1. MDCU COMPREHENSIVE EXAM 4. stretching of quadriceps muscle
STEP 2 5. increase activity with knee
27 ก F 2552 flexion >90 degree
4. A man experienced a low back pain
F ก
after lifting object from the floor. He was
ก ก F F
diagnosed with protusion of L4-5 disc.
Which of the following nerve root will be
ORTHO compressed and what symptoms will he
1. What is the mechanism of injury from present with?
seat-belt injury? 1. L4 nerve root weakness of
1. Flexion injury quadriceps muscle
2. Flexion rotation injury 2. L4 nerve root weakness of
3. Extension injury
tibialis anterior
4. Extension distraction injury
3. L5 nerve root sensory loss at
5. Vertical compression injury
2. What is INCORRECT about flexion heel
rotation injury of TLS spine? 4. L5 nerve root weakness of
1. It s unstable injury. tibialis anterior
2. Neurological involvement is 5. L5 nerve root decreased ankle
common. jerk
3. It cannot be treated
5. A 25 yr-old man, sudden right back
conservatively.
4. Surgery is indicated when there pain radiate to Rt. leg while he was
is progressive neurological picking up object from floor. What s not
deficit. appropriate for acute management?
5. Bad prognosis in the presence 1. bed rest
of abnormal reflexes. 2. NSAIDs
3. In the case of chronic OA knee. What 3. pelvic traction
is NOT appropriate management? 4. lumbosacral support
1. paracetamol 5. transcutaneous electrical nerve
2. ultrasound therapy stimulation
3. stretching of hamstring muscle

2. 6. Postpartum woman in breast-feeding 1. ultrasound therapy
period presented with pain and swelling 2. moist heat
of Rt. wrist. PE: tender, nodule at radial 3. laser
side of Rt. hand. The pain was 4. cold pack
aggravated by doing ulnar deviation. 5. hydrotherapy
What is the diagnosis?
9. ก 5 ก ก
1. carpal tunnel syndrome 3 ก ก 1
2. cubital tunnel syndrome F ก hip joint limit ROM. F
3. carpal ganglion F
4. stenosing tenosynovitis 1. กF ก ก ischemic
5. rheumatoid arthritis with necrosis femoral head
2. ก กก F ก
rheumatoid nodule
3. unilateral กก F bilateral
7. F F F , 2nd Rt.
4. prognosis Fก F F ก
PIP Lt. elbow 1 F 10
Sexual intercourse PV: normal 5. ก ก ก deformity
F ก warm, swelling and 10. ก 12 ก severe pain right
tenderness at 2nd PIP and Rt. wrist, Lt. thigh, F F 1 FกF
elbow. What is the most appropriate ก กก F
F ก F F ก ก F
investigation?
F F F ก
1. Lt. elbow arthrocentesis
2. Rt. wrist arthrocentesis 1. ultrasound Rt thigh
3. H/C 2. X-ray hip with Rt thigh
4. cervical swab ER MED AND TRAUMA
8. F 70 chronic bilateral knee 11. Which of the following management
pain with morning stiffness less than 20 can offer the best chance in treatment
of PEA?
min for 6 months, PE: bow leg, atrophy
1. Early defibrillation
of quadriceps muscle, tender at medial 2. Early administration of atropine
side of both knee, full ROM, pain on 3. Early transcutaneous pacing
end. What is the most appropriate
management?

3. 4. Rapid identification and 3. observe for signs of
correction of immediate compartment syndrome
correctable cause 4. tetanus toxoid IM and tetanus
12. 30 yr-old man sustained stab chest antitoxin
wound at Lt. parasternal border. He was 15. Which is CORRECT about brain
restless but can speak fluently. BP edema?
80/60 PR 110/min PE: engorged neck 1. Brain edema is solely due to
vein, equal breath sound, no tracheal vasogenic edema.
deviation. After resuscitation with 2. Blood brain barrier disruption is
Oxygen and RLS, what s the next the least likely to cause brain
management? edema
1. ET intubation with 3. Uptake and degradation of fluid
hyperventilation protein by glial cells is one of
2. continue RLS IV the mechanism of vasogenic
3. consider pericardiocentesis and edema.
refer to trauma center 4. Mannitol is effective only in the
4. needle thoracocentesis area that the BBB is broken.
13. A man was struck by a lightning 30 16. F 20 F ก
minutes ago. PE reveals burned wound F ก F F
at Lt. buttock and Rt. arm, otherwise F F
WNL. He is clinically stable. What is the 1. F F F ก
next management?
1. Admit for observation 2. ก ก ก
2. colostomy
3. sigmoidoscopy 3. F valium 10 mg IV
4. wound dressing and discharge 4. blood gas
14. A man was bitten by a snake at his 17. F pelvic
leg 30 minutes ago. The leg is swollen fracture (APC III) with perineal
and erythematous. There is a fang mark laceration. After initial resuscitation, the
at the wound. He also has hematuria. subsequent management would consist
Which of the following management is of which of the followings?
NOT appropriate? 1. ORIF with debridement and
1. coagulogram colostomy
2. antivenum

