1. Faculty Medicine, Naresuan University
Phitsanulok, Thailand
National license
Part II
March 2008 - 2010
Naresuan medical student union
Phitsanulok, Thailand

2. PediatrSource: med.nu.ac.th/samo
National council of thai medical student samomed_nu@hotmail.com
b. Asthma
Pediatrics 3.
c. Pulmonary...
Cardiology
National test 2008 Giant papillae
1. newborn Cubblestone
heart murmur,
a. Trachoma
cataract,
b. Inclusion Conjunctivitis
congenital infection
c. Hay fever Conjunctivitis
(Rubella)
d. Vernal
karatoconjunctivitis
2. 6
e. Epidemic Conjunctivitis
4
4.
PE: tachycardia, tachypnea,
pansystolic murmur 2/6 at left
parasternal border, cyanosis
a. Hypoxic spell PE: central

3. cyanosis, clubbing finger, AMbu
Loud P , diastolic rumbing tube Amiodalone
murmur 3/6 at Lt upper EKG ventricular
parasternal border lung: clear tachycardia management
a. Defibilation
b. Ca gluconate
c. NaHCO3
a. Pulmonary embolism
d. Adenosine
b. Aortic regurgitation
e. Direct – current
c. Hypoxic spell
synchronized
d. Eisenmenger complex
cardioversion
e. Congestive heart failure
National test 2009
7.
neck vein engorge, lung =
fine crepitation at base both
lung
5.
a. heart failure
8.
,
neurologic exam normal a. choanal atresia
b. PDA
a. EKG c. TE fistula
b. Blood sugar d. BPD
c. hr Holter monitor 9. 18
d. EEG widely fixed split S2
e. otherwise:WNL
6. 2 VSD
pulse BP a. ASD

4. b. VSD

5. National test 2010 a. Oral mucolytic
10. Case TOF b. Oral antibiotic
central cyanosis c. IV Aminophylline
CultureEntero spp.  d. IV dexamethasone
ATB? e. NB. Ipratropium
Ans. Vancomycin bromide
3. 1
Pulmonary barking cough, inspiratory
National test 2008 stridor, expiratory rhonchi
1. 3 IV
a. Ampicilin IV
Lung: rhonchi right lung b. Cloxacilin IV
investigation c. beta-agonist
a. AP, lateral d. adrenaline
b. PA, lateral e. ETT
c. Inspiration and 4. Barking
exspiration cough Mx
d. Right lateral decubitus a. Adrenaline NB stat
e. Left lateral decubitus b. Salbutamol NB stat
2. 6 U/D Asthma c. Dexamethasone IV
2d PE: d. Prednisolone po
suprasternal, 5. 10 mo 3
intercostal, subcostal mo
retraction, inspiratory and inspiratory
exspiratory wheezing, RR stridor, chest drawning
40/min salbutamol 3 dose epinephrine
20 min epinephrine
exp. wheezing
a.
b.

6. c. 8.
d.
diagnosis
6. asthma a. larlyngomalacia
b. epiglottic cyst
2-3
9. 7
a. Oral salbutamol
PE : erythematous swelling
b. Inhale sulbutamol
turbinate, postnasal drip,
c. Inhale steroid
d. Inhale ipratropium + mucopurulent discharge
Salbutamol
National test 2009 a. Sinusitis
7. 10 b. Bronchiolitis
c. Allergic rhinitis
PE : 10. 4
good consciousness,no
cyanosis, prolong expiration PE:Trachea shift to Left ,
time with wheezing both lungs decrease Rt.breath sound
nebulized CXR:hazzeness Rt.lung
salbutamol 2 dose Dx.
a. Tuberculin test
b. Thoracocentesis
a. nebulized adrenaline c. Nasopharyngeal culture
b. aminophylline infusion 11.
c. IV corticosteroid 3 amoxicillin
d. nebulized corticosteroid 1
e. nebulized ipratropium
bromide V/S nasal discharge,

7. injected pharynx, posterior Dematology
nasal drip National test 2008
a. sinusitis 1.
b. allergic rhinitis wheeze
c. pharyngitis anaphylaxis first med
d. acute bronchitis
12. 9 Adrenaline
(Epinephrine)
3 BW 7 kg 2. 6
PR 120 lung: wheezing both
lung, CXR: perihilar 3
infiltration, PPD 4 mm PE: Multiple ill-
brochodilator Dx defined, fine scaly patch,
a. Retian FB hypopigmented macule and
b. Diaphragmatic hernia patch KOH:
c. TB negative
d. GERD a. Vitiligo
e. Asthma b. Pityriasis alba
c. Pityriasis vesicolor
National test 2010 d. Tinea facialis
13. 1  e. Contact leukoderm
? 3. 5
Ans. Epinephrine NB
14. 5 
prognosis
 Dx
AOM a. CBC
a. Myelingotomy b. ESR
b. ATB ear drop c. Skin biopsy
c. oral ATB d. UA

