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E. premature delivery
11) 12 years old female arrives with her upset mother to clinic that describe that her daughter has not Mensterued yet. According to mother all the female spouses menstured by age and therefore this dealy is concerning. On detailed history the child seems healthy asymptomatic. On physical physical examination the child has appropriate growth, primary pubic hair, and early evidence of breast bud. What should be told to concerned mother?
A) This is primary amenorrhea that requires further evaluation.
B) This is primary amenorrhea but further evaluation should only be performed in 6 months.
C) This is not amenorrhea and therefore there is no reason for further evaluation.
D) The sex sign caused by estrogen administration and the exact preparation that she took should be evaluated.
E) Pelvic imaging is require to rule out mullerian agenesis.
12) 25 years old female seek consultation for amenorrhea. This is a healthy female that is sexually active of uses condoms for contraception. History include regular menses 4/28, last menses about 3 month ago amenorrhea. No abnormal event since. Which of following correct?
A) There is no reason for concern, progesterone should be administered to induce menses.
B) This is secondary amenorrhea and hormonal profile should be obtained to rule out premature
ovarian failure.
C) It is likely that she has polycystic ovary syndrome and ultrasound should be performed to
confirm the diagnosis.
D) This is secondary amenorrhea and therefore pregnancy should be ruled out first.
E) Hysteroscopy to demonstrated uterine cavity should be performed.
13) Which of the following defines primary amenorrhea?
A) Amenorrhea in the presence of secondary sexual development at age of 13.
B) Amenorrhea in the presence of secondary sexual development at age of 15.
C) Amenorrhea in the presence of secondary sexual development at age of 17.
D) Amenorrhea in the presence of secondary sexual development at age of 16.
E) Amenorrhea in the presence of secondary sexual development at age of 18.
14) Which of the following defined as primary amenorrhea?
A) Kallman syndrome.
B) Sheehan syndrome.
C) Asherman syndrome.
D) Pregnancy.
E) Premature ovarian failure.
15) Which of the following is a characteristic of female athletic syndrome?
A) Menses response to progestron administration.
B) Pituitary hypertrophy.
C) No menses is response to estrogen and progestron administration.
D) Hirsutism and acne.
E) Decreased bone mass.
16) Which of the following contraceptive methods shock syndrome has been associated?
A) Oral contraceptive pill (OCP).
B) Progestin only pill.
C) Male condoms.
D) Vaginal diaphragma.
E) Intrauterine contraceptive device (IUCD).
17) 36 years old multiparous female and her husband request information regarding vasectomy. You should advice them that when compared to female sterilization the following is true (about vasectomy)?
A) Has the same failure rate.
B) Require a longer hospitalization.
C) Is effective sooner.
D) Carries a higher mortality rate.
E) Is less reversible.
18) A 49 years old female experiences irregular vaginal bleeding of 3 months duration. You perform an endometrial biopsy, which obtains copious tissue with velvety, lobulated texture.The pathologist report show proliferation of grandular and stromal element with dilated endometrial glands. Cyctologic atypia is absent. Which of the following is the best way to advice the patient?
A) The presence of dilated endomaterial gland is usual.
B) The histological finding is called cystic atrophy.
C) The tissue may be weakly premalignant.
D) She requires a hysteroscopy.
E) No further therapy is needed.
19) What is the most common uterine sarcoma?
A) Leiomyosarcoma.
B) Endometrial stromal sarcoma.
C) Endolymphatic stromal myosis.
D) Malignant mixed mesodermal tumor.
E) Lymphoma.
20) Two days after surgery of 25 years women, you received the pathology report of the ovarian tumor. It is mucinous cystadenoma of low Malignant potential mixed with well differentiated carcinoma. The tumor has not invaded the ovarian capsule, lymphatic or mesovarium. Omental and retroperitoneal lymph node biopsies and peritoneal washing are negative for tumor cells. How does you advice this patient?
