Professional Documents
Culture Documents
NBME 2 Block 1-4
NBME 2 Block 1-4
Block 1
C) Prophylactic antibiotics
A) Atrial fibrillation
B) Atrial flutter
H) Torsades de pointes
I) Wandering pacemaker
J) Wolff-Parkinson-White syndrome
A) Elliptocytes
B) Howell-Jolly bodies
C) Schistocytes
D) Sickle cells
E) Spherocytes
5.) A sexually active 20-year-old woman has had fever, chills, malaise, and pain of the
vulva for 2 days. Examination shows a vulvar pustule that has ulcerated and
formed multiple satellite lesions. Nodes are palpated in the inguinal and
femoral areas. A smear of fluid from the lesions establishes the diagnosis.
Which of the following is the most likely causal organism?
A) Chlamydia trachomatis
B) Haemophilus ducreyi
C) Neisseria gonorrhoeae
E) Treponema pallidum
A) Acute pyelonephritis
D) Rhabdomyolysis
7.) A 16-year-old girl comes to the physician for her first prenatal
visit at 12 weeks' gestation. She has not had any immunizations since
the age of 5 years. She has received the following immunizations at the
recommended ages:
5 Diphtheria-tetanus-pertussis
3 Hepatitis B
1 Measles-mumps-rubella
4 Oral poliovirus
A) Diphtheria-tetanus-pertussis
E) Hepatitis B
F) Inactivated poliovirus
Which of the following is the most likely explanation for these findings?
B) Hyperaldosteronism
A) Corticosteroid therapy
B) Interferon therapy
C) Penicillamine therapy
D) Chronic phlebotomy
E) No therapy indicated
10.) A 26-year-old man has had anxiety and insomnia since he lost his
job 1 month ago. He also has had palpitations, daily headaches, and
flatulence. He has no history of psychiatric disorders. His mother has
a history of bipolar disorder, mixed, and his father has alcoholism;
his younger sister had a history of drug abuse but has been abstinent
from drugs for 3 years. Which of the following is the most likely
diagnosis?
A) Adjustment disorder
B) Alcoholic hepatitis
C) Cholangiocarcinoma
F) Congestive hepatitis
G) Gallstone pancreatitis
H) Gilbert's syndrome
I) Infectious hepatitis
J) Intravascular hemolysis
12.) A 24-year-old third-year medical student comes to the student health clinic for
evaluation of jaundice which he noticed this morning. He has had no abdominal
pain, itching, or weight change. He takes no medications. He describes recent
anxiety over anticipation of the upcoming Step 2 examination. His temperature is
37 C (98.6 F), blood pressure is 120/80 mm Hg, pulse is 76/min, and respirations
are 12/min. Examination shows no abnormalities except for scleral icterus.
B) Alcoholic hepatitis
C) Cholangiocarcinoma
F) Congestive hepatitis
G) Gallstone pancreatitis
H) Gilbert's syndrome
I) Infectious hepatitis
J) Intravascular hemolysis
13.) A 37-year-old woman with a 2-year history of hypertension comes for a follow-up
examination; her hypertension has worsened despite treatment with a low-sodium
diet and a -adrenergic blocking agent. She has a history of rheumatic fever and
Graves' disease treated with 131I. Her blood pressure is 160/106 mm Hg, and
pulse is 80/min. Serum studies show:
A) Adrenal cortex
B) Adrenal medulla
C) Aorta
D) Renal arteries
E) Renal glomeruli
F) Thyroid gland
14.) A 27-year-old woman comes to the physician because of muscle weakness and
cramps for 2 weeks. She has been taking a -adrenergic blocking agent for
hypertension for 2 years. She had chronic lymphocytic thyroiditis (Hashimoto's
disease) 1 year ago. Her blood pressure is 160/108 mm Hg, and pulse is 60/min.
Serum studies show:
A) Adrenal cortex
B) Adrenal medulla
C) Aorta
D) Renal arteries
E) Renal glomeruli
F) Thyroid gland
B) Nitroprusside therapy
C) Sympathetic block
D) Femoral arteriography
A) Aortic stenosis
F) Pulmonary stenosis
G) Tetralogy of Fallot
J) Normal heart
18.) A previously healthy 57-year-old woman comes to the physician because of three
episodes of blurred vision in the right eye over the past 3 weeks; each episode
lasts approximately 5minutes. Retinal examination shows a small refractile body at
The bifurcation of a retinal artery. The remainder of the examination shows no
abnormalities. Which of the following is the most appropriate next step in
diagnosis?
A) Cerebral angiography
B) Echocardiography
C) Electroencephalography
19.) A 67-year-old woman comes to the physician for her first influenza virus
vaccination. She has a history of untreated hypertension. Her blood pressure is
160/100 mm Hg, and pulse is 100/min. Shortly after administration of the
influenza virus vaccine, she develops shortness of breath, hives, and angioedema.
Which of the following is most likely to have prevented this reaction?
E) Amantadine therapy
F) Insulin therapy
G) Rimantadine therapy
20.) A 7-year-old girl is brought to the physician because of a 2-day history of fever,
headache, sore throat, and swollen glands. She does not have a runny nose,
congestion, or cough. She has no allergies to medications. Her temperature is
38.6C (101.4 F), blood pressure is 100/60 mm Hg, pulse is 120/min, and
respirations are 16/min. Examination shows a swollen, erythematous oropharynx
With tonsillar exudates. The anterior cervical lymph nodes are enlarged and
tender. No other abnormalities are noted. Which of the following is the most likely
causal organism?
A) Adenovirus
B) Corynebacterium diphtheriae
C) Group A streptococcus
D) Haemophilus influenzae
E) Mycoplasma pneumoniae
A) Cardiogenic shock
B) Hypovolemic shock
C) Neurogenic shock
D) Septic shock
B) Esophageal rupture
C) Pancreatitis
D) Pericarditis
E) Tuberculosis
23.) A 2-year-old girl with tricuspid atresia has increasing respiratory distress for 2
days. She has been recovering uneventfully from an operation 10 days ago to join
systemic venous return with pulmonary arterial circulation. Over the past 4 days,
she has been weaned off mechanical ventilation, started on oral feedings, and
is receiving chest physiotherapy for atelectasis. Her temperature is 37.4 C (99.3 F),
blood pressure is 98/64 mm Hg, pulse is 120/min, and respirations are 46/min.
