ข้อสอบ MD NL ชุดที่ 26 
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ชื่อ *
รหัสนินิต *
1. สภาวะที่มีการอดอาหารเป็นเวลานาน จะมีการเปลี่ยนแปลงของกระบวนการทางชีวเคมีอย่างไรKetolysis ในตับเพิ่มขึ้น *
1 point
2. ชายอายุ 20 ปี เป็นไข้หวัดมา 3 วัน ซื้อยารับประทานเอง มีอาการอ่อนเพลีย ซีด ปัสสาวะดำ ตรวจร่างกายพบว่าซีดปานกลาง ตาเหลืองเล็กน้อย คลำม้ามไม่พบ ชายผู้นี้น่าจะมีความบกพร่อของเอนไซม์ในวิถีใด *
1 point
3. หญิงอายุ 45 ปี หิวน้ำบ่อย ปัสสาวะบ่อย ตรวจพบ fasting plasma glucose 220 mg/dL น้ำตาลในเลือดสูงขึ้นเกิดจากการมีกระบวนการใดมากกว่าปกติ *
1 point
4. ชายอายุ 60 ปี กินเหล้ามาตลอด 10 ปี ต่อมาหมดสติ ญาตินำส่งโรงพยาบาล แพทย์วินิจฉัยว่าเป็น hepatic encephalopathy ผู้ป่วยรายนี้น่าจะมีความผิดปกติของกระบวนการใด *
1 point
5. ชายอายุ 30 ปี ซื้อยากินเอง ซีด ตัวเหลือง ตาเหือง ภาวะดังกล่าวเกิดจากความผิดปกติของอะไร *
1 point
6. ชายอายุ 60 ปี เป็นโรคหัวใจวายเรื้อรัง พอตรวจศพพบ Old myocardial infarction พอตรวจ slide พบ fibrous scar แล้ว myocardium รอบๆ จะมีลักษณะแบบใด *
1 point
7. หญิงมีรอบเดือน 28 วัน มีครั้งละ 4 วัน ถามว่าระหว่างมีประจำเดือนมีการเปลี่ยนแปลงอะไรที่ผนังมดลูก *
1 point
8. ชายอายุ 50 ปี สูบบุหรี่ประจำ มาโรงพยาบาลเพราะเจ็บแน่นหน้าอก ตรวจ serum creatinine kinase และ troponin ได้สูงขึ้น จะมีการเปลี่ยนแปลงที่ cell กล้ามเนื้อหัวใจอย่างไร *
1 point
9. เด็กชายอายุ 5 ปี ได้รับการรักษาด้วยการฉายรังสีจนครบ พบขนาดก้อนเล็กลงเล็กน้อย ข้อใดคือกลไกการดื้อต่อการรักษาของมะเร็ง *
1 point
10. Pletelet-derived growth factor ทำให้ cell แบ่งตัวโดยจับกับ receptor โดยใช้อะไรทำหน้าที่ signal transduction *
1 point
11. ทารกชายแรกเกิด 6 ชั่วโมง มีอาการสำลักน้ำนมแม่ในครั้งแรกที่ให้นม ตรวจร่างกายพบว่าฟังเสียงหัวใจได้ในด้านขวา bowel sound ฟังได้ในด้านซ้าย หน้าท้องแฟบ ทารกควรมีความผิดปกติแต่กำเนิดอื่นใดร่วมด้วย *
1 point
12. An infant is born with abnormal development of Meckel cartilage. Which structure will be most likely defective? *
1 point
13. A newborn  baby is diagnosed with DiGeorge syndrome, which is characterized by congenital thymic aplasia due to pharyngeal pouch development abnormality. Apart from thymus gland, which structure may also be absent in this baby? *
1 point
14. A 10-year-old boy was accidentally injured at his right foot for 2 days. His wound was progressed to be painful, erythematous ulcerated lesion filled with pus. Investigation showed numerous PMNs in pus drained from his lesion. Which component is responsible for the result of investigation? *
1 point
15. A 10-year-old boy was diagnosed with influenza for 7 days. What is the main immune defense mechanism in this patient? *
1 point
16. A 30-year-old woman with syphilis gave birth to a girl. Her baby's blood test showed  Treponema pallidum specific antibody. Which immunoglobulin isotype is most specific to her baby’s immune response? *
1 point
17. A 20-year-old woman has a dirty wound at left hand. She has already received complete 3 doses of tetanus toxoid due to dog bite 2 years ago. What is true about the antibody response to the possible tetanus toxin in this time compared with the previous episode? *
1 point
18. A 25-year-old pregnant woman came for antenatal care. Which vaccine is contraindicated for her condition? *
1 point
19. A 10-year-old girl was brought to hospital by her mother due to unconsciousness after being stung by bee. She was fully recover after epinephrine administration. Which immunoglobulin mediates this condition? *
1 point
20. A 25-year-old woman was diagnosed with cellulitis and treated with dicloxacillin. Half an hour later, she developed hives and difficulty breathing. Which immune mechanism contributes to her condition? *
1 point
21. A 20-year-old woman presented with hypotension, hives and swelling of lip and eyelids immediately after eating shellfish. Which is the most appropriate investigation to determine the causative agent? *
1 point
22. A 40-year-old woman presented with fatigue, arthritis at both wrists and MCP joints, photosensitivity, alopecia. Her blood test revealed ANA +ve. Which immune component contributes to her condition? *
