MemoCard lernen mit System

6 YO known case of congestive heart failure , present in ER with SOB after playing , HR : 200 other examination normal , ask about apportiate mangment : ⁃ iv fursamide ⁃ observation as symptom expected of ⁃ his diagnos .

pregnant with diffuse goiter not mentioned tsh and t4 , us showed bilateral nodule one solid 0.5x0.8 and one 2x3 most appropiate management? A. FNA both B. FNA large C. Follow up D. Thyroid scan

Case of stroke and complain of weakness in the arm leg and face, intact speech and sensation where’s the damage? A. Middle cerebral artery B. Anterior cerebral artery C. Mid basilar artery D. Vertebral artery

a, based on votes

A scenario of patient came to clinic with preeclampsia without severe features ( I think at 32 or 33 weeks). What you do? A- Admission for observation B- Give appointment at outpatient clinic after 1 week

Patient with a history of Hashimoto's disease for 25 years presented now with a rapid growing tumor of the thyroid and weight loss (100% sure) what is it most likely diagnosis: A. Papillary B. Medullary C. Anaplastic D. Thyroid Lymphoblastic

60 YO male patient k/c of DM and HTN presented to ER with: neck pain and sweating for one hour. He has a previous history of recurrent chest pain which resolve spontaneously after resting. ECG done and showed non-specific ST segment and T wave changes. Troponin is normal. What is your next step? •A. Repeat troponin after 6 hours •B. Discharge the patient •C. Do stress ECG test •D. Give aspirin and nitroglycerin

a um alqura

Child sit unsupported, smiles coos and points to his mouth with his finger A. 2 months B. 5 months C. 7 months D. 10 months

Child 4 years , her mother told you she is always yelling and say NO and hitting , what is the diagnosis? ⁃ Anxiety disorder ⁃ Depression ⁃ Mental retardation ⁃ Temper tantrum

12 years old boy asymptomatic came for routine f/u was found to have irregular pulse heart rate :80 vitals:stable and normal Hight > 90 sentile Wt 25 sentile Most likely prognosis: A.heart block B .normal development C.syncopal episode D.Myocardial dysfunction

Child with stab wound in the lower right chest and free fluid in the andomen ,most appropriate thing to do A/thoracotomy B/thoracostomy C/exploratory laboratomy

SLE case case arthritis and malar rash no renal \ CNS\ CVS symptoms, tt:- 1- HQC+azathioprim 2-HQC+ methotrexate 3-HQC+ MMF 4-HQC+ cyclophosphamide

patient came to the clinic for a check - up , he has some abdominal pain , endoscopy done for him revealed multiple ulcers . The biopsies were taken and showed positive H.pylori and mucosa - associated lymphoid tissue ( MALT lymphoma ) . The management should be ? A. H.pylori eradication ✅ B. Surgical resection C. Chemotherapy D. Anti - acid medication

An 8 year old girl with persistent and continuous diarrhea, she drinks 3 pints of goat milk per day and is a fussy eater. Which of the following conditions explain her presentation? Labs: Hb Low, MCV Low and MCHC High A) psychological Deprivation B) Giardiasis Parasitic Infection C) Aplastic Anaemia D) Hypothyroidism

a, survey

Weman her husband has gonorrhea what’s the most diagnostic for her A- anogenital swap B- high vaginal swap C- endocervical swap D- urine culture جاني هذا بس الخيارات غير كانت كذا Male suspected gonorrhea: A. urethral swab B. vesicular cx ' C. urine cx

C, A

A case of young male asymptomatic presented abnormal LFT. He is a smoker and drinks alcohol in the weeknds. Labs showed high AST ALT Tbilli and slightly high iron and TIBC and very high ferritin (450). What is the cause of his abnormal LFT A-hemochromatosis B-alcoholic hepatitis C-cholangitis

vertex presentation deliver by 1 forceps delivery 2 spontaneous delivery 3 CS 4 ventose

type of polyp with highest risk of cancer? A. Villous B. Tubular C. Tubulovillous

