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#1
Which of the following compartments is associated with meningocele?

A. Posterior mediastinal compartment

B. Middle mediastinal compartment
C. Anterior mediastinal compartment
D. All are correct
E. None of the above

#2
Which of the following compartments is associated with Morgagni hernias?

A. Posterior mediastinal compartment

B. Middle mediastinal compartment
C. Anterior mediastinal compartment
D. All are correct
E. None of the above

#3
Which of the following compartments is associated with Bochdalek hernia?

A. Posterior mediastinal compartment

B. Middle mediastinal compartment
C. Anterior mediastinal compartment
D. All are correct
E. None of the above

#4
You are seeing a patient with a facial edema, hypertension and oliguria with "tea-colored"
urine. To determine the etiology according to patient's history your next question should be
about:

A. Recent pneumonia.
B. Recent pharyngitis or pyoderma.
C. Mumps, varicella, infectious mononucleosis, hepatitis B.
D. Family history of chronic glomerulonephritis.
E. All are correct.

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#5
A 50-year-old black male with a 10-year history of hypertension is brought to the hospital. ECG
shows a polymorphic ventricular tachycardia characterized by QRS complexes that change in
amplitude and electrical polarity appearing to "twist" around the isoelectric line. A prolonged
QT interval and U waves are present. Which of the following cardiovascular drugs may cause
the above syndrome?

A. Quinidine
B. Procainamide
C. Disopyramide
D. Sotalol
E. All are correct

#6
For which of the following toxic overdoses is hemoperfusion recommended as the method of
choice for drug removal?

A. Aspirin
B. Digoxin
C. Both
D. Neither

#7
For which of the following toxic overdoses is hemodialysis recommended as the method of
choice for drug removal?

A. Aspirin
B. Digoxin
C. Both
D. Neither

#8
A 40-year-old while male is seen for progressive loss of vision in his left eye over the past 7
months. He was healthy until last summer, when he noted blurring of his vision while reading,
which was better when he covered his left eye. He had his eyeglass prescription changed, but
in the last 2 months has noted more rapid deterioration in his vision. He had some loss of libido
and impotence approximately 4 months ago. He was laid off from his job as a glasscutter 2
months ago, is currently separated from his wife and living with his parents. To confirm the
diagnosis you will investigate:

A. IGF-I serum level

B. Visual field exam
C. MRI of the pituitary region
D. Basal prolactin serum level
E. All of the above
F. Only B, C and D are correct

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#9
Which of the following statements regarding the lupoid hepatitis (chronic active hepatitis) is
correct?

A. Predominantly in young females

B. Often accompanied thyroiditis
C. Antibodies to smooth muscle and antinuclear antibodies may be found
D. Accompanied by amenorrhea
E. All are correct

NOTE: Question 10 and 11 both refer to the following case.

A 55-year old female was admitted to the hospital because of syncope. She had been in good
health until six years prior when she noticed for the first time a light-headedness, fading vision,
and a sensation of tightness. Usually, she would become light-headed when getting out of her
car after a short drive. In the beginning, the symptoms occurred very rarely and infrequently,
but over the next few years, episodes of presyncope increased in frequency. She also noted
that kneeling would cause her symptoms to resolve promptly. Four weeks before the hospital
admission, she experienced her first syncope. She underwent a 48-hour Holter monitor, which
showed normal sinus rhythm during another syncopal episode. Additional patient history was
notable for rheumatic fever at the age of eight.

#10
Refer to the above case. A diagnosis of orthostatic hypotension was made. A differential
diagnosis should include:

A. Hypoglycemia.
B. Shy-Drager syndrome.
C. Aortic stenosis.
D. Alcoholism.
E. All of the above.

#11
Refer to the above case. Which of the following therapeutic interventions is likely to provide
clinical benefit?

