set11(Nasi)

[cyrus1345]

A boy (5 may 8 yrs old) was brought by his mother with c/o right hip pain for 3 days. The boy had upper respiratory infection prior this hip pain. After working up, it is dx as septic arthritis.

1. what is the cause ?

a. strep. Pneumo.

B. staph. A.

c. other bacteria (no surgical intervention)



2. what antibiotics ?

a. methicillin

b. penicillin

c. vancomycin d others



3.

2 days after antbx, now there are a few small maculae (2-3 mm in diameter) without itching or redness. What do you do ?

a. d/c antx

b. continue the treatment

c change to another antx.

D others



Answers…………………..1) staph aureus 2) methicillin 3) change the antibiotics




Q)23 yrs old women with a vaginal presure symptoms and on pe has a 5 cm cystic mass,use diaphram for contraception, pregnancy test negative

next step

1.u/s
2.observation for 6-8 weeks
3.birth control pills
4.laprotomy


ANSWERE ultrasound




********************************



Q)What is the best method to diagnose CHF


a. Echo

b. PE and symptomes

c ECG

d Serum levels of B-type natriuretic peptide

e CXR


*******************************


Q)Would anyone post the exact inetrvals for pap smear (cervical cancer screening), breast cancer screeing, prostate cancer screening and colorectal cancer??

This is very important topic as I had many Q in this topic




Q)How do you treat Cocaine abuser with 210/115 BP?
Cocaine induced HTN - treated with Benzo, Nitroglycerin or Nitroprusside drip and Phentolamine 1 mg IV
No beta blockers like propranolol



Q) Which is not a sign of ovulatory bleeding,

1)Infrequent heavy bleeding
2)Presence of premenstrual symptoms
3)Dysmenorrhea
4)Breast tenderness
5)Change in cervical mucus
6)Mittleschmertz


Answer is 1…


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Q) which is maximum risk for preoperative assesment of cardiac function


1)Suspected critical aortic stenosis
2)Myocardial infarction within six months with age >70
3)Poor general medical status and emergency operation
4th was easy to be removed

Answer is 1 read below
this was totally confusing as i did not read this topic nicely now i know the answer please try to discuss , lots of questions

Risk

Age older than 70 years 5
Myocardial infarction within six months 10
Myocardial infarction after six months 5

Canadian Cardiovascular Society Angina Classification*
Class III 10
Class IV 20
Unstable angina within six months 10
Alveolar pulmonary edema
Within one week 10
Ever 5
Suspected critical aortic stenosis 20

Arrhythmia
Rhythm other than sinus or sinus plus atrial premature beats 5
More than five premature ventricular beats 5
Emergency operation 10
Poor general medical status† 5
SOURCE IS AAFP ALSO AMERICAN HEART INEX



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Q)a 8 month old kid cant turn over…what is the next exam


neuroreflex
check teeth
????
Answer Is neuroexam.neuro reflex




Q)29 yo M with severe diarrhea, o/e listless but responsive, vitals stable, Na 118,K 2.9, hco3 12,,urine na <10
R

a IV hypetonic saline
b hypotonic
c isotonic
d fluid restriction
e hco3


Answer is isotonic solution

Q)primi with 34 weeks,


next step
1)take culture
2)start oxytocin

answer is take culture first



what next

-bp,smac,cbc.normal
-ct with contrast
-mri
-ivp

do we have to save money by doing ct-scan or be more perfect doning mri, i was confused, kaplan says mri, so i clicked mri.but what are your opinions

answer CT, mri requires sedation



********************************


Q)A 3-month-old child was exposed to an adult with active pulmonary tuberculosis. What is the recommended approach to this problem?

A. Administer a TST and reevaluate in 3 months.
B. Administer a TST, perform a CXR, and reevaluate in 3 months.
C. Administer a TST, perform a CXR, administer INH, and reevaluate in 3 months.
D. Reevaluate after 3 months.
E. None of the above.

ans: C

the kid should be given INH prophylaxis even if CXR/PPD are negative. You have to reevaluate in 3 months with a skin test:
. if the test is negative :- to D/C INH
. if the test is positive :- to coninue INH for another 6 months (total 9 months )




*************************************************

Q)A pt on warfarin and heparin develops thrombocytopenia and petechias, what is next ?


a. d/c heparin only
b. d/c warfarin only
c. continue both
d. d/c both
Answer is dc both seems to be the answer




Q)25 yr old male routine visit with his father diag with colon cancer, what will you ask him next

-age of onset
-family h/o
-diet pattern
-sign and sym
answer is family history

Q)pt has been treated with lithium and developed hypothyroidism. after stopping lithium, when do you do tsh:
1- 3ds
2- 1w.
3- 2w.
4- 1m.
5- 3m
answer is 4-6 weeks




Q)pt has been treated with 0.075 mg thyroxin for possible hypothyroidism. you want to stop the drug and test the patient to see if he really has hypo-, when:
same options like the previous.
note: the amount is real.

An initial dose of thyroxine of 0.05 to 0.075 mg per day is usually sufficient to normalize the serum thyrotropin level.Patients with coronary artery disease should receive lower initial doses (e.g., 0.0125 to 0.025 mg daily). Serum thyrotropin levels should be measured four to six weeks after therapy is begun, after any change in the dose, and then annually once the levels become stable. Thyroxine requirements may increase over time if there is progressive thyroid failure.
NEJM



Q)pt with history of cancer. dnr. developed stroke at home what do you do.

-leave him home
-give him drug for pain.
-admit

admit the pt. Seems to be the answer



Q)DMI glucose 160 wants to sport:
1- insulin before match.
2- glucose before match.
3-nothing…..GLUSOCE BEFORE MATCH OR NOTHING ????



Q))you want give quinolon to a pt. whuch drug of the following should you warn him from:


1- coumadin
2- theophyllin
3- propanolol

answer is theophyliine



Q)50 y.o.w with multiple problems told you she is gonna get married from somebody she has met 2 weeks ago and asking you to attend:

1- congrat.. so nice of you to ask me but i am sorry i cant.
2- no my proffesional cant let me
3-you have so many problems it will affect on you negatively.
4-arent you too old to get married
5-is too soon to get married after two weeks only of knowing him


answer is A



Q)stroke family want dnr. you dont have previllage in that hospital and the doc wount give the familly dnr. the familly now calling you to support them having dnr for their pt:
1- tell them to take the pt to a hosp where he has previllage.
2- ask attorny.
3- tell me about the pt situation


answer is tell me more about the patient



Q)
pictures of fundoscopy ( glaucoma, DM, and cmv)
skin (herpes zoster)
ecg (1st degree block) preop.



Q)pregnant exposed to a lacy rashed boy:

1- it will not affect you.
2- you get mild disease.
3- you are vaccinated to this. no harm
4- your may loose your fetus

Q)pt haevy smoker, losT 8Lb lately, surem Ca++ 11.5,

what do you do next?
a.recheck Ca++ level
b.check CXR


answer is chest x ***


Q)pt has unilateral hearing loss, tinnus. also has lung Ca

what is most likely her symptom?


ANSWER IS MAYBE METASTASIS



Q)A diabetic pt with non healing ulcer..next step
Debribment

Antibiotic


Answer Is debribe first

ALL solved file # 3





Q)A diabetic man with sexual dysfunction,,comes in for evalutaion of depression,, he is found to be depress..what is the best treatment
a)paroxitine (paxil)
b)fluoxetine (prozac)
c)sertraline (zoloft)
d)citalopram (celexa)
e) bupriopram (wellbutrin)

Answer is E.
wellbutrin and serzone are the only antidepressant that I know have least effect on sexual function.
I have checked it out this is not a guess.






