IMLE 3/2019

Which of the following cervical condition characterized by white coloring of the epithelial cells in acetic acid?

Cervical dysplasia

Correct Incorrect Correct answer

Normal cervical epithelium

Correct Incorrect Correct answer

Nabothian cyst

Correct Incorrect Correct answer

Squamous cell carcinoma

Correct Incorrect Correct answer

Benign polyp

Correct Incorrect Correct answer

A or/and D

Correct Incorrect Correct answer

B or/and C

Correct Incorrect Correct answer

30 y.o women no children has HSIL on pap smear colposcopy with biopsies and cervical sampling revealed a lesion in uterine cervix ,which is the next diagnostic and therapeutic step?

Simple hysterectomy

Correct Incorrect Correct answer

Laser ablation of cervix

Correct Incorrect Correct answer

Conization and endocrrvical curettage

Correct Incorrect Correct answer

Repeat colposcopy in 6M

Correct Incorrect Correct answer

PCR testing for HPV

Correct Incorrect Correct answer

26y.o primapara women in her 21 week pregnancy she has had colposcopy 2M early due to post coital bleeding the colposcopy was defined as unsatisfactory since the transformation zone was not identified what is the next diagnostic step?

Endocervical currttage

Correct Incorrect Correct answer

Conization

Correct Incorrect Correct answer

Pap smear

Correct Incorrect Correct answer

Repeat colposcopy in few weeks

Correct Incorrect Correct answer

Repeat colposcopy post partum

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

D or/and E

Correct Incorrect Correct answer

How often HIV positive women need to have pap smear?

Every 2 years

Correct Incorrect Correct answer

Twice a year on the first year after being diagnosed and then every year

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Annually for the first 3 years after being diagnosed and then every 3 years

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Every 3 years

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Every year if HOV positive otherwise every 3 years

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Which of the following procedures carries the highest risk of pundendal artery injury?

Uterosacral ligament suspension

Correct Incorrect Correct answer

Sacrospinous ligament fixation

Correct Incorrect Correct answer

Abdominal sacrocolpopexy

Correct Incorrect Correct answer

Colpoclesis

Correct Incorrect Correct answer

Anterior colprrhaphy

Correct Incorrect Correct answer

61y.o female undergoes endometrial biopsy due to vaginal bleeding endometroid adenocarcinoma FIGO grade 1 is identified ,what is the best treatment?

Laparoscopic simple hysterectomy and salpingo oophectomy

Correct Incorrect Correct answer

Radical hysterectomy,peritoneal cytology and pelvic and inguinal L.N biopsy

Correct Incorrect Correct answer

Simple hysterectomy and salpingo oopherectomu ,peritoneal cytology and pelvic and pre aortal L.N biopsies

Correct Incorrect Correct answer

Radical hysterectomy deviation of the ovaries from pelvis peritoneal cytology and excision of the omentum

Correct Incorrect Correct answer

Simple hysterectomy and salping without oophorectomy or L.N biopsies

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18y.o women present with painful labial swelling and urinary retention examination reveals vesicular lesion on labia minora and majora as well as inguinal lymphadenopathy which of the following recommended treatment?

Ciprofloxacin and clindamycin

Correct Incorrect Correct answer

Acyclovir

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Cefaroxime and metronidazole

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Local steroids

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Azirhromycin

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59y.o women present post menopause vaginal bleeding ultrasound reveals endometrial thickening and a solid 6cm mass on right ovary endometrial biopsy results are endometrial hyperplasia without atypia serum estradiol is elevated what is the most likely diagnosis?

Endometroid endometrial carcinoma

Correct Incorrect Correct answer

Granullosa cell tumor

Correct Incorrect Correct answer

Mature cystic teratoma

Correct Incorrect Correct answer

Krukenberg tumor

Correct Incorrect Correct answer

Serous papillary endometrial carcinoma

Correct Incorrect Correct answer

50 years old women mother of three with hirsutism and irregular menstruation had an endometrial biopsy due to endometrial thickening. Biopsy reveals atypical complex endometrial hyperplasia. She has no significant medical history , BMI 28. Which of the following is the most appropriate next step?

Ultrasound follow up and repeat biopsy in 6 months

Correct Incorrect Correct answer

Hysterectomy and salpingo oophorectomy

Correct Incorrect Correct answer

Combined oral contraceptives and follow up with endometrial biopsy

Correct Incorrect Correct answer

Focused radiation with brachytherapy

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Medroxy progesterone acetate depo 150 mg every month

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An 86 years old women a widow with history of ischemic heart disease, present with pelvic prolapse and urinary retention. On examination significant prolapse of the uterus and the anterior wall. Which of the following is the best therapeutic option?

Abdominal sacrocolpopexy

Correct Incorrect Correct answer

Anterior colporrhaphy

Correct Incorrect Correct answer

Colopecleisis

Correct Incorrect Correct answer

Pessary

Correct Incorrect Correct answer

Systemic estrogen

Correct Incorrect Correct answer

Which of the following procedures Carrie’s the greatest risk of the injury to the uterine?

Uterosacral ligament suspension

Correct Incorrect Correct answer

Burch colposuspension

Correct Incorrect Correct answer

Sacrospinous ligament fixation

Correct Incorrect Correct answer

Total vaginal hysterectomy

Correct Incorrect Correct answer

Anterior topography

Correct Incorrect Correct answer

Which of the following areas in the female has greatest nerve (of any kind ) concentration?

Clitorios

Correct Incorrect Correct answer

Vagina

Correct Incorrect Correct answer

Labia minora

Correct Incorrect Correct answer

Mons pubis

Correct Incorrect Correct answer

Hymenal ring

Correct Incorrect Correct answer

Which of the following is considered a risk factor for eclampsia?

Glaucoma

Correct Incorrect Correct answer

Preexisting diabetes mellitus

Correct Incorrect Correct answer

Multiparous woman

Correct Incorrect Correct answer

Medical cannabis usage

Correct Incorrect Correct answer

Early miscarriage in the past

Correct Incorrect Correct answer

Which of the following women fulfills the criteria for severe preeclampsia?

A 33 year old woman , 34 weeks pregnant , blood pressure 155/95 on tow measurements 2 hours apart.

Correct Incorrect Correct answer

A 40 year old woman ,18 weeks pregnant , blood pressure 142/90 and 4 g protein in 24 h urine collection.

Correct Incorrect Correct answer

A 19 year old woman ,41 weeks pregnant , blood pressure 150/92, nausea and right lower quadrant pain.

Correct Incorrect Correct answer

A 32 year old woman ,32 weeks pregnant ,blood pressure 170/85 ,and oliguria of 200 ml of urine per 24 h.

Correct Incorrect Correct answer

A 25 year old woman ,35 weeks pregnant ,blood pressure 145/95 on 2 measurements 6 h apart ,diffuse pruritus ,and normal liver function tests.

Correct Incorrect Correct answer

Which of the following is the most appropriate antimicrobial treatment for a pregnant woman with severe community acquired pneumonia?

Azithromycin+ ceftriaxone

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Doxylin +ampicillin

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Metronidazole + azithromycin

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Ciprofloxacin

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Augmentin (coamoxyclave)

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The most appropriate treatment for mild hyperemesis gravidum

IV thiamin 100mg for 3 days

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Oral pramin 5-10 mg 3 times aday

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Pyridoxine 10-30 mg for up to 4 times a days

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Admit for iv total parenteral nutrition

Correct Incorrect Correct answer

Zofran 8mg 2 -3 times a day

Correct Incorrect Correct answer

A or/and D

Correct Incorrect Correct answer

B or/and C

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All of the following are complications of hyperemesis gravidum except:

Gastric ulcers

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Werenckie encephalopathy

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Acute tubular necrosis

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Splenic rupture

Correct Incorrect Correct answer

Metabolic acidosis

Correct Incorrect Correct answer

A or/and D or/and E

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B or/and C

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All answers are correct

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30 years old woman, at 36 weeks of gestation, with sever vomiting over the last week, upper abdominal pain, malaise, in emergency romm exam normal blood pressure, no proteinuria but with scleral and skin jaundice, cbc: thrombocytopenia liver function tests are 10 times normal, increased ammonia, hypoglycemia.

Test the patient for 21 hydroxylase mutation and admit for spontaneous labor

Correct Incorrect Correct answer

Order and administer platelets prior to immediate cesarean section

Correct Incorrect Correct answer

Blood pressure followed up with 24h urine collection and cesarean section if deterioration.

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Steroid administration for fetal lung maturation and labor induction.

Correct Incorrect Correct answer

27 years old woman 34th week of gestation with pruritus mostly in hands and legs, normal blood pressure, urine stick is negative for proteinuria, labs: mild hyperbilurubinemia, mild increase in liver enzymes and bile acids, Which of the following included in woman treatment?

Ursodeoxycholic acid

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Heparin

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Aspirin

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V B6

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Immediate delivery

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Which hormone is associated with pathogenesis of cholecystitis during pregnancy?

Estrogen

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Testosterone

Correct Incorrect Correct answer

Progesteron

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Serotonin

Correct Incorrect Correct answer

HPL

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and D

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Which of the following may appear in an infant of diabetic mother?

Hyperglycemia

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Respiratory distress syndrome

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Hypercalcemia

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Bowel obstruction

Correct Incorrect Correct answer

Anemia

Correct Incorrect Correct answer

Complications of hyperthyroidism in pregnancy?

Post-term delivery

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Macrosomia

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Polyhydramnios

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Placenta abruption

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Intra uterine growth restriction

Correct Incorrect Correct answer

Postpartum follow up of gestational diabetes?

Postprandial glucoses level 6 weeks after delivery

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TSH 6 weeks after delivery

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Fasting glucose 6-12 weeks after delivery

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Echo 3 months after delivery

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75 g glucose tolerance test 6 weeks after delivery

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

D or/and E

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A 23 year old woman with a history of polycistic ovary syndrome (PCOS) present to the emergency room 13 days after ovum aspirations, 2 embryos were implanted in her uterus. She now complain of abdominal fullness and pain and dyspnea.
Which of the following is true regarding her condition?

In this patient, fluid afe shifting from the extravascular space to the intravascular space.

Correct Incorrect Correct answer

The dose of GNRH agonist she has received is directly associated with this condition

Correct Incorrect Correct answer

Polyuria is a complication of her condition

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Hyponatremia is a complication of her condition

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This is a self-limiting condition and there is no reason to admit her

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A 25 year old female complain of severe pelvic pain during menses and sexual intercourses. She is having unprotected intercourses for the past year and has not conceived. On exam-palpable and tender small lesion at the sacro-uterine ligaments.
Which of the is a risk factor for her suspected diagnosis?

A history of breast feeding

Correct Incorrect Correct answer

Parity

Correct Incorrect Correct answer

Poly-menorrhea

Correct Incorrect Correct answer

Polycystic ovary syndrome

Correct Incorrect Correct answer

There is no genetic factor associated with this condition

Correct Incorrect Correct answer

A 32-year-old woman undergoes diagnostic laparoscopy for pelvic pain. Peritoneal lesion were biopsied and demonstrated hemosiderin accumulation and endometrial nodules with no evidence of malignancy. The lesions were found only on the peritoneum and the sacro-uterine ligaments.
Which of the following is correct regarding this case?

The goal of hormonal treatment is to normalize the menses

Correct Incorrect Correct answer

Progestagens bring pain relief to only about 40% of the patients

Correct Incorrect Correct answer

Adhesiolysis should be performed during surgery in an attempt to restore normal pelvic Anatomy

Correct Incorrect Correct answer

Danazol mechanism of action is to block the FSH effect on the ovary

Correct Incorrect Correct answer

There is absolutely no increase in pregnancy rates following surgical treatment

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

C or/and D

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A 25-year-old couple os diagnosed with idiopathic primary infertility. They have had tow cycles of ovary stimulation and intrauterine insemination with no conception. They are considering in vitro fertilization (IVF) and are concerned about complications.
Which of the following success rates and risks is relevant to this couple?

There is an increase risk of intrauterine, but not extrauterine, multiple pregnancies associated with IVF

Correct Incorrect Correct answer

There is a somewhat increased risk of fetal epigenetic disorder associated with IVF

Correct Incorrect Correct answer

Ovary overstimulation is a risk of fertility treatments, but it improves in case of successful conception

Correct Incorrect Correct answer

There is no increased risk of genetic and anatomic disorders in neonates born after intracytoplasmatic injection (ICSI)

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The success rate is determined mainly by the number of fertilized oocytes

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No answer is correct

Correct Incorrect Correct answer

All answers are correct

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A couple married for 4 years has failed to conceive. The women has regular ovulation and a normal utero-salpingography. Sperm test-revealed sperm volume of 2 ml, 1,000,000 cells/ml, 50% motility, and 5% with normal morphology according to kruger. A repeat sperm test revealed no significant changes.
Which of the following is the best treatment for this couple?

Intrauterine insemination without ovary stimulation

Correct Incorrect Correct answer

Ovary stimulation with clomiphene and intrauterine insemination

Correct Incorrect Correct answer

Ovary stimulation with gonadotropins and intrauterine insemination

Correct Incorrect Correct answer

In vitro fertilization with drops containing 100,000 sperm cells/oocytes

Correct Incorrect Correct answer

In vitro fertilization with intracytoplasmic sperm injection (ICSI)

Correct Incorrect Correct answer

A 35-year-old woman with normal menstrual cycles presents to the clinic with a 1-week delay in here menstrual bleeding. Past medical is positive for Hodgkin’s lymphoma treated with ABVD (adriamycin, bleomycin, vincristine and doxorubicin) 10 years ago. Blood work revealed estradiol 998 pmol/L, progesterone <2nmol/L, FSH 23 IU/L, LH 56 IU/L.
Which of the following is true regarding her condition?

