Colloquium 2006 B

180 Questions

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Academic Quizzes & Trivia

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Questions and Answers
  • 1. 
    • A. 

      Anterior cord syndrome

    • B. 

      Central cord syndrome

    • C. 

      Posterior cord syndrome

    • D. 

      Reflex sympathetic dystrophy

    • E. 

      Spinal cord hemisection

  • 2. 
    A 2-year-old child drinks kerosene that had been left in a glass. After the first swallow,she cries and drops the glass. She is most likely to develop  
    • A. 

      Aplastic anemia

    • B. 

      Chemical pneumonitis

    • C. 

      Coma and/or convulsions

    • D. 

      Hepatitis

    • E. 

      Peripheral neuritis

  • 3. 
    A 58 year old woman had a hysterectomy for endometriosis. She asks you if she needs a PAP smear. You tell her that in her case :        
    • A. 

      PAP smear screen is no longer needed

    • B. 

      She should l have annual PAP until age 70

    • C. 

      She should have a PAP every 3 years

    • D. 

      PAP should be done if she has a positive family history of cervical or ovarian cancer

    • E. 

      PAP smear should be done one more time only

  • 4. 
    All the following have aided in the diagnosis of Pneumocystis except: 
    • A. 

      Transtracheal aspiration

    • B. 

      Transbronchial lung biopsy

    • C. 

      Culture of bronchial washings

    • D. 

      Needle aspirate of the lungs

    • E. 

      Bronchial brushings

  • 5. 
    A 70 year old man presents to the emergency department complaining ofabdominal pain, He describes the pain as crampy and primarily in his left lower quadrant. He has had minimal nausea, but complains of constipation.His past medical history is significant for hypertension, hyperlipidemia , gout, and diverticulosis. His medications include atenolol and simvastatin. He is allergic to penicillin. His temperature is 38.0 degree C (100.4 F), blood pressure is 140/60 mm Hg, pulse is 100/min, and respirations are 20/min. his physical examination issignificant for tenderness to palpation at the left lower quadrant without rebound or guarding. His rectal examination is guaiac negative. His heart and lung examinations are unremarkable. Which of the following is the most likely diagnosis  
    • A. 

      Appendicitis

    • B. 

      Diverticulitis

    • C. 

      Diverticulosis

    • D. 

      Ischemic colitis

    • E. 

      Sigmoid volvulus

  • 6. 
    A 35-year-old woman undergoes her first screening mammogram. Which of the following mammographic findings would require a breast biopsy          
    • A. 

      Breast calcifications larger than 2 mm in diameter

    • B. 

      Five or more clustered breast micro calcifications per square centimeter

    • C. 

      A density that effaces with compression

    • D. 

      Multiple round well-circumscribed breast densities

  • 7. 
    A patient on warfarin (Coumadin) presents with severe gastrointestinal bleeding. The best choice for rapidly restoring normal coagulation would be giving him:       
    • A. 

      Tissue plasminogen activator (tPA)

    • B. 

      Methylprednisolone (Solu-Medrol)

    • C. 

      Fresh frozen plasma

    • D. 

      Oral vitamin K

    • E. 

      Packed red blood cells

  • 8. 
    • A. 

      Glucose    

    • B. 

      Haloperidol

    • C. 

      Lorazepam

    • D. 

      Thiamine

    • E. 

      Valproic acid

  • 9. 
    A 26 year old primigravid woman at 35 weeks'gestation comes to the labo rand delivery ward because of painful uterine contractions and a gush of fluid. Sterile speculum examination reveals a pool of clear fluid in the vagina that is nitrazine positive, When the fluid is examined under the microscope, a "ferning" pattern is seen. Cervical examination shows the patient to be 4 cm dilated, 100% effaced, and at 0 station. Fetal fingers can be felt along side the fetal head, External uterine monitoring shows the fetal heart rate to be in the 130s and reactive. Which of the following is the most appropriate next step in management  
    • A. 

      Expectant management

    • B. 

      Oxytocin augmentation

    • C. 

      Forceps delivery

    • D. 

      Vacuum delivery

    • E. 

      Cesarean section

  • 10. 
    A 58 year old chronic alcoholic presents with fever and shortness of breath. His chest X-ray shows numerous well-defined nodules less than 5 mm in diameter. You suspect :  
    • A. 

      Bronchiectasis

    • B. 

      Primary pulmonary tuberculosis

    • C. 

      Reactivation of old tuberculosis

    • D. 

      Miliary tuberculosis

    • E. 

      Pneumocystis carinii

  • 11. 
    • A. 

      Cerebral MRI

    • B. 

      EEG

    • C. 

      XRay of the skull and sinus

    • D. 

      A careful interview

    • E. 

       A careful clinical examination

  • 12. 
    • A. 

      Birth asphyxia

    • B. 

      Sacral agenesis

    • C. 

      Hypocalcemia

    • D. 

      Hypoglycemia

    • E. 

      Cardiac septal hypertrophy

  • 13. 
    Regarding fluoride supplementation for the prevention of caries in preschool children. The most current evidence supported recommendation is to prescribe fluoride: 
    • A. 

      Beginning at birth for breast fed children

    • B. 

      Beginning at 6 months of age if fluoride concentration in the child's drinking water is below recommended levels

    • C. 

      Beginning at 6 months for all children

    • D. 

      Children at high risk based on a fluoride blood level

    • E. 

      Using topical applications as in toothpaste

  • 14. 
    A previously healthy 20-year-old male is admitted to the hospital with acute onset of left-sided chest pain. Electrocardiographic findings are normal, but chest x-ray shows a 40% left pneumothorax. Treatment consists of which of the following procedures  
    • A. 

      Observation

    • B. 

      Barium swallow

    • C. 

      Thoracotomy

    • D. 

      Thoracostomy

    • E. 

      Thoracostomy and endotracheal intubation

  • 15. 
    A previously healthy 5-year-old child develops a limp and complains of hip pain, The most likely cause is  
    • A. 

      Septic arthritis

    • B. 

      Slipped capital femoral epiphysis

    • C. 

      Transient synovitis

    • D. 

      Osteosarcoma

    • E. 

      Juvenile rheumatoid arthritis

  • 16. 
    Which of the following is not a sign of Parkinson disease: 
    • A. 

      Rigidity

    • B. 

      Spasticity

    • C. 

      Akinesia

    • D. 

      Tremor

    • E. 

      Depression

  • 17. 
    • A. 

      Amoxicillin

    • B. 

      Clindamycin

    • C. 

      Erythromycin

    • D. 

      Oxacillin

    • E. 

      Vancomycin

  • 18. 
    You have just prescribed phenytoin (Dilantin) for a 12-year-old boy with new onset of epilepsy.Of the following side effects, which is most likely to occur in this patient                                                                                    
    • A. 

      Lymphoma syndrome

    • B. 

      Raynaud's phenomenon

    • C. 

      Acute hepatic failure

    • D. 

      Gingival hyperplasia

    • E. 

      Optic atrophy

  • 19. 
    • A. 

      Positive flank pain on percussion

    • B. 

      Positive rectal examination

    • C. 

      Vaginal examination is negative

    • D. 

      Positive Mc Burney sign =localised guarding

    • E. 

      Fever at 38.5

  • 20. 
    In comparison to cow milk, human mild contains more  
    • A. 

      Protein

    • B. 

      Sodium

    • C. 

      Casein

    • D. 

      Calcium

    • E. 

      Calories

  • 21. 
    • A. 

      Ampicillin

    • B. 

      Rifampin

    • C. 

      Aztreonam

    • D. 

      Cefotaxime

    • E. 

      Metronidazole

  • 22. 
    In a patient with jaundice which is characteristic of significant hepatocellular damage  
    • A. 

      Elevated transaminases

    • B. 

      Elevated alkaline phosphatase

    • C. 

      Hypercholesterolemia

    • D. 

      Hypoalbuminemia

    • E. 

      Elevated INR (prothrombin time) without decrease in factor V

  • 23. 
    Multiple sclerosis leads usually to all the following except:
    • A. 

      Desequilibrium

    • B. 

      Muscular weakness

    • C. 

      Amyotrophy affecting one or many members

    • D. 

      Sensory troubles affecting one or many members

    • E. 

      Urinary difficulty

  • 24. 
    • A. 

      Hydrochlorothiazide

    • B. 

      Enalapril

    • C. 

      Metoprolol

    • D. 

      Losartan

    • E. 

      Valsartan

  • 25. 
    The most common presentation of congenital aganglionic megacolon (Hirschsprung disease) in the newborn is                             
    • A. 

      An abdominal mass

    • B. 

      Diarrhea

    • C. 

      Intestinal obstruction

    • D. 

      Peritonitis

    • E. 

      Sepsis

  • 26. 
    A 37 year old man presents to the emergency room after 3 days of feeling weak.He drinks alcohol daily but denies illicit drug use.He called the paramedics when he began to experience palpitations and lightheadedness with exertion. On physical examination his pulse irregularly irregular at the rate of 126/min.electrocardiogram in this patient would most likely demonstrates which of the following 
    • A. 

