2102

Gynecology:

1. Williams 30.33: at what point postpartum (weeks) does menstruation normally return in a non-breast-feeding woman: a. 4 to 6 b. 6 to 8 c. 12 to 14 d. 16 to 18 2. Williams 41-13: During what period of gestation does high-dose ionizing radiation exposure pose the most serious risk of mental retardation: a. 4 to 7 weeks. b.8 to 15 weeks. c. 20 to 26 weeks. d. 28 weeks to term. 3. Williams 58-29: You counsel your pregnant patient that the most effective prevention of maternal CMV infection involves which of the following: a. Pregnancy inactivated-virus vaccine administration. b. Good hygiene and hand washing. c. CMV immunoglobulin given within 72 hr of viral exposure. d. Ganciclovir administration within 72 hr of viral exposure. 4. Williams 45-16: Beta-blockers, in particular atenolol, are associated with which of the following perinatal morbidities: a. Preterm birth. b. Hyperglycemia. c. Fetal-growth restriction. d. Respiratory distress syndrome. 5. (Pretest gyn 309) A patient is diagnosed with carcinoma of the breast. Which of the following is the most important prognostic factor in the treatment of this disease? a. Age at diagnosis b. Size of tumor c. Axillary node metastases (axillary lymph node involvement) d. Estrogen receptors on the tumor e. Progesterone receptors on the tumor 6. (Pre-test gynecology 316) A 22-year-old woman presents for her first Pap smear. She has been sexually active with only one boyfriend since age 19. Her physical exami- nation is completely normal. However, 2 weeks later her Pap smear results return showing HGSIL. There were no endocervical cells seen on the smear. Which of the following is the most appropriate next step in the management of this patient? a. Perform a cone biopsy of the cervix b. Repeat the Pap smear to obtain endocervical cells c. Order HPV typing on the initial Pap smear d. Perform random cervical biopsies e. Perform colposcopy and directed cervical biopsies 7. (Pre-test gyn 436) A 36-year-old woman presents to your office for contraception. She has had three vaginal deliveries without complications. Her medical his- tory is significant for hypertension, well-controlled with a diuretic, and a seizure disorder. Her last seizure was 12 years ago. Currently she does not take any antiepileptic medications. She also complains of stress-related headaches that are relieved with an over-the-counter pain medication. She denies any history of surgeries. She is divorced, smokes one pack of ciga- rettes per day, and has three to four alcoholic drinks per week. On exami- nation, her vital signs include weight 90 kg, blood pressure 126/80 mm Hg, pulse 68 beats per minute, respiratory rate 16 breaths per minute, and tem- perature 36.4C (97.6F). Her examination is normal except for some lower extremity nontender varicosities. She has taken birth control pills in the past and wants to restart them because they help with her cramps. Which of the following would contradict the use of combination oral contraceptive pills in this patient? a. Varicose veins b. Tension headache

c. Seizure disorders d. Smoking in a woman over 35 years of age e. Mild essential hypertension 8. Most common indication for laparotomy in the 2nd trimester: a. Appendectomy. b. Cholecystectomy. 9. Normmal fetal heart rate monitoring, a transient decrease in hear trate occuring at or after the peak of uterine contraction, which may indicate fetal hypoxia. Smotth decelration after maternal contracion: a. Late deceleration. b. normal c. Varibale. d. early deceleration. 10. 17 y old has 16 cm adenexal mass: a. Brenner tumor. b. Dysgerminoma (?). 11. Chacking ovarian reserve capacity: a. FSH on 3 day (?) b. Estradiol on day 6. c. LH before ovulation. 12. Prematur rupture of the membrane--> Antibiotics. 13. To detect GDM in 90% sensitivity u need a threshold of 130. 14. HRT effect: Prevent osteoporosis, decrease vasomotor instability, decrease vaginal atrophy. 15. Chronic HT in pregnancy, what don't we measure--> Catecholamine in urine. 16. 22 mm cyst: a. normal ovulation (physiological cyst). b. functional cyst. c. normal before ovulation. d. normal after ovulation. 17. A pregnant patient with cervical dilation 6-9 cm in 2 h--> Normal labor. 18. Disease past by cats to pregnant women--> Toxoplasmosis. 19. Athelet female triad: a. Give them hormones and they will have mensturation. b. High gonadotropin. 20. A woman with heterozygotic Laiden mutation develops DVT while on oral contraceptives: a. Inferior vena cava filter. b. heparin and stop OCP for life. 21. watery vaginal discharge in a 70 y old woman: a. Benign tumor. b. Metastatic tumor. c. Endothelial tumor. d. Epithelial tumor from colon carcinoma. 22. An 80 y old women develops an 8 cm adenexal mass: a. Epithelial cancer. b. Ovarian cancer. 23. Umbilical cord prolapse is most common in: a. Complete breech. b. Frank breech. c. Transverse lie. d. Single leg breech.

24. Long term administration of heparin in pregnancy: a. Internal hemorrhage. b. Osteoporosis. 25. How to improve placental insufficiency: Left lateral position of the mother. 26. Earliest sign of puberty in girls--> Thelerach. 27. Webe neck--> Turner syndrome. 28. Pregnancy 28 weeks, elevated liver enzymes (HEELP syndrome): a. Mg and immediate delivery. b. Plasmaphoresis. c. Platelet transfusion and observation of liver enzymes. d. Expected management. 29. What is true about teratoma--> A tumor from 3 germ cell layers.

Internal:

30. Braton-internal , q113: A 41 y old business executive presents to your office and complains of palpitation and shortness of breath. After further questioning, he admits to heavy alcohol consumption the previousevening. On examination, he is found to have an irregular heartbeat of 130 bpm. The most likely diagnosis is: a. Ventricular tachycardia. b. ventricular fibrillation. c. premature ventricular contractions (PVCs). d. atrial fibrillation. e. Wolff-Parkinson-White syndrome. 31. Braton-internal, q 286: Which of the following statments regarding enoxaparin (Lovenox) is true: a. It use has been shown to be cost-effective in an outpatient setting. b. The medication does not require laboratory monitoring. c. The incidence od thrombocytopenia is the same as with heparin. d. it must be given through an intravenous route. e. it is safe to use in renal failure patients. 32. Braton, internal q. 302: The most common cause of chronic cough: a. Postnasal drip. b. bronchiectasis. c. Gastroesophageal reflux. d. Asthma. e. ACE inhibitors. 33. V-85 (harrison) A 35-year-old woman comes in for a routine visit. Her past medical history is significant for poorly con- trolled type 2 diabetes mellitus (HbA1C of 8.4%), ob- structive sleep apnea, hypertension, and dyslipidemia. Her body mass index is 42 kg/m2. Blood pressure in clinic is 154/87 mmHg and fasting plasma glucose is 130 mg/ dL. Her medications include metformin, insulin, rami- pril, hydrochlorothiazide, and atorvastatin. You have di- agnosed her with the metabolic syndrome. Based on our current understanding of the metabolic syndrome, treating which of the following underlying conditions is the primary approach to treating this disorder? A. Hyperglycemia B. Hypercholesterolemia C. Hypertension D. Inflammatory cytokines E. Obesity 34. A 54y old man had an accident, according to a urinary catheter -450 ml of bloody urin, which test is needed:

a. cystoscopy. b. pyelography. c. CT without contrast. d. Retrograde urethrogram. e. PT testitography.

