1) AS7.yearcld woman comesto the plysician because ofa 2.dey stony fever, rsh en her chest ond beck, anddise body achas, She has a eelzire sonar andes been along phenain er 1 month She aga hs ryperensin vested uth hysochlaattvaade. She nas no own araiesShehas smakedlonetat pack of gern fair aU years ers ks ona lasso vane daly Hes laperatute fs 284°C (101 VF} pubes Tin, angled ptesouree 1270 rm Pubs oxmay fooe 151 shows an ygen saturation of 8% Soh mile hmgh nodes ate abated inthe ceria, allay, and inguinal chains, they measure ss then 1 em gach Theres an braamatous macuagapulat rash ovo tha turk The abdomee ws tenderin ther upper adadrar and iver adgo is pated 3 cm belo He itt costa marci, Laberatorsties shove Hematocit 40% Levooote cout {n.g0cimm® “Seaimented neutopils 55% Eosinophis 10% Lymahocites 30% Monon oe Fltelet count 250000? senm Ceci “mat ast a0 Aur yout FepatitsC anibosly negative HEsAg negative He sgt mi HBsAg negative Plood cuties ere gate. ich of he folowing Is the os appropnatsnew-stp inmenagernert? _A) Measuromont of serum oetoprotin conesnratonBlood cultures are negative. Which of the following is the most appropriate nest step in management? A) Measurement of serum o-fetoprotain concentration B) Sorum parvovirus antibody assay C] Discontinuation of phenytoin therepy D] Prednisone therepy E] Switch trom nycrochlorothiazide to lisinopril F] Bone marrow biopsy G] Lymph node biopsy2. A 2oxjeanolelmanis broupttt the emergency department 30 minutes ater the udcen onsetot severe headache Tollwedty bss of consciousness for 10 minus. esterday, ne tipped andl dovm ene gt af sais. He wes dazed fr appronimatel § minutes ater tho fllburwas otherwise uninured He has hed fever, nasal congestion ‘and cous for days reatod with asp and ascudoephiedine. Cne woek agate had a severaheadache bet persisted or I hour andwasrelioved ath asprin On arial, hes shporous Hs tempereureis 378°C [10] use s 10m, respranens are iin, ana bod pressure Is 1800 mm H The ful ae reund anaveactve Totgn. ceuer mosemonts a ul Funduscopic examination stewssne abnormalwes. Terais moderato nuchal Vii vith fred vin, Muscle tones norm Desp tendon refieses are increased but smmetical Babinski Signs prose blatral Tho patient moves his eaombes syrmetealy in response to pan sumul ACT scan the head vthoutconrast is shown Which of he oloningis he most lelycause of is pair’ Ios ct Al Bectenalmeningts )Headtraums CC) Hepes simpexencaphais [D)Rupauea bey aneurysm ) Tuberculous meninotsthe same Selectone answer or each erin te se “The recparse options forthe ned 2 tem For ecch patient with vertigo, select he most they agnosis, A Acoustic schwannoma 6 Benign gosttonalyertee ©) Corobatiar nemantags | Complex partial seizure | Endolmphatic fistla F] Heonentation scree 6G] Merire disease FH) Postealinypotension 1) Yartbrobasilar ransontschomic tack 2. A.5D,yearcld man hashad episodes of suden savorecizaness aver he past yaers. He descibesthase episodes as a sensation of spring. They ete associated wh ‘sveatna, paler, nausea, and occasionalvomting. He has nt noted an otvcus precipitant. The episodes occur as atten as weekly and a5 nequenty es every 3to4 months “They usual last 203 hours, Hehas noiced a decroaseinheanng anda coretanthissing noise nthe ight ear Examntian shows hearing bss inthe right earForoach paiontth verge, seocttho most kel olaonosis |) Acoustic schuannoma £5) Benign posivona erage }Cerebeliarnemorage D}Complex pata sire E)Endeymmphaic fla F] Hyperentlabon seroma G)Meniere sense H)Posuralhuperension 1 Vertebrobasilar tansien scheme atack 4. Over te past 2 years, a 25:ear-old worn has had episodes of spnning sensation The episodes occur abrupt, are associtedwihnsusea ae vortng, and last about ‘ hour Thefist episode occurted when the aplane inwhich she was Veveing ascended to cru altude Subsequent episodes have occarted on elevates, and she hes hacinia isode!nten she syaczes, Po years aga, she Sustaheg aconeuesian eral Eearnalon shave decraasos heering Be gt a5, A Syearcld boy mth corobra pays brougttt to plysician for a school tysical examination. He dd not aku tho age of &years andi ust eatringto use ons to feadhimselt He wears neering aids because of lateral sensorineural nating ss Ho fcaWes prysical o:cupatonal, ana specenerapy His at Te St percentile or height enchwoigt, ne has remained below he Sth percents for head circumference sine bith, Examination shows ht escola. Theres irereased muscle tone inl ‘eavombes, teal ane spastity, and cific hypareenia Ha hasan alane gal Peychorectesbng shows anlQ of 65. CT Scan othe head shoe uncle Iypenttsnstes long th verucue margins. Which oho foloning se rasta