1

{username}

A 32-year-old female is undergoing a cholecystectomy. It was decided to give her prophylactic

cephalosporin.
When should the first dose be given?
A. The evening before surgery

B. At least two hours before the start of the surgery

C. Within an hour before the start of the surgery

D. Before the end of the surgery

{username}

A 52-year-old male is brought to the ER after a road accident. During his examination he opens his
eyes in reaction to pain, confused, and upon pinching of the trapezius on the right he tries to
move the touching hand away with his left hand.
What is his Glasgow Coma Score (GCS)?
A. 10

B. 11

C. 12

D. 13

1
3

{username}

A 26-year-old male is rushed to the emergency room due to multiple vomiting after a night of
binge drinking. The young man complains of abdominal pain and also reports that the last
vomiting was bloody and these continue to be bloody in the emergency room as well.
What is the most likely diagnosis?
A. Mallory-Weiss tears

B. Boerhaave syndrome

C. Plummer-Vinson syndrome

D. Dieulafoy's lesion

{username}

A 23-year-old male, underwent splenectomy 8 years ago due to thalassemia. Presents in the ER
with a fever of 40°C, chills, and his condition rapidly deteriorates to septic shock.
Which of the following vaccines might have prevented this situation?
A. Mumps vaccine

B. Pneumococcus vaccine

C. Pertussis vaccine

D. Pseudomonas vaccine

2
5

{username}

A 32-year-old female, 20 weeks pregnant, detects a lump in her breast. Biopsy results
demonstrate DCIS (ductal carcinoma in situ).
What is the most recommended treatment?
A. Breast conserving surgery (lumpectomy) + radiotherapy

B. Breast conserving surgery (lumpectomy)

C. Mastectomy

D. Neoadjuvant antihormonal therapy

{username}

A 32-year-old female arrives at the emergency department 5 days after cholecystectomy with
complaints of abdominal pain and vomiting. A drain is inserted that secretes about 600 ml of bile
per day. After an investigation, the source of leak is identified to be from the stump of the cystic
duct that had opened.
What is the next step in the management of this case?
A. Observation with antibiotic treatment - high chance that it will close on its own

B. ERCP with stent insertion

C. Surgery to reclose the cystic duct

Surgery to create anastomosis between the bile duct and the intestine -
D.
choledochoduodenostomy

3
7

{username}

A 73-year-old male presents with vomiting and abdominal pain. X-ray performed (attached).
What is the most common cause of this finding?

A. Hernia

B. Adhesions

C. Tumor

D. Bezoar

{username}

Which of the following describes the common cause of prehepatic portal hypertension?
A. Budd-Chiari syndrome

B. Portal vein thrombosis

C. Right heart failure

D. Constrictive pericarditis

4
9

{username}

A 30-year-old male is examined in the ER due to acute abdominal pain for several hours.
Abdominal examination demonstrates signs of peritoneal irritation. On chest and abdomen x-rays
- evidence of free air in the abdominal cavity. During the surgery, a 3 mm perforation was found in
the anterior wall of the first part of the duodenum.
What will be the next step in the management of this case?
A. Initial suturing and closure of the perforation

B. Gastrectomy with billroth II reconstruction

C. Closure of the perforation with omentum (omentopexy)

D. Biopsy of the ulcer margins and then closure of the perforation with sutures

10

{username}

Which of the following is the most common liver abscess etiology?

A. Arterial seeding

B. Portal seeding (secondary to other intrabdominal inflammatory process)

C. Direct invasion of colonic or duodenal tumors

D. Bile seeding following cholangitis or cholecystitis

5
11

{username}

A 27-year-old female, presents with upper right abdominal pain for two days, nausea and
vomiting, chills, and a temperature of 38.5°C. On her examination - tenderness in the upper right
abdomen with a positive Murphy's sign.
Apart from blood tests, what is the most correct next step to advance the diagnosis?
A. Abdominal ultrasound

B. Acute abdominal x-ray

C. Abdominal CT

D. Abdominal MRI

12

{username}

Which of the following is the most common complication after Whipple surgery due to pancreatic
head adenocarcinoma?
A. Bleeding

B. Bile leak - from the anastomosis to the bile ducts

C. Wound infection

D. Delayed emptying of the stomach

13

{username}

Which of the following muscles has a significant role in maintaining continence?

A. Puborectalis

B. Pubococcygeus

C. Iliococcygeus

D. Transversus perineal

6
14

{username}

A 55-year-old female is diagnosed with appendicitis with pus, undergoing laparoscopic

appendectomy, with no bowel contents leaking.
What is the degree of wound infection according to the CDC?
A. Clean

B. Clean contaminated

C. Contaminated

D. Dirty-infected

7
15

{username}

An 18-year-old male is injured in a car accident. The paramedic inserts a needle into the chest
(needle thoracostomy) at the accident site due to poor air intake on the left. The patient is sedated
and ventilated. Attached is an x-ray taken upon his arrival to the trauma room.

What is the next step in the management?

A. Whole-body CT

B. Performance of Extended-FAST

C. Another needle in the right chest

D. Inserting a chest drain on the left

8
16

{username}

Which of the following are the main cells in the proliferation phase of wound healing?
A. Macrophages

B. Monocytes

C. Neutrophils

D. Fibroblasts

17

{username}

Which of the following definitions most accurately describes Spigelian hernia?

