NLE1 2024-2 Jul SMST PDF

แนวข้อสอบ National Licensing Examination (NLE) ขั้นตอนที่1 : วิทยาศาสตร์การแพทย์พื้นฐาน ครั้งที่ 2 ประจําปี พ.ศ. 2567 (Official version)  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ...

แนวข้อสอบ National Licensing Examination (NLE) ขั้นตอนที่1 : วิทยาศาสตร์การแพทย์พื้นฐาน ครั้งที่ 2 ประจําปี พ.ศ. 2567 (Official version)  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 แนวข้อสอบ National Licensing Examination (NLE) ขั้นตอนที่1 : วิทยาศาสตร์การแพทย์พื้นฐาน ครั้งที่ 2 พ.ศ. 2567 (Official version) สอบเมื่อวันที่ 13 กรกฎาคม พ.ศ. 2567 คําชี้แจง 1. ข้อสอบฉบับนี้เป็นเพียงแนวข้อสอบสำหรับการสอบ National Licensing Examination (NLE) ขั้นตอนที่1 : วิทยาศาสตร์การแพทย์พื้นฐานเท่านั้น ไม่อนุญาตให้เผยแพร่หากไม่ได้รับ อนุญาต 2. ข้อสอบฉบับนี้เกิดจากความร่วมมือของสโมสรนักศึกษาแพทย์ ฝ่ายวิชาการ และนิสิตนักศึกษา แพทย์ทุกสถาบัน 3. ข้อสอบมีทั้งหมด 152 ข้อถูกแบ่งออกเป็นตามหมวดดังตาราง จำนวนข้อสอบตามหมวดรอบ 13 ก.ค. 67 เป็นต้นไป (B1.1 - B1.4 ถูกนำไปรวมกับระบบร่างกาย) หมวด จำนวนข้อสอบจริง ข้อสอบที่มี B1.5 Pathogenesis and laboratory investigation 5 10 B1.6 Gender, ethnic, and behavioral considerations 5 0 B1.7 Multisystem processes 5 4 B1.8 General pharmacology 5 18 B1.9 Quantitative methods 10 1 1  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 B2 Hematopoietic and Lymphoreticular systems 30 8 B3 Central and Peripheral Nervous systems 30 21 B4 Skin and Related Connective tissue 15 5 B5 Musculoskeletal system 15 9 B6 Respiratory system 30 12 B7 Cardiovascular system 30 13 B8 Gastrointestinal system 30 14 B9 Renal/Urinary system 30 9 B10 Reproductive system 30 18 B11 Endocrine system 30 10 รวม 300 152 2  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 หากมีการแก้ไขตัวข้อสอบ สามารถสแกนได้ที่ QR Code นี้เพื่อดูการ Update ข้อมูล ขอเชิญชวนตอบแบบสอบถามข้อเสนอแนะต่อการจัดทา NL1 Exercise เพื่อนาความเห็นไป พัฒนาการดาเนินงานต่อไป หากพบข้อสอบที่มีจุดผิดพลาด โปรดแจ้งมาที่ QR code นี้ เพื่อที่จะได้อัพเดทต่อไป 3  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 B1.5 Pathogenesis, pathophysiology, basic pathological process and laboratory investigation 1. Before starting allopurinol therapy, which genetic test is recommended to assess the risk of severe cutaneous adverse reactions? A. HLA-B5701 B. HLA-DRB1 C. HLA-DQB1 D. HLA-A3101 E. HLA-C*0602 2. A patient develops a brain infection after swimming in contaminated water. Which organism is the likely causative agent? A. Naegleria fowleri B. Toxoplasma gondii C. Cryptococcus neoformans D. Candida albicans E. Aspergillus fumigatus 3. A sexually active patient presents with symptoms suggestive of a genitourinary infection. However, standard cultures fail to identify any microorganisms. What is the suspected organism causing this condition? A. Chlamydia trachomatis B. Neisseria gonorrhoeae C. Treponema pallidum D. Candida albicans E. Trichomonas vaginalis 4  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 4. A newborn infant and mother have different blood types. The mother is Rh-negative, and the infant is Rh-positive. What type of immune reaction is expected to occur if maternal Rh antibodies cross the placenta and enter fetal circulation? A. Type I hypersensitivity reaction B. Type II hypersensitivity reaction C. Type III hypersensitivity reaction D. Type IV hypersensitivity reaction E. Anaphylactic reaction 5. A 42-year-old patient presents with well-demarcated, erythematous plaques covered with silvery scales on the elbows and knees. Histopathological examination reveals epidermal hyperplasia and infiltration of T helper 17 (Th17) cells and T helper 1 (Th1) cells in the dermis. Explain the molecular pathophysiology of psoriasis involving Th17 and Th1 cells, and discuss the implications for targeted therapy in managing this chronic inflammatory skin condition. A. Inhibition of TNF-alpha B. Blockade of IL-17A C. Enhancement of IL-10 production D. Suppression of mast cell degranulation E. Upregulation of IgE synthesis 5  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 6. A patient with G6PD deficiency exhibits symptoms after taking a certain medication. Which inheritance pattern is most likely associated with this enzyme deficiency? A. X-linked recessive B. Autosomal dominant C. Autosomal recessive D. Y-linked E. Mitochondrial 7. When performing a Pap smear, what is the recommended medium for preserving the collected specimen for cytological examination? A. 70% ethanol B. 95% ethanol C. Formalin D. Saline E. Glutaraldehyde 8. What is the primary function of the APC gene? A. Regulation of cell cycle checkpoints B. Promotion of DNA replication C. Mismatch repair D. Inhibition of cell proliferation E. Activation of apoptosis pathways 6  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 9. What is the role of HER2 (Human Epidermal Growth Factor Receptor 2) in cellular physiology? A. Regulation of cell adhesion B. Enhancement of DNA repair C. Stimulation of angiogenesis D. Amplification of epithelial growth factor signaling E. Inhibition of cell differentiation 10. A 28-year-old sexually active male presents to the emergency department with acute onset severe knee pain and swelling. He reports recent unprotected sexual contact. Joint aspiration reveals purulent fluid, and Gram staining shows gram-negative diplococci. Which pathogen is most likely responsible for this patient's joint infection? A. Neisseria gonorrhoeae B. Streptococcus pneumoniae C. Staphylococcus aureus D. Escherichia coli E. Pseudomonas aeruginosa B1.6 Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environment -ไม่มีแนวข้อสอบ- 7  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 B1.7 Multisystem processes 1. Divers who go deep underwater are at risk of developing which condition due to the increased partial pressure of gases? A. Carbon monoxide poisoning B. Nitrogen narcosis C. Oxygen toxicity D. Decompression sickness E. Hypercapnia 2. A 30-year-old male presents to the emergency department with acute hemolytic anemia following the ingestion of fava beans. His medical history is unremarkable, but he reports similar episodes of hemolysis in the past after consuming certain foods or medications. Which enzyme deficiency is most likely responsible for his condition? A. Pyruvate kinase B. Glucose-6-Phosphate Dehydrogenase (G6PD) C. Hemoglobin A2 D. Heme oxygenase E. Transketolase 8  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 3. A person experiences submersion in cold water, leading to a condition where the body conserves heat by reducing blood flow to the extremities. Which of the following physiological responses is most likely associated with this condition? A. Peripheral vasoconstriction B. Increased