StateExam15.02.

2016
By:AbuAnzehMuhammad

Part A

01. A diagnosis of cystic fibrosis is established in a 3-year-old boy.

What is the pattern of inheritance in this disease?
(A) Autosomal dominant
(B) Autosomal recessive
(C) X-linked recessive
(D) X-linked dominant
(E) Sporadic
02. A term infant is born to a mother who has been using crack cocaine.
This infant is at an increased risk for which of the following pathologies?
(A) Anemia
(B) Intrauterine growth retardation
(C) Hypercalcemia
(D) Macrosomia
(E) Postmaturity
03. A 1-month-old infant presents with fever of 39C and vomiting. A urinary tract
infection is suspected.
Which of the following is the most likely reason for the increased risk of this infant
to contract urinary tract infection?
(A) The mother was colonized with Group B streptococcus
(B) The infant is not circumcised
(C) The infant has prune belly syndrome
(D) The infant has galactosemia
(E) There is a family history of vesicoureteral reflux

04. An 8-year-old child is hospitalized because of paroxysms of severe colicky

abdominal pain. On physical examination there is generalized abdominal
tenderness. An exploratory laparotomy reveals an edematous intestine without
specific lesions. The appendix appears normal but is removed. Postoperatively the
abdominal pain persists, and hematuria develops. Values for BUN and creatinine
are normal. On next day, tender swelling of both ankles and knees is noted.
Which additional findings would most likely be present in this child?
(A) Shock
(B) Meningitis
(C) Hepatitis
(D) A purpuric rash
(E) Hemorrhagic pancreatitis
05. A diagnosis of Werdnig-Hoffman disease in an infant with severe hypotonia.
Which other finding will support this diagnosis?
(A) Normal deep tendon reflexes
(B) Seizures
(C) Fasciculations of the tongue
(D) Recurrent fevers
(E) Atrophy of the optic nerve
06. A 2-year-old Arab child that are first cousin, presents with painful swelling
fingers and toes, Laboratory evaluation reveals hemoglobin of 9 g/dL with white
blood cell count of 11,500 and platelet count of 250,000. Which additional
laboratory test will support your diagnosis?
(A) Skeletal survey
(B) VDRL testing
(C) Bone marrow aspiration
(D) Hemoglobin electrophoresis
(E) Serum calcium measurement

07. An 8-year-old boy is referred for new-onset seizures. Which of the following
would mostly support a diagnosis of complex partial (psychomotor) seizures?
(A) Normal mental state, consciousness, and responsiveness during seizure
(B) A brief tonic-clonic phase
(C) Automatisms
(D) 3-per-second spike-and-wave pattern on EEG
(E) Normal mental state, consciousness, and responsiveness after seizure
08. A38-week infant is born to a mother with gestational diabetes. Birth weight is
4255 g. What would you expect to see most commonly in this infant?
(A) Neural tube defect
(B) Small left colon syndrome
(C) Cardiomegaly
(D) Hydronephrosis
(E) Renal dysplasia
09. A 12-year-old girl develops jaundice, progressive tremors, and emotional
lability. You are most likely to find which of the following during physical
examination?
(A) Head circumference greater than 95th percentile
(B) Brown discoloration of the limbic region of the cornea
(C) Bilateral conductive hearing loss
(D) Generalized lymphadenopathy
(E) Sacral hair tuft and dimple
10. A 10-month-old infant is unable to sit by herself and parents have noticed an
exaggerated startle response. What are you most likely to find on physical
examination?
(A) Holosystolic murmur
(B) Absent knee-jerk reflex
(C) Syndactyly
(D) Cherry red macular spot
(E) Bilateral inguinal hernias

11. An infant has been diagnosed with congenital hypoparathyroidism. Which

finding is most likely revealed in evaluation?
(A) Microcephaly
(B) Hyponatremia
(C) Hyperkalemia
(D) Goiter
(E) Candidiasis
12. In clinical practice is important to determine which type of Diabetes a given
child is likely to have (type I versus Type II) and then to confirm this with
appropriate testing distinguish him a clinical feature of type I diabetes mellitus is
that patients tend to?
(A) Be obese
(B) Exhibit acanthosis nigricans on the neck and axilla
(C) Have a family history of diabetes
(D) Have celiac disease
(E) Have high serum insulin level
13. A 5-year-old girl suffers from a second episode with meningococcal
meningitis. What is the best next laboratory study?
(A) Quantitative immunoglobulin levels
(B) T-cell subset analysis
(C) CH50
(D) Quantitative nitroblue tetrazolium test
(E) Delayed hypersensitivity skin testing
14. A previously healthy 5 years old present with acute onset of edema and
oliguria, laboratory reveal hypoalbuminemia and hypercholesterolemia, a week
after the initiation of oral corticoid treatment the child has abdominal pain and high
fever. Which antibiotic should be given to the child?
(A) 3rd generation of cephalosporin
(B) Amoxicillin
(C) Trimethoprim/Sulfamethoxazole (TMP/SMX)
(D) Azithromycin
(E) Tetracycline

15. A 16-year-old with morbid obesity. Which of the following conditions is the
most common cause for pulmonary insufficiency in obese adolescent?
(A) Pneumothorax
(B) Gastric esophageal reflux disease
(C) Congestive heart failure
(D) Asthma
(E) Sleep apnea
16. A 7-year-old boy has chronic fecal soiling but only rarely has a voluntary
bowel movement. What is the most common explanation?
(A) Hirschsprung disease
(B) Functional fecal retention
(C) Hypothyroidism
(D) Lead poisoning
(E) Iron therapy
17. An infant is born to a mother who acquired primary CMV infection during
pregnancy. What will be the most likely finding in this infant?
(A) Hepatosplenomegaly and jaundice
(B) Subclinical infection
(C) Microcephaly and intrauterine growth retardation
(D) Sensorineural hearing loss
(E) Thrombocytopenia
18. A 14-year-old girl has irregular menstrual bleeding since menarche 1 year ago
what is the most cause?
(A) Immature hypothalamic pituitary ovarian axis
(B) Polycystic ovarian
(C) Blood dyscrasia
(D) Systemic illness
(E) Sexually transmitted disease

19. A 14-year-old boy has an acutely painful and swollen scrotum which action
would be the next step?
(A) FNA
(B) Bone marrow aspiration
(C) Surgical exploration
(D) Oral antibiotic
(E) Bed rest and analgesia
20. A 5-day infant boy has jaundice, the total bilirubin 14 mg and the direct
bilirubin is 4 mg. Which of the following test is the most appropriate for
establishing the diagnosis?
(A) Blood type and direct antibody test on the infant blood
(B) Blood type and direct antibody test on the mother blood
(C) Urinalysis and culture
(D) Hepatitis serology
(E) Examination of infant blood
21. A 5-year-old boy present with acute severe chest pain, ECG and enzyme
studies confirm the diagnosis of acute myocardial infarction, cardiac
catheterization reveals a coronary artery aneurysm with thrombosis, which
constellation of symptoms in the past could explain this finding?
(A) Conjunctivitis, fever, cervical lymphadenopathy
(B) Meningitis, conjunctivitis, pallor
(C) Cervical lymphadenopathy, hepatitis, rash
(D) Fever, irritability, pancreatitis
(E) Hepatosplenomegaly, rash, conjunctivitis
22. A 3-month old infant has persistent stridor since birth. What is the most likely
cause?
(A) Vascular ring
(B) Laryngomalacia
(C) Tracheomalacia
(D) Laryngeal cleft
(E) Subglottic stenosis

23. A 9-year-old child has hematuria and increased serologic titer to

antistreptolysin O. what will be the most likely finding?
(A) Decreased level of serum C3
(B) IgA deposits in kidney biopsy
(C) Decreased serum albumin
(D) Decreased urinary protein/creatinine ratio
(E) Hypercalciuria
24. A 6-year-old girl with short stature has webbing of the neck, a low posterior
hairline, a broad chest and cubitus valgus. Which organ is affected most frequently
in patients with this syndrome?
(A) Heart
(B) Kidneys
(C) Ovaries
(D) Thyroid
(E) Pancreas
25. Which of the following is the usual presentation of an annular pancreas in
childhood?
(A) Hypoglycemia
(B) Hyperglycemic acidosis
(C) Jaundice
(D) Vomiting
(E) Steatorrhea
26. The classic radiologic finding in duodenal atresia is?
(A) A totally gasless abdomen
(B) Free air below the diaphragm
(C) The double bubble sign
(D) The anchor sign
(E) The string sign

27. During the first year of life, birth length increases by what percent?
(A) 25%
(B) 50%
(C) 75%
(D) 100%
(E) 125%
28. A 15-year-old male presents with a 2-day history of fever, chills, and cough.
He complains of aching muscles. Today he noticed his urine was red. Examination
revealed a tired-appearing adolescent with fever, pharyngitis, nasal congestion, and
tender calf muscles. Urine analysis reveals a positive test for hemoglobin with no
red blood cells seen on microscopic examination. Which of the following is most
likely to reveal the source of the red urine?
(A) Detailed dietary history
(B) Renal ultrasound
(C) Intravenous pyelogram
(D) Immunoglobulin levels
(E) Serum creatine kinase
29. A school-age child is examined because of itchy scalp and minute white-gray
structures are noted firmly attached to the hair shafts. Which treatment
recommended?
(A) A selenium-containing shampoo
(B) A 1% permethrin cream rinse
(C) Oral tetracycline
(D) Oral and topical tetracycline
(E) Oral griseofulvin
30. A normal 6-month-old infant has a continuous cardiac murmur and bounding
peripheral pulses. What action should be taken next?
(A) Karyotype evaluation
(B) Surgical or catheter correction of the defect
(C) Life-long endocarditis prophylaxis for at risk procedures
(D) Repeating examination at the age of 12 months
(E) Reassuring of the parents

31. Most nasal polyps in children are due to?

(A) Cancer
(B) Allergic Rhinitis
(C) Immunodeficiency
(D) Cerebrospinal fluid leak
(E) Adenoidal Hypertrophy
32. A 2-day-old, is noted to have tachypnea with weak pulses and grayish cyanosis
of the lips. Oxygen saturations were noted to be 85% and declining. Chest x-ray
shows cardiomegaly and echocardiogram reveals the presence of hypoplastic left
heart syndrome. Considering the patients present condition, which is the best
initial intervention that should be taken?
(A) Give indomethacin
(B) Consult a pediatric cardiologist for surgical options
(C) Start prostaglandin E1
(D) Start phenylephrine
(E) Give oxygen at 100%
33. A 3-year-old girl is examined because of bruising. Her family denies fever or
weight loss but states she had a cold 3 weeks ago. She is afebrile and happy and
playful and has generalized ecchymoses and petechiae. What should be the first
test you obtain?
(A) Bone marrow aspirate
(B) Neisseria meningitides latex assay of the cerebrospinal fluid
(C) Rickettsia serology
(D) Skeletal survey looking for healing fractures
(E) Complete blood count and differential
34. A 15-year-old female has 4-day history of fever and cough. Chest x-ray
findings include bilateral patchy infiltrates. Oxygen saturation is normal. What is
the most likely etiology of her pneumonia?
(A) Streptococcus pneumoniae
(B) Staphylococcus aureus
(C) Mycoplasma pneumoniae
(D) Chlamydophila psittaci
(E) Pneumocystis jiroveci

