1

A 34-year-old schizophrenic female is treated regularly with clozapine. She

has a blood test every month.

Which of the following will dictate discontinuing clozapine treatment?

1
WBC 2,300 cells/ml

2
Sodium 130 meq/L

3
Potassium 4.2 meq/L

4
Creatinine 1.6 mg/dl

Which of the following is considered an ego defense mechanism according

to the psychoanalysis theory?

1
Containing

2
Injection

3
Intellectualization

4
Holding

1
3

A 24-year-old male avoids leaving the house for the last few months, spends
long hours in the bathroom, washes every item before he touches any
object, and avoids social contacts. During his examination, he describes
thoughts of an infection he can’t get out of his head.

Which of the following is the most correct regarding the disorder he has?

1
Over 50% of the cases appear following a stressful event

Diagnosis is usually made during the first year after the symptoms
2
appear
In most cases the natural course includes significant improvement
3
without treatment
The content of the compulsive thought has an effect on the
4
prognosis

A 37-year-old bipolar male, has been treated with 1200 mg of lithium for the
last 10 years. Recently, 10mg of escitalopram were added due to depression
and anhedonia. The patient presents with diarrhea and severe restlessness.
Examination reveals acute changes in heart rate and blood pressure.

Which of the following is the most likely explanation for his condition?

1
Neuroleptic malignant syndrome

2
Serotonergic syndrome

3
Hypernatremia

4
Anticholinergic syndrome

2
5

A 25-year-old woman has been admitted in a psychotic state. She is treated

with intramuscular haloperidol at 10 mg per day. After a week the patient
developed confusion and disorientation in place and time. Examination
reveals muscle rigidity, unstable blood pressure, a temperature of 38.3°C.
Laboratory results reveal CPK of 2467u\l (normal range 29-168) leukocytosis,
and elevated liver enzymes.

Which of the following is the most appropriate next therapeutic step?

Discontinue intramuscular haloperidol and change to intravenous

1
haloperidol
This is a normal reaction to haloperidol treatment that will resolve
2
within hours and therefore no treatment is necessary

3
Intravenous naloxone should be initiated

4
Intravenous saline and cooling should be initiated

Which of the following adverse effects of carbamazepine is not dose

dependent?

1
Blurred vision

2
Vertigo

3
Gastrointestinal discomfort

4
Pancreatitis

3
7

A 33-year-old single male lives alone, and works as a programmer in a tech

company. He asked his employer to work from home as he prefers to be
alone. He has never been in a relationship and says he never thought he
would enjoy one. He has no friends and does not miss company. When he is
with people he seems apathetic to compliments and prefers not to have
small talk. During feedback meetings with his superior seems apathetic to
criticism.

Which of the following is the most likely diagnosis?

1
Obsessive compulsive personality disorder

2
Schizoid personality disorder

3
Narcissistic personality disorder

4
Histrionic personality disorder

Which of the following is not part of the thought disorders typical to

psychosis?

1
Tangential thinking

2
Circumstantial thinking

3
Obsessive thinking

4
Thought blocking

4
9

Which of the following is characteristic of depression in the elderly?

1
Atypical depression

2
Significant weight gain

3
Multiple somatic complaints

4
Normal self-value

10

Which of the following is the most correct regarding mood and affect in
schizophrenic patients?

1
Flat affect is not considered a sign of the disease

2
Flat affect may be attributed to Parkinson side effects

Elevated affect is a common sign of depression in schizophrenic

3
patients

4
Decreased emotional reaction is a rare sign of schizophrenia

5
11

A 45-year-old male watched a news report of a deadly car accident.

Immediately afterwards he started to feel panic accompanied with a feeling
that he is about to die. The panic subsided after a few hours but in the
following days, he has been experiencing nightmares, and compulsive
thoughts that he was about to die. He reports his wife has been killed in a
car accident 10 years ago, while they were in divorce proceedings. He
reports returning to normal life too shortly after her death.

Which of the following is the most appropriate treatment?

1
Dynamic psychotherapy

2
Solian (amisulpiride)

3
Dyadic psychotherapy

4
Leponex (clozapine)

12

All of the following are considered common comorbidities of schizophrenia

except?

1
HIV

2
COPD

3
Obesity

4
Rheumatoid arthritis

6
13

A 25-year-old single male complains of irritability, insomnolence, felling very

energetic, and an especially good mood. He reports these episodes last a
few days to weeks, and in between there are longer periods in which he feels
depressed, hopeless, tired, burnt out, and thinks of ending his life.

Which of the following is the most appropriate treatment for his condition?

1
Depalept (valproic acid)

2
Levitra (vardenafil)

3
Remeron (mirtazapine)

4
Parlodel (bromocriptine)

14

A 22-year-old female reports daily vomiting, fear of gaining weight, and daily
sport activity. Examination reveals cavities in her teeth, BMI 16.

Which of the following may appear on laboratory results?

1
Hypokalemia

2
Low cholesterol

3
Low amylase

4
Leukocytosis

7
15

A 31-year-old female presents to the emergency room with her family. They
report that for the last week she has been full of energy, hardly sleeps,
spends a lot of money, speaks a lot, and is aggressive toward her family.

Which of the following drugs is the most appropriate for treating her current
state?

1
Haloperidol

2
Duloxetine

3
Trazodone

4
Paroxetine

16

A 30-year-old single man is diagnosed with schizophrenia and diabetes type

1. He is treated with haloperidol and insulin. Aripiprazole was added 2
months ago. He is brought to the emergency room with an acute change in
his condition, angry, psychomotor restlessness, and aggressive. His thoughts
are unorganized and he is not oriented regarding time or place.

Which of the following is the most likely explanation for his condition?

1
Adverse effect of aripiprazole

2
Manic state

3
Exacerbation of schizophrenia

4
Hypoglycemia

8
17

Which of the following is characteristic of atypical depression?

1
Vomiting

2
Loss of appetite

3
Worse in the mornings

4
Increased sleep

18

A 47-year-old physically well woman who works as a teacher has no history

of drug or alcohol abuse. She has been admitted for the first time in a state
of paranoid psychosis, and has been diagnosed with schizophrenia.

Which of the following is the most correct statement regarding this woman?

1
Antipsychotic drugs will most probably not help her

2
She will most probably experience touch hallucinations

3
She will most probably experience nihilistic delusions

4
She will most probably return to function well after discharge

9
19

A 27-year-old healthy female, who does not use drugs and works as a
software engineer and is valued by her supervisor. She takes short breaks
and hurries back to her table, and avoids crowds. She has trouble sleeping
since she was asked to present a project she has been working on to the
managing staff. She is afraid of not succeeding in the presentation, to be
laughed at and humiliated. She is aware that her fears and their influence on
her functioning is disproportional. She reports she is shy, and during her
studies never answered questions in class although she knew the answers.

Which of the following is the most likely diagnosis?

1
Generalized anxiety disorder

2
Avoidant personality disorder

3
Dependent personality disorder

4
Social anxiety disorder

20

Which of the following is at the greatest risk to commit suicide?

A 41-year-old widower, who works as a dentist, and has back pains

1
due to a recently diagnosed herniated disc
A 24-year-old single economy student, who cries a lot lately since he
2
failed a test
A 19-year-old single female soldier, returns home every day, and
3
does not get along with her superior officer
A 50-year-old married man, who works as a painter, and has trouble
4
sleeping for the last 2 weeks

10
21

Which of the following may be used as an emergency contraceptive, after

unprotected intercourse, and at what timing?

1
Intrauterine device - up to 14 days after intercourse

2
Estrogen pills - up to 48 hours after intercourse

Combined high dose oral contraceptives – up to 72 hours after

3
intercourse

4
Vaginal spermicides – up to 24 hours after intercourse

22

A woman who has delivered at term, after a pregnancy complicated by

gestational diabetes controlled by medication, comes for postpartum follow
up.

Which of the following recommendation is the most appropriate for this

patient?

1
No special follow up

The patient should continue the medication she received during the
2
pregnancy

3
The patient should complete a 75gr glucose loading test

4
The patient should have an echocardiogram

11
23

Ultrasound examination of an 18-week-old fetus reveals a neural tube defect

(NTD).

Which of the following describes the same parent's chance of another fetus
with NTD?

1
3%

2
25%

3
50%

4
75%

12
24

A 32-year-old woman underwent dilation and curettage due to a missed

abortion.
βHCG follow-up after the procedure is below.

Which of the following is the next step in managing this patient?

1
Total body CT

2
Diagnostic hysteroscopy

3
Combined chemotherapy

4
Serum CA-125 levels

13
25

During labor there is difficulty to extract the shoulders after the head comes
out.

Which of the following is the first action that must be done?

1
Immediate cesarean section

McRoberts maneuver – hyperreflexia of the mother’s legs towards

2
her abdomen

3
Vacuum extraction

4
Zavanelli maneuver – returning the baby’s head into the vagina

26

A 30-year-old women with a history of regular menstruation, presents with

amenorrhea for 9 months, and pregnancy has been excluded.

Which of the following is the next diagnostic step?

1
Progesterone challenge test

2
Serum estradiol levels

3
3 months of ultrasound follicles follow up

4
Serum TSH and prolactin levels

14
27

Which of the following is at increased risk when a pregnancy is conceived

through IVF?

1
Early abortions

2
Ectopic pregnancies

3
Pregnancy induced thrombocytopenia

4
Large for gestational age newborns

28

A 25-year-old woman, with a history of irregular menstruation, complains of

hirsutism.

Which of the following will explain her condition?

1
Hyperprolactinemia

2
Congenital adrenal hyperplasia

3
Endometriosis

4
Addison syndrome

15
29

An 8-week pregnant asymptomatic woman has 100,000 colonies of E. coli on

a routine urine culture.

Which of the following is the most appropriate next step?

1
No treatment is necessary

2
Antibiotic treatment should be given throughout the pregnancy

3
Oral antibiotics should be prescribed for 7 days

4
Intravenous antibiotic treatment should be administrated for 3 days

30

A 38-weeks pregnant woman presents in active labor. Her fetus is in breech

presentation, and she is interested in a vaginal delivery.

Which of the following is a contraindication for this type of delivery?

1
Frank breech presentation

2
Gestational diabetes

3
A cesarean section in her previous delivery

4
The fetal head is in hyperreflexia

16
31

A 27-year-old woman with pre-gestational diabetes presents on early stages

of pregnancy.

Which of the following is the most appropriate recommendation for her

follow up?

1
Amniocentesis

2
Cesarean section at term

3
Fetal echo on the second trimester

4
Weekly non-stress test (NST) starting at the 28th week of pregnancy

32

A 32-year-old woman had her last period 7 months ago. Hormone profile
includes FSH 75 IU, and estradiol 30 mmol/L.

Which of the following can explain these findings?

1
Androgen insensitivity syndrome

2
Fragile X premutation

3
Asherman syndrome

4
PCOS (Polycystic ovary syndrome)

17
33

A 28-year-old woman, planning to conceive, complains of cyclic abdominal

pain over the last 2 years, which have worsened over the last month.
Gastrointestinal work up and gynecological examination including PAP
smear are normal. Ultrasound demonstrates a 7cm diameter lesion on one
of the adnexa (photo below).

Which of the following surgical procedures is the most appropriate?

1
Salpingo-oophorectomy on that side

2
Excision of the lesion only

3
Drainage and ablation of the lesion

4
Hysterectomy and salpingo-oophorectomy

18
34

A 60-year-old woman presents with prolonged valvular itching and mild

bleeding. Examination reveals a cauliflower like lesion of the left labia
majora.

Which of the following is the next diagnostic step?

1
Serum CA-125 levels

2
CT scan of the abdomen and the pelvis

3
Radical vulvar excision

4
Biopsy of the lesion

35

A 30-year-old woman presents with unpainful vulvar ulcers.

Which of the following will advance the diagnosis for ulcers cause?

1
Aerobic culture from the ulcer

2
Serum syphilis PCR

3
Microscopic “dark field” examination of a sample from the ulcer

4
Serology for gonorrhea

19
36

A 24-year-old woman comes for consultation for a PAP smear result of

atypical glandular cells (AGC).

Which of the following is the most appropriate recommendation?

1
Repeat PAP in 6 months

2
colposcopy combined with Endocervical sampling

3
Conization

4
Laser ablation

37

A post-partum woman presents 2 weeks after delivery with massive vaginal

bleeding with clots.

Which of the following is the most common reason for her bleeding?

1
Perineal tear

2
Coagulation disorder

3
Placental abruption

4
Placental remnants

20
38

Which of the following in a twin pregnancy is a complete indication for

cesarean section?

Leading twin (A) in vertex presentation and twin B is in transverse

1
presentation

2
Previous caesarean section

3
Monochorionic monoamniotic twins

4
Preterm labor prior to 35 weeks

39

Which of the following is part of the work up for recurrent abortions?

1
Antiphospholipid antibodies

2
Factor V Leiden

3
Protein S

4
MTHFR mutation

40

Which of the following findings on physical examination raises suspicion of

an ovulation disorder?

1
Galactorrhea

2
Vertical skin striae

3
Hypostatic hypotension

4
Sacro-uterine ligament granules

21
41

Which of the following is the expected karyotype of a 16-year-old short

statured girl with gonadal dysgenesis and primary amenorrhea?

1
46XX

2
46XY

3
45X

4
47XXY

42

A 72-year-old woman presents with two episodes of vaginal bleeding over

the last month. Ultrasound reveals a 9mm thick endometrium and Pipelle
biopsy failed due to cervical stenosis. The cervix seems smooth and normal.

Which of the following is the most appropriate recommendation?

1
High dose progesterone

2
CT of the abdomen and the pelvis

3
Repeat ultrasound in 2 months

4
Endometrial biopsy in the operating room

22
43

A 65-year-old woman presents with abdominal pain. Examination reveals an

adnexal finding.

Which of the following findings on a bimanual physical examination is

suggestive of malignancy?

1
The finding is mobile

2
The finding is cystic

3
The finding is bilateral

4
Douglas pouch is smooth

44

A 44-year-old, generally healthy married woman with 3 children, has been

recently diagnosed with LYNCH syndrome.

Which of the following is the most appropriate treatment?

1
Combined oral contraceptives

2
Hysterectomy and salpingo-oophorectomy

3
Tamoxifen treatment

4
Follow up with CA-125 levels and ultrasound every 6 months

23
45

The attached monitor strip is seen during active labor of a healthy woman.

To which category does this fetal monitor fall into?

1
Category I

2
Category II

3
Category III

4
Category IV

24
46

Which of the following women is the most suitable candidate for trial of
labor after cesarean section (TOLAC)?

1
A woman with a history of a cesarean section with a vertical incision

2
A woman in active labor with breech presentation

A woman on her 40th week of pregnancy, with the cord as the

3
leading part
A woman on her 39th week of pregnancy, who had a cesarean
4
section due to placenta previa

47

A 12-week pregnant woman presents with the attached lab results.

Which of the following is the best recommendation to this patient?

1
Routine follow up

2
Cord villous sampling as soon as possible

3
Amniocentesis on the 21st week of pregnancy

4
Termination of pregnancy

25
48

A 53-year-old generally healthy woman complains of severe heat waves. Her

history is positive for a hysterectomy due to myomas 10 years ago. Her
physical examination is normal and laboratory results include low estrogen
and increased FSH (>40 IU).

Which of the following is the first line of therapy?

1
A progesterone-based agent

2
An estrogen-based agent

3
Combined oral contraceptives

4
Selective progesterone receptor modulator

49

A woman underwent labor induction due to severe eclampsia. 45 minutes

later she presents with massive vaginal bleeding.

Which of the following is contraindicated in this situation?

1
PGF2α

2
Misoprostol

3
Oxytocin

4
Methylergonovine

26
50

A 40-year-old primipara woman, has normal nuchal translucency (1.2mm).

Second trimester biochemical testing reveals and 1:100 risk for Down’s
syndrome. The woman refuses amniocentesis since she is afraid of losing
the pregnancy.

Which of the following is the best recommendation?

1
Routine pregnancy follow-up

2
Chorionic villous sampling (CVS)

3
Cell-free fetal DNA testing

4
Termination of pregnancy

51

A 12-year-old boy presents with fatigue and malaise that have recently
become worse, followed by dyspnea. His mother reports episodes of
cyanosis following light physical activity. He has been followed up by a
cardiologist due to a VSD until 2 years of age, and the follow up was
discontinued since they moved. Chest X-ray demonstrates an enlarged heart
silhouette, and enlargement of the pulmonary artery.

Which of the following is the most appropriate treatment for this patient?

1
Beta blockers

2
Systemic steroids

3
Phosphodiesterase inhibitors

4
Alpha agonists

27
52

A 13-year-old generally well girl is referred to the emergency room for

workup of malaise, recurrent episodes of fever, weight loss, arthralgia, and
abdominal pain. History reveals exposure to non-pasteurized milk products.

Which of the following is the most likely clinical finding?

1
Hepatosplenomegaly

2
Uveitis

3
Petechial rash

4
Oral aphthae

53

Which of the following genetic aberrations is responsible for fragile X

syndrome?

1
Point mutation

2
Microdeletion

3
Aneuploidy

4
Triplet repeat expansion

28
54

A 3-months-old infant presents with stridor, episodes of spitting up and

vomiting, with arching of the back and neck. The mother reports the stridor
is improved while arching. Thickening of the feeds was unhelpful.

Which of the following tests is most appropriate for the most likely
diagnosis?

1
Chest x-ray

2
Echocardiography

3
Lateral neck X-ray

4
Abdominal ultrasound

29
55

A 5-year-old boy is referred for workup of a fever up to 39 oC, for the last 2
weeks. The fever is accompanied by limping and pain in the legs. The photos
below show the physical findings.

Which of the following is typical for his most likely diagnosis?

1
Mastoiditis

2
Serositis

3
Anterior uveitis

4
Pancreatitis

30
56

A 1-year-old male is referred for anemia workup. Examination reveals pallor

of the skin and conjunctivas. Blood smear and laboratory results are below.

Which of the following is the most likely diagnosis?

1
Iron deficiency anemia

2
Vitamin B12 deficiency

3
Diamond-Blackfan anemia

4
Beta thalassemia minor

31
57

A 2-year-old male was referred for workup of failure to thrive and recurrent
respiratory infections. Complete blood count including differential are
normal. All types of immunoglobulins are low, there are low
immunoglobulins in response to vaccination, and CD19 levels are <1% of
lymphocyte count. Sweat test is normal.

Which of the following is typical in the toddler’s most likely diagnosis?

1
Hepatosplenomegaly

2
Absent thymus

3
Absent tonsils and lymph nodes

4
Atopic dermatitis

32
58

A 2-year-old female presents with a rash appearing 5 hours ago. History is

positive for fever up to 39oC over the last 3 days. The mother reports the
fever resolved today and then the rash appeared. Examination is positive for
a maculopapular rash over the trunk which disappears when compressed.

Which of the following is the most likely diagnosis?

1
Measles

2
Rubella

3
Roseola

4
Varicella

33
59

A 1-month-old infant female is referred for workup of significant hypotonia,

respiratory distress, and feeding difficulties. Laboratory results are positive
for elevated CPK, and an echocardiogram reveals hypertrophic
cardiomyopathy.

Which of the following is the most appropriate treatment for this disease?

1
Enzyme replacement therapy

2
Gene therapy

3
Bone marrow transplantation

4
Steroid therapy

60

A 16-year-old, generally healthy boy presents with fever, headaches,

dyspnea, hemoptysis, malaise,
and hematuria. Examination reveals he is pale, with respiratory rate of
24/min, bilateral lung rales with reduced breath sounds on the right, and
sensitivity upon sinus percussion. No other abnormal findings.

Which of the following diagnostic tests will facilitate decisions regarding the
most likely diagnosis?

1
Chest X-ray

2
Sinus X-ray

3
Lung biopsy

4
Renal biopsy

34
61

A 16-year-old girl presents to the clinic with 3 days of worsening throat pain,
with no rhinorrhea or cough. Examination reveals erythema of the pharynx
with no exudate, and bilateral cervical lymphadenopathy.

Which of the following is the most appropriate next step?

1
Paracetamol and observation

2
Quick pharyngeal smear

3
Antibiotic treatment

4
Cervical ultrasound

62

A 5-year-old boy is brought to the ER following a motor vehicle accident. On

arrival he seems in pain but fully conscious. Vital signs - pulse 55/min, room
air saturation 98%, blood pressure 140/90 mmHg. Neurological examination
is normal. In light of the above, which of the following is the most important
test?

1
Abdominal ultrasound

2
Lumber Spain x-ray

3
Brain CT

4
Chest x-ray

35
63

A 17-year-old male with bipolar disorder is referred to the emergency room

with vomiting, nausea, confusion, and unstable gait. Vital signs include a
temperature of 36oC, heart rate of 100/min, and saturation of 96% in room
air. Examination is positive for resting tremor and myoclonus.

An overdose of which of the following drugs may cause these symptoms?

1
Clonazepam

2
Lithium

3
Cocaine

4
Tetrahydrozoline

36
64

A 6-weeks-old male infant with a history of normal pregnancy and delivery,

presents with vomiting after each meal, restlessness and failure to gain
weight over the last few days. A photo of physical examination findings is
below.

Which of the following is the most appropriate treatment?

1
Gastrostomy

2
Pyloromyotomy

3
PPI blockers

4
Anti-reflux treatment

37
65

On routine examination of a 1-month old infant, you notice asymmetrical

lower limb folds. Barlow and Ortolani tests are positive.

Which of the following is a risk factor of this condition?

1
Multiparous mother

2
Oligohydramnios

3
Low birth weight

4
Traumatic birth

38
66

A few-hours-old newborn develops the finding in the photo below.

Which of the following is a common complication of this condition?

1
Seizures

2
Hemolytic anemia

3
Hyperbilirubinemia

4
Hearing deficit

39
67

A 7-year-old boy presents with fatigue, excessive weight gain, and arrested
growth over the last year. Examination reveals hypertension and purple
striate over the abdomen and thighs. His serum glucose is increased.

Which of the following is the most appropriate diagnostic test?

1
ACTH test

2
Urinary cortisol

3
Urinary catecholamines

4
OGTT

68

A 5-year-old boy presents with an afebrile limp starting the day before. His
mother reports a febrile illness 10 days earlier. On examination - he bares
weight with a limp in his right leg, with tenderness upon right hip joint
rotation. Laboratory results include normal CPK and no leukocytosis. Hip
joint ultrasound demonstrates a small amount of clear fluid on the right, and
synovial thickening.

Which of the following is the most appropriate treatment?

1
Rest and oral NSAIDs

2
Hip joint fluid aspiration and intravenous antibiotics

3
Obtaining a blood culture and intravenous antibiotics

4
Intravenous steroids

40
69

A 3-year-old male is followed up for being under the 3rd height percentage.
He has polydipsia and polyurea, with high serum sodium and normal
glucose. Examination reveals the finding in the photo below, and MRI reveals
an ectopic posterior hypophysis.

Which of the following is the most likely diagnosis?

1
Septo-optic dysplasia

2
Noonan syndrome

3
Beckwith-Wiedemann syndrome

4
Sotos syndrome

41
70

A 7-year-old girl’s parents and teachers report recent episodes of

unawareness and stillness, occurring a few times a day and lasting 5-10
seconds. EEG is below.

Which of the following is the most likely diagnosis?

1
Juvenile myoclonic epilepsy

2
Benign epilepsy with centro-temporal spikes

3
Childhood absence epilepsy

4
Complex partial seizures

42
71

A 16-year-old girl with anorexia nervosa and acute weight loss has been
admitted with an 1600 calorie per day dietary plan.

Which of the following complications can the girl develop during the initial
stages of the dietary plan?

1
Hypophosphatemia

2
Hypomagnesemia

3
Hypocalcemia

4
Hyperkalemia

72

A 10-year-old’s parents complain he daydreams and they have to repeat

every order several times. They report he is unorganized, forgets to do his
homework, and has difficulties in school. His physical examination is normal.
Awake and sleep EEG are normal.

Which of the following is the next diagnostic test?

1
Genetic counseling

2
Brain MRI

3
Serum lactate

4
Questioners for the parents and teachers

43
73

A 15-year-old boy complains of fatigue and a tendency to sleep during the

day. His parents are worried of his deteriorating school performance over
the last 3 months. He goes to sleep at midnight and wakes up at 7am,
sleeps late on weekends, usually eats a snack an hour before he goes to
sleep, and performs regular physical activity after school. He does not snore,
and does not wake up during his sleep. He is generally health with no
regular medication, and has a normal physical examination with a BMI of 22.

Which of the following is the most appropriate recommendation?

1
Avoid a snack before sleep

2
Reduce the frequency of physical activity

3
Prolong sleeping hours during the week

4
Start melatonin treatment before sleep

74

A 15-year-old boy presents with a few months of deteriorating hearing.

Hearing tests reveal bilateral sensoneuronal deficit. The boy reports
recurrent episodes of hematuria, and a maternal uncle with similar
symptoms.

Which of the following is the most likely diagnosis?

1
Goodpasture disease

2
Penderd syndrome

3
Berger’s disease

4
Alport syndrome

44
75

A 10-year-old generally healthy girl presents with 6 months of dysphagia to

liquids and solids, and episodes of vomiting of undigested food. Weight loss
of 2 Kg. Physical examination is normal.

Which of the following is the most appropriate diagnostic test?

1
Brain imaging

2
Esophageal manometry

3
Abdominal ultrasound

4
Gastroscopy

45
76

A 3-year-old male presents with fever, diarrhea, and vomiting for 5 days,
accompanied by malaise
and abdominal pain. Examination reveals hypertension. Blood count and
smear are below.

Which of the following is the most appropriate treatment for the boy’s most
likely diagnosis?

1
Obtain a blood culture and start Rocephin treatment

2
Combined IVIG and systemic steroids

3
Retain a fluid balance and blood pressure management

4
Administer a unit of blood and a unit of platelets

46
77

A 14-year-old girl with diagnosed asthma presents with episodes of

dysphagia to solids for the last 5 months. Gastroscopy image is attached.

Which of the following is the most appropriate treatment?

1
Antifungal treatment

2
Esophageal dilation

3
Avoiding 6 kinds of foods

4
Antibiotics

47
78

A 12-year-old boy presents with the physical findings in the photos below.

Which of the following will most likely be found in this patient?

1
Optic glioma

2
Tourette syndrome

3
Autism

4
Deafness

48
79

A 3-year-old girl presents to the emergency room with drooling and trouble
swallowing, which started after playing with a TV remote. She is
hemodynamically and respiratory stable, with no drooling, and drinking
freely. Chest X-ray is below.

Which of the following is the next step?

1
Admit for observation

2
Gastroscopy the next day

3
Urgent bronchoscopy

4
Urgent gastroscopy

49
80

A 5-year-old boy presents with fever and throat pain for the last 2 days.
Examination is positive for enlarged, erythematous tonsils, with bilateral
exudate.

Which of the following will make a bacterial infection less probable?

1
Rash

2
Abdominal pain

3
Rhinorrhea

4
Headache

81

A 4-months-old infant is evaluated due to sleep apnea and severe

constipation.
Blood gasses reveal CO 2 accumulation during the night, with normal values
during the day.

Which of the following diagnostic tests will facilitate the most likely
diagnosis?

1
Upper gastrointestinal imaging

2
Bronchoscopy

3
Sleep lab

4
Anteroposterior chest x-ray

50
82

A 3-year-old boy presents with polydipsia and polyurea, with no glucosuria.

Blood osmolarity is increased and urine osmolarity is decreased.

Which of the following is the most likely diagnosis?

1
Diabetes insipidus

2
Diabetes mellitus

3
Compulsive drinking

4
Adrenal insufficiency

51
83

A 17-year-old who is followed up by a cardiologist due aortic root dilatation,

presents with sudden respiratory distress and left chest pain. He has no
fever or additional complaints. Examination reveals he is 180 cm high and
weighs 63 Kg. Blood pressure is 120/75, room air saturation is 91%, 105
beats/min, and respiratory rate of 20/min. Heart sounds are normal, his
chest is symmetrical, with slightly reduced breath sounds on the left. Chest
X-ray is below.

Which of the following treatments, in addition to supplementary oxygen, is

most appropriate for this patient?

1
Antibiotics

2
Bronchodilator inhalations

3
Calcium channel blockers

4
Observation

52
84

A preterm infant is delivered via an emergency cesarean section at 25-weeks’

gestation due to placental abruption. He requires intubation and is treated
with surfactant. At 3 days of age a routine brain ultrasound is performed.

Which of the following condition is this test screening for?

1
Intraventricular hemorrhage

2
Arterial-venous malformation

3
Cephalohematoma

4
Hydrocephalus

85

A 5-months-old generally well infant who is fed with mil substitutes, has two
smoking parents, and a paternal history of asthma. He presents to the
emergency room with two days of fever, cough and rhinorrhea,
with difficulty in feeding. His oxygen saturation is 91% in room air, he is
dyspneic and breathes 40 breaths per minute, and auscultation reveals
slight rales over both lungs.

Which of the following treatments, in addition to supplementary oxygen, is

most appropriate for this patient?

1
Inhalations

2
Intravenous fluids

3
Systemic steroids

4
A combination of steroids and inhalations

53
86

A 14-year-old girl presents with weight loss, nervousness, excessive

sweating, heat intolerance, and tremor. Laboratory results include
undetectable TSH and increase FT4. A facial photo is below

Which of the following is the most likely explanation for the findings in the
picture?

1
Increased anti- thyroglobulin antibodies

2
Increased anti-TPO antibodies

3
Levothyroxine treatment adverse effects

4
Increase sympathetic activity

54
87

A child is diagnosed with atopic dermatitis. He is referred for examination

due to the rash in the photos.

Which of the following is the most appropriate treatment?

1
Calcineurin inhibitors (Elidel)

2
Systemic steroids and skin lubrication

3
Local mupirocin

4
Acyclovir

55
88

A 4-year-old girl presents with 4 days of fever, maculopapular rash,

worsening malaise, and dyspnea which appeared on the day of admission.
Examination reveals a temperature of 38.3°C, low blood pressure, heart rate
of 160/minute, maculopapular rash which disappears with compression,
bilateral cervical lymphadenopathy, erythema and hypertrophy of the
pharynx with no exudate. Heart rate is fast and regular with gallop and a
new murmur, good and equal breath sounds, and a soft abdomen with mild
hepatosplenomegaly.

Which of the following is the most appropriate treatment?

1
Intravenous fluids and antibiotics

2
Intravenous fluids and beta blockers

3
Antiviral treatment combined with antibiotics

4
Antiviral treatment combined with steroids

89

Karyotype testing is performed as part of a workup of a teenager with

delayed puberty and reveals 47XXY.

Which of the following physical findings is typical for this boy’s condition?

1
Short stature

2
Ectopic kidney

3
Café ole spots

4
Gynecomastia

56
90

A 13-year-old boy has been hit by a ball during a soccer game, two days prior
to his arrival. He has been complaining of epigastric pain since, fever, and
vomiting. His examination is positive for significant abdominal epigastric
tenderness.

Which of the following tests will most probably promote diagnosis?

1
Gastroscopy

2
Upright plain abdominal X-ray

3
Serum lipase and amylase

4
Liver function tests

91

A 6-year-old girl with a history of Fontan operation presents with episodes of

tachycardia and separate episodes of presyncope with dizziness and
weakness.

Which of the following is the most appropriate treatment?

1
Digoxin and diuretics

2
Pacemaker implantation and beta blockers

3
Diagnostic/therapeutic cardiac catheterization

4
Calcium channel blockers

57
92

An 8-year-old boy presents with a limp over the last week, with no history of
trauma. Over the last two days he has high systemic fever. Examination
reveals a temperature of 38.5oC, refusal to bear weight on the right leg, and
significant tenderness in external rotation of the right hip. Laboratory results
include leukocytosis and elevated inflammatory markers, and ultrasound
demonstrates a large quantity of turbid fluid in the right hip joint.

Which of the following is the most likely causative agent?

1
Staphylococcus aureus

2
Kingella kingae

3
Neisseria gonorrhea

4
Group B streptococcus

93

A 2-year-old toddler comes in for routine checkup. Her height is in the 55 th

percentile, and her weight in the 40th percentile. Her vital signs are normal,
she obeys simple orders as “shut your eyes” but not complicated orders
including 3 components. She uses about 75 words, and can make a sentence
using two components. She recognizes her body parts.

Which of the following can this toddler most likely perform?

1
Drive a tricycle

2
Jump on one leg

3
Stand on one leg

4
Build a tower of 6 cubes

58
94

A 2-year-old male presents with the finding in the photo below. Abdominal
ultrasound reveals an abdominal mass.

Which of the following is the most typical for the toddler’s most likely
diagnosis?

1
Mediastinal mass on a chest x-ray

2
Increased urine catecholamines

3
Increased alpha-fetoprotein

4
Increased beta HCG

59
95

A 6-year-old girl with a history of sickle cell anemia presents with fever.
Blood tests reveal significantly decreased hemoglobin and very low
reticulocytes.

Which of the following is the most likely causative agent?

1
Rhinovirus

2
Adenovirus

3
Parvovirus B19

4
Metapneumovirus

60
96

A term, few hours old newborn, with a history of a normal pregnancy and
delivery, presents with respiratory distress. Examination reveals dyspnea
and grunting, use of accessory muscles, and abdominal breathing.
Auscultation to the lungs reveals bowel sounds. X-ray is below.

Which of the following is the most likely diagnosis?

1
Congenital diaphragmatic hernia

2
Respiratory distress syndrome

3
Meconium peritonitis

4
Necrotizing enterocolitis

61
97

All of the following reflexes are seen in a normal newborn, except:

1
Stepping

2
Moro

3
Parachute

4
Grasp

98

Which of the following is typical of a newborn to a mother with gestational

diabetes?

1
Hyperglycemia

2
Cardiomegaly

3
Retinopathy

4
Low birth weight

62
99

A 16-year-old male was referred due to suspected immunodeficiency after

two episodes of Neisseria meningitidis meningitis, with no additional
infections. Development, physical examination, and immunoglobulin levels
are normal.

Which of the following tests will promote diagnosis?

1
Complement hemolytic assay (CH50)

2
Sub-group lymphocytic analysis

3
Bone marrow aspiration

4
Isohemagglutinin titers levels

100

A 5-year-old female presents with a growth spurt, breast budding, and

genital hair. Left hand X-ray revealed advanced bone age. LH levels after
LHRH injection were increased. Brain MRI was normal.

Which of the following is the most appropriate treatment?

1
Observation

2
LHRH agonist

3
Estrogen

4
Progesterone

63