Hernia in the triangle between the 12 th rib, the paraspinal muscles, and the internal
A.
oblique muscle

B. An internal hernia in the pelvis at the obturator foramen

A hernia between the iliac crest, the latissimus dorsi muscle, and the external oblique
C.
muscle

A hernia between the rectus and the semilunar line on the right or left abdominal wall at
D.
the level of the arcuate line

18

{username}

A 76-year-old male, hospitalized with abdominal pain due to cholecystitis. In his examination,
tenderness and resistance are detected in the upper right abdomen. Temperature of 39°C, pulse
105 per minute, breathing rate 25 per minute, in blood tests - WBC 18000. Negative results of
blood cultures taken in the emergency room and in the department.
How is his condition defined?
A. SIRS

B. CARS

C. Sepsis

D. Septic shock
9
19

{username}

What material are most gallstones made of?

A. Cholesterol

B. Calcium cholesterol

C. Black pigment

D. Brown pigment

20

{username}

Which of the following combinations characterizes the most common metabolic disorder in
patients suffering from multiple vomiting due to gastric outlet obstruction (choose the most
accurate answer)?
A. Hyperkalemia, metabolic acidosis

B. Hyperkalemia, metabolic alkalosis

C. Hypokalemia, metabolic acidosis

D. Hypokalemia, metabolic alkalosis

21

{username}

Which of the following injuries should be identified and treated as early as the primary survey
based on clinical signs (even before imaging)?
A. Simple hemothorax

B. Tension pneumothorax

C. Pulmonary contusion

D. Bronchial injury

10
22

{username}

Which of the following findings raises the highest suspicion of Zollinger-Ellison syndrome?
A. pH level higher than 3 in the stomach (without use of medications)

B. Gastric ulcer with high secretin levels

C. pH level lower than 2 in combination with a high gastrin level

D. Gastric ulcer with high levels of somatostatin

23

{username}

A 68-year-old female undergoes a right hemicolectomy due to a tumor. One day after the surgery,
a fever of 38.3°C appears.
What is the most likely etiology?
A. Anastomotic leak

B. Wound infection

C. Atelectasis

D. Aspiration

24

{username}

A 78-year-old male was hospitalized in the surgical department for evaluation due to weight loss,
epigastric pain radiating to the back, and new, deepening jaundice. During his hospitalization, a
diagnosis of pancreatic head adenocarcinoma is obtained by imaging.
Which finding in the physical examination suggests widespread metastatic involvement to the
pelvis?
A. Sister Mary Joseph node

B. Virchow node

C. Blumer’s shelf

D. Courvoisier sign

11
25

{username}

A 78-year-old female is diagnosed with a tumor in the lower rectum involving the sphincters. After
discussion, it was decided to offer the patient abdominoperineal resection.
What will you explain the patient regarding the offered treatment?
A resection of the lower rectum will be performed through the anus with a primary
A.
anastomosis of the colon to the anus

A resection of the rectum will be performed through an abdominal incision and through
B. the perineum with primary anastomosis between the rectum and the anus, and a
temporary stoma

A resection of the rectum and anus will be performed through an abdominal incision and
C.
through the perineum without anastomosis, with a permanent stoma

A resection of the rectum and anus will be performed through an abdominal incision and
D.
the descending colon will be connected to the opening that remains in their place

26

{username}

A 60-year-old female patient arrives at your clinic due to pain immediately after meals, mainly in
the epigastrium and anterior chest. As part of the investigation, the following X-rays were carried
out:

Which of the following is the most likely diagnosis?

A. Diaphragm rupture

B. Reflux (esophageal reflux)

C. Esophageal diverticulum (mid-esophageal diverticulum)

12
D. Para-esophageal hernia
27

{username}

A 64-year-old male was diagnosed with a 6 cm mass in the greater curvature of the stomach. An
endoscopic ultrasound examination determined that the source of the tumor was in the muscular
layer of the gastric wall. A needle biopsy result diagnosed a spindle cell tumor originating from
smooth muscle layer, and it was stained positive for DOG1, CD117, CD34.
Which cells are responsible for the development of the described tumor?
A. Cajal cells

B. Parietal cells

C. Goblet cells

D. Chief cells

28

{username}

Which of the following statements is true regarding the etiology of a malignant tumor of the
esophagus?
A. Usually discovered at an early stage following screening with gastroscopy

B. Usually discovered at an advanced stage with 5-year survival lower than 20%

There is a global rise in the incidence of squamous cell carcinoma and a decrease in
C.
adenocarcinoma due to an increase in smoking, drinking hot tea, and using cannabis

A history of caustic ingestion is a significant risk factor for the development of

D.
esophageal adenocarcinoma

13
29

{username}

As part of an end-of-life assessment for the possibility of removing a kidney for transplantation -
which of the following unconscious patients is in a state of “brain death” (assuming that body
temperature is normal and there are no signs of poisoning)?
A 42-year-old male in a state of unconsciousness that has lasted for at least 3
A.
consecutive months (chronic vegetative state)

B. A 39-year-old male with a normal angiogram of the anterior cerebral artery

A 34-year-old male with no response on all neurological tests of all levels of the brain, as
C.
well as a positive apnea test