Q)Most important risk factor for breast cancer?
a)involment of upper outer quadrent
b)breast cancer in mother
c)breast cancer in sister
d)use of OCP
e)early onset of breast cancer in family

Answer e

Q)karotype of completed hydatidiform mole is?
a)46 xy
B)45 xy
c)46xx
d)69xxx
e) or somethnig else..please specify?





Types



Complete Mole




Total hydatidiform change
Marked proliferation of trophoblastic cells
No evidence of fetal vessels
Karyotype: 46XX
Derived from haploid 23X sperm
Sperm duplicates chromosomes without cell division
Higher risk for malignant change




Partial Mole




Associated with a fetus (may be only vessels)
Moderate trophoblastic proliferation
Karyotype: Triploid (69XXX or 69XXY)
Fertilization by more than one sperm
Malignant change less likely than in complete mole





Q)Painful gross or microscopic hematuira (s/s -> kidney stone):these are the steps >>>> U/A > KUB > IVP > CT ??

Q)

-thyroid disorders,
-early menopause
-or somethign else???

answer is osteoprosis and early menopause AND STRESS FRACTURES




Q)What IS the most common associated finding in patient with paNIC DISORDER?
a)aLCOHOLISM
B)OCD
C)DEPRESSION
D) SUBSTANCE ABUSE DISORDER
Answer is depression

Q) A WOMAN IS TAKING OCP NOW PREGNANT ? effect of OCP ON FETUS

what will u do or say??

a) Sono..if boy consider abortion
b) sono if girl Do abortion
c) tell her no adverse effect on fetus

answer is C. I have cheked this out. No harm to baby

Q)A man with 5x5 cm mass in left lobe of thyroid which is found to be papillary carcinoma..The man has develop HOARSENESS. the right lobe of thyroid is irregular on exam.. what is the best treatment

a)radiation
b)partial thyroidectomy plus radiation
c)total thyroidectomy with left neck dissection
d)total thyroidectomy with removal of enlarged nodes

answer is B or C ?? one of them


Q)2 yo child, mother reports he is pulling his LEFT ear, no fever vomiting, appetite good exam reveals cooperative kid,tympanic membrane red, no fluid on tympanogram..
what will u do?
a)PO amoxillin
b)gentamycin ear drops
c)refer to ENT
d)tylenol only
E)reassurance

Answer is possibly E reassurance.. I guess
DON’T KNOW THE ANSWER

Q)woman with symptomatic Tachycardia, otherwise stable, positive for signs of hyperthyroidism,,,what is the IMMEDIATE way to treat her symptoms?
a)PTU
b)RAI
c)surgery
d)propranolol

answer is D


Q)pt with heart rate of 45/min, BP 90/50, PR constant.Every third wave without QRS complex?
management?
A)atropine IV push
b)observation
c)external pacemaker
d)transvenous pacemaker

Answer is C.
Atropine should not be used to treat Mobitz type II block associated with BBB
Hemodynamically unstable pts should be treated initially temporary transvenous pacemaker insertion followed by permanent pacemaker implantation.

Q) picture of a 7-8 yo boy with ulceration in AXILLA and lateral chest only...what is the most likely diagnosis?
A)impetigo
b)subepidermal bullous dermatosis
c)herpes
d)bullous pehphigoid

Answer is impetigo

Q)most effective contraceptive????

a)condom
b)IUD
c)ethynyl estradiol + levonorgestrol orally
d)medroxypregestrone acetate IM (depot)

ANSWER IS OCP (COMINED )

Q) Glucagon is least likely to be used for severe hypoglycemia in

1) Type II DM
2) Malnourished patient
3) Infant overdose of injected insulin
4) Obese patient > 65yrs
answer is B

Q)Can a boy with Type I Diabetes compete in competitive sports? If yes what precautions to be taken, regarding insulin dose?
decrease insuline (and take a snack ?) exercise = insulin so need less insulin prior to exercise.

Q)Infection of which valve is most likely to be associated with the development of heartblock.
a. tricuspid
b. Pulmonic
c. Tricuspic and pulmonic
d. Aortic
e. Mitral
Answer is E


MULTIPLE SCLEROSIS

Q1) how do u check the progression of multiple sclerosis?
Q2) how to u follow Multiple sclerosis?
Q3) Diagnostic test of Multiple sclerosis
Q4) Effect of pregnancy on multiple sclerosis?

Answers to above question
1) Progression based on clinic
2) F/U depend on clinical course
3) Dx MRI
4) Pregnancy? Pregnancy exacerbate MS symptom. Agree with rest of info.

Q)person with symptoms of Obstructive sleep apnea...what is the first/next step?
a)sleep study
b)medical workup
c)CPAP treatment

Answer is Medical w/u as below

1.r/o hypothyrid. ENT exam
2.polysomnogram
3.treat-weight reduction(doesnot work) >>>cpap

Q)Most common site of pancreatic cancer?
Answer is adeno carcinoma (type) head of the pancreas(site)


Q)A mother is concern about obese child 3 y. what is the reason child is obese

-mother behaviour problem
-child neglect
-genetic
-eating disorder

ANSWER IS MOTHERS behavioral problems excessive eating may lead to childs excessive eating



Q)OLD lady with hemoptysis,Sob,questionable murmur.X *** chest HTN with Left artial enlargement, EKG a fib,Both artial enlagement AND rt. vent hyperthrophy?

what is the diagnosis?
Answer is mitral stenosis

Q)A 41 yr old women with a 2 month history of abdominal pain and reports constipation and altered calibre of stool with a history of weight loss of 9 pounds. What is the likely possibilty?

-Inflammatory bowel disease
-Irritable bowel disease
-Colon cancer
-Tropical sprue
-celiac disease

Answer is colon cancer.



Q)A 4 yo comes to ER with muscle weakness, miosis, salivation, diarrhea, heart rate slowing down. You will give;

A. naloxone
B. atropine and pralidoxime
C. flumazenil
D. N-acetylcysteine
E. Pyridoxine

B. atropine and pralidoxime





Q) A 14 year old boy with acne lesions on face and back on benzoic peroxide and topical tretenoin with only partial response. What will you do next

-Oral tretenoin
-Corticosteroids
-Oral tetracycline
-topical erythromycin

Answer is oral antibiotic ( tetra)


Q) Treatment of spasticity in post stroke patient
Answer is beclofen

Q)Pt came with chest pain. No EKG is done yet...after oxygen,,,next step?
a)aspirin
b)captopril
c)heparin
d)metoprolol
e)streptokinase

Answer is aspirin


Q) Treatment of influenza. Indications and limitation of AMANTADINE

Answer is
influ. A amantidine within 48-72 hrs


Q)Pregnant women in third trimester had Placenta abrutio due to MVA due to wearing seat belt(lap and shoulder ) question ask what would you recommend pregnant in third trimester?

1. don't wear seat belt

2. wear only shoulder strap seat belt

3. wear only Lap strap seat belt

4. wear the regular shoulder and lap seat belt.

Answer 4 wear both seat belts


Q) A kid had fx. clavicle question than ask what is next management?

1. ?sling

2. ?cast

3. ?sugery
Answer is Sling and immobilize.

Q) 16 year old high school drop out did not have periods for last 3 months. She is sexually active with one patner for 1 year. Does not use contracptives. Preg. test positive.

The reason that this adolescent's failure to use contraceptive

A. Concern about weight gain
B. Cost of Contraception
C. Patner's opposition to contraception
D. Concern about confidentiality
E. Desire to become pregnant

Surprisingly answer is desire to become pregnant?



