaH8C O IHi8 jaIiCHI8 aCHIC KUHCy iHHiy i8
jiCiCHa aZOICHia. iCiCHa aZOICHia UC\COj8 WHCH aHIOiC_-
HaIiOH O KiUHCy DOOU HOW CaH HO OH_Ci HaiHIaiH _OHCiH
ai BIiaIiOH iaIC [L1}. Hi8 COHUiIiOH _CHCiay OCCHi8 iH
jaIiCHI8 WiIH a HCm aiICHa jiC88HiC DCOW HH _ UHI
Hay OCCHi aI Hi_HCi jiC88HiC8 iH iHU\iUHa8 WIH CHiOHiC KiU
HCy Ui8Ca8C CK) Oi iH IHO8C WHO IaKC HCUiCaIiOH8 IHaI CaH
aICi OCa _OHCiHai HCHOUyHaHiC8 8HCH a8 `bD18.
aLiCHI8 WIH jiCiCHa aZOICHia Hay Ha\C a Hi8IOiy O HHiU
O88C8 aHU UCCiCa8CU HHiU iHIaKC aCCOHjaHiCU Dy jHy8iCa
CXaHiHaIiOH BHUiH_8 COH8i8ICHI WiIH CXIiaCCHai HHiU \O-
HHC UCjCIiOH 8HCH a8 jO8IHia HyjOICH8iOH. OWC\Ci IHC8C
BHUiH_8 aiC aD8CHI U Hj IO D7 O jaIiCHI8 WiIH IH8 COHUi-
IiOH. àH8Ca \OHiIiH_ aHU aHOiCXia aCCOHjaHiCU Dy iCa-
Ii\Cy OW DOOU jiC88HiC iH IHC aD8CHCC O CUCHa Oi HiiHC
8CUiHCHI aDHOiHJiIC8 8IiOH_y 8H__C8I jiCiCHa aZOICHia.
DCHIC iHICi8IiIia HCjHiiIi8 Hay DC CaH8CU Uy H8C O CCiIaiH
UiH_8 iHCHUiH_ aHIDiOIiC8 aHU `b^18 aHU Ca88iCay HaH
iC8I8 a8 jyHiia CHKOCyIC Ca8I8 Oi CO8iHOjHi8 OH HiUay8i8.
C\Ci ia8H aHU DOOU CO8iHOjHiia a8O Hay DC jiC8CHI. HC
HiiHC 8CUiHCHI iH aCHIC IHDHai HCCiO8i8 H8Hahy 8HOW8 HHUUy
DiOWH Ca8I8 Oi IHDHai CjiIHCia CC Ca8I8. 1CHa \CiH IHiOH-
DO8i8 i8 aH HHCOHHOH CaH8C O aCHIC KiUHCy iHHiy a88OCiaICU
WiIH HCHaIHiia aHU HCjHiOIiCiaH_C jiOICiHHiia. Hi8 COHUi-
IOH i8 HO8I OHCH a88OCiaICU WiIH HCHDiaHOH8 HCjHiOjaIHy
Hai_HaHCy IiaHHa Oi HyjCiCOa_HaDC 8IaIC8. HC HOiHa
HiiHay8i8 HCj8 CXCHUC aCHIC UICi8IIia HCjHHIi8 aCHIC IHDH-
ai HCCiO8i8 aHU iCHa \CiH IHiOHDO8i8 a8 IHC CaH8C O IHi8
jaIiCHI8 iCHa UCCOHjCH8aIOH.
PO1T
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Suf8, oguf,hdhofmufhySS.
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!cllum ]A. Acutc kidncy injury. Crit Carc Mcd. 2008,3(suppl + ):Si+i-
Si+5. IMI: I8382i85]
lIOH HSWOt. L
bOUCBIOHB DOCIVO. 1lt0I dt00tItt ntbl00Iby
BtIb 0n 0ngt0hnitn ltttl 00tktr
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UO8COIHCO8JiIJH. !HCOHIiOCU HyCiICH8iOHJHUjiOICiH
HHJ JiC iHjOiIJHI HOGiBJDC ii8KJCIOi8 Oi jiO_iC88i\C KiU-
HCy Ui8CJ8C. OWCiiH_ DOOU jiC88HiC i8 CiiIiCJ iC_JiUC88 O
IHC HHUCiyiH_ Ui8CJ8C. Oi jJIiCHI8 WiIH CHiOHiC KiUHCy Ui8
CJ8C_uiUCHC8iCCOHHCHUDOOUjiC88HiCIJi_CI8O C88IHaH
1o/ HH _ Oi C88 IHJH 1ZO/7O HH _ WHCH 8i_HiB
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DiUiIy JHU HOiIJiIy JHU HiIHCiHOiC iHCiCJ8C8 JU\Ci8C 8iUC
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t8uf,dSUWdS8S8fUgf8SSU.
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IHCiCOiC IHC DC8I COHi8C O JCIiOH WOHG DC IO OOW IHC
jJIiCHICO8CyIOCH8HiCHCUOC8 HOI UC\COj HiCHlC8i_H8 Oi
8yHjIOH8OiOIHCi iHUiCJIiOH8OiGiJy8i8JHU 8Iii\COiIiJH8
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8iHH C\C. 1iKCWi8C HO iCJ8OH CXi8I8 IO jCiOiHJH JDUOHi
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Item 1 Answer:
Educational Objective: 1t0gH0t 00Ht dtt0t dHt h
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Educatonal Objectve: 1rt| h_trktmt Bt|h
tHPtH6nt tttnm gnt6Hh.
HC DCSI HHCUJIC IiCJIHCHI OjUOH S HIiJ\CHOUS CJCUH
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WJ\CSJWUCHH_OIHC_bbCOHjCXCSBJ1UH_SIHJIHU-
CJIC HyjCiKJCHC CJiUOIOXCIy H IHS jJICHI WIH CHiOHC
KUHCyUSCJSC. HCCHOCCOIiCJIHCHIOiHyCiKJCHJJHU
IHCJ__iCSS\CHCSSOISH1jCHCHIJIOHUCjCHUJi_CyOHIHC
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JHU HCUiOHUSCUJi HJHCSIJIOHS. HC JjjiOXHJIC iCJ
UOHSHjDCIWCCHCCCIiOCJiUO_iJjHCCHJH_CSJHUIHCSCiUH
jOIJSSUHCOHCCHIiJIOHSSUDSIJHIJyHOUBCUDyCHJH_CS
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CXJHjC WIH IHC SHHIJHCOUS jiCSCHCC O HyjOHJIiCHJ
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KJCHJHJyiCSUIHSCDOUSJHUjOICHIJyJIJCCCIDCJUS-
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J HCIJDOC JCUOSS. H IHC JDSCHCC O J CCUJi SH J OW
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Educatonal Objectve: JtgH6tt ttH dt0tht
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IiJUJDCICSHSjUUS.HSjJICHISCCJiyHyjCiOSHOJi JS
CSIHJICU Dy HUIjyH_ IHC SCiUH SOUUH C\C Dy 2 310
HOSHyK_ 310 HOyK_[ HOiHJ 275-295 HOSHyK_
275-295 H OyK_[]. HC JjjiOjiJIC iCHJ iCSjOHSC IO
HyjCiOSHOJIyS IO HJXHJy COHCCHIiJIC IHC UiHC [_CH
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iCSjOHSCSHOISCCHHIHSjJUCHI.HUSHCHJSCIHCiUJDCICS
HSjUUS Oi J SOUIC UUiCSS. 1 SOUIC UUiCSS S HOSI OHCH
CJUSCUDyH_Ci_yCCHJ.HSjJICHIUOCSHJ\CJjJSHJ_U
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DCCJUSCIHCiCHJIHiCSHOU Oi_UCOSC iCJDSOQIOH H HOSI
jCiSOHS S200 IO 225 H_yU 11.1 IO12.5 HHOy]. Ui-
IHCiHOiC 8OHIC GHiC88 8 H8Hay CHaiaCICi2CG Dy 8OIOHiC-
Iy O IHC HiHC WHCiCa8 IHi8 QaICHI Ha8 a HaiKCGy HyQOIOHC
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1yQCiO8HOai QaHCHI8 WI1OHI _HCO8Hia WHO HaVC 8HDHaX-
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8IH_H8HH_ DCIVCCH CCHIia aHG HCQHiO_CHC GaDCIC8
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Questons
TBH 1 jBasc]
/ 0yca: old vonan livmp in a nu:sinp lonc virl hIsroiy
oI dcncnria is adnirrcd ro rlc losiral virL ncunonia. In
rlc cnc:pcncy dca:rncnr, a c:ilc:al inr:avcnous linc vas
insc:rcd, a:o:iarc anriliorics vc:c iniriarcd, slc vas pvcn
oxypcn ly nasal cannula, and a u:ina:y carlcrc: vas laccd.
n lysical cxaninarion, rcnc:aru:c is 3.3C 101.0I},
llood :cssu:c is 140/ nn Hp, ulsc :arc is 100/nin,
and :csi:auon :arc is 16/ min. Iulnona:y ausculrauon :cvcals
lcn lovc: lolc c:acllcs. Ca:diac cxaninarion is no:nal. Mod
c:arc copniuvc inai:ncnr is norcd lur no inarrcnuon o: Iocal
ncu:olopic dccirs.
Slc is :ovidcd acccss ro lc: plasscs and lca:inp aid, and a
la:pc clocl and mplr liplr a:c in lacc in lc: :oon.
Whch ot thc toIIowng addnonaI stcps shouId bc takcn
to prcvcnt dcIrum u ths pancnt!
A} Adninisrci lcnzodiazcinc, as nccdcd
I} Adnimsrc: dilcnyd:aninc Io: slcc
C} Adninisrc: laloc:idol rvicc daily
I} Clccl viral sipns cvc:y 4 louis rl:oupl rlc niplr
Rcnovc lc: u:ina:y carlcrc:
TBH Z jBasc]
A 7yca:old vonan vas losiralizcd 4 days apo anci sus-
raininp a iiplr li nacru:c in a Iall. Slc undcivcnr su:pical
:cai: virl :iplr li :claccncnr 3 days apo and did nor Illy
avalc I:on pcnc:al ancsrlcsia unril 12 lou:s anc: cxrula
rion. . lc: alc:rncss las inc:cascd, slc las lcconc inc:cas
inply apirarcd. Jlc aricnr las a 4ycai lisro:y oI Alzlcinc:
dcncnria. Slc las no orlc: c:rincnr c:sonal o: Ianily ncd
ical lisro:y. Cu::cnr ncdicarions a:c doncczil, ncnanrinc,
and lovnolccula:vciplr lca:in.
n lysical cxaninarion roday, rcnc:aru:c is 37.2C
.0I}, llood :cssu:c is 100/6 nn Hp, ulsc :arc is
100/nin and :cpula:, and icsi:arion iarc is 1/nin. Jlc
aricnr can novc all Iou: linls virl pua:dInp oI rlc :iplr
lovc: hnl. Slc is inarrcnuvc and diso:icnrcd ro unc and lacc
and cxlilirs conlarivcncss alrc:narinp virl lypc:sonno
lcncc. Jlc :cnaindc: oI rlc ncuiolopic cxaninarion is un:c
na:lallc, wirlour cvdcncc oI Iocal Lndnps o: ncmnpsnus.
Whch ot thc toIIowng s thc most IkcIy dagoss!
A} Acurc sr:olc
I} Acurc vo:scninp oI Alzlcinc: dcncnria
C} Mcninpiris
I} Iosroc:arivc dcli:iun
ZTb
TBH d jAOvancCO]
A 75-yca:-old vonan virl a lisro:y oI cl:onic olsr:ucrivc
ulnona:y discasc is cvaluarcd in rlc inrcnsivc ca:c unir Ioi
dcli:iun. Slc lad a ncdian src:norony and :cai: oI an ao:
ric dissccrion and vas cxrularcd uncvcnrIIly on osroc:a
rivc day 4. Jvo days larc: slc dcvclocd Hucruarions in lc:
ncnral srarus and inarrcnrion. Wilc sul in rlc inrcnsivc ca:c
unir, slc lccanc apirarcd, ullinp ar lc: lincs, arrcnrinp ro
clinl our oI lcd, and aslinp ro lcavc rlc losiral. Hc: airc-
:ial llood pas valucs aic no:nal. Jlc aricnr las no lisro:y
oI alcolol alusc o: orlc: sulsrancc alusc. Jlc usc oI nc
qucnr o:icnrarion cucs, caln :cassuiancc, and :cscncc oI
Ianily mcnlc:s las donc lirrlc ro :cducc rlc aricnr's api
rarcd lclavioi. Mcdical cvaluarion idcnriLcs no Iocal ncu:o
lopic dcLcirs and no cvidcncc oI inIccrion o: ncralolic
alno:naliry.
Which ot thc toIIowng s thc most appropratc thcrapy!
A} Iilcnlyd:aninc
I} Haloc:idol
C} Lo:azcan
I} I:ooIol
TBH R jBasc]
A 36-yca:-old vonan is cvaluarcd in rlc cnc:pcncy dca:r
ncnr Io: a 3-day lisro:y oI conIsion and Ialls. Jlc aricnr
livcs alonc and is acconanicd ly lc: ncipllo: vlo says rLar
rLc aricnr's synrons sccn ro lc pcrrinp voisc. Jlc aucnr
las a 1 0-yca: lisro:y oI cl:onic alcololisn and las lad :cccnr
vciplr loss duc ro dia::lca. Slc ralcs no ncdicarions.
n lysical cxaninarion, rcnciaru:c is 35.6C 6.0I},
llood :cssu:c is 142/76 nn Hp, ulsc :arc is 0/nin, :cs-
i:arion :arc is 14/nin; IMI is 17. Jcno:al nusclc vasr
inp, sumcn su:aclavicula: Iossac, and alscnr adIosc sro:cs
a:c norcd. Aldoninal cxaninarion ndinps a:c no:nal. n
ncu:olopic cxaninarion, rlc aricnr is conIscd; slc is unallc
ro srarc rlc darc and docs nor lnov rlc nanc oI rlc losi
m. Mailcd lo:izonral nysrapnus is norcd. Jlc:c is no nuclal
:ipidiry o: olvious noro: vcalncss. Icc rcndon :ccxcs a:c
:cduccd, and lanra: icsonscs a:c Hcxo:. Jlc aricnr las a
nailcdly araxic pair.
Whch ot thc toIIowng s thc bcst nnaI managcmcnt!
A} lccr:ocncclalop:aly
I} Halocndol
C} Jlianinc
I} \anconycin, anicillin, and cciaxonc
Z1b NeurOlOQy
I1em 5 jAOvanCCOj
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C HaS \SHa HaHCHaIOHS aHU DCC\CS HC SCCS mCC H IHC
iC_CiaIOi. S HCUCa HSIOiy HCHUCS IyjC Z UaDCICS HC-
IHS WIH jm jCijHCia HCHiOjaIHy COiOHaiy aiICiy US
CaSC UCiCSSOH aHU HCaiI !aHiC. CUCaIOHS aiC _yDHDUC
HOiIijIyHC U_OXH OiaZCjaH HCIOjiOO SHOji
aSjDH aHU jia\aSIaIH. C UOCS HOI iCHCHDCi HOW OH_ HC
HaS DCCH IaKH_ IHCSC HCUCaIOHS aHU ! IHCiC Ha\C DCCH aHy
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SOHay HSHay WHC WIH a WCCKCHU HCa.
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aiC HOiHa OXy_CH SaIHiaIOH S HOiHa WIH IHC jaICHI
DiCaIHH_ aHDCHI J. C S HaIICHI\C aHU HOI OiCHICU IO
IHC Oi jaCC. S SCOiC OH IHC HCHIa bIaIC 1XamHa
IOH S J/ [Z/ U HOHIHS a_O}. CSHIS O! aDOiaIOiy
SIHUCS HCHUH_ CCCIiOyIC C\CS aHU \Ci CHCHSIiy aHU
iCHa HHCIOH SIHUCS aiC HOiHa. / O! IHC DiaH S
HOiHa.
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[L} CjiCSSOH
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HHHICS IO IHC CH aiH aHU C_ CHHSHCSS O! IHC CH HaHU
IHaI DC_aH HHHICS a_O aHU a SHDSCqHCHI i_HISUCU
IHiODDH_ HCaUaCHC aHU HaHSCa. JHS S IHC hiSI IHC SHC HaS
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COHIiaCCjI\C j.
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SHiC S J+/Z HH _ jHSC iaIC S JJ/HH aHU iCSjia-
HOH iaIC S Z/ HH. / OIHCi CXaHHaHOH hHUH_S aiC HOiHa.
CSHIS O! aDOiaIOiy SIHUCS aHU a LJ SCaH O! IHC HCaU aiC
aSO HOiHa.
YCD Ol lDc lOllOWu_ S lDc uOSl lKcly Ua_OSS
_iaHC WIH aHia
[1} HIjC SCCiOSS
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I1em 7 jaslCj
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SHiC H IHC DaCK O! IHC HCaU. bHC HaS HO HaHSCa aHU CaH COH
IHHC IO WOiK UHiH_ IHC HCaUaCHCS. bHC HaS HaU IHCSC
HCaUaCHCS SHCC a_C J yCaiS aHU HOICS IHaI IHCy HOW SCCH
IO DC HOiC !iCqHCHI aHU aSSOCaICU WIH CSS SCCj aHU
HCiCaSCU SIiCSS. YHCH IiCaICU WIH DHjiO!CH Oi aCCIa
HHOjHCH IHC HCaUaCHCS aDaIC H HHHICS HHIiCaICU IHCy
aSI SC\Cia HOHiS. bHC IyjCahy HSCS HCaUaCHC HCOCaHOH !OHi
IO SX IHCS jCi HOHIH.
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H_S OH IHC _CHCia jHySCa CXaHHaIOH hHUH_S HCHU
H_ IHOSC OH a HCHiOO_C C\aHaIOH aiC HOiHa.
YCD Ol lDc lOllOwu_ S lDc uOSl lKcly Ua_OSS
LHiOHC Uay HCaUaCHC
[1} LHSICi HCaUaCHC
[L} _iaHC HCaUaCHC WIHOHI aHia
[} JCHSOHIyjC HCaUaCHC
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CHCi_CHCy UCjaiIHCHI !Oi IHC SHUUCH OHSCI O! a SC\CiC OCCj
Ia HCaUaCHC UHiH_ UC!CCaIOH HOHiS a_O !OOWCU Dy IWO
CjSOUCS O! \OHHH_. JHC HCaUaCHC iCaCHCU HaXHHH H ICH
S| WIHH SCCOHUS. bHC HaS HC\Ci HaU a HCaUaCHC KC IHS
DC!OiC. bHC iCOiIS HO HCCK SIHCSS Oi HCHiOO_C SyHjIOHS.
Ci HOIHCi aHU IWO SSICiS Ha\C a HSIOiy O! H_iaHC.
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DOOU jiCSSHiC S J+/ HH _ jHSC iaIC S V/mH aHU
iCSjiaIOH iaIC S Z/HH. JHC jaICHI S H S_HhCaHI US
IiCSS aS a iCSHI O! IHC jaH. JHCiC S HO C\UCHCC O! HCHH_S-
HHS jajCUCHa Oi !OCa HCHiOO_C S_HS.
YCD Ol lDc lOllOw_ S Uc uOSl aQQtOQtalc ucXl SlcQ
u uaua_cucul
LJ aH_O_iajHy O! IHC HCaU aHU HCCK
[1} HHDai jHHCIHiC
[L} ÒHCOHIiaSI LJ O! IHC HCaU
[} bHDCHIaHCOHS aUmHSIiaIOH O! SHHaIijIaH
I1em 9 [aslCj
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H_iaHC !iCqHCHCy aHU SC\CiIy O\Ci IHC jaSI U HOHIHS.
_iaHC aIIaCKS WHCH !OiHCiy OCCHiiCU IWO Oi IHiCC ImCS
CaCH HOHIH aiC HOW OCCHiiH_ ajjiOXHaICy IHiCC IHCS
CaCH WCCK WIH CaCH aIIaCK aSIH_ aI CaSI JZ HOHiS. bHC HaS
HO OIHCi HCUa jiODCHS aHU IaKCS OHy aHOIijIaH aS
HCCUCU !Oi aCHIC H_iaHC.
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jHySCa CXaHHaHOH HCHUH_ a HCHiOO_C CXaUHaIOH aiC
HOiHa.
1 O! IHC DiaH SHOWS HO aDHOiHaICS.
YCD Ol Uc lOllOWu_ S lDc uOSl aQQtOQtalc UcaUcul
lOt lhS QaDcul
1OIHHHH IOXH
[1} iOjiaHOO
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TBH j8asc]
D byCuiOU WOHuH S C\uHuICU iH IHC CHCi_CHCy UCjuiI-
HCHI uHCi SHC WuS WIHCSSCU Ui\H_ CiiuHCuy OH u CIy SIiCCI.
HIuy, IHC juICHI WuS HHuDC IO uHSWCi uHy qHCSIOHS uHU
HuU U1CHIy WIH HCi SjCCCH. JWCHIy HiHHICS uICi, HCi
SjCCCH WuS HU, uHU, uIHOH_H SHC UU HOI Hu\C uHy iCCO-
CCIOH O IHC juSI CW HOHiS C\CHIS, SHC WuS uDC IO jiO\UC
SOHC UCIuS O HCi iC, HCHUH_ HCi HHSDuHUS HuHC. YCH
HCi HHSDuHU uii\CU, IHC juICHI WuS uDC IO iCCO_HZC HiH,
DUI ! HHHICS uICi SHC UiU HOI iCCO_HZC HiH. O C\UCHCC
O HuHCHuIOHS Oi UCHSOHS CXSIS.
JHC HHSDuHU iCjOiIS IHuI IHC juICHI HuS HuU u _iuUHu uHU
jiO_iCSS\C CO_HI\C HjuiHCHI O\Cl IHC jiC\OHS b yCuiS
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iOuHS uDOHI IHC HOHSC. bHC HuS CHiOHiC jiODCHS WIH HCi
HCHOiy uHU HuHu_H_ uCI\ICS O Uuy \iH_.
YCD ol thc lohowng is thc most IikcIy diagosis
[D] iCiiHH
iCiHH SHjCiHjOSCU OH UCHCHIu
[\] iCHCHIu
[i] SyCHOSiS
TBH j8aslC]
D ! yCuiOU HuH iS C\uHuICU Oi HCHOiy UiHCHIy IHuI,
uCCOiUH_ IO HS WiC, DC_uH HSUiOHSy Oi yCuiS CuiCi. C
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C\Ci8jiC8CHIJCiO88IHCIHOiJX. CHIJ8IJIu8JH_uJ_CJHU
CiJHiJ HCi\C HHCIiOH JiCHOiHJ.
\OHjCIC DOOU COuHI iC8uI8 CiyIHiOCyIC 8CUiHCHIJIiOH
iJIC 8CiuH CiCJIiHiHC JHU CiCJIiHC KHJ8C C\C8 JHU i\Ci
CHCHi8IiyIC8IiC8uI8JiCHOiHJ.
P CHC8I iJUiO_iJjH 8HOW8HO JDHOiHJiIiC8.
YDO O tDC OllOWD_ 8 tDC uO8t lKCly Ua_O88:
[P] PHyOIiOjHiC JICiJ8CCiO8i8
[1] iJDCIiC HCuiOjJIHy
[\] LuiJiH1JiiC 8yHUiOHC
[] yCOjJIHy
TH Z7 jBaslCj
POyCJiOUWOHJHi8C\JuJICUiHIHCOHCCOiJOHOHIH
Hi8IOiy O ii_HIHJHU HuHDHC88 JHU IU_iH_. HC 8Jy8 IHJI
IHC8C 8yHjIOH8 iH\O\C IHC CHIiiC HJHU 8CCH IO DC WOi8C
WHCH8HCUD\C8OiHOU8JDOOKOiHCW8jJjCiJHUHJ\CDCCH
JWJKCHiH_ HCi JI H_HI. HC iCjOiI8 HO Hi8IOiy O HCCK jJU
Oi HJHU WCJKHC88. Ci8OHJ JHU HCUiCJ Hi8IODC8 JiC
HOHCOHIiiDuIOiy JHU 8HC IJKC8 HO HCUiCJIiOH.
LCHCiJjHy8iCJ CXJHHJIiOH iC\CJ8HO JDHOiHJiIiC8. Cu
iOO_iC CXJHiHJIiOH 8HOW8 HOiHJ 8IiCH_IHDuI 8CH8Oiy O88
iH IHCHi8I UiCC Ui_iI8 JHU HC iJUJ HJ O IHC OuiIH Ui_iI
U IHC ii_HI HJHU.
YDCD O tDC OllOWD_ 8 tDC uO8t lKCly Ua_O88:
[P] \JQJ HI1C8yHUiOHC
[1] UC _uCi\JiH ICHO8yHO\iIi8
[\] LJH_iOHCy8I8
[] lHJiHCi\CCOHjiC88iOH [LuyOH IuHHC8yHUiOHC]
TH Z
1 ODCSC yCaiOU HaH HaS HaU HCiCaSH_ jaH aU IH-
_H_ H HS CCI Oi HOiC IHaH o HOHIHS. HC jaICHI HaS HOI
SCCH a jHySCaH H HOiC IHaH Z yCaiS. S OHy OIHCi SyHj-
IOHS aiC aI_uC Duiiy \SOH aHU HOCIuia. C IaKCS HO
HCUCaIOHS.
\H CXaHHaIOH VIa S_HS aiC HOiHa i S o. CSuIS O
SKIH OjHIHaHOSCOjC CaiUOjuHOHaiy aHU aDUOHHa
CXJHaIOHS aiC HOiHa. \H HCuiOO_C CXaHiHaIOH HC HaS
SCHSOiy OSS H IHC CCI aU USIa C_S. uSCC SIiCH_IH aHU
iCuCXCS aiC HOiHa.
Wch ot thc toIIowng tcsts W most mcly dagosc thc
cusc ot thc ncmoIogc ndngs?
^) \iCaIHC KHaSC C\C
[i} aSIH_ DOOU _uCOSC C\C
[\] uHDai juHCIuiC aHU CCiCDiOSjHa HuU aHaySS
,I) buia HCi\C DOjSy
NeurOOgy 221
>CC!O d
MGUtOO@
DSWfS BDO LflIlQUS
|tem 1 Answer. E
Educatonal Ob]ectve. 1ltVtHl B/lHm H g0ltHD
0l bgb lIk.