Examination shows nasal flaring, grunting, and intercostal retractions. An x-ray
film of the chest shows large bilateral pleural effusions. Thoracentesis yields 300
mL of whitish-yellow fluid. The supernatant remains uniformly opaque on
centrifugation. Which of the following is the most likely cause of the pleural
effusions?
A) Chylothorax
C) Empyema
D) Pulmonary embolism
24.) A 23-year-old man is brought to the physician by his mother because he has heard
a voice over the past month telling him to hurt himself. His mother says that her
son has no friends and is a lifelong loner; since graduating from high school, he
has been unable to hold a job. He admits to smoking marijuana occasionally and
drinking six beers weekly. Examination shows a poorly groomed man with poor
eye contact. He has a flat affect and limited facial expression. He says he has no
intention of harming himself or others. Which of the following is the most
appropriate next step in management?
C) Admit him to the partial hospital program and prescribe oral lithium carbonate
25.) A 23-year-old man is brought to the physician by his mother because he has heard
a voice over the past month telling him to hurt himself. His mother says that her
son has no friends and is a lifelong loner; since graduating from high school, he
has been unable to hold a job. He admits to smoking marijuana occasionally and
Drinking six beers weekly. Examination shows a poorly groomed man with poor
Eye contact. He has a flat affect and limited facial expression. He says he
has no intention of harming himself or others. Which of the following is the most
appropriate next step in management?
C) Admit him to the partial hospital program and prescribe oral lithium carbonate
A) Delayed normal
B) Normal delayed
C) Delayed delayed
D) Normal normal
28.) A previously healthy 62-year-old man comes to the physician because of a 2-month
history of progressive shortness of breath and a mild nonproductive cough. He
does not smoke. He worked in a foundry most of his adult life before retiring 2
years ago. Vital signs are within normal limits. Crackles are heard at both lung
Bases with no wheezes. Cardiac examination shows an accentuated P2. The
remainder of the examination shows no abnormalities. An x-ray film of the chest
shows prominent interstitial markings at the lung bases. Echocardiography shows
an ejection fraction of 55%. Pulmonary function testing is most likely to show
which of the following?
B) Mitral stenosis
E) Tricuspid stenosis
30.) A 32-year-old woman comes to the physician because of weakness of the lower
extremities for 2 days. Three years ago, she had pain and partial loss of vision of
the right eye; the vision returned to normal after 6 weeks. There is mild pallor of
the right optic disc. She has impaired tandem gait. Babinski's sign is present
bilaterally. There is mild spasticity of the lower extremities and mild weakness of
the iliopsoas and hamstring muscles. Serum creatine kinase activity is 50 U/L.
Which of the following is the most likely diagnosis?
G) Multiple sclerosis
H) Myasthenia gravis
K) Polymyositis
L) Pontine astrocytoma
M) Pontine infarction
O) Transverse myelitis
31.) A healthy 42-year-old man comes to the physician for a life insurance evaluation.
He smoked one-half pack of cigarettes daily for 20 years but quit 10 years ago. His
father died of a myocardial infarction at the age of 65 years. The patient weighs 93
kg (205lb) and is 178 cm (70 in) tall. His blood pressure is 160/110 mm Hg,
pulse is 96/min, and respirations are 16/min. Physical examination, ECG, and an x-
ray film of the chest show no abnormalities. Laboratory studies are within normal
limits except for a serum cholesterol level of 206 mg/dL. Which of the following is
the greatest risk factor for cerebral infarction in this patient?
A) Genetic profile
B) History of smoking
C) Hypercholesterolemia
D) Hypertension
E) Obesity
Because of her condition, this patient is at greatest risk for which of the following
deficiencies?
A) Niacin
B) Vitamin A
C) Vitamin B2 (riboflavin)
E) Vitamin C
A
) Bicarbonate
B
) Calcium lactate
C
) Methenamine mandelate
D
) Probenecid
E
) Thiazide diuretic
34.
Hematocrit 36%
Leukocyte count 16,500/mm3
Serum
Na+ 145 mEq/L
Cl 106 mEq/L
K+ 3.8 mEq/L
HCO3 19 mEq/L
Urea nitrogen (BUN) 32 mg/dL
A
) X-ray films of the abdomen while supine and
standing
B
) Abdominal ultrasonography
C
) Upper gastrointestinal series with contrast
D
) HIDA scan
E
) Fiberoptic endoscopy of the upper
gastrointestinal tract
A
) Disseminated primary herpes simplex
B
) Eczema
C
) Scabies
D
) Secondary syphilis
E
) Vasculitis
A
) Trimethoprim-sulfamethoxazole prophylaxis
B
) Insertion of a Foley catheter
C
) Total prostatectomy
D
) Transurethral prostatectomy
E
) No treatment is available
A
) Breast abscess
B
) Breast cyst
C
) Breast hematoma
D
) Fibroadenoma
E
) Fibrocystic changes of the breast
F
) Intraductal adenoma
A
) Caudate nucleus
B
) Parietal lobe
C
) Prefrontal lobe
D
) Putamen
E
) Temporal lobe
A
) Advanced sleep phase syndrome
B
) Alcohol abuse
C
) Delayed sleep phase syndrome
D
) Major depressive disorder
E
) Melatonin deficiency
F
) Poor sleep hygiene
G
) Normal aging
A
) Cyclosporine
B
) Enalapril
C
) Felodipine
D
) Penicillin G
E
) Pravastatin
A
) Correction only with casting
B
) Correction only with physical therapy
C
) Left-hand dominance
D
) Permanent nerve damage
E
) Spontaneous healing without treatment
42. A 22-year-old man with schizoaffective disorder
is brought to
the emergency department 2 hours after the sudden
onset of neck and back
pain. The symptoms began after taking one of his
medications for his
psychiatric disorder. The dosage was increased
yesterday, but he does
not recall the names of either of his medications. He
has no other
history of serious illness. Physical examination
shows rigid contraction
of the neck and back muscles with arching. On mental
status
examination, he is alert and cooperative and hears a
faint voice that tells him to
wash windows. He is oriented to person, place, and
time. Which of the
following medications is most likely responsible for
this patient's
symptoms?
A
) Clozapine
B
) Haloperidol
C
) Lithium carbonate
D
) Trazodone
E
) Valproic acid
A
) Heredity
B
) Hypertension
C
) Parity
D
) Type 2 diabetes mellitus
E
) Weight
A
) Bilateral thalamic
B
) Left frontal
C
) Left pontine
D
) Right caudate
E
) Right midbrain
A
) Anal fissure
B
) Fistula in ano
C
) Pruritus ani
D
) Thrombosed external hemorrhoids
E
) Thrombosed internal hemorrhoids
A
) X-ray film of the right knee
B
) Gastrointestinal series with small-bowel
follow-through
C
) Nuclear scan of the right knee
D
) MRI of the right knee
E
) Antibiotic therapy
F
) Arthrocentesis
block 2
1.