35. Many children of different ages in your clinic with upper respiratory
symptoms. Which of the following children is most likely to have group A
streptococcal infection?
(A) Exudative pharyngitis in a 1-year-old
(B) Tonsillitis, rash, and fever in a 5-year-old
(C) Cough and pharyngitis in a 15-year-old
(D) Slapped cheek appearance in a 5-year-old
(E) Fever, congestion, cough, and pharyngitis in a 3-year-old
36. A newborn infant has microcephaly, periventricular calcifications, jaundice,
and thrombocytopenia. Which of the following congenital infection is most likely?
(A) Epstein-Barr virus
(B) Cytomegalovirus
(C) Coxsackievirus B
(D) Human immunodeficiency virus
(E) Human parvovirus B-19
37. A mother call and reports that her 4years old son was found playing with an
open bottle of drain cleaner about an hour ago. She tells that he now refuses to
drink and talk but appears alert. You advise the mother to do which of the
following?
(A) Administer syrup of ipecac
(B) Closely observe the child and bring to the ER if condition worsens
(C) Administer activated charcoal
(D) Give the child cold frozen fruit
(E) Immediately bring the child to the ER for evaluation
38. A toddler presents with known ingestion of iron tablets. By Proventil count of
pills remaining in the bottle, it appears that he is vomiting now. Which chelating
agent should be administered?
(A) Deferoxamine mesylate
(B) EDTA
(C) British anti lewisite (BAL)
(D) Hemoglobin
(E) Penicillamine

39. A 4-year-old child has a history of developing a persistent cough for the last 3
weeks. A mycoplasma pneumoniae infection is suspected. Which is the most
appropriate treatment for this child?
(A) Cefuroxime
(B) Chloramphenicol
(C) Erythromycin
(D) Penicillin
(E) Tetracycline
40. What is the most common clinical presentation of infants with unilateral
multicystic dysplastic kidney?
(A) Abdominal mass
(B) Hematuria
(C) Hyperthermia
(D) Nephrotic syndrome
(E) Oliguria
41. A 5-year-old male presents with a 48hour history of headache and
meningismus, evaluation of the CSF reveals clear fluid with normal protein and
glucose content. The CSF cell count reveals 300 WBS. HPF ,90% Lymphocytes
Which is the etiologic agent?
(A) Streptococcus pneumoniae
(B) Haemophilus influenzae
(C) Neisseria meningitides
(D) Adenovirus
(E) Enterovirus
42. A 3-year-old boy present with acute right leg pain and limp. There is no history
of trauma. He holds his right hip in external rotation and flexion. He appears
otherwise well and is afebrile. His WBC is normal and ESR is 25 mm.hr. What is
the treatment option at this time?
(A) Intravenous antibiotics
(B) Surgical drainage of the right hip
(C) Anti-inflammatory drugs and bed rest
(D) Oral antibiotics
(E) Intramuscular steroids

43. A 2-year-old child develops apnea, cyanosis, and loss of consciousness with
repeated generalized clonic jerks after being scolded by his mother, on
examination the child appears completely normal, what is the treatment option?
(A) Tegretol
(B) Valproic acid
(C) Antiarrhythmics
(D) Cardiac pacemaker
(E) Counseling of parents
44. You evaluate an 8-year-old girl with hyperactivity and inattentiveness. Which
of the following manifestation is required to make the Diagnosis of attention
deficit hyperactivity disorder?
(A) Occurrence before the age of 10 years
(B) Concurrent learning disability
(C) Impulsivity
(D) History of birth trauma
(E) A sibling with the diagnosis of ADHD
45. At what age should the tonic neck reflex disappear?
(A) 3 months
(B) 4 months
(C) 68 months
(D) 1216 months
(E) 1720 months
46. The mother of a 2yearold girl wonders if her daughters motor skills are age
appropriate. Which of the following is a motor skill that most 2yearolds have
attained?
(A) Stands on one foot for 10 seconds
(B) Climbs stairs using alternating feet
(C) Pedals a tricycle
(D) Copies a circle
(E) Builds a tower of 810 cubes

47. A woman plans to breastfeed her baby. The most current nutritional
recommendations indicate she should supplement the babys nutrition with which
vitamin?
(A) Vitamin A
(B) Vitamin B
(C) Vitamin C
(D) Vitamin B12
(E) Vitamin D
48. The most accurate method for assessing adiposity in the office setting is which
of the following?
(A) Measurement of weight
(B) Calculation of percent above ideal body weight for height using age/sex norms
(C) Calculation of body mass index (weight/height2)
(D) Measurement of subcutaneous fat thickness
(E) Use of densitometry
49. A 6yearold girl has vomiting, headache and irritability. she does not appear
dehydrated. When reviewing her vitals, you notice her weight is up 3 kg from just
weeks ago. laboratory findings are: Na +112 mEq/L, K +4.0 mEq/L, CL75mEq/ L,
HCO319mEq/L, BUN 10 mg/L and creatinine 0.4 mg/dl. A spot urine sodium
concentration is 100 mEq/L. which is the cause for these findings?
(A) Decreased glucocorticoid production
(B) Decreased mineralocorticoid production
(C) Increased oral intake of water
(D) Decreased antidiuretic hormone secretion
(E) Increased antidiuretic hormone secretion
50. The most common neurological sequelae associated with bacterial meningitis
in children is?
(A) Cognitive impairment
(B) Chronic seizure disorder
(C) Prolonged fever
(D) Impaired hearing
(E) Delay in acquisition of language

51. A 27-year-old woman presents to the emergency room with palpitations and a
hot feeling in her chest. Her medical history is unremarkable and she takes no
regular medications. Attached is the ECG performed at the ER. Which of the
following medications is the drug of choice for this patient?
(A) Digoxin
(B) Propranolol
(C) Amiodarone
(D) Adenosine
(E) Atropine
52. An 80-year-old man presents to the emergency room with severe shortness of
breath. He is known to have heart failure and has been suffering from fever and
cough over the last week. Chest X-Ray reveals multiple infiltrations. Which of the
following implies ARDS rather than pulmonary congestion due to left heart failure
as the source of these infiltrates?
(A) The infiltrates are mainly in the pulmonary hilum
(B) The infiltrates are mainly in the periphery of the lungs
(C) The pulmonary capillary wedge pressure (PCWP) is 12 mmHg
(D) Oxygen enrichment via cannula raises the oxygen saturation from 78% to 97%
immediately
(E) The shortness of breath has appeared and deteriorated over a short time period
53. A 56-year-old man presents to the emergency room with chest pain. which of
the following complaints in the most consistent with a myocardial infarction?
(A) The pain radiates to the right arm
(B) The pain is characterized by a stabbing/electrifying quality
(C) The pain is eased by the leaning forward
(D) The pain radiates to the left arm
(E) The pain lasted less than 15 minutes in continuity

54. A 78-year-old man has been treated with steroids (prednisone at dose of 1
mg/kg body weight) due to a rash and an allergic reaction to a new
antihypertensive drug he has been prescribed. 3 weeks following steroid use a
severe rash (see attached photo) has appeared on his face. Which of the following
is the best treatment for this patient?
(A) Increasing the dose of the prednisone to 1.5 mg/kg body weight
(B) Hospitalizing the patient for IV steroids
(C) Initiating drug therapy for varicella zoster virus (VZV)
(D) Initiating antibiotic therapy aimed at gram negative bacteria
(E) Ceasing steroid therapy immediately and following the rash regression
55. A 50-year-old man presents with cough and mild hemoptysis, which occurred
10 days ago and has resolved. which of the following diagnostic test is most
appropriate for this patient?
(A) Chest X-Ray
(B) Chest CT
(C) Referral for bronchoscopy
(D) Referral for pulmonary function tests
(E) Complete blood count and a coagulation panel
56. When examining a patient in your clinic, you meticulously listen to their heart
sounds. Which of the findings on auscultation always warrants a referral of the
patient for echocardiography?
(A) An early systolic murmur
(B) A diastolic murmur
(C) A mild diastolic grade 2 murmur
(D) A venous hum continuous murmur

57. A 70-year-old man presents to the emergency room with a temperature of

40C and the deterioration of his consciousness level. physical examination
reveals nuchal rigidity and hemiparesis. A working diagnosis of the meningitis is
established. Which of the following is the most correct order of actions to be
performed next?
(A) Drawing blood for cultures and initiating antimicrobial treatment prior to
performing a head CT.
(B) Drawing blood for cultures and performing a lumbar puncture due to the
urgency of the treatment a head CT may be omitted.
(C) Antimicrobial treatment by initiated, there is no need for a head CT due to the
certainty of the diagnosis.
(D) There is no need for blood cultures prior to the initiation of antimicrobial
treatment. Only CSF culture
58. A 70yearold man is hospitalized for workup of a febrile illness. he has had a
splenectomy a year before due to immune thrombocytopenia idiopathic (ITP). A
blood smear revealed Howell jolly bodies. Which of following sentence is most
correct regarding this patient?
(A) This patient has a 60-fold increased risk for sepsis as compared to the general
population.
(B) 5 years following his splenectomy his risk for sepsis equals the risk of the
general population
(C) If the diagnosis is pneumonia, pneumococcal pneumonia is not likely to be the
infections pathogen
(D) Klebsiella pneumoniae is the most common pathogen causing infectious
disease in these patients
(E) Since the splenectomy was performed due to ITP the patient is not at an
increased risk for sepsis.

