August

14, 2010 1) Damage to which structure is responsible for hearing loss in one ear. A. Cochleo nucleus B. Medial Geniculate nucleus (auditory) C. Lateral geniculate nucleus (visual) D. Lateral Lemniscus 2) A 10day old neonate was brought to the ER because of abdominal distension, fever and vomiting that started 2days ago when he was stopped from breast feeding and put on oral formula containing milk products. The child passes 3000ml of stool every 2hours. Whats the next appropriate step of treatment? A. Encourage breast feeding B. Possible lactose intolerance C. Malabsorption of fats syndrome D. Vitamin deficiencies 3) A patient complains of vision loss on the left eye. On physical examination, he is unable to abduct and adduct his left eye. What is the causes this symptoms in this patient? A. Cavenous sinus thrombosis( CN 6,3, V1, 4) B. Occulomotor damage C. Brain hienation 4) Pt comes to ER aggravated, confused and irritable. What drug is responsible for these symptoms A. Cocaine B. Phenycyclidine C. Amphetamine D. Benzodiazepines E. Opiods 5) 70 Old lady that used to be marathon runner, has Shortness of breath after exercising for last month? What is likely responsible for the shortness of breath. normal aging

6) bunch of red lesions?

The Picture above was similar showing of penis, 19 yr old boy and it has a

A. Condiloma lata (2ndary syphilis) B. Chancre (prim syphylis) C. Chancroid (painful ,H.ducreyi) D. Condyloma Acuminata 7) A patient with sore throat, fever and muscle weakness reported to the clinic. A culture of the bacterial shows a group A streptococcus pyogenes infection. This patient is at risk of developing A. Glomerulonephritis B. Septic Artritis C. Carcinoma of the tongue 8) Athlete comes in for routine physical examination. P/E shows fixed wide splitting on both inspiration and expiration. The possible diagnosis is A. Aortic stenosis B. VSD C. ASD D. Pulmonic stenosis 9) Drawing of man, and show stethoscope diagram listening at sterna notch. What listening is likely to be heard in this healthy patient? A. Bronchial breath sounds B. Vesicular C. Bronchiovesicular ******According to ICM manual it should be bronchial (pg 35) 10) A patient with severe abdominal pain, nausea and vomiting now complains of passing blood in z the stool. He recalls having a trauma about 2years ago. On physical examination, he is found to have pain in the flank area. What vessel is severely damaged in this patient? A. Celiac trunk B. Abdominal Aorta C. Inferior mesenteric artery D. Superior mesenteric artery 11) Gets one sided excruciating headaches from sharp light? This diagnosis is A. Cluster headaches (rhinorrhea, lacrimia) B. Migraine (bcoz patient has aura)----treat with sumatriptine etc C. Subarachnoid hemorrhage 12) Doctor tells woman tests got back and say shes HIV +ve, and she said its from extra marital affair that takes place about 4years ago. She told the physician not to tell her husband because he will beat me to death The next appropriate step for the physician is to? A. Set up a counseling for the couple (initiate discussion) B. You know your husband is my patient too and I am obligated to tell him 2

C. I want you to tell your husband the test results 13) A 28year old female comes into your office 4months after lung transplantation for cystic fibrosis. She is married to a 38 year old who is a carrier for cystic fibrosis and they are planning on doing in vivo fertilization with her husband sperm and not from a donor. As a physician you are concerned about the chance of both couple having a child with cystic fibrosis, but the couple insists on this test. The physician is concerned about the result based on what ethics? A. Viracy - B. Autonomy respect pts wishes, patient is making informed decision C. Nonmalficence do no harm D. Beneficence. act in pts best interest; may conflict with autonomy 14) A patient with last fourth finger flexed towards the thumb in a clawish way, what other problem will help to further the diagnosis? A. Lubrincals muscle B. Palmars facia ****claw hand can be caused by lubrincals muscle as well i. Ulnar Claw 1. Loss of medial lumbrical fxn a. Fracture of hook of hamate (falling onto outstretched hand) i. Claw appears when asked to straighten fingers b. Carpal tunnel syndrome (Popes blessing) c. Dislocated lunate 4th and 5th digits are clawed (Popes blessing) 15) A patients tongue is deviated to the left. Which lesion causes this A. Left Hypoglossal nerve B. Left Glossopharyngeal nerve C. Right Vagus nerve D. Right Glossopharyngeal nerve E. Right Hypoglossal nerve 16) Guy with tongue deviated to left, and body paralysis on the right. On physical examination, hes find to have numbness on the right side of the face and muscle parasis on the left. Other cranial nerves abnormalities are unremarkable. The lesion is likely localized to A. left internal genu (only motor loss) B. left Medulla (medial medullary syndrome) C. Right medulla D. Spinal cord 17) A patient complains of dilated pupil in the left eye. On physical examination, Both pupils does not react to light either directly or conceptually. Theres no accommodation. Wheres the lesion? A. Right sympathetic B. Right Parasympathetic 3

