Exam 03.2017 Full
Exam 03.2017 Full
Exam 03.2017 Full
com
Guide:
OQ.03.2017.A.001:
OQ.03.2017 = old exam 03.2017
A = part A
001= Question number 1
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באהדה רבה,
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OQ.03.2017.A.001
Which of the following laboratory results is predictable
predictable of negative prognosis in a 60
60-year-old man with
community-acquired
acquired pneumonia?
A. 13,500 neutrophils/microliter on complete blood count
B. Serum sodium of 121 meq/l
C. 378,000 platelets on complete blood count
D. Serum glucose of 223 mg/dL
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OQ.03.2017.A.002
A 52-year-oldold man presents with malaise, shortness of breath, productive cough with foul smelling grey
utum, and a temperature of 38 oC over the last two weeks. Given the X-ray,
sputum, ray, which of the following is
the most likely diagnosis?
A. Lobar pneumonia
B. Atypical pneumonia
C. COPD exacerbation
D. Lung abscess
E. Lung cancer
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OQ.03.2017.A.003
A 67-year-oldold woman is admitted for workup of a febrile disease. Staphylococcus MRSA has grown in
three blood cultures. Six days into adequate antibiotic treatment she develops lung edema, and
auscultation reveals a diastolic murmur above the aorta. Which of the following is the next therapeutic
step?
A. Broad spectrum antibiotics in order to cover ggram negative bacteria
B. 5 consecutive days of intravenous Lasix (furosemide)
C. Refer the patient to emergent heart surgery
D. Cease antibiotics and obtain another blood culture
E. Chest CT with IV contrast
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OQ.03.2017.A.004
A 27-year-oldold woman presents to the emergency room with a temperature of 40 oC and severe pain over
the right shin. Her systolic blood pressure is 92 mmHg. On examination the shin is very tender on
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palpation, but there is no local swelling or erythema of the skin. Complete blood count reveals 42,000
leukocytes/mql. Which of the following
fol is the most likely diagnosis?
A. Necrotizing fasciitis
B. Cellulitis
C. Myositis
D. Erysipelas
E. Stasis dermatitis
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OQ.03.2017.A.005
An 82-year-old old woman was referred from the nursing home due to severe diarrhea and high fever. Stool
examination revealed Clostridium difficile (CDT) infection. Her systolic blood pressure is 83 mmHg, and
complete blood count revealed 28,500 leukocytes/mql,
leukocytes/mql, and a creatinine of 2.3 mg/dl. Which of the
following is the best treatment for this patient?
A. Oral metronidazole, 500 mg, 3 times daily
B. Intravenous metronidazole, 500 mg, 3 times daily
C. Oral vancomycin, 125 mg, 4 times daily
D. Intravenous vancomycin, 125 mg, mg 4 times daily
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OQ.03.2017.A.006
A usually healthy 20-year-old old female complains of sudden urinary irritation with urgency and increased
frequency. She is not pregnant. What is the best course of management?
A. Urinalysis and cultures and start antibiotic treatment according to results
B. Empiric antibiotic treatment with no further tests
C. Recommend drinking water and rest without antibiotic treatment
D. Refer to a gynecologist before any other testing or treatment
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OQ.03.2017.A.007
A 23-year-oldold medical student complains of anxiety before his anatomy exam. Based on the attached
ECG, which of the following is the most likely diagnosis?
OQ.03.2017.A.008
Which of the following diseases typically causes both stenosis and insufficiency of the mitral valve?
A. Chordae rupture as a complication of acut acute myocardial infarction
B. Acute bacterial endocarditis
C. Dilated cardiomyopathy
D. Rheumatic heart disease
E. Blunt trauma to the chest
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OQ.03.2017.A.009
A 62-year-oldold man presents to the emergency room with, malaise and palpitations. His history is positive
for paroxysmal atrial fibrillation. Attached is the ECG script performed immediately.
A. Ventricular tachycardia
B. Ventricular fibrillation
C. Atrial flutter
D. Atrial fibrillation with LBBB
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OQ.03.2017.A.010
A patient complains of pain andd erythema of the nose and cheek cheek for several days, and is now complaining
of numbness of part of the face and double vision. Examination reveals reve ls partial paralysis of the eyeball
muscles on the right. What diagnosis should be suspected suspected?
A. Frontal lobe stroke
B. A tumor pressing the optic chiasm
C. Injury to the anterior pituitary gland
D. Injury ry to the posterior pituitary gland
E. Cavernous sinus thrombosis
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OQ.03.2017.A.011
A 62-year-oldold woman complains of feeling cold, hair loss, and constipation. Which of the following tests
is appropriate for this patient?
A. ANA antibodies
B. TSH
C. Urine for catecholamines
D. HbA1C
E. Tumor markers CA-125, 125, CEA
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OQ.03.2017.A.012
A 52-year-oldold man with advance heart failure (due to several myocardial infarcts)) complains that he is
experiencing enlargement and tenderness in the breast tissue which bothers him over the last month.
Which of the following drugs is responsible for these symptoms?
A. Carvedilol
B. Amiodarone
C. Warfarin
D. Furosemide
E. Spironolactone
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OQ.03.2017.A.013
A 44-year-oldold woman recently diagnosed with Burkitt’s Bur lymphoma has begun chemotherapy 3 days ago.
Her laboratory results today reveal increased creatinine, hypophosphatemia, hypocalcaemia hypocalc and
hyperureacemia. Which of the following explains these ph phenomena?
A. Transformation to aggressive leukemia
B. Typical renal injury secondary to chemotherapy
C. Renal injury typical to lymphoma
D. Renal injury due to tumor lysis syndrome
E. Treatment is probably causing rabdomyolisis
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OQ.03.2017.A.014
Which of the following is the target hemoglobin value in a patient with chronic renal insufficiency treated
recombinant erythropoietin and iron?
A. 8 gr/dl at the most
B. 10-11,5
11,5 gr/dl at the most
C. Above 12 gr/dl
D. The hemoglobin level vel should be as high as possible
possibl
E. There isn’t a set target; target should be adjusted to each patient separately
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OQ.03.2017.A.15
A 28-year-oldold man had a febrile illness with cough for a few days. Two days later he presents with
recurrent hematuria. Which of the following is the most likely diagnosis?
A. IgA nephropathy
B. Post streptococcal glomerulonephritis
C. Lupus nephritis
D. Primary bladder tumor
E. Primary renal malignancy
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OQ.03.2017.A.016
A 52-year-oldold woman, with cervical carcinoma presents with fever up to 39 oC, chills, nausea and
vomiting, and systolic blood pressure of 76 mmHg. There is pus in the urine. Blood work reveals renal
insufficiency and an ultrasound scan demonstrates right hydronephrosis. Which of the following is the
most appropriate treatment?
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erythematic, nodular, non itching rash over the legs (photograph attached). Which of the following is the
most likely diagnosis?
A. Asthma
sthma with atopic background
B. TBC
C. ANCA associated vasculitis
D. Sarcoidosis
E. SLE
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OQ.03.2017.A.026
Which of the following
lowing doesn’t cause clubbing ?
A. lung cancer
B. COPD
C. Cirrhosis
D. IBD
E. lung interstitial disease
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OQ.03.2017.A.027
Which
hich of the following change course of COPD patient with serious hypoxia ??
A. short acting B-agonist
agonist inhalation
B. LABA inhalation
C. permanent prophylactic antibiotics such as doxycilline
D. Oxygen
E. regular home physiotherapy
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OQ.03.2017.A.028
Which of the following COPD patient fits tthe criteria of stage gold three?
A. FEV1/FVC and FEV1>=30% but <50%
B. FEV1/FVC>0.8 and FEV1>=50% predicted
C. FEV1/FVC<0.5 and FEV1<50 FEV1 but >=10% predicted
D. FEV1/FVC<0.6 and FEV1>=50% but <70% predicted
E. FEV1/FVC >=0.8 and FEV1>=30
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OQ.03.2017.A.029
Which of the following treatment is recommended for ascites in cirrhotic patients?
