IMLE 11/2018

A 34 y.o undergoes a routine checkup, interested in conceiving. She reveals that over the last few months her menstruation shortened from 28 to 20 days. What is the most likely mechanism of this phenomena ?

Decrease in progesterone during the luteal phase.

Correct Incorrect Correct answer

Decrease in LH prior to ovulation.

Correct Incorrect Correct answer

Increase in FSH at the beginning of menstrual cycle.

Correct Incorrect Correct answer

Increase of LH prior to ovulation.

Correct Incorrect Correct answer

39 y.o single woman with amenorrhea, heat waves, weight gain last year, generally healthy, BMI 34, she has been on oral contraceptive from 20-30 y.o., smoking 20 cig/day since 15 y.o. her FSH levels 40&50 u/L on two separate tests. What is the most likely risk factor?

Over weight

Correct Incorrect Correct answer

Absence of pregnancies in her past

Correct Incorrect Correct answer

Prolonged use of oral contraceptives.

Correct Incorrect Correct answer

Smoking

Correct Incorrect Correct answer

A 50 years old woman has presented due to worsening of heat waves and disrupted sleep. She has been on fluoxetine over the last two years, to treat heat waves. At 45 yo, she was treated with mastectomy and local radiation due to breast cancer and is now treated with tamoxifen. What is the most appropriate treatment ?

Stop fluoxetine treatment

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Increase the dose of fluoxetine

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Initiate estrogen treatment

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Initiate black cohosh treatment

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27 y.o. never pregnant, presents with several years of prolonged lower abdominal pain, especially around menstruation, that has become worst lately. She has been trying unsuccessfully to conceive over the last 2 years. A vaginal bimanual exam reveals granulation of the uterosacral ligament. What most accurate diagnostic test (gold standard in terms of specificity and sensitivity) for her condition?

Contrast abdominal CT

Correct Incorrect Correct answer

Transvaginal US

Correct Incorrect Correct answer

Serum CA125 during menstruation

Correct Incorrect Correct answer

Diagnostic laparoscopic

Correct Incorrect Correct answer

A 46 yo woman is a candidate for diagnostic laparoscopy due to chronic pelvic pain, dysmenorrhea and dyspareuria. Which most likely anatomic location for typical findings characteristic of the most common diagnosis in this case?

Ovaries

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Pouch of douglas

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Posterior broad ligament

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Uterosacral ligament

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56 yo woman presents with vaginal dryness, urinary urgency and incontinence, dyspareuria and increased sensitivity of the breasts. Physical examination is normal except for vaginal atrophy. Which of the patient’s complains have nothing to do with her normal status?

Vaginal dryness

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Urinary urgency

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Dyspareuria

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Sensitivity of the breast

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49 y.o. mother of three presents with dysmenorrhea, dyspareuria and chronic pelvic pain which is worst during her period and affects her quality of life. She has undergone laparoscopic resection of endometrotic lesions 10 years ago, and is not interested in conceiving again. Her medical history is positive for hypercoagulability, and pulmonary emboli while using oral contraceptive. What is the most appropriate treatment?

GnRH antagonist

Correct Incorrect Correct answer

Surgical ablation of the remaining endometriotic lesions

Correct Incorrect Correct answer

Hysterectomy and oophorectomy

Correct Incorrect Correct answer

Progesterone treatment

Correct Incorrect Correct answer

26 yo is treated medically for endometriosis. She complains of gaining weight, acne, changes in her voice, and depression following the beginning of treatment. Which of the following endometriosis treatment causes these adverse effects?

Combined contraceptive

Correct Incorrect Correct answer

GnRH agonist

Correct Incorrect Correct answer

Danazole

Correct Incorrect Correct answer

Progesterone

Correct Incorrect Correct answer

36 yo woman trying to conceive for 3 months, she has been suffering from endometriosis for the last 10 years, she was diagnosed by a laparoscopic procedure in which 2 cysts – 8 cm diameter were resected and the diagnosis was confirmed histologically. While she was treated with combined oral contraceptive she was asymptomatic, but after the treatment was stopped the pelvic pain is back. Which is the treatment of choice in order to achieve conception in this patient ?

An additional laparoscopic surgery

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In vitro fertilization

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Treatment with GnRH agonist

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Treatment with danazole

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A married 30 yo woman with no children is undergoing IVF due to severe sperm disorder. Her history is positive for polycystic ovary disease and 10 follicles of over 14 mm were identified on vaginal US prior to HCG injection. Two days following the injection she presents with abdominal pain, distention and nausea. On exam she is afebrile and hemodynamically stable. Which is most substantial risk factor for her condition?

The woman's age

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IVF due to male factor

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The number of follicles

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Polycystic ovary syndrome

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A 30 year old mother of two is treated with IVF for infertility due to a mechanical factor (bilateral salpinx obstruction )which of the following statement is correct regarding the association between fertility treatments and congenital anomalies?

Fertility treatment are not associated with congenital anomalies

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There is a 1.8 fold risk of congenital anomalies associated with in vitro fertilization when compared to spontaneous pregnancies

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There is a 0,6% increase in the risk of congenital anomalies associated with in vitro fertilization when compared to spontaneous pregnancies

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ICSI (intra cytoplasmic sperm infection) minimizes the rate of congenital anomalies with in vitro fertilization

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A 39 year old childless woman is treated with in vitro fertilization due to a mechanical infertility after 10 days of ovarian stimulation a vaginal ultrasound demonstrates 3 follicles sized 16,15 and 19mm .Endometrial mucosa is 5mm thick and serum estradiol level is 2200pMol/L (600pg/ml)considering the presented data,which of the following positively predicts treatment success?

The women’s age

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Number of follicles

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Follicle diameter

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Serum estradiol level

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A 30 year old woman has a colposcopy due to a finding of high grade squamous intra epithelial lesion (HSIL )on PAP smear ,the colposcopy report stated that the exam was unsatisfactory and the cervical biopsy revealed CIN1 ( cervical intraepithelial neoplasia ). Which of the following is the next therapeutic step?

Radical hysterectomy

Correct Incorrect Correct answer

Cervical laser ablation

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End cervical curettage and conization

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Repeat colposcopy in 6 months

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A 35 year old woman presents to the emergency room with severe lower abdominal pain with no fever two months prior to her presentation she has gone through endocervical conization due to CIN2 ,her last period was 5 weeks ago ,during her examination she seems in pain and palpitation reveals severe sensitivity and fullness in central and lower abdomen ,laboratory results include a normal leukocyte count ,Hg 11 gr% ,normal urine analysis and a negative pregnancy test, ultrasound shows turbid fluid filling the uterine cavity.
Which of the following is the most likely diagnosis?

Hematometra

Correct Incorrect Correct answer

Acute cervicitis

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Tubo-ovarian abscess

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Urinary tract infection

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A 41 year old woman was diagnosed with human immunodeficiency virus ( HIV ) a week prior to her presentation in the clinic for a routine checkup. PAP smear 7 months ago was normal . Which of the following tests should be performed at this time?

Colposcopy

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Repeat PAP smear

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Endocervical curettage( ECC)

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Serum human papilloma virus ( HPV ) antibodies

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A 39 years old women with polycystic ovary and obesity have received a PAP smear result noting atypical glandular cells. Which of the following is next step in patient workout

Repeat PAP smear in 6 months

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Colposcopy, endocervical curettage and endometrial biopsy

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Endocervical conization

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Endocervical cryo-ablation

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A 62 years old women had a endometrial biopsy due to vaginal bleeding. Biopsy result was endometrioid adenocarcinoma FIGO grade 3. What is the most appropriate treatment

Simple hysterectomy, ovaries not included, peritoneal cavity cytology and pelvic lymph node sampling

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Radical hysterectomy, peritoneal cytology and pelvic groin lymph node sampling

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A simple hysterectomy, including ovaries, peritoneal cavity cytology and pelvic and para aortic lymph node sampling

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Radical hysterectomy deferring ovaries from pelvis, peritoneal cavity cytology and omental resection

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A 29 years old childless woman with hirsutism had an ultrasound performed due to irregular menstrual period. Ultrasound demonstrate a thickened endometrium and biopsy reveal well differentiated adenocarcinoma grade 1. What is the most appropriate treatment

Repeat ultrasound and biopsy in 6 months

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Hysterectomy and salpingo- oophorectomy staging laparotomy followed by radiation treatment

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High dose progesterone with follow up by endometrial biopsy

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Hysterectomy and salpingo oophorectomy staging laparotomy (omental and lymph node resection) and supplemental chemotherapy

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A 70 years old woman had a colporrhaphy due to pelvic organ prolapse 3 days prior to her presentation with left flank pain. Physical examination revealed severe sensitivity upon percussion and ultrasound shows severe hydronephrosis. Which following procedure is most likely to cause injury to ureter

Uterosacral ligament suspension

Correct Incorrect Correct answer

Sacrospinous ligament fixation

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Abdominal sacrocolpopexy

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Vaginal mesh colpopexy

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An 80 years old widow with a background of heart failure underwent transvaginal hysterectomy and pelvic organ prolapse repair 10 years ago, she now present with prolapse of the vaginal stump. Examination reveals prolapse grade 4 and trial of pessary insertion failed. What is the most appropriate treatment

Abdominal sacrocolpopexy

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Laparoscopic sacrocolpopexy

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Colpocleisis

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Burch colposuspension

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In which of the following situations is intraoperative prophylactic antibiotics indicated in addition to preoperative antibiotic treatment?

Hysterectomy in a 90 years old woman 90 kg, intraoperative bleeding around 500 ml

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Salpingo-oophorectomy in a woman with history of pelvic infection

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Cesarean section due to placenta accreta with hemorrhage of 1800 ml

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Transvaginal hysterectomy while opening the peritoneum

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A 64 years old woman undergoing workup for vaginal bleeding. Ultrasound scan reveals thickened endometrium and solid 6cm in diameter, right ovarian mass. Endometrium biopsy demonstrated complex hyperplasia with atypia, and serum estradiol was high. Hysterectomy with salpingo-oophorectomy was performed. Which of the following is most likely the pathology of the ovarian mass ?

Papillary serous carcinoma

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Borderline serous tumor

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Transitional epithelium

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Granulosa theca cell tumor

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24 years old primigravida with vaginal bleeding and hyperemesis on week 7 post menstrual age. Ultrasound reveals a gestational sac with small fetal echo and no pulse, and around it cystic finding with a snow storm appearance. BHCG was 40,000. Curettage was performed . which of the following is the most typical findings in examining the uterine content ?

Absence of fetal blood cells

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Negative p-57 stainN

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Diffuse types of trophoblast cells

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Triploid karyotype 69xxy

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26 years old woman with purulent foul smelling vaginal discharge, vaginal itching and burning sensation while urinating, vaginal smear reveals parasites with flagella. Which of the following is the most appropriate treatment ?

Cefazolin 500 mg X 3/d , for 7 days

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Single dose of po metronidazole 2g

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Single dose of IM penicillin G5000 units

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po ciprofloxacin in 500 mg X 2/d , for a week

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All of the following vaccines are indicated in pregnancy except?