      Sinus tachycardia

    • B. 

      Ventricular premature beats

    • C. 

      Atrial fibrillation

    • D. 

      Premature atrial contractions

    • E. 

      Sinus arrhythmia

  • 27. 
    A 21 year old woman presents with a 6 cm nontender mass located in the center of her neck. On physical examination the thyroid gland is normal in size and there are no bruits audible over the mass. She has no other symptoms or complaints.She does not smoke or drink alcohol.Which of the following is the most likely diagnosis    
    • A. 

      Branchial cleft cyst

    • B. 

      Thyroglossal ductal cyst

    • C. 

      Lipoma

    • D. 

      Carotid body tumor

    • E. 

      Laryngocele

  • 28. 
    A 35 year old man G1 PO presents to her obstetrician's office at 8 weeks gestation. She has a history of type I diabetes and is a very concerned regarding the possible risks this illness may have on her fetus. As the patient's physician, you tell her that all of the following are possible risks that can result from having diabetes in pregnancy except  
    • A. 

      Fetal malformations

    • B. 

      First-trimester spontaneous abortions

    • C. 

      Macrosomia

    • D. 

      Preterm labor

    • E. 

      Cesariean section

  • 29. 
    Over the past week, you treated 10 members of a health club members for folliculitis and outer ear infections.You suspect bacterial contamination of the swimming pool.Which one of the following is the most likely cause?      
    • A. 

      Streptococcus pneumoniae

    • B. 

      Pseudomonas aeruginosa

    • C. 

      Corynebacterium ulcerans

    • D. 

      Staphylococcus epidermidis

    • E. 

      Escherichia coli

  • 30. 
    According to controlled trials, the best lung cancer screening strategy in smokers is to :  
    • A. 

      Helical CT of chest every 5 years

    • B. 

      Low-dose CT of chest annually

    • C. 

      Sputum examination every 6 months

    • D. 

      Annual chest X-rays with sputum examination

    • E. 

      No screening strategy is currently recommended

  • 31. 
    Varicoceles appear to cause male infertility by 
    • A. 

      Interfering with sperm production

    • B. 

      Blocking epipidymal sperm motility activation

    • C. 

      Increasing the likelihood of sperm antibody formation

    • D. 

      Interfering with sperm movement through cervical mucus

    • E. 

      None of the above

  • 32. 
    Each of the following is a cutaneous manifestation associated with both Crohn's disease and Ulcerative Colitis except   
    • A. 

      Pyoderma gangrenosum

    • B. 

      Erythema nodosum

    • C. 

      Erythema multiform

    • D. 

      Oral aphtous ulceration

    • E. 

      Pyostomatis vegetans

  • 33. 
    A 25-year-old man has had type 1 diabetes mellitus for 5 years.His physician is concerned about the possibility of permanent renal damage. Which of the following is the best early indicator for diabetic nephropathy?   
    • A. 

      Albuminuria

    • B. 

      Hypertension

    • C. 

      Rising blood urea nitrogen

    • D. 

      Rising creatinine

    • E. 

      Urinary tract infection

  • 34. 
    A 65 year old woman who presents with the sudden onset of abdominal pain is found to have a perforated jejunal ulcer at laparotomy. Which of the following drugs is most likely to be associated with this clinical scenario   
    • A. 

      Alcohol

    • B. 

      Enteric-coated potassium tablets

    • C. 

      Tetracycline

    • D. 

      Prednisone

    • E. 

      Nonsteroidal anti-inflammatory drugs (NSAIDS)

  • 35. 
    A 5-year-old boy is admitted to the hospital for treatment of H.influenzae meningitis. His 3-year-old incompletely immunized sibling should receive prophylaxis with
    • A. 

      Intravenous ceftriaxone

    • B. 

      Intravenous cefotaxime

    • C. 

      Oral rifampin

    • D. 

      Oral erythromycin

    • E. 

      Oral amoxicillin

  • 36. 
    Diagnosis of hypertrophic Cardiomyopathy is usually made using: 
    • A. 

      Physical examination

    • B. 

      Chest X ray

    • C. 

      EKG

    • D. 

      Echocardiogram

    • E. 

      Nuclear cardiac scan

  • 37. 
    A 16 year old high school student presents with the sudden onset of sharp right sided chest pain associated with shortness of breath. He denies any history of trauma. On physical examination the patient is afebrile with a respiratory rate of 28/min. neck examination reveals no tracheal deviation. On lung auscultation the patient has decreased fremitus, hyperresonance and diminished breath sounds over the right posterior hemithorax. Which of the following is the most likely diagnosis   
    • A. 

      Tension pneumothorax

    • B. 

      Secondary pneumothorax

    • C. 

      Pulmonary embolus

    • D. 

      Spontaneous pneumothorax

    • E. 

      Pneumonia

  • 38. 
    A 62 year old woman comes to the physician because of bleeding from the vagina.She states that her last menstrual period came 11year ago and that she has had no bleeding since that time. She has hypertension and type 2 diabetes mellitus. Examination shows a mildly obese woman in no apparent distress. Pelvic examination is unremarkable. Anendometrial biopsy is performed that shows grade 1 endometrial adenocarcinoma. Which of the following is the most appropriate next step in management
    • A. 

      Chemotherapy

    • B. 

      Cone biopsy

    • C. 

      Dilation and curettage

    • D. 

      Hysteroscopy

    • E. 

      Hysterectomy

  • 39. 
    A 71 year old man complains of occasional lower back pain. His blood pressure is 150/85 mmHg and his pulse is 80/min. cardiac examination reveals an S4 gallop. Abdominal examination reveals a pulsatile mass approximately 5.0 cm in diameter palpable in the epigastric area.Peripheral pulses are normal. Which of the following is the most likely diagnosis 
    • A. 

      Abdominal aortic aneurysm

    • B. 

      Cancer of the proximal colon

    • C. 

      Peptic ulcer disease

    • D. 

      Chronic pancreatitis

    • E. 

      Lipoma of the abdominal wall

  • 40. 
    A 69 year old patient is admitted to the neurology service following a stroke. During the next few days,the staff observes that the patient has developed the clinical picture of mania, Which area of the brain has most likely been affected by the stroke?  
    • A. 

      Left hemispheric lesions including Broca's area

    • B. 

      Left prefrontal cortex

    • C. 

      Midbrain lesion

    • D. 

      Right frontal lobe

    • E. 

      Thalamus

  • 41. 
    A 45-year-old woman is discovered trapped beneath a concrete slab after an explosion. She is alert, but both legs are immobilized by debris.Rescue workers must work slowly to extricate the woman because the building is highly unstable.They predict that she will remain trapped for as long as 12 hours. She is alert and can drink.In addition to keeping her warm, what else should be done?
    • A. 

      Administer a β-blocker

    • B. 

      Start an intravenous infusion of saline solution at 500 mL/h.

    • C. 

      Administer intravenous fluids at 500 ml/h after she is extricated.

    • D. 

      Administer a calcium channel blocker.

    • E. 

      Administer an endothelia antagonist.

  • 42. 
    A Healthy patient comes to the ER for fever, abdominal cramps and diarrhea. Arterial blood gases reveal:            PH 7.28            PCO2 24mmHg            HCO3 11Meq/lThe acid-base disorder involved is:
    • A. 

      Metabolic acidosis with respiratory compensation

    • B. 

      Metabolic acidosis with respiratory acidosis

    • C. 

      Acute respiratory acidosis

    • D. 

      Chronic respiratory acidosis

    • E. 

      Acute on chronic respiratory acidosis

  • 43. 
    • A. 

      Severe mitral regurgitation

    • B. 

      Myocardial infarction

    • C. 

      Pulmonary embolism

    • D. 

      Ventricular arrhythmia

    • E. 

      Congestive heart failure

  • 44. 
    A previously healthy afebrile 3 year old has a sudden tonic clonic seizure.His history and physical exam are unremarkable. His blood count,CT scan of brain and a lumbar puncture are normal.Which one would be most useful next: 
    • A. 

      Arterial blood gas

    • B. 

      Serum chemistry evaluation

    • C. 

      Chromosomal analysis

    • D. 

      EEG

    • E. 

      MRI of brain

  • 45. 
    Forty-eight hours after a motor vehicle accident,a 47 year old man develops restlessness and hypoxemia.He has retinal and conjuctival hemorrhages,and fat is seen in the retinal vessels. A petechial rash is visible in the upper chest and supraclavicular areas.Lung examination reveals bilateral crackles,and chest radiograph shows interstitial bilateral infiltrates.Fat globules are present in the urine. The patient requires immediate endotracheal intubation.Which of the following is the most likely diagnosis 
    • A. 

      Fat embolism

    • B. 

      Hospital-acquired pneumonia

    • C. 

      Mendelson syndrome

    • D. 

      Cardiac pulmonary edema

    • E. 

      Pneumocystis carinii pneumonia

  • 46. 
    Side effects of corticosteroids include    
    • A. 

      Peripheral obesity

    • B. 

