1

{username}

A 22-year-old female patient, for about a year she has been eating large amounts of food in a
binge-like manner, in a short period of time during the day. She does not vomit or take laxatives
afterwards. What is the most likely diagnosis?
A. Bulimia nervosa

B. Binge eating disorder

C. Purging disorder

D. Night eating syndrome

{username}

What is true in the context of olfactory reference syndrome?

A. Common rituals that include bathing and changing clothes

B. Higher incidence in women

C. Olfactory hallucinations as part of the clinical picture

D. Paranoid delusions

{username}

It is likely to see all the following side effects as part of the mirtazapine treatment except:
A. Muscle pains

B. Disturbing dreams

C. Dizziness

D. Blurred vision

1
4

{username}

Which of the following is considered a mature defense mechanism?

A. Anticipation

B. Reaction formation

C. Projection

D. Acting out

{username}

A 23-year-old female patient, diagnosed with bipolar disorder and regularly treated with a mood
stabilizer, but does not remember the name of the medication. Complains of weight gain and asks
to change the medication.

Which mood stabilizer, among the following, is the young woman is most likely taking?
A. Carbamazepine

B. Valproic acid

C. Topiramate

D. Aripiprazole

2
6

{username}

A 25-year-old female patient, diagnosed with bipolar disorder, has been complaining of a low
mood for about two weeks. Works as a receptionist at a hotel. Convinced that she made a critical
mistake at work which will bring the hotel to huge losses. She stopped going to work, feels tired,
and has a drop in energy especially in the mornings, even though she wakes up earlier than usual
and can’t go back to sleep. In addition, she complains of a lack of appetite and, according to her,
forces herself to eat despite this.

Which of the following medications would be most effective for her?

A. Risperidone

B. Ziprasidone

C. Quetiapine

D. Aripiprazole

{username}

A 48-year-old male patient, married with three children, an engineer, functions well in all aspects
of daily life. He has been complaining for about six months about the presence of parasites in his
body. Underwent a comprehensive physical examination according to his complaints without a
finding that can explain them.
Which of the following is the most likely diagnosis?
A. Delusional disorder, somatic type

B. Somatic symptom disorder

C. Conversive disorder

D. Factitious disorder

3
8

{username}

Which of the following is a risk factor for the development of depression in the elderly?
A. Old age

B. 55 years of marriage

C. Minimental score (MMSE) 27

D. Chronic renal failure

{username}

A 52-year-old male patient arrives to a psychiatric evaluation for the first time in his life. Claims
that his wife forced him to undergo the evaluation due to his conflict with the neighbors which
causes a lot of tension at home. On examination: suspicious and irritable, bad mood. No
interruptions in thinking. Thoughts content: anger and suspicion towards the neighbors, he
explains that from a young age he does not trust others and has no friends. According to him “A
man is a wolf to another man”. Expresses negative feelings about people around him. Claims that
the neighbors make mess in the elevator on purpose to annoy him, but not entirely sure. No
evidence of perception disorders.
Which of the following is the most likely diagnosis?
A. Schizoid personality disorder

B. Schizophrenia

C. Paranoid personality disorder

D. Delusional disorder paranoid type

4
10

{username}

Psychiatric assessment as part of a consultation-liaison must include all of the following, except:
A. Medical history

B. Family history

C. Details about the current treatment

D. Neurological examination

11

{username}

What is the difference between group therapy with a cognitive-behavioral approach, and group
therapy with a psychodynamic approach?
In a psychodynamic approach, the main focus is on dynamic processes within and
A. outside the group, while in a cognitive-behavioral approach, the focus is on ability to
control symptoms

B. In a psychodynamic approach the group size is smaller

C. In a psychodynamic approach, the frequency of meetings is greater

In a psychodynamic approach, the emphasis is on adapting to everyday life, unlike in the

D.
cognitive-behavioral approach

12

{username}

Which of the following epidemiological data is true about Neuroleptic Malignant Syndrome (NMS)?
A. 0.5-5% of patients taking antipsychotics may develop this syndrome

B. Women and men are equally likely to develop the syndrome

The elderly are at greater risk of developing this syndrome compared to the young
C.
people

D. With long-term use of antipsychotics, the mortality rate may reach 20%

5
13

{username}

What is the chance of psychotic relapse within a year in a schizophrenic patient without medicinal
treatment?
A. Over 50%

B. Under 5%

C. 25%

D. 40%

14

{username}

During a psychiatric evaluation the patient is asked where he lives. His answer is “I am traveling to
New York, to eat apples, agriculture is the most important profession in the world.”
What is the appropriate definition for the thought process described?
A. Associative looseness (derailment)

B. Clang association

C. Neologism

D. Perseveration

15

{username}

Which of the following is true regarding the use of benzodiazepines to treat panic disorder?
A. During an acute exacerbation, it is recommended to avoid the use of benzodiazepines

With prolonged use of benzodiazepines, most cases will not develop tolerance to the
B.
anxiolytic effect

C. Benzodiazepines can be used without concern of dependence

It is not recommended to combine benzodiazepines with selective serotonin reuptake

D.
inhibitors (SSRI)

6
16

{username}

All of the following findings are likely to be observed in a laboratory test of a patient suffering from
anorexia nervosa, except:
A. Decreased growth hormone

B. Hypercholesterolemia

C. Increased liver enzymes

D. Increased prolactin

17

{username}

A 19-year-old male patient complains that he is ugly, feels that others are laughing at him. Since
the age of 16, he has been obsessively concerned with the flaws he sees in his face. Mostly
complains that his nose is ugly, too big, often looks in the mirror and examines his face. His
mother disagrees with him, and thinks that his nose is beautiful, his face is beautiful, and there is
no need to perform cosmetic surgery. From his life history it appears that until the age of 15 his
achievements in studies were good, he got along well socially. The preoccupation with the
appearance of the face caused a significant reduction in social activity, caused decreased ability to
concentrate in studies, and a decrease in achievements.
Of the following, what is the most appropriate treatment for his condition?
A. Lithium

B. Olanzapine

C. Escitalopram

D. Cosmetic rhinoplasty

7
18

{username}

A 21-year-old female patient, not married, student, complains of irritability, and difficulty falling
asleep, fatigue and difficulty concentrating on studies. According to her, these symptoms
appeared about two months ago after she was raped on her way home from a party. She tried to
file a complaint with the police but did not remember the details, and when she tried to tell what
she remembered she was overwhelmed with anxiety and since then prefers not to talk about the
incident. Her friend, trying to cheer her up, invited her to go back to partying but she refuses.
Before going to sleep, memories of the event arise and during sleep she has dreams with violent
content. Blaming herself for being raped because of cleavage in her blouse.

