imle 18.02.2013

8/10/2019 IMLE 18.02.2013

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State Exam 18.02.2013

By: Alhag Abu Anzeh Muhammad ([email protected])

Part A:

1. The breast fed infant of a mother who is a strict vegetarian ma ex!erience deficienc of which of the fo""owing vitamins if the

mother is not receiving s#!!"ements of the vitamin$

A. %it &1

&. %it &'

(. %it &12

). %it (

E. %it )

2. A *+ear+o"d gir" who was !revio#s" hea"th !resents with a 1 wee, histor of noct#rna" !eriana" itching. There are no other

sm!toms and findings on !hsica" examinations are norma". The most a!!ro!riate thera! is:

A. &acitracin ointment to the !eriana" area

&. )i!henhdramine ora"" as needed for itching

(. Sing"e ora" dose of mebenda-o"e re!eated in 2 wee,s

). A 2 wee, co#rse of amoxici""inc"av#"anate

E. /etocona-o"e in a sing"e dose

3. A chi"d s#ffers a !rovo,ed bite from a stra dog that was ca!t#red b anima" contro" and a!!ears hea"th. The most a!!ro!riate

action wo#"d be to:

A. (onfine and observe the dog for 10 das for signs s#ggestive of rabies

&. S#bmit the dogs head for examination for rabies

(. &egin rabies vaccination

). Administer h#man rabies imm#ne g"ob#"in 456 and begin rabies vaccination

E. 7one of the above beca#se it was a !rovo,ed attac,

'. A menta"" retarded 1'+ear+o"d bo has "ong face "arge ears micro!enis and "arge testes. (hromosoma" ana"sis is "i,e" to

demonstrates which of the fo""owing$

A. Trisom 21

&. Trisom 18

(. Trisom 13

). 9ragi"e sndrome

E. ;i""iams sndrome

<. A 10+ear+o"d bo is examined beca#se of rec#rrent headaches. The headaches started * months ago and occ#r abo#t once a month.

e is asm!tomatic between e!isodes. Each headache begins with b"#rr vision and abdomina" !ain fo""owed b right+sided throbbing

!ain. 4t "asts abo#t *0 min#tes d#ring which he fee"s better if he ta,es some ib#!rofen and rests in a dar,ened room. The most "i,e"

diagnosis is:

A. &rain abscess

&. Sei-#re disorder

(. =igraine

). Todds !ara"sis

E. =axi""ar sin#sitis

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*. A 2+ear+o"d bo is seen in o#r office beca#se of fever ear !ain and !osta#ric#"ar swe""ing erthema and tenderness. The !inna

!rotr#des o#t on the invo"ved side. The tm!anic membrane is red and b#"ging with decreased mobi"it seen on !ne#matic otosco!.

The ang"e of the >aw is easi" !a"!ated and the o!ening to Stensen?s d#ct a!!ears norma". The !atient has never had an == vaccine.

The most "i,e" diagnosis is:

A. &acteria" !arotitis

&. =#m!s

(. Externa" otitis). Ac#te mastoiditis

E. (hronic mastoiditis

@. 7ew !arents as, o# how to red#ce the chance of their bab s#ffering from s#dden infant death sndrome S4)S6. o# te"" them to

!"ace the chi"d in which of the fo""owing for s"ee!$

a. S#!ine !osition

b. Prone !osition

c. Seated !osition

d. Trende"enb#rg !osition

e. A hammoc,

8. An 8+ear+o"d gir" is bro#ght to the hos!ita" whi"e active" sei-ing. She has been hos!ita"i-ed man times before for stat#s e!i"e!tic#s.

She is receiving va"!roic acid at home to contro" the sei-#res. The first ste! in the management of this !atient is to:

A. Administer 20 mB,g 0.CD norma" sa"ine

&. Estab"ish sec#re intraveno#s access and administer an anticonv#"sant

(. Administer activated charcoa" via 75 t#be

). Stabi"i-e airwa and !rovide 100D oxgen

E. Perform gastric "avage

C. A <+ear+o"d bo !resents with a histor of gross" b"ood #rine !#ff ees and headache for one da. e has been a we"" deve"o!ed

chi"d b#t he did have a fever and sore throat abo#t 10 das ago which reso"ved witho#t treatment. The most "i,e" diagnosis is:

A. Ac#te cstitis

&. 4gA ne!hro!ath

(. Ac#te !e"one!hritis

). Postinfectio#s g"omer#"one!hritis

E. &enign hemat#ria

10. A 3+r+o"d bo !resents to an #rgent care c"inic with a 3+da histor of abdomina" !ain and diffic#"t wa",ing. Abnorma" findings

inc"#de b"ood !ress#re of 12080 mm g diff#se abdomina" tenderness !#r!#ric rash of the hands and an,"es and diff#se !eriartic#"ar

tenderness and swe""ing of the an,"es. The most "i,e" diagnosis is:

A. Sstemic "#!#s erthematos#s

&. /awasa,is disease

(. #veni"e rhe#matoid arthritis

). enoch+Sch n"ein !#r!#ra

E. Stevens+ohnson sndrome

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11. ;hat is the most significant serio#s com!"ication arising from /awasa,i disease$

A. (oronar ane#rism

&. /idne fai"#re

c. Stro,e

d. P#"monar embo"ism

e. Ac#te "e#,emia

12. A 12 months o"d ma"e infant =editerranean origin noted to have !a""or and has been fed simi"ac with iron since birth his exam

otherwise norma" exce!t for !a"!ab"e s!"een .&:C.C =(%:*@=((:32);:12etic#"octe 1.<D PBT:2'0000 which one is tr#e$

a. b "eve" of C.C gmd" is the "ower "imit of norma" for this 12 months o"d

b. The dietar histor is !robab" not tr#e since the !atient is iron deficient

c. The retic#"octe is high s#ggest hemo"tic !rocess

d. The infant m#st he "osing b"ood and stoo" sho#"d be chec,ed for occ#"t b"ood

e. g e"ectro!horesis sho#"d ma,e the correct diagnosis

13.1< ear o"d com!"aining of fever abdomina" !ain sex#a"" active with 2 !artner com!"aint of ds!are#nia on examination e""ow

thic, vagina" discharge b#t no visib"e genita" "esion most !robab" infected with:

a. .inf"#en-a

b. (andida a"bicans

c. (h"amidea !a""ed#m

d. Tre!enoma

e. #man !a!i""oma vir#s

1'. Parents awa,ened at night b 2 ears o"d son deve"o! nois breathing ins!iration mar,ed retraction of chest f"aring nostri" bar,ing

co#gh has mi"d #!!er res!irator tract infection 2 das ago. ;hich the most "i,e" diagnosis:

a. Asthma

b. E!ig"ottitis

c. &ronchi"itisd. %ira" cro#!

.e 9oreign bod in T bronch#s

1<. The most im!ortant extra med#""ar site for re"a!se in chi"dhood ac#te "m!hatic "e#,emia ABB6:

a. Adrena" g"and

b. /idne

c. B#ng

d. eart

e. (entra" nervo#s sstem

1*. 7ewborn deve"o!s se!sis and shoc, which !athogens most "i,e" can sstem or foca" infection of newborn:

a. Sta!h a#rea#s

b. 5ro#! A stre!t

c. 5ro#! & stre!

d. E.co"i

e. er!es sim!"ex vir#s

8/10/2019 IMLE 18.02.2013


1@. A ' ears o"d gir" seen 10 das fo""owing #!!er res!irator infection her ,nees and an,"e swo""en and !ainf#" and tem! 3C ( cardiac

examination '* ssto"ic m#rm#r at the a!ex antistre!to"sin titer high. These findings consist with:

a. Ac#te rhe#matic fever

b. Se!tic arthritis

c. #veni"e idio!athic arthritis

d. %ira" !ericarditis

e. Ac#te "e#,emia

18.12 ears o"d bo !resented with 2' h histor of shar! !"e#ritic chest !ain worsen in s#!ine !osition tem!erat#re 38.< ( !ericardia"

r#b is heard. The most "i,e" diagnosis is:

a. =#sc"os,"eta" chest !ain

b. Pericarditis

c. &acteria" endocarditis

d. =co!"asma !ne#monia

e. P#"monar embo"ism

1C. The most common ca#se of snco!e in chi"dhood:

a. Tachcardia ass with wo"f !ar,insonian white sndrome

b. Bong F+T sndrome

c. &reath ho"ding s!e""

d. !ertro!hic cardiomo!ath

e. 7e#rocardiogenic snco!e

20. A * wee,s bo ,nown congestive heart fai"#re d#e to cardiomo!ath ;g ' /g ta,en 3*0 m" form#"e dai" which of the fo""owing

most "i,e" conseG#ence of decrase inta,e in this infant:

a. !oca"cemia

b. !og"cemia

c. !o,a"emia

d. Poor growth in "engthe. Poor weight gain

21. The stinging insect most "i,e" to ca#se an ana!h"actic reaction in a chi"d is:

A. =osG#ito

&. Sand f"

(. one bee

). Ant

E. ead "ice

22. The chest x+ra of a 3+da infant with congenita" heart disease demonstrates an abnorma"" sha!ed heart and no thmic shadow.

;hat imm#nodeficienc sho#"d o# s#s!ect$

A. Ataxia+te"angiectasia

&. +"in,ed h!er+4g= sndrome

(. ;is,ott+A"drich sndrome

). )i5eorge sndrome

E. Be#,octe adhesion deficienc

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23. A 12 month+o"d infant was diagnosed with +"in,ed agamag"ob#"inemia a recessive &+ce"" deficienc after having had m#"ti!"e

sino!#"monar tract infections s#ch as otitis media sin#sitis and !ne#monia. ;hat is an a!!ro!riate treatment for him$

A. P"asma!horesis

&. 4ntraveno#se imm#nog"ob#"in

(. (hemothera!

). igh dose steroids

E. En-me re!"acement thera!

2'. A mother of a *+ear+o"d gir" states that her da#ghters academic !erformance has decreased d#ring the "ast ear. er teacher

notices her staring freG#ent" thro#gho#t the da. Sometimes she seems Hoff in her own wor"dH and does not res!ond to G#estions. An

EE5 examination revea"s a 3+ert- genera"i-ed s!i,e and wave !attern. ;hat sei-#re t!e is this !atient most "i,e" to have$

A. Absence

&. TonicIc"onic

(. =oc"onic

). Sa"aam attac,s

E. (om!"ex !artia"

2<. A 2.< ear o"d bo is seen beca#se of a second febri"e sei-#re. The two e!isodes occ#red ' months a!art and described as

genera"i-ed tightening of the bod fo""owed b >er,ing invo"ving a"" fo#r extremities and "asting 3 to < min#tes each time. Jn both

occasions the tem!rat#re was 38.8K(. At this time o#r recommendation wo#"d be:

A. 9#rther tests inc"#ding EE5 and =4 scan

&. Treatment with !henobarbita"

(. Treatment with va"!roate

). Admit to hos!ita" for cardiac res!irator monitoring

E. Ed#cation and co#nse"ing for the fami"

2*. The s,i""s of ,ic,ing a ba"" and >#m!ing in !"ace are gross motor mi"estones that occ#r at which age$

A. 1< months&. 18 months

(. 2' months

). 30 months

E. 3* months

2@. &ased on orientation to chi"d deve"o!ment when wo#"d o# te"" !arents the highest ris, of accidenta" !oisoning in chi"dren is

!resent$

A. * months

&. 1 ear

(. 2 ears

). ' earsE. * ears

28. ;hich of the fo""owing is a freG#ent manifestation of enterovir#s infection$

A. Ataxia

&. 4nt#ss#sce!tion

(. Parotitis

). er!angina

E. ena" fai"#re

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2C. A *+ear+o"d gir" is hos!ita"i-ed after a conv#"sion. Jn examination she is a"ert and witho#t distress. Jn her s,in o# notice the

!resence of cafe+a#+"ait s!ots a Shagreen !atch and s#b#ng#a" fibromas. ;hat is the most "i,e" diagnosis$

A. 7e#rofibromatosis

&. St#rgeI;eber sndrome

(. =c(#ne+A"bright sndrome

). Addissons disease

E. T#bero#s sc"erosis

30. A 1<+month o"d ma"e is bro#ght to the !ediatrician beca#se he seems m#ch sma""er than his two o"der brothers were at that age. e

has been genera"" hea"th exce!t for 2 e!isodes of otitis media and occasiona" Hco"dH. e began wa",ing at 11 months and can now sa

HmamaH HdadaH and names of his brothers. ;hat is the most "i,e" a!!ro!riate next ste!$

A. Perform a )anver )eve"o!ment screening test

&. As, the mother to com!"ete a 3 da diar of a"" the food that the chi"d has eaten