Pertussis vaccine at 32 weeks gestation

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Tetanus vaccine at 10 weeks gestation following exposure

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An active varicella vaccine at 13 weeks gestation following exposure

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Inactivated polio vaccine (salk) at 28 weeks gestation during a polio epidemic

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Which of the following is the most appropriate candidate for trial of labor after cesarean section (TOLAC) given a normal fetal monitor pattern?

History of cesarean section at full dilatation and a 2900 g fetus

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History of classic ( longitudinal ) c section

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History of cesarean section due to twin pregnancy and induction is now indicated due a macrosomic fetus

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History of cesarean section due to non-reassuring fetal monitoring

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Which of the following describes the treatment for a pregnant woman with SLE and antiphospholipid syndrome?

Aspirin and coumadin throughout the pregnancy

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Plaquenil and clexane starting at 20 weeks PMA

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Aspirin and clexane throughout the pregnancy

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Aspirin starting at 12 weeks PMA

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Which of the following is considered pathology in a woman 1 week postpartum (vs. the end of a normal pregnancy)?

Decrease in total blood volume

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Increase in cardiac output

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Increase total lung capacity

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Increase in platelet adhesion

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Which of the following diseases is inherited autosomal dominant fashion?

Achondroplasia

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Familial dysanatomia

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Cystic fibrosis

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Ataxia telangiectasia

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Which of the following neonatal complications is typical in pregnancies at unbalanced type 1 diabetic women?

Heart defects

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Limb defects

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Neonatal hypothyroidism

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Neonatal hyperglycemia

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A woman in her 38 gestation of gestation with a headache. Blood pressure is 155/115 on two separate measures and urinalysis is positive for protein +3.which of the following is the next step in this patient`s managment ?

Medically stabilize the blood pressure and await spontaneous labor.

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Immediate caesarean section

Correct Incorrect Correct answer

Stabilize blood pressure ,evaluate urine output and coagulation panel and induce labor while administering magnisium sulphate.

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Immediate treatment with magnesium,corticosteroids,and nitroprusside while inducing labor

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Which of the following statements regarding infections during pregnancy is true?

Para virus B19 may cause severe fetal polycythemia

Correct Incorrect Correct answer

Varicella virus may cause congenital defects in gastrointestinal tract

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Treponema paldidum (syphilis) may cause smaller than normal placenta

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Rubella virus may cause blindness and deafness in the neonate

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Which of the following defines a normal non stress test ?

Two acceleration of at least 20 beats/min for 10 seconds over 15 minutes

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One acceleration of at least 30 beats/min for 30 seconds over 20 minutes

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Two acceleration of at least 15 beats for 15 seconds over 20 minutes

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One acceleration of at least 10 beats/min for 20 seconds over 15 minutes

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A healthy women in her 32 nd week of pregnancy presents to the emergency room with worsening shortness of breath,cough and palpations. Upon arrival her blood pressure is normal, pulse 135 beats/min, temperature 37.1, cbc is normal. Ecg demonstrates sinus tachycardia with significant right axis deviation. Which of the following is most reliable diagnostic test?

D-dimer measurement

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Ct angiography

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Chest radiograph

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Ventilation-perfusion scinigraphy

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Which of the following is risk factor for preterm labor?

Maternal age of 30

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Regular physical activity during the pregnancy

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A history of labor at 34 week gestation

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Maternal BMI of 25

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A disabled 90 year old female with dementia is referred from nursing home to the hospital due to altered conscious and refusal to eat or drink for past tow days. Her systolic blood pressure 140 and her serum Na level is 163 meq/L which of the following is the most appropriate mean to correct this electrolytes disorder ?

iv 0.9% saline, 2000 ml

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iv 0.45% saline , 2000ml

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iv 5% dextrose ,2000ml

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water via nasogastric tube 2000ml

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A 55 year old male has diabetic , end stage renal failure , and treated with permanent hemodialysis , his serum potassium level 6.7 ,ecg shows new AV block with wide complex bradycardia , what is the intial treatment?

Beta agonist inhelation

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IV calcium gluconate

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IV dextrose and insulin

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Order urgent dialysis

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A 76 year old male present with abdominal pain , jaundice , and weight loss, he has elevated total bilirubin , elevated direct bilirubin , elevated ALP while ALT and AST are normal , he is admitted due to bilateral DVT , which of the following test most likely confirm the diagnosis ?

Anti HBV igm

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CA-125

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Anti mitochondrial antobody

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CA-19-9

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A 32 year old male complains of dysphagia to solid food, weight loss, upper abdominal pain and nausea, all tgese symptoms are worsening in the past month. What is the most appropriate next test?

Gastroscopy

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Colonscopy

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ERCP

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Total body CT

Correct Incorrect Correct answer

88 years old is admitted due to intermittent chest pain in the last 24 hours, he is unconscious and blood pressure cannot be measured, ecg:
The most appropriate management:

Unsynchronized cardiovention

Correct Incorrect Correct answer

IV metaprolol 5 mg

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Synchronized cardiovention

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IV ikacor 5 mg

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70 years old male is admitted due to COPD exacerpation, during admition (MAT) is noted, what is the most appropriate management:

Improve breathing and control COPD exacerbation

Correct Incorrect Correct answer

Beta blockers

Correct Incorrect Correct answer

Calcium channel blocker

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Amiodarone

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Xray, 71 years old male with severe heart failure is admitted due to dyspnea and dry cough, what is the correct description:

Bilateral congestion typical of left heart failure

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Right pleural effusion typical of right heart failure

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Large right consolidation typical of pneumonia

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Left hyperinfiltration typical of obstructive disease

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The treatment of patient with stable coronary heart disease that not undergo coronary stent placement:

Aspirin alone

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Aspirin + clopidogrel

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Aspirin + ticagrelor

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Aspirin + prasugrel

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52 years old acute myocardial infarction 2 years ago treated for systolic heart failure, recently complains breast enlargement and sensitivity, which drugs may cause this phenomenon?

Aspirin

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Eplerenone

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Spironolactone

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Hydrochlorothiazide

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70 years old male complains abdominal pain, physical examination is normal, labs: (hemoglobin 7.7) (MCH 18) (RDW 24%) (reticulocyte 1.2%) (serum iron 13) (urea 12) what is the next step in evaluation:

Total body ct and oral + iv contrast

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Liver and bile duct ultrasound

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Colonoscopy

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Gastroscopy

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61 years old female is admitted due to malaise , (hemoglobin 7.4) ( creatinine 2.2) (LDH 660) (thrombocytopenia 64000), new visual field deficit is demonstrated and temp 38.4 . What is the most important initial study:

Coombs test

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Peripheral blood smear

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ESR

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Blood culture

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81 years old male complains lack of apitite and early satiety, physical exam reveals enlarement of spleen, CBC demonstrate 82000, lymphocytes + 120000 thrombocytes, diagnosed with CLL, what stage is the disease:

Very low risk according to rai and binet

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Low risk according to rai and binet

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Intermediate risk according to rai and binet

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Advanced stage, high risk according to rai and binet

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21 years old male is admitted for investigation of weight loss and night sweat, enlargement of spleen, cervical + inguinal lymphadenopathy, LABS: mild anemia, normal thrombocytes, hyoerkalemia, elevated uric acid, acute renal failure, what is the most propable disease:

ALL

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AML

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Lymphoma + tumor lysis syndrome

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Severe bacterial sepsis

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77 years old female who live at home complains burning sensation, frequency + urgency while urination, urinalysis is negative for nitrates, urine culture is positive with over 100000 colonies of gram positive cocci, what is expected pathogen:

Streptococcus pneumonia

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Enterococcus fecalis

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Haemophilus influenza

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Escherichia coli

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A 42 years old female with breast cancer is treated with chemotherapy via port-A-cath central line she admitted with a fever of 40 decrease of systolic Bp to 65 deteriorated consciousness nausea and vomiting which of the following must be included in the initial treatment?

Vancomycin

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Ceftriaxone

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Levofloxacin

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Clindamycin

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A 31 years old male born in Ukraine and migrated to israel last year complains of dyspnea weight loss night sweats productive cough in past two months bilateral consolidation are reported on chest x-ray necrotic lymph nodes are identified on CT. What is the next step in evaluation of this paitent ?

Empiric treatment with ceftriaxone

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Empiric treatment with levofloxacin

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Sputum testing for acid fasting staining (ziehl neelsen)

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Rigid bronchoscopy

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A 34 years old female is admitted to ER with high fever deteriorated consciousness nausea and vomiting initial physical examination reveals nuchal rigidity a brain CT scan is ordered and will be performed in 10 minutes. What is the next step in management of this paitent?

Blood cultures and delay therapy until CT results

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Lumbar puncture , blood cultures and delay therapy until CT results

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Blood cultures ,begin empiric antibiotic treatment and continue therapy after CT results

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Lumbar puncture ,blood cultures , begin empiric antibiotic treatment and continue therapy after CT results.

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A 55 years old male brought unconscious to the ER there is no previous medical history ( ECG attached) what is the diagnosis?

ST elevation MI

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Non ST elevation MI

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Complete AV block

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Pacemaker rhythm

Correct Incorrect Correct answer

Which of the following causes membranous nephropathy?

Pharyngitis

Correct Incorrect Correct answer

Psychogenic polydipsia

Correct Incorrect Correct answer

Alports syndrome

Correct Incorrect Correct answer

Systematic lupus erythematous

Correct Incorrect Correct answer

24 old year female is diagnosis with renal failure and hypertension since the age of 20 she had recurrent urinary tract infection during childhood and she has bilateral scarred kidney on ultrasound what is the most likely diagnosis?

Reflux nephropathy

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Hypertensive renal disease

Correct Incorrect Correct answer

Pyelonephritis

Correct Incorrect Correct answer

Polycystic kidney disease

Correct Incorrect Correct answer

35 year old Male is referred for evaluation of flank pain and hematuric for the past few months he was recently diagnosed with arterial hypertension suspect lower abdominal masses on physical examination his father and grandfather suffered from kidney problems and the father died of cerebral hemorrhage what is the most likely diagnosis?

Pyelonephritis

Correct Incorrect Correct answer

Renal stones

Correct Incorrect Correct answer

Tuberose sclerosis

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Polycystic kidney disease

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28 year old female presents with facial rash fever limbs edema malaise and renal failure she has lower serum albumin with proteinuria kidney biopsy demonstrates focal glomerulonephritis with sub epithelial and mesangial immune episitis as well as leukocyte infiltration what is the most likely diagnosis?

Lupus nephritis class 3

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Lupus nephritis class 2

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Lupus nephritis class 1

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Membranous glomerlunephritis

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Which of the following is caused by genetic mutation of type intravenous collagen in the glomerulas basal membrane?

Berger's syndrome

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Liddle's syndrome

Correct Incorrect Correct answer

Goodpasture syndrome

Correct Incorrect Correct answer

Alport's syndrome

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A 70 year old Male with past history of colon cancer that was treat with surgery and abdominal radiotherapy is admit for evaluation of weight loss fatigue nausea and back pain he has acute renal failure and normocytic anemia ultrasound demonstrates bilateral hydronephritis intravenous fluids do not improve the renal function what is the most likely diagnosis?

