State Exam 18.02.

2013
By: Alhag Abu Anzeh Muhammad (baghdats@yahoo.com)
Part A:
1. The breast fed infant of a mother who is a strict vegetarian ma ex!erience deficienc of which of the fo""owing vitamins if the
mother is not receiving s#!!"ements of the vitamin$

A. %it &1
&. %it &'
(. %it &12
). %it (
E. %it )

2. A *+ear+o"d gir" who was !revio#s" hea"th !resents with a 1 wee, histor of noct#rna" !eriana" itching. There are no other
sm!toms and findings on !hsica" examinations are norma". The most a!!ro!riate thera! is:

A. &acitracin ointment to the !eriana" area
&. )i!henhdramine ora"" as needed for itching
(. Sing"e ora" dose of mebenda-o"e re!eated in 2 wee,s
). A 2 wee, co#rse of amoxici""in.c"av#"anate
E. /etocona-o"e in a sing"e dose

3. A chi"d s#ffers a !rovo,ed bite from a stra dog that was ca!t#red b anima" contro" and a!!ears hea"th. The most a!!ro!riate
action wo#"d be to:

A. (onfine and observe the dog for 10 das for signs s#ggestive of rabies
&. S#bmit the dog0s head for examination for rabies
(. &egin rabies vaccination
). Administer h#man rabies imm#ne g"ob#"in 123456 and begin rabies vaccination
E. 7one of the above beca#se it was a !rovo,ed attac,

'. A menta"" retarded 1'+ear+o"d bo has "ong face8 "arge ears8 micro!enis and "arge testes. (hromosoma" ana"sis is "i,e" to
demonstrates which of the fo""owing$

A. Trisom 21
&. Trisom 18
(. Trisom 13
). 9ragi"e : sndrome
E. ;i""iams sndrome

<. A 10+ear+o"d bo is examined beca#se of rec#rrent headaches. The headaches started * months ago and occ#r abo#t once a month.
2e is asm!tomatic between e!isodes. Each headache begins with b"#rr vision and abdomina" !ain8 fo""owed b right+sided8 throbbing
!ain. 4t "asts abo#t *0 min#tes8 d#ring which he fee"s better if he ta,es some ib#!rofen and rests in a dar,ened room. The most "i,e"
diagnosis is:

A. &rain abscess
&. Sei-#re disorder
(. =igraine
). Todd0s !ara"sis
E. =axi""ar sin#sitis


*. A 2+ear+o"d bo is seen in o#r office beca#se of fever8 ear !ain8 and !osta#ric#"ar swe""ing8 erthema8 and tenderness. The !inna
!rotr#des o#t on the invo"ved side. The tm!anic membrane is red and b#"ging8 with decreased mobi"it seen on !ne#matic otosco!.
The ang"e of the >aw is easi" !a"!ated and the o!ening to Stensen?s d#ct a!!ears norma". The !atient has never had an ==3 vaccine.
The most "i,e" diagnosis is:

A. &acteria" !arotitis
&. =#m!s
(. Externa" otitis
). Ac#te mastoiditis
E. (hronic mastoiditis

@. 7ew !arents as, o# how to red#ce the chance of their bab s#ffering from s#dden infant death sndrome 1S4)S6. Ao# te"" them to
!"ace the chi"d in which of the fo""owing for s"ee!$

a. S#!ine !osition
b. Prone !osition
c. Seated !osition
d. Trende"enb#rg !osition
e. A hammoc,

8. An 8+ear+o"d gir" is bro#ght to the hos!ita" whi"e active" sei-ing. She has been hos!ita"i-ed man times before for stat#s e!i"e!tic#s.
She is receiving va"!roic acid at home to contro" the sei-#res. The first ste! in the management of this !atient is to:

A. Administer 20 mB.,g 0.CD norma" sa"ine
&. Estab"ish sec#re intraveno#s access and administer an anticonv#"sant
(. Administer activated charcoa" via 75 t#be
). Stabi"i-e airwa and !rovide 100D oxgen
E. Perform gastric "avage

C. A <+ear+o"d bo !resents with a histor of gross" b"ood #rine8 !#ff ees8 and headache for one da. 2e has been a we"" deve"o!ed
chi"d8 b#t he did have a fever and sore throat abo#t 10 das ago which reso"ved witho#t treatment. The most "i,e" diagnosis is:

A. Ac#te cstitis
&. 4gA ne!hro!ath
(. Ac#te !e"one!hritis
). Postinfectio#s g"omer#"one!hritis
E. &enign hemat#ria

10. A 3+r+o"d bo !resents to an #rgent care c"inic with a 3+da histor of abdomina" !ain and diffic#"t wa",ing. Abnorma" findings
inc"#de b"ood !ress#re of 120.80 mm 2g8 diff#se abdomina" tenderness8 !#r!#ric rash of the hands and an,"es8 and diff#se !eriartic#"ar
tenderness and swe""ing of the an,"es. The most "i,e" diagnosis is:

A. Sstemic "#!#s erthematos#s
&. /awasa,i0s disease
(. E#veni"e rhe#matoid arthritis
). 2enoch+Sch n"ein !#r!#ra
E. Stevens+Eohnson sndrome






11. ;hat is the most significant serio#s com!"ication arising from /awasa,i disease$

A. (oronar ane#rism
&. /idne fai"#re
c. Stro,e
d. P#"monar embo"ism
e. Ac#te "e#,emia

12. A 12 months o"d ma"e infant =editerranean origin noted to have !a""or and has been fed simi"ac with iron since birth 8his exam
otherwise norma" exce!t for !a"!ab"e s!"een .2&:C.C . =(%:*@.=(2(:32.3);:12.3etic#"octe 1.<D .PBT:2'0000 which one is tr#e$
a. 2b "eve" of C.C gm.d" is the "ower "imit of norma" for this 12 months o"d
b. The dietar histor is !robab" not tr#e since the !atient is iron deficient
c. The retic#"octe is high s#ggest hemo"tic !rocess
d. The infant m#st he "osing b"ood and stoo" sho#"d be chec,ed for occ#"t b"ood
e. 2g e"ectro!horesis sho#"d ma,e the correct diagnosis

13.1< ear o"d com!"aining of fever8 abdomina" !ain8 sex#a"" active with 2 !artner com!"aint of ds!are#nia on examination e""ow
thic, vagina" discharge b#t no visib"e genita" "esion most !robab" infected with:
a. 2.inf"#en-a
b. (andida a"bicans
c. (h"amidea !a""ed#m
d. Tre!enoma
e. 2#man !a!i""oma vir#s

1'. Parents awa,ened at night b 2 ears o"d son deve"o! nois breathing ins!iration 8mar,ed retraction of chest 8f"aring nostri" 8bar,ing
co#gh has mi"d #!!er res!irator tract infection 2 das ago. ;hich the most "i,e" diagnosis:
a. Asthma
b. E!ig"ottitis
c. &ronchi"itis
d. %ira" cro#!
. e 9oreign bod in 3T bronch#s

1<. The most im!ortant extra med#""ar site for re"a!se in chi"dhood ac#te "m!hatic "e#,emia 1ABB6:
a. Adrena" g"and
b. /idne
c. B#ng
d. 2eart
e. (entra" nervo#s sstem

1*. 7ewborn deve"o!s se!sis and shoc, which !athogens most "i,e" can sstem or foca" infection of newborn:
a. Sta!h a#rea#s
b. 5ro#! A stre!t
c. 5ro#! & stre!
d. E.co"i
e. 2er!es sim!"ex vir#s


1@. A ' ears o"d gir" seen 10 das fo""owing #!!er res!irator infection 8her ,nees and an,"e swo""en and !ainf#" and tem! 3C ( 8cardiac
examination '.* ssto"ic m#rm#r at the a!ex8 antistre!to"sin titer high. These findings consist with:
a. Ac#te rhe#matic fever
b. Se!tic arthritis
c. E#veni"e idio!athic arthritis
d. %ira" !ericarditis
e. Ac#te "e#,emia

18.12 ears o"d bo !resented with 2' h histor of shar! !"e#ritic chest !ain worsen in s#!ine !osition8 tem!erat#re 38.< (8 !ericardia"
r#b is heard. The most "i,e" diagnosis is:
a. =#sc"os,"eta" chest !ain
b. Pericarditis
c. &acteria" endocarditis
d. =co!"asma !ne#monia
e. P#"monar embo"ism

1C. The most common ca#se of snco!e in chi"dhood:
a. Tachcardia ass with wo"f !ar,insonian white sndrome
b. Bong F+T sndrome
c. &reath ho"ding s!e""
d. 2!ertro!hic cardiomo!ath
e. 7e#rocardiogenic snco!e

20. A * wee,s bo ,nown congestive heart fai"#re d#e to cardiomo!ath ;g ' /g ta,en 3*0 m" form#"e dai" 8which of the fo""owing
most "i,e" conseG#ence of decrase inta,e in this infant:
a. 2!oca"cemia
b. 2!og"cemia
c. 2!o,a"emia
d. Poor growth in "ength
e. Poor weight gain

21. The stinging insect most "i,e" to ca#se an ana!h"actic reaction in a chi"d is:
A. =osG#ito
&. Sand f"
(. 2one bee
). Ant
E. 2ead "ice

22. The chest x+ra of a 3+da infant with congenita" heart disease demonstrates an abnorma"" sha!ed heart and no thmic shadow.
;hat imm#nodeficienc sho#"d o# s#s!ect$
A. Ataxia+te"angiectasia
&. :+"in,ed h!er+4g= sndrome
(. ;is,ott+A"drich sndrome
). )i5eorge sndrome
E. Be#,octe adhesion deficienc



23. A 12 month+o"d infant was diagnosed with :+"in,ed agamag"ob#"inemia8 a recessive &+ce"" deficienc after having had m#"ti!"e
sino!#"monar tract infections s#ch as otitis media8 sin#sitis8 and !ne#monia. ;hat is an a!!ro!riate treatment for him$
A. P"asma!horesis
&. 4ntraveno#se imm#nog"ob#"in
(. (hemothera!
). 2igh dose steroids
E. En-me re!"acement thera!

2'. A mother of a *+ear+o"d gir" states that her da#ghter0s academic !erformance has decreased d#ring the "ast ear. 2er teacher
notices her staring freG#ent" thro#gho#t the da. Sometimes she seems Hoff in her own wor"dH and does not res!ond to G#estions. An
EE5 examination revea"s a 3+2ert- genera"i-ed s!i,e and wave !attern. ;hat sei-#re t!e is this !atient most "i,e" to have$

A. Absence
&. TonicIc"onic
(. =oc"onic
). Sa"aam attac,s
E. (om!"ex !artia"


2<. A 2.< ear o"d bo is seen beca#se of a second febri"e sei-#re. The two e!isodes occ#red ' months a!art and described as
genera"i-ed tightening of the bod fo""owed b >er,ing invo"ving a"" fo#r extremities and "asting 3 to < min#tes each time. Jn both
occasions the tem!rat#re was 38.8K(. At this time8 o#r recommendation wo#"d be:
A. 9#rther tests inc"#ding EE5 and =34 scan
&. Treatment with !henobarbita"
(. Treatment with va"!roate
). Admit to hos!ita" for cardiac res!irator monitoring
E. Ed#cation and co#nse"ing for the fami"

2*. The s,i""s of ,ic,ing a ba"" and >#m!ing in !"ace are gross motor mi"estones that occ#r at which age$
A. 1< months
&. 18 months
(. 2' months
). 30 months
E. 3* months

2@. &ased on orientation to chi"d deve"o!ment8 when wo#"d o# te"" !arents the highest ris, of accidenta" !oisoning in chi"dren is
!resent$
A. * months
&. 1 ear
(. 2 ears
). ' ears
E. * ears

28. ;hich of the fo""owing is a freG#ent manifestation of enterovir#s infection$
A. Ataxia
&. 4nt#ss#sce!tion
(. Parotitis
). 2er!angina
E. 3ena" fai"#re
2C. A *+ear+o"d gir" is hos!ita"i-ed after a conv#"sion. Jn examination she is a"ert and witho#t distress. Jn her s,in o# notice the
!resence of cafe+a#+"ait s!ots8 a Shagreen !atch8 and s#b#ng#a" fibromas. ;hat is the most "i,e" diagnosis$

A. 7e#rofibromatosis
&. St#rgeI;eber sndrome
(. =c(#ne+A"bright sndrome
). Addisson0s disease
E. T#bero#s sc"erosis

30. A 1<+month o"d ma"e is bro#ght to the !ediatrician beca#se he seems m#ch sma""er than his two o"der brothers were at that age. 2e
has been genera"" hea"th exce!t for 2 e!isodes of otitis media and occasiona" Hco"dH. 2e began wa",ing at 11 months and can now sa
HmamaH HdadaH and names of his brothers. ;hat is the most "i,e" a!!ro!riate next ste!$
A. Perform a )anver )eve"o!ment screening test
&. As, the mother to com!"ete a 3 da diar of a"" the food that the chi"d has eaten
(. Send b"ood for G#antitive imm#nog"ob#"ins
). P"ot his height and weight on growth chart and com!are to !revio#s charts
E. obtain a sweat ch"oride test

