2015-NL2 Exam CU

National License Examination step 2 May, 2015

Faculty of Medicine Chulalongkorn University, Bangkok, Thailand

ถง นองๆน องๆนสสตแพทย ต แพทยจจฬาฯ ฬาฯ Examination step 2 โดยนสตแพทยจฬาฯ ซ  นับเป บเปนครั   ครังแรกท  งแรกท มการรวบรวมข ารรวบร วมขอสอบ National License Examination ซ งเกดข  ดข น จากความตั   จากความตังใจของน งใจของนสสตแพทย ต แพทยจจฬาฯร   ฬาฯรนท   นท 66 66 ท  ทอยากเห อยากเหนข นขอสอบท   อสอบทสมบ สมบรณ รณใกล ใกลเค เคยงข ยงขอสอบจร อสอบจรงเพ   งเพอการศ อการศกษาเร กษาเรยนร ยนร ของนอง อง อยางถ างถกต กตอง อง มใช ใชททองค องคยยเวเวรรดเพ   ดเพอสอบเท อสอบเทานั   านัน แตยัยังสามารถว งสามารถวนนจฉั จฉัย สงตรวจเพ   งตรวจเพมเต มเตม และใหการรั การรักษาท  เหมาะสมได หมาะสม ได อันจะ เปนประโยชน นประโยชนแก แกคนไข คนไขในอนาคต

การสอบในขั   การสอบในขันตอนท   นตอนท 2 2 เปนข นขอสอบโจทย อสอบโจทยและตั และตัวเล วเลอกภาษาอั อกภาษาอังกฤษ งกฤษ 100% (ยกเวนของน นของนตตเวชศาสตร เวชศาสตรเพ เพยง ยง 5 ขอ) การสอบแบงเป งเปนคร  นคร งเชาและคร และคร ง บาย ใชเวลาอย วล าอยางละ างละ 3 ชั ชั วโมง ขอสอบม สอบ มเน น อหาปะปนกัน ดังนั  นนองสามารถเจอข งสามารถเ จอขอสอบ อายรศาสตร รศาสตร ศั ศัลยศาสตร ลยศาสตร ฯลฯ ฯลฯ ไดทั  ทังคร   งครงเช งเชาและคร   าและครงบ งบาย าย ขอขอบคณไปป ณไปป เบ เบรรดเดย ดเดย ว ว น และเพ   และเพอนๆอ อนๆอกมากมายท  กมากมายท ใหความชวยเหล ยเ หลอ ทั  งท ท พมพ มพและช และชวยกลั  วยกลั นกรอง ส ส งน น จะ เกดข   ดขนไม นไมได ไดเลยหากขาดแรงงานและก เลยหากขาดแรงงานและกาลั าลังจากคนเหล งจากคนเหลาน  าน  ขอขอบคณคณาจารย ณคณาจารยท  ทคอยพร คอยพร าสอนด าสอนดวยความห วยความหวงใยเสมอมา วงใยเสมอมา สดท ดทายน   ายน เอกสารฉบั เอกสารฉบับน   บนยัยังไม งไมสมบ สมบรณ รณนันัก และยังม งมขขอบกพร อ บกพรองอย   องอยมาก มาก หากอานแล านแลวพบข วพบขอผ อผดพลาด ดพลาด หรอขาดตก อขาดตก บกพรองประการใดก องประการใดกขออภั ขออภัยมา ยมา ณ ท  ทน  น ดวยความปรารถนาด วยความปรารถนาด แพทยจจฬาฯ ฬาฯ ร  รนท   นท 66 66

ถง นองๆน องๆนสสตแพทย ต แพทยจจฬาฯ ฬาฯ Examination step 2 โดยนสตแพทยจฬาฯ ซ  นับเป บเปนครั   ครังแรกท  งแรกท มการรวบรวมข ารรวบร วมขอสอบ National License Examination ซ งเกดข  ดข น จากความตั   จากความตังใจของน งใจของนสสตแพทย ต แพทยจจฬาฯร   ฬาฯรนท   นท 66 66 ท  ทอยากเห อยากเหนข นขอสอบท   อสอบทสมบ สมบรณ รณใกล ใกลเค เคยงข ยงขอสอบจร อสอบจรงเพ   งเพอการศ อการศกษาเร กษาเรยนร ยนร ของนอง อง อยางถ างถกต กตอง อง มใช ใชททองค องคยยเวเวรรดเพ   ดเพอสอบเท อสอบเทานั   านัน แตยัยังสามารถว งสามารถวนนจฉั จฉัย สงตรวจเพ   งตรวจเพมเต มเตม และใหการรั การรักษาท  เหมาะสมได หมาะสม ได อันจะ เปนประโยชน นประโยชนแก แกคนไข คนไขในอนาคต

การสอบในขั   การสอบในขันตอนท   นตอนท 2 2 เปนข นขอสอบโจทย อสอบโจทยและตั และตัวเล วเลอกภาษาอั อกภาษาอังกฤษ งกฤษ 100% (ยกเวนของน นของนตตเวชศาสตร เวชศาสตรเพ เพยง ยง 5 ขอ) การสอบแบงเป งเปนคร  นคร งเชาและคร และคร ง บาย ใชเวลาอย วล าอยางละ างละ 3 ชั ชั วโมง ขอสอบม สอบ มเน น อหาปะปนกัน ดังนั  นนองสามารถเจอข งสามารถเ จอขอสอบ อายรศาสตร รศาสตร ศั ศัลยศาสตร ลยศาสตร ฯลฯ ฯลฯ ไดทั  ทังคร   งครงเช งเชาและคร   าและครงบ งบาย าย ขอขอบคณไปป ณไปป เบ เบรรดเดย ดเดย ว ว น และเพ   และเพอนๆอ อนๆอกมากมายท  กมากมายท ใหความชวยเหล ยเ หลอ ทั  งท ท พมพ มพและช และชวยกลั  วยกลั นกรอง ส ส งน น จะ เกดข   ดขนไม นไมได ไดเลยหากขาดแรงงานและก เลยหากขาดแรงงานและกาลั าลังจากคนเหล งจากคนเหลาน  าน  ขอขอบคณคณาจารย ณคณาจารยท  ทคอยพร คอยพร าสอนด าสอนดวยความห วยความหวงใยเสมอมา วงใยเสมอมา สดท ดทายน   ายน เอกสารฉบั เอกสารฉบับน   บนยัยังไม งไมสมบ สมบรณ รณนันัก และยังม งมขขอบกพร อ บกพรองอย   องอยมาก มาก หากอานแล านแลวพบข วพบขอผ อผดพลาด ดพลาด หรอขาดตก อขาดตก บกพรองประการใดก องประการใดกขออภั ขออภัยมา ยมา ณ ท  ทน  น ดวยความปรารถนาด วยความปรารถนาด แพทยจจฬาฯ ฬาฯ ร  รนท   นท 66 66

ตารางขอสอบสาหรับการประเมนความร การประเม นความร   ความสามารถในการประกอบว วามสามารถในการประกอบวชาช ชาชพเวชกรรม ขั นตอนท   ตอนท 2 2 ความร   วทยาศาสตร ทยาศาสตรการแพทยคล นนก :

นขอสอบปรนั อสอบปรนัยแบบ ยแบบ One best response เน อหาข อหาขอสอบอ อสอบองตามประกาศแพทยสภาท งตามประกาศแพทยสภาท  ลักษณะข กษณะขอสอบ อสอบ เปนข 12/2555 เร เร อง อง เกณฑความร ความร ความสามารถในการประเม ความสามารถในการประเมนเพ นเพ อรั อรับใบอน บใบอนญาตเป ญาตเปนผ น ผประกอบ ประกอบ วชาช ชาชพเวชกรรม พเวชกรรม พ.ศ.2555 สวนท วนท  2 2-5 ข. ค. ง. และ จ. งตามหมวดและกล มของ มของ Competencies ของเกณฑมาตรฐานฯ มาตรฐานฯ ของแพทยสภา จานวนข านวนขอสอบ อสอบ ม 300 ขอ แบงตามหมวดและกล ภาคผนวกท  ดังน งน  านวนขอสอบ อสอบ 30 ขอ หมวดท  1 และหลักการด กการดแลทั  แลทั วไป วไป จานวนข 1 ภาวะปกตและหลั หัวข วขอ 1.1 การสรางเสร างเสรมส มสขภาพ ขภาพ และระบบบรบาลส บาลสขภาพในส ขภาพในสขภาพของบ ขภาพของบคคล คคล ชมชน มชน และประชาชน (ดรายละเอ รายละเอยดในส ยดในสวนท  วนท  3 3 ค. สขภาพและการสร ขภาพและการสรางเสร างเสรมส มสขภาพ ขภาพ ) 1.2 การรวบรวมขอมล และประเมนป นปญหาทางสขภาพของบ ขภาพของบคคล คคล ครอบครัว และชมชนในความ มชนในความ รับผ บผดชอบโดยใช ดชอบโดยใช ว วธธการทางระบาดว ก ารทางระบาดวทยาพ  ทยาพ นฐาน 1.3 การประเมนส นสขภาพ ขภาพ และใหคคาแนะน า แนะนาท ท เหมาะสมเพ เหมาะสมเพ อความม อความมสสขภาพด ข ภาพด แกบบคคลตามวั คคลตามวัยและ ยและ สภาวะตางๆ างๆ ตั ตั งแต งแตทารกในครรภ ทารกในครรภ ทารกแรกเกด วัยก ยกอนเข อนเขาเร าเรยน ยน วัยเร ยเรยน ยน วัยร ยร น วัยหน ยหน มสาว มสาว ผ ใหญ หญงม งมครรภ ครรภ วัยส ยสงอาย งอาย ผพพการ ก าร และผ ททพพลภาพ พพลภาพ 1.4 การเช อมโยงความสั อมโยงความสัมพั มพันธของส ของสขภาพบ ขภาพบคคลกั คคลกับส บสขภาพครอบครั ขภาพครอบครัว ประเมนพั นพัฒนาการและป ฒนาการและปญหา ญหา สขภาพของครอบครั ขภาพของครอบครัว รวมทั  รวมทั งให งใหคคาปรกษาและด กษาและดแลป แลปญหาส ญหาสขภาพเบ ขภาพเบ องตนแก นแก ผผปปวยและครอบครั ว ยและครอบครัว 1.5 การตรวจสขภาพ ขภาพ ตรวจคัดกรองโรค ดกรองโรค และออกความเหนหร นหรอหนั อหนังส อรั อรับรองความเห บรองความเหนไดอย อยาง เหมาะสม 1.6 การตรวจและใหความเห ความเหนหร นหรอท อทาหนังส งสอรับรองเก บรองเกยวกั ยวกับผ บ ผปปวย ว ย ผพพการและท ก ารและทพพลภาพ พพลภาพ ผเส เสยหาย ยหาย ผตตองหา อ งหา หรอจ อจาเลย าเลย ตามความท กฎหมายกาหนดให าหนดใหพนั พนักงานสอบสวน กงานสอบสวน องคกร กร หรอศาลในก อศาลในกจการ จการ ตาง าง ๆ ได เชน หนังส งสอรับรองส บรองสขภาพ ขภาพ หนังส งสอรั อรับรองความพ บรองความพการท การทพพลภาพ พพลภาพ หนังส งสอรับรองการตาย บรองการตาย การเปนพยานต นพยานตอพนั อพนักงานสอบสวนและศาล กงานสอบสวนและศาล 1.7 การชันส นสตรพล ตรพลกศพ กศพ เกบวั บวัตถ ตถพยานจากศพ พยานจากศพ รวมกั วมกับพนั บพนักงานสอบสวน กงานสอบสวน ตามทหมายก หมายกาหนดได สามารถออกรายงานการชันส นสตรพล ตรพลกศพ ให กศพ ใหถถอยค อ ยคาเป าเปนพยานในชั  นพยานในชั นสอบสวนและชั นศาลได นศาลได 1.8 การระบป ปญหา ญ หา วเคราะห เคราะห และใหแนวทางปฏ แนวทางปฏบับัตตเช เชงเวชจรยศาสตร ยศาสตร (ด (ดรายละเอ รายละเอยดใน ยดใน สวนท วนท 4 ง. เวชจรยศาสตร ยศาสตร) และกฎหมายท เก เก ยวข ยวของ (ดรายละเอ รายละเอยดใน ยดใน สวนท  วนท  5 5 จ. กฎหมายท  กฎหมายท เก เก ยวข ยวของกั องกับการ บการ ประกอบวชาช ชาชพเวชกรรม) พเวชกรรม)

จานวนข านวนขอสอบ อสอบ 4 3 3

2 4 4

5

5

านวนขอสอบ อสอบ 270 ขอ หมวดท  2 ภาวะผดปกต ดปกตจจาแนกตามระบบอวั า แนกตามระบบอวัยวะ ยวะ จานวนข จาแนกออกเป าแนกออกเปน 3 กล  กล ม ดังน งน  กล มท มท  1 1 45 ขอ - กลไกการเกดโรค ดโรค - การวนนจฉั จ ฉัยเบ องต องตน - การบาบั าบัดรั ดรักษา กษา ได ไดอย อยางทั างทันท นทวงท วงท - รขขอจ อ จากั ากัดของตนเองและปร ดของตนเองและปรกษา กษา ผเช เช ยวชาญหร ยวชาญหรอผ อ ผมมประสบการณ ป ระสบการณ มากกวาไดอย อยางเหมาะสม างเหมาะสม

