(.) 2 1 9 2551

. update 2551 4

D. , , , , , E. .

MD 31 KKU

F. Med 14 THAMMASAT University G. peck

.. version ^_^

Medicine H. 32

Urine protein 1+, red blood cell cast specific a. Rheumatoid factor b. ANA c. Anti-histone antibody

d. Anti ds-DNA antibodyI. 35 4

wbc = 89000, intracellular e. Cloxacillin f. Gantamicin g. Ceftriazone PMN = 90%, G/S: gram negative diplococci

h. DoxycyclineJ.

i. Metronidazole

Generalized

Tonic

Clonic

neurological deficit papilledema CT j. Taenia solium l. Toxocara k. Taenia saginata m. Toxoplasma

scan: multiple calcified cystic lesion

n. GnathostomaK. 55

4 1 AFB negative 3 CXR reticulonodular o. culture for TB p. Start anti-TB drug q. Bronchoscopy r. Aspiration s. PCR for TB infiltration with thickening cavity

L.

18

2

Upper

motor power 4/5, lower 1/5, absent DTR t. Transverse myelitis u. GBS v. MG w. Neurosyphilis

M. 30 1

neck vein engorgement, Hepatomegaly EKG diffuse ST-T change, low voltage x. Restrictive pericarditis y. Beri beri aa. z. Cardiac tamponadeN.

Dilated cardiomyopathy 9

o

BT= 39.0

PR= 120 /min, RR = 40 /min, crepitation both lungs, cellulitis bb.

C,

decreased breath sound left lung cc.S. aureus

Salmonella spp.

dd. ee.

H. influenzae Mycoplasma pneumonia 5

ff. Mycoplasma tuberculosisO. 50

tenderness and guarding at epigastrium, liver dullness +ve gg. acute pancreatitis

P. rash vesicle

hh. VZVQ.

BT = 39 oC, erythema and tender at left upper thigh ii. S. aureus jj. S. pyogenes kk.H. influenzae ll. P. aeruginosa

40

R.

1 10 mm. TIA

DM, HT

nn. oo. pp.

Temporal lobe ischemia Cerebella ischemia Bells palsy

S. 18

Upper respiratory tract infection Interstitial infiltration qq. Ampicillin CXR

rr. Ciprofloxacin tt. Gentamicin uu.

ss.Roxithromycin Augmentin

T.

(

5 ) vv.Hypokalemia ww. Hyperkalemia

xx.Hyponatremia

yy.Hypernatremia zz.Hypocalcemia aaa. Acute gastric dilation

bbb.

SIADH peripheral

U.

neuropathy (wrist drop)

V. CKD K = 7 EKG change W. 40 3

mmHg, PR = 110/min, RR = 24 /min, BT = 39 ccc. ddd. eee. ggg. Enteric fever Dengue fever Leptospirosis Murine typhus 50 o

BP = 120/80 C, mild jaundice, ling clear, liver 2 cm BRCM

fff. Scrub typhusX.

4

tenderness of quadriceps muscle, purple-red discoloration over the upper forehead, hhh. eyelids and cheeks Polymyositis

iii. Dermatomyositis

jjj. Psoriasis kkk. lll. SLE Mixed connective tissue disease

Y. 40 1

CXR WNL mmm. nnn. ooo. ppp. qqq.

Skin test

CT chest

Sputum AFB Bronchoscopy PFT

Z. 50 25

1 BP = 120/70 mmHg, fine crepitation both lower lungs, rrr.Digoxin sss. PMI 6th ICS 1 cm lateral to MCL, S3 gallop Thiamine

ttt. Atropine

AA.

uuu. vvv. xxx. yyy. www.

Chigger mite Louse Tick Aedes egypti Flea BP 60/30 mmHg

BB.

zzz. Cardiogenic shock Spinal shock Neurogenic shock Hypovolemic shock Obstructive shock

sacral reflex aaaa. bbbb. cccc. dddd.

CC. 18

2-3

eeee. ffff. gggg. hhhh.

inhale corticosteroid

inhale salbutamol prn + alpha-agonist as need steroid

iiii. Oral bronchodilator

beta-agonist as need + steroid

jjjj. Salbutamol inhalation as needed

kkkk.

Long acting beta2 agonist + corticosteroid

DD.Motor Cycle Accident lesion T2 Foley Catheter

llll. Inhaled corticosteroid

BP 180/110 RR nnnn. oooo. qqqq. rrrr. mmmm. off F/C

Hydralazine pppp. BP ADVICE

EE. 70

no Underlying Disease EKG AF

5 ssss. tttt. uuuu. vvvv. ASA Warfarin Clopidogrel

FF. .PE: HT + Cushing appearance

Lab

GG. subacute thyroiditis HH.T4 TSH

Increase cortisol level

wwww. ASA+propanplol Dx? xxxx. yyyy. zzzz. Simple Goiter Iodine def Thyroid CA

aaaaa. Subacute thyroiditisII. 28 2

bbbbb. Hashimoto Thyroiditis

ccccc.

sphincter tone lesion ddddd. Basal pons fffff. parasagital sinus

PE

:

DTR

3+

,

loss

of

eeeee. Thoracic area

Lumbosacral area bronchial asthma lung :

JJ.

ggggg. Clonus medularis Wheezing

expirat

KK.EKG : bradycardia vital sign

hhhhh. iv. Dexametazone

(80/50 mmHg, HR = 30) iiiii. jjjjj. Atropine dobutamine

LL. 27 2 PE: white patch

kkkkk. anti-HIV

MM. EKG ( Mobitz II)

lllll.

Atropine Lidociane

mmmmm.

nnnnn. DigitalisNN.

ooooo. Cardioversion 68

ppppp. Rabies vaccine qqqqq. Tetanus viccine rrrrr. ttttt. HBV vaccine HPV vaccine sssss. Influenza vaccine

OO. 18

PE: lung clear, rub chest uuuuu. Endocarditis vvvvv. xxxxx. wwwww. Pancarditis Myocarditis

PP. 16 homozygous Beta-thal

Pneumonia

rhythm,

BP drop, irregular heart rate & complication yyyyy. hepatosplenomegaly

1

heart

cardiac siderosis

zzzzz.

Cardiac hypertrophy

aaaaaa. Immune cardiomyositisQQ.

bbbbbb. Extramedullary hematopoiesis at heart crescent shape at frontal region cccccc. Acute epidural hemorrhage dddddd. Acute subdural hemorrhage eeeeee. Subacute epidural hemorrhageRR.clinical rheumatoid arthritis

20

Motorcycle

Accident

CT

ffffff.

Ibuprofen

gggggg. Paracetamol hhhhhh. MTX iiiiii. jjjjjj. Sulfazalazine Chloroquine

SS. DM with HT

Costovertebral angle tenderness kkkkkk. Ceftriaxone IV llllll. mmmmmm. Ceftriaxone

Ofloxacin

TT. 22 PR

RR miosis

nnnnnn. Atropine oooooo. Naloxone pppppp. DiazepamUU. 40 80 kg 160 cm.