59. A 60-year-old man was admitted due to a clinical and radiologic community
acquired pneumonia. Zinat (cefuroxime, 2nd generation cephalosporins) treatment
was initiated by the treating physician.
Which of the following pathogens is not covered by this antimicrobial agent?
(A) Streptococcus group A
(B) Streptococcus pneumoniae
(C) Haemophilus influenzae
(D) Chlamydia pneumoniae
(E) Neisseria gonorrhoeae
60. A patient with a diagnosis of community acquired pneumonia is admitted to the
ward. prior to treatment there are several optional diagnostic steps. Which of the
following sentences is true regarding the diagnostic workup of this patient?
(A) If the pathogen causing the patient's pneumonia is streptococcus pneumoniae
the rate of positive blood cultures is over 70%
(B) For a reliable sputum culture there needs to be more than 100 squamous cells
and less than 10 neutrophils in the collected sputum
(C) A high level of procalcitonin protein in the blood points to a virus as the
causative agent
(D) A cavitation in the upper lung fields raises suspicion for tuberculosis and
sputum should be sent for Ziehl Neelsen testing
(E) If coxiella Burnetii (Q fever) is suspected as the causative agent of the
pneumonia, it is easily isolated from blood cultures
61. In many cases hospitalization of patients with febrile illnesses requires
considering the possibility of Infective endocarditis. This disease has multiple
symptoms and signs. Which of the following signs or symptoms is the most rare
(less than 1 %) in infective endocarditis?
(A) Stroke like neurological disorders
(B) Bleeding of the nail bed
(C) Unilateral hearing loss
(D) Glomerulonephritis
(E) Diffuse musculoskeletal pain

62. A 70 years old man has returned, ahead of time, from a prolonged visit to third
world country due to diarrhea over the last 2 days. Which of the following
sentences is the most correct regarding this patient?
(A) The most common causative agent for travelers diarrhea is salmonellas
(B) Recommended antimicrobial agent for treatment of traveler diarrhea is
Augmentin
(C) One should avoid at all cost adding loperamide to antimicrobial treatment
(D) Travelers diarrhea is the most commonly with a short duration and selfresolving
(E) Parasitic infection with schistosomiasis is common cause for acute diarrhea in
traveler to 3rd world country
63. A 80-year-old man lives in a nursing home he has completed antibiotic
treatment for UTI a week ago and now present with diarrhea more than 15
stool/day without vomiting the stool doesn't contain blood and complete blood
count reveals pounded leukostasis 20.000 WBC. Which of the following is most
likely causative agent?
(A) Escherichia coli
(B) Shigella sonnei
(C) Clostridium difficile
(D) Streptococcus pneumoniae
(E) Chlamydia trachomatis
64. A 73-year-old man is admitted with severe hip pain and fever and chills over
the last 2 weeks an X-Ray reveal damage to the bone tissue and sequestrum in light
of these finding. Which of the following is the most likely causative agent to
patient disease?
(A) Candida albicans
(B) Staphylococcus aureus
(C) Staphylococcus epidermidis
(D) Pseudomonas aeruginosa
(E) Haemophilus influenzae

65. 40 years old woman lives in Israel, she has not left country over the last 2
years, presented to ER due to febrile illness, headache, rash on body over last
week. Laboratory results: thrombocytopenia and elevated liver function tests. You
suspect infection disease. Which of the following will point you to specific
diagnosis?
(A) Patient has severe dysuria
(B) Patient was bit by tick 1 week ago
(C) Patient lost 30kg over last 6 months
(D) Patient has been experiencing hair loss over the last 3 days
(E) Patient has been experiencing epigastric pain over the last 2 weeks
66. A 30 years old man present with febrile illness of 2 weeks and cervical
lymphadenopathy. You suspect infectious mononucleosis. Which of the following
laboratory results is the most consistent with diagnosis?
(A) CBC reveals over 10 000 neutrophils
(B) Biochemistry reveals deterioration of renal functions
(C) Over 10% atypical lymphocytes are demonstrated in peripheral blood smear
(D) Thrombocytosis over 400.000
(E) CBC reveals over 1500 Eosinophils
67. Which of the following patient is at highest risk for CMV infection?
(A) Lung transplant patient with pneumonia, 3 months after transplantation
(B) Kidney transplant patient with pneumonia, 6 months after transplantation
(C) Patient with AIDS and CD 4 count of 350
(D) Patient with colitis one-week post bone marrow transplantation
(E) Hypertensive patient with new onset colitis
68. A 70 years old man treated with high dose steroids for many years, admitted to
hospital due to cough over last month, shortness of breath and room air saturation
80%, auscultation of lungs reveal few crepitations and on chest X-Ray billet lung
infiltrations. Next diagnostic procedure is?
(A) No need for work up, anticoagulant treatment should be initiated immediately
(B) An open lung biopsy in order to diagnose interstitial lung disease
(C) Sputum culture for fungi, clinical presentation is consistent with aspergillus
infection
(D) Performing BAL, sending extracted fluid for pathological staining
(E) Antimicrobial treatment after sending sputum for culture and biochemistry

69. Some diseases are not regarded as infectious diseases, even though their
development is associated with specific pathogens. Which sentences describes
such an association?
(A) CMV infection is associated with large % of small intestine sarcomas
(B) HSV 8 is associated with some of Kaposi s sarcoma cases
(C) HPV is associated with large % of gastric carcinoma
(D) Helicobacter pylori is most probably associated with the large portion of head
and neck tumors
(E) Staphylococcus aureus positive culture raises the suspicion of a large intestine
malignancy
70. A 50 years old man presents with a febrile illness followed by a rush. His
family history is positive for deficiency of late components of the complement
system. Which of the following pathogens would you suspect in this patient?
(A) Staphylococcus aureus
(B) Rubella
(C) Neisseria meningitides
(D) Chlamydia trachomatis
(E) HIV
71. A 70 years old man is hospitalized with new onset of hearing loss. He has been
taking a new antimicrobial agent for last 3 weeks. Which of the following
antibiotics could cause this problem?
(A) Ciprofloxacin
(B) Amikacin
(C) Amoxicillin
(D) Chloramphenicol
(E) Augmentin
72. A 28 years old woman with SLE is hospitalized for nephrologic work up.
Which of the following urinary findings is most consistent with diffuse
proliferative glomerulonephritis?
(A) 3g of urinary protein and no RBCs
(B) 1g of urinary protein/24h with microscopic hematuria
(C) WBC casts
(D) Oxalate crystals
(E) Finding of RBC and WBC

73. A 60 years old woman presents with joint pain and dry sensation in her mouth
and eyes. Which of the following autoantibodies are most likely to be positive in
this patient?
(A) Anti SSA/Ro
(B) Anti mitochondrial antibodies
(C) Anti CCP
(D) Anti RNA polymerase 3
(E) Anti SM
74. A 23 years old woman presents with malaise and weight loss over last 2
months. Her physician found weak right radial pulse and murmur over right
subclavian artery. Which disease is most consistent with these findings?
(A) SLE
(B) Giant cell arteritis
(C) Takayasu arteritis
(D) EBV
(E) Microscopic polyarteritis
75. A 80 years old man with history of renal failure and elevated serum creatinine
(2mg/dl), hypertension, diuretic treatment, present to ER with swelling, pain and
erythema of the base of first toe. Which is recommended treatment in this case?
(A) High dose colchicine on regular basis
(B) Initiating treatment with allopurinol only at this point
(C) Local steroid injection to aching joint
(D) High dose NSAIDs for 2 weeks
(E) Since this is most likely adverse effect of ACE inhibitor, the drug should be
ceased immediately
76. Which of the following patients is most likely to have rheumatoid arthritis?
(A) 30 years old man with pain and swelling of both knees and ulcers in mouth and
genitals
(B) 55 years old woman with pain and swelling of both hands
(C) 30 years old woman with acute renal failure and hand pain
(D) 45 years old woman with swelling of hands, ulcers at fingertips, thickening of
finger skin
(E) 60 years old woman with swelling of hand and feet palms, and lung and
subcutaneous nodules

77. A 30 years old woman complains of 3 months of joint pain, prolonged morning
stiffness and swelling of the hands. Laboratory results revealed normal CRP and
significantly increased anti CCP titer. Which of the following treatment is the most
appropriate first line of treatment for this patient?
(A) CRP is normal, hence there is no need for treatment
(B) Because this is a young patient ANFT inhibitor should be initiated immediately
(C) Hydroxychloroquine (plaquenil) treatment
(D) Methotrexate treatment
(E) Treatment with an anti-interleukin 1 monoclonal antibody such as anakinra
78. During your shift in the emergency room a patient with pulmonary edema due
to an acute myocardial infarct is admitted. He has atrial fibrillation and bedside
echocardiography demonstrates a low ejection fraction. Which of the following is
correct regarding the possibility of using digoxin as therapeutic agent in this
patient?
(A) Digoxin treatment does not improve survival in acute heart failure but does
improve survival chronic heart failure
(B) The combination of an inotropic effect and slowing down the fibrillation rates
makes Digoxin the drug of choice in this case
(C) Digoxin treatment is no longer customary in acute chronic heart failure
(D) Digoxin treatment does improve survival of patients with acute heart failure,
however it is a therapeutic option in patient with atrial fibrillation
(E) . Digoxin is a recommended therapeutic option in heart failure only in patients
with treatment failure on beta blocker and calcium channel blocker
79. A 52 years old male smoker is admitted for diagnostic work up of a pulmonary
lesion seen on X-Ray. Biopsy revealed small cell cancer. Which of the following is
true regarding the prognosis of this disease?
(A) Most of these tumors are not chemotherapy sensitive
(B) Most of these tumors are not chemotherapy sensitive and the 5-year survival is
good
(C) Most of these tumors are not chemotherapy sensitive and still the 5-year
survival is good
(D) Most of these tumors are chemotherapy sensitive and still the 5-year survival is
good
(E) This is a very heterogeneous group of tumors and generalization of their
chemotherapy sensitivity in not possible

80. 41 years old woman diagnosed with breast cancer 3 years ago and has been
receiving hormonal therapy since. she has been experiencing severe back pain over
the last 2 weeks, which raises the suspicion of an epidural space metastasis. Which
of the following is the regarding this suspicion?
(A) This is likely scenario and a spinal MRI should be performed as soon as
possible
(B) Breast cancer does not tend metathesize to the spine hence this is very unlikely
possibility
(C) In the absence of neurological deficits on physical examination the chance of
breast cancer metastasis are slim to none
(D) The diagnostic test of choice for epidural space metastases is CT with IV
contrast
(E) Only if the pain persists for the next two weeks spinal MRI should be
recommended
81. A 81 years old man underwent diagnostic work up for prolonged anemia. The
work up revealed 15 gr/l of monoclonal protein (M protein) in this blood. Bone
marrow biopsy demonstrated 2.5%plasma cell. He is asymptomatic apart from
being weak due to his anemia. The rest of his labs including renal and liver
functions, as well as skeletal X-Rays are normal. Which of the following definition
is the most appropriate for this case?
(A) Monoclonal gammopathy of undetermined significance
(B) Smoldering multiple myeloma
(C) Symptomatic multiple myeloma
(D) Non secretory myeloma
(E) POEMS syndrome

82. A 42 years old complains of prolonged cough. Chest X-Ray revealed

pronounced hilum and laboratory results were significant for mildly elevated liver
function test. After establishing the diagnosis of sarcoidosis was made. Which of
the following describes is the therapeutic concept in these patient?
(A) Systemic steroid therapy should be initiates since liver function test are
elevated
(B) Many sarcoidosis patients do not require any treatment. Systemic steroid
therapy is unnecessary in this case
(C) Cough indicates pulmonary damage, which is uncommon in this disease and
warrants aggressive treatment
(D) Systemic steroid therapy should be initiated and if it fails, next line of
treatment is cytotoxic drugs
(E) Elevated liver function tests are not a part of this disease and this finding
warrants further work up and exclusion of other conditions prior to treatment of
any kind
83. A 28 years old women with prolonged headache had a brain MRI as a part of
her diagnostic work up. MRI revealed a nonfunctioning macroadenoma of the
pituitary gland. Which of the following describes the therapeutic approach in this
patient?
(A) Only follow up with no need for medical or surgical intervention
(B) Referral for transsphenoidal tumor resection
(C) Medical treatment with steroid hormone synthesis inhibitors
(D) Referral to localized to the gland including the tumor
(E)

