QUESTIONS..PLEASE POST THEM INDIVIDUALLY AND LET'S DISCUSS A

[Anonymous]

//A 42-year-old nightclub singer who smokes heavily and drinks a moderate amount of alcohol complains of episodes of hoarseness for 2 months associated with an occasional dry cough. The most recent episode has lasted for 3 weeks.In the initial care of this patient, which one of the following would be the most appropriate?
Perform indirect laryngoscopy
Prescribe a cough suppressant and expectorant


//A 28-year-old white female presents with symptoms of painful and frequent urination. She has never had a urinary tract infection. The onset has been gradual over the past week. There is no associated hematuria, flank pain, suprapubic pain, or fever. There is no itching or vaginal discharge. A midstream urine specimen taken earlier in the week showed significant pyuria but a culture was reported as no growth. She has taken trimethoprim/sulfamethoxazole (Bactrim, Septra) for 2 days without relief. Her only other medication is an oral contraceptive agent. The most likely infectious agent is
Escherichia coli
Chlamydia trachomatis
Candida albicans
Staphylococcus saprophyticus

///The feature which most helps to distinguish premenstrual syndrome (PMS) from other conditions is
the patient's age
a history of sterilization
fluid retention
social withdrawal
a regular symptom-free interval

//The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is associated with
urinary sodium loss
hypothyroidism


///Following initial emesis or gastric lavage, continuous nasogastric suction should be maintained with which one of the following suspected poisonings?
Phenobarbital
Methyl alcohol
Propoxyphene (Darvon)
Phencyclidine (PCP)
Methamphetamine

///Which one of the following statements is true regarding suture material?
Nylon provokes a greater inflammatory response than silk
Nylon has better handling characteristics than silk
Monofilament sutures are less likely to harbor bacteria
Chromatization of catgut renders it nonabsorbable
Polyglycolic acid (Dexon) and polyglactin 90 (Vicryl) are nonabsorbable

///Which one of the following statements is true concerning anaphylaxis?
On reexposure to an agent, the rate of similar or worse reaction is nearly 100%
Atopic individuals are at significantly higher risk for anaphylactic reactions to drugs or insect stings
Antihistamines and corticosteroids are the drugs of choice in the initial treatment of an acute reaction
All patients who have anaphylaxis and are unstable should be hospitalized and monitored for 24 hours

///A 38-year-old African-American female comes to your office complaining of "joint pains." The metacarpophalangeal joints of both hands are red and swollen. Fluid aspirated from an involved joint shows 5000 WBCs/mm3 which are predominantly neutrophils. Radiographs of the hands show juxta-articular osteoporosis of the metacarpophalangeal joints. The most likely diagnosis is
osteoarthritis
rheumatoid arthritis
gout
ankylosing spondylitis
gonorrhea-associated arthritis

////A serum thyroglobulin determination is useful in
monitoring the effectiveness of surgical treatment for thyroid cancer
determining the amount of thyroid binding globulin in serum


//A 45-year-old white male consults you because of a painless, circular, 1-cm white spot inside his mouth, which he noticed 3 days ago. You are treating him with propranolol (Inderal) for hypertension, and you know him to be a heavy alcohol user. After careful physical examination, your tentative diagnosis is leukoplakia of the buccal mucosa. You elect to observe the lesion for 2 weeks. On the patient's return, the lesion is still present and unchanged in appearance.The best course of management at this time is to
perform a biopsy of the lesion
Physical Exam


///A 48-year-old white female comes to your office complaining of severe hot flashes, sweats, and insomnia. She stopped having periods 6 months ago and has not had any surgery. Which one of the following is the most appropriate therapy?
Conjugated estrogen, 0.625 mg daily, and medroxyprogesterone, 5 mg daily for 14 days each month


//A 46-year-old African-American male comes to your office complaining of the sudden onset of severe dizziness for one day. His symptoms include a sensation of abnormal rotation of his environment, as well as occasional headaches. He has felt nauseated but has not vomited. On examination, he has resting nystagmus. There is no hearing loss, and a thorough neurologic examination is otherwise normal. He is vertiginous in all positions. Which one of the following is the most likely diagnosis?
Basilar artery migraine with vertigo
Benign positional vertigo
Vestibular neuronitis
Meniere's disease
Eustachian tube dysfunction

