IMLE 3/2018

Infertility workup for a 30-year-old couple revealed a normal sperm test, normal menstruation and a normal uterine cavity and tubal patency on hysterosalpingography. Which of the following tests will contribute the most to this couple’s diagnosis?

karyotype test for both of them.

Correct Incorrect Correct answer

repeating the sperm test.

Correct Incorrect Correct answer

post coital test.

Correct Incorrect Correct answer

post coital test.sperm DNA fragmentation.

Correct Incorrect Correct answer

Which of the following is a contraindication for performing a hysterosalpingography?

past history of appendicitis

Correct Incorrect Correct answer

past history of Pelvic Inflammatory Disease.

Correct Incorrect Correct answer

presence of a complex ovarian mass.

Correct Incorrect Correct answer

past history of uterine perforation during curettage.

Correct Incorrect Correct answer

past history of a cesarean section.

Correct Incorrect Correct answer

In which of the following diagnosis there is an absolute indication for gonadal resection immediately after the diagnosis and at any age?

Turner syndrome

Correct Incorrect Correct answer

swyer syndrome

Correct Incorrect Correct answer

46xx ovarian dysgenesis

Correct Incorrect Correct answer

Testicular feminization syndrome

Correct Incorrect Correct answer

savage syndrome

Correct Incorrect Correct answer

A 15-year-old girl is undergoing workup for primary amenorrhea. Physical examination reveals short stature and absent secondary sex signs. Blood shows FSH 50 IU/L, LH 40 IU/L, estradiol < 73 pMol/L. Which of the following is the next diagnostic test?

Testosterone, DHEA, DHEAS

Correct Incorrect Correct answer

Anti-Mullerian hormone

Correct Incorrect Correct answer

karyotype

Correct Incorrect Correct answer

pelvic ultrasound

Correct Incorrect Correct answer

pelvic MRI

Correct Incorrect Correct answer

A 30-year-old woman who has given birth 2 year ago to a term 3400gr baby, has had amenorrhea since the delivery and is interested in conceiving, the delivery was characterized by increased postpartum hemorrhage due to uterine atony and she received a blood transfusion. The hemorrhage did not require surgical intervention the woman did not succeed in breast feeding and received levothyroxine and prednisone post-delivery. Pelvic US revealed normal uterus and ovaries with small follicles. Which of the following is best treatment for inducing ovulation in this woman?

clomiphene

Correct Incorrect Correct answer

follicle stimulating hormone

Correct Incorrect Correct answer

letrozole

Correct Incorrect Correct answer

luteinizing hormone

Correct Incorrect Correct answer

human menopausal ganado tropine

Correct Incorrect Correct answer

Which of the following is the most efficient in long term (over 6 months) suppression of hirsutism?

metformin

Correct Incorrect Correct answer

finasteride

Correct Incorrect Correct answer

combined oral contraceptives

Correct Incorrect Correct answer

ketoconazole

Correct Incorrect Correct answer

flutamide

Correct Incorrect Correct answer

Which of the following is risk factor for endometriosis?

menarche at age 14

Correct Incorrect Correct answer

menorrhagia

Correct Incorrect Correct answer

parity

Correct Incorrect Correct answer

prolonged breast feeding

Correct Incorrect Correct answer

amenorrhea

Correct Incorrect Correct answer

In which of the following in vitro fertilization procedures in there an indication for intra cytoplasmic sperm injection?

A post washing sperm concentration of 6 million

Correct Incorrect Correct answer

the woman's age is 42

Correct Incorrect Correct answer

The man's age is 50

Correct Incorrect Correct answer

The ovum has been defrosted

Correct Incorrect Correct answer

Third treatment cycle or more

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Which of the following complication is not more common with in vitro pregnancies in comparison to spontaneous pregnancy.

multiple gestation

Correct Incorrect Correct answer

ectopic pregnancies

Correct Incorrect Correct answer

first trimester miscarriages

Correct Incorrect Correct answer

premature lobar 5-low birth weight

Correct Incorrect Correct answer

In which of the following contraceptive methods would the LH level throughout the menstrual cycle be the highest?

combined oral contraceptive (estrogen +progesterone) with a fixed does

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progesterone oral contraceptive

Correct Incorrect Correct answer

combined oral contraceptive (estrogen +progesterone) with a change dose.

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progesterone injected as depo

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copper inta IUD

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Which of the following differentiates a levonorgestrel secreting (IUD) Mirena compared to copper IUD?

significantly increased efficiency

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longer us is allowed.

Correct Incorrect Correct answer

increased change of pelvic inflammatory disease

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increased rate of mild bleeding associated with the beginning of using the device

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increased menstrual bleeding associated with prolonged use

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Which of the following malignancies is an absolute contraindication for estrogen only hormone replacement therapy, even when the patient is in complete remission after hysterectomy and salpingo-oophorectomy?

cervical cancer

Correct Incorrect Correct answer

sero papillary ovarian Cancer

Correct Incorrect Correct answer

endometrial cancer stage 2-3

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mucinous ovarian cancer

Correct Incorrect Correct answer

brenner ovarian cancer

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An 82-old-woman, with diabetes, lung disease and severe IUD present with prolapse of pelvic organ, which significantly affects her life quality. Examination reveals grade 4 prolapse, pessary treatment fails and there is decision to treat it surgically. Which of the following surgeries is the most appropriate for this woman?

anterior & posterior colporrhaphy

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laparoscopic hysterectomy & oophorectomy

Correct Incorrect Correct answer

open sacrocolpopexy

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insertion of a TVT band

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le foot procedure

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A 38-year-old woman mother of 3 present with urine leakage during coughing, sneezing or laughing, she denies frequently urgency or burning sensation associated with urination, physiotherapy treatment has failed. Which of the following is most appropriate treatment?

midurethral sling

Correct Incorrect Correct answer

periurethral bulking agents 2- burch colposuspension

Correct Incorrect Correct answer

anticholinergic treatment

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Marshall-Marchetti-Krantz procedure

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A 68-year-old woman has had curettage due to postmenopausal bleeding pathology revealed endometrial papillary serous adenocarcinoma. Which of the following is the most appropriate treatment?

brachytherapy by radiation

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hysterectomy and external radiation

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oral progestative treatment

Correct Incorrect Correct answer

levonorgestrel secreting intrauterine device (Mirena)

Correct Incorrect Correct answer

hysterectomy, salpingo-oophorectomy resection of lymph nodes and chemotherapy.

Correct Incorrect Correct answer

A 65-year-old women presents with abdominal distention over the past few weeks. CT reveals Ascites, omentum thickening, and a complex ovarian mass. Which of the following is a risk factor for her condition?

Early menarche

Correct Incorrect Correct answer

Early menopause

Correct Incorrect Correct answer

Oral contraceptive

Correct Incorrect Correct answer

Tubal ligation

Correct Incorrect Correct answer

Asian race

Correct Incorrect Correct answer

A 34-year-old women at 7 weeks of her 3rd pregnancy, presents with hyperemesis, Beta HCG 400000, and ultrasound reveals an irregular gestational sac with many hyperechoic and cystic findings.Which is the next therapeutic step?

Curettage and follow up Beta HCG levels

Correct Incorrect Correct answer

Azithromycin D treatment

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Beta HCG follow up and repeat ultrasound in 4 weeks

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Methotrexate treatment

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Injection of KCL into the gestational sac

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A 57-year-old women with history of controlled diabetes and hypertension, presents with vaginal bleeding. Endometrial biopsy reveals complex hyperplasia with atypia. Which is the most appropriate treatment?

Resection of the lesion via hysteroscopy

Correct Incorrect Correct answer

Endometrial ablation

Correct Incorrect Correct answer

Hysterectomy and salpingo-oophorectomy

Correct Incorrect Correct answer

Ultrasound follow up and a repeat biopsy in a year

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Local radiotherapy

Correct Incorrect Correct answer

A 26-year-old women with recurrent pelvic inflammatory disease, presents with right upper abdominal pain which is worsen by deep breaths. Examination reveals diffuse abdominal tenderness mainly over the right upper quadrant. A decision has been made to perform a laparoscopy. Which of the following findings will explain her complains?

Adhesions between the ovary and the sigmoid colon

Correct Incorrect Correct answer

Salpingo ovarian abscess

Correct Incorrect Correct answer

Left fallopian tube pregnancy without bleeding

Correct Incorrect Correct answer

Violin string adhesions above the liver

Correct Incorrect Correct answer

Adhesions of the omentum to the abdominal wall

Correct Incorrect Correct answer

A 19-year-old women presents with significant valvular pain and burning sensation. Examination reveals vesicular lesions on the right labia minora and vaginal opening. There is an enlarged lymph node in the right groin. Which of the following test will facilitate the diagnosis of this patient?

Viral culture

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KOH test

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Cell culture and PCR

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Serum antibodies

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Gram stain

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A 32-year-old woman presents with a non-itching vaginal discharge with a fish smell. Examination with speculum reveals a greyish, homogeneous discharge. The smell increases with KOH test and a smear shows clue cells. Which of the following is the most common causative agent?

Gardnerellavaginalis

Correct Incorrect Correct answer

Trichomanisvaginalis

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Group B streptococcus

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Candida Albicans

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Chlamydia trachomatis

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A 22-year-old woman presents with an itchy vaginal discharge. Examination reveals a whitish odorless discharge which looks like a cottage cheese. Which of the following is the recommended treatment of this condition?

Oral ciprofloxacin, 500 mg, for one week

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Oral fluconazole, 150 mg, one time

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Intimate vaginal soap rinses for 2 weeks

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Oral Metronidazole, 1500 mg, for one week

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IM penicillin G, one million unit, one time

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A 27-year-old woman presents with pain and swelling of the vulva. Examination reveals she is in pain, with a temperature of 38°c, and a swollen and tender lesion with fluctuation located on the lower posterior third of the right labia majora. Which of the following is the most appropriate treatment?

Oral Doxycycline for one week

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Vulvoscopy and biopsy

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Local pressure and cooling

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Surgical drainage

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Topical clotrimazole cream

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A 42-year-old women, mother of three, is evaluated due to low grade squamous intraepithelial lesion (LSIL) on a routine PAP smear. Colposcopy was defined unsatisfactory. Which of the following is the next step?

Repeat PAP smear

Correct Incorrect Correct answer

Conisation

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Laparoscopic hysterectomy

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Cryoablation

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HPV typing and follow up

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An asymptomatic woman in active labor, has a white blood cells of 20.000. Which of the following is the most appropriate best step?

Blood and urine cultures, and antibiotic treatment while waiting culture results.

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C-section as soon as possible.

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Take temperature, blood and urine cultures and IV antibiotics.

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No intervention is required, this is a normal finding during labor

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Complete blood count should be repeated postpartum, and oral antibiotics treatment should be initiated.

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A 25-year-old primigravida, with spontaneous conception presents for her first check up. Which of the following data will be used for gestational dating?

Women ovulation date according to temperature follow up.

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Last day of her last menstruation.

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First day of her last menstruation.

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Date of sexual interaction the women thinks she conceived in.

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Date of positive home pregnancy test.