กล มท มท  2 2

กล มท มท  3 3

225 ขอ - กลไกการเกดโรค - กลไกการเกดโรค ดโรค ดโรค - การวนนจฉั - การวนนจฉั จ ฉัยดวยตนเอง จ ฉัยแยกโรค วยตนเอง - การบาบั - การแก ไขปญหา าบัดรั ดรักษา กษา ได ญหาเฉพาะหนา/ หลักในการด กในการดแล แล ไดดดวยตนเอง วยตนเอง า/ หลั - การฟ นฟ นฟสภาพ สภาพ การสรางเสร างเสรมส มสขภาพ ขภาพ รักษา กษา - การฟ นฟ และการปองกั องกันโรค นโรค นฟสภาพ สภาพ การสรางเสร างเสรมส มสขภาพ ขภาพ และ งตอเพ  อเพ อปร อปรกษาผ กษาผ เช เช ยวชาญกรณ ยวชาญกรณ โรค การปองกั องกันโรค นโรค - การสงต รนแรงหร นแรงหรอซั อซับซ บซอนเก อนเกนความสามารถ ดสนใจส นใจสงต งตอเพ  อเพ อปรกษาผ กษาผ เช เช ยวชาญ ยวชาญ - การตัดส

จาแนกตามกล าแนกตามกล มโรค มโรค ดังน งน  หัวข วขอ 2.1 อาการ / ปญหาส ญหาสาคั าคัญ 2.2 โรคกล มอาการ มอาการ / ภาวะฉ ภาวะฉกเฉ กเฉน (กล มท มท  1) 1) 2.3 โรคตามระบบ

จานวนข านวนขอสอบ อสอบ รวมกั วมกับโรคกล บโรคกล มท  1 1 และ โรคตามระบบ 45

225

I. INFECTIOUS INFECTIOUS AND PARASITIC DISEASES

II. NEOPLASM

20 6

III. DISEASES OF BLOOD & BLOOD FORMING ORGANS AND DISORDERS INVOLVING

14

THE IMMUNE MECHANISM IV. ENDOCRINE, NUTRITIONAL, AND METABOLIC DISEASE

15

V. MENTAL & BEHAVIORAL DISORDERS

15

VI. DISORDERS OF THE NERVOUS SYSTEM

14

VII. DISORDERS OF THE EYE AND ADNEXA

6

VIII. DISORDERS OF THE EAR & MASTOID PROCESS

6

IX. DISORDERS OF THE CIRCULATORY SYSTEM

14

X. DISORDERS OF THE RESPIRATORY SYSTEM

14

XI. DISORDERS OF THE DIGESTIVE SYSTEM

14

XII. DISORDERS OF SKIN & SUBCUTANEOUS TISSUE

7

XIII. DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE

13

XIV. DISORDERS OF THE GENITO URINARY SYSTEM

14

XV. PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM

18

-

XVI. CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD

8

XVII. CONGENITAL MALFORMATIONS, DEFORMATIONS AND CHROMOSOMAL

5

ABNORMALITIES XIX. INJURY, POISONING AND CONSEQUENCES OF EXTERNAL CAUSES

12

XX. EXTERNAL CAUSES OF MORBIDITY & MORTALITY

10

รวม

225

ฃ

2

ขั  ขันตอนท   นตอนท 2/2558 ครั   ครังท   งท 1 จัดสอบเม   ดสอบเมอวั อวันท   นท 3 พฤษภาคม 2558 สถตตท  ท นนาสนใจ าสนใจ คะแนนเฉล   คะแนนเฉลยท ยทกสถาบั กสถาบัน (รอยละ) อยละ) คาเบ   าเบยงเบนมาตรฐาน ยงเบนมาตรฐาน

63.3 8.6

เกณฑผ ผาน า น (รอยละ) อยละ)

52.33

คนตก (รอยละ) อยละ) คะแนนสงส งสด คามั ามัธยฐาน ธยฐาน ฐานนยม ยม

10

%

193 คะแนน 195 คะแนน

ผลการสอบจาแนกตามหั าแนกตามหัวข วขอในตารางข อในตารางขอสอบ อสอบ หัวข วขอ C1.1

คะแนนเฉล   คะแนนเฉลยท ยทกสถาบั กสถาบัน

หัวข วขอ

คะแนนเฉล   คะแนนเฉลยท ยทกสถาบั กสถาบัน

67.2 ± 20.5

C2.3.1

70.5 ± 12.5

C2.3.2

58.7 ± 21.3

C2.3.3

67.6 ± 14.7

C2.3.4

64.3 ± 13.1

C2.3.5

69.7 ± 12.8

C2.3.6

67.6 ± 14.6

C2.3.7

75.9 ± 18.0

C2.3.8

54.3 ± 18.7

C2.3.9

68.0 ± 15.5

C2.3.10

55.0 ± 13.7

C2.3.11

65.1 ± 13.5

C2.3.12

60.2 ± 21.9

C2.3.13

67.8 ± 14.2

C2.3.14

55.9 ± 14.4

C2.3.15

62.1 ± 12.5

C2.3.16

56.9 ± 18.2

C2.3.17

56.8 ± 22.6

C2.3.18

55.9 ± 14.2

C2.3.19

57.0 ± 15.6

C1.8

83.4 ± 23.1 38.1 ± 26.2 31.6 ± 32.8 60.3 ± 23.8 68.5 ± 21.0 63.0 ± 23.2 44.2 ± 21.7

C2.1

57.0 ± 15.6

C1.2 C1.3 C1.4 C1.5 C1.6 C1.7

เปอรเซนไทล จาแนกตามคะแนน คะแนน

เปอรเซนไทล

217

87.12

190

45.64

246

99.89

216

86.12

189

44.19

245

99.80

215

85.07

188

42.53

242

99.69

214

83.71

187

40.73

241

99.55

213

82.43

186

38.98

240

99.26

212

81.14

185

37.31

239

98.97

211

79.59

184

35.72

238

98.82

210

78.07

183

34.31

236

98.55

209

76.73

182

33.06

235

98.28

208

75.41

181

31.85

73.78

30.75

97.67

207

180

233

72.06

29.35

97.21

206

179

232

70.58

27.94

96.83

205

178

231

68.95

26.89

96.34

204

177

230

203

67.41

176

26.00

229

95.73 202

65.98

175

24.79

201

64.17

174

23.36

200

62.31

173

22.17

199

60.59

171

20.16

198

58.99

170

19.09

197

57.42

168

17.32

196

55.83

167

16.27

195

53.94

166

15.26

194

51.95

165

14.51

193

50.25

162

12.58

192

48.66

158

10.42

191

47.16

228 227

95.26 94.97

226

94.59

225

93.96

224

93.27

223

92.42

222

91.57

221

90.81

220

90.03

219

89.18

218

88.18

National License Examination steps 2 ( ชด A) 1.

A 30-year-old man is collapsed with no pulse. After start CPR, monitoring EKG is shown below. What is the next step management

2.

A.

Atropine

B.

Amiodarone

C.

Chest compression

D.

Cardioversion

E.

Defibrillation

A 35-year-old man presented COPD with exacerbation. He was on mechanical ventilator 1 day ago. Today, he develops dyspnea, diaphoresis and cyanosis. PE: RR 32/min, PR 120/min, BP 90/60 mmHg, decreased breath sound, normal S1 S2, no murmur. What is the most likely lung f inding in this patient A.

Diffuse rales

B.

Bilateral wheezing

C.

Dullness on percussion

D.

Prolong expiratory phase

E.

Trachea shift from midline

3. 4.

A 50-year-old woman depressed mood, insomnia, loss of appetite and suicidal idea. She also hear the voice telling her to die to end her suffering. The symptoms started after her 25 years old son died 2 months ago. She had not done any housework and spent the time alone in her room all day. Which of the following is the most likely diagnosis

5.

A.

Grief reaction

B.

Acute stress reaction

C.

Schizoaffective disorder

D.

Major depressive disorder with psychotic feature

E.

Adjustment disorder with depress mood

ผ หญง ผ ใหญ ไมแก อาการแนนหนาอก เหง อแตก หายใจไมออก3ครั ง/เดอน กังวล กลัวตาย ไมกลาออกไปไหนคนเดยว จะใหยา อะไร A.

Propanolol

B.

Fluoxetin

C.

Diazepam

D.

Chlorpromazine

rd

National License Examination steps 2 part 1 (3 May 2015)

6.

A 65-year-old man presents with dyspnea for 1 day. BT 37 C, RR 32/min, BP 200/140 mmHg.PE: fine crepitation both lungs, edema both legs. What is the most appropriate management A.

Nitroglycerine

B.

Atenolol

C.

Nitroprusside

D.

Hydralazine

7. 8.

A 30-year-old woman, BMI 28, presents with

ต นตอนกลางคนข นมา 2 รอบ รวมกับอาการงวงตอนกลางวัน มหลับตอนทางาน.

What is the most likely diagnosis

9.

A.

Primary snoring

B.

Obstructive sleep apnea

C.

Hypoventilation syndrome

D.

Obesity hypoventilation

A 14-year-old girl, with no underlying disease, was raped 2 days ago. She has regular menstrual cycle of 28 days. LMP was 18 days ago. What is the proper management for pregnancy prevention?

10.

11.

A.

Reassure

B.

DMPA 150 mg IV stat

C.

Levonorgestrel (0.75 mg) 2 tab po stat

D.

Ethyl estradiol (20 mcg) 2 tab po stat

E.

Medroxyprogesterone acetate (5 mg) 2 tab po stat and repeat dose within 12 hr

A patient epidural hematoma with midline shift intubation. What is the initial management A.

Mannitol

B.

Hyperventilate

C.

Dexamethasone

A 25-year-old man brought to hospital by parents. There are benzodiazepine and amitriptyline empty bottle beside him. PE: drowsiness, BT 37.0, BP 90/60 mmHg, RR 12/min, pinpoint pupil. Wh at is the initial management

12.

A.

Naloxone

B.

NG tube

C.

Endotracheal tube

A 40-year-old woman presented at ER with snake bite. She did not know what kind of snake it is. PE: BT 37 c, PR 80, RR 12, BP 110/60 mmHg, ptosis and generalized weakness, fang mark at dorsal foot. What is the initial management? A.

Antibiotics

B.

Antivenom

C.

ET intubation

D.

Anti toxin

E.

Wound debridement

13. 14. 15.

25-year-old female patient presents with foul smell vaginal discharge. PE: yellow-greenish discharge with red spot at cervix and vagina. What is the etiology? (โจทยใหมาแคน จรงๆ) A Thai

A.

Candida albican

B.

Neisseria gonorrhoeae

2

rd


16.

C.

Hemophilia ducreyii

D.

Gardnerella vaginalis

E.

Trichomanas vaginalis

A 20-year-old female presents with fever for 4 days. PE: Bilateral cervical lymphadenopathy, palpable liver 2 cm BRCM. There are lesions in her mouth as shown in the picture. What is the initial investigation?

17.

A.

Throat swab

B.

CBC

C.

Hemoculture

D.

Liver function test

E.

Anti EBV IgM Titer

A 6-year-old presents with dyspnea, hoarseness, cough, chest tightness. History of rhinorrhea in the morning. PE: BT 37, RR 30, HR 100, lung-bilateral expiratory wheezing, rhonchi. What is the most likely diagnosis A.

Asthma

B.

Bacterial tracheitis

C.

Bronchitis acute

D.

Bronchiolitis acute

E.

Pneumonia

18. 19.

A 32-year-old woman comes with palpitation. PE: PR 120 bpm, diffuse thyroid enlargement with tenderness. T3 5, T4 4, TSH 0.001. What is the appropriate management

20.

A.

I131

B.

Ceftriaxone

C.

PTU

D.

Methimazole

A 7-day-old infant delivery at home. He is irritable, feeding difficult, generalized rigidity, muscle spasm to response. Umbilical stump normal. What is the most likely diagnosis

21.

A.

Tetanus

B.

Meningitis

C.

Encephalitis

D.

Hypocalcemia

E.

Hypoglycemia

A 35-year-old man HIV-positive presented with 2 weeks of fever, 1 week of progressive right side weakness headache vomiting, and seizure 1 day PTA. CT with contrast shown multiple nodular lesions at basal ganglia, thalamus and cerebellum. What is the diagnosis A.

Lymphoma

B.

Toxoplasmosis

C.

Cryptococcosis

3

rd


22.

A woman hyperthyroid. T3, T4, TSH 0.01. What is the appropriate investigation A. B. C.

Fine needle aspiration

D.

Thyroid scan and uptake

E. 23.

Chronic alcoholism has foul smell purulent sputum pneumonia RUL. PE: crepitation RUL. CXR: RUL cavity with air fluid level. What is the antibiotics

24.

A.

Azithromycin

B.

Ceftriazone

C.

Trimethoprim-sulfamethoxazole

D.

Amoxicillin-clavulanate

E.

Anti TB drugs

A 65-year-old man underlying dilated cardiomyopathy present with dyspnea and edema for 2 weeks. PE: afebrile, edema 3+ both legs, minimal ascites, coarse crepitation both lower lungs, liver 4 FB BRCM. CXR: increase alveolar opacity at both lower lungs with left pleural effusion. A thoracentesis was done. Pleural effusion: straw color. What is the case of effusion Effusion 3

WBC

25.

Serum

350 cell/mm

-

N60

-

L40

-

Protein

2.5

6.0

LDH

200

400

Glucose

70

100

A.

Congestive heart failure

B.

Hepatic hydrothorax

C.

Malignant pleural effusion

D.

Parapneumonic effusion

E.

Tuberculouspleuritis

A 25-year-old man presents with fever and rash at palm and sole. Lab: positive VDRL 1:128, reactive TPHA. What is the appropriate treatment A.

Benzathine penicillin G 2.4 mu IM single dose

B.

Benzathine penicillin G 2.4 mu IM weekly for 3 wk

C.

Doxycyclin

D.

Ceftriaxone 1 g IV single dose

26. 27.

