July 2013:

1- 4 yo male, his teacher said he can't set with his friends in a circle more than 15 min, he
refuses to share his games with his friends, starts crying when his mother left him in the
school, he sets quite in his mother lab, but doesn’t allow her to examine his ear, has two
cousins one with ADHD, and the other with autism. What does the child have?

a- ADHD

b- Autism

c- Separation disorder

2- 23 yo male, prefer to be alone or with his girlfriend in his house, doesn’t like to be outside
with other people because he feels they keep looking at him, when he is between people he
gets episodes of tachypnea and feels "paranoid". pt has?

a- Schizoid personality disorder

b- Social phobia

c- There was no avoidant personality disorder.

3- Young male came to ER after he got fight with other guys and was kicked on his stomach,
pt has low BP, bilateral flank ecchymosis, in urinalysis +4 RBC. Next step?

a- Cyctoscopy

b- Ct abdomen

c- Renal venography

4- old pt was admitted for COPD exacerbation, was given the treatment regime, the weekday
doctor suspect PE so he asks for CT angio on Friday, and tried to contact weekenday doctor
to tell him to follow the CT, but he couldn't, so he told the nurse to do so..next day pt has
vital signs deterioration, the weekend day doctor didn't check the CT till Saturday night and
found multiple PE, the committee of the hospital has a meeting, what's the best
recommendation they may make?

a- Let the weekday doctor has the pager number of weekend day doctor to call him.

b- Let the weekday doctor write on the chart what he wants in details

c- Let the weekday doctor email the weekend day doctor about the patients
d- Let the weekday doctor and the weekend day doctor meet every Friday after noon to
discuss the patients cases together.

5- A study to treat a disease with medication, the risk of the disease with the treatment 0.50
and without the treatment 0.75, what's the NNT?

1/ 0.75 – 0.50 = 400

6-medication adv. about "esseprosso" for HTN, asks what was the medication compared
with?

Placebo

Which medication group does this drug belong to (in the adv. the drug lowers the BP and
HR)?

B blocker.

7- drug adv. About drug for DM, it was only one page taking about the drug.

what's the best benefit of this drug?

For type 1diabetic peds on insulin

For type 1 dibetic ped on oral medication

For only type 1 diabetic adults

It was mentioned that it's given for adult and peds for type 1 DM and uncontrolled type 2.

which is the best route to give the drug?

IM

SC

It's mentioned in the adv that it's given SC

The drug compared with?

Oral DM medication

Regular insulin

It was mentioned that it was compared with insulin but didn’t mentioned which type.

8- 2x2 tablet, asks about odd ratio?

9- pt drink a lot of alcohol tried a lot to stop drinking but failed, joined a program to help
him in that and asks if there's a medication can help him?
Bupropion

Methyl…Acetate (sorry couldn't remember the exact name)

I can't remember if naloxon and naltrexon mentioned also.

10- old lady has DM, HTN, came with substernal pain radiate to her left arm, not relieved by
NTG, ECG shows LBBB which wasn't on the last year ECG, toroponin within normal range,
next step?

a- Exercise stress test

b- Go for catheterization

c- Nuclear stress test

11- male with DM, HTN, GERD and gastric ulcer, on multiple meds but was no meds for
GERD, has substernal pain, not relieved by NTG, BP: 150/70, ECG was normal except T
wave inversion (as I remember it was in all leads), what the cause of the pt complain?

a- Acute coronary syndrome

b- GERD

c- Aortic dissection

d- There was no NSTEMI

12- Young lady, h/o splenoctomy after accident long time ago, she will has dental procedure,
what should u give her as prophylaxis?

a- Amoxicillin

b- Vancomycin

c- No need for prophylaxis

13- young child with holosystolic murmur in the left sterna border, 1/6 in intensity, doesn't
have any complain and he's totally normal, what should u give him as prophylaxis?

a- Amoxicillin

b- Vancomycin
c- No need for prophylaxis.