      Gigantism

    • C. 

      Cataracts

    • D. 

      Hypoglycemia

    • E. 

      Hypotension

  • 47. 
    The feeding of honey to infants less than 6 months of age has been associated with   
    • A. 

      Anaphylaxis

    • B. 

      Hypernatremia

    • C. 

      Infantile botulism

    • D. 

      Jaundice

    • E. 

      Listeriosis

  • 48. 
    An infant born to a mother with hyperparathyroidism is likely to develop  
    • A. 

      Hypercalcemia

    • B. 

      Hypocalcemia

    • C. 

      Parathyroid carcinoma

    • D. 

      Hyperthyroidism

    • E. 

      Hyperparathyroidism

  • 49. 
    Currently,when viral hepatitis occurs post blood transfusion, it is usually
    • A. 

      Type A

    • B. 

      Type B

    • C. 

      Cytomegalovirus

    • D. 

      Type C

    • E. 

      Mononucleosis

  • 50. 
    A 75-year-old woman is admitted to the hospital after suffering a cerebrovascular accident. Her computed tomography (CT) scan shows a focal nonhemorrhagic infarction in the right hemisphere. During the physical examination, no muscular weakness is noted; however the patient is not responding to any visual, auditory, or tactile stimuli on the left side of her body. The woman also has a deficit involving only the inferior portion of her left visual field in both eyes. Which lobe of the brain has been principally affected by this stroke 
    • A. 

      Parietal

    • B. 

      Frontal

    • C. 

      Occipital

    • D. 

      Temporal

  • 51. 
    A 39 year old woman,gravida 2,para 2 at 40 weeks gestation comes to the labor rand delivery ward after a gush of fluid with regular,painful contractions every two minutes.She is found to have rupture of the membranes and to have a cervix that is 5 centimeters dilated a fetus in vertex presentation,and a reassuring fetal heart rate tracing.She is admitted to the labor and delivery ward.Two hours later she states that she feels hot and sweaty.Temperature is 38.3 C (101 F).She has -mild uterine tenderness.Her cervix is now 8 centimeters dilated and the fetal heart tracing is reassuring.Which of the following is the most appropriate management of this patient
    • A. 

      Administer antibiotics to the mother after vaginal delivery

    • B. 

      Administer antibiotics to the mother now and allow vaginal delivery

    • C. 

      Perform cesarean delivery

    • D. 

      Perform cesarean delivery and then administer antibiotics to the mother

    • E. 

      Perform intra-amniotic injection of antibiotics

  • 52. 
    A 48 year old woman develops pain in the right lower quadrant while playing tennis. The pain progresses and the patient presents to the emergency room later that day with a low-grade fever,a white blood count of 13,000 and complaints of anorexia and nausea as well as persistent,sharp pain of the lower quadrant.On examination she is tender in the right lower quadrant with muscular spasm and there is a suggestion of a mass effect.An ultrasound is ordered and shows an apparent mass in the abdominal wall.Which of the following is the most likely diagnosis 
    • A. 

      Acute appendicitis

    • B. 

      Cecal carcinoma

    • C. 

      Hematoma of the rectus sheath

    • D. 

      Torsion of an ovarian cyst

    • E. 

      Cholecystitis

  • 53. 
    During a community-wide outbreak of influenza, a 29-year-old man develops fever, chills, increased sputum production, and right-sided pleuritic chest pain 3 days after he began to improve from what he thought was the flu. On physical examination, his temperature is 38.2 °C), respiration rate is 22/min. pulse rate is 108/min, and blood pressure is 128/76 mm Hg. Examination of the chest discloses dullness to percussion with decreased breath sounds over the lower third of the right chest and bronchial breath sounds. A chestradiograph shows right lower lobe consolidation with an adjacent effusion. On lateral decubitus films, the effusion is free-flowing and measures I.5 cm in depth. Routine laboratory studies, two blood culture specimens, and sputum samples are obtained, and antibiotics are begun.Which of the following studies should be done next? 
    • A. 

      Legionella urine antigen test

    • B. 

      Diagnostic thoracentesis

    • C. 

      Fiberoptic bronchoscopy

    • D. 

      MRI of the chest

    • E. 

      Ventilation—perfusion lung scan

  • 54. 
    An 81  year old woman presents with syncope. Blood pressure is 120/80 mmHg heart rate is 40/min.There is no jugular venous distention but cannon alpha waves are visible. Lung and heart examinations are otherwise normal.Which of the following is the most likely cause of her syncope?      
    • A. 

      Ventricular tachycardia

    • B. 

      Complete heart block

    • C. 

      Atrial flutter

    • D. 

      Atrial  fibrillation

    • E. 

      Cardiac tamponade

  • 55. 
    Among the following causes of acute appendicitis,which is the most exceptionl: 
    • A. 

      Tumor of the appendix

    • B. 

      Parasite

    • C. 

      Lymphoid hyperplasia

    • D. 

      Fecalith

  • 56. 
    A 22  year old woman  gravida 4,para 3  at 38 weeks' gestation comes to the  labo rand delivery ward.An  ultrasound demonstrates that the fetus is in  the breech position. A cesarean delivery is performed.During the operation, the physician who has received no recent immunizations is stuck with a needle that had been used on the patient. Which of the following is this physician at greatest risk of contracting               
    • A. 

      HIV

    • B. 

      Hepatitis B

    • C. 

      Hepatitis C

    • D. 

      Scabies

    • E. 

      Syphilis

  • 57. 
    Normal cerebrospinal fluid includes all the following except:
    • A. 

      10 cells/mm3

    • B. 

      All the cells are mononucleated

    • C. 

      Proteins less than 0.4 mg/l

    • D. 

      Glucose less than 60% of the glycemia

    • E. 

      Absence of oligoclonal bands of the gammaglobulin

  • 58. 
    The most common  cause of acute, painful scrotal swelling in adolescent is   
    • A. 

      Inguinal hernia

    • B. 

      Hematocele

    • C. 

      Torsion of the spermatic cord

    • D. 

      Epididymitis

    • E. 

      Orchitis

  • 59. 
    You are asked to provide a consult on a 13 year old boy who wishes to join his high school track team. The patient is asymptomatic but carries a diagnosis of having a functional heart murmur. Heart examination reveals a nonradiating systolic ejection murmur heard best at the left sternal border.The murmur does not increase with Valsalva maneuver, hand grip, or inspiration. Which of the following is the most appropriate next step in management 
    • A. 

      No further management is necessary

    • B. 

      Transthoracic echocardiogram

    • C. 

      Transoesophageal echocardiogram

    • D. 

      Electrocardiogram

  • 60. 
    An 18-year-old boy presents with cough, chest pain, and low grade nightly fevers of several weeks duration. He has a 4-year history of smoking two packs of cigarettes per day. Chest x-ray reveals a large mass in the mediastinum with extension into the right upper chest. Your leading diagnosis is  
    • A. 

      Adenocarcinoma

    • B. 

      Squamous cell carcinoma

    • C. 

      Small cell carcinoma

    • D. 

      Lymphoma

    • E. 

      Metastatic Wilms tumor

  • 61. 
    The worst prognostic factor in a patient with aortic stenosis is the presence of : 
    • A. 

      Congestive heart failure

    • B. 

      Angina

    • C. 

      Syncope

    • D. 

      Pernicious anemia

    • E. 

      Atrial fibrillation

  • 62. 
    A 32-year-old woman at 16 weeks gestation presents with right lower quadrant pain. You suspect appendicitis. Which one of the following imaging studies would be most appropriate for initial evaluation of this patient?
    • A. 

      CT of the abdomen

    • B. 

      MRI of the abdomen

    • C. 

      Ultrasonography of the abdomen

    • D. 

      A small bowel series

    • E. 

      Intravenous pyelography

  • 63. 
    A 26-year-old trauma victim is being resuscitated following an auto accident complicated by hypotension from a fractured pelvis and resultant hemorrhage.The patient becomes hypotensive with a normal CVP, oliguric, and febrile and complains of flank pain. The most likely diagnosis is 
    • A. 

      Hypovolemic shock

    • B. 

      Acute adrenal insufficiency

    • C. 

      Gram-negative bacteremia

    • D. 

      Transfusion reaction

    • E. 

      Ureteral obstruction

  • 64. 
    Dopamine is a frequently used drug in critically ill patients because    
    • A. 

      At high doses it increases splanchnic flow

    • B. 

      At high doses it increases coronary flow

    • C. 

      At low doses it decreases heart rate

    • D. 

      At low doses it lowers peripheral resistance

    • E. 

      It inhibits catecholamine release

  • 65. 
    A 27 year old hyperthyroid woman stopped taking propylthiouracil 6 weeks ago.She presents with moist skin,fine tremor,BP 136/58,heart rate 134 beats/min and a diffusely enlarged thyroid.Initial symptom control is best achieved with  
    • A. 

      Propranolol

    • B. 

      Potassium iodide

    • C. 

      Verapamil

    • D. 

      Adenosine

    • E. 