sweating C. Dilated pupils D. Elevated heart rate E. Increased respiratory rate 4. A patient with a hip fracture develops skin retraction. Which of the following complication is most likely associated with this presentation? A. Infection B. Nerve injury C. Delayed union D. Avascular necrosis E. Hematoma B1.8 General pharmacology 1. Which of the following is commonly administered to counteract anemia induced by methotrexate therapy? A. Folic acid B. Ferric acid C. Vitamin B12 D. Erythropoietin E. Iron supplements 9  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 2. Mydriasis is a potential side effect associated with the use of which eye drop medication? A. Pilocarpine B. Brimonidine C. Atropine D. Timolol E. Dorzolamide 3. What is the standard triple therapy regimen for eradicating Helicobacter pylori infection? A. Amoxicillin + metronidazole + pantoprazole B. Amoxicillin + clarithromycin + omeprazole C. Clarithromycin + tetracycline + ranitidine D. Metronidazole + omeprazole + doxycycline E. Amoxicillin + clarithromycin + omeprazole 4. A patient presents with inflamed, swollen, red, and warm skin indicative of a skin infection. Which antibiotic is most appropriate for treating this condition? A.Amoxicillin B. Dicloxacillin C. Clindamycin D. Doxycycline E. Roxithromycin 10  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 5. Roxithromycin is often recommended to be taken before meals primarily because: A. It increases effectiveness by altering bacterial metabolism B. It enhances absorption due to improved bioavailability on an empty stomach C. It reduces the risk of gastrointestinal side effects D. It ensures better patient compliance with the dosing regimen E. It decreases the likelihood of drug interactions with food components 6. A patient shows symptoms of Trichuris trichiura infection. Which medication is commonly prescribed for this condition? A. Mebendazole B. Praziquantel C. Ivermectin D. Albendazole E. Metronidazole 7. Which of the following antibiotics is known to decrease the effectiveness of hormonal contraceptives by inducing hepatic enzymes? A. Rifampicin B. Azithromycin C. Ciprofloxacin D. Amoxicillin E. Clindamycin 11  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 8. A patient with stable angina who is on isosorbide dinitrate and propranolol starts taking sildenafil. Which side effect should be monitored? A. Hypotension B. Hyperglycemia C. Tachycardia D. Constipation E. Insomnia 9. A 30-year-old woman who is taking oral contraceptive pills for birth control is diagnosed with tuberculosis and started on a multidrug regimen that includes rifampicin. Which mechanism of rifampicin is most likely responsible for potentially reducing the e ffectiveness of her contraceptive pills? A. Inhibition of estrogen production B. Induction of cytochrome P450 enzymes C. Inhibition of progesterone receptors D. Increase in follicle-stimulating hormone (FSH) levels E. Reduction in luteinizing hormone (LH) levels 10. A patient receiving high-dose methotrexate therapy for cancer treatment develops severe mucositis and myelosuppression. Which of the following supplements should be administered to reduce the toxicity of methotrexate? A. Vitamin B12 B. Vitamin D C. Folinic acid D. Vitamin K E. Vitamin C 12  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 11. A patient with a history of seizures is treated with antiepileptic medications and subsequently develops extrapyramidal symptoms (EPS). Which of the following medications is most likely responsible for these symptoms? A. Phenytoin B. Carbamazepine C. Valproate D. Levetiracetam E. Lamotrigine 12. A patient with an infection is prescribed both amoxicillin and gentamicin. Upon discovering hypertension, the medical team plans to administer loop diuretics. What adverse effect should they be cautious about with this combination? A. Nephrotoxicity B. Ototoxicity C. Hepatotoxicity D. Bone marrow suppression E. Hyperkalemia 13. Clotrimazole is an antifungal medication commonly used to treat various fungal infections of the skin, nails, and mucous membranes. Which of the following fungal infections is primarily treated with clotrimazole due to its mechanism of action? A. Tinea versicolor B. Candidiasis C. Ringworm (Tinea corporis) D. Athlete's foot (Tinea pedis) E. Scabies 13  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 14. How does timolol aid in reducing intraocular pressure in patients with open-angle glaucoma? A. Increases aqueous humor production B. Enhances trabecular meshwork outflow C. Reduces ciliary body secretion D. Expands Schlemm's canal E. Constricts pupil diameter 15. A patient presents with dilated pupils, agitation, tachycardia, and hypertension. Upon further questioning, the patient admits to recent cocaine use. Which neurotransmitter reuptake inhibition mechanism is primarily responsible for the symptoms observed in this patient? A. Dopamine B. Norepinephrine C. Serotonin D. GABA E. Acetylcholine 16. A pregnant woman experiences bilateral leg weakness despite taking both birth control pills and tuberculosis medication. What component of her tuberculosis treatment regimen is likely causing this symptom? A. Isoniazid B. Rifampicin C. Pyrazinamide D. Ethambutol E. Streptomycin 14  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 17. A 45-year-old taxi driver presents with complaints of nasal congestion and watery rhinorrhea every morning for the past few weeks. He reports no history of allergies or sinus infections. Physical examination reveals clear nasal discharge and boggy nasal mucosa. Which of the following medications would be most appropriate as initial therapy for managing his symptoms? A. Loratadine B. Pseudoephedrine C. Fluticasone nasal spray D. Diphenhydramine E. Acetaminophen 18. A 32-year-old female presents with widespread musculoskeletal pain, fatigue, and sleep disturbances persisting for several months. Physical examination reveals multiple tender points on palpation. Based on her symptoms and clinical findings, she is diagnosed with fibromyalgia. Which medication is typically recommended as first-line treatment to manage her condition? A. Gabapentin B. Amitriptyline C. Pregabalin D. Duloxetine E. Acetaminophen 15  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 B1.9 Quantitative methods 1. If the sample size decreases from 1200 to 600 in a clinical trial, what is the likely effect on statistical analysis? A. Decrease in power B. Decrease in type I error C. Increase in type II error D. Decrease in confidence interval width E. Increase in effect size B2 Hematopoietic and Lymphoreticular systems 1. A patient with thalassemia has a low MCV (mean corpuscular volume) and shows 4% HbA2 on electrophoresis. This finding is consistent with: A. Thalassemia major B. Thalassemia intermedia C. Thalassemia minor D. Beta-thalassemia trait E. Alpha-thalassemia trait 2. If a father has hemoglobin HbH disease and the mother carries alpha-thalassemia trait, what is the probability that their child will inherit beta-thalassemia trait? A. 0% B. 25% C. 50% D. 75% E. 100% 16  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 3. In children, which anatomical structure primarily serves as the site for hematopoiesis, the process of blood cell production? A. Spleen B. Thymus C. Liver D. Bone marrow E. Kidneys 4. A patient with chronic renal failure receives erythropoietin (EPO) therapy to manage anemia. Which of the following laboratory findings is expected due to increased EPO administration? A. Polychromasia B. Howell-Jolly bodies C. Basophilic stippling D. Schistocytes E. Heinz bodies 5. A patient presents with prolonged bleeding after minor injuries and excessive bleeding during menstruation. Laboratory tests show reduced levels of von Willebrand factor (vWF). Which factor deficiency is associated with von Willebrand disease? A. Factor II B. Factor V C. Factor VIII D. Factor IX E. Factor XII 17  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 6. A 25-year-old male presents with recurrent epistaxis, easy bruising, and prolonged bleeding after minor trauma. Laboratory investigations reveal prolonged bleeding time and decreased platelet aggregation. Upon further evaluation, a snakebite with envenomation is suspected. What should be assessed in the snakebite victim to determine the bleeding tendency, and how can this guide management decisions? A. Prothrombin time (PT) B. Activated partial thromboplastin time (aPTT) C. Platelet count D. Fibrinogen level E. Bleeding time 7. What is the preferred treatment for severe malaria caused by Plasmodium species, particularly in regions with high resistance to other antimalarial drugs? A. Chloroquine B. Artemisinin C. Doxycycline D. Quinine E. Artesunate 8. A painter presents with basophilic stippling on a blood smear. This finding is most indicative of exposure to which toxic substance? A. Lead poisoning B. Mercury poisoning C. Cadmium poisoning D. Arsenic poisoning E. Carbon monoxide poisoning 18  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 B3 Central and Peripheral Nervous systems 1. Pain around the umbilicus is most likely associated with which part of the small intestine? A. Duodenum B. Jejunum C. Ileum D. Cecum E. Appendix 2. A patient presents with confusion, ataxia, and ophthalmoplegia due to a thiamine deficiency. Which syndrome is most likely associated with these symptoms? A. Wernicke's encephalopathy B. Parkinson's disease C. Alzheimer's disease D. Huntington's disease E. Guillain-Barré syndrome 3. Schwann cells are primarily associated with the formation of which condition affecting the peripheral nerves of the foot? A. Tarsal tunnel syndrome B. Plantar fasciitis C. Achilles tendinitis D. Morton's neuroma E. Hallux valgus 19  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 4. A patient presents with ptosis, a condition characterized by drooping of the upper eyelid. Which nerve is most commonly associated with causing ptosis? A. Facial nerve (CN VII) B. Oculomotor nerve (CN III) C. Trigeminal nerve (CN V) D. Abducens nerve (CN VI) E. Trochlear nerve (CN IV) 5. A 55-year-old patient complains of severe, stabbing facial pain triggered by activities such as chewing or brushing teeth. Upon examination, the pain is localized to the right side of the face along the jawline. Which cranial nerve is primarily involved in this patient's condition? A. Cranial nerve I (Olfactory nerve) B. Cranial nerve V (Trigeminal nerve) C. Cranial nerve VII (Facial nerve) D. Cranial nerve IX (Glossopharyngeal nerve) E. Cranial nerve XII (Hypoglossal nerve) 6. A patient complains of pain radiating from the fingers down to the groin area. This type of pain is an example of referred pain. Which spinal levels are typically associated with referred pain from the fingers to the groin? A. C5-C6 B. T12-L2 C. L4-L5 D. S1-S2 E. T7-T8 20  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 7. A patient is brought to the clinic with complaints of difficulty understanding spoken language. Upon further examination, the patient shows no signs of motor deficits or sensory loss. Which area of the brain is most likely affected in this patient? A. Broca's area B. Wernicke's area C. Angular gyrus D. Hippocampus E. Thalamus 8. A patient presents to the emergency department with sudden severe headache, nausea, and loss of consciousness. A CT scan reveals subarachnoid hemorrhage. Which vessel is most commonly associated with this type of hemorrhage? A. Anterior communicating artery B. Middle cerebral artery C. Posterior communicating artery D. Basilar artery E. Circle of Willis 9. A patient presents with symptoms suggestive of epidural hemorrhage, and an X -ray reveals the involvement of a specific vessel. Which vessel is typically associated with epidural hemorrhage? A. Middle meningeal artery B. Anterior cerebral artery C. Posterior cerebral artery D. Basilar artery E. Internal carotid artery 21  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 10. A patient complains of radiating pain from the lower back to the groin. Which dermatome level corresponds to the area where the pain radiates? A. T10 B. L1 C. L2 D. L3 E. L4 11. A patient presents with headaches and visual disturbances. MRI reveals a pituitary adenoma compressing the optic chiasm. What visual field defect is commonly associated with compression of the optic chiasm by a pituitary tumor? A. Hemianopia B. Quadrantanopia C. Bitemporal hemianopia D. Homonymous hemianopia E. Scotoma 12. A 65-year-old patient presents with bradykinesia, resting tremor, and rigidity. Neurological examination reveals a masked facies and shuffling gait. What pathophysiological mechanism underlies the reduction in dopamine levels in Parkinson's disease, and how do these changes contribute to the clinical manifestations observed in affected individuals? A. Increased dopamine degradation B. Decreased dopamine synthesis C. Impaired dopamine release D. Dopamine receptor hypersensitivity E. Dopamine transporter deficiency 22  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 13. A 40-year-old male presents with double vision and difficulty moving his left eye laterally. Neurological examination reveals weakness of the left lateral rectus muscle and reduced lateral gaze on the affected side. Imaging confirms a lesion involving the cavernous sinus. Which