///A 3-year-old white male, whose father is a myasthenia gravis patient being treated with pyridostigmine (Mestinon Timespan, 180 mg), apparently ingested approximately 20 of these tablets 4 hours ago. When you see the child in the hospital emergency department he is vomiting and has diarrhea and abdominal cramping. Other signs and symptoms include increased peristalsis, salivation, wheezing, and profound muscle weakness.To counteract the principal symptoms, you would use an intravenous injection of
atropine sulfate
physostigmine (Antilirium)
epinephrine 1:1000
edrophonium chloride (Enlon, Tensilon)

//In a woman with preeclampsia, the impending onset of eclampsia is most likely to be indicated by
headache and visual disturbances
urinary protein excretion >300 mg/dL/24 hr


///The most common complication of anterior shoulder dislocation in a patient under the age of 20 is
recurrent dislocation
median nerve compression
subdeltoid bursitis
fracture of the greater tubercle of the humerus
rotator cuff tear

///With regard to sexual behavior during normal pregnancy, physicians should inform the couple that
female orgasm should be avoided, because it stimulates uterine contractions
women's preoccupation with the baby lessens their need for holding and cuddling
pelvic vasocongestion in midpregnancy is likely to decrease sexual arousal
vaginal intercourse should be avoided late in the third trimester because it increases the risk of infection
milk ejection with sexual excitement is normal

***In adults, which one of the following cardiac problems is most often associated with a crescendo/decrescendo systolic murmur along the left sternal border, a diastolic flow murmur along the left sternal border, and a wide, fixed splitting of the second heart sound?
Atrial septal defect
Tricuspid insufficiency
Ventricular septal defect
Mitral insufficiency

//Which one of the following statements is true of manic-depressive problem drinkers?
Heavier drinking characteristically occurs during the manic phase
Heavier drinking characteristically occurs during the depressive phase


///The use of fecal occult blood testing to screen for colorectal cancer
has been clearly shown in well-designed, controlled trials to reduce overall mortality from the disease
is associated with a high proportion of false-positive results
is a nearly ideal screening test because it requires little patient preparation and cooperation
will identify at least 95% of individuals with occult colorectal cancers if done on a regular and periodic basis
is very valuable for patients with a known history of ulcerative colitis

////In an adolescent who is not sexually active, the most appropriate choice of therapy for primary anovulatory dysfunctional uterine bleeding is
dilatation and curettage
intermittent 5-day courses of medroxyprogesterone acetate (Provera)
iron intramuscularly, and vitamin B12
a low-dose, estrogen-dominant oral contraceptive
,

///A 42-year-old white female has a 5.0x7.0-mm pigmented lesion removed from the skin of the dorsal thorax by excisional biopsy. The width of the surgical margins is 4.0 mm and the excision extends to the subcutaneous fat. There are no satellite lesions, no palpable regional lymph nodes, and no distant metastases. The pathology report reads, "Malignant melanoma, 0.65 mm thick by Breslow measurement technique. All specimen margins are free of tumor."Which one of the following is most appropriate at this time?
Immunotherapy
Radiation therapy
Chemotherapy
Wide reexcision
No further treatment

///You are treating an 18-year-old white male college freshman for allergic rhinitis. It is October and he tells you that he has severe symptoms every autumn which impair his academic performance. He has a strongly positive family history of atopic dermatitis.

Which one of the following medications is considered optimal treatment for this condition?
Intranasal glucocorticoids
Intranasal cromolyn sodium
Intranasal decongestants
Oral antihistamines

////Which one of the following antiepileptic agents would be least likely to reduce the efficacy of oral contraceptives?
Phenobarbital
Phenytoin (Dilantin)
Paramethadione (Paradione)
Valproic acid (Depakene)
Carbamazepine (Tegretol)