35. A hospitalized patient receive blood transfusion. The patient is flashed, has abdominal discomfort and 38.4 t fever. What is the best management? a. Administration of acetaminophen and to slow the transfusion rate b. Administration of diphenhydramine and continue the transfusion c. 100mg hydrocortisone i.v. And slow transfusion rate d. Stop transfusion and increase i.v. Fluid e. i.v. Ranitidine and order abdominal series x-ray 36. Which of the following is associated with C.M.L? a. leukopenia b. philadelphia chromosome c. elevated leukocyte alkalosis phosphatase d.thrombocytopenia e. decreased b12 levels 37. A 70 y old man with a history of significant weight loss, hemoglobin 7.2, low ferritin. His anemia is econdary to: a. chronic disease/process (ferritin is high).
b. iron deficiency anemia.

c. B12 deficiecny anemia. d. folic acid deficiecny anemia. 38. Risk of sudden death: a. Long QT syndrome. b. Brugada syndrome.
39. A 50 year-old man complain of recurrent chest pain that radiates down his left arm and has been occurring over the past 9 months.The pain is described as a retrosternal pressure. It is brought on by walking or other strenuous exercise and is relieved by 2 minutes at rest. His vital signs are stable and the physical examination is unremarkable. The most likely diagnosis: A)Myocardial infarction B)Stable angina C)Unstable angina D)Pericarditis E)Pleurisy

40. What do you check in hypothyroidism: a. TSH. b. T4 c. T3.

41. A 54 year old male complains of dyspnea for 8 months.He has minimal prior medical care, non prior problems and denise taking any medications.He smokes 1 package of cirgarrets for the last 30 years.On physical examination stable prolonged expiratory phase an diminished breath sounds bilaterally.The most likely cause of this chronic dyspnea:

a. Pulmonary embolism. b. COPD. c. DM

d. MI e. Pneumonia.
42. A previously healthy 26 year old male complained of abdominal cramps for the past 2 days.Loose stool in a 24h stool specimen reveals presence of blood and WBC.The most likely diagnosis: a. Stasphylococus food poisoning. b. Rotavirus. c. Crohns disease. d. Shigellosis. e. Irratibal bowel syndrome.

43. Most common electrolyte abnormality in re-feeding syndrome: A. Hyponatremia. b. Hypokalameia. c. hypophosphatemia (?) d. hypocartinemia. e. hypomagnesemia. 44. A 67 y old man with pneumonia, what is the most common cause in these group of patients: a. Moraxela cataralis. b. Strep. Pneumonia (?). 45. Complciations of a patient with jak 2 mutation: a. Budd chiari (?) b. HT. c. Essential thrombocytosis. 46. Stage fo renal failure. 47. Bulemic patient that vomits--> borehave sydrome. 48. How long do you need to treat IV drug users with infective endocarditis: a. 4-6 weeks. b. 3 months. 49. Which will not cause depletion of AT (anti-thrombin): a. OCP. b. Cirrhosis. c. Nephrotic syndrome. d. Heparin. e. DIC. 50. Causes of lactic acidosis: Anerobic metabolism. 51. A man with GERD, used to smoke in the past and drinks alcohol occasionally, what will increase the risk of squamous cell carcinoma of the esophagus: -Smoking. -Alcohol. -GERD. -All. 52. HT, high sodium--> Primary aldosteronism. 53. Woman with rheumatoid arthritis, what is the most specific test: a. Rheumatoid factor. b. CPP (anti-citrulinated peptide). 54. A girl with DM high HBA1C 14--> Poor glucose control. 55. Decrease in platelets in patients with prostatic aortic vallve--> Stop heparin and start argatroban. 56. ...--> Aortic stenosis. 57. MALT lymphoma--> Triple therapy.

58. Prevention of asthma excerbation: a. Albuterol. b. Steroids. c. Cromylin. 59. What would be the worst prognosis in rheumatic arthritis: a. Rapidly developing subcutaneous nodules. 60. Woman with previous history of endocarditis needs to undergo dental procedure with gingival involvement: a. No prophylaxis. b. Amoxycclin. c. Clindamycin. 61. CML patient is asymptomatic--> Iminatib. 62. A woman with malar rash, ANA positive , fatigue, swollen wrist and fingers (MIP)--> Lupus. 63. Specific therapy for atrial fibrillation with hyperthyroidisnm--> Propanolol. 64. ...--> Transesophageal.

Phsyciatry:

65. (Kaplan 14.14) Minor signs and symptoms of the benzodiazepine discontinuation syndrome commonly include A. grand mal seizures B. psychosis C. nightmares D. hyperpyrexia E. death 66. (Kaplan 14.22) In distinguishing schizophrenia from amphetamine-induced toxic psychosis, the presence of which of the following is most helpful? A. paranoid delusions B. auditory hallucinations C. clear consciousness D. tactile or visual hallucinations E. intact orientation 67. (Kaplan 15.2) Late-onset schizophrenia A. is clinically distinguishable from schizophrenia. B. is more common in men. C. has an onset after age 60. D. is associated with a preponderance of paranoid symptoms. E. results in poorer response to antipsychotic medications. 68. (Kaplan 15.11) Clozapine (Clozaril) A. causes significant increases in prolactin levels B. is associated with a 10 to 20 percent incidence of agranulocytosis C. requires monthly monitoring of blood chemistry D. has been associated with few, if any, extrapyramidal side effects E. is believed to exert its therapeutic effect mainly by blocking dopamine receptors 69. (Kaplan 17.26) Double depression is characterized by A. Two episodes of major depressive disorder per month consistently B. Superimposed bipolar II disorder and atypical depression C. Recurrent major depressive disorder superimposed with dysthymic disorder D. Two family members suffering from major depressive disorder concurrently E. Recurrent major depressive disorder with current symptoms twice as disabling as usual 70. (Kaplan 17.35) A27-year-old patient has been diagnosed with bipolar disorder. Before starting this patient on lithium for mood stabilization, which of the following laboratory tests should be obtained?

A. Thyroid function tests, creatinine, liver function tests B. Thyroid function tests, complete blood count, pregnancy test C. Thyroid function tests, liver function tests, pregnancy test D. Thyroid function tests, creatinine, pregnancy test E. Thyroid function tests, creatinine, complete blood count

71. (Kaplan 45.15) The first symptom of ADHD to remit is usually A. hyperactivity B. distractibility C. careless mistakes in schoolwork D. impulsivity E. learning difficulties 72. (Pre test psychiatry 316). A 32-year-old man is being treated for a severe major depression. Which of the following symptoms, if present, is one of the most accurate indicators of long-term suicidal risk? a. Revenge fantasies b. Presence of rage in the patient c. Hopelessness d. Presence of guilt e. The patient has a need for punishment 73. Which of the following is the most common side effect of methylphenidate (Ritalin): a. tremor. b. hypotension. C. weight gain. d. insomnia. e. liver toxicity. 74. Which of the following electrolyte abnormalities is associated with bulimic patients ? a.Metabolic acidosis. b.Respiratory acidosis. c.Metabolic alkalosis. d.Respiratory alkalosis. e.Normal electrolytes. 75. Post traumatic stress disorder differs from adjustmaent disorder in that PTSD: a. occurs in vetrians. b. characterized by impairment od social functioning. c. Persists longer after the stress has abated. d. is characterized by preoccupation with the stress. e. can be accompanied with depression. 76. What will decrease the level of triglycerides: a.fibrates (?). b. Niacin. 77. Substance intoxication that may mimic full range of symptoms seen in schizophrenia: a. Alcohol. b. Ecstasy. c. Phencyclidinase (?) 78. Suicide, old man--> ECT. 79. Most common side effect of fluoxetine--> Nausea. 80. Treatment of tourett--> Haloperidol. 81. Treatment of panic attack: a. Sertraline. b. Carbamezapine. 82. Which of the following is the most common somatization disorder--> Conversion.

83. When should clopadagrel be stopped: a. 1 day before surgery. b. 7 days before surgery. c. 1 month before surgery. d. 10 days before surgery. 84. All of the following are true except--> Mania is always followed by depression. 85. The highest risk of suicide is in patients with: a. Cancer. b. HIV. C. Huntington. d. Brain injury. 86. A physichiatric patient does not want to eat: a. Feed fim forcefully. b. ECT. 87. Criteria for hospital admission of a patient with AN: A. hypotension. b. arrhythmias. c. bradycardia. d. angina. e. Lanugo. 88. Criteria for weight change with depression: a. any weight change. b. 10% weight loss in 1 month. c. 5% weight loss in 1 months. 89. The differance between fascticuis and malingering--> Secondary gain. 90. Side effects of chronic marijuana use: a. Avolation. b. Antimotivational syndrome. 91. ...-> Heroin withdrawal 92. ...--> fluoxetine will increase the level of faloperidol.