(. Send b"ood for G#antitive imm#nog"ob#"ins

). P"ot his height and weight on growth chart and com!are to !revio#s charts

E. obtain a sweat ch"oride test

31. A 1+month+o"d infant is seen beca#se of !ro"onged >a#ndice. e was born at home after a norma" !regnanc. Jn examination o#

notice a >a#ndice of the s,in. is " iver is not en"arged. There is a white !#!i""ar ref"ex in both ees and the #rine examination is !ositive

for red#cing s#bstances. ;hat is the most "i,e" diagnosis$

a. Se!sis

b. 5"#cose+*+!hos!hate dehdrogenase deficienc

c. Phen",eton#ria

d. %ira" he!atitis

e. 5a"actosemia

32. ;hich of the fo""owing statements abo#t ne#rob"astoma is tr#e$

a. 7e#rob"astoma is a benign t#mor of the ne#ra" crest ce""s that form the adrena" cortex and the !aras!ina" !arasm!athetic gang"ia

b. The ma>orit of ne#rob"astoma t#mors occ#r in the thoracic cavitc. 7e#rob"astoma is the most common so"id ma"ignant t#mor in infanc

d. 4n ne#rob"astoma of the abdomen dis!"acement of the ,idne and distortion of the ca"cea" sstem often occ#rs

e. =ost !atients are treated with s#rger a"one beca#se distant metastases are rare

33. 7o red ref"ex is seen on f#ndosco!ic examination of a newborn. ;hich is the most "i,e" diagnosis$

a. etinob"astoma

b. (ongenita" cataract

c. Pigmentar ,eratitis

d. (ongenita" g"a#coma

e. Toxocariasis

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3'. A neonate born at 28 wee,s gestation is now 2 wee,s of age. 7asogastric feeds are started. 9ort+eight ho#rs after starting feeds

the neonate deve"o!s a distended abdomen b"ood stoo" !ne#matosis intestina"is and free air on abdomina" radiogra!h. Baborator

st#dies revea" thrombocto!enia. The chi"d becomes !ersistent" h!otensive des!ite maxima" medica" thera!. The most "i,e"

diagnosis is:

a. 7ecroti-ing enteroco"itis

b. Se!sis

c. As!iration !ne#monia

d. =a"rotation

e. e>#na" atresia

3<. A 12+ear+o"d ma"e ado"escent !resents with a 1+month histor of fever weight "oss fatig#e night sweats and !ain and"oca"i-ed

swe""ing of the mid!roxima" fem#r. ;hich of the fo""owing is the most "i,e" diagnosis$

a. Ewings sarcoma

b. Jsteosarcoma

c. (hronic osteome"itis

d. &enign bone t#mor

e. Eosino!hi"ic gran#"oma

3*. An afibri"e <+ear+o"d gir" !resents with tachcardia at 220 beats !er min#te. Jn E(5 a reg#"ar narrow+com!"ex tachcardia is seen.

The rhthm converts with one dose of adenosine intraveno#s" to norma" sin#s rhthm with !re+exitation de"ta waves6 noted

thro#gho#t the !recordia" "eads. There is no cardiomega" on chest +ra. The tachcardia is most "i,e" consistent with:

a. Bong F+T sndrome

b. ;o"f+Par,inson+;hite sndrome

c. Sin#s tachcardia

d. Atria" f"#tter

e. Atria" fibri""ation

3@. A <+ear+o"d bo !resents with !ro"onged fever and a new 1* ssto"ic e>ection m#rm#r heard best at the right #!!er sterna" border.

Jn extremit examination s!"inter hemorrhages and !etechia are noted. ;hich of the fo""owing is the most "i,e" diagnosis based onc"inica" descri!tion$

a. Endocarditis

b. he#matic heart disease

c. /awasa,i disease

d. Pericardia" eff#sion

e. )i"ated cardiomo!ath

38. A *+wee,+o"d breast fed infant is seen a!!earing G#ite we"". is mother states that for the "ast wee, the infant has had n#mero#s

!eriods of inconso"ab"e cring "asting few ho#rs each. 7othing seems to he"!. =ost of the s!e""s occ#r in the "ate afternoon and evening

and between the e!isodes the infant "oo,s and feeds we"". ;hat is the most "i,e" diagnosis$

a. Jtitis media

b. 4nt#ss#sce!tions

c. =i", !rotein into"erance

d. (o"ic

e. (e"iac disease

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3C. A !revio#s" hea"th 2+w,+o"d now has !rogressive "etharg. Phsica" examination revea"s m#sc"e rigidit o!isthotonos !ost#re

!eriods of h!ertonicit and f"accidit. Baborator data revea" !og"cemia metabo"ic acidosis and cerebra" edema. P"asma "eve"s of

"e#cine iso"e#cine and va"ine are e"evated. The most "i,e" diagnosis is:

a. artn#! disease

b. =a!"e sr#! #rine disease

c. Phen",eton#ria

d. omocstin#ria

e. 5a"actosemia

'0. Short stat#re and growth fai"#re ma be the !resenting com!"aints for which of the fo""owing conditions$

a. #veni"e idio!athic arthritis

b. 4ns#"in+de!endent diabetes me""it#s

c. (rohns disease

d. Ac#te "e#,emia

e. 9ami"ia" =editerranean 9ever

'1. A 1* ear o"d fema"e !atient !resent with short stat#re and no secondar sex#a" characteristics. ;hich diagnosis sho#"d be most"$

a. T#rner sndrome

b. 4so"ated growth hormone deficienc

c. (#shing disease

d. 9ami"ia" short stat#re

e. Addison disease

'2. A 3+ear o"d gir" is diagnosed with new onset ins#"in de!endent diabetes me""it#s. ;hich of the fo""owing "aborator findings is

consistent with diabetic ,etoacidosis$

a. !og"cemia

b. !ercarbia

c. /etones in #rine

d. 4ncreased veno#s b"ood !

e. )ecreased &L7

'3. An infant who was born at home !resents to o#r office at 3 das for chec, #!. The teenaged mother did not receive !renata" care.

o# notice bi"atera" !#r#"ent discharge from the ees of the bab. There is mar,ed ee"id edema and con>#nctiva" swe""ing. ;hat is the

most "i,e" !athogenic agent$

a. (h"amdia trachomatis

b. 7eisseria gonorrhea

c. 5ro#! & stre!tococc#s

d. Toxo!"asma gondii

e. Tre!onema !a""id#m

''. ;hich of the fo""owing c"inica" !resentation is most consistent with an infant with !"oric stenosis$

a. Pro>ecti"e non bi"io#s emesis

b. &i"io#s emesis

c. &"ood diarrhea

d. %io"ent e!isodes of intermittent co"ic, !ain and emesis

e. ight "ower G#adrant abdomina" tenderness

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'<. A '+ear o"d bo !resented with a < da histor of genera"i-ed edema. Jn examination o# notice !#ff ees scrota" edema and

ascites. Lrina"sis revea"s a s!ecific gravit of [email protected] 'M !rotein#ria and is otherwise #nremar,ab"e. Ser#m cho"estero" is *'8

mgd" e"evated a"b#min is 2.3 gd""ow6 (3 is 83 mgd" norma"6 and ser#m creatinine 0.3 mgd". ;hat is the next ste! in managing

this chi"d$

a. Perform ,idne bio!s

b. &egin thera! with amoxici""in

c. &egin thera! with ora" !rednisone

d. Admit the !atient for intraveno#s f"#ids

e. Start !eritonea" da"isis

'*. A 1C+ear o"d fema"e o# have fo""owed for 10 ears in o#r !ractice has recent" married she and her 22+ear o"d h#sband are

!"anning to start a !regnanc. o# advice her to start ta,ing fo"ic acid. This is im!ortant to !revent:

a. Premat#rirt

b. S,#"" defects

c. (hromosoma" defects

d. 7e#ra" t#be defects

e. Jsteo!enia

'@. A+* da o"d infant is re!orted to have an abnorma" screening test for congenita" h!othroidism the most "i,e" etio"og for this

res#"t is:

a. =aterna" graves disease treated with !ro!"thio#raci"

b .=aterna" antithro!in antibodies

c. 4odine deficienc

d. dsgenetic throid g"and

e. The newborn screen was !erformed at 12 ho#rs of age

'8. A 3+ear o"d bo is bro#ght to the emergenc room with com!"aint of !ersistent rhinorrhea for the !ast *+wee,s. Jtherwise the

!atient has been asm!tomatic on examination o# note that the !atient has mo#th breathing and has dar, circ"es #nder his ees. 4n

the nose o# find water discharge and edemato#s swo""en b"#ish m#co#s membrane witho#t erthema. The most "i,e" diagnosis is:

a. (hronic #!!er res!irator infection

b. Sin#sitis

c. 7asa" foreign bod

d. A""ergic rhinitis

e. (S9 "ea,

'C. A !revio#s" hea"th 18+month+o"d has been !"aing in a se!arate room from his fami". The fami" notes the s#dden onset of

co#ghing which reso"ved in a few min#tes s#bseG#ent" the !atient a!!ears to be norma" exce!t for increased amo#nts of droo"ing and

ref#sed to ta,e foods ora"". ;hich of the fo""owing is the most "i,e" ex!"anation for this todd"ers condition$

a. Severe gastro eso!hagea" ref"#x

b. 9oreign bod in the air+wa

c. (ro#!

d. E!ig"ottitis

e. 9oreign bod in the eso!hag#s

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<0. A !revio#s" hea"th and f#"" imm#ni-ed 13 ear+o"d bo !resents with 2+wee, histor of non!rod#ctive co#gh and "ow+grade fever.

Jn examination o# note norma" res!irator ra"es are de"eted at the bi"atera" "#ng bases. ;hich of the fo""owing is the most "i,e" ca#se

of !ne#monia in this ado"escent$

a. Pne#mocctis carnii

b .Sta!h"ococc#s a#re#s

c. 5ro#! & stre!tococc#s

d. aemo!hi"#s inf"#en-a t!e &

e. =co!"asma !ne#monia

<1. A 2@+ear+o"d man !resents to the emergenc de!artment after receiving b"ows to the head. e o!ens his ees with !ainf#" stim#"i

is conf#sed and "oca"i-es to !ain. ;hat is his g"asgow coma score$

A. 13

&. 11

(. C

). @

<2. A '<+ear+o"d otherwise hea"th woman !resents after a motor vehic"e accident. She is hemodnamica"" stab"e and on" minima"

tenderness in her right #!!er G#adrant. A 9AST exam foc#sed abdomina" sonogra!h for tra#ma6 is !ositive with f"#id seen in the

he!atorena" fossa and the !e"vis. ;hich of the fo""owing is the next best ste! in her management$

A. Jbservation on"

&. (T scan

(. Ba!arosco!

). Ex!"orator "a!arotom

<3. The idea" time to administer !ro!h"actic antibiotics to a !atient #ndergoing co"on resection is:

A. 8 ho#r before s#rger with a dose re!eated at the time of incision

&. 2 ho#r before s#rger with a dose re!eated at the time of incision

(. 1 ho#r before s#rger

). At the time of incision

<'. T#mor staging for most e!ithe"ia" cancers inc"#des a"" of the fo""owing exce!t:

A. T#mor si-e

&. T#mor m#tations

(. 7oda" invo"vement

). )istant s!read

<<. ;hich of the fo""owing conditions increases a womans ris, of breast cancer$

A. Sc"erosing adenosis

&. 9ibroadenoma

(. At!ica" "ob#"ar h!er!"asia

). 4ntrad#cta" !a!i""oma

<*. ;hich of the fo""owing is an indication for cho"ecstectom in an asm!tomatic !atient with an incidenta" finding of ga""stones$

A. An histor of abdomina" !ain

&. 9ami" histor of com!"ications of cho"e"ithiasis

(. Porce"ain ga""b"adder

). 9reG#ent trave" o#t of the co#ntr

8/10/2019 IMLE 18.02.2013


<@. A '8+ear+o"d !atient !resents with s#dden onset of bi"atera" "ower abdomina" !ain after s!asmodic co#ghing. Jn examination

there is a 8+cm tender mass in the mid "ower abdomen that remains #nchanged with contraction of the rect#m m#sc"es. ;hich of the

fo""owing is the most "i,e" diagnosis$

A. #!t#red aortic ane#rsm

&. Jbt#rator hernia

(. S!ige"ian hernia

). ect#s sheath hemathoma

<8. 9o""owing doc#mentation of a firm mass in the testes b #"traso#nd in a 32+ear+o"d ma"e tiss#e sho#"d be obtained for diagnosis

b:

A. 9ine+need"e as!iration

&. (ore+need"e bio!s

(. J!en bio!s

). Jrchiectom

<C. A @< ear+o"d man with a histor of mocardia" infarction 2 ears ago !eri!hera" vasc#"ar disease with sm!toms of c"a#dication

after ha"f b"oc, h!ertension and diabetes !resents with a "arge ventra" hernia. e wishes to have the hernia re!aired. ;hich of the

fo""owing is the most a!!ro!riate next ste! in his !reo!erative wor,#!$

A. A norma" e"ectrocardiogram E(56 !rec"#des the need for f#rther cardiac testing

&. e sho#"d #ndergo an exercise stress test

(. e sho#"d #ndergo coronar arter b!ass !rior to o!erative re!air of his ventra" hernia

). e sho#"d #ndergo a !ersantine tha""i#m stress test and echocardiogra!h

E. is histor of mocardia" infarction within 3 ears is !rohibitive for e"ective s#rger. 7o f#rther testing is necessar.

*0. A '0+ear+o"d man #ndergoes an a!!endectom for ac#te a!!endicitis. 9ina" !atho"og revea"s a 2.<+cm carcinoid at the ti! of the

a!!endix. Bm!h nodes are negative. ;hich of the fo""owing is tr#e abo#t this condition$

A. 7o f#rther treatment is necessar

&. There is a significant chance that carcinoid sndrome wi"" deve"o! in the !atient(. The !atient sho#"d receive chemothera!