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What is melasma

hyper pigmentation appearing skin areas which were not exposed to sun

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dark , even stains on the abdomen and limbs

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hyper pigmentation appearing on skin areas exposed to sun

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a blood longitudinal line on the abdominal midline

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dark ; Nevus stain on the face with a mask like appearance

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A woman on her 20th week of gestation arrivals to the ER with fever, cough, shortness of breath and malaise, a week after on itchy rash on her abdomen and limbs, there is clinical suspicion of a varicella infection and chest x-ray is concurrent with varicella pneumonia. Which of the following is the most appropriate first therapeutic step?

intravenous fluids, antipyretics, and antihistamines

Correct Incorrect Correct answer

awaits treatment pending PCR result

Correct Incorrect Correct answer

amniocentesis in order to assess fetal infection

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intravenous acyclovir

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varicella intravenous immunoglobulin (VZIG)

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In which stage does the fetal division occur in dichorionic diamniotic twins

before the 3rd day post conceptual day

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day 4-8 post conception

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day 8-13 post conception

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after the 13th day post conception

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anytime up to 13 days post conception

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A 25-year-old women on her 2nd pregnancy is now 8 weeks pregnant, she was diagnosed with SLE and her first pregnancy ended with IUFD (intrauterine fetal death) at 27 weeks. Labs results before the current pregnancy revealed lupus anticoagulant antibodies on a few tests performed 3 months apart. Which of the following treatment will be included in her current pregnancy

coumadin and aspirin during the first half of her pregnancy

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plasmapheresis every 2 weeks up until term

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prednisone treatment throughout the pregnancy

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aspirin and heparin throughout the pregnancy

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colchicine and plaquenil (Hydroxychloroquine intermittently up until term

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Which of the following is the most common clinical presentation of placenta previa?

first trimester vaginal bleeding

Correct Incorrect Correct answer

vaginal bleeding accompanied by lower abdominal pain after the 36th week of gestation

Correct Incorrect Correct answer

painless vaginal bleeding around the 34th week of gestation

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premature bleeding amniotic fluid leak accompanied by premature contraction appearing on the second half of pregnancy

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suspicious fetal monitoring during labor

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Which of the following is an absolute contraindication for vacuum extraction?

vaginal tear on previous delivery

Correct Incorrect Correct answer

maternal HBV infection

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fetal weight of over 4000 gr

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premature labor at 33 weeks of gestation

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occipitoposterior presentation

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Which of the following is the most common cause of postpartum hemorrhage?

uterine atony

Correct Incorrect Correct answer

vaginal canal tears

Correct Incorrect Correct answer

coagulopathies

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uterine infection

Correct Incorrect Correct answer

remnant pregnancy material

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A 23-years-old primigravida, on her36th week of gestation presents with loss of fetal movements over the last two days. Ultrasound shows a pulseless fetus compatible with 34 weeks. There is clinical suspicion of DIC. Which of the following laboratory results will establish this diagnosis?

platelets 160,000, fibrinogen 500,normal blood smear.

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fibrinogen 200, platelets 100,000, low D-dimer.

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prolonged PT, low D-dimer, normal blood smear

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normal PTT, platelets 90,000, fibrinogen 140

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schistocytes on a blood smear, fibrinogen 400, normal PT

Correct Incorrect Correct answer

A 77-year-old woman presents with abdominal pain and fullness, ca125 levels are increased. Which of the following is included in the differential diagnosis?

ovarian malignancy and pancreatitis

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ovarian malignancy and colitis

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ovarian malignancy and peritonitis

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colon malignancy and hepatitis

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Which of the following is the best therapeutic agent for acute promyelocytic leukemia?

imatinib

Correct Incorrect Correct answer

all-trans retinoic acid (atra)

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everolimus

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trastuzumab

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A 64-year-old man with a picc (peripherally inserted central catheter) line, which is used for delivering chemotherapy of gastric cancer, presents with fever (39°c), hypotension (systolic blood pressure 66 mmhg) and deteriorated mental status. Which of the following describes the best management of the central line upon admission?

remove the central line and send the tip for culture

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administer broad spectrum antibiotics through and leave it in

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leave the line in, administer antibiotics and antifungal agents through the line

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place a peripheral line, without touching the central line

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An 80-year-old woman brought to emergency due to deteriorated consciousness, her systolic blood pressure is 45 mmhg, she is pale, her skin is cold and diaphoretic. Which is the most appropriate first step in managing the patient?

synchronized cardioversion

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unsynchronized cardioversion

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intravenous beta blocker (i.e metoprolol)

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intravenous loading of antiarrhythmic agent (i.e amiodarone)

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A 50-year-old man was admitted due to acute shortness of breath and chest pain. Auscultation reveals bilateral rales over the lower half of lungs, without dullness in percussion, systolic blood pressure 210 mmhg, oxygenation saturation with face mask is only 82%. Which of the following is best treatment?

sublingual mononit and wait 10 minutes for the blood pressure reduced

Correct Incorrect Correct answer

intravenous fluid

Correct Incorrect Correct answer

intravenous antibiotics (1 gr ceftriaxone)

Correct Incorrect Correct answer

intratracheal intubation before any medical treatment

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A 50-year-old, type 2 diabetic woman, presents with severe right knee pain. The knee is tender and swollen, with no history of trauma, her temperature is 38° c and white blood cell count 112,000, 91% neutrophils in synovial fluid. Which is the most likely diagnosis?

gout disease

Correct Incorrect Correct answer

pseudo-gout disease

Correct Incorrect Correct answer

rheumatoid arthritis

Correct Incorrect Correct answer

infectious arthritis

Correct Incorrect Correct answer

Urine culture of an elderly lady hospitalized for a urinary tract infection is positive for extended spectrum beta lactamase gram negative bacteria. Which of the following antimicrobial agents the most appropriate for the patient treatment?

amikacin

Correct Incorrect Correct answer

penicillin g

Correct Incorrect Correct answer

ampicillin

Correct Incorrect Correct answer

cefuroxime

Correct Incorrect Correct answer

Which of the following ventilation modes is the most appropriate for a patient intubated and ventilated in an internal medicine ward due to severe pneumonia?

assist control, ac

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synchronized intermittent mandatory ventilation, simv

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continuous positive airway pressure, cpap

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bi-level positive airway pressure, bipap

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A 96-year-old man, 2 days post-coronary therapeutic catheterization with stent placement, presents with a temperature of 38°c, malaise and cyanosis of the toe. Blood work reveals leukocytosis and eosinophilia

sepsis, bacteremia

Correct Incorrect Correct answer

endocarditis, infection of the stent

Correct Incorrect Correct answer

cholesterol emboli

Correct Incorrect Correct answer

deep vein thrombosis (dvt)

Correct Incorrect Correct answer

A 44-year-old woman, after prolonged hospitalization for antibiotic treatment due to pneumonia presents abdominal pain and severe diarrhea, up to 10 times a day. Her temperature is 39°c, CBC reveals 19,300 leukocytes, creatinine serum level is 2. stool is positive for clostridium difficile toxin. Which is the most appropriate treatment?

stopping the antibiotics she is receiving for pneumonia

Correct Incorrect Correct answer

stopping the antibiotics and initiating oral metronidazole

Correct Incorrect Correct answer

stopping the antibiotics and initiating oral vancomycin

Correct Incorrect Correct answer

initiating intravenous fidaxomicin, in addition to the antibiotics she is already receiving for pneumonia

Correct Incorrect Correct answer

A 33-year-old woman presents with lower limb weakness, which started a week after a viral illness. Which of the following findings in cerebro-spinal fluid from a L.P. support a diagnosis of Guillain-Barre syndrome?

low glucose

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high proteine.

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high cell count

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low lactate.

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A 16-year-old girl present to the emergency room claiming to have ingested 30 g of paracetamol 15 minutes earlier. Which of the following is the most appropriate treatment?

The dose is not toxic, she may be discharged.

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Admit for observation, since toxicity may develop over the next 72 hours.

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Urgent oral activated charcoal treatment.

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The dose she ingested is lethal; she should be admitted for supported treatment.

Correct Incorrect Correct answer

A 52-year-old man, 3 hours post pleural fluid drainage, complains of shortness of breath and stabbing left chest pain, nausea and diaphoresis. Which of the following is the most likely diagnosis?

Right pneumonia.

Correct Incorrect Correct answer

Dissection of the ascending aorta.

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Left pneumothorax.

Correct Incorrect Correct answer

Acute myocardial infarction due to pain and stress.

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A 35-year-old morbidly obese man, is admitted due to shortness of breath, blood gasses reveal pH =7.36, PCO 2 =61.7, HCO 3 =34.5, lactate=23. Which of the following is the best definition for these results?

Uncompensated respiratory acidosis.

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Metabolic alkalosis.

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Metabolic acidosis.

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compensated respiratory acidosis

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A 14-year-old boy, who lives in a little settlement in the Shomron Area, plays with dog puppies who wander around. Over the past couple of days he complains of headaches and a purpuric rash on the limbs and torso. Which of the following is the best way to manage this patient upon arrival to the hospital?

Obtaining blood cultures followed by I.V. ceftriaxone treatment.

Correct Incorrect Correct answer

Obtaining viral disease serology and initiating I.V. fluids.

Correct Incorrect Correct answer

Obtaining blood cultures followed by I.V. doxycycline treatment.

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Obtaining viral and rickettsia serology and initiating I.V. fluids

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A 64-year-old woman presents with malaise, hypotension and confusion. Her blood work reveals urea 86, creatine 1.8, Ca 14.4 and normal PTH. Which of the following is the most likely diagnosis?

Primary hyperparathyroidism

Correct Incorrect Correct answer

Hypercalcemia and uremia due to primary renal failure.

Correct Incorrect Correct answer

Malignancy associated hypercalcemia.

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Hypercalcemia due to chronic renal failure.

Correct Incorrect Correct answer

A 55-year-old woman, known to have DM type 2 for the past 10 years has begun a new antidiabetic drug. Over the last couple of days, she has been experiencing hematuria, urgency and frequency in urination and fever. Which of the following drugs is most likely to cause these symptoms?

Basal insulin.

Correct Incorrect Correct answer

Bolus (short acting insulin).

Correct Incorrect Correct answer

Sitagliptin.

Correct Incorrect Correct answer

Dapaglifozin

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Which of the following is true regarding the differentiation between diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS)?

Renal function is normal in DKA while HHS is characterized by acute renal failure.

Correct Incorrect Correct answer

Serum HCO 3 levels are lower in HHC compared to DKA.

Correct Incorrect Correct answer

Anion gap is higher in DKA vs.HHS.

Correct Incorrect Correct answer

pH levels are lower in HHS than in DKA.

Correct Incorrect Correct answer

An 81-year-old man, on chronic renal failure medication presents with symptomatic bradycardia. Attached is the emergency room monitor script. Which of the following therapeutic agents most likely caused his symptoms?

Digoxin.

Correct Incorrect Correct answer

Metoprolol

Correct Incorrect Correct answer

Propranolol.

Correct Incorrect Correct answer

Amiodaron.

Correct Incorrect Correct answer

A 24-year-old woman is diagnosed with chronic renal failure. She is known to have recurrent UTI since childhood and ultrasound reveals scarring of both kidneys. Her blood pressure 145/92. Which of the following is most likely diagnosis?

Reflux nephropathy.

Correct Incorrect Correct answer

Hypertensive renal disease.

Correct Incorrect Correct answer

polycystic kidney disease.

Correct Incorrect Correct answer

Pyelonephritis

Correct Incorrect Correct answer

A 35-year-old man complains of acute flank pain and hematuria. Examination reveals hypertension and laboratory results include creatinine of 2,5. His father and grandfather had a renal disease and his father died of a cerebral hemorrhage. Which of the following is the most likely?

Polycystic kidney disease

Correct Incorrect Correct answer

Medullary sponge kidney

Correct Incorrect Correct answer

Diabetic nephropathy

Correct Incorrect Correct answer

Tuberous Sclerosis

Correct Incorrect Correct answer

A 21-year-old woman, presents with unilateral vision loss. During her hospital stay it turns out there is a urinary incontinence issue as well, and the treating physician suspects multiple sclerosis. What is the test of choice for diagnosis MS?

Brain CT without contrast

Correct Incorrect Correct answer

Brain CT with contrast

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Brain MRI

Correct Incorrect Correct answer

Spinal Myelography

Correct Incorrect Correct answer

An 82-year old woman was referred to the emergency room due to loss of consciousness. In the emergency there were tonic-clonic movements of all 4 limbs and tongue biting, followed by 2 hours of drowsiness. The blood pressure is 125/82 and rectal temperature 37°C. The women had a major CVA on the previous year. Which of the following is the most likely diagnosis?

Bacterial Meningitis

Correct Incorrect Correct answer

Viral Meningitis

Correct Incorrect Correct answer

General seizure complication of the previous CVA

Correct Incorrect Correct answer

Worsening Parkinson’s Disease

Correct Incorrect Correct answer

A 60-year-old woman, with no familial history of renal disease, presents with hematuria over the last few months, she denies urgency or frequency in urination, smokes 2 packs a day and takes prophylactic aspirin. Urine is positive for erythrocytes. What is the most likely diagnosis?