A 25-year-old man is brought to the emergency
department after being
discovered semiconscious and incoherent at home. On
arrival, he is
stuporous. His blood pressure is 105/70 mm Hg, pulse
is 80/min, and
respirations are 12/min. Examination shows cool, damp
skin. The pupils are
pinpoint and react sluggishly to light. Which of the
following is the
most likely substance taken?
A
) Alcohol
B
) Barbiturates
C
) Cocaine
D
) Heroin
E
) LSD
A
) The court
B
) The patient
C
) The patient's parent
D
) The patient's sister
E
) No consent is necessary
A
) Borrelia burgdorferi
B
) Brucella melitensis
C
) Francisella tularensis
D
) Leptospira interrogans
E
) Rickettsia rickettsii
A
) Adrenal adenoma
B
) Brenner tumor
C
) Carcinoid tumor
D
) Granulosa cell tumor
E
) Hyperthecosis
F
) Islet cell tumor
G
) Sertoli-Leydig cell tumor
A
) Transvaginal ultrasonography of the pelvis
B
) Colposcopic-guided biopsy
C
) Endometrial biopsy
D
) Endometrial ablation
E
) Culdocentesis
A
) Increase intake of dietary fiber
B
) Restrict caffeine
C
) Stress management
D
) Weight loss
A
) Cystitis
B
) Epididymitis
C
) Spermatocele
D
) Testicular torsion
E
) Testicular tumor
A
) Decreased plasma renin activity
B
) Decreased serum angiotensin II levels
C
) Increased serum angiotensin I levels
D
) Increased serum bradykinin levels
E
) Increased serum histamine levels
A
) Excessive platelet destruction
B
) Factor VIII deficiency
C
) Inadequate platelet production
D
) Uncontrolled activation of coagulation and
fibrinolytic cascades
E
) Vitamin K deficiency
A
) Age of the patients
B
) Diagnostic bias
C
) Lead time bias
D
) Recall bias
E
) Type II error
11.
Hemoglobin 10 g/dL
Serum
Na+ 135 mEq/L
Cl 110 mEq/L
K+ 4.2 mEq/L
HCO3 22 mEq/L
Urea nitrogen (BUN) 40 mg/dL
Creatinine 1.6 mg/dL
A
) Cardiac output
B
) Fall in systolic arterial pressure with
inspiration
C
) Left ventricular end-diastolic pressure
D
) Mitral regurgitation
E
) Ventricular septal wall motion
A
) Acoustic neuroma
B
) Benign positional vertigo
C
) Brain stem transient ischemic attacks
D
) Meniere's disease
E
) Viral labyrinthitis
A
) Supine and erect x-ray films of the abdomen
B
) Upper gastrointestinal series
C
) Ultrasonography of the upper abdomen
D
) CT scan of the abdomen
E
) HIDA scan of the biliary tract
A
) Oral isotretinoin
B
) Systemic corticosteroids
C
) Topical benzoyl peroxide
D
) Topical corticosteroids
E
) Topical metronidazole
15. A previously healthy 67-year-old man comes to
the physician
because of a 4-month history of hand weakness,
intermittent tingling of the
small fingers of his hands, and mild neck pain.
Examination shows
wasting, weakness, and fasciculations of the
interossei muscles. Sensation
is decreased to pinprick and vibration in the small
fingers of each
hand. Triceps tendon reflexes are decreased. Which
of the following is
the most likely diagnosis?
A
) Amyotrophic lateral sclerosis
B
) Cervical spondylosis
C
) Multiple sclerosis
D
) Myasthenia gravis
E
) Myasthenic (Lambert-Eaton) syndrome
F
) Myotonic muscular dystrophy
G
) Polymyalgia rheumatica
H
) Polymyositis
I
) Progressive neuropathic (peroneal) muscular
atrophY
A
) Disulfiram
B
) Donepezil
C
) Fluoxetine
D
) Haloperidol
E
) Methylphenidate
F
) Valproic acid
17.
A
) Measurement of plasma renin activity
B
) Serum lipid studies
C
) 24-Hour urine collection for measurement of
metanephrine level
D
) Echocardiography
E
) Captopril renal scan
A
) Excessive sweat electrolyte level
B
) Excessive sweat volume
C
) Excessive urinary output
D
) Excessive vasopressor secretion
E
) Inadequate sweat production
19.
Hematocrit 37%
Leukocyte count 16,000/mm3
Serum
Total bilirubin 1.1 mg/dL
Amylase 32 U/L
Lactate dehydrogenase 110 U/L
Urine WBC 35/hpf
A
) Abruptio placentae
B
) Appendicitis
C
) Cholelithiasis
D
) Colitis
E
) Pyelonephritis
A
) Thyroid scan
B
) 131I therapy
C
) Propylthiouracil therapy
D
) Thyroxine therapy
E
) Left thyroid lobectomy
A
) Bacterial vaginosis
B
) Precocious puberty
C
) Urinary tract infection
D
) Vaginal foreign body
E
) Vaginal laceration
F
) von Willebrand's disease
23.
A
) Hepatitis A vaccine
B
) Typhoid vaccine
C
) Oral isoniazid prophylaxis
D
) Oral mefloquine prophylaxis
E
) Oral trimethoprim-sulfamethoxazole prophylaxis
F
) Intramuscular immune globulin
A
) Congenital cytomegalovirus encephalopathy
B
) Congenital toxoplasmosis encephalopathy
C
) Hypoxic-ischemic encephalopathy
D
) Neurofibromatosis
E
) Tuberous sclerosis
25.
Chlamydia culture
+
ELISA
+
38
5
-
455
A
) 2/40
B
) 5/43
C
) 38/40
D
) 38/43
E
) 38/493
A
) Bromocriptine therapy
B
) Clomiphene therapy
C
) Conjugated estrogen therapy
D
) Ergot derivative therapy
E
) Hysteroscopy
F
) Laparoscopy
G
) Dilatation and curettage
H
) Endometrial ablation
I
) Exploratory laparotomy
J
) Total abdominal hysterectomy
A
) Observation
B
) Broad-spectrum antibiotic therapy
C
) Isoniazid therapy
D
) Intravenous amphotericin B therapy
E
) Tube thoracostomy
28.