Which of the following signs is a favorable prognosis for the disorder from which the young
woman suffers?
A. Rapid onset of symptoms, shortly after the rape event

B. Concomitant existence of attention and concentration deficit disorder

C. Alcohol consumption

D. Partial contact with parents

19

{username}

All of the following are possible treatments for neuroleptic malignant syndrome, except:
A. Supportive medical treatment

B. Amantadine

C. Bromocriptine

D. Zuclopenthixol

8
20

{username}

Which statement most accurately describes the characteristics of mortality in patients dealing with
anorexia nervosa?
A. Most deaths are caused by a physical complication

B. Most deaths occur as a result of suicide

C. Most deaths are caused by side effects of the medicinal treatment

D. The death rate in this population is double compared to the general population

21

{username}

Which of the following tests is not required in order to define “unexplained infertility”?
A. Post-coital test

B. Bilateral patency of the fallopian tubes

C. Proof of ovulation

D. Demonstration of a normal uterine cavity

22

{username}

A 55-years-old female patient, married +3 children, a PAP test demonstrated the presence of
HPV16. Endocervical curettage (ECC) was performed and the following pathology test result was
obtained: adenocarcinoma in situ. Conization was performed and the following pathology test
result was obtained: a few foci of adenocarcinoma in situ, clear margins.
What is the recommendation for further treatment?
A. Follow-up only

B. Repeated conization

C. Hysterectomy

D. Radical hysterectomy

9
23

{username}

Which of the following is the main reason for performing a low-transverse cesarean section
instead of a classical one, as was done as part of standard practice in the past?
A. The fastest extraction of the fetus from the uterus

B. Reducing the risk of rupture of the uterus in the next pregnancy

C. Reducing the risk of injury to the bladder

D. Shortening the duration of the surgery

24

{username}

A female patient complains of urinary incontinence. The urodynamic test demonstrates urine
leakage at a relatively low intra-abdominal pressure.
Which of the following surgeries is appropriate in this diagnosis?
A. Midurethral sling

B. Colporaphy

C. Sacrospinous ligament fixation

D. Vaginal hysterectomy

25

{username}

For which group of genetic diseases is the majority of the genetic screening tests before
pregnancy are intended?
A. Autosomal recessive

B. Autosomal dominant

C. Dominant X-linked

D. Mitochondrial

10
26

{username}

A 45-year-old female patient arrives for consultation due to uterine myoma. A fundal myoma
measuring about 10 cm in diameter was observed in the ultrasound, significantly larger compared
to the previous scan about a year ago (then it had a diameter of 7 cm). The patient received a
recommendation to undergo a hysterectomy due to a suspected malignancy.
How can you differentiate between a fibroid (myoma) and a sarcoma (leiomyosarcoma) of the
uterus?
A. According to the appearance in the ultrasound examination

B. According to the MRI imaging of the uterus, pelvis and abdomen

C. According to the clinical signs - rapid growth of the myoma

D. According to the amount of mitoses and the degree of atypia in the pathology

11
27

{username}

A 28-year-old female patient, planning a pregnancy, complains of menstrual abdominal pains for
two years, with worsening in the last month. Normal gastroenterological investigation. On a
gynecological examination, there is noticeable fullness and tenderness in the left adnexa. In a
pelvic ultrasound examination, the finding in the image was demonstrated to the left of the
uterus.
What is the likely diagnosis?

A. Functional ovarian cyst

B. Bloody corpus luteum

C. Endometrioma

D. Epithelial ovarian cancer

12
28

{username}

As part of an azoospermia investigation, the patient receives a genetic diagnosis of Klinefelter's

syndrome.
What fertility treatment should be offered to him?
A. Testosterone

B. Gonadotropins

C. GnRH pump

D. Sperm donation

29

{username}

A 30-year-old woman before her second delivery arrives to the clinic at pregnancy week 37 and
complains of itching, mainly in her abdomen. The mother is not taking any medications and has
no known sensitivity to medications or other substances. Abdominal examination demonstrated
the rash that appears in the image. No rash in other areas of the body. Blood tests - CBC and
chemistry - no abnormal findings.
What is the most likely diagnosis?

A. Pemphigoid gestationis

B. Pustular psoriasis of pregnancy

C. Pruritic urticarial papules and plaques of pregnancy

D. Intrahepatic cholestasis of pregnancy

13
30

{username}

A 40-year-old woman in the 7th week of her fifth pregnancy arrives to a doctor with pain and
swelling in her left calf. Doppler ultrasound raises a high suspicion of DVT.
What is the recommended treatment?
A. LMWH from diagnosis until 6-12 weeks after delivery

B. LMWH for six months and then resume treatment for 6-12 weeks after delivery

C. Warfarin for six months and then resume treatment for 6-12 weeks after delivery

D. Warfarin for six months

31

{username}

A patient at pregnancy week 35 arrives to the community clinic with a complaint of a reduction in
fetal movements. There is no monitor in the clinic. An ultrasound is performed which
demonstrates a fetal heart rate around 150, without body movements or breathing movements.
An amniotic sac of 1 cm was measured.
What is the right decision to make in the clinic?
A. Let the patient eat and drink and check again in an hour

B. Tell the patient to return for follow-up in two days

C. Transfer the patient by ambulance to the hospital maternity ER

D. Perform a Doppler ultrasound to check middle cerebral artery flow

14
32

{username}

A 23-year-old woman in the 33rd week of her first pregnancy arrives to the emergency room due
to a dull pain in her right abdomen. On examination, diffuse tenderness in the abdomen is evident,
slightly more on the right. In CBC: WBC 18000, hemoglobin 12 and platelets 335000. Abdominal
ultrasound does not demonstrate the appendix.
What would be the right way to establish the suspected diagnosis?
A. Abdominal CT