31. A 1+month+o"d infant is seen beca#se of !ro"onged >a#ndice. 2e was born at home after a norma" !regnanc. Jn examination o#
notice a >a#ndice of the s,in. 2is "iver is not en"arged. There is a white !#!i""ar ref"ex in both ees8 and the #rine examination is !ositive
for red#cing s#bstances. ;hat is the most "i,e" diagnosis$
a. Se!sis
b. 5"#cose+*+!hos!hate dehdrogenase deficienc
c. Phen",eton#ria
d. %ira" he!atitis
e. 5a"actosemia

32. ;hich of the fo""owing statements abo#t ne#rob"astoma is tr#e$
a. 7e#rob"astoma is a benign t#mor of the ne#ra" crest ce""s that form the adrena" cortex and the !aras!ina" !arasm!athetic gang"ia
b. The ma>orit of ne#rob"astoma t#mors occ#r in the thoracic cavit
c. 7e#rob"astoma is the most common so"id ma"ignant t#mor in infanc
d. 4n ne#rob"astoma of the abdomen8 dis!"acement of the ,idne and distortion of the ca"cea" sstem often occ#rs
e. =ost !atients are treated with s#rger a"one beca#se distant metastases are rare

33. 7o red ref"ex is seen on f#ndosco!ic examination of a newborn. ;hich is the most "i,e" diagnosis$
a. 3etinob"astoma
b. (ongenita" cataract
c. Pigmentar ,eratitis
d. (ongenita" g"a#coma
e. Toxocariasis









3'. A neonate born at 28 wee,s0 gestation is now 2 wee,s of age. 7asogastric feeds are started. 9ort+eight ho#rs after starting feeds8
the neonate deve"o!s a distended abdomen8 b"ood stoo"8 !ne#matosis intestina"is8 and free air on abdomina" radiogra!h. Baborator
st#dies revea" thrombocto!enia. The chi"d becomes !ersistent" h!otensive des!ite maxima" medica" thera!. The most "i,e"
diagnosis is:
a. 7ecroti-ing enteroco"itis
b. Se!sis
c. As!iration !ne#monia
d. =a"rotation
e. Ee>#na" atresia

3<. A 12+ear+o"d ma"e ado"escent !resents with a 1+month histor of fever8 weight "oss8 fatig#e8 night sweats8 and !ain and"oca"i-ed
swe""ing of the mid!roxima" fem#r. ;hich of the fo""owing is the most "i,e" diagnosis$
a. Ewing0s sarcoma
b. Jsteosarcoma
c. (hronic osteome"itis
d. &enign bone t#mor
e. Eosino!hi"ic gran#"oma

3*. An afibri"e <+ear+o"d gir" !resents with tachcardia at 220 beats !er min#te. Jn E(5 a reg#"ar narrow+com!"ex tachcardia is seen.
The rhthm converts with one dose of adenosine intraveno#s" to norma" sin#s rhthm with !re+exitation 1de"ta waves6 noted
thro#gho#t the !recordia" "eads. There is no cardiomega" on chest :+ra. The tachcardia is most "i,e" consistent with:
a. Bong F+T sndrome
b. ;o"f+Par,inson+;hite sndrome
c. Sin#s tachcardia
d. Atria" f"#tter
e. Atria" fibri""ation

3@. A <+ear+o"d bo !resents with !ro"onged fever and a new 1.* ssto"ic e>ection m#rm#r heard best at the right #!!er sterna" border.
Jn extremit examination8 s!"inter hemorrhages and !etechia are noted. ;hich of the fo""owing is the most "i,e" diagnosis based on
c"inica" descri!tion$
a. Endocarditis
b. 3he#matic heart disease
c. /awasa,i disease
d. Pericardia" eff#sion
e. )i"ated cardiomo!ath

38. A *+wee,+o"d breast fed infant is seen a!!earing G#ite we"". 2is mother states that for the "ast wee, the infant has had n#mero#s
!eriods of inconso"ab"e cring "asting few ho#rs each. 7othing seems to he"!. =ost of the s!e""s occ#r in the "ate afternoon and evening
and between the e!isodes the infant "oo,s and feeds we"". ;hat is the most "i,e" diagnosis$
a. Jtitis media
b. 4nt#ss#sce!tions
c. =i", !rotein into"erance
d. (o"ic
e. (e"iac disease


3C. A !revio#s" hea"th 2+w,+o"d now has !rogressive "etharg. Phsica" examination revea"s m#sc"e rigidit8 o!isthotonos !ost#re8
!eriods of h!ertonicit8 and f"accidit. Baborator data revea" 2!og"cemia8 metabo"ic acidosis8 and cerebra" edema. P"asma "eve"s of
"e#cine8 iso"e#cine8 and va"ine are e"evated. The most "i,e" diagnosis is:
a. 2artn#! disease
b. =a!"e sr#! #rine disease
c. Phen",eton#ria
d. 2omocstin#ria
e. 5a"actosemia

'0. Short stat#re and growth fai"#re ma be the !resenting com!"aints for which of the fo""owing conditions$
a. E#veni"e idio!athic arthritis
b. 4ns#"in+de!endent diabetes me""it#s
c. (rohn0s disease
d. Ac#te "e#,emia
e. 9ami"ia" =editerranean 9ever

'1. A 1* ear o"d fema"e !atient !resent with short stat#re and no secondar sex#a" characteristics. ;hich diagnosis sho#"d be most"$
a. T#rner sndrome
b. 4so"ated growth hormone deficienc
c. (#shing disease
d. 9ami"ia" short stat#re
e. Addison disease

'2. A 3+ear o"d gir" is diagnosed with new onset ins#"in de!endent diabetes me""it#s. ;hich of the fo""owing "aborator findings is
consistent with diabetic ,etoacidosis$
a. 2!og"cemia
b. 2!ercarbia
c. /etones in #rine
d. 4ncreased veno#s b"ood !2
e. )ecreased &L7

'3. An infant who was born at home !resents to o#r office at 3 das for chec, #!. The teenaged mother did not receive !renata" care.
Ao# notice bi"atera" !#r#"ent discharge from the ees of the bab. There is mar,ed ee"id edema and con>#nctiva" swe""ing. ;hat is the
most "i,e" !athogenic agent$
a. (h"amdia trachomatis
b. 7eisseria gonorrhea
c. 5ro#! & stre!tococc#s
d. Toxo!"asma gondii
e. Tre!onema !a""id#m

''. ;hich of the fo""owing c"inica" !resentation is most consistent with an infant with !"oric stenosis$
a. Pro>ecti"e non bi"io#s emesis
b. &i"io#s emesis
c. &"ood diarrhea
d. %io"ent e!isodes of intermittent co"ic, !ain and emesis
e. 3ight "ower G#adrant abdomina" tenderness

'<. A '+ear o"d bo !resented with a < da histor of genera"i-ed edema. Jn examination o# notice !#ff ees8 scrota" edema and
ascites. Lrina"sis revea"s a s!ecific gravit of 1.0208P2+@.08 'M !rotein#ria and is otherwise #nremar,ab"e. Ser#m cho"estero" is *'8
mg.d" 1e"evated8 a"b#min is 2.3 g.d"1"ow68 (3 is 83 mg.d" 1norma"6 and ser#m creatinine 0.3 mg.d". ;hat is the next ste! in managing
this chi"d$
a. Perform ,idne bio!s
b. &egin thera! with amoxici""in
c. &egin thera! with ora" !rednisone
d. Admit the !atient for intraveno#s f"#ids
e. Start !eritonea" da"isis

'*. A 1C+ear o"d fema"e o# have fo""owed for 10 ears in o#r !ractice has recent" married8 she and her 22+ear o"d h#sband are
!"anning to start a !regnanc. Ao# advice her to start ta,ing fo"ic acid. This is im!ortant to !revent:
a. Premat#rirt
b. S,#"" defects
c. (hromosoma" defects
d. 7e#ra" t#be defects
e. Jsteo!enia

'@. A+* da o"d infant is re!orted to have an abnorma" screening test for congenita" h!othroidism8 the most "i,e" etio"og for this
res#"t is:
a. =aterna" graves0 disease treated with !ro!"thio#raci"
b .=aterna" antithro!in antibodies
c. 4odine deficienc
d. dsgenetic throid g"and
e. The newborn screen was !erformed at 12 ho#rs of age

'8. A 3+ear o"d bo is bro#ght to the emergenc room with com!"aint of !ersistent rhinorrhea for the !ast *+wee,s. Jtherwise the
!atient has been asm!tomatic on examination8 o# note that the !atient has mo#th breathing and has dar, circ"es #nder his ees. 4n
the nose o# find water discharge and edemato#s8 swo""en8 b"#ish m#co#s membrane witho#t erthema. The most "i,e" diagnosis is:
a. (hronic #!!er res!irator infection
b. Sin#sitis
c. 7asa" foreign bod
d. A""ergic rhinitis
e. (S9 "ea,

'C. A !revio#s" hea"th 18+month+o"d has been !"aing in a se!arate room from his fami". The fami" notes the s#dden onset of
co#ghing which reso"ved in a few min#tes8 s#bseG#ent" the !atient a!!ears to be norma" exce!t for increased amo#nts of droo"ing and
ref#sed to ta,e foods ora"". ;hich of the fo""owing is the most "i,e" ex!"anation for this todd"er0s condition$
a. Severe gastro eso!hagea" ref"#x
b. 9oreign bod in the air+wa
c. (ro#!
d. E!ig"ottitis
e. 9oreign bod in the eso!hag#s


<0. A !revio#s" hea"th and f#"" imm#ni-ed 13 ear+o"d bo !resents with 2+wee, histor of non!rod#ctive co#gh and "ow+grade fever.
Jn examination o# note norma" res!irator ra"es are de"eted at the bi"atera" "#ng bases. ;hich of the fo""owing is the most "i,e" ca#se
of !ne#monia in this ado"escent$
a. Pne#mocctis carnii
b .Sta!h"ococc#s a#re#s
c. 5ro#! & stre!tococc#s
d. 2aemo!hi"#s inf"#en-a t!e &
e. =co!"asma !ne#monia

<1. A 2@+ear+o"d man !resents to the emergenc de!artment after receiving b"ows to the head. 2e o!ens his ees with !ainf#" stim#"i8
is conf#sed8 and "oca"i-es to !ain. ;hat is his g"asgow coma score$
A. 13
&. 11
(. C
). @

<2. A '<+ear+o"d otherwise hea"th woman !resents after a motor vehic"e accident. She is hemodnamica"" stab"e and on" minima"
tenderness in her right #!!er G#adrant. A 9AST exam 1foc#sed abdomina" sonogra!h for tra#ma6 is !ositive with f"#id seen in the
he!atorena" fossa and the !e"vis. ;hich of the fo""owing is the next best ste! in her management$

A. Jbservation on"
&. (T scan
(. Ba!arosco!
). Ex!"orator "a!arotom

<3. The idea" time to administer !ro!h"actic antibiotics to a !atient #ndergoing co"on resection is:
A. 8 ho#r before s#rger with a dose re!eated at the time of incision
&. 2 ho#r before s#rger with a dose re!eated at the time of incision
(. 1 ho#r before s#rger
). At the time of incision

<'. T#mor staging for most e!ithe"ia" cancers inc"#des a"" of the fo""owing exce!t:
A. T#mor si-e
&. T#mor m#tations
(. 7oda" invo"vement
). )istant s!read

<<. ;hich of the fo""owing conditions increases a woman0s ris, of breast cancer$
A. Sc"erosing adenosis
&. 9ibroadenoma
(. At!ica" "ob#"ar h!er!"asia
). 4ntrad#cta" !a!i""oma

<*. ;hich of the fo""owing is an indication for cho"ecstectom in an asm!tomatic !atient with an incidenta" finding of ga""stones$
A. An histor of abdomina" !ain
&. 9ami" histor of com!"ications of cho"e"ithiasis
(. Porce"ain ga""b"adder
). 9reG#ent trave" o#t of the co#ntr


<@. A '8+ear+o"d !atient !resents with s#dden onset of bi"atera" "ower abdomina" !ain after s!asmodic co#ghing. Jn examination8
there is a 8+cm8 tender mass in the mid "ower abdomen that remains #nchanged with contraction of the rect#m m#sc"es. ;hich of the
fo""owing is the most "i,e" diagnosis$
A. 3#!t#red aortic ane#rsm
&. Jbt#rator hernia
(. S!ige"ian hernia
). 3ect#s sheath hemathoma

<8. 9o""owing doc#mentation of a firm mass in the testes b #"traso#nd in a 32+ear+o"d ma"e8 tiss#e sho#"d be obtained for diagnosis
b:

A. 9ine+need"e as!iration
&. (ore+need"e bio!s
(. J!en bio!s
). Jrchiectom

<C. A @< ear+o"d man with a histor of mocardia" infarction 2 ears ago8 !eri!hera" vasc#"ar disease with sm!toms of c"a#dication
after ha"f b"oc,8 h!ertension8 and diabetes !resents with a "arge ventra" hernia. 2e wishes to have the hernia re!aired. ;hich of the
fo""owing is the most a!!ro!riate next ste! in his !reo!erative wor,#!$
A. A norma" e"ectrocardiogram 1E(56 !rec"#des the need for f#rther cardiac testing
&. 2e sho#"d #ndergo an exercise stress test
(. 2e sho#"d #ndergo coronar arter b!ass !rior to o!erative re!air of his ventra" hernia
). 2e sho#"d #ndergo a !ersantine tha""i#m stress test and echocardiogra!h
E. 2is histor of mocardia" infarction within 3 ears is !rohibitive for e"ective s#rger. 7o f#rther testing is necessar.