14- young lady has ulcer in her medial side of ankle where she hit it with the disk it has been
for the last two weeks without an improvement, there was a photo of 10 cm of red shallow
ulcer what the best to do?

a- Hyper pressure oxygen

b- Sharp edge debrement

15- 42 yo lady with vaginal pruritus, on examination it was small mildly erythematous raised
lesion on the labia majora, what's the cause?

a- HPV

b- HSV

c- Chlamydia

d- Bacteria vaginalsis

16- media Q: was so easy,

One for AR in old pt with fatigue, and has wide pulse pressure

One for normal healthy child the same in sample, ask what to tell the parents? Reassurance

17- 4 day old baby, uncomplicated delivery done at home, his mother noticed some red
mottled on the umbilical cord, and red color on his eye, by examination baby has retinal
hemorrhage, next step?

a- Vit k

b- Vit D

c- Vit A

18- study to compare the URI in two group, first group was nurses , second group was store
worker, the first group was checked once weekly, the second group was checked once every
three days. The study shows that first group has higher URI incidence comparing to the
second group. What's the bias in this group?

a- Selection
b- Confounding

c- Measurement

I think the right answer is a, I’m not sure.

19-pt with MM, what's the mechanism for hypercalcemia?

a- Osteoclast activation by…..(I don't remember)

b- Vit D activation

20- young lady with difficulty hearing for low frequency sounds, her father has the same
problem, what's the diagnosis?

Otosclerosis

21- young lady after surgery for craniopharyngioma, has mental status deterioration, high
Na, high serum osmolarity, low urine osmolarity, what’s the cause?

a- SIADH

b- ADH deficiency and water waste

22- lady with small mass in her dorsal wrist, it's painful, not changed in size, on examination
it's hard mass not moveable with moving the fingers, what's the diagonosis?

a- Tendonitis

b- Ganglion

c- There was not any kind of tumors in the choices

23- middle age lady with symptoms of hyperthyroidism, high T4, T3, low TSH, has palpable
thyroid gland (didn’t mentioned if it's tender or not), low radio uptake iodine, what’s the
diagnosis?

a- Graves

b- Exogenous thyroxin

c- Release of preformed thyroxin due to thyroiditis

c
24- Young lady with one episode of vision loss, last year she experienced urinary
incontinence and parasthesia in her legs which resolved spontaneously, what's the diagnosis?

MS

25- middle age lady doesn't have any complain, one of her relatives died of pancreatic
cancer, ask the doctor about new test for pancreatic cancer screening, the doctor did the test
and it was positive. What u should tell the pt?

a- She's at high risk for pancreatic cancer du to family history

b- She's at high risk for pancreatic cancer due to the test result

c- She's not at high risk for pancreatic cancer since she doesn't have any symptoms

26- doctor has a good funds and want to do something to help in improving the health
system. which is the best thing to invest in?

a- Smoking cessation

b- Alcohol drinking

27- 60 yo lady with history of sun burn last year, her cousin died of melanoma at 63, there’s
a picture for her showing a brown mass in her shoulder about 5 cm. it didn’t change in size
or color, what’s the most risk factor for this lesion?

a- history of sun burn

b- genetic factor

c- age

28- 42 yo lady experiencing prolonged and heavy menses for the last six months, her menses
were regular, genital exam is normal, last pap smear didn't show any abnormalities, doesn't
smoke or drink, vital signs normal, what's the best method for her complain?

a- Estrogen oral contraceptive

b- Estrogen ring

c- Progestin IUD

d- Copper IUD

d
29- youn male has watery diarrhea for the last couple days, abdominal cramps, no fever, vital
signs are normal, he has h/o travel to mexico, what's the cause?

a- Rotavirus

b- E.coli (I don't remember which type)

c- Salmonella

d- Entamebia hystolitica

30- pt treated for TB, and has parasthesia in his R leg, one of the drugs he takes INH, what
could prevent this?

B6.

31- 6 months old baby he can say "ma, ga, ba", he can sit without help, he can't between his
hands, can't take things from others?

All choices regarding Fine motor, gross motor, language

Gross motor and language is normal, I’m not sure if his fine motor is normal or abnormal.

32- old lady underwent upper endoscopy, doctor has hard time doing it because there was
resistance for the scope to go in, pt vomited multiple time, after finishing , doctor noticed
swelling in her neck, CXR shows air in the neck, what's the cause?

a- Pharynx rupture

b- Proximal esophagus rupture

c- Bronchial rupture

d- Trachea rupture

33- young male, he's totally normal regarding the physical exam and blood tests except
LDL:250, what to do?

a- Diet and exercise

b- Start simvastatin

c- Start gimfeprizole

d- Start niacin

b
34- two Q about the test to check renal function in DM pt?