Serum
Na+ 132 mEq/L
Cl 90 mEq/L
K+ 5.9 mEq/L
HCO3 6 mEq/L
Urea nitrogen (BUN) 48 mg/dL
Glucose 600 mg/dL
Creatinine 2.8 mg/dL
Urine
Glucose 4+
Ketones 3+
Protein 1+
A
) Acute interstitial nephritis
B
) Acute renal failure
C
) Diabetic nephropathy
D
) Hyperinsulinemia
E
) Increased plasma ketone level
A
) Measurement of serum creatine kinase and lactate
dehydrogenase
activities
B
) Echocardiography
C
) Dipyridamole thallium scan
D
) Ventilation-perfusion lung scans
E
) Myocardial biopsy
A
) Amoxicillin
B
) Amoxicillin-clavulanate
C
) Cefprozil
D
) Erythromycin
E
) Penicillin G
A
) Intravenous pyelography
B
) Renal ultrasonography
C
) Voiding cystourethrography
D
) Intramuscular antibiotic therapy and
reexamination in 24 hours
E
) Intravenous antibiotic therapy
A
) Oral phosphate supplementation
B
) Oral vitamin D supplementation
C
) Intranasal calcitonin therapy
D
) Parenteral bisphosphate therapy
E
) Parenteral parathyroid hormone therapy
A
) Prohibit swimming on cloudless days
B
) Apply the sunblock lotion 45 minutes before
swimming
C
) Change to a higher-level SPF lotion
D
) Apply Burrow's solution compresses after each
overexposure
E
) Daily use of antioxidant vitamin supplement
F
) Early treatment of any sun overexposure with
topical
corticosteroids
A
) Antitoxin
B
) Azathioprine
C
) Interferon
D
) Pyridostigmine
E
) Riluzole
A
) Child abuse
B
) Congenital syphilis
C
) Hypocalcemia
D
) Lead poisoning
E
) Seizures
A
) Decreased systemic vascular resistance
B
) Increased pulmonary vascular resistance
C
) Increased systemic vascular resistance
D
) Intracardiac left-to-right shunt
E
) Intracardiac right-to-left shunt
A
) Immune globulin
B
) Hepatitis B immune globulin (HBIG) only
C
) Hepatitis B vaccine series only
D
) Hepatitis B vaccine series and HBIG
E
) Hepatitis B vaccine series and hepatitis A
vaccine
38.
Serum
Glucose 90 mg/dL
Protein 7 g/dL
Lactate dehydrogenase 300 U/L
Pleural fluid
pH 7.25
Glucose 75 mg/dL
Protein 4.5 g/dL
Lactate dehydrogenase 280 U/L
Leukocyte count 2000/mm3
Segmented neutrophils 15%
Lymphocytes 85%
A
) Bacterial pneumonia
B
) Collagen vascular disease
C
) Congestive heart failure
D
) Malignancy
E
) Pulmonary embolus with infarction
F
) Viral pleuritis
A
) Common bile duct stone
B
) Drug-induced jaundice
C
) Hemolytic jaundice
D
) Pancreatic carcinoma
E
) Viral hepatitis
A
) Candidal skin test
B
) Flow cytometry identification of B lymphocytes
C
) Nitroblue tetrazolium test
D
) T-lymphocyte receptor stimulation by concanavalin
A
E
) Total serum hemolytic complement assay
A
) Mitochondrial disorder
B
) Mucopolysaccharidoses disorder
C
) Organic acid metabolism disorder
D
) Renal tubular acidosis
E
) X-linked leukodystrophy
A
) Chlamydia trachomatis
B
) Clostridium botulinum
C
) Clostridium tetani
D
) Group A streptococcus
E
) Group B streptococcus
F
) Listeria monocytogenes
G
) Neisseria gonorrhoeae
H
) Streptococcus pneumoniae
42.
A
) Adjustment disorder with depressed mood
B
) Bereavement
C
) Bipolar disorder, depressed
D
) Dysthymic disorder
E
) Major depressive disorder
A
) Echocardiography
B
) Renal ultrasonography
C
) MRI of the back
D
) Colposcopy
E
) Laparoscopy
B
) Decreased cerebellar volume
C
) Hippocampal symmetry
D
) Increased lateral ventricle size
E
) Multiple white-matter hyperintensities
Report Abuse
* block 3:---
A
) Antiestrogens
B
) Antiprogestationals
C
) Medroxyprogesterone
D
) Oral contraceptives
E
) Ovulation-inducing drugs
A
) Exercise and weight reduction program
B
) Measurement of urine catecholamine levels
C
) Measurement of urine corticosteroid levels
D
) Captopril therapy
E
) Hydrochlorothiazide therapy
A
) Carcinoma of the bladder
B
) Detrusor instability
C
) Neurogenic bladder
D
) Urethral diverticulum
E
) Uterine prolapse
A
) Fasting gastrin level
B
) Fasting insulin and glucose levels
C
) Glucagon level
D
) Glucose and somatostatin level
E
) Glucose and vasoactive intestinal
A
) Reexamination in 1 year if the patient has not
had menarche
B
) Measurement of serum follicle-stimulating hormone
and luteinizing
hormone levels
C
) Measurement of serum thyroid-stimulating hormone
and prolactin
levels
D
) Karyotype analysis
E
) Progesterone withdrawal test
F
) Pelvic ultrasonographypolypeptide levels
6.
Serum
Glucose 35 mg/dL
Bilirubin (total) 2.3 mg/dL
Urine
Glucose negative
Reducing substances 3+
A
) Decreased gluconeogenesis
B
) Decreased insulin secretion
C
) Increased glucagon secretion
D
) Increased gluconeogenesis
E
) Increased insulin secretion
F
) Insulin resistance
7. A 75-year-old man has had hypertension for 25
years. There is an
unusually prominent pulsation of the abdominal aorta
in the upper
midabdomen. A systolic bruit is heard at this site.
Femoral, popliteal, and
pedal pulses are present. Which of the following is
the most
appropriate initial diagnostic study?