      Diltiazem

  • 66. 
    The single most critical factor in evaluating the growth of a child is  
    • A. 

      Body mass index

    • B. 

      Upper-to-lower body segment ratio

    • C. 

      Bone age

    • D. 

      Height velocity

    • E. 

      Arm span width

  • 67. 
    << Physiologic jaundice >> of the newborn  
    • A. 

      Is an unconjugated hyperbilirubinema

    • B. 

      Usually appears within the first 12h of life

    • C. 

      Is more common in term than in preterm infants

    • D. 

      Is generally associated with moderate anemia and reticulocytosis

    • E. 

      Is uncommon in Black infants

  • 68. 
    In iron deficiency anemia, diagnosis is confirmed by giving oral iron replacement, and then 1 week later  
    • A. 

      Repeating hemoglobin level

    • B. 

      Performing hemoglobin electrophoresis

    • C. 

      Checking serum iron level

    • D. 

      Measuring red blood cell indices

    • E. 

      Performing reticulocyte count

  • 69. 
    Patients on amiodarone (Cordarone) should be monitored regularly for : 
    • A. 

      Thyroid function tests

    • B. 

      Amiodarone levels

    • C. 

      Chest X rays

    • D. 

      Stools for occult blood

    • E. 

      Audiograms

  • 70. 
    Hemoptysis is associated with all the following except 
    • A. 

      Mitral stenosis

    • B. 

      Bronchiectasis

    • C. 

      Pneumonia

    • D. 

      Empyema

    • E. 

      Bronchogenic carcinoma

  • 71. 
    A 68 year old woman suddenly develops a fever of 38.2 degree C and a severe headache one evening.The following morning she also  experiences a stiff neck and uncharacteristic drowsiness.At the emergency room,her temperature is 38.8 degree C,and there are pain and resistance on flexion of her neck.The patient is noted to be mentally competent although lethargic.A cerebrospinal fluid (CSF) sample is obtained by lumbar puncture.On the basis of the history and physical examination of this patient what is the most probable diagnosis 
    • A. 

      Brain abscess

    • B. 

      Fungal meningitis

    • C. 

      Bacterial meningitis

    • D. 

      Viral encephalitis

  • 72. 
    A 25-year-old man presents with a large malignant melanoma on his back.There is no apparent lymphadenopathy. The most important prognostic factor is 
    • A. 

      Tumor thickness

    • B. 

      Tumor diameter

    • C. 

      Tumor location

    • D. 

      The patient's gender

    • E. 

      Mitotic rate

  • 73. 
    Which of the following is not true of appendicitis 
    • A. 

      It is the most common acute abdominal surgical condition

    • B. 

      It is the most frequent in the fifth and sixth decades

    • C. 

      The amount of lymphoid tissue in the appendix is roughly related to the likelihood of developing the condition

    • D. 

      The incidence has been declining

    • E. 

      Obstruction of the appendiceal lumen is the fundamental inciting mechanism

  • 74. 
    The most common roentgenographic abnormality in a child with asthma is    
    • A. 

      Bronchiectasis

    • B. 

      Generalized hyperinflation

    • C. 

      Lower lobe infiltrates

    • D. 

      Pneumomediastinum

    • E. 

      Right middle lobe atelectasis

  • 75. 
    In hypercotisolisrn one can observe all the following except:.
    • A. 

      Hyperleucocytosis

    • B. 

      Eosinophilia

    • C. 

      Hypokaliemia

    • D. 

      Hypercalciuria

    • E. 

      Decrease testosterone in men

  • 76. 
    A 50 year old man comes to the emergency room with a history of vomiting of 3 day's duration.His past history reveals that for approximately 20 years,he has been getting a epigastric pain,lasting for 2 to 3 weeks,during early spring and autumn.He remembers getting relief from pain by taking milk and antacids.Physical examination showed fullness in the epigastric area with visible peristalsis,absence of tenderness and normal active bowel sounds. The most likely diagnosis is 
    • A. 

      Gastric outlet obstruction

    • B. 

      Small bowel obstruction

    • C. 

      Volvulus of the colon

    • D. 

      Incacerated umbilical hernia

    • E. 

      Cholecystitis

  • 77. 
    A 54-year-old woman undergoes a laparotomy because of a pelvic mass.At exploratory laparotomy,a unilateral ovarian neoplasm is discovered that is accompanied by a large omental metastasis.Frozen section diagnosis confirms metastatic serous cystadenocarcinoma.The most appropriate intraoperative course of action is 
    • A. 

      Excision of the omental metastatis and ovarian cystectomy

    • B. 

      Omentectomy and ovarian cystectomy

    • C. 

      Excision the omental metastatis and unilateral oophorectomy

    • D. 

      Omentectomy and bilateral salpingo-oophorectomy

    • E. 

      Omentectomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy

  • 78. 
    A 40 year old woman presents with weakness, fatigue, anorexia and weight loss.Her blood pressure is 90/60,she has diffuse skin and mucous membranes hyperpigmentation.Her serum sodium is low and serum potassium high.The most likely diagnosis is : 
    • A. 

      Hypothyroidism

    • B. 

      Adrenal failure

    • C. 

      Pituitary adenoma

    • D. 

      Hyperaldosteronism

    • E. 

      Ovarian tumor

  • 79. 
    The first visible sign of puberty in girls is  
    • A. 

      Development of breast buds

    • B. 

      Appearance of early public hair

    • C. 

      Menarche

    • D. 

      Enlargement of the clitoris

    • E. 

      Appearance of axillary hair

  • 80. 
    A 71 year old woman with a history of chronic congestive heart failure presents to her family physician for a routine checkup. The physician notices that she has lost 10 kg since her last visit 6 months ago. When questioned, the patient gives a history of intermittent periumbilical pain that is worse after large meals and so she has begun to cat less out of fear of precipitating the pain. Which of the following is the most likely diagnosis 
    • A. 

      Pancreatitis

    • B. 

      Intestinal ischemia

    • C. 

      Cholecystitis

    • D. 

      Small bowel obstruction

    • E. 

      Peptic ulcer disease

  • 81. 
    A 19 year old girl presents with the chief complaint of bloody diarrhea for 2 months.She has abdominal discomfort and feels she has lost some weight.She also complains of tenesmus. Abdominal examination is normal.Rectal exam reveals stool containing blood and pus.Which of the following is the most likely diagnosis 
    • A. 

      Irritable bowel syndrome

    • B. 

      Ulcerative colitis

    • C. 

      Giardiasis

    • D. 

      Hemorrhoids

    • E. 

      Diverticulcsis

  • 82. 
    Starting at what gestational age an anti Rh D maternal immunization (RhoGam) can provoque a foetal death in utero:
    • A. 

      12 weeks gestation

    • B. 

      20 weeks gestation

    • C. 

      26 weeks gestation

    • D. 

      30 weeks gestation

    • E. 

      34 weeks gestation

  • 83. 
    A 64 year old woman is to undergo hysterectomy for uterine cancer.She is on aspirin 325 mg daily for past history of a transient ischemic attack.The most appropriate management to prevent perioperative bleeding is to: 
    • A. 

      Stop aspirin 5 days before surgery

    • B. 

      Stop aspirin 14 days before surgery

    • C. 

      Decrease aspirin to 81 mg for 1 week then stop it 3 days before surgery

    • D. 

      Add vitamin K orally

    • E. 

      Do not change aspirin

  • 84. 
    • A. 

      Thyrotoxicosis

    • B. 

      Sarcoidosis

    • C. 

      Addison disease

    • D. 

      Verner syndrome(Watery diarrhea & hypokaliemia)

    • E. 

      All of the above

  • 85. 
    Among the following, the most common cause of acquired sensorineural hearing loss in infancy is  
    • A. 

      Hyperbilirubinemia

    • B. 

      Congenital infection

    • C. 

      Ototoxic drug exposure

    • D. 

      Neuroblastoma

    • E. 

      Late onset group B streptococcal meningitis

  • 86. 
    • A. 

      Flat T waves

    • B. 

      Widened QRS complexes

    • C. 

      U waves

    • D. 

      Shortened QT interval

    • E. 

      ST segment depression

  • 87. 
    Elevation of alpha foeto protein of at least 5 times normal:
    • A. 

      Is constantly found in hepatocarcinoma

    • B. 

      Can be seen in chronic hepatitis with elevated transaminase

    • C. 

      Can be seen in kidney cancer

    • D. 

      Is specific of hepatocarcinorna on cirrhosis

    • E. 

      Is usually present in secondary hepatic carcinoma

  • 88. 
    All the following are associated with hyperparathyroidism except   
    • A. 

      Muscle weakness

    • B. 

      Myalgias, arthralgias

    • C. 

      Depression

    • D. 

      Increase in serum phosphate

    • E. 

      Pancreatitis

  • 89. 
    A 50 year old diabetic is scheduled for an angiography with contrast.Which one of the following medications should be stopped 2-3 days before the test ? 
    • A. 

      Acarbose

    • B. 

      Glimepiride

    • C. 

      Metformin

    • D. 