43 years come to your clinic to check,, only Hba1c 6.9 Ask about management? ما ذكر عنده سمنة او مرض مزمن فقط جا العيادة يفحص ولقينا التراكمي كذا 1- metformin 2- life style 3- low Carbohydrate 4- insulin

a case of rheumatoid arthritis came for follow up, he is well controlled on steroid and hydroxychloroquine Labs all normal except high fasting blood glucose and A1C What to do? A- stop steroid and start methotrexate B- stop steroid and start ibuprofen C- continue same treatment

steroids shouldn’t be initiated for long term since this patient has controlled symptoms. Methotrexate is given to patients with moderate to severe disease activity. Ibuprofen can be given to relieve symptoms but this patint has none, but by exclusion it seems the best choice.

27 Y.O with history of confusion for 2 days and seizure for 5 hours. He is not oriented to time, place and person. He has history of unprotected sex for 6 years. Serum cryptococcal antigen positive, what is the most appropriate next step? A. HIV serology. B. SF Toxoplasmosis testing. C. CSF Syphilis serology. D. Herpes simplex testing

patient who had right big toe pain and because of that “written like this” he was diagnosed with gout and treated with allopurinol. He’s a known case of psoriasis. He presented now with right big toe pain, right ankle pain and bilateral knee pain and there was no improvement with allopurinol. Labs shows high uric acid What’s the diagnosis? A- active pseudo-gout arthritis B- active gout arthritis C- psoriasis arthritis D- Osteoarthritis

Patient diagnosed with persistent afib. HTN & DM. Has no contraindications to any anti-thrombotic. What’s the first line anti-thrombotic? A. Aspirin B. Clopidogrel C. Aspirin + Clopidogrel D. Warfarin

28 male with lower back pain ,erythmatous and B/L knee jointLabs were of insignificant values ,how to dx? * HLB27 * MRI SPINE * CT SPINE * JOINT Aspiration

Patient underwent lap chole for multiple gallstones 7 days ago, presents with vague abdominal pain. On US there is fluid around the gallbladder (something like that) and the CBD is 9 mm. What is the most likely diagnosis or cause? A - CBD injury B - Retained stone in CBD C - Sub-hepatic collection D- slipped clips

Pediatric patient came with fever and sore throat, the tonsils were congested and he had papular lesion with erythematous base on his mouth and gingivitis: HSV EBV Coxsackie

Pt had fibroid myomectomy, risk of placenta accreta? A) Decrease B) Increased C) Unknown D) No risk

30 year women complained of dry cough very sever comes in attack that she can not complete talking intial dx as alergic rhinitis took intranasal steroid but no improvemt ..they mentioned that she has allergy to dust .on exam slight nasal congesion. FEV1/FVC <70 and improved by 20% with bronchodilator ..what you want to do: A- Chest ct B- Skin allergy test C- IgE antibody level D- Methacholline chalenge test

Patient coming from an endemic area for malaria. Later on, he was admitted to the hospital with Heart failure. Doctor did not ask the patient about travel or medication history. Thus, he ordered the nurse to give digoxin. Who is at fault? A) Computerized drug prescription system B) Nurse failed to write drug formularies C) Pharmacist who failed to check prescription D) Patient who did not bring his medicine pack/ report his medicines

DM with hx of pad, had pain when he walks 300m and relieved by rest what will you do A- CTA B- vascular ultrasound C- conventional Angio D- MRA

Next? B ✅ Best or Gold standard or most diagnostic? C ✅

45yo Women , has abdominal distention . Imaging shows moderate ascites , pleural effusion & bilateral ovarian masses . Ca 125 is elevated 90something . What is the dx? A- Epithelial ovarian cancer B- sex cord tumor C- germ cell tumor

Patient after cholangitis intervention with the following WBCs 9, RR 18, HR 80 (exactly 80 not 90), normal BP, Temp: 38 exactly 38). What is the cause: - sepsis - SIRS - bactermia - septic shock

pt from India with sign and symptoms of Meningitis , labs wbc : lymphocytes , high protein .. A- TB meningitis B-viral meningitis C-Bacterial meningitis

more info

Pt had fibroid myomectomy, risk of placenta accreta? A) Decrease B) Increased C) Unknown D) No risk