1UCiy [JIiCHI8 WiIH J Hi8IOiy O UCHCHIiJ JiC JI vCiy Hi_H
H8K Oi UCvCO[iH_ UCiiiHH UHHH_ J HO8[iIJiZJIiOH. Cbi
iHH i8 JH JCHIC 8IJIC O COH!8iOH IHJI HJy HJHiC8I J8 J
iCUHCCU CvC O COH8CiOH8HC88 CO_HiIivC JDHOiHJbIiC8 [Ci
CC[IHJ Ui8IHiDJHCC8 Oi CHOIiOHJ Ui8IHiDJHCC8. iCvCHIiOH
iHvOvC8 JUUiC88iH_ HCUiCJ JHU CHviiOHHCHIJ i88HC8. lii
HJiy CJIHCICi8 JiC J88OCiJICU WiIH HCiCJ8CU H8K O UCIiiHH. H
IHC JD8CHCC O J HCUiCJ iHUiCJIiOH Oi J CJIHCICi [C._. iCiCvC
HHHJiy iCICHIiOH HOHIOi LHiU 8IJIu8 iH JCHICy u [JIiCHI8
WHCH IHi8 UiiCCIy iH[JCI8 HCUiCJ IiCJIHCHI HJHJ_C [JHCHI8
WiIH 8IJ_C 3 Oi 4 [iC88HiC HCCi8 OH IHC DHIIOCK8} iI 8HOHU
DC iCHOvCU.
CHZOUiJZC[iHC8 JHU Ui[HCHHyUiJHiHC HJvC 8CUJIH_ CHCCI8
DHI CJH CJH8C UCiiiHH iH IHC CUCiy. HCy 8HOHU _CHCiJy DC
JvOiUCU HHC88 J 8[CCiBC iHUiCJIiOH i8 [iC8CHICU 8HCH J8 DCH
ZOUiJZC[iHC8 Oi JCOHO VUUiJWJ Oi Ui[HCHHyUiJHHC Oi
JH JCi_iC iCJCIiOH. /ICiHJIivC HOH[HJiHJCOO_iC HCIHOU8
Oi iCJXJIiOH iHCHUC HH8iC HJ88J_C JHU HCUiIJIiOH.
H J[[iO[HJIC 8CCCICU [JHCHI8 WiIH 8CvCiC UCiiiHH OWUO8C
HJO[CiiUO HJy C88CH IHC 8CvCiiIy JHU UHiJIiOH O UCbiiHH
DHI iI i8 HOI iHUiCJICU Oi IHC [iCvCHIiOH O UCiHHH. HC H8C
O JHIi[8yCHOIiC HCUiCJIiOH8 iH CUCiy [JIiCHI8 WiIH UCHCH
IiJ i8 J88OCiJICU WiIH JH iHCiCJ8CU ii8K O UCJIH [iiHJiiy UHC
IO iHCCIiOH 8HCH J8 [HCHHOHiJ. . HOiHJ 8CC[WJKC CyCC
8HOHU DC HJiHIJiHCU J8 HHCH J8 [O88iDC HZiH_ iHICi
iH[IiOH8 Oi HHHCCC88Jiy IC8IiH_ UHiiH_ UC Hi_HI JHU KCC[
iH_ J b_HI OH JHU iHCiCJ8iH_ 8IiHHJIiOH UHiiH_ IHC UJy.
CCSS 0 dIlBg dl0S, gdSSS, dB0 CdBS dB0 Im0Vd 0 uBBCS
SdI ISIdlBS dB0 dIlBdI CdIS dI 0dSlC I0C0uIS 0
I0uC IlSK 0 0lIlum lB IS0BS d IlSK.
DlC_aQDy
inOuyc SK. !cl|r|um m O|dcr crsOns. ` ng | Ncd. 2UU;3+(11}:
117-. INI!: 1+U1]
ZZZ
|tem Answer.
Educatonal Objectve. 10gH0It g0Ihgtl0lVt B/l~
Hm H 0 g0ltHl Wlb BmtHl0.
HC HO8I iKCy UiJ_HO8i8 i8 [O8IO[CiJIivC UCiiiHH. JHCHI8
WiIH UCmHH HJvC JCHIC HHCIHJIiH_ HCHIJ 8IJIH8 CHJH_C8
WiIH UiHCHIy iH OCH8iH_ Oi HJiHL_ JIICHIiOH JHU Ui8Oi
_JHiZCU U_. J8CU OH [8yCHOHOIOi JCIiviIy IHCiC JiC
OHi Iy[C8 O UCiiiHH. I) Hy[OJCHvC 2) Hy[CiJCIivC 3) HiXCU
UCiiiHH WiIH H_O JHU Hy[CiJCIiviIy JHU 4) UCiiiHH WiIH
OHI CHJH_C8 iH [8yCHOHOIOi JCIiviIy. CiiiHH iH CUCiy
[JIiCHI8 VIH CHiOHiC UCHCHIiJ H8HJy iC8HI8 UOH JH JCHIC
HCUiCJ [iODCH. H JUUiIiOH [JIiCHI8 WiIH CHiOHiC UCHCH
IiJ UOH JHO8I JHy CJH8C JiC JI _iCJICi ii8K Oi UCmHH JHCi
8Hi_Ciy WiIH _CHCiJ JHC8IHC8iJ. Hi8 [JIiCHI VIH J Hi[ UJC
IHiC WHO HHUCiWCHI ii_HI Hi[ 8Hi_Ciy VIH _CHCiJ JHC8IHC
8iJ JHU UiU HOI iCCOvCi UOH IHC JHC8IHC8iJ mu12 HOHi8 JHCi
CXIHDJIiOH HO8I iKCy HJ8 [O8IO[CiJIivC UCmHH. bHCH UCii
iHH i8 Hi_Hy [iCUiCIJDC JHU OHCH CJ8iy HJHJ_CU Dy iUCHIi
BCJIiOH JHU COiiCCIiOH O J HHUCiyiH_ Ui8OiUCi8 JHU IHC
iCHOvJ Oi iCUHCIiOH O COHIHDHIiH_ JCIOi8.
HC [O88iDiiIy O JCHIC 8IiOKC HH8I DC COH8iUCiCU iH J [JIiCHI
VIH J CHJH_C iH HCHIJ 8IJIu8. OWCvCi IHi8 [JHCHI HJ8 HO
CiHiCJ C\UCHCC O 8HCH JH CvCHI WHiCH HJKC8 IHi8 UiJ_HO8i8
CXIiCHCy HHiKCy.
bHi_Ciy UOC8 HOI CXJCCiDJIC /ZHCiHCi UCHCHIiJ [Oi UCHCH
IiJ O JHy OIHCi CJH8C} DHI iJIHCi [iOUHCC8 J 8H[CiiH[O8CU
UCiiiHH. iHJy UCHCHIiJ UOC8 HOI JCHICy WOi8CH OvCi 8Cv
CiJ HOHi8 IHC UCCiHC i8 8ICJUiy [iO_iC88ivC.
Hi8 [JIiCHI HJ8 HJU UCHCHIiJ Oi 4 yCJi8 IHJI HJ8 JDiH[Iy
_OIICH WOi8C JHCi 8Hi_Ciy. /IHOH_H HOI iH[O88iDC HCHH
_iIi8 i8 Hi_Hy HHiKCy iH IHi8 8CIIiH_ C8[CCiJy _ivCH IHC
JD8CHCC O JHy 8H[[OiIiH_ [Hy8iCJ CXJHiHJIiOH BHUiH_8
iHCHUiH_ HCm_CJ iiiiIJIiOH.

dlBS Wl CI0BlC 0mBd dI d gIdI IlSK 0I 0IlUm
dI SuIgI Wl gBId dBSSld.
DlC_aQDy
udOlI |I, |Oncs , asmusscn I, S|lvcrstc|n |I, inOuyc SK,
NarcantOn|O Iindccndcnt vascu|ar and cOgn|bvc nsk LctOrs IOr Ost-
Ocrat|vc dc||r|um. A | Ncd. 2UU7;12U(V}:U7-1o. INi!:
177U1]
ItemS Answer:
Educational Objective: 1rt0I mtrtnm tn Ibt tnn
:tPt t0rt nntI wtIb 0n 0nIt:)tb6Itt 0gtnI (b06trtd6).
CajjiOjiaICIiCaIHCHIOiISjaHCHISaOjCHUO.YCH
SUjjOiI\C CaiC S HSUHCCHI Oi jiC\CHIOH Oi IiCaIHCHI O
UCiUH SyHjIOH COHIiO WI HCUCaIOH S OCCaSOHay
HCCCSSaiy IO jiC\CHI aiH Oi IO aOW C\aUaIOH aHU IiCaI-
HCHI H IC HICHS\C CaiC UHI. C iCCOHHCHUCU IHCiajy
Oi UCiUH S aHIjSyCOIC a_CHIS aIOU_ HO UiU_S aiC
ajjiO\CUDyICl..OOUaHUiU_/UHHSIiaIOHOiIHiS
HUCaHOH.\H_OH_iaHUOHZCUjaCCDO-COHIiOCUIiaSaiC
H\CSH_aHH_UHCiCHIHaHa_CHCHISIiaIC_CSOiHICHS\CCaiC
UHI UChU ./ iCCCHI SySICHaIC C\UCHCC iC\CW OUHU HO
C\UCHCC O SUjCiOHIy Oi SCCOHU-_CHCiaIOH 1IjSyCOICS
COHjaiCUWIaOjCiUOOiUCiUH.aOjCHUOUOCSHOI
CaUSC iCSjiaIOiy SUjjiCSSOH WC S OHC iCaSOH IaI I S
OHCHUSCUHjaICHISWIyjO\CHIaIOiyiCSjiaIOiyaUiC
WOiCqUiCSCUaIOH.. aHIjSyCOICa_CHISaHUCSjCCay
ÌyQCa a_CHISSUCaSaOjCHUOjOSCaiSOIOiSaUCSUC
jOHICSCXIiajyiaHUaSUCCHCCISaHUICHCUiOCjHCHa_-
HaHI SyHUiOHC.
jCHyUiaH1iHC aHU OICi aHIUSIaH1CS aiC a HaOi HS
aCIOiOiUCiUHCSjCCay H OUCi jaICHIS.OiaZCjaHS
aCIUayUCDO_CHCaHU IS USC H a UCiOUSjaICHISOUU
DC CaiCHy iC-C\aUaICU CXCCjI jCiajS H jaICHIS CXjCi-
CHCH_DCHZOUaZCjHCWIUiaWaOiUChiU IiCHCHS.CiC
SLO C\UCHCC UaIjiOjOOaSaHyiOCH IiCaIH_ UCiU .
KTX PO1Y
N0 0IUg lS dI0VE0 hE U.b. 000 dB0 IUg 0mlBlSIdl0B 0I
hE IEdmEB 0 0EllIlUm, U CllBlCdl IdClCE gUl0EllBES IEC0m-
mEB0 dBlSCh0lC dgEBS, SUCh dS hdl0EIl00l.
1DO_aQhy
\JHQDC |Ou8!JHl D D\uD D C! J. HJiHJCOO_lCJ HJHJ_CHCH!
O! UCliluH lH HO8Ql!JlZCU JUu!8J 8y8!CHJllC C\lUCHCC iC\lCW. | LCH
H!CiH CU. 2V2+(].+-Dc. . 1V+2+c[
ItemA Answer:
Educational Objective: Jt0gn6:t 0nd Dt0I Wtrnttkt
tnttb060Ib) dnt h Ibt0mtnt mtttnt).
S jaICHI SOUU iCCC\C IIaH1iHC HOW aS IHC DCSI HIa
HaHa_CHCHI.CaSYCiHCCCHCCjaOjaIy aSyHUiOHC
IaIiCSUISOHUCCCHCyOVIaH1IHaHHjOiIaHICOCH-
ZyHC H SC\Cia DOCCHCa jaIWayS O IC DiaH. yjCa
CIHCa HaHCSIaIOHS O IC USOiUCi HCUUC HCHIa SIaIHS
CaH_CS HySIa_HUS OjIaHOjC_a aHU UHSICaUy _aI a
\aiyH_HHICHSIyOHHHOiIOSC\CiC.YHCHICiCSa UU-
IOHa OSSOHCHOiyWIaCOHaDUaIOiyjSyCOSSICCOH-
GIOHSUCSCHDCUaSYCiHCC-OiSaOHSyHUiOHC.CCaS-
SCa CHCa IiaU O _aI aIaXa CHCCjaOjaIy aHU
OjIaHOjC_aSSCCHHOHy V7OaHCCICUjaHCHIS.\OH
UIOHS aSSOCaICU WI YCiHCC CHCCjaOjaIy HCUUC
/ aCOOaDUSC CaHCCi yjCiCHCSS _ia\UaiUH jiO-
NeurCCQy 223
OH_CUIOIaQaiCHICiaHUIiIOHjOSISUi_CaSIaIUS [jaiHCU-
aiyDaiaIiCSUi_CHCS]aHU_UCOSCOaU_m ajiCUSjOSCU
jaICHI].
CCaUSCYCiHCC CHCCjaOjaIy iCHaHS a CHCa Ua_HO-
SS OICi HCUiOO_C USOiUCiS SOUU DC COHSUCiCU H IS
jaICHI aHCi IHaHHC aS DCCH aUHHSICiCU. CCIiOCH
CCjaO_iajy CaH Cj CXCUUC a SCZuiC USOiUCi SUC aS
HOHCOH\US\C SIaIUS CQCjICUS. HCCIOHS HCUUH_
CHCCjaIS aHU HCHH_IS Oi WC HIia\CHOUSaUHHS-
IiaIOH O DiOaU-SjCCIiUH aHIDOIC UiU_S [SUC aS \aH-
COHyCHaHjCHaHUCCHiaXOHC]HayDCajjiOjiaICaSO
SOuUDCjalIOICUHCiCHHaUa_HOSSaHUCaHDCCXCUUCU
WICCiCDiOSjHa HUU aHaySS.
aOjCiUO S HOI HUCaICU B IS jaICHI WO S COHHSCU
DUI aS HO ajjaiCHI SIOiy O jSyCOSS Oi a_IaIOH. OHC
jaHCHISWIYCiHCCCHCCjaOjaIyUOa\Ca_IaHOHa-
UCHaIOHS aHU DCa\Oia USIUiDaHCCS IHaI CaH HHC aH
aCUICjSyCOSS.
O
WEIBlCkE EBCEhdl0dh lS CdUSE0 hldmlBE 0ElClEBC dB0
md IESUl lB mEBdl SdUS ChdBgES, 0hhdlm0lEgld, SdgmUS,
dB0 UBSEd0 gdl, l lS ES IEdE0 Wlh hldmlBE.
1DO_aQDy
bCCHl L bCiiJ D. YCIHlCKC8 CHCCQHJOQJ!Hy. HCW CHlCJ 8C!UH_8 JHU
iCCCH! JU\JHCC8 lH UlJ_HO8l8 JHU HJHJ_CHCH!. JHCC! CuiO.
2(D].++2-+DD. . 1+c+VV[
Item Answer:
Educational Objective: Jt0gn6:t mtdt0It6n
tndnttd mtrtnm.
C HOSI Cy Ua_HOSS S IOXC CHCCjaOjaIy jiCSCHIH_
aS UChiUH. CiUH S aH aCUIC SIaIC O COHHSOH IaI Hay
HaHCSIaSaiCUUCCUC\COCOHSCOUSHCSSCO_HH\CaDHOi-
HaICS jCiCCjIUa USIuiDaHCCS Oi CHOIOHa USIuiDaHCCS.
C jiCSCHCC OaSICHXS SU__CSIS aIOXC/HCIaDOCCaUSC O
IHiSjaICHISSyHjIOHS.CjaICHISIaH_SC\CiaHCUCa-
IOHS IaI H_I Hjai CO_HIOH. / jiHC SUSjCCI S HOi
IijIyHC,ISUiU_aSaHICOHCi_CjiOjCiICSaHUSCy
IO CaUSC HjaiHCHI H jaICHIS WII aICHI COhHCi_C UC-
CCHCyICCUCfyOijaICHISWIHUCO_HH\CHjaiHCHI
Caiy UCHCHIa Oi aiHSOH USCaSC]. _OXH JHU IC SCUa
I\C-yjHOIC OiaZCjaH Hay aSO COHIiDUIC IO CO_HI\C
HjaiHCHI.
yHjIOHS O aCOO WIUiaWa HOSI |Cay OCCUi aHCi
CCSSaIOH O jiOOH_CU SUSIaHCU aCOO HIaC. OWC\Ci
HOSIjCOjCUiHHaHCjSOUCaSOHaSUSDaICUDyIHiS
jaICHIaHUISjaIICiHOU_SHOIaSSOCaICUWISUS-
IJIHCU _H DOOU JCOHO C\CS IHaI aiC lCqUSIC Oi WIIH-
UiaWaSyHjIOHS OHaDiUjICCSSaIOH./COOhC aUtHOSS
UC\COjS Z IOZ+OUiSaHCiICaSIUJHUlCSO\CWIH
Z+IO+ OUiSaSyHjIOHaICjClOUHUCSOiICiIHaHIaI
CXjCiCHCCU Dy IHS jaICHI. aUCHaIOHS aiC USUay VSUa
224 ` Neu|CCQy
aHUaiCHOIaSSOCaICUWIHCOUUH_OIHCSCHSOiUHaHUaiC
HOIaSSOCaICUWiIHaSICDS.
H jaICHIS WIH Caiy 1ZHCHCi UCHCHIa UCiUH S jiO
UUCCUHOiCiCaUyDyaHUCHOHCi_CHCUCaUOHS..ZHCHCi
UCHCHIaCaHHOIDCiUCUOUIHIHSjaICHIDUICSIaDiSHiH_
IHC Ua_HOSS WOUU iCqUiC iCHO\a O IHC CaUSaIi\C a_CHI
aHU iC-C\aUaIOH aHCi iCCO\Ciy. OWC\Ci aSICiXS a S_HO
HCIaDOC CHCCjHaOjaIHy WOUU DC UHUSUa H IHS SCIIH_
aHU jOHIS SIiOH_y IO a HCIaDOC CHCCjHaOjaIHy aHU HOI
UCHCHIa.
CjiCSSOH Hay CaUSC CHIOHC CO_HI\C HjaiHCHI [jSCU-
UOUCHCHUa}aHUU CUIy COHCCHIiaUH_DUIHOIaSICHXSaHU
aH aICiCU C\C O COHSCOUSHCSS.
KEX P0 | __
L0ghtv8mpIm8htcc0mph8dbyluctuthg|8thIgyhd
htt8ht0h,hucht0hS,hdSt8IxSm0St |k8yI8SutSlI0m
t0xc8hc8ph0pthy.
1DlO_aQHy
!nouyc SI. Oc|irium in o|dcr pcrsons crratum in !ng| | Mcd.
200;354:155]. !ng| | Mcd. 200;354(11):115-115. IM!O:
15401]
ItemB Answer: A
Educatonal Ob]ectve: 1t0gW0it mtgI0tWt bt000tbt
Btlb0I0.
HiSjaICHI S HOSI HCyCXjCiCHCH_ aH_iaHC WIH aUia.
1jjiOXHaICy D7 IOZ7 O jaICHIS WiIH H_iaHC CXjCi-
CHCC aUia WIHH HOUi O Oi UUiH_ HCaUaCHC. 1Uia COHSI
IUICS HCUiOO_C aDHOiHaICS HCUUH_ \SUa OSS HaUC
HaIOHS HUHDHCSS IH_iH_ WCaKHCSS Oi COHHSOH. 1Uia S
CaUSCUDySjiCaU_COiICaUCjiCSSOHaWa\COaDHOiHa
CCCIHCa UiSCHai_CS IHaI Lia\C SOWy aCiOSS IHC DiaHS SUi-
aCCaHUCSSCHIaySHOiI-CHCUIIHCDiaH. yjCayaUiaaSIS
aCWHHUICSDUIHayaSIUjIO HOUijCiSyHjIOH.1UUi
IOHaCHCaCUCSSUjjOiIH_aUa_HOSSOH_iaHCaiCIHC
jaICHIS yOUH_ a_C IHC aDSCHCC O \aSCUai iSK aCIOiS aHU
IHCaHIy HSIOiy OH_iaHC. HaUUIOH IHC USCHCSSO
IHSjaICHISSyHjIOHSaHUIHCIjiO_iCSSOHaiCHOiCCOH-
jaIDC WIH H_iaHC IHaH a OCa \aSCUai jiOCCSS SUCH aS a
IiaHSCHI SCHCHC aIIaCK.
1IHOU_HHULjCSCCiOSSMS) SHOUUDCHIHCU CiCHIa
Ua_HOSS O HCUiOO_Ca SyHjIOHS H a yOUH_ WOHaH IHS
jaICHI S CSS KCy IO Ha\C MS IHaH a H_iaHC Oi SIiOKC
DCCaUSCHCijiCSCHIaIOHWaS HOiCaCUICIHaHWOUUDCIyj
CaHMS, aHUMS SHOII_CayaSSOCaICUWIHaIHiODDH_
HCaUaCHC.
aiIa SCZUiCS H WHCH IHC jaICHI HaHIaHS H aWaiCHCSS
aiCCaSSBCUaSSHjCjaiUaWHCiCaSIHOSCH\O\H_aHaICi-
aIOHO COHSCOUSHCSS aiC CaSSBCU aS jaiIa COHjCX. aiIia
SCZUiCS IHaI OH_HaIC H IHCICHjOiaODC OHCH DC_H WIH
aHaUiaWHCHHayCOHSSIOaCCH_OUCJ aiSH_Cj
_aSIiC SCHSaIOH Oi aUIOHOHC USIUiDaHCCS. 1UIOHaISHS
SUCH aS j SHaCKH_ aiC aSO SU__CSI\C O jaiIa COHjCX
SCZUiCS DUIaIHiODDH_ HCaUaCHCWIH HaUSCaS HOI.
i_CHHa HCUia_a S aSSOCaICU WIH jaH OCCUiiH_ H
jaiOXySHSIHaIH\O\CSOHCOiHOiCU\SOHSO IHCIii_CH
Ha HCi\C. aCH CjSOUC Hay jCiSSI DCIWCCH a CW SCCOHUS
aHU Z HIHUICS aHUjaH Hay DC HICHSCy SHaQ Oi SIaDDH_.
CHa\Oi SUCH aS aCC WaSHH_ Oi IOUCHIH_ IOOIH DiUSHH_
OiCHCWiH_HayIi__CiaHC\CHI. HCjaICHISSyHjIOHSaiC
HOI COHSSICHIWIHIi_CHHaHCUia_a.
KN 1
b8tW88h 1Vhd V 0lpt8htSWthmgIh88xp8I8hc8uI
Wthh 1 h0uI0l0IduIhgh8dch8 chIct8I28d byvI8ty0l
h8uI00gc Sympt0mS, hcudhg vSu0SS,hucht0hS,humb-
h8SS, thghg, W8kh8SS, 0Ic0hluS0h.
1DlO_aQHy
Wi|son |I. !n thc c|inic. Migrainc crratum in P !ntcrn Mcd.
2008;148(5):408]. A!ntcm Mcd. 200;14(P):!1C-1-!1C-1.
IM!O: 1P5180]
|tem? Answer:
Educatonal Ob]ectve: 1t0gW0it hWit0W_t
bt000tbt.
HSjaICHIHaSICHSOH-IyjCHCaUaCHCIHCHOSIjiC\aCHIO
aHCaUaCHCIyjCS. CHSOH-IyCHCaUaCHCS a UU DaICia
Oi UUSC HCaUaCHC OHCH UCSCiDCU aS a jiCSSUiC Oi SqUCCZ
H_ SCHSaIOH O HU IO HOUCiaIC HICHSIy. HCiC aiC HO
aCCOHjaHyH_H_iaHC CaIUiCS [HaUSCa CHCSSjHOIOjHO
DajHOHOjHODa} aHUIHC jaH HCIHCiWOiSCHSWIHHO\C
HCHI HOi jiOHDIS aCI\Iy. HC KCy CaIUiC IHaICSIaDSHCS a
Ua_HOSSOICHSOH-IyCHCaUaCHCSIHCaCKOUSaDH_jaH.
\HiOHCUayHCaUaCHCSaHOHSjCCBCICiHIHaIiCCiSIODOIH
jiHaiy [HCUUH_ H_iaHC} aHU SCCOHUaiyHCaUaCHCUSOi-
UCiS H WHCH HCaUaCHC S jiCSCHI OH HOiC IHaH D UayS jCi
HOHIH Oi aI CaSI o HOHIHS. SK aCIOiS Oi CHiOHC Uay
HCaUaCHC HCUUC ODCSIy a HSIOiy O iCqUCHI HCaUaCHC
[HOiC IHaH jCi WCCK}CaHCHCCOHSUHjIOH aHU O\CiUSC
[ÙaySjCiHOHI}OaCUICHCaUaCHCHCUCaIOHSHCUU
H_aHa_CSCSCi_OISIijIaHSaHUOjOUS.HaUUIOHHOiC
IHaHHaOajaICHISWiIHCHiOHCUayHCaUaCHCHa\CSCCj
USIUiDaHCCaHUHOOUUSOiUCiSSUCHaSUCjiCSSOHaHUaHX
CIy. \HiOHCH_iaHCaHUHCUCaUOHO\CiUSCHCaUaCHCO\Ci
WHCHH_y iCjiCSCHI IHC HOSI COHHOH aHU CHaCH_H_ O
IHC CHiOHC Uay HCaUaCHCUSOiUCiSH CiHCa jiaCICC.
\USICiHCaUaCHCSaja USaDH_HCaUaCHCIHaIHayDC
aSSOCaICUWIHaUIOHOHCSyHjIOHSSUCHaSICaiH_OiiHiH
OiiHCa. \USICi HCaUaCHCS aiC IyjCay UHaICia aHU jCiOi
DIa/ICHjOiaaHUaiCaSSOCaICUWIHaICaSIOHC OIHCO
OW_CaIUiCSOHLHCSaHCSUCaSIHCHCaUaCHC.COHUHCH\J
iiIaIOH/aCiHaIOH iHHOiiHCa/HaSa COH_CSIOH CyCiU
CUCHa aCa/OiCHCaUSWCaIH_ aHUHOSS/jIOSS. \USICi
CjSOUCS USUay aSI IO o WCCKS aHUiCHSSOHjCiOUSUSU
ay aSIZ IO HOHIHS.
i_iJiHC HCJUJCHC i8 J iCCUiiCHI HCJUJCHC Ui8OiUCi IHJI HJH
iC8I8 iH JIIJCK8 J8IiH_ +IO 72HOUi8. 1_iCJ CHJiJCICii8IiC8 O
H_iJiHC JiC iI8 UHJICiJ OCJIiOH jU8JIiH_ qUJiIy HOUCi-
JIC Oi 8C\CiC iHICH8i| J__iJ\JHOH Dy iOUIiHC jHy8iCJ JCIi\-
iIy JHU J88OCiJIiOH WiIH HJU8CJ JHUyOi jHOIOjHODiJ JHU
jHOHOjHODiJ. 1Hi8 jJIiCHI UOC8 HOI UC8CiiDC U8JDiiIy Oi JHy
OIHCi CJIUiC8 O Hi_iJiHC HCJUJCHC. /HCUiOO_C JUiJ OCCUi8
iH OHy OHC IHiiU O jJICHI8 WIH Hi_iJiHC. 1HC JUiJ COH8i8I8
O 8UCH vi8UJ 8yHjIOH8 J8 jCiCCjIOH8 O BJ8HC8 O _HI JiC8
O HJ8HH_ i_HI IHJI OHCH OiH J Zi_ZJ_ jJIICiH JHU JH JlCJ
O O88 O V8iOH 8UiiOUHUCU Dy J HOiHJ hCU O vi8iOH.