Bladder Cancer

Correct Incorrect Correct answer

Lung cancer

Correct Incorrect Correct answer

Urinary tract infection

Correct Incorrect Correct answer

Aspirin adverse effect

Correct Incorrect Correct answer

A 28-year-old woman, presents with arthritis, malaise and temperature of up to 37.8C over the last couple of months. Over the last week she developed a butterfly shaped facial rash. Examination reveals calve and ankle edema. Renal biopsy reveals focal glomerulonephritis with sub endothelial and mesangial immune deposits. Which of the following is the most likely diagnosis?

Lupus nephritis class I

Correct Incorrect Correct answer

Lupus nephritis class II

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Lupus nephritis class III

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Minimal change disease

Correct Incorrect Correct answer

A 36-year-old, small cell lung cancer patient is admitted due to paresthesia in the lower limbs and loss of urinary and fecal continence. Which of the following is the most likely diagnosis?

Brain metastases of the lung cancer

Correct Incorrect Correct answer

Chest radiotherapy adverse effect

Correct Incorrect Correct answer

A metastasis compressing the spinal cord

Correct Incorrect Correct answer

Paraneoplastic neuropathy

Correct Incorrect Correct answer

A 67-year-old heavy smoker women presents with neck swelling and hoarseness. Cervical lymph node biopsy reveals squamous cell carcinoma. Which of the following is the next diagnostic step?

Referral to ENT

Correct Incorrect Correct answer

Total body CT

Correct Incorrect Correct answer

Total body PET CT

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CEA markers levels in the serum

Correct Incorrect Correct answer

A 19-year-old man presents with bloody diarrhea, weight loss, and wrist pain. Examination reveals left lower abdominal tenderness. His father and uncle are diagnosed with Crohn’s disease. Colonoscopy reveals continues colitis between the splenic flexure and rectum. Stool culture are negative including clostridium toxin. Which of the following is the most likely diagnosis?

Crohn’s colitis

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Left sided ulcerative colitis

Correct Incorrect Correct answer

Pancolitis

Correct Incorrect Correct answer

Cecitis

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67-year-old women treated with aspirin is referred to the emergency room due to pre-syncope on admission her blood pressure is 70/55 and her pulse is 122. Rectal examination reveals a large amount of melena. Her medical history is positive for several hemorrhoid ligations. Which of the following will assist in this patient diagnosis?

Colonoscopy, searching for polyps

Correct Incorrect Correct answer

Rectoscopic hemorrhoid ligation

Correct Incorrect Correct answer

Gastroscopy in order to locate the source of bleeding

Correct Incorrect Correct answer

Abdominal artery angiography

Correct Incorrect Correct answer

Which of the following therapeutic agents used in the treatment of patients with heart failure does not prolong the life expectancy?

Enalapril

Correct Incorrect Correct answer

Carvedilol

Correct Incorrect Correct answer

Digoxin

Correct Incorrect Correct answer

Eplerenon

Correct Incorrect Correct answer

An 80-year-old man admitted due to shortness of breath and chest pain. Echocardiography reveals aortic stenosis with a gradient of 72 mmHg and 0.4 cm maximal valve diameter. Which of the following is true regarding the valvular disease described in this question?

Mild aortic stenosis

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Mild to moderate aortic stenosis

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Moderate aortic stenosis

Correct Incorrect Correct answer

Severe aortic stenosis

Correct Incorrect Correct answer

A 35-year-old man presents with fever and upper abdominal pain. Examination reveals conjunctival jaundice and tender enlarged liver palpable under the rib cage. laboratory results include positive HBsAg, negative anti-HBs, positive anti-HBc IgG, with no evidence of anti-HBe in serum. Which if the following is the correct diagnosis?

Chronic Hepatitis B infection

Correct Incorrect Correct answer

Acute Hepatitis B infection.

Correct Incorrect Correct answer

acute Hepatitis C infection.

Correct Incorrect Correct answer

acute Hepatitis D infection.

Correct Incorrect Correct answer

A 40-year-old woman who was recently diagnosed with autoimmune hepatitis and started on azathioprine (imuran) treatment present with fever and severe leukopenia. Which of the following test would predict this effect of imuran treatment?

thiopurine methyltransferase(TPMT) active test

Correct Incorrect Correct answer

bone marrow biopsy

Correct Incorrect Correct answer

increase liver function test before initiating of therapy

Correct Incorrect Correct answer

increase sediment rate before initiating of therapy

Correct Incorrect Correct answer

A 24-year-old man feeling very sick for the last couple of days fever 38°c present with severe conjunctivitis, oral ulcer (photo attached) and a rash, which of the following is the most likely diagnosis?

Rubella

Correct Incorrect Correct answer

Measles

Correct Incorrect Correct answer

Influenza

Correct Incorrect Correct answer

Rickettia

Correct Incorrect Correct answer

A 70-year-old woman, 10 days after chemotherapy treatment for breast cancer, admitted with temperature 38.9°c, Systolic blood pressure 100, blood count of 120 WBC, 42,000 platelets. She is complaining of cough and mild gingival bleeding. Which of the following is the most appropriate treatment?

WBC and platelet infusion.

Correct Incorrect Correct answer

injection of GCSF and platelet infusion.

Correct Incorrect Correct answer

injection of GCSF and antibiotic treatment.

Correct Incorrect Correct answer

platelet transfusion and antibiotic treatment.

Correct Incorrect Correct answer

A 18-year-old man is diagnosed with multiple myeloma presents with malaise and lower limb edema, he was recently diagnosed with nephrotic syndrome, he has hepatosplenomegaly. Which stain on renal biopsy would establish the most likely diagnosis?

Gram stain

Correct Incorrect Correct answer

E&H staining

Correct Incorrect Correct answer

congo red

Correct Incorrect Correct answer

methylene blue

Correct Incorrect Correct answer

A patient presents to emergency room following tonic-clonic seizure. Laboratory results include acute renal failure and increased CPK up to 18,000. Which of the following additional laboratory results are most likely found in this patient?

Hyperkalemia and metabolic acidosis

Correct Incorrect Correct answer

Hypokalemia and metabolic alkalosis.

Correct Incorrect Correct answer

Hypokalemia and metabolic acidosis.

Correct Incorrect Correct answer

Hyponatremia and hyperkalemia

Correct Incorrect Correct answer

63-year-old woman with rheumatoid arthritis and chronic 5 mg prednisone treatment is admitted due to fever, hypotension, general malaise and an infiltrate on CXR. She remains hypotensive during her hospital stay despite adequate antibiotics therapy. What is the best next therapeutic step?

broad spectrum antibiotics

Correct Incorrect Correct answer

ceasing antibiotics and obtaining repeat blood culture

Correct Incorrect Correct answer

stress dose steroids

Correct Incorrect Correct answer

high volume IV fluids

Correct Incorrect Correct answer

A 51-year-old man with diabetes mellites for 10 years undergoes a CT scan with oral and intravenous contrast. His basic creatinine level is 1,4 mg. When should the creatinine level be re-checked, in order to rule out contrast induced nephropathy?

on the day of the scan

Correct Incorrect Correct answer

on the day following the scan

Correct Incorrect Correct answer

3-5 days after the scan

Correct Incorrect Correct answer

14 days after the scan

Correct Incorrect Correct answer

A 28-year-old woman, was diagnosed with helicobacter pylori via urease breath test. She had completed a 14-day quadruple treatment course of PPl’s (proton pump inhibitors) and three antibiotics and now is asymptomatic. Which of the following is the next step?

serology for helicobacter pylori

Correct Incorrect Correct answer

proving treatment efficacy is unnecessary

Correct Incorrect Correct answer

Repeat gastroscopy in the next few months

Correct Incorrect Correct answer

Repeat breath test at least 6 weeks from the end of the antibiotic treatment

Correct Incorrect Correct answer

A 70-year-old man is admitted for work up of iron deficiency anemia and recurrent hematochezia. Gastroscopy and colonoscopy during the current hospital stay failed to identify the source of bleeding. Which of the following is the next step in evaluating this patient?

repeat gastroscopy and colonoscopy in one year

Correct Incorrect Correct answer

virtual colonoscopy

Correct Incorrect Correct answer

completion with endoscopic capsule

Correct Incorrect Correct answer

celiac serology

Correct Incorrect Correct answer

A 80-year-old man is admitted due to pneumonia. He does not get out of bed. His medical history includes gastric cancer treated with surgery and chemotherapy, rheumatoid arthritis, diabetes and Parkinson’s disease. His creatinine level is 0.8 mg %. Which of the following is the best DVT prophylaxis in this patient?

Sc heparin, once daily

Correct Incorrect Correct answer

low molecular weight heparin (LMWH) once daily

Correct Incorrect Correct answer

oral Coumadin, aiming for INR of 2-3

Correct Incorrect Correct answer

foot pump usage, and avoiding anticoagulation medication

Correct Incorrect Correct answer

A man 30-year-old with shortness of breath last week he complains of penetration left chest pain during deep inspiration decreased breath, sound on the left dullness on percussion and decreased left remits. What is the most likely diagnosis?

left alveolar infiltrate

Correct Incorrect Correct answer

left pleural effusion

Correct Incorrect Correct answer

left pulmonary emboli

Correct Incorrect Correct answer

left pulmonary edema

Correct Incorrect Correct answer

A man 65-year-old with severe renal failure and anemia. Hgb 8.5 g/dL. What is true regarding erythropoietin treatment?

erythropoietin replaces therapy

Correct Incorrect Correct answer

erythropoietin requires iron supplementation

Correct Incorrect Correct answer

no association between erythropoietin treatment and iron storage status

Correct Incorrect Correct answer

erythropoietin is inefficient increase of anemia due to renal failure

Correct Incorrect Correct answer

A 20-year-old man with long standing diagnosis of atopic dermatitis allergy to dost mites and seasonal rhinitis present with shortness of breath, auscultation reveals expiratory wheezing and prolonged expiration. Which of the following will prove the diagnosis?

obstructive type spirometry

Correct Incorrect Correct answer

restriction type spirometry

Correct Incorrect Correct answer

high resolution chest CT with a honeycomb pattern

Correct Incorrect Correct answer

high resolution chest CT with a ground glass pattern

Correct Incorrect Correct answer

A 70-year-old man with history of diabetes and hypertension, BMI 33 no smoker, worsening malaise, body weight stable and thyroid function test is normal. He mentions no sleep for many hours a night and still falls asleep at noon, polysomnography revels apnea hypopnea index of 35. Which of the following most likely diagnosis?

severe sleep apnea

Correct Incorrect Correct answer

COPD

Correct Incorrect Correct answer

severe pulmonary hypertension

Correct Incorrect Correct answer

primary neurologic disease (sleep seizures)

Correct Incorrect Correct answer

A 66-year-old woman with progressive lung cancer complains of shortness of breath and severe weakness on minimal physical activity chest x-ray reveals an enlargement heart, ECG is attached. Which of the following is the most likely diagnosis ?

bilateral atelectasis

Correct Incorrect Correct answer

bilateral pleural effusions

Correct Incorrect Correct answer

a large pericardial effusion

Correct Incorrect Correct answer

a large pulmonary embolus

Correct Incorrect Correct answer

A 33-year-old man evaluated of infertility he had known situs inversus and present with chronic productive cough. An image of chest CT is attached. Which of the following is the most likely diagnosis?

pulmonary edema due to heart failure

Correct Incorrect Correct answer

pulmonary bronchioles

Correct Incorrect Correct answer

pulmonary TB

Correct Incorrect Correct answer

viral pneumonitis

Correct Incorrect Correct answer

A woman 47-year-old admitted for workup of headache, hypertension, palpitations and events of facial flushing and pallor. Which of the following is next diagnosis of pheochromocytoma?

cardiac holter for 24 hours

Correct Incorrect Correct answer

ACTH test

Correct Incorrect Correct answer

urinary catecholamines over 24 hours

Correct Incorrect Correct answer

bilateral adrenal catheterization

Correct Incorrect Correct answer

The mother of a 2-week-old infant reports that since birth, her infant sleeps most of the day; she has to awaken her every 4 hours to feed, and she will take only an ounce of formula at a time. She also is concerned that the infant has persistently hard, pellet-like stools. On your examination you find an infant with normal weight and length, but with an enlarged head. The heart rate is 75 beats per minute and the temperature is 35°C (95°F). The child is still jaundiced. You note large anterior and posterior fontanelles, a distended abdomen, and an umbilical hernia. This clinical presentation is likely a result of which of the following?