A 65-year-old man presents with hematochezia. BP 80/60 mmHg, P 110. NG lavage no bile, no blood. After resuscitate, what should be done A.

Angiogram

B.

Colonoscope

C.

CT abdomen

D.

Esophagogastroscopy

4

rd


28.

A 46-year-old man complains of vomiting after dinner for 1 month. He has this symptom before and progressive epigastric pain for 3 years. Weight loss. PE: tender at epigastrium, hypertympanic percussion, normal bowel sound. What is the most likely diagnosis A.

Esophageal stenosis

B.

Pyloric stricture

C.

Gastric cancer

D.

Colon cancer

E.

Achalasia

29. 30.

A 1-year-old boy had a watery diarrhea for 2 days, today he has periodic screaming, crying and also mucous-bloody diarrhea, PE:

(ไมใช RLQ จรงๆนะ). What is the most likely diagnosis?

abdomen- ill defined mass can be palpated at RUQ A.

Intussusception

B.

Meckel's diverticulum

C.

Acute gastroenteritis

D.

Midgut volvulus

E.

Pyloric stenosis

31. 32.

(ไมไดให sign อะไรมาเลย)

A patient pain wrist radial side. She has just delivery her child. What is the diagnosis A.

Wrist joint arthritis

B.

Median nerve entrapment

C.

DeQuervain tenosynovitis

33. 34.

A 70-year-old female has left wrist pain for 2 days. PE: BT 38, tender along joint line with redness and swelling, other WNL. Arthrocentesis reveals WBC 5,000 (N96,L4) intracellular rhomboid shape crystal. Which is the pertinent finding in radiology

35.

A.

Marginal erosion

B.

Chondrocalcinosis

C.

Punch-out lesion

D.

Narrowing joint space

E.

Marginal osteophyte

A 75-year-old patient with chronic neck pain for 3 years. Pain radiates from neck to right index and middle finger. PE: decrease nd

pinprick at 1,2 fingers, decrease forearm and wrist extension power. Triceps areflexia, other WNL. What is the diagnosis A.

Ulnar nerve neuropathy

B. C.

Radial nerve neuropathy

D.

C7 radiculopathy

E.

Median nerve neuropathy

F.

Brachial plexopathy

5

rd


36.

A 30-year-old man has warm, swelling at PIP joint, wrist joint both hands for 2 months. He has stiffness of bilateral wrist joint in the morning 2 hours. X-ray hand reveals periarticular osteopenia A.

Psoriatic arthritis

B.

Osteoarthritis

C.

Rheumatoid arthritis

D.

Reactive arthritis

37. 38.

An 18-year-old woman presents with edema fever 2 days. She has this symptom 2 years ago. PE: pustule at leg. What is the diagnosis

39.

40.

A.

Lupus nephritis

B.

IgA nephropathy

C.

Poststreptococcal glomerulonephritis

A 55-year-old man has gross hematuria with clot, no fever but have right flank pain. What is the most appropriate management A.

Cystoscope

B.

CT abdomen

C.

KUB ultrasound

D.

Repeat UA

E.

Intravenous pyelogram

A 28-year-old woman, primigravidarum, GA 10 weeks, little bleeding per vagina with blight red blood. PV: os closed, old blood clot. Ultrasound presents gestational sac, 10 week-size, normal fetal heart activity. What is the appropriate management

41.

A.

Bed rest

B.

Cervical cerclage

C.

Estradiol

D.

Sedatic and narcotic drug

E.

Inhibit with tocolytic

A patient fever admit for hospital acquired pneumonia treat with … and vancomycin 7 days. The symptoms improve but develop

diarrhea and fever again. What is the cause A. B.

Clostridium difficile

C. D. 42.

Entamoeba histolytica

(variable deceleration)What is the management

6

rd


43.

A.

Drip oxytocin

B.

Amniotomy

C.

Observe

D.

Emergency c/s

E.

Intrauterine resuscitation

A 35-year-old female patient primigravida GA 10 week by LMP presented with blood spotting. PE: Uterus 20 week size. Ultrasonography revealed numerous cystic appearance. What is the most appropriate management?

44.

A.

Waiting for spontaneous abortion

B.

Misoprostal vaginal suppository

C.

Suction curettage

D.

Fractional curettage

E.

Hysterectomy

A 24-year-old woman presents with abnormal vaginal bleeding with abdominal pain for 6 hours. LMP 2 months. Urine pregnancy weakly positive. PE: P 110/min, BP 90/60 mmHg. Abdomen- distended, generalized guarding, pain at suprapubic. PV: NIUBnomal, Vg- normal, Cx- cervical motion tenderness and minimal bleed per os, Adx- 4cm mass at right adnexa, tender. What i s the most likely diagnosis

45.

A.

Rupture ovarian cyst

B.

Acute appendicitis

C.

Ectopic pregnancy

D.

Tortion ovary

E.

Tuboovarian cyst

A 40-year-old woman first ANC at GA 12 weeks. She has severe nausea, vomiting, dark urine. PE: fundal 2/3 above pubic symphysis. What is the most proper investigation A.

Serum β-hCG

B.

46.

47.

48.

C.

Ultrasound

D.

Amniocentesis

E.

Progesterone supplement

ผ ปวยชาย วัยกลางคน U/D : DM มาดวย acute Rt pinna & auricle tender & redness , severe pain เม อโดนดงหถาม management A.

Topical ATB

B.

Oral ATB

C.

Oral ATB and Topical steroid

D.

Oral ATB and Topical ATB

E.

IV ATB

A patient with dyspnea. Oxygen sat 86%. CXR: interstitial infiltration both lungs. What is the etiology A.

Virus

B.

Bacteria

C.

Fungus

D.

Protozoa

E.

Prion

A woman A.

กังวลวาจะเปนโรครายแรง ตอมากังวลวาสามขับรถไปขางนอกจะอันตราย Generalized anxiety disorder

7

rd


49.

A 10-day-old neonatal, birth weight 3,200 g, presents with jaundice. She is exclusively breastfed and passes loose y ellow stool 6-7 times per day. PE: weight 4,000 g, mild to moderate jaundice, otherwise normal. Lab: Hct 48%, microbillirubin 16 mg/dL. What is the most appropriate management

50.

A.

Expose to sunlight in the morning

B.

Force oral fluid

C.

Switch to infant formula

D.

Continue breastfeeding

E.

Phototherapy

A 30-year-old woman has headache. She takes many supplement medication. PE: papilledema. CT: no abnormality. Other normal. What is the diagnosis A.

Vitamin A toxicity

B.

Vitamin D toxicity

C.

Vitamin E toxicity

D.

Zinc toxicity

E.

Copper toxicity

51. 52.

A 65-year-old man has progressive fatigue for 3 months. PE: marked pale, mild jaundice, no hepatosplenomegaly, no superficial lymphadenopathy, Hb 14, MCV 120, platelet 65,000. What is the diagnosis

53.

A.

Lymphoma

B.

Autoimmune hemolytic anemia

C.

Megaloblastic anemia

D.

Chronic myelogenous leukemia

E.

Aplastic anemia

A 3-year-old boy presents with dark urine 1 day. He has had fever 2 days ago. No medication. He has history of neonatal jaundice. BT 38 C, P 120. PE: mild jaundice, icteric sclera, no hepatosplenomegaly. PBS: Hct 28%, normochromic, normocytic anemia with Hb leakage from RBC. What is the diagnosis

54.

55.

A.

Autoimmune hemolytic anemia

B.

G6PD deficiency

C.

Hemoglobin H disease

D.

Iron deficiency anemia

A SLE patient on steroid then develop dyspnea, stool change. What is the cause A.

Strongyloid stercolaris

B.

Capillaria philippinensis

C.

Necator americanus

D.

Entamoeba histolytica

A patient dyspnea. Oxygen sat 86%. CXR: interstitial infiltration both lungs. What is the cause A. B.

Pneumocystis jiroveci

C.

Cryptococcus neoforman

D. 56.

A 6-year-old boy presents with fever, sore throat and dysphagia for 2 days. PE: BT 39, P112, bulging posterior pharyngeal wall, anterior cervical lymphadenopathy, stiffness of neck, no hepatosplenomegaly. What is the diagnosis

8

rd


57.

A.

Acute epiglottitis

B.

Peritonsillar abscess

C.

Retropharyngeal abscess

D.

Infectious mononucleosis

E.

Ludwig angina

A woman has tinnitus both ears. Sometimes dizziness for 1 -2 days. PE: normal hearing both ears A.

Psychotic

B.

Meniere disease

C. D. 58.

Benign paroxysmal positional vertigo

A 35-year-old man admitted day 2 for herniorhaphy. He develops agitation, confusion, visual hallucination. What is the most likely cause of his symptom

59.

A.

Head injury

B.

Substance abuse

C.

Stress

D.

Cognition

E.

Psychiatry in family

After 6 months of parental divorce, a 13-year-old girl ingested 20 tabs of paracetamol before she was brought to hospital 1 hour. PE: irritable and apathy. Which of the following is most likely diagnosis

60.

A.

Anxiety disorder

B.

Major depressive disorder

C.

Adolescent turmoil

D.

Anxiety disorder

E.

Borderline personality disorder

An 18-year-old man

ไปซอมยงปน 2 days ago. กลับมาไดยน เสยง tinnitus. Otoscope: normal eardrum. Tuning fork 512 Hz: Weber

not lateralized, Rinne positive both ears. What is the diagnosis

61.

A.

Otosclerosis

B.

Osteochondroma

C.

Acoustic trauma

D.

Minere disease

E.

Ossicular chain dislocation

A 4-year-old boy presents with fever and loss of appetite for 10 days. 3 days prior to admission, he had consciousness deterioration with vomiting. PE: BT 39 c, PR 83, BP 110/80 mmHg, stiff neck positive, Babinski sign positive, hyperreflexia. LP: WBC 550 (N10, L90), protein 500, sugar 20 (blood 100), gram stain negative, indian ink negative. What is the most appropriate management? A.

Acyclovir

B.

Oseltamevir

C.

Ceftriaxone

D.

Amphotericin B

E.

Antituberculous medication

9

rd


62.

63.

A child has had otitis media. Today he develops dyspnea. What is the antibiotics A.

Ceftriaxone

B.

Augmentin

A girl has left eye pain itching watery discharge 3 days PTA, then the right eye develop this symptom.PE: conjunctival injection, chemosis, follicle reaction, preauricular lymph node. What is the diagnosis

64.

A.

Trachoma

B.

Chlamydia conjunctivitis

C.

Allergic conjunctivitis

D.

Endemic keratoconjunctivitis

A tennis player has right eye pain and cannot look upward. He has history of tennis ball hit his right eye before symptom 2 weeks. What is the diagnosis

65.

A.

Rupture globe

B.

Blow out fracture

A patient burn 2 hours before arriving at hospital. PE reveals severe skin burn at left and right upper extremities and anterior trunk. Body weight 50 kg. What is the management

66.

A.

RL… ml/hr

B.

RL 450 ml/hr

C.

NSS 450 ml/hr

D.

RL 600 ml/hr

E.

NSS 600 ml/hr

A 60-year-old mancomes with acute chest pain radiated to back. He had DM, Hypertension, dyslipidemia. PE: agitation, PR 110, RR 30,BP 160/100(left), BP 90/60(right). EKG: tachycardia. What is the diagnosis

67.

A.

Aortic dissection

B.

Takayasu arteritis

C.

Coarctation of aorta

D.

Acute coronary syndrome

A 50-year-old man has acute chest discomfort 3 days. His father death from myocardial infarction at 45 years old. PE: normal S1

(ไมไดบอกคาปกตมาให). What is the diagnosis

S2, S3 gallop. EKG: ST depression at lead II, III, aVF. TroponinT0.12ng/mL

68.

A.

Acute unstable angina

B.

Non ST elevate myocardial infarction

C.

Acute myocarditis

D.

Recent transmural infarction

E.

Prinzmetal angina

A 45-year-old man presents with leg pain 2 hours ago. PE: PR 110 total irregular, right leg cold and pale skin, posterior popliteal pulse absent, dorsalispedis absent, pain at right first toe, paresthesia below right ankle, no muscle paralysis. What is appropriate diagnosis

69.

A.

compartment syndrome

B.

acute popliteal embolism

C.

acute femoral-popliteal thrombosis

D.

deep vein thrombosis

A 20-year-old man presents with fever, dry cough for 2 weeks. BT 38 C, BP 100/70 mmHg, PR 70, pruritic popular eruption, multiple lymphadenopathy, lung crepitation, O2 sat 83%. CXR: diffuse bilateral opacity. What is the proper antibiotics A.

Ceftriaxone

10

rd


70.

B.

Trimetoprim-sulfamatoxazol

C.

Azithromycin

D.

Anti TB drugs

E.

Amphotericin B

A 50-year-old man came with bloats for years. Previous investigations were normal. He has history of a stressful couple. His wife always made him feel minimal. He concerns having serious conditions when he has abdominal discomfort. What is the diagnosis

71.

A.

Panic disorder

B.

Dysthymia

C.

Hypochondriasis

D.

Generalized anxiety disorder

E.

Obsessive compulsive disorder

A 55-year-old man has chronic intermittent well-defined erythematous greasy scaly plaque at nasolabial fold, glabella, eyebrow, external ear canal. What is the diagnosis

72.

A.

Rosecea

B.

Tinea faciae

C.

Acne vulgaris

D.

Psoriasis vulgaris

E.

Seborrheic dermatitis

A woman 3 months postpartum has diffuse hair loss. Hair pulling test club-shaped hair at proximal. What is the diagnosis A.

Alopecia areata

B.

73.

C.

Telogen effluvium

D.

Tricophillomania

E.

Androgenetic alopecia

(ไมไดบอก strawberry tongue, lymph

A 2-year-old boy has fever, rash, edematous hands and feet. ESR 60. What is the diagnosis node)

74.