A
) X-ray film of the abdomen
B
) Abdominal ultrasonography
C
) Doppler ultrasonography of the arteries of the
legs
D
) Abdominal aortography
E
) Intravenous pyelography
A
) Juvenile rheumatoid arthritis
B
) Osgood-Schlatter disease
C
) Septic arthritis
D
) Slipped capital femoral epiphysis
E
) Toxic synovitis
A
) Bradykinesia
B
) Cogwheel rigidity
C
) Decreased rate of eye blinking
D
) Postural reflex impairment
E
) Tremor
A
) Measurement of serum follicle-stimulating hormone
level
B
) Serum lipid studies
C
) 24-Hour urine collection for measurement of
creatinine clearance
D
) X-ray film of the chest
E
) ECG
F
) No further studies indicated
11.
Serum
Na+ 138 mEq/L
Cl 98 mEq/L
K+ 3.4 mEq/L
HCO3 21 mEq/L
Urea nitrogen (BUN) 55 mg/dL
Glucose 105 mg/dL
Creatinine 1.3 mg/dL
Amylase 40 U/L
Urine
Ketones moderate
WBC negative
RBC negative
Na+ 8 mEq/L
Protein negative
A
) Acute tubular necrosis
B
) Amoxicillin-induced acute interstitial nephritis
C
) Ibuprofen-induced renal failure
D
) Post-streptococcal glomerulonephritis
E
) Severe volume depletion
A
) Colon cancer
B
) Diverticulosis
C
) Duodenal ulcer
D
) Hemorrhoids
E
) Inflammatory bowel disease
A
) Angiotensin-converting enzyme (ACE) inhibitor
B
) Aspirin
C
) Benzodiazepine
D
) Calcium-channel blocking agent
E
) Corticosteroids
F
) Thiazide diuretic
A
)
132 89 2.8 39 5.0 1.025
B
)
133 110 3.9 16 6.0 1.015
C
)
163 117 4.3 22 5.5 1.003
D
)
165 115 4.5 19 5.0 1.030
16.
pH 7.24
PCO2 85 mm Hg
PO2 60 mm Hg
A
) Encouraging deep breathing and cough
B
) Administration of 40% oxygen via nasal cannula
C
) Administration of furosemide
D
) Transfusion of 1 unit of packed red blood cells
E
) Reintubation and mechanical ventilation
A
) Catatonia
B
) Complex partial seizure
C
) Conversion reaction
D
) Dissociative fugue
E
) Malingering
F
) Tonic-clonic seizure
A
) Alcoholic peripheral neuropathy
B
) Ankylosing spondylitis
C
) Guillain-Barr syndrome
D
) Herniated intervertebral disc
E
) Multiple sclerosis
F
) Polymyositis
G
) Syringomyelia
A
) Plasmapheresis
B
) Additional chemotherapy
C
) Intravenous antibiotic therapy
D
) Intravenous corticosteroid therapy
E
) Transfusion of 2 units of leukocytes
F
) Transfusion of 2 units of packed red blood cells
20.
Hematocrit 32%
Mean corpuscular volume 88 m3
Serum
Glucose 130 mg/dL
Creatinine 1.7 mg/dL
Urine
Protein 2+
WBC 810/hpf
RBC none
Bacteria none
Nitrates none
A
) Intravenous pyelography
B
) Discontinue current medication
C
) Antibiotic therapy for recurrent urinary tract
infections
D
) Insulin therapy for diabetes mellitus
E
) Upper endoscopy
20.
Hematocrit 32%
Mean corpuscular volume 88 m3
Serum
Glucose 130 mg/dL
Creatinine 1.7 mg/dL
Urine
Protein 2+
WBC 810/hpf
RBC none
Bacteria none
Nitrates none
A
) Intravenous pyelography
B
) Discontinue current medication
C
) Antibiotic therapy for recurrent urinary tract
infections
D
) Insulin therapy for diabetes mellitus
E
) Upper endoscopy
A
) No treatment
B
) Radiation therapy
C
) Chemotherapy
D
) Combination radiation therapy and
chemotherapy
E
) Resection of the colon tumor
B
) Influenza virus
C
) Meningococcal
D
) 23-Valent pneumococcal
E
) Varicella
A
) Adjustment disorder with depressed mood
B
) Bipolar disorder
C
) Brief psychotic disorder
D
) Dysthymic disorder
E
) Schizoaffective disorder
A
) Abruptio placentae
B
) Cervical incompetence
C
) Premature labor
D
) Uterine anomaly
E
) Uterine infection
A
) Bacterial meningitis
B
) Acute alcohol intoxication
C
) Brain stem infarction
D
) Cerebral infarction
E
) Cryptococcal meningitis
F
) Enterovirus infection
G
) Hepatic encephalopathy
H
) Herpes simplex encephalitis
I
) Huntington's disease
J
) Hypoglycemia
K
) Lyme disease
A
) Listeria monocytogenes
B
) Neisseria meningitidis
C
) Pseudomonas aeruginosa
D
) Streptococcus bovis
E
) Streptococcus pneumoniae
A
) Abruptio placentae
B
) Ectopic pregnancy
C
) Hydatidiform mole
D
) Hyperthyroidism
E
) Preeclampsia
A
) Cervical osteoarthritis
B
) Meningitis
C
) Ruptured cervical disc
D
) Subarachnoid hemorrhage
E
) Syringomyelia
A
) Antibiotic therapy
B
) Anticoagulant therapy
C
) Intravenous digoxin therapy
D
) Intravenous furosemide therapy
E
) Chemotherapy
F
) Radiation therapy
G
) Pericardiocentesis
A
) Acne rosacea
B
) Acne vulgaris
C
) Basal cell carcinoma
D
) Discoid lupus erythematosus
E
) Seborrheic dermatitis
A
) Increase the dosage of corticosteroids
B
) Increase the dosage of cyclosporine
C
) Begin amphotericin therapy
D
) Begin ganciclovir therapy
E
) Begin heparin therapy
A
) Adenovirus
B
) Haemophilus influenzae
C
) Mycoplasma pneumoniae
D
) Respiratory syncytial virus
E
) Streptococcus pneumoniae
3. Three days after undergoing a right hip
replacement for
rheumatoid arthritis, a 77-year-old man is brought to
the physician because of a
2-day history of pain, burning, and itching of his
left eye and left
side of his forehead. He has the sensation that there
is a speck of dirt
in his left eye. Current medications include
prednisone and
methotrexate. Examination of the left eye shows
conjunctival injection and
swelling of the upper eyelid. There is an
erythematous rash over the left
side of the forehead and tenderness to palpation from
the upper eyelid
to the vertex. A photograph of the rash is shown.
Which of the
following is the most appropriate next step in
management?