8. National test 2010
4. 8 
BP = 80/50
mmHg. 
lung: no wheezing Mx???
a. Adrenaline IM
b. CPM IV
Neonatal
National test 2008
1. Term newborn BW = 4000 g
Blood sugar =
26 mg%
a. Oral 10% D/W 10 ml/kg
b. IV 10% D/W 2 ml/kg
c. IV 10% D/W 4 ml/kg
d. IV fluid with GPR 4-6
mg/kg/min
e. IV fluid with GPR 6-8
mg/kg/min
f. IV hydrocortisone 10
mg/kg/day

9. 2. newborn 6.
41 wk with gm
meconium stain AF + fetal
distress
gm
a. +
Dx.
b. ET tube + suction
a. Duodenal atresia
3. newborn preterm GA 32
b. Pyloric stenosis
wk 1,500 gm
c. Inborn error metabolism
12
d. Sepsis
e. Hirchsprung disease
a. Spyringomyelin
b. Lacitin National test 2009
c. Phosphatidyl inositol 7.
d. Phosphatidyl glycerol 6 hr
4. Female Infant 5 hr APGAR a. Apt’s test
8,9 1,5 min BW 4,200 gm. b. striae tear
c. plt
cm. Hc 35 cm. What’s the
most appropriate investigation
for diagnosis? 8. 2
a. Plasma Glucose .
b. Urine Ketone PE : flaccid, flobby, RR
c. Serum Ammonia 10/min, HR 50/min
5. Case preterm 32 wk. BW
1,500 g
a. Glucose
Respiratory distress b. Arenaline
syndrome c. NSS
d. Chest compression
e. PPV

10. 9. 2 Wt 11. 1 1
2800g. long 47cm. Well PE: BT 39.5°C, BP
baby clinic 80/60 PR 140 RR 42,
petechiae with purpura at
Growth curve P3 lower extremities
156cm. 149cm. a. dextran
b. dopamine
13y
c. NSS
a.
d. platelet
b. e. FFP
c.
d. hormone
e. bone mass
10. GA 41
wk BW 3400 g meconium
stained AF APGAR= 2,5 1
5 10
glucose 50 Hct
58%
a. meningitis
b. hypoglycemia
c. polycythemia
d. perinatal asphyxia
e. intraventricular
hemorrhage

11. 12. 3 a. Hypopituitary
b. Hyperinsulinemia
PROM 10 c. Hypercortisol
d. Adrenal insufficiency
e. Alocohol withdrawal
investigate
syndrome
a. stool exam
15.
b. CBC
LMP 12 Hr
c. H/C
BW 3200
d. plain film abdomen
RR 60 bpm
13. 9
meconium stain fluid
Hct70% DTX 50
a. Pneumonia
b. Polycythemia
a. language c. Hypoglycemia
b. walking d. RDS
c. stranger anxiety e. MAS
d. teeth impaction
e. don’t give toy when
asked
Development
National test 2010 National test 2008
14. NB 4200 gm 2 1. 9 3
.
BS  37  10%glucose IQ test 109
 25% glucose 79
Plasma glucose 50 mg/dl 80 97

a. dyslexia

12. b. dyscalculia d. Acyclovir 48 hr
c. mental retard tion e.
d. Attention deficit disorder
5.
e. Autism
a. 10
2. 3
b. 12
1
c. 2
visit
a. OPV, DPT
d. 3
b. Hib
10-20
c. MMR, OPV, DPT
e. 5
d. HBV
e. OPV, DPT, JE 6. 6
3. 6 yr vaccine 2
5 yr 2 cm
vaccine
a. Rabies vaccine
7. 4 TB
b. TT
BCG scar
c. Rabies vaccine +
CXR tuberculin test
Tetanus toxoid
13 mm
d. Rabies vaccine
a. INH prophylaxis
Rabies Ig
b. start TB
e. TT + Rabies vaccine
c. repeat tuberculin test
Rabies Ig
3
4. 7 Dx Chickenpox d.
e. AFB from gastric lavage
a.
b. National test 2009
c. 8. 5

13. deltoid and hip c. separation anxiety
flexor d. to give toy
a. beri beri 12. 2 well baby
b. muscular dystrophy clinic BCG 1 HBV
3 ( DDT,OPV 3 ) JE 2
9. 5 MMR 1
a. JE
b. JE, Hib
X-ray
c. OPV, DPT,JE
Frontal sinus
d. OPV, DPT, Hib
Frontal Ethmoid ,
13.
Body weight – P25
a. a. Patau’s syndrome
b. Consult b. Edward syndrome
c.
c. Turner syndrome
d.
d. Klinefelter syndrome
Refer
e. Down syndrome
e.
14. IQ 60
1
10. 5
3 Hz. spike a.
wave hyperventilation b.
11. 9 c.
d. 9
15. 2 BCGx1,
HBVx3 DPTx3 MMRx1 JEx2
a. speech
b. walk a. DPT,OPV