A.

Scarlet fever

B.

Kawasaki disease

C.

Meningococcal

A 30-year-old man has motorcycle accident 2 cm laceration and contaminated wound with muscle exposed left leg. X -ray left leg: segmental bilateral and fibular fracture. What is the most proper management A.

IV cloxacillin

B.

Explore wound

C.

Saline irrigation with antibiotics

D.

Plate and screw fixation

E.

Delayed primary closure

11

rd


75.

A 20-year-old male, multi-drugs use, was brought to the hospital 1 hour ago with severe agitation. BT 40 C, BP 175/90 mmHg, RR 36/min, PR 110 irregular. PE: comatose with dilated pupils. While the doctor was performing the physical examination, the patient had a cardiac arrest. CPR and defibrillation were performed for 1 hour but not success. What is the most likely causative substance?

76.

A.

Cocaine

B.

Metamphetamine

C.

Heroin

D.

Marijuana

E.

Ethanol

คนท เปน DM,HTN มประวัต stroke ลมทกอยางในชวต A.

77.

Vascular dementia

A patient car accident presents with hematuria. PE: flank bruising 5 cm. FAST negative. UA: RBC>100, WBC 2 -5. What is the most helpful investigation

78.

A.

Angiography

B.

CT abdomen

C.


A 2-year-old girl presented with hoarseness and noisy breathing on inspiring for 2 days which happened after an episode of fever with cough and rhinorrhea. PE: Rhonchi both lung, no crepitation. What is the most appropriate management?

79.

A.

Lateral neck x-ray

B.

Film chest with neck

C.

Inhaled corticosteroid

D.

Salbutamol

E.

Guaifenesin

A newborn PROM reveal meconium. Dyspnea, meconium aspiration. What is the management A. B.

Chest compression

C. D. E. 80.

Orotracheal tube and suction

A 6-year-old boy brought by his mother for certificate of disability. IQ 60. What is the cause of disability

81.

A.

Idiopathic

B.

Birth asphyxia

C.

Chromosomal abnormalities

D.

Cerebral palsy

E.

Environment

ผ ปวยเดก จาอายและเพศไมได ประวัตชัก Generalized tonic clonic seizure 30 min มารดาปฏเสธประวัตอ น  ทกส งอยางไมวาจะ Head injury infection trauma ครั งน เปน First episode เลย ถาม What is the most appropriate management? A.

Diazepam IV

B.

Phenytoin IV

C.

Phenobarbital IV

D.

Sodium valproate Oral

E.

Endotracheal tube

12

rd


82.

An 80-year-old man diagnosed prostate cancer 2 years ago. Now he has bone and lung metastasis. His daughter doesn’t want to tell him because his wife was diagnosed hepatocellular carcinoma 3 years ago and die soon after she k new. What is the management A. B. C. D. E.

83.

สัญญากับลกสาววาจะบอกผ ปวยเม อพรอม บอกลกสาววาเปนสทธของผ ปวยท จะร ผล เรยก family conference หาวธบอกผ ปวย ตอรองลกสาววาผ ปวยอาจจะร แลวจากการท เปนโรคมานาน บอกลกสาววาถารักษาโดยไมบอกความจรงจะทาใหผ ปว ยไมเช อ (ภาพน เลย). His father height 160 cm,

An 8-year-old boy with asthma on inhaled steroid for 2 years. Growth chart as shown mother 150 cm. What is the cause of delayed growth

84.

A.

Chronic asthma

B.

Constitutional growth delay

C.

Familial short stature

D.

Growth hormone deficiency

E.

Chronic use of steroid

A 10-year-old girl presents with drowsiness and hyperpnea 2 hours PTA. She has polyuria and polydipsia for 1 month. PE: BT 37 C, PR 70, RR 30, BP 90/70 mmHg, capillary refill 3 sec. Lab: BS positive. After fluid resuscite what is the proper management A.

3% NaCl

B.

Kayexalate

C.

7.5% NaHCO

D.

NPH insulin

E.

Regular insulin

3

85.

13

600 mg/dl, Na 125, K 5.5, HCO3 8, Cl 98, urine ketone

rd


86.

A 34-year-old patient with underlying thalassemia underwent a blood transfusion. He developed back pain, fever, chill and dark urine 15 minutes after receiving transfusion. V/S BT 37 c, BP 110/70, PR 90, RR 20. What is the most likely diagnosis?

87.

A.

Allergic reaction

B.

Anaphylactic reaction

C.

Acute hemolytic reaction

D.

Febrile reaction

E.

Sepsis

A 60-year-old man was admit in the hospital with acute gastroenteritis and treated with antispasmodic agent and antiemetic agent, the patient look good. But 4 hours later, he was restless, abdominal pain, BP 170/110, PR 110, PE: cystic mass 8 x 8 cm at suprapubic area. What is the appropriate management for this patient

88.

A.

Consult surgeon

B.

Urinary catheterization

C.

Morphine infusion

D.

Emergency abdominal ultrasonography

A 20-year-old man accident stupor, close his eyes, on endotracheal tube before refer. With pain stimuli, left arm flex, right arm extend. Evaluate the Glasglow coma score

89.

A.

E1VtM4

B.

E1VtM3

C.

E1VtM2

D.

E1V1M3

E.

E1V1M2

A 60-year-old male had syncope while taking a shower. He has had well controlled HT, DLP for 5 year. PE: delayed carotid upstroke, SEM grade III right and left UPSB, neurological exam: normal, others: unremarkable. What is the most likely diagnosis A.

Transient ischemic attack

B.

Mitral valve prolapse

C.

Aortic stenosis

D.

Sick sinus syndrome

E.

Vasovagal attack

90. 91. 92.

93.

What is the diagnosis A.

Epidural hemorrhage

B.

Subdural hemorrhage

C.

Subarachnoid hemorrhage

D.

Intracerebral hemorrhage

E.

Intraventricular hemorrhage

A 60-year-old woman underlying DM has cholangitis. BP 80/50 mmHg. After NSS load 15 minutes BP 80/50 mmHg. JVP 1 cm above sterna angle. What is the most appropriate management A.

Albumin 5%

B.

NSS load 15 minutes

C.

Dopamine

D.

Norepinephrine

14

rd


E. 94.

Hydrocortisone

A 35-year-old man developed a sharp epigastric pain 1 day. He has had history of chronic dyspepsia for 4 years. PE: BT 37 C, P 110, BP 110/70, tender epigastric pain, guarding, loss of liver dullness. What is the diagnosis

95.

96.

A.

Ruptured hepatoma

B.

Peptic perforate

C.

Ruptured appendicitis

D.

Ruptured sigmoid diverticulitis

E.

Acute appendicitis

A patient acute headache. PE: left eye 5 mm NRTL, right eye 2 mm RTL, right hemiparesis. What is the diagnosis A.

Epidural hematoma

B.

Subdural hemorrhage

C.


A 35-year-old woman, P4004 had vaginal delivered a 4,000 g baby, and had complete placental delivery 1 hr. Postpartum she developed massive vaginal hemorrhage. BT 37 C, RR 20, PR 100, BP 80/50 mmHg. Uterine fundus is 1/4 above umbilicus, poor uterine contraction. No vaginal or cervical laceration. After fluid resuscitation and urine catheterization, what is the most appropriate management

97.

A.

PGE2 IV

B.

Dopamine infusion

C.

Oxytocin and uterine massage

D.

Bilateral hypogastric artery ligation

E.

Hysterectomy

A 25-year-old woman with anal pain during passing hard stools, no significant weight loss, no abdominal pain. PE: cracked skin at posterior A.

Anal abscess

B.

Hemorrhoid

C.

Anal fissure

D.

Fistula in ano

98. 99.

A 9-year-old boy has an acute dyspnea. He has underlying disease Tetralogy of Fallot comes with dyspnea and cyanosis PE: central cyanosis with pan systolic murmur grade A.

Morphine

B.

Digitalis

C.

Enalapril

3/6 at apex What is the appropriate management?(ทกชอยเปนยาหมดเลย

15

rd


100. A 40-year-old male patient presents with fever for 4 days. He had a history of pain and tenderness of right ankle. The symptoms of right ankle are now improved. Now, he has tenderness of left knee. PE: Inflammation of left knee. A small pustule on right calf. Synovial fluid - turbid, WBC 35,000 /cu.mm. (N 90%), Gram stain - no organism, no crystal. What is the most appropriate management? A.

IV cloxacillin

B.

IV ceftriaxone and doxycycline

C.

High dose aspirin

D.

Colchicine

E.

Prednisolone

101. A patient has abdominal pain radiate to back. He drinks alcohol 10 years. After NPO, fluid resuscitation and analgesia, what is the most useful management A.

NG decompress

B.

IV ceftriaxone

C.

IV omeprazole

D.

IV somatostatin analog

E.

ERCP with sphincterectomy

102. A 32-year-old woman underlying SLE for 2 years, on prednisolone 40 mg/day, has fever with respiratory symptom. She has abdominal bloating with loosing stool few days ago. PE: BT 39, RR 22, PR 100, BP 100/70, lung - basal rale, abdomen- mild generalized tenderness, no organomegaly. What is the cause A.

Strongyloides stercoralis

B.

Necator americanus

C.

Opisthorchis viverrini

D.

Capillaria philippinensis

E.

Giardia lamblia

103. 104. A 24-year – old Thai female patient was diagnosed as Myasthenia gravis. She loss to follow up for 1 month. This time she comes

ไมแนใจวาม decrease chest movement ปาว)

with dyspnea. PE: cyanosis, shallow breathing, decrease breath sound both lungs ( What is the etiology of the dyspnea symptom A.

Shunt

B.

Death space

C.

Hypoventilation

D.

VQ mismatch

E.

Poor perfusion

105. 106. A 50-year-old patient with hypertension, no renal bruits. What is the management A. B. C.

Thiazide

D.

…nolol

E.

Captopril

107. A 50-year-old woman with alcoholic cirrhosis. BP 100/60 mmHg, P 102, moderate pale, mild jaundice, minimal ascites. Hct 24%, platelet 80,000, INR 1.7, PTT 43 sec. What blood component should be given first

16

rd


A.

Fresh whole blood

B.

PRC

C.

Cryoprecipitate

D.

Fresh frozen plasma

E.

Platelet concentration

108. A 30-year-old woman presents with vomiting and diarrhea, RLQ pain. PE: tender at RLQ. LMP 2 weeks. What is the diagnosis A.

Appendicitis

B.

Tuboovarian abscess

C.

Mittelschmerz

D.

Colitis

E.

Ileitis

109. A child has fever and take medication. After that he develops skin desquamation at face, genitalia. What is the diagnosis A. B.

Steven Johnson syndrome

C. D.

Staphylococcal scalded skin syndrome

110. A 62-year-old man was injury by dirty bamboo stick at his right arm 4 days PTA. BT 39.1C, BP 100/70, PR 100. P E: swelling, erythematous with hemorrhagic bleb at right arm. What is the most appropriate antimicrobial agent in this case A.

Amoxicillin-clavulanate

B.

Ceftazidime

C.

Penicillin G

D.

Metronidazole

E.

Dicloxacilin

111. A 30-year-old man was hit at neck. He cannot move arms and legs. PE: BP 90/60 mmHg, P 50, decrease sensation below

(มทั ง spinal shock, neurogenic)

shoulder. DTR 0. What is the diagnosis

112.

A.

Spinal shock

B.

Cardiogenic shock

C.

Neurogenic shock

D.

Hypovolemic shock

ผ ปวยชาย 25 ป ประวัตมาดวย Greenish purulent discharge with pain on urination 2 weeks มประวัต Multiple sex partners และ unsafe sex ถาม most appropriate management? A. ชอยท จาไดคอ Ceftriaxone+Doxycycline

113. A 35-year-old woman was admitted under diagnosis of acute pyelonephritis. Ceftriaxone was administered for 3 days, but she still has fever. Urine culture - E. coli sensed cephalosporin. Abdominal ultrasonography - Lt. hydronephrosis with Lt. upper ureteric stone. What is the most appropriate management? A.

Continue ceftriaxone

B.

Switch from Ceftriaxone to Clindamycin

C.

Cystoscopy with uretric stent insertion

D.

Extracorporeal shock wave lithotripsy

E.

Percutaneous urolithotomy

17

rd


114. A patient numbness index finger, decrease function of thumb. What is the diagnosis A.

Carpal tunnel syndrome

115. A 63-year-old man present with acute urinary retention. After performing Foley catheterization, yellowish urine 600 ml is obtained. He has had lower urinary tract symptoms for 1 year. Direct rectal exam: prostate enlargement without nodule. What is the most appropriate initial investigation A.

Serum creatinine

B.

Ultrasound

C.

Urine analysis

D.

Cystoscope

E.

Urodynamic examination

116. A heavy smoker woman has dyspnea on exertion underlying COPD for 3 years. Spirometry test shows prolong expiratory phase irreversible obstruction. Which is the most appropriate for her exercise tolerance A.

Inhale short acting beta agonist

B.

Inhale corticosteroid

C.

Anticholinergic

D.

Sustained release theophylline

E.

Inhale long acting beta agonist

117. A 60-year-old woman menopause 10 years presents with dyspareunia 1 year. PV: atropic vaginal mucosa with scantly discharge. What is the management A.

Reassure

B.

Pelvic floor exercise

C.

Oral estrogen

D.

Transdermal estrogen

E.

Vaginal estrogen cream

118. A 30-year-old woman

อาการทั วไปปกตด PE: cyst at adnexa bilaterally, right 6 cm, left 5 cm. What is the management

A.

FSH, LH, estradiol

B.

Ultrasound

C.

CT abdomen

D.

