03.03.

2011
By: Alhag Abu Anzeh Muhammad (baghdats@yahoo.com)
Part A:

1. The most common neurological squela associated with bacterial meningitis in children is:

A. mental retaridation
B. chronic seizure disorder
C. imaired !ision
". imaired hearing
#. beha!ioral disturbance


2. The most common cause o$ !iral meningoencehalitis in children is:

A. An entero!irus
B. %eres simle& !irus
C. An arbo!irus
". dmums !irus
#. A resirator' !irus


3. A 12('ear old girl e&eriences acute monocular blindness o$ 2 da's duration ast medical histor' re!eals that she
has had headaches $or the ast 3 'ears that she cannot charatcerize one brie$ eisode o$ diloia) and one eisode o$
arasthesias o$ the $eet. The eisodes were hot related in time) did non occur in immediate ro&imit' to the
headache) and resol!ed sontaneousl'. *inding o$ h'sical e&amination) including the $unduscoic e&mination) are
unremar+able other than reduced !isual acuit'. The most imortant diagnostic ste is to er$orm:

A. CT scan
B. ,-.
C. A electroencehalogram /##01
". eriheral ner!e conduction test2s
#. A sural ner!e bios'


3. 4hich o$ the $ollowing is the etiolog' in most cases o$ ma'asthenia gra!is5

A. inheritance as a rcessi!e trait .
B. inheritance as an 6( lin+ed trait .
C. ostin$ectious usuall' a$ter either in$luenza orchic+eno&.
". autoimmune disorder
#. idioathic


7. A 3('ear old bo' resents to an urgent care clinic with a 3(da' histor' o$ abdominal ain and di$$icult' wal+ing)
Abnormal $indings include blood ressure o$ 120 890 mm %g .di$$use abdominal tenderness and swelling o$ the
an+les. The most li+el' diagnosis is:

A. :'stemic luus er'thematosus
B. ;awasa+i2s disease
C. <u!enile rheumatoid arthritis
". %enoch(schonlein urura
#. :te!ens(=ohonson s'ndrome




>. A 12 'ear old bo' resents with 1 'ear histor' o$ worsening ol'uria and a 2 to 3 w+ histor' nausea $atigue and
malaise serum creatinine is 3.0 mg dl bicarbonate is 17 mg dl. ?rinal'sis shows seci$ic gra!it' o$ 1.003 trace
leu+oc'tes trace blood and no rotein with 3(7 4BCs er high(ower $ield) 3(7 -BCs er high(ower $ield and no
-BC casts which o$ the $ollowing is the most li+el' diagnosis5

A. acute oststretococal glomerulonehritis
B. chronic interstitial nehritis
C. minimal(change nehritic s'ndrome
". acute interstitial nehritis
#. chronic glomurulonehritis


@. Trisom' 21 is associated with5

A. malrotation
B. endocardial cushion de$ect
C. cle$t alate
". renal disease
#. senson'nural hearing loss


9. 4hat is the most signi$icant comlication arising $rom ;awasa+i disease5

A. coronar' aneur'sms
B. +idne' $ailure
C. gallbladder h'dros
". gastrointestinal bleeding
#. h'ertension


A. 4hich o$ the $ollowing medication grouings most aroriate $or a atient older than 7 'ears with moderate
ersistent asthma5

A. none
B. a dail' low dose inhaled corticosteroid
C. a dail' low dose inhaled corticosteroid and a long acting inhaled beta 2 agonist
". a dail' oral corticosteroid
#. a dail' medium dose inhaled corticosteroid and inhaled nedocromil

10. Periheral ulmonic stenosis atent ductus arteriosus ) retinoat') cataracts) heatoslenomagal')
=aundice and ner!e dea$enss are the clinical mani$estation t'icall' associated with which o$ the $ollowing
congenital de$ects5

A. to&olasmosis
B. s'hilis
C. rubella
". c'tomegalo!irus
#. hi!

11. A newborn has a d'smorhic $eature. The regnanc' was comlicated b' a breach resentation. %e shows
decreases mo!ements) ol'h'dramnios) h'otonia) $lat $ace) $lat occiut) eicanthal $olds and abdominal
distention. The couse o$ this is:

A. Trisom' 13
B. Trisom' 19
C. #dward s'ndrome
". Trisom' 9
#. Trisom' 21
12. An 11 'ear old girl is e&amined because o$ $atigue) arthralgia and malar rash. Baborator' re!els ositi!e
anti nuclear anti bodies. Cou susect :B# .4hat test i$ ositi!e with be the most seci$ic $or diagnose :B:

A. Anti( smith antibodies
B. Anti double strand antibodies
C. Anti hosholiid antibodies
". Anti cardioliin antibodies
#. Antinuclear antibodies


13. An 19 month girls is e&amine because o$ a blood strea+ stools .the stool is
grossl' ositi!e $or hemoccult blood test. :he comlain o$ constiation. 4hat is the most li+el' the diagnosis:

A. Anal $issure
B. Petic ulcer
C. ,allor' 4eiss s'ndrome
". .B"
#. Decrotizing enterocolitis


13. 0alactosemia) a disorder o$ carboh'drate metabolism) is inherited in an
autosomal recessi!e attern .4hat are the ris+ o$ galactosemia in arents who are both carriers o$ the disorder:

A. 100
B. @7
C. 70
". 27
#. 10


17. A 3 'r old resent to the ediatrician with $e!er) allor) anore&ia) =oints ain) etechiae and
heatoslenomegal'. The most li+el' the diagnosis is:

A. Acute l'mgenous leu+emia
B. Acute ,'elogenous Beu+emia
C. <u!enile chronic m'elogenous leu+emia
". Alastic anemia
#. Esteosarcoma


1>. Deonate born at 29 wee+s gestation is now 2 wee+s o$ age. Dasagastric $eeds are started. 39 hours a$ter
starting $eeds the neonate de!elos a distended abdomen) blood' stool) neumatosis intestinalis) and $ree air on
abdomen radiograh. Baborator' studies re!eal thromboc'toenia. The child becomes h'otensi!e. The
most li+el' diagnosis is:

A. intestinal obstructions
B. asiration neumonia
C. malrotation
". necrotizing enterocolitis
#. =e=unal atresia








1@. Cou are called to deli!er' room $or a routine birth. The in$ant cries when the cord is cut. Cou e&amine the child
under the warmer and notice that when he stos cr'ing) his chest hea!es and he turns blue. Cou are unable to ass
the nasogastric tube through the nose $or suctioning. 4hich condition is the most li+el' causing the
in$ants resirator' distress5

A. choanal atresia
B. !ocal cord aral'sis
C. subglottic stenosis
". recurrent lar'ngeal ner!e damge
#. lar'ngeal web


19. A >(monthe old male in$ant resents to the ediatrician with arresting heart rate o$ 70 beat er minute. Ph'sical
e&amination re!eals no rash) and there is no histor' o$ rash. En chest radiograh there is no cardiomegal'. The
$amil' histor' re!eals maternal s'stem luus er'thematosus. 4hich o$ the $ollowing diagnoses is the most li+el' cause
o$ brad'cardia5

A. l'me disease
B. congenital comlete heart bloc+
C. sinus node d's$unction
". cardiom'oath'
#. sinus brad'cardia


1A. A12 month(old in$ant resent with hemoglobin le!el o$ @.7 and hemotocrit 22F the mean coruscular
!olume >7 and the ad=usted reticuloc'te count is 1F . 4hat is the most li+el' cause o$ the anemia in this child5

A. iron de$icienc'
B. chronic disease
C. transient er'throc'toenia o$ childhood
". talassemia
#. ar!o!irus b1A alastic crisis


20. *eeding between >(12 months o$ age characterized b':

A. willing to be $ed b' a stranger
B. struggle $or indeendence
C. the in$ant uses a soon $or $eeding
". oor weight gain re$lectus a disease
#. the in$ant ob=ect to holding a soon


21. 0rowth between > and 12 'ears is characterized b' annual weight and height increments o$:

A. 3.7 +g ) > cm
B. > +g ) 3.7 cm
C. 7 +g ) 10 cm
". 10 +g ) 7 cm
#. 1.7 +g ) 7 cm

22. -egarding resuscitati!e e$$orts in children) the most imortant goal is:

A. restoration o$ age aroriate heart rate
B. aroriate mo!ement o$ the chest wall
C. auscultation o$ equal breath sounds in both lung $ields
". adequate o&'gen deli!er' and utilization o$ the bod' tissues
#. alation o$ equal ulses in all $our e&tremities
23. A A month old bo' is brought to the emergenc' room in lim and unresonsi!e
state. .nitial e&amination shows a ulse rate o$ 37 8min and occasional irregular
breaths. A$ter initiation o$ cr /including tracheal intubation1 deli!ar' o$ o&'gen !ia
ositi!e ( ressure breaths and chest comression ) multile attemts to insert an
intra ( !enous line $ail. The most aroriate ne&t ste in manegment should be:

A. obtain an arterial blood gas samle
B. lace in intraosseous needle and administer $luids and introic agents
C. obtain a GstateG head ct stud' to e!aluate reasons $or unresonsi!eness
". lace transthoracic cardiac acema+er
#. lace a thoracostom' tube to e!acuate a ossible neumothora&


23. The most recommended treatment $or se!ere combined immunede$icienc' is:

A. gene thera'
B. monthl' i! gammaglobulin
C. monthl' i! gammaglob'lin and inter$eron(H/gama1
". monthl' i! gammaglobulin and il(9(monoclonal antibod'
#. stem cell translantation


27. "ela'ed searation o$ the umbilical cord a$ter birth suggests which o$ the $ollowing t'es o$
immune de$icienc':

A. b(cell de$ect
B. t(cell de$ect c1combined b and t cell de$ect
C. hagoc'tic $unction de$ect
". comlement comenent de$icienc'


2>. A 12('r old white girl resent with arthralgia o$ the +nees and elbow and swollen hands o$ > months duration.
:he has intermittent $e!er and has lost @.7 +g in weight. Ether than swollen =oints) $indings on h'sical
e&amination are normal. 3 'ears earlier) she was $ound to ha!e thromboc'toenia and was diagnosed with .TP. .n
addition) one summer) she had se!ere sunburn) and 2 tears ago she had mouth sores. Toda' she has a hematocrit o$
27F) ositi!e combs test) and the urinanal'sis shows multile -BC. The most common li+el' diagnosis is:

A. =u!enile rheumatoid arthritis
B. .TP
C. e!ans s'ndrome
". eriarteritis nodosa
#. :B#


2@. A @7('r old bo' de!elos rogressi!e s'mtoms o$ $e!er) lassitude) arthralgias)
headache and abdominal ain. Ph'sical e&amination shows heatoslenomegall'.
*urther questioning disco!ers that he and his $amil' li!e in a rural area and consume
unasteurized dair' roducts in their diet. The the most li+el' etiologic agent o$ this
illness is:

A. actinom'ces
B. bartonella hensallae
C. brucella
". $rancisella tularensis
#. Cersinia enterocolitica



29. A 7('r old bo' is noted b' the arents to snore at night. The child has also had roblems sta'ing awa+e in
reschool and has had behai!oral roblems. The $ather also snores. Ph'sical e&amination o$ the child re!eals
large) in+) none&udati!e tonsils. The most aroriate ne&t ste is:

A. lar'ngosco'
B. ol'somnograh'
C. ambulator' anea anal'sis
". telemetr'
#. arterial blood gas anal'sis


2A. The aroriate initial thera' o$ se!ere obstructi!e slee anea s'ndrome in a child is:

A. adenotonsillectom'
B. tracheostom'
C. arahar'ngeal muscle surger'
". theoh'lline
#. bilerel ositi!e airwa' ressure



30. A @ months(old girl resent with tem. 39.3 BP @0830mm) di$$use etechia $irst noted 3 hours be$ore
resentation. Platelets count 99)0008mm3) and white blood cell count o$ 33)0008mm3 with 23F neutrohils and
32F bands. The in$ant has recei!ed all recommended !accination. 4hich o$ the $ollowing is the most li+el'
bacterial etiolog' o$ this resentation5

A. stah'lococcus aerus
B. stretococcus neumonia
C. neiserria meningitides
". haemoh'llus in$luenza t'e b
#. coli o 17@:h@