///You examine a 67-year-old Hispanic male who has severe periumbilical abdominal pain, vomiting, and diarrhea which began suddenly several hours prior to his office visit. His temperature is 37.0° C (98.6° F), blood pressure 110/76 mm Hg, and respirations 28/min. His abdomen is slightly distended, soft, and diffusely tender; bowel sounds are normal. Other findings include clear lungs, a rapid and irregularly irregular heartbeat, and a pale left forearm and hand with no palpable left brachial pulse. Right arm and lower extremity pulses are normal. Urine and stool are both positive for blood on chemical testing. His hemoglobin is 16.4 g/dL (N 13-18) and his WBC count is 25,300/mm3 (N 4300-10,800). The diagnostic imaging procedure most likely to produce a specific diagnosis of his abdominal pain is
intravenous pyelography
sonography of the abdominal aorta
a barium enema
celiac and mesenteric arteriography
contrast venography

///An athletic 34-year-old African-American male has experienced several bouts of severe muscle cramps and weakness during prolonged competition at racquetball tournaments. Following these episodes, his medical evaluations have revealed creatinine phosphokinase levels of over 2000 U/L (N 17-148), erythrocyte sedimentation rates of 10 mm/hr (N 1-13), and normal urinalyses. He denies any history of rash or other joint symptomatology, and otherwise enjoys good health between these episodes. Which one of the following would most likely confirm your diagnosis?
A muscle biopsy
An antinuclear antibody (AN level
Hemoglobin electrophoresis
An aldolase level
Electrocardiography

///A 24-month-old African-American female whom you have followed for routine well child care and a few episodes of otitis media is brought to the office by her mother for a regular well child visit. The mother is concerned that the child's language development seems to be slower than she remembers with her older children. Which one of the following would be a cause for concern at this age?
She is unable to name pictures on a standardized test, such as the Denver Developmental Screening Test
She is making sentences of only two or three words

///The most common site of bleeding in patients with epidural hematoma is the
sagittal sinus
middle cerebral artery
middle meningeal artery
posterior meningeal artery
transverse sinus

////Which one of the following is most characteristic of a pterygium?
The lesion is potentially malignant
It represents the encroachment of a pinguecula on the cornea
Intense conjunctival itching is produced
A conjunctival burn usually precedes its development



///Which one of the following would be the most appropriate therapy for her urinary tract infection?
Ciprofloxacin (Cipro)
Nalidixic acid (NegGram)
Trimethoprim/sulfamethoxazole (Bactrim, Septra)
Amoxicillin
Tetracycline

///Which one of the following fractures should be immobilized with the phalanx in extension?
A comminuted fracture of the distal phalanx
A fracture of the proximal interphalangeal joint
Mallet finger with an avulsion fracture of the extensor tendon of the distal phalanx
An undisplaced fracture of the shaft of the distal phalanx

///A 35-year-old white female complains of unilateral frontotemporal headaches. During these episodes, which occur every 2 to 3 weeks, she becomes nauseated, sometimes to the point of vomiting. The headaches are throbbing in character and last for 1 to 3 hours, often causing her to leave her job early. Relief is sometimes obtained with simple analgesics, but more often with sleep or the passage of time. On the basis of this history alone, the most likely diagnosis is
sinusitis
a brain tumor
muscle tension headache
cluster headache
migraine headache

///Evidence of cardiomegaly on a chest film is found early in which one of the following?
Coarctation of the aorta
Pulmonic stenosis
Tetralogy of Fallot
Tricuspid atresia
Transposition of the great vessels

///A 32-year-old farmer comes to your office because of an upper respiratory infection. While he is there he points out a lesion on his forearm that he first noted approximately 1 year ago. It is a 1-cm asymmetric nodule with an irregular border and variations in color from black to blue. The patient says that it itches and has been enlarging for the past 2 months. He says he is so busy that he is not sure when he can return to have it taken care of. In such cases the best approach would be to

perform an elliptical excision as soon as possible
perform a punch biopsy and have the patient return if the biopsy indicates pathology


///Which one of the following is recommended for the treatment of dry skin in the elderly?
Use soap more thoroughly to clean all areas of skin when bathing
Take long, hot tub baths rather than brief showers
Dry the skin vigorously with a towel immediately after bathing
Avoid emollients, especially those containing lactate or urea
Keep the heat turned down somewhat in the winter to avoid drying out the indoor air