A) Biopsy of the contralateral ovary.
B) Removal of the uterus and contralateral adnexa.
C) Postoperative chemotherapy.
D) Postoperative radiation therapy.
E) No further therapy.
21. 27 year old gravida 2 para1 is at your clinic on the 30th week of gestation for routine prenatal visit. She suffers from “serosal fibroids”. The pregnancy is unremarkable thus far. The fundus is 37 cm from the symphysis. In discussing possible complications of a fibroid uterus during pregnancy you mention that she is at a highest risk for:
a. PROM
b. Placenta previa
c. Gestational diabetes
d. Breech presentation
e. Placental abruption
22. 55 year old woman in menopause presents to your office with a history of a 3 day light vaginal bleeding. You should:
a. Prescribe vaginal estrogen for atrophic vaginitis and to come back if the bleeding isn’t better
b. A hysterectomy and bilateral salpingoophorectomy to rule out endometrial cancer
c. Take history, perform physical examination, endometrial tissue sampling and pelvic ultrasound
d. Recommend her to go on a diet, since there is increased production of estrone in obese women
23. Which of the following organs are first affected by spread and encroachement of advanced ovarian cancer:
a. Brain
b. Ureter
c. Intestine
d. Stomach
e. Spleen
24. 52 year old woman after menopause complains of urinary frequency, urgency and urge incontinence. Otherwise she is healthy. What should be included in behavioral treatment?
a. Relaxation techniques
b. Anticholinergic medications
c. Voiding every hour during daytime
d. Bladder retraining
e. Incontinence pad testing
25. 38 year old female with two year history of heavy menstrual flow of 9 days every period. Menses occur every 32 days. There is no bleeding between menses. Next step in evaluation:
a. Coagulation profile
b. Pregnancy test
c. Endometrial biopsy
d. Pelvic ultrasound
e. TSH evaluation
26.
A 24 year old salesperson is referred for an evaluation of difficulty dealing with costumers because she gets "so nervous and anxious that my mind gets blank". A careful evaluation revels that she has social phobia. She is motivated to obtain treatment and continue doing her job. All of the following interventions, except:
a. Selective serotonin reuptake inhibition – SSRI's
b. Flooding
c. Modeling
d. Systematic desensitization
e. Electrical convulsion therapy – ECT
27. Factitious disorder with predominant physical signs and symptoms is also known as:
a. Hypochondriasis
b. Munchhausen
c. Munchhausen by proxy
d. Somatoform disorder
e. Factitious disorder not other specified
28. Which of the following is true about blood-injection-injury phobia?
a. Twice as common in women than men
b. Low familial inheritance
c. Sever tachycardia and hypertensive response
d. Easily treated
e. Bradycardia and hypertension often follow initial tachycardia
29. The term double depression is used to describe:
a. Major depressive disorder superimposed on grief reaction
b. Major depressive disorder superimposed on dysthemia
c. Major depressive patient not responding to treatment
d. Major depressive disorder with psychosis
e. Major depressive disorder with anxiety
30. A 26 year old Caucasian make is stable on lithium for bipolar disorder for the past 4 years. During his routine visit with his family physician, he complains of fatigue and lack of motivation. He is also feeling very cold during this winter and has gained weight. He wonders if he is getting depressed again. What is the next most appropriate step to take in this case?
a. Diagnose depression and start the patient on antidepressants
b. Obtain patient lithium levels
c. Check patient Thyroid stimulating hormone (TSH) levels
d. Discontinue lithium
e. Consider electric convulsion therapy (ECT)
31- 46 female is 6 week postpartum complains of felling low in her mood and having crying spells, lack of motivation and feeling hopelessness for the past 4 weeks what diagnosed to have postpartum depression?
a. True risk of infanticide is minimal
b. SSRI are contraindicated
c. Risk of depression during subsequent pregnancy is high
d. Suicide risk is low
e. Hospital admission is rarely required
32- Which SSRI is least likely to case serotonin discontinuation syndrome?
a. Paroxetine
b. Citalopram
Escitalopram
Fluoxetine (Prozac)
Sertraline
33- Of all tricyclic antidepressants which of the following most potent serotonin reuptake inhibition activity?
