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> Tests from Exam, 7/10/13
сообщение 8.10.2013, 6:34
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Part A:

Schwartz?s questions:

---- BRCA2 mutations are associate with all of the following EXCEPT?
( from SCHWARTZ 9th edition page 91)
A. Gastric cancer
B. Lung cancer
C. Ovarian cancer
D. Prostate cancer

----For average patients, routine screening is recommended for all but the following disease?
( from SCHWARTZ 9th edition page 95 )
A. Breast cancer
B. Colorectal cancer
C.Cervical cancer
D. Pancreatic cancer

----- Cytokines are which type of hormone?
( from SCHWARTZ 9th edition page 5 )
A. Polypeptide
B. Amino acid
C. Fatty acid
D. Carbohydrate

-----The primary physiologic effect of nitric oxide (NO) is?
( from SCHWARTZ 9th edition page 7 )
A. Increased platelet adhesion
B.Increased leukocyte-endothelial adhesion
C.Increased microthrombosis
D. Increased Smooth muscle relaxation

----- Which of the following is the primary fuel source after acute injury?
( from SCHWARTZ 9th edition page 9 )
A. Fat
B. Muscle (protein)
C. Glycogen
D. Ketone bodies

Answer: A
?Lipids are not merely nonprotein, noncarbohydrate fuel
sources that minimize protein catabolism in the injured patient. Lipid metabolism potentially influences the structural
integrity of cell membranes as well as the immune response
during systemic inflammation. Adipose stores within the
body (triglycerides) are the predominant energy source (50
to 80%) during critical illness and after injury. Fat mobilization (lipolysis) occurs mainly in response to catecholamine
stimulus of the hormone-sensitive triglyceride lipase. Other
hormonal influences which potentiate lipolysis include adrenocorticotropic hormone (ACTH), catecholamines, thyroid
hormone, cortisol, glucagon, growth hormone release, reduction in insulin levels, and increased sympathetic stimulus.

----- Which of the following drugs irreversibly inhibits platlet COX (cyclo-oxagenase)?
( from SCHWARTZ 9th edition page 21 )
A. Ibuprofen
B. Clopidogrel
C. Aspirin
D. Celebrex

-----------Which of the following patients would be considered candidate for bariatric surgery?
( from SCHWARTZ 9th edition page 273 )
A. 70 year old, BMI 48, with well-controlled diabetes
B. 22 year old, BMI 34, with brittle (uncontrollable) diabetes
C. 35year old, BMI 38, with no comorbidities
D. 56 year old, BMI 42, with no comorbidities

-----------Traction diverticula in the esophagus are the results of ?
( from SCHWARTZ 9th edition page 246 )
A. A congenital defect
B. Infection or inflammation
C. Motility disorders
D. Trauma, usually iatrogenic

----- Which of the following gastric polyps is considered pre-malignant?
( from SCHWARTZ 9th edition page 266 )
A. Hamartomatous
B. Heterotopic
C. Inflammatory
D. Adenomatous

----- In addition to regional lymphadenectomy, appropriate surgical treatment for T2 carcinoma of the gallbladder is?
( from SCHWARTZ 9th edition page 346)
A. Cholecystectomy only
B. Cholecystectomy with resection of liver segments IVB AND V
C. Cholecystectomy with limited right hepatectomy
D. Cholecystectomy with extended right hepatectomy

---- Wich of the folloeing makes curative resection of an esophageal caner unlikely?
( from SCHWARTZ 9th edition page249)

A Tumor length >6cm
B Weight loss > 10%
C recurrental laryngeal nerve Plasy ( invasion)
D >2 abnormal lymph nodes on CT scan

---- Which of the following is the best test to confirm eradication of H. pylori
( from SCHWARTZ 9th edition page 263 )
A. Negative histology after biopsy during EGD
B. Negative fecal antigen
C. Negative urea breath test
D. Negative urea blood test

Which of the following is consistently the largest artery to the stomach?
( from SCHWARTZ 9th edition 255 )

A. left gastric artery
B Right gastric artery
C left gastroepiploic artery
D Right gastroepiploic artery

(pretest 135)
A 36-year-old man who was hit by a car presents to the ER with hypotension. On examination, he
has tenderness and bruising over his left lateral chest below the nipple. An ultrasound examination is
performed and reveals free fluid in the abdomen. What is the most likely organ to have been injured in
this patient?
a. Liver
b. Kidney
c. Spleen
d. Intestine
e. Pancreas

(138 pretest)

A 25-year-old woman arrives in the ER following an automobile accident. She is acutely dyspneic
with a respiratory rate of 60 breaths per minute. Breath sounds are markedly diminished on the right side.
Which of the following is the best first step in the management of this patient?
a. Take a chest x-ray.
b. Draw arterial blood for blood-gas determination.
c. Decompress the right pleural space.
d. Perform pericardiocentesis.
e. Administer intravenous fluids

(pretest 143)

Following blunt abdominal trauma, a 12-year-old girl develops upper abdominal pain, nausea, and vomiting. An upper gastrointestinal series reveals a total obstruction of the duodenum with a coiled spring appearance in the second and third portions. In the absence of other suspected injuries, which of the following is the most appropriate management of this patient?

a. Gastrojejunostomy
b. Nasogastric suction and observation
c. Duodenal resection
d. TPN (total parental nutrition) to increase the size of the retroperitoneal fat pad
e. Duodenojejunostomy

A 27-year-old man presents to the ER after a high-speed motor vehicle collision with chest pain and
marked respiratory distress. On physical examination, he is hypotensive with distended neck veins and
absence of breath sounds in the left chest. Which of the following is the proper initial treatment?
a. Intubation
b. Chest x-ray
c. Pericardiocentesis
d. Chest decompression with a needle
e. Emergent thoracotomy

(pretest 209)

A 19-year-old college student presents with a testicular mass, and after treatment he returns for
regular follow-up visits. Which of the following is the most useful serum marker for detecting recurrent
disease after treatment of nonseminomatous testicular cancer?
a. Carcinoembryonic antigen (CEA)
b. Human chorionic gonadotropin (hCG)
c. Prostate-specific antigen (PSA)
d. CA125
e. p53 oncogene