). The !atient sho#"d #ndergo re+ex!"oration and a right hemico"ectom

E. =ost a!!endicea" carcinoids are 2.< cm or "arger when discovered

*1. A '< ear+o"d woman #ndergoes excisiona" bio!s for a mammogra!hic abnorma"it. 9ina" !atho"og revea"s benign !atho"og

witho#t at!ia however severa" foci of "ob#"ar carcinoma in sit# B(4S6 are detected at the excision margins. ;hich of the fo""owing

choices wo#"d be the best management o!tion$

a. Excisiona" bio!s to achieve negative margins

b. =astectom with sentine" "m!h node bio!s

c. adiation thera!

d. &i"atera" tota" mastectomies with immediate reconstraction

e. ("ose c"inica" and mammogra!hic fo""ow+#!

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*2. A 28+ear o"d "actating woman !resents with a 2+da histor of breast !ain that is !rogressive" worsening. Jn examination a '+cm

area of s,in ad>acent to the ni!!"e is red and tender with some edema and no detectab"e f"#ct#ance.

=anagement wo#"d consist of:

a. 9ine+need"e as!iration

b. S,in bio!s

c. 4ncision and drainage

d. Jra" antibioticse. =ammogra!h

*3. A *0ear+o"d man !resents with obstr#ctive >a#ndice acho"ic stoo"s and weight "oss. An #"traso#nd scan demonstrates a di"ated

bi"iar tree and no ga""stones. A dnamic contrast+enhanced (T scan demonstrates a mass "oca"i-ed to the head of !ancreas witho#t

evidence of distant metastasis adeno!ath or vasc#"ar invasion. The !atient is otherwise in good hea"th. ;hich of the fo""owing best

describes the ro"e of !reo!erative !erc#taneo#s bio!s of the mass in this setting$

a. 4t is high" sensitive

b. 4t is nons!ecific

c. 4t is associated with a high com!"ication rate

d. 4t sho#"d be ro#tine" !erformed

e. 4t is #nnecessar

*'. A '+wee, o"d infant !resents to the emergenc de!artment with increasing" !ro>ecti"e vomiting that is nonbi"io#s and a !a"!ab"e

sma"" right #!!er G#adrant mass. The infant has severe h!och"oremic+h!o,a"emic metabo"ic a",a"osis. ;hich of the fo""owing is tr#e$

a. The condition is more common in fema"es

b. The #rine ! wi"" "i,e" be acidic

c. Emergenc s#rger is indicated

d. L"trasonogra!h is a"was necessar to confirm the diagnosos

e. S#rger wi"" "i,e" reG#ire a gastrointestina" b!ass

*<. Two months after s!"enectom for 4TP the !atient is noted to have !etechia and a decrease !"ate"et co#nt. A !eri!hera" b"oodsmear is noteworth for the absence of owe""+o"" bodies. ;hich of the fo""owing is the best recommendation$

a. (T scan of the abdomen

b. &one marrow bio!s

c. 7o wor,+#! neededN administer steroids

d. adio"abe"ed red b"ood ce"" &(6 scan

e. 7o wor,+#! neededN administer imm#nog"ob#"in

**. The most acc#rate mean of determining T and 7 staging of gastric adenocarcinoma is:

a. Tri!"e+!hase he"ica" com!#ted tomogra!h (T6 scan

b. )iagnostic "a!arosco!

c. Endosco!ic #"trasonogra!h

d. =agnetic resonance imaging with gado"ini#m

e. Positron emission tomogra!h scan

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*@. A 28+ear o"d woman #ndergoes a segmenta" i"ea" resection d#ring the co#rse of an adhesio"sis for an ac#te sma"" bowe""

obstr#ction. Jn !osto!erative da * she is noted to have thic, bi"e+co"ored f "#id emanating from the the mid"ine wo#nd. After 4%

hdration the next ste! in management sho#"d be:

a. (T scan of the abdomen

b. L!!er gastrointestina" sma"" bowe"" fo""ow+thro#gh with water+sho#"d contrast.

c. 9ist#"ogram

d. J!erative re+ex!"oration

e. Jctreotide

*8. After a tota" throidectom the right voca" cord is noted to be fixed in a !aramedian !osition. The most "i,e" re!resents:

a. 4n>#r to the B7 ec#rrent "arngea" nerve6

b. 4n>#r to the externa" branch of the s#!erior "arngea" nerve

c. 4n>#r to the interna" branch of the s#!erior "arngea" nerve

d. Tra#ma from endotrachea" int#bation

e. (om!ression from hematoma

*C. A 23+ear o"d man s#stains b"#nt chest tra#ma fo""owing a high+s!eed motor vehic"e accident. e is hemodnimaca"" stab"e. ;hich

of the fo""owing conditions is an indication for thoractom$

a. Lndrained hemothorax des!ite a t#be thoracostom

b. (ontin#o#s chest t#be drainage of more than 200mBhr of b"ood for ' ho#rs.

c. 4ntia" chest t#be o#t!#ts of 1100=B

d. ;ide mediastin#m

e. 9"ai" chest

@0. The three findings in acha"asia are:

a. 4ncreased BES resting !ress#re decreased BES re"axation increased eso!hagea" !erista"tic activit

b. )ecreased BES resting !ress#re increased BES re"axation decreased eso!hagea" !erista"tic activit

c. 4ncreased BES resting !ress#re decreased BES re"axation decreased eso!hagea" !erista"tic activit

d. )ecreased BES resting !ress#re increased BES re"axation increased eso!hagea" !erista"tic activit

@1. The most common etio"og of eso!hagea" !erforation is:

a. S!ontaneo#s r#!t#re &oerhaaves sndrome6

b. 4nstr#menta" !erforation

c. 9oreign bod in eso!hag#s

d. &arretts eso!hag#s

@2. ;hich of the fo""owing is tr#e regarding 54ST gastrointestina" str#ma" t#mors6$

a. S#rger is the mainsta of treatment

b. =ost 54STS are fo#nd in the stomach

c. 54STS res!ond we"" to imatinib mes"ate 5"eevec6

d. 54STS #s#a"" !resent with #!!er gastrointestina" b"eeding

e. A"" the above

8/10/2019 IMLE 18.02.2013


@3. ;hich of the fo""owing com!"ications of crohns disease is "east common$

a. Enteroentera" fist#"as

b. Enteroc#taneo#s fist#"as

c. 9ree !erforation

d. strict#res

@'. ;hich is the most "i,e" ca#se of int#ss#ce!tion in a 20+ear+o"d man$

a. 4dio!athic

b. Bm!homa of the sma"" bowe"

c. (arcinoid

d. Adhesions

@<. ;hich of the fo""owing is tr#e regarding adenomato#s co"onic !o"!s$

a. Po"!s "ess than 1 cm in diameter are #n"i,e" to be ma"ignant

b. %i""o#s adenomas most common" occ#r in the cec#m

c. 9AP fami"ia" adenomato#s !o"!osis6 is an a#tosoma" recessive condition

d. amartomato#s !o"!s have a high incidcncc of ma"ignant transformatione. 9eca" occ#"t b"ood testing has not changed the morta"it from co"on cancer

@*. A sixt+o"d !atient with two bo#ts of inche Stage 44 divertic#"ar disease sho#"d be treated with:

a. Sigmoid co"ectom and anastomosis

b. Transverse co"ostom

c. Sigmoid resection end co"ostom and m#co#s fist#"a

d. &owe" rest 4% antibiotics

e. Tota" abdomina" co"ectom

@@. A"" of the fo""owing are indicative of !oor !rognosis in ac#te !ancreatitis exce!t:

a. Ser#m ca"ci#m "eve" "ess than 8.0 mgdB

b. !erg"cemia

c. Ser#m am"ase "eve" more than five times norma" on admission

d. Arteria" oxgen tension "ess than *0 mmg

e. Ser#m "actic dehdrogenase B)6 more than three times norma"

@8. A victim of b"#nt abdomina" tra#ma #ndergoes a !artia" he!atectom. )#ring s#rger he receives 12 #nits of !ac,ed red b"ood ce""s.

4n the recover room he is noted to be b"eeding from intraveno#s !#nct#re sites and the s#rgica" incision. ;hich of the fo""owing

statements regarding the coag#"o!ath is most "i,e" tr#e$

a. The !atient has an #n,nown !rimar b"eeding disorder

b. The coag#"o!ath is secondar to the !artia" he!atectom

c. The coag#"o!ath is secondar to di"#tiona" thrombocto!enia and deficienc of c"otting factors from the massive b"ood transf#sion

d. The treatment is ora" vitamin /.

e. The treatment is intraveno#s vitamin /

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@C. ;hich of the fo""owing is tr#e of mammogra!h$

a. 4s the most effective means of screening for breast carcinoma

b. 4s more effective in detecting breast carcinomas in !ostmeno!a#sa" women

c. ;hen norma" sho#"d not exc"#de bio!s of a !a"!ab"e s#s!icio#s breast mass

d. A"" of the above

80. Statistica"" the most !owerf#" !redictor of !rognosis for breast cancer is:

a. The !resence of intramammar "m!hatic invo"vement.

b. The grade of differentiation of the t#mor

c. The !resence of mar,ed intrad#cta" carcinoma aro#nd the !rimar t#mor

d. The si-e of the t#mor

e. The n#mber of axi""ar "m!h nodes invo"ved with metastatic t#mor

81. A 33+ears o"d woman !regnant for the third time !resent at 3 months with a 2+cm mass in the inner as!ect of the "eft breast. A

need"e as!iration revea"s no f"#id o# wo#"d:

a. Arrange for mammogram beca#se m#"ticentric "esions are common d#ring !regnancb. (onsider termination of !regnanc beca#se chemothera! has been shown to be #sef#" in node+negative !remeno!a#sa" !atients

c. Ex!editio#s" obtain a histo"ogic diagnosis of the mass

d. ;ait #nti" the third trimester beca#se s#rger is safer at that time

82. 9ine need"e as!iration bio!sies are often #sef#" for which of the fo""owing entit ies$

a. Throid nod#"es

b. &reast mass

c. Biver mass

d. Bm!hoadeno!ath

e. B#ng mass

83. Acce!tab"e bio!s methods for a !igmentation "esion inc"#de a"" for the fo""owing exce!t:

a. Excision bio!s

b. P#ncher bio!s

c. Shave bio!s

d. 4ncisiona" bio!s

8'. A *< ears o"d man has an enteroc#tane#s fist#"a originating in the >e>#n#m secondar to inf"ammator+bowe" disease. ;hich of the

fo""owing wo#"d be the most a!!ro!riate f"#id re!"acement of the enteric "oss$

a. )extrose <D

b. 3D norma" sa"ine

c. inger "actate so"#tion

d. 0.CD sodi#m ch"oride

e. *D sodi#m bicarbonate so"#tion

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8<. A @2 ears o"d man stat#s !ost+coronar arter b!ass graft (A&56 < ears ago !resents with hematoche-ia abdomina" !ain and

fever. (o"onosco! revea"s !atches of d#st+a!!earing m#cose at the s!"enic f"ex#re witho#t active b"eeding. ;hich of the fo""owing is