*0. A '0+ear+o"d man #ndergoes an a!!endectom for ac#te a!!endicitis. 9ina" !atho"og revea"s a 2.<+cm carcinoid at the ti! of the
a!!endix. Bm!h nodes are negative. ;hich of the fo""owing is tr#e abo#t this condition$
A. 7o f#rther treatment is necessar
&. There is a significant chance that carcinoid sndrome wi"" deve"o! in the !atient
(. The !atient sho#"d receive chemothera!
). The !atient sho#"d #ndergo re+ex!"oration and a right hemico"ectom
E. =ost a!!endicea" carcinoids are 2.< cm or "arger when discovered

*1. A '< ear+o"d woman #ndergoes excisiona" bio!s for a mammogra!hic abnorma"it. 9ina" !atho"og revea"s benign !atho"og
witho#t at!ia however8 severa" foci of "ob#"ar carcinoma in sit# 1B(4S6 are detected at the excision margins. ;hich of the fo""owing
choices wo#"d be the best management o!tion$
a. Excisiona" bio!s to achieve negative margins
b. =astectom with sentine" "m!h node bio!s
c. 3adiation thera!
d. &i"atera" tota" mastectomies with immediate reconstraction
e. ("ose c"inica" and mammogra!hic fo""ow+#!




*2. A 28+ear o"d "actating woman !resents with a 2+da histor of breast !ain that is !rogressive" worsening. Jn examination8 a '+cm
area of s,in ad>acent to the ni!!"e is red and tender with some edema and no detectab"e f"#ct#ance.
=anagement wo#"d consist of:

a. 9ine+need"e as!iration
b. S,in bio!s
c. 4ncision and drainage
d. Jra" antibiotics
e. =ammogra!h

*3. A *0ear+o"d man !resents with obstr#ctive >a#ndice8 acho"ic stoo"s8 and weight "oss. An #"traso#nd scan demonstrates a di"ated
bi"iar tree and no ga""stones. A dnamic contrast+enhanced (T scan demonstrates a mass "oca"i-ed to the head of !ancreas witho#t
evidence of distant metastasis8 adeno!ath8 or vasc#"ar invasion. The !atient is otherwise in good hea"th. ;hich of the fo""owing best
describes the ro"e of !reo!erative !erc#taneo#s bio!s of the mass in this setting$
a. 4t is high" sensitive
b. 4t is nons!ecific
c. 4t is associated with a high com!"ication rate
d. 4t sho#"d be ro#tine" !erformed
e. 4t is #nnecessar

*'. A '+wee, o"d infant !resents to the emergenc de!artment with increasing" !ro>ecti"e vomiting that is nonbi"io#s and a !a"!ab"e
sma"" right #!!er G#adrant mass. The infant has severe h!och"oremic+h!o,a"emic metabo"ic a",a"osis. ;hich of the fo""owing is tr#e$
a. The condition is more common in fema"es
b. The #rine !2 wi"" "i,e" be acidic
c. Emergenc s#rger is indicated
d. L"trasonogra!h is a"was necessar to confirm the diagnosos
e. S#rger wi"" "i,e" reG#ire a gastrointestina" b!ass

*<. Two months after s!"enectom for 4TP8 the !atient is noted to have !etechia and a decrease !"ate"et co#nt. A !eri!hera" b"ood
smear is noteworth for the absence of 2owe""+Eo"" bodies. ;hich of the fo""owing is the best recommendation$
a. (T scan of the abdomen
b. &one marrow bio!s
c. 7o wor,+#! neededN administer steroids
d. 3adio"abe"ed red b"ood ce"" 13&(6 scan
e. 7o wor,+#! neededN administer imm#nog"ob#"in

**. The most acc#rate mean of determining T and 7 staging of gastric adenocarcinoma is:
a. Tri!"e+!hase he"ica" com!#ted tomogra!h 1(T6 scan
b. )iagnostic "a!arosco!
c. Endosco!ic #"trasonogra!h
d. =agnetic resonance imaging with gado"ini#m
e. Positron emission tomogra!h scan



*@. A 28+ear o"d woman #ndergoes a segmenta" i"ea" resection d#ring the co#rse of an adhesio"sis for an ac#te sma"" bowe""
obstr#ction. Jn !osto!erative da *8 she is noted to have thic, bi"e+co"ored f"#id emanating from the the mid"ine wo#nd. After 4%
hdration8 the next ste! in management sho#"d be:
a. (T scan of the abdomen
b. L!!er gastrointestina" sma"" bowe"" fo""ow+thro#gh with water+sho#"d contrast.
c. 9ist#"ogram
d. J!erative re+ex!"oration
e. Jctreotide

*8. After a tota" throidectom8 the right voca" cord is noted to be fixed in a !aramedian !osition. The most "i,e" re!resents:
a. 4n>#r to the 3B7 13ec#rrent "arngea" nerve6
b. 4n>#r to the externa" branch of the s#!erior "arngea" nerve
c. 4n>#r to the interna" branch of the s#!erior "arngea" nerve
d. Tra#ma from endotrachea" int#bation
e. (om!ression from hematoma

*C. A 23+ear o"d man s#stains b"#nt chest tra#ma fo""owing a high+s!eed motor vehic"e accident. 2e is hemodnimaca"" stab"e. ;hich
of the fo""owing conditions is an indication for thoractom$
a. Lndrained hemothorax des!ite a t#be thoracostom
b. (ontin#o#s chest t#be drainage of more than 200mB.hr of b"ood for ' ho#rs.
c. 4ntia" chest t#be o#t!#ts of 1100=B
d. ;ide mediastin#m
e. 9"ai" chest

@0. The three findings in acha"asia are:
a. 4ncreased BES resting !ress#re8 decreased BES re"axation8 increased eso!hagea" !erista"tic activit
b. )ecreased BES resting !ress#re8 increased BES re"axation8 decreased eso!hagea" !erista"tic activit
c. 4ncreased BES resting !ress#re8 decreased BES re"axation8 decreased eso!hagea" !erista"tic activit
d. )ecreased BES resting !ress#re8 increased BES re"axation8 increased eso!hagea" !erista"tic activit


@1. The most common etio"og of eso!hagea" !erforation is:

a. S!ontaneo#s r#!t#re 1&oerhaave0s sndrome6
b. 4nstr#menta" !erforation
c. 9oreign bod in eso!hag#s
d. &arrett0s eso!hag#s

@2. ;hich of the fo""owing is tr#e regarding 54ST 1gastrointestina" str#ma" t#mors6$

a. S#rger is the mainsta of treatment
b. =ost 54STS are fo#nd in the stomach
c. 54STS res!ond we"" to imatinib mes"ate 15"eevec6
d. 54STS #s#a"" !resent with #!!er gastrointestina" b"eeding
e. A"" the above




@3. ;hich of the fo""owing com!"ications of crohn0s disease is "east common$

a. Enteroentera" fist#"as
b. Enteroc#taneo#s fist#"as
c. 9ree !erforation
d. strict#res

@'. ;hich is the most "i,e" ca#se of int#ss#ce!tion in a 20+ear+o"d man$

a. 4dio!athic
b. Bm!homa of the sma"" bowe"
c. (arcinoid
d. Adhesions

@<. ;hich of the fo""owing is tr#e regarding adenomato#s co"onic !o"!s$

a. Po"!s "ess than 1 cm in diameter are #n"i,e" to be ma"ignant
b. %i""o#s adenomas most common" occ#r in the cec#m
c. 9AP 1fami"ia" adenomato#s !o"!osis6 is an a#tosoma" recessive condition
d. 2amartomato#s !o"!s have a high incidcncc of ma"ignant transformation
e. 9eca" occ#"t b"ood testing has not changed the morta"it from co"on cancer


@*. A sixt+o"d !atient with two bo#ts of 2inche Stage 44 divertic#"ar disease sho#"d be treated with:

a. Sigmoid co"ectom and anastomosis
b. Transverse co"ostom
c. Sigmoid resection8 end co"ostom and m#co#s fist#"a
d. &owe" rest8 4% antibiotics
e. Tota" abdomina" co"ectom

@@. A"" of the fo""owing are indicative of !oor !rognosis in ac#te !ancreatitis exce!t:

a. Ser#m ca"ci#m "eve" "ess than 8.0 mg.dB
b. 2!erg"cemia
c. Ser#m am"ase "eve" more than five times norma" on admission
d. Arteria" oxgen tension "ess than *0 mm2g
e. Ser#m "actic dehdrogenase 1B)26 more than three times norma"

@8. A victim of b"#nt abdomina" tra#ma #ndergoes a !artia" he!atectom. )#ring s#rger8 he receives 12 #nits of !ac,ed red b"ood ce""s.
4n the recover room8 he is noted to be b"eeding from intraveno#s !#nct#re sites and the s#rgica" incision. ;hich of the fo""owing
statements regarding the coag#"o!ath is most "i,e" tr#e$

a. The !atient has an #n,nown !rimar b"eeding disorder
b. The coag#"o!ath is secondar to the !artia" he!atectom
c. The coag#"o!ath is secondar to di"#tiona" thrombocto!enia and deficienc of c"otting factors from the massive b"ood transf#sion
d. The treatment is ora" vitamin /.
e. The treatment is intraveno#s vitamin /





@C. ;hich of the fo""owing is tr#e of mammogra!h$

a. 4s the most effective means of screening for breast carcinoma
b. 4s more effective in detecting breast carcinomas in !ostmeno!a#sa" women
c. ;hen norma"8 sho#"d not exc"#de bio!s of a !a"!ab"e s#s!icio#s breast mass
d. A"" of the above


80. Statistica""8 the most !owerf#" !redictor of !rognosis for breast cancer is:

a. The !resence of intramammar "m!hatic invo"vement.
b. The grade of differentiation of the t#mor
c. The !resence of mar,ed intrad#cta" carcinoma aro#nd the !rimar t#mor
d. The si-e of the t#mor
e. The n#mber of axi""ar "m!h nodes invo"ved with metastatic t#mor

81. A 33+ears o"d woman !regnant for the third time !resent at 3 months with a 2+cm mass8 in the inner as!ect of the "eft breast. A
need"e as!iration revea"s no f"#id8 o# wo#"d:

a. Arrange for mammogram beca#se m#"ticentric "esions are common d#ring !regnanc
b. (onsider termination of !regnanc beca#se chemothera! has been shown to be #sef#" in node+negative !remeno!a#sa" !atients
c. Ex!editio#s" obtain a histo"ogic diagnosis of the mass
d. ;ait #nti" the third trimester beca#se s#rger is safer at that time

82. 9ine need"e as!iration bio!sies are often #sef#" for which of the fo""owing entities$
a. Throid nod#"es
b. &reast mass
c. Biver mass
d. Bm!hoadeno!ath
e. B#ng mass


83. Acce!tab"e bio!s methods for a !igmentation "esion inc"#de a"" for the fo""owing exce!t:
a. Excision bio!s
b. P#ncher bio!s
c. Shave bio!s
d. 4ncisiona" bio!s

8'. A *< ears o"d man has an enteroc#tane#s fist#"a originating in the >e>#n#m secondar to inf"ammator+bowe" disease. ;hich of the
fo""owing wo#"d be the most a!!ro!riate f"#id re!"acement of the enteric "oss$
a. )extrose <D
b. 3D norma" sa"ine
c. 3inger "actate so"#tion
d. 0.CD sodi#m ch"oride
e. *D sodi#m bicarbonate so"#tion



8<. A @2 ears o"d man stat#s !ost+coronar arter b!ass graft 1(A&56 < ears ago !resents with hematoche-ia8 abdomina" !ain8 and
fever. (o"onosco! revea"s !atches of d#st+a!!earing m#cose at the s!"enic f"ex#re witho#t active b"eeding. ;hich of the fo""owing is
the most a!!ro!riate management of the !atient$
a. Angiogra!h with administration of intra+arteria" !araverine
b. Emergent "a!arotom with "eft hemico"ectom and transverse co"ostom
c. Aortomesenteric b!ass
d. Ex!"orator "a!arotom with thrombectom of the inferior mesenteric arter
e. Ex!ectant management

8*. A 2+wee,s o"d infant in fo#nd to have a hdroce"e. ;hich is the best co#rse of treatment$
a. S#rger of the age of * months
b. S#rger of the age of 2 ears
c. As!iration of the hdroce"e
d. Transscrota" hdroce"ectom of the age of 2 ears
e. 7one of the above