Pediatrics:

93. (Nelson acute ill q.27) Regarding resuscitative efforts, the most important goal is: a. Restoration of age-appropriate heart rate b. Appropriate movement of the chest wall c. Auscultation of equal breath sounds in both lung fields d. Adequate oxygen delivery and utilization for the body tissues e. Palpation of equal pulses in all four extremities 94. (Nelson, cancer q. 5)Which of the following cancers has the highest incidence in young children (<7y of age): a. Ewing sarcoma. b. Hodgkin disease. c. Testicular cancer. d. Retinoblastoma. e. Osteosarcoma. 95. (Nelson, the digestive system Question . 21) A 3-mo-old infant presents for a well-child evaluation. Which of the following complaints would be a cause for concern? A. Regurgitation of 15-30 mL of formula three times a day B. One bowel movement every other day C. Three bowel movements per day

D. Liver edge palpable 10 cm below the right costal margin E. Hemoccult-positive stool 96. (Nelson, endocraniology Question . 5) A 6-yr-old girl underwent removal of a craniopharyngioma 3 mo previously. She is on a thyroid replacement regimen, but her mother reports she is very fatigued. The next step would be to: a. Increase the dose of her thyroid medication. b. Schedule a growth hormone stimulation test
c. Measure ACTH and cortisol

d. Obtain an MRI study of her head e. Measure IGF-1 and IGFBP-3 97. (Nelson, nephrology, Question . 11) A 3-yr-old boy presents to an urgent care clinic with a 3-day history of abdominal pain and difficulty walking. Abnormal findings include blood pressure of 120/80 mm Hg, diffuse abdominal tenderness, purpuric rash of the hands and ankles, and diffuse periarticular tenderness and swelling of the ankles. The most likely diagnosis is: a. Systemic lupus erythematosus b. Kawasaki's disease c. Juvenile rheumatoid arthritis
d. Henoch-Schonlein purpura

e. Stevens-Johnson syndrome

98. (Pre-test pediatrics 26). A 5-year-old boy presents with the severe rash shown in the photographs. The rash is pruritic, and it is especially intense in the flexural areas. The mother reports that the symptoms began in infancy (when it also involved the face) and that her 6-month-old child has similar symptoms. Which of the following is the most appropriate treatment of this condition? a. Coal-tar soaps and shampoo b.Topical anti-fungal cream c. Ultraviolet light therapy d. Moisturizers and topical steroids e. Topical antibiotics 99. (Pretest pediatrics 34) A 20-month-old child is brought to the ED because of fever and irritability and refusal to move his right lower extremity. Physical examination reveals a swollen and tender right knee that resists passive motion. Which of the following is the most likely to yield the diagnosis in this patient? a. Examination of joint fluid b. X-ray of the knee c. Erythrocyte sedimentation rate (ESR) d. CBC and differential e. Blood culture 100. (Pre test pediatrics 185). A newborn infant has mild cyanosis, diaphoresis, poor peripheral pulses, hepatomegaly, and cardiomegaly. Respiratory rate is 60 breaths per minute, and heart rate is 250 beats per minute. The child most likely has congestive heart failure caused by which of the following? a. Large ASD and valvular pulmonic stenosis b. VSD and transposition of the great vessels c. Total anomalous pulmonary venous return d. Hypoplastic left heart syndrome e. Paroxysmal atrial tachycardia 101. (Pre-test pediatrics 202). A 10-month-old infant has poor weight gain, a persistent cough, and a history of several bouts of pneumonitis. The mother describes the child as having very large, foul-smelling stools for months. Which of the following diagnostic maneuvers is likely to result in the correct diagnosis of this child? a. CT of the chest b. Serum immunoglobulins c. TB skin test d. Inspiratory and expiratory chest x-ray

e. Sweat chloride test

102. (Pre-test pediatrics 246). A 12-month-old girl has been spitting up her meals since 1 month of age. Her growth is at the 95th percentile, and she is otherwise asymptomatic and without findings on physical examination. Which of the following is the most likely diagnosis? a. Pyloric stenosis b. Partial duodenal atresia c. Hypothyroidism d. Gastroesophageal reflux e. Tracheoesophageal fistula

103. (Pre-test pediatrics 321). A 6-year-old child is hospitalized for observation because of a short period of unconsciousness after a fall from a playground swing. He has deve- loped unilateral pupillary dilatation, focal seizures, recurrence of depressed consciousness, and hemiplegia. Which of the following is the most appro- priate management at this time? a. Spinal tap b.CT scan c.Rapid fluid hydration d.Naloxone e.Gastric decontamination with charcoal 104. (Pre-test pediatrics 323). A 6-year-old boy had been in his normal state of good health until a few hours prior to presentation to the ER room. His mother reports that he began to have difficulty walking, and she noticed that he was falling and unable to maintain his balance. Which of the following is the most likely cause for his condition? a. Drug intoxication b. Agenesis of the corpus callosum c. Ataxia telangiectasia d. Muscular dystrophy e. Friedreich ataxia 105. (Pre-test pediatrics 347). An 18-month-old child presents to the emergency center having had a brief, generalized tonic-clonic seizure. He is now postictal and has a tem- perature of 40C (104F). During the lumbar puncture (which ultimately proves to be normal), he has a large, watery stool that has both blood and mucus in it. Which of the following is the most likely diagnosis in this patient? a. Salmonella b. Enterovirus c. Rotavirus d. Campylobacter e. Shigella 106. (Pre test pediatrics 364). A 14-year-old girl awakens with a mild sore throat, low-grade fever, and a diffuse maculopapular rash. During the next 24 hours, she develops tender swelling of her wrists and redness of her eyes. In addition, her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. Four days after the onset of her illness, the rash has vanished. Which of the following is the most likely diagnosis? a. Rubella b. Rubeola c. Roseola d. Erythema infectiosum e. Erythema multiforme 107. (Pre-test pediatrics 403). A healthy 1-year-old child comes to your office for a routine checkup and for immunizations. His parents have no complaints or concerns. The next day, the CBC you performed as customary screening for anemia returns with the percentage of eosinophils on the differential to be 30%. Which of the following is the most likely explanation? a. Bacterial infections b. Chronic allergic rhinitis c. Fungal infections d. Helminth infestation e. Tuberculosis

108. (Pre-test pediatrics 488). An 18-year-old male college student is seen in the student health clinic for urinary frequency, dysuria, and urethral discharge. Which of the following is likely to explain his condition? a. Herpes simplex b. Escherichia coli urinary tract infection c. Chlamydial urethritis d. Syphilis e. HIV infection 109. a 12 month-old infant presents with hemoglobin level of 7.5 and hemotocrit 22% the mean corpuscular volume 65 and the adjusted reticulocyte count is 1%. what is the most likely cause of the anemia in this child: a. Iron deficiency. b. chronic disease. c. transient erythrocytopenia of childhood. d. talassemia. e. Parvovirus b19 aplastic crisis. 110. Which of the following is the most likely diagnosis of a 3 year old boy that runs in circules, avoids eye contact and doesn't talk? a. ADHD. b. CD. c. Dyslexia. d. Infntile autism. e. Mental retardation. 111. A 12 year old Ashkenazi jewish girl suffer from anemia , leukopenia ,thrompocytopenia, large spleen on x-ray femur show erlenm eyer flask, abnormal bone marrow the most likely diagnosis? a- Tay-sachs disease b- Gaucher disease c- Mucopolysaccheridosis d- Canavan disease e- Glycogen storage disease 112. What is the mediator of urticaria: a. IgE b. Complement.
1. T-cell.

113. (February 2011) An 11 y old girl is examined because of fatigue, arthralgia and malar rash. Laboratory test reveals positive anti nuclear anti bodies, you suspected SLE. What test if positive would be the most specific for the diagnosis of SLE:
a. anti smith antibodies. b. Anti double strand antibodies.

c. anti phospholipid antibodies. d. anti-cardiolipin antibodies. e. antinuclear antibodies.