Morbidly obese man with hiatal hernia and GERD grade 3, what’s the best procedure? A. Ring B. Sleeve gastrectomy C. Roux en Y gastric bypass D. balloon

2. Pt with history of diarrhea, weight loss, and fatigue. ESR high. CT scan: findings of crohn but I can’t remember exact wording ( something terminal ilum and strictures in jejunum). Hgb is low. What else are you going to find in your physical examination? 1. Nail pitting 2. Splenomegaly 3. Perianal dissease 4. Erythema marginatum

Child (new born) with forceful vomiting, already not detected any anomaly what the cause? Pyloric stenosis Necrotizing enterocolitis Atresia Something for the heart

45 years old male with history of constipation, with family history of colon cancer , came to u , colonscopy report shows normal colon, which of the following most likely protective for colon cancer ( or highest one that decrease his chance of having cancer or most protective something like this ) Maintaining healthy weight and excersize Annual colonoscopy Low fiber diet Other irrlevant

Smoker has acute cough with yellowish sputum and had red streak in sputum for 2 days , high fever, CXR: right lower lobe lung infiltration ? A) community acquired pneumonia B) acute bronchitis C) TB

prophylactic antibiotic for appendicitis duration A. Preoperative then stop immediately B. Preoperative then stop 3 days after surgery C. Preoperative then stop 5 days after surgery D. Preoperative then stop 7 days after surgery

Young SLE female pt on treament. Developed urinary incontinence, hypereflexia, paraplegic or paresthesia. (Sx mostly neuro) what the most important test to do immediately? Lumber puncture & MRI brain Lumbar puncture & ct brain Lumbar puncture & MRI spine LP, MRI, MRA, and MRV of the brain

C. Answer is LP and MRI of the spine. This is a case of Transverse myelitis as a neurological complication of SLE. Management is IV steroid and Cyclophosphamide.

90-year-old Female patient with with long standing incisional hernia, came to ER with abdominal pain and fecalith discharge, her hernia is strangulated with ulcers and necrotic all vital are normal, what will u do ? A. Dressing B. Laparoscopy C. MRI D. Lapratomy abdomen

Femal after a choly developed fever rigor T 38 WBC 11 BB 110/70: SIRS bacteremia Sepsis Severe Sepsis

Female after a chole developed fever rigor T 38 WBC 11 BB 110/70: SIRS bacteremia Sepsis Severe Sepsis

Worse headache of life with neck pain. In physical examination pupil poor reactive to light. CT negative. What do next? A- lumbar puncture B- MRI neck C- MRI brain

Chest gunshot wound. Entry was lateral to left nipple and exit point below left scapula, patint suddenly become worse w/ raised JVP and muffled heart sound, your action? A- Pericardiocentesis B- Immediate thoractomy C- CT

Young women with depression (and other symptoms) prior to her cycle every month it is effecting her work what to give her A- ssri B- medroxyprogesterone C- progesterone D- estrogen

Which diuretic prevent reaccumulation of ascites - loop, thiazide, aldosterone antagonist

65-year-old heavy smoker is coming for a general examination. What is the best screening test for him? A. Osteoporosis B. Colon cancer C. Abdominal Aortic Aneurism

Patient with lung cancer and has hypercalcemia, what is the type ? -Squamous cell carcinoma -small cell lung cancer

Female with multiple small ovarian cyst , androgen production high , insulin resistance , anovulation and HTN ( exactly like this ) what is the diagnosis ? 1- gycecomstia 2- kallman syndrome 3- kllifnter 4- Stein-Leventhal syndrome

Typical case of hemolytic anemia and blood film show spherocytosis,Hb:8, MCV MCHC normal range, WBC: 3, PLT: 500, LDH AST ALT high, low haptoglobin most appropriate treatment? A-blood transfusion B-corticosteroids C-hydroxyurea