A. Potassium restriction to 8 gr/d
B. Sodium restriction to 2 gr/d
C. Protein restriction to 30 gr/d
D. Calcium restriction to 12 gr/d
E. Chloride restriction to 6 gr/d
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OQ.03.2017.A.030
A 40-year-old man has a paracentesis of peritoneal fluid with a serum ascites albumin gradient (SAAG)
score of <1.1 mg%. Which of the following diagnosis is possible in this scenario?
A. Tuberculosis
B. Peritoneal carcinoma
C. Rheumatic arthritis
D. Heart failure
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OQ.03.2017.A.031
A 65-year-oldold man, known to have renal failure with creatinine of 2 gr/dl, diabetes, and a gastric ulcer, is
admitted with an acute episode of gout disease. Which of the following treatments is the most appropriate
in this patient?
A. NSAIDs
B. Colchicine
C. Allopurinol
D. Prednisolone
E. AntiTNF
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OQ.03.2017.A.032
Which of the following provides the best clinical description of the first acute episodes of gout disease?
A. Appears in the wrist
B. Begins at noon after a heavy meal
C. The episode evolves gradually during the course of two days
D. Untreated, the episode will resolveresolv spontaneously in 3 weeks
E. The clinical presentation may resemble cellulitis
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OQ.03.2017.A.033
A 35-year-oldold woman complains of general aches in the neck, shoulder. Flank, and shin areas over the
last 4 month. Additionally, she complains of sleep disturbances, decreased concentration and worsening
fatigue. She denies a rash. CPK, TSH, CRP, ESR and complete blood count are within the normal range.
Which of the following is the most mo likely diagnosis?
A. SLE
B. Sjogren’s syndrome
C. Inflammatory bowel disease
D. Fibromyalgia
E. Hypothyroidism
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OQ.03.2017.A.034
An 18-year-old old presents with fever and an inflammatory lesion of the…
You diagnose him with erysipelas. Which of the following bacteria is the most common causative agent?
A. Staphylococcus aureus
B. Staphylococcus epidermitis
C. Streptococcus group A
D. Streptococcus pneumonia
E. Escherichia coli
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OQ.03.2017.A.035
A 40-year-old healthy woman diagnosed with a urinary tract infection with Enterococcus faecalis. No
history of previous antibiotic treatment. Which of the following is the most appropriate antibiotic
treatment?
A. Ceftriaxone
B. Gentamycin
C. Amoxicillin
D. Aztreonam
E. Oflaxacin
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OQ.03.2017.A.036
What is the purpose of head CT in patients in the emergency emergency room with suspected stroke?
A. Diagnose of the extent and location if ischemic cerebrovascular events
B. Ruling out cerebral hemorrhagic event
C. Ruling out brain tumor or metastasis
D. Differentiating a local ischemic event from cardiac emboli
E. Ruling out a frontal stroke
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OQ.03.2017.A.037
Which of the following patients would be diagnosed as diabetic?
A. 30-year-old old man, fasting glucose, in two tests on different days 116mg/dl.
B. 41-year-old old asymptomatic man, glucose 190mg/dl on two random tests
C. 37-year-old old man, feeling well,well HbA1C 6.7% in two tests on different days during hospitalization
D. 40- year-old woman,, 2 hours after a glucose tolerance test, blood glucose is 175 mg/dl
E. 36-year-old old man, blood glucose 46mg/dl on a random test
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OQ.03.2017.A.038
A 17-year-oldold man, with diabetes type 1 has been complaining of stomach ache, and nausea for last two
days. Blood glucose is 217 mg/dl dl,, bicarbonate is 12mg/, and serum potassium level are 3.3mg/l.
Which of the following must be a part of the treatment in the emergency room?
A. Subcutaneous insulin
B. Intravenous insulin
C. Intravenous empirical antibiotics
D. Intravenous bicarbonate
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OQ.03.2017.A.039
Which of the following is considered a risk factor for osteoporosis by the FRAY questionnaire?
A. Male gender
B. Non smoker
C. Rheumatoid arthritis
D. Psoriasis
E. Consuming wine on Fridays
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OQ.03.2017.A.040
Which of the following drugs warrants complete blood count follow up?
A. Aspirin
B. Plavix
C. Optalgin
D. Methimazole
E. Penicillin G
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OQ.03.2017.A.041
Which of the following drugs may cause red man syndrome?
A. Chloramphenicole
B. Doxycycline
C. Vancomycin
D. Metronidazole
E. TMP-MTX
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OQ.03.2017.A.042
A 70 year-oldold man complains of malaise, which gets worse during the evening and night. He has
difficulty in opening his eyes and shaking hands during the night. night. He has recently begun a work-up
work of
anterior mediastenal mass.
Which of the following diagnosis fists this association?
A. Brain metastasis of lung cancer
B. signs of lymphproliferative disease
C. Advanced tuberculosis
D. Myasthenia gravis due to thymoma
E. Malignant thyroid tumor
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OQ.03.2017.A.043
A 50-year old man with a mid-systolicsystolic crescendo-de-crescendo murmur.
Which of the following heart defects cause this kind of murmur?
A. Mitral insufficiency
B. Mitral Stenosis
C. Aortic insufficiency
D. Aortic Stenosis
E. VSD
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OQ.03.2017.A.044
Which of the following findings on neurologic examination points to a problem originating in the
Substania nigra?
A. Cogwheel rigidity
B. Dysmetria
C. Intubation
D. Myoclonus
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OQ.03.2017.A.045
Which of the following is correlated with the disease severity iin n inflammatory bowel diseases?
A. Pyoderma gangrenosum
B. Erythema nodosum
C. Posterior Uveitis
D. Alopecia
E. Sacroileitis
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OQ.03.2017.A.046
A 72-year old man with long lasting diabetes. He is feeling well and is afebrile.
Attached is a photograph of his right foot. Which of the following is the most likely diagnosis of patient?
A. Septic arthritis
B. Cellulitis
C. Charcot arthropathy
D. Club foot
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OQ.03.2017.A.047
Which of the following mutations is common in myeloproliferative diseases such as polycythemia vera?
A. EGRF
B. HER 2
C. VEGF
D. JAK2
E. P53
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OQ.03.2017.A.048
Which of the following is an absolute indication for thrombolysis in patients with pulmonary emboli?
A. Room air oxygenxygen saturation of 78%
B. Heart rate of 122 bmp
C. Systolic blood pressure of 74 mmHg
D. Signs of right ventricular
entricular strain on echocardiography
E. Patient complains of compressing chest pain by the patient
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OQ.03.2017.A.049
Which of the following IS NOT considered a risk factor for obstruction sleep apnea?
A. Obesity
B. Female gender
C. Micrognathia
D. Acromegaly
E. Family history of sleep apnea
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OQ.03.2017.A.050
Which of the following is the treatment of choice for skin candidiasis?
A. Fluconazole tablets
B. Topical azole
C. Caspofungin
D. Amphotericin B
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OQ.03.2017.A.051
A woman on her 39th week of gestation presents to the emergency room with prolapse of cord. Which of
the following statements the most accurate regarding the common situation in which this would occur, occur
and the
he most appropriate management?
A. Cord prolapse is more common in term vs vs. preterm babies, and it requires an emergency cesarean
section
B. Cord prolapse pse is more common in preterm babies, and the most appropriate management is
returning the cord to the uterine cavity
C. Cord collapse is more common in vertex presentation vs. vs transverse or footling breech, and it
requires and emergency cesarean section
D. Cord presentation and it delivering the baby as soon as
rd collapse is more common in vertex presentations,
possible
E. Cord collapse is more common in term babies babies, and requires artificial rupture of membranes and
instrumental delivery
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OQ.03.2017.A.052
A 38 week pregnant woman presents present with headaches, BP of 155/115, and +3 protein on urinary exam.
Which
hich of the following is most important next step in managing this patient?
A. Magnesium sulfate treatment while inducing labor
B. Medical
edical management of the hypertension, awaiting spontaneous delivery
C. Emergency cesarean section
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D. Immediate
mmediate treatment with magnesium, corticosteroids and nitropruside,, and induction of labor
E. Brain imaging as soon as possible
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OQ.03.2017.A.053
A woman on her 28th week of gestation is treated with magnesium sulfate in the high high-risk pregnancy unit
due to premature contractions and cervical effacement to 4mm. The womann complain complains of extreme fatigue
and shortness of breath, and on physical examination you find complete loss of patellar reflexes. Which of
the following is the immediate therapeutic
herapeutic next step?