1 point
23. A 10-year-old boy with history of bee sting 5 minutes ago, developed red swelling at the site of bee sting. Which pathological reaction do you expect to find at that lesion? *
1 point
24. An autopsy of a 65-year-old man with cardiac arrested showed: gross findings – 2 cm. grayish lesion at left ventricle, microscopic findings – myocardial fiber necrosis, numerous hemosiderin- laden macrophages, loose vascular and fibroblastic proliferation. How long does this man have died? *
1 point
25. A 60-year-old man presented with prolonged fever and multiple cervical lymph node enlargement for 4 weeks. A lymph node biopsy was performed and shown in the figure. Which pathologic finding is demonstrated in his lymph node biopsy? *
1 point
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26. A 45-year-old man presented with chronic back pain. The radiography revealed fracture of thoracic vertebral bodies. Bone biopsy showed aggregation of epithelioid cells, plasma cells and lymphocytes with central caseous necrosis. What is the most likely causative pathogen? *
1 point
27. A 10-year-old boy suffered from chronic cough and low-grade fever for 3 months. Chest X-ray found radiopaque nodular and peritracheal lymphadenopathy. His mother had a history of pulmonary tuberculosis. What is the most likely pathologic finding from his tracheal lymph node biopsy? *
1 point
28. A 30-year-old woman had accident with closed fracture of right femur. One day later, she developed sudden onset of dyspnea and hypoxemia. What is the most likely cause of her condition? *
1 point
29. A 60-year-old woman presented with weight loss and skin hyperpigmentation. PE: hyperkeratosis and hyperpigmentation of skin at neck, axillae, flexures and anogenital area. Endocrinologic studies revealed normal serum levels of adrenal corticosteroids and glucocorticoids. Which tumor can cause these findings? *
1 point
30. A 50-year-old heavy smoker presented with progressive dyspnea for 5 months. PE: truncal obesity, numerous skin bruises. Which tumor is associated with these findings? *
1 point
31. A 60-year-old man with a history of difficult urination presented with pathologic fracture and multiple bone lesions. Bone biopsy revealed dysplastic glands infiltrating in the bone marrow. What is the most proper tumor-related marker in this patient? *
1 point
32. A 50-year-old man presented with epistaxis. Further investigation revealed nasopharyngeal carcinoma. What is the risk factor of this disease? *
1 point
33. A 5-year-old boy presented with high-grade fever and stiff neck for 2 days. CSF examination: WBC 200/mm3 (N 10%, L 90%), glucose 80 mg/dL (plasma glucose 100 mg/dL), protein 55 mg/dL. What is the most likely diagnosis? *
1 point
34. A 30-year-old man presented with fever and headache for 2 days. PE: stiff neck. CSF examination revealed normal opening pressure, slightly elevated protein level, normal sugar level, WBC 200/mm3 (L 85%, N 15%). What is the most likely diagnosis? *
1 point
35. A 20-year-old woman presented with fever and stiff neck for 2 days. PE: T 39oC, BP 90/60 mmHg, multiple purpuric lesions at buttock and legs. The physician sends her blood for bacterial culture before prescribing antibacterial drug. Which is the most appropriate method for blood collection? *
1 point
36. A 40-year-old woman presents with high-grade fever and alteration of consciousness. Physical examination shows stiff neck. CSF examination reveals Cryptococcus neoformans. Anti-HIV antibody is performed. Which ethical issue is violated on this situation? *
1 point
37. หญิงอายุ 25 ปี ตั้งครรภ์ 38 สัปดาห์มาปรึกษาแพทย์เพื่อทำ cesarean section เนื่องจากต้องการให้บุตรคลอดวันนี้เพราะเป็นวันศิริมงคล แพทย์จึงทำการผ่าตัดให้ตามความต้องการของผู้ป่วย การกระทำของแพทย์ผู้นี้ขัดต่อหลักเวชจริยเวชศาสตร์ในข้อใด *
1 point