Q) Which of the following drugs is the least sedating and anticholinergic, which can be prescribed safely to elderly patients with depression?

a.fluoxetine
b.MAOI
c.Imipramine
d.Sertraline
e.Trazodone

Q) 4 year old boy has swallowed a coin...x *** showed coin in lower 1/3 of esophagus..
a.ask the parents to check for coin in stool
b.do and endoscopy
c.give syrup ipecac
d.give a laxative

a 3 year old boy swallowed a coin and its in the duodenum...same choices as above...

Answer

1—do endoscopy

2- watch in stool

Q) A healthy young pt with ppd test 15 mm induration next step?

Answer is chest x ***



Q)First child of this lady has Duchenne's. What are the chances that she will again have a baby with Duchenne's?

-25 % overall,

-50 % if it is a boy,

-O% if it is a girl ( assumption is that mother is a carrier and father is healthy)

this is sex-linked recessive disorder. Affected child is boy. The mother must be carrier. So, the chance of her next child to be affected will be 50% among her sons or 25% among all of her children.


Q) A pt has flu and was treated with Amantadine. Now the Q ask the drug is belonged to:

1.chemotherapy
2.antibiotics

Answer is chemotherapy


Q) A 24 y/o woman came to your office with frothy vaginal discharge and rash on her cervix. You diagnosed her with Trichomoniasis vaginitis. You gave her RX for metronidazole. She remined you that she is breastfeeding. What should you do now?

Answer is give metronidazole and ask her not to feed for 24 hours


Q) a patient with tibial osteomylelitis, cultures taken , xray done,antibiotics started which is the next best step leading to diagnosis presents on second day of osteomyleitis

a)mri
b)bone scan

ANSWER: MRI

Q) A man with 5x5 cm mass in left lobe of thyroid which is found to be papillary carcinoma..The man has develop HOARSENESS. the right lobe of thyroid is irregular on exam.. what is the best treatment
a)radiation
b)partial thyroidectomy plus radiation
c)total thyroidectomy with left neck dissection
d)total thyroidectomy with removal of enlarged nodes

Answer is C

Q)
Kid with meningitis,but family don't want tx. what to do?

-respect their wish
-court order
-go ahead and treat.

GO ahead and treat….. is the answer.



Q)8wks pregnant women returing from vacationing in conneticut discover a tick on skin, 1 wk later noticed a lesion ask for treatment.?
LYME disease is the scenerio here …
Answer is amoxicillin or cefta. if CNS involved NO tetracycline because she is pregnant
If this patient was not pregnant then tetracycline is doc ten day therapy is usually reserved for isolalated erythema migrans....if systemic or severe symptoms therapy is recommended for 21 days.
any one of the following
tetracycline 250 po qid
doxycycline 100 mg po bid
amoxicillin 500 po tid








Q)a patient has asthma since childhood now is pregnant she ask what the chances baby has asthma.

-none
-25
-50
-100

25% if one parent involved 50 % if both have asthma



Q)Stroke pt was treated and vital signs are stable. Now the pt has blood vomiting. Dx:
1.diffuse gastritis
2.gastric ulcer
3.others..
Answer is diffuse gastritis

Q) Low back pain with lower extremity neurological s/s and bladder problem. Dx ?
1.spinal stenosis
2.disc hernia

Spinal stenosis is the answer..

Q)Organ donation. Father and sister agree. But mother did not agree. What do you do ?

Point about organ donation.. DO not take organs from the body until FAMILY agrees.. in this situation,,, try to resolve the conflict… let them have family meeting educate them etc etc..

If in the end family is not agreeing with the donation..DO NOT Take organs..



Q)Pneumococcal vaccine is indicated for which one of the following?
A- 15-year-old with recurrent sinusitis and URI
b- 8-year-old with recurrent tonslitis
c 3-year-old with nephrotic syndrome
d- 6-month-old with sickle-cell disease
e- 3-month-old whose mother has active human immunodeficiency virus (HIV) infection

Answer is C.. minimum age is 2 years.. both nephritic and sickle cell will need vaccine





Q)Which one of the following is the most appropriate management?

1-Perform serial L/S ratios until greater than 3.0, followed by prompt delivery
2-Induce labor, with careful fetal monitoring
3-Perform an immediate cesarean section
4-Follow the mother weekly with serial ultrasounds
5-Follow the mother weekly with nonstress tests

Answer is 2…. Induce labour and monitor fetus

Q)A 22-year-old white female who works in the newborn nursery of a hospital consults you regarding her exposure yesterday to an infant with congenital rubella. Today she has a positive pregnancy test and is 8 weeks pregnant by dates and examination. Her rubella immunization status is unknown.

Your immediate recommendation is
A) a therapeutic abortion
b) intramuscular gamma globulin
c) oral amantadine (Symmetrel)
d) a rubella antibody test
e) an MMR vaccination

Answer is D…. rubella antibody test

Q) In a woman with preeclampsia, the impending onset of eclampsia is most likely to be indicated by
A) urinary protein excretion >300 mg/dL/24 hr
b) facial edema
c) increased serum uric acid
d)headache and visual disturbances

Answer is D…… headache and visual disturbances

Q)35 yrs male iv drug abusers with a history of haemorrhagic shock 6 month ago came with weakness, P/E enlarged liver 3cm ALT 400 and rest of the liver function test normal. which one of the following investigations is the most important to diagnose the case?

a)HbS Ag + HbcIgM
b)HBV PCR DNA
C)HCV Ab
d)Liver biopsy
e)HbSAg+ HbcIgM + HDV Ab

Answer is C hepC AB

Q) 45 years old woman with history of DM and mild Hypertension with occational history of seizure for last 6 month came to your office with 6 hours h/o headach right sided partial ptosis,pain in lower half of face and neck rigidity.what would be the cause?
a)Trigeminal neuralgia
b)SAH of Post communicating artery
c)SAH of PICA
d)Brainstem glioma
e)Lacunar stroke

Answer is C…..Ipselateral facial pain sensetion,ipselateral horner's syndrom
and involvement of V11 nerve (bells palsy).

Q) 60 years old female h/o chronic diabetes & Hypertension with a left sided stroke came in ER 3 month ago with repeated attack of seizure there she was given some anti-seizure medication for Chronic control but last two months she developed incontinence with no urinary symptoms.The most likely cause
a)UTI
b)Phenytoin therapy
c)Carbamazapine
d)Valproic acid
e)BHP
Answer is B PHENYTOIN therapy

Q)which of the following anomalies is the major concern with chronic lead intoxication?

a. Abnormal bone growth
b. Hyperurecemia and gout
c. Microcytic anemia
d. lower I.Q. scores

Answer is D lowe IQ score

Q) A 6-year-old Hispanic female develops watery diarrhea, with at least twelve episodes over a 48-hour period. She is taking fluids orally without nausea and vomiting, is afebrile, and has an unremarkable physical examination except for hyperactive bowel sounds. There are no signs of dehydration.
According to current practice guidelines, which one of the following is the most appropriate recommendation?

