Upload final tables 15.11.2023

general_surgery.csv

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+question,answer
+"A 23-year-old is undergoing surgery for an incarcerated femoral hernia. As part of the surgery, a cut was made of the ligament named after Cooper and bleeding started. For which artery should superselective angiography be performed?
+A. Obturator artery.
+B. Superior epigastric artery.
+C. Inferior Epigastric Artery.
+D. Femoral Artery.
+",A
+"In which surgeries to repair an inguinal hernia with an anterior approach is there an indication for a tissue-type repair.
+(without network)?
+A. In smokers.
+B. In diabetics.
+C. In recurrent inguinal hernia repair.
+D. When a bowel resection was necessary after it  was incarcerated.
+",D
+"What is the surgical approach in a patient suffering from an incarcerated femoral hernia with intestinal necrosis who is urgently operated upon?
+A. Bassini repair.
+B. McVay repair.
+C. Lichtenstein repair.
+D. Shouldice repair.
+",B
+"A 70-year-old man complains of tenderness and swelling in the right testicle 3 days after open surgery to repair a recurrent inguinal hernia on the right.
+What is the recommended treatment in this situation?
+A. Antibiotics.
+B. Surgery to review the scrotum.
+C. Anti-inflammatory and pain relievers.
+D. Anticoagulants.
+",C
+"A female patient is a candidate for a right mastectomy (mastectomy) due to malignancy. A sentinel node resection was performed in the right armpit,  the frozen section showed  metastasis. What should be the next step of the surgical treatment?
+A. Lymphatic dissection of the right armpit - layer 1 and 2.
+B. Removal of 3 sentinel lymph nodes.
+C. Intraoperative radiation.
+D. To end  the surgical operation.
+",A
+"A 55-year-old candidate for breast conserving surgery due to malignancy in the left breast. During her examination, the malignant mass, 1.5 cm in diameter, was felt in the left breast in the upper outer quadrant, but there were no other findings on examination. During surgery, the malignant mass was resected and 2 sentinel nodes were removed. The nodes were found to be positive for metastases. In addition to radiation to the entire breast, what does the treatment of the patient require?
+A. Lymphatic dissection of the left armpit - layer 1 and 2.
+B. Systemic treatment (hormonal or chemical).
+C. Total mastectomy.
+D. Intraoperative radiation to the armpit.
+",B
+"What is the second most common malignancy in the breast?
+A. INVASIVE DUCTAL CARCINOMA.
+B. INVASIVE LOBULAR CARCINOMA.
+C. MUCINOUS CARCINOMA.
+D. INVASIVE PAPILLARY CARCINOMA.
+","A,B,C,D"
+"The treatment for BORDERLINE PHYLLODES TUMOR type must include, in addition to its excision:
+A. Radiation to the operated breast.
+B. Taking sentinel lymph nodes in the armpit on the same side.
+C. Excision with a desirable margin of at least 1 cm.
+D. Systemic treatment.
+",C
+"Where is Ghrelin secreted from?
+A. From the antrum.
+B. From the body of the stomach.
+C. From the fundus.
+D. From the whole stomach.
+","B,C"
+"A patient with a BMI of 36 presents with one of the following underlying diseases. What underlying disease is not  an indication for bariatric surgery?
+A. Diabetes.
+B. Dyslipidemia.
+C. Ischemic heart disease.
+D. Hypertension.
+",C
+"According to the findings of the Swedish Obese Subjects study, what was the reduction in mortality in patients followed for 15 years post bariatric surgery?
+A. About 80%.
+B. About 30%.
+C. About 15%.
+D. About 5%.
+",B
+"Which finding would confirm the suspicion that a candidate for surgery for obesity is suffering from Pickwickian syndrome?
+A. Dilated aorta on chest x-ray.
+B. Hematocrit below 35 in blood count.
+C. Peaked T-waves in the ECG.
+D. PO2>pCO2 in blood gases.
+",D
+"Which of the following treatments has been shown to reduce mortality in sepsis?
+A. Anti-TNF antibody.
+B. Recombinant IL-1Ra.
+C. Recombinant activated protein C.
+D. So far no effective treatment has been found.
+",D
+"What are Kupffer cells in the liver?
+A. Macrophages.
+B. Basement membrane cells.
+C. Hepatic stem cells.
+D. Dendritic cells.
+",A
+"A TEG (thromboelastogram) was taken for a bleeding injured person, showing an elongated R. What is the treatment in this case?
+A. FFP.
+B. Platelets.
+C. Tranexamic acid.
+D. Heparin.
+",A
+"A 62-year-old diabetic was rescued 12 hours after falling in a wadi. During his examination, a lumbar spine fracture was suspected, with partial motor deficits in the lower limbs. It was decided not to give the injured person steroids. What will justify the decision?
+A. Age over 60.
+B. Background diabetes.
+C. The injury happened 12 hours ago.
+D. The paralysis is partial.
+",C
+"Which of the following is a contraindication for a kidney transplant?
+A. Systemic lupus.
+B. NYHA heart failure 4.
+C. HIV.
+D. Diabetes.
+",B
+"What is the purpose of the CMV test in the donor before small intestine transplant surgery?
+A. Prevention of the development of severe colitis in the transplant recipient.
+B. Prevention of CMV retinitis in the transplant recipient.
+C. Prevention of hearing loss in the transplant recipient.
+D. Prevention of the development of lymphoma in the transplant recipient.
+","A,D"
+"A female patient was diagnosed with a mass in the abdominal wall. Pathology was suggestive of desmoid. In which case will we choose supervision only?
+A. The patient has abdominal pain.
+B. The mass pushes the ureter.
+C. The mass grew from 8 to 10 cm in the radiological follow-up.
+D. A 15 cm mass.
+",D
+"Which of the syndromes is most likely the risk factor for sarcoma of the abdominal wall in a 16-year-old boy?
+A. MEN I.
+B. Li-Fraumeni Syndrome.
+C. BRCA2.
+D. Peutz-Jeghers syndrome.
+",B
+"What size intubation tube will we use in an 8 child?
+A. 3.
+B. 4.
+C. 5.
+D. 6.
+",D
+"A 6-year-old boy who was injured in a car accident has evidence of partial nerve damage in the lower limbs that passes after a few hours. A total body CT was performed and no obvious injury to the spinal vertebrae was demonstrated. What is the diagnosis?
+A. Diffuse axonal injury.
+B. Air emboli.
+C. Spinal injury.
+D. Thrombosis of the spinal plexus.
+",C
+"What is the disadvantage of Peroral endoscopic myotomy (POEM) compared to Laparoscopic Heller
+Myotomy?
+A. An increase in mortality.
+B. Longer recovery time.
+C. Higher recurrence rate of dysphagia.
+D. An increase in the frequency of reflux.
+","C,D"
+"Which of the following describes the mechanism of action of MYCOPHENOLATE MOFETIL?
+A. INOSINE MONOPHOSPHATE DEHYDROGENASE Antagonist.
+B. IL antagonist-2.
+C. ANTI CD25 MONOCLONAL ANTIBODIES.
+D. ANTI CD3 MONOCLONAL ANTIBODIES.
+",A
+"What is a side effect of CYCLOSPORINE A?
+A. Gingival recession.
+B. Extreme drop in blood pressure.
+C. Hypertrichosis.
+D. Diabetes that is difficult to balance.
+",C
+"What would not adversely affect prognosis in intrahepatic cholangiocarcinoma (IHCC)?
+A. Vascular involvement.
+B. Multifocal.
+C. Lymph nodes in the porta hepatis are positive for the tumor.
+D. CEA above 200 ng/mL.
+",D
+"What is considered an absolute contraindication to liver resection due to colorectal metastases?
+A. Number of metastases of 4 or more.
+B. Margins are close.
+C. 20%<Future Liver Remnant.
+D. Bilateral involvement of the liver lobes.
+",C
+"1.5 years ago, a 40 year old underwent a right colon resection due to adenocarcinoma, STAGE 1.
+In oncological follow-up and in light of an increase in CEA to 15 ng/mL, imaging was performed (PET CT, MRI, CT) which demonstrated one metastasis in segment 2 of the liver with a maximum size of 3 cm. He underwent successful removal surgery.
+And the metastasis was excised with a clean margin of 2 cm. What is the expected survival rate for 5 years?
+A. 80%.
+B. 60%.
+C. 30%.
+D. 15%.
+",B
+"With reference to liver adenoma, LIVER CELL ADENOMA, which of the following is considered the most significant risk factor for the development of malignancy?
+A. B-CATENIN mutation.
+B. Inflammatory Adenoma.
+C. HNF1A mutation.
+D. Adenomatosis.
+",A
+"A 32 year old patient is 20 weeks pregnant and has peptic ulcer disease. She is admitted to the emergency department due to sudden severe pain in the abdomen, and signs of peritoneal irritation on physical examination. In blood tests - leukocytosis, liver and pancreas functions within the norm. What will be the first imaging test for further investigation? 
+A. X-Ray. 
+B. US. 
+C. CT. 
+D. MRI. 
+
+",A
+"A patient is hospitalized in the intensive care unit, ventilated, anesthetized, and paralyzed. Abdominal.
+compartment syndrome is suspected and Intra-abdominal pressure is measured through a catheter in the bladder. How should the measurement be performed?
+A. Pressure measurement at the beginning of inspirium.
+B. Pressure measurement at the end of inspirium.
+C. Average of the measurements during several breathing cycles.
+D. Pressure measurement during cessation of breathing.
+",D
+"A 1.5 year-old is crying, and seems to be suffering. The stomach is slightly swollen, and sensitivity is noted on abdominal examination. 
+US examination for diagnosing intra-abdominal pathology was performed. Which of the following is the most common sonographic finding?
+A. Ovarian environment.
+B. Enlarged mesenteric lymph nodes.
+C. Target sign.
+D. Meckel's diverticulitis.
+",C
+"In the case of vascular trauma, an approach to repair which blood vessel among the following would be optimal after performing the Left medial visceral rotation maneuver?
+A. Inferior Vena Cava.
+B. Part II of Superior Mesenteric Artery.
+C. Left external iliac artery.
+D. Celiac trunk.
+",D
+"In a patient who regularly takes NSAIDS painkillers drugs from which group may
+Increase the risk of bleeding in the digestive system?
+A. Selective serotonin reuptake inhibitors.
+B. Alpha-adrenergic agonists.
+C. H2-receptor antagonists.
+D. GLP-1 receptor agonist.
+",A
+"A 50 year old, with at least 10 years known for peptic disease and recurrent duodenal ulcer despite optimal drug treatment is  hospitalized due to bleeding from the ulcer. Endoscopy to stop the bleeding was partially successful. The patient is stable, but his hemoglobin level is decreasing. During hospitalization, he received 7 doses of PC, 3 of which were in the past 24 hours. Surgical treatment was decided. What is the scope of the recommended surgery? 
+A. Pyloroplasty, truncal vagotomy. 
+B. Antrectomy, truncal vagotomy. 
+C. Parietal cell vagotomy. 
+D. Partial gastrectomy, Billroth-II reconstruction. 
+
+",B
+"A 50-year-old man was treated with angioembolization due to bleeding from a posterior duodenal ulcer. The radiologist writes that a blockage of the Inferior Pancreaticoduodenal Artery (IPDA) was performed.
+In what order did the catheter pass from the aorta to the IPDA?
+A. Celiac Trunk Lt Gastric Artery- Gastroepiploic Artery  IPDA.
+B. Celiac Trunk Common Hepatic Artery Gastroduodenal Artery IPDA.
+Third. Superior Mesenteric Artery Gastroepiploic Artery IPDA.
+D. Celiac Trunk Splenic Artery Gastroepiploic Artery IPDA.
+",B
+"Which lymph nodes will be cut in D-2 gastrectomy in addition to those which are cut in a 1D gastrectomy?
+A. Short gastric lymph nodes.
+B. Middle colic lymph nodes.
+C. Right paracardiac lymph nodes.
+D. Proximal splenic lymph nodes.
+",D
+"According to the Forrest Classification, which of the following types of peptic ulcer is most likely to rebleed?
+A. Non-bleeding visible vessel.
+B. Adherent clot.
+C. Flat pigmented spot.
+D. Clean base ulcer.
+",A
+"In which type of stomach ulcer from the following is there usually excess secretion of acidity in the stomach?
+A. Type 1.
+B. Type 3.
+C. Type 4.
+D. Type 5.
+",B
+"A 44 year old underwent surgery in which an obstructing tumor was found in the region of the jejunum-allium junction. An oncological resection was performed. In the pathological evaluation, immunohistochemical staining appears to be positive for anoctamin-1, KIT. What type of tumor is this most likely? 
+A. Carcinoid. 
+B. Lymphoma. 
+C. GIST. 
+D. Hamartoma. 
+
+",C
+"A 36 year old, is undergoing HIPEC Cytoreduction Surgery due to Pseudomyxoma peritonei.
+Which of the following is the most common chemotherapy drug used in HIPEC?
+A. Cisplatin.
+B. Mitomycin C.
+C. Oxaliplatin.
+D. Docetaxel.
+",B
+"Due to a herniated disc, pressure is created on the nerve roots of L5. In which of the sphincters is it possible to expect to see an injury?
+A. Nobody.
+B. In the internal sphincter.
+C. In the external sphincter.
+D. In both.
+","A,B"
+"A risk factor for anal squamous cell carcinoma?
+A. HIV.
+B. EBV.
+C. CMV.
+D. Rotavirus.
+",A
+"A 72 year old diabetic is sick for a week: high fever and uncontrolled diabetes. In the ER : redness and crepitations in the skin of the perineum. On examination, septic fever, leukocytosis and worsening of kidney functions. After fluid infusion and antibiotics - what is the next step?
+A. Abdominal and pelvic CT.
+B. Urgent surgery.
+C. Opening an abscess in the ER.
+D. Hospitalization in the surgical department for continued antibiotic treatment.
+",B
+"What does a positive push test mean for a patient with suspected NECROTIZING FASCIITIS?
+A. Lack of muscle response to diathermy during perineal exploration.
+B. Absence of bleeding during exploration of the perineum with a finger.
+C. Ability to perform a dissection of subcutaneous tissue in the perineum area to a depth of 1 cm using.
+Finger only.
+D. The appearance of bleeding during exploration of the perineum with a finger, indicates the viability of the tissues.
+",C
+"A 74 year old patient is after hip joint replacement surgery that was complicated by paralytic ileus and evidence of CD
+(Clostridium difficile infection) with bloody mucous stool. What is the recommended treatment for this patient?
+A. IV Metronidazole 500 MG X 3/d + rectal Vancomycin.
+B. Oral Vancomycin 500 MG X 3/d.
+C. Oral Fidaxomicin 200MGX2/d.
+D. Fecal microbiota transplantation.
+",A
+"A generally healthy 60 year old is hospitalized in the surgical department due to gangrene in the perineum. He underwent  urgent debridement in the operating room and continued intravenous antibiotic treatment for two weeks due to the growth of Clostridium septicum in the blood. What is the mandatory recommendation for this patient upon discharge?
+A. Colonoscopy as soon as possible.
+B. Completion of antibiotic treatment for one month.
+C. Continue treatment with a home VAC.
+D. Birohematological.
+",A
+"For a patient suffering from hypothermia, what are the pathognomonic changes in the ECG?
+A. QRS segment widening.
+B. Elevated J POINT.
+C. Pointed T waves.
+D. Inverted U waves.
+",B
+"One of the first signs of malignant hyperthermia is:
+A. Spasm of the masseter muscle.
+B. Arrhythmia.
+C. Metabolic acidosis.
+D. Fever.
+",A
+"What is the most common bacteria that causes surgical site infections (SSI)?
+A. Pseudomonas aeruginosa.
+B. Streptococcus.
+C. Escherichia coli.
+D. S. aureus.
+",D
+"A patient with a background of ischemic heart disease and hypertension is a candidate for elective major abdominal surgery.
+Additional background: diabetes, hypertension, heavy smoking. What is expected to lower the rate of cardiovascular complications and perioperative mortality for this patient?
+A. Quit smoking a week before surgery.
+B. Discontinuation of drugs from the ACE inhibitor group the day before surgery.
+C. Increasing the dose of beta-blockers (־²-blockers) the day before surgery.
+D. Discontinuation of metformin treatment the day before surgery.
+",B
+"A female patient, after major abdominal surgery, has decreased urination. She weighs 60 kg. The amount of urine
+In the urinometer 12 hours after surgery was CC 280. On laboratory: creatinine 1.7 (base 0.8). What degree of acute kidney injury is this?
+A. Level 1.
+B. Level 2.
+C. Level 3.
+D. Level 4.
+",B
+"A patient with borderline creatinine clearance (CCT) is a candidate for abdominal CT with intravenous contrast material.
+Which means is considered the most effective for preventing acute kidney injury?
+A. Acetylcysteine.
+B. And vitamin C.
+C. Change.
+D. 0.9% IV NaCl.
+",D
+"3 weeks after ventral hernia repair surgery with mesh, during which the partial resection of the small intestine and anastomosis were performed, a patient comes to the emergency department with a clinical picture of intestinal obstruction. What is the most common reason?
+For this finding?
+A. Adhesions.
+B. Leakage from the anastomosis site with the formation of a collection.
+C. Internal hernia.
+D. Edema in the anastomosis area.
+",A
+"A patient with a background of cirrhosis, who has undergone Abdominoperineal Resection, comes to the emergency department due to bleeding from parastomal medullas. On admission hemodynamically stable. A week ago, he was hospitalized due to the same problem, and ligation was performed. What is the most effective treatment for this complication?
+A. Local adrenaline injection.
+B. Religation of varicose veins.
+C. Ablation of varicose veins.
+D. TIPS.
+",D
+"In an examination of a patient who underwent Hartman urgent surgery, two days after the operation, a suspicion of ischemia of the stoma was raised. In his examination - a soft abdomen, but the necrotic area seems to involve only the mucosa. What is the recommended treatment?
+A. Supervision.
+B. Local excision of areas of necrosis.
+C. The release of the skin from the mucosa.
+D. Repeat laparotomy and revision of the stoma.
+",A
+"A 30 year old is usually healthy. He was referred to the ER after a car accident, with a seatbelt sign.
+In TOTAL BODY CT.
+He was diagnosed with multiple rib fractures, without other injuries. The patient is in great pain. What is the treatment?
+The most suitable?
+A. IV MORPHINE.
+B. IV PETHIDINE.
+C. Surgery to fix fractures.
+D. Epidural anesthesia.
+",D
+"A 30 year old was brought to the emergency department after attempting suicide by hanging. Upon addmission they are unconscious, blood pressure is 
+90/60, and heart rate is 40. The appropriate treatment will be based on?
+A. Crystalloid fluids.
+B. Vasopressure treatment.
+C. Steroids.
+D. Blood products.
+","A,B"
+"A 35 year old is 1 day after bariatric surgery. Decreases in saturation were observed with hypoxia. In the CT angio of the lungs: massive PE in the right pulmonary artery. The patient was admitted to the respiratory intensive care unit, anesthetized and ventilated, and treatment with IV heparin was initiated. Due to drops in blood pressure and tachycardia, the patient underwent an echocardiogram which demonstrated increased pulmonary pressure and right heart failure. The treatment will be based on?:
+A. Crystalloid liquids and DOBUTAMINE.
+B. NITROGLYCERIN AND NITROPRUSSIDE.
+C. ASPIRIN AND NITROPRUSSIDE.
+D. Crystalloid fluids and epinephrine.
+",A
+"A 50 year old with a background of  COPD is hospitalized after resection of the esophagus and thoracic esophagogastric anastomosis and was successfully extubated two weeks ago. Now they have pulmonary edema and hypoxia. What is the recommended treatment?
+A. Connection to a BIPAP device.
+B. Connection to a CPAP device.
+C. Intubation and use of the SIMV method.
+D. Intubation and use of the high-frequency FREQUENCY VENTILATION method.
+",C
+"A 72 year old with kidney failure is treated with dialysis. He was referred to the emergency room after being hit by a vehicle.
+CT showed fractures in the pelvis, without active bleeding. Conservative treatment was decided. What anticoagulation therapy is recommended for this patient?
+A. Anticoagulation should not be given to this patient.
+B. Pneumatic socks.
+C. Low molecular weight heparin.
+D. Unfractionated heparin.
+",D
+"Due to uncontrolled fistula after DISTAL PANCREATECTOMY -  a patient is treated with TPN, sandostatin, and fasting.
+After a week, a subfebrile fever appeared. Blood cultures, urine cultures, and cultures of fluid drained from the fistula are sterile. Despite treatment with IV Augmentin there is no clinical improvement. What is the recommended empiric treatment?
+A. Fluconazole.
+B. Vancomycin.
+C. Steroids.
+D. Septrin.
+",A
+"A 60 year old with cirrhosis of the liver - Child-Pugh score - B, suffers from ascites. Two weeks ago he was admitted to the intensive care unit after a stroke. During his hospitalization, several episodes of aspiration were observed. What is the appropriate method of feeding?
+A. Feed by TPN.
+B. Enteral feeding by PEG insertion.
+C. Enteral feeding by Nasogastric tube.
+D. Surgical gastrostomy.
+","B,C"
+"A 19-year-old soldier, suffering from a gunshot wound to the jaw only, is fully conscious with a saturation of 96%. When he arrives in the shock room, he vomits a lot of blood, and the saturation drops to 85%. Repeated intubation attempts fail due to the large amount of blood in the oral cavity. What is the next step to take?
+A. Laryngeal mask airway.
+B. Tracheostomy.
+C. Videoscope-directed orotracheal intubation.
+D. Cricothyroidotomy.
+",D
+"A 20 year old fell from scaffolding 6 meters high, and injured his head. He was sent to a shock room with an oxygen mask.
+In the initial assessment, he opens his eyes in reaction to voice, pupils are equal and react to light, locates pain with his hand, and mumbles. Of all the characteristics that determine the GCS assessment, which is the best predictor of neurological recovery from the head injury?
+A. Pupil reaction.
+B. The motor position.
+C. The murmur.
+D. Opening the eyes.
+",B
+"A 40-year-old laborer fell from a crane at a height of 7 meters, injured his head and pelvis, was ventilated, and admitted to the ER. After a physical examination and full body CT, it was found that he suffered from a frontal cerebral contusion and pelvic fractures, but without blush. Before he was admitted he had a GCS of 6. After the introduction of ICP in the operating room, he is hospitalized for monitoring in the general intensive care unit.
+In intensive care, 5 hours after he arrived the ICP measurements are rising and abnormal. Which of the following actions is not effective for initial treatment of this condition:
+A. Lifting the head.
+B. Cooling the patient.
+C. Hyperventilation.
+D. Administration of mannitol.
+",B
+"What were the conclusions of the CRASH-2 study regarding the use of the preparation tranexamic acid (hexapron)?
+A. Increased the number of thrombotic events.
+B. Lowered the use of blood units in elective surgeries.
+C. Lowered overall mortality.
+D. Reduced the need for surgery.
+",C
+"A 43 year old stabbed himself in a suicide attempt on the right side of the neck, to the right and below the cricoid. He was intubated in the field and a dressing was placed on the stab wound. In the emergency department, he is hemodynamically stable, and breathing well. On examination of the wound, active bleeding is seen from the wound with air bubbles rising from the puncture area. In a chest x-ray: an intubation tube is seen in place, with no findings in the lungs. After starting a large transfusion of blood, what should be done with the injured person?
+A. Angioembolization to stop the bleeding.
+B. Bronchoscopy and insertion of a stent into the trachea.
+C. Tracheostomy in the operating room.
+D. Exploratory in the neck.
+",D
+"A 20-year-old, who was riding a dirt bike, was hit in the neck by a strap that was tied between two trees. He was brought to the emergency room alert, with relaxed breathing, and impressive abrasion marks on his neck on the left. After a first review in the emergency department, he was taken for a neck CTA, where a GRADE 1 left common carotid contusion was found, with no other findings. What should be done with the injured?
+A. Exploration in an operating room.
+B. Angiography with a carotid stent.
+C. Aspirin.
+D. Supervision only.
+",C
+"One of the effects of exposure to smoke in a closed space is inhalation of HCN which exposes the body to cyanide. Which of the following does cyanide cause at the cellular level?
+A. Reduces ATP levels.
+B. Paradoxically lowers LACTIC ACID levels.
+C. Impairs mitochondrial function.
+D. Increases the aerobic respiration of the cell.
+","A,C"
+"What is the reason for postponing elective surgery for another 6 weeks in case of using Avastin.
+(Bevacizumab).
+A. Due to side effect of cardiomyopathy.
+B. Due to side effect of arrhythmias.
+C. Due to side effects of bleeding.
+D. Due to side effects of hypercoagulability.
+",C
+"An 18 year old underwent excision of an ulcerative skin lesion and a biopsy revealed superficial spreading malignant melanoma. The penetration depth is 0.9 mm according to Breslow's scale. What is the treatment?
+A. Wide excision with a margin of 0.5 cm.
+B. Wide excision with a margin of 1 cm.
+C. Wide excision with a margin of 1 cm + sentinel node biopsy.
+D. Wide excision with a margin of 2 cm + sentinel node biopsy.
+","B,C"
+"Which infection agent was found to be associated with the development of Idiopathic thrombocytopenic purpura (ITP)?
+A. Helicobacter pylori.
+B. E. Coli.
+C. Mycobacterium tuberculosis.
+D. Neisseria meningitidis.
+",A
+"A 30-year-old woman underwent laparoscopic splenectomy due to ITP. A drain was left in the operation.
+In POD-3, a white-yellow discharge appeared in the drain. Despite the drainage, there is a chronic discharge that does not diminish after two weeks. What would be the appropriate treatment for the current situation?
+A. Adding fluconazole to the treatment.
+B. Distal pancreatectomy.
+C. Puestow pancreaticojejunostomy.
+D. Endoscopic sphincterotomy.
+",D
+"After a long course in intensive care due to pancreatitis, a 35-week pregnant woman was found suffering from a complicated urinary tract infection by E. Coli bacteria with multiple resistances but sensitive to Gentamicin only. What is the risk of treatment with this drug?
+A. Deafness of the newborn.
+B. Premature closure of fetal cardiac vessels.
+C. Coloring the baby's teeth.
+D. Damage to the cartilage of the fetus.
+",A
+"A 32-year-old normally healthy woman, 12 weeks pregnant, goes to the clinic due to a prominent umbilical hernia that bothers her.
+The umbilical hernia is slightly sensitive but not incarcerated and there have been no cases of incarceration in the past. At what time is it better to operate?
+Her?
+A. In the second trimester.
+B. In the third trimester.
+C. Two weeks after giving birth.
+D. 8 weeks after birth.
+",D
+"A usually healthy 30 year old is 10 weeks pregnant and complaining of epigastric pain.  US was performed.
+And then an MRI demonstrated a suitable image of a 3 cm adenoma of the left lobe of the liver. What would be the treatment recommendation?
+A. Second-trimester surgery.
+B. Surgery if there is evidence of bleeding.
+C. Postpartum surgery.
+D. Immediate surgery.
+",A
+"According to studies, which temporary abdominal closure technique in a patient after damage control will give the maximum chance for definitive abdominal closure in the future?
+A. Closure of the skin only.
+B. Bogota bag.
+C. Vacuum-assisted closure.
+D. Dressing with steridrape.
+",C
+"In the lateral region of the abdominal wall, in which layer is the nerves that innervate the abdominal wall?
+A. Between the peritoneum and transversalis fascia.
+B. Between the transversalis fascia and the transversus abdominis muscle.
+C. Between the transversus abdominis muscle and the internal oblique muscle.
+D. Between the internal oblique muscle and the external oblique muscle.
+","C,D"
+"A 45 year old is undergoing evaluation for abdominal swelling. Colonoscopy was found to be normal. Abdominal CT shows a large amount of non-clear fluid throughout the abdomen with small masses scattered throughout the abdomen. The appendix is enlarged up to 4 cm, with non-clear fluid inside and nodules on the wall. In the biopsy: mucin and atypical cells. What is the recommended treatment for the patient?
+A. Best supportive care.
+B. PARP inhibitors.
+C. Cytoreductive surgery and HIPEC.
+D. Neoadjuvant Chemotherapy.
+",C
+"A 54 year old has complained of back pain for 4 months. A CT was performed and then an MRI which demonstrated a retroperitoneal mass
+with a diameter of 5 cm corresponding to RETROPERITONEAL FIBROSIS. Despite the proximity to the ureters, no expansion of the renal pelvis is visible. What is the initial treatment for the patient?
+A. Aspirin treatment.
+B. Insertion of a stent into the ureters.
+C. Surgery to release the ureters.
+D. Methotrexate treatment.
+",B
+"A female patient is scheduled for surgery to remove a lipoma in the abdominal wall. From previous surgeries, she knows she tends to develop keloids in surgical scars. What may prevent the development of a keloid after surgery?
+A. Radiation treatment of the scar.
+B. A tattoo of bleomycin in the scar area.
+C. Injection of verapamil into the wound area.
+D. Dressing with silicone.
+",D
+"Treatment with Hyperbaric Oxygen has been found to help heal a wound in several situations including ischemia of the wound.
+What constitutes an absolute contraindication to this treatment?
+A. Evidence of bacterial infection of the wound.
+B. Diabetes.
+C. Extensive burn of over 40%.
+D. Therapeutic treatment with Doxorubicin.
+",D
+"The ultimate wound healing that does not leave a scar is fetal wound healing.
+Which factor is found in high concentration in the wound of a fetus compared to the wound of an adult?
+A. TGF־²1.
+B. FGF.
+C. IL10.
+D. PDGF.
+",C
+"To which stage of the wound healing process does epithelial migration belong?
+A. Inflammatory.
+B. Proliferative.
+C. Maturational.
+D. Remodeling.
+","A,B"
+"Which of the following tumors is more common in FAP carriers?
+A. Thyroid cancer.
+B. Endometrial cancer.
+C. Kidney cancer.
+D. Breast cancer.
