Medpass Exam 2 الأمتحان القطري

A 20 year old woman without any medical history. Has irregular menstruation, every 35 80 days. Taking Rakuten because of Acne. An ultrasound image is attached. What is the best treatment for her
condition?

A 70 years old woman had a colporrhaphy due to pelvic organ prolapse 3 days prior to her presentation with left flank pain. Physical examination revealed severe sensitivity upon percussion and ultrasound shows severe hydronephrosis . Which following procedure is most likely to cause injury to ureter?

For which of the following you will give an oral combined contraceptive?

A 28 year old women with ASCUS in PAP smear, her colposcopy shows the picture below. What is your next step?

Which of the patients have the highest risk of developing ovarian hyperstimulation syndrome ( OHSS)?

Which of the following is not a risk factor for cervical carcinoma?

A 32 year old women has 2 children, trying to conceive beyond the last two years. History of 2 normal delivery and 2 termination of pregnancy with curettage. After the second termination she notice a significant reduction in the menstruation bleeding. Semen analysis of her husband: volume 3 ml, concentration 30 m/ ml, motility 60 %, morphology 5 %.

What is the next step for evaluation?

The definition of the third stage of delivery?

29 year old women without children, after 4 cycles of IVF without pregnancy. The picture below is from a test that you did for her.

What is the most appropriate step?

Which of the following is the most appropriate candidate for trial of labor after cesarean section ( TOLAC)?

Which of the following correct regarding semen analysis?

Which of the following is not considered a risk factor for Severe pre-eclampsia?

The most important prognostic factor in IVF ?

A woman is found to have oligohydramnios at 28 weeks of gestation. Which of the following is the most likely causes?

Which of the following is an absolute indication of the procedure in the image:

A nullipara 33 years old women, 40 weeks of pregnancy. Arrive to the emergency room with vaginal bleeding. Her vital signs: BP 100 55 ,HR 100 , temp 36.6 . the uterus is hypertonic. In the examination moderate bleeding. Biophysical profile is normal. Monitor with variable decelerations.
What is the most common diagnosis in this case?

A 90 years old with a history of heart failure underwent transvaginal hysterectomy and pelvic organ prolapse repair 10 years ago, she now presents with prolapse of the vaginal stump. Examination reveals prolapse grade 4 and trial of pessary insertion failed. What is the most appropriate treatment?

What is your recommendation for a diabetic woman pre pregnancy?

A 35 years old childless woman with irregular menstrual period. Her ultrasound demonstrates a thickened endometrium and biopsy reveal complex hyperplasia with atypia.
What is the most appropriate treatment?

39 years old, who gave birth 5 times vaginally is having now uncontrolled pregnancy diabetes. Last weight of the fetus is approximately 4100 gr. During delivery you are having difficulty to
deliver the shoulder after the head. What is the best next step?

24 year old women with dyspareunia and dysmenorrhea, in ultrasound a cyst of 2 cm in the right ovary. What is the most
appropriate treatment?

Which of the following is normal physiologic change during pregnancy?

Which of the following is a criterion for Bacterial Vaginosis?

A 35 year old in her second pregnancy. 6 weeks according to her LMP. She came to the emergency room because bloody discharge. Beta hCG 1700 , before two days it was 1500 . You demonstrate a tubal mass 15 mm and empty uterus.

What is the most appropriate step in this case?

A 30 year old woman has a colposcopy due to a finding of high grade squamous intra epithelial lesion ( HSIL) on PAP smear, the colposcopy report stated that the exam was unsatisfactory and the cervical biopsy revealed CIN 1 cervical intraepithelial neoplasia). Which of the following is the next therapeutic step?

Which of the following correct about Copper IUD ( Intrauterine device)?

How you will determine the stage in women with ovarian cancer?

A 42 year old woman with history of irregular menstruation, in the past 2 terminations of pregnancy. She is smoker. Which of the following
is the correct devise for her?

A 62 years old women had a endometrial biopsy due to vaginal bleeding. Biopsy result was endometrioid adenocarcinoma FIGO grade 3 .

What is the most appropriate treatment?

65 years old female, smoker and hypertensive, complains about exertional dyspnea and peripheral edema. Physical examination is normal including normal point of maximal impulse. On Echo study Ejection fraction of 60%, enlarged left atrium and moderate-severe pulmonary hypertension. What is the most common etiology for her condition?