A 29-year-old male, ventilated, receiving vasopressor treatment, normal isotope brain

D.
imaging

30

{username}

A 16-year-old female underwent a splenectomy due to ITP (idiopathic thrombocytopenic purpura)

which was resistant to drug treatment. About a week after the surgery, she arrives at the
emergency room with a spontaneous nosebleed. Platelet count on her admission - 9000 (normal
values: 150,000-400,000).
Which of the following most likely explains her condition?
A. Platelet production disorder

B. Inadequate reduction of postoperative steroids

C. Presence of accessory spleen

D. Bone marrow failure

14
31

{username}

A 35-year-old male arrives at the emergency department 5 days after inguinal hernia repair
surgery with a swollen, painful, and tender testicle on the same side of the repair. US scan
demonstrates ischemic orchitis.
What is the recommended treatment at this stage?
A. Orchiectomy

B. Pain relievers and NSAIDS

C. Immediate surgery to remove the surgical mesh

D. Immediate surgery and dilation of the inguinal canal

32

{username}

Which of the following small intestinal neuroendocrine tumors will most likely lead to carcinoid
syndrome?
A. A 2 cm tumor with metastases in the liver

B. A 15 cm tumor

C. A 7 cm tumor causing intestinal obstruction

D. A 5 cm tumor causing fistula to the colon

15
33

{username}

A 57-year-old male, psychiatric patient, complains of abdominal swelling and the absence of stools
for about two days. On examination: blood pressure 130/85, pulse 92 per minute, temperature
37.6°C. Very swollen abdomen, no significant tenderness, on rectal examination - empty ampule.
Abdominal x-ray results attached.

What is the next step in the management of this case?

A. Administration of laxatives with enemas

B. Endoscopic decompression

C. Diagnostic laparoscopy

D. Laparotomy with bowel resection

16
34

{username}

below are four candidates for bariatric surgery.

Which of them has an absolute contraindication for the surgery?
A. A 23-year-old male with BMI = 47, underlying Prader Willi syndrome

B. A 58-year-old female, BMI = 37, uncontrolled diabetes

A 17-year-old male, BMI = 44, failed to lose weight on all the diet treatments he was
C.
referred to

A 68-year-old female, BMI = 42 and hypercholesterolemia, who did not respond to all the
D.
diet treatments to which she was referred

35

{username}

A 72-year-old female, presenting with fresh bleeding from the lower gastrointestinal tract. At
admission: blood pressure - 130/82, pulse 94. In the inserted nasogastric tube - bile content, no
visible blood.
What is the first test of choice to detect the source of the bleeding?
A. CT angiography

B. Formal angiography

C. RBC scintigraphy

D. Colonoscopy

36

{username}

Which of the following actions is included in phase A of the initial round according to the ATLS?
A. Auscultation to air intake

B. Glasgow coma score evaluation

C. Stopping of bleeding in the hand

D. Fixation of the cervical spine

17
37

{username}

A 50-year-old male was referred to the emergency room by the family doctor due to an incidental
finding of serum calcium level of 13.8 mg% (normal value: 8.5-10.8). In the investigation done at
the hospital, serum PTH level of 420 ng/L (normal value: 15-65) and urinary calcium level of 390
mg/24 hours (normal value: 100-250) were found.
What will the immediate treatment for this patient include?
A. Oral calcitonin

B. Thiazide diuretic

C. IV normal saline

D. Bisphosphonates

18
38

{username}

A 53-year-old male with no underlying diseases, arrived at the emergency department due to
upper right abdominal pain for the past 5 days, accompanied by extreme weakness, fever, and
night sweats. On his examination - he looks sick, no cough and no respiratory distress,
temperature 38.7°C, normal blood pressure and saturation, reduced air intake on the right, no
rhonchi or wheezing. Abdomen - soft, tenderness focused in the upper right abdomen, no signs of
peritoneal irritation. On laboratory tests: leukocytes 18,000 with 82% polymorphonuclear,
hemoglobin 12 g/dl, platelets 210,000, bilirubin 2.2 g/dl mostly direct, ALT 500 I/U, AST 635 I/U.
The following is an image of an abdominal CT -

Based on the findings seen in image (CT), what is the likely cause of the patient's illness?
A. Diverticulitis

B. Acute right-sided heart failure

C. Portal vein thrombosis

D. Cirrhosis

19
39

{username}

Which syndrome is common in non-sporadic desmoid tumors?

A. Lynch syndrome

B. Multiple endocrine neoplasm (MEN) II syndrome

C. Familial adenomatous polyposis (FAP) syndrome

D. Li-Fraumeni syndrome

40

{username}

Which of the following is defined as part of the lethal triad in shock?

A. Hyperthermia - fever

B. Metabolic alkalosis

C. Hypotension

D. Coagulopathy

41

{username}

A 60-year-old male complains of difficulty swallowing, feeling that “the food does not go down”.
Weight loss of about 5 kg. You suspect achalasia.
Which of the following will strengthen your decision regarding the diagnosis?
A. Severe pain in the chest and barium swallow demonstrates “corkscrew esophagus”

Regurgitation of food, bad breath, and barium swallow demonstrates a diverticulum at

B.
the level of the hypopharynx

Burning sensation in the chest, especially when lying down, and during a manometry
C.
test, excessive high-amplitude peristalsis is observed along the length of the esophagus

On a manometry test, there is a lack of relaxation of the lower esophageal sphincter

D.
(LES), and esophageal dilation without adequate peristaltic waves

20
42

{username}

Which of the following statements is correct regarding the treatment of achalasia?