38. A 55-year-old woman is evaluated for health maintenance. Her weight is 85 kg. and height is 150 cm. She also has hypertension. This woman has greater risk for developing which of the following disease? *
1 point
39. A 60-year-old man was told by his doctor that he had stage IV colon cancer. He did not believe his doctor and ignored what he was told. What is the man's coping mechanism? *
1 point
40. หญิงอายุ 15 ปี บ้านอยู่ใกล้เหมืองตะกั่ว ซีดมาก ตรวจพบสารตะกั่วในน้ำที่ใช้บริโภคและในเลือดของผู้ป่วย ภาวะซีดที่พบในผู้ป่วยรายนี้เกิดจากตะกั่วไปยับยั้งเอนไซม์ใดในกระบวนการสังเคราะห์ heme *
1 point
41. A 30-year-old diabetic woman presented with fever, hyperpnea and drowsiness. Her blood examination revealed FPG 400 mg/dL, Na+ 135, K+ 5.7, Cl- 100, HCO 3- 15 mmol/L. What is the main mechanism of hyperkalemia in this case? *
1 point
42. หญิงอายุ 80 ปี อ่อนเพลีย คลื่นไส้อาเจียนในสั่นมา 1 วัน ECG พบ loss of P wave, widening QRS complex และ tall peaked T wave ลักษณะดังกล่าวน่าจะเกิดจากภาวะใดต่อไปนี้ *
1 point
43. ชายอายุ 15 ปี เป็น type 1 DM ปัสสาวะบ่อยและหิวน้ำบ่อย มีอาการหายใจเร็วมา 2 ชั่วโมง ตรวจร่างกายพบ BP 80/50 mmHg, HR 100/min, regular, RR 24/min ตรวจเลือดพบ glucose 400 md/dL ข้อใดเป็นการรักษาเบื้องต้นที่เหมาะสมที่สุด *
1 point
44. A และ B อายุ 20 ปี เป็น monozygotic twin มีลักษณะทางกายภาพเหมือนกันทุกประการ ผลตรวจวัดการใช้ออกซิเจนขณะทำ dynamic exercise (HR 120 bpm) เท่ากับ 15 และ 30 mL/min/kg ตามลำดับ ปัจจัยใดส่งผลให้การใช้ออกซิเจนของ A และ B แตกต่างกัน *
1 point
45. A 60-year-old man had a dystrophic nail plate. Further investigation revealed hyaline septate hyphae. What is the most appropriate treatment? *
1 point
46. A 15-year-old boy has multiple vesicles on erythematous base at upper lip. Further investigation from his lesions found multinucleated cells. What is the appropriate treatment? *
1 point
47. A 40-year-old man presented with fever, anemia and alteration of consciousness after his trip to Myanmar. His thin blood film was shown in the figure. What is the most appropriate treatment for this patient? *
1 point
Captionless Image
48. A patient with non-falciparum malaria received chloroquine and other antipyretic medication. Afterward, his sclerae became icterus. What is the mechanism of his icteric sclerae? *
1 point
49. A 30-year-old man had taken codeine for cough suppression. Four days later, he developed stupor from codeine metabolite. Genotypic study revealed CYP2D6 mutation. What is the most likely cause of this finding? *
1 point
50.  A 70-year-old man had a cardiac arrest. He received a positive inotropic drug for treatment. What is the most likely mechanism of this drug? *
1 point
51. A 75-year-old man with a history of prostatic hyperplasia had a recent onset of increased difficulty urinating. His symptom began shortly after he started taking a nasal decongestant orally for cold symptoms. Which receptor is most likely involved in his symptom? *
1 point
52. What is the most appropriate test to study about oral hypoglycemic drug and plasma glucose? *
1 point
53. การทดสอบสำหรับวินิจฉัย melioidosis ในกลุ่มประชากรหนึ่งซึ่งมี prevalence 10% พบ sensitivity 80% และ specificity 75% ค่าใดต่อไปนี้จะเพิ่มขึ้นหากนำไปทดสอบในกลุ่มประชากรที่มี prevalence ของโรคดังกล่าว 20% *
1 point
54. การหาค่า cut-off point ของการตรวจ tumor marker ในการวินิจฉัย colonic carcinoma ควรพิจารณาจากสิ่งใดต่อไปนี้ *
1 point
55. Cerebral venous sinus thrombosis เป็นโรคที่มีอุบัติการณ์ 1/100,000 ต่อปี หากต้องการศึกษา risk factor ของโรคดังกล่าว ควรเลือกใช้ study design รูปแบบใด *
1 point
56. แพทย์ต้องการศึกษาหาความสัมพันธ์ระหว่างการกิน fenfluramine กับ อัตราการเกิด primary pulmonary hypertension ซึ่งเป็นฤทธิ์แทรกแซงที่ร้ายแรงจากการกินยาดังกล่าวติดต่อกันเป็นเวลานาน รูปแบบการวิจัยใดเหมาะสมที่สุดและไม่ขัดต่อหลักจริยธรรมการวิจัยในคน *
1 point
57. หากต้องต้องการศึกษาความสัมพันธ์ของการสูบบุหรี่กับมะเร็งปอดควรเลือกใช้ study design รูปแบบใด จึงจะ valid และไม่ขัดต่อหลักจริยธรรมการวิจัยในคน *
1 point
58. ข้อมูลการศึกษาหนึ่งพบว่า incidence rate ของผู้ที่สูบบุหรี่แล้วเป็น lug cancer เท่ากับ 20/1,000 ส่วน incidence rate ของผู้ที่ไม่สูบบุหรี่แล้วเป็น lung cancer เท่ากับ 10/10,000 ข้อสรุปจากการศึกษาในข้อใดถูกต้อง *