FBG 180 qqqqqq. rrrrrr. tttttt. Metformin ssssss. Acarbose

Dx. DM,

Glibenclamide . 1 , PE: mild

VV. 25

exophthalmos, generalized enlarged thyroid both lobe, . (Graves), T4..,T3 400, TSH 100 scope Patch? a. Cotrimoxazole b. Norfloxacin c. Metronidazole 66. Cushing syndrome HHHHHHHHHH.Hypocalcemia IIIIIIIIII.Hyperkalemia JJJJJJJJJJ.Increased cortisol level KKKKKKKKKK.Advance bone age LLLLLLLLLL.Increased renin plasma activity

67. 4 yr 2 wk PE: Pallor, petichiae CBC Hb 7, Hct 22, WBC 3200(N 35, E 3, L 62), Platelet 26000, MCV 90 Investigation MMMMMMMMMM.Serum ferritin NNNNNNNNNN.Bleeding time

OOOOOOOOOO.Reticulocyte count PPPPPPPPPP.Screening coagulogram QQQQQQQQQQ.Bone marrow aspiration 68. 9 3 BW 7 kg PR 120 lung: wheezing both lung, CXR: perihilar infiltration, PPD 4 mm brochodilator Dx RRRRRRRRRR.Retian FB TTTTTTTTTT.TB SSSSSSSSSS.Diaphragmatic hernia UUUUUUUUUU.GERD 69.

VVVVVVVVVV.Asthma (Purpura fulminan) Stiff neck : positive

WWWWWWWWWW.N.meningitidis 70. asthma 2-3

XXXXXXXXXX. Oral salbutamol YYYYYYYYYY.Inhale sulbutamol

ZZZZZZZZZZ.Inhale steroid AAAAAAAAAAA.Inhale ipratropium + Salbutamol

71. 6 2

72. 10 MCA ER PE: swelling at Rt elbow, normal triangle landmark of Rt notmal neurovascular Dx BBBBBBBBBBB.Elbow dislocation elbow,

CCCCCCCCCCC.Displaced olecranon fracture DDDDDDDDDDD.Displaced supracondylar fracture EEEEEEEEEEE.Displaced lateral condylar fracture 73. 6 FFFFFFFFFFF.Displaced medial supracondylar fracture truncal obesity , acne ,

Buffalo hump , moon face c

GGGGGGGGGGG. Hypocalcemia HHHHHHHHHHH.Hyperkalemia IIIIIIIIIII.Advance bone age JJJJJJJJJJJ.Increase serum cortisol KKKKKKKKKKK.Increase activity of rennin 74. 6 Hct 36 WBC 6500 2 Plt.150,000 Lab time

petechiae & ecchymosis at extremities LLLLLLLLLLL. Bleeding

CBC : Hb 12

MMMMMMMMMMM.PT NNNNNNNNNNN.PTT OOOOOOOOOOO.Thromin time PPPPPPPPPPP.Venous clotting time 75. 2 VSD pulse BP

ventricular tachycardia management QQQQQQQQQQQ. Defibilation RRRRRRRRRRR.Ca gluconateSSSSSSSSSSS.NaHCO3

AMbu tube Amiodalone EKG

TTTTTTTTTTT.Adenosine UUUUUUUUUUU.Direct current synchronized cardioversion

76. 19 PTT 50 sec (control 30 sec), PT 13 sec (control 14 sec), no prolonged bleeding time VVVVVVVVVVV.Lupus coagulopathy

WWWWWWWWWWW.Factor VII deficiency XXXXXXXXXXX.Factor VIII deficiency

YYYYYYYYYYY.von Willebrand factor deficiency 77. 3 mild pale other WNL 13.5 kg , blood smear : hypochromic microcytic anemia AAAAAAAAAAAA.Iron deficiency ZZZZZZZZZZZ.Hereditary platelet dysfunction

Surgery BBBBBBBBBBBB. 47

3 a. Analgesic b. Try reducing c. Observe and plan admit d. Surgery e. Reassure and plan discharge 5

CCCCCCCCCCCC.

epigastrium 2 Abdomen : generalized guarding, absent bowel sound f. Plain abdomen

g. CT abdomen h. Ultrasound j. MRI i. Abdomen seriesDDDDDDDDDDDD.

22

3

2 cm oval shape, firm, smooth and movable k. Fat necrosis l. Fibroadenoma m. Fibrocystic disease n. Intraductal carcinomaEEEEEEEEEEEE.

o. Intraductal papilloma

56

colonoscopy polyps at descending colon polypectomy p. Villous adenoma q. Tubulovillous adenoma r. Tubulous adenomaFFFFFFFFFFFF.

s. Reduction t. Ultrasound

hernia

testis

1

u. Surgery v. Radiation w. ReassureGGGGGGGGGGGG. 30

5

Ultrasound vascular blood flow x. Orchitis y. Epididymitis aa. bb.

increase

z. Incarcerated hernia Acute torsion testis Torsion of appendix testis

HHHHHHHHHHHH.

pseudocyst at the front of pancreas 4 dd. ee. gg. cc.Partial Pancreatectomy Total Pancreatectomy Excision of pseudocyst Percutaneous drainage

ff. Internal drainage

IIIIIIIIIIII.

30 , 86/70 mmHg

laceration 3 cm anterior to sternocleidomastoid hh. ii. Explore wound at OR jj. CT kk.MRIJJJJJJJJJJJJ.

Explore wound at ER

ll. Angiography

30

distal

below knee amputation stump mm. nn. oo. pp. qq. 7 10 15 30 45

KKKKKKKKKKKK. 16

2 cm. right breast rr. ss. tt.

well define 2.5 centimeter mass, firm consistency at the

uu.

Fine needle aspiration 6 12

vv.Ultrasound ww.

xx.Mammogram yy.

LLLLLLLLLLLL. 35 5

2 Abdomen tender

at

epigastrium, liver dullness, decreased bowel sound zz.Alcoholic gastritis aaa. bbb. ccc. ddd.

Bowel perforation Acute pancreatitis Cholecystitis Spontaneous Bacterial Peritonitis 35

MMMMMMMMMMMM.

6 3 . eee. ggg. hhh. Injected 5% phenol Hemorrhoidectomy Cryosurgery

fff. Rubber band ligation

iii. Reassure and follow upNNNNNNNNNNNN.

65

Colorectal Cancer 1 3 restless, body temperature = 39 OC , Blood Pressure =100/70 mmHg ,Pulse Rate =110/min , Respiratory Rate = 26/min Acute abdominal generalized abdominal tenderness, generalized bowel guarding, rebound tenderness, absent bowel sound series dilatation with intraabdominal free air jjj. Ceftriazone + Metronidazole kkk. lll. Clindamycin +Ceftazidime mmm. nnn. Clindamycin + Gentamicin Ampicillin + Gentamicin Ceftazidime + Gentamicin 65 Car accident Blood pressure drop,

OOOOOOOOOOOO.

ooo. ppp. qqq. sss.