114. What is the most significant complication arising from Kawasaki disease: a. Coronary aneurysm. b. Kidney failure. c. Gallbladder hydrops. d. Gastrointestinal bleeding. e. Hypertension. 115. Trisomy 21 is associated with: a. Malrotation. b. Endocardial cushion defect. c. Cleft palate. d. Renal disease. e. Sensoyural hearing loss. 116. A 2 day old infant, bleeding from the vagina:

a. Withdrawal bleeding from maternal estrogen (?). b. abuse. 117. Positive prognosis of autism: a. Easy toilet training. b. converse with the parents. c. Reciprocal interaction (?) 118. Chil gets PEEP oxygen decrease PCO2 increases, decrese PEEP oscilitaory ventilation, 10mg/dl fluid: a. Chest transillumintion. b. Oscilatory ventilation. c. High frequency oscilatroy ventilation. d. Decreased PEEP. 119. A 6 y old child , never had dry periods, always has pee since birth. What do you suspect: a. Vesicourethral reflex disease. b. normal child. c. Emotional problems. 120. TPN complications: sepsis. 121. Patient with respiratory infection 2 weeks ago and in laboratroy he had proteinuria+1, albumin 3.5, HT: a. IgA nephropathy. b. Post infection nephropathy. 122. Who needs to get a prophylaxis for PCP--> HIV child. 123. Parentds say that there baby does not grow like his brothers when theyr were the same age, but he is healthy. What should you do: a. Check his previous weight and compare. 124. Nasal polyps--> Seen in CF. 125. 2 year old boy, watery diarrhea for 2 weeks, no RBC in stool--> Rotavisus. 126. Muscial murmur at left sternal border at 10 y old child examination: a. pulmonary stenosis. b. VSD. c. Inocent murmur. d. ASD. 127. Short child with short mother and short father: (nelson) a. Constitutional. b. Familial short stature. 128. A child 2y old, on physical exam unilateral wheezing of the right lobe of the lung--> Foreign body. 129. Common complication of obese child--> Slipped capital femoral epiphysis.
Surgery:

130.(Pretest surgery q.133) A 10 year old boy was the backseat belted passenger in a high speed motor vehicle collision. On presentation to the ER he is awake, alert, and hemodynamically stable. He is complaining of abdominal pain and has an ecchymosis on his anterior abdominal wall where the seatbelt was located. Which of the following statements is true regarding need for additional workup? a. a. The boy can be safely discharged home without any other workup, since his abdominal pain is probably secondary to his abdominal wall ecchymosis. b. The boy can be safely discharged home if his amylase level is normal c. The boy can be safely discharged home if abdomen plain films are negative for the presence of free air. d. The boy can be safely discharged home if an abdominal CT is negative e. The boy should be observed regardless of negative test result. 131. (2009)A boy with fracture of the hand, pain in the fingers, what to do: a. Clevage of the cast/open cast.

b. Elevation of the hand. c. Analgesia.

132. A 44 years old woman has papillary thyroid carcinoma of the right lobe confirmed by fine-needle aspiration. Ultrasound study stages the tumor as T1(1.5 CM). optimal surgical management would be: A. Right thyroidlobectomy, selective mode dissection of the right side B. Right thyroidlobectomy, level VI (central compartment) nod dissection C. Total thyroidectomy, selective dissection on the right side D. Total thyroidectomy, level VI dissection ,and selective dissection of the right side E. Total thyroidectomy

133. A 23 year old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the second postoperative day, she begins to complain of a tingling sensation in her hands. She appears quite anxious and later complains of muscle cramps. Which of the following is the most appropriate initial management strategy? a. 10 ml of 10% Magnesium sulfate IV b. Oral vitamin D c. 100 micro gram oral synthroid d. Continuous infusion of calcium gluconate e. Oral calcium gluconate. 134. A 35 year old woman with a history of previous right thyroidectomy for a benign thyroid nodule now undergoes completion thyroidectomy for a suspicious thyroid mass. Several hours postoperatively she develops progressive swelling under the incision, stridor and difficulty breathing. Orotracheal intubation is successful. Which of the following is the most appropriate next step? a. Fiberoptic laryngosopy to rule out bilateral vocal cord paralysis b. Administration of IV calcium c. Administration of broad spectrum antibiotics and debridement of the wound d. Wound exploration e. Administration of high dose steroids and antihistamines.
135. A 46 years old women ask about the need for surgery, since she was recently diagnosed with Crhon's Disease. Indication for operation in Chron's include all except: A. Intestinal obstruction B. Enterovesical fistula C. Prolonged use of steroids D. Enterovaginal fistula E. Free perforation 136. 55 years old with 1st episode of diverticulitis, hemodynamicaly stable and improve within 48h receiving antibiotic and nothing by mouth. CT show stranding of sigmoid mesentery, but no free air evidence of an abcess.The next step should be: A) Resection and anastomosis B) Resection and colostomy C) Discharge + elective colectomy D) Discharge + oral antibiotic E) Colonoscopic intraluminal stench

137. A41 years old men complains on regurgitation of saliva and undigested food, an esophaogram reveals "birds beak" deformity. which of the following statments is true about the condition: A. Chest pain is common in advanced stage of the disease. B. More patients are improved by forcefull dialatation then by surgical intervention. C. Manometry can be expected to show increase resting pressure of the LES.

D. Initial surgical treatment consist primarily of resection of the distal esophagus with reanastomosis to the stoma above the diaphragm. E. Patients with this disease are at no increased risk for the development of carcinoma.

138. Small bowel perforation in blunt trauma is reliably detected by: a. Abdominal CT. b. Focused assesment with sonography for trauma (FAST). c. Diagnostic peritoneal lavage. d. Physical examination on admission. e. None of the above. 139. A 55y old female with no medical history is being evaluated for melena and is found to have a 2 cm gastrointestinal stroma tumor (GIST) in the anterior wall of the stomach. The diagnosis is confirmed with the diagnosis of immunochemical staining. There is no adjusant organ invasion or diatant metastasis. What is the recommended treatment? a. Open or laparoscopic margin free tumor excision and follow up. b. Subtotal gastrectomy and regional lymph node dissection. c. Treatment with tyrosine kinase inhibitors till complete respons and after surgery in case of medical treatment failure. d. Treatment with tyrosin kinase inhibitors imitinab. e. Wedge resection. 140. A 15 year old otherwise healthy female high school student begins to notice galactorrhea. A pregnancy test is negative. Which of the following is a frequently associated physical finding? a. Gonadal atrophy b. Bitemproal hemianopsia c. Exophthalmos and lid lag d. Episodic hypertension e. Buffalo hump
141. A 36 years old man has a blood pressure of 70/40 mm/Hg after a motor vehicle crash .resuscitation is initiated. Focused assessment with sonography for trauma (FAST) is positive for fluid in the abdomen . on examination of the pelvis ,fracture related crepitus and an enlarging perineal hematoma are appreciated .the patients blood pressure does not improve with resusciatation. The next step in management should be: A. CT of the abdomen and pelvis B. Diagnostic peritoneal lavage C. Placement of an external pelvic fixator D. Exploratory laparotomy E. Pelvic angioembolization

142. What can glutan sensitive patients eat:

a. Rice.

b. Barly. C. Ray. 143. Fracture of the mid-shaft humerus , which nerve is injured: a. Radial nerve. b. Median nerve. c. Ulnar nerve. d. Brachial nerve. e. Axillary nerve. 144. A man has an MI, he feels its the same sort of pain he had the last time he presented to the hospital 1 h after the pain has started, the catheterization lab is 3 hours away, what will you do next: a. Transfer 3h for catherterization lab. b. Perform PCI. c. Thrombolytics. d. Medical management (?) 145. What is the most important to do regarding check ups for coagulation in preoperative period: a. check bleeding time. b. INR. c. PT

d. PTT. e. Complete medical history (?) 146. Patient with cirrhosis has massive hematomas, endoscopy revelas blood filling distal esophagus: a. Ruptured esophageal varices (?). b. Duodenal ulcer. 147. Man with pain post meal for months , now hypotensive, pain in midabdomen, pain from hell. Bloody stool, amylase elevated: a. Hemorrhagic pancreatitis (?). b. Toxic megacolon. c. Small bowel infract. 148. Gunshot under the nipple: a. Thoracotomy. b. Pericardiocenthesis (?) 149. Birds beak--> Sigmoid volvulus.