C. Optic nerve D. Left parasympathetic a. Pupillary Control i. Constriction (miosis) 1. Parasympathetic (CN III ciliary gang) ii. Dilation (mydriasis) 1. Sympathetic (T1 Pregang sympathetic superior cervical ganglion postganglionic sympath long cilary nerve) b. Pupillary Light Reflex (light eye CN II edinger westphal nucleus bilateral constriction) i. Bilateral Constriction 1. Light in either pupil constricts bilaterally E. Facial nerve 18) A patient present with 2mm right pupil and 4mm left pupil. Both pupil reacts poorly to light in the dark and in the light room direct and conceptual. Wheres problem: A. right parasympathetic B.left parasympathetic. C. Left sympathetic D. Right Sympathetic E. Left Optic 19) Picture of girl with an enlarged skin small lesion on face. Thought it was pimple and tried popping it but only sometimes a lil blood comes out. The lesion has been there for 2years and asymptomatic. This lesion is A. Basal cell carincoma. B. Actinic keratinosis C. Nevus 20) A patient with Sickle cell now has fever, malaise and joint pain. This patient is at risk of developing A. Gonococal arthritis B. Osteonecrosis ( should be osteomyelitis) C. Syphillitc arthritis a. Joint Pain i. Osteomylelitis 1. S. aureus 2. Neutrophils destroy bone 3. Abscess (brodys) 4. Sickle Cell Dz Salmonella Osteomyelitis a. Potts Dz ii. Gonococcal Arthritis 1. Septic arthritis swollen knee 2. Migratory arthritis 3. 1 joint 4

iii. Osteonecrosis iv. Microthrombi 1. Sickle cell pts develop thrombi a. This could occlude one of the smller joint arteries 21) A 10 day old infant was brought to the emergency room following a 28th gestational birth. The physician noticed no reflexes. Test is being done to elicit what reflex? A. Startle /moro reflex ( birth 4months) B. Mantle ***At birth test for Rooting/sucking Reflex (child turns head in direction of stroke on cheek when sicking nipple to suck, disappear in 2 months), moro reflex (when startled, arms and legs extend) 22) A lady with breast cancer? She is likely to develop A. Bony metastasis B. Cirhosis C. Pulmonary embolism 23) A patient with a 35 year history of hypertension and on Hydroclorothiazide now developes renal calculi. The patient also complains of pain in the big toe. An Xray of the kidney is likely to show a calculi made up of? A. Calcium oxalate crystals B. Sodium monophosphate C. Cystine 24) Pt. taking Metoprolol and aspirin for HTN and arthritis for 5yrs, develop renal flank pain? This patient is likely to develop? A. Toxic acute tubular necrosis. B. Diffuse interstitial nephritis C. Pyelonephritis a. pril drugs are ACE inhibitors (metoprolol is used for same ish cept its a B-blocker) i. tx HTN, CHF, diabetic renal dz b. Acute tubular necrosis i. Muddy brown casts ii. proximal tubular epithelium necrosis iii. assoc: renal ischemia,(shock,sepsis), myoglobulinuria, toxins iv. loss of cell polarity c. Drug-Induced Interstitial Nephritis i. NSAID use ii. Acute interstitial renal inflammation iii. Fever, rash, eosinophila, hematuria

