IMLE 1/2021 امتحان الوزارة كامل

Which of the following is not classified under anxiety disorders according to the DSM-5?

A 31 years old woman on the 38 presents to the local clinic with severe headache. Blood pressure was 140/90 on two separate measurements. Which of the following is the next step in managing this case?

which of the following requires high-risk pregnancy follow up?

A 5- year-old boy with autism spectrum disorder (ASD) presents with restlessness over the last few days, and refusal to walk. History reveals he doesn’t eat much, and his diet is based on schnitzel and water Examination of the mouth shown in the picture. Complete blood count revealed anemia Which of the following is the most likely cause of his disease?

A 9-months-old baby with atopic dermatitis develops the extensive rash demonstrated in the picture

Which of the following is the most recommended treatment?

An 8-year-old girl presents with a 12-day febrile disease, and shortness of breath over the last day, Examination is significant forinspiratory dyspnea, 92% saturation in room air, mild hepatosplenomegaly, and the finding in attached picture. Laboratory findings include leukocytosis with atypical lymphocytes, a sterile pharyngeal culture, and the findings in the table attached.

EBNA IgG   (-)
EBV IgM VCA ( +)

Which treatment improve girls condition ?

A 60-year-old male is referred due to malaise. His past medical history is positive for ischemic heart disease and diabetes. On examination – distinct pale skin and sclera, ulcers at the side of the mouth, and kolonychia. Labs – Hb 6.5. Which of the following is the expected patient’s MCV?

Which of the following direct oral anticoagulants (DOACs) is a thrombin inhibitor?

39-A 45-year-old male is evaluated for frequent urination in the past several months. He is usually healthy and otherwise asymptomatic and is not on any current medication. Both his parents had type 2 diabetes. His physical examination is normal. Labs-fasting glucose 220 mg/dl and HBA1C 8%.

Which of the following is the first line of treatment in this patient?

Which of the following bacteria is most likely to cause infective endocarditis over normal endotel without structural cardiac defects?

All of the following are associated with developing incisional hernia, except:

All of the following are consistent with primary hyperparathyroidism, except:

A 20-year-old male complains of severe anal pain that increase during defecation as if “knives are cutting him” and accompanied by fresh blood. This started after an episode of constipation The patient refuses rectal examination because every contact causes pain and there are no masses outside the anus.

Which of the following is recommended on top of stool softeners and analgesics?

What is the recommended treatment for a patient with long lasting daily alcohol consumption who presents with confusion and hallucinations three days after stopping drinking?

A 25 weeks pregnant 30 years old woman has a glucose challenge test (GCT) result of glucose 203mg/dl. Which of the following is the next step in managing this patient?

Which of the following is the most appropriate test to evaluate a suspected uterine anomaly in a 7-Y.O girl?

A 3-year-old boy was admitted due to fever and cough over the last 2 days. Radiological findings are presented in the following x-ray.

Which of the following is the most likely causative agent?

A few hours old newborn presents with bilious vomiting. Pregnancy history includes polyhydramnios. Examination reveals a hypotonic newborn, with a soft and non-distended abdomen  Imaging is attached

Which of the following is the most probable diagnosis?

A-4-year-old girl has had 5 episodes of wheezing and shortness of breath over the last year. She has been treated with bronchodilators and inhaled steroids as an outpatient. Her recent chest x-ray is normal Which of the following predicts continuous symptoms into adulthood?

Direct oral anticoagulants (DOACs) are recommended to which of the following patients?

A 60-year-old male is brought to the ER due to an episode of palpitations and dyspnea two hours prior to his arrival. On examination-respiratory distress, diaphoretic, diffuse rales over the lungs, irregular rapid heart sounds, pulse 160/min, blood pressure 80/50 mmHg, oxygen mask saturation 85%. ECG.

Which of the following is the most appropriate management?

What is the most common cause of death in a 70-year-old male with CKD stage 4?

A55-year-old male undergoes abdominal CT due to right lower quadrant pain. An incidental left adrenal 3 cm mass is demonstrated.

Which of the following is not part of the evaluation?

A 65-year-old male is diagnosed with 3 cm breast mass. On biopsy-breast carcinoma.

Which of the following is correct?

Which of the following is the most common wound healing inhibitor?

A 49-year-old male with previous abdominal surgeries is admitted to the ER due to abdominal pain and vomiting. Abdominal X-ray is below.

Which of the following is the most likely diagnosis?

All of the following are characterized by cognitive function impairment, except:

Combined oral contraceptive decrease the risk of:

attached a uterine X-ray of a 28 Y.O woman, performed during infertility work up. Which of the following is the most recommended treatment?

A 16-year-old girl presents with facial swelling and shortness of breath which appeared the same morning, and had become worse over the last hours, Her history is positive for few events of facial swelling that resolved spontaneously Examination reveals findings in the attached pictures, heart rate of 125/min. respiratory rate of 25 breaths/min, blood pressure 110/75, saturation of 96% in room air, and non-pitting edema of the face, tongue, oral mucosa, and larynx. Which of the following is the most likely finding in her blood work?