undenng cause otis ch'sebnormalnes? A)Chonc ead eposira E)Congentaleyomegalcus rtecton CiFragie X scrome D)Prenghetorunia6, Tiree days after admission tote hospital bacauso ofan & hou tistory of waakness and numbness ofthe nght sds of te face end Hote upper exromios, 82 year-old woman oscemes comalass. On admission, she was vealed vt acpi She has eraser dept Her pulse aby, and Soe pressure 130/100 mh She ot esponsiv to verbal ertactesirul Examination shows an fmm ef pup thats nanreactive anda 3.7m ict pupil tis reechve. He let eyes deviated ound ‘There Is cecasional mevement ofthe let hand and ct end ne movemet fhe rg sce ofthe face ornightexeniiies Deep tendon ewes are 4+ nthe ngR Upper nd loner exteriies abrei sgn spreseron the igh. Har senum Sedum eoresngeton is 131 mEq. heh af Bs olen ste most lay agnosis? A) Cerobel tamatoma EMetabotc encephilorsty C)Micbran hemethage Pome ntrcuon E)UncethernatonA at-yeer.ad woman comes tote prysician because of a 4mortn history of afcuty walking, content heedache, and unary incontinence. Her symptoms have wersenet ver is past arin Trainer vat acetaminoghen and biol hes ot elsvadher headache. Shahas had ld amo, marie sines 2 fatar etic colision 5 {years ago in whch ae ose censciausness. She has nadie generalized fonc.clonc stares aver fe past year. Her ister has mufple sclerosis. Me patente signs are Shinn normal Wis Exarination saws nwralseength in he upper ec oaar eres ares neteasad cle er he lst aeribes Deep tron reeves a rormalin he upper esemites and brskinthe lover extremities, Sehinsksighis present baka. Her gat s broad-based and spastic. Sensation siract. hich of he Tolouing she most key ocaton of ts patent’ lasion? EE) Gended spnal cord (C) Patel erobra eorex O)Pone ) Thoracic spinel cova8. AAT ygarold man comes othe pysicianDecause ofa 3nont history of rtaitet pain o be gt id e is are. The pan boginsin te ogion ofthe ee, radlats tothe ‘hin, and lasts fr 1 to 2 seconds tis precipitated by expostro to coll weather, cinking 8 cold laud, eetng,ardbruchng fs toot. He has penersion and ‘2svoecephageal ten clovate, Madicabons nde hyarechavatazie ard artacks, Vil signe re win notmal nis, Examination chaws oa abnmalbes, Wich ofthe folowing ste mast appropriate pharmacotherapy for peanin is pation? A} Canseicin 1) Carbamazepine )Diebtanae Dy Fluoeetne E}Onyeodone9. A67.yoarcld manic bought tho plysiclanby his wf cause ofa mon tstry of efieuty remembering both recent an! emote events. He abo has ad jorky ‘mocemants of is ars and fos for4 tasks Hehas had bee of blancs and hes falen sacral mash waking, He e nates Examination shohs requeré myoclonic ang of al exremites, increased muscle ore, ad hyperectverefewes abinad sgt f present lateral ACCT sce ofthe head shows ld aroghy Cerebrospinal fg ‘analysis shows no abeoealbes excop fora prom cencentaton of 80 my. EEG Shows a generalized Siow backgyound reruplodby Synchronous sharp Wee complexes, hich ofthe follwing isthe mest kel clagnesis? 1) Croutteltdobob cisnase 2) Demarto, Alzheimer ipe =) Demema wn Lavy bodies 2) Hepatlemtcuar dayoncretion [icon disease) = Mutvnfrct(vascuan dementia10. A62y0ar-ld manis adited a the hospital fo bar laminate. One day postoperatively, He has a low-grade fever sccrdary to a inary tad infschon. He aso has ‘fut seeping aright and ttesiment th orazepem is stated. To dys postoperative he becomes dows and confused. On examination. is iicut to arouse, and his saeech is sured Mls abe to erceor ae sme quesons, tua inks tis thera and hat he yao s 158 cacperates pay wi ermal sanity {psig The remaieer ofthe examneton shows no snarmalies” Which ofthe foloningis the most Heol diagnos s? A) Coroorainfarcion E)Dementa, aeneimerype (C}Metaboie encepnalepaty DiNencenisive status epilepticus ) Subeiral hematoma11, 4 12 year-clé gis broughto the physician bocause cf requert headaches over he past months and vein and nausea for 2 ds. Her chreprecc physician aavsed herparerts to seek acitiona evasion because she as not Fespendoa to manulaien and nassage Merapy The pater takes ne precision medicavon, butte ene tan takes mull supolemensincuding megacoses of mufitains. Her moth had stomach wus Teck ago. The patents bined preseue is 13080 mmg Nelraagie examination shows a abromales. A phetograpn a Me OPAC Findus is shoeh Labaratey studies re Serum Ne 140 mat ke 42 reat. Prolactin ong Line spectiegawty 1090 \Which othe folowing isthe most kel cause ofthis paler’ apc hreinas? Aj Diabetes insipidus 5) Frortaliooewunar )Ptutay mcroadenoma 1) Systemic pus erereosus Eytan A tony12. AT1-year-oK man's brought the emergency depanment 3 haus etre acute onset has aso netioed ngthis memira ‘aly swalcning water He has rparension aaiedeah atence. Hh vores ence he emergency department Fis temperaute is 7°™ (0 6°}, pulse 8 BSN, respirations ao 20in, andbioed pressure is 170/100 mm Ha, Exaination shows lof pcss. The etaupl is 2 mim, andthe ight pupils mm. Bosh pups ere reechve 1 fe ofthe face andthe right sid of ho Nah There ie coarse yetagmus on atoral gaze. Muscle yengh vs normal. Sanea onto lemperatra ie 3 body The most cause ofhesefindings occlusion of which of he flowing teres? A) Lida eorebral B).Lettpostoriorintriorcorebelar Len vertebral D)Rght idee certral EE) Right posto inircerebeler F)Rigttvenstral reased oer19, A 324yearold man's trouattto the emergeney department ty a tienabeceuse ct teak history of chavior Eaters evening, the peter staedte sive at 100 mis perhaur, weaving in and ut of rac on be intersats ghey untilone of is passengers comanced him drop her of athe apartment His rend then Insistea.on bringing tobe hospital for evaliaon. The patent works ata Grakerage frm and has Deen atthe ofice alright on several occasions is past week Several lof hs customers have sarod to complainthat he cals late aright and tak about pans fr thoir money tht do rot make sanso. His fend describes tis behavior a= ompletelunehorscteneie besais ne ite prencusy a sss money manger The pehentyircaly Shes eur Dears cn wseinignts and upto avazen om weskenes His temporare is 37°C (98°F) pulse s Sin resprations ro 10min, and bloodpressure fs YAO! mm Hg Ptysical examination shows no afer abnormalities ce rmerta status exarnnaton, nis afectisinepprearatey bight He speaks quciy na is cricutto erupt He says teche is upset about being brougnto the emergency ‘spartan, ne thon laugh’ end sates me ne can clear everyhing yp Ho says at Na has eceived a secret message egardng anew economic davaloprentthat ‘nab al af his customers andhim to become weal. He hasbeen sewing pigs cheng ea eutandnow knows exec whatnieeds 9 be dane Une tsicoogy Seteaning saga neh o hereon ete mest aly agro? A) Atention.deictiyparactnty disorder 5) polar asoraer ©} Cyelatymie sore D)Delusenal isordar E} Major depressive cleorder wih peychonc features F) Schaoatectve cisorder 15) Schizopinenis FH) Substance-irluced mood disordervedan boca of arty hn ST EMRERSUBREER se unanncene an 14, An82yoatold woman comes to lnsisatiness nen yealong etal hisiory nces oteoathins, pei ler disease, endiyparifadamia, Cert medications ate ‘Sheh shistry af ecofl abuse bites abstained fram dinang fr's years Neurologic examinenion shows eophy of Ie upper eerny ang ncreesed tone bath Ibo saemies Musle serge inte ln upper extemyis 2 aap laden (elaees are 2a Be biceps ard brachitodals alta, eben aie leas, hd + athe inees ancl ankies. Bobi sgn is present blstrally Sensation to pinprck andtemneranre is decreased! over tele dersalforeem ane and. Proproceptan and Sengaten to bration ate matked¥y decreasod lite ankles and toes. She nas a ‘Which athe olbvsng isthe rosy ciegnosis? A) Bitar ereenalplexopaty E)Epidua cera cemprassien (C) Patent manne oma Dj Petinere neuropatny E} Spondiatic cenical myelopathy15, AST yoarold man vith a 10-yae history of ADS coms to the emergency daparbnert because ofa 8-day history af otuse headache and mile woeiaess of his ethan. He has net had fever or cls. Hshas been unable ofoletete chy active anretionral hetapy dus to sevore nausea. Hs only medications timathepim.sulamehoxazals Hs rt Cate T-yrnphocye caure 2 weeks ago wes Slr NormaleSO0}, and plasma HV ra oad is6 100.000 coplesim., Hes ale en cnentedta person, lace mest {’ndtime. His puso sTODHm, and ood pressu Is SO/6O myn Hy Muscle sng 45 ntl hand, Neurologic examineionshowsmno ober Tocalnnanys. Laberany studies shows Serum Na" 128 mE oh Ke 33nEQL a SemEoh Hoo, meEgh Creatine mai urns Sou Same QL smal Sal mostra HO ACTscen afte head shows a ing-eonencig eGIHERREREERGME: Wich of he follwing isthe rmatikely explanation fr hese abaretoy fnaings? A) cute beter necrosis 1) Acdsen isease ChF4povolemis Dy Sat-wssing neptropaty E) Synctome of inappropriate secretion of ACH (vasepressin)16. A prosoustyheaty 21-year-old man is trout the prysclen STREETER. ny tors iGRESMEDEB curing a colege football game. Examination shows a bulge amerior toe sheulde. An xray of he rit shoulder shows an arerorisleceion Aer dosed reaucton, fee is runibnass ver the proximal teal arm and marked lweakraos of ebducdon Which of te folowing is tho met ly so of nero muy? 1) larynerve IpMusculecutanecusrene atthe wist £5) Cemicainorve rot atte eenacaforainan J) Racial nome above tie elbow Lang toracienere Kj Radial rene atte elbow DD) Median nerve above the elbow LiRadia rane at he wrist EE] Median ner atthe abou 1M) Suprascapular nerve F)Meckan nave che vast N}Thoracodorsel none {G) Muscuocutaneous nae above the bow ,Unar nerve ate alvore H)Muscuocutaneous nerve at te eave17, 42 manhole boys brought oe physician or afollwup examination 2 wesks ater complting a 10-day couse of aman fran aa nfacton, Hs fae is ‘oncemned because his sen has hed many eer infecons since bith, and Hs speechis dfcut to understand The cit walks and uns wit ony occasional fale andis able © 0 Climb onumiure. Ho can stack seven blocks witout aficly. Ho 1s at tho Toth percent for helo and weight Curing the amination, ho doesnot say ary words, anche intemiianty bbbles or screams. Examinatien shows raced lmparic membranes ih poor mevemertth pieumasc closcopy Wich of fe follwing is re ‘he most appropiee est step in manager A) Reassurance Bi] Measuremert ct bood| ©) Audomeny D)CTscanofthohead E] 10.Day couse of igh dose amoxciirclaulanat= F insertion ef ympenostemy bas leadconcenranenays that he fel the geo vold smal volumes of urine ‘A 2.yearlc man comestathe plysician because of ‘vary 2 hous. Occasional, Ne as been unable to reaeh Ble bahroom numa, Sb ori ago,he Sustaiod a Neue of Ce vtenhe doveirio a shallow poo Hafhed ‘Uachinresis wth oss of Sersat onto pinprick bolaw C8. He was hosaitaized end underwere surgical decompression and stazation olowed by immobilization in halo bravefor srs. He nas regained mest ctor ane snsory funtion is ttperaie |s 27°C (98.6°F), puss 1s 7O¥rIN ed equa, and Wood prassure Is 13070 men Caria nowes ae intact Muscle sreng isi inthe detld an bicens musces bilatrally and is 55 thence, Daep tenon reflexes ar T+ lteraly ithe biceps and 3+ Dilatrall nha tiesps, quadriceps, ad gastocramus muscles Babish sgn rs present blalraly Sensaton to pirplck and tenporaure is midy decreased bol tie Upper chest Wich ofthe follwing isthe MmaslkoW cause ofthis patent's inary sxmatoms? AyDemsorgpensfenis B) Diabetes insipidus C}Flaceid baer 1} Overtewincontrence Eoutetonstuction18. Apresouslyheathy 25-jar-ol waman is brought ta the emergency department 30 minutes ahr being stuck ty moter vehicle. On env, shes den and onerted enc ‘pons leg alr. Her vil signs afe win nomalimtsExamneion stews normal sensory fe motor nction Ite foot Posteorubal end dorsalis pecs puss are hotmal Xtexs show a minimal cisplaced conminued midshat facure of he tba Te ler osramiy is splmtedin te emergency department ei te patent admit forobscratn. Tire tous lao, se has numbness nor eot and increasing pain inher lower enmity. Examination row shove decreased sensation lit ouch or the foot and pain »th passive extension of fhe oes hich ofthe folowing isthe mast propriate neat ste in management? A) Elevation ofthe axromity 5) Measurement of compartment prossures ) Antcoaguest trap 1) Angiograpy ) Closed reduction F Neve exploraven 16} Open reduction ani H}Open reeuctonandintema ration20, A S7-year-oldman comes to the pyscian bacause of 2o0k history of constant Needeche, abdominal pan, and zines. He has ha genoralzecwadkness anc ‘decreased vision cuing this pening He has n istry of seriousness er sual preblems end takes no medications. He hes Ived and worked an aruratarm al of i if. Fo ans 4 2 ortoramady quer tv tos weekly. His bod pressure Is 12502 ren Hg The pups era 3 mm aid raat stow to Dlg. Th patents urate to read ‘any ters on the Snellen chant can count fngers held oot non this face. Funduseopic examinetion shows paler ofthe optic ees. Abdominal examination shows ‘tse tandemnass but no rebound Muscle srengi is 4/5 i all eeremives. Exposure to whieh of Me foleaing Toxnsis he most kel cause of is patents syrptoms? AynHecene E)Methanol (Cp Matte ketone Dyorganopnasprete E)Tokne F) TcHoroetilone21, Aprovousiyhesty 721d woman is broughto the plyscin by her daughter because of progressive meron oss and corfsion cing the past 18 montis. Altioush ‘ie as had mi forgets for 5 yeas, er symptoms earratcalyncreacod dung Be pact 18 morths. ANS, dalop te haar. Thats atgtteatokd bul Penghoral pulses are decreased Babin signs present onthe Wich of fe falang isthe most appropiate phamacctetep/? A) Aspirin BE}. Chpideare )Diptiarnae D)Hepann E} Waraxn22, Am TB-yeacald man comes ote physician because of icuty waka for week, Examination shows visuals het re constcted equaly mab eyes on clese end ‘sbi testing He has colansing eet oh muscle sven lesthg Oe ef rerbes He slaggats Wom se o sida ven ar bul dows rota On Romberg tes, Ne orupty also the et. Tere 1s hemisensery oss ta lghtoueh, npc, ibaa, and proprioception ane lene stops exeety the mide. Which afte tloing ihe most ity dagnesis? £8) Cetebota deganereion EE) Cervical spinal cor compression (C)Comersion disorder Gulla Bare syncrome E)Mutipe sclerosis F) Sensory msuropaty cy Tanesaateais Hy vitamin (cobalamin) eencleneysince tng 25040 weight 18 hours ago. He has had unary 2, A 50-year-old man has hadlowrback pain asiabngto the right butock and pesator hgh tothe Incorbnence dung bs me. The Aciles tendon refles absent on he night. ond here is decreased petianel enseion. Sait grasa causes 8 matked incressein Pain int posteric thigh and leg Which of te folbwing ic te mostly cause of tose frdngs? A) Cauda oauina compression 5) Epiarsinematoma ChLumbasacr sain }S1 eve rectradioulonatty EE) Transverse ysis24, An 87-year-old women is boughttn the physician ty hr son beceuse of 7-mont history of decreasing abilty to fncion Independant. Sho sna longer abe ta vite chocke and otsn gets Insts crving She has ppartension and yperlpidemia, Curent medicetons include chbroiazde and pravastatin. Her lmporaur is 37°C (G36, puseis 8dimn, esprabons are 12min, andblood presses 170/100 mm Hg Physical examinaion shows nother abnorales. Mental status exarinabon Shows poor cencenranan She is onemtedto person and lace Bt Noto me. Shes abet Fecal zero ot of tree oblecs ater 5 minues, Cognition and constucbona lly aro décreasod, Laboratory ndings ate inthe rofsonce rig. Wich of te olorangis tho most appropiate nex stp in ciagnosis? ‘Aj Meacuemert of serum armonia concentiabon ) Neuropsychologicel testing C)PET scan Ds ore bran EVEES25, A S2:year-oldweman is brought tothe emergency doparment | hour aftr the acute onset left sided weakness invoking the face, arm, anleg. She had rheumaic fever Guta chichocelancwas tld at hatume tatshe had @ eet mums Met fulso 16 22min and ogulaty regular Examinaton shows riederat litsided woeiess abinda sign is peserton te let Which ofthe alluing is he most lkely cause ofthese hrngs? ‘Gh Meningovascuar syphilis Higa Ips wate prope J) Pateneramen ave ) Subelanan ste eyndrems LU Verticuar septa detect A) tial fbntion Bacterial endocarats ©) Ceroud atay assectn Dj Carotd atherosclerosis EDiabotes malts FyFipenension28. A 42yeacold manis brouphto the emergency department 20 minutes ae the onset of generaizedtoni-clonc sures. Ho has @ 3-year history ofa seu disorder Uwsatod with shorn, batho doos not ake hs mecieation a6 proscibod. He has longstanding akotoism. He is siporous. Neurlogte examination shows no focal indo. Hisemagicbinconcertration is gla, and mean cepuscularwoume s 105 m2. A deficiency of wich of hefollwing isthe most Hey cause o hs patent's hematcogte frcings? AyFole acid 5) Mtamin, amine) oP tamin Boon) 1) tamin E)\tammin 8 [cobatamin) Fy amin C‘A 12.yoer-ol i isbrougit tote plysican by ne parents because of a 2. eek histoy/of suten,unconfalae movements of nr fac, ams, and lays. hon she etempts ymptnms donot occur cning sleep. She has noched loss ef cansciewsness Two mens ago, she to contol tese movements, they increase in Fequency and intensity haga oro tvoct tha resokecotoul eaten et parents fer tat she Wal fewed, pees Wal Schoo) and as not hed ary race stessors Her tarrptes 15.37 5 (96°F, pubes GCimin, respirations are 20min, and blvd pressures BAD mm Hg. Examination shows recuert regular, scesmesie rewemers of he face fang ips aedlower esteribes. The femandes ote avian shh ra abnermialbes & CT scan he baad ard ah EES sho ho abramaes, hich a Bie falling isthe most key siagnosis? 8) Absonce setae £8) Compl pata seis (©) Comrsion cor 1) Setenhem chorea )Teuretedisrder2 A preousy neany T2yearoks man’s brought ta tha prysielan | day aor he sudden se osc in is et oye that YasowsewhIN AS mines He Neda ska apisade inte same eye 2 weoks ago He has nothad headache, fatigue, weakness, jw pain, or Aculybrsthing He appears well His pulse is 72min, respirations are Tain {nd bid pressure is 172% mm Hg, Examinaion shows no abierralves” A rade 29, sary Systlc mur IShaardwih occasional actoplc Deas. which che aloning isthe most appropriate nex step in Giagrosis? A) Sitlamp examination ofthe et eye 6B) Determination of eryénocite secimentstion rte (©) 24Hour ambulatory ECE montorng Dj Cacti dipec utrasenography E)Ecnacarsiogtenty F)CT seen of te head28. An 82-year-old woman with demerti, Alhsime tps, is brought the piysiion by her husband because he has had promrssive ficult feecing her over te past “4 nao. He says she no longer svealon food tal he pus hr mouth, aven woh rompung. Sho ne longer says ts name, andhe Deloves ashe doos nt recomrize him, Hehas been her pimarycareguer ford years. She doos net have an advance directive, He sajs he does nol manta hasten hor death He was to correo take care oh her athome outs cercemed abotcnis ably to do so. He decines placement ofa gaatostory tube. She fs 163 cm (Sf lad weighs 49 (9b BMS 7 ‘She appears wel gtcomad ut atoutshed, She lenatexerlad wo pen, pats, cra. The emalrder of Be examnaten sah no eromnales. he a he Toa isthe most appropiate recommendtion? ‘A)Oralmutivtein supplemertation at home ) Oral uttinalsupplemertatien al home (C)Hospee cer atom (Dj Admssiono Bie hospital fortotl parenteral nuiion EE) Transferto a dled nursing cere aay forte feeding20, A 47-year-old man comes tn he physician because of 1-day ister of crooping of tho right eld He has na histor of serious ness and takes no medications. Vital ‘igno ao wh normal hte, Pyical variation shoves aio over Bio Nght side othe face. The tght eyed doops $v, The ht pugalis $m, ane! ke pupl is Sm, bo pupils ate reactive, Visual aculy is 20/20 on thenghl and 20125 onthe le. Canialnervs are aherse intact Muscle srenghh's 15 trousheut Deep tendon refx are 1 treughout. Sensabanisintact. An MRI cf hich ofthe folowing ismostikey to corm the diagnosis? Al Lower neck 5) Meu ) Mebrain 1) Dear eri E) Pore31, AS2:yea-ckd men comes tothe physician because of @|-month story of numbness and nding ofthe sng and smalfngersof his rit hand hatradlates to his palm. Hs ‘sampioms ae now constat and axacorbatedairigt. He has 2 2veek history of dacreasod gnp stngth end washng ofthe cra muscles nhs ig and. He has ot ae neckar aim pain Feur months ago, he was clagnosed with pancreatic cancer, since then, he undenwort Whipp procedure and is cuentyrecoing chemotherapy with ‘gometabine, Since his agnosis, alas had sigficar fugue and an 18-ko 404b} weight ss. Hers 173 cm (308 nal now eo hs ka (120), BPs 18 kan’, His temperatures 37°C (28 0°F),pube is 5m, and Lond pressures 120/79 mm Hg. Theres wasting of fhe nlerosseous muscles onthe igh. Muscectenath is 375in the nglt ntsrosseous ane mypamneriar muscles and for daltorum protuncus of tend and sta fingers, is fl elscvnere. oop tendon relowas ara 2- hnoushout Eabine signe absent Sensation o pinrik and temperate i decreased over the Unerazpact of fe palm and coreum of fe hander and smal Angers Propoceatnis tect. Te remahider afte neutcioate earnnation shons no atnermaites Which che felewinais he most ikely cause of his petients smmptoms? A) CB neve root on by tumor E)Conica aise nemason (C}Chemetnerapyneurctxiiy Dj Unnarnerve compression ) Vitamin. (cabalamin deficiency22, AsT-year-olamansto recent emigratearrom Madeo ls beughtto tha emargancy depatinere hur ar a ‘generalzod tnic-clenic selzue that ested 3 minutes. He has a -veekhistry of contartheadactes. Hes ohernise hal. He is esualy active. He has scked ano packof agate daly ot 22 years Plysical and neuvioa ‘aminatonsshovsno abnotmalias. An MF of fe Eainis shown Which ofthe folowing ise mest ily isk Facto for the dovolopment ofthis patent's condtion? +) roome inocton 6B) Artuepod bore nection C)Fecalcontaminenon aod 1) Seaualimercouse wih an infected partner E) Smoking sbacco38, An82.year-cld women isbraucht othe emeroancy depanmert because of en é-hour ister of fever and progressive confusion, Four devs ago, she tended spcnic and ate barbecued fot dogs and homemade unpaseunzad chassa, She has sevara pemphigus Ysatad wih daly ora prednisone. atival, sha is sormolet. Her tamperaire 15 334°C [108°F} Piysical examination shows aria neck Newolog examination shows no focal findings, lumbar puncture Held tabi hid. Cerebrospinal Mg ‘hati sews: cose 24mg, Protein {eomora, 2mm? ‘Seamed neurophis 60% Menooytes 40% ‘A.Gram stain of cerebrospinal Mid shows numereus cram-positve bell Which of thefollawngis the most kel causal organism? Ay Bacitussubtiis By Clesinum perimgens C)Canmetactenum species Dy) Hsemaphiisinueneae ) isons manaeytogenas Fy Stepiococeus preumoniae24, A AT yearokd man\sbrought tthe emergency department by his nds 0 minus afer a generalized tonic-clonic seizure that lasted 2 mites He had bean smoking ‘rack cocaine when the slzire began He sUespensive. Examination shows a 7mm diated le pupitat is nenreactve to lige. Thee is eroeping othe ng loner face. He has mismiet dcerobrate posting into right upper end lover exterites. Deep tendon flrs are hyperachve on the ott Back signs prosent onthe night & CT sean ofthe haadshaws an nbacaretral hemonthape Which ofthe eloving Spee of corsbal ection tha mast Vey eause offs conakion? acon Bi) Cerebetartonsitar ©) Subtle 1) Transtntona EUpeer26, A 27-year-old woman comes tothe physician because of sfiliafSLEKiSTSRGAESTEESHIEESEEMSIN ond pain wih movemert ofthe cht eve. Her isl acuity is 202 Inthe nant aye and 20720 nthe let ey. he pups are oq he nEEUANBAERTBGMLD direct oft but reacts consensual to lightin the opposte pul Funduscopic ‘examination shores oral ndings. Ata folensup vit ® wooks later, sion inthe ight ee s 20720. Theres rild pallor of ho right optic dsc, Theremainder ef he ‘@aminatonis unchanged. This paints at greatest nik forhich ofthe olowina? 8) Corebrartrction ByLye disease ChMutpl slerosis Dj Systamielupus anthomatosus EE) Wegener oranulomernsis36, A 79yearold woman comes tothe pysicin becouse o » AGREE ESEAENEEAEESISESEE nt ighttempors ares end pain inthe ay een chewing. Over i2s/iaddifuse panin tho back, shoulders, and tems hats worse on mil xorbon. Thre teidemoss 0 palpabon aver tho emote muscles ‘ho gest mont, bilaterally Neurobetc examinatn shows no focalindings Which of te folovengis the most ely cause ofthis patents im pain? A] Chronic atiaue symtoms 5) Ftromaloa ) Lyme assase D) Pokryalasrteumaica | Rheumetoi arris F] Systemic pus enematosus3 ‘A 24eer-od gt has the sudden onset of Physical examination shows ani th norma ita signs. She Tha necks sipple. Analysis of cerebrospinal ud st re (NO-T) anda pete Soule cueypoatee tae sbi ContenrshoGHROM/ Sram tanshowe no oransme Miht be tolwing te most ey doors? pate cesblar avs BjAtaiwilengecaste GjBeon paca Sheeler estore Eifotachstars unable to28, A Briyear-cld oman eth comesto the plyscian becauss: urn ttistin, she has hada tingling sensation inher nas nao creasing Tiny with ev AIGA, such 25 SF meumstid vis Smpoms have Dee" menage vith comcostrois Examination shows marked rhaumafte a snare eas Mesos bilateral Deep tendon reflexes ere 3+ inte upper exremites Which of the foloningis the mostappropiatenet sep agnosis _A) Measurement of srum crete kinase acy 1) cra of he hands C)DEXA sean pM of tie worcal spine }Elecromyograpry andere conduction stusies39, A 27:yea-cld women is brouch SHTBHERINESEELEETEF a S.y2ck history of double wsion She says thal he cube vision most fen curs when she looks upward feta the nght She isciten asyrotamatc ine maming Her fends nave commented on eroopiness of het eels Her enly medicatan sen oral contraceptive Examination shows blatra ptosis hats grater nthe ight eye than in helt The plosiss worsened by gazing upward for BO seconds There is weakness of abduct of ‘Me righteye and micweeiess of He Rortal muscle, The remahcer ate neuloalc examinenion shows no abriomaies. Which of folowingis te most eoprogn ate inal pharmacotherapy for tis pian’? A) Azathioprine )Cycospenne CChtmmune gobuin Dj Preerisens E)Pyosugrine40, A Toyearcld manis bought tothe emergency department 1 hour ater be suddon onset of ncoerdneton and elumsiness; he as alen severalb res. Physical oxaminaten hove troadbeced unsead gat eo SMEEOGMEREM et ye doe ot SABRE cretecto personne place orb ands. ‘que and rambing in his history. Whien af hefolowirgis ne most ey alaghosis? E)Hepatoienculer degeneration [ison disease) (C)Spinoverebelar sti, Ye | DD) Wernick encephalepatty41. 8.57. year-old woman comes to the ptysician because off {ETGGRITEREMEBBIOcressive slurred speech and gait unsteadiness, She also has had mild occipital headache Shetses no escasineCcarnaven hoe ee ERAS secinongte snes Siehaiige2c aes noaeretermient AMOI Tre ors antes obo igtonprenmen OMe crlanenosalobee Fergal lositath anana tone Mace arengn eae nino rcope oat Sxerors eue an ogsoae mesbuaualy Cee ona ees oe eas ts sm aka Serotonin os abnermates. hich fe folowing isto mastiko¥ diagnosis? A) Epidural abscoss 2) Epidural spinal cord meretasis ©} Singomyets 1D) Tumor ofthe foramen magnum EE) Vertebral oetaeryaits42, A 24year-cld woman has weakness other rightleg of 83628. (84) fubzem nenoom. Examineton shows ‘cakes of OMIM everson ofthe cht ani, inversion an ars normal. Tate an a jo. Rates ae tact, ‘ich ofthe tlewing she mast ike location ofthe lesion? A)Baca ganote H)Frompanetalcatex )Brachialplens intemal cepsue }Brain stem “Durbar nerve roct, DD) Canicainere reat )Lurbosecal pews E) Common peroneal ners Ly median nena F) Conus moauls Muses )Fetarainene 1) Seite none48, & 25.year-ol4 woman has had at “The pein generally begins 28a cll acte soon ater Wala gracualy worsens. The pains facerberea Stewed by acotrrinopnen an soap. Prysical examinatien shaves 0 jes Which the fonng ste most ely agnosis? A Cerebral neoplasm 8) Custer headache ©) Frontal snus 1D) Moraine wih aura | Moraine wither aura F) Temporal areriis 5) Tensiontypeheadache Hy Tigemind noua48, 6 74a ola woman ou ‘te SSS sce terdemess bine weakness or diagnosis? a) Flbronyosts )Pobrtenisnodesa EpEohmjestis 1) Systemic pus erthematosus E)Tompecaletenis to he emergency depanment 1 nou eer he sudden onstof paral Mindhess. Sha has had bse gta fever, occa headaches, pan of re memring sthess for 2 