Clomipramine
Imipramine
Amitriptyline
Desipraminn
34- which symptom has to be present to diagnose major depression disorder?
Depressed mood or loss of interest or pleasure
Lack of energy or motivation
Lack of appetite
Hopelessness
Gilt or worthlessness
35- 36 year old pregnant admitted due to possible infection associated with IV heroin, she is 5 month into her pregnancy and would like to quit heroin for good, what best course of action?
Allow her to continue to use heroin as withdrawal is dangerous
Methadone maintenance
Naltrexone
Advise her to stop heroin and start supportive therapy
Buprenorphine
36- Good test of recent memory?
Subtract 7 from 100
Ask Their date of birth
Ask How many sibling they have
Ask What they had eat for their last meal
Ask Who is the president
37- Most common case of delirium within 3 day of postoperative in a 40 year old man with history of alcohol dependence?
Delirium tremens
Infection
Pain medication postoperative
Pain stress of surgery
38- Clinical feature which may be associated with delirium
Disorganized thought process
Hallucination
Illusion
All of the above
39- Which of the following drug is best use to treat acute delirium?
Amobarbital (amytal)
Chlorpromazine
Diazepam
haloperidol
physostigmine
40- Mouth ulceration is associated with which of the following types of withdrawal?
a. alcohol
b. benzodiazepins
c. cocain
d. nicotin
e. opoids
41. the postpartum blues:
A. occur in up to 50 percent of women after childbirth
B. are self-limited
C. begin shortly after childbirth and lessens in severity over the course of a week
D. are considered to be normal
E. all of the above
42. Depression and mania share which of the following symptoms?
A. Psychomotor acceleration
B. Low-self esteem
C. Grandiosity
D. Anger
E. Pessimism
43. The highest suicide rates are in which of the following age groups?
A. Under age 15
B. 15 to 24 year olds
C. 25 to 44 year olds
D. 45 to 64 year olds
E. Over age 65
44. The best indicator for increased risk of suicide?
a. Alcohol dependance
b. Marriage
c. Previous suicidal behavior
d. Schizophrenia
e. Major depressive disorder
45. Which of the following antidepressants would not be the best choice for the above patient with a
history of suicidal ideation?
A. SSRI
B. MAOI
C. Bupropion (Wellbutrin)
D. TCA
E. Venlafaxine (Effexor)
46. Generalized Anxiety disorder
A. is least likely to coexist with another mental disorder
B. has a female to male ration of 1:2
C. is a mild condition
D. has about a 50 percent chance of a recurrence after recovery
E. has a low prevalence in primary care settings
47. Tourett’s disorder has been shown to possibly have a familial and genetic relationship with
A. panic disorder
B. OCD
C. generalized anxiety disorder
D. social phobia
E. none of the above
48. Medical disorders to be considered in the differential diagnosis of somatization disorder include
A. multiple sclerosis
B. systemic lupus erythematosus
C. acute intermittent porphyria
D. all of the above
49. The most accurate statement regarding pain disorder is
A. It is diagnosed equally among men and women
B. Peak ages of onset are in the second and third decades
C. It is least common in persons with blue collar occupations
D. First degree relatives of patients have an increased likelihood of having the same disorder
E. Depressive disorders are no more common in patients with pain disorder than in the general public
50. Factitious disorders are best treated by which of the following?
A. Immediate discharge from the hospital
B. Confrontation about the patient’s deceit
C. Focusing on management rather than cure
D. Performing only minimally invasive procedures to satisfy the patient
E. Using low-dose neuroleptics to decrease the patient’s physical distress
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61. Which of the following tumor markers is most closely associated with the diagnosis of Gastrointestinal Stromal Tumor – GIST?