      Glyburide

    • E. 

      Chlorpropamide

  • 90. 
    • A. 

      Purulent secretions

    • B. 

      Maxillary pain

    • C. 

      Maxillary tenderness

    • D. 

      Toothache

    • E. 

      Worsening symptoms after initial improvement

  • 91. 
    A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy 
    • A. 

      Previous tubal surgery

    • B. 

      Pelvic inflammatory disease (PID)

    • C. 

      Use of a contraceptive uterine device (IUD)

    • D. 

      Induction of ovulation

    • E. 

      Exposure in utero to diethylstilbestrol (DES)

  • 92. 
    One should be concered about a term infant who has not passed a meconium stool
    • A. 

      During the process of birth

    • B. 

      Within a few minutes of birth

    • C. 

      By 1-2h of life

    • D. 

      By 6-12h of life

    • E. 

       By 24h of life

  • 93. 
    All the following criteria are predictive for the severity of an episode of pancreatitis except  
    • A. 

      Age

    • B. 

      Amylase level

    • C. 

      Blood glucose

    • D. 

      White blood cell count

    • E. 

      Pa02

  • 94. 
    All the following about increased intracranial pressure is true EXCEPT:  
    • A. 

      Resulting from head injury

    • B. 

      Resulting from intracranial tumors

    • C. 

      Relieved by solute diuresis

    • D. 

      An indication for spinal tap

    • E. 

      Treatable with ventriculostomy

  • 95. 
    A 30 year old woman uses albuterol inhaler once or twice a week to relieve her wheezing. You tell her that she needs :
    • A. 

      No additional medications

    • B. 

      Low dose steroids

    • C. 

      Oral beta 2 agonists

    • D. 

      Long acting beta 2 agonists inhalers

    • E. 

      Low dose steroid and long acting beta2 agonists

  • 96. 
    Five days after a total hip replacement a 72 year old woman becomes acutely short of breath, diaphoretic and hypotensive. Both lung fields are clear to auscultation and percussion but examination of the neck reveals mild jugular venous distention with prominent A waves. Heart sounds are normal, ECG shows sinus tachycardia with a new right bundle-branch block and minor non-specific ST-T wave changes. The most likelydiagnosis is   
    • A. 

      Aspiration

    • B. 

      Acute myocardial infarction

    • C. 

      Aortic dissection

    • D. 

      Pulmonary thromboembolism

    • E. 

      Pericarditis

  • 97. 
    A recently married 29-year-old nulliparous female plans to become pregnant.Which one of the following supplemental vitamins or minerals would you advise this patient to begintaking? 
    • A. 

      Thiamine

    • B. 

      Iron

    • C. 

      Calcium

    • D. 

      Folate

    • E. 

      Iodine

  • 98. 
    A 36 year old male presents to the emergency room with painless sudden onset of voluminous watery diarrhea. He is afebrile. Gram-stain of the stools reveals a curved gram-negative rod.The most likely diagnosis is     
    • A. 

      Giardiasis

    • B. 

      Salmonellosis

    • C. 

      Shigellosis

    • D. 

      Clostridial colitis

    • E. 

      Cholera

  • 99. 
    A 2 year old swallowed a button battery 3 hours ago.She is asymptomatic. An X-ray shows that the battery has passed the stomach and that it is 2 cm in diameter. You recommend to her parents: 
    • A. 

      Immediate endoscopic removal

    • B. 

      Observe and repeat X-ray in 48 hours

    • C. 

      Observe and repeat X-ray in 1 week

    • D. 

      Reassure parents that no need to do anything unless the child has abdominal pain

    • E. 

      Schedule endoscopy in 24 hours

  • 100. 
    A 15 year old girl is brought to you by her parents.Her weight dropped from 55 kg to 39 kg in one year.The patient denies any problem.She is active and says never feels hungry. Her exam is normal.The most likely diagnosis at this time is: 
    • A. 

      Hyperthyroidism

    • B. 

      Diabetes mellitus

    • C. 

      Anorexia nervosa

    • D. 

      Cancer

    • E. 

      Adrenal insufficiency

  • 101. 
    A 23 year old woman on treatment for major depression, presents to you 6 weeks pregnant. She has been doing well on fluoxetine (Prozac) and asks if she should change it. You tell her :
    • A. 

      Continue fluoxetine

    • B. 

      Switch to a tricyclic antidepressant

    • C. 

      Switch to valproic acid

    • D. 

      Switch to lithium carbonate

    • E. 

      Add bupropion

  • 102. 
    A 38 year old woman gravida 4, para 4,comes to the physician 8 days after a cesarean delivery complaining of redness and pain at the left most aspect of her incision.Her cesarean delivery was performed secondary to a non-reassuring fetal heart rate tracing. She was feeling well after the operation until 4 days ago, when she developed pain and redness around her incision,Her temperature is 37 C (98,6 F),blood pressure is 118/78mmHg, pulse is 88/min,and respirations are 12/min.there is marked erythema and induration around the incision.At the left margin of the incision there is a fluctuant mass. Which of the following is most appropriate next step in management   
    • A. 

      Expectant management

    • B. 

      Oral antibiotics only

    • C. 

      IV antibiotics only

    • D. 

      Incision and drainage

    • E. 

      Laparotomy

  • 103. 
    Anterior hypothalamic insufficiency can induce all the following except
    • A. 

      Anemia

    • B. 

      Hyperpigmentation

    • C. 

      Amenorhea

    • D. 

      Fatigue

    • E. 

      Hair loss

  • 104. 
    Concerning arterio venous malformation in the cerebral bed which one is wrong:
    • A. 

      Can be revealed by epileptic crisis

    • B. 

      Can be revealed by meningeal bleeding

    • C. 

      Can be treated by surgery and/or embolisation

    • D. 

      Can be giant

    • E. 

      Is a congenital defect of the arteries and veins

  • 105. 
    A patient with pneumococcal meningitis gives a history of severeanaphylactic reaction to parenteral penicillin. The antibiotic of choice would be  
    • A. 

      Ampicillin

    • B. 

      Ceftriaxone

    • C. 

      Gentamicin

    • D. 

      Vancomycin

    • E. 

      Aztreonam

  • 106. 
    A patient with a mechanical prosthetic valve should be anticoagulatedwith the following target INR
    • A. 

      2.0

    • B. 

      3.0

    • C. 

      4.0

    • D. 

      5.0

  • 107. 
    You examine an 18-year-old male college student with a 5-day history of fever, sore throat, and fatigue. Physical examination reveals an exudative tonsillitis and bilateral enlarged and slightly tender posterior cervical lymph nodes.The spleen is palpable 3 cm below the rib cage. The agent most likely responsible for this patient's illness is 
    • A. 

      Group A beta-hemolytic Streptococcus

    • B. 

      Adenovirus

    • C. 

      Toxoplasma gondii

    • D. 

      Epstein-Barr virus

    • E. 

      Corynebacterium diphtheria

  • 108. 
    The arthritis of acute rheumatic fever usually    
    • A. 

      Is monoarticular

    • B. 

      Heals without deformity

    • C. 

      Appears after the fever subsides

    • D. 

      Is seen only in patients with concurrent carditis

    • E. 

      Involves large and small joints equally

  • 109. 
    Each of the following organisms may be associated with bloody diarrheaexcept
    • A. 

      Entamoeba histolytica

    • B. 

      Shigella bodyii

    • C. 

      Giardia Lamblia

    • D. 

      Campylobacter jejuni

    • E. 

      Escherichia coli

  • 110. 
    A common complication of pelvic inflammatory disease secondary to chlamydia infection of the lower genital tract is  
    • A. 

      Perihepatitis

    • B. 

      Coagulopathy

    • C. 

      Arthritis

    • D. 

      Meningitis

    • E. 

      Endocarditis

  • 111. 
    A 16 year old boy is referred to your practice for leg claudication. His right arm blood pressure is 150/110 mmHg. On auscultation a systolic  murmur best heard over the middle of the upper back is detected. You also find that the patient's femoral pulses are diminished when compared to his brachial pulses. Which of the following is the most likely diagnosis 
    • A. 

      Patent ductus arteriosus

    • B. 

      Ventricular septal defect

    • C. 

      Coarctation of the aorta

    • D. 

      Atrial septal defect

  • 112. 
    A 75 year old male complains of unilateral headache.On one occasion he transiently lost his vision.He also complains of aching in the shoulders and neck.There are no focal neurologic findings. Carotid pulses are normal without bruit. There is some tenderness over the left temple. Laboratory data show a mild anemia. Which of the following tests is the most likely to be abnormal
    • A. 

      Carotid ultrasound

    • B. 

      CT scan

    • C. 

      Erythrocyte sedimentation rate

    • D. 

      X-ray of the left shoulder

    • E. 

      Skull films

  • 113. 
    A 50 year old woman with a history of essential hypertension presents to the emergency department with a severe headache, nausea and vomiting and photophobia.On examination, her BP is 160/100 mmHg.She is mildly confused and has nuchal rigidity without focal neurologic signs.The most likely diagnosis is 
    • A. 