Which of the following is the best contaception in pt w a history of PE? A-IUD B- permenat steriilization C-levonorgestrel D- condom

Case of pylori stenosis na 130 bicarb decreased a little bit i forger how much What to give: Npo Ng tube Iv na Iv bicarb

IVNS

25 year old woman had severe pelvic inflammatory disease 2 years ago that was treated by intravenous antibiotics. The isolated organism was clamydia. Since then the patient was trying for pregnancy but failed. She had normal regular period and normal seminal analysis. A. Ultrasound monitoring of her ovulaion B. Magnetic resonance image of the pelvis C. Hysterosalpingogram

14 y female complain of vaginal bleeding in interval of 3 weeks to 2 months, she has normal development and normal secondary features, every thing normal What to do? A- Reassure B- OCP C- Order FSH and prolactin

Elderly man presented to the ER with rigid distended abdomen prepared for laparotomy with hypotension and fever (38) X ray showed free air under diaphragm What is the best initial resuscitation option ? A- intubation and ionotropes B-Broad spectrum Abx C-Colloid via central line D-Crystalloid fluid via peripheral line

Child with RLQ pain anorexia and fatigue who look ill with mass in RLQ, leukocytosis with left shift:- 1- US 2- CT

6 m/o infant present to ER with sudden apnea & color change. Mother gave history of recurrent vomiting and multiple chest infections. On exam he looks failing to thrive with dystonic neck posturing while crying. Which of the following considers as high risk case for the above disease? A- Obese baby B- Preterm infant C- Post pertussis infection D- Following inguinal hernia repair

56 years old patient had an upper Gl bleeding due to esophageal varices and was given IV fluid. Which of the following should be given to reduce mortality? A. Vasopressin B. Octreotide C. Nadolol D. Ceftriaxone

146. Pregnant 37 week with BP 160/110 every thing else was normal Her BP during pregnancy was 120/90 no protinurea ? A.Gestational HTN B.Preeclampsia C.Eclampsia

A 35 years old male has repeated attacks of hematemesis. On examination, he has spider angioma and bilateral gynecomastia with splenomegaly. Labs showing high liver enzymes. What is the most appropriate next atep after initial resuscitation with IV fluid? A. Abdominal X-Ray. B. Upper GI endoscopy. C. Nasogastric tube insertion. D. Give antibiotics.

3 y old child has asthma best way to diagnose? chest xray PFT and spiromymetry detailed history,physical examination and improvment post dialator therapy

Open fracture

jpj

Male patient came from India RUQ pain .. on and off fever for 3 weeks . raised LFT , high WBC (Neurtrophol 70% Lymphocytes 20%) . image showed homogenous hypoechoic mass in the liver. a) hydatid cyst b) TB abscess c) amebic abscess d) pyogens abscess

Patient with cushing syndrome will go for surgery for adrenal tumor, what you will give before surgery? A-IV hydrocortisone B- IV fludrocortisone

PRESCHOOL VACCINATION

70 years old, menopause, came seeking hormonal replacement therapy, and you explained that there is no benefit in her case, but she insisted, what you will do? A) Refer her to another gynaecologist B) Prescribe her the medication C) Refuse her the medication D) Consult the ethics department

Young man with palpitation only, comes Suddenly lasts for 5-10 mins Everything was normal ECG normal rhythm What is the most appropriate? Initial invx? Holter Echo Excercize ecg

Patient with long term history of DM type1 in12 weeks of gestation. HbA1C 12. Which of the following complication is most likely to happen? A. Preeclampsia B. Polyhydroamnios C. Congenital malformation D. IUGR Explanation:

Q37 - Pathophysiology regarding patient with appendicitis complicated by appendicular mass (Abscess), patient was feverish (38.7)? A - Peripheral Vasoconstriction B - Decreased Cardiac Index C - Redistribution of Blood D - Bradycardia

19 yrs old dysmenorrhea resolve on 3rd day and resolve after few , Sxs associated with sever pain radiated to upper thigh, she had this for several years and getting worse A- Primary dysmenorrhea B- premenstrual C- secondary dysmenorrhea D- endometriosis

A Physical Sx and the presentation is typical for Primary, the only exception is that it’s getting worse. جاني في نوڤمبر وحطيت A.