4. 2. pelvic stabilization and 3. fiberoptic guided nasotracheal
colostomy intubation
3. ORIF and debridement 4. cricothyroidotomy
4. explor perineum 5. tracheostomy
5. pelvic traction and debridement 21. F 25
18. F ก F F F ก ER F F Fก
ก ก F F ก
ก ก F ก 2 F BP 90/60 mmHg F RLS
ก IV load 2000 ml ก F BP
1. urethral stone 90/60 F F F
2. vesical stone 1. load RLS F ก 2000 ml.
3. ureteral stone 2. emergency explor. Lap.
4. acute pyelonephritis 3. DPL lower abdomen
5. acute cystitis 4. emergency angiography
19. F 18 ก ก 1 5. group O Rh - blood transfusion
ก 5 F 22. F ก ก3 unconscious
Rabies vaccine 5 ก supraorbital ridge F F F
8 F vaccine F ก GCS
1. Rabies vaccine booster 2 doses 1. 4
2. Rabies vaccine 3 doses 2. 5
3. Rabies vaccine 5 doses 3. 6
4. Rabies vaccine 5 doses and 4. 7
Rabies immunoglobulin 5. 8
5. Rabies Ab 23. F F F ER ก
F กก F protective level F F ก pinpoint pupil
F F vaccine F F neurodeficit F
20. F ก ก
F F ER 1. opioid overdose
inspiratory stridor ก ก airway 2. alcohol intoxication
F F 3. benzodiazepine overdose
1. head tilt-jaw thrust F PED
AMBU bag 24. A 10-yr old girl visits you because of
2. direct laryngoscope and ET a goiter. Her mother states that she has
intubation poor performance at school. PE: diffuse

5. thyroid enlargement, rubbery 2. Serum electrolyte
consistency, irregular surface. TFT: 3. USG KUB system
FT4=6 FT3=1.4 TSH=20. What is the 4. VCUG
best investigation for diagnosis?
5. IVP
1. thyroid globulin
2. USG thyroid 27. 5 yr-old boy was stung by wasps 10
3. FNA days ago. He came to hospital because
4. thyroid scan of fever, swollen wrist and ankle and
5. Antinuclear antibody urticaria. What is the most likely
25. Male term neonate with exclusive diagnosis?
breast feeding developed jaundice on 1. serum sickness
DOL 3. He was treated with intensive
2. post infective arthritis
phototherapy. Serum bilirubin decline
from 20 mg/dl to 19 mg/dl in 4 hr. His 3. pyomyositis
laboratory test shows that Coomb s test 4. toxic vasculitis
negative, G6PD not deficient. PBS: 5. Henoch-Schonlein purpura
microspherocyte. Maternal blood group 28. Male neonate, BW 2000g with
is B Rh+. His blood group is O Rh+. dyspnea and cyanosis. PE: meconium
What is the next management?
staining at nail, grunting and stridor.
1. continue phototherapy,
exchange if MB>20 What is the first management?
2. continue phototherapy, 1. give oxygen
exchange if MB>25 2. suction at hypopharynx
3. partial exchange transfusion 3. evaluate APGAR
4. total exchange transfusion 4. Intubation
5. stop breast feeding and switch 5. positive pressure ventilation
to formula, then repeat MB
29. A 1-hr old male neonate with BW
again
26. A full term neonate, PE: penoscrotal 2000 g. BT 35.5°C HR 180/min BP
opening of the urethral meatus, cannot 40/28 mmHg. ABG: pH=7.16 PaO2=30
palpate both sides of testis in the PCO2=50 HCO3=12. What is the least
scrotum. What is the emergency likely to be the problem in this patient?
management? 1. cold stress
1. Serum creatinine
2. respiratory acidosis

6. 3. metabolic acidosis 3. salbutamol NB with ipatropium
4. hypoxemia bromide
5. hypovolemic shock 4. budesonide NB
5. adrenaline NB
30. An 8-month-old girl presents with 2
33. 2 yr-old male presented with calf
days of high fever. Physical examination pain. PE: hematoma at calf with
reveals BT 38oC, tense anterior tenderness, multiple large ecchymosis
fontanelle, clear sensorium, and at lower extremities. Coagulogram
generalized maculopapular rash. Which reveals prolonged PT, normal PTT and
of the following is the most likely TT. What is the proper management?
diagnosis? 1. cryoprecipiate
2. Vit. K 10 mg IV
1. Varicella
3. DDAVP
2. Measles 4. plt. transfusion
3. Exanthem subitum 34. Preterm neonate GA 32 wk BW
4. Erythema infectiosum 1600 develops grunting and retraction
5. Viral meningitis after delivery. What is the appropriate
early management?
31. A 6 yr-old boy presented with 1. ABG
erythematous vesicle, pruritus and 2. CPAP
excoriation at popliteal and cubital area. 3. CXR
What is the appropriate management? 4. TPN
1. topical cotrimazole 5. IV fluid
2. topical triamcinolone 35. 6 yr-old boy presented with fever,
3. oral doxycycline barking cough and stridor. PE: stridor,
32. A child presented with acute barking cough, harsh breath sound,
asthmatic attack. At ER, he was given 3 inspiratory stridor. Subcostal and
doses of NB salbutamol. After supracostal retraction RR 32/min What s
administration of 3 doses, wheezing and the appropriate management?
retraction still persist. He still has 1. salbutamol NB
respiratory distress. What is the next 2. ipatropium NB
management? 3. adrenaline NB
1. IV hydrocortisone 4. IV corticosteroid
2. Intubation 5. ET intubation