Explore laparotomy

119. A 16-year-old woman never has menstruation. PE: normal secondary sex characteristic, tense cystic mass at pelvis, purplish bulging mass at the introitus A.

Bartholin cyst

B.

Endometriotic cyst

C.

Imperforate hymen

120. A 34-year-old woman previous pregnancy 3 times but abort in 7, 11, 8 weeks, respectively. What is the most likely cause of abortion A.

Myoma uteri

B.

Bicornuate uterus

C.

Infection

D.

Cervical incompetence

E.

Chromosomal abnormalities

121. A 30-year-old breast feeding woman has right breast tenderness. PE: tender and swelling at right periareola area. What is the most appropriate management

18

rd


A.

Cold compression

B.

IV steroid/NSAID

C.

Oral steroid/NSAID

D.

Oral antibiotics

E.

Incision and drainage

122. A 36-year-old primigravida GA 30 weeks come for ANC. PE: fundal height 1/4 above umbilicus, FHS 140/min. Ultrasound: th

single viable fetus, estimated fetal weight less than 10 percentile of normal average GA. Which is the best investigation for fetal surveillance

123.

A.

Fetal movement count

B.

Non stress test

C.

Biophysical profile

D.

Contraction test

E.

Umbilical artery doppler

เดกเหลอง 37 weeks, 2800 grams. At 18 hour, bilirubin 18, Hct normal ทาอะไร A.

intensive phototherapy

B.

total blood transfusion

C.

partial blood transfusion

124. A 28-year-old woman primigravida, GA 30 weeks. PE: fundal height of uterus 3/4 above umbilical. Palpable two large parts, and multiple small parts. What is the most likely cause A.

Wrong date

B.

Polyhydramnios

C.

Fetal macrosomia

D.

Multiple pregnancy

E.

Pregnancy with myoma uteri

125. A 6-hour newborn has dyspnea. APGAR 7,10 at 1,5 minutes. His symptom relieve after O2 supplement. PE: inactive. He has PROM 22 hours. What is the diagnosis A.

Respiratory distress

B.

Bacterial sepsis

C.

Cerebral hypoxia

D.

Transient tachypnea of the newborn

126. A 3-month-old boy with a history of delayed passing meconium. He has off and on abdominal distension, not pass stool for 5 days. PE: distended abdomen, not tender. What is the most appropriate management? A.

Laxative

B.

Soap irrigation

C.

Unison enema

D.

Saline irrigate rectum

E.

Rectal stool evacuation

127. An area with high prevalence goiter 20%. Who should be screening first A.

Preschool

B.

Primary school

C.

Teenager

D.

Pregnancy

E.

Elderly

19

rd


128. A 2-month-old infant has loud breathing when sucking. The symptom improved when the infant is in pronation position. PE: BW 5 kg, RR 44, HR 144, inspiratory stridor, harsh breath sound, no wheezing both lungs. What is the most appropriate management? A.

Reassure

B.

Epinephrine NB

C.

Salbutamol NB

D.

Laryngoscopy

E.

Tracheoscopy

129. A man underlying heart disease CABG 3 years ago presents with ecchymosis, left hemiparesis. CT: right parietal intracerebral hemorrhage. His medication is warfarin. INR 5. What is the immediate management

130.

A.

Tranexamic acid

B.

Protamine sulfate

C.

Vitamin K

D.

Cryoprecipitate

E.

FFP

ผ ปวย schizophrenia ไดยา haloperidol 20 mg มา 10 ป ครั งน มาดวย aggressive hallucination ไดเพ มยาเปน 30 mg 2 สัปดาหตอ มา อาการดขน  hallucination หายแลว แตมอ าการตัวแขง What is the proper management A.

Increase haloperidol

B.

Chlorpromazine

C.

Benzodiazepine

D.

Relaxing training

E.

Electroconvulsive therapy

131. A 20-year-old male underlying leukemia S/P chemotherapy presented with fever 39 C for 7 days. PE: unremarkable except skin as shown in the picture. CBC: Hct …, WBC 1000(L90,N10), platelet 20000. What is the appropriate treatment A.

Ceftriaxone

B.

Imipenem

C.

Vancomycin

D.

Piperacillin-tazobactam

E.

Clindamycin-doxycycline

132. A 2-year-old boy poor vision at night, dry conjunctiva, follicular erythema at elbow and knee. What is the investigation A.

serum retinoic

B.

serum

133. 134.

เดก มผ น ปวดขอ What is the diagnosis A.

Still disease

B.

Lyme disease

135. 136. A 3-year-old boy has respiratory distress 2 days. He has history of nonspecific respiratory tract infection 2 weeks ago. PE: BT 37C, RR 40/min, PR 130/min, BP 90/50 mmHg, normal S1 S2, gallop, no friction rub, lung crepitation, no splenomegaly, hepatomegaly 4 cm BRCM, span 10 cm. What is the diagnosis A.

Pericarditis

B.

Viral myocarditis

20

rd


C.

Infective endocarditis

D.

Acute rheumatic fever

E.

Dilated cardiomyopathy

137. 138. A 2x-year-old woman committed suicide. She has just fight with her boyfriend. She has bad long term relationship with her previous boy friend. She feels empty. She has been using some substance, hurt herself even little problem. What is the diagnosis A.


B.

Borderline personality disorder

C.

Histrionic personality disorder

139. 140. 141. 142. A 9-year-old girl has fever and productive cough for 2 weeks. During that period she has a swelling and tender at her right knee which relieve in 1 week. After, she has a red and tender at her left ankle. PE: BT 38 C, RR 20, normal S1S2, left ankle red and tender with limit of motion. What is the most appropriate investigation for diagnosis A.

Chest X ray

B.

Echocardiography

C.

Electrocardiography

D.

Antistreptolysin-O

E.

ESR

143. A 65-year-old man 3 days after lower anterior resection from rectal cancer has swelling left thigh, no erythema. PE: left pitting edema 2+, normal skin, normal pulse. What is the diagnosis A.

Cellulitis

B.

Lymphedema

C.

Necrotizing fasciitis

D.

Hematoma

E.

Deep vein thrombosis

144. 145. A 10-year-old boy

ไมไปโรงเรยน1ป ชอบชกตอยเพ อนท รร หนออกจากบานตอนกลางคน สบบหร  กัญชา มเร องชกตอย ขโมยเงน

พอแม. What is the diagnosis A.

School phobia

B.

Oppositional defiant disorder

C.

Conduct disorder

D.

Impulsive disorder

E.

Antisocial personality disorder

146.

21

rd


147. A woman has a happy married life with her husband for 10 years. Six months prior, she seemed depressed with complaining numbness at her hands and feet. There was violence between her and her husband. Their relationship became distant. She started to be like this after her only child was diagnosed with leukemia which relapses after chemotherapy. What is the most likely diagnosis of this family? A.

Midlife crisis

B.

Couple violence

C.

Family of the dying

D.

Family of chronic illness

E.

Family of morphogenesis

148. A man has had car accident. Now he is good conscious. The police ask you to check blood alcohol level. When will you do it A.

After ask for the patient permission

B.

If the accident has an injury or death

C.

พสจ นไดวา ผ ชายคนน เปนคนขับรถ

D.

If the police have the formal permission from court

E.

จะเอาไปเคลมประกัน

55-year-old female present with high grade fever, chill and productive cough for 3 days. Her symptoms were not improved after taking azithromycin for 2 days. She developed chest pain during inspiration. BT 39 c, PR 90 bpm, RR 20/min, BP 130/90 mmHg,

149. A

what is most proper management? A.

Ceftriaxone

B.

Ciprofloxacin

C.

Clarithromycin

D.

Co-trimoxazole

E.

Piperacilin-tazobactam

150.

22

National License Examination steps 2 ( ชด C) 1.

A 25-year-old woman presents to ER with tachypnea, palpitation, chest discomfort, limb paresthesia for 1 hour after severe dysmenorrheal. PE: RR 30, P 100, carpopedal spasm. What is the initial management A.

2.

B.

IV diazepam

C.

Analgesic drug

D.

Nasal canular oxygen

E.

Refer to psychologist

A diagnostic test Polymerase chain reaction was compared with gold standard culture in 2000 subjects. Culture positive

Culture negative

PCR positive

800

600

PCR negative

200

400

What is the sensitivity and specificity

3.

Sensitivity

Specificity

A.

80

40

B.

60

40

C.

20

60

D.

40

80

E.

40

60

A 17-year-old boy was persuaded to join the research for normal optic nerve function. Who has authority to sign a consent form for this research

4.

A.

Himself

B.

His parent

C.

His 20-year-old brother

D.

His advisor

E.

Hospital director

A 46-year-old woman presents with intermittent palpitation and sweating, irritable, anxious and heat intolerance. Her menstruation is regular but decrease in the past 6 months. She drinks 5 cups of coffee daily. PE: BT 37, PR 84, BP 110/70, others unremarkable. What is the diagnosis A.

Carcinoid tumor

B.

Perimenopause

C.

Hyperthyroidism

D.

Excessive caffeine ingestion

E.


rd


5.

A 52-year-old woman, amenorrhea for 6 months. She drinks a glass of wine daily, smoking 10 cigarette, exercise by walking in the weekend. She has no family history of spine or hip fracture. Vital signs normal, height 165, weight 70 kg. What is the most important factor to develop osteoporosis A.

Age

B.

Obesity

C.

Decrease activity

D.

Smoking

E.

Alcohol

มายปลดเกษยณ มารพ.เพราะเพ อนบานไปเจอขณะกาลังพยายามแขวนคอตัวเอง 2 wk กอนหนาน เพ งไปพบ แพทย ไดรับการวนจฉัย Major depressive disorder ไมเคยม suicidal idea มากอน ถามการ manage ในครั งน  A. Admit + ประเมน suicidal risk B. บอกเพ อนบานใหชวยสังเกตอาการผดปกต C. ใหสังคมสงเคราะหเขาเย ยมบานทันท D. ให amitriptyline 2 weeks

6.

A 61-year-old man

7.

A 60-year-old man, end stage hepatoma, admitted for severe pain that relieve by morphine. He develops stupor, disoriented to time place person 2 days later. What is the management

8.

A.

Naloxone

B.

Haloperidol

C.

Decrease morphine

D.

เปล ยนเปนtramol

E.

Continue morphine

A 28-year-old GA 10 weeks presents with veginal bleeding. PV: os close, uterus 10 weeks size. Pr esent fetal cardiac activity. What is the management

9.

A.

Bed rest

B.

Estradiol supplement

C.

Cervical cerclage

In the kindergarten, one child in the classroom of 20 students was diagnosed chickenpox. What is appropriate management to prevent outbreak

10.

A.

close school for 7 days

B.

close his classroom for 7 days

C.

oral acyclovir for all student in the classroom

D.

oral acyclovir for student who never receive varicella vaccine

E.

give varicella vaccine for student who never receive varicella vaccine

A 25-year-old female has a 2-month infant breastfeeding comes for family planning. She wants exculsive breastfeeding. What is the best contraceptive method

11.

A.

Combine oral contraceptive pill

B.

Contraceptive patch

C.

Vaginal ring

D.

Depot medroxyprogesterone

E.

Tubal ligation

A 17-year-old man presents with fever, sore throat, and cough. He has history of anemia 2 times in the last 2 years. PE: BT 38.5, PR 80, BP 123/75, RR 16, moderate pale conjunctivae, moderate icteric sclera, injected pharynx and tonsil swelling. Liver and

24

rd


spleen can't be palpitated. Hb 7, Hct 20, WBC 8800(N80% L12% M5%) platelet normal. What should be the finding of peripheral blood smear in this patient

12.

A.

Hypochromic, microcytic RBC with target cell

B.

Normochromic, normocytic RBC with microspherocyte

C.

Hypochromic, microcytic RBC with ovalocyte and elliptocyte

D.

Normochromic, normocytic RBC with spherocyte and fragmented RBC

E.

Normochromic, normocytic RBC with ghost cell and hemoglobin leakage cell

A 30-year-old bus driver has car accident fracture femur. At ER BP 90/60 become normal after resuscitate. Set OR for ORIF discharge home at 14 days. His boss asks for medical certificate. What is the most appropriate to write down

13.

A.

Detail of car accident

B.

Date and duration of sick leave

C.

Date return to work

D.

Initial abnormal vital sign

E.

Detail of operation

A 12-year-old male patient, with a complete history of standard immunization DTP5 OPV5 MMR2 HBV3 BCG1 JE3. What is the recommended vaccine at this time

14.

A.

dT

B.

MMR

C.

JE

D.

HBV

E.

Pneumococcal

A 25-year-old woman presents with fever and dyspnea for 1 day. She has had cough and sore throat for 3 days. PE: BT 39.4, PR 110, RR 26, BP 100/70. Chest x ray: bilateral alveolar infiltrate at lower lung. SpO2 90%. Throat swab negative for influenza virus. What is the appropriate management A.

Oral azithromycin

B.

IV ceftriaxone

C.

IV levofloxacin

D.

IV ceftriaxone + oral oseltamivir

E.

IV levofloxacin + oral oseltamivir

25

rd


15.

A 50-year-old man underlying hypertension on amlodipine 10 mg/day, enalapril 40 mg/day. He had oliguria for 2 days. Today, family takes him to the hospital, unconscious. PE: RR 14, PR 70, BP 130/80 mmHg, normal S1 S2, no gallop, JVP 3 cm, no

(ภาพน เลย). What is the initial appropriate management

crepitation, edema 2+ both legs. EKG as shown

16.

A.

Hemodialysis

B.

IV furosemide

C.

Calcium gluconate

D.

Hydralazine

E.

Insulin with glucose

You are a first year intern at province hospital. Your patient has an undiagnosed facial lesion that you want to take a photo and consult dermatologist via LINE application. What is the appropriate management

17.

