01.03.

2010
By: Alhag Abu Anzeh Muhammad (baghdats@yahoo.com)
Part A:

1- an 8-mo-old girl is brought to your office with complaint that she has deelopment delay. her head is enlarged! and
she feeds poorly and does not focus. you e"amine that baby and find her hypotonic and unable to sit. she has
considerable head lag. ad head circumference is aboe the #$ th percentile.
which of the following disease would consider the most probable diagnosis %

a.birth asphy"ia
b. familial hydrocephalus
c.rubella infection in utero
d.canaan disease
e.hunler disease


2- a serios complication of the treatment of hypernatremic dehydration is %

a. cerebral thrombosis
b. cerebral edema
c. hypoglycemia
e. none of the aboe


3- the best feeding protocol for a temperamentally irregular infant is %

a. a fi"ed schedule
b.one based on the parent&s schedule
c. eery 1-2 hr
d. one based on demand
e. '0 min for each feeding


(- during e"amination of an 8-mo-old child! the difficulty of optimal chest auscultation is due primarily to %

a. recent meal with gastric distention
b. rapid respiratory rate
c. stranger an"iety
d. transmited nasal sounds
e. pliable chest wall


$- which of the following is a )nown complication of ascular ring%

a. renal failure
b. heart failure
c. cardiac arrhythmia
d. tracheomalacia
e. constipation








'- a $-yr-old with A*+, who is receiing -idoudine! lamiudine! and ritonair presents whith rapid respiratory
rate progressie dyspnea of 2 days duration. there is no feer. the chest radiograph reeals bilateral diffuse aleolar
disease. the most important diagnostic test whoud be%

a. ./ scan of the chest
b. pharyngeal swab for iral and bacterial cultures
c. blood gas profile
d. serum lactate dehydrogenase leel
e. bronchoaleolar laage for cytology


0- A '-yr-old girl who was preiously healthy presents with a 1-w) history of nocturnal perianal itching
there are no other symptoms ! and findings on physical e"amination are normal. the most appropriate therapy is %

a. bacitracin ointment to the perianal area
b. diphenhydramine of mebenda-ole repeated in 2 w)
c.
d. a 2-w) course of amo"icillin1claulanate
e. )etocona-ole! in a single dose


8- A (-mo-old child with itamin + deficiency ric)ets would be e"pected to show all of the following e"cept%

a. craniotabes
b. bowleg
c. rosary
d. low serum phosphate leels
e. high al)aline phosphatase leeles

#- A $-yr-old boy who lies in an urban area is hospitali-ed because of low grade feer! flaccid
paralysis of both leges! sensory changes! and absent an)le deep tendon refle"es. the child receied
only two immuni-ations with oral polioaccine 23P45 ! at the ages of 2 and ' mo. the most probable diagnosis is%

a. acute paralytic poliomyelitis due to wild polioirus
b. paralysis due to nonpolioenteroiruses
c. accine- associated poliomyelitis
d. guillain-barre syndrome
e. tic)-bite paralysis

10- which of the following may be a manifestation of enteroirus infection%

a. ata"ia
b. intususception
c. parotitis
d. herpangina
e. renal failure

21- a20-month-old child is brought to the ed because of feer and irritability and refusal to moe his right )nee
that resists-passie motion.
which of the following is the most important test to confirm the impression of septic arthritis:

A ."-ray of the )nee
b. e"amination of the 6oint
c. erythrocyte sedimentation rate
d. complete blood count and differential
e. blood culture


22- as apart of your anticipatory guidance to new parents of healthy newborn you suggest putting the child in
which of the following position for sleep%

a.supine position
b.prone position
c.seated postion
d.trendelenburg postion
e.a hammoc)


23- amentally retarted 1(-year old boy has along face! large ears !micropenis!and large testes.
chromosome analysis is li)ely to demonstrate which of the following%

a.trisomy 21
b.trisomy 18
c.trisomy 13
d.fragile " syndrome
e.williams syndrome


2(- amother wisches to breast-feed her newborn infant !but is worried about medical conditions that would
prohibit her from doing so.you counsel her that of her listed conditions which of the following is acontraendication
to breast-feeding%

a.upper respiratory tract infection
b.crac)ed and bleeding nipples
c.mastitis
d.inerted nipples
e.hi infection


2$- afull-term infant is born after a normal pregnancy deliery howeer is complicated by marginal placental
separation .at 12 hours of age !the child although appearing to be in good health !passes a bloody meconium
stool .for determining the cause of the bleeding.
which of the following diagnostic procedures should be performed first%

a.a barium enema
b.an apst test
c.gastric laage with the normal saline
d.an upper gastrointestinal series
e.a platelet count prothrombin time and partial thromboplastin time


2'- during a regular chec)up of an 8-year -old child you note a loud first heart sound with a fi"ed and
widely split second heart sound at the upper sternal border that does not change with respirations.the
patient is otherwise actie and healthy.which of the following heart lesions most li)ely e"plains these findings%

a.atrial septal defect2A,+5
b.entricular septal defect24,+5
c.isolated tricuspidal regurgition
d.tetralgy of fallot
e.mitral ale prolapse






20- a2 year -old child has a 2 wee) history of splitting feers which hae been as high as (0. she has spindle-
shaped swelling of finger 6oints and complains of upper sternal pain.when she has feer ! the parents note a faint
salamon -colored rash that resoles with the resolution of the feer.she has had no con6unctiitis or mucositis ! but
her heart sound are muffled and she has increased pulsus parado"us .
which of the following is the most li)ely diagnosis%

a.acute rheumatic feer
b.6uenile rheumatoid arthritis
c.to"ic synoitis
d.septic arthritis
e.osteoarthritis


28- a 12 -yr-old girl is hospitali-ed in intensie care.she has a foley catheter and a urine culture is
positie for enterococcus .in addition to remoing the catheter.
which antibiotics is the recommended agent for treatment of enterococcus infections%

a.penicillin
b.ampicillin
c.clindamycin
d.erthromycin
e.ancomycin


2#- a 10 month -old infant has poor weight gain !a persistent cough and a history of the seeral bouts of
pneumonitis . the mother describes the child as haing ery large foul -smelling stools for months. 7hich of the
following diagnostic maneuers is li)ely to result in the correct diagnosis of this child%

a.ct of the chest
b.serum immunnoglobins
c.tb s)in test
d.inspiratory and e"piratory chst "-ray
e.sweeat chloride test


30- preiously healthy actie 18 month -old child presents with unilateral nasal obstruction and foul - smelling
discharge .the child&s e"amination is otherwise unremar)able .which of the following is the most li)ely diagnosis%

a.foreign body
b.nasal polyps
c.frontal sinusitis
d.deaited septum
e.choanal atresia


31. A $year old child with iron deficiency and seere episodes of grossly! bloody 2maroon5 stools.
7hich is the most li)ely e"planation for his anemia%

8: 9ec)el dierticulum.


32. A 0month old child reciees chron. total parenteral nutrition for short gut syndrom.
7hich is the most typical complication of total parenteral nutrition%

A: ,epsis


33. A 1(y old girls with a # month history of diarrhea! abdominal pain 2periumbilical and postprandial5! weight loss
and blood in stool. 7hat is the most li)ely diagnose%

.: .hron:s disease


3(. /wo wee)s after a iral syndrome a 2year old deelops bruising and petechia more prominent
oer both legs. ;"amination shows no hepatosplenomegaly or lymph node enlargement. 8lood tests
show normal haemoglobin! haematocrit and 78. count and 1$.000 /hrombocytes. 7hat is the most li)ely diagnosis%

+: *diopathic thrombocytopenic purpura


3$.3n a routine screening for complet bloodtest a 1year old noted to hae a microcytic anemia. A follow up
haemoglobin electrophorese demonstrates increased cencentration of haemoglobin A2.
/he child is most li)ely to hae%

8:8eta thalassemia trait.


3'. <ien folid acid to a pregnant woman preents the child from haing which defect%

+:=eural tube defect.


30. A $year old boy has bloody urin! puffy eyes and headache for one day. >e had feer and a sore throat 10
days ago which resoled without treatment. 7hat is the most li)ely diagnosis%

+:Post infectious glomerulo nephritis.


38. A 18month old has 10 hours of feer and irritability. .,? 2000 78. #0@ polymorphnu)lear. ,pinal fluid
is depressed. >e is treated with .efota"im and 4ancomycin. 8 hours after treatment he gets general conulsions.
7hat is the ne"t step%

+:3rder sodium serum concentration.