84. Which of the following lines in the attached table describes the treatment goal
values in a man from type 2 diabetes?
(A) HBA1C <7%, preprandial glucose 80130, postprandial glucose <100, LDL
cholesterol <100, HDL cholesterol >50, triglycerides <150
(B) HBAl <6.5%, pre-prandial glucose 80130, postprandial glucose 100, BP <
140/90, LDL<70, HDL>50, TG<200
(C) HBA1C < 6.5%, preprandial glucose 140180, postprandial glucose <180,
arterial blood pressure <120/80, LDL cholesterol <160, HDL cholesterol >40,
triglycerides <209
(D) HBA1C <7, preprandial glucose 80130, post prandial glucose <180, BP<
140/90, LDL <100, HDL >40, TG< 150
(E) HBA1C<6%, preprandial glucose 140180, postprandial glucose <180, arterial
blood pressure <120/80, LDL cholesterol <70, HDL cholesterol >50, triglycerides
<200
85. A 19-year man with diabetes type 1 has been admitted for investigation of
abdominal pain and nausea over the last week, two days prior to his admission he
stopped eating and therefore has not injected any insulin he is suspected of
developing diabetic ketoacidosis which of the following lab results support this
diagnosis?
(A) Serum bicarbonate 19 meq/l
(B) Serum ph 7.32
(C) Calculated Anion gap is within normal limits
(D) Serum pCO2 is lower than normal
(E) Significant renal function deterioration

86. A 57-year-old woman hospitalized for urinary tract infection complicated by

severe sepsis. During her stay a few electrolytes imbalances including significant
hypomagnesemia are noted. Which of the following is the most appropriate
treatment?
(A) The patient should receive IV magnesium. The dose should be adjusted to
renal function
(B) The patient should received intramuscular magnesium there is no need to
adjust the dose to the patient renal function
(C) There is no need to correct the magnesium levels when the sepsis will surpass
the magnesium will naturally correct itself
(D) The hypomagnesemia should be corrected by oral magnesium. A high dose
should be avoided to avoid severe constipation
(E) If on top hypomagnesemia there is hypocalcemia only magnesium should be
given to the patient and there is no need to add both magnesium and calcium
87. A 49 woman is admitted due to significant hypercalcemia, no similar
electrolyte abnormalities were evident on her routine follow up blood work for the
last year, up until lately, blood work during her hospitalization revealed low serum,
PTH, which of the following diagnosis causing hypercalcemia is the most likely in
this patient?
(A) Primary hyperparathyroidism
(B) Hyperparathyroidism secondary to renal failure
(C) Malignancy associated hypercalcemia
(D) Vitamin D poisoning
(E) Granulomatous disease associated hypercalcemia
88. A 47-year-old woman is admitted for workup of malaise, laboratory
investigations revealed acute renal failure, and urinary examination revealed
eosinophilic sediment, which of the following diagnosis/causes lead to this
patients acute renal failure?
(A) Renal injury due to malignant hypertension
(B) Myoglobinuria associated renal injury
(C) Renal injury due to atheroembolic disease
(D) An autoimmune disease/vasculitis
(E) Prerenal azotemia

89. A 71-year-old man dialysis patient (due to diabetic nephropathy) missed two
dialysis treatments and presents to the emergency with chest pain, and the pain is
relieved by leaning forward and is accompanied by nausea and shortness of breath.
ECG revealed low voltage complexes at the limb probes. Laboratory results
included Na 136 mmol/L, K 5.2 mmol/l, urea 313 mg%, and creatinine 7.7 mg%.
Which of the following is the most urgent treatment and what is its aim?
(A) Hemodialysis in order to decrease serum potassium
(B) Hemodialysis in order to decrease serum urea
(C) Ultrafiltration in order to decrease fluid overload
(D) Hemodialysis in order to decrease serum creatinine
(E) Urgent coronary catheterization
90. A 60 years old man presents at the ER with malaise and feeling of irregular
heart beats. ECG image. Which is the most likely diagnosis?
(A) Normal sinus rhythm
(B) Sinus rhythm with 1 degree AV block
(C) Sinus rhythm with 2 degree AV block (Mobitz Wenckebach phenomenon)
(D) Sinus rhythm with second degree AV block (Mobitz II)
(E) Third degree (complete) AV block
91. Which of the following statements regarding the course and treatment of the
patient with fever of unknown origin (FUO) is true?
(A) The first step is to exclude factitious fever
(B) In contrast to the past, nowadays there is no need to perform a dermal
tuberculin test (Mantua test)
(C) Pet CT imaging have no value, in FUO work ups
(D) A temporal artery biopsy should be performed in every patient over the age of
40 with FUO
(E) The initial blood test of FUO workup should include protein electrophoresis

92. A 44-year-old woman with chronic diarrhea, abdominal pain and weight loss
over the last year. Diagnosis by colonoscopy: mild to moderate ulcerative colitis.
Which is the first line of treatment?
(A) 5ASA preparation
(B) Corticosteroids
(C) Methotrexate
(D) Purine analogues (such asa 6MP)
(E) Anti TNF therapy (infliximab)

93. A 54-year-old man is known to have liver cirrhosis to hepatitis C. He has been
admitted due to a clinical presentation of hepatic encephalopathy, for the fourth
time during the last month. His laboratory work up reveals bilirubin of 4.2mg%,
INR 2.7(without anticoagulation therapy) and he requires repeated parentheses due
to ascites. Which of the following is his cirrhosis by the child pugh grading
system?
(A)
(B)
(C)
(D) Serum creatinine is necessary for calculating the cirrhosis grade
94. A 42-year-old woman has heavy bleeding during menstruation. Her
hemoglobin level is 9.9gr%, ferritin level 8 mg/l, and her blood smear reveals
microcytic hypochromic RBCs. Which of the following sentences describes the
grade of iron deficiency in this patient?
(A) Negative iron balance
(B) Iron deficient erythropoiesis
(C) Iron deficiency anemia
(D) Decreased iron stores core

95. Heparin induced thrombocytopenia (HIT) may develop while using heparin as
anti-coagulation therapy. In which of the following patient that uses (HIT) is the
most likely diagnosis?
(A) The platelet count is 82,000, the patient has been treated with low molecular
weight heparin and suffered a coronary artery thrombosis
(B) the platelet count started decreasing a day after initiating heparin therapy,
concurrently severe calf pain appeared and DVT was diagnosed
(C) A patient with pancreatic cancer, platelet count prior to his admission was
64,000, during his hospitalization he had infectious cholangitis and the platelet
count decreased to 52,000
(D) A patient treated with heparin after hip replacement surgery, platelet count
decreased to 84,000 on the 8th day post heparin initiation
(E) An elderly patient was admitted due to a urinary tract infection, treated with
heparin and developed sepsis,4 days after the initiation of heparin therapy the
platelet count decreased by 30% from the baseline while her body temperature
raised and she became hypotensive
96. What is the most common epidemiologic basis for the following malignant
disease: Burketts lymphoma, cervical cancer, T cell leukemia, hepatocellular
cancer?
(A) These malignancies appear almost exclusively in developing countries
(B) These malignancies are associated with a preceding viral infection
(C) These malignancies develop from a germ cell single mutation.
(D) These malignancies appear exclusively in young patient, under the age of 50
(E) The pathophysiology of these disease is not yet understood

97. In which of the following patient in the care unit non invasive ventilation is not
an appropriate treatment?
(A) A 44-year-old man hospitalized with a clinical presentation of inferior wall
acute myocardial infarct, his systolic blood pressure 80 mmhg and he has
pulmonary edema
(B) A 50-year-old woman hospitalized due to pneumonia, her body temperature is
now 39.8C and he has true chills
(C) An 88-year-old man hospitalized due to sepsis, most probably due to a urinary
tract infection, he was admitted two weeks prior to this in a surgical ward for
diagnostic workup for anemia
(D) A 50-year-old woman hospitalized for observation after being in a motor
vehicle accident as a pedestrian she is now suffering from shortness of breath, most
probably due to ARDS
(E) A 90-year-old man hospitalized with acute confusion most probably due to
pneumonia, he is now regained full cognition but is still not oxygenating well
98. A 78-year-old woman has been admitted to severe diarrhea laboratory results
included ph 7.27, PCO2 40,6 mmhg, HCO3 18.3mmol, NA137meq/l, cl98meq/l.
Which of the following diagnosis is the most appropriate for this patient?
(A) Respiratory acidosis, normal anion gap
(B) Metabolic acidosis, normal anion gap.
(C) Respiratory acidosis, wide anion gap
(D) Metabolic acidosis, wide anion gap
99. A 52-year-old man has had a kidney transplant 3 year ago lately he developed
hypertension, difficult to balance diabetes and osteoporosis, to which of the
following anti-rejection drugs would you attribute these side effect?
(A) Glucocorticoids
(B) Cyclosporine A
(C) Tacrolimus
(D) Azathioprine
(E) Mycophenolate mofetil

100. A 28-year-old has started on a extreme diet and has therefore developed
vitamin deficiency, he is admitted to the psychiatric ward due to depression, and
his work up reveals megaloblastic anemia atrophic glossitis, and increased serum
homocysteine. Which vitamin deficiency would explain these finding?
(A) B1 thiamine
(B) Vitamin A
(C) Folic Acid
(D) Vitamin E
(E) Vitamin C
101. A 36-year-old male was found unconscious on scene following a motor
vehicle accident as a driver, he is rushed to the ER with blood pressure of 70/40
mmhg and 34 breath/min. On physical examination there is distinct tracheal
deviation to the left, breathing sound are absent on the right, and the right chest is
tympanic on percussion, there is also jugular vein distention. What is the next step
in the management of this patient?
(A) Bed side cardiac echocardiography
(B) Chest CT with IV contrast
(C) Intubation and ventilation
(D) Decompression of the chest with a needle
(E) Insertion of two large bore IV and fluid resuscitation
102. A 32-year-old female is brought to the ER following a motor vehicle accident
as a passenger. She is unconscious with equal pupils that respond to light, her
blood pressure is 70/40 mmhg, pulse is 115 beats/min and respiratory rate 20/min.
The abdomen is distended with injury signs and peristalsis is absent. Intubation and
ventilation are performed and 2 liters of IV fluid are administered. The blood
pressure is now 80/40 mmhg and the pulse is 118 beats/min What is the next step
in the management of this patient?
(A) Another 2 liter of IV fluid
(B) Head CT
(C) Exploratory laparotomy
(D) Abdominal CT
(E) Thoracotomy