Congenital megacolon (Hirschsprung disease)

Correct Incorrect Correct answer

congenital hypothyroidism

Correct Incorrect Correct answer

sepsis

Correct Incorrect Correct answer

infantile botulism

Correct Incorrect Correct answer

normal development

Correct Incorrect Correct answer

A 2-year-old boy is brought into the emergency room with a complaint of fever for 6 days and the development of a limp. On examination, he is found to have an erythematous macular exanthem over his body, ocular conjunctivitis, dry and cracked lips, a red throat, and cervical lymphadenopathy. There is a grade 2/6 vibratory systolic ejection murmur at the lower left sternal border. A white blood cell count and differential show predominant neutrophils with increased platelets on smear. Which of the following is the most likely diagnosis?

scarlet fever

Correct Incorrect Correct answer

rheumatic fever

Correct Incorrect Correct answer

Kawasaki disease

Correct Incorrect Correct answer

juvenile rheumatoid arthritis

Correct Incorrect Correct answer

infection mononucleosis

Correct Incorrect Correct answer

An ill-appearing 2-week-old girl is brought to the emergency room. She is pale and dyspneic with a respiratory rate of 86 breaths per minute. Heart rate is 195 beats per minute, heart sounds are distant, a gallop is heard, and she has cardiomegaly on x-ray. An echocardiogram demonstrates poor ventricular function, dilated ventricles, and dilation of the left atrium. An ECG shows ventricular depolarization complexes that have low voltage. Which of the following is the most likely diagnosis.

endocardial fibroelastosis

Correct Incorrect Correct answer

pericarditis

Correct Incorrect Correct answer

myocarditis

Correct Incorrect Correct answer

aberrant left coronary artery

Correct Incorrect Correct answer

glycogen storage disease of the heart

Correct Incorrect Correct answer

A 3-day-old infant with a single second heart sound has had progressively deepening cyanosis since birth but no respiratory distress. Chest radiography demonstrates no cardiomegaly and normal pulmonary vasculature. An ECG shows an axis of 120° and right ventricular prominence. Which of the following congenital cardiac malformations is most likely responsible for the cyanosis?

Tetralogy of Fallot

Correct Incorrect Correct answer

Transposition of large vessels

Correct Incorrect Correct answer

Atresia tricuspid valve

Correct Incorrect Correct answer

Atresia of the pulmonary artery with a normal interventricular septum

Correct Incorrect Correct answer

Total abnormal drainage of pulmonary veins below the diaphragm

Correct Incorrect Correct answer

A 16-year-old girl is seen by the pediatrician for a preparticipation sports evaluation. She reports no illness and takes no medications. Family history is positive for adult onset diabetes in the paternal grandparents and “a heart murmur” in her mother. On physical examination the temperature is 36.7°C (98.0°F), heart rate is 75 beats per minute, respiratory rate is 60 breaths per minute, and blood pressure is 110/70 mm Hg. Weight is at the 25th percentile and length is at the 50th percentile for age. Chest has good air movement without distress. Heart has normal S1 and S2 with a late apical systolic murmur preceded by a click noted. Pulses are normal. Capillary refill is less than 3 seconds. Which of the following is the most likely diagnosis?

Atrial septal defect

Correct Incorrect Correct answer

Aortic stenosis

Correct Incorrect Correct answer

Tricuspid insufficiency

Correct Incorrect Correct answer

Mitral valve prolapse

Correct Incorrect Correct answer

Defect of interventricular septum

Correct Incorrect Correct answer

A 3-hour-old neonate is seen by the pediatrician for initial evaluation. The neonate was born vaginally, at term to a 33-year-old mother whose pregnancy was complicated by poorly controlled insulin dependent gestational diabetes and gestational hypertension. On physical examination the temperature is 37°C (98.6°F), heart rate is 155 beats per minute, respiratory rate is 55 breaths per minute, O2 saturation is 85% on room air, and 99% on 5 L/min nasal cannula. Weight, length, and head circumference are at the 95th percentile. The head has molding and flat fontanels. Pupils are equally round and reactive to light; red reflex is normal. The chest has irregular, labored breathing, and decreased breath sounds on the right side. Heart has normal S1 and S2 without murmur. Abdomen is soft, nontender, and without hepatosplenomegaly. Extremities show decreased tone and spontaneous movement of the right arm. A stat portable chest radiograph is normal. Which of the following is the most appropriate next step?

Taking a swab from the nasopharynx for viruses

Correct Incorrect Correct answer

Fibrobronchoscopy

Correct Incorrect Correct answer

Computed tomography of the thorax

Correct Incorrect Correct answer

Ultrasound examination of the chest

Correct Incorrect Correct answer

Sputum for culture

Correct Incorrect Correct answer

A 10-year-old boy is injected with an extract of pollen. Two minutes later, the boy begins to complain of nausea and a strange sensation in his chest. His face is red and his voice is muffled. What is the top priority in the treatment of this attack of anaphylaxis?

Intubation of the trachea

Correct Incorrect Correct answer

Intramuscular injection of diphenhydramine

Correct Incorrect Correct answer

Purpose of oxygen

Correct Incorrect Correct answer

Intramuscular injection of epinephrine

Correct Incorrect Correct answer

Purpose of corticosteroids

Correct Incorrect Correct answer

Previously, a healthy child of 18 months was in a separate room. Parents suddenly heard a fit of cough that went away in a few minutes. After that the child looks normal, except for excessive salivation and refusal to eat. What is the most likely explanation for the condition of this child?

Severe pylorospasm

Correct Incorrect Correct answer

Foreign body in the respiratory tract

Correct Incorrect Correct answer

Croup

Correct Incorrect Correct answer

Epiglottitis

Correct Incorrect Correct answer

Foreign body in the esophagus

Correct Incorrect Correct answer

A 5-year-old boy is seen by a pediatrician in consultation from a general practitioner. The child has a history of chronic and recurrent upper respiratory tract infections, several admissions to the hospital for pneumonia, and three surgeries for PE tubes for chronic otitis media. His most recent radiograph is normal other than a right-sided heart. In order to confirm the diagnosis nasal mucosa biopsy was performed, which is expected in this biopsy

Eosinophilic infiltrate

Correct Incorrect Correct answer

Bartonella pertussis

Correct Incorrect Correct answer

Absence of nasal mucosa glands

Correct Incorrect Correct answer

Random orientation of nasal cilia

Correct Incorrect Correct answer

Nasal polyps

Correct Incorrect Correct answer

A 6-week-old child develops increased respiratory rate and a nonproductive cough. Physical examination is significant for rales and rhonchi. The past medical history for the child is positive for an eye discharge at 3 weeks of age, which was treated with a topical antibiotic drug. The most likely organism causing this child’s condition is

Neisseria gonorrhoeae

Correct Incorrect Correct answer

Staphylococcus aureus

Correct Incorrect Correct answer

Group B streptococcus

Correct Incorrect Correct answer

Chlamydia trachomatis

Correct Incorrect Correct answer

Herpes simplex virus

Correct Incorrect Correct answer

An 18-month-old infant is found with the contents of a bottle of drain cleaner in his mouth. Which of the following treatment options is most appropriate?

causing vomiting with Ipeciana

Correct Incorrect Correct answer

rapid endoscopy

Correct Incorrect Correct answer

Decontamination with activated charcoal

Correct Incorrect Correct answer

Neutralization by infusion of a solution with the opposite reaction Ph

Correct Incorrect Correct answer

gastric lavage with a probe

Correct Incorrect Correct answer

A 7-year-old boy has crampy abdominal pain and a rash mainly on the back of his legs and buttocks as well as on the extensor surfaces of his forearms. Laboratory analysis reveals proteinuria and microhematuria. He is most likely to be affected by

Systemic lupus erythematosus

Correct Incorrect Correct answer

Anaphylactoid purpura

Correct Incorrect Correct answer

Post streptococcal glomerulonephritis

Correct Incorrect Correct answer

Appendicitis

Correct Incorrect Correct answer

Dermatomyositis

Correct Incorrect Correct answer

Which condition is contraindications to perform of diagnostic lumbar puncture?

Significant increase wbc count consist with bacteremia

Correct Incorrect Correct answer

Bulging fontanelle

Correct Incorrect Correct answer

Lumbar puncture 2 day before

Correct Incorrect Correct answer

Marked uncooperativeness on part of the patient

Correct Incorrect Correct answer

Severe cardiopulmonary decompression

Correct Incorrect Correct answer

2 or/and 5

Correct Incorrect Correct answer

Friends are considering adopting from another country a “special needs” child. The family has few details, but the information they have received so far suggests the 4-year-old child has had surgery for an endocardial cushion defect, is short for his age, and had a history of what sounds like surgically repaired duodenal atresia at birth. You are suspicious this child may have which of the following syndromes?

Klinefelter syndrome

Correct Incorrect Correct answer

Waardenburg syndrome

Correct Incorrect Correct answer

Marfan syndrome

Correct Incorrect Correct answer

Dawn syndrome

Correct Incorrect Correct answer

Turner syndrome

Correct Incorrect Correct answer

An otherwise healthy 7-year-old child is brought to you to be evaluated because he is the shortest child in his class. Careful measurements of his upper and lower body segments demonstrate normal body proportions for his age. Which of the following is the most likely diagnosis?

Congenital hypothyroidism

Correct Incorrect Correct answer

Congenital hypopituitarism

Correct Incorrect Correct answer

Marfan syndrome

Correct Incorrect Correct answer

growth hormone deficiency

Correct Incorrect Correct answer

Klinefelter syndrome

Correct Incorrect Correct answer

A 6-year-old boy is scheduled for umbilical hernia repair. On the day before his surgery, he develops nasal congestion. Which of the following would prompt most anesthesiologists to reschedule this elective procedure?

Wheezing on physical exam

Correct Incorrect Correct answer

Clean nasal discharge

Correct Incorrect Correct answer

History of being born at 36 weeks gestation

Correct Incorrect Correct answer

Drinking apple juice 5 hours ago

Correct Incorrect Correct answer

History of nasal congestion alone

Correct Incorrect Correct answer

A 7-year-old boy is wetting his bed at night. He was never dry. At night he sleeps very soundly and is difficult to arouse. What is the best initial treatment?

Advice the parents to discipline the child.

Correct Incorrect Correct answer

Send for psychiatric consultation

Correct Incorrect Correct answer

Fluid intake restriction at evening

Correct Incorrect Correct answer

Conditioning with auditory alarm

Correct Incorrect Correct answer

Decompression administration

Correct Incorrect Correct answer

A 4-month-old infant currently hospitalized due to hypoglycemia. Parents report that he typically feed every 3 hours. On examination hepatomegaly is evident, laboratory results reveal an elevated lactic acid level, elevation of uric acid, elevated triglycerides. What the most likely diagnosis?

