State Exam 20.09.

2012
By: Alhag Abu Anzeh Muhammad (baghdats@yahoo.com)
Part A

1. 6 years old boy has stool in his underwear daily. He was toilet trained at 2 without difficulty. !er the
last2 years he had de!elo"ed chronic consti"ation. #he fecal soilin$ de!elo"ed o!er the last % months. He
is otherwise normal. Examination re!eals stool in rectal !ault. &nitial mana$ement should include which of the
followin$'

a. barium enema followed by rectal bio"sy
b. time out from school when he has stool in his underwear
c. family consultin$
d. clear fecal im"action and short term stool softener use
e. daily enemas for ( wee)s


2. A 2 year old child has multi"le e"isodes of brief shrill cry followed by a "rolon$ed ex"iration and a"nea.
He was born after normal "re$nancy and deli!ery. *rowth and de!elo"ment are normal. #he first e"isode
occurred immediately after the mother refused to $i!e the child some +uice, the child became cyanotic-
unconscious- and had $enerali.ed clonic +er)s. A few moments later the child awa)ened and had no
residual effects. Physical examination is normal. /hich of the followin$ is most li)ely dia$nosis'

a. Sei.ure disorder
b. 0ru$ in$estion
c. Hy"eracti!ity with attention deficit
d. Per!asi!e de!elo"ment disorder
e. 1reath2holdin$ s"ell


%. A 32month2old child with "oor $rowth "resents to the E4 with $enerali.ed tonic2clonic sei.ure acti!ity of about %02
minute duration that sto"s u"on the administration of lora.e"am. /hich of the followin$ information $athered from
the mother will be most hel"ful'

a. #he child has had rhinorrhea
b. #he child is de!elo"mentally normal- as are his siblin$s
c. #he mother has been dilutin$ the infant5s formula to ma)e it last lon$er
d. number and ty"e of "ets
e. #he mother is sin$le and unem"loyed

(. 6ull term newborn infant is ha!in$ e"isodes of cyanosis and a"nea which are worse with attem"tin$ to feed but
seems better with cryin$. /hich of the followin$ is most im"ortant next ste" to 7uic)ly establish the dia$nosis'

a. Echocardio$ram
b. 8entilation "erfusion scan
c. Passa$e of catheter into nose
d. Hemo$lobin electro"horesis
e. 1ronchosco"ic e!aluation of "alate and larynx


3. % month old child is been cryin$ at the same time each day- you sus"ect colic. /hat is true about colic'

a. onset at % month and "ea) at 6 months
b. almost all cases are due to lactose intolerance
c. ty"ical at afternoon and e!enin$
e. with any de$ree of abdominal distension should ha!e 9# abdomen


6. % year old has "ersistent rhinorrhea for the last "ast 6 wee)s. therwise the "atient has been
asym"tomatic. n "hysical examination you notice mouth breathin$ and dar) circles under the eyes. &n the nose-
watery dischar$e and edematous bo$$y bluish mucous membrane with no erythema. :ost li)ely dia$nosis;

a. chronic bronchitis
b. sinusitis
c. nasal forei$n body
d. aller$ic rhinitis
e. 9S6 lea)

<. 3 year old immuni.ed $irl is seen in the emer$ency de"artment because of fe!er- sore throat and
res"iratory distress that has de!elo"ed in the last % hours. She is droolin$- holdin$ her nec) in a
hy"erextended "osition- she has mild stridor but does not ha!e bar)y cou$h. #he "atient most li)ely to ha!e;

a. !iral crou"
b. s"asmodic cou$h
c. e"i$lottitis
d. bacterial tracheitis
e. asthma

=. A 9 mounts boy- "re!iously healthy and normally $ainin$ wei$ht was recently dischar$e from the
hos"ital. #he hos"itali.ation was due to a se!ere rota!irus diarrhea that re7uires rehydration. ( days later the baby
still has loss stools. He is now drin)in$ his re$ular cow>s mil) formula well. n "hysical examination he is ha""y and
well hydrated. 4e"eat rota!irus test is ne$ati!e. /hat is the reason for the baby>s continued diarrhea'

a. cow mil) "rotein aller$y
b. star!ation diarrhea
c. secondary lactose intolerance
d. !iral $astroenteritis
e. cystic fibrosis

9. a mother brin$s her 2 year old baby for re$ular chec)u". She is confused about which "osition to "ut her baby to
slee". /ith re$ard to infant slee"in$ "osition- how should you consult the mother'

a. "lace the baby on the belly
b. "lace the baby on the side
c. ele!ate head of the baby>s crib
d. ele!ate the foot of infant crib
e. "lace on the bac)


10. #he most common neurolo$ical se7uela associated with bacterial menin$itis- and usually "resents at the time of
initial infection is'

a. mental retardation
b. chronic sei.ure disorder
c. im"aired !ision
d. im"aired hearin$
e. beha!ioral disturbances


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21. bese- 9 years old $irl- history of "ersistent headache and blurred !ision. :ild !omitin$ . ?o fe!er. &n "hysical
examination "a"illedema. 8isual field testin$ inferior nasal blind s"ot. :4& normal. AP "ressur &S ele!ats- 9S6
com"osition &S normal. Aab. ?ormal. /hat &S the most li)ely dia$nosis'

Pseudotumor cerebri


22. ( day old infant- noted to be suc)in$ on a honey2 filled "acifier. Cou caution the mother a$ainst its isr because its
contents can cause;

&nfantile botulism


2%. &nfant = day old- hi$h #SH and low #(. &f this condition &S Aeft untreated;

Prolon$ed +aundice
2(. 9om"lication of hy"ernatremic dehydration &S;

9erebral edema.


23. you are e!aluatin$ an bese- 10 years old boy for diabetes. He has stron$ 6amily history of ty"e2
diabetes mellitus. His mother is concern about recent sym"toms of "olyuria and "olydi"sia. /hat of the followin$ is a
dia$nostic for diabetes mellitus;

a. ?on fastin$ "lasma $lucose of 210 m$Hdl
b. fastin$ "lasma $lucose of 110 mdHdl
c.22hour $lucose durin$ $lucose tolerance test of 163m$Hdl
d. acanthosis ni$ricans on nec)
e. sym"tomes alone are enou$h to ma)e the dia$nosis.


26. Hb =.3 mc!110fl- reticulocyt count 0.3. :ost li)ely dia$nosis is;

8itamin 112 deficiency


2<. /omen "ositi!e $i!e birth at term infant A "ositi!e. Ht 33I - bilirubin 12 m$Hdl. /ich of the followin$
lab findin$s A1 hemilytic disease;

a "ositi!e coombs test

2=. 1 years old- failur to thri!e- fre7uent lar$e !oids of diluted urine- excessi!e thirst and e"isods of
dehydration without !omitin$ and diarea. !er the years family members re"orts similar history . #he most li)ely
dia$nosis is;

0iabete insi"idus.

29.10 years old - &s ha!in$ JcoldJ for 1( days- "urulent nasal dischar$e- facial "ain. :ost li)ely dia$nosis;

:axillary sinusitis

%0. A 6 month infant with lar$e foul smellin$ stools &s not $ainin$ wei$ht.

9hloride 6= ''''

%1. A 3 month old child re$ularily re$ur$itates lar$e "ortions of her feeds. PH "robe study showed si$nificant
"eriods of low eso"ha$eal PH. #he child has normal $rowth and no other si$nificant "ast medical history. /hich
is the best mana$ement at this "oint;

a. barium swallow and u""er K*AL $astrointestinal series
b. oral reflux medications
c. eso"ha$eal manometry
d. close obser!ation only
e. sur$ical correction

%2. a 6 wee) old is admitted with +aundice- total 1ilirubin is 12m$Hdl with direct 1ilirubin 3m$Hdl. /hat is most li)ely
the disorder'

a. A1 incom"ability
b. biliary atresia
c. 4h incom"ability
d. *ilbert disease
e. breast2mil) +aundice
%(. a 2 year old boy has #eratolo$y of fallot. #oday he arri!es with acute febrile illness. n examination-
he com"lains of headaches- lethar$y- has nysta$mus and ataxia. /hat will be the most a""ro"riate first test
to order'

a. @rine dru$ screen
b. 1lood culture
c. lumbar "uncture
d. 9# of brain
e. echocardio$ram


(12 2 Cear old boy is seen because of "allor. His mother sees e drin)s ( $lasses of cow>s mil) a day. A
91S re!eals a hemo$lobin of =.2 $H0A an a :98 of 63 fl. /hich of the followin$ is com"atible with this "atients'

A2decreased red blood cell distribuition
12 decreased serum feritin
92 increased reticolocyt count
02 increased serum iron le!el
E2 increased white blood cell count


(22 /hich of the followin$ reflexes is normally absent in a newborn '

A2 S#A4#AE KmoroL
12 hand $ras"
92 crossed adductor
02 Asymmetric tonic nec)
E2 "arachute