Bradycardia Cardiogenic shock Cushing response Hypovolemic shock Septic shock

rrr.Neurogenic shock

PPPPPPPPPPPP.

35

trachea shift , Right pneumothorax ( tension pneumothorax) ttt. Pleural tapping uuu. vvv. Observe vital sign Oxygen mask with bag Emergency ORIF 31

www.

QQQQQQQQQQQQ.

left parasternal border 5 Blood xxx. yyy. zzz. aaaa. bbbb. Pressure distant heart sound drop

Echocardiogram Pericardiocentesis CT chest MRI chest

Observe vital sign and clinical sign and symptom

RRRRRRRRRRRR. 13

shape hemorrhage hyperdensity area cccc. dddd. acute epidural hemorrhage acute subdural hemorrhage

stupor CT scan cresent

eeee. ffff. gggg.

subacute epidural hemorrhage subacute subdural hemorrhage subacute intradural hemorrhage

SSSSSSSSSSSS. 14

Blood pressure drop hhhh. Cervical Collar iiii. ET intubations jjjj. CT and MRI kkkk.

Glasgow Coma Score = 8

IV fluid and dopamine if necessary

TTTTTTTTTTTT. 2

llll. Refer to the nearest hospial immediately

Loose sphincter tone, areflexia both legs mmmm. Parasagittal nnnn. oooo. pppp. qqqq. Basal pons Thoracic cord

Lumbosacral nerve root Conus medullaris

UUUUUUUUUUUU. 14

burn 1st degree burn = 4% , 2nd

degree burn= 27% 15 inhalation injury Parklands formula rrrr. tttt. 200 ml/hr 250 ml/hr 290 ml/hr 340 ml/hr 390 ml/hr 52 ssss. uuuu. vvvv.

VVVVVVVVVVVV.

Leftt lung decrease breath sound, Abdomen: tender with guarding wwww. Hiatal hernia xxxx. yyyy. zzzz. Esophageal rupture Tension pneumothorax Mallory-Weiss syndrome

WWWWWWWWWWWW. 65 U/D AAA

aaaaa. Deep neck infection

PE: ecchymosis CBC Hb: 10, Hct: 30, WBC bbbbb. D-dimer ccccc. Bleeding time

8600 (N 75, L 25), PT 15, PTT 33, fibrinogen 150 lab

ddddd. Platelet function test eeeee. Protein C, Protein S

fffff.

Fibrinogen level 24 Intracranial bruise,

XXXXXXXXXXXX.

chemosis , 2 severe head injury ggggg. Intraorbital abscsee iiiii. jjjjj. hhhhh. Carotid cavernous fistula

Chronic subdural hematoma Posttraumatic hydrocephalus 18 Ruptured opthalmic aneurysm ()

kkkkk.

YYYYYYYYYYYY.

2x1 cm lllll. mmmmm.

tetanus toxoid Rabies vaccine Rabies Ig

nnnnn. 1 ooooo. ppppp.ZZZZZZZZZZZZ. 70

qqqqq.

rrrrr.

Rabies vaccine Rabies Ig

Rectal examination : firm , slightly enlarged and firm prostate gland sssss.

,U.A. : normal

Urethral stricture

ttttt. vvvvv.

Acute

prostatitis cancer

uuuuu. Prostate wwwww.

Neurogenic bladder BPH 2

AAAAAAAAAAAAA. 36

T=37.3

RR=18

muffled voice , no stirdor , erythema at film lateral neck

posterior pharynx xxxxx. yyyyy. zzzzz.

Ludwig

Epiglotitis

angina

aaaaaa. Paravertebral abscessBBBBBBBBBBBBB. 20

Tracheobronchitis

bbbbbb. Retropharyngeal abscess

emphysema cervical

prominence

BP 110/70 loss of laryngeal subcutaneous

cccccc. Orotracheal intubations dddddd. Nasotracheal intubations ffffff. Tracheostomy

eeeeee. Nasal Orotracheal intubations gggggg. CricothyroidotomyCCCCCCCCCCCCC.

CPR

Pink

Frosty sputum hhhhhh. Positive Pressure ventilation iiiiii. Mask with bagDDDDDDDDDDDDD.Pt.

bladder thickening acute cholangitis supportive NPO + ATB jjjjjj. llllll. ATB 14 6 wk

cholangitis

3

U/S

:gall

kkkkkk. LC

EEEEEEEEEEEEE.Pt. 6 hr tender at RLQ ,

+ rebound tenderness mmmmmm. nnnnnn. Emergency surgery oooooo. Pericardiocentesis

Observe abdominal sign

FFFFFFFFFFFFF.Pt. trauma beck triad GGGGGGGGGGGGG.

:

Esophageal rupture40. X-ray mediastinal shift, bowel thorax pppppp. diaphragmatic herhernia qqqqqq. TAOOb & Gyn

HHHHHHHHHHHHH.pt 45 gangrene

1. 32 G2P1 GA 24 wk A) Fasting blood sugar B) 50 g OGTT C) 100 g OGTT D) Random glucose E) Urine sugar 2. internal rotation of right arm, extended arm with flex wrist A) C1-2 B) C3-4 C) C5-6 D) C8-T1 E) T2-3 3. G1P0 GA 34 wk sterile A) Tocolytic drug B) Dexamethasone C) IV prophylactic ATB D) Observe sign of chorioamnionitis E) PV progression 4. G2P1 GA 38 wk uterine contraction 3 30 Cervix dilate 3 cm, 50% effacement, station 0, membrane intact PV A) Amniotomy B) Syntocinon C) US D) Observe E) C/S 5. 28 mitral stenosis 8

speculum fluid posterior fornix fern test: positive

A)

B) C) tertiary center D) 6. A) B) pubic C) E)

D) 7. 26 GA 8 week Ultrasound GA A) Femur length B) BPD C) CRL D) Abdominal circumference E) Head circumference 8. 32 GA 20 wk vaginal bleeding 7 20 A) B)

C) 20 D) 7 20 9. Obesity with DM E) 10. Vacuum extraction A) Cephalhematoma B) Epidural hematoma C) Subdural hematoma D) Subgaleal hematoma E) Caput succedaneum 11. 24 G1P1. Hydramnios oxytocin Vaginal delivery

bleed 1500 ml bleed PE : Uterus FH> umbilical post partum hemorrhage A) B) Hydramnios C) 12. 30 term maneuver A) McRobert maneuver B) Modified crede C) Zillneuing . 13. G4P3 GA 38 wk true labor PV: OS open 7cm cord Fetus Normal Most approp Mx ( C/S) 14. valva Herpes (NL, C/S,) 15. HbH disease profile Hct 37 MCV 87 reti count 0.5 Hct 38 MCV 72 reti 1 Hb A) - - / B) / D) B / B0 E) B / B+ C) / - D) oxytocin

16. 28 G1P0 GA 38 wk . 2 . FHR 150 at RLQ Cervical os closed , ANC uterine segment ? IIIIIIIIIIIII.Normal delivery JJJJJJJJJJJJJ.Cesarean section