(213 pretest)
An 11-year-old girl presents to your office because of a family history of medullary carcinoma of the
thyroid. Physical examination is normal. Which of the following tests should you perform?
a. Urine vanillylmandelic acid (VMA) level
b. Serum insulin level
c. Serum gastrin level
d. Serum glucagon level
e. Serum somatostatin level

(215 pretest)
A 50-year-old man is incidentally discovered to have a low-grade mucosa-associated lymphoid
tissue (MALT) lymphoma on biopsy of the stomach during esophagogastroduodenoscopy for dyspepsia.
CT scans of the chest, abdomen, and pelvis demonstrate no evidence of enlarged regional lymph nodes or
distant metastases. Which of the following is the initial treatment of choice?
a. Total gastrectomy with esophagojejunostomy
b. Total gastrectomy with esophagojejunostomy and adjuvant chemotherapy
c. Chemotherapy
d. Steroids
e. Antibiotics

(222 pretest)

A 53-year-old woman presents with bright red blood per rectum, increased abdominal distention,
and weight loss. She is found to have a large fungating mass 8 cm from the anal verge. No other lesions
are identified. Biopsy is consistent with invasive rectal adenocarcinoma. Endorectal ultrasound shows
invasion of the tumor into the perirectal fat and multiple enlarged lymph nodes. CT scans of the chest,
abdomen, and pelvis do not show any metastases. She would like to preserve her sphincter if possible.
Which of the following is the best treatment option for this patient given her preferences?
a. Abdominoperineal resection
b. Neoadjuvant chemoradiation followed by low anterior resection
c. Neoadjuvant chemoradiation followed by abdominoperineal resection
d. Transanal excision followed by adjuvant chemoradiation
e. Neoadjuvant chemoradiation followed by transanal excision


A 57-year-old woman develops bony metastases 1 year after right modified radical mastectomy for
breast cancer. The tumor was estrogen receptor-negative, progesterone receptor-negative, and Her-2/neu
positive. Which of the following agents is indicated for treatment of her metastatic disease?
a. Antiestrogen (Tamoxifen)
b. Selective estrogen receptor modulator (Raloxifene)
c. Monoclonal antibody (Trastuzumab)
d. Aromatase inhibitor (Anastrozole)
e. 5-fluorouracil


A 35-year-old woman with a history of previous right thyroidectomy for a benign thyroid nodule
now undergoes completion thyroidectomy for a suspicious thyroid mass. Several hours postoperatively,
she develops progressive swelling under the incision, stridor, and difficulty breathing. Orotracheal
intubation is successful. Which of the following is the most appropriate next step?
a. Fiberoptic laryngoscopy to rule out bilateral vocal cord paralysis
b. Administration of intravenous calcium
c. Administration of broad-spectrum antibiotics and debridement of the wound
d. Wound exploration
e. Administration of high-dose steroids and antihistamines

. A 35-year-old woman presents with a lump in the left breast. Her family history is negative for
breast cancer. On examination the mass is rubbery, mobile, and nontender to palpation. There are no
overlying skin changes and the axilla is negative for lymphadenopathy. An ultrasound demonstrates a
simple 1-cm cyst in the area of the palpable mass in the left breast. Which of the following represents the
most appropriate management of this patient?
a. Reassurance and reexamination
b. Immediate excisional biopsy
c. Aspiration of the cyst with cytologic analysis
d. Fluoroscopically guided needle localization biopsy
e. Mammography and reevaluation of options with new information


A 55-year-old woman presents with a slow-growing painless mass on the right side of the neck. A
fine-needle aspiration of the nodule shows a well-differentiated papillary carcinoma. A complete neck
ultrasound demonstrates a 1-cm nodule in the right thyroid without masses in the contralateral lobe or
lymph node metastasis in the central and lateral neck compartments. With regards to this patient, which of
the following is associated with a poor prognosis?
a. Age
b. Sex
c. Grade of tumor
d. Size of tumor
e. Lymph node status

A 45-year-old woman presents with hypertension, development of facial hair, and a 7-cm suprarenal
mass. Which of the following is the most likely diagnosis?
a. Myelolipoma
b. Cushing disease
c. Adrenocortical carcinoma
d. Pheochromocytoma
e. Carcinoid

A 36-year-old woman presents with palpitations, anxiety, and hypertension. Workup reveals a
pheochromocytoma. Which of the following is the best approach to optimizing the patient pre

a. Fluid restriction 24 hours preoperatively to prevent intraoperative congestive heart failure
-+b. Initiation of an α-blocker 24 hours prior to surgery
c. Initiation of an α-blocker at 1 to 3 weeks prior to surgery
d. Initiation of a β-blocker 1 to 3 weeks prior to surgery
e. Escalating antihypertensive drug therapy with β-blockade followed by α-blockade starting at least 1
week prior to surgery

261 pretest - are you sure we had this question? (Alon Kirsh asking) i didnt see it also (irine)
me also (eddie)
A 40-year-old woman presents with a rash involving the nipple-areola complex for the last month
with associated itching. On physical examination there is crusting and ulceration of the nipple with
surrounding erythema involving the areola and surrounding skin, no palpable breast masses, and no
cervical or axillary lymphadenopathy. Which of the following is the most appropriate next step in the
management of this patient?
a. Reexamine the patient in 1 month
b. Corticosteroid cream to the affected area
c. Administration of oral antibiotics
d. Mammogram and biopsy of the affected area
e. Modified radical mastectomy

264 pretest - this question didn?t appear
A 30-year-old woman presents with hypertension, weakness, bone pain, and a serum calcium level
of 15.2 mg/dL. Hand films below show osteitis fibrosa cystica. Which of the following is the most likely
cause of these findings?
a. Sarcoidosis
b. Vitamin D intoxication
c. Paget disease
d. Metastatic carcinoma
e. Primary hyperparathyroidism