Retroperitoneal fibrosis

Correct Incorrect Correct answer

Aortic aneurysm

Correct Incorrect Correct answer

Amyloidosis

Correct Incorrect Correct answer

Renal cell carcinoma

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A 55-year-old male is treated with prophylactic aspirin on admission he presents with painless hematuria and no other urinary complaints. He smokes half a pack of cigarettes for 20 years.
Urinalysis shows hematuria. What is the most likely diagnosis?

Kidney stones

Correct Incorrect Correct answer

Metastatic lung cancer

Correct Incorrect Correct answer

UTI

Correct Incorrect Correct answer

Bladder cancer

Correct Incorrect Correct answer

A 55-year-old male has elevated serum GT (GGT) what is the clinical significance?

GGT is not elevated in obstructive jaundice

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GGT is the only marker for liver disease monitoring

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GGT is the only test elevated in obstructive jaundice

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GGT is elevated in alcohol consumption and fatty liver

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A 57-year-old male is evaluated for abdominal pain and diarrhea, he complains of cough, fever and arthritis. Duodenal biopsy show macrophages with periodic acid Schiff staining.
What is the most likely diagnosis?

Chron’s disease

Correct Incorrect Correct answer

Celiac disease

Correct Incorrect Correct answer

Whipple disease

Correct Incorrect Correct answer

Carcinoid syndrome

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70 tear old male is admitted to the E.R with abdominal pain and a new atrial fibrillation on the E.C.G. the pain is constant at 10/10, the abdomen is soft with no peritonitis. What is the next step?

CT angiography

Correct Incorrect Correct answer

Plain abdominal X-ray

Correct Incorrect Correct answer

Chest X-ray

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Serum amylase and lipase

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48-year-old female is evaluated for fatigue, arthritis, mood change, new onset of diabetes and enlarged liver. Which of the following supports the diagnosis of hemochromatosis?

CRP

Correct Incorrect Correct answer

Hemoglobin

Correct Incorrect Correct answer

Transferrin saturation

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Urine and serum copper levels

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A 45-year-old male with reflux and abdominal pain, mild epigastric tenderness and no supraclavicular lymphadenopathy. Gastroscopy revels small ulcer, biopsy shows low grade MALToma. What is the recommended treatment at this stage?

Chemotherapy

Correct Incorrect Correct answer

Partial gastrectomy

Correct Incorrect Correct answer

Radiotherapy

Correct Incorrect Correct answer

H. pylori eradication

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A 30-year-old male returned from central America yesterday complains of high frequency watery diarrhea with abdominal pain. On physical examination he is slightly pale, mild abdominal tenderness, active peristalsis, no skin rash or lymphadenopathy, no fever blood pressure 100/80 heart rate 100 BPM what is the causing agent?

Enterotoxigenic/ aggressive E. coli

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Salmonella

Correct Incorrect Correct answer

Norovirus

Correct Incorrect Correct answer

Giardia lamblia

Correct Incorrect Correct answer

60-year-old female with 2 month of back pain that disturbs her sleep, thirst, constipation, normocytic anemia, thrombocytopenia, leucopenia, acute renal failure and hypercalcemia. What is the most likely diagnosis?

Secondary amyloidosis

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Non-Hodgkin lymphoma

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Multiple myeloma

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B12 deficiency

Correct Incorrect Correct answer

A 30-year-old male with severe retractable asthma that is treated with multiple cycles of systemic steroids now complains of left thigh and inguinal pain that worsens when he steps. Which test will help confirm the most likely diagnosis?

Auto antibodies

Correct Incorrect Correct answer

CRP

Correct Incorrect Correct answer

Left knee X-ray

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Left hip joint MRI

Correct Incorrect Correct answer

A 61-year-old farmer complains of right hip joint pain that worsens in the last year. The pain is worse during work and peaks at the end of the day and during strenuous activity. What is the most likely diagnosis?

Osteoarthritis

Correct Incorrect Correct answer

Gout

Correct Incorrect Correct answer

Rheumatoid arthritis

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Septic arthritis

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Which of the following Antibodies is the most prevalent in patient with lupus?

Anti-SM

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Anti double stranded DNA

Correct Incorrect Correct answer

Rheumatoid factor

Correct Incorrect Correct answer

Anti-nuclear antibodies

Correct Incorrect Correct answer

Which of the following is most associated with Raynaud’s phenomenon?

SLE

Correct Incorrect Correct answer

Polymyositis

Correct Incorrect Correct answer

Ankylosis spondylitis

Correct Incorrect Correct answer

Systemic sclerosis

Correct Incorrect Correct answer

A 71-year-old male is admitted due to right heart failure exacerbation and is treat his persistent hypokalemia. Which of the following blood test may aid in solving this problem?

Serum phosphate level

Correct Incorrect Correct answer

Serum magnesium level

Correct Incorrect Correct answer

Serum vitamin K level

Correct Incorrect Correct answer

Serum vitamin B12

Correct Incorrect Correct answer

A 51-year-old male is admitted with symptomatic atrial fibrillation. He is started on sotalol. What needs to be followed during his admission?

Renal function

Correct Incorrect Correct answer

Lung function

Correct Incorrect Correct answer

QT segment on ECG

Correct Incorrect Correct answer

Left ventricle ejection fraction (LVEF)

Correct Incorrect Correct answer

A 47-year-old female with metastatic breast cancer complains of back pain and urinary incontinence on examination symmetric motoric weakness. MRI diagnoses neoplastic spinal cord compression. What is the next step in management?

Radical mastectomy and adjuvant radiation

Correct Incorrect Correct answer

Radiation therapy within one-week symptoms onset

Correct Incorrect Correct answer

Immediate therapy with dexamethasone

Correct Incorrect Correct answer

Urodynamic testing of the pelvic floor for urinary incontinence

Correct Incorrect Correct answer

A 50-year-old male is diagnosed with small cell lug cancer by chest -abdomen-pelvic CT and a biopsy. What testis essential in the evaluation of the disease?

Brain MRI

Correct Incorrect Correct answer

Renal ultrasound

Correct Incorrect Correct answer

Liver and bile ducts ultrasound

Correct Incorrect Correct answer

EEG

Correct Incorrect Correct answer

Which of the following treatments has been proved to prolong the life expectancy of patients with chronic obstructive pulmonary disease (COPD)?

Bronchodilator inhalation

Correct Incorrect Correct answer

Steroid inhalation

Correct Incorrect Correct answer

Systemic steroids

Correct Incorrect Correct answer

Oxygen

Correct Incorrect Correct answer

Which of the fallowing side effects is associated with SGLT2 inhibitors?

Lower respiratory tract infection

Correct Incorrect Correct answer

Urinary tract infection

Correct Incorrect Correct answer

Autoimmune diseases

Correct Incorrect Correct answer

Cardiovascular events

Correct Incorrect Correct answer

A 76 year-old-female is seropositive for beta 2 glycoprotein, lupus anti-coagulant, anti-cardiolipin. Past history is positive for 3 abortions and lower limb deep vein thrombosis DVT. She now complains of dyspnea and right chest pain.
Which of the following test should be performed?

Lower limbs doppler ultrasound

Correct Incorrect Correct answer

Serum D-dimer levels

Correct Incorrect Correct answer

CT-angio of the pulmonary arteries

Correct Incorrect Correct answer

Heart echo

Correct Incorrect Correct answer

A 22-year-old-female started taking oral contraceptive 3 months ago. She now has painful lesions on the shins (attached photo). What is the most likely diagnosis?

Discoid lupus

Correct Incorrect Correct answer

Erythema nodosum

Correct Incorrect Correct answer

Pyoderma gangrenosum

Correct Incorrect Correct answer

Pityriasis rosea

Correct Incorrect Correct answer

Healthy,50 y.o, 1 week with cephalexin for skin infiction diffuse skin praitius alt+ ast x5 what is the diagnosis?

Auto immun hepatitis

Correct Incorrect Correct answer

HCC

Correct Incorrect Correct answer

Cholescyctitis

Correct Incorrect Correct answer

DILT

Correct Incorrect Correct answer

30 y.o with penicillin for streptococal pharyngitis and dyspnia and mulasia, tachycardia, tachypnia, BP 70/30, treatment?

Stop penicillin and start guinolone

Correct Incorrect Correct answer

Im epinephrine

Correct Incorrect Correct answer

Po presone

Correct Incorrect Correct answer

D loratudine

Correct Incorrect Correct answer

62 y.o malase and new renal failure , calcium 12.4, normal PTH, what is the diagnosis?

Malignancy associated hypercalcimia

Correct Incorrect Correct answer

Sarcodiosis

Correct Incorrect Correct answer

Primary hyperparathyroidsm

Correct Incorrect Correct answer

Vitamin D intoxicatig

Correct Incorrect Correct answer

19 y.o diabetes (DM) type 1 nausea , abdominal pain not eating will and stop insulin , biocarbonat 12, what is the diagnosis?

HHS

Correct Incorrect Correct answer

Diabetic gastroparesis

Correct Incorrect Correct answer

Acute gastroenteritis

Correct Incorrect Correct answer

Diabetic keto acidosis

Correct Incorrect Correct answer

57 y.o female has urosepsis in admissin she develop sever epistaxis and right calf swelling has sever thrombocytopenia , prolong pt,ptt, fragmented cell on blood smear. What is the diagnosis?

Disseminated intravascular coagulation(DIC)

Correct Incorrect Correct answer

IPT

Correct Incorrect Correct answer

Autoimmune hemolytic anemia

Correct Incorrect Correct answer

Aplastic anemia

Correct Incorrect Correct answer

A patient that underwent Roux-En-Y bypass 6 months ago , now complains of significant malaise , facial flushing , abdominal pain and diarrhea shortly after mostly sweet meals , what is the most likely diagnosis?

Early dumping syndrome

Correct Incorrect Correct answer

Colon obstruction

Correct Incorrect Correct answer

Lactic acidosis

Correct Incorrect Correct answer

Inflammatory bowel disease

Correct Incorrect Correct answer

An exclusively breast fed 2month old infant is seen in clinic .the mother is a strict vegetarian and does not eat Any animal products. What is the specific dietary vitamin would be given to the mother

Vitamin A

Correct Incorrect Correct answer

Vitamin B12

Correct Incorrect Correct answer

Vitamin E

Correct Incorrect Correct answer

Vitamin K

Correct Incorrect Correct answer

A 1week old infant presents with fever of 39C and vomiting.On examination he is alert but fussy and cries with palpations of his abdomen .on evaluation urine Analysis shows 50-100 WBC/HPF with positive leukocyte Estrace and nitrites CSF examinations is normal And cultures from Blood,Urine are pending ,Which is the best Empiric Treatment

Ampicilin and gentamicin

Correct Incorrect Correct answer

Cefriaxone and Ampicillin

Correct Incorrect Correct answer

Vancomycin and penicillin

Correct Incorrect Correct answer

Metrionadzole and Azithromycin

Correct Incorrect Correct answer

An 8 year old child is hospitalized because of paroxysms of severe Colicky Abdominal pain on Exam ,There is Generalized Abdominal Tenderness.An exploratory laparotomy Revelas an edematous Intestine without specific lesions .Postoperatively the Abdominal pain persists and hematuria develops.values of BUN and creatinine are normal.On the next day tender swelling of both Ankles and knead is noted .Which of the following is the most probable diagnosis?