FH 3/4 >

USG at 3 trimester mass 8 cm @ anterolateral lower

KKKKKKKKKKKKK.Cesarean section with myomectomy LLLLLLLLLLLLL.Cesarean section with hysterectomy 17. A) wet smear B) G/S C) C/S 18. 18 U/S mass Rt. Adnexal hypoecoic without internal content A) functional ovarion cyst B) PCOS 19. A) perineum B) suprapubic C) fundus D) flex hip

E) 20. Pt 28 y. G_P_ C/S day 2 breast engorge tender adnexa, Cx.: lochia rubra Dx ( 10) A. breast abscess B. mastitis C. pelvic infection D. TOA E. C/S wound infection 21. 52 menopause , lochia rubra , c/s no oozing PV- tender on cervix motion,

A) 300 B) 500 C) 800 D) 100022. IUD 6

E) 2000

A) Ultrasound B) X-ray C) urine pregnancy test D) hook IUD 23. 39 65 kg 152 cm 4200 gm risk DM

E) IUD

A) B) C) E) > 25

D) macrosomia24. neural tube defect (folate) 25. female 18 yr GA 12 wk G1P0 ()

PE: 8 wk mens cervix Diagnosis? NNNNNNNNNNNNN.Complete abortion PPPPPPPPPPPPP.Imminent abortion MMMMMMMMMMMMM.Threatened abortion OOOOOOOOOOOOO.Inevitable abortion QQQQQQQQQQQQQ.Incomplete abortion 26. GA 20 wk LMP fundal height umbilicus A) ultrasound

27. severe preeclampsia A) urgent C/S B) obsererve

B) void

28. Pt. pregnancy BP 140/90 mmHg, urine alb 1+ A) mild preclamsia 29. 7 3 2 Asthma Asthma RRRRRRRRRRRRR. SSSSSSSSSSSSS. soy formular milk TTTTTTTTTTTTT. Hydrolysated extend casein formular UUUUUUUUUUUUU. VVVVVVVVVVVVV. Serum IgE 30. TB Tuberculin test 4 mm ? WWWWWWWWWWWWW. TB XXXXXXXXXXXXX.INH prophylaxis 1 month ZZZZZZZZZZZZZ.... YYYYYYYYYYYYY.Observe chest X ray 6 31. 21 LMP 6 wk. vagina PV: uterine normal size, soft, no adnexal mass, not tender, TVS : no intrauterine sac, no mass, Mx? AAAAAAAAAAAAAA.D&C BBBBBBBBBBBBBB.Serun -hCG CCCCCCCCCCCCCC.Exploratory laparotomy DDDDDDDDDDDDDD.Diagnostic laparotomy EEEEEEEEEEEEEE.MTX injection

32. 28 3 , swelling, tender, red labia minora 2.5 cm Tx? FFFFFFFFFFFFFF.Incision biopsy GGGGGGGGGGGGGG.Excision biopsy HHHHHHHHHHHHHH.Masupialization IIIIIIIIIIIIII.I&D JJJJJJJJJJJJJJ.Needle aspiration

33. 24 G1P0

Ut. U/S Double decidual sac sign KKKKKKKKKKKKKK. Demise embryo LLLLLLLLLLLLLL.Implant bleed

GA 6 wk bleeding

PV

MMMMMMMMMMMMMM.Ectopic pregnancy NNNNNNNNNNNNNN.Intrauterine pregnancy OOOOOOOOOOOOOO.Anembryonic pregnancy34. 30 Wet smear 10%KOH ( epithelium = clue cell) . 1. Amoxicillin 2. Doxycycline 3. Metronidazole 4. Ceftriaxone 5. Ofloxacin 35. GA 38 wk term mucous bloody shown, cervix dilate 3 cm. Vx, FHR 144/min ( Rt labia major lesion ulcer discharge vagina) Mx. PPPPPPPPPPPPPP. Normal labour

QQQQQQQQQQQQQQ. podophyline NL RRRRRRRRRRRRRR. TCA NL TTTTTTTTTTTTTT.Cesarean section UUUUUUUUUUUUUU.Omeprazole VVVVVVVVVVVVVV.Misoprostal XXXXXXXXXXXXXX.Ranitidine SSSSSSSSSSSSSS. Silver nitrate NL 36. 30 3 EGD DU

WWWWWWWWWWWWWW.Sucralfate YYYYYYYYYYYYYY.Cimetidine 37. 30 GP1021 GA 38 wk in labor Drip Syntocinon BP 80/50 mmHg Fetal part Fetal heart sound Dx. ZZZZZZZZZZZZZZ.Abruptio placentae AAAAAAAAAAAAAAA.Placenta previa CCCCCCCCCCCCCCC.Vasa previa BBBBBBBBBBBBBBB.Uterine rupture DDDDDDDDDDDDDDD.Prolapse cord

38. 40 G2P1 GA 8 wk Down syndrome EEEEEEEEEEEEEEE.1/50 FFFFFFFFFFFFFFF.1/100 GGGGGGGGGGGGGGG.1/200 HHHHHHHHHHHHHHH.1/300 IIIIIIIIIIIIIII.1/400

39. 38 G4P3 GA 39 wk, no ANC, 2hr PTA ., contraction 5 30, PV: 7cm,station -2 Management

JJJJJJJJJJJJJJJ.ObserveKKKKKKKKKKKKKKK. syntocinon

LLLLLLLLLLLLLLL.Partial breech extraction NNNNNNNNNNNNNNN.Emergency C/S

MMMMMMMMMMMMMMM.Total breech extraction40. 8 wk Mitral stenosis OOOOOOOOOOOOOOO. PPPPPPPPPPPPPPP. QQQQQQQQQQQQQQQ. Tertiary care RRRRRRRRRRRRRRR. SSSSSSSSSSSSSSS.

41. 28 G6P5005 transverse lie 4 cm. a. cytotec b. external version c. C/S d. Cx Internal version

42. 60 9 2 vital sign stable a. F/U 6 mo b. Colposcopy c. Endometrial ablation d. Endometrial sampling e. OCP 43. G1PO hydramnios labor pain 6 hr Pethidine 2 hr 600cc. Fundus 2 FB > umbilicus , flabby

e. Voohees

a. b.

c. d. Hydramnios e. Pethidine 44. . G1P0 GA 32 wk PROM 1 hr Contraindication . refer a. steroid b. O2 c. Antibiotics d. .. e. Progression 45. 18 2 PE: well-defined mass 2 cm in diameter , firm consistency , mild tenderness at UOQ manage a. self-breast examination b. 3 c. FNA d. Mammogram 2 46. risk factor uterine atony :

e. Ultrasound 1 Polyhydramnios

47. 28 S/P C/S Day 2 v

PE: T 38 C, Breast marked engorge and tenderness, Abd mild tenderness, oozing bleed mild tenderness,

MIUB: WNL, Cx: tender on motion , lochia rubra, no mass, Ut: mild tender, 20 wk size, Adx: tenderness both sides A. Mastitis B. Breast Abscess C. Pelvic infection D. TOA Dx