15 month boy came to ER complaining of abdominal discomfort, emesis, stool with blood and mucus on phisycal examination he has increase abdominal sound X-ray report shows obstractive bowel ( written like this ) A- give antibiotic B- Go to OR and do surgery C- Barium enema D- bowel rest, IV hydration and wait until symptoms gone

What cause ripening to the cervix? A) oxitocin B) prostaglandin

Patient present with “ring in his eyes” what is most likely diagnosis A. Wilson's Disease ✅ B. Hemochromatosis

An old patient with symptoms of fever and productive cough admitted to isolation as a case of T.B, then next day results came out showing him having HIV. What shall you do now? A. Start anti-HIV immediately B. Start anti T.B for 3 months then anti-HIV C. Consider Pneumocystis Carinii D. Start both ant T.B and anti-HIV

Young male came afrer RTA and FSAT was order Which of the following most probably to found? - pneumothorax -subdural hematoma -hallo viscous injury -interpertoneal free fluid

28 year old female presented following radiation of neck with neck swelling. Ultrasound showed swelling in the left lobe of the thyroid of 3x4cm of papillary thyroid cancer. Which of the following is the best management? A) Left Lobectomy B) Left Lobectomy with Isthmusectomy C) Subtotal Thyroidectomy D) Total Thyroidectomy

Which of the following antidepressants causes constipation? A- SSRI B- Snri C- Tca D- Moa

Patient undergoing laprascopic cholecystectomy, as they were inserting the tubes "laprascopy equipment" patient developed severe bradycardia 40 min/hr What could be the cause? A. Cold air inflation B. Streching of the preitoneum

15 year old girl has sparse pubic hair not reaching the mons pubis, breast budding with areolar enlargement, but with no clear distinction between breast and areola. No contour of breast was seen. What Tanner stage is she? a. Tanner I b. Tanner II c. Tanner III d. Tanner IV

about child present with projectile vomiting , on abdminal examination , olive like mass , what is the mx ? Pyleromytomy

Observation

vaccination at birth? Hep B, Dtap MMR, BCG MMR, Hep B BCG

family notices that their grandfather is starting to gradually forget important events and basic things in his life, like the directions in his house and the name of his children. The family is concerned he might have Alzheimers. What is the most likely diagnosis of this patient's presentation? 1. Benign forgetfulness 2• Alzheimers 3. Vascular dementia 4. Lewy Body dementia

post delivery 10 days or weeks came with fever and chills, there is swelling and tender with cracked nipple and lymphadenopathy 1- puerporal sepsis 2- breast abscess 3- cardiomypathy

38 weeks with placental aprubtion baby and IUFD cervix Is 5 cm dailted what to do "no vitals " Observe Cs Augmentation of labor No IOL in the choices, no vitals, no hours

Type of anemia with with sarcoidosis IDA, anemia of chronic disease, hemolytic anemia

35 female diabetic smoker history of sub fertility What concern u in this pregnancy A- hx of fertility B- smoker hx C- maternal age D- dm

SLE PT came for follow up, labs reveal slightly elevated crt. +bun , biopsy was indicated and showed (minimal change) grade 1 , BP :150/90 what is next ? A- give steroid B-observe C- treat HTN

Neoborn with tachypnea , tachycardia and difficulty feeding , on oscultation there was parasternal heave and single S1 heart sound , what is the essential part of the initial management? A-NSAID B-Diuretics C-Dopamine D-Prostaglandine

d, based on votes

34 weeks pregnant in active labor, abdomen is contracting every 5 minutes, Station - 3, 4 cm dilated, membrane intact, CTG is reactive, everything else is normal as far as I remember, what is your next step? A) C-section B) Ventose C) Rupture of membrane D) Tocolytic