A
) Measurement of erythrocyte sedimentation rate
B
) MRI of the brain with contrast
C
) Acyclovir therapy
D
) Corticosteroid therapy
E
) Lumbar puncture
A
) Measurement of serum thyroid-stimulating hormone
level
B
) Direct antiglobulin (Coombs') test
C
) ACTH stimulation test
D
) Ventilation-perfusion lung scans
E
) Echocardiography
A
) Arrival for care in an ambulance
B
) Claim that pain is work-related
C
) Gender
D
) Nulliparity
E
) Positive straight-leg raising test
F
) Radiation of the pain into the posterior lower
extremity
A
) Alcohol
B
) Cervical cap
C
) Cigarettes
D
) Isotretinoin
E
) IUD
A
) Abide by the daughter's wishes
B
) Ask the patient if he wishes to discuss his test
results,
preferably with his daughter present
C
) Tell the daughter it is a legal requirement to
tell the patient
any and all results of medical testing
D
) Consult with the hospital attorney
E
) Ask another physician to take over the
patient's care
A
) Folic acid
B
) Niacin
C
) Vitamin A
D
) Vitamin B1 (thiamine)
E
) Vitamin B2 (riboflavin)
F
) Vitamin B6
G
) Vitamin B12 (cyanocobalamin)
H
) Vitamin C
I
) Vitamin D
J
) Vitamin E
K
) Vitamin K
A
) An increase in urinary pH
B
) Damage to the epithelial lining of the ureters
C
) Lack of inhibitors of crystal formation
D
) Presence of urease-splitting bacteria
E
) Urinary supersaturation with uric acid
A
) Chemical dependency counseling before pregnancy
B
) Discontinuation of anticoagulant therapy during
pregnancy
C
) Discontinuation of prednisone during pregnancy
D
) Switching from warfarin to heparin before
pregnancy
E
) No change in treatment before or during pregnancy
A
) Carbamazepine
B
) Chlordiazepoxide
C
) Disulfiram
D
) Lithium carbonate
E
) Nortriptyline
A
) Borrelia burgdorferi
B
) Epstein-Barr virus
C
) Herpes simplex virus 1
D
) Poliovirus
E
) Treponema pallidum
F
) Varicella-zoster virus
43. A 30-year-old woman comes to the physician
because of
long-standing unhappiness that may have started when
she was rejected by her
classmates as a teenager. She says that although she
has good days, many
days are dominated by negative thoughts about herself.
She appears
somewhat sad and tends to be readily critical of
herself. Although she
sleeps satisfactorily, she often finds her energy
level decreased by the
end of the day. She also has been forgetful. She
weighs 59 kg (130 lb)
and is 157 cm (62 in) tall. Physical examination and
laboratory
studies show no abnormalities. Which of the following
is the most likely
diagnosis?
A
) Adjustment disorder with depressed mood
B
) Depersonalization disorder
C
) Dissociative identity disorder
D
) Dysthymic disorder
E
) Hypothyroidism
F
) Major depressive disorder
G
) Schizoaffective disorder
A
) Measurement of serum a1-antitrypsin level
B
) Methacholine challenge test
C
) Quantitative measurement of serum antibody levels
D
) Sweat chloride test
E
) Ventilation-perfusion lung scans
A
) Cardiogenic shock
B
) Congestive heart failure
C
) Decreased systemic vascular resistance
D
) Decreased venous return
E
) Hypovolemic hypoperfusion
F
) Increased systemic vascular resistance
BLOCK 4:--
A
) Reassurance
B
) Electroencephalography
C
) CT scan of the head
D
) Anticonvulsant therapy
E
) Lumbar puncture
A
) The results do not show an association between
rotavirus vaccine
and intussusception, but they may be related
B
) The results show sufficient statistical power to
identify an
association between rotavirus vaccine and
intussusception
C
) Rotavirus vaccine is associated with a 39% risk
for
intussusception
D
) Rotavirus vaccine causes intussusception in 1.9%
of infants
E
) Rotavirus vaccine prevents 80 cases of
intussusception per 100,000
infant-years
3.
Hematocrit 44%
Leukocyte count 12,000/mm3
Serum
Na+ 138 mEq/L
Cl 100 mEq/L
K+ 4 mEq/L
HCO3 25 mEq/L
Bilirubin, total 1.6 mg/dL
Alkaline phosphatase 100 U/L
Aspartate aminotransferase
(AST, GOT) 14 U/L
Alanine aminotransferase
(ALT, GPT) 12 U/L
Amylase 1100 U/L
A
) Acute cholecystitis
B
) Acute pancreatitis
C
) Acute perihepatitis
D
) Ascending cholangitis
E
) Duodenal ulcer
F
) Viral hepatitis
A
) Inhaled bronchodilators
B
) Inhaled cromolyn sodium
C
) Inhaled ipratropium bromide
D
) Intravenous corticosteroids
E
) Subcutaneous epinephrine
5.