8@. A '8 ears o"d man is stabbed in the right #!!er G#adrant8 he arrives in the emergenc de!artment h!otensive and with abdomina"
tenderness. 2e is ta,en emergent" to the o!eration room for "a!arotom. At ex!"oration he is fo#nd to have a <+cm "aceration to the
dome of the "iver that is no "onger b"eeding. 7o other in>#ries are fo#nd8 the next ste! in management this in>#r wo#"d be:
a. Pring"e mane#ver
b. Pring"e mane#ver and finger fract#re ex!"oration of the in>#r
c. Ex!"oration of the in>#r
d. )rain in>#r area and c"ose the abdomen
e. ("ose the abdomen and get an angiogram

88. The first !riorit d#ring eva"#ation of the m#"ti!"e in>#r !atient who is h!otensive is to:
a. Estab"ish intraveno#s access
b. Jbtain b"ood for crossmatch
c. Perform a mini+ne#ro"ogic examination
d. Access the airwa
e. Search for occ#"t b"eeding

8C. The initia" treatment for !atient with m#"ti!"e bi"atera" ribs fract#res and f"ai" chest with (J2 retention is$
a. Endotrachea" int#bation and !ositive+!ress#re venti"ation
b. S#rgica" fixation of the ribs
c. (hest wa"" immobi"i-ation with sand bags
d. 4ntercosta" nerve b"oc,s

C0. A '1 ears o"d man com!"ains of reg#rgitation of sa"iva and of #ndigested food8 an eso!hagogram revea"s a birds+bea, deformit8
which of the fo""owing statements is tr#e abo#t this condition$
a. (hest !ain is common in the advanced stages of this disease
b. =ore !atients are im!roved b forcef#" di"atation than b s#rgica" intervention
c. =anometr can be ex!ected to show high resting !ress#re of the "ower eso!hagea" s!hincter 1BES6
d. 4nitia" s#rgica" treatment consists !rimari" of resection of the dista" eso!hag#s with re+anastamosis to the stomach above dia!hragm
e. Patients with this disease are at no increased ris, for the deve"o!ment of carcinoma


C1. A '3+ ear o"d woman with irritab"e bowe" sndrome was in her #s#a" state of hea"th #nti" a!!roximate" 2 months ago. She
com!"ained of intermittent abdomina" !ain with na#sea no fever. Bast night her !ain became more severe and she !resented to the
emergenc de!artment with fever 3C.@ with rigors. 4n the emergenc de!artment she had rigors and sc"era icter#s8 direct bi"ir#bin 2.' 8
a",a"ine !hos!hatase '00 8 ;&( 18.<00 8 AST 20 8 and ABT 21 . L"traso#nd revea"ed a common bi"e d#ct stone. ;hat is the next ste!$
a. Antibiotics and #rgent s#rgica" bi"iar decom!ression 1E3(P6
b. Antibiotics and endosco!ic retrograde cho"angio!ancreatogra!h
c. Antibiotics and trans he!atic bi"iar decom!ression
d. Antibiotics8 s#rgica" decom!ression and cho"ecstectom

C2. 3egarding #rinar retention after amb#"ator s#rger8 which of the fo""owing statements is not tr#e $
a. Lrinar retention is most freG#ent" associated with herniorrha!h and anorecta" !roced#res
b. S!ina" anesthesia b#t not genera" anesthesia is a !redis!osing factor for !osto!erative #rinar retention
c. Posto!erative #rinar retention can freG#ent" be asm!tomatic
d. Amb#"ator s#rger !atients m#st void as criterion for discharge

C3. Se"ect the correct statement regarding f"ai" chest:
a. 4t occ#rs when three or more ad>acent ribs are fract#red in one !"ace
b. ;or, of breathing is increased secondar to !aradoxica" chest wa"" motion
c. Patients with f"ai" chest sho#"d be aggressive" res#scitated beca#se of the !robab"e deve"o!ment of a !#"monar cont#sion
d. Patients with this condition sho#"d be !ro!h"actica"" int#bated secondar to high "i,ehood of res!irator fai"#re
e. 4f a !atient does reG#ire mechanica" venti"ation8 it is im!ortant to avoid the #se of !ositive end+ex!irator !ress#re

C'. A 20 ears o"d ;oman is invo"ved in a high+s!eed motor vehic"e accident with signification damage to the front of the car. She
arrives in the emergenc de!artment with 5(S score of 1<. 2eart rate of 120 beats.min8 res!irator rate of 18 breaths.min8 and a
ssto"ic b"ood !ress#re of mm2g. A chest radiogra!h is obtained and demonstrates a 10+cm mediastin#m a deviation of the "eft stem
bronch#s. ;hat the most a!!ro!riate next ste! in management$
a. Jbservation
b. Beft+sided chest t#be
c. 3e!eated chest radiogra!h in * ho#rs
d. (T angiogram of the chest
e. Transeso!hagea" echocardiogram

C<. ;hich of the fo""owing is tr#e of rhabdomo"sis$
a. Ac#te rena" fai"#re occ#r secondar to the re"ease of mog"obin
b. An a",a"otic environment !romotes the formation of mog"obin casts in the rena" t#b#"es 8 thereb worsening the ,idne damage
c. The rena" fai"#re from rhabdomo"sis t!ica"" reso"ves within 3+< das
d. Severe h!onatremia is a freG#ent com!"ication
e. A",a"ini-ation to P2 between 8 and C is an im!ortant treatment goa"

C*. ;ith regard to breast carcinoma in men8 which statement is tr#e$
a. it is detected most common" in men *0+@0 ears o"d
b. 5necomastia is a ris,
c. 4t is common" associated with a m#tation in &3(A1 gene
d. The !rognosis is worse stage for stage that for woman
e. Sentine" "m!h node bio!s is contraindicated

C@. A 33 ears o"d asm!tomatic women is referred to the c"inician with abnorma" findings on a mammogram. 7o masses are !a"!ab"e
in either breast. The mammogram shows a tight c"#ster or microca"cifications at 2 o0c"oc, !osition in her "eft breast. =agnification
com!ression views show at "east 20 tin irreg#"ar ca"cifications in a 2+cm area that var in sha!e and densit with no associated mass
"esion. There are no other ca"cifications !resent in either breast. ;hich of the fo""owing is the most "i,e" diagnosis$
a. B(4S
b. 9ibroadenoma
c. 4nfi"trating d#cta" carcinoma
d. )(4S 1d#cta" carcinoma in sit#6
e. 9ibrocstic changes

C8. A @2 ears o"d man #ndergoes an aortobifemora" graft for sm!tomatic aortoi"iac occ"#sive disease. The in inferior mesenteric arter
14=A6 is "igated in its aortic attachment. 2' ho#rs after s#rger the !atient has abdomina" distension8 fever and b"ood diarrhea. ;hich
of the fo""owing is the most a!!ro!riate diagnostic st#d for this !atient$
a. Aortogram
b. =agnetic resonance imaging 1=346
c. (om!#ted tomogra!h 1(T6 scan
d. Sigmoidosco!
e. &ari#m enema

CC. The most common ca#se of gastric o#t"et obstr#ction in ad#"ts is$
a. Pe!tic #"cer disease
b. Extrinsic neo!"astic com!ression
c. 5astric cancer
d. Primar "m!homa of the stomach
e. )#odena" (rohn0s disease

100. ;hich of the fo""owing is tr#e regarding the initia" treatment of !atients with ac#te com!"ete sma"" bowe" obstr#ction$
A. 4mmediate s#rger is warranted as soon as the diagnosis is made
&. 7asogastric decom!ression for 2' ho#rs a""ows s!ontaneo#s reso"#tion of com!"ete bowe" obstr#ction on a"" !atients
c. The !resent of fever8 tachcardia8 "oca"i-ed !ain or "e#,octosis s#ggests strang#"ation and warrants !rom!t s#rger
d. A"" !atients with com!"ete sma"" bowe" obstr#ction reG#ire b"ood !"asma for res#scitation
e. 4f a sma"" bowe" resection m#st be !erformed8 a stoma and m#co#s fist#"a are necessar beca#se an anastomosis is s#b>ect to non
hea"ing in the face of obstr#ction

101. ;hich of the fo""owing serve as "andmar,s when assessing descent of the feta" head$

A. 4schia" s!ines
&. Sm!hsis !#bis
(. 4schia" t#berosities
). Sacra" !romonotor









102. The diagona" con>#gate is ca"c#"ated b meas#ring the distance between which of the fo""owing anatomica" str#ct#res$

A. (occx and inner margin of sm!hsis !#bis
&. Ti! of scar#m and inner margin of sm!hsis !#bis
(. 4schia" s!ine and externa" margin of sm!hsis !#bis
). Sacra" !romontor and inferior !oint of sm!hsis !#bis

103. At what gestationa" age does the #ter#s become too "arge to "ie tota"" within the !e"vis$

A. * wee,s
&. 12 wee,s
(. 1* wee,s
). 20 wee,s

10'. ;hat is !igmentation of the mid"ine8 anterior abdomina" s,in d#ring !regnanc ca""ed$

A. Striae gravidar#m
&. Binea nigra
(. (h"oasma
). =e"asma

10<. At what gestationa" age sho#"d "aborator testing for gestationa" diabetes 1<0 5r g"#cose cha""ange test6 be !erformed$

A. 10+1* wee,s
&. 20+2' wee,s
(. 2'+28 wee,s
). 33+3* wee,s

10*. ;hat n#trient d#ring !regnanc is 7JT adeG#ate" !rovided b diet a"one$

A. (a"ci#m
&. =agnesi#m
(. 4ron
). %itamin A

10@. Ao#r !atient8 a Para 18 is considering a second !regnanc. 2er first chi"d was anence!ha"ic and died soon after birth. Ao#
recommend what dai" dose of fo"ic acid !ericonce!t#a"" to red#ce the ris, of rec#rrence$

A. 0.' mg
&. ' mg
(. '0 mg
). '00 mg

108. ;hich of the fo""owing characteri-es tr#e "abor$

A. Pain"ess contractions with r#!t#re of membranes
&. Engagement of the feta" head
(. Progressive cervica" di"atation and effacement
). 3hthmic "ower abdomina" !ain




10C. ;hat is a "aceration invo"ving the s,in8 m#co#s membrane8 !erinea" bod8 and ana" s!hincter ca""ed$

A. 9irst degree
&. Second degree
(. Third degree
). 9o#rth degree

110. A grad#a"8 smooth dece"eration of the feta" heart rate that fo""ows the !ea, of a contraction describes which of the fo""owing
dece"eration t!es$

A. Bate
&. Ear"
(. %ariab"e
). Pro"onged






































Part &:

1. ;hich of the fo""owing ranges ref"ects the t!ica" "enghth of contractions d#ring "abor$

a. 20+30 sec#nds
b. 30+'0 sec#nds
c. <0+*0 sec#nds
d. 100+120 sec#nds

2. ;hich of the fo""owing is not ris, factor for gestationa" diabetes$

a. Age O2< ear
b. Prior macrosomia infant
c. Prior sti"" born infant
d. Sister with diabetes

3. A woman with severe !reec"am!sia was given =gSJ'. 2ow is the 0agnesi#m0 excreted from the bod$

A. & diff#sion thro#gh the "#ngs
&. & con>#gation in the "iver
(. 4n the #rine thro#gh the ,idnes
). & secretion into the gastrointestina" tract

'. ;hat is the feta" and neonata" ris, of materna" 4TP$

a. 4ncreased absorbtion rate
b. Thrombocto!enia
c. 7ecroti-ing enteroco"itis
d. 7o ris,

<. A '1 ear o"d gravida 3 woman !resents with heav !ro"onged menstr#a" b"eeding. L! #nti" 8 months ago she had reg#"ar month"
menses which "asted '+< das .her !hsica" examination and !a! smear are norma". Jn !e"vic #"traso#nd8 the endometri#m is 1' mm
and there is a 2cmx1.2cm "esion in the #terine cavit . her &+hc58 TS28 and endometria" bio!s are norma". ;hich of the fo""owing is the
most "i,e" diagnosis$

a. Endometria" !o"!
b. Endometria" h!er!"asia
c. 9ibroid #ter#s
d. Adenomosis
e. )sf#nctiona" #terine b"eeding

*. '@+ear+o"d gravida 3 !ara 3 fema"e has had fibroids a"" of her "ife and has a"was reg#"ar timed heav menses. 3ecent" the
freG#enc and G#antit of her b"eeding increased. 2er TS2 and endometria" bio!s were norma". 2er hematocrit is 31 D8 !e"vic LS
shows a m#"tifibroid #ter#s of 18 cm. 3 ear ago her #ter#s was 1< cm and ' ears before that it was 12 cm. The !atient sm!toms
wo#"d best treated b:

a. Jra" contrace!tive !i""s
b. Tota" abdomina" hsterectom
c. SeG#entia" hormone re!"acement thera!
d. 2sterosco!ic momectom
e. Abdomina" momectom


@. The mainsta of treatment of e!ithe"ia" ovarian cancer at stage 444A is:

a. 3adiation thera! a"one
b. S#rger thera! a"one
c. S#rger fo""owed b chemothera!
d. S#rger fo""owed b radiation thera!
e. (hemoradiation