cranial nerve is most likely affected in this patient, and what specific clinical manifestations would confirm this diagnosis? A. Optic nerve (CN II) B. Oculomotor nerve (CN III) C. Trochlear nerve (CN IV) D. Trigeminal nerve (CN V) E. Abducens nerve (CN VI) 14. A 50-year-old male presents with a sudden onset of ipsilateral hemiparesis and contralateral loss of pain and temperature sensation below the level of the lesion. MRI reveals a lesion involving half of the spinal cord (hemicord) with sparing of the dorsal columns. What syndrome is described in this patient, and what are the underlying anatomical and pathophysiological mechanisms contributing to its presentation? A. Brown-Sequard syndrome; ipsilateral corticospinal tract injury B. Central cord syndrome; anterior spinal artery thrombosis C. Lateral medullary syndrome; vertebral artery dissection D. Conus medullaris syndrome; cauda equina compression E. Cauda equina syndrome; lumbar disc herniation 23  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 15. A newborn infant presents with weakness and lack of movement in the left upper limb shortly after birth. Physical examination reveals reduced muscle tone and absence of Moro reflex. Diagnostic evaluation confirms Erb's palsy, a form of brachial plexus injury. Which specific nerve roots of the brachial plexus are typically affected in Erb's palsy, and what clinical manifestations are associated with damage to these nerve roots? A. C2-C3 B. C4-C5 C. C5-C6 D. C6-C7 E. C7-T1 16. A patient presents with loss of the cremasteric reflex. Which nerve is likely involved in this neurological finding? A. Genitofemoral nerve B. Ilioinguinal nerve C. Obturator nerve D. Femoral nerve E. Sciatic nerve 17. A patient with neurofibromatosis type 1 (NF1) exhibits cutaneous neurofibromas. These tumors originate from which type of cells? A. Schwann cells B. Langerhans cells C. Melanocytes D. Fibroblasts E. Myocytes 24  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 18. A 28-year-old pregnant woman undergoes routine prenatal screening, which includes maternal serum markers. Her alpha-fetoprotein (AFP) levels are found to be significantly elevated. What condition is AFP elevation most indicative of in the fetus? A. Down syndrome B. Anencephaly C. Congenital heart defect D. Spina bifida E. Cystic fibrosis 19. A 25-year-old male soccer player sustains a traumatic knee injury during a game, resulting in tears of both the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL). Upon further evaluation, magnetic resonance imaging (MRI) reveals additional damage to which structure, often associated with this specific injury pattern? A. Medial meniscus B. Lateral meniscus C. Medial retinaculum D. Medial patellofemoral ligament E. Medial meniscus root 20. A patient presents with dilated third and lateral ventricles on brain imaging. At which level of the cerebrospinal fluid (CSF) pathway is likely to be blocked? A. Foramen of Monro B. Cerebral aqueduct (aqueduct of Sylvius) C. Foramen of Magendie D. Foramen of Luschka E. Fourth ventricle 25  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 21. A newborn is delivered with excessive traction during birth, resulting in injury to the spinal nerves. Which of the following conditions is most likely affected by this injury? A. Erb's palsy B. Klumpke's palsy C. Diaphragmatic paralysis D. Radial nerve injury E. Sciatic nerve injury B4 Skin and Related Connective tissue 1. A patient presents with a "kissing lesion" on the skin. This lesion is most likely caused by: A. Pediculus capitis B. Sarcoptes scabiei C. Pthirus pubis D. Dermatophytes E. Paederus dermatitis 2. A patient presents with a non-blistering burn injury characterized by erythema and superficial damage to the epidermis and dermis. Which skin layer primarily prevents fluid leakage and provides a barrier against infection following thermal injury? A. Stratum corneum B. Stratum lucidum C. Stratum granulosum D. Stratum spinosum E. Stratum basale 26  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 3. Prolonged exposure to hot water without blister formation primarily affects which layer of the skin? A. Stratum basale B. Stratum spinosum C. Stratum granulosum D. Stratum lucidum E. Stratum corneum 4. A farmer has had prolonged sun exposure for approximately 20 years. At which level of the skin is he most likely to develop skin cancer? A. Stratum corneum B. Epidermis C. Dermis D. Subcutaneous tissue E. Basement membrane 5. A patient presents with a linear rash on the posterior aspect of the knee and thigh. The lesion is erythematous with central clearing and blister formation. The patient recalls recent outdoor activities in a rural area. Which of the following conditions is most likely responsible for this presentation? A. Tinea corporis B. Cellulitis C. Paederus dermatitis D. Scabies E. Allergic contact dermatitis 27  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 B5 Musculoskeletal system 1. A mobile mass is observed in the midline of the neck that moves with swallowing. This finding is most consistent with: A. Branchial cleft cyst B. Dermoid cyst C. Thyroglossal duct cyst D. Ranula E. Lymphadenopathy 2. A child presents with purpura, joint pain, and abdominal pain. What clinical condition should be suspected? A. Henoch-Schönlein purpura B. Kawasaki disease C. Juvenile idiopathic arthritis D. Systemic lupus erythematosus E. Rheumatic fever 3. Myasthenia Gravis is primarily caused by: A. Autoimmune destruction of acetylcholine receptors at the neuromuscular junction B. Excessive production of acetylcholinesterase C. Deficiency of acetylcholine release D. Mutation in the dystrophin gene E. Impaired calcium release from the sarcoplasmic reticulum 28  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 4. Which condition involves the lateral epicondyle and affects the pronator teres muscle, as well as De Quervain's tenosynovitis affecting the flexor pollicis brevis? A. Cubital tunnel syndrome B. Golfer's elbow C. Tennis elbow D. Carpal tunnel syndrome E. Trigger finger 5. A 40-year-old patient presents with sudden onset of unilateral periorbital edema and proptosis. Imaging reveals bone erosion involving the orbit. Which facial bone is most likely affected in this patient? A. Maxilla B. Zygomatic bone C. Ethmoid bone D. Frontal bone E. Sphenoid bone 6. During a physical examination of a patient's knee, the anterior drawer test reveals an abnormal forward movement of the tibia relative to the femur when the knee is flexed to 90 degrees. Which ligament is most likely affected by this finding? A. Anterior cruciate ligament (ACL) B. Medial collateral ligament (MCL) C. Posterior cruciate ligament (PCL) D. Lateral collateral ligament (LCL) E. Patellar ligament 29  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 7. A 35-year-old female presents with fluctuating muscle weakness that worsens with exertion and improves with rest. She also experiences ptosis and diplopia. Electromyography shows decremental muscle responses upon repetitive nerve stimulation. What is the underlying pathophysiology of these symptoms in myasthenia gravis, and how does this condition differ from other neuromuscular disorders? A. Impaired acetylcholine release at the neuromuscular junction B. Autoantibodies against voltage-gated calcium channels C. Inhibition of acetylcholinesterase activity D. Impaired calcium influx into muscle cells E. Mutation in the dystrophin gene 8. A patient presents with pain and swelling at the base of the thumb. Which tendon is most commonly affected in de Quervain's tenosynovitis? A. Abductor pollicis longus B. Extensor pollicis longus C. Flexor pollicis longus D. Abductor pollicis brevis E. Flexor pollicis brevis 9. Which muscle is primarily responsible for the initial abduction of the shoulder joint? A. Supraspinatus B. Infraspinatus C. Teres minor D. Subscapularis E. Deltoid 30  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 B6 Respiratory system 1. Premature infants are at risk of respiratory distress due to underdeveloped: A. Type I pneumocytes B. Type II pneumocytes C. Alveolar macrophages D. Surfactant-producing cells E. Pulmonary capillaries 2. A patient with respiratory distress presents with a pH of 7.25, pCO2 of 55 mmHg, and HCO3- of 24 mEq/L. What is the primary acid-base disturbance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis E. Mixed acid-base disorder A patient with severe vomiting has the following arterial blood gas (ABG) results: pH 7.50, pCO2 28 mmHg, HCO3- 24 mEq/L. What is the likely compensation mechanism? A. Respiratory compensation for metabolic alkalosis B. Metabolic compensation for respiratory alkalosis C. Respiratory compensation for metabolic acidosis D. Metabolic compensation for respiratory acidosis E. There is no compensation present 31  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 4. A diabetic patient with diabetic ketoacidosis (DKA) presents with ABG results: pH 7.20, pCO2 32 mmHg, HCO3- 15 mEq/L. What is the primary acid-base disturbance, and what is the expected compensation? A. Metabolic acidosis with respiratory compensation B. Metabolic alkalosis with respiratory compensation C. Respiratory acidosis with metabolic compensation D. Respiratory alkalosis with metabolic compensation E. Mixed acid-base disorder without compensation 5. A patient is hyperventilating due to anxiety, leading to ABG results: pH 7.48, pCO2 29 mmHg, HCO3- 22 mEq/L. What is the primary acid-base disturbance, and what compensatory mechanism is occurring? A. Respiratory alkalosis with metabolic compensation B. Respiratory acidosis with metabolic compensation C. Metabolic acidosis with respiratory compensation D. Metabolic alkalosis with respiratory compensation E. There is no compensatory mechanism present 6. A patient undergoes pulmonary function testing and the following volumes are measured: Total Lung Capacity (TLC) of 6000 mL, Functional Residual Capacity (FRC) of 3000 mL, and Residual Volume (RV) of 1500 mL. Calculate the residual volume as a percentage of the total lung capacity. A. 15% B. 20% C. 25% D. 30% E. 35% 32  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 7. A climber ascends a high mountain and pauses periodically to adjust to the altitude before continuing. Which physiological response is likely to decrease under these conditions? A. 23-bisphosphoglycerate (2,3-BPG) levels B. Central chemoreceptor sensitivity C. Hemoglobin-oxygen affinity D. Respiratory rate E. Pulmonary capillary pressure 8. Emphysema is a type of chronic obstructive pulmonary disease (COPD) characterized by irreversible damage to the alveolar walls and enlargement of air spaces within the lung parenchyma. Which of the following enzymatic imbalances is primarily responsible fo r the pathogenesis of emphysema? A. Decreased elastase activity B. Increased antiprotease activity C. Impaired mucociliary clearance D. Excessive surfactant production E. Increased elastase activity 33  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 9. Chronic bronchitis is a progressive respiratory condition characterized by persistent inflammation and narrowing of the airways. Patients typically present with a chronic cough and production of sputum lasting for at least 3 months in each of 2 consecutive years. Which of the following pathophysiological mechanisms best explains the hallmark symptom of chronic cough and sputum production in chronic bronchitis? A. Dysregulation of surfactant production B. Hyperplasia of bronchial smooth muscle C. Excessive goblet cell hyperplasia D. Decreased pulmonary capillary density E. Impaired ciliary function 10. Which medication is commonly used to prevent acute exacerbations of asthma by providing bronchodilation and reducing airway inflammation? A. Salbutamol (albuterol) B. Prednisone C. Montelukast D. Ipratropium E. Theophylline 11. In pulmonary function testing, a patient's total lung capacity (TLC) is measured as 6 liters, functional residual capacity (FRC) is 3 liters, and residual volume (RV) is 1 liter. What is the approximate volume of air that can be exhaled after a normal inspiration? A. 2 liters B. 3 liters C. 4 liters D. 5 liters E. 6 liters 34  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 12. A 68-year-old bedridden patient with a history of cerebrovascular disease and dysphagia develops aspiration pneumonia. During aspiration, a foreign object enters the posterior segment of the right upper lobe of the lung. Identify the anatomical location where the object is most likely to lodge and explain the consequences of such an occurrence on respiratory function. A. Posterior basal segment B. Apical segment C. Anterior segment D. Medial segment E. Lateral segment B7 Cardiovascular system 1. A child with a continuous machinery-like heart murmur is most likely experiencing which congenital heart defect? A. Atrial septal defect (ASD) B. Ventricular septal defect (VSD) C. Tetralogy of Fallot D. Patent ductus arteriosus (PDA) E. Coarctation of the aorta 2. In cases of esophageal varices, which vein is primarily responsible for their formation? A. Left epigastric vein B. Left gastric vein C. Portal vein D. Superior mesenteric vein E. Splenic vein 35  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 3. A patient presents with ST elevation in leads