+",A
+"A 45-year-old was diagnosed with medullary thyroid cancer; in which situations should a chest/abdominal CT scan be performed to rule out distant metastases?
+A. Calcitonin level above 500 pg/ml.
+B. If there are enlarged lymph nodes in section 2.
+C. Primary tumor over 4 cm.
+D. CEA levels above 150.
+",A
+"In which cases is there an advantage in posterior retroperitoneal adrenalectomy?.
+A. The patient with Cushing's syndrome needs bilateral adrenalectomy.
+B. Left adrenalectomy for a patient with a BMI of 45.
+C. Right adrenalectomy for a patient with 45 BMI.
+D. A patient with a 7.0 cm pheochromocytoma.
+",A
+"A 56 year old with known Cushing's syndrome is one month after right adrenalectomy due to his disease. He was admitted to the intensive care unit due to severe pneumonia. The next day he has low blood pressure, severe abdominal pain, nausea, and vomiting. What is the preferred initial treatment?
+A. Normal saline and intravenous hydrocortisone 100 mg.
+B. Glucose solution and intravenous administration of Dexcort 4 mg.
+C. Administration of U10 insulin and initiation of vasopressor therapy.
+D. Antibiotic treatment also covers bacteria of the digestive system and initiation of norepinephrine.
+",A
+"Which nerve may be damaged during upper pole release during thyroid lobectomy?
+A. External branch of superior laryngeal nerve.
+B. Internal branch of superior laryngeal nerve.
+C. Recurrent laryngeal nerve.
+D. Non-recurrent laryngeal nerve.
+",A
+"A 52 year old with end-stage renal failure was diagnosed with secondary hyperparathyroidism. He was referred for surgery. In pre-surgery imaging, US, and mapping - there is no evidence of a parathyroid adenoma. In D4CT, two enlarged glands on the right were suspected. What is the preferred surgical option?
+A. 3.5 Parathyroid gland resection together with thymus resection.
+B. Excision of 2 enlarged glands described in imaging.
+C. Bilateral cervical examination and excision of the glands that appear enlarged.
+D. Excision of 4 parathyroid glands with cryopreservation.
+",A
+"What is the preferred initial treatment for amiodarone-induced thyrotoxicosis?
+A. Methimazole.
+B. PTU propylthiouracil.
+C. Radioactive Iodine ablation.
+D. Total thyroidectomy.
+",A
+"Which of the following would be an indication for surgery for a 70-year-old, asymptomatic, with a new diagnosis Primary hyperparathyroidism?
+A. Compression fracture in 3L a year ago.
+B. T SCORE in the femoral neck minus 2.1.
+C. Calcium urine collection 350 mg/24 hours.
+D. Thyroid cancer in her past.
+",A
+"Why is there a decrease in pulse pressure in initial shock?
+A. Vasoconstriction causes higher diastolic pressures.
+B. A decrease in cardiac activity causes lower systolic pressures.
+C. The release of catecholamines causes an increase in systolic pressures.
+D. An increase in heart rate causes an increase in diastolic pressure.
+",A
+"Which heart rate would indicate the best prognosis in a patient with arterial bleeding?
+A. 50 beats per minute.
+B. 70 beats per minute.
+C. 100 beats per minute.
+D. 120 beats per minute.
+",B
+"How is the modified shock index calculated?
+A. Heart rate divided by PULSE PRESSURE.
+B. Heart rate divided by diastolic blood pressure.
+C. Heart rate divided by systolic blood pressure.
+D. Heart rate divided by mean arterial blood pressure (MAP).
+",D
+"What is the body's first compensatory mechanism in response to a hypovolemic shock?
+A. An increase in the secretion of catecholamines by the adrenal medulla.
+B. Activation of the renin-angiotensin system by the kidneys.
+C. Increase in sympathetic activity by baroreceptors in the aorta and carotids.
+D. Increasing blood flow to vital organs by constricting peripheral blood vessels.
+",C
+"What is the most effective way to warm a wounded person during trauma?
+A. Cover the patient with a heating blanket.
+B. Administer warmed intravenous fluids.
+C. Administering heated fluids into the pleural space.
+D. Heating the room to 37 degrees.
+",C
+"What is the recommended method for correcting a coagulation problem in patients with congestive heart failure?
+A. FFP.
+B. PCC.
+C. Whole blood.
+D. Tranexamic Acid.
+",B
+"Which of the following contains blood with the highest oxygen content?
+A. Inferior Vena Cava.
+B. Superior Vena Cava.
+C. Pulmonary artery.
+D. Coronary sinus.
+","A,B,C,D"
+"In which of the following cases is a preoperative nutritional assessment necessary?
+A. 70 year old man, BMI 19.
+B. 54-year-old man, unplanned weight loss from 80 to 74 kg in the last year.
+C. 35 year old woman, albumin levels 3.3.
+D. A 57-year-old woman, a decrease in eating of 40% of the usual diet in the last week.
+",A
+"What is the imaging of choice for assessing body mass before surgery?
+A. DXA mapping (Dual Emission X-ray Absorptiometry).
+B. US muscles.
+C. CT.
+D. MRI.
+",A
+"A patient with severe inflammation of the pancreas, in shock, is being treated with amine drugs in the intensive care unit. What is the recommended nutritional administration?
+A. TPN.
+B. Nasogastric feeding.
+C. Post pyloric nasogastric feeding.
+D. Feeding Jejunostomy.
+","A,C"
+"Which of the following dietary recommendations is recommended for a critically ill hospitalized patient in intensive care?
+A. Determine the amount of secretion in the nasogastric tube and calculate the volume of the oral economy according to this.
+B. Start oral feeding within 24-48 hours and increase the amount up to the feeding goals within a week.
+C. Immediate start of intravenous feeding.
+D. Avoid administering prokinetic drugs in treating a patient in the intensive care unit.
+",B
+"A street dweller is brought to the hospital after being attacked. Upon examination, he appears to be in a very poor nutritional state. What is the electrolyte disorder that may develop when he starts feeding it?
+A. Hyponatremia.
+B. Hypernatremia.
+C. Hypophosphatemia.
+D. Hyperkalemia.
+",C
+"Which patient is at risk for short bowel syndrome?
+A. 25 years old, after a car accident, he underwent right colon resection and segments of small intestine. The remaining length of the small intestine is 90 cm.
+B. 62 years old, after an acute mesenteric event in which a small intestine was resected. The length of the remaining small intestine is 80 cm.
+C. 75 years old after Total Proctocolectomy.
+D. 35-year-old Crohn's disease patient who underwent surgery to remove a 120 cm jejunostomy from the Treitz.
+",A
+"A patient who underwent sleeve surgery develops nutritional deficiencies. Which condition is the most common?
+A. Hypothyroidism.
+B. Megaloblastic anemia.
+C. Lactic acidosis.
+D. Zinc deficiency.
+",B
+"A patient underwent Heller myotomy surgery. A few days later he was diagnosed with a perforation and rushed to surgery. Which of the options is most suitable for starting enteral feeding as early as possible?
+A. Nasogastric.
+B. Nasoduodenal.
+C. Gastrostomy.
+D. Jejunostomy.
+",D
+"A patient with severe carotid stenosis and recurrent TIA events despite treatment with aspirin
+is a candidate for carotid endarterectomy. What is the patient's ASA rating?
+A. 2 ASA.
+B. 3 ASA.
+C. 4 ASA.
+D. 5 ASA.
+","B,C"
+"A patient with an inguinal hernia that bothers him when playing golf asks for advice on the best time for surgery. A month ago, due to a positive stress test, he underwent catheterization, and due to severe stenosis, angioplasty was performed, and a drug-eluting stent was inserted. He is currently being treated with aspirin and Pelvis. What is the desired date for surgery?
+A. A month and a half since the catheterization.
+B. 3 months after the catheterization.
+C. 6 months from the catheterization.
+D. A year since the catheterization.
+",D
+"What is not included in Fried frailty phenotype?
+A. Weight loss.
+B. Memory loss.
+C. Weakness in grip.
+D. Slow walk.
+",B
+"What is the main risk factor for postoperative delirium?
+A. Trauma.
+B. Dementia.
+C. History of past surgeries.
+D. Diabetes.
+",B
+"Where does the hindgut end?
+A. In the upper third of the rectum.
+B. In the middle third of the rectum.
+C. In the lower third of the rectum.
+D. In the anal canal.
+",D
+"What is the disadvantage of mechanical preparation of the colon before colon resection surgery?
+A. Excessive risk of wound infection.
+B. Excessive risk of leak.
+C. Excessive risk of electrolyte disturbances.
+D. Excessive risk of thromboembolic events.
+",C
+"A patient, after surgery, develops an active infection with Clostridium difficile that does not respond to antibiotic treatment. It was decided to treat with Fecal Microbiota Transplant. What is the most effective approach to providing this treatment?
+A. Swallowing frozen capsules.
+B. Administration through a nasogastric tube.
+C. Colonoscopy administration.
+D. There is no difference in effectiveness between the approaches.
+","C,D"
+"A patient underwent a colonoscopy and complete excision of a polyp on a stalk. The margins are clean. in pathology Well differentiated adenocarcinoma that involves the entire head of the polyp and also penetrates the submucosa of the stalk. What is the chance of metastases to the lymph nodes?
+A. Less than 10%.
+B. 15-20%.
+C. 35%.
+D. Over 40%.
+",A
+"A trauma patient undergoes a laparotomy due to bleeding from the liver. A pulse was felt.
+Lateral and right to the common bile duct. What is the blood vessel felt?
+A. Common hepatic artery.
+B. Hepatic propria artery.
+C. Replaced right hepatic artery.
+D. Cystic artery.
+",C
+"A 40-year-old woman is diagnosed with asymptomatic gallstones during a US performed for a workup of urinary tract infections. What is the chance that you will need surgery anyway in the next 20 years due to the onset of symptoms?
+A. About 1%.
+B. About 5%.
+C. About 10%.
+D. 20-30%.
+",D
+"A 30 year old is admitted through the ER with upper right abdominal pain and evidence of fever and peritonitis in the upper right abdomen. She has had similar events in her past that went away without treatment. US is performed due to suspicion of cholecystitis , demonstrating a non-swollen gallbladder, a thickened wall, and stones inside. The findings are inconclusive. What additional test should be performed to help diagnose cholecystitis?
+A. CT with contrast material.
+B. CT without contrast material.
+C. HIDA scan.
+D. MRCP.
+",C
+"What are the typical stones formed de novo in the bile ducts?
+A. Black stones.
+B. Brown stones.
+C. Cholesterol stones.
+D. Cholesterol stones with calcium.
+",B
+"A 50 year old is after a successful ERCP for cholecystitis secondary to gallstones. In the image after the catheter balloon has passed, there is no evidence of stones in the bile ducts. The patient wants to understand what is the risk of a repeated complication of gallstones if he does not undergo a gallbladder resection.
+A. Less than 10%.
+B. 20%.
+C. 30%.
+D. Over 50%.
+",D
+"A patient was operated on for gallstone ileus. What is the chance of the presence of additional large stones in the intestine?
+A. About 10%.
+B. About 20%.
+C. About 30%.
+D. 50% or more.
+",A
+"A post-CABG patient diagnosed with acalculous cholecystitis responds well to percutaneous drainage and antibiotics. Imaging two weeks after recovery shows that there is no evidence of stones in the gallbladder and there is good passage of contrast material to the biliary tract and duodenum. What is the next step in treatment?
+A. Pulling out the drain.
+B. Pulling out the drain and ordering an elective cholecystectomy 6 weeks after.
+C. Elective cholecystectomy along with drainage after 6 weeks.
+D. Leaving the drain for supervision for another 3 months.
+",A
+"A 55-year-old patient was diagnosed with a type I choledochal cyst after an episode of cholangitis that responded well to antibiotics. What is the recommended treatment?
+A. Resection with Roux-en-Y hepaticojejunostomy.
+B. Cyst drainage with Roux-en-Y cystojejunostomy.
+C. Sphincterotomy by ERCP.
+D. Supervision only.
+",A
+"What is the main cause of bicarbonate secretion from the pancreas?
+A. The vagus nerve.
+B. Trypsin.
+C. Secretin.
+D. Cholecystokinin.
+",C
+"What is the best CT scan to assess the extent of pancreatic necrosis in a patient with acute pancreatitis?
+A. Before contrast agent injection.
+B. In the arterial phase.
+C. In the venous phase.
+D. In the late review (180-200 seconds after injection).
+",C
+"A 75-year-old man is diagnosed with acute pancreatitis due to gallstones. Blood tests upon admission:
+Glucose 140 mg, leukocytes 20,000, LDH IU/L200, and AST IU/L 90. What is the degree of inflammation according to Ranson's criteria?
+A. Mild degree.
+B. Medium degree.
+C. Severe degree.
+D. Cannot be calculated.
+",D
+"A 45-year-old underwent an abdominal CT for suspicion of appendicitis, and randomly, one cystic lesion was demonstrated in the body of the pancreas. Among these data, what does not support the diagnosis of mucinous cystic neoplasm?
+A. Age of the patient.
+B. The gender of the patient.
+C. The location of the lesions.
+D. Number of lesions.
+",B
+"A 56-year-old man is being investigated for cystic lesions in the pancreas that were randomly discovered in a whole-body CT following a car accident. MRCP demonstrated several cysts in the tail, body, and head of the pancreas with a maximum diameter of one of the cysts located in the body of the pancreas - about 2.2 cm with a thick wall that takes up contrast material enhancement, without Virsong expansion, without a nodule or septum in the contents, without lymphadenopathy No additional aggravating findings were demonstrated in the EUS. What is the further management of the case?
+A. Review in a year.
+B. EUS or MRI in 3 months.
+C. Left pancreatectomy.
+D. Complete resection of the pancreas.
+",B
+"A 68-year-old woman is hospitalized for two weeks due to acute inflammation of the pancreas. Due to the worsening of her condition, with a heart rate of 107 and temperature of 38.9, she underwent an abdominal CT, which demonstrated 2 connected collections with a diameter of about 6 cm adjacent to the pancreas. What is the further management of the case?
+A. Antibiotic treatment with Imipenem.
+B. EUS-guided puncture of the collections for culture.
+C. CT-guided percutaneous drainage.
+D. Endoscopic Cystogastrostomy.
+",B
+"Which of the following measures is included in the qSOFA SCORE?
+A. Heartbeat.
+B. Body temperature.
+C. Breathing rate.
+D. Urine output.
+",C
+"What electrolyte disorder is common in patients with severe burns?
+A. Euvolemic hyponatremia.
+B. Euvolemic hypernatremia.
+C. Hypervolemichyponatremia.
+D. Hypervolemic hypernatremia.
+",A
+"A patient with intestinal obstruction and multiple vomiting develops tachycardia. Superficial T waves are observed in the ECG.
+As well as U waves. What is the appropriate treatment?
+A. IV FUSID.
+B. IV KCL.
+C. IV NS.
+D. IV BISOPROLOL.
+",B
+"Which of the following is the preferred agent for induction of anesthesia in an asthmatic patient?
+A. Ketamine.
+B. Midazolam.
+C. Etomidate.
+D. Thiopental.
+",A
+"A 30-year-old is known to have ulcerative colitis and is under biological treatment. He is hospitalized for 5 days due to a flare-up of the disease and is being treated with high-dose fluids and steroids without improvement. Now, his pulse is 110, WBC are 15,000, temperature 38.3, transverse colon on x-ray is 6 cm in diameter, no peritonitis. What is the next step in the management of the case?
+A. Immediate colonoscopy to decompress the bowel.
+B. Immediate colonoscopy to inject vancomycin antibiotics into the rectal area to treat the condition.
+C. Colectomy with ileostomy.
+D. Complete resection of the colon and rectum, with ileostomy.
+",C
+"A 73-year-old man with diabetes and heart failure comes to the emergency room with abdominal pain, tenesmus, and bloody diarrhea. As part of the workup, a colonoscopy is performed, which demonstrates an edematous, reddish segment that bleeds easily with ulcers in the mucosa. Note that the uninvolved areas appear normal. What is the most common location to find it?
+A. Cecum.
+B. The spleen glove.
+C. Ascending colon.
+D. Rectum.
+",B
+"A 65 year old with diabetes and hypertension comes to the emergency room with right abdominal pain and local sensitivity to the touch, and a temperature of 38.5. A CT is performed, which demonstrates diverticulitis of the ascending colon, 1a Hinchey. What is true about the therapeutic approach in this situation?
+A. Excision after the flare-up.
+B. Excision in the same hospitalization due to a high chance of perforation and abscess in this location.
+Third. If you go for surgery, a total abdominal colectomy should be performed to avoid leaving disease in the sigmoid and left colon as well.
+D. The therapeutic approach is similar to sigmoid diverticulitis.
+",D
+"In what situations would we recommend surgery in a patient who responded to conservative treatment for an episode of diverticulitis?
+A. In young people.
+B. In kidney transplant recipients.
+C. In right-sided diverticulitis.
+D. After a second episode of diverticulitis.
+",B
+"In which position should the stoma location be marked before surgery?
+A. Sitting down.
+B. Lying down.
+C. Lying down with back and head raised to 30-45 degrees.
+D. The position is not important.
+",A
+"A 25 year old has fistulous Crohn's disease involving the terminal ileum. Which organ will be most commonly involved?
+A. Ascending colon.
+B. Sigma.
+C. Urinary bladder.
+D. Uterus.
+",B
+"What is the correct abdominal CT protocol when Pancreatic Neuroendocrine Tumor is suspected.
+(PNET).
+A. Without contrast material.
+B. Arterial phase.
+C. Portal phase.
+D. Late phase.
+",B

internal_medicine.csv

@@ -0,0 +1,816 @@
+question,answer
+"What will reduce the high incidence of malignant diseases in kidney transplant recipients?
+A. Providing prophylactic treatment with Valganciclovir.
+B. Giving preventive treatment by Aciclovir.
+C. Treatment with mTOR inhibitors instead of Calcineurin inhibitors.
+D. Treatment with mycophenolate mofetil instead of mTOR inhibitors.
+",C
+"What is true about the risks of performing an endoscopy?
+A. In diagnostic endoscopy the risk of bleeding is around 5%.
+B. A patient with a prosthetic valve undergoing EUS and FNA should be given endocarditis prophylaxis.
+C. The risk of pancreatitis after ERCP is around 5-30%.
+D. Percutaneous gastrostomy insertion has a 30% risk of infection.
+",
+"When can EBV-lymphoproliferative disease develop after a kidney transplant?
+A. Starting two months after the transplant.
+B. Starting 12 months after the transplant.
+C. Starting two weeks after the transplant.
+D. Starting 5 years after the transplant.
+",A
+"What is considered a risk factor for sudden death in a 35-year-old patient with Hypertrophic Cardiomyopathy?
+A. Appearance of atrial fibrillation.
+B. Thickening of the apical parts of the ventricles.
+C. Mitral valve insufficiency.
+D. The absence of blood pressure elevation at the peak of exertion.
+",D
+"A 34-year-old woman is requesting a consultation regarding drug treatment for obesity. She states that she is usually ""full"" and has gained about 15 kg for no reason in the last two years without substantial diet and physical activity changes. Her blood pressure was 167/94, and purple striae was found on the abdomen and beneath the axilla. What are the next step required for diagnosis?
+A. Cortisol level in the morning. 
+B. Blood cortisol level in the morning. 
+C. Urine collection for cortisol. 
+D. ACTH level in the blood. 
+
+",C
+"A 75 year old was admitted to the hospital due to Malena. What would indicate the need for an urgent endoscopy?
+A. 150 ml of blood in the nasogastric tube bag.
+B. Blood pressure 80/60 mmHg.
+C. Treatment with Antiaggregants.
+D. The hemoglobin value is 10 g/dL.
+",B
+"A 60 year old with a background of liver cirrhosis is hospitalized due to varicose vein bleeding. What is true about antibiotic treatment in this patient?
+A. Antibiotic treatment should be given for a week.
+B. Antibiotic treatment is not recommended for this patient.
+C. Long-term antibiotic treatment should be given.
+D. Antibiotic treatment should be given if the patient is a candidate for varicose vein ligation.
+",A
+"A 71 year old patient is anesthetized, ventilated, and treated with ceftriaxone due to sepsis. In their history: Parkinson's disease, ischemic heart disease, hypertension, and depression.
+Until hospitalization, he regularly took Levodopa + Carbidopa, Aspirin, Citalopram, Amlodipine, and Valsartan.On the third day of hospitalization, there was an aggravation: fever of 40 C, rigidity, Labile arterial blood pressure, increased creatinine and increased CPK. What is the most likely reason for the clinical and laboratory deterioration?
+A. Ceftriaxone treatment failure.
+B. Discontinuation of Parkinson's disease treatment.
+C. Discontinuation of depression treatment.
+D. Drug fever for Ceftriaxone.
+",B
+"What is true about the treatment of Myelofibrosis?
+A. A JAK inhibitor has curative potential in myelofibrosis.
+B. A common side effect of JAK inhibitors is leukocytosis.
+C. Interferon alpha can reduce fibrosis in the early stage.
+D. Steroids may worsen anemia in myelofibrosis.
+",C
+"Who should be given the medicine Fluticasone + Vilanterol?
+A. For patients with Asthma but not for patients with COPD.
+B. For patients with COPD but not for patients with Asthma.
+C. For patients with COPD and also for patients with Asthma.
+D. For patients with Emphysema but not for patients with Asthma.
+",C
+"When should you try to lower the blood pressure of a patient who is suffering from an acute ischemic stroke and is not intended for thrombolytic therapy?
+A. When blood pressure values are above 220/130.
+B. When blood pressure values are above 180/110.
+C. When blood pressure values are above 160/100.
+D. When blood pressure values are above 140/90.
+",A
+"In which case of NSTEMI is Prasugrel treatment better than Clopidogrel?
+A. 40 years old with PCI to the bypassed artery.
+B. 64 years old intended for conservative treatment.
+C. 64 years old undergoing PCI to the left main about a month after a stroke.
+D. 80 years old with atrial fibrillation who underwent PCI to the right artery.
+",A
+"A 74-year-old man was hospitalized due to an MI. In their history:  type 2 diabetes was diagnosed about 17 years ago, and is treated with Metformin.
+Last HbA1c was 7.6%. He has microalbuminuria with preserved renal function, dyslipidemia with an LDL level of 128 mg/dL, and repeated episodes of pancreatitis. What treatment is recommended?
+A. Semaglutide.
+B. Empagliflozin.
+C. Sitagliptin.
+D. Repaglinide.
+",B
+" A 40-year-old man who underwent a gastroscopy due to pain in the abdomen and a decrease of about 5% in his body weight was found to have  an ulcer in the first part of the duodenum measuring 8 mm. What is true about a duodenal ulcer?
+A. A biopsy should be taken to rule out malignancy.
+B. Most duodenal ulcers are associated with Helicobacter pylori.
+C. In most cases, the ulcer in the duodenum is larger than 3 cm.
+D. Duodenal ulcers appear at an older age than stomach ulcers.
+",B
+"What is true about vaccination against S. Pneumoniae in a 50-year-old woman with multiple myeloma? 
+A. The polysaccharide vaccine (PPSV23) should be given every 5 years in this patient. 
+B. The conjugate vaccine (PCV13) effectively prevents invasive infections in this patient. 
+C. Do not give the polysaccharide vaccine (PPSV23) to this patient. 
+D. Vaccinating with the PPSV23 vaccine before the PCV13 vaccine is better. 
+
+",B
+"What is required for laboratory follow-up about 3 months after starting Rosuvastatin treatment?
+A. ALT.
+B. CPK.
+C. LDH.
+D. INR.
+",A
+"What is the most accepted treatment today for patients suffering from HTN due to Atherosclerotic stenosis of one of the renal arteries?
+A. Elastant angioplasty.
+B. Angioplasty with a stent.
+C. ACE inhibitors.
+D. Calcium channel blockers.
+",C
+"A 50-year-old man with obesity and reflux, treated with Proton Pump Inhibitor, came to the ER with Paresthesia and leg cramps. What caused the symptoms?
+A. Hypomagnesemia.
+B. Hypokalemia.
+C. Hyponatremia.
+D. Hypercalcemia.
+",A
+"A 70-year-old man with heart failure and end-stage renal failure treated with hemodialysis, is hospitalized, and ventilated due to pulmonary edema. He was hospitalized 3 weeks ago due to an infection from the dialysis catheter and was treated with antibiotics. 10 days later, he developed a fever, with purulent discharge from the tube and a new filtrate on a chest x-ray. What is the empiric antibiotic treatment in this case? 
+A. Ceftazidime + Azithromycin. 
+B. Meropenem + Clarithromycin. 
+C. Piperacillin-Tazobactam + Levofloxacin. 
+D. Piperacillin-Tazobactam + Azithromycin. 
+
+",C
+"What is the most important prognostic factor in AML at the time of diagnosis?
+A. The size of the spleen.
+B. The height of the WBC count.
+C. The percentage of blasts in the bone marrow.
+D. The chromosomal changes.
+",D
+"A 55 year old was admitted due to pain and swelling in the proximal interphalangeal joints (PIP) with morning stiffness.
+Her grandmother had arthritis. The patient denies psoriasis, abdominal pain and diarrhea. What is the best course of action at this point?
+A. ANA test.
+B. ANCA test.
+C. Ultrasound examination.
+D. Photo of the hands.
+",C
+"What will reduce the high incidence of malignant diseases in kidney transplant recipients?
+A. Providing prophylactic treatment with Valganciclovir.
+B. Giving preventive treatment by Aciclovir.
+C. Treatment with mTOR inhibitors instead of Calcineurin inhibitors.
+D. Treatment with mycophenolate mofetil instead of m-TOR inhibitors.
+",
+"Which drug can cause acute renal failure through the mechanism of acute tubular necrosis (ATN).? 
+A. Cisplatin.
+B. Aciclovir.
+C. Rifampin.
+D. Ciprofloxacin.
+","A,C"
+"A usually healthy 19 year old was admitted to the cardiac intensive care unit with a diagnosis of Acute Viral Myocarditis.
+The echocardiogram showed left ventricular enlargement with a 40% ejection fraction. Which drug is most recommended at this stage of the disease?
+A. Ibuprofen.
+B. Ramipril.
+C. Prednisone.
+D. Oseltamivir.
+",B
+"A 42 year old is generally healthy. Due to neck discomfort, he underwent a neck US examination, which showed a normal thyroid gland and a 7 mm oval structure suspicious for a parathyroid adenoma. In the laboratory, PTH is increased 1.5 times the upper value of the norm, calcium 8.7 mg/dL, phosphorus 3.5 mg/dL, albumin 4 g/d ""L. What is the next step in managing the case? 
+A. Parathyroidectomy. 
+B. FNA guided by the US. 
+C. Vitamin D levels. 
+D. CT head and neck with contrast material.
+",C
+"What is true about inflammatory bowel diseases, CD (Crohn's disease), and UC (Ulcerative colitis)?
+A. Smoking is a risk factor for UC.
+B. The incidence of diseases has been increasing in recent decades.
+C. Appendectomy is a risk factor for UC.
+D. UC has a stronger genetic basis than CD.
+",B
+"A 60-year-old man with hyperlipidemia and hypertension is hospitalized for chest pain. During hospitalization,
+fever and phlebitis appear near a peripheral IV without other abnormal findings on physical examination. During the hospitalization, the patient undergoes a TTE echocardiogram demonstrating a calcified aortic valve. In blood culture, growth of Staphylococcus aureus appears in one test tube without additional growth in other tubes. What is the right approach now?
+A. Start treatment and perform a TEE as soon as possible to rule out endocarditis.
+B. Start treatment and repeat the TTE echocardiogram later.
+C. Start treatment and repeat TTE echocardiography if the condition worsens.
+D. Start treatment and perform a PET-CT as soon as possible to rule out an abscess.
+",B
+"A 39 years old, with epilepsy and regular treatment with Phenytoin 300 mg per day, is hospitalized due to pneumonia and treated with Ceftriaxone and Azithromycin. After a day, horizontal nystagmus and instability in walking developed. In the laboratory: leukocytosis 13,000 mm3, albumin 2.9 g/dL, BUN 19 mg/dL, triglycerides 112 mg/dL, blood phenytoin level 17 ng/L (norm 10- 20 ng/l). What is the most likely cause of the patient's neurological symptoms?
+A. Involvement of the central nervous system in pulmonary infection.
+B. Reduction in phenytoin clearance.
+C. A decrease in the concentration of albumin in the blood.
+D. Interaction between phenytoin and antibiotic treatment.
+",C
+"A 50 year old is complaining of abdominal pain. In the laboratory: hemoglobin 9 g/dL, MCV 98, leukocytes 2,900 in mcm, platelets 100,00 in mcm, LDH 800, bilirubin 2.7 mg/dL, and direct 0.7. CT Angio shows mesenteric vein thrombosis. What is the test of choice that will lead to a diagnosis?
+A. BCR: ABL.
+B. Osmotic Fragility.
+C. JAK2.
+D. Flow Cytometry.
+",D
+"In which of the patients suffering from Rheumatoid arthritis is the use of Methotrexate permitted?
+A. 35 years old pregnant.
+B. 65 years old with interstitial lung disease.
+C. 55 years old with chronic kidney failure (creatinine 2.2 mg/dL).
+D. 80 years old with hypertension and AFIB.
+",D
+"A 30-year-old with moderately severe asthma comes to the emergency room with a presentation suitable for an asthma attack. She says she has been treated with Ventolin only as needed for the past two years. What treatment should she receive after completing the treatment for the acute attack? 
+A. ICS+LABA inhaler.
+B. LABA regularly by inhaler. 
+C. LAMA regularly in the inhaler. 
+D. Low-dose oral prednisone.
+
+",A
+"Which drug can cause kidney damage through the mechanism of Thrombotic Microangiopathy (TMA)?
+A. NSAIDs.
+B. Bevacizumab.
+C. Gentamicin.
+D. Trimethoprim-Sulfamethoxazole.
+",B
+"In which situation should beta blockers be avoided as part of the treatment of a 60-year-old with NSTEMI?