103. A 20-year-old male is brought to the ER following a fall from 10m. The
patient is unconscious, blood pressure of 100/50 mmhg, pulses 120 beats/min, 6
breath/min. Oxygen saturation of 86% on mask, on examination several
facial cuts and condensed temporal fracture are identified.
What is the most effective method to oxygenate this patient?
(A) Laryngeal mask
(B) Nasotracheal intubation
(C) Needle cricothyroidotomy
(D) Orotracheal intubation
(E) Surgical tracheostomy
104. A 20-year-old male is brought to the ER following a motor vehicle accident as
a driver, upon arrival his blood pressure 90/60 mmhg, heart rate of 125 beats/min.
After 2 liters of IV fluid his blood pressure increased to 110/70 mmHg and the
pulse is now 90 beats/min. He has left upper quadrant abdominal tenderness.
Ultrasound identifies fluid at the splenorenal space. What is the next step in the
management of this patient?
(A) Exploratory laparotomy
(B) Abdominal CT scan
(C) Admission to the ICU
(D) Intubation and ventilation
(E) Diagnostic laparoscopy
105. A 30 years old is brought to the ER following a motor vehicle accident as a
back seat passenger, her blood pressure is 110/80, pulse 0f 90, RR 12 beats/min a
change in which of the following is the first sign of hypovolemia?
(A) Systemic blood pressure
(B) Heart rate
(C) Respiratory rate
(D) Consciousness level
(E) Capillary Refill

106. A 60 years old male referred to the ER due to nausea and increase Abdominal
pain over the last 3h. Past medical history is positive for IHD, PVD, and AF. He is
not treated with anticoagulant due to peptic ulcer bleeding, on admission he seen in
severe pain, temperature 37.9C, BP 140/90, abdominal soft with diffuse
tenderness and decrease peristalsis. What is most appropriate diagnosis?
(A) Bowel Obstruction
(B) Mesenteric Ischemia
(C) Peptic ulcer perforation
(D) Acute cholecystitis
107. 46 years female arrive to the ER because RUQ pain with nausea and vomiting
in the past 12 h, she describes similar episodes in the past occurring following a
fatty meal thats relieved within 2 h. She has DI, Hyperlipidemia. On examination
T.38, Vital sign are stable, RUQ tenderness. Abdominal US revealed Gallstone,
Gallbladder, thickening with wall edema, normal bile duct, normal liver function.
Next Step?
(A) Cholecystectomy within 72 h
(B) ERCP
(C) PTC
(D) HIDA SCAN
(E) Abdominal CT

108. A 40 years female arrived to the ER due to RUQ abdominal pain, temperature
39.6. Vital signs are stable. Abdominal US revealed dilation of CBD with
cholelithiasis, choledocholithiasis. WBC count is 20.000, bilirubin 100, direct
bilirubin 8. Next step in management this Patient on the antibiotic treatment?
(A) ERCP
(B) Laparotomy with stone extraction from common bile duct and
cholecystectomy
(C) Laparotomy cholecystectomy
(D) PTC
(E) Endoscopic US

109. A 75 years old female is admitted to the ER with lower abdominal pain
accompanied by nausea of two days. Her temperature is 37.9 stable vital signs.
Left lower abdominal tenderness. WBC count of 14.000 and CT scan demonstrates
sigmoid diverticula with 5 cm abscess near the sigmoid colon. What the next most
appropriate step?
(A) Broad spectrum IV antibiotics and observation
(B) Broad spectrum oral antibiotics, NPO and observation
(C) Laparotomy with sigmoid resection
(D) Laparotomy with excision drainage
(E) CT guided percutaneous abscess drainage

110. A70 years old female is brought to ER for acute severe diffuse abdominal
pain, nausea. She has hypertension s/p CVA, diabetes, and hyperlipidemia. she has
a fever of 38.2, blood pressure 150/90, pulse 110 beats/minute. On examination the
abdomen is markedly tender. Without peristalsis positive grading and positive
rebound. WBC is 17.000. What is the most likely diagnosis?
(A) Acute pancreatitis
(B) Ruptured aortic aneurism
(C) Bowel ischemia
(D) Acute cholecystitis
(E) Acute appendicitis

Part B

01. A 30 old male is coming to clinic due to pain and swelling over coccyx .no
previous similar episodes. What is the most likely diagnosis?
(A) Perianal abscess
(B) Pilonidal disease
(C) Crohn's disease
(D) Hydradenitis suppurativa
(E) Tumor mass
02. A 56 years old male comes to the ER due to massive bleeding, vomiting. He is
known to have esophageal varices due to liver cirrhosis, on admission BP 100/60,
PULSE 110. Which of the following most appropriate next step in this patient
management?
(A) Octreotide
(B) Endoscopy with varices ligation
(C) Endoscopy with sclerotherapy
(D) Insertion of 2 Large bore IVs and IV fluids
(E) Insertion of Sengstaken-Blakemore tube
03. A 60-year-old male arrives to ER for severe abdominal pain that started 2 hours
prior to his arrival following initial evaluation free air is identified under the
diaphragm on chest X-Ray. The patient is prepared fibrillation for which he treated
with warfarin. His international normalized ratio (INR) is 2.1. What is the most
appropriate treatment in preparation of this patient for surgery?
(A) Red blood cell transfusion
(B) Platelet transfusion
(C) Vitamin k
(D) Whole blood transfusion
(E) Fresh frozen plasma (FFP)

04. A 22 years old male arrives to the ER complaining of abdominal pain for one
week. The pain is located in RLQ and slightly worsening with movement, in the
last 2 days radiate to the back and he has no appetite. On examination temperature
38.2, pulse 110, RLQ tenderness with no peritonitis. Passive extension of the Right
Hip when the patient lies on the left side cause severe abdominal pain, WBC count
16.000 most Diagnosis?
(A) Periappendicular abscess
(B) Tumor of the Cecum
(C) Pyelonephritis
(D) Crohns disease
(E) Diverticulitis
05. A 35 years old female underwent total thyroidectomy for grave's disease one
week ago. She now complains of muscle cramps sinus rhythm with prolonged QT
on ECG. What is the most likely diagnosis?
(A) Hypercalcemia
(B) Hypocalcemia
(C) Hyponatremia
(D) Hypermagnesemia
(E) Hypophosphatemia
06. A 32 years old female comes to clinic complaining of occasional bloody
discharge from the left nipple. There are no breast or axillary masses on
examination. Ultrasound is normal. Which of the following is the most likely
diagnosis?
(A) Fibrocystic change
(B) Fibroadenoma
(C) Intraductal papilloma
(D) Ductal carcinoma in situ
(E) Paget's disease

07. A 45 years old male was involved in an accident 10 years ago and had his
spleen removed he now comes to the ER complaining of high fever, chills and
productive cough. During treatment the patient deteriorates rapidly with decrease
in blood pressure. Which of the following immunization could have prevented this
patient current event?
(A) Influenza virus immunization
(B) Pertussis immunization
(C) Pneumococcal immunization
(D) Up to date antitetanus
(E) Varicella immunization
08. A 60 years old male is admitted to ER for jaundice, he is in no distress and
without any other complaints, vital signs are normal, he has profound jaundice of
the skin and sclera with no other findings. abdominal US demonstrates marked
dilation of the intra and extrahepatic bile ducts with suspected mass of the head of
the pancreas. Which of the following tumor markers is the most specific and
sensitive for this patient condition?
(A) CA 153
(B) CEA
(C) CA199
(D) CA 125
(E) CA 724
09. Which of the following is most common etiology for upper GI bleeding?
(A) Peptic ulcer
(B) Gastritis
(C) Mallory Weiss tears
(D) Dieulafoy's lesion
(E) Gastric malignancy

10. A usually healthy 45 male arrive to ER complaining of severe epigastric pain

that started 1 hour prior to his arrival. On the examination BP135/80 mmhg, pulse
110, T38.5. severe epigastric tenderness with guarding and positive rebound, WBC
18000 hemoglobin 14 lactate 3.5 CXR is given bellow, what is the next step in the
management of this patient?
(A) Abdominal CT
(B) Urgent surgery
(C) Gastroscopy
(D) Gastrografin swallow study
11. A 35 years woman arrived to clinic after she palpated right breast mass. Her
history is negative for any risks factors for breast cancer. Right breast examination
reveals a palpable well defined mass, elastic, mobile, nontender without axillary
lymphadenopathy, breast US demonstrates simple 1.5 cm cyst at the location
where the mass is palpated. What is the next step in the management of the
patient?
(A) Surgical excision of the cyst
(B) Follow up in 6 months
(C) Mammography
(D) Cyst drainage
(E) Gun biopsy
12. A 75 years man comes to clinic with complaints of testicular pain, examination
reveals a right inguinal swelling that protrudes to the scrotum which of the
following hernias is the most characterize by the findings?
(A) Femoral
(B) Spigelian
(C) Direct inguinal
(D) Indirect inguinal
(E) Incisional

13. A 45-year-old male undergoes successful appendectomy for acute appendicitis,

pathology reveals a carcinoid tumor 0.8 cm in the tip of the appendix, no
lymphovascular invasion, and negative resection margins what is the next step in
the management?
(A) Follow up
(B) Chest and abdominal CT
(C) Right hemicolectomy
(D) PETFDG scan
(E) Sandostatin scan
14. A 77 years old male diagnosed with rectal adenocarcinoma 5 cm from the anal
verge, chest CT and abdomen rule out metastasis, transrectal ultrasound
demonstrate tumor that penetrate entire rectal wall with no lymph node
involvement, what next step in management?
(A) Surgical with colostomy, chemoradiation, and resection of rectum
(B) Chemoradiation and then resection of the rectum
(C) Chemoradiation only, no need for surgery
(D) Surgery followed by chemoradiation
(E) Chemotherapy alone, no need for surgery
15. Damage control approach was developed in order to avoid lethal triad. What is
included in this triad?
(A) Renal failure, acidosis, hypocoagulability
(B) Hypocoagulability, hypothermia, acidosis
(C) Thrombocytopenia, hypothermia, acidosis
(D) Liver failure, hypothermia, acidosis
16. In which of the following enteral nutrition is recommended?
(A) Paralytic
(B) Severe short bowel syndrome
(C) High output intestinal fistula
(D) Inflammatory bowel disease
(E) GI obstruction

17. A 85-year-old woman was recently diagnosed with a large gastric tumor at the
antrum, she comes to the ER complaining of multiple vomiting.
What is the expected Acid-Base disturbance on blood gases?
(A) Respiratory Acidosis
(B) Respiratory Alkalosis
(C) Metabolic Alkalosis
(D) Metabolic Acidosis
(E) Combined Metabolic Acidosis and Respiratory Acidosis
18. Which of the following is characteristic following massive blood transfusion?
(A) Hypocalcemia
(B) Hypokalemia
(C) Hypercalcemia
(D) Hypomagnesemia
(E) Hyperphosphatemia

19. A 60-year-old male underwent left colectomy 5 days ago, he now has
temperature of 38, welling and erythema at the surgical site with suspected wound
infection. Which of the following pathogens is expected to be isolated from the
wound?
(A) Staph Aureus
(B) Clostridium
(C) Staph coagulase negative
(D) Streptococcus
(E) Gram negative Rods

20. All of the following are risk factors for developing incisional hernia, Except?
(A) Morbid Obesity
(B) Malnutrition
(C) Ascites
(D) Ischemic Heart
(E) Wound Infection