KN O1MT
1BSl0B hd0dCh lS 0lSlBgUlSh0 l0m mlgldlB D h dC
hd dlBS Wlh BSl0B hd0dCh dl B0 0lSdD0 dB0 CdB
Cdll 0U dClVllS 0 0dl lVlBg lB d B0lmd, X0lB mdBBl.
DhO_aQHy
b8CCO b. 1i8_HO8HC I88HC8 iH lCH8iOHly[C C8U8CC. \Hii 8IH 1C8U8CC
C[. Z1Z(}.+++1. _1. 1V
ItemB Answer:
Educational Objective: Manaqr a tbundrrlap
bradarbr.
1Hi8 jJHCHI 8HOuU UHUCi_O HOHCOHIiJ8I 1 O IHC HCJU. bHC
HJ8 CXjCliCHCCU J IHuHUCiCJj HCJUJCHC WHCH i8 J 8C\CiC JHU
CXQO8i\C HCJUJCHC IHJI i8 HJXiHJ iH HICH8iIy JI Oi ViIHiH
8CCOHU8 O OH8CI. \Ciy IHUHUCiCJj HCJUJCHC HU8I DC iHHC
GiJICy C\JUJICU IO UCICCI jOICHHJy CJIJ8IiOjiC COHGiHOH8
C8jCCiJy 8UDJiJChHOiU HCHOiiHJ_C. /HC_JH\C 1 8CJH O IHC
HCJU 8HOUU DC OOWCU Dy J UHDJi jUHCIUiC IO J88C88 Oi
DOOU iH IHC CCiCDiO8jiHJ BUU HOI UCICCICU OH IHC 1 8CJH.
DOIH IHC 1 8CJH O IHC HCJU JHU UHDJi jUHCIUiC JiC HC_
JI\C HO8I O IHC OIHCi CJU8C8 O IHUHUCiCJj HCJUJCHC 8UCH
J8 JH UHiUQIUiCU CCiCDiJ JHCUiy8H J CJiOIiU Oi \CiICDiJ
JiICiy Ui88CCIiOH CCiCDiJ \CHOU8 8iHU8 IHiOHDO8i8 JHU
iC\Ci8iDC CCiCDiJ \J8OCOH8IlCHOH 8yHUOHC CJn DC CXCUUCU
Dy HOHiH\J8i\C Jn_O_iJjHy. 1 JH_O_iJjHy O IHC HCJU JHU
HCCK CJH UCICCI UHUjIUiCU JHCUiy8H8 J8 8HJ J8 o HH iH
UJHCICi JHU IHU8 i8 JUCqUJIC IO CXCUUC IHi8 UiJ_HO8i8. J_-
HCIiC iC8OHJHCC JH_O_iJjHy M) WOUU J8O DC JjjiOjli
JIC H IH8 8CIIiH_. OIH 1 JH_iO_iJjHy JHU CJH DC
jCiOiHCU WiIH J \CHOU8 jHJ8C IO CXCUUC CCiCDiJ \CHOU8
8iHU8 IHiOHDO8i8. \i\CH IHJI HO8I CJU8C8 O IHUHUCiCJj
HCJUJCHC CJH DC CXCUUCU Dy 8UCH HOHH\J8i\C JH_O_iJQHy
i QliOi CCiCDiO8jiHJ HUiU JHJy8i8 HJ8 8HOWH HO CviUCHCC O
J 8UDJiJCHHOiU HCHOiiHJ_C COH\CHIiOHJ CCiCDiJ JH_O_iJ-
jHy iH WHiCH J CJIHCICi i8 iH8CiICU iHIO J Ji_C JiICiy JHU
JU\JHCCU IHiOU_H IHC CJiOHU JiICiy i8 UHHCCC88Jiy.
CCJU8C IHC jJHCHI HJy HJ\C iHIiJCCiCDiJ DCCUiH_ ViIH HJ88
CHCCI IHC jCiOiHJHCC O J UHDJi jUHCIUlC COUU iC8UI iH
DiJiH8ICH HCiHiJHOH. 1Hi8 i8 WHy IHC UHDJi jUHCIUlC i8 jCi-
OiHCU OHy JHCi J1 8CJH i8 jClOiHCU. IHC 1 8CJn iC\CJ8
iHIiJCCiCDiJ DCCGH_ J UHDJi QUHCIUiC i8 UHHCCC88Jly.
Neu|OOQy 22b
1iCJIHCHI WiIH J \J8OCOH8IiiCIi\C UlU_ 8UCH J8 8UHJIlijIan
WOUU HOI DC JjjiOjDJIC UHIi IHC OIHCi CJU8C8 O IHUHUCi-
CJj HCJUJCHC HJ\C DCCH CXCUUCU. iU_8 WI IHC jOICHHJ
IO COH8IiiCI CXIiJCiJHiJ JHU iHIiJCiJHiJ CCiCDiJ \C88C8 CaH
jiCCijiIJIC Oi CXJCCiDJIC IHC CCiCDiJ i8CHCHiJ IHJI HJy DC
J88OCiJICU WiIH JiICiiJ Ui88CCHOH JHU iC\Ci8iDC CCiCDiJ \J8O-
COH8IiiCIiOH 8yHUiOHC8.

AhUB0lCd hd0dCh lS d 0Bld BUl00glC mlgBC hd
mUS D lmm0ld VdUd0 0 0C 0Bld CddSl0hlC
C0B0ll0BS, SCld SUDdldChB0l0 hm0llhdg.
DlO_aQHy
bCWCUl J) 8l8iH b 1OGICK 1\. JHHUCiC8[ C8U8CC. 8HCCl
`CHiO. ZO(}.Z11. _1. 1o1VVZ
ItemS Answer:
Educational Objective: Trrat a patrnt prapbylart-
rally ]ar mqranr wtb prapranalal.
1HC HO8I JjjiOjiiJIC IiCJIHCHI Oi IH8 jJHCHI i8 jiOjiJHOO.
iOjHyJCIiC IiCJIHCHI 8HOUU DC COH8iUCiCU iH jJHCHI8 WHO
CXjCiiCHCC 2 Oi HOiC UJy8 O HCJUJCHC jCi WCCK. ^CJly +"
O jJIiCHI8 WiIH Hi_iJiHC HCCU jiC\CHIi\C IiCJIHCHI. 1HCiC i8
CviUCHCC BOH JI CJ8I IVO iJHUOHiZCU UOUDCDHU jJCCDO-
COHIlOCU 8IUUiC8 IO 8UjjOiI IHC U8C O Ci_HI UiU_8 J\JiJDC
H IHC \HiICU bIJIC8 [IOjiiJHJIC \JQiOiC JCiU JHiIiij|iHC
HCIOjiOO jiOjiJHOO HO JHU CXIlJCI O IHC jJHI UI-
ICiDUi iOOI !:tcit: hy/ridu) JHU IVO HOHjHJiHJCOO_iC
JjjiOJCHC8 [iCJXJIiOH IHCiJjy JHU DiOCCUDJCK}.
bC\CiJ iJnUOHZCU jJCCDO-COHIiOCU IiiJ8 HJ\C OUHU HO
COH8i8ICHI 8IJH8HCJy 8i_HiLCJHI DCHChI8 Oi DOIUHUH IOXin
HCCIiOH iH IHC IiCJIHCHI O CQi8OUC Hi_iJiHC HCJUJCHC. biH
Jiy IHCiC i8 HO C\iUCnCC O CHCJCy Oi HOiIiij|iHC Oi 8Ci-
IiJHC iH IHC jiC\CHIi\C IiCJIHCHI O H_iJiHC.
l0hdClC m0lCdl0B Sh0U0 D lBlld0 lB dlBS Wlh W0 0l
m0l mlgldlB ddCKS l WK.
DlO_aQHy
\i8OH |. H lC CIHIC. I_i8IHC _Cii8lHH IH /HH HlCiH CU.
Z1+(O}.+. ^HlCiH CU. Z1+(V}.J\111J\111.
_1. 1VO1
Item 1 Answer:
Educational Objective: !aqnasr dlrum suprrm-
pasrd an dmrnta.
1Hi8 jJIiCHI HJ8 UCiiiUH 8UjCiHjO8CU OH UCHCHIJ. Cil
iUH i8 JH JICiCU C\C O aCiInC88 OHCH iH COHHCCIiOH WiIH
_ODJy iHjJiiCU CO_HiIiOH. I i8 IyjiCJy CHJiJCICiiZCU Dy
JDiUjI OH8CI JHU HJy DC J88OCiJICU WiIH iJjiU HUCIUJIiOH8 O
JCiIHC88 JIICHIiOH HCHOiy JHU j8yCHOHOIOi JCHvi| [Oi
CXJHjC CIHJi_y Oi J_IJIiOH}. CHCHIiJ i8 JH JCqUiiCU JHU
jCi8i8ICHI iHjJiiHCHI O iHICCCIUJ JDiiIy IHJI COH[iOHi8C8
22b Neu|CCQy
aI CaSI IHiCC aiCaS O HCHIa HCIOHH_. aH_ua_C HCHOiy
\SuOSaIa SKS CHOIOH Oi CiSOHaIy Oi CO_HIOH.
CHCHIa I_Cay HaS aH uSUOuS OHSCI aHU S uSuay SIaDC
HOH Uay IO Uay. |\Ci IHC jiOIiaCICU COuiSC O UCHCHUa HaHy
jaICHIS Hay CXjCiCHCC aH aCuIC UCiuH VIH COHmSCU aHU
SuiiCU SjCCCH SOHHOCHCC a_IaIOH IiCHuOuSHCSS
uHSICaUHCSS aS aHU WOiSCHCU HCOHIHCHCC. |hCH IHC
UCiuH S BOH a SujCiHjOSCU HCSS [HOSI COHHOHy a
uiHaiy IiaCI HCCIOH Oi jHCuHOHa] a HCOCaIOH CiiOi aH
Hjuiy Oi SOHC OIHCi CauSC IHaI HuSI DC SOu_HI aHU HaHa_CU.
SyCHOSS CHCOHjaSSCS UCuSOHS HauCuaUOHS OSOi_aHZCU
SjCCCH aHU USOi_aHZCU Oi CaIaIOHC DCHa\Oi. HjaiCU CO_-
HUOH HOuUH_ UCCiCHCHIS H SHOiI-ICiH HCHOiy aHU aIICH-
IOH S aSO CHaiaCICHSIC. HS jaICHIS SuUUCH UCCmC H IHC
SCIIH_ O UCHCHIa aHU aDSCHCC O HauCHaIOHS aHU UCu-
SOHS S HOiC KCy IO iCjiCSCHI aH aCuIC UCiuH iaIHCi IHaH
aH aCuIC jSyCHOSS.
P1
v6I h6 C0uI56 0 06m6d, md d65 md 6k6I6C6 d dCu6
06Ium, Wh C0u560 d0 5uII60 566Ch, 50m06C6, dgd0,
I6mu0u5655 u56d0655, d5, d0 W0I5660 C06C6.
DlO_aQDy
1aH |1 \i8OH ^, y \. CiliUH m !HC OGCl CHCl_CHCy GCQal!-
HCH! Qa!iCH!. a QuiC! CQiGCHiC. HCl_ CG LiH Ol!H P.
2J2(}.JJ-J. 1. 2/V2+_
lIOH DSWOf.
LOUCBIODB DgOCIVO. 1tgn0v //tmtr mmnh.
HC HOSI KCy Ua_HOSS S /ZHCHCi UCHCHIa. CHCHIa S
a CHCa SyHUiOHC H WHCH HuIjC CO_HI\C UOHaHS
HCuUH_ HCHOiy aH_ua_C SjaIa SKS uU_HCHI aHU
jiODCH SO\_aiC H1jaiCU IO a USaDm_ UC_iCC. bOHC
UCHCHIH_ HCSSCS CaH aSO aHCCI HOHCO_HI\C HCuiOO_C
mHCUOHS SuCH aS _aI. SCaSCS IHaI CauSC UCHCHUa OhCH jiO-
UuCC CHaiaCICiSIC jaIICiHS O CO_HI\C [aHU SOHCIHCS
HOHCO_HU\C] HjaiHCHI IHaI CaH aU Ua_HOSS. /ZHCHCi
UCHCHUa S CHaiaCICHZCU Dy jiOHHCHI HCHOiy OSS aHOHa
COHSIIuCIOHa ajiaXa aHOSO_HOSa [HjaiCU iCCO_HIOH O
HCSS] aHU \aiaDC UC_iCCS O CiSOHaIy CHaH_C.
\iCuIZCUI|aKOD USCaSC [\|] S IHC HOSI COHHOH O IHC
HHHaH jiOH USCaSCS WIH aH aHHua HCUCHCC O CSS IHaH J
H 1 CiSOHS. HC HaH CHCa CaIuiCS O \| aiC
UCHCHUa IHaI jiO_iCSSCS O\Ci HOHIHS [iaIHCi IHaH yCaiS aS H
IS CaSC] aHU SIJiIC HyOCOHuS aIHOu_H IHC aIICi Hay HOI
DC jiCSCHI Caiy H HC HCSS. |HCi jiOHHCHI CaIuiCS
HCuUC \Sua Oi CCiCDClai USIuiDaHCC jyiaHUa/ CXIiajyia-
HUa UySmHCIOH aHU aKHCUC HuISH.
CHCHUa WI CWy DOUCS S aCCOHjaHCU Dy jJOHSH
\Sual HauC!HaUOHS aHU uCIuaU_ SyHjIOHS HOHC O WHCH
IHS jaICHI HaS. HC CHaiaCICiSIC CO_HI\C jiOBC O UCHCH-
Ia H jaICHIS WH UCHCHIa WH CW DOUCS HCuUCS
HjaiCU CaiHH_ aHU aIICHIOH jSyCHOHOIOi SOWH_ COH-
SIiuCIOHa aiaXa aHU HOiC jiOOuHU \SuOSjaIa Hjai-
HCHI DuI CSS mCHOiy HjaiHCHI HaH H SHaiy SIa_CU
jaUCHIS WU /ZHCHCi UCHCHIa.
1iOHIOICHjOia UCHCHIa S a jiO_iCSS\C HCuiOjSyCHaIiC
COHUIOH. aICHIS HIiay Ha\C DCHa\Oia aHU jCiSOHaIy
CHJ_CS HaI iaH_C HOH ajaIy IO SOCa USHHDIOH. HCy
a IO CHaH_C HCi OOHCS DiuSH I1Ci ICCH juiSuC HCi Oi-
HCi HICiCSIS Oi !HIaIC HaHy O HCi jiCVOuS aCUVUCS I1aI
COHSUIuICU a HOiHa Uay. HCy Hay BaIC H a SCCHH_y UO-
SyHCiaIC aSHOH OH a aiICuai aCI\Iy SuCH aS _OH_ IO HC
DaIHiOOH SOiIH_ IHiOu_H a WaCI HOaiUH_ Ha_aZHCS Oi
WaICHH_ ICC\SOH. bOHC jaICHIS Ha\C _iCaICi USHmDIOH
aHU CHOIOHa aDiIy [CiyH_ Oi au_ HajjiOjHaICy].

h6m6I 06m6d 5 ChdIdC6I60 0 I0m6 m6m0I 055,
d0md, C05IuC0d dIdkd, d050g05d (mdI60 I6C0g0
0 655), d0 vdId06 06gI665 0 6I50d Chdg6.
DlO_aQDy
a88 DiH8 1N H !HC CiHiC. CHCH!ia. 1H H!ClH CG.
2J+(/}.JL+-1-JL+-J. _1. J/V++_
lIOH Z DSWOf.
LOUCBIODB DgOCVO. 1rtl /Dbttmtr mmtnlt
tlb n tt[tb0tntsrst tnbt0tr (00nttDtJ.
HS jaICHI SHOuU iCCC\C UOHCCZ. HC 1OSICH
HCHIa bIaIC 1XaH1HaIOH [b1] OSCDHaICS WC
DCIWCCH IHC HaOi SIa_CS O UCHCHIa uSCU Oi jiO_HOSS aHU
HaHa_CHCHI juqOSCS. HC b1 SCOiC iaH_C OJ IO o
COiiCSjOHUS IO HU UCHCHIa JJ IO IO HOUCiaIC UCHCH-
Ua aHU IO J IO SC\CiC UCHCHUa. mS jaUCHI HaS /ZHCHCi
UCHCHIa aHU S aI a HU SIa_C O HjaiHCHI. HC mOSI
ajjiOjiaIC HCUCaIOH VH WHCH IO DC_H IiCaIHCHI S aH
aCCIyCHOHCSICiaSC HHDIOi O WHCH HCiC aiC CuiiCHIy
IHiCC. UOHCjCZ i\aSI_HiHC aHU _aaHIamiHC. H jaICHIS
WH HU HOUCiaIC Oi SC\CiC /ZHCHCi UCHCHIa HC uSC O
aCC|CHOHHCSICiaSC HHDIOiS aiC aSSOCaICU WH a SHa DuI
SIaISICay S_HCaHI HjiO\CHCHI H jCiOiHaHCC O HSIiu-
HCHIa aHU mHCI!OHa aCI\IiCS O Uay \H_ aHU CaiC_\Ci
SIiCSS aHU Hay DC aSSOCaICU WIH HjiO\CU CO_HIi\C mHC-
IOH COHjaiCU WH jaUCHIS IiCaICU WiH jaCCDO. iCaIHCHI
CCCIS aiC SHa aHU HOI aWayS ajjaiCHI H jiaCICC.
\HOHCSICiaSC HHDIOiS aiC _CHCiay SaC DuI Ha\C S_Hh-
CaHIy HOiC SUC CHCCIS HaH jaCCDO HOuUH_ UaiiHCa Hau-
SCa \OHIH_ aHU SyHjIOHaIC DiaUyCaiUa. HC _aSIiO-
HICSIHa SUC CHCCIS aiC uSuay IiaHSCHI aHU HU.
\HK_O DODa aHOu_H SaC HaS HCOHSSICHI aHU uHCOH-
\HCH_ C\UCHCC O DCHChI H HC IiCaIHCHI O /ZHCHCi
UCHCHIa. /SO HCiC S HO iC_uaIOH iC_aiUH_ HC COHICHIS
O HCiDa CXIiaCIS WHCH aOWS Oi \maDIy H UOSC SIICH_IH
aHU quaIy.
_uCUajHC S aH aHUjSyCHOUC Oiu_ aHU SCiHC S aH aHU-
UCjiCSSaHI a_CHI. /HOu_ DOI CaH DC uSCU u jaUCHIS WIH
tZHCnCi UCnCLUa ICu uSC S HiICU IO IiCaInCLI O DCHa\-
Oia SyHIOHS O SyCHOSS aHU UCiCSSOH iCSCCU\Cy HC-
ICi O ViCH IiS aUCHI HaS CXiDICU. OVC\Ci BICSC HCU-
CaUOHS aiC IO DC uSCU H SuCH aUCHIS IC iSS HuSI SI DC
CaiCJy VC_HCU a_aHSI IC DCHChIS. /HUSyCHOUCS Ha\C m-
ICU CHCCU\CHCSS H IiCaUH_ DCHavOia iODCnS aHU aiC aSSO-
CaICU VI HCiCaSCU iS O UCaIh H aUCHIS VlI UCHCHUa.
O1MY
ISl hdImdC0hId 0I ml0 lZhmI 0md S dB
dClCh0lSIdS h00I.
1DO_aQDy
Naycux !. arly Plzhcmcr's dscasc. ` ngl | Ncd. 2U1U;2(2):
21V+-22U1. lNJl: 2UbbU]
lIOH 1 HSWOt.
LOUCBIOHB DOCIVO. 1It0I ]HtI0H0 mtHt
H 0 ]0ItHI nIb 00P0Htt0 7JbtmtI mmtHI0 nIb
mtm0HIHt.
HC HOSI aiOiaIC HCXI SIC H IiCaInCHI S IC aUUIOH O
nCnaHIHC. HS aICHI HaS /ZHCHCi UCHCHIa IaI S HOU-
CiaICy aU\aHCCU aHU HOV HaS UHCuICS VIH DaSC aCIVICS
O Uay \H_. HC `HCIyaSaiIaIC iCCCIOi aHIa_OLiSI
HCnaHIHC S IHC OHy Uiu_ aiO\CU Dy IC 1.b. OOU aHU
iu_ 1UHHSIiaIOH aS iSIHC IiCaIHCHI O HOUCiaIC IO
aU\aHCCU 1ZHCnCi UCnCHUa. CnaHUHC HaS DCCH SHOVH IO
niO\C CO_HIOH aHU _ODa aSSCSSHCHI O UCHCHIa DuI
ViC IHC CHaH_CS Ha\C DCCH SIaISICay S_HCaHI IC CH-
Ca CHCCI S HOI aVayS C\UCHI. CnaHIHC nay niO\C qua-
IyO-C nCaSuiCS DuI IHCSC hHUH_S aiC HOI iODuSI.
/IHOu_H C\UCHCC S HiICU ICiC S SOnC Su__CSIOH IHaI
IC SICCU aiOaCH O aUUH_ HCHaHIHC IO a iC_nCH IaI
HCuUCS a CHOHCSICiaSC HHDIOi [SuCH aS UOHCCZ] iCSuIS
H a nOUCSI aUUIOHa DCHCI O\Ci SuDSIIuIH_ HCHaHIHC
Oi IHC CHOHCSICiaSC LHDIOi.
_uCIaLC S aH aHISyCHOIC nCUCaIOH aHU SCiIiaIHC S aH
aLIUCiCSSaHI a_CHI. 1IHOu_H DOIH Uiu_S CaH DC uSCU H
aICHIS VIH /ZHCHCi UCHCHIa ICi uSC S HICU IO IHC
IiCaIHCHI O IHC DCHavOia SynIOnS O SyCHOSS aHU UCiCS-
SOH iCSCCI\Cy HCICi O VHCH IS aUCHI HaS aI IS IHC.
HC CHCCI\CHCSS O aHISyCHOIC HCUCaIOHS S OH DCHa\-
Oia iODCHS S HICU aHU ICi uSC S aSSOCaICU VIH aH
HCiCaSCU iS O UCaIH H aICHIS VlIH UCHCHIa.
SCOHUHuH_ IC UOHCCZ IaCH Dy IS aUCHI VIOuI SuD-
SUIuUH_ aHOIHCi Uiu_ IO HJHa_C HCi HCUOHa UCCHC VOuU
HOI HC SOV Oi OIHCiVSC HiO\C IHC COuiSC O HCi USCaSC.
PO13
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ii_UiIy aiC a8yHHCIiiC. bH8IaiHCU C\OUOja iC8jOH8i\CHC88 i8
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HC jaICHI8 HUiH_8 aiC HOI COHjaIIDC WiIH CCi\iCa Uy8IO
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COHUiHOH. 88CHHa IiCHOi HO8I COHHOHy aHCCI8 IHC HjjCi
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KEN PO1T
t5l8ft m000Ql0g8085 Sgfmp0Stv8 0CuS!htChCuS8
hvSv8dS8S8hmmuh0C0mpf0mS8dpt8htS,pftCufy
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Item 1 Answer: A
Educational Ob]ective: 1I0qH0t . mcmgums
tl0ql0HQ 1 mtHIHqIlI.
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Item 1 Answer:
Educational Ob]ective: 1I0qH0t mtHIHq0t0tt0
mtHIHqIlI.
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cD|Dg|G.lucdUyItstcrta mcnctytccncs1s lJ.|l|cdw|||
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d|J|dc| lDdV|D|c.||JD.|c.|||H.l||ccD|l||JDO|!ts
Z30 Neu|OOQy
lt/l2 HCHiH_OCHCCjHJHSiJH_CSBOHJHUmCSSWIHC\Ci
JHU HCHIJ SIJIUS CHJH_CS IO J HJHI COUiSC WIH COHJ.
I SHOI JSSOCJICUWIH J iJSH.
HCCJSSCjiCSCHIJIOHOOCKyOUHIJHSjOIICUC\CiSJ
SC\CiC HCJUJCHC C\Ci HyJ_J JHU JiIHJ_J. HiOHDOCy-
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Item Z Answer: L
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JICiCCJ8C HOQHHC 8HJIC J8 HCCGCG
OH_-JCIiH_ HOiQHiHC 8HJIC IWiCC GJiy JHG OXy-
COGOHC J8 HCCGCG
[1} \XyCOGOHC J8 HCCGCG
240 cOIOQy
TH d jAOvanceO]
1 VyCaiOG VOHaH iS C\aHaICG aI HOHC Dy a ViSiIU_ HOS
iCC HHiSC Oi GySHCa IHaI DC_aH GayS a_O aHG HaS VOiS
CHCG iH IHC aSI 2 HOHiS. HC aIiCHI HaS HCIaSIaIiC DiCaSI
CaHCCi. HC HaS CXCCHICG a GO-HOIiCSHSCiIaIC OiGCi aHG HaS
GiSCOHIiHHCG CaHCCi IiCaIHCHI. \\Ci IHC aSI O VCCKS HCi
Oia iHIaKC HaS VOiSCHCG aHG SHC CaHHOI VaK WIIHOHI aSSiS
IaHCC DCCaHSC O VCaKHCSS. Ci aiH iS VC COHIiOCG WiIH
CXICHGCGiCCaSC HOQHiHC aHG iHHCGiaICiCCaSC HOQHiHC
aS HCCGCG Oi DiCaKIHiOH_H aiH.
HC HOSiCC HHiSC iCOiIS IHaI IHC aIiCHI iS aCiI aHG Oii-
CHICG. NiIa Si_HS aiC HOiHa. \Xy_CH SaIHiaIiOH iS V7 WiIH
IHC aIiCHI DiCaIHiH_ aHDiCHI aii. HC HaS CiaCKCS aHG Caiy
iHSiiaIOiy VHCCZiH_ O\Ci DOIH HH_ HCGS aHG a iCGHCCG
COH_H CHOiI. HC HaS HIG GHHCSS IO CiCHSSiOH aHG iCGHCCG
DiCaIH SOHHGS O\Ci IHC ii_HI DaSC. HCiC iS HO _ H_Hai
\CHOHS GiSICHIiOH Oi CiiHCia CGCHa. Ci aSI GOSC O
CXICHGCGiCCaSC HOiHC VaS O HOHiS a_O aHG HCi aSI GOSC
O iHHCGiaICiCCaSC HOQHiHC VaS yCSICiGay.