Acute Post streptococcal Glomerulonephritis

Correct Incorrect Correct answer

Acute lymphoblastic leukemia

Correct Incorrect Correct answer

Familial Mediterranean Fever

Correct Incorrect Correct answer

Anphylacted fever

Correct Incorrect Correct answer

A 4950 male infant is delivered vaginally after a 38 weeks gestation complicates by maternal poorly controlled Type 2 Diabetes.A shoulder dystocia was noted during the delivery.At 4 hours of Age ,The baby’s left Arm is internally Rotated ,And the Forearm is extended and pronated .the baby doesn’t move her left Arm when the examiner assesses the Moro Reflex. Which physical Examination finding is associated with the finding of the Arm?

Absent left thumb

Correct Incorrect Correct answer

A hyperpigmented patch on the left ches

Correct Incorrect Correct answer

A 2 -vessel Umbilical Cord

Correct Incorrect Correct answer

A constricted Left pupil

Correct Incorrect Correct answer

A 4 year old male presents with 6 days of fever , Erythematous Tongue and lips non Exudative Bulbar Conjunctivitis,Cervical lymphadenopathy,And generalizes Macular Papular Rash .What is the appropriate treatment for this infant ?

Corticosteroid

Correct Incorrect Correct answer

NSAIDS

Correct Incorrect Correct answer

IVIG

Correct Incorrect Correct answer

IV Antibiotics

Correct Incorrect Correct answer

Male infant born 26week gestation developts tachycardia and abdominal destination prior to passing a blood tinged stool following his first feeding his exam reveals decreased tone and activity tenderness on palpation of the Abdomin,and and paucity of abdominal sounds. His abdomen X-ray shows diffuse pneumatosis intestinal without pneumoperitoneum or portal venous air what the most probable diagnosis?

Respiratory distress syndrome

Correct Incorrect Correct answer

Intestinal volvulos

Correct Incorrect Correct answer

Necrotizing enterocolitis

Correct Incorrect Correct answer

Intussuscueption

Correct Incorrect Correct answer

Which is the most common complication of child with tetraology of fallot that didn’t undergo acorrectivr surgery?

Brain abscess

Correct Incorrect Correct answer

Brain hemorrhage

Correct Incorrect Correct answer

Cerebral thrombosis

Correct Incorrect Correct answer

Bacterial endocardits

Correct Incorrect Correct answer

2 years old boy with one month history of slow growing, nontender mass beneath the right mandible the overlyning skin is erythematous and 2 days ago it began to spontaneously produce purulent drainage What is the most probable diagnosis ?

Burkitts lymphoma

Correct Incorrect Correct answer

Cat scratch disease

Correct Incorrect Correct answer

Cystic hygroma

Correct Incorrect Correct answer

Mycobactrial lymphoadenitis

Correct Incorrect Correct answer

36 week old is born to a mother with gestational diabetes birth weight is 4255g which laboratory result would be expected mostcommonly in this infant?

Hypoglycemia

Correct Incorrect Correct answer

Hypoglycemia

Correct Incorrect Correct answer

Hypocalcemia

Correct Incorrect Correct answer

Hypernatremia

Correct Incorrect Correct answer

12 years old girl developed jaundice, progressive tremors, emotionl liability and brown discoloration of limbic region of Corina, the girl has abnormality in which metabolic system?

Zinc

Correct Incorrect Correct answer

Lead

Correct Incorrect Correct answer

Copper

Correct Incorrect Correct answer

Iron

Correct Incorrect Correct answer

6 year old girl came in at end of summer with multiple dark lesions on legs and arms for tue last month, lesion about 1cm in size, dark, nonpalpable, non tender, and not pruritic. She complains of musquito bites over the summer, what is the diagnosis?

Impetigo

Correct Incorrect Correct answer

Post Inflammatory Hyperpigmentation

Correct Incorrect Correct answer

HSP

Correct Incorrect Correct answer

Tinea Corpis

Correct Incorrect Correct answer

12 year old female seen because of fever, arthritis, oral ulcers, malar rash and photosensitivity, you suspect autoimmune disease, what is the most specific test for this patient?

ANA

Correct Incorrect Correct answer

Double stranded DNA

Correct Incorrect Correct answer

Anti- Ro

Correct Incorrect Correct answer

Anti Histone Ab

Correct Incorrect Correct answer

Following 2 serious infections with N.meningitides, a diagnosis of terminal complement component dificiency was made. What vaccine is contraindicated in this patient

OPV

Correct Incorrect Correct answer

BCG

Correct Incorrect Correct answer

Rotavirus

Correct Incorrect Correct answer

None of the above

Correct Incorrect Correct answer

A 5-month-old infant is seen because of attacks of back extension and torticollis that happens a few times every day and last for 2-3 minutes. A Sandifer Syndrome is suspected, What is the reason for this phenomenon?

Hypoxemia attacks

Correct Incorrect Correct answer

Gastroesophageal reflux

Correct Incorrect Correct answer

A viral infection

Correct Incorrect Correct answer

Metabolic encephalopathy

Correct Incorrect Correct answer

A newborn infant is born with a port-wine nevus which is well demarcated over the distribution of the right trigeminal area of the face. Which is most frequently associated with this condition?

Hemangiomas of the abdominal viscera

Correct Incorrect Correct answer

Normal mental development

Correct Incorrect Correct answer

Glaucoma

Correct Incorrect Correct answer

Microcephaly

Correct Incorrect Correct answer

A 12-month-old boy is seen because of refusal to walk. He began walking at 10 months of age. He has been doing well until this point. His exam reveals a moderately ill infant with temperature of 39.2 C, an externally rotated left hip with limitation to passive and active motion. What is the causative organism for this illness?

Neisseria Meningitides

Correct Incorrect Correct answer

Group A streptococcus

Correct Incorrect Correct answer

Staphylococcus Aureus

Correct Incorrect Correct answer

Salmonella

Correct Incorrect Correct answer

All of the answers correct

Correct Incorrect Correct answer

3-week-old boy presents with a 4-day history of difficulty feeding with evidence of dyspnea and decreased urinary output. He is afebrile and lethargic with skin pallor most notable in the lower extremities. Auscultation of his heart reveals a gallop rhythm and peripheral pulses are absent in the feet. What is the cause of his current symptoms?

Bacterial Sepsis

Correct Incorrect Correct answer

Cardiogenic shock

Correct Incorrect Correct answer

Sickle cell disease

Correct Incorrect Correct answer

Azothermia

Correct Incorrect Correct answer

A 7-month-old girl has failure to thrive. She passed meconium 24 hours after birth and had one episode of rectal prolapse a month ago. There is no polyuria. She is normotensive on exam. Lab tests reveal a metabolic alkalosis.
Her renal function electrolytes, magnesium and hepatic panel are normal with a decreased serum albumin of 2.8 . What is the most probable diagnosis?

Bartter Syndrome

Correct Incorrect Correct answer

Cystic fibrosis

Correct Incorrect Correct answer

Gitelman Syndrome

Correct Incorrect Correct answer

Renal tubular acidosis

Correct Incorrect Correct answer

A 17-year-old female presents with a complaint of missed period. Menarche occurred at age 13, and her periods have been regular for last 18 months. She normally bleeds for 4 to 5 days with moderate flow. Her last menses was 2 months ago. After performing a history and physical exam, What would be the next laboratory test in her evaluation?

CBC

Correct Incorrect Correct answer

Urine β-hCG

Correct Incorrect Correct answer

Serum quantitative β-hCG

Correct Incorrect Correct answer

LH level

Correct Incorrect Correct answer

A patient with hus has the best prognosis when the syndrome is caused by?

Shigella infection

Correct Incorrect Correct answer

Factor h dificiency

Correct Incorrect Correct answer

Thrombomoduline deficiency

Correct Incorrect Correct answer

C3 synthesis mutation

Correct Incorrect Correct answer

A 10 years old male has cervical lymphodenopathy, eustachian tube blockage, nasal obstruction and epistaxis. A nasopharengeal carcinoma is diagnosed, infection with which organism caused this disease?

Rubella

Correct Incorrect Correct answer

Varciella

Correct Incorrect Correct answer

Ebshtain barr virus

Correct Incorrect Correct answer

Cytomegalo virus

Correct Incorrect Correct answer

In which immune deficiency disease do patients have a specific difficulty in dealing with an Ebshtain bar virus infection?

X- linked aggamaglobulinemia

Correct Incorrect Correct answer

X-linked lymphoproliferative syndrome

Correct Incorrect Correct answer

Ataxia telangioctasia

Correct Incorrect Correct answer

Chronic granulomatuse disease

Correct Incorrect Correct answer

A 5 years old boy presents with a number of grand mal seizures and the decision was made to start him on valporic acid treatment . The parents ask which factor may precipitate the appearance of liver necrosis while taking this drug?

Male gender

Correct Incorrect Correct answer

Age under 2 years

Correct Incorrect Correct answer

Family history of epilepsy

Correct Incorrect Correct answer

An allergic reaction to phenobarbitol

Correct Incorrect Correct answer

A 5- years old girl diagnosed with systemic lupus, is seen because of changes of behaviour and involuntary movements. On exam a milk made grip is noted. This sign represents which clinical problem?

Chorea

Correct Incorrect Correct answer

Atetosis

Correct Incorrect Correct answer

Dystonia

Correct Incorrect Correct answer

Pyramidal sign

Correct Incorrect Correct answer

12 years old girl is seen because of ptosis and muscle weakness after repetitive use. Mystenia gravis is suspected. Which drug is cotraindicated in this patient?

Penicillin

Correct Incorrect Correct answer

Propranolol

Correct Incorrect Correct answer

Succynlcholine

Correct Incorrect Correct answer

Phenytoin

Correct Incorrect Correct answer

In which of the following conditions is a tall stature is expected?

Turner syndrome

Correct Incorrect Correct answer

Klinfeltter syndrome

Correct Incorrect Correct answer

Celiac disease

Correct Incorrect Correct answer

Hypothyroidism

Correct Incorrect Correct answer

During circumcision procedure perform in an infant, a sener hypospadias and bilateral undereducdent tests were found. What should be the next diagnostic step?

Ametabolic screen

Correct Incorrect Correct answer

Karyotype

Correct Incorrect Correct answer

Kidney ultrasound

Correct Incorrect Correct answer

Barium enema

Correct Incorrect Correct answer

A 6 years old boy is evaluated for headaches. He reports two three episodes over the last 2months that are accompanied by initial onset of blurry vision followed by severe pounding-pain type .what is the cause for the headaches?

Migraine

Correct Incorrect Correct answer

Posterior fossa tumor

Correct Incorrect Correct answer

Chronic

Correct Incorrect Correct answer

Myopia

Correct Incorrect Correct answer

Which of the following reflexes is normally absent in a new born?

Statle

Correct Incorrect Correct answer

Plamar grasp

Correct Incorrect Correct answer

Parachute

Correct Incorrect Correct answer

Crossed adductor

Correct Incorrect Correct answer

A 4 years old girl is seen because of hair loss . On exam she has a 5-cm area of alopecia on the scalp over the right ear . Closer examination of the skin of the scalp in this area reveals smooth and shiny skin with no evidence of tiny broken hair or irritation of the underlying scalp.what is the diagnosis in this patient?