A. Emergency cesarean section
B. Switching from magnesiumagnesium treatment to indomed
C. IV calcium gluconate
D. Prepare for intubation and transfer to ICU
E. IV hypertonic saline
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OQ.03.2017.A.054 (OQ.09.2015.A.065)
A 39-year-old woman on her 24th th week of her 3rd pregnancy. Her blood type is B B- and she had a baby
with hydrops fetalis on her second pregnancy. How ow should her current pregnancy be managed?
A. Deliver
eliver the baby at 34 week of gestation to avoid similar situation
B. Follow middle cerebral artery flow from the 18th week of gestation estation onward
C. Biophysical
iophysical profile from the 23th week of gestation onward
D. Uterine
terine artery flow follow up from the 16th week of gestation onward
E. follow up maternal antibody titer and administer 300 mcg of anti-D anti D if necessary
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OQ.03.2017.A.055 (OQ.09.2015.A.062)
Which of the following is the definition of a normal non stress test?
A. Three accelerations of at least 10 seconds of 15 bpm above baseline du ring a time period of 20
during
minutes
B. One acceleration of at least 20 seconds of 20 bpm above baseline during a time period of 20
minutes
C. Fetal monitoring with no decelerations over at least 25 minutes
D. Two accelerations of at least 10 seconds of 20 bpm above baseline during a time period of 30
minutes
E. Two accelerations of at least 15 seconds of 15 bpm above baseline during a time period of 20
minutes
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OQ.03.2017.A.056
A 21-year-oldold woman, 26 weeks pregnant describes a round, erythematosus,, elevated, and non-painful non
ulcer that has appeared six weeks earlier in the proximity of the vaginal opening. She notes having
unprotected sex with several partners over the last year. Which of the following would you expect on a
fetal sonogram?
A. Hydronephrosis and hyper-echogenic
hyper bowel
B. Severe oligohydramnion
C. Hepatosplenomegaly, polyhydramnion, and an enlarged placenta
D. Chorioretinitis and brain calcifications
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A 35-year-oldold single woman wishes to evaluate her ovarian reserve, so she can decide at what age to
conceive. Which of the following predicts a low ovarian reserve?
A. Corpus luteum on the 22nd day of the menstrual cycle
B. A 27-day day long menstrual cycle
C. Serum progesterone of 3-6 3 ng/ml on day 22 of the menstrual cycle
D. LH level higher than FSH level on the 14th day of the menstrual cycle
E. Increased serum estradiol on day 3 of the menstrual cycle
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OQ.03.2017.A.67
A 28-year-oldold woman wishes to conceive. Work up of the couple reveals: normal sperm test, and a
menstrual cycle of 45-60 60 days. She was offered treatment with clomiphene citrate, for ovulation
induction. Which of the following statements is true regarding the chances and risks of this treatment?
A. There is a 25% risk of a multiple embryo pregnancy
B. There is a 75% chance of conceiving every treatment cycle
C. There is a 95% chance of achieving ovulation in every treatment cycle
D. There iss an increased risk of blurred vision and emotional lability
E. The risk for a multiple embryo pregnancy exists only if the patient will also receive HCG
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OQ.03.2017.A.68
A 35-year-old woman was referred for hysterosalpinography
hystero as a part of a check
k up of suspected
mechanical infertility; she was offered to perform the test with aqueous or oily contrast material material. Which
of the following is true regarding the comparison of these low contrast materials?
A. aqueous contrast provide better imaging of the salpinx vs. oily contrast material
B. there is greater chance of conceiving after imaging with oily contrast material vs. aqueous material
C. aqueous contrast provide better imaging of the the uterine cavity vs. oily aqueous contrast material
D. there is a decreased risk of granuloma following imaging with oily contrast material vs. aqueous
contrast material
E. there is a slightly greater risk of abdominal pain after imaging with aqueous contrast contr vs. oily contrast
material
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OQ.03.2017.A.69
Which
hich of the following treatment is the most appropriate for a 40-year-old old woman with severe
endometriosis who wishes to conceive?
A. GNRH agonist for a year
B. combined oral contraceptive for a year
C. aromatase inhibitors for a year
D. adhesiolysis and lesion ablation
E. IVF
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OQ.03.2017.A.70
Which of the following is a characteristic of the dermatologic changes during menopause?
A. subcutaneous edema
B. decreased in elastin and increase in collagen
C. increased blood vessels
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D. epidermal flattening
E. skin erythema
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OQ.03.2017.A.71
Which of the following is true regarding intra cytoplasmic sperm injection (ICSI)?
A. Is necessary when a defrosted sperm is used to fertilize the ova
B. Is necessary when pre implantation molecular diagnosis is desired
C. There is no need for it if he sperm is motile
D. Performed only when the sperm used was produced from testes
E. Is routinely performed in patients over 40
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OQ.03.2017.A.72
A 26-year-oldold woman who has had unprotected sex 48 hours previously is interested in contraception.
She has an unremarkable history, a 28-day 28 day menstrual cycle, and her last menstruation was 21 days ago.
Which of the following is the best way to avoid pregnancy in this woman?
A. The timing of the intercourse does not necessitate intervention
B. Recommend regular use of combined oral contraceptives
C. Recommend regular use of progesterone only oral contraceptives
D. Recommend high dose levonogestrel
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OQ.03.2017.A.73
A 35-year-oldold married woman, mother of three, with an unremarkable medical, surgical, obstetrical and
gynecological history wishes to place an intrauterine device (IUD) for contraception. She is debating
whether to use a copper or a progesterone secreting device. Which of the following describes the
difference between these two devices?
A. There is a higher risk of ectopic pregnancies with the progesterone secreting device vs. the copper
device
B. Over time, the progesterone secreting device is associating with ddecreased
ecreased bleeding vs. the cooper
device
C. There is a decreased risk for pelvic inflammatory disease with copper vs. progesterone secreting
device
D. The copper device is a significantly less efficient contraceptive
E. The progesterone secreting device is efficient for a bigger period of time compared to the copper
device.
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OQ.03.2017.A.74 (SIMILARSIMILAR to OQ.09.2015.A.084)
An 82-year-old old diabetic woman, with history of an ischemic heart disease and renal failure, presents with
prolapse of the pelvic organs that significantly deteriorates her quality of life. Examination reveals uterine
prolapse grade 3. Which of the following is the most appropriate treatment?
A. An anterior colporraphy operation
B. Transvaginal hysterectomy
C. Antimuscarinic therapy
D. A combined anterior-posterior
posterior operation
E. Local estrogen and use of a passary
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OQ.03.2017.A.75 (OQ.02.2016.B.101)
A 38-year-oldold woman, mother of 3, presents with leakage of urine when coughing, laughing, and
sneezing. She denies urgency, frequency, or a burning sensation while urinating. Which of the following
is the recommended initial therapy?
A. A TVT tape
B. Collage injection to the bladder neck
C. Burch colposuspension
D. Anticholinergic treatment
E. Pelvic floor exercises
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OQ.03.2017.A.76
A 66-year-old woman oman went through curettage due to postmenopausal bleeding. Pathology revealed
papillary serous adenocarcinoma of the endometrial mucosa. Which of the following is the most
appropriate treatment for this patient?
A. Aromatase inhibitors
B. A radical hysterectomy including salpino-oophrectomy
salpino
C. High dose progesterone for 6 month months
D. Mirena ( intra uterine device secreting levonogestrel )
E. A hysterectomy,
ysterectomy, salpino-oophorectomy,
salpino plus removal of the omentum and lymph nodes
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OQ.03.2017.A.77 (OQ.10.2016.B.011)
Which of the following is considered a protective factor from epithelial ovarian cancer?
