Tuesday

,17Jul
y
2018

Gener
alMedi
cineExam
Par
tOneExam

1.20yearsoldfemalepatientcamewi t
hleftbreastmassoffourmont hsdurat
ion.Shehas
associ
atedpremenstrualpainovert
hesite.Thephysicalbr
eastfi
ndingshows2* 2cm
fi
rmill
-def
inedtendermassi nlef
tupperouterquadrantwit
hgreenishdi
scharge.Whatis
themostlikel
ydiagnosi
s?

a.Fi
broadenosi
s

b.Br
eastabscess

c. Fi
broadenoma

d.Paget
sdi
sease

Thecor
rectansweri
s:Fi
broadenosi
s

2.A20y earol dmalewhohadnopr evi

oushist
oryofli
verdisease,present
edwithnausea,
vomiti
ng,jaundiceandlowgr adefev
erofoneweek.Af t
er3day shebecamedr owsy,
thenstuperous.Healsohadepi st
axisandgi
ngival
bleeding.LabsHg=12g/ dl
, ALT=
600mg/ dl
, AST=550mg/ dlandALP=400mg/ dl,
BilT=12mg/ dl,Bil
Dir=6mg/dl,I
NR=
2.4.Whatist hemostli
kelydiagnosi
sofabovepati
ent?

a.Acut
evi
ral
Hepat
it
is

b.Ful
minantHepat
icf
ail
ure

c. Budd-
Chi
ari
syndr
ome

d.Dr
ugi
nducedhepat
it
is

Thecor
rectansweri
s:Ful
minantHepat
icf
ail
ure

3.A33y ear-
oldmal epati
entpresentedwi t
har ef
err
al paperhavi
nganassessmentof
NYHAcl ass-II
ICongestiveheartfai
luresecondarytodilat
edcar di
omyopathy .BP100/
70mmHg.Hehascongest edchestandswol lenextremiti
es.Hehasnoar rhythmiaon
ECG.Echocardiographyshowedenl argedchamber swithglobalhypoki
nesis.Whatisthe
bestt
reatmentt obestart
edf i
rst
?

a.ACE-
inhi
bit
or

b.Di
uret
ic

c. Di
goxi
n

d.β-
blocker
Thecor
rectansweri
s:Di
uret
ic

4.A12y earoldmalepat
ientsust
ainedlacer
ati
onoverthescalpaft
erafi
ghtacci
dent.
Uponpresentat
ionhehad4by2cm l acerati
onov
ert helef
tpari
etal
boneareawith
act
ivebleedi
ngandskullbonewasv i
sibl
ebutnofractur
enoted.Whatinst
rumentshoul
d
youusef i
rst
?

a.Ti
ssuef
orceps

b.Si
nusf
orceps

c. Lane’
sfor
ceps

d.Mosqui
tof
orceps

Thecor
rectansweri
s:Mosqui
tof
orceps

5.A14y earoldmal epati

entpresentedwithperi
-umblicalpai
nwhi chl
atershif
tedtoright
l
owerquadr antoffi
veday sdurati
on.Sincetwoday sback,thepainbecomedul laching
andclaimst ohav ehighgradefever.Onphysicalexaminati
on, bl
oodpressure-
110/70,
pulserate-100,temperature-
37.60C.andhehasar i
ghtlowerquadrantmasswhi chwas
tense.Whatwi llt
henextst epinthemanagementoft hepatient?

a.St
artpar
ent
eral
ant
ibi
oti
cs

b.Wat
chf
ulwai
ti
ng

c. Doabdomi
nal
ult
rasound

d.Doabscessdr
ainage

Thecor
rectansweri
s:Doabdomi
nal
ult
rasound

6.A14y earol dmalepati

entsustainedheadinjur
yafterhewashitbyast one.Upon
examination,hehadstabl
ev i
talsignsandwasconsci ous.Hehad5by2cm l acer
ati
on
overthelefttemporal
bone.CT- Scanwassentandshowed5mm epi duralhematoma
withbonedepr essi
onof15mm.I twasdeci
dedt hatheneedssurgi
calinter
venti
on.
Whatwi l
lbet hepossi
bleindi
cationforoperati
on?

a.Epi
dur
alhemat
oma

b.Depr
essedskul
lfr
act
ure

c. Compoundf
ract
ure

d.Hi
sage

Thecor
rectansweri
s:Depr
essedskul
lfr
act
ure

7.A15y ear–oldmalepati
entpresent
st otheOPDwi thrightthi
ghpai
nfulswell
ingoffour
daysdurati
on.Hehasassoci
atedhighgradeinter
mittentfever
,chi
ll
sandrigor.On
examinati
onheissi
cklooki
ng,T=390C.PR=120/ min,RR=24/ minandhasilldefi
ned,
tenderf
luct
uantswel
li
ngoverthelater
alaspectofri
ghtt hi
gh.Whatisthetr
eatment
modalit
yforthi
spati
ent
?
 a.I
nci
sionanddr
ainage+Br
oadspect
rum I
Vant
ibi
oti
cs

b.or
alant
ibi
oti
csandappoi
nthi
mforr
e-ev
aluat
ion

c. I
nci
sionanddr
ainage+t
hor
oughi
rr
igat
ion

d.Br
oadspect
rum I
Vant
ibi
oti
cs

Thecor
rectansweri
s:I
nci
sionanddr
ainage+Br
oadspect
rum I
Vant
ibi
oti
cs

8.A20y earoldmalepatientsustai
nedbluntabdomi nal
traumawi t
hguardingandunst
abl
e
vi
talsigns,otherexaminati
onwasunr emar kable.Hewasdi agnosedtohave
hemor rhagi
cshockwi thint
ra-per
it
oneal hemor r
hage.Att heER,doubl
eIVlinewas
securedandr esuscit
atedwithfourbagsofN/ S,thentheBPi ncr
easedto80/50mmHg.
Whati sthenextbestmanagementf ortheabov ecase?

a.Taket
hepat
ientt
oORf
orexpl
orat
ion

b.St
artt
hepat
ientoni
not
ropes

c. Cont
inueonr
esusci
tat
ionunt
ilv
ital
signi
sst
abi
l
ized

d.Gi
vet
hepat
ientcr
oss-
mat
chedbl
ood

Thecor
rectansweri
s:Taket
hepat
ientt
oORf
orexpl
orat
ion

9.A20y earoldmalepat
ientsust
ainedbul
l
eti
njurytohischestofonehourdurat
ion.On
examinati
onair
waywasi nt
actbuthewasinrespir
atorydi
str
esswi t
huseofaccessory
muscles.Hehadsucki
ngwoundwi t
hadecreasedairentr
yoftheleftsi
de.Whatisthe
fi
rstopt
ionofmanagement ?

a.I
nser
twi
debor
eneedl
e

b.Appl
y3waydr
essi
ng

c. I
ntubat
ethepat
ient

d.I
nser
tchestt
ube

Thecor
rectansweri
s:Appl
y3waydr
essi
ng

10.A20y ear
-ol
dmal epati
entpresentwit
hpalpit
ati
on,ir
ri
tabi
l
ityandsigni
fi
cantweightloss
of3mont hsdurat
ion.Hi
sBPwas150/ 90mmHg, PR=120/mi nandhas4x5cm ant eri
or
neckmasst hatmoveswithswallow.Whatinvest
igat
ionshouldbedonefirstt
oknow
thepr
oblem ofthepati
ent
?

a.Ser
um T4&
T3

b.Radi
oiodi
neupt
aket
est

c. Ser
um al
kal
i
nephosphat
ase

d.Ser
um i
odi
nel
evel

Thecor
rectansweri
s:Ser
um T4&
T3
 11.A22y earol
dfemalepati
entpresent
edwi t
hdysuria,
frequencyandurgencyofur
inati
on
ofthr
eedaysdurat
ion.Shewast r
eatedforsi
milarcompl i
antonemonthago.Otherwise
shehasnofeverorchil
l
s.Oninvesti
gati
on;ur
ineanalysisreveal
edpy
uriaof5WBC/ HPF.
Whatisthenextst
epinthemanagementoft hispati
ent?

a.Tr
ial
POant
ibi
oti
cs

b.Ur
inecul
tur
e

c. Cy
stoscopy

d.Abdomi
nal
ult
rasound

Thecor
rectansweri
s:Ur
inecul
tur
e

12.A25y earol
dfemalepat
ientinvolv
edinroadtr
affi
cacci
dentandpr
esent
edtothe
emergencydepart
mentwithani nj
uryt
oherlef
tlegwit
hahugedeglovedwound.What
i
sthebestsolut
iontoi
rr
igatethiswound?

a.I
odi
ne

b.Nor
mal
sal
i
ne

c. St
eri
l
ewat
er

d.Di
l
utedal
cohol

Thecor
rectansweri
s:Nor
mal
sal
i
ne

13.A25yearoldfemal
epati
entpresentedwithpoly
uria,pol
ydy
psia,
nocturi
a.Lab
i
nvest
igat
ionshowedi
ncreasedserum sodium l
evel.Whati
sthebestini
ti
altr
eat
ment
f
orthi
spatient
?

a.Loopdi
uret
ic

b.Chl
orpr
opami
de

c. Car
bamazepi
ne

d.Desmopr
essi
n

Thecor
rectansweri
s:Desmopr
essi
n

14.A25y earol
dman, whohasbeenapparentl
yquitewel
l,
complainsofsuddenonsetof
sharpandstabbi
ngpainlocal
i
zedtot
hel ef
tsideoft
hechestfoll
owedbydy spnea,
cyanosi
sandf ai
nti
ng.Ther
eisnopyr
exia.Themostli
kelydi
agnosisi
s?

a.Empy
ema

b.Lobarpneumoni
a

c. Spont
aneouspneumot
hor
ax

d.Pl
eur
alef
fusi
on

Thecor
rectansweri
s:Spont
aneouspneumot
hor
ax
 15.A25y earol
dpati
entcamet ot
heemer gencydepartmentaft
erroadtr
afficacci
dentwit
h
compoundfemoralf
ractur
ewithacti
vebleeding.Onexaminati
onhisbloodpressurei
s
80/50mmHg, pul
serateof130/min,
hemogl obinof5gm/dl,bl
oodgroupnotdet er
mined.
Whichtypeofbl
oodcanbegi v
entothepat i
entasanemer gency?

a.AB+Ve

b.AB-
Ve

c. O+Ve

d.O–v
e

Thecor
rectansweri
s:O–v
e

16.A25yearoldpregnantmothercomesforelecti
vecesareansect
ion.Vi
tal
signsarewi
th
i
nnormalrange.Youdiscussedwit
hthepatientandsheagreedtobeoperatedunder
spi
nal
anesthesia.Whatdermatomelev
elisadequateforthi
ssurgery?

a.T4-
T6

b.T8-
T6

c. T10-
T12

d.T8-
T10

Thecor
rectansweri
s:T4-
T6

17.A25y ear-
oldfemalebar-
ladycametoyourcl
i
nicformedicalcheckup.Laborator
y
i
nvesti
gati
onswer edoneandHBsAgwasposi ti
ve.Youwanttoknowwhet herthis
hepat
iti
sBv ir
usisacuteorchroni
c.Whatl
aborat
oryinv
esti
gationisimportanttoknow
thi
s?

a.Ant
i-
HBe

b.ant
i–HBs

c. Ant
i–HBc

d.HBeAg

Thecor
rectansweri
s:Ant
i–HBc

18.A25y ear-oldmalepatientwhowasdi agnosedtohav ev al

vularheartdiseaseandwas
onfoll
owup, pr
esentedwi t
hhighgradefeverandhemat ur i
aof4day sdur at
ion.On
physi
cal examinat
ionT=38. 50C.ther
eislow-pit
ched,rumbl i
ng,diastol
icmur murheard
bestattheapex.Echocar di
ographyshowedt her
eisintracardiacvegetation,RBCcasts
onurineandCr eati
nine=0. 9mg/dl.Whatbestempi r
ical t
reatmentwoul dy oustar
tfor
thi
spatient?

a.Naf
cil
l
inandCef
azol
i
n

b.Cef
tri
axoneandGent
amy
cin
 c. Vancomy
cinandRi
fampi
n

d.Met
roni
dazol
eandCl
oxaci
l
li
n

Thecor
rectansweri
s:Cef
tri
axoneandGent
amy
cin

19.A26y earoldmalepati
entcamebyambul ance.Onexaminat
ion,hehasshort
nessof
breat
h,ort
hopneaandBP75/ 50mmHg, el
evatedJVP,anddi
stanthear
tsounds.CXR
showedbigf l
askshapedcardiacshadow.Whati st
hemostlikel
yphysi
calfi
ndingi
nthi
s
pati
ent?

a.Pul
susPar
adoxus

b.Thi
rdhear
tsound.

c. Per
icar
dial
Knock

d.Kussmaul
ssi
gn

Thecor
rectansweri
s:Pul
susPar
adoxus

20.A26y earol
dmal epati
entsustai
nedstabinj
urytohi
sneckoft wohour sdurati
on.Upon
present
ati
on,hecancommuni cateandthereisnoact
ivebleedingthr
ought hewound.
Thewoundexpl or
ati
onreveal
edthathewasst abbedatthelevelofC-6anteri
orl
ywith
breechofplat
ysma.Whichofthef ol
l
owingsignsmandatessur gi
calexpl
orati
on?

a.Br
uit

b.Nonexpandi
nghemat
oma

c. Pul
sel
essness

d.Wi
denedmedi
ast
inum

Thecor
rectansweri
s:Pul
sel
essness

21.A27y ear-ol
dfemal epati
entwasdiagnosedtohav erheumat oidart
hrit
isandwason
i
ndomet hacin,methotr
exateandlowdoseofpr ednisoloneforthelastsixmonths,
present
edwi thexacerbati
onofjoi
ntpain.Aft
ercompl eteinvesti
gati
onrituxi
mabwas
addedforpoorr esponse.Whatdrugisnon-di
sease-modi f
y i
nganti-
rheumat i
cdr
ugfor
thi
spatient?

a.Met
hot
rexat
e

b.Pr
edni
sol
one

c. Ri
tuxi
mab

d.I
ndomet
haci
n

Thecor
rectansweri
s:I
ndomet
haci
n

22.A28Yearoldmalepati
entpresent
edwi
thheadache,
neckpain,
onandof fnecksti
ffness,
l
owgr adef
everof3months.Hisexami
nati
onshowedmildneckri
gidi
tyanddecreased
hear
inginl
eftear
.LPwasdoneandCSFr esul
tshowedWBC=300cel l/mm3, pr
otei
n
 150mg/
dlandposi
ti
veVDRL.Whati
sthebestmanagementf
ort
hispat
ient
?

a.Benzant
hinePeni
cil
l
in2.
4mI
U,I
M,st
at

b.Cef
tri
axone1gm I
M st
at

c. Cr
yst
all
i
nepeni
cil
l
in12mI
U,I
Vfor10day
s

d.Pr
ocai
nepeni
cil
l
in2.
4mI
U,I
M,st
at

Thecor
rectansweri
s:Cr
yst
all
i
nepeni
cil
l
in12mI
U,I
Vfor10day
s

23.A28y ear
-oldfemalepati
entpresentedwithepisodiccrampyabdominalpainforthelast
thr
eemont hs.Thepainisassociat
edwi t
hloosest oolsbuti
mprovedwithdefecation.
Shecl ai
medt hatshefeelssenseofincompleteev acuati
onofherst
ool.Other
wiseno
pert
inentphy si
calexaminati
onandlaborator
yfindings.Whatisthemostli
kelydiagnosis
ofthispatient?

a.Tr
opi
cal
spr
ue

b.Chr
oni
cpancr
eat
it
is

c. Ul
cer
ati
veCol
i
tis

d.I
rr
it
abl
ebowel
syndr
ome

Thecor
rectansweri
s:I
rr
it
abl
ebowel
syndr
ome

24.A28y ear-
oldy oungmancametoy ourcl
i
nicwithcomplai
ntofhoarsenessofvoi
ceof6
mont hsdurat i
on;hewasseenbyanENTspeci al
istwhoviewedmassont hegl
otti
s.
Biopsywast akenandshowedsquamouscellcarcinomaofthegl
otti
s.Whatcoul
dbe
theri
skf actorinthi
spati
ent
?

a.EBVi
nfect
ion

b.Hi
stor
yofchewi
ngchat

c. Hi
stor
yofal
cohol
int
ake

d.HPVi
nfect
ion

Thecor
rectansweri
s:Hi
stor
yofal
cohol
int
ake

25.A3- y
ear -oldpresent swit
ha24- hourshist
oryofl i
mpingandprogressi
veinabi
li
tytobear
weight .Parentsr ecall
nohistoryoftr
auma, butnotethatherecentl
yhadanupper
respi
r atoryinfection.Thepatient
’svit
alsi
gnsar establ
eexceptforlowgradefever.
Physical exami nationisl
imit
edbecauseofpai n.Anult
rasoundfoundhipeff
usionwith
l
abor atoryv al
uesofWBC- 15,000(97%PMN) ,ESR-120,andCRP-5.0mg/dl.Whatisthe
nextbestst epinmanagi ngthispati
ent?

a.Emer
genthi
par
thr
otomy

b.Admi
tforobser
vat
ion

c. Obt
ainanMRI
 d.St
artt
hepat
ientonI
Vant
ibi
oti
cs

Thecor
rectansweri
s:Emer
genthi
par
thr
otomy

26.A30y earol
df emal epat
ienti
nvolv
edinroadtraffi
caccidentof6hoursdurati
on.She
sustainedtraumat oherabdomenandcompl aini
ngofhemat uri
a.Onexaminati
onshe
wasi npain,vit
al si
gnsarewithi
nnormal r
ange.Onabdomi nalexaminat
iontherewasno
tenderness.Investi
gati
ons:normalCBC,CTscanoft heabdomenshowsnonexpandi ng
peri
-renalhemat omaconf i
nedtotherenalret
roperi
toneum.Whatisthegradeofthis
renalinj
ury?

a.Gr
adeI
II

b.Gr
adeI
V

c. Gr
adeI
I

d.Gr
adeI

Thecor
rectansweri
s:Gr
adeI
I

27.A30y earoldmalefact
oryworkersust
ainedpowdert ypeofchemicalbur
n.Hecame
i
mmedi atel
ytothehospit
alandonphysicalexaminati
onhehaser yt
hematouschange
overt
her i
ghtupperext
remitywit
hthepowderst i
l
l t
here.Whatshouldbethefi
rst
tr
eatmentprotocol
?

a.St
artr
esusci
tat
ion

b.Washoutt
hepowder

c. Dustof
fthepowder

d.I
rr
igat
ethewound

Thecor
rectansweri
s:Dustof
fthepowder

28.A30y earol
dmalepat
ienti
spresentedaft
err
oadtr
aff
icacci
dent
.Thepati
entmoans,
doesn’
topenhi
seyestopainf
ulsti
muli,
andhasdecer
ebrat
epostur
e.Whatist
heGCSof
thepati
ent?

a.8

b.6

c. 4

d.5

Thecor
rectansweri
s:5

29.A30y earol dmalesustai

nedinjuryashewasgoredbyanox.Hehasdev eloped
paraplegiawit
hsensorylevelatT4.HisBPis80/
50mmHg, PRof60/ min,RRof20/
min.
Thepat ientwasprev
iouslyhealt
hyandisnotonanymedicat
ion.Thepati
entwas
presentedanhouraftertheinjur
y.Whatist
hecauseoflowBPi nthepati
ent?
 a.Neur
ogeni
cshock

b.Spi
nal
shock

c. Car
diogeni
cshock

d.Tr
aumat
icshock

Thecor
rectansweri
s:Neur
ogeni
cshock

30.A30y ear-
oldladywhogavebirt
h2weeksbackpresentwit
hl eftlegswell
i
ngof2days.
Onphy si
calexaminat
ion,
tenderl
eftl
egwi
thdi
screpancyofleftcalfswell
i
ng=4cm.You
sentthepati
entforDoppl
erUS.Whatdoyouexpectfr
om thei nvesti
gat
ionrepor
toft
his
pati
ent?

a.Nor
mal
Doppl
erf
low

b.Di
amet
eroft
hev
ein

c. Lackofv
eincompr
essi
bil
i
ty

d.Shunt
ingoft
hebl
oodf
low

Thecor
rectansweri
s:Lackofv
eincompr
essi
bil
i
ty

31.A30y ear-ol
dmal epati
entpresentswit
hl owgr adefever,nightsweati
ngandsigni
fi
cant
weightl ossofonemont hduration.Phy
sical examinati
onshows2x3cm non- t
ender,
discreteandr ubber
ytypeofleftsubmandi bularandaxil
larylymphnodes.Biopsyofthe
l
ymphnodeshowsReed- St
ernbergcellneart hecenterofthef i
eld.Whati
sthemost
l
ikelydiagnosisofthispati
ent?

a.Hodgki
nsdi
sease

b.Non-
Hodgki
nsl
ymphoma

c. My
cosi
sfungoi
des

d.Bur
kit
tsl
ymphoma

Thecor
rectansweri
s:Hodgki
nsdi
sease

32.A30y ear-oldmalesust ai
nsadi
splacedint
ra-capsularfemoralneckfr
actureaf t
era
motorv ehicl
ecolli
si
on.OnExami nat
ion,
theneur ovascularst
ructur
esareintactbutthe
i
njur
edl imbi sshort
enedandexternal
lyr
otated.Whati sthemostl i
kel
yexpect ed
complicati
onatt woy earfol
l
ow-
up?

a.Chondr
oly
sis

b.Mal
uni
on

c. Hi
pinst
abi
l
ity

d.Av
ascul
arnecr
osi
s

Thecor
rectansweri
s:Av
ascul
arnecr
osi
s
 33.A31- year-
oldwomanpr esent edtoemer gencyOPDwi thprogressivedif
fi
cult
yofwalki
ng
associ atedwithl
owerbackpai nanddi ff
icultyofcli
mbi ngst ai
rs.Sheisunabletowri
te
andhasapastmedi calhi
st oryoftypeIdi abetes.Onexami nati
on,crani
alnervesar
e
i
nt actbutt her
eisabsentsensat iontov i
brationandpi n-pr
ickinherupperlimbst ot
he
elbowandl owerli
mbst ot helevelofhip.Poweri nthel owerl i
mbi s3/5withabsent
reflexesandmut eplantars.HerBPi s124/ 85mmHg, pulse68andO?sat urat
ion98%on
air.Whati sthemostlikel
ydi agnosisforthispat i
ent?

a.My
ast
heni
agr
avi
s

b.Di
abet
icneur
opat
hy

c. Gui
l
lai
n–Bar
résy
ndr
ome

d.I
nfect
iveneur
opat
hy

Thecor
rectansweri
s:Gui
l
lai
n–Bar
résy
ndr
ome

34.A32-year-
oldwomanwi t
hcompl exparti
alsei
zureswhowast aki
ngant i
epi
lept
icdrugs,
hasbeenseizure-f
reeforoneyear,butshewantstodi sconti
nuethedrugs.Shehas
normalint
ell
igenceandanor malneurologi
cexami nat
ion.HerEEGisnor mal.What
aspectofherprofi
ledoesnotguaranteesuccessfulwithdrawalf
rom medicati
on?

a.Nor
mal
neur
ologi
cexami
nat
ion

b.Si
ngl
ety
peofpar
ti
alorgener
ali
zedsei
zur
e

c. Sei
zur
e-f
reef
or1y
earonAEDs

d.EEGnor
mal
i
zedwi
tht
reat
ment

Thecor
rectansweri
s:Sei
zur
e-f
reef
or1y
earonAEDs

35.A36y ear-
oldmalepatientfr
om “Humer a”pr
esent
edwi t
hhighgr adeint
ermit
tentfever,
chi
ll
sandr igor
softhreeweeksdur at
ion.Physi
calexaminat
ionshowedpal econjuncti
ve
andsplenomegaly.Bonemar rowwasdoneandshowedamacr ophagewit
hintracel
lul
ar
Amastigotes.Whatfi
rstli
netreat
mentwoul dyoustartf
orthispati
ent?

a.Ar
tesunat
e

b.Amphot
eri
cinB

c. Sodi
um st
ibogl
uconat
e

d.Neomy
cin

Thecor
rectansweri
s:Sodi
um st
ibogl
uconat
e

36.A40y earoldmalepatientsust
ainedroadsi deaccidentoftwohour sdurat
ion.He
complainsofgeneral
i
zedabdomi nalpain.Onphy si
calexaminat
ion,bloodpressur
e-
80/40mmHg, pul
serate-120/minandf eeble.Guardingandrigi
ditynotedonabdominal
examinati
onandhasbr uisi
ngoverthebi l
ateralf
lank.Whichonei sthemostl i
kel
ycause
ofhypotensi
on?

a.Spl
eni
cinj
ury
 b.Pel
vi
cinj
ury

c. Li
veri
njur
y

d.Ret
roper
it
oneal
inj
ury

Thecor
rectansweri
s:Ret
roper
it
oneal
inj
ury

37.A40y earol
dmal epresentst
otheemer gencydepart
mentwi t
hhist
oryofvomit
ingof
coff
eegroundmat terof3daysdurati
on.HeisdiagnosedtohaveCLDwithasci
tes.He
hasstabl
ev i
tal
signs.Whichofthefol
lowinghasnopl acef
ortheacut
emanagementof
thepati
ent.

a.Pr
opr
anol
ol

b.Oct
reot
ide

c. Omepr
azol
eiv

d.I
vCi
prof
loxaci
l
li
nori
vcef
tri
axone

Thecor
rectansweri
s:Pr
opr
anol
ol

38.A40y earoldmal e,r

elat
ivel
ywell
patientcamewi thobsti
pat
ionoftwoday sdurati
on
wit
hassociatedhi st
oryofabdominalpainanddistensi
on.Uponexaminati
on,BP-
90/60mmHg, PR-92/minandhasdr ybuccal mucosa.Hehastensebutnont ender
abdomenwi thbloodystoolonexaminingfinger
.Thepossibl
ecauseoft heabove
complainti
s?

a.Si
gmoi
dvol
vul
us

b.I
leosi
gmoi
dknot
ti
ng

c. I
ntussuscept
ions

d.Ul
cer
ati
vecol
i
tis

Thecor
rectansweri
s:Si
gmoi
dvol
vul
us

39.A40year-
oldmalepresent
swithaonemonthhist
oryofheelpai
naft
erst
arti
ngt
rai
ning
f
orTheGreatEthiopi
anRun.Theheel
ist
enderwhensqueezedbutnoswell
i
ng.Afoot
r
adi
ographisunremarkabl
e.Whati
sthemostli
kel
ydiagnosi
s?

a.St
ressf
ract
ure

b.Subt
alarar
thr
it
is

c. Ost
eomy
eli
ti
s

d.Acut
efr
act
ure

Thecor
rectansweri
s:St
ressf
ract
ure

40.A40y ear
-ol
dpat i
entwhowasdiagnosedtohaveCir
rhosi
sfrom Chr
oni
chepati
ti
sCt wo
year
sback,recentl
ydevel
opedi
ncreasedabdominal
swell
ing.Hehasnoperi
pheral
 edema.Abdomi nalU/
Sshowedmoder at
eascit
es.Asceti
cflui
danal
ysi
sshowedserum
asci
tesalbumingradi
ent1.
1g/
dl.Whatisthemostappropri
ateimmedi
atemanagement
fort
hispatient
?

a.Lar
gev
olumepar
acent
esi
s

b.Spi
ronol
act
one

c. Fr
usemi
de

d.Nor
fl
oxaci
n

Thecor
rectansweri
s:Spi
ronol
act
one

41.A45y earol dfemalepati

entcamewithant
eri
orneckswel l
ingoft hr
eey earsdurati
on.
Shehasr ecentlydevel
opedweightl
osswit
heasyf at
igabi
li
tyandpal pit
ation.Upon
examination,shehasPRof110/ minandhasdif
fusel
yenlar gedthyroi
dglandwi thpal
m
sweatingonmuscul oskel
etalsy
stem.Whatphysi
calfindi
ngi ndi
catesprimar y
thyr
otoxicosis?

a.Acr
opachy

b.Fi
net
remor

c. Faci
alf
lushi
ng

d.Pr
oxi
mal
muscl
eweakness

Thecor
rectansweri
s:Acr
opachy

42.A45y earol
dmalepat
ientunder
wentchol
ecystect
omyforsy mpt
omati
cchol
eli
thi
asi
s.
Af
tertwodays,
hedevelopedabdomi
naldi
stensionwi
thleakageofbi
l
ethr
oughwound
si
te.Whatwoul
dbethenextappropr
iat
emanagement?

a.Par
ent
ral
ant
ibi
oti
cs

b.Resusci
tat
ion

c. Expl
orat
ion

d.NGt
ubedecompr
essi
on

Thecor
rectansweri
s:Expl
orat
ion

43.A45y ear-
oldP-I
Ifemalepresent
stoyourcli
nicwit
hsignandsymptomssuggestiveof
cerv
icalcancer
.Onhistor
y,shetel
lsyouthatshehadonlyonesexualpar
tnerwhoisher
husband,hadnohistor
yoft r
eatmentforSTI
sandisnotasmoker .Whatri
skfact
or
shouldbeassessed?

a.Hi
stor
yofuseofOCPs

b.Ageofmenar
che

c. Hi
stor
yofsexual
par
tner
soft
hehusband
 d.Hi
stor
yofpassi
vesmoki
ng

Thecor
rectansweri
s:Hi
stor
yofsexual
par
tner
soft
hehusband

44.A5y ear
-ol
dchil
df al
lfrom atr
eeandsustainedinjur
ytother
ightt
high.Hehasmild
t
highswell
ingwithintactneur
ovascul
arst
ructure.Femor
alx-
rayshowedat r
ansver
se
midshaftf
emoral fr
acturewit
hacentimetershorti
ng.Whati
smostacceptablewayof
t
reat
inghisfr
acture?

a.I
mmedi
atehi
pSpi
cacast
ing

b.Ski
ntr
act
ionf
oraweekt
henhi
pspi
cacast
ing

c. Fl
exi
blei
ntr
amedul
l
arynai
l

d.Openr
educt
ionandpl
ati
ng

Thecor
rectansweri
s:I
mmedi
atehi
pSpi
cacast
ing

45.A50-y earol
dmal epat ientpresentedtotheemer gencydepartmentwit
hacompl ai
ntof
severeepigast
ri
cst abbi ngpainof12hour sdur ati
onaf terameal,t
hepainradiat
esto
thebackandgetr elievedonl eaningforward.Hehasal soassociat
ednauseaand
vomiting.Thepat
ienti sknownal cohol
icforthelast15y ear
s.Onexaminati
onhei ssick
l
ookingandhasst ablev it
alsi
gns.Oni nvesti
gationshehasnor malCBC,abdominal
ult
rasoundandabdomi nalx–r ay.Whatisthenextbesti nvest
igat
ivemodali
tythathelps
i
nr eachingatadiagnosi s?

a.Ser
um amy
lasel
evel

b.Ser
um al
kal
i
nephosphat
isel
evel

c. Ser
um al
bumi
n

d.Ser
um bi
l
uri
binl
evel

Thecor
rectansweri
s:Ser
um amy
lasel
evel

46.A50y earol
df emalepat i
entcamewi thri
ghtbreastmassof2y earsdurat
ionwi thni
pple
ret
ractionbutnodi schargewasnot ed.Onphysicalexaminati
on,shehadr ightupper
outerquadrantmasswhi chis4x6cm i nsize.Iti
snotfixedbothtot heunderlyi
ngand
overly
ingstructur
es.Shehasni ppleretr
acti
onwi t
hassociated1x1cm i psilat
eralf
ir
m
axi
llar
yl ymphnodewhi chismovablebutmat t
ed.Wi tht
hisassessmentshewas
i
nvestigatedandhadr i
ghtductalcancerwit
hnomet ast
asis.I
nwhi chcli
nicalstagedid
shepr esent
?

a.St
age3B

b.St
age3C

c. St
age2B

d.St
age3A

Thecor
rectansweri
s:St
age3A
 47.A50y ear-ol
dmal e,
whowasaheav ysmoker,hasproduct
ivecoughandshortnessof
breathforthelast3years.Onphysi
calexaminati
on,
therewashy perr
esonanceon
percussion,decr
easebreathsounds,wheezesandcrackl
esatlungbase.What
medicat i
onisNOTusedi nl
ongterm managementofthiscase?

a.Or
alcor
ti
cost
eroi
ds

b.Oxy
gent
her
apy

c. I
nhal
edcor
ti
cost
eroi
ds

d.Bet
aagoni
sts

Thecor
rectansweri
s:Or
alcor
ti
cost
eroi
ds

48.A53y ear
-oldmal epatientwhoisonf ol
lowupf orthediagnosisofchr
onickidney
diseasepresentedwi thlossofconsciousnessof2day sdur ati
on.Onphysi
cal
exami nat
ion,BP=160/ 100mmHg, PR=100/ min,T=37.60C., pal
econj
uncti
vaeandGCS
=10/15.Thephy si
ciandecidedtoreferthi
spatientfordi
alysis.Whati
sthemostlikel
y
reasonofr efer
ralfordialy
sis?

a.GCS=10/
15

b.PR=100/
min

c. BP=160/
100mmHg

d.T=37.
6oc

Thecor
rectansweri
s:GCS=10/
15

49.A54- year
-ol
dmani sref
err
edt oyourcl
i
nicforheadaches.Hehasbeenhavi
ng
headachessincehisf or
ti
es.Theheadachesoccur1t o8timesperdayandareuni
lat
eral
,
severe,st
abbingtype,andlocali
zedtot
heor bi
t.I
tisassoci
atedwi
thlacr
imat
ionand
conjuncti
vali
nject
ion.Whatisthemostlikel
ydiagnosi
softhispat
ient
?

a.Medi
cat
ionov
eruseheadache

b.Cl
ust
erheadache

c. Tensi
onheadache

d.Ty
pical
migr
aine

Thecor
rectansweri
s:Cl
ust
erheadache

50.A55y earoldmal epati

entcamewi t
hlossofconsci
ousnessaf t
erhesust
ainedmotor
vehi
cleacci dent.Uponexami nat
ion,bl
oodpressur
e180/ 100mmHg, pul
serate-
60/mi
n,
oxygensat urati
on-95%.HehadaGCSof8wi thdil
atedandfixedpupi
lonri
ghtsidewi
th
l
eftsideneur ologi
cdefici
t.Thenextoptionofmanagementi s?

a.I
ntubat
ethepat
ient

b.Puthi
m oni
ntr
a-nasal
oxy
gen
 c. Tr
eatt
her
aisedI
CP

d.Ev
acuat
ethehemat
oma

Thecor
rectansweri
s:I
ntubat
ethepat
ient

51.A55y earoldmale,di
abeti
candhy pertensi
vef ort
helast10yearswasonr egul
arfol
l
ow
up.Recentl
yhedev el
opedasuddenl eftanter
iorchestpainonexer
t i
on.ECGShowsST
segmentelevat
ioninanter
olat
eral
pr ecordi
alleads.Cardi
acbiomarkersareel
evat
ed.
Whatisthemostl i
kel
ydiagnosi
soft hepatient?

a.Per
icar
dit
is

b.St
abl
eangi
na

c. Unst
abl
eangi
na

d.My
ocar
dial
inf
arct
ion

Thecor
rectansweri
s:My
ocar
dial
inf
arct
ion

52.A55y earoldpat
ientunder
wentsub-total
thyr
oidect
omyformul t
inodul
argoiter
.Inthe
recov
ery,shedevel
opeddiff
icul
tyofbreat
hingwithai
rhungerandhadswel l
i
ngov erthe
anter
iorneckwit
hmi ni
malsoakingoverthedressi
ng.Howshouldthispat
ientbe
managed?

a.Opent
hewound

b.Gi
veheri
ntr
avenousst
eroi
d

c. Changet
hedr
essi
ng

d.Putheroni
ntr
anasal
oxy
gen

Thecor
rectansweri
s:Opent
hewound

53.A55y ear
-ol
dfemalepat i
entcamet oyourcl
ini
cwithsy
mptomsofheadache, pr
uri
ti
s
andburni
ngsensationoverlowerextr
emiti
es.OnP/EshehasBP=150/ 100mmHgand
spl
enomegaly.Laborat
oryshowedhemat ocri
tof68%andPlat
eletof500x103µ/l
.What
wil
lbeyourbestnextstep?

a.Measur
eser
um er
ythr
opoi
eti
nlev
el

b.Conf
ir
m JACK2mut
ati
on

c. Measur
eRBCmass

d.Measur
ear
ter
ial
oxy
gensat
urat
ion

Thecor
rectansweri
s:Measur
eRBCmass

54.A55y ear-ol
dfemalewast r
eatedforUTIthreet imesinthepasttwoy earsanduri
ne
cul
tur
esshowedPr ot
eusandKl ebsiell
aspecies.Currentl
yshehasrightfl
ankpain,but
noprevioushist
oryofnephrol
i
thiasis.Akidney-uret
er-bl
adder(KUB)viewwith
tomographyreveal
spoorlyopacifi
eddendr i
ti
cst oneintherenalpel
visandlowerpole
 cal
yces.Whati
sthecomposi
ti
onoft
hest
onei
nthi
spat
ient
?

a.Cal
cium oxal
atest
ones

b.Magnesi
um ammoni
um phosphat
est
ones

c. Ur
icaci
dst
ones

d.Cal
cium phosphat
est
ones

Thecor
rectansweri
s:Magnesi
um ammoni
um phosphat
est
ones

55.A55y ear-ol
dmalepati
entcamet oyourcli
nicwithsy mpt omsofleftsidepluri
ti
cchest
pain,
drycoughhighgradef everofoneweekdur ation.OnP/ E,T=38.5oc, RR=28/min,
dull
nessanddecreasedairent r
yoverl
eftposteri
orl ungfiel
d.Laboratoryshowed
exudati
vet y
peofpleur
al f
lui
dandgr am posit
ivediplo-cocci
.Hewasst atedon
anti
obiot
ics.Whataddi
tionalmeasurewoul dyoutake?

a.I
ntubat
ion

b.Addst
eroi
d

c. Obser
vat
ion

d.Chestt
ubei
nser
ti
on

Thecor
rectansweri
s:Chestt
ubei
nser
ti
on

56.A55- year
-ol
dwomani srefer
redbyaGPf oruppergast roint
esti
nal(GI)endoscopy
fol
lowingafourmont hhistor
yofepi gastr
icpaindespitetreatmentwithantacidsand
protonpumpi nhi
bit
ors.Ther esult
sdemonst r
ateaduodenal ulcercoupledwitha
positi
vecampy l
obacter-
li
keor gani
sm test.Thepatienthasnopastmedi calhi
stor
yand
knowndr ugall
ergi
es.Whati st hemostappr opri
atetherapyforthi
spat i
ent?

a.Amoxi
cil
l
in,
ant
aci
dandcl
ari
thr
omy
cin

b.Omepr
azol
e,amoxi
cil
l
inandcl
ari
thr
omy
cin

c. Omepr
azol
e,ant
aci
dandamoxi
cil
l
in

d.Omepr
azol
e,ci
met
idi
neandcl
ari
thr
omy
cin

Thecor
rectansweri
s:Omepr
azol
e,amoxi
cil
l
inandcl
ari
thr
omy
cin

57.A6mont holdmaleinfantispr esent

edtoPedi at
ricOPDwi t
hcoughandf astbreat
hing
of2weeksdur ati
on.Hismot heralsoexplai
nedthathehadexcessi vesweatingand
i
nterrupti
onduri
ngbreastf eeding.OnP/ E,heisi
nr espi
rat
orydistr
esswi t
hRR=68/ min,
PR=144/ Mi
nandT=38. 50C.Hehasi nt
ercostalandsubcostalret
ract
ions,GradeII
I
Systoli
cmur murbestheardatLUSBandt enderhepatomegaly.Whatisthemostl i
kely
Cardiaclesi
onofthi
sinfant ?

a.PS

b.ASD
 c. VSD

d.PDA

Thecor
rectansweri
s:PDA

58.A60y ear–oldmalepat
ientwasunder goingsur
ger
yforbenignpr
ost
ati
chyperpl
asi
a
andtheesti
matedint
raoperati
vebloodlosswas1200ml ,butbl
eedi
ngcontr
oll
edatthe
endofthesurger
y.Whatisthebestpost-oper
ati
vef
lui
dmanagementofthispati
ent
?

a.Repl
acet
hedef
ici
twi
thequal
amount(
1200ml
)ofcr
yst
all
oids+mai
ntenance

b.Tr
ansf
usehi
m wi
thoneuni
tofwhol
ebl
oodandmai
ntenancef
lui
d.

c. Tr
ansf
usewi
tht
wouni
tsofpl
asma+mai
ntenancef
lui
d

d.Tr
ansf
usehi
m wi
tht
wouni
tsofwhol
ebl
ood+mai
ntenancef
lui
d

Thecor
rectansweri
s:Tr
ansf
usehi
m wi
tht
wouni
tsofwhol
ebl
ood+mai
ntenancef
lui
d

59.A60y ear–oldmalepat
ientwasunder goingsur
ger
yforbenignpr
ost
ati
chyperpl
asi
a
andtheesti
matedint
raoperati
vebloodlosswas1200ml ,butbl
eedi
ngcontr
oll
edatthe
endofthesurger
y.Whatisthebestpost-oper
ati
vef
lui
dmanagementofthispati
ent
?

a.Sepsi
s

b.Sept
icshock

c. Sy
stemi
cinf
lammat
oryr
esponsesy
ndr
ome

d.Sev
eresepsi
s

Thecor
rectansweri
s:Sev
eresepsi
s

60.A60y earoldfemalepat
ientunderwentr i
ghthemi col
ect
omyf orcol
onicmass.Onher
si
xthpostoperat
iveday,
shedev elopedabdomi nalpai
nwithvomiti
ng.Onphysi
cal
examinati
on,PRis120/minandabdomi nalexaminati
onisnotabl
efordist
ensi
on,
other
wiseshehasnoper ti
nentfinding.Themostlikel
ydiagnosi
sis?

a.Dehy
drat
ion

b.Par
aly
tici
l
eus

c. Woundi
nfect
ion

d.Anast
omot
icl
eak

Thecor
rectansweri
s:Anast
omot
icl
eak

61.A60y earol
dmal epati
entistakentoORforcompl etesmal lbowelobst
ruct
ionaf t
erhe
present
edwithbi
liousvomiti
ngof4day sdur
ation.Intr
a-operati
vel
y,hehadav i
able
dist
endedbowelandde- r
otati
onwasdone.Post operat
ivel
y,hest i
l
lhadabdomi nal
dist
ensi
onwithbil
iousvomi t
ingandhashypoactivebowel sounds.Themostlikely
causeofil
eusis?
 a.Hy
pokal
emi
a

b.Hy
pomagnesemi
a

c. Hy
ponat
remi
a

d.Hy
pocal
cemi
a

Thecor
rectansweri
s:Hy
pokal
emi
a

62.A60y ear -
oldmalepatientoninhal
edcorti
cost
eroi
dsf ort
hediagnosisofCOPD
presentedwi t
hexacerbati
onofshortnessofbreat
handgener ali
zedbodyswell
ingof
twoweeksdur at
ion.Physical
examinati
onshowsr al
es,wheezing,r
aisedJVP,
parasternalheav
e,hepatomegalyandpitti
ngedema.Whati sthemostl i
kel
ydi
agnosi
sof
thi
spat i
ent?

a.Congest
ivehear
tfai
l
ure

b.di
l
atedcar
diomy
opat
hy

c. I
ntr
acar
diacshunt
ing

d.Cor
pul
monal
e

Thecor
rectansweri
s:Cor
pul
monal
e

63.A60y ear-
oldmalepati
entpresentedtoneurologyrefer
ralcl
i
nicwithchiefcomplaintof
shakingofl ef
thandandgaitabnor mali
tyofei
ghtmont hsdurati
on.Cli
nicalexaminati
on
revealedmaskedf ace,
rest
ingtremorofl ef
thand,bradyki
nesiaandcogwheel ri
gidi
tyon
l
eftsideoft hebodywithnormal gaze.Brai
nMRIr eveal
ednormal st
udy.Whati sthe
mostl ikel
ydiagnosi
softhi
spat i
ent?

a.Par
kinson’
sdi
sease

b.Pr
ogr
essi
vesupr
anucl
earpal
sy

c. Mul
ti
plesy
stem at
rophy

d.Cor
ti
cobasal
degener
ati
on

Thecor
rectansweri
s:Par
kinson’
sdi
sease

64.A65y ear–oldfemalepat i
entpresentedwithr i
ghtupperquadrantpainofayear
durati
onassociatedwithprogressiveyell
owdi scolor
ati
onoftheey es.Onexaminat
ion
shehasadeepi cter
icscler
aandmi l
dr i
ghtupperquadranttendernessandpalpabl
egall
bladder.Abdominalult
rasoundshoweddi l
atedbi l
i
arytr
eebutnost one.What
coagulati
onprofil
eismost l
yaffectedinthispatient?

a.Bl
eedi
ngt
ime

b.PTT

c. I
NR

d.PT
Thecor
rectansweri
s:PT

65.A65yearol
dmalepatienthadinter
mi t
tenthi
stor
yofabdominalpai
nwi t
hbloodyst
ool.
Hehadnoremar
kablephy si
cal
f i
nding.Whatshouldbethef
irsti
nvest
igat
ivemodal
it
y
f
ortheabov
ecomplaint?

a.Fecal
occul
tbl
oodt
est

b.Col
onoscopy

c. Fl
exi
bleSi
gmoi
doscopy

d.Abdomi
nal
CT

Thecor
rectansweri
s:Col
onoscopy

66.A65y ear
-ol
dmal esmokerpat i
entpresentedwit
hproductivecoughwi t
ht hi
ckand
tenaci
oussput um, andnon-foulsmelli
ng,of3weeksdur at
ion.Physicalexamination
showscr ackl
esandwheezi ngonlungauscul t
ati
on,andclubbingofthedi gi
ts.ChestCT
wascomment edandi tsays"t
ram t
racks"onleftl
owerlobe.Whati sthemostl ikely
diagnosisofthispatient?

a.Lungabscess

b.I
diopat
hicpul
monar
yfi
brosi
s

c. Br
onchi
ect
asi
s

d.Chr
oni
cbr
onchi
ti
s

Thecor
rectansweri
s:Br
onchi
ect
asi
s

67.A70y ear-ol
dmalediabeti
cpati
entwhowasonmedi cati
onforthelast15y ears
present
swi t
hli
ghtheadednessandvisual
blur
ri
ngwhenhest andssince2weeksback.
HisBPis130/90mmHgatsi tt
ingand90/60mmHgatst andingposit
ion.Otherwi
sehe
hasnoot hersi
gnsandsy mptoms.Whatisthemostl
ikel
ycauseofpat ient
’scondi
ti
on?

a.Vol
umedepl
eti
on

b.Mul
ti
plesy
stem at
rophy

c. Aut
onomi
cneur
opat
hy

d.Lewybodysy
ndr
ome

Thecor
rectansweri
s:Aut
onomi
cneur
opat
hy

68.A70y ear-
oldmal epati
entcametoyourcl
ini
cwit
hpain,
sti
ff
nessandswell
i
ngofdi
stal
i
nter
-phalangealdigi
tsbi
lat
eral
l
y.X-
rayshowederosi
onoft
hejoi
nts.Whati
sthemost
l
ikel
ydiagnosis?

a.Ost
eoar
thr
it
is

b.Sy
stemi
clupuser
ythemat
ous
 c. Gout
yar
thr
it
is

d.Rheumat
oidar
thr
it
is

Thecor
rectansweri
s:Ost
eoar
thr
it
is

69.A78- y
ear -
oldmanwi t
hhy pertension,tobaccouse,andhy perl
i
pidemi apresentswithan
episodeoft r
ansientaphasial ast
ing30mi nutesanddif
fi
cultywi t
hright-
arm
coor dinati
on.Hei sexaminedanhourl aterandnoneurologicdefici
tisfound.Abr ai
n
MRIshowsnosi gnofacut eischemi a.Caroti
dduplexsuggests70%t o90%st enosisof
thepr oximal l
eftint
ernalcarotidarteryatthebulb.Hehasnohi st
oryofcor onaryart
ery
disease, andhisEKGi snor mal .Whati sthebestopti
onforst r
okepr eventi
onint hi
s
patient ?

a.Car
oti
dst
ent
ing

b.Hi
gh-
dosest
ati
nther
apy

c. Car
oti
dendar
ter
ect
omy

d.Aspi
ri
n

Thecor
rectansweri
s:Car
oti
dendar
ter
ect
omy

70.A9-y ear-
oldboyisbeingtreatedforacuteosteomy el
i
tisofthedist
alti
biawith
appropriat
eIVant i
biot
ictherapy.Aftert
hreedaysoftreatment,hefai
l
st oshowany
cli
nicali
mpr ovement.Thepat i
entsubsequentlyundergoneformalopensurgical
debridement,withoutcomplicat
ions.Whatserialeval
uati
onisthemostr el
iablemet
hod
todet er
minetheear l
ysuccessoft reatment?

a.Er
ythr
ocy
tesedi
ment
ati
onr
ate

b.C-
react
ivepr
otei
n

c. Whi
tebl
oodcel
lcount

d.Radi
ogr
aphs

Thecor
rectansweri
s:C-
react
ivepr
otei
n

71.Afarmerispresent
edtotheemergencyaf terhei
ngestedanunknownsubst ance.Heis
agi
tat
ed,haspinpoi
ntpupil
sandhispanti ssoakedinurineandfeces.Thechestisf
ull
oft
ransmitt
edsoundsonauscultati
on.HisPRi s60/minandoxy gensatur
ati
onis80%
onroom air
.Whatisthemostli
kelypoisoningagentthathetook?

a.Ant
ichol
i
ner
gicagent

b.Sy
mpat
homi
met
ic

c. Her
bici
de

d.Achol
i
ner
gicagent

Thecor
rectansweri
s:Achol
i
ner
gicagent
 72.Afouryearoldgi
rlhasmulti
plejointswel
li
ngf orover6months.Sheissl
owtomov ei
n
themorningandmov esasifsti
ffforthefi
rsthoursoftheday.Thenaft
er,
shewil
l
becomev er
yacti
ve.Shehasnor ashandverylit
tl
elimi
tati
onofrangeofmoti
on.Her
ESRis40mm/ hr
.Whatisthemostl i
kel
ydiagnosis?

a.Juv
eni
l
erheumat
oidar
thr
it
is

b.React
ivear
thr
it
is

c. Sept
icar
thr
it
is

d.Sy
stemi
clupuser
ythemat
osus

Thecor
rectansweri
s:Juv
eni
l
erheumat
oidar
thr
it
is

73.Afouryearoldmalechi l
dpresentedtoy ourcli
nicwithsuddenonsetofhi ghgradefever
,
cough,chi
ll
sandchestpai n.Hehadhi storyofupperrespir
atorytractsymptomsforthe
l
astfi
veday s.Onphysicalexaminati
on,thechildisinrespi
ratorydist
resswithRRof
50/min.Chestauscul
tati
onr ev
ealedcoar secrepit
ati
onatthel eftsub-
scapularar
ea.
Whatisthemostl i
kel
yet i
ologi
cagentf ortheabov econdit
ion?

a.Ecol
i

b.St
aphy
lococcusaur
eus

c. Gr
oupAß-
hemol
yti
cst
rept
ococcus

d.St
rept
ococcuspneumoneae

Thecor
rectansweri
s:St
rept
ococcuspneumoneae

74.Aknowndi abeticpati
entpr esent
edtot heemer gencyaf t
erdiscontinui
nghisinsuli
nfor2
day s.HisBPwas90/ 60,PRwas110/ mi n.Hisrandom bloodgl ucoselevel=350mg/ dl
,
Urineket one=+3, Ser
um sodi um =130mEq/ l,
andSer um potassium =6mEq/ l
.
I
nt r
av enous3l i
ter
sofnor mal sal
inewasgi venandt hepat i
entstartedproducinguri
ne.
Thesubsequentsal i
nef l
uidwasadmi nisteredwith20mEqofpot assi
um chlori
deadded
toal it
erofsal ine.Regularinsuli
n0.1iu/kgI Vwasgi ven,t
hencont i
nuedwithinfusi
onof
0.1iu/kg/hour .Thepatientwasbei ngf
ol l
owedwi thvenousbl oodgasanal ysis.Whatis
themi st
akei nthepatient’
smanagement ?

a.Regul
ari
nsul
i
nshoul
dbest
art
edwi
thl
oadi
ngdoseof10i
uivand10i
uIM

b.Ar
ter
ial
andnotv
enousbl
oodgasanal
ysi
sshoul
dbeusedt
omoni
tor

c. Pot
assi
um shoul
dnotbest
art
ed

d.0.
45%sal
i
neandnotnor
mal
sal
i
neusedaf
teri
nit
ial
resusci
tat
ion

Thecor
rectansweri
s:Pot
assi
um shoul
dnotbest
art
ed

75.Amani spresentedtotheemergencyaf t
eraroadtraff
icacci
dent.Thepat i
enti
s
unr
esponsi
v e,l
ooksobeseandhadl otsofsecret
ions.Theint
ernwhof i
rstsawthe
pat
ientt
ri
edt osuckoutthesecret
ions,inser
tedoralai
rwayanddi dchinli
ft,
headti
ltand
j
awt r
ustmaneuv erstoopent
heai r
way .Hecall
edy outoeval
uatet hepati
ent.What
 shoul
dthei
nter
nhav
eav
oided?

a.Headt
il
t

b.Chi
nli
ft

c. Jawt
rust

d.I
nser
ti
ngor
alai
rway

Thecor
rectansweri
s:Headt
il
t

76.Amot herhasbreastf
edhernewbornfor4days.Thenewborn'
sbi
rthweightwas2100g
buthenowwei ghsonly1900g.Whenshesqueezesherni
pplebef
orefeedi
ngherbaby,
hermilkappear
sv er
ywatery.Whatwi
llbey
ouradv i
cetot
hismother?

a.Cont
inuebr
eastf
eedi
ngexcl
usi
vel
yfort
henext6mont
hs

b.St
arthi
m onf
ormul
ami
l
kinaddi
ti
ont
oherbr
eastmi
l
k

c. St
arthi
m onf
ull
str
engt
hcow’
smi
l
kinaddi
ti
ont
oherbr
eastmi
l
k

d.St
artonexcl
usi
vef
ormul
afeedi
ngf
ort
henext6mont
hs

Thecor
rectansweri
s:Cont
inuebr
eastf
eedi
ngexcl
usi
vel
yfort
henext6mont
hs

77.Aneonateisdeli
veredbydi
ff
icultvacuum ext
ract
ion.Tenhour
safterdeli
very,
the
neonateappear
spal e,
hasaheartrateof180beatsperminuteandisnoticedtohavea
boggyswelli
ngofthewholescalp.Thepackedcellvol
umeandhemogl obin
concentr
ati
onarelow.Whatisthecor r
ecttr
eatmentofthi
sprobl
em afteradmitt
ingt
o
NICU?

a.Mai
ntenancef
lui
d

b.Par
ti
alexchanget
ransf
usi
on

c. Tr
ansf
ussi
onwi
thwhol
ebl
ood

d.I
Vant
ibi
oti
cs

Thecor
rectansweri
s:Tr
ansf
ussi
onwi
thwhol
ebl
ood

78.Anewl ydel
iver
edf emaleneonatedevelopedf ai
l
uretopassmeconi um of48hours
durationwithabdomi naldi
stensi
on.Onphy sicalexaminati
on,shehaspulserat
e-
120/ min,shehadhugel ydi
stendedabdomenandhasnoanal openi
ng.Itwasalsoseen
thatshehadasi ngleopeni
nganteri
orl
ywi thpassageoff ecesbuthasnodi f
fer
ent
urethralorvagi
nal openi
ng.Whatwoul dbet hediagnosis?

a.I
mper
for
ateanuswi
thcl
oaca

b.I
mper
for
ateanuswi
thr
ect
ovest
ibul
arf
ist
ula

c. I
mper
for
ateanuswi
thr
ect
ovagi
nal
fist
ula

d.I
mper
for
ateanuswi
thper
ineal
fist
ula
Thecor
rectansweri
s:I
mper
for
ateanuswi
thcl
oaca

79.Ani nemont holdinf

antpresentswi
tha2weekhi st
oryofparoxysmalcough, low-grade
fever,post-t
ussiv
evomiti
ngandnasal di
scharge.Physi
calexaminat
ionr evealsbil
ateral
oti
tismedi aandconjunct
ivalhemorr
hages.Scatter
edinspi
rator
yral
esar epr esent
bil
aterall
y.ThecompletebloodcountshowsaWBCcountof45, 000cells/mm3, 95%of
whichr epresentl
ymphocytes.Whatprev
enti
vemeasur ewouldy outake?

a.Pr
ophy
lact
icant
ibi
oti
c

b.I
sol
atet
hei
nfant

c. Gammagl
obul
i
nforhi
ghr
iskbabi
es

d.DPTv
acci
nat
ion

Thecor
rectansweri
s:DPTv
acci
nat
ion

80.ApatientwithHIVinf
ecti
onwasl osttofol
lowupf ortwoy ear
sandpr esentedrecent
ly
wit
hpr ogr
essiveconfusi
on,decr
easedv i
sion,
dysarthr
iaandhemi paresisoftwomont hs
durat
ion.HisCD4countwas43/ µl
.ThebrainMRIshowedbi l
ater
al,non-enhanci
ng
l
esionsinthewhitemat t
eroftheperi
ventr
icul
arpariet
o-occupit
alregionwithnomass
eff
ect.Whatisthemostl i
kel
ycauseoft hi
sdisease?

a.HI
V

b.HSVI

c. JCv
irus

d.EBV

Thecor
rectansweri
s:HSVI

81.Asev eny earoldfemaleHI Vinf

ectedpati
entf orthepast4y earswasonf ol
lowupand
taki
ngherARTwi t
hpooradher ence.Shenowpr esentedwit
hi nsi
diousonsetoff
ast
breathingandcough.Shehasgener al
i
zedly
mphadenopat hy,wheezing,di
git
alcl
ubbing
andhepat o-spl
enomegal y.Heroxygensaturationis85%.ChestX- r
ayshowedbi l
ater
al
reti
culonodularinf
il
tr
ates.Whatist hemostlikelydiagnosi
sofherpr obl
em?

a.Ly
mphoi
dInt
erst
it
ial
Pneumoni
ti
s(LI
P)

b.Mi
l
li
aryTuber
cul
osi
s

c. Pneumocy
sti
cJer
oveci
Pneumoni
a(PJP)

d.Sev
erecommuni
tyacqui
redpneumoni
a

Thecor
rectansweri
s:Ly
mphoi
dInt
erst
it
ial
Pneumoni
ti
s(LI
P)

82.Asixmont holdfemalechil
dwasadmi tt
edandt r
eatedforacut emeningit
is.She
i
mpr ovedini
ti
all
y.Afewday saftertheonsetofanti
bioti
ctherapy,shedev el
oped
recur
renceofhighgradefeverandpr oj
ecti
levomiti
ng.Physicalexaminati
onr eveal
ed
i
ncreasedheadci r
cumference,bulgi
ngfontanel
,andseparationofsutures,2episodes
ofabnormalbodymov ementandchangei nment at
ion.Whati smostimpor tant
 l
i
fesav
ingmanagementoft
hischi
l
d?

a.Per
for
mingSubdur
alTap

b.Neur
osur
gical
consul
tat
ionf
ort
hei
rsur
gical
int
erv
ent
ion

c. Changi
ngt
heant
ibi
oti
cst
omor
epot
entones

d.Admi
thert
opedi
atr
icI
CUf
orpossi
bler
espi
rat
orysuppor
t

Thecor
rectansweri
s:Per
for
mingSubdur
alTap

83.Asi xyearoldmalechil
dpr esentedwithfeverandcoughof3weeksdur ation.I
naddi t
ion,
hedev el
opedv omit
ing,speechi mpair
mentandsei zureinthelastoneweek.Onphy si
cal
examination,hehasnuchal ri
gidi
ty,
positi
veKerni
ng&Br udzi
nski si
gns,
hy per
toniaand
disori
entati
on.CSFanalysi
sshowedWBCof280cel ls/mm3, L-82%&N- 18%,glucose40
mg/ dlandprotei
nis95mg/ dl
.Whati sthemostlikel
ydiagnosis?

a.Compl
i
cat
edbact
eri
almeni
ngi
ti
s

b.Tuber
cul
ousmeni
ngi
ti
s

c. Cr
ypt
ococcal
meni
ngi
ti
s

d.Vi
ral
meni
ngoencephal
i
tis

Thecor
rectansweri
s:Tuber
cul
ousmeni
ngi
ti
s

84.At er
mf emalenewbor nwei ghing2400gram i
sdeliver
edatGhandi Hospit
al,by
spontaneousvaginaldeli
verywi t
hApgarscoresof2and3i nthe1stand5thmi nut es,
respect
ivel
y.Respirat
orydistresswasapparenti
nt hedel
iveryroom, wi
thdiminished
breathsoundsont heleftsi
deofchestandhear tsoundsaredi spl
acedtotherightand
theabdomenl ooksscaphoi d.Whatistheunderl
yingcauseoft heprobl
em ofthis
Newbor n?

a.Congeni
tal
Hear
tDi
sease

b.Di
aphr
agmat
icHer
nia

c. I
ntr
aut
eri
negr
owt
hrest
ri
cti
on

d.Respi
rat
oryDi
str
essSy
ndr
ome

Thecor
rectansweri
s:Di
aphr
agmat
icHer
nia

85.Athreeyearol
dmal e,
unv
accinatedchi
l
dawakensatni
ghtwit
haf ev
erof39.
5oCand
cough.Onphysical
exami
nati
on,hehasdrool
i
ngofsali
vaandstr
idor
.Whatisthe
opti
mal managementoft
hischil
d?

a.I
mmedi
ateadmi
ssi
onandadmi
nist
rat
ionofami
nophy
ll
ine

b.I
mmedi
ateadmi
ssi
onandi
nhal
ati
ont
her
apywi
thr
acemi
cepi
nephr
ine

c. I
mmedi
ateadmi
ssi
onf
orpossi
blei
ntubat
ionandi
vant
ibi
oti
cs
 d.Tr
eat
mentwi
thor
alant
ibi
oti
cs

Thecor
rectansweri
s:I
mmedi
ateadmi
ssi
onf
orpossi
blei
ntubat
ionandi
vant
ibi
oti
cs

86.Athreeyearsoldmalechil
disbroughttoyourpediat
ricOPDwi thanoccasional
abdominalpai
nanddi st
enti
onofaweekdur ati
on.OnPhy sicalexaminati
on,t
hevital
si
gnsareallnormalexceptsl
ightabdominaldi
stenti
on.Stoolexaminati
onreveal
edov a
ofHymenolepisnana.Whatwi l
lbeyourmanagementoft hischil
d?

a.St
atdoseofMebendazol
e

b.Al
bendazol
syr
upf
or3day
s

c. Ni
closami
det
absoncedai
l
yfor5day
s

d.St
atdoseofNi
closami
det
abs

Thecor
rectansweri
s:Ni
closami
det
absoncedai
l
yfor5day
s

87.Atwomont hol
dmaleinfanthadnon- bi
l
lousvomiti
ngoftwoweeksdurat
ion.On
examinati
onhehasv i
sibl
eper i
stal
ti
cwav ei
nleftupperpar
toft
heabdomen.Themost
l
ikel
yelectr
olyt
eabnormali
tyis?

a.Hy
per
nat
remi
a

b.Aci
dur
ia

c. Hy
per
kal
emi
a

d.Met
abol
i
caci
dosi
s

Thecor
rectansweri
s:Aci
dur
ia

88.At woyearoldmalet oddl

erisbroughttoPediatri
cOPDwi thacompl ai
ntofhighgrade
fever
,coughandnasal di
schar
geof3day sdurati
on.Onphy si
calexaminat
ion,PR=128,
RR=50andTo=38. 5oC.Hehasbi l
ateralr
edey es,er
ythematousmaculopapularski
n
rashstart
ingfr
om ther et
roaur
icul
arareathenpr ogr
esstoinvolv
et het
runk.Whatisthe
mostlikel
ydiagnosis?

a.Measl
es

b.Meni
ngococcemi
a

c. Mumps

d.Sev
ercommuni
tyacqui
redpneumoni
a

Thecor
rectansweri
s:Measl
es

89.Ay earol
dmal epati
entcamewi t
hr i
ghtsi
deundescendedtest
issi
ncebi
rth.Upon
examinati
on,therei
smassf el
tintheri
ghtingui
nal
regionwit
habsentt
estisontheri
ght
sideofthescrotum.Hewassentf orconfi
rmati
onandultr
asoundr
eveal
edi ngui
nal
testi
s.Whatistheimport
anceofor chi
dopexy?

a.I
ncr
easesr
iskoft
orsi
on
 b.I
ncr
easesr
iskoft
rauma

c. Decr
easer
iskofmal
i
gnancy

d.I
mpr
ovesf
ert
il
it
y

Thecor
rectansweri
s:I
mpr
ovesf
ert
il
it
y

90.An18y earol
dmalepatientpresentedwithf
acial
swelli
nginthemorningwhich
progressestobecomegener ali
zedbodyswelli
ng.Labinvest
igat
ionshowedHg=13g/dl
,
Urinedipsti
ck+3prot
ein,Serum Creati
nine=1mg/ dl
.Whatnextbestinv
est
igat
ionwi
l
l
youdo?

a.Ur
inar
yal
bumi
ntocr
eat
ini
ner
ati
o

b.24hrUr
inar
ypr
otei
n

c. Sul
fosal
i
cyl
i
caci
dtest

d.Ur
inar
ypr
otei
ntocr
eat
ini
ner
ati
o

Thecor
rectansweri
s:24hrUr
inar
ypr
otei
n

91.An18y earoldmalepati
entwhohasanunspecif
iedcardi
acprobl
em,hasbeensentto
yourcli
nicf
rom adenti
stforeval
uati
onbefor
eheundergoesadental
procedur
ewhich
i
nvolvesthegingi
va.Whatcondit
ionmakesyougiv
eprophyl
acti
canti
biot
ic?

a.Pr
ost
het
ichear
tval
ve

b.Aor
ti
cRegur
git
ati
on

c. Mi
tr
alst
enosi
s

d.Di
l
atedcar
diomy
opat
hy

Thecor
rectansweri
s:Pr
ost
het
ichear
tval
ve

92.An18y earol
dmal esustai
nedfl
amebur ninj
urywithanest i
mat
edbodysurfacear eaof
30%.Thepatient
’sweighti
s50kg.Yourseniorhasadvisedyoutogi
v ehi
m aringer’s
l
actat
eIVaf t
ercalcul
ati
ngthef
luidr
equirementforthefir
st24hoursusi
ngpar kl
and’s
for
mula.Howmuchf l
uiddoesthepati
entrequir
eforfi
rst24hours?

a.5l
i
ter
s

b.6l
i
ter

c. 8l
i
ter

d.3l
i
ter

Thecor
rectansweri
s:6l
i
ter

93.An86-year-
oldmanpresentstotheemergencyroom wit
hinanhouronsetofri
ght
hemipl
egiaandglobalaphasi
a.Hehasnosi gni
fi
cantmedical
hist
oryandhislaborat
ory
dat
aareallnormal.Neuroi
magingfi
ndsnohemor rhageandnosignsofacuteischemia.
 Howdoy
oupr
oceedi
nmanagi
ngt
hispat
ient
?

a.Av
oidgi
vi
ngI
Vti
ssuepl
asmi
nogenact
ivat
ort
PAast
hisi
sanol
dpat
ient
.

b.Ref
ert
hepat
ientf
ormechani
cal
thr
ombect
omy
.

c. Gi
veI
Vti
ssuepl
asmi
nogenact
ivat
or(
tPA)
.

d.Av
oidgi
vi
ngI
Vti
ssuepl
asmi
nogenact
ivat
ort
PAasbr
ainMRIi
snor
mal
.

Thecor
rectansweri
s:Gi
veI
Vti
ssuepl
asmi
nogenact
ivat
or(
tPA)
.

94.Aneightyearoldmalechildpr
esentswitha10%wei ghtl
ossov ert
heprevi
ous2weeks
andnightti
meenur esi
s.Onphysicalexami
nati
on,heissleepyandhasrapiddeep
respi
rat
ion.I
nvest
igati
onsshowedt hatbl
oodglucoseof500mg/ dlandur
ineketoneof
2+.Whatshouldbet hefi
rstst
epinthemanagementoft hischi
ld?

a.Sodi
um chl
ori
de

b.Pot
assi
um chl
ori
de

c. I
sot
oni
cfl
uids

d.Regul
ari
nsul
i
n

Thecor
rectansweri
s:I
sot
oni
cfl
uids

95.Ei
ghtmonthsoldHIVexposedinfanti
sonfol
lowupatARTcl i
nic.HisDNAPCRdoneat
6weeksofagewasnegat i
ve.Thenurseadvi
sedt
hemot hertoconti
nuebreastfeeding
andco-
tr
imoxazol
eprophylaxi
s.Whatshoul
dbeyourresponseifthemotherasksy ou
whentostopt
heco-tr
imoxazole?

a.Cont
inueunt
ilt
heageof5y
ear
s

b.Cont
inueunt
ilHAARTi
sst
art
ed

c. Cont
inueunt
ilHI
Vinf
ect
ioni
sexcl
uded

d.Cont
inueunt
ilt
heageof18mont
hs

Thecor
rectansweri
s:Cont
inueunt
ilHI
Vinf
ect
ioni
sexcl
uded

96.Fortyyears-ol
dmalefarmerpresent
edwit
hmuscleaches,tr
ismusanddif
ficul
tyof
swallowing.Fourdaysbackhesustai
nednai
li
njur
ytohisleg.Onphysi
calexaminati
on,
BP=130/ 90mmHg, PR=110/minRR=24/minandtemperature=390C.Whatist hepoor
prognosticsignofthi
spati
ent
?

a.PR=110/
min

b.BP=130/
90mmHg

c. RR=24/
min

d.Temper
atur
e=39oc

Thecor
rectansweri
s:Temper
atur
e=39oc
 97.Ful
l-
terminfantisbornafteranormalpr
egnancyanddeli
very
;howev er
,iti
scompli
cat
ed
bymar gi
nalplacental
separati
on.At12hour
sofage, t
heinf
ant,al
thoughappear
ingto
beingoodheal th,
hasv omiti
ngofacoff
eegroundmat t
er.Whatisthemostli
kel
y
di
agnosticproceduresthatshoul
dbeperfor
medf i
rstt
odeterminethecauseofthe
bl
eeding?

a.Apl
atel
etcount
,pr
othr
ombi
nti
me,
andpar
ti
alt
hrombopl
ast
int
ime.

b.Gast
ri
clav
agewi
thnor
mal
sal
i
ne

c. Abar
ium enema

d.AnAptt
est

Thecor
rectansweri
s:AnAptt
est

98.Inacommuni t
yneartoAwashRi verwit
hapopulationof100,000peopletherewerea
tot
alof1,000deat
hsfrom allcasesduri
ngt hey
earoft hefl
oodi n2005.Astudyofal
l
casesofTubercul
osi
sf oundthatthenumberofdeat hsinthatareaduetoTubercul
osi
s
i
ny ear2005was300(200mal e,100female)whereasinyear2004onl y60(50maleand
10female).Whati
sthecr udemor tal
i
tyrat
eofthiscommuni tyinyear2005?

a.10per
1000

b.30per1000,

c. 100per1000

d.60per
1000,

Thecor
rectansweri
s:10per
1000

99.Twent ytwoy ears-ol

df emalepatientpr esentedt ooutpati
entdepartmentfr
om Gambell
a
aftershelostherconsci ousnessf or2day s.Herpar ent
stoldyouthatshehashighgrade
fever,chi
ll
sandr igors.Physicalexami nationr ev
ealedpaleconjuncti
vaeandGCSof
10/ 15.Labor
atoryshowedHg=8g/ dl
,creat i
nine=2mg/ dlandarteri
alpHof=7.
3.Blood
fi
lm wasposi ti
vef orP.fal
ciparum.Sev ermal ari
awasconsi deredandmanagementwas
started.Whatpar ameterdefinessev eref alci
parum malariaforthi
spati
ent?

a.Cr
eat
ini
ne=2mg/
dl

b.GCSof10

c. Ar
ter
ial
pHof=7.
3

d.Hg=8g/
dl

Thecor
rectansweri
s:GCSof10

100. A30y ear

-ol
dmal eRVIpat
ientonAZT+3TC+EFVf orthelast5years,
present
ed
wit
hpai nonswall
owing,si
gni
fi
cantweightl
oss,feverandwaterydiar
rheaof2mont hs
durat
ion.Vi
rall
oadwasdoneandi tisconsi
stent
ly10,000copi
es/ml .Whati
st hebest
tr
eatmentregimenforthi
spati
ent
?

a.TDF+D4T+ATV/
r
 b.AZT+NVP+ATV/
r

c. AZT+3TC+ATV/
r

d.TDF+3TC+ATV/
r

Thecor
rectansweri
s:TDF+3TC+ATV/
r

Fi
nishr
evi
ew

Gener
alMedi
cineExam

Par
tTwoExam
 1.A20y earoldnull
-grav
idacomest otheOPDforanannualexaminat
ionandtore-fi
l
lher
oralcont
racepti
ves.Shehasr ecentl
ynotedavagi
naldi
scharge.Shehasbeensexual l
y
acti
vefor3y ear
sandi sinconsist
entwit
hcondom use.Whatisthemostli
kelytestthat
shouldbedone?

a.Cer
vical
HPVDNAt
est
ing

b.Chl
amy
diaAnt
ibodyt
est

c. Col
poscopy

d.Cer
vical
cyt
ologyscr
eeni
ng

Thecor
rectansweri
s:Chl
amy
diaAnt
ibodyt
est

2.20y earoldpatientcamefrom rural ar

eawi t
hcough, chestpainandfeverofoneweek
duration.Hedeniedanyill
nesspr iortothisepisode.Onphy si
calexaminati
onheiswell
l
ooki ngandonchestexami nati
ont hereiscrepit
ati
onandr elat
ivedul
lnessonri
ghtupper
chestf i
eld.Therestofchestisclear.Whatist hemostcommonchestx- r
ayfi
ndi
ng?

a.Consol
i
dat
ion

b.Hi
l
arl
ymphadenopat
y

c. Massi
vepl
eur
alef
fusi
on

d.Lungcy
st.

Thecor
rectansweri
s:Consol
i
dat
ion

3.22yearoldmalepat ientcamewit
hswell
ingandpainoflef
tlowerthighofoneandhal f
year’
sdurat
ion.X-rayshowedmixeddist
alfemoral
scl
eroti
candlyticbonelesionwit
h
normalkneejointspaceandart
icul
arcar
til
age.Whati
sthemostl i
kelydiagnosisf
orthi
s
case?

a.Chr
oni
cost
eomy
eli
ti
s

b.My
cet
oma

c. Ewi
ng’
ssar
coma

d.Ost
eogeni
csar
coma

Thecor
rectansweri
s:Ost
eogeni
csar
coma

4.26y earsol
dpr i
mi-gr
av i
dpresentedtothelaborwar dafterbei
ngrefer
redfrom aheal
th
centeraft
erlabori
ngf or6hours.Themembr aneruptur
edont hewayt othehospit
aland
herANCr evealednoidentif
iedri
sk.Uponpr esent
ation,shewasinlaborpainandher
vi
talsignswerestable,pervagi
nalexaminationshowedaf ul
lydi
lat
edcervixwitht
he
presenti
ngpartatthepelvicfl
oorandtheliquorwascl ear.TheFHRper si
stent
ly
demonst r
atedacountof110bpm.Whatwoul dbet henextstep?

a.Pr
epar
eforemer
gencyCS

b.St
artaugment
ati
on
 c. Pr
epar
eforr
out
inedel
i
ver
y

d.Appl
yout
letf
orceps

Thecor
rectansweri
s:Pr
epar
eforr
out
inedel
i
ver
y

5.A1y ear-
oldinfantpresentswithdryskinandfewrecurrenter
ythemat ouspapulesover
hischeeks,scalpandext ensorpar
tofhisextr
emiti
esof6mont hdur ati
on.Hehasbeen
applyi
ngemol l
ientsbutst i
ll
hasdevelopednewlesions.Hismot herhasahi st
oryof
asthmaandhi sf at
herhasahi stor
yofsinusi
ti
s.Whati sthepreferr
edt r
eatmentthi
s
case?

a.Ter
binaf
incr
eam

b.Per
met
hri
nlot
ion

c. Momet
asonef
urat
ecr
eam

d.Fusi
dicaci
dcr
eam

Thecor
rectansweri
s:Momet
asonef
urat
ecr
eam

6.A10mont hol dchildwasadmi t

tedfort
hesecondt i
mewi t
hthediagnosisofpneumoni
a.
Onfurt
herhistoryretr
iev
ingthepati
enthadpoorhistor
yofsunli
ghtexposur e.On
phy
sicalexaminationanter
iorf
ontaneli
s3.5cm andhasHar r
ison’
sgroov e.What
l
aborat
oryfindingsareconsist
entwitht
hecli
nical
conditi
onofthepatient?

a.LowCa+2,
nor
mal
phosphor
usandhi
ghPTH

b.LowCa+2,
lowphosphor
usandl
owPTH

c. Nor
mal
Ca+2,
nor
mal
phosphor
usandhi
ghPTH

d.Nor
mal
Ca+2,
lowphosphor
usandhi
ghPTH

Thecor
rectansweri
s:LowCa+2,
nor
mal
phosphor
usandhi
ghPTH

7.A10y earoldboycamewi thtesti

cul
arpai
nof5hoursdur at
iont
oyouandalll
ab
examinati
onisnormal.Youwantt osendhi
mt oradi
ologydepar
tmentandi
nvest
igat
e
him.Themosti mpor
tantinvesti
gati
vemodali
tyi
s?

a.CTScan

b.X-
ray

c. MRI

d.Doppl
erul
tr
asound

Thecor
rectansweri
s:Doppl
erul
tr
asound

8.A12-month-ol
dmal echi
ldisev
aluatedforafi
ve-
minut
elonggener
ali
zedtoni
c-cl
oni
c
sei
zureassoci
atedwithatemperatureof39.
50C.Whatisthemostimpor
tantpredi
ctor
off
utureepil
epsyinthi
schil
d?
 a.Recur
rentf
ebr
il
esei
zur
es

b.Fev
ergr
eat
ert
hananhourbef
oref
ebr
il
esei
zur
e

c. Neur
odev
elopment
alabnor
mal
i
ties

d.Compl
exf
ebr
il
esei
zur
e

Thecor
rectansweri
s:Neur
odev
elopment
alabnor
mal
i
ties

9.A14-yearoldboywhohadhi storyofwaterydi
arr
heafor4day snowpr esent
switha
complai
ntofr ecurr
entepi
sodesofbl oodintheuri
ne.Urineanaly
sisreveal
edprot
einur
ia
andhemat ur
ia.Yoususpectt hatthi
scouldbearenalcompl i
cati
onfoll
owingtheacute
gast
roenteri
ti
sst at
e.Whatist heli
kel
yetiol
ogyofdiar
rheaforthi
sboy ?

a.E.col
iO157:
H7

b.Shi
gel
l
aspeci
es

c. Campy
lobact
erspp.

d.Ent
amoebahi
stol
yti
ca

Thecor
rectansweri
s:Campy
lobact
erspp.

10.A15y earol
dmal echildnoticedasy mmetri
crightthi
ghenlargement.Hisparentst
ook
hi
mt ohospital
wher eimagingr eveal
edsoftti
ssueswel l
ing.Bi
opsywasdonef or
confi
rmati
onwhi chrevealedstri
atedmusclewi thint
erv
eningeosinophil
i
crich
mononuclearcelli
nfi
lt
ratearoundcal ci
fi
edlar
v ae.Whatisthemostlikel
ycauseofthe
pati
ent’
scondit
ion?

a.Echi
nococcusgr
anul
osus

b.Tr
ichi
nel
aspi
ral
i
s

c. St
rongi
l
oidesst
ercol
ari
s

d.Onchocer
cav
olv
ulus

Thecor
rectansweri
s:Tr
ichi
nel
aspi
ral
i
s

11.A16y earol
dgirlpr
esentswi t
hheavyvaginalbl
eedi
ngaft
eratwomont hdelayinher
menses.Pregnancytestisnegat
iveandultr
asoundshowsathi
nendomet r
ium.No
coagul
ati
onoranatomi caldef
ectwereidenti
fi
ed.Whati
sthebestchoi
ceoft r
eatment?

a.Hy
ster
oscopi
cabl
ati
on

b.Conj
ugat
edest
rogen

c. Shar
pcur
ett
age

d.Hi
ghdosepr
ogest
in

Thecor
rectansweri
s:Conj
ugat
edest
rogen

12.A16y
earol
dmal
epat
ientcamewi
tht
hechi
efcompl
aintofr
ightsi
der
ecur
rentepi
staxi
s
 withnasal obstructi
onofsixmont hdur ati
on.Sincelastmonththebleedi
ngbecome
sev ereandhehasal sostar
tedtodev elopproptosisandcheekswelli
ng.Anter
ior
rhinoscopicexami nati
onshowsr eddishpol y
poidmassi ntheri
ghtnasalcavit
y.
Par anasalsi
nusCTshowswi deningoft hepytergopal
ati
nefossawithextensi
onofthe
massi ntotherightsidenasalcavit
yandant eriorbowingofposter
iorwallofmaxi
ll
ary
sinus.Whati sthemostl i
kelydiagnosis?

a.I
nver
tedpapi
l
loma

b.Ant
rochoanal
pol
yp

c. Juv
eni
l
enasophar
yngeal
angi
ofi
broma

d.Ol
i
fact
oryneur
obl
ast
oma

Thecor
rectansweri
s:Juv
eni
l
enasophar
yngeal
angi
ofi
broma

13.A16years-
oldmal epat
ientpr
esentst
otheOPDwi t
hanasy mptomaticery
thematous
i
ndur
atedscalyplaquel
esionovert
helef
tcheekofthr
eeyearsdurat
ion.Therear
e
si
mil
arcasesintheareaheliv
esin.Whati
sthemostlikel
ydiagnosi
s?

a.Spor
otr
ichosi
s

b.Faci
alCel
l
uli
ti
s

c. Cer
vicof
aci
alact
inomy
cosi
s

d.Local
i
zedcut
aneousl
eishmani
asi
s

Thecor
rectansweri
s:Local
i
zedcut
aneousl
eishmani
asi
s

14.A19yearoldboycamewit
hf everandpainofleftfemurofsixdaysdurat
ion.Physi
cal
exami
nati
onshowedtemperatureof38.50C.andlocalt
endernessonproximallef
t
femur
.Youorder
edx-r
ayofthef emur.Whatisthemostr el
i
ablesignfort
heabov ecase?

a.Per
iost
eal
react
ionofdi
ff
erentt
ype

b.Pr
esenceofsequest
rat
ion

c. Lossofmuscl
efatpl
anei
ndi
ff
erentdegr
ee

d.Lami
nart
ypeofcal
l
usf
ormat
ion

Thecor
rectansweri
s:Lossofmuscl
efatpl
anei
ndi
ff
erentdegr
ee

15.A19y earoldpri
mi gr
avidaatter
m wascomplai
ningheadacheandbl
urr
ingofvi
sion.Her
BPwas180/ 95mmHg.Shewasst abi
l
izedandcesar
eandeliv
erywasdoneforf
ailed
i
nducti
on.Af t
eronehourofthedeli
ver
yherBPwas110/ 70mmHg.Whati st
hemost
l
ikel
yexplanati
onforthefal
linBP?

a.Anest
hesi
a

b.Magnesi
um sul
fat
e

c. Di
uresi
s
 d.Hemor
rhage

Thecor
rectansweri
s:Hemor
rhage

16.A19y ear-
oldfemalepatientpresentswithrecur
rentnon-
foul
smell
ingcurdli
kewhiti
sh
vaginaldischarge.Hercurrentepi
sodestartedaweekback.Shenev erhadanysexual
i
nt er
course.Shehasnoot heroral,
hairnail
orskinlesi
ons.Whati
sthemostl i
kel
y
diagnosis?

a.Gonor
rhea

b.Vagi
nal
candi
diasi
s

c. Chl
amy
dia

d.Pr
imar
ysy
phi
l
is

Thecor
rectansweri
s:Vagi
nal
candi
diasi
s

17.A19y ear-
oldmalepat i
entpresentswithmul ti
pleabscessoverthebackandchestof4
daysdurati
on.Heusedt ohav ecomedons, pust
ules,papul
esandnodulesoverthef
ace
previ
ousl
y.Inaddi
tion,hecompl ai
nsoff ever,j
ointpainandpainoverhi
sclav
icl
e.On
physi
calexaminat
ion,hehashepat o-splenomegal y
.WBCcountwas20, 000cell
s/mm3.
Whatisthemostlikelydiagnosis?

a.Acnef
orm er
upt
ion

b.SAPHOsy
ndr
ome

c. Acnef
ulmi
nance

d.Acnecongl
obat
e

Thecor
rectansweri
s:Acnef
ulmi
nance

18.A2- year-
oldi
sfoundwithanopenedemptybott
leofacetaminophent
abletsandhaspi
l
l
fr
agment sinhismouth.Whatisthemaj
orcauseofmor bi
dit
yandmor t
alit
yinacut
e
poisoningwit
hacetaminophen?

a.Hepat
ici
njur
y

b.Gast
ri
cbl
eedi
ng

c. Hy
pogl
ycemi
a

d.Met
abol
i
caci
dosi
s

Thecor
rectansweri
s:Hepat
ici
njur
y

19.A20y earoldfemalepati
entvisi
tedENTcl i
nicwit
hthecomplaintofhearingdecrement
ofthr
eemont hdurati
on.Tunningforkexaminati
onshowsrinnetestispositi
veinthel
eft
earandnegativei
ntherightear.Webertestshowslat
eral
i
zationtotherightear.Whati
s
themostlikel
yint
erpr
etati
onoft her
esult?

a.Conduct
ivehear
ingl
ossi
nthel
eftear
 b.Sensor
yneur
alhear
ingl
ossi
nlef
tear

c. Conduct
ivehear
ingl
ossi
nther
ightear

d.Sensor
yneur
alhear
ingl
ossi
nri
ghtear

Thecor
rectansweri
s:Conduct
ivehear
ingl
ossi
nther
ightear

20.A20y earoldprimigravi
daladyat31weeksofgest at
ionpr
esentswithagushoff l
uid
pervaginaofonedaydur at
ion.Shehasnofev erorabdomi
nalpain.Examinati
onshows
noactiv
el eakthroughthecervical
OS.Padt estwasalsonon-
reveali
ng.Ultr
asound
suggestsadecr easeinAmni oti
cfl
uid.Whatisthemostsensit
ivetestthatyoucando
fr
om theamni oticfl
uid?

a.WBC

b.I
L6

c. Gr
am st
ain

d.CRP

Thecor
rectansweri
s:I
L6

21.A20y ear -
oldmani sbroughttotheemer gencydepartmentafterexhibi
ti
ngbi zar
re
behavior.Foratleastoneyear,heexperienceddelusi
onsandaudi tor
yhallucinat
ions.
Thehal l
ucinat
ionsconsistofseveralv
oicescomment i
ngont hepat i
ent’
sbehav i
orand
givi
nghi m commands.Hebecamesoci all
yisol
atedanddysfunctionalasar esul
tof
thesesy mptoms.Hedeni escurrentdr
uguseormedi calpr
oblems.Whati sthemost
l
ikelydiagnosi
s?

a.Br
iefpsy
chot
icdi
sor
der

b.schi
zoaf
fect
ivedi
sor
der

c. Schi
zophr
eni
a

d.psy
chosi
ssecondar
ytosubst
anceabuse

Thecor
rectansweri
s:Schi
zophr
eni
a

22.A20-year-oldgir
lhasasi x-monthhist
oryofexcessi veshowering, uptofi
vehoursata
ti
me.Thisshower i
ngispr ecededbyrecur
rentthought sofbeingdi rt
yorunclean.The
pati
entbecomesi ncr
easinglyanxi
ousbecauseoft hesethought sunlesssheisableto
shower.Shehasapar ti
cularorderofshoweri
ngt hatmustbef ollowedorshemustst art
overagain.Thepat i
enti
sawar eoftheabnormal natureofhert houghtsandbehav i
or
andisdistressedbythem.Whati sthebesttr
eatmentmodal i
tyf ortheabovepatient
?

a.Behav
ior
alt
her
apy

b.Counsel
l
ing

c. Psy
cho-
educat
ion

d.Psy
chody
nami
cpsy
chot
her
apy
Thecor
rectansweri
s:Behav
ior
alt
her
apy

23.A21y earoldPar a-Ihasj

ustgavebirt
htoa2700gm neonat e.Rightaft
erthedeli
veryher
BPwas170/ 100mmHg.Shest artedtohavepr
ofusevaginal bl
eedingwhereitwas
di
ffi
cultt
ocont rolwithbi
manual compressi
onandoxytocininfusion.Whatisthenext
besti
nterventi
oni s?

a.PGF2al
pha

b.Di
l
atat
ionandCur
ett
age

c. Er
gomet
ri
ne

d.Bl
ynchsut
ure

Thecor
rectansweri
s:PGF2al
pha

24.A22y earoldpri
mi gr
avidaat16weeksofgestati
onwaspr escr
ibednit
rofur
antoinaft
er
aurinet estr
eveal
sa105col onyfor
mingunitofE.coil
.Shewascounsel edaboutthe
possibil
ityofhavi
ngascendingupperur
inar
ytracti
nfecti
on.Whatisthemostlikely
outcomeoft hi
spregnancy?

a.Esophageal
atr
esi
a

b.Macr
osomi
a

c. Neur
alt
ubedef
ect

d.Lowbi
rt
hwei
ght

Thecor
rectansweri
s:Lowbi
rt
hwei
ght

25.A24- year-
oldladygr av i
da2, para1at37weeksofgest ati
onpr esentstotheemer gency
unitwithmal aise,chil
ls,andv omiti
ng.Hert emper
atureis38.10C, bl
oodpr essure
110/70mmHg, pulseis100/ mi n,
andherr espi
rat
ionsare18/ min.Shehasut eri
ne
tenderness.Hercer v
ical examinati
oni s2to3cm dilat
ed, 40%effaced,vertexat-1
stati
onandmembr aner aptured.Mild-
to-
moderatecontracti
onsar epalpatedand
recordedev ery5t o10mi nut
es.Urinal
ysi
sshowsnoev i
denceofbact er
ia.Whatar ethe
mostappr opr i
atenextst epinmanagi ngthisl
ady?

a.Gi
vest
eroi
dsf
orenhanci
ngf
etal
lungmat
uri
ty

b.Fet
alf
ibr
onect
int
est
ing

c. Admi
nist
rat
ionofi
ntr
avenousant
ibi
oti
csandi
nduct
ionofl
abor

d.Tr
eat
mentwi
thmagnesi
um sul
fat
efort
ocol
ysi
s

Thecor
rectansweri
s:Admi
nist
rat
ionofi
ntr
avenousant
ibi
oti
csandi
nduct
ionofl
abor

26.A25y earoldpri
migrav i
dacomest oyourcli
nicforaquestoft r
ansfertootherhospi t
al
fordeli
very
.Sheiscurrentl
y36weeks.Shewasdi agnosedtohav eHIVatfirstscreeni
ng
andwasputonHAARTsi ncethen.Herpregnancyotherwi
sewasuncompl icated.A
recentvi
ralLoadwas2000copi es/mlandCD4countof250/ mm3.Whati st hemost
l
ikelymethodandtimingofdeliver
ytoreducether i
skofmot hertochil
dtransmi ssi
onis?
 a.Cesar
eandel
i
ver
yat38week

b.Vagi
nal
del
i
ver
yat37weeks

c. Vagi
nal
del
i
ver
yat39weeks

d.Cesar
eandel
i
ver
yat39week

Thecor
rectansweri
s:Cesar
eandel
i
ver
yat38week

27.A25y ear
-ol
df emalepati
entpresentedwithpr
oducti
vecoughof2weeks.Physi
cal
examination–v i
talsi
gn-BP:120/ 70mmHg, PR:96/min,
Temp:380c,
chesthasbil
ater
al
rhal
es.Laboratoryinv
esti
gati
on: sputum AFBposi
ti
ve.Whati
sthemostli
kelyty
peof
hypersensit
ivi
tyreact
ion?

a.Hy
per
sensi
ti
vi
tyI
V

b.Hy
per
sensi
ti
vi
tyI
II

c. Hy
per
sensi
ti
vi
tyI

d.Hy
per
sensi
ti
vi
tyI
I

Thecor
rectansweri
s:Hy
per
sensi
ti
vi
tyI
V

28.A26yearoldgr
avi
da-Imot
hercameforANCf ol
l
ow-up.U/
Sdemonst
rat
edatwi
n
pr
egnancy
.Ital
soshowedabil
ater
aladnexal
mass.Themostl
i
kel
ycausei
s?

a.Cor
pusl
uteum Cy
st

b.Fol
l
icul
arcy
st

c. Der
moi
dcy
st

d.Thecal
utei
ncy
st

Thecor
rectansweri
s:Thecal
utei
ncy
st

29.A26y earoldpara-
Iwomanwasadmi tt
edandemer gencycesar
eandeliverydonefor
obstructedlabor
.At3rdpost
-operati
veday,shehadashoot i
ngfeverwit
hf oulsmell
i
ng
vaginaldischar
geandasub-invol
uteduter
us.Shewast aki
ngacombi nationof
cli
ndamy ci
nandgentamyci
nbuthasnotr esponded.Whatorganism i
sthemostl i
kely
eti
ology?

a.Ent
erococcus

b.Bact
eroi
dFr
agi
l
is

c. Chl
ymi
diaTr
achomi
ti
s

d.Cl
ost
ri
dium Per
fer
inges

Thecor
rectansweri
s:Ent
erococcus

30.A26y earol
dwomanpr esent
swithi
ncr
easedfacial
hai
r,deepeni
ngofherv
oice,and
eust
achianappear
ancewhichhaspr
ogressedovert
hepastyear.Onexami
nati
onshe
 hascl
i
ter
omegal
l
yandapal
pabl
emassont
hel
eftov
ary
.Whati
sthemostl
i
kel
ycause?

a.Fi
broma

b.Gr
anul
osacel
ltumor

c. Ser
tol
il
eydi
gtumor

d.Dy
sger
minoma

Thecor
rectansweri
s:Ser
tol
il
eydi
gtumor

31.A27y earol
dmul t
iparouswomanv i
sit
stheOPDf ori
rregul
arvagi
nal bl
eedi
nganda
positi
vehomepr egnancytest
.Inthepastt woweeks, shehaddiffuselowerabdominal
pain.Examinat
ionrevealsaheartrateof94/minandaBPof100/ 60mmHg.Abdomeni s
softwi t
hnoguardingandspeculum exami nati
onrevealsascantybrownbloodinthe
vaginalvaul
tandacl osedcer
vix.Trans-v
aginalsonographyisnormal.Whatshoul
dbe
thenextstep?

a.RepeatherUSi
noneweek

b.Ser
um pr
ogest
erone

c. Det
ermi
neser
ial
Ser
um HCG

d.Di
l
atat
ionandcur
ett
age

Thecor
rectansweri
s:Det
ermi
neser
ial
Ser
um HCG

32.A28y earol
dfemalepati
entpresent
switht
allst
ature,l
ongfi
nger,
andbi
lat
eralsub
l
axati
onoflens,mit
ral
valvepr
olapseandaort
icdissect
ion.Whati
sthemostli
kely
pat
hogenesisfort
hepati
ents’
conditi
on?

a.Def
ecti
ngr
owt
hregul
ati
ngpr
otei
n

b.Def
ecti
nenzy
mepr
otei
n

c. Def
ecti
nst
ruct
urepr
otei
n

d.Def
ecti
ntr
anspor
tpr
otei
n

Thecor
rectansweri
s:Def
ecti
nst
ruct
urepr
otei
n

33.A28y earoldnullgr
avi
dhasanabor ti
onat10weeks.Shei sworr
iedaboutherfut
ure
fer
ti
li
ty.Fr
om hist
ory,y
ourecognizedthatherbr
otherhasamosaicdownsy ndrome.You
advi
sehert hatcl
i
nical
l
yrecogni
zedf i
rsttr
imest
erpregnanci
esmightendupinan
abort
ion.Themostcommonchr omosomal abnormali
tycausi
ngthi
sabort
ionis?

a.Monosomy

b.Pol
ysomy

c. Tr
ipl
oidy

d.Tr
isomy
Thecor
rectansweri
s:Tr
isomy

34.A29yearol
dwomanandherpar t
nercametot
heOPDf ornotbei
ngabletoconceive.
Hermensescomesever
y40days.Shehasnor
mal smearsandwasnev ertr
eatedforSTI
.
HerBMIwas29kg/m2.Shehassever
eacneonherfaceandchest.Day3LHl evel
is8
I
U/L.Whati
sthemostli
kel
ycause?

a.Cushi
ngsy
ndr
ome

b.Tur
nersy
ndr
ome

c. Pol
ycy
sti
cov
ari
ansy
ndr
ome

d.Met
abol
i
csy
ndr
ome

Thecor
rectansweri
s:Pol
ycy
sti
cov
ari
ansy
ndr
ome

35.A3y earoldmalechil
dcamewi ththecompl aintofprogressivehoarsenessofvoicewit
h
di
fficultyofbr
eathi
ngofonemont hdurat
ion.Hewaspr eviouslyoperat
edtwot i
mesf or
si
mi larcomplai
ntandt hefamilyadmittedthattherewasani mprovementaf t
ereach
oper ati
on.Fl
exi
blefi
bro-opti
claryngoscopicexami nat
ionshowsexophy ti
clesi
onatthe
anter i
orcommissureofv ocalf
olds.Whatwi ll
bet hemostl ikel
ydiagnosis?

a.Vocal
cor
dpol
yp

b.Squamouscel
lcar
cinoma

c. Vocal
cor
dnodul
e

d.Lar
yngeal
papi
l
loma

Thecor
rectansweri
s:Lar
yngeal
papi
l
loma

36.A3y ear
-oldchil
dcamet odist
ricthospi
talwi
thwhi t
ishlesi
onatthecenterofthedark
partofl
efteyewhichwasnot i
ced5mont hsback.Therewasneithereyeproblem pr
ior
tothi
snorhistor
yoftrauma.Visualacui
tywas6/ 6righteyeandnol i
ghtpercept
ionlef
t
eye.Ontorchexaminati
ontherewaswhi ti
shpupil
laryrefl
exonleftey
e.Whatbest
measureshouldbetaken?

a.Counsel
thef
ami
l
yandsendhomeast
her
eisnov
isual
pot
ent
ial

b.Ref
ert
hepat
ientur
gent
lyt
oopht
hal
mol
ogi
st

c. Tel
lthepat
ient
stoseekbet
tercar
eatconv
eni
entt
ime

d.Gi
veanappoi
ntmentf
orr
e-ev
aluat
ionaf
tert
womont
hs

Thecor
rectansweri
s:Ref
ert
hepat
ientur
gent
lyt
oopht
hal
mol
ogi
st

37.A30y earoldmal
epati
entvisit
edENTcl i
nicbecauseoftherecurrenteardischarge
associ
atedwit
hheari
nglosshehashadi nthel
eftearforthepastteny ear
s.Otoscopic
examinati
onshowswetcentralper
forat
ionoftheleftt
ympani cmembr anebutt heri
ght
tympanicmembranei
sintact.Whatisthenextappropri
atestepinthemanagementof
thi
spatient
?
 a.Ty
mpanopl
ast
ywi
thPOamoxi
cil
l
in

b.Aur
alt
oil
etwi
thgent
amy
cineardr
op

c. Aur
alt
oil
etwi
thPOamoxi
cil
l
in

d.Aur
alt
oil
etwi
thci
prof
loxaci
neardr
op

Thecor
rectansweri
s:Aur
alt
oil
etwi
thci
prof
loxaci
neardr
op

38.A30y earoldpati
entpresentst
oemergencyroom wit
hri
ghtsideepist
axisoftwohour
s
dur
ati
on.Ant er
iorr
hinoscopi
cexaminat
ionshowsbleedi
ngfrom l
it
tl
e’sarea.
Caut
erizat
ionwast r
iedbutitwasnotsuccessf
ul.Whati
sthenextappropri
ate
management ?

a.Ar
ter
ial
li
gat
ion

b.Ar
ter
ial
embol
i
zat
ion

c. Ant
eri
orpacki
ng

d.Post
eri
orpacki
ng

Thecor
rectansweri
s:Ant
eri
orpacki
ng

39.A30y ear
-ol
df emalepati
entpresentedwi ththyroi
dmassof10y earswithrecenttwo
monthsenlar
gement .Pati
enthadpr i
orr adi
ationther
apyaroundneckr egionfor
unspeci
fi
eddisease.Biopsyexaminationshowedcel lul
arprol
if
erationofmalignant
fol
li
cul
arcell
swithnucleargroove,nuclearcleari
ngandintr
anucl eari
nclusi
on.Whatis
themostli
kelydiagnosi
sofabov ecase?

a.Medul
l
arycar
cinoma

b.Papi
l
lar
ycar
cinoma

c. Anapl
ast
iccar
cinoma

d.Fol
l
icul
arcar
cinoma

Thecor
rectansweri
s:Papi
l
lar
ycar
cinoma

40.A30y ear-
oldparaIIfemalepati
ent,whogav ebirt
honey earback,pr
esentedwithfr
ontal
headacheofoney ear,pr
ogressiv
elydecreasedv i
sioninbothey esof6mont hs.She
saysthatshewasbumpi ngwi thshoulderofotherpeoplebecauseshecannotseeon
si
des.Onexami nati
onherv i
sionis6/9.Theonl yperti
nentfindi
ngispall
orofthediscon
nasalsi
de.Whatist hemostappr opr
iateini
ti
altestforthiscase?

a.Col
orv
isi
ont
est

b.Vi
sual
fiel
dtest

c. MRIoft
hebr
ain

d.CTscanoft
hecr
ani
um
Thecor
rectansweri
s:Vi
sual
fiel
dtest

41.A30-year
-ol
dpregnantpat
ientwhoisdi
agnosedt
ohavepr
ecl
ampsiapresent
satt
erm
wit
hblurr
edvisi
onandBPof150/ 100mmHg.Whatist
hebestnextst
epofmanagement
ofthi
spati
ent?

a.I
Vhy
dral
azi
neandwat
chf
orpr
ogr
ess

b.St
abi
l
izeherwi
thmagnesi
um sul
fat
eanddel
i
ver

c. Gi
vest
eroi
dsanddel
i
veri
n48hour
s

d.Pl
anf
oranel
ect
ivedel
i
ver
yat39weeks

Thecor
rectansweri
s:St
abi
l
izeherwi
thmagnesi
um sul
fat
eanddel
i
ver

42.A31y ear
-oldmalepatientpresent
swithamultipl
ehy po-pigment
edpatchesov erhis
butt
ocksarea,hecompl ai
nsofnumbnessov erhisfingersandtoes.Onphysical
examinat
ion,heappearstohav edecr
easedsensationoft ouchoverar
easoft helesi
on
andhehasenl ar
gedrightulnarner
ve.Whati
nv est
igativ
emodal it
ywill
helpyout oreach
i
ndiagnosis?

a.AFBst
ainofski
nsmear

b.Gi
emsast
ainofski
nsmear

c. Ner
veconduct
ionst
udy

d.Di
rectI
mmunef
luor
escenceoft
hel
esi
onal
biopsy

Thecor
rectansweri
s:AFBst
ainofski
nsmear

43.A32y earoldgravi
datwo,paraoneat35weeksi saknownhy per
tensiv
epat i
enton
Methyldopa,HerANCfoll
ow-upwasunr emar kabl
euntiltwoweeksbackwher eitshows
alaginfetalgr
owth.Shehasnoheadache, bodyswel l
i
ngorepi gastr
icpain.Upon
examinati
on,BPis140/90mmHg, fundalheightis34cm, andthebiophy si
calpr
ofil
e
(BPP)scorewas4.Whati sthenextbestmanagementf orthi
spatient
?

a.Fol
l
owupt
il
lter
m

b.BPPshoul
dber
epeat
edandascor
ebel
ow6mandat
est
ermi
nat
ion

c. Leci
thi
n-sphi
ngomy
eli
nrat
ioshoul
dbedet
ermi
ned

d.I
mmedi
atet
ermi
nat
ioni
swar
rant
ed

Thecor
rectansweri
s:BPPshoul
dber
epeat
edandascor
ebel
ow6mandat
est
ermi
nat
ion

44.A32y earoldpar a-
twowomancamet ot heOPDwi t
hbloodydischargefr
om t hewound
si
tefi
veday saf t
erelecti
veCSwasdone.HerPost operat
ivecourseinthehospi t
al was
unr
emar kable.Onexami nati
on, hertemper atur
ewas370C.anduponr emov al ofthe
sur
gicalsti
tch,ther
ewaswoundsi tehemat omawhi chwasdrained.Therectusf ascia
wasnotedt obei nt
actandnoski ner y
themaorpuswasseen.Thewoundwascl eaned
andappropriatel
ydressedt wiceperday .Af t
erthr
eeday sther
ewasgr anulati
ont issue
wit
houtev i
denceofi nfect
ion.Thenextbestst epinthecareofthispati
entis?
 a.Secondar
ywoundCl
osur
e

b.I
odi
nepackdr
essi
ng

c. Cont
inuet
hesamer
egi
men

d.Cl
oxaci
l
li
nfor10day
s

Thecor
rectansweri
s:Secondar
ywoundCl
osur
e

45.A32y earsoldpri
mi gravi
daat41weeksofgest ati
onpresent edtothedeli
v er
yunitafter
apushi ngdownpainof7hr s.HerANCf oll
ow-upwasunremar kabl
e.Atpresentat
ion,
shewasi nthe2ndst ageoflabor,
andwast akentodel
iverycouch.Theheadwas
del
iveredbuttheshouldersfai
ledtorot
ate.Theat
tendi
ngmi dwifeclai
msshehast ri
ed
tofl
ext hekneestowardthemot her’
sabdomenwi t
hsupr apubicpressure,butwasnot
successful
.Whatisthenextmaneuv ertobedone?

a.Woodscr
ewmaneuv
er

b.McRober
tsmaneuv
er

c. Zav
anel
l
imaneuv
er

d.Rubi
nmaneuv
er

Thecor
rectansweri
s:Rubi
nmaneuv
er

46.A32-year
-ol
d,gr
avi
daIII
,38weekspregnantpr
esentedtotheantenatalcl
i
nic,abdomi
nal
exami
nationandul
tr
asonogr
aphyreveal
edcompl et
ebreechpresentati
onwithno
appar
entanomali
es,t
heesti
matedfetalwei
ghtis3250gm, appr
opriatemanagementis?

a.Fol
l
owup,
wai
ti
ngf
oronsetofl
abor

b.I
nduct
ionofl
abor
.

c. El
ect
ivecesar
eansect
ion.

d.Fol
l
owwi
thweekl
ySonogr
aphy

Thecor
rectansweri
s:Fol
l
owup,
wai
ti
ngf
oronsetofl
abor

47.A33y ear
-ol
dmani sbr
oughtinbyhisfami l
yafterr
efusi
ngt odri
nkflui
dsfor24hours.
Hiswifer
eportsatwoweekshi st
oryofincreasedenergy,eati
ngli
tt
le,t
alki
ngagreat
deal
,andint
errupti
ngothersf
requent
ly,decreaseneedforthesleepandsingi
ngloudly
duri
ngthenight.Whati
st hemostli
kel
ydi agnosisf
ortheabov ecasescenari
o?