שאלה מונפצת(אדי) - לא זוכר חיה כזאת True. We didn?t have it


A 35-year-old woman presents with frequent and multiple areas of cutaneous ecchymosis. Workup
demonstrates a platelet count of 15,000/μL, evaluation of the bone marrow reveals a normal number of
megakaryocytes, and ultrasound examination demonstrates a normal-sized spleen. Based on the exclusion
of other causes of thrombocytopenia, she is given a diagnosis of immune (idiopathic) thrombocytopenic
purpura (ITP). Which of the following is the most appropriate treatment upon diagnosis?
a. Expectant management with close follow-up of platelet counts
b. Immediate platelet transfusion to increase platelet counts to greater than 50,000/μL
c. Glucocorticoid therapy
d. Intravenous immunoglobulin (IVIG) therapy
e. Referral to surgery for laparoscopic splenectomy


A 59-year-old woman presents with right lower quadrant pain, nausea, and vomiting. She undergoes
an uncomplicated laparoscopic appendectomy. Postoperatively, the pathology reveals a 2.5-cm mucinous
adenocarcinoma with lymphatic invasion. Staging workup, including colonoscopy, chest x-ray, and
computed tomography (CT) scan of the abdomen and pelvis, is negative. Which of the following is the
most appropriate next step in her management?
a. No further intervention at this time; follow-up every 6 months for 2 years
b. Chemotherapy alone
c. Neoadjuvant chemotherapy followed by right hemicolectomy
d. Ileocecectomy
e. Right hemicolectomy

294. A 41-year-old man complains of regurgitation of saliva and of undigested food. An esophagram
reveals a dilated esophagus and a bird?s-beak deformity. Manometry shows a hypertensive lower
esophageal sphincter with failure to relax with deglutition. Which of the following is the safest and most
effective treatment of this condition?
a. Medical treatment with sublingual nitroglycerin, nitrates, or calcium-channel blockers
b. Repeated bougie dilations
c. Injections of botulinum toxin directly into the lower esophageal sphincter
d. Dilation with a Gruntzig-type (volume-limited, pressure-control) balloon
e. Surgical esophagomyotomy

299. A 56-year-old previously healthy physician notices that his eyes are yellow and he has been losing
weight. On physical examination the patient has jaundice and scleral icterus with a benign abdomen.
Transcutaneous ultrasound of the abdomen demonstrates biliary ductal dilation without gallstones. Which
of the following is the most appropriate next step in the workup of this patient?
a. Esophagogastroduodenoscopy (EGD)
b. Endoscopic retrograde cholangiopancreatography (ERCP)
c. Acute abdominal series
d. Computed tomography (CT) scan
e. Positron emission tomography (PET) scan

306. A 42-year-old man with no history of use of NSAIDs presents with recurrent gastritis. The patient
was diagnosed and treated for Helicobacter pylori 6 months ago. Which of the following tests provides
the least invasive method to document eradication of the infection?
a. Serology testing for H pylori
b. Carbon-labeled urea breath test
c. Rapid urease assay
d. Histologic evaluation of gastric mucosa
e. Culturing of gastric mucosa

I don?t remember this question, only the first one with the Urea Breath test
גם אני לא זוכר.

A 22-year-old college student notices a bulge in his right groin. It is accentuated with coughing, but
is easily reducible. Which of the following hernias follows the path of the spermatic cord within the
cremaster muscle?
a. Femoral
b. Direct inguinal
c. Indirect inguinal
d. Spigelian
e. Interparietal

. A 22-year-old woman presents with a painful fluctuant mass in the midline between the gluteal folds.
She denies pain on rectal examination. Which of the following is the most likely diagnosis?
a. Pilonidal abscess
b. Perianal abscess
c. Perirectal abscess
d. Fistula-in-ano
e. Anal fissure

327. A 62-year-old man has been noticing progressive difficulty swallowing, first solid food and now
liquids as well. A barium study shows a ragged narrowing just below the carinal level. Endoscopic
biopsy confirms squamous cell carcinoma. Which of the following provides the most accurate information
regarding the T stage of an esophageal carcinoma?
a. Computed tomography
b. Positron emission tomography
c. Magnetic resonance imaging
d. Endoscopic ultrasound
e. Bronchoscopy

330. A 73-year-old woman presents to the emergency room complaining of severe epigastric pain
radiating to her back, nausea, and vomiting. CT scan of the abdomen demonstrates inflammation and
edema of the pancreas. A right upper quadrant ultrasound demonstrates the presence of gallstones in the
gallbladder. Which of the following is an important prognostic sign in acute pancreatitis according to
Ranson?s criteria?
a. Amylase level
b. Age
c. Total bilirubin level
d. Albumin level
e. Lipase level

Following blunt abdominal trauma, a 12-year-old girl develops upper abdominal pain, nausea, and vomiting. An upper gastrointestinal series reveals a total obstruction of the duodenum with a ?coiled spring? appearance in the second and third portions. Appropriate management is
a. Gastrojejunostomy
b. Nasogastric suction and observation
c. Duodenal resection
d. TPN to increase the size of the retroperitoneal fat pad
e. Duodenojejunostomy

1.65 year old, low anterior resection due to rectal cancer.
one the 5th post operative day- T 39, BP 159/90,RR28, abdominal ct-pelvic abscess .
what describe the condition?
b.sepsis( right one?)
c.sever sepsis

2.a 52 year old man with gastric outlet obstruction.
duadenal ulcer, hypochloremia , hypokalemia, metabolic alkalosis.
which most relevant treatment?
a.0.9 NaCl 0.9% kcl until signs of volume?.

שאלות שזכרתי בערך-סליחה על העברית ,פשוט גמרו לי תצורה.ואני עייף מכדי לחפש או לכתוב באנגלית את הגרמנית שלהם-(מי שזוכר אותם , שימצא בקבצים או בספרים ושישבץ בבקשה במקום הנכון ):

שאלה על אישה עם נגטיב אסטרוגן רצפטור-brest cancer, negative estrogen, negative progestron, positive HER2,,,,
a.trastuzumab. correct
b.aromatase inhib

שאלה על איזה איבר אנטומי נמצא בצד שמאל מתחת לפטמה

innervation of the clitoris -

הייתה שאלה עם סטרפטוקוקוס בוביס..

היתה שאלה על סיצטיס פיברוזיס- וכלוריד סווט טסט

שאלה על חלב לא מפוסטר- וברוצלה

lobular carcinoma in situ.
a. observation and mammogram.