A. Early menorrhea
B. Late menopause
C. Oral contraceptives
D. Endometriosis
E. Caucasians
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OQ.03.2017.A.78
A 34-year-old woman on the 7th week of her 3rd pregnancy presents with hyperemesis gravidarum. Beta
HCG is 1,000,000. Which of the following is typical of the most likely diagnosis?
A. Maternal bradycardia
B. The uterus is smaller than expected for gestation
C. Spider hemangioma of the skin
D. Hypotension
E. Snow storm image on sonogram
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OQ.03.2017.A.79
Which of the following is true regarding the intermediate fluid and the use of energy in hysteroscopy?
A. When using bipolar energy saline should not be used
B. When using bipolar energy glycin may be used as the intermediate fluid
C. Uterine perforation is more common when using bipolar energy
D. Hypokalemia is a common complication of using glycin
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A 22-Year-old old woman presents with an itching vaginal secretion. Examination reveals a white odorless
secretion, which looks like cottage cheese. Which of the following is the most appropriate treatment?
A. Ciprofloxacin for 1 Week
B. A Single dose of Fluconazole
C. Vaginal washes with an intimate soap for 1-week 1
D. A Single dose of metronidazole
E. Penicillin G for 3 days
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OQ.03.2017.A.85
A 27-Year-old woman presents with pain and swelling of the vulva. Examination reveals a woman in
distress, fever up to 38.5 C. and you palpable a tender, swollen, fluctuating mass in the lower third of the
right labia majora. Which of the following is the most common cause of this phenomenon?
A. An obstructed glandular duct
B. Infection of a hair follicle
C. Recto-vaginal fistula
D. Urethral infection
E. local trauma
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OQ.03.2017.A.86
A 41 year old man reports he tends to look back constantly, worried he might have dropped a coin or
stepped on an insect and killed it. He avoids touching objects, and when he does touch an object, he needs
to convince himself he didn't break it. His sole passion in life is cleaning his house, which he does daily.
Which of the following is the most likely diagnosis?
A. Paranoid personality disorder
B. Acute and transient paranoid psychosis
C. Obsessive compulsive disorder
D. Schizophrenia
E. Hypochondriasis
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OQ.03.2017.A.87
A 50 years old was arrested for beating his wife. In his questioning he claimed he is convinced she is
cheating on him with the neighbor, since he found traces of semen in her underwear. He claims he has
following her for a long time, checked her phone and found calls from an unidentified caller, which
inced him beyond doubt that she talks to her love. Which of the following is the most likely
convinced
diagnosis:
A. delusional disorder - erotomanic type
B. delusional disorder - grandiose type
C. delusional disorder - jealous type
D. delusional disorder - persecutory type
E. delusional disorder - addictive type
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OQ.03.2017.A.88
Which of the following is considered a type of psychotherapy:
A. ECT
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OQ.03.2017.A.93
Which
hich of the following describes the difference between dementia and delirium:
A. the thoughts in delirium are slow, vs. racing thought in dementia
B. the thoughts in delirium are disorganized, vs. impoverished thoughts in dementia
C. delirium is characterized by normal awareness vs. reduced awareness in dementia
D. delirium is characterized by significant long term memory impairment vs. preserved memory in
dementia
-------------------------------------------------------------------------------
OQ.03.2017.A.094
A 32-year-oldold lawyer presents to the clinic complaining of distress that began following the relocation of
his law office to a place further in town, which forces him to drive to work. He describes a significant fear
of driving, entering in the car makes him scared he will be killed in a car accident, which causes
tachycardia , shortness of breath and cold sweat. He tried to drive, but was forced to stop for vomiting.
What is the most likelykely diagnosis?
A. Acute psychotic episode
B. Specific phobia
C. Social anxiety disorder
D. General anxiety disorder
E. Substance anxiety disorder
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OQ.03.2017.A.095
Which of the following is a symptom of catatonia?
A. Catalepsy
B. Visual hallucination
C. Negative symptoms
D. Sad mood
E. Delusions of grandeus
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OQ.03.2017.A.096 (OQ.10.2016.B.031)
Which of the following IS NOT a positive prognostic sign in schizophrenia?
A. Mood disorder
B. Marriage
C. First psychotic break after the age of 40
D. A strong familial support system
E. Negative symptoms
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OQ.03.2017.A.097
Brain computerized tomography in schizophrenic patients may reveal:
A. Lateral and third ventricle dilatation
B. Significantly increased grey matter
C. Brain stem asymmetry
D. Significantly increased limbic system structures
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OQ.03.2017.A.98
A 58-year-oldold man presents to the emergency room with visual hallucinations of angels hovering aside
him wherever he goes. On examination he reveals he has been suffering from headaches, which awake
him from asleep over the last two month. He is generally healthy, this is the first episode, and he has no
psychiatric history, and takes no regular medications.
First step in the patient management:
A. Start perphenazine
rphenazine 32 mg * 1/d urgently
B. Request compulsory admission from the district psychiatrist
C. Brain imaging
D. Mini mental state examination
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OQ.03.2017.A.99
Which of the following is true regarding patients diagnosed with PTSD?
A. 30% make full recovery
B. 50% experience severe symptoms throughout their life without remission
C. After 1 year 90% will have mild symptoms
D. After 5 years 10% will have full recovery
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OQ.03.2017.A.100
A 26-year-oldold woman is experiencing daily bouts of extreme overeating, followed by guilt , intention
vomiting and a daily run of 5 km. Her BMI is 24.
What is the most likely diagnosis?
A. Anorexia nervosa
B. Bulimia nervosa
C. Body dismorphic disorder
D. Somatic symptoms disorder
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OQ.03.2017.A.101
hich of the following drugs has the lowest incidence of extrapyramidal adverse effect ?
Which
A. leponex (clozapine)
B. halidol (haloperidol)
C. respiridol (respiridone)
D. perphanen (Perphenazine)
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OQ.03.2017.A.102
A 36-year-oldold man presents to the emergency room with chest pain. He was convinced he was having a
heart attack, complained of feeling light headed and was sweating. An examination by a cardiologist and
an internal medicine doctor was normal, and he was sent sent for a psychiatric evaluation. His history revealed
th
that this was his 6 visit to the ER with similar complains over the last 2 month. Which of the following
is the most likely diagnosis?
A. Somatic symptom disorder
B. Panic disorder
C. Pain disorder
D. Factitious disorder
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C. Immigrants
D. Chronic pain
E. Alcohol abuse
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OQ.03.2017.A.108
In patients with mental disorders, which of the following is the best predictor for violent behavior?
A. A history of violence
B. Drug abuse
C. Following therapeutic recommendations
D. Unexpected stressors
E. The type and the course of the mental illness
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OQ.03.2017.A.109
Which of the following is the best predictor of suicide in hospitalized psychiatric patients?
A. A history of suicidal attempts
B. The number of past hospitalizations
C. Stress
D. The length of the current hospitalization
E. Compliance to treatment
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OQ.03.2017.A.110
A 70-year-oldold man has started antidepressant medication last week. He complains of severe drowsiness.
Which of the following drug is most likely to cause this phenomenon?
A. Duloxetine (cymbalta)
B. Bupropion (wellbutrin XR)
C. Fluoxetine (prozac, prizma, flutine)
D. Escitalopram (cipralex, esto)
E. Mirtazapine (miro, remeron)
Part B
OQ.03.2017.B.001
Prolonged use of Lithium (licarbium) may cause all of the following except
A. Slight hand tremor
B. Weight gain
C. Renal injury
D. Thyroid injury
E. Hepatic injury (cirrhosis)
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OQ.03.2017.B.002
Which tests and why is it important to perform monthly blood tests in patient receiving Clozapine
(leponex)?
A. Complete blood count due to risk for thrombocytopenia
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A 38-year-oldold lawyer, going through a divorce is troubled by the process, nervous, having trouble to fall
asleep, and suffers from stress and headaches. She is feeling distressed and manages to work and function
at home. Which of the following is the most likely diagnosis?
A. Acute stress disorder
B. Posttraumatic stress disorder
C. Adjustment disorder
D. Somatization disorder
E. Major depressive disorder
-----------------------------------------------------------------
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OQ.03.2017.B.008
A 27-year-old woman describes transient episodes when she suddenly feels while speaking that it is not
her talking. She becomes troubled and worried and asks herself “who in fact is talking?”. She describes
herself in those moments as if she is listening to someone else talk. These episodes usually appear in
social circumstances that trigger anxiety. Which of the following is the most likely diagnosis?