55 years old male suffers from heart failure with reduced ejection fraction. He is treated with Enalapril and Spironolactone and yet still symptomatic. Echo study revealed 25% ejection fraction. Which drug you recommend to add to his regimen?

65 years old woman suffers from dyspepsia. gastroscopy shows wide and hypertrophic stomach folds as well as deep ulcers. Biopsy shows lymphocytic infiltration of MALT lymphoma. What is the treatment for this patient condition?

50 years old female comes to medical attention due to urinary symptoms and fever. Two days later urinary culture are positive for E. coli ESBL.  Which of the following is an appropriate therapy?

85 years old male with diffuse large B cell lymphoma comes to medical attention due to high spiking fever for the past two days. Blood cultures are drawn and treatment with ceftriaxone is started. Three days later he is still having spiking fevers, and blood cultures are positive for gram positive rods. What is the best next step?

A young asymptomatic cirrhotic patient with HBV DNA of 3000, liver enzymes 30-40 (normal levels). What is your recommendation regarding her cirrhosis treatment?

62 years old woman suffers from pain in her shoulders and right arm for the past two weeks. In the past month she suffers also from headache and fever up to 38. In her examination: non-palpable right sided temporal pulse, normal pulse in the left side. Lab: Hb 10, ESR 94. What is the initial treatment for this patient if we confirm the diagnosis?

10- 60 years old male complaints about dyspnea and chest pain for the past week. He has small cell lung carcinoma and undergoes Chemo therapy for the past two months. His blood pressure is 60/30 and heart rate 113, room air saturation 88% and his physical exam revealed remarkable JVP. An emergent bedside Echo study is performed.

What is the best therapy for his condition?

75 years old female suffers from stage 1 Chronic lymphoid leukemia complaints about dyspnea for the past month. On physical exam she has jaundice and her spleen is enlarged. Blood tests revealed Hemoglobin level of 5 mg/dL with normal WBC and platelets level, high LDH and low Haptoglobin. Blood smear show mild spherocytosis. Which of the following will confirm the diagnosis?

What is the most important prognostic factor in Acute myeloid leukemia?

Which of following is and indication for Chronic resynchronization therapy- CRT in Heart failure patient?

68 years old patient with diarrhoea and abdominal pain for several months. He undergone gastroscopy: esophagitis and several ulcers in the stomach, colonoscopy was normal, abdominal CT shows a mass attached to the second part of the duodenum. What test is expected to be high in the blood tests?

55 years old patient with Ulcerative Colitis since several years has high cholestatic enzymes for the past two years. Lab shows: AST and ALT around 50, ALP GGT around 300, AMA is negative. What is the best next step?

60 years alcoholic male presents with signs of heart failure. Echo study was performed and revealed and ejection fraction of 20%. He is started on beta blockers, ACE-I and furosemide. A month later he is asymptomatic but his ejection fraction is still 20%. He stopped drinking alcohol at diagnosis. What is the best next step?

50 years old woman comes to medical attention due to fever for the past two weeks. She had mitral valve replacement surgery two months ago. A blood cultures are withdrawn and she is suspected to have infective endocarditis. Echo study revealed a 10 mm vegetation on the prosthetic mitral valve. Which of following is the most likely pathogen for her condition?

67 years old man hospitalized with unstable angina and underwent PCI, he takes Beta-blockers, ACE-I, Aspirin and Clopidogrel. 5 days after his hospitalization his Creatinine raised from a base of 1.1 to 3 mg\dL, urine dipstick without protein or leukocytes, renal ultrasound is normal. What explains his condition?

Patient with end stage renal failure [stage 5], congestive heart failure, takes furosemide 120 mg daily was hospitalized due to worsening legs oedema. Furosemide dosage is elevated but without clinical response. He starts to suffer also from dyspnoea and massive weight gain. What is the best step in this patient management?

45 years old unconscious patient, does not respond to pain. On lab he has Hyponatremia of 112, potassium is Normal. His friend tells you that the patient took a pill of MDMA [ecstasy] several hours before admission. What is the treatment for this patient condition?