7. 36. A 9 yr-old girl was brought to ER 5. primary immune deficiency
because of high fever, hematemesis 39. A male neonate, BW 2000g
and abdominal pain. PE reveals BT developed dyspnea shortly after delivery.
39.5°C and hepatomegaly. CBC: Hct PE: meconium staining at nail,
45.6% WBC 1500 (N 30% L 65% AL intercostal retraction. What s the
5%). What is the most likely diagnosis? diagnosis?
1. Septic shock 1. respiratory distress syndrome
2. Dengue hemorrhagic fever 2. meconium aspiration syndrome
3. Viral myocarditis 3. transient tachypnea of newborn
4. Aplastic anemia 40. A 8-yr old boy presented with fever
5. Idiopathic thrombocytopenic and Lt. hemiparesis for 1 wk. BT 39°C
purpura with clubbing fingers. Motor weakness
37. What is the most likely to be born to gr.II Lt. side. What s the treatment?
mother with Graves disease that is 1. IV antibiotics then observe
currently controlled? 2. intrathecal antibiotics then
observe
1. hypothyroid infant
3. IV steroid then observe
2. hyperthyroid infant 4. surgical drainage
3. mongoloid infant 5. Emergency craniotomy
4. infertile infant 41. ก 7 F F 2
5. infant with ambiguous genitalia F F ก HR 120/min RR
20/min BP 100/80 BT 38°C CVS:
38. A 5 yr-old boy was brought to the pansystolic murmur gr. II/IV MS:
hospital. He has a history of recurrent swelling Rt. knee. What s the
respiratory tract infection and failure to diagnosis?
thrive. Physical examination reveals 1. Rheumatic fever
chronically ill child, oral thrush and 2. Viral myocarditis
insect-bite dermatitis both legs. The 3. Kawasaki disease
other history is that both of his parents 4. Rheumatoid arthritis
died from pulmonary TB. What s the 5. Salmonella infective endocarditis
most likely diagnosis? 42. A 6 yr-old leukemic boy F 5
1. malnutrition
bleeding per gum purpura
2. disseminated TB
3. disseminated candidiasis BP 70/40 BT 40°C Hct 20% WBC 800
4. pediatric HIV

8. (N5% L 95%) plt. 30000 ก 2. H2 blocker
ก 3. UGI study
1.septic shock 4. USG abdomen
2.DHF 5. Endoscope
3.viral meningitis 46. กก 10 F F
4.infective endocarditis F ก dirty patch tonsil
43. ก8 F F F F Fก
F ก BT 40°C , whitish 1. Diphtheria infection
mucopurulent patch at pharyngotonsillar 2. Infectious mononucleosis
area both sides, neck swelling, 3. Streptococcal pharyngitis
hepatomegaly Fก 4. Leptospirosis
47. ก 2 F multiple flaccid
1. Diphtheria infection
2. Infectious mononucleosis bullae and superficial erosion at upper
3. Streptococcal pharyngitis lip and chin. F ก
4. Leptospirosis
5. retropharyngeal abscess 1. HIV Ab
44. ก 3 1 F F 2. Tzanck smear
F ก ก F F ก
3. biopsy
F PBS: hypochromic microcytic
4. KOH
anemia F management
5. gram stain
1. F FeSO4 48. ก 6 3
2. Hb typing
1 BT 38°C BP ~90mmHg RR
3. serum ferritin 20, stupor, hyperreflexia, marked
4. stool occult blood
jaundice, no hepatosplenomegaly. What
45. ก 10 F F 2 is the proper management?
wt loss 1 kg ก ก F 1. lactulose
awakening pain, N/V F F 2. NAC via NG tube
antacid, กF ก F F 3. D10W 10 cc/kg IV
ก ก 4. intubation and hyperventilation
1. amitryptiline hs 49. ก 1 full term BW 3200 g
ก full cow

9. milk 8 oz. 20-30 cc/feed 6 52. F F F anaphylaxis F
feeds/day F ก ก F
F ก F F F F 1. JE
ก ก PBS: hypochromic 2. Influenza
microcytic anemia anisocytosis 1+ CBC: 3. H. influenzae
Hb 8 MCV 67 RDW 19 other WNL. 4. meningococcal meningitis
What is the diagnosis? 5. pneumococcus
1. Iron deficiency anemia 53. F ก ก F ก
2. Folate deficiency F F ก F ก F F F
3. B12 deficiency F F กF ก ก กF
4. Niacin deficiency 1. intestinal atresia F 10%
5. Vit. C deficiency case
50. ก ก ก F urine ก 2. Fก polyhydramnios
ก 48 . F ก 3. F associated anomaly F
bilateral flank masses with tense ascites ก
urine cath F F urine Fก 4. ก ก
54. ก 5 F recurrent UTI,
1. UPJ obstruction VCUG ก F investigation F
2. VUR 1. IVP
3. cystic nephroma 2. CT scan
4. Wilm s tumor 3. USG
5. neuroblastoma 55. ก ก ก BW 3200
51. ก 15 F ก g F F ก ก
F F ก F F F 35 mg/dl F
ER no response, GCS 4 bilateral 1. F IV umbilical artery
pinpoint pupils RR7/min After intubation, 2. F IV 10%D/W
what is the next appropriate 3. Fก 5%D/W
management? 4. F IV. . . .
1. IV naloxone 56. ก 3 F cough
2. IV flumazenil and dyspnea ก ก URI 3
3. IV atropine กF respiratory distress 2
4. gastric lavage F ก cyanosis, barking cough,
5. activated charcoal via NG tube decreased breath sound both lungs.
What s the next management?