A. Depersonalization disorder
B. Depressive disorder
C. Dissociative identity disorder
D. Posttraumatic stress disorder
E. Narcissistic personality
nality disorder
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OQ.03.2017.B.009
A 35-year-oldold man with no history of psychiatric illness,illness, and who had never used drugs, tries cannabis for
the first time. With his friends encouragement he smoked two cannabis cigarettes, one after the other,
about 3 minutes per cigarette. 30 minutes later he felt tachycardia, a dry mouth, increasing anxiety, and a
feeling his throat closing and he is goi going
ng to suffocate and die. Which of the following is the most likely
diagnosis?
A. Hyperthyroidism, goiter
B. Brief psychotic disorder
C. Cannabis-induced
induced anxiety disorder
D. Cannabis withdrawal
E. First episode schizophrenia
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OQ.03.2017.B.010
Which of the following is part of the criteria for autism spectrum disorder diagnosis?
A. Disorganized speech characterized by unclear and parallel talk
B. Stereotypical
typical and repetitive movement
C. Broad and diverse areas of interest
D. Difficulty in keeping attentive and tendency to mistake a…. uncarefulness
E. Recurring thoughts, experienced as intrusive and unwanted
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OQ.03.2017.B.11
In which of the following the pulse pressure is normal?
A. Shock class I
B. Shock class II
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OQ.03.2017.B.029
What is the most common metabolic disorder following gastric resection?
A. Hypoglycemia
B. Iron deficiency anemia
C. Hypernatremia
D. Decrease in triglyceride
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OQ.03.2017.B.030
Why is hypothermia so harmful in trauma?
A. In trauma there is heat loss through the skin to the environment
B. Hypothermia contributes to coagulopathy
C. Hypothermia increases cellular ATP deficiency
D. Hypothermia causes capillary vasoconstriction
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OQ.03.2017.B.031
Which of the following is correct regarding cardiac tamponade following trauma?
A. Decreased venous return to the heart
B. Diagnosed by pericardiocentesis
C. Rarely affects patient’s survival
D. Cannot be caused by penetrating injury
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OQ.03.2017.B.032
An 8-year-oldold girl is brought by her parents to the ER following a fall from the window and injury to the
right thigh. Initial evaluation reveals a 5 cm wound in the medial aspect with active bleeding. What
should be included in the immediate management?
A. Direct wound pressure
B. Tourniquet placement above the wound
C. Wound dressing with external fixation fixat (Thomas)
D. Urgent surgery
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OQ.03.2017.B.033
A 30-year-oldold male is admitted to the ER 20 minutes following a knife stab to the right upper chest. On
admission he is fully alert and conscious,
conscious, pulse of 110 bpm, blood pressure is 80/60, and respiratory rate
is 20/minute. Chest X-ray ray demonstrates large hemothorax. Left chest drain is inserted and 1700 ml of
blood are immediately drained. What is the most appropriate next step?
A. Bronchscopy
B. Left thoracoscopy
C. Insertion of another chest drain
D. Left thoractomy
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OQ.03.2017.B.034
What is the most common etiology for lower gastrointestinal bleeding?
A. Colon cancer
B. Diverticulosis
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C. Colitis
D. Angiodysplasia
E. Inflammatory bowel disease
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OQ.03.2017.B.035
A 42-year-oldold male has ulcerative colitis for 10 years years. Which of the following is not a definitive surgical
treatment?
A. total proctocolectomy with ileoctomy
B. restorative proctocolectomy with ileal pouch-anal
pouch anastomosis(IPAA)
C. total proctocolectomy with ileal reservoir(kock pouch)
D. subtotal abdominal colectomy
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OQ.03.2017.B.036
A 35 year old male is diagnosed with familial adenomatous
aden polyposis syndrome (FAP).
( Which of the
following is correct?
A. He needs to undergo a colonoscopy every 5 years.
B. his children have 25%chance of having FAP
C. the risk of colon cancer by the age of 50 reaches 100%
D. The surgical treatment of choice for this patient is total abdominal colectomy and ileorectal
anastomosis.
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OQ.03.2017.B.037
A 52 year old female is referred to the ER due to dark discharge from a laparotomy scar one month
following a laparotomy for small bowel obstruction. Abdominal CT demonstrates entero entero-cutaneic fistula.
Which of the following may help spontaneous closure of the fistula?
A. partial small bowell obstruction distal to the fistula
B. fistula secretion of more than 500ml/d
C. fistula tract longer than 20cm
D. epithelization of the fistula tract
E. previous radiation to the involved bowel segment
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OQ.03.2017.B.038
A 65-year-oldold male is admitted to the ER with right upper quadrant pain, fever of 39, 39 and chills. His
blood pressure is 100/40; he has jaundice of the sclera, sclera and RUQ tenderness. Labsabs- WBC of 15,000,
bilirubin 5, AST 200, GGT 1000. Abdominal bdominal ultrasound demonstrates cholelithiasis with no wall
thickening of the gallbladder. There here is intrahepatic bile dilation; CBD is 13 mm with a gallstone at its
end. What is the next step in management?
A. urgent surgery to remove the gallbladder and extract the choledochus stone
B. urgent endoscopic retrograde cholangiopancreatogram (ERCP)
C. NPO, IV fluids, IVantibiotics and elective surgery in the future
D. treatment with ursodeoxycholic acid to dissolve the stone and consider lithotripsy
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OQ.03.2017.B.039
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OQ.03.2017.B.044
A 35-year-oldold man has a previous history of splenectomy following blunt trauma many years ago. The
patient presents to the ER with high fever, chills, muscle pain, pain, and general malaise. On the first day of
admission the patient develops severe sepsis with hypotension, coagulopathy and respiratory distress.
Which prior treatment could have prevented this clinical deterioration?
A. Annual flu vaccine
B. Prophylactic antibiotic treatment with regular low dose resprim
C. Low dose steroids treatment
D. Triple vaccination for streptococcus pneumonia,, haemophilus influenza, and Neisseria
meningitides
E. Intravenous immunoglobulin (IV Ig) treatment
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---------------------------------------------
OQ.03.2017.B.045 (same as OQ.10.2016.B.065 or similar)
What is the most common etiology for upper gastrointestinal bleeding?
A. Peptic ulcer disease
B. Gastritis
C. Mallory-Weiss tears
D. Dieulafoy’s lesion
E. Gastric malignancy
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OQ.03.2017.B.046
A 60-year-oldold hepatitis C carrier male with a history of variceal bleeding is admitted to the ER for
vomiting blood. His blood pressure on arrival is 110/70 and he has splenomegaly and ascites on physical
examination. His hematocrit is 25%. What is the first step in managing this patient before performing per
gastroscopy?
A. IV octreotide infusion
B. Treatment with beta blockers (i.e. propranolol)
C. PT test and cryglobuling infusion if increased
D. Empiric treatment with platelets
E. Gastro esophageal tamponade with Sengstaken-Blackmore tube
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OQ.03.2017.B.047
A usually healthy 45-year-old old male is admitted to the ER with epigastric pain. The patient describes
sudden onset pain on 10 am. On examination – heart rate of 110, blood pressure of 135/80, temperature is
38,5, and severe epigastric tenderness with positive rebound tenderness. Labs – WBC of 18,000 with 18%
bands, hemoglobin 14, lactate 3,5. Chest X-ray X demonstrates free air ir under the right diaphragm. What is
the next step in the management of this patient?
A. Gastrographin swallow test and decision accordingly
B. Urgent laparotomy
C. Urgent right thoracotomy
D. Urgent gastroscopy
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OQ.03.2017.B.048
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B. FNA
C. Mammography
D. Breast ultrasound
E. Breast MRI
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OQ.03.2017.B.053
A 64-year-oldold male has morbid obesity, COPD, diabetes, and heavy smoking. Pas surgical history is
positive for an exploratory laparotomy with surgical site infection during the postoperative course. He is
evaluated for an incisional hernia. All of the following are risk factors for developing incisional hernia
EXCEPT:
A. Obesity
B. Heavy smoking
C. COPD
D. Wound infection
E. Iron deficiency anemia
-----------------------------------------------------------------------------------------------
OQ.03.2017.B.54
A 45-year-oldold female is diagnosed with 2 cm nodule of the right thyroid lobe. In which of the following
scenarios a thyroid scan will be included in her evaluation?