YDCD O tDC OOWD_ S tDC DCSt D3D3_CDCDt OQDOD
Or DCr UySQDC3:
[1) 1 SHCHCHIa GOSC O iHHCGiaICiCCaSC HOQHUC
[1) HCi_CHCy GCaiIHCHI C\aHaIiOH
HiOSCHiGC
OHC OXy_CH IHCiay
>CC!O J
HCOO@
D5W0f5 BDO LffQU05
IBH 1 DSWBt.
bOUCBIODB DgBCIVB. 1P0B0h 0 0rt0!I m0!!.
Jhc ncxt managcmcnt stcp lor ms paucnt is to ohtain an ultra
sound ol thc right hrcast. Jhc rcast !magng Rcporting and
ata Systcm !RS) is a standardizcd rcpornng systcm lor
m ography nndngs and a sourcc ol rccommcndations lor
mrthcr managcmcnt. Catcgory assignmcnts arc cithcr incom
plctc catcgory 0) or nnal asscssmcnt catcgorics through 6).
Catcgory Z nndings corrcspond to nndings compauhlc vth
hcnign nodulcs or cysts or hcnign calcincations. ut hccausc
this paticnt`s mass has pcrsistcd through scvcral mcnstrual
cyclcs, shc nccds mrthcr cvaluation dcspitc thc normal mam-
mogram. ccausc shc is oldcr than 30 ycars and thc mam
mogram is classincd as !IS Zthc ultrasound is thc ncxt
appropriatc tcst. Jhis is uuc lor mammogams ratcd !RS
3. \ltrasound scrvcs to dstinguish cystic hom solid masscs.
/cystic mass should hc aspiratcd and thc huid scnt lor cyto
logc cvaluation hloody or rccurrcnt. 1solid mass rcquircs
hiopsy hy nncnccdlc aspirauon, corc nccdlc, or cxcision. !l thc
mammogram is classincd as !-IS + or 5, malignan is
much morc hkcly and a tissuc diagnosis vth nnc nccdlc aspi-
ratc or hiopsy is thc most appropriatc managcmcnt.
!mcritcd gcrmhnc ahnormalitics in 11I.1 and 11I. Z
gcncs conlcr vcry high risk lor hrcast and ovarian canccr
ahsolutc risk ol hrcast canccr grcatcr than 60" hy agc 50
ycars). !cwcr than 5" ol all cascs ol hrcast canccr arc attrih
utcd to gcrmlinc ahnormalitics in thcsc gcncs, howcvcr, and
thc prcvalcncc ol thcsc ahnormalitics in thc gcncral popula-
tion is approximatcly /800. Jcsting lor 11I.1 and
11I. Z gcncs should hc pcrlormcd only in womcn who
appcar to havc a gcnctic risk muluplc rclativcs vith hrcast or
ovanan canccr, cspccially vth carlyonsct ol discasc). Jhcsc
womcn and thcir lamilics should hc rclcrrcd to a gcncuc coun
sclor lor discussion and considcrauon ol thcsc complcx issucs.
Jhis paticnt docs not havc an incrcascd gcnctic risk lor hrcast
canccr and tcsting lor 11I.1 and 11I.Z gcncs is not
mdicatcd.
KEX PO1WT
blS UllS0R0glh SlVS 0 0SRgUSh CSC l0m S0l0
mSSS.
DlC_aQHy
blCiH I,\HCHaH|CHCi8 . +HC iaUiOO_C WOiKuQ O! a QaQaDC DiCa8!
ma88. \C\C \iH | CU. ZV,7(o):17bo. i11: 1VZbo++
Z41
IBH Z DSWBt. L
bOUCBIODB DgBCIVB. 10gH0!t 10gtI d!t0!t 0j Ibt
0rt0!I.
Jhis paticnt has Iagct discasc ol thc hrcast, dcnncd as a pcr
sistcnt, scaling, cczcmatous, or ulccratcd lcsion involving thc
nipplc/ arcolar complcx. Histologically, thc hallmark ol Iagct
discasc ol thc hrcast is thc prcscncc ol malignant, intracpithc
lial adcnocarcinoma cclls Iagct cchs) within thc cpidcrmis ol
thc nipplc associatcd vith an undcrlying invasivc or intraduc
tal canccr. !t is oncn msdagnoscd on thc nrst prcscntation as
cithcr cczcma or psonasis, hut whcn thcrc is a lack ol rcsponsc
to appropriatc thcrapy, a hiopsy should hc pcrlormcd.
Jhc most charactcrisuc lcsions ol chronic cutancous lupus cry-
thcmatosus arc discoid lcsions appcaring as crythcmatous,
innltratcd plaqucs that arc covcrcd vith scalc and arc associ
atcd vith lollicular plugging. Jhcsc lcsions arc most oncn
lound on thc lacc, ncck, and scalp. 1 thcy cxpand, thcy
dcvclop dcprcsscd ccntral scars. Jhis paticnt`s lcsion, locauon,
and appcarancc arc not clinically compauhlc with chronic cuta
ncous lupus.
!ichcn simplcx chronicus is a locahzcd disordcr charactcrizcd
hy intcnsc pruntus, which lcads to a localizcd arca ol lichcni-
ncd skin thickcncd skin with incrcascd and cxaggcratcd skin
markings duc to scratching). Jhis paticnt has no cvidcncc ol
hchcnincation.
Jhc most common lorm ol psoriasis is plaquc psoriasis. Jhc
skin lcsions ol this disordcr arc shaqly dcmarcatcd, crythc
matous plaqucs covcrcd hy silvcrywhitc scalcs that ahcct thc
scalp and cxtcnsor surlaccs clhows and knccs) as wcll as thc
nails. /singlc patch ol psoriasis locatcd on thc mpplc would
hc a vcry rarc prcscntatron.
KEY _ _ _ _,__,_____
g 0SS 0 h lS S 0UCl ClCR0m h lSRS S
lSSR, SClRg, CZm0US, 0l UlCl0 lS0R RV0lVRg h
Rl/l0ll C0mlX R0 m mSKR 0l m0l RgR C0R-
00RS SUCh S CZm.
DhC_aQHy
\ai8KaH La!l L bO8HO\8KKH 1 Cl a. ia_Cl`8 Ui8Ca8C O! lHC DiCa8l:
lHC CXQCiCHCC O! !HC 1uiOQCaH 1H8U!ulC O! \HCOO_y aHU iC\CW O! !HC
!Cia!uiC. iCa8! \aHCCi C8 +iCa!. Zo11Z(o):b1obZ1. _i11:
1oZ+Z
Z4Z ncOIOgy
Item d Answer: A
Educatonal Ob]ective: 0H0Qt 0 0lt0l m0 Htlb
0[tl0lt0H 0l 0t0[y.
HCHO8IJjjiOjiiJICHJHJ_CHCHIOjIiOHi8BJ1C-HCCUCJ8ji-
iJIiOH Oi DiOj8y O IHC DiCJ8I HJ88. D jJIiCHI VIH J DiCJ8I
HJ88iCquiiC8IHjCJ88C88HCHI:jJjJHOHHm O_iJjHyViIH
OiViIHOuIHIiJ8OHO_iJjHyJHU8ui_CJC\JuJHOHOiDiOj8y.
JH1HO_iJH8HJyDCHOiHJiH IO OjJICHI8ViIH
DiCJ8IuHj88OHCOWHiCHHJyDCCJHCCiOu8./CijCiOi-
HJHCCODiJICiJUiJ_HO8IiCHJHHO_iJQHy IHCiHiIiJOCu8
O IHC WOiuj O J UOHiHJHI DiCJ8I HJ88 i8 IO Ui8IiH_ui8H J
8iHQCCy8IHOHJ8OHUHJ88DyBHC-HCCUCJ8jiiJIiOH [D}
OiuIiJ8OHO_iJjHy. IHCHuiUHOHDi8DOOUyIHCHuiU
8HOuU uHUCi_O CyIOO_iC C\JuJIiOH. YOHCH WiIH 8iHQC
Cy8I8 8HOuUUHUCi_OJDiCJ8ICXJH1iHJIiOH IO WCC8 JHCi
Cy8I J8jiiJIiOH IO C\JuJIC Oi Cy8I iCCuiiCHCC Oi J iC8iUuJ
uHj. D 8OiU HJ88 iCquiC8 J I88uC UJ_HO8i8Dy EHC-HCCUC
J8jiiJIiOH DiOj8y [1} COiC-HCCUC DiOj8y Oi CXCi8iOHJ
DiOj8y. JIiCHI8 WiIH DCHi_H D1 Oi COiC-HCCUC DiOj8y
iC8uI8 JHU HC_JIi\C HJH1HO_iJH iCquiiC CO8C CiHJCJO
OW-ujO IHCDiCJ8IJDHOiHJiIy.
I i8 iHJjjiOjiiJIC IO OD8Ci\C IHC jJICHI WiIHOuI HiIHCi
WOiuQOiIO]u8IiCjCJIHJHHO_iJjHyJICiDCCJu8C8HCHJ8
J Ui8CiCIC HJ88 IHJI HJy iCjiC8CHI DiCJ8ICJHCCi UC8jiIC IHC
HOiHJHmO_iJjHiCBHUiH_8.1\CHiaHuIiJ8OuHUi8HC_-
JIi\C IHCjJICHI iCquiiC8 Ii88uC 8JHjiH_.
HCiOCODiCJ8I1Oi8CiCCHH_Hi_H-H8QJIiCHI8i8Cui-
iCHIy DCiH_ C\JuJICU. H QJICHI8 ViIH JH C8IJDi8HCU UiJ_-
HO8i8 O DiCJ8I CaHCCi iI HJy DC O \JuC iH UCICiHiHiH_ IHC
CXICHIOUi8CJ8C.HI18jJHCHIJDiCJ8I1WOuUHOIOD\i-
JIC IHCHCCU Oi BHC-HCCUC J8jiiJIiOH Oi DiOj8y JHU i8 HuCH
HOiC CXjCH8i\C IHJH uIiJ8OHO_iJjHy.
ApI8hIWIh 0I8SImSSI8quI8SSpII0h0I 00pSyI8gId-
8SS0lmmm0gIphyI8SuIS.
DlO_aQDy
IcrlkOwskc I, 5mthIndman !, I|ung IN, Lrady . LvaluatOn OI
abnOrmal mammOgraphy rcsults and palpablc brcast abnOrmaLtcs. P
Intcrn Ncd 2003;13v(+):2/+2+. 1NI:12vbv3[
ItemA Answer: L
Educatonal Ob]ectve: 1V0R0 0 [0lttHl Htlb
t0lymQt 0lt0l t0Httl j0l lRm0l tD0QtH 0Hd [l0Qt
l0Htlttt[Hl l0lR.
HCHCXI8ICQi8 JIuHOiC8IiO_CH-iCCCjIOi [11}JHUjiO_C8-
ICiOHC-iCCCjIOi [1}J88Jy.18jJICHIHJ8CJiy-8IJ_CDiCJ8I
CJHCCi[8IJ_C}DJ8CUOHIHCIuHOi8iZC <2CH},JD8CHIyHjH
HOUC iH\O\CHCHI JHU HO JjjJiCHI HCIJ8IJ8C8 DJ8CU OH HCi
8yHjIOH8 QHy8iCJCXJHJHJIOH HHUiH_8 JHU iOuIiHC DOOU
IC8I8. HC 8ICQ IHJI WOuU DC HO8I HCjH iH UiiCCIiH_ IHC
JjjiOJCHIOHJHJ_CHCHIOIHi8jJIiCHIi8IOQCiOiHJHJ88Jy
Oi CXjiC88iOH O 11 JHU 1 IO UCICiHHC IHC OQIiHJ 8y8
ICHiCIiCJIHCHIJHUIHi8C\JuJIi\C8ICj8HOuUDCjCiOiHCU
iH J CJ8C8 O jiiHJiy DiCJ8I CJHCCi. 1HUOCiiHC IHCiJjy [Oi
CXJHQC IJHOXiCH JiOHJIJ8C iHHiDiIOi8 H\C8IiJHI JHU
HC_C8IiO JCCIJIC} i8DCHCHCJOHyiHjJIiCHI8WiIH11jO8-
iIi\C Oi 1jO8iIi\C IuHOi8. JIiCHI8 WHO8C IuHOi8 JiC HOi-
HOHCiCCCQIOiHC_JH\CJiCiCHJCIOiyIOCHUOCiiHCIiCJIHCHI
JHU 8HOuU iCCCi\C CHCHOIHCiJjy iH8ICJU.
HjJICHI8VI1 CJiy-8IJ_C DiCJ8I CJHCCi I1C iOuIiHC C\JuJ-
IOHi8iI1iICUIOJIHOiOu_H18IOiyaHUjHy8iCJCXJHiHJIiOH
UiJ_HO8IiC HJHHO_iJQHy CHC8I iJUiO_iJjHy JHU iOuIiHC
DOOUIC8I8 [iHCuUiH_H\CiCHCH1i8IiyIC8I8}.HC u8COJUUi-
IOHJ iHJ_iH_ 8IHUiC8 Oi DOOU IC8I8 i8 HOI WJiiJHICU iH IHC
JD8CHCC O 8jCCiHC 8yHjIOH8 DCCJu8C IHCy HJy CJU IO IHC
UCICCIiOH O JDHOiHJiIiC8 O HO 8i_HCJHCC [J J8C-jO8iI\C
IC8I iC8uI}.
H CJiy-8IJ_C Ui8CJ8C UC jO8iIi\C jiCUiCI\C \JuC O JDHOi-
HJBHUiH_8OWHOC-DOUyjO8iIiOHCH1i88iOHIOHO_iJjHyi8
JjQiOXiHJICy UCiCOiCIHi8I_COiHJ_iH_HOUJiIy i8
HOI iCCOHHCHUCU. HC JD8CHCC O HCIJ8IJ8C8 iH J 8CHIiHC
JXu JiyyHjHHOUCHJ8JHi_HHC_JIi\CjiCUiCI\C\JuCOD\i-
JIH_ IHC HCCU Oi J COHjCIC JXiJiy yHjH HOUC Ui88CCIiOH
WiUiI8 J88OCiJICU HOiDiUiIy.
DDOuI ODiCJ8ICJHCCiCJ8C8JiCJIIiiDuIJDCIOiJiCHi_H-
jCHCIiJHCC HuIJIiOH8 iH J CW 8jCCiHC _CHC8, HuIJIiOH8 iH
11I.1 JHU 11I.Z JCCOHI Oi uj IO O J CJ8C8 O
HCiCUIJiyJHUJDiCJ8ICJHCCi.Hi8jiOjOiHOHi8Hi_HCi
iH jJIiCHI8WIHDiCJ8I CJHCCiJI JyOuH_Ci J_COOH8CIJHUiH
C8 WiIH HuIijCDiCJ8I Oi O\JiiJH CJHCCi CJ8C8. C8IiH_
OiIHC 11I.1 Oi 11I.Z_CHCiHIH8 jJICHI WOuUHOIDC
iHUiCJICUWiUOuIJHOiCCOHjCiH_JHiyHi8IOiyOUi8CJ8C.
ASSyl0I8kpI8SS0h0l8SII0g8hhdpI0g8SI8I0h8I8C8pI0ISS
CIuChd8I8ImhhgIh80pImSySI8mCII8Im8hIl0I 0I8SI
ChC8IhdSh0ud 08p8Il0Im8dhpI8hISWIh pImIy0I8SI
ChC8I.
DlO_aQDy
arlsOn !W, Allrcd , AndcrsOn II, Iurstcn I|, artcr W Ldgc
5I, Lrban |I, larrar W LOldstcn I|, Lradshar \,Iaycs l, Iuds
A, |ahanzcb N, Icl ! I|ug IN, NarcOm 1I, Naycr L,NcOrmck
I, Iabcll IN, 1crcc I|, !ccd L, 5mth NI, 5OmlO L, Jhcrault K,
JOpIam `5, Ward |I, Wncr L1, WOlII A; Ì Ircast anccr
lncal 1ractcc Ludclncs 1ancl. Ircast canccr. Lncal pracucc gudc
Lncs n OncOlOgy. | Iatl Ompr anc Ictw. 200v;/(2):122v2. 1NI:
1v200+1[
ItemB Answer:
Educatonal Ob]ectve: 1lt0l 0 [0lttHl Htlb 0lt0l
t0Httl 0Hd 0 m0 j0t0 lRm0l Htlb Rm[ttHmy, tHltHt
H0m dtttlt0H, 0Hd l0dt0lt0H.
Hi8jJIiCHI8HOuUuHUCi_ODiCJ8IUHjCCIOHyju88CHIHC
yHjH HOUC DiOj8y OOWCU Dy iJUiJIiOH UCiJjy. 1iCJ8I
uHjCCIOHy ju8 iJUiJIiOHUCiJjyi8KHOWHJ8 DiCJ8I-COH-
8Ci\iH_IHCiJjy. 1iCJ8I-COH8Ci\iH_ I1CiJjy COH8i8I8 O CXCi-
8OHOLHCjiHaiyIUHOiOOWCUDyiaUaLOHIOLHCiCHaH-
H_j8aICiaDiCa8IU88UCaHU8_CHCiayHUCaICUOijaUCHI8
WIH OCa U8Ca8C aHU 8Ha IUHOi8 Oi WHCH COH8Ci\aIOH
WOHCia_OOUCO8HCUCiC8UI.OWC\Ci,jaUCHIjiCCiCHCC8
HU8I DC COH8UCiCU H IHC 8Ui_Ca UCC8OHHaKH_ jiOCC88.
HC 8Ui\\a iaIC Oi WOHCH HHUCi_OH_ DiCa8ICOH8Ci\H_
IHCiajy 8 CqU\aCHI IO IHaI O IHO8C WHO UHUCi_O Ha8ICC-
IOHy, WIH DiCa8ICOH8Ci\H_ IHCiajy iC8UIH_ H HjiO\CU
CO8HCUCOUICOHC8aHUC88HOiDUIyIHaHHa8ICCIOHy.O8I
jaICHI8 IiCaICU WIH UHjCCIOHy WIHOUI iaUaIOH IHCiajy
Ha\CaHI_HD8KOiOCaiCCUiiCHCCIHCiCOiC,IH8IiCaImCHI
HOUaIy CaHHOI DC iCCOHHCHUCU. H aUUIOH, 8CHIIHC
yHjH HOUCDOj8y8a 8aC aHUaCCUiaICHCIHOUOi 8CiCCH-
IH_ IHC aXaiy yHjH HOUC8 Oi HCIa8Ia8C8 H WOHCH WIH
8HaDiCa8IIHHOi8.CHIHCyHjHHOUCDOj8yHa8iCjaCCU
HaXaiyyHjHHOUCU88CCIOHOiIHC8Ia_H_OU8Ca8CH
HaHy WOHCH WIH Caiy8Ia_C, CHCay yHjH HOUCHC_a-
I\CDiCa8ICaHCCi.HCi8IUiaHH_ jOi8CHIHC]yHjHHOUC
8 UCHICUDyHjCCIH_DUCUyC aHUiaUOaCI\CCOOUHIO
IHC IUHOi 8IC. IHC 8CHIHC yHjH HOUC UOC8 HOI COHIaH
HCIa8Ia8C8, I8UHIKCyIHaIHOiCU8IaaXaiyyHjHHOUC8
V COHIaH HCIa8Ia8C8 COH8CqUCHIy, HO HiIHCi 8Ui_Ciy 8
HUCaICU H IH8 8CIIH_, aHU IHC IOXCIy hOH a H aXaiy
yHjH HOUC U88CCIOH 8 a\OUCU. OWC\Ci, IHC 8CHIHC
yHjHHOUC8HOW8HCIa8IaUCH\O\CHCHI,IHCHaXaiyyHjH
HOUC U88CCIOH 8 jCiOiHCU IO UCICiHHC IHC HUHDCi O
H\O\CU yHjHHOUC8.
CCCI\CC8LiO_CH iCCCjIOiHOUUaIOi88UCHa8IaHOXICHaiC
HOI HUCaICU H jaIICHI8 WIH C8IiO_CH iCCCjIOiHC_aI\C
IUHOi8.

|ump8Cl0myWlhS8hlh8ymphh0d8b0pSyl00W8dbybf8Sl
fIdl0hSlh8ppI0pfl8mhg8m8hl0lW0m8hWlhSm,
l0CbI8SlChC8I
1DO_aQHy
uCHOZ l. UiJUOH !CiJQy Oi CJiyS!J_C DiCJS! CJHCCi JCi DiCJS!
COHSCiViH_ SUi_Ciy. I H_ | CU. 2V(Jj.-. _1i.
JVJJO[
lIOD H5WOt!
bOUCBIOHB D[OCIVO! rttn u u|tn| u| 0g0 r:k
j6r t66rttm tunttl
HC DC8I COOiCCIa CaHCCi 8CiCCHH_ 8IiaIC_y Oi IH8 jaICHI
8COOHO8COjy aI a_COO yCai8 aHU IHCH C\Ciyo IO O yCai8. 1
amIyH8IOiyOCOOiCCIaCaHCCiOiaUCHOHaIOU8jOyj88_-
HlBCaHIy IHCiCa8C8 a jCi8OH8 i8K Oi COOiCCIa CaHCCi. HC
jiC8CHCCOCOOiCCIaCaHCCiHai8IUC_iCCiCaI\CCaiiC8a
IV'OOU IO IHiCCOU HCiCa8CU CIHC i8K O\Ci IHC _CHCia
jOjUaUOHIHaID8K8UOUDCUa_aHBUCaHCCICUiCaU\CWa8
Ua_HO8CU DCOiC a_C +O yCai8. IWO i8IUC_iCC iCaI\C8
Ha\C COOiCCIaCaHCCi, LHC COOiCCIa CaHCCi D8K ajjiOaCHC8
Z7. 1OijCi8OH8 WIH a amIyH8IOiyO COOiCCIa CaHCCi H
a i8I-UC_iCC iCaI\C, 8CiCCHH_ 8 HIaICU CIHCi aI a_C +
cOOQy Z4J
yCai8 Oi DC_ _ i yCai8 CaiCi IHaH IHC UaHO88 O IHC
yOUH_C8I aHCCICU aH y HCHDCi. HOiHa, COOHO8COjy 8
iCjCaICU C\Ciy o IO O yCai8. CCaU8C IH8 jaICHI HaU
COOHO8COjy 8CiCCHH_ aI IHC a_C O O yCai8, COOHO8COjy
8HOUUDCOCiCUaI8OHCIHCDCIWCCHa_C8OoaHUOOyCai8.
1aHa aUCHOHaIOU8 jOyjO88 aHUaIICHUaICUa aUC-
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jO88 8 UCICCICU OH CHUO8COjy. H IHC8C jaICHI8, IC8HH_ Oi
HUIaIOH8 H IHC /1L _CHC 8 iCa8OHaDC. 1OWC\Ci, IH8
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CiOiHIH_ COOHO8COjy aI a_C O yCai8 aHU IHCH C\Ciy i
yCai8 8 IHC iCCOHHCHUaIOH Oi jaICHI8 aI a\Cia_C i8K Oi
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Item 1 Answer: A
Educational Objective: Monoqc presmn conccr
scrccnnq by dscussnq rsks ond bcnc1.
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jJIiCHI8 WiIH CJHCCi WHO WCiC HOI Oxy_CH GCjCHGCHI CJH-
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DOHJ!C CVC O! Zz HCQ/1 [Zz HHOy1.
Wich ot thc toIIowing is thc most IcIy causc ot his rcs
piratory taiIurc:
[/ \HIOHiC OD8!IHC!VC HHOHJIy Ui8CJ8C
[D UiOJ!HiC HHOHJIy HDIO8i8
[\ ^CHIOHH8CHJI WCJKHC88
1HHOHJIy JI!CIiJ HyCI!CH8iOH
TD b jAOvanceO]
/ oyCJIOU HJH i8 CVJHJ!CU !OI J iyCJI Hi8!OIy O! Uy8
HCJ !HJ! HJ8 _IJUHJy WOI8CHCU UHIiH_ !HC J8! DOH!H8.
1C HJ8 Uy8HCJ J! IC8! DH! HJ8 HO OI!HOHCJ. HC J!iCH!
ICOI!8 H8 DICJ!HiH_ i8 DC!!CI WHCH yiH_ HJ! JHU i8 WOI8C
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8HIC i8 iiU/ HH 1_ H8C IJ!C i8 U/HiH JHU IC8iIJ
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JIC CCJI. /8Ci!C8 i8 IC8CH! J8 JIC CHDDiH_ CIiHCIJ CyJHO8i8
JHU 8iUCI HCVi. OWCI CX!ICH1i!iC8 8HOW i i!!iH_ CUCHJ.
HC CHC8! XIJy i8 HOIHJ.
Wich ot thc toIIowing is thc most IikcIy causc ot this
pancnt's dyspnca:
[/ DIOHCHO_CHiC CJICiHOHJ
[D \OH8!IiC!VC CIiCJIU!8
[\ 1HHy8CHJ
1CJ!OHHOHJIy 8yHUIOHC
TD jBasc]
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OI!HOHCJ. bHC i8 O!HCIWi8C WC JHU !JKC8 HO HCUiCJ!iOH8.
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1_ H8C IJ!C i8 iUU/HiH JHU IC8iIJ!OH IJ!C i8 ZJ/HDH.
HC CJIO!U H8!IOKC i8 UiHiH8HCU JHU UCJyCU COHJICU
Vi!H !HC JiCJ H8J!OH. \JIUiJC CXJHDHJ!OH 8HOW8 J 8H8
!JHCU CJIUiJC JCX iHH8C _IJUC o/ J!CCJKH_ 8y8!OiC
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!iOH. HC ICHJHUCI O! !HC CXJHiHJ!iOH i8 HOIHJ.
Which ot thc toIIowing is thc most IikcIy diagosis:
[/ /OI!C 8!CHO8i8
[D /!DJ 8C!J UC!CC!
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1HHOHJIy VJVHJI 8!CHO8i8
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UCCICJ8CU DICJ!H 8OHHU8 OVCI !HC O8!CIOI I_H! !HOIJX. HC
CJIUiJC CXJH1iHJ!iOH i8 HOIHJ.
/ CHC8! IJUiO_IJH i8 OD!JiHCU JHU i8 8HOWH.
Which ot thc toIIowing is thc most IikcIy diagosis:
[/ 1CJI! !JiHIC
[D 1yUIOHCHHO!HOIJX
[\ 1HCHHOHiJ
1HHOHJIy CHDOi8H
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/ ZUyCJIOU WOHJH i8 CVa!HJ!CU iH !HC CHCI_CHCy UCJI!
HCH! !OI JH JCH!C Ci8OUC O! WHCCZiH_ JHU Uy8HCJ Wi!HOH!