Tinea carpitis

Correct Incorrect Correct answer

Traction alopecia

Correct Incorrect Correct answer

Trichotilomania

Correct Incorrect Correct answer

Alopecia areata

Correct Incorrect Correct answer

A 6 –month-old infant has chronic cough . sweat chloride test show chloride 104 mmol/l (normal is <40) on the right arm and 108 on the left arm with adequete volume of sweat at each site. What is the next appropriate step in evaluating this patient?

Repeat the sweat test for confirmation and refer to a CF center

Correct Incorrect Correct answer

Refer to a geneticist for futher evaluation

Correct Incorrect Correct answer

Obtain stool elastase

Correct Incorrect Correct answer

Complete an endocrine workup for adrenal insuficiency

Correct Incorrect Correct answer

An 8-year old girl is having episodes where she stops moving and talking, demonstrates a blank facial expression, and rapidly blinks her eyelids. These episodes last about 5-15 seconds, after which she returns completely to her normal behavior, which pattern is expected in an EEG study in this patient?

Hypsarhythmia

Correct Incorrect Correct answer

Temporal lobe spikes

Correct Incorrect Correct answer

Generalized 4-5 Hz polyspike and slow wave discharge

Correct Incorrect Correct answer

Three per second spike and wave

Correct Incorrect Correct answer

A 6-month-old female infant is seen beacause of cough, shortness of breath, and wheezing. This is the second similar episode in this child . the parents are concerned about the outcomes of the disease in their child . which is a major early childhood risk factor for persistent asthma?

Allergic rhinitis

Correct Incorrect Correct answer

Parent asthma

Correct Incorrect Correct answer

Eosinophilia

Correct Incorrect Correct answer

Allergy to food

Correct Incorrect Correct answer

A 14-year-old boy with prune belly syndrome is seen because of chronic renal failure for the past 5 years. Which abnormality associated with untreated chronic renal failure is a common finding?

Microcytic anemia

Correct Incorrect Correct answer

Hyperparathyrodism

Correct Incorrect Correct answer

Osteosclerosis

Correct Incorrect Correct answer

Low growth hormone

Correct Incorrect Correct answer

A 3-year-old boy is evaluated because of few dark red skin lesions that are round and palpable on her thighs and waist. The lesions are slightly hyperkeratotic . biopsy obtained from a lesion reveals an angiokeratoma. The child complains of severe burning pain involving the palms and soles . what is the diagnosis of this patient ?

Gaucher disease

Correct Incorrect Correct answer

Fabri disease

Correct Incorrect Correct answer

Krabbe disease

Correct Incorrect Correct answer

Metachromatic leukodystrophy

Correct Incorrect Correct answer

It is mandatory to be vaccinated with meningococcal vaccine when traveling to which of the following cities?

Mecca

Correct Incorrect Correct answer

Johannesburg

Correct Incorrect Correct answer

Cairo

Correct Incorrect Correct answer

Moscow

Correct Incorrect Correct answer

A 12-year-old boy, new emigrant from the USA , is seen with a rash that is diagnosed as erythema migrans. This skin lesion is important in diagnosing an infection with which organism?

Borrelia burgdorferi

Correct Incorrect Correct answer

Treponema carateum

Correct Incorrect Correct answer

Mycobacterium lepra

Correct Incorrect Correct answer

Leptospira icteohemorrhagica

Correct Incorrect Correct answer

Which site is the most common to be affected with candida infection in 6 months old infant?

Vaginal

Correct Incorrect Correct answer

Diaper area

Correct Incorrect Correct answer

Nails

Correct Incorrect Correct answer

Lower neck

Correct Incorrect Correct answer

A previously healthy 8 week infant present with a hepoglycemic seizure and blood glucose of 14 mg/dl. on exam she appears helthy well hydrated and the 95% for both weight and length she has been brestfeeding every 3 hours aside from hypoglycemia comprehensive metabolic panel is normal. Her urinalysis showed negative ketones with no reducing substances. What is the most probably diagnosis?

Adrenal insufficiency

Correct Incorrect Correct answer

Glecogen storage disease

Correct Incorrect Correct answer

Galactosemia

Correct Incorrect Correct answer

Congenital hyperinsulinism

Correct Incorrect Correct answer

10 years 10 years E wing sarcoma presents with fever and neutropenia empiric IV antibiotics are administered an hour later he becomes hypotensive and unresponsive. On exam he has bleeding gums and petechiae. His laboratory results show a low platelet count prolonged PT and PTT his D-dimers are elevated his fibrinogen is decreased and RBC fragments are noted in the blood smear. What is the diagnosis?

Disseminated intravascular coagulopathy (DIC)

Correct Incorrect Correct answer

Idiopathic thrombocytopenic purpura (ITP)

Correct Incorrect Correct answer

Hemolytic-uremic syndrome (HUS)

Correct Incorrect Correct answer

Kassabach-merritt phenomena

Correct Incorrect Correct answer

A 6 month old male infant has profuse watery diarrhea, his pulse is 200 BPM, he has sunken eyes, capillary refill of 5 seconds, appears grey, and has weak central pulses and absent peripheral pulses. Six trials to get an IV started have been unsuccessful. What is the next step?!

Obtain a saphenous vein cut down

Correct Incorrect Correct answer

Intubate and administer fluids through nasogastric tube

Correct Incorrect Correct answer

Place line via an intraosseous needle

Correct Incorrect Correct answer

Place a subclavian central venous line

Correct Incorrect Correct answer

10 years old male is making unusual movement in the last 3 month previously healthy with normal development. On examination he grimaces and blinks sporadically .its not associated with pain or irritation .this movement occurs multiple times a day and seems to happen more often when the boy is tired or distressed.what is the diagnosis?

Obsessive-compulsive disorder

Correct Incorrect Correct answer

Toretto syndrome

Correct Incorrect Correct answer

Simple motor tics

Correct Incorrect Correct answer

Normal behavior

Correct Incorrect Correct answer

8 years old girl with no history present with an acute urticarial rash over the past 3 days . she had viral infection one week age prior to onset of rash. Which of the following is the most appropriate medication for the treatment of acute urticarial rash that lasting more than 3 month

Prednisone

Correct Incorrect Correct answer

Montelukast

Correct Incorrect Correct answer

Diphenhydramine

Correct Incorrect Correct answer

Propranolol

Correct Incorrect Correct answer

21 years old mother is given birth to a normally apprentice newborn she report that she is taking drugs, the use of which drug by the mother is a contraindication for breastfeed her child?

Codeine

Correct Incorrect Correct answer

Morphine

Correct Incorrect Correct answer

Cocaine

Correct Incorrect Correct answer

Methadone

Correct Incorrect Correct answer

The active vaccination for varicella is given to all children in Israel .the parent of a 1 years old girl are concerned about the policy and would like to know the fact about administration indication . which of the following patient is allowed to receive this vaccination?

A patient with cellular immunodeficiency

Correct Incorrect Correct answer

A pregnant women

Correct Incorrect Correct answer

A patient with humoral immunodeficiency

Correct Incorrect Correct answer

A patient with leukemia

Correct Incorrect Correct answer

A 6 month old male is seen because of gross motor delay and cardiomegaly, his parent were married in a consanguineous marriage which syndrome explain this patient condition.

Pompe disease

Correct Incorrect Correct answer

Tay-sach

Correct Incorrect Correct answer

Galactosemia

Correct Incorrect Correct answer

Myotonic muscular dystrophy

Correct Incorrect Correct answer

5 years old boy ate peanut butter within 5 min he develop shortness of breath, tongue swelling ,generalized urticaria, vomiting ,peanuts IGE is very elevated what should we recommend for the patient management.

Elimination of peanut from diet

Correct Incorrect Correct answer

Oral antihistamine

Correct Incorrect Correct answer

Oral steroid at the event of acute allergic reaction

Correct Incorrect Correct answer

Daily injectable epinepherine

Correct Incorrect Correct answer

6 years old previously healthy boy present to medical care with fever chills headache, chest radiograph show bilateral extensive interstitial infiltrates. His old sister has a kitten and a parrot, another parrot has died recently from unknown disease. What is the diagnosis of this patient?

Psittacosis

Correct Incorrect Correct answer

Mycoplasma pneumonia infection

Correct Incorrect Correct answer

Egionellosis

Correct Incorrect Correct answer

Influnza virus pnemonia

Correct Incorrect Correct answer

3 month male seen because of vomit and diarrhea his stool examination reveals a watery stool with no (blood ,white blood cell or lipid drops) reducing substance test positive on stool which diagnosis is consist with this finding

Cow milk protein allergy

Correct Incorrect Correct answer

Dysentery due to shigella

Correct Incorrect Correct answer

Intussusception

Correct Incorrect Correct answer

Lactose intolerance

Correct Incorrect Correct answer

A 2 years old present with several days of rectal bleeding ,the mother first noticed reddish colored stool 2 days ago and since then changed several diapers with blood. The child is afebrile, alert, playful, and is earing without emesis, he is tachycardic and his abdominal examination is normal. What diagnostic procedure should be ordered at this time?

barium enema

Correct Incorrect Correct answer

Abdominal ultrasound

Correct Incorrect Correct answer

Radionuclide scan

Correct Incorrect Correct answer

Stool culture

Correct Incorrect Correct answer

A 22-year old woman complains of fear of losing control, palpitations, shortness of breath, and nausea lasting 10 minutes and resolving spontaneously.
An organic workup did not reveal any abnormalities .
Which of the following is the most appropriate treatment:

Aripiprazole

Correct Incorrect Correct answer

Escitalopram

Correct Incorrect Correct answer

Haloperidol

Correct Incorrect Correct answer

Valproic acid

Correct Incorrect Correct answer

Which of the following is considered a specific phobia?

Technophobia

Correct Incorrect Correct answer

Pyrophobia

Correct Incorrect Correct answer

Social phobia

Correct Incorrect Correct answer

Intimacy phobia

Correct Incorrect Correct answer

Which of the following is included in the assessment of cognitive function during psychiatric evaluation?

Alterness, memory, and abstract thinking

Correct Incorrect Correct answer

Abstract thinking, perception disorders, and alterness

Correct Incorrect Correct answer

Abstract thinking, perception disorders, and alterness

Correct Incorrect Correct answer

Rate of thought, concentration, and alterness

Correct Incorrect Correct answer

Which of the following is a negative sign in psychiatry?

Delusion

Correct Incorrect Correct answer

Unorganized speech

Correct Incorrect Correct answer

Diminished affect

Correct Incorrect Correct answer

Hallucinations

Correct Incorrect Correct answer

A-30-year old man during a psychiatric evaluation describes prescution delusions with no perception disorders. He is restless, his speech is rapid, and when he asked where he lives describes the apartment, the street, and the neighbors, but doesn’t answer the actual question.

Blocking

Correct Incorrect Correct answer

Neologism

Correct Incorrect Correct answer

Tangentiality

Correct Incorrect Correct answer

Circumstantiality

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

C or/and D

Correct Incorrect Correct answer

Which of the following symptoms of diagnostic of catatonia?