8. The abso"#te contraindication for the #se of estrogen+containing ora" contrace!tive inc"#des:

a. A histor of migraine headaches
b. A histor of !#"monar embo"ism
c. A histor of bi"iar co"ic
d. Sm!tomatic fibroid #ter#s
e. S!tomatic contro""ed h!ertension

C. A 2< ear o"d woman !resents to her gneco"ogist with a !rinci!a" com!"aint of !rimar inferti"it "asting one ear. She has reg#"ar
!eriods that she consider somewhat heav associated with cram!ing !ain d#ring the first 2+3 das of her menses . she #ndergoes a
hsterosa"!ingogram which confirmed t#ba" !atenc b#t demonstrated an irreg#"ar #terine cavit s#rface consistent with s#b+m#cosa"
moma. (onsidering this !atients desire for a !regnanc8 what is the most a!!ro!riate treatment for her fibroid$

a. Lterine arter embo"i-ation
b. (ombined ora" contrace!tive
c. )e!ot medrox!rogesterone
d. 2sterosco!ic momectom
e. Tota" hsterectom

10. A co""eag#e as,s for o#r o!inion with a !atient she is c#rrent" examining. The !atient is a 3@+ear+o"d 52 P2 who is !resenting with
!ostcoita" s!otting. 2er menstr#a" !eriods are reg#"ar in amo#nt and timing. She has never had this sm!tom before and has had the
same sex#a" !artner8 her h#sband8 for 8 ears. Jn exam she has norma" externa" fema"e genita"ia and a norma" vagina. 2er cervix shows
no discharge or cervica" motion tenderness. The cervica" os is noted to contain a 3+mm f"esh !ed#nc#"ated mass. 2er #ter#s is norma"
in si-e8 mobi"e and non tender. 2er "ast Pa! smear was * months ago and was negative for ma"ignanc. 2ow wo#"d this !atient be best
managed$

a. Jbservation and menstr#a" ca"endar
b. 3e!eat Pa! smear
c. Pe"vic #"traso#nd
d. 3emove the mass in the office at that time
e. Abdomina" hsterectom

11. A 2@ear o"d woman !resent to the emergenc de!artment com!"aining of vagina" discharge and abdomina" !ine have fever is
38.1Hc . and on abdomina" examination she has tenderness is the right #!!er g#ardant .and "ower abdomina" with minima" !eritonea"
sings .she was fo#nd to have a m#co#s e""ow discharge on biman#a" examination she has cervica" motion tenderness and bi"atera"
adnexa" tenderness her whit b"ood co#nt is 1'.3 and !e"vic LS shows a norma" #ter#s and norma" ovaries bi"atera"" .the most "i,e"
diagnosis for this !atient is which of the fo""owing$

a. cervicitis
b. Endomometritis
c. P4)
d. TJA
e. LT4

Canceled 12. A 'C ear o"d woman !resent com!i"ing of v#"var !in that increases with amb#"ation and intercosta" .she a"so notes a "#m!
on her right "abia that has increased in si-e over the !ast '8 ho#rs and is G#it . !ainf#" .the !atient has had these same sm!toms in the
!ast .on exam she has a <cm .tender cst on the medica" as!ect of the right "abia that extends 1 to 2cm awa .what wo#"d be ear first
ste! in management of the !atient$

a. Sits baths
b. Antihistamine agent
c. Boca" antibiotics
d. Sim!"e v#"vectom
e. =ars#!ia"i-ation


Canceled 13. A *< ear o"d !ost+meno!a#sa" fema"e !resent for her ann#a" exam witho#t com!"ains. she has a witho#t !atch area
between the !osterior forchette of the vagina;itho#t !r#rit#s or irritation. o# obtain a bio!s of the area .and the !atho"og re!ort
diagnosis "ichen sc"erosis what is the first "ine treatment for this "esion$

a. ;ide "oca" excision
b. ("obetaso"
c. Baser ra!ori-ation
d. Tro!ica" antif#nga"
e. Tro!ica" estrogen cream


1'. A 28 ear !aint #nderwent a di"atation and evac#ation of the #ter#s for com!"ete mo"ar !regnanc .she was fo""owed withe wee,"
&+hcg "eve"s .initia"" her &+ hcg "eve"s dec"ined . #nfort#nate" the "eve" then !"atea#ed and 8+wee,s after evac#ation .began to rise for
two wee, the !atient has been re"iab" ta,ing ora" contrace!tive !i""s .the eva"#ation of metastatic disease in negative .how do o#
mange her disease of this stage$

a. (ontin#e ex!ectant management
b. 3e!eat )P(
c. Tota" abdomina" hsteroctoma
d. Sing"e Iagent chemothera!
e. =#"ti+agent chemothera!


1<. ;hich of the fo""owing is not regarding s!erm !re!aration and intra#terine in>ection 1i#i6$

a. 4T is a mean to treat s!erm disorder defined as mi"d to moderate
b. The !#r!ose of s!erm enhancement is to choose s!erm with advanced movement
c. The !#r!ose of s!erm enhance is to im!rove s!erm ca!acitation
d. The !#r!ose of s!erm enhance is to concentrate the semen sam!"e
e. The !#r!ose of s!erm enhance is to discard the semina" f"#id


1*. ;hich of the fo""owing is correct regarding varicoce"e in men$

a. 4t invo"ves s#bstantia" stenosis of the testic#"ar veno#s !am!iniform !"ex#s
b. ("inica" varicoce"e is defind as !a"!a"e di"ated veins on !hsica" examination of the testes
c. %aricoce"e."igation or embo"i-ation a"was im!rove s!erm G#a"it
d. =a"e inferti"it is a"was an indication for re!air of s#bc"inica"1seen b #"tra so#nd6 varicoce"e
e. 4t is wide" acce!ted that varicoce"e red#ces s!erm G#a"it b decreasing testes tem!erat#re


1@. ;hich of the fo""owing is correct regarding testosterone$

a. <0D of the testosterone in !rod#ced b the ovar
b. 80D is binded of S2&5 and 1CD is binded to a"b#min
c. The testosterone that is binded to S2&5 is the active testosterone
d. 2<D of the testosterone is !eri!hera" formed
e. (irc#"ating testosterone "eve" in mat#re woman are abo#t 100ng.d"

18. 4n which of the fo""owing cases !regnanc m be achieved on" via invitro ferti"i-ation$

a. A fa""o!ian t#be that was damaged and obstr#cted fo""owing P4) and a norma" contra"atera" on
b. An obstr#cted fa""o!ian t#be fo""owing 1P4)6 and a contra "atera" one after !regnanc and sa"!ingostom
c. Lni"atera" sa"!ingectom and ma"e s!erm c#nt of 10Q< ce""s.m"
d. =a"e s!erm c#nt of 100R10Q* ce""s.m" and an obstr#cted fa""o!ian t#be fo""owing 1P4)6
e. 9a""o!ian t#be with hdrosa"!inx and !assage of co"or to the !e"vis and norma" contra"atera" on

1C. ;hich of the fo""owing is a test for ovarian reserve$

a. 9S2 "eve" one cc"e da3
b. Estradio" "eve" on cc"e da *
c. Progesterone "eve" fo""owing ov#"ation
d. B2 "eve" before ov#"ation
e. 4nhibin A "eve"

20. ;hich of the fo""owing is not an 4%9 com!"ication$

a. Jvarian over stim#"ation
b. 9a""o!in t#be !regnancies
c. =#"tifeta" !regnancies
d. 2eteroto!ic !regnancies
e. Jvarian cancer

21. ;hat is correct for oseo!erosis$

a. &one mass increase ti"" age '0
b. women "oose on average 10D bone mass after meno!a#se
c.2<D of women above age <0 wi"" have osteo!orosis
d. T score O +1
e. Estrogen in not the first "ine thera!

22. ;hat are the indications for estrogen treatment in meno!a#se$

a. Jsteo!orosis !revention8 coronar heart disease !revention8 management of vagina" and v#"var atro!h
b. Jsteo!orosis !revention8 treatment of vasomotor sm!toms8 management of vagina" and v#"var atro!h
c. (oronar heart disease !revention8 mood im!rovement8 !revention of A"-heimerSs disease
d. =ood im!rovement8 treatment of vasomotor sm!toms8 !revention of A"-heimerSs disease
e. (oronar heart disease !revention8 management of vagina" and v#"var atro!h8 !revention of A"-heimerSs disease






23. ;hat is not tr#e abo#t ovarian stim#"ation$

a. (an be triggered b recombinant or #rinar gonadotro!ins
b. There is indication for ser#m estradio" test and LS for fo""ic#"ar monitoring
c. 2(5 give at "east one fo""ic"e at si-e 1'mm
d. 5n32 agonist and antagonist given to !revent
e. Jv#"ation occ#r 3*hr after 2(5 administration


2'. ;hat is tr#e regarding a woman with =T""erian agenesis$

A. The "ac, the #!!er !art of the vagina
&. 9a""o!ian t#bes exist
(. '*:A or '<:0 ,arot!e
). Entire vagina and #ter#s are missing
E. &"eeding wi"" a!!ear after estrogen and !rogesterone administration

2<. ;hich of the fo""owing !"acenta" im!"antation most "i,e !redis!osed to inverted #terine in 3
rd
stage of "abor$

a. 9#nda"
b. Anterior
c. Posterior
d. Batera"
e. B#mbar stage of "abor

2*. A @0+ear+o"d man com!"ains of fever and !ain in his "eft ,nee. Severa"
das !revio#s"8 he s#ffered an abrasion of his ,nee whi"e wor,ing in his garage.
The ,nee is red8 warm8 and swo""en. An arthocentesis is !erformed8 which shows 2008000 "e#,octes.UB and a g"#cose of 20 mg.dB. 7o
crsta"s are noted. ;hich of the fo""owing is the most im!ortant next ste!$

a. 5ram stain and c#"t#re of >oint f"#id
b. Lrethra" c#"t#re
c. Lric acid "eve"
d. Antin#c"ear antibod
e. Antine#tro!hi" cto!"asmic antibod

2@. Se!tic arthritis $$$

a. Stre! !ne#monia
b. 7essiriha
c. E.co"i
d. Sta! ar#s

28. *< ear8 man8 s#dden onset of sever ,nee !ain. /nee is red8 swo""en and tender. )= in the histor and cardiomo!ath. 4n : ra
"inear ca"cification. /nee diagnosis made b:

a. Ser#m #ric acid
b. Ser#m ca"ci#m
c. Arthcentesis and !ositive birefrigniat
d. (rsta"s
e. 3eh#matid factor

2C. @0+ear+o"d fema"e with mi"d dementia com!"ains of hi! !ain. There is some "imitation of motion in the right hi!. The first ste! in
eva"#ation is:

a. (&( and erthroctes sedimentation rate
b. 3he#matoid factor
c. :+ra of right hi!
d. &one scan

30. A '0+ear+o"d a"coho"ic deve"o!s co#gh and fever. (hest :+ra shows an air+f"#id "eve" in the s#!erior segment of the right "ower
"obe. The most "i,e" etio"ogic agent is:

a. Stre!tococc#s !ne#monia
b. 2aemo!hi"#s inf"#en-a
c. Begiona"e
d. Anaerobes

31. A *0 ear+o"d ma"e on as!irin8 nitrates and beta b"oc,er8 being fo""owed for chronic stab"e angina8 !resent to E.3 with histor of 2+3
e!isodes of more severe and "ong "asting angina chest !ain each da over the !ast 3 das8 E(5 and cardiac en-mes are norma". &est
co#rse of action

a. Admit the !atient and begin 4.% digoxin
b. Admit the !atient and begin 4.% he!arin
c. Admit the !atient and give !ro!h"actic thrombo"tic thera!
d. Admit the !atient for observation with no change in medications
e. )ischarge the !atient from E.3 with increase nitrates and beta b"oc,er

32. A"coho"ic 3< ear+o"d ma"e is admitted for na#sea8 vomitting and abdomina" !ain that radiates to bac,8 Bab va"#e that s#ggests a
!oor !rognosis in the !atient is:

a. E"evated ser#m Bi!ase
b. E"evated ser#m Am"ase
c. Be#,octosis of 20.000.VB
d. )iasto"ic b"ood !ress#re higher than C0 mm2g

33. '0 ear+o"d cigarette smo,er com!"ais of e!igastric !ain8 we"" "oca"i-ed8 nonradiating and described a b#rning. The !ain !artica""
re"ieved b eating. There is no weight "oss he has not #sed 7SA4)8 the !ain has grad#a"" worsened over severa" months. =ost sensitive
wa to ma,e a s!ecific diagnosis:

a. &ari#m :+ra
b. Endosco!
c. Sero"ogic test for 2. P"ori
d. Ser#m 5astrin

3'. The best wa to eradicate 2. P"ori is$

a. Jme!ra-o"e 20 mg PJ for * wee,s8 3anitidine 300 mg PJ Ghs * wee,s
b. Jm!era-o"e 20 mg &4)8 Amoxici""in 1000 mg &4)8 ("arithromcin <00 mg &4) for 1' das
c. &ito+&ismo" and =etronida-o"e &4) for @ das
d. S#cra"fate 200 mg F4) for * wee,s