25) Jewish couple cant get A BABY- because THEY HAVE SEX WHEN SHE IS NOT OVULATING. She has her menses regularly. Physical examination shows that the male is fertile. Today, they are in your office for counseling. The next appropriate step for the physician is A. Refer the couple to a jewish physician who understand the condition better B. Prescribe medication to delay her ovulation C. Suggest the man decide on either having a baby or exercising his religion 26) Semen of a guy, and gives u stats: mobility, amount of semen, etc and asks what hormone would be 4 times amount in serum? LH/prolactin/testorterone/fshetc. not sure I THINK I PUT LH RESPONSIBLE FOR LEYDIG CELLS STIMULATION SPERM PRODUCTION 27) Boy had knee pain, and there was problem as distal end of femur. Ostoeids were being made. X ray shows spindle shaped cells on the distal femur. This patient is at risk of developing? A. giant cell cancer of bone ?? (Benign-epiphysis of distal femur- expanding lytic lesion-soap bubble multinucleated giant cells) B. Osteosarcoma (Metaphysis-sunburst=spiculated pattern from calcified malignant osteoid) C. Osteod osteoma (radiolucent focus surrounded by sclerotic bone-nocturnal pain relieved by ASA) D. Chondrosarcoma (malignant)

28)

Image of crystals and said aspirated from knee of a patient? A. Psuedogout B.Gout a. Gout i. Urate crystals (tophus, podagra, attack after large meal or alcohol) ii. Needle shaped crystals iii. Negatively birefringent (yellow under parallel light and blue under perp light) b. Pseudogout i. Calcium crystals ii. Weakly positively birefringent iii. Effects LARGE joints (knee) iv. Crystals are yellow under perp light and BLUE under parallel light

29) A 58year old woman brings her husband to the office because her husband is getting slow. She reports that her husband spends more time in shaving and takes longer to put on shirt. Which neurotransmitter is responsible for his symptoms? (Parkinson dz) A. Dopamine B. Ach (Alz dz) C. Serotonin D.GABA 30) Longitudinal tears in rectum and causing blood in the stool. The possible cause is? A. Fissures B. Fistula C. hemorrhoids 31) Girl at farm, and got a rash that expands to inner thigh. Following excoriation and pruititus, what test needs to be done to confirm the diagnosis? A. KOH test B. PAS C. Acid fast (Myc bact) D. Tzanc smear (Herpes) 32) Women getting fatigued. But normal menses, and normal GIT, and 63% hematocrit, increased RBC and WBC, platelets normal. What need to check? A. VitB cobalamine level B. level of thyroxin 33) One pt 23 with bp 120/78 and a pulse of 62 compared with another teenager with bp 128/82 and a pulse of 78. What is the explanation for the differences in pulse? A. Decrease Stroke volume B. increase stroke volume C. preload D. afterload a. Stroke Volume i. Increases in anxiety, preg, exercise ii. Decreases in FAILING heart b. Preload (end-diastolic) i. Ventricular End-diastolic volume ii. Increases with exercise, excitement, overtransfusion (inc blood volume) iii. Preload pumps up the heart c. Afterload (end systolic) i. Mean arterial pressure (proportional to peripheral resistance) ii. Increase in this increases Cardiac Output iii. Vasodilators, Aortic Stenosis, HTN, Mitral regurg decrease afterload 7

34) Old guy that lost (4.5g)10 lbs in 2 months, and pain when swallowing bread/bean initially. Now, he complains of pain on swallowing both solids and liquids. This patient etiology is? A. atrophy of muscles B. Achalasia C. Congenital pyloric stenosis D. Esophageal spasm E. carcinoma of esophagus 35) Had a baby, and baby in supine when sleeping and stops breathing like for 10 seconds. Had episoides of this b4? What is it? Obstructive Sleep apnea 36) A couple present to the clinic for counseling. The wife states that her husband sleeps irresistibly at anytime of the day. For a better diagnosis, what test are you likely to perform A. Sleep study B. Depression test **Depression causes a Sleep disturbance as well 37) How can you differentiate between pain caused by inflammatory and non inflammatory arthritis? A. Treatment with acetaminophen B. NSAID a. Inflammatory Arthritis i. Rheumatoid Arthritis (morning stiffness) 1. Positive RF 2. Swan neck deformity, Boutonniere deformity 3. Ulnar deviation, subcut. nodules b. Non-inflammatory Arthritis i. Osteoarthritis 1. Wear and tear of joints 2. Osteophytes 3. Herberdens and bouchards nodes 4. Pain in weight-bearing joints 5. Improve with rest (worse at end of day) 6. 38) A patient with sore throat, fever and lymphadenopathy. A Gray membrane in throat is found that is easily scraped off. The causative agent is A. Corynebacterium Diptheria B. Candida Albicans C. Streptoccocus pyogens D. Infectious Mononucleosis (pharyngeal erythema, lymphadenopathy) E. Hairy cell leukoplakia (cant be scraped) 39) Had interstitial pulmonary fibrosis and bilateral crackles in the Lungs. What labs are you likely to observed. It was more towards a restrictive Lung disease 8