A 52-year-old woman comes to the emergency department
6 days after knee
arthroplasty because of constant, right-sided chest
pain and shortness
of breath for 24 hours. Her blood pressure is 110/50
mm Hg, pulse is
114/min, and respirations are 24/min. Examination of
the heart, lungs,
and extremities shows no abnormalities. Arterial
blood gas analysis on
room air shows:
pH 7.49
PCO2 29 mm Hg
PO2 66 mm Hg
A
) Discharge home and reexamination in 2 weeks
B
) Exercise stress test
C
) Pulmonary function tests
D
) Echocardiography
E
) Pulmonary angiography
F
) Ibuprofen therapy
B
) Adjustment disorder with depressed mood
C
) Dysthymic disorder
D
) Generalized anxiety disorder
E
) Major depressive disorder
F
) Panic disorder with agoraphobia
G
) Post-traumatic stress disorder
A
) Defect in thyroxine (T4) biosynthesis
B
) Graves' disease
C
) Multinodular goiter
D
) Riedel's thyroiditis
E
) Thyroid carcinoma
F
) Thyroiditis
G
) Toxic adenoma
H
) Triiodothyronine (T3) thyrotoxicosis
A
) Acute gastrointestinal bleeding
B
) Adrenal insufficiency
C
) Aortic valve rupture
D
) Cardiac tamponade
E
) Congestive heart failure
F
) Pneumonia
G
) Pulmonary embolism
H
) Sepsis
Hematocrit 40%
Leukocyte count 14,000/mm3
Platelet count 350,000/mm3
pH 7.5
PCO2 16 mm Hg
PO2 64 mm Hg
Hematocrit 38%
Leukocyte count 12,000/mm3
Platelet count 350,000/mm3
pH 7.5
PCO2 16 mm Hg
PO2 64 mm Hg
A
) Reduce the dosage so as not to impair respiration
B
) Administer the dosage necessary to control pain
despite
respiratory impairment
C
) Administer the dosage necessary to control pain
and add a
centrally acting stimulant
D
) Appeal to the family to convince the patient to
tolerate a bit
more pain
A
) Reassurance
B
) Topical corticosteroid therapy
C
) Intravenous acyclovir therapy
D
) Intravenous ampicillin and gentamicin therapy
E
) Intravenous nafcillin therapy
A
) Reexamination in 6 months
B
) Thyroid function tests
C
) DNA testing
D
) Measurement of bone age
E
) CT scan of the head
A
) Acute pancreatitis
B
) Brain tumor
C
) Diabetic gastroparesis
D
) Diabetic ketoacidosis
E
) Drug toxicity
F
) Food poisoning
G
) Gastric bezoar
H
) Gastric carcinoma
I
) Pyloric channel ulcer
J
) Small-bowel obstruction
K
) Uremia
A
) Abruptio placentae
B
) Ectopic pregnancy
C
) Incomplete abortion
D
) Placenta previa
E
) Threatened abortion
F
) Normal pregnancy
B
) Central nervous system infection
C
) Diffuse axonal injury
D
) Diffuse cortical atrophy
E
) Left temporal lobe infarction
F
) Multiple, small, central nervous system
infarctions
G
) Subdural hematoma
A
) Chronic infectious trigonitis
B
) Large intravesical calculus
C
) Obstetric trauma
D
) Polycystic kidney disease
E
) Spastic neurogenic bladder
A
) Electroencephalography
B
) CT scan of the head
C
) Intravenous ampicillin therapy
D
) Intravenous haloperidol therapy
E
) Intravenous lorazepam therapy
A
) Carcinoma of the lung
B
) Histoplasmosis
C
) Hodgkin's disease
D
) Sarcoidosis
E
) Tuberculosis
19. A 52-year-old woman comes to the physician
because of difficulty
climbing stairs for 4 months. She has also noted that
her thighs hurt
when she presses on them. She has had increasing
difficulty combing
her hair because she tires easily. On examination,
she pushes herself
out of the chair with her arms. There is weakness of
the proximal
muscles of the extremities. Which of the following is
the most likely
diagnosis?
A
) Cauda equina syndrome
B
) Cerebellar degeneration
C
) Cervical spinal cord compression
D
) Diabetic polyneuropathy
E
) Femoral artery insufficiency
F
) Guillain-Barr syndrome
G
) Lumbar spinal stenosis
H
) Multiple sclerosis
I
) Normal-pressure hydrocephalus
J
) Polymyositis
K
) Sensory neuropathy
L
) Tabes dorsalis
A
) Acute myelogenous leukemia
B
) Cirrhosis of the liver
C
) Hodgkin's disease
D
) Miliary tuberculosis
E
) Myelofibrosis
A
) Exercises to strengthen abdominal muscles
B
) Exercises to strengthen paravertebral muscles
C
) Bed rest for 5 to 7 days
D
) Use of a muscle relaxant
E
) Use of a nonsteroidal anti-inflammatory drug
22. A 42-year-old woman, gravida 2, para 2, has had
increasing
fatigue, dyspnea, orthopnea, and paroxysmal nocturnal
dyspnea over the past
2 days. She has had several episodes of hemoptysis;
she had one
episode of pulmonary edema during pregnancy 2 years
ago. A loud S1, a
snapping sound in diastole, and a rumbling diastolic
murmur are heard at the
apex. Which of the following is the most likely cause
of her
condition?
A
) Atrial myxoma
B
) Bicuspid aortic valve
C
) Postpartum cardiomyopathy
D
) Rheumatic heart disease
E
) Viral myocarditis
A
) Application of ice packs to the affected breast
B
) Use of a breast pump
C
) Immediate discontinuation of breast-feeding
D
) Bromocriptine therapy
E
) Penicillinase-resistant antibiotic therapy
A
) Ephedrine
B
) Magnesium sulfate
C
) Nifedipine
D
) Oxytocin
E
) Terbutaline
A
) Clonidine
B
) Metoprolol
C
) Quinidine
D
) Sulfinpyrazone
E
) Verapamil
26. A 35-year-old woman is brought to the emergency
department by
her family because of shortness of breath, tightness
in her chest, and
palpitations for 2 hours. Over the past 11 months,
she has had five
similar episodes; during the last episode 3 weeks ago,
she was treated with
an intravenous medication that caused conversion to
sinus rhythm. Her
blood pressure is 95/60 mm Hg, and pulse is 165/min
and regular. The
lungs are clear to auscultation. Which of the
following is the most
likely underlying dysrhythmia?
A
) Accelerated idioventricular rhythm
B
) Accelerated junctional rhythm
C
) Atrial fibrillation
D
) Multifocal atrial tachycardia
E
) Normal sinus rhythm
F
) Paroxysmal supraventricular tachycardia
G
) Premature supraventricular beats
H
) Premature ventricular beats
I
) Sick sinus syndrome
J
) Sinus bradycardia
K
) Sinus tachycardia
L
) Ventricular fibrillation
M
) Ventricular tachycardia
27.