10. 1. ipatropium bromide NB 3. Electrical stimulation for Rt. limb
2. steroid NB 4. ADL training
3. intubation 5. Ambulation training
4. salbutamol NB 60. A man suffered from Lt. hemiplegia
57. ก 8 F . ก F applied for a rehabilitation program.
F F ก ก F F After hard work of rehabilitation, he
PE: lethargy, pinpoint pupil. Oral and develops Lt. arm edema. What is the
nasa cavity: copious secretion. lung: appropriate management?
crepitation both lungs. Abdomen: 1. Continued rehabilitation
hyperactive bowel sound. Fก 2. Elastic bandage and rest
3. Consult radiologist for Doppler
1. opioid overdose
ultrasound
2. organophosphate poisoning
4. Stellate ganglion block
3. Phenobarbital overdose
4. paraquat poisoning 61. F 30
58. F ก 6 underlying ก F muscle spasm
truncus arteriosus F mild F ก trigger point at
cyanosis, tachypnea, tachycardia supraspinatus muscle ก ก
F ก crepitation and hepatomegaly ก ก F
CXR: cardiomegaly with increased
1. aerobic exercise
pulmonary vasculature What is the
appropriate Management? 2. strengthening exercise
1. knee-chest position 3. stretching exercise
2. Furosemide
62. F 25 MCA
3. Morphine
2 กF spinal cord injury
4. Bicarbonate
T2 ASIA II
5. Beta-blocker
rehabilitation program respiratory
REHAB
system F
59. What s the most appropriate
1. Aerobic exercise
rehabilitation program for Rt. thalamic
2. Diaphragmatic respiration and
hemorrhage patient diagnosed for 2
purse lip breathing
days?
3. incentive spirometry
1. Bed positioning
4. Arm swing
2. Active ROM exercise
PREVENTIVE

11. 63. F 38 4. F
F
50 F ก F 67. Influena vaccine F F ก
ก กF ก F ก
1. CPK 1. 3
2. echocardiogram 2. 7
3. Serum lipid profile 3. 14
4. EKG 4. 21
5. Exercise stress test 5. 28
64. F 50 F ก ก 68. ก F ก ก
F ก ก F lab
polio ก F
F F
1. ก F F
2. ก ก 1. F
3. pap smear 2.
4. serum cholesterol 3. F
5. tumor marker 4. F
65. F ก F ก
69. ก stool occult blood
ก กกF
1. Chronic hepatitis infection ก F F sensitivity
ultrasound liver 80% specificity 20% F ก
2. Chronic hepatitis infection ก 10% ก
AFP F F ก F
3. risk atherosclerosis 1. 10%
HDL, cholesterol, TG 2. 31%
4. Menopause bone 3. 50%
density 4. 70%
5. 90%
66. F Hepatitis A
F vaccine ก ก F
1.
2.
3. ก ก F

12. STAT 72. ก ก F ก
70. A F ก ก F caffeine ก ก ก migraine
กF ก ก F F ODD ratio
F Migraine No
ก (%) disease migraine
F 1000 27% Caffeine - 40 200
Caffeine + 60 100
6000 10% 1. 0.2
F 3000 13% 2. 0.33
3. 0.6
A Fก F 4. 2
Fก ก F F 5. 3
ก ก PSYCHI
1. ก F % F 73. F ก F
F F กก F F ก 2 กF F ก
F ก ก F Fก F F ก
2. F ก cross sectional ก ก panic attack
study ก axis I
3. F ก F 1. Acute stress disorder
F กF F 2. Adjustment disorder
4. F ก F 3. Generalized anxiety disorder
กF F Fก 4. Posttraumatic stress disorder
71. Incidence ก ก CA lung 5. Panic disorder
smoker F Fก 6/1000 F 74. ก 2
incidence ก F nonsmoker F F ก ก F F
2/1000 incidence ก ก CA F ก F F
lung ก smoking F 1. F ก F
a. 4%
b. 25% 2. F F F F F
c. 33%
3. F F F ก
d. 50%
4. F F F F F F Fก
e. 67% 5. F ก F F
F ก F ก

13. 75. F F F 3. ก F F กก
ก กก F กก
ก F ก ก ก ก 79. F F กก F ก
F
ก ก
Fก
1.
adjustment disorder F ก F FF
2.
OCD F F F F F
3.
PTSD F Fก
4.
generalized anxiety disorder 1. Schizophrenia
76. ก ก ก F 2. OCD
F ก 3. Depression
1. F F F
4. GAD
80. F F ก F กF F
2. F
ก ก F F ก ก ก Dx
3. F F 1. Antisocial
F 2. Depression in adolescent
4. F 3. Adolescent turmoil
ก 81. ก 18 F
5. F F 2 ก กF F F
F ก F
F F ก ก
77. F ก F
FF
F . F
F ก ก F ก
1. ก F
2. F 1. school refusal
3. 2. adjustment disorder in
4. adolescent
78. F ก ก smoking F F
3. depression in adolescent
ก
1. F F F ก ก ก 4. adolescent turmoil
5. schizophrenia
F กF ก
2. ก F ก morning nicotine 82. F F psychosis
กก F 1. F ก

14. 2. ก F ก 85. 30 graphic designer
ก F ก F F 2
3. กF F F ก F ก FกF
4. F ก F F F F F F ก ก
ก 1. somatization disorder
83. F 33 F ก F 2. somatoform pain disorder
ก ก admit F 3. somatoform autonomic
psychosis 3 F 3 dysfunction
F 3 F 4. conversion disorder
F F ก 5. somatoform disorder unspecified
F ก F ก F 86. F F ก
F F F F personality depression ก
F ก ก
1. paranoid กF F F
2. schizoid F F F F F
3. borderline ก F F
4. ntisocial
5. schizotypal 1. ก ก
84. 45 ก F F 2. depression
ก 1 F F ก 3. psychological support
ก F กF 4.
ก FF
FORENSIC
F ก F 87. F F F
F F ก ก
F ก F ก 1. ก ก
F Fก 67
1. generalized anxiety disorder 2. ก F
2. delusional disorder
3. ก ก F F
3. schizophrenia
F
4. paranoid personality disorder 4. ก ก