(%2 A 2 year old boy is admitted to the hos"ital with hi$h fe!er four 6 days- swellin$ of the ands and feets-
scarlentiniform chan$es of the ton$ue- $enerali.ed reed macular rash- dray sedmentation reet M
throm"ocytosis. /hich of the followin$ is the best initial man$manet'

A2 cardiac catheteri.ation
12 &8&* M as"irin orally
92 na"roxen orally
02 &.8 "ulse corticosteroids
E2 methotrexate orally

((2 A 9 month old $irl "resent to the E4 with res"iratory distress- $runtin$ M cyaiosis . u start 2 by face mas)- but
the child is still in a si$nificant res"iratory distress M become a"noic. #he best next ste" is'

A2 start chest com"retion
12 "erforme Heimlich maneu!er- maybe the child as"irate somethin$ 92 obtain
blood $as
02 send the child for 4B2chest
E2 start ba$ 2 !al!e mas) !entilation with 100H100 o2

(32 A 3 year old boy "resent with a history of $rossly blood urine- "uffy eyes M headache for 1 day. He
has been will with fe!er M sore throat about 10 days which resol!ed with out treatment,
most li)ely dia$nosis;

A2 acute cystitis
12 &$A ne"hro"athy
92 acute "yelonefritis
02 "ostinfaction $lomerulone"hrtis
E2 beni$n hematuria
(62 10 years old female with fe!er- "ain - swellin$ in her left elbow for 2 days M ri$ht )nee for % days-
today her ri$ht )nee us E . #he arthritis was "receded by a % days history of fe!er M sore throat 2
wee)s a$o. Aaboratory results re!eal un ele!ated antistre"tolwsin. #he most li)ely dia$nosis us '

A2 S.A.E
12 idio"athic 4.A
92 acute rheumatic fe!er
02 $onococal arthritis
E2 "soriatic arthritis


(<2 /hich of the followin$ cancer occurs "rimarily durin$ childhood'

A2 1reast cancer
12 4enal cell cancer
92 /ilms tumor
02 #hyroid cancer
E2 9olon cancer


(=2 #he most im"ortant extramedullary site of rela"se in childhood acute lym"hoblastic leu)emia is'

A2 Adrenal $lands
12 )idney
92 lun$
02 heart
E29entral ?er!ous System

(92 8ery2low2birth 2wei$ht K N 1300 $ L infant are best describes as'

A2 "redominantly $rowth restricted
12 "redominantly P4E:A#@4E
92 "redominantly "ostdate
02 the result of maternal illness
E2 the result of "lacental infraction


302 An 1= year old female- u ha!e followed for 6 years- has recently married - she M husband are "lannin$ to
start a "re$nancy .u ad!ise her to start ta)en folic acid - this is im"ortant to "re!ent '

A2 "rematurity
12 s)ull defects
92 chromosomal defects
02 neural tube defects
E2 osteo"enia


31L A <3 year2old man is com"lainin$ that for se!eral months he has been ex"eriencin$ increasin$
fati$ue. He has a history of hy"ertension- $astroeso"ha$eal reflux disease- and lar$e dia"hra$matic hernia. He has not
ex"erienced any wei$ht loss or other $eneral sym"toms.n "hysical examination- con+uncti!al "allor is noted. A fecal
occult blood testK61#L is "ositi!e. Aaboratory testin$ re!eals iron deficiency anemia. /hich of the followin$ is most
li)ely cause of this "atient5s anemia'

a. *astric cancer.
b. 9olorectal cancer.
c. An$iodys"lasia.
d. Pe"tic ulcer disease.
e. 0ia"hra$matic hernia and eso"ha$itis.
32L A 6< year2old man with a medical history of hy"ertension "resents is com"lainin$ of "ain of
acute onset in his ri$ht )nee. He was well at the time he went to bed last ni$ht. He denies under$oin$ any trauma. n
examination of the ri$ht )nee; ran$e of motion is limited- surroundin$ erythema and an effusion are noted. All other
+oints are normal. 6or this "atient- which of the followin$ measures can be used to confirm the dia$nosis of acute
$out'

a. Serum uric acid measurement.
b. Arthrocentesis.
c. #rial of steroid in+ection for "ain relief.
d. #rial of colchicines for "ain relief.
e. B2ray of the )nee.


3%L A %6 year2old man who contracted he"atitis 1 13 years a$o is chec)ed for !iral serolo$ies to
better understand his he"atitis 1 status. #est results are ne$ati!e for he"atitis 1 surface anti$en
KH1sA$L- he"atitis 1 surface antibody KH1sAbL- and &$: antibody to core "rotein K&$: anti H1cL- but the "atient test
"ositi!e for total anti2H1c. /hat is the best ex"lanation for this "atient5s serolo$ic "rofile'

a. He has acute he"atitis 1 infection.
b. He has chronic he"atitis 1 infection.
c. He has remote he"atitis 1 infection.
d. He has no reliable e!idence for e!er ha!in$ been infected with !irus he"atitis 1.

3(L a (% year old woman was recently dia$nosed with diffuse scleroderma . for the "ast two years she has
been ex"eriencin$ s)in thic)enin$ with "ain and itchin$. She also re"orts increasin$ difficulty with mo!ement
of her )nees because of thic) s)in. She denies ha!in$ any shortness of breath- on examination the "atient5s
blood "ressure is 1(3H92 mmH$- her "ulse is =( beatsHmin- and her oxy$en saturation is 9<I. n room air-
the remainder of the "hysical examination is consistent with her dia$nosis of diffuse scleroderma . laboratory
data show blood urea nitro$en K1@?L !alue of 2( m$Hdl and a creatinine chemistries urinalysis shows 1O and
2O "rotein. Six months a$o- her blood "ressure was 123H<= m$Ht$ and her 1@? and creatinine were 12 m$Hdl
and 0.9 m$Hdl- res"ecti!ely which of the followin$ inter!entions is most a""ro"riate for this "atient of this
time'

a. &nitiation of an$iotensin 2 con!ertin$ en.yme KA9EL inhibition.
b.initiation of calcium channel bloc)er.
c. &nitiation of a thia.ide diuretic.
d. 4enal bio"sy.
e. 9lose monitorin$ for further ele!ation of blood "ressure.


33L A 6( year old man is found to ha!e a mar)edly ele!ated absolute lym"hocyte count durin$ a "reo"erati!e
e!aluation for a total )nee arthro"lasty. He denies ex"eriencin$ any wei$ht lose- ni$ht sweets- or P lum"s and
bum"sP- which of the followin$ is re7uired to ma)e the dia$nosis of 9AA in this "atient'

a. An AA9 Kabsolute lym"hocyte countL $reater that 10-000Hml
b. &dentification of a monoclonal 1 cell "o"ulation with characteristic "henoty"e by flow cytometny .
c. A bone marrow bio"sy with characteristic findin$s.
d. #horacic- abdominal- on "eri"heral lym"hadeno "athy .


36L A <1 year2old man with a medical history of 99A "resents with new2onset fe!ers and ni$ht sweats- as well as
ra"idly enlar$in$ nodes in his ri$ht axilla. Cou are concerned about richter transformation.
/hich of the followin$ is the best dia$nostic inter!ention of this "atient'

a. Serum flow cytometry.
b. 6ine2needle as"iration of axillary node.
c. Excisional lym"h node bio"sy.
d. 1one marrow bio"sy.
3<L A %2 year2old man "resents with a testicular mass. His examination is unremar)able exce"t for a "al"able- firm
left testicular mass. #he "resence of which of the followin$ mar)ers si$nifies a nonseminimatous testicular cancer'

a. human chorionic $onadotro"inKhc*L.
b. 9A2123.
c. 9A 1929.
d. Q2feto"rotein KA6PL.
e. carcinoembryonic anti$enK9EAL


3=L A %= years old man with a history of testicular cancer "resents with fati$ue- dys"nea on exertion- and
$enerali.ed wea)ness- he underwent chemothera"y 10 years a$o. Subse7uent serial e!aluations ha!e not re!ealed
any remainin$ testicular cancer. n "hysical examination- the "atient is found to ha!e "ale con+uncti!ae and nail
beds- as well as scattered lower2extremity "etechiae.
/hat "ossible lon$2term side effects of chemothera"y could be res"onsible for this "atient5s sym"toms'

a. 9ardio!ascular disease.
b. Hy"ercholesterolemia.
c. Aeu)emia.
d. 9erebro!ascular disease.
e. 4etro"eritoneal fibrosis.