Gynecology:

1. Williams 30.33: at what point postpartum (weeks) does menstruation normally return in a non-breast-feeding woman: a. 4 to 6 b. 6 to 8 c. 12 to 14 d. 16 to 18 2. Williams 41-13: During what period of gestation does high-dose ionizing radiation exposure pose the most serious risk of mental retardation: a. 4 to 7 weeks. b.8 to 15 weeks. c. 20 to 26 weeks. d. 28 weeks to term. 3. Williams 58-29: You counsel your pregnant patient that the most effective prevention of maternal CMV infection involves which of the following: a. Pregnancy inactivated-virus vaccine administration. b. Good hygiene and hand washing. c. CMV immunoglobulin given within 72 hr of viral exposure. d. Ganciclovir administration within 72 hr of viral exposure. 4. Williams 45-16: Beta-blockers, in particular atenolol, are associated with which of the following perinatal morbidities: a. Preterm birth. b. Hyperglycemia. c. Fetal-growth restriction. d. Respiratory distress syndrome. 5. (Pretest gyn 309) A patient is diagnosed with carcinoma of the breast. Which of the following is the most important prognostic factor in the treatment of this disease? a. Age at diagnosis b. Size of tumor c. Axillary node metastases (axillary lymph node involvement) d. Estrogen receptors on the tumor e. Progesterone receptors on the tumor

6. (Pre-test gynecology 316) A 22-year-old woman presents for her first Pap smear. She has been sexually active with only one boyfriend since age 19. Her physical exami- nation is completely normal. However, 2 weeks later her Pap smear results return showing HGSIL. There were no endocervical cells seen on the smear. Which of the following is the most appropriate next step in the management of this patient? a. Perform a cone biopsy of the cervix b. Repeat the Pap smear to obtain endocervical cells c. Order HPV typing on the initial Pap smear d. Perform random cervical biopsies e. Perform colposcopy and directed cervical biopsies 7. (Pre-test gyn 436) A 36-year-old woman presents to your office for contraception. She has had three vaginal deliveries without complications. Her medical his- tory is significant for hypertension, wellcontrolled with a diuretic, and a seizure disorder. Her last seizure was 12 years ago. Currently she does not take any antiepileptic medications. She also complains of stress-related headaches that are relieved with an over-the-counter pain medication. She denies any history of surgeries. She is divorced, smokes one pack of ciga- rettes per day, and has three to four alcoholic drinks per week. On exami- nation, her vital signs include weight 90 kg, blood pressure 126/80 mm Hg, pulse 68 beats per minute, respiratory rate 16 breaths per minute, and tem- perature 36.4C (97.6F). Her examination is normal except for some lower extremity nontender varicosities. She has taken birth control pills in the past and wants to restart them because they help with her cramps. Which of the following would contradict the use of combination oral contraceptive pills in this patient? a. Varicose veins b. Tension headache c. Seizure disorders d. Smoking in a woman over 35 years of age e. Mild essential hypertension 8. Most common indication for laparotomy in the 2nd trimester: a. Appendectomy. b. Cholecystectomy. 9. Normmal fetal heart rate monitoring, a transient decrease in hear trate occuring at or after the peak of uterine contraction, which may indicate fetal hypoxia. Smotth decelration after maternal contracion: a. Late deceleration. b. normal c. Varibale. d. early deceleration. 10. 17 y old has 16 cm adenexal mass: a. Brenner tumor. b. Dysgerminoma (?). 11. Chacking ovarian reserve capacity: a. FSH on 3 day (?) b. Estradiol on day 6. c. LH before ovulation. 12. Prematur rupture of the membrane--> Antibiotics. 13. To detect GDM in 90% sensitivity u need a threshold of 130. 14. HRT effect: Prevent osteoporosis, decrease vasomotor instability, decrease vaginal atrophy. 15. Chronic HT in pregnancy, what don't we measure--> Catecholamine in urine. 16. 22 mm cyst: a. normal ovulation (physiological cyst).

b. functional cyst. c. normal before ovulation. d. normal after ovulation. 17. A pregnant patient with cervical dilation 6-9 cm in 2 h--> Normal labor. 18. Disease past by cats to pregnant women--> Toxoplasmosis. 19. Athelet female triad: a. Give them hormones and they will have mensturation. b. High gonadotropin. 20. A woman with heterozygotic Laiden mutation develops DVT while on oral contraceptives: a. Inferior vena cava filter. b. heparin and stop OCP for life. 21. watery vaginal discharge in a 70 y old woman: a. Benign tumor. b. Metastatic tumor. c. Endothelial tumor. d. Epithelial tumor from colon carcinoma. 22. An 80 y old women develops an 8 cm adenexal mass: a. Epithelial cancer. b. Ovarian cancer. 23. Umbilical cord prolapse is most common in: a. Complete breech. b. Frank breech. c. Transverse lie. d. Single leg breech. 24. Long term administration of heparin in pregnancy: a. Internal hemorrhage. b. Osteoporosis. 25. How to improve placental insufficiency: Left lateral position of the mother. 26. Earliest sign of puberty in girls--> Thelerach. 27. Webe neck--> Turner syndrome. 28. Pregnancy 28 weeks, elevated liver enzymes (HEELP syndrome): a. Mg and immediate delivery. b. Plasmaphoresis. c. Platelet transfusion and observation of liver enzymes. d. Expected management. 29. What is true about teratoma--> A tumor from 3 germ cell layers.

Internal:

30. Braton-internal , q113:

A 41 y old business executive presents to your office and complains of palpitation and shortness of breath. After further questioning, he admits to heavy alcohol consumption the previousevening. On examination, he is found to have an irregular heartbeat of 130 bpm. The most likely diagnosis is: a. Ventricular tachycardia. b. ventricular fibrillation. c. premature ventricular contractions (PVCs). d. atrial fibrillation. e. Wolff-Parkinson-White syndrome. 31. Braton-internal, q 286: Which of the following statments regarding enoxaparin (Lovenox) is true: a. It use has been shown to be cost-effective in an outpatient setting. b. The medication does not require laboratory monitoring. c. The incidence od thrombocytopenia is the same as with heparin. d. it must be given through an intravenous route. e. it is safe to use in renal failure patients. 32. Braton, internal q. 302: The most common cause of chronic cough: a. Postnasal drip. b. bronchiectasis. c. Gastroesophageal reflux. d. Asthma. e. ACE inhibitors. 33. V-85 (harrison) A 35-year-old woman comes in for a routine visit. Her past medical history is significant for poorly con- trolled type 2 diabetes mellitus (HbA1C of 8.4%), ob- structive sleep apnea, hypertension, and dyslipidemia. Her body mass index is 42 kg/m2. Blood pressure in clinic is 154/87 mmHg and fasting plasma glucose is 130 mg/ dL. Her medications include metformin, insulin, rami- pril, hydrochlorothiazide, and atorvastatin. You have di- agnosed her with the metabolic syndrome. Based on our current understanding of the metabolic syndrome, treat- ing which of the following underlying conditions is the primary approach to treating this disorder? A. Hyperglycemia B. Hypercholesterolemia C. Hypertension D. Inflammatory cytokines E. Obesity 34. A 54y old man had an accident, according to a urinary catheter -450 ml of bloody urin, which test is needed: a. cystoscopy. b. pyelography. c. CT without contrast. d. Retrograde urethrogram. e. PT testitography.