15. 88. F F F 2. F F
ก 276 277 3. F
1. ก ก 4. F F
ก 13
5. F F ก ก
2. ก. 14 F
ก F 18 F
F 91. F Fก rigor
3. 20 F mortis ก F F
ก 20 F 1. F F septic shock
F F 2. ก กก กF
FF 3. CO poisoning
89. F 16 F F
4. กกF
F ก
F ก ก 5. กF ก
F 92. ก F ก ก ก
sperm acid phosphatase F
negative F กก ก ก F ก ก ก F F
1. ก F F F ก F
ก F ก 1. ก
2. ก F F F 2. ก F
F ก F 3. ก .
3. ก F F ก
F ก F 4. ก .
4. F ก F F F ก F
ก F 93. F F ก F
90. F F F . F F F F 10
F F . F ก F ก F
F F F F F F F
F F F F F
ก F 1. ก ก 10
F ก ก F F F 2. F ก
1. F

16. 3. กF F ก tonsillar exudate both sides, bulging of
F F ก ก F F lateral pharyngeal wall Fก ก
4. F F ก F
1. aspiration and oral ATB
กก F 21 F
2. oral ATB only
3. IV ATB only
94. F F F pattern 4. external drainage and ATB
abrasion tram line 5 ก 5. tonsillectomy
F 98. F 40 ก F
1. ก F F F ก F
F 5 F ก F ก F
ก ก F F Fก F
2. ก F ก ก F
ก Fก
F 5
3. ก F ก F F 5 1. Meniere disease
4. ก F ก ก F 2. positional vertigo
F F ก F 3. vestibular neuritis
4. paroxysmal nonpositioning
ENT vertigo
95. ก 4 F greenish 99. ก 10 กF
discharge from Lt. nostril ก ATB F greenish
F F nasal discharge ก ก
1. foreign body and กF ก F F ก
remove greenish nasal discharge F
2. culture for fungus and treat nasopharynx F discharge
3. culture and ATB F ก mild tenderness over
4. CT sinus maxillary sinus area Fก ก
96. Organic solvent ก F F 1. topical decongestant only
ก hearing loss 2. topical decongestant + oral ATB
1. Toluene 3. topical decongestant + oral
2. Styrine antihistamine
3. Xylene 4. topical decongestant + nasal
97. 25 F F F steroid
ก F F ก F trismus,

17. 100. ก 10 ก 4. IV dobutamine 0.35 mg/min
F8 discharge ก ก 5. IV isoproterenol 5.0 mcg/min
ก ก otoscope F attic 103. A thai male, U/D alcoholism
perforation with keratin debris Fก
presented with orthopnea, PND, JVP 3
ก
1. ATB eardrop cm, S3 gallop, cardiomegaly, pretibial
2. myringoplasty with tube pitting edema, warm extremities. Which
3. modified radical mastoidectomy is the most appropriate management?
4. radical mastoidectomy 1. Lasix 80 mg IV bolus
101. F allergic 2. Lasix 300 mg IV drip in 24 hour
rhinitis 3 กF purulent discharge, 3. Thiamine 100 mg IV
nasal congestion, PE: tender both
4. Dobutamine
frontal sinus F investigation
1. nasal decongestant 104. A pregnant woman is diagnosed
2. nasal decongestant + amoxicillin with P. falciparum malaria. What is the
3. nasal decongestant + appropriate medication?
doxycycline 1. IV quinine
4. nasal decongestant + CT 2. IV artesunate
5. nasal decongestant +
3. Artesunate+mefloquine
radiograph
4. Artesunate+doxycycline
MED
102. A 48 years old male was admitted 5. Chroloquine+primaquine
to coronary care unit with an acute 105. A man has had exertional angina
inferior wall myocardial infarction. Two and syncope. His blood chemistry
hours after admission, his BP = 86/52 shows total cholesterol 250 and PE
HR 40 bpm with sinus rhythm. Which of reveals DBP> 90 on several occasion.
the following would be the most
What is the diagnosis
appropriate initial therapy?
1. Mitral stenosis
1. Immediate insertion of a
2. Mitral regurgitation
temporary transvenous
3. Aortic stenosis
pacemaker
4. Aortic regurgitation
2. IV atropine sulphate 0.6 mg
5. Tricuspid stenosis
3. IV NSS 300 mL in 15 minutes

18. 106. 70 yr-old woman with underlying 2. bilateral carotid sinus massage
disease of DM has watery diarrhea. She 3. IV adenosine
said that 5 days ago she had dysuria 4. IV lidocaine
and diagnosed to have UTI. 5. synchronized cardioversion
Ciprofloxacin was prescribed then. 109. What is the advantage of using
Which of the followings has the LEAST colloid solution compared with
benefit? crystalloid?
1. sigmoidoscope 1. Colloid solution has bigger
2. stool for C. difficile toxin molecule and doesn t cross
3. Ba enema plasma membrane.
4. stool occult blood 2. ก F colloid F F 1:1
5. metronidazole 400 mg bid 7 days ก
107. A 50 yr-old woman had chest pain 3. 40 cc of fluid was held in the
3 hrs ago. At ER, her EKG shows plasma for every 1 g of colloid
inverted T wave in lead II, III and aVF. infused.
Her initial medication includes O2 4. No evidence stated that colloid
therapy, IV NTG, beta-blocker and ASA. is better than crystalloid.
What is the next proper management? 5. colloid solution is not at risk for
1. IV thrombolytic agent transmitted disease
2. Percutaneous angioplasty 110. A 51 yr-old woman with underlying
3. IV heparin COPD and prolonged intubation for
4. emergency CABG hypercarbic respiratory failure. Her
108. A man came to ER because of current UA shows WBC 3-5/hpf, many
palpitation and dizziness. EKG reveals yeast. She is afebrile, clinically stable.
supraventricular tachycardia with Foley catheter draining dark yellow
ventricular rate of 150 bpm. Right urine. Urine culture grow >10000
carotid sinus massage was done but no colonies of C. albicans. What s the most
response was observed. What is the appropriate management?
next management? 1. treat only if U/C grow >100000
1. continue carotid sinus massage colonies