- Pseudom. colitis:
a.Metronidazol oral .
b.Vancomycin i.v


Which of the following reflexes is normally absent in a newborn ?
a. STARTLE (moro)
b. hand grasp
c.crossed adductor
d. Asymmetric tonic neck
E- parachute

correct E

Trisomie 21 with
a malrotation
b cleft palate
c renal
d.endocardial cushion defect.

correct D

PANCREATITIS part of rannson criteria:

the mid pelvic small.about the interspinosus diameter:
c 9-11
d 12
e the interspinous is not imoprtant to determine.

שאלה על מה מקור האנרגיה כתוצאה מטראומה?
c.keton bodies
d.muscle protein

An 11-year-old girl presents to your office because of a family history
of medullary carcinoma of the thyroid. Physical examination is normal.
Which of the following tests would you perform? (pretest surgery)
a. Urine vanillylmandelic acid (VMA) level
b. Serum insulin level
c. Serum gastrin level
d. Serum glucagon level
e. Serum somatostatin level

שאלה על איזה כלי דם הכי גדול? SHWARTZ 9th editiion 26-2.
a.right gatsric
b.left gastric
c.left gastricepiploic
d.right gastric epiploic

Which of the following irreversibly inhibits COX (cyclooxygenase enzyme)?
C. Aspirin

After how long after cancer free period is a woman with prior breast cancer is regarded as cured?

שאלה בפסיכיאטריה(שחזורים)- על קשר בין טורט למחלות אחרות

שאלה על אישה בת 20,
20 year old female,recieved IM haloperidol , suddenly high fever,
confusion,increased WBC,what is the least appropriate treatment?
a. stop medicine
d.monitor vital signs
e. symptomatic relief ?.או משהו בסגנון
$$שאלה בפסיכיאטריה(שחזורים) על קשר בין התאבדות-תשובה: למעל גיל 65
איך קרא כשההרניה נכנסת לקרימסטר או משהו כזה$$
a.direct hernia
b.indirect hernia
c.paranedian hernia

psyco: social fobia

14years old girl present to pediatrician ,she has ?freaking out? describe shaking ,grasping for hair, feeling like going die for few min and resolve spontaneous in various time and various situations . Most likely diagnosis
a) Dysthemic disorder
b) Social phobia
c) Separation anxiety
d) Panic

שאלה בפסיכיאטריה על אישה שכל הזמן דואגת לילד שלה. חייבית לדעת כל רגע נתון מה קורה עם הסובבים איתה. לא ישנה טוב בלילה בגלל דאגות:
c. obssesive compulsive personality disorder* true
d. General anxiety disorder

שאלה בפסיכיאטריה-(שחזורים) מה הגורם הכי גדול להתאבדות- נסיונות קודמים

שאלה בפסיכיאטריה- במה מהמחלות הבאות יש הכי הרבה גורמי מוות טבעיים ולא טבעיים..

שאלה בגיינ על השפעת האסטרוגן על מצב המוקוס בסרביקס:

patient with sickle cell has higher risk for :
encapsulated bacteria.

roll on back, supine position, sits, does not have pincer grasp, which age:
(not in order)
a.4 mon
b.6 mo
c.1 yr

3. A 71 year old male comes with the complaint of dysphagia and weight loss. After evaluation with endoscopy and biopsy squamous carcinoma of the distal esophagus is found.
He is scheduled for neoadjuvant chemoradiation with esophagectomy. Preoperative he is started on TPN (total parenteral nutrition). Considering his severe malnutrition reflected by albumin less than 1g/dL, what is your major concern after starting the TPN?

A. hyperkalemia
B. hypermagnesemia
C. hypoglycemia
D. hypophosphatemia
E. hypochloremia

4. A 23 year old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the second. postoperative day, she begins to complain of a tingling sensation in her hands. She appears quite anxious and later complains of muscle cramps. Which of the following is the most appropriate initial management strategy?
a. 10 ml of 10% Magnesium sulfate IV
b. Oral vitamin D
c. 100 micro gram oral synthroid
d. Continuous infusion of calcium gluconate
e. Oral calcium gluconate.

5. A 65-year-old man has an enterocutaneous fistula originating in the jejunum secondary to inflammatory bowel disease. Which of the following would be the most appropriate fluid for replacement of his enteric losses?

A. 5% something
B. 3% normal saline
C. Ringer lactate solution
D. 0.9% sodium chloride
E. 6% sodium bicarbonate solution

correct C

7.A 42 year old man sustains a gunshot wound to the abdomen and is in schok.Multiple units of packed red blood cells are transfused in an effort to resuscitate him.He complains of numbness around his mouth and displays carpopedal spasm and a positive Chvostek sign.An electrocardiogram demonstrates a prolonged OT interval.Which of the following is the most appropriate treatment?
a)Intravenous bicarbonate
b)Intravenous potassium
c)Intravenuos calcium
d)Intravenous digoxin
e)Intravenous parathyroid hormone

8.amos ivry

9. A 25 year old women was involved in a motor vehicle accident, she presents with diminished breathing sounds; what?s the initial treatment?
A chest x ray
B. Decompress right chest via needle.
C. Pericardiocentesis

correct B

10. A 12 year old girl was in a motor vehicle accident. The duodenum is obstructed and it?s 2nd and 3rd part have a coiled appearance on imaging. There are no other injuries. She is stable.
What?s the next step in management?
A. Nasogastric tube and observation.
B. Duodenojejunustomy
C. Gastrojejunostomy
D. Duodenal resection

11.amos ivry
12.ira lurie
13.ira lurie
14.עדי שפרינג
15.רעות מזרחי
16.רעות מזרחי

17.a 35 year old with a history of previous right thzroidectomy for a benign thyroid noduls
now , undergoes completion thyroidectomy for a suspicious thzroid mass several hours
postoperatively, she develops progressive swelling under the incision, stridor and difficulty breathing .orotracheal intubation
is successful -which of the following is the most appropriate next step?

A-fiberoptic laryngoscopy to rule out bilateral vocal cord paralysis
B-administration of IV cacium
C-administration of broad spectrum antibiotics and debridment of the wound
D-wound exploration
E-administration of high dose steroids and antihistamines Correct
18.hsham yasin
19.hsham yasin

20. LCIS: wich treatment: osservation
21. ipertensione, hirsutism, adrenal mass : adenocorticoide ca
22.נתנאל אלקבץ

24.A 59 year-old women presents with right lower puadrant pain,nausea,and vomiting,she undergoes an uncomplicated
laparoscopic appendectomy.Postoperatively the pathology reveals a 2.5-cm mucinous adenocarcinoma with lymphatic
invasion. Staging workup, including colonoscopy,chest x-ray. And computed tomography (CT) scan of the abdomen and pelvis,is negative.
Which of the following is the best next step in her management?
A. No further intervention at this time,follow-up every 6 months for 2 years
B. Chemotherapy
C. Neoadjuvant chemotherapy followed by right hemicolectomy
D. Ileocecectomy
E. Right hemicolectomy

25.איתן לויטס
26.לורה זל
28. A 22-year-old woman presents with a painful fluctuant mass in the midline between the gluteal folds.
She denies pain on rectal examination. Which of the following is the most likely diagnosis?
a. Pilonidal abscess
b. Perianal abscess
c. Perirectal abscess
d. Fistula-in-ano
e. Anal fissure

29.עדי דני
30.אלינור קרן
31.אלינור קרן
32khalaila fadi
33.khalaila fadi
34.מאיה אבידן
35מאיה אבידן
BRCA2 gene is not involved in which cancer
a) prostate
c )ovaries
d )gastric
.a women after lung cancer treatment at remission , when she will be considered cancer free
a:2 years
b:4 years
c:10 years

38.kedan fatme

43. Which of the following is consistently the largest artery to the stomach?
( from SCHWARTZ 9th edition page 255 )
A. Left Gastric A
B. Right Gastric A
C. Left Gastroepiploic A
D. Right Gastroepiploic A

44. Which of the following is the best test to confirm eradication of H. pylori
( from SCHWARTZ 9th edition page 263 )
A. Negative histology after biopsy during EGD
B. Negative fecal antigen
C. Negative urea breath test
D. Negative urea blood test

45.אשר פיין

48.2 cm mass in the topproximal transverse colon,whats the treatment ?
b.ascending colectomy
c. left hemicolectomy
d.extended right hemicolectomy

49.cholecystectomy in aymptomatic patient- when to remove?
a.porcelin gold bladder . correct

50. אמיר ביכלר
51.Bashar fteiha
52.Bashar Fteiha
60.awad halag
67.תמר קס
68.מריאלה מושבה
69.מור בוסתן
70.A 7 months-old girl present with temp. 38.3 BP 70/30mm, diffuse petechia first noted 4 hours before
presentation. Platelets count 88,000/mm3, and white blood cell count of 43,000/mm3 with 23% neutrophils and
42% bands. The infant has received all recommended vaccination. Which of the following is the most likely
bacterial etiology of this presentation?

A. staphylococcus aerus
B. streptococcus pneumonia
C. neiserria meningitides
D. haemophyllus influenza type b
E. coli o 157:h7

71.A 10 mo-old child presents to the emergency department with a 4 day history of fever, with temp. 39 c, and
watery diareea, just expirienced a generalized seziure. What is the most common syndrome?

A. Sallmonela gastroenteritis
B. Aeromonas gastroenteritis
C. Shigella gastroenteritis
D. Rotavirus gastroenteritis
E. Drug ingestion

לא זוכר שאלה כזאת.(אדי)

שאלה על ילד שאכל סנדביץ?-

75.Patient with short gut syndrome receiving total parenteral nutrition. What is the most common complication of TPN?
A. Sepsis
B. Renal failure
C. Chronic diarrhea
D. Vitamin A deficiency
E. Irreversible atrophy of the mucosa of small intestine

76. What is the main different sign in meningitis in adults compared to children?
( I don?t remember the whole answers but one of them was Brudzinski - which i think the correct one) i
77.יעל אברמוב

An 18-month-old infant is found with the contents of a bottle of drain cleaner in his mouth. Which of the following treatment options is most appropriate? (pretest ped)
a. Immediate emesis
b. Endoscopic examination within the first 12 to 24 hours
c. Decontamination by activated charcoal
d. Neutralization by drinking a solution of the opposite pH
e. Have the patient drink copious amounts of milk or water

A 2 yr old child is found playing with a can of crystalline drain cleaner. The child's mother
telephones you for help. There are several crystals in the mouth, which you have the mother wash out. The next step in treatment should be to:

□Have the mother administer lemon juice or orange juice to neutralize the alkaline crystals and come to your office
□Have the mother administer water or milk and call you back in 2 hr
■Have the mother administer water or milk and bring the child in for esophagoscopy
□Simply observe the child because the crystals are so bitter that the child was trying to spit them out when the mother called, and therefore no problems should occur
□Administer ipecac at home and bring the child in to see you
dont remember that one?.

80.A 7 mo old girl presents with a temperature of 103.8°F, blood pressure of 70/30 mm Hg, diffuse petechiae first noted 4 hr before presentation, platelet count of 88,000/mm , and white blood cell count of 4300/mm , with 23% neutrophils and 42% bands. The infant has received all recommended vaccinations. Which of the following is the most likely bacterial etiology of this presentation?

□Staphylococcus aureus
□Streptococcus pneumoniae
■Neisseria meningitidis
□Haemophilus influenzae type b
□Escherichia coli O157:H7


83.A12 month-old female infant with failure to thrive is bronght to the office her parents note that she is very fussy and offen
spits up after feedings she also has two loose foul-smelling stool lach day.Which of the following foods can she eat safety
without aggravating or inducing her symptoms?
A. Rice
B. Wheat
C. Oats
D. Barley
E. Rye

84.שרון קרקוף
85. שרון קרקוף
89. Children with sickle cell anemia more susceptible to?
A. Gram negative rods
B. Encapsulated organism
C. Fungal infection
D. Viral infection
E. S. aureus

94.גל בן חיים
95.גל בן חיים
98.a young girl arrives to the ER with complaints of pelvic pain. she has new sexual partner and a mucous discharge?what is the diagnosis ?
a. ovarian cyst
b. appendicitis abcess
c.tubo-ovarian abcess
d.ectopic pregneny

99.אהוד וינשטיין
100.דרור סדן
101. state of the art pregnancy, 25 b- hcg, when can detect pregnancy?
a.5 days after fertilization
b. 24h after fertilization
c. on the day of expected meneses
d. 5 weeks after LMP
e. 6 weeks after LMP

102 21 y.o woman P1, bleeding extensively postpartum. What is the most important mechanism of hemostasis in postpartum hemmorhage?
A. Contraction of muscles bundles
B. Fibrynolysis inhubition
C. Increase blood clotting
D. Intramyometrial ?? by vasoconstriction
E. Decrease blood pressure

103. what increased in pregnancy
e)TBG (thyroid binding globulin)

104.אורן הלפרין
105.אורי ברלינר

106.provide mother that give infant with congenital tube defect can prevent recrrency by folic acid. The recommended dose?

107. 39 wks in active labor had seizures, got magnezium IV, whats the next step?
c. C- section
d. MG sulphate ??. prompt delivery

108. what decrease in preeclamsia?
a. response to vasopressors
b.sodium concentration??
d. liver function

109. Pregnant, 34w gestation, pruritus in palms and soles, elevated liver enzymes and elevates alk.phosphatase. what is the diagnosis?
b. Diabetes melitus
c. pregnancy cholestasis
d. progresteron allergy

110. increase in pregnancy
a. AST
b.hematocrit - NOT TRUE
d. total binding thyroglobulin

(pretest peds)
A 10-year-old girl has had a ?cold? for 14 days. In the 2 days prior to the
visit to your office, she has developed a fever of 39°C (102.2°F), purulent
nasal discharge, facial pain, and a daytime cough. Examination of the nose
after topical decongestants shows pus in the middle meatus. Which of the following
is the most likely diagnosis?

a. Brain abscess
b. Maxillary sinusitis
c. Streptococcal throat infection*
d. Sphenoid sinusitis
e. Middle-ear infection

------ similar to 116 pretest peds.
As you are about to step out of a newly delivered mother?s room, she
mentions that she wants to breast-feed her healthy infant, but that her
obstetrician was concerned about one of the medicines she was taking.
Which of the woman?s medicines, listed below, is clearly contraindicated in
a. Ibuprofen as needed for pain or fever
b. Labetalol for her chronic hypertension - (not true taken from pretest ped!)
c. Carbamazepine for her seizure disorder
d. Lithium
e. Acyclovir for her HSV outbreak

Part B:

1.fetal part in related to the mother .what is considered?


2. in a breech delivery .the baby body reached till the umbilical. the doctor pull the baby. the name of this?

a.complete breech extraction
c. partial breech extraction (assisted breech delivery by the obstetrician with spontaneous delivery of the fetus to the level of the umbilicus.)
רונית בוימל

3.נועה אשכנזי

4. Nabothian cysts mostly occur,

A.. wolffian duct remnant
C. cervical uterine folds bla bla something
A. sqamous carcinoma
E. paramesonephric duct

5. אלון קירש PID is associated with what anatomy aspect of the fallopian tube

a. It is a conduit from peritoneal space to uterine cavity.
b. It is found in the utero-(ovarian) ligament.
c. It has 5 separate parts.
d. It is attached to the ipsilateral ovary by messosalpinx.
e. It is entirely extraperitoneal.

6.בן בוגן
7.בן בוגן

8.Narin Zeineh

9.when the conization for the cervix is not possible:
a.pap test is not equivalent for the biopsy test
c. on biopsy when it is microinvasive
d.on biopsy when its is very invasive.
e. CIN III on biopsy

A 9 year-old patient asthmatic patient uses albuterol 3 times per week,for the last 10 days she had wheezing day and night,increased the inhaler to 3-4 times a day,on examination there is a diffuse wheezing with moderate subcostal retraction, next step in management:

A. order chest XR to asess for pneumonia
B. Systemic steroids
C. Lekutriens
D. Low dose inhalation steroids
E. Start 5 days course of systemic corticosteroid

A 14 years old female present with amenorrhea and absent sexual characterestics . very high leverl of LH and FSH :

A.. kalmann
B. gonadal dysegenesis
C. pregnancy

10.אורטל בר-זיו
11.אריאל זיסמן
12.נתנאל אלקבץ
13.אורטל בר-זיו
14.עדי שפרינג
15.אריאל זיסמן
17.דני הלוי
18. In a young, obese, chronically anovulatory woman with an elevated LH:FSH ratio which of the following is the preferred method of ovulation induction?
A. metformin
B. human menopausal gonadotropins (hMGs)
C. pulsatile gonadotropin-releasing hormone (GnRH)
D. clomiphene citrate
E. Bromocriptine mesylate

20.מנור צוקרמן
21.מנור צוקרמן
22.רונית בוימל
24.Rana Zenaldeen
25.איתן לויטס
26.לורה זל
28. what increase risk for suicide in the future?
c, previous attempent .

29.gebara shadi
30.Mohammad Rabea
40.muhammad abu leil.
41.muhammad abu leil
43.הדס פולצ?ק

44. which of the following regarding hyperaldosteronism is true?
A. the most common cause of secondary hyperaldosteronism are CHF and cirrhosis with ascites
B. treatment of primary adrenal hyperaldosteronism is spironolactone
C. Hyperkalemia and metabolic acidosis
D. Increase renin and aldosterone

45.אשר פיין
50.אמיר ביכלר
55.אמיר אמארה
56.אמיר אמארה
57.Mahmod Awad
58.Mahmod Awad
60.awad halag
61.fahed merei
62.fahed merei
67.תמר קס
68.מריאלה מושבה
69.מור בוסתן

70. 49 y/o patient is found to have glucose level 246. Diagnosis of type 2 DM was made. what is the best approach to determine renal function?
A)albumin/creatinine ratio
B)unlikely that the patient has nephropathy since he was just diagnosed
C)measure BUN and creatinine
D)renal US
E)24 hour urine collection, creatinine clearance and total protein excrition

71 What is false for elderly delirium?
A)most common reasons are infection, hypotension, hypoxia and medication
B)By definition can be acute or chronic
C)may be frequently associated with anti-arrhythmics,neuroleptics, TCA and antihistamines
D)patient may suffer from hallucinations and fluctuating alertness


73.What is NOT a risk factor for congestive heart failure in patients with atrial fibrillation? ( this Q. is not in its correct number as in the exam as i don?t remember the exact no.)
A. AF>1yr
B. Older age
C. Left atrial enlargement
D. Normal heart size

75.salman abo freha
76.אלטייב אגבאריה
77.אלטייב אגבאריה
79.Tomek Kotek
80.raafat aqeel
81.raafat aqeel
82.ahmad yassin
83.טל קלונסקי
84.טל קלונסקי
85.ahmad yassin
86.באהר כריים
87.באהר כריים
88.מוחמד עאסלה
89.מוחמד עאסלה
90. Nashed hamuda
91. Nashed hamuda
92. Fakher kashkosh
93. Fakher kashkosh
94. מוחמד אבו סבית
95.מוחמד אבו סבית
96.Majd Qassum
99.אהוד וינשטיין
100.דרור סדן
101. Least likely to cause benzodiazepines withdrawel syndrome?
b. use of half life BZD
e. gradual taper of BZD
102. An 18 y.o arrived to ED after assaulting a police officer in the street??..
A. Inhalant
B. Benzodiazepines
C. Opioids
D. Hallucinogens
E. Amphetaminesן
104.אורן הלפרין
105.אורי ברלינר
106.יגאל שפונט
107. יגאל שפונט
108.איריס הראל
109איריס הראל1רשטיין

26. A 24 year old salesperson is referred for an evaluation of difficulty dealing with costumers because she
gets "so nervous and anxious that my mind gets blank". A careful evaluation revels that she has social phobia. She is
motivated to obtain treatment and continue doing her job. All of the following interventions, except:
a. Selective serotonin reuptake inhibition - SSRI's
b. Flooding
c. Modeling
d. Systematic desensitization
e. Electrical convulsion therapy ? ECT

29. The term double depression is used to describe:
a. Major depressive disorder superimposed on grief reaction
b. Major depressive disorder superimposed on dysthemia
c. Major depressive patient not responding to treatment
d. Major depressive disorder with psychosis
e. Major depressive disorder with anxiety

35- 36 year old pregnant admitted due to possible infection associated with IV heroin, she is 5
month into her pregnancy and would like to quit heroin for good, what best course of action?
a. Allow her to continue to use heroin as withdrawal is dangerous
b. Methadone maintenance
c. Naltrexone
d. Advise her to stop heroin and start supportive therapy
e. Buprenorphine

37- Most common case of delirium within 3 day of postoperative in a 40 year old man with history of alcohol
a. Delirium tremens
b. Infection
c. Pain medication postoperative
d. Pain stress of surgery

40- Mouth ulceration is associated with which of the following types of withdrawal ?
a. alcohol
b. benzodiazepins
c. cocain
d. nicotin
e. opoids

42. Depression and mania share which of the following symptoms?
A. Psychomotor acceleration
B. Low-self esteem
D. Anger
E. Pessimism

43. The highest suicide rates are in which of the following age groups?
A. Under age 15
B. 15 to 24 year olds
C. 25 to 44 year olds
D. 45 to 64 year olds
E. Over age 65

44. The best indicator for increased risk of suicide?
a. Alcohol dependence
b. Marriage
c. Previous suicidal behavior
d. Schizophrenia
e. Major depressive disorder

47. Tourett?s disorder has been shown to possibly have a familial and genetic relationship with:
A. panic disorder
C. generalized anxiety disorder
D. social phobia
E. none of the above

78. A 32-year-old male with chronic paranoid schizophrenia, in full remission is married and living a productive life. He and his
wife decide to have children, but would like to know the probability of children developing schizophrenia.
Which of the following statements is correct?
A. The risk is similar to that of general population (1%).
B. The risk is about 50%
C. The risk is much lower than the general population because he will be able to recognize the early signs of schizophrenia and
seek prompt treatment for the child
D. The risk is about 10%
E. The risk is about 100%

82. A 56 year old anxious executive calls at 5:00 because he woke up with chest tightness and shortness of breath. He was scared that he was having a heart attack and he also reported feeling dizzy, trembling, and his heart was pounding, he thought he was going to die. The symptoms subsided in 20 minute and by the time the emergency medical services arrived he was sitting in his living room and in no distress. The patient's electrocardiogram reading was normal and his cardiac enzymes were also found to be normal. What is the most likely diagnosis?
a. Nocturnal panic attack
c. Psychophysiological insomnia
d. Somatization disorder
e. Myocardial infraction
83. A 22 year old female is

105. Which of the following factor is common in victims of elder abuse?
a. Alcohol abuse
b. Social isolation
c. Mental illness
d. Hostility
e. Prescription drug abuse

105. Which of the following is considered to be a good prognostic factor with patient with anorexia nervosa?
A. Late age of onset.
B. Family members open to participate in patient care.
C. Early age onset.
D. No suicidal behavior.
E. No previous hospitalization

102. 18 y.o boy came to ED after assaulting a policeman officcer
103. good prognosis of anorexia nervosa
a) early onset
b) chronic illness
c) induce vomiting
d)Binge eating

66. Anorexia nervosa has mortality rate of up to approximately:
A. 1%
B. 18%
C. 30%
D. 42%
E. 50%

Pervasive pattern of grandiosity, lack of empathy and need for admiration suggest the diagnosis of which personality disorder?
a) borderline
b) Narcissistic
c) paranoid
d) Passive aggressive
e) Schizotypical

Suicide among schizophrenic patient
a) Most frequently secondary to commanding hallucinations
b) Most often in the later year of the illness
c) Occurs most often in older female patient
d) Approximately 10% presently