A 17-year-old boy presents with shortness of breath and nausea starting few minutes after being stung by a bee. His examination includes blood pressure of 65/40, and a heart rate of 140 per minute. He improved after been treated with an adrenaline Injection. He has been stung by bees twice before without a systemic reaction. His blood work is significant for increased anti bee venom igE levels Which of the following is the best approach?

Which of the following is the most appropriate next step?

A 24-year-old male undergoes gastroscopy due to abdominal pain and antrum gastritis is demonstrated with positive helicobacter pylori.

Which of the following is the most appropriate treatment?

A 70-year-old male is admitted to the ER following night lower limb bums from an oven several days ago Pain is severe. Past medical history – diabetes and hypertension. On examination-pulse regular 100/min, blood pressure 80/50 mmHg, T 39°C, room air saturation 99%. On examination of the foot-purplo vesicles and severe tenderness Right lower limb CT-soft tissue gas.

Which of the following is correct?

Which of the following is an indication for urgent dialysis in a patient that has been unsuccessfully treated conservatively?

A 67-year-old male is referred by an occupational physician due to suspected significant occupational exposure in his past. His chest X-ray demonstrates “calcified pleural plaques”. To which of the following substances was he most likely exposed?

Which of the following is the most common etiology of small bowel obstruction?

A 22-year-old male arrives to the ER following a gunshot wound to the pelvis. He rapidly deteriorates and one of your colleagues is worried that he will develop the lethal triad of trauma.

Which of the following correctly describes this triad?

An 80-year-old male is admitted to the ER due to severe inguinal pain in the past 2 hours. On examination – a 5 cm rigid, tender, right inguinal mass. Surgery is decided with the diagnosis of incarcerated inguinal hernia. The patient is on Plavix due to atrial fibrillation. While waiting for surgery the patient reports improvement in pain and on repeat examination the mass is gone.

What is the most recommended approach?

A shy male describes increased sensitivity that does not allow him to develop intimate relationships. When he tries to talk to other people he feels greatly insecure.

He avoids social activities despite wanting more friends. He avoids relationships in fear of denial, humiliation, and criticism.

Which of the following is the most likely diagnosis?

32 Years old married woman, with no children, presents with amenorrhea over the last 18 months. She reports normal sexual development during puberty, regular menstruation, and no gynecological issues in the past. Which of the following is the most likely cause of her amenorrhea?

A woman on her 30 week of pregnancy presents with vaginal bleeding and contraction. Ultrasound demonstrates a pulseless week of the fetus, with biometric features appropriate for the 28 gestation. Which of the following test supports a diagnosis of disseminated intravascular coagulation(DIC)?

Complete blood count and blood smear of a 2,5-year-old toddler demonstrates the findings in the picture and table

Which of the following is the most likely cause of his disease?

A 7-year-old boy was brought to the emergency room unconscious after being in a motor vehicle accident. He wasn’t wearing a seat belt. Examination reveals an occipital hematoma on the head, and a right arm and calf deformity. Which of the following is the most appropriate next step?

A-2-hour-old newborn is evaluated for central cyanosis. Oxygen saturation in room air is 60%, heart rate is 160 per minute, breath sounds are good and equal, and there is no murmur. Hyperoxia test revealed low PaO2). Chest x-ray is attached.

A 77-year-old male complains of increasing malaise over the past year. On examination – splenomegaly. Labs – Hb 7.6 (NL 12-16): WBC 11,000 (NL 4,300-10,800): PLT 104,000 (NL 150,000-450,000 haptoglobin 201 (NL 50-150). Coombs test is negative. Peripheral blood smear-teardrop shaped red cells and nucleated red cells. Bone marrow-dry tap.

Which of the following is the most likely diagnosis?

Recently the world is dealing with the corona pandemic that is caused by the SARS-CoV-2 virus and causes COVID pneumonia and acute respiratory distress syndrome (ARDS).Which of the following is an ARDS criterion?

Which of the following is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP)?

A 48-year-old male is admitted due to increasing abdominal pain and it was over the past 6 weeks On examination-bilateral axillary lymphadenopathy up to 2 cm and use abdominal tenderness without rebound. Abdominal pelvic CT scan demonstrated retroperitoneal and mesenteric lymphadenopathy Axillary lymph node biopsy demonstrates diffuse large B-cell lymphoma PET CT demonstrates axillary mesenterial and retroperitoneal lymph node enlargement Bone marrow biopsy is normal

Which of the following is the most appropriate treatment?

A 27-year-old male is brought to the ER following a stab wound to the left flank below the rib cage. The knife is still stuck to his flank. Initial evaluation – hypovolemic shock. Which of the following is the most suitable approach?

Wound healing has several stages. Which of the following blood cells is the most dominant in the first two days of wound healing (inflammation phase)?

Which of the following is considered a positive prognostic factor on CT in adrenal incidentaloma?

A 34 years old schizophrenic female treated with oral haloperidol 20 mg a day and no other medications. She arrives urgently to the ER. On her examination, diaphoretic, muscle rigidity. Fever is 40.5 C, heart rate 130 beats per minute, blood pressure 195/95. Labs-leukocytosis and elevated CK levels. Which of the following is the most likely diagnosis?