The proposed treatments decrease the pressure of the lower sphincter but do not treat
A.
the decrease in esophageal peristalsis

The existing medical treatments have been proven to be effective in the long term and
B.
allow a good quality of life for many years

With a one-time treatment of botox injection to the lower sphincter, relaxation of the
C.
sphincter is possible for prolonged periods

Achalasia surgery is not recommended since it is ineffective and there are reports in the
D.
literature of a higher complication rate than with pneumatic dilation treatments

43

{username}

Which of the following represents the common etiology for acute pancreatitis in the adult
population in the West?
A. Blunt trauma to the upper abdomen

B. Systemic autoimmune diseases (such as lupus)

C. Medications

D. Gallstone disease

44

{username}

Which of the following is the most correct statement regarding the treatment of gastroesophageal
reflux disease (GERD)?
For most patients with the syndrome, a combination of antacid drugs and lifestyle
A.
changes is a sufficient treatment

It is forbidden to take PPI drugs for more than 8 weeks, and surgery is necessary to
B.
prevent reflux

C. Diaphragmatic hernia is a contraindication for GERD surgery

21
Most surgeries are based on placing a synthetic mesh around the esophagus to prevent
D.
acid reflux
45

{username}

Which of the following hernias is the most common incarcerated hernia?

A. Femoral hernia

B. Umbilical hernia

C. Inguinal hernia

D. Incisional hernia

46

{username}

A 35-year-old lactating woman, gave birth one month ago. Arrives at the clinic due to a fever of
38°C and eryhtema on the surface of the right breast. No history of similar eposodes. An
ultrasound (US) is performed, which demonstrates an abscess measuring 3.5 cm in diameter.
What is true about the case?
A. Gram-negative bacteria are the main pathogen in this condition

For an abscess during breastfeeding, surgical drainage with an incision above the
B.
abscess should be performed as soon as possible

C. It should be drained using a needle under ultrasound guidance

D. The histological findings in this scenario will usually be duct ectasia

47

{username}

What is true about the mechanism and prognosis of epidural hematoma versus subdural
hematoma?
A. Bleeding from a tear in the middle meningeal artery, usually good prognosis

B. Bleeding from a tear in the middle meningeal artery, usually poor prognosis

C. Bleeding from rupture of bridging veins, usually good prognosis

D. Bleeding from rupture of bridging veins, usually poor prognosis

22
48

{username}

A 73-year-old male, presenting with acute bleeding from the lower gastrointestinal tract.
What is the most common cause of such bleeding?
A. Hemorrhoids

B. Diverticulosis

C. Arteriovenous malformation (AVM)

D. Neoplasia

49

{username}

What is true about breast cancer in males?

A. Tends to occur at younger ages than in women

B. Gynecomastia is a risk factor

C. The BRCA mutation does not increase the risk in males

D. Klinefelter syndrome (47, XXY) is a risk factor

50

{username}

A 20-year-old male has been complaining for about a week of severe pain in the anus that
increase with bowel movements. The pain is described “like cutting knives” and is accompanied by
fresh blood. The pain appeared after an episode of constipation. The patient does not allow an
examination of the area due to severe pain upon any touch. On observation, no external mass
was observed at the anus.
What is the most likely diagnosis?
A. Anal fissure

B. Anal fistula

C. Hemorrhoids

D. Perianal abscess

23
51

{username}

A 9-year-old girl is admitted due to headaches, rhinitis, cough, and fever of over 39°C for 10 days.
On examination she is alert and vital, when tilting her head down headaches increase, on
auscultation of the lungs there is an equal and good air intake.
What is the most recommended treatment in this patient?
A. Symptomatic treatment with antipyretics and cold relievers

B. Treatment with antibiotics, Moxypen

C. Treatment with steroids and antiviral drug

D. Hospitalization and urgent head imaging

52

{username}

A 10-year-old boy is admitted to the emergency room due to sleepiness and vomiting since the
day of his admission. On his examination, there are signs of dehydration and evidence of weight
loss. The parents report that for several weeks, he has been drinking larger amounts than usual
and urinating a lot.
Which of the following tests would most likely advance the diagnosis?
A. Fluid deprivation test

B. Urine calcium levels

C. Urgent brain imaging

D. Blood cortisol levels

24
53

{username}

A male baby aged one year and two months, healthy and vaccinated, arrives at the emergency
department due to a sudden stridor. A few hours before his visit, mild hoarseness appeared with
complaints that may indicate mild infection in the upper respiratory tract. No fever, saturation 99%
on RA. On auscultation to the heart - regular sounds, no murmurs, symmetrical chest, normal
expansion. On auscultation to the lungs - coarse crepitations from an upper source.
What is the treatment of choice in this situation?
A. Antibiotic treatment with Moxypen

B. Adrenaline inhalation

C. Ventolin inhalation

D. Aerovent inhalatio

25
54

{username}

A 14-year-old boy, complaining of pain in his left knee for 3 weeks after an injury. X-ray
demonstrated the attached finding.
What is the most likely diagnosis?