B. Diagnostic/therapeutic laparoscopy

C. Amniocentesis

D. MRI

33

{username}

45-years-old female patien, married +3 children, menometrorrhagia in the last six months.
Endometrial biopsy was performed at the clinic (Pipelle).
Pathology result: complex atypical hyperplasia. During the consultation at the clinic following the
result, the woman refuses any surgery.
What is the most correct advise to her?
A. Follow-up only

B. Diagnostic and therapeutic hysteroscopy

C. Treatment with combined pills

D. Progestative treatment and repeated biopsy in 3-6 months

15
34

{username}

During the second stage of labor, with the fetal head at S+2, a prolonged deceleration is observed,
and the medical team prepares for vacuum extraction of the newborn.
Which of the following would cause the team to perform a C-section instead of proceeding with an
instrumental delivery?
A. Estimated fetal weight is around 4100 grams

B. Preterm labor

C. Vaginal bleeding

D. Face presentation

35

{username}

A 53-year-old healthy woman arrives for a consultation complaining of severe hot flashes. A
hysterectomy was performed due to uterine myomas about 10 years ago. Normal examination.
Blood tests indicate a low estrogen level and a high FSH level (over 40IU).
Which of the following is the first line of treatment for her condition?
A. Progesterone-only therapy

B. Estrogen-only therapy

C. Selective estrogen receptor modulator

D. Selective progesterone receptor modulator

16
36

{username}

At what age primary amenorrhea investigation should be started in a girl with breast buds and
pubic hair?
A. 13

B. 15

C. 17

D. 8

37

{username}

A 32-year-old female patient, married + 1, had birth about two years ago. Significant post-partum
hemorrhage occurred during the birth. No menstruations since the delivery. Attached is a brain
MRI that was performed as part of the investigation.
According to the findings in the image and the clinical description, what is the most likely cause of
amenorrhea in this case?

A. Asherman syndrome

B. Macroadenoma – prolactinoma

C. Sheehan’s syndrome

D. Craniopharyngioma

17
38

{username}

In the delivery room, a 39-year-old woman gives birth to her fifth child around her expected due
date. She has underlying asthma with several attacks during pregnancy, last attack 3 days ago. She
is treated with regular inhaler treatment (steroids and bronchodilators). Immediately after the
delivery of the placenta, the midwife reports PPH and on examination atony of the uterus is
detected.

Which of the following medications should be administered after oxytocin?

A. PGF2ALFA

B. PGE2

C. ERGOTAMINE

D. PGE1

39

{username}

During childbirth, difficulty is diagnosed in extracting the baby's shoulders after the head comes
out and the midwife calls for the doctor's help.
Of the following actions, which is the first action to take?
A. Turning the mother into the on all fours position

B. Hyperflexion of the mother's legs towards her abdomen (McRoberts maneuver)

C. Vacuum extraction

D. Returning the head of the fetus to the vagina (Zavanelli maneuver)

18
40

{username}

A 42-year-old woman underwent curettage due to a delayed abortion and pathology result
demonstrated complete hydatidiform mole. On HCG follow-up a month later, it increases every
week - 1300, 5000, 9000.
Which of the following tests is the most important for deciding on the appropriate treatment?
A. Abdomen and chest imaging

B. Spine MRI

C. BHCG test before curettage

D. TSH

19
41

{username}

During the second stage of labor, when the head of the fetus is at the level of the ischial spines,
the monitor data in the image is observed and the midwife calls you, the doctor managing the shift
in the delivery room.
What should you do?

A. Lying on the side, oxygen and fluids, discontinuation of pitocin

B. Pitocin dose increase and fundal pressure for an immediate delivery

C. Instrumental delivery with a vacuum or with forceps

D. Emergency cesarean section

20
42

{username}

During a laparoscopic hysterectomy, the senior surgeon demonstrates to the intern the course of
the ureters and emphasizes their most vulnerable area in such a surgery.
What is this area?
A. At the entrance of the ureter to the pelvis when crossing the pelvic brim

B. In the passage of the ureter parallel to the internal iliac artery

C. In the passage of the ureter under the uterine artery in the cardinal ligament

D. At the entrance of the ureter into the bladder

43

{username}

Which of the following patients is the most suitable candidate for a vaginal delivery attempt after
cesarean section? (TOLAC- trial of labor after cesarean section)
A. A patient who underwent a classic cesarean section

A patient who was previously operated on due to a breech presentation and an inverted
B.
T incision was performed for the purpose of extraction

A patient after a vaginal birth following which a lateral rupture of the uterus was
C.
diagnosed

D. A patient who underwent cesarean section due to placenta praevia

44

{username}

A young and healthy patient arrives at the beginning of her pregnancy and receives
recommendations for the course of the pregnancy.
Which of the following recommendations is correct?
A. Physical activity should be reduced during pregnancy

B. Sexual intercourse should be avoided between week 24 and week 32

C. Iron must be consumed daily from the moment the pregnancy is discovered

D. Get vaccinated against the flu in the winter season

21
45

{username}

What is the preferred treatment for a patient diagnosed with breast cancer at 18 weeks of
pregnancy?
A. Modified radical mastectomy

B. Lumpectomy + radiation

C. Chemotherapy

D. Termination of pregnancy

46

{username}

Attached is a result of an ultrasound examination performed to a 34-year-old patient on the third

day of her period as part of an ovarian reserve investigation.

What can be said about the ovarian reserve according to this test?
A. Low

B. Good

C. Cannot be assessed due to the timing of the test in the cycle

D. Can only be assessed with the result of estradiol blood test

22
47

{username}

A 34-year-old woman after a successful vaginal birth following induction of labor due to
gestational diabetes, which was medicinally controlled (insulin), arrives for a follow-up at the end
of the postpartum period.
Which of the following recommendations is correct in this context?
A. Blood test for HBA1C

B. Continue the medicinal treatment she received during pregnancy

C. 75-gram glucose tolerance test

D. Echocardiography

48

{username}

What is the main complication of ovarian stimulation by gonadotropins as part of IVF treatments?
A. OHSS – Ovarian Hyperstimulation Syndrome

B. Ovarian bleeding

C. PID – Pelvic Inflammatory Disease

D. VTE – Venous Thromboembolism

23
49

{username}

A 70-years-old female patient, with mild swelling in the abdomen. On examination - shifting
dullness. On blood test: CA-125=987. Referred to pelvic US.
Which of the following images is likely to be seen on the US scan?