 A. B. C. D.

TLC RV FEV FVC VC Decreased Decreased decreased decreased decreased Increased Increased Increased Increased Increased No change No change No change No change No change Decreased Increased Decreased Decreased Increased 40) A patient had severe pain when he opens his mouth and difficulty swallowing. P/E shows plaques and carcinoma of A. Lung B. Tongue C. Pharynx D. Thyroid 41) A patient was rushed to the ER after complaining of severe headache during sexual intercourse. Blood pressure is 160/118. This HTN is caused by A. idiopathic cranial hypertention B. Subarachnoid Hemorrhage C.Pulmonary Hypertension a. Subarachnoid Hemmorhage i. Worst headache of my life ii. Berry aneurysm rupture (from anterior communicating artery) iii. Assoc w/ Adult PKD b. Idiopathic Cranial HTN

42) An 8year old girl was rushed to the ER for flank pains, abdominal distension and fever. This is the second time shes having this pain in 6months duration. The most common cause of her symptoms is A. Sexual abuse B. Vesicourethral reflux. ***page 420 of First Aid Sexual abuse predisposes to UTIs (pyelonephritis)
43) Accident, guy severed pituitary stalk. Which hormone is likely to increase in overgrowth after 6months. A. Prolactin B. ADH(Vasopressin) C. Growth Hormone D. FSH E. Thyroxin 44) A 12year old boy with infection, and mass in the mid line of neck just above the thyroid cartilage. The diagnosis is? A. Thyroglossal duct cyst

B. Brachial cleft 45) Young man, 183 cm, 70 kg.. severe pain in one side of chest spontaneous pneumothorax 46) Black woman complains of shortness of breath, fatigue and pain in the joints. An Xray of the chest shows hilar lympadenopathy. This patient is suffering from A . Sarcoidosis C. EBV D. Chronic Bronchitis E. Herpes Virus 47) A born baby with meconium plug. What test needs to be done to further the diagnosis A. sweat chloride levels B. Vitamin C deficiency C. Stool culture 48) A patient with Skipped beats, midsystolic and late systolic murmur. Prolapse of mitral valves 49) Cresendo decresendo - Aortic Stenosis 50) Wide varied split pulmonary stenosis,LBBB 51) Osteoarthritis with the classic description, old lady 52) A patient develops fever, tender nodules on finger and erythematous lesions after dental work. This patient is likely to develop? A. Telangiectasia B. Bacterial Endocarditis C. Rheumatoid Arthritis D. Cardiac tamponade 53) Benign positional vertigo nausea, vomiting, NO tinnituslies down and feels better 54) A patient with type I Diabetes Mellitus complains of nausea, vomiting and itching in the legs. P/E shows a non healing ulcer in the legs. What causes the nausea, vomiting and itching in this patient? A. Menierres disease B. Autonomic Neuropathy C. Diabetic Ketoacidosis 55) A patient with malignant mesothelioma. What substance is likely responsible for his disease. A. Asbestosis B. Silicosis C. Coal tar 56) Old lady with vaginal problems, pain, severe itching I put bacterial vaginosis 57) Young child with lympadenopathy, fever, malaise and NO splenomegaly dont remember the answer RUBELLA

10

58) baby , days old , bloody diarrhea since mom started feeding him with formula, he has distention, blood in stool and diarrhea 12 times a day- ? a. Common Causes of bloody diarrhea i. Y. Enterocolitica 1. Day-care outbreaks, pseudoappenditicitis ii. C. difficile 1. Watery and bloody diarrhea 2. Too many antibiotics PMC iii. Salmonella 1. Enterocolitis, lactose neg., flaggelum iv. Shigella 1. Dysentery (diahrra w/ blood and mucus), Shiga Toxin, lactose neg. v. EHEC 1. HUS 2. Shiga-like toxin (enterohemorrhagic E. coli) vi. EIEC 1. Invased colonic mucosa vii. Campylobacter 1. Comma or S_shaped org., oxidase positive viii. E. Histolytica 1. Cysts w/ 4 nuclei, cysts in H20 2. protzoan 59) A patient with excruciating chest pain without exertion, that radiates to the subscapula. This is as a result of A. Dissection of the aorta B. Myocardial Infarction C. Pericarditis 60) all the signs of Irritable bowel syndrome, when the man had an urgency to go poop and always has diarrhea in the morning I put IBS 61) woman has some abdominal pain and pain in the wrist since 6months ago. she took time off work and when shes home, she made her husband and children do all the cooking and cleaning because of the pain. She was prescribed Ibuprofen and still the pain persists. As a physician, your next step is to A. schedule her to go back to work B. factitious pt plays sick role to get medical attn C. somatization,( physical sx w/o sufficient organic cause) D. Schedule her for an Interdiciplinary pain program Somatization disorder- no identifiable cause of physical symptoms, more common in women (1st aide 424) 62) A 56year old Female with excessive bleeding A. Liomyomata leiomyoma B. Uterine Neoplasia 11

 63) Pain that was constant in the umbilical region for a long time and patient can only lay down with his right leg flexed, and has guarding . On P/E she complains of severe left lower abdominal pain on guarding. Other test is unremarkable. The possible diagnosis is A. Appendicitis B. small bowel ischemia C. Diverticulitis D. Peptic ulcer disease **Appendix is on RIGHT side, I would go with Diverticulitis (LLQ pain, fever, leukocytosis left sided appendicitis) 64) 68 year old man wakes up at night to urinate. He states that he can feeL the bladder not fully emptied. P/E shows bladder distention and urine backup in the bladder. The probable cause is A. external urethal sphincter stenosis B. BPH C. penile urethra stenosis . 65) Female comes in with complaints of shortness of breath, headache and pain in the abdomen. She has been in the office multiple times for the last 6months for the same symptoms. P/E is unremarkable. This patient is likely suffering from A. Factitious pt plays sick role to get medical attn B. Malingering pt fakes disorder for specfic gain (avoid work, obtain drugs) and avoids tx by doctors C. Hypochondriac preoccupation w/ and fear of having serious illness despite med. eval and ressuranc D. Somatization disorder - 66) A patient complains of severe pain in the area of the foot and calf. Palpation of the leg shows a tender leg with grade 2+ edema. The causative agent is likely an A. Arterial insufficiency B. Venous Insufficiency C. Claudification D. Lymphatic obstruction 67) Myxoma moving thing in the atrium that gets stuck sometimes 68) A 26year old male present with pain in the joints and chestpain. He was diagnosed with syphilis at 19 and dont remember taking penicillin. What type of heart sounds is likely to be heard in this patient. (syphilis causes calcification &(aneurysm) of aortic root & ascending aortic arch (tree bark appearance)= results in Aortic valve insufficiency*** A. A grade 2/4 systolic heart sounds best heard at carotid apex B. A2 C. P2 D. Holosystolic murmur VSD, 12

E. Loud, Diastolic, S2 sounds at Fourth Left prasternal intercostals space =AR (1st aide 245) 69) A patient was referred to you by a physician. You are a consultant and the patient tells you , says I will kill myself when I get discharged from the ER. Your next appropriate step is A. call the police B. Refer the patient back to the physician C. Discharge the patient 70) A 19year old male who is sexually active admits to multiple male sex partners. When asked if he used condoms, he says sometimes. He is here complaining of an acute pain in the upper quadrant and his vaccination is up to date. P/E shows a nodular swelling(xanthoma) on the elbows and knee pain. What lab test will clearly indicate your diagnosis A. IgM anti Hepatitis B virus B. IgG anti Hepatitis B virus C. ESR ( in RHD, Takayasu arteritis, Temporal (giant cell) arteritis) D. HIV 71) A woman who is a vegetarian consumes too many vitamins supplements, has dry preorial and jaundice. What vitamin toxicity causes this adverse effects A .Vitamin A B. Vitamin B12 C. Vitamin B6 D. Vitamin D E. Vitamin C 72) A patient was rushed to the ER complaining of pain in the abdominal pain. When asked she said the pain is all over her body. On Palpation she points to the umbilicus. She prefers to lie on her back because the pain is severe on the right lower quadrant. The diagnosis is A. Diverticulosis B. Appendicitis C. Ischemic Colitis D. Irritable bowel syndrome 73) A patient who you told to stop smoking about a year ago presents to your clinic and told you that he smokes 2 packs of cigarettes a day since his last visit. Your next words are A. Have you tried any Nicotine patches B. Are you trying to quit smoking C. I thought I told you to stop smoking. Smoking will kill you 74) A young man complains of severe pain in the forehead and joints. He had a trauma that causes an hemartoma in the joints(hemarthrosis-bleeding in joint) . He said his uncle and great grand uncle had the same symptoms. What factor is causes this symptoms A. Hageman Factor VII deficiency B. Von willebrand factor deficiency C. Factor VIII deficiency 13

75)

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woman with malaise, fever and weight loss. Blood pressure is 136/85 and R8. He also complains of abdominal pain and lab test is positive for occult blood in stool. The diagnosis is A. Polyarteritis nodosa (Ist aide 270 -MELENA!! Myalgia, HTN, cutaneous eruption) B. Ischemic Colitis C. Diverticulosis D. Appendicitis A patient with Ptosis, miosis and anhidrosis (Horners syndrome) complains of pain along the ulnar nerve distribution. This pain is cause by A. Heart B. Kidney C. Spleen D. Skin E. Lung - pancoast tumor Man comes to doc and says that all that the only problem with his life is difficulty finding a girlfriend because he is too shy, and he had a Girlfriend before but she broke up with him because he is shy. This patient is suffering from what personality disorder? A. avoidant B. schizoid C. Dependent D. Antisocial A patient who is on Chemotherapy for 6months returns and states that I will die if I have to continue this medications She is scheduled for a 1 year chemotherapy. What will you do to help this patient A. Discontinue the chemotherapy at the patients wish B. Halve the drug inorder to reduce the side effects C. Discuss other treatment options A 38year old woman with lump in the breast was examined and a biopsy of the lump shows metastasis to the right upper axilla. When told that her Biopsy was positive for breast cancer, she said I should have come earlier, my mother and sister died of breast cancer Whats the next step the physician is likely to take? A. Tell her not to worry because there are good treatment options available for the treatment of breast cancer B. Schedule her for immediate operation C. Advice her, shes not going to die D. I understand this is an emotional period for you, I will schedule you for an appointment next week so we can discuss the treatment options SHeehans syndrome - classic case (postpartum hrge resulting in ant pituitary infarct & necrosis) 14

81) When a woman has her period what hormone decrease? I put progesterone (progesterone withdrawal ) ( progesterone= indicative of ovulation, Progest. inhibits LH&FSH) 82) A 7moths old baby cries like crazy when there are strangers around and the mom around. The explanation for this condition is A stranger anxiety B. separation anxiety 83) A patient is able to abduct the arm but complains of pain on supination of the forearm. Which of the following structure is responsible for this condition? A. Bicipital tendonitis B. Damage to rotator cuff muscle C. Carpal turnel syndrome D. Rheumatoid Arthritis 84) Q about a lady that gained weight, half of eyebrows were missing and other fatigueetc for a few months hypothyroidism 85) Some queston about either LBBB or RBBB a. Wide paradoxical split= LBBB, AS, HCM b. Wide varying split w/ inspiration= RBBB, PS, MR c. Wide fixed split= ASD 86) A Q about some guy having tremor, something.ataxia when walking and one sided body ataxia when sitting. signs of cerebellar damage 87) A 15year old boy who was diagnosed with ALL come back and he doesnt want to get chemotherapy again. His parents wants him to try this particular treatment options. Your answer is A. call in parents for a meeting to discuss it with them and him B. Treat the patient regardless of his will C. Provide other treatment options for the patients 88) Old man fell in bathtub and was brought to the hospital. MR of the brain shows no fracture or other deformities. 72hours later, he was found unconscious. Whats the cause A. Rupture of bridging veins (subdural hematoma) B. Fracture of Temporal skull C. Rupture of Middle Meningeal artery (Epidural hematoma) D. Subarachnoid Hemorrhage (berry aneurysm) 89) What distinguishes cardiogenic shock(weak thread pule) and hypovolemic shock(rapid pulse)? A. Tachycardia B. Weak pulse 15

C. Hypotension D. Cool, clammy skin E. Arrhythmia 90) A patient with Renal calculi. These calculi are made up of ? A. Arginine B. Cystine C. Homocysteine 91) Patient talks to the doc and doc sits 3 feet away with hands open and asks open ended questions. As Soon as the patient starts talking the doctor starts writing notes. What will hinder the rapport btw pt and doc? A. distance between Doc and patient B. Taking Notes C. Hands open 92) Pt has epigastric pain, the pain goes away with food sometimes peptic ulcer ***duodenal ulcer pain goes away with food 93) A patient was rushed to the ER with dilated pupils that are not reacting to light. Further examination when the corneal is stroked with cotton wool, elicits no response. Theres loss of abducton and adduction on the Left eye. Where is the lesion A. Cortical B. Diencephalon C. Midbrain D. Pons (CN 5, 6,7,8) E. Medulla 94) A patient complains of increase heart rate after he was on over the counter herbal prescription for weight loss. On physical examination, the blood pressure is normal, but the patient has tachychardia. What herbal drugs causes this sudden rise in HR? A. Echinacea B. Ginseng C. Ma huang D. Saw palmetto E. Ginsaw 95) A 46year old male was rushed to the ER after he was found unconscious on the floor. He is a chronic alcoholic. On P/E he is irritable and Obtunded. What vitamin deficiency is responsible for this patients symptoms A. Vitamin B12 B. Niaciin C. Vitamin B1(Thiamine) D. Vitamin B6(Pyridoxine) 16

 96) A patient with red ulcers and central clearing on the face, back and elbows. The ulcers is made up of vesicular papules that causes itching. What infection causes this symptoms A. Psoriasis B. Hypothyroid C. Chicken Pox D. Lime disease 97) A patient with chest pain, shortness of breath and purulent cough. X ray of the chest shows Increased Tactile Vocal fremities on the Right due to consolidations. What other abnormalities are you likely to see in this patient? A. Calcifications in the upper middle lobe B. Lobal pneumonia C. Mycobactetium Tuberculosis D. Herpes E. S. aureus 98) A 60year old male was rushed to the ER following episodes of irritation, stiff neck and hypotension. A chest Xray of the Lungs shows opaque calcifications in the apical lobes of the upper lung. Other physical examination is unremarkable. Whats the diagnosis A. Mumps B. Herpes encephalitis C. S. pneumonia D. Tuberculous Meningitis E. H. influenza 99) Dermatomyositis or Eaton Lambert: A patient whose muscle biopsy from the Soleus muscle was taken becaue she complained of muscle weakness and other symptoms. Dermatomyositis malar rash, heliotrope, gottrons papules, shaw and face rash PLUS prox. Muscle weakness Eaton Lambert symptoms improve w/ exercise and nerve stimulation, dry mouth, muscles of legs and arms effected, 100) A 45year old man who smokes 2 pack of cigarettes a day for the past 20 years is examined for shortness of breath and tachypnea. On physical examination, what other abnormalities are you likely to observe in this patient PaO2 PCO2 TVF Breath sounds A. Decreased Decreased Decreased Wheezles B. Decreased Increased Increased Wheezles C. Decreased Increased Decreased Rales D. Decreased Increased Increased Crackles 101) Classic Rheumatoid Arthritis case of a patient with pain in the elbows, hip and ankle joints that is relieved by rest or Ibuprofen. On examination, a nodular swelling on the distal interphalangeal joints bilaterally. 17

102) A patient complains of copious white mucous discharge from her vaginal. No adnexal masses were found. Which organism is responsible for this? A. Chlamydia trachomatis B. Human Pappilloma Virus C. Herpes D. HIV E. Bacterial Vaginosis F. Lymphogranuloma Inguinale 103) A patient presents with severe pain on the left arm that is relieved by Ibuprofen. On physical examination, the patient complains of pain on active flexion of the arm against resistance. Theres no pain on passive flexion of the arm. Other test is unremarkable. Whats the problem? A. Dermatomyositis B. Eaton-Lambert syndrome C. More options D. Malingering 104) A patient complains of one week history of abdominal fullness, nausea and vomiting. The skin appears to be jaundiced. Stool test is positive for occult blood. No adnexal masses are found in the flank. Abdominal Xray and computed tomography shows air. The possible diagnosis is A. Colon cancer B. Perforated viscus C. GERD D. Dissection of the aorta E. Peptic ulcer F. Diverticulitis G. Pyelonephritis

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