31. A 10 mo(old child resents to the emergenc' deartment with a 3 da' histor' o$ $e!er) with tem. 3A c) and
water' diareea) =ust e&irienced a generalized seziure. 4hat is the most common s'ndrome5

A. :allmonela gastroenteritis
B. Aeromonas gastroenteritis
C. :higella gastroenteritis
". -ota!irus gastroenteritis
#. "rug ingestion


32. A 10 'ears old child rezents to the o$$ice with unilateral con=uncti!itis) that has been resent $or 7 da's. Cou
alate an enlarged eriauricular node on the same side. :he has no histor' o$ recent tra!el) but her $amil'
introduced a +itten aro&imatel' 2 monthes ago. The most li+el' etiologic agent resonsible $or her condition:

A. Borellia burgdor$eri
B. *rancisella tularensis
C. Bartonella hensalea
". :tah'lococcus aureus
#. To&olasma gondii






33. A 2 mo(old in$ant is susected o$ ha!ing in$ant botulism. 4hich is the best means to con$irm the diagnosis5

A. Bumber uncture
B. CT(scan
C. muscle bios'
". electorom'ograh'
#. $ecal secimen


33. 4hich o$ the $ollowing is true5

A. ulcerati!e colitis is t'icall' characterized b' rectal saring
B. crohnIs disease is t'icall' characterized b' s+i lesions
C. ulcerati!e colitis t'icall' in!ol!es the terminal ileum
". ulcerati!e colitis is t'icall' characterized b' transmural disease
#. crohnIs disease is t'icall' characterized b' cr't abscesses


37. A A mo(old in$ant accidentall' ingests un+nown quantit' o$ digitalis. 4hich is the most signi$icant noncardiac
mani$estation o$ to&icit' in this child5

A. $e!er
B. dizziness
C. !omiting
". !isual disturbances
#. urticaria


3>. A12 'ears old bo' comes to the emergenc' deartment at midnight with a comlaint o$ se!ere scrotal ain since @
.m. there is no histor' o$ trauma. 4hich o$ the $ollowing is the most aroriate $irst ste in his management5

A. order surgical consult immediatel'
B. order radioisotoe scan as an emergenc'
C. order urinal'sis and gram stain $or bacteria
". arrange $or an electi!e ultrasound e&amination
#. order electi!e ultrasound e&amination


3@. A > 'r old bo' whose ast medical histor' is ositi!e $or three urinar' tract in$ections) resents with a blood
ressure o$ 1708A0 mmhg. %e is li+el' to e&hibit which o$ the $ollowing s'mtoms or signs5

A. multile cranial ner!e alsies
B. headaches
C. h'ore$le&ia
". increased urinar' outut
#. right !entricular h'ertroh'


39. A > 'r old girl underwent remo!al o$ craniohar'ngioma 3 months re!iousl'. :he is on th'roid relacement
regimen but her mother reorts she is !er' $atigued. The ne&t ste would be:

A. increase the dose o$ her th'roid medications
B. schedule a growth hormone stimulatiom test
C. measure ACT% and cortisol
". obtain ,-. stud' o$ her head
#. measure .0* ( 1 and .0*BP ( 3


3A. "uring routine screening CBC) a 1 'r old child is noted to ha!e ronounced eosinohilia. 4hich o$ the
$ollowing is the most li+el' e&lanation5

A. bacterial in$ection
B. chronic allergic rhinitis
C. helmith in$estation
". tuberculosis


30. A > month old in$ant has been e&clusi!el' $ed a commerciall' a!ailable in$ant $ormula. ?on introduction o$ $ruit
=uices) the child de!elos =aundice) heatomegall') !omiting) letharg') irritabilit' and siezures. Test $or urine reducing
substances are ositi!e. 4hich o$ the $ollowing is li+el' to e&lain the childs condition5

A. t'rosinemia
B. galactosemia
C. $ructose intolerance
". alha 1 anti trisin de$icienc'
#. glucose > hoshate deh'drogenase de$icienc'.


31. 1 mo child is admitted during hot weather a$ter generalized seizure. %ead CT is
normal. *amil' members state that recentl' the' ha!e strated to dilute the child2s
$ormula in order to add water to his diet. ,ost robabl' the seizures was caused b':

A. %'erthermia
B. Child neglect
C. %'ernatremia
". %'onatremia
#. Con!ulsions associated increased temerature


32. All o$ the $ollowing are imortant in the in!estigation o$ tall atients e&cet:

A. *amil' anal'sis
B. Plasma $actor .0*(1
C. %omocustin
". Chromosomal anal'sis
#. Bong $att' acids


33. A 12 ') girl) comlains on muscle crams and tingling in hands and $eet that are not related to e$$ort. 4hen she
grass a door handle she canIt release the gras due to hand sasm. The most imortant lab anal'sis is:

A. Blood glucose determination
B. Blood calcium
C. #,0
". Der!e conduction !elocit'
#. Arterial blood gas


33. A 1> ' girl comlains on headaches $or the ast 13 months) and !isual changes $or the ast 2 wee+s. Dow she
has galactorrhea. Bast menstrual eriod was 3 mo ago. The galactorrhea is most robabl' due to:

A. :tress o$ amenorrhea
B. #le!ated rolactin le!el
C. #le!ated estrogen le!el
". ,igren
#. Adrenal insu$$icienc'
37. 13 ' girl is admitted with !aginal bleeding which is longer and ha!ier then her usual menstruation which is
irregular and started 13 mo ago. :he is ale) tach'cardic. Cour ne&t ste in diagnosis:

A. :tart medro&'rogesteron /ro!era1
B. :tart con=ugated estrogen /remarin1
C. %ct determination
". #strogen le!el determination
#. Platelets nI determination


3>. A A ') girl) was admitted with de!elomental dela' and regression a$ter normal de!eloment until > mo. -esonds
with $ear to loud noise) macrocehalus. En e&amination decresed !isual contact) cheri red sots on retina. The
diagnosis is robabl':

A. Ta' sachs
B. 0oucherIs disease
C. *abr'Is disease
". 0alactosemia
#. 0l'cogen storage disease t'e 1


3@. A 7 mo) rominent motor dela') h'otinia and cardiomegal'. C;(9>0?8.. ".A0DE:.::

A. :inal muscular atroh'
B. %'oth'roidism
C. Prader willi
". PomeIs disease
#. "awn s'ndrome


39. 4hich o$ the $ollowing is an ad!antage o$ s+in tests /:+in ric+ test (:PT1 comared with the -A:T
to identi$' seci$ic .g#5

A. :PT are not in$luenced b' antihistamin administration
B. :ensiti!it' o$ :PT is higher than -A:T
C. :PT are semi quantitati!e
". :PT are associated with low ris+ o$ allergoc reaction
#. :P- are not in$luenced b' dernograhics


3A. 4hich is B#A:T B.;#BC h'sical sign on e&amination o$ child with moderate asthma5

A. Thac'nea
B. 4heezing
C. Clubbing
". "ecresed air conduction on auscultation in right middle lung loe
#. .ncreased size o$ anterio(osterior chest


70. Durse states that a new born bab' girl) 3.7 +g a$ter reeated C(sectionwas breathing hea!il'8hoarsel' a$ter 10
min. A$ter birth) on e&amination there were no hea!' breathing) breathing rate( 3>8min. E2 saturation(A>F. The child
is reacti!e. De&t ste:

A. :esis in!estigation
B. Chest &(ra'
C. Ebser!ation) and i$ the hea!' breathing will start again) hositalization in new born .C?.
". :ur$actant thera'
#. Positi!e end e&irator' ressure through nasal mas+
7>. A @2 'ears old man with acute urinar' retention and blurred !ision a$ter ta+ing antideressions $or 3 da's)
which o$ these medication has these side e$$ects5

A. !enla$a&ina
B. aro&etine
C. buroion
". ne$azodone
#. amitrit'line


7@. A9 'ear(old bo' constantl' cleaning thorat and blin+ing e'es $or 3 wee+s) s'mtoms intermittentl' $or se!eral
'ears. De!er comlete $ree $rom s'mtoms $or more o$ one or two da's. *irst medication in this case:

A. Alrazolam
B. meth'henidrate
C. %aloeridol
". Amitrit'line
#. lithium


79. %ormones is most commonl' used in the ad=u!ant treatment o$ deression:

A. rogesterone
B. cortisol
C. ACT%
". le!oth'rotine
#. Prolactin


7A. A@2 'ear(old with long stor' o$ recurrent s'chotic deression) hositalized during a relase. %e has rostatic
h'ertroh') coronar' heart disease) recurrent orthostatic h'otension. 4hich o$ the $ollowing is the most
aroriate antis'chotic medication $or this atient5

A. chlorromazine
B. clozaine
C. thioridazine
". haloeridol
#. olanzaine


>0. The BJ" actino deend on her interaction with which o$ the $ollowing recetors:

A. 0ABA
B. :erotonin
C. D,"
". "oamine
#. Acet'lcholine


>1. 4hich o$ the $ollowing statements is true about $ire setter5

A. girls and bo's are equall' at ris+ $or athological $ire setting
B. $ire sartated b' children rarel' cause an' serious damage
C. children 'ounger than > are not li+el' to e&eriment with $ire
". the rognosis $or treated children is e&elant
#. a commonl' associated $eature is lower than a!erage .K


>2. Ale&ith'mia is:

A. an unleasant mood
B. a loss o$ intrest in and withdrawal $rom leasurable acti!ities
C. an inabilit' to describe or to be aware o$ emotion or mood
". a normal range o$ mood iml'ing absence o$ deressed or ele!ated emotional state
#. a state in which a erson is easl' anno'ed and ro!o+ated to anger


>3. 4hich o$ the $ollowing drugs is best used to treat acute delirium5

A. chlorromazine/taroct'l1
B. b1diazeam /!alium1
C. haloeridol /halodol1
". amobarbital /am'tal1
#. h'sostagmen salic'late /antilirium1


>3. 4hich o$ the $ollowing is the most common s'mtom attern associated with EC"5

A. obsession o$ doubt.
B. obsession o$ contamination.
C. intensi!e thoughts.
". obsession o$ doubt.
#. comulsi!e hoarding.


>7. ,edical comlication o$ eating disorder related to weight loss include all o$ the $ollowing e&cet:

A. erosion o$ dental enamel with corresonding deca'
B. bra'cardia
C. constiation and dela'ed gastric emt'ing
". abnormal taste sensation
#. osteoorosis


>>. Anore&ia ner!osa has mortalit' rate o$ u to aro&imatel':

A. 1F
B. 19F
C. 30F
". 32F
#. 70F


>@. The $irst s'mtom o$ A"%" to remit as usuall':

A. h'eracti!it'
B. distractibilit'
C. careless mista+es in school wor+
". imulsi!it'
#. learning di$$iculties

>9. 4hen an e&aminer as+s a atient to count bac+wards b' @ starting at 100L:

A. recent memor'
B. remote memor'
C. concentration
>A. A 9 'ear old bo' resent $or a routine !isit) 1 mounth earlier 'ou diagnosed tourette disease and rescribed him
medications. %e and his arents reorted that the medication is being hel$ul. 4hich o$ the $ollowing is the most
common initial s'mtom o$ tourette5

A. e'e tics) such as blin+ing
B. $acial tics) such as grimacing or lic+ing
C. !ocal tics such as throat clearing or grunting
". whole bod' tics) such as bod' roc+ing or el!ic thrusting
#. sel$ abusi!e tics) such hitting


@0. A 9 'ear old child re$erred to the clinic because o$ bed wetting) se!eral beha!ioral
inter!entions ha!e been attemted) including eliminated $luid inta+e in the e!ening)
scheduled awa+enings at nights to use the bathroom and urine alarm /bell and ad1.
These techniques were unsuccess$ul and the child continued to urinate e!er' night.
4hich medication is the most aroriate to rescribe to treat the enuresis:

A. retalin
B. aro&etin
C. trazodone
". imeramin /rimonil1
#. benztroine /cogentin1


@1. 4hich o$ the $ollowing is the most common side e$$ect o$ m'th'lhenidate /-italin15