The hormone profile may be associated with the ABVD she has received in the past

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Menstrual bleeding is expected in about tow weeks

Correct Incorrect Correct answer

Information regarding the use of oral contraception should be obtained

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The hormone profile may be compatible with pregnancy, and a pregnancy test shoul

Correct Incorrect Correct answer

76 years old female is brought to the ER due to generalized malaise and palpitations. These symptoms occur episodically over the last week. B.P 125/85 mmHg.

Electrocardioversion

Correct Incorrect Correct answer

Cardioversion with amiodarone

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Decrease heart rate with beta blockers

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Decrease heart rate with digoxin

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Cardioversion with adenosine

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71 years old man with (HOCM) hypertrophic cardiomyopathy and pneumonia. Systolic B.P is 90 mmHg. Body temperature is 38.8
Ecg shown

Electrocardioversion

Correct Incorrect Correct answer

High dose noradrenaline

Correct Incorrect Correct answer

I.V fluids with monitoring B.P

Correct Incorrect Correct answer

I.V fusid

Correct Incorrect Correct answer

High dose dopamine

Correct Incorrect Correct answer

51 year old male arrived to the ER due to severe central chest pain that radiated to the jaw and right arm. Past medical history is positive for hypertension, diabetes mellitus and dyslipidemia. In lung auscultation – moist rales and crepitations are heard at the base of both lungs. Systolic B.P is 85 mmHg.

I.V heparin

Correct Incorrect Correct answer

S.C low molecular weight heparin

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I.V dose dopamine to maintain systolic B.P above 90 mmHg

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I.V bate blocker, metaprolol single dose

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I.V Ca channel blocker, verapamil single dose

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88 years old female with dyspnea. Evaluated chest x-ray diagnosis pulmonary edema.
Heart echo identified that her aortic valve area is 0.59 cm2 with a gradient of 30mmHg. The LVEF is 20%. What is the most probable diagnosis?

Normal aortic valve, pulmonary edema by left ventricle failure alone

Correct Incorrect Correct answer

Mild aortic stenosis caused by L.V.F

Correct Incorrect Correct answer

Moderate aortic stenosis causing heart failure

Correct Incorrect Correct answer

Severe aortic stenosis causing heart failure

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Normal echo, proceed with non-cardiac evaluation.

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27 years old complains of chest pain that worsens when bending forward. During the past week she has elevated body temperature, general malaise and dyspnea. Below is the ECG at the E.R
what is the most appropriate next step?

Cardio scan to rule out MI

Correct Incorrect Correct answer

Chest CT scan with I.V contrast to rule out aortic dissection

Correct Incorrect Correct answer

Thin slice chest CT scan to evaluate lung parenchyma

Correct Incorrect Correct answer

Heart echo to evaluate for pericardial effusion

Correct Incorrect Correct answer

MRI (CMR) to rule out constrictive pericarditis

Correct Incorrect Correct answer

67 years old male is discharged from the hospital following MI. Atorvastatin 80 mg once a day is prescribed. Upon discharge what needs to be explained to the patient regarding the use of this medication?

Musculoskeltal pain is expected but it always resolves within 2 weeks.

Correct Incorrect Correct answer

Elevated blood cpk is expected but it always resolves within 2 weeks

Correct Incorrect Correct answer

The aim of treatment is to decrease HDL cholesterol

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The aim of the treatment is to elevate the life expectancy following MI

Correct Incorrect Correct answer

The aim of the treatment is to decrease the chest pain that is expected following MI

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Patient with known arterial hypertension. Has now orthostatic hypertension. History reveals ischemic heart disease and diabetes. Which medication should not be given anymore?

Ramipril (ACE Inhibitor)

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Bisoprolol (beta Blocker)

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Doxazocin (alpha Blocker)

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Empagliflozin (SGLT 2 inhibitor)

Correct Incorrect Correct answer

Insulinglargine

Correct Incorrect Correct answer

55 year old woman admitted for evaluation of 2 episodes of syncope during morning walks. No medical history, no medication. EKG is attached. Management?

Pacemaker implantation as early as possible

Correct Incorrect Correct answer

Coronary catheterization to rule out arterial occlusion as early as possible

Correct Incorrect Correct answer

Holter monitor 24 hours

Correct Incorrect Correct answer

Heart rate monitoring with implanted monitor 30 days

Correct Incorrect Correct answer

Tilt Test

Correct Incorrect Correct answer

Heavy smoker,55 years old, has dyspnea since one week with yellowish sputum, his tibial edema is worsening. Lung auscultations reveals prolonged expiratory bilateral wheezes. Oxygen saturation in room 87%. EKG reveals tachycardia. Next treatment in ER?

I.V. low dose fusid

Correct Incorrect Correct answer

Intubation and mechanical ventilation

Correct Incorrect Correct answer

Increase oxygen to maintain 87%

Correct Incorrect Correct answer

Bronchodilatation inhalations

Correct Incorrect Correct answer

Beta 1 Blocker

Correct Incorrect Correct answer

66 year old patient with COPD, now acute onset of confusion, drowsiness and productive cough. Body Temperature 34 degrees Celsius. X-Ray of the chest reveals positive right base infiltration. Blood gases: pH .12, pCo2=102. Most appropriate next step?

Empiric antibiotics and non-invasive ventilation with BiPAP

Correct Incorrect Correct answer

Empiric antibiotics and invasive ventilation

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I.v. Steroids and empiric antibiotics

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I.V. haloperidol

Correct Incorrect Correct answer

Warm up patient and repeat blood gas when body temperature is 37

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

C or/and D

Correct Incorrect Correct answer

90 year old male has general malaise, dyspnea, and fever of 38, systolic blood pressure 85 mmHg. Chest X-Ray reveals right pleural effusion. CRP 350 mg/l. next step?

Chest CT with i.v.

Correct Incorrect Correct answer

Empiric antibiotics, continue according to response

Correct Incorrect Correct answer

Pleural effusion tapping o rule out empyema

Correct Incorrect Correct answer

Bronchoscopy with BAL

Correct Incorrect Correct answer

Blood culture, avoid empiric antibiotic treatment until culture are positive

Correct Incorrect Correct answer

70 year old female with fever and throat pain. On CBC absolute neutrophile count is 80. The patient has a history of hyperthyroidism with multiple drugs. Which medication is causing her acute illness?

Beta blocker (bisoprolol)

Correct Incorrect Correct answer

Diuretics (hydrochlorothiazide)

Correct Incorrect Correct answer

Antithyroid drug

Correct Incorrect Correct answer

Steroids (prednisone)

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Fever reducing medication (paracetamol)

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80 year old female with permanent atrial fibrillation is treated with b-blocker and oral anti coagulation (DOAC). She is in the ER for sudden right hemiparesis and dysarthria. Most probable diagnosis and first step in the ER?

Suspected cerebral infarct as a complication of atrial fibrillation, transesophageal echo as soon as possible

Correct Incorrect Correct answer

Suspected thromboembolic cerebral infarct, i.v. heparin single dose

Correct Incorrect Correct answer

Suspected cerebral bleeding, immediate brain CT without i.v. contrast

Correct Incorrect Correct answer

Suspected cerebral bleeding, 4 units FFP before any work up

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Suspected thromboembolic

Correct Incorrect Correct answer

An 80-year-old female with sever epilepsy is brought to the ER due to detoriorated consciousness, low blood pressure, pus in the urine and high fever. A week earlier she was discharged from the hospital and then was diagnosed with urine tract infection and both urine and blood cultures were positive for E. Coli ESBL. What is the most appropriate antibiotic treatment at this point?

IV meropenem.

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IV ceforal.

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IV imipenem.

Correct Incorrect Correct answer

IV ceftraixone

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IV gentamycin.

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and D

Correct Incorrect Correct answer

A 50-year-old male who is usually healthy undergoes removal of toe nail of his right foot due to paronychia. Two days following the procedure he complains of erythema, swelling, and pain in his right calf. Temperature is 37.8C, what is the treatment of choice?

Quinolone (e.g ofloxacin).

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First generation cephalosporine (e.g cefazolin).

Correct Incorrect Correct answer

Clindamycin.

Correct Incorrect Correct answer

Aminoglycosides.

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Second generation cephalosporin.

Correct Incorrect Correct answer

A or/and D

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B or/and E

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A 76-year-old male was discharged from the hospital 3 days ago after coronary bypass surgery. During his admission pericarditis was diagnosed and he was treated with colchicine. Since yesterday he complains of diarrhea that is mixed with pus and blood. Blood pressure is 80mmHg and temperature is 39C. His pulses is 110 beats per minute, regular. WBC is 22,000 and CRP is very high. What is the most likely diagnosis?

Bowel infarct due to emboli from the heart

Correct Incorrect Correct answer

Clostridium defficile colitis

Correct Incorrect Correct answer

Inflammatory bowel disease exacerbation (e.g crohn’s disease).

Correct Incorrect Correct answer

Side effect of colchicine.

Correct Incorrect Correct answer

Nosocomial pneumonia.

Correct Incorrect Correct answer

67-An 89-year-old female is admitted due to urinary tract infection. During the night she becomes extremely irritable, hits herself, and screams blurry sentences. A full and dilated urinary bladder is suspected on physical examination with about 800ml on bladder scan. What is the next step?

Sedation with IM haloperidol.

Correct Incorrect Correct answer

Sedation with IM midazolam.

Correct Incorrect Correct answer

Sedation with IM prothiazine.

Correct Incorrect Correct answer

Insertion of urinary catheter.

Correct Incorrect Correct answer

Diuretic and repeat bladder scan in two hours.

Correct Incorrect Correct answer

A 46-year-old male complaines of dry cough and dyspnea for the past week. Chest X-ray is below. What is the most appropriate next test?
Chest X-ray: solid mass on the right lower lobe.

Heart echo.

Correct Incorrect Correct answer

Pulmonary function test.

Correct Incorrect Correct answer

Gastroscopy.

Correct Incorrect Correct answer

Colonoscopy.

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Chest CT.

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A 67-year- old female with a history of gastric peptic ulcer is brought to the ER due to large amount of hematochezia. Blood pressure at the ER is 70/40mmHg and pulse is 120 per minute. Rectal examination- massive hematochezia. After units of blood and IV anti-acid treatment the blood pressure does not rise and the patient develops shock. What is the most appropriate next step?

Gastroscopy and colonoscopy

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CT enterography.

Correct Incorrect Correct answer

Colonoscopy only

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Angiography with endovascular intervention.

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Emergent laparotomy.

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A 50-year-old homeless is brought to the ER with fever of 38.5C and jaundice. Labs – hemoglobin 11.8 g/dL, WBC 11.200, PLT 108.000, AST 240U/L (normal up to 35), ALT 64U/L, bilirubin 2.4, elevated INR (2.1). Liver biopsy reveals hepatocyte ballooning, neutrophil infiltration, Mallory-Denk bodies, steatosis, and intrasinusoidal fibrosis. What is the most likely diagnosis?

Acute hepatitis B

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Autoimmune hepatitis

Correct Incorrect Correct answer

Acute alcoholic hepatitis

Correct Incorrect Correct answer

Drug induced liver injury.

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Liver injury due to bacterial sepsis.

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A 37 year-old with non treated ulcerative colitis for 10 years complains of painful ulcerative wound in her right foot (image). She denies fever or chills but does report having about five bloody bowel movements a day . What is the next step in management of this patient?

Right knee MRI

Correct Incorrect Correct answer

Urgent colonoscopy

Correct Incorrect Correct answer

Steroid treatment

Correct Incorrect Correct answer

Compression dressing

Correct Incorrect Correct answer

Above knee amputation

Correct Incorrect Correct answer

A 56-year-old male complains of progressive dysphagia over the last year .barium upper GI study demonstrates the given image. Chest CT with no findings other than sever dilation of the esophagus . The patient is not interested in surgery and requests other treatment. Which of the following is an appropriate non-surgical treatment option for this diagnosis ?

Nasogastric tube feeding

Correct Incorrect Correct answer

Pneumatic dilation of the gastroesophageal junction via gastroscopy

Correct Incorrect Correct answer

Gastric pylorus stenting

Correct Incorrect Correct answer

Very high dose of proton pump inhibitors ( PPIs)

Correct Incorrect Correct answer

PEG insertion

Correct Incorrect Correct answer

A 36-year-old male is diagnosed with iron deficiency anemia on repeat exams over the last few month continuing weight loss over the last two month . Denies abdominal pain or change in bowel movements no family history of malignancy or IBD. What is the most appropriate evaluation?

Switch to gluten free diet

Correct Incorrect Correct answer

Occult blood test

Correct Incorrect Correct answer

Colonoscopy and gastroscopy

Correct Incorrect Correct answer

Genetic testing for APC mutation

Correct Incorrect Correct answer

Chest-abdominal pelvic CT

Correct Incorrect Correct answer

No answer is correct

Correct Incorrect Correct answer

All answers are correct

Correct Incorrect Correct answer

Which of the following is disease with hyper absorption from the GI tract to the portal system ?