35. A hospitalized patient receive blood transfusion. The patient is flashed, has abdominal discomfort and 38.4 t fever. What is the best management? a. Administration of acetaminophen and to slow the transfusion rate b. Administration of diphenhydramine and continue the transfusion c. 100mg hydrocortisone i.v. And slow transfusion rate d. Stop transfusion and increase i.v. Fluid e. i.v. Ranitidine and order abdominal series x-ray 36. Which of the following is associated with C.M.L?

a. leukopenia b. philadelphia chromosome c. elevated leukocyte alkalosis phosphatase d.thrombocytopenia e. decreased b12 levels 37. A 70 y old man with a history of significant weight loss, hemoglobin 7.2, low ferritin. His anemia is econdary to: a. chronic disease/process (ferritin is high).
b. iron deficiency anemia.

c. B12 deficiecny anemia. d. folic acid deficiecny anemia. 38. Risk of sudden death: a. Long QT syndrome. b. Brugada syndrome.
39. A 50 year-old man complain of recurrent chest pain that radiates down his left arm and has been occurring over the past 9 months.The pain is described as a retrosternal pressure. It is brought on by walking or other strenuous exercise and is relieved by 2 minutes at rest. His vital signs are stable and the physical examination is unremarkable. The most likely diagnosis: A)Myocardial infarction B)Stable angina C)Unstable angina D)Pericarditis E)Pleurisy

40. What do you check in hypothyroidism: a. TSH. b. T4 c. T3.

41. A 54 year old male complains of dyspnea for 8 months.He has minimal prior medical care, non prior problems and denise taking any medications.He smokes 1 package of cirgarrets for the last 30 years.On physical examination stable prolonged expiratory phase an diminished breath sounds bilaterally.The most likely cause of this chronic dyspnea:

a. Pulmonary embolism. b. COPD. c. DM d. MI e. Pneumonia.

42. A previously healthy 26 year old male complained of abdominal cramps for the past 2 days.Loose stool in a 24h stool specimen reveals presence of blood and WBC.The most likely diagnosis: a. Stasphylococus food poisoning. b. Rotavirus. c. Crohns disease. d. Shigellosis. e. Irratibal bowel syndrome.

43. Most common electrolyte abnormality in re-feeding syndrome: A. Hyponatremia. b. Hypokalameia. c. hypophosphatemia (?) d. hypocartinemia. e. hypomagnesemia. 44. A 67 y old man with pneumonia, what is the most common cause in these group of patients: a. Moraxela cataralis. b. Strep. Pneumonia (?). 45. Complciations of a patient with jak 2 mutation: a. Budd chiari (?) b. HT. c. Essential thrombocytosis. 46. Stage fo renal failure. 47. Bulemic patient that vomits--> borehave sydrome. 48. How long do you need to treat IV drug users with infective endocarditis: a. 4-6 weeks. b. 3 months. 49. Which will not cause depletion of AT (anti-thrombin): a. OCP. b. Cirrhosis. c. Nephrotic syndrome. d. Heparin. e. DIC. 50. Causes of lactic acidosis: Anerobic metabolism. 51. A man with GERD, used to smoke in the past and drinks alcohol occasionally, what will increase the risk of squamous cell carcinoma of the esophagus: -Smoking. -Alcohol. -GERD. -All. 52. HT, high sodium--> Primary aldosteronism. 53. Woman with rheumatoid arthritis, what is the most specific test: a. Rheumatoid factor. b. CPP (anti-citrulinated peptide). 54. A girl with DM high HBA1C 14--> Poor glucose control. 55. Decrease in platelets in patients with prostatic aortic vallve--> Stop heparin and start argatroban. 56. ...--> Aortic stenosis. 57. MALT lymphoma--> Triple therapy. 58. Prevention of asthma excerbation: a. Albuterol. b. Steroids. c. Cromylin.

59. What would be the worst prognosis in rheumatic arthritis: a. Rapidly developing subcutaneous nodules. 60. Woman with previous history of endocarditis needs to undergo dental procedure with gingival involvement: a. No prophylaxis. b. Amoxycclin. c. Clindamycin. 61. CML patient is asymptomatic--> Iminatib. 62. A woman with malar rash, ANA positive , fatigue, swollen wrist and fingers (MIP)--> Lupus. 63. Specific therapy for atrial fibrillation with hyperthyroidisnm--> Propanolol. 64. ...--> Transesophageal.

Phsyciatry:

65. (Kaplan 14.14) Minor signs and symptoms of the benzodiazepine discontinuation syndrome commonly include A. grand mal seizures B. psychosis C. nightmares D. hyperpyrexia E. death 66. (Kaplan 14.22) In distinguishing schizophrenia from amphetamine-induced toxic psychosis, the presence of which of the following is most helpful? A. paranoid delusions B. auditory hallucinations C. clear consciousness D. tactile or visual hallucinations E. intact orientation 67. (Kaplan 15.2) Late-onset schizophrenia A. is clinically distinguishable from schizophrenia. B. is more common in men. C. has an onset after age 60. D. is associated with a preponderance of paranoid symptoms. E. results in poorer response to antipsychotic medications. 68. (Kaplan 15.11) Clozapine (Clozaril) A. causes significant increases in prolactin levels B. is associated with a 10 to 20 percent incidence of agranulocytosis C. requires monthly monitoring of blood chemistry D. has been associated with few, if any, extrapyramidal side effects E. is believed to exert its therapeutic effect mainly by blocking dopamine receptors 69. (Kaplan 17.26) Double depression is characterized by A. Two episodes of major depressive disorder per month consistently B. Superimposed bipolar II disorder and atypical depression C. Recurrent major depressive disorder superimposed with dysthymic disorder D. Two family members suffering from major depressive disorder concurrently E. Recurrent major depressive disorder with current symptoms twice as disabling as usual

70. (Kaplan 17.35) A27-year-old patient has been diagnosed with bipolar disorder. Before starting this patient on lithium for mood stabilization, which of the following laboratory tests should be obtained? A. Thyroid function tests, creatinine, liver function tests B. Thyroid function tests, complete blood count, pregnancy test C. Thyroid function tests, liver function tests, pregnancy test D. Thyroid function tests, creatinine, pregnancy test E. Thyroid function tests, creatinine, complete blood count

71. (Kaplan 45.15) The first symptom of ADHD to remit is usually A. hyperactivity B. distractibility C. careless mistakes in schoolwork D. impulsivity E. learning difficulties 72. (Pre test psychiatry 316). A 32-year-old man is being treated for a severe major depression. Which of the following symptoms, if present, is one of the most accurate indicators of long-term suicidal risk? a. Revenge fantasies b. Presence of rage in the patient c. Hopelessness d. Presence of guilt e. The patient has a need for punishment 73. Which of the following is the most common side effect of methylphenidate (Ritalin): a. tremor. b. hypotension. C. weight gain. d. insomnia. e. liver toxicity. 74. Which of the following electrolyte abnormalities is associated with bulimic patients ? a.Metabolic acidosis. b.Respiratory acidosis. c.Metabolic alkalosis. d.Respiratory alkalosis. e.Normal electrolytes. 75. Post traumatic stress disorder differs from adjustmaent disorder in that PTSD: a. occurs in vetrians. b. characterized by impairment od social functioning. c. Persists longer after the stress has abated. d. is characterized by preoccupation with the stress. e. can be accompanied with depression. 76. What will decrease the level of triglycerides: a.fibrates (?). b. Niacin. 77. Substance intoxication that may mimic full range of symptoms seen in schizophrenia: a. Alcohol. b. Ecstasy. c. Phencyclidinase (?) 78. Suicide, old man--> ECT.

79. Most common side effect of fluoxetine--> Nausea. 80. Treatment of tourett--> Haloperidol. 81. Treatment of panic attack: a. Sertraline. b. Carbamezapine. 82. Which of the following is the most common somatization disorder--> Conversion. 83. When should clopadagrel be stopped: a. 1 day before surgery. b. 7 days before surgery. c. 1 month before surgery. d. 10 days before surgery. 84. All of the following are true except--> Mania is always followed by depression. 85. The highest risk of suicide is in patients with: a. Cancer. b. HIV. C. Huntington. d. Brain injury. 86. A physichiatric patient does not want to eat: a. Feed fim forcefully. b. ECT. 87. Criteria for hospital admission of a patient with AN: A. hypotension. b. arrhythmias. c. bradycardia. d. angina. e. Lanugo. 88. Criteria for weight change with depression: a. any weight change. b. 10% weight loss in 1 month. c. 5% weight loss in 1 months. 89. The differance between fascticuis and malingering--> Secondary gain. 90. Side effects of chronic marijuana use: a. Avolation. b. Antimotivational syndrome. 91. ...-> Heroin withdrawal 92. ...--> fluoxetine will increase the level of faloperidol.