E. C/S wound infection 48. 35 G1P0 GA 16 Wk DM A. Urine Sugar B. FBS C. GCT (50 g) E. HbA1C

D. OGTT (100 g) 24-28 Wk 49. 40 G1P0 GA 16 wk amniocentesis increased AFP risk A. Cleft lip B. Bilary atresia

C. Duodenal atresia D. Neural tube defect E. Esophageal stenosis 50. 14 3

2

abdominal : tense

cystic mass , 1/3 > suprapubic , labia majora

: normal , Gaping labia minor with purple tissue , PR : pelvic mass 12 cm , cystic consistency TTTTTTTTTTTTTTT.Vulva CA UUUUUUUUUUUUUUU.Ovarian tumor

VVVVVVVVVVVVVVV.Imperforated anus WWWWWWWWWWWWWWW.Sarcoid boterioides XXXXXXXXXXXXXXX.Foreign Body in Vulva 51. 70 Subungual hyperkeratosis ,

Onycholysis , KOH branching septate hyphae YYYYYYYYYYYYYYY. Topical ketoconazole ZZZZZZZZZZZZZZZ.Topical Itraconazole AAAAAAAAAAAAAAAA.Topical cotrimazole BBBBBBBBBBBBBBBB.Oral ketoconazole CCCCCCCCCCCCCCCC.Oral itraconazole

52. 35 P1021 G4 Oxytocin drip BP 130/100 FHS 2/3

DDDDDDDDDDDDDDDD. Myoma uteri

EEEEEEEEEEEEEEEE.Full bladder FFFFFFFFFFFFFFFF.Theated Ut. Rupture GGGGGGGGGGGGGGGG.Hypertonic Ut. Contraction53. 28 3 2

HHHHHHHHHHHHHHHH. IIIIIIIIIIIIIIII.......

JJJJJJJJJJJJJJJJ. KKKKKKKKKKKKKKKK.

Conjugated estrogens

LLLLLLLLLLLLLLLL.

0.625 mg 21

3 54. Pt. pregnancy BP 140/90 mmHg, urine alb 1+ a. mild preclamsia 55. Pt. severe preclamsia GA 33 wk cervical change a. induction with oxytocin b. induction + painless labor 56. Pt. amiotic fluid centesis AFP a. neural tube defect

57. pt 14 primary amenorrhea mass suprapubic 10 week size firm PV normal labia major bulging vagina : Imperforate hymen 58. pt dysmenorrheal cystic

mass at adnexa with multiple nodule in cul-de-sac: endometritis

59. a. 10 b. 12 c. 14 60. 20 5 cervical U/S : serum hCG

Ortho & Rehabilitation MMMMMMMMMMMMMMMM. orbit

A) Caucasian B) Mongolian C) Nigro .......NNNNNNNNNNNNNNNN.C

1

5-8

myelopathy

A) traction + MRI B) traction C) OOOOOOOOOOOOOOOO. RA swan

neck modality A) block exercise

B) tension-gliding exercise

C) low-load, high repetitive resistant exercisePPPPPPPPPPPPPPPP. 22

D) high load, high repetitive resistant exercise

flexion, abduction, internal rotation diagnosis A) Fx pelvic

B) Fx acetabulum C) Fx neck of femur D) Intertrochanteric FxQQQQQQQQQQQQQQQQ. 10

E) Posterior hip dislocation

PE: swelling at Rt elbow, triangle landmark at Rt elbow A) Dislocation elbow B) Displaced olecranon fracture

C) Displaced supracondylar fracture D) Displaced lateral condylar fracture E) Displaced medial condylar fractureRRRRRRRRRRRRRRRR. 65 crepitation Dx

1) OA 2) RA 3) gout

4) pseudogoutSSSSSSSSSSSSSSSS. 10 MCA

PE:swelling at elbow, triangle landmark at Rt. Elbow, Dx? TTTTTTTTTTTTTTTT.Dislocation elbow

UUUUUUUUUUUUUUUU.Displaced olecranon Fx VVVVVVVVVVVVVVVV.Displaced supracondylar Fx Fx WWWWWWWWWWWWWWWW.Displaced lateral condylar XXXXXXXXXXXXXXXX.Displaced medial epicondyla FxYYYYYYYYYYYYYYYY. 25 Motorcycle

accident Dx.

PE: Leg - internal rotation, adduction, hip flexion

ZZZZZZZZZZZZZZZZ.Posterior hip dislocation

AAAAAAAAAAAAAAAAA. 59

Biceps reflex BBBBBBBBBBBBBBBBB.C5

CCCCCCCCCCCCCCCCC.C6 DDDDDDDDDDDDDDDDD.C7

EEEEEEEEEEEEEEEEE.C8 FFFFFFFFFFFFFFFFF.T1

GGGGGGGGGGGGGGGGG. 20

X-ray fracture neck of humerus HHHHHHHHHHHHHHHHH.Deltoid IIIIIIIIIIIIIIIII.Brachialis JJJJJJJJJJJJJJJJJ.Biceps

KKKKKKKKKKKKKKKKK.Triceps LLLLLLLLLLLLLLLLL.CoracobrachialisMMMMMMMMMMMMMMMMM. 52 yr

PE: sensory intact, no thenar atrophy, Phalen test +ve Tx NNNNNNNNNNNNNNNNN.Observation OOOOOOOOOOOOOOOOO.NSAIDS PPPPPPPPPPPPPPPPP.Epidural steroid injection QQQQQQQQQQQQQQQQQ.Long arm cast RRRRRRRRRRRRRRRRR.A1 pulley release

SSSSSSSSSSSSSSSSS. 22 10

. Mx

T2 BP 180/110, PR 56 bpm TTTTTTTTTTTTTTTTT. Foley catheter

UUUUUUUUUUUUUUUUU. VVVVVVVVVVVVVVVVV. Hydralazine WWWWWWWWWWWWWWWWW. BP

XXXXXXXXXXXXXXXXX.

YYYYYYYYYYYYYYYYY.Pt 69 yr , OA ZZZZZZZZZZZZZZZZZ. isotonic

genu varum

AAAAAAAAAAAAAAAAAA. strength

BBBBBBBBBBBBBBBBBB. isometric Hamstring CCCCCCCCCCCCCCCCCC. medial DDDDDDDDDDDDDDDDDD.

Cervical traction

EEEEEEEEEEEEEEEEEE.MRIFFFFFFFFFFFFFFFFFF.Cervical traction . 8 kg GGGGGGGGGGGGGGGGGG. Cervical traction

HHHHHHHHHHHHHHHHHH.Heat

IIIIIIIIIIIIIIIIII. 25 Fracture

neck of humerus a. Brachioradialis m. b. Deltoid m. c. Brachial m. e. Biceps m.

d. Coracobrachialis m.JJJJJJJJJJJJJJJJJJ. 90

1 cervical traction 30

5-8 kg 1 wk a. traction b. traction d. c. physical modality e. + traction then MRI

KKKKKKKKKKKKKKKKKK. Rt.