19. 2. treat only if repeat UA show >25 followings is NOT appropriate
WBC/hpf management?
3. give fluconazole via NG 1. Insulin IV push
4. off Foley catheter 2. NSS IV load
5. intravesicular amphotericin B 3. IV KCl
111. A 55 yr-old man has substernal 4. IV bicarbonate
chest pain for 2 hrs. The pain was dull 5. empirical ATB
and radiated to Lt. shoulder but not to 113. A patient sustained spinal cord
the arm. At ER, 12-lead EKG was done. injury from T6 level. He came to ER
Which of the following management with tachycardia, plethora and
should NOT be done? diaphoresis. He claimed that he missed
his routine urinary catheterization today.
What is the appropriate management?
1. bed rest with leg elevation
2. urinary catheterization
3. stellate ganglion block
114. A 45 yr-old healthy woman has
headache for 2 weeks. PE: reveals stiff
neck positive. LP was done. CSF open
1. gastric lavage pressure 28 cmH2O, WBC 250 (L>N)
2. IV PPI protein 400, sugar 25 (plasma glucose
3. upper GI endoscopy 100), no bacteria in gram stain. What is
4. Oral Antacid your diagnosis?
5. nutritional support 1. TB meningitis
112. A 75 yr-old female was brought to 2. Aseptic meningitis
the hospital because of alteration of 3. Purulent meningitis
consciousness. PE reveals fever, 4. Eosinophilic meningitis
lethargy, tachypnea. ABG: pH=7.26 5. Cryptococcal meningitis
PCO2=56 PaO2=35 HCO3=26. DTx
shows hyperglycemia. Which of the

20. 115. Middle aged man came to ER CBC: Hb 7, MCV 102, RDW 20%,
because of sudden severe headache, normal WBC and plt. What test should
sudden onset of Rt. hemiparesis and be done for the definitive diagnosis?
numbness. He was alert at first 1. HAM test
presentation but later he lost his 2. Coombs test
consciousness. PE: right pupil fixed 3. Stool occult blood
dilated. After that, he has respiratory 4. G-6-PD assay
arrest. What is the most likely 5. Hb typing
diagnosis? 118. A patient with underlying disease
1. Superior sagittal sinus of chronic hepatitis C infection had
thrombosis percutaneous liver biopsy 3 days ago.
2. Cerebellar hemorrhage Today he develops fever, RUQ pain,
3. Pontine hemorrhage jaundice and melena. What is the most
4. Diffuse subarachnoid likely diagnosis?
hemorrhage 1. Hemobilia
5. Medullary hemorrhage 2. Hepatitis from reactivation
116. A man was bitten by a snake with 119. A 20 yr-old woman came to you for
black and white stripe in Rayong routine check up. She weighs 97 kg
province. At ER, PE reveals fang with 153 cm in height. V/S WNL. PE:
marks. Later he developed ptosis, unremarkable. AST 34 ALT 123 HBs Ag
dyspnea and muscle weakness. Which and anti-HCV negative. What is the
of the following snake has bitten him? diagnosis?
1. cobra 1. HAV infection
2. king cobra 2. HBV infection
3. Malayan krait 3. HCV infection
4. Malayan pit-viper 4. Fatty liver
5. Russel viper 120. A24 yr-old adolescent had sudden
117. 40 yr-old woman developed fatigue onset of pleuritic chest pain and
and dyspnea for 3 wks. PE: moderately dyspnea for 1 hour. He is a tall, thin
pale, mild jaundice, mild splenomegaly. man with no underlying disease. PE:

21. decrease Rt. breath sound, RR 24/min, this event. Today he presents with
normal BP and PR. Chest X-ray shows painful and swollen joint. PE reveals
Rt. pneumothorax 50%, otherwise WNL. painful and swollen Rt. knee joint with
What is the appropriate management? limited ROM due to pain. His
1. Tube thoracostomy coagulogram shows prolonged APTT,
2. IV fluid normal PT. The laboratory abnormality
3. Consult CVT for video assisted can be corrected by mixing study. And
thoracotomy when the patient s serum is mixed with
4. Observe the serum from hemophilia A patient, it
121. A 65 yr-old man was admitted shows prolonged APTT. What is the
because he had post CVA left most appropriate management?
hemiparesis. 5 days later, he develops 1. DDAVP
Lt. leg edema. PE: left thigh edema, not 2. Cryoprecipitate
tender. What is the investigation for 3. Cryo-removed plasma
definitive diagnosis? 4. FFP
1. D-dimer 5. PRC transfusion
2. lymphangiography 124. A 60 yr-old man with heavy
3. contrast radiograph smoking, presented with progressive
4. radionucleotide venography dyspnea and dyspnea on exertion. His
5. Doppler USG symptom now is stable. He has
122. Which is the least likely to happen yellowish phlegm 5-6 cc every day. PE:
in lightning injury? bilateral rhonchi Hct 49% Which of the
1. apnea following treatment has been showed to
2. cardiac standstill prolong his survival?
3. immediate muscle necrosis
1. ACEI
4. keraunoparalysis 2. theophylline
5. ruptured tympanic membrane 3. Oxygen
123. A 20 yr-old man has a history of 4. Steroid
bleeding diathesis since he was a child. 5. beta-agonist
No one in the family has experienced