60 years old smoker and hypertensive male comes to the emergency room due to stabbing chest pain in midsternal area radiating to the back. Vital signs: blood pressure of 160/90 and heart rate of 120. Physical exam: diaphoretic and pale, weak pulses in legs and his left arm. His ECG looks normal. What is the next best step to diagnose this man condition?

83 years old patient comes to the emergency room due to hypokalaemia of 2.5 mg/dL.

In which situation you expect this patient potassium level in the urine to be low?

45 years old male comes to the emergency department due to chest pain. ECG reveal ST elevation myocardial infarction in lateral wall. He undergoes and emergent PCI and drug eluting stent is placed in his left circumflex artery. After two days of observation you plan to discharge him home today. Which of the following statement is correct regarding his medication regimen?

80 years old bedridden patient comes to hospital due to confusion. In lab test Sodium 160, and Potassium of 5. His blood pressure 120/80.  What is the best step in this patient management?

72 years old patient with asthma is treated with SABA, ICS in low dose. Recently she suffers from dyspnoea which interrupts her daily activity and awaken her twice a week at night. How should you manage this patient?

30 years old female comes to medical attention due to low consciousness. Medical history reveal that she gave birth to a child several months ago. On the ER her temperature is 39, and on lab: Hb 7 mg/dL, Thrombocytes 80000, Creatinine level 2 mg/dL. Direct coombs test is negative.  Blood smear is shown below. What is the best treatment strategy for this patient?

What is true regarding infectious lung abscess?

70 years old males diagnosed with new onset hypertension. On exam: Blood pressure 160/100, heart rate 55. On Lab: Sodium 142, Potassium 5. What is the best therapy for this patient?

55 years old male comes to consult due to fever, cough with sputum and dyspnea. He tells you that he has been on a cruise trip a week ago. On chest x-ray you diagnose pneumonia with CRUB-65 score of 0. You start treatment with Amoxicillin yet the patient still has symptoms after three days. You order a second chest x-ray which shows the same findings. On lab: mild leukocytosis and Sodium level of 128 mg/dL. What is the next best step?

27 years old male comes to medical consult due to gum bleeding for the past week. You perform a CBC which reveal 15% peripheral blast cells with promyelocytes. Bone marrow aspiration is performed and the patient is positive for t [15,17]. What is the cornerstone for his therapy?

70 years old female comes to medical attention due to palpitation for the past three days. Blood pressure 120/80, heart rate 100. Her ECG strip is shown below. She is known to be hypertensive and had TIA event several years ago.

What is best therapy for this patient?

A 65 years old man with dyspnoea performed pulmonary function tests:

TLC 160%             RV 180%

FEV 1.0 30%         FVC 60%

DLCO 60%

What is this patient most likely diagnosis?

45 years old female who underwent colon resection due to cancer removal several days ago, suddenly suffers from dyspnoea, tachycardia, and low blood pressure 80\40, her CXR is normal. What is the next step?

80 years old patient recently diagnosed with high grade lymphoma comes to medical attention due to palpitation. She tells you that she started therapy with R-CHOP. Labs: Creatinine 2 mg/dL, Potassium 6 mg/dL, Phosphor 8 mg/dL, Uric acid 12 mg/dL, Calcium 6 mg/dL and LDH 3000 [Normal range 120-360]. What is the diagnosis for her condition?

20 years old male was treated for the past two weeks with Penicillin for syphilis. Now he complaints about multiple diarrheal episodes. On lab: 20000 WBCs. Assuming you confirm the suspected condition, what is the best initial therapy?

20 years old man presents with fever and severe thigh pain. On exam you notice a scabby bite with red swollen and tender thigh. After a while he deteriorated, a spiking fever of 40, with blood pressure of 60/30 and severe tachycardia. What is the cornerstone for his treatment?

30 years old male comes to medical attention due to fever and seizures. After drawing blood cultures, starting intravenous antibiotic therapy and performing head CT test you decide to perform lumbar puncture. On LP: WBC 500, mainly neutrophils, glucose 30 mg/dL, Protein 200 mg/dL and high opening pressure. What is the diagnosis for this patient?

50 years old woman suffers from pneumonia. She is being treated with antibiotics for the past 5 days, but without any improvement. Repeat CXR reveal pleural effusion, a pleural fluid aspiration was performed: Milky fluid with glucose 20 and pH 6.9 was tapped.

What is the best next step in managing this patient?