30 years woman presents with 3 consecutive early miscarriages. Which of the following tests is included in the primary work up?

A 27 Y.O single women with no children, reports lower abdominal pain during menstruation and intercourse, her examination is significant for pelvic tenderness, especially over the sacro-uterine ligaments. Vaginal ultrasound demonstrates an ovarian cyst with a diameter of 3 cm (photo below).

Which of the following describes the first line of treatment in this case?

A 3-year- old boy presents with facial and limb edema Urinalysis reveals significant proteinuria and blood work results are presented in the table.

Which his most likely disease ?

A 13-year-old boy presents to the emergency room due to ankle and calf pain, dizziness and pharyngeal pain, that started 20 minutes before, while walking in the forest. Examination reveals flushing, blood pressure 70/40, heart rate of 130/min, respiratory rate of 30/min, saturation 95% in room air, and the finding in the picture attached

Which of the following is the mandatory immediate treatment in this case?

A-3-month-old baby presents with severe restlessness with no additional symptoms. Examination reveals an afebrile infant, with normal oxygen saturation in room air, heart rate of 240/min, blood pressure of 80/40. The rest of the physical examination is normal. Which of the following will contribute the most to diagnosis?

A 33-year-old male is evaluated at the ER due to headaches and right eye pain for the past 5 days. He also reports painful ulcer in the scrotum. He denies fever or joint pain. He also complains of intermittent oral ulcers in the past 5 years. No regular medications On examination – T 36.8°C, pulse 85/min, blood pressure 130/76 mmHg, five oral mucosal ulcers, no nuchal rigidity, 1 cm ulcer over his scrotum. Labs-Hb 11.1: WBC 15.600. Normal head CT. lumbar puncture – 13 leukocytes/UL, 100% lymphocytes, negative Gram stain. Which of the following is the most likely diagnosis?

A 28-year-old male complains of dyspnea on moderate and intense exercise. On examination – blood pressure 130/80 mmHg, pulse regular 84/min, Heart-sinus, 3/6 holosystolic murmur over the heart base and left sternal border. ECG-sinus rhythm with left ventricle hypertrophy Echocardiography-hyper dynamic systolic function with LVEF of 70%, hypertrophy of ventricular septum, systolic anterior motion (SAM) of the mitral valve, and dynamic obstruction of the left ventricle outlet

Which of the following is a risk factor for sudden death in the patient and therefore ICD defibrillator implantation should be considered?

A 78-year-old male with morbid obesity and uncontrolled hypertension and diabetes is brought to the ER due to compressing chest pain and significant malaise that lasted 30 minutes. On admission – blood pressure 80/40 mmHg, irregular pulse 123/min. Below is his (ECG.)

All of the following are acceptable treatments, except:

A healthy 55-year-old male with no medications is admitted to the ER due to multiple vomiting of stomach content for 3 days. No fever or diarrhea, On examination-dry mucosa, decreased skin turgor, pulse 110/min, blood pressure 130/85, supine 100/50 standing, Labs – pH 7.45, bicarbonate 32 mEq/dl.

Which of the following is the most expected in this patient?

Below are two photos of two patients with dysphagia.

Which of the following is correct?

Which of the following is the most common location of the base of the appendix in acute appendicitis?

A 53-year-old male is POD1 after cholecystectomy and complains of right upper quadrant severe pain, fever, chills, and large amount of bile in the drain that was left at the gallbladder bed. He also complains of fullness and lack of appetite.

Which of the following is correct?

40 Years old female with mood disturbance is treated with sertraline 200mg and another drug that she started taking in the last week. She arrives to the ER in severe restlessness and non- stop diarrhea. Which of the following drugs is most likely added to her treatment?

Which of the following is an absolute contraindication for regional anesthesia for labor?

A woman in the beginning of her pregnancy is interested in genetic testing of the fetus. Which of the following is true regarding the differences between chorionic villus sampling (CVS)and amniocentesis?

A 14-yeat-old girl presents with 6 weeks of fatigue, weight loss, painless oral ulcers, and recurrent episodes of high fever. In addition, she reports Intermittent left wrist and right knee pain Her examination is significant for the finding in the picture.

A 13-year-old girl presents with few months of intermittent fever, night sweats, weight loss, and night time itching. Examination is significant for hepatosplenomegaly and an enlarged right supraclavicular lymph node Which of the following is the first next diagnostic test?

A- 17-year-old girl has been having migraines for the last 2 years, and has been treated with acamol (acetaminophen). Lately she reports a significant increase in frequency of the migraines. with no change in their character. Neurological examination is normal. Which of the following is the most recommended prophylactic drug at this point?

Patients with atrial fibrillation are at risk for systemic arterial emboli and stroke. Which of the following patients is considered to have the lowest risk for embolic CVA?

A 23-year-old female was diagnosed with ulcerative colitis several months ago and treated with 5-ASA with no improvement. She is admitted due to severe colitis exacerbation and is treated with IV steroids with no improvement Which of the following is the next step in treatment?

