qcm

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="02c285a1erlcgo.png"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>usmle med 6</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="usmle med 6"><U><B>home</B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="pearls 1"><U>pearls 1</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="pearls 2"><U>pearls 2</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="pearls 3"><U>pearls 3</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="pearls 4"><U>pearls 4</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="pearls 5"><U>pearls 5</U></A>   |   <B>qcm</B>   |   <A HREF="id19.htm" TARGET="_top" TITLE="answers"><U>answers</U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="02ad2c00dkelyh.png"> <bR> <div>   <a href="http://counter.mycomputer.com/"><img alt="Counter" src="http://counter.mycomputer.com/c.count?u=DHAMMOUD&c=1" border=0></a>   </div> <div> danil hammoudi.md</div> <div>  <img src="HTMLobj-92/aniGif.gif" border="0" align="bottom" width="340" height="60">  </div> <bR> <div> <A HREF="id23.htm" TARGET="_top" TITLE="pearls 1"><U>pearls 1</U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="pearls 2"><U>pearls 2</U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="pearls 3"><U>pearls 3</U></A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="pearls 4"><U>pearls 4</U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="pearls 5"><U>pearls 5</U></A></div> <div> qcm</div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="answers"><U>answers</U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>qcm</I></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="433" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 288 WIDTH="213"><div> <B>A 30-year old man presents to the emergency room with an acute onset of severe, colicky left flank pain, with radiation of the pain down the abdomen into the groin. He has increased frequency of urination and dysuria. Physical examination shows tenderness in the left costovertebral angle. Urinalysis shows positive dipstick for blood. Sediment examination confirms the presence of hematuria.</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 1.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> The most common metabolic abnormality associated with this patient's disease is:</div> <div> Hypercalciuria </div> <div> Increase urine citrate </div> <div> Hyperuricemia </div> <div> Alkaline urine pH </div> <div> Distal renal tubular acidosis </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 344 WIDTH="213"><bR> <div>  <A NAME="question_2_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>A 65-year-old woman presents to the emergency room with a distended, diffusely painful abdomen. She has not had any bowel movements or passed gas for the past 3 days. An abdominal x-ray reveals distended loops of the small bowel with a stepladder pattern of differential air-fluid levels.</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 2.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> The mechanism that most likely produced these findings is </div> <div> Ischemia secondary thrombosis of the superior mesenteric artery </div> <div> Adhesions from previous surgery </div> <div> Torsion of the bowel around the mesenteric root </div> <div> Intussusception of the terminal ileum into the cecum </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 286 WIDTH="213"><bR> <div>  <A NAME="question_3_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>A 58-year-old man with a 20 pack history of smoking is being evaluated for a coronary artery bypass graft.</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 3.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> The best preoperative screen of pulmonary function for this patient would be:</div> <div> Arterial pH </div> <div> Arterial carbon dioxide tension (PCO2) </div> <div> Arterial oxygen tension (PO2) </div> <div> Forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 707 ><NOBR><bR> <div>  <A NAME="question_4_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>Specialized Vaccines</B> </div> </NOBR></tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 4.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> All the following statements concerning specialized vaccines are true EXCEPT:</div> <div> Haemophilus influenza B vaccine is recommended for those patients with recurrent otitis media or a history of acute epiglottitis. </div> <div> Influenza vaccine is not recommended for normal children. </div> <div> Pnuemococcal vaccine should be administered, after 2 years of age, to those children who have functional or anatomic aspenia (e.g.sickle cell disease). </div> <div> It is generally recommended that all newborns be immunized with hepatitus B virus (HBV) vaccine. </div> <div> Newborns of mothers carrying HBV antigen should receive hepatitus B immune globulin at birth and should be actively immunized with HBV vaccine. </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 267 WIDTH="213"><div>  <A NAME="question_5_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Pediatrics</B> </div> </tD> <tD VALIGN=CENTER WIDTH="213"><bR> <div> <B>QUESTION 5.