Celiac disease

Correct Incorrect Correct answer

Gastric lymphoma (MALTOMA)

Correct Incorrect Correct answer

Pernicious anemia

Correct Incorrect Correct answer

Whipple disease

Correct Incorrect Correct answer

Wilson disease

Correct Incorrect Correct answer

A 30-year-old male is being consulted for incidental finding of serum HCV Ab with HCV RNA of 120000 copies . His liver function tests are normal. He is vaccinated for hepatitis A and B , and HIV test is negative. On ultrasound normal size and texture liver, what is the most appropriate management?

Follow liver enzymes and if ALT is twice the normal range initiate antiviral therapy

Correct Incorrect Correct answer

Annual ultrasound and initiate antiviral therapy when signs of cirrhosis develop

Correct Incorrect Correct answer

Refer for treatment with direct acting antiviral agent with curative intent

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Immediate therapy with Tenofovir

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Repeat relevant serology in three months

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A52-year-old male with fatty liver cirrhosis arrives to clinic due to mild confusion and slow speech blood pressure and temperature are normal and physical examination is normal except for small amount ascites on abdominal exam lab- CBC is normal except for mild transaminase elevation (X2 the upper limit) electrolytes including potassium are all normal, what is most appropriate treatment?

Platelet transfusions and repeat labs

Correct Incorrect Correct answer

Lactulose

Correct Incorrect Correct answer

Oral vancomycin

Correct Incorrect Correct answer

Mefformin

Correct Incorrect Correct answer

Antibiotic treatment-fidaxomycin

Correct Incorrect Correct answer

A patient diagnosed with drug induced lupus, which of the following is the most likely to cause it ?

Baclofen

Correct Incorrect Correct answer

Methotrexate

Correct Incorrect Correct answer

Procainamide

Correct Incorrect Correct answer

Isoniazid

Correct Incorrect Correct answer

Methylprednisolone

Correct Incorrect Correct answer

A 25 years old female gives birth to a baby that shortly after birth is diagnosed with completle AV block that requires pacemaker implantation,wich of the following antibodies is most likly to be found in the mother blood?

Anti Ro/ssa antibodies

Correct Incorrect Correct answer

Rheumatoid factor

Correct Incorrect Correct answer

CANCA

Correct Incorrect Correct answer

Ds dna antibody

Correct Incorrect Correct answer

Anti endomysial antibody

Correct Incorrect Correct answer

A or/and D

Correct Incorrect Correct answer

B or/and E

Correct Incorrect Correct answer

A 72 years old male complanis of acute right knee pain,on examination the knee is warm and swollen,body temperature is 37,knee tap reveals 12600wbc and knee xray identifies calcification of the cartilage.fluid culture is negative for bacteria,what is the most likely diagnosis?

Gout

Correct Incorrect Correct answer

Septic arthritis

Correct Incorrect Correct answer

Viral arthritis

Correct Incorrect Correct answer

Pseudo gout

Correct Incorrect Correct answer

Reactive arthritis

Correct Incorrect Correct answer

A 25 years old female with the diagnosis of systemic lupus erythmatos under goes kidny biopsy due to unset of nephrotic syndrome,result are positive for diffuse proliferative glomeronephritis (WHOclass IV) what is the recommended treatment of this patient?

Azathioprine

Correct Incorrect Correct answer

Methotrexate

Correct Incorrect Correct answer

Prednisolone and IV cyclosporine

Correct Incorrect Correct answer

Azathioprine and prednisone

Correct Incorrect Correct answer

Rituximab

Correct Incorrect Correct answer

22 years female is being evaluated for pan less cervical lymphadenopathy she describe night sweats and pruritus ,lymphoma is suspected and lymph node is excised,pathology reveals numerous cells including lymphocytes,histocytes ,plasma cells ,and large cell with two nucleus inside.what is the most common subtype of this lymphoma?

1 Nodular sclerosis

Correct Incorrect Correct answer

2 Lymphocyte rich

Correct Incorrect Correct answer

3 Lymphocyte-depleted

Correct Incorrect Correct answer

4 Mixed cellularity

Correct Incorrect Correct answer

5 Diffuse large Bcell lymphoma

Correct Incorrect Correct answer

Wich of the following lab result is associated with irone deficiency anemia?

Elevate TiBc or transferrin

Correct Incorrect Correct answer

Elevated ferritin

Correct Incorrect Correct answer

Increased number of reticlocytes

Correct Incorrect Correct answer

Elevated MCV calve

Correct Incorrect Correct answer

Thrombocytopenia

Correct Incorrect Correct answer

A 75 years old male is brought to the ER due to episode of confusion and no abnormalities on head imaging ,past history is positive for MALT lymphoma,labs hemoglobins 8.2 WBC 2400 MCV 111 what can be seen on this paient bone marrow biopsy?

Change compatible with MDS

Correct Incorrect Correct answer

Megaloblastic changes

Correct Incorrect Correct answer

Fatty replacement of the bone marrow

Correct Incorrect Correct answer

Dry tap

Correct Incorrect Correct answer

Acute myeloid leukemia

Correct Incorrect Correct answer

A 75 years old female is two weeks following knee replacement and is trated with enoxaprin for DVT prophylaxis on examination diffuse skin petechiae ,she complains of massive nose bleeding,on the leg contralateral tonthe one of surgery there is erythema with pitting edema and positive homan’smsing,what isnthe most likely explication to her condition?

The patient did not take her medication and therefore developed DVT

Correct Incorrect Correct answer

The patient developed antibodies to heparin and platelet factory complexes

Correct Incorrect Correct answer

The patient developed sever ADMATSB deficiency

Correct Incorrect Correct answer

Pancytopenia is acommon side effect of this treatment

Correct Incorrect Correct answer

Bacteria sepsis as a complication of herbrecent surgery

Correct Incorrect Correct answer

A 55 year old male that is usually healthy is admitted due to general malaise, nausea, and vomiting .
Labs-creatinine 2.7 mg/dl(normal at baseline), urea 102 mg/dl, hemoglobin 9.2g/dl, calcium 13.3 mg/dl, PTH lower then normal.
Which of the following best describes this patient ?

Primary renal failure due to elevated calcium levels.

Correct Incorrect Correct answer

Hypercalcemia due to primary hyperparathyroidism causing renal failure.

Correct Incorrect Correct answer

Hypercalcemia secondary to malignancy causing renal failure.

Correct Incorrect Correct answer

Renal failure due to bleeding and dehydration causing hypercalcemia

Correct Incorrect Correct answer

Acute parathyroid failure

Correct Incorrect Correct answer

A 19 year old type 1 diabetic patient complains of abdominal pain and nausea.
Labs- bicarbonate 13 meq/l, hyperglycemia of 303 mg/dl, systolic blood pressure is 77 mmHg.
What is the most probable diagnosis?

Hyperosmolar state.

Correct Incorrect Correct answer

Sever dehydration

Correct Incorrect Correct answer

Septic shock

Correct Incorrect Correct answer

Diabetes ketoacidosis

Correct Incorrect Correct answer

Distributive shock.

Correct Incorrect Correct answer

A 72 year old male is admitted due to lower abdominal pain. Physical examination suggests large urinary retention. U/s diagnoses 900 ml in the urinary bladder.
What is the most appropriate management?

Initiate therapy with alpha blocker.

Correct Incorrect Correct answer

Referral for immediate nephrostomy.

Correct Incorrect Correct answer

Urinary catheter insertion and IV fusid.

Correct Incorrect Correct answer

Urinary catheter insertion and discharge the patient.

Correct Incorrect Correct answer

Urinary catheter insertion and admit the patient for observation.

Correct Incorrect Correct answer

A 51 year old male with FMF now presents with end stage renal failure. His blood pressure is low and there fore he cannot undergo hemodialysis. He complains of diarrhea, malabsorption and weight loss.
Which of the following phenomena explains this entity?

Systolic hear failure caused by FMF.

Correct Incorrect Correct answer

AA amyloidosis as a complication of FMF.

Correct Incorrect Correct answer

AL amyloidosis .

Correct Incorrect Correct answer

Chronic colchicine intoxication as part of FMF treatment.

Correct Incorrect Correct answer

Stomach malignancy which is a known complication of FMF.

Correct Incorrect Correct answer

A 55 year old male with APLA syndrome just landed after a flight from the USA and complains of dyspnea , stabbing left chest pain and cough with small drops of blood.
What is the most appropriate next step in diagnosis?

Heart echo to rule out pulmonary hypertension.

Correct Incorrect Correct answer

Blood test for D- dimer to rule out pulmonary embolism

Correct Incorrect Correct answer

Urgent angiography to locate the source of pulmonary bleeding.

Correct Incorrect Correct answer

Angio CT to rule out pulmonary embolism.

Correct Incorrect Correct answer

Admission for observation for 24 hours.

Correct Incorrect Correct answer

A 92 year old female is admitted for treatment of urinary tract infection. During `her first night at the hospital she develops sever agitation and hits her roommate. She claims that “they are here to take me”. Her temperature is 38.6 °c.
What is the most likely diagnosis that explains her behavior?

Delirium

Correct Incorrect Correct answer

Dementia

Correct Incorrect Correct answer

Sepsis

Correct Incorrect Correct answer

CVA

Correct Incorrect Correct answer

Cerebral tumor or metastasis.

Correct Incorrect Correct answer

Which of the following is a contraindication for the use of BiPaP for nom invasive ventilation?

Hypercarbia

Correct Incorrect Correct answer

Hyponatremia

Correct Incorrect Correct answer

Hypoxemia

Correct Incorrect Correct answer

Blurred consciousness.

Correct Incorrect Correct answer

Pulmonary hypertension

Correct Incorrect Correct answer

Which of the following combinations of lab results is compatible with the diagnosis of autoimmune hemolytic anemia?

Hemoglobin low , MCV high , reticulocyte % increased , haptoglobin concentration low coombs test positive

Correct Incorrect Correct answer

Hb low, MCV low, reticulocyte % Normal , haptoglobin concentration Normal , Coombs test positive.

Correct Incorrect Correct answer

Hb Normal, MCV low , reticulocyte% decreased, haptoglobin concentration low, coombs test negative

Correct Incorrect Correct answer

Hb low, MCV normal, reticulocyte % increased, haptoglobin concentration Normal, Coombs negative .

Correct Incorrect Correct answer

Hb high, MCV high, reticulocyte % increased, haptoglobin concentration low, Coombs positive.

Correct Incorrect Correct answer

22 years old female complains of fever accompanied by mild skin rash for three weeks, labs: CMV IgG positive, CMV IgM negative, EBV -EBNA positive,serum ferritin level is very high. Repeat blood cultures are negative. What is the most likely diagnosis?

Chronic CMV infection

Correct Incorrect Correct answer

Acute EBV infection

Correct Incorrect Correct answer

Adult onset still’s disease

Correct Incorrect Correct answer

Endocarditis

Correct Incorrect Correct answer

Chronic rickettsial infection

Correct Incorrect Correct answer

No answer is correct

Correct Incorrect Correct answer

All answers are correct

Correct Incorrect Correct answer

19 years old soldier just trained in the Sharon area , two days later he began to complain of high fever , sever headache and a rash on the trunk and the palms of the hands. Labs : anemia and thrombocytopenia.
Which of the following should be initiated immediately?

IV third generation cephalosporins.

Correct Incorrect Correct answer

Doxycycline

Correct Incorrect Correct answer

Oral systemic steroids.

Correct Incorrect Correct answer

Plasmapheresis

Correct Incorrect Correct answer

Topical steroidal ointment

Correct Incorrect Correct answer

66 years old female is diagnosed with nob small cell-lung cancer (NSCLC), with positive mutation for epidermal growth factor receptor EGFR , which of the following is correct regarding the prognosis?

Especially worse because of the positive mutation.

Correct Incorrect Correct answer

Better even though there is no treatment targeted to this mutation

Correct Incorrect Correct answer

Better because there is no treatment targeted to this mutation.

Correct Incorrect Correct answer

Worse in comparison to small cell lung cancer.

Correct Incorrect Correct answer

The prognosis is not related to the EGFR mutation.

Correct Incorrect Correct answer

60 years old male undergoes surgery for cholangiocarcinoma removal . Which of the following tumor markers will be of value for disease recurrence follow up?

CA19-9

Correct Incorrect Correct answer

CA 125

Correct Incorrect Correct answer

CEA

Correct Incorrect Correct answer

CA 15-3

Correct Incorrect Correct answer

Afp

Correct Incorrect Correct answer

55 years old male undergoes coronary categorization for NSTEMI During the procedure drug eluding stent (DES) is placed . Which of the following medication regimen is most appropriate assuming he has no other past medical history.

Aspirin+ warfarin

Correct Incorrect Correct answer

Clopidegril + LMWH

Correct Incorrect Correct answer

Prasegrel + dabigtram

Correct Incorrect Correct answer

Presogrel + warfarin

Correct Incorrect Correct answer

Ticagreol + aspirin

Correct Incorrect Correct answer

Which of the following combination is highly suspicious of pleural effusion?

Dullness to percussion + increased fremitus + creptations on auscultation.

Correct Incorrect Correct answer

Resonance to percussion + decreased freimtus+ bronchial breathing sounds.

Correct Incorrect Correct answer

Dullness to percussion+ decreased fremitus+ decreased breath sounds

Correct Incorrect Correct answer

Hyper resonance on percussion + increased fremitus + wet rales on auscultation.

Correct Incorrect Correct answer

Congested jugular veins+ decreased fremitus+ positive Hepatojugular reflex .

Correct Incorrect Correct answer

What is the preferred treatment approach to correct hypernatremia with normal blood pressure?