////A healthy 28-year-old laboratory technician consults you about a test he ran "for the heck of it." He is asymptomatic, and the results of his physical examination are within normal limits. However, laboratory studies show a total serum bilirubin level of 1.9 mg/dL (N < 1.0) with an indirect level of 1.3 mg/dL (N < 06). Determinations of liver enzyme and serum alkaline phosphatase levels are normal. The hemoglobin level is 15.0 g/dL (N 13-18) and stable; the reticulocyte count is 1% (N 0.5-1.5). The most likely diagnosis is
Wilson's disease
Crigler-Najjar syndrome
Gilbert's syndrome
alcoholic hepatitis
non-A, non-B hepatitis

///The parents of a 1-year-old child bring him to your office because 30 minutes ago he swallowed an 11.5-mm button battery which his grandmother dropped while changing the batteries in her hearing aid. The child seems fine when you examine him. Which one of the following is the most appropriate advice?
---A radiograph should be obtained immediately to see if the battery is lodged in the esophagus
--All ingested batteries should be retrieved, endoscopically if necessary, because electric current or chemicals leaking from the battery are likely to injure the gastrointestinal tract

////The most accurate method for the laboratory diagnosis of Chlamydia trachomatis infection is
cytologic examination of epithelial cell scrapings
antigen detection using the direct-smear fluorescent antibody (F test
measuring antigen-antibody reactions through an enzyme-linked immunosorbent assay (ELIS
serologic studies using microimmunofluorescence (MI
a culture of the organism


///A 75-year-old otherwise healthy white female states that she has passed out three times in the last month while walking briskly during her daily walk with the local senior citizens mall walkers' club. This history would suggest which one of the following as the etiology of her syncope?
Vasovagal syncope
Transient ischemic attack
Orthostatic hypotension
Atrial myxoma
Aortic Stenosis

///A 73-year-old white male who is otherwise in good health noted a sudden shower of flashing lights before his left eye a few hours ago. The most likely diagnosis is
migraine syndrome
retinal detachment
vitreous floaters
central retinal vein thrombosis
temporal lobe tumor

///Which one of the following statements regarding herpes zoster is true?
Pneumonitis and central nervous system infection occur frequently in the immune-competent host
Immune-competent individuals commonly develop a second episode of infection
Disseminated zoster is frequently fatal
Post-herpetic neuralgia is rare in adults younger than age 50

///A 60-year-old African-American male with type 2 (non-insulin-dependent) diabetes mellitus and hypertension has been on glyburide (DiaBeta, Micronase) and sustained-release verapamil (Calan, Isoptin) for 5 years. Since starting him on captopril (Capoten) 6 weeks ago, you have monitored his serum creatinine levels, which have risen from 1.4 mg/dL to 3.0 mg/dL (N 0.6-1.5). Which one of the following would indicate a diagnosis of interstitial nephritis, as opposed to an ischemic cause of acutely worsening renal function?
A BUN/creatinine ratio <10
Urine osmolality >350 mOsm/kg (increased)
Mild to moderate proteinuria on a urine dipstick
Urine sediment containing WBCs, WBC casts, RBCs, eosinophils, and eosinophil casts


/////A 24-year-old white female complains of a 3-month history of joint pains, rash, and fatigue. Which one of the following test results provides the greatest support for a diagnosis of connective tissue disease?
WBC count 3500/mm3
Erythrocyte sedimentation rate 75 mm/hr
Antinuclear antibody (AN positive, titer 1:80
Antinuclear antibody (AN positive, titer 1:320
Positive rheumatoid factor

///A 75-year-old white male with dementia of the Alzheimer's type presents with syncope. He often feels faint upon rising from his chair and occasionally passes out. His medication consists of thioridazine (Mellaril), 25 mg daily for agitation. The only pertinent abnormality found on examination is a 20-mm Hg fall in systolic blood pressure after standing for 1 minute. Appropriate initial management would be to
encourage the patient to wear elastic stockings
instruct the patient to arise slowly from his bed or chair
discontinue the thioridazine
prescribe fludrocortisone (Florinef), 0.1 mg daily

///A 52-year-old white female has a family history of hypertension and diabetes. She is considering postmenopausal hormone replacement but is worried about her own risk factors.You counsel her that postmenopausal hormone replacement treatment can
improve her lipid profile
increase her risk of forming blood clots


///The main reason for giving iodinated contrast prior to CT scanning of the head is to increase the likelihood of visualizing
a subdural hematoma
an epidural hematoma
an intracranial hemorrhage
an acute thrombotic stroke
an intracranial neoplasm