3<. '0 ear+o"d ma"e with "ong standing a"coho" ab#se com!"ains of abdomina" swe""ing which has been !rogressive over severa"
months8 2istor of 54 b"eeding8 on !hsica" examination s!ider angigrams and !a"mar ethema 8 abdomina" co""atera" vesse"s are seen
aro#nd #mbi"ic#s8 shiftting d#""ness and d#""ness f"an, are noted. =ost im!ortant 1
st
ste! in !atient eva"#ation :

a. )iagntostic !ancreatitis
b. L!!er 54 series
c. Ethano" "eve"
d. (.T scan


3*. ;hi"e 2os!ita"i-ed a cirrhotic !atient menta" stat#s deteriorates8 2e has been having g#aiac+!ositive stoo"s and "ow grade fever8 2e
a"so received sedation for agitation8 on !hsica" examination !atient is conf#sed8 no meningea" signs and no foca" ne#ro"ogica" findings8
there is h!erref"exia and nonrhthmic fa!!ing tremors of the wrist8 most "i,e" ex!"anation for the menta" stat#s change:

a. T#berc#"osis meningitis.
b. S#bd#ra" hematoma.
c. A"coho" withdraw" sei-#re.
d. 2e!atic ence!ha"o!ath

3@. A '0 ear+o"d white ma"e com!"ains of wea,ness8 weight "oss and abdomina" !ain8 on !hsica" examination the !atient has diff#se
h!er!igmentation and !a"ab"e "iver edge8 !o"arthritis of the wrists and hi!s is a"so noted8 fasting b"ood s#gar 18< mg.d" most "i,e"
diagnosis :

a. 4ns#"in+de!endent )=
b. Pancreatic carcinoma
c. Addisons )isease
d. 2emochromatosis

38. A 3' ear+o"d white woman is treated for #rinar tract infection with amoxici""in8 4nitia"" she im!roves b#t < das after beginning
treatment she deve"o!s rec#rrent fever8 abdomina" b"oating and diarrhea with *+8 "oose stoo"s !er da8 o# s#s!ect Antibiotic+
associated co"itis8 The best diagnosis test is:

a. 4dentification of ("ostridi#m diffici"e toxin in the stoo"
b. 4so"ation of ("ostridi#m diffici"e in a stoo" c#"t#re
c. Stoo" !ositive for ;&(
d. )etection of 4g5 antibodies against ("ostridi#m diffici"e in the ser#m

3C. A << ear+o"d ma"e is being eva"#ated for consti!ation there is no histor of !rior 5.4. Sm!toms8 2b is 10 g.d"8 =(% is @2 f"8 Ser#m
iron is ' #g.d" W7orma" <0+1<0X8 Sat#ration is 1D W7orma" 20+'< DX8 ferritin is 10 #g." W7orma" 1<+'00 #g."X next ste! in the eva"#ation of
this !atient anemia:

a. 3&( fo"ate
b. 4ron absor!tion st#dies
c. (o"onosco!
d. &one =arrow examination







'0. A *0 ear+o"d asm!tomatic man is fo#nd to have "e#,octosis when a ro#tine (&( is obtained8 Phsica" exam shows no
abnorma"ities8 s!"eein is notma" si-e8 Babrator data:
2gb: C g.d" W7orma" : 1'+18X
Be#,octes: '08000 .#" W7orma": '300+10800X
Peri!hera" b"ood smear shows a differentia" that inc"#de C@D sma"" "m!hoctes.
The most "i,e" diagnosis$

a. Ac#te monoctic "e#,emia
b. (hronic me"ogeno#s "e#,emia
c. (hronic "m!hoctic "e#,emia
d. T#berc#"osis

'1. A !atient diagnosed to s#ffer from chronic "m!octic "e#cemia wi"" reG#ire chemothera!:

a. 4f the white b"ood ce"" co#nt rises
b. 4f "m!hadeno!ath deve"o!s
c. To contro" anemia or thrombocto!enia
d. Jn" when ac#te "m!hoctic "e#,emia deve"o!s


'2. A *' ear o"d ma"e is hos!ita"i-ed with a transient ischemic attac, and is eva"#ated for carotid disease. Phsica" exam is norma". (&(
on admission is norma". the !atient is started on he!arin. A re!eat (&( 1 wee, "ater shows an 2g of 1'8 ;&( C000 and PBT 10000.
Ao# sho#"d$

a. Jbtain a bone marrow st#d
b. Jbtain a "iver s!"een scan
c. S#s!ected dr#g ind#ced thrombocto!enia !#r!#ra
d. &egin corticosteroids for 4TP

'3. The !atient described deve"o!s thrombosis of the brachia" arter. The next ste! in management is:

a. B#!#s anticoag#"ant
b. Antin#c"ear antibod
c. Be!ir#din or dana!aroid
d. 4ncrease he!arin dose

''. A @0 ear o"d intensive care #nit !atient com!"ains of fever and sha,ing chi""s. The !atient deve"o!s h!otension8 and b"ood c#"t#res
are !ositive for gram negative baci""i. The !atient begins b"eeding from veni!#nct#re sites and aro#nd his fo"e catheter. "aborator
st#dies are as fo""ows: 2(T 38D8 ;&( 1<0008 PBT '0000 1norma" 130000to '000068 !erifera" b"ood smear: fragmented 3&(0s. PT
e"evated8 PTT e"evated8 !"asma fibrinogen @0 1norma" 200+'006. The best co#rse of thera! in this !atient is:

a. &egin he!arin
b. Treat #nder"ing disease
c. &egin !"asma!heresis
d. 5ive vitamin /
e. &egin red b"ood ce"" transf#sion






'<. A 30 ear o"d fema"e with graves0 disease has been started on !ro!h"thio#raci". She com!"ains of "ow grade fever8 chi""s and sore
throat. The most im!ortant initia" ste! in eva"#ating this !atients fever is$

a. Ser#m TS2
b. Ser#m T3
c. (&(
d. (hest :+ra
e. &"ood c#"t#re

'*. A 2C ear o"d woman !resents to the emergenc de!artment with a com!"aint of s#dden onset of "eft facia" wea,ness that was
noticed b her cowor,er. She denies fever8 rash or an other sm!toms. Jn !hsica" examination she has no other ne#ro"ogic deficits
other than what is shown described. ;hen as,ed to sh#t her "eft ee8 she cannot. ;hich of the fo""owing is the most "i,e" diagnosis$

a. &e"" !a"s
b. =a"ingering
c. 3amsa h#nt sndrome
d. &rain t#mor
e. (erebrovasc#"ar event

'@. A '8 ear o"d man with a !ast medica" histor of he!atitis ( and cirrhosis !resents to the emergenc de!artment with a com!"aint of
ac#te onset of abdomina" !ain and chi""s. Ao# decide to !erform a !aracentesis. Ao# retrieve 1 B of c"o#d f"#id. Baborator ana"sis of
the f"#id shows a ne#tro!hi" co#nt of <<0 ce"".mm
3
. ;hich of the fo""owing is the most a!!ro!riate choice of tratment$

a. =etronida-o"e
b. %ancomcine
c. Am!hotericine
d. 7eomcine and Bact#"ose
e. (efotaxim

'8. A @2 ear o"d woman with a histor of h!ertension and tobacco #se !resents to o#r c"inic com!"aining of chest !ain for the "ast 2
wee,s. She describes the !ain as !ress#re "i,e8 with radiation to the "eft arm. 4t is exacerbated b exertion and re"ieved b rest. There
are no associated sm!toms. She denies an histor of chest !ain. 2er vita" signs are stab"e and the !hsica" examination is
#nremar,ab"e. An E(5 shows signs of "eft ventric#"ar h!ertro!h. Baborator tests inc"#ding cardiac biomar,ers are within norma"
"imits. which of the fo""owing is the most "i,e" diagnosis$

a. 7on STE=4
b. Pericarditis.
c. Lnstab"e angina
d. Stab"e angina

'C. A <2 ear o"d man with a histor of h!ertension8 diabetes and h!er"i!idemia !resents to the emergenc de!artment with chest
!ain of 3 ho#rs d#ration. an E(5 shows 1 mm ST de!ression in the inferior "eads. Tro!onin is e"evated and the !atient is diagnosed with
a non STE=4. 2e is treated with as!irin8 meto!ro"o"8 he!arin and c"o!idogre" and admited to the coronar care #nit. a "eft heart
catheteri-ation revea"s CCD occ"#tes right coronar arter. P(4 is !erformed with adr#g e"#ting stent. 2ow "ong sho#"d this !atient be
treated with c"o!idogre"$

a. Jne wee,
b. 1 month
c. At "east 3 months
d. At "east one ear


<0. A <C ear o"d man is diagnosed with a non STE=4. She receives a dr#g e"#ted stent to her midd"e "eft anterior descending coronar
arter. Transthoracic echocardiogra!h revea"s an E9 of 3<D. 2er medications at discharge inc"#de as!irin8 c"o!idogra"8 atorvastatin8
meto!ro"o" and rami!ri". According to the g#ide"ines8 which of the fo""owing medication sho#"d be added to this !atient0s regimen$

a. ;arfarin
b. 9#rosemide
c. E-etimibe
d. S!irono"actone


<1. A '<+ear+o"d fema"e !resents to o#r office. She was see 10 das ago b a co""eag#e with com!"aints of !rogressive fatig#e8
ma"aise8 and abdomina" discomfort occ#rring over the "ast 10 months. She has a"so com!"ained of !o"arthra"gias. She is not obese and
does not drin, a"coho". 2er recent "aborator tests revea" norma" ser#m chemistries8 norma" tota" bi"ir#bin8 norma" a",a"ine
!hos!hatase8 as!artate aminotransferase 1AST6 C2 4L.B8 a"anine aminotransferase 1ABT6 8* 4L.B8 ser#m a"b#min 3.2 g.dB8 tota" !rotein
*.8 g.dB and increased +g"ob#"in "eve". Ao# s#s!ect a#toimm#ne he!atitis 1A426. 4n addition to obtaining a "iver bio!s8 which of the
fo""owing "aborator tests he"!s estab"ishing a diagnosis of A42 in this !atient$

A. Antin#c"ear antibod 1A7A6
&. Antimitochondria" antibod 1A=A6
(. Anti+Saccharomces cerevisiae antibod 1AS(A6
). Anti+smooth m#sc"e antibod 1AS=A6


<2. A *2+ear+o"d fema"e !resents to o#r office !rior to starting (2JP chemothera! 1cc"o!hos!hamide8 Adriamcin Wdoxor#bicinX8
vincristine8 and !rednisone6 for new" diagnosed non+2odg,in "m!homa. She has a histor of treated he!atitis & 10 ears !revio#s"
and has had no seG#e"a from the disease or treatment8 confirmed b a seroconversion of 2&eAg !ositive stat#s to anti+2&e and 2&sAg
to anti+2&s stat#s. She is not on an medications c#rrent". 2er !hsica" examination is significant on" for b#", adeno!ath. Prior to
initiating chemothera!8 which of the fo""owing diagnostic tests sho#"d be chec,ed in this !atient$

A. Ser#m crog"ob#"in "eve"s
&. Abdomina" #"trasonogra!h to eva"#ate for bi"iar obstr#ction
(. 2e!atitis & vira" "oad b P(3 am!"ification8 2&sAg8 and anti+2&c
). 3e!eat "iver bio!s to ens#re tr#e eradication of he!atitis &


<3. A '3+ear+o"d man !resents with !a"!itations and shortness of breath. Jn examination8 his b"ood !ress#re is 12'.80 mm 2g8 heart
rate is 128 beats . min and irreg#"ar8 and tem!erat#re is 3*.*K(. 2e has moderate bi"atera" exo!htha"m#s8 a !a"!ab"e goiter8 and mi"d
wea,ness8 in his bi"atera" "ower extremities. An E(5 confirms atria" fibri""ation with ra!id ventric#"ar res!onse and TS2 at 0.003 UL.mB
10.< to '.@ UL.mB6. ;hich of the fo""owing is the most a!!ro!riate treatment for the atria" fibri""ation in this !atient$

A. Pro!"thio#raci"
&. 4odide
(. Pro!rano"o"
). Prednisone








<'. A **+ear+o"d man is bro#ght to the emergenc de!artment b his wife. She re!orts that he accidenta"" too, an extra dose of each
of his medications abo#t 3 ho#rs ago. 2is medications are as!irin8 meto!ro"o"8 and f"#vastatin. Phsica" examination revea"s a somno"ent
man with a heart rate of 33 b!m and a b"ood !ress#re of @<.30 mm 2g. 2e is treated with intraveno#s f"#ids 14%68 activated charcoa"8
and a cathartic agent. ;hich of the fo""owing is the best treatment for h!otension and bradcardia ca#sed b ac#te beta+b"oc,er
toxicit$