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> A 12-month-old child presents with iron deficiency anemia and a history of rectal bleeding unassociated with pain. Which diagnosis is the most likely in this patient?</div> <div> Intussusception </div> <div> Duodenal ulcer </div> <div> Angiodysplasia </div> <div> Meckel's diverticulum </div> <div> Ulcerative colitis </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 305 WIDTH="213"><div>  <A NAME="question_6_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Cause and Effect</B> </div> </tD> <tD VALIGN=CENTER WIDTH="213"><bR> <div> <B>QUESTION 6.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> Which combination suggests "cause and effect "?</div> <div> Aluminum Toxicity---parkinsonism </div> <div> Carbon monoxide---Huntington's disease </div> <div> Head Trauma---multiple sclerosis </div> <div> Genetic Trait---infantile spasms </div> <div> Preceding viral illness---Guillain-Barre syndrome </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 343 ><NOBR><div>  <A NAME="question_7_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Diabetic Ketoacidosis</B> </div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="213"><bR> <div> <B>QUESTION 7.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> A patient with diabetic ketoacidosis (DKA) is being treated with insulin. During therapy, the patient develops respiratory paralysis requiring intubation and assisted ventilation. What is the mechanism for the patient's respiratory failure?</div> <div> An anaphylactic reaction against insulin </div> <div> Glucose toxicity </div> <div> Ketoacidosis </div> <div> Hypophosphatemia </div> <div> Hyperkalemia </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 669 ><NOBR><div>  <A NAME="question_8_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Diptheria-Tetanus-Pertussis</B> </div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="213"><bR> <div> <B>QUESTION 8.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> If convulsions follow after administering a diphtheria-tetanus-pertussis (DTP) vaccine, which procedure is recommended for future immunizations?</div> <div> Leave out the diphtheria component of the vaccine, and give pertussis and tetanus on the next immunization. </div> <div> Leave out the tetanus component of the vaccine, and give diphtheria toxoid alone on the next immunization. </div> <div> Leave out the tetanus and pertussis components of the vaccine, and give diphtheria toxoid alone on the next immunization </div> <div> Leave out the pertussis component of the vaccine, and give diphtheria-tetanus toxoid on the next immunization </div> <div> Give DPT again on the next immunization </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 209 WIDTH="213"><div>  <A NAME="question_9_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Fractures</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 9.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> The potential loss of blood from a closed fracture is greatest in fractures of the:</div> <div> Humerus </div> <div> Tibia and fibula </div> <div> Pelvis </div> <div> Spine </div> <div> Femur </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 248 WIDTH="213"><div>  <A NAME="question_10_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Statistical Tests</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 10.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> Which statistical test would be most appropriate for assessing the difference in age among three groups of patients?</div> <div> Student's t-test </div> <div> Analysis of variance </div> <div> Correlation coefficient </div> <div> Chi-squared test </div> <div> Logistic regression </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 209 WIDTH="213"><div>  <A NAME="question_11_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Fistulas</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 11.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> The most common fistula in the gastrointestinal tract usually results from:</div> <div> Crohn's disease </div> <div> Ulcerative colitis </div> <div> Diverticular disease </div> <div> Childbirth </div> <div> Peptic ulcer surgery </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 210 WIDTH="213"><div>  <A NAME="question_12_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Complications Associated With Cartoid Endarterectomy</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 12.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> A 65-year-old man dies within 24 hours of a cartoid endarterectomy. The most likely cause of death is:</div> <div> An embolic stroke </div> <div> Pulmonary embolism </div> <div> Air embolism </div> <div> Acute myocardial infarction </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 267 WIDTH="213"><div>  <A NAME="question_13_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Sexual Issues</B> </div> </tD> <tD VALIGN=CENTER WIDTH="213"><bR> <div> <B>QUESTION 13.