Below knee amputation stump

1. 2. 3. 4. 5.

7 10 15 30 45 palsy Lesion

LLLLLLLLLLLLLLLLLL.Erbs

MMMMMMMMMMMMMMMMMM.C8 T1NNNNNNNNNNNNNNNNNN.Rheumatoid arthritis

film

OOOOOOOOOOOOOOOOOO. Elbow sprain PPPPPPPPPPPPPPPPPP.Elbow dislocation QQQQQQQQQQQQQQQQQQ.Supracondylar Fx of humerus RRRRRRRRRRRRRRRRRR.Lateral Condylar Fx of humerus Fx of

SSSSSSSSSSSSSSSSSS.Lateral epicondylar humerusTTTTTTTTTTTTTTTTTT. 59

Biceps,Bicep reflex UUUUUUUUUUUUUUUUUU. C5 VVVVVVVVVVVVVVVVVV.C6 WWWWWWWWWWWWWWWWWW.C7 XXXXXXXXXXXXXXXXXX.C8 YYYYYYYYYYYYYYYYYY.T1

ZZZZZZZZZZZZZZZZZZ.carpal tunnel syndrome tx : AAAAAAAAAAAAAAAAAAA.observe

BBBBBBBBBBBBBBBBBBB.tendon release CCCCCCCCCCCCCCCCCCC.NSAIDsDDDDDDDDDDDDDDDDDDD.

C-spine traction Mx :

23.

triangular landmark a) supracondylar fracture c) olecranon fracture d)... b) lateral condylar fracture

MRI

ENT

1. 40 muffled voice film lateral neck soft tissue technique EEEEEEEEEEEEEEEEEEE.Epiglotitis FFFFFFFFFFFFFFFFFFF.Ludwig angina GGGGGGGGGGGGGGGGGGG.Laryngotracheitis HHHHHHHHHHHHHHHHHHH.Retropharyngeal abscess IIIIIIIIIIIIIIIIIII.Parapharyngeal abscess

2. 30 1 2 left ear drum: normal , right ear drum: dark blue, retracted ear drum, Weber test: localized to right, Rinne test: left AC>BC, right BC>AC JJJJJJJJJJJJJJJJJJJ.Loratadine

KKKKKKKKKKKKKKKKKKK.Pseudoephredine LLLLLLLLLLLLLLLLLLL.Serrtic peptidase MMMMMMMMMMMMMMMMMMM.Chloramphenical eardrop NNNNNNNNNNNNNNNNNNN.Myringotomy

3.

ear drum : intact , Weber : no lateralization , Renne : Rt BC > AC , Lt AC>BC OOOOOOOOOOOOOOOOOOO.Acoustic trauma PPPPPPPPPPPPPPPPPPP.Otosclerosis QQQQQQQQQQQQQQQQQQQ.Meniere RRRRRRRRRRRRRRRRRRR.Steatosis SSSSSSSSSSSSSSSSSSS.Otitis media

4. 29 5 PE: 0.5 cm. TTTTTTTTTTTTTTTTTTT.? UUUUUUUUUUUUUUUUUUU.entropion VVVVVVVVVVVVVVVVVVV.ectropion WWWWWWWWWWWWWWWWWWW.allergic rhinitis

XXXXXXXXXXXXXXXXXXX.Meibomian gland dysfunction 5. erythematous with bulging

at posterior TM YYYYYYYYYYYYYYYYYYY.Tetracycline ZZZZZZZZZZZZZZZZZZZ.Amoxycillin AAAAAAAAAAAAAAAAAAAA.Erythromycin BBBBBBBBBBBBBBBBBBBB.Doxycycline CCCCCCCCCCCCCCCCCCCC.Amoxy-clavulonic 6. 5 DDDDDDDDDDDDDDDDDDDD.Choanal atresia EEEEEEEEEEEEEEEEEEEE.High arch palate FFFFFFFFFFFFFFFFFFFF.Hypertrophy of adenoid

GGGGGGGGGGGGGGGGGGGG.Foreign body of nasal cavity HHHHHHHHHHHHHHHHHHHH.Congenital tumor of nasal cavity 7. 25 6 Dx IIIIIIIIIIIIIIIIIIII.Atrophic rhinitis 3

JJJJJJJJJJJJJJJJJJJJ.Vasomotor rhinitis KKKKKKKKKKKKKKKKKKKK.Chronic irritative rhinitis LLLLLLLLLLLLLLLLLLLL.Rhinitis medicamentosa MMMMMMMMMMMMMMMMMMMM.Severe allergic rhinitis

with polypoid change 8.

Foreign body impact 9. 45 NNNNNNNNNNNNNNNNNNNN.CA nasopharynx

OOOOOOOOOOOOOOOOOOOO. otitis media ? 10. bullous myringitis Macrolide

Eye 1. 5 VA 20/200 20/40 with pinhole, VA 20/100 20/30 with pinhole PPPPPPPPPPPPPPPPPPPP.Catarax QQQQQQQQQQQQQQQQQQQQ.Ambyopia RRRRRRRRRRRRRRRRRRRR.Strabismus SSSSSSSSSSSSSSSSSSSS.Refractive error

TTTTTTTTTTTTTTTTTTTT.Color blindness 2. 40 UUUUUUUUUUUUUUUUUUUU.Dry eye VVVVVVVVVVVVVVVVVVVV.Cataract WWWWWWWWWWWWWWWWWWWW.Glaucoma XXXXXXXXXXXXXXXXXXXX.Retinitis pigmentosa YYYYYYYYYYYYYYYYYYYY.Loss of accommodation 3. 58 3 PE : Rt eye - ciliary injection, cloudy cornea, shallow anterior Lt eye - deep anterior chamber, lens sclerosis

chamber, pupil 5 mm no reactive to light Dx.

ZZZZZZZZZZZZZZZZZZZZ.Acute iridocyclitis

AAAAAAAAAAAAAAAAAAAAA.Phagomorphic glaucoma BBBBBBBBBBBBBBBBBBBBB.Phagolytic glaucoma CCCCCCCCCCCCCCCCCCCCC.Acute dry eye DDDDDDDDDDDDDDDDDDDDD.intermittent dry eye 4. 55 1 Wk 3

Dx chalazion I&C 3 recurrent EEEEEEEEEEEEEEEEEEEEE.Local steroid injection FFFFFFFFFFFFFFFFFFFFF.I&C with Culture systemic Antibiotics investigation culture GGGGGGGGGGGGGGGGGGGGG.Warm compression with HHHHHHHHHHHHHHHHHHHHH.Biopsy and microbial IIIIIIIIIIIIIIIIIIIII.Aspiration and Gram strain, KOH exam and

5. Glaucoma (acute angle closure glaucoma) JJJJJJJJJJJJJJJJJJJJJ.Beta blocker KKKKKKKKKKKKKKKKKKKKK.Atropine eye drop LLLLLLLLLLLLLLLLLLLLL.Pilocapine eye drop MMMMMMMMMMMMMMMMMMMMM.Oral glycerol 6. 30 Dx. PE:

mild cornea and lens ? , Ciliary injection, pupil 5 cm fixedA. Migraine B. Uveitis

C. Acute glaucoma

7. 20 contact lens, mild conjunctival injection, corneal ulcer 2 cm A. Topical ATB B. Pressure patch C. Contact lens culture

8. miosis, diaphoriasis, BP drooling NNNNNNNNNNNNNNNNNNNNN.Opioid

OOOOOOOOOOOOOOOOOOOOO.Cocaine PPPPPPPPPPPPPPPPPPPPP.Carbimate 9. 3 normal cornea QQQQQQQQQQQQQQQQQQQQQ.