-Age-appropriate diet without milk products
-Age-appropriate diet
-Clear liquid diet alone
-Clear liquid diet (juices, soft drinks) and loperamide (Lomotil) orally

Answer is B age appropriate diet

Q) what is the most common associated finding in patients with panic disorder?
a. Alcoholism
b. OCD
c. Depression
d. Any substance abuse

Answer is C depression


Q) Which is the most accurate method for detecting Down's syndrome
a. amniocentesis
b. CVS sampling
c. ultrasound
d. MRI

Answer is karotyping BY amniocentesis

Q) what is the single most important risk factor for the development of postpartum depression:

a- history of depression
b- history of bipolar disorder
c- a greater than average postpartum drop in serum progesterone
d- a recent stressful life event
e- the mother's experience as a child in her family of origin

Answer A.. history of depression




Q) A patient with Few pounds weight loss. He has been unable to eat due to pain with swallowing either liquid or solids. He smokes one pack of cigarettes per day. On PE, he is a thin man with diffuse cervical and axillary lymphadenopathy . His T- 101,4. There is no oral thrush and his lung have fine bronchi at right base. What is most appropriate diagnostic test?
A) Barium esophagram
b) endoscopy with biopsy
C) empiric trial of antifungal with ketocanazole
d) empiric treatment with ganciclovir
E) give him a prednisone


Answer is B…. barium is the initial/first test… Endoscopy/biopsy is the diagnostic



Q) 60 yrs old lady moved to a new residential center a year ago and came for annual exam. She has no specific complain and just mentioned that she only slept for 5 hrs a day. She functions well. Physic examination is WNR. What do you do for short sleep time of this lady.
1. It is normal for old lady
2. Prozac
3. Benzodiazepem
4. lifestyle change with more exersize

Answer is 4. lifestyle change with exercise….it could be normal not sure yet


Q) A 45 year old man comes to the doctors office and complains of "the worst headache in his life".
He is awake and oriented. He refuses to have a CT.
A lumbar puncture yields lightly blood tinged sample with rbc count 300,000
wbc count 55000(90% polyps), protein-88,glucose-20
gram stain is negative.
Most appropriate treatment is

a)E aminocaproic acid
b)angiography
c)iv ceftriaxone
d)heparin

Answer is B….. SAH diagnosis is angiography….after LP and CT… tx is surgical Clipping


Q)A 40 yr old man with a history of DM and sexual dysfunction comes to you with a history of insomnia, loss of apetite, fatigue,feeling of worthlessness, and guilt, diminished ability to concentrate and depressed mood for 4 months. Which of the following would be the most appropriate treatment for this patient

a. Paroxetine
b. fluoxetine
c. sertraline
d. citalopam
e. bupropion

Answer is E…… Bupriopion



Q)Which of the following is most characteristic of a patient who has vitamin C deficiency?
(A) Diarrhea and delusions
(B) Ocular muscle palsy and dementia
(C) Cheilosis and beefy red tongue
(D) Perifollicular hemorrhages and hyperkeratosis
(E) Paresthesias and ataxia

Answer is D.

Q) What you will see in a biopsy of lchen planus ?

Answer is hyperkeratosis

Q)Orbital cellulitis

Next step
a) ct scan
b) iv antibiotics

Answer is Iv antibiotics first then investigations

Q) which is the best dx choice of pituitary tumor ?
a. CT
b. MRI
c others
Answer is A… MRI is the best


Q)which of the following causes acute hepatic necrosis?
INH,
A.acetaminophen
B.halothen,
C.methydopa

Answer is A…. ACETAMINPHEN


Q)A DM type II pt is under glipizide. His current glucose level is 270. what is the next:
A..add insulin
B.add metformin
C.add pioglitazone
D.add glyburide

Answer is B .. add metformin………if sulfonylurea failed to control it then add metformin and if both fail to control then add a thiazolidinedone
and if they fail to improve give insulin




Q) a man loss of vision in 24hrs c/o curtain in eyes.,no pain
A)ret.detachment
B)retinal artery obst.
C)retinal vein obt.

Answer is A retinal detachment

) which is the best test for confirming rupture of membrane ?

a. pool test
b. nitrazine test
c. fern test
d. U/S

Answer is B.


Q) In gallbladder, sludge by u/s and pt has symptoms with pain fever and has diabetic,next step

-ct abdomen
-start antibiotic
-ercp
-observation

Answer is CT ( acalcolus cholecystitis )

Q) Which of the following drugs is the least sedating and anticholinergic, which can be prescribed safely to elderly patients with depression?

a.fluoxetine
b.MAOI
c.Imipramine
d.Sertraline
e.Trazodone

Q) 45 y/o guy who was 5' 5'' tall and weighed 280 pounds and is on HTZ for HTN and Metformin for DM and HbA1c is 6%....and BP is well controlled and 130/80....so in this patient what is the risk for Cardio vascular disease?


is it obesity or DM.

Answer is DM




Q) What is the treatment choice for a lung cancer pt with Horner's syndrome ?
1.surgery
2.chemo.
3.radiation
4.observation

Answer is radiation




Q) 1) Who should perform the surgery of organ procurement for transplant?

I think transplant team form recepiant's hospital, I know that is the case for cardiac transplant. Not sure for others?

Answer is transplant team.

2)Prior to remove organs, should donor be terminated by removing operator and make him complete death (no spontaneous respiration, circulation etc) or maintain his/her in brain dead condition (B/P + above 90 mmHg etc..) during surgery to retrive organ?

Answer is do not remove ventilation….until organ is taken out.



Q)girl with DM 1 now reach puberty,what is advice regarding insulin. increase,decrease,same no change?

answer is increase insulin.


Q) A women came to the office was diagnosed with STD(Trichomonia) husband want to find out how that happen? what should you do?

Tell the husband to ask her wife….always let them talk first before u interfere… ok

Q) Female pregnany rh+ , husband is rh-, now he ask you why this happen?

Nothing to worry now… only WORRY when female is NEGATIVE> if she is positive then its Fine..do nothing.



HOW to follow Multiple sclerosis

Answer is f/u with MRI…… INITIAL diagnosis made by MRI


Q) baseball pichter with shoulder injury,xray with compound fracture of clavicle

1. what is the treatment?

ANSWER is ORIF.. open reduction, internal fixation

2. When he can play the game ?
Answer is 2-3 months

Q) orbital cellulitis

next step
a) ct scan
b) iv antibiotics

Iv antibiotics is the answer


Q) 5y/o hiv+ boy found to have pcp tx?
pentamidine or dapsone?

Answer is pentamidine. Some say dapsone…. Still need clarification..



Q) 45 years old woman with history of DM and mild Hypertension with occational history of seizure for last 6 month came to your office with 6 hours h/o headach right sided partial ptosis,pain in lower half of face and neck rigidity.what would be the cause?
a)Trigeminal neuralgia
b)SAH of Post communicating artery
c)SAH of PICA
d)Brainstem glioma
e)Lacunar stroke

WELL answer is SAH secondary to PICA.

Answer is C…..Ipselateral facial pain sensetion,ipselateral horner's syndrom
and involvement of V11 nerve (bells palsy).






Q) A patient with Few pounds weight loss. He has been unable to eat due to pain with swallowing either liquid or solids. He smokes one pack of cigarettes per day. On PE, he is a thin man with diffuse cervical and axillary lymphadenopathy . His T- 101,4. There is no oral thrush and his lung have fine bronchi at right base. What is most appropriate diagnostic test?
A) Barium esophagram
b) endoscopy with biopsy
C) empiric trial of antifungal with ketocanazole
d) empiric treatment with ganciclovir
E) give him a prednisone


Answer is barium is initial test….. ENDO biopsy is diagnostic..