3#. A 'year old girl comes to the hospital after conulsion. ,he is alert without distress. 3n her s)in you notice
caf-au-lait spots! a ,hagreen patch and periungal fibromas.
7hich is the most li)ely diagnosis%

;:Addison disease


(0. 7hich of the following is an effectie screening test for /-cell function%

a. Absolute lymphocyte count
b. ?low cytometry for .+( 2helper5 and .+8 2cytoto"ic5 / cell
c. Aespiratory burst assay
d. .andida s)in test
e. 9umps antibody titer after mumps accination






(1. 7hich of the following is a complication of intraenous immunoglobulin 2*4*<5 /herapy %

a.Anaphyla"is
b.Aenal failure
c./rasmission of >*4
d.>epatic to"icity
e.>yperglycemia


(2. /he treatment of choice for a 3-years old boy suffering from acute otitis media is :

a.A-ythromycin
b.<entamycin
c..hloramphenicol
d.;rythromycin
e.Amo"ieillin


(3. /he state laboratory calls your office telling you that a newborn infant ! now 8 days old! has an eleanted
thyroid stimulating hormone 2/,>5 and low thyro"in 2/n5 on his newborn screen! *f this condition is left
untreated ! the infant is li)ely to demonstrate which of the following in the first few months of life%

a.>yperrefle"ia
b.>yperirritability
c.+iarrea
d.Prolonged 6aundice
e.>yperphagia


((. A 18-years old girl has hepatosplenomegaly! an intention tremor! disarthria! dystonia and
deterioration of her school performance! she also deeloped abnormal urine with e"cess glucare !
protein and uric acid! she has a seeral-year history of eleated lier en-ymes of un)nown etiology .
7hich of the following best e"plains her condition%

a.<alactosemia
b.B1-antitrypsin deficiency
c.<ilbert syndrome syndrome
d.+ubin Cohnson
e.7ilson disease


($. A 12-years-old boy has scent! long! slightly pigmented pubic hairs! slight enlargement of his penis ! a pin) testure
and enlarged scrotum! >e is most li)ely at 7hich tanner stage%

a.1
b.2
c.3
d.(
e.$

('. An 18-years old male collage student is seen in the student health clinic for urinary freDuency! dysuria! and
urethral discharge . 7hich of the following is li)ely to e"plain this condition%

a.>erpe" simple"
b.;scherichia coli urinarytract infection
c..lamydial urethritis
d.,yphilis
e.>i infection
(0. Allergy to 7hich of the following food products is the most common in children%

a.Peanut
b.,esame
c.;gg
d.?ish
e..ow&s mil)


(8. An 8-years old -----------ne"t action %

a.;"plain that is a mild side effect of the drug .
b.<ie the child oral anti histamine .
c.*n6ect corticosteroids *4
d.*n6ect epinefrin *9
e.*ntubate and start mecchenical entilation


(#. /he parents -----------ne"t action %

a.,econdary bacterial infection
b.8athing with tepid water
c.Application of steroid scream before the emollient .ool!
d.humid ambient temperatures
e.;"cessie use of Eubrification


$0. A 1-month old infant who is otherwise and well and asymptomatic ! has been brought in because of
a rash . the child has inflammatory scalp scale which has a combination of greasy! yellow and
erythematous features ! as well as infiammation of the nec)! a"illary and inguinal creases.
the most li)ely diagnosis is%

a.Atopic dermatitis
b.,eborrheic dermatitis
c.Psoriasis
d.Eangerhans cell histiocytosis
e..andidiasis


$1. a 10-year-old girl is seen by her primary care physician for the ealuation of left lower Duadrant pain. /he
physician felt a pelic mass on physical e"amination and ordered a pelic ultrasound. Fou are consulted because an
oarian neoplasm is identified by the ultrasound.
7hich of the following is the most common oarian tumor in this type of patient%

a. <erm cell
b. Papillary serous cyst epithelial
c. ?ibrosarcoma
d. 8renner tumor
e. ,arcoma botryoides


$2. 7hich is the narrowest diamerter of the pelic inlet through which the fetal head must pass%

a. /rue con6ugate
b. +iagonal con6ugate
c. /ranserse con6ugate
d. 3bstetrical con6ugate

$3. /he >.< receptor is also the receptor for ehat other hormone%

a. E>
b. ?,>
c ;striol
d. Progesterone


$(. >ighest leels of hPE 2human placental lactogen5 can be found in which of the following%

a. ?etal urine
b. ?etal serum
c. Amniotic fluid
d. 9aternal serum


$$. 7hich of the following is decreased during normal pregnancy%

a. <lomerular filtration rate
b. Aenal plasma flow
c. .reatinine clearance
d. ,erum concentration of urea nitrogen


$'. At what leel does compression of the ureters by the graid uterus occur%

a. 8ladder trigone
b. Pelic brim
c. ,acrospinous ligaments
d. Greteroescical 6 unction


$0. 7here o"ytocin is primarily synthesi-ed%

a. Adrenal gland
b. Placenta
c. Posterior pituitary
d. 3ary


$8. A 21-year-old woman returns to your office for ealuation of an abnormal Pap smear. /he Pap smear
showed sDuamous abnormality suggestie of a high-grade sDuamous intraepithelial lesion 2><,*E5.
.olposcopy confirms the presence of a serical lesion consistent with seere cerical
dysplasia 2.*= ***5.
7hich of the following human papilloma irus 2>P45 types is most often associated with this type of lesion%

a. >P4 type '
b. >P4 tybe 11
c. >P4 tybe 1'
d. >P4 tybe (2
e. >P4 tybe ((

$#. *solated fetal structural defects are most commonly found in which of the following organ%

a. Eier
b. >eart
c. 8ladder
d. =eural tube
'0. 7hat is the lie if the fetal and maternal a"es cross at a ($-degree angle%

a. Eongitudinal
b .8reech
c. 3bliDue
d. /ranserse


'1- what is the most common position of the fetal erte" as it enters the pelis%

A.Aight occipitoanterieor 2A3A5
8.Aight occipitotranserse 2A3/5
.. Eeft occipitoanterieor 2E3A5
+. Eeft occipitotranerse 2 E3/ 5


'2-what is the primary mechanism of placental site hemostasis%

A.4asoconstriction by contracted uterus
8.Prostaglandins secretion
..9aternal hypotension
+.+ecreased cardiac output


'3- what happens to perinatal mortality after (2 wee)s gestation%

A.9ar)edly decreased
8. ,lightly decreased
.. =o change
+. *ncreased


'(- A woman with chronic hypertension was prescribed alpha-methyldopa at 2( wee)s gestation.
what is the mechanism of action of alpha-methyldopa%

A.Aela"es arterial smooth muscles
8.*ncreased sodium and water diuresis
..*ncreased peripheral ascular resistance
+.Acts centrally to decrease ascular tone


'$- which of the following techniDues is best for the diagnosis of fetal cytomegaloirus infection%

A. Amniocentesis or cordocentesis
8. .horionic illus sampling
.. Gltrasound
+. 9agnetic resonance imaging











''- A 32-year-old woman presents to the emergency room complaining of seere lower abdominal
pain. 3n bimanual pelic e"amination. 8ilateral adne"al masses are palpated. /he patient is sent to
the ultrasound department! and a transaginal pelic ultrasound demonstrated bilateral tubo-oarian
abscesses. 7hich of the following is the most appropriate ne"t step in the management of this patient%

A.Admit the patient for emergent laparoscopic drainage of the abscesses
8..all interentional radiology to perform ./-guided percutaneous drainage of the abscesses
..,end the patient home and arrange for intraenous antibiotics to be administered by a home health agency
+.Admit the patient for intraenous antibiotic therapy
;.Admit the patient for e"ploratory laparotomy!/A>18,3


'0- A$$-year-old <3P3 with a history of fibroids presents to you complaining of irregular aginal
bleeding. 3n physical e"amination! her uterus is 12 wee)s in si-e and irregularly shaped. >er oaries are not
palpable! A urine pregnancy test is negatie.
7hich of the following is the most reasonable ne"t step in the ealuation of this patient%

A.,chedule her for hysterectomy
8.*nsert a progesterone-containing intrauterine deice 2*G+5
..Arrange for outpatient endometrial ablation
+.Perform an office endometrial biopsy
;.Arrange for outpatient coni-ation of the ceri"


'8- A couple present to your office to discusspermanent sterili-ation. /hey hae three children and are sure they do
not want any more. Fou discuss the ris) and benefits of surgical sterili-ation.
7hich of the following statements is true regarding surgical sterili-ation%

A./hey cannot be performed immediately postpartum
8. /hey hae become the second most common method of contraception
../hey can be considered effectie immediately in females 2bilateral tubal ligation5
+./hey can be considered effectie immediately in males 2asectomy5
;./ubal ligation should be performed in the secretory phase of the menstrual cycle


'#- Patients with /urner:s syndrome will most commonly display which of the following endocrine profiles%

A.;leated /,>! normal ?,>! normal prolactin
8.;leated ?,>! normal /,>! normal prolactin
..;leated prolactin! normal /,>! normal ?,>
+.=ormal ?,>! normal /,>! normal prolactin



00- A 1$ year old patient with a diagnosis of 9ayer-Ao)itans)y-Huster->auser syndrome is referred to you
because of cyclic pelic pain. Fou may counsel the patient that:

A./he pain cannot be real because she does not hae any pelic structures.
8.,he does not reDuire any imaging of the urinary tract.
..,)eletal abnormalities are uncommon with this disorder.
+.>er pain may be related to the presence of a rudimentary mullerian structure with functioning endometrium.