A. Suppressed TSH
B. Ultrasound will identify another nodule in the left lobe
C. Thyroid scan should be performed in any case
D. Patient has a previous history of thyroiditis
E. Elevated thyroglobulin
------------------------------------------
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OQ.03.2017.B.55 (OQ.10.2016.B.077)
A 45-year-oldold male has a history of Hodgkin’s lymphoma that was treated with radiation to the
mediastinum
ediastinum and neck. The patient now presents with a 3 cm mass in the left lobe of the thyroid. FNA
diagnoses malignancy. Which of the following is the most likely malignancy in this patient?
A. Follicular carcinoma
B. Hurtle cell carcinoma
C. Papillary carcinoma
D. Medullary carcinoma
E. Anaplastic carcinoma
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OQ.03.2017.B.056 (OQ.10.2016.B.079)
A 55-year-oldold female is diagnosed with primary hyperparathyroidism. What can be an indication for
surgery in this patient?
A. A calcium level of 11 mg/dL (NL 8.5-10.5) 8.5
B. Recent admission for nephrolithiasis
C. Osteopenia (bone density of the forearm of - 1.8)
D. Urinary calcium of 300 mg/24h (NL 100-300) 100
E. Family history of hypercalcemia
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OQ.03.2017.B.057
A 28-year-oldold male with Crohn’s disease has been treated with steroids until 4 month ago and is currently
treated with Rafassal. He is now admitted for resection of the terminal ileum and the cecum. The morning
following surgery the patient complains of abdominalabdominal pain, nausea and vomiting. His blood pressure is
80/50, he is treated with IVF and IV antibiotics (rocephin+flagyl). What should be added to this patient’s
treatment?
A. Hydrocortisone
B. 4th generation cephalosporin
C. IV insulin
D. Noradrenalin
E. Dexamethasone
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OQ.03.2017.B.058
Hepatocellular carcinoma is epidemically associated with aassociated ssociated with all of the following EXCEPT:
A. Viral infection with hepatitis A
B. Viral infection with hepatitis B
C. Viral infection with hepatitis C
D. Wilson’s disease
E. Alcoholic hepatitis
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OQ.03.2017. B.059 (02.01.PreTest
02.01.PreTest-Surgery-13e.07.361)
A 61-year-oldold female with a history of unstable angina is complaining of bloody vomiting following
hiccups and vomiting after a night of extensive drinking. Endoscopy demonstrates longitudinal tears in
the gastro-esophageal bleeding. Which of the following is the next most
esophageal junction that are not actively bleeding.
appropriate step in management?
A. Angiography and embolization
B. Balloon tamponade
C. Exploratory laparotomy, gastrostomy, and over over-suturing of the tear
D. Systemic vasopressin infusion
E. Conservative management
-------------------------------------------------------------------------------
OQ.03.2017.B.060 (02.01.PreTest-Surgery-13e.04.182)
(02.01.PreTest
A 58-year-oldold male is brought to the ER following a fall from a 3m ladder. On examination – vital signs
are normal, no respiratory distress, multiple right rib fractures. Chest X ray demonstrates right
X-ray
hemothorax and a thoracostomy tube are inserted. 700 mll of blood are drained immediately and over the
next 4 hours the drain continues to drain another 300 ml/h. Which of the following is the definitive
treatment in this patient?
A. Platelets
B. Fresh frozen plasma
C. Insertion of another chest drain
D. Thoracotomy
E. Observation
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OQ.03.2017.B.061 (06.06.Blueprints-QaA-for-STEP-2.03.01.001)
(06.06.Blueprints
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An 8-year-oldold girl is brought in to the hospital while actively seizing. She has been hospitalized many
times before for status epilepticus and is receiving valproic acid at home to control seizures. The first step
in management of this patient is:
A. Administer ter 20 mL/kg 0,9% normal saline
B. Establish secure IV access and administer an anticonvulsant
C. Stabilize airway and provide 100% oxygen
D. Administer activated charcoal via nasogastric tube
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OQ.03.2017.B.062 (06.06.Blueprints-QaA-for-STEP-2.03.01.009)
(06.06.Blueprints
month old infant was delivered at 33 weeks gestation. The neonatal course was complicated by grade
A 6-month
II intraventricular hemorrhage on the left and initial slow feeding. The baby has been growing well but is
noted to have weakness on the right side and increased increased deep tendon reflexes in the right extremity. A
cerebral palsy is suspected. What is the diagnosis?
A. Diplegia
B. Hemiplegia
C. Extrapyramidal cerebral palsy
D. Quadriplegia
E. Dystonic cerebral palsy
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OQ.03.2017.B.063 (06.06.Blueprints-QaA-for-STEP-2.03.01.019)
(06.06.Blueprints
A 12-year-oldold female is admitted because of profuse, watery diarrhea that last 72 hours. Fluid
management has been difficult because the patient is noted to be hypertensive despite massive amounts of
diarrhea and marginal urine outputoutput.. On physical examination: she appears healthy but has multiple, brown
pigmented lesions on n the extremities, back and trunk. What of the following explains the findings?
A. Severe anxiety with neurodermatitis relate to hospitalization
B. Adrenal carcinoma with associated catecholamine release
C. Tachycardia and hypertension due to hyperthyroidism
D. Renovascular
scular hypertension secondary to neurofibromatosis
E. Tuberous sclerosis with intrarenal and intracardiac tubercles
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OQ.03.2017.B.064 (06.06.Blueprints-QaA-for-STEP-2.03.02.051)
(06.06.Blueprints
A 4-year-old male presents with 6 days of fever fever, erythematosus tongue and lips, nonexudative,
none bulbar
conjunctivitis, cervical lymphadenopathy and generalized maculopapular rash. A diagnosis of Kawasaki
disease is made. Which is the best therapy?
therapy
A. Alfa interferon (100 units IV) and Prednisone (2 mg/kg/day PO)
B. Prednisone (2 mg/kg/day) and Nafcillin (50 mg/kg/day IV)
C. Nafcillin (50 mg/kg/day IV) and Alfa interferon (100 units IV)
D. Nafcillin (50 mg/kg/day IV) and IVIG (2 gr/kg)
E. IVIG (2 gr/kg) and aspirin (100 mg/kg/day PO)
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OQ.03.2017.B.065 (03.07.Rudolphs-Pediatrics-22e.03.004)
(03.07.Rudolphs
A 16-year-oldold girl has been admitted with diagnosis of anorexia nervosa. At the last 6 month she has
placed herself on a calorie-restricted
restricted diet. One month prior to admission she had become irritable and had
a depressed mood. Over the last week she has also als developed diarrhea and an erythematosus rash that is
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accentuated by sunlight exposure. The skin in the erythematosus area is rough, cracked and thick. Which
vitamin deficiency in this patient?
patient
A. A
B. B3
C. B12
D. D
E. E
-------------------------------------------------------------------------------
OQ.03.2017.B.066 (SIMILAR to 03.07.Rudolphs-Pediatrics-22e.03.016)
03.07.Rudolphs
A 10-day-old former 3.02-kg up. The infant is breast-
kg full term infant presents for a routine check-up.
feeding. He was discharged at 2 days of age from the nursery. His discharge weight was 2.85 kg. At 4
days of age his weight reached a nadir of 2.65 kg. Parents report that his stool transitioned from
meconium to yellow-mustard colored by 3 days of age. He is now 3.03-kg kg today at his 10-day-old
10 visit.
He has four wet diapers per day. Which of the following is an alarming sign for inadequacy of his breast- breast
feeding?