+A. When the systolic blood pressure is 110 mmHg.
+B. With a pulse of 66 beats per minute.
+C. When the patient has pulmonary edema.
+D. When there is an interstitial lung disease.
+",C
+"A 22 year old underwent a colonoscopy, due to diarrhea and rectal bleeding, and treatment with 5-ASA was recommended.
+What is the possible side effect of the drug?
+A. Pancreatitis.
+B. Acute Tubular Necrosis.
+C. Aphthous Stomatitis.
+D. Reactivation of hepatitis B.
+",A
+"An 80 year old, comes to the ER due to confusion. On examination, blood pressure is 220/110 mmHg in the right hand and 100/60 mmHg in the left hand. What is the next immediate step in this situation?
+A. Immediate lowering of systolic blood pressure below 120 mmHg.
+B. Lowered blood pressure to 160/100 mmHg within two hours.
+C. Performing brain CT.
+D. Fundus examination.
+",A
+"What is true about the side effects of Azathioprine?
+A. Pancreatitis is irreversible.
+B. Leukopenia is idiosyncratic.
+C. There is a genetic predisposition to the development of side effects.
+D. Acute Interstitial Nephritis is a very common phenomenon.
+",C
+"A 60 years old with endocarditis on a native valve and growth of C. albicans in the blood, is receiving treatment with appropriate antibiotics. The patient has vegetation on a 7 mm aortic valve. Under adequate treatment, he is without fever. What is true about the indications for surgery in this patient?
+A. This patient must be operated on within 24-48 hours.
+B. Even if he responds well to treatment, this patient should be operated on.
+C. There is no indication to operate on this patient if the cultures are sterile after 48 hours.
+D. There is no indication to operate on this patient due to the size of the vegetation.
+",B
+"A 47 year old is diagnosed with polycythemia vera. In the laboratory: hemoglobin 19 g/dL, hematocrit 58%, Leukocytes 14,000 per cubic meter, platelets 670,000 per cubic meter, and uric acid 9.5 mg/dL. What is the treatment policy for this patient?
+A. Keep the hemoglobin 15-16 g/dL.
+B. Keep the hematocrit below 45%.
+C. To start treatment with Anagrelide.
+D. Start treatment with Allopurinol.
+",B
+"A 72 year old experiences with sepsis due to a urinary tract infection accompanied by acute kidney failure. In the laboratory: creatinine 2.5 mg/dL (base: 1 mg/dL) and BUN 70 mg/dL. His urine output during the first 6 hours of his hospitalization is 20 ml. His weight is 80 kg. What is his estimated GFR?
+A. About 1 m/min.
+B. About 20 ml per minute.
+C. About 30 ml per minute.
+D. About 40 ml per minute.
+",A
+"What is true about antibiotics in inflammatory bowel disease (IBD)?
+A. Constitute the first line in the treatment of exacerbation of ulcerative colitis.
+B. Constitute the first line in the treatment of Pouchitis.
+C. Are not effective in the treatment of fistulous Crohn's disease.
+D. Are not effective in the treatment of peri-anal Crohn's disease.
+",B
+"A 50-year-old diabetic was hospitalized due to fever and severe pain in her right leg. On examination there is low blood pressure,
+and in the laboratory there are high inflammation markers and elevated CPK. Gram + cocci in blood cultures. What is the preferred antibiotic treatment?
+A. IV Clindamycin + IV Penicillin.
+B. IV Metronidazole + IV Penicillin.
+C. IV Clindamycin + IV Amoxicillin-Clavulanate.
+D. IV Azithromycin + IV Ceftriaxone.
+",A
+"What is true about the treatment of metabolic acidosis in chronic renal failure?
+A. NaHCO3 should be treated only when the bicarbonate value is lower than 15 mAq/liter due to the high sodium content in the drug.
+B. There is no need to treat acidosis because most patients in grade IV have acidosis with a normal anion gap.
+C. Continuous chronic treatment with NaHCO3 may slow down the progression of kidney failure.
+D. Treatment with KHCO3 is the treatment of choice for acidosis due to advanced renal failure.
+",C
+"A 77 year old has worsening shortness of breath, and a holosystolic murmur at the left sternal border on auscultation
+Which increases during inhalation. What is the most likely valvular disorder?
+A. Insufficiency of the tricuspid valve.
+B. Mitral valve insufficiency.
+C. Aortic valve stenosis.
+D. Insufficiency of the pulmonary valve.
+",A
+"What is true about the risk of colon cancer in patients with ulcerative colitis (UC)?
+A. The risk of development in patients with UC is twice that of the general population.
+B. In patients with extensive and prolonged disease, a colonoscopy is recommended every 5 years.
+C. Treatment with ASA-5 for more than 5 years increases the risk of cancer.
+D. The presence of stricture does not predict colon cancer in patients with UC.
+",A
+"A 40 years old with Rheumatoid Arthritis, treated with Infliximab, is hospitalized due to fever, pain, swelling, and redness in the knee for several weeks. Knee puncture demonstrated a cloudy fluid, direct surface test for pathogens was negative, as was culture.
+What is the correct approach in this case?
+A. Send liquid to culture for fungi.
+B. Send a synovium culture for mycobacteria.
+C. Start treatment for gonococcal arthritis.
+D. Inject corticosteroids into the knee.
+",B
+"A 39-year-old woman diagnosed with primary biliary cholangitis was hospitalized due to spontaneous peritonitis. In the hospital, a nosebleed appears, while in the laboratory PTT, 3.7 INR 64 seconds, factor VII level 20%, factor V 80%, and fibrinogen 280 mg/dL. What is the treatment of choice to correct the coagulation disorder in the patient?
+A. Intravenous vitamin K.
+B. Intravenous factor VIII concentrate.
+C. Activated factor VII.
+D. Activated prothrombin concentrate complex.
+",A
+"A 70-year-old woman with metabolic syndrome unwent catheterization with the opening of the LAD. So far, she has taken Atorvastatin at a dose of 10 mg per day. In the laboratory: HDL 38 mg/dl, LDL 150 mg/dl, and triglycerides 140 mg/dl. What would be recommended as treatment at this stage?
+A. Increasing the dose of Atorvastatin to 80 mg.
+B. Adding Bezafibrate 200 mg per day.
+C. Replacing Atorvastatin with Ezetimibe.
+D. Adding a PCSK9 inhibitor.
+",A
+"A 40-year-old woman complains about the swelling of her fingers and a cough for about six months and notes a change in the color of her fingers.
+Hands exposed to cold turn white and then turn blue. What is the most important index for follow-up during the initial investigation of her illness?
+A. Pulse.
+B. Oxygen saturation.
+C. Sugar values.
+D. Blood Pressure.
+",D
+"What can cause peripheral jaundice?
+A. Decreased cardiac output.
+B. Pulmonary arteriovenous fistula.
+C. Acquired methemoglobinemia.
+D. Climbing to high altitude.
+",A
+"What is the accompanying phenomenon of secondary hyperparathyroidism in patients with chronic renal failure?
+A. Adynamic bone disease.
+B. Erythropoietin resistance.
+C. Cardiac calcification.
+D. Tumoral calcinosis.
+","B,D"
+"What is included in the calculation of the Child-Pugh Classification for cirrhosis?
+A. Sodium level.
+B. Fibrinogen level.
+C. Bilirubin level.
+D. PTT level.
+",C
+"What is the correct approach in suspected osteomyelitis of the spine?
+A. The start of antibiotic treatment should not be delayed under any circumstances.
+B. Surgical intervention is required mainly if the source is hematogenous spread.
+C. The recommended duration of antibiotic treatment is 8-12 weeks.
+D. It is possible to treat with oral medications while adjusting to the sensitivity profile.
+",D
+"Which drug has demonstrated superiority over others in reducing proteinuria in renal failure patients.
+Chronic?
+A. Amlodipine.
+B. Tamsulosin.
+C. Clonidine.
+D. Verapamil.
+",D
+"In which of the following conditions may ""paradoxical splitting"" of the second heart sound be found?
+A. Stenosis of the aortic valve.
+B. Mitral valve stenosis.
+C. Hypertrophic cardiomyopathy.
+D. Diastolic dysfunction of the heart.
+",A
+"In which of the following situations would a liver biopsy be recommended?
+A. Assessment of fibrosis in a patient with hepatitis C.
+B. Assessment of disease severity in hepatitis B.
+C. Evidence of fatty liver seen in US.
+D. Suspected autoimmune hepatitis.
+",D
+"A young man complained of purulent diarrhea and abdominal pain during the past day, which appeared about two hours after eating in a restaurant, and he admits eating a suspicious potato salad the day before presentation. What is reasonable to assume about his condition? 
+A. This is about ingesting enterotoxin in food from the restaurant. 
+B. This is a Shigella infection from spoiled food. 
+C. This is an E. coli O157:H7 infection. 
+D. This is an infection with Bacillus cereus. 
+
+",B
+"What constitutes a good prognostic factor in a patient with IgA nephropathy?
+A. Recurrent events of macrohematuria.
+B. Male gender.
+C. Older age at the time of diagnosis.
+D. Biopsy findings consistent with RPGN.
+",A
+"What are the considerations regarding the treatment of fever and neutropenia (neutropenic fever) after chemotherapy treatment.?
+A. Aminoglycoside monotherapy is an accepted treatment for fever and neutropenia.
+B. Addition of an aminoglycoside plus a beta-lactam is the recommended treatment.
+C. Empirical fluconazole should be given if an Aspergillus infection is suspected.
+D. Quinolone prophylaxis in anticipation of prolonged neutropenia reduces mortality.
+",D
+"For how long after myocardial infarction my troponin levels may remain higher than normal in the presence of normal kidney function?
+A. Up to 48 hours.
+B. Up to four days.
+C. 7-10 days.
+D. 14 days.
+",C
+"What is true about antibiotics in inflammatory bowel disease (IBD)?
+A. Constitute the first line in the treatment of exacerbation of ulcerative colitis.
+B. Constitute the first line in the treatment of Pouchitis.
+C. Are not effective in the treatment of fistula Crohn's disease.
+D. Are not effective in the treatment of peri-anal Crohn's disease.
+",D
+"A 70-year-old man with heart failure and COPD is hospitalized due to respiratory exacerbation and treated with inhalation therapy  and Azithromycin. currently, he has fever, tachycardia, low blood pressure, and noticeable diffuse tenderness on palpation of the abdomen.
+What is true about the preferred treatment?
+A. Oral Fidaxomicin.
+B. Oral Vancomycin and Intravenous Metronidazole.
+C. Oral Fidaxomicin and Intravenous Metronidazole.
+D. A combination of oral and intravenous Vancomycin.
+",B
+"A 66-year-old woman has no history of smoking but has asthma. A chest x-ray was performed due to suspicion of inflammation in the lung. A lump was found in the left lung. What is the most likely histology of this tumor? 
+A. Adenocarcinoma. 
+B. Small Cell Carcinoma. 
+C. Squamous Cell Carcinoma. 
+D. Neuroendocrine tumor. 
+
+",A
+"According to the result of the urine albumin/creatinine ratio, who of the following has microalbuminuria?
+A. 15 mg/mg.
+B. 15 mg/g.
+C. 45 mg/mg.
+D. 45 mg/g.
+",D
+"What is the most common cause of SA node dysfunction?
+A. Medicines.
+B. Hypoxemia.
+C. Hypothyroidism.
+D. Hypothermia.
+",A
+"A 55 years old was hospitalized due to acute hepatitis. According to his wife, he has been drinking alcohol for many years daily, but the patient strongly denies it and claims that he drinks once a month. Which test combination will support the patient's statement? 
+A. Bilirubin mg/dL 3, mg/dL ALT 175, AST mg/dL 350. 
+B. Bilirubin mg/dL 4, mg/dL ALT 380, AST mg/dL 170. 
+C. Bilirubin mg/dL 1.8, mg/dL ALT 5000, AST mg/dL 9000. 
+D. Bilirubin mg/dL 8, mg/dL ALT 670, AST mg/dL normal level. 
+
+",B
+"A 60-year-old woman is being ventilated in the intensive care unit due to sepsis, and has a GI tube and a urinary catheter. In urine culture there is growth of Candida. What is true about Candida?
+A. The presence of neutropenia will strengthen the decision to treat.
+B. Candida overgrowth is rare.
+C. Fluconazole is not a relevant treatment option.
+D. It should be treated even if there are no symptoms at all.
+",A
+"In which kidney disease is steroid treatment beneficial?
+A. Acute renal failure on the background of cholesterol emboli.
+B. Focal segmental glomerulosclerosis on the background of hepatitis B.
+C. Membranous interstitial nephritis on the background of lung malignancy.
+D. Acute interstitial nephritis due to the use of PPI.
+",D
+"A 55-year-old man who was hospitalized due to STEMI underwent PCI within an hour, with a stent for the blocked artery without complications. Before discharge, when the patient is in good condition, he asks how soon it will be possible to return to regular sexual activity. What is your answer? 
+A. After 6 months. 
+B. After a week. 
+C. After a month. 
+D. After two months. 
+
+",B
+"Which of the following is the factor with the lowest frequency as a reason for the development of liver cirrhosis?
+A. Hepatitis C.
+B. Cardiac cirrhosis.
+C. Hepatitis B.
+D. Fatty liver.
+",B
+"A 30-year-old man complains of burning and discharge from the urethra for the first time in his life. He used to have intercourse  with a permanent partner. What is true about treatment?
+A. A combination of Amoxicillin and Levofloxacin should be treated.
+B. Doxycycline should also be included in the treatment for M. genitalium.
+C. The treatment includes oral Azithromycin at a dose of 1,000 mg.
+D. Azithromycin has no significance in the treatment of N. gonorrhoeae.
+",C
+"What is the renal damage that can be caused by both hypercalcemia and hypokalemia?
+A. Decreased ability to concentrate urine.
+B. Acute renal failure.
+C. A decrease in the production capacity of ammonium.
+D. RTA type II.
+",A
+"A 34-year-old man with HIV was diagnosed as suffering from PCP, and after 3 days of treatment with Trimethoprim Sulfamethoxazole he developed weakness and jaundice in the skin and conjunctiva. In the laboratory: hemoglobin 6 g/dL, MCV 96, platelets, and leukocytes are normal, Bilirubin 3.2 mg/dL, of which 0.5 is direct, the liver enzymes are normal, LDH 1,000. Blood smear is without cell fragments. Normal coagulation functions. The COOMBS test is negative.
+What is the most likely diagnosis?
+A. DIC as part of severe sepsis.
+B. Autoimmune hemolytic anemia.
+C. Microangiopathic hemolytic anemia.
+D. Hemolytic anemia secondary to PD6G deficiency.
+",D
+"What is a possible side effect after successful treatment with adenosine in a patient with SVT?
+A. Transient atrial fibrillation.
+B. Hypotension.
+C. Torsades de pointes.
+D. Pericarditis.
+",A
+"A 40-year-old woman was admitted due to spasmodic abdominal pain. A CT stone protocol scan demonstrates an adrenal mass on the left side with a diameter of 1.3 cm and a density of 5 HU. On examination after analgesia, blood pressure was 105/70 mmHg and she had a regular pulse with 80 bpm. What is the next step in case management?
+A. Synacthen test (ACTH).
+B. Test for blood metanephrine levels.
+C. Test for aldosterone and renin levels.
+D. Test for hydroxyprogesterone 17 levels in the blood.
+",B
+"A 60-year-old woman with cirrhosis of the liver due to fatty liver was hospitalized due to fever, abdominal pain, and ascites. The blood sample showed leukocytosis and a paracentesis from the ascites showed 350 neutrophils per µL and culture from the liquid showed E. coli, Enterococcus and s. viridans. What is true about her condition? 
+A. This is a typical culture for SBP. 
+B. The albumin concentration in the ascites fluid is likely lower than one g/dL. 
+C. The bacteria cultured from the liquid will most likely be cultured in the blood. 
+D. Abdominal imaging is necessary as part of the investigation. 
+
+",D
+"A 30-year-old man with a BMI of 30 and a family history of gout was referred for the first time due to severe pain and swelling in the 1st MTP joint. In the laboratory: c1HBA, 6.6% LDL cholesterol 140 mg/dL, triglycerides 270 mg/dL. In addition. Uric acid 8.1 mg/dL, which he has had for several years. The current attack was treated with an NSAID in review. At 6 months follow up, there have been no further attacks, and the blood tests are stable. What is the recommendation now? 
+A. Colchicine treatment. 
+B. Appropriate diet and drinking a lot. 
+C. Allopurinol treatment. 
+D. If the patient has tophi, the treatment of choice is Probenecid. 
+
+",B
+"A 40 year old, who is generally healthy, is admitted due to fever, severe headache, and vomiting for two days. In his examination, the patient was confused with a purpuric rash on the limbs. In a lumbar puncture, 80 cells, most of them mononuclear, increased protein, and normal glucose were detected. What is true about his condition?
+A. Prednisone should also be added to the treatment.
+B. Prophylactic antibiotic treatment should be given immediately to the family members.
+C. Doxycycline should also be added to the empiric treatment.
+D. Aciclovir should be treated.
+",C
+"What is the treatment for obstructive sleep apnea?
+A. CPAP with mouth and nose mask.
+B. BiPAP with mouth and nose mask.
+C. BiPAP with nasal mask only.
+D. CPAP with mouth mask only.
+",A
+"What are the considerations for giving intravenous potassium?
+A. The maximum intravenous rate is 40 mcg per hour.
+B. It is better to treat through a jugular infusion when a central vein is required.
+C. To correct from 2 to 4 mcg/liter, 400-800 mcg of potassium should be given.
+D. The maximum concentration of potassium through a central vein is 10 meq/dL.
+",C
+"What is true about Chronic Myelogenous Leukemia (CML?).
+A. Interferon treatment significantly improved the course and survival.
+B. Acceptable first-line treatment is the administration of Tyrosine Kinase Inhibitors.
+C. It is recommended to refer patients in remission from their disease to an allogeneic bone marrow transplant.
+D. The long-term survival (8 years) of CML patients is about 40-20%.
+",B
+"Which of the tests does not diagnose myocardial ischemia?
+A. CT calcium scoring.
+B. CT coronary angiography.
+C. PET.
+D. Cardiac MRI.
+","A,B"
+"A 38-year-old woman was diagnosed with Graves' disease and was treated with Mercaptizol. Three weeks After starting the treatment, a temperature of 38.3ֲC was measured, and a sore throat appeared. Blood count showed leukocytosis with left shift deviation. Throat swab is positive for Streptococcus. Empirical treatment with penicillin was initiated. What. The therapeutic approach at this stage? 
+A. Continue Mercaptizol simultaneously as antibiotics. 
+B. Immediately suspend treatment with Mercaptizol. 
+C. Add oral steroids. 
+D. Change the Mercaptizol to PTU. 
+
+",A
+"What is true about the treatment of patients suffering from fatty liver disease (NAFLD)?
+A. Metformin is recommended as a treatment for NAFLD.
+B. NAFLD can be used after a liver transplant.
+C. There is a contraindication to the treatment with statins.
+D. Bariatric surgery reduces fibrosis.
+",B
+"A 50 year old woman with asthma presents with purpura, weakness in the right hand, and paraesthesia in the left leg. In the Blood: 5,000 Eosinophils in cubic millimeters. What is the test with the best ability to determine the prognosis?
+A. CT chest in thin sections.
+B. Nerve biopsy.
+C. Echocardiography.
+D. ANCA.
+",C
+"A 35-year-old woman, who had a kidney transplanted two months ago, was hospitalized due to fever and confusion. She has a known allergy to penicillin.
+In lumbar puncture: 700 mononuclear cells, glucose 30 mg/dL (in blood 100 mg dL), high protein, and in blood smear:  gram positive rods. What is true about treatment?
+A. Doxycycline IV should be added to the treatment.
+B. Empirical coverage with ceftriaxone is sufficient in this case.
+C. Dexamethasone treatment will improve the prognosis.
+D. The treatment of choice is Sulfamethoxazole-Trimethoprim IV.
+",D
+"A 58 year old had a DVT event about 6 years ago that appeared after a flight. Now, they comes to the emergency room with a shortness of breath that started suddenly. On examination: 21 breaths per minute, pulse 110 regular, temperature 36.8, and oxygen saturation 95% in the chest x-ray a small amount of pleural fluid is noted at the right base. What is the best test for the diagnosis of PE? 
+A. CT-angio. 
+B. Echocardiography. 
+C. Ventilation/perfusion scan. 
+D. Check dimer-D and decide on imaging. 
+
+",A
+"What is the most likely etiology for hypokalemia in a patient whose blood potassium levels are 2.2 Maq/liter, sodium 140 maq/l, chlorine 114 maq/l, creatinine 1.2 mg/dL, and in the gas test pH 
+7.25, bicarbonate 18 mq/l, 2PCO 33 mq/l. In the urine test: potassium 10 mAq/liter and creatinine 50 mg/dL?
+A. Diarrhea.
+B. RTA type 1.
+C. Using variables.
+D. Eating licorice.
+","A,B"
+"What could be the presentation of cardiac myxoma?
+A. Ventricular ascending conduction block.
+B. Aortic stenosis.
+C. Right heart failure.
+D. Intracardiac thrombus.
+",D
+"A 50-year-old man, known to have hepatitis C, comes to the ER due to bloody vomiting for the past day. In his examination, there is ascites, and in the lab tests, hemoglobin is 10 g/dL. Three large varicose veins were found in gastroscopy. What is true about Endoscopic variceal ligation? 
+A. The development of an ulcer in the ligament area is common in half of the patients. 
+B. Ligation is recommended for large bleeding varices in the fundus of the stomach. 
+C. After tying the varicose veins, there is no need for further tying. 
+D. Varicose vein ligation is effective in most patients as a treatment for active bleeding. 
+
+",D
+"What is the strategy to reduce urinary catheter-related infections (CAUTI?).
+A. Intermittent catheterization in patients with spinal cord injury.
+B. A silver-coated catheter is better than a regular catheter.
+C. A Nitrofurazone-coated catheter is better than a regular catheter.
+D. Supra pubic catheter is better than a permanent catheter in preventing bacteriuria.
+",A
+"All of the following patients, whose weight is the same, suffer from hyperkalemia with a blood potassium concentration of 5.8. Which of them has the lowest total body  potassium?
+A. A patient suffering from oliguric renal failure.
+B. A patient suffering from Addison's disease.
+C. A patient suffering from IV type RTA.
+D. A patient suffering from digoxin poisoning.
+",D
+"What is true about Hodgkin's lymphoma?
+A. This lymphoma represents about 50% of all lymphomas.
+B. Subdiaphragmatic lymphadenopathy is characteristic mainly in young women.
+C. This lymphoma can present as erythema nodosum.
+D. This lymphoma can present with hypocalcemia.
+",C
+"A 66-year-old man with hypertension underwent ablation about 3 months ago for the treatment of paroxysmal atrial fibrillation. He complains about shortness of breath and hemoptysis that have worsened since the procedure. What is the most likely diagnosis that will lead to this presentation?
+A. Esophageal tear.
+B. Pulmonary embolism.
+C. Pulmonary valve stenosis.
+D. Mitral valve stenosis.
+","A,B,C,D"
+"What is true regarding  GERD (Gastroesophageal Reflux Disease).
+A. The most sensitive test for diagnosis is pH monitoring for 24 hours.
+B. A normal gastroscopy rules out the possibility of GERD.
+C. Proton Pump Inhibitor treatment is only recommended for people aged 50 and over.
+D. Gastroscopic follow-up is designed to rule out the development of Lymphoma M.
+",A
+"A 30-year-old man, after a respiratory infection, has been suffering from pain in the joints of the fingers and a palpable purpuric rash for about a week on the calves and abdomen. What test will indicate the severity of his illness?
+A. Serum immunoglobulins test.
+B. Periodic urine and kidney function test.
+C. Periodic hemoglobin and fecal occult blood tests.
+D. Skin biopsy.
+",B
+"What is the recommended dose of Albuterol (Salbutamol) for the treatment of hyperkalemia?
+A. 2.5 mg.
+B. 5 mg.
+C. 10 mg.
+D. 25 mg.
+",C
+"A 77 years old man with heart failure (EF 30%), was treated with beta-blockers. He was admitted due to shortness of breath and an aggravation in peripheral edema. On examination: blood pressure 85/50 mmHg and heart rate 90 per minute. Intravenous Furosemide treatment did not improve his respiratory condition. What is the possible treatment?
+A. Noradrenaline.
+B. Dobutamine.
+C. Levosimendan.
+D. Dopamine.
+",B
+"A 65 year old, was diagnosed about 5 years ago as suffering from 4 cm long Barrett's Esophagus after an endoscopy.
+In a recent biopsy, more than one focus of high-grade dysplasia was found.
+What is the best management?
+A. Endoscopic follow-up and repeat biopsies every year.
+B. Complete resection of the esophagus.
+C. Radiofrequency Ablation.
+D. Proton Pump Inhibitor treatment only.
+",C
+"A 30 year old  presents with pain in the buttock that worsens at night and wakes him up from sleep. In the morning, his back is stiff for about an hour, when exercising, 
+there is considerable relief. Which test would be most likely to be diagnostic?
+A. HLA B27
+B. Bone scans.
+C. CT of the lumbar spine.
+D. MRI targeting the Sacroiliac joints.
+",D
+"A 66-year-old suffers from arthritis, ischemic heart disease, hypertension, and heart failure. He underwent a puncture of Pleural fluid that appeared in the last few days, mainly on the right. The liquid is straw-colored. Due to an error, the liquid is only tested for protein (0.45 from the serum) and LDH (0.65 from the blood and 0.6 from the accepted upper value of LDH). What is true about this patient? 
+A. If the protein gradient is greater than 31 L/g, it is a transudate. 
+B. There is a greater than 95% chance that it is an exudate. 
+C. This is a transudate, possibly secondary to the patient's arthritis. 
+D. A glucose level in the pleural fluid above 60 dL/mg indicates a transudate. 
+
+",A
+"What should be added to the drug regimen of an 82-year-old woman with HFrEF (25% ejection fraction), who suffers from anasarca that is resistant to high doses of furosemide in the presence of normal renal function and the following lab results?
+PH: 7.48, Glucose 120 mg/dL, pCO2 67 mmHg, Na 141 mEq/L, HCO3 46, mEq/L, K 5.3 mEq/L, Lactate ג€“ normal levels, Cl 89 mEq/L, Albumin 3.8 gr/dL.
+A. Amiloride.
+B. Disothiazide.
+C. Aldospirone.
+D. Acetazolamide.
+",D
+"In what situation can a fourth heart sound be heard?
+A. Mitral stenosis.
+B. Tricuspid stenosis.
+C. Aortic stenosis.
+D. Pulmonic stenosis.
+",C
+"What is recommended for a 35-year-old whose sister was diagnosed with colon cancer at the age of 50?
+A. Fecal occult blood test.
+B. DNA test in feces.
+C. Colonoscopy now.
+D. Colonoscopy at age 40.
+",D
+"Which drug is not suitable for the treatment of a patient suffering from inflammatory bowel disease with sacroiliitis And uveitis?
+A. Infliximab.
+B. Certolizumab.
+C. Etanercept.
+D. Adalimumab.
+",C
+"An 18-year-old came to the hospital because of weakness. In the laboratory, she is found to have metabolic alkalosis, and it is suspected that she is suffering from an eating disorder and is vomiting proactively after every meal. What could you find in urinalysis
+that will help make a diagnosis?
+A. Ph acidosis, potassium high.
+B. Ph acidosis, potassium low.
+C. Ph alkalosis, potassium low.
+D. Ph alkalosis, potassium high.
+",D
+"A 50-year-old woman is being treated with peritoneal dialysis. She was admitted due to abdominal pain without fever. What constitutes a diagnosis of Peritonitis in this patient?
+A. The presence of a large amount of free fluid in the stomach.
+B. Neutrophil count / 60 ml in the ascites fluid.
+C. Glucose concentration 300 mg in the ascites fluid.
+D. Evidence of purulent discharge from the catheter entry area.
+",B
+"An 84 year old is known to suffer from chronic lymphocytic leukemia (CLL) In stage II of the disease, according to Rai Staging. She is Hospitalized due to syncope and in the blood count hemoglobin is 8 g/dL, lymphocytes 100,000  per cubic meter, platelets 300,000 per cubic meter, and reticulocytes 150,000 per cubic meter. What can be said about her condition?
+A. This is about the progression of her disease to stage III.
+B. It is probably IgM and complements antibody-mediated hemolysis.
+C. Pure red cell aplasia in.
+D. It is probably IgG antibody-mediated hemolysis.
+",D
+"A 63-year-old woman with metastatic breast cancer is admitted after deteriorating consciousness. On inspection, the impression is of poor condition, very elevated JVP, and low blood pressure. What is expected to be found in this patient?
+A. Left ventricular hypertrophy.
+B. Slow atrial fibrillation.
+C. Diastolic IV sound.
+D. Pulsus alternans.
+",D
+"A 25-year-old with recently diagnosed celiac disease, asks about co-morbidities that can appear.
+What disease may accompany  Celiac disease?
+A. Atopic Dermatitis.
+B. Diabetes mellitus type 1.
+C. Acute Leukemia.
+D. Acute pancreatitis.
+",B
+"A 60-year-old man has been suffering from lower back pain for several years and edema in his legs. He presents due to Advanced kidney failure (creatinine 3 mg/dL).
+ US shows bilateral hydronephrosis and CT also shows peri-aortitis. What is the initial treatment for the patient?
+A. Methotrexate.
+B. Corticosteroids.
+C. Cyclophosphamide.
+D. Anti-IL-6 antibody.
+",B
+"A 74 year old known to suffer from COPD, level GOLD III. About a year ago, he was in the emergency room due to a flare-up of his illness. For the past two days, he has reported worsening shortness of breath, increased coughing, and white sputum. He is hospitalized with the presumption of a flare up. What is the treatment for this patient? 
+A. Prednisone (40 mg daily for 5-14 days) and antibiotics. 