Glycogen storage disease

Correct Incorrect Correct answer

Pompe disease

Correct Incorrect Correct answer

Gaucher disease

Correct Incorrect Correct answer

Tay Sachs disease

Correct Incorrect Correct answer

Mucopolysaccharidosis

Correct Incorrect Correct answer

A 7-years old girl is diagnosed with chickenpox because of mild fever and typical rash. On the 4th day of illness her rash seems to be worsening and is painful. The temperature is now 39.5°C. what is the next best course of action?

start acyclovir

Correct Incorrect Correct answer

start antibiotics

Correct Incorrect Correct answer

start intravenous gamma globulin

Correct Incorrect Correct answer

continue symptomatic treatment

Correct Incorrect Correct answer

start topical hydrocortisone

Correct Incorrect Correct answer

Twelve children in a hasidic community have contracted a similar infection. They all present with a rising fever, conjunctivitis, cough and cold symptoms, and a maculopapular rash that appears on days 3 to 4 of fevers and that spreads from the hairline downward within a 24-hour span. All 12 children attend school together and 11 of the 12 are unvaccinated. One of the boys in the group is noted to have a few white lesions on his oral mucosa surrounded with red areolae.One of the boys in the group is noted to have a few white lesions on his buccal mucosa, surrounded with red areole. What is the most common complication of this disease?

subacute sclerosing panencephalitis

Correct Incorrect Correct answer

corneal ulcers

Correct Incorrect Correct answer

myocarditis

Correct Incorrect Correct answer

ruptured spleen

Correct Incorrect Correct answer

acute otitis media

Correct Incorrect Correct answer

A 12-year-old girl presents with abdominal pain, headache, and flu-like symptoms for 1 week. Several days later the patient begins experiencing increased headache and neck pain. She additionally has difficulty swallowing with increasing episodes of what are thought to be laryngeal spasms along with generalized weakness and progressive paralysis. She lives in a rural area. Initial evaluation of the cerebral spinal fluid does not reveal any bacteria. Samples are sent for evaluation of different causes of encephalitis. Brain biopsy is undertaken given the patient’s worsening condition and reveals Negri bodies. The patient’s current condition could have best been prevented by means of:

passive and active immunization

Correct Incorrect Correct answer

careful examination for ticks after exposures

Correct Incorrect Correct answer

application of topical DEET

Correct Incorrect Correct answer

sodium stibogluconate

Correct Incorrect Correct answer

albendazole

Correct Incorrect Correct answer

The parents of a healthy 4-year-old girl who weighs 22 kg are planning to travel to India and want to get malaria prophylaxis prior to the journey. After discussion of their travels you determine they are going to an area with chloroquine-resistant Plasmodium falciparum . The best recommendation for a malaria prophylaxis agent for their daughter is:

doxycycline

Correct Incorrect Correct answer

atovaquone

Correct Incorrect Correct answer

quinine sulfate

Correct Incorrect Correct answer

mefloquine

Correct Incorrect Correct answer

clindamycin

Correct Incorrect Correct answer

You have diagnosed a 16-year-old girl with cat scratch disease (CSD) after she presented with a right axillary mass. The mass has been present for 2 weeks. Her past medical history is negative. What is the most accurate statement regarding Management?

supportive treatment

Correct Incorrect Correct answer

azithromycin treatment

Correct Incorrect Correct answer

fine needle aspiration of lesion

Correct Incorrect Correct answer

oral corticosteroids

Correct Incorrect Correct answer

intravenous amoxicillin clavulanate

Correct Incorrect Correct answer

A 6-year-old boy who is new to your clinic has dysmorphic facies, sparse hair, hypoplastic nails, cleft palate, and hypodontia with teeth that are peg shaped. You also notice his father has a similar appearance. The patient otherwise has normal development. What category of conditions does this patient have?

Ehlers-Danlos Syndrome

Correct Incorrect Correct answer

Ichthyosis

Correct Incorrect Correct answer

atopy

Correct Incorrect Correct answer

ectodermal dysplasia

Correct Incorrect Correct answer

neurocutaneous disorder

Correct Incorrect Correct answer

A 10-year-old girl with severe acute hepatic insufficiency was hospitalized in the intensive care unit. What is the most common cause of death of these patients?

Sepsis

Correct Incorrect Correct answer

Renal failure

Correct Incorrect Correct answer

Brainstem Herniation

Correct Incorrect Correct answer

Hemorrhagic shock

Correct Incorrect Correct answer

Respiratory failure

Correct Incorrect Correct answer

Deficiency of which vitamin is associated with increased risk of night blindness?

Vitamin A

Correct Incorrect Correct answer

Vitamin D

Correct Incorrect Correct answer

Vitamin C

Correct Incorrect Correct answer

Vitamin K

Correct Incorrect Correct answer

Vitamin E

Correct Incorrect Correct answer

A 3-year-old boy presents with prolonged epistaxis and a history of easy bruising. There is no family history of bleeding problems. The patient’s laboratory studies show a normal CBC and smear, normal von Willebrand panel, and normal PT and PTT, but platelet aggregation showed no response to adenosine diphosphate (ADP), thrombin, and epinephrine, and platelets were found to lack GpIIb/IIIa. The most likely diagnosis is:

Bernard-Soulier Syndrome

Correct Incorrect Correct answer

Glanzmann thrombasthenia

Correct Incorrect Correct answer

Shwachman-Diamond syndrome

Correct Incorrect Correct answer

Kostmann disease

Correct Incorrect Correct answer

Pearson syndrome

Correct Incorrect Correct answer

A 12-year-old male who is undergoing chemotherapy for acute lymphoblastic leukemia has chemotherapy-induced pancytopenia, for which he receives a blood transfusion. After the transfusion starts, he develops vomiting, fever, and chills. He does not have any rash or shortness of breath. His blood transfusion is stopped, with rapid resolution of his symptoms. Shortly afterwards, his urine turns dark colored and cloudy. What other findings are consistent with the patient’s clinical picture?

New infiltration on X-ray

Correct Incorrect Correct answer

Metabolic alkalosis

Correct Incorrect Correct answer

Hypocalcemia

Correct Incorrect Correct answer

Low Haptoglobin

Correct Incorrect Correct answer

Polycythemia

Correct Incorrect Correct answer

A 39-week gestation infant was born after an uneventful pregnancy. Following delivery, the infant has respiratory distress and is found to have truncus arteriosis. Further examination reveals a low calcium (6.0 mg/dL) and low PTH. What is this child’s most likely diagnosis?

Williams Syndrome

Correct Incorrect Correct answer

DiGeorge syndrome

Correct Incorrect Correct answer

Neonatal Graves disease

Correct Incorrect Correct answer

Beckwith–Wiedemann syndrome

Correct Incorrect Correct answer

Congenital hypothyroidism

Correct Incorrect Correct answer

A 5-year-old boy presents with Tanner III pubic hair, oily skin, and acne. A bone age radiograph of his left hand and wrist is advanced at 9 years. There is concern that the child may have nonclassic congenital adrenal hyperplasia (CAH). Which of the following would be the best laboratory test to evaluate for CAH?

Cortisol

Correct Incorrect Correct answer

Testosterone

Correct Incorrect Correct answer

ACTH

Correct Incorrect Correct answer

17-hydroxyprogesterone

Correct Incorrect Correct answer

DHEA-S

Correct Incorrect Correct answer

A 3-year-old boy has been having headaches that wake him up from sleep for the last week. He has vomited several times. He says he sees “2 doctors” when he looks at you. On examination, he has end-gaze horizontal nystagmus bilaterally and gait ataxia. He cannot bury his sclera on the left. He is unable to tolerate a funduscopic examination. What is the most likely etiology for his headaches?

Migraine

Correct Incorrect Correct answer

Tension-type headache

Correct Incorrect Correct answer

Idiopathic intracranial hypertension

Correct Incorrect Correct answer

Cerebral aneurysm

Correct Incorrect Correct answer

Posterior fossa mass

Correct Incorrect Correct answer

A neonate is being loaded on phenobarbital for seizures. What is the most likely side effect the neonatology team should be prepared for?

Hyponatremia

Correct Incorrect Correct answer

Respiratory suppression

Correct Incorrect Correct answer

Anaphylaxis

Correct Incorrect Correct answer

Hypertension

Correct Incorrect Correct answer

Dystonic reaction

Correct Incorrect Correct answer

A 2-year-old boy comes to your clinic for a checkup. He is well except that he walks with a slight in-toed gait.When you place him prone on the examination table with his knees flexed and measure the angle formed by the axis of the thigh and the axis of the foot, you note that the foot is internally rotated.You diagnose internal tibial torsion. The best management for this condition at this age is:

refer to a pediatric orthopedic surgeon for serial casting

Correct Incorrect Correct answer

obtain leg radiographs to measure accurately the thigh foot angle

Correct Incorrect Correct answer

suggest high top straight last shoes with arch support

Correct Incorrect Correct answer

send patient to be fitted for a penis browne bar

Correct Incorrect Correct answer

no treatment is need at this age

Correct Incorrect Correct answer

A 9-month-old boy is seen for a well-child exam. This is his first visit to the clinic since the age of 2 months because his parents are homeless and have been living in multiple shelters. He has been bottle fed and reportedly began solids around 6 months of age. The mother does not report any excessive spitting-up, feeding problems, or undercurrent illnesses. On exam, he is alert and interactive, but markedly thin. The rest of the physical exam is normal. His growth chart reveals that his head circumference and length have dropped from the 90th to the 75th percentile, while his weight has dropped from the 75th to less than the 25th percentile. CBC, lead level, urinalysis, CMP, thyroid function, HIV, and sweat tests are all normal. The best next step in management would be:

contrast head MRI

Correct Incorrect Correct answer

contrast head CT

Correct Incorrect Correct answer

nuclear medicine gastric emptying study

Correct Incorrect Correct answer

colonoscopy with biopsy

Correct Incorrect Correct answer

observe feeding and calories count

Correct Incorrect Correct answer

A 6-year-old boy is examined because of encopresis. The patient had been successfully toilet trained at 3 years of age, but the mother reports the boy now goes several days without having a bowel movement. His stools are so large in size that there is pain with bowel movements. About three times a week, the patient has loose stool that leaks into his underwear. This is causing great problems with teasing at school. On physical examination, you find a large amount of stool in the rectum. The best next step in the management of this patient is:

institute a low fiber diet

Correct Incorrect Correct answer

prescribe enemas or laxatives to evacuate retained stool

Correct Incorrect Correct answer

have child sit on a toilet for at least 30 minutes (or until bowel movement) daily

Correct Incorrect Correct answer

order a barium enema

Correct Incorrect Correct answer

refer patient to a child psychiatric

Correct Incorrect Correct answer

A 2-year-old boy presents to the clinic and has pallor on exam. His mother states that he drinks 45 ounces of cow’s milk a day.A CBC reveals a hemoglobin of 8.2 and a mean corpuscular volume (MCV) of 65. Which of the following indices is compatible with this patient’s diagnosis?

Decreased red blood cell distribution width (RDW)

Correct Incorrect Correct answer

increased serum ferritin

Correct Incorrect Correct answer

increased total iron binding capacity (TIBC)

Correct Incorrect Correct answer

increased reticulocyte count

Correct Incorrect Correct answer

increased serum iron level

Correct Incorrect Correct answer

A 12-year-old boy returns home from summer camp. After 2 days he develops frequent watery diarrhea and a mild fever. He is seen in your clinic on the third day of his illness. He looks to be mildly dehydrated and stool examination shows no evidence of blood or white blood cells. His mother is worried that he may have swallowed some water when swimming in the camp lake. The physician discusses the possibilities with the mother and together they decide on a treatment plan. Which of the following would likely be part of that plan?

3 days trial of erythromycin

Correct Incorrect Correct answer

admission to the hospital for iv fluids and culture of stool

Correct Incorrect Correct answer

a trial of metronidazole while awaiting stool giardia antigen test

Correct Incorrect Correct answer

oral rehydration continued diet and reevaluation in the next two days

Correct Incorrect Correct answer

a call to the local health authority requesting investigation of the camp facilities.

Correct Incorrect Correct answer

A 12-year-old child is being seen in your office for the acute onset of a swollen left testicle. There is no history of trauma. On physical exam you notice an erythematous, swollen, painful left testicle with an absent cremasteric reflex. Which of the following is most consistent with the management of this condition?

surgical consultation should not be delayed

Correct Incorrect Correct answer

intravenous fluid are first priority

Correct Incorrect Correct answer

CT scan should be used to confirm the diagnosis

Correct Incorrect Correct answer

antibiotics are necessary for proper treatment

Correct Incorrect Correct answer

mumps should be ruled out with antibody titer

Correct Incorrect Correct answer

A 6-month-old infant is seen with failure of thrive. Physical examination reveals significant loss of subcutaneous tissue growth retardation and rachitic rosary. A diagnosis of rickets most probably due to vitamin d deficiency is made. Which of the following blood laboratory test is likely?

the serum calcium will be normal

Correct Incorrect Correct answer

alkaline phosphatase will be high

Correct Incorrect Correct answer

parathyroid hormone will be low

Correct Incorrect Correct answer

vitamin d will be normal

Correct Incorrect Correct answer

the serum phosphorus will be high

Correct Incorrect Correct answer

A 6-month-old boy is seen in your office because of atopic dermatitis refractory to standard therapy, and only partially responsive to topical steroids. There is a history of prolonged bleeding from his newborn circumcision, and he has had some intermittent bloody diarrhea. He has also had two bouts of otitis media in the past 2 months. Which one of the following disorders is likely to apply to this patient?