a. CEA
b. CD117
c. HER2/neu
d. CEA125
e. p53
62. A 67 years old woman presents with pelvic pain. CT shows a mass near her right pelvic wall. CT guided biopsy reveal spindle type with few mitotic cells. At exploration 2cm pedunculated mass is noted on the antimesentric border of mid ileum. Appropriate therapy would be:
a. ligation of the mass at the pedunculated stalk
b. wedge excision of the bowel containing the mass
c. wide excision, regional lymph node dissection
d. wedge excision, imatinib
e. wide excision, regional lymph node dissection, imatinib
63. The most appropriate treatment for a patient with 2cm diffuse large B cell lymphoma limited to the antrum of the stomach would be:
a. total gastrectomy
b. chemotherapy, radiation followed by total gastrectomy
c. systemic chemotherapy
d. distal gastrectomy
e. chemotherapy, radiation.
64. A 27 years old female presents for evaluation after a recent diagnosis of cutaneous melanoma on her right leg. On examination the lesion is irregular with discoloration but no ulceration. Physical examination of the right inguinal shows no palpable nodes. Pathological analysis of the punch biopsy of the lesion reveals a 3.1mm thick lesion. In addition to 2cm margin total excision of the primary, the next step in management of her inguinal nodes should be:
a. observation
b. sentinel lymph node biopsy
c. elective lymphadenectomy
d. radiotherapy
e. isolated limb perfusion
65. A 75 years old man taking NSAIDs for arthritis presents with an acute abdomen and pnumoperitoneum. His symptoms are 6 hours old and his vital signs are stable after the infusion of 1L normal saline solution. What should be the next step in the management of this patient?
a. Computed tomography of the abdomen
b. Esophagogastroduodenoscopy
c. Antisecretory drugs, broad spectrum antibiotics, and surgery if he fails to improve within 6hrs
d. Antisecretory drugs, antibiotics for H.Pylori, and surgery if he fails to improve within 6hrs
66. Which of the following is not a risk factor for developing a surgical site infection – SSI?
a. Radiation exposure
b. Recent surgery
c. Prolonged hospitalization
d. Infancy
67. A 68 years old man is admitted to the hospital after having passed three large maroon colored stools. On arrival at the hospital, he passes more bloody stools as well as clots. He is pale, orthostatic, and tachycardic. Nasogastric aspirates are bilious. After resuscitation is begun, which of the following is the most appropriate initial test?
a. Angiography
b. Nuclear medicine red blood cell scan
c. Rigid proctoscopy
d. Colonoscopy
e. Barium enema
68. A 4 years old patient presents with diffuse scald wounds after being held in a hot tub of water. There are circumferential blisters present over the right leg (from hip to toes) and circumferential blistering over the lower left leg (from knee to toes). The right thigh, abdomen and back below the umbilicus, as well as the buttocks and perineum are red hot but without blisters. What is the total burn surface area?
a. 25%
b. 36%
c. 46%
d. 54%
69. Epstein-Barr virus is associated with which of the following cancers?
a. Nasopharyngeal carcinoma
b. Non-Hodgkin’s lymphoma
c. Adult T cell leukemia
d. Kaposi’s sarcoma
70. Which of the following is the most significant risk factor for invasive breast cancer when screening a patient for risk?