A. The patient is required to sit on the edge of the bed for three to five minutes in the
morning.
B. A high sodium diet
C. 9-a-fludrocortisone (Florinef)
D. b-adrenergic blockade
E. Clonidine
F. Lysin vasopressin
G. All of the aboveLysin vasopressin
H. Only A + B + C are correct

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#12
A 45-year old white male complains of fatigue with hair combing and stair-climbing. What is the
most likely diagnosis?

A. Eaton-Lambert syndrome
B. Polymyositis
C. Myasthenia gravis
D. Polymyalgia rheumatica
E. All of the above

#13
Meningitis and meningoencephalitis in the immunocompromised patient after splenectomy are
frequently caused by:

A. Neisseria meningitidis.
B. Haemophilus influenzae.
C. Streptococcus pneumoniae.
D. Listeria monocytogenes.
E. A + B + C are correct.

#14
Meningitis and meningoencephalitis in the immunocompromised patient with impaired cellular
immunity are frequently caused by:

A. Cytomegalovirus.
B. Cryptococcus neoformans.
C. Toxoplasma gondii.
D. Listeria monocytogenes.
E. All of the above.
F. None of the above.

#15
Bacterial toxin causing food poisoning is produced by:

A. Staphylococcus aureus.
B. Clostridium perfringens.
C. Bacillus cereus.
D. Escherichia coli.
E. All of the above.
F. Only A + B + C are correct.
G. Only A + B are correct.

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#16
Epidemiologic characteristics of Rotavirus infection include:

A. Transmission by inadequately cooked shrimp and shellfish.

B. Outbreaks in child-care centers or custodial institution; person-to-person transmission.
C. Survives dessication in processed dairy, poultry, and meat products; zoonosis.
D. Almost always follows antimicrobial therapy.
E. Person-to-person transmission; very rare in USA, Canada, and Europe.
F. None of the above.

#17
Epidemiologic characteristics of Campylobacter jejuni infection include:

A. Transmission by inadequately cooked shrimp and shellfish.

B. Outbreaks in child-care centers or custodial institution; person-to-person transmission.
C. Survives dessication in processed dairy, poultry, and meat products; zoonosis.
D. Almost always follows antimicrobial therapy.
E. Person-to-person transmission; very rare in USA, Canada, and Europe.
F. None of the above.

#18
Epidemiologic characteristics of Yersinia enterocolitica infection include:

A. Transmission by inadequately cooked shrimp and shellfish

B. Outbreaks in child-care centers or custodial institution; person-to-person transmission
C. Survives dessication in processed dairy, poultry, and meat products; zoonosis
D. Almost always follows antimicrobial therapy
E. Person-to-person transmission; very rare in USA, Canada, and Europe
F. None of the above

#19
Refer to the above case. The laboratory studies should probably show:

A 50-year old white male with diagnosed peptic ulcer disease (PUD) has nausea and severe
vomiting for two days. Physical examination shows a patient with confusion and pale skin,
tachycardia 140 bpm, and blood arterial pressure of 90/50.

A. Metabolic alkalosis.
B. Hypokalemia.
C. Hypochloremia.
D. Hypotonic hyponatremia.
E. All of the above.
F. A + B + C are correct.

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#20
Right-sided lesions of the colon are usually associated with:

A. Melena.
B. Hematochezia.
C. Both of the above.
D. Neither of the above.

#21
Left-sided lesions of the colon are usually associated with:

A. Melena.
B. Hematochezia.
C. Both of the above.
D. Neither of the above.

#22
The passage of bright red blood through the rectum is called:

A. Melena.
B. Hematochezia.
C. Both of the above.
D. Neither of the above.

#23
Dark, tarry stools are called:

A. Melena.
B. Hematochezia.
C. Both of the above.
D. Neither of the above.

#24
What is the sign of lower GI bleeding?