Catalpsy,mutism, negatism

Correct Incorrect Correct answer

Narcolepsy,ecopraxia, corproxia

Correct Incorrect Correct answer

Mannerism, sterotypy panic attack

Correct Incorrect Correct answer

Stupor, neologism , agitation

Correct Incorrect Correct answer

Which of the following is not a part of differential diagnosis of schizophrenic like symptoms?

Vitamin B12

Correct Incorrect Correct answer

Neurosyphilis

Correct Incorrect Correct answer

Aids

Correct Incorrect Correct answer

Epilepsy

Correct Incorrect Correct answer

Which of the following will predict a bipolar disorder in a 30 years old with recurrent episodes of depression

Early onset

Correct Incorrect Correct answer

Depression without a significant psychomotor delay

Correct Incorrect Correct answer

Pre partum depretion

Correct Incorrect Correct answer

A history of good response to ssri

Correct Incorrect Correct answer

A 25 years old woman describes an almost daily most of the days over the last 3 years she described her concentration diffeclts low self estrogen decrease sleep and appetite she she denies ever experiencing manic symptom which of the following is the most likely diagnosis

Major depression with atypical features

Correct Incorrect Correct answer

SchiZoid personality disorder

Correct Incorrect Correct answer

Dysthymia

Correct Incorrect Correct answer

Cyclothymia

Correct Incorrect Correct answer

Which of the following is not a symptom of hypomania?

Inflated self esteem

Correct Incorrect Correct answer

Decreased need for sleep

Correct Incorrect Correct answer

Distractibility

Correct Incorrect Correct answer

Slowing of speech rate

Correct Incorrect Correct answer

Which of the following psychiatric disorder is treated with phototherapy?

Bipolar disorder with psychotic symptoms

Correct Incorrect Correct answer

Panic disorder with agoraphobia

Correct Incorrect Correct answer

Depressive disorder with a seasonal component

Correct Incorrect Correct answer

Obsessive compulsive disorder

Correct Incorrect Correct answer

A 35 year old man presents to the emergency room with a seizure for the first time in his life , he reveals that he had stopped taking his medication tow days ago after prolonged use.
Which of the following is most probably the medication he has stopped taking?

Risperidone

Correct Incorrect Correct answer

Clonazepam

Correct Incorrect Correct answer

Methylphenidate

Correct Incorrect Correct answer

Fluoxetine

Correct Incorrect Correct answer

A 40 years old women gave birth of her first baby 2 days ago. The baby is well, for the last week she cries constantly, she denies feeling of guilt sleeping problems and suicidal thoughts, she denies psychiatric disorder in her famly . Which of the following is the most likly diagnosis?

Major depression

Correct Incorrect Correct answer

Dysthymia

Correct Incorrect Correct answer

Baby blues

Correct Incorrect Correct answer

Premenstrual syndrome

Correct Incorrect Correct answer

An 80 years old man has been brought to the emergency room by his son, who describes an extreme change is his father state over the past 2 months . The father doesn’t speak much , sights , says, repeatedly that he is sick of life and when asked simple question such as what day it is answer with i dont know i dont remember. Which of the following is most likely diagnosis?

Alzheimers dementia

Correct Incorrect Correct answer

Picks dementia

Correct Incorrect Correct answer

Pseudo dementia

Correct Incorrect Correct answer

Eldery schizophrenia

Correct Incorrect Correct answer

A 42 years old schizophrenic womn on risperidone treatment for 10 years. Is brought to the emergency room by her husband which is worried about irregular movments she has been having lately including sticking out her tongue and making strange noises with her lips.
Which of the following is the most likely diagnosis ?

Akathisia

Correct Incorrect Correct answer

Parkinsons

Correct Incorrect Correct answer

Tardive dyskinesia

Correct Incorrect Correct answer

Dystonia

Correct Incorrect Correct answer

Which of the following is the most common reason for delirium 3 days after surgery in a 40 year old alcoholic man.

Infection

Correct Incorrect Correct answer

Pain medication

Correct Incorrect Correct answer

Post surgery pain

Correct Incorrect Correct answer

Delirium tremens

Correct Incorrect Correct answer

Which of the following is not true regarding a child with ADHD.

There is increased risk for ADHD in his siblings.

Correct Incorrect Correct answer

The child is at decreased risk for behavioral problems compared to the population.

Correct Incorrect Correct answer

Of all the symptoms hyperactivity is the most common to pass with tim.

Correct Incorrect Correct answer

There is a good chance he will respond to methylphenidate.

Correct Incorrect Correct answer

A basically pleasant ; shy. Responsible and hard working man has sustained a head injury in his place of work. Since his injury he has been making sexual comments to his friends loses his concentration easily and is easy to get angry at minimal provocations.
Which part of his brain was most probably injured?

Occipital lobe

Correct Incorrect Correct answer

Frontal lobe

Correct Incorrect Correct answer

Temporal lobe

Correct Incorrect Correct answer

Limbic lobe.

Correct Incorrect Correct answer

Which of the following is true regarding hoarding disorder by the DSM 5?

Is classified as a separate disorder

Correct Incorrect Correct answer

Is part of anxiety disorder

Correct Incorrect Correct answer

Is part of neuro cognitive disorder

Correct Incorrect Correct answer

Is part of personality disorder

Correct Incorrect Correct answer

Which of the following is true regarding the suicide risk among psychiatric patients?

Psychiatric patient have a double fold risk for suicide compared to the general population.

Correct Incorrect Correct answer

There is no established association between psychiatric hospitalization and suicide risk.

Correct Incorrect Correct answer

A history of psychiatric hospitalization increase the risk for suicide.

Correct Incorrect Correct answer

The suicide risk during a psychiatric hospitalization is stable.

Correct Incorrect Correct answer

Which of the following is true regarding the use of atypical (second generation) antipsychotic medications.

There is an FDA warning regarding the risk for metabolic in all of these drugs.

Correct Incorrect Correct answer

It is a safe treatment for psychosis in adult patients with dementia.

Correct Incorrect Correct answer

These drugs are more effective in the treatment of negative symptom of schizophrenia as compared to positive symptoms.

Correct Incorrect Correct answer

Clozapine is the treatment of choice for treatment resistant major depression disorder.

Correct Incorrect Correct answer

Which of the following is true regarding clozapine treatment?

Dose does not influence the risk for seizures.

Correct Incorrect Correct answer

A complete blood count should be performed twice a week during the first year of treatment.

Correct Incorrect Correct answer

Over salivation is a rare adverse effect.

Correct Incorrect Correct answer

Myocarditis and cardiomyopathy are rare adverse effect.

Correct Incorrect Correct answer

Which of the following is true regarding lamotrigine?

When a rash appears the dose should be decreased by 50% and patients should be followed.

Correct Incorrect Correct answer

More effective for manic episodes than for depressive episodes.

Correct Incorrect Correct answer

There no need for blood level tests to determine the dosing.

Correct Incorrect Correct answer

Decrease in dose is indicated when used in combination with carbamazepine.

Correct Incorrect Correct answer

All are correct

Correct Incorrect Correct answer

All are false

Correct Incorrect Correct answer

Which of the following i true regarding course of bipolar disorder?

Bipolar disorder most commonly with a manic episodes.

Correct Incorrect Correct answer

30% of bipolar disorder patient are only manic.

Correct Incorrect Correct answer

An untreated manic episode will last an average of 13 month.

Correct Incorrect Correct answer

After approximately 5 episodes the inter episodes gap stabilizes.

Correct Incorrect Correct answer

A 16 year old giral attends a special needs class at school over the years she is described as a student with difficults especially in concentration an organization socially she is usually very quiet , spends the recess alone and hase no friends when there is a change in rutine such as a cancelled class due to a teachers illness a pop quiz or a field tripe. Her mother says that as an infant she used to bange hear head at the bed bars befor falling a sleep; always played on her own and excited used to jumb up down and wave her hands. Which of the following is the most likly diagnosis?

Paranoid oersonality disorder

Correct Incorrect Correct answer

Autism spectrum disorder

Correct Incorrect Correct answer

Childhood schizophrenia

Correct Incorrect Correct answer

ADHD without hyperactivity

Correct Incorrect Correct answer

Which of the following drug is most likely tu cause extrapyramidal side effects?

Chlorpromazine

Correct Incorrect Correct answer

Clozapine

Correct Incorrect Correct answer

Haloperidol

Correct Incorrect Correct answer

Ziprasidone

Correct Incorrect Correct answer

A 23-year-old woman complains of eating binges followed by feeling like she is loosing control. After the binges she goes for long runs and takes laxatives. This happens once a month over the last 6 months. She is 165 cm tall and weigh 70 kg. Which of the following is the most likely diagnosis?

Psychosomatic disorder

Correct Incorrect Correct answer

Anorexia nervosa

Correct Incorrect Correct answer

Hypothyrodism

Correct Incorrect Correct answer

Bulimia nervosa

Correct Incorrect Correct answer

Which of the following is the treatment for Tourette’s disorder?

Habit reversal

Correct Incorrect Correct answer

Methylphenidate 10mg/d

Correct Incorrect Correct answer

Levothyroxine

Correct Incorrect Correct answer

Inter personal therapy

Correct Incorrect Correct answer

Which of the following characterizes a child with ADHD according to the Dsm-5?

Hardly speaks during the day

Correct Incorrect Correct answer

Seems not to be listening when spoken to

Correct Incorrect Correct answer

Is able to await his turn

Correct Incorrect Correct answer

Remember his homework and assignments

Correct Incorrect Correct answer

Which of the following characterizes obession?

Inadequate reality testing

Correct Incorrect Correct answer

A bothersome mental image

Correct Incorrect Correct answer

Repetitive behavior

Correct Incorrect Correct answer

Does not cause stress

Correct Incorrect Correct answer

38 years old man has been injured in motor vehicle accident, since then he completely refrains from driving. He has episodes of reliving the accident, and when he is in the area of the accident experiences anxiety, palpitations, and diaphoresis

An undisturbed, dreamless, 8 hours sleep at night

Correct Incorrect Correct answer

Experiencing the world as a dangerous and scary place

Correct Incorrect Correct answer

Dramatic and attention drawn behavior

Correct Incorrect Correct answer

Woman voice cursing at him and blaming him for the accident

Correct Incorrect Correct answer

50 years old man accuses his wife being unfaithful, he has no proof, he is suspicious and follow her, in examination he reveals that since he was young he found it difficult to trust people and easily offended,tend to interpreting neutral saying as if they were against him.
Which of the following is the most likely the diagnosis?

Avoidant personality disorder

Correct Incorrect Correct answer

Paranoid personality disorder

Correct Incorrect Correct answer

Histrionic personality disorder

Correct Incorrect Correct answer

Dipendent personality disorder

Correct Incorrect Correct answer

Which of the following caratterizes narchessistic personality disorder?

A chronic feeling of emptiness

Correct Incorrect Correct answer

Drammatic and theatrical behavior exaggerated demonstration of feeling

Correct Incorrect Correct answer

Exaggerated occupation with fantasies of success and wealth

Correct Incorrect Correct answer

Preference for solo activities

Correct Incorrect Correct answer

Which principal will not be a part psycodynamic psycotherapy treatment?

Encouraging free associations

Correct Incorrect Correct answer

Having multiple sessions per week

Correct Incorrect Correct answer

Interpreting dreams

Correct Incorrect Correct answer

Directing the patient to conduct an anxiety attack diary

Correct Incorrect Correct answer

For which of the following exposure and response prevention is used?