22. 125. A 39 yrs-old male visits your office 4. need surgical correction in bed-
for routine check up. His lipid profile ridden case
shows cholesterol 150 mg/dl and 5. cardiomyopathy is a clinical
triglyceride 300 mg/dl. His father died feature
from acute MI 4 yrs ago. What is the 128. 40 yr-old female came to the
most appropriate initial management? hospital because she had fever and
1. Dietary modification acute RUQ pain. PE: BT 38°C,
2. Exercise tenderness at RUQ, no rebound
3. Gemfibrozil tenderness. What is the most
4. Cholestyramine appropriate investigation?
5. clofibrate 1. Plain film abdomen
126. A nurse had a history of contacting 2. USG upper abdomen
person known to have pulmonary TB. 3. UGI study
She came to visit you at your office. 4. CT
From her medical record, PPD skin test 5. MRI
was done last year with a result of 0.3 129. Which is INCORRECT about DVT?
cm at 48 hr. You send her to have PPD 1. Virchow triad consists of
skin test again which shows an hypercoagulable state,
induration of 13 mm at 48 hr. What endothelial injury and pulmonary
should you do next? embolism
1. CXR 130. 25 ก
2. INH 300 mg/day for 3 months postnasal drip, granular pharynx F
3. check baseline liver enzymes F F
4. check liver enzyme every 3 asthma, eczema eosinophil
months ก nasal discharge ก
5. repeat PPD skin test again next F ก ก
week 1. serum IgE level (radiodiffusion)
127. Which is INCORRECT about 2. serum IgE level (radio
muscular dystrophy? immunoabsorbent assay)
1. probably muscle enzyme defect 3. food elimination test
2. muscle wasting in specific 4. skin test
muscle group
3. genetically determined

23. 131. F 30 Graves 1. penicillin
disease ก PTU F 150 mg/day 2. dicloxacillin
maculopapular rash 3. ceftriaxone
4. ciprofloxacin
F
5. gentamicin
1. dose 300 mg/day 135. F 75
2. dose 100 mg/day
F ก F F
3. MMI 7.5 mg/day
F ก BP 110/90 PR
4. F lithium 54/min RR 10/min F F
carbonate
F murmur
5. F bowel sound F melena
prednisolone
F
132. F Fก CBC: Hb 10.1 WBC 5100 plt. 130000
hyperventilation F DTx 67 mg/dl
1. methamphetamine E lyte: Na 126 Cl 109 K 4.5 HCO3 27
2. cocaine ABG: pH 7.23 pCO2 64 pO2 72 HCO3
3. alcohol
27
4. marijuana
F F investigation
133. F F
ก
F F F F F ก 1-2
1. serum cortisol, insulin level, C-
F F F F
peptide
F F F ก F
2. TSH, free thyroxine
1. annual influenza virus
3. serum Ca, PTH
2. HAV vaccine
4. EKG, echocardiogram
3. HBV vaccine
5. urine toxicology screen
4. polyvalent pneumococcal
136. F F F hypersensitivity
peptide vaccine
1. MP rash + liver enzyme
5. varicella vaccine
increase ก navirapine 2
134. F 2. facial angioedema ก ACEI
F perianal abscess F 3

24. 3. wheal and flare ก penicillin characteristics ก PR mass
2 anterior to rectum Fก
4. target lesion ก 1. Vaginal agenesis
2. Imperforated hymen
sulfonamide 5
3. Bicornuate uterus
ANES 4. Gonadal agenesis
137. Spinal anesthesia should not be 141. F LSA ก F F
done in 1. Transverse
1. patient with high fever 2. Cephalic presentation
2. patient with history of post dural 3. Breech presentation
puncture headache from 4. blow presentation
previous SAB
5. Face presentation
3. patient with mild scoliosis
4. patient with asthma 142. F GA 38 weeks F ก
5. severe pre-eclampsia patient F deceleration not
138. F F induction agent associated with uterine contraction
increased ICP ก F
1. Thiopental 1. Utero-placental insufficiency
2. Ketamine 2. Vagal stimulation
3. Propofol
3. Oligohydramnios
4. midazolam
5. etomidate 143. F 30 GA 16
139. A 70 yr-old man has pain after an F F F F
operation. What is the appropriate post- ก chromosome
op pain management? ก F F F ก down
1. paracetamol 500 mg prn syndrome F F F F
2. pethidine 25 mg IM q..h
F
3. MO 10 mg IM q 6 h
1. F F ก
4. MO 5 mg IV q 3 h
OB-GYN 2. ก F กก
140. F 15 F F ก กF ก down
(30 ) 1-2 ก syndrome F
F กF 3. ก F F ก กก F
F ก F secondary sexual F F