A. tremor
B. %'otension
C. weight gain
". insomania
#. li!er to&cit'

@2. A 17 'ears old is brought in to the ediatricians o$$ice b' her mother) who is
concerned about her lac+ o$ aarent aetite. The atient is wearing bagg' clothes
but her weight is in the @0(th ercentile $or her height. :he admits that she Gdoes not
eat muchG) but she claims to ha!e a !oracious aetite. :he is acti!e in school
musical roductions) and she is !er' worried about Ggetting $atG and not getting the
lead art. %er medical histor' is unremar+able and although she started
menustruating at age 13) she has not had her eriod $or at least 7 mounths. 4hich o$
the $ollowing laborator' abnormalities would be the most li+el' $ound in atient5

A. "ecreased C-%
B. %'erholesteroemia
C. %'ergl'cemia
". %'erth'roidism
#. Beu+oc'tosis.


@3. A atient reorts to 'ou that $or the ast wee+ ot two he has had the belie$ that his intestines and his heart ha!e
been remo!ed. 4hen as+ed about his lac+ o$ getting out in the world he resonds Gwhat world5 There is no worldG.
This asect o$ atients illness would be best re$$ered to as wich o$ the $ollowing5

A. :chizaa$$ecti!e disorder
B. Cagras s'ndrome
C. *olie a2 deu&
". Cotard s'ndrome
#. ,a=or deression

@3. A 72 'r old woman who has been treated with medication $or 3 'ears $or a
chronic mood disorder reorts that although she $eels well) she wonders i$ her
medication is cousing side e$$ects. :he comlains o$ dr' mouth) trouble urinating and occasional dizziness when
she gets out o$ the bed. 4hich o$ the $ollowing medications is the most li+el' being rescribed5

A. *luo&etine
B. .miramid /Premonil1
C. Phenelzine
". Bithium
#. "i!alroe& sodium


@7. A 39 'ear old woman resents to 'our clinic telling that she has had disturbing)
recurrent thoughts about harming her @ mo old in$ant. :he imagines using a +ni$e and stab her child. :ince ha!ing
these distressing thoughts) she had remo!ed all shar ob=ects $rom her +itchen. Because o$ this) she has not been able
to reare meals at home and has chosen to bu' $ast $ood or ta+e(out $ood $or $amil' meals. :he has not shared
these thoughts with her husband. The most accurate diagnosis $or this condition is which o$ the $ollowing5

A. imulsi!e control disorder not otherwise seci$ied
B. EC"
C. obsessi!e(comulsi!e ersonalit' disorder
". s'chosis not otherwise seci$ic
#. schisot'al ersonalit' disorder


@>. * 3> 'ear old man is brought to the emergenc' deartment in resirator' arrest. En e&amination: he is
unresonsible) and the medical student rotating thought the emergenc' deartment obser!ers inoint uils and
antecubital trac+ mar+s. There is susicion that atientIs condition ma' be the result o$ a drugs o!erdose. The
atient most li+el' has o!erdosed on which o$ the $ollowing drugs5

A. cocaine
B. PCP
C. heroin
". alcochol
#. inhales


@@. A >0 'ear old man has a histor' o$ le$t middle cerebral stro+e. 4hich o$ the $ollowing s'chological
disturbances is the most common $ollowing such a neurologic e$$ect5

A. an&iet'
B. EC"
C. deression
". mania
#. anic s'mtoms


@9. Postmortem studies and C:* samling $rom li!ing atients ha!e re!ealed a correlation between aggression)
imulsi!eness) and suicide) and a low le!el in the metabolism o$ which o$ the $ollowing neurotransmitters comared
to control sub=ects5

A. doamine
B. 0ABA
C. glutamine
". noreinehrine
#. serotonin


@A. A 27 '.o. man is brought into the emergenc' deartment lethargic and stuorous. %e resonds onl' to ain$ul
stimuli) wa+es u brie$l' and 'ells) then goes bac+ to slee. Ambulance ersonal reort that the' $ound him near a
house +nown $or drug tra$$ic+ing. There is no e!idence o$ h'sical in=ur'. 4hich o$ the $ollowing medications should
he recei!e $irst5

A. de&trose and $lumaztnil
B. de&trose) $lumazenil) and nalo&one
C. de&trose) $lumazenil) nalo&one) and thiamine
". de&trose and nalo&one
#. de&trose) nalo&one and thiamine


90. A social wor+er ma+es a routine !isit to a 3 '.o. bo' who has =ust been returned
to his biological mother a$ter sending 3 month in $oster care as a result o$ a se!ere
neglect.the child initiall' aears !er' sh' and cling $ear$ull' to his mother. Bater on) he starts la'ing in a !er'
destructi!e and disorganized wa'. 4hen a mother tries to sto him $rom throwing bloc+ at her) he starts +ic+ing and
biting. The mother becomes enraged and start shouting. 4hich o$ the $ollowing is the most li+el' diagnosis $or this
child5

A. oositional de$iant disorder
B. A"%"
C. reacti!e attachment disorder
". osttraumatic stress disorder
#. ma=or deression


9>. A23'ear old)gra!ida1)ara0)hase andergone Colosco' $or e!aluation o$ high grade lesion $ound on a
smear.The squamocolumnar =unction was !isible in its entirel')and the endocer!ical curettage was normal . A
direct bios' o$ the cer!i& re!ealed a 1mm $ocus o$ in!asion. The ne&t best ste is:

A. -adical trachelectom'
B. cr'otherab' o$ cer!i&
C. cold ;ni$e conization o$ cer!i&
". simle h'sterectom'
#. -adical h'sterectom'


9@. The ?terus and the $alloian tubes arise embr'ologicall' $rom which o$ the $ollowing5

A. ,ullerian ducts
B. 4ol$ian ducts
C. urogenital sinus
". mesonehric ducts


99. .n Pregnanc'. what is the Chadwic+ sign5

A. Bluish discoloration o$ the h'eremic !aginal mucosa
B. lower uterine :egment so$tening
C. Tenderness o$ breasts with enlargement
". uterus alable abo!e the ubic s'mh'sis

9A. 4hat is the a!erage weight gain during normal regnanc'5

A. 7)7 +g
B. A)7 +g
C. 12)7 +g
". 17)7 +g
A0. At what gestational age can e&aminer t'icall' $irst detect $etal mo!ements5

A. 17 wee+s
B. 1> wee+s
C. 20 wee+s
". 23 wee+s


A1. "uration o$ regnanc' $rom $irst da' o$ B,P:

A. 270
B. 2>0
C. 2@0
". 290


A2. Pregnant women with which condition should be !accinated against in$luenza no matter what stage o$ regnanc':

A. Allergic rhinitis
B. %'erth'roidism
C. .nsulin deendent ",
". ABB regnant women


A3. :e!ere maternal h'oth'roidism has been lin+ed to which:

A. Cretinism
B. "war$ism
C. %'ogonadism in children
". Bimb reduction de$ormit'


A3. "e$inition o$ reacti!e non stress test:

A. 1 acceleration in 20 min
B. 2 acceleration in 20 min
C. 9 acceleration in 20 min
". 17 acceleration in 20 min


A7. "uring !ibroacustic stimulation testing what $etal resonse is measured5

A. Breathing
B. %eart beating
C. #'e mo!ement
". Bod' mo!ement


A>. 4hich o$ the $ollowing is DET art o$ the management o$ shoulder d'stocia5

A. 4oods screw maneu!er
B. $undal ressure
C. ,c-oberts maneu!er
". deli!er' o$ osterior shoulder




A@. 4hat is the aro&imate incidence o$ breech resentation at term5

A. 0.7F
B. 3F
C. @F
". 12F


A9. An 19 'ear old consults 'ou $or e!aluation o$ disabling ain with her menstrual
eriods. The ain has been resent since menarche and is accomanied b' nausea and
headache. %istor' otherwise unremar+able) and el!ic e&amination is normal. Cou
diagnose rimar' d'smenorrheal and recommend initial treatment with which o$ the $ollowing5

A. #rgot deri!ati!es
B. Anti(rostaglandin
C. 0onadotroin(realsing(hormone /0n-h1 analogs
". "anazol
#. Codein.


AA. .n an amenorrheic atient who has had ituitar' ablation $or a craniohar'ngioma) which o$ the $ollowing
regimens is most li+el' to result in an o!ulator' c'cle5

A. Clomihene citrate
B. Pulsatile in$usion o$ 0n-%
C. Continuous in$usion o$ 0n-%
". %uman menoausal or recombinant gonadotroin
#. %uman menoausal or recombinant gonadotroin $ollowed b' human chorionic gonadotroin /hC01


100. 4hich o$ the $ollowing medications is used $irst line thera' in the treatment o$ el!ic ain endometriosis5

A. unoosed estrogen
B. "e&amethasone
C. "anazol
". 0onadotroins
#. Parlodel


101. The resentation o$ Asherman s'ndrome t'icall' in!ol!es:

A. Amenorrhea
B. Eligomenorrhea
C. ,enorrhagia
". ,etrorrhagia
#. "'smenorrhea

102. "uring the e!aluation o$ secondar' amenorrhea in a 23('ear(old woman) h'errolactinemia is diagnosed.
4hich o$ the $ollowing conditions could cause increased circulating rolactin concentration and amenorrhea in this
atient5

A. :tress
B. Primar' huerth'roidism
C. Anore&ia ner!osa
". Congenital adrenal h'erlasie
#. Pol'c'stic o!arian disease


103. Buteal hase de$ects are o!ulator' disorders. 4hich o$ the $ollowing studies er$ormed in the second
hal$ o$ the menstrual c'cle is hel$ul in ma+ing this diagnosis5

A. :erum estradiol le!els
B. ?rinar' regnanetriol le!els
C. #ndometrial bios'
". :erum $ollicle(stimulating hormone /*:%1 le!els
#. :erum luteinizing hormone /B%1 le!els


103. A 22('ear(old woman consults 'ou $or treatment o$ hirsutism. :he is obese and has $acial acne and hirsutism
on her $ace and eriareolar regions and a male escutcheon. :erum B% le!el is 37 m.?8mB and *:% is A m.?8mB.
Androstenedione and testosterone le!els are mildl' ele!ated) but serum "%A: is normal.
The atient does not wish to concei!e at this time.
4hich o$ the$ollowing single agents is the most aroriate treatment o$ her condition5

A. Eral contraceti!es
B. Corticosteroides
C. 0n-% agonist
". Bromocritine
#. 4edge resection


107. A 23('ear(old woman resents $or e!aluation o$ a @(month histor' o$ amenorrhea. #&amination discloses
bilateral galactorrhea and normal breast and el!ic e&amination. Pregnanc' test is negati!e. 4hich o$ the
$ollowing classes o$ medication ma' be the cause o$ her condition5

A. Antiestrogens
B. 0onadotroins
C. Phenothiazines
". Prostaglandins
#. 0n-% analogues


10>. 4hich o$ the $ollowing $indings characterizes a normal semen samle5

A. Beu+oc'te count M 1 milion er ml
B. :erm concentration o$ 37 milion er ml
C. 3F normal serm morholog'
". 10F rogressi!e serm motilit'
#. A !olume o$ 1 ml


10@. Cou see $i!e ostmenoausal atients in the clinic. #ach atient has one o$ the conditions listed) and each
atient wishes to begin hormone relacment thera' toda'. 4hich atient would 'ou start on thera'
immediatel'5

A. ,ild essential h'ertension
B. Bi!er disease with abnormal li!er $unction tests
C. Personal histor' o$ brest cancer
". ?ndiagnosed genital tract bleeding
#. Treated stage 3 endometrial cancer







109. The most imortant indication $or surgical reair o$ a searate uterus is5

A. %abitual abortion
B. "'smenorrhea
C. ,enometrorrhagia
". "'sareunia
#. Premature deli!er'


10A. "anazol used in the treatment o$ endometriosis causes which o$ the $ollowing changes within the
endometrium and endometriosis tissue5

A. "'slasia
B. %'oestrogenism
C. %'erlasia
". neolasia
#. in$lammation


110. A 27 'r old woman) gra!ida 3) ara 3) with a histor' o$ leiom'omas) resents to the emergenc' deartment
reorting el!ic resure. :he denies cardiac) renal) or heatic s'mtoms. A el!ic ultrasound shows a 10 cm le$t
uterine mass that has the echogenicit' o$ $ibroid) ressure $rom the $ibroid ma' also cause5