Which of the following improve prognosis in a patient with COPD and emphysema in the upper lung fields?

Which of the following is a screening test for Cushing syndrome?

75 years old woman is 6 weeks pregnant. In her blood tests: TSH 7 [High], free T4 17 [Normal]. She is totally asymptomatic. What should you do for her lab findings?

78 years old woman who had Parathyroidectomy one week ago comes to medical attention with generalized weakness and tetany. What would you expect to be seen in her physical examination ?

39 years old patient suffers from ankylosing spondylitis. He takes NSAIDS on regular basis but still symptomatic. He is started on Adalimumab (Biological therapy). Two weeks later he develops rash, arthritis, myalgia and positive ANA test. Anti-histone test also is positive. What is the best step in this patient management?

Which antigen is specific to systemic lupus erythematous?

55 years old woman arrives to emergency room with severe confusion. Her blood pressure 220\120, pulse 90, temperature 37. In physical examination she has tense hands skin and ulcers in her fingers, small and fish-like mouth opening with telangiectasias on the face. Lab shows: Potassium 4, Urea 50, Creatinine 2.5. What is the best treatment for this patient?

82 years old patient with Squamous Cell Carcinoma of the lungs, arrives with weakness and fatigue, and signs of dehydration. He has calcium level of 14 mg/dL. What other findings on blood tests you expect for this patient?

Which of the following are the most likely physical examination finding in a patient with emphysema?

A patient is treated for UTI. Two days later he develops renal failure, hypokalemia and hypomagnesemia. Assuming that the following are secondary to his antibiotic therapy, which antibiotic he is treated with?

Which of the following is the first step in the treatment of diabetic ketoacidosis?

55 years old man with dyspnoea worsening in the last month as well as headache and facial swelling, and prominent veins in his chest wall, he has an elevated JVP in the left side. He is known to be a heavy smoker, and he reports losing 20 kg over the past 6 months. What could explain his symptoms?

23 years old type I Diabetes Miletus patient comes to medical therapy due to nausea and vomiting. On admission an acetone smell from her mouth, she is in moderately dyspnoeic and her abdomen is tender. On lab Glucose 450 mg/dL, potassium 2.5 mg/dL, pH 7.1, Bicarbonate 10 meq. What is the best next step in her management?

Which of the following is NOT a side effect of furosemide?

Which of the following is NOT a cause of secondary hypertension?

60 years old male comes to medical attention due to hemiplegia that started 2 hours before admission. After a quick diagnosis you diagnose ischemic stroke on head CT. On lab thrombocytopenia 55000, Creatinine 3 mg/dL, AST 300 mg/dL. On ECG new onset atrial fibrillation. Which of the following is contraindication for thrombolysis therapy in

this patient?

32 years old female develops DVT in her right leg two weeks after delivery. Lab workup a month later reveal positive B2 Glycoprotien antibodies and positive Lupus anticoagulant and Anticardiolipin. Which of the following is the best management in this patient?

Which of the following is NOT a sign for severe aortic stenosis?

A 65 years old patient comes to medical attention due to high grade fever. On admission his blood pressure is 60/30 and his fever 39.5. You start IV fluids and IV antibiotics and he is stabilized. On lab: WBC 20,000 Hb 10 mg/dL and thrombocytopenia 85000, PT 30 seconds PTT 45 seconds [both prolonged] and fibrinogen 80 mg/dL (Low). On smear- several schistocytes. Which of the following is NOT part of this patient therapy?

A 55-year-old man is seen due to palpitation. Examination is notable for a blood pressure of 112/68 mmHg and heart rate of 180 beats/min. ECG is attached. With carotid sinus massage, the heart rate

transiently drops to 130 beats/min, but then returns to 180 beats/min. Which of the following is the most

appropriate next step in management?

Which of the following is NOT an appropriate treatment for osteoporosis?

The most common cause of a pleural effusion is:

57 years old patient with cirrhosis secondary to non-alcoholic steatohepatitis, was discovered to have oesophageal varices in screening test. There is no symptoms or history of variceal bleeding.

What is your recommendation for this patient?

A 4 days infant has not yet transferred meconium. What is most likely to be found in anamnesis or tests?

5 years old boy with fever for 6 days. In addition, chapped lips, peeling at the tips of the fingers, enlarged cervical lymph
node 2 cm, redness in both eyes, and a rash in the limbs. What is the treatment?