COH_H OI 8H!HH IOUHC!iOH. bHC HJ8 HJU HCQHCH! CVJHJ
!iOH8 iH CDCI_CHCy UCJI!HCH!8 !OI 8iD1iJI Ci8OUC8. H
DC!VCCH !HC8C Ci8OUC8 HHUiH_8 OH Hy8iCJ CXJH1iHJ!OH JHU
HHOHJIy HHC!iOH !C8!iH_ iHCHUiH_ HC!HJCHOiHC CHJ
CH_C HJVC DCCH HOIHJ. bHC i8 O!HCIWi8C HCJ!Hy JHU !JKC8
HO HCUiCJ!OH8.
\H Hy8iCJ CXJHiHJIiOH IHC JIiCHI HJ8 iH8iiJIOiy JHG CXi
iJIOiy WHCCZiH_ JHG i8 iH HOGCiJIC Gi8COHOiI. HC ICHCi-
JIHiC i8 .J \ _V.`} H8C iJIC i8 J/HiH JHG iC8iiJ
IiOH iJIC i8 Z+/HiH OXy_CH 8JIHiJIiOH OH JHDiCHI J i8 V7.
DHCi iCCCiViH_ JDHICiO JHG iHIiJVCHOH8 COiIiCO8ICiOiG8 8HC
COHIiHHC8 IO WHCCZC JHG i8 iH HOGCiJIC iC8iiJIOiy Gi8IiC88.
\Xy_CH 8JIHiJIiOH OH JHDiCHI Jii iCHJiH8 JI V7. \HC8I
iJGiO_iJH 8HOW8 GCCiCJ8CG HH_ VOHHC8.
YCh O thC OllOWtD_ tS thC uOSt aQQIOQItatC uaDa_C
uCDt OI thtS QaDCDt:
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yCJi8 J_O WJ8 HOiHJ. bHC J8O HJ8 _J8IiOC8OHJ_CJ iCHHX
Gi8CJ8C JHG JyHJHG HCHOHCHOH. bHC iHICiHiIICHIy GCVC
O8 HCCi8 OH IHC H_CiH8. \HiiCHI HCGiCJHOH8 JiC JOGi
iHC OHCiJZOC JHG HiIiO_yCCiiH OiHIHCHI.
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8y8IOiC HHiHHi JI IHC OWCi CH 8ICiHJ DOiGCi IHJI iHCiCJ8C8
WiIH iH8iiJIiOH. HC HH_8 JiC CCJi IO JH8CHIJIiOH. HC
JDGOHiHJ CXJHJIiOH i8 HHiCHJiKJDC. bCCiOGJCIyy i8 iC
8CHI JHG iIIiH_ 8CJi8 JiC V8iDC OVCi 8CVCiJ H_CiIi8. HCiC
i8 HO CiiHCiJ CGCHJ.
\OHCIC DOOG COHHI JHG CiyIHiOCyIC 8CGiHCHIJIiOH iJIC
JiC HOiHJ. CCIiOCJiGiO_iJH 8HOW8 CViGCHCC O ii_HI VCH-
IiiCHJi HyCiIiOHy. \HC8I iJGiO_iJH 8HOW8 HO iHHIiJIC8.
HHOHJiy DHCIiOH 8IHGC8.
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+7 O iCGiCICG
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JHG CHiiIiC CHC8I JiH. ii_HI JHG JICiJ GCCHDiD8 CHC8I
X-iJy8 COHHiH IHJI IHC CH8iOH i8 HCC HOW_ _WiIHOHI CVi-
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PuImOnaj MeOcne Z55
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HOW aHU uH_ \OuHCS [CXCuUH_ iCSLiCL\C uH_ USCaSC}.
CHOCaiUO_ia[HySaH CaiyUa_HOSLCLCSL Oi[aLCHLSWLH
S_HS aHU SyH[LOHS O 1/. HS SLuUy S uSCU LO CXCuUC
COH_CHLaHCaiLUSCaSC,SuCHaSaL!JSC[LaUCCCL,aHU\a\u-
aiHCaiL USCaSC, SuCH aS HL!a SLCHOSS, LHaL Hay HaHCSL aS
[uHOHaiy HyQCiLCHSOH. CHOCaiUO_ia[Hy Hay DC uSCU LO
CSLHaLC [Ca i_HL \CHLiCuai SySLOC [iCSSuiC LiCuS[U
iC_ui_LaLOH S HOLCUOH CXaHHaLOH.
1CHCaUa_HOSS OCHiOHC ODSLiuCL\C QuHOHa!y USCaSC
['\11} SHOuU DC COHSUCiCU H aH\ QaLCHL WHO HaS UyS[
HCa, CHiOHC COu_H Oi SQuLuH QiOUuCLOH, aHU/Oi a HSLOiy
OiSaCLOiSOiLHCUSCaSC. HCUa_HOSSO'\11S COH-
HHCUaHUSLa_CUDyS[iOHCLiy. HiS [aHCHL HaSHO HSaC-
LOiS,SyHQLOHS,OiQHySCaCXaIHaHOH1UH_S[DaiiCCHCSL,
UCCiCaSCUDiCaLHSOuHUS,WHCCZH_}LOSuQQOiLLHCUa_HOSS
O'\11. 1aLCHLSWLH'\11Ha\CV_/`' </7.
1HLCiSLHa uH_ USCaSC [11} SaCOHHOH[uOHaiyHJH-
CSLaLOHHQaLCHLSVLHSySLCHCSCCiOSSWHOaSOHa\CUyS-
[HCaJHUaL_uC,aHUQaLCHLSWLH11aSOuSuayHa\CUi\
COu_.HCaDSCHCCO aLCHS[iaLOi\CiaCCSOH[ulHOHai\
CXaH1iHaLOHJHUHCQiCSCHCCOHOiHJUH_\OuHCSOHQU-
HOHai\BHCLOHLCSLH_BiLHCia!_uCa_aHSLLHSCOHULOH.
1H [aLCHLS WLH 1, LHC uH_ \OuHCS aiC CSS LHaH d7 O
[iCUCLCU.
Zbb PumCn8ry MeOcne
1CH \CHIiiCHai aiHiC Hay HaHiC8I a8 Uy8jHCa aHU aI_HC
aHU Hay DC a88OCiaICU WiIH CaiUaC HHiHHi8. 1OWC\Ci lH8
COHOtOH s uCy m UC aDsCHCC O!aOOtOHa aDHOrHa
CaiUiOjHHOHaiy CXaHiHaliOH HHUiH_8 8HCH a8 aH b_ Oi b_
_aOj aHU jHHOHaIy CiaCKC8. H aUUIiOH CHC8I iaUiO_iajH8
iH jaIiCHI8 WiIH CH \CHIHCHai HCaiI aiHiC H8Hay UCHOH
8IIaIC jHHOHaIy \a8CHai COH_C8IiOH.

hSCd SgBS 0 Vd0 Um0BdI dII ISSUI BCU0 d
0U0 _, X0 S b_, Um0BC 0W mUImUI, dB0 ICUS0 IgUI
gd0B.
DO_aQHy
_HuHU ICa\, 1iOVH !HC S[CCIiUm Ol SCCiOUCimu UH_
USCuSC. bCmH CS[i \DI \uiC CU. ZZ(+}:+1-+ZV. 11:
1+bV[
Item Answer:
Educational Objective: Trcat a remp|rand p|cura|
cgren wtb rbcrt tu|c dranapc.
HC HCXI 8ICj iH lHC HaHa_CHCHI O IHi8 jaIiCHI i8 CHC8I IHDC
UIaHa_C O IHC jCHIa CH8iOH. H jCHia CH8iOH8 a88OCiaICU
WiIH HCHHOHia IHC iC8CHCC O OCHaICU CHia HHiU
jCHIa HHiU WiIH a j1 C88 IHaH .2 jCHia HHiU WiIH a _H
CO8C C\C C88 IHaH H_/U1 ,3.3 HHO/1} aCIaIC UCHy-
UIO_CHa8C C\C _ICaICi IHaH /1 jO8ili\C jCHia HHiU
LiaH 8IaiH Oi CHIHiC Oi IHC jiC8CHCC O _iO88 jH8 iH IHC
jCHia 8jaCC jiCUiCI8 a jOOi iC8jOH8C IO aHHDiOHC8 aOHC 8HCH
CD8iOH8 aIC IiCaICU WiIH UiaiHa_C O IHC HHiU IHiOH_H a
CaIHCICi OI CHC8I IHDC.
Hi8 jaICHI8 Hi8IOiy i8 COHjaHDC WiIH COHHHm|-aCQHiiCU
jHCHHOHia [COH_H 8jHIHH C\CI CHi8} aHU IHC iaUi-
O_iajHiC hHUiH_8 aiC COH8i8ICHI WiIH a CC-HOWiH_ jCHia
CH8iOH. CCaH8C IHi8 jaIiCHI8 CHia HHiU HGH_8 jiCUiCI a
jOOi iC8jOH8C IO aHIiDiOIiC8 aOHC H8 CH8iOH i8 CaCU a tcm
p/itat:d parapn:umcnit :[usicn. / | 8CaH Hay DC HCjD
IO UCICCI \Ciy 8Ha CH8iOH8 IO UCICiHiHC IHiCKHC88 O IHC
jCHIa iHiH_ IO Ui8IiH_Hi8H CHjyCHa [jH8 iH IHC jCHia
8jaCC} OH a HH_ aD8CC88 Oi IO UCICCI aH HHUCiyiH_ Hai_
HaHCy OD8CHICU Dy IHC jCHia HHiU HOWC\CI HOHC O lHC8C
iHGCalOH8 ajy IO IHi8 aIiCHI aHU a | 8CaH i8 HOI HCCUCU.
O8I jCHia CD8iOH8 IC8O\C WilH IICaIHCHI O IHC HHUCfy-
iH_ Ui8Ca8C. HC OHy CD8iOH8 IHaI H8Hay iCQHiiC u\a8i\C
liCaIHCHI aiC COHHCaICU jaiajHCHHOHiC CH8iOH8 [8HCH a8
IH8 OHC} CHjyCHa aHU Hai_HaHCy. H jaIiCHI8 WlH jHCH
HOHia IHOiaCiC CHjyCHa UC\COj8 WHCH aHIiDiOIiC8 aiC HOI
_i\CH [Oi UCayCU} aHU IHC jCHia 8jaCC i8 HOI UiaiHCU iH a
IiHCy HaHCi. H I8 Ca8C \UCOa88i8ICU IHOia8COjiC 8Hi_Ciy
[N/} i8 iHUiCaICU IO DICaK UOWH OCHaHOH8 aHU UIaiH jH8
OH lHC CHia Ca\iIy. HCiCOIC HOI iHICi\CH_ WiIH CHC8I
IHDC jaCCHCHI i8 iHajjiOjiiaIC Oi IH8 jaICHI aHU N/
8Hi_CIy i8 O\Cfy a__IC88i\C IHCIajy aI IHi8 jOiHI iH IiHC.
B dIdBUm0BC US0B, h ISBC 0 0CUd0 UId U0,
uld u0 wh d H SS hd .,uld U0 wh d gUC0S
V SS hdB bmg/0L mm0/L], dCd 0h0I0gBdS
gIdI hdB 1 U//L, 0SV UId U0 Idm SdB 0I CUUI,
0I h ISBC 0 gI0SS US B h UId SdC I0CS h B0
0I ChS U0 0IdBdg.
DO_aQHy
buH bD. 1u_HOSS uHU muHu_CmCHI Ol [uiu[HCUmOHC CHSOHS uHU
Cm[yCmu. \H HlCCI 1S. Z+b(11}.1+-. 11. 1VVZoZ
Item Answer: L
Educational Objective: !apnerc p|cura| cgren.
HC HO8I iKCy Ua_HO8i8 i8 jaiajHCHHOHiC jCHia CH8iOH.
1ai_C HHiU aCCHHHaIiOH iH IHC jCHIa 8jaCC DOCK8 IiaH8-
Hi88iOH O 8OHHU DCIWCCH IHC HH_ aHU IHC CHC8I Wa jCi
CH88iOH O\Ci aH CH8iOH i8 UH aHU IaCIiC [\OCa} CHiIH8 i8
UiHiHi8HCU Oi aD8CHI. \H aH8CHIaIiOH IHC HO8I COHHOH
hJ1UiH_8 aiC UCCiCa8CU IO aD8CHI DiCaIH 8OHHU8 O\Ci IHC CH-
8iOH. 1C\Ci aHU jCHia CH8iOH 8H__C8I8 aH HHUCiiH_ iHCC
IOH Hai_HaHCy Oi a88OCiaICU COa_CH \a8CHai Ui8Ca8C. HC
jaIiCHI8 Hi8IOiy O iCCCHI OH8CI O C\Ci aHU COH_H HaKC8 a
jHCHHOHiaiCaICU jaIajHCHHOHiC CH8iOH HO8I iKCy.
1CaiI aiHiC CaH DC a88OCiaICU WiIH a jCHia CH8iOH DHI
OIHCi 8yHjIOH8 aHU 8i_H8 O HCaiI aiHiC 8HCH a8 OiIHOjHCa
CC\aICU CCHIia \CHOH8 jIC88HiC _ aHU jCHjHCia CUCHa aiC
iKCy IO DC jiC8CHI. 1HiIHCiHOiC HCaiI aiHiC iH a 2+-yCai-
OU jCi8OH WHO Wa8 jiC\iOH8y WC i8 \Ciy HHH8Ha.
aliCHI8 WIH ODaI jHCHHOHia IyiCay Ha\C IaCH_HCa C\Ci
CIaCKC8 DiOHCHa DiCaIH 8OHHU8 aHU UHHC88 IO jCICH88iOH
WiIH iCUHCCU DiCalH 8OHHU8. CCaH8C COH8OiUaICU HH_ Ii88HC
i8 aH CXCCCHI IIaH8HiIICi O 8OHHU aHU \DiaHOH IaCIiC CHi
lu8 i8 iHCICa8CU HOI UCCiCa8CU a8 iH jCHIa CH8iOH
HCHHOIHOiaX 8HOHU DC COH8iUCiCU u aHy jaIiCHI WiIH 8HU-
UCH OH8CI O jCHiiIiC CHC8I jaiH aHU Uy8jHCa. HC jHy8iCa
CXaHiHaliOH Hay 8HOW UCCiCa8CU DiCaIH 8OUHU8 aHU HyjCi-
iC8OHaHCC IO jCiCH88iOH OH IHC aHCCICU 8iUC iaIHCi IHaH UH
HC88 IO jCiCH88iOH.

LdIg UId US0B S dSS0Cd0 Wh 0UBSS 0 ICUSS0B
dB0 d0SB 0I 0CIdS0 dC [V0Cd] ImUS dB0 0Idh S0UB0S
0VI h dC0 dId.
DO_aQHy
YOH_ \i, OiOyU-iCUUC |,bIiuUS b1. 1OCS IHS [uICHI HuVC u [CUiu
CHSOH: |A. ZVo1(o}.oV-1. 11. 1V1bb+b
Item 1 Answer:
Educational Objective: tvoluon o tubcrculcus
plcurol cgscn wth o plcurol bcpsy.
HC HO8I JjjiOjiiJIC HCXI 8ICj i8 J jCHiJDiOj8y. 1C iKCy
HJ8 J IHDCiCHOH8 jCHiJ CH8iOH DJ8CU OH IHC 8HDJCHIC [o-
WCCK} UHiJIiOH O 8yHjIOH8 JHU IHC CHJiJCICii8IiC8 O IHC
jCHiJ CH8iOH. CCJH8C O IHCjJIiCHI8J_C JHU IHCjiC8CH-
IJLiOH ViIH JH i8OJICU jCHiJ CH8iOH jiiHJiy IHDCiCHO8i8
i8HO8I iKCy. 1IHDCiCHOH8 CH8iOHi8IyjiCm yCXHUJIi\CDy
DOIHjiOICH[jCHiJBHiUIO8CiHHjiOICHiJIiO_iCJICiIHJH
0.5) JHU JCIJIC UCHyUiO_CHJ8C [11} CiiICHJ [jCHiJ HHiU
IO 8CiHH 11 iJIiO _iCJICi IHJH 0.o JHU jlCHiJ BHiU IO
8CiHH HjjCiHiI8 O HOiHJ 11 iJIiO _iCJICi IHJH 0.o).
HCCCHJiiC8jOH8CHIHCjCHiJHHiUi8CJ88iCJyyHjHO-
CyC[_iCJICiIHJH80 HJIHiCyHjHOCyIC8}.1OWC\CiiICJH
DCHCHIIOjHiCVIHiHIHCBi8I2 WCCK8JHCiWHiCHiIIyjiCJy
C\O\C8 iHIO IHC CJ88iC yHjHOCyIC-jiCUOHiHJHI CXHUJIC.
YHCiCJ8jCHiJBHiUCHIHiC8Oi)t0uutl?lHmJiCjO8iIi\C
iH C88 IHJH OHC IHiiU O CJ8C8 IHC COHDiHJIiOH O jCHiJ
DiOj8yOi Hi8IOO_C C\JHJIiOH JHUCHIHiCi8 IyjiCJy jO8i-
Ii\C H HOiC IHJH IWOIHiU8OCJ8C8.
HCo-WCCK Hi8IOiyO8yHjIOH8i8IOOOH_OiJIyjiCJDJC-
ICHJjHCHHOHiJ,HOUCmICiHIiJICWJ8jiC8CHIOHIHCCHC8I
iJUiO_iJjH JHU LHC CCHJi iC8jOH8C iH IHC jCHiJ BHiU WJ8
jiiHJHy yHjHOCyIiC iJIHCi IHJH HCHIiOjHiiC. HCiCOiC J
DJCICHJjHCHHOHiJViLJjJIJjHCHHOHiCCH8iOHi8HHKCy
JHU JH CHjiiiC COHi8C O JZiIHiOHyCiH WOHU HOI DC JjjiO-
jHJIC.
\HC8I \ 8CJH Hi_HI DC HCjIO J88C88WHCIHCiIHCiCi8 JH
HHUCiyiH_jJiCHCHyHJuIiJICIHJIWJ8HOIVi8iDCOHjJiH
CHC8I iJUiO_iJjH DHI iI WOHU HOI HCj H UCICiHHH_ IHC
HHUCiyiH_ CJH8COIHCjCHiJ CH8iOH.
1CXiDC DiOHCHO8COjy ViIH COCCIiOH O 8JHC8 Oi H8IO-
O_yJHUCHIHiC i8H8CHOiUiJ_HO8iH_jHHOHJiyIHDCiCH-
O8i8 H IHC 8CIHH_ O jHHOHJIy jJiCHCHyHJ Ui8CJ8C. 1OW-
C\CiIHC yiCU BOH CHIHiC O DiOHCHOjHHOHJiy 8CCiCHOH8
[ODIJiHCUCiLHCiJ88jHIHHOiDiOHCHO8COjiC8JHjC8}i8OW
C8jCCiJy iH IHC JD8CHCC O jHHOHJIy jJiCHCHyHJ JDHOi-
HJiIiC8OH CHC8I iJUO_iJjH.

pl8hlWlhlub8ICuUu$p8uI8llu$UhlypCypI8$8hl$Wlh
ymphUCyl8-pI8dUmhhl8kudlv88llu$Uh.
DO_aQHy
8CaaHIC . H IHC CIHIC. JuDCICuO8I8 _CIIaIuD IH HICIH CU.
2V;1b1(+}:2V2._. PHICIH CU. 2V;1b(11}:JIC1-C1+; quIZ
JC1C. _1: 1V+oo[
PUmOnary NCUCnC Zb1
Item 1 Answer: A
Educational Objective: Ooqncsc chylcthcro.
HC HO8I iKCy UiJ_HO8i8 i8 CHyOIHOiJX. \HyOIHOiJX i8
UiJiHJ_CO yHjHJIiCHHiUiHIOIHCjCHiJ8jJCC8CCOHUJIyIO
Ui8iHjIiOH Oi DOCKJ_C O IHCIHOiJCiCUHCI OiOHC O iI8yH-
jHJHC IIiDHIJHC8. Ji_HJHCy i8 IHC HO8I COHHOH CJH8C O
CHyOIHOiJX DHI IIJHHJ i8 IHC 8CCOHU HO8I COHHOH CJH8C.
\HyOIHOiJX CJH J8O OCCHi iH J88OCiJIiOH WiIH jHlHOHJIy
IHDCiCHO8i8 JHU CHiOHiCHCUiJ8IiHJiHCCIiOH8 8JiCOiUO8i8
yHjHJH_OCiOHyOHJIO8i8JHUiJUiJHOHBDiO8i8.HCjCHiJ
HHiUiH CHyOIHOiJX i8 H8HJy Hi|DHIHJyJ8ODC8CiOH8Oi
8CiO8JH_UHCOH8HHJlHOHii8HCUjJHCHI8VIHiIHCJIiHIJKC.
HC jCHiJ HHiU IH_yCCiiUC COHCCHIIJIiOH iH J CHyOIHOiJX
i8 IyjiCJy _iCJICi IHJH JJ0 H_/U I.24 HHO/} JHU
OCCHi8H J88OCiJIiOHVIH JOW jCHiJHHiUCHOC8ICiO COH-
CCHIiJIiOH. IHCjCHiJHHiUIii_yCCHUCC\C i8 C88IHJH50
H_/U ,0.o HHO/}CHyOIHOiJXi8 HHiKCy.
1CJiI JiHiCi8 J88OCiJICUViIHJIIJH8HUJH\CjCHiJ CH8iOH.
HC jCHiJ HHiU jiOICiH IO 8CiHH jiOICH iJIiO i8 >0.5 JHU
HiKy JjjCJiJHCC O IHC CH8iOH CXCHUC8 HCJiI JHiC J8 J
jO88iDC UJ_HO8i8. JiJjHCHHOHiC CH8iOH i8 H8HJy J88OCi-
JICUViIH JHCHIiOjHiCjCOCyIO8i8. HDCiCHO8i8 i8IHC HO8I
COHHOH CJH8C O yHjHOCyC-jiCUOHHJHI CXHUJIC WOiU-
VUC IyjiCJy J8 Hi_H J8 0 IO 5 yHjHOCyIC8. JHCHI8
ViIH IHDCiCHOH8 jCHiJCH8iOH H8HJy jiC8CHIVIH JHOH-
jiOUHCIi\C COH_H CHC8I jJiH JHU C\Ci JHU IHC CH8iOH i8
H8HJy jJC yCOW iH COOi. Hi8 jJHCHI8 jiC8CHIJLiOH JHU
H8IOiyO yHjHOHJUOHOI8HjjOiIIHDCiCHO8i8J8IHCCJH8C
OIHC CH8iOH.
1h8mU$lCUmmUhCu$8$UlChyUlhUIkI8ChC8IhdlIum,
Ulh8ICu$8$I8pumUhIylub8ICuU$$,ChIUhCm8d$lh
hl8ClUh$,$ICUdU$$,ymphhgU8UmyUmlU$$,hdIdlUh
lbIU$$.
DO_aQHy
P_IaWa N, 1OCKCH baHH bP. CuIa HuIU aHay8I8 IH CHyOIHOIaX.
IHC8I. 2o;1(C}.1+C1++1. _1: 1oVV1_
Item 1R Answer:
Educational Objective: Trcot rcspronry ]olurc
wth mcchoncol vcntlotcn.
HC HO8I JjjiOjiJIC LJHJ_CHCHI Oi IHi8 jJHCHI i8 iHIHDJ-
IiOH JHU HCCHJHiCJ \CHIJIiOH JHU JUHi88iOH IO IHC iHICH-
8i\CCJiCHHiI. HCCJH8COJCHIC\CHHJIOiyJiHiCHjJHCHI8
ViIHCXJCCiDJIiOH8OJ8IHHJi8iHCiCJ8CUJiWJyiC8i8IJHCCJHU
J8O UyHJHiC HyjCDJIiOH IHJI iCUHCC8 CHC8I-WJ COHji-
JHCC. OIH COHHDHIC IO CXCC88i\C WOiK O DiCJIHH_. iOH-
CHO8jJ8L JiiWJy CUCHJ JHU 8CCiCHOH8 J8 WC J8 CXCC88i\C
CXjiiJIOiy JiiWJy COJj8C CJH8C\CiCyiCUHCC JiWJy UJHC-
ICiiC8HHH_iHHJiKCUyjiOOH_CUCXjiJIiOH. HCiCJ8CUiC8
jiiJIOiy UH\C JHU H_H HCIJDOiC UCHJHU8 HCiCJ8C HHHIC
\CHUJHOHJHUCXjiJHOHDCIWCCHDiCJIH8i8HCOHjCIC.iO-
Zb8 |umCHry MediCiHe
_iC88\C8IaCKH_O DiCaI8CaU8IOaHCQUDiaHOHaIaH_HCi
UH_\OuHCVIH_HCiO8H\CCHU -CXiaIOiya\COaiiC8
8UiC [aUIO1111OiHIiH8C1111}a88OCaICUVIHUyHaHC
ai IiaiH_ aHU HyjCHaIOH. HC a88OCaICU HaIICHH_ O
ICUaj!a_HUCCiCa8C8I8!HCHOHJHUOiCC8_iCaICiiCaHCC
OH aCCC88Oiy HU8CC8 iICi HCiCa8H_ CaiDOH UOXUC jiO
UUCHOHaHUOXy_CHCOH8UHjHOHa8aiC8UIOICHCHCCHCy
O IHC8C HU8CC8 COHjaiCU VIH a iOCiy HCIOHH_
UaHia_H.OC\CiCaiIiaH_CaHa8OCaU8Ca\COaiiUIUiC
aHU HaiKCU iCUUCIOH8 H \CHOU8 iCIUiH IO IC i_HI HCaiI
iC8UUH_HjHCUHOUOiJXaHUHyjOICL8OHiC8jCCH\Cy.yj
Cay aICHI8 VIH aH a8IHHa CXaCCiDaIOH HIay iC8CHI
WIH iC8iaIOiy aKaO88. O_HIy CC\aICU Oi C\CH HOiHa
1aC_ C\C8OHCHiHUCaICHCHUH_iC8jiaIOiyaUiCiaICi
IHaH iCCO\Ciy aHU CHCa COiiCaIOH 8 CiICa OiHICQiCI-
H_ aiICHa DOOU _a8 J1UiH_8 H IH8 8CIIH_./UUIOHa Ca
IUiC8 IHaI 8U__C8I iC8iaIOiy aUiC H U8 jaICHI HCUUC
jU8COXHCIiyC88IaHVO7 1_C88IaH/OHH_ [1.
K1a} iC8iaIiOH iaIC _iCaICi IHaH o/HH aHU HCaiI iaIC
_iCaICiIaH12/HH.

K8SpItUIyCdUSS,hypUk8m,hdltgu8I8hdCtUhSlUI
htubtUhhdm8ChhCv8httUhhpt8htSWthhCut8
8kC8IbtUhUSthm.