A. Melena.
B. Hematochezia.
C. Both of the above.
D. Neither of the above.

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#25
Hypotonic hyponatremia is characteristic of:

A. Diabetes insipidus (central) .

B. SIADH
C. Both of the above.
D. Neither of the above.

#26
High serum osmolality is characteristic of:

A. Diabetes insipidus (central) .

B. SIADH.
C. Both of the above.
D. Neither of the above.

#27
Highly diluted urine is seen in:

A. Diabetes insipidus (central).

B. SIADH.
C. Both of the above.
D. Neither of the above.

#28
Small cell carcinoma is the most common cancer associated with:

A. Diabetes insipidus (central) .

B. SIADH.
C. Both of the above.
D. Neither of the above.

#29
Refer to the attached case. Which of the following therapeutic interventions is likely to provide
clinical benefit?

A 20-year old college student was referred to the hospital for a one-year history of persistent
dry cough and exertional dyspnea. The patient had been normal until two years ago, when he
was hospitalized for gastrointestinal bleeding associated with ascites. Esophageal varices
were found on endoscopy. After the acute episode, he was placed on lactulose and
spironolactone daily and returned to school. He remained well until about year ago, when he
had viral influenza and developed fever, productive cough, and muscle aches.

Subsequently, he returned to school but found that his exercise tolerance was significantly
decreased. Persistent dry cough and dyspnea (he was unable to walk more than two hundred
yards without stopping to rest) were developed. There is no past history of asthma or

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pneumonia. He has never been an alcohol drinker, but he has smoked cigarettes for six years.
He had jaundice at age six months, and also had intermittent episodes of jaundice until the age
of ten. His sister died of emphysema at age 25 and a brother died of hepatic cirrhosis at age
40. On examination his body temperature was 38.0oF, pulse 88, respirations 22/min, blood
pressure 120/90 mm Hg. His complexion was dark, there was numerous spider angiomata
over the upper chest, and he had gynecomastia. A fluid wave was elicited on physical
examination of the abdomen by striking one flank and feeling the transmitted wave on the
opposite flank. The spleen tip was palpable 6 cm below the costal margin. There were
prominent superficial veins, pretibial edema, and enlarged hemorrhoids in rectal examination.

A. Transplantation
B. Protease inhibitors as potential agents
C. Bronchodilator therapy
D. No specific therapy for the hepatic disorder is available
E. All of the above
F. Only A + B are correct

#30
Which of the following may not be clinically distinguishable from cerebral ischemia without the
aid of a CT scan?

A. Intracerebral hemorrhage
B. Subarachnoid hemorrhage
C. Both of the above.
D. Neither of the above.

#31
Sudden onset of severe headache, vomiting, and alteration in mental status are characteristic
of:

A. Intracerebral hemorrhage
B. Subarachnoid hemorrhage
C. Both of the above.
D. Neither of the above.

#32
Chronic systemic hypertension is the most common cause of:

A. Intracerebral hemorrhage.
B. Subarachnoid hemorrhage.
C. Both of the above.
D. Neither of the above.

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#33
Rupture of a saccular (berry) aneurysm, caused by defects in the arterial media and internal
elastic membrane, is the most common cause of:

A. Intracerebral hemorrhage.
B. Subarachnoid hemorrhage.
C. Both of the above.
D. Neither of the above.

#34
Complications including rebleeding, vasospasm with ischemia, hydrocephalus, seizures, and
hyponatremia are characteristic of:

A. Intracerebral hemorrhage.
B. Subarachnoid hemorrhage.
C. Both of the above.
D. Neither of the above.

#35
Brain herniation and brainstem compression may occur as a complication of:

A. Intracerebral hemorrhage.
B. Subarachnoid hemorrhage.
C. Both of the above.
D. Neither of the above.

#36
Systemic blood pressure should be lowered in treatment of:

A. Intracerebral hemorrhage.
B. Subarachnoid hemorrhage.
C. Both of the above.
D. Neither of the above.

#37
Hypotension must be avoided, only extreme elevations in blood pressure
(diastolic >130 mm Hg) should be treated in:

A. Intracerebral hemorrhage.
B. Subarachnoid hemorrhage.
C. Both of the above.
D. Neither of the above.

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#38
Which test is most useful in the diagnosis of pancreatic cancer?