A 21-year-old male is rushed to the ER after being stung by a bee and became dyspneic. He complains of nausea, abdominal pain and difficulty in breathing. On examination-respiratory distress, pulse 100/min, erythematous diffuse skin rash, expiratory wheezes over both lungs Which of the following is the first step in treatment?

A 75-year-old female is admitted to fever with anemia, thrombocytopenia, and acute renal failure The physician on call suspects disseminated intravascular coagulation (DIC) Which of the following practically rules out (almost 100%) this possibility?

A 58-year-old male is evaluated for mild epigastric pain and discomfort that started a week ago. He also complains of significant weight loss in the past several months.

Which of the following is correct regarding suspected gastric tumor?

Which of the following is correct with regards to diagnostic laparoscopy for suspected acute abdomen?

Which of the following can cause intrinsic cardiogenic shock?

which of the following side effects is characteristic of anticholinergic drugs such as biperiden ( dekinet ) ?

55 Years old female is afraid of being infected by an infectious disease and therefore she wears rubber gloves and face mask while at home. She washes her hands and changes gloves every 30 minutes and cleans the kitchen marble with special alcoholic detergent three times a day. On examination, she states that is clear to her fear is exaggerated and irrational and she wants to get rid of it but doesn’t know how, and that every time she tries to resist the urge to wash hands she panics of getting sick and dying. Which of the following is the most appropriate treatment?

On two semen specimens, taken 6 weeks apart, of a healthy, 30 Years man, there were less than 5 million cells per ml. Which of the following is the diagnostic next step?

Which of the following is a complication of in vitro fertilization?

A 6-hour-old neonate presents with frothing from the mouth and nose, and difficulty in breathing during eating. On examination he is generally well, and cries without respiratory distress. Which of the following is the next diagnostic test?

A 10-years-old boy examined in the emergeney room due to seizure followed by a few episodes of bloody diarrhea. A week earlier his brother and sister suffered from diarrhea Examination reveals a temperature of 39.5oC poor nutritional condition, and rectal prolapse. Stool smear is demonstrated in the attached picture. Treatment with intravenous Isotonic solution is initiated.

Which of the following is the recommended treatment at this point?

A-4-month-old baby presents to the emergency room after getting hit by his 2-year-old brother. This is his 3^rd time in the emergency room due to falls. Examination is significant for restlessness. chest tenderness on palpation, he doesn’t move his left leg, Laboratory results including a complete blood count, biochemistry and inflammatory markers is normal X-ray is attached

Which of the additional findings is likely to be present in this baby?

A 64-year-old male with diabetes, hypertension, and smoking complains of 6 months of compressing chest pain on moderate exercise, radiating to the left arm and accompanied by dyspnea. On examination-wide split of S2, a 3/6 holosystolic murmur at the apex, radiating to the axilla

Which of the following is most probable to be found on physical examination?

A female, Israeli native, nursing school student, is on clinical rotation and undergoes a Mantoux test. Result is 10 mm and she is asymptomatic Chest X-ray is normal.

What is the recommended treatment?

A 75-year-old male started treatment with IV acyclovir due to herpes infection involving the eye and nose. Before treatment the patient had high fever and barely ate or drank On examination-blood pressure of 100/60 mmHg, pulse 100/min, T 38°C, no other abnormal findings.

Which of the following is this patient most likely to develop?

Which of the following is the most common incarcerated hernia?

A 25-year-old male is admitted to the ER following a knife stab to the abdomen. On admission – fully conscious, no distress, hemodynamically stable. Abdomen – stab wound under the umbilicus approximately 10 cm to the left of the midline, omentum outside the skin, no peritonitis.

Which of the following is the next step in management?

A 60-year-old healthy female with no prior surgeries is admitted to the ER due to diffuse abdominal pain and vomiting in the past several hours. On examination – tender, distended abdomen. Abdominal X-ray – air fluid levels compatible with small bowel obstruction.

Which of the following is the most likely diagnosis?

A 55-year-old female is referred for evaluation due to suspected inflammatory breast carcinoma. Which of the following is likely to be found on examination?

A fifty years old male complains of severe anxiety.

All of the following findings may support the diagnosis of anxiety, except:

All of the following are advantages of long half-life benzodiazepines, except:

A healthy mother of two 28 years old women, had a rich family history of breast and ovarian cancer, and has been found to be BRCA-1 positive. Which of the following is the most appropriate recommendation for this woman?

A 29 Y.O presents with amenorrhea for 18 months. She describes menarche at the age of 14, and years of regular menstruation. In addition, the patient reports excretion of milk from the beasts. Which of the following details in the patient’s history would support the most likely diagnosis?

A 10-year-old boy has been clearing his throat and making sniffing voices at school, His neurological examination is normal. Which of the following is the boy’s most likely diagnosis?

Blood work was obtained from a generally healthy 6-year-old boy, as per parental request. Complete blood count was normal, and serumn igA anti TG2 was 100 units (normal value <15 units) The boy does not have abdominal pain, and passes normal stool once a day. Family history is negative for celiac. Which of the following describes the recommended approach?

4-month-old infant presents with infantile spasm episodes, worsening over the last 4 weeks.. Which of the following is the most appropriate first line anti- epileptic drug?

An 80-year-old male is admitted to internal medicine department due to new left pleural effusion. Which of the following is diagnostic of exudative fluid?

A 42-year-old healthy male is referred to the ER due to fever of 39.5°C and malaise COVID 19 swab is negative. On chest X-ray-loft lower lobe infiltrate consistent with left lobar pneumonia. He was treated accordingly with levofloxacin with no Improvement after 3 days of treatment.

Which of the following is reasonable?

-A 30-year-old male is admitted with severe anterior chest pain that radiates to the neck and left shoulder. The pain is exacerbated by deep breaths and position changes In examination in pain, blood pressure 110/70 mmHg, pulse 90/min regular, T 37.9°C room air saturation 96%. No jugular vein distention. Sinus normal heart sounds without murmurs Lungs-bilateral normal breathing sounds without rals or wheezes. Labs-leukocytosis with left shift. (ECG).

Which of the following is the most appropriate treatment?

A 70-year-old male is admitted with fever, chills, right upper quadrant pain, and scleral jaundice. Abdominal ultrasound – cholelithiasis and bile duct dilation.

Which of the following is the most recommended next step?

A 45-year-old female is diagnosed with 4.5 cm right breast carcinoma, HER2NEU (+), ER/PR (-), and axillary lymph node involvement. She undergoes mastectomy with axillary lymph node dissection, 5 positive lymph nodes.

Which of the following is correct regarding the adjuvant therapy?

A 75-year-old male is referred to the ER due to skin and scleral jaundice for the past week. On examination – skin and scleral jaundice, cachectic, right upper quadrant smooth non-tender mass. Rectal examination – acholic stool. Labs – elevated bilirubin and CA 19-9 levels.

Which of the following is the correct name for this finding?

A 60-year-old male with Crohn’s disease is a candidate for Whipple surgery due to pancreatic tumor. Four months prior to his current admission he was admitted with Crohn’s disease exacerbation and was treated with 40 mg prednisone per day that was later tapered after his discharge.

Which of the following steroid dose is recommended prior to anesthesia induction?

23 years old female is taking risperidone 5 mg/d for a long time. She complains of chest congestion and milky discharge, irregular Menses , decreased libido. bHCG is negative. Which of the following tests should be ordered?

40 years old female reports avoiding touching objects and after touching something she has to convince herself that she didn’t break it. She looks behind her back many times during the day because she is works she hadn’t noticed a coin that she dropped or that she stopped on a bug and accidently killed it. Since childhood she fell disgusted of her father and avoided touching or hugging him. Her only desire is to clean her house, which she does every day. Which is the most likely diagnosis?

A 38-week pregnant woman has a fetus a sonographic estimated weight of 4600 gr. Which of the following factors can provide the best explanation for this situation?

The finding in the picture is revealed during a neonatal examination. The mother has encountered a febrile illness during the first trimester. The mother has not received routine immunization and had no prenatal follow up. Which of the following findings is likely in this newborn, now or further in life?

A 36-hour-old newborn girl, delivered at home, is brought to the hospital due to multiple seizures. Serum glucose is normal, PT, PTT are prolonged, and a CT scan reveals a focal brain bleed. Which of the following is the most likely cause of this newborn’s bleeding?

Which of the following is the most common serious bacterial infection in neonates presenting with fever?

A- 10-day-old newborn presents with significant tremor in 4 limbs. He was born at 40 weeks of gestation, to a mother with gestational DM . Examination reveals a generally well not dysmorphic newborn, with significant tremor and restlessness. Laboratory results are presented in the table.

Which of the following is the most likely diagnosis ?

A 45-year-old female is evaluated for abdominal pain and diarrhea. Her complaints started 3 days ago Initially her stool was soft and later she noticed fresh blood remains in her stool History taking reveals that 5 days before her symptoms she attended a picnic and ate a hamburger with potato salad and mayonnaise. She also reports that two other guests developed diarrhea On examination-looks well, tachycardia 115/min, hyperperistalsis with diffuse abdominal tenderness Labs-WBC 17.400, creatinine 1.2 mg/d. positive blood in stool Which of the following pathogen is the most likely cause of her symptoms?

A 35-year-old female with type 1 diabetes diagnosed at the age of 5 years is controlled and treated with insulin pump. In the last few days – fever, diarrhea, and vomiting.

On examination – pale, very weak, altered consciousness, blood pressure 90/60 mmHg pulse 110/min regular, room air saturation 99%. Labs – Hb 15; WBC 20,000; glucose 5500 mg/dl; sodium 130 mEq/L: potassium 5.5 mEq/L: chloride 100mEq/L, creatinine 1.1 mg/dl; HCO3 12 mEqL: PH 7.12.

Which of the following is part of the initial treatment?

A 80-year-old male with atrial fibrillation is treated with amiodarone He is brought to the ER after being found unconscious On admission-pulse 40min regular blood pressure 130/96, rectal temperature 353°C room air saturation 94%. Stupor, cold and dry skin, delayed reflex relaxation. ECG-sinus bradycardia.

Which of the following is the most appropriate treatment?

Which of the following is considered a negative prognostic factor in thyroid cancer?

Which of the following is correct regarding cancer in humans?

Which of the following is the most common etiology for portal vein pyelophlebitis?

Which of the following behaviors is characteristic of self- mutilation?

34 Years old male who is treated with PERPHENAN due to psychosis develops extrapyramidal side effects. All of the following recommendations are valid, except:

Which of the following raises the suspicion of malignancy in an ovarian mass demonstrated by ultrasound in a 65 Years old women?

A 4 Y.O boy presents with petechial of the trunk and limbs. Examination does not reveal gingival bleeding, hepatosplenomegaly, or lymphadenopathy. Complete blood count is normal except for platelets of 25.000/mm3 (normal values 150- 450.000). peripheral blood smear revealed no blast cells. Which of the following is the most recommended approach?

A 16-year-old boy with a history of asthma, presents with acute chest pain after basketbell training, Examination reveals a hemodynamically and respiratory stable teenager, with normal oxygen saturation in room air, and decreased breath sounds on the right, Chest x-ray is attached.

Which of the following is the most appropriate next step?

A-6-year-old girl presents with a week of lower limbs weakness, numbness up to the navel level, with trouble in urinating and defecating. These complaints followed a febrile illness. CSF examination revealed a negative gram stain, and a slightly increased protein level. Which of the following is the most appropriate treatment?

A-2-year-old boy. of Jewish Ashkenazi descent, had developed well until 5 months of age, and then a developmental regression occurs, with an exaggerated startle reflex, In time deafness and blindness developed, as well as an inability to speak or walk. Examination reveals marked hypotonia, macrocephaly, and the retinal finding in the attached picture.
Which of the following is the most likely diagnosis?

A 50-year-old female with hypothyroidism is treated medically She is admitted due to fatigue, malaise, and scleral jaundice. On examination-oriented to time and place, hemodynamically stable, no fever, mild skin and scleral jaundice, mild right upper quadrant tenderness. No other abnormal findings. Labs-AST 300 (NL 5-40) ALT 370 (NL 14-63) ALP 120(NL 30-115), GGT 55 (NL 5-60), bilirubin 3 (NL <1) of which 2 is direct History taking-no new medications, viral evaluation is negative, liver ultrasound in the past was normal without bile duct dilation, Antinuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA) are positive Which of the following is the most likely diagnosis?

A 35-year-old female complains of a year of pruritus and rigidity of the skin over her fingers that has spread beyond her elbows and involves the chest She also reports finger cyanosis especially during cold temperatures. Labs -normocytic normochromic anemia around 10, elevated CRP, creatinine 0.8, normal urine Anti-Scl-70 (anti topoisomerase 1) positive.

Which of the following extra-cutaneal is expected in this patient?

A 20-year-old HIV female patient is admitted due to confusion and favor of 38.4°C Labsb 3.2 gridl, Platelets 16.000, Urea 60 mg/dl, Creatinine 25 mg/dl, Total Bilirubin 5.5 mg/dl. Direct Bilirubin 0.5 mg/dl, Indirect Bilirubin 5.0 mg/dl, LDH 1150 UI, PT 13 sec, INR 1.08 PTT 30 sec, Control PTT 30 sec, Fibrinogen 300 mg/dl. Schistocytes (fragmented red cells) are noted on peripheral blood smear.

Which of the following is the most likely diagnosis?

Which of the following bariatric procedures is considered restrictive only?

A 73-year-old male arrives to the ER with vomiting, acute abdominal pain, and suspected acute abdomen on physical examination. Labs – lactic acidosis.

Which of the following is the next step at the ER?

All of the following fit peptic ulcer disease, except:

14 years old boy skips school very often in the past year Since childhood, he sets fires and breaks objects, harasses and beats children in the neighborhood.

Which of the following is most compatible with this disorder?

Which of the following is considered a physiological change during pregnancy?

A 38 weeks pregnant woman presents with malaise, nausea ,repeat vomiting , headache, and jaundice. Laboratory results are significant for hypoglycemia, hyperammonemia, and elevated liver enzymes. Which of the following is the most likely diagnosis?

A 2 Y.O boy can run and climb steps, builds a tower of 7 blocks, eats with a spoon, and can say a 2-3-word sentence. Which of the following describes this toddler’s developmental stage?

A 18-year-old boy presents with gynecomastia. He is 1.85m tall (>97%) and his testicles are at a pre-puberty volume. Which of the fallowing is the most probable diagnosis?

A-4-year-old boy presents with a week of purulent lesion under his left ear, which was followed by fever and the finding demonstrated in the attached picture, Palpation reveals tender and warm lesion.

Which of the following is the treatment of choice?

A 55-year-old female is evaluated before gynecological surgery. No past medical history or any complaint: On examination – blood pressure 120/80 mmHg, pulse 76/min regular, wide and constant S2 split. No other abnormal findings. Below is her ECG.

Which of the following is the most likely diagnosis?

Which of the following is not considered a risk factor for developing chronic obstructive pulmonary disease?