IV NaC1 0.9%

Correct Incorrect Correct answer

IV NaC1 0.45%

Correct Incorrect Correct answer

IV NaC1 5%

Correct Incorrect Correct answer

Drinking water via nasogastric tube

Correct Incorrect Correct answer

Hold deinking for 24 hours

Correct Incorrect Correct answer

Which of the following does not decrease serum potassium levels during the treatment for hyperkalemia ?

Fusid

Correct Incorrect Correct answer

Calcium gluconate

Correct Incorrect Correct answer

Salbutamol

Correct Incorrect Correct answer

Insulin

Correct Incorrect Correct answer

Propranolol

Correct Incorrect Correct answer

A or/and D

Correct Incorrect Correct answer

B or/and E

Correct Incorrect Correct answer

A newborn with cardiac anomalies and hetrotaxy is evaluated for ivemark syndrome and increase of platalet , sign could be due underlying syndrome. Which lab test would confirm the diagnose?

Howel-jolly body on blood smear.

Correct Incorrect Correct answer

Positive test in JAK 2 .

Correct Incorrect Correct answer

Increase Erethrocyte sedimation rate.

Correct Incorrect Correct answer

Decrease RBC pits.

Correct Incorrect Correct answer

Low serum iron.

Correct Incorrect Correct answer

No answer is correct

Correct Incorrect Correct answer

All answers are correct

Correct Incorrect Correct answer

10 Y.O male with osteomyelitis , history of multiple skin abscess.
Culture of abcess grew staphylocuucs aeurus, 2 years ago he had lymphadenitis requiring antibitics. What is the diagnosis ?

Chronic granulotus disease.

Correct Incorrect Correct answer

Wiskot Aldrich syndrome.

Correct Incorrect Correct answer

Severe combined immuodefecincy.

Correct Incorrect Correct answer

Hyper IgE syndrome.

Correct Incorrect Correct answer

Milk protein allergy.

Correct Incorrect Correct answer

9 YO boy with history of syncope with prolonged QT on ECG .. therapy ?

intracardiac defibrillator

Correct Incorrect Correct answer

Beta blockers

Correct Incorrect Correct answer

Digoxin

Correct Incorrect Correct answer

Amidirone

Correct Incorrect Correct answer

Pacemaker

Correct Incorrect Correct answer

A or/and D

Correct Incorrect Correct answer

B or/and E

Correct Incorrect Correct answer

15 YO concerned about pubertal development , 3ml testes bilaterally not firm, not able to smell coffe , FSH and LH , testosterone are low.
Diagnosis?

Klinfelter syndrome

Correct Incorrect Correct answer

Noonan syndrome

Correct Incorrect Correct answer

Parder willi syndrome

Correct Incorrect Correct answer

Turner syndrome

Correct Incorrect Correct answer

Kalmman syndrome

Correct Incorrect Correct answer

5 YO girl , short stature , restless, dificcult sleep at night .
Lab:hyperthyroid, on physical exam multiple jagged hyperpigmented macule on her back, abdomen don’t cross mid line , has tarnner 2 breast development , diagnosis ?

Peutz-jegners syndrome

Correct Incorrect Correct answer

Mccune abright syndrome

Correct Incorrect Correct answer

Classic congenital adrenal hyperplasia

Correct Incorrect Correct answer

Familial gonadotropien indepent puberty

Correct Incorrect Correct answer

Granulosa cell tumor

Correct Incorrect Correct answer

6 YO with history of 1 week nocturnal perinanal itching
No symptom , physical exam normal , probable etiology?

Crhons disease

Correct Incorrect Correct answer

Enterobiasis

Correct Incorrect Correct answer

Cow milk allergy

Correct Incorrect Correct answer

Ulcerative colitis

Correct Incorrect Correct answer

Zinic deficney

Correct Incorrect Correct answer

Most children can follow a simple 2 steps requeste at age :

10 month

Correct Incorrect Correct answer

12 month

Correct Incorrect Correct answer

18month

Correct Incorrect Correct answer

24 month

Correct Incorrect Correct answer

Variable age

Correct Incorrect Correct answer

A newborn has been diagnosed with aniridia. Which other abnormality is associated to this condition?

kidney mass on abdominal U/S

Correct Incorrect Correct answer

increased level of vanilmandelic acid in plasma

Correct Incorrect Correct answer

wide mediastinum shadow on x-ray.

Correct Incorrect Correct answer

evidence of bone metastasis on nuclear study.

Correct Incorrect Correct answer

mass of head on MRI

Correct Incorrect Correct answer

A newborn infant is examined in the nursery.The infant was a product of a benign pregnancy and vaginal delivery.The measurment of his fronto-occipital head circumference is about 2cm larger than the initial measurement done several hours before.On exam tachycardia is noted with spongy feel to the entire scalp.What is the management of this condition?

Transfer to the newborn ICU.

Correct Incorrect Correct answer

Observation and parental reassurance.

Correct Incorrect Correct answer

CT scan of the skull with bone windows.

Correct Incorrect Correct answer

surgical driange

Correct Incorrect Correct answer

Elevation of the head of the crib

Correct Incorrect Correct answer

A newborn infant is born to a mother that is a carrier of hepatitis B surface antigen (HbsAg-positive),which is the most appropriate action in managing this infant?

Screen the infant for HbsAg

Correct Incorrect Correct answer

Isolate the infant with enteric precautions

Correct Incorrect Correct answer

Screen the mother for hepatitis B`e`Antigen(HbeAg)

Correct Incorrect Correct answer

Administer hepatitis B immune globulin and hepatitis B vaccine ro the infant.

Correct Incorrect Correct answer

Do nothing because transplacentally aquired antibody will prevent infection in the infant.

Correct Incorrect Correct answer

A 4-year-old child is observed to hold his eyelids open with his fingers and to close one eye periodically,especially in the evening.He has some trouble swalling his food.He can throw a ball and runs well.which test is most likely to aid in the diagnosis?

Muscle biopsy

Correct Incorrect Correct answer

Creatine phosphokinase (CPK) in serum

Correct Incorrect Correct answer

Effect of test dose of edrophonium

Correct Incorrect Correct answer

Chest x-ray.

Correct Incorrect Correct answer

Antinuclear antibody in serum.

Correct Incorrect Correct answer

A male infant,born at 26 weeks gestation develops tachycardia and abdominal distention prior to passing a blood-tinged stool.His exam reveals decreased tone and activity,tenderness on palpatation of the abdomen,and paucity of abdominal sounds.His abdominal x-ray shows diffuse pneumatosis intestinalis without pneumoperitoneum or portal venous Air.The child is diagnosed with Necrotizing enterocolitis.What is the most probable precipitating factor for this condition?

Septicemia

Correct Incorrect Correct answer

Hyaline membrane disease

Correct Incorrect Correct answer

Meconium ileus

Correct Incorrect Correct answer

Early feeding

Correct Incorrect Correct answer

Jaundice.

Correct Incorrect Correct answer

A 2-year-old boy,a child of new immigrants from erythrea,presents with high fever,coryza,stridorous cough,conjunctivitis and a diffuse confluent maculopapular rash.Measles is suspected.Administration of which vitamins is of specific therapeutic value in this child?

A

Correct Incorrect Correct answer

B12

Correct Incorrect Correct answer

C

Correct Incorrect Correct answer

D

Correct Incorrect Correct answer

E

Correct Incorrect Correct answer

A 2-years-old boy presents with a 1-monts history of slow-growing,nontender mass beneath the right mandible.The overlying skin is erythematous,and 2 days ago it began to spontaneously produce purulent driange.A diagnosis of atypical mycobacterium lymphadenitis is made.What is the preferred management?

A fine needle aspiration for culture diagnosis

Correct Incorrect Correct answer

Ct study of head and neck

Correct Incorrect Correct answer

Surgical excision of affected lymph nodes.

Correct Incorrect Correct answer

PCR study of blood samples for mycobacterium

Correct Incorrect Correct answer

High dose oral corticosteriods.

Correct Incorrect Correct answer

A 12 –year-old girl develops jaundice,progressice tremors,emotional lability,and brown discoloration of the limbic region of the cornea.What is the most appropriate next diagnostic step in this girl?

Closed liver biopsy

Correct Incorrect Correct answer

Open liver biopsy

Correct Incorrect Correct answer

ERCP study

Correct Incorrect Correct answer

Copper level in urine.

Correct Incorrect Correct answer

Anti-nuclear antibody in serum.

Correct Incorrect Correct answer

A 2 years old boy of an arab origin ,is evaluated because of pallor, laboratory study shows low hemoglobin, low MCV,and normal RBC count. One month treatment with oral iron did not increase the hemoglobin level, what is the next appropriate management?

Check feritin level in blood

Correct Incorrect Correct answer

Check vitamin B12

Correct Incorrect Correct answer

Send for hemoglobin electrophoresis

Correct Incorrect Correct answer

Check bone marrow aspirate for aplastic anemia

Correct Incorrect Correct answer

Test the folic acid level

Correct Incorrect Correct answer

A 4 month old infant is seen in the emergency department,the child is in significant distress with profuse crackles billaterally on lung ascultation and a barely audiable heart beat, where is the correct place to palpate for a pulse in this infant?

Femoral artery

Correct Incorrect Correct answer

Carotid artery

Correct Incorrect Correct answer

Radial artery

Correct Incorrect Correct answer

Brachial artery

Correct Incorrect Correct answer

Axillary artery

Correct Incorrect Correct answer

A 10 years old boy is seen for a routine physical exam, he is asymptomatic and his blood pressure and examination are normal, urine exam by dipstick shows 1+ hemoglubin and negative protien. microscopic urine sediment contains 10-20 RBC’s HPF, what is the next step of management?

Mesure GFR

Correct Incorrect Correct answer

Renal ultrasound

Correct Incorrect Correct answer

Hearing test

Correct Incorrect Correct answer

Check urinalysis of parents

Correct Incorrect Correct answer

Serum creatinine and BUN

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and D or/and E

Correct Incorrect Correct answer

All answers are correct

Correct Incorrect Correct answer

Which of the following would be expected in 6 month old child with large ventricular septal detect?

Cyanosis

Correct Incorrect Correct answer

Enlarged heart on chest roentogram

Correct Incorrect Correct answer

Continus cardiac murmur

Correct Incorrect Correct answer

Decresed pulmonary vascular on chest roentogram

Correct Incorrect Correct answer

Evidence of predominately right ventricular hypertrophy on ECG.

Correct Incorrect Correct answer

Which of the following findings on urinalysis is common in children with recurent gross or microscopic hematuria,normal renal ultrasound, normal test of renal function?

Hyperkaliuria

Correct Incorrect Correct answer

Hypercalciurea

Correct Incorrect Correct answer

Hypernatriuria

Correct Incorrect Correct answer

Hyperglycuria

Correct Incorrect Correct answer

Bone-jones protinuria

Correct Incorrect Correct answer

A 2 years old child drinks gasoline that has been left in a glass,after the first swallow she cries and drop the glass, what do you suspect she might develop first ?

PALLOR

Correct Incorrect Correct answer

COMA

Correct Incorrect Correct answer

Tachypnea

Correct Incorrect Correct answer

Jundice

Correct Incorrect Correct answer

Cardiac arrest

Correct Incorrect Correct answer

A 13 years old boy has 3 days history of low grade fever , upper respiratory symptoms and sore throat. He is seen in the emergency department because 2 hours ago he had an abrupt onset of high fever , difficulty swallowing and salivation, his pharynx has a fluctuant bulge in the posterior wall, what is the most appropriate initial management?

Narcotic analgesic

Correct Incorrect Correct answer

Oral penicillin

Correct Incorrect Correct answer

Surgical intervention

Correct Incorrect Correct answer

Streptococcus

Correct Incorrect Correct answer

Monospot test

Correct Incorrect Correct answer

During instruction of a young couple before discharge from nursery the young mother seeks for information regards the risk factors for sudden death syndrome.Which of the following is a risk factor related to the child?

Female Gender

Correct Incorrect Correct answer

Accelerated growth

Correct Incorrect Correct answer

Lack of immunization

Correct Incorrect Correct answer

Hard bedding surface

Correct Incorrect Correct answer

Breast feeding

Correct Incorrect Correct answer

A newborn shows respiratory distress after birth, the nurse has a problem in inserting a tube through his nose.A diagnosis of choanal atresia is suspected. What symptom is found in a bilateral atresia?

The cyanosis is relieved during eating

Correct Incorrect Correct answer

Sucking a pacifier relieves the cyanosis

Correct Incorrect Correct answer

The cyanosis improves during crying

Correct Incorrect Correct answer

Sucking the lips is a late symptom in the clinical course

Correct Incorrect Correct answer

The child is asymptomatic until the first cold

Correct Incorrect Correct answer

A 1 year old boy is seen because of stridor. On exam he is tachypneic and in respiratory distress.A racemic epinephrine inhalation treatment is considered.In which disorder this treatment should be used cautiously?

Cleft palate

Correct Incorrect Correct answer

Tetralogy of Fallot

Correct Incorrect Correct answer

Pneumonia

Correct Incorrect Correct answer

Nasal obstruction

Correct Incorrect Correct answer

Epilepsy

Correct Incorrect Correct answer

A 3 month old girl has inspiratory difficulty from birth.An extensive workup reveals the presence of congenital sub glottis hemangioma. What is the initial treatment of choice for this infant?