A.

Inform patient about the necessary of correct diagnosis

B.

Inform patient by ask for consent verbally

C.

Inform patient to sign consent formally and conceal name, HN

D.

Ask the hospital director permission before the patient

E.

Ask the hospital director and patient sign consent formally and conceal name, HN

A woman G2P1001 GA 38 weeks, previous low transverse cesarean section, presents with bleeding per vagina and abdominal pain. PR 120/min, BP 80/60 mmHg. Can palpable fetal part. What is the diagnosis

18.

19.

20.

A.

Placenta previa

B.

Uterine rupture

C.

Abruption placenta

มอาการ burst of emotion ใจสั น รอนวบวาบ หวาดระแวงกลัววาจะมคนมาทาราย พฤตกรรมเปล ยนไป โดยเม อ 2 วันกอนขณะตอนเดนประทวงมเหตการณเพ อนรวมเดนประทวงโดนยงตายตอหนา ลกสาวบอกวาไมเคยเปนแบบน มากอน A protester man

A.

Adjustment disorder

B.

Acute stress disorder

C.


D.

Bereavement depression

E.

Post traumatic disorder

เดกกนอะไรสักอยางแลว Anaphylaxis ม Wheezing .... ถามMx A.

IM epinephrine

B.

IV CPM

A 25-year-old female primigravida GA 35 week, normal previous ANC,presents with persistent headache 3 days. PE: BP 170/110 mmHg, pitting edema, DTR 3+, FHR 140, uterine contraction interval 2 min, duration 50 sec, moderate intensity, Cx dilate...cm,

26

rd


effacement 50%, station 0, intact membrane, urine albumin 2+. After MgSO4 IV, BP 140/90 mmHg. What is the next proper management A.

Amniotomy

B.

IV dexamethasone

C.

IV antihypertension

D. E. 21.

Emergency C/S

A 35-year-old man has car accident 1 hr PTA. BT 36.5 C, BP 90/60 mmHg, RR 25, PR 120, moderate pale. PE: E2V3M2 pupil 2 mm SRTL BE, open wound with bleeding at left leg. Hct 20%. What is the initial management A.

FAST

B.

ET tube

C.

22.

D.

Assess IV fluid

E.

Stop bleeding by pressure

A patient vomiting and diarrhea after consume a lot of food at party. What is the cause consume

Not consume

Diarrhea in 20 people

Diarrhea in 20 people

12

10

18

19

10

15

Fried rice

15

5

Papaya salad

5

10

Roast chicken

A.

Roast chicken

B. C.

23.

D.

Fried rice

E.

Papaya salad

A woman G1P0 GA… in labor. Second stage for 1 hour. Contraction interval 2 minute, duration 45 sec, station 3+. What is the proper management

24.

A.

Observe progression of labor

B.

Vacuum extraction

C.

Forceps extraction

D.

Emergency cesarean section

A 3-year-old child presents with fever and sore throat, multiple vesicles on palm and sole. What is the etiology A.

RSV

B.

Streptococcus group A

C.

Coxsackic A

D.

Influenza virus

E.

Herpes virus

27

rd


25.

A woman GA 10 week has photophobia and headache. The headache usually unilateral and radiate from … to occipital. What is the management A.

Amlodipine

B.

NSAID

26. 27.

A 25-year-old nurse needle sticks injury. The patient denied history of HIV. The nurse anti-HIV negative. Post-exposure prophylaxis 10 days she developed fever, cough, fatigue. Which investigation is the most useful at this time A.

ELISA

B.

Qualitative PCR

C.

Viral load

D.

Viral culture

E.

Western blot

28. 29.

30.

A 30-year-old man underlying HIV has runny nose with purulent discharge 10 days, no mass. What is the treatment A.

Amoxicillin

B.

Amoxiclav

C.

Ceftriaxone

D.

Ciprofloxacin

E.

Itraconazole

(ภาพน 

A 19-year-old woman G1P0 GA 37 weeks, no ANC, fully dilate, station 0. Fetal monitoring as shown(late deceleration )

เลย). What is the management

31.

A.

Oxytocin

B.

Observation

C.

Vacuum extraction

D.

Forceps extraction

E.


A patient seizure. CT: hypodensity lesion at medial temporal lobe. What is the management A.

Acyclovir

28

rd


32.

A 7-year-old child diagnosis pneumonia treat with cefotaxime 4 days but not improve. CXR: right pleural effusion. Thoracentesis profile straw color, Sp.gr 1.030, protein 3.0, sugar 49, WBC 1500 (PMN85, L15), no organism. What is the management

33.

A.

Add cloxacilin

B.

Switch to imipenem

C.

Repeat thoracentesis

D.

Intercostal drainage

E.

Surgical decortications

A 30-year-old female underlying dyslipidemia, on simvastatin, presents with persistent whitish patch on her tongue. The tongue scraping has been done and the KOH preparation has showed as the picture. (

34.

ภาพน เลย). Which medication is the most appropriate?

A.

Nystatin

B.

Gentian violet

C.

Oral griseofluvin

D.

Oral ketoconazole

E.

Systemic itraconazole

A 70-year-old man presents with new onset of epigastric pain and postprandial fullness for 4 weeks. No weight loss, no poor appetite. PE: unemarkable. What is the appropriate management

35.

A.

life style modification

B.

prokinetic agent

C.

PPI

D.

CTWA

E.

esophagogastroduodenoscopy

A 10-week GA pregnant woman have fever and chill 2 weeks. PE: BT 39 C, BP 100/60 mmHg. PBS as shown. What is the appropriate management

36.

A.

Artesunate mefloquine

B.

Quinidine clindamycin

C.

Chloroquine doxycycline

D.

Chloroquine primaquine

E.

Quinine mefloquine

A patient fever, jaundice, RUQ pain. PE: BT 38 C, PR 80, jaundice, tender at RUQ, liver cannot palpable. Ultrasound: multiple hypoechoic cyst, largest 7 cm at right hepatic lobe. Needle aspiration reveals pus. Moreover than antibiotics IV, what should be done

37.

A.

Laparoscopic drainage

B.

Endoscopic drainage

C.

Percutaneous aspiration

D.

Percutaneous catheter drainage

E.

Open drainage

A woman underlying chronic kidney disease, poor controlled DM, develop fever and dyspnea 3 days. Sputum slender gram negative rod. What is the management A.

Piperacillin/tazobactam

B.

Ceftazidime

C.

Ceftriaxone

29

rd


38.

A 65-year-old woman has colicky abdominal pain. History of bowel habit change and significant weight loss 2 months PTA. PE: marked abdominal distension, soft, palpable mass at LLQ. What is the diagnosis A.

Sigmoid vulvulus

B.

Obstructed colonic cancer

C.

Sigmoid diverticulosis

39. 40.

A 50-year-old woman presents for fever with chill, abdominal pain, nausea vomiting 1 day. PE: BT 39, not pale, mild jaundice, moderate tender at right costal margin. LFT- albumin 3.8, globulin 2.6, TB 5.5, DB 3.8, AST 350, ALT 300, ALP 180, amylase 240. What is the diagnosis

41.

A.

Acute pancreatitis

B.

Acute cholangitis

C.

Acute cholecystitis

D.

Acute viral hepatitis

E.

Pyogenic liver abscess

A 60-year-old woman has febrile, pain at first metatarsophalangeal joint. PE: BT 37.8 C, right first metatarsophalangeal joint tenderness, swollen, warm, erythematous. What is the most useful investigation

42.

A.

Serum uric

B.

Hemoculture

C.

Synovial fluid analysis

D.

Plain film

E.

Rheumatoid factor

A patient GA… PV: cephalic presentation, prolapsed cord, fully dilated cervix, station 0. Cannot do cesarean section within 30

minutes. What is the proper management

43.

A.

Knee chest position

B.

Forceps extraction

C.

Vacuum extraction

D.

Manual replacement the prolapsed cord above the presenting part

E.

ไมมใ หใสfoley

A 38-year-old man has right side pain for 1 hour. PE: RLQ tenderness, other normal. Hct 38%, WBC 12,000(N88, L8). UA: RBC 50-100/hpf, WBC 5-10/hpf. What is the most proper investigation

44.

A.

Plain KUB

B.

IVP

C.

U/S KUB

D.

CT non contrast

E.

MRI

A man has progressive headache 1 month. BT 37.8 C, stiff neck positive. LP: open pressure 30 mmHg, protein 500, WBC 500(PMN30%, L20%, E50%), no RBC. CT: normal study. No neurodeficit. What is the diagnosis A.

Hookworm

B.

Mycobacterium tuberculosis

C.

Taenia solium

D.

Taenia saginata

E.

Cryptococcus neoformans

30

rd


45.

A 20-year-old woman with joint pain for 3 months. BT 38 C. PE: tender and swelling of all PIP joint both hands and left knee, UA: RBC 10, WBC 0-3, protein 2+. ANA 1:1280, anti ds DNA positive. What is the most likely finding in this patient

46.

A.

Anti sm antibody

B.

Hypercomplementemia

C.

Thrombocytosis

D.

Indirect coomb test positive

E.

Bone joint erosion

A 35-year-old man comes for check up. Stool occult blood negative. His father has colon cancer, diagnosis at 55 years old. What should you suggest A.

Plan for colonoscopy now

B.

Colonoscopy at 45 years old

C. 47.

ผ ปวยหญงมาดวยอาการ Hypermenorrheaตรวจรางกายพบ petechiaeตามตัว Platelet 10,000 Labอ นๆปกตถาม most appropriate management?

48.

A.

Prednisolone

B.

Azathiopine

C.

Cyclosporin

D.

IVIG

E.

Platelet transfusion

A 24-year-old woman twin pregnancy GA 34 weeks has watery discharge from vagina. PE: fundal height 4/4 above umbilicus, cephalic-breech, FHS normal. What is the proper management

49.

A.

Urine analysis

B.

Nitrazine paper at perineum

C.

Sonography to evaluate amniotic fluid

D.

Finger examination to estimate cervical dilatation

E.

Speculum for pooling of fluid

A 2-day-old child GA 34 weeks, birth weight 2,200 g. APGAR score 2, 5 at 1, 5 minutes. Microbilirubin 16 mg%

ทา

phototherapy. What is the most important factor for hearing screening test

50.

A.

Birth weight

B.

APGAR score

C.

Gestational age

D.

Phototherapy

E.

Microbilirubin

A newborn his right testis not in scrotum. PE: left groin mass 1x2 cm, movable. What is the appropriate management A.

Follow up in 6 months

B.

CT testis

C.

Testis scan

D.

Angiogram

E.

Explore scrotum and orchidopexy

31

rd


51.

A 30-year-old man presents with jaundice 1 week. He drinks whisky daily for 10 years. He had headache 3 days ago and take paracetamol 2 tab 500 mg every 4 hours. PE: BT 37, icteric sclera, spider nevi, palmar erythema, mild hepatomegaly, mild tenderness, no ascites. What is the diagnosis A.

Acute hepatitis B

B.

Paracetamol toxicity

C.

Ascending cholangitis

D.

Acute cholecystitis

E.

Alcoholic hepatitis

52. 53.

54.

A 40-year-old woman immediately hoarsness after cholecystectomy under GA. What is the most likely diagnosis A.

Laryngeal web

B.

Vocal cord nodule

C.

Vocal cord paralysis

D.

Intubation granuloma

E.

Cricoarytenoid dislocation

A 20-year-old patient has just had electrical injury from construction site 1 hr PTA. PE: PR 80, regular, BP 110/80, burn at right hand and left leg. What is the investigation

55.

A.

Electrolyte

B.

Creatinine kinase

C.

Troponin T

D.

Urine analysis

E.

Electrocardiogram

A 40-year-old man

ขณะกาลังว งออกกาลังกลางแดด loss of consciousness ปวดหัว คล นไส อาเจยน. BT 40, PR 140, BP 160/100,

RR 30, no neurological deficit, other WNL. Cr 4 A.

Heat stroke

B.

Myocarditis

C.

Intracerebral hemorrhage

D. 56.

57.

A 25-year-old man with blurred vision after drinking illegal liquid. V/S…. What is the most appropriate management A.

Ethyl alcohol

B.

Activated charcoal

C.

Gastric lavage

D.

MgSO4

E.

Hemodialysis

A 30-year-old female on ARV for 1 year. She has no other underlying disease or other medication. This visit, she comes for an annual checkup. FBS 88mg/dL, HCO3 17, Cr 2.1(last year 0.8 mg/dl). UA: protein 2+, glucose 3+. What is that ARV A.

Zidovudine

B.

Efravirenz

C.

Lamivudine

D.

Tenofovir

E.

Nevirapine

32

rd


58.

An 18-month-old boy diagnosis supracondylar fracture. After close reduction and casting 8 hours, he cried and pain at the casting arm. What is the appropriate management A. B.

Elevate limb

C.

Splitting cast and padding

D. E. 59.

60.

Fasciotomy

A 62-year-old man has proximal muscle weakness improve with repetitive movement. Chest x-ray is shown. What is the diagnosis

A.

Lymphoma

B.

Lung cancer

C.

Germ cell tumor

D.

Thymoma

A 60-year-old woman with painless gross hematuria, amorphous shape blood clot, no flank pain, no fever. What is the most useful investigation

61.

A.

Film KUB

B.

U/S KUB

C.


D.

CT abdomen

E.

Cystoscope

A 59-year-old woman has post coital bleeding. Pap smear: squamous cell carcinoma. Cervical biopsy:CIN 1. What is the most appropriate management

62.

A.

Conization

B.

Fractional curettage

C.

Hysterectomy

D.

Wertheim operation

E.

Chemoradiation

A 55-year-old female presents with progressive dysphagia, fatigue, weight loss 10 kg in 2 months. What is the most appropriate investigation A.