Q) 60 yrs old lady moved to a new residential center a year ago and came for annual exam. She has no specific complain and just mentioned that she only slept for 5 hrs a day. She functions well. Physic examination is WNR. What do you do for short sleep time of this lady.
1. It is normal for old lady
2. Prozac
3. Benzodiazepem
4. lifestyle change with more exersize

Answer is its normal for her….if it was little young patient then other rcommendation.. sleep hygiene etc etc


Q)Which of the following is most characteristic of a patient who has vitamin C deficiency?
(A) Diarrhea and delusions
(B) Ocular muscle palsy and dementia
(C) Cheilosis and beefy red tongue
(D) Perifollicular hemorrhages and hyperkeratosis
(E) Paresthesias and ataxia

Answer is D.





Q) What is the initial management for GERD?
Answer is life style modification … like sleep with head elevated then meds h2 blocker or omeprazole.

Q)Do we to refer patient to surgery if he just had colon polyp ca, confined only to the polyp not to the mucosa?
Answer is yes

Q) A 28 y/o woman just had hysterectomy. She is 300 LB has obesity for many years. She is asking for HRT. What is your action?
If complete TAH BSO then HRT is ok….
Answer is give her HRT.

Q) A 28 y/o woman is 36 wks pregnant, has a girl with Turner syndrome, asking what is her baby's risk for this syndrome?

Q) TCA toxicity what do you give the Pt?
Answer is alkalinize urine with Nacho3

Q) a 16y/o girl needs C_SECTION currently living with parents, who will sign consent?
Answer is No…parents consent is required.

Q) A 15y/o girl 8wks pregnant wants abortion,she does not want parents to know. can she give her own consent.

Answer is yes….
Q) which of the following causes acute hepatic necrosis?
inh, acetaminophen ,halothen, methydopa
Answer is acetaminophen is more common, halothene also causes necrosis

Q) a 17y/o girl comes to office in request of contraceptive,after discussing various forms, she decided that she want to be sterilzed(tubes tied) you then explain to her that this choice is not the best for her and that is 95% permanent, but still insist on procedure, now do you go ahead?


Remember this NO do not perform coz it is irreversible ..pt has not finished child bearing age yet. Around 35

Answer is convence for other good contraceptives.

Next qs… she agreed what is the best contraceptive answer is DMPA

Q) a 16y/0 female comes to office in request of OCP, she secretely tells you that she is having sex with a men in his 40's since the age of 12, and tells you that he is very nice to her, should you break confidentialy and report case?

Answer is yes report case

Q)a man loss of vision in 24 hrs c/o curtain in eyes.,no pain

-ret.detachment
-retinal artery obst.
-retinal vein obt.

Q) mom just had baby now leaving hospital best way to keep baby sit?

seat should be in the middle of the back seat....and kid face is toward back (trunck ) of the car

q)both parents healthy 1st child has polyctstic kidney dz, now want to know chances of another kid with pkd.

none
25
50
100

answer 25 % in kids as it is recessive in adults its 50% coz its dominant



Q) Hiker exploring the grand canyon went into many caves,after developed pneumonia ,histo or cocci?

Answer is histoplasmosis in moist cave and coccidio. in dry caves,,,is histoplasmosis

Q) a patient just diagnosed with HIV+ when you give antiretroviral therapy? Now, cd4 is <1000, or cd4<500

recommendations are to initiate treatment for HIV-infected patients with CD4 cells < 350/µL or viral load > 30,000 copies/mL by branched-chain DNA or 55,000 copies/mL by PCR testing.




Q) A retinal picture with exudates. The pt,s glucose is 150. vision blurred. Next

1.control pt,s glucose level into normal range
2.laser phototherapy
3.check HA1c
4.others.

Answer to this qs is laser photocoagulation

laser photocoagulation is for prolifertive retinopathy

and pototherapy is for background retinopathy to stabilize the vessel

first step is rx of non prolif. diab retinopathy, by glucose control.
first step in rx of prolif. diab. retinopathy is laser !
ref.cmdt.231 (2002)

Q) What test is used for making a diagnosis of mitochondrial disease ?
Answer is

screen, blood carnitine levels
genetic testing by southern blot if negative
gold standard is muscle biopsy in biopsy u will see red tagged fibre

Q) 34 yo white man, HTN: 150/95. No other diseases. (not mention primary or secondary HTN). What drug you should prescribe to him:

1.b-blocker
2.ACE I
3.Diuretics
4.Ca blocker
Answer is young pt. with hyperdynamic circulation -beta blockers are recommended although none of the anti-htn drugs are C/I.



Q) What is the complications of meniscus injury ?
tear of medial meniscus is more common than lateral.

Cmplication > Hemarthrosis
Locked knee
Locked knee should be reduced in 24 hrs, because beyond this period, effusion cause loss of elasticity of the meniscus, preventing it to snap back into its normal position.


Q)A 13 yo girl brought by her mother for routine PE. Stage II, no menstruation. On bend exam, you noticed her left shoulder/scapula is higher 4 cm than right. (no degree info. provided). You recommend:

1.follow up in 6 months
2.ref to ortho. surgeon
3.Brace
4.surgery
5.others..

Answer is refer to ortho… greater then 2 cm needs referral to ortho.
There are three basic options for the treatment of scoliosis. These include observation, bracing, or surgery. Alternative treatments, although currently popular, have no proven benefit in the current orthopedic scientific literature.

Observation

is the preferred management choice for curves at low risk of further progression, and where the natural history is favorable. This would include curves less than 20o, or curves under 40o after the child has reached skeletal maturity.

Bracing

is preferred for curves in which there is documented progression of the curve and where the child has not reached skeletal maturity. These curves are at risk for progression, and the goal of the bracing is to stop this progression. The final option for scoliosis is

surgical

This is generally reserved for curves which are out of balance or those in excess of 50o. Curves of this magnitude tend to progress after the onset of skeletal maturity and ultimately cause significant functional compromise.

according to this the patient shoud be followed for 6 months & if any progression is found then suggest a brace !!



Q) A premenopause woman with flushing and emotional unstable s/s comes to office for HRT. The pt¡¯s mother has breast cancer at age of 60. you give her

1. no HRT, since she has family hx of breast cancer.
2. HRT
3. others

ANSWER is give HRT family history fo cancer is not a contraindication of HRT

Q) You decide to give Levothyroxine to a pregnant pt with hypothyroidism at:
1 increased dose
2 same dose as non-pregnant pt
3 decreased dose
4 only b-blocker

Answer is increase dose….
Next question why
Answer is …. Pt. who are pregnant, on hrt, or infection have increases in TBG

Q) Loading phenytoin is via IV not IM. Why ?

Purpose of loading dose is to quickly bring pts. serum concentration of the drug to specific level.
Volume of distribution is fastest with IV.


q)A DM type II pt is under glipizide. His current glucose level is 270. what is the next:
1.add insulin
2.add metformin
3.add pioglitazone
4.add glyburide

Answer is add metformin



Q) 1 wk baby turn blue when feeding but when cry is pinkish??
Answer is choanol atresia

Bilat. or unilat. obsstruction of nasal airway, by boney or membraneous structure. If it is bilateral will be noticed on the 1st day of life.
Baby is a nose breather. Develops cyanosis while feeding b/c nasal airway ostructed. Cyanosis resolves when crying as the mouth allows air entry to resp. system.
DX.When suction catheter cannot be passed from nose to mouth.
TX. Surgical reconstruction

Q) pt.need immunoglobulins, you give, develops severe anaphylaxis.

-chronic granulomatous dz,

-regular allergic reaction,

-IGA DEFFICIENCY.

Answer is IGA deficiency Patients with IgA deficiency may develop antibodies to IgA, and can have severe reactions (including anaphylaxis, a potentially life-threatening allergic reaction) to transfusions of blood and blood products. If transfusions are necessary, they should ideally come from another IgA-deficient individual.