A. Ewing's sarcoma

B. Osteosarcoma

C. Osteomyelitis

D. Lymphoma

26
55

{username}

An 18-month-old baby girl arrives at the pediatric ER due to fever for 3 days accompanied by
restlessness. Physical examination demonstrates the findings shown in the attached images.
Which of the following steps must be included in case management?

A. Initiation of oral antibiotic treatment

B. Eardrum puncture and collection of culture

C. Urgent brain MRI

D. Initiation of empiric treatment with anticoagulants

56

{username}

A 17-year-old male patient returned two weeks ago from a trip to Africa. Now suffering from a
fever of 39.8°C accompanied by headaches, muscle pains, and chills. On physical examination:
prominent pallor, mild hepatosplenomegaly. Laboratory tests demonstrated anemia,
thrombocytopenia, and metabolic acidosis. In repeated anamnesis: did not take the medication
that was recommended to him before the trip at a travel clinic and even slept in an open area
during the trip.
What test is recommended to advance the most likely diagnosis and treatment?
A. Bacterial stool PCR

B. Chest x-ray and abdominal US

C. Bone marrow test for the presence of blasts

D. A thick drop + a quick test for the pathogen

27
57

{username}

A 5-year-old boy, generally healthy, arrived due to complaints of nocturnal enuresis, has never
been weaned off diapers at nighttime. The mother reports that he tends to talk and walk in his
sleep. Normal physical examination.
In addition to the urine osmolarity test, what other tests are recommended in order to advance
the diagnosis?
A. Abdominal ultrasound, blood glucose level

B. Blood osmolarity, urine culture

C. Urine glucose level and urine culture

D. Blood osmolarity, abdominal ultrasound

58

{username}

A 13-year-old boy is hospitalized due to prolonged fever, weakness, and myalgia. The physical
examination reveals a new murmur on auscultation to the heart and an enlarged spleen is
palpated. Later, lesions appeared as seen in the attached images. Blood cultures positive.
What is the common pathogen that causes this condition?

A. Neisseria gonorrhea

B. Staphylococcus aureus

C. Streptococcus pneumonia

D. Haemophilus influenza

28
59

{username}

A 15-year-old girl suffering from Turner syndrome with bicuspid aortic valve complains of pain
after exertion in both legs. Chest x-ray and ECG demonstrate signs consistent with left ventricular
hypertrophy. Femoral pulse is not palpable.
Which of the following signs would most likely support the etiology for her condition?
A. Wide pulse pressure

B. Diminished pulses in all extremities

C. Radial-femoral pulse delay

D. Bradycardia

60

{username}

An 8-month-old female is hospitalized due to a urinary tract infection. At the age of 6 months, she
was hospitalized due to pyelonephritis and was treated with antibiotics according to standard
practice with a good response. After hospitalization, she underwent an ultrasound of the kidneys
and urinary tracts with no evidence of pathological findings.
What would be your recommendation for this baby at the end of the current treatment?
A. Completion of cystography and renal scintigraphy

B. Prophylactic antibiotic treatment and cystography

C. There is no need for further imaging and/or prophylactic treatment

D. Renal scintigraphy and prophylactic antibiotic treatment

29
61

{username}

A six-month-old female is hospitalized in the pediatric intensive care unit for septic shock, her
weight is at the 1st percentile, and her head circumference is at the 20th percentile. In her past,
repeated hospitalizations due to respiratory infections. On the second day of hospitalization, a
result is received of the growth of gram-negative bacteria in blood culture and skin lesions appear
as described in the image.
What is the most likely pathogen causing the baby's illness?

A. Staphylococcus aureus

B. Pseudomonas aeruginosa

C. Klebsiella oxytoca

D. Kingella kingae

30
62

{username}

A 6-year-old boy is getting up from the floor as seen in the images. Blood test demonstrates CPK
levels of 25,000 IU/L (normal below 160).
What is the most likely diagnosis?

A. Duchenne muscular dystrophy

B. Spinal muscular atrophy

C. Charcot-Marie-Tooth disease

D. Guillain-Barre syndrome

63

{username}

An infant aged one year and six months suffers from recurrent, projectile vomiting after each
feeding, as well as a lack of weight gain. Abdominal US demonstrates evidence of considerable
thickening of the pylorus.
Which finding in the blood tests is highly likely to support the diagnosis?
A. Metabolic alkalosis in blood gases test

B. Direct hyperbilirubinemia

C. Increase in liver enzymes

D. Hyperchloremia

31
64

{username}

A two-month-old female baby arrives for evaluation due to complaints that have persisted since
she was a week old, including, among other things, noisy breathing and stridor mainly when lying
on her back, feeding difficulties and slow weight gain. On her examination - the baby is alert and
vital, saturation 98% in RA, equal and good air intake, inspiratory stridor is heard, on auscultation
to the heart - regular sounds without murmurs, the rest of the examination without findings.
What is the most recommended treatment in this case?
A. Supervision and close monitoring of weight

B. Anti-reflux diet and antacids

C. Lying down with elevation of the head of the bed

D. Treatment with bronchodilator inhalations

65

{username}

During the examination of a one-month-old infant, a murmur was heard. Blood oxygen saturation
at rest is around 80% in room air, without improvement after oxygen administration.
Which of the following etiologies could explain his condition?
A. Tetralogy of Fallot