+B. Prednisone (40 mg daily and decrease over 3-6 weeks) and antibiotics. 
+C. Prednisone, (40 mg daily for a week) without antibiotics. 
+D. Oxygen in a concentration that will maintain a saturation of at least 95%. 
+",A
+"A 30-year-old man was admitted with weakness, headache, abdominal pain, and frequent urination last week, with no fever,
+and his blood pressure is 110/80. In blood - potassium is 6.1, sodium 158, and in urine: 800 Osmolality. What explains the findings?
+A. Nephrogenic diabetes insipidus.
+B. Central diabetes insipidus.
+C. Addison's crisis.
+D. Type I diabetes mellitus.
+",D
+"A 40-year-old, who is usually healthy, was referred to the hospital due to platelet values of 600,000/mm3 and a headache. On physical examination there were no neurological deficits. CT with and without contrast material demonstrated a cerebral infarction. During The hospitalization was diagnosed as having primary thrombocytosis (ET). What is the treatment?
+A. Platelet pheresis.
+B. Apixaban.
+C. Aspirin.
+D. Hydroxyurea + Aspirin.
+","C,D"
+"A 40-year-old woman suffers from repeated episodes of pain attributed to a peptic ulcer and diarrhea. Gastrin level 300 picogram/ml (normal up to 150 picogram/ml). An adenoma was recently found in the parathyroid. Her sister has pituitary adenoma. What is the treatment of choice for her condition?
+A. Surgical resection of an adenoma.
+B. Somatostatin analog treatment.
+C. High-dose PPI therapy.
+D. Gastrectomy.
+",C
+"A 35-year-old woman suffers from FMF, which manifests itself in repeated attacks of arthritis, abdominal pain, and an Erysipelas rash. She is treated with Colchicine 2 mg per day. Despite the treatment, she is symptomatic and the attacks
+recur. What is the recommended treatment for this patient?
+A. Low-dose daily prednisone.
+B. Rituximab every 6 months.
+C. Canakinumab once a month.
+D. Tocilizumab once a month.
+",C
+"A 35 year old with no history of lung disease, has been suffering from fever and shortness of breath for about a week. In a chest x-ray, scattered filtrates and significant distortion are noted. He was treated with an antibiotic without improvement after 3 days. In BAL
+51% macrophages, 22% neutrophils, and 27% eosinophils were found. What is the most likely diagnosis?
+A. Acute Eosinophilic Pneumonia.
+B. Cryptogenic Organizing Pneumonia.
+C. Acute Hypersensitivity Pneumonitis.
+D. Eosinophilic Granulomatosis with Polyangiitis (EGPA).
+",A
+"What is the treatment for a patient with polyuria and hypernatremia secondary to chronic lithium treatment?
+IV DDAVP .a.
+B. Furosemide.
+C. Thiazide.
+D. Acetazolamide.
+",C
+"A 70-year-old man is admitted to investigate dyspnea on exertion. On inspection: he is in good general condition, and a mid-systolic murmur was heard. What is most likely to be found in this patient?
+A. A second voice is weakened.
+B. First sound split.
+C. The increase in the murmur after an early beat.
+D. The murmur increases when changing from lying down to standing.
+",
+"A 68-year-old man is admitted to the hospital for an investigation of progressively worsening shortness of breath. In ECO there is a pressure drop according to
+the tricuspid gradient of 55 and severe-moderate MR . His history is noteworthy of  COPD with FEV1 of 60% of the expected and moderate sleep apnea which is not treated. A mean PAP of 44 and a Pulmonary Capillary Wedge pressure of  19 mmHg were found  during right heart catheterization. What can be concluded about The main cause of pulmonary hypertension?
+A. This is pulmonary precapillary blood pressure that is consistent with his lung disease.
+B. This pulmonary blood pressure corresponds to group I - idiopathic primary hypertension.
+C. This is postcapillary pulmonary hypertension that corresponds to his lung disease.
+D. This is postcapillary pulmonary hypertension consistent with his heart disease.
+",D
+"What is the most likely cause of the following laboratory results in a 55-year-old man?
+Serum: Osmolality - 265 mOsm/KgH, Na - 115 mEq/L.
+Urine: Osmolality  80 mOsm/KgH, Na  15 mEq/L.
+A. Nephrogenic DI.
+B. SIADH.
+C. Beer potomania.
+D. Diuretics.
+",C
+"What is true about follicular lymphoma?
+A. Follicular lymphoma is the most common lymphoma.
+B. Remission can be achieved in most patients and most of them have a complete cure of the disease.
+C. Most patients will have a translocation (14:18) and increased expression of bcl2.
+D. The rate of transformation to DLBCL lymphoma is about 10% per year.
+",C
+"A 78 year old with atrial fibrillation had a pacemaker implanted following a pause in the transition from atrial fibrillation to sinus rhythm. She was admitted to the hospital due to new heart failure. What would indicate that this is a problem with the pacemaker? 
+A. Regular heart rate. 
+B. Maximum systolic murmur in the intercostal space on the right. 
+C. Pulsations are prominent when looking at the jugular vein. 
+D. Irregular heart rate. 
+
+",C
+"To which condition/disease can the lung functions (all in values greater than expected) be found as:
+FVC 85% DLCO, 99% FRC, 75% TLC, 59% FEV1, 63%.
+A. Myasthenia Gravis.
+B. Morbid Obesity.
+C. Pulmonary Fibrosis.
+D. COPD + Emphysema.
+",A
+"A 26 year old with type 1 diabetes for 4 years is hospitalized for DKA. She is treated with fluids and insulin
+intravenously at a rate of 2 units per hour. In the last few hours, she began complaining of weakness and paraesthesia at her fingers ends. In the laboratory L/U 700 CPK (norm up to L/U 170). What is the possible explanation for her condition?
+A. Hyperkalemia.
+B. Hypophosphatemia.
+C. Hypercalcemia.
+D. Hypermagnesemia.
+",B
+"How are drug doses adjusted according to creatinine clearance (CrCl) in patients with Chronic kidney failure? 
+A. Doses of drugs whose 40% clearance is hepatic, should not be adjusted.
+ B. Loading doses of most drugs for intravenous administration should not be adjusted. 
+C. The dose of any antibiotic currently in use must be adjusted. 
+D. Maintenance doses of most orally administered drugs should not be adjusted. 
+",B
+"Which condition is associated with venous and arterial thrombotic events?
+A. Factor V Leiden .
+B. Polycythemia Vera.
+C. Elevated Factor VIII.
+D. Prothrombin G20210A .
+",B
+"In a routine physical examination of a 74-year-old woman, a significant, but non-tender enlargement of a gland was found the shutter The gland is freckled with an uneven texture with bilateral knots, and the largest one on the right side is approx.
+2 cm. The patient denies difficulty breathing or swallowing and states that the findings in the examination have been present for many  years.In the laboratory: mL/miU 0.3 TSH (the normal range mL/miU 0.34-4.25). What is the next step?
+A. US neck to characterize the contextuality.
+B. Neck-chest CT with contrast material.
+C. Technetium mapping of the thyroid gland.
+D. FNA for the large nodule under US guidance.
+",C
+"Which of the following immunological effects of the following drugs is true? 
+A. Daratumumab is an antibody against CD30. 
+B. Nivolumab works against -PD1. 
+C. Brentuximab is an antibody against CD20. 
+D. Ipilimumab works against -PD1. 
+
+",B

obgyn.csv

@@ -0,0 +1,877 @@
+question,answer
+"A 26-year-old female patient is referred for surgical resection of a complex ovarian cyst of 7 cm, mostly clear, with a septum and papillary projection of 7 mm. The cyst has been known for 6 months. What is the next step in case management?
+A. Administering pills and performing a repeat ultrasound examination in 6 months.
+B. Laparoscopic excision of the cyst and its removal in a bag.
+C. Draining the cyst under US guidance and sending the fluid for cytology.
+D. Laparoscopic surgery and entering the cyst cavity with the laparoscope to discover or rule out malignancy signs.
+",C
+"What is included in the protocol of Enhanced Enhanced Recovery after surgery (ERAS)?
+A. Fast at least 6 hours before surgery.
+B. Before surgery, with a high probability of resection and bowel resection, bowel preparation must be performed by emptying.
+C. PCA (Patient Controlled Analgesia) should be used to treat pain after surgery.
+D. In surgery lasting more than 3 hours, 500 ml of crystalloids must be given for each additional hour of surgery.
+",C
+"25 years old, without children, would like to give birth in the future.
+She underwent a right Salpingo-oophorectomy due to a tumor.
+The histological sample from the resection diagnosed a DYSGERMINOMA with a diameter of 7 cm in the right ovary and, in addition, a 5 mm focus of The same growth in the left ovary that was resected completely. No evidence of further dispersion. What is the next step in the management?
+A. Follow up every 3 months by voice and markers.
+B. Chemotherapy using BEP.
+C. Completion of ovariectomy and left fallopian tube and addition to BEP.
+D. Completion of left ovary and tubal resection and addition of radiation to the pelvis.
+",B
+"In surgery for epithelial ovarian cancer, a tumor involving both ovaries was found with a diameter of 5cm that adheres to the rectum without a separation plane.
+Hysterectomy and resection of ovaries and omentum were performed, lymph node sampling was performed, and resection of a segment of the rectum was performed.
+In pathology: two ovaries with a SEROUS tumor, omentum, and peritoneal biopsies without evidence of tumor, tumor distribution on the intestine's surface that is evident, and positive lymph nodes that were positive for tumor cells were noted. What is the stage of the disease?
+A. II.
+B. IIIA1.
+C. IIIA2.
+D. IIIB.
+","B,D"
+"A 38 year old mother of 3, discovered she was  carrying a BRCA2 mutation after her mother got ovarian cancer at age 55.
+She has a Regular menstrual cycle, uses a copper intrauterine device, and does not want another pregnancy.
+What is the treatment to reduce this patient's ovarian cancer risk?
+A. Surgery to remove the ovaries and fallopian tubes before age 40.
+B. Replacing the device with combined pills and Surgery to remove the ovaries and fallopian tubes no more than the age of 45.
+C. Expanding genetic testing to determine the degree of risk for ovarian cancer and, depending on the result, determining the timing of surgery For oophorectomy and fallopian tubes.
+D. Surgery to remove the ovaries and fallopian tubes about 5 years before the mother's age of diagnosis.
+",B
+"A 30-year-old married woman without children would like to conceive. She underwent laparoscopic surgery to remove the right ovary and fallopian tube due to a complex cyst.
+ Pathology Revealed Endometrioid Ovarian Cancer Grade II. What is the next step in case management?
+A. Administration of complementary chemotherapy.
+B. Performing PET-CT and, if regular - follow-up every 3 months.
+C. Exploratory laparotomy, staging while preserving the uterus and left ovary and, if normal - follow-up only.
+D. Exploratory laparotomy, staging while preserving the uterus and left ovary, and, if regular - Administration of chemotherapy.
+",C
+"A 64-year-old woman was operated on for a stage III mucinous ovarian tumor and left with a small residual disease of less than 1 cm. What is the next treatment?
+A. AVASTIN+GEMZAR.
+B. Treatment protocol for colon cancer.
+C. Taxol + Carboplatin and then maintenance treatment with PARPP inhibitors.
+D. Taxol + Carboplatinum combined with AVASTIN.
+",D
+"What is the treatment for the recurrence of high-grade serous epithelial ovarian cancer?
+A. Liposomal Doxorubicin (Caylex) when the disease returned 4 months after the end of the initial chemotherapy treatment.
+B. Carboplatinum when the disease returned 8 months after the end of the initial chemotherapy treatment.
+C. Taxol (Paclitaxel) when the disease returned 8 months after the end of the initial chemotherapy treatment.
+D. Avastin (Bevacizumab) when the disease returned 4 months after the end of the initial chemotherapy treatment.
+",A
+"In which genes were mutations found in cervical tumors without the presence of HPV?
+A. KRAS.
+B. TP53.
+C. BRCA.
+D. POLE.
+",A
+"What is the lifetime risk of ovarian cancer in a woman with LYNCH SYNDROME?
+A. 0.5-1%.
+B. Y 6-12%.
+C. 18-22%.
+D. 30-40%.
+",B
+"What is the most accurate description of POLE  mutation?
+A. Disruption of the segment of 53P associated with prognosis in ovarian malignancy.
+B. Disruption of an enzyme involved in DNA repair associated with the prognosis of uterine malignancy.
+C. Disruption of the enzyme involved in DNA replication is associated with the prognosis of ovarian malignancy.
+D. Disruption of the KRAS segment associated with the prognosis of uterine malignancy.
+",B
+"A 32 year old, underwent a wide biopsy of the cervix. Histology revealed SQUAMOUS CELL CARCINOMA, with a penetration depth of 8 mm, with penetration into lymphatic vessels and blood vessels. On clinical examination, a tumor with a maximum diameter of 5 cm without evidence of parametrium or vaginal involvement. On imaging, there is no evidence for ectopic tumor involvement. According to the STAGING from 2018, in which disease stage is the patient?
+A. I-B-2.
+B. I-B-3.
+C. II-A-2.
+D. III-C-1.
+",B
+"At what stage of cervical malignancy, without penetration into blood vessels and lymphatic vessels, is it appropriate to perform an excision Radical neck RADICAL TRACHELECTOMY to preserve fertility?
+A. I-A-1.
+B. I-B-1.
+C. I-B-2.
+D. I-B-3.
+",B
+"What is the 5-year survival rate in cases of invasive cervical cancer in stage B-II (according to the latest STAGING)?
+A. About 90%.
+B. About 70%.
+C. About 50%.
+D. About 30%.
+","B,C"
+"Which of the following parameters is a high-risk factor for malignant recurrence of the cervix after surgery?
+A. Surgical margins close to the tumor tissue.
+B. The size of the tumor.
+C. Tumor penetration into more than half of the stroma of the cervix.
+D. Penetration into blood vessels or lymphatic vessels.
+",A
+"What does type II RADICAL HYSTERECTOMY include?
+A. Cutting of the uterine artery at its origin from the iliac.
+B. Resection of the uterosacral ligament in its entirety.
+C. Excision of about half of the cardinal ligament.
+D. Excision of half of the vagina.
+",C
+"What factors affect the chances of detecting the sentinel gland in surgeries for cervical malignant tumors?
+A. Performing the previous conization.
+B. The size/volume of the tumor tissue.
+C. Duration of injection of the dye.
+D. The diameter of the injector of the dye.
+",B
+"In which areas is it acceptable to inject the dye or fluorescence to identify the sentinel gland in surgery due to Cervical malignancy?
+A. At 3:00 and 9:00 of the cervix.
+B. At 6:00 and 12:00 of the cervix.
+C. At 3:00 and 6:00, at 9:00, and 12:00 of the cervix.
+D. The injection should be adapted to the location and size of the tumor in the cervix.
+",A
+"What is the recommendation for the SCREENING survey for the early diagnosis of endometrial cancer in women treated with tamoxifen?
+A. Measuring the thickness of the endometrium every six months.
+B. Measuring the thickness of the endometrium every year.
+C. Endometrial biopsy every year.
+D. Following the recommendation in the general population.
+",D
+"What is the stage of the disease in endometrial malignancy with the involvement of the parametrium?
+A. IIB.
+B. IIIA.
+C. IIIB.
+D. IIIC.
+",C
+"A 65-year-old woman underwent a biopsy from a 5 cm vestibular tumor on her right lip.
+On PET-CT, inguinal and vaginal glands were observed and enlarged to about 3-4 cm.
+What is the next step in treatment?
+A. Radiation therapy for the tumor in the groin and pelvis, followed by surgery to remove the rest of the tumor and the glands.
+B. Excision surgery of vulvar cancer and radiation therapy to the glands in the groin and pelvis.
+C. Excision surgery of vulvar cancer, excision of the glands in the groin, and postoperative radiation therapy to the groin and pelvis.
+D. Excision surgery of vulvar cancer, excision of the glands in the groin and pelvis, and radiation therapy after the surgery to the groin and pelvis.
+",D
+"What is included in the Enhanced Recovery After Surgery (ERAS) protocol?
+A. Fast at least 6 hours before surgery.
+B. Before surgery, with a high probability of resection and bowel resection, bowel preparation must be performed by emptying.
+C. PCA (Patient Controlled Analgesia) should be used to treat pain after surgery.
+D. In surgery lasting more than 3 hours, 500 ml of crystalloids must be given for each additional hour of surgery.
+",C
+"A 26-year-old female patient is referred for surgical resection of a complex ovarian cyst of 7 cm, mostly clear, with a septum and papillary projection of 7 mm. The cyst has been known for 6 months. What is the next step in case management?
+A. Administering pills and performing a repeat ultrasound examination in 6 months.
+B. Laparoscopic excision of the cyst and its removal in a bag.
+C. Draining the cyst under US guidance and sending the fluid for cytology.
+D. Laparoscopic surgery and entering the cyst cavity with the laparoscope to discover or rule out malignancy signs.
+",B
+"A 17-year-old girl is referred to the emergency room due to two-day history of left abdominal pain and suspicion of ovarian torsion. In her history, the girl has been under follow-up for 3 months due to a simple ovarian cyst on the left with a diameter of 7 cm. On Laparoscopy, left ovarian torsion was observed twice, black in color, without possibly identifying an ovary. The situation has not changed since allowing the release of ovarian torsion. What is the next step during the surgical procedure?
+A. Try to identify and cut the fallopian tube only.
+B. Identify the cyst and remove it.
+C. Release of ovarian torsion without further intervention.
+D. Cut out the ovary without identifying findings.
+",C
+"A 38-year-old female patient was referred for excision of type 2-5 myoma with a diameter of 8 cm before continuing with in vitro fertilization treatments.
+What is the correct consideration in choosing the surgical approach: open, endoscopic, robotic approach in relation To the success of in vitro fertilization treatments?
+A. In terms of the improvement in fertility, there is no difference between the various surgical techniques, but the recovery is faster, and the rate of Complications is lower in endoscopic surgeries.
+B. The improvement in fertility is greater in laparotomy, but the rate of surgical complications is greater in laparotomy, and there is faster recovery in endoscopic surgeries.
+C. The improvement in fertility is greater in endoscopic surgeries, especially in robotic surgeries.
+D. The consideration of fertility is secondary since a laparotomy must be performed - since a myoma of this size must be removed from the abdominal cavity requires a laparotomy.
+",A
+"What is the risk of molar pregnancy after successful combined chemotherapy treatment in a woman with GTN?
+A. 1%.
+B. 5%.
+C. 10%.
+D. 25%.
+",A
+"What may be damaged when fixing the vaginal dome to the Sacrospinous ligament?
+A. Sacral nerve S3-4.
+B. The pudendal nerve.
+C. Superior gluteal artery.
+D. External pudendal artery.
+","A,B"
+"What is found in the Bacterial Vaginosis test, and culture of a woman who comes with symptoms of increased secretions and meets the criteria for Desquamative Inflammatory Vaginitis?
+A. Proliferation of parabasal cells, proliferation of leukocytes, and proliferation of Gram-positive bacilli.
+B. Proliferation of clue cells and proliferation of leukocytes, and gram-negative cocci culture.
+C. Proliferation of parabasal cells and inflammatory cells in gram-positive cocci culture, usually streptococci.
+D. Proliferation of neutrophils and identification of diplococci (gonococcal).
+",C
+"A female patient was admitted due to three painful ulcerated lesions on the labia majora on the right side. In testing: The ulcer is very sensitive to touch, and inguinal lymphadenopathy is sensitive to palpation. What is the most likely clinical diagnosis?
+A. Herpes.
+B. Syphilis.
+C. Chancroid.
+D. Genital warts.
+",C
+"A woman before a laparoscopic hysterectomy due to benign uterine pathology wishes to consider a subtotal hysterectomy vs. a total hysterectomy.
+What is the difference between the two surgeries in this case?
+A. Subtotal hysterectomy has the advantage of preserving sexual function.
+B. After a subtotal hysterectomy, there is a 1%-2% chance of repeat surgery for cervicectomy.
+C. In subtotal hysterectomy, there is a significant reduction in the risk of urinary incontinence symptoms.
+D. In subtotal hysterectomy, there is a lower chance of symptoms of constipation.
+",B
+"Which index was found to be the most significant predictor of the possibility of completing a hysterectomy with a vaginal approach?
+A. The patient's weight.
+B. Pubic arch angle.
+C. Location and length of the cervix.
+D. Previous pelvic surgeries.
+",B
+"What characterizes the pathogenesis of fibroids?
+A. In half of fibroids it is possible to identify a translocation in chromosome 22.
+B. Polyclonal tumors that develop from a large number of parent cells.
+C. Progesterone does not encourage the appearance and proliferation of fibroids.
+D. Growth factors such as beta-TGF or bFGF are overexpressed in fibroblasts.
+",D
+"What is the correct description for fibroid classification and location according to FIGO?
+A. Type 0 - pedunculated - inside the uterine cavity or pedunculated protrudes into the abdominal cavity.
+B. Type 2 - pedunculated into the uterine cavity by less than 50% of its diameter.
+C. Type 4 - all in the myometrium but reaches the endometrium or serosa.
+D. Type 7 - more than 50% of its diameter protrudes from the serosa.
+",B
+"What is considered a contraindication to treating fibroids by embolizing the uterine arteries?
+A. Uterine insufficiency.
+B. Heart failure due to rheumatic disease.
+C. A multifarious uterus the size of about 20 weeks of pregnancy.
+D. A fundal fibroid with a diameter of 10 cm, far from the uterine arteries.
+",A
+"Which of the following is a protective factor against endometriosis?
+A. Smoking.
+B. Nulliparity.
+C. Increase in BMI.
+D. A diet rich in protein.
+","A,C"
+"What is the expected increase in B-HCG levels within 48 hours in a normal intrauterine pregnancy?
+A. At least 50% if the initial ־²HCG level is less than 1,500 mIU /ml.
+B. At least 60% if initial ־²HCG level 1,500-3,000 mIU /ml.
+C. At least 70% if the initial ־²HCG level is greater than - 3,000 mIU /ml.
+D. At least 80% regardless of initial ־²HCG level.
+",A
+"A 34-year-old woman was referred in the 6th week of her pregnancy due to bloody discharge. No intrauterine or ectopic pregnancy was observed on ultrasound.
+B-HCG tracking demonstrates a 40% increase in values by 48 hours.
+At what threshold value of B-HCG will medical treatment be given for ectopic pregnancy without a sonographic diagnosis of the location of pregnancy?
+A. 1000 mIU/mL.
+B. 1500 mIU/mL.
+C. 2500 mIU/mL.
+D. 3500 mIU/mL.
+",D
+"A healthy 55-year-old woman has suffered from an increased frequency of urination and occasional urinary urgency with leakage for several years. Physical and gynecological examinations are normal.
+What is the necessary test for establishing an initial diagnosis and adjusting treatment?
+A. TIP-Q test.
+B. General urine test and culture.
+C. Urinary tract ultrasound.
+D. Urodynamics.
+",B
+"What is the possible measurement range for the Ba point according to the POP Q method when the TVL value is 8 cm?
+A. Between -3 cm and +3 cm.
+B. Between -3 cm and +8 cm.
+C. Between -8v and +3 cm.
+D. Between -5 cm and +5 cm.
+",B
+"A 40-year-old female patient presented due to prolapse. In her examination the following POP Q values:
+Aa: -3cm.
+Ba: -3cm.
+C: +2cm.
+D: -8cm.
+Ap: -3cm.
+Bp: -2cm.
+TVL: 8cm.
+What is the diagnosis?
+A. STAGE 1 CYSTOCELE.
+B. STAGE 2 RECTOCELE.
+C. STAGE 3 UTERINE PROLAPSE.
+D. STAGE 3 CERVICAL ELONGATION.
+","C,D"
+"A female patient suffers from STAGE 3 pelvic organ prolapse.
+A Cuboid Pessary was fitted since she was not interested in surgical repair.
+What should be the frequency of removing and cleaning the Pessary?
+A. Every day.
+B. Once a week.
+C. Once a month.
+D. Once every two months.
+",A
+"A 30 year old has had amenorrhea for 12 months. The level of FSH in her blood is 78 units/liter, and estradiol is 35 picomoles/liter. Which test should she be referred to in order to establish a diagnosis of Premature Ovarian Autoimmune Insufficiency (POI)?
+A. To test for antibodies of the Anti 21-Hydroxylase/Anti Adrenal.
+B. For ovarian biopsy.
+C. Anti-Ovarian Antibodies for testing.
+D. Anti-Thyroid Peroxidase/Anti-Thyroglobulin type of antibodies for testing.
+",A
+"Which cytotoxic drug has the highest genotoxic potential?
+A. Bleomycin.
+B. Vincristine.
+C. Busulfan.
+D. Cisplatin.
+",C
+"Mutations in the G- Protein system can cause genetic diseases.
+Of the following, which is the correct combination of mutation and clinical condition?
+A. A mutation in the Activating LH receptor will cause male pseudohermaphroditism.
+B. A mutation in Gia (stimulatory) will cause hypothyroidism.
+C. A mutation in the Inactivating FSH receptor will cause Premature ovarian failure.
+D. A mutation in Rhodopsin will cause Diabetes insipidus.
+",C
+"What is the pathogenesis of  Congenital lipoid adrenal hyperplasia?
+A. An autosomal dominant disease resulting from a gene mutation located on chromosome 6.
+B. A disease caused by a mutation in the protein gene to the Steroidogenic Acute Regulator (StAR) protein.
+C. A disease resulting from a combined deficiency of 3B- hydroxysteroid dehydrogenase and  17c450P.
+D. Hereditary disease in which the steroidogenesis process is defective/missing in the adrenal gland and normal in the ovary.
+",B
+"Which of the following contains the highest amount of triglycerides?
+A. VLDL.
+B. IDL.
+C. LDL.
+D. HDL.
+",A
+"What is the structural difference between OXYTOCIN and VASOPRESSIN-ARGININE?
+A. One amino acid in position 2.
+B. Two amino acids in positions 3 and 8.
+C. Three amino acids in positions 1, 4, 6 and 9.
+D. At the position of the bisulfite bridge within the molecule.
+",B
+"What characterizes the amplitude and frequency of the LH pulses during the menstrual cycle?
+A. Maximum amplitude in the mid-luteal phase with the highest frequency in the follicular phase, the early one.
+B. The lowest amplitude in the mid-follicular phase, with the highest frequency in the luteal phase, is the late one.
+C. Maximum amplitude in the early luteal phase with the lowest frequency in the luteal phase, the late one.
+D. The lowest amplitude in the mid-follicular phase with the lowest frequency in the phase.
+The late follicular.
+",C
+"What are the pinopodes in the rooting process?
+A. Structures that appear on the stromal cells of the endometrium.
+B. Structures appearing on flat epithelial cells without microvilli.
+C. Structures that adhere to the blastocyst before fertilization.
+D. Cellular structures that appear on day 15 and disappear on day 20 of the menstrual cycle.
+",B
+"When, for the first time, could messenger RNA to create hCG be detected in the human fetus?
+A. After the fertilization of the blastocyst.
+B. At the stage of about 100 cells.
+C. In the morula stage.
+D. At the 6-8 cell stage.
+",D
+"What is the reaction that the enzyme 21  Hydroxylase catalyzes?
+A. 11-Deoxycortisol to cortisol.
+B. Deoxycorticosterone to corticosterone.
+C. Deoxycortisol-11 to 17-OH-Progesterone.
+D. Progesterone to 17-OH-Progesterone.
+",C
+"A 25 year old has a history of PCOS and a BMI of 30. Her last menstrual period was two months before her application. In a sonographic examination, the endometrium is 10 mm, the ovaries are without a primary follicle. She has a Low blood estradiol level and low progesterone level.
+What causes the endometrium to reach this thickness?
+A. Estradiol from aromatization of DHEA.
+B. Estrone from androstenedione aromatization.
+C. DHEA aromatization estriol.
+D. Estradiol from aromatization of androstenedione.
+",B
+"What characterizes the LH in women with PCOS compared to women with regular ovulation?
+A. There is an increase in the frequency and amplitude of LH secretion.
+B. The biological activity of LH is lower.
+C. The common LH isoform in women is more acidic.
+D. In these women, the level of LH secreted in response to GnRH is less.
+",A
+"What is the effect of increased insulin levels on the level of androgens and SHBG in women with PCOS?
+A. Increase in androgen production in granulosa cells and decrease in SHBG production.
+B. An increase in the production of androgens in granulosa cells and an increase in the production of SHBG.
+C. Decrease in androgen production in theca cells and decrease in SHBG production.
+D. Increase in androgen production in theca cells and decrease in SHBG production.
+",D
+"What meets the definition of Metabolic Syndrome?
+A. Waist circumference: 78 cm, blood pressure: 145/92, triglycerides: 128, fasting sugar: 90, HDL level: 62.
+B. Waist circumference: 90 cm, blood pressure: 130/85, triglycerides: 132, fasting sugar: 96, HDL level: 58.
+C. Waist circumference: 78 cm, blood pressure: 135/82, triglycerides: 160, fasting sugar: 110, HDL level: 40.
+D. Waist circumference: 90 cm, blood pressure: 135/80, triglycerides: 140, fasting sugar: 95, HDL level: 55.
+",C
+"A 25 year old has oligomenorrhea, acne, fatigue, muscle pains, and a recently discovered hypertension. What test should be completed for the diagnosis?
+A. Dexamethasone test.
+B. HOMA -IR test.
+C. DHEA level.
+D. Thyroid antibodies.
+",A
+"Which of the following situations is a reason for recurrent miscarriages?
+A. Increased in the level of Antithrombin 3.
+B. Factor 7 is reduced.
+C. Factor 10 is increased.
+D. Increased antiplasmin.
+",C
+"A sample of which of the following is the most reliable for PGT-A (Preimplantation Genetic Testing?).
+A. First polar body.
+B. Second polar body.
+C. Blastomere.
+D. Trophectoderm.
+",D
+"Which of the following conditions is an absolute contraindication to the use of Depo Provera as a contraceptive?