A. Beg ulcer
B. *emoral ner!e ressure
C. suer$icial thrombohlebitis
". etechial rash
#. !aricose !eins




























Part B:

1. A 2@ 'ear old woman) gra!ida 2) ara 1 at 30 wee+ o$ gestation resents to clinc $or a routine renatal !isit.
:he has +nown to su$$er $rom Gserosal $ibroidsG. %er $undus measures 3@cm $rom the ubis..n discussing
ossible comlications o$ a $ibroid uterus during regnanc' 'ou mention that she is at highest ris+ $or:

A. reterm remature ruture o$ membranes /PP-E,1
B. Placental re!ia
C. Pregnanc' induced h'ertension /P.%1
". Breech resentation
#. lacental abrution


2. 4hich o$ the $ollowing atients is unli+el' to ha!e endometriosis:

A. A 1A('ears old with c'clic ain and bicornuate uterus with a non communication uterin hor
B. A 29 'ear( old atient with c'clic el!ic ain and who has a mother and sister with indometriosis
C. A 27 'ear old $emal with a histor' o$ d'sarunia) ain$ul nodular masses in the recto!aginal setum
an a le$t adne&al mass
". A 29 'ear old with menorrhagia a 3 cm submucosal m'oma
#. A 32 'ear old with in$ertilit' and d'smenorrhea an a $i&ed and retro!erted uterus on h'sical
e&amination


3. A 27'ear(old woman rimigra!ida is in the emergenc' room comlaining o$ lower el!ic ain and sotting $or
the ast wee+.%er last normal menstrual eriod was @ wee+s ago.'ou ha!e obtained a serum B(hC0. 4hich was
3000 .?NB and a trans!aginal ultrasound was er$ormed wich re!ealed no gestational sac in the endometrial ca!it'.
Do adne&al masses and no $ree $luid in the cul de sac. The ne&t ste in the management o$ this atient is:

A. -eassurance and reeat B(hC0 in 13 da's
B. Baarosco'
C. Baarotom'
". methotrea&ate)singl dose thera'
#. "ilatation and curettagge


3. A 13 'ear old nulligra!id girl reorts menstrural bleeding e!er' 37 to 70 da' and bleeding $or 3 da'.she
e&erienced menarche at age 13 she is not se&uall' acti!e.%er h'sical e&amination is unremar+able and her
serum regnanc' test is negati!e.The ne&t best ste in management is:

A. #strogen onl' ills
B. reassurance
C. D:A."s
". %'sterosco' and dilatation an curettage
#. dilatation and curettage
*. coagulation ro$ile


7. A 3>('ear old multiarous woman =ust underwent a h'sterectom' becaus o$ a molar regnanc'.other than her
treatmente $or gestational trohoblastic disease)'ou obtain a B(hC0 two da's a$ter the oeration.4hat is the ne&t
ste in management o$ this atient5

A. B(hC0 in on wee+
B. ,ethotre&at treatmente
C. li!er $unction test in two wee+s
". el!ic CTscan
#. chest radiograh in one month

>. A 2> 'ear old woman gra!id 3 ) ara 3 is hail' married she is $actor O leiden
mutation carrier she has regular eriods that last A(10 da's are e&tremel' hea!' and
are associated with se!ere craming she is $airl' sure she has comleted childbearing)
which o$ the $ollowing contraceti!e metods will be the most reliable and suitable $or her5

A. coer .?"
B. rogesterone .?"(,.-#DA
C. combined oral contraceti!e ills
". !aginal ring D?OA-.D0
#. condom


@. A 32 'ear old woman gra!id 3 ara 3 =ust deli!ered a !iabile $emale in$ant weighting 3000 grams !ia cesarian
section $or nonreassuring $etal heart rate attern) she reci!ed intrathecal sinal anesthetic and nacratic $or ain relie$
durig the rocedure ) her $ole' catheter is le$t in lace $or se!eral hours a$ter the cesarian section this will re!ent5

A. stress incontinence
B. urge incontinence
C. o!er$low incontinence
". mi&ed incontinence
#. reoerati!e urinar' tract in$ection


9. A 77 'ear old woman with her *,B at age 70 resent with a histor' o$ 3 da's o$ light !aginal bleeding 'ou should5

A. gi!e her !aginal estrogen $or atrohic !aginitis and tell her to come bac+ i$ the bleeding doesnIt
get better
B. er$orm a h'sterectom' and bilateral salingo(oohorectom' to rule out endometrial cancer
C. ta+e a histor' er$orm a h'sical e&amination er$orm endometrial tissue samling and order a el!ic
ultrasound or er$orm h'sterosco'
". recommend she go on a diet since there is increased roduction o$ estrone in obese women
#. start #T instead o$ %T since a rogestogen ma' ma+e hor bleed


A. A 20 'ear old resente to 'ou with a dee e&ca!ating ainless lesion abo!e the clitoris o!erl'ing the ubic
bone. %er serum O"-B is ositi!e. A lumbar uncture and anal'sis o$ her cerebrosinal $luid also 'ields a
ositi!e O"-B the best term to describe her lesion is:

A. cond'loma acuminatum
B. cond'loma latum
C. chancre
". gumma
#. bubo

11. A 39 'ear old woman is being e!aluated $or cough that ersist $or 3 month. :he
describe that it occur dail') Donroducti!e) with no hemot'sis. :he ha!e no
d'snea) wheezing) $e!er) weight los ) no night sweats or recent illness. :o tra!els
recentl'. :he wasnPt e&osed no an'one who ha!e been ill. :he ne!er smo+e. :he
was diagnosed with essential h'ertension > months ago and ta+e lisinoril dail'.
Ph'sical e&amination is unremar+able. Do oral 8har'ngeal e&udate or drainage.
Chest & ra' is normal. 4hich is the most aroriate management otion $or this atient this time5

A. "iscontinue lisinoril
B. Chest CT
C. :irometr'
". :tart antihistamine 8 decongestion combination
#. :tart roton um inhibitors

12. A 71 'ears old woman is e!aluated during a routine e&am. she ha!e no histor' o$ h'ertension ) no tabaco use
) and no $amil' histor' o$ heart disease .she ta+e con=ugated estrogen combined with medro&'rogesterone acetate
$or intolerable hot $lashes .h'sical e&amination is normal) B,. 31. *ast liid anel: Total cholesterol 219 mg8dl) %"B
32 mg8dl) B"B 129 md8dl) trigl'ceride 230 mg8dl. The ne&t aroriate ste is:

A. Calculate the $ramingham ris+ $actor
B. Calculate the non(%"B le!el
C. Prescribe atro!astin
". Prescribe gem$ibrozil


13. A >9 'ears old woman is being e&amined. Bast 'ear she had a ain$ul rash in the
side o$ her bac+ that was sel$(limited. :he doesnIt recall a histor' o$ chic+eno&. :he
ta+es no medication) no allerg'. %er !ital sign are normal) and h'sical e&amination
is normal. %er CBC) li!er enz'me) and serum chemistr' are normal. :he has
scheduled an in$luenza !accine $or toda'. The !accine strateg' $or toda' is:

A. Joster !accine i$ negati!e $or !aricella anti bod'
B. Joster !accine i$ ositi!e $or !aricella anti bod'
C. Joster !accine now
". Joster !accine now Q > months
#. Joster !accine is not indicated.


13. A >0 'ear old woman has a ersistent ain a$ter an eisode o$ heres zoster 3 month ago) in!ol!ing the right side
T3 dermatome. :he claim that the ain inter$ere with her slee. %istor' is normal. Oital sign are normal. The lesion is
crusted o!er and aears heals. The most aroriate treatment $or this atient is:

A. Ac'clo!ir
B. Codeine
C. 0abantin
". .buro$en
#. Toical L.


17. A 3> 'r old. 4ith low %"B. Do chest ain. %istor' o$ 10 ac+ a 'ear smo+ing. .
:he is o!erwight with no coronar' disease histor'. BP133892 mm %0. B,. 2A. %eart
e&amination is normal with no murmur or gallo rh'thm. Total cholesterol is 1A9
mg8dl) %"B 33) B"B 12A. Trigl'ceride 19. The management o$ this atient is:

A. #&ercise stress test
B. 0em$ibrozil
C. Dicotinic acid
". Pra!astatin
#. Bi$est'le modi$ication













1>. A32('ears(old man has a 7 da' histor' o$ ersistent nasal congestion and ain in
the right $orehead area associated with a clear nasal discharge and mild cough. The
atient reorts that he has had similar eisodes in the ast that were heled b'
antibiotics. ,edical histor' is otherwise unremar+able and he currentl' ta+e no
medication .on h'sical e&amination) !ital sings including temerature are normal.
,ild right suborbital ridge tenderness is resent the nares are atent with a clear
mucoid discharge. There is no har'ngeal er'thema or e&udate. The lungs are clean
to auscultation which o$ the $ollowing is the beast initial management5

A. amo&icillin
B. CT scan o$ the sinuses
C. lain $ilms o$ sinuses
". s'mtomatic treatment
#. trimethorim(sul$amatho&azole


1@ .4hich o$ the$ollowing it true regarding h'o!olemic shoc+5

A. loss o$ 20(30F o$ blood !olume leads to shoc+ h'siolog'
B. loss o$ R20F o$ the blood !olume will mani$est as orthostasis
C. oliguria is a crutcial rognostic sign o$ imending !ascular collase
". s'mtoms o$ h'o!olemic shoc+ di$$er $rom those o$ hemorrhagic shoc+
#. the $irst sign o$ h'o!olemic shoc+ is mental obtundation

19. A 29('ears(old man is e!aluated $or 2 month histor' o$ recurrent con$usion)
alitation) and diahoresis occurring whene!er he misses brea+$ast. The s'mtoms are relie!ed with eating. %is
medical histor' is otherwise unremar+abl and he ta+es no medications. En h'sical e&amination !ital signs are
normal and B,. is 2>.the rest o$ the general h'sical e&amination is normal .results o$ laborator' studies show a
$asting lasma 0B? 72 mg8dl and insulin 19u8ml /normal 2(201. 4hich is the most aroriate ne&t ste in diagnosis5

A. CT o$ the abdomen
B. endoscoic ultrasonograh' o$ the ancreas
C. home glucose monitoring
". octreotide scan
#. suer!ised @2(hour $ast in the hosital

1A. A 37 'ear old man is e!aluated $or a 3 month histor' o$ $atigue) constiation and oluria he also has a 7('ear
histor' o$ h'ertension .current medication are losatan and diltiazam. Ph'sical e&amination $inding including
!ital signs are normal. Baborator' studies: ca 11.3 creatinine 1.1 mg8dl 0B? $asting 99 mg8dl T:% 1.2 . ,easurement
o$ which o$ the $ollowing should be done ne&t5

A. calcitonin
B. 27 h'dro&' !itamin d
C. arath'roid hormone
". arath'roid hormone related rotein

20. A >9 'ear old women is re(e!aluated a$ter laborator' studies show a $asting glu
113 she has a maternal $amil' histor' o$ t'e 2 diabetes mellitus. En h'sical
e&amination )blood ressure is 132899 and B,. 2A other !ital signs and e&amination
$indings are normal .she undergoes an oral tolerans test during which her 2 hour
lasma glu increases 137 %emoglobin A1C 7.9F B"B 110 %"B 39 Trigl'c 1@2
4hich o$ the $olloing is the most aroriate treatment recommendation to control her glu 5

A. acrabose administration
B. diet and e&ercise
C. met$ormin administration
". ramiril administration
#. rosiglitazone administration
21. A 37 'ear old woman is e!aluated $or a > ( months histor' o$ wea+ness)
menstrual irregularities hirsutism) .nsomnia and emotional labilit'. :he also rerts an
9(+g weight gain during this eriod. :he was re!iousl' health'. :he ta+es no
medications. En h'sical e&amination) temerature is 3>) blood ressure is 1@281A0
mmhg) ulse rate is >98min) resiration rate is 1> 8min) and bmi is 32. The atient has
a rounded) lethoric $ace with increased suracla!icular and dorsal $at ads. There
are areas o$ une&lained ecc'moses o!er the uer and lower e&tremities. Abdominal
e&amination re!eals urule striae. :he has ro&imal muscle wea+ness. -esults o$
routine laborator' studies are normal e&cet $or serum otassium le!el o$ 3.3 meq8l.
4hich o$ the $ollowing is the most aroriate ne&t test $or this atient5