the most a!!ro!riate management of the !atient$

a. Angiogra!h with administration of intra+arteria" !araverine

b. Emergent "a!arotom with "eft hemico"ectom and transverse co"ostom

c. Aortomesenteric b!ass

d. Ex!"orator "a!arotom with thrombectom of the inferior mesenteric arter

e. Ex!ectant management

8*. A 2+wee,s o"d infant in fo#nd to have a hdroce"e. ;hich is the best co#rse of treatment$

a. S#rger of the age of * months

b. S#rger of the age of 2 ears

c. As!iration of the hdroce"e

d. Transscrota" hdroce"ectom of the age of 2 ears

e. 7one of the above

8@. A '8 ears o"d man is stabbed in the right #!!er G#adrant he arrives in the emergenc de!artment h!otensive and with abdomina"

tenderness. e is ta,en emergent" to the o!eration room for "a!arotom. At ex!"oration he is fo#nd to have a <+cm "aceration to the

dome of the "iver that is no "onger b"eeding. 7o other in>#ries are fo#nd the next ste! in management this in>#r wo#"d be:

a. Pring"e mane#ver

b. Pring"e mane#ver and finger fract#re ex!"oration of the in>#r

c. Ex!"oration of the in>#r

d. )rain in>#r area and c"ose the abdomen

e. ("ose the abdomen and get an angiogram

88. The first !riorit d#ring eva"#ation of the m#"ti!"e in>#r !atient who is h!otensive is to:

a. Estab"ish intraveno#s access

b. Jbtain b"ood for crossmatch

c. Perform a mini+ne#ro"ogic examination

d. Access the airwa

e. Search for occ#"t b"eeding

8C. The initia" treatment for !atient with m#"ti!"e bi"atera" ribs fract#res and f"ai" chest with (J2 retention is$

a. Endotrachea" int#bation and !ositive+!ress#re venti"ation

b. S#rgica" fixation of the ribs

c. (hest wa"" immobi"i-ation with sand bags

d. 4ntercosta" nerve b"oc,s

C0. A '1 ears o"d man com!"ains of reg#rgitation of sa"iva and of #ndigested food an eso!hagogram revea"s a birds+bea, deformit

which of the fo""owing statements is tr#e abo#t this condition$

a. (hest !ain is common in the advanced stages of this disease

b. =ore !atients are im!roved b forcef#" di"atation than b s#rgica" intervention

c. =anometr can be ex!ected to show high resting !ress#re of the "ower eso!hagea" s!hincter BES6

d. 4nitia" s#rgica" treatment consists !rimari" of resection of the dista" eso!hag#s with re+anastamosis to the stomach above dia!hragm

e. Patients with this disease are at no increased ris, for the deve"o!ment of carcinoma

8/10/2019 IMLE 18.02.2013


C1. A '3+ ear o"d woman with irritab"e bowe" sndrome was in her #s#a" state of hea"th #nti" a!!roximate" 2 months ago. She

com!"ained of intermittent abdomina" !ain with na#sea no fever. Bast night her !ain became more severe and she !resented to the

emergenc de!artment with fever 3C.@ with rigors. 4n the emergenc de!artment she had rigors and sc"era icter#s direct bi"ir#bin 2.'

a",a"ine !hos!hatase '00 ;&( 18.<00 AST 20 and ABT 21 . L"traso#nd revea"ed a common bi"e d#ct stone. ;hat is the next ste!$

a. Antibiotics and #rgent s#rgica" bi"iar decom!ression E(P6

b. Antibiotics and endosco!ic retrograde cho"angio!ancreatogra!h

c. Antibiotics and trans he!atic bi"iar decom!ression

d. Antibiotics s#rgica" decom!ression and cho"ecstectom

C2. egarding #rinar retention after amb#"ator s#rger which of the fo""owing statements is not tr#e $

a. Lrinar retention is most freG#ent" associated with herniorrha!h and anorecta" !roced#res

b. S!ina" anesthesia b#t not genera" anesthesia is a !redis!osing factor for !osto!erative #rinar retention

c. Posto!erative #rinar retention can freG#ent" be asm!tomatic

d. Amb#"ator s#rger !atients m#st void as criterion for discharge

C3. Se"ect the correct statement regarding f"ai" chest:

a. 4t occ#rs when three or more ad>acent ribs are fract#red in one !"aceb. ;or, of breathing is increased secondar to !aradoxica" chest wa"" motion

c. Patients with f"ai" chest sho#"d be aggressive" res#scitated beca#se of the !robab"e deve"o!ment of a !#"monar cont#sion

d. Patients with this condition sho#"d be !ro!h"actica"" int#bated secondar to high "i,ehood of res!irator fai"#re

e. 4f a !atient does reG#ire mechanica" venti"ation it is im!ortant to avoid the #se of !ositive end+ex!irator !ress#re

C'. A 20 ears o"d ;oman is invo"ved in a high+s!eed motor vehic"e accident with signification damage to the front of the car. She

arrives in the emergenc de!artment with 5(S score of 1<. eart rate of 120 beatsmin res!irator rate of 18 breathsmin and a

ssto"ic b"ood !ress#re of mmg. A chest radiogra!h is obtained and demonstrates a 10+cm mediastin#m a deviation of the "eft stem

bronch#s. ;hat the most a!!ro!riate next ste! in management$

a. Jbservation

b. Beft+sided chest t#be

c. e!eated chest radiogra!h in * ho#rs

d. (T angiogram of the chest

e. Transeso!hagea" echocardiogram

C<. ;hich of the fo""owing is tr#e of rhabdomo"sis$

a. Ac#te rena" fai"#re occ#r secondar to the re"ease of mog"obin

b. An a",a"otic environment !romotes the formation of mog"obin casts in the rena" t#b#"es thereb worsening the ,idne damage

c. The rena" fai"#re from rhabdomo"sis t!ica"" reso"ves within 3+< das

d. Severe h!onatremia is a freG#ent com!"ication

e. A",a"ini-ation to P between 8 and C is an im!ortant treatment goa"

C*. ;ith regard to breast carcinoma in men which statement is tr#e$

a. it is detected most common" in men *0+@0 ears o"d

b. 5necomastia is a ris,

c. 4t is common" associated with a m#tation in &(A1 gene

d. The !rognosis is worse stage for stage that for woman

e. Sentine" "m!h node bio!s is contraindicated

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C@. A 33 ears o"d asm!tomatic women is referred to the c"inician with abnorma" findings on a mammogram. 7o masses are !a"!ab"e

in either breast. The mammogram shows a tight c"#ster or microca"cifications at 2 oc"oc, !osition in her "eft breast. =agnification

com!ression views show at "east 20 tin irreg#"ar ca"cifications in a 2+cm area that var in sha!e and densit with no associated mass

"esion. There are no other ca"cifications !resent in either breast. ;hich of the fo""owing is the most "i,e" diagnosis$

a. B(4S

b. 9ibroadenoma

c. 4nfi"trating d#cta" carcinoma

d. )(4S d#cta" carcinoma in sit#6

e. 9ibrocstic changes

C8. A @2 ears o"d man #ndergoes an aortobifemora" graft for sm!tomatic aortoi"iac occ"#sive disease. The in inferior mesenteric arter

4=A6 is "igated in its aortic attachment. 2' ho#rs after s#rger the !atient has abdomina" distension fever and b"ood diarrhea. ;hich

of the fo""owing is the most a!!ro!riate diagnostic st#d for this !atient$

a. Aortogram

b. =agnetic resonance imaging =46

c. (om!#ted tomogra!h (T6 scan

d. Sigmoidosco!

e. &ari#m enema

CC. The most common ca#se of gastric o#t"et obstr#ction in ad#"ts is$

a. Pe!tic #"cer disease

b. Extrinsic neo!"astic com!ression

c. 5astric cancer

d. Primar "m!homa of the stomach

e. )#odena" (rohns disease

100. ;hich of the fo""owing is tr#e regarding the initia" treatment of !atients with ac#te com!"ete sma"" bowe" obstr#ction$

A. 4mmediate s#rger is warranted as soon as the diagnosis is made

&. 7asogastric decom!ression for 2' ho#rs a""ows s!ontaneo#s reso"#tion of com!"ete bowe" obstr#ction on a"" !atients

c. The !resent of fever tachcardia "oca"i-ed !ain or "e#,octosis s#ggests strang#"ation and warrants !rom!t s#rger

d. A"" !atients with com!"ete sma"" bowe" obstr#ction reG#ire b"ood !"asma for res#scitation

e. 4f a sma"" bowe" resection m#st be !erformed a stoma and m#co#s fist#"a are necessar beca#se an anastomosis is s#b>ect to non

hea"ing in the face of obstr#ction

101. ;hich of the fo""owing serve as "andmar,s when assessing descent of the feta" head$

A. 4schia" s!ines

&. Sm!hsis !#bis

(. 4schia" t#berosities

). Sacra" !romonotor

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102. The diagona" con>#gate is ca"c#"ated b meas#ring the distance between which of the fo""owing anatomica" str#ct#res$

A. (occx and inner margin of sm!hsis !#bis

&. Ti! of scar#m and inner margin of sm!hsis !#bis

(. 4schia" s!ine and externa" margin of sm!hsis !#bis

). Sacra" !romontor and inferior !oint of sm!hsis !#bis

103. At what gestationa" age does the #ter#s become too "arge to "ie tota"" within the !e"vis$

A. * wee,s

&. 12 wee,s

(. 1* wee,s

). 20 wee,s

10'. ;hat is !igmentation of the mid"ine anterior abdomina" s,in d#ring !regnanc ca""ed$

A. Striae gravidar#m

&. Binea nigra

(. (h"oasma

). =e"asma

10<. At what gestationa" age sho#"d "aborator testing for gestationa" diabetes <0 5r g"#cose cha""ange test6 be !erformed$

A. 10+1* wee,s

&. 20+2' wee,s

(. 2'+28 wee,s

). 33+3* wee,s

10*. ;hat n#trient d#ring !regnanc is 7JT adeG#ate" !rovided b diet a"one$

A. (a"ci#m

&. =agnesi#m

(. 4ron

). %itamin A

10@. o#r !atient a Para 1 is considering a second !regnanc. er first chi"d was anence!ha"ic and died soon after birth. o#

recommend what dai" dose of fo"ic acid !ericonce!t#a"" to red#ce the ris, of rec#rrence$

A. 0.' mg

&. ' mg

(. '0 mg

). '00 mg

108. ;hich of the fo""owing characteri-es tr#e "abor$

A. Pain"ess contractions with r#!t#re of membranes

&. Engagement of the feta" head

(. Progressive cervica" di"atation and effacement

). hthmic "ower abdomina" !ain

8/10/2019 IMLE 18.02.2013


10C. ;hat is a "aceration invo"ving the s,in m#co#s membrane !erinea" bod and ana" s!hincter ca""ed$

A. 9irst degree

&. Second degree

(. Third degree

). 9o#rth degree

110. A grad#a" smooth dece"eration of the feta" heart rate that fo""ows the !ea, of a contraction describes which of the fo""owingdece"eration t!es$

A. Bate

&. Ear"

(. %ariab"e

). Pro"onged

8/10/2019 IMLE 18.02.2013


Part &:

1. ;hich of the fo""owing ranges ref"ects the t!ica" "enghth of contractions d#ring "abor$

a. 20+30 sec#nds

b. 30+'0 sec#nds

c. <0+*0 sec#nds

d. 100+120 sec#nds

2. ;hich of the fo""owing is not ris, factor for gestationa" diabetes$

a. Age O2< ear

b. Prior macrosomia infant

c. Prior sti"" born infant

d. Sister with diabetes

3. A woman with severe !reec"am!sia was given =gSJ'. ow is the agnesi#m excreted from the bod$

A. & diff#sion thro#gh the "#ngs

&. & con>#gation in the "iver(. 4n the #rine thro#gh the ,idnes

). & secretion into the gastrointestina" tract

'. ;hat is the feta" and neonata" ris, of materna" 4TP$

a. 4ncreased absorbtion rate

b. Thrombocto!enia

c. 7ecroti-ing enteroco"itis

d. 7o ris,

<. A '1 ear o"d gravida 3 woman !resents with heav !ro"onged menstr#a" b"eeding. L! #nti" 8 months ago she had reg#"ar month"

menses which "asted '+< das .her !hsica" examination and !a! smear are norma". Jn !e"vic #"traso#nd the endometri#m is 1' mm

and there is a 2cmx1.2cm "esion in the #terine cavit . her &+hc5 TS and endometria" bio!s are norma". ;hich of the fo""owing is the

most "i,e" diagnosis$

a. Endometria" !o"!