60 y/o Patient was discharged from icu after 2 weeks of having mi, the patient have another appointment with elective cholecystectomy. When should he do it? A. Upon discharge B. 6 weeks C. 6 months D. Until symptoms resolve

Patient smoker on chest x ray there was a nodule which of the following will make you suspect malignancy? A- Size more than 1(not say 2.5 ) B- Hypercalcemia C.smoking D.....iam not remember

8 years old boy. Mother complained of poor training to bathroom which muscles is targeted in therapy? A- Perianal B- Pelvic floor C- Rectus muscle D- Detrusor

Scenario suspect endometriosis, most appropriate way to diagnose? US Laparascopy MRI Biopsy

Women with uncomplicated pyelonephritis ( the diagnosis was given like this ) , what Antibiotics would you give her : A - Ciprofloxacin B - One of the Macrolides ( I forgot which one ) C - ceftriaxone

Female with ovarian tumor, ascites Then ask ho to stage her tumor ? A. Paracentases B. CT abdomen pelvis and chest c. surgical staging

Crhon’s disease on prednisolone and mesalamine , presenting with perianal fistula … abdominal symptoms controlled with no diarrhea , management ? A- methotroxate B- Budesomide C- Azythromycin D- Odalizumab or influximab

Child with viarl infection not improving with 2 inhaled saba:- 1- cough suppressant 2- leukotrine 3-ICS 4- oral beta agonist

Patient came with Diarrhoea, culture came as shigella, what is the antibiotic of choice? Ceftriaxone Azithromycin Amoxicillin

A 72 year old man presented with an episode of right sided weakness that lasted 10 minutes and fully resolved and he is clinically stable, he has no other medical illness. On examination: BP 110/70, HR 95, T 36.6 Which of the following is the most appropriate next step in the management? A.Aspirin. B. Warfarin, INR 3-4 C. Warfarin, INR 2-3 D. No additional drug treatment

Delayed bone age but normal growth velocity:- 1- reassurance 2- basic tests ( CBC,TSH…etc)

after using PPI when to do urea test? -2weeks -4weeks

2weeks ppi

4 weeks antibiotic

Folic acid quantity for a healthy lady wants to conceive and with no prior diseases or disorders A) 1 mg B) 5 mg C) 10 mg D) 15 mg

pic of spherocytosis

LOOKS LIKE A RED BALL NOT CONCAVE

Child with face swelling and sacral edema with abnormal liver test and proteinuria Dx? A-CHF B-Chronic liver disease C-Nephrotic syndrome D- Low protein diet

History of obese diabetic female with irregular menstruation every 8-9wks , presented with heavy uterine bleeding since last menstraul cycle which was 15days ago and still … Dx ? A- chronic an-ovulation B- Submucosal fibroid C- Uterine atrophy

Patient came after 3 days after Roux-En-Y surgery complaining of fever chill and left shoulder pain, best diagnostic investigation? A. CT with contrast B. Endoscy C. Laparoscopy D. Exploratory laparatomy

Patient came with lesions on the groin, get inflamed frequently with Nontender, skin-colored, on the level of the skin, dome-shaped papules with central umbilication - skin tag - molluscum contagiosum - furnucle ?puncule شيء زي كذا

case of a patient with a large amount of fluid in the pouch of douglas A- laparotomy B- suction and evacuation

Women with worsening dysphagia for 9 months for both liquid and solids, she recently have ill defined central chest pain, no other past history. Clinical examination was unremarkable, labs was unremarkable, except of ESR = 13 ( the normal was up to 10 ), what is the diagnosis? A. Pharyngeal pouch B. Achalasia C. Esophageal web D. Squamous cell carcinoma of the esophagus

Post menopausal women present with itchiness and oderless discharge with vaginal excoriation what is the dx A- Candidiasis B- triachomniasis C- vagnosis D- atrophied vaginitis

Female patient pregnant with history of previous 4 C-section presented with mild bleeding and hypotension, what is the most likely cause of her presentation “This is the full scenario no further details” A- cord prolapse B- Uterine rupture C- abruptio placentae D- fetal vessel rupture