A. A

B. B

C. C

D. D

50

{username}

In which of the following cases there is an indication for a karyotype test?

A. Recurrent miscarriages

B. Genetic screening before pregnancy

C. An isolated finding of oligohydramnios in pregnancy

D. Before starting IVF treatments

24
51

{username}

A 42-year-old male patient, with no underlying diseases, presents to the emergency room due to
fever, vomiting and headache. During the physical examination he is fully conscious, oriented in
place and time. Fever of 39.3°C, pulse 110 per minute (regular), blood pressure 130/80 mmHg,
and nuchal rigidity. Normal fundus examination. The rest of the neurological examination is
normal.
What is the most recommended next step in this case management in the emergency room?
A. A brain CT should be performed before a lumbar puncture

There is no point in taking blood cultures if a CSF culture is taken before antibiotic
B.
treatment

C. Steroids should be given about an hour after the start of the antibiotic treatment

Lumbar puncture and immediate empiric antibiotic treatment with Ceftriaxone and
D.
Vancomycin

25
52

{username}

A 54-year-old male patient, construction worker, presents with complaints of shortness of breath
upon light exertion, edema in the lower limbs, and fatigue for the last 10 days. He reports waking
up last night from sleep with the feeling that he could not breath and had to sit upright until
morning. The patient has a long history of alcohol consumption. He rules out chest discomfort or
underlying heart disease. His chest X-ray is presented below. An echocardiogram obtained in the
emergency room demonstrated severe global hypokinesis of the left ventricle and an ejection
fraction (LVEF) of 20%. He was treated with intravenous furosemide and underwent initial
stabilization.

Which of the following treatment combinations would be the long-term treatment that would have
the most positive effect on this patient's life expectancy?

A. Valsartan/Sacubitril-Bisoprolol-Eplerenone-Empagliflozin

B. Lisinopril-Bisoprolol-Digoxin-Dapagliflozin

C. Valsartan-Atenolol-Furosemide-Verapamil

D. Enalapril-Metoprolol-Milrinone-Digoxin

26
53

{username}

A 28-year-old male patient complains of coughing up blood, fever, dyspnea, hypertension, and
bloody urine (hematuria). On the urine sediment, there are casts of red blood cells, protein +2, and
red blood cells 10-20. On the blood tests: creatinine 3.5 mg/dL, BUN 86 mg/dL, hemoglobin 11 g/d.
On the chest x-ray, bilateral opacities in the lungs.
Which of the following is the most likely diagnosis?
A. Antiglomerular Basement Membrane Disease

B. Nephrotic Syndrome.

C. Post Streptococcal Glomerulonephritis

D. Churg Strauss Syndrome

54

{username}

A 22-year-old male patient presents with a finding of systolic murmur and a history of his father's
sudden death at the age of 48. He is diagnosed with Hypertrophic Obstructive Cardiomyopathy
(HOCM).
Which of the following symptoms is a risk factor for sudden death in this patient?
A. Onset of atrial fibrillation

B. Mitral valve regurgitation

C. Absence of blood pressure elevation at the peak of exertion

D. Onset of exertional angina pectoris

27
55

{username}

A 72-year-old female patient, refugee from Ukraine, arrived to Israel a year and a half ago. Was
hospitalized due to a fever that lasted for two months, night sweats, and a productive cough.
Which of the following statements is most correct regarding the possibility that the patient has
tuberculosis?
Using sputum smear with staining for acid-fast bacilli has a sensitivity of about 50% for
A.
active tuberculosis

Tuberculosis is unlikely in this case since more than a year passed between leaving the
B.
endemic area and the onset of symptoms

Tuberculosis diagnosis using molecular methods (Nucleic Acid Amplification - Xpert

C.
MTBF/RIF) has a low sensitivity and specificity (about 40%)

D. In pleural tuberculosis, the sensitivity of a direct pleural fluid smear is about 80%

56

{username}

A 60-year-old male patient, underlying COPD with a history of active heavy smoking, complains of
significant dyspnea on exertion. Arrived for a consultation regarding treatment. On examination -
saturation 88% at rest in room air. On auscultation to the lungs - expiratory wheezing over both
lungs. On spirometry - obstructive disorder with FEV1 = 35% of predicted. Chest CT - emphysema
is evident in the upper lobes, the rest of the lungs are relatively intact. The patient asks about life-
prolonging treatments.
All of the following treatments have been proven to be life-prolonging, except:
A. Treatment with Roflumilast (Phosphodiesterase 4 (PDE4) Inhibitor)

B. Quitting smoking

C. Oxygen therapy

D. Lung volume reduction surgery

28
57

{username}

An immunocompromised patient develops a clinical picture of fever, diarrhea, and abdominal

pains. After a few days, there is growth of bacteria on a direct blood smear.
Which of the following findings would raise the suspicion of Listeriosis?
A. Gram-negative rods

B. Gram-positive rods

C. Gram-negative cocci

D. Gram-positive cocci

58

{username}

A 60-year-old male patient is admitted to the hospital due to dyspnea and unilateral pleural fluid
on the left, a puncture of this fluid was performed.
Which of the following laboratory findings is an indication for pleural drainge insertion?
A. Pleural fluid pH=7.25

B. LDH fluid to serum ratio 0.9

C. A fluid in which the eosinophils count is 5%

D. Triglyceride level 128 mg/dL in the pleural fluid

59

{username}

All of the following coagulation factors are affected by acute liver failure, except:
A. Factor 1

B. Factor 5

C. Factor 8

D. Factor 13

29
60

{username}

A 65-year-old male patient has type 2 diabetes and neuropathy. Admitted to ER due to fever and
an ulcer on his left foot. On examination, a deep ulcer is observed with a purulent discharge. In an
orthopedic examination using a metal tool the bone could be reached.
Which of the following is most likely correct regarding the infection in this case?
A. The most likely diagnosis in this case is cellulitis with subcutaneous involvement

B. The most likely diagnosis in this case is osteomyelitis

C. Candida Albicans will most likely grow in the bone culture

D. A gram-negative bacterium is the most common pathogen that causes this infection

61

{username}

A 21-year-old male patient, of Arab origin, presents with visual impairment, during an
ophthalmologist's examination Panuveitis was diagnosed. In addition, mentions repeated
episodes of aphthae in the mouth and genitalia.
What is true regarding the most likely diagnosis?
A. There is a tendency for significant bleeding episodes

B. Most patients are positive for HLA B27

The arthritis in this disease is usually multi-articular and causes deformations and
C.
erosions

D. There may be digestive system involvement similar to Crohn's disease

30
62

{username}

Which of the following proteins is most responsible for iron transport in plasma?
A. Albumin

B. Transferrin

C. Haptoglobin

D. Ferritin

63

{username}

A 70-year-old male patient presents with complaints of difficulty in swallowing solids and liquids
and chest pains for several months. States that he lost about 5 kg. As part of the investigation, he
was referred to a barium swallow test (image below).