///An 8-year-old white male is brought to your office by his parents, who are concerned about the number of colds he has had. Your chart review indicates that he has had approximately 15 upper respiratory infections each year. Most were viral, but he also had several episodes of sinusitis. Family history reveals that the mother has similar problems and has recently been diagnosed as having rheumatoid arthritis. The most likely immune deficiency in this child is
Bruton's panhypogammaglobulinemia
DiGeorge's syndrome
Wiskott-Aldrich syndrome
combined immunodeficiency
selective IgA deficiency

///A 4-year-old white male who has diarrhea and abdominal distention is brought to your office. Laboratory examination of the stools reveals Giardia lamblia trophozoites. In treating this patient, the drug of choice is
furazolidone (Furoxone)
metronidazole (Flagyl)


///For a 7-year-old white male with inflammatory scalp alopecia, which one of the following would be the treatment of choice, if a KOH preparation reveals hyphae?
Oral griseofulvin (Fulvicin)
Topical nystatin (Mycostatin)
Topical miconazole (Monistat)
Topical amphotericin B (Fungizone)

///A 17-year-old white male comes to your office after football practice with a 2-day history of sore throat, headache, fever, chills, and cough..PE:
Temperature........39.7° C (103.4° F)
Pulse..............84/min
Blood pressure.....112/74 mm Hg
Throat.............hyperemic, no cervical adenopathy
Nose...............nasal mucosa is boggy and a clear watery discharge is present
Chest..............rales and rhonchi are noted in the right anterior chest
Neurologic exam....normal
You decide to treat this infection with
penicillin
cephalothin (Keflin)
erythromycin
trimethoprim-sulfamethoxazole (Bactrim, Septra)

///A 60-year-old white female is scheduled to have a total abdominal hysterectomy. She is currently in good health, but the general surgeon is concerned because the patient had a pulmonary embolus 10 years ago. Which one of the following is most effective for prevention of another embolus?
Subcutaneous heparin prophylaxis
Full heparinization after surgery
Aspirin prophylaxis
Impedance plethysmography, 36 and 72 hours after surgery
No prophylaxis necessary

////A 76-year-old white male consults you regarding impotence. He describes not only an inability to achieve an erection but also a marked decline in his libido. A serum testosterone level is reported as low. Which one of the following laboratory studies should be ordered next?
Renal panel
Cortisol level
FSH level
Estradiol level
Prolactin level


///Congenital dysplasia of the hip
causes dislocation of the hip only at birth
is correctable early in life by multiple diapering
requires open reduction if dislocation is detected after 18 months of age
generally begins as laxity of the surrounding capsule and soft tissues

///With the exception of hepatitis B immunization administration when mothers are hepatitis B surface antigen negative, the immunization schedule in preterm infants should be
based on corrected (postconceptual) age
based on chronologic (postnatal) age
delayed until catch-up growth (growth acceleration) has begun
altered so that inactivated polio vaccine is given for the first two doses
altered so that DPT immunization is preceded by a 0.1-mL test dose

////6-month-old white male is noted to have a scrotal mass that fills and empties depending upon his position. Crying increases the size of the mass. Which one of the following is the most likely cause?
Communicating hydrocele
Tumor
Varicocele
Epididymitis
Incarcerated hernia

///Which one of the following is the most likely result of the inhalation of silicon dioxide particles by foundary workers using sand with casted metals?
Progressive pulmonary fibrosis
Sarcoidosis
Lung cancer
Allergic asthma
Alpha1-antitrypsin deficiency

///Which one of the following statements concerning bacteremia after health-care procedures is true?
The incidence of bacteremia is generally highest for dental and oral procedures
A significant rate of bacteremia is noted with proctoscopy
Uncomplicated vaginal delivery frequently causes bacteremia and endocarditis
Most episodes of bacteremia after dental extractions last several hours
The incidence of bacteremia after urinary bladder catheterization is the same whether urinary infection is present or not