60L A <2 year old woman com"lains of fati$ue- easy bruisin$- wei$ht loss- and abdominal distention. Her "ulse is
sli$htly fast- and she has notable "allor and s"lenome$aly. 1lood counts re!eal anemia and thrombocytosis- you are
concerned that she may ha!e myelofibrosis- what would you ex"ect to see on this "atient>s "eri"heral blood smear if
she did ha!e myelofibrosis'

a. #eardro" cells
b. Schistocytes
c. 1urr cells
d. Acanthocytes

61. A %= yHo woman with se!ere asthma is com"lainin$ that for the "ast 2 days she has been ex"eriencin$ "ro$ressi!e
shortness of breathe. n examination- "atients res"iratory rate is 1= 1P:- room air saturation; =6I. She had a few
ex"iratory whee.es with little air mo!ement.
4esults of arteriole blood $as; PH,<.2- Pa2, 62 mmH$- P92, 6% mmH$.
n the basis of the arterial blood $ases measurements which of the followin$ 1ES# describes this "atients condition;

AL Acute hy"oxemic res"iratory failure
1L Acute hy"ercarbic res"iratory failure
9L 9hronic hy"ercarbic res"iratory failure
0L:ixed hy"oxemic and hy"ercarbic res"iratory failure


62. A %< yHo woman is brou$ht for e!aluation for altered mental status. She has
no medical "roblems and only ta)es 9P.
Her husband re"orts that the "atient has had a fe!er for 22% days.
n examination- "atient is febrile K%=.9 9L- con+uncti!ae are "ale.
She has "al"able "ur"ura on her lower extremities .
Aab results; Hb, 6 $Hdl- Plt count, 20-000Hmm%- creatinine,2.=m$Hdl.
Peri"heral smear shoes e!idence of microan$io"athic hemolysis.
which of the followin$ inter!entions is the :S# a""ro"riate ste" to ta)e next for this "atient'

AL Platelets transfusion t o raise PA# R 30-000Hmm%
1L "latelets transfusion to raise PA# R 100-000Hmm%
9L &nitiation of as"irin thera"y
0L Plasma exchan$e for 6 session
EL sur$ical for s"lenctomy
6%. A <2 yHo woman with 9P0 and hy"ertension "resents for a follow u" !isit.
She has recently been admitted for an acute exacerbation of her 9P0.
Her most common recent s"irometry results shows an 6E81H689 ratio of 0.(=.
/hich of the followin$ inter!entions has been shown to reduce the number of acute 9P0 exacerbation'

AL Short actin$ anticholiner$ic inhalers
1L short actin$ inhalational 1eta2a$onists
9L &nhaled corticosteroids
0L xy$en thera"y.


6(.A 32 yHo woman smo)es S "ac) of ci$arettes "er day and drin)s 1 bottle of beer a wee). She has *E40 for
which she ta)es PP&. Aast year her father was dia$nosed with eso"ha$eal cancer.
6or this "atient which of the followin$ ris) factor for eso"ha$eal cancer'

AL#obacco use
1LAlcohol
9L *E40
0L all of the abo!e

63. A (< yHo woman with SAE is com"lainin$ of chest "ain- fe!er and cou$h of 3 days duration. #he results of
"hysical examination are; si$nificant tem". of %=.29- 1P, 93H30 mmH$- H4,11( 1P:. Aun$ examination re!eals
ins"iratory crac)les at the bases. 9B4 shows diffuse infiltrates and a ri$ht sided effusion. Patient under$oes
thoracosynthesis. /hich of the followin$ thoracosynthesis findin$s would be consistent with a lu"us effusion'

AL excudate
1L transudate
9L !ery low $lucose
0L O $ram stainin$
EL hi$h /19 count


66. A (0 year old women under$o a routine abdominal ultrasound- #here is no inflammation but two stones
are found in si.e less then 3 mm she denies any sym"toms and she has no "ast - what is the best next ste";

A. 9holecystectomy
1. E49P
9. bser!ation
0. P#9
E. :49P


6<. A 1= year old with easy brusin$- lym"hocytes 6000 "latelets 200-000 hemo$lobin 1% P# 1% P## <0 which was
rechec)ed 6< . /hat is the most li)ely dia$nosis'

A. 6actor < deficiency
1. lu"us
9. 6actor < inhibition
0. *lan.mam thrombasthesis

6=. A 6% year old man with irre$ular rhythm who wal)s 2 mile with no dys"nea was chec)ed in a 12 lead E9* and
found to ha!e mobits 2 heart bloc) and A111 - when &s a "acema)er indicated '

A. &n asym"tomatic it is not indicated
1. indicated when there is a stable rhythm
9. &ndicated only when there is a widen G4S
0. in all A8 bloc) it is indicated

69. A 63 year old man with intermittent "al"itation for 2 months- the "al"itation are un"redicted from
se!eral minutes to hours. #he "aitents history has well controlled hy"ertension and he denies alcohol use.
n E9* there is atrial fibrillation with 9( 1P: and left !entricular hy"ertro"hy what is the best next ste" '

A. 9ardiac catherisation
1. #rans eso"ha$us echocardio$ram
9. Pulmonary function test
0. 9# An$io of chest


<0. A <= year old man with hy"ertension has shows on E9* atria fibrillation what best describes the use of oral
anticoa$ulant '

A. Hi$h ris) "t o!er <3 y are contraindicated
1. low ris) for thromboembolic are not indicated
9. #he combination of as"irin and 9lo"idro$rele is e7ui!alent to warfarin in hi$h ris) "t
0. /arfarin shown su"eriority to as"irin in "atients o!er <3 years


<1. a %3 years old woman who was dia$nosed with atrio!entriculare node reentry tachycardia but is not ta)in$
medications is admitted to the hos"ital for a hysterectomy. #he ni$ht before the sur$ery she
de!elo"s tachycardia with heat rate of 11( b"m. /hich of the followin$ is the best medication to slow this "atient>s
heart rate and establish sinus rhythm;

a. amiodarone
b. "rocainamide
c. adenosine
d. "ro"afenon


<2. a 2% years old man with ty"e & 0: "resents to routine diabetes mana$ement. He had difficulty with
adherence and has been mana$ed with twice daily fixed dose insulin. #oday his HbA1 is 9I. /hich of the followin$
insulin re$imens would offer the best $lycemic control for this "atient;

a. lon$ actin$ insulin in+ected daily
b. ra"id actin$ insulin in+ected before meals
c. lon$ actin$ insulin in+ected daily and ra"id actin$ insulin before meals
d. continuin$ current fixed dose insulin mixture in+ected daily

<%. an =2 years old woman with history of breast cancer "resent to the clinic with com"lains of headache for the "ast
2 wee)s. She describes daily retro orbital headaches that are worse in the mornin$. &n addition- she notes se!ere
nausea and !omitin$. :4& of the brain re!eals multi"le metastatic lesion. /hich of the followin$ is the most
a""ro"riate initial mana$ement for this "atient;

a. 1io"sy the lesions
b. Sur$ical resection
c. 0examethasone
d. 4e"eat :4& in 6 months

<(. a (2 years old man with a medical history si$nificant for lun$ cancer is brou$ht because of altered mental status.
n examination he has orthostatic hy"otension and dry mucous membranes. Aaboratory e!aluation re!eals 9a 1(.3
m$Hdl and creatinine 2 m$Hdl. /hich of the followin$ is the most a""ro"riate initial mana$ement of this "atient;

a. 0.9I saline bolus
b. 6urosemide
c. Pamidronate
d. 0.(3I saline bolus

<3. A 23 years old man was recently dia$nosed with leu)emia. Aaboratory e!aluation re!eals
"ancyto"enia- hy"er)alemia KE 6.= :e7HlL- uric acid 1% m$Hdl- hy"er"hos"hatemia 12 m$Hdl and ele!ated lactate
dehyro$enase KA0HL. /hat is the most li)ely cause of his electrolyte abnormalities;

a. Aaboratory error
b. #umor lysis syndrome
c. Acute renal failure
d. 1one metastases


<6. a <3 years old man with lun$ cancer com"lains of "ro$ressi!e dys"nea for 2 months. n "hysical examination
he has distended +u$ular !eins- "lethoric face and !enous collaterals on his chest wall and distant heart sounds. /hat
is the most li)ely dia$nosis;

a. Pericardial tam"onade
b. 9onstricti!e "ericarditis
c. 9on$esti!e heart failure
d. Su"erior !ena ca!a syndrome


<<. a <2 years old woman with history of hy"ertension and tobacco use is com"lainin$ about chest "ain for the last 2
wee)s. She describes the "ain as "ressure li)e with radiation to the left arm. &t is exacerbated by exertion and relie!ed
by rest. #here are no associated sym"toms. Her "hysical examination is unremar)able. E9* shows si$ns of left
!entricular hy"ertro"hy. Aaboratory test includin$ cardiac biomar)ers are within normal limits. /hich of the followin$
is the most li)ely dia$nosis;

a. ?on S#E:&
b. Pericarditis
c. @nstable an$ina
d. Stable an$ina


<=. a (< years old woman is e!aluated 2 hours after the onset of acute ri$ht sided wea)ness. A noncontrast 9# of the
head showed no e!idence of hemorrha$ic e!ent. Her blood "ressure at this time is 190H120
mmH$. /hich of the followin$ statements concernin$ blood "ressure and the treatment of acute ischemic stro)e is
the most accurate;

a. Ele!ated blood "ressure should be a$$ressi!ely treated in this settin$
b. 9erebral blood flow is inde"endent of intracranial "ressure
c. Antihy"ertension thera"y is needed in this "atient before $i!in$ thrombolytics
d. Hy"ertension should ne!er be treated in the settin$ of acute ischemic stro)e