Which of the following tests has the highest sensitivity for moving forward with the diagnosis?
A. Abdominal CT

B. Gastroscopy with biopsies

C. Esophageal manometry

D. Abdominal US

31
64

{username}

Which of the following descriptions of lung functions most likely fits a patient with restrictive lung
disease due to idiopathic fibrosis?

FEV1: Forced Expiratory Volume in 1 Second

FVC: Forced Vital Capacity
FRC: Functional Residual Capacity
RV: Residual Volume
TLC: Total Lung Capacity
DLco: Diffusion Capacity of Lung for Carbon Monoxide
A. A

B. B

C. C

D. D

32
65

{username}

A 73-year-old female patient, was hospitalized due to a urinary tract infection. Growth of
Escherichia coli in blood and urine cultures. The patient receives prophylactic heparin. The next
day, the patient vomited once with traces of fresh blood. On her examination: blood pressure was
80/50, regular pulse of 110 per minute, new neurological symptoms, and the appearance of
ecchymoses and petechiae on the skin. On the laboratory tests: increased D-Dimer, increased INR,
low platelets, and fibrinogen decreased. On brain CT, new small ischemic infarcts.
Which of the following is the most likely diagnosis?
A. Bleeding secondary to prophylactic heparin

B. DIC - Disseminated Intravascular Coagulation

C. Idiopathic thrombocytopenia

D. Allergic reaction to the antibiotic treatment

66

{username}

A 78-year-old female patient, referred for evaluation of recently diagnosed syncope and heart
murmur. After a careful physical examination, you conclude that the patient has severe aortic
valve stenosis.
Which of the following descriptions of murmurs best fits the patient's diagnosis?
Prominent systolic murmur in the left second intercostal space, with a fixed splitting of
A.
S2

A high grade 5/6 systolic murmur in the right second intercostal space, a small-volume
B.
carotid pulse that rises and falls slowly, paradoxical splitting of S2

A high systolic murmur heard at the base of the heart that increases in intensity with the
C.
Valsalva Maneuver and a fast-rising, high-volume carotid pulse

D. Grade 5/6 holosystolic murmur at the apex of the heart, radiating to the axilla

33
67

{username}

A 65-year-old male patient treated with dialysis and diagnosed with systolic heart failure is
admitted to the emergency room due to a fall and hand injury. The blood tests demonstrated a
potassium level of 7.5 mEq/L (normal values 3.5-5.1), the ECG diagram shows the disappearance of
P-waves and widening of the QRS complex.

What is the most urgent immediate step in this case management?

A. Discontinuation of Spironolactone

B. IV administration of Calcium Gluconate

C. Blood gas test for Bicarbonate

D. Urgent dialysis

34
68

{username}

A 19-year-old male patient complains of a greenish-colored discharge of sputum for two years,
half a cup a day. On his physical examination, there is slight clubbing of the nails and a few
inspiratory wheezes over the lungs. Respiratory function test demonstrates mild to moderate
obstructive disorder.
On chest CT - a “tram tracks” sign and a “signet-ring” sign as shown in the figure.

What is the most likely diagnosis?

A. Chronic obstructive pulmonary disease

B. Emphysema

C. Idiopathic pulmonary Fibrosis

D. Bronchiectasis

35
69

{username}

A 50-year-old patient, usually healthy, recently used an NSAID due to lower back pain. He is now
hospitalized due to melena. Upon admission - hemoglobin 12 gr/dL (baseline value - 14 gr/dL).
Upon his admission, PPI treatment was started according to standard procedure. A gastroscopy
was performed which demonstrated an ulcer in the duodenal bulb with a clean base.

What is the most correct statement in the context of this case management?
A. There is a low chance of significant bleeding recurrence from this ulcer

B. Endoscopic treatment with Bipolar Electrocoagulation is necessary

C. Intensive Proton Pump Inhibitor (PPI) treatment in high doses is necessary

D. There is a need to hospitalize the patient for observation for additional 5 days

70

{username}

Which of the following conditions is considered the most common reason for the development
of hypercalcemia?
A. Primary hypoparathyrodism

B. Vitamin A toxicity

C. Hypothyrodism

D. Use of Furosemide

36
71

{username}

Which of the following patients is most likely to develop a hyperglycemic hyperosmolar state?
A. A 30-year-old male patient with type 1 diabetes

B. An 82-year-old female patient with type 2 diabetes

C. A 12-year-old male patient with type 1 diabetes

D. A 43-year-old female patient with type 2 diabetes

72

{username}

Which of the following conditions is the most common cause of neuropathic joint disease (Charcot
joint)?
A. Amyloidosis

B. Diabetes Mellitus

C. Syringomyelia

D. Tabes Dorsalis

73

{username}

A 38-year-old female patient, healthy non-smoker, was admitted to the hospital due to coughing
up blood in the amount of 20 cc per day. The patient is hemodynamically and respiratory stable,
normal chest x-ray, and normal laboratory tests including blood count.
What is the next step in the clinical investigation/management of this case?
A. Chest CT

B. Bronchoscopy

C. Follow up only and treatment of the cause

D. Echocardiography

37
74

{username}

An 80-year-old male patient, suffering from malnutrition. It was decided to start treatment with
total parenteral nutrition (TPN). In the next day the patient develops weakness, strabismus, and
confusion. On examination, he is confused and complains of weakness and paresthesias, the rest
of the examination is normal.