Obsessive compulsive disorder

Correct Incorrect Correct answer

Delusional disorder

Correct Incorrect Correct answer

Schizotypal personality disorder

Correct Incorrect Correct answer

Dissociative disorder

Correct Incorrect Correct answer

In which of the following diseases hepatobiliary iminodiacetic acid (HIDA) can be used for diagnosis?

Acute appendicitis

Correct Incorrect Correct answer

Small bowel perforation

Correct Incorrect Correct answer

Acute cholecystitis

Correct Incorrect Correct answer

Thyroid carcinoma

Correct Incorrect Correct answer

Which of the following is the most common etiology for hemobilia?

Latrogenic injury

Correct Incorrect Correct answer

Tumor at the vater`s papilla

Correct Incorrect Correct answer

Coumadin treatment

Correct Incorrect Correct answer

Penetrating trauma

Correct Incorrect Correct answer

A 60-year-old male undergoes right hemicolectomy for colon cancer. Pathology reveals invasion to the muscularis layer but not to the peri-colic fat. Seventeen lymph nodes are free of tumor. What is the most acceptable treatment at this time?

Chemotherapy

Correct Incorrect Correct answer

Completion to subtotal colectomy

Correct Incorrect Correct answer

Follow-up only

Correct Incorrect Correct answer

Radiation to the surgical field

Correct Incorrect Correct answer

A 70-year-old man is admitted to the ER with sever abdominal pain and a fever of 39c. On examination he seems in the pain with diffuse peritonitis, CT demonstrates free abdominal air mild amount of free fluid, and thickening of the sigmoid with fat stranding around it . What is the most appropriate treatment?

Hydration, broad spectrum antibiotics, and close follow-up

Correct Incorrect Correct answer

Hydration, broad spectrum antibiotics, and urgent colonoscopy

Correct Incorrect Correct answer

Laparotomy and suturing of the bowel perforation

Correct Incorrect Correct answer

Laparotomy, resection of the segmoid, and the colostomy

Correct Incorrect Correct answer

A 68 year-old male is diagnosed with sigmoid volvulus. De-volvulus is performed via sigmoidoscopy and the patient is currently asymptomatic. What is the recommended further treatment?

Follow-up

Correct Incorrect Correct answer

Elective sigmoidectomy

Correct Incorrect Correct answer

Emergent sigmoidectomy

Correct Incorrect Correct answer

Sigmoidopexy to the abdominal wall

Correct Incorrect Correct answer

A 30-year-old female complains of a mass in the anterior abdominal wall that has increased in size over the past two months and causes discomfort. Abdominal CT demonstrates a homogenous mass that arises from the abdominal wall soft tissue, biopsy demonstrates spindle cells and fibrous strome. Immunohistochemistry staining is positive for b-catenin. What is the recommended treatment?

Chemotherapy

Correct Incorrect Correct answer

Follow-up

Correct Incorrect Correct answer

Wide margin excision

Correct Incorrect Correct answer

Radio frequency ablation (RFA)

Correct Incorrect Correct answer

A woman undergoes routine mammography with findings compatible with BIRADS5. What is the most appropriate next step?

Follow-up

Correct Incorrect Correct answer

CT guided biopsy

Correct Incorrect Correct answer

Stereotactic biopsy

Correct Incorrect Correct answer

Lumpectomy and sentinel lymph node biopsy

Correct Incorrect Correct answer

A 60-year-old female undergoes lumpectomy for ductal carcinoma in-situ (DCIS). Pathology reveals that the tumor is invasive ductal carcinoma. What is the most appropriate next step?

Completion to mastectomy

Correct Incorrect Correct answer

Another surgery for the sentinel lymph node biopsy

Correct Incorrect Correct answer

Prophylactic contra-lateral mastectomy

Correct Incorrect Correct answer

Follow-up

Correct Incorrect Correct answer

For which of the following annual breast MRI follow-up is recommended?

A 65-year-old female with a history of breast cancer

Correct Incorrect Correct answer

A 35-year-old female following surgery for phyllodes tumor

Correct Incorrect Correct answer

A man with a history of breast cancer

Correct Incorrect Correct answer

A 50-year-old female with a history of radiation to the chest due to lymphoma

Correct Incorrect Correct answer

A 68-year-old female with 3cm invasive breast cancer.
Estrogen receptor (ER) – positive
Progesterone receptor (PR) – positive.
HER2/neu-positive
A biopsy from a suspicious axillary lymph node demonstrates carcinoma. What is the most appropriate treatment?

Lumpectomy and axillary lymph node dissection

Correct Incorrect Correct answer

Neoadjuvant chemotherapy

Correct Incorrect Correct answer

Mastectomy and sentinel lymph node biopsy

Correct Incorrect Correct answer

Lumpectomy and sentinel lymph node biopsy

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

C or/and D

Correct Incorrect Correct answer

30 M referred to the ER for severe abdominal pain. Examination pain abdominal peritonitis. Surgery pre pyloric 7mm perforation identified. Preferred surgical procedure?

Heineke mikulicz pyloroplasty

Correct Incorrect Correct answer

Graham's patch repair

Correct Incorrect Correct answer

Antrectomy

Correct Incorrect Correct answer

Pyloric exclusion

Correct Incorrect Correct answer

58 M appendectomy. During surgery 1.5 cm mass noted appendiceal tip. Pathology- mucinous adenocarcinoma. Appropriate treatment:

Follow-up

Correct Incorrect Correct answer

Resection of the cecum

Correct Incorrect Correct answer

Radiation therapy to appendiceal bed

Correct Incorrect Correct answer

Right hemicolectomy

Correct Incorrect Correct answer

80 M diagnosed with gastric ulcer that is benign on biopsy. Following therapeutic course for h.pylori and anti acids a repeat gastroscopy is performed and the ulcer is demonstrated again, repeat biopsy is benign as well. What is the most appropriate treatment at this time?

Another therapeutic course for H.pylori and anti acids

Correct Incorrect Correct answer

Endoscopic resection of the ulcer

Correct Incorrect Correct answer

Surgical resection of the ulcer

Correct Incorrect Correct answer

Treatment with sucralfate for 3 moths and repeat gastroscopy

Correct Incorrect Correct answer

80 M admitted to the ER with abdominal distention and constipation for 4 days. Abdominal CT with rectal examination reveals obstruction sigmoid mass and proximal colon that is vary distended. What is the recommended procedure at this time?

Urgent colonoscopy and biopsy of the mass

Correct Incorrect Correct answer

Hartmann’s procedure

Correct Incorrect Correct answer

Sigmoidectomy and anastomosis

Correct Incorrect Correct answer

Total abdominal colectomy and end ileostomy

Correct Incorrect Correct answer

69 M complains anal pain during bowel movements and some blood on the toilet paper. A proctologist identifies anal fissure. What is the first line of treatment?

Lateral internal sphincterotomy

Correct Incorrect Correct answer

NSAIDS

Correct Incorrect Correct answer

Biofeedback

Correct Incorrect Correct answer

Topical treatment with nitroglycerin ointment

Correct Incorrect Correct answer

75 M referred to the ER due to scleral and skin jaundice for the past week. Examination scleral and skin jaundice and looks cachectic. In his right upper quadrant a smooth nontender mass is palpated. Rectal examination- acholic stool. Labs-elevated bilirubin and CA 19-9. What is the common name of the abdominal finding?

Courvoisier sign

Correct Incorrect Correct answer

Rovsing sing

Correct Incorrect Correct answer

Virchow node

Correct Incorrect Correct answer

Murphy sing

Correct Incorrect Correct answer

What is true with regards of femoral hernia?

The most conmen hernia in female

Correct Incorrect Correct answer

Cooper’s ligament is the upper border of the hernia

Correct Incorrect Correct answer

The hernia is medial to the femoral vein

Correct Incorrect Correct answer

An inguinal hernia is also identified in the majority of the cases

Correct Incorrect Correct answer

Which of the following is true regarding umbilical hernia in children?

There is high incidence of complications such as incarceration and therefore surgery should be performed as early as possible

Correct Incorrect Correct answer

Surgery is performed if the hernia does not close until the age of 2 years.

Correct Incorrect Correct answer

Commonly operated until age of 5 years

Correct Incorrect Correct answer

It is congenital and common hernia that is most cases will spontaneously close till the age of 2.

Correct Incorrect Correct answer

Which of the following is true regarding diagnostic laparoscopy for acute abdomen?

The prominent advantage is high diagnostic rate and the ability to treat laparoscopy a number of etiologies that cause acute abdomen

Correct Incorrect Correct answer

The diagnostic rate is only 50%

Correct Incorrect Correct answer

It is mostly adventitious in retroperitoneal pathologies

Correct Incorrect Correct answer

The utility pf diagnostic laparoscopy is decreasing

Correct Incorrect Correct answer

Which of the following is a clear positive and suspicious finding on diagnostic peritoneal lavage (DPL) for evaluation of acute abdomen?

A-Bilirubin in the lavage fluid

Correct Incorrect Correct answer

More than 1000 WBCs/ml in the lavage fluid

Correct Incorrect Correct answer

Creatinine in the lavage fluid

Correct Incorrect Correct answer

More then 50,000 RBCs/ml in the lavage fluid

Correct Incorrect Correct answer

Which of the following tests should be preformed in an elderly patient that arrives to the ER with vomiting, acute abdominal pain, fisical findings consist with acute abdomen, and lactic acidosis.

Abdominal angio-ct

Correct Incorrect Correct answer

Diagnostic peritonial lavage

Correct Incorrect Correct answer

Abdominal ultrasound

Correct Incorrect Correct answer

Abdominal angiography

Correct Incorrect Correct answer

Which of the following is true regarding acute upper gastrointestinal bleeding

It only includes bleeding that are proximal to vaters ampulla

Correct Incorrect Correct answer

It only includes bleeding that are from the stomach or duodenum

Correct Incorrect Correct answer

It is the most common etiology of significant bleeding from th GI tract

Correct Incorrect Correct answer

Mostly arises from esophageal varices

Correct Incorrect Correct answer

which of the followimg bariatric procedures is considered as restrictive only

Laparoscopic adjustable gastric banding LAGB

Correct Incorrect Correct answer

Biliopancreatic diversion BPD

Correct Incorrect Correct answer

Roux-en-y gastric bypass

Correct Incorrect Correct answer

duodenal swich DS

Correct Incorrect Correct answer

All of the following are considered an advantage of sleeve gastrectomy over Roux-en-y gastric bypass EXCEPT

Decrease in incidence of internal hernia episodes

Correct Incorrect Correct answer

Dumping syndrome

Correct Incorrect Correct answer

Malabsorbtion

Correct Incorrect Correct answer

Decrease in incidence of leak

Correct Incorrect Correct answer

Whick of the following is correct regarding Barret’s esophagus

It is not related related to GERD

Correct Incorrect Correct answer

It involves metaplasia

Correct Incorrect Correct answer

It involves dysplasia

Correct Incorrect Correct answer

An anti reflux procedure solves the problem

Correct Incorrect Correct answer

70 years old male is admitted to the ER dou to fever, chills right upper quadrant pain and scleral jaundice , abdominal ultrasound demonstrates cholelithiasis with bile duct dilation which of the following tests is included in this patient

Hepatic iminodiacetic acid scan ( HIDA)

Correct Incorrect Correct answer

Abdominal ct

Correct Incorrect Correct answer

ERCP

Correct Incorrect Correct answer

Percutaneos transhepatic choloangiography (PTC)

Correct Incorrect Correct answer

60 y old healthy female undergoes virtual colonoscopy (abdominal ct ) gallstones are suspected and later confirmed by abdominal US there is no history of pancreatitis or jaundice but the patient does describe reflux that is dependent on food types and responds well to anticid tablets with of the following is recommended treatment:

Laparoscopic cholecystectomy

Correct Incorrect Correct answer

Oral medication that can dissolve the stone

Correct Incorrect Correct answer

Injection of dissolving substance directly into the gallbladder

Correct Incorrect Correct answer

Follow-up

Correct Incorrect Correct answer

55-year-old male arrives to the ER directly from the airport describing abdominal pain in the past 4 days, associated with vomiting during his trip to Africa. The pain was diffused and after several hours it localized to the lower abdomen he was treated there with IV fluid and analgesics with temporary improvement he now complains of RLQ pain and fever with decreased appetite and no vomiting. On examination he has RLQ tenderness and guarding. With of the following will be included in this patient management ?