      Hemorrhagic stroke

    • B. 

      Ruptured cerebral aneurysm

    • C. 

      Meningitis

    • D. 

      Ischemic cerebrovascular accident

    • E. 

      Transient ischemic attack

  • 114. 
    • A. 

      Neonatal meningitis

    • B. 

      Congenital heart disease

    • C. 

      Cystic fibrosis

    • D. 

      Fetal distress

    • E. 

      Tracheoesophageal fistula

  • 115. 
    A 40 year old male with long standing alcohol abuse complains of abdominal swelling, which has been progressive over month, He has a history of gastrointestinal bleeding. On physical exam there are spider angiomata and palmer erythema, abdominal collateral vessels are seen around the umbilicus. There is shifting dullness , and bulging flanks arenoted. A paracentesis is performed on the patient, the serum albumin minus ascitic fluid albumin equals 1,2 g/dl, The most likely cause of his ascites is 
    • A. 

      Portal hypertension

    • B. 

      Pancreatitis

    • C. 

      Tuberculosis

    • D. 

      Hematoma

    • E. 

      Lymphoma

  • 116. 
    A 68 year old patient is referred for persistently heme-positive stools.His hemoglobin level was initially in the low-normal range,and oral iron supplementation has raised it to mid-normal levels, his primary care physician has performed a single-contrast barium enema and rigid sigmoidoscopy, both of which were unrevealing. The patient is not no NSAIDS and has no upper gastrointestinal symptoms. The most appropriate next step would be to   
    • A. 

      Observe the patient

    • B. 

      Repeat the occult blood tests

    • C. 

      Perform flexible sigmoidoscopy

    • D. 

      Perform an air-contrast barium enema

    • E. 

      Perform colonoscopy

  • 117. 
    A patient has the following pulmonary function tests: Diminished FEV1, Normal FVC, increased static compliance, decreased DLCO, increase Total Lung Capacity.The most likely diagnosis is: 
    • A. 

      Emphysema

    • B. 

      Chronic bronchitis

    • C. 

      Asthma

    • D. 

      Pulmonary fibrosis

    • E. 

      Neuromuscular weakness affecting the thoracic wall and the diaphragm

  • 118. 
    A 51 year old man is involved in a motor vehicle accident. He was not wearing a seat belt and remembers striking the steering wheel during the collision. On arrival at the emergency room, the patient is complaining of chest pain and shortness of breath. His blood pressure is 120/80 mmHg but decreases to 90/50 mmHg at the end of inspiration. He has jugular vein distension with distant heart sounds. Lung examination reveals normal breath sounds bilaterally. Which of the following is the most likely diagnosis     
    • A. 

      Aortic dissection

    • B. 

      Ruptured aorta

    • C. 

      Pneumothorax

    • D. 

      Congestive heart failure

    • E. 

      Cardiac tamponade

  • 119. 
    A 2-year-old male presents with upper respiratory symptoms for 3 days and 1 day of fever, irritability,and right ear pain.Examination reveals a temperature of 39 degree C,clear rhinorrhea,an immobile right tympanic membrane with diffuse light reflex.The most appropriate initial therapy is  
    • A. 

      Antihistamines and ibuprofen

    • B. 

      Antihistamines and acetaminophen

    • C. 

      Penicillin

    • D. 

      Amoxicillin

    • E. 

      Erythromycin

  • 120. 
    In an unresponsive apneic infant under 1 year of age, pulse should be checked by feeling the: 
    • A. 

      Brachial artery

    • B. 

      Carotid artery

    • C. 

      Radial artery

    • D. 

      Ulnar artery

    • E. 

      Cardiac apex

  • 121. 
    The best initial study for a child with secondary nocturnal enuresis is 
    • A. 

      Renal ultrasound

    • B. 

      Voiding cystourethrogram

    • C. 

      Abdominal radiograph

    • D. 

      Urine analysis

    • E. 

      Creatinine clearance

  • 122. 
    • A. 

      Erythrocyte sedimentation rate (ESR)

    • B. 

      Rheumatoid factor

    • C. 

      Antinuclear antibodies (ANAs)

    • D. 

      HLA-B8

    • E. 

      Sacroiliac radiographs

  • 123. 
    • A. 

      Trichomonas

    • B. 

      Candida

    • C. 

      Human Papilloma Virus

    • D. 

      Chlamydia

    • E. 

      Gardnerella

  • 124. 
    A 36-year-old man with no previous medical history presents with a complaint of dyspepsia unresponsive to H2 receptor antagonists. Upper endoscopy reveals a duodenal ulcer, and clot test Helicobacter pylori is positive. He is treated with PPI (proton pump inhibitor), with antibiotics to eradicate H Pylori, Two months later, he is asymptomatic, and feels well. Which of the following is the most appropriate next step?  
    • A. 

      Upper gastrointestinal barium study

    • B. 

      H Pylori serology

    • C. 

      Upper endoscopy

    • D. 

      Determination of serum gastrin level

    • E. 

      Breath test for H Pylori

  • 125. 
    • A. 

      Platelets count below 75000

    • B. 

      A prothrombin time below 50%

    • C. 

      A supra hepatic gradient of pressure of more than 12 mmHg

    • D. 

      The presence of many varicoses veins

    • E. 

      Presence of a significant collateral circulation

  • 126. 
    A 68 year old man is admitted to the medical service for chest pain.The patient has an 80 pack-year smoking history and is known to have an elevated total cholesterol but unknown LDL and HDL components. He is a known insulin-dependent diabetic with a recent hemoglobin A 1c fraction of 8.3%. he has a history of chronic, stable angina precipitated by exertion and relieved by rest. During the examination he is free from chest pain. His blood pressure is 160/90 mmHg,pulse is 90/min, and respirations are 22/min. he is mildly diaphoretic, On physical examination, he has an S3 gallop, bibasilar course rales, and anabdominal bruit. A chest radiograph shows mild pulmonary edema. On ECG obtained on arrival to the floor shows ST segment depressions in leads V3, V4, V5 and V6. which of the following is the most likely diagnosis
    • A. 

      Costochondritis

    • B. 

      Pulmonary embolus

    • C. 

      Musculoskeletal chest pain syndrome

    • D. 

      Myocardial ischemia

    • E. 

      Myocardial infarction

  • 127. 
    In a cirrhotic patient,all the following factors are risks for developing hepatocellular carcinoma except: 
    • A. 

      Age less than 50

    • B. 

      Male sex

    • C. 

      Viral cause of cirrhosis

    • D. 

      Hepatocellular insufficiency

    • E. 

      Presence of large cell dysplasia

  • 128. 
    Kernicterus is most likely related to the serum level of   
    • A. 

      Total bilirubin

    • B. 

      Conjugated bilirubin

    • C. 

      Unconjugated bilirubin

    • D. 

      Haptoglobin

    • E. 

      Hemoglobin

  • 129. 
    A 32 year old woman presents with a 2-day history of "the room spinning",She tastes that this occurs when she suddenly moves her head from one position to another.She complains of nausea and vomiting accompanying the spinning sensation but has no other symptoms. On physical examination, she is afebrile and her tympanic membranes are bilaterally normal. Nystagmus to the left is produced when the patient is lying on her left side. Which of the following is the most likely diagnosis?   
    • A. 

      Cerebellopontine tumor

    • B. 

      Viral labyrinthitis

    • C. 

      Benign paroxysmal positional vertigo

    • D. 

      Meniere's disease

    • E. 

      Trismus

  • 130. 
    A 32 year old man is stabbed in the arm. There is no evidence of vascular injury, but he cannot flex his three radial digits. He has injured  the  
    • A. 

      Flexor pollicis longus

    • B. 

      Radial nerve

    • C. 

      Median nerve

    • D. 

      Thenar and digital nerves at the wrist

    • E. 

      Ulnar nerve

  • 131. 
    A 72 year old man has the sudden onset of suprapubic pain and oliguria.His temperature is 38.0 degree C (100.4 degree F), pulse is 100/minute, respirations are 12/minute, and BP is 110/72 mm Hg.Abdominal examination is only remarkable for a tender, distended urinary bladder.Immediate management of this patient should be to   
    • A. 

      Obtain a flat plate of the abdomen

    • B. 

      Perform abdominal ultrasonography

    • C. 

      Insert a urethral catheter

    • D. 

      Administer furosemide IV

    • E. 

      Obtain an IVP

  • 132. 
    Flexible esophagogastroduodenoscopy is indicated for all of the following except 
    • A. 

      The acute phase after corrosive ingestion

    • B. 

      Gastric ulcer

    • C. 

      Upper GI bleeding

    • D. 

      Dysphagia

    • E. 

      Epigastric pain with normal x-ray findings

  • 133. 
    Rebound hypertension is more likely with which one of the following :  
    • A. 

      Clonidine

    • B. 

      Captopril

    • C. 

      Hydrochlorothiazide

    • D. 

      Losartan

    • E. 

      Diltiazem

  • 134. 
    The most common permanent complications of congenital cytomegalovirus infection involve the 
    • A. 