A. cos'ntroin stimulation test
B. high dose de&amethasone suression test
C. measurement o$ morning serum cortisol le!el
". measurement o$ 23 ( hour urine $ree cortisol r&cretion


22. A >@ 'ear old woman is trans$erred to the cardiothoracic intensi!e care unit /icuS a$ter undergoin reair o$ an
abdominal aortic aneurism. she has a (12 'ear histor' o$ t'e 2 diabetes mellitus. %er blood glucose le!el arrai!al
at the icu is 29A mg8dl . although no longer on cardioulmonar' b'ass um treatment to( control her blood
glucose le!el during her icu sta':

A. insulin glargine ) once dail'
B. intra!enous insulin in$usion
C. neutral rotamine hagebro/nh1insulin ) twice dail'
". regular insulin administered on sliding scale


23. A@> 'ear old woman is ree!aluated a$ter results o$ th'roid $unction tests)
er$ormed 2 wee+s ago are abnormal. The atient otherwise $eels well. :he has a
histor' o$ h'ertension) atrial $ibrillation) gastroesohageal re$lu& disease and
deression. Current medication are metorolol) amiodarone ) war$arin ) omerazole) and sertraline. -esiration
rate 178min .the th'roid gland is smooth and normal size. Cardiac e&amination re!eals an irregular rh'thm. "ee
tendon re$le&es are normal.
Baborator' studies:
Tsh >.7 u8ml
Th'ro&ine /t31) $ree 2.3 ng8dl /31 mol 8l1
Triiodoth'ronine /t31) $ree 0.9 ng8l /1.2 mol8 l 1

4hich o$ the $ollowing medications is most resonsible $or the laborator' result5

A. amiodarone
B. metorolol
C. omerazol
". sertraline













23. An 19 'ear old woman is e!aluated $or tach'cardia) ner!ousness) decreased
e&ercise tolerance and weight loss o$ > months duration) she has otherwise been
health'. %er sister has gra!es disease. :he ta+es no medications. En h'sical
e&amination) blood ressure 1298 @9 mmhg. Pulse rate is 1238min) resiration rate is 1>8min and bmi is 1A.7.The
is no rotosis. An e&amination o$ the nec+ re!eals a smooth th'roid gland that is greater than 1.7 times the
normal size. Cardiac e&amination re!eals regular tach'cardia with grade 28> earl' s'stolic murmur at the base. %er
lungs are clear to auscultation .laborator' studies:
%uman chorionic gonadotroin ( negati!e
Tsh R 0.01 u8ml
Th'ro&ine /t31) $ree 7.7ng8dl /@1 mol8l1
Triiodoth'ronine /t31 $ree 7.7ng8dl /@1 mol8l1

4hich o$ the $ollowing is the most aroriate treatment regiment at this time5

A. atenolol onl'
B. methimazole onl'
C. atenolol and methimazole
". radioacti!e iodine and methimazole


27. Crohn2s disease is associated with which o$ the $ollowing:

A. in$lammation limited to the suer$icial la'er o$ the bowel wall
B. seci$ic a$$init' to in!ol!e the rectosigmoid =unction
C. continous mucosal areas o$ ulceration that a$$ect the anus
". $istula $ormation


2>. An obese @7 old women is e!aluated $or ersistent h'ergl'cemia. :he has
$ollowed a strict regimen o$ diet and e&ercise in an attemt to control her
h'ergl'cemia. %ome blood glucose monitoring has shown rearendial le!els
between 120 and 1>0 mg8dl and occasional ostarendial le!els e&ceeding 200 mg8dl. :he has a histor' o$
h'ertension and h'erliidemia. Current medication include lisinoril) h'drochlorothiazide) and ra!astatin. Oital
signs and h'sical e&amination $indings are normal. #&cet B,. o$ 30.the serum creatine le!el is 0.9 mg8dl and the
urine is negati!e $or micro albuminuria.4hich o$ the $ollowing is the most
aroriate ste in treatment to imro!e her gl'cemic control:

A. continue the diet and e&ercise $or additional 3 months
B. begin e&enatide
C. begin glimeiride
". begin met$ormine
#. begin iogliazone


2@. A 32 'ear old $emale h'sician is beginning a ost graduate $ellowshi at a
uni!ersit' hosital and must undergo tuberculin s+in testing. :he is health') she grew
u in A$rica and comleted medical school and residenc' training in Bondon. :he
recei!ed BC0 !accine as a child. tuberculine s+in testing results indicate a 1>mm
area o$ induration at the tuberculine s+in testing site. Ph'sical e&amination is normal.
4hich o$ the $ollowing us the most aroriate ne&t ste in the management o$ this atient5

A. chest radiograh
B. isoniazide) ri$amin) 'rizonamide and ethambutol
C. reeat tuberculin +in testing in 2 wee+s
". no additional thera' or e!aluation



29. A @7 'ear(old men with t'e 2 diabetes mellitus is e!aluated in the emergenc' deartment $or draining chronic
ulcer on the le$t $oot) er'thema and $e!er. "rainage initiall' began 3 wee+s ago. Current medication include
met$ormin and biguanide. En h'sical e&amination he is not ill aearing. Tem is 3@.A) other !ital signs are
normal. The le$t $oot is slightl' warm and er'thematous. A lantar ulcer that is
draining urulent material is resent o!er the $ourth metatarsal =oint. A metal rob
ma+es contacts with bone. the reminder o$ the e&amination is normal. The leu+oc'te count is normal and an #:-
rate is @0mm 8h. A lane radiograh o$ the $oot shows numerous leu+oc'tes) gram ositi!e cocci in clusters) and
gram negati!e rods. 4hich o$ the $ollowing is the most aroriate management now5

A. Begin imienem
B. Begin !ancom'cin and ce$tazidime
C. Begin !ancom'cin and metronidazole
". Per$orm bone bios'


2A. A 2@ 'ear old re!iousl' health' woman is diagnosed with communit' acquired
neumonia) $or which she recei!es ce$tria&one thera'. ,edical histor' is otherwise
non contributor'. -outine and m'cobacterial sutum clusters are er$ormed. The
atient reco!ers une!ent$ull' o!er the subsequenttwo wee+s and a $ollow u
radiograh shows imro!ement. The routine sutum culture re!els onl' normal $lora)
howe!er a$ter 3 wee+s the m'crobacterial cultures gro!es 2 colonies o$
m'cobacterium a!ium comle&. 4hich is the most aroriate ne&t ste in management5

A. initiate clarithrom'cin) ri$amin and ethambutol
B. initiate isoniazide
C. initiate ri$amin) 'rizonamide and ethambutol
". no $urther treatment


30. A1A 'ears old male college student has 2 da' histor' o$ urethral discharge and
burning sensation on urination. %e has had 3 $emale se&ual artners in the ast
month. Ph'sical e&amination discloses a scant mucoid discharge $rom the urethral
ori$$ice. Do rashes or other lesions are seen. 0ram stain o$ the urethral secretions
shows greater than 12 ol'morhonuclear cells8 %*P. Do intra ( or e&tra(cellular
organism are seen. 4hich o$ the $ollowing is the most aroriate treatment5

A. ac'clo!ir orall'
B. azithrom'cin orall'
C. benzathine enicillin 0 intramuscularl'
". ce$i&ime orall'
#. metronidazole orall'


31. A >7 'ear(old man is e!aluatesd in the #- $or a 3 da' histor' o$ gradual'
worsening low bac+ ain and $e!er. %e was e!aluated b' his internist 3 wee+s ago $or these s'mtomes) but his
condition has recentl' worsened. En hisical e&amination 39c) other !ital signs are normal. 0eneral e&amination
including neurological e&amination is normal. ,-. o$ the sine shows inhancement o$ the B3(B3 endlates
and in$lamator' collections are seen. The atient is hositalised. Blood cultures are
negati!e. The atientIs ain has worsened. The most aroriate ne&t ste) in the management o$ this atient is:

A. begin ce$tria&one
B. begin na$ciline
C. CT(gaided ercutaneus niddle bios'
". reeat blood cultures




32. A >7 'ear(old male is e!aluated because a screen urine culture $or insurance
olic' grows more then 10T colon' $orming ut8mB # coli. There is no $e!er) disuria) urinar' $requenc' or other
s'mtomes. ,edical histor' is unremar+ble. There are no allergies) no medications. Ph'sical e&amination is
normal. 4hat is the most aroriate treatment $or this atient5

A. amo&iciline
B. ciro$lo&acine
C. trimetorime( sul$ametho&azole
". no treatment


33. A 27 'ears(old woman is e!aluated in urgent care because o$ the recent onset o$
heel ain) that is eseciall' se!er when =ogging. :he has been ta+in iburo$en $or the
ast @ da's. %er additional medications are low(dose oral contrracetion) that she has
been ta+ing $or the ast 7 'ears and multi!itamines. :he does not smo+e sigarettes) is
otherwise health') there is no histor' o$ h'ertention. Ph'sical e&amination re!eals
1>28102 mm%g) uls A0 beats8min) B,. 23. The remainder o$ the e&amination) including cardioulmonar')
$undoscoic and neurological e&amination) is normal.
4hich o$ the $ollowing is the most aroriate management o$ this atientIs h'ertension5

A. begin catoril
B. begin h'droclorothiazide
C. begin labetolol
". discontinue iburo$en


33. A 37 'ears(old male comes $or a new atient e!aluation. %e ta+es no
medications. %is arents both ha!e diabetes mellitus. En h'sical e&amination blood resure 1>08100 mm%g)
B,. . The remainder o$ the e&amination is unremar+ble. Bab studies) including serum electrolites) B?D) ceatinine
le!els) urinalisis are normal. .n addition to li$est'le modi$ications) which is the most aroriate ne&t ste in this
atientIs management5

A. lisinoril and h'droclorothiazide
B. metorolol and h'droclorothiazide
C. terazosine
". no thera'


37. A 22 'ears(old woman is e!aluated at an on(site medical center a$ter callasing
while running a marathon. :heIs disoriented. "uring the e!aluation she e&iriences a generalised tonico(clonic
seizure lasting 3 minutes. A wristband indicated diabetes mellitus. En h'sical e&amination) temerature is normal)
blood resure 1208>0 mm%g) uls rate 100) resirator' rate 29. There is no e!idence o$ h'o!olemia or
edema. Cardioulmonar' e&amination is normal. En neurological e&amination she is con$used) but has no
e!idance o$ $ocal neurological de$icit. En laborator' e&amination glucose is 120 mg8dl) sodium 119 mg8dl. 4hat is the
most aroriate ne&t ste in this acientIs management5

A. 3F saline in$usion
B. 7F glucose b' i.!. bolus
C. i.!. $urosemide
". normal saline in$usion








3> A 7> 'ears old man resents to 'our o$$ice with comlains o$ UchronicV diarrhea.
%e states that he has had loose stools $or the last 2 da's. %e denies blood in the stool) $e!er) and has no weight loss
and no recent tra!el. Aroriate management at this time includes:

A. obser!ation
B. chec+ stool cultures
C. colonosco'
". stool $at studies


3@. A >0 'r old man is e!aluated during routine e&amination. The atient has smo+ed a ac+ o$ igarettes $or 27
'ears. %e has tried to quit smo+ing with nicotine gum and !arenicline) but has been nsuccess$ul. %e has mild
airwa' obstruction) but has good e&ercise tolerance and no cough) sutum roduction or hemot'sis. The
imortance o$ smo+ing cessation is re!iewed with the atientL.