Abdominal CT to confirm the diagnosis of peri appendicular abscess followed by laparoscopic appendectomy

Correct Incorrect Correct answer

Abdominal CT to confirm the diagnosis of peri appendicular abscess and laparoscopic drainage if it cannot be drained percutaneously

Correct Incorrect Correct answer

Abdominal CT to confirm the diagnosis of peri appendicular abscess followed by antibiotic treatment

Correct Incorrect Correct answer

Followed by drainage and antibiotics scheduled laparoscopic interval appendectomy 6 weeks after discharge with no further evaluation

Correct Incorrect Correct answer

During laparoscopy for perforated appendicitis a culture is taken from the abdominal fluid with of the following bacteria is the most likely to grow:

Escherichia coli

Correct Incorrect Correct answer

Streptococcos viridans

Correct Incorrect Correct answer

Group d streptococci

Correct Incorrect Correct answer

Pseudomonas aeruginosa

Correct Incorrect Correct answer

A polyp is resected from the cecum in colonscopy and pathology revels carcinoma in situ or intramucosal carcinoma. With of the following layers cannot be involved by the cell in order to establish the diagnosis?

Muscolaris propria

Correct Incorrect Correct answer

Submucosa

Correct Incorrect Correct answer

Muscolaris mucosai

Correct Incorrect Correct answer

Neck of the polyp

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and D

Correct Incorrect Correct answer

A 20 year old male with known familial adenomatous polyposis in his family undergoes colonoscopy that demonstrates thousands of polyps throughout the colon,enterscopy until the fourth part of the duodenum is negative and neck ultrasound rules out thyroid disease .what is the next step in the management of this patient?

Repeat colonscopy in a year

Correct Incorrect Correct answer

Total procto colectomy with ileal pouch anal anastomosis(IPAA)

Correct Incorrect Correct answer

Subtotal colectomy and permanent ileostomy

Correct Incorrect Correct answer

Cystoscopy to rule out urine bladder transitional cell carcinoma (TCC)

Correct Incorrect Correct answer

A 50 year old male complians of melena and fatigue .in the ER he is hemodynamcly stable with fresh blood in his nasogastric tube.gastroscopy demonstrates a malfunction with an exposed blood vessel that bled in the submucosa in the lesser curvature about 6 cm from the gastro esophagyeal junction. What is the most likely diagnosis?

Dieulafoy's lesion

Correct Incorrect Correct answer

Stomach adenocarcinoma

Correct Incorrect Correct answer

Antral ulcer

Correct Incorrect Correct answer

Duodenal ulcer

Correct Incorrect Correct answer

A previously healthy 70 year old male is admitted to the ER due to bloody bowel movements. he never had a colonoscopy performed and he does not take any medications. his abdomen is soft without tenderness .there is bile in the nasogastric tube and fresh blood on rectal examination .which of the following is the most commmon etiology of this bleeding?

Colon ischemia

Correct Incorrect Correct answer

Diverticulosis

Correct Incorrect Correct answer

Colon adenocarcinoma

Correct Incorrect Correct answer

Inflammatory bowel disease

Correct Incorrect Correct answer

What does damage control mean when treating trauma patient?

Stop bleeding and infectious in an unstable a trauma patient

Correct Incorrect Correct answer

Focus on anatomical reconstruction of injuries in a stable trauma patient

Correct Incorrect Correct answer

Packing only in an unstable trauma patient

Correct Incorrect Correct answer

Focus on anatomical reconstruction of injuries in a stable and unstable trauma.

Correct Incorrect Correct answer

A 61 year old male is admitted to the ER due to abdominal pain .his abdomen is distended tympnaic on percusion ,without perotenitis ,he is hemodynamcly stable with no fever and mild leukocytosis. An abdominal x-Ray is performed (below). What is the most probable diagnosis?

Sigmoid volvulus

Correct Incorrect Correct answer

Pseudo obstruction

Correct Incorrect Correct answer

Obstructing rectal tumour with incomeptent ileocecal valve

Correct Incorrect Correct answer

Gastric dilation

Correct Incorrect Correct answer

A 40 year old female is fiagnosed with a 1.2 cm isoechoic, regular border, nodule of the left thyroid lobe. TSH<0.005(nl 0.5-4.5) what is the most appropriate next step in her evaluation?

Repeat neck untrasound in 3 months

Correct Incorrect Correct answer

Ultrasound guided nodule biopsy

Correct Incorrect Correct answer

Iodine scan

Correct Incorrect Correct answer

Serum calcitonin

Correct Incorrect Correct answer

A 40 year old male undergoes FNA of a 2 cm thyroid nodule. In which of the following repeat FNA is recommended ?

Bethesda I-non diagnostic

Correct Incorrect Correct answer

Bethesda IV -follicular neoplasm

Correct Incorrect Correct answer

Bethesda V- suspicious for malignancy

Correct Incorrect Correct answer

Bethesda VI- malignant

Correct Incorrect Correct answer

A 50 year old male is diagnosed with primary hyperaldostronism. A CT scan demonstrated a 1 cm right adrenal nodule and a 1.5 cm left adrenal nodule. Which of the following is next step in this patient’s evaluation?

MIBG scan

Correct Incorrect Correct answer

Sesta -MIBI scan

Correct Incorrect Correct answer

Adrenal vein sampling

Correct Incorrect Correct answer

Adrenal ultrasound

Correct Incorrect Correct answer

For which of the following tumours is barrett’s esophagitis a risk factor?

Squamous cell carcinoma

Correct Incorrect Correct answer

Adenocarcinoma

Correct Incorrect Correct answer

Leomyosarcoma

Correct Incorrect Correct answer

Gastrointestinal stromal tumor (GIST)

Correct Incorrect Correct answer

Which of the following test is diagnostic for gastroesophageal reflux?

Endoscopy

Correct Incorrect Correct answer

Manometry

Correct Incorrect Correct answer

PH mentoring

Correct Incorrect Correct answer

esophagography

Correct Incorrect Correct answer

A 60 years old, female is admitted for evaluation of gastric cancer, on gynecological examination and rectal examination an extensive fullness is palpated in the pelvis and is suspicious for tumor spread what is the name of the pathology?

Blummer’s shelf

Correct Incorrect Correct answer

Kurken bergs tumor

Correct Incorrect Correct answer

Sister Mary joseph metastatic node

Correct Incorrect Correct answer

Virchow’s metastatic nodes

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

C or/and D

Correct Incorrect Correct answer

33 years female is admitted with acute cholecystitis what is the preferred timing of cholecystectomy in this patient?

Six week since the onset of cholecystitis

Correct Incorrect Correct answer

Three month since symptoms onset

Correct Incorrect Correct answer

Within a week of symptoms onset

Correct Incorrect Correct answer

Wait for at least a week and no longer than six weeks

Correct Incorrect Correct answer

All of the following are a part of Reynold’s pentad in cholangitis except?

Jaundice

Correct Incorrect Correct answer

Low blood pressure

Correct Incorrect Correct answer

paO2<60 mmhg

Correct Incorrect Correct answer

Right upper quadrant pain

Correct Incorrect Correct answer

What is the most common etiology of chronic pancreatitis?

Hyperparathyroidism

Correct Incorrect Correct answer

Medications

Correct Incorrect Correct answer

Trauma

Correct Incorrect Correct answer

Alcohol

Correct Incorrect Correct answer

17 years old male was stabbed by knife above the umbilicus. On examination he is hemodynamically stable abdominal ct iv contrasts does not demonstrating free air or fluid, the patient is admitted for observation, 6 hours later the patient develops diffuse abdominal tenderness. What is the most appropriate treatment at this point?

Abdominal ct with oral contrast

Correct Incorrect Correct answer

Board spectrum antibiotics and clinical follow up

Correct Incorrect Correct answer

Urgent gastroscopy

Correct Incorrect Correct answer

Explorative laparotomy

Correct Incorrect Correct answer

45 year old female, no previous submission or surgeries, came with right upper quadrant pain that started at evening, accompanied with nausea, no vomiting or fever, which of the following signs approve the dx:

Rovsing sign

Correct Incorrect Correct answer

Murphy sign

Correct Incorrect Correct answer

McBurney sign

Correct Incorrect Correct answer

Obturator sign

Correct Incorrect Correct answer

Healthy 45 years old male came to the ER with epigastric pain, the patient reported severe pain started at 10 am, at physical ex: HR 110, BP 90/60, T 38.5. significant epigastric with guarding rebound.
Labs:18000 wbc, 18% stab HB 14 chest exray is below. Wwhat should be the next step in treating the patient:

Abdominal ct

Correct Incorrect Correct answer

Urgent surgery

Correct Incorrect Correct answer

Urgent gastroscopy

Correct Incorrect Correct answer

Gastrografin study

Correct Incorrect Correct answer

45 years old male is admitted to the ER with RLQ pain and 38 temperature, on examination RLQ peritonitis was confirmed with abdominal ct and appendectomy was performed. 0.6 cm carcinoid tumor at the tip of the pancreas was detected, no lymphatic invasion, and the dissection resulted in free(clear) margins.

Follow-up

Correct Incorrect Correct answer

Repeat test and abdominal ct

Correct Incorrect Correct answer

Right hemicolectomy

Correct Incorrect Correct answer

Perform FDG scan

Correct Incorrect Correct answer

55 years old female with primary hyperparathyroidism. .Which of the following is an indication for surgery:

Ca 11 +N8.6-10.5

Correct Incorrect Correct answer

Recent nephrolithiasis

Correct Incorrect Correct answer

Osteopenia with bone density at forearm 1.8

Correct Incorrect Correct answer

Familial hypercalcemia

Correct Incorrect Correct answer

Which of the following confirms the diagnosis of hirsshpring disease:

Barium enema

Correct Incorrect Correct answer

Rectal manometry

Correct Incorrect Correct answer

Rectal biopsy

Correct Incorrect Correct answer

Abdominal ct

Correct Incorrect Correct answer

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