      Central nervous system

    • B. 

      Heart

    • C. 

      Hematopoietic system

    • D. 

      Immune system

    • E. 

      Liver

  • 135. 
    Mesenteric infarctus of arterial origin should be suspected in patients with acute abdominal pain associated with all the following prior medical history except: 
    • A. 

      Myocardial infarctus

    • B. 

      Mitral stenosis

    • C. 

      Cerebral vascular events

    • D. 

      Cardiogenic shock

    • E. 

      Aortic dissecting aneurysm

  • 136. 
    • A. 

      Pruritus

    • B. 

      Bradycardia

    • C. 

      Steatorrhea

    • D. 

      Clay colored stools

    • E. 

      Gastrointestinal bleeding

  • 137. 
    An 18-year-old woman presents with arthritis that is asymmetrical and involves more than three joints. The arthritis is migratory, affecting one joint for several days and improving,then affecting another joint. On physical examination the patient has several subcutaneous nodules and her cardiac exam reveals an S3 gallop.Which of the following is the most likely diagnosis 
    • A. 

      Lyme disease

    • B. 

      Endocarditis

    • C. 

      Rheumatoid arthritis

    • D. 

      Gout

    • E. 

      Rheumatic fever

  • 138. 
    Which one of the following is an osmotic laxative? 
    • A. 

      Psyllium

    • B. 

      Polyethylene glycol

    • C. 

      Senna

    • D. 

      Mineral oil

    • E. 

      Docusate sodium

  • 139. 
    Stenosis of th right renal artery could lead to:
    • A. 

      Increased rennin release from the left kidney

    • B. 

      Decreased urinary sodium concentration by the right kidney

    • C. 

      Increased sodium reabsorption by the right kidney

    • D. 

      Increased rennin release from the right kidney

    • E. 

      A compensatory hypoaldosteronism in the controlateral kidney

  • 140. 
    A 20 year old patient with nausea, vomiting and vertigo one week following an upper respiratory tract infection likely has           
    • A. 

      Otitis

    • B. 

      Benign positional vertigo

    • C. 

      Vestibular neuronitis

    • D. 

      Acoustic neuroma

  • 141. 
    Manifestations of the first stage of severe acute iron poisoning include  
    • A. 

      Lethargy and coma

    • B. 

      Metabolic alkalosis and hypertension

    • C. 

      Hemolysis and neutropenia

    • D. 

      Renal, hepatic and cardiac injury

    • E. 

      Hypoglycemia and hepatic injury

  • 142. 
    Which of the following antibodies is the most specific in primary biliary cirrhosis:
    • A. 

      Anti smooth muscle antibody

    • B. 

      Antimitochondrial antibodies

    • C. 

      Anti LKM1 antibodies

    • D. 

      Antinuclear antibodies

    • E. 

      P-ANCA

  • 143. 
    The most common initial manifestation of increasing intracranial pressure in the victim of head trauma is            
    • A. 

      Change in level of consciousness

    • B. 

      Ipsilateral (side of hemorrhage) papillary dilation

    • C. 

      Contralateral papillary dilation

    • D. 

      Hemiparesis

    • E. 

      Hypertension

  • 144. 
    A 10-year-old male presents with an acute episode of nausea,vomiting and severe testicular pain.On examination,scrotal edema and erythema with lack of cremasteric relex are noted. Color-flow Doppler ultrasonography confirms the suspected diagnosis.The initial treatment of choice is  
    • A. 

      Observation for 24 h

    • B. 

      Immediate surgical exploration

    • C. 

      Chemotherapy

    • D. 

      Intravenous antibiotics

    • E. 

      Intramuscular ceftriaxone

  • 145. 
    • A. 

      Asthma

    • B. 

      Diabetes mellitus

    • C. 

      Hyperthyroidism

    • D. 

      Seizure disorder

    • E. 

      Sickle cell anemia

  • 146. 
    A 17 year old male football player reports a sudden pain in the left side of his chest with shortness of breath during warm up for the game. Exam reveals a tachypneic anxious man with decreased breath sounds on the left. The most helpful test in this situation is ;  
    • A. 

      EKG

    • B. 

      Arterial blood gas

    • C. 

      Ventilation perfusion scan

    • D. 

      CT angiography

    • E. 

      Chest X ray

  • 147. 
    The target LDL in a diabetic should be:   
    • A. 

      < l00 mg/dL

    • B. 

      < 130 mg/dL

    • C. 

      < 160 mg/dL

    • D. 

    • E. 

      < 220 mg/dL

  • 148. 
    A 57 year female with arthritis aphtous stomatitis and gynecological non specific complaints was admitted to the hospital because of sudden onset of rectal bleeding. A sigmoidoscopy showed anal canal ulcer. The most likely possibility is 
    • A. 

      Ulcerative colitis

    • B. 

      Chlamydia

    • C. 

      Behcet disease

    • D. 

      Crohn disease

    • E. 

      Reiter syndrome

  • 149. 
    A 16 year old boy presents with the chief complaint of palpitations while in gym class. The palpitations occur with moderate exertion and are relieved with rest.He denies shortness of breath, dizziness, and chest pain.Heart examination reveals a systolic murmur that increases with standing.Which of the following is the most likely diagnosis
    • A. 

      Mitral regurgitation

    • B. 

      Aortic insufficiency

    • C. 

      Tricuspid regurgitation

    • D. 

      Hypertrophic cardiomyopathy

    • E. 

      Mitral stenosis

  • 150. 
    A 74 year old diabetic presents with a well-demarcated ulcer on the lateral aspect of his left ankle. You are unable to feel the pulses of his feet because of significant edema. The most appropriate next step would be to:
    • A. 

      Prescribe elastic bandages

    • B. 

      Prescribe aspirin 300 mg daily

    • C. 

      Prescribe pentoxifylline (Trental) 800 mg daily

    • D. 

      Perform venography

    • E. 

      Perform a noninvasive ultrasonic arterial evaluation

  • 151. 
    A 37 year old woman gravida 3, pare 2 comes to her physician for follow-up on her ectopic pregnancy.She was diagnosed with an ectopic  pregnancy 7 days ago and given methotrexate.She now presents with abdominal pain that started this morning.Examination is significant for moderate left lower quadrant tenderness.Laboratory analysis shows that  her beta-HCG value has doubled over the past week.Transvaginal ultrasound shows that the ectopic pregnancy is roughly the same size but there is an increased amount of fluid in the pelvis.Which of the following  is the most appropriate next step in management 
    • A. 

      Expectant management

    • B. 

      Repeat methotrexate

    • C. 

      Laparoscopy

    • D. 

      Oophorectomy 

    • E. 

      Hysterectomy

  • 152. 
    The most common manifestation of cystic fibrosis in the newborn infant Is      
    • A. 

      Pneumonia

    • B. 

      Intrauterine growth retardation

    • C. 

      Meconium ileus

    • D. 

      Wheezing

    • E. 

      Hypochloremic alkalosis

  • 153. 
    A 48 year old man presents with inability to move the right side of his mouth.On physical examination,the patient has difficulty raising his right eyebrow,puffing out his right cheek, and smiling using the right side of his mouth.His nasolabial fold on the right is absent. Blinking is sparse on the right compared to the left,but extraocular muscles are intact and pupils are equal and reactive,the patient's tongue is midline. Which of the following is the most likely diagnosis  
    • A. 

      Paralysis of cranial nerve V

    • B. 

      Paralysis of cranial nerve VII

    • C. 

      Paralysis of cranial nerve XII

    • D. 

      Horner syndrome

    • E. 

      Pancoast tumor

  • 154. 
    A 60 year old man presents to your office with an 80 pack/year history of cigarette smoking.He complains of some dyspnea on exertion,He has an increased anteroposterior thickness of the thorax.Lung examination reveals decreased fremitus,hyperresonnance on percussion,and diminished breath sounds.Which of the following is the most likely diagnosis  
    • A. 

      Bronchiectasis

    • B. 

      Asthma

    • C. 

      Emphysema

    • D. 

      Pleural effusion

    • E. 

      Pneumonia

  • 155. 
    A 54 year old obese woman presents with the chief complaint of hemoptysis.She states that over the last day she coughed up approximately 10 ml of blood- streaked sputum.She denies fever,chills,chest pain,or shortness of breath.She does admit to a recent upper respiratory tract infection with cough and a copious amount of sputum production.She remembers similar episodes of cough with bloody sputum occurring after colds for the last several years.She smokes one pack of cigarettes per day since high school.Examinations of the pharynx and lungs are normal.Which of the following is the most likely diagnosis
    • A. 

      Chronic bronchitis

    • B. 

      Tuberculosis

    • C. 

      Adenocarcinoma of the lung

    • D. 

      Congestive heart failure

    • E. 