B. Congenital mitral insufficiency

C. Tricuspid regurgitation

D. Congenital aortic stenosis

32
66

{username}

A 5-day-old male, referred to the emergency room due to a seizure that stopped after the
administration of Dormicum (Midazolam). On examination - no fever, alert, normotensive fontanel,
cleft palate and small ears, systolic murmur on auscultation to the heart. On initial laboratory tests
- ionized calcium 0.6 (low). An echocardiogram demonstrated a Truncus Arteriosus type defect.
Which test is highly likely to identify the underlying genetic disorder in the baby's diagnosis?
A. Chromosomal microarray

B. Methylation test

C. Trinucleotides repeats test

D. Southern blot test

67

{username}

A 3-year-old boy arrives at the pediatric ER after swallowing a cleaning agent. In sampling of the
agent: pH = 14.
Which of the following is the most recommended as initial treatment after the cleaning agent
ingestion?
A. Neutralization by administration of an acidic solution

B. Dilution by drinking milk or water

C. Induction of vomiting

D. Gastric lavage

33
68

{username}

A premature neonate born at week 29, now week 32. Fed with infant formula in amounts suitable
for his weight. On examination he is panting and grunting, pale, his abdomen is swollen and
tender, bloody stools.
What is the next step in the management of this case?
A. Transition to breastfeeding

B. Start hypoallergenic diet

C. Complete fasting

D. Switch to low-lactose diet

34
69

{username}

A 3-year-old male (as described in the image), has short stature for his age, referred for
investigation due to incidental blood tests described in the table:

Several “café-au-lait” spots are observed on physical examination.

Which of the following findings are highly likely to be related to the child's disease?

A. Hypersegmentation of the neutrophil nuclei

B. Low alpha-fetoprotein levels

C. Pancreatic insufficiency

D. Lymphocyte chromosome breakage

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{username}

A 4-year-old boy is referred due to fever that has lasted for about two weeks, with a temperature
of around 39°C every day. During this period the child has been complaining of pain in the knees
and hands, also the mother mentions a rash on the back (see in the image) that appears
intermittently. On his examination, there is evidence of arthritis in the wrists as well as in the
knees.
Which of the following clinical findings will most likely accompany his illness?

A. A new heart murmur and evidence of mitral regurgitation on echocardiogram

B. Enlargement of the liver, spleen, and lymph nodes

C. Positive test for RF or anti CCP

D. Positive test for ANA and anti-smooth muscle Ab

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{username}

A two-month-old male arrives for examination due to findings on his scalp (image attached).
Attempting to peel off the scabs leads to pulling out the roots of the hair along with the scab. On
physical examination, except for slight skin dryness and the findings on the scalp, the baby is alert,
relaxed, with no other findings.
What is the recommended treatment at this stage?

A. Systemic treatment with steroids

B. Antifungal shampoo treatment

C. Systemic treatment with antihistamines

D. Lubricating the scalp and maintaining skin moisture

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{username}

A 6-year-old boy, normally healthy, examined due to a rash in the shins and mainly in the area of
the ankles and buttocks. The rash does not disappear when pressed and has a purplish color. Two
days after the onset of the rash abdominal pain appeared. Blood pressure is normal, blood count
is normal, chemistry panel is normal and on urinalysis there is evidence of 30 red blood cells in
the field of vision under the microscope. His complaints resolve about a week later.
What would be the recommendation for the child at this stage?
A. Checking ANCA levels and performing a chest x-ray

B. Test for IgA and anti GBM level

C. Test for ANA and dsDNA

D. Weekly urinalysis for two months

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{username}

A 15-year-old male arrives due to a rash on his face for the past two months (see image)
accompanied by muscle pain and muscle weakness, pain and swelling in his right knee.
Blood test results are described in the table:

Based on these data, what is the most likely diagnosis for this young man?
A. Systemic lupus erythematosus

B. Juvenile dermatomyositis

C. Seronegative rheumatoid arthritis

D. Juvenile systemic sclerosis

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{username}

An 8-year-old boy arrives at the emergency department due to restlessness, hyperventilation, and
loss of appetite which appeared several hours before his admission. On examination: pulse 280
per minute, temperature 37.3°C, BP 60/35 mmHg, 70 breaths per minute.
What is the most recommended treatment in this case?
A. IV beta blockers

B. IV adenosine

C. IV digoxin

D. Unsynchronized cardioversion

75

{username}

An 11-year-old boy, healthy until now, arrived due to fever of up to 39°C, weakness, lack of
appetite and sore throat. On examination he is alert, tonsils in pharynx are enlarged with redness
and exudates, submandibular and cervical lymph nodes are enlarged, sensitive and mobile. On
abdominal examination there is impression of mild enlargement of the liver and spleen. Atypical
lymphocytes were observed in the blood smear.
What will you expect to see in the serology tests results?
A. Anti VCA-IgG positive, Anti VCA-IgM negative

B. EBNA-IgG positive, Anti VCA-IgG negative

C. Anti VCA-IgM positive, EBNA-IgG positive

D. Anti VCA-IgG positive, EBNA-IgG positive

40
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{username}

A 15-year-old boy is referred for evaluation due to a drop in his academic achievements and new
complaints of anxiety and depression. Blood tests demonstrate increased levels of liver enzymes
and hemolytic anemia. An eye examination revealed the attached finding (in the image).
What blood test finding is highly likely to support the diagnosis?