DO_aQHy
!azarus SC. Cani. pra.Ii.c. Lmcrgcn.y IrcaImcnI OIasIhma. ^ Lnp
| Mcd. 2OIO,J0J8):5501. IMII: 2O8I88|
lIOD 1 DSWOf. b
bOUCBIODB DgOCIVO. 1tgtH [u[ lhtI0[) ]0I
0lhm0 Htlh )mtt t0Iltt0I0td.
HC HO8I ajiOjiaIC HaHa_CHCHI Oi U8 jaICHI 8 a 8HOiI
COUi8C O Oia COiICO8ICiOU8. H8 jaICHI WIH iC\OU8y
WC-COHIiOCUa8U aHa8HaUO88OCOHIiO aHCiaiC8
iaIOiyIiaCIHCCIOH./8HOiICOUi8COaHOiaCOiICO8ICiOU
[Oi CXaHC iCUH8OHC .O H_/K_ Uay Oi O IO / Uay8}
CaH iC8O\C IHC a8Ia 8yHjIOH8 aHU CHaDC IC jaICHI IO
iC_aHCOHIiO O HCi U8Ca8C. I 8 UHCCai WHCICi UOUDH_
OiC\CHQUaUiUjIH_}ICUO8COHHaCUCOiHCO8ICiOU88aH
CHCCI\C8IiaIC_y H aCC OOia COiICO8ICiOU8.
1HIDOIC8 aiC_CHCiay HOIiCCOHHCHUCUOiaCUICiC8jia
IOiyHCCIOH8Ha8IaDCCaU8CHO8IOIC8CiHCCIOH8aiC
\ia aHU IHC iOUIHC U8C O aHIDOIC8 H jaICHI8 WIH aH
a8IHHa CXaCCiDaIOH8 HOI iCCOHHCHUCU.
CDUZCU IHCiajy aI HOHC 8HOUU DC iC8Ci\CU Oi jaICHI8
WHO CaHHOI U8C a HCICiCU-UO8C HHaCi ajjiOiaICy.
/IHOU_H HCDUZCU DiOHCHOUaIOi IHCiajy CaH DC HOiC
CHCCI\CiHiC\Ci8H_DiOHCHOCOH8HCIOHIHaHHCICiCU-UO8C
HHaCUDiOHCHOUiaIOi8HCDUZCUIHCiajy8HOUUHOIDCU8CU
a8 a 8UD8IIHICOiOia COiICO8ICiOU ICiajy H jaHCHI8VI
a8IHaCXaCCiDaIiOH8./UUH_aCUKOIiCHCHOG_a_CHI
CaHDCCOH8UCiCUiHjaICHI8WHOCaHHOIOi HOIIaKCOia
COiICO8ICiOU8HOWC\CiCUKOIHCHCiCCCIOiaHIa_OH8I8aiC
C88OICHlaHl-H aIOiya_CHI8IHaHCOilCO8ICiOU8aHU
aiC HOI CCCI\C H jaICHI8 WIH 8_HHCaHI CXaCCiDaIOH8.
/UUiH_ a OH_-aCIH_ a_OH8I WOUU DC iCa8OHaDC H I8
jaICHI HCi 8yHIOH8 Ci88I aHCi IC Oia COiICO8ICiOU
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IHJH 1 yCJi8. \ IHC8C jJIiCHI8 _J8IiOHIC8IiHJ 8yHjIOH8
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CySIiC BDiOSiS UH_ UiSCaSC CHCSI iaUiO_iajHy IyjiCay SHOWS
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D HOW\OUHC OOj WHiCH iHCUUCS OiCCU iHSjiiaIOiy aHU
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DC jCiOiHCU HCXI IO C\aUaIC IHiS jaIiCHI. /IHOU_H SHOiiH_
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CHOU_H !Oi IHC Uia_HOSiS. OySOHHO_iajHy iS iCqUiiCU IO
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IiaIiH_ HCaiI auUiC iOH HOHCaiUIaC CaUSCS O SHOiIHCSS O
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CCHIiaIOH CSS IHaH J j_yH aiC UHiKCy IO Ha\C aCUIC
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jUHOHaiy CHDOiSH iS a COHSiUCiaIiOH. OWC\Ci IHC jaHCHI
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DC COHSiUCiCU H ah jaIiCHIS WiIH ODSIiUCIi\C SCCj ajHCa aHU
COHjaIiDC SyHjIOHS DCCaUSC iI iS a CqUCHI CaUSC O UCaIH
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lI0H Z DSW0t!
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0nt0 0 0 tt6nd0ry t0ut 6j b_trDnt6n.
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aCIOiS !Oi ODSIiUCIi\C SCCj ajHCa [\D} iHCUUC CXCCSSi\C
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SCCj HCaiI aiUiC iCCUiiCHI aIiia BDiiaIIOH SIiOKC iHSUiH
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HC_aIi\Cy aHCCI qUJIy O! H!C aHU aCaUCHIC aHU OCCUjaHOHa
jCi!OiHaHCC Hay iHCiCaSC IHC iiSK O! \CHiCUai aHU WOiK-
iCaICU aCCiUCHIS aHU Hay iHCiCaSC IHC O\Cia HOiIaiIy iaIC.
OySOHHO_iJjHyiS iCqUiiCUIO UCICiHHCIHC jiCSCHCC JHU
SC\Cii| O IbD. HCiJjyiSiCCOHHCHUCUOiJjJHCHISVIH
IbD JHU CXCCSSi\C UJyIiHC SCCjiHCSS iHSOHHiJ iHjJiiCU
CO_HiIiOH HOOUUiSOiUCiHyjCiICHSiOH iSCHCmC HCJiI US-
CJSC Oi SIiOKC. iCJIHCHI O IbD HOUCSIy iCUUCCS DOOU
jiCSSHiCB mJHyDHIHOI JjJHCHISWiLHHy[CiICHSiOH.
D2-HOUiuiiHCBCCCOiHSOHCJSUiCHCHIiSJSCiCCHiH_ICSI
Oi IUSHiH_ SyHUiOHC. DIHOU_H jJIiCHIS WIH H_CiCOiIi-
SOISHHJyUC\COjODCSiIyJHUHyjCiICHSiOHIHiSjJIiCHIHJS
CWOIHCiBUiH_SCOHjJIiDCViIHIHiSUiSOiUCiSUCHJSHUS-
CC WCJKHCSS CCCHyHOSiS H_OKJCHiJ UHCXjJiHCU OSICO
jOiOSiS JHU UiJDCICS HCiIUS. CiCUIJHCOUS iCHJ JiICiy
JH_iO_iJjHy iS USCU IO UiJ_HOSC iCHJ JiICiy SICHOSiS. DIHCi-
OSCCiOIiCiCHO\JSCUJiUiSCJSCiSUSUJyJSSOCiJICUViIHWUC-
SjiCJU JIHCiOSCCiOSiS jCiijHCiJ \JSCUJi USCJSC CJiUiO\JS
CUJiUiSCJSCJHUiSCHCHiCIJi_CIOi_JHUJHJ_CWHiCHiSHOI
C\iUCHI iH IHiS jJIiCHI. HC iJLiO O jJSHJ JUOSICiOHC IO
jJSHJiCHiHJCIi\iIyiSIHCjiCCiiCUSCiCCHiH_ICSIOiHyjCi-
JUOSICiOHiSH. yjCiJUOSICiOHiSH CJUSCS HyjCiICHSiOH
HyjOKJCHiJ JHUHCIJDOiC JKJOSiS. CCJUSCIHCSCHUH_S
JiC HOI jiCSCHI iH IHiS jJIiCHI J jJSHJ JUOSICiOHCiCHiH
JCIi\iIy iJHOiS HOI iHUiCJICU.
KN O ______
|t8htSWthuhtf8t8dObStfuctv8S88h8hv8gf8t8f
k8hOOdOld8v8OhgSySt8mchy8ft8hSOh.
DlO_aQDy
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CUtOOSL. 2JJ(}.o2V-oV. i1i. 2JJbo_
Item Z7 Answer: L
Educatonal Objectve: 1I0gH0t tt_gtHIt 0tg0~
HIUIHg ]Htm0HI0.
HCHOSIiKCyUiJ_HOSiSiSCiyjIO_CHiCOi_JHZiH_jHCUHO-
HJ[II].HISHOHSHOKCiWIHOUIJHyCXjOSUiCHISIOiyHJS
JCUIC IO SUDJCUICUC\COjHCHI O HOHSjCCiCSySICHiC JHU
iCSjiiJIOiySyHjIOHSWIHJUOmHJHIJ\COJi[OjJCiCJHOH]
jiOCCSSOHCHCSIiJUiO_iJjH. HCICHjOOIHCUiSCJSCjiOCCSS
iS LHC KCy IO UiHCiCHIiJIiH_ \I BOH OIHCi iHICiSIiIiJ UH_
UiSCJSCS.IIiSOHCHJCUICOiSUDJCUICViIHSyHjIOHOHSCI
OCCUiiiH_VIHiH2 HOHIHSO jiCSCHIJIiOHiHIHCHJOiiIyO
jJIiCHIS. HCjiCSCHIJIiOHiSSOSU__CSIi\COJHJCUICOiSUD-
JCUICOWCiiCSj!|JIOiyIiJCI!HCCHOHIHJIjJHCHISHJ\CJHOSI
JWJySDCCHIiCJICUWiLHJHUJiCUIOiCSjOHUIOOHCOiHOiC
COUiSCSOJHIiDiOIiCSDCOiC UJ_HOSiS.
HCUiJ_HOSiSOJSDCSIOSiSiSDJSCUOHJCOH\iHCiH_HiSIOiyO
JSDCSIOSCXjOSUiCJHUUCBHiICC\iUCHCCOiHICiSIiIiJDiOSiS.
HCHOSISjCCiBCHUiH_OHCHCSIiJUiO_iJjHiSDiJICiJjJi
IiJy CJCiCU jCUiJ jJQUCS. HiS jJIiCHI JCKS JHCXjOSUiC
HiSIOiyJHiHICiSIiIiJiHIiJICJHUC\iUCHCCOjCUiJUiSCJSC
HJKiH_JSDCSIOSiSJHH1iKCyUiJ_HOSiS.
PumCnaj MedCne Z73
IOHHUHiIy-JCqUiiCU jHCUHOHiJ iS JH JCUIC iHCCIiOUS
jiOCCSSIHJIjiO_iCSSCSO\CiUJySHOIWCCKSJHUWOUUHJ\C
iCSjOHUCUIOC\OBOXJCiH.
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OH_CUCOU|SCVIHC\iUCHCCOiCSjiiJIOlySyjIOHSJHUiJUi
O_iJjHIC hHU_S IHJI jiO_iCSS SOWy O\Ci HOHIHS Oi yCJiS.
UiO_iJjHiC BHUiH_S iHII JiCJSO UiSIiHCI BOHIHOSCiH
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SCHI iH jJIiCHIS WiIH II. HC OjJCiIiCS JiC JHOSI JWJyS
DiJICiJWIH\JiiCUUiSIiiDUIiOH. IHCOIHCKCy iJUiO_iJjHiC
CJIUiCS O II iS IHC ICHUCHCy Oi II OjJCiIiCS IO
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iCU iI HJS J UOHiHJHI iHICiSIiIiJ [iCIiCUJi] jJIICiH WiIH Oi
WIHOUL OjJCiIiCS.
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cut8dS8S8fOgf8SSOhhdbt8fv8OflhgOct8SOh
ch8StfdOgfh.
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Item Z Answer: A
Educatonal Objectve: 1I0gH0t 00tI.
HCUiJ_HOSiSOJSDCSIOSiSiSDJSCUOHJCOH\iHCiH_HiSIOiyO
JSDCSIOSCXjOSUiCVIHJHJjjiOjHJICyOH_JICHIjCHOU !
IO 1O yCJiS] JHU UCHiIC C\iUCHCC OiHICiSIiIiJ BDiOSiS WiIH
OUI OIHCi iKCy CJUSCS. HiS jJIiCHI WOiKCU JS JH lHSUJIOi
WHCH JSDCSIOS CXjOSUiC WJS SIiViUCSjiCJUJHUiSJI iiSK Oi
JSDCSIOS-iCJICU UH_ UiSCJSC. HC HOSI SjCCiHC HHUiH_ OH
CHCSI iJUiO_iJjHiSDiJICiJ jJiHJy CJCiBCUjCUiJjJQUCS.
CUiJ jJqUCS JiC OCJ OHCH jJiHJy CJCiBCU DiOUS HS-
SUC COCCIiOHS OH IHC jJiiCIJ jCUiJ JHU JiC COHSiUCiCU J
HJiKCiOJSDCSIOSCXjOSUiC.
UiOjJIiC jUHOHJiy BDiOSiS jiCSCHIS WIH SOWy jiO_iCS-
Si\CUySjHCJ JHUJ CHiOHC HOHjiOUUCIi\CCOU_H. HC CHCSI
iJUiO_iJjHiSJHOSIJWJySJDHOiHJJIIHCHHCOjiCSCHIJ-
IiOH WIH UCCiCJSCU UH_ \OUHCS JHU DJSJ iCIiCUJi OjJCi
IiCS. DHOSI J jJIiCHIS HJ\C J jHySiOO_C iCSIiiCH\C jiOCCSS
[UCCiCJSCUÌIOIJUH_CJjJCi|HCIiOHJiCSiUUJCJjJC
iIy] JS WCJSiHjJiiCU_JS CXCHJH_CWIH J UCCiCJSCU ICC.
OWC\CiJSDCSIOSiSiSJHUCHHOiCiKCyUiJ_HOSiSHJjJHCHI
WiIHJjOSiIi\CCXjOSUiC HISIOiy JHUiJUiO_iJjHICC\UCHCCO
jCUiJ jJQUCS.
bJiCOiUOSiSOCCUiSHOSICOHHOHyiHyOUH_JHUmIUUC-J_CU
JUuIS WIH J jCJK iHCUCHCC !H IHC IiU UCCJUC. OiC IHJH
V7 O jJICHIS WIH SJiCOiUOSiS HJ\CUH_ iH\O\CHCHI. HC
CHCSIiJUO_iJjHHJySHOWHiJiyHjHJUCHOjJIHyJOHCHIJi
yHjHJUCHOjJIHyJHUiCHCUJiOjJCiHCSjiCUOHiHJHLyiHIHC
UjjCi UH_ ZOHC Oi iCIiCUJi OjJCiIiCS WiIHOUI HiJi yH-
jHJUCHOjJIHy. UHOHJiy HCIiOHICSISHJyiC\CJJiCSIHC-
Z14 PumOaj MeCCe
LVC aLLCrL anU rCUuCLlOL L IC Or may C LOrma. JHC
aLCLLs a_C, rCUOmLaLLy OVCr OC nVOVCmCLL, OCCu-
aLOLaHsLOry,anUCuraaquCsar_uCa_aLsLumOLary
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Questons
TH 1 j8aslCj
A 0-ycar-old woman has nocd rccurrcn, righ clLow pain.
Jhc pain occurs mainly wih hc usc oI hc arm and hand, no
vih Lcnding hc clLow. Shc has nocd no pain or cndcrncss
in ohcr joins.
ExaminaLion oI hc righ arm shows markcd cndcrncss ovcr
hc lacral cpicondylc. Jhc clLow rangc oI moion is normal,
and hcrc is no rcdncss or swclling. Rcsiscd wns cxcnsion
cxaccrLacs hc clLow pain.
YCU ODC O tUC OOWID_ I8 tUC DO8t uCy UIa_O8I8:
A, CuLial unncl syndromc
I, Lacral cpicondyLis
C, lccranon Lursiis
Scpic arLhriis
TH Z jAOvanCCOj
A 45ycarold woman is cvaluacd in Lhc omcc Ior a 3-monLh
hsory oI pain, simcss, and swclling oI hc small joins oI
Lhc hands and Icc. Shc also has incrcasing Iaiguc Lha has
causcd hcr o miss work a lcas day pcr wcck. Shc has no
ohcr mcdical proLlcms.
n physical cxaminaLion, hc val signs and gcncral physical
cxaminaion, including skin cxaminaion, arc normal. A pho-
ograph oI onc oI hcr hands is shown Ilac 29,.
Complcc Llood coun, scrum chcmisrics, and urinalysis arc
all normal. Er,ocyc scdimcnaion rac is 44 mm/h.
YCU O tUC OOwID_ I8 tUC DO8t uCy UIa_O8I8:
A, scoarhriis
I, Isoriaic arhriis
C, Rhcumaoid arhriis
Syscmic lupus cryhcmaosus
TH d j8aslCj
A 8-ycar-old oLcsc woman is cvaluacd Lccausc righ hip
pain Lha worscns whcn shc gocs up and down sairs. Shc says
ha shc canno slccp on hcr righ sidc Lccausc oI pain ovcr
hc hp and can localizc Lhc pain Ly poining Lhc lacral aspcc
oI hcr hip. Shc has Lccn acivc and in good hcalh.
n physical cxaminaLion, moving hc hip Lhrough roaion,
cxion, and cxcnsion docs no clici pain, Lu aLducion
rcproduccs hc pain minimally. Jhcrc is m ,unrcsnccd rangc
oI moion. Jhcrc is cndcrncss o prcssurc ovcr Lhc lacral
aspcc oI hc righ hip.
Z19
YCU O tUC OOWD_ I8 tUC DO8t IKCy Ua_O8I8:
A, Avascular nccrosis oI hc Icmoral hcad
I, scoarhriis
C, Rcumaoid arhriis
Jrochancric Lursiis
TH R j8aslCj
A 35-ycar-old woman is cvaluacd Ior a 5-day hisory oI acuc
ngh kncc pain Lha Lcgan whcn shc hoppcd down hom Lhc
Lcd oI a Lruck, wisLing hcr kncc. Shc cxpcricnccd a popping
scnsaLion and a gradual onsc oI kncc join swclling ovcr hc
ncx scvcral hours. Sincc hcn, shc has conunucd o havc mod
crac pain, paricularly whcn walking up or down sairs. Shc
rcpors no locking or giving way oI Lhc kncc or any prcvious
kncc injury.
n physical cxaminaion, hc righ kncc has a minimal cm
sion wiLh rangc oI moLion. Jhc mcdial aspcc oI Lhc join
linc is cndcr o palpaion. Maxmally fcxg hc hip and kncc
and applyng aLducion valgus, Iorcc o hc kncc whilc cxcr
nally roaing hc Ioo and passivcly cxcnding hc kncc
McMurray cs, rcsul in a palpaLlc snap Lu no crcpiLus.
YCU O tUC OOw_ I8 tUC DO8t IKCy UIa_O8I8:
A, Anscrinc Lursiis
I, Ancrior cruciac ligamcn car
C, Mcniscal car
IaclloIcmoral pain syndromc
TH b jAOvanCCOj
A -ycar-old woman is cvaluacd Lccausc oI righ kncc pain
oI 4 wccks` duraLion. Alhough hc kncc is si Ior 20 o 30
minucs in hc morning, shc docs no havc much pain a work.
Walking up hc sairs in hcr housc, howcvcr, causcs a good
dcal oI pain, which is no rclicvcd Ly iLuproIcn or acca
minophcn. Knccling also causcs pain. Kncc radiographs donc
wccks ago show mld mcdial comparmcn oscoarLhriis
Lilacrally.
n physical cxaminaion, shc is ovcrwcigh. Jhcrc is coarsc
crcpius vLh fcxion and cxcnsion oI hc righ kncc. Ioh
knccs arc in sligh varus angulaion Low-lcggcd,. n pal-
paion, hcrc is cndcrncss along Lhc join margins oI Loh
knccs and cxquisic cndcncss o digal prcssurc a hc mcdial
uppcr LiLia on hc righ Lha rcproduccs hcr pain. !n addiLion,
wih hc paLicn`s ngh kncc scmifcxcd, palpaion along hc
mcdial scmimcmLranous cndinous hamsnng, cdgc oI hc
high cliciLs pain whcn Lhc cxag nngcrs mcc hc iLia.
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IHC CHOia HCaU aiC HHKCy CaH8C8 O IHC jaH.
KEY PO1WT
PatIent wIth tr0chanterIc b0rItI can p0Int wIth 0ne !Inger t0 the
00rce 0! the paIn 0n the atera hIp and actIvey reIted abd0c-
tI0n 0! the hIp w0ren the paIn.
DhO_agDy
OHDCCD 1 allCSOH 1. iOCHaHlCilC DHiSlllS [_iCalCi liOCHaHlCi QalH
SyHGiOHC}. ayO Cm1iOC. i;7i:55-. 11. 8+2885]
lIOH DSWOt. L
LOUCBIODB DgOCIVO. J0gn0rt mtnrt0 h01
HC jaICHI8 H8IOiy 8 8H8jCOH8 Oi a HCH8Ca ICai. aHCHI8
IyjCay UC8CiDC a IW8IH_ HHiy WIH UC OOI H a WC_HI-
DCaiH_ jO8IOH H WHCH a jOjjH_ Oi ICaiH_ 8CH8aHOH 8
OHCH CI OOWCU Dy 8C\CiC jaH. bWCH_ OCCHi8 O\Ci 8C\-
Cia HOHi8 H COHIia8I IO _aHCHIOH8 HHiC8 H WHCH
8WCH_ 8 HCUaIC. aICHI8 WIH HCH8Ca ICai8 Hay iCjOiI
a CCKH_ Oi OCKH_ O IHC KHCC 8CCOHUaiy IO OO8C CaiIa_C
H IHC KHCC DHI OHCH Ha\C jaH OHy OH WaKH_ jaiICHaiy
_OH_ Hj Oi UOVH 8Iai8. aH aOH_ IHC OHI HC 8 7 8CH-
8I\C Oi a HCH8Ca ICai aHU aH aHUDC jOj Oi 8Haj OH IHC
CHiiay IC8I 8 V7 8jCCmC Oi J HCH8Ca ICai.
/H8CiHC DHi8H8 8 CHaiaCICiZCU Dy jaH aHU ICHUCiHC88 O\Ci
IHC aHICiOHCUJ J8jCCI O IHC OWCi C_ DCOW IHC OHI HC
O IHC KHCC. HC OCaIOH O IHC jaICHI8 jaH aHU HCi aDHOi-
Ha jHy8Ca CXaHHaIOH HHUH_8 UO HOI 8HjjOiI IHC Ua_
HO88 O aH8CiHC DHi8I8.
_aHCHIOH8 UaHa_C H8Hay OCCHi8 d J iC8UI O OiCCB 8IiC88
Oi UiCCI DOW8 IO IHC KHCC WHC IHC CXIiCHIy 8 DCJiH_
WC_HI. XCC88\C HCUa iOIaIOH WIH a jaHICU OOI 8IiC88C8
IHC aHICiOi CiHCaIC _aHCHI. / jOjjH_ Oi ICaiH_ 8CH8aIOH
8 BCQHCHIy iCjOiICU H jaICHI8 WIH _aHCHIOH8 UaHa_C.
H8 jaICHI8 jHy8Ca CXaHHaIOH HHUH_8 jaiICHaiy IHC
HheumalOOQy Z89
iC8HI O IHC CHiiay IC8I 8HjjOiI a Ua_HO88 O HCH8Ca
iaIHCi IHaH _aHCHIOH8 HHiy.
aIChOCHOia jaH 8yHUiOHC 8 IHC HO8I COHHOH CaH8C O
CHiOHC KHCC jaH H aCI\C aUHI8 jaiICHaiy WOHCH
yOHH_Ci IHaH +b yCai8. HC CXaCCiDaIOH O IHC jaH Dy _OH_
UOWH 8ICj8 aHU IHC UC\COjHCHI O KHCC 8IHC88 aHU jaH aI
iC8I WHCH IHC KHCC 8 HCXCU Oi aH CXICHUCU jCiOU O HHC aiC
CHC8 IO IHC Ua_HO88. CjiOUHCH_ IHC jaH Dy hiHy HO\-
H_ IHC jaICa aOH_ IHC CHHi COHBiH8 IHC Ua_HO88. H8
jaICHI8 H8IOiy aHU jHy8Ca CXaHHaIOH hHUH_8 aiC COH
88ICHI WIH aCHIC HHiy IO IHC HCH8CH8 iaIHCi IHaH IHC
jaICOCHOia jaH 8yHUiOHC.
PO1T
PaIn a0ng the j0Int Ine I 1benItIve !0r a menIca tear and a
p0p 0r nap 0n the McM0rray tet I J1 pecI!Ic.
DO_agDy
|aCKSOH |1 \aCy 1L iOCHKC ! vaHaHOH Ol aCHlC KHCC QalH m
QilHaiy CaiC. 1HH 1HlCiH CG. 2003;i3(7):575-588. 11:
i+53022]
lIOH b DSWOt.
LOUCBIODB DgOCIVO. J0gn0rt 0nrtInt 0nrlr.
HC jaICHI Ha8 aH8CiHC DHi8I8 IHC HaHCH\Ci WIH IHC KHCC
8CHHCXCU HCj8 IO COHHiH IHC Ua_HO88. H aH8CiHC DHi8-
I8 IHC Ua_HO88 iC8I8 OH IHC HHUH_ O OCa ICHUCiHC88 OH
IHC HjjCi HHCi IDa aDOHI b CH U8Ia IO IHC HCUa aiIC-
Hai iHC O IHC KHCC. aICHI8 aiC H8Hay HUUCa_CU Oi OUCi
aHU OHCH Ha\C KHCC O8ICOaiIiH8 DHI IHC jiODCH CaH OCCHi
H aCI\C yOHH_ jCOjC a8O. \8HaIy IHCiC 8 HO iCUHC88
8WCH_ Oi HCiCa8CU WaiHIH aI IHC ja 8IC. I Hay DC
I1aI IHC HHUCiyH_ jiODCH 8 8IiaH O IHC jC8 aH8CDHH8 ICH-
UOH iaIHCi IHaH IiHC DHi8I8. |OiICO8ICiOU HCCIOH aI IHC
DHi8a 8IC aHO8I aWay8 jiO\UC8 iCC O jaH. \HCH KHCC
jaH aIIiDHICU IO C\CH 8C\CiC O8ICOaiIHiI8 O IHC KHCC U8-
ajjCai8 aHCi IiCaIHCHI O IHC aH8CiHC DHi8I8. CCaH8C IHC
COiICO8ICiOU 8 HCCICU HIO 8OH I88HC IHC i8K O ICHUOH
iHjIHiC 8 HHHa. H aUUIOH jaICHI8 8OHU aUHCiC IO a
iC_HCH O 8OHCIiC QHaUiCCj8 CXCiC8C8 aHU ajjCaDC
WC_HI iCUHCIiOH.