RRRRRRRRRRRRRRRRRRRRR.ceftriazone im 10. mature cataract glaucoma on top (Phagomorphic) 11. 9 1 cobble

bone stone (papillaly) 2 Vernal keratoconjunctivitis Psychiatry 1. 35 SSSSSSSSSSSSSSSSSSSSS.Midazolam TTTTTTTTTTTTTTTTTTTTT.Lorazepam UUUUUUUUUUUUUUUUUUUUU.Clonazepam VVVVVVVVVVVVVVVVVVVVV.Temazepam WWWWWWWWWWWWWWWWWWWWW.CDZ 2. XXXXXXXXXXXXXXXXXXXXX.Thioridazine YYYYYYYYYYYYYYYYYYYYY.Risperidone ZZZZZZZZZZZZZZZZZZZZZ.Haloperidol

AAAAAAAAAAAAAAAAAAAAAA.Chlorpromazine BBBBBBBBBBBBBBBBBBBBBB.Clozapine 3. 9 3

CCCCCCCCCCCCCCCCCCCCCC.sibling rivalry DDDDDDDDDDDDDDDDDDDDDD.Schizophrenia EEEEEEEEEEEEEEEEEEEEEE.Simple phobia FFFFFFFFFFFFFFFFFFFFFF.Simple reaction

GGGGGGGGGGGGGGGGGGGGGG.Separation anxiety disorder 4. 45 IIIIIIIIIIIIIIIIIIIIII. HHHHHHHHHHHHHHHHHHHHHH. JJJJJJJJJJJJJJJJJJJJJJ. KKKKKKKKKKKKKKKKKKKKKK. LLLLLLLLLLLLLLLLLLLLLL.

5. 25 appendectomy 3 2 wk NNNNNNNNNNNNNNNNNNNNNN.Delirium MMMMMMMMMMMMMMMMMMMMMM.Normal grief reaction OOOOOOOOOOOOOOOOOOOOOO.Brief psychosis PPPPPPPPPPPPPPPPPPPPPP.Adjustment disorder with depress mood QQQQQQQQQQQQQQQQQQQQQQ.MDD with psychotic

feature 6. 24 underlying schizophrenia 20 RRRRRRRRRRRRRRRRRRRRRR.Delirium SSSSSSSSSSSSSSSSSSSSSS.Akathisia

TTTTTTTTTTTTTTTTTTTTTT.Acute Stress disorder UUUUUUUUUUUUUUUUUUUUUU.Relapsed schizophrenia VVVVVVVVVVVVVVVVVVVVVV.Brief psychotic disorder

7. 22 ER

3 5 WWWWWWWWWWWWWWWWWWWWWW. XXXXXXXXXXXXXXXXXXXXXX. YYYYYYYYYYYYYYYYYYYYYY. ZZZZZZZZZZZZZZZZZZZZZZ.

AAAAAAAAAAAAAAAAAAAAAAA.

8. REM Sleep

BBBBBBBBBBBBBBBBBBBBBBB.Dream CCCCCCCCCCCCCCCCCCCCCCC.Penile erection in male DDDDDDDDDDDDDDDDDDDDDDD.Decrease respiratory rate EEEEEEEEEEEEEEEEEEEEEEE.Change in body temperature FFFFFFFFFFFFFFFFFFFFFFF.Near-total paralysis in skeletal muscle

9. 18 GGGGGGGGGGGGGGGGGGGGGGG. Fluoxetine HHHHHHHHHHHHHHHHHHHHHHH.Paroxetine IIIIIIIIIIIIIIIIIIIIIII.Lithium JJJJJJJJJJJJJJJJJJJJJJJ.Imipramine KKKKKKKKKKKKKKKKKKKKKKK.Amitryptylline

10. 40 admit

BP 150/110 HR 80 LLLLLLLLLLLLLLLLLLLLLLL.IM Halopuridol

MMMMMMMMMMMMMMMMMMMMMMM.IV Diazepam NNNNNNNNNNNNNNNNNNNNNNN.IM Clopixel adephine OOOOOOOOOOOOOOOOOOOOOOO.IM Clopomazine PPPPPPPPPPPPPPPPPPPPPPP.IM Thiamine 11. 50 . QQQQQQQQQQQQQQQQQQQQQQQ.Denial RRRRRRRRRRRRRRRRRRRRRRR.Depair SSSSSSSSSSSSSSSSSSSSSSS.Depression TTTTTTTTTTTTTTTTTTTTTTT.Bargianing UUUUUUUUUUUUUUUUUUUUUUU.Anger 12. 40 Schizophrenia 1 PR = 120/ min, others: WNL, EKG: sinus tachycardia VVVVVVVVVVVVVVVVVVVVVVV.Haloperidol

WWWWWWWWWWWWWWWWWWWWWWW.Thioridazine XXXXXXXXXXXXXXXXXXXXXXX.Fluphenazine ZZZZZZZZZZZZZZZZZZZZZZZ.? 13. Schizophrenia Haloperidol 20 mg/d, YYYYYYYYYYYYYYYYYYYYYYY.Perphenazine

Trihexyphenidyl 6 mg/d AAAAAAAAAAAAAAAAAAAAAAAA. Haloperidol

BBBBBBBBBBBBBBBBBBBBBBBB. Haloperidol .. CCCCCCCCCCCCCCCCCCCCCCCC.

Psychotherapy long acting

DDDDDDDDDDDDDDDDDDDDDDDD.

EEEEEEEEEEEEEEEEEEEEEEEE.? 14. 3 FFFFFFFFFFFFFFFFFFFFFFFF.Schizophrenia

GGGGGGGGGGGGGGGGGGGGGGGG.Bipolar disorder HHHHHHHHHHHHHHHHHHHHHHHH.Anxiety disorder IIIIIIIIIIIIIIIIIIIIIIII.Depressive disorder JJJJJJJJJJJJJJJJJJJJJJJJ.?