Tracheostomy

Correct Incorrect Correct answer

Systemic corticosteroids

Correct Incorrect Correct answer

Steroid local injection to the tumor

Correct Incorrect Correct answer

Endoscopic laser excision

Correct Incorrect Correct answer

Oral propranolol

Correct Incorrect Correct answer

A 36 2/7 week, 1800 gr, male, infant is born to 32 year old gravida 1 woman with pregnancy induced hypertension.At 30 seconds of age,he is spontaneously crying on the delivery room table and has heart rate of 110 beats/minute. Which step is the most important in the initial management of this infant?

Administer positive pressure ventilation via a mask and bag

Correct Incorrect Correct answer

Provide continuous positive airway pressure (CPAP)

Correct Incorrect Correct answer

Administer a 10 cc/kg intravenous bolus of normal saline

Correct Incorrect Correct answer

Dry the infant with warm towels and suction his nose and mouth

Correct Incorrect Correct answer

Deliver 2 cc/kg intravenous bolus of 10% dextrose

Correct Incorrect Correct answer

A 24 years old, gravida 2, para 1 bedouin woman is seen for the first time for prenatal care.Her previous delivery occurred at home.At 34 weeks gestational ultrasound examination of the fetus reveals thickened subcutaneous tissue and fluid in the pleural cavity.Sampling of the amniotic fluid shows bile pigment and percutaneous umbilical blood sampling shows fetal anemia.Which of the following is the most likely cause of this infant presentation?

Human parvovirus B19

Correct Incorrect Correct answer

Cytomegalovirus

Correct Incorrect Correct answer

Complex congenital heart diseases

Correct Incorrect Correct answer

Rh antibody exposure

Correct Incorrect Correct answer

Supraventricular tachycardia

Correct Incorrect Correct answer

A 16 years old male presents with fever, abdominal pain in the right scrotum.One week ago he had parotitis.What is the most common cause of this patient’s diagnosis?

Chlamydia Trachomatis

Correct Incorrect Correct answer

Staphylococcus a

Correct Incorrect Correct answer

Coxsackievirus

Correct Incorrect Correct answer

Adenovirus

Correct Incorrect Correct answer

Mumps Viru

Correct Incorrect Correct answer

Sexually active 15 years male presents with 3 hours history of left side testicular pain and dysuria, he reports no history of trauma. On exam scrotum is painful and red. The patient reports pain relief when you elevate the testis.
Which diagnostic test când help confirm the diagnosis?

Doppler ultrasound

Correct Incorrect Correct answer

Test for chlamydia

Correct Incorrect Correct answer

Complete blood Count

Correct Incorrect Correct answer

Dark field microscopy

Correct Incorrect Correct answer

Radionuclide imaging

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

C or/and D

Correct Incorrect Correct answer

10 month old boy seen because of unusual movements of his eyes they seems to jitter with extreme nystagmus. Around the eyes dark coloration is noted.
What is the most likely diagnosis?

Willis tumor

Correct Incorrect Correct answer

Neuroblastoma

Correct Incorrect Correct answer

Dermatomyositis

Correct Incorrect Correct answer

Amphetamine poisoning

Correct Incorrect Correct answer

Convulsive disorder

Correct Incorrect Correct answer

14 month boy with 3 days of abdominal pain, vomiting and diarrhea arrives to emergency room and appear lethargic. Temperature 38.5, pulse 150, respiratory rate 30, blood pressure 100/60, oxigen saturation 98% on room air. He has sunken eyes and dry mucous membranes. His abdomen is tender and capillary refill time is 4 second. After administration of supplemental oxygen the next proierity mangement is

Obtain blood culture and adminstiring antibiotics

Correct Incorrect Correct answer

Endotracheal intubation and mechanical ventilation

Correct Incorrect Correct answer

Checking potential toxic substances in urine

Correct Incorrect Correct answer

Intravenous access and initiation of fluid infusion

Correct Incorrect Correct answer

Immideate consultion with surgeon for mangement of the abdominal pain

Correct Incorrect Correct answer

15 weeks old boy presents with poor appetite, weight loss, abdominal distention and decreased energy. Laboratory results reveals elevated AST, Alt and total birubin. Stool is very pale in color.
What is the most common reason for liver failure and need for liver transplantation patient this age

Wilson disease

Correct Incorrect Correct answer

Autoimmune hepatitis

Correct Incorrect Correct answer

Viral hepatitis

Correct Incorrect Correct answer

Biliary atresia

Correct Incorrect Correct answer

Paracetamol intoxication

Correct Incorrect Correct answer

15 years old girl with history of lymphoma received a hematopoietic stem cell transplant after a myeloablative conditioning regimen 100 days ago. Her early course was unremarkable. She presents now with cough, low grade fever and dyspnoea. She has tachypnea and her chest radiograph is normal. She reports missing one of her post transplant medications for the past 2 months.
This medication is most likely;

Acyclovir

Correct Incorrect Correct answer

Ferrous sulfate

Correct Incorrect Correct answer

Prednisone

Correct Incorrect Correct answer

Tacrolimus

Correct Incorrect Correct answer

Trimethiprium – sulfa

Correct Incorrect Correct answer

5 month old is diagnosed with glycogen storage disease type 1a.
What is the most appropriate mechanism tie prevent night time hypoglycemia?

Administration of a dose of glucagon

Correct Incorrect Correct answer

Adding corn starch to all his feeds

Correct Incorrect Correct answer

Providing continus night time nasogastric feeds

Correct Incorrect Correct answer

The parents should feed this child as needed when cries

Correct Incorrect Correct answer

Parents should feed him every 6-7 hours overnight

Correct Incorrect Correct answer

Recuurent infection with niesseria is related to which complement deficiency?

c6

Correct Incorrect Correct answer

c1 inhibitor

Correct Incorrect Correct answer

c2

Correct Incorrect Correct answer

c3

Correct Incorrect Correct answer

c1q

Correct Incorrect Correct answer

A 6 month old is seen because of failure to thrive, recurrent pneumonia and otitis media, on physical examination an irritable child with an extensive eczematous rash on his trunk and legs, he has moderate hepatosplenomegaly and a few patechiae on his legs. Which is the most likely finding in complete blood count and smear in this child?

Neutropenia

Correct Incorrect Correct answer

Polycytemia

Correct Incorrect Correct answer

Microcytosis

Correct Incorrect Correct answer

Thrombocytopenia

Correct Incorrect Correct answer

Lymphoblasts

Correct Incorrect Correct answer

A 12 year old girl present to the emergency department with acute onset of facial flushing, abdominal pain, diffuse pruritus, diaphoresis and shortens of breath. The symptoms started minutes after eating almonds. She is observed for 12 hours without any reccurent of symptoms. Which discharge instruction is most appropriate?

Start daily diphenhydramine to prevent another episode

Correct Incorrect Correct answer

Start daily loratadine to prevent another episode

Correct Incorrect Correct answer

Use inhaled fluticasone if another such episode occurs

Correct Incorrect Correct answer

Inject epinephrine if another such episode occurs

Correct Incorrect Correct answer

Use inhaled ventolin if another such episode occurs

Correct Incorrect Correct answer

A 15 year old boy had a history of an IgE mediated hypersensitivity to penicillin. Which medications is least likely to cause a hypersensitivity reaction?

Imipenem

Correct Incorrect Correct answer

Aztreonam

Correct Incorrect Correct answer

Ceftazidime

Correct Incorrect Correct answer

Cefazolin

Correct Incorrect Correct answer

Ampicillin

Correct Incorrect Correct answer

A 15 year old girl has painful recurrent mouth sores that occurred 6 times in the last year. She had also 1 episode of genital ulceration 2 months ago. cultures taken from mouth and genital lesions were negative. On exam she has evidence of synovitis in both of her ankle and a pustular rash on her arms. Which test will be helpful in ascertaining the diagnosis?

A skin biopsy

Correct Incorrect Correct answer

A pathergy test

Correct Incorrect Correct answer

MRI of brain

Correct Incorrect Correct answer

CRP

Correct Incorrect Correct answer

Rheumatoid factor

Correct Incorrect Correct answer

A mother with no prenatal care gives birth to a term infant with intrauterine growth retardation, microcephaly, hepatosplenomegaly, thrombocytopenia and sensorineural hearing loss. The concern is of congenital CMV infection. Which is the most important diagnosis study for CMV evaluation for a newborn?

Viral culture

Correct Incorrect Correct answer

Brain biopsy

Correct Incorrect Correct answer

Viral PCR

Correct Incorrect Correct answer

RPR

Correct Incorrect Correct answer

Antibody titers

Correct Incorrect Correct answer

A 6 month old infant who recently underwent a kasai procedure to biliary atresia, present with fever, there is no clear source of the fever on exam and urine labs results show no signs of likely infectious etiology for the patient’s condition?

Cytomegalyvirus

Correct Incorrect Correct answer

Ebterococcus

Correct Incorrect Correct answer

Entamoeba

Correct Incorrect Correct answer

Salmonella

Correct Incorrect Correct answer

Streptococcus

Correct Incorrect Correct answer

An 11 year old boy is diagnosed with actinomyosis after presenting with a neck mass the diagnosis is confirmed after an excisional biopsy and gram stain of the tissue showed gram positive filamentous acid fast negative organisms. Which is the preferred treatment for this infection?

Penicillin

Correct Incorrect Correct answer

Ceftriaxone

Correct Incorrect Correct answer

VancomycinVancomycin

Correct Incorrect Correct answer

Clindamycin

Correct Incorrect Correct answer

Trimethoprine sulfa

Correct Incorrect Correct answer

Botulism is suspected in a 14 week old male infant who presents with constipation and poor feeding as well as weak cry, poor suck, and expressionless face, and a significant head lag on exam. What is the best method to confirm the diagnosis ?

EMG

Correct Incorrect Correct answer

Serum IgM level for C.botulinum

Correct Incorrect Correct answer

Serum toxin assay

Correct Incorrect Correct answer

Stool specimen for toxin assay

Correct Incorrect Correct answer

Stool culture for C.botulinum

Correct Incorrect Correct answer

A 12 year old girl presents with severe earache for 1 day. Yesterday she participated in a swimming competition. Initially the ear was pruritic, but has become more painful. On examination there is severe pain with touching and pulling the auricle. Otoscopic examination reveals an edematous ear canal with no visualization on the tympanic membrane. Which is the most likely organism causing her symptoms?

Staph. Aureus

Correct Incorrect Correct answer

Hemophilus influenza

Correct Incorrect Correct answer

Aspergillus niger

Correct Incorrect Correct answer

Pseudomonas aeruginosa

Correct Incorrect Correct answer

Moraxella catarrhalis

Correct Incorrect Correct answer

A 1 year old infant is diagnosed with pertussis after he presents with difficulty breathing and fits of coughing for the past 2 days. Which is the most common complication of pertussis ?

Death

Correct Incorrect Correct answer

Rib fracture

Correct Incorrect Correct answer

Pneumonia

Correct Incorrect Correct answer

Seizures

Correct Incorrect Correct answer

Encephalopathy

Correct Incorrect Correct answer

A 1 day old infant is born prematurely. The birth was induced secondary to maternal hemodynamic instability, and septic like picture following a non specific flulike illness and gastroenteritis. The baby in the nursery suddenly becomes septic. CSF analysis shows 75 lymphocytes, Glucose 50 mg/dL, Protein 40 mg/dL. What is the most likely diagnosis ?

Aseptic meningitis

Correct Incorrect Correct answer

Hypoglycemia

Correct Incorrect Correct answer

Listeriosis

Correct Incorrect Correct answer

Galactosemia

Correct Incorrect Correct answer

Necrotizing enterocolitis

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and D

Correct Incorrect Correct answer

A full term infant is born to a 19 year old mother who diagnosed with syphilis. What is the drug of choice for treatment of neonatal syphilis ?

Tetracycline

Correct Incorrect Correct answer

Erythromycin

Correct Incorrect Correct answer

Penicillin G

Correct Incorrect Correct answer

Vancomycin

Correct Incorrect Correct answer

Azithromycin

Correct Incorrect Correct answer

A 2 year old girl is seen after a witnessed ingestion of bottle containing liquid oven cleaner. At approximately 1 hour after the time of ingestion, she appears irritable, but in no acute distress, breathing comfortably. There are no visible oral lesions and she is not drooling, but refuses to drink. Which is the best option to manage this patient ?

Administration of an emetic agent

Correct Incorrect Correct answer

Placement of nasogastric tube for decompression

Correct Incorrect Correct answer

Immediate endoscopic evaluation for extent of injury

Correct Incorrect Correct answer

Admit for observation and IV hydration

Correct Incorrect Correct answer

No further treatment is necessary

Correct Incorrect Correct answer

A 7 day old male with trisomy 21 presents for routine checkup. His mother mentions that he passed meconium at 72 hours of life after rectal stimulation with a thermometer. He has not had another bowel movement and his abdomen appears more distended. On exam he has distended but soft abdomen with appropriate bowel sounds. On rectal exam the anus is normally placed and anal sphincter is tight. What is the most likely diagnosis ?

A duodenal web

Correct Incorrect Correct answer

Hirschsprung disease

Correct Incorrect Correct answer

Milk protein intolerance

Correct Incorrect Correct answer

Cystic fibrosis

Correct Incorrect Correct answer

Functional constipation

Correct Incorrect Correct answer

A 76 years old female is being evaluated in the ER for suicidal thoughts but refuses to be admitted which of the following is the most significant risk factor for complete suicide?