\8ICOaiIHiH8 aHU _OHI WOHU jiOUHCC BHUH_8 HICU IO IHC
KHCC OHI aHU aiC HOI a88OCaICU WIH OCJ ICHUCiHC88 O IHC
HjjCi HHCi IDa. HCHHaIOU aiIHiI8 O IHC KHCC 8 HHCOH-
HOH jaiICHaiy I 8 a8yHHCIICa aHU WOHU HOI jiOUHCC
OCa ICHUCiHC88 aOH_ IC HjjCi IDa.
NW
|n anerIne b0rItI the dIagn0I ret 0n the !IndIng 0! !0ca ten-
derne 0n the 0pper Inner tIbIa ab00t b Cm dIta t0 the medIa
artIc0ar Ine 0! the knee.
DO_agDy
1aiSSOH L aHH |. HC SyHGiOHC Ol aHSCilHC DHiSlHS. ÔvCiOOKCG
Gla_HOSlS. /ilHilHS 1HCHH. i85;28:i02-5. 11. +038358]
Z90 HheUmalOOQy
Item Answer: E
Educational Ob]ective: !ianerc retanr cu nn-
dinitir.
VOIJIOi CuH ICHUHI8 JH HHJHHJIOH O IHC 8ujiJ8jHJIu8
JHU/ Oi HHJ8jHJIu8 ICHUOH IHJI CJH J8O H\O\C IHC 8uD
JCiOHJ Dui8J 8 J COHHOH O\Ciu8C Hjuiy. 8 Hjuiy 8 CHJi
JCICiZCU Dy 8uDJCiOHJ ICHUCiHC88 JHU HjH_CHCHI
jJH COHjiC88OH O IHC iOIJIOi Cu ICHUOH8 JHU
8uDJCiOHJ Dui8J DCIWCCH !HC HuHCiJ HCJU JHU IHC
JCiOHOH WIH JiH CC\JHOH. JH H jJHCHI8 WI iOIJIOi CuH
ICHUHI8 OHCH OCCui8 WIH iCJCHH_ O\CiHCJU JHU WHCH y_
OH IHC 8HOuUCi. HC jJ88\C jJ-JiC HJHCu\Ci J88C88C8 IHC
UC_iCC O HjH_CHCHI. HC CXJHHCi jJCC8 OHC HJHU OH IHC
JCiOHOH JHU IHC OIHCi OH !HC OiCJiH mU JDUuCI8 IHC JiH
WHC jiC\CHIH_ IHC jJICHI HOH 8Hiu__H_. uDJCiOHJ
jJH JI IO UC_iCC8 O JDUuCIOH 8u__C8I8 HOUCiJIC
HjH_CHCHI WHC jJH JI +OUC_iCC8 Oi C88 8u__C8I8 8C\CiC
HjH_CHCHI. JH WIH iC88ICU HU-JiC JDUuCIOH 8 J 8jC-
CC hHUH_ Oi iOIJIOi CuH ICHUHIH8. ljjiOjHJIC !iCJIHCHI8
Oi JCuIC ICHUHI8 HCuUC `lii8 CC JHU CXCiC8C8 O\Ci-
HCJU iCJCHH_ JHU m_ 8HOuU DC HICU.
lUHC8\C CJj8uI8 [iOZCH 8HOuUCi} 8 CHJiJCICiZCU Dy J
UCCiCJ8CU iJH_C O 8HOuUCi HOIOH jiCUOHJHIy iC8uHH_
HOH 8IDC88 iJICi IJH HOH jJH Oi WCJKHC88.
CjIJ ICHUHI8 8 J8O JH O\Ciu8C Hjuiy H WHCH IHC DCj-
IJ _iOO\C HJy DC ICHUCi JHU JHICHOi 8HOUUCi jJH 8 CCICU
WIH iC88ICU OiCJiH 8ujHJIOH Oi CDOW HCMOH.
\CHOHuHCiJ JiIiH8 8 OHCH iCJICU IO IiJuHJ JHU IHC _iJU-
uJ OH8CI O jJH JHU 8IHC88 O\Ci HOHIH8 IO yCJi8.
l IOD iOIJIOi CuH u8uJly iC8uI8 H JiH WCJKHC88 jJiHCuJiy
VI JDUuCHOH JHU/ Oi CXICiHJ iOIJIOH. l jO8H\C UiOj-JiH
IC8I [HJDIy IO 8HOOIHy OWCi IHC JHCCICU JiH HOH
JDUuCIOH} 8 J \Ciy 8jCCC DuI iCJI\Cy H8CH8I\C HCIHOU
Oi UJ_HO8H_ iOIJIOi CuH ICJi.
K0tt0I Cut8hdhtSSChICt8I28dbySubCI0mt8hd8Ih8SS
hdmphg8m8ht,ph0t8h0CCuISWthI8Chhg0v8Ih8dhd
Wh8hyhg0hth8Sh0ud8I.
DC_aQDy
OCS!CI \ LCOI_C b !|1. bHOHGCI IHQIH_CHCH! SyHGIOHC.
A| CG. Zb11(b}:+bZ+bb. :1bZ++[
Item 7 Answer: A
Educational Ob]ective: !ianerc rc]rrcd rbeu/dr
an.
HC HO8I JjjiOjHJIC HCXI 8ICj H IH8 jJICHI8 HmJ_CHCHI
8 J CC8I iJUO_iJjH IO C\JuJIC Oi J CJu8C O iCCiiCU jJH !O
IHC 8HOuUCi. VCCiiCU 8HOuUCi jJH H COHIiJ8I IO HIHH8C
8HOuUCi jiODCH8 8 JWJy8 J88OCJICU WIH J HOiHJ 8HOu-
UCi CXJHHJIOH IHJI UOC8 HOI JICi IHC 8C\CiIy Oi IHC CHJiJC-
ICi O IHC jJH. 8 jJICHI8 CXJHHJIOH 8 HOI 8jCCC Oi J
jiOCC88 H\O\H_ IHC 8HOuUCi JjjJiJIu8. HCiC JiC HO jHy8-
CJ CXJHHJIOH 8_H8 IHJI OCJZC IHC jJH IO JHy 8HOuUCi
8IiuCIuiC. UCuJi 8yHjIOH8 UuC IO HCi\C CHIiJjHCHI JI
IHC C\C O IHC CCi\CJ 8jHC H_HI DC jOOiy OCJZCU IO IHC
IiJjCZu8 Oi JiH HOWC\Ci IHC8C 8yHjIOH8 JiC u8uJy JCCOH
jJHCU Dy jJiC8IHC8J8 Hu8CC WCJKHC88 JHU JDHOiHJ
iCHCXC8 WHCH JiC JD8CHI H IH8 jJHCHI. VCCiiCU 8HOuUCi
jJH 8 OHCH IHC iC8uI O JH uHUCiyH_ HIiJIHOiJCC jiOCC88.
l CHC8I iJUO_iJjH HJy HCj IO UCHI] JH uHUCiyH_
HIiJIHOiJCC jiOCC88 8uCH J8 JH JjCJ uH_ IuHOi C8OH
Oi jHCuHOIOiJX.
Hy8CJ IHCiJjy WOuU DC J iCJ8OHJDC OjIOH IHC 8HOuUCi
jJH WCiC OuHU IO DC Hu8CuO8KCCIJ H HJIuiC HOWC\Ci
_\CH HCi iJH_C O HOHOH JHU HO OCJZH_ 8_H8 OH CXJH-
HJIOH jHy8CJ IHCiJjy 8 uHRCy IO DC HCj JHU i!HCi
C\JuJIOH Oi IHC CJu8C O IHC 8HOuUCi jJH 8 WJiiJHICU.
KCW8C WIHOuI C\UCHCC O CIHCi J Hu8CuO8KCCIJ Oi JH
HIiJ-JiICuJi CIOO_y HCIHCi J 8KCCIJ Hu8CC iCJXJHI HOi
HIiJ-JiICuJi COiICO8ICiOU HjCCIOH WOuU DC JjjiOjiJIC.
JH iJUO_iJjHy HJ8 HICU uIIy H IHC HIJ C\JuJIOH O
8HOuUCi jJH H IHC JD8CHCC O IiJuHJ Oi 8HOuUCi UCOiHIy.
HJ_H_ HJy DC HCCC88Jiy H jJICHI8 WIH 8C\CiC Oi jCi88ICHI
jJH JHU/ Oi HCHOHJ O88. IH8 jJHCHI J iJUO_JjH WOUU
DC uHKCy IO UCHOH8IiJIC CHJH_C8 _\CH IHJI 8HC HJ8 HJU HO
IiJuHJ JHU HCi jHy8CJ CXJHHJIOH 8HOW8 HO HUH_8 O
8HOuUCi jJIHOO_y.

K88II8dSh0ud8Iph,hC0htIStt0htIhSCSh0ud8IpI0b8mS,
SWySSS0Ct8dWthh0ImSh0ud8I8Xmht0htht
d08Sh0tt8Ith8S8v8Ity0Ith8ChICt8I0th8ph.
DC_aQDy
I!CHC \ 1GCDaO 1 ay 1 \aII 1. bHOHGCI QaIH: GIa_HOSIS aHG
HaHa_CHCH! IH QIIHaIy CaIC. |. Zb1(bZb}:11Z+. :
1ZZ+[
Item Answer:
Educational Ob]ective: Trcate/ymyapia rumatica.
HC HO8I JjjiOjHJIC HJHJ_CHCHI H IH8 jJHCHI 8 IO HCiCJ8C
IHC jiCUH8OHC UO8J_C IO .OH_/ U JHU JUU HCIOIiCXJIC
H_ WCCKy. yjCJy jJICHI8 VIH jOyHyJ_J JCHC\C iC8O-
uIOH O IHCi 8yHjIOH8 VIH OW-UO8C jiCUH8OHC , IO Z
H_/U} OHCC IHC8C 8yHjIOH8 JiC COHIiOCU IHC jiCUH8OHC
UO8J_C CJH LCH DC IJjCiCU. OWC\Ci jOyHyJ_J iHCuHJI
CJ COHHOHy iCCui8 WHCH LHC jiCUHI8OHC UO8J_C 8 DCH_
IJjCiCU. iuiH_ HJiC8 IHC jiCUH8OHC UO8J_C 8HOuU DC
HCiCJ8CU IO IHC HHHuH JHOuHI HCCUCU IO jiO\UC 8yHj-
IOHJIC iCC OHCC 8yHjIOH8 8uD8UC 8OWCi IJjCD_ O I1C
UO8J_C 8 WJiiJHICU.
CCJu8C IWO jiC\Ou8 JIICHjI8 IO IJjCi U8 jJICHI8 jiCU-
H8OHC UO8J_C DCOW .O H_/U HJ\C DCCH uH8uCCC88 IHC
JUUIOH O J 8ICiOU-8jJiH_ J_CHI J8 WCh J8 JH HCiCJ8C H HCi
jiCUH8OHC UO8J_C 8 WJiiJHICU. CIHOIiCXJIC H jJiICuJi
HJS DCCH SHOWH IO DC JH CCCIiVC SICiOiG-SjJiiH_ J_CHI iH
jJIiCHIS WiIH jOyHyJ_iJ iHCHHJIiCJ.
HS jJIiCHIS jiCGSOHC GOSJ_C SHOHG DC iHCiCJSCG IO IHC
HiHiHHH GOSJ_C HCCGCG IO COHIiO HCi SyHjIOHS WHiCH iH
ImS iHGiViUHJ HJS DCCH SHOWH IO DC DCDCCH JHG .b H_/G.
HCiCJSiH_ IHiS jJHCHIS jiCUHiSOHC GOSJ_C IO ZH_/ G WOHG
HHHCCCSSJiIy jJCC HCi JI _iCJICi iiSK Oi COiIiCOSICiOiG IOXI
CiIy. JD HJS HOI DCCH SHOWH IO DC JH CHCCIiVC SICiOiG
SjJiiH_ J_CHI iH jJIiCHIS WiIH jOyHyJ_iJ iHCHHJIiCJ JHG
IHCiCOiC WOHG HOI DC IHUICJICG Oi IHIS jJIiCHI.

Mh0IXd lS dB ClV SI0l0SdIlBg dgB lB h Id
mB 0 0mdgld IhUmdlCd.
DO_aQDy
JgO!Jb uO N,0!Jtt|Ol| L 0l J| byl0M|t NJtU||l| blUUy
L!OUg O! l0 lJ||J| bOt|0ly !O! 0UMJlO|O_y. i!0U||O|0 g|U
M0lOl!0xJl0 !O! gO|yMyJ|_|J !0UMJl|tJ. J !J|UOM|Z0U UOUU|0U|||U
g|Jt0UO-tO|L|O||0U l!|J|. /|| |l0!| N0U. Z+1+1[).+V-O.
iN.1O+0000[
ItemB Answer:
Educatonal Objectve: 1t|0I [t|JHm|0 m|IUtHH
t|JJI0HI b3QDyOCOCCUS 3UI0US J|[It 0tIUtIJ HIU
V0Ht0m)tH.
HC HOSI JjjiOjHJIC iHiHJ JHHDiOHC SCCCHOH Oi IHiS jJHCHI
iS VJHCOHyCiH. bCjIIC JiIHiiIiS iS J HCGiCJ CHCi_CHCy.
CHJIO_CHOHS SjiCJG iS IHC HOSI COHHOH HCCHJHiSH O
]OiHI iHCCHOH DCCJHSC IHC SyHOViHH HJS HO DJSCHCHI HCH
DiJHC JHG iS IHCiCOiC jJiIiCHJiy VUHCiJDC IO iHCCIiOH.
S/cphy/otottus iS IHC HOSI COHHOH _iJHjOSiIiVC Oi_JHSH
JHCCIIH_ HJIiVC JHG jiOSIHCIIC ]OiHIS JHG iHCCIiOH VIIH IHC
HCIHiCIiHiCSiSIJHI SIiJIH iS DCCOHiH_ IHCiCJSiH_y COHHOH.
|OiHIS IHJI HJVC DCCH jiCViOHSy GJHJ_CG JiC HOiC iKCy IO
DCCOHC iHCCICG IHJH SIiHCIHiJy HOiHJ ]OiHIS. H jJiIICHJi
jJIiCHIS ViIH iHCHHJIOiG JiIHHHS HJVC HSHJy HSCG IHIiJJiHC
HJi COiIiCOSICiOiGS Oi iHHHHOSHjjiCSSiVC J_CHIS JI SOHC
jOiHI iH IHCii GiSCJSC COHiSC JHG JiC IHCiCOiC jJiIiCHJiy
SHSCCjIiDC IO iHCCIiOH. bCjIiC JiIHiIIiS JSO iS HOiC IKCy IO
HJVC J jOyJiIiCHJi jiCSCHIJIiOH iH jJIiCHIS ViIH jiCCXISIiH_
iHCHHJIOiG JiIHiiIIS IHJH iH OIHCi jJHCHIS. H _CHCiJ VJH
COHyCiH iS IHC CHjiiiC IHCiJjy O CHOiCC Oi COHHHHiIy
JCqHiiCG SCjIiC JiIHiiHS JHG SyHOViJ HHiG jOSiIiVC Oi _iJH
jOSiIiVC COCCi Oi iH jJIICHIS JI OW iiSK Oi _iJHHC_JIiVC
iHCCIiOH JHG WiIH J HC_JIiVC SyHOViJ HHiG LiJH SIJiH.
CCJHSC IHS jJIiCHIS SyHOVIJ uHIG iS jOSiHVC Oi _iJHjOSi
HVC COCCi JHG DCCJHSC O iHCiCJSiH_ COHCCD JDOHI HCIHiCiIH
iCSiSIJHI S/cphy/otottus cu:us(MR^) iHCCIiOH iH IHC COH
HHHIIy VJHCOHyCU iS IHC iHiHJ IiCJIHCHI O CHOiCC jCHGiH_
CHIUiC iCSHIS. OGiBCJIiOHS O IHC iHIIiJ JHIiDiOIiC iC_iHCH
CJH DC HJGC IO HJiiOW COVCiJ_C VIIH CCJZOiH Oi HJCiIH
WHCH CHIHiC iCSHIS JiC JVJiJDC DHI JiC HOI _CHCiJy iCC
OHHCHGCU JS IHiHJ CHjiiiC IHCiJjy DCCJHSC O IHC jiCVJCHCC
O1b iH IHC COHHHHIy.
HeumlOOQy Z91
\CHiiJXOHC iS IHC iHiHJ JHHDiOIiC O CHOiCC iH jJIiCHIS JI iiSK
Oi _OHOCOCCJ iHCCIiOH. LOHOCOCCJ JiIHiiIiS iS IHC HOSI
COHHOH OiH O DJCICHJ JiIHiiHS IH yOHH_ SCXHJy JCIiVC
jCiSOHS JHG SHOHG DC COHSiGCiCG IH jJHCHIS WHO jiCSCHI WIIH
Hi_iJIOiy ICHOSyHOViIiS JHG JiIHiJ_J.
PO17
|B gBId, VdBC0mClB lS h mlIlC hId 0 Ch0lC 0I C0m
mUBldCqUlI0 SlC dIhIllS Wlh SB0Vld Ul0 0SllV 0I
gIdm0SllV C0CCl dB0 lB dlBS d 0W IlSK 0I gIdmBgdlV
lBCl0BS dB0 Wlh d 0gdlV Idm SdlB ISU.
DO_aQDy
NJL0V | Y0lO| N |O|0 / |0|U N OJKl0y L. Jtl0!|J| 0gUt
J!l||U || JUU|l. |t0l. Z1O[V1).+0OO. iN. ZZ0[
ltem 1 Answer: A
Educational Objectve: 10gH0J| J|[It 0tIUtIJ H 0
[0I|HI HIU tU|Hm00 0tIUtIJ.
HIS jJHCHI HOSI uCy HJS SCjIiC JiIHiiHS WHICH HSHJy HJH
iCSIS JS JCHIC HOHOJiIHiiIIS JHG iS CHJiJCICiiZCG Dy jJiH OH
jJSSiVC iJH_C O HOIiOH iH IHC JDSCHCC O KHOWH IiJHHJ.
iIHiOCCHICSiS O IHC WiiSI V HOSI IKCy HCj IO CSIJDiSH J
GiJ_HOSiS iH IHiS jJIiCHI.
bCjHC JiIHiiHS SHOHG jJiHCuJiy DC SHSjCCICG iH jJHCHIS VIIH
HHGC!y_ iHCHHJIOO_C GiSOiUCiS SHCH JS iHCHHJIOiG J
IiS WHO jiCSCHI WiIH J SHGGCH SiH_C ]OiHI HJiC IHJI iS HOI
JCCOHjJHiCG Dy OIHCi CJIHiCS O IHC jiCCXiSIiH_ GiSOiGCi.
OWCVCi J jJIICHIS WHO jiCSCHI ViIH JCHIC HOHOJiIHiiIiS
SHOHG DC jiCSHHCG IO HJVC SCjIiC JiIHiiIiS HHII SyHOViJ HHiG
JHJySiS ViJ JiIHiOCCHICSiS CXCHGCS IHS COHGiIiOH. byHOViJ
HHiG JHJySiS iS IHC OHy GCBI1IHVC WJy IO GiJ_HOSC SCjHC JiIHiI
IiS JHG iS CHIiCJ IO _UiGC JHIiDiOIIC IiCJIHCHI. JIiCHIS WIIH
SHSjiCiOH Oi IHIS COHGiIiOH SHOHG DC_iH CHjiiIC SySICHiC
JHIiDiOIiC IHCiJjy HHI CHIHiC iCSHIS JiC JVJiJDC.
bHi_CJ GiJIHJ_C Oi GcDiiGCHCHI ViJ JiIHiOSCOjy HJy DC WJi
iJHICG iH jJIiCHIS WiIH SCjIiC JiIHiiIiS WHO GO HOI iCSjOHG IO
iCjCJICG jCiCHIJHCOHS GiJiHJ_C JHG JjjiOjiiJIC JHIiDiOIiC
IHCiJjy DHI WOHU HOI DC JH JjjiOjiIJIC IHIIIJ iHICiVCHIiOH.
|OiHI JHG DOHC GJHJ_C GHC IO iHCCHOH JiC iCJHVCy JIC iJUi
O_iJjHIC BHGH_S. H JCHIC SCjHC JiIHDHS HOHSjCCihC SOHHS
SHC !HCSS JHG ]OiHI CHSiOHS JiC OHCH IHC OHy IHIHJ iJUi
O_JjHiC BI1UIH_S JHG GO HOI CSIJDiSH IHC GiJgOSiS O IHCCUOH.
OHC SCJHS JiC HOiC SCHSiHVC iH GCICCUH_ Bd JIOiy CSiOHS
iH DOHCS JHG ]OiHIS DHI JSO JiC HOI SjCCiBC Oi iHCCHOH.
1 O IHC JHCCICG ]OIHI iS CSjCCiJy HSCH iH GCICCIiH_ JVJS
CHJi HCCiOSiS SOHIiSSHC HJSSCS JHG COCCIiOHS O HHiG HOI
ViSHJiZCG Dy OIHCi iHJ_iH_ HOGJIIICS DHI WOHG HOI CSIJD
ISH IHC GiJ_HOSiS O iHCCIiOH.
kEX PO1MT
dlBS Wh0 ISB Wlh dCU m0B0dIhIllS Sh0U0 b
ISUm0 0 hdV SlC dIhIllS UBl SB0Vld Ul0 dBdSlS Vld
dIhI0CBSlS XCU0S hlS C0B0ll0B.
Z5Z HeUmlOOQy
bO_aQHy
Ihcran K, ShOana I. Sctc arthrts n atcnts vth rccxstny
n!ammatOry arthrts. NP). Z00Z;1Z(11):10b10. INI1:
1Zb1bbj
Item Answer: D
Educational Objective: !ouarr )rarrhrrr aur
ujrrrau.
Hi8 jJIiCHI HO8I iKCy HJ8 jiO8IHCIiC OiHI iHCCIiOH WHiCH
HJyOCCUiJIJHyIiHCiHIHCjO8IOjCiJIi\CjCiiOU. iO8IHCIiC
OiHIiHCCIiOH8IHJIOCCUiJHCiIHCi8IjO8IOjCiJI\CyCJiJiC
HO8I HCqUCHIy CJU8CU Dy HCHJIO_CHOU8 8jiCJU O Oi_JH-
i8H8IOIHCjiO8IHCIiCOiHI.HC8OUiCCOHCCIiOHiHI88CI-
IiH_ i8 OHCH ODviOU8 JHU iHCUUC8 8KiH Oi_CHIOUiiHJiyIiJCI
iHCCIiOHOi J8 iH IH8 jJIiCHI JHJD8CC88CU IOOIH. JiHi8 IHC
jiCUOHiHJHIOiOHy8yHjIOHiHjJUCHI8WiIHjiO8IHCHCOHI
iHCCIiOH JHU C\Ci JHU CUKOCyIO8i8 JiC HCqUCHIy JD8CHI.
JHCHI8WiIHjiO8IHCHCOiHIiHCCHOHU8UJyHJ\CJHCC\JICU
CiyIHiOCyIC 8CUiHCHIJIiOHiJIC.UiO_iJjHyHJyiC\CJjiO8-
IHCUCOO8CHiH_DUIHJiUWJiCOO8CHiH_HJyOCCUiiHjJHCHI8
ViIHOUI iHCCIiOH J8 WC.
HC_OU 8IJHUJiU OiUJ_HO8iH_ jiO8IHCIC OiHI iHCCIiOH i8
JiIHiOCCHIC8i8 Oi iHIiJOjCiJIi\C Ii88UC 8JHjHH_ WiIH CUIUiC
DCOiCJHIDiOIiCIHCiJjyi8iHIiJICU.HC8yHO\iJHUiUCUKO-
CyICCOuHIiHjJIiCHI8WiIHjiO8IHCIiCOiHIHCCIiOHi8U8UJy
OWCiCOHjJiCUWIHIHJIiHjJIiCHI8VIHOIHCiOiH8O8Cj-
IiC JiI1iiIi8.
^8CjIiC OO8CHH_ iCCi8 IOO88 O XJIiOHO IHC JiIHiOjJ8Iy
COHjOHCHI8 WHiCHi8JHJOiOH_-ICiHCOHjiCJHOHOHij
JiI1iOjJ8Iy.HCHO8I8H_HJHC8IJIiOHOIHi8COHUiIiOH
i8 jJiH iH IHC jiOXiHJ JHU HCUiJ J8jCCI O IHC IHi_H IHJI i8
WOi8CViIHWCi_HIDCJiiH_.\8ICOy8i8i8IyjiCJy8CCHOHiJUi-
O_iJjH8OJHCCICUjJICHI8WHiCHIHi8jJIiCHIUOC8HOIHJ\C.
/CjIiCOO8CHiH_J8OWOUUHOICXjJiHIHi8jJHCHI8HJH-
HJIOiy8yHOviJHUiU.
H8 jJIiCHI8 CC\JICU 8yHOJ HUiU CUKOCyIC COUHI ViIH J
jiCUOHiHJHCC O HCUIiOjH8 i8 8U__C8Ii\C O _OUI DUI IHi8
COHUiIOHUOC8HOIHJ\CJ8UDJCUICOH8CIJHU UOC8HOICOH-
HOHy JHCCI IHC Hj8. / JCUICJIIJCK O _OUI J8O WOUU DC
J88OCiJICU WiIH Ciy8IJ8\i8iDCOH jOJiiZCUi_HI HiCiO8COjy
OIHC8yHO\iJHUiU.
i_HCHICU\iOHOUUJi8yHO\iI8i8JiJiCjiOiCiJH\C8yHOvi-
H8IHJIHO8ICOHHOHyiH\O\C8IHCHijOiKHCC.JUiO_iJjH8
iH jJICHI8 WiIH IHi8 COHUiIiOH HJy iC\CJ DOHC CiO8iOH8 Oi
HJy DC HOiHJ. i_HCHICU \iOHOUUJi 8yHO\iIi8 IyjiCJy
UC\COj8 iH yOUH_ jJIiCHI8 JHU i8 HOI J88OCiJICUViIH jiO8-
IHCIiCOiHI jJCCHCHI.
EN FO1WT
dS W I0SC [0 C0, d S I00md
0I 0 Sm0m, d0 VI d0 Uk0C0SS dI IqU
d0S.
bO_aQHy
Jramuz P, Zmmcrl Y. 1aynOss and trcatmcnt OI mlantassOcatcd
scuc arthnts and OstcOmyclus. urr InIcct 1s Ic. Z00;1 0( b ):3V1
+03. INI1: 1ZZ01j
Item Answer: D
Educational Objective: Jrror orun aur rh o uau-
rnradol our-ummomry dru (N5H! ).