Hematocrit 36%
Leukocyte count 18,000/mm3
Segmented neutrophils 85%
Lymphocytes 15%
Platelet count 200,000/mm3
Pleural fluid
Leukocyte count 75,000/mm3
Segmented neutrophils 98%
Lymphocytes 2%
A
) Chemotaxis
B
) Immotile cilia
C
) Opsonization
D
) Phagocytic oxidative metabolism
E
) Phagocytosis
F
) T-lymphocyte function
A
) Acute aortic dissection
B
) Angina pectoris
C
) Esophageal spasm
D
) Myocardial infarction
E
) Pulmonary embolism
A
) Cerebral venous occlusion
B
) Communicating hydrocephalus
C
) Cytotoxic edema
D
) Idiopathic intracranial hypertension
E
) Impaired absorption of cerebrospinal fluid
F
) Infratentorial mass lesion
G
) Interstitial edema
H
) Overproduction of cerebrospinal fluid
I
) Vasogenic edema
A
) Increase in home nighttime lighting
B
) Prescription for chloral
ydrate
C
) Prescription for diazepam
D
) Prescription for haloperidol
E
) Use of nighttime mechanical restraints
A
) Immune complex deposition
B
) Inflammatory reaction to antisynovial antibodies
C
) Inflammatory reaction to monosodium urate
crystals
D
) Neisseria gonorrhoeae infection
E
) Streptococcus pneumoniae infection
pH 7.41
PCO2 40 mm Hg
PO2 52 mm Hg
A
) Acute respiratory distress syndrome
B
) Atelectasis
C
) Congestive heart failure
D
) Fat embolism syndrome
E
) Pneumonia
F
) Pneumothorax
A
) CT scan of the abdomen
B
) Intravenous neostigmine therapy
C
) Esophagogastroduodenoscopy
D
) Nasogastric intubation
E
) Laparotomy
A
) 24-Hour urine collection for measurement of
creatinine clearance
B
) 24-Hour urine collection for measurement of
17-hydroxycorticosteroid and total 17-ketosteroid
levels
C
) Measurement of serum aldosterone level
D
) Magnetic resonance angiography of renal vessels
E
) CT scan of the abdomen
A
) Calcium
B
) Creatinine
C
) Glucose
D
) Testosterone
E
) Thyroid-stimulating hormone
A
) Bipolar disorder
B
) Borderline personality disorder
C
) Major depressive disorder
D
) Schizophrenia
E
) Substance-induced mood disorder
A
) Calcium, furosemide, and 3% saline
B
) Calcium, insulin, and digitalis
C
) Calcium, insulin, and glucose
D
) Glucose, furosemide, and phosphate
E
) Glucose, glucagon, and bicarbonate
A
) Danazol therapy
B
) Gonadotropin-releasing hormone agonist therapy
C
) Oral contraceptive therapy
D
) Total abdominal hysterectomy and bilateral
salpingo-oophorectomy
E
) No further treatment indicated
A
) Administration of parenteral antibiotics
B
) Admission to the hospital for medical management
C
) Admission to the hospital for operative
management
D
) Colon contrast studies
E
) Discharge for follow-up by personal physician
F
) Endoscopy
G
) MRI of the abdomen
H
) Observation in the emergency department
A
) Administration of parenteral antibiotics
B
) Admission to the hospital for medical management
C
) Admission to the hospital for operative
management
D
) Colon contrast studies
E
) Discharge for follow-up by personal physician
F
) Endoscopy
G
) MRI of the abdomen
H
) Observation in the emergency department
A
) Horseshoe kidney
B
) Nephrolithiasis
C
) Papillary necrosis
D
) Polycystic kidney disease
E
) Renal cell carcinoma
A
) Isoniazid and folic acid supplementation
B
) Isoniazid and rifampin
C
) Isoniazid and vitamin B1 (thiamine)
supplementation
D
) Isoniazid and vitamin B6 supplementation
E
) No prophylaxis indicated
43.
Hemoglobin 10 g/dL
Leukocyte count 3000/mm3
Segmented neutrophils 85%
Lymphocytes 15%
Platelet count 350,000/mm3
Serum
IgA <5 mg/dL
IgG 300 mg/dL
IgM <5 mg/dL
A
) AIDS
B
) Chronic granulomatous disease
C
) Severe combined immunodeficiency
D
) Thymic-parathyroid dysplasia (DiGeorge syndrome)
E
) X-linked agammaglobulinemia
B
) Ileocolic
C
) Inferior mesenteric
D
) Left gastric
E
) Left gastroepiploic
F
) Middle colic
G
) Posterior penetrating
H
) Right colic
I
) Right gastroepiploic
J
) Splenic
K
) Superior hemorrhoidal
L
) Superior mesenteric
A
) Amoxicillin does not alter the course of
Salmonella enteritidis
B
) Amoxicillin has caused pseudomembranous colitis
C
) Amoxicillin is absorbed at the level of the
jejunum, leaving no
drug to be delivered to the colon
D
) Oral amoxicillin is not absorbed into the
systemic circulation in
the presence of diarrhea
E
) Salmonella has expressed an inducible -lactamase
that inactivates
amoxicillin
46.
Hematocrit 25%
Leukocyte count 11,000/mm3
Serum
Bilirubin
Total 3.2 mg/dL
Direct 0.3 mg/dL
Alkaline phosphatase 56 U/L
A
) Aggregation of cholesterol in the gallbladder
B
) Inhibition of glucuronosyltransferase
C
) Lysis of erythrocytes
D
) Malnutrition-induced cirrhosis
E
) Neoplastic growth in the gallbladder
BLOCK 1
1. 1. e
2. a
3. B
4. E
5. a? b?
6. b
7. b
8. C
9. D
10. A
11. J
12. H
13. d
14. a
15. d
16. b
17.
18. d
19. A
20. c
21. A
22. B
23. a
24. b
25. B/D
26. A
27. e
28. C
29. D
30. G
31. D
32. B
33. E
34. A
35. c
36. a
37. f
38.A
39. G
40. a
41. E
42. B
43. E
44. D
45. B
46. F
BLOCK 2
1 .D
2.B
3.A
4. G??
5. C
6. C
7.B
8.D
9.A
10.C??
11.C
12.D
13. C
14.C
15.A
16.C
17. A /?? E
18.B
19.B
20.E
21.E
22.D
23.D
24. E
25.C
26.F
27.B
28.E
29.B
30.D
31.E
32.B
33.A
34.A
35.E
36.E
37.E
38.F
39.D
40.B ??
41.E
42.D
43.E
44. E
45. C( OSTEOMYLITIS)
46.D
BLOCK 3
1.d
2.c
3.c
4.b
5.a
6.a
7.b
8.d
9.c
10.b
11.e
12.b
13.d
14.a
16.e
17.c
18.g
19.c
20.b
21.e
22.b
23.c
24.b
25.h
26.e
27.c
28.d?
29.g
30.a
31.d.
32.d
33.c
34.c
35.b
36.c.
37.b
38.d
39.a
40.d
41.e.
42.f
43.d
44.b
45.c
46.d
BLOCK 4
1.a
2.a
3.b?
4. e/a
5.e/b
6.f
7.c
8.c/g
9.g
10.a/c.. very controvertial plz explain
11.a
12.c
13.e
14.e
15.f
16.c
17.e/d
18.d
19.j
20.a /? E
21.e/d
22.d
23.a
24.a?
25.b
26.f
27.d
28.d
29.d
30.a
31.b
32.b
33.d nosogastric suction
34.d
35.e
36.a
37.b
38e?
39.d
40.d
41.d
42.d
43.c
44.a
45.b??
46.c