months. Her temperature is 377°C 69.F), nd bcod pressures 13888 nm Ha. There is generalized ‘rophyOptihalmebgic sainabon sows eden ‘whch of the flowing ete meet kal45. A BIS)SBREGBH cores tothe pysician bocausa of Ho ha BSREREGHTanshas been pocry compart ith hs medication He is ofersise asymptomatic. He s er but corfused. His bed ress.reis Z4QNIED mmm Hg Furduscopic examinatn shoiietsthaeSee Seer ‘hich ofthe toleung isthe most appropriate shamacctherspy? Ayam ptyine GpNtocipine )Clonaine Hyntropnsside C)Dexamethascne DbPrechisone D)Ergcterine 4) Propranciol Ebuprotan ) Sumatnptan Fimenysergas“46, A 2.yeerold manis comatose 3 hous afer being At behind hele earwith aetwhile catching ina sefball ome. He wes dezetfor afew seconds afer he jury bucwas lteiaan eri nthe emergancy caparenert 2 nous ago Examiragon shat re snowed lage ruse beting hale aa no ear aborakbes wera nce WAFch ofS folowing te most key explanation fer these findings? A)Elearaptsiologc dstuncion 2) Epidalhemorhage (C} Hemorhage nto the cerebral hemisphere 1} Shearing ens carupton or axons ) Subdura hermonfageAT. R6T. year-old woman comesto the pysieian because of ayuartistry of gradual progressive shakin of har eae and hands. Th shana dcteases ater sho chinks & ‘dass ofvine She sngtshandcarsnant Sha has aistoy of ypetansion Peaed wth banaospnl and hjpetlideria reated ih atorvastatin, She as consume our {gasses ef wine dal or 35 years Her bloc resaures 14212 mm Ha. Examination shows a rapid emer ofthe head and vaice. Tete isa ghTecency tema of he hanes ontngeenase sing Wich ote leur the most epproplais phermacameragy to fis peters Wear? A) Catbidopa levodopa E)Disatvam C)Prengtein DiPrepranoat E) Tahewphonic48, 8 22.yeer-oldweman comesto the physician because ofa Goneelchistory offic ang askep and early meming awaksring. She say that she is bred throughout the {ey andhas become creasingly table wth Per family and canovers. She fds eafcutto goto work She has netnatices ny mprovementin her sleep despite nt ftniangeaes past roan ar exercising in he evering. Shed lange enjoys garding an eaching ht chen ta mets care She tals gully about howe Sep ‘deprivation safecting hor family. Shohas hada decreased eppette resutingin a4&-kg TOeb) wegtt loss during the past 8 woeks. She has ne Hsioy psychic hase. So takes no medications. Sh doos iat smoke wr usa lat clugs and an cccasionaty dink alate. Sho appoars bred. He lamperatue is 37°C {99 °F), pul Btn, and Blood pressures 116I?4 nm Hg Physical examnaton shows no abnormalites Wental status ecamnaten sors aac effec: She becomes eet and ays ‘hat shehas teen Sed ince herTatherwas clognosed wth ng cancer 4 ments ago She £3, “have havo eat kiling Tyee, ut [WOU never Uy cicren at ‘nay atavonto psyctesnerapy, ech of te foleaing is te most appropriate ni sop n managament? £8) Suppor group fr tlatves of caneor its B) Busprono thrapy C) Diphentysremine therapy etbecine 1) Fluoxetine herany E] Lecazepam theepy,49, 27-year-old man comes tothe emergency departmentbaceuss hehas bean unabl to vidfor 24 hours Over he pest 6 days, he has had srarualy progressive ilar legweakness. He had te enset tow back pan 7 days ago wile worlng ite garden He hes a itary of maverous drug use. Hstemperature I 38 °C (102F). Examination shows moderate weakness and fypertetena cf tha lower eaTorivesDlloaly Babel sigs reson bray Sensaon to pinpick s decreased Deb the urblicus, and sonsatonto ight euch, irorick, proprioception, endvbrton s decreased ver both over exami. Which ofthe fllaing isthe mos el locaton of the lasion? -) Coriel spinal cord 5) Conus medulars Ch Femeral ner Dy} Lumbar nerve roct )Lumeosacralpios )Nouramuseularunebon G)Seiancnerve HyTheraci spinalcord Utara50) A 67-year-old weman\s eugte to the emexgancy depanmant ty Nr husbard 1 Nour ater Me surkdanenset of ncomprahansine spacchthat begen shorty ae Braktast Her husband describes her speech cing Be encode as unt end well aroused bit llof logical werd combinations, making impossile for herto be understood. He Says tat she dso did ret soem to understand im or folow commands. She has typetension,Wyperif.dema, and asia. Curert mecealons include lovestatn aed lisinopal She is aera to aspirin On sv her language functions nom Her pulse is 8Gnin and rua, and bloodpressure is 152468 mm Hg. Physical and neurologic ‘varinagons shaven enotmalias Eehocerchograpy shows no enormalas. carci dup uvesonogrspy seks ab tangas ee fear carob) ane, Ne Fiahtisnormel Wich othe falling isthe most appropriate intervention to decrease t's patent's isk or fae eisodes? A) Clopidearel herapy 1B) Esrogen replacement therapy Ch Preprancolheraps Daron there EpLatcatets ercanarectamy