a. >2 first degree relatives with breast cancer
b. 2 previous breast biopsies in a patient <50 years of age
c. Age <12 at menarche
d. Atypical hyperplasia in a previous breast biopsy
71. (Schwartz?) Lymphatic drainage from the supraglottic larynx is primarily to:
a. The prelaryngeal (Delphian) node
b. Paratracheal nodes
c. Deep cervical nodes
d. Superior jugular nodes*
72. (Schwartz?) Level V lymph nodes in the neck are located:
a. In the submental area
b. In the anterior triangle
c. In the posterior triangle*
d. In the inferior jugular chain
73. (Schwartz?) Heparin induces anticoagulation primary by:
a. Increasing production of antithrombin
b. Increasing the activity of antithrombin
c. Increasing conversion of factor X to Xa
d. Increasing conversion of factor XI to XIa
74. (Schwartz?)The most common location of gastrointestinal stromal tumors (GIST) is:
a. Stomach*
b. Duodenum
c. Jejunum
d. Ileum
75. (Schwartz?) A high output enterocutaneous fistula is defined as draining more than:
a.100 mL/day
b. 500 mL/day*
c. 1000 mL/day
d. 2000 mL/day
76. The most common cause fo small bowel obstruction is
a. Adhesion
b. Hernia
c. Malignancy
d. Crohn's disease
77. A 24-year-old woman in the 20th week of pregnancy experiences a single episode of biliary colic. The most appropriate initial management is:
a. observation with plans to follow her after delivery for recurrent episodes.
b. Dietary changes
c. Elective laparoscopic cholecystectomy during 2nd trimester.
c. Elective open cholecystectomy during 2nd trimester.
78 Surgery is indicated in which of the following asymptomatic patients with primary hyperparathyroidism?
a. Mildly elevated urinary calcium excretion (>100mg/dl).
b. Reduction in creatinine clearance by 10%
c. Serum calcium> 0.8 above the upper limits of normal
d. Age < 50 years
79. Pacient with carcinoma of 1 cm of diameter in tiroid glandule with out adenopaty Treatment of medullary thyroid cancer:
a. Total thyroidectomy
b. Total thyroidectomy+ cervical LN dissection
80. The most common cause of primary parathyroidism is
a. Parathyroid adenoma
b. Multiple parathyroid adenomas
c. Parathyroid hyperplasia
d. Parathyroid carcinoma
Q81 part B - which of the following would be the first diagnostic test ordered in patient with solitary thyroid noudle?
a. radioactive iodine scan
b. CT or MRI
c. fine needle aspiration
d. core needle aspiration
Q82 part B - a 35 year old woman experiences an acute onset of epigastric and right upper quadrant pain several hours after large dinner. she has had similar episodes in the past that resolved after a few hours. this episode persists, and she has fever and nonbilious vomiting. what is the most likely source of the abdominal pain?
a. perforated ulcer
b. acute appendicitis
c. perforation following bowel obstruction
d. acute cholecystitis
e. diverticulitis
Q83 part B - a 57 year old woman with a 1.5 cm infiltrating ductal carcinoma is found to be ER negative, PR negative, and HER - 2/neu positive. she comes to your office to discuss treatment options. what would you recommend?
a. modified radical mastectomy alone
b. wide local excision. radiation therapy and tamoxifen.
c. simple mastectomy, sentinel lymph node biopsy, trastuzumab (Herceptin) and tamoxifen.
d. modified radical mastectomy and adjuvant chemotherapy.
e. wide local excision, sentinel lymph node biopsy, radiation therapy and adjuvant chemotherapy with trastuzumab.
Q84 part B - a 35 year old woman has a 5 year history of poorly controled hypertension. she is taking three different medications, including a diuretic, b-blocker, and potassium supplements. what would be the next step in establishing the diagnosis of surgically correctable hypertension?
a. CT of the abdomen and pelvis
b. urine catecholamines.
c. serum aldosterone and renin levels
d. renal US
e. saline suppresion testing
Q85 part B - a 44 year old man is due to undergo laparoscopic adrenalectomy for pheochromocytoma. which of the following agents shoud NOT be given as the initial oronly medication to help achieve appropriate preoperative adrenoreceptor blockade?
a. phenoxybenzamine
b. amlodipine
c. prazosine
d. atenolol
e. metyrosine
Q86 part B - following surgery a patient develops oliguria. you believe the patient is hypovolemic, but you seek corroborative data before increasing intravenous fluid. which of the following values supports the diagnosis of hypovolemia?