Resides in a village

Correct Incorrect Correct answer

Post history of alcohol abuse

Correct Incorrect Correct answer

Widowd a year ago

Correct Incorrect Correct answer

The patient age

Correct Incorrect Correct answer

Suffers from anxiety attacks

Correct Incorrect Correct answer

Whish of the following is not an indication for treatment with bupropion?

Attention defect disorders

Correct Incorrect Correct answer

Anxiety disorders

Correct Incorrect Correct answer

Sexual dysfunction

Correct Incorrect Correct answer

Smoking cessation

Correct Incorrect Correct answer

cocain withdrawal

Correct Incorrect Correct answer

A or/and D

Correct Incorrect Correct answer

B or/and E

Correct Incorrect Correct answer

Which of the following symptoms associated with depression cannot predict bipolar disorders ?

Rapid onset

Correct Incorrect Correct answer

Postpartum development

Correct Incorrect Correct answer

Mixed symptoms

Correct Incorrect Correct answer

Family history of bipolar disorders

Correct Incorrect Correct answer

Prolonged duration of over 6 months

Correct Incorrect Correct answer

A or/and D

Correct Incorrect Correct answer

C or/and E

Correct Incorrect Correct answer

During therapy session the patient says to the therapist “ I feel that you criticize me the way my dad used to do front of the entire family I hated him and I hate you for it “ what is this psychodynamic phenomenon called?

Transference

Correct Incorrect Correct answer

Free associations

Correct Incorrect Correct answer

Resistance

Correct Incorrect Correct answer

Blocking

Correct Incorrect Correct answer

Counter transference

Correct Incorrect Correct answer

A 40 weeks pregnant female who is diagnosis with bipolar disorders type 1 dor 10 years in now complaining for very mild depression symptoms and requests to renew her lithium that was discontinued 18 months ago what is the most appropriate medical treatment at this time?

Renew lithium immediately to avoid worsening for depression

Correct Incorrect Correct answer

Close follow-up until delivery and renew lithium after with a warning not to breast feed

Correct Incorrect Correct answer

Begin valproic acid instead of lithium

Correct Incorrect Correct answer

Begin tegretol instead of lithium

Correct Incorrect Correct answer

Begin gabapentin instead of lithium

Correct Incorrect Correct answer

32 year old female with adjustment disorder complains of feeling bad in general. She stopped medication 2days ago abruptly against medical advice. She has tonicclonic seizures first time in her life. Which of the following medications is most likely the one that she stopped taking?

Risperidone

Correct Incorrect Correct answer

Lamotrigine

Correct Incorrect Correct answer

Clonazepam

Correct Incorrect Correct answer

Fluoxetine

Correct Incorrect Correct answer

Setaline

Correct Incorrect Correct answer

Which pf the following is considered a peripheral symptom of anxiety?

Constipation

Correct Incorrect Correct answer

Hyporwflexia

Correct Incorrect Correct answer

Tachicardia

Correct Incorrect Correct answer

Puppilary mydriaiss

Correct Incorrect Correct answer

Hypersalivation

Correct Incorrect Correct answer

A or/and B

Correct Incorrect Correct answer

C or/and D

Correct Incorrect Correct answer

25 y.o. male evaluated following a panic attack. Recently discounted regular drug abuse. Which van cause panic attacks during withdrawal?

Amphetamine

Correct Incorrect Correct answer

Anticholinergs

Correct Incorrect Correct answer

Theophylline

Correct Incorrect Correct answer

Opaites

Correct Incorrect Correct answer

Nicotine

Correct Incorrect Correct answer

No answer is correct

Correct Incorrect Correct answer

All answers are correct

Correct Incorrect Correct answer

30y.o. man complains multiple symptoms:abdominal pain, gastric fullness after meal., constipations, palpitations, irregular pulse, blurred vision, dyspnea, malaise. Extensive workup by family physician and other experts were negative. Several hours a day he search diagnosis and treatment. Last 2years he has been living on a disability allowance, because he cannot work due to his symptoms. The most probable diagnosis:

Conversion disorder

Correct Incorrect Correct answer

Somatic symptom disorder

Correct Incorrect Correct answer

Illnesses anxiety disorder

Correct Incorrect Correct answer

Pain disorder

Correct Incorrect Correct answer

Fractious disorder

Correct Incorrect Correct answer

28 years old male who has been washing his hands up to 50 times a day due to fear of infection, does not step on the white lines on the side walk, has rituals of moving objects in his room for up to 2 hours, and thinks a lot of lucky numbers. He has come to seek treatment due to his suffering and stress. Which of the following is the most effective treatment for his condition?

A combination for psychoanalysis and drug theraphy

Correct Incorrect Correct answer

Placebe treatment

Correct Incorrect Correct answer

A combination of behavioral treatment and drug theraphy

Correct Incorrect Correct answer

Psychodynamic therapy alone

Correct Incorrect Correct answer

Admition and anti-psychotic theraphy

Correct Incorrect Correct answer

A 25 years old with daily cannabis recreational use for the past 2 years.What are the risks in cannabis use?

Severe bradycardia

Correct Incorrect Correct answer

Decreased motor skills during cannabis euphoria

Correct Incorrect Correct answer

The risk for developing cannabis dependency is 1:50

Correct Incorrect Correct answer

Psychosis and anxiety

Correct Incorrect Correct answer

Conjunctiva blood constriction

Correct Incorrect Correct answer

Which of the following is not a part of the dialectional behavioral therapy (DBT)?

Individual therapy

Correct Incorrect Correct answer

Groups skills training

Correct Incorrect Correct answer

telephone consultation

Correct Incorrect Correct answer

Flooding

Correct Incorrect Correct answer

Consultation team

Correct Incorrect Correct answer

A 70 years old male is consulted due to symptoms of sadness, lack of energy, sleep disturbance, crying a lot, decreased appetite, weight loss.Medical treatment with citalopram 20 mg once daily is started. A month later the patient is admitted due to confusion, agitation, sleepiness, his blood Na level is 129. What is the most likely diagnosis?

Electrolyte imbalance due to depression disorder.

Correct Incorrect Correct answer

SSRI induced hyponatremia.

Correct Incorrect Correct answer

First symptom of Alzheimer dementia.

Correct Incorrect Correct answer

SSRI induced maniformic episode

Correct Incorrect Correct answer

Pharmacological non compliance.

Correct Incorrect Correct answer

A 27 years old female treated with halidol 10 mg due to first episode of psychosis. 2 days later she arrives to the ER complaining of neck muscle rigidity and blurred speech due to tongue muscle rigidity. She has hypersalivation and her head is tilted to the left. What is the most appropriate treatment at this time?

Increase halidol to 15 mg

Correct Incorrect Correct answer

Continue treatment without any changes

Correct Incorrect Correct answer

Add Wellbutrin (bupropion) 300 mg

Correct Incorrect Correct answer

Add Dekinet ( Biperidin) 2 mg

Correct Incorrect Correct answer

Add Depalept ( valporic acid) 200 mg

Correct Incorrect Correct answer

A 22 year old female swallowed about 20 acamol tablets after her boyfriend told her that he is going to break up with her. On exam superficial cuts on her left arm that were done following a fight that she had with her mother. She complains of frequent mood changes and constant emptiness felling. What is the most likely diagnosis?

Schizotypal personality disorder

Correct Incorrect Correct answer

Generalized anxiety disorder

Correct Incorrect Correct answer

Schizoaffective disorder

Correct Incorrect Correct answer

Borderline personality disorder

Correct Incorrect Correct answer

Attention deficient disorder

Correct Incorrect Correct answer

A 22 year old male excersises in the gym and lifts weights 5 times a week for over a year. His parents complain of behavioral changes and that he bought a new music system for 20.000 NIS yesterday. They also say that he is lately inpatient, hostile, and verbally aggressive. On exam rapid and high volume speech. He declares that he want to compete in bodybuilding competition in las vegas next month. What is the most appropriate next step?

CBC and start fluoxetine 20 mg immediately

Correct Incorrect Correct answer

Blood testestrone level and start olanzapine

Correct Incorrect Correct answer

Urinalysis and start methylphenidate

Correct Incorrect Correct answer

Blood clozapine level and start ECT

Correct Incorrect Correct answer

ECG and start mirtazapine

Correct Incorrect Correct answer

A 30 year old male is admitted for the first time due to psychotic episode that started 2 weeks prior to his admission. Exam on admission, does not speak, stares, muscle rigidity, fever of 38.5 c, blood pressure of 160/100, pulse 120/minute. Which of the following blood tests must be performed in order to complete the diagnosis and avoid complications?

Thyroid function tests

Correct Incorrect Correct answer

Tegretol ( Carbamazapine) levels

Correct Incorrect Correct answer

Creatine kinase levels

Correct Incorrect Correct answer

Drug urine tests

Correct Incorrect Correct answer

Brain MRI

Correct Incorrect Correct answer

A 35 year_old female complains of constant need to count everything she does, wash her bed linen every day, check her house locks five times and twice a day, and she believes that if she won’t check the locks something terrible will happen to her family. What is the most appropriate treatment?

Dialeatical-behavioral therapy

Correct Incorrect Correct answer

Cognitive-behavioral therapy

Correct Incorrect Correct answer

Hypnosis

Correct Incorrect Correct answer

Prolonged exposure

Correct Incorrect Correct answer

Family therapy

Correct Incorrect Correct answer

A 45-year-old male with no psychiatric history is treated with sertraline due to first episode of major depression. Following a month of treatment his mood improves, he reports 3 hours of sleep per night and feeling of increased energy. He goes on a shopping spree and spends 15,000 NIS on shoes and clothes for his wife who complains that he speaks loudly and constantly and asks for sexual intercourse in an increasing frequency. What is the most probable diagnosis?

Psychosis as part of schizophrenia

Correct Incorrect Correct answer

Mania due to SSRI treatment

Correct Incorrect Correct answer

Psychosis due to illegal drug use

Correct Incorrect Correct answer

General anxiety disorder exacerbation

Correct Incorrect Correct answer

Onset of Alzheimer dementia

Correct Incorrect Correct answer

Which of the following is used for the treatment of acute manic state ?

Olanzapine

Correct Incorrect Correct answer

Mirtazapine

Correct Incorrect Correct answer

Fluoxetine

Correct Incorrect Correct answer

Methylphenidate

Correct Incorrect Correct answer

Trihexyphenidy1

Correct Incorrect Correct answer

SSRIs are indicated for all of the following ,except:

Obsessive compulsive disorder

Correct Incorrect Correct answer

Bulimia nervosa

Correct Incorrect Correct answer

Social anxiety disorder

Correct Incorrect Correct answer

Headaches

Correct Incorrect Correct answer

Depression

Correct Incorrect Correct answer

All of the following are suicidal risks , except:

Male gender

Correct Incorrect Correct answer

Physical illness

Correct Incorrect Correct answer

Unemployment

Correct Incorrect Correct answer

Winter season

Correct Incorrect Correct answer

Single status

Correct Incorrect Correct answer

All of the following are positive prognostic signs of schizophrenia, except:

Early age onset

Correct Incorrect Correct answer

Acute onset

Correct Incorrect Correct answer

Mood disorder symptoms

Correct Incorrect Correct answer

Positive symptoms

Correct Incorrect Correct answer

Close support system

Correct Incorrect Correct answer

A 25-year-old female arrives to the ER complaining of false thoughts of prosecution following separation from her boyfriend a week earlier. The symptoms also include loss of appetite and weight loss. Which of the following is the least likely diagnosis?

Schizophrenia

Correct Incorrect Correct answer

Depression episode

Correct Incorrect Correct answer

Manic state

Correct Incorrect Correct answer

Brief psychotic disorder

Correct Incorrect Correct answer

Anorexia nervosa

Correct Incorrect Correct answer

A or/and D

Correct Incorrect Correct answer

C or/and E

Correct Incorrect Correct answer

A 45 year old man was initially reffered by his employer for psychiatric evaluation due to false thoughts of prosecution by his co-worker ,in the past nine months with no others symptoms what is the most likely diagnosis once organoc etiology is rouled out?

Delusional disorder

Correct Incorrect Correct answer

Shizofrenia

Correct Incorrect Correct answer

Short psychotic episode

Correct Incorrect Correct answer

Psychotic dependent

Correct Incorrect Correct answer

Manic state

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

all answers are correct

Correct Incorrect Correct answer

Which of the following is correct regarding mother or newborn and the treatment with ssri medication during pregnancy?

All of these drugs increase the risk of pulmonary hypertension in the newborn

Correct Incorrect Correct answer

Taking fluxtetin during pregnancy increase the risk of low intillegent and behavioral problems in the newborn

Correct Incorrect Correct answer

The risk of injury to the newborn when taking ssri during pregnancy is higher than the risk of major depression exacerbation during pregnancy when the medication is stopped

Correct Incorrect Correct answer

Newborn to mothers taking ssri are at increased risk for ssri withdrawal syndrome shortly after birth

Correct Incorrect Correct answer

Breast feeding is contraindicated in mothers taking ssri

Correct Incorrect Correct answer

A 16 years old male with autism is brought to the ER by parents due toside effect of slow psychomotor response and muscle rigidity to the extent that he has fallen down while walking , his parents note that his current medication has started 3 months ago after a period of violent behavior at school ,they dont remmber the drug name. His blood prolactin from last week is high , what is the most probable medication to cause these symptoms?