A. High levels of ceruloplasmin

B. High levels of ferritin

C. Low levels of alpha1 antitrypsin

D. Low levels of lipase

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{username}

You are examining a 4-month-old baby described in the image below.

Despite an abnormal result in the newborn screening, he did not receive appropriate treatment
for his illness.
What additional finding would strengthen the probable diagnosis in this case?
A. Rapid pulse

B. Large fontanelle

C. Large testicles

D. Café-au-lait spots

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{username}

A normally healthy 7-year-old boy is examined at the clinic for fever and rash. Physical
examination demonstrates the findings shown in the attached images. Except for the fever, the
child feels well, vital signs are normal.
What is the most recommended combination treatment in this case?

A. Pharyngeal swab and starting antibiotic treatment with Amoxycillin

B. Hospitalization and initiation of antibiotic treatment with Ampicillin + Clindamycin

Bolus administration of intramuscular Adrenalin and initiation of antihistamine

C.
treatment

D. Echocardiogram and starting treatment with aspirin and IVIG

79

{username}

A 13-year-old female, has underlying celiac disease and hypothyroidism. Examined due to short
stature. At examination: short and thick neck, distant nipples and wide chest.
Which cardiac finding is most typical of the girl's condition?
A. Mitral valve prolapse

B. Hypertrophic cardiomyopathy

C. Bicuspid aortic valve

D. Atrial septal defect

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{username}

A 7-year-old boy with obesity reports mood changes and excessive irritability. At school he often
falls asleep during class. The parents report snoring and secondary nocturnal enuresis.
Which of the following tests will most likely advance the diagnosis of this child?
A. Polysomnography in a sleep laboratory

B. Blood copper level

C. Brain imaging

D. Blood iron panel

81

{username}

A 15-day-old baby with a fever of 38.2°C. Normal obstetric course, heart rate and blood pressure
are normal, no fever-related findings on physical examination. Laboratory test: leukocytes 6000
with normal differential, normal hemoglobin and platelets, normal complete chemistry panel.
Which of the following tests must be performed as part of proper case management?
A. Echocardiography

B. HSV-1 in cerebrospinal fluid

C. Blood culture

D. ESR

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{username}

A one-month-old male infant is brought to the emergency room due to focal seizure. The
pregnancy was normal, home birth. The baby is breastfed and gaining weight well. In the
anamnesis: after circumcision he was hospitalized for one day for observation due to bleeding.
There is no evidence of diseases in the family.
What is the most likely cause of the baby's illness?
A. Magnesium deficiency

B. Vitamin K deficiency

C. Hypernatremia

D. Hyperkalemia

83

{username}

A 7-year-old boy, normally healthy, underwent an ECG as part of screenings for a football team
(attached).
What is the type of the arrhythmia?

A. Supraventricular tachycardia

B. Sinus node dysfunction

C. Congenital complete atrioventricular (AV) block

D. Phasic sinus arrhythmia with junctional escape beat

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{username}

You are examining a newborn with the finding described in the image. Background: born to a
mother who suffered from diabetes during pregnancy, with a birth weight of 5,200 kg, vaginal
birth.
What is the most appropriate treatment for his condition?

A. Follow-up only

B. Immediate surgery

C. Administration of steroids

D. Topical warming

46
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{username}

An 18-month-old baby is evaluated due to lack of weight gain. He has had several past episodes of
dehydration that required fluid infusion. Not taking any medications. The blood test he had is
described in the table:

Considering the findings of the tests, which finding will strengthen the decision regarding the
child's diagnosis?
A. High level of urinary calcium

B. Low level of urinary protein

C. High level of urinary sodium

D. Low level of urinary potassium

86

{username}

A 3-year-old male toddler, normally healthy, is examined in the emergency room due to a
generalized tonic-clonic seizure that lasted about ten minutes. During his examination, a
temperature of 40°C was measured. The parents describe a similar incident approximately six
months ago.
How can the seizure be defined?
A. Febrile status epilepticus

B. Simple febrile convulsion

C. Complex febrile convulsion

D. Dravet syndrome

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{username}

A healthy and vaccinated 10-year-old boy arrives at the clinic due to diarrhea for about two weeks.
The frequency of bowel movements - 3-4 times a day, liquid texture without blood or mucus, no
fever, reports a mild lack of appetite, no abdominal pain. On examination: normal nutritional
status, soft abdomen without enlargement of liver or spleen. Microscopic examination of the feces
demonstrated the following findings (see image).
What is the recommended treatment?

A. Metronidazole

B. No need for treatment

C. Azithromycin

D. Ciprofloxacin

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{username}

A 10-year-old boy presents with the findings in the image below. In addition, several Lisch nodules
are observed in the eye examination.
Which of the following findings may most likely accompany his illness?

A. Port-wine birth mark

B. Shagreen patches

C. Retinal angiomas

D. Inguinal freckling

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{username}

A six-month-old male is brought for examination due to paleness. According to the mother, he
receives iron supplement therapy according to standard practice. Blood count test is as described
in the table:

The measured values were demonstrated on 2 consecutive tests.