Q) postpartum fever not responding to broad spectrum abx,ct scan no abscess, next step in mangement
d&c
vanco
heparin

Answer is heparin Thrombophlebitis could be the cause of fever when it does not respond to antibiotic.

Q) which is the best dx choice of pituitary tumor ?
a. CT
b. MRI
Answer is MRI



************


Q) A lab study of a 25 yo pregnant woman showed her fasting glucose level is 175 at 28 wks. She was later on dx as having GDM. What is the initial management for this pt ?
1.non-phamcology therapy (multiple, small, nonglycemic meals and increased exercise)
2.start insulin now
3.observation only
4.anti-DM drugs

Answer

is start insulin now
Clinicians and patients with GDM are reluctant to start insulin therapy, but it is the key to achieving a good outcome. Research suggests that early intervention with insulin is superior to diet therapy alone.

*************************

Q)Friends, a 2 y/o baby boy for past 4hrs been having bilious vomiting, after appropriate study found out to have midgut volvulus. The vovulus is located most likely in.

small bowel
large bowel
sigmoid

midgut volvulus common in neonates and infants due to malrotaion.

YES, I pick small bowel also, in adult it's more common in the large bowel.

************************

Q)

OCP effect:ESTROGEN : PROGESTRON



LDL Choles. HDL glucose

1. D D I -
2. I D - I
3. - - - I
4. - - - D


- = unchanged; D = decreased; I = increased

choleterol : increased
trigly ; increased
hdl+ldl : no change
glucose : ???


Answer is OCP= no change in ldl and hdl but TG increase


*****************************


Q) (HRT effect ON LIPIDS)..ESTROGEN


LDL Choles. HDL glucose


1. D D I -
2. I D - I
3. - - - I
4. - - - D




- = unchanged; D = decreased; I = increased

*cholest : inc
*trigly : inc
*glocuse : ??
*HDL & LDL : no change

IN HRT there is only estrogen part.. so these are the effect. If HRT is combined with progesterone then same effect as OCP.

ldl decrese and HDL increase



************************************************** **********


Q

Of the following, which one predicts the poorest prognosis of sarcoidosis ?

1.hilar LN enlargment
2.alkaline phosphatase increased (>700)
3.erythema nodosum
4.parotid gland stones
5.hypercalcemia
6.LDH increased

I THINK ans is hypercalcemia out o these,,, LFT are also poor prognostic signs.

erythema nodusm, hilar lymph node...good prognosis

= bone,neuro and liver involment bad prognosis
= lung parenchymal involment worst prognosis
= Markers for a poor prognosis include advanced CXR stage, extrapulmonary disease (predominantly cardiac and neurologic), and evidence of pulmonary hypertension. Multiple studies have demonstrated that the most important marker for prognosis is the initial CXR stage (see Table 2).


*********
Q) a pt, AF for 2 wks. HR < 100 after digioxin. TEE: no clot in heart. Next
1.warfarin
2.heparin
3.DC conversion

Q) 1. A 30 yo woman. Depression s/s. father died and she is just divorced, all within one month. Dx ?
A.adjustment disorder
B.depression disorder
C.others

Answer is adjustment d/o

2. same pt. what next ?
A.anti-depression medication
B.ref to psychiatrist
C.provide ..surpport
D.others

Answer is provide support


Q

A DM pt, also HTN. Urine protein ++. Dx ?

1.diabetic nephropathy
2.HTN nephropathy
3.others

Most likely diabetic nephropathy


a 47-yo woman comes for routine. All (-). Next
1.mammgram
2.oral Ca
3.CXR
4.other irrelevant

Answer Mammogram

Q) A pt with Parkinson diz s/s (also) has depression s/s and comes to office. in interview, pt denies he has depression ( such as mood problem). Q asks in the following, which one is used to make a dx of Parkinson, rather than depression ?

1.pt denies he is depressed
2.masked face
3.other Parkinson s/s


Q) placenta previa¡¯s risk factors are

1.hx (previous) of placenta previa
2.smoking
3.family hx
4.fetus abnormal position (presentation) Risk factors:

*Prior cesarean section,
*multiparity,
*multiple gestation,
-erythroblastosis,
-smoking (affects placental migration),
-Hx of placenta previa,
-increasing maternal age.

source: blueprint-OB-GYN

Q) A 30 year-old man who was PPD positive one year ago and has been used INH for 6 months. Now comes to office for follow-up. His current CXR is negative and he is asymptomatic. Next
1.PPD
2.CXR
3.d/c INH and routine f/u
4.CBC
5.sputum test

Answer is 3

Q1)

a pt with typical s/s and PE of herpes zoster. Next:

A.Tzanck test
B.acyclovir
C.CBC
D.others


2.

Same pt, appropriate treatment has initiated. Next:

A.isolate the patient until his lesion become crusted
B.isolate the pt until complete recovered
C.no need to be isolated
D.others.

ANSWER B AND A

Chickenpox is a clinical diagnosis. In unclear cases, a Tzanck prep is used. Infectious from 24 hr before the appearance of the rash until all the lesions are crusted, which usually occurs 1 week after the onset of rush. Blueprints in Ped.


Q

50-yo symptomatic woman comes for routine PE. She was found to have increased ocular pressure. And later-on, was dx as having chronic open-angle glaucoma.
Next
1.funduscopy
2.visual fields test
3.slitlamp
4.others

Answer is Fundoscopy.

Q) kid swallow button size battery, no resp. symtoms,happy,comfortable, the battery is at mid esoph.
endoscopy to retrieve
observe in stool.

Answer is endoscopy

Q) kid playing basketball jump to block ball landed heard "pop" after ward pain but was able to walk with limp. acl or medial menicus
Answer is ACL



Q) orbital cellulitis

next step
a) ct scan
b) iv antibiotics

Some say CT first other say IV antibiotics


Orbital cellulitis is manifested by an abrupt onset of fever, proptosis, restriction of extraocular movements, and swelling and redness of the lids, usually in a child. Infection of the paranasal sinuses is the usual underlying cause. Immediate treatment with intravenous antibiotics is necessary to prevent optic nerve damage and spread of infection to the cavernous sinuses—manifested as increased restriction of extraocular movements, impaired visual acuity, diminished pupillary reflexes, and papilledema, all of which may be bilateral—meninges, and brain. The response to antibiotics is usually excellent, but abscess formation may necessitate surgical drainage.


Q) 2. When treating urinary tract infection(UTI) in the third trimester, the antibiotics of choice is?
A. cephalosporin
B. tetracycline
C. sulfonamide
D. nitrofurantoin
E. none of the above

Nitrofurantoin is not recommende din third trimester, answer is cephalosporin
PCN and CEPHALOSPORIN are most commonly used

Read the qs carefully.. nitro is C/I, tetra is also C/I , sulphanomide is not a good idea here. Leaves us with Cephalosporin . which is the answer.. PCN is also ok in pregnancy.

Q

sarcoidosis........what to check for

. ace level
. ca level


answer is ace level

********************************


13 year old raped by Moms boy friend 2 finger test, smiled at you before the test, donot want to upset the mother by having a baby............

. child protective service
. reassurance

answer is child protective but look for other ans


69 yr old came to hospital from the NH complians of 98.8 fever, cough, b/l pleural effusion, b/l upper lobe infilterate, .show a chest xray............

. pencillin-metronidazole
. erythromycin-cefuzime
. trimethprium- sulphth


RX

answer is B erythromysin-cefuzime


*********************

Pt has a surgery got 2 Prbc during the procedure, receive antibiotic forgot the name ..nusre called u after 2 hours with agitation, dementia and rash on the chest.........