a.Hy
pomani
a

b.Mani
a

c. Er
otomani
a

d.Kel
ept
omani
a

Thecor
rectansweri
s:Mani
a
 48.A35y earoldcomplainsofconst
antdeeppelvi
cpai
nthatincreasedoverthepastfew
years.Itgetsworsedur i
ngmenses,coi
tusandbowelmov ement.Examinati
onreveal
s
bil
ateraltender
nessov erthel
owerabdomen.OnU/S,thereisa6cm leftadnexalmass,
fi
xedut erusanduterosacrall
i
gament.Whatist
hemostl i
kel
ycause?

a.Endomet
ri
oma

b.Fi
broma

c. Thecal
uti
ency
st

d.Ter
atoma

Thecor
rectansweri
s:Endomet
ri
oma

49.A35y earol
dgravida-
IV,para-II
IataGAof38weeks, presentswithpushingdownpain
off
ivehours.Shehasf ourstrongcontr
act
ionsandfetalweightesti
mationis2000gm.
Cer
vixis6cm dil
atedwi t
hf acepresent
ati
on,mentum posteri
or.Whatisthenextopt
ion
ofmanagement ?

a.Rot
atet
oment
um ant
eri
or

b.Re-
eval
uat
eaf
ter2hour
s

c. Augment
ati
on

d.Cesar
eandel
i
ver
y

Thecor
rectansweri
s:Re-
eval
uat
eaf
ter2hour
s

50.A35y ear
-oldfemalepat i
entpresentedwi t
hteari
ng,phot
ophobiaandforeignbody
sensat
ionof2y earsdurati
on.Shewasr emovingheruppereyeli
dlashrepeat
edly
,but
thesymptomsper si
sted.Onexami nati
ont heeyel
ashesweret ur
nedinwardandrubbi
ng
onthecornea.Whatmeasur eisbestf orthepati
ent’
scondit
ion?

a.Tar
sot
omy

b.Caut
eri
zi
ngt
her
out
esofey
elashes

c. Tr
eat
ingwi
thant
ibi
oti
cs

d.Epi
l
ati
on

Thecor
rectansweri
s:Tar
sot
omy

51.A35y ear -
oldknownasthmat
icfemal epati
entpresent
edtoOPDwi thcl
oudi
ngofv i
sion
i
nbot hey eswhichstar
ted2yearsbackandpr ogressi
vel
ywor senedovert
ime.Shehas
al
sodi ff
icult
yofseei
ngwhenbr i
ghtlighti
spresentoff-
centerofhervi
sualf
iel
d(has
gl
are).Noot herocul
arcompl
aint.Shehasbeenusi ngprednisol
oneonmul t
ipl
e
occasions.Whatisthemostl
ikelydiagnosi
s?

a.Ker
ati
ti
s

b.Opt
icneur
opat
hy
 c. Cat
aract

d.Gl
aucoma

Thecor
rectansweri
s:Cat
aract

52.A35y ear
-ol
dmal eknownHIV/AIDSpat i
entpr esentedtoy ouwithprogr essiv
elossof
vi
sionofl
efteyeinthel
astonemont h.Hehasnoot herocularcompl aint.On
examinat
ionnoremarkabl
eabnormalityont heant eri
orpartoftheey e.Onf undus,t
here
wasareaofhemor r
hagemixedwi t
hwhi t
ishlesioni nvol
vingthemacul a.Hi sCD4+T-cel
l
countwas45cells/
ml.Whatisthemostl ikelycauseofl ossofv i
sionint hi
spatient
?

a.Cy
tomegal
ovi
rusr
eti
nit
is

b.Her
pessi
mpl
exr
eti
nit
is

c. HI
Vret
inopat
hy

d.Toxopl
asmosi
sret
ini
ti
s

Thecor
rectansweri
s:Cy
tomegal
ovi
rusr
eti
nit
is

53.A35- year-oldwomani ni
ti
all
ypr esentedfortreatmentatthemedi calemergencyroom.
Sher eportedthatwhilesitti
ngatherdeskatwor k,shehadsuddenl yexperi
enced
dif
ficult
ybr eat
hing,dizzi
ness, t
achy cardi
a,shakiness,andafeeli
ngoft er
rorthatshe
wasgoi ngt odieofahear tat
tack.Af ullmedical ev
aluati
onrevealednosignof
cardiovascular,
pulmonar y,orot heril
l
ness.Shehadexper i
encedtwoaddi t
ionalepi
sodes
overt helastmont h.Whati sthemostl i
kel
ydi agnosis?

a.Pani
cat
tack

b.Gener
ali
zedanxi
etydi
sor
der

c. Soci
alAnxi
etydi
sor
der

d.Pani
cdi
sor
der

Thecor
rectansweri
s:Pani
cdi
sor
der

54.A37y ear-ol
df emaleHIVpat i
entwithaCD4countof95cel
l/mm3pr esentswitha
persi
stentpainfulul
cerinvol
vingthegenit
alar
eaandthei
nter-
glut
ealclef
toftwoyear
s
durat
ion.Sher ecall
sthattheini
ti
all
esionswerev
esicl
eswhicheasil
yruptur
ed.Whati
s
themostl i
kel
ydi agnosis?

a.Pr
essur
eul
cer

b.Her
pessi
mpl
ex

c. Her
peszost
er

d.Apht
housul
cer

Thecor
rectansweri
s:Her
pessi
mpl
ex

55.A39-
year
-ol
dwomani
sdi
agnosedashav
ingpr
obabl
eut
eri
nef
ibr
oidsbasedonapel
vi
c
 examinationr
evealinganenlargedi
rr
egularut
erus.Sheiscur
rent
lyasy
mpt omati
cand
expressedsurpr
iset hatshehad“gr
owths”oftheuter
us.Whatwouldbethenextmost
anti
cipatedmanifestati
on?

a.I
nfer
ti
li
ty

b.Menor
rhagi
a

c. Pel
vi
cpai
n

d.Ur
eter
alobst
ruct
ion

Thecor
rectansweri
s:Menor
rhagi
a

56.A4-month-oldfemal einfantbroughtbyherpar entstoPEOPDwi t

hacompl i
antof
excessi
vesleepiness,poorbr eastfeedingandcoldextremiti
es.Onexaminat
ionshehas
widel
yopenedant er
iorfontanel,noisyrespi
rati
onandpr otr
udedtongue.Which
l
aborator
yinvestigati
oni smostappr opri
ateinthi
sinfant?

a.Ser
um TSHl
evel

b.Ser
um T3l
evel

c. Ser
um t
otal
T4l
evel

d.Ser
um t
hyr
ogl
obul
i
nlev
el

Thecor
rectansweri
s:Ser
um t
otal
T4l
evel

57.A40y earoldmanwasbr oughttotheemergencyroom byhissonf or“conf

usion.”The
sondescr i
bedt hathealwaysstaysathome.Het hinkst
hatthegov er
nmentof fi
cial
s
wantt opersecutehim andclai
mst hathehasevidenceforthat.Heprohibi
tedthefamil
y
member snottowat chtel
evisi
onorlist
enradi
obecausehet hi
nksthattheoffi
cial
swil
l
receiv
ei nf
ormat i
onabouthim.Whatwoul dbethemostl ikel
yfindi
ngont hement al
statusexami nati
onofthispati
ent?

a.El
evat
edaf
fect

b.Fl
uct
uat
ingconsci
ousness

c. Del
usi
ons

d.Conf
abul
ati
on

Thecor
rectansweri
s:Del
usi
ons

58.A41y earol
dwomanr et
urnsforfol
lowuponemonthaf t
ertreat
mentofaurinarytr
act
i
nfect
ion.Repeatur
inedipsti
cktestrev
eal
s2+blood,withnegati
veprot
ein,
leukocyt
e
est
eraseandnitr
it
e.Thenextstepintheev
aluat
ionofthi
swomani s?

a.Ret
esti
n3mont
h

b.Cy
stoscopy

c. Renal
Ult
rasound
 d.I
ntr
avenouspy
elogr
am

Thecor
rectansweri
s:Cy
stoscopy

59.A41y ear-
oldmalet eacherst ar
tedtohav epr obl
em inreadingf i
neprint
satusual
r
eadingdistancesincet helastoney earwhichwor senedov ert
ime.Theproblem
worsensespecial
lyindi mlightanditimpr oveswhenhei ncreasesthereadi
ngdi stance.
Hedidnothav eanyv isualproblem orotherocularproblem pr i
ortothat
.Hisdistance
vi
sionis6/6inbothey eandt henearv i
sionis6/12.Noot herfi
ndings.Whati
st hemost
l
ikel
ydiagnosisofhiscondi ti
ons?

a.Pr
esby
opi
a

b.Hy
per
opi
a

c. My
opi
a

d.Ast
igmat
ism

Thecor
rectansweri
s:Pr
esby
opi
a

60.A42-year-
oldman, whohasbeendi agnosedwi t
hmajordepressi
onhadt woprior
epi
sodeswhi chwer esuccessf
ull
ytreatedwi t
hAmi t
ri
pty
li
ne( TCA)butthepati
ent
deci
dedtodi scont
inuebecauseofthei ntol
erablesi
deeff
ect.Whatalter
nati
ve
medicati
onsdoy oupr escr
ibewhent r
icycli
cs(TCA)arenotanoption?

a.At
ypi
cal
Ant
ipsy
chot
ics

b.Benzodi
azepi
nes

c. Sel
ect
iveser
otoni
nreupt
akei
nhi
bit
ors

d.Moodst
abi
l
izer
s

Thecor
rectansweri
s:Sel
ect
iveser
otoni
nreupt
akei
nhi
bit
ors

61.A43y earold,paraVImot herwit

hdy sf
unct
ionaluteri
nebleedi
ng,comesf orcounsel
li
ng
regardinghy st
erect
omy .Previ
ouslyendometri
alablat
ionhasbeent r
iedandwasnot
effecti
v e.Sheismorbidl
yobesewi thBMI42,onpel vi
cevaluat
iontheuter
usi smobil
e.
OnUl trasonographythereisnoadnexalmass.Whati sthebestrouteofsurgeryfort
his
patient?

a.Robot
ic

b.Lapar
oscopi
c

c. Vagi
nal

d.Abdomi
nal

Thecor
rectansweri
s:Vagi
nal

62.A45-year
-ol
dmanhashi storyofheav
ydr i
nkingwhi chaf
fectedhisl
ifeinmanyaspects.
Hereport
sblackouts,
aninabil
i
tytoquitdr
inking,andtol
eranceforalcohol
.Hehastri
ed
t
oquitonseveraloccasi
onsbuthasbeenunabl etodoso.Whati sthemostli
kel
yini
ti
al
 medi
cal
compl
i
cat
iont
hatcanbepr
event
ed?

a.Chr
oni
cli
verdi
sease

b.Wi
thdr
awal
sei
zur
e

c. Hepat
icencephal
opat
hy

d.Wer
nicke’
sencephal
opat
hy

Thecor
rectansweri
s:Wi
thdr
awal
sei
zur
e

63.A46y ear
-ol
dmalepatientwit
hknownhistor
yofi schemicheartdiseasefr
om massi
ve
myocardi
ali
nfar
cti
onhasmur alt
hrombus.Her ecentl
ydevelopedacut el
iv
eri
njur
y.
Wedgebiopsyfr
om li
vershowedbranchofhepaticarter
yembol iwithnecr
osi
s.Whatis
t
hemostl i
kel
yprimar
yr egi
ontoundergonecrosi
s?

a.Hepat
icv
ein

b.Cent
ral
vei
n

c. Por
tal
vei
n

d.Hepat
icar
ter
y

Thecor
rectansweri
s:Cent
ral
vei
n

64.A50y earol
dwhosel astmenseswast woy ear
sago, presentedwit
habriskbri
ghtred
bl
eedingwhichwasrecurrentinthepastt
woweeks, itwaspai nl
essandnoclotwas
passed.Onexaminati
onshei shypert
ensi
veandmi l
dlyobese.Thev ul
vaandthev agina
arethi
nnedanddry.Thephy si
cianadvi
sedherforhysterectomy.Whati
st hemostlikel
y
endometri
albi
opsyreport
?

a.Si
mpl
ehy
per
plasi
awi
that
ypi
a

b.Compl
exhy
per
plasi
awi
that
ypi
a

c. Compl
exhy
per
plasi
awi
thoutat
ypi
a

d.Si
mpl
ehy
per
plasi
awi
thoutat
ypi
a

Thecor
rectansweri
s:Compl
exhy
per
plasi
awi
that
ypi
a

65.A50yearol
dwomanf al
ldownwithov erst
retchedhandanddevelopeddeformityatt
he
l
eftwr
ist
.Youhaveorderedwri
stx-r
ayandf oundoneoft heboneswasf r
actured.What
i
smostli
kelybonet
obef r
act
uredi
nt hiscase?

a.Lunet

b.Radi
us

c. Ul
na

d.Scaphoi
d

Thecor
rectansweri
s:Radi
us
 66.A50y ear-
oldmalepati
entpresentedwithepigastr
icburnof6mont hswhichis
exacer
bateduponspicydiet
.Hei sdiagnosedtohav egastr
oesophagealrefl
uxdi
sease.
Endoscopyrev
ealednomassbutbi opsywast akenforrout
ineexaminat
ion.Whati
sthe
mostlikel
ycel
lul
archangethatyouwi l
lsee?

a.Hy
per
plasi
a

b.Met
apl
asi
a

c. At
rophy

d.Apopt
osi
s

Thecor
rectansweri
s:Met
apl
asi
a

67.A6y earol
dmalechil
dhasbrownur i
neandheali
ngimpet
igolesi
ons.Hepresent
swith
hypert
ensi
on,
dyspnea,per
ior
bit
aledema,andhepat
omegaly.Whatisthemostli
kel
y
causeofhi
sprobl
em?

a.Py
elonephr
it
is

b.Post
-st
rept
ococcal
glomer
ulonephr
it
is

c. I
gAnephr
opat
hy

d.Nephr
oti
csy
ndr
ome

Thecor
rectansweri
s:Post
-st
rept
ococcal
glomer
ulonephr
it
is

68.A60y ear
-oldmalepati
entpr
esentedtothemedicalOPDwithoccasi
onalpainov
erhis
kneeandfingerj
oint
sandwasgi venorali
bupr
ofen.Thenextdayhepresent
edwithpai
n
andswell
ingofhisfaceandl
ips.Howdoy oumanagethi
scase?

a.Addor
alant
ihi
stami
nes

b.Cont
inuei
bupr
ofen

c. Subst
it
utei
bupr
ofenwi
thpar
acet
amol

d.Di
scont
inuei
bupr
ofen

Thecor
rectansweri
s:Subst
it
utei
bupr
ofenwi
thpar
acet
amol

69.A64y earoldmanwhounder wenthi psurger

ythreeday sagostartedtohav evisual
hall
ucinati
ons,paranoia,
disori
entationandstupors.Onexami nati
oninthef ol
lowing
mor ni
ng, t
hepatientisori
entedtoper sonandplacebutnott otime.Otherwise,the
result
sofhi sment al
statusexami nati
onarenormal .Hehasnopr iorhi
storyof
substanceuseorpsy chi
atr
icil
lness.Whatisthemostl ikel
ydiagnosis?

a.Psy
chosi
s

b.Dement
ia

c. Del
i
rium
 d.Del
i
rium t
remens

Thecor
rectansweri
s:Del
i
rium

70.A65y ear-
oldhypert
ensi
v epati
entpresentedwi thpainl
essdecreasedv i
sioninri
ghteye
of5day sdurat
ion.Nootherocularcomplaint.Onexami nat
ion,thevisi
onwas6/ 60right
eyeand6/ 6lef
teye.Theperti
nentfindi
ngwasdi ffusehemorrhagewi t
hcot t
onwool
spotinall
quadrantandswollendisconr i
ghtf undus.Nocopper /si
l
verwiringinbot
h
eyes.Whatisthemostlikel
ydiagnosisinthispat i
ent?

a.Cent
ral
ret
inal
art
eryoccl
usi
on

b.Hy
per
tensi
ver
eti
nopat
hy

c. Br
anchr
eti
nal
vei
noccl
usi
on

d.Cent
ral
ret
inal
vei
noccl
usi
on

Thecor
rectansweri
s:Cent
ral
ret
inal
vei
noccl
usi
on

71.A65y ear-ol
dmalefarmerwhousual lyspendshi sti
mewor kingout doorsonhi sf arm
presentswithahyper-
pigment edpapuleov erhisnoseoft hreey earduration.Thei ni
tial
l
esionwassmal lbutitprogr essi vel
yincr
easedt oattaini t
scur rentsize.Thel esi
on
occasionall
ybl
eedsbuti tisasy mptomat ic.Onphysical exami nati
on, hehasasi ngle
ul
ceratednodulewithat ransl ucentroll
edbor derandtelangi ectasia.Hehasno
si
gnifi
cantlymphadenopat hy .Biopsyshowedaggr egationsofbasal oidker at
inocy t
es
withi
nav ari
abl
yfibr
omy xoi dst r
omaandasl i
t-
li
keretr
act ionofst romaf rom tumor
i
slands.Whatisthediagnosi soft hepatient?

a.Mel
anoma

b.Squamouscel
lcar
cinoma

c. Act
ini
cker
atosi
s

d.Basal
cel
lcar
cinoma

Thecor
rectansweri
s:Basal
cel
lcar
cinoma

72.A7mont holdmalei nfantpr

esentswithshortnessofbreathandwheezi ng.Hehada2
dayshistoryofcoughandcor yzaandlowgr adef ev
erbeforehisbreat
hingbecomes
worse.Hei snownotmanagi ngtobreastfeed.Onexami nati
onhehassi gnsof
respi
ratorydi
str
ess.Ther earecr
acklesanddi ff
usewheezingt hr
oughoutthechest
.
Whati sthemostlikelyinf
ecti
ngorganism?

a.Respi
rat
orysy
ncy
tial
vir
us

b.St
rept
ococcuspneumoni
a

c. Adenov
irus

d.Par
ainf
luenzav
irus

Thecor
rectansweri
s:Respi
rat
orysy
ncy
tial
vir
us
 73.A7- year-ol
dgir
landhermot hercomet oy ourcli
nicbecausethemot herrecei
veda
noticef r
om herdaughter’sschool t
hattwochi l
dreninherclasswer ebeingt r
eatedfor
“Streptococcalt
hroatinfecti
on.”Thegirli
scur r
entl
yasy mptomat i
cbuthashi storyof2
episodesofphar yngi
tisinthepasty earforwhichwast reat
edwi thazithr
omy cin.She
andot herhouseholdcont actsdonothav ehistoryofrheumaticfever.Herexami nati
on
resultsarenormal.Whi chofthef ol
lowingisthemostappr opri
atenextst epin
managementt hisgir
l?

a.Thr
oatswabf
orgr
oupASt
rept
ococcusRapi
dAnt
igenDet
ect
ionTest

b.Obser
vat
iononl
y

c. Amoxi
cil
l
inf
or10day
s

d.Ant
ist
rept
oly
sinOant
ibodyt
it
er

Thecor
rectansweri
s:Ant
ist
rept
oly
sinOant
ibodyt
it
er

74.A72houroldnewbor npresentst
opedi
atr
icemergencyOPDwi t
hthecomplai
ntof
di
ff
icul
tyofbreat
hing.NumbersixFol
eycathet
erwasunabl
et opassvi
abothnostr
iland
par
anasalsi
nus.CTshowsat r
esi
aofbot
hchoanae.Whatisthenextappr
opri
atest
epi n
hi
s/hermanagement ?

a.Emer
gencyr
epai
roft
hechoanae.

b.Or
alai
rwaypl
acementf
oll
owedbyr
epai
roft
hechoanae.

c. Emer
gencyt
racheost
omyf
oll
owedbyr
epai
roft
hechoanae.

d.Appoi
ntt
hepat
ientt
ocomeatt
heageoff
ivey
ear
sfort
her
epai
r.