b. Endometria" h!er!"asia

c. 9ibroid #ter#s

d. Adenomosis

e. )sf#nctiona" #terine b"eeding

*. '@+ear+o"d gravida 3 !ara 3 fema"e has had fibroids a"" of her "ife and has a"was reg#"ar timed heav menses. ecent" the

freG#enc and G#antit of her b"eeding increased. er TS and endometria" bio!s were norma". er hematocrit is 31 D !e"vic LS

shows a m#"tifibroid #ter#s of 18 cm. 3 ear ago her #ter#s was 1< cm and ' ears before that it was 12 cm. The !atient sm!toms

wo#"d best treated b:

a. Jra" contrace!tive !i""s

b. Tota" abdomina" hsterectom

c. SeG#entia" hormone re!"acement thera!

d. sterosco!ic momectom

e. Abdomina" momectom

8/10/2019 IMLE 18.02.2013


@. The mainsta of treatment of e!ithe"ia" ovarian cancer at stage 444A is:

a. adiation thera! a"one

b. S#rger thera! a"one

c. S#rger fo""owed b chemothera!

d. S#rger fo""owed b radiation thera!

e. (hemoradiation

8. The abso"#te contraindication for the #se of estrogen+containing ora" contrace!tive inc"#des:

a. A histor of migraine headaches

b. A histor of !#"monar embo"ism

c. A histor of bi"iar co"ic

d. Sm!tomatic fibroid #ter#s

e. S!tomatic contro""ed h!ertension

C. A 2< ear o"d woman !resents to her gneco"ogist with a !rinci!a" com!"aint of !rimar inferti"it "asting one ear. She has reg#"ar

!eriods that she consider somewhat heav associated with cram!ing !ain d#ring the first 2+3 das of her menses . she #ndergoes a

hsterosa"!ingogram which confirmed t#ba" !atenc b#t demonstrated an irreg#"ar #terine cavit s#rface consistent with s#b+m#cosa"

moma. (onsidering this !atients desire for a !regnanc what is the most a!!ro!riate treatment for her fibroid$

a. Lterine arter embo"i-ation

b. (ombined ora" contrace!tive

c. )e!ot medrox!rogesterone

d. sterosco!ic momectom

e. Tota" hsterectom

10. A co""eag#e as,s for o#r o!inion with a !atient she is c#rrent" examining. The !atient is a 3@+ear+o"d 52 P2 who is !resenting with

!ostcoita" s!otting. er menstr#a" !eriods are reg#"ar in amo#nt and timing. She has never had this sm!tom before and has had the

same sex#a" !artner her h#sband for 8 ears. Jn exam she has norma" externa" fema"e genita"ia and a norma" vagina. er cervix shows

no discharge or cervica" motion tenderness. The cervica" os is noted to contain a 3+mm f"esh !ed#nc#"ated mass. er #ter#s is norma"

in si-e mobi"e and non tender. er "ast Pa! smear was * months ago and was negative for ma"ignanc. ow wo#"d this !atient be best

managed$

a. Jbservation and menstr#a" ca"endar

b. e!eat Pa! smear

c. Pe"vic #"traso#nd

d. emove the mass in the office at that time

e. Abdomina" hsterectom

11. A 2@ear o"d woman !resent to the emergenc de!artment com!"aining of vagina" discharge and abdomina" !ine have fever is

38.1Hc . and on abdomina" examination she has tenderness is the right #!!er g#ardant .and "ower abdomina" with minima" !eritonea"

sings .she was fo#nd to have a m#co#s e""ow discharge on biman#a" examination she has cervica" motion tenderness and bi"atera"

adnexa" tenderness her whit b"ood co#nt is 1'.3 and !e"vic LS shows a norma" #ter#s and norma" ovaries bi"atera"" .the most "i,e"

diagnosis for this !atient is which of the fo""owing$

a. cervicitis

b. Endomometritis

c. P4)

d. TJA

e. LT4

8/10/2019 IMLE 18.02.2013


Canceled 12. A 'C ear o"d woman !resent com!i"ing of v#"var !in that increases with amb#"ation and intercosta" .she a"so notes a "#m!

on her right "abia that has increased in si-e over the !ast '8 ho#rs and is G#it . !ainf#" .the !atient has had these same sm!toms in the

!ast .on exam she has a <cm .tender cst on the medica" as!ect of the right "abia that extends 1 to 2cm awa .what wo#"d be ear first

ste! in management of the !atient$

a. Sits baths

b. Antihistamine agent

c. Boca" antibioticsd. Sim!"e v#"vectom

e. =ars#!ia"i-ation

Canceled 13. A *< ear o"d !ost+meno!a#sa" fema"e !resent for her ann#a" exam witho#t com!"ains. she has a witho#t !atch area

between the !osterior forchette of the vagina;itho#t !r#rit#s or irritation. o# obtain a bio!s of the area .and the !atho"og re!ort

diagnosis "ichen sc"erosis what is the first "ine treatment for this "esion$

a. ;ide "oca" excision

b. ("obetaso"

c. Baser ra!ori-ation

d. Tro!ica" antif#nga"e. Tro!ica" estrogen cream

1'. A 28 ear !aint #nderwent a di"atation and evac#ation of the #ter#s for com!"ete mo"ar !regnanc .she was fo""owed withe wee,"

&+hcg "eve"s .initia"" her &+ hcg "eve"s dec"ined . #nfort#nate" the "eve" then !"atea#ed and 8+wee,s after evac#ation .began to rise for

two wee, the !atient has been re"iab" ta,ing ora" contrace!tive !i""s .the eva"#ation of metastatic disease in negative .how do o#

mange her disease of this stage$

a. (ontin#e ex!ectant management

b. e!eat )(

c. Tota" abdomina" hsteroctoma

d. Sing"e Iagent chemothera!

e. =#"ti+agent chemothera!

1<. ;hich of the fo""owing is not regarding s!erm !re!aration and intra#terine in>ection i#i6$

a. 4T is a mean to treat s!erm disorder defined as mi"d to moderate

b. The !#r!ose of s!erm enhancement is to choose s!erm with advanced movement

c. The !#r!ose of s!erm enhance is to im!rove s!erm ca!acitation

d. The !#r!ose of s!erm enhance is to concentrate the semen sam!"e

e. The !#r!ose of s!erm enhance is to discard the semina" f"#id

1*. ;hich of the fo""owing is correct regarding varicoce"e in men$

a. 4t invo"ves s#bstantia" stenosis of the testic#"ar veno#s !am!iniform !"ex#s

b. ("inica" varicoce"e is defind as !a"!a"e di"ated veins on !hsica" examination of the testes

c. %aricoce"e."igation or embo"i-ation a"was im!rove s!erm G#a"it

d. =a"e inferti"it is a"was an indication for re!air of s#bc"inica"seen b #"tra so#nd6 varicoce"e

e. 4t is wide" acce!ted that varicoce"e red#ces s!erm G#a"it b decreasing testes tem!erat#re

8/10/2019 IMLE 18.02.2013


1@. ;hich of the fo""owing is correct regarding testosterone$

a. <0D of the testosterone in !rod#ced b the ovar

b. 80D is binded of S&5 and 1CD is binded to a"b#min

c. The testosterone that is binded to S&5 is the active testosterone

d. 2<D of the testosterone is !eri!hera" formed

e. (irc#"ating testosterone "eve" in mat#re woman are abo#t 100ngd"

18. 4n which of the fo""owing cases !regnanc m be achieved on" via invitro ferti"i-ation$

a. A fa""o!ian t#be that was damaged and obstr#cted fo""owing P4) and a norma" contra"atera" on

b. An obstr#cted fa""o!ian t#be fo""owing P4)6 and a contra "atera" one after !regnanc and sa"!ingostom

c. Lni"atera" sa"!ingectom and ma"e s!erm c#nt of 10Q< ce""sm"

d. =a"e s!erm c#nt of 100R10Q* ce""sm" and an obstr#cted fa""o!ian t#be fo""owing P4)6

e. 9a""o!ian t#be with hdrosa"!inx and !assage of co"or to the !e"vis and norma" contra"atera" on

1C. ;hich of the fo""owing is a test for ovarian reserve$

a. 9S "eve" one cc"e da3

b. Estradio" "eve" on cc"e da *c. Progesterone "eve" fo""owing ov#"ation

d. B "eve" before ov#"ation

e. 4nhibin A "eve"

20. ;hich of the fo""owing is not an 4%9 com!"ication$

a. Jvarian over stim#"ation

b. 9a""o!in t#be !regnancies

c. =#"tifeta" !regnancies

d. eteroto!ic !regnancies

e. Jvarian cancer

21. ;hat is correct for oseo!erosis$

a. &one mass increase ti"" age '0

b. women "oose on average 10D bone mass after meno!a#se

c.2<D of women above age <0 wi"" have osteo!orosis

d. T score O +1

e. Estrogen in not the first "ine thera!

22. ;hat are the indications for estrogen treatment in meno!a#se$

a. Jsteo!orosis !revention coronar heart disease !revention management of vagina" and v#"var atro!h

b. Jsteo!orosis !revention treatment of vasomotor sm!toms management of vagina" and v#"var atro!h

c. (oronar heart disease !revention mood im!rovement !revention of A"-heimers disease

d. =ood im!rovement treatment of vasomotor sm!toms !revention of A"-heimers disease

e. (oronar heart disease !revention management of vagina" and v#"var atro!h !revention of A"-heimers disease

8/10/2019 IMLE 18.02.2013


23. ;hat is not tr#e abo#t ovarian stim#"ation$

a. (an be triggered b recombinant or #rinar gonadotro!ins

b. There is indication for ser#m estradio" test and LS for fo""ic#"ar monitoring

c. (5 give at "east one fo""ic"e at si-e 1'mm

d. 5n agonist and antagonist given to !revent

e. Jv#"ation occ#r 3*hr after (5 administration

2'. ;hat is tr#e regarding a woman with =""erian agenesis$

A. The "ac, the #!!er !art of the vagina

&. 9a""o!ian t#bes exist

(. '* or '<0 ,arot!e

). Entire vagina and #ter#s are missing

E. &"eeding wi"" a!!ear after estrogen and !rogesterone administration

2<. ;hich of the fo""owing !"acenta" im!"antation most "i,e !redis!osed to inverted #terine in 3rd

stage of "abor$

a. 9#nda"b. Anterior

c. Posterior

d. Batera"

e. B#mbar stage of "abor

2*. A @0+ear+o"d man com!"ains of fever and !ain in his "eft ,nee. Severa"

das !revio#s" he s#ffered an abrasion of his ,nee whi"e wor,ing in his garage.

The ,nee is red warm and swo""en. An arthocentesis is !erformed which shows 200000 "e#,octesUB and a g"#cose of 20 mgdB. 7o

crsta"s are noted. ;hich of the fo""owing is the most im!ortant next ste!$

a. 5ram stain and c#"t#re of >oint f"#id

b. Lrethra" c#"t#re

c. Lric acid "eve"

d. Antin#c"ear antibod

e. Antine#tro!hi" cto!"asmic antibod

2@. Se!tic arthritis $$$

a. Stre! !ne#monia

b. 7essiriha

c. E.co"i

d. Sta! ar#s

28. *< ear man s#dden onset of sever ,nee !ain. /nee is red swo""en and tender. )= in the histor and cardiomo!ath. 4n ra

"inear ca"cification. /nee diagnosis made b:

a. Ser#m #ric acid

b. Ser#m ca"ci#m

c. Arthcentesis and !ositive birefrigniat

d. (rsta"s

e. eh#matid factor

8/10/2019 IMLE 18.02.2013


2C. @0+ear+o"d fema"e with mi"d dementia com!"ains of hi! !ain. There is some "imitation of motion in the right hi!. The first ste! in

eva"#ation is:

a. (&( and erthroctes sedimentation rate

b. he#matoid factor

c. +ra of right hi!

d. &one scan

30. A '0+ear+o"d a"coho"ic deve"o!s co#gh and fever. (hest +ra shows an air+f"#id "eve" in the s#!erior segment of the right "ower

"obe. The most "i,e" etio"ogic agent is:

a. Stre!tococc#s !ne#monia

b. aemo!hi"#s inf"#en-a

c. Begiona"e

d. Anaerobes

31. A *0 ear+o"d ma"e on as!irin nitrates and beta b"oc,er being fo""owed for chronic stab"e angina !resent to E. with histor of 2+3

e!isodes of more severe and "ong "asting angina chest !ain each da over the !ast 3 das E(5 and cardiac en-mes are norma". &est

co#rse of action

a. Admit the !atient and begin 4.% digoxin

b. Admit the !atient and begin 4.% he!arin

c. Admit the !atient and give !ro!h"actic thrombo"tic thera!