What is the most likely cause of his condition?

A. Hypophosphatemia

B. Hypercalcemia

C. Hyponatremia

D. Hyperkalemia

75

{username}

In which of the following conditions of chronic kidney disease and edema, is it recommended to
limit fluid intake?
A. Chronic kidney disease and hyperkalemia

B. Chronic kidney disease and hypomagnesemia

C. Chronic kidney disease and hyponatremia

D. Chronic kidney disease with a BUN to creatinine ratio of >20

38
76

{username}

A 60-year-old male patient with anterior STEMI, is treated by primary PCI. On examination -
hemodynamically stable, no signs of heart failure, and no chest pains. Monitor demonstrates
premature beats from a ventricular origin.
Which of the following medications is the most recommended to treat his condition and to
prevent ventricular fibrillation?
A. Verapamil

B. Abciximab

C. Metoprolol

D. Lidocaine

77

{username}

A 43-year-old female patient completed treatment with Penicillin V due to pharyngitis and was
admitted due to extreme weakness. On examination: pallor and jaundice. Laboratory tests:
hemoglobin 8 g/dL, MCV 94, reticulocytosis, increased LDH, indirect hyperbilirubinemia, positive
Coombs test.
Which of the following is the most likely diagnosis?
A. Hemolytic anemia

B. Megaloblastic anemia

C. Aplastic anemia

D. Acute upper gastrointestinal bleeding

39
78

{username}

A 26-year-old female patient, has been complaining of pain in the joints of the hands for 6 months,
and describes a feeling of stiffness in the morning for about 45 minutes. Rules out skin rash,
mouth sores, or eye infections. During her examination, there is an impression of swelling and
pain in the metacarpophalangeal (MCP) joints number 2, 3, 4, 5 bilaterally and in the wrists
bilaterally.

Which of the following is the most correct in the context of the disease the patient is suffering
from?
A. Atypical - symmetrical appearance of arthritis

B. The most common extraarticular manifestation is uveitis

C. The appearance of Anti CCP or Rheumatic Factor antibodies supports the diagnosis

D. The absence of Anti CCP or Rheumatic Factor antibodies rules out the diagnosis

79

{username}

A 24-year-old male patient, journalist, traveled from Israel to a small town near Mumbai in India.
He did not receive vaccinations before the trip. One week after returning home, he was admitted
to the hospital with complaints of a fever of 40°C, abdominal pains, headaches, diarrhea, and a
heart rate of 50 beats per minute. On physical examination, mild diffuse tenderness in the
abdomen, splenomegaly, and a dull maculopapular rash on the torso, which disappears upon
pressure.

What is the most recommended empiric treatment in this case?

A. Ceftriaxone & Azythromycin

B. Gentamycin

C. Cloxacillin

D. Intravenous Immune Globulin (IVIG)

40
80

{username}

A 50-year-old male patient, in his blood tests hemoglobin 20 g (normal value 13-16).
Which of the following scenarios would most likely lead to the diagnosis of Polycythemia Vera?
A. RBC Mass normal, erythropoietin normal

B. RBC Mass increased, erythropoietin normal

C. RBC Mass increased, erythropoietin increased

D. RBC Mass normal, erythropoietin increased

81

{username}

A 71-year-old patient has the following results on laboratory tests: serum sodium 138 mEq/L,
serum potassium 4.9 mEq/L, serum chloride 100 mEq/L. Arterial blood gas test in room air: pH
7.48, Pco2 21 mmHg, bicarbonate 15 mEq/L.
What is the most likely acid-base balance disorder in this patient?
A. Respiratory Alkalosis & Metabolic Acidosis with High Anion Gap

B. Respiratory Alkalosis & Metabolic Acidosis with Normal Anion Gap

C. Metabolic Alkalosis & Respiratory Acidosis with Normal Anion Gap

D. Metabolic Alkalosis & Respiratory Acidosis with High Anion Gap

41
82

{username}

A 76-year-old female patient arrives to your clinic due to complaints of palpitations in recent
months. Past medical history is positive for hypertension and type 2 diabetes for ten years.
An echocardiogram demonstrated evidence of mild left ventricular hypertrophy without a valvular
problem. The ECG chart is presented below.

Which of the following medications would be suitable in this case for long-term treatment?

A. Ticagrelor

B. Rivaroxaban

C. Aspirin

D. Heparin

42
83

{username}

A 30-year-old male patient, with underlying asthma, arrives to the emergency room with an acute
attack of dyspnea without fever. No pathological finding on the chest X-ray.
Which of the following would be part of the case management?
A. IV magnesium

B. IV anticholinergics

C. IV diuretics

D. IV empirical antibiotics

84

{username}

A 77-years-old female patient presents with increasing dyspnea accompanied by fatigue in recent
weeks. On her physical examination, a holosystolic murmur was detected at the left sternal border
that increases with deep inspiration.
What is the most likely valvular disorder in this case?
A. Mitral valve regurgitation

B. Tricuspid valve regurgitation

C. Aortic valve stenosis

D. Pulmonary valve regurgitation

43
85

{username}

Which of the following conditions is most likely to be caused by chronic hypokalemia?

A. Hypotension

B. Metabolic acidosis

C. Polyuria

D. Diarrhea

86

{username}

A 64-year-old male patient has been complaining of a mild productive cough and mild shortness
of breath for the past 3 days. On examination, he is lucid, temperature 38°C, respiratory rate
26/min, and blood pressure 100/74. The chest x-ray demonstrates evidence of a lobar infiltrate in
the right lower lobe.
Which of the following findings will assist in the decision regarding the patient's hospitalization?
A. White blood cell count

B. Glomerular Filtration Rate (GFR) level

C. Blood Urea Nitrogen (BUN) level

D. Heart rate

44
87

{username}

A 19-year-old male patient is brought to the emergency room by his friends after he was unable to
stand up at the end of a 30 km journey with equipment on his back. He complains of severe pain
in his legs and that his urine is darker than usual. In the laboratory tests electrolytes are normal
except calcium 11, creatinine 1.4 mg/dL, BUN 90 mg/dL, creatine kinase (CK) 25,000, hemoglobin
15.8 g/dL. Urine stick was positive for hematuria, but few red blood cells were observed in the
laboratory.
What will be the first step in the treatment of this young man?
A. Aggressive rehydration

B. Correction of calcium levels

C. Intravenous administration of steroids

D. Dialysis

88

{username}

An 80-year-old male patient is hospitalized to the internal ward due to pneumonia and a stroke. In
the third week of hospitalization, he develops a fever and diarrhea.