<9. a (3 years old woman is e!aluated for nausea- !omitin$ and abdominal "ain of %2( wee)s duration.
6urther history re!eals "olyuria and muscle wea)ness althou$h "hysical examination does not re!eal any
abnormalities. Her serum 9a le!el is 1% m$Hdl- intact "arathyroid hormone is ele!ated and she is dia$nosed with
"rimary hy"er"arathyroidism. /hich of the followin$ is the next ste" in the mana$ement of this
"atient>s hy"ercalcemia;

a. 4eferral for "arathyroidectomy
b. Prescribe hydrochlorothia.ide
c. 1io"hos"honate thera"y re$ardless of her bone mineral density
d. 4e"eat serum calcium in % months





=0. a <0 years old man with s7uamous cell lun$ cancer is admitted with altered mental status. #he "atient>s
wife re"orts he has become increasin$ly confused o!er the last 2 days. Physical examination is si$nificant for heart
rate of 113 b"m and dry mucosa membranes. #he "atient is somnolent and unable to follow commands. Aaboratory
serum 9a le!el is 13.1 m$Hdl. /hat is the most a""ro"riate thera"y for his hy"ercalcemia;

a. 6luid restriction with loo" diuretics
b. &ntra!enous .oledronic acid
c. Subcutaneous calcitonin
d. &ntra!ascular !olume ex"ansion with intra!enous normal saline


90. A 33 hy"ertension history - 1st ste" of mane$ment;

a.#hrombolytic thera"y
b.i.! mor"hine
c.P9&
d.mar)ers


91.30years old male with inferior :yocardial infarction ;

a.lt heart cath5
b. an$io"lasty
c.sur$ical re"air
d. an$io"lasty


92. A 63 years old with 0iabetes mellitus- hy"erli"idemia and tobacco abuse "resents with chest "ain for the "ast %
days. #he "ain is worse with exertion and was relie!ed by sublin$ual nitro$lycerin until today
when "ain "ersisted. #he "ain radiates to the +aw and is associated with nausea and dia"horesis. n
examination the blood "ressure is 90H30- H4 96- on E9* there are S# de"ression in the inferior leads and the 9E2:1
and tro"onin le!els are ele!ated. /hich of the followin$ medication should be a!oided in thr mana$ement of this
"atient'

a. he"arin
b. as"irin
c. nitrates
d.A9E


9%. A (0 year old female with a history of coronary artery disease- status "ost2"ercutaneous coronary inter!ention
with a dru$2elutin$ stent 1 year a$o- "resents to the emer$ency de"artment with fe!er and ri$ht u""er 7uadrant "ain
for 1 day. An abdominal sono$ram re!eals $allstones with li)ely cholecystitis and no biliary ductal dilation. She is
admitted for antibiotics and a $eneral sur$ery consultation- the sur$eon is concerned because the "atient is on
clo"ido$eral for a dru$2elutin$ stent. &f "ossible- how lon$ should sur$ery be delayed after sto""in$ the "atients
clo"ido$eral;

a. 1 day.
b. < days.
c. 1 month.
d. 2 wee)s.







9(. A (0 y old man with a history of &8 dru$ abuse "resents with fe!er and chills for 1 wee). His examination
re!eals a new holosystolic murmur at the left lower sternal border that increase with ins"iration. He is febrile
at %=.99. Cou "lan to admit him for wor) u" and treatment of infecti!e endocarditis. what duration of &8
antibiotics is necessary for this "atients illness.

a. ( to 6 wee)s.
b. < to 10 days.
c. % months.
d. 1 year.


93. A <0 year old man with a history of hy"ertension and diabetes "resents to the mana$ement of chronic
an$ina for the "ast year. His chest "ain now occurs one or % times "er month- ty"ically last 3 minutes- and
are relie!ed by rest and sublin$uinal nitro$lycerin. A recent "harmacolo$ic stress test showed a re!ersible
"erfusion defect. /hat is the most a""ro"riate next ste" in the mana$ement for this "atients an$ina;

a. Add mor"hine to the "atients re$imen.
b. 9oronary an$io$ra"hy
c. Aifestyle modification includin$ exercise
d. 9ontinue with the current mana$ement.


96. A 39 year old female with a history of a heart murmur but no other sym"toms or rheumatic fe!er. #he murmur is
2H6 crescendo decrescendo that radiates to the carotid artery. #he murmur decreases with
!alsal!a maneu!er and on standin$- the most li)ely dia$nosis is;

a. aortic stenosis
b2 tricus"id re$ur$itation
c2 mitral re$ur$itation
d2 hy"ertro"hy obstructi!e cardiomyo"athy

9<. 60 years female S# ele!ation :& with Aeft !entricular e+ection fraction of 23I- treatment;
a.furasamide
b. coronary by"ass
c. icd im"lant
d. amlodi"ine


9=. 29 old female with cardiac arrest most li)ely dia$nosis;

a. bru$ada syndrome
b. lon$ G# syndrome
c. :&
d. stro)e


99. A 33 year old male with urose"sis started on &8 fluid and "i"ercillin2ta.obactam. His sym"toms
$radually im"ro!ed until hos"ital day23- when he de!elo"s a rash and low $rade fe!er. Aab tests re!eal an
increased creatinine and a urinalysis with blood cells and eosino"hils. /hat is the most li)ely dia$nosis'

a. "rerenal disease
b. ?e"hrotic syndrome
c. acute tubular necrosis.
d. acute interstitial renal disease




100. A (0 years old woman with history of hy"ertension M diabetes !isit your clinic with the com"liant of
wei$ht $ain. n examination you find 2 obese female - moon facies and su"racla!ic fat "ads. Cou consider
cushin$ syndrome as dia$nosis. for this "atient- what is the best dia$nostic test for cushin$ syndrome'

a. hi$h dose dexamethasone su""ression test
b. 2(2h urine free cortisol
c. random cortisol le!el
d. "lasma adrenocorticotro"ic hormone le!el


1012 /hat is the recommendation concernin$ the administration of ::4 !accine durin$ "re$nancy'

a. 9ontraindicated
b. #he same as in non2"re$nant woman
c. nly for "ost ex"osure
d. nly if there is ris) factors
e. Should be administer if there is noTTT


1022 &n which $estational a$e laboratory screenin$ for diabetes should be "erformed'

a.10216wee)
b.16220 wee)
c. 2022% wee)
d. 2(22= wee)
e. %22%6 wee)


10%2 %1 year old woman *2P1 in (0 wee) $estation has "ro$ress in labor from 3 to 6 cm cer!ical dilation o!er 2 hours.
/hich of the followin$ best describe the labor'

a. Prolon$ed latent "hase
b. Accelerate acti!e "hase
c. Arrested acti!e "hase
d. Protected acti!e "hase
e. ?ormal labor


10(2 /hat is the most common com"lication of Para cer!ical bloc)'

a. :aternal hy"otension
b. 9?S toxicity
c. 6etal bradycardia
d. 1leedin$
e. arrest of dilation


1032 /hich deleterious effect is associated with oxytocin when $i!en intra!enously as a 10 unit bolus'

a. 9ardiac arrhythmia
b. Hy"otension
c. ?euromuscular bloc)
d. Sei.ure
e. @terine relaxation



1062 /ith "rima with une!entful cer!ix and estimated fetal wei$ht of %=00$ which is the most a""ro"riate
mana$ement at (2O0 wee) $estation'

a. #o re date the "re$nancy
b. 9esarean deli!ery
c. Hos"itali.ation and bed rest
d. 9er!ical ri"enin$- than labor induction
e. E"idural anal$esia "rior to induction of labor


10<2 Dy$otic di!ision to form dichroniotic diammniotic twins accrue durin$ which of the followin$ time "eriod
followin$ fertili.ation'

a. N<2 hours
b. R<2 and N120 hours
c. R120 and N2(0 hours
d. R26( hours


10=2 @ltra sono$ra"hic e!idence "ointin$ to the dia$nosis of monochronionicity in "re$nancy with twins include
which of the followin$'

a. # si$n
b. #wo se"arated "lacenta
c. #win with different $ender
d. 0i!idin$ membrane of more than 2 mm thic)
e. Aambda si$n


1092 At what time are most non obstetric sur$ical "rocedure "erformed when indicated durin$ "re$nancy'

a. 1st trimester
b. 2nd trimester
c. %rd trimester
d. Post2"artum


1102 9hronically hy"ertensi!e woman de!elo" su"erim"osed se!ere "reeclem"sia at %6 wee) of $estation- all of the
followin$ re$ardin$ deli!ery are acce"table exce"t;

a. :a$nesium administration
b. E"idural anesthesia
c. /ait for deli!ery at term
d. &mmediate induction of labor
e. &mmediate c2 section













Part 1

1. A "re$nant woman with H&8 was admitted to hos"ital which of the followin$ re$imen effect "neumoscystisis carnii
"neumonia;

A. A:P&9&A&?
1. E4C#H4:C9&?
9. 9#4&:BADAE
0. AD&#H4H4:C9&?
E. 8A?9:C9&?


2. /HA# &S #HE most common cause of acute renal failure in "re$nancy'

A. dru$ abuse
1.systimic lu"us erythematus
c. Preeclam"sia or eclam"sia
d. Sic)le2cell disease
E.dehydration


%. /hat "re$nancy com"lication associated with ru"tured a""endix with "eritonitis'

A. 6etal $rowth restriction
1. li$ohydroamnios
9. 9horioamnionitis
0. Preterm labor
E. Pylone"hritis


3. /hat is the most li)ely course of rheumatoid arthritis in "re$nancy;

a. Stable durin$ and "ost"artum
b. :ild flare durin$ and "ost"artum
c. Serious flare durin$- remission "ost"artum
d. :ar)ed im"ro!ement durin$- flare "ost"artum.


6. /hich of followin$ correct re$ardin$ &86 com"lication'

A. with i!f "re$nancy is an increase for multi fetus "re$nancy but not for ecto"ic "re$nancy
1. ?9E &86 &S A9HE8&0 #HE4E &S ? 0&66E4E?9E &? 1S#A#4&9 @#9:E AS 9:PA4E0 # SP?#A?@S
P4E*?A?9C
9. 8A4&A? HCPE4S#&:@AA#&? &S 9:PA&9A#&? 6 &86 /H&9H A**4E8A#ES /&#H A9H&8E0 P4E*?A?9C
0. #HE4E &S SH4# &?94EASE 64 *E?&#&9S :@#A#&? 4 0E64:#&ES &? ?E/14? 6AA/&?*
&9S&


<.:A44&0 9@PAE 6 ( A##E:P#S # 9?9&8E /&#H ? S@99ES 6E:AAE E8AA@A#&? ?4:AA SPE4:A#&9
E8AA@A#&? ?4:AA SPE4:A#&9 E8AA@A#&? 4E8EAAS 2:A- 2 :&A&? 9EAAS 30I :#&A&#C A?0 3I ?4:AA
9EAAS 4EPEA# SPE9&:E? ?# S&*?&6&9A?# 0&66E4E?# /H&9H 6 #HE 6AA/&?*S &S APP4P&A#E :A?*:E?#;

E. &? 8&#4 6E4#&A&ADA#&? /&#H &?#4A 9C#PAAS:&9 SPE4: &?FE9#&?





=. AAA 6 #HE 6AA/&?* A4E 9AEA4 com"lications 6 &86 EB9EP#;

A. o!er all mobile s"erm cell count lower than 2 millions cells
1. bilateral fallo"ian tube distress of the female "artner
9. decrease o!arian reser!e of the female "artners
0. PS
E. SE8E4E E?0:E#4&AA A0HES&?


9. /H&9H 6 #HE 6AA/&?* 9A??# 1E @SE SPE4:8@AA#&?

A. human urinary $oandotro"ins
1.recumbinant human 6SH
9.recombinant human AH
0.hi$hly "urified human urinary $oandotro"in
E. recombinant andro$en


10. /hich of the followin$ not considered a com"lication related to "re$nancy achie!ed with fertility treatment'

A. multi fetus "re$nancy
1.ecto"ic "re$nancy
9.o!arian hy"er stimulation syndrome
0.mullarian "re$nancy
E. "remature deli!ery


11L 12 years old female arri!es with her u"set mother to clinic that describe that her dau$hter has not
:ensterued yet. Accordin$ to mother all the female s"ouses menstured by a$e and therefore this dealy is
concernin$. n detailed history the child seems healthy asym"tomatic. n "hysical "hysical examination the child has
a""ro"riate $rowth- "rimary "ubic hair- and early e!idence of breast bud. /hat should be told to concerned mother'

AL #his is "rimary amenorrhea that re7uires further e!aluation.
1L #his is "rimary amenorrhea but further e!aluation should only be "erformed in 6 months.
9L #his is not amenorrhea and therefore there is no reason for further e!aluation.
0L #he sex si$n caused by estro$en administration and the exact "re"aration that she too) should be e!aluated.
EL Pel!ic ima$in$ is re7uire to rule out mullerian a$enesis.


12L 23 years old female see) consultation for amenorrhea. #his is a healthy female that is sexually acti!e of uses
condoms for contrace"tion. History include re$ular menses (H2=- last menses about % month a$o
amenorrhea. ?o abnormal e!ent since. /hich of followin$ correct'

AL #here is no reason for concern- "ro$esterone should be administered to induce menses.
1L #his is secondary amenorrhea and hormonal "rofile should be obtained to rule out "remature o!arian failure.
9L &t is li)ely that she has "olycystic o!ary syndrome and ultrasound should be "erformed to confirm the dia$nosis.
0L #his is secondary amenorrhea and therefore "re$nancy should be ruled out first.
EL Hysterosco"y to demonstrated uterine ca!ity should be "erformed.


1%L /hich of the followin$ defines "rimary amenorrhea'

AL Amenorrhea in the "resence of secondary sexual de!elo"ment at a$e of 1%.
1L Amenorrhea in the "resence of secondary sexual de!elo"ment at a$e of 13.
9L Amenorrhea in the "resence of secondary sexual de!elo"ment at a$e of 1<.
0L Amenorrhea in the "resence of secondary sexual de!elo"ment at a$e of 16.
EL Amenorrhea in the "resence of secondary sexual de!elo"ment at a$e of 1=.


1(L /hich of the followin$ defined as "rimary amenorrhea'

AL Eallman syndrome.
1L Sheehan syndrome.
9L Asherman syndrome.
0L Pre$nancy.
EL Premature o!arian failure.


13L /hich of the followin$ is a characteristic of female athletic syndrome'

AL :enses res"onse to "ro$estron administration.
1L Pituitary hy"ertro"hy.
9L ?o menses is res"onse to estro$en and "ro$estron administration.
0L Hirsutism and acne.
EL 0ecreased bone mass.


16L /hich of the followin$ contrace"ti!e methods shoc) syndrome has been associated'

AL ral contrace"ti!e "ill K9PL.
1L Pro$estin only "ill.
9L :ale condoms.
0L 8a$inal dia"hra$ma.
EL &ntrauterine contrace"ti!e de!ice K&@90L.


1<L %6 years old multi"arous female and her husband re7uest information re$ardin$ !asectomy. Cou
should ad!ice them that when com"ared to female sterili.ation the followin$ is true Kabout !asectomyL'

AL Has the same failure rate.
1L 4e7uire a lon$er hos"itali.ation.
9L &s effecti!e sooner.
0L 9arries a hi$her mortality rate.
EL &s less re!ersible.


1=L A (9 years old female ex"eriences irre$ular !a$inal bleedin$ of % months duration. Cou "erform an endometrial
bio"sy- which obtains co"ious tissue with !el!ety- lobulated texture.#he "atholo$ist re"ort show "roliferation of
$randular and stromal element with dilated endometrial $lands. 9yctolo$ic aty"ia is absent. /hich of the followin$ is
the best way to ad!ice the "atient'


AL #he "resence of dilated endomaterial $land is usual.
1L #he histolo$ical findin$ is called cystic atro"hy.
9L #he tissue may be wea)ly "remali$nant.
0L She re7uires a hysterosco"y.
EL ?o further thera"y is needed.


19L /hat is the most common uterine sarcoma'

AL Aeiomyosarcoma.
1L Endometrial stromal sarcoma.
9L Endolym"hatic stromal myosis.
0L :ali$nant mixed mesodermal tumor.
EL Aym"homa.
20L #wo days after sur$ery of 23 years women- you recei!ed the "atholo$y re"ort of the o!arian tumor. &t is mucinous
cystadenoma of low :ali$nant "otential mixed with well differentiated carcinoma. #he tumor has not in!aded the
o!arian ca"sule- lym"hatic or meso!arium. mental and retro"eritoneal lym"h node bio"sies and "eritoneal washin$
are ne$ati!e for tumor cells. How does you ad!ice this "atient'


AL 1io"sy of the contralateral o!ary.
1L 4emo!al of the uterus and contralateral adnexa.
9L Posto"erati!e chemothera"y.
0L Posto"erati!e radiation thera"y.
EL ?o further thera"y.



21. 2< year old $ra!ida 2 "ara1 is at your clinic on the %0th wee) of $estation for routine "renatal !isit. She suffers
from Userosal fibroidsP. #he "re$nancy is unremar)able thus far. #he fundus is %< cm from the
sym"hysis. &n discussin$ "ossible com"lications of a fibroid uterus durin$ "re$nancy you mention that she is at a
hi$hest ris) for;

a. P4:
b. Placenta "re!ia
c. *estational diabetes
d. 1reech "resentation
e. Placental abru"tion


22. 33 year old woman in meno"ause "resents to your office with a history of a % day li$ht !a$inal bleedin$. Cou
should;

a. Prescribe !a$inal estro$en for atro"hic !a$initis and to come bac) if the bleedin$ isn5t better
b. A hysterectomy and bilateral sal"in$oo"horectomy to rule out endometrial cancer
c. #a)e history- "erform "hysical examination- endometrial tissue sam"lin$ and "el!ic ultrasound
d. 4ecommend her to $o on a diet- since there is increased "roduction of estrone in obese women


2%. /hich of the followin$ or$ans are first affected by s"read and encroachement of ad!anced o!arian cancer;

a. 1rain
b. @reter
c. &ntestine
d. Stomach
e. S"leen




2(.32 year old woman after meno"ause com"lains of urinary fre7uency- ur$ency and ur$e incontinence. therwise
she is healthy. /hat should be included in beha!ioral treatment'

a. 4elaxation techni7ues
b. Anticholiner$ic medications
c. 8oidin$ e!ery hour durin$ daytime
d. 1ladder retrainin$
e. &ncontinence "ad testin$




23. %= year old female with two year history of hea!y menstrual flow of 9 days e!ery "eriod. :enses occur e!ery %2
days. #here is no bleedin$ between menses. ?ext ste" in e!aluation;

a. 9oa$ulation "rofile
b. Pre$nancy test
c. Endometrial bio"sy
d. Pel!ic ultrasound
e. #SH e!aluation


26. A 2( year old sales"erson is referred for an e!aluation of difficulty dealin$ with costumers because she
$ets Jso ner!ous and anxious that my mind $ets blan)J. A careful e!aluation re!els that she has social
"hobia. She is moti!ated to obtain treatment and continue doin$ her +ob. All of the followin$ inter!entions- exce"t;

a. Selecti!e serotonin reu"ta)e inhibition 2 SS4&>s
b. 6loodin$
c. :odelin$
d. Systematic desensiti.ation
e. Electrical con!ulsion thera"y 2 E9#


2<. 6actitious disorder with "redominant "hysical si$ns and sym"toms is also )nown as;

a. Hy"ochondriasis
b. :unchhausen
c. :unchhausen by "roxy
d. Somatoform disorder
e. 6actitious disorder not other s"ecified


2=. /hich of the followin$ is true about blood2in+ection2in+ury "hobia'

a. #wice as common in women than men
b. Aow familial inheritance
c. Se!er tachycardia and hy"ertensi!e res"onse
d. Easily treated
e. 1radycardia and hy"ertension often follow initial tachycardia


29. #he term double de"ression is used to describe;

a. :a+or de"ressi!e disorder su"erim"osed on $rief reaction
b. :a+or de"ressi!e disorder su"erim"osed on dysthemia
c. :a+or de"ressi!e "atient not res"ondin$ to treatment
d. :a+or de"ressi!e disorder with "sychosis
e. :a+or de"ressi!e disorder with anxiety


%0. A 26 year old 9aucasian ma)e is stable on lithium for bi"olar disorder for the "ast ( years. 0urin$ his routine !isit
with his family "hysician- he com"lains of fati$ue and lac) of moti!ation. He is also feelin$ !ery cold durin$ this
winter and has $ained wei$ht. He wonders if he is $ettin$ de"ressed a$ain. /hat is the next most a""ro"riate ste" to
ta)e in this case'

a. 0ia$nose de"ression and start the "atient on antide"ressants
b. btain "atient lithium le!els
c. 9hec) "atient #hyroid stimulatin$ hormone K#SHL le!els
d. 0iscontinue lithium
e. 9onsider electric con!ulsion thera"y KE9#L
%12 (6 female is 6 wee) "ost"artum com"lains of fellin$ low in her mood and ha!in$ cryin$ s"ells- lac) of moti!ation
and feelin$ ho"elessness for the "ast ( wee)s what dia$nosed to ha!e "ost"artum de"ression'

a. #rue ris) of infanticide is minimal
b. SS4& are contraindicated
c. 4is) of de"ression durin$ subse7uent "re$nancy is hi$h
d. Suicide ris) is low
e. Hos"ital admission is rarely re7uired


%22 /hich SS4& is least li)ely to cause serotonin discontinuation syndrome '

A. Paroxetine
1. 9italo"ram
9. Escitalo"ram
0. 6luoxetine KPro.acL
E. Sertraline


%%2 f all tricyclic antide"ressants which of the followin$ most "otent serotonin reu"ta)e inhibition acti!ity'

a. 9lomi"ramine
b. &mi"ramine
c. Amitri"tyline
d. 0esi"raminn


%(2 /hich sym"tom has to be "resent to dia$nose ma+or de"ression disorder'

a. 0e"ressed mood or loss of interest or "leasure
b. Aac) of ener$y or moti!ation
c. Aac) of a""etite
d. Ho"elessness
e. *ilt or worthlessness


%32 %6 year old "re$nant admitted due to "ossible infection associated with &8 heroin- she is 3
month into her "re$nancy and would li)e to 7uit heroin for $ood- what best course of action'

a. Allow her to continue to use heroin as withdrawal is dan$erous
b. :ethadone maintenance
c. ?altrexone
d. Ad!ise her to sto" heroin and start su""orti!e thera"y
e. 1u"renor"hine

%62 *ood test of recent memory'

a. Subtract < from 100
b. As) #heir date of birth
c. As) How many siblin$ they ha!e
d. As) /hat they had eat for their last meal
e. As) /ho is the "resident






%<2 :ost common case of delirium within % day of "osto"erati!e in a (0 year old man with history of alcohol
de"endence'

a. 0elirium tremens
b. &nfection
c. Pain medication "osto"erati!e
d. Pain stress of sur$ery


%=2 9linical feature which may be associated with delirium;

a. 0isor$ani.ed thou$ht "rocess
b. Hallucination
c. &llusion
d. All of the abo!e


%92 /hich of the followin$ dru$ is best use to treat acute delirium'

a. Amobarbital KamytalL
b. 9hlor"roma.ine
c. 0ia.e"am
d. halo"eridol
e. "hysosti$mine


(02 :outh ulceration is associated with which of the followin$ ty"es of withdrawal '

a. alcohol
b. ben.odia.e"ins
c. cocain
d. nicotin
e. o"oids

(1. #he "ost"artum blues;

A. occur in u" to 30 "ercent of women after childbirth
1. are self2limited
9. be$in shortly after childbirth and lessens in se!erity o!er the course of a wee)
0. are considered to be normal
E. all of the abo!e

(2. 0e"ression and mania share which of the followin$ sym"toms'

A. Psychomotor acceleration
1. Aow2self esteem
9.*randiosity
0. An$er
E. Pessimism


(%. #he hi$hest suicide rates are in which of the followin$ a$e $rou"s'

A. @nder a$e 13
1. 13 to 2( year olds
9. 23 to (( year olds
0. (3 to 6( year olds
E. !er a$e 63
((. #he best indicator for increased ris) of suicide'

a. Alcohol de"endance
b. :arria$e
c. Pre!ious suicidal beha!ior
d. Schi.o"hrenia
e. :a+or de"ressi!e disorder


(3. /hich of the followin$ antide"ressants would not be the best choice for the abo!e "atient with a
history of suicidal ideation'

A. SS4&
1. :A&
9. 1u"ro"ion K/ellbutrinL
0. #9A
E. 8enlafaxine KEffexorL

(6. *enerali.ed Anxiety disorder;

A. is least li)ely to coexist with another mental disorder
1. has a female to male ration of 1;2
9. is a mild condition
0. has about a 30 "ercent chance of a recurrence after reco!ery
E. has a low "re!alence in "rimary care settin$s


(<. #ourett5s disorder has been shown to "ossibly ha!e a familial and $enetic relationshi" with;

A. "anic disorder
1. 90
9. $enerali.ed anxiety disorder
0. social "hobia
E. none of the abo!e

(=. :edical disorders to be considered in the differential dia$nosis of somati.ation disorder include;

A. multi"le sclerosis
1. systemic lu"us erythematosus
9. acute intermittent "or"hyria
0. all of the abo!e

(9. #he most accurate statement re$ardin$ "ain disorder is;

A. &t is dia$nosed e7ually amon$ men and women
1. Pea) a$es of onset are in the second and third decades
9. &t is least common in "ersons with blue collar occu"ations
0. 6irst de$ree relati!es of "atients ha!e an increased li)elihood of ha!in$ the same disorder
E. 0e"ressi!e disorders are no more common in "atients with "ain disorder than in the $eneral "ublic


30. 6actitious disorders are best treated by which of the followin$'

A. &mmediate dischar$e from the hos"ital
1. 9onfrontation about the "atient5s deceit
9. 6ocusin$ on mana$ement rather than cure
0. Performin$ only minimally in!asi!e "rocedures to satisfy the "atient
E. @sin$ low2dose neurole"tics to decrease the "atient5s "hysical distress
61. /hich of the followin$ tumor mar)ers is most closely associated with the dia$nosis of *astrointestinal Stromal
#umor 2 *&S#'

a. 9EA
b. 9011<
c. HE42Hneu
d. 9EA123
e. "3%


62. A 6< years old woman "resents with "el!ic "ain. 9# shows a mass near her ri$ht "el!ic wall. 9#
$uided bio"sy re!eal s"indle ty"e with few mitotic cells. At ex"loration 2cm "edunculated mass is noted on the
antimesentric border of mid ileum. A""ro"riate thera"y would be;

a. li$ation of the mass at the "edunculated stal)
b. wed$e excision of the bowel containin$ the mass
c. wide excision- re$ional lym"h node dissection
d. wed$e excision- imatinib
e. wide excision- re$ional lym"h node dissection- imatinib


6%. #he most a""ro"riate treatment for a "atient with 2cm diffuse lar$e 1 cell lym"homa limited to the antrum of the
stomach would be;

a. total $astrectomy
b. chemothera"y- radiation followed by total $astrectomy
c. systemic chemothera"y
d. distal $astrectomy
e. chemothera"y- radiation.



6(. A 2< years old female "resents for e!aluation after a recent dia$nosis of cutaneous melanoma on her ri$ht le$. n
examination the lesion is irre$ular with discoloration but no ulceration. Physical examination of the ri$ht in$uinal
shows no "al"able nodes. Patholo$ical analysis of the "unch bio"sy of the lesion re!eals a %.1mm thic) lesion. &n
addition to 2cm mar$in total excision of the "rimary- the next ste" in mana$ement of her in$uinal nodes should be;

a. obser!ation
b. sentinel lym"h node bio"sy
c. electi!e lym"hadenectomy
d. radiothera"y
e. isolated limb "erfusion


63. A <3 years old man ta)in$ ?SA&0s for arthritis "resents with an acute abdomen and "numo"eritoneum. His
sym"toms are 6 hours old and his !ital si$ns are stable after the infusion of 1A normal saline solution. /hat should be
the next ste" in the mana$ement of this "atient'

a. 9om"uted tomo$ra"hy of the abdomen
b. Eso"ha$o$astroduodenosco"y
c. Antisecretory dru$s- broad s"ectrum antibiotics- and sur$ery if he fails to im"ro!e within 6hrs
d. Antisecretory dru$s- antibiotics for H.Pylori- and sur$ery if he fails to im"ro!e within 6hrs
e.





66. /hich of the followin$ is ?# a ris) factor for de!elo"in$ a sur$ical site infection 2 SS&'

a. 4adiation ex"osure
b. 4ecent sur$ery
c. Prolon$ed hos"itali.ation
d. &nfancy


6<. A 6= years old man is admitted to the hos"ital after ha!in$ "assed three lar$e maroon colored stools. n arri!al at
the hos"ital- he "asses more bloody stools as well as clots. He is "ale- orthostatic- and tachycardic. ?aso$astric
as"irates are bilious. After resuscitation is be$un- which of the followin$ is the most a""ro"riate initial test'

a. An$io$ra"hy
b. ?uclear medicine red blood cell scan
c. 4i$id "roctosco"y
d. 9olonosco"y
e. 1arium enema


6=. A ( years old "atient "resents with diffuse scald wounds after bein$ held in a hot tub of water. #here are
circumferential blisters "resent o!er the ri$ht le$ Kfrom hi" to toesL and circumferential blisterin$ o!er the lower left
le$ Kfrom )nee to toesL. #he ri$ht thi$h- abdomen and bac) below the umbilicus- as well as the buttoc)s and "erineum
are red hot but without blisters. /hat is the total burn surface area'

a. 23I
b. %6I
c. (6I
d. 3(I


69. E"stein21arr !irus is associated with which of the followin$ cancers'

a. ?aso"haryn$eal carcinoma
b. ?on2Hod$)in5s lym"homa
c. Adult # cell leu)emia
d. Ea"osi5s sarcoma


<0. /hich of the followin$ is the most si$nificant ris) factor for in!asi!e breast cancer when screenin$ a "atient for
ris)'

a. R2 first de$ree relati!es with breast cancer
b. 2 "re!ious breast bio"sies in a "atient N30 years of a$e
c. A$e N12 at menarche
d. Aty"ical hy"er"lasia in a "re!ious breast bio"sy



<1. KSchwart.'L Aym"hatic draina$e from the su"ra$lottic larynx is "rimarily to;

a. #he "relaryn$eal K0el"hianL node
b. Paratracheal nodes
c. 0ee" cer!ical nodes
d. Su"erior +u$ular nodes




<2. KSchwart.'L Ae!el 8 lym"h nodes in the nec) are located;

a. &n the submental area
b. &n the anterior trian$le
c. &n the "osterior trian$leV
d. &n the inferior +u$ular chain


<%. KSchwart.'L He"arin induces anticoa$ulation "rimary by;

a. &ncreasin$ "roduction of antithrombin
b. &ncreasin$ the acti!ity of antithrombin
c. &ncreasin$ con!ersion of factor B to Ba
d. &ncreasin$ con!ersion of factor B& to B&a


<(. KSchwart.'L#he most common location of $astrointestinal stromal tumors K*&S#L is;

a. Stomach
b. 0uodenum
c. Fe+unum
d. &leum


<3. KSchwart.'L A hi$h out"ut enterocutaneous fistula is defined as drainin$ more than;

a.100 mAHday
b. 300 mAHday
c. 1000 mAHday
d. 2000 mAHday


<6. #he most common cause of small bowel obstruction is;

a. Adhesion
b. Hernia
c. :ali$nancy
d. 9rohn>s disease


<<. A 2(2year2old woman in the 20th wee) of "re$nancy ex"eriences a sin$le e"isode of biliary colic. #he most
a""ro"riate initial mana$ement is;

a. obser!ation with "lans to follow her after deli!ery for recurrent e"isodes.
b. 0ietary chan$es
c. Electi!e la"arosco"ic cholecystectomy durin$ 2nd trimester.
d. Electi!e o"en cholecystectomy durin$ 2nd trimester.


<=. Sur$ery is indicated in which of the followin$ asym"tomatic "atients with "rimary hy"er"arathyroidism'

a. :ildly ele!ated urinary calcium excretion KR100m$HdlL.
b. 4eduction in creatinine clearance by 10I
c. Serum calciumR 0.= abo!e the u""er limits of normal
d. A$e N 30 years



<9. Patient with carcinoma of 1 cm of diameter in thyroid $landule without adeno"aty.
#reatment of medullary thyroid cancer;

a. #otal thyroidectomy
b. #otal thyroidectomyO cer!ical A? dissection
d.


=0. #he most common cause of "rimary "arathyroidism is;

a. Parathyroid adenoma
b. :ulti"le "arathyroid adenomas
c. Parathyroid hy"er"lasia
d. Parathyroid carcinoma


=12 which of the followin$ would be the first dia$nostic test ordered in "atient with solitary thyroid noudle'

a. radioacti!e iodine scan
b. 9# or :4&
c. fine needle as"iration
d. core needle as"iration

=2 2 a %3 year old woman ex"eriences an acute onset of e"i$astric and ri$ht u""er 7uadrant "ain se!eral hours after
lar$e dinner. she has had similar e"isodes in the "ast that resol!ed after a few hours. #his e"isode "ersists- and she
has fe!er and nonbilious !omitin$. what is the most li)ely source of the abdominal "ain'

a. "erforated ulcer
b. acute a""endicitis
c. "erforation followin$ bowel obstruction
d. acute cholecystitis
e. di!erticulitis

=% 2 a 3< year old woman with a 1.3 cm infiltratin$ ductal carcinoma is found to be E4 ne$ati!e- P4
ne$ati!e- and HE4 2 2Hneu "ositi!e. she comes to your office to discuss treatment o"tions.
what would you recommend'

a. modified radical mastectomy alone
b. wide local excision. radiation thera"y and tamoxifen.
c. sim"le mastectomy- sentinel lym"h node bio"sy- trastu.umab KHerce"tinL and tamoxifen.
d. modified radical mastectomy and ad+u!ant chemothera"y.
e. wide local excision- sentinel lym"h node bio"sy- radiation thera"y and ad+u!ant chemothera"y with trastu.umab.