A. )o!amine
&. 4so!rotereno"
(. 5"#cagon
). )igoxin


<<. Ao# are as,ed to eva"#ate a <<+ear+o"d man with 5*P) deficienc who deve"o!ed ac#te onset of shortness of breath after receiving
to!ica" ben-ocaine !rior to an endosco!. Phsica" examination revea"s a mi"d" canotic man who is tach!neic and tachcardic. P#"se
oximetr revea"s an oxgen sat#ration of 82D. ;hich of the fo""owing "aborator tests is most "i,e" to confirm this !atient0s diagnosis$

A. =ethemog"obin "eve"
&. (arboxhemog"obin "eve"
(. Acetamino!hen "eve"
). %eno#s oxgen sat#ration


<*. A @2+ear+o"d woman with rhe#matoid arthritis is bro#ght to the emergenc de!artment b her da#ghter. The !atient0s da#ghter
re!orts that her mother has been having more >oint !ain for the "ast 2 das8 and this morning8 she too, an extra dose of oxcodone. She
then became conf#sed8 !rom!ting her da#ghter to bring her to the emergenc de!artment. Phsica" examination revea"s an e"der"
woman who is somno"ent and diffic#"t to aro#se. 2er heart rate and b"ood !ress#re are stab"e8 b#t she is on"
breathing 8 times !er min#te. 2er !#!i"s are 1 mm in diameter and smmetric. Jf the fo""owing8 what is the best treatment for this
!atient at this time$

A. 4ntraveno#s f"#ma-eni"
&. 4ntraveno#s fome!i-o"e
(. Transveno#s cardiac !acema,er
). 4ntraveno#s na"oxone

<@. A @<+ear+o"d !atient !resents to the E3 after a s#dden snco!a" e!isode. 2e is again a"ert and in retros!ect describes occasiona"
s#bsterna" chest !ress#re and shortness of breath on exertion. 2is "#ngs have a few bibasi"ar ra"es8 and his b"ood !ress#re is 110.80. Jn
cardiac a#sc#"tation8 the c"assic finding o# ex!ect to hear is:

A. A harsh ssto"ic crescendo+decrescendo m#rm#r heard best at the #!!er right sterna" border
&. A diasto"ic decrescendo m#rm#r heard at the mid+"eft sterna" border
(. A ho"ossto"ic m#rm#r heard best at the a!ex
). A midssto"ic c"ic,


<8. A @2+ear+o"d ma"e comes to the office with intermittent sm!toms of ds!nea on exertion8 !a"!itations8 and co#gh occasiona""
!rod#ctive of b"ood. Jn cardiac a#sc#"tation8 a "ow+!itched diasto"ic r#mb"ing m#rm#r is faint" heard toward the a!ex. The origin of
the !atient?s !rob"em !robab" re"ates to:

A. 3he#matic fever as a o#th
&. Bong+standing h!ertension
(. Si"ent =4 within the !ast ear
). (ongenita" origin


<C. A @0+ear+o"d ma"e com!"ains of the s#dden onset of snco!e. 4t occ#rs witho#t warning and with no sweating8 di--iness8 or "ight+
headedness. 2e be"ieves e!isodes tend to occ#r when he t#rns his head too G#ic," or sometimes when he is shaving.
The best wa to ma,e a definitive diagnosis in this !atient is:

A. E(5
&. (arotid massage with E(5 monitoring
(. 2o"ter monitor
). E"ectro!hsio"ogic st#dies to eva"#ate the A% node


*0. A 32+ear+o"d diabetic fema"e who ta,es an estrogen+containing ora" contrace!tive and drin,s three beers !er da is fo#nd to have a
trig"ceride "eve" greater than 1000 mg.dB. She is at ris, for which of the fo""owing com!"ications$

A. Ac#te !ancreatitis
&. S#dden cardiac death
(. Ac#te !eri!hera" arteria" occ"#sion
). Ac#te rena" ins#fficienc
E. =ositis


*1. A hea"th '< ear o"d women with no medication comes to o#r office with 10 das of nasa" congestion8 sore throat8 dr co#gh and
initia" "ow tem!erat#re8 a"" that near" reso"ved. Jver the !ast 2'+'8 ho#rs she deve"o!s a shar! chest !ain b dee! ins!iration or co#gh
b#t no ds!nea. )#e the severit of the !ain the n#rse ma,es E(5 that shows a diff#se ST+e"evation.
Jn the !hsica" examination is most "i,e" to find:

a6 Bo#d !#"monic com!onent of S2
b6 A S3 ga""o!
c6 A !ericardia" friction r#b
d6 A bi"atera" basi"ar ra"es
e6 A high b"ood !ress#re of 1*0.100 mm2g


*2. A 20 ears o"d n#rsing st#dent com!"ains of asthma on s#rgica" rotation. She deve"o!s dermatitis of the hands and the sm!toms
worse when she in the o!eration room.
;hich of the fo""owing is correct$

a6 This is an a""ergic reaction that is a"was begins
b6 The !atient sho#"d eva"#ate for "atex a""erg with s,in test or s!ecific 4gE antibod
c6 This sndrome is "ess common now than 10 ears ago
d6 An ora" corticosteroids is indicated


*3. A 30 ears o"d man deve"o!s s,in rash8 !#rities and mi"d whee-ing 20 min#tes after an 4.% Pe"ogram !reformed for eva"#ation of a
rena" stone sm!tomatic.
A best a!!roach to diagnosis inc"#des:

a6 Perform a 2' ho#rs #rine+histamine meas#rement
b6 =eas#re of 4gE to radio contrast media
c6 )iagnosis of radio contrast media sensitivit histor
d6 3ecommend intra derma" s,in testing



*'. A 2@ ears o"d #ndergoes a fo""ow #! eva"#ation < months after the diagnosis of idio!atic !#"monar embo"ism for which she was
!rescribed at * month co#rse anticoag#"ant thera!. 9ami" histor8 a materna" grandmother too, warfarin man ears for #n,nown
reasons. An o"der brother with histor of )%T at age 32. Patient ta,es no ora" contrace!tive !i""s or other medication. She is hea"th.
The (&( is norma"8 473 is 3.0 ;hich of the fo""owing is most a!!ro!riate next ste! of eva"#ation of the !atient:

a6 4mmediate thrombo!hi"ie+screening
b6 EA/2 m#tation ana"sis
c6 7o f#rther eva"#ation is needed
d6 Thrombo!hi"ie+screening at "east two wee,s after thera! session



*<. A 82 ears o"d man com!"ains of two ho#rs severe chest !ain that occ#rred whi"e !"aing tennis. &"ood !ress#re on admission is
1'0.@08 !#"se 110. 7o signs of congestive heart fai"#re. P#"ses a"" !a"!ab"e8 abdomina" exams are norma"8 ne#ro"ogic exams are norma"
and stoo"+5#aniac is negative8 no histor of gastro intestina" b"eeding8 !revio#s stro,e head tra#ma or ma>or s#rger8 no histor of
vasc#"ar disease or "iver disease. E(5 shows ST segment e"evation of 3 mm in "eads %1+%3 and 3 !remat#re ventric#"ar beats.min. 4nitia"
treatment of choice is:

a6 Pro!h"actic Bidocaine
b6 Thrombo"tic thera! with as!irin
c6 2e!arin
d6 As!irin a"one

**. A frai" 80 ears o"d n#rsing home resident had severa" e!isodes of snco!e8 a"" which have occ#rred whi"e she was ret#rning to her
room after brea,fast. She com!"ains of "ight headedness and stats she fee"s co"d and wea,. She ta,es nitrog"cerin in the morning for
histor of chest !ain b#t denies recent chest !ain or shortness of breath. The most "i,e" method of diagnosis is:

a6 (ardiac catheter
b6 Post!randia" b"ood !ress#re monitoring.
c6 2o"ter+monitor
d6 (T scan

*@. A 30 ears o"d women !resent with com!"ains of !aresthesias8 wea,ness8 "ea, of coordination and diffic#"t with gait. 2er sm!toms
are worse after hot shower. Examination of cerebros!ina" f"#id shows o"igoc"ona" imm#nog"ob#"in antibodies 4g5. The most "i,e"
diagnosis is:

a6 =#"ti!"e sc"erosis
b6 2#ntington disease
c6 Par,inson disease
d6 7e#rofibromatosis disease
e6 Amotro!hic "atera" sc"erosis 1ABS6

*8. A <* ears o"d man !resent to o#r office with com!"ains of chronic diarrhea. 2e states that he has "oose stoo" for the "ast 2 das. 2e
denies b"ood in stoo" and fever. 2e has no weight "oss and no recent trave". A!!ro!riate management at this time inc"#des:

a6 Jbservation
b6 (hec, stoo" c#"t#re
c6 (o"onosco!
d6 Stoo" fat st#d




*C. A 23 ears o"d man c"imbing =o#nt /i"iman>aro has no medica" !rob"ems and ta,es no medication. Short" after the c"imbs he
deve"o!s sever shortness of breath8 !hsica" examination shows diff#se bi"atera" crac,"es. ;hich is the most "i,e" etio"og$

a6 Ac#te interstitia" !ne#monitis
b6 Ac#te res!irator distress sndrome
c6 (ardiogenic shoc,
d6 (omm#nit acG#ired !ne#monia
e6 2igh a"tit#de !#"monar edema

@0. A *< ears o"d man admitted to the hos!ita" with com!"ains of shortness of breath. 2e has no !rior medica" care. Baborator notifies
o# of &+ natri#retic !e!tide va"#e of 1<00 !g.d"8 o# s#s!ect the fo""owing diagnosis:

a6 Asthma exacerbation
b6 (JP) exacerbation
c6 P#"monar embo"ism
d6 )%T
e6 (ongestive heart fai"#re

@1. A hos!ita"i-ed !atient is receiving a b"ood transf#sion. The f"oor n#rse re!orts that the !atient is f"#shed8 is com!"aining of
abdomina" discomfort8 and has a tem!erat#re of 38.'K(. The most a!!ro!riate management is to:

A. 5ive the !atient acetamino!hen and contin#e the transf#sion at a s"ower rate
&. Administer di!henhdramine and contin#e the transf#sion
(. Administer 100 mg of hdrocortisone intraveno#s" and red#ce the rate of the transf#sion
). Sto! the transf#sion and increase intraveno#s f"#ids
E. Administer intraveno#s ranitidine and order an abdomina" series x+ra

@2. A <8+ear+o"d woman with a !revio#s histor of infectio#s endocarditis !resents for advice regarding antibiotic !ro!h"axis !rior to a
denta" !roced#re. The !roced#re wi"" invo"ve significant gingiva" mani!#"ation. She has no ,nown a""ergies. ;hich of the fo""owing is
recommended !ro!h"axis for this !atient$

A. Bevof"oxacin
&. ("arithromcin
(. 7o antibiotic !ro!h"axis is needed
). Amoxici""in

@3. ;hich of the fo""owing is the most "i,e" factor contrib#ting to chronic me"oid "e#,emia$

A. Ex!os#re to radiation
&. 9ami" histor of cancer
(. Tobacco ab#se
). Phi"ade"!hia chromosome

@'. A '1+ear+o"d b#siness exec#tive !resents to o#r office and com!"ains of !a"!itations and shortness of breath. After f#rther
G#estioning8 he admits to heav a"coho" cons#m!tion the !revio#s evening. Jn examination8 he is fo#nd to have an irreg#"ar heartbeat
of 130 b!m. The most "i,e" diagnosis is:

A. %entric#"ar tachcardia
&. %entric#"ar fibri""ation
(. Premat#re ventric#"ar contractions 1P%(s6
). Atria" fibri""ation
E. ;o"ff+Par,inson+;hite sndrome
@<. A !revio#s" hea"th 2*+ear+o"d man !resents with abdomina" cram!ing and 9ever that has "asted for 2 das. 2e has had 10 stoo"s
in the "ast 2' ho#rs. A stoo" s!ecimen revea"s the !resence of b"ood and ;&(s. The most "i,e" diagnosis:

A. Sta!h"ococca" food !oisoning
&. 3otavir#s
(. (rohn disease
). Shige""osis
E. 4rritab"e bowe" sndrome

@*. A"" of the fo""owing dr#gs can ca#se !schotic sm!toms simi"ar to schi-o!hrenia E:(EPT :

A. Ecstas
&. J!ioids
(. Phencc"idine
). /etamine
E. Bsergic acid dieth"amide 1BS)6

@@. The !reva"ence of schi-o!hrenia is:

A. 10D
&. 1D
(. <D
). 0.1D
E. 2D

@8. A 32+ear+o"d ma"e with chronic !aranoid schi-o!hrenia8 in f#"" remission is married and "iving a !rod#ctive "ife. 2e and his wife
decide to have chi"dren8 b#t wo#"d "i,e to ,now the !robabi"it of chi"dren deve"o!ing schi-o!hrenia. ;hich of the fo""owing statements
is correct:

A. The ris, is simi"ar to that of genera" !o!#"ation 11D6.
&. The ris, is abo#t <0D
(. The ris, is m#ch "ower than the genera" !o!#"ation beca#se he wi"" be ab"e to recogni-e the ear" signs of schi-o!hrenia and see,
!rom!t treatment for the chi"d
). The ris, is abo#t 10D
E. The ris, is abo#t 100D

@C. A 3*+ear+o"d !regnant women is admitted to the medica" center for !ossib"e infection associated with intraveno#s heroin in>ection.
She admit to heroin de!endenc. She is < month into her !regnanc and wo#"d "i,e to HG#it the heroin for goodH ;hat is the best
co#rse of action in this !atient$

A. A""ow her to contin#e
&. =ethadone maintenance
(. 7a"trexone
). Advise her to sto! heroin and start s#!!ortive thera!
E. &#!reno!hinea

80. ;hich of the fo""owing has the most reinforcing effects8 that is8 the greatest !otentia" to become addicted$
A. (ocaine
&. A"coho"
(. =ari>#ana
). 2eroin
E. 7icotine

81. The re"ationshi! between mitra" va"ve !ro"a!se 1=%P6 and !anic disorder can be described as$

a. 4m!ortant to recogni-e and treat mitra" va"ve !ro"a!se in !anic disorder
b. 2igh c"inica" re"evance.
c. Patient with !anic disorder are !redis!osed to deve"o! =%P
d. 2igher incidence of =%P in !atients with !anic disorder
e. Panic disorder is ver we"" contro""ed if =%P is corrected.