+A. Liver adenoma that developed while using birth control pills.
+B. Epilepsy.
+C. Sickle cell anemia.
+D. Three or more proven cases of pelvic inflammatory disease (PID).
+",A
+"Which contraceptive has the lowest expected failure rate?
+A. Sponge with spermicide.
+B. Diaphragm with spermicide.
+C. Female condom.
+D. Male condom.
+","B,D"
+"Which of the following amenorrhoeic women will not respond to treatment with a GnRH pump to achieve ovulation?
+A. A woman with hyperprolactinemia.
+B. A woman with long-term GnRH agonist treatment for endometriosis.
+C. A woman with PCOS.
+D. A woman with amenorrhea due to intense physical activity.
+",B
+"What is the characteristic of ovulation induction treatment in women with PCOS using letrozole compared to clomiphene Citrate treatment?
+A. A lower rate of abortions.
+B. A higher rate of multiple pregnancies.
+C. Progesterone levels are higher in the luteal phase.
+D. Similar ovulation rates after five treatment cycles.
+",C
+"What is the expected outcome of the induction of menstrual bleeding using progesterone in women with PCOS and amenorrhea who will start treatment with clomiphene citrate compared to starting treatment without menstruation?
+A. Shortening the period to achieve ovulation.
+B. Increasing pregnancy and birth rates.
+C. Extending the time to achieve pregnancy.
+D. Help to achieve a thicker endometrium during the treatment.
+",C
+"Which of the following gonadotropins is not suitable for inducing single follicle ovulation in women with PCOS?
+A. Corifollitropin alfa.
+B. Follitropin alfa.
+C. Follitropin beta.
+D. HMG.
+",A
+"Which of the following gonadotropins is produced in a human cell line?
+A. Corifollitropin alfa.
+B. Follitropin alfa.
+C. Follitropin beta.
+D. Follitropin delta.
+",D
+"How do dopamine agonists induce ovulation in women with hyperprolactinemia?
+A. They suppress the production and secretion of estradiol, which leads to an increase in the secretion of FSH.
+B. Influence the pituitary to secrete LH+FSH through VEGF receptors.
+C. Stimulate the secretion of GnRH from the hypothalamus following the removal of inhibition by prolactin.
+D. Release the GnRH receptors in the pituitary occupied by prolactin.
+",C
+"Which of the following women have an increased incidence of endometriosis?
+A. Women with regular physical activity.
+B. Women who consume large amounts of coffee.
+C. Women who smoke heavily.
+D. Women with BMI bigger than 30.
+",B
+"What characterizes macrophage cell activity in women with endometriosis?
+A. The presence of macrophages in the peritoneal fluid is unique to the state of endometriosis.
+B. A decrease in VEGF secretion from macrophages contributes to the formation of fibrosis and adhesions in the pelvis.
+C. A decrease in the secretion of IL-8 suppresses the response of macrophages to ectopic endometrium.
+D. Increase in TNF secretion inhibits macrophage function in response to ectopic endometrium.
+",D
+"Which of the following hormonal profiles characterizes a man diagnosed with Young's syndrome?
+A. Low FSH and LH, low testosterone, low prolactin.
+B. High FSH and LH, testosterone is normal, prolactin is normal.
+C. High FSH and LH, testosterone is low, prolactin is high.
+D. Normal FSH and LH, testosterone is normal, prolactin is normal.
+",D
+"How does a man's aging affect his fertility?
+A. There is no change in the morphology of the sperm cells.
+B. Decrease in FSH levels.
+C. Decrease in flow volume.
+D. Decrease in the concentration of sperm cells.
+",C
+"Which of the following does not impair male fertility in the presence of a large varicocele?
+A. Hypoxia and stasis.
+B. Delay in the descent of the testicle in fetal life.
+C. An increase in the temperature of the testicle.
+D. Delay in the removal of toxins from the testicle.
+",B
+"What is the most likely diagnosis of a man who is repeatedly tested with high gonadotropin levels and low testosterone?
+A. Prolactin secreting tumor.
+B. Kalman syndrome.
+C. Testicular failure.
+D. Congenital Bilateral Absence of Vas Deferens.
+",C
+"What is the gene responsible for the differentiation of gonads into testes?
+A. SOX9.
+B. DAXI.
+C. BMP15.
+D. CYP26B1.
+",A
+"A one-day-old girl was found with mild virilization of the external genitalia. An ACTH test was performed which found a high level of 17 alpha hydroxypregnenolone.
+What is the most likely enzymatic disorder?
+A. 3 beta OH dehydrogenase.
+B. 21 hydroxylase.
+C. 17 beta OH dehydrogenase.
+D. 11 beta hydroxylase.
+",A
+"A girl with a hormonal profile as described:
+FSH 2 IU/L LH 2 IU/L ESTRADIOL -30pg/ml DHEAS 50 ng/dL.
+What tanner stage is she at?
+A. Tanner 1.
+B. Tanner 2.
+G. Tanner 3.
+D. Tanner 4.
+",B
+"A 4-year-old girl is examined due to an incident of vaginal bleeding. In her examination, her breasts are Tanner 2. Pubic hair is Tanner 1.  She has a low gonadotropin level and a low estradiol level. What is the most likely diagnosis?
+A. McCune-Albright syndrome.
+B. Functional ovarian follicular cysts.
+C. Granulosa cell tumor.
+D. Gonadoblastoma.
+","A,B,C,D"
+"What is the effect of menopausal estrogen therapy on the lipid profile?
+A. Increases the amount and activity of lipoprotein receptors.
+B. Increases levels of lipoprotein(a).
+C. Reduces Triglycerides levels.
+D. Reduces catabolism of LDL.
+","A,C"
+"What constitutes an advantage of adding androgens to menopausal women treated with HRT?
+A. Reducing the incidence of breakthrough bleeding.
+B. Reducing the frequency and intensity of heat waves.
+C. Beneficial effect on bone density.
+D. Beneficial effect on the lipid profile.
+",C
+"A 37-year-old is facing the start of an IVF cycle due to mechanical infertility.
+Which of the following measures has the highest sensitivity for predicting the retrieval of fewer than four oocytes?
+A. AFC = 7.
+B. 0.5 ng/mL = AMH.
+C. FSH= 11 IU/L 11 on day 3 of the menstrual cycle.
+D. Estradiol = 300 pMol/L on day 3 of the menstrual cycle.
+",B
+"A 38-year-old is undergoing an IVF treatment cycle with a long agonist protocol.
+12 follicles with a diameter of 18-20 mm were suctioned, without pelvic fluid. No eggs are found in the follicular fluid test. What explains the absence of eggs?
+A. Injection of the trigger 38 hours before pumping.
+B. Using the DECAPEPTYL trigger at a dose of 0.2 mg.
+C. Use of rhCG in a reduced dose (125 micrograms).
+D. Use of uhCG in a reduced dose (5000 units).
+",B
+"What is the first histological change observed in the endometrium after ovulation?
+A. Ciliogenesis around gland openings.
+B. Hematopoietic cell appearance.
+C. Stromal cell cytonuclear enlargement.
+D. Subnuclear glycogen vacuole appearance.
+",D
+"What does FSH surge cause during the menstrual cycle cause?
+A. Compression of the cumulus cells in the follicle.
+B. An increase in OMI (oocyte maturation inhibitor) level in the follicle.
+C. Increase in the level of plasminogen activator in the follicle.
+D. Decreased expression of LH receptors in the follicle.
+",C
+"Which of the following is not associated with an increase in FSH secretion during the late luteal phase?
+A. Decrease in the level of INHIBIN A in the blood.
+B. An increase in the frequency of GnRH secretion.
+C. A decrease in the level of progesterone in the blood.
+D. Increase in the level of INHIBIN B in the blood.
+",D
+"A Transgender female receives treatment with estrogen. What is the serum estradiol level that is the treatment goal?
+A. 50 Picogram/ml.
+B. 150 Picogram/ml.
+C. 350 Picogram/ml.
+D. 450 Picogram/ml.
+",B
+"Which of the following will help to treat male Transgender until masculinization is achieved?
+A. Spironolactone.
+B. Finasteride.
+C. Leuprolide acetate.
+D. Estradiol Valerate.
+",C
+"What is the main reason for using ethinyl estradiol instead of natural estradiol In Combined birth control pills?
+A. Natural estradiol activity is poor when given together with progestin.
+B. Natural estradiol has more side effects.
+C. Ethinyl estradiol is metabolized in the liver, unlike estradiol.
+D. Natural estradiol has poor activity when administered orally.
+",D
+"How will a mutation in the LH receptor affect the development of the female reproductive system?
+A. Fetal theca cells will not synthesize androgens.
+B. The baby will be born with ovarian cysts.
+C. The uterus, fallopian tubes, and the upper third of the vagina will not develop properly.
+D. There will be no effect on fetal life.
+",D
+"What is the purpose of testing polymorphic markers during PGT-M? (Preimplantation Genetic Testing for Monogenic Disorders).
+A. To enable the diagnosis of more than one mutation.
+B. To enable the diagnosis of new mutations (novo-de).
+C. Check for aneuploidy/aneuploidy.
+D. Reduce the risk of misdiagnosis.
+",D
+"A 30-year-old woman and a 35-year-old man with a pre-mutation to fragile x (180 repeats) request a pre-implantation examination. What is the most appropriate genetic diagnostic technique in this case?
+A. The pre-mutation test and polymorphic markers in the blastocyst.
+B. Testing the mutation and polymorphic markers in a 3-day-old fetus.
+C. The pre-mutation test and markers for the X chromosome.
+D. Diagnosis of the sex of the fetus only.
+",D
+"What constitutes a bad prognostic marker for complications for the mother and the fetus in the case of placental abruption?
+A. Placenta previa.
+B. Finding of subchorionic hematoma in ultrasound.
+C. Low levels of fibrinogen.
+D. Increased level of AFP (fetal protein) in the screening of the second trimester.
+",C
+"At week 34 of her pregnancy, a woman is preparing for her fifth birth. She has had 4 cesarean sections in the past and is currently pregnant and was diagnosed with a placenta previa. She is arriving due to bloody urine. On admission, she was in good general condition and had normal vital signs. Urine culture is normal. In urinalysis and urine sediment microhematuria is detected. What is the next step in management?
+A. Cystoscopy.
+B. US Doppler or MRI.
+C. Cystography.
+D. Kleihauer-Betke test.
+",B
+"Which of the following Uterotonic drugs has the shortest response time?
+A. Misoprostol in oral administration.
+B. Methylergonovine (Methergine) intramuscular.
+C. Prostaglandin F2 (Hemabate) intramuscularly.
+D. Misoprostol in rectal administration.
+",B
+"What are the expected metabolic changes in the fetus with IUGR (intrauterine growth retardation)?
+A. An increase in the amount of ammonia in the amniotic fluid.
+B. An increase in the amount of essential amino acids in the fetal blood.
+C. An increase in the amount of triglycerides in the fetus's blood.
+D. A decrease in the partial pressure of CO2 in the fetal blood.
+","A,C"
+"The concentration of which of the following hormones decreases according to the severity of placental insufficiency in fetuses with a reduction In intrauterine growth (IUGR?).
+A. Corticotropin-releasing hormone.
+B. Adrenocorticotropic hormone.
+C. Osteocalcin.
+D. Cortisol.
+",C
+"Which biochemical marker in the maternal blood is an indicator for predicting intrauterine growth restriction (IUGR)?
+A. Decreased maternal alpha serum fetoprotein (MSAFP).
+B. Decreased hCG levels.
+C. Decreased pregnancy-associated plasma protein A (PAPP-A).
+D. Elevated placental growth factor (PlGF).
+",C
+"A pregnant woman at 31 weeks of pregnancy is referred for evaluation due to fetal weight assessment in the 3rd percentile. What is the flow-Doppler index whose deterioration will determine making a decision to immediate deliver the newborn ?
+A. Umbilical artery.
+B. Ductus venosus.
+C. Uterine artery.
+D. Cerebral-Placental Ratio.
+",B
+"A pregnant woman at 33 weeks with unbalanced gestational diabetes is treated with insulin, threatening preterm delivery. What is the preferred tocolytic treatment?
+A. B Adrenergic receptor agonists.
+B. Magnesium sulfate.
+C. COX inhibitors.
+D. Calcium channel blockers.
+",D
+"A 30-year-old woman, pregnant for the second time at 25 weeks, arrived due to regular contractions every 4 minutes. The previous pregnancy ended in Premature birth at week 30.
+Treatment with Betamethasone, magnesium sulfate, indomethacin, and penicillin was started. What could be the side-effect on this patient?
+A. Oligohydramnios.
+B. Hypoglycemia of the newborn.
+C. Pulmonary hypertension of the newborn.
+D. Persistent ductus arteriosus in the newborn.
+",A
+"What is the follow-up required for women diagnosed with macroadenoma during pregnancy?
+A. Blood prolactin levels.
+B. Visual field test.
+C. MRI head.
+D. CT head.
+","A,B"
+"A woman with mitral valve stenosis arrived for pre-pregnancy counseling. When and why is the maximum load on the valve expected?
+A. Weeks 16-28 due to the increase in heart rate.
+B. Week 29-36, due to increased pulmonary flow resistance.
+C. Weeks 8-16 due to increased blood pressure and peripheral resistance.
+D. Weeks 20-36 due to the increase in cardiac output.
+",D
+"Which of the following factors contributes to the condition of physiological hypercoagulability during pregnancy?
+A. Increase in the number of platelets and their activity.
+B. Increase in the free fraction of s protein.
+C. An increase in the concentration of factors 11.
+D. On the fibrinogen concentration.
+",D
+"What are the recommended tests during pregnancy after achieving pregnancy with preimplantation genetic testing (PGT) due to a balanced translocation to the father?
+A. Prenatal ultrasound screening for detection of fetal anomalies.
+B. Fetal echocardiography.
+C. Cell-free DNA.
+D. Amniocentesis.
+",D
+"What is the typical disorder of an android pelvis during childbirth?
+A. Deep transverse arrest.
+B. Cephalopelvic disproportion.
+C. Arrest of dilatation.
+D. Brow presentation.
+",B
+"Which of the following fetal malformations is most common in women with a high BMI?
+A. Polycystic kidney.
+B. Anorectal atresia.
+C. Sacral agenesis.
+D. Hypospadias.
+",B
+"What is the most common complication in subsequent pregnancies in a woman who has previously had a placenta accreta?
+A. Uterine rupture.
+B. Placenta accreta.
+C. Placental abruption.
+D. The uterine hypotonia during childbirth.
+",B
+"Persistent polyhydramnios in the third trimester is associated with an increased risk of which of the following?
+A. Preeclampsia.
+B. IUGR.
+C. Cholestasis of pregnancy.
+D. Amniotic Band Syndrome.
+","A,B"
+"As part of an prolonged pregnancy follow-up at week 40+ 7 days, a biophysical profile of 8/10 and AFI = 45 mm was observed. What is the fetal risk in this situation?
+A. Contractures in the limbs.
+B. Lung hypoplasia.
+C. Meconium aspiration syndrome.
+D. Sepsis.
+",C
+"A 32 year old, underwent a wide biopsy of the cervix. Histology revealed SQUAMOUS CELL CARCINOMA, with a penetration depth of 8 mm, with penetration into lymphatic vessels and blood vessels. On clinical examination, a tumor with a maximum diameter of 5 cm without evidence of parametrium or vaginal involvement. On imaging, there is no evidence ror ectopic tumor involvement. According to the STAGING from 2018, in which disease stage is the patient?
+A. I-B-2.
+B. I-B-3.
+C. II-A-2.
+D. III-C-1.
+",D
+"What is the indication for cesarean section in women with inflammatory bowel disease?
+A. Combined biological treatment with Imuran during pregnancy.
+B. Recurrent attacks during pregnancy.
+C. Active perianal disease with involvement of the rectum in Crohn's patients.
+D. Treatment with Rafassal started in the third trimester.
+",C
+"What does the passage of glucose through the placenta depend on?
+A. GLUT1 1 channels (Glucose Transporter-1) channels which depend on sodium activity.
+B. GLUT1 channels that depend on insulin activity.
+C. GLUT1 channels that reach 50% saturation when the average sugar level is 90 mg/dL.
+D. GLUT4 channels which are not affected by the state of maternal diabetes.
+",C
+"Which of the following is related to the development of fetal growth retardation?
+A. Maternal treatment with steroids.
+B. Fetal hypothyroidism.
+C. Low levels of IGF2 (Insulin Growth Factor II) in the mother's blood.
+D. Increased secretion of insulin by the fetus.
+","A,C"
+"What is the effect of practicing an emergency simulation of umbilical cord prolapse on a real outcome?
+A. Improves the time from the moment of diagnosis until the delivery.
+B. Improves the Apgar score of newborns.
+C. Reduces the rate of NICU admissions.
+D. Lowers the rate of hypoxic-ischemic encephalopathy.
+",A
+"Which of the following factors increases the risk of damage to the newborn's scalp after a vacuum birth?
+A. Using a metal spoon.
+B. The duration of the operation lasts about ten minutes.
+C. Uniform traction along the axis of the birth canal.
+D. One application of the spoon.
+",A
+"In which of the following clinical situations is it possible to wait 48 hours to complete steroid treatment before the delivery?
+A. Week 36 with PET and blood pressure around 180/110 under medication.
+B. Week 31 with HELLP without signs of fetal deprivation.
+C. Week 29 with PET and a creatinine level of 2 mg/dL.
+D. Week 29 with PET and pulmonary edema.
+",B
+"Which of the following complications is more common in cases of HELLP syndrome?
+A. Pulmonary edema.
+B. Acute renal failure.
+C. Coagulation disorder type DIC.
+D. Liver failure.
+",C
+"What is the relationship between the various factors in preeclampsia?
+A. Increased sFlt level, low VEGF free level, low PLGF free level.
+B. Increased sFlt level, high VEGF free level, low PLGF free level.
+C. Low sFlt level, low VEGF free level, low PLGF free level.
+D. Low sFlt level, high VEGF free level, low PLGF free level.
+",A
+"In which of the following situations may a vaginal delivery be allowed in a twin pregnancy?
+A. A Leading twin in breech presentation weighing 2,200 grams, second twin in head presentation weighing 3,000 grams.
+B. Lead twin in breech presentation weighing 3,000 grams, second twin in head presentation weighing 2,200 grams.
+C. Lead twin in head presentation weighing 2,200 grams, second twin in breech presentation weighing 3,300 grams.
+D. Lead twin in head presentation weighing 3,000 grams, second twin in breech presentation weighing 2,100 grams.
+",D
+"A BCBA twin pregnancy demonstrates a growing gap between the two fetuses (discordance). At week 30, the small fetus was found without a pulse (IUFD).
+How should the pregnancy be managed?
+A. Performing a brain MRI for the survived fetus to plan delivery at 34 weeks.
+B. Continue routine growth monitoring for the fetus that survived and delivery at week 37.
+C. Performing Doppler monitoring in the MCA for a fetus that survived and delivery at 34. weeks.
+D. To recommend a delivery after completing the Celestone Chronodose course.
+",B
+"What condition is required for the laboratory definition of subclinical hypothyroidism?
+A. TSH level of 12 mIU/L in the presence of FT4 in the normal range.
+B. TSH level of 8 mIU/L in the presence of FT4 in the normal range.
+C. A TSH level of 4.5 mIU/L in the presence of FT4 is below the normal range.
+D. TSH level of 12 mIU/L in the presence of FT4 below the normal range.
+",B
+"24 years old woman in her first pregnancy, without pregnancy monitoring, presents during active labor. On her examination, cervical effacement is 80% and 5 cm open. Membranes are intact, vertex presentation. What should be done in the first step?
+A. Ultrasound to demonstrate the head, neck, and fetal spinal cord.
+B. Cesarean section.
+C. Start Pitocin at a low dose.
+D. Artificial rupture of membranes.
+",A
+"Which of the following decreases the chance of a successful external cephalic version?
+A. Gestational age between 35-34 weeks.
+B. Performance in the latent phase of birth.
+C. Spinal anesthesia before the procedure.
+D. Breech presentation.
+",B
+"A pregnant woman gave birth via vaginal delivery with significant postpartum bleeding due to atony, characterized by a drop in blood pressure.
+She received a transfusion of 4 portions of blood. In a blood test: hemoglobin 8% grams creatinine 2.3 mg/dL. What is the first step in finding out the blood test results?
+A. Urine collection for quantitative protein.
+B. Fluid administration and creatinine monitoring.
+C. Urine collection for potassium.
+D. Administering diuretics.
+",B
+"What is the result of using oxytocin to induce labor in HIGH DOSE vs. LOW DOSE?
+A. Increases the rate of cesarean sections.
+B. Increases the rate of chorioamnionitis.
+C. Increases the rate of uterine ruptures.
+D. It shortens the duration of childbirth.
+",D
+"A woman preparing for her first birth at 41 weeks is  being induced using oxytocin for a duration of 26 hours. On examination: the cervix is open to 3 cm, 70% effacement, head in 1-S, amniotic fluid comes down clean. Fetus Monitoring is Normal. She has 4 contractions in 10 minutes. What should be done next?
+A. Cesarean section.
+B. Change the bag of oxytocin.
+C. Take a break (window) in giving oxytocin.
+D. Internal monitoring Calculation of contraction in Montevideo units.
+",A
+"A woman about to give birth for the first time at 41 weeks is  being induced At a cervical opening of 3 cm, a Rupture of the amniotic membranes was done.
+What is expected of the birth process as a result of this action?
+A. Shortening the duration of childbirth by an average of two hours.
+B. Increasing the probability of cesarean section.
+C. Increasing the probability of an instrumental birth.
+D. Increasing the probability of neonatal infection.
+",A
+"A woman in her second pregnancy, at 28 weeks, is admitted with amniotic fluid leaking.
+On examination, oral temperature of ֻ38 C, maternal heart rate of 120 beats per minute, sensitivity to palpation above the uterus is noted, and fetal tachycardia on monitoring is 180 beats per minute. What should be done next after antibiotic coverage?
+A. Amniocentesis.
+B. Administering tocolytics.
+C. Administration of steroids and a delivery after 48 hours.
+D. Delivery.
+",D
+"A woman at 35 weeks of pregnancy is hospitalized due to a fever of 39 degrees, weakness, and complaints of upper respiratory infection. The woman was vaccinated against the flu at week 30. Influenza A virus was detected on nose culture. How should it be treated?
+A. Start treatment with oseltamivir.
+B. Give a booster of the vaccine with nasal drops.
+C. Immediate delivery.
+D. Azenil treatment.
+",A
+"A 40 year old, during her first pregnancy, is admitted at 30 weeks due to shortness of breath.
+In the examination, blood pressure was 130/80, pulse 100, and saturation was 92% in room air. Limbs without signs suspicious of DVT. What is the next step?
+A. Chest X-ray.
+B. ECG.
+C. V/Q Scan.
+D. Doppler leg veins.
+",A
+"What is the unique contribution to the transfusion of various blood products?
+A. FRESH-FROZEN PLASMA contains fibrinogen and coagulation factors V, XI, XII.
+B. CRYOPRECIPITATE contains the von Willebrand factor and factor VII.
+C. One dose of PACKED RED BLOOD CELLS increases the hematocrit by 1%.
+D. One dose of PLATELET CONCENTRATES raises the level of platelets by 20,000.
+",A
+"Which women are most likely to have a vaginal delivery after cesarean section?
+(VBAC).
+A. A woman who gave birth in a previous vaginal birth.
+B. A woman who had a cesarean section due to ""lack of progress"".
+C. The birth that ended in a cesarean section began spontaneously.
+D. BMI of 35.
+",A
+"Which of the following is a risk factor for uterine rupture during an attempted vaginal delivery after a cesarean section (TOLAC).
+A. Rupture of membrane over 18 hours.
+B. Closing the uterine wall in two layers in the previous surgery.
+C. A gap of two years between the surgery and the birth attempt.
+D. Induction of labor.
+",D
+"In which of the following malformations is there in an added value for a fetal MRI test?
+A. Complete lack of the CEREBELLAR VERMIS.
+B. CPAM.
+C. VSD.
+D. SACROCOCCYGEAL TERATOMA.
+","A,D"
+"A woman has a history of one miscarriage in the first trimester and another ׳´chemical׳´ pregnancy underwent an investigation, and as part of it, a TSH level was found at the upper limit of the norm. What is the next step in case management?
+A. Testing for the presence of anti-thyroid antibodies.
+B. Thyroid hormone replacement therapy.
+C. Repeat the test and with a similar result follow-up only.
+D. Antithyroid drug treatment.
+","C,A"
+"A 34-year-old applies for pre-pregnancy counseling. She has a history of portal hypertension. About a year ago, there was significant bleeding from varicose veins in the esophagus, and she underwent Emergency endoscopic ligation. A blood pressure of 130/80 was measured at the visit. What is the recommendation in case of pregnancy?
+A. Gastro-esophageal endoscopy in the first trimester.
+B. Start treatment with beta-blockers.
+C. Prophylactic ligation of the splenic artery in the second trimester.
+D. Treatment with LMWH in a prophylactic dose starting from the second trimester.
+",B
+"A woman is 28 years old and 20 weeks into her first pregnancy. Her background includes pre-gestational diabetes type 1. She came to the ER with abdominal pain, vomiting, and confusion. Blood glucose level was 250 mg/dl, and her Potassium level was 3.8 mEq/L, PH 6.95.
+Which of the following is part of the treatment for this woman?
+A. Administration of hypertonic saline.
+B. Administration of intramuscular insulin immediately.
+C. Administration of bicarbonate.
+D. Giving calcium.
+",C
+"A pregnant woman in the 8th week of pregnancy, has chronic hypertension controlled with Enalapril (from the ACE INHIBITORS family). The treatment is Changed to LABETALOL.
+What is the recommendation for pregnancy monitoring?
+A. Amniocentesis.
+B. Fetal echocardiography.
+C. Continue pregnancy monitoring as usual.
+D. Targeted screening of the fetal kidneys.
+",C
+"In the blood tests of a 41-year-old pregnant woman, G1P0, after prolonged infertility, the blood type is A minus. Positive anti-D antibodies in a titer of 1:4 are revealed in week 10. In week 24, the titer is 1:32. The partner is unavailable for testing.
+A free fetal DNA test in the mother's blood shows that the fetus is RhD-negative and the sex is female. What is the next step in the pregnancy follow-up?
+A. Repeating the fetal-free DNA test in the mother's blood.
+B. Villous chorionic sampling biopsy.
+C. Fetal blood sampling at week 32.
+D. Ultrasound examination - Doppler PSV_ MCA every two weeks.
+",D
+"Which of the organs of the fetus has the ability to self-regulate blood flow autoregulation?
+A. Gallbladder.
+B. Stomach.
+C. Cerebellum.
+D. Myocardium.
+",D
+"A 28 year old G2 P1 LC0 at 30 is diagnosed at weeks with severe fetal growth retardation (below the 1st percentile for Pregnancy age). She underwent tests, and no genetic etiology or infection was found. In the assessment of the fetus and considerations for the timing of the delivery, what is the finding with the highest risk of acidemia and intrauterine fetal death?
+A. DV Doppler index elevation below 2SD.
+B. Category II fetal heart rate tracing.
+C. Absent end diastolic flow in the umbilical artery.
+D. Category III fetal heart tracing and oligohydramnios.
+",D

pediatrics.csv

@@ -0,0 +1,709 @@
+question,answer
+"According to the clinical guidelines:
+In Which of the following conditions is it recommended to treat carriers of Group A Streptococcus (GAS) in the pharynx?
+A. In a community outbreak of glomerulonephritis secondary to GAS.
+B. In children over 1 year of age with repeated episodes of tonsillitis.
+C. When one of the household members of a sick child is immunocompromised.
+D. In an outbreak of impetigo in kindergarten with a number of sick children.
+",A
+"A 17 years old with a healthy background has had difficulty in studies since childhood. On examination: height in the 95th percentile and weight in the 75th percentile. Long legs relative to the torso, gynecomastia, small testicles, and pubic hair in Tanner grade 3. What is the probable diagnosis? 
+A. It is a physiological gynecomastia of puberty, and withdrawal is expected. 
+B. There is an increased risk of breast cancer and mediastinal tumors. 
+C. A complete maturation process and normal fertility are expected. 
+D. The testosterone treatment improves fertility. 
+
+",B
+" A blood pressure value between the 90th and 95th percentile for gender and height is measured twice in a routine blood pressure test for a 16-year-old who normally healthy. According to clinical guidelines, what is the recommended approach?
+A. Repeat the test in a week and if the value is similar, start treatment with ACE inhibitors.
+B. Recommend a proper diet, physical activity and repeated blood pressure measurement in 6 months.
+C. Repeat the test at the age of 18 because this is most likely an accidental and asymptomatic finding.
+D. Perform a kidney Doppler ultrasound and blood test for serum renin and aldosterone levels.
+",B
+"A 3-month-old suffers from convulsions on the right side of his body. During the pregnancy he was diagnosed with a rhabdomyoma in the heart, the course of the birth was normal. What is true about the likely diagnosis in this infant? 
+A. It is likely that his parents are relatives. 
+B. More common in Jews of Ashkenazi origin. 
+C. Usually, it is a new mutation. 
+D. The inheritance is from the mother only. 
+
+",C
+"A one and a half year old manages to turn over in both directions, does not crawl but tries to move forward and sitting is unstable. She is are able to grasp an object handed to her, manages to pass an object from hand to hand, smiles, and utters sounds but not syllables. What is the approximate developmental age level of the girl? 
+A. 2-3 months. 
+B. 5-6 months. 
+C. 7-8 months. 
+D. 10-12 months. 
+
+",B
+"A 2 year old, without an atopic background, is recovering from an RSV infection, and still coughs and wheezes occasionally. In the laboratory - serum IgE level of 600 units/ml in serum (norm up to 200). What is your clinical conclusion regarding the laboratory answer? 
+A. Allergic disease is highly likely, and anti-IGE treatment should be started. 
+B. This is a high probability of an Aspergillus infection. 