A 7 year old, generally healthy, was admitted to the emergency room due to the rash shown in the photo that
appeared in the last few days. He looks well, Laboratory test platletes , wbc , hemoglobin normal.

Which of the following is an indication for steroid treatment?

A few hours age newborn looks cyanotic and suffer from respiratory distress. Physical examination shows tachypnea , loud
S2 with no murmurs, room air saturation is 65 %. After connecting him to 100 % oxygen mask the measured saturation
increases to 68 %. What is he most likely diagnosis ?

A child born to African immigrant parents, presented with neck stiffness and strabismus and 3 weeks of high fever. His
blood glucose 95 mg/ dL . CSF glucose 10 , protein 1200 ,WBC 95 with 80 % lymphocytes. Which of the following is most
likely pathogen for this child condition?

A 3 months old infant was first exposed to cow&# 39 ;s milk.Till now he has been breastfeeding only. One day later he is
admitted to ER due to bloody stools. The child looks well, What is your recommendation?

A two years old child arrives to ER due to high fever and cough. In his examination he is pale, pulse 160 , BP 70 40 , slow
capillary filling, enlarged and sensitive spleen. About six months ago he suffered a similar event treated with a blood
transfusion. In lab: Hb 7 , reticulocytes 4 % [High]. His blood smear is attached. Which of the following could
prevent this situation in the future?

A 6 year old girl, hospitalized due to a prolonged fever of 12 days, is accompanied by findings in the attached picture. After
IVIG treatment, no improvement was observed. What is the recommended treatment now?

A boy suffers from eczema without improvement under steroid and anti histamines therapy. Known for hospitalizations
due to pneumonia. In blood tests: small platelets and thrombocytopenia 17,000 . Leukocytes and hemoglobin are
normal. What is the definitive treatment?

Which of the following conditions is absolute contraindication to a diagnostic lumbar puncture?

A newborn infant born from a mother with polyhydramnios presents with excessive salivation along with coughing and
choking with the first oral feeding. An x ray of the abdomen shows gas in the stomach and a nasogastric tube
coiled in the esophagus. Which of the folloewing is most likley assosiated with the diagnosis ?

you was called to test a one day old newborn, due to a rash, in his test a temperature of 36.5 degrees, a pulse of 80 per

minute, 40 breaths per minute, which of the following tests will confirm the reasonable diagnosis?

A 12 years old has a history of atopic dermatitis at the age of one years old. Now he has difficulty swallowing solids but can
swallow fluids. He also reports frequent epigastric pain and recurrent non bloody vomiting.

Which is the first step treatment?

Two years old boy is admitted to the emergency room due to multiple vomiting, respiratory distress accompanied by fever up
to 40 . At his admission pulse 150 , respiratory rate 45 , and saturation 98 %. At lab mildly elevated WBC and CRP extremely
high, sodium 128 , potassium 4 . A chest photograph was attached. What is the most common pathogen for his condition?

The state laboratory calls your office telling you that a newborn infant, now 8 days old, has an elevated TSH and low T 4
on his newborn screen. If this condition is left untreated the infant is likely to demonstrate which of the following in the first
few months of life?

10 years old boy whose parents did not perform any geneticpre pregnancy tests, suffer from metabolic disturbances. In
physical exam: Large protruding ears. What else is characteristic of this syndrome?

16 years old girl suffer from occasional headaches. The headaches are bilateral and squeezing and lasts several hours.
They occur once a month. On social history you learn that she missed few weeks of school but continues to meet with friends.
She has no significant medical history. She denies weight loss, nausea, vomiting. Her physical examination is normal. Her
mother suffers from headache attacks too. What is the most probable diagnosis?

A 14 year old boy was examined at the clinic forgynecomastia ( see picture ). In his test a tall boy with small
testicles, in laboratory an increased FSH, what test is required for further diagnosis?

Which of the following is most associated with increased risk of asthma persistence in adulthood?

A 5 months old boy whose diet is based on goats ’ milk only and has not yet started solid
food. In lab: anemia with MCV 95 , reticulocytes 1 %. What is the appropriate treatment?

A child suffers from polydipsia and polyuria for the past several weeks. After fasting during the night, in morning tests:
blood sodium 151 , osmolarity in urine 100. What is the most likely diagnosis?