21. An 84-year-old male underwent right inguinal repair. On the morning after
surgery he complains of right testicular pain and tenderness with scrotal erythema.
What is the next step in the management of this patient?
(A) Pain killers
(B) Doppler ultrasound of the testes
(C) Urgent surgery
(D) Antibiotic treatment
(E) Pressure dressing

22. An 84-year-old male is admitted for elective left inguinal hernia repair. During
surgery a hernia is identified protruding from the posterior wall of the inguinal
canal medial to the inferior epigastric vessels and lateral to the rectus sheath.
Which of the following correctly describes the Hernia?
(A) Indirect Hernia
(B) Direct Hernia
(C) Femoral Hernia
(D) Richters Hernia
23. Which of the following is included in the definition of systemic inflammatory
response syndrome (SIRS)?
(A) Heart Rate >90 beats/min
(B) Blood Pressure <80/40 mmHg
(C) Urine Output <30 ml/h
(D) PO2/F10 ratio <200
(E) Oxygen saturation <90%

24. A usually except obesity, 35-year-old female arrives to the ER complaining of

RUQ pain that started following an especially large meal 24h ago. She complains
of nausea without vomiting, no diarrhea and no urinary symptoms. On physical
examination right upper quadrant tenderness mild leukocytosis, full liver
enzymes are normal. What is the next diagnostic step?
(A) Abdominal Pelvic CT
(B) Endoscopic Ultrasound
(C) Upper Abdomen Ultrasound
(D) Hydroxy Iminodiacetic acid (Hida) Scan

25. A 50-year-old female arrives to the ER with fever 38.4 and right lower
abdominal pain. On physical examination tenderness and peritonitis localized to
the RLQ, Labs are normal except for WBC count of 18.000 abdominal CT scan
demonstrates diverticulitis of the right colon without an abscess, free air, or
contrast Leakage. What is the most appropriate initial management?
(A) NPO, IV fluids and Antibiotics
(B) Colonoscopy
(C) Right Hemicolectomy with end ileostomy
(D) Right Hemicolectomy with primary anastomosis
(E) Fiber Enriched Diet

26. A 60-year-old male underwent colonoscopy following a positive fecal occult

blood test. A right colon polyp was excised. Which of the following polyps has
greatest malignant potential?
(A) 2.5 cm pedunculated tubular polyp
(B) 1.5 cm sessile tubular polyp
(C) 2.5 cm sessile villous polyp
(D) 3 cm hyperplastic
27. Which of the following describes a right colon tumor that is defined as stage 4
by the TNM system?
(A) A tumor that invades an adjacent organ, such as the urinary bladder
(B) A tumor with metastatic spread to regional lymph nodes
(C) A tumor that invades the muscularis propria
(D) A tumor with a single liver metastasis 1 cm in greatest diameter

28. What is the recommended genetic testing for family members of patient with
familial adenomatous polyposis?
(A) Screening for STK 11 gene
(B) Screening for APC gene
(C) Screening for MSH2 and MIH genes
(D) Screening for RET gene

29. A 19-year-old female complains of constipation and sharp pain on defecation

accompanied by mild fresh blood. On examination lateral right anal fissure.
What topical treatment can be offered to this patient?
(A) Calcium channel Blockers (Nifedipine)
(B) Beta Blockers (Metoprolol)
(C) Lidocaine and Steroids
(D) Anal gel containing Botulinum Toxin

30. A 70-year-old female arrives to clinic following and ultrasound guided fine
needle aspiration of a thyroid nodule. The cytology result is positive for
malignancy. All of the following are possible cytology results, Except?
(A) Papillary Carcinoma
(B) Follicular Carcinoma
(C) Medullary Carcinoma
(D) Anaplastic Carcinoma
(E) Melanoma Metastasis
31. A 71 years old man develops dysphagia for both solids and liquids and weight
loss of 10 kg over the past 6 months. He undergoes endoscopy, demonstrating a
distal esophageal lesion and biopsies are consistent with squamous cell carcinoma.
He is scheduled for neoadjuvant chemoradiation followed by an esophagostomy
preoperatively. He is started on total parenteral nutrition, given his severe
malnutrition reflected by an albumin of less than 1 gr/dl. Which of the following is
most likely to be concern initially in starting total parenteral nutrition in this
patient?
(A) Hyperkalemia
(B) Hypermagnesemia
(C) Hypoglycemia
(D) Hypophosphatemia
(E) Hypochloremia

32. A 45-year-old woman is treated for pneumonia with antibiotics, one week later
she arrives to the ED room with nausea and copious diarrhea. She is suspected of
having pseudomembranous colitis. She is afebrile and has no peritoneal signs. She
has a mild leukocytosis. Which of the following is the appropriate initial
management strategy?
(A) Administration of antidiarrheal agent
(B) Exploratory laparotomy with left hemicolectomy and colostomy
(C) Exploratory laparotomy with subtotal abdominal colostomy and ileostomy
(D) Administration of i.v vancomycin
(E) Administration of oral metronidazole
33. A 35-year-old woman with a history of previous right thyroidectomy for a
benign thyroid nodule now undergoes completion thyroidectomy for a suspicious
thyroid mass. Several hours postoperatively, she develops progressive swelling
under the incision, stridor, and difficulty breathing. Orotracheal intubation is
successful. Which of the following is the most appropriate next step?
(A) Fiberoptic laryngoscopy to rule out bilateral vocal cord paralysis
(B) Administration of i.v calcium
(C) Administration of broad-spectrum antibiotics and debridement of the wound
(D) Wound exploration
(E) Administration of high dose steroids and antihistamines
34. A 36-year-old woman presents with palpitation, anxiety and hypertension,
workup reveals a pheochromocytoma. Which of the following is the best approach
to optimizing the patient cooperatively?
(A) Fluid restriction 24 hours preoperatively to prevent intraoperative congestive
heart failure
(B) Initiation of an -blocker 24 hours prior to surgery
(C) Initiation of an -blocker at 1 to 3 weeks prior to surgery
(D) Initiation of a -blocker 1 to 3 weeks prior to surgery
(E) Escalating antihypertensive drug therapy with -blockade followed by
blockade starting at least 1 week prior to surgery

35. A 73-year-old woman presents to the ED room complaining of severe

epigastric pain radiating to her back, nausea and vomiting. CT scan of the abdomen
demonstrates inflammation and edema of the pancreas. A right upper quadrant US
demonstrates the presence of gallstones in the gallbladder. Which of the following
is an important prognostic sign in acute pancreas according to Ranson's criteria?
(A) Amylase level
(B) Age
(C) Total bilirubin level
(D) Albumin level
(E) Lipase level
36. For average risk patients routine cancer screening is recommended for all but
the following disease?
(A) Breast cancer
(B) Colorectal cancer
(C) Cervical cancer
(D) Pancreatic cancer
37. Which of the following is an indication for cholecystectomy in an
asymptomatic patient with an incidental finding of gallstones?
(A) Morbid obesity
(B) Family history of complication and chololithiasis
(C) Porcelain gallbladder
(D) Frequent travel out of the country
38. After a total thyroidectomy the right vocal is noted to be fixed in a paramedian
position. This most likely represents?
(A) Injury to the RLN
(B) Injury to the external branch of the superior laryngeal nerve
(C) Injury to the internal branch of the superior laryngeal nerve
(D) Trauma from endotracheal intubation
(E) Compression from hematoma

39. A tumor staging for most epithelial cancers include all of the following,
except?
(A) Tumor size
(B) Tumor mutations
(C) Nodal involvement
(D) Distant spread
40. Which of the following is the most common malignant tumor in the liver?
(A) hepatocellular carcinoma
(B) Hemangiosarcoma
(C) Metastases
(D) cholangiocarcinoma
(E) Hepatoblastoma
41. A 80 years old male was brought by his family to the ED describing a rapidly
increasing amnesia over the last few weeks. He occasionally soils himself. On
examination he has decreased memory at all ranges decreased mood and describes
hesitation to walk because he fell and was injured several times. What is most
likely to be found on a brain CT?
(A) Ventricular dilatation with signs of frontal lobe compression
(B) General wasting with supra and infra tentorial sulcus dilatation
(C) Diffuse left cerebellar infarct
(D) Caudate nucleus atrophy with lateral ventricle dilatation
(E) Normal brain CT
42. All of the following statement regarding suicide in the elderly are correct
except?
(A) Suicide rates are especially high in this age group compared general population
(B) Most of the elderly who committed suicide discusses prior to the act
(C) a feeling of loneliness is a risk factor for suicide
(D) the elderly do not use violent means to commit suicide
(E) Chronic physical illness is a risk factor for suicide

43. A patient complains that she was transferred to a high level floor at work and
that she cannot take the elevator and therefore floor it is hard for her to get to work.
Which of the following treatment was found most effective to treat this patient?
(A) Dynamic psychological therapy
(B) Behavioral psychological therapy
(C) Dynamic psychological group therapy
(D) Benzodiazepine therapy
(E) SSRI therapy
44. All of the following are monoamine neurotransmitters except?
(A) Glutamic acid
(B) Histamine
(C) Serotonin
(D) Dopamine
45. A 24 years old female with schizophrenia is not responding to risperidone and
is switched to olanzapine. Which of the following side effects is most likely to
decrease her readiness to adhere to the change in therapy?
(A) Hyperarousability
(B) Extrapyramidal symptoms
(C) Cholinergic effects
(D) Weight gain
(E) Tardive dyskinesia
46. Which of the following obsession is most common in patients with obsessive
compulsive disorder (OCD)?
(A) Pathological doubtfulness
(B) Need for symmetry
(C) Thoughts of aggressiveness
(D) Fear of infection
(E) Somatic thoughts

47. What is the most correct definition of type 2 bipolar disorder?

(A) At least one episode of major depressive disorder and at least one manic
episode
(B) At least one episode of major depressive disorder and at least one manic
episode or hypomanic episode
(C) At least one episode of major depressive disorder and at least one hypomanic
episode
(D) At least one depressive episode but not major depressive disorder and at least
one hypomanic episode
(E) At least one mild depressive episode and at least one manic episode
48. All the following are positive symptoms of schizophrenia except?
(A) Tactile hallucination
(B) False thoughts of guilt
(C) Unorganized and bizarre behavior
(D) False thoughts of prosecution
(E) Flattened affect
49. All of the following may be part of serotonin syndrome except?
(A) Hyperthermia
(B) Over responsive reflexes
(C) Myoclonus
(D) Hypotension
(E) Hypertension
50. Which of the following causes the most significant QT prolongation?
(A) Clozapine
(B) Olanzapine
(C) Risperidone
(D) Ziprasidone
(E) Quetiapine