1 point
59. การศึกษาการใช้ยาพ่นขยายหลอดลมให้ถูกวิธีในผู้ป่วย asthma จำนวน 2 กลุ่ม กลุ่มละ 10 คน โดยกลุ่มแรกได้รับการสอนและฝึกปฏิบัติ ส่วนอีกกลุ่มหนึ่งให้ศึกษาจากแผ่นพับ พบว่าผลที่เกิดขึ้นไม่แตกต่างกัน ต่อมาได้เพิ่มผู้ป่วยเข้าไปอีกเป็นกลุ่มละ 100 คน ปรากฏว่าผลที่ได้มีความแตกต่างกัน ผลที่ได้จากการศึกษาในช่วงแรกจัดเป็น error รูปแบบใด *
1 point
60. ข้อมูลจากงานวิจัยพบว่า คนที่อาศัยอยู่ใกล้เสาไฟฟ้ามีโอกาสเป็นมะเร็งเม็ดเลือดขาวมากกว่าคนทั่วไป ค่าทางสถิติในข้อใดทำให้ผลวิจัยดังกล่าวมีความน่าเชื่อถือมากที่สุด *
1 point
61. A 25-year-old woman presented with pale and sweaty skin after criminal abortion. Which cell is most likely increased in her blood smear? *
1 point
62. A 35-year-old man presented with fatigue for 6 months. CBC: Hct 30% (normal 40%), reticulocyte count 8% What is the corrected reticulocyte count in this patient? *
1 point
63. A 40-year-old man underwent duodenal dissection. He presented with fatigue and malaise for 6 months. PE: moderate pallor, no jaundice. CBC: Hb 8 g/dL, MCV 60 fL, WBC 5,500/mm3, platelet 550,000/mm3. Which of the following is most likely found in this patient? *
1 point
64. A 40-year-old woman presented with hypermenorrhea for 1 year. She also complained of fatigue and malaise. PE: moderately pale, no jaundice, no hepatosplenomegaly. Which of the following is most likely decreased to compensation in this patient? *
1 point
65. A 55-year-old woman presented with fatigue. CBC: Hb 7 g/dL, WBC 7,000/mm3, platelet 210,000/mm3. Further investigations revealed decreased serum iron and low normal total iron binding capacity. Which of the following could be her underlying disease? *
1 point
66. A 60-year-old woman presented with chronic fatigue and anemia. CBC: Hb 10.1 g/dL, MCV 122 fL, WBC 5,000/mm3 (N 75%, L 25%), platelet 135,000/mm3. Peripheral blood smear revealed hyper- segmented neutrophils. Which condition is most related with her disease? *
1 point
67. A 10-year-old boy presented with fatigue and dark urine for 2 days after taking co-trimoxazole. PE: mildly pale CBC: Hct 30% Peripheral blood smear: normochromic normocytic RBCs, polychromasia, bite cells, ghost cells Which of the following is most likely defective in this patient? *
1 point
68. A 35-year-old man presented with chronic anemia and mild jaundice. He also noticed dark urine occasionally in the morning. CBC: Hb 8 g/dL, WBC 3,800/mm3, platelet 90,000/mm3. RBC morphology: hypochromic microcytic, anisocytosis 2+, spherocyte – few, polychromasia – few, basophilic stippling, NRC 1/100 WBCs. What is the primary defect of red blood cells in this patient? *
1 point
69. A 20-year-old man presented with chronic fatigue. PE: markedly pale, moderate jaundice, hepatosplenomegaly. Peripheral blood smear showed anisopoikilocytosis and numerous target cells. Which of the following is most likely defective in this patient? *
1 point
70. The hemoglobin typing of pregnant woman is EA (E 30%) and her husband is A2A (A2 4.5%). What is the chance in percentage that their baby is genetically normal? *
1 point
71. A 20-year-old man presented with chronic fatigue. PE: markedly pale, moderate jaundice, hepatosplenomegaly. Peripheral blood smear showed anisopoikilocytosis and numerous target cells. Which of the following should be prescribed in this patient? *
1 point
72. A previously healthy man came for health check-up. CBC: Hb 13.5 g/dL, MCV 70 fL, WBC 6,400/mm3, platelet 257,000/mm3. What is the most likely diagnosis? *
1 point
73. A 60-year-old man presented with easily fatigue for 1 month. CBC: Hb 7 g/dL, WBC 1,500/mm3 (N 25%, L 70%, E 2%, M 3%), platelet 30,000/mm3. Which of the following is the most appropriate investigation? *
1 point
74. A 30-year-old woman presented with dyspnea and malaise. Physical examination showed moderately pale. The further investigations were consistent with aplastic anemia. Which industrial occupation can cause her disease? *