What is the most likely diagnosis?
A. Iron deficiency anemia

B. Lead poisoning

C. Hemolytic anemia

D. Diamond Blackfan anemia

90

{username}

A 17-year-old male, usually healthy, was transported to the emergency room by ambulance after
experiencing a loss of consciousness. Upon examination in the ER, he appeared confused,
lethargic, and disoriented to his surroundings. Blood test showed alcohol level of 240 mg/dl (high).
Urine toxic screen is negative.
What is the probable cause of death in this case?
A. Respiratory depression

B. Acute liver failure

C. Acute pancreatitis

D. Encephalitis

50
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{username}

A 13-month-old male infant, healthy so far, not vaccinated, examined in the clinic for fever and
rash (image attached). In addition, cough, runny nose, and erythema of the conjunctiva. Later,
similar symptoms were diagnosed among ten children of the kindergarten that the child attends.
The child's diagnosis was confirmed by a PCR test in saliva and urine. The baby was hospitalized
for pneumonia.
What is the typical complication of his disease?

A. Dilated cardiomyopathy

B. Sensorineural hearing loss

C. Blindness and retinopathy

D. Subacute sclerosing panencephalitis

51
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{username}

A 7-year-old boy arrives for evaluation due to complaints of a persistent cough. His medical
history is positive for several pneumonias and repeated episodes of excretory ear infections. As
part of the investigation of chronic cough, a chest x-ray is performed that demonstrates the
observed finding (see X-ray).
What additional finding would most likely support the diagnosis?

A. Increased chloride level in sweat

B. Low nasal NO level

C. Low elastase level in stool

D. Low blood lipase level

52
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{username}

A 10-year-old boy complains of weakness and back pain. On his examination - weakness in the
lower extremities. After a few days, weakness also appeared in the upper limbs. On the physical
examination, reflexes cannot be produced. The parents mention that about two weeks before the
onset of the complaints, he suffered from diarrhea. A lumbar puncture was performed.
Which finding in the cerebrospinal fluid (CSF) will support the presumed diagnosis with the highest
probability?
A. Low levels of glucose in relation to the blood

B. Protein levels above twice the normal values

C. Number of white cells over 15 per mm 3

D. Lactate levels three times higher than normal

94

{username}

A 9-year-old boy was stung by a bee and arrives at the emergency department with widespread
redness on the surface of the skin, itching, and general weakness. On admission: pulse 190, blood
pressure 60/40 mmHg, 40 breaths per minute, saturation 90%, capillary refill of 1 second.
What will be the immediate next step in the treatment?
A. Quick set up for intubation

B. Administration of 0.1 mg of IM adrenaline

C. Administration of oral steroids (prednisone 1 mg per kg)

D. Administration of oral antihistamines

53
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{username}

The following image describes a 16-year-old girl with short stature, complaints of hearing loss, who
is under cardiac follow-up.
What is the most likely diagnosis?

A. Fragile X syndrome

B. Turner syndrome

C. Trisomy X

D. Klinefelter's syndrome

54
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{username}

As part of routine tests for a healthy 15-year-old boy, protein +2 was found in repeated urine
tests. On examination: Normal blood pressure and pulse, BMI in the 90th percentile, the rest of
the physical examination is normal. Normal blood count, kidney functions and albumin within the
norm.
Which of the following tests would most likely advance the diagnosis?
A. Creatinine-to-protein ratio in first morning urine

B. US of the kidneys and urinary tracts

C. The level of protein excretion in the urine during a 24-hour collection

D. Blood lipid profile

97

{username}

A newborn child suffers from respiratory distress that began immediately after birth. An attempt
to insert a nasogastric tube was unsuccessful.
Which of the following statements is correct regarding the presumed diagnosis?
A. In most cases, there is no cognitive impairment in this diagnosis

B. Down syndrome should be suspected

C. In most cases, this diagnosis is not accompanied by newborn cyanosis

D. CHARGE association should be suspected

55
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{username}

A 5-year-old boy, diagnosed on the autistic spectrum, admitted due to decreased appetite,
restlessness, and in recent days weakness in the lower limbs. Refuses to walk. On his examination,
non-specific sensitivity over the lower extremities as well as the finding described in the image.

What is the most likely cause of the child's complaints?

A. Calcium deficiency

B. Vitamin C deficiency

C. Vitamin E deficiency

D. Vitamin A deficiency

99

{username}

A 16-year-old girl, with overweight and hirsutism, complains of irregular menstruation.

Investigation that included prolactin levels, thyroid function, ACTH test, and urine collection for
cortisol was normal.
Which of the following findings would support the most likely diagnosis?
A. Multiple follicles in the ovaries on an US

B. Low levels of androstenedione in the blood

C. Low LH levels relative to FSH levels in the blood

D. Low levels of estrogen in the blood

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{username}

A 4-month-old girl, until now has been exclusively breastfed, is brought for examination due to
bloody stools. On examination - gaining weight well, vital, soft abdomen, no signs of anal fissure.
Stool PCR negative for enteropathogens. The mother indicates that for the past few weeks she has
been fed infant formula.
What is the most recommended treatment in this case?
A. Supplementation of probiotics

B. Infant formula with hydrolyzed protein

C. Treatment with antibiotics for 5 days

D. Switch to anti-reflux diet

57