d. Admit the !atient for observation with no change in medications

e. )ischarge the !atient from E. with increase nitrates and beta b"oc,er

32. A"coho"ic 3< ear+o"d ma"e is admitted for na#sea vomitting and abdomina" !ain that radiates to bac, Bab va"#e that s#ggests a

!oor !rognosis in the !atient is:

a. E"evated ser#m Bi!ase

b. E"evated ser#m Am"ase

c. Be#,octosis of 20.000VB

d. )iasto"ic b"ood !ress#re higher than C0 mmg

33. '0 ear+o"d cigarette smo,er com!"ais of e!igastric !ain we"" "oca"i-ed nonradiating and described a b#rning. The !ain !artica""

re"ieved b eating. There is no weight "oss he has not #sed 7SA4) the !ain has grad#a"" worsened over severa" months. =ost sensitive

wa to ma,e a s!ecific diagnosis:

a. &ari#m +ra

b. Endosco!

c. Sero"ogic test for . P"ori

d. Ser#m 5astrin

3'. The best wa to eradicate . P"ori is$

a. Jme!ra-o"e 20 mg PJ for * wee,s anitidine 300 mg PJ Ghs * wee,s

b. Jm!era-o"e 20 mg &4) Amoxici""in 1000 mg &4) ("arithromcin <00 mg &4) for 1' das

c. &ito+&ismo" and =etronida-o"e &4) for @ das

d. S#cra"fate 200 mg F4) for * wee,s

8/10/2019 IMLE 18.02.2013


3<. '0 ear+o"d ma"e with "ong standing a"coho" ab#se com!"ains of abdomina" swe""ing which has been !rogressive over severa"

months istor of 54 b"eeding on !hsica" examination s!ider angigrams and !a"mar ethema abdomina" co""atera" vesse"s are seen

aro#nd #mbi"ic#s shiftting d#""ness and d#""ness f"an, are noted. =ost im!ortant 1st

ste! in !atient eva"#ation :

a. )iagntostic !ancreatitis

b. L!!er 54 series

c. Ethano" "eve"

d. (.T scan

3*. ;hi"e os!ita"i-ed a cirrhotic !atient menta" stat#s deteriorates e has been having g#aiac+!ositive stoo"s and "ow grade fever e

a"so received sedation for agitation on !hsica" examination !atient is conf#sed no meningea" signs and no foca" ne#ro"ogica" findings

there is h!erref"exia and nonrhthmic fa!!ing tremors of the wrist most "i,e" ex!"anation for the menta" stat#s change:

a. T#berc#"osis meningitis.

b. S#bd#ra" hematoma.

c. A"coho" withdraw" sei-#re.

d. e!atic ence!ha"o!ath

3@. A '0 ear+o"d white ma"e com!"ains of wea,ness weight "oss and abdomina" !ain on !hsica" examination the !atient has diff#seh!er!igmentation and !a"ab"e "iver edge !o"arthritis of the wrists and hi!s is a"so noted fasting b"ood s#gar 18< mgd" most "i,e"

diagnosis :

a. 4ns#"in+de!endent )=

b. Pancreatic carcinoma

c. Addisons )isease

d. emochromatosis

38. A 3' ear+o"d white woman is treated for #rinar tract infection with amoxici""in 4nitia"" she im!roves b#t < das after beginning

treatment she deve"o!s rec#rrent fever abdomina" b"oating and diarrhea with *+8 "oose stoo"s !er da o# s#s!ect Antibiotic+

associated co"itis The best diagnosis test is:

a. 4dentification of ("ostridi#m diffici"e toxin in the stoo"

b. 4so"ation of ("ostridi#m diffici"e in a stoo" c#"t#re

c. Stoo" !ositive for ;&(

d. )etection of 4g5 antibodies against ("ostridi#m diffici"e in the ser#m

3C. A << ear+o"d ma"e is being eva"#ated for consti!ation there is no histor of !rior 5.4. Sm!toms b is 10 gd" =(% is @2 f " Ser#m

iron is ' #gd" W7orma" <0+1<0X Sat#ration is 1D W7orma" 20+'< DX ferritin is 10 #g" W7orma" 1<+'00 #g"X next ste! in the eva"#ation of

this !atient anemia:

a. &( fo"ate

b. 4ron absor!tion st#dies

c. (o"onosco!

d. &one =arrow examination

8/10/2019 IMLE 18.02.2013


'0. A *0 ear+o"d asm!tomatic man is fo#nd to have "e#,octosis when a ro#tine (&( is obtained Phsica" exam shows no

abnorma"ities s!"eein is notma" si-e Babrator data:

gb: C gd" W7orma" : 1'+18X

Be#,octes: '0000 #" W7orma": '300+10800X

Peri!hera" b"ood smear shows a differentia" that inc"#de C@D sma"" "m!hoctes.

The most "i,e" diagnosis$

a. Ac#te monoctic "e#,emiab. (hronic me"ogeno#s "e#,emia

c. (hronic "m!hoctic "e#,emia

d. T#berc#"osis

'1. A !atient diagnosed to s#ffer from chronic "m!octic "e#cemia wi"" reG#ire chemothera!:

a. 4f the white b"ood ce"" co#nt rises

b. 4f "m!hadeno!ath deve"o!s

c. To contro" anemia or thrombocto!enia

d. Jn" when ac#te "m!hoctic "e#,emia deve"o!s

'2. A *' ear o"d ma"e is hos!ita"i-ed with a transient ischemic attac, and is eva"#ated for carotid disease. Phsica" exam is norma". (&(

on admission is norma". the !atient is started on he!arin. A re!eat (&( 1 wee, "ater shows an g of 1' ;&( C000 and PBT 10000.

o# sho#"d$

a. Jbtain a bone marrow st#d

b. Jbtain a "iver s!"een scan

c. S#s!ected dr#g ind#ced thrombocto!enia !#r!#ra

d. &egin corticosteroids for 4TP

'3. The !atient described deve"o!s thrombosis of the brachia" arter. The next ste! in management is:

a. B#!#s anticoag#"ant

b. Antin#c"ear antibod

c. Be!ir#din or dana!aroid

d. 4ncrease he!arin dose

''. A @0 ear o"d intensive care #nit !atient com!"ains of fever and sha,ing chi""s. The !atient deve"o!s h!otension and b"ood c#"t#res

are !ositive for gram negative baci""i. The !atient begins b"eeding from veni!#nct#re sites and aro#nd his fo"e catheter. "aborator

st#dies are as fo""ows: (T 38D ;&( 1<000 PBT '0000 norma" 130000to '00006 !erifera" b"ood smear: fragmented &(s. PT

e"evated PTT e"evated !"asma fibrinogen @0 norma" 200+'006. The best co#rse of thera! in this !atient is:

a. &egin he!arin

b. Treat #nder"ing disease

c. &egin !"asma!heresis

d. 5ive vitamin /

e. &egin red b"ood ce"" transf#sion

8/10/2019 IMLE 18.02.2013


'<. A 30 ear o"d fema"e with graves disease has been started on !ro!h"thio#raci". She com!"ains of "ow grade fever chi""s and sore

throat. The most im!ortant initia" ste! in eva"#ating this !atients fever is$

a. Ser#m TS

b. Ser#m T3

c. (&(

d. (hest +ra

e. &"ood c#"t#re

'*. A 2C ear o"d woman !resents to the emergenc de!artment with a com!"aint of s#dden onset of "eft facia" wea,ness that was

noticed b her cowor,er. She denies fever rash or an other sm!toms. Jn !hsica" examination she has no other ne#ro"ogic deficits

other than what is shown described. ;hen as,ed to sh#t her "eft ee she cannot. ;hich of the fo""owing is the most "i,e" diagnosis$

a. &e"" !a"s

b. =a"ingering

c. amsa h#nt sndrome

d. &rain t#mor

e. (erebrovasc#"ar event

'@. A '8 ear o"d man with a !ast medica" histor of he!atitis ( and cirrhosis !resents to the emergenc de!artment with a com!"aint ofac#te onset of abdomina" !ain and chi""s. o# decide to !erform a !aracentesis. o# retrieve 1 B of c"o#d f"#id. Baborator ana"sis of

the f"#id shows a ne#tro!hi" co#nt of <<0 ce""mm3. ;hich of the fo""owing is the most a!!ro!riate choice of tratment$

a. =etronida-o"e

b. %ancomcine

c. Am!hotericine

d. 7eomcine and Bact#"ose

e. (efotaxim

'8. A @2 ear o"d woman with a histor of h!ertension and tobacco #se !resents to o#r c"inic com!"aining of chest !ain for the "ast 2

wee,s. She describes the !ain as !ress#re "i,e with radiation to the "eft arm. 4t is exacerbated b exertion and re"ieved b rest. There

are no associated sm!toms. She denies an histor of chest !ain. er vita" signs are stab"e and the !hsica" examination is

#nremar,ab"e. An E(5 shows signs of "eft ventric#"ar h!ertro!h. Baborator tests inc"#ding cardiac biomar,ers are within norma"

"imits. which of the fo""owing is the most "i,e" diagnosis$

a. 7on STE=4

b. Pericarditis.

c. Lnstab"e angina

d. Stab"e angina

'C. A <2 ear o"d man with a histor of h!ertension diabetes and h!er"i!idemia !resents to the emergenc de!artment with chest

!ain of 3 ho#rs d#ration. an E(5 shows 1 mm ST de!ression in the inferior "eads. Tro!onin is e"evated and the !atient is diagnosed with

a non STE=4. e is treated with as!irin meto!ro"o" he!arin and c"o!idogre" and admited to the coronar care #nit. a "eft heart

catheteri-ation revea"s CCD occ"#tes right coronar arter. P(4 is !erformed with adr#g e"#ting stent. ow "ong sho#"d this !atient be

treated with c"o!idogre"$

a. Jne wee,

b. 1 month

c. At "east 3 months

d. At "east one ear

8/10/2019 IMLE 18.02.2013


<0. A <C ear o"d man is diagnosed with a non STE=4. She receives a dr#g e"#ted stent to her midd"e "eft anterior descending coronar

arter. Transthoracic echocardiogra!h revea"s an E9 of 3<D. er medications at discharge inc"#de as!irin c"o!idogra" atorvastatin

meto!ro"o" and rami!ri". According to the g#ide"ines which of the fo""owing medication sho#"d be added to this !atients regimen$

a. ;arfarin

b. 9#rosemide

c. E-etimibe

d. S!irono"actone

<1. A '<+ear+o"d fema"e !resents to o#r office. She was see 10 das ago b a co""eag#e with com!"aints of !rogressive fatig#e

ma"aise and abdomina" discomfort occ#rring over the "ast 10 months. She has a"so com!"ained of !o"arthra"gias. She is not obese and

does not drin, a"coho". er recent "aborator tests revea" norma" ser#m chemistries norma" tota" bi"ir#bin norma" a",a"ine

!hos!hatase as!artate aminotransferase AST6 C2 4LB a"anine aminotransferase ABT6 8* 4LB ser#m a"b#min 3.2 gdB tota" !rotein

*.8 gdB and increased +g"ob#"in "eve". o# s#s!ect a#toimm#ne he!atitis A46. 4n addition to obtaining a "iver bio!s which of the

fo""owing "aborator tests he"!s estab"ishing a diagnosis of A4 in this !atient$

A. Antin#c"ear antibod A7A6

&. Antimitochondria" antibod A=A6

(. Anti+Saccharomces cerevisiae antibod AS(A6). Anti+smooth m#sc"e antibod AS=A6

<2. A *2+ear+o"d fema"e !resents to o#r office !rior to starting (JP chemothera! cc"o!hos!hamide Adriamcin Wdoxor#bicinX

vincristine and !rednisone6 for new" diagnosed non+odg,in "m!homa. She has a histor of treated he!atitis & 10 ears !revio#s"

and has had no seG#e"a from the disease or treatment confirmed b a seroconversion of &eAg !ositive stat#s to anti+&e and &sAg

to anti+&s stat#s. She is not on an medications c#rrent". er !hsica" examination is significant on" for b#", adeno!ath. Prior to

initiating chemothera! which of the fo""owing diagnostic tests sho#"d be chec,ed in this !atient$

A. Ser#m crog"ob#"in "eve"s

&. Abdomina" #"trasonogra!h to eva"#ate for bi"iar obstr#ction

(. e!atitis & vira" "oad b P( am!"ification &sAg and anti+&c

). e!eat "iver bio!s to ens#re tr#e eradication of he!atitis &

<3. A '3+ear+o"d man !resents with !a"!itations and shortness of breath. Jn examination his b"ood !ress#re is 12'80 mm g heart

rate is 128 beats min and irreg#"ar and tem!erat#re is 3*.*K(. e has moderate bi"atera" exo!htha"m#s a !a"!ab"e goiter and mi"d

wea,ness in his bi"atera" "ower extremities. An E(5 confirms atria" fibri""ation with ra!id ventric#"ar res!onse and TS at 0.003 ULmB