82. A <* ear o"d anxio#s exec#tive ca""s at <:00 beca#se he wo,e #! with chest tightness and shortness of breath. 2e was scared that
he was having a heart attac, and he a"so re!orted fee"ing di--8 tremb"ing8 and his heart was !o#nding8 he tho#ght he was going to die.
The sm!toms s#bsided in 20 min#te and b the time the emergenc medica" services arrived he was sitting in his "iving room and in no
distress. The !atient0s e"ectrocardiogram reading was norma" and his cardiac en-mes were a"so fo#nd to be norma". ;hat is the most
"i,e" diagnosis$

a. 7oct#rna" !anic attac,
b. PTS)
c. Pscho!hsio"ogica" insomnia
d. Somati-ation disorder
e. =ocardia" infraction


83. A 22 ear o"d fema"e is se"f I referred for an eva"#ation to r#"e o#t bi!o"ar disorder. She com!"ains of ra!id mood swings with a
contro""ab"e anger and irritabi"it. )#ring the assessment it is noted that she has not had an s#stained re"ationshi!s for man ears and
fee"s em!t she fear abandonment b her fries and b"ames other of ma,ing her fee" angr . ;hat is the most im!ortant differentia"
diagnosis in this !atient$

a. =a>or de!ressive disorder
b. &order"ine !ersona"it disorder
c. 2istrionic !ersona"it disorder
d. )e!ressive !ersona"it
e. 5enera"i-ed anxiet disorder

8'. <* ears I o"d fema"e is admitted to an ac#te !schiatric in!atient #nit for severe de!ression the !atient was r#minating abo#t
s#icide and g#i"t fee"ings that were distressing her. She is HconvincedH that she has committed sin and deserved to be !#nished.
a"tho#gh there was nothing in her histor to >#stif this the resident doctor thin,s that the !atient is obsessed with tho#ghts of g#i"t
and fee" that the !atient has a !rimar obsessiona" disorder a tria" of antide!ressant medication was not he"!f#" des!ite tring a high
dose the attending !hsician ex!"ains that the !atient is not obsessiona" b#t severe" de!ressed beca#se $

a. She has s#icide ideation
b. She has indeed committed sin and is now de!ressed
c. She is distressed b the g#i"t fee"ing and is HconvincedH of the sin
d. The attending !hsician thin,s so
e. Antide!ressants a"one were not effective

8<. The manifestation of de!ression sm!toms are s"ight" different age gro#!s and a"so in men and women. Agitated de!ression is a
term more common" #sed to describe de!ression in which gro#! of !atients$

a. Ao#ng chi"dren
b. Ado"escents
c. Ad#"ts
d. ;omen
e. E"der"
8*. The term do#b"e de!ression is #sed to describe$

a. =a>or de!ressive disorder s#!erim!osed on grief reaction
b. =a>or de!ressive disorder s#!erim!osed on dsthmia
c. =a>or de!ressive disorder8 !atient not res!onding to treatment
d. =a>or de!ressive disorder with !schosis
e. =a>or de!ressive disorder with anxiet


8@. A 3* I ear o"d (a#casian ma"e is stab"e on "ithi#m for bi!o"ar disorder for the !ast ' ears .d#ring his ro#tine visit with his fami"
!hsician. 2e com!"ains of fatig#e and "ac, of motivation. 2e is a"so fee"ing ver co"d d#ring this winter and has gained weight. 2e
wonders if he is getting de!ressed again. ;hat is the next most a!!ro!riate ste! to ta,e in this case$

a. )iagnose de!ression and start the !atient on antide!ressants
b. Jbtain the !atients "ithi#m "eve"s
c. (hec, the !atient0s throid I stim#"ating hormone
d. )iscontin#e "ithi#m
e. (onsider E(T


88. A '* o"d fema"e who is * wee, !ost!art#m com!"ains of fee"ing "ow in her mood and having cring s!e""s8 "ac, of motivation and
fee"ing of ho!e"essness for the !ast ' wee, she is diagnosed with !ost!art#m de!ression. ;hich of the fo""owing is tr#e abo#t
!ost!art#m de!ression$

a. 3is, of infanticide is minima"
b. Se"ective serotonin re#!ta,e inhibitors 1SS34s6 are contraindicated
c. 3is, of de!ression d#ring s#bseG#ent !regnancies is increased
d. S#icide ris, is "ow
e. 2os!ita" admission is rare" reG#ired

8C. ;hich of the fo""owing SS34s is "east "i,e" to ca#se serotonin discontin#ation sndrome$

a. Paroxetine
b. (ita"o!ram
c. Escita"o!ram
d. 9"#oxetine
e. Sertra"ine

C0. Jf a"" of the tricc"ic antide!ressants which of the fo""owing has the most !otent serotonin re#!ta,e inhibition activit$

a. ("omi!ramine
b. 4mi!ramine
c. Amitri!t"ine
d. 7ortri!t"ine
e. )esi!ramine







C1. A ne#ro"ogist is cons#"ted b !sciatrist to assess a '2 ears o"d de!ressed woman with recent onset of Ym#sc"e twitchesZ. She was
ta,ing (ita"o!ram 80mg. )#"oxetine '0mg was recent" added beca#se of s#bo!tima" res!onse to (ita"o!ram a"one. She denies an
a"coho" or s#bstance ab#se. Jn examination8 the ne#ro"ogist notes that the !atient is s"ight" disoriented and a"so has mi"d tremors and
h!erref"exia. ;hat is the most "i,e" ca#se of the Ym#sc"e twitchesZ in this !atient$

a. Serotonin sndrome
b. A"coho" withdrawa" sndrome
c. 7e#ro"e!tic ma"ignant sndrome
d. =a"ingering
e. Ence!ha"itis

C2. ;hich of the fo""owing antide!ressant b"oc,s re#!ta,e of do!amine$

a. %en"afaxine
b. &#!ro!ion
c. &#s!irone
d. =irta-a!ine
e. 9"#oxetine

C3. The advancement in (entra" 7ervo#s Sstem 1(7S6 !harmaco"og is attrib#ted to the better #nderstanding of ne#rotransmitters
and ne#rorece!tors. ;hich of the fo""owing is tr#e abo#t ne#rorece!tors $

a. <+2T
2A
antagonists enhance 3a!id Ee =ovement 13E=6 s"ee!
b. <+2T
1A
antagonists are anxio"tics
c. =ost t!ica" anti!scotics are )
2
agonists
d. )
2
rece!tors are fo#nd in the "imbic sstem
e. [
2
+adrenergic agonists ca#se increase of nore!ine!hrine re"ease


C'. A <* ears o"d ma"e with histor of cronic ben-odia-e!ine #se for insomnia is bro#ght to Emergenc )e!artment 1E)6 b his
da#ghter with com!"aints of sedation8 incoherence and !rob"ems with coordination. 2is da#ghter states that he had been #sing
dia-e!am 10+20mg ever night for man ears. She a"so reca""s that a few das ago her father saw his fami" !hsician and got a new
medication for some other !rob"em. The E) !hsician chec,s the c#rrent medication "ist and be"ieves that the !atient has
ben-odia-e!ine overdose. ;hich of the fo""owing can increase the "eve"s of ben-odia-e!ine$

a. To!iramate
b. (imetidine
c. Phentoin
d. (arbama-e!ine
e. 3ifam!icin

C<. Se"ective m#tism is defined as:

a. 3ef#sa" to s!ea, in "earning sit#ations
b. 4nabi"it to s!ea, in s!ecific socia" sit#ations
c. Jccasiona" ref#sa" to s!ea, in schoo"
d. (onsistent ref#sa" to s!ea, in s!ecific socia" sit#ations
e. 7one of the above





C*. 9irst sm!tom of Attention )eficit 2!eractivit )isorder 1A)2)6 to remit is #s#a"":

a. 2!eractivit
b. )istractibi"it
c. (are"ess mista,es in schoo" wor,
d. 4m!#"sivit
e. Bearning diffic#"ties

C@. 4n To#rette?s disorder8 the initia" tics are in the:

a. 9ace and nec,
b. Arms and hands
c. &od and "ower extremities
d. 3es!irator sstem
e. A"imentar sstem

C8. &efore iss#ing diagnosis of en#resis8 a #rina"sis m#st be done to r#"e o#t which common condition$

a. &"adder infection
b. Str#ct#ra" ma"formation
c. The common co"d
d. A #rinar tract infection
e. Lrethra stenosis

CC. =a>or de!ression disorder in schoo" aged chi"dren$

a. =a !resent as irritab"e mood rather than de!ressed mood
b. Ls#a"" inc"#des !ervasive anhedonia
c. 4nc"#des mood+congr#ent a#ditor ha""#cinations "ess common" than in ad#"ts with the same disorder
d. 4s never diagnosed in the context of bereavement
e. 7one of the above

100. ;hich of the fo""owing is not a negative !schotic sm!tom$

a. 9"at affect
b. A!ath
c. )isorgani-ed thin,ing
d. Avo"ition
e. Povert of tho#ghts

101. ;hich of the fo""owing !schotic sm!toms common" co+occ#re with ado"escent s#bstance #se disorder$

a. S#icida" ideation and s#icide attem!ts
b. Panic attac,s
c. 3e ex!eriencing n#mbing and avoidance
d. &inging and !#ring
e. A"" of the above






102. 3is, factors for the deve"o!ment of ado"escent s#bstance ab#se inc"#des a"" of the fo""owing exce!t:

a. Ear" onset of cigarette smo,ing
b. )iminished !arenta" s#!ervision
c. Pervasive deve"o!menta" disorder
d. Parenta" s#bstance ab#se
e. (ond#ct disorder

103. )ementia of the A"-heimerSs t!e acco#nt for what !ercentage of o"d age dementia$

a. 10D
b. 20D
c. '0D
d. *0D
e. 80D

10'. E"der" !ersons ta,ing anti!schotic are es!ecia"" s#sce!tib"e to the fo""owing side effects exce!t$

a. A,athesia
b. Paresthesias
c. )r mo#th
d. Tradive ds,inesia
e. A toxic conf#sa" state

10<. ;hich of the fo""owing factor is common in victims of e"der ab#se$

a. A"coho" ab#se
b. Socia" iso"ation
c. =enta" i""ness
d. 2osti"it
e. Prescri!tion dr#g ab#se

10*. ;hich of the fo""owing is the greater ris, factor for s#icide$

a. Lnem!"oment
b. Sing"e stat#s
c. Bow income stat#s
d. 3esident of #rban area
e. 2istor of admission to a !schiatr hos!ita"

10@. ;hich of the fo""owing e"ectro"te abnorma"ities is associated with b#"imic !atients$

a. =etabo"ic acidosis
b. 3es!irator acisdosis
c. =etabo"ic a",a"osis
d. 3es!irator a",a"osis
e. 7orma" e"ectro"tes





108. A '2+ear o"d man is seen in o#r office. 2e has recent" seen a !schiatrist and is being treated for severe de!ression. The !atient
cannot reca"" the medication that he is ta,ing8 b#t remembers that his !schiatrist to"d him not to eat cheeses or aged meats. ;hich of
the fo""owing agent is this !atient most "i,e" ta,ing$

a. Tricc"ic antide!ressant
b. Se"ective serotonin re"ease inhibitor
c. =onoamine oxidase 1=AJ6 inhibitor
d. 7e#ro"e!tic
e. Anxio"tic

10C. 2igh fever8 tachcardia8 tach!nea8 dia!horesis8 h!ertension and sei-#res deve"o! in a !schiatric !atient who is receiving
ha"o!erido". The most "i,e" diagnosis$

a. =a"ignant h!ertension
b. 3habdomo"sis
c. 7e#ro"e!tic ma"ignant sndrome
d. Se!sis
e. Serotonin sndrome

110. (hi"dren who exhibit sm!toms of schoo" avoidance with na#sea8 vomiting and abdomina" !ain ma benefit from$

a. Antide!ressant medication
b. =eth"!henidate
c. Pschothera!
d. &en-odia-e!ine




























18.02.2013:

Part A:
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Part &:
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100. (
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