01- A (' year old woman comes to your office worried about her decreased se"ual desire and
perimenopausal symptoms. >er medical and surgical history are significant only for right salpingo-
oophorectomy 10 years ago. Gpon performing her annual e"am! you feel left adne"al fullness! and
pelic sonogram shows an 8-cm cyst. After discussion of potential remoal of the oary! the patient is
ery worried that remoal of her remaining oary will leae her with no testosterone. Fou tell her that:

A.=early all testosterone production is from her remaining oary and her concerns are 6ustified.
8.3ne fourth of her testosterone production is fron her oary! one fourth from her adrenals! and the remaining
..half from peripheral conersion.
+./estosterone production is not lin)ed to a woman:s oaries.
;.<ien that she is perimenopausal! she li)ely has little testosterone circulating anyway.


02- 7hich of the following is the best e"planation for the mechanism of the action of the intrauterine deice
2*G+5%

a. >yperperistalsis of the fallopian tubes accelerates oocyte transport and preents fertili-ation
b. A subacute or chronic bacterial endometritis interferes with implantation
c. Premature endometrial sloughing associated with menorrhagia causes early abortion
d. A sterile inflammatory response of the endometrium preents implantation
e. .erical mucus is rendered impenetrable to migrating sperm


03-A $0 year old healthy woman presents to the office for a routine gynecologic isit. ,he
complains of new onset episodes of intense heat through her nec) and chest followed by periods of
profuse sweating. ,he is concerned because these episodes interfere with her ability to wor) and also
wa)e her up from sleep. 7hat is the most effectie therapy for the symptoms the patient is describing%

a.4enlafa"ine
b..lonidine
c.;strogen replacement
d.8lac) cohosh


0(- A '2 year old woman presents to your office complaining of discomfort and pain with
intercourse! which she notes has deeloped oer the past few years. A physical e"am reeals atrophic aginal
mucosa. 7hat initial therapy would you recommend for this patient%

a.A aginal estrogen
b./ransdermal estrogen
c.9arriage counseling
d.3ral hormone replacement therapy


0$- 7hile ealuating a 30-year-old woman for infertility! you diagnose a bicornuate uterus. Fou e"plain that
additional testing is necessary because of the woman:s increased ris) of congenital anomalies in which organ system%

a. ,)eletal
b. >ematopoietic
c. Grinary
d. .entral nerous
e. /racheoesophageal







0'- *n an amenorrheic patient who has had pituitary ablation for a craniopharyngioma! which of the following
regimens is most li)ely to result in an oulatory cycle%

a. .lomiphene citrate
b. Pulsatile infusion of gonadotropin-releasing hormone 2<nA>5
c. .ontinuous infusion of <nA>
d. >uman menopausal or recombinant gonadotropin
e. >uman menopausal or recombinant gonadotropin followed by human chorionic gonadotropin 2h.<5


00- +uring the 3ulation of infertility in 2$ year old female .... showed eidium of of Asherman syndrome.
which one of the following smptoms would be e"pect in the Patient:

a. >ypomenorrhea
b. 3ligomenorrhea
c. 9enorrhagia
d. 9etrorrhagia
e. +ysmenorrhea


08- A 22-year-old woman consults you for treatment of hirsutism. ,he is obese and has facial acne and
hirsutism on her face and periareolar regions and a male escutcheon. ,erum E> leel is 3$ m*G1mE and ?,>
is # m*G1mE. Androstenedione and testosterone leels are mildly eleated! but serum +>A, is normal. /he
patient does not wish to conceie at this time.
7hich of the following single agents is the most appropriate treatment of her condition%

a. 3ral contracepties
b. .orticosteroids
c. <nA>
d. Parlodel
e. 7edge resection


0#- A 1#-year-old patient presents to your office with primary amenorrhea. ,he has normal breast and pubic hair
deelopment! but the uterus and agina are absent. +iagnostic possibilities include:

a. IFF syndrome
b. <onadal dysgenesis
c. 9ullerian agenesis
d. Hlinefelter syndrome
e. /urner syndrome


80 - A $(-year-old woman undergoes a laparotomy because of a pelic mass. At e"ploratory laparotomy! a unilateral
oarian neoplasm is discoered that is accompanied by a large omental metastasis. ?ro-en section diagnosis confirms
metastatic serous cystadenocarcinoma. /he most appropriate intraoperatie course of action is:

a. ;"cision of the omental metastasis and oarian cystectomy
b. 3mentectomy and oarian cystectomy
c. ;"cision of the omental metastasis and unilateral oophorectomy
d. 3mentectomy and bilateral salpingo-oophorectomy
e. 3mentectomy! total abdominal hysterectomy! and bilateral salpingooophorectomy





815 which of the following is the ma6or cause of unplanned pregnancies in women using oral contracepties%

a5 brea) through oulation at midcycle
b5 high freDuency of intercorse
c5 incorrect use of oral contracepties
d5 gastrointestinal malabsorption
e5 deelopment of antibodies


825 A postmenopausal woman presents with pruritic white lesions on the ula. Punch biopsy of a representatie area
is obtained. 7hich of the following histologic findings is consistent with the diagnosis of lichen sclerosis%

a. 8lunting or loss of rete pegs
b. Presence of thic)ened )eratin layer
c. Acute inflammatory infiltration
d. *ncrease in the number of cellular layers in the epidermis
e. Presence of mitotic figures


835 A '$-year-old woman presents to your office for ealuation of genital Prolapse.
7hich of the following factors is least important in the subseDuent deelopment of genital prolapsed in this patient%

a. .hronic cough
b. .hronic constipation
c. .hronic hypertension
d. .hildbirth trauma
e. 9enopause


8(5 An intrauterine pregnancy of appro"imately 10 wee)s gestation is confirmed in a 30-year-old <$P( woman with
an *G+ in place. /he patient e"presses a strong desire for the pregnancy to be continued. 3n e"amination! the string
of the *G+ is noted to be protruding from the cerical os.
7hich of the following is the most appropriate course of action%

a. Eeae the *G+ in place without any other treatment.
b. Eeae the *G+ in place and continue prophylactic antibiotics throughout pregnancy.
c. Aemoe the *G+ immediately.
d. /erminate the pregnancy because of the high ris) of infection.
e. Perform a laparoscopy to rule out a heterotopic ectopic pregnancy.


8$5 A '2-year-old woman presents for annual e"amination. >er last spontaneous menstrual
period was # years ago! and she has been reluctant to use postmenopausal hormone replacement because of a strong
family history of breast cancer. ,he now complains of diminished interest in se"ual actiity.
7hich of the following is the most li)ely cause of her complaint%

a. +ecreased aginal length
b. +ecreased oarian function
c. Alienation from her partner
d. Gntreatable se"ual dysfunction
e. Physiologic anorgasmia







8'5 A 00-year-old man with a dementing disorder dies in a car accident. +uring the preious $ years! his personality
had dramatically changed and he had caused much embarrassment to his family because of his intrusie and
inappropriate behaior. Pathological e"amination of his brain shows frontotemporal atrophy! gliosis of the frontal
lobes: white matter! characteristic intracellular inclusions! and swollen neurons. Amyloid plaDues and neurofibrillary
tangles are absent. 7hich of the following is the most li)ely diagnosis%

a. Al-heimer disease
b. Pic) disease
c. .reut-feldt-Ca)ob disease
d. 812 deficiency dementia
e. >*4 dementia


805 2(-year-old preiously healthy man is brought to the emergency room after he began yelling that people on the
bus were out to hurt him. *n the emergency room! he is agitated! hyperigilant! and an"ious. >e is unable to gie
much history other than to say that he is a graduate student and nothing li)e this has eer happened before.
7hich of the following is the most li)ely cause of this behaior%

a. +elirium
b. Pic) disease
c. +issociatie disorder
d. 4itamin 812 deficiency
e. .ocaine into"ication


885 emaciated and lethargic 1'-year-old girl arries at the emergency room. >er blood pressure is 0$1$0! her heart
rate is $2 beats per minute! her potassium is 2.8 meD1E! and her bicarbonate is (0 meD1E. /he girl:s parents
report that she has lost 3$ lb in 3 months but is still coninced that she is oerweight. ,he eats only ery small
amounts of low-calorie food! and she runs 2 to 3 hours eery day.
7hat other actiities is this patient most li)ely to hae engaged in%

a. ,e"ual promiscuity
b. ;thanol abuse
c. Purging
d. 7earing tight clothes
e. ,hoplifting


8#5 A 23-year-old man comes to the physician with the complaint that his memory has worsened oer the past 2
months and that he has difficulty concentrating. >e has lost interest in his friends and his wor). >e has difficulty with
abstract thoughts and problem soling. >e has also felt depressed. 9A* scan shows parenchymal abnormalities.
7hich of the following is the most li)ely diagnosis%

a. Al-heimer disease
b. 4ascular dementia
c. >*4-related dementia
d. Eewy body disease
e. 8inswanger disease


#05 which of the following is the most common cause of delirium in elderly%

a5 substance abuse
b5 accidental poisining
c5 hypo"ia
d5 use of multiple medication