HCHO8IJjjiOjiiJICIiCJIHCHIOiIHi8jJIiCHIi8JUHiH8IiJ-
IiOHOJH^bD18UCHJ8iHUOHCIHJCiH. 1CmIi\CUiJ_HO8i8
O_OUIiCqUiiC8IHCiUCHIiBCJIiOH OHOHO8OUUHUiJICCiy8-
IJ8 OH JiIHiOCCHIC8i8 Oi J8jiiJIiOH O J IOjHU8. 1UiiH_ JH
JIIJCKO_OUIHCCUC-8HJjCUHOHO8OUiuHUiJICCiy8IJ8UJI
IyjiCJyJjjCJiCH_UCUDyIHCHCUIiOji8JiCv8iDCOHCOH-
jCH8JICUjOJiiZCUi_HIHiCiO8COjy.^b^18 COiUCO8ICiOiU8
JHU COCHiCiHC JiCOjIiOH8iHIHCIiCJIHCHIOJHJCUICJIIJCK
O_OUI.^bD18JiCi_yCHCCIi\CWHCHJUHiHi8ICiCUUUi-
H_ JH JCUIC JIIJCK DUI IHCy 8HOUU DC U8CU ViIH CJUIiOH H
jJICHI8JID8KOiiCHJiHjJiiHCHIDCCUiH_ OiUCCiUi8Oi-
UCi8 C8jCCiJy iH IHC CUCiy. \iJ HIiJ-JiIiCUJi Oi iHIiJ-
\CHOU8 COiIiCO8ICiOiU IHCiJjy i8 J8O CHCCIi\C H JCUIC _OUIy
JIIJCK8. OWC\Ci OiJJHUiHIiJ\CHOU8IHCiJjyHJyDCjiOD-
CHJHC HjJIiCHI8 ViIH UiJDCIC8 HCmIU8. \OCHCiHC i8 HO8I
CCCIi\C iH jJIiCHI8 WiIH HOHOJiIiCUJi iH\O\CHCHI JHU
WHCH U8CU ViIHiH IHC i8I Z+ HOUi8 O 8yHjIOH8 CJH JDOiI
J 8C\CiC JIIJCK. DI IHC i8I 8i_H O JH JIIJCK H jJICHI8 ViIH
HOiHJ iCHJ HCIiOH I8 J_CHI i8U8UJyJUHiH8ICiCU IWO
OiIHiCCIiHC8UJiyUHIiIHCjJIiCHICXjCiiCHCC88yHjIOHJIC
iCiCUC\COj8_J8IiOiHIC8HHJIOXiCiIyOiiCJCHC8JHJXiHuH
UO8CO H_ jCi JIIJCK.
ÔjUiiHOJHUCDUXO8IJIJiCXJHIiHCOXiUJ8CiHHiDiIOi8U8C-
BiHiCUUCiH_UDCJCiUC\C8iHjJHCHI8ViIHiCCUiiCHIJIIJCK8
OJCUIC_OUIJHUjJIiCHI8ViIHUDCJCiUIOjiOiiCHJ8IOHC8.
JjiUCOHIiO O8CiuHUiiCJCiUC\C8_CHCiJyi8HOI HCCC8-
8Jiy UUDH_JHJCUICJIIJCKJHUJCUICiHCiCJ8C8 JHU UCCiCJ8C8
iHIHCUiCJCiUC\CJICiIHC8ICJUy8IJICJHUHJyjiOOH_IHC
CUiiCHI JIIJCK Oi jiCCijiIJIC HCW JIIJCK8. iOjHyJCIC
COCHiCiHC OW-UO8C COiIiCO8ICiOiU8 Oi ^bD18 iHiIiJICU JI
CJ8I i WCCK DCOiC DC_ _ Oi JUU8IiH_ IHC UO8C O UDC
JCiUOWCiiH_IHCiJjyHCjIOjiC\CHIUi8CJ8CBJiC8J88OCiJICU
ViIHCHJH_C8iHUiiCJCiUC\C8JHUHJyHCCUIODCCOHIiHUCU
UHUIHCiJjCUIiC8CiUHUDCJCiUC\C8HJ\CDCCHJCHC\CU <
H_/U .+ HHO/]]. iOOH_CU U8C O IHC8C J_CHI8 HJy
DC iHUCJICU iH jJIiCHI8 ViIH CHiOHiC IOjHJCCOU8 _OUI UHIi
IHCUi8CJ8Ci8COHIiOCU.
NbS, C0IC0SI00S, d0 C0CC dI 00S Id
m 0 d dCU ddCk 0 g0U.
DO_aQHy
YlsOn ). In thc clnc. LOut. P Intcrn Ncd. Z010;1bZ(3):IJZ1
IJ21. INI1: 201Z+ZZ]
Item 1 Answer. L
Educatonal Objectve. 1It0l b_tIPIIttmI0 HIlb
PIIt 0tId~0HtIIHg lbtI0[y.
HC HO8I ajjiOjiIaIC IHCiajy Oi IHI8 jaIICHI I8 OWGO8C
COCHICIHCaHGaOjHiIHO.'iIICiIaOiIHIIaHH_IiCaIHCHIO
H_CiHiiCCHIaiHjaIICHI8WIH8yHjIOHaIIC_OHIIHCHGCIHC
jiC8CHCC O IOjHI Oi iCHa 8IOHC8 HHIIjC aIIaCK8 O aCHIC
_OHIOiaHI8IOiyOaGCCiCa8H_jCiIOGDCDCCHaIIaCK8. lDC
aCIGOWCiH_ IHCiajy IyjICay I8 HOI IHIIIaICG HHIH a jaHCHI
CXjCiICHCC8 IWO GOCHHCHICG aCHIC aIIaCK8. 1ICIaiy jH!IHC
iC8IiICIIOH WCI_HI O88 aHG GI8COHIiHHaIIOH O aCOHO Hay
HCj IO GCCiCd8C HDC aCIG C\C8 IH jaIICHIS VIIH HiG HyjCi
HiiCCHiaaHG8yHjIOHaIIC_OHI. CGICaHOH8IHaIiaI8C8CiHH
HiICaCIGC\C8 8HCH a8 IHIaZIGCGIHiCIIC8aHGOWGO8C8aICy
aIC88HOHGDCGI8COHIHHCGIalICiHaH\CIHCiajyI8a\aIaDC.
OWC\CiHO8I jaIICHI8VIIH iCCHiiCHI _OHIyaIIaCK8 jaiIIC-
HaiyIHO8CWiIHIOjHaCCOH8GCjO8II8iCqHIiCjHaiHaCOO_C
IHCiajy IO OWCi 8CiHH C\C8 O HiIC aCIG. HC _Oal IH HiIC
aCIGOWCiIH_IHCiajyI8IOaCHiC\Ca8CiHHHiCaCIGC\CC88
IHaHo.0 H_yG0.4 HHOy}HOIH8IC\C8VIIHIHIHCHOi-
Hal iaH_C. YCH IHC HiC aCIG C\C8 aiC DCOW o.0 H_yG
0.4 HHOy} HOHO8OGIHH HiaIC Ciy8Ia8 BOH WIIH IHC
OIHIaHGBOH8OHIi88HCIOjHaCCOH8GCjO8II8aiCiCaD8OiDCG.
1iOjHyaCHCCOCHICIHCOWGO8CCOiHCO8ICiOIG8 0 H_y GOi
C88}Oi HOH8ICiOIGa aHIiIHBaHHaIOiy GiH_8 [`/118}IHI-
IIaICG aI Ca8I WCCK DCOiC DC_ _ Oi aGH8IH_ IHC GO8C
O HiIC aCIGOWCiIH_ IHCiajy HCj IO jiC\CHI GI8Ca8C BaiC8
a88OCIaICGWIHCHaH_C8IHHiICaCIGC\C8aHGHayHCCGIODC
COHIIHHCG HHII IHCiajCHIIC 8CiHH HiIC aCIG C\C8 Ha\C DCCH
aCHIC\CG.
OWGO8C `/118 8HCH a8 IHGOHCIHaCIH Oi OWGO8C
COCHiCiHC Hay jiC\CHIaIIaCK8O _OHI DHI GO HOIOWCiHiIC
aCIGC\C8aHGIHCiCOiCCaHHOIjiC\CHIIHCCOHHHHCGaCCH-
HHaIIOHO HiICaCIG IH 8OH II88HC8[IOjHI}HiiC aCIG KIGHCy
8IOHC8 Oi GC8IiHCIi\C aiIHiIII8.
|I0hdCC C0ChCB, 0W00S C0IC0SI00S, 0I NbS dI
Bd0 d dS 1 Wk 00I 0gBBBg 0I d0[USBg h 00S 0
UIC dC0~0WIBg hId 0 IvB 0SdS dIS dSS0Cd0
Wh ChdBgS B UIC dC0 vS.
DO_aQDy
Y8OH |I. H Ic CUHC. LOuI. HIciH cU. 2JJb2(o}:\2-J-
d\2-J. _ii: 2J2+22[
Item 1 Answer. A
Educatonal Objectve. 1I0gH0t t0tIPm [yI0[b0~
[b0 dIbydI0 m[0IlI0H dIt0t.
HI8 jaIICHI Ha8 CaCIHH jyiOjHO8jHaIC GIHyGiaIC [ '111}
GCjO8IIIOH GI8Ca8C jiC8CHIIH_ a8 j8CHGO_OHI. 18CHGO_OHI
HJHIC8I8a8aCHICOi8HDaCHICaIIaCK8OWaiHIHaHG8WCiH_
IH OHC IO IWO OIHI8 IHaI iC8CHDC aCHIC _OHIy aiIHiOjaIHy.
18CHGO_OHII8a88OCIaICGVIIHiHBaHHaIOiy8yHO\alBHIGaHG
KCumlOOQy 53
IHCjiC8CHCCO'111 Ciy8Ia8 IHaIaiCWCalyjO8IH\CyDIiC
iIH_CHI aHG iHOHDOIG IH 8HajC 8CCH OH jOaiZCG I_HI
HICiO8COjy. iCaIHCHI O aH aCHIC j8CHGO_OHI aIIaCK jiI-
HaiIy IH\O\C8 `/i18 DHI a COiICO8ICiOIG Oi COCHiCIHC
WOHG DCajjiOjiIaICaICiHaII\CCHOICC8.
HI8 jaIICHI8 iaGIO_iajHIC JHG jHy8ICal CXaHHaHOHBHGIH_8
a8OaiC8H__C8H\COO8ICOJ!ImH8.\8ICOaiImH8IHaIHaHIC8I8
HjaHCHI8VIIH '111GCjO8IHOH OiIHCjiC8CHCCOCHOHGiO-
CaCIHO8I8 OH iaGIO_iajHy I8 KHOWH a8 j8CHGOO8ICOaiIHiIH8.
HI8 GC_CHCiaH\C COHGIHOH HIHIC8 O8ICOaiIHDH8CXCCjI IHaI
IIHayaHCCIOHI8HOIIyjICalyIH\O\CGiHO8ICOJH88HCH
a8IHCV!I8I8HCIaCaQOjHalJH_CaOHI88HOUGCi8aHGaUKlC8.
HCSyHO\IalBHIGHjaHCHI8VIIHj8CHGOO8ICOaiIiIH8I8HOH
H aIOiOIHj8CHGOO8ICOaiImH8aHGj8CHGO_OHIHay
DC jiC8CHI IH IHC 8aHC jaIICHI. HC IiCaIHCHI O j8CHGO
O8ICOaiImH8I8HOGiHCiCHIIHaHIHCIiCaIHCHIOO8ICOJiIHiI
H8 aHG IHCHGC8 aGCqHaIC aHa_C8Ia jHy8ICal aHG OCCHjaHOHa
IHCiajyaHGaiIHiOja8IyOi8yHjIOHaHCGI8Ca8CHHiC8jOH8I\C
IO HOiC COH8Ci\aH\C IHC!ajy.
'HaiaCICiI8IIC CaIHiC8 O CHiOHIC ajaIIIC GCjO8IIIOH GI8Ca8C
IHCHGC ai_C HIHBm y iHaHHaIOiy CH8IOH8 IHaI H8Hay
GC\COjIHIHC8HOHGCiOiKHCCGC8IiHCHOHOa88OCIaICGICH-
GOH8IiHCIHiC8aHGCHOHiCjaIH.'aCIHHajaHICCiy8Ia8Hay
OHyajjCaia8aHOQHOH8HOHDI!CUH_CHICiy8Im IHCCHHj8
OH 8yHO\a HIG Jay8I8 aHG IHCiCOiC aiC HOI IGCHIICG OH
iOHIIHC CXaHIHaIiOH. 1GCHUCaHOH O IHC8C Ciy8Ia8 iCQHIiC8
8jCCIa 8IaIHIH_ Oi Ciy8Ia aHay8I8 IHaI I8 HOI iOHIIHCy a\aI-
aDC. HCaD8CHCCOIHC8CCiy8Ia8IHIHI8jaIICHICXCHGC8IHI8
COHGiIIOH.
LOHI I8 CaH8CG Dy IHC GCjO8IHOH O HOHO8OUIHHHiaIC Ciy8-
Ia8IHIHCH88HC8OaHGaiOHHGIHCOIHI8.aiyaIIaCK8O_OHI
aiCHOHOaiHCHlaiaHGHO8ICOHHOHyIH\O\CIHCHFIHCIaIai
8OjHaJH_CaOIHI WHCiCa8 CHiOHIC _OHIHayHaUIC8Ia88yH
HCIiIC IH\O\CHCHI O IHC 8Ha OIHI8 O IHC HaHG8 JHG CCI
aCCOHjJHICGDyIOjHIaHG8HDCOiHCalCiO8IOH8OHiaGiO_ajHy.
1CHI1IH\C GIa_HO8I8 O _OHI I8 C8IaDI8HCG Dy IHC jiC8CHCC O
8IiOH_yHC_aH\CyDuCUH_CHIHCCGC8HajCGCiy8IJ8OHjOai-
IZCG I_HI HICiO8COjy O 8yHO\Ia HIG Oi HIG BOH a IOjHH8
WHICH I8 HOI COH8I8ICHIVIIHIHI8jaHCHI8 BHGIH_8.
HC GIa_HO8I8 O 8CjIC aiIHiIII8 8HOHG DC COH8IGCiCG IH a
jaIICHI8 WIIH aCHIC HOHOaiIHiIIi8 aHG a 8HGGCH IHCiCa8C IH
jaIH iH a CHiOHCayGaHa_CGOIHI. HI8 jaHCHI8 OIHI BHIG
I8IHaIOiyDHIIHCCHKOCyICCOHHII8HOI8HHCICHIlyCC
\aICG IO 8H__C8I 8CjIIC aiIHII8.
KEX PO1WT
|SU00g0U S dSS0Cd0 Wh dCU 0I SU0dCU ddCkS 0
WdImh dB0 SWBg B 0B 0 W0 [0BS hd ISm0 dCU
g0U dIhI0dh dB0 Wdk 0Sv 0IIBgB CISdS hd
dI Ih0m000 B Shd SB 0B 0dIZ0 gh mCI0SC0 0 SB
0vd U0.
DO_aQDy
O8cHIJ PI. ljUJIc H CJ!CuH UcjO8IOH U8cJ8c8. \uii \jH
!cuHJIO. 2JV(2}.Jb-J2. _ii. J2VoJq
Z94 HheumalOlOQy
Item Answer:
Educational Ob]ective: !iapnasc asuaarr0riris af r0c
kncc.
Hi8jJIiCHIHO8IiKCyHJ8O8ICOJiIHiiIi8OIHCKHCC.1CHJ8
IVOii8KJCIOi8OiIHi8COHGiIiOHJGVJHCCGJ_CJHGJHOCCH
jJIiOH iHVOViH_ iCjCIiIiVC DCHGiH_ JHG jHy8iCJ JDOi.
\8ICOJiIHiiIi8COHHOHyJHCCI8WCi_HIDCJiiH_OiHI88HCHJ8
IHCKHCC8JHGi8CHJiJCICiiZCGDyjJiHOHJCH\iIyIHJIi8iCiCVCG
VIH iC8I. WCiH_ iH jJIiCHI8 WiIH IHi8 COHGiIiOH i8 H8HJy
HHJ JHG iJH_C O HOIiOH HJy DC iHICG. DCCOiGiH_ IO
IHC DHCDCJH \OC_COHCHHJIOO_y O8ICOJiIHDIi8O IHC
KHCCCJHDCGiJ_HO8CGHKHCCjJH i8JCCOHjJHiCGDy JICJ8I
IHiCC O IHC OOWiH_ CJIHiC8. J_C _iCJICi IHJH yCJi8
HOiHH_8IiDC88J8IH_C88IHJH HiHHIC8CiCjiIH8DOHy
ICHGCiHC88 DOHy CHJi_CHCHI JHG JH JD8CHCC O jJjJDC
WJiHIH. H8 jJIiCHI8 iJGiO_iJjHiC H11GiH_8 O O8ICOjHyIC8
OHI8jJCC HJiiOWiH_ 8CCiO8i8 JHG Cy8I OiHJIiOH JiC I_i
CJOIH8COHGiIiOH./iIHiOCCHIC8i8i8HOIHCCC88JiyIOC8IJD
i8HJ GiJ_HO8i8 O O8ICOJiIHDIi8.
JIiCHI8 WiIH JVJ8CHJi HCCiO8i8 O IHC KHCC IyjiCJy CXjCii
CHCC jJiH OH WCi_HI DCJiiH_ JHG HJy HJVC J jm iHiICG
iJH_C O HOIiOH. 1OWCVCi IH8 COHUIiOH J8O i8 J88OCiJICG
WiIHjJiDOHiC8IJHGHO8ICOHHOHyOCCHi8HjJHCHI8WHO
H8C COiIiCO8ICiOiG8 HJVC 8y8ICHiC HjH8 CiyIHCHJIO8H8 Oi
COH8HHC CXCC88iVC JHOHHI8 O JCOHOiC DCVCiJ_C8.JGi
O_iJjH8iHjJIiCHI8WiIHJVJ8CHJiHCCiO8i8H8HJyiCVCJGCH
8iIy CHJH_C8 8HDCHOHGiJ iJGiOHCCHCy Cy8I8 8CCiO8i8 JHG
CVCHIHJyOiHI8jJCC HJiiOWiH_.
HCHHJIOiG JiIHiiIi8 HJy DC J88OCiJICG WiIH J iHiICG iJH_C
O HOIiOH JHG OiHI8jJCC HJiiOWiH_ Vi8iDC OH iJGiO_iJjHy.
JIiCHI8 WiIH iHCHHJIOiG JiIHiiIi8 H8HJy HJVC 8yHHCIiiC
JiIHiiIi8IHJIJHCI8JICJ8IIHCC OiHI8J8 WC J8 JH CCVJICG
CiyIHiOCyIC 8CGiH\CHIJIiOH iJIC JHG i8 J88OCiJICG WiIH HOD
iH_ 8IiHC88 IHJI jCi8i8I8 Oi HOiC IHJH HiHHIC8. H JGGi
IiOHiHCHHJIOiGJiIHiiIi8J8OWOHGHOICXjJiHIHCjiC8CHCC
O8HDCHOHGiJ 8CCiO8i8 JHGO8ICOjHyIC8OH iJGiO_iJjHy.
DIOiHHCGiJHCHi8CH8WOHGCJH8CjmiH IHC KHCC JHG CJH
OCCHiiHIHCCGCiyiHJ88OCiJIiOHWiIHO8ICOJiIHiIi8.JIiCHI8
WIH JCHIC HCH8CJ GJHJ_C OHCH GC8CDDC J IWi8IH_ iHHiy
WiIHIHCOOIiHJWCi_HI DCJiiH_jO8iIiOHiHWHiCHJjOjjiH_
OiICJiiH_8CH8JHOHi8CIOOWCGDy8CVCiCjJiHiHJGUiIiOH
IHi8 COHGiIiOH i8 CHJiJCICiiZCG Dy IHC 8CH8JHOH IHJI IHC KHCC
OCK8 Oi_VC8OHI.
|hySc8xmht0hhdhgSc0hSSt8htWth0St80fthftS0th8
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Item Answer:
Educational Ob]ective: Manapc asuaarr0riris af r0c
kncc.
Hi8jJIiCHIHJ8 O8ICOJiImIi8 O IHC KHCC. HC HO8I JjjiO
jiiJICHCXI8ICjiHHCiHJHJ_CHCHIi8iCCiiJOijHy8iCJIHCi
JjyWHiCHi8JHJjjiOjiiJICHi8IiHCHJHJ_CHCHIOjIiOHOi
jJIiCHI8 WIH IHi8 COHGiIiOH. _HJGDCCj8 HH8CC IiJiHiH_ iH
jJiIiCHJi HJ8 DCCH 8HOWH IO iCGHCC jJiH B IHi8 jOjHJIiOH
_iOHj.l8COOVCiIHCCOHHICiJCCIJHiHOjHCHOiJHDi
OH JHJ8HCCGCGDJ8i8 J8OHJy DCHCHIIH8jJIiCHI.
DiIHiO8COjy JHG O IHC KHCC WOHG HO8I iKCy iCVCJ
JDHOiHJiHC8OIHCJiHCHJiCJiUJ_CHOIV8iDCOHjJiHiJUi
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O8ICOJiIHiIi8.H Jiy J8jiiJIiOHOIHCKHCCOiHIWOHGDC
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IHCiHOiC IHi8jJIiCHI GOC8HOI HJVC JHCH8iOH.

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Item Answer:
Educational Objective: !iapnasc asuaarr0riris af r0c
]rr raQamcraraQa| ainr.
Hi8 jJIICHI HO8I iKCy HJ8 O8ICOJiIHiiIi8 O IHC Hi8I CJi
jOHCIJCJijJOiHI. \8ICOJiIHiIi8 iH IH8 OCJIiOH OHCH jiC
8CHI8 WiIH WC OCJiZCG ICHGCiHC88 IO jJjJIiOH. OVCHCHI
O IHC IHHHD iH J CiiCHJi HOIOH [_iiHG IC8I} V OHCH
CiCiI IHC jJiH. iCGi8jO8iH_ JCIOi8 iHCHGC iCjCIIiVC H8C O
IHCWii8IOiIHHHD. JIiCHI8 HJy jiC8CHIWIHjJiH 8WCiH_
Oi CHJi_CHCHI O IHC CJijOHCIJCJQJ OiHI iCCO_HZCG J8
8QHJD_OiDOXiH_JIIHCDJ8COIHCIHHHD./88OCiJICGHHG
iH_8 O O8ICOJiIHiiIi8 JiC COHHOH JHG HJy iHCHGC DOHCy
CHJi_CHCHI O IHC Gi8IJ iHICijHJJH_CJ OiHI8 [1CDCiGCH
HOGC8} Oi IHC jiOXiHJ iHICijHJJH_CJ OiHI8 [1OHCHJiG
HOGC8}.
HCHHJIOiG JiIHiiIi8 i8 JH iHB JIOiy JiIHiiIi8 HO8I OHCH
JCCIiH_ IHC 8HJ OiHI8 O IHC HJHG8 [Wii8I HCIJCJQOjHJ
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8CHIOHjJjJIiOHOIHCGi8IJJ8jCCIOIHCiJGJ8]OiG. Hi8
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LHC ViSLS a_aHSL CaCH OLHCi [HaCH S_H] Hay CXaCCiDaLC
SyHjLOHS.yHjLOHSaiCOHCHVOiSCaLH_HLOiViLHiCjCL-
LVCHOVCHCHLSOiCOHLiHuOuSjiCSSuiCOH LHC VHSL SuCH aS
L_H_ OHaKCyDOaiU.
IiySLaHUuCCUaiLHiHSHLHCHaHUSSuSuayaSSOCaLCUVLH
CVUCHCC O OiHL iHaHHaLOH SuCH aS iCUHCSS aHU VaiHLH.
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untcr I|.1n thc clnc. |stcOarthrtts. 1ntcrn Ncd. 2007;1+7(3):
IJI1IJI1. INII: 177v702|
Item 1 Answer: A
Educatonal Ob]ectve: Manapc atun asnaar0iris
aj r0c kncc wir0 nansnaida| anri-injmmamy dups.
HC DCSL HaHa_CHCHL Oi LHS jaLCHL S LO DC_H a HOHSLCi-
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iKCy HaS aCuLCOSLCOaiLHiiLSO LHC KHCC. IaSSC BHUH_S O
OSLCOaiLHiiLS HCuUC jaH VLH aCLVLy LHaL S iCCVCU ViLH
iCSL. HC jaLCHL`S iaUiO_iajHC HUiH_S O OHL SjaCC Hai-
iOViH_ SuDCHOHUia SCCiOSS aHU OSLCOjHyC OiHaLiOH aiC
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USjOSCS HH LO HCUa COHjaiLHCHL OSLCOaiLHiLS UuC LO
uHCVCH OaUH_ OiCCS VHCHaHDuaLH_. C HaS aCU LiCaL-
HCHLVLHaCCLaHHOjHCHaHUIHCiCOiCaHOiaD11SuCH
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CaLHCiajyLCHjOiaiyuSCOaCaHCaHUDiaCH_OiLajH_aiC
aSO iCaSOHaDC HLa HLCiVCHLOHS. D11S aiC aSSOCaLCU
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VaSCuai USCaSC. HC DHCiCaH IOC_C O CuHaLOO_y
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UOCS HOL Su__CSL SCjLC aiLHiLS. 1H HOmaHHaLOiy aiLHi-
LS LHC SyHOVa uU CuKOCyLC COuHL S uSuay CSS LHaH
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untcr I|. In thc cnc. |stcOarthrtts. P Intcrn Ncd. 2007;1+7:
IJI1IJI1. INII: 177v702|
Item 1 Answer:
Educatonal Ob]ectve: !iapnasc 0cumamid
ar0iris wir0 t0aatnisrit adiapap0it [ndinps.
P iaUO_iajH SHOVH_ Hai_Ha OHL CiOSOHS VOuU HOSL
iKCy SujjOiLa Ua_HOSS OiHCuHaLOU aiULS [1]. am
iaUO_iajHSOLHCHaHUSaHUCCLSHOuUDCjCiOiHCUaLLHC
HHCOUa_HOSSHjaHCHLSViLHiHCuHaLOUaiLHHSLOUCLCCL
CiOSOHSJHU OHL-SjaCC HaiiOVH_. iOSOHSO CaiHa_C aHU
DOHCaiCCaiUHaCaLuiCSO 1.iOSOHSaHUOHL-SjaCCHai-
iOVH_ Hay UCVCOj aS Caiy aS2 LO HOHLS aHU aiC OHCH
jiCSCHLHOHLHSaHCiLHCOHSCLOiHCuHaLOUaiLHiLS. iO-
_iCSSOH S HOiC iajU Caiy H LHC USCaSC. 1H a jaHCHL ViLH
SyHHCLHCaSyHOvLiSO LHCSHaOHLSO LCHaHUaHUjiO-
OH_CUHOiHH_SH CSSXiaySSHOVH_OHLCiOSOHSSHOSL
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Educational Objective: !iopncsc [brcmyoyio.
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Educational Objective: !iopncsc Seprcn syndrcmc.
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