What is true about the etiology of his disease?

A. Clostridiodes difficile is the second most common cause of this disease after Salmonella

Risk factors for clinical Clostridiodes difficile infection include the use of antibiotics as
B.
well as severe underlying morbidity

C. Clostridiodes difficile diarrhea is almost always bloody

The treatment for a non-severe first episode of Clostridiodes difficile infection is

D.
Metronidazole

45
89

{username}

A 60-year-old healthy male patient, is referred to the emergency department due to high fever,
nausea, and vomiting. States that he took Amoxicillin for 10 days due to an upper respiratory tract
infection. On examination: temperature 38.1°C, blood pressure 125/80 mmHg, pulse 92 per
minute. Mild rash on the torso and limbs. Urinalysis: protein +1, white blood cells 10-20, red blood
cells 20-30, few casts of white blood cells.
Blood test: sodium 134 mEq/L, potassium 5.8 mEq/L, chloride 110 mEq/L, BUN 88 mg/dL,
creatinine 2.8 mg/dL, pH 7.24, bicarbonate 14 mEq/L, white blood cells 13200/mm3, of which
polymorphonuclear 68%, eosinophils 12%, lymphocytes 12%, monocytes 8%.

Which of the following is the most likely cause of this clinical syndrome?
A. Acute Glomerulonephritis

B. Tubulointerstitial Nephritis

C. Obstructive Uropathy

D. Chronic Kidney Disease

90

{username}

Which of the following medications is most likely to increase the risk of osteoporosis ?
A. Nonsteroidal anti-inflammatory drugs (NSAID)

B. Glucocorticoids

C. Angiotensin Converting Enzyme Inhibitor (ACEI)

D. Laxatives

46
91

{username}

All of the following clinical manifestations characterize ankylosing spondylitis, except:

A. Morning stiffness

B. Pain/stiffness that improves with physical activity

C. Gradual onset of pains

D. In most cases, the symptoms appear after the age of 40

92

{username}

A 54-year-old male patient, has underlying hypertension, hyperlipidemia, and obesity. Admitted
due to pain and swelling in the right knee for a week. On his examination: temperature 37.7°C, the
right knee is sensitive, swollen, red, and warm.
Which of the following tests would most significantly advance the diagnosis?
A. Blood tests for Rheumatic Factor, Anti CCP

B. MRI of the knee

C. Puncture of the knee and aspiration of synovial fluid for tests

D. Blood tests for Antinuclear Antibodies and complement levels

47
93

{username}

A 40-year-old female patient, arrived at the clinic for consultation regarding medicinal treatment
for obesity. States that she gained 15 kg in weight without a substantial change in diet. In her
examination, blood pressure was 170/95 mmHg, central obesity, and on the abdominal
examination striae are noted along the abdomen.
What is the next step in the clinical investigation?
A. Blood cortisol level in the morning

B. Urine collection for cortisol

C. ACTH levels in the blood

D. CT of the adrenals

94

{username}

A 34-year-old male patient, has ulcerative colitis that was diagnosed several years ago. Despite
several flare-ups in recent months, agrees to take only Sulfasalazine.
Which of the following extra-intestinal manifestations is most likely associated with this diagnosis?
A. Peripheral Arthritis

B. Ankylosing Spondylitis

C. Pyoderma gangrenosum

D. Sacroiliitis

48
95

{username}

A 55-year-old patient, was admitted to the emergency room due to chest pains and general
weakness for about an hour. Past medical history is positivie for heavy smoking, hypertension,
diabetes. Vital signs: blood pressure - 130/80, pulse - 90, saturation - 98% on room air. The patient
is pale and sweating. Normal breathing sounds on lung auscultation. His ECG is below.

What is the most recommended next step in this patient’s treatment?

The patient should receive oxygen through nasal cannula regardless of his saturation
A.
level

B. Short-acting dihydropyridine calcium channel blockers should be started

C. Beta blockers should be started within 24 if the patient has Killip class III

D. Morphine should be started to alleviate the pain

49
96

{username}

A 35-year-old male patient, was diagnosed with ulcerative colitis 15 years ago. In the last three
years, treated with Infliximab due to pancolitis. Feels well, no diarrhea, and no abdominal pains.
On colonoscopy - from the anus to the transverse colon there are no signs of inflammation. In the
transverse colon there is a stricture that does not allow passing the colonoscope.
What is the most recommended step in the management of this case?
A. Endoscopic dilation of the stricture

B. surgical treatment

C. Continuation of current medicinal treatment

D. Increasing the dose of Infliximab

97

{username}

A 72-year-old male patient, with hypertension for about 10 years, presents with complaints of
sudden discomfort in the chest and back for about 45 minutes. The discomfort is excruciating,
described as “tearing”, and radiates from the front chest to the neck and back. As you examine the
patient, his speech becomes slurred, his right arm and leg become weak. ECG – Sinus and
demonstrated no changes in the ST-T segment.

What test should be performed immediately?

A. Brain CT without contrast agent

B. Coronary angiography

C. Fundus examination

D. Bedside echocardiography

50
98

{username}

A 53-year-old female patient, has underlying AIDS. Was admitted to the emergency room due to
dizziness, and instability in gait for two days. On her physical examination - confused, depressed
consciousness, multiple petechiae on the abdomen and arms. On the initial laboratory
investigation: hemoglobin 7 g%, thrombocytopenia 17,000 with cell fragments in the smear,
creatinine 2.5 mg/dL, BUN 55 mg/dL.