15. 18 LLLLLLLLLLLLLLLLLLLLLLLL.Imipramine

KKKKKKKKKKKKKKKKKKKKKKKK.Buspirone MMMMMMMMMMMMMMMMMMMMMMMM.Chlorpromazine NNNNNNNNNNNNNNNNNNNNNNNN.Clomipramine OOOOOOOOOOOOOOOOOOOOOOOO.? 16. 35 yr 2 PPPPPPPPPPPPPPPPPPPPPPPP.Lorazepam QQQQQQQQQQQQQQQQQQQQQQQQ.Midazolam RRRRRRRRRRRRRRRRRRRRRRRR.Tenazepam TTTTTTTTTTTTTTTTTTTTTTTT.? SSSSSSSSSSSSSSSSSSSSSSSS.Chlodiazepoxide

17. 25 2 SI 6 HIV negative 3 3 DSM IV UUUUUUUUUUUUUUUUUUUUUUUU. Conversion disorder

VVVVVVVVVVVVVVVVVVVVVVVV.Chronic schizophrenia WWWWWWWWWWWWWWWWWWWWWWWW.Schizotypal personality disorder XXXXXXXXXXXXXXXXXXXXXXXX.Delusion disorder ;somatic type

YYYYYYYYYYYYYYYYYYYYYYYY.?

18. emphysema BP , conscious A.withdraw B.develop dementia C.develop personality disorder 19. PTSD PTSD ZZZZZZZZZZZZZZZZZZZZZZZZ. AAAAAAAAAAAAAAAAAAAAAAAAA. BBBBBBBBBBBBBBBBBBBBBBBBB. CCCCCCCCCCCCCCCCCCCCCCCCC.? DDDDDDDDDDDDDDDDDDDDDDDDD.?

20. ( ) EEEEEEEEEEEEEEEEEEEEEEEEE.Methanal

FFFFFFFFFFFFFFFFFFFFFFFFF.Ethalene glycol 21. NS intact . GGGGGGGGGGGGGGGGGGGGGGGGG.B1 IV HHHHHHHHHHHHHHHHHHHHHHHHH.50% glucose IV 22. panic, IIIIIIIIIIIIIIIIIIIIIIIII.Panic attack JJJJJJJJJJJJJJJJJJJJJJJJJ.Acute stress disorder 23. diaporesis, miosis, drooling KKKKKKKKKKKKKKKKKKKKKKKKK.opioid LLLLLLLLLLLLLLLLLLLLLLLLL.organophospate 24. learning deficit Alexia 25. ADHD methylphenidate 26. amphetamine overdose confirm

blood urine 27. 65 Forensic 1. MMMMMMMMMMMMMMMMMMMMMMMMM.2 hr NNNNNNNNNNNNNNNNNNNNNNNNN.2-4 hr PPPPPPPPPPPPPPPPPPPPPPPPP.6-8 hr OOOOOOOOOOOOOOOOOOOOOOOOO.4-6 hr QQQQQQQQQQQQQQQQQQQQQQQQQ.8-10 hr 2. Hyoid bone RRRRRRRRRRRRRRRRRRRRRRRRR.Mothering

SSSSSSSSSSSSSSSSSSSSSSSSS.Complete hanging TTTTTTTTTTTTTTTTTTTTTTTTT.Incomplete hanging UUUUUUUUUUUUUUUUUUUUUUUUU.Ligature strangulation VVVVVVVVVVVVVVVVVVVVVVVVV.Manual strangulation

3. 57 . ER EKG 20 poisoning WWWWWWWWWWWWWWWWWWWWWWWWW.Acute XXXXXXXXXXXXXXXXXXXXXXXXX.Rupture aneurysm

YYYYYYYYYYYYYYYYYYYYYYYYY.Acute heart failure ZZZZZZZZZZZZZZZZZZZZZZZZZ.Cardiopulmonary failure AAAAAAAAAAAAAAAAAAAAAAAAAA.Coronary heart disease 4. A. E. D. G. J. B. C.

H.

.F.

I.

6. 3 1

severe brain laceration, fracture base of skull rupture trachea of skull A. severe brain laceration with gun short wound ,fracture base B. C. D. E. ..( ) ..( )

F. severe brain laceration with fracture base of skull with tracheal rupture 7.

BBBBBBBBBBBBBBBBBBBBBBBBBB. sperm CCCCCCCCCCCCCCCCCCCCCCCCCC. sperm & acid

phosphatase

DDDDDDDDDDDDDDDDDDDDDDDDDD.

vagina sperm

EEEEEEEEEEEEEEEEEEEEEEEEEE. sperm

8. FFFFFFFFFFFFFFFFFFFFFFFFFF.

GGGGGGGGGGGGGGGGGGGGGGGGGG. HHHHHHHHHHHHHHHHHHHHHHHHHH. 9.

inevitable abortion A. B.

Preventive & community medicine 1. 45 IIIIIIIIIIIIIIIIIIIIIIIIII.CXR JJJJJJJJJJJJJJJJJJJJJJJJJJ.Mammogram

KKKKKKKKKKKKKKKKKKKKKKKKKK.Fasting blood sugar LLLLLLLLLLLLLLLLLLLLLLLLLL.Blood cholesterol MMMMMMMMMMMMMMMMMMMMMMMMMM.CBC 2. Nosocomial infection 20% NNNNNNNNNNNNNNNNNNNNNNNNNN. OOOOOOOOOOOOOOOOOOOOOOOOOO. PPPPPPPPPPPPPPPPPPPPPPPPPP. 6 QQQQQQQQQQQQQQQQQQQQQQQQQQ.-

RRRRRRRRRRRRRRRRRRRRRRRRRR.

3. 2000 TB 200 CXR 150 TB CXR 30 CXR TB A. B. C. D. E. 3 7 15 27 F.

4. 19 30 SSSSSSSSSSSSSSSSSSSSSSSSSS. TTTTTTTTTTTTTTTTTTTTTTTTTT. UUUUUUUUUUUUUUUUUUUUUUUUUU.

20

VVVVVVVVVVVVVVVVVVVVVVVVVV. WWWWWWWWWWWWWWWWWWWWWWWWWW.

5. RCT chemo 2 ? XXXXXXXXXXXXXXXXXXXXXXXXXX......... YYYYYYYYYYYYYYYYYYYYYYYYYY.........

ZZZZZZZZZZZZZZZZZZZZZZZZZZ. AAAAAAAAAAAAAAAAAAAAAAAAAAA. 6. BP cuff adult BBBBBBBBBBBBBBBBBBBBBBBBBBB.Bias

CCCCCCCCCCCCCCCCCCCCCCCCCCC.Confounder DDDDDDDDDDDDDDDDDDDDDDDDDDD.Contamination EEEEEEEEEEEEEEEEEEEEEEEEEEE.Co-intervention 7.

FFFFFFFFFFFFFFFFFFFFFFFFFFF.Beneficence

GGGGGGGGGGGGGGGGGGGGGGGGGGG.Autonomy HHHHHHHHHHHHHHHHHHHHHHHHHHH.Confidentiality 8.

IIIIIIIIIIIIIIIIIIIIIIIIIII. JJJJJJJJJJJJJJJJJJJJJJJJJJJ. .KKKKKKKKKKKKKKKKKKKKKKKKKKK.

9. 2.000 xray 80 CA 50 1,920 CA % ( choice ) CA X-ray X-ray 10. 16 150 200 1770 1800 1920 2000 50 CA 30 xray CA 150 x-ray 80

LP

11. Autonomy

12. people empowerment