1 point
75. A 30-year-old man was cut by a sharp knife at his wrist. He had a complete tear of median nerve. A surgery was performed. Which cell is responsible for repairing the nerve in the healing process? *
1 point
76. A 30-year-old man complained of periodic muscle weakness in both legs. PE: proximal muscle weakness all extremities, decreased deep tendon reflexes. Blood tests revealed Na+ 140, K+ 2, Cl- 110, HCO 3 - 22 mmol/L. Which of the following is most likely found in his muscles? *
1 point
77. A 45-year-old man presented with headache and blurred vision. Brain imaging showed dilation of lateral and third ventricles. What is the most likely site of lesion? *
1 point
78. A 60-year-old man had an occlusion of anterior spinal artery. Which of the following is most likely to be normal? *
1 point
79. After a motorcycle accident, a 30-year-old man presented with loss of vibration and proprioception on the right side and loss of pain and temperature sensation on the left side below the umbilicus. What is the most likely site of lesion? *
1 point
80. A 50-year-old man presented with numbness. PE: paresthesia of right side of body and left side of face, normal cranial nerves. What is the most likely site of lesion? *
1 point
81. A 55-year-old woman with breast cancer has received chemotherapy and developed vomiting as a side effect. Which area in the brain is responsible for this side effect? *
1 point
82. A 40-year-old woman noticed weakness at right upper and lower extremities and double vision. Left pupil was larger than the right. Left eye was outward and downward. Right lower facial muscle paralysis was also observed. What is the most likely site of lesion? *
1 point
83. A 60-year-old man had constricted pupils. His pupils were poor constrict to light but constrict briskly to accommodation. What is the most likely site of lesion? *
1 point
84. A 70-year-old man presented with slow movement, resting tremor, muscle rigidity and postural instability. Which structure is the most likely site of lesion? *
1 point
85. A 65-year-old man presented with resting tremor, pill rolling hands, and slow movement. Which of the following enzymes is most likely deficient in this patient? *
1 point
86. A 60-year-old man presented with right sided weakness and motor aphasia for 1 hour. CT scan of brain revealed cerebral infarction without hemorrhage. Which drug is most effective for treatment in this patient? *
1 point
87. A farmer who works in the rice field has thickened skin on palms and soles. Which of the following is most likely involved? *
1 point
88. A 25-year-old pregnant woman, GA 6 weeks, makes decision to self-medicate for her acne problem. Which drug is most likely cause a problem to a developing fetus? *
1 point
89. A 5-year-old girl had subacute eczema. She was diagnosed with atopic dermatitis. Which pathogen is most likely associated with her condition? *
1 point
90. A 25-year-old woman presented with skin lesions at elbow. PE: well-defined erythematous plaques with silvery scale at both elbows. What is the pathogenesis of her disease? *
1 point
91. A 30-year-old man was diagnosed with severe psoriasis. He was treated with infliximab. What is the main target site of action of this drug? *
1 point
92. A 60-year-old woman presented with weight loss and skin hyperpigmentation. PE: hyperkeratosis and hyperpigmentation of skin at neck, axillae, flexures and anogenital area. Endocrinologic studies revealed normal serum levels of adrenal corticosteroids and glucocorticoids. Which tumor can cause these findings? *
1 point
93. A 60-year-old woman was diagnosed with osteoporosis. She was treated with alendronate. What is the major action of this drug? *
1 point
94. A 20-year-old man was lifting weights for 2 weeks. His muscle strength was increased without increasing muscle mass. Which of the following best explains his finding? *
1 point