A. Regaining birth weight by 10 days of age
B. Loss of 12% of birth weight
C. Transition to mustard-coloredcolored stool by 3 days of age
D. Presence of four wet diapers per day
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OQ.03.2017.B.067 ( 03.07.Rudolphs-Pediatrics-22e.05.003)
03.07.Rudolphs
A full-term,
term, male neonate is delivered vaginally. One application of vacuum extractor to the neonate’s
head was required to facilitate delivery. On examination at 12 hours of age, the baby has a well well-
circumscribed, fluctuating mass over the parietal skull that does not cross suture lines. The overlying skin
is erythematous but intact. He is active and alert and rest of the examination is unremarkable. His
capillary hematocrit is 45%. Which step is next indicated in the management of this neonate?
A. Intravenouss ampicillin and cefotaxime
B. Serum bilirubin levels
C. Aspiration of the mass with a tuberculin syringe
D. Topical bacitracin ointment to the mass
E. Transfusion of packed red blood cells
-------------------------------------------------------------------------------
OQ.03.2017.B.068 (03.07.Rudolphs-Pediatrics-22e.05.006)
(03.07.Rudolphs
A full-term, 9-week-old follow up appointment. She was delivered vaginally
old female infant is seen for a follow-up
from the breech presentation. In the nursery, hip examination was unremarkable bilaterally in Ortolani
and Barlow maneuvers. Physical examination at this visit shows normal movement of the lower
dysplasia of the hip (DDH) in
extremities. What is the appropriate screening strategy for developmental dysplasia
this infant?
A. Repeat Ortolani and Barlow maneuvers
B. Comparison of the lower extremity length
C. Ultrasonography of both hips
D. Radiographs of both hips
E. CT scanning of both hips
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OQ.03.2017.B.069
A male infant is born at 26 weeks gestation (birth weight 800 gr) develops tachycardia and abdominal
distention prior to passing a blood
blood-tinged stool. His examinationination reveals decreased tone and activity,
tenderness on palpation of the abdomen, and paucity of abdominal sounds. His abdominal X X-ray shows
diffuse pneumatosis intestinalis without pneumoperitoneum or portal venous air. What is the most likely
diagnosis?
A. Meconium ileus
B. Necrotizing enterocolitis
C. Pyloric stenosis
D. Intestinal malrotation with volvulus
E. Gastroenteritis
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OQ.03.2017.B.070 (03.07.Rudolphs-Pediatrics-22e.06.003)
(03.07.Rudolphs
Which hormone is the most influential in affecting breast development during puberty?
A. Progesterone
B. Thyroxin
C. Growth hormone
D. Insulin
E. Estrogen
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OQ.03.2017.B.071 (03.07.Rudolphs-Pediatrics-22e.07.012)
(03.07.Rudolphs
The parents of a 10 years old are concerned that he is not doing well in school. He is a healthy, active 10 10-
old boy with no history of developmental delays. He states that he enjoys school and likes to read.
year-old
His teacher describes him as an active participant in class, engaged, and cooperative. He has difficulty
completing his homework assignments, particularly for English class, and his grades have decreased
recently. He has always struggled with penmanship. What is the most likely diagnosis?
A. Dyslexia
B. Dyscalculia
C. Dysnomia
D. Dysgraphia
E. Pragmatic language disorder
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OQ.03.2017.B.072
Which of the following is associated with frequent crying (colic) in an infant that is 3 months old?
A. Brest feeding
B. Gastroesophageal reflux
C. Lactose intolerance
D. Cow's mild allergy
E. Normal behavior of the infant
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OQ.03.2017.B.073 (03.07.Rudolphs-Pediatrics-22e.07.017)
(03.07.Rudolphs
A 15 months old female is seen in a well-child
well clinic. Mom is concerned that she only has 5 to 10 words
and is not putting words together. She points to body parts by name and follows 11-step commands
without gestures. What is the most appropriate next step?
drmada.com הגרסה הכי מעודכנת תמיד אפשר לתרגל חינם ב.גרסה זו ראשונית
A. Referral to audiology
B. Referral to speech-language
language pathologi
pathologist
C. Comprehensive developmental assessment
D. Reassurance
E. CT scan of head
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OQ.03.2017.B.074 (03.07.Rudolphs-Pediatrics-22e.09.037)
(03.07.Rudolphs
A 13 years old with refractory acute mylogenous leukemia (AML) and chronic pain is started on an
opioid treatment. Which medication has a slow elimination phase that may lead to drug toxicity?
A. Morphine
B. Hydromorphone
C. Fentanyl
D. Oxycodone
E. Methadone
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OQ.03.2017.B.075 (03.07.Rudolphs-Pediatrics-22e.11.027)
(03.07.Rudolphs
A 2-week-old old neonate is admitted with sepsis. Blood cultures reveal sepsis due to Escherichia coli ( E.
coli ). On physicalcal examination she is lethargic, skin appears icteric, and she has hepatomegaly. Testing
on urine reveals the presence of nonglucose reducing substances. What is the most likely underlying
diagnosis?
A. Glycogen storage disease
B. MSUD
C. Organic acidemia
D. Galactosemia
E. Urea cycle defect
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OQ.03.2017.B.076 (03.07.Rudolphs
03.07.Rudolphs-Pediatrics-22e.12.023)
Tay Sachs disease is an autosomal recessive degenerative neurologic disease. It is relatively common in
French speaking immigrants
the Cajun population of Louisiana. Cajuns descend from a group of French-speaking
(Acadians) from eastern Canada in the 18th century. It is postulated that one of them was a man who was
a carrier for the Tay Sachs mutation. His descendants carry the mutation and intermarriage has led to
appearance of the disease. This phenomenon of a mutation originating with a single individual is known
as:
A. Consanguinity
B. Endogamy
C. Decreased fitness
D. Founder effect
E. Genetic drift
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OQ.03.2017.B.077 (03.07.Rudolphs-Pediatrics-22e.13.012)
(03.07.Rudolphs
Patients with disorders of B-cell cell development are susceptible to infections from encapsulated organisms
and enteroviral infections. These patients typically become symptomatic at what age?
A. In the second decade of life
B. Between the ages of 5 and 10
drmada.com הגרסה הכי מעודכנת תמיד אפשר לתרגל חינם ב.גרסה זו ראשונית
A. Blood culture
B. Bone culture
C. MRI of the knee
D. Synovial fluid culture
E. Ultrasound of the knee
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OQ.03.2017.B.083
A young girl is hospitalized with papulo vesicular rash diagnosed as chicken pox. On the 4th day of the
papulo-vesicular
exanthema, her rash seems to be worsening and more painful. She now has a fever of 39.2 C . What is the
next best treatment?
A. Acyclovir
B. Antibiotics
C. IVIG
D. Topical hydro cortisone
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OQ.03.2017.B.084 (03.07.Rudolphs-Pediatrics-22e.17.034)
(03.07.Rudolphs
A 5-year-oldold boy presents with foul smelling diarrhea along with mild abdominal pain and loss of
foul-smelling
appetite for 2 weeks. Evaluation of the patient’s stool sample taken that day is positive for Giardia lamblia
by EIA. The best treatment for the patient’s condition would be:
A. TMP sulfa
B. Metronidazole
C. Ciprofloxin
D. Azithromycin
E. Paromomycin
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OQ.03.2017.B.085 (03.07.Rudolphs-Pediatrics-22e.17.036)
(03.07.Rudolphs
A 17 years old female is diagnosed at 16 weeks of pregnancy via ATB titers as likely having contracted
Toxoplasmosis gondii during gestation.
gestation What is the most likely way that she has acquired this infection?
A. Blood transfusion
B. Food containing cyst
C. Ingested house cat feces
D. Municipal water supply
E. Cat fleas containing larvae
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OQ.03.2017.B.86 (03.07.Rudolphs-Pediatrics-22e.17.068)
(03.07.Rudolphs
A 1-year-old, unimmunized infant is admitted with difficulty breathing and “fits” of coughing associated
with whooping for the last two days. Which of the following is the most complication of this disease?
A. Death
B. Rib fracture
C. Pneumonia
D. Seizures
E. Encephalopathy
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OQ.03.2017.B.87
drmada.com הגרסה הכי מעודכנת תמיד אפשר לתרגל חינם ב.גרסה זו ראשונית
A 14-year-oldold boy was admitted to the pediatric ward yesterday for periorbital cellulitis of the right eye.