Olanzapine

Correct Incorrect Correct answer

Risperidone

Correct Incorrect Correct answer

Fluroxamine

Correct Incorrect Correct answer

Methylphenidate

Correct Incorrect Correct answer

Diazepam

Correct Incorrect Correct answer

Which of the following statement is the most accurate regarding sucide risk and psychiatric patients

Psychiatric patients are at 2 folds sucide risk comparing to general population

Correct Incorrect Correct answer

There is no association between history and psychiatric

Correct Incorrect Correct answer

History of psychiatric admission increase sucideal risk

Correct Incorrect Correct answer

The sucideal risk during psychiatric is constant does not change

Correct Incorrect Correct answer

History of psychiatric admission increase sucideal risk in men but not women

Correct Incorrect Correct answer

Which of the following personality disorders has the highest moral level (rigid superego)?

Avoidant

Correct Incorrect Correct answer

Obssesive compulsive

Correct Incorrect Correct answer

Narcisstic

Correct Incorrect Correct answer

Dependent

Correct Incorrect Correct answer

Paranoid

Correct Incorrect Correct answer

A 31 year old female weight 45 and her height 163cm claims that she is fat and therefor does not eat , which is likely to found?

Increase cholesterol level

Correct Incorrect Correct answer

Tachycardia

Correct Incorrect Correct answer

Increase body temperature

Correct Incorrect Correct answer

Increase blood sugar

Correct Incorrect Correct answer

Increase blood pressure

Correct Incorrect Correct answer

Under which of the following value of blood electrolytes level ,clozapine should be discontinued?

3000 cells/mm3

Correct Incorrect Correct answer

2000 cells/mm3

Correct Incorrect Correct answer

5000 cells/mm3

Correct Incorrect Correct answer

1500 cells/mm3

Correct Incorrect Correct answer

500 cells/mm3

Correct Incorrect Correct answer

No answer is correct

Correct Incorrect Correct answer

All answers are correct

Correct Incorrect Correct answer

Which of the following is diagnostic criteria of conduct behavior disorder by the DSM 5?

Behavior must include repeat pattern of property destruction

Correct Incorrect Correct answer

Behavior must include repeat pattern of lies and theft

Correct Incorrect Correct answer

Behavior must continue for at least one year

Correct Incorrect Correct answer

Behavior must appear before age 18

Correct Incorrect Correct answer

Behavior must include repeat pattern of skipping school before age 9

Correct Incorrect Correct answer

No answer is correct

Correct Incorrect Correct answer

All answers are correct

Correct Incorrect Correct answer

A 19 year old soldier serves in the army for the past 3 months ,complain to the army psychiatrist of trouble falling a sleep and sleep disturbance, also mention anxiety with decreased mood ,denies change in appetite ,an-hedonism ,or suicidal thoughts ,feels difficult in wearing the uniform and returning to his base every Sunday following weekend leave ,the anxiety increase when he is retaineded of his tough commander, what is the most likely diagnosis?

Acute stress disorder

Correct Incorrect Correct answer

Major depression disorder

Correct Incorrect Correct answer

Posttraumatic stress disorder

Correct Incorrect Correct answer

Panic disorder with agrophobia

Correct Incorrect Correct answer

Adjustment disorder

Correct Incorrect Correct answer

64 years old male undergoes routine colonscopy and a pedunculated polyp at the cecum is identified and completely resected. On pathology poorly differentiated adenocarcinoma.that invades the submucosa. What is the most appropriate next step?

Genetic evaluation

Correct Incorrect Correct answer

Formal right hemicolectomy

Correct Incorrect Correct answer

Cecectomy

Correct Incorrect Correct answer

Repeat colonscopy in two months

Correct Incorrect Correct answer

Chemotherapy

Correct Incorrect Correct answer

40 years old female with ulcerative colitis for 10 years undergoes colonscopy that demonstrates neoplasm in the left colon. On biopsy high grade dysplasia . What is the most appropriate next step in management?

Endoscopic resection of the lesion

Correct Incorrect Correct answer

Formal left hemicolectomy

Correct Incorrect Correct answer

Follow up only

Correct Incorrect Correct answer

Biologic therapy to control disease

Correct Incorrect Correct answer

Total proctoclrctomy

Correct Incorrect Correct answer

An 50 years old female with hypertension and diabetes is brought to the ER due to rectal bleeding for two days. Her vital signs are stable normal breathing soft abdomen cherry red stool on rectal examination. Labs hg decreased from 12 to 10 . Nasogastric tube drains bile content. She is admitted to colonscopy and 24H later the bleeding stops. What is the most likely bleeding etiology in patient?

Hemorrhoids

Correct Incorrect Correct answer

AVM

Correct Incorrect Correct answer

IBD

Correct Incorrect Correct answer

Colon cancer

Correct Incorrect Correct answer

Diverticulosis

Correct Incorrect Correct answer

45 years old female is involved as a pedestrian in motor vehicle accident and is brought to the ER, her blood pressure 130/80 pulse 100 focused assessment with sonography in trauma (fast), is negative for abdominal fluid, pelvic X-ray demonstrated multiple pelvic fractures (open book). All of the following can assist in patient stabilization except:

Pelvic binder

Correct Incorrect Correct answer

Angiography

Correct Incorrect Correct answer

Extra peritoneal packing

Correct Incorrect Correct answer

External Pelvic fixation

Correct Incorrect Correct answer

Explorative laparatomy

Correct Incorrect Correct answer

A 40 year old male is admitted to the ER following stap wound to the abdomen on exam alert without distress hemodynamic stable stab wound 5 cm lateral and inferior to the umilicus with omentum protouding out of skin no signs of peritonitis, what is the most appropriate next step in mangment?

Abdominal CT

Correct Incorrect Correct answer

Explorative laparotomy

Correct Incorrect Correct answer

Local wound exploration

Correct Incorrect Correct answer

Focused assessment with sonography in trauma (fast)

Correct Incorrect Correct answer

Diagnostic peritoneal lavage

Correct Incorrect Correct answer

40 years old healthy male is evaluated at the ER for obstructive jaundice and pruritus abdominal ct demonstrates pancreatic head mass adenocarcinoma on biopsy, family history is positive for 29 years old sister with breast carcinoma. which of the following genes should be evaluated in this patient?

BRCA1

Correct Incorrect Correct answer

BRCA2

Correct Incorrect Correct answer

K-ras

Correct Incorrect Correct answer

MNHY

Correct Incorrect Correct answer

P53

Correct Incorrect Correct answer

Which of the following are poor prognosis is patients with thyroid malagnancy?

Tumor size >3cm

Correct Incorrect Correct answer

Age <40 years

Correct Incorrect Correct answer

Male gender

Correct Incorrect Correct answer

Well differntiated carcinoma on histology

Correct Incorrect Correct answer

Tumor without capsular invasion

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and E

Correct Incorrect Correct answer

All of the following are symptome of primary hyperparathyroidism exept?

Muscle pain

Correct Incorrect Correct answer

Constipation

Correct Incorrect Correct answer

Polyria

Correct Incorrect Correct answer

Decreased ability to concuntrate

Correct Incorrect Correct answer

Increased appetite

Correct Incorrect Correct answer

What is the most common etiology of primary hyperparathyroidism?

Aldosterone producing adenoma

Correct Incorrect Correct answer

Bilateral adrenal hyperplasia

Correct Incorrect Correct answer

Aldosterone producing adenocarcinoma

Correct Incorrect Correct answer

Familial hyperaldosterosim

Correct Incorrect Correct answer

Pituitary adenoma

Correct Incorrect Correct answer

Which of the following is good prognostic sign of CT scan of an adrenal incidentoloma?

Invesular borders

Correct Incorrect Correct answer

Hypervascularty

Correct Incorrect Correct answer

Slow contrast washout

Correct Incorrect Correct answer

Necrosis within the mass

Correct Incorrect Correct answer

Relative large fatty content

Correct Incorrect Correct answer

A 36 years old male was involved in an all terrian vehicle accident on exam at the ER -alert blood pressure 150/90 , pulse 130 , room air saturation 94% , diffuse tenderness of right chest wall with decrease breathing sound on that side , chest X-ray demonstrates the following?

Chest tube draining over 800ml of fresh blood

Correct Incorrect Correct answer

Saturation of 80%

Correct Incorrect Correct answer

Chest tube that drains fresh blood of 300ml/h over several hours

Correct Incorrect Correct answer

Evidence of heart contusion on top of the lung contusion.

Correct Incorrect Correct answer

Sternal fracture

Correct Incorrect Correct answer

A 68 years old male with hypertension and hyperlipidemia has barrett’s esophagus for 8 years and undergoes annual gastroscopeas follow-up. High grade dysphasia is demonstrated on his last exam. What is the most recommend management ?

Decrease gastroscopy frequency to onc every 3 years.

Correct Incorrect Correct answer

Continue with annual gastroscopy

Correct Incorrect Correct answer

Increase gastroscopy frequency to once every 6 months

Correct Incorrect Correct answer

Esophagoctomy or endoscopic mucosal resection

Correct Incorrect Correct answer

Begin chemoradiation therapy

Correct Incorrect Correct answer

A 50 years old healthy female undergoes mammography. A mass is identified in her left breast at 9’oclock . Ultrasound is performed left breast 1.5cm mass with irregular margin 9’oclock , BIRADS 5 , with no lymphadenopathy. What is the most appropriate next step?

Excisional biopsy

Correct Incorrect Correct answer

Repeat US in 3 months

Correct Incorrect Correct answer

Corr neddle biopsy ( trucut )

Correct Incorrect Correct answer

Lumpectomy and sentinel axillary lymph node biopsy

Correct Incorrect Correct answer

Mastectomy and sentinel axillary lymph node biopsy

Correct Incorrect Correct answer

A 40 years old female undergoes total thyroidectomy due to Graves’ disease. Two hours following surgery she complains of nausea. On exam -pulse is 140 , temperature is 38.6c , she looks confused, surgical site appears normal without seedlings or erythema. What is the most appropriate management?

Broad spectrum antibiotics

Correct Incorrect Correct answer

IV L-thyroxine

Correct Incorrect Correct answer

Steroids

Correct Incorrect Correct answer

Alpha blockers

Correct Incorrect Correct answer

Proton pump inhibitors

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and E

Correct Incorrect Correct answer

A 45 yrears old healthy female with no prior admission or surgeries complains of right upper quadrant pain that started the night brfore. The pain was accompanied by some nausea but no vomiting or fever. Witch of the following sings can indicate the most probable diagnosis?

Rovsing’s sign

Correct Incorrect Correct answer

Murphy’s sign

Correct Incorrect Correct answer

Mcburny’s sign

Correct Incorrect Correct answer

Blumberg’s sign

Correct Incorrect Correct answer

Obturators sign

Correct Incorrect Correct answer

Wich of the following increase the risk for surgical site infection?

Hypothermia

Correct Incorrect Correct answer

Hypercholesterolemia

Correct Incorrect Correct answer

Increase oxygen delivery

Correct Incorrect Correct answer

Usage of antiseptic soap the evening before surgery

Correct Incorrect Correct answer

Body mass index (BMI) of 22

Correct Incorrect Correct answer

All of the following are targets of biological targeted therapy. Exept?

Estrogen receptors

Correct Incorrect Correct answer

HER 2

Correct Incorrect Correct answer

c-KIT

Correct Incorrect Correct answer

CEA

Correct Incorrect Correct answer

EGFR

Correct Incorrect Correct answer

All of the following can be the origin of sarcoma, except?

Adipocyte

Correct Incorrect Correct answer

Myocytes

Correct Incorrect Correct answer

Epithelial cells

Correct Incorrect Correct answer

Neurons

Correct Incorrect Correct answer

Bone cells

Correct Incorrect Correct answer

Which of the following tumors is characterized by the markers C-kit, DOG1, CD117?

Lymphoma

Correct Incorrect Correct answer

Liposarcoma

Correct Incorrect Correct answer

Carcinoid

Correct Incorrect Correct answer

Gastrointestinal stromal tumors (GIST)

Correct Incorrect Correct answer

Phyllodes tumor

Correct Incorrect Correct answer

In which of the following a sentinel lymph node biopsy will be added to lumpectomy?

Excision of phylodes tumor

Correct Incorrect Correct answer

Excision of lobular carcinoma in situ (LCIS)

Correct Incorrect Correct answer

Excision of invasive breast cancer (IDC).

Correct Incorrect Correct answer

Excision of atypical ductal hyperplasia (ADH)

Correct Incorrect Correct answer

Excision of breast papilloma

Correct Incorrect Correct answer

In which of the following scenarios follow up with breast MRI is recommended?

Female with history of breast cancer diagnosed at size less than 5 mm

Correct Incorrect Correct answer

A female following breast augmentation with silicone implants

Correct Incorrect Correct answer

A female whose mother and sister were diagnosed with breast cancer

Correct Incorrect Correct answer

Female taking hormone replacement therapy

Correct Incorrect Correct answer

Female diagnosed with Lynch syndrome

Correct Incorrect Correct answer

Which of the following procedures is recommended for a woman diagnosed with ductal carcinoma in situ (DCIS) involving most of the breast?

Lumpectomy and sentinel lymph node biopsy

Correct Incorrect Correct answer

Simple mastectomy

Correct Incorrect Correct answer

Radical mastectomy

Correct Incorrect Correct answer

Mastectomy with sentinel lymph node biopsy

Correct Incorrect Correct answer

Lumpectomy

Correct Incorrect Correct answer

A 32 year-old man is admitted for evaluation of an abdominal mass. Desmoid tumor is diagnosed in biopsy, which of the following is associated with high incidence of this tumor?