1. transfusion reaction
2. drug reaction
3.

Answer is transfusion reaction…


13 yr old vegetative state after a accident.. neurolgist not hopefull, pt show some limb movement and positive gag reflex.............parents wants to stop the life support .what to do

1. remove the life support
2. EEG to confim the brain death
3. hospital ethic commity
4. court order

answer is remove the life support



69 yr old from NH with temp of 98.7 complain of cough, leg edema, cardiomegaly, b/l pleaural effusion, upper lung infilterate.........

1. chf
2. strep neumonie
3. mycoplasma pneumonie
4. staph pneumonia

Answer is CHF


a young pt started on haloperidol is wandering in room and is restless, what is the side effect he is having

a) akathesia
b) maliganant hyperthermia
c) dystonia

ans) a


u suspect child abuse in paed. pt, who do u inform first

a)police
b)child protection services
c)social services

i thought the ans is b



Q
drug of choice in hypertensive emerergency
ans) sodium nitroprusside



Q

cheese like vaginal discharge in 35 year old pt

whaT does she have

ans) candida






Q

drugs of choice in 35 year old white htn pt

a) thiazide and ace inh
b) thiazide and beta block

my ans was b


Q

drugs of choice in 35 year old african american htn pt

ans)ca channel blokers


**********
Q

what test we do before starting the prednisone...........in a 45 yr old with newly diagnose arthritis............

1. dexa
2. serum cortisol level
3. xray lumbar spine
4, Mri lumbr spine


2. question

what are the other drugs of choice

1.gold thio
2.cyclophosphamide
3.cyclosporine
4.methotrexate

Answer is dexa scan and methotrexate

***************************


Mepridine toxicity...............

answer is spasm
OVERDOSAGE / TOXICOLOGY — Symptoms of overdose include CNS depression, respiratory depression, mydriasis, bradycardia, pulmonary edema, chronic tremor, CNS excitability, and seizures. Treatment is symptomatic. Naloxone, 2 mg I.V. with repeat administration as necessary up to a total dose of 10 mg, can be used to reverse opiate effects. Naloxone should not be used to treat meperidine-induced seizures.



**************


19 yr old came with fever, photophobia, neck supple................chart shows lymphocytes and increase protean in csf.

rx will include ceftriaxone and

1. acyclovir
2. tetracycline
3. vancomycin
4. corticosteroids


answer is corticosteroids.


*****************


depressesed pt with premature ejaculation
what do u use

ans


ssri-flouxetene

********************



s/p vaginal delivery heavy bleeding, done manual massage next...

A angiogram and embolisation

B hysteroscopy

C laproscopy

D laprotomy

E ct abdomen

answer

Is angiogram and embolization.

if that fail do ligation of hypogastric artery

if that fail do hysterectomy

Ideally u do this.. uterine massage then oxytocin,,, but it is not in the choice.



*******************************



Pt presented with unstable angina and after initial mx pt was stabilized.for the next 48hrs he had no angina at rest.EKg was normal.
what is next.

-Stress test and then catherization

-catheterization without a stress test.

I think it should be catheterization without a stress test.Do you all agree with me?


Answer is Cath without stress…






Q)

Female pt. o 8 wks pregnent, vaginal bleeding and abd pain.
HCg 1500 , Vaginal Us shows no IU Preg.
what is next

-culdocentesis
-laporoscopy
-laparotomy

answer is

-laproscopy ……
-rupture- laparotomy
-no rupture- laparoscopy
to simplify


****************************************


Hydralzine ...s/e

Answer is given below read all the s/e

*Lupus like syndrom : +ve ANA and AHA
*Reflex techycardia and increase myocardial 02 demand
*headach and flushing
*nausia, dizziness, diaphoreisis
*salt and water retention



***********

Q)60 yr morning and evening glucose is 80 and 100 take 28 units of nph and 14 reg in morning, 14 unit in the evening of nph and reg.

1. decrease insulin
2. decrease calorie
3. increase insulin
4. readjust calorie
5. readjust insulin

answer is Readjust insulin


Q)70 yr old drinks one cup of coffee in the morning, do light exercise in the morning couldn't slep in the night

1. increase strenous exercise
2. stop the cup of coffee
3. read and relax in the bed before going to sleep
4. ssri
5.

Answer is Some mild to moderate exercise in the evening




Q)patent visits 4-6 wks after MI for follow up

can he have sex- no info given about his present status



-off course he can



*********************

patient has hyponatremia- clincan features of addisons given , the pt is having


a)salt wasting due to cortisol deficiency



****************************



Q)middle aged pt want chronic steroids, hip xrays shows chages of avascular necrosis

what do u plan


my ans was- continue steroid theray anticipating or planning for bil. hip relacement in the future


answer is hip replacemt surgery or schedul for surgery ( hip replacement )



**********************


Q)pateint with gonoria

what do u give-ceftriaxone and doxy





Q)how do u remove the tatto s shown in picture

ans. laser therapy treatment of choice


Q)what is more specific for osteomyelitis

MRI or bone scan


answer is MRI.





Q)rapid strep test-

very sensitive and specific- at least thats what i thought-look up guys

Correct answer is HIGH specifity and low sensitivity…..





Q)picture of candida rash in diaper area
decribes satellite lesions


what is it- Answer is candida







Q)bi polar pateint

what do u give

ans-lithium






Q)what is the commenest complication of this drug

ans-tremors

this pt can also have -hypothyroidism






Q)remeber they also asks about nephrogenic D I

but i wast asked






Q
how do u assess severity of sarcoidoses

ans-ACE level







Q)some crap about patient, then on multiple drugs what caused the myoclonic jerks-


ans-meperidene

i got 2 questins on this










Q)can a reganant woman recieve influenza shot

ans - yes






A 50-yo symptomatic woman comes for routine PE. She was found to have increased ocular pressure. And later-on, was dx as having chronic open-angle glaucoma.

Next
1.funduscopy
2.visual fields test
3.slitlamp
4.others


Answer is fundoscopy





a pt with typical s/s and PE of herpes zoster. Next:

A.Tzanck test
B.acyclovir
C.CBC
D.others

Answer is acylovir

2.Same pt, appropriate treatment has initiated. Next:

A.isolate the patient until his lesion become crusted
B.isolate the pt until complete recovered
C.no need to be isolated
D.others.

Answer is A





A 30 year-old man who was PPD positive one year ago and has been used INH for 6 months. Now comes to office for follow-up. His current CXR is negative and he is asymptomatic. Next
1.PPD
2.CXR
3.d/c INH and routine f/u
4.CBC
5.sputum test

Answer is D/c INH and routine f/u


Q)placenta previa¡¯s risk factors are

1.hx (previous) of placenta previa
2.smoking
3.family hx
4.fetus abnormal position (presentation)

Answer is A previous history.





Q)A pt with Parkinson diz s/s (also) has depression s/s and comes to office. in interview, pt denies he has depression ( such as mood problem). Q asks in the following, which one is used to make a dx of Parkinson, rather than depression ?
1.pt denies he is depressed
2.masked face
3.other Parkinson s/s

(I¡¯m sure there is no rest tremer in the choice, check twice, positive)



a 47-yo woman comes for routine. All (-). Next

1.mammgram
2.oral Ca
3.CXR
4.other irrelevant

Answer is A mammogram.