=( 2 a %3 year old woman has a 3 year history of "oorly controled hy"ertension. she is ta)in$ three different
medications- includin$ a diuretic- b2bloc)er- and "otassium su""lements. what would be the next ste" in establishin$
the dia$nosis of sur$ically correctable hy"ertension'

a. 9# of the abdomen and "el!is
b. urine catecholamines.
c. serum aldosterone and renin le!els
d. renal @S
e. saline su""resion testin$





=3 2 a (( year old man is due to under$o la"arosco"ic adrenalectomy for "heochromocytoma. which of the followin$
a$ents shoud ?# be $i!en as the initial oronly medication to hel" achie!e a""ro"riate
"reo"erati!e adrenorece"tor bloc)ade'

a. "henoxyben.amine
b. amlodi"ine
c. "ra.osine
d. atenolol
e. metyrosine


=6 2 followin$ sur$ery a "atient de!elo"s oli$uria. you belie!e the "atient is hy"o!olemic- but you see)
corroborati!e data before increasin$ intra!enous fluid. which of the followin$ !alues su""orts the dia$nosis
of hy"o!olemia'

a. urine sodium of 2= mE7HA
b. urine chloride of 13 mE7HA
c. fractional excretion of sodium less than 1
d. urineHserum creatinine ratio of 20
e. urine osmolality of %30 mosmH)$


=< 2 a (3 year old woman with 9rohn>s disease and a small intestine fistula de!elo"s tetany durin$ the second wee)
of "arenteral nutrition. the laboratory findin$s include;
?a 2 1%3
E 2 %.2
9l 2 10%
H9% 2 23
9a 2 =2
:$ 2 1.2
P( 2 2.(
albumin 2 2.(
an arterial blood $as sam"le re!eals a "H of <.(2- P92 of %=- and P2 of =( mmH$.
which of the followin$ is the most li)ely cause of the "atients tetany'

a. hy"er!entilation
b. hy"ocalcemia
c. hy"oma$nesemia
d. essential fatty acid deficiency
e. focal sei.ure


==2 a !ictim of blunt abdominal trauma under$oes a "artial he"atoectomy. durin$ sur$ery he recie!es
twel!e units of "ac)ed red blood cells. in the reco!ery room he is noted to be bleedin$ from intra!enous
"uncture sites and the sur$ical incision. which of the followin$ statements re$ardin$ coa$ulo"athy is most li)ely true'

a. the "atient has n un)nown "rimary bleedin$ disorder
b. the coa$ulo"athy is secondary to the "artial he"atectomy
c. the coa$ulo"athy is secondary to dilutional thrombocyto"enia and deficiency of clottin$ factors from the
massi!e blood transfusion.
d. the treatment is oral !itamin E
e. the treatment is intra!enous !itamin E






=9 2 a "atient with a solid mali$nancy is discussin$ chemothera"y with his oncolo$ist. he is interested in the ris)s of
the treatment. what is the "rimary toxicity of doxorubicin KadriamycinL'

a. cardiomyo"athy
b. "ulmonary fibrosis
c. "eri"heral neuro"athy
d. uric acid ne"hro"athy
e. he"atic dysfuncion


90 2 a (1 year old man com"lainin$ of re$ur$itation of sali!a and undi$ested food. an eso"ha$o$ram re!eals a
bird>s2bea) deformity. which of the followin$ statements is true about his condition'

a. chest "ain is common in the ad!anced sta$es of this disease.
b. more "atients are im"ro!ed by forceful dilation than by sur$ical inter!ention
c. manometry can be ex"ected to show hi$h restin$ "ressure of the lower eso"ha$eal s"hincter KAEsL
d. sur$ical treatment consists "rimary of resection of the distal eso"ha$us with reanastomosis to the stomach
abo!e the dia"hra$m
e. "atients with this disease are at no increased ris) for the de!elo"ment of carcinoma


91. A (1 yHo man "resents with food and sali!a re$ur$itation - an eso"ha$o$ram was "erformed and shown Jbeard
lea) J "henomenon what is true '

A .9hest "ain is common in this condition
1. 6irst "erform forceful dilation than "roceed to sur$ery
9. :anometry show increase AES restin$ tone
0. 4esection abo!e the dia"hra$m
E. #here is no increased ris) for carcinoma


92. % findin$s in achalasia ;

A. &ncreased AES restin$ "ressure - decreased AES relaxation - increased eso"ha$eal action
1. 0ecreased AES restin$ "ressure - &ncreased AES relaxation - 0ecreased eso"ha$eal action
9. &ncreased AES restin$ "ressure - 0ecreased AES relaxation - 0ecreased eso"ha$eal action
0. 0ecreased AES restin$ "ressure - &ncreased AES relaxation - &ncreased eso"ha$eal action


9%. An antireflux "rocedure unsuccessful because;

A. *astric outlet obstruction was not identified
1. /ell dilated "re!ious stricture
9. 0ecreased sali!a "roduction
0. #ransthoracic fundo"lasty


9(. Eso"ha$eal "erforation fre7uently caused;

A. S"ontaneous ru"ture
1. &nstrumental "erforation
9. 6orei$n body
0. 1arrett>s eso"ha$us





93. /hich one is not contribute to di$estion of fats in small intestine;

A. 1rush border en.ymes
1. Pancreatic li"ases
9. 1ile salts
0.'


96. /hich one is not characteristic of chronic 9rohn>s disease ;

A. 4ectal bleedin$
1. Perianal disease
9. 0iarrhea
0. Abdominal "ain


9<. &ntussus"ection in 20yHo man ;

A .&dio"athic
1 . 9arcinoid
9. Adhesions
0 . Aym"homa


9=. Aesions associated with Peut.2Fe$her syndrome ;

A.Sessile adenomas
1. 9luster lesions in duodenum
9. Hamartoma
0. &t has A4 inheritance


99. /hat is ?ot an indicator for an o"en cholycestectomy ;

a. "oor "ulmonary or cardiac reser!e
b.third trimester $estation
c. child5s class 9 li!er disease
d. sus"ected $allbladder cancer
e. Pre!ious $astric by"ass "rocedure


100. Primary scleroti.in$ cholan$itis associated with which disorder ;

A. 9rohn>s disease
1. 0iabetes
9. 4heumatoid arthritis
0. @lcerati!e colitis
E. 9hronic "ancreatitis


101. /hich of the followin$ does ?# stimulate bile flow'

A. 9holecysto)inin$
1. bile salts
9. !a$al stimulation
0. s"lachnic stimulation
E. secretin

102. Acute ischemia in lower extremity;

a. most often the result of femoral artery thrombosis
b. can ne!er occur as a conse7uence of 08#
c. is ne!er amenable to treatment with thrombolytic treatment
d. is most often the result of cardiac embolic e!ents
e. rarely result in limbHKlife' ?ot sure & wrote correctL threatenin$ ischemia


10%. /hich of the followin$ re$ardin$ aneurysms is true'

a. inflammatory aneurysm of the aorta rarely ru"ture.
b. s"lenic artery aneurysm are usualy atherosclerotic.
c. thrombosis of "o"liteal artery aneurysm may be treated with thrombolytic thera"y
d. infected aneurysm of the aorta usualy re7uire com"lete excision and extraanatomic re!asculari.aion
e. aneurysms of the he"atic artery are the most common !isceral aneurysms


10(. 1reast conser!ation sur$ery in breast carcinoma;

a. resulted ma+or im"oro!ement in mortality and morbidity.
b. has resulted durable sur!i!al data com"arable to those for mastectomy for certain breast cancer

103. ductal carcinoma of breast in situ;

a. is almost always bilateral.
b. has become more fre7uently dia$nosed because of the use of mammo$ram.
c. cannot "resent as a "al"able mass.
d. is fre7uently associated with microsco"ic lym"h node metastases.


106L A %%2year2old woman "re$nant for the third time "resent at % months with a 22cm mass in the inner as"ect of
the left breast. A needle as"iration re!eals no fluid. Cou would;

aL arran$e for a mammo$ram because multicentric lesions are common durin$ "re$nancy.
bL consider termination of "re$nancy because chemothera"y has been shown useful in nodene$ati!e "remenu"ausal
"atients.
cLex"editionsly obtain a histolo$ic dia$nosis of the mass.
dLwait until the third trimester because sur$ey is safer at that time.


10<L 4is) factors for the de!elo"ment of melanoma include all of the followin$ exce"t;

aLfair hair.
bLli$ht com"lexion.
cL$reen eyes.
dLmulti"le ne!i.


10=L /hich of the followin$ endosco"ic "e"tic ulcer characteristics has the hi$hest ris) for recurrent bleedin$;

aL oo.in$ ulcer.
bLclean based ulcer.
cLnonbleedin$ J!isible !esselJ
dLnonbleedin$ ulcer with an o!erlyin$ clot.
eL0ieulafoy ulcer.


109L A %=2year2old man was ta)en to an emer$ency facility after his car s)idded on the freeway and struc) a "illar. His
!ital si$ns were as follows; "uls ==Hmin, res"irations 20Hmin, blood "ressure 100H<0 mmH$. Physical examination
re!ealed non"rominent +u$ular nec) !eins- no indication of cyanosis- and symmetric breath sounds. A "osterior2
anterior chest B2ray film re!ealed a widened mediastinum. /hich of the followin$ choises is the most li)ely dia$nosis'

aLru"tured aortic aneurysm.
bLcardiac tam"onade.
cLdissection of the thoracic aorta.
dLmyocardial contusion
eL"ulmonary contusion.


110L /hich of the followin$ statements is true about sur$ery for "heochromocytomas'

aL"atient should recei!e "reo"erati!e alfa2bloc)ade for 1 to ( wee)s "rior to sur$ery.
bLthe adrenal !ein should be ta)en only after the arterial su""ly is isolated and li$ated.
cLintra!enous fluids should be restricted until the tumor is remo!ed.
dL"reo"erati!ebeta2bloc)ade should "recede any alfa2bloc)es to a!oid the "reci"itation of mali$nant hy"ertension.
eLbilateral adrenalectomy should be "erformed for "atients with :E?2a.







































20.09.2012;

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