Thecor
rectansweri
s:Or
alai
rwaypl
acementf
oll
owedbyr
epai
roft
hechoanae.

75.Adiskbatt
eryi
sseenasafor
eignbodyi
nthenoseofa2y
earoldchi
ldotherwisethe
chil
disi
nstabl
econdi
ti
on.Whi
chofthefol
l
owingist
hemosti
mportantconsider
ationi
n
themanagement?

a.El
ect
iveschedul
eforENTev
aluat
ion

b.I
mmedi
ater
emov
ali
sindi
cat
ed

c. Nasal
dropst
ofaci
l
itat
eexpul
sion.

d.Expect
antmanagementasspont
aneousexpul
sioni
sexpect
ed

Thecor
rectansweri
s:I
mmedi
ater
emov
ali
sindi
cat
ed

76.Afiveyearol
dfemalechi
ldhasdevel
opedred,
roughenedski
ninsun-
exposedar
eas
overthepast2year
s.Shealsohasachroni
cwaterydi
arr
hea.Whi
chvit
amindefi
ciency
i
smostconsi st
entwit
hthesefi
ndi
ngs?

a.Thi
ami
ne

b.Ni
aci
n
 c. Py
ridoxi
ne

d.Vi
tami
nA

Thecor
rectansweri
s:Ni
aci
n

77.Agener
alpr
acti
ti
onerwasassignedt
odosur
veyontr
achomainhisdist
ri
ct.Thet
eam
f
oundthepr
eval
enceoft r
achomaamongchi
l
drenofonetoni
neyearstobe25%.What
measur
eshoul
dbet aken?

a.Gi
vet
reat
mentt
othei
ndi
vi
dual
cases

b.Gi
vet
reat
mentt
ofami
l
ywi
tht
hecases

c. Gi
vemasst
reat
mentt
ocommuni
ti
eswher
ethecasesar
epr
eval
ent

d.Gi
vemasst
reat
mentt
othewhol
edi
str
ict

Thecor
rectansweri
s:Gi
vemasst
reat
mentt
othewhol
edi
str
ict

78.Alargeadnexalmasswasremovedfrom a30yearol
dpatient
.Shehasbeen
complaini
ngofoccasi
onalvomi
ti
ngforthepast4months.Shehasnovaginalbl
eedi
ng.
Hist
ologicexami
nati
onrev
ealsSi
gnetri
ngcell
s.I
nwhattumorar et
hesecell
sseen?

a.Der
moi
dcy
st

b.Kr
ukenber
g

c. Endomet
roi
d

d.Br
eener

Thecor
rectansweri
s:Kr
ukenber
g

79.Amot herhasbroughtherei
ghtyearsolddaught
erbecauseofthedevelopmentof
breastsovert
hepastyear.Nowshei srequi
ri
ngbrasandbeingteasedbyherfr
iends.On
examinati
on,shehastannerSt
age-Ipubichai
rdevel
opment.Whatisthemostlikel
y
diagnosi
s?

a.Pr
emat
ureTel
arche

b.Pr
ecoci
ouspuber
ty

c. Gr
owt
hspur
t

d.Adr
enar
ch

Thecor
rectansweri
s:Pr
emat
ureTel
arche

80.Apregnantwomancomest otheANCclai
mingt hatshehascrav
ingforice,
star
chor
cl
ay.Herhusbandexpl
ainst
hatsheisemoti
onallyl
abil
efort
helastfewweeks.Shei
s
cur
rent
lyat32weeks.Whatlabor
ator
yparameterisli
kel
ytobeaffected?

a.El
ect
rol
yte

b.Ser
um TSH
 c. CBC

d.Or
ganFunct
ionTest

Thecor
rectansweri
s:CBC

81.Asixmont holdchil
dwhowasongoat smi lksi
ncetheageof3mont hspresentedwi t
h
i
rri
tabi
li
ty,
invol
untarymovementsandl ossofappeti
teoftwoweeksduration.Physical
Exam showedpal econj
unct
ivae.Per
ipheralmorphologyshowedlar
geneutrophil
size
andhishemogl obi
nis5gm/ dL.Whatist hebestt
reatmentfort
hepati
ent
?

a.Fol
i
caci
d

b.Vi
tami
nB12

c. I
ron

d.Vi
tami
nB6

Thecor
rectansweri
s:Fol
i
caci
d

82.Asi xyear
-oldgirlhasbeenr ef
erredtoagener al
Hospit
al byherteacherbecauseshe
display
sinattenti
on, r
est
lessness,di
stract
ibi
li
ty,
andpoorconcent rat
ion,whichr
esul
tsin
pooracademi cper for
mance.Herpar entsdescri
beasimilardif
fi
cultyathome.Shedoes
nothav eanysy mptomsofdepr essi
on,psychosi
s,ordevelopmentalproblems.Whati
s
thebesttreatment ?

a.Psy
chost
imul
ant

b.Ant
iepi
l
ept
ics

c. Ant
ipsy
chot
ics

d.Ant
i-
depr
essant

Thecor
rectansweri
s:Psy
chost
imul
ant

83.Atwomont holdinf
anthasahist
oryofpat
entductusart
eri
osusli
gati
onatonemonthof
age.Thei
nfanthasweakcryandbreat
hyvoice.Hehaschokingandgaggi
ngwit
hfeeds
andhasbeenont hi
ckenedf
ormula.Whati
st hemostli
kel
ydiagnosi
s?

a.Uni
l
ater
alv
ocal
cor
dpal
sy

b.Subgl
ott
icst
enosi
s

c. Lar
yngomal
aci
a

d.Muscl
etensi
ondy
sphoni
a

Thecor
rectansweri
s:Uni
l
ater
alv
ocal
cor
dpal
sy

84.Atwoyearol
dchi
ldpresent
swithnasalobst
ructi
onsincebi
rth.Onphysi
calexaminat
ion
t
herei
scysti
cnontendermassintheuppernasalbr
idgewhichexpandswit
hcr y
ing.
Whati
sthemostli
kelydi
agnosi
s?
 a.Gl
i
oma

b.Aneur
ysm

c. Encephal
ocel
e

d.Der
moi
dcy
st

Thecor
rectansweri
s:Encephal
ocel
e

85.Awomanhasjustdel
iv
eredherfi
rstchi
l
daf teranuncompli
cat
edpr egnancy.Shetol
d
t
hephy
sici
anthatshewantstouseacontracepti
vebutwantstoexclusiv
elybreastf
eed.
Whi
chcont
racept
ivemethodshouldbeavoidedduri
ngbreastf
eeding?

a.I
UCD

b.COC

c. DepoPr
over
a

d.POP

Thecor
rectansweri
s:COC

86.An18y earoldgravi
da-
I,ateightweeksofgest
ati
oncomplainsnauseaandv omit
ing
overthepastweekoccur r
ingonadai l
ybasi
s.Onexaminat
ion,sheisdehydrat
edand
exhausted.Ur
inal
ysi
sshowsket one+3.Whatsever
ecomplicati
onisanti
cipat
edinthi
s
case?

a.Wei
ghtl
oss

b.Hy
pokal
emi
a

c. Hy
pocal
cemi
a

d.Pr
otei
nur
ia

Thecor
rectansweri
s:Hy
pokal
emi
a

87.An18y earoldnul
li
-gr
avidpresent
edwithalowerabdomi nalpainfoll
owinghermenses.
Sheissexuall
yacti
veandusescondom i nt
ermitt
entl
y.Shehasnei thernauseanor
vomiti
ng.Examinat
ionreveal
saT39. 40C,cer
vicalmoti
ont enderness,uni
lat
eral
adnexal
tender
nessandamucopur ul
entcerv
ici
ti
s.Uri
neHCGi snegat i
ve,andWBCcount9, 500
cell
spermm3.Whati sthenextstepinhermanagement ?

a.acy
clov
ir

b.ket
oconazol
e

c. ant
ibi
oti
cs

d.NSAI
D

Thecor
rectansweri
s:ant
ibi
oti
cs

88.An8-
year
-ol
dboyi
sseeni
nregul
arOPDf
orpr
ogr
essi
veweakness.Onexami
nat
ion,
he
 i
sfoundtohav ehipwaddleandenl
argementofbot
hcalves.Heisambul
atory
,buthis
muscl
estrengthisdi
minishedsymmetri
cal
ly
.Whatcli
nicalf
indi
ngismostconsi
stent
wi
ththeproblem t
hechil
d?

a."
Footdr
op"gai
t

b.I
ncr
easeddeept
endonr
efl
ex

c. My
otoni
a

d.Gowersi
gn

Thecor
rectansweri
s:Gowersi
gn

89.Aneightyearol
dchildpr esentedwithfeverandj
ointpainoffi
v edaysdurat
ion.Phy
sical
Examinat
ion:Pul
ser at
e112/ min,Respi
rator
yrat
e24/ min,Temperatur
e380C.The
pati
ental
sohasgr adeIIIsystoli
cmur muratapex.ChestX-rayisnormalandASOi s
posi
tiv
e.Whatwillbetheappr opriatemanagementoft hi
spatient?

a.Aspr
inandBenzat
hinePeni
cil
l
in

b.Pr
ednsol
oneandBenzat
hinePeni
cil
l
in

c. Di
uret
ics,
Aspr
inandBenzat
hinePeni
cil
l
in

d.Di
uret
ics,
Prednsol
one,
Benzat
hinePeni
cil
l
in

Thecor
rectansweri
s:Aspr
inandBenzat
hinePeni
cil
l
in

90.I
nawell-
babycli
nic,t
hechil
dyouareexaminingt
urnsherheadwhenhernamei scall
ed.
Shei
sabletosay“ Mama”.Hermothert
oldyoushecanalsosay“Dada.”Shecoul
dsay
‘
bye-
bye’toyouwhenshel ef
tther
oom.Whati sthel
eastconsi
stentageofthi
schil
d?

a.11mont
hs.

b.15mont
hs

c. 9mont
hs

d.7mont
hs

Thecor
rectansweri
s:11mont
hs.

91.Motherwhobroughtherchi
l
df orEPIwant
edtoknowthedi
ff
erencebetweenwhol
ecel
l
per
tussi
svacci
nesandacell
ularpert
ussi
svacci
ne.Howyoubestdescr
ibeacel
l
ual
r
per
tussi
svacci
netothemot her?

a.I
trequi
resf
ewerdoses

b.I
tisassoci
atedwi
thf
ewersi
deef
fect
s

c. I
tismor
eimmunogeni
c

d.I
tisl
essexpensi
ve

Thecor
rectansweri
s:I
tisassoci
atedwi
thf
ewersi
deef
fect
s
 92.Onexaminati
ony oufoundt hatthethyr
oidgl
andofa14y earoldgi
rli
sfi
rm,non-t
ender
,
mobil
eandsy mmet r
icall
yenlarged.Thethyr
oxinel
eveli
s5.2mcg/dL(normal,
5.6to
11.
7mcg/ dL)andthet hyr
oid-st
imulati
nghormonelevel
is17.5mIU/mL(normal,
0.2to
7.
6mI U/
mL) Ofthefoll
owingt heli
kelycondi
ti
onis?

a.Hashi
mot
o’st
hyr
oidi
ti
s

b.Gr
avesDi
sease

c. Si
mpl
ecol
l
oidgoi
ter

d.Acut
esuppur
ati
vet
hyr
oidi
ti
s

Thecor
rectansweri
s:Hashi
mot
o’st
hyr
oidi
ti
s

93.Asixyear
soldfemalechildwhoi srecent l
ydi
agnosedtohaveacutely
mphobl ast
ic
l
eukemia(ALL)af
terinvest
igati
onrev ealedWBC-3000cell
/ml,
bonemar rowshowed
l
ymphoblast
iccel
lswithL3mor phology .Themotherasksabouttheprognosi
sofher
chi
l
d.Whichoneoft hefoll
owingindicatesunfav
orabl
eprognosis?

a.Ageof6y
ear
s

b.L3mor
phol
ogy

c. Bei
ngf
emal
e

d.Leucopeni
a

Thecor
rectansweri
s:L3mor
phol
ogy

94.Thedoctorwhil
eatt
endi nglaboringmotheraft
erunevent
fulsecondst
age,not
iced
massivevagi
nalbl
eedingf ol
lowingdeli
veryofthebaby.Whatwouldbethemostlikel
y
appropr
iat
efi
rstact
iont obet akentosafeli
feofthewomanwhi lehewastheonly
personi
nwardatmi dnight?

a.Remov
epl
acent
amanual
l
y,compr
esst
heut
erus

b.Ut
erot
oni
cdr
ug

c. Compr
esst
heabdomi
nal
aor
taandaskf
orhel
p

d.Opendoubl
eIVl
i
ne.

Thecor
rectansweri
s:Compr
esst
heabdomi
nal
aor
taandaskf
orhel
p

95.A23-month-
oldf
emal
eishospi
tal
i
zedforedematoussever
eacut
emal
nut
ri
ti
on.Whati
s
mostli
kel
ycondi
ti
onf
oll
owingi
nappr
opri
atel
yrapidt
reat
ment?

a.Hy
per
phosphat
emai
a

b.Hy
per
kal
emi
a

c. Hy
per
nat
remi
a

d.Hy
pophosphat
emi
a
Thecor
rectansweri
s:Hy
pophosphat
emi
a

96.Whileassessi
ngt heageofachil
d,heisdevel
opment
all
ynor
mal,isabl
etosi
twit
hout
support,
cantransferobj
ect
sfrom onehandtotheot
her
,andspeaksinamonosyl
l
abi
c
babble.Whati
st heprobabl
eageoft hi
schi
ld?

a.6mont
h

b.9mont
h

c. 4mont
h

d.12mont
h

Thecor
rectansweri
s:6mont
h

97.Whi l
erevi
ewingyournot
esfory ourmicrobi
ologyf
inalexaminati
on,
youl
earntthat
staphyl
ococcalf
oodpoisoningiscausedbyaheat -
stable,
prefor
medent
erotoxin.What
featur
esareexpectedi
nthisdiseaseprocess?

a.Vomi
ti
ngandabdomi
nal
cramps,
fol
l
owedbydi
arr
hea

b.Concur
rentst
aphy
lococcal
bact
eremi
a

c. Hi
ghf
ever
,andheadache

d.Hemat
ogenousst
aphy
lococcal
pneumoni
a

Thecor
rectansweri
s:Vomi
ti
ngandabdomi
nal
cramps,
fol
l
owedbydi
arr
hea

98.A21y earoldwomanbr oughtbyherfami lymember swi ththecomplai

ntofdiff
icult
yof
f
all
ingasleepofthreedaysdurat
ion.Duringev al
uati
on, sherapi
dlymovesfrom one
t
houghttoanot her,
atapacethatisdiff
icultforthel
istenertokeepupwith,butalloft
he
i
deasarel ogi
call
yconnect
ed.Whatt ypeoft houghtprocessabnor mal
i
tythepatienthas?

a.Ci
rcumst
ant
ial
i
ty

b.Fl
i
ghtofi
deas

c. Tangent
ial
i
ty

d.l
ooseni
ngofassoci
ati
on

Thecor
rectansweri
s:Fl
i
ghtofi
deas

99.Youarecal
ledtoseea33y earoldwomani nl
aborwit
hagestati
onalageof41+2weeks,
asthemidwifeisconcernedabouttheCTG.Shehadar ai
sedBPof150/100mmHgt wo
day
sbackwher ecer v
icalri
peni
ngandinducti
onwasdone.Onexaminati
oncervi
xis4
cm di
lat
ed,stat
ion-2,andmeconium st
ainedli
quor
.Whatpatt
ernofheartr
atetr
aci
ng
mandatesurgentdeli
very?

a.Ear
lydecel
erat
ion

b.Var
iabl
edecel
erat
ion
 c. Lat
edecel
erat
ion

d.pr
olongeddecel
erat
ion

Thecor
rectansweri
s:Lat
edecel
erat
ion

100. Youngsexual
lyact
ivegir
lcamewit
hreddi
shdiscol
orat
ionofheruri
neandsev
ere
l
eftf
lankpainof5hoursdurati
on.HerLMPis4daysago.Whatisthebestmodal
it
yof
i
nvesti
gati
onfortheabovecase?

a.I
ntr
avenouspy
elogr
aphy

b.MRIofabdomen

c. Er
ectpl
anabdomi
nal
x-r
ay

d.Ul
tr
asoundofabdomen

Thecor
rectansweri
s:Ul
tr
asoundofabdomen

Fi
nishr
evi
ew