Barium swallow

B.

Upper GI study

C.

CT chest and abdomen

D.

Esophagomanometry

E.

Esophagogastroduodenoscopy

33

rd


63.

A 29-year-old woman presents with right breast mass 1 cm at 10 o’clock. PE: smooth surface, mobile, not tender. What is the most appropriate management

64.

A.

Observe

B.

Mammogram

C.

Ultrasound

D.

Core needle biopsy

E.

Fine needle aspiration

A 8-year-old boy diagnosis ALL presents with prolong fever, anemia, bone pain. Hct 28%, WBC 200,000(N10, L90), platelet 55,000. BM aspiration- lymphocyte>80%. After chemotherapy 1 day. What is the most serious metabolic complication

65.

A.

Hypercalcemia

B.

Hypernatremia

C.

Hyperuricemia

D.

Hyperkalemia

E.

hyperphosphatemia

A 20-year-old woman underlying rheumatic heart disease has low grade fever for 1 month. BT 38C, P 100, BP 110/70. PE: petichiae at conjunctiva and finger, diastolic rumbling and pansystolic murmur at apex. What is the diagnosis A.

Acute leukemia

B.

Exacerbate rheumatic carditis

C.

Meningococcemia

D.

Infective endocarditis

E. 66.

67.

A child whose father is Hb H disease and mother α-thal 1 trait. What is the risk the child will have a disease A.

0%

B.

25%

C.

50%

D.

75%

E.

100%

A woman diagnosed deep vein thrombosis 3 months ago. She takes coumadin 3 mg daily. She has an accidentally fracture femur and has to operate within 24 hours. INR 3.0. What is the management

68.

A.

Platelet

B.

FFP

C.

Cryoprecipitate

D.

IV vitamin K

E.

Tranexamic acid

A 19-year-old boy came to hospital with mild fever and fatigue 3 days. PE: mild pale conjunctiva, mild icteric sclera, other WNL. CBC: Hb 8, WBC 4200 (N40%, L60%). PBS: hemoglobin contracted cell, ghost cell, polychromasia 2+. What is the diagnosis A.

Hb H disease

B.

G6PD deficiency

C.

AIHA

D. E. 69.

Aplastic anemia

A 20-year-old boy, previously healthy, has hemarthrosis left knee after playing football. He never has this symptom before. Hct WBC platelet 150,000, PTT 50, INR 1.1. What is the most likely diagnosis

34

rd


70.

A.

Cirrhosis

B.

Hemophilia

C.

von Willebrand factor

D.

vitamin K deficiency

E.

Disseminated intravascular coagulopathy

A 7-year-old boy presents with abdominal pain 1 day. He has had rash and arthralgia for 1 week. BT 37, Hct 38%, stool RBC positive. What is the appropriate management

71.

A.

ATB

B.

Steroid

C.

Antihistamine

A 65-year-old DM patient male was given glibenclamide for 1 year. He developed rash then he decided to stop all medication. After 6 months, he was fatigue and dyspnea. FBS 312, BUN 62, Cr 5.6. What is the most appropriate management

72.

A.

Diet control

B.

Metformin

C.

Glibenclamide

D.

Pioglitazone

E.

Insulin injection

A 55-year-old woman with hyperthyroid, on methimazole for 1 year. She was admitted with congestive heart failure. PR 110 irregular, no exophthalmos, thyroid gland 60 g, diffused enlargement. Free T3 3.2 pg/mL, free T4 2.0 ng/dL, TSH 0.05 mIU/L. What is the most appropriate long term management

73.

A.

PTU

B.

Methimazole high dose

C.

Methimazole, lithium

D.

Thyroidectomy

E.

Radioiodine treatment

A 35-year-old male presents with muscle weakness 2 hours after lunch. He is a construction worker. PE: hoarseness, muscle weakness grade I/V all extremities, normoreflexia, mild paresthesia in both hands and feet. What is the most likely diagnosis A.

Thiamine deficiency

B.

Myasthenia gravis

C.

74.

D.

Periodic paralysis

E.

Polymyositis

A HIV patient on medication 1 year. He has oliguria BUN… Cr… What is the most helpful in diagnosis

A.

CD4

B.

KUB ultrasound

C.


35

rd


75.

A 65-year-old woman presents with fatigue, anorexia and weight loss 5 kg in 3 months. She has underlying chronic knee pain takes herbal medication. PE: obese, moon face, acanthosis nigricans at axilla. FBS 60 mg/dl, BUN 10, Cr 0.8, Na 122, K 5.1, Cl 91, HCO3 22. What is the most useful investigation

76.

A.

Thyroid function test

B.

Serum morning cortisol

C.

Dexamethasone suppression test

D.

Aldosterone level

E.

Fraction extraction Na

A 38-year-old woman has felt boring, loss of interest, slow speech, and insomnia for 1 month. Sometimes, she hears the noise telling her to jump out of the window. Which of the following is the most likely diagnosis

77.

A.

Adjustment disorder with depressed mood

B.

Dysthymic disorder with psychotic feature

C.

Major depressive disorder with psychotic feature

D.

Schizophrenia with secondary depression

E.

Mixed anxiety depressive disorder

A 16-year-old patient after radiation nasopharyx develops polyuria. Urine 8 L/day. Urine osmolarity 200, serum osmolarity 300. What is the diagnosis A.

Adrenal insufficiency

B.

Cerebral salt wasting

C.

Central diabetes insipidus

D. E. 78.

Syndrome of inappropriate antidiuretic hormone secretion

มาดวยออนเพลย ซด มประวัตเปน CA stomach ตัดกระเพาะไปแลว วนจฉัย A.

B12 deficiency

B.

Folic deficiency

79. 80.

A

25-year-old woman comes to see a male practitioner. She exaggerately complains about her physical symptom, her feelings, and

her personal life. She is flirting and seductive toward the doctor. She tries to have a social relation. Today she asks you out for lunch. What is the most appropriate management

81.

A.

Go out with her and share the bill

B.

Refer her to a female doctor

C.

Refuse but don't explain the reason

D.

Give her your number and have dinner after finish work

E.

Tell her that it's inappropiate the patient-doctor relationship

A 25-year-old female complains of being easily fatigued for 2 months. PE: moderately pale, no jaundice, no lymphadenopathy, no hepatosplenomegaly. CBC: Hb 19%, WBC 5,500 (N 60, L 35, M5) platelet 650,000 hypochromic microcytic red cells. What is the most likely diagnosis A.

AIHA

B.

G6PD deficiency

C.

HbH disease

D.

Iron deficiency anemia

E.

Aplastic anemia

36

rd


82.

83.

คนไข cirrhosis bleeding. Platelet 80,000, PTT 80 sec, PT 20 sec. What is the best management A.

Pack red cell

B.

Platelet concentration

C.

Cryoprecipitate

D.

Fresh frozen plasma

A 10-year-old boy comes with his parents. His teacher told that has multiple staring, not answer the teacher for 10 seconds daily. He has no memory of what happened. PE: no neurological deficit. What is the diagnosis A.

84.

B.

Absence seizure

C.

Confusional states

D.

Complex partial seizures

A 6-year-old boy has itchy eye and increase lacrimation. PE: watery discharge, eyelid swelling, fine papillae at upper tarsus of conjunctiva, corneal neovascularization. Which of the following is the most likely diagnosis

85.

A.

Trachoma

B.

Foreign body

C.

Viral conjunctivitis

D.

Allergic conjunctivitis

E.

Bacterial conjunctivitis

A 1-year-old boy on queuing list of TOF operation. He has had fever treat with ATB but not improve 2 weeks. Today he is right hemiplegia. Neck stiffness positive. What is the diagnosis

86.

A.

Meningitis

B.

Encephalitis

C.

Brain abscess

A 48-year-old man has right eye pain after motorcycle riding. Fluorescein reveals white opacity at cornea 2 cm. What is the appropriate management

87.

A.

Remove foreign body

B.

Teramycin eyedrop

C.

Tetracaine eyedrop

D.

Oral antibiotics

E.

Dexamethasone eyedrop

A woman underlying DM has rhinorrhea for … PE: nasal discharge from middle meatus. What is the management

A. 88.

Rhinoscope

A patient burn, black airway. He can breathe. What is the management A.

Oropharyngeal

B.

Endotracheal tube

C.

Cricothyroidotomy

D.

Tracheostomy

37

rd


89.

A 25-year-old man has relapsed generalized weakness in 6 months. PE: BP 180/100 mmHg, proximal muscle weakness all limb grade 4, DTR 2+. Electrolyte: Na 140, K 2.2, HCO3 32. What is the investigation

90.

A.

Urine VMA

B.

Serum cortisol

C.

Serum aldosterone

D.

Thyroid function test

E.

Renal artery ultrasound

A 70-year-old man, underlying HT, comes with abdominal pain 1 hour. BP 90/60 mmHg, P 110/min. He has history of abdominal mass with bruise. What is the initial management

91.

92.

A.

FAST

B.

CT abdomen

C.

Angiography

D.

Acute abdomen series

E.

Emergency laparotomy

ผ ชาย swelling, erythema scotum, cramasteric reflex positive. What is the diagnosis A.

Epididymitis

B.

Torsion testis

C.

Incaecerate hernia

A 25-year-old woman with chronic low back pain 1 month comes with legs weakness for 6 days. She has history of CA breast 2 year. PE: loss sensation lower T4 level, muscle power grade 5 upper extremities, grade 2 both legs, DTR 3+, loose sphincter, Babinski dorsiflexion. What is the most appropriate management

93.

A.

bone scan

B.

bone biopsy

C.

X-ray TL spine

D.

CT brain

E.

MRI spine

A 19-year-old male football player presents with hypopigmented macular and patch with fine scale at upper chest and back, not pain. What is the diagnosis

94.

A

A.

Vitiligo

B.

Pityriasis alba

C.

Tinea corporis

D.

Pityriasis vesicolor

E.


40-year-old women progressive memory loss for 2 years. It increases mistake in working last 6 months.Her boss must repeat

over and loudly, sometimes she can't remember her friends who taking to her. Her hand writing not change. She is a lone care giver of her mother

95.

75 years old with terminal dementia for 6 years. What is the diagnosis

A.

Care giver burden

B.

TIA

C.

Alzheimer disease

D.

Frontal dementia

E.

Work place hard time

women death, subconjuntival hemorrhage both eyes, irregular abrasion and mark muscle contusion at neck. What is the manner of death

38

rd


96.

A.

Suicidal

B.

Homicide

C.

Accident

D.

Animal injury

E.

Undetermined

A 2-year-old boy dead on the bed. Autopsy: generalized cerebral edema, acute subdural hematoma at right temporoparietal region, retinal hemorrhage. What is the mechanism of death

97.

A.

Direct force at orbit

B.

Contralateral brain trauma

C.

Ipsilateral rotational accerelate

D.

Impact contusion from falling

E.

Accerelation-decerelarion from shaking

An 8-year-old boy, underlying asthma, presents with severe dyspnea. He took salbutamol MDI 2 puff but not improve. PE: suprasternal and subcostal retraction, inspiratory and expiratory wheezing. What is the next management

98.

99.

A.

IV dexamethasone

B.

Albuterol NB

C.

Subcutaneous adrenaline

D.

Subcutaneous terbutaline

E.

IV aminophylline

คนไข delirium เหนหนเตมเตยง ทาไง A.

Haloperidol

B.

Diazepam

C.

Lithium

A dementia patient. She has ataxic gait. What is the investigation A.

CT brain

100. A 20-year-old man

หแววมา 3 วัน he เกบตัว since เขามหาลัยไมไดเม อ 2 ปกอ น. What is the diagnosis

A.

Brief psychotic disorder

B.

Schizophrenia

101. A 60-year-old man gain weight 3 kg in 6 months. PE: P 50, cold extremities, puffy eyelid and face, BMI 30. What is the most appropriate investigation A.

Albumin

B.

BUN Cr

C.

Blood sugar

D.

Urinalysis

E.

Thyroid function

39

rd


30-year-old female comes to you to consult her abnormal values in laboratory investigation. She has no underlying disease, no family history of CAD. Her lab result is: TC 250 Triglyceride 800 HDL 20. What is the most appropriate medication

102. A

103.

A.

Fish oil

B.

Ezetimibe

C.

Simvastatin

D.

Fenofibrate

E.

Cholecystyramine

เดกชายเจบห 2 ขาง มไข แพทยให ATB ทาน อก1สัปดาหมอ าการดข น เปน otitis media ใกลหายแลว หซา ยไมเจบ หขวาเหลอ mild tympanic membrane perforate, minimal purulent discharge ทาอะไร A.

Topical ATB

B.

Antihistamine

C.

Mastoidectomy

104. A 35-year-old man from UdonThani presents with acute fever, severe headache. He has history of eating raw pork 2 weeks ago and nausea vomiting, diarrhea. PE: neck stiffness, bilateral hearing loss. What is the etiology A.

Leptospirosis

B.

Burkholderia pseudomallei

C.

Streptococcus suis

D.

Ancylostoma cantonensis

E.

Influenza virus

105. A child has history of carbamazepine for 2 weeks. He develops fever. PE: BT 38.5, bilateral conjunctivitis, target lesion at head trunk extremities. Nicolsky sign positive. Skin detachment 35% BSA. What is the most likely diagnosis A. B.

Erythema multiforme

C.

Steven Johnson syndrome

D.

Toxic epidermal necrolysis

E.

Staphylococcal scalded skin syndrome

106. A 50-year-old man underlying hypertension on amlodipine. He has heavy alcohol drinking. Serum uric acid 11 mg/dL, Cr 0.8. He has no history of gouty arthritis, urate nephropathy or tophi found. What is the most appropriate management? A.

Oral allopurinol

B.