///A 77-year-old white female who has diabetes mellitus is hospitalized for acute pyelonephritis and improves after 3 days of therapy. On the fourth day, previous symptoms suddenly intensify to produce high fever, colicky flank pain, and grossly bloody urine. Intravenous pyelography demonstrates cavities and sinuses in the region of the papillae. What is the most likely diagnosis?
Acute glomerulonephritis
Renal papillary necrosis
Renal infarction
Acute tubular necrosis

***The most likely condition to be associated with a staghorn calculus is
urinary tract infection
hyperparathyroidism



///You diagnose acute pancreatitis in a 45-year-old white male. As you initiate therapy and closely monitor his progress, which one of the following complications is most likely to develop?
Hypomagnesemia
Hypoglycemia



///Which one of the following is true concerning idiopathic thrombocytopenic purpura in children?
There are inadequate numbers of megakaryocytes in the marrow
The spleen is enlarged
The prognosis is poor
Vitamin K should be administered
Prednisone should be administered in severe cases


///Which one of the following radiographic findings is typical of mechanical small bowel obstruction?
Air-fluid levels in the large and small bowel
Early distention of the bowel distal to the obstruction
Air within the wall of the small bowel
A stepladder appearance of air-fluid levels on the erect film
Increased transit time of a barium meal

///Which one of the following occurs in over 90% of patients using isotretinoin (Accutane) for acne?
Hirsutism
Cheilitis
Rhinitis
Increased HDL cholesterol

[FLK]

did you make these up or are these from your exam?

people should be careful in quoting previous questions!

[Anonymous]

//36 yrs old 30 wks pregnant woman previous 2 babies normal vaginal delivery 8.5lbs & 9 lbs respectively.has gestational diabetes. wants to deliver at home . what is her risk?
a. prolong delivery
b. baby will get hypoglycemia after delivery
c. placenta previa
d. growth delay
e. infection


//67 yrs old with lower extermities BP 180/90. upper extremities 150/85 what is Dx?
a. essential HTN
b. renal artery stenosis
c. pheochromocytoma
d. malignant HTN


//Vegetarian woman with lactose intolerance, and they ask what she will be deficient in?
a. Vit B12
b. Iron
c. Ca


//patient with chronic pancreatitits
what will you order
a) amylase
b)lipase
c) LDH
d) calcium
e) trypisn


//55-year old patient
recuperating from acute episode of pancreatitis...has hematemesis. On endoscopy gastric varices are observed, no esophageal varices seen. What is the diagnosis


//young male with no risk factors fhx of nephrolithiasis comes in with classic presentation of renal stones.UA with hematuria; Next step
1. UA
2. Ucx
3. Renal u/s
4. AXR
5. CT abdomen and pelvis


//35 y F, with DM came with osteomylits. she came with c/o discahrge since 10
days. what is next step
a. bone scan
b. MRI
c. bone c/s


//25 y , basket ball player , hited at temporal area. what is next
The area is bruised and has swelling.Pt is c/o pain but not drowsy.
a. observe
b. Ct head
c. intubate


//Pt with nose bleeding, with tampons in one nostril, comes with hypotension, fever.
a) It's cause by a bacteria
b) It's a toxin
I think It could be toxic shock syndrome


//pt with ppd 12mm, last year ppd was neg and CXR was +, they gave MX at that time. what should you do.
a) repeat CXR
b) give Mx
c) repeat PPD
d) Nothing


//Pt with morning stiffness and bilateral joint pain. what is the symptom the pt is most likely to present.
a) pericardial friccion rub
b) subcutaneous nodule.


//Pt with trauma on the left eye...Baseball hit...Fundoscopy looks like retinal hemorrhage.
a) refer to Ophtalmologist
b)patch the eye
c) do nothing.


// Child with febrile seizure...
the parents want to know about the future risk of having a seizure.
a) the child is at no greater risk of having seizure comparing to the genral population
b) the child have a greater risk of having seizure in the future.
c) there is no way to predict the risk of seizure in the future.


//Pt is intubated the families bring you a living will saying the pt did not want DNR.
a) Excuse your self because this is a big mistake
b) extubate the pt, but keep with fluids and medicines
c) Extubate the pt, but keep only fluids
d) Do not extubate the pt.