51. Which of the following may be used for treatment of benzodiazepine?

(A) Oxazepam (vaben)
(B) Diazepam (valium)
(C) Clonazepam (clonex)
(D) Zolpidem (stilnox)
(E) Flumazenil (anexat)
52. A 45-year-old male was brought to the ER by his son. The patient is anxious
and has tremor. The son describes "my father drinks alcohol for many years and
today the vodka ran out". The patient is likely to have initial alcohol withdrawal
what symptoms are not likely to be found during the withdrawal process?
(A) Visual hallucinations
(B) Tremor
(C) Seizures
(D) Delirium
(E) Sleepiness
53. All of the following are risk factors for developing delirium except?
(A) Status post orthopedic surgery
(B) Male gender
(C) Multiple drug treatment
(D) Dehydration
(E) Social phobia
54. All of the following are diagnostic criteria for atypical depression except?
(A) Depressed mood towards the evening
(B) Severe insomnia
(C) Significant hypersomnia
(D) Increased appetite and weight gain
(E) Irritability tendency

55. All of the following are types of perception disturbance except?

(A) Hallucination
(B) Illusions
(C) Delusions
(D) Depersonalization
(E) Derealization
56. A highly functional 76-year-old male with no psychiatric historic history is
brought to the ER by his family for deterioration, convergence and decreased
eating and drinking in the last month. He claims that he doesn't remember anything
and that there is no point in life. What is the most unlikely expected finding?
(A) Perseverations
(B) Depressive affect
(C) Self-neglect
(D) Monotonic and decreased talk
(E) Self guilt
57. A 60-year-old female is referred for treatment due to decreased memory,
depressed mood, motoric slow down and indifference. The family describes that
she repeatedly complaints of feeling cold and she has prolonged constipation.
Which of the following will aid in the diagnosis?
(A) Thyroid function tests
(B) Serum sodium level
(C) Lumbar puncture
(D) Serum serotonin level
(E) Brain CT
58. Which of the following therapeutic intervention is least likely to be effective in
a patient with adjustment disorder?
(A) SSRI therapy
(B) Benzodiazepines therapy
(C) Short term psychotherapy
(D) Crisis intervention
(E) Mood stabilizers therapy

59. What is the most appropriate early intervention for a 4 years old child with
autistic spectrum disorder?
(A) Medical intervention with anxiolytic m for behavioral disorder
(B) Speech and language intervention with intensive paramedical therapy
(C) Psychoanalytic psychological therapy intervention
(D) Early intervention with neurological therapy to avoid epilepsy development
(E) No need for early therapy intervention
60. A married 45-year-old male who is sloppy dressed tells the physician that in
the past few months he feels different pains, wakes up many times at night and
there are days that it is hard to get out of bed. during the evening he feels
afterwards, he starts to cry when he admits that in the last few days he missed a
few days of work. he feels very guilty about that. what assessment is not extreme
importance at this first meeting?
(A) Fecal occult blood test because of high suspicion of gastrointestinal tumor
(B) Detailed physical examination to establish the evaluation and work up needed
(C) Ask about suicidal thoughts or plans
(D) Ask his wife about his mental status and function at home
(E) Admit the patient to psychiatry department
61. Which of the following medication does not warrant follow-up
blood test every few months?
(A) Methylphenidate
(B) Clozapine
(C) Risperidone
(D) Lithium
(E) Depalept

62. A 30-year-old male is diagnosed with schizoaffective disorder, with multiple

psychiatric admissions in the past year. He was stable with lithium 1200 mg and
risperidone 2 mg. He calls the psychiatrist on call and tells him that he returned
from a 5 days trip to the desert and there was lack in water. His speech is weak and
blurred. He is trembling and doesn't feel stable when walking. What is
recommended at this point?
(A) Refer and accompany to immediate psychiatric admission
(B) Drink water, take a sleeping pill, lithium and risperidone and come tomorrow
to the psychiatry clinic
(C) Drink water, don't take lithium and risperidone and come tomorrow to the
psychiatry clinic
(D) Refer immediately with escort to the ER for suspected lithium intoxication
(E) Drink water, take lithium but do not take risperidone and come tomorrow to the
psychiatry clinic
63. A patient tells his physician that for the past several years he has to do
everything three times "so that nothing bad will happen". He repeats every pray for
3 times and knocks on wood three times. He tries to avoid it, but his life is
becoming increasingly difficult. Lately he has been asking his kids to make sure
they wash their hands 3 times. At first it did not seem to make sense but now he
got used to this and he thinks it logical. What is the most likely diagnosis?
(A) OCD
(B) Obsessive-Compulsive Personality Disorder
(C) Psychotic state, probably schizophrenia
(D) Cultural belief that is not pathological
(E) Delusional disorder
64. A religions unmarried couple kissed against their religious belief while they
were fully dressed and the female was sexually aroused. Since then she is
convinced that she is pregnant. Several urinal testing were negative and ultrasound
was also negative. She is being lied to and does not understand why. This is a
symptom of?
(A) Obsessive thought
(B) Overvalued idea
(C) Delusion
(D) Emotional guilt response to a forbidden act

65. A mother comes with her 5 years son and worries because since they moved an
apartment he started talking to himself in his room. When she asked him about it,
he told her about Jeff who is coming to play with him when he is sad and he
describes his look and says that he loves Jeff. What is the appropriate intervention?
(A) Reassure the mother, explain it's a normal phenomena and ask of any other
signs of distress
(B) Refer to a psychiatrist due to suspected psychiatric state
(C) Refer to social service evaluation for suspected sexual abuse
(D) Refer to epilepsy evaluation
66. A 35 years old female is taking lithium for a year for a year for bipolar disorder
in the last 3 months her mood is normal, but she complains of significant weight
gain, constipation, tiredness, and cold intolerance. This is most likely due to?
(A) Lithium induced hyperthyroidism
(B) Lithium induced hypothyroidism
(C) Beginning of a depressive episode
(D) Beginning of a manic episode
(E) Lithium induced hyperparathyroidism
67.
(A)
(B)
(C)
(D)
(E)
68. A 72 years old female is referred for evaluation 4 months after her husband
who has advanced Alzheimer's disease was transformed for a nursing home, she
depressed mood, cry a lot, difficult sleep at night and guilt feeling for putting him
in horrible place, she visit him every day and continues with hobbies, spend time
with her grandchild, and active in sport, what is the correct intervention?
(A) Initiating antidepressants for depressed mood
(B) Initiating sleeping pill for sleep distant
(C) Initiating supporting psychological therapy for adjustment disorder
(D) This is normal and no interest need

69. A 22 years old male complains to his physician of difficulty in talking in front
of audience and he cant eat or drink in front of people, he is shy to speak to his
personal manager and even avoids returning products to his store if he is not
satisfied. When he toes store act he blushed and palpitation and shortness of breath
and feel anxiety and mouth is dry. What is preferred psychotherapy for the
diagnosis of social anxiety?
(A) Dynamic to discover origin of social anxiety
(B) Cognitive behavior to gradually exposure to social
(C) Dialectical - Behavioral for coping with the aggressiveness
(D) Supporting for support in various life situations
(E) Art therapy to improve the ability of non-verbal expression
70. A 3 years old child was found playing with baby dolls while mimicking distinct
sexual position between the dolls. The most appropriate response?
(A) No need for intervention, this is normative development phase at this age
(B) The parents at reports this is abnormal behavior
(C) Report to social services of suspected sexual abuse
(D) Discuss with the child if he understands his actions
(E) Punish the child
71. A 24 years old female was brought to the ER following suicide with overdose
diazepam and drink half liter vodka. What is expected response?
(A) Blurred consciousness, slow psychomotor, pinpoint pupils, low blood pressure
(B) Hypotension, fever, sweating
(C) Pruritus, stress, goose bumps, psychomotor restlessness
(D) Blurred conscience, blurred speak, unstable gate, disinhibition
72. Most common neurologically-cognitive side effect seen after electroconvulsive
treatment (ECT)?
(A) Amnesia
(B) Echolalia
(C) Aphasia
(D) Akinesia
(E) Abulia

73. A 12 years old boy has significant behavioral problems at school and home. He
is cheeky and refuse to accept authority, his psychiatrist is debating between
oppositional defiant disorder, OCD and conduct disorder. Which of the following
affirms diagnosis of the conduct disorder?
(A) The boy hoarseness other kids in school
(B) The boy was seen abusing pets
(C) The boy accuses other for his mistake
(D) The boy is angry and lie threshold for frustrated
(E) The boy misses a lot of schooldays
74.
(A)
(B)
(C)
(D)
(E)
75.
(A)
(B)
(C)
(D)
(E)
76.
(A)
(B)
(C)
(D)
(E)

77.
(A)
(B)
(C)
(D)
(E)
78. In which of the following are the ovaries fully resistant to gonadotropin
treatment?
(A) Kallman syndrome
(B) Sheehan syndrome
(C) Asherman syndrome
(D) Fragile X syndrome
(E) Premature ovarian failure
79.
(A)
(B)
(C)
(D)
(E)
80. Which of the following is the most appropriate treatment for 40 years old
woman with endometriosis who wishes to conceive?
(A) GNRH agonist for 6 months
(B) Combined oral contraceptive 12 months
(C) Aromatase inhibitors for 6 months
(D) In vitro fertilization
(E) Laparoscopic ablation and curettage of endometriosis lesions

81. Which of the following is true regarding complications in vitro fertilization?

(A) Increased risk for multiple embryos, but not for ectopic pregnancies
(B) The outcome is identical to that of spontaneous pregnancies including the rate
of multiple embryos
(C) Increased risk of breast and endometrial cancer
(D) Increased risk of premature labor and low birth weight
(E) Significantly increased risk of spontaneous abortion
82. Tahel, a 30 years old woman, wishes to freeze ova for future use. She asks for
information regarding the use of these ova in the future. Which of the following is
true regarding future use of frozen ova?
(A) There are concerns regarding higher aneuploidy rates in the defrosted ova
compared to fresh ova
(B) There are concerns regarding higher birth defect rates in embryos of defrosted
ova compared to fresh ova
(C) There are concerns regarding higher rates of developmental disabilities in
babies born from defrosted ova compared to fresh ova
(D) The survival rate of frozen and defrosted ova is low
(E) Fertilization following defrosting of ova is done by micromanipulation only
83. Which of the following is associated with lower conception rates after
implantation of fresh embryos?
(A) An age of 32
(B) Embryos grade A
(C) Endometrial thickness of 10 mm
(D) Infertility due to endometriosis
(E) Implantation of 2 embryos

84. A married mother of 4 36yearold woman ask for consult regarding

contraception. She has a history of PID has chronic pelvic pain and is a smoker.
Which of the following is true regarding Depot medroxyprogesterone acetate as
contraception?
(A) At the age of 36 years the failure rate is 2 pregnancies per 100 years of use
(B) In smokers this agent increases the rate of ectopic pregnancies compared to
other contraceptives
(C) It decreases the incidence of endometrial carcinoma
(D) If there are pelvic endometrial implants the contraceptive may worsen her pain
(E) Long term use does not influence bone density
85. Which of the following is true regarding the use of Nuvaring (a vaginal ring
secreting estrogen and progesterone) as contraceptive is true?
(A) The failure rate is 2 pregnancies per 100 years of use
(B) It needs to be fitted prior to use
(C) Continuous application is required for efficient use
(D) 10-15% of users may display signs of local inflammation
(E) The active substance is secreted in a fluctuate pattern
86. A 18-year-old has presented after having unprotected sex. Which of the
following is true regarding the efficiency and safety of emergency contraceptives?
(A) A copper intrauterine device may be inserted if the intercourse has taken place
less than 96 hours ago
(B) High dose levonorgestrel is efficient 120 hours after sexual intercourse
(C) High dose combined oral contraceptives use efficient only in the first 48 hours
after intercourse
(D) 5% of women experience gastrointestinal symptoms. When using combined
oral contraceptives for emergent contraception
(E) Levonorgestrel doesn't differ from combined oral contraceptives in means of
gastrointestinal adverse effects