#1. a$8 year old woman with chronic mental disorder !comes to the physician with irregular choreoathetoid
moements of her hands and trun) .she states that the moments get worse under stressful conditions.
which of the following medications is most li)ely to hae caused this disorder:

a-fluo"etine
b-perphena-ine
c-dia-epam
d-phenobarbitol
e-clo-apine


#2. '2 year old man with chronic schi-ophrenia is brought to the ;A after he is found wandering
around his halfway house confused and disoriented.his serum =a is 123 meD1l and urine =a is $ meD1l the patient
has been treated with risperidone (mg1day for the past 3 years with good symptoms control .his roommate reports
that the patient often complain of feeling thirsty .which of the following is most li)ely cause of this symptoms:

a-renal failure
b-inappropriate 2 A+> 5 secretion
c-addison disease
d-phsychogenic polydipsia
e-nephrotic syndrome


#3. 0$ years old man is being cared for in hospic setting. >e has widely spread prostatic carcinoma and is
considered terminal. 7hich of the following psychiatric symptoms are seen in #0@ of all terminal patients:

a-delusions
b-hallucinations
c-flight of ideas
d-an"iety
e-depression


#(. a 2$ year old man comes to the psychiatrist with chef complaint of depressed mood for * month . his mother !to
whom he was ery close died 1 month ago and since that time he has felt sad and been ery tearful . he has
difficulty concentrating! has lost 1.$ )g and is not sleeping soundly through the night.
which of the following is the most li)ely diagnosis:

a-ma6or depression
b-disthymia
c-post traumatic stress disorder
d-ad6ustment disorder
e-uncomplicated bereaement


#$.how long after stro)e is a patient at higher ris) of deeloping a depressie disorder:

a-2 wee)s
b-2months
c-'months
d-1year
e-2years






#'. a 20 years old woman has been feeling blue for the past 2 wee)s. ,he has little energy and has
trouble concentrating. ,he states that ' wee)s ago she had been feeling ery good with lots of energy
and no need for sleep. ,he says that this pattern has been occurring for at least the past three years
though the episodes hae neer been so seer that she couldn:t wor).
which of the following is the diagnosis:

a- border line personality disorder
b-seasonal affecting disorder
c-cyclothymic disorder
d-ma6or depression!recurrent
e-bipolar disease! depressed


#0. which of the following is a relatie contraindication for ;./:

a-space occupaing lesion in the brain
b-pregnancy
c-hypertension
d-sei-ure disorder
e-post myocardial infarction ' months earlier


#8. 32 year old man is being treated for ma6or depression. 7hich of the following symptoms. *f present is one of the
most accurate indicators of long term suicidal ris):

a-reenge fantasies
b-presence of rage in the patient
c-hopelessness
d-presence of guilt
e-the patient has need for punishment


##. 28 years old ta"i drier is chronically consumed by fears of haing accidentally run oer a
pedestrian . although he tries to conince himself that his worries are silly! his an"iety continues to mount until he
dries bac) to the scene of the accident and proes to himself that no body lies hurt in the street . this behaior
e"emplifies which of the following:

a-a compulsion secondary to obsession
b-an obsession triggered by a compulsion
c-a delusional ideation
d-a typical manifestations of obsessie compulsie personality disorder
e-a phopia


100. 33 years old man comes to his physician for an >*4 test !the test is positie. /he patient has no signs or
symptoms of A*+,.
which of the following psychiatric diagnosis may deelop in as many as 2$@ of patient informed of positie >*4 test:

a-ad6ustment disorder with an"iety
b-P/,+
c-bipolar disorder! manic
d-panic disorder
e-hypochondriasis






101. eery ( to $ wee)s a usually well functioning few day irritation:

d. pre menstrual


102. A young woman presents to the emergency room omiting bright red blood. 3nce she is medically stable! the
intern who performs her physical e"amination notices that the enamel of her front teeth is badly eroded and her
parotid glands are swollen. 7hich of the following best describes the source of these medical complications%

a. *nadeDuate caloric inta)e
b. Purging
c. Ea"atie abuse
d. +iuretic abuse
e. *pecac to"icity


103. A $2-year-old woman is diagnosed with breast cancer that is metastatic to her bones. ,he comes to the
psychiatrist for help in managing her depressed mood and an"iety secondary to this diagnosis. 7hich of the following
would most li)ely indicate an increased ulnerability to suicide if found in this patient! in addition to her an"iety and
depressed mood%

a. /he e"tent of the cancer:s spread to her bones
b. /he location of the bone metastases to her bones
c. A feeling of a loss of control
d. >ow much pain she has with the metastases 2een though it is currently wellcontrolled5
e. A history of social phobia


10(. A 3'-year-old woman comes to the emergency room after she is found unresponsie at a party. Grine
to"icology is positie for cocaine. Gpon awa)ening! the patient is interiewed and is found to hae a history
consistent with cocaine abuse. 7hich of the following is this patient at an increased ris) for haing%

a. +eath by suicide
b. Aoidant personality disorder
c. A+>+
d. 8ipolar disorder--mania
e. 9ild mental retardation


10$. A 1'-year-old male with a long record of arrests for brea)ing and entering! assault and battery! and drug
possession is found dead in his room with a plastic bag on his head. ?or seeral months he had been e"periencing
headaches! tremors! muscle wea)ness! unsteady gait! and tingling sensations in his hands and feet. /hese symptoms
2and the manner in which the boy died5 suggest that he was addicted to which of the following substances%

a. P.P
b. .ocaine
c. 9ethamphetamine
d. An inhalant
e. >eroin









100. A 28-year-old business e"ecutie sees her physician because she is haing difficulty in her new
position! as it reDuires her to do freDuent public spea)ing. ,he states that she is terrified she will do or say something
that will cause her e"treme embarrassment. /he patient says that when she must spea) in public! she becomes
e"tremely an"ious and her heart beats uncontrollably. 8ased on this clinical picture.
which of the following is the most li)ely diagnosis%

a. Panic disorder
b. Aoidant personality disorder
c. ,pecific phobia
d. Agoraphobia
e. ,ocial phobia


108. 8en-odia-epines! barbiturates! and many anticonulsants e"ert their influence through which of the following
types of receptors%

a. 9uscarinic
b. +opaminergic
c. <lutamic
d. Adrenergic
e. Aminobutyric acid 2<A8A5-allergic


10#. After being struc) on the head by a four-by-four piece of wood! a preiously serious and
dependable construction wor)er starts ma)ing inappropriate se"ual remar)s to his cowor)ers! is easily distracted!
and loses his temper oer minor proocations. 7hat part of his brain has most li)ely been damaged%

a. 3ccipital lobe
b. /emporal lobe
c. Eimbic system
d. 8asal ganglion
e. ?rontal lobe


110. A 10-year-old boy is brought to the emergency room by his friends after he Jtoo) a few pillsK at a
party and deeloped physical symptoms! including his nec) twisting to one side! his eyes rolling upward! and his
tongue hanging out of his mouth. /he patient responds immediately to $0 mg of diphenhydramine intramuscularly
with the resolution of all physical symptoms. 7hich of the following substances is most li)ely to hae caused the
symptoms%

a. 9ethamphetamine
b. 9eperidine
c. Alpra-olam
d. 9ethylphenidate
e. >aloperidol













Part 8:

1. A (3-year-old man is admitted to the neurology serice after he went blind suddenly on the morning of
admission. /he patient does not seem oerly concerned with his sudden lac) of ision. /he only time he
gets upset during the interiew is when he is discussing his mother:s recent death in *srael--he was
supposed to bring his mother to the Gnited ,tates! but did not because he had been using drugs and did
not sae the necessary money. Physical e"amination is completely negatie.
7hich of the following is the most li)ely diagnosis%

a. .onersion disorder
b. >ypochondriasis
c. ?actitious disorder
d. 9alingering
e. +elusional disorder



2. A '#-year-old man with a diagnosis of delirium has symptoms of psychosis which include: frightening auditory and
isual hallucinations and paranoid delusions.
7hich of the following medications should be chosen first for this man:s symptoms%

a. >aloperidol
b. Luetiapine
c. 4alium
d. 3lan-epine
e. Miprasidone


3. A 3(-year-old man recurrently perceies the smell of rotten eggs. /his )ind of hallucination is most commonly
seen in patients with which of the following diagnoses%

a. Parietal tumors
b. =arcolepsy
c. <rand mal epilepsy
d. Partial comple" sei-ures
e. 7ilson disease


(. A 2$-year-old woman is diagnosed with schi-ophrenia when! after the sudden death of her mother! she
begins complaining about hearing the oice of the deil and is suddenly afraid that other people are out to
hurt her. >er history indicates that she has also e"perienced a 3-year period of slowly worsening social
withdrawal! apathy! and bi-arre behaior. >er family history includes ma6or depression in her father.
7hich of the following details of her history leads the physician to suspect that her outcome may be poor%

a. ,he is female.
b. ,he was age 2$ at diagnosis.
c. ,he had an acute precipitating factor before she began hearing oices.
d. ,he had an insidious onset of her illness.
e. /here is a history of affectie disorder in her family