Wiskott-Aldrich syndrome

Correct Incorrect Correct answer

ataxia telangiectasia

Correct Incorrect Correct answer

x-linked gammaglobulinemia

Correct Incorrect Correct answer

severe combined immunodeficiency

Correct Incorrect Correct answer

hyper igM syndrome

Correct Incorrect Correct answer

A 12-year-old girl has ptosis and muscle weakness after repetitive use. A diagnosis of myasthenia gravis is suspected. Which is the best test to confirm the diagnosis?

emg

Correct Incorrect Correct answer

eeg

Correct Incorrect Correct answer

anti acetylcholine antibodies in the serum

Correct Incorrect Correct answer

muscle biopsy

Correct Incorrect Correct answer

serum creatine phosphokinase (CPK) level

Correct Incorrect Correct answer

A or/and D

Correct Incorrect Correct answer

B or/and C

Correct Incorrect Correct answer

A child presents on the hospital ward with respiratory distress, exhibited by nasal flaring, intercostal retractions, grunting respirations, and cyanosis. You start oxygen by facemask, but the child is still in significant respiratory distress and becomes apneic. The best next step is:

start chest compressions

Correct Incorrect Correct answer

start chest compressions

Correct Incorrect Correct answer

obtain blood gas

Correct Incorrect Correct answer

send child to radiology department for x-ray

Correct Incorrect Correct answer

start bag-valve mask ventilation with 100% oxygen

Correct Incorrect Correct answer

A 10-year-old girl comes to the ED in July because of severe right-sided ear pain that has been getting progressively worse over the last 2 days. She has had no upper respiratory symptoms or fever. When you pull on her pinna she screams out in pain. On examination, you see a whitish discharge in the ear canal. The best treatment would be:

topical otic antibiotic steroids

Correct Incorrect Correct answer

intramuscular ceftriaxone

Correct Incorrect Correct answer

benzocaine otic solution

Correct Incorrect Correct answer

oral amoxicillin

Correct Incorrect Correct answer

apply warm compresses to ear

Correct Incorrect Correct answer

A 10-month-old baby comes to the ER because of a fever of 40°C. Your examination reveals that the baby has an immobile, bright red, bulging eardrum. During your examination, the baby has a generalized tonic-clonic seizure. A spinal tap shows normal CSF. You suspect that the baby had a febrile convulsion. Which is the best treatment the parents can give the child if the convulsion recurs at home

cold bath

Correct Incorrect Correct answer

rectal diazepam

Correct Incorrect Correct answer

oral antibiotics

Correct Incorrect Correct answer

rectal paracetamol

Correct Incorrect Correct answer

ibuprofen orally

Correct Incorrect Correct answer

C or/and E

Correct Incorrect Correct answer

B or/and D

Correct Incorrect Correct answer

A 4-year-old boy with a history of complex congenital heart disease presents with 4 days of fever, fatigue, anorexia, headache, and myalgias. On physical examination the boy is febrile and looks pale. He has a loud murmur and the spleen is enlarged. Laboratory tests reveal mild anemia and an elevated erythrocyte sedimentation rate (ESR). What is the most important next step in the management of this patient?

administer digoxin and furosemide

Correct Incorrect Correct answer

administer iv penicillin and gentamicin

Correct Incorrect Correct answer

administer amantadine for influenza

Correct Incorrect Correct answer

obtain blood culture from multiple sites

Correct Incorrect Correct answer

perform an urgent Echo study

Correct Incorrect Correct answer

A previously healthy, term 15-month-old male presents to the ER with a history of the sudden onset of rectal bleeding. The parents deny fever, vomiting, diarrhea, or abdominal pain. He has had three episodes of bright red blood per rectum. Hemodynamically, he is stable and his initial hemoglobin is 11. Which of the following tests is most likely to give you the correct diagnosis?

flat plate x-ray of the abdomen

Correct Incorrect Correct answer

abdominal ultrasound

Correct Incorrect Correct answer

Meckel scan

Correct Incorrect Correct answer

CT of the abdomen

Correct Incorrect Correct answer

upper GI barium study

Correct Incorrect Correct answer

At 43 weeks’ gestation, a long, thin infant is delivered. The infant is apneic, limp, pale, bradycardic, and covered with “pea soup” amniotic fluid. Which of the following is the best first step in the resuscitation of this infant at delivery?

suction of the trachea under direct visualization

Correct Incorrect Correct answer

artificial ventilation with bag and mask

Correct Incorrect Correct answer

artificial ventilation with endotracheal tube

Correct Incorrect Correct answer

administration of 100% oxygen by mask

Correct Incorrect Correct answer

catheterization of the umbilical vein

Correct Incorrect Correct answer

A 25-year old man presents to the emergency room with bizarre behaviour and delusions of pursuit, without anomalies in perception. during his examination, he stops mid sentence and is not able to collect his line of thought. Which of the following defines his finding?

blocking

Correct Incorrect Correct answer

neologism

Correct Incorrect Correct answer

sound association

Correct Incorrect Correct answer

tangency

Correct Incorrect Correct answer

idiosyncratic thought.

Correct Incorrect Correct answer

Which of the following in an A group criterion for schizophrenia according to the DSM-5?

dysphoria

Correct Incorrect Correct answer

thought disturbance

Correct Incorrect Correct answer

pressured speech

Correct Incorrect Correct answer

low self esteem

Correct Incorrect Correct answer

money spending

Correct Incorrect Correct answer

All of the following are sleep disorders except:

Narcolepsy

Correct Incorrect Correct answer

Coprophilia

Correct Incorrect Correct answer

Night Terror

Correct Incorrect Correct answer

Sleep apnea

Correct Incorrect Correct answer

Cataplexy

Correct Incorrect Correct answer

A 25-year-old woman presents to the emergency room with a first episode of chest pain palpitations diaphoresis and anxiety for major cardiac event. Which of the following describes the initial management of this patient?

calm the patient down and ask for a psych consultation

Correct Incorrect Correct answer

check the vital signs blood glucose

Correct Incorrect Correct answer

thyroid function test ECG

Correct Incorrect Correct answer

administer anti-anxiety drug right away

Correct Incorrect Correct answer

ask the patient to breath into a paper bag head ct scan

Correct Incorrect Correct answer

A 32-year-old woman presents to the clinic with recurrent panic attack over the last few months. She has undergone a physical work up that turned out normal. All of the following diagnosis panic attacks except?

avoidance

Correct Incorrect Correct answer

palpitations and diaphoresis

Correct Incorrect Correct answer

trigger preceding the panic attack

Correct Incorrect Correct answer

onset while using illicit drugs

Correct Incorrect Correct answer

derealization feelings

Correct Incorrect Correct answer

Which of the following is a bad prognostic sign in schizophrenia?

Acute onset

Correct Incorrect Correct answer

Onset at young age

Correct Incorrect Correct answer

Posture symptoms

Correct Incorrect Correct answer

Good support system

Correct Incorrect Correct answer

Family history of mood disorders

Correct Incorrect Correct answer

A 45-year-old bipolar woman receives 900 lithium for the last 2 years. She has presented to the emergency room with severe diarrhea and extreme restlessness 2 weeks after adding another drug treatment. Which of the following is most likely to be the added drug?

fluoxetine 60mg

Correct Incorrect Correct answer

perphenazine 4mg

Correct Incorrect Correct answer

bupropione 150mg

Correct Incorrect Correct answer

folic acid 5mg

Correct Incorrect Correct answer

olanzapine 5mg

Correct Incorrect Correct answer

Which of the following does not fulfill the criteria for traumatic event according to the dsm-5?

paramedic exposed to multiple events some of them through the media during event debriefing

Correct Incorrect Correct answer

a soldier who participated in shooting event inside a building

Correct Incorrect Correct answer

a taxi driver involved in a motor vehicle accident

Correct Incorrect Correct answer

a man who got notified his love was killed in car crash

Correct Incorrect Correct answer

a mother of low in steamed argument with a healthcare manager

Correct Incorrect Correct answer

Which of the following drugs has lowest rate of extrapyramidal symptoms ?

leponex (clozapine)

Correct Incorrect Correct answer

halidol (haloperidol)

Correct Incorrect Correct answer

risperdal (risperidone)

Correct Incorrect Correct answer

perphenan (perphenazine)

Correct Incorrect Correct answer

abilify ariply (aripiprazole)

Correct Incorrect Correct answer

What drug produces the most frequent metabolic syndrome?

Olanzapine

Correct Incorrect Correct answer

Perphenazine

Correct Incorrect Correct answer

Aripiprazole

Correct Incorrect Correct answer

Haloperidol

Correct Incorrect Correct answer

Ziprazidone

Correct Incorrect Correct answer

Which of the following Is absolute contraindication for Clozapine:

Leukocytosis

Correct Incorrect Correct answer

Constipation

Correct Incorrect Correct answer

History of ischemic heart disease

Correct Incorrect Correct answer

Simultaneous treatment with carbamazepine

Correct Incorrect Correct answer

History of Syncope

Correct Incorrect Correct answer

Which of the following is not a characteristic of the physical examination in stimulant overdose?

Agitation

Correct Incorrect Correct answer

Bradycardia

Correct Incorrect Correct answer

Hypertension

Correct Incorrect Correct answer

Constricted pupils

Correct Incorrect Correct answer

Tachycardia

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and D

Correct Incorrect Correct answer

A 52-year-old man with long standing alcohol abuse, was diagnosed 2 weeks ago in the emergency room as having delirium. He present to the ER again, conscious, passive, disoriented regarding time and place, with ataxia and ophthalmoplegia. Which of the following is the treatment of choice?

Intravascular glucose

Correct Incorrect Correct answer

Very high dose of halidol

Correct Incorrect Correct answer

High dose of thiamine

Correct Incorrect Correct answer

High dose of vitamin B12

Correct Incorrect Correct answer

High dose of pyridoxine

Correct Incorrect Correct answer

A 72-year-old man’s wife reports to his primary physician that lately he has been experiencing memory loss and personality changes. Which of the following is compatible with the stages of Alzheimer’s dementia as opposite to pseudo dementia?

There is a difference between night and day (morning are harder and his mood is improving at evening)

Correct Incorrect Correct answer

The patient is answer most of the questions with "I don't know "

Correct Incorrect Correct answer

The clinical symptoms developed rapidly.

Correct Incorrect Correct answer

The patient hides his cognitive difficulties and insist everything is Ok.

Correct Incorrect Correct answer

The patient has history of depression.

Correct Incorrect Correct answer

Which of the following laboratory results is not compatible with anorexia nervosa?

hypercholesterolemia

Correct Incorrect Correct answer

Leukopenia

Correct Incorrect Correct answer

Hyperkalemia

Correct Incorrect Correct answer

Hyperthyroidism

Correct Incorrect Correct answer

Low CH

Correct Incorrect Correct answer

A 34 years old schizophrenic man, treated with 20 mg halidol (haloperidol) present to the emergency room with diaphoresis and tremor. Examination reveals blood pressure of 200/90, pulse – 130 bpm, a temperature of 40.8° c and muscle rigidity. Labs show increase CPK. What is the most likely the diagnosis?

Lithium intoxication

Correct Incorrect Correct answer

Wernicke encephalopathy

Correct Incorrect Correct answer

Neuroleptic malignant

Correct Incorrect Correct answer

Serotonin syndrome

Correct Incorrect Correct answer

Hypothermia

Correct Incorrect Correct answer

A 35-year-old woman with schizoaffective disorder has been on prolonged risperidone (6 mg) treatment, she present with breast congestion and lactation and irregular menstrual cycle. Beta- HCG test negative. Which of the following is the best diagnostic test for her condition?