Neurofibromatosis

Correct Incorrect Correct answer

Familial adenomatous polyposis (FAP)

Correct Incorrect Correct answer

Ehlers-Danlos syndrome

Correct Incorrect Correct answer

Crohn's disease

Correct Incorrect Correct answer

Zollinger-Ellison syndrome

Correct Incorrect Correct answer

Which of the following is the most common retroperitoneal sarcoma?

Angiosarcoma

Correct Incorrect Correct answer

Gastrointestinal stromal tumors (GIST)

Correct Incorrect Correct answer

Liposarcoma

Correct Incorrect Correct answer

Desmoid tumor

Correct Incorrect Correct answer

Osteosarcoma

Correct Incorrect Correct answer

An 80 years female with several comorbidity as well as ishemic heart disease(IHD) is being elevated for 8cm rectal prolapse what is the most appropriate treatment?

Abdominperineal resection(APR)

Correct Incorrect Correct answer

Altemeier operation

Correct Incorrect Correct answer

Fiber rich diet

Correct Incorrect Correct answer

Stool softners

Correct Incorrect Correct answer

Proctotomy with total mesorectal exertion

Correct Incorrect Correct answer

An 88 years old bed ridder male with Parkinson disease and dementia is admitted due to sigmoid volvulus . fever 38c , vital signs are stable normal breath sound without peritonitis colonscopy reduce the volvulus but the mucosa seems necrotic with ulcers what is the most appropriate next step in treatment?

Urgent sigmodictomy and Hartman procedure

Correct Incorrect Correct answer

Rectal tube placement and observation

Correct Incorrect Correct answer

Repated colonscopy in several days

Correct Incorrect Correct answer

NPO , IV fluids and antibiotics

Correct Incorrect Correct answer

Colonic pexia

Correct Incorrect Correct answer

A young female with history of inflammatory bowel disease is brought to ER due to abdominal pain on exam fever of 39 c blood pressure 95/55 diffuse abdominal tenderness without peritonitis labs WBC 15000 PH 7.4 CRP=140 Abdominal x- ray very dilated large bowel with normal small bowel what is the most appropriate next step in management?

NPO,IV fluids , antibiotics and observation

Correct Incorrect Correct answer

Total proctocolectomy

Correct Incorrect Correct answer

Total abdominal colectomy

Correct Incorrect Correct answer

Decompression by colonscopy

Correct Incorrect Correct answer

Surgical exision with loop ileostomy

Correct Incorrect Correct answer

A or/and C

Correct Incorrect Correct answer

B or/and E

Correct Incorrect Correct answer

On pathology following an appendectomy a carcinoid tumor is diagnosed 1cm located at the tip, does not involve the base of the appendix no lymphovascular or mesoappendical invasion no lymph node involvement what is the most appropriate next strp in mangment?

Observation only

Correct Incorrect Correct answer

Diagnostic laproscopy

Correct Incorrect Correct answer

Right hemicolectomy

Correct Incorrect Correct answer

Resection of terminal ileum and cecum

Correct Incorrect Correct answer

Chemotherapy

Correct Incorrect Correct answer

A 40 year old female arrives to ER due to fever of 38.5 and right lowe quadrant abdominal pain on exam yenderness with focal pertontotis at RLQ labs are normal exept for WBC 18000 abdominal CT demonstrated divertivlotis of the right colon with no abscess free fluid or contrast leak what is the most appropriate intial treatment?

NPO, IV fluid and IV antibiotics

Correct Incorrect Correct answer

Colonoscopy

Correct Incorrect Correct answer

Right hemiloctomy with ileostomy

Correct Incorrect Correct answer

Right hemocolectomy with primary anastomosis

Correct Incorrect Correct answer

Fiber rich diet

Correct Incorrect Correct answer

A 32 year old alcoholic male who arrived some time ago from Jordan complains of right upper quadrant pain and fever for two days abdominal CT demonstraded a liver fluid collection peripheral ring enhancement in the right lobe serology is positive for Entamoeba histolica what is the most appropriate intial treatment?

Entamoeba therapy

Correct Incorrect Correct answer

Precutaneous drainage of fluid collection

Correct Incorrect Correct answer

Marsupialization of fluid collection

Correct Incorrect Correct answer

Surgical drainage of fluid collection

Correct Incorrect Correct answer

Liver resection

Correct Incorrect Correct answer

A 32 years old female present with agitation and dyspnea 2 hours following subtotal thyroidectomy on exam tachycardic with significant anterior neck swelling. What is the most appropriate treatment?

Tracheostomy

Correct Incorrect Correct answer

Reopen the neck incision

Correct Incorrect Correct answer

Measure serum calcum

Correct Incorrect Correct answer

Administrer morphine

Correct Incorrect Correct answer

chest x-ray

Correct Incorrect Correct answer

What are the most common metabolic changes following gasterectomy?

Low albumin

Correct Incorrect Correct answer

Iron deficiency anemia

Correct Incorrect Correct answer

Increased triglycerides levels

Correct Incorrect Correct answer

Hyperglycemia

Correct Incorrect Correct answer

Decreased cholesterol levels

Correct Incorrect Correct answer

Which of the following is correct regarding the use of NSAIDs?

There is no association between the dose and the risk for upper GI bleeding

Correct Incorrect Correct answer

There s no association between the dose and the risk for upper GI ulcers

Correct Incorrect Correct answer

The use of NSAIDs with steroids increase the risk for GI bleeding

Correct Incorrect Correct answer

The use of NSAIDs with anticoagulant dose doesn’t increase he risk for GI bleeding

Correct Incorrect Correct answer

Taking NSAIDs anove the age of 40 years increase the risk for GI bleeding

Correct Incorrect Correct answer

Which of the following is correct with regards to ASA surgical risk scoring?

There are 5 scores

Correct Incorrect Correct answer

There are 6 scores

Correct Incorrect Correct answer

The letter E stands for elective surgery

Correct Incorrect Correct answer

Score of 1 represents the highest risk

Correct Incorrect Correct answer

The score is the best predictor for surgical site complication

Correct Incorrect Correct answer

Childhood radiation exposure is the most important risk factor for which of the following thyroid malignancy?

Follicular carcinoma

Correct Incorrect Correct answer

Medullary carcinoma

Correct Incorrect Correct answer

Papillary carcinoma

Correct Incorrect Correct answer

Thyroid lymphoma

Correct Incorrect Correct answer

Anaplastic carcinoma

Correct Incorrect Correct answer

Which of the following determines a high malignancy potential in a patient with GIST?

Size larger than 2 cmand up to 5 mitoses per microscopic field

Correct Incorrect Correct answer

Size up to 2 cm and morethan 5 mitoses per microscopic field

Correct Incorrect Correct answer

Size larger than 10 cm and up to 5 mitoses microscopic field

Correct Incorrect Correct answer

Size larger than 5 cm and more than 5 mitoses microscopic field

Correct Incorrect Correct answer

Size 2-5 cm and more than 5 mitoses per microscopic field

Correct Incorrect Correct answer

Which of the following is a risk factor for wound dehiscence?

Use of synthetic suture

Correct Incorrect Correct answer

Prolonged use of steroid

Correct Incorrect Correct answer

Use of prophylactic antibiotics

Correct Incorrect Correct answer

Use of metal lips for skin closure

Correct Incorrect Correct answer

Use of mesh for fascia closure

Correct Incorrect Correct answer

Which of the following increase the risk of gastric cancer?

Fat and protein rich diet

Correct Incorrect Correct answer

Smoking

Correct Incorrect Correct answer

High socioeconomic class

Correct Incorrect Correct answer

Female gender

Correct Incorrect Correct answer

Low complex carbohyd

Correct Incorrect Correct answer

Which of the following is risk factor for postoperative pulmonary complications?

OR time over an hour

Correct Incorrect Correct answer

Use of local anesthesia only

Correct Incorrect Correct answer

Obesity

Correct Incorrect Correct answer

Diabetes

Correct Incorrect Correct answer

COPD

Correct Incorrect Correct answer

Which of the following causes fever as a result of infection alone?

Pancreatitis

Correct Incorrect Correct answer

Abdominal hematoma

Correct Incorrect Correct answer

Lung infraction

Correct Incorrect Correct answer

Diverticulitis

Correct Incorrect Correct answer

A calculous cholecystitis

Correct Incorrect Correct answer

B or/and C

Correct Incorrect Correct answer

D or/and E

Correct Incorrect Correct answer

Which of the following is true regarding groin hernia?

Women are at 2 fold risk for groin hernia in comparison to men

Correct Incorrect Correct answer

The most common hernia in men is direct hernia

Correct Incorrect Correct answer

FemorAl hernia is more common in men

Correct Incorrect Correct answer

Indirect hernia is the most common hernia in women

Correct Incorrect Correct answer

Indirect and femoral hernias are more common on the left than on the right side

Correct Incorrect Correct answer

Which of the following is correct regard anal fissure?

If the anal fissure is at a medial and not laterAl location then other comirbidities such as crohn diseases should be evaluated

Correct Incorrect Correct answer

Surgical treatment involve incision of the external sphincter muscle

Correct Incorrect Correct answer

Surgical treatment with sphincter muscle incision is inferior to topical medical treatment

Correct Incorrect Correct answer

Topical treAtment include b-blocker

Correct Incorrect Correct answer

Stool incontinence is a possible complication of surgical treatment

Correct Incorrect Correct answer

Which of the following is true regards to abdominal perineal resection?

It is also called miles operation

Correct Incorrect Correct answer

Stoma can be avoided by using meticulous surgical technique

Correct Incorrect Correct answer

Its not the preferred procedure when sphincters are involved

Correct Incorrect Correct answer

It is more suitable for patients with rectal tumor and no sphincter involvement

Correct Incorrect Correct answer

Anterior resection is the preferred procedure for patients with preoperative stool incontinence

Correct Incorrect Correct answer

What does TEM procedure stand for ?

Transumbilical endoscopic microscopy

Correct Incorrect Correct answer

Transanal endoscopic microsurgery

Correct Incorrect Correct answer

Transrectal endoscopic microscopy

Correct Incorrect Correct answer

Total endovascular microsurgery

Correct Incorrect Correct answer

Transvascular endoscopic microsurgery

Correct Incorrect Correct answer

Which of the following characterize amebic liver abcess in comparison to pyogenic (bacterial) abcess?

Amebic abcess is usually not associated with jaundice while pyogenic abcess is associated with jaundice

Correct Incorrect Correct answer

Amebic abcess is more common among age over 50 while pyogenic abcess is more common at 20-40 age

Correct Incorrect Correct answer

Amebic abcess usually present as several liver lesions while pyogenic abcess is usually a single liver lesion

Correct Incorrect Correct answer

Amebic abcess is more common in diabetic patients while pyogenic abcess is less common in diabetic patients

Correct Incorrect Correct answer

Amebic abcess is more common in female while pyogenic abcess is more common in male

Correct Incorrect Correct answer

Which of the following is correct regards to clinical suspicion of appendicitis?

Surgery is preferred over CT in male patients with symptoms of less than 48 hours and equivocal presentation.

Correct Incorrect Correct answer

Unpregnant females with symptoms of less than 48 hours and CT rulling out acute abdominal pathology can be discharged with no need for observation.

Correct Incorrect Correct answer

Surgery is recommended in unpregnant females with symptoms of less than 48 hours and CT is not needed.

Correct Incorrect Correct answer

Surgery is recommended in males with typical symptoms of less than 48 hours and CT is not needed.

Correct Incorrect Correct answer

CT is recommended in pregnant females with symptoms of less than 48 hours.

Correct Incorrect Correct answer

No answer is correct

Correct Incorrect Correct answer

All answers are correct

Correct Incorrect Correct answer

When is the correct timing for preop prophylactic antibiotics?

The evening before the surgery

Correct Incorrect Correct answer

Right before skin incision.

Correct Incorrect Correct answer

An hour or less before surgery

Correct Incorrect Correct answer

Two hours before surgery.

Correct Incorrect Correct answer

Three hours before surgery

Correct Incorrect Correct answer

Which of the following procedures is the best treatment for a 1,5 cm insulinoma located in the mid pancreas?

Enucleation

Correct Incorrect Correct answer

Wedge resection

Correct Incorrect Correct answer

Distal pancreatectomy

Correct Incorrect Correct answer

Duodenal sparing total pancreatectomy

Correct Incorrect Correct answer

Follow up

Correct Incorrect Correct answer

Which of the following is the most common complication of chronic pancreatitis?

Haemorrhage

Correct Incorrect Correct answer

Necrotizing pancreatitis

Correct Incorrect Correct answer

Pseudocyst

Correct Incorrect Correct answer

Duodenal obstruction

Correct Incorrect Correct answer

Pancreatic tumour

Correct Incorrect Correct answer

A 50 years old man undergoes esophagogastroduodenoscopy EGD for symptoms of vague intermittent abdominal pain. Areas of central gastritis are noted. Biopsies obtained show the presence of helicobacter pylori as well as low- grade, mucosa associated lymphoid tissue MALT lymphoma. What is the most appropriate initial treatment?

Observation with repeat EGD in 6 months

Correct Incorrect Correct answer

H.pylori eradication.

Correct Incorrect Correct answer

Radiation

Correct Incorrect Correct answer

Chemotherapy

Correct Incorrect Correct answer

Subtotal gastrectomy

Correct Incorrect Correct answer

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