87. Which of the following statements regarding vertical transmissions of HIV is

true?
(A) In the absence of drug therapy for HIV carrier mother transmission rates are
35% during pregnancy and labor
(B) In the absence of drug therapy for the HIV carrier mother transmissions rates
during breast feeding are about 60%
(C) For a given viral load transmission of HIV during a prior delivery increases the
transmissions rates for the current delivery
(D) Every HIV carrier should be offered a cesarian section in order to lower
transmissions rates
(E) During a vaginal delivery, scalp monitoring of fetus is recommended
88. In which of the following is a C-section with classical incision indicated?
(A) The mother has a coagulation disorder
(B) Breech presentation at 26 weeks of gestation
(C) Term gestation, posterior placenta
(D) Term gestation, Breech presentation
(E) CS at 36 gestation weeks
89. In which of the following women is vacuum delivery the most appropriate?
(A) 33 weeks, estimated birth weight 2550 gr
(B) 38 weeks, fully dilated for 2 hours, the fetus has hydrocephalus
(C) 38 weeks, GDMA2, estimated birth weight 3800 gr, occiput posterior
presentation
(D) 39 weeks, GDM, estimated birth weight 4100 gr
(E) 37 weeks, estimated birth weight 3200 gr, spina +2, face presentation

90. A 32-year-old woman presents to the delivery room towards, her first delivery
was by CS due to breech presentation. Her second was a normal spontaneous
vaginal delivery, she is now fully dilated with mild decelerations. Two hours later
massive vaginal bleeding appears and the fetus's head changes from spina +2 to
spina 1. Which of the following is the most appropriate treatment?
(A) Emergency CS under general anesthesia
(B) Spinal anesthesia and CS
(C) Immediate vacuum delivery
(D) Rushing the patient until spontaneous vaginal delivery
(E) Epidural anesthesia to ease the pain
91. A 32 years old woman present to the delivery room in active labor at 38 weeks
gestation, her first delivery was a normal vaginal delivery, her second delivery was
via CS due to placenta previa. Which of the following is the best recommendation
regarding the mode of delivery?
(A) A vaginal delivery is optional if the CS was with a classical incision
(B) A prior CS due to placenta previa in any incision type is a contraindication for
a vaginal delivery
(C) A vaginal delivery trial is possible if the prior CS was with a low horizontal
incision
(D) Given the woman's history her chances of a successful vaginal delivery one
slim, therefore a trial of vaginal delivery is not recommended
(E) The woman should have an immediate CS since she arrived in active labor

92. A primipara 32 years old, 38 weeks gestation is in labor. She has been given
epidural analgesia, 3 hours after full cervical dilatation the fetus's head is at spina
+2, longitudinal suture, and occiput posterior presentation. Fetal heart rate
monitoring is completely normal and you decide to end labor due to prolonged
second stage. Which of the following is true regarding instrumental deliveries?
(A) Shoulder dystocia is more common in vacuum extraction vs forceps
(B) If the mother doesn't have diabetes, instrumental delivery is possible up to a
birth weight of 4500 g
(C) The success rate of vaginal instrumental delivery is higher in vacuum
extraction than forceps
(D) In vacuum extraction there one more maternal, but less neonatal complications
compared to forceps deliveries
(E) Regardless of the estimated birth weight, instrumental deliveries should not be
attempted in women with gestational diabetes
93. A 12 years old woman comes to the clinic with her mother seeking advice
regarding the human papilloma virus vaccine. Which of the following did the CDC
recommend regarding this vaccine?
(A) Not recommended for women over 20
(B) The vaccine is only recommended for women in high risk of contracting HPV
(C) The vaccine is recommended for all girls aged 11-12
(D) Girls that have been exposed to the virus should not be vaccinated
(E) There is no point in vaccinating boys for HPV
94. In which of the following cervical setting applying lugol to epithelial cells in
the schiller test will result in dark color.
(A) Cervical dysplasia
(B) Normal cervical epithelia
(C) Scarring of the cervix
(D) Cervical cyst
(E) Squamous carcinoma

95. A 32 years old woman was diagnosed with cervical intraepithelial neoplastic
CIN III. Which of the following describes her odds of developing cervical cancer
without treatment?
(A) 80-90%
(B) 5-10%
(C) 2-3%
(D) 30-40%
(E) 100%
96. Which of the following is not a risk factor for epithelial ovarian cancer?
(A) Early age at first menstruation
(B) Late menopause
(C) Oral contraceptives
(D) Endometriosis
(E) Caucasians
97. A 61 years old woman presents with abdominal distension over the last couple
weeks. Physical examination reveals massive ascites and pelvic exam
demonstrated a solid fixed mass with 15 cm diameter. Pelvic sonogram revealed a
complex mass of the right ovary with increased blood flow. Chest x ray is normal.
CA125 is 1200 (normal range up to 35). Which of the following is the most
appropriate diagnostic and therapeutic step?
(A) CT scan followed by exploratory laparotomy
(B) Endometrial biopsy
(C) Peritoneal tap
(D) Local irradiation to the pelvis
(E) Combination of radiation and chemotherapy
98. A 52 years old mother of 3 presents with post coital bleeding. Physical
examination reveals an ulcerated mass measuring 5 cm on the cervix. the pelvis
and parametrium are following. What is the best treatment for this patient?
(A) Radical hysterectomy and chemoradiation
(B) Radiotherapy and chemoradiation
(C) Palliative care
(D) Radiotherapy followed by radical hysterectomy
(E) Chemotherapy followed by a radical hysterectomy

99. A 25 years old presents with vaginal swelling and pain, she seems suffering
and her body temp is 38.3. You palpate a swollen painful fluctuating mass of the
posterior third of the labia majora. Which of the following is the most appropriate
immediate treatment of this patient?
(A) Incision and drainage of the mass
(B) Antifungal treatment
(C) Biopsy of the mass
(D) Excision of the mass
(E) Metastasis work up
100. A 25 years old presents with non-itching foul smelling vaginal discharge.
examination reveals grayish foul smelling discharge which increase upon addition
of diluted KOH. Microscopic examination shoes clue cells in vaginal discharge.
Which of the following is the most recommended treatment?
(A) First generation cephalosporins
(B) A single dose 150 mg fluconazole
(C) Vaginal irrigation with intimate soap
(D) Metronidazole
(E) Amoxicillin
101. A 38 years old mother of 3 presents with urine leakage during coughing,
sneezing or laughing. she denies frequency, urgency or burning sensation during
urination. Which of the following is the most appropriate primary treatment?
(A) A TVT strap
(B) Collagen injection to bladder neck
(C) Burch colposuspension
(D) Anticholinergic treatment
(E) Exercise for pelvic floor

102. A 39 years old women presents at the 9th week of her third pregnancy with
hyperemesis. A sonogram revealed a snowstorm image with much irregular uterine
content and no embryonic sac/ -hcG is 200000. which of the following is the best
initial therapeutic step?
(A) Suction curettage
(B) Methotrexate
(C) Misoprostol
(D) Hysterectomy
(E) Expectant management
103. A 19-year-old woman presents to the clinic due to severe vaginal pain and a
burning sensation. Physical exam reveals vesicular lesions at the left labia minora
and vaginal opening. An enlarged inguinal lymph node is palpated. Which of the
following is the recommended therapy for this patient?
(A) Acyclovir
(B) Metronidazole
(C) Cefazoline
(D) Fluconazole
(E) Betamethasone

104. A 26-year-old woman with a history of PID and chronic pelvic pain
undergoes diagnostic laparoscopy. Laparoscopy reveals violin string adhesions at
the hepatic region. Which is of the following is the most likely causative agent for
this patients PID?
(A) Group A streptococcus
(B) Chlamydia Trichomatis
(C) Gardnella Vaginalis
(D) E. Coli
(E) Enterococcus fecalis

105. Which of the following statements describes the current recommendation for
iron treatment during pregnancy?
(A) Iron supplementation should be given during pregnancy only to women with
low ferritin levels
(B) Only anemic women should be supplemented
(C) Supplementation should be given from the third trimester onwards
(D) All pregnant women should be given 30mg of iron regardless of an anemia
diagnosis
(E) Only anemic pregnant women should be given iron

106. A 32-year-old alcoholic female is on her 26th week of pregnancy. Which of

the following are associated risks with maternal alcohol consumption?
(A) Macrosomia and attention deficits
(B) Intra uterine growth retardation and cranio-facial defects
(C) Intra uterine coagulation disorders
(D) Placental abruption and premature labor
(E) Pre-eclampsia
107. A primigravida woman has come from a faraway country and is unsure of her
immunization status. Which of the following statements regarding immunization
during pregnancy is true?
(A) Inactive viral Vaccines should not be given
(B) Flu vaccine is indicated for pregnant women during the flu season
(C) Rubella vaccine is recommended in the first trimester
(D) Diphtheria and tetanus vaccines are contraindicated
(E) The flu vaccine may damage the fetus
108. Which of the following is the most common maternal cause for a small for
gestational age newborn?
(A) Hypertension
(B) Smoking
(C) Malnutrition
(D) Vascular disease
(E) Maternal small body dimensions

109. A 32-year-old woman with SLE is 38 weeks pregnant. She presents with
severe headaches, epigastric pain, and nausea. Physical examination reveals a
distraught patient, blood pressure of 180/112, soft abdomen, and normal fetal
monitor. Urinary protein is +3. Which of the following is the next therapeutic step?
(A) Observation at the high risk pregnancy unit
(B) Administration of Nifedipine to decrease blood pressure
(C) Steroid administration
(D) Administration of Magnesium and prompt delivery
(E) Decreasing blood pressure medically and renal biopsy
110. A 28-year-old woman, 29 weeks pregnant, presents with malaise and decrease
in her fitness level over the last few weeks. She notes occasional palpitations and
transient shortness of breath. Physical Examination reveals a patient at ease with
no signs of distress. She has mild jugular congestion, regular heart signs with a
split of S1 and a blowing mid systolic murmur on the left sternal border. ECG
reveals normal sinus rhythm and QRS axis deviation without signs of ischemia.
Which of the following is the most likely diagnosis?
(A) Aortic stenosis
(B) Aortic insufficiency
(C) Mitral stenosis
(D) Mitral insufficiency
(E) These findings are normal during pregnancy