Prolactin

Correct Incorrect Correct answer

Creatinine kinase

Correct Incorrect Correct answer

Renal function

Correct Incorrect Correct answer

hemoglobin a1c

Correct Incorrect Correct answer

Amylase

Correct Incorrect Correct answer

All of the following techniques are used in cognitive-behavioral therapy except:

Gradual exposure

Correct Incorrect Correct answer

Identification of non- adaptive assumptions

Correct Incorrect Correct answer

Practicing relaxation methods

Correct Incorrect Correct answer

Examining automatic thoughts

Correct Incorrect Correct answer

transference interpretation

Correct Incorrect Correct answer

All of the following are considered comorbidities of Tourette’s disorder except

depression

Correct Incorrect Correct answer

psychosis

Correct Incorrect Correct answer

Attention deficit disorder

Correct Incorrect Correct answer

obsessivecompulsive disorder

Correct Incorrect Correct answer

Which of the following is not considered a risk factor for complete suicide

Age above 45

Correct Incorrect Correct answer

Female gender

Correct Incorrect Correct answer

Existence of physical illnesses

Correct Incorrect Correct answer

Repeat suicide attempts

Correct Incorrect Correct answer

Alcohol abuse

Correct Incorrect Correct answer

A 45-year-old schizophrenic man is brought to the emergency room due to sore throat, fever and impaired consciousness. Complete blood count reveals an absolute neutrophils count of 500. Which of the following drugs has this patient began taking 2 weeks ago?

Olanzapine

Correct Incorrect Correct answer

Lithium

Correct Incorrect Correct answer

Assival

Correct Incorrect Correct answer

Carbamazepine

Correct Incorrect Correct answer

Which of the following cardiac adverse effects may caused by tricyclic antidepressants (TCA)?

T wave elevation

Correct Incorrect Correct answer

Bradycardia

Correct Incorrect Correct answer

Prolonged QT

Correct Incorrect Correct answer

Hypertension

Correct Incorrect Correct answer

ST elevation

Correct Incorrect Correct answer

A very shy patient describes excessive anxiety in social and intimate situations. She avoids social interactions due to her fear of criticism although she is interested in having more friends. Which of the following is most likely personality disorder?

paranoid disorder

Correct Incorrect Correct answer

avoidant disorder

Correct Incorrect Correct answer

schizoid disorder

Correct Incorrect Correct answer

dependent disorder

Correct Incorrect Correct answer

A 55-year-old man is afraid to contract infectious disease. Therefore he wears rubber gloves when leaving his house and when at home he washes his hands every half an hour and washes the kitchen counter with an alcoholic solution. In his examination he states he understands his fear is irritable and he would like to get rid of it but does not know how. Since every time he does not wash his hands he becomes anxious and he will get sick and die. Which of the following is the most appropriate treatment?

family group

Correct Incorrect Correct answer

hypnosis

Correct Incorrect Correct answer

Cognitive-Behavioral Therapy (CBT)

Correct Incorrect Correct answer

social skills rehabilitation

Correct Incorrect Correct answer

Which of the following neurocognitive disorders is characterized by behavioral disinhibition. Apathy and early loss of insight?

Alzheimer’s dementia

Correct Incorrect Correct answer

major neurocognitive vascular disease

Correct Incorrect Correct answer

frontotemporal dementia

Correct Incorrect Correct answer

neurocognitive disorder due to multiple sclerosis

Correct Incorrect Correct answer

During a psychiatric evaluation of a 35-year-old man was asked if he thinks people are talking about him behind his back. His response was to take of his pants and curse at the examiner. Which of the following would be the best way to describe his behavior in the final report?

poor reality checking

Correct Incorrect Correct answer

poor social judgment

Correct Incorrect Correct answer

poor cognitive function

Correct Incorrect Correct answer

poor insight

Correct Incorrect Correct answer

poor orientation

Correct Incorrect Correct answer

A41- year-old man had been sad over the last month it was difficult to fall asleep, loss of appetite, lost 4 kg and hard to concentrate at work. He feels tired and lack of energy. Suicidal thoughts and insist that his condition is a punishment for a nuclear holocaust he has caused. What is the most likely diagnosis?

dysthymia

Correct Incorrect Correct answer

major depressive disorder

Correct Incorrect Correct answer

paranoid personality disorder

Correct Incorrect Correct answer

delusional disorder

Correct Incorrect Correct answer

depressive disorder with psychotic features

Correct Incorrect Correct answer

A 23-year-old grad student is brought to emergency after being picked up for driving at an excessive speed. Over the last week she has not been sleeping much and has took a loan of 150.000 shekel from bank to open business. She is reporting an excellent mood, Speak quickly laughs a lot and sometimes is difficult to follow her speech, thinking fast, exceptionally concentrated and that she has discovered her new abilities to have a business. What is the most likely diagnosis

episode of agitated depression

Correct Incorrect Correct answer

b personality disorder

Correct Incorrect Correct answer

acute retraction to trauma

Correct Incorrect Correct answer

manic episode

Correct Incorrect Correct answer

narcissistic personality disorder

Correct Incorrect Correct answer

Which of the following is not used in treatment of depression

venlafaxine

Correct Incorrect Correct answer

fluoxetine

Correct Incorrect Correct answer

escitalopram

Correct Incorrect Correct answer

reserpine

Correct Incorrect Correct answer

bupropion

Correct Incorrect Correct answer

Which of the following is an indication for ECT?

worsening catatonic schizophrenia

Correct Incorrect Correct answer

worsening ADHD

Correct Incorrect Correct answer

multiple sclerosis

Correct Incorrect Correct answer

anorexia nervosa

Correct Incorrect Correct answer

conversion disorder

Correct Incorrect Correct answer

A 15-year-old male that underwent splenectomy a year ago due to ITP is now reporting of spontaneous nasal bleeding his CBC reveals 10,000 platelets. What test needed to confirm the diagnosis?

bone marrow aspirate

Correct Incorrect Correct answer

partial thromboplastin time

Correct Incorrect Correct answer

peripheral blood smear for Howell jolly bodies

Correct Incorrect Correct answer

prothrombin time

Correct Incorrect Correct answer

US is performed for abdominal pain in a 78-year-old male and abdominal aortic aneurysm (AAA) of 5 cm in size is diagnosed. What is the major risk factor of AAA development?

age over 75

Correct Incorrect Correct answer

smoking

Correct Incorrect Correct answer

diabetes

Correct Incorrect Correct answer

family history of AAA

Correct Incorrect Correct answer

use of blood pressure medications

Correct Incorrect Correct answer

A 40-year-old male with splenectomy following a motor vehicle accident 10 year ago now presents to the ER with high fever chills and productive cough. During his initial management he rapidly deteriorates with hypotension. Which of the following immunizations could have prevented the current situation

varicella

Correct Incorrect Correct answer

pertussis

Correct Incorrect Correct answer

pneumococcus

Correct Incorrect Correct answer

anti tetanus

Correct Incorrect Correct answer

The most common cause of UGI bleeding:

peptic ulcer disease

Correct Incorrect Correct answer

Mallory-Weiss Tear

Correct Incorrect Correct answer

dieulafoy lesion

Correct Incorrect Correct answer

gastric cancer

Correct Incorrect Correct answer

A 64-year-old male is evaluated for back pain and after his spine x ray a CT angiography with a reconstruction is performed. He is referred to the ER due to the following finding. What is the most significant complication of this finding?

thrombosis

Correct Incorrect Correct answer

emboli to the feet

Correct Incorrect Correct answer

enteric fistula

Correct Incorrect Correct answer

Rupture

Correct Incorrect Correct answer

The most common cause of UGI bleeding:

peptic ulcer disease

Correct Incorrect Correct answer

Mallory-Weiss Tear

Correct Incorrect Correct answer

dieulafoy lesion

Correct Incorrect Correct answer

gastric cancer

Correct Incorrect Correct answer

A 64-year-old male is evaluated for back pain and after his spine x ray a CT angiography with a reconstruction is performed. He is referred to the ER due to the following finding. What is the most significant complication of this finding?

thrombosis

Correct Incorrect Correct answer

emboli to the feet

Correct Incorrect Correct answer

enteric fistula

Correct Incorrect Correct answer

Rupture

Correct Incorrect Correct answer

Most common complication following laparoscopic sleeve gastrectomy?

death

Correct Incorrect Correct answer

staple line leak

Correct Incorrect Correct answer

bleeding

Correct Incorrect Correct answer

gastric stricture

Correct Incorrect Correct answer

CVA

Correct Incorrect Correct answer

Which of the following is an indication for surgery in patients with ulcerative colitis?

primary sclerosing cholangitis

Correct Incorrect Correct answer

toxic mega colon

Correct Incorrect Correct answer

multiple joint arthritis

Correct Incorrect Correct answer

ankylosing spondylitis

Correct Incorrect Correct answer

pyoderma gangrenosum

Correct Incorrect Correct answer

Which of the following hernias are considered an absolute indication?

femoral hernia

Correct Incorrect Correct answer

inguinal hernia

Correct Incorrect Correct answer

umbilical hernia

Correct Incorrect Correct answer

diaphragmatic hernia

Correct Incorrect Correct answer

A 62-year-old male undergoes rectoscopy for rectal bleeding and a rectal cancer is identified. What are the chances for another synchronous colon cancer in this patient?

0,3%

Correct Incorrect Correct answer

3%

Correct Incorrect Correct answer

13%

Correct Incorrect Correct answer

23%

Correct Incorrect Correct answer

A 30-year-old man is brought to the ER with a first episode of massive bloody vomiting. He is extremely unstable hemodynamically and resuscitation is begun. What is the next step in management?

Blakemore tube insertion

Correct Incorrect Correct answer

Gastroscopy

Correct Incorrect Correct answer

Angiography

Correct Incorrect Correct answer

Emergent surgery

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and D

Correct Incorrect Correct answer

A woman is 60-year-old in the process of examination for the subsequent infections of the urinary tract. An ultrasound examination of the abdominal cavity organs was performed, on which stones in the gallbladder were identified. In the anamnesis there was no biliary colic, inflammation of the gallbladder, there was no jaundice and pancreatitis. What is the treatment?

There is no need for treatment; no symptoms

Correct Incorrect Correct answer

The use of drugs that dissolve concrements

Correct Incorrect Correct answer

Extracorporeal lithotripsy

Correct Incorrect Correct answer

Removal of the gallbladder (cholecystectomy)

Correct Incorrect Correct answer

A 65-year-old female is admitted with fever chills, jaundice. US demonstrates cholelithiasis and bile duct dilation. What is the most common bacteria causing the fever?

Staphylococcus aureus

Correct Incorrect Correct answer

Staphylococcus pyogenes

Correct Incorrect Correct answer

E coli

Correct Incorrect Correct answer

Bacteroides fragilis

Correct Incorrect Correct answer

A 27-year-old man is admitted due to severe epigastric abdominal pain following alcohol binging. On examination alert without fever diastase. Amylase level is 8 times the normal level. CT demonstrates pancreatitis with no evidence of free air. What is the indication for antibiotic indication treatment

Ampicillin

Correct Incorrect Correct answer

Ampicillin + gentamicin

Correct Incorrect Correct answer

Ampicillin + gentamicin + metronidazole

Correct Incorrect Correct answer

No need for treatment

Correct Incorrect Correct answer

Which metabolic imbalance can cause current episode of pancreatitis?

Hypercholesterolemia

Correct Incorrect Correct answer

Hypertriglyceridemia

Correct Incorrect Correct answer

Hypocalcemia

Correct Incorrect Correct answer

Factor V Leiden deficiency

Correct Incorrect Correct answer

According to gastric ulcers classifications which of the following types is associated with NSAIDS treatment?

Type II

Correct Incorrect Correct answer

Type III

Correct Incorrect Correct answer

Type IV

Correct Incorrect Correct answer

Type V

Correct Incorrect Correct answer

All are right

Correct Incorrect Correct answer

All are false

Correct Incorrect Correct answer

Which of the following most common cause tumor of appendix?

Adenocarcinoma

Correct Incorrect Correct answer

Carcinoid mucus

Correct Incorrect Correct answer

Tumor

Correct Incorrect Correct answer

Gastrointestinal stromal tumor

Correct Incorrect Correct answer

In which location if colorectal carcinoma neoadjuvant chemoradiotherapy may be considered?