A. CT scan of abdomen
B. ERCP
C. Angiography
D. Ultrasound of abdomen
E. A + B are correct

#39
A shortened QT interval is caused by:

A. Hypercalcemia
B. Digitalis
C. Hyperkalemia at level of 5.5 - 6.0 mEq/L
D. None of the above
E. All of the above

#40
Diagnostic criteria for left anterior fascicular block include:

A. Small q wave in lead I.

B. Small r wave in lead III.
C. QRS axis +120 degrees.
D. All of the above.
E. Only A and B are correct.

#41
A 46-year-old black male with hypertension suffers from recurrent oppressive, squeezing chest
pains at rest. He complains of this same type of pain when he is presented to the Emergency
Center. ECG shows transient ST-segment elevations. The most likely diagnosis is:

A. Prinzmetal's angina.
B. Variant angina.
C. Acute myocardial infarction.
D. Acute aortic dissection.
E. A and B are correct.

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#42
A 46-year-old black male with hypertension suffers from recurrent oppressive, squeezing chest
pains at rest. He complains of this same type of pain when he is presented to the Emergency
Center. ECG shows transient ST-segment elevations. Several diagnostic studies are
performed. The patient is suspected of having Prinzmetal's angina or variant angina.
Appropriate treatment should include:

A. Nitrates.
B. Calcium channel blockers.
C. Beta blockers.
D. All of the above.
E. Only A and B.

NOTE: Question 43 and 44 both refer to the following case.

A 28-year-old white male patient began having decreased energy about 2.5 years ago. About
one year ago he began having increased breast size, and increased fatigue. About eight
months ago he had further breast enlargement, decreased weight, decreased libido,
decreased spontaneous erections without alteration of hair pattern, decreased penis/testicular
size or breast discharge. On admission, he was found to have hypertension, cachexia, and
papilledema. He had also gynecomastia with tender right breast tissue of 6 cm,
hyperpigmented areola 3.5 cm, and left breast tissue 4.5 cm (areola 4 cm). His laboratory
evaluation included increased urinary estrogen and aldosterone.

#43
Refer to the above case. The most appropriate test to support a diagnosis of adrenal
carcinoma with feminization is:

A. CT scan of abdomen.
B. Biopsy of abdominal masses.
C. CT of sella turcica.
D. Karyotyping.
E. A and B are correct

#44
Refer to the above case. A diagnosis of adrenal carcinoma with feminization was made. The
most appropriate treatment is:

A. Surgery.
B. Mitotane.
C. Repeated surgery with recurrence.
D. All of the above.
E. only A and B.

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#45
A 50-year-old man presents with acute severe epigastric pain, anorexia, nausea, vomiting and
diaphoresis. ECG showed myocardial infarction. These clinical manifestations are related to:

A. Increased vagal tone.

B. Irritation of the diaphragm.
C. Pancreas irritation.
D. All of the above.
E. Only A and B are correct.

#46
Human growth hormone is prescribed for:

A. Turner syndrome.
B. Kidney insufficiency.
C. Short stature in children.
D. Elderly.
E. All of the above.

#47
If only breathing is arrested in an adult patient during CPR:

A. Begin rescue breathing with two slow, independent ventilations.

B. Check the pulse once a minute.
C. Rescue breathing with 12 breaths per minute.
D. Continue breathing as long as the breathing inadequacy persists.
E. All of the above

#48
Brain stem stroke causes which type of ophthalmoplegia?

A. Bilateral
B. Unilateral
C. Both
D. Neither

#49
Myasthenia gravis causes which type of ophthalmoplegia?

A. Bilateral
B. Unilateral
C. Both
D. Neither

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