a. urine sodium of 28 mEq/L
b. urine chloride of 15 mEq/L
c. fractional excretion of sodium less than 1
d. urine/serum creatinine ratio of 20
e. urine osmolality of 350 mosm/kg
Q87 part B - a 45 year old woman with Crohn's disease and a small intestine fistula develops tetany during the second week of parenteral nutrition. the laboratory findings include:
Na - 135
K - 3.2
Cl - 103
HCO3 - 25
Ca - 82
Mg - 1.2
PO4 - 2.4
albumin - 2.4
an arterial blood gas sample reveals a pH of 7.42, PCO2 of 38, and PO2 of 84 mmHg.
which of the following is the most likely cause of the patients tetany?
a. hyperventilation
b. hypocalcemia
c. hypomagnesemia
d. essential fatty acid deficiency
e. focal seizure
Q88 part B - a victim of blunt abdominal trauma undergoes a partial hepatoectomy. during surgery he recieves twelve units of packed red blood cells. in the recovery room he is noted to be bleeding from intravenous puncture sites and the surgical incision. which of the following statements regarding coagulopathy is most likely true?
a. the patient has n unknown primary bleeding disorder
b. the coagulopathy is secondary to the partial hepatectomy
c. the coagulopathy is secondary to dilutional thrombocytopenia and deficiency of clotting factors from the massive blood transfusion.
d. the treatment is oral vitamin K
e. the treatment is intravenous vitamin K
Q89 part B - a patient with a solid malignancy is discussing chemotherapy with his oncologist. he is interested in the risks of the treatment. what is the primary toxicity of doxorubicin (adriamycin)?
a. cardiomyopathy
b. pulmonary fibrosis
c. peripheral neuropathy
d. uric acid nephropathy
e. hepatic dysfuncion
Q90 part B - a 41 year old man complaining of regurgitation of saliva and undigested food. an esophagogram reveals a bird's-beak deformity. which of the following statements is true about his condition?
a. chest pain is common in the advanced stages of this disease.
b. more patients are improved by forceful dilation than by surgical intervention
c. manometry can be expected to show high resting pressure of the lower esophageal sphincter (LEs)
d. surgical treatment consists primary of resection of the distal esophagus with reanastomosis to the stomach above the diaphragm
e. patients with this disease are at no increased risk for the development of carcinoma
91. A 41 y/o man presents with food and saliva regurgitation, an esophagogram was performed and shown "beard leak " phenomenon what is true?
A.Chest pain is common in this condition
B. First perform forceful dilation than proceed to surgery
C. Manometry show increase LES resting tone
D. Resection above the diaphragm
E. There is no increased risk for carcinoma
92. 3 finding in achalasia:
A. Increased LES resting pressure, decreased LES relaxation, increased esophageal action
B. Decreased LES resting pressure, Increased LES relaxation, Decreased esophageal action
C. Increased LES resting pressure, Decreased LES relaxation, Decreased esophageal action
D. Decreased LES resting pressure, Increased LES relaxation, Increased esophageal action
93. An antireflux procedure unsuccessful because:
A. Gastric outlet obstruction was not identified
B. Well dilated previous stricture
C. Decreased saliva production
D. Transthoracic fundoplasty
94. Esophageal perforation frequently caused:
A. Spontaneous rupture
B. Instrumental perforation
C. Foreign body
D. Barrett's esophagus
95. Which one is not contribute to digestion of fats in small intestine:
A. Brush border enzymes
B. Pancreatic lipases
C. Bile salts
D.?