Pediatrics:

93. (Nelson acute ill q.27) Regarding resuscitative efforts, the most important goal is: a. Restoration of age-appropriate heart rate b. Appropriate movement of the chest wall

c. Auscultation of equal breath sounds in both lung fields d. Adequate oxygen delivery and utilization for the body tissues e. Palpation of equal pulses in all four extremities 94. (Nelson, cancer q. 5)Which of the following cancers has the highest incidence in young children (<7y of age): a. Ewing sarcoma. b. Hodgkin disease. c. Testicular cancer. d. Retinoblastoma. e. Osteosarcoma. 95. (Nelson, the digestive system Question . 21) A 3-mo-old infant presents for a well-child evaluation. Which of the following complaints would be a cause for concern? A. Regurgitation of 15-30 mL of formula three times a day B. One bowel movement every other day C. Three bowel movements per day D. Liver edge palpable 10 cm below the right costal margin E. Hemoccult-positive stool 96. (Nelson, endocraniology Question . 5) A 6-yr-old girl underwent removal of a craniopharyngioma 3 mo previously. She is on a thyroid replacement regimen, but her mother reports she is very fatigued. The next step would be to: a. Increase the dose of her thyroid medication. b. Schedule a growth hormone stimulation test
c. Measure ACTH and cortisol

d. Obtain an MRI study of her head e. Measure IGF-1 and IGFBP-3 97. (Nelson, nephrology, Question . 11) A 3-yr-old boy presents to an urgent care clinic with a 3-day history of abdominal pain and difficulty walking. Abnormal findings include blood pressure of 120/80 mm Hg, diffuse abdominal tenderness, purpuric rash of the hands and ankles, and diffuse periarticular tenderness and swelling of the ankles. The most likely diagnosis is: a. Systemic lupus erythematosus b. Kawasaki's disease c. Juvenile rheumatoid arthritis
d. Henoch-Schonlein purpura

e. Stevens-Johnson syndrome

98. (Pre-test pediatrics 26). A 5-year-old boy presents with the severe rash shown in the photographs. The rash is pruritic, and it is especially intense in the flexural areas. The mother reports that the symptoms began in infancy (when it also involved the face) and that her 6-month-old child has similar symptoms. Which of the following is the most appropriate treatment of this condition? a. Coal-tar soaps and shampoo b.Topical anti-fungal cream c. Ultraviolet light therapy d. Moisturizers and topical steroids e. Topical antibiotics 99. (Pretest pediatrics 34) A 20-month-old child is brought to the ED because of fever and irritability and refusal to move his right lower extremity. Physical examination reveals a swollen and tender right

knee that resists passive motion. Which of the following is the most likely to yield the diagnosis in this patient? a. Examination of joint fluid b. X-ray of the knee c. Erythrocyte sedimentation rate (ESR) d. CBC and differential e. Blood culture 100. (Pre test pediatrics 185). A newborn infant has mild cyanosis, diaphoresis, poor peripheral pulses, hepatomegaly, and cardiomegaly. Respiratory rate is 60 breaths per minute, and heart rate is 250 beats per minute. The child most likely has congestive heart failure caused by which of the following? a. Large ASD and valvular pulmonic stenosis b. VSD and transposition of the great vessels c. Total anomalous pulmonary venous return d. Hypoplastic left heart syndrome e. Paroxysmal atrial tachycardia 101. (Pre-test pediatrics 202). A 10-month-old infant has poor weight gain, a persistent cough, and a history of several bouts of pneumonitis. The mother describes the child as having very large, foulsmelling stools for months. Which of the following diagnostic maneuvers is likely to result in the correct diagnosis of this child? a. CT of the chest b. Serum immunoglobulins c. TB skin test d. Inspiratory and expiratory chest x-ray
e. Sweat chloride test

102. (Pre-test pediatrics 246). A 12-month-old girl has been spitting up her meals since 1 month of age. Her growth is at the 95th percentile, and she is otherwise asymptomatic and without findings on physical examination. Which of the following is the most likely diagnosis? a. Pyloric stenosis b. Partial duodenal atresia c. Hypothyroidism d. Gastroesophageal reflux e. Tracheoesophageal fistula

103. (Pre-test pediatrics 321). A 6-year-old child is hospitalized for observation because of a short period of unconsciousness after a fall from a playground swing. He has deve- loped unilateral pupillary dilatation, focal seizures, recurrence of depressed consciousness, and hemiplegia. Which of the following is the most appro- priate management at this time? a. Spinal tap b.CT scan c.Rapid fluid hydration d.Naloxone e.Gastric decontamination with charcoal 104. (Pre-test pediatrics 323). A 6-year-old boy had been in his normal state of good health until a few hours prior to presentation to the ER room. His mother reports that he began to have difficulty walking, and she noticed that he was falling and unable to maintain his balance. Which of the following is the most likely cause for his condition? a. Drug intoxication b. Agenesis of the corpus callosum c. Ataxia telangiectasia d. Muscular dystrophy e. Friedreich ataxia

105. (Pre-test pediatrics 347). An 18-month-old child presents to the emergency center having had a brief, generalized tonic-clonic seizure. He is now postictal and has a tem- perature of 40C (104F). During the lumbar puncture (which ultimately proves to be normal), he has a large, watery stool that has both blood and mucus in it. Which of the following is the most likely diagnosis in this patient? a. Salmonella b. Enterovirus c. Rotavirus d. Campylobacter e. Shigella 106. (Pre test pediatrics 364). A 14-year-old girl awakens with a mild sore throat, low-grade fever, and a diffuse maculopapular rash. During the next 24 hours, she develops tender swelling of her wrists and redness of her eyes. In addition, her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. Four days after the onset of her illness, the rash has vanished. Which of the following is the most likely diagnosis? a. Rubella b. Rubeola c. Roseola d. Erythema infectiosum e. Erythema multiforme 107. (Pre-test pediatrics 403). A healthy 1-year-old child comes to your office for a routine checkup and for immunizations. His parents have no complaints or concerns. The next day, the CBC you performed as customary screening for anemia returns with the percentage of eosinophils on the differential to be 30%. Which of the following is the most likely explanation? a. Bacterial infections b. Chronic allergic rhinitis c. Fungal infections d. Helminth infestation e. Tuberculosis 108. (Pre-test pediatrics 488). An 18-year-old male college student is seen in the student health clinic for urinary frequency, dysuria, and urethral discharge. Which of the following is likely to explain his condition? a. Herpes simplex b. Escherichia coli urinary tract infection c. Chlamydial urethritis d. Syphilis e. HIV infection 109. a 12 month-old infant presents with hemoglobin level of 7.5 and hemotocrit 22% the mean corpuscular volume 65 and the adjusted reticulocyte count is 1%. what is the most likely cause of the anemia in this child: a. Iron deficiency. b. chronic disease. c. transient erythrocytopenia of childhood. d. talassemia. e. Parvovirus b19 aplastic crisis. 110. Which of the following is the most likely diagnosis of a 3 year old boy that runs in circules, avoids eye contact and doesn't talk? a. ADHD. b. CD. c. Dyslexia. d. Infntile autism. e. Mental retardation.

111. A 12 year old Ashkenazi jewish girl suffer from anemia , leukopenia ,thrompocytopenia, large spleen on x-ray femur show erlenm eyer flask, abnormal bone marrow the most likely diagnosis? a- Tay-sachs disease b- Gaucher disease c- Mucopolysaccheridosis d- Canavan disease e- Glycogen storage disease 112. What is the mediator of urticaria: a. IgE b. Complement.
1. T-cell.

113. (February 2011) An 11 y old girl is examined because of fatigue, arthralgia and malar rash. Laboratory test reveals positive anti nuclear anti bodies, you suspected SLE. What test if positive would be the most specific for the diagnosis of SLE:
a. anti smith antibodies. b. Anti double strand antibodies.

c. anti phospholipid antibodies. d. anti-cardiolipin antibodies. e. antinuclear antibodies.