A. 19*( $luorodeo&'glucose and ositron emission tomograh' /*"0(P#T1
B. chest radiograh'
C. siral CT o$ the chest
". sutum c'tolog'
#. no screening


39. A 33 'ears old is e!aluated $or a > month histor' o$ d'snea) regurgitation o$ sour $luid and eructation. There is
not associated $e!er) chills) weight loss or !omiting. The condition $ailed to resond to > wee+s o$ omerazole
therah'. The atients medical histor' includes h'ertension) diabetes mellitus and obesit' /B,. 3>1. %er
mediacations are lisinoril) meth$ormin and insulin glargine. En e&amination !ital
signs are normal) there is mild eigastric tenderness without rebound and stool is
negati!e $or occult blood. 4hich o$ the $ollowing is the most aroriate ne&t
diagnostic ste in the e!aluation o$ this atient5

A. ambulator' esohageal P% monitoring
B. barium esohagograh'
C. CT scan o$ the chest
". esohageal manometr'


3A. A 27 'ear old man is e!aluated $or > month histor' o$ eight loose) non blood'
stools a da'. %e also has abdominal ain and small =oint arthritis. The atient has a 7 'ear histor' o$ chrons
disease) initiall' treated with corticosteroids but then maintained on azathiorine thera'. :mall bowel radiograhic
series shows no stricturing disese but som) e acti!e =e=uno ileitis. Azathiorine metabolites were
recentl' measured and were $ound to be at theraeutic concentration. 4hich o$ the $ollowing is the most
aroriate additional thera' $or this atient5

A. 7( aminosal'cilates
B. anti tumor necrosis $actor alha inhubitor
C. calcineurin inhibitor
". corticosteroids












30. A @2 'ear old man is e!aluated $or 2 month histor' o$ eigastric discom$ort
associated in the ast > wee+s with 3.>+g weight loos. %e has dar+ urine and light
stool. The atient has no signi$icant medical histor' and ta+es no medications. En
h'sical e&amination !ital signs are normal) there is scleral icterus) !isible =aundiced
s+in and mild eigastric tension. Baborator' studies are signi$icant $or total bilirubin
o$ 9.2 mg8dl and al+aline hosatase o$ >39 ?8B. CT scan o$ the abdomen shows
$ullness in the head o$ the ancreas and biliar' dilation but no e!ident ancreatic
mass.which o$ the $ollowing is the most aroriate ne&t ste in the management o$
this atient5

A. endoscoic ultrasonograh'
B. measurment o$ CA 1A(A concentration
C. surgical e&loration
". ultrasonograh' o$ the abdomen
#. !isceral angiograh'


31. A 3@ ' 4) is admitted $or rimar' e&amination. Do comlaints and no
athological $indings on e&amination. %er $ather died $rom ,. at the age o$ @1. The
mother is 91 ' old and still ali!e. There is no cancer in the $amil' histor') but a $riend o$ the atient was diagnosed
with cancer o$ the large intestine and she is concerned regarding her ris+ to de!elo the same. En e&amination the PB
and the ulse are normal) B,.W27.7. Do other $indings. Baborator' anal'sis is normal. 4hich o$ the
$ollowing is the most aroriate in!estigation $or earl' detection o$ cancer o$ the
large intestine in this atient5

A. Annual digital rectal e&amination
B. Colonosco' e!er' 10 'ears
C. Barium enema with double contrast e!er' 3 'ears
". *le&ible sigmoidosco' e!er' 10 'ears


32. @2 4) @2 'ears is being in!estigated $or comlaints about increasing ain in her
right +nee $or the ast 'ear. The ain is more se!ere in the medial art o$ the =oint)
aggra!ated b' stress and decreases during rest. :he has no morning sti$$ness and
swelling. :he $elt no =amming or recoil in this =oint. En e&amination blood ressure
and ulse are normal) there is an increase o$ bone at the ro&imal and distal
interhalangeal =oints. Do signs o$ e$$usion in the right +nee =oint. Passi!e $le&ion
and e&tension o$ the right +nee cause ain. Tests) including comlete blood count)
#:- and C(reacti!e rotein were normal. 6(ra' o$ the right +nee =oint is normal. .n
addition to acetaminohen as needed) which o$ the $ollowing is most aroriate ne&t
ste in treating this atient:

A. Arthrosco'
B. ;nee =oint uncture
C. ,-. o$ the +nee =oint
". h'siothera'











33. A 32 'ears male is undergoing in!estigation $or ain and sti$$ness at the lower
bac+) which is /the ain1 decreased b' e&cersise and hot shower $or the ast 10 'ears.
Do histor' o$ dermatological diseases) ohtalmological or intestinal as well. %e did
not su$$er $rom in$ections o$ the gastrointestinal or genitourinar' s'stems. En
e&amination blood ressure and ulse (normal. :acroiliac =oints and lumbar sine are
ain$ul uon in alation. There is a comlete loss o$ bending $orward at the lower
sine. :tanding straight against the wall) he cannot touch the wall with the bac+ o$ his
head. 6(ra' images re!eal comlete $usion o$ the sacroiliac =oints on both sides and a
square shae o$ !ertebral bodies throughout the lumbar and thoracic sine. .n
addition to initiation o$ D:A."Is and h'siothera') the ne&t most aroriate treatment $or this atient is:

A. etanercet
B. low dose rednisone
C. metothre&ate
". sul$asalazine


33. 4hich o$ the $ollowing is most closel' related with <ulian Barre s'ndrome5

A. normal #,0 at the late hase o$ the disease
B. descending as'mmetrical aral'sis
C. redisosing trauma
". the s'mtoms usuall' begin at the lower e&tremities
#. low le!els o$ rotein in C:* /C#-#B-E:P.DAB *B?."1


37. 4hat can be caused with the use o$ Proton Pum .nhibitors /PP.15

A. Oit. C de$icienc'
B. Oit. " de$icienc'
C. Oit. B12 de$icienc'
". *olic acid de$icienc'


3>. A @9 '8o arri!es to urgent care clinic with new onset o$ chest ain. %e describes it as crushing in thele$t
substernal area. Don radiating) resent $or 13 hours. Do rior eisodes. %e has histor' o$ h'ertension and
h'erliidemia. %e is ta+ing asirin) h'drochlorothiazide) ator!astatine. b.. 1008@0 on right arm ) 1078@2 on le$t arm.
Pulse 100. -esiration rate 1>8. no =ugular !ein distension ) no murmurs ) no rubs. lungs are clear ) no eriheral
edema. Baborator': latlets 120.000) serum creatinine +inase 370) troonin >0. .nitial ecg shows st segment ele!ation
o$ 2mm in ii) iii) and a!$ also st segment deression in !2 !3. Chest &(ra' aears
normal. 4hich o$ the $ollowing is the best managment $or this atient5

A. chest c.t. with contrast
B. echocardiogram
C. rimar' ercutaneous inter!ention
". thrombol'tic thera'












3@. A 7A '8o male) e!aluated $or chest ain) sometimes accomanied b' a burning
sensation) which begad about 3 wee+s ago. The ain comes during eriods o$ both
e&certion and rest. %e has a +nown histor' o$ h'ertension $or which he ta+es
ni$ediine. The atient recentl' sustained a +nee in=ur' that re!ented him to wal+
without a cane. En h'sical e&amination he is $ound to be a$ebrile) b8 13989>) ulse @3) resirator' rate 1>) bod'
mass inde& 29.no signs o$ heart $ailure. Baborator': cholesterol 210) ldl 130) hdl 30) creatinine 1.2) cardiac enz'mes
negati!e. ecg shows BO% ) with normal sinus rate. And no changes $rom rior ecg. 4hich is the most aroiate test
to er$orm ne&t5

A. adenosin ositron emission tomograh' stress test
B. cardiac catheterization with coronar' angiograh'
C. coronar' arter' calcium score
". c.t. coronar' angiograh'
#. nuclear er$usion imaging stress test


39. 4hich o$ the $ollowing is not a diagnostic criteria $or diabetes mellitus5

A. random lasma glucose M 200
B. $asting lasma glucose 130
C. abnormal glucose tolerance
". %bA1C o$ @.7


3A. A >7 '8o male comlains o$ 2 months o$ chest ain with e&certion. Pain is
relie!ed uon rest. %e has e&certional d'snea) orthonea) lower e&tremit' edema. %e has 27 'ears histor' o$
h'ertension) he smo+es 33 'ears and he ta+e onl' 'drochlorothiazide. %e is a$ebtile) b8 119890) ulse A7)
resiration rate 1>8 he has mild =ugular !ein distension. Cardiac e&amination resents regular rate and r'thm) :1 :2
sounds) no murmurs and no s3. Crac+les are heared at both lungs bases. %e has mild bilateral edema at his an+les.
Troonint less than 0.01 ecg is normal on echocardiogram he has e=ection $raction o$ 30F he had global h'o+inesia
and mild BO%. 4hich is the most aroriate diagnosis test5

A. cardiac catheterization
B. cardiac mri
C. radionuclide !entriculograh'
". nuclear medicine stress test
#. standard e&cersize stress test


7>. A 33 'ear(old woman tr'ing to be regnant) $or 9 'ears is e!aluated o$ her
recei!ing ositi!e regnanc' test results. ,edical histor' is signi$icant $or 3
miscarriages >'ears) 3 'ears and 1 'ear ago. #ach o$ which occurred earl' in her
regnancies $ollowing her test miscarriage) laborator' studies indicated the resence o$ a luus inhibitor and
antihosholiid antibodies. Do histor' o$ !enous thromboembolism. %er last menstrual eriod was aro&imatel' 7
wee+s ago. Ph'sical e&amination is normal. 4hich o$ the $ollowing is the most aroriate anticoagulation $or
duration regnanc'5

A. $ull dose un$ractionated hearin
B. low dose asirin
C. roh'lactic B,4% lus low dose o$ asirin
". roh'lactic dose B,4%
#. war$arin







7@. A 70 'ear(old woman. .n the #" $or 3 da's $or histor' o$ ain) swelling and
er'thema the le$t leg. Do recent histor' o$ immobilization) cancer surger' or dee
!enous thrombosis. Ph'sical e&amination: tem.3@.@XC PAE 132892) C- >78min) --
1>8min) le$t leg disclose warmth and circum$erence er'thema and tenderness limited
on the osterior tibial ortion o$ the leg. The circum$erence is 1 cm greater than the
right when measured 10 cm below the tibial tuberosit'. Bocalized tenderness along
the distribution o$ the dee !enous s'stem and itting edema are absent as are !enous
!aricosities. 4hich o$ the $ollowing is the most aroriate ne&t ste in diagnosis5

A. CT scan o$ the leg
B. "(dimer assa'
C. "ule& ultrasonograh'
". ,-. o$ the leg
#. !enograh'


79. A 29 'ear(old man is e!aluated at a communit' center o$ health $or 10 da's
histor' o$ sore throat) headache) $e!er anore&ia and muscle aches. 2 da's ago a rash
de!eloed on his trun+ and abdomen. Pre!iousl' health' and has had no contact with
ill ersons. %e has had multile male and $emale se&ual artner and in$requentl' uses
condoms. %e has %.O test se!eral times) all were negati!e. Ph'sical e&amination)
39.>XC) se!eral small ulcers on the tongue and buccal mucosa) cer!ical and
soracla!icular l'mhoadenoath' $aint maculoaular rash is resent on the trun+
and the abdomen. -aid lasma test ordered. 4hich diagnosis studies should also be done5

A. C"3 cell count measurement
B. #BO .g, measurement
C. %.O -DA !iral load measurement
". :+in bios'


7A. A 29 'ear old man) > month histor' o$ eisodic d'snea) cough and wheezing. As a child he has asthma and
allergies) but has been as'mtomatic since his earl' teenage 'ears. :'mtoms started a$ter uer res. tract in$ection
and the' are trigged b' e&ercise or cold air. %e awa+ened with asthma s'mtoms 7( > nights a month. Do medication
and otherwise is health'. Ph'sical e&amination is normal) r& chest normal) *#O1 @0F o$ redicted with 17F
imro!ement with inhaled albuterol. 4hich is the most aroriate thera'5

A. Aziathrom'cin
B. inhaled albuterol as needed
C. inhaled low(dose o$ corticosteroid lus inhaled albuterol as needed
". long act Y(agonist
#. long act Y(agonist inhaled albuterol as needed


>0. A 32 'ear(old man hositalized e!aluated $or d'snea lus leuritic chest ain)
$racture o$ the right $emur 3 wee+s ago. :u$$er o$ h'ertension with the onl' medics is h'drochlorothiazide.
Ph'sical e&amination) 39.1XC) %- 1108min) -- 228min) PA 1308@9) B,. 23Z laborator' studies are normal)
toonins undetectable. #;0) ele!ation light o$ - wa!es in O3(O>) K-: has le$t ward a&is. Contrastenhanced CT scan
shows emboli in the arteries er$using lingual and osterior basal segment o$ le$t lower lobe. ,ost aroriate
treatment:

A. in$erior !ena ca!a $ilter
B. .O un$ractionated hearin
C. .O tissue lasminogen acti!ator
". mechanical clot dissolution
#. surgical embolectom'

>1. A atient undergoes a segmental mastectom' and negati!e margins are obtained) two sentil l'mh node are
identi$ied.on $inal histological e!aluation a >mm region o$ macrometastases is $ound on %H# staining within two
o$ the l'mh node) the ne&t ste should be:

A. comletion mastectom'
B. comletion a&illar' dissection
C. a&ilar' dissection and breast radiation thera'
". s'stemic chemothera' alone
#. no $urther a&illar' oeration


>2. A ost(menoausal woman with new diagnosis o$ breast cancer in her le$t breast elects to undergo
mastectom'. 4hich o$ the $ollowing statement about contralateral roh'lactic mastectom' is true5

A. o!erall mortalit' is imro!ed
B. there is a sur!i!al ad!antage $or atient with higher stage cancer
C. the incidence o$ contralateral breast cancer is signi$icantl' reduced
". sentenil l'mh node bios' should be done bilaterall'
#. reconstrication should be dela'ed until $inal histoatholog' is a!ailable


>3. A atient with cirrhosis has large esohageal !arices but has ne!er had bleeding eisode. %e is unable to
tolerate a non selecti!e beta bloc+er) re!ention o$ an initial bleeding eisode is best accomlished b':

A. endosco' ligation
B. T.P:
C. endoscoic sclerothera'
". octreotide
#. a small diameter interosition ortoca!al shunt


>3. A 70 '8o man with histor' o$ s'mtomatic 0#-" has BarrettIs esohagus diagnosed on uer
endosco') which o$ the $ollowing statement is true5

A. surgical treatment $or s'mtom o$ re$lu& is not warranted
B. BarrettIs esohagus is seen in 70F o$ atient with 0#-"
C. PP. will reduce the area o$ barrettIs esohagus
". surgical treatment o$ atient re$lu& s'mtoms will not reduce the ris+ o$ esohageal cancer
#. endoscoic ablation will reduce the ris+ o$ esohageal cancer


>7. A 77 '8o man resent with his $irst eisode o$ di!erticulitis he is hemod'namical' normal and imro!e within
39 hrs recei!ing antibiotics and nothing b' mounth. CT re!eals stranding o$ sigmoid esentr'. But no $ree air or
e!idence o$ an' abscess. The ne&t ste in treatment should be:

A. resection) anastamosis.
B. resection and colostom'.
C. discharge and electi!e colectom'.
". discharge) oral antibiotics and obser!ation.
#. colonscoic intramural stent








>>. A12 hours a$ter colonosco' and remo!al o$ 2.7 cm sessile ol' $rom cercum) 77 'ears old woman as
abdominal ain) $e!er) leu+oc'tosis) mind tenderness in the right lower quadrant. Do $ree air in the bdomen. The ne&t
ste should be:

A. admission serial abdominal e&amination
B. e&lorator' larotom'
C. abdominal CT
". colosco'
#. gastrogra$$in enema


>@. A 39 'ear old man with le$t lower quadrant ain. Beu+oc'tosis) low grad $e!er)
no eritoneal signs. "mission o$ CT was interreted showing acute di!erticulitis) no
er$oration or abscess. A$ter @2 hours $ treatment with i.! antibiotics and $luid the
ain resol!ed) bowel $unction and aetite became ormal) leu+oc'tosis resol!ed) the
ne&t ste is:

A. sigmoid colectom' rior to discharge
B. electi!e colectom' >(9 wee+s a$ter discharge
C. colosco' rior to discharge
". obser!ation and medical management a$ter discharge
#. $ollow(u CT


>9. A 77 'ear old woman with ileocecectom' $or chron disease undergos cholec'stectom' $or s'mtomatic
gallstones. "iarrhea and stool $requenc' are increased mar+edl' ostoerati!el'. De&t ste:

A. bismuth
B. octreotide
C. loeramide
". cholest'ramine
#. anceriatic enz'me.


@0. A >7 'ears old atient has 3 cm rectal ol'. The lower age o$ the mass is > cm $rom anal !erge. Bios'
shows $ocus o$ adenocarcinoma. CT abdomen and chest shows no metastasis. The endorectal ultrasound shows
se!eral erirectal l'mh nodes. The best management is:

A. local e&cision
B. local e&cision ad=u!ant chemothera'
C. total mesorectal e&cision with coloanal anastromosis
". neoad=u!ant chemothera' and total mesorectal e&cision with coloanal anastromosis.
#. neoad=u!ant chemothera' and total mesorectal e&cision and abdomenoerineal resection.


@1. A man resents with reeated eisodes o$ blood' stools. #sohagogastroduodenosco' and colonosco' are
normal. The ne&t ste in managment should be:

A. :mall bowel barium 6(ra's.
B. CT electrol'sis
C. Casule endosco'
". Push and ull enterosco'
#. ,esenteric angiograh'





@2. A >7 'ear old man remains in the .C? one mounth a$ter coranar' arter' b'ass
gra$tting. %e has been treated $or two eisodes o$ neumonia and continnues to
require !entilator' suort. %e de!elos water' diarrhea and abdominal distention.
:tool sent $or clostridium di$$icile to&in is ositi!e and oral metronidazole thera' is initiated. *i!e da's later) he
de!eloes h'otension requering !asoressors) renal insu$$icienc') and an ele!ated 4BC count o$ 3>)0008mm3. The
most aroriate management would be:

A. .ntra!enous Oancom'cin
B. Oancom'cin enemas
C. Cecostom' tube lacement.
". "i!erting trans!erse loo colostom'
#.


@3. A common h'siologic characteristic o$ setic shoc+ is:

A. #le!ated central !enous ressure
B. %igh s'stemic !ascular resistance
C. Bow cardiac outut
". :'stemic !asodilation


@3. ,ost sergical site in$ectious become clinecal' e!ident:

A. 4hithin 2 da's o$ oeration
B. 7 or more da's a$ter oeration
C. Because o$ $e!er immediatel' a$ter oeration
". Becouse the atient did not ha!e an adequate sha!e o$ the oerati!e site
#. A mounth a$ter oeration


@7. The most common couse o$ a small bowel obstruction is:

A. Tumor
B. Ool!ulus
C. Adhesions
". .leocolic intussuscetion


@>. An abdominal comartment s'ndrome roduces all o$ the $ollowing e&cet:

A. acute renal $ailure
B. h'o&ia
C. intestinal obstruction
". ele!ated urinar' bladder ressure
#. h'ercarbia


@@. A 30 '.o. woman with 1)7 sm alable brest mass undergoes ?: guided core needle bios'. %istolog'
showed cellular $ibroadenoma with ossibilit' o$ a h'lloides tumor. Aroriate management includes:

A. a > month $ollow u ?:. .$ lesion size is stable) continue e&ectant management
B. e&cisional bios' to di$$erentiate between the 2 ossibilities
C. wide local e&cision /lumectom'1 with the intent to achie!e 1 to 2 sm negati!e margins around the lesion
". wide local e&cision with sentinel bios'
#. wide local e&cision with radiation


@9. PagetIs disease is caused b' which o$ the $ollowing rocesses:

A. atoic dermatitis on the nile due to allergies
B. intraductal carcinoma that sreads into the eidermis o$ the basement membrane
C. in!asi!e carcinoma that causes nile in!ersion and then ulceration
". in!asion o$ the dermal l'mhatics under the nile called :a'Is le&us
#. a ailloma in a large subareolar duct causing discharge and on the nile


@A. A >0 '8o man suddenl' de!eloed se!ere abdominal ain. .n the emergence deartment 2 hours later his
abdomen was so$t and nontender) his white blood cells were 19)3008mm3) and his arterial blood % was
@)32. The robable diagnosis is5

A. acute aendicitis
B. acute ancreatitis
C. suerior mesenteric arter' embolism
". er$orated duodenal ulcer


90. A >0 '.o. man comes to the emergenc' deartment obtunded and h'otensi!e with melena and
hematochezia. %e has no histor' o$ rior surger' or alcohol abuse. %is h'sical e&amination is unre!ealing with
stigmata o$ li!er disease. The most li+el' source o$ bleeding is:

A. colonic di!erticula
B. small bowel angiod'slasia
C. bleeding duodenal ulcer
". aortoenteric $istula


9>. A 39 old $emale who is a candidate $or a mastectom' due to breast cancer arri!es to the clinic see+ing consult
regarding breast reconstruction .she is a candidate $or ad=u!ant radiation and chemothera'. 4hat t'e o$
reconstruction is most suitable $or this Patient5

A. "esite the radiation )she has an indication $or immediate reconstruction with tissue e&anders in order
to reser!e the s+in
B. this is an indication $or immediate reconstruction using autologous $las onl'
C. dela'ed reconsruction o$ about > month und using autologous $las are recommended a$ter the
comletion o$ the radiation and chemothera'
". there is no otion $or earl' or dela'ed breast reconstruction in a atient treated with radiation


9@. A 30 'ear old male with a gunshot to the abdomen arri!es to the emergenc' room. %is last meal was 9
hours ago .The atient is ta+en emergentl' to oerating room. 4hich o$ the $ollowing is correct5

A. there is no need $or deli!ering 100F E2 $or 7 minutes rior to the induction o$ anesthesia
B. cricoid ressure should be alied rior to the induction o$ anesthesia to a!oid asiration
C. cricoid ressure is not warranted as the last meal was o!er 9 hours ago
". surger' ma' be r$ormed under local anesthesia


99. 4hich o$ the $ollowing is correct regarding an incarcerated hernia in a 2 'ear old child5

A. this is indication $o urgent surger'
B. it is associated with undescendend testis
C. an attemt to reduce it is ad!isable
". in most o$ the times it is a congenital direct hernia


9A. 4hat is the annual ris+ $or ruture) dissection) and death when the diameter o$ the ascending aorta e&ceeds 7cm5

A. 1.7 F
B. 3F
C. 3.7F
". >.7F


A0. A 3> 'ear old male was in!ol!ed in motor c'cle accident )he has an isolated in=ur' that includes a $racture o$ the
right mid $emur .what o$ the $ollowing statement is correct5

A. the acceted treatment $or this $racture is late and screws $i&ation within 23 hours
B. the acceted treatment $or this $racture is intramedullar' nails within >(9 hours
C. the acceted treatment $or this $racture is e&ternal $i&ation as soon as ossile to a!oid the comlication $at emboli
this should be $ollowed b' ermanent $i&ation in 3(7 da's
". Timing o$ :urger' is o$ no imortance. .t is acceted to oerate on such atients according to
oerating room a!ailabilit'


A1. A 3 ' old bo') a$ter $racture $i&ation with cast at the e!ening. At night $elt ain and $inger tingling. 4hat is the ne&t
treatment5

A. Another morhine dose to ease the ain
B. #le!ate the arm on 2 illows
C. Een cast
". ?rgent &(ra'


A2. A 17' bo') a$ter scroatal in=ur' during $ootball. Comlains on se!ere localized ain. En e&am. Testicle $irm
and tender. De&t treatment8e!aluation:

A. Bocal cooling and scroatal ele!ation
B. Eerati!e e&loration reair o$ tunica albuginea
C. ?rgent "oler
". Admission $or $ollow(u on hematoma de!eloment


A3. >0 ') ,) rectal carcinoma 7 cm abo!e anal !erge. Do metastasis to distant sites. T-?: shows in!asion to
erirectala $at /uT31 without regional B.D in!ol!ement. Treatment:

A. -adical resection /low anterior1 and total mesorectal resection.
B. Combined treatment: neoad=u!ant chemothera' $ollowed b' -adical resection /low anterior1 and total
mesorectal resection.
C. -adical resection /low anterior1 and total mesorectal resection $ollowed b' chemothera'
". Deoad=u!ant Q T-?:) CT and surger' i$ residual tumor is de$ined in imaging


A3. Acceted treatment o$ malignant cutaneous intermediate thic+ness melanoma: /Breslow 1(31 on right arm:

A. 4ide local e&cision with 1cm margin $rom initial lesion
B. 4ide local e&cision with 1cm margin $rom initial lesion Qsentinel l'mh node bios'
C. 4ide local e&cision with 2cm margin $rom initial lesion
". 4ide local e&cision with 2 cm margin $rom initial lesion Q sentinel l'mh node bios'





A7. A 77) ,) comes to #- with se!ere eigastric ain. 2 months ago he has comleted trile treatment o$ ulcer in $irst
art o$ duodenum with ositi!e %.P'lori. En Chest &(ra' air under the right diahragm is detectible. De&t ste:

A. ?rgent endosco'
B. Ementoe&'
C. Pel!ic CT with contrast
". Antrectom'


A>. A 7>('ear(old $emale arri!es to the #- because o$ <aundice. :he has no ast
medical histor'. Baborator' $inding include a bilirubin o$ 12@ and signi$icantl'
ele!ated cholestatic and heatocellular enz'mes. En abdominal ?ltrasound the
gallbladder is distended with no stones. The CB" is 19mm and there is e&tra and
intra(heatic bile duct dilatation. :erum CA1A(A Be!els are 1200. Abdominal CT
identi$ies a ancreatic head mass without :,O in!ol!ement. 4hat is the ne&t ste in this atientIs ,anagement5

A. 0allbladder drainage
B. -esection o$ the duodenum in the ancreatic head
C. PTC
". Blood %BO and %CO testing
#. Deoad=u!ant chemothera'


A@. An 99('ear old male comes to the #- because o$ e&cruciating inguinal ain. Two wee+s ago he su$$ered an
acute m'ocardial ischemia and is ta+ing asirin since. En e&amination he seems to be in ain) with no $e!er) heart
rate o$ 117 beats ro minute) regular. %is abdomen is not distended and there is no e!idence o$ eritonitis. %e has an
incarcerated) non reducible) tight inguinal hernia. 4hat is the ne&t ste in this atientIs ,anagement5

A. PTCA
B. Thallium stress test
C. :urger'
". Another attemt to reduce the hernia under dee sedation
#. Abdominal el!ic CT.

A9. A 20('ear(old male is in=ured a edestrian in a motor(!ehicle accident. At the #-
is $ull' conscious. BP is 1108@0) her rate is A7. -oom saturation is A2F. En
#&amination there are abrasions on the right chest and abdomen) de$ormation o$ the
right arms and normal eriheral ulses. *A:T indenti$ies small amount o$
abdominal $luid) CT indenti$ies a stage 3 li!er laceration with no acti!e bleeding) and
signi$icant right lung contusion. 4hat is the ne&t ste in this atientIs ,anagement5

A. Positi!e ressure !entilation
B. Baarotom'
C. Angiograhic #mbolization o$ the li!er
". .ntensi! care obser!ation
#. :urgical reair o$ arm $racture

AA. A 39 'ear old $emale arri!es to the #- with $e!er o$ 39.7 and right uer
abdominal ain. A wee+ rior to her admission she underwent laaroscoic
cholec'stectom'. En e&amination she is alert and oriented. 4ithout scleral icterus) and normal aearing surgical
incisions. Bibrator' $inding include Beucoc'stosis 17)000) slightl' ele!ated li!er enz'mes) and normal bilirubin)
what is the ne&t ste in this atientIs ,anagement5

A. #-CP and stent insertion
B. Abdominal ?ltrasound
C. Bi!er scan
". #&lorator' laarotom'
#. broad(sectrum antibiotics treatment and obser!ation.
100. A usual health' 37 'ear old $emale in comlaining o$ 2 months uer abdominal
ain that radiates to right shoulder a$ter a $att' meal. The ain resol!es 30 minutes
a$ter she ta+es otalgin. Do $e!er or !omiting is associateted. The atient is now in
the #- due to <aundice $or 3 da's without $e!er or abdominal ain. En #&amination
the abdomen is not tender. Baborator' $inding include ( no Beucoc'tosis) howe!er
li!er $unction tests are ele!ated with Bilirubin o$ 90 /normal R1@1 in abdominal
ultrasound there are stones in the gallbladder) the gallbladder is not distended)
gallbladder wall is not thic+ened. The CB"Is diameter is A mm. 4hat is the ne&t ste in this atientIs ,anagement5

A. DPE) .O $luids and antibiotics) $ollow u on li!er enz'mes and i$ the' imro!e laaroscoic
cholec'stectom'
B. DPE) .O $luids and antibiotics) and subsequent #-CP and surger' o$ gallbladder remo!al.
C. #-CP and surger' o$ gallbladder remo!al.
". #?: or ,-CP


101. A health' 70('ear(old male arri!es to the #- with lower quadrant ain) !omiting) and abdominal distention.
Abdominal CT demonstrates mass at the heatic $le&ure with no small bowel distention. 4hat is the aroriate
treatment5

A. Dasogastric tube) .O $luids) $ollowed b' a wor+ u and reoerati!e e!aluation that includes tumor
mar+ers) colonosco') and comletion o$ chest CT
B. ?rgent right hemicolectom'
C. :tent insertion to relie!e the obstruction and rearation $or surger'
". %artmann2s rocedure


102. A health' @0('ear(old male is brought to the trauma unit a$ter being in!ol!ed in a motor !ehicle accident as a
seat belt(wearing dri!er. The collision on in an intercit' highwa'. There are no direct in=uries. En e&amination) BP
is 130890) heart rate is 110 beats er minute) and there is a seat belt sign across the abdomen. *A:T
demonstrates moderate amount o$ $luid in the el!is. The atient is ta+en to a CT scan that identi$ies moderate
amount o$ $luid in the el!is but the abdominal organs aear normal. 4hat is the ne&t ste in this atient2s
management5

A. #&lorator' laarotom'
B. -eeat CT in 2 hours
C. DPE) .O $luids and antibiotics and admission to intensi!e care unit
". -eeat *A:T in > hours


103. A 102('ear(old male is brought to the #- because o$ multile !omiting and
abdominal distentions. Past medical histor' is ositi!e $or h'ertension) benign
rostate h'ertroh') ischemic and !al!ular heart disease) Alzheimer and Par+inson disease. En e&amination) the
abdomen is !er' distended) with suraubic $ullness and tenderness. :tool stones are $ound on digital rectal
e&amination. En abdominal 6(ra') the colon is $ull o$ stool and air without small bowel dilatation.
4hich is the ne&t ste in this atient2s management5

A. Abdominal CT scan
B. Colonosco'
C. ?rinar' bladder catheterization and manual $ecal disimaction
". %artmann2s rocedure







103. A 7@('ear(old $emale h'sician that is usuall' health' is admitted to the #- due
to rogressi!el' abdominal distention and constiation in the last two months. .n the
last wee+ her s'mtoms worsened and her last bowel mo!ement was 10 da's ago.
:he comlains o$ se!ere nausea with no abdominal ain or !omiting. En
e&amination) the abdomen is !er' distended) t'manic) with no hernias or scars. En
laborator') hemoglobin ( 10.2) 4BC ( 11)000) and chemister' is normal other than
h'onatremia o$ 132. En abdominal 6(ra' the right and trans!erse colon are much
dilated with no small bowel distention. 4hich is the ne&t ste in this atient2s management5

A. Colonosco' a$ter $ast bowel rearation
B. Abdomino(el!is CT with .O and PE contrast
C. 0astrograhin enema
". #&lorator' laarotom'


107. 4hich o$ the $ollowing $actors has the strongest a$$ect on the rognosis o$ breast cancer atient5

A. The size o$ the tumor
B. The tumor2s histologic t'e
C. The number o$ in!ol!ed l'mh nodes
". The resence o$ hormonal recetors in the rimar' tumor


10>. A health' 77 'ear old male is comlaining o$ constiation and rectal bleeding. %e is re$erred to
colonosco' that identi$ies a rectal ulcerated mass 3 cm $rom the anal !erge. Bios' demonstrates
adenocarcinoma. 4hat is the ne&t ste in this atintIs management8treatment5

A. Bow anterior resection
B. Abdominoerinal resection
C. -e$er the atient to CT and Trus as soon as osible
". -e$er the atient to an oncologist $or radiation and chemothera'


10@. 4hat is the most common etiolog' $or small bowel obstruction in adults5

A. incarcerated inguinal hernia
B. incarcerated $emoral hernia
C. ost oerati!e adhesions
". crohnIs disease


109. All o$ the $ollowing are comensation mechanisms in h'o!olemic shoc+ e&cet5

A. increased eriheral s'stemic resistance seconder' to increased cathecholamins le!els
B. increased le!els o$ 2)3 "P0
C. a right shi$t o$ the hemoglobin dissociation cur!e seconder' to acidosis
". decreased cardiac contractilit'











10A. 4hat is correct regarding dee in$ection e!ol!ing a relaced +nee or hi5

A. it alwa's de!elos on the $irst $ew wee+s $ollowing surger' and is usuall' treated with antibiotics $or 10
da's
B. it can de!elo moths[/ 1 and e!en 'ears $ollowing the =oint relacement surger' and surgical treatment
and .O antibiotics $or > wee+s are indicated
C. it is a rare comlication /less than 0.01F1 because smooth metals are in!ol!ed with sur$ace that reels
in$ections
". because o$ its se!erit' there is an indication $or initiation o$ broad sectrum antibiotics on the most remote clinical
susicion) e!en be$ore an' test er$ormed

110. 4hat is the main ob=ecti!e in hi or +nee =oint relacement5

A. a!oid deterioration o$ h'siological load on the =oints abo!e and below the relaced =oint
B. enable athletes) eseciall' ro$essional) to achie!e load and stress that the nati!e =oint is incaable o$
er$orming
C. a!oid intra(=oint $racture in atient that are ro!e $or it /diabetics) recurrent $alls) dementia1
". decrease ain and imro!e the qualit' o$ li$e o$ atients








































03.03.2011

Part A:

1. "
2. A
3. B
3. "
7. "
>. B
@. B
9. A
A. C
10. C
11. #
12. A.B
13. A
13. "
17. A
1>. "
1@. A
19. B
1A. A
20. A.B
21. A
22. "
23. B
23. #
27. "
2>. #
2@. C
29. B
2A. A
30. C
31. C
32. C
33. #
33. B
37. C."
3>. A
3@. B
39. C
3A. "
30. C
31. "
32. #
33. B
33. B
37. C
3>. A
3@. "
39. B
3A. C
70. C
71.
72.
73.
73.
77.
7>. #
7@. C
79. "
7A. "
>0. A
>1. #
>2. C
>3. C
>3. B
>7. A."
>>. B
>@. A
>9. C
>A. A
@0. "
@1. "
@2. A.B
@3. "
@3. B
@7. B
@>. C
@@. C
@9. #
@A. #
90. C
91.
92.
93.
93.
97.
9>. C
9@. A
99. A
9A. C
A0. C
A1. "
A2. "
A3. A
A3. B
A7. B
A>. B
A@. B
A9. B
AA. #
100. C
101. A
102. A
103. C
103. A
107. C
10>. B
10@. A
109. A
10A. B
110. #






























Part B:

1. "
2. "
3. #
3. B
7. A
>. B
@. C
9. C
A. "
10.
11. A
12. B
13. C.#
13. C
17. #
1>. "
1@. C
19. #
1A. C
20. B
21. B
22. B
23. A
23. C
27. "
2>. "
2@. A
29.
2A. "
30. B
31. C
32. "
33. "
33. A
37. A
3>. A
3@. #
39. A
3A. B
30. A.B
31. B
32. "
33. A
33. "
37. C
3>. C
3@. B.#
39. "
3A. A
70.
71.
72.
73.
73.
77.
7>. C
7@. B.C
79. C
7A. C
>0. B
>1. B.C
>2. C
>3. A
>3. "
>7. "
>>. C
>@. "
>9. "
>A.
@0. "
@1. C
@2. #
@3. "
@3. B
@7. "
@>. C
@@. B.C
@9. B
@A. C
90. C
91.
92.
93.
93.
97.
9>. C
9@. B
99. C
9A. C."
A0. B
A1. C
A2. C
A3. B.C
A3. "
A7. B.C
A>. B
A@. C
A9. "
AA. B
100. B."
101. B
102. A.B
103. C
103. C."
107. C
10>. C
10@. C
109. "
10A. B
110. "