0.< to '.@ ULmB6. ;hich of the fo""owing is the most a!!ro!riate treatment for the atria" fibri""ation in this !atient$

A. Pro!"thio#raci"

&. 4odide

(. Pro!rano"o"

). Prednisone

8/10/2019 IMLE 18.02.2013


<'. A **+ear+o"d man is bro#ght to the emergenc de!artment b his wife. She re!orts that he accidenta"" too, an extra dose of each

of his medications abo#t 3 ho#rs ago. is medications are as!irin meto!ro"o" and f"#vastatin. Phsica" examination revea"s a somno"ent

man with a heart rate of 33 b!m and a b"ood !ress#re of @<30 mm g. e is treated with intraveno#s f"#ids 4%6 activated charcoa"

and a cathartic agent. ;hich of the fo""owing is the best treatment for h!otension and bradcardia ca#sed b ac#te beta+b"oc,er

toxicit$

A. )o!amine

&. 4so!rotereno"(. 5"#cagon

). )igoxin

<<. o# are as,ed to eva"#ate a <<+ear+o"d man with 5*P) deficienc who deve"o!ed ac#te onset of shortness of breath after receiving

to!ica" ben-ocaine !rior to an endosco!. Phsica" examination revea"s a mi"d" canotic man who is tach!neic and tachcardic. P#"se

oximetr revea"s an oxgen sat#ration of 82D. ;hich of the fo""owing "aborator tests is most "i,e" to confirm this !atients diagnosis$

A. =ethemog"obin "eve"

&. (arboxhemog"obin "eve"

(. Acetamino!hen "eve"

). %eno#s oxgen sat#ration

<*. A @2+ear+o"d woman with rhe#matoid arthritis is bro#ght to the emergenc de!artment b her da#ghter. The !atients da#ghter

re!orts that her mother has been having more >oint !ain for the "ast 2 das and this morning she too, an extra dose of oxcodone. She

then became conf#sed !rom!ting her da#ghter to bring her to the emergenc de!artment. Phsica" examination revea"s an e"der"

woman who is somno"ent and diffic#"t to aro#se. er heart rate and b"ood !ress#re are stab"e b#t she is on"

breathing 8 times !er min#te. er !#!i"s are 1 mm in diameter and smmetric. Jf the fo""owing what is the best treatment for this

!atient at this time$

A. 4ntraveno#s f"#ma-eni"

&. 4ntraveno#s fome!i-o"e

(. Transveno#s cardiac !acema,er

). 4ntraveno#s na"oxone

<@. A @<+ear+o"d !atient !resents to the E after a s#dden snco!a" e!isode. e is again a"ert and in retros!ect describes occasiona"

s#bsterna" chest !ress#re and shortness of breath on exertion. is "#ngs have a few bibasi"ar ra"es and his b"ood !ress#re is 11080. Jn

cardiac a#sc#"tation the c"assic finding o# ex!ect to hear is:

A. A harsh ssto"ic crescendo+decrescendo m#rm#r heard best at the #!!er right sterna" border

&. A diasto"ic decrescendo m#rm#r heard at the mid+"eft sterna" border

(. A ho"ossto"ic m#rm#r heard best at the a!ex

). A midssto"ic c"ic,

<8. A @2+ear+o"d ma"e comes to the office with intermittent sm!toms of ds!nea on exertion !a"!itations and co#gh occasiona""

!rod#ctive of b"ood. Jn cardiac a#sc#"tation a "ow+!itched diasto"ic r#mb"ing m#rm#r is faint" heard toward the a!ex. The origin of

the !atient?s !rob"em !robab" re"ates to:

A. he#matic fever as a o#th

&. Bong+standing h!ertension

(. Si"ent =4 within the !ast ear

). (ongenita" origin

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<C. A @0+ear+o"d ma"e com!"ains of the s#dden onset of snco!e. 4t occ#rs witho#t warning and with no sweating di--iness or "ight+

headedness. e be"ieves e!isodes tend to occ#r when he t#rns his head too G#ic," or sometimes when he is shaving.

The best wa to ma,e a definitive diagnosis in this !atient is:

A. E(5

&. (arotid massage with E(5 monitoring

(. o"ter monitor). E"ectro!hsio"ogic st#dies to eva"#ate the A% node

*0. A 32+ear+o"d diabetic fema"e who ta,es an estrogen+containing ora" contrace!tive and drin,s three beers !er da is fo#nd to have a

trig"ceride "eve" greater than 1000 mgdB. She is at ris, for which of the fo""owing com!"ications$

A. Ac#te !ancreatitis

&. S#dden cardiac death

(. Ac#te !eri!hera" arteria" occ"#sion

). Ac#te rena" ins#fficienc

E. =ositis

*1. A hea"th '< ear o"d women with no medication comes to o#r office with 10 das of nasa" congestion sore throat dr co#gh and

initia" "ow tem!erat#re a"" that near" reso"ved. Jver the !ast 2'+'8 ho#rs she deve"o!s a shar! chest !ain b dee! ins!iration or co#gh

b#t no ds!nea. )#e the severit of the !ain the n#rse ma,es E(5 that shows a diff#se ST+e"evation.

Jn the !hsica" examination is most "i,e" to find:

a6 Bo#d !#"monic com!onent of S2

b6 A S3 ga""o!

c6 A !ericardia" friction r#b

d6 A bi"atera" basi"ar ra"es

e6 A high b"ood !ress#re of 1*0100 mmg

*2. A 20 ears o"d n#rsing st#dent com!"ains of asthma on s#rgica" rotation. She deve"o!s dermatitis of the hands and the sm!toms

worse when she in the o!eration room.

;hich of the fo""owing is correct$

a6 This is an a""ergic reaction that is a"was begins

b6 The !atient sho#"d eva"#ate for "atex a""erg with s,in test or s!ecific 4gE antibod

c6 This sndrome is "ess common now than 10 ears ago

d6 An ora" corticosteroids is indicated

*3. A 30 ears o"d man deve"o!s s,in rash !#rities and mi"d whee-ing 20 min#tes after an 4.% Pe"ogram !reformed for eva"#ation of a

rena" stone sm!tomatic.

A best a!!roach to diagnosis inc"#des:

a6 Perform a 2' ho#rs #rine+histamine meas#rement

b6 =eas#re of 4gE to radio contrast media

c6 )iagnosis of radio contrast media sensitivit histor

d6 ecommend intra derma" s,in testing

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*'. A 2@ ears o"d #ndergoes a fo""ow #! eva"#ation < months after the diagnosis of idio!atic !#"monar embo"ism for which she was

!rescribed at * month co#rse anticoag#"ant thera!. 9ami" histor a materna" grandmother too, warfarin man ears for #n,nown

reasons. An o"der brother with histor of )%T at age 32. Patient ta,es no ora" contrace!tive !i""s or other medication. She is hea"th.

The (&( is norma" 47 is 3.0 ;hich of the fo""owing is most a!!ro!riate next ste! of eva"#ation of the !atient:

a6 4mmediate thrombo!hi"ie+screening

b6 A/2 m#tation ana"sisc6 7o f#rther eva"#ation is needed

d6 Thrombo!hi"ie+screening at "east two wee,s after thera! session

*<. A 82 ears o"d man com!"ains of two ho#rs severe chest !ain that occ#rred whi"e !"aing tennis. &"ood !ress#re on admission is

1'0@0 !#"se 110. 7o signs of congestive heart fai"#re. P#"ses a"" !a"!ab"e abdomina" exams are norma" ne#ro"ogic exams are norma"

and stoo"+5#aniac is negative no histor of gastro intestina" b"eeding !revio#s stro,e head tra#ma or ma>or s#rger no histor of

vasc#"ar disease or "iver disease. E(5 shows ST segment e"evation of 3 mm in "eads %1+%3 and 3 !remat#re ventric#"ar beatsmin. 4nitia"

treatment of choice is:

a6 Pro!h"actic Bidocaineb6 Thrombo"tic thera! with as!irin

c6 e!arin

d6 As!irin a"one

**. A frai" 80 ears o"d n#rsing home resident had severa" e!isodes of snco!e a"" which have occ#rred whi"e she was ret#rning to her

room after brea,fast. She com!"ains of "ight headedness and stats she fee"s co"d and wea,. She ta,es nitrog"cerin in the morning for

histor of chest !ain b#t denies recent chest !ain or shortness of breath. The most "i,e" method of diagnosis is:

a6 (ardiac catheter

b6 Post!randia" b"ood !ress#re monitoring.

c6 o"ter+monitor

d6 (T scan

*@. A 30 ears o"d women !resent with com!"ains of !aresthesias wea,ness "ea, of coordination and diffic#"t with gait. er sm!toms

are worse after hot shower. Examination of cerebros!ina" f"#id shows o"igoc"ona" imm#nog"ob#"in antibodies 4g5. The most "i,e"

diagnosis is:

a6 =#"ti!"e sc"erosis

b6 #ntington disease

c6 Par,inson disease

d6 7e#rofibromatosis disease

e6 Amotro!hic "atera" sc"erosis ABS6

*8. A <* ears o"d man !resent to o#r office with com!"ains of chronic diarrhea. e states that he has "oose stoo" for the "ast 2 das. e

denies b"ood in stoo" and fever. e has no weight "oss and no recent trave". A!!ro!riate management at this time inc"#des:

a6 Jbservation

b6 (hec, stoo" c#"t#re

c6 (o"onosco!

d6 Stoo" fat st#d

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*C. A 23 ears o"d man c"imbing =o#nt /i"iman>aro has no medica" !rob"ems and ta,es no medication. Short" after the c"imbs he

deve"o!s sever shortness of breath !hsica" examination shows diff#se bi"atera" crac,"es. ;hich is the most "i,e" etio"og$

a6 Ac#te interstitia" !ne#monitis

b6 Ac#te res!irator distress sndrome

c6 (ardiogenic shoc,

d6 (omm#nit acG#ired !ne#moniae6 igh a"tit#de !#"monar edema

@0. A *< ears o"d man admitted to the hos!ita" with com!"ains of shortness of breath. e has no !rior medica" care. Baborator notifies

o# of &+ natri#retic !e!tide va"#e of 1<00 !gd" o# s#s!ect the fo""owing diagnosis:

a6 Asthma exacerbation

b6 (JP) exacerbation

c6 P#"monar embo"ism

d6 )%T

e6 (ongestive heart fai"#re

@1. A hos!ita"i-ed !atient is receiving a b"ood transf#sion. The f"oor n#rse re!orts that the !atient is f"#shed is com!"aining ofabdomina" discomfort and has a tem!erat#re of 38.'K(. The most a!!ro!riate management is to:

A. 5ive the !atient acetamino!hen and contin#e the transf#sion at a s"ower rate

&. Administer di!henhdramine and contin#e the transf#sion

(. Administer 100 mg of hdrocortisone intraveno#s" and red#ce the rate of the transf#sion

). Sto! the transf#sion and increase intraveno#s f"#ids

E. Administer intraveno#s ranitidine and order an abdomina" series x+ra

@2. A <8+ear+o"d woman with a !revio#s histor of infectio#s endocarditis !resents for advice regarding antibiotic !ro!h"axis !rior to a

denta" !roced#re. The !roced#re wi"" invo"ve significant gingiva" mani!#"ation. She has no ,nown a""ergies. ;hich of the fo""owing is

recommended !ro!h"axis for this !atient$

A. Bevof"oxacin

&. ("arithromcin

(. 7o antibiotic !ro!h"axis is needed

). Amoxici""in

@3. ;hich of the fo""owing is the most "i,e" factor contrib#ting to chronic me"oid "e#,emia$

A. Ex!os#re to radiation

&. 9ami" histor of cancer

(. Tobacco ab#se

). Phi"ade"!hia chromosome

@'. A '1+ear+o"d b#siness exec#tive !resents to o#r office and com!"ains of !a"!itations and shortness of breath. After f#rther

G#estioning he admits to heav a"coho" cons#m!tion the !revio#s evening. Jn examination he is fo#nd to have an irreg#"ar heartbeat

of 130 b!m. The most "i,e" diagnosis is:

A. %entric#"ar tachcardia

&. %entric#"ar fibri""ation

(. Premat#re ventric#"ar contractions P%(s6

). Atria" fibri""ation

E. ;o"ff+Par,inson+;hite sndrome

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8/10/2019 IMLE 18.02.2013


81. The re"ationshi! between mitra" va"ve !ro"a!se =%P6 and !anic disorder can be described as$

a. 4m!ortant to recogni-e and treat mitra" va"ve !ro"a!se in !anic disorder

b. igh c"inica" re"evance.

c. Patient with !anic disorder are !redis!osed to deve"o! =%P

d. igher incidence of =%P in !atients with !anic disorder

e. Panic disorder is ver we"" contro""ed if =%P is corrected.