114. What is the most significant complication arising from Kawasaki disease: a. Coronary aneurysm. b. Kidney failure. c. Gallbladder hydrops. d. Gastrointestinal bleeding. e. Hypertension. 115. Trisomy 21 is associated with: a. Malrotation. b. Endocardial cushion defect. c. Cleft palate. d. Renal disease. e. Sensoyural hearing loss. 116. A 2 day old infant, bleeding from the vagina: a. Withdrawal bleeding from maternal estrogen (?). b. abuse. 117. Positive prognosis of autism: a. Easy toilet training. b. converse with the parents. c. Reciprocal interaction (?) 118. Chil gets PEEP oxygen decrease PCO2 increases, decrese PEEP oscilitaory ventilation, 10mg/dl fluid: a. Chest transillumintion. b. Oscilatory ventilation. c. High frequency oscilatroy ventilation. d. Decreased PEEP. 119. A 6 y old child , never had dry periods, always has pee since birth. What do you suspect: a. Vesicourethral reflex disease. b. normal child.

c. Emotional problems. 120. TPN complications: sepsis. 121. Patient with respiratory infection 2 weeks ago and in laboratroy he had proteinuria+1, albumin 3.5, HT: a. IgA nephropathy. b. Post infection nephropathy. 122. Who needs to get a prophylaxis for PCP--> HIV child. 123. Parentds say that there baby does not grow like his brothers when theyr were the same age, but he is healthy. What should you do: a. Check his previous weight and compare. 124. Nasal polyps--> Seen in CF. 125. 2 year old boy, watery diarrhea for 2 weeks, no RBC in stool--> Rotavisus. 126. Muscial murmur at left sternal border at 10 y old child examination: a. pulmonary stenosis. b. VSD. c. Inocent murmur. d. ASD. 127. Short child with short mother and short father: (nelson) a. Constitutional. b. Familial short stature. 128. A child 2y old, on physical exam unilateral wheezing of the right lobe of the lung--> Foreign body. 129. Common complication of obese child--> Slipped capital femoral epiphysis.
Surgery:

130.(Pretest surgery q.133) A 10 year old boy was the backseat belted passenger in a high speed motor vehicle collision. On presentation to the ER he is awake, alert, and hemodynamically stable. He is complaining of abdominal pain and has an ecchymosis on his anterior abdominal wall where the seatbelt was located. Which of the following statements is true regarding need for additional workup? a. a. The boy can be safely discharged home without any other workup, since his abdominal pain is probably secondary to his abdominal wall ecchymosis. b. The boy can be safely discharged home if his amylase level is normal c. The boy can be safely discharged home if abdomen plain films are negative for the presence of free air. d. The boy can be safely discharged home if an abdominal CT is negative e. The boy should be observed regardless of negative test result. 131. (2009)A boy with fracture of the hand, pain in the fingers, what to do: a. Clevage of the cast/open cast. b. Elevation of the hand. c. Analgesia.
132. A 44 years old woman has papillary thyroid carcinoma of the right lobe confirmed by fine-needle aspiration. Ultrasound study stages the tumor as T1(1.5 CM). optimal surgical management would be: A. Right thyroidlobectomy, selective mode dissection of the right side B. Right thyroidlobectomy, level VI (central compartment) nod dissection C. Total thyroidectomy, selective dissection on the right side D. Total thyroidectomy, level VI dissection ,and selective dissection of the right side

E. Total thyroidectomy

133. A 23 year old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the second postoperative day, she begins to complain of a tingling sensation in her hands. She appears quite anxious and later complains of muscle cramps. Which of the following is the most appropriate initial management strategy? a. 10 ml of 10% Magnesium sulfate IV b. Oral vitamin D c. 100 micro gram oral synthroid d. Continuous infusion of calcium gluconate e. Oral calcium gluconate. 134. A 35 year old woman with a history of previous right thyroidectomy for a benign thyroid nodule now undergoes completion thyroidectomy for a suspicious thyroid mass. Several hours postoperatively she develops progressive swelling under the incision, stridor and difficulty breathing. Orotracheal intubation is successful. Which of the following is the most appropriate next step? a. Fiberoptic laryngosopy to rule out bilateral vocal cord paralysis b. Administration of IV calcium c. Administration of broad spectrum antibiotics and debridement of the wound d. Wound exploration e. Administration of high dose steroids and antihistamines.
135. A 46 years old women ask about the need for surgery, since she was recently diagnosed with Crhon's Disease. Indication for operation in Chron's include all except: A. Intestinal obstruction B. Enterovesical fistula C. Prolonged use of steroids D. Enterovaginal fistula E. Free perforation 136. 55 years old with 1st episode of diverticulitis, hemodynamicaly stable and improve within 48h receiving antibiotic and nothing by mouth. CT show stranding of sigmoid mesentery, but no free air evidence of an abcess.The next step should be: A) Resection and anastomosis B) Resection and colostomy C) Discharge + elective colectomy D) Discharge + oral antibiotic E) Colonoscopic intraluminal stench

137. A41 years old men complains on regurgitation of saliva and undigested food, an esophaogram reveals "birds beak" deformity. which of the following statments is true about the condition: A. Chest pain is common in advanced stage of the disease. B. More patients are improved by forcefull dialatation then by surgical intervention. C. Manometry can be expected to show increase resting pressure of the LES. D. Initial surgical treatment consist primarily of resection of the distal esophagus with reanastomosis to the stoma above the diaphragm.

E. Patients with this disease are at no increased risk for the development of carcinoma.

138. Small bowel perforation in blunt trauma is reliably detected by: a. Abdominal CT. b. Focused assesment with sonography for trauma (FAST). c. Diagnostic peritoneal lavage. d. Physical examination on admission. e. None of the above. 139. A 55y old female with no medical history is being evaluated for melena and is found to have a 2 cm gastrointestinal stroma tumor (GIST) in the anterior wall of the stomach. The diagnosis is confirmed with the diagnosis of immunochemical staining. There is no adjusant organ invasion or diatant metastasis. What is the recommended treatment? a. Open or laparoscopic margin free tumor excision and follow up. b. Subtotal gastrectomy and regional lymph node dissection. c. Treatment with tyrosine kinase inhibitors till complete respons and after surgery in case of medical treatment failure. d. Treatment with tyrosin kinase inhibitors imitinab. e. Wedge resection. 140. A 15 year old otherwise healthy female high school student begins to notice galactorrhea. A pregnancy test is negative. Which of the following is a frequently associated physical finding? a. Gonadal atrophy b. Bitemproal hemianopsia c. Exophthalmos and lid lag d. Episodic hypertension e. Buffalo hump
141. A 36 years old man has a blood pressure of 70/40 mm/Hg after a motor vehicle crash .resuscitation is initiated. Focused assessment with sonography for trauma (FAST) is positive for fluid in the abdomen . on examination of the pelvis ,fracture related crepitus and an enlarging perineal hematoma are appreciated .the patients blood pressure does not improve with resusciatation. The next step in management should be: A. CT of the abdomen and pelvis B. Diagnostic peritoneal lavage C. Placement of an external pelvic fixator D. Exploratory laparotomy E. Pelvic angioembolization

142. What can glutan sensitive patients eat:

a. Rice.

b. Barly. C. Ray. 143. Fracture of the mid-shaft humerus , which nerve is injured: a. Radial nerve. b. Median nerve. c. Ulnar nerve. d. Brachial nerve. e. Axillary nerve. 144. A man has an MI, he feels its the same sort of pain he had the last time he presented to the hospital 1 h after the pain has started, the catheterization lab is 3 hours away, what will you do next: a. Transfer 3h for catherterization lab. b. Perform PCI. c. Thrombolytics. d. Medical management (?)

145. What is the most important to do regarding check ups for coagulation in preoperative period: a. check bleeding time. b. INR. c. PT d. PTT. e. Complete medical history (?) 146. Patient with cirrhosis has massive hematomas, endoscopy revelas blood filling distal esophagus: a. Ruptured esophageal varices (?). b. Duodenal ulcer. 147. Man with pain post meal for months , now hypotensive, pain in midabdomen, pain from hell. Bloody stool, amylase elevated: a. Hemorrhagic pancreatitis (?). b. Toxic megacolon. c. Small bowel infract. 148. Gunshot under the nipple: a. Thoracotomy. b. Pericardiocenthesis (?) 149. Birds beak--> Sigmoid volvulus.