+C. It is not possible to conclude regarding the diagnosis because the diagnostic value of this test is low. 
+D. You should proceed clearly and perform an IgE test for specific antigens. 
+
+",C
+"A newborn is hospitalized in a hospital after being born at 26 weeks weighing 750 grams. His economy is
+Based  on the basis of cow's milk and receives the addition of environmental oxygen only. At the age of 3 weeks, multiple apneas appear, green residual content is seen in the nano gastric tube and bloody stools appear. What would be the indication for surgical intervention?
+A. Fixed loop in repeat abdominal X-ray.
+B. Air fluid level above the liver in Decubitus photography.
+C. Erythema and swelling of the abdominal wall around the navel.
+D. Bloody stools that persist under fasting.
+",B
+"According to the clinical guidelines: A usually healthy six years old is hospitalized due to high fever and a limp for the past two days. On physical examination: sensitivity when moving the hip joint on the right, lab results demonstrated increased inflammation indicators. On US, a large amount of fluid was detected in the hip, in which 80,000 leukocytes/mm were counted. A blood culture was taken, and intravenous cephemazine was administered. What is true about the common etiology and its treatment? 
+A. Often, there is an anamnesis of (Aphthous Stomatitis) recently. 
+B. Only in about 5% of cases can the generator be isolated from the blood. 
+C. Intravenous treatment is recommended for 3 weeks. 
+D. In case of penicillin allergy, you can consider an alternative treatment with Rasperim. 
+
+",D
+"A 6-year-old is examined in the ER due to general weakness, salivation, difficulty coughing, and slow and unclear speech from the day before her referral. Two weeks earlier she suffered from a fever which passed after 3 days. In a finger-to-nose test, bilateral dysmetria, positive Romberg with a tendency to fall to the right side, clonus and a pathological Babinski sign on the right. What is the most likely diagnosis? 
+A. Guillain-Barre syndrome. 
+B. Acute demyelinating encephalomyelitis. 
+C. Low-grade thalamic glioma. 
+D. Acute post-infectious focal cerebellitis. 
+
+",B
+"A 4-month-old was examined at the hospital because of insufficient weight gain. No examinations were performed during pregnancy. The baby was born at 37 weeks, weighing 2.8 kg, his weight today - 4 kg. The parents are first cousins and healthy. The baby is fed with breast milk and Baby Formula supplements - he eats between 90-120 ml every three hours. He urinates a lot and suffers from constipation. When examining him, there are signs of moderate dehydration and significant thinness in the emergency department—the pulse - 150 per minute, normal blood pressure. The rest of the physical examination is regular. In the laboratory: Hemoglobin g/dl -14.5 reference 10-12. PH 7.6 reference 7.35 -7.45 . HCO3 mEq/L 38 reference 16-24. Serum. Creatinine mg/dl 0.22 reference 0.2-04. Urea mg/dl 50 reference 5-18. K+ 2.2 references 4.1-5.3. NA + 137 reference 134-144. Cl 89 reference 98-106. Urine. CL 60 <10. Na+ 25. K+ 30. What else is expected to be found in the laboratory tests? 
+A. Hypercalciuria. 
+B. Hypermagnesemia. 
+C. Aldosterone is low in the blood. 
+D. Prostaglandin E levels are low in the urine. 
+
+",A
+"A 12-year-old was examined at the ER after an incident of syncope. The child is generally healthy, and an active athlete, without regular medication. Which of the additional data, if it appears in the anamnesis, will be a warning sign (""red flag"")? 
+A. ECG performed in the emergency department measured 0.41 QTC. 
+B. He had Kawasaki disease in the past. 
+C. Before he lost consciousness he ""saw black"" and felt dizzy. 
+D. Loss of consciousness appeared after prolonged standing. 
+
+",B
+"A 3-week-old boy, who was born after a normal pregnancy and was fed only breast milk, was examined due to prolonged neonatal jaundice since birth. In the anamnesis, pale stools and slow weight gain are noted, in laboratory tests:
+Total bilirubin 9 mg/dl reference <1.2.
+Direct bilirubin 3.5 mg/dl , reference < 0.2.
+Abdominal ultrasound examination demonstrates a gallbladder. What is the probable diagnosis:
+A. Jaundice of breastfeeding.
+B. Fructosemia.
+C. Biliary atresia.
+D. Crigler-Najjar syndrome.
+",C
+"A 12-year-old suffering from asthma has IGE blood levels of 250 IU (normal level 0-100).
+Prophylactic treatment with inhalers containing high-dose steroids was initiated. After 3 months he is still suffering from repeated shortness of breath attacks. His examination shows ""Moon facies"" and the rate of weight gain and growth in height are slow for his age. What is the next step in treatment?
+A. Increasing the frequency of inhalations with B2-AGONISTS.
+B. Nonsteroidal Antiinflammatory Agent + Long-Acting Inhaled Anticholinergic.
+C. Leukotriene-Modifying agent.
+D. Biological treatment with OMALIZUMAB.
+",D
+"A 12-year-old boy/boy comes to the clinic and declares that he doesn't feel like a male and demands that you address him as a female. The boy asks what the process is for changing his gender to female. In the conversation, you get the impression that he is very determined in his opinion and feels like a girl from a very young age. His mother, who came with him, confirms his feelings. In his examination - there is only pubic hair that is not frizzy. Testicles slightly enlarged. Which of the following is true about the steps in the process? 
+A. Treatment with GnRH analogs can be started. 
+B. Sex reassignment surgeries will only be done after the adolescent has lived according to the new gender for at least 4 years. 
+C. Sex reassignment surgery should not be approved before the age of 20. 
+D. You can proceed to surgery now. 
+
+",A
+"An 18 month old has been suffering from crying and restlessness for several days, especially when changing diapers, and difficulty moving from lying down to standing. In blood culture: preliminary report of growth of gram-negative coccobacillus. What is the recommended treatment for her probable illness?
+A. Cefazolin.
+B. Clindamycin.
+C. Amoxicillin.
+D. Amikacin.
+",A
+"A 4-year-old is referred for growth assessment. The parents are both tall. As a baby, she suffered from edema in her limbs which went away at the age of two days and she is known to have a bicuspid aortic valve. On examination - weight and height in the 10th percentile, without dysmorphism. What is the next step in diagnosis? 
+A. Growth hormone stimulation test. 
+B. Karyotype test. 
+C. Sweat test. 
+D. MR angiography. 
+
+",B
+"According to the clinical guideline, which of the following is the indication for brain imaging in children with headache?
+A. 10 years old with a headache that changes in nature and worsens during physical activity.
+B. 15 years old with headaches for several years and a family history of malignancies.
+C. A 6.5-year-old boy with headache and nausea during long trips.
+D. A child with headaches and a family history of a coagulopathy.
+",A
+"A 14-year-old who has been treated for a long time with a particular drug complains of headaches, vomiting, and lack of. Appetite. On examination: dry, peeling skin and a cut (""fissure"") in the corner of the mouth. What drug most likely caused his condition? 
+A. Minocycline. 
+B. Roaccutane. 
+C. Growth hormone. 
+D. GCSF. 
+
+",B
+"An 8-year-old was examined after, in the last month, he described people and sights that are not observed by others. In conversation with the boy, he sounds slow and confused. Which of the following is suspicious of a primary organic disease rather than a primary psychiatric one? 
+A. Gender. 
+B. The hallucinations of voices. 
+C. The age of the child. 
+D. Disorganized speech. 
+
+",C
+"An 8-year-old boy was brought to the emergency room unconscious, and on examination, his pulse was 50 per minute. What is the initial treatment required? 
+A. Intravenous administration of epinephrine. 
+B. Heart massage at a rate over 100 per minute. 
+C. Securing an airway and providing oxygen. 
+D. Intravenous administration of atropine at a minimum dose of 0.1 mg. 
+
+",C
+"A 12 year old, who is healthy so far, complains of muscle pain and dark urine for two days that started after the onset of fever, cough, and a runny nose. Creatine kinase (CPK) is 10,000 U/L (high) in a laboratory test. Previously normal CPK values. Normal muscle biopsy. No additional findings. What is the probable diagnosis? 
+A. Glycogen storage disease type 1 (Von Gierke.). 
+B. Short-chain acyl-CoA dehydrogenase deficiency (SCAD). 
+C. Becker muscular dystrophy (BMD). 
+D. CPT2 carnitine palmitoyl transferase 2 (CPT2). ",D
+"A newborn was born at week 25 of pregnancy weighing 700 grams. On the fourth day of his life, there was an increased oxygen consumption and intubation was required. On examination: a 2/6 murmur was heard maximally between the shoulder blades, and the peripheral pulses were well palpated. The blood count is age-appropriate. What is the recommended treatment at this stage? 
+A. Surgical ligation. 
+B. Ibuprofen. 
+C. Prostacyclin. 
+D. Caffeine. 
+
+",B
+"A 6-month-old is exclusively breastfed until 4 months, and from about 2 months, he receives a supplement of dairy formula. The last two times, about two hours after he received dairy formula, vomiting began, followed by pallor, and after a few more hours, diarrhea with visible blood and mucus—a negative milk allergy skin test was conducted with a positive histamine control. No atopic background is known in the family. What is the most likely diagnosis? 
+A. IgE-mediated milk allergy. 
+B. Eosinophilic gastroenteropathy. 
+C. Food protein-induced enterocolitis syndrome. 
+D. Allergic proctocolitis-IgE mediated. 
+
+",C
+"A 15-year-old girl is being examined for joint pain and a rash. In the anamnesis note that she has been less active in the last year. On her examination: soft abdomen, no tenderness on palpation, palpable spleen 4 cm below the rib cage, liver not enlarged. The results of the blood tests are shown in the table. Hemoglobin 11.5 g/dl Reference 13.5 11.5. Platelets 120,000 103/ml Reference 350 150. WBC 4 * 103/ml Reference 15.5  5. Albumin 3 g/dl Reference 5.2 3.6. Total bilirubin 1.5 mg/dl Reference <1.5. Direct bilirubin 1.2 mg/dl Reference <0.2. GGT 120 Reference 5-24. Alk. phosphatase 300U/L Reference 100- 320. ALT 400 U/L Reference 10- 30 AST 300 U/L Reference 10- 35 INR. 1.3 U/L Reference 0.97 - 1.3. Abdominal ultrasound examination showed a non-enlarged liver, with a coarse and gritty texture and an enlarged spleen. What is the recommended first-line treatment for her probable illness? 
+A. Infusion of IVIG. 
+B. Oral cyclosporine. 
+C. Performing plasmapheresis. 
+D. Systemic steroids. 
+
+",D
+"A baby born on time, in a normal birth, begins on the second day of life to suffer from shortness of breath, and a decrease in oxygen levels in the blood. On examination: the heart sounds are weak on the left, the baby was treated with oxygen for a week and improved. What will it be possible to find in the child when he is 3 years old? 
+A. High chance of finding clubbing in the fingers. 
+B. Moist cough that started at a young age and still continues. 
+C. Liver vascular congestion with gallstones. 
+D. Many soft and smelly stools. 
+
+",B
+"A 3-day-old child is referred to the ER due to pallor, jaundice, and shortness of breath. He was born in a normal delivery at term after a normal pregnancy, including two scans that were concluded as normal. On his examination, the baby is breathing and pale, the capillary filling is slow, the heart sounds are regular, and there is a maximally short systolic murmur in the lower left border of the sternum in the space between the 3-4 ribs radiating to the back, the liver is not enlarged, and the femoral pulse is weakly felt, and delayed relative to the brachial pulse. In the laboratory tests: metabolic acidosis. What is the recommended initial treatment at this stage? 
+A. Giving a bolus of 0.9% NaCl solution. 
+B. Initiation of treatment with intravenous prostaglandin-E1. 
+C. Starting treatment with Phosphodiesterase 3 inhibitor. 
+D. Transfusion of packed red blood cells (PRBC). 
+
+",B
+"A 3-year-old was examined due to weakness and a general unwell feeling. The findings in the blood count: HB 8.8 g/dl reference range 10.5- 15. MCV 63 fl reference range 70-85. RDW 16.5% reference range 12-15. RBC 3.8 10^9/ml^3 reference range 4-5.2. Treatment appropriate for his likely illness was initiated, which of the following would be the first sign of a response to this treatment? 
+A. An increase in the level of ferritin. 
+B. A drop in heart rate to a normal range. 
+C. An increase in the level of reticulocytes. 
+D. Improvement in general feeling. 
+
+",D
+"A usually healthy two year old, is suffering from vomiting for several days and diarrhea multiple times per day for two days. On her examination, her pulse was 160/min, temperature 37 degrees Celsius, respiratory rate 45/min, and length in the 50th percentile, and she is apathetic, with dry mucous membranes. After administration of a Saline solution through the vein, urine with a specific gravity of 1030 is obtained with a ketone value of 3 + in the laboratory tests: Na+ 131 reference range 135-145. K+ 2.9 reference range 3.4- 4.7. CL 112 reference range 98-106. HCO3 12 reference range 22-26. Urea 50 reference range 10.8 -38.4. Creatinine 0.5 reference range 0.16 - 0.39. Ph 7.26 reference range 7.35 -7.45. What is the most likely diagnosis? 
+A. Metabolic acidosis secondary to bicarbonate loss in diarrhea. 
+B. Metabolic acidosis of tubular origin. 
+C. Ketotic metabolic acidosis due to lack of eating. 
+D. Metabolic acidosis secondary to acid loss in vomiting. 
+
+",A
+"5 days old was examined due to dozens of cases during the day of automatic sucking movements, irregular breathing, and twitching of the eyes, without rhythmic movements of the limbs, which lasted for about a minute. Between the events, the newborn looks healthy. What anamnestic detail would support the diagnosis of fifth day fits. 
+A. Apgar 3 at the age of ten minutes. 
+B. The mother drank alcohol while pregnant. 
+C. A phenomenon similar to his father at this age. 
+D. His brother is being treated with valproic acid. 
+
+",C
+"A 7-year-old who got sick a month ago with Corona (COVID-19) with mild symptoms is hospitalized for fever for the past 5 days, with diarrhea, shortness of breath with light exertion, and cold sweat when eating. On physical examination, a ""strawberry"" tongue and non suppurative conjunctivitis are noted. An echocardiogram shows a slight decrease in heart function. Treatment with IVIG at a dose of 2 grams per kg and an infusion of methylprednisolone at a dose of 2 mg per kg per day was started. Three days after the treatment, there is still no clinical improvement. What is the recommended treatment now? 
+A. Repeat dose of IVIG. 
+B. Aspirin 100 mg/kg/d. 
+C. Anakinra (Kineret). 
+D. High dose vitamin D. 
+
+",C
+"In which situations should the termination of growth hormone treatment be considered? 
+A. When the bone age is 14 years for boys and 13 years for girls. 
+B. In an isolated growth hormone deficiency, the growth rate is lower than 5 cm per year. 
+C. Glucose intolerance, high blood values of hemoglobin A1C, and high blood glucose level. 
+D. When the height of the child measured in the clinic exceeds the height of the father.",C
+"Which of the following is the indication for giving a soy-based baby food solution? 
+A. A month-old with bilateral cataracts, episodes of hypoglycemia, and sepsis with E. coli. 
+B. One-week-old with bloody stools, apathy, and metabolic acidosis feeds on milk formula. 
+C. A baby who underwent heart surgery and developed a chylothorax on the right. 
+D. 6 months old, has been hospitalized for three days due to gastroenteritis. 
+
+",A
+"A 14-year-old known to suffer from anorexia nervosa (restrictive) is brought to the ER. Her condition worsened. Which of the following findings is the most disturbing? 
+A. Significant changes in heart rate with changes in position. 
+B. Two vomits a day. 
+C. Secondary amenorrhea for about two months. 
+D. She Continues reducing the food she consumes during the day. 
+
+",A
+"A 4 year old drowned in a public pool. The boy was taken out of the water without breathing but returned to breathing on his own after a minute of CPR. When he arrived at the emergency room, he was fully conscious, with a pulse of 110 beats per minute, blood pressure of 90/60 mm Hg, and saturation on room air at 99%. Physical and neurological examinations were normal. What is the next step in case management? 
+A. Discharge after 8 hours of monitoring and normal physical examination. 
+B. Hospitalization in the children's ward with mask oxygen treatment. 
+C. Chest X-ray after 4 hours of drowning and treat accordingly. 
+D. Upon his arrival, complete a chest x-ray and blood gas test; if they are normal, he can be released. 
+
+",A
+"A baby who was born at 41 weeks and needed aspiration of a lot of meconium from the respiratory tract at birth Develops hypoxemia at the age of 12 hours that does not respond to oxygen. After intubation and starting ventilation, there is still hypoxemia and hypercarbia. What is the next step in case management? 
+A. Adding Nitric Oxide to the gas mixture. 
+B. Intratracheal surfactant. 
+C. Connection to ECMO. 
+D. High-frequency ventilation. 
+
+","A,B,C"
+"An 11 month old is hospitalized due to pneumococcal meningitis. The medical background includes several ear infections and hospitalization at the age of 9 months for myositis due to an enterovirus. The baby is developing well, is vaccinated according to age, and has a normal family history. His physical examination is normal. Which of the following would help in the probable diagnosis? 
+A. Performing a blood count to make sure there is no eosinophilia. 
+B. Performing a DHR test on the question of Chronic Granulomatous Disease. 
+C. Performing a flow cytometry test to check the percentage of B cells. 
+D. There is no reason to perform further tests. 
+
+",C
+"A 13 years old, has been suffering for two months from 2-3 episodes of bloody diarrhea per day, weakness, and poor appetite, with no significant weight loss. On examination: thin, slight tenderness in the lower left quadrant of the abdomen. No mass was felt. The anus looks normal. In blood tests,  microcytic anemia is noted, inflammation markers - normal. General chemistry in the blood is within the normal range. Stool cultures for bacteria and parasites: negative. Abdominal ultrasound examination demonstrates thickening of the wall of the left colon. In colonoscopy: signs of inflammation in the left ascending colon throughout its length. In a biopsy from the large intestine: signs of active chronic inflammation without granulomas. What is the appropriate treatment for the probable disease? 
+A. Oral treatment with 5ASA (Mesalamine). 
+B. Intravenous administration of methylprednisolone (Solumedrol). 
+C. Initial treatment with diet only with a special formula such as Modulan. 
+D. Intravenous treatment with infliximab (Remicade). 
+
+",A
+"A child suffering from chronic lung disease is treated with inhalers of bronchodilators and steroids, oral pancreatic enzymes, and respiratory physiotherapy regularly. Recently, there has been a worsening of his condition, manifested by an increasing cough and difficulty in physical activity. In the laboratory tests: the level of eosinophils in the blood: 1500/mm (normal < 700), and the serum IgE level of IU/ml 2500 (normal range up to 100). There is no worsening in the chest x-ray compared to previous chest x-rays. What is the recommended treatment? 
+A. Increasing the dose of oral enzymes and repeating the blood count after about a month. 
+B. Intravenous antibiotics are effective against Pseudomonas-. 
+C. Increasing the frequency of respiratory physiotherapy and inhalations with steroids. 
+D. Systemic administration of steroids together with antifungal and anti-IGE treatment. 
+
+",D
+"A 9 year old has had a fever of 39C, weakness, and fatigue for 10 days. He was examined last week by a doctor in the community due to a fever of 38-38.5C and muscle and joint pain. He was diagnosed with a flu-like illness. In the medical background, the child is under medical follow-up by a cardiologist due to a murmur and ""a problem with one of the valves"". On examination: fever of 39.6C, Pulse of 145 beats per minute, respirations 38 per minute, blood pressure 102/56 mm Hg, and 98% saturation on room air. The child looks tired. On auscultation: systolic murmur on the upper right side of the sternum. What is the most common cause of the probable disease in children? 
+A. Coxiella burnetii. 
+B. Viridans group streptococci. 
+C. Streptococcus pyogenes (group A strep). 
+D. Staphylococcus epidermidis. 
+
+",B
+"A one-year-old girl came for medical checkups due to paleness. Her lab results are HB 9.7 g/dl, reference range 10.5- 14. MCV 58 fL reference range: 70 -85. RDW 12.5% reference range 12- 15. RBC 5.8 MIL/ml3 reference range: 4- 5.2. Treatment with oral iron was started. In a blood count after two months, the hemoglobin is unchanged. What is the most likely reason for the lack of response to treatment? 
+A. Giving iron with food. 
+B. Poor response to treatment. 
+C. Incorrect diagnosis. 
+D. Presence of celiac disease. 
+
+",C
+"A 5 week old is referred for medical examination due to lack of weight gain. The pregnancy and delivery were normal. Feeds by breastfeeding 7 times a day. On examination: weight 3.7 kg (at birth 3.3), length in the 25th percentile, head circumference in the 50th percentile, poor skin turgor, sunken fontanelles, normal male genitalia and testicles in the sac. In the laboratory:
+Serum na 129 meq/L reference range 132-140.
+Serum K 6 meq/L reference range 4.1- 5.3.
+Serum CL 109 meq/L reference range 98- 106.
+Plasma HCO3 15 meq/L reference range 22-26.
+Serum 17 (OH) progesterone normal.
+Serum aldosterone 2000 reference range: elevated.
+Plasma renin 250 reference range elevated.
+Urinary  Na/k ratio <1.
+Urinary  CA/ creatinine 0.2 mg/ mg reference range : normal.
+What is the most likely diagnosis?
+A. Distal renal tubular acidosis.
+B. Aldosterone synthase deficiency.
+C. Salt losing congenital adrenal hyperplasia.
+D. Pseudohypoaldosteronism.
+",D
+"A 12-year-old girl is being examined for high fever, headaches, multiple episodes of diarrhea, considerable restlessness and sleep disturbances for about a week: heart rate 159 per minute, blood pressure 140/90 mmHg, the skin is moist and there is a noticeable eye bulge. What might additionally be found during her probable illness?
+A. Atopic dermatitis.
+B. Leukemia.
+C. Hemolytic anemia.
+D. Vitiligo.
+",D
+"A two year old splashed washing liquid on himself and now his eyes are red and watery.
+What is the recommended treatment at this stage?
+A. Bring him to the nearest emergency room for treatment.
+B. Washing the eyes with milk and an urgent PH test of the liquid.
+C. Wash the eyes with running water for at least 30 minutes.
+D. Local treatment with drops containing steroids and antihistamines.
+",C
+"In a medical examination, an 11-year-old is suffering from swelling in the knee joints, with signs of arthritis are found in both, as well as sensitivity and limitation of movement in the hip joints. In the laboratory tests: anemia (hemoglobin 9.5 g/dL) and increased inflammation indices (CRP 5.5 mg/dL). When JIA was suspected, treatment with the anti-TNF drug Etanercept was started. After about two months, the boy was again referred for examination due to abdominal pain for two weeks and the appearance of red nodules, sensitive to the touch, on his calves. What test could be aimed at diagnosing the child's most likely disease?
+A. Genetic testing in the question of FMF.
+B. Genetic testing for the presence of the HLA-B51 allele.
+C. Testing the level of ANA in the blood.
+D. Calprotectin test in stool.
+",D
+"What is true in the recommendations for diagnosing and geneticizing familial Mediterranean fever (FMF)? In children? 
+A. A negative genetic test means that the child does not have FMF. 
+B. Patients with a homozygous M694V mutation are at increased risk of developing more severe disease. 
+C. There is no need to treat heterozygous patients (such as those in whom one mutation was found). 
+D. Treatment for M694V heterozygous mutation should be initiated in asymptomatic subjects. 
+
+",B
+"A one year old girl has fever as high as 39 degrees for 3 days. After the fever subsides, a pink rash appears on the torso, it does not itch and disappears when pressed. What would be true about possible complications of her probable illness?
+A. Convulsions are the most common complication and appear in about a third of cases.
+B. In infection involving the CNS, a high incidence of long-term developmental disorders.
+C. Myocarditis is the most common complication in bone marrow transplants.
+D. Sensorineural deafness may develop during reactivation.
+",A
+"A 5-year-old suffers from nocturnal bedwetting without daytime bedwetting. The child slept a whole night without the need to get up to drink, his motor and cognitive development is normal, and bowel movements are normal. There are no abnormal findings on physical examination. In a urinalysis, the specific gravity is 1015, with no nitrites, blood, protein, or white cells. What is the recommended approach in this case? 
+A. Kidney and bladder ultrasound. 
+B. Fasting sugar test. 
+C. Urine examination under a microscope. 
+D. Relaxation and Continue to follow up. 
+
+",D
+"A 10 year old, has been suffering for the last six months from fears related to leaving his room, and he avoids social gatherings. In addition, there is an excessive preoccupation with disturbing thoughts. SSRI treatment was started. About three weeks later, he was brought to the clinic due to marked impulsivity and restlessness. What is the recommended treatment? 
+A. Adding another antidepressant drug. 
+B. Reducing the dose of the current drug. 
+C. Starting antipsychotic medication. 
+D. Initiate behavioral therapy. 
+
+",B
+"A two-year-old boy was found in his grandmother's house, and many medications were scattered around him. When he arrived at the emergency room, he was sleepy; his pulse was 60 beats per minute, his blood pressure was 65/45 mm Hg, and his glucose was 50 mg/dl in the glucometer test. An infusion was set up with glucose, the drugs the grandmother is being treated with include propranolol, amlodipine, clonidine, and metformin. What is the recommended treatment for his most probable disease? 
+A. Intravenous glucagon. 
+B. Intravenous Atropine. 
+C. Subcutaneous Octreotide. 
+D. Intravenous calcium gluconate. 
+
+",A
+"A two-month-old boy was examined due to apathy and difficulty eating. He was born at term weighing 3 kg. On examination: Weight 5 kg, tachycardia, a slight tremor of the limbs, liver amplitude is normal. In the laboratory: glucose level In the blood - 35 mg/dL, blood lactate level is normal, and no ketones in the urine test. What is the probable diagnosis? 
+A. Hepatic glycogen storage disease. 
+B. Hyperinsulinemia. 
+C. Adrenal insufficiency. 
+D. Urea cycle disorder. 
+
+",B
+"A month-and-a-half-old girl has been suffering from a bothersome cough for a week, accompanied by edema of the face and occasional vomiting without fever. At home she has a 7-year-old sister who has also been coughing for a long time. In her examination: she is alert, the pulse is 170 bpm, and auscultation to the lungs is normal. On the blood count there is lymphocytosis. What is true about the treatment required for her probable illness? 
+A. Azithromycin is the drug of choice for all ages for both treatment and prevention. 
+B. Vaccinated people who were exposed to the baby do not need prophylactic treatment. 
+C. The disease requires airborne isolation until the end of 5 days of treatment. 
+D. The main treatment is to shorten the disease duration and not prevent the spread. 
+
+",A
+"A 10-year-old was examined due to episodes of exertional syncope. His maternal grandfather died of cardiac arrest at the age of 40 years. on the ECG: the heart rate is 70 per minute, the QTc segment is 0.47 seconds, the PR segment is 0.16, and a QRS width of 0.1 milliseconds. What is the recommended treatment? 
+A. Calcium channel blockers. 
+B. Avoiding physical exertion. 
+C. Beta-blockers. 
+D. Implantation of a defibrillator (ICD). 
+
+",C
+"A 6-month-old was examined due to failure to thrive (FTT). There was only partial follow-up during pregnancy, and he was born without special events. In his background, he had an unknown fever related to “ears” and “teeth.” During his examination, weight is in the 5th percentile, height is below the 5th percentile, and a lump was palpable in the lower abdomen. During the test, a weak stream of urine was observed. In the Blood laboratory tests: Creatinine - 2.1 mg/dl, normal values 0.16 – 0.39. Urea - 12 g/dl, normal values 9.5 – 13. Plt - 250,000/uL, normal values - 150,000 – 450,000. In the urine laboratory tests: Protein +. WBC +. A thin catheter was inserted into the urinary bladder, and a cystography was performed which demonstrated grade 4 bilateral reflux, a urinary bladder with uneven walls, and the urethra not demonstrated. What is the recommended treatment? 
+A. Giving a bolus of saline 20 ml/kg. 
+B. Leaving the catheter in for several days. 
+C. Surgical repair of reflux. 
+D. Start preventive antibiotic treatment. 
+
+",B
+"Two weeks old, delivered  via cesarean section at term, weighing 4380 grams, is referred to the ER due to Involuntary hand movements.
+Which serum test will help with the diagnosis?
+A. Sodium.
+B. Potassium.
+C. Bicarbonate.
+D. Calcium.
+",D
+"A 9-month-old boy has been suffering from recurring episodes of high fever accompanied by diarrhea in recent months which last 3-7 days.
+The parents are healthy and of Dutch origin. A widespread macular rash is found on physical examination. Cervical lymphadenopathy is noted, and on examination of the pharynx - aphthae on the tongue. Which test will help establish the probable diagnosis?
+A. For common mutations in the MEFV gene that encodes the pyrin protein.
+B. HLA-B27 test.
+C. Increased level of MEVALONATE in the urine that increased during an attack.
+D. Test for the Cryopyrin protein level in the blood.
+",C
+"According to the clinical guidelines, Which of the following is recommended to be referred for a developmental assessment at the Child Development Institute? 
+A. 5 years old, who has difficulty cutting and holding a pencil. 
+B. 6 years old, who in the past suffered from bacterial meningitis. 
+C. 7 years old, now diagnosed with learning disabilities. 
+D. 5 years old, suffering from encopresis and anxiety disorder. 
+
+",B
+"A two-year-old was tested for suspected autism (ASD).
+All of the following tests are essential in clarifying this problem except:
+A. Hearing test.
+B. Examining the skin with a Wood's lamp.
+C. Echocardiography test.
+D. Head circumference measurement.
+",C
+"According to the clinical guidelines:
+In which cases of type 2 diabetes should insulin treatment be started?
+A. Glycated hemoglobin level (A1C of 9.3%).
+B. Headaches and a serum glucose level of 250 mg/dL.
+C. Family history of microvascular complications.
+D. BMI percentile above 99 for age and sex.