95. A 5-year-old boy presented with tiredness and fatigue. PE: weakness of shoulder and pelvic girdles with enlargement of calf muscles. Immunohistochemical study of his muscle biopsy revealed completely absent of dystrophin. What is the most likely diagnosis? *
1 point
96. A 5-year-old boy presented with tiredness and fatigue. PE: weakness of shoulder and pelvic girdles with enlargement of calf muscles. His muscle biopsy revealed extensive replacement of muscle fibers by fat cells. Which of the following is absent in his muscle biopsy? *
1 point
97. A 45-year-old woman was inability to protract her left shoulder. PE: prominent left scapula when push against the wall. Which nerve is most likely injured? *
1 point
98. A 40-year-old woman presented with pain at lateral epicondyle of right humerus. Which muscle tendon is most likely to be normal? *
1 point
99. A 55-year-old man presented with epistaxis and hemoptysis. PE: swelling of nasal septum, bleeding from nasopharynx. A surgery was required to prevent the future recurrence. Which artery must be ligated? *
1 point
100. A 45-year-old woman is suffering from hoarseness. She has a history of thyroidectomy. The most likely injured nerve is originated from which of the following? *
1 point
101. A 25-year-old woman was diagnosed with allergic rhinitis. She was prescribed intranasal decongestant for relieving her symptoms. Which of the following is most likely occurred when she takes this drug continuously for 10 days? *
1 point
102. A 70-year-old man complained of runny nose for 2 days. His underlying diseases included hypertension and chronic constipation. Which drug is appropriate for treatment in this patient? *
1 point
103. A 45-year-old man has a mass at medial aspect of superior mediastinum. Which structure is most likely compressed? *
1 point
104. A 45-year-old man developed pleuritic chest pain and dyspnea for 2 days. PE: dullness on percussion and decreased breath sound over the left lung field. Which of the following is the most likely pathologic condition? *
1 point
105. A 20-year-old primigravida with diabetes has the onset of premature labor pain at the 30th week of gestation. Which medication should be administrated to her for preventing the occurrence of respiratory distress syndrome in her premature newborn? *
1 point
106. A 50-year-old man was diagnosed with liver cirrhosis. He presented with dyspnea and tachypnea. PE: abdominal distension with positive fluid thrill. What does this abdominal finding affect respiration? *
1 point
107. An 80-year-old man had a history of choking while having a dinner 3 days ago. He presented with fever, chills, productive cough with yellowish green sputum for 1 day. Which of the following is most likely found in his sputum culture? *
1 point
108. A 30-year-old man presented with fever, dry cough and progressive dyspnea for a few days. Pulse oximetry shows 80% oxygen saturation. CXR shows bilateral ground glass infiltration. Anti-HIV is positive with CD4+ count of 150/mm3. What is the most likely causative pathogen? *
1 point
109. A 50-year-old woman was diagnosed with diffuse interstitial lung disease. Her chest imaging showed supradiaphragmatic plaques. Sputum cytology revealed no atypical cell. Pulmonary function tests: normal FEV 1/ FVC ratio, decreased FVC.What is the most likely occupation of this patient? *
1 point
110. A physician places his stethoscope at 5th ICS left sternal border. Which structure is most likely to be auscultated? *
1 point
111. A physician put his stethoscope on the patient's chest on the right side next to the sternal angle. Which structure is most likely to be auscultated? *
1 point
112. A 25-year-old runner has resting heart rate 60/min. After taking a short dash, his pulse rate rise up to 110/min. Which phase of cardiac cycle is most likely decreased duration in this runner? *
1 point
113. A 40-year-old woman presented with fatigue and dizziness. PE: markedly pale conjunctiva, cardiac murmur. Which is increased resulting in cardiac murmur? *