Cecum

Correct Incorrect Correct answer

Descending colon / sigmoid

Correct Incorrect Correct answer

Rectum

Correct Incorrect Correct answer

None

Correct Incorrect Correct answer

A female patient is diagnosed with breast cancer and offered either mastectomy or lumpectomy. Which of the following is true?

The chances of cure are similar in both procedures.

Correct Incorrect Correct answer

The chances of cure are higher with mastectomy than lumpectomy.

Correct Incorrect Correct answer

The chances of cure are higher with lumpectomy than mastectomy.

Correct Incorrect Correct answer

None is right

Correct Incorrect Correct answer

A 52-year-old female with no risk factors for cancer except age underwent mammography and ultrasound that identified a small several millimeters nonpalpable findings that is termed BI RADS 2 cyst. What is the most appropriate management?

Continue routine follow up

Correct Incorrect Correct answer

Repeat mammography in 6 months

Correct Incorrect Correct answer

Biopsy

Correct Incorrect Correct answer

Surgery

Correct Incorrect Correct answer

Which nerve can be injured during resection of an adenocarcinoma in patient with primary hyperparathyroidism?

Vagus nerve

Correct Incorrect Correct answer

Hypogastric nerve

Correct Incorrect Correct answer

Phrenic nerve

Correct Incorrect Correct answer

Recurrent laryngeal nerve

Correct Incorrect Correct answer

A 30 years old male is being evaluated for pancreatic mass. Biopsy confirms adenocarcinoma. Which gastric mutation can be suspected?

MEN I

Correct Incorrect Correct answer

MEN II

Correct Incorrect Correct answer

BRCA1

Correct Incorrect Correct answer

BRCA2

Correct Incorrect Correct answer

What is the hernia of Richter?

Infringement of the antimesenteric wall of the intestine in the hernia

Correct Incorrect Correct answer

Lumbar hernia

Correct Incorrect Correct answer

Injury of the appendix in the inguinal hernia

Correct Incorrect Correct answer

The presence of a straight and oblique inguinal hernia at the same time

Correct Incorrect Correct answer

A routine mammogram revealed changes classified as BIRADS-4. What needs to be done at this stage?

Continue ambulatory care

Correct Incorrect Correct answer

Fine-needle biopsy (FNA)

Correct Incorrect Correct answer

Perform trepanobiopsy (CORE Needle biopsy)

Correct Incorrect Correct answer

Perform a sectoral resection of the breast (Lumpectomy)

Correct Incorrect Correct answer

A 60-year-old man undergoes an abdominal scan and a 7 cm adrenal mass is identified (incidentaloma) the mass is not active hormonally. What should be explained to the patient?

surgery indication due to risk of malignancy

Correct Incorrect Correct answer

surgery indication due to risk of future hormonal activity

Correct Incorrect Correct answer

follow up in 6 months

Correct Incorrect Correct answer

this is an incidental finding and nothing need to be done

Correct Incorrect Correct answer

A woman of 50-year-old, held fasting on the Day of Judgment (Yom Kippur), was taken to the admissions office for dizziness, weakness, tremors, excessive sweating, and seizures. The level of glucose in the blood, measured in the admissions department of 40 mg / dL (2.22 mmol/l). After the introduction of glucose, the symptoms disappeared. What is the likely diagnosis of this patient?

Diabetes mellitus of the first type.

Correct Incorrect Correct answer

Insulinoma.

Correct Incorrect Correct answer

Gluconoma.

Correct Incorrect Correct answer

Hormonal-inactive pancreatic tumor.

Correct Incorrect Correct answer

A young male got drunk last night followed by multiple vomiting. He is admitted with upper abdominal pain, chest pain, tachycardia and fever. What is the most likely diagnosis

Mallory Weiss syndrome

Correct Incorrect Correct answer

Boerhaave syndrome

Correct Incorrect Correct answer

Plummer Vinson syndrome

Correct Incorrect Correct answer

Dieulafoy lesion

Correct Incorrect Correct answer

What is treatment patient with 3 cm GIST that is 3cm in size located at greater curvature of stomach

total gastrectomy

Correct Incorrect Correct answer

partial gastrectomy with lymph nodes

Correct Incorrect Correct answer

wedge resection with clear margin

Correct Incorrect Correct answer

glivec

Correct Incorrect Correct answer

A young man of 30 years turned to the pain in the upper half of the abdomen, the temperature to 38.5, in the anamnesis leukocytosis. An ultrasound study of the abdomen in the spleen revealed a liquid formation with a diameter of 4 cm, which is probably an abscess. What is the treatment of choice in this case?

percutaneous puncture drainage + antibiotics

Correct Incorrect Correct answer

Laparoscopic splenectomy

Correct Incorrect Correct answer

open splenectomy

Correct Incorrect Correct answer

only intravenous antibiotic therapy

Correct Incorrect Correct answer

A 50-year-old man received a closed stomach injury as a result of a car accident. On the computer tomography of the abdomen, a liver rupture was revealed, with intravenous contrast introduced its extravasation at the point of rupture. Blood pressure 110/80 mm Hg The pulse is 110 beats per minute. What is the next step in the conduct of the victim?

urgent surgery and liver tamponade

Correct Incorrect Correct answer

surveillance in the intensive care unit, blood transfusion

Correct Incorrect Correct answer

urgent angiography

Correct Incorrect Correct answer

laparoscopy, coagulation of the bleeding vessel

Correct Incorrect Correct answer

In an operation for which of the following breast tumors, there is no need to perform a biopsy of the sentinel node?

phyllodes tumor

Correct Incorrect Correct answer

Medullary carcinoma

Correct Incorrect Correct answer

Invasive Lobular Carcinoma

Correct Incorrect Correct answer

invasive flow carcinoma

Correct Incorrect Correct answer

Papillary carcinoma

Correct Incorrect Correct answer

Which of the following studies for the diagnosis of acute cholecystitis is the most sensitive?

Ultrasound

Correct Incorrect Correct answer

Computed tomography

Correct Incorrect Correct answer

cholescintigraphy (HIDA)

Correct Incorrect Correct answer

ERCP

Correct Incorrect Correct answer

Which of the adjuvant therapy following lumpectomy for 2cm a ductal carcinoma in situ with positive receptors?

no need for therapy

Correct Incorrect Correct answer

radiation

Correct Incorrect Correct answer

tamoxifen

Correct Incorrect Correct answer

radiation and tamoxifen

Correct Incorrect Correct answer

Which of the following findings is diagnostic of papillary mucinous neoplasm IPMN?

mucinum secretion seen from the wirsung duct on endoscopy

Correct Incorrect Correct answer

hourglass appearance of wirsung duct on ERCP/MRC

Correct Incorrect Correct answer

serum CA 19-9 level

Correct Incorrect Correct answer

wirsung duct calcification

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

C or/and D

Correct Incorrect Correct answer

A 42-year-old male is admitted to ER with calcium level of 13.5 mg/dL on evaluation PTH level are 380 pg/ml and urinary calcium 350/24H. What is the immediate management of the patient?

calcitonin PO

Correct Incorrect Correct answer

disothiazide

Correct Incorrect Correct answer

normal saline IV

Correct Incorrect Correct answer

Bisphosphonates

Correct Incorrect Correct answer

parathyroidectomy

Correct Incorrect Correct answer

A 27-year-old female has chronic renal failure and on hemodialysis. Blood calcium level 8.5 mg/dL and PTH 1800 pg/ml, ALP 200 IU and she has advanced bone disease. What is the most probable diagnosis

Primary hyperparathyroidism

Correct Incorrect Correct answer

secondary hyperparathyroidism

Correct Incorrect Correct answer

Tertiary hyperparathyroidism

Correct Incorrect Correct answer

Hyperparathyroidism – jaw tumor syndrome

Correct Incorrect Correct answer

Calciphylaxis

Correct Incorrect Correct answer

A 35-year-old patient undergoes total thyroidectomy due to papillary carcinoma. Her mother has surgery in the past because of the same diagnosis. Pathology reveals 2 tumor foci in the thyroid. one is 2.5 cm with extrathyroidal extension and the other is 6 mm in size. Which of the above is bad outcome predictor in the patient?

Family history of thyroid cancer

Correct Incorrect Correct answer

Extrathyroidal extension

Correct Incorrect Correct answer

Tumor in size greater than 2cm

Correct Incorrect Correct answer

Two tumor foci

Correct Incorrect Correct answer

Female gender

Correct Incorrect Correct answer

A 27-year-old female patient is admitted due to headaches and dizziness. Her BP is 210/130 and pulse 140. Urinary metanephrines are elevated. Abdominal CT demonstrates 5.5 cm a right Adrenal mass. MRI demonstrates T2 enhancement of the mass. What is the initial medial treatment in preparation of surgery?

normalol

Correct Incorrect Correct answer

deralin

Correct Incorrect Correct answer

phenoxybenzamine

Correct Incorrect Correct answer

prazosin

Correct Incorrect Correct answer

Cardoral

Correct Incorrect Correct answer

A 22-year-old female with no family history of breast cancer is referred for a breast mass. examination reveals around mobile 2 cm mass in the right Breast. What is the recommended next step?

Breast ultrasound

Correct Incorrect Correct answer

Core biopsy

Correct Incorrect Correct answer

Excisional biopsy

Correct Incorrect Correct answer

Fine needle aspiration

Correct Incorrect Correct answer

Mammography

Correct Incorrect Correct answer

A 65-year-old female patient is diagnosed with rectal tumor 7cm from the anus and 3 cm in diameter. Transrectal ultrasound demonstrate T3. Abdominal and chest CT rule out metastases. What is the most appropriate next step in management of the patient?

Anterior resection

Correct Incorrect Correct answer

Colonoscopic local resection of the tumor

Correct Incorrect Correct answer

Transanal endoscopic microsurgery TEM

Correct Incorrect Correct answer

Neoadjuvant chemoradiotherapy

Correct Incorrect Correct answer

A 49-year-old female is a candidate for left colectomy due to descending colon cancer. What is the preoperative prophylactic antibiotic regimen?

Ceftriaxone and metronidazole

Correct Incorrect Correct answer

Cefazolin

Correct Incorrect Correct answer

Ampicillin

Correct Incorrect Correct answer

Gentamicin and clindamycin

Correct Incorrect Correct answer

A usually healthy 45-year-old female is admitted to ER following a motor vehicle accident as a driver. She is hemodynamically stable with minimal right Upper quadrant tenderness. Focused abdominal sonographic test FAST is positive for free fluid in hepatorenal compartment and the pelvis. What is the next step in her evaluation?

Diagnostic peritoneal lavage DPL

Correct Incorrect Correct answer

CT SCAN

Correct Incorrect Correct answer

Laparoscopy

Correct Incorrect Correct answer

Exploratory laparotomy

Correct Incorrect Correct answer

Which of the following bariatric has the highest nutritional complication rate?

laparoscopic adjustable bleeding

Correct Incorrect Correct answer

roux-en Y gastric bypass

Correct Incorrect Correct answer

sleeve gastrectomy

Correct Incorrect Correct answer

duodenal switch

Correct Incorrect Correct answer

A 32-year-old male underwent an adrenalectomy due to pheochromocytoma one year ago. He is now diagnosed with medullary thyroid carcinoma. What is the most probable genetic syndrome?

MEN1

Correct Incorrect Correct answer

MEN 2A

Correct Incorrect Correct answer

MEN 2B

Correct Incorrect Correct answer

familial medullary carcinoma

Correct Incorrect Correct answer

A 32-year-old male undergoes routine colonoscopy and a 2.5 cm tubular polyp is resected. Pathology reveals a microscopic focus of carcinoma in the polyp. In which of the following there is indication of segmental colon resection margin?

distance of 2 mm from the resection margin

Correct Incorrect Correct answer

lymphovascular invasion

Correct Incorrect Correct answer

well differentiated carcinoma histology

Correct Incorrect Correct answer

.

Correct Incorrect Correct answer

Which of the following polyps carries highest risk factor?

tubular adenoma

Correct Incorrect Correct answer

villous adenoma

Correct Incorrect Correct answer

tubulovillous adenoma

Correct Incorrect Correct answer

hamartomatous adenoma

Correct Incorrect Correct answer

location in right colon

Correct Incorrect Correct answer

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