A 3 weeks old male infant is eating poorly, has repeated emesis, and has not regained his birth weight. On physical
examination he appears dehydrated and is noted to have increased pigmentation of skin creases and genitalia. In addition
to measuring electrolytes, assay of which of the following hormones would be most informative?

What is the treatment of Q 73

A two years old infant develops severe urticaria two minutes after exposure to Bamba . He has also facial swelling and
respiratory difficulty. His GCS 15 , with hypotension and 91 % saturation. Wheezing is heard on auscultation to the lungs.
What is the initial treatment required for this condition?

A one week old baby, healthy so far and well breastfed, comes with recurrent vomiting. The mother brought a jar of
vomit with blood spilled in the milk. The mother has cracked nipple. During his stay at the ER he breastfeeds without vomiting.

How should the investigation be continued?

A 2 years old boy has been awakening at night a lot and is restless in recent days. While replacement of his diaper his
mother notices white worms in the anus. What is true about the disease?

Which of the following vaccines is not performed for six months old child vaccinated under the Israeli plan?

Witch of the following can be a complication and cause of mortality in cystic fibrosis?

A boy who swallowed a battery a day ago comes to the ER.

The battery is seen on x ray it in the middle esophagus, what’s the treatment?

A baby was born at week 36 at instrumental birth, a day later represented with jaundice, bilirubin measured 11 mg/ dL , mostly
direct. Physical examination is normal. Feeding is from breastfeeding. What is the most appropriate explanation for his jaundice?

A 3 months old girl arrived at your clinic with swelling of the arms and legs, excess skin in the neck, distant nipples and
systolic murmur 2 6 border at the left side of the sternum. Which sentence fits the above syndrome?

5 years old, comes to clinic due to unstable gait with aggravation in recent years, in his examination nystagmus , and
the findings appearing in the attached picture . Also He was hospitalized several times due to recurrent pneumonia,

What is likely to be found in addition?

A newborn infant with stigmata of Down syndrome. Which of the following lesions is most likely associated in this baby?

During a preschool physical, the mother of a 5 year old girl states the family follows a strict vegan diet (a diet excluding all
animal products including eggs, milk, and milk products, as well as meats and fish). which of the following symptoms is this child
likely to have?

A 3 months old infant is brought to the hospital because of altered mental status changes. Examination shows a sleepy baby
who is difficult to arouse. Fundoscopic examination shows retinal hemorrhages. Examination otherwise is unremarkable. What is
the best next diagnostic test?

A 12 years old boy just returned from Boy Scout Camp in United states. He now has fever, myalgia .

You suspect Lyme disease, which of the following is true ?

You examine an 18 years old male college student with a 5 day history of fever, sore throat, and fatigue. Physical
examination reveals an exudative tonsillitis and bilateral enlarged and slightly tender posterior cervical lymph nodes. The
spleen is palpable 3 cm below the rib cage. In which of the following conditions you give him steroids?

A 6 years old girl presents with unilateral nonpainful , nonsuppurative conjunctivitis and
preauricular lymphadenitis. What is the most likely causative organism?

An 8 months old child has vomiting and screaming episodes for 12 hours. Physical
examination reveals a sausage shaped mass in the right upper quadrant.

Which of the following is the first step procedure for diagnosis ?

A newborn has delayed passage of meconium stools and barium enema radiograph shows dilated proximal colon and
small obstructed distal colon. What should be the next diagnostic test?

A previously healthy, active, 18 month old African American child presents with unilateral nasal obstruction and foul smelling
discharge. The child s examination is otherwise unremarkable. Which of the following is the most likely diagnosis?

An 18 months old child presents to the emergency center having had a brief, generalized seizure. He is now postictal and
has a temperature of 40 c. During the lumbar puncture (which ultimately proves to be normal), he has a large, watery stool that
has both blood and mucus in it. Which of the following is the most likely diagnosis?

The most common sequel associated with bacterial meningitis is?

Characteristic clinical manifestations of Duchenne Muscular Dystrophy include?

Which of the following is a side effect of Growth hormone treatment?

A newborn to a diabetic mother is noticed to have a flank mass and red skin during physical examination by the doctor.
Lab High Hb and hematocrit , low platelets. Urine dipstick hematuria without WBCs. What is the most likely diagnosis?