Oral colchicine

C.

Advice avoid alcohol

D.

Advice high carbohydrate diet

E.

Change to hydrochlorothiazide

107. A 20-year-old woman has polyuria, fatigue. Her weight gain 10 kg in 3 weeks. BP 120/80 mmHg. PE: weight 100 kg, height 150 cm, acanthosis nigrican. UA: sugar 2+, WBC 0-1, RBC 0-1. What is the most useful investigation A.

Repeat UA

B.

Capillary blood sugar

C.

Fasting blood sugar

D.

Oral glucose tolerance test

E.

Dexamethasone suppression test

108. A 38-year-old woman married for 2 years, no contraception. Left and right adnexal mass, fluid at cal de sac. What is the diagnosis A.

Leiomyoma

B.

Endometrioma

40

rd


C.

Dermoid cyst

D.

Ovarian cyst

109. An 10-hour newborn,term, has jaundice. BT 37 C, mark jaundice, other normal. Hct 38%,A, Rh positive, microbilirubin 10. Mother: O, Rh positive. Direct coomb test weakly positive. Indirect coomb test negative. What is the diagnosis A.

Rh incompatible

B.

AO incompatible

C.

Physiologic jaundice

D.

Neonatal hepatitis

E.

G6PD deficiency

110. A patient has urticaria and itching. What is the appropriate management A.

IV

B.

IV

C.

PO cetirizine

D.

PO ceftriaxone

E.

PO

.

111. A 20-year-old male always repeat checking the door lock 20-30 times The symptom progress in 3 months. He goes to work late. No underlying disease. PE: normal. No history of substance abuse. What is the diagnosis A.

Phobia

B.


C.

Obsessive compulsive disorder

D.

Personality disorder

112. A 75-year-old woman with chronic illness is found death in bed. The external examination found multiple small bruises on the inside of upper lip, conjunctival hemorrhage both eyes. Rigor is fully and Livor mortis at the posterior part of back. Which of the following is the suggestive cause of her death A.

Smothering

B.

Manual strangulation

C.

Unexplained sudden death syndrome

D.

Degenerative disease

E.

Ligature strangulation

113. An 8-year-old boy has rhinorrhea especially at night. He has itcing eyes, allergic shiner. PE: pa le turbinate. What is the appropriate management A.

NSS irrigate

B.

Antihistamine

C.

Oral leukotriene

D.

Nasal steroid

E.

Topical decongestant

114. An 18-year-old man presents with right otalgia after right ear picking for 1 day. PE: as shown. What is the most proper management A.

Ear toilet

B.

ATB eardrop

C.

Paper patch

D.

Tympanoplasty

E.

Myringoplasty

41

rd


115. A 20-year-old man presents with bilateral intermittent limb weakness for 2 days. He has history of alcohol drinking this week. PE: BP 120/80 mmHg, proximal muscle weakness, normal sensory and cranial nerve. Lab: Na 135, K 2, Cl 108, HCO3 15, BUN 15, Cr 0.6. Urine: pH 7.0, Na 40, K 40, Cl 40. What of the following is the most likely diagnosis A.

Alcoholic ketoacidosis

B.

Renal tubular acidosis

C.

Methanol intoxication

D.

Primary hyperaldosteronism

E.

Hypokalemic periodic paralysis

116. A 6-year-old boy bleeding after tooth-extraction yesterday. PE: blood oozing from tooth-extracted wound and ecchymosis at buttock and lower extremities. CBC: Hct 30%, WBC 8500, platelet 250,000 with pale stain, PTT 30, PT 11.5. What is the best management A.

Dexamethasone

B.

Cryoprecipitate

C.

Platelet transfusion

D.

IV vitamin K

117. A term male newborn ceasarean section has respiratory distress. BT 37, RR38/min, BP 90/60, PR 140/min, O2 sat 94% room air. PE: no adventitious sound, flare alar nasi, mild supraclavicular retraction. CXR: mild hyperaerate infiltrate bilateral mild effusion both lungs. What is the diagnosis A.

Acute respiratory distress

B.

Tetralogy of Fallot

C.

Patent ductusarteriosus

D.

Transient tachypnea of the newborn

E.

Persistent pulmonary hypertension of the newborn

118. A patient has unknown snake bite at his finger. VCT 30 minutes. PE: fang mark 1 cm, bleb at hand. PTT 40 sec, PT 12 sec. What is the appropriate management A.

Peak flow

B.

ET tube

C.

Anti venom

D.

Follow up PT in 6 hours

119. An 18-year-old man had motorcycle accident. PE: PR 80, BP 120/80, internal rotate of hip, flexion, neovascular intact. What is the diagnosis A.

Fracture neck of femur

B.

Intertrochanteric fracture

C.

Acetabular fracture

D.

Anterior hip dislocation

E.

Posterior hip dislocation

120. A 30-year-old man was hit by baseball at left eye 30 minutes ago. PE: as shown in the picture. VA-hand movement. Other normal. Skull film no fracture. What is the management A.

CT orbit

B.

Pressure patch

C.

Eye irrigation with saline

D.

ATB eyedrop

42

rd


E.

Absolute bed rest with head elevation 30

o

121. A 2-year-old boy has had several episode of rhinorrhea 2 months. He has 3 course of 7 days oral ATB. The symptoms relieve after ATB but recur when stop. PE: right nose: mucopurulent discharge, left normal nasal mucosa. What is the most appropriate management A.

Nasoscopy

B.

Nasal discharge gram stain/ culture

C.

Film paranasal sinus

D.

Blood for immunoglobulin

E.

Ceftriaxone IV

122. A 20-year-old woman with numbness at lip and tongue 1 hr PTA. Later progress weakness and limb paresthesia. PE: vital signs stable, consciousness, sensory decrease at face trunk and all extremities, motor power grade II, areflexia. Which history taking is helpful for the diagnosis

123.

A.

Prior flu vaccine

B.

Prior febrile illness

C.

Canned food

D.

Horseshoe crab

E.

Level of other toxin in blood

ชาย unconscious พอเจอลอคหอง drowsiness, BT 37, RR 10, pinpoint pupil นาจะไดรับสารใด A.

Heroine

B.

Organophosphate

C.

Cocaine

D.

Amphetamine

124. A 3-year-old boy presents with fatigue (

หรอ ไขต า น แล) He had dental carried last…. PE: pansystolic murmur 3/6, no pericardial

อ นๆจาไมได). What is the diagnosis

rub, mild hepatomegaly ( A.

viral carditis

B. C.

pericarditis

D.

infective endocarditis

E.

cardiomyopathy

125. A 20-year-old woman primigravida GA 38 weeks presents with abdominal pain. PE: BP 150/90 mmHg, puffy eyelid, pretibial edema, no uterine contraction. PV: dilate 3 cm, effacement 20%, station 0, membrane intact. Lab: urine protein 2+. What is the management A.

Reassure and follow up twice a week

B.

Induction at GA 39 week

C.

Admit and close observe

D.

Admit and induction

E.


126. A 30-year-old man acute pain right eye. PE: ciliary injection, cloudy lens, shallow anterior chamber, right IOP 60 mmHg. During waiting for ophthalmologist, what is the most appropriate management A.

Timolol

B.

Atropine

C.

Polymyxin B

D.

Steroid

43

rd


127. A 10-year-old girl comes with fatigue for 1 week. PE: BT38c, moderate pallor, spleen 1 cm BLCM. CBC: Hct 21%, WBC 4000(N60,L40) platelet 250,000. PBS: normochromic normocytic RBC, polychromasia2+, spherocyte 3+. Direct antiglobulin positive. Reticulocyte count 10%. What is the most appropriate management A.

Splenectomy

B.

FeSO4

C.

Prednisolone

D.

PRC transfusion

E.

IVIG

128. A 30-year-old woman bitten by stray dog at right leg. She got complete rabies vaccine 2 years ago. What is the management A.

Booster 1 dose of vaccine

B.

Booster 2 doses of vaccine

C.

Complete 5 doses of vaccine

D.

Immunoglobulin alone

E.

Complete vaccine and immunoglobulin

129. A term male infant, normal delivery, birth weight 2 kg, APGAR 9,10, ANC normal, has jitteriness at 2 hour. PE: plethora, no jaundice. Hct 68%, BS 30 mg/dL, hypocalcemia. After prescribing 10%D/W 2 ml/kg push with glucose infusion rate 6 mg/kg/hr and maintenance with rate 65 ml/kg/day. What is the most appropriate next step management

130.

A.

Increase rate to 90

B.

Partial exchange transfusion

C.

Total exchange transfusion

D.

10% Calcium gluconate IV

E.

Phenobarbital IV

เดกนอย Newborn เกดมา day3 รองกวน พบรอบๆสะดอออกแดงบวม PE: VS BT37 RR 48 PR 120 Abdomen: Periumbilical inflammation with no discharge. What is the most appropriate management? A.

Dressing

B.

Amoxycillin-Clavulanate oral

C.

Cloxacillin IV

D.

Ceftazidime IV

E.

Gentamicin IV

131. A 2-month-old child with rash both cheeks, scalp 1 month on and off. Mother has allergic rhinitis. PE: dry itchy erythematous plaque with scale and yellow crust. What is the diagnosis A.

Atopic dermatitis

B.


C.

Tinea faceii

D.

Contact dermatitis

E.

Impetigo contagiosa

132. 133.

ชาย 70 ป เปน end stage liver/renal? disease มารพ.แลว arrest หลังจาก resuscitate CPR BP 70/40 EKG: VF ( จาไมผด ครับ) ลกชาย บอกให resuscitate ตอ แตลกสาวนา living will มาแสดงและบอกวา พอเขยนไววาไมรับการ resuscitate คณจะ? A.

Stop resuscitate as patient will

B.

resuscitate

C.

ตอระหวางรอใหลกสาวเคลยรกับลกชายใหจบ resuscitate ตอ รอถาม ผอ.รพ. 44

rd


D.

ตอ รอถามฝายกฎหมายของรพ.

resuscitate

134. A patient was normal until morning when he wake up 2hr PTA. BP high, no murmur, no carotid bruit. CT as shown. What is the management A.

ASA

B.

Heparin

C.

Streptokinase

D.

Tissue plasminogen activator

135. A 14-year-old boy was sent to the hospital in order to test for illicit drug usage by his father. He did not know the reason sent to the hospital, but he remember that his teacher told him of skipping class and stealing drugs. What is your initial management A.

Do the urine examination

B.

Tell the boy about the reason

C.

Ask permission from the boy

D.

Make relationship with the boy

E.

Ask his father to tell the boy the reason

136. A 70-year-old woman has back and knee pain, joint stiffness and pain most occurring in the morning, better in 15 minutes and aggravated again in the evening. PE: swelling and mild tenderness at 2 to 5 distal interphalangeal joint, full range of motion, no pain, crepitation on right knee movement. What is the diagnosis A.

Osteoarthritis

B.

Psoriasis arthritis

C.

Rheumatoid arthritis

D.

Ankylosing spondylytis

E.

Osteoporosis

137. A patient underlying DM has ophthalmoplegia. PE: limit eye movement laterally both eyes. What is the most likely diagnosis A.

Myasthenia gravis

B.


C.

Cavernous sinus mass

D.

Mononeuritis multiplex

138. A 30-year-old car accident with a big blow to chest 30 minutes PTA. At ER, PE: alert, BP 70/40 mmHg, PR 120, RR 22, engorged neck vein, fainted heart sound, trachea in midline, normal breath sound. Resuscitate with NSS vital sign not change. What is the next proper management at this stage A.

Observe

B.

Inotropic drug

C.

Endotrachial intubation

D.

Bilateral intercostals drain

E.

Pericardiocentesis

139.

45

rd


140. If you are the doctor in the 30-bed community hospital, which intervention will you use to prevent TB infection in health-care workers A.

All suspected patients wear mask

B.

All health care workers wear mask

C.

PPD test in all health-care workers

D.

Isolate TB-suspected patients to the corners of the ward

E.

Install air conditioners to every OPD consult department

141. A child has multiple shallow ulcers at posterior palate and posterior pharynx vesicles at hands and feet. What is the most appropriate to prevent infection A.

Wear mask

B.

Wear glove

C.

Wash hands

D.

Antibiotics

E.

Immunization

142. A 25-year-old woman feels rapid heartbeat, sweating and fearful at night. She is an only child and never leaves her hometown. Two months ago she got a scholarship to study in Bangkok and move to stay in the dormitory. One of her friend had been robbed 3 days ago. After that she felt insecure and have symptoms. She is scared to be alone and afraid to die from heart attack. What is the most likely diagnosis A.

Panic disorder

B.

Hypochondriasis

C.

Acute stress disorder

D.

Posttraumatic stress disorder

E.


143. A 30-year-old woman, primigravida, delivered her first child as the picture. Which of the following supplement that should be given to her to prevent the same problem in her second child A.

Zinc

B.

Folic acid

C.

Pyridoxine

D.

Ascorbic acid

E.

Ferrous sulfate

144. A 26-year-old woman primigravida GA 15 week comes for ANC.She concerns that her child might have Down syndrome since her cousin’s child has Down syndrome. What is your management

A.

Reassure that there is no risk

B.

Triple quad screening

C.

Nuchal translucency

D.

Amniocentesis

E.

Chorionic villus sampling

145. A 50-year-old man presents with generalized edema and weight gain for 2 weeks. He has no underlying disease. He took over the counter medication for knee pain 2 months ago. PE: BP 130/80 mmHg. Cr 3.0. UA: Sp.gr 1.010, protein 2+, WBC 10-20, RBC 23/HPF. What is the most likely cause A.

Nephrotic syndrome

B.

Acute tubular necrosis

C.

Acute interstitial nephritis

46

2015-NL2 Exam CU

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