II, III, and aVF on an ECG. This finding indicates myocardial infarction affecting which part of the heart? A. Right atrium B. Left ventricle C. Right ventricle D. Inferior wall E. Anterior wall 4. In avascular necrosis affecting the femoral head or inter-trochanteric area, which blood vessel is commonly involved? A. Neck of femur B. Obturator artery C. Femoral artery D. Popliteal artery E. Common iliac artery 5. A patient with coronary artery disease (CAD) who is taking isosorbide dinitrate decides to self- administer sildenafil. What potential side effect is most concerning in this scenario? A. Hypotension B. Hypertension C. Tachycardia D. Hyperglycemia E. Seizures 36  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 6. In myocardial infarction (MI) with ST elevation, which phase of cardiac electrical activity is primarily affected? A. Atrial depolarization B. Ventricular depolarization C. Ventricular repolarization D. Atrial repolarization E. Atrial contraction 7. Complete heart block is associated with conduction block at which specific location in the heart? A. Bundle of His B. Purkinje fibers C. Atrioventricular node D. Sinoatrial node E. Bundle branches 8. A 45-year-old female presents with joint pain, swelling, and morning stiffness lasting more than an hour. On examination, she has rheumatoid nodules and Swan neck deformities. Auscultation reveals a murmur best heard over the left sternal border. Which heart valve is most likely involved in causing this murmur in rheumatoid arthritis? A. Mitral valve B. Tricuspid valve C. Aortic valve D. Pulmonary valve E. Bicuspid valve 37  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 9. A newborn infant presents with cyanosis, dyspnea, a harsh systolic murmur, and clubbing of fingers and toes. Echocardiography confirms a ventricular septal defect, overriding aorta, pulmonary artery stenosis, and right ventricular hypertrophy. What congenital heart defect is consistent with these findings? A. Tetralogy of Fallot B. Atrial septal defect C. Patent ductus arteriosus D. Coarctation of the aorta E. Transposition of the great arteries 10. An elderly patient with a history of hypertension presents with reduced compliance and increased stiffness of the large arteries. What pathological changes occur in the vessel walls in hypertension, and how do these alterations contribute to vascular dysfu nction and cardiovascular complications in the elderly population? A. Increased collagen deposition B. Smooth muscle hypertrophy C. Endothelial dysfunction D. Atherosclerotic plaque formation E. Elastic lamina fragmentation 38  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 11. A 45-year-old male smoker presents with symptoms suggestive of Buerger's disease (thromboangiitis obliterans), including intermittent claudication and digital ischemia. Diagnostic evaluation reveals multiple segmental occlusions affecting small- and medium-sized arteries in the extremities. What characteristic feature differentiates Buerger's disease from other vascular disorders characterized by thrombosis? A. Intermittent claudication B. Absence of pulse in the affected limb C. Superficial thrombophlebitis D. Multiple segmental occlusions E. Raynaud's phenomenon 12. A patient who is bedridden develops avascular necrosis of the head of the femur. This condition typically arises due to occlusion of which blood vessels? A. Femoral artery B. Deep femoral artery C. Medial circumflex femoral artery D. Lateral circumflex femoral artery E. Inferior gluteal artery 13. In avascular necrosis of the head of the femur, which blood vessel is typically affected? A. Femoral artery B. Medial circumflex femoral artery C. Deep femoral artery D. Lateral femoral circumflex artery E. Obturator artery 39  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 B8 Gastrointestinal system 1. Consuming raw or undercooked fish poses a risk of infection with which parasite? A. Giardia lamblia B. Taenia solium C. Trichinella spiralis D. Gnathostoma E. Schistosoma mansoni 2. A patient who consumes alcohol excessively presents with vomiting and subsequent hematemesis. The most likely cause of this presentation is: A. Esophageal varices B. Mallory-Weiss tear C. Hiatal hernia D. Gastroesophageal reflux disease (GERD) E. Peptic ulcer disease 3. A patient presents with chronic constipation and abdominal distension. Colonoscopy reveals no ganglion cells in both the submucosal and mucosal layers of the colon. What is the likely diagnosis? A. Crohn's disease B. Ulcerative colitis C. Hirschsprung disease D. Diverticulitis E. Irritable bowel syndrome 40  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 4. During an esophagogastroduodenoscopy (EGD), longitudinal mucosal tear is observed at the gastroesophageal junction. This condition is: A. Zenker's diverticulum B. Mallory-Weiss tear C. Esophageal varices D. Schatzki's ring E. Barrett's esophagus 5. What anatomical membrane allows abdominal contents to herniate into the hemithorax due to a defect? A. Peritoneopericardial membrane B. Pleuroperitoneal membrane C. Pericardiopephoric membrane D. Pericardialperitoneal membrane E. Peritonealpleuro membrane 6. In which organ are Kupffer cells primarily found, serving a role in immune function and detoxification? A. Kidney B. Spleen C. Liver D. Pancreas E. Lungs 41  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 7. A 60-year-old patient presents with suspected liver cancer. Which tumor marker is most commonly elevated and used for diagnostic purposes in hepatocellular carcinoma? A. Alpha-fetoprotein (AFP) B. Carcinoembryonic antigen (CEA) C. CA 19-9 D. CA 125 E. Prostate-specific antigen (PSA) 8. A patient with hereditary spherocytosis presents with an acute episode of abdominal pain and jaundice. Laboratory investigations show evidence of hemolytic anemia and elevated bilirubin levels. On imaging, splenomegaly is noted. What histological finding in the spleen is associated with hereditary spherocytosis, and how does this contribute to the development of splenic complications such as infarction? A. Hemolytic anemia B. Thrombocytopenia C. Splenic infarction D. Aplastic crisis E. Sickle cell crisis 9. In hepatocellular carcinoma (HCC), which tumor marker is most commonly elevated and used for monitoring? A. CA 19-9 B. AFP C. CEA D. CA 125 E. PSA 42  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 10. A 55-year-old male presents with symptoms of dyspepsia and weight loss. Upper gastrointestinal endoscopy reveals a gastric mass, and histopathological examination shows characteristic signet ring cells. These cells are distinguished by their abundant intra cytoplasmic mucin that