A DM pt, also HTN. Urine protein ++. Dx ?
1.diabetic nephropathy
2.HTN nephropathy
3.others

Answer is diabetic nephropathy




A 30 yo woman. Depression s/s. father died and she is just divorced, all within one month. Dx ?
A.adjustment disorder
B.depression disorder
C.others

2. same pt. what next ?
A.anti-depression medication
B.ref to psychiatrist
C.provide ..surpport
D.others


Answers are adjustment d/o and tx is provide support





a pt, AF for 2 wks. HR < 100 after digioxin. TEE: no clot in heart. Next

1.warfarin
2.heparin
3.DC conversion

Of the following, which one predicts the poorest prognosis of sarcoidosis ?

1.hilar LN enlargment
2.alkaline phosphatase increased (>700)
3.erythema nodosum
4.parotid gland stones
5.hypercalcemia
6.LDH increased



OCP effect:


LDL Choles. HDL glucose
1. D D I -
2. I D - I
3. - - - I
4. - - - D
- = unchanged; D = decreased; I = increased












Dx of Acute hepatitis B (based on serology pattern) and treatment ?



A newborn with cocaine s/s. mother used cocaine. Need to take newborn¡¯s urine to do toxicology test.
Next:
1.let mother sign consent
2.no need from mother for consent
3.others.

Answer is consent from mother


a 15-yo girl who is a player of school sport team (did no mention what kind) comes to office for left knee pain. PE tenderness in knee and anterior tibia. Next
A.X-***
B.MRI
C.CT
D.U/S

answer is X ray….. bone scan is the diagnostic test

2.

same pt. dx is made as having stress fracture, next

A.cast
B.splint
C.adjustment conditioning program
D.others

answer is adjustment conditioning program




A 18-yo girl, laparoscopy for appendicitis. Appendix is normal, but tubal swollen is found bilaterally. What do you do ?

1.drainage
2.tubal removal
3.hysterectomy
4¡..forgo

Answer is drainage




A typical (s/s) TB pt (immigrant, 60 yo, man). CXR cavity. (not mention sputum culture and AFB test). Next ?
1.admit to hospital for anti-TB treatment
2.send home for anti-TB treatment
3.others.

Answer is admit to hospital for anti TB treatment






A acute closed-angle glaucoma pt. what is the initial treatment ?

1.pilocapine
2.IV acetazolamin or mannitol
3. others ¡
Answer is IV acetazolamide or manitol if u have to pick one then its acetazolamide



A pregnant pt (forgot weeks). Fetal Heart tones suddently drops to 60/min. what is next ?

1.O2 to mother
2.c-section
3¡.
Answer is oxygen to mother and change her position.


MVA, the driver, no belt, throw out, was intubated by paramedics. Now in ER, no RR, no HR/pulse. (No info. of neuro reflexes, EKG, EEG), next

1.announce death, do nothing
2.thoracotomy to compress heart
3.open brain
4¡.
No DC shock is in the choice.

Question: if both do nothing and DC shock in the choice. Which do you guys select ?

ANSWER is pronounce death.


HIV + pt. syphilis positive, no active lesions and the time of syphilis status is unknown. What is the treatment ?
1.penicillin IM once
2.pencillin IM once a wk for 3 weeks
3.pencillin iv 14 days
4. others

Answer is PCN x 3 q wkly




Pt comes with hot flashes past history of pulmonary embolism, smoker and takes sertraline for depression. treatment?

A. Estrogen and progesterone

B. Raloxifene

C. Clonidine

D. Tamoxifen


Answer is clonidine.



A trigeminal neuralgia pt comes to office. He told you he read a article about a new method of treatment for his diz¡¡.(did not mention whether FDA approved or not). You read it and

1.use this new method without telling pt
2.use this new method with a permission of the pt
3.contact authors of the article to get more detailed info.
4.hold until another article to confirm this new method
5.contact FDA to get approve to let you use this method



a 3 yr-old boy¡OM¡.meningitis (no specific bacteria mentioned). Q asks

1.day care ctr workers need prophylactic treatment
2.day care ctr workers do not need prophylactic treatment
3.others
Answer is NO prophylaxis




a HIV pt with pneumonia (s/s and CXR). His CD4 > 500. next

1.erythromycin
2.bactrim
3.gentamicin
3 others

Answer is erythromycin



DM pt has bilateral decreased perception of vibration. Dx


1.spinal lesions of DM
2.DM peripheral neuropathy
3.others

Answer is bilateral neuropathy secondary to DM





a CO poisoning pt waked up. Vital sign is normal. Q asks of the following, which one is the most important you should keep watching this pt ?
1.headache
2.weakness
3¡..

Answer is weakness

I could not provide all of the choice. But Q here: is there any complication (short term) of CO poisoning more important than headache ?





a 17 yo girl with dysmenorrhea. Both NSIADs and OCP did not work. Next ?
1.CT pelvic
2.U/S
3.laparoscopy
4.hysterosalpingogram
5.do nothing,

Answer is laproscopy



Newborn baby Hb is very low and need transfusion. But parents don¡¯t agree due to religion reason. You

1.go ahead to transfuse
2.court order
3.hospital committee
4.respect parents and do nothing

Answer is he needs transfusion, go ahead??? Or maybe court




you know one of your colleagues who is a surgeon is alcohol abuser. You should

1.report to state medical board
2.report to medical director of your hospital
3.talk to him
4.let his girlfriend who is your pt to talk to him
5.do nothing

Answer is inform medical director of the program


a new test for UTI. Specificity and sensitivity are both better than old one. Q asks the new test:
1.increase false positive
2.increase false negative
3.increase reliability
4.increase validity


a middle-aged man with recurrent ankle sprain (I-II). He comes again for ankle sprain. Next
1.short splint
2.long splint
3.avoid weight bearing
4.pain medication
5.surgical repair

ANSWER is surgical repair.


A picture of x-*** film of a 18-yo man¡¯s foot. He had foot injury 3 weeks ago. Painful. From picture, you can see some calcification in the soft tissue around the bone. No fracture is noticed. This is a sign of
1.injury recovered
2.tumor
3.osteomyelitis

ANSWER IS injury recovered
myositis ossificans




A term pregnant pt who starts delivery is found active vaginal HPV infection. You recommend:
1.vaginal delivery
2.c-section
3.give medication to stop delivery and treat HPV first
4¡

ANSWER is c- section ( actibe HPV requires c section)



**********
A 32 weeks pregnant pt with severe cervical dysplasia. Next

1. treatment
2. no treatment


answer is no tx


additional Q: how about LSIL in the same pt ?

If treatment is needed, What kind of treatment is the best ?

LSIL dont need Rx
need repeat PAP and colposcopy


***************




A pt hit his car¡¯s steering wheel during MVA several hours ago. He is suspicious to have cardiac contusion (s/s). next
1.EKG
2.Cardiac enzymes
3.Echo
4¡.

No CXR in the choice
Answer is EKG





a 45-yo woman who works in an old city building got scratched by a bat. She had vaccinated with Rabies before and her ab titer is positive. Next
1.vaccine
2.Rig
3.Rig + Vaccine
4.do nothing

Answer is DO nothing




Q)A pt, MVA, after transfusion, jaundice. LFT normal. Next to do

1.dircte coomb test
2.indirect coomb test
3.others.


Q)A pt got 18 cm wound on medial thigh, bleeding. You

1.direct pressure to wound
2.press femoral A
3.others

Answer is direct pressure to the wound.




Q)Is current smoking absolute C/I to lung transplant procedure ?

Answer is yes.









Q)a pregnant pt with preeclampsia. Bp is 160/120. what anti-HTN medication ?



1. methyldfopa
2. b blocker labetalol
3¡.
No hydralazin in choice.

Answer is B blocker labetolol