1 point
114. A marathon runner has a resting HR of 54/min. What is the most responsible mechanism for the resting HR in this athlete (compared with normal person)? *
1 point
115. A 50-year-old man presented with chest pain. PE: BP 80/40 mmHg, HR 120/min. Investigations revealed ST elevation on ECG and increased serum troponin T level. Which of the following factors is decreased and responsible for hypotension in this patient? *
1 point
116. A woman came for check up. PE: HR 100/min. Echocardiography showed end-diastolic volume 200 mL and end-systolic volume 160 mL. What is her ejection fraction? *
1 point
117. Voluntary press the carotid body, which of the following is increased response? *
1 point
118. A 65-year-old man presented with chest pain radiating to left arm for 1 hour. He also had diaphoresis. Which part of ECG is most likely abnormal? *
1 point
119. A 40-year-old man came for check-up. His chest X-ray showed left atrial hypertrophy. What is the most likely cause of his X-ray finding? *
1 point
120. A 60-year-old man presented with change of bowel habit and weight loss. Colonoscopy revealed a mass at the descending colon. Biopsy findings were consistent with carcinoma. Which artery will be ligated at the time of tumor removal? *
1 point
121. A 30-year-old woman has abnormal motility of GI tract. No high propulsive activity of stomach and duodenum is found during fasting state. Which hormone is most likely defective in this patient? *
1 point
122. A 50-year-old man presented with burning sensation in his chest and sour taste in his mouth. Endoscopy with biopsy of lower esophagus was performed. Which epithelial change is most likely found in this patient? *
1 point
123. A 45-year-old man presented with dysphagia and weight loss. Endoscopy revealed mass at lower esophagus. Biopsy findings of the mass were consistent with squamous cell carcinoma. Which of the following is most likely associated with his disease? *
1 point
124. A 60-year-old woman presented with abdominal bloating and fullness after a few bite meal. She had a poorly controlled type 2 DM for 15 years. PE: abdominal distension, hypoactive bowel sound. Gastroparesis was suspected. Which drug is most appropriate for treatment? *
1 point
125. A 30-year-old man had a head injury from car accident. He underwent major operation. Few days later, he developed epigastric pain. Coffee ground content was found on his NG tube. Endoscopy revealed shallow gastric lesion. Biopsy of the lesion showed numerous neutrophils, erosion and new hemorrhage. What is the most likely diagnosis? *
1 point
126. A 30-year-old man presented with dyspepsia and epigastric pain for 6 months. PE: within normal limits. Gastric biopsies found chronic mucosal inflammation with corkscrew-like organisms. Which of the following is the highest risk of gastric cancer? *
1 point
127. A 70-year-old man has a history of dyspepsia and significant weight loss. Gastroscopy is performed and shows fungating ulcerative mass with necrosis at gastric antrum. Which of the following is most likely microscopic finding of this mass? *
1 point
Clear selection
129. A 50-year-old man underwent total gastrectomy due to gastric carcinoma. Which of the following is the most likely consequence? *
1 point
130. A 50-year-old man with adenocarcinoma underwent terminal ileal resection. Which of the following is most likely defective in this patient? *
1 point
131. A 30-year-old man presented with severe watery diarrhea and vomiting. Later he developed oliguria. PE: BP 90/60 mmHg, P 100/min. Blood tests revealed BUN 45 mg/dL and Cr 4.5 mg/dL. Which of the following is most responsible for oliguria in this patient? *
1 point
132. A 20-year-old man who works in a battery factory for 5 years. Urinalysis revealed aminoaciduria and glycosuria. Which structure is most likely defective in this patient? *
1 point