82. A <* ear o"d anxio#s exec#tive ca""s at <:00 beca#se he wo,e #! with chest tightness and shortness of breath. e was scared that

he was having a heart attac, and he a"so re!orted fee"ing di-- tremb"ing and his heart was !o#nding he tho#ght he was going to die.

The sm!toms s#bsided in 20 min#te and b the time the emergenc medica" services arrived he was sitting in his "iving room and in no

distress. The !atients e"ectrocardiogram reading was norma" and his cardiac en-mes were a"so fo#nd to be norma". ;hat is the most

"i,e" diagnosis$

a. 7oct#rna" !anic attac,

b. PTS)

c. Pscho!hsio"ogica" insomnia

d. Somati-ation disorder

e. =ocardia" infraction

83. A 22 ear o"d fema"e is se"f I referred for an eva"#ation to r#"e o#t bi!o"ar disorder. She com!"ains of ra!id mood swings with a

contro""ab"e anger and irritabi"it. )#ring the assessment it is noted that she has not had an s#stained re"ationshi!s for man ears and

fee"s em!t she fear abandonment b her fries and b"ames other of ma,ing her fee" angr . ;hat is the most im!ortant differentia"

diagnosis in this !atient$

a. =a>or de!ressive disorder

b. &order"ine !ersona"it disorder

c. istrionic !ersona"it disorder

d. )e!ressive !ersona"it

e. 5enera"i-ed anxiet disorder

8'. <* ears I o"d fema"e is admitted to an ac#te !schiatric in!atient #nit for severe de!ression the !atient was r#minating abo#t

s#icide and g#i"t fee"ings that were distressing her. She is HconvincedH that she has committed sin and deserved to be !#nished.

a"tho#gh there was nothing in her histor to >#stif this the resident doctor thin,s that the !atient is obsessed with tho#ghts of g#i"t

and fee" that the !atient has a !rimar obsessiona" disorder a tria" of antide!ressant medication was not he"!f#" des!ite tring a high

dose the attending !hsician ex!"ains that the !atient is not obsessiona" b#t severe" de!ressed beca#se $

a. She has s#icide ideation

b. She has indeed committed sin and is now de!ressed

c. She is distressed b the g#i"t fee"ing and is HconvincedH of the sin

d. The attending !hsician thin,s so

e. Antide!ressants a"one were not effective

8<. The manifestation of de!ression sm!toms are s"ight" different age gro#!s and a"so in men and women. Agitated de!ression is a

term more common" #sed to describe de!ression in which gro#! of !atients$

a. o#ng chi"dren

b. Ado"escents

c. Ad#"ts

d. ;omen

e. E"der"

8/10/2019 IMLE 18.02.2013


8*. The term do#b"e de!ression is #sed to describe$

a. =a>or de!ressive disorder s#!erim!osed on grief reaction

b. =a>or de!ressive disorder s#!erim!osed on dsthmia

c. =a>or de!ressive disorder !atient not res!onding to treatment

d. =a>or de!ressive disorder with !schosis

e. =a>or de!ressive disorder with anxiet

8@. A 3* I ear o"d (a#casian ma"e is stab"e on "ithi#m for bi!o"ar disorder for the !ast ' ears .d#ring his ro#tine visit with his fami"

!hsician. e com!"ains of fatig#e and "ac, of motivation. e is a"so fee"ing ver co"d d#ring this winter and has gained weight. e

wonders if he is getting de!ressed again. ;hat is the next most a!!ro!riate ste! to ta,e in this case$

a. )iagnose de!ression and start the !atient on antide!ressants

b. Jbtain the !atients "ithi#m "eve"s

c. (hec, the !atients throid I stim#"ating hormone

d. )iscontin#e "ithi#m

e. (onsider E(T

88. A '* o"d fema"e who is * wee, !ost!art#m com!"ains of fee"ing "ow in her mood and having cring s!e""s "ac, of motivation and

fee"ing of ho!e"essness for the !ast ' wee, she is diagnosed with !ost!art#m de!ression. ;hich of the fo""owing is tr#e abo#t

!ost!art#m de!ression$

a. is, of infanticide is minima"

b. Se"ective serotonin re#!ta,e inhibitors SS4s6 are contraindicated

c. is, of de!ression d#ring s#bseG#ent !regnancies is increased

d. S#icide ris, is "ow

e. os!ita" admission is rare" reG#ired

8C. ;hich of the fo""owing SS4s is "east " i,e" to ca#se serotonin discontin#ation sndrome$

a. Paroxetine

b. (ita"o!ram

c. Escita"o!ram

d. 9"#oxetine

e. Sertra"ine

C0. Jf a"" of the tricc"ic antide!ressants which of the fo""owing has the most !otent serotonin re#!ta,e inhibition activit$

a. ("omi!ramine

b. 4mi!ramine

c. Amitri!t"ine

d. 7ortri!t"ine

e. )esi!ramine

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C1. A ne#ro"ogist is cons#"ted b !sciatrist to assess a '2 ears o"d de!ressed woman with recent onset of Ym#sc"e twitchesZ. She was

ta,ing (ita"o!ram 80mg. )#"oxetine '0mg was recent" added beca#se of s#bo!tima" res!onse to (ita"o!ram a"one. She denies an

a"coho" or s#bstance ab#se. Jn examination the ne#ro"ogist notes that the !atient is s"ight" disoriented and a"so has mi"d tremors and

h!erref"exia. ;hat is the most "i,e" ca#se of the Ym#sc"e twitchesZ in this !atient$

a. Serotonin sndrome

b. A"coho" withdrawa" sndrome

c. 7e#ro"e!tic ma"ignant sndromed. =a"ingering

e. Ence!ha"itis

C2. ;hich of the fo""owing antide!ressant b"oc,s re#!ta,e of do!amine$

a. %en"afaxine

b. &#!ro!ion

c. &#s!irone

d. =irta-a!ine

e. 9"#oxetine

C3. The advancement in (entra" 7ervo#s Sstem (7S6 !harmaco"og is attrib#ted to the better #nderstanding of ne#rotransmittersand ne#rorece!tors. ;hich of the fo""owing is tr#e abo#t ne#rorece!tors $

a. <+T2A antagonists enhance a!id Ee =ovement E=6 s"ee!

b. <+T1A antagonists are anxio"tics

c. =ost t!ica" anti!scotics are )2 agonists

d. )2 rece!tors are fo#nd in the "imbic sstem

e. [2+adrenergic agonists ca#se increase of nore!ine!hrine re"ease

C'. A <* ears o"d ma"e with histor of cronic ben-odia-e!ine #se for insomnia is bro#ght to Emergenc )e!artment E)6 b his

da#ghter with com!"aints of sedation incoherence and !rob"ems with coordination. is da#ghter states that he had been #sing

dia-e!am 10+20mg ever night for man ears. She a"so reca""s that a few das ago her father saw his fami" !hsician and got a new

medication for some other !rob"em. The E) !hsician chec,s the c#rrent medication "ist and be"ieves that the !atient has

ben-odia-e!ine overdose. ;hich of the fo""owing can increase the "eve"s of ben-odia-e!ine$

a. To!iramate

b. (imetidine

c. Phentoin

d. (arbama-e!ine

e. ifam!icin

C<. Se"ective m#tism is defined as:

a. ef#sa" to s!ea, in "earning sit#ations

b. 4nabi"it to s!ea, in s!ecific socia" sit#ations

c. Jccasiona" ref#sa" to s!ea, in schoo"

d. (onsistent ref#sa" to s!ea, in s!ecific socia" sit#ations


8/10/2019 IMLE 18.02.2013


C*. 9irst sm!tom of Attention )eficit !eractivit )isorder A))6 to remit is #s#a"":

a. !eractivit

b. )istractibi"it

c. (are"ess mista,es in schoo" wor,

d. 4m!#"sivit

e. Bearning diffic#"ties

C@. 4n To#rette?s disorder the initia" tics are in the:

a. 9ace and nec,

b. Arms and hands

c. &od and "ower extremities

d. es!irator sstem

e. A"imentar sstem

C8. &efore iss#ing diagnosis of en#resis a #rina"sis m#st be done to r#"e o#t which common condition$

a. &"adder infection

b. Str#ct#ra" ma"formationc. The common co"d

d. A #rinar tract infection

e. Lrethra stenosis

CC. =a>or de!ression disorder in schoo" aged chi"dren$

a. =a !resent as irritab"e mood rather than de!ressed mood

b. Ls#a"" inc"#des !ervasive anhedonia

c. 4nc"#des mood+congr#ent a#ditor ha""#cinations "ess common" than in ad#"ts with the same disorder

d. 4s never diagnosed in the context of bereavement


100. ;hich of the fo""owing is not a negative !schotic sm!tom$

a. 9"at affect

b. A!ath

c. )isorgani-ed thin,ing

d. Avo"ition

e. Povert of tho#ghts

101. ;hich of the fo""owing !schotic sm!toms common" co+occ#re with ado"escent s#bstance #se disorder$

a. S#icida" ideation and s#icide attem!ts

b. Panic attac,s

c. e ex!eriencing n#mbing and avoidance

d. &inging and !#ring

e. A"" of the above

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102. is, factors for the deve"o!ment of ado"escent s#bstance ab#se inc"#des a"" of the fo""owing exce!t:

a. Ear" onset of cigarette smo,ing

b. )iminished !arenta" s#!ervision

c. Pervasive deve"o!menta" disorder

d. Parenta" s#bstance ab#se

e. (ond#ct disorder

103. )ementia of the A"-heimers t!e acco#nt for what !ercentage of o"d age dementia$

a. 10D

b. 20D

c. '0D

d. *0D

e. 80D

10'. E"der" !ersons ta,ing anti!schotic are es!ecia"" s#sce!tib"e to the fo""owing side effects exce!t$

a. A,athesia

b. Paresthesiasc. )r mo#th

d. Tradive ds,inesia

e. A toxic conf#sa" state

10<. ;hich of the fo""owing factor is common in victims of e"der ab#se$

a. A"coho" ab#se

b. Socia" iso"ation

c. =enta" i""ness

d. osti"it

e. Prescri!tion dr#g ab#se

10*. ;hich of the fo""owing is the greater ris, factor for s#icide$

a. Lnem!"oment

b. Sing"e stat#s

c. Bow income stat#s

d. esident of #rban area

e. istor of admission to a !schiatr hos!ita"

10@. ;hich of the fo""owing e"ectro"te abnorma"ities is associated with b#"imic !atients$

a. =etabo"ic acidosis

b. es!irator acisdosis

c. =etabo"ic a",a"osis

d. es!irator a",a"osis

e. 7orma" e"ectro"tes

8/10/2019 IMLE 18.02.2013


108. A '2+ear o"d man is seen in o#r office. e has recent" seen a !schiatrist and is being treated for severe de!ression. The !atient

cannot reca"" the medication that he is ta,ing b#t remembers that his !schiatrist to"d him not to eat cheeses or aged meats. ;hich of

the fo""owing agent is this !atient most "i,e" ta,ing$

a. Tricc"ic antide!ressant

b. Se"ective serotonin re"ease inhibitor

c. =onoamine oxidase =AJ6 inhibitor

d. 7e#ro"e!tice. Anxio"tic

10C. igh fever tachcardia tach!nea dia!horesis h!ertension and sei-#res deve"o! in a !schiatric !atient who is receiving

ha"o!erido". The most "i,e" diagnosis$

a. =a"ignant h!ertension

b. habdomo"sis

c. 7e#ro"e!tic ma"ignant sndrome

d. Se!sis

e. Serotonin sndrome

110. (hi"dren who exhibit sm!toms of schoo" avoidance with na#sea vomiting and abdomina" !ain ma benefit from$

a. Antide!ressant medication

b. =eth"!henidate

c. Pschothera!

d. &en-odia-e!ine

8/10/2019 IMLE 18.02.2013


18.02.2013:

Part A:

1.

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2.

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3.

A

'.

)

<.

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)

@.

A

8.

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C.

)

10.

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13.

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)

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18.

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28.

)

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3*.

&

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8/10/2019 IMLE 18.02.2013


'2.

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8/10/2019 IMLE 18.02.2013


8*.

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8/10/2019 IMLE 18.02.2013


Part &:

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8/10/2019 IMLE 18.02.2013


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8/10/2019 IMLE 18.02.2013


88.

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108.

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10C.

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110.

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imle 18.02.2013

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