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    QUESTIONS..PLEASE POST THEM INDIVIDUALLY AND LET'S DISCUSS AND CLOSE THEM ALL..PLEASE

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    //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

  2. #2
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    bannedFLK
    FLK is offline Temporarily Banned
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    etiology please

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

    people should be careful in quoting previous questions!

  3. #3
    Anonymous is offline Unregistered Guest
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    plz help to Break them up///thanks

    //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

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