displaces the nucleus peripherally. What specific feature of signet ring cells contributes to their characteristic appearance on microscopy, and what is the clinical significance of identifying these cells in gastric adenocarcinoma? A. Presence of mucin-filled vacuoles B. Abundant eosinophilic cytoplasm C. Glandular formation D. Spindle-shaped cells E. Keratinization 11. Gastroesophageal reflux disease (GERD) is primarily caused by dysfunction of which sphincter? A. Lower esophageal sphincter B. Pyloric sphincter C. Ileocecal sphincter D. Anal sphincter E. Cardiac sphincter 12. A cluster of patients presents with symptoms of bloody diarrhea and abdominal cramps after consuming raw vegetables from a local salad bar. Upon investigation, the causative agent is identified as a bacterium known to cause severe gastrointestinal illness. Which pathogen is most likely responsible for this outbreak? A. Salmonella enterica B. Clostridium botulinum C. Listeria monocytogenes D. E. coli O157 E. Staphylococcus aureus 43  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 13. A 35-year-old female patient presents to the physician with sudden onset abdominal pain and constipation. Upon examination, it is noted that the patient has evidence of parasite eggs in her gastrointestinal tract. What medication is most appropriate for treating the infection caused by these parasite eggs? A. Ivermectin B. Doxycycline C. Metronidazole D. Albendazole E. Fluconazole 14. A barefoot farmer presents with a migrating skin lesion. What medication would be appropriate for treating this condition? A. Albendazole B. Ciprofloxacin C. Acyclovir D. Hydrocortisone E. Omeprazole B9 Renal/Urinary system 1. A urine microscopy reveals the presence of white blood cell (WBC) casts. This finding is most indicative of: A. Acute interstitial nephritis B. Acute pyelonephritis C. Glomerulonephritis D. Chronic renal failure E. Tubulointerstitial nephritis 44  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 2. Following surgery with a transfusion of blood products, which electrolyte disturbance is most concerning due to its potential association with neuromuscular irritability, cardiac arrhythmias, and tetany? A. Hyperkalemia B. Hypernatremia C. Hypocalcemia D. Hypercalcemia E. Hyponatremia 3. A patient with acute gouty attacks and elevated serum uric acid is prescribed allopurinol. What is the primary mechanism of action of allopurinol? A. Inhibits uric acid reabsorption in the kidneys B. Increases uric acid excretion C. Inhibits xanthine oxidase D. Inhibits cyclooxygenase enzymes E. Increases renal blood flow 4. Which of the following medications interacts with NSAIDs by competing for renal tubular secretion, potentially increasing NSAID toxicity? A. Probenecid B. Acetaminophen C. Omeprazole D. Prednisone E. Metformin 45  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 5. A 45-year-old patient presents with chronic kidney disease and multiple cysts observed bilaterally on ultrasound. Family history reveals similar renal manifestations in several relatives. Which genetic disorder is most likely responsible for the patient's condition? A. Autosomal Recessive Polycystic Kidney Disease (ARPKD) B. Alport Syndrome C. Medullary Sponge Kidney D. Autosomal Dominant Polycystic Kidney Disease (ADPKD) E. Multicystic Dysplastic Kidney 6. A 65-year-old male patient with a history of hypertension and dehydration presents to the emergency department with acute kidney injury. Laboratory tests reveal elevated blood urea nitrogen (BUN) and creatinine levels, with a BUN/Creatinine ratio greater than 20. Which of the following conditions is most likely causing these findings? A. Acute tubular necrosis B. Glomerulonephritis C. Chronic kidney disease D. Prerenal azotemia E. Postrenal obstruction 7. A patient presents with low serum chloride (Cl), potassium (K), and sodium (Na) levels. Which class of diuretic is most likely responsible for these electrolyte imbalances? A. Thiazide diuretics B. Loop diuretics C. Potassium-sparing diuretics D. Carbonic anhydrase inhibitors E. Osmotic diuretics 46  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 8. A patient presents with low serum potassium (K) and sodium (Na) levels. Which class of diuretic is most likely responsible for these electrolyte imbalances? A. Thiazide diuretics B. Loop diuretics C. Potassium-sparing diuretics D. Carbonic anhydrase inhibitors E. Osmotic diuretics 9. A male patient weighs 70 kg and has a serum sodium level of 160 mEq/L. What is his estimated deficit? A. 4 liters B. 5 liters C. 6 liters D. 7 liters E. 8 liters B10 Reproductive system 1. What term describes the condition of the ectocervix when it exhibits squamous hyperplasia and intraepithelial neoplasia? A. Endometrial carcinoma B. Endometriosis C. Cervical intraepithelial neoplasia (CIN) D. Leiomyoma E. Ovarian cystadenoma 47  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 2. A 20-year-old woman presents with amenorrhea and seeks advice regarding contraception. What diagnostic test should be performed first? A. GnRH stimulation test B. FSH and LH levels C. hCG urine test D. Transvaginal ultrasound E. Pap smear 3. A cheerleader presents with acute abdominal pain. Which condition should be considered as a cause of her symptoms? A. Appendicitis B. Pancreatitis C. Testicular torsion D. Ovarian torsion E. Kidney stones 4. A patient presents with a painful swelling near the vaginal opening, which worsens with activity and sitting. What gland is likely affected? A. Skene's gland B. Bartholin's gland C. Cowper's gland D. Sebaceous gland E. Prostate gland 48  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 5. During labor, epidural anesthesia is commonly administered by injecting medication into the epidural space near which anatomical landmark? A. Ischial spine B. Sacral promontory C. Coccyx D. Iliac crest E. Lumbar vertebra 6. What substance typically accumulates within an ovarian cyst mass and contributes to its characteristic appearance on imaging studies? A. Blood products B. Pus C. Mucus D. Urine E. Lymph 7. In syphilis, which stage is characterized by the presence of cauliflower -like lesions (condylomata lata)? A. Primary syphilis B. Secondary syphilis C. Tertiary syphilis D. Latent syphilis E. Congenital syphilis 49  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 8. A 60-year-old male presents with difficulty urinating and a sensation of incomplete emptying of the bladder. Digital rectal examination reveals an enlarged and "floating" prostate gland. Which anatomical structure is most likely to be compressed, causing these symptoms? A. Bladder B. Bulbar urethra C. Penis