14. b. DPT,OPV,JE
c. DPT,OPV,Hib
d. DPT,OPV,MMR
endocrine
National test 2008
1.
webbed neck,
wide nipple distance and low
hair line
a. Decrease Insulin
b. Decrease GH
c. Increase estrogen
d. Increase GnRH
e. Decrease PTH

15. 2. 14 exophthalmos, smooth skin.
8 PR120 FT4 TSH
/ Antityroglobulin 1:1600
a. Iodized oil
b. Iodized salt
c. Lugol solution
progesterone d. Methimazole
challenge test: negative 5.
estrogen-progesterone hyperpnea, +ve
challenge test: urine ketone 4+ Dx
negative a. DKA
b. Sepsis
a. Ovarian failure c. meningitis
b. PCOS 6. DM
c. Exercise amenorrhea sign
d. Asherman’s syndrome hypoglycemia DTX 30
3. 13 yr Hct 63 Management
generalize 3 mo a. Early feeding
FT4 1.25, TSH b. Bolus 10%D/W 2ml/kg
3.5 Dx c. Plasma exchange
a. Simple goiter
b. Hashimoto thyroiditis 7.
c. Subacute thyroiditis Cushing syndrome
d. Iodine deficiency
a. Hypocalcemia
e. CA thyroid
4. b. Hyperkalemia
c. Increased cortisol level
PE: Thyroid d. Advance bone age
diffuse enlarged,

16. e. Increased renin plasma
activity Gastrointestinal
8. 6 1. 8
truncal 3 PE:
obesity , Buffalo hump , moon epigastrium pain Lab: serum
face c acne , : Na 145 K 3.0... UA: ketone
4+
a. Hypocalcemia
b. Hyperkalemia
c. Advance bone age a. 0.45 % NaCl 20 ml/kg
d. Increase serum cortisol b. 0.9% NaCl 20 ml/kg
e. Increase activity of c. 0.45% NaCl 10 ml/kg +
rennin KCl 20 mEq
d. 0.9% NaCl 10 ml/kg +
National test 2009 KCl 20 mEq
9. acanthrosis e. RLS
nigrican National test 2009
a. insulin 2. 3
b. cortisol . PE :
c. thyroid confuse, diaphoretic, profuse
sweating, drooling and
10. 12 miosis.
. 2
PE : obesity, acanthosis nigricans a. ethanol
b. atropine
a. Cortisol c. naloxone
b. Hyperinsulinemia d. haloperidol
c. Growth hormone e. dimenhydramine
d. Hypothyroidism
e. Hyperuricemia

17. 3. 38. 6 1. 12
electrolyte 1
a. hypochloremic
hyponatremic management
metabolic acidosis a. EKG
b. hypochloremic b. Blood glucose
hypokalemic c. 24 – hr holter monitoring
metabolic acidosis d. EEG
c. hyperchloremic e. No further investigation
hypokalemic
metabolic acidosis 2. term 2
d. hypochloremic BW 4,600 gm
hypokalemic
PE: BT = 37, PR = 150 AF
metabolic alkalosis
bulging, mod pale, no jx,
e. hypochloremic
CBC: WBC 8,500 platelet
hyperkalemic metabolic
190,000
alkalosis
a. sepsis
4. hepaptitis carrier
b. SDH
HbsAg positive,
c. Idiopathic vitamin K
HBeAg positive AST/ALT
deficiency of infant
:15/17 investigation 3.
a. Viral load
b. CT abdomen
Upper/Lower motor weak gr
c. Liver biopsy
IV/II DTR no impaired pain
and touch, glottic stroking
Neurology pattern
National test 2008 a. Beri Beri

18. b. GBS
4. Drooling,
miosis, dysphoresis, profuse
sweating
a. Ethanol
b. Organophosphate
c. Opioid
d. Ephedrine
e. Cocaine
5. 4 mo WBC
18000 (N 80%), Hct 6.9%, Dx
a. Subdural hematoma
National test 2009
6. . 8
clinical
meningitis
1. A) LP
2. B) LP
3. C) .
4. D) CT brain
5. E) H/C ATB