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> A 40-year-old, happily married man sometimes fantasizes that his wife is wearing high-heeled shoes when they have sex. The best description for this man is:</div> <div> Exhibitionism </div> <div> Fetishism </div> <div> Frotteurism </div> <div> Voyeurism </div> <div> Normal </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 382 ><NOBR><div>  <A NAME="question_14_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Cognitive Disorders</B> </div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="213"><bR> <div> <B>QUESTION 14.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> A highly anxious woman complains of seeing gruesome murders committed in alleyways all over the city and believes that her landlord is pumping poisonous gas into her apartment. Which condition is causing her symptoms?</div> <div> Dementia </div> <div> Obsessive-compulsive disorder </div> <div> Panic disorder </div> <div> Posttraumatic stress disorder </div> <div> Generalized anxiety disorder </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 190 WIDTH="213"><div>  <A NAME="question_15_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <div> <B>Disturbed Recall</B> </div> </tD> <tD VALIGN=CENTER WIDTH="213"><bR> <div> <B>QUESTION 15.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> Disturbed recall is an essential feature of:</div> <div> Organic psychosis </div> <div> Conversion disorder </div> <div> Dissociative fugue </div> <div> Major depression </div> <div> Delirium </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 305 WIDTH="213"><div> <B> <A NAME="question_16_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <bR> <div> <B>Elderly Patients</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 16.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> All of the following are considered normal in a 75-year-old man EXCEPT:</div> <div> Mild glucose intolerance </div> <div> Increased serum alkaline phosphatase </div> <div> Increased autoantibody production </div> <div> Decreased creatinine clearance </div> <div> Slight increase in hemoglobin concentration </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 HEIGHT= 597 ><NOBR><bR> <div> <IMG SRC="04d523f0.png" border=0 width="338" height="575" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 228 WIDTH="213"><div> <B> <A NAME="question_17_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <bR> <div> <B>A 43-year-old patient with end-stage renal disease has the above electrocardiogram (ECG):</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 17.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> For specifically reversing the effect on the cardiac muscle in this patient, the physician should administer: </div> <div> Sodium bicarbonate </div> <div> Furosemide </div> <div> Calcium gluconate </div> <div> Glucose plus insulin </div> <div> A cation-exchange resin </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 171 WIDTH="213"><div> <B> <A NAME="question_18_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <bR> <div> <B>A 28-year-old female secretary has the onset of insomnia, irritability, increased psychomotor activity, and impulsivity. </B></div> </tD> <tD VALIGN=TOP><NOBR><bR> <div> <B>QUESTION 18.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> This combination suggests:</div> <div> Psychosis </div> <div> Antisocial traits </div> <div> Mania </div> <div> Anxiety </div> <div> Depression </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 209 WIDTH="213"><div> <B> <A NAME="question_19_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <bR> <div> <B>A 21-year-old woman presents with complaints of painful intercourse on vaginal entry since she got married, as a virgin, 1 month ago. </B></div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 19.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> Which condition is the most likely cause of her pain? </div> <div> Narrow <FONT SIZE="3" COLOR="#800000" FACE="Arial" >hymen</FONT> </div> <div> Psychogenic problem </div> <div> Endometriosis </div> <div> Pelvic inflammatory disease (PID) </div> <div> Atrophic vaginitis </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="213"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="213" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="213"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="213" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 324 WIDTH="213"><div> <B> <A NAME="question_20_1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <bR> <div> <B>Accidents tend to occur within certain age groups.</B> </div> </tD> <tD VALIGN=TOP WIDTH="213"><bR> <div> <B>QUESTION 20.1</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> All of the following pairings of accidents with the most common age-group in which they occur are accurate EXCEPT: </div> <div> Suffocation-6 months old </div> <div> Baby-walker injury-1 year old </div> <div> Drowning in a swimming pool-2 years old </div> <div> Pedestrial injury-6 years old </div> <div> Accidental poisoning-7 years old </div> <div> <U>Show Answer</U><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 HEIGHT= 19 WIDTH="427"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="427" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> <bR> </td> </tr></table></body>