What is the most appropriate treatment for the patient's condition at this stage?
A. Plasma exchange

B. Imuran

C. Methylprednisolone pulse therapy

D. Eculizumab

99

{username}

A 62-year-old male patient, admitted due to fever and urinary urgency, is diagnosed with urinary
tract infection. At his physical examination, there is no tenderness in the abdomen or in the waist.
On rectal examination, a slight enlargement of the prostate is observed without tenderness. In the
urine culture, growth of E.Coli, sensitive to all types of standard antibiotics.
What is the most accurate statement about the therapeutic approach in this patient?
A. The treatment of choice is Trimethoprim/Sulfamethoxazole (TMP/SMX) for 7-14 days

B. Today it is common to prescribe a short treatment of up to five days

C. Fluoroquinolones should not be used as they do not penetrate the urinary tract

D. Intravenous Ceftriaxone treatment should be prescribed for at least ten days

51
100

{username}

Which of the extra glandular conditions of Sjögren syndrome is the most common?
A. Peripheral neuropathy

B. Lymphoma

C. Arthralgia/arthritis

D. Vasculitis

101

{username}

A 74-year-old male patient, was hospitalized due to fever of 38.5°C PO for a month, accompanied
by general weakness, chills, night sweats, lack of appetite and a 3 kg weight loss. Fifteen months
ago, he underwent CABG and a biological aortic valve replacement. On his physical examination,
the patient is hemodynamically stable, a short 2/6 systolic murmur at the aortic auscultation point.
Apart from these findings - the physical examination demonstrates no pathological findings. Blood
cultures were taken and an echocardiogram was performed which demonstrated vegetation on
the aortic valve.

Which of the following pathogens most likely causes the condition?

A. Coagulase-Negative Staphylococci (CONS)

B. Viridans Streptococci

C. Kingella Kingae

D. Coxiella Burnetii

52
102

{username}

A 65-year-old male patient, with hypertension, is undergoing an investigation due to iron-

deficiency anemia. As part of the investigation, he underwent a gastroscopy and a colonoscopy,
which were normal. It is suspected that this bleeding originates from the small intestine.
Which of the following is the most likely diagnosis?
A. Meckel's diverticulum

B. Vasculitis of the small intestine

C. Crohn's Disease

D. Vascular ectasia

103

{username}

A 25-year-old female patient, arrived to the emergency room due to dyspnea and pain in the right
chest for two days. Rules out fever, orthopnea, PND, or peripheral edema. She recently started
using birth control pills without additional medications. The physical examination is normal,
hemodynamically stable, and oxygen saturation in room air is 99%. Blood count, ECG and chest X-
ray within the norm.
Which of the following tests would most likely advance the diagnosis?
A. CT Angiography of the lungs

B. Echocardiography

C. Pro B-Natriuretic Peptide (BNP)

D. D-Dimer

53
104

{username}

An 80-year-old patient, retired anatomy professor, fell and briefly lost consciousness while giving a
lecture to a medical school class. Woke up spontaneously. No chest discomfort or palpitations and
no symptoms of sweating or nausea. Underlying hypertension, treated with Aspirin, Ramipril, and
Diltiazem. An ECG performed on site by Magen David Adom is presented below:

After collecting a comprehensive history from the patient and connecting him to the monitor,
what would be the most suitable first step in this case management?
A. Implantation of a permanent pacemaker for sick sinus syndrome

B. Initiation of Amiodarone treatment

C. Addition of low-dose Metoprolol

D. Discontinuation of Diltiazem treatment

54
105

{username}

A 64-year-old male patient is hospitalized due to increasing fatigue and bleeding while brushing
his teeth for 3 weeks. Blast cells are noted on blood smear. A bone marrow test demonstrates
Acute Promyelocytic Leukemia (APL), with Cytogenic Rearrangement of t(15;17)(q22;q12).
Which of the following medications will be part of the induction treatment in this case?
A. Acyclovir

B. Sildenafil

C. Tretinoin (All-Trans-Retinoic Acid) [ATRA]

D. Rituximab

106

{username}

A 40-year-old male patient was referred to the emergency room due to fever up to 38.3ºC for two
weeks, sweating, tremors, and weight loss. Before the described event he suffered from a viral
respiratory illness that lasted for several days. At his examination in the ER: temperature 38ºC,
blood pressure 130/80, heart rate 120 - sinus rhythm, and neck examination demonstrated
sensitivity on palpation of the thyroid gland. In the laboratory tests - low TSH, FT4 -60 (normal
value is up to 20 mU/L), increased ESR. During hospitalization, radioiodine uptake test was
performed which did not demonstrate uptake in the thyroid gland.

What is the most likely diagnosis?

A. Graves' Disease

B. Toxic adenoma of the thyroid gland

C. Pituitary adenoma

D. Subacute thyroiditis

55
107

{username}

A 50-year-old male patient, works in an office job, has underlying obesity and hypertension.
Complains of fatigue and sleepiness during the day, tends to fall asleep while watching TV, and
mentions that he had a car accident because he fell asleep while driving. Reports headaches,
especially in the morning. His wife says he snores at night. At examination - increased blood
pressure. central obesity, short neck. The rest of the examination did not demonstrate any
abnormal findings.
Which of the following tests would most likely advance the diagnosis?
A. Overnight polysomnogram

B. Stress test

C. ElectroEncephalogram (EEG) during wakefulness and sleep

D. Holter monitor

108

{username}

A 26-year-old generally healthy female patient, in the second trimester of her pregnancy,
is hospitalized due to chills, fever of 38.9°C, swelling, redness, and warmth in the right knee.
Which of the following is the most likely pathogen causing the patient's condition?
A. Staphylococcus Aureus

B. Streptococcus Pyogenes

C. Nisseria Gonorrhoeae

D. Pseudomonas Aeruginosa

56
109

{username}

An 18-year-old healthy female patient, presents to the emergency room due to fever, muscle pain,
recurrent vomiting, bloody diarrhea, and abdominal pain for about 10 days. In a stool culture sent
from the clinic - growth of Campylobacter Jejuni. Treatment with fluids and antipyretics was
started.
What is the most suitable therapeutic approach in this case?
A. Ceftriaxone for 7 days

B. Ofloxacin for 10 days

C. Monitoring in hospital without antibiotic treatment

D. Azythromycin for 3 days

110

{username}

Which of the following statements is the most correct regarding Irritable Bowel Syndrome (IBS)?
A. Most patients with IBS suffer from bloody stools

B. Most patients with IBS are males over the age of 45

C. The diagnosis of IBS is based on the findings of the serological/laboratory tests only

Abdominal pain is a necessary condition for going forward with the decision on a
D.
diagnosis of IBS

57