D. Urethra E. Prostate 9. A 28-year-old male presents with multiple small, raised, and cauliflower-like lesions on his genitalia. These lesions are painless and have a rough texture upon palpation. Which viral infection is most likely responsible for these findings? A. Human Papillomavirus (HPV) B. Herpes Simplex Virus (HSV) C. Varicella-Zoster Virus (VZV) D. Cytomegalovirus (CMV) E. Epstein-Barr Virus (EBV) 10. A 55-year-old woman presents with a sensation of pelvic pressure and a bulging sensation in the vaginal area. On physical examination, her cervix is observed to protrude through the vaginal opening during straining. Which pelvic floor muscles are primarily involved in supporting the uterus and preventing uterine prolapse? A. Levator ani B. Obturator internus C. Piriformis D. Coccygeus E. Transversus perinei 50  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 11. A 30-year-old male presents with infertility and a history of undescended testes in childhood. Physical examination confirms bilateral cryptorchidism. What potential long-term complication is this patient at risk for if the condition remains untreated throughout childhood and adolescence? A. Epididymitis B. Testicular torsion C. Hydrocele D. Varicocele E. Testicular cancer 12. Which gene is associated with breast cancer metastasis, particularly to bone and other sites? A. BRCA1 B. BRCA2 C. HER2/neu D. TP53 E. E-cadherin 13. In the context of vaginal bleeding, uterine enlargement, and absence of fetal parts, which condition is suspected? A. Ectopic pregnancy B. Placental abruption C. Hydatidiform mole D. Cervical polyp E. Endometrial hyperplasia 51  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 14. In polycystic ovarian syndrome (PCOS), which of the following is typically increased? A. Luteinizing hormone (LH) B. Estradiol C. Progesterone D. Testosterone E. Inhibin B 15. Increased levels of follicle-stimulating hormone (FSH) are indicative of which disease? A. Polycystic ovarian syndrome (PCOS) B. Turner syndrome C. Klinefelter syndrome D. Menopause E. Ovarian cancer 16. A patient presents with difficulty conceiving and is found to have fluid-filled sacs in the ovaries. What is the likely cause of this condition? A. Endometriosis B. Polycystic ovarian syndrome (PCOS) C. Ovarian cancer D. Hydrosalpinx E. Ovarian torsion 52  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 17. A 28-year-old sexually active female presents with vaginal discharge. Microscopic examination of a wet mount preparation reveals the presence of a motile protozoan with flagella. What is the name of the organism responsible for this infection? A. Trichomonas vaginalis B. Candida albicans C. Neisseria gonorrhoeae D. Treponema pallidum E. Escherichia coli 18. Which medication inhibits the enzyme 5-alpha-reductase, thereby helping in the management of conditions such as benign prostatic hyperplasia and male pattern baldness? A. Sildenafil B. Tadalafil C. Finasteride D. Vardenafil E. Alprostadil B11 Endocrine system 1. Hashimoto's thyroiditis, an autoimmune thyroid disorder, is primarily characterized by which of the following conditions? A. Hyperthyroidism, resulting from excessive thyroid hormone production B. Hypothyroidism, due to autoimmune destruction of thyroid tissue C. Thyroid storm, a life-threatening exacerbation of hyperthyroidism D. Thyrotoxicosis, caused by toxic nodules in the thyroid gland E. Thyroid nodule formation, leading to palpable masses in the neck 53  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 2. A patient taking a weight-loss medication develops an increase in FT4 levels. This side effect is most likely due to: A. Hypothyroidism B. Hyperthyroidism C. Adrenal insufficiency D. Hypoparathyroidism E. Hyperparathyroidism 3. A 20-year-old woman who has never had a menstrual period seeks advice on contraception. Which hormone test should be ordered initially? A. GnRH B. FSH C. LH D. Estradiol E. Progesterone 4. A patient presents with symptoms of thyroid dysfunction, including numbness and tetany. Which of the following treatments or medications would be most appropriate to manage these symptoms? A. Calcium B. Calcitonin C. Bisphosphonates D. Thyroid hormone replacement E. Antithyroid medications 54  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 5. A woman who recently gave birth continues to breastfeed her newborn and is sexually active. Which hormones primarily prevent her from getting pregnant during this period? A. Estrogen and progesterone B. Prolactin and oxytocin C. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) D. Human chorionic gonadotropin (hCG) E. Gonadotropin-releasing hormone (GnRH) 6. A patient presents with low levels of thyroid-stimulating hormone (TSH) and thyroxine (T4) in blood tests. Subsequent administration of thyrotropin-releasing hormone (TRH) results in a significant increase in both TSH and T4 levels. Where is the most likely defect in this patient's endocrine axis? A. Hypothalamus B. Anterior pituitary C. Thyroid gland D. Parathyroid glands E. Adrenal glands 7. A patient presents with episodes of severe headaches, palpitations, sweating, and markedly elevated blood pressure. Imaging reveals a chromaffin cell tumor localized in the adrenal medulla. Which hormone is predominantly secreted by chromaffin cells and contributes to the symptoms observed in this patient? A. Aldosterone B. Cortisol C. Epinephrine D. Insulin E. Thyroxine 55  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 8. A patient presents with paroxysms of headache, sweating, palpitations, and elevated blood pressure. Imaging reveals an adrenal mass. Which structure is most likely affected in this patient, leading to these symptoms? A. Reticular zone B. Glomerulosa C. Fasciculata D. Medulla E. Cortex 9. Which hormone plays a crucial role in promoting closure of bone growth plates, thereby halting further longitudinal bone growth? A. Growth hormone (GH) B. Thyroid hormone (T3/T4) C. Estrogen D. Testosterone E. Parathyroid hormone (PTH) 10. A person purchases weight-loss medication online without exercising or controlling their diet. Which hormone level is most likely to be elevated in this individual? A. T3 (Triiodothyronine) B. T4 (Thyroxine) C. TSH (Thyroid Stimulating Hormone) D. Cortisol E. Insulin 56  สหพั นธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ แนวข้อสอบ NL1 วันที่ 13 ก.ค. 67 การสอบ NL1 รอบต่อไป: วันที่ 5 ตุลาคม 2567 เปิดรับสมัครช่วงสิงหาคม 2567 *********************************************Best of luck********************************************* *******************************************End of the test******************************************* 57