----- what doesnt casue manic episode?????
A. carbamezopine
B. disulfiram
C. isoniazid
D. beta Blockers

nabothian cyst
a. obstruction...
b. crypt
c. squamous

state of the art pregnancy pregnancy in 25 beta-hcg
A. implantation
B. 5 days after fertilization
C. day of the menstruation
D. week 5
E. week 6

heparin switch to warfarin according to IND
neurocardiogenic syncope bradycardia
cardiac stress test st depression 0.5

cobalamin deficiency, except:
d. severe def. rarely present with neurological symptoms

--- not given in MI without any arrhythmia?
a.b blocker
c. Lidocaine

---- diabetes leg ulcer:
e. vascular disease impair the healing

A 32-year-old man presents to your clinic for evaluation of headaches. He has had episodic pounding headaches for 6 months. He never had headaches like this before in his life. He denies using illicit drugs. He has no family history of hypertension. On physical examination, the patient is hypertensive, with a blood pressure of 180/105 mm Hg. No further abnormalities are noted. You begin a workup for second-ary causes of hypertension.
Which of the following statements regarding pheochromocytomas is true?
A. 90% of pheochromocytomas are malignant
B. Almost all patients with pheochromocytomas have episodic hypertension, making diagnosis difficult in a single clinic visit
C. The incidence of pheochromocytoma is increased in patients with multiple endocrine neoplasia type 1
D. Treatment of pheochromocytoma is surgical; alpha blockade should be induced with phenoxybenzamine, beginning at least 7 days before surgery

A 56-year-old patient with stage D ischemic cardiomyopathy comes to you for a second opinion. He is already receiving furosemide, an angiotensin-converting enzyme (ACE) inhibitor, a beta blocker, and spironolactone. He has been told by a specialist that he needs a device to avoid dying from an irregular heart rhythm.
What nonpharmacologic treatments are available for the prevention of sudden cardiac death in patients with ischemic cardiomyopathy?
A. Ventricular assist device (VAD)
B. Implantable cardioverter defibrillator (ICD)
C. Biventricular pacemaker
D. Intra-aortic balloon pump (IABP)
** why not d? it?s a problem with coronaries (=blood vessels) and not an ectopic electrical generating impulse (meaning: icd is good ressocitator in case you have arrythmia not ischemic problem). Please enlight me please. maybe i got it all wrong...
** the B is FROM ACP book

A 40-year-old white woman whom you have been treating for resistant hypertension presents for rou- tine follow-up. Laboratory results of screening tests were normal. There is electrocardiographic evidence of LVH. The patient's lipid profile is normal. The patient has been receiving a thiazide diuretic, a calci- um channel blocker, and an ACE inhibitor at near maximal doses for several weeks. Her blood pressure today remains very elevated, at 175/100 mm Hg. She experienced a minimal response to titration of her antihypertensive medicines. With the exception of elevated blood presure and a fourth heart sound, the patient's physical examinations have been consistently normal. Today, the physical examination is unchanged, except that you notice a soft bruit in the left upper quadrant.

Which of the following statements regarding renovascular hypertension is true?

A. Renovascular hypertension is an exceptionally rare cause of hyperten- sion in patients with treatment-resistant hypertension
B. Stenosing lesions of the renal circulation cause hypertension through ischemia-mediated activation of the renin-angiotensin-aldosterone system
C. Fibromuscular disease is an uncommon cause of renovascular hyper- tension in patients of this age
D. Atheromatous disease and fibromuscular disease are equally frequent causes of renovascular hypertension

Your nurse alerts you that a patient in your clinic has severely elevated blood pressure.Thepatientisa 45-year-old man without other significant medical history. The patient?s blood pressure is 220/125 mm Hg; blood pressure measurements are essentially the same in both arms. The patient says that he is feel- ing fine. He has had no symptoms of flushing, sweating, or headache, nor has he had visual changes, focal weakness, numbness, chest pain, dyspnea, or decreased urine output. On examination, neurologic status is normal. An S4 gallop and trace pretibial edema are noted. The lungs are clear to auscultation. An ECG shows sinus rhythm with LVH. There is no evidence of ischemia or infarction.

How should you manage this patient?

A. Administer sublingual nifedipine, 10 mg

B. Administer atenolol, 50 mg, and follow up in 24 hours

C. Prescribe atenolol, 50 mg, and follow up in 1 week

D. Admit him to the intensive care unit for cardiac and blood pressure monitoring and intravenous nitroprusside therapy

----- 220/140 hypertension
nothing else
a. release home
b. beta blocker IV
c. give a prescription for beta blocker
d. ICU. Nitropruside IV, monitor - the book gives a different answer

Which of the following is NOT a risk factor for cardioversion failure in this patient?

A. Duration of AF of longer than 1 year
B. Older age
C. Left atrial enlargement
D. Normal-sized heart

++++ most common type ovarian cancer
A. Epithelial
B. Stromal
C. Germ
E. metastasis

+++++ when diagnosis endometrial cancer, which stage of disease is most likley?
E. recurent

++++++ boy speak 5 words, hearing defect is susfected
A. Audiogram
E. head CT with focus on inner canal

A 55 year old women presents with a slow growing painless mass on the right side of the neck.a fine needle aspiration of the nodule shows a well differentiated papillary carcinoma. a complete neck ultrasound demonstrate a 1 cm nodule in thre right thyroid without masses in the contralateral lobe or lymph node metastasis in central and lateral neck compartments. with regards to this patient,which of the following is associated with a poor prognosis in this patient?
(pretest sug)

a. age.
c.grade of tumor.
d.size of tumor.
e.lymph node status.

Not shown by trial to decrease mortalitly and ????..?
A. ACE and ARB
D. Digoxin
what is the right answer ?? NOT SURE.. SORRY

-------- how to locolize the ovaries in ultrasound? by which anatomical landmark

A. bladder
B. cul de sac
C. uterus
d. iliac vessels
E. rectum

renal ultasound

three vessel disease
blue toe - emboli

24 hours later sudden abdominal pain
-abdomen aorta aneurysm rupture
- Disection

Представленная Админом выше психоделическая фантасмагория раскрывает перед читателем диалектическую экзистенциальность синдрома посткоитальной абстиненции, когда индивидуум не способен селективно абстрагироваться от ламинантно присущих ему девиантных аберраций, являя тем самым яркий пример конвергенции деструктивной ментальности и перманентно когнитивного креатива.
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