+",A
+"A 13 years old has been suffering for about a year from difficulty concentrating, low mood, difficulty sleeping at night, a lack of desire to do anything, and lack of appetite.
+What is the most recommended treatment?
+A. Parenting interventions.
+B. Interpersonal Psychotherapy.
+C. Stimulant Medication.
+D. Lithium therapy.
+",B
+"A 16-year-old, with many behavioral disorders in the past, was found unconscious in the street in the morning, and next to him was an empty alcoholic beverage bottle. On arrival at the ER: he has fluctuating levels of consciousness When he wakes up, he reports that he does not see. Breathing: 30 per minute, heart rate 75 beats per minute, blood pressure 90/60, deep breathing; in the fundus examination: edema and congestion of the optic disc. Blood alcohol level at the upper limit of the norm. Additional blood tests are described: Glucose - 70 mg/dL, normal levels 60-100. Na - 139 meq/L, normal levels 135-145. K - 139 meq/L, normal levels 135-145. Cl - 100 meq/L, normal levels 98-106. HCO3 - 8 meq/L, normal levels 21-24. PH - 7.25, normal levels 7.35-7.45. What is the recommended treatment? 
+A. Gastric lavage and activated charcoal. 
+B. Peritoneal dialysis. 
+C. Supervision in intensive care until ethanol levels decrease. 
+D. Fomepizole. 
+
+",D
+"A one week-old boy, is suffering from vomiting and apathy. On examination he is weak and sleepy. The laboratory values are attached:
+Ammonia - 300 mcg/dL, normal values 20-80.
+PH - 7.1, normal values 7.35-7.45.
+Sodium (Na) - 140 mMol/L, normal values 135-145.
+Chloride (Cl) - 100 mMol/L, normal values 97-110.
+Bicarbonate - 10 mMol/L, normal values 18-24.
+What is the most likely diagnosis?
+A. Organic acidity.
+B. Disorder in the urea cycle.
+C. Galactosemia.
+D. Glycogen storage disease.
+",A
+"A two-day-old baby was diagnosed with polyhydramnios during pregnancy is now being evaluated because of watery stools, sleepiness, and poor appetite. On physical examination - prolonged capillary filling, dryness of the mucous membranes, and sunken Fontanelle. During pregnancy polyhydramnios was diagnosed. In laboratory tests: glucose: 72 mg/dL,.
+PH 7.48, HCO3 30 meq/L (high), Na 130 meq/L (low), K 3.1 meq/L (low), Cl.
+87 meq/L (low).
+What is the most likely diagnosis?
+A. CONGENITAL CHLORIDE DIARRHEA.
+B. CONGENITAL SODIUM DIARRHEA.
+C. GLUCOSE-GALACTOSE MALABSORPTION .
+D. CONGENITAL LACTASE DEFICIENCY.
+",A
+"A 3-month-old baby with slight difficulty in eating and slow weight gain exerts himself while eating and is sweating, and panting. On examination: 50 breaths per minute; on auscultation: good air intake to the lungs, without crepitations, irregular heart sounds with a continuous coarse murmur in the left upper chest that radiates to the back, appropriate pulses, liver palpable about 2-3 cm under the arch of the ribs. The most likely diagnosis: 
+A. Large VSD. 
+B. A large ASD. 
+C. Large PDA. 
+D. Peripheral stenosis of the pulmonary valve PS. 
+
+",C
+"A 4-year-old suffers from abdominal pain and a CT scan of the abdomen reveals a solid finding with a diameter of 12x10 cm.
+In laboratory tests:
+HB 12 g/dL, normal values - 11.5-14.5.
+WBC 7 (units are - 10 in the power of 3 and ml in the power of 3), normal values - 5-15.
+PLT 160 (units are - 10 in the power of 3 and ml in the power of 3), normal values 150-140.
+Uric Acid 9 mg/dL, normal values - 2.2-5.5.
+Creatinine 1.2 mg/dL, normal values  - 0.3-0.7.
+LDH 4000 U/L, normal values  - <615.
+What electrolyte disturbance is typical in his condition?
+A. Hypernatremia.
+B. Hyperphosphatemia.
+C. Hypercalcemia.
+D. Hypokalemia.
+",B
+"A one-month-old infant has been hospitalized due to soft stools for the past three days and repeated vomiting since the day he was admitted. At home, he was treated in, addition to breastfeeding, with an oral rehydration solution of table salt and water prepared by the mother. In the Blood laboratory tests: Na 165 mEq/L, normal range - 132 142. K 4 mEq/L, normal range - 4.1 5.3. Urea 30 Urea mg/dl, normal range 8.4 25.8. Osmolarity 335. In the Urine laboratory tests: Na 170 mEq/L. Osmolarity 425. The US of the Kidneys was normal. What is the likely cause of electrolyte disturbance in this baby? 
+A. Dehydration. 
+B. Mutation in the ADH receptor. 
+C. A disturbance in the thirst center. 
+D. Salt poisoning. 
+
+
+",D
+"A 9 month old is examined in the ER due to a Tonic-clonic convulsion in 4 limbs that lasted 10 minutes and stopped spontaneously an hour before his arrival. It should be noted that the child was vaccinated until the age of two months only. When he arrived at the emergency room, a temperature of 40 degrees Celsius was measured. Which of the details in this baby's anamnesis would justify performing a lumbar puncture? 
+A. The age of the baby. 
+B. The height of the fever. 
+C. The duration of the convulsion. 
+D. The immune status.
+
+",D
+"A 12-year-old has been suffering for about two years from repeated episodes of painful aphthous ulcers in the oral cavity. In the last year, there were also several incidents of ulcers in the scrotal area and an erythematous Swollen rash on the calves that lasted for several continuous days. In the last month, he was diagnosed as suffering from anterior uveitis.
+What is the most dangerous complication of the most likely diagnosis?
+A. Joint deformations.
+B. Hypercoagulability.
+C. Nephrotic syndrome.
+D. Pericarditis.
+",B
+"According to the vaccination guidelines: The mother of a 13-year-old boy consults with you about giving a vaccine against Corona. Which of the following sentences is correct? 
+A. An interval of two weeks between the administration of the flu vaccine and the administration of the corona vaccine must be taken. 
+B. Do not give the vaccine if anaphylaxis has been described in the past to Glycol Ethylene Poly (PEG). 
+C. If the child has previously had myocarditis, it is recommended to vaccinate with the mRNA vaccine. 
+D. It is possible to vaccinate as usual even in fever conditions above 38. 
+
+",B
+"A 6.5 year old girl is generally healthy, and has had normal development. As part of an investigation for abdominal pain, the Abdominal US was performed, and multiple ovarian cysts were demonstrated - with a maximum diameter of 1 cm. Which of the following statements correctly describes the finding? 
+A. Clinically insignificant finding. 
+B. High risk of developing an ovarian torsion. C. Endogenous/exogenous estrogen exposure. 
+D. A suspicious finding for a malignant process. 
+
+",A
+"An 11 month old, refuses to crawl for two days. The parents deny fever/known injury/exposure to ill patients/exposure to unpasteurized dairy products. On her examination: vital signs are normal, and she is not carrying Weight on the right leg, sensitivity was noted when palpating the fibula bone on the right. What is true about the diagnosis?
+A. Growth of the disease generator is expected in about 60% of the blood cultures.
+B. X-ray is the test of choice in the early stages of the disease.
+C. MRI has a higher sensitivity than CT.
+D. The level of CRP is a sensitive index for diagnosis and is in direct correlation with joint damage.
+",C
+"According to the vaccination guidelines, which of the following constitutes a contraindication to administering the vaccine in first grade? 
+A. Body temperature above 38.0 C. 
+B. Treatment with steroid inhalers. 
+C. A state of cerebral palsy. 
+D. father with epilepsy. 
+
+",A
+"A 3-and-a-half-year-old was sent to child development evaluation due to suspected developmental delay. The doctor notes in his examination the enlargement of the liver and spleen. In the developmental examination, the child has difficulty walking, is unable to run, his vocabulary is poor (50 words), does not compose sentences, has difficulty Copying a circle and a cross, builds a tower from 3 cubes, and has difficulty cutting paper. Which of the following additional findings can be found in the child? 
+A. Enlargement of testicles and protruding ears. 
+B. Marked obesity and hypogonadism. 
+C. Coarse facial features and excess hair. 
+D. Bluish discoloration in the white of the eye. 
+
+",C
+"A 14-year-old is hospitalized due to anorexia nervosa, and in her examination, a BMI of -14 is noted. A nasogastric tube was inserted, and nutrition support was given. On her examination after about 24 hours, she looked pale and weak, accelerated heart rate (tachycardia) was measured, and she had dyspnea. What can explain her condition? 
+A. Aspiration. 
+B. Hypokalemia. 
+C. Bacterial infection. 
+D. Suicidal attempt. 
+
+",B
+"A two and a half-year old arrived at the ER after he was hit in the head by the edge of a table in his home. After crying for a short time, he briefly turned pale and lost consciousness for a few seconds without convulsive movements. After about half a minute, he fully recovered. The vital signs and physical examination were normal in his examination, with No evidence of scalp hematoma. What is the recommended approach? 
+A. Hospitalization for a neurologist examination and completion of an EEG. 
+B. Short observation in the emergency room followed by calming the parents and release. 
+C. Completion of ECG and hospitalization for echocardiography. 
+D. Completing a computed tomography (CT) of the head. 
+
+",B
+"A 3-year-old boy has suffered since infancy from recurrent infections in the nevus and skin and episodes of hypoglycemia with Ketones in the urine. In his examination, he had an enlarged liver and a round face. In the laboratory: neutrophils 400\ microliter (low) and high uric acid level. What else is expected to develop in his probable illness? 
+A. Hypothyroidism. 
+B. Inflammatory bowel disease. 
+C. Hypertrophic cardiomyopathy. 
+D. Peripheral neuropathy. 
+
+",B
+"A 10-year-old was examined for weight loss and upper abdominal pain, melena, and  diarrhea for two months. In a gastroscopy, multiple ulcers were observed in the esophagus and stomach. The fasting serum gastrin level test was high. Which of the following could be the likely diagnosis? 
+A. Ulcerative Colitis-UC. 
+B. Multiple Endocrine neoplasia 1- MEN1. 
+C. Short Bowel Syndrome-SBS. 
+D. EE-Eosinophilic Esophagitis. 
+
+",B
+"A 4-year-old has been suffering for a long time from a chronic cough and large, smelly stools. Under Physical examination, clubbing of the fingertips was found. Which test will help diagnose her disease? 
+A. Elastase level in urine. 
+B. The level of NO in exhaled air. 
+C. Esophageal radiograph after barium ingestion. 
+D. Testing the nasal potential difference. 
+
+",D
+"13 years old, suffers from being overweight and Polydipsia. Blood glucose test 96 mg/dL while fasting and 137 mg/dL two hours after glucose loading.
+What is the recommended approach in this situation?
+A. Start insulin treatment.
+B. Repeat the test in 3 months.
+C. Start medical treatment.
+D. Change lifestyle.
+",D
+"A 5-year-old boy was examined for fever and sore throat for 3 days, and his examination revealed pharyngeal erythema. A throat culture was taken, and treatment with antipyretic drugs was started. The fever returned to normal after a day, and after 3 additional days, the growth of GAS (streptococcus bacillus A) in the pharyngeal culture was detected. What is the recommended approach according to the clinical guidelines? 
+A. Take a repeated pharyngeal culture and treat if it is positive. 
+B. Give a treatment with Ceforal for 5 days. 
+C. Give a treatment with amoxicillin for 10 days. 
+D. Clinical follow-up at the clinic and treatment with amoxicillin if the fever persists. 
+
+",C
+"A 15 year old was exposed to her grandmother who has pulmonary tuberculosis.
+What is true about the PPD test that the girl should do?
+A. The test includes an intramuscular protein injection and measuring the redness around the injection after 48 hours.
+B. A false negative test is possible in malnutrition, viral infection, and attenuated live vaccine.
+C. BCG vaccination in the past can cause a false negative Mento test.
+D. The test must be performed within 48 hours of exposure to the TB.
+",B
+"A two-month-old girl, after a normal pregnancy and birth, is exclusively breastfed and is gaining weight well.
+She suffers from recurring episodes of restlessness and crying that last at least 3 hours a day, for about three days A week. She was examined several times by a pediatrician with no pathological findings both in a physical examination and in developmental assessment.
+What is true regarding the probable diagnosis of the baby?
+A. Usually starts in the first week of life.
+B. Lasts until the age of eight months.
+C. Same incidence in breastfeeding and Infant formula.
+D. More common in first-born male babies.
+",C
+"According to the clinical guidelines:
+In which of the following situations is it recommended to measure blood pressure before the age of 3?
+A. In a child with chronic liver disease.
+B. In a child with failure to thrive (FTT).
+C. In a child with a family history of neurofibromatosis.
+D. In a child with a history of prematurity.
+",D
+"A 15-year-old boy who was in a car accident injured his back and lower limbs later suffered from sleep disorders, pain of a burning nature, and hyperesthesia in the left leg in a distribution corresponding to the nerves found In lumbar vertebrae 4 - 5 L. Treatment with acetaminophen and ibuprofen did not bring a noticeable improvement. What is the recommended treatment now? 
+A. Oxycodone (Oxycontin). 
+B. Valproic acid (Depalept). 
+C. Cannabinoids. 
+D. Amitriptyline. 
+
+",D
+"What is a contraindication to breastfeeding a newborn?
+A. Unbalanced maternal diabetes.
+B. Hepatitis C of the mother.
+C. Untreated tuberculosis of the mother.
+D. Galactosemia of the mother.
+",C
+"A one-year-old suffers from an allergy to eggs, which manifested itself as an anaphylactic reaction with shortness of breath and a generalized rash at age 9 months after exposure to an omelet.
+Where should the MMRV vaccine be given to the baby, and should we give him the vaccine?
+A. It is highly desirable to avoid giving the vaccine now.
+B. The vaccine can be given without special instructions.
+C. Give the vaccine in the presence of a doctor and under supervision.
+D. The vaccine can be given in an allergy clinic.
+","B,C,D"
+"A 5-year-old resident of an agricultural farm goes to the doctor because of a fever for a week, stomach aches, and pains in his joints. On examination, he is pale, has an enlarged liver and spleen, and swelling in the right knee was noted with limitation in range of motion. What is true about the presumptive diagnosis? 
+A. The test of choice for diagnosis is a serological test. 
+B. A bone marrow examination must progress the diagnosis. 
+C. The blood culture is positive in most cases. 
+D. Meningitis is a common complication of the disease. 
+
+",A
+"A three-year-old has been hospitalized due to a high fever, occuring only in the evening, for about two weeks, combined with a gentle rash on the chest. On physical examination, an enlarged spleen was palpable. During the hospitalization, Swelling in the knee joints appeared, and a chest X-ray showed pleural fluid. In the laboratory tests: 22000 White blood cells/ millimeter cube in the blood count and a serum CRP level of 17 mg/dL (normal < 0.5), Blood sedimentation 100 mm in the first hour. Which of the following would raise suspicion of a life-threatening complication of her likely illness? 
+A. Hypernatremia. 
+B. Decrease in blood sedimentation. 
+C. Increased protein level in the urine. 
+D. Thrombocytosis. 
+
+",B
+"A 7 years old suffers from pain in the upper chest area, heartburn that does not respond to treatment with antacid, and difficulty swallowing solid food.
+What is the recommended initial treatment for the most likely diagnosis?
+A. Low fiber diet.
+B. Oral prednisone treatment.
+C. Flagyl (metronidazole) oral.
+D. Elimination of suspect foods.
+",D
+"A 9 year old suffers from frontal headaches for 8 months, accompanied by nausea without vomiting,.
+The pain has a pulsating nature and an intensity of 9/10, does not respond to painkillers, and does not wake the patient from sleep but is exacerbated when exposed to light.
+There is no family history of headaches.
+What is considered an indication for performing an imaging test on the child?
+A. The absence of a family history of migraine.
+B. Headache for more than 6 months.
+C. Age younger than 10 years.
+D. Lack of benefit with analgesic treatment.
+",A
+"A 4 years old i  bleeding from the chin a day after falling while playing in the garden. The bleeding did not stop under direct pressure and required for suturing in an operating room. In the anamnesis, the umbilical stump fell out at the age of two months. She suffered from recurrent hematomas after minor injuries. The parents are of Bedouin-Arab descent, and are cousins from the second degree. The blood count at the age of 10 months was normal. In tests now - hemoglobin: 7.2. Gram/dl, the level of platelets in the blood is normal and the coagulation functions are normal. What is a possible cause of the girl's illness? 
+A. Von Willebrand disease type I. 
+B. Missing factor. 13. 
+C. Carriers for hemophilia A. 
+D. Missing factor .11. 
+
+",B
+"A 9-year-old is being examined due to the development of vaginal hair for a year. In her examination, height and weight are in the 90th percentile. Curled hair is present between the labia and the axilla. In the X-RAY of the palm, the age of the bones is 11 years. In the lab. Serum testosterone level is normal, 17-hydroxyprogesterone (P-OH17) level in blood is 3 times the norm and LH and FSH levels below the measurement threshold. What is the most likely diagnosis? 
+A. Brain tumor that caused all the symptoms. 
+B. The maturation process is normal for her age. 
+C. The non-classical hyperplasia of the adrenals. 
+D. Adrenal tumor that caused all the symptoms. 
+
+",C
+"An 8-year-old, healthy, was awakened from sleep with a third event within a month that involved Chewing movements and later jumping of the right hand that lasted three minutes and passed spontaneously. At the time of the event, he was Conscious with open eyes and unable to speak. The physical examination is now normal. on the EEG: left centrotemporal epileptic activity. Brain MRI is normal. What is the recommended approach? 
+A. Carbamazepine (Tegretol). 
+B. Lamotrigine (Lamictal). 
+C. Phenobarbital (Luminal). 
+D. Follow up only. 
+
+",A
+"A mother to a girl suffering from a peanut allergy is now 12 weeks pregnant. How it is possible to prevent allergy in the child that will be born?
+A. Avoid eating peanuts during pregnancy.
+B. Expose to peanuts only after one year of age.
+C. The mother should avoid peanuts in the diet for those who are exclusively breastfed until the age of 4 months.
+D. Expose to peanuts after the start of exposure to solid foods, around the age of 4-6 months.
+",D
+"A generally healthy 12 year old is suffering from sore throat and fever for 5 days, with general weakness, and fatigue. On examination, enlarged tonsils with white surfaces on their surface, cervical lymph nodes are enlarged on both sides and the edge of the spleen is palpable 2 cm below the rib cage. The Rapid strep test in the clinic is negative.
+What is true about his illness?
+A. Rupture of the spleen is a common and potentially life-threatening complication.
+B. Thrombocytopenia is mild in more than 50% of cases.
+C. High ferritin and SOLUBLE-IL-2 levels are expected in most children.
+D. Prophylactic intubation is required due to possible secondary obstruction of the airways.
+",B
+"A 7 years old has suffered from edema, foamy urine, but no blood. On examination, her blood pressure is normal, and on lab tests, the kidney functions are normal. Systemic prednisone treatment was started for 8 weeks up to now. In repeated blood tests: hypoalbuminemia, hyperlipidemia, creatinine to albumin ratio in urine is 3.5 mg/mg (normal < 0.2). What is the next step in case management? 
+A. A biopsy of the kidney. 
+B. Another course of steroids. 
+C. Adding Rituximab treatment. 
+D. Mapping of the kidneys with DMSA. 
+
+",A
+"A 6-year-old has been examined for weakness and pain in the upper right abdomen for the past year. In the family, the father underwent a splenectomy at the age of 10, he does not know why. On examination: paleness, slight jaundice in the conjunctiva, and the edge of the spleen is palpable. In the laboratory: hemoglobin 7.5 mg per deciliter (normal 11.5 - 13.5). Indexes are normal. Liver enzymes are normal. What is the test that will help identify the diagnosis: 
+A. Level of pancreatic enzymes in the blood. 
+B. Serology for EBV. 
+C. Peripheral blood culture. 
+D. Hemoglobin electrophoresis. 
+
+",C
+"A 15-year-old woman is referred to the emergency department due to a fever of up to 39 degrees Celsius, vomiting, and diarrhea from the day of her admission. On examination, moderate general condition, with a blood pressure of 80/50, 150 beat per minute, and a widespread erythematous rash with redness in the throat and strawberry tongue. In laboratory tests: WBC: 15 K/uL, normal values 4.5-11. NEUT: 70%, normal values 44-62%. PLT: 90 K/micrL, normal values 150-450. CRE: 1.1 mg\dl, normal values 0.5-0.95. UREA: 60 mg\dl, normal values 17-43. What is true about the course and diagnosis of the presumed disease: 
+A. Bacteremia and secondary seeding of the bacteria in the various organs. 
+B. A definitive diagnosis is based on identifying the bacteria in a pharyngeal culture. 
+C. A toxin secreted by the bacteria causes the disease. 
+D. The disease has mortality exceeding 20% despite appropriate treatment. 
+
+",C
+"A 7-year-old girl has been suffering from frequent soft stools and swollen eyelids on both sides for a week. In initial tests, the albumin level in the blood – was 2.5 grams per deciliter (normal values: 3.6 to 5.2 grams per deciliter), and the urinalysis was normal. What laboratory test result is expected to be found in addition? 
+A. High level of elastase in the blood. 
+B. High amylase level in the blood. 
+C. A high level of alpha-1-antitrypsin in the blood. 
+D. Low level of lymphocytes in peripheral blood. 
+
+",D
+"A 3 year old, who is healthy and vaccinated has had watery diarrhea up to 5 times a day, without vomiting or fever for 3 days. In a stool culture taken, the growth of campylobacter jejuni was detected. What is true about the treatment of this bacteria? 
+A. It is necessary to give antibiotic treatment to all children with a positive stool culture for bacteria. 
+B. Antibiotic treatment given at the beginning of the disease can shorten the duration of the disease. 
+C. The treatment of choice for this bacteria is ciprofloxacin. 
+D. In case of bacteremia from this bacteria, treatment with ceftriaxone should be given. 
+
+",B

psychiatry.csv

@@ -0,0 +1,905 @@
+question,answer
+"What is the equivalent dose of Risperidone, beyond which (higher than) no antipsychotic benefit was observed, and side effects were evident, according to the review article:
+Examination of Dosing of Antipsychotic Drugs for Relapse Prevention in Patients with Stable Schizophrenia - A Meta-analysis JAMA Psychiatry 2021.
+A. 2 mg.
+B. 3 mg.
+C. 4 mg.
+D. 5 mg.
+",D
+"Which of the antihistamines is used as a treatment for delayed orgasm resulting from treatment with SSRI's?
+A. Promethazine.
+B. Cyproheptadine.
+C. Fexofenadine.
+D. Chlorpheniramine.
+",B
+"What criteria distinguishes ADHD from a manic/hypomanic episode?
+A. Distractedness.
+B. Impulsiveness.
+C. Fluency.
+D. Little need for sleep.
+",D
+"Which of the withdrawal symptoms from cannabis is less common?
+A. Excessive sleepiness.
+B. Anxiety.
+C. Headaches.
+D. Chills.
+",A
+"Which of the following drugs does not act as a Dopamine-agonist?
+A. Bupropion.
+B. Bromocriptine.
+C. Brexpiprazole.
+D. Cariprazine.
+",A
+"A patient suffering from pheochromocytoma comes to a psychiatric consultation. What is the most common mental complaint he will express?
+A. Auditory hallucinations.
+B. Anxiety.
+C. Depression.
+D. Cognitive impairment.
+",B
+"Which test does not have to be conducted before treatment with stimulants in children and youth?
+A. Height.
+B. Weight.
+C. Blood Pressure.
+D. Blood count.
+",D
+"A 35-year-old woman comes to a psychiatric emergency room accompanied by her husband for the first time in her life and claims that a foreign man is impersonating her relatives to hurt her. To the examiner's question: ""Are all the people around impersonating and changing identities""? She answers that no, only that specific person is impersonating people close to her. What syndrome does the patient have?
+A. Fregoli.
+B. Clerambault.
+C. Cotard.
+D. Schneider.
+",A
+"In which of the following personality disorders is Splitting more common?
+A. Compulsive.
+B. Narcissistic.
+C. Avoidant.
+D. Paranoid.
+",B
+"According to Freud's psychosexual theory, the pathology of which stage will manifest itself in constant ambivalence, hesitation and indecision?
+A. Orally.
+B. Anal.
+C. Genital.
+D. Phallic.
+",B
+"Who treated Bertha Pappenheim before Freud?
+A. Joseph Breuer.
+B. Jean-Martin Charcot.
+C. Pierre Janet.
+D. Albert Londe.
+",A
+"In which of the following diagnoses, is a dissociative phenomenon not a criterion in the 5-DSM?
+A. Acute Stress Disorder.
+B. Post-Traumatic Stress Disorder.
+C. Adjustment Disorder.
+D. Panic Disorder.
+",C
+"According to the law for the treatment of the mentally ill (1991), when can the district psychiatrist order involuntary ambulatory outpatient medical treatment?
+A. Only in cases where the conditions for forced hospitalization are met.
+B. Only at the end of a forced hospitalization period.
+C. Only when the patient refuses to be examined by a psychiatrist.
+D. Only after a benefit in his condition, which allows him to be released from forced hospitalization.
+",A
+"All the following procedures require repeated/continuous treatment except:
+A. VNS.
+B. DTMS.
+C. DBS.
+D. Anti Cingulotomy.
+",D
+"What is the main reason for the recommendation not to add SSRI's to Clozapine?
+A. It reduces its blood levels.
+B. Increase the risk of contractions.
+C. Increase risk of agranulocytosis.
+D. Reduce its effectiveness in suicide levels.
+",B
+"A 35 year old  divorced man has been hospitalized five times  for manic states as part of bipolar disorder. He is not compliant with his treatment between his hospitalizations. His parents are concerned about the prognosis. What is the average period of remissions (remissions) between his future hospitalizations?
+A. A month or two.
+B. Six-nine months.
+C. Two to two and a half years.
+D. Four-five years.
+",B
+"Which sign is not typical after taking PCP?
+A. Hypothermia.
+B. Depression.
+C. Paranoia.
+D. Hypertension.
+",A
+"A 30-year-old woman came accompanied by her husband with complaints of weight loss and weakness. A physical examination revealed nothing. With the exception of a difficult feedback conversation at work about two months ago, her husband does not indicate any other triggers. The woman mentions difficulty swallowing and a feeling that something is stuck in her throat, so she does not eat and hardly drinks. What is the most likely diagnosis for her?
+A. Somatic Symptom Disorder.
+B. Illness Anxiety Disorder.
+C. Conversion Disorder.
+D. Adjustment Disorder.
+",C
+"What disorders did Freud describe in Anna's case?
+A. Conversion.
+B. Psychosis.
+C. Obsessive-compulsive disorder.
+D. Autism.
+",A
+"Which symptom overlaps between schizophrenia, bipolar disorder, and major depression, according to the characteristics of the categories of DSM?
+A. Hallucinations.
+B. Insomnia.
+C. Lack of reason.
+D. Irritability.
+",A
+"Which of the following psychosocial factors most increases the risk of suicidal behavior in children and teenagers?
+A. Childhood neglect.
+B. Sexual abuse.
+C. Physical violence.
+D. Social difficulties.
+",B
+"Discontinuing which of the following SSRI's would be less likely to cause withdrawal syndrome?
+A. Fluoxetine.
+B. Paroxetine.
+C. Fluvoxamine.
+D. Sertraline.
+",A
+"Which of the following comorbid disorders is less common in adults with ADHD?
+A. Anxiety Disorder.
+B. Depression.
+C. Delusional Disorder.
+D. Substance use disorder.
+",C
+"What is the best definition of the ""principle of reality"" according to Freud?
+A. Having a normal reality test.
+B. The ability to delay immediate gratification.
+C. The ability to distinguish between good and bad.
+D. Innate tendency to avoid pain.
+",B
+"Which of the following characterizes the aging of the human brain?
+A. 37% decrease in the weight of the brain.
+B. Decreased permeability of the blood-brain barrier.
+C. Increase in blood flow.
+D. Sulci widening.
+",D
+"Martin Seligman's research led to progress in understanding which of the following disorders?
+A. Depression.
+B. PTSD.
+C. OCD.
+D. Anxiety.
+",A
+"A20-year-old was referred for consultation by a plastic surgeon after undergoing two nose surgeries but continues to claim that her nose is deformed, even though everyone tells her that the operations were successful. She is completely convinced, her nose crooked and ugly. What drug treatment is recommended as the first line for her?
+A. Aripiprazole.
+B. Escitalopram.
+C. Buspirone.
+D. Phenelzine.
+",B
+"Which of the following drugs was found to be more effective in combination with SSRI's in the JAMA 2022 article Combining Antidepressants vs Antidepressant Monotherapy for Treatment of Patients with Acute Depression - A Systematic Review and Meta-analysis?
+A. Mirtazapine.
+B. Bupropion.
+C. Reboxetine.
+D. Venlafaxine.
+",A
+"The condition of a 50-year-old suffering from major depression is starting to improve. What characterizes the suicidal risk for him at this stage?
+A. Decreases due to the improvement in condition.
+B. Increased due to the return of planning capabilities.
+C. Does not change at this stage and will increase only when building the insight.
+D. Decreases due to the hope, created due to the beginning of the improvement.
+","A,B"
+"Which of the following is not a criterion of narcissistic personality disorder according to 5-DSM?
+A. Expectation of personal treatment.
+B. Lack of empathy.
+C. Affective lability.
+D. Exploitation of others.
+",C
+"A 25-year-old man came to the examination accompanied by a colleague from work. About two weeks he was attacked and robbed on the way home at knifepoint, but without physical harm. He complains of a decrease in concentration and difficulty in performing tasks at work, sudden dissociations, anxiety, and hot flashes with sweat when watching TV programs with violence. At night, he falls asleep after a glass of whiskey but still wakes up tired, jumps at any noise, and does not leave his house in the hours of darkness. What is the most likely diagnosis for him?