A newborn baby girl who was born at term weighing 2100 g is noted to have blueberry type skin lesions, mild icterus , and a
large spleen on palpation. The eye examination is grossly normal, but brain imaging shows periventricular calcifications. What is
the most likely diagnosis is?

A newborn infant presents with skin lesion typical of erythema toxicum . What is the most likely management?

A baby girl arrives at the clinic with this finding, what is the additional finding that may be revealed on an eye examination?

Two months old infant hospitalized for bronchiolitis . He looksapathetic with 70 breaths per minute, his pulse is 180 per
minute. His parents tell you that at home two of his brotherssuffer from rhinitis. In the examination of arterial blood gases:
pO 2 50 mmHg
pCO 2 70 mmHg
What is the appropriate treatment?

A 49 year old patient with bipolar disorder treated with lithium, comes to the ER with abdominal pain and vomiting. Upon examination,
there is tremor and dysarthria. Which has most likely happened?

A person with schizophrenia in full remission under treatment of clozapine. In a regular CBC 2,000 WBC and 500 neutrophils. What to do?

What differentiates bupropion from SSRI?

A 30 year old female with schizophrenia, stable on monotherapy of risperidone, complains of weight gain.
What is the best alternative of treatment?

A 6 th year medicine student comes to the clinic during final test period. He complains that ever since the second year he has been feeling down, feeling he is a failure ””, low self-esteem. Also, he has lost interest in the studies, and for the past years, has been spending watching TV series, though not enjoying them. He complains of low sexual drive.
Appetite and sleep are normal. During examination, he reveals he would rather die, but denies any suicidal plans or intent.
What is the most likely diagnosis?

A therapist feels sexual attraction to his patient. He notices she uses the same perfume as his wife. What is the mechanism?

What remits last in ADHD?

I know I make up the symptoms, but I don’t know why …”, what is
the likely disorder?

A 40 year old male patient comes to the ER, 15 minutes after he had a fight with his wife, and complains of shortness of breath,

chest pain and paresthesia in the fingers and around the mouth.
What is the first thing to do?

A 78 year old patient was accompanied by his daughter to the emergency room. Several months ago, he fell into his home and since then

has gradually decreased his social functioning and ability to lead independent life. He is worried about being left alone.

Upon examination, low cooperation, dysphoric affect, often asks to stop the test due to fatigue and often answers I do not know ””;

, results of his cognitive test are inconsistent. What is the most likely diagnosis?

What is a common side effect of valproic acid?

A 27 year old is diagnosed with schizophrenia. In his examination, only negative symptoms are identified.
Which of the following can be found?

A 30 year old female, who works at an advertising agency, usually healthy. She says that lately she feels very good, only needs 4 hours of
sleep a night and does really well at work. Her parents bring her to a psychiatrist because they are worried and say she is talking too fast.
What should be done?

A 23 year old female patient referred to psychiatric clinic by her family physician. She says she needs to check if the doors are closed in
her house, repeatedly, otherwise something bad will happen ””. This has been going for several years now.
What is the most appropriate treatment for her condition?

A 23 year old patient is hospitalized in a psychiatric ward due to a psychotic episode. He is treated with diazepam, carbamazepine and
risperidone for two weeks. Now he is referred to a general ER due to sweating, fever, hypertension and acute confusion.
What will be used to treat his condition?

A 21 year old female is referred to psychiatric consultation due to mood swings. After a thorough examination, the psychiatrist thinks the
diagnosis is borderline personality disorder. Which of the following findings is supportive of this diagnosis?

Which of the following is specifically aimed at suicidal gestures?

A 60 year old woman was brought to the hospital by her children. They say that for about a month she has a low mood, does not get out of bed,
refuses to eat. She tried recently treatment with escitalopram but did not take the medication regularly. In the ER, she I lying on the bed motionless
with eyes open. In response to the question & quot; “How do you feel”? ; she answers:”How do you feel” ?
What is the recommended treatment?

A 22 year old yeshiva student referred to the clinic because of distress following thoughts that forced him to repeat prayers repeatedly. He thinks he
may not have said the prayers correctly and with enough intention. He says he finds himself devoting several hours every morning to prayers and finds it
difficult to perform his daily tasks. What is the most appropriate intervention?

