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?

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

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

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?

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?

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

Which of the following is risk factor for endometriosis?

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

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

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

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

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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

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?

What is melasma

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?

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

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

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

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

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

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?

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?

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

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?

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?

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?

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?

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?

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?

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

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?

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?

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?

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?

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?

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?

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?

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?

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

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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

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?

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?

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 ?

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?

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?

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?

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?

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.

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?

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?

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?

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?

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?

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

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

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?

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

Which condition is contraindications to perform of diagnostic lumbar puncture?

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?

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?

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?

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?

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?

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?

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?

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:

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:

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?

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?

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?

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

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:

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?

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?

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?

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?

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

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:

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:

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:

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?

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?

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?

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?

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?

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?

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:

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:

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

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?

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?

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?

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?

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

All of the following are sleep disorders except:

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?

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?

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

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?

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

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

What drug produces the most frequent metabolic syndrome?

Which of the following Is absolute contraindication for Clozapine:

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

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?

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?

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

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?

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?

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

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

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

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?

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

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?

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?

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

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?

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?