+A. Posttraumatic Stress Disorder.
+B. Generalized Anxiety Disorder.
+C. Adjustment Disorder.
+D. Acute Stress Disorder.
+",D
+"A patient complained that her mother is too involved and even intrusive in her life because she is constantly pestering her about every choice she makes. The therapist replied that the mother's excessive involvement can be seen as an expression of love, through which she tries to teach the daughter how to take care of herself in a way that will prepare her for an independent life without her having to experience mistakes similar to those the mother experienced in her life. What technique did the therapist use?
+A. Clarification.
+B. Reframing.
+C. Confrontation.
+D. Paradoxical treatment.
+",B
+"What disorder may be characterized by the astasia-abasia phenomenon?
+A. Normal Pressure Hydrocephalus.
+B. Conversion Disorder.
+C. Dissociative Identity Disorder.
+D. Alcohol Intoxication.
+",B
+"Which of the following is not part of the terms belonging to borderline personality organization according to Otto Kernberg?
+A. Ego weakness.
+B. Non-integrative superego.
+C. Using segmentation and projective identification.
+D. Separation anxiety.
+",D
+"A 28-year-old man is admitted for a manic episode and is being treated with lithium. He develops a coarse tremor. Which of the following drugs is more likely to worsen Lithium-Induced Postural Tremor?
+A. Propranolol.
+B. Caffeine.
+C. Lorazepam.
+D. Clozapine.
+",B
+"Which of the following is the least significant risk factor for the development of depression in the elderly?
+A. Age itself.
+B. Chronic disease.
+C. Widowhood.
+D. Low socioeconomic level.
+",A
+"Which of the following delusional disorders has a worse prognosis?
+A. Somatic.
+B. Erotomania.
+C. Persecutory.
+D. Grandiose.
+",D
+"A 30-year-old woman suffering from type 1 bipolar disorder is frequently admitted to a closed ward. Which characteristics are less critical in becoming a rapid cycler?
+A. Being a woman.
+B. Inheritance of Rapid cycling.
+C. Depressive and hypomanic attacks in her past.
+D. Discontinuation of lithium treatment.
+",B
+"What is characteristic of a convulsion due to alcohol withdrawal?
+A. Does not require CT.
+B. Often evolves into status.
+C. It usually appears in epileptic patients who use alcohol.
+D. Tony Clooney.
+",D
+"What did Freud mean by the term ""narcissism""?
+A. Investing libido in ego.
+B. Self-infatuation.
+C. The pleasure principle.
+D. Emotional cathexis.
+",A
+"Lack of which of the following will cause the triad of Delirium, Dementia, Diarrhea:
+A. Cyanocobalamin.
+B. Niacin.
+C. Thiamin.
+D. Ascorbic acid.
+",B
+"What is the symptom that appears in the vast majority of children with schizophrenia?
+A. Delusions.
+B. Hallucinations.
+C. Flattened or mismatched effect.
+D. Poor content of speech.
+",C
+"What is the most common comorbidity of kleptomania?
+A. Delusional disorder.
+B. Affective disorder.
+C. Post-traumatic disorder.
+D. Dissociative disorder.
+",B
+"Which of the following drug interactions is not typical of valproic acid?
+A. Lowers blood diazepam level.
+B. Increases tremors in combination with lithium.
+C. Increases sedation in combination with antipsychotic drugs.
+D. Lowers the level of phenytoin in the blood.
+",A
+"A 35-year-old man has been suffering from alcohol addiction for 10 years. He recently started expressing suicidal thoughts. What is the most significant factor in terms of suicidal risk in this patient?
+A. Presence of a major depressive state.
+B. Binge drinking.
+C. Antisocial personality disorder.
+D. Family pressure to detox from alcohol.
+",A
+"Which SSRI does not belong to the group of tricyclic antidepressants (TCAs)?
+A. Nortriptyline.
+B. Trazodone.
+C. Doxepin.
+D. Desipramine.
+",B
+"Which term is not included in Narrative psychotherapy?
+A. Fabula.
+B. Metaphor.
+C. Plot.
+D. Character.
+",A
+"What sign does not appear after taking LSD?
+A. Mydriasis.
+B. Aktisia.
+C. Decreased tendon reflexes.
+D. Lack of coordination.
+",C
+"What is the optimal initial treatment for a patient with panic attacks for the first time in his life?
+A. Mirtazapine 7.5 mg + Lorazepam 1 mg.
+B. Escitalopram 2.5 mg + Alprazolam 1 mg.
+C. Paroxetine 20 mg + Quetiapine 25 mg .
+D. Venlafaxine 37.5 mg + Mirtazapine 7.5 mg.
+",B
+"What is the level of disease severity for most patients diagnosed with developmental intellectual disabilities? (Intellectual disability).
+A. Mild.
+B. Moderate.
+C. Severe.
+D. Profound.
+",A
+"In which of the following neurological disorders is accompanying depression more common?
+A. Multiple sclerosis.
+B. Parkinson's disease.
+C. Epilepsy.
+D. Cerebrovascular disease.
+",B
+"Which of the following disorders is less common among patients admitted to a general hospital?
+A. Depression.
+B. Delirium.
+C. Substance use disorder.
+D. Brief psychotic disorder.
+",D
+"Which of the following is more likely than others to develop tardive dyskinesia?
+A. A 70 year old woman treated with Perphenazine.
+B.  A 22-year-old man who develops acute dystonia under Haloperidol.
+C.  A 30 year old woman with schizophrenia and treated with Zuclopenthixol.
+D. A 71 year old man treated with Ziprasidone.
+",A
+"Which of the following drugs acts as an SSRI?
+A. Mirtazapine.
+B. Vortioxetine.
+C. Bupropion.
+D. Reboxetine.
+",B
+"Which of the following signs would not help differentiate an epileptic seizure from a non-epileptic seizure (NES)?
+A. The presence of a gag reflex after the convulsion.
+B. Injury during the convulsion.
+C. Loss of sphincters control during the convulsion.
+D. An increase in the level of acetylcholine in the blood after the seizure.
+",D
+"Which of the following disorders is characterized by a lack of interest in social communication?
+A. Paranoid personality disorder.
+B. Schizoid personality disorder.
+C. Psychosis characterized by persecutory thoughts.
+D. Avoidant personality disorder.
+",B
+"What is Acceptance and Commitment Therapy based on?
+A. Understanding that anxiety exists and looking at it non-judgmentally.
+B. Trying to figure out what the source of the problem is.
+C. Dealing with the existence of anxiety through exposure.
+D. Acceptance and commitment to adhere to CBT treatments.
+",A
+"Which of the following drugs is not used as a weight loss treatment?
+A. Metformin.
+B. Topiramate.
+C. Amphetamine.
+D. Amantadine.
+",D
+"A 40 year old is suffering from tics and obsessive-compulsive disorder with only a partial response to treatment under SSRI's. Which of the following might be most effective for him?
+A. Haloperidol.
+B. Risperidone.
+C. Chlorpromazine.
+D. Mirtazapine.
+",B
+"Which OCD treatment for children and youth is not approved by the FDA?
+A. Citalopram.
+B. Fluvoxamine.
+C. Clomipramine.
+D. Sertraline.
+",A
+"Which of the following disorders is not part of formal thinking disorders?
+A. Neologism.
+B. Ineffability.
+C. Clang Association.
+D. Perseverance.
+",B
+"Which of the following physical symptoms is less common when using cannabis?
+A. Increased appetite.
+B. Tachycardia.
+C. Dry mouth.
+D. Increase in blood pressure.
+",D
+"Which of the following has not been shown to be effective in treating PTSD?
+A. Paroxetine.
+B. Prazosin.
+C. Sertraline.
+D. Lorazepam.
+",D
+"What does the concept of condensation describe, according to Freud?
+A. Transferring an amount of energy from an object to a symbolic representation of an object.
+B. A mixing of feelings that are transferred to expressing an imagined character.
+C. Unconscious feelings or desires that combine into one character, which appears in sleep.
+D. Transferring unwanted feelings to physical expression.
+",C
+"In which form of psychotherapy is the use of metaphors common?
+A. Supportive.
+B. Narrative.
+C. Positive.
+D. Cognitive.
+",B
+"Which of the following is not a prenatal risk factor for the development of autism in a newborn?
+A. Maternal  old age.
+B. Paternal  old age.
+C. Gestational diabetes.
+D. Third birth or more.
+",D
+"A34-year-old is getting a second opinion after a family doctor diagnosed her with panic attacks and started treatment with Citalopram about a week ago. She feels worse and asks for immediate help with an Alprazolam prescription because she heard that it helped her friend very quickly. What is the correct approach in the above case?
+A. Take Alprazolam only as an SOS.
+B. Take Alprazolam at the beginning of every day for symptom prevention.
+C. Avoid giving Alprazolam at all costs because of addiction.
+D. Increase Citalopram dose.
+",B
+"Which sign does not appear in stimulant poisoning?
+A. Meiosis.
+B. Tachycardia.
+C. Increase in blood pressure.
+D. Agitation.
+",A
+"Which of the following is a risk factor for Obstructive sleep apnea?
+A. Female gender.
+B. Low body weight.
+C. Hyperactivity of the thyroid gland.
+D. Middle age.
+",D
+"A 25-year-old was admitted to a psychiatric examination after he lost NIS 10,000 in the evening at the casino and refused to Stop betting while attacking the casino staff. He does not regret his behavior. Which diagnosis is less likely for him?
+A. Gambling disorder.
+B. Manic episode.
+C. Intermittent explosive disorder.
+D. Dissocial personality disorder.
+",C
+"A 27-year-old is hospitalized in a closed ward claims that the staff members are impersonators and that they change faces. Sometimes, he claims that the nurse is his mother, and sometimes, he claims that the head of the ward is his deceased uncle. What syndrome does the patient suffer from?
+A. Capgras.
+B. Double Personality.
+C. Multiple personality.
+D. Fregoli.
+",A
+"A 63-year-old man with a dominant right hand, who suffers from hypertension and hyperlipidemia comes to the neurological emergency room due to a sharp change in his condition. According to his wife, he suddenly became incoherent in his answers when asked about simple things, and his speech was incoherent. He is without dysarthria and is unable to follow simple commands. Head CT with contrast material shows a Lacunar infarct. What is the most likely location of the infarct in the brain of the Patient?
+A. Right frontal.
+B. Right occipital.
+C. Left parietal.
+D. Left temporal.
+",D
+"A 31-year-old man is admitted with acute psychotic mania, and is raging and violent. He adamantly refuses oral therapy. It was decided to calm him down by administering benzodiazepine intramuscularly. Which drugs from the following would be more suitable for rapid sedation?
+A. Lorazepam.
+B. Clonazepam.
+C. Alprazolam.
+D. Diazepam.
+",A
+"What is the composition of a special psychiatric committee?
+A. A senior jurist and two psychiatrists on behalf of the state.
+B. Retired judge, psychiatrist and criminologist.
+C. Judge, Senior legal Advocate and Psychiatrist.
+D. The deputy to the government adviser, psychiatrist and criminologist.
+",B
+"What is the correct technique in family therapy?
+A. The therapist's avoidance of controlling what is happening.
+B. Encouraging free associations between the couple.
+C. Allowing them to lash out at each other.
+D. Transparency of everything that happens.
+",D
+"Which drugs among the following is preferred as an adjunct to relieve withdrawal symptoms from benzodiazepines?
+A. Carbamazepine.
+B. Valproic acid.
+C. Lamotrigine.
+D. Topiramate.
+","A,B"
+"What is the recommended test for a child with several physical anomalies, developmental delay, and intellectual disability?
+A. Level of ceruloplasmin in urine.
+B. Prolactin level in the blood.
+C. Chromosomal analysis.
+D. Porphyrin in urine.
+",C
+"Which group of drugs shows more effectiveness in treatment-resistant PTSD?
+A. ATYPICAL ANTIPSYCHOTICS.
+B. SSRI's.
+C. SNRI's.
+D. ANTICONVULSANTS.
+",A
+"Which of the following drugs is more recommended for the treatment of delirium due to Parkinson's disease?
+A. OLANZAPINE.
+B. QUETIAPINE.
+C. ARIPIPRAZOLE.
+D. AMISULPRIDE.
+",B
+"Which of the following side effects characterizes lithium treatment?
+A. Constipation.
+B. The appearance of U waves in the ECG.
+C. Change in protein metabolism.
+D. A Decrease in the convulsion threshold.
+",D
+"According to which of the following is the degree of severity of intellectual-developmental disability determined according to the DSM-5.
+A. The IQ score.
+B. Adaptive functional capacity.
+C. The anatomical location of the injury.
+D. Presence of a chromosomal syndrome.
+",B
+"A 50-year-old alcoholic is admitted to the department, claiming that he used to work there and the head of the department is his childhood friend. What disorder is this?
+A. Confabulation.
+B. Pseudologia fantastica.
+C. Pseudodementia.
+D. Reminiscence.
+",A
+"In the rehabilitation department, the staff usually uses a token economy. What type of treatment does this method belong to?
+A. Educational.
+B. Behavioral.
+C. Supportive.
+D. Psychosocial.
+",B
+"Dopamine agonists are not used for which disorder?
+A. NMS.
+B. Parkinsonism.
+C. Hyperprolactinemia.
+D. Hypersexuality.
+",D
+"What is the name of a symptom that describes a denial of the disease?
+A. Anosmia.
+B. Anosognosia.
+C. Apperception.
+D. Asomatognosia.
+",B
+"Which of the following signs does not belong to Affective flattening?
+A. Failure to make eye contact.
+B. Monotonous voice.
+C. Decreased spontaneous movements.
+D. A neglected performance.
+",D
+"Which of the following scales is a projective scale?
+A. Bender.
+B. TAT..
+C. MMPI.
+D. Clock drawing.
+",B
+"A patient who started treatment with Lamotrigine two months ago complains of a rash. On his examination, you identified a new benign maculopapular rash. How should you act?
+A. Treatment should be stopped immediately.
+B. You should continue with the existing dose and ensure the rash is monitored by a dermatologist, which, in most cases, will not develop into Stevens-Johnson syndrome.
+C. If the treatment has a positive effect, a quick skin biopsy can be performed to rule out Steven Johnson syndrome, and treatment can be continued if it is ruled out.
+D. The dose should be reduced, even at the cost of clinical worsening, while adding a low dose of Valproic Acid.
+",A
+"What is required for the diagnosis of PTSD according to 5-DSM?
+A. Only personal exposure to an event with traumatic potential such as the risk of death.
+B. At least one intrusive symptom.
+C. At least one symptom of a negative change in mood or cognition.
+D. At least one symptom of a change in arousal.
+",B
+"A 58-year-old finds it difficult to get rid of her belongings when moving despite repeated requests from her husband, who claims that the house is filled with ""garbage no one needs"" such that there is no room to move around. She argues and claims that every item she has collected has value. What is the most likely spectrum of the disorder she suffers from?
+A. The autistic.
+B. The psychotic.
+C. The traumatic.
+D. The obsessive-compulsive.
+",D
+"A 40 year old senior manager who is married and a father of three is an adaptable and successful guy. In a meeting with friends, he claims that ""it is clear that there will be an economic crisis and our pensions will be wiped out."" What defense mechanism is he using?
+A. Projection.
+B. Humor.
+C. Repression.
+D. Anticipation.
+",D
+"What is the typical cognitive impairment in TRANSIENT GLOBAL AMNESIA?
+A. Retrograde amnesia.
+B. Confusion.
+C. Anterograde amnesia.
+D. Autobiographical amnesia.
+",C
+"Is it possible, and in what situation, to appeal an inspection order?
+A. Only when it is a non-urgent test order.
+B. When the request was referred by a social worker or by a doctor, who is not a psychiatrist.
+C. When the person applies within 24 hours with a request to appeal to the district psychiatric committee.
+D. An inspection order cannot be appealed at all.
+",D
+"What is the essential difference between a child suffering from a SOCIAL COMMUNICATION DISORDER and a child diagnosed with autism?
+A. Absence of cognitive impairment in SCD.
+B. Absence of recurrent symptoms and narrow interests in SCD.
+C. Absence of functional impairment in SCD.
+D. The absence of ADHD as a comorbidity in SCD.
+",B
+"Which of the following drugs does not belong to cholinesterase inhibitors?
+A. Galantamine.
+B. Rivastigmine.
+C. Tacrine.
+D. Memantine.
+",D
+"A 24 years old, who is currently neither studying nor working, was released from the IDF due to a medical profile 21 since he became passive, introverted, not interested in what was happening, and claimed that everyone was against him. He has not used drugs in the past. Last month, he became hyperactive, wasted money, and argued with people, claiming he was the most talented. He is admitted to a closed ward in an agitated state of mind, and is disorganized in his thoughts and behavior, fights and shouts that he is God on earth while hearing the voice of his deceased father. An effective reduction is evident. In laboratory tests - urine positive for THC (according to his mother, he smoked cannabis only once). Which is his most likely diagnoses?
+A. Schizoaffective disorder.
+B. Schizophrenia.
+C. Cannabis-induced psychotic disorder.
+D. Manic psychotic episode.
+","A,B,C,D"
+"Which of the following factors may serve as a protective factor against suicide in schizophrenia patients?
+A. Secularism.
+B. White ethnicity.
+C. Having abstract thinking.
+D. Negative signs are evident.
+",D
+"A 37 year old is hospitalized with consent in a closed ward for the first time in her life due to depressive complaints, accompanied by intentions to swallow pills with a suicidal purpose. Her history includes being raped, depression, anxiety, ADHD, a short psychotic manic attack, use of a variety of drugs, including cocaine, synthetic opiates, and even Ritalin, in addtion to repeated self-harm and suicidal thoughts. In the past, she was hospitalized in the ward for dual mental illness, where she was treated with a combination of Duloxetine, Amantadine, Propranolol, Trazodone, Valproic acid, Quetiapine, and Clotiapine. According to her and according to the record, she continued all the treatment except for Amantadine, plus Methylphenidate and Bupropion. On examination, she rules out suicide. Her affect seems much duller than depression. Her movements are slow and jerky. A tremor appears in the upper limbs. What is the most appropriate  next step?
+A. Discontinuation of Clotiapine. ֿ.
+B. Replacing Quetiapine with Risperidone.
+C. Increasing the Propranolol dose.
+D. Replacing valproic acid with lithium.
+",A
+"A 12-year-old boy has been suffering for several years from motor tics that come and go in the face and neck. A vocal single tic of clearing the throat has also been present for a year. What is his most likely diagnosis?
+A. Persistent motor or vocal tic disorder.
+B. Tourette's disorder.
+C. Transient tic disorder.
+D. Stereotypic movement disorder.
+",B
+"Who developed the concept of signal anxiety?
+A. Pavlov.
+B. Skinner.
+C. Bowlby.
+D. Freud.
+",D
+"At what stage according to Erikson does the midlife crisis develop?
+A. Initiative vs Guilt.
+B. Intimacy vs Isolation.
+C. Integrity vs Despair.
+D. Generativity vs. Stagnation.
+",D
+"Which of the following drugs is most likely to cause weight loss?
+A. Topiramate.
+B. Carbamazepine.
+C. Valproic acid.
+D. Lamotrigine.
+",A
+"In which group of patients is TMS safer?
+A. Pregnant women.
+B. Suffer from arrhythmias.
+C. Suffer from low blood pressure.
+D. Suffer from diabetes.
+","A,B,C,D"
+"A 35-year-old man with an acute manic psychotic attack is admitted to a closed ward, according to a forced and urgent hospitalization order. He is  uncooperative, violent, delusional, refuses treatment, and attacks staff members. Which drug from the following would be an initial treatment of choice to calm him down as quickly as possible? 
+A. Olanzapine. 
+B. Lamotrigine. 
+C. Quetiapine. 
+D. Valproic acid. 
+
+",A
+"According to the 'TADS', how is combining CBT with long-term medication more effective than medication alone, for youth suffering from major depression?
+A. In anhedonia.
+B. In the mood.
+C. In reducing suicidal thoughts.
+D. In reducing agitation.
+",C
+"A 42 year old has been suffering from bipolar disorder for years, which has not respond to any treatment except for lithium. She was in remission for two years without medication. She was admitted to the hospital in an acute manic state. With the resumption of lithium, she developed Diabetes Insipidus. Which of the following might help her?
+A. Distribution of lithium administration 4 times a day.
+B. Fluid restriction.
+C. Avoidance of Thiazide administration.
+D. Spironolactone administration.
+",D
+"Which of the following disorders is less likely to cause dementia?
+A. Diabetic Ketoacidosis.
+B. AIDS.
+C. SLE.
+D. Creutzfeldt-Jakob Disease.
+",C
+"A 30-year-old, with depression resistant to antidepressants, started taking thyroid hormones. Which side effect is it likely to develop?
+A. Weight gain.
+B. Constipation.
+C. Sleepiness.
+D. Sweating.
+",D
+"After a fatal car accident the offending driver rationally, and  without expression of emotion, tells the policeman about the turn of events. What defense mechanism does he use?
+A. Acting out.
+B. Isolation.
+C. Undoing.
+D. Projection.
+",B
+"Which of the following mood stabilizers is cardiotoxic?
+A. Lamotrigine.
+B. Carbamazepine..
+C. Valproic Acid.
+D. Lithium.
+",D
+"Which disorder is not an indication for B-blockers treatment?
+A. Akathisia.
+B. Tremor as a result of lithium use.
+C. Tardive dyskinesia.
+D. Anxiety.
+",C
+"Which of the following side effects is more common with Buspirone?
+A. Headache.
+B. Weight gain.
+C. Sexual dysfunction.
+D. Insomnia.
+",A
+"Which of the following is less sedative?
+A. Desipramine.
+B. Amitriptyline.
+C. Doxepin.
+D. Maprotiline.
+",A
+"Which of the following neuroleptic drugs is most likely to cause jaundice?
+A. Perphenazine.
+B. Chlorpromazine.
+C. Risperidone.
+D. Haloperidol.
+",B
+"What behavior is less typical of an impostor?
+A. Evading military service.
+B. Attempt to avoid criminal responsibility.
+C. Need to feel sick.
+D. Need for a place to live in.
+",C
+"Which temperament is more characteristic of sentimentality?
+A. Persistence.
+B. Reward dependence.
+C. Novelty seeking.
+D. Harm avoidance.
+",B
+"What is the IQ range that characterizes Borderline intellectual functioning?
+A. 51-60.
+B. 61-70.
+C. 71-80.
+D. 81-90.
+",C
+"Which of the following do not use barbiturates?
+A. Electric shocks.
+B. Narco Analysis.
+C. Cramps.
+D. Withdrawal from SSRIs.
+",D
+"A 28 year old suffering from epilepsy and resistant depression is treated with ECT.
+Which of the following is more likely to occur after treatment?
+A. Aggravation of epilepsy.
+B. Upregulation in ־² receptors.
+C. Increased blood flow in the brain.
+D. Decreased brain metabolism.
+",D
+"What genetic syndrome is characterized by hard and compulsive biting of lips and fingers?
+A. Adrenoleukodystrophy.
+B. Lesch-Nyhan.
+C. Maple Syrup.
+D. Down syndrome.
+",B
+"What is not included in the principles of psychopharmacological treatment for the elderly?
+A. Administering doses as low as possible.
+B. Most drugs are given in equal distribution 3-4 times a day.
+C. Liquid formulation is better in some cases.
+D. Avoiding administering medications in the evening.
+",D
+"Which nervous system in laboratory animals was damaged by MDMA?
+A. Serotonergic.
+B. Glutamatergic.
+C. Noradrenergic.
+D. Dopaminergic.
+",A
+"A 16 year old was treated with fluoxetine due to a depressive episode and responded with complete remission. After how long is it recommended to stop the treatment?
+A. Three months.
+B. Six months.
+C. One year.
+D. Two years.
+",C
+"Who invented the term Persecutory Anxiety?
+A. Eugen Bleurer.
+B. Emil Kraepelin.
+C. Kurt Schneider.
+D. Melanie Klein.
+",D
+"Which psychiatric disorder is more common in cancer patients?
+A. Adjustment disorderן¿¼.
+B. Panic disorder.
+C. Delirium.
+D. Major depression.
+",A
+"Six weeks after being injured in a serious car accident, a 40 year old reports a drop in mood, difficulty falling asleep and concentrating, multiple somatic complaints, and nightmares. She has not returned to work since the accident. Which of the following is the most likely diagnosis?
+A. PTSD.
+B. Major depression.
+C. Adjustment disorder.
+D. Somatoform disorder.
+",C
+"Which side effect is less likely to be caused by VNS treatment?
+A. Dyspnea.
+B. Bradycardia.
+C. Dysphonia.
+D. EPS.
+",D
+"Which of the following is a symptom of inattention in ADHD?
+A. Poor organizational ability.
+B. Lots of chatter.
+C. Tendency to interrupt other people's words.
+D. Tendency to move arms and legs while sitting.
+",A
+"A 67-year-old turns to a sexologist with a request to prescribe him Sildenafil. What would not be a sign of caution before administering the drug?
+A. Diabetes.
+B. Hypertension.
+C. Ischemic heart disease.
+D. His older age.
+",D
+"According to Freud, the pleasure principle and the reality principle are aspects of the function of:
+A. Super Ego.
+B. Ego.
+C. Subconscious.
+D. Unaware.
+",B
+"Which of the following drugs is less suitable for the treatment of delirium due to its stimulating effect?
+A. ZIPRASIDONE.
+B. QUETIAPINE.
+C. PALIPERIDONE.
+D. PIMOZIDE.
+",A
+"In which of the following disorders are SSRI's and Clomipramine less effective?
+A. Body Dysmorphic Disorder.
+B. Excoriation Disorder.
+C. Hoarding Disorder.
+D. Obsessive-compulsive disorder.
+",C
+"Which of the following signs is included in Schneider's first-rank symptoms?
+A. Avolition.
+B. Audible thoughts.
+C. Ambivalence.
+D. Autism.
+",B
+"A 48-year-old patient has been treated for years in a clinic for mood disorders due to bipolar disorder. During the visit, he complains of dysphoria, lack of spontaneity, slow reactions and memory disturbance. Which of the following is least likely to cause this?
+A. Giving lithium.
+B. Depression.
+C. Hypothyroidism.
+D. Hypocalcemia.
+",D
+"A new intern is questioned by the department manager every morning due to flaws in the records of the follow-up and intake papers. At first, she reacts with tears and frustration and even considers leaving the profession, but she slowly improves and is no longer questioned  by the department manager. What technique does is the manager using when they stop questioning the intern? 
+A. Negative reinforcement. 
+B. Exposure. 
+C. Disappointment. 
+D. Punishment.
+",A
+"What is the main differential diagnosis of SOCIAL COMMUNICATION DISORDER?
+A. CHILD ONSET FLUENCY DISORDER (STUTTERING).
+B. EXPRESSIVE LANGUAGE DEFICIT.
+C. RECEPTIVE LANGUAGE DEFICIT.
+D. AUTISM SPECTRUM DISORDER.
+",D
+"Which term does not describe the repetition of the same words and phrases?
+A. Logoclonia.
+B. Perseverance.
+C. Verbigeration.
+D. Paraphasia.
+",D
+"What are the rules for preventing orthostatic hypotension with MAOI treatment?
+A. Caffeine restriction.
+B. Administering medication once a day.
+C. Low salt diet.
+D. Drinking restriction.
+",A
+"Which of the following drugs will cause more sexual dysfunction in a patient with an anxiety disorder?
+A. Quetiapine.
+B. Buspirone.
+C. Reboxetine.
+D. Mirtazapine.
+",A
+"Which of the following TCA's is least anticholinergic?
+A. Imipramine.
+B. Desipramine.
+C. Nortriptyline.
+D. Amitriptyline.
+",B
+"Which of the following is the least involved in anxiety disorders?
+A. Serotonin.
+B. Dopamine.
+C. Acetylcholine.
+D. GABA.
+",C
+"What is the most representative example of Interoceptive exposure?
+A. A person with panic attacks runs in place, in order to speed up his pulse.
+B. A student who has to go to school, even though he doesn't want to.
+C. An anorexic who is used to eating small amounts of food 5 times a day.
+D. A patient with PTSD who voluntarily recalls the traumatic event.
+",A
+"What is the most common obsession in children and youth diagnosed with OCD?
+A. Need for symmetry.
+B. Fear of harming others.
+C. Preoccupation with morality and guilt.
+D. Fear of infections and contagion.
+",D
+"What percentage of the total amount of serotonin in the human body, is concentrated in the brain?
+A. 1.5%.
+B. 15%.
+C. 35%.
+D. 75%.
+",A
+"Which of the following signs appears in hallucinogen poisoning?
+A. Dry skin.
+B. Meiosis.
+C. Bradycardia.
+D. Blurred vision.
+",D
+"What is the mechanism by which SSRIs cause yawning?
+A. Weakness.
+B. Insomnia.
+C. Effect on the hypothalamus.
+D. Reducing REM Latency.
+",C
+"Which of the following mental illnesses is less associated with Tourette's disorder?
+A. Depression.
+B. OCD.
+C. ADHD.
+D. Schizophrenia.
+",D
+"A 30 year old woman who was previously divorced, is trying to build a new relationship with a 28-year-old man. During a meeting with him , he tells her she ""doesn't look well today"". She didn't respond to him. When she returned home, she started yelling at her children: ""You made a mess again! When will it end?"". Which of the following defense mechanisms did the mother use? 
+A. Rationalization. 
+B. Projection. 
+C. Displacement. 
+D. Denial. 
+
+",C
+"What is the expression of Orgasmic Anhedonia?
+A. Lack of sexual desire.
+B. Lack of orgasm.
+C. The absence of an orgasmic sensation.
+D. Mental anguish during orgasm.
+",C
+"Which of the following preparations is more likely to increase the occurrence of Stevens-Johnson syndrome in combination with Lamotrigine?
+A. Escitalopram.
+B. Valproic acid.
+C. Risperidone.
+D. Lorazepam.
+",B