$./he first symptoms of A+>+ to remit is usually:

a. hyperactiity
b.+istractiity
c. carless mistac)s in schoolwor)
d. *mpulsiity
e. learning difficulties
'. A ($-year-old man is diagnosed as haing diabetes and will reDuire insulin. >is physician e"plains the use of the
medication and tells the patient that he will need to be seen at freDuent interals until his
glucose leels come under good control. /he patient has always been somewhat hostile with the
physician! but upon hearing this news! he says angrily! JFou doctors are always the sameN Fou always want control--of
my time! of my money! and now of my eery actionNK As far as the physician )nows! this patient has neer had an
unpleasant encounter with a physician before.
7hich of the following is the most li)ely e"planation for the patient:s reaction to his doctor%

a. /he patient is becoming delusional.
b. /he patient is e"periencing transference to this authority figure.
c. /he patient is splitting.
d. /he patient is becoming manic.
e. /he patient is anticipating being re6ected by his physician


0. A 2(-year-old woman comes to the psychiatrist with a 2-month history of short episodes of Jfeeling
li)e * am going to die.K +uring these episodes! she also notes feelings of di--iness and nausea! along with a
feeling of cho)ing. ,he describes these episodes as ery frightening and she is terrified of haing another. ,he denies
substance use of any medical problems. 7hich of the following treatment regimens should be started%

a. *mipramine
b. ?luo"etine
c. Phenel-ine
d. Paro"etine and alpra-olam
e. 8uspirone and citalopram


8.7hich of the following is not an appropriate pharmacologic treatment for tic disorder%

a. methylphenitate
b. guanfacine
c. risperidone
d. clonidine
e. haloperidol


#. A demanding 2$-year-old woman begins psychotherapy stating that she is both desperate and bored. ,he
reports that for the past $ or ' years she has e"perienced periodic an"iety and depression and has made seeral
suicidal gestures. ,he also reports a ariety of impulsie and self-defeating behaiors and se"ual promiscuity. ,he
wonders if she might be a lesbian! though most of her se"ual e"periences hae been with men. ,he has abruptly
terminated two preious attempts at psychotherapy. *n both cases she was enraged at the therapist because he was
unwilling to prescribe an"iolytic medications. 7hich of the following is the most li)ely diagnosis%

a. +ysthymia
b. >istrionic personality disorder
c. Antisocial personality disorder
d. 8orderline personality disorder
e. *mpulse control disorder not otherwise specified


10. A 30-year-old woman is diagnosed as bipolar. At the same time that this illness is diagnosed! it is discoered
that she is pregnant. 7hich of the following drugs has the highest ris) to the fetus if used%

a. 4alproic acid
b. Eithium
c. .hlorproma-ine
d. >aloperidol
e. ?luo"etine
115 fie days after an uneentful cholecystectomy!an asymptomatic middle aged woman is found to hae a
serum leel of 12$ m;D1E. which of the following is the most appropriate management strategy for this patient%

a.Administration of hypertonic saline solution
b.Aestriction of free water
c.Plasma ultrafiltration
d.>emodialysis
e.Aggressie diuresis with furosemide


125 patient with a nonobstructing carcinoma of the sigmoid colon is being prepared for eectie resection .
7hich of the following reduces the ris) of postoperatie infectious complications%

a.A single preoperatie parenteral dose of antibiotic effecti e against aerobes and anaerobes
b.Aoidance of oral antibiotics to preent emergence of .lostridium duffucile
c.Postoperatie administration for (8 h of parenteral antibiotics effectie against aerobes and anaerobes
d.Postoperatie administraion of parenteral antibiotics effectie against aerobes and anaerobes until the patient&s
intraenous lines and all other drains are remoed
e.Aedosing of antibiotics in the operating room if the case lasts for more than 2 h


135 '8 year old man is admitted to the coronary care unit with an acute myocardial infraction.>is
postinfraction course is mar)ed by congestie heart failure and intermittent hypotention .3n the fourth day in
hospital!he deelops seere midabdominal pain.3n physical e"amination!blood pressure is #01'0 mm >g and pulse is
110 beats per minute and regularOthe abdomen is soft with mild generali-ed tenderness and distention.8owel sounds
are hypoactie:stool >ematest is positie.
7hich of the following is the most appropriate ne"t step in this patient&s management%

a.8arium enema
b.Gpper gastrointestinal series
c.Angiography
d.Gltrasonography
e.*mmediate celiotomy


1(5A '$ year old manundergoes a low anterior resection for rectal cancer. 3n the fifth day in hospital!his
physical e"amination shows a temperature of 3# .2102 ?5!blood pressure of 1$01#0 mm >g!pulse of 110
beats per minute and regular!and respiratory rate of 28 breaths per minute.Acomputed tomografhy 2./5 scan
of the abdomen reeals and abscess in the pelis.
7hich of the following most accurately describes his present condition%

a.,,i-surgical site infection
b.,epsis
c.,ere sepsis
d.,ptic shoc)
e.,ere septic shoc)


1$5A cirrotic patient with abnormal coagulation studies due to hepatic synthetic dysfunction reDuires an urgent
cholecystectomy. A transfusion of ??P is planned to minimi-e the ris) of bleeding due to surgery.
7hat is the optimal timing of the transfusion%

a5/he day before surgery
b5/he night before surgery
c53n call to surgery
d5*ntraoperatiely
e5*n the recoery room


1'5A (2 year old man sustains a gunshot wound to the abdomen and is in scho).9ultiple units of pac)ed red blood
cells are transfused in an effort to resuscitate him.>e complains of numbness around his mouth and
displays carpopedal spasm and a positie .hoste) sign.An electrocardiogram demonstrates a prolonged 3/ interal.
7hich of the following is the most appropriate treatment%

a5*ntraenous bicarbonate
b5*ntraenous potassium
c5*ntraenuos calcium
d5*ntraenous digo"in
e5*ntraenous parathyroid hormone


105A teenage boy falls from his bicycle and is run oer by a truc).3n arrial in the emergency room2;A5!he is awa)e
and alert and appears frightened but in no distress. /he chest radiograph suggests an air-fluid leel in the left lower
lung field and the nasogastric tube seems to coil upward into the ne"t best step in his management%

a5Placement of a left chest tube
b5/horacotomy
c5Eaparotomy
d5;sofagogastroscopy
e5+iagnostic peritoneal laage


185A '$ year old man who smo)es cigarettes and has chronic obstructie pulmonary disease falls and
fractures the third! fourth! and fifth ribs in the left anterolatral chest. .hest "-ray is otherwise normal.
7hich of the following would be the most appropriate ne"t step in his management%

a5,trapping the chest with adhesie tape
b5Admission to the hospital and treatment with oral analgesia
c5/ube thoracostomy
d5Placement of an epidural for pain management
e5,urgical fi"ation of the fractured ribs


1#5A 3' year old man who was hit by a car presents to the ;A with hypotension.3n e"amination!he has tenderness
and bruising oer his left lateral chest below the nipple.An ultrasound e"amination is performed and reeals free fluid
in the abdomen. 7hat is the most li)ely organ to hae been in6ured in this patient%

a5Eier
b5Hidney
c5,pleen
d5*ntestine
e5Pancreas




205 An 18 year old male was assaulted and sustained significant head and facial trauma.
7hich of the following is the most common initial manifestation of increased intracranial pressure%

a5.hange in leel of consciounsness
b5*psilateral2side of hemorrhage5 pupillary dilation
c5.ontralateral pupillary dilation
d5>emiparesis
e5>ypertension


315 what statement is regarding the treatment of pancreatic carcinoma%

a. is more common in the body of the gland
b. surgery in well slected patients is the most effectie treatment.
c. in case of painless 6aundice the carcinoma is not resecteble.
d. it can be resectble only if locali-ed in body or tail.
e. is associated with diabetes insipidus.


325 3( years old woman with complicated appendicectomy after acute appenditis the biopsy demonstrate a 1 cm
carcinoid tumor. /he best management in this case%

a. hemycolectomy only
b. hemycolectomy with chemiotherapy
c. chemiotherapy only
d. wide resection only
e. no further treatment


335 88 years old with terminal renal failure! coronary disease and brain metastasis complains acute colecistitis.
7hat is the best treatment of the colecistitis in this patient%

a. tube colecistostomy
b. open colecistectomy
c. laparoscopic colecistectomy
d. intraenous antibiotics and colecistectomy
e. lithotripsy and long term bile acid therapy.


3(5 what complication is associated with pancreasectomy%

a. diabetes mellitus
b. hypercalcemia
c. hyperphosphatemia
d. constipation
e. weight gain


3$5 what statement is true regarding hepatic hemangioma%

a. is the most common benign tumor in lier
e. the primary treatment is surgery

3'5 in 0$ years old man with asymptomatic carotid built. what is the best test for is ealuation%

a. transcranial +oppler
b. eco +oppler
c. computeri-ed tomography angiography
d. arch aortogram
e. magnetic resonance angiography.

305 '( years old man with a story of a triple bypass 2 years ago actually treated with thia-ide diuretic and aspirin.
/he correct statement regarding antiplatelet therapy%

a. aspirin is not an effectie antiplatelet therapy
b. antiplatelet wor) mechanism is by enhancing prostaglandin sintesis
d. aspirin is also used for enous thrombosis
e. antiplatelet effect is permanent and last for all platelet life generally around 20-2$ days
385 3' years old man present in ;A with renal colic. A" demonstrate 1.$ cm stone in upper urinary trac).
7hat is best treatment%

a. hydratation and analgesic therapy only is non effectie
b. serial A" are useful to follow the stone
c. it is associated with microematuria
d. after the resolution it is probable a recurrence of another episode of )idney stone.
e. increased leel of 8G= and creatinine are e"pected.


3#5 2$ years old with a painful full penis erection for seeral hours. 7hich of the ne"t statements are true%

a. it can be associated with sic)le disease.
e. it can be treated primarily with surgical corpospongiosal shunt


(05 in '$ years old man what is the best test for differential diagnosis between septic arthritis and gout%

a.white blood cell count
e. ealuation of synoial fluid aspiration.


(1.A '0 years old male was admitted for seere right abdominal pain!body temperature is 30 c.ultrasounography
shows an aconstic shadow in the common bile duct.tis condition is commonly associated with:

a.;leated con6ugated bilirubin
b.;leated uncon6ucated bilirubin
c.decrease in al)aline phosphatase
d.ery high leels of ,<3/ and ,<P/


(2.when choledocholithiasis is suspected by abdominal ultrasound the ne"t most appropriate test or procedure will
be:

a.computed tomography 2./5
b.biliary scintigraphy
c.;ndoscopic retrograde pancreaticography2;A.P5
d.;mergency surgery


(3.a 00 year old man had abdominal ultrasound for the follow up of an abdominal aortic aneurism .the
presence of stones in the gallbladder is indentified.the patient suffers from some low bac) discomfort only! which is
thought to be attributed to the aneurysm. the appropriate ne"t step in managing the gallstones is:

a.obseration
b.laparoscopic cholecystectomy
c.open cholecystectomy
d.ultrasound of gallbladder


((.a (# year old man was the restrained drier in a motor ehicle collision! he decelerated rapidly in order to aoid
hitting another car and swered into a ditch. he complains of chest pain.
which of the following finding on chest I-Aay would be most suspicious for an aortic in6ury%

a.multiple right-sided rib fractures
b.a left pulmonary contusion
c.widening of the mediastinum greater than 8 cm
d.pnemomediastinum
($./he optimal time to gie immuni-ation to patients undergoing electie splenectomy is:

a.at least 2 months before surgery
b.at least 2 wee)s before surgery
c.in the holding area 6ust prior to surgery
d.on the day of discharge from the hospital after splenectomy


('.,pigelian hernias occur:

a.on the lateral border of the rectus abdominis
b.in the lines alba.
c.in the medial wall of the inguinal canal
d.in the femoral triangle
e.in the epigastrium


(0.a 1' year old girl undergoes total colectomy for familial adenomatous polyposis 2?AP5.two years later !there is a (
cm asymptomatic abdominal wall mass in the incision. the appropriate management is:

a.Acourse of decarba-ine and do"orubicin
b.a course of incristine!actinomycin !and cyclophosphamide
c.Aadiation therapy to the area.
d.wide resection of the mass


(8.symptoms of retroperitoneal sarcoma are usually produced by:

a.bleeding into the tumor mass.
b.compression of ad6acent tissue
c.inasion of retroperitoneal organs.
d.metastasis to retropertoneal organs
e.metastasis to retroperitoneal lymph nodes


(#. /wele hours after haing undergone a subtotal thyroidectomy !a 30 year old woman deelops agitation and
difficulty breathing.e"amination reeals tachycardia and anterior cerical swelling. the surgical dressing is dry.
the most appropriate treatment at this point would be immediate:

a.insertion of an orotracheal tube.
b.Ae-opening of the cerical wound
c.determining the serum calcium concentration
d.administration of morphine
e.chest "-ray



$0./he treatment of choice for a 1.8 cm in diameter =0!90 inasie breast cancer in $0 years old women is:

a.lumpectomy alone.
b.lumpectomy!sentinel lymph node biopsy! and radiation.
c.mastectomy with sentinel lymph node biopsy and radiation.
d.mastectomy with a"illary lymph node dissection and radiation




'15 you are inestigating the cause for a patient&s anemia. he is a $0-year-old man who was found to hae a
hematocrit of 2$@on routine ealuation. his hemat ocrit was (0@1 year ago. mean corpuscular olume is 80!mean
corpuscular hemoglobin concentration *s 2$.reticulocyte count is $@.reiew of the peripheral blood smear shows
mar)ed numbers of polychromatophilic macrocdytes. ferritin is 3(0mg1l. what is the cause of this patient&s anemia%

A. defectie erythroid marrow proliferation
8. e"traascular hemolysis
.. intraascular hemolysis
+. iron-deficiency anemia
;. occult gastrointestinal 8E;;+*=<


'25 A 03-year-old man is admitted to the hospital with 3 wee)s of malaise and feers. >is past medical
history is notable only for hypertension controlled with a thia-ide diuretic. >e smo)e one pac) of cigarettes per day
and wor)s as an attorney. >is physical e"amination is notable only for a new systolic heart murmur heard best in the
metral region. >is laboratory e"amination is notable for mild anemia! an eleated white blood cell count! and oc-
casional rad blood cells on clean catch urine. 8lood cul-tures grow ,treptococcus bois and echocardiogram shows a
P1-cm egetation on the mitral ale. 7hat additional ealuation is indicated for this patient%

A. .ollonoscopy.
8. >ead ./ scan.
.. pulmonary embolism protocol ./ scan.
+. Aenal biopsy.
;. /o"icology screen.


'35A healthy '2QyearQold woman returns to your clinic after undergoing routine colonoscopy. findings included
two 1.3Qcm sessile2flat-based5!illous adenomas in her ascending colon that were remoed during the
procedure. what is the ne"t step in management%

A. colonoscopy in 3 month
8. colonoscopy in 3 years
.. colonoscopy in 10 years
+. ct scan in the abdomen
;. partial colectomy
?. Aeassurance

'(5 7hich of the following statements about cardiac to"icity from cancer treatments is true%

a.+o"orubicin-based cardiac to"icity is idiosyncratic and does-independent.
b.Anthracycline-induced congestie heart failure is re-ersible with time and control of ris) factors.
c.9ediastinal irradiation often results in acute peri-carditis during the first few wee)s of treatment.
d..hronic constrictie pericarditis often manifests symptomatically up to 10 years after treatment.
e./he incidence of coronary atherosclerosis in pa-tients who hae a history of madiastinal irradiation is the same as
that in age-matched controls.


'$5/he triad of portal ein thrombosis! hemolysis! and pancytopenia suggests which of the following
diagnoses%

a.Acute promyelocytic leu)emia.
b.>emolytic-syndrome 2>G,5.
c.Eeptospirosis .
d.Paro"ysmal nocturnal hemoglobinuria 2P=>5.
e./hrombotic thrombocytopenia purpura 2//p5.



''5 7hich of the following best describes the mechanism of action of clopidogrel%

A. Actiates antithrombin and inhibits clotting en-ymes.
8. binds to the actiated <P**b1***a receptor on the platelet surface to bloc) binding of adhesie molecules.
.. inhibits cycloo"ygenas 1 2.3I-15 on platelets to decrease production of thrombo"ane A2.
+. inhibits phosphodiesterase to bloc) the brea)down of cyclic adenosine monophosphate2cA9P5to inhibit platelet
actiation.
;. irreersibly bloc)s p2y12 to preent adenosine diphosphate2A+P5-induced platelet aggregation

'05which of the following symptoms is most suggestie of an esophageal mass%

A. ;arly satietly
8. liDuid phase dysphagia only
.. 3dynophagia with chest pain
+. 3ropharyngeal dysphagia
;. solid phase dysphagia progressing to liDuid phase dysphagia

'85which of the following carries the best disease prognosis with appropriate treatment%

A. 8ur)itt&s lymphoma
8. diffuse large 8 cell lymphoma
.. follicular lymphoma
+. mantle cell lymphoma
;. nodular sclerosing >odg)in&s disease

'#5 A (8 year -old woman is admitted to the hospital with anemia and thrombocytopenia after
complaining of profound fatigue. her initial hemoglobin is 8.$ g1dl ! hematocrit 2$.0@! and platelet count
(2!0001ml. her leu)ocyte count is #$(01ml! but 8@ blast forms are noted on peripheral smear. A chromosomal
analysis show a reciprocal translocation of the long arms of chromosomes 1$ and 10! t21$O105!and a diagnosis of acute
promyelocytic leu)emia is made. the induced regimen of this patient should include which of the following drugs:

A. All-trans-retinoic acid2A/AA!or triretinoin5
8. arsenic
.. cyclophosphamide!daunorubicin!inblastin!and prednisone
+. ritu"imab
;. whole-body irradiation

005A $'-year-old patient inDuires about screening for colon cancer. >e has no ris) factors for colon concer! other the
age. 7hich of the following statements is true regarding which screening test you recommend for this patient%

A. $0@ of patients with a positie fecal occult blood testing hae colon cancer.
8. 3ne-time colonoscopy detects more adanced le-sions than one-time fecal occult blood testing with
sigmoidoscopy.
.. Perforation rates for sigmoidoscopy and colons-copy are eDuialent.
+. sigmoidoscopy has not been shown to reduce mortality.
;. 4irtual colonoscopy ia as effectie as endoscopic colonoscopy for detecting P$ mm in si-e. 2

015 A ('-year -old woman presents with new onset ascites and seere abdominal pain : a hepatic +oppler
e"amination reeals hepatic ein thrombosis . she also reports tea colored urine on occasion !particularly in the
morning !as well as recurrent worsening abdominal pain .3n further ealuation !she is found to hae an
undetectable serum haptoglobin !eleated serum lactase dehydrogenase !hemoglobinuria and eleated reticulocyte A
peripheral smear shows no schistocytes .7hat is the most li)ely diagnosis %

A- adenocarcinoma of the oary
8- antiphospholipid syndrome
.- aplastic anemia
+- factor 4 leiden deficiency
;- paro"ysmal nocturnal hemoglobinria
025 A 10-year-old woman presents to the clinic complaining of aginal itchiness and malodorous discharge.,he is
se"ually actie with multiple partners !and she is interested in getting tested for se"ually transmitted diseases .A wet-
mount microscopic is performed !and trichomonal parasites are identified.
7hich of the following statements regarding trichomoniasis is true%

A- a ma6ority of women are asymptomatic
8- no treatment is necessary as disease is self-limited
.- the patient&s se"ual partner need not be treated
+- trichomoniasis can only be spread se"ually
; - tricomoniasis is 100@ sensitie to metronida-ole


035 A 32-year-old man presents with 6aundice and malaise .>e is found to hae acute hepatitis 8 with positie
hepatitis 8 irus 2>845 +=A and ; antigen . 7hich of the following antiiral agents are approed as part of a
therapeutic regimen for mono-infection with hepatitis 8 %

A- efairen-
8- gancicloir
.- lamiudine
+- rimantadine
;- tenofoir


0(5 the most common cause of traeler:s diarrhea is:

A-campylobacter 6e6uni
8- entamoeba histolytica
.- enteroto"igenic ;scherichia coli
+- giardia lamblia
;- ibrio cholera



0$5 *n the inpatient setting !e"tended-spectrum beta-lactamase 2;,8E5-producing gram-negatie infection are most
li)ely to occur after freDuent use of which of the following classes of antibiotics %

A- carbapenems
8- macrolides
.- Duinolones
+- third-generation cephalosporine


0'5 which of the following is true regarding influen-a prophyla"is %

A- patients receiing an intramuscular influen-a accine should be warned of the increased of
<uillain8arre syndrome
8- patients with hypersensitiity to eggs should not receie the intramuscular accine
.- the intramuscular influen-a accine is a lie !attenuated strain of influen-a that is based on isolates from the
preious year&s strains of influen-a A and 8
+- the intramuscular influen-a accine should not be gien to immunocompromised hosts
;- the intranasal spray .Rflu-mistR !is an inactiated irus preparation based on the preious year&s strains of influen-a







005 A patient presents to the clinic complaining of nausea! omiting !crampy abdominal pain !and
mar)edly increased flatus . the patient has not e"perienced any diarrhea or omiting but notes that he has been
belching more than usual and he describes a Rsulfur-li)eR odor when he does so . he returned from a 3-
wee) trip to peru and ecuador seeral days ago and notes that his symptoms began about a wee) ago. <iardiasis is
considered in the differential .7hich of the following is true regarding <iardia %

A- boiling water prior to ingestion will not )ill <iardia cysts
8- <iardia is a disease of deeloping nations Oif this patient had not traelled !there would be no li)elihood of
giardiasis
.- hematogenous dissemination and eosinphilia are common
+- ingestion of as few as 10 cysts can cause human disease
;- lac) of diarrhea ma)es the diagnosis of <iardia ery unli)ely


085 7hich of the following statements is true regarding ulceratie colitis %


0#5 *n a patient with bacterial endocarditis ! which of the following echocardiographic lesions is most to lead to
emboli-ation %

A- $-mm mitral ale egetation
8- $-mm tricuspid ale egetation
.- 11-mm aortic ale egetation
+- 11-mm mitral ale egetation
;- 11-mm tricuspid ale egetation

805 ,eeral family members present to a local emergency room 2 days after a large family summer picnic where deli
meats and salads were seered . /hey all complain of profuse diarrhea !headaches !feers !and myalgias ./heir
symptoms began S2( h after the picnic . *t appears that eeryone who ate Aunt ;mma&s bologna surprise was afflicted
.Aoutine cultures of blood and stool are negatie to date .
7hich of the following is true regarding Eisteria gastroenteritis %

A- antibiotic treatment is not necessary for uncomplicated cases
8- carriers are asymptomatic but can easily spread infection ia the fecal-oral route
.- gastrointestinal illness can result from ingestion of single organism
+- illness is to"in-mediated !and organisms are not present at the time of infection
;-person-to-person spread is a common cause of out-brea)s

815 A 1#-years-old woman comes to your office after being bitten by a bat on the ear while camping in a primitie
shelter .she is unable to produce a accination record. 3n physical e"amination ! she is afebrile and appears well .
/here are two small puncture mar)s on the pinna of her left ear .
7hat is an appropriate accination strategy in this conte"t %

a.*ntraenous ribairin
b.=o accination
c.Aabies immunoglobulins
d.Aabies inactiated irus accine
e.Aabies inactiated irus accine plus immunoglobulins

825 *n a patient who has undergone a traumatic splenectomy! what test can be ordered to establish lac) of splenic
function %

a../ scan of abdomen
b.=eutrophil migration studies
c.Peripheral blood flew cytometry
d.Peripheral blood smear


835 A person with lier disease caused by ,chistosoma ansoni would be most li)ely to hae:

a.ascites
b.esophageal arices
c.gynecomastia
d.6aundice
e.spider nei


8(5 7hich of the following represents an emergent 2same day5 indication for cardiac surgery in a patient with
infectie endocarditis %

a..ulture-proen fungal endocarditis
b..ulture-proen resistant organism with septic pulmonary emboli
c.Prosthetic ale endocarditis ( months after surgery
d.,inus of 4alsala abscess ruptured into right heart
e.,taphylococcus lugdunensis in a patient with preious history of endocarditis


8$5 A 30-years-old female is seen in the clinic before undergoing an esophageal dilation for a stricture. >er past
medical history is notable for mitral ale prolapse with mild regurgitation. ,he ta)es no medications and is allergic to
penicillin. >er physician should recommend which of the following%

a..larithromycin $00 mg P3 1 h before the procedure
b..lindamycin ($0 mg P3 1 h before the procedure
c.4ancomycin 1 g intraenously before the procedure
d./he procedure is low-ris) ! and therefore no prophyla"is is indicated
e.>er alular lesion is low-ris) ! and therefore no prophyla"is is indicated

8'5 A 08-years-old male presents to the clinic complaining that eery time he shaes with a straight ra-or!
he passes out. >is symptoms hae been occurring for the last 2 months. 3ccasionally! when he puts on a
tight collar! he passes out as well. /he loss of consciousness is brief! he has no associated prodrome! and
he feels well afterward. >is past medical history is notable for hypertension and hypercholesterolemia.
>is only medication is hydrochlorothia-ide. 3n physical e"am his ital signs are normal! and his cardiac
e"am is normal with the e"ception of a fourth heart sound. 7hich of the following is the most appropriate
ne"t diagnostic test%

a.,tress echocardiography
b.Adenosine thallium scan
c..omputed tomogram of the nec)
d..arotid sinus massage
e./ilt table test


805 A 30-years-old male with 7olff-Par)inson-7hite syndrome deelops a broad-comple" irregular tachycardia
at a rate of 200 beats per minute. >e appears comfortable and has little hemodynamic impairment. Gseful
treatment at his point might include:

a.+igo"in
b.Amiodarone
c.Propranolol
d.4erapamil
e.+irect-current cardioersion





885 7hich of the following patients meets criteria for the diagnosis of the metabolic syndrome %

a.A man with waist circumference of 110 cm ! wellcontrolled diabetes mellitus with fasting plasma glucose of #8
mg1dE! and blood pressure of 1(010$ mm>g
b.A woman with triglycerides of 180 mg1dE ! waist circumference of 0$ cm ! and polycystic oary syndrome
c.A man with nonalcoholic lier disease ! obstructie sleep apnea ! and blood pressure of 13$1#0 mm>g
d.A woman with high-density lipoprotein 2>+E5 of $( mg1+l ! blood pressure of 12$180 mm>g ! and fasting plasma
glucose of 8$ mg1dE


8#5 7hen treating a patient with a non -,/-segment eleation myocardial infarction 2=,/;9*5! ris)
stratification and timely administration of anti-ischemic and antithrombotic therapies are paramount. ?or a patient
with unstable angina with negatie biomar)ers.
which medication regimen is most appropriate an initial treatment%

a.Aspirin ! beta bloc)er! spironolactone ! >9<-.oA reductase inhibitor 2statin5
b.Aspirin ! clopidogrel ! nitroglycerin ! beta bloc)er! heparin
c.Aspirin ! nitroglycerin ! beta bloc)er! heparin ! glycoprotein **81***a inhibitor
d.Aspirin ! morphine ! o"ygen ! nitrates


#05 7hich of the following associations correctly pairs clinical scenarios and community-acDuired pneumonia
2 . A P 5 pathogens%

a.Aspiration pneumonia: ,treptococcus pyogenes
b.>eay alcohol use: atypical pathogens and ,treptococcus aureus
c.Poor dental hygience: .hlamydia pneumoniae! )lebsiella pneumoniae
d.,tructural lung disease: Pseudomonas aeruginosa ! ,. aureus
e./rael to southwestern Gnited ,tates: Aspergillus spp


#1. 7hich of the following forms of hepatitis does =3/ hae a chronic state%

A5 >epatitis A
85 >epatitis 8
.5 >epatitis .
+5 >epatitis +


#2. 7hich of the following organisms is responsible for the deelopment of pseudomembranous colitis%

A5 ;scherichia coli
85 .lostridium difficile
.5 Pseudomonas aeruginosa
+5 9ethicillin-resistant ,taphylococcus aureus
;5 ;nterococcus faecalis


#3. 7hich of the following medications is used for the treatment of pseudomembranous colitis%

A5 9etronida-ole
85 Amphotericin 8
.5 Hetocona-ole
+5 Acycloir
;5 *ntraenous ancomycin



#(. 7hich of the following statements about diabetic retinopathy is true%

A5 Proliferatie retinopathy is associated with a poorer prognosis than nonproliferatie retinopathy.
85 =onproliferatie retinopathy is associated with neoasculari-ation.
.5 ,ymptoms of retinopathy usually begin with eye pain.
+5 +iabetics should hae eye e"aminations eery 3 years.
;5 Gnfortunately! there is no treatment for diabetic retinopathy


#$.7hich of the following signs and symptoms are associated with ,6ogren&s syndrome%

A5 >epatomegaly! chronic rhinitis! and palmar erythema
85 Heratocon6unctiitis! parotid gland enlargement! and "erostomia
.5 .onfusion! tremors! and peripheral neuropathies
+5 Polycythemia! leu)ocytosis! and negatie rheumatoid factor
;5 >ypere"tensibility of 6oints! iriditis! and glossitis

#'.7hich of the following laboratory results best support the diagnosis of subclinical hypothyroidism%

A5 =ormal /(! low /,>
85 =ormal /(! high /,>
.5 Eow /(! high /,>
+5 =ormal /(! normal /,>
;5 Eow /(! borderline low /,>

#0. A high urinary sodium concentration in the presence of a low plasma osmolality is most closely associated with:

A5 syndrome of inappropriate antidiuretic hormone 2,*A+>5
85 third-degree burns
.5 hyperglycemia
+5 prolonged diarrhea
;5 water oerload


#8.,ide effects of 3-hydro"y-3-methylglutaryl coen-yme A 2>9< .oA5 reductase inhibitors include:

A5 chronic rhinitis
85 infertility
.5 rhabdomyolysis
+5 orthostatic hypotension
;5 cataracts


##.A 2(-year-old poorly controlled diabetic patient presents to your emergency room with )etoacidosis! feer! pain!
and purulent drainage of the sinuses with blac) eschar formation affecting the nasal septum. /he most li)ely
diagnosis is:

A5 mucormycosis
85 cocaine use
.5 chronic sinusitis
+5 Pseudomonas infection
;5 ,taphylococcus infection





100.A '2-year-old business e"ecutie with a history of migraines is noted to hae hypertensionO otherwise! he
is healthy. 7hich of the following is the best medication for the treatment of his mhypertension%

A5 8eta 8loc)er
85 Angiotensin-receptor bloc)er
.5 Alpha 8loc)er
+5 A.; inhibitor
;5 /hia-ide diuretic
?5 alcohol withdrawal


101. 7hich of the following is an effect of niacin use%

A5 *ncreased E+E cholesterol
85 *ncreased triglyceride leels
.5 *ncreased >+E cholesterol
+5 >ypoglycemia
;5 +ecreased uric acid leels


102. A '0-year-old alcoholic man! currently being treated for gastritis! presents to the office with painful breasts that
appear enlarged. /he most li)ely cause is:

A5 breast cancer
85 e"cessie calcium carbonate ingestion
.5 cimetidine use
+5 trauma
;5 prolactinoma


103. A '0-year-old man presents with pain! swelling! and redness of the first metatarsal phalangeal 6oint. >is
cardiologist recently prescribed hydrochlorothia-ide for his hypertension. /he most li)ely diagnosis is:

A5 podagra
85 degeneratie 6oint disease
.5 rheumatoid arthritis
+5 osteomyelitis
;5 9orton&s neuroma


10(. 7hich of the following alues is acceptable for a '$-year-old man who had a preious coronary artery bypass
graft%

A5 /otal cholesterol of 21$ mg1dE
85 >+E cholesterol of 32 mg1dE
.5 E+E cholesterol of '8 mg1dE
+5 /riglycerides of 228 mg1dE
;5 8lood glucose of 130 mg1dE


10$. A blood urea nitrogen 28G=5: creatinine leel greater than 20 is associated with:

A5 dehydration
85 renal stones
.5 bladder outlet obstruction
+5 hypercalcemia
;5 renal artery stenosis


10'. 7hich of the following is the most appropriate medication for the treatment of hypertension in a diabetic
patient%

A5 8eta 8loc)er
85 A.; inhibitor
.5 +iuretic
+5 .alcium-channel bloc)er
;5 Alpha 8loc)er


100. A '0-year-old woman presents with complaints of diffuse pro"imal muscle pain! low-grade feers! and
generali-ed fatigue. Eaboratory findings include an eleated ;,A and mild anemia.
/he most li)ely diagnosis is:

A5 influen-a
85 dermatomyositis
.5 polymyalgia rheumatica
+5 systemic lupus erythematosis
;5 rheumatoid arthritis


108. 7hich of the following is associated with pseudogout%

A5 .alcium pyrophosphate crystal deposition in the large 6oints
85 Eac) of response with the use of colchicine
.5 >igh uric acid leels
+5 Eac) of response with the use of anti-inflammatory medication
;5 =egatie birefringence seen with polari-ed microscopy

10#. a '$ year old man complains of gynecomastia and galactorhea with erectile dysfunction.
the most li)ely diagnosis is:

a5breast cancer
b5testicular cancer
c5prolactinoma
d5adrenal adenoma
e5diabetes mellitus

110. 7hich of the following conditions is often the first sign of amyloidosis%

A5 Proteinuria
85 .>?
.5 .ardiac arrhythmias
+5 Aheumatoid arthritis
;5 =ight blindness








01.03.2010
Part A:
1. +
2. 8
3. +
(. .
$. +
'. ;
0. .
8. 8
#. +
10. +
11.
12.
13.
1(.
1$.
1'.
10.
18.
1#.
20.
21. 8
22. A
23. +
2(. ;
2$. 8
2'. A
20. 8
28. 8
2#. ;
30. A
31. 8
32. A
33. .
3(. +
3$. 8
3'. +
30. +
38. +
3#. ;
(0. +
(1. A
(2. ;
(3. +
((. ;
($. 8
('. .
(0. ;
(8. +
(#. A
$0. 8
$1. A
$2. +
$3. A
$(. +
$$. +
$'. 8
$0. .
$8. .
$#. 8
'0. .
'1. .
'2. A
'3. +
'(. +
'$. A
''. +
'0. +
'8. .
'#. 8
00. +
01. 8
02. +
03. .
0(. A
0$. +
0'. ;
00. A
08. A
0#. .
80. ;
81. .
82. A
83. .
8(. .
8$. 8
8'. 8
80. ;
88. .
8#. .
#0. +
#1. .
#2. +
#3. A
#(. ;
#$. ;
#'. .
#0. A
#8. .
##. A
100. A
101. +
102. 8
103. .
10(. A
10$. +
10'.
100. ;
108. ;
10#. ;
110. ;







Part 8:
1. A
2. A
3. A
(. +
$. A
'. 8
0. +
8. A
#. +
10. A
11. 8
12. A
13. .
1(. 8
1$. .
1'. .
10. .
18. +
1#. .
20. A
21.
22.
23.
2(.
2$.
2'.
20.
28.
2#.
30.
31. 8
32. ;
33. A
3(. A
3$. A
3'. 8
30. A
38. A
3#. A
(0. ;
(1. A
(2. .
(3. A
((. .
($. 8
('. A
(0. +
(8. 8
(#. 8
$0. 8
$1.
$2.
$3.
$(.
$$.
$'.
$0.
$8.
$#.
'0.
'1. A
'2. A
'3. 8
'(. +
'$. +
''. ;
'0. ;
'8. ;
'#. A
00. 8
01. ;
02. +
03. .
0(. .
0$. +
0'. 8
00. +
08.
0#. +
80. A
81. ;
82. +
83. 8
8(. +
8$. A
8'. +
80. ;
88. A
8#. 8
#0. +
#1. A
#2. 8
#3. A
#(. A
#$. 8
#'. 8
#0. A
#8. .
##. A
100. A
101. .
102. .
103. A
10(. .
10$. A
10'. 8
100. .
108. A
10#. .
110. A