25. 4. กF F ก 147. What is the most likely to be found
ก down syndrome F in infant born from mother who drank a
F F lot in first trimester?
5. F F 1. Cleft lip, cleft palate
144. Most common cause of uterine 2. Microcephaly
rupture between pregnancy is? 3. hydrocephalus
1. ก ก F C/S 148. Which of the following ATB is
กF contraindicated in pregnancy?
2. Prolonged labor 1. Ceftriaxone
3. Unattended labor with oxytocin 2. augmentin
infusion 3. metronidazole
4. Fetal malposition 4. azithromycin
145. Pregnant woman HIV positive, 5. ofloxacin
CD435 F ก Oral candidiasis 149. F F GA 32 wk. F
ก CXR: cavitation AFB 3+ 12 ก periumbilical F
which is the least appropriate F RLQ, PE: guarding at RLQ
management Fก ก
1. F IRZE 1. Ultrasound
2. Start AZT, 3TC, efavarenz 2. Appendectomy
3. Nevirapine F F F 3. Observe
4. ATB
4. Plan start ARV 5. Emergency exploratory
Anti TB drug laparotomy
146. What is the most common 150. F asymmetrical IUGR
symptom of HEELP syndrome? uteroplacental
1. epigastrium pain insufficiency Doppler ultrasound
2. headache
3. pulmonary edema 1. Increase umbilical artery
4. blurred vision resistance

26. 2. Decrease umbilical artery 154. 55 abdominal
resistance discomfort PE: abdomen mild distension,
3. Increase umbilical artery ascites. USG: suspected left ovarian
mass ก chance early
systemic flow
ovarian CA
4. Increase MCA systolic flow
1. 5%
5. Increase MCA resistance
2. 10%
151.GDM class C F 3. 25%
insulin F ก 4. 50%
1. decrease in human chorionic 5. 75%
somatomammotropin
EYE
152. F ก ก ก consent 155. F ก 5 F ก
laparoscopic tubal ligation F F F F F F
5
1. F advice F F VA: RE 20/100 with PH 20/70
Fก LE: 20/30
2. F ก F F esotropia 45 prism
F F myopia RE +0.5 LE +0.25
3. F advice F F 100% no limit of motion
F ก F ก F ก F
4. F F F
F ก F esotropia with
F amblyopia RE Management?
5. ก ก F 1. observe F
vasectomy, condom F/U 1
153. Known case CA ovary F 2. F F F
Na 135 K 4 Cl 103 HCO3- 23 3. CT scan
ก F
Ca 18 F initial management
4. F ก amblyopia
1. IV NSS keep urine output 200-
5. F ก F ก
300 mL/hr 156. F ก F
2. Calcitonin injection F F pseudoesotropia
3. bisphosphonate ก
4. Hemodialysis 1. telecanthus

27. 2. epicanthus ก F protruding at groin region but it can t be
3. narrow palpebral fissure reduced anymore. He has no fever. The
SURG mass is tender. What is the LEAST
157. A 60 yr-old man has reducible right
appropriate management?
groin mass for 2 years. But 12 hrs ago
1. Try reduction is safe.
he developed pain at groin mass. He
tried to reduce the mass but found that 2. He needs emergency surgery
it is irreducible. He also had nausea because this is an emergency
and vomiting. PE: HR 100 BT 38oC. Rt. condition.
groin mass 5 cm, irreducible with 3. Elective herniorrhapy can be
tenderness. What is the appropriate scheduled.
management?
160. Which is correct about papillary
1. Analgesic and muscle relaxant +
carcinoma of bladder?
trying reduction
1. mostly asymptomatic
2. Analgesic and muscle relaxant +
2. rarely metastasize
observe
3. could be treated by TUR-BT
3. Emergency herniorrhaphy
ETHICS
4. Emergency laparotomy
158. F 70 ก lower 161. F end stage lung CA
urinary tract symptoms (LUTS) PE: F F ก prognosis F
prostate hypertrophy with firm nodular ก F F F F F
ก 2 F ก
at right lobe. What is the most
cardiopulmonary arrest F F
appropriate investigation?
F F กF ก ก
1. ultrasound KUB F F F CPR F F
2. transrectal ultrasound with F F ก
biopsy ก F F F F
3. PSA ก F ก F
4. CT scan 1. F F ก
159. 50 yr-old man had history of
reducible groin mass for 8 years. 2 2. F F
hours PTA, he noticed a mass F ก
F F F

28. 3. F F F กF 164. F 25 F
4. F ก ก F F F
กF F F ก F corneal abrasion
5. F F F F
F 1. ก F
162. ก ก F 2. topical steroid
F F 3. topical ATB + pressure patch
F ก Fก ...
165. F EKG Pulseless
F ก F ก F Electrical activity
F F F 1. Defibrillation
1. 7 2. Atropine
2. 15 3. Adenosine
3. 17 4. Lidocaine
4. 18 166. ก ก FกF F F F
5. 20 ก ก 2 ก F F กF F
ADD ON F ก F ก ก
163. ก 6 F ก ก F ก ก
ก F F ก 1. Experimental study
FFก F 4 2. cohort study
F ก F F ก F 3. historical cohort study
F F 4. case control study
180/100 F 350 (L 80% 167. F F hearing loss
N 20%) 70 ( 100) F Retraction of TM Rt.
50 Fก Tympanogram F type B F
1. Toxic encephalopathy F ก type A F
2. Viral meningitis 1. nasopharynx
3. Purulent meningitis
4. Tuberculous meningitis
5. Fungal meningitis

29. 168. Which of the followings is TRUE 3. Remove blood clot and chemical
concerning thyroglossal duct cyst? cautery
1. It was found at lateral of neck 4. Packing
2. Origin Base of tongue 170. ก 10 F UGIB ก
169. ก F ก resuscitation F F
ก . F 1. EGD
F
1. give vaseline ointment
2. Remove blood clot and electrical
cautery
F
AC F F ก F
Topo MDCU 60
5/3/2552
23.45