What makes a good prognostic factor of psychotic episode?

which of the following is true regarding acute upper gastrointestinal bleeding ?

70 years old male is admitted to the ER duo to fever, chills right upper quadrant pain and scleral jaundice , abdominal
ultrasound demonstrates cholelithiasis with bile duct dilation. which of the following tests is included in this patient?

35 y old male arrives to the ER directly from the airport describing abdominal pain in the past 4 days, associated with vomiting during
his trip to Africa. The pain was diffused and after several hours it localized to the lower abdomen he was treated there with IV fluid
and analgesics with temporary improvement he now complains of RLQ pain and fever with decreased appetite and no vomiting. On
examination he has RLQ tenderness and guarding.

Which of the following will be included in this patient management ?

A 50 year old male complians of melena and fatigue .in the ER he is hemodynamically stable with fresh blood in his nasogastric tube.

gastroscopy demonstrates an exposed blood vessel that bleed in the submucosa in the lesser curvature about 6 cm from the gastro esophagyeal junction .

what is the most likely diagnosis?

A previously healthy 70 year old male is admitted to the ER due to bloody bowel movements. he never had a colonoscopy
performed and he does not take any medications. his abdomen is soft without tenderness .there is bile in the nasogastric tube
and fresh blood on rectal examination .which of the following is the most common etiology of this bleeding?

A 50 year old male is diagnosed with primary hyperaldostronism a CT scan demonstrated a 1 cm right adrenal
nodule and a 1.5 cm left adrenal nodule . which of the following is next step in this patient;s evaluation ?

60 y old healthy female undergoes virtual colonoscopy (abdominal ct ) gallstones are suspected and later confirmed by
abdominal US there is no history of pancreatitis or jaundice but the patient does describe reflux that is dependent on food types
and responds well to anti acid tablets with of the following is recommended treatment :

what does damage control mean when treating trauma patient ?

A 40 year old female is diagnosed with a 1.2 cm isoechoic regular border ,nodule of the left thyroid lobe. TSH; 0.5( nl 0.5-4.5 )

what is the most appropriate next step in her evaluation ?

A 40 year old male undergoes FNA of a 2 cm thyroid nodule.In which of the following repeat FNA (only) is recommended ?

a 60 years old female is admitted for evaluation of gastric cancer, on gynecological examination and rectal examination an
extensive fullness is palpated in the pelvis and is suspicious for tumor spread, what is the name of this pathology?

33 years female is admitted with acute cholecystitis what is the preferred timing of cholecystectomy in this patient?

All of the following are a part of Reynolds;s pentad in cholangitis except ?

What is the most common etiology of chronic pancreatitis?

17 years old male was stabbed by knife above the umbilicus on examination he is hemodynamically stable, abdominal CT
with iv contrasts does not demonstrating free air or fluid, the patient is admitted for observation 6 hours later the patient
develops diffuse abdominal tenderness, what is the most appropriate treatment at this point?

45 yr old female , no previous admission or surgeries , came with right upper quadrant pain that started at evening ,
accompanied with nausea , no vomiting or fever , which of the following signs approve the Dx ?

Healthy 45 years old male came to the ER with epigastric pain ,the patient reported severe pain started at 10 am , at physical examination
:HR 110 , BP 90 60 , T 38.5 . significant epigastric with guarding rebound Labs: 18000 wbc , 18 % stab HB 14 chest X-ray show free
air under diaphragm .what should be the next step in treating the patient ?

45 years old male is admitted to the ER with acute appendicitis, appendectomy was performed. Later on,

on pathology 0.6 cm carcinoid tumor at the tip of the appendix was detected , no lymphatic invasion , and the dissection resulted in

free(clear) margins

55 years old female with primary hyperparathyroidism which of the following is an indication for surgery ?

A 2 cm invasive cancer of the proximal transverse colon should be treated with :

The treatment of choice for chronic anal fissures is :

An absolute contraindication to breast conserving surgery for breast cancer is :

Meckel’s diverticulum :

Gastrointestinal diverticula do not occur in :

The diagnostic test of choice for suspected acute sigmoid diverticulitis is :

Small bowel obstruction in an elderly female without external hernia or previous surgery is most likely caused by :

The optimal management of traumatic duodenal hematoma is: