IMLE 1/2021 امتحان الوزارة كامل

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

Social anxiety disorder

Correct Incorrect Correct answer

Agoraphobia

Correct Incorrect Correct answer

Panic disorder

Correct Incorrect Correct answer

Generalized anxiety disorder

Correct Incorrect Correct answer

Illness anxiety disorder

Correct Incorrect Correct answer

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?

Routine follow up until 40 weeks of gestation

Correct Incorrect Correct answer

Twice-daily blood pressure measurements until 41 weeks of gestation

Correct Incorrect Correct answer

initiating treatment with beta blockers

Correct Incorrect Correct answer

24-hour urine protein collection

Correct Incorrect Correct answer

Referral to the emergency room

Correct Incorrect Correct answer

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

A history of unexplained stillbirth

Correct Incorrect Correct answer

A history of unexplained stillbirth

Correct Incorrect Correct answer

The mother is a carrier of fragile-X

Correct Incorrect Correct answer

A history of a child with a congenital heart defect

Correct Incorrect Correct answer

A large for gestational age fetus

Correct Incorrect Correct answer

A history of a cesarean section

Correct Incorrect Correct answer

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?

Hypervitaminosis.

Correct Incorrect Correct answer

Vitamin B deficiency

Correct Incorrect Correct answer

Vitamin C deficiency

Correct Incorrect Correct answer

Hypervitaminosis D

Correct Incorrect Correct answer

Vitamin E deficiency

Correct Incorrect Correct answer

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?

Rafapen(penicillin G)

Correct Incorrect Correct answer

Ceforal (Cephalexin)

Correct Incorrect Correct answer

Rocephin (ceftriaxone)

Correct Incorrect Correct answer

Moxypen (amoxicillin)

Correct Incorrect Correct answer

Doxillin (doxycucline)

Correct Incorrect Correct answer

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 ?

Left tonsillar drainage

Correct Incorrect Correct answer

Ganciclovir for a month

Correct Incorrect Correct answer

Clindamycin (Dalacin C) for a week

Correct Incorrect Correct answer

short course of steroids

Correct Incorrect Correct answer

Acyclovir for a week

Correct Incorrect Correct answer

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?

MCV of 70, findings point out iron deficiency anemia

Correct Incorrect Correct answer

MCV of 85, findings point out anemia secondary to chronic renal failure

Correct Incorrect Correct answer

MCV of 101, findings point out anemia secondary to alcohol consumption

Correct Incorrect Correct answer

MCV of 80, findings point out vitamin B12 deficiency anemia

Correct Incorrect Correct answer

MCV of 70, findings point out folic acid deficiency anemia

Correct Incorrect Correct answer

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

Dabigatran

Correct Incorrect Correct answer

Rivaroxaban

Correct Incorrect Correct answer

Apixaban

Correct Incorrect Correct answer

Edoxaban

Correct Incorrect Correct answer

Warfarin

Correct Incorrect Correct answer

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?

Dipeptidyl peptidase IV inhibitor (Sitagliptin-Januvia)

Correct Incorrect Correct answer

Sodium-glucose cotransporter 2 inhibitor (Empagliflozin-Jardiance)

Correct Incorrect Correct answer

GLP-1 agonist (Liraglutide-Victoza)

Correct Incorrect Correct answer

Biguanide (Metformin)

Correct Incorrect Correct answer

Thiazolidinedione (Rosiglitazone-Avandia)

Correct Incorrect Correct answer

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

Streptococcus viridans

Correct Incorrect Correct answer

Staphylococcus aureus

Correct Incorrect Correct answer

Streptococcus gallolyticus

Correct Incorrect Correct answer

Coagulase negative staphylococcus

Correct Incorrect Correct answer

Haemophilus spp

Correct Incorrect Correct answer

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

Morbid obesity

Correct Incorrect Correct answer

Chronic lung disease

Correct Incorrect Correct answer

Hypertension and renal failure

Correct Incorrect Correct answer

Steroids and chemotherapy

Correct Incorrect Correct answer

Surgical site infection

Correct Incorrect Correct answer

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

A single adenoma will be found in most patients

Correct Incorrect Correct answer

Patients complain of bone pain and frequent urination

Correct Incorrect Correct answer

Fatigue and memory loss are common

Correct Incorrect Correct answer

Increased appetite

Correct Incorrect Correct answer

Decreased concentration and insomnia

Correct Incorrect Correct answer

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?

Topical ointment based on calcium channel blockers or nitrates

Correct Incorrect Correct answer

Incision over the hemorrhoid and clot evacuation

Correct Incorrect Correct answer

Surgical resection of internal hemorrhoids

Correct Incorrect Correct answer

Anal dilatation

Correct Incorrect Correct answer

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?

Support take and referral to rehabilitation center

Correct Incorrect Correct answer

Antipsychotic medications

Correct Incorrect Correct answer

Cognitive behavioral therapy

Correct Incorrect Correct answer

Benzodiazepines

Correct Incorrect Correct answer

IV ethanol

Correct Incorrect Correct answer

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?

Routine follow up

Correct Incorrect Correct answer

Repeat GCT at 28 weeks of gestation

Correct Incorrect Correct answer

Oral glucose tolerance test(OGTT)

Correct Incorrect Correct answer

Initiating treatment for gestational disease

Correct Incorrect Correct answer

initiate treatment with insulin pump

Correct Incorrect Correct answer

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

Vaginal ultrasound

Correct Incorrect Correct answer

Diagnostic hysteroscopy

Correct Incorrect Correct answer

Laparoscopy

Correct Incorrect Correct answer

MRI of the abdomen and pelvis

Correct Incorrect Correct answer

Abdominal x-ray

Correct Incorrect Correct answer

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?

Streptococcus pneumonia

Correct Incorrect Correct answer

Chlamydia pneumonia

Correct Incorrect Correct answer

Legionella pneumophilia

Correct Incorrect Correct answer

Mycoplasma pneumonia

Correct Incorrect Correct answer

Klebsiella pneumonia

Correct Incorrect Correct answer

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?

Intussusception

Correct Incorrect Correct answer

Duodenal atresia

Correct Incorrect Correct answer

Intestinal malrotation

Correct Incorrect Correct answer

Pyloric stenosis

Correct Incorrect Correct answer

Biliary atresia

Correct Incorrect Correct answer

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?

Exposure to cow milk earlier than 1 year of age

Correct Incorrect Correct answer

Being a twin

Correct Incorrect Correct answer

Similar medical history of one of her parents

Correct Incorrect Correct answer

Breast feeding during the first months of life

Correct Incorrect Correct answer

Large for gestational age at birth

Correct Incorrect Correct answer

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

Atrial fibrillation in a patient with creatinine 5.5 and GFR 10

Correct Incorrect Correct answer

Atrial flutter in a patient with mechanical mitral valve

Correct Incorrect Correct answer

Atrial fibrillation in a patient with rheumatic heart disease and severe mitral stenosis

Correct Incorrect Correct answer

A patient with sinus rhythm and mechanical mitral valve and left atrial appendage resection

Correct Incorrect Correct answer

Atrial fibrillation in a patient with CHA2DS2 VASc score 3

Correct Incorrect Correct answer

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?

Decrease heart rate by IV bata blockers

Correct Incorrect Correct answer

Decrease heart rate by IV non-dihydropyridines calcium channel blockers

Correct Incorrect Correct answer

Urgent electrical cardioversion

Correct Incorrect Correct answer

Urgent medical cardioversion with IV amiodarone

Correct Incorrect Correct answer

Non-invasive ventilation support with BIPAP and IV diuretics (furosemide)

Correct Incorrect Correct answer

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

Cardiovascular disease

Correct Incorrect Correct answer

Pericarditis

Correct Incorrect Correct answer

Metabolic acidosis

Correct Incorrect Correct answer

Recurrent infections

Correct Incorrect Correct answer

Tertiary hyperparathyroidism

Correct Incorrect Correct answer

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?

Blood metanephrines

Correct Incorrect Correct answer

24h urine for free cortisol excretion

Correct Incorrect Correct answer

Midnight salivary or plasma cortisol

Correct Incorrect Correct answer

24h urine for calcium excretion

Correct Incorrect Correct answer

1 mg overnight dexamethasone suppression test

Correct Incorrect Correct answer

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

Which of the following is correct?

Repeat biopsy is recommended due to the rarity of breast cancer in males

Correct Incorrect Correct answer

This is most probably lobular breast carcinoma

Correct Incorrect Correct answer

Most male patients report a long course of gynecomastia before the diagnosis of breast cancer

Correct Incorrect Correct answer

Local and systemic spread will determine the extent of surgery

Correct Incorrect Correct answer

In most cases there is no role for antihormonal therapy since ER/PR positive tumors are rare in male patients

Correct Incorrect Correct answer

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

Hypocalcemia

Correct Incorrect Correct answer

Infection

Correct Incorrect Correct answer

Vitamin B6 deficiency

Correct Incorrect Correct answer

Aspirin treatment

Correct Incorrect Correct answer

Smoking

Correct Incorrect Correct answer

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?

Colitis

Correct Incorrect Correct answer

Small bowel obstruction

Correct Incorrect Correct answer

Diverticulitis

Correct Incorrect Correct answer

Large bowel obstruction

Correct Incorrect Correct answer

Bile duct obstruction

Correct Incorrect Correct answer

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

Dysthymic disorder

Correct Incorrect Correct answer

Major depressive disorder

Correct Incorrect Correct answer

Bipolar disorder

Correct Incorrect Correct answer

Schizophrenia

Correct Incorrect Correct answer

Somatic symptom disorder

Correct Incorrect Correct answer

Combined oral contraceptive decrease the risk of:

Thromboembolic events

Correct Incorrect Correct answer

Ovarian cancer

Correct Incorrect Correct answer

Chlamydia lower vaginal tract infections

Correct Incorrect Correct answer

Uterus cervical cancer

Correct Incorrect Correct answer

Gallbladder stones

Correct Incorrect Correct answer

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?

Salpingectomy and in vitro fertilization

Correct Incorrect Correct answer

Surgical hysteroscopy

Correct Incorrect Correct answer

Ovum donation

Correct Incorrect Correct answer

Ovarian stimulation and intrauterine insemination

Correct Incorrect Correct answer

Surrogacy

Correct Incorrect Correct answer

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?

Anti daDNA tinlibodies

Correct Incorrect Correct answer

Decreased C3 levels

Correct Incorrect Correct answer

Decreased albumin levels

Correct Incorrect Correct answer

Increased eosinophil levels

Correct Incorrect Correct answer

Decreased C1 Inhibitor levels

Correct Incorrect Correct answer

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?

Permanent prophylactic antihistamine treatment

Correct Incorrect Correct answer

Gradual immunization by bee venom

Correct Incorrect Correct answer

Automatic antihistamine injection for self-use

Correct Incorrect Correct answer

Permanent low dose steroids

Correct Incorrect Correct answer

Automatic steroid Injection for self-use

Correct Incorrect Correct answer

Which of the following is the most appropriate next step?

Since it is a sinus rhythm, continue the same treatment

Correct Incorrect Correct answer

Start chest compressions immediately

Correct Incorrect Correct answer

Synchronized cardioversion using 50 joules

Correct Incorrect Correct answer

Intravenous atropine

Correct Incorrect Correct answer

Unsynchronized cardioversion using 50 joules

Correct Incorrect Correct answer

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?

Amoxicillin with proton pump inhibitor (PPI)

Correct Incorrect Correct answer

Amoxicillin with tetracycline

Correct Incorrect Correct answer

Levofloxacin

Correct Incorrect Correct answer

Levofloxacin with PPI

Correct Incorrect Correct answer

Levofloxacin, amoxicillin, and PPI

Correct Incorrect Correct answer

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?

Cefazolin (Cefamezin) is the treatment of choice

Correct Incorrect Correct answer

Piperacillin/tazobactam (Tazocin) is the treatment of choice

Correct Incorrect Correct answer

Vancomycin and amikacin are the treatment of choice

Correct Incorrect Correct answer

Debridement of the involved issues without antibiotics is the treatment of choice

Correct Incorrect Correct answer

Penicillin and clindamycin are the treatment of choice

Correct Incorrect Correct answer

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

Hypokalemia

Correct Incorrect Correct answer

Pulmonary edema

Correct Incorrect Correct answer

Low blood pressure

Correct Incorrect Correct answer

Sepsis

Correct Incorrect Correct answer

Hypernatremia

Correct Incorrect Correct answer

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?

Silica

Correct Incorrect Correct answer

Asbestos

Correct Incorrect Correct answer

Coal miners

Correct Incorrect Correct answer

Beryllium

Correct Incorrect Correct answer

Talc

Correct Incorrect Correct answer

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

Tumors of the small bowel

Correct Incorrect Correct answer

Adhesions following bariatric surgery

Correct Incorrect Correct answer

Intestinal malrotation

Correct Incorrect Correct answer

Incarcerated inguinal hernia

Correct Incorrect Correct answer

Adhesions following abdominal or pelvic surgery

Correct Incorrect Correct answer

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?

Acidosis, hypothermia, coagulopathy

Correct Incorrect Correct answer

Acidosis, hyperthermia, hyper coagulopathy

Correct Incorrect Correct answer

Alkalosis, hypothermia, coagulopathy

Correct Incorrect Correct answer

Alkalosis, hypothermia, hyper coagulopathy

Correct Incorrect Correct answer

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?

Patient can be discharged with planned elective hernia repair

Correct Incorrect Correct answer

Proceed with the original surgical plan

Correct Incorrect Correct answer

Admit the patient for observation, discharge after 24 hours with follow-up by his primary physician

Correct Incorrect Correct answer

Admit the patient for observation and operate within the same admission after Plavix discontinuation

Correct Incorrect Correct answer

Surgery should be avoided and hernia strap is recommended

Correct Incorrect Correct answer

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?

Paranoid personality disorder

Correct Incorrect Correct answer

Avoidant personality disorder

Correct Incorrect Correct answer

Schizoid personality disorder

Correct Incorrect Correct answer

Dependent personality disorder

Correct Incorrect Correct answer

Narcissistic personality disorder

Correct Incorrect Correct answer

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?

Mullerian agenesis

Correct Incorrect Correct answer

Turner syndrome mosaicism

Correct Incorrect Correct answer

Asheman syndrome

Correct Incorrect Correct answer

Eating disorder

Correct Incorrect Correct answer

Diabetes

Correct Incorrect Correct answer

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)?

Low D-Dimer level

Correct Incorrect Correct answer

Low fibrinogen level

Correct Incorrect Correct answer

Short (PT/PTT)

Correct Incorrect Correct answer

Thrombocytosis

Correct Incorrect Correct answer

Hemoglobin of 13 g%

Correct Incorrect Correct answer

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?

Celiac

Correct Incorrect Correct answer

Wilson

Correct Incorrect Correct answer

Thalassemia major

Correct Incorrect Correct answer

Cystic fibrosis

Correct Incorrect Correct answer

Aplastic anemia

Correct Incorrect Correct answer

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?

Analgesic with fentanyl

Correct Incorrect Correct answer

Airway evaluation

Correct Incorrect Correct answer

Fixation to a backboard

Correct Incorrect Correct answer

Limb fixation to a splint

Correct Incorrect Correct answer

Evaluation of vital signs

Correct Incorrect Correct answer

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.

Urgent cardiac catheterization

Correct Incorrect Correct answer

Mechanical ventilation

Correct Incorrect Correct answer

Immediate treatment Prostaglandin E1

Correct Incorrect Correct answer

Immediate treatment with indomethacin

Correct Incorrect Correct answer

Raskind balloon atrial septostomy

Correct Incorrect Correct answer

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?

Aplastic anemia

Correct Incorrect Correct answer

Chronic myelocytic leukemia

Correct Incorrect Correct answer

Myelofibrosis

Correct Incorrect Correct answer

Pure red cell aplasia

Correct Incorrect Correct answer

Autoimmune hemolytic. Anemia (AIHA)

Correct Incorrect Correct answer

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?

PaO2/F10,2</= 200

Correct Incorrect Correct answer

Right ling infiltrate

Correct Incorrect Correct answer

Pulmonary pressure > 60 mmHg

Correct Incorrect Correct answer

Loft ventricle ejection fraction 35%

Correct Incorrect Correct answer

Decreased right ventricle function

Correct Incorrect Correct answer

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

Cholangitis

Correct Incorrect Correct answer

Pancreatitis

Correct Incorrect Correct answer

Perforation

Correct Incorrect Correct answer

Pseudocyst infection

Correct Incorrect Correct answer

Gastritis

Correct Incorrect Correct answer

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?

Combined treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)

Correct Incorrect Correct answer

Observation

Correct Incorrect Correct answer

Combined treatment with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP). and whole-body radiation

Correct Incorrect Correct answer

Autologous bone marrow transplantation

Correct Incorrect Correct answer

Radiation to involved lymph nodes

Correct Incorrect Correct answer

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?

Retrieve the knife so it will not interfere with the patient's examination

Correct Incorrect Correct answer

Abdominal CT to rule out other injuries

Correct Incorrect Correct answer

Fluid resuscitation, quick survey for bleeding source, initiate blood products, quick transfer to the operating room

Correct Incorrect Correct answer

Intubation, transfer to ICU until stabilized with fluids and antibiotics, and then transfer to the operating room

Correct Incorrect Correct answer

High dose dopamine to increase blood pressure

Correct Incorrect Correct answer

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)?

Lymphocytes

Correct Incorrect Correct answer

Macrophages

Correct Incorrect Correct answer

Fibroblasts

Correct Incorrect Correct answer

Neutrophils

Correct Incorrect Correct answer

Eosinophils

Correct Incorrect Correct answer

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

Relatively large amount of lipomatous content

Correct Incorrect Correct answer

Irregular borders

Correct Incorrect Correct answer

High vascularity

Correct Incorrect Correct answer

Slow contrast washout

Correct Incorrect Correct answer

Central necrosis

Correct Incorrect Correct answer

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?

Lithium intoxication

Correct Incorrect Correct answer

Wernicke encephalopathy

Correct Incorrect Correct answer

Serotonin syndrome

Correct Incorrect Correct answer

Neuroleptic malignant syndrome

Correct Incorrect Correct answer

Acute dystonia

Correct Incorrect Correct answer

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

Blood pressure Holter

Correct Incorrect Correct answer

Testing for congenital hyper coagulation

Correct Incorrect Correct answer

Karyotyping of both partners

Correct Incorrect Correct answer

Glucose tolerance test

Correct Incorrect Correct answer

Laparoscopic examination of the uterine structure

Correct Incorrect Correct answer

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?

Local vaginal estrogen

Correct Incorrect Correct answer

Local vaginal antibiotics

Correct Incorrect Correct answer

Combined contraceptives

Correct Incorrect Correct answer

Surgical excision of the cyst

Correct Incorrect Correct answer

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 ?

Intussusception

Correct Incorrect Correct answer

Hemolytic anemia

Correct Incorrect Correct answer

Gastrointestinal bleeding

Correct Incorrect Correct answer

Renal vein thrombosis

Correct Incorrect Correct answer

Mitral valve prolapse

Correct Incorrect Correct answer

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?

Oral anti histamine

Correct Incorrect Correct answer

Intravenous steroids

Correct Incorrect Correct answer

Intra muscular epinephrine

Correct Incorrect Correct answer

Intravenous fluid bolus

Correct Incorrect Correct answer

Intravenous antibiotics

Correct Incorrect Correct answer

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?

Abdominal x-ray

Correct Incorrect Correct answer

ECG

Correct Incorrect Correct answer

Complete blood count

Correct Incorrect Correct answer

Urinalysis

Correct Incorrect Correct answer

Chest X-ray

Correct Incorrect Correct answer

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?

Syphilis

Correct Incorrect Correct answer

Chancroid

Correct Incorrect Correct answer

Behcet's disease

Correct Incorrect Correct answer

Systemic lupus erythematous

Correct Incorrect Correct answer

Herpes simplex virus infection

Correct Incorrect Correct answer

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?

Documented new onset of atrial fibrillation

Correct Incorrect Correct answer

His father developed ventricular tachycardia on the fourth day following myocardial infarction

Correct Incorrect Correct answer

A ventricular septum width of 33 mm on echocardiography

Correct Incorrect Correct answer

Increase in blood pressure on stress test

Correct Incorrect Correct answer

Atrial premature beats (APC'S) on ECG

Correct Incorrect Correct answer

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:

Immediate catheterization with primary PCI

Correct Incorrect Correct answer

Heparin

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

Nitrates

Correct Incorrect Correct answer

Copidogrel

Correct Incorrect Correct answer

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?

Urine specific gravity < 1.018

Correct Incorrect Correct answer

Urine chloride > 25 mm

Correct Incorrect Correct answer

Urine osmolality < 300 mOsmkg

Correct Incorrect Correct answer

Urine HCO3 < 20 mM

Correct Incorrect Correct answer

Fractional excretion of sodium (FENа) < 1%

Correct Incorrect Correct answer

Below are two photos of two patients with dysphagia.

Which of the following is correct?

Patient A has a tumor of the gastroesophageal junction

Correct Incorrect Correct answer

Patient B has mid esophagus diverticulum

Correct Incorrect Correct answer

Patient A has achalasia

Correct Incorrect Correct answer

Patient B has reflux

Correct Incorrect Correct answer

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

Pelvis (61%)

Correct Incorrect Correct answer

Where the three taeniae coli merge

Correct Incorrect Correct answer

Along the Toldt line

Correct Incorrect Correct answer

Next to the right colic artery that supplies the appendix

Correct Incorrect Correct answer

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?

The etiology is bile leak form the cystic duct due to a clip that "fell" off the cystic duct stump

Correct Incorrect Correct answer

This is a very rare phenomena after surgery for acute cholecystitis and will self-resolve

Correct Incorrect Correct answer

The treatment should include Antipyretics, and analgesics only

Correct Incorrect Correct answer

ERCP is contraindicated due to his severe condition

Correct Incorrect Correct answer

Blood and urinary cultures should be taken, await results, and start antibiotics accordingly

Correct Incorrect Correct answer

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?

Lithium

Correct Incorrect Correct answer

Depalept

Correct Incorrect Correct answer

Topiramate

Correct Incorrect Correct answer

Lamictal

Correct Incorrect Correct answer

Carbamazepine

Correct Incorrect Correct answer

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

Cesarean section due to prolonged rupture of membranes

Correct Incorrect Correct answer

Back pain

Correct Incorrect Correct answer

Coagulopathy

Correct Incorrect Correct answer

Thrombocytopenia 100,00

Correct Incorrect Correct answer

Hypertension

Correct Incorrect Correct answer

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?

CVS provides a more reliable diagnosis

Correct Incorrect Correct answer

CVS carries a greater risk of a miscarriage

Correct Incorrect Correct answer

CVS allows diagnosis of the mother and the fetus

Correct Incorrect Correct answer

CVS is possible later in the pregnancy

Correct Incorrect Correct answer

CVS is possible only in a vaginal approach

Correct Incorrect Correct answer

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.

Positive pathergy tesy

Correct Incorrect Correct answer

Serum Anti-Smith Ab

Correct Incorrect Correct answer

Elevated serum IgA

Correct Incorrect Correct answer

Elevated serum CPK

Correct Incorrect Correct answer

Blasts in a blood smear

Correct Incorrect Correct answer

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?

Abdominal and chest CT

Correct Incorrect Correct answer

AP and lateral chest x-ray

Correct Incorrect Correct answer

Technetium scan

Correct Incorrect Correct answer

Lymph node biopsy

Correct Incorrect Correct answer

Positron emission tomography (PET) scan

Correct Incorrect Correct answer

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?

Naproxen (Naxyn)

Correct Incorrect Correct answer

Anti-epileptics

Correct Incorrect Correct answer

Cannabidiol

Correct Incorrect Correct answer

Sumatriptan (imitrex)

Correct Incorrect Correct answer

Ibuprofen (Brufen)

Correct Incorrect Correct answer

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 45-year-old female with severe mitral stenosis due to rheumatic heart disease

Correct Incorrect Correct answer

A 64-year-old female with type Il diabetes controlled by medications

Correct Incorrect Correct answer

A 70-year-old male with hypertension controlled by two antihypertensive medications

Correct Incorrect Correct answer

A 40-year-old male with controlled heart failure and left ventricle ejection fraction (LVEF) of 36%

Correct Incorrect Correct answer

A 50-year-old healthy male with documented episodic atrial fibrillation for the past 6 months

Correct Incorrect Correct answer

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?

Azathioprine

Correct Incorrect Correct answer

Methotrexate

Correct Incorrect Correct answer

Natalizumab

Correct Incorrect Correct answer

Usteklunumab

Correct Incorrect Correct answer

Cyclosporine

Correct Incorrect Correct answer

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?

IM epinephrine 0.5 mg and repeat injection every 5-20 minutes

Correct Incorrect Correct answer

IM epinephrine 0.5 mg with IV metoprolol 5 mg

Correct Incorrect Correct answer

IM hydrocortisone 150 mg with PO telfast (antihistamine) 180 mg

Correct Incorrect Correct answer

IM hydrocortisone 200 mg and IV metoprolol 5 mg

Correct Incorrect Correct answer

Epinephrine 0.5 mg, hydrocortisone 100 mg, metoprolol 5 mg, telfast 180 mg

Correct Incorrect Correct answer

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?

Prolonged PT

Correct Incorrect Correct answer

Normal fibrinogen level

Correct Incorrect Correct answer

Normal levels of fibrin degradation products (FDPs)

Correct Incorrect Correct answer

Platelets count 90.000

Correct Incorrect Correct answer

Presence of schistocytes (fragmented red cell) on peripheral blood smear

Correct Incorrect Correct answer

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?

Gastroscopy, lesion biopsies, and endoscopic ultrasound (EUS) should be performed to determine the type and stage of tumor

Correct Incorrect Correct answer

Gastrectomy with wide margins should be performed regardless of the tumor location

Correct Incorrect Correct answer

Gastric cancer is usually not aggressive and survival is over 5 years

Correct Incorrect Correct answer

Neoadjuvant chemoradiotherapy followed by surgery can achieve good results in cases of locally advanced gastric cancer

Correct Incorrect Correct answer

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

The main advantage is high diagnostic rate (over 80%)

Correct Incorrect Correct answer

It is diagnostic in 50% of the cases

Correct Incorrect Correct answer

The main advantage is diagnosis of retroperitoneal pathologies

Correct Incorrect Correct answer

Its use is decreasing

Correct Incorrect Correct answer

Which of the following can cause intrinsic cardiogenic shock?

Cardiac tamponade

Correct Incorrect Correct answer

Sepsis

Correct Incorrect Correct answer

Tension pneumothorax

Correct Incorrect Correct answer

Myocardial infarction

Correct Incorrect Correct answer

Head trauma

Correct Incorrect Correct answer

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

Increased drooling

Correct Incorrect Correct answer

Diarrhea

Correct Incorrect Correct answer

Blurred vision

Correct Incorrect Correct answer

Increased sweating

Correct Incorrect Correct answer

frequent urination

Correct Incorrect Correct answer

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?

Family group therapy

Correct Incorrect Correct answer

Hypnosis

Correct Incorrect Correct answer

cognitive behavioral therapy

Correct Incorrect Correct answer

social skills rehabilitation

Correct Incorrect Correct answer

Dialectical behavior therapy

Correct Incorrect Correct answer

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?

Postcoital test

Correct Incorrect Correct answer

Hormone profile(LH,FSH,testosterone)

Correct Incorrect Correct answer

An additional semen exam in 3 months

Correct Incorrect Correct answer

Testing antibodies to sperm

Correct Incorrect Correct answer

Testicular biopsy

Correct Incorrect Correct answer

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

Increased risk of epithelial ovarian cancer

Correct Incorrect Correct answer

Increased risk of endometrial cancer

Correct Incorrect Correct answer

Early menopause

Correct Incorrect Correct answer

Increased risk of Down syndrome in the fetus

Correct Incorrect Correct answer

Ectopic pregnancy

Correct Incorrect Correct answer

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?

Insertion of a nasogastric tube

Correct Incorrect Correct answer

Complete blood count and blood gasses

Correct Incorrect Correct answer

Echocardiography

Correct Incorrect Correct answer

ECG

Correct Incorrect Correct answer

Abdominal and chest CT

Correct Incorrect Correct answer

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?

Oral ampicillin (Penibrin)

Correct Incorrect Correct answer

IV trimethoprim-sulfamethoxazole (Resprim)

Correct Incorrect Correct answer

IV cefuroxime (Zinacef)

Correct Incorrect Correct answer

IV ceftriaxone (Rocephine)

Correct Incorrect Correct answer

Oral doxycycline (Doxilin)

Correct Incorrect Correct answer

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?

Abdominal mass

Correct Incorrect Correct answer

Increased PTH levels

Correct Incorrect Correct answer

Low calcium levels

Correct Incorrect Correct answer

Increased head circumference

Correct Incorrect Correct answer

Retinal hemorrhages

Correct Incorrect Correct answer

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?

Loud S1

Correct Incorrect Correct answer

Opening snap

Correct Incorrect Correct answer

s3

Correct Incorrect Correct answer

Pulsus parvus et tardus

Correct Incorrect Correct answer

Water hammer pulse

Correct Incorrect Correct answer

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?

Isoniazid for 12 months

Correct Incorrect Correct answer

Rifampin for 4 months

Correct Incorrect Correct answer

Isoniazid + rifampin for 1 month

Correct Incorrect Correct answer

Isoniazid + rifampin for 6 months

Correct Incorrect Correct answer

Rifampin+moxifloxacin for 4 months

Correct Incorrect Correct answer

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?

Acute renal failure

Correct Incorrect Correct answer

Heart failure

Correct Incorrect Correct answer

Hypothyroidism

Correct Incorrect Correct answer

Hypokalemia

Correct Incorrect Correct answer

Hypomagnesemia

Correct Incorrect Correct answer

Which of the following is the most common incarcerated hernia?

Femoral

Correct Incorrect Correct answer

Umbilical

Correct Incorrect Correct answer

Inguinal

Correct Incorrect Correct answer

Incisional

Correct Incorrect Correct answer

Hiatal

Correct Incorrect Correct answer

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?

Abdominal CT

Correct Incorrect Correct answer

Exploratory laparotomy

Correct Incorrect Correct answer

Local wound exploration

Correct Incorrect Correct answer

Focused assessment with sonography in trauma (FAST)

Correct Incorrect Correct answer

Diagnostic peritoneal lavage

Correct Incorrect Correct answer

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?

Duodenal ulcer perforation

Correct Incorrect Correct answer

Incarcerated femoral hernia

Correct Incorrect Correct answer

Acute cholecystitis

Correct Incorrect Correct answer

Perforated appendicitis

Correct Incorrect Correct answer

Obstructing left colon cancer

Correct Incorrect Correct answer

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?

Fever above 38°C at diagnosis

Correct Incorrect Correct answer

Retraction of the breast skin with ulceration

Correct Incorrect Correct answer

Thickening of the breast skin will be the only finding on mammography

Correct Incorrect Correct answer

Axillary lymph node involvement is unlikely

Correct Incorrect Correct answer

A fifty years old male complains of severe anxiety.

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

Palmar hyperhidrosis

Correct Incorrect Correct answer

Tachycardia

Correct Incorrect Correct answer

Tremor

Correct Incorrect Correct answer

Miosis

Correct Incorrect Correct answer

Hyperreflexia

Correct Incorrect Correct answer

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

Decreased required daily frequency

Correct Incorrect Correct answer

Decreased plasma concentration variability

Correct Incorrect Correct answer

Decreased withdrawal symptoms

Correct Incorrect Correct answer

Decreased sedative effect

Correct Incorrect Correct answer

Better in patients with low compliance to treatment

Correct Incorrect Correct answer

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?

Pelvic MRI twice a year

Correct Incorrect Correct answer

Avoidance of combined oral contraceptives

Correct Incorrect Correct answer

Salpingo-oophorectomy at the age of 35 years

Correct Incorrect Correct answer

Pap smear twice a year

Correct Incorrect Correct answer

Yearly colonoscopy from the age of 40

Correct Incorrect Correct answer

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?

Hair loss and weight loss

Correct Incorrect Correct answer

New onset of visual disturbances

Correct Incorrect Correct answer

A history of using oral contraceptives

Correct Incorrect Correct answer

A painful rash along a dermatome of the chest

Correct Incorrect Correct answer

Intensive exercise toward triathlon

Correct Incorrect Correct answer

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?

Attention deficit disorder

Correct Incorrect Correct answer

Tourette syndrome

Correct Incorrect Correct answer

Vocal tics

Correct Incorrect Correct answer

Chorea minor

Correct Incorrect Correct answer

Anxiety disorder

Correct Incorrect Correct answer

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?

Perform abdominal CT

Correct Incorrect Correct answer

Perform serum EMA and genetics for HLA

Correct Incorrect Correct answer

Outpatient follow up of growth curves

Correct Incorrect Correct answer

Endoscopy including small bowel biopsy

Correct Incorrect Correct answer

Gluten free diet and repeat the tests in 6 months

Correct Incorrect Correct answer

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?

Lamotrigine (Lamictal)

Correct Incorrect Correct answer

Carbamazepine (Tegretol)

Correct Incorrect Correct answer

Intra-muscular ACTH

Correct Incorrect Correct answer

Valproic acid (Valporal)

Correct Incorrect Correct answer

Vigabatrin (Sabry)

Correct Incorrect Correct answer

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?

Fluid to serum protein ratio lower than 0.5

Correct Incorrect Correct answer

Fluid to serum LDH ratio greater than 0.6

Correct Incorrect Correct answer

Fluid LDH lower than half the upper value of serum LDH

Correct Incorrect Correct answer

Albumin difference between the serum and fluid greater than 1.1

Correct Incorrect Correct answer

Number of white cells in fluid greater than number of white cells in serum

Correct Incorrect Correct answer

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?

The antibiotic treatment should be changed to cefuroxime (Zinacef)

Correct Incorrect Correct answer

Stool cultures should be sent to rule out abdominal infection

Correct Incorrect Correct answer

Immediate chest X-ray should be performed to rule out pleural effusion as a complication of pneumonia

Correct Incorrect Correct answer

Wait another 72 hours prior to decision on treatment modification

Correct Incorrect Correct answer

The patient has an indication to proceed with partial loft lobectomy

Correct Incorrect Correct answer

-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?

Immediate catheterization with primary percutaneous coronary intervention

Correct Incorrect Correct answer

Echocardiography and start ibuprofen and colchicine

Correct Incorrect Correct answer

Chest X-ray and tube thoracotomy

Correct Incorrect Correct answer

Chest CTA and immediate anticoagulation therapy

Correct Incorrect Correct answer

Chest CTA and immediate fibrinolytic therapy

Correct Incorrect Correct answer

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?

Hepatic iminodiacetic acid (HIDA) scan

Correct Incorrect Correct answer

Triphasic abdominal CT

Correct Incorrect Correct answer

Endoscopic retrograde cholangiopancreatography (ERCP)

Correct Incorrect Correct answer

Percutaneous transhepatic cholangiography (PTC)

Correct Incorrect Correct answer

Ultrasound guided gallbladder aspiration for cultures and treat accordingly

Correct Incorrect Correct answer

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?

Despite undergoing mastectomy there is an indication for radiation therapy

Correct Incorrect Correct answer

Radiation of the surgical field will only decrease local recurrences but will not affect survival

Correct Incorrect Correct answer

There is no role for radiation therapy if the patient will be treated with chemotherapy

Correct Incorrect Correct answer

Since the patient has positive lymph nodes then radiation should be limited to the axilla alone

Correct Incorrect Correct answer

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?

Courvoisier gallbladder

Correct Incorrect Correct answer

Positive Rovsing sign

Correct Incorrect Correct answer

Virchow node

Correct Incorrect Correct answer

Positive Murphy sign

Correct Incorrect Correct answer

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?

300 mg hydrocortisone

Correct Incorrect Correct answer

200 mg hydrocortisone

Correct Incorrect Correct answer

100 mg hydrocortisone

Correct Incorrect Correct answer

50 mg hydrocortisone

Correct Incorrect Correct answer

500 mg hydrocortisone

Correct Incorrect Correct answer

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?

Amylase

Correct Incorrect Correct answer

Creatinine kinase

Correct Incorrect Correct answer

Renal function tests

Correct Incorrect Correct answer

Prolactin

Correct Incorrect Correct answer

Hemoglobin A1C

Correct Incorrect Correct answer

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?

Paranoid personality disorder

Correct Incorrect Correct answer

Hypochondriasis

Correct Incorrect Correct answer

Acute and transient paranoid psychosis

Correct Incorrect Correct answer

Schizophrenia

Correct Incorrect Correct answer

Obsessive compulsive disorder

Correct Incorrect Correct answer

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?

TORCH-congenital infection

Correct Incorrect Correct answer

Gestational age

Correct Incorrect Correct answer

Placental insufficiency

Correct Incorrect Correct answer

Gestational diabetes

Correct Incorrect Correct answer

Smoking

Correct Incorrect Correct answer

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?

Congenital neural deafness

Correct Incorrect Correct answer

Intracranial calcifications

Correct Incorrect Correct answer

Congenital heart defect-VSD

Correct Incorrect Correct answer

Limb hypoplasia

Correct Incorrect Correct answer

Galactosemia

Correct Incorrect Correct answer

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?

Maternal thrombocytopenia

Correct Incorrect Correct answer

Vitamin K deficiency

Correct Incorrect Correct answer

Hemophilia A

Correct Incorrect Correct answer

Congenital CMV infection

Correct Incorrect Correct answer

Traumatic birth

Correct Incorrect Correct answer

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

Bacterial pneumonia

Correct Incorrect Correct answer

Bacterial meningitis

Correct Incorrect Correct answer

Urinary tract infection

Correct Incorrect Correct answer

Primary bacteremia

Correct Incorrect Correct answer

Arthritis/osteomyelitis

Correct Incorrect Correct answer

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 ?

Autoimmune hypothyroidism

Correct Incorrect Correct answer

Transient hypoparathyroidism

Correct Incorrect Correct answer

Turner syndrome

Correct Incorrect Correct answer

Vitamin D deficiency

Correct Incorrect Correct answer

Congenital hypocalcemia

Correct Incorrect Correct answer

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?

Bacillus cereus

Correct Incorrect Correct answer

Vibrio cholerae

Correct Incorrect Correct answer

Shiga toxin-producing

Correct Incorrect Correct answer

E.coli Staphylococcus aureus

Correct Incorrect Correct answer

Brucellosis

Correct Incorrect Correct answer

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?

Bicarbonate, short acting insulin, IV NaCl 0.45%

Correct Incorrect Correct answer

Bicarbonate, long acting insulin, IV NaCl 0.9%

Correct Incorrect Correct answer

Short acting insulin, IV NaCl 0.9%

Correct Incorrect Correct answer

IV short acting insulin and SC long acting insulin, IV NaCl 0.46%

Correct Incorrect Correct answer

Short acting insulin, IV NaCl 3%, inhalation salbutamol (Ventolin)

Correct Incorrect Correct answer

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?

IV Levothyroxin 200 mag

Correct Incorrect Correct answer

IV ceftriaxone 2g

Correct Incorrect Correct answer

SC epinephrine 0.5 mg

Correct Incorrect Correct answer

IV naloxone 2mg

Correct Incorrect Correct answer

IV flumazenil 0.1 mg

Correct Incorrect Correct answer

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

Age below 40

Correct Incorrect Correct answer

3 cm tumor size

Correct Incorrect Correct answer

Tumor without capsular invasion

Correct Incorrect Correct answer

Male gender

Correct Incorrect Correct answer

Well differentiated adenocarcinoma histology

Correct Incorrect Correct answer

Which of the following is correct regarding cancer in humans?

Cancer incidence increases in people over the age of 80 years

Correct Incorrect Correct answer

There is significant phenotype similarity between sporadic and inherited cancer

Correct Incorrect Correct answer

Approximately 5-10% of breast cancers are inherited and two genes were identified – BRCA1 and BRCA2

Correct Incorrect Correct answer

Ultraviolet radiation is the only radiation that causes malignant changes in humans

Correct Incorrect Correct answer

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

Bile duct obstruction by a stone or tumor

Correct Incorrect Correct answer

Diverticulitis, appendicitis

Correct Incorrect Correct answer

Caroli disease

Correct Incorrect Correct answer

Obstruction by ascariasis

Correct Incorrect Correct answer

Previous history of bile duct surgery

Correct Incorrect Correct answer

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

It's incidence is the same between the general population and those with mental illness.

Correct Incorrect Correct answer

mostly there is a wish to die

Correct Incorrect Correct answer

More common in men.

Correct Incorrect Correct answer

Lasts several years.

Correct Incorrect Correct answer

Usually begins in the fifth decade of life.

Correct Incorrect Correct answer

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

Wait and observe

Correct Incorrect Correct answer

Decrease antipsychotic drug dose

Correct Incorrect Correct answer

Decrease antipsychotic drug to another atypical antipsychotic drug

Correct Incorrect Correct answer

Add antiparkinsonian drug

Correct Incorrect Correct answer

Change to low potency typical antipsychotic drug

Correct Incorrect Correct answer

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

Calcifications within an ovarian cyst

Correct Incorrect Correct answer

A clear cyst with a diameter of 8cm

Correct Incorrect Correct answer

Sediment in an ovarian cyst

Correct Incorrect Correct answer

Bilateral findings

Correct Incorrect Correct answer

A single thin septum within the cyst

Correct Incorrect Correct answer

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?

Intravenous steroids

Correct Incorrect Correct answer

(IVIG)

Correct Incorrect Correct answer

Urgent splenectomy

Correct Incorrect Correct answer

Clinical follow up and avoidance of trauma

Correct Incorrect Correct answer

Rituximab (Mabthera)

Correct Incorrect Correct answer

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?

Insert a right chest drain

Correct Incorrect Correct answer

Admit the boy and supply supplemental oxygen through a face mask

Correct Incorrect Correct answer

Chest CT for evaluation

Correct Incorrect Correct answer

Obtain arterial blood gasses

Correct Incorrect Correct answer

Initiate antibiotic treatment

Correct Incorrect Correct answer

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?

Intravenous steroids

Correct Incorrect Correct answer

Intravenous ceftriaxone

Correct Incorrect Correct answer

Intravenous vancomycin

Correct Incorrect Correct answer

Prophylactic sedation and ventilation

Correct Incorrect Correct answer

Daily physiotherapy and respiratory therapy

Correct Incorrect Correct answer

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?

Tay-Sachs disease

Correct Incorrect Correct answer

Pyruvate carboxylase deficiency

Correct Incorrect Correct answer

Congenital CMV infection

Correct Incorrect Correct answer

Maple syrup urine disease

Correct Incorrect Correct answer

Pyruvate denydrogenase deficiency

Correct Incorrect Correct answer

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?

Primary billary Clinthosis

Correct Incorrect Correct answer

Primary sclerosing cholangitis

Correct Incorrect Correct answer

Autoimmune hepatitis

Correct Incorrect Correct answer

Cirrhosis secondary to HBV infection

Correct Incorrect Correct answer

Acute viral hepatitis

Correct Incorrect Correct answer

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?

Recurrent aphthae

Correct Incorrect Correct answer

Interstitial lung disease

Correct Incorrect Correct answer

Calcinosis (calcifications)

Correct Incorrect Correct answer

Telangiectasias

Correct Incorrect Correct answer

Hirsutism

Correct Incorrect Correct answer

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?

Immune thrombocytopenic purpura (ITP)

Correct Incorrect Correct answer

Thrombotic thrombocytopenic purpura (TTP)

Correct Incorrect Correct answer

Hemolytic-uremic syndrome (HUS)

Correct Incorrect Correct answer

Von Willebrand disease (WWD)

Correct Incorrect Correct answer

Disseminated intravascular coagulation (DIC)

Correct Incorrect Correct answer

Which of the following bariatric procedures is considered restrictive only?

Band (LAGB)

Correct Incorrect Correct answer

Biliopancreatic diversion (BPD)

Correct Incorrect Correct answer

Roux-en-Y gastric bypass

Correct Incorrect Correct answer

Duodenal switch (DS)

Correct Incorrect Correct answer

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?

Abdominal CT

Correct Incorrect Correct answer

Supine and upright or left lateral decubitus abdominal

Correct Incorrect Correct answer

X-ray

Correct Incorrect Correct answer

Abdominal ultrasound

Correct Incorrect Correct answer

Abdominal angiography

Correct Incorrect Correct answer

All of the following fit peptic ulcer disease, except:

Pallor

Correct Incorrect Correct answer

Jaundice

Correct Incorrect Correct answer

Multiple vomiting

Correct Incorrect Correct answer

Upper abdominal pain

Correct Incorrect Correct answer

Melena

Correct Incorrect Correct answer

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?

At least two episodes of running away his parents' house.

Correct Incorrect Correct answer

Symptoms must start before the age of 7 years.

Correct Incorrect Correct answer

Diagnosis most include animal abuse.

Correct Incorrect Correct answer

Symptoms must last for at least 3 months

Correct Incorrect Correct answer

Does not necessitate studies, occupational, or social dysfunction.

Correct Incorrect Correct answer

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

Increase blood pressure

Correct Incorrect Correct answer

Increased heart rate

Correct Incorrect Correct answer

Increased hemoglobin

Correct Incorrect Correct answer

Increase platelets

Correct Incorrect Correct answer

Increased creatinine

Correct Incorrect Correct answer

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?

Hemolytic uremic syndrome(HUS)

Correct Incorrect Correct answer

Acute gastroenteritis

Correct Incorrect Correct answer

Viral hepatitis

Correct Incorrect Correct answer

Thrombotic thrombocytopenic purpura(TTP)

Correct Incorrect Correct answer

Acute fatty liver of pregnancy (AFLP)

Correct Incorrect Correct answer

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?

Normal for his age

Correct Incorrect Correct answer

Delayed gross motor development

Correct Incorrect Correct answer

Delayed fine motor development

Correct Incorrect Correct answer

Significant delay in language development

Correct Incorrect Correct answer

Delay in linguistic and motor development

Correct Incorrect Correct answer

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?

Klinefelter syndrome

Correct Incorrect Correct answer

Fragile X syndrome

Correct Incorrect Correct answer

Hypophysial tumor

Correct Incorrect Correct answer

Breast tumor

Correct Incorrect Correct answer

Adrenal

Correct Incorrect Correct answer

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?

Amoxycilin (Moxypen)

Correct Incorrect Correct answer

Cephalexin (Ceforal)

Correct Incorrect Correct answer

Penicillin G (Rafapen)

Correct Incorrect Correct answer

Ciprofloxacin (Ciproxin)

Correct Incorrect Correct answer

Clarithromycin (Klacid)

Correct Incorrect Correct answer

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?

Mitral stenosis

Correct Incorrect Correct answer

Aortic regurgitation

Correct Incorrect Correct answer

Anteroseptal myocardial infarction

Correct Incorrect Correct answer

Atrial septal defect

Correct Incorrect Correct answer

Bifascicular block (RBBB & left anterior hemiblock)

Correct Incorrect Correct answer

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

Smoking

Correct Incorrect Correct answer

Childhood pneumonia

Correct Incorrect Correct answer

Asthma

Correct Incorrect Correct answer

Adulthood pneumonia

Correct Incorrect Correct answer

Coal mining

Correct Incorrect Correct answer

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

Rifaximin

Correct Incorrect Correct answer

Lactulose

Correct Incorrect Correct answer

Correct electrolyte abnormalities

Correct Incorrect Correct answer

Corticosteroids

Correct Incorrect Correct answer

Zinc

Correct Incorrect Correct answer

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?

Norepinephrine

Correct Incorrect Correct answer

IV NaCl 3%

Correct Incorrect Correct answer

IV NaCI 0.9%

Correct Incorrect Correct answer

Extended spectrum Blactamase (ESBL) antibiotic coverage

Correct Incorrect Correct answer

Glucocorticoids

Correct Incorrect Correct answer

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

A 35-year-old male, a candidate for proctectomy due to malignancy

Correct Incorrect Correct answer

A 30-year-old healthy male, a candidate for laparoscopic hernia repair

Correct Incorrect Correct answer

A 35-year-old healthy male, a candidate for hemorrhoidectomy

Correct Incorrect Correct answer

A 30-year-old female, a candidate for planned cesarean section

Correct Incorrect Correct answer

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?

Enlarged supraclavicular node (Virchow node)

Correct Incorrect Correct answer

Enlarged umbilical node (Sister Mary Joseph node)

Correct Incorrect Correct answer

Ovarian mass (Krukenberg tumor)

Correct Incorrect Correct answer

Enlarged liver, jaundice, and ascites

Correct Incorrect Correct answer

All of the above

Correct Incorrect Correct answer

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

Calcified mass at the right lower quadrant

Correct Incorrect Correct answer

Air in the bile system

Correct Incorrect Correct answer

Distended loops of small bowel with air-fluid levels

Correct Incorrect Correct answer

Distended gallbladder on US

Correct Incorrect Correct answer

Cholelithiasis on ultrasound

Correct Incorrect Correct answer

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

Depression symptoms are present in 15% of the elderly who live in the community.

Correct Incorrect Correct answer

Depression symptoms are present in 15% of the elderly who live in nursing homes.

Correct Incorrect Correct answer

Age itself is a risk factor of depression.

Correct Incorrect Correct answer

Widower family status is associated with tendency to depressive disorder.

Correct Incorrect Correct answer

Prolonged physical illness is associated with tendency to depressive disorder.

Correct Incorrect Correct answer

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?

Karyotype

Correct Incorrect Correct answer

Follow up until the age of 17

Correct Incorrect Correct answer

Hormone profile

Correct Incorrect Correct answer

Brain MRI

Correct Incorrect Correct answer

Progestin challenge test

Correct Incorrect Correct answer

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?

Polycystic ovary syndrome

Correct Incorrect Correct answer

Seroli-Leyding tumor

Correct Incorrect Correct answer

Congenital adrenal hyperplasia(CAH)

Correct Incorrect Correct answer

Cushing syndrome

Correct Incorrect Correct answer

Mature cystic teratoma (dermoid)

Correct Incorrect Correct answer

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?

IV doxycycline (Doxillin)

Correct Incorrect Correct answer

IV cefazoline (Cefamizin)

Correct Incorrect Correct answer

IV cefotaxime (Claforan)

Correct Incorrect Correct answer

IV clindamycin (Dalacin)

Correct Incorrect Correct answer

IV vancomycin

Correct Incorrect Correct answer

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?

Hypokalemia

Correct Incorrect Correct answer

Hypernatremia

Correct Incorrect Correct answer

Hypocalcemia

Correct Incorrect Correct answer

Hypomagnesemia

Correct Incorrect Correct answer

Hyperphosphatemia

Correct Incorrect Correct answer

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?

Gilbert disease

Correct Incorrect Correct answer

Crigler-Naijar syndrome

Correct Incorrect Correct answer

Biliary atresia

Correct Incorrect Correct answer

Spherocytosis

Correct Incorrect Correct answer

Thalassemia major

Correct Incorrect Correct answer

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?

Treat with colchicine and later increase the dialysis regimen

Correct Incorrect Correct answer

Steroids at 1 mg/kg and later increase the dialysis regimen

Correct Incorrect Correct answer

Urgent dialysis and later increase the dialysis regimen

Correct Incorrect Correct answer

IV high dose diuretics

Correct Incorrect Correct answer

Increase the heparin dose during dialysis

Correct Incorrect Correct answer

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?

Recent papers did not demonstrate an advantage of aspirin and prasugrel over aspirin and clopidogrel

Correct Incorrect Correct answer

Ticagrelol causes dyspnea shortly after treatment initiation

Correct Incorrect Correct answer

There is no proven advantage of aspirin and clopidogrel over aspirin alone in patients that were treated conservatively for a year without catheterization

Correct Incorrect Correct answer

Double antiplatelet therapy is indicated for at least a year, especially in patients with drug eluting stents, to avoid restenosis

Correct Incorrect Correct answer

It is recommended to stop clopidogrel in patients with NSTEMI that are treated with beta adrenergic receptor blockers

Correct Incorrect Correct answer

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?

Continue treatment without interruption

Correct Incorrect Correct answer

Discontinue treatment 7 days before the procedure

Correct Incorrect Correct answer

Discontinue treatment 5 days before the procedure and confirm normal INR

Correct Incorrect Correct answer

Discontinue treatment 2 days before the procedure and no need for heparin until the procedure

Correct Incorrect Correct answer

Discontinue treatment 3 days before the procedure and start heparin until the procedure

Correct Incorrect Correct answer

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?

Systemic lupus erythematosus (SLE)

Correct Incorrect Correct answer

Dermatomyositis

Correct Incorrect Correct answer

Granulomatosis with polyangiitis (previous Wegener granulomatosis)

Correct Incorrect Correct answer

Relapsing polychondritis

Correct Incorrect Correct answer

Cryoglobulinemic vasculitis

Correct Incorrect Correct answer

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

Laxatives and polyethylene glycol

Correct Incorrect Correct answer

Endoscopic decompression

Correct Incorrect Correct answer

Laxatives and enemas

Correct Incorrect Correct answer

Diagnostic laparoscopy

Correct Incorrect Correct answer

Laparotomy with bowel resection

Correct Incorrect Correct answer

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?

Mini-Cog evaluation

Correct Incorrect Correct answer

Echocardiography

Correct Incorrect Correct answer

Carotid arteries Doppler

Correct Incorrect Correct answer

Glucose tolerance test

Correct Incorrect Correct answer

Pulmonary function test

Correct Incorrect Correct answer

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?

Laparoscopic cholecystectomy

Correct Incorrect Correct answer

Oral medical treatment to dissolve the stones

Correct Incorrect Correct answer

Direct injection of substance to the gallbladder to dissolve the stones

Correct Incorrect Correct answer

Observation only

Correct Incorrect Correct answer

ERCP

Correct Incorrect Correct answer

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?

In most cases symptoms will progress over time

Correct Incorrect Correct answer

In most cases it will resolve spontaneously.

Correct Incorrect Correct answer

Improved prognosis if symptoms develop gradually.

Correct Incorrect Correct answer

Rate of resolution is 50% within a year

Correct Incorrect Correct answer

Supporting family and friends do not improve prognosis.

Correct Incorrect Correct answer

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?

Antibiotics

Correct Incorrect Correct answer

Anticholinergic treatment

Correct Incorrect Correct answer

A urinary catheter for a few days

Correct Incorrect Correct answer

Tension free vaginal tape(TVT)

Correct Incorrect Correct answer

Transvaginal hysterectomy

Correct Incorrect Correct answer

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?

Routine follow up

Correct Incorrect Correct answer

Repeat Pap smear in one year

Correct Incorrect Correct answer

Colposcopy

Correct Incorrect Correct answer

Conization

Correct Incorrect Correct answer

HPV immunization

Correct Incorrect Correct answer

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.

Fluid restriction, penicillin, decreasing blood pressure

Correct Incorrect Correct answer

Steroids and anti-hypertension therapy

Correct Incorrect Correct answer

NSAIDs and maintenance fluids

Correct Incorrect Correct answer

Cyclophosphamide (Cytoxan) and steroids

Correct Incorrect Correct answer

Low protein, high calorie diet

Correct Incorrect Correct answer

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?

Legg-Calve-Perthes disease

Correct Incorrect Correct answer

Acute left septic hip

Correct Incorrect Correct answer

Left transient synovitis

Correct Incorrect Correct answer

Slipped capital femoral epiphysis

Correct Incorrect Correct answer

Osteoid osteoma

Correct Incorrect Correct answer

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?

Ulcerative colitis

Correct Incorrect Correct answer

Crohn's disease

Correct Incorrect Correct answer

Protein losing enteropathy

Correct Incorrect Correct answer

Anorexia nervosa

Correct Incorrect Correct answer

Celiac disease

Correct Incorrect Correct answer

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?

Amyloidosis

Correct Incorrect Correct answer

Familial dyslipidemia

Correct Incorrect Correct answer

Unilateral renal artery occlusion

Correct Incorrect Correct answer

Prolonged use of NSAIDs

Correct Incorrect Correct answer

Chronic nephrolithiasis disease

Correct Incorrect Correct answer

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?

High dose aspirin

Correct Incorrect Correct answer

Loratadine

Correct Incorrect Correct answer

Amoxicillin clavulanic acid (Augmentin

Correct Incorrect Correct answer

Prednisone

Correct Incorrect Correct answer

Doxycycline

Correct Incorrect Correct answer

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

Pulmonary fibrosis

Correct Incorrect Correct answer

Obesity

Correct Incorrect Correct answer

Asthma

Correct Incorrect Correct answer

Emphysema

Correct Incorrect Correct answer

Pneumonia

Correct Incorrect Correct answer

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?

NSAIDs such as Naproxen

Correct Incorrect Correct answer

Allopurinol

Correct Incorrect Correct answer

Febuxostat

Correct Incorrect Correct answer

Intraarticular steroid injection

Correct Incorrect Correct answer

SC interfukin 1 inhibitor (Anakinra)

Correct Incorrect Correct answer

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?

Lymphoma

Correct Incorrect Correct answer

Crohn's disease

Correct Incorrect Correct answer

Perforated adenocarcinoma

Correct Incorrect Correct answer

Typhoid enteritis

Correct Incorrect Correct answer

Diverticulosis

Correct Incorrect Correct answer

Ringer lactate solution contains all of the following, except:

Sodium

Correct Incorrect Correct answer

Potassium

Correct Incorrect Correct answer

Calcium

Correct Incorrect Correct answer

Magnesium

Correct Incorrect Correct answer

Chloride

Correct Incorrect Correct answer

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:

Pelvic sheet wrap

Correct Incorrect Correct answer

Angiography

Correct Incorrect Correct answer

Extraperitoneal packing

Correct Incorrect Correct answer

External pelvic fixation

Correct Incorrect Correct answer

Exploratory laparotomy

Correct Incorrect Correct answer

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?

Haloperidol 10mg once per day

Correct Incorrect Correct answer

Citalopram 20mg once per day

Correct Incorrect Correct answer

Resprim forte 1 Tab twice per day

Correct Incorrect Correct answer

Biperiden 2mg once per day

Correct Incorrect Correct answer

Propranolol 10mg once per day

Correct Incorrect Correct answer

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?

Follow up in 6 months

Correct Incorrect Correct answer

3-Dimensional ultrasound

Correct Incorrect Correct answer

Colonoscopy

Correct Incorrect Correct answer

Hysteroscopy

Correct Incorrect Correct answer

Hysterectomy

Correct Incorrect Correct answer

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?

Threatened abortion

Correct Incorrect Correct answer

Inevitable abortion

Correct Incorrect Correct answer

Incomplete abortion

Correct Incorrect Correct answer

Missed abortion

Correct Incorrect Correct answer

Anembryonic pregnancy

Correct Incorrect Correct answer

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?

Complete blood count

Correct Incorrect Correct answer

Stool culture

Correct Incorrect Correct answer

Celiac serology

Correct Incorrect Correct answer

Sweat test

Correct Incorrect Correct answer

Stool calprotectin

Correct Incorrect Correct answer

Which of the following describes normal puberty?

Breast buds at 9 years of age

Correct Incorrect Correct answer

Increased testicular volume at 8 years of age

Correct Incorrect Correct answer

Genital hair in a 7-year-old girl

Correct Incorrect Correct answer

Axillar hair in a 9-year-old boy

Correct Incorrect Correct answer

Genital hair in a 9-year-old boy

Correct Incorrect Correct answer

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?

Prophylactic antimicrobial therapy with Moxypen (amoxicillin)

Correct Incorrect Correct answer

Intravenous cefuroxime (Zinacef)

Correct Incorrect Correct answer

Middle ear drainage and antibacterial treatment according to discharge culture

Correct Incorrect Correct answer

Rule out conductive hearing loss

Correct Incorrect Correct answer

Ventilation tube insertion

Correct Incorrect Correct answer

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?

Azithromycin daily

Correct Incorrect Correct answer

Prednisone

Correct Incorrect Correct answer

Theophylline

Correct Incorrect Correct answer

IV Alpa1 antitrypsin

Correct Incorrect Correct answer

Calcium channel blockers

Correct Incorrect Correct answer

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?

Low molecular weight heparin

Correct Incorrect Correct answer

Vancomycin

Correct Incorrect Correct answer

Cefazolin

Correct Incorrect Correct answer

Ciprofloxacin

Correct Incorrect Correct answer

Oxacillin

Correct Incorrect Correct answer

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?

Subclinical hypothyroidism, treat with Eltroxin

Correct Incorrect Correct answer

Subclinical hypothyroidism, follow-up only

Correct Incorrect Correct answer

Hypothyroidism, treat with Eltroxin

Correct Incorrect Correct answer

Hypothyroidism, thyroid scan is needed to decide on treatment

Correct Incorrect Correct answer

Results are incorrect, repeat tests

Correct Incorrect Correct answer

A 47-year-old female is treated for 1 week with cefalexin (Ceforal) for right leg cellulitis. She complains of systemic fever and diffuse maculopapular rash. Labs – creatinine 2.4 mg/dl (baseline 0.9) and BUN 39 mg/dl, absolute eosinophilia 2100. On urine sediment – red blood cells and white blood cells casts.

Which of the following is the next step?

Urgent hemodialysis

Correct Incorrect Correct answer

Cyclophosphamide

Correct Incorrect Correct answer

IV steroids ASAP

Correct Incorrect Correct answer

Discontinue Ceforal

Correct Incorrect Correct answer

Rituximab

Correct Incorrect Correct answer

A 58-year-old male is a candidate for elective inguinal hernia repair. He is treated with apixaban (Eliquis) doe to chronic atrial fibrillation.

How long before surgery is this medication should be stopped to avoid surgical bleeding?

6 hours prior to surgery

Correct Incorrect Correct answer

12 hours prior to surgery

Correct Incorrect Correct answer

24 hours prior to surgery

Correct Incorrect Correct answer

2-3 days prior to surgery

Correct Incorrect Correct answer

1 week prior to surgery

Correct Incorrect Correct answer

A 60-year-old female undergoes routine mammography and biopsy of right breast suspicious clustered calcifications. DCIS is diagnosed. What is the most appropriate management?

Mastectomy is indicated but immediate reconstruction should be avoided due to high local recurrence rates in the first few years

Correct Incorrect Correct answer

Mastectomy is preferred over breast conserving surgery in DCIS due to high local recurrence rates, even if breast conserving surgery can be technically performed

Correct Incorrect Correct answer

Mastectomy is preferred due to increased long term survival in comparison to breast conserving surgery

Correct Incorrect Correct answer

Adding Tamoxifen to patients with DCIS decreases local recurrence rates mainly in young patients

Correct Incorrect Correct answer

There is no indication for adjuvant Tamoxifen treatment in this patient if she will be treated with breast conserving surgery and radiation

Correct Incorrect Correct answer

A 69-year-old healthy male is diagnosed with rectal tumor, 7 cm from the anal verge. Total body CT and pelvic MRI demonstrate the tumor invading all the muscle layers (T3) and involved lymph nodes next to it. No distant metastases.

What it the recommended step on his treatment?

Abdominoperineal resection

Correct Incorrect Correct answer

Low anterior resection

Correct Incorrect Correct answer

Transanal endoscopic microsurgery

Correct Incorrect Correct answer

Neoadjuvant chemoradiotherapy

Correct Incorrect Correct answer

A 35 years old female with bipolar disorder is brought to the ER and complains of a rash that started the same day she started a new drug. Which is the most appropriate clinical approach?

psychiatrist should reassure her and discharge her from the ER since a rash is not a known side effect of mood stabilizes and antidepressants.

Correct Incorrect Correct answer

Any rash must be taken seriously as carbamazepine and lamotrigine specially can cause Steven Johnson syndrome.

Correct Incorrect Correct answer

Irrelevant to the cause of the rash, steroids should be added now to the new drug until the rash resolves.

Correct Incorrect Correct answer

She should be admitted to internal medicine because the rash is usually accompanied by lymphadenopathy.

Correct Incorrect Correct answer

ENT should be consulted as the rash is usually accompanied by decreased hearing

Correct Incorrect Correct answer

Which of the following is included in the management of premature rupture of membranes on the 33-week of gestation during the first 48 hours given chorio-amnionitis was ruled out?

Ampicillin & Erythromycin & steroids

Correct Incorrect Correct answer

Ampicillin & steroids & tocolytics

Correct Incorrect Correct answer

Ampicillin & steroids & magnesium for fetal neuroprotection

Correct Incorrect Correct answer

Ampicillin & erythromycin & steroids & tocolytics & magnesium for fetal neuroprotection

Correct Incorrect Correct answer

Ampicillin & steroids & induction of labor

Correct Incorrect Correct answer

A certain X-linked dominant disease causes a mild disease in females and is lethal in males. A male baby is born, with a mild presentation. Which of the following can be assumed regarding his karyotype?

46XY

Correct Incorrect Correct answer

47XYY

Correct Incorrect Correct answer

47XXX

Correct Incorrect Correct answer

47XXY

Correct Incorrect Correct answer

47YYY

Correct Incorrect Correct answer

A 15 Y.O girl complains of nervousness, trouble sleeping, headache, and deterioration in her school work. Her examination reveals the findings in the picture. Which of the following will assist her diagnosis?

Serum thyroid stimulating IgG levels

Correct Incorrect Correct answer

Neck ultrasound to characterize the thyroid gland

Correct Incorrect Correct answer

Technetium scan of the thyroid gland

Correct Incorrect Correct answer

Serum anti thyroid peroxidase levels

Correct Incorrect Correct answer

Serum thyroid binding globulin levels

Correct Incorrect Correct answer

A 7-year-old boy presents with a few months of polyuria, polydipsia, failure to gain weight headaches, and vomiting Laboratory results are presented in the table. After been given vasopressin (ADH), the urinary osmolality Increased and the blood osmolality decreased.

WHICH disease can explain these findings ?

Wilms's tumor

Correct Incorrect Correct answer

Hodgkin's lymphoma

Correct Incorrect Correct answer

Rhabdomyosarcoma

Correct Incorrect Correct answer

Langerhans cell Histiocytosis

Correct Incorrect Correct answer

Osteosarcoma

Correct Incorrect Correct answer

A 16-year-old boy presents with 2 weeks of chest pain, lateral to the lower sternal border. The pain is worsened by movement and position changing, and not accompanied by shortness of breath or affected by strain, Which of the following is a possible treatment for his condition?

Naxyn (naproxen)

Correct Incorrect Correct answer

Prednisone (meticorton)

Correct Incorrect Correct answer

Intravenous IgG

Correct Incorrect Correct answer

Acamol (paracetamol)

Correct Incorrect Correct answer

Losec (PPl blocker)

Correct Incorrect Correct answer

A 55-year-old male underwent mechanical prosthetic mitral valve replacement today. Permanent anticoagulation therapy is considered.

Which of the following is correct?

Start heparin and direct oral anticoagulants (DOACs) and after 5 days of combined treatment continue to bitrate DOACs to an INR 1.5-2.0

Correct Incorrect Correct answer

Start direct oral anticoagulants (DOACs) immediately after surgery

Correct Incorrect Correct answer

Start heparin and warfarin and after 5 days of combined treatment continue to titrate warfarin to an INR 1.5-2.0

Correct Incorrect Correct answer

Start heparin and warfarin and after 5 days of combined treatment continue to titrate warfarin to an INR 2.5-3.5

Correct Incorrect Correct answer

Permanent subcutaneous heparin alone is the treatment of choice

Correct Incorrect Correct answer

A 60-year-old malo is an active smoker. On routine CBC-Hb 19, Hct 55, WBC 8,500, Platelets 300,000, MCV 88. Which of the following is the next step in evaluation of this patient?

Repeat CBC in tube without EDTA

Correct Incorrect Correct answer

Test JAK2 mutation

Correct Incorrect Correct answer

Erythropoietin serum levels

Correct Incorrect Correct answer

Carboxyhemoglobin in arteria blood

Correct Incorrect Correct answer

Lung function test

Correct Incorrect Correct answer

Which of the following is correct regarding Q fever?

Pneumonia is the most common presentation (about 40% of the cases)

Correct Incorrect Correct answer

Rickettsia conorii is the causative agent

Correct Incorrect Correct answer

Doxycycline for 2 weeks is the treatment of choice

Correct Incorrect Correct answer

Diagnosis is made by urinary toxin

Correct Incorrect Correct answer

There is chronic phase in this disease

Correct Incorrect Correct answer

Which of the following is the most commonly involved joint in calcium pyrophosphate dihydrate arthropathy (CPPD arthropathy)?

Knee

Correct Incorrect Correct answer

Ankle

Correct Incorrect Correct answer

Shoulder

Correct Incorrect Correct answer

Wrist

Correct Incorrect Correct answer

Elbow

Correct Incorrect Correct answer

A 30-year-old healthy female is diagnosed with left breast mass. Ultrasound demonstrates a simple 3 cm cyst. Which of the following is correct?

A breast mass larger than 2 cm necessitates surgical removal

Correct Incorrect Correct answer

Cancerous tumors are very common in breast cysts and therefore surgical removal is warranted

Correct Incorrect Correct answer

Patients with breast cysts are at an increased risk for developing breast cancer and therefore should be invited for follow-up every 3 months

Correct Incorrect Correct answer

The cyst should be surgically removed with wide margins if cyst aspiration produces green or yellow fluid

Correct Incorrect Correct answer

No further treatment is warranted if ultrasound demonstrates simple cyst and aspiration produces straw-colored fluid

Correct Incorrect Correct answer

A 70-year-old male with no past medical history is evaluated for right inguinal pain in the past 6 hours. On examination – a tender 6 cm mass.

What is the next step in management?

Abdominal CT

Correct Incorrect Correct answer

Mass aspiration

Correct Incorrect Correct answer

Urgent surgery

Correct Incorrect Correct answer

Inguinal ultrasound

Correct Incorrect Correct answer

An attempt to reduce the mass

Correct Incorrect Correct answer

A 73-year-old male presents with acute lower gastrointestinal bleeding. Which of the following is the most common etiology?

Hemorrhoids

Correct Incorrect Correct answer

Inflammatory bowel disease

Correct Incorrect Correct answer

Arteriovenous malformation (AVM)

Correct Incorrect Correct answer

Neoplasia

Correct Incorrect Correct answer

Diverticulosis

Correct Incorrect Correct answer

Which of the following situations is correct regarding absolute contraindication for electroconvulsive treatment (ETC)?

A patient with space occupying lesion at the nervous system

Correct Incorrect Correct answer

Pregnancy

Correct Incorrect Correct answer

Myocardial infarction 1 week ago

Correct Incorrect Correct answer

A patient with ICP

Correct Incorrect Correct answer

None of the mentioned situations is absolute contraindication ECT

Correct Incorrect Correct answer

Twenty-nine woman has genital Herpes on her 30 gestation. Which of the following is the most appropriate recommendation of this stage?

Avoidance of intercourse until a vaginal delivery

Correct Incorrect Correct answer

Intravenous acyclovir for 10 days

Correct Incorrect Correct answer

Elective cesarean section at 39 weeks of gestation

Correct Incorrect Correct answer

Prophylactic acyclovir from 36 weeks of gestation until delivery

Correct Incorrect Correct answer

Empiric acyclovir treatment of the woman and her partner

Correct Incorrect Correct answer

Which of the following could be detected by a bi-manual pelvic examination?

A 2 cm submucosal myoma

Correct Incorrect Correct answer

The time of ovulation

Correct Incorrect Correct answer

Tenderness on the right adnexa

Correct Incorrect Correct answer

The texture of the salpinges

Correct Incorrect Correct answer

Polycystic ovaries

Correct Incorrect Correct answer

A 17-year-old boy is undergoing workup for abdominal pain. Laboratory results reveal positive, low titer anti-nucicar antibodies (ANA) After a week the patient is well with no abdominal pain. Which of the following represents correctly the significance of the blood test result for thin patient?

The boy most probably has systemic lupus erythematosus

Correct Incorrect Correct answer

The boy is expected to develop rheumatoid arthritis throughout his life

Correct Incorrect Correct answer

The boy's chances of developing an autoimmune disease are low

Correct Incorrect Correct answer

The boy should bo referred to check additional autoantibodies and abdominal MRI should be performed to rule out inflammatory bowel disease

Correct Incorrect Correct answer

A 6-morth-old infant is referred for work up of constipation and abdominal distention. The baby passed his first meconium at the age of 3 days, and has been padding stool every few days after insertion of a rectal thermometer The imaging results are attached.

Which of the following test will contribute the most to diagnosis?

Colonoscopy

Correct Incorrect Correct answer

Rectal biopsy

Correct Incorrect Correct answer

Abdominal ultrasound

Correct Incorrect Correct answer

Stool calprotectin

Correct Incorrect Correct answer

Sweat test

Correct Incorrect Correct answer

A-1-year-old infant is admitted for urinary tract infection and treated accordingly. She had responded to treatment and improved after 48 hours. Renal ultrasound is normal. Which of the following represents the recommended approach?

Prophylactic antibiotics and cystography

Correct Incorrect Correct answer

DMSA scan in 6 months

Correct Incorrect Correct answer

Cystography followed by a DMSA scan

Correct Incorrect Correct answer

Follow up by physician

Correct Incorrect Correct answer

Repeat ultrasound in 6 months

Correct Incorrect Correct answer

A 70-year-old male is admitted to the ER with fever for a month, lack of appetite, weight loss, and prolonged cough. X-ray is below. Which of the following is the most likely diagnosis?

Right pneumonia

Correct Incorrect Correct answer

Right pneumothorax

Correct Incorrect Correct answer

Right lung abscess

Correct Incorrect Correct answer

Right foreign body

Correct Incorrect Correct answer

Right lung space occupying lesion

Correct Incorrect Correct answer

A 67-year-old healthy male, complains of increasing fatigue and back pain in the past 3 months. The only medication he has been taking is acetaminophen. On examination-tenderness over the spine and pitting edema at the ankles. No other abnormal finding: Spine X-ray demonstrates compression fracture of L1. Labs – Hb 8 g/dL: WBC 4,000; Platelet 300,000: Albumin 2.7 g/dL: Total Protein 9.2 gl; Calcium 13.4 mg/dl: Creatining 2.1 mg/dl. Which of the following is correct?

Bone scan is essential for diagnosis

Correct Incorrect Correct answer

Prostate specific antigen (PSA) level is essential for diagnosis

Correct Incorrect Correct answer

Serum parathyroid hormone level will be elevated

Correct Incorrect Correct answer

Serum protein electrophoresis & free light chains test should be performed

Correct Incorrect Correct answer

Echocardiography is essential for diagnosis

Correct Incorrect Correct answer

Which of the following patients can be diagnosed with acute myeloid leukemia?

A patient with 8% blasts on peripheral blood and t122.9) translocation

Correct Incorrect Correct answer

A patient with down syndrome and 2% blasts on bone marrow biopsy

Correct Incorrect Correct answer

A patient with 15% blasts on peripheral blood and inversion of chromosome 18 -(16) inv

Correct Incorrect Correct answer

A patient with over 50% cells that express BCR-ABL on bone marrow biopsy

Correct Incorrect Correct answer

A patient diagnosed with essential thrombocytosis that presents with absolute neutrophilia and PDGFR gene mutation

Correct Incorrect Correct answer

A 40-year-old drug abuse male is admitted due to a fever of 38.5’C without any other symptoms. Chest X-ray demonstrates left lower lobe infiltrate. Echocardiography – large tricuspid valve vegetation. Labs-positive rheumatoid factor. Blood cultures are pending.

Which of the following is most probable to grow on blood cultures?

Enterococcus faecalis

Correct Incorrect Correct answer

Streptococcus gallolyticus

Correct Incorrect Correct answer

Coagulase-negative staphylococci

Correct Incorrect Correct answer

Staphylococcus aureus

Correct Incorrect Correct answer

Cardiobacterium hominis

Correct Incorrect Correct answer

A 60-year-old male with ischemic heart disease is treated with antiplatelet therapy due to catheterization last year. He arrives to the ER with malaise, cold diaphoresis, melena, low blood pressure (100/70), and tachycardia 110/min.

What is the first step in management?

ER urgent gastroscopy due to upper gastrointestinal bleeding

Correct Incorrect Correct answer

Rapid fluid resuscitation, blood, and blood products as needed

Correct Incorrect Correct answer

IV antacids and helicobacter pylori eradication with antibiotics

Correct Incorrect Correct answer

Urgent surgery to stop the bleeding – the patient is unstable

Correct Incorrect Correct answer

A 50-year-old male with cirrhosis is clear minded, oriented to time and place, and coherent. He is a candidate to an elective surgery due to colon cancer. On examination – no ascites. Labs – bilirubin 2.4, albumin 3, PT 18 seconds, INR 2.

Which of the following is recommended?

Start diuretics

Correct Incorrect Correct answer

Correct coagulopathy

Correct Incorrect Correct answer

Start beta blockers, lactulose, and sandostatin

Correct Incorrect Correct answer

Improve serum albumin level

Correct Incorrect Correct answer

Liver biopsy

Correct Incorrect Correct answer

An 80-year-old male complains of solid dysphagia, weight loss, and new hoarseness. He has reflux for many years and is treated with antacids. Upper GI Tract Barium X-ray- mid esophagus stricture.

Which of the following is the most likely diagnosis?

Achalasia

Correct Incorrect Correct answer

Esophageal malignancy

Correct Incorrect Correct answer

Esophageal stricture secondary to reflux

Correct Incorrect Correct answer

Schatzki's ring

Correct Incorrect Correct answer

IMLE 1/2021 امتحان الوزارة كامل

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