Which of the following is not a recommended treatment in hepatic encephalopathy?

A 75-year-old male resides at a nursing home following CVA. His past medical history includes several myocardial infarctions and systolic heart failure due to ischemic heart disease and type 2 diabetes He is referred to the ER due to acute deterioration, fever, chills, and confusion On examination-delirium, fever 38.5°C, saturation 90% with oxygen, systolic blood pressure 80 mmHg pulse regular 115/min. His limbs are cold, lungs clear, abdomen is soft without peritonitis, no skin rash no meningeal signs. Chest X-ray is normal. COVID-19 swab negative on PCR Preliminary Gram stain of urine demonstrates Gram negative bacillus

Which of the following is the first step in management?

Which of the following patients will require prophylactic treatment for venous thrombo-embolism?

A 65-year-old female is diagnosed with gastric carcinoma on endoscopy performed due to weight loss. Heavy smoker. Which of the following findings on examination will raise the suspicion for metastatic disease?

All of the following imaging findings support the diagnosis of gallstone ileus, except:

All of the following are correct regarding epidemiology of depression in the elderly, except:

15 years old girl reports she had not started menstruation. She reports breast buds and genital hair, both evident on physical examination. Vaginal hymen is normal. Ultrasound has not demonstrated a uterus. Which of the following is the next appropriate test?

A 22 years old single woman with no children presents with sudden hirsutism that started 4 months ago, and discomfort in the lower right abdomen. She has regular menstruation, and no additional complaints. Her BMI is 21. Ultrasound demonstrates a 5cm right ovarian mass. Which of the following is the most likely diagnosis?

A 3 Y.O boy presents with 2 days of fever and a day left knee pain. Examination reveals reasonable general condition, a temperature of 39 C, and the finding in the attached picture. Laboratory results are presented in the table.

Which of the following is the recommended treatment?

An 8-year-old boy presents to the emergency room with diabetic ketoacidosis and had been treated accordingly, Two hours later the attached ECG was performed.

Which of the following is expected in this child’s blood work?

A-3-week-old nawborn was admitted due to jaundice. Laboratory results, include total bilirubin of 12 mg/di, and direct bilirubin 7.5 mg/di (normal value <10% of total bilirubin) Which of the following is the most probable diagnosis?

A 20-year old male with Alport syndrome causing terminal renal failure is admitted to the ER due to chest discomfort and dyspnea over the past two days. On examination – pericardial friction rub, lungs are clear. Chest X-ray – cardiomegaly with no infiltrates or edema. He reports starting hemodialysis a month ago, twice weekly for 3 hours each.

Which of the following is the most appropriate treatment?

A 69-year-old male is brought to the ER due to a first episode of compressing pain at the anterior chest for several hours. On examination no distress, clear lungs, normal heart sounds without murmurs. Pulse p/min regular, blood pressure 120/80 mmHg, room air saturation 97% ECG-normal sinus rhythm, troponin on admission 564 ng/ml (NL up to 7). Antiplatelet therapy is initiated with the diagnosis of non-ST elevation myocardial infarction (NSTEMI) Which of the following is correct with regards to antiplatelet treatment in NSTEMI patients?

A 60-year-old male with a history of atrial fibrillation is treated with rivaroxaban (Xarelto) Normal kidney function tests. He is scheduled for a colonoscopy for polyp removal that was previously demonstrated and not resected since.

Which of the following is the recommended approach regarding rivaroxaban?

A 50-year-old healthy male is admitted due to bloody cough accompanied by dyspnea for the past two day He also reports bloody urine in the past 24 hours His history is positive for joint pain at the hands and knees with morning rigidity and no swelling On examination-dyspnea 24 min, blood pressure 135/80 mm pulse 105 min. T 37 6’C decreased bilateral breathing sounds with diffuse crackles over the lungs, normal heart sound, soft abdomen, no organomegaly, elevated purpural rash over the shins. Labs-normocytic mild anemia 10, creatinine 2.5 mg dl (normal at baseline) urine erytrocytes with little protein, urine sediment – dysmorphic red cells and casts Elevated erythrocyte sedimentation rate 60, positive cytoplasmic antineutrophilic cytoplasmic antibody (0-ANCA).

Which of the following is the most likely diagnosis?

A 57-year-old male, psychiatric patient, is admitted due to abdominal distention and lack of bowel movements for the past two days. On examination – blood pressure 130/85, pulse 92/min, T 37.6°C. Abdomen – very distended, no significant tenderness, empty ampulla on rectal examination. Abdominal X-ray is given below

An 80-year-old male has hypertension and diabetes that are medically controlled. He is a smoker, independent, and active (swims 45 minutes twice a week). He is a candidate for left inguinal hernia repair.

Which of the following preoperative tests is recommended?

A 65-year-old healthy female undergoes routine virtual colonoscopy (abdominal CT) that demonstrates cholelithiasis and later confirmed by ultrasound. No past medical history of abdominal pain, jaundice, or pancreatitis. The patient reports heartburn associated with certain foods that responds to oral antacids.

Which of the following is recommended?

A woman describes an event of near drowning during a family vacation about six weeks ago. Since the event she has nightmares and intrusive thoughts of the event, decreased mood, and she is afraid of going into the water. Which of the following is a typical course of the described disorder?

A 70 Years old generally healthy woman presents with symptoms of urinary urgency, non-stress incontinence, and nocturia (3-4 times a night). Physical examination demonstrates cystocele grade 2 and uterine prolapse grade 1. Urinary exam including cultures is normal. Which of the following is the most appropriate treatment?

A healthy 30 Y.O woman has received the result of atypical squamous cells of unknown significance (ASC_US) on a routine Pap smear test. She series post coital bleeding and the cervix seems normal on physical examination Which of the following is the best recommendation for this woman?

A 7 Y.O boy presents with 2 days of hematuria, several weeks after having an episode of pharyngitis. His examination is significant for hypertension. Laboratory results include low serum C3, proteinuria and microscopic examination of the urine revealed red blood cell casts.

A 15-year-old girl with hypothyroidism and obesity complains of limp and left hip pain for the past 3 weeks following an injury during sports lesson. The pain radiates to the knee, occasionally wakens her up from sleep, and worsened during the past two days to the level that she needs support in walking. The physical and imaging findings are below. What is the most likely diagnosis?

A-14-year-old girl has lost 10 kg over the last months. Examination reveals a very thin girl, heart rate of 55/min (normal values 60-80). Laboratory results Include low serum potassium, and elevated liver function tests and cholesterol. Which of the following is the most likely diagnosis?

A patient with recent diagnosis of chronic renal failure is evaluated by a renal ultrasound that demonstrates large kidneys. Which of the following diagnoses can explain this finding?

A 19-year-old soldier is referred due to three days of maculopapular rash over the upper and lower limbs including this pains fever 38°C and headache severity of 3/10. He reports that the symptoms began several days after training and sleeping outdoors in the northern part of the country Examination is normal except for the rash in the photos below Labs-leukopenia, thrombocytopenia, hyponatremia and mildly elevated liver function tests Which of the following is the next step in treatment?

In which of the following the highest residual volume is expected?

A 65-year-old male with nephrolithiasis, hypertension, dyslipidemia, renal failure with creatinine around 2 He is evaluated due to severe foot pain that started 24 hours prior to Ng admission and increased to the point that he cannot step on his leg. This is his first episode

On examination the photo below.

Which of the following is the most appropriate treatment?

A 30-year-old male is operated for right lower abdominal pain and tenderness and suspected appendicitis. Upon scope insertion the following terminal ileum finding is demonstrated (photo). The appendix is normal.

Which of the following is suspected?

Ringer lactate solution contains all of the following, except:

A 50-year-old female is brought to the ER after being hit by a car as a pedestrian. On admission – blood pressure 110/70, pulse 110/min, no free fluid on focused assessment with sonography in trauma (FAST). Pelvic X-ray – multiple pelvic fractures consistent with open book formation.

All of the following may assist in stabilizing this patient, except:

A 60 Y.O female has lost 12 Kg in the past three months. She awakers during the night, feeis lack of energy, and displays significant sadness and despair. She cries a lot and lost interest in leisure activities and friends. On examination she says there is no longer a point to her life. Extensive labs and imaging studies are all normal. Which is the recommended treatment?

A 60 Years old woman, in menopause during the last 10 years, presents with vaginal bleeding. Vaginal ultrasound demonstrates irregular mucosa, 8mm at the fundus, and 1mm over the rest of the uterus (demonstrated in the picture below) Which of the following is the most appropriate recommendation for this patient?

27 Y.O presents on the 9 pregnancy follow up, after IVF. she has no complaints. Vaginal ultrasound is attached. Which of the following defines the finding in the picture?

A 3-year-old boy is undergoing work up due to failure to thrive History Is positive for several large smelly stools per day, and several episodes of pneumonia and cough necessitating inhalation therapy. Which of the following tests will contribute the most to diagnosis?

Which of the following describes normal puberty?

A-2-year-old boy presents with speech difficulties. His history is positive for multiple ear infections. Examination now reveals bilateral turbid eardrums, and middle ear effusion .The boy is well, calm, and afebrile. Which of the following the most appropriate next step?

A 65-year-old COPD male smokes 2 packs a day for 30 years. He is admitted due to disease exacerbation and is known to the team for repeated admissions, latest one 4 months ago Lately he almost never leaves his house and is treated with maximum inhalations.

Which of the following is recommended upon discharge?

A 43-year-old male arrives to the ER with high fever, chills, and swelling and pain of his right leg. He denies chest pain or dyspnea. Past medical history is positive for type 2 diabetes Past surgical history is positive for right foot varices ligation On examinant – fever38.7°C, pulse 99/min, blood pressure 138/72 mmHg well defined erythematous warm area at the right leg. Fungi between the fingers of the feet

Which of the following is the recommended treatment?

A patient with routine labs -thyroid stimulating hormone (TSH) 8 mUVL (NL 0.4.4); T3 and T4 normal. peroxidase (TPO) antibodies are negative. The patient is asymptomatic with no past medical history. Which of the following is the most appropriate approach?