Microalbumin in urine

35- young child, has short stature and short limbs, normal head size, where's the problem?

Fibroblast growth factor 3 receptor

36- pt with cushing syndrome symptoms, high dose cortisone test was negative, what's the
next test?

a- MRI brain

b- Abdomen CT

37- 14 yo female, brought by her mother because she didn't have her menarch yet, tanner
stage 2, pelvic exam normal regarding the uterus and vagina, what to tell the mother?

Reassurance

38- young male with sore throat, fever, splenomegaly, CBC 30% atypical lymphocytes,
what's the mechanism?

a- Monoclonal lymphocyte proliferation

b- Leukemoid reaction

c- Infection with normal reaction to stress

39- pt with bipolar disorder treated with lithium, now has urine frequency with high Na, high
serum osmolarity, low urine osmolarity, what the mechanism?

Renal insensitivity to ADH

40- sensitivity

1-specificity

what's the best sensitivity and specificity?

41- pt with removed pituitary gland, on thyroxin, and cortisol, has symptoms of
hypothyroidsm, what test is useful?

a- TSH
b- TRH

c- T3

d- T4

I choose b, I think the right answer is d.

42- pt with non tender nodule in back of his neck, the biopsy shows papillary carcinoma,
what’s next step?

a- Radio iodine ablation

b- Surgical removal of the nodule

43- young male with sickle cell disease, has epigastric and RUQ pain, vomited, last year he
had acute chest syndrome last year which he admitted to the hospital for, high total bilirubin,
what's the diagnosis?

Cholecystitis

44- young child with absence seizures sings, what would you see in EEG?

Diffuse 3Hz spike wave pattern.

45- young male with anemia, has relative with anemia, picture of spherocytosis, what can
help this pt?

Splenoctomy

46- 18 weeks pregnant wants to know if her child has down syndrome, what to do?

a- chorionic villi sample

b- amniocentesis for karyotype

I choose b, but not sure.

47- lady in forties, has family history of breast cancer, finds a lump in her breast,
mammography shows malignant characteristics, FNA shows carcinoma, and metastasis to
axillary lymph node, what’s the most important prognostic factor?

a- Age

b- Lymph node metastasis

c- Family history

b
48- male with symptoms of fatigue, weight loss, CXR shows lung opacity, high Ca, normal
PTH, what’s does the pt have?

a- Adenocarcinoma

b- Small cell carcinoma

c- Squamous cell carcinoma

49- pregnant woman, with sing and symptoms of hyperthyroidism ,no more info. How to
treat her?

a- Surgery

b- Propylthuioracil

c- Radio iodine

d- Treat after delivery

50- young male, brought by his wife, he hasn’t slept for the last two days. Very obsessive
with buying through internet, has big muscles, physical exam reveals small testes and
gyncomastia, what’s the problem?

a- Androgens use

b- Cocaine

c- PCP

d- Heroin

51- young lady, history of two miscarriages in first trimester, history of DVT, arthralagia,
now she’s pregnant, what can you find with her?

a- Anti cardiolipin anibodies

b- Protein C deficiency

c- Protein S deficiency

d- Anti platelets anti bodies

a
52- old male, difficulty swallowing, foul smelling in his mouth, weight loss, regurgitates
undigested food, what’s the diagnosis?

a- Zenker diverticula

b- SCC

c- Achalasia

53- child with history of bloody diarrhea, deterioration of renal function, anemia, in the end
it’s mentioned frankly that the O157 H7 is the cause, what’s the mechanism?

a- Toxin

b- Invasion

c- Inflammation

54- pt with motor accident, has injuries on his head, chest and abdomen, didn’t loss his
consciousness, BP around 100/70, HR 50, what’s the cause?

a- Increased intracranial pressure

b- Intraabdominal hemorrhage

c- pericardial Tamponade

55- pt with motor accident, has laceration on his abdomen and chest, pelvic X-ray shows
pubic bone fracture, blood on his urethra, what does he have?

a- Intraperitonial bladder rupture

b- Urethral rupture

c- Kidney injury

56- pt with urethral discharge, has multiple sexual partners, in shows Chlamydia, no
gonococcus, what’s the treatment?

a- Azithromycin

b- Ceftriaxon

c- Vancomycin