      Pulmonary infarctus

  • 156. 
    A 23 year old student presents to your office for health clearance to play collegiate sports. He is asymptomatic and exercises daily. On physical examination his blood pressure is 160/50 mmHg and his pulse rate is 60/min. there is pulses bisferiens. Heart examination reveals an early diastolic rumble at the apex and a blowing diastolic murmur at the left sternal border. Nail beds reveal a Quincke pulse. Which of the following is the most likely diagnosis
    • A. 

      Cardiac tamponade

    • B. 

      Aortic insufficiency

    • C. 

      Mitral stenosis

    • D. 

      Atrial septal defect

    • E. 

      Tetralogy of Fallot

  • 157. 
    A 64 year old man with a history of hypertension presents with sharp midsternal chest pain that is intermittent and radiates to his back between his shoulder blades.Blood pressure is 170/110 mmHg in his right arm and 90/60 mmHg in his left arm.Heart auscultation reveals a diastolic murmur. ECG is normal.Chest radiograph reveals a widened mediastinum.Which of the following is the most likely diagnosis
    • A. 

      Myocardial infarction

    • B. 

      Pulmonary embolus

    • C. 

      Aortic dissection

    • D. 

      Coarctation of the aorta

    • E. 

      Aortic stenosis

  • 158. 
    A 22 year old graduate student presents with a 2-week history of a dry cough.Her symptoms include sore throat at the start of the illness, low-grade fever, and generalized malaise.She is otherwise healthy and does not drink alcohol,or smoke cigarettes.Several of her colleagues at school are ill with a similar illness.Physical examination reveals normal vital signs,and lung examination reveals some crackles at the right midaxillary line.Which of the following is the most appropriate  
    • A. 

      Pneumococcal pneumonia

    • B. 

      Mycoplasma pneumonia

    • C. 

      Aspiration pneumonia

    • D. 

      Primary pulmonary hypertension

    • E. 

      Legionella pneumonia

  • 159. 
    You are examining a 6 months old boy for the first time and you cannot feel his right testicle in the scrotum but can palpate it high in the inguinal canal and cannot bring it down to the scrotum.You recommend to parents: 
    • A. 

      Re-evaluation in 6 months

    • B. 

      Pelvic ultrasound

    • C. 

      Serum testosterone

    • D. 

      Urology consultation soon

    • E. 

      Surgery when the boy is 2 years old

  • 160. 
    • A. 

      Pancreatitis

    • B. 

      Subarachnoid hemorrhage

    • C. 

      Renal failure

    • D. 

      Chronic arthritis

    • E. 

      Cardiomyopathy

  • 161. 
    A 25 year old pregnant woman presents for her 6 weeks postpartum visit, her pressure is 124/78.She tells you that during her third trimester,she had a blood pressure of 170/100 and moderate edema.She had no proteinuria and no other symptoms or signs or abnormal laboratory tests whatsoever. You tell her that she most likely had :  
    • A. 

      Mild preeclampsia

    • B. 

      Moderate preeclampsia

    • C. 

      Gestational hypertension

    • D. 

      Preeclampsia superimposed on hypertension

    • E. 

      Preeclampsia with HELLP syndrome

  • 162. 
    Among the following biological tests, which one will allow to differentiate between Basedow and the other causes of hyperthyroidism
    • A. 

      TSH

    • B. 

      Antiperoxidase antibodies

    • C. 

      Antibodies anti TSH receptors

    • D. 

      Free T4

    • E. 

      T3

  • 163. 
    A 71 year old man presents to your office with the chief complaint of a 20 kg weight loss over the last 4 months.He has anorexia and generalized weakness.Abdominal examination is positive for a scaphoid abdomen and a palpable nodule found in the area of the umbilicus,The nodule is irregular and appears to replace part of the umbilicus.Which of the following is the most likely cause of the physical examination findings   
    • A. 

      Pancreatic cancer

    • B. 

      Esophageal cancer

    • C. 

      Hepatocellular cancer

    • D. 

      Renal cell carcinoma

    • E. 

      Hodgkin's lymphoma

  • 164. 
    An 80 year old woman complains of a 4 month history of worsening  gait and low back pain that is worse on walking. She denies any trauma and is not incontinent. She has been fairly healthy and only takes iron supplements. On examination, she has hypoactive muscle stretch reflexes in the legs. The plain x-rays of the lumbosacral region show degenerative changes that seem age-appropriate. Which of the following is the most likely diagnosis? 
    • A. 

      Acute lumbar disc herniation

    • B. 

      Cervical stenosis

    • C. 

      Lumbar stenosis

    • D. 

      Myopathy

    • E. 

      Normal pressure hydrocephalus

  • 165. 
    A 6 year old girl has hard bilateral masses in the inguinal areas.The priority is to     
    • A. 

      To reduce both mass

    • B. 

      To operate with the diagnosis of bilateral inguinal hernia of the ovaries

    • C. 

      To request a karyotype

    • D. 

      Do a fine needle aspirate and cytology examination

    • E. 

      Do a surgical biopsy of the mass

  • 166. 
    During hemolytic anemia, it is unusual to find:
    • A. 

      A hemoglobin level at 4 gr/l

    • B. 

      A reticulocyte count at 6%

    • C. 

      A sedimentation rate at 35mm

    • D. 

      An elevated haptoglobin

    • E. 

      An iron level normal or elevated

  • 167. 
    All the following can explain anemia in a 6 month newborn except:
    • A. 

      Deficit in pyruvate kinase

    • B. 

      Spherocytosis

    • C. 

      Peptic oesophagitis

    • D. 

      Iron deficiency

    • E. 

      Lead intoxication

  • 168. 
    An 18 month child with fever of 39°C, cough and dyspnea,could have all the following except:         
    • A. 

      Lobar pneumonia

    • B. 

      Acute bronchiolitis

    • C. 

      Acute tracheo-bronchitis

    • D. 

      Acute pharyngitis

    • E. 

      Purulent pleuresia

  • 169. 
    Among the following , which artery is responsible for posterior epistaxis:
    • A. 

      Ascending pharyngeal artery

    • B. 

      Sphenopalatine artery

    • C. 

      Posterior ethmoidal artery

    • D. 

      External  carotid artery

    • E. 

      Internal carotid artery

  • 170. 
    A 30 year old has a discharge from his right ear of a long duration, right sided headache, decreased hearing in his right ear and motion precepitated vertigo. The most likely diagnosis is: 
    • A. 

      Meniere disease of the right ear

    • B. 

      Right acoustic neuroma

    • C. 

      Multiple sclerosis

    • D. 

      Benign paroxysmal vertigo

    • E. 

      Cholesteatoma of the right mastoid

  • 171. 
    Age related macular degeneration:
    • A. 

      Essentially involves internal retina layers

    • B. 

      Is a recessive disease

    • C. 

      Occurs in patients less than 60 years

    • D. 

      Can induce central scotoma

    • E. 

      The main symptom is a peripheral visual field defect

  • 172. 
    The best exam to evaluate regional abdominal lymph nodes metastasis is 
    • A. 

      Lymphography

    • B. 

      Endoscopic ultrasound

    • C. 

      ERCP

    • D. 

      CT scan

    • E. 

      Barium swallow

  • 173. 
    Concerning gastric cancer, endoscopic ultrasound has all the following advantages except:
    • A. 

      Evaluation of the depth of the lesion

    • B. 

      Detecting lymph node invasion next to lesion

    • C. 

      Detection of intra hepatic lesions

    • D. 

      Visualise the pancreas

    • E. 

      Discovery of an intramural lesion

  • 174. 
    • A. 

      Nifedipine

    • B. 

      Colchicine

    • C. 

      Beta blockers

    • D. 

      Aspirin

    • E. 

      Corticoids

  • 175. 
    The infection to look for in case of recurrent erythema multiforme is: 
    • A. 

      Measles

    • B. 

      Herpes virus infection

    • C. 

      Syphilis

    • D. 

      Scarlet fever

    • E. 

      Rickettsia

  • 176. 
    Heliotrope rash of the face and lids is characteristic of
    • A. 

      Dermatomyositis

    • B. 

      Sarcoidosis

    • C. 

      Disseminated lupus erythematosus

    • D. 

      Scleroderma

    • E. 

      Behcet disease

  • 177. 
    The most common ocular lesion found in Horton disease is:  
    • A. 

      Conjonctivitis

    • B. 

      Papillar edema

    • C. 

      Anterior optic ischemic neuropathy

    • D. 

      Chorioretinitis

    • E. 

      Cataract

  • 178. 
    • A. 

      Decreased ferritin

    • B. 

      Decreased hemoglobin

    • C. 

      Increased reticulocyte count

    • D. 

      Decreased - MCV

    • E. 

      Decreased MCH

  • 179. 
    All Patients with myelodysplasia will have: 
    • A. 

      Sideroblastic rings

    • B. 

      Blasts more than 5%

    • C. 

      Can go on acute leukemia

    • D. 

      Have chromosomic abnormalities

    • E. 

      Dysplastic medullary changes

  • 180. 
    • A. 

      Placental tear

    • B. 

      Breech presentation

    • C. 

      Occlusion of the umbilical cord

    • D. 

      Uterine rupture

    • E. 

      Maternal hypotension