133. A 50-year-old woman is diagnosed with type 2 DM. Urinalysis shows specific gravity 1.020, glucose 2+, ketone bodies trace. Her blood glucose is 350 mg/dL. Her blood pressure is in normal range. Which mechanism is most responsible for her glycosuria? *
1 point
134. A 20-year-old type 1 diabetic patient was prescribed a SGLT-2 inhibitor as an adjuvant. Her renal function was normal. Which substance has clearance value equal to glucose clearance in this patient? *
1 point
135. A diuretic increases urine flow, decreases urine calcium, increases plasma pH and decreases plasma potassium concentration. Which of the following is most likely inhibited by this drug? *
1 point
136. A 20-year-old woman was prescribed mannitol for treatment of cerebral edema after motorcycle accident. Which of the following is the main action of this drug? *
1 point
137. A woman experienced polyuria and polydipsia after brain surgery. Her physician prescribed ADH analogue. After taking this drug, her urine osmolality increased while her plasma osmolality decreases. The renal clearance of which substance is most likely decreased? *
1 point
138. A 35-year-old man has ADH-secreting lung tumor. Which of the following is most likely to be found in this patient? *
1 point
139. A 60-year-old woman presented with polyuria. History of taking herbal medication during past week was noted. Fresh urine volume of 300 mL was obtained after her last voiding 2 hours ago with osmolality of 100 mOsm/kg. Which of the following is the most likely effect of herbal medication? *
1 point
140. A 60-year-old man was diagnosed with type 2 DM for 20 years. PE: BP 150/100 mmHg. UA: protein 3+, WBC 2-3/hpf, RBC 0-1/hpf. Which pathologic finding is most likely found on his renal biopsy? *
1 point
141. A 20-year-old woman has no menstruation, no uterus and no adnexa. PE: normal female external genitalia, blind vaginal pouch. Karyotype is 46, XY. What is the most likely diagnosis? *
1 point
142. The histology of an ovarian tissue shows some atretic follicles with many corpus albicans, but no developing follicles or corpus luteum. Which of the following is most likely to have an ovary with these microscopic findings? *
1 point
143. A 45-year-old woman presented with right breast mass with bloody nipple discharge. Biopsy revealed fibrovascular core with epithelial cells and myoepithelial cells. What is the most likely diagnosis? *
1 point
144. A 65-year-old man had an irregular mass at his penis. He was diagnosed with well-differentiated squamous cell carcinoma confirmed by tissue biopsy. Which histopathological finding is most relevant to the diagnosis? *
1 point
145. A 55-year-old man complained about dysuria for 6 months. PE: prostate enlargement, rubbery consistency. UA: RBC 0-1/hpf, WBC 0-1/hpf. What is the most likely diagnosis? *
1 point
146. A 30-year-old woman presented with palpitation and weight loss for 2 weeks. PE: BP 130/80 mmHg, P 120/min, regular, fine tremor at both hands, diffuse enlargement of thyroid gland. Her blood tests showed TSH 0.01  µU/mL (0.2-4.0), free T 410.0 ng/dL (0.9-1.9). Which drug is used to lower her heart rate? *
1 point
147. A 30-year-old woman presented with painless neck mass size 1.5 cm. Fine needle aspiration biopsy showed follicular cells with ground-glass nuclei, nuclear groove and intranuclear pseudo- inclusion. What is the most likely diagnosis? *
1 point
148. A 40-year-old man went on a neck surgery. One week later, he had hypocalcemia. Which cell will be most likely stimulated? *
1 point
149. A 50-year-old man had a total thyroidectomy and excision of jugular nodes. Twelve hours later, he developed circumoral numbness and paresthesia in his fingertips. Which finding is most likely found in this patient? *
1 point
150. A 65-year-old type 2 diabetic man had BMI 28 kg/m2. Blood tests showed BUN 10 mg/dL and creatinine 0.7 mg/dL. Which drug is most appropriate for treatment? *
1 point
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