19. National test 2010
6.  Absance
a. Sepsis

b. Prematurity
Ans. Na valproate
c. Thalassemia
d. G6PD deficiency
7. 1   ER
e. ABO incompatibility
  Cyanosis no heart
2. ,
sound First
, CBC : Plt
management ?
,Dx?
a. O2 mask 100%
a. ITP
b. ET tube
c. Defibrillation
d. Chest compression
e. Adrenaline iv
8. 1  3
Hb 27% Hepatosplenomegaly
a. Iron
Infectious & Others
b. G6PD National test 2008
c. Hb typing 7. 4
d. Osmotic fragility BP = 90/60 mmHg, PR= 120
/min
Stiff neck positive
Hematology
National test 2008
1. NB 35 wk, 2700 g Blood 8. 5
group O, Rh positive 4 cervical
Hct lymphadenopathy,
40% TB = 10 Splenomegaly and gray patch
at tonsil

20. retraction,
greenish patch at posterior
a. EBV
pharynx and tonsils
b. Diptheria
c. GAS a. Croup
d. Measles b. Diptheria
9. 2 4 PTA c. Candidiasis
38 PE: drooling d. Streptococcus tonsillitis
, posterior pharynx e. Infectious
Dx mononucleosis
a. Acute tracheitis 12. TB AFB
b. Acute epiglottitis 2+ CXR cavity 6
c. Viral croup PPD 4 mm
d. Laryngitis manage
e. Retropharyngeal 13. 10 U/D Bthal/HbH
abscess
10. 2 splenectomy
1 Sx Vaccine
prophylaxis
1-2 a. Typhoid vaccine
3-5 b. Influenza vaccine
c. Pneumococcal vaccine
a. Pneumococcal vaccine
d. Meningococal vaccine
b.
14. 4
c. antihistamine PE: milky patch at tonsil,
cervical LN 1-2 node
d. 2 cm 2 ,
e. liver 2 cm
BRCM, spleen 2 cm BLCM
11. 2 1 wk

21. a. Infectious d. Fortum + Amikacin
mononucleosis e. Fortum + Vancomycin
b. TB lymphadenitis 17.
c. Streptococcal (Purpura fulminan)
pharyngitis Stiff neck : positive
d. Dipthelia
Ans N.meningitidis
e. Lymphoma
15. 9
18.
para, amoxy 3 ampicillin
PE:
endoscope
sunken eyeball, dry lips,
hyperemia Tx?
perianal redness
a. Metronidazole
b. Ceftriaxone
a. Salmonella 19. 9 mo
b. Shigella otitis media
c. Rotavirus
d. Lactose deficiency 3 mo
e. Antibiotic related pneumonia, S.pneumo, Hib,
diarrhea defect
16. a. B cell
b. T cell
c. Phagocytic defect
, PE:
d. Complement
lethargy, moderate jaundice,
20. 4 yr 1 d
erythematous indurated mass
at Rt. Breast, ATB ? PE: BP 90/60, RR 40, PR
a. Ceftriaxone 120, stiff neck +ve,
b. Ampicillin +Gentamicin Purpura??? Dx
c. Cloxacillin + Gentamicin a. Salmonella

22. b. N. meningitides
c. Listeria monocytogenes
d. S. pneumonia
e. H. influenza
21. 4-5
Amoxy 2
a. X-ray PNS
b. nasal
speculum
c. Amoxicillin/Clavulinic
acid
d. Amoxycillin
e. Consult
22. UTI
Ampicillin 14
WBC=1-5,RBC>100
scope Patch?
a. Cotrimoxazole
b. Norfloxacin
c. Metronidazole

23. National test 2009 25. 6
1
23. 10
3
…
PE : BT 39 c, swelling at Rt. 6
Knee and proximal tibia, Rt. .
Inguinal LN enlarged and PE : BT
tendered 39.8 BP 70/45 PR 140 RR 40
no cyanosis, engorged neck
a. Arthrocentesis
vein, distant heart sound,
b. Rt. Knee x-ray
crepitation both lungs, liver 3
c. Bone aspiration
cm BRCM
d. ESR
e. Bone scan a. pericardiocentesis
24. 1 2 b. dopamine
c. ET intubation
.
d. CPR
PE: moderate pale, mild
e. NSS
icteric sclera, tachycardia, no
26.
hepatosplenomegaly.
n/v
CBC: Hct 24% WBC 11500
(N 76% L 21% M3%) plt. stiff neck
470000 PBS: bite cell, basket positive
cell, anemia a. Nae
a. Hb H disease b. H. influ
b. G 6 PD deficiency c. Strep pneumo
c. PNH 27. 4
d. AIHA 39.5 C BP 80/60 PR 140 RR
e. hereditary 42 petechiae and purpura
spherocytosis

24. at lower extremities
a. atropine
b. prednisolone
c. NSS
d. platelet transfusion
e. FFP
28.
Otitis
media Amoxycillin
2
management
a. oral amoxicillin
b. oral amoxy-clavurunic
acid
c. tympanoplasty
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