//Pt with terminal illness previously stipulate his wish not to accept any heroic measures to prolong his life, before admiting to the hospital he change his mind and needs everything to be done, so does his family. Pt need intubation, considering the seriousness of his illness
a) Do not agree to intubate since this is medical futility
b) try to do everything possible to seve the pt**
c) Call the ethic committe to handle the situation


/Pt with RUQ pain, jaundince, X-ray showing calcifications.
a) Chronic pancreatitis
b) Gallstones-pancreatitis
c) Hepatitis
d) Cholecistitis


//Lactating woman very worry if she would have enough milk to feed his baby, and about if the colostrum is not very nutritive what are your recommendations.
a) the child will need exclusively breast milk until 4-6 months old**
b) If the child cries, you can give formular
c) Start firs with formula and posteriorly, breast milk.


//7 yo boy with scoliosis of 7cm, Xray show hemivertebra; what is the next best step.
a) refer to ortho for surgical management
b) Conservative management
c) Prescribe a brace
d) The disease is progressive.


//Pilot coming to medical consultation for impotance, you decided to prescribe Viagra, what are the recommendations.
a) there are no recommendations
a) He can't fly
b) He should take the medicine 24 hrs before the flight.


//Pt has allergic rhinitis, is taking diphenidramine, the pt, will be travelling and will be taking scuba diving class.
a) tell him to discontinue the medicine
b) There is no need to discontinue the med
c) He would better cancel his classes.


//33 YO, Pregnant pt with 10Weeks of gestation, present with a mobile mass in the left breast, she previously have a history a cystic disease. there is no adenomegaly.
a) DO a USG
b) Check the pt, after she deliver
c) DO a mammogram
/


/The famous Edwards.....Couples and their baby is dianosed with 18, they decided to continue with the pregnancy, at delivery the child has APGAR 0, what should you do.
a) Just shake the pt, until APGAR increase
b) Follow the pt whishes and perform the maneuvers
c) Don't perform resuscitation
/


/Pt with many ulcers onn the lateral surface of the tongues on an erythematous bases
a) Acyclovir
b)Ganciclovir
c) Vidarabine



//16 Yo pregnant woman, married is required C-section, who needs to give the consent
a) herself
b) her parents
c) the husband



//Pt with Hyperthyroidism, treated with I131, the pt is receiving synthroid because of hypothyroidism. How should you follow the pt.
a) TSH
b)t4
c) T3



Egyptian woman, come into the clinic, Inquiring about circumcision of for her daughter, what will you tell her.
a) in med school they do not teach us that, so we do not practice that in the US
b) Is there anyone that you know, they have practice that on.
C) I can’t do it



//75 yo female with a pic of Uterine or rectal prolapse.
a) refer the pt to General surgery
b) refer the pt to OBGYN
c) pessary



//38 yo male pt in the ED, with pain in right leg. PE. an erythematous skin, tender to palpation. CBC with WBC slightly increase. You suspect the pt is seriously ill, which labs study would help you confirm your supspicion.
a) blood culture??
c) high serum cortisol level
d) ABG
c) Hg level



//New born with infectious conjuntivitis, pt born in a hospital and receive erytromycin ointment, what is the most likely etiology.
a) chlamydia
b) N. Gonorrhea
c) Herpez virus
d) chemical conjunctivitis
Pts with cough, malaise, fever for 2 months. CXR hiliar calcifications, and imagen sugestive of cavitation in upper lobe.
a) Give Mx for tb*8
b) methenamine sylver
c) check ELISA for HIV.
/


/ 8 yo girl presenting with many Upper respiratory tract infections, now come with purulent sputum. show an Chest-X-Ray....enlarged bronchi
a) give ABX, everytime the pt presents with ppneumonia
b) give ABX and check for clorhide test.


++++++++++++++++++++++++++

A 17y/o in MVA ,lost lot of blood and given crystalloids.She is scheduled for surgery.
In pocket you find A card saying she follows Jehovah witness and should not be transfused
blood products even if life threatening. Her parents arrived in hospital. at this time you should

1. Let her bleed to death.
2. Transfuse blood
3. Ask parents to consent for blood
4. Give erythropoietin
5. GIve patient to different doctor.

15y/o Female patient Sexually active .you prescribed OC pills. Her father calls you and asks did you
prescribe "the pill" to my daughter. In answering his Q your response should be based on

1.informed consent
2.confidentiality
3.parents right to know