On history he frequently has sinus problems and seasonal allergies. The patient was started on oral
clindamycin yesterday morning, but today shows signs of mild proptosis and chemosis that were not
present at admission. The change is symptoms can be explained due to the appearance of which of the
following?
A. Orbital cellulitis
B. Sinus vein thrombosis
C. Brain abscess
D. Bacterial meningitis
E. Sphenoidal sinusitis
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OQ.03.2017.B.088
A 16-year-oldold Bedouin male presents with fever, hepatosplenomegaly, lymphadenopathy and arthritis.
The mother reports that they make their own goat cheese. A zoonotic infectious disease is suspected.
Which of the following is the best treatment option?
A. Ceftriaxone
B. Doxycycline
C. Cephalexin
D. Azithromycin
E. Erythromycin
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OQ.03.2017.B.089 (03.07.Rudolphs-Pediatrics-22e.18.016)
(03.07.Rudolphs
A 16-year-oldold boy presents with complaint of scalp scaling and mild itching for the last 6 months. He
shampoos every other day. On examination he has scaling and erythema in the alar grooves and medial
brows. He has no alopecia. What is the most likely diagnosis?
A. Tinea capitis
B. Seborrheic dematitis
C. Psoriasis
D. Atopic dermatitis
E. Contact dermatitis
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OQ.03.2017.B.090 (03.07.Rudolphs-Pediatrics-22e.19.006)
(03.07.Rudolphs
What is the most important physical examination finding diagnosing otitis media with effusion?
A. Dull tympanic membrane appearance
B. Absent light reflex
C. Decreased tympanic membrane mobility
D. Obscure ossicles
E. Air bubbles behind the tympanic membrane
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OQ.03.2017.B.091 (03.07.Rudolphs-Pediatrics-22e.19.018)
(03.07.Rudolphs
A 6-year-oldold boy presents with intermittent high fevers, pharyngitis, lymphadenopathy and mouth
aphthae. His throat has been cultured several times and has never grown group A streptococcus. What is
the most likely diagnosis?
A. Familial mediterranean fever ((FMF)
B. PFAPA
C. Lymphoma
D. Kawasaki disease
E. Viral pharyngitis
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OQ.03.2017.B.092 (03.07.Rudolphs-Pediatrics-22e.21.008)
(03.07.Rudolphs
A 15-years-oldold female complains of daily penumbilical abdominal pain without identifiable trigger for the
past 12 months. Review of growth records indicates that she has been between the 50th and 75th
percentiles for body mass index over the past several years. years. Physical examination is unremarkable. What
additional finding suggests an organic cause for her pain rather than a functional etiology?
A. Pain is severe enough to cause significant school absenteeism
B. History of irritable bowel syndrome is first-degree
first relatives
C. Sensation of incomplete evacuation after passage of stools
D. Complaint of fatigue and headache in addition to abdominal pain
E. Awakening from sleep to pass loose stool at night
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OQ.03.2017.B.093 (03.07.Rudolphs-Pediatrics-22e.21.010)
(03.07.Rudolphs
A 20-month-old old female is seen with a 4-month
4 history of 3-5 5 watery stools per day. She is in the 60th
percentile for weight and 75th percentile for height. Her mother describes her as a playful child and has
no concern other than the diarrhea. Dietary history reveals that the girl eats 3 meals and at least 2 small
snacks and drinks 2-33 cups of apple juice in addition to 350 cc of milk each day. Which is the most
appropriate step in management of this patient?
A. Determination of stool electrolytes and osmolality
B. Determination of stool pH and reducing substances
C. Stool culture
D. Two-week
week trial of glucose-free
glucose diet
E. Two-week trial of juice--free diet
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OQ.03.2017.B.094 (03.07.Rudolphs-Pediatrics-22e.21.011)
(03.07.Rudolphs
A 32-month-old old girl is seen because of constipation. Which finding in the child’s medical history
suggests an organic cause of constipation rather than functional cause?
A. Daily fecal soiling in undergarments
B. Two urinary tract infections within the last 6 months
C. Involuntary encopresis
D. Small-caliber,
caliber, thin appearing stools
E. Episodes of posturing with crossing of the legs and screaming
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OQ.03.2017.B.095 (03.07.Rudolphs-Pediatrics-22e.22.007)
(03.07.Rudolphs
A previously healthy 9-year-old old male presents with jaundice and is found to have a total bilirubin of 11
mg/dL with a direct component of 8.5 mg/dL.Which test is the most useful indicator of hepatic synthetic
function?
A. Cortisol
B. Total and free carnitine and acyl carnitine
C. Complete blood count with platelets
D. Prothrombin time
E. Antinuclear antibody
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OQ.03.2017.B.096
A one year old boy was found to have iron deficiency anemia on a routine screening . In which
circumstance a parenteral iron on administration is considered?
considered
A. Abdominal pain associated with oral intake .
B. Malabsorption .
C. Concomitant folate deficiency .
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OQ.03.2017.B.101
An 8 year old with a history of sickle cell nephropathy is admitted with sickle cell pain crisis .
Electrolytes reveal potassium of 4.3meq\l
4.3meq and on EKG demonstrates peaked T-waves waves . What is the most
appropriate next step ?
A. Intravenous calcium gluconte
B. Oral kayexelate
C. Echocardiography
D. Intravenous sodium bicarbonte
E. Intravenous frrosemide
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OQ.03.2017.B.102 (03.07.Rudolphs-Pediatrics-22e.26.013)
(03.07.Rudolphs
Which of the following forms of congenital heart lesion is most common?
A. Truncus arteriosus
B. Total anomalous pulmonary venous connection
C. Ventricular septal defect
D. Hypoplastic left heart syndrome
E. Aortic stenosis
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OQ.03.2017.B.103 (03.07.Rudolphs-Pediatrics-22e.26.021)
(03.07.Rudolphs
A 7 weeks old previously healthy, infant is seen because of a 2 weeks history y of irritability while feeding
feeding,
poor oral intake and tachypnea. She is afe ile. On exam respiratory rate is 60 per minute, without
afebrile.
retraction,, heart rate is 170 per minute,
minute, liver edge is 4cm below the costal margin. She has an active
precordium and d a new pan systolic murmur at the apex. The ECG show sinus tachycardia, deep Q wave in
leads I, aVL, and V4-6. 6. What is the most likely diagnosis?
A. Glycogen storage disease
B. Pericarditis
C. Supraventricular tachycardia
D. Anomalous origin of left coronary artery
E. Endocardial fibroelastosis
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OQ.03.2017.B.104 (03.07.Rudolphs-Pediatrics-22e.26.024)
(03.07.Rudolphs
A 15 year old male is evaluated in the clinic . His father had recently drowed while swimming in a pool .
A couple of months ago , his father had had a fainting episode after running . The boy admits that he has
palpitations during sport activity , but he never fainted or had any
had some episodes of dizziness and palpitations
chest pain . Chest X-ray ray is normal . What changes on his ECG are most worris one ?
A. First degree AV block ( prolonged RR interval )
B. Premature atrial contraction
C. Prolonged QTc interval
D. Sinus arrhythmia
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OQ.03.2017.B.105 (03.07.Rudolphs-Pediatrics-22e.27.011)
(03.07.Rudolphs
A 2 year old boy comes to the ED with sudden onset of cough and respiratory distress . His father was
watching television and eating popcorn when he noted his son coughing on the floor . On exam :
wheezing is auscultated on the left lung . What is the most appropriate study to order ?
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OQ.03.2017.B.110 (03.07.Rudolphs-Pediatrics-22e.29.014)
(03.07.Rudolphs
An 8 year old boy comes in with 2 days of left sided facial weakness . He awoke with it in the morning
and it has been stable since . On examination , the left side of his face moves significantly less than the
right . The forehead is involved in palsy . T he remainder of his neurologic examination is normall . What
The
is the localization of his facial weakness ?
A. Cortex
B. Muscle
C. Seventh nerve
D. Eighth nerve
E. Midbrain