96. Which one is not characteristic of chronic Crohn's disease:
A. Rectal bleeding
B. Perianal disease
C. Diarrhea
D. Abdominal pain
97. Intussuspection in 20y/o man:
A.Idiopathic
B. Carcinoid
C. Adhesions
D. Lymphoma
98. Lesions associated with Peutz-Jegher syndrome:
A.Sessile adenomas
B. Cluster lesions in duodenum
C. Hamartoma
D. It has AR inheritance
99. What is Not an indicator for an open cholycestectomy:
a. poor pulmonary or cardiac reserve
b.third trimester gestation
c. child’s class C liver disease
d. suspected gallbladder cancer
e. Previous gastric bypass procedure
100. Primary sclerotizing cholangitis associated with which disorder:
A. Crohn's disease
B. Diabetes
C. Rheumatoid arthritis
D. Ulcerative colitis
E. Chronic pancreatitis
101. Which of the following does NOT stimulate bile flow?
A. Cholecystokining
B. bile salts
C. vagal stimulation
D. splachnic stimulation
E. secretin
102. Acute ischemia in lower extremity:
a. most often the result of femoral artery thrombosis
b. can never occur as a consequence of DVT
c. is never amenable to treatment with thrombolytic treatment
d. is most often the result of cardiac embolic events
e. rarely result in limb/(life? Not sure I wrote correct) threatening ischemia
103. which of the following regarding aneurysms is true?
a. inflammatory aneurysm of the aorta rarely rupture.
b. splenic artery aneurysm are usualy atherosclerotic.
c. thrombosis of popliteal artery aneurysm may be treated with thrombolytic therapy
d. infected aneurysm of the aorta usualy require complete excision and extraanatomic revascularizaion
e. aneurysms of the hepatic artery are the most common visceral aneurysms
104. breast conservation surgery in breast carcinoma:
a. resulted major imporovement in mortality and morbidity.
b. has resulted durable survival data comparable to those for mastectomy for certain
breast cancer
c.
d.
105. ductal carcinoma of breast in situ:
a. is almost always bilateral.
b. has become more frequently diagnosed because of the use of mammogram.
c. cannot present as a palpable mass.
d. is frequently associated with microscopic lymph node metastases.
106)A 33-year-old woman pregnant for the third time present at 3 months with a 2-cm mass in the inner aspect of the left breast. A needle aspiration reveals no fluid. You would:
a) arrange for a mammogram because multicentric lesions are common during pregnancy.
b) consider termination of pregnancy because chemotherapy has been shown useful in node-negative premenupausal patients.
c)expeditionsly obtain a histologic diagnosis of the mass.
d)wait until the third trimester because surgey is safer at that time.
107)Risk factors for the development of melanoma include all of the following except:
a)fair hair.
b)light complexion.
c)green eyes.
d)multiple nevi.
108)Which of the following endoscopic peptic ulcer characteristics has the highest risk for recurrent bleeding:
a) oozing ulcer.
b)clean based ulcer.
c)nonbleeding "visible vessel"
d)nonbleeding ulcer with an overlying clot.
e)Dieulafoy ulcer.
109)A 38-year-old man was taken to an emergency facility after his car skidded on the freeway and struck a pillar. His vital signs were as follows: puls 88/min; respirations 20/min; blood pressure 100/70 mmHg. Physical examination revealed nonprominent jugular neck veins, no indication of cyanosis, and symmetric breath sounds. A posterior-anterior chest X-ray film revealed a widened mediastinum. Which of the following choises is the most likely diagnosis?
a)ruptured aortic aneurysm.
b)cardiac tamponade.
c)dissection of the thoracic aorta.
d)myocardial contusion
e)pulmonary contusion.
110)Which of the following statements is true about surgery for pheochromocytomas?
a)patient should receive preoperative alfa-blockade for 1 to 4 weeks prior to surgery.
b)the adrenal vein should be taken only after the arterial supply is isolated and ligated.
c)intravenous fluids should be restricted until the tumor is removed.
d)preoperativebeta-blockade should precede any alfa-blockes to avoid the precipitation of malignant hypertension.
e)bilateral adrenalectomy should be performed for patients with MEN2a.