Pt after splenectomy surgery presented with with multiple episodes of intestinal obstruction Now complianing of abdominal destination pain rigidity sluggish bowel sounds Vitality stable X ray air fluid level What is the intial management? A- Paracentesis B- gastrografin enema C- expl laparotomy D- NGT , analgesic, bowel rest

Scenario of critical limb ischemia, what’s the most diagnostic investigation? A- CTA B- MRA C- Conventional angiography D- ultrasound

C Peripheral Arterial Disease ( PAD ) Investigations: 1st ( Start By simple ) Laboratory tests: CBC, Hgb, RBS, Lipid profile, RFTs. 2nd ( Vascular Labs ): - Doppler US to detect the pulse by Sound. - Ankle-Brachial Index at rest and exercise if drop > 20% —> ischemia - Segmental pressure measurement: to find the location of stenotic artery. 3rd ( Imaging ) If Asked Next? Start by Duplex US If asked the Gold standard or best investigation to detect PAD? Choose Conventional Angiography. Usually we start by US if not diagnostic we use CTA If the patient have renal impairment and we cannot use CTA due to the contrast usually we go for MRA. If none of the above is Diagnostic? Conventional Angio is the gold standard for theraputic and diagnostic purposes. Note: If the patient have PAD then presented suddenly with leg pain and suspicion of Acute ischemia? Give Heparin. Heparinization immediately required.

Vaccination of 2 months? IPV, HBV, rota virus, Hib, PCV13, DTaP or bcg, hep b or mcv4

Patient had a fracture and is being treated, he developed severe pain and swelling, what which of the following signs, indicates the earliest damage? Decrease pulse Parasthesia Discoloration Foot drop

patient came with hx of appendectomy 2 years ago came with s&s of bowel obstruction, vitally stable and bowel sound are exaggerated with minimal diffuse tenderness. WBC: 11.5, Xray shows multiple air fluid levels: A- Echo B- Ultrasound C- CT abdomen D- laparotomy

What is the age in month of child talk 6-10 words, know 2 body parts, immature pencil grasp? A-17 B-19 C-12 D-24

70s female complaining of dysuria, frequency, urgency. On examination there is a Grade 2 anterior wall and vaginal prolapse. What is the most appropriate next step in management? A- vaginal hysterectomy B- anterior repair C- Urinalysis

Condulioma lata

wart-like lesions on the genitals.

A full term born came with respiratory distress and chest X ray showed fluid in the fissures. He is born by cesarean section. Most likely diagnosis A-Transient tachypnea of newborn B-Sepsis C- Meconium aspiration D-Hyaline membrane disease

Alcoholic, right hypochondriac pain and i think weight loss alpha fetoprotein is high No other labs Image: CT showed multiple lesion in liver and cirrhosis A-Hepatocellular carcinoma B-pancreatic cancer

Heroin addict want to start a program to eliminate the addiction, which drug would you choose? A- Naloxone B-Methadone

B, OVERDOSE GIVE NALOXONE

Why ACIs is Contraindicated during pregnancy : fetal anomaly Renal impairment of the fetus

Female obese,HTN, hypercholesterolemia ,smoking BMI:38 What is direct related to Stroke ? -HTN -obese -hypercholesterolemia -smoking

30 year women complained of dry cough very sever comes in attack that she can not complete talking intial dx as alergic rhinitis took intranasal steroid but no improvemt ..they mentioned that she has allergy to dust .on exam slight nasal congesion FEV1/FVC <70 and improved by 20% with bronchodilator ..what you want to do: Chest ct Skin allergy test IgE antibody level Methacholline chalenge test

A 3-year-old child was brought by his mother for a regular check-up. The child behaved badly, continued to shout “NO!” and throw toys. His mother tried to stop him but he continued to ignore his mother. Which of the following would you advise this mother? A) Ignorance B) Counselling C) Positive reinforcement D) Punish the child

Pregnant in 39 or 38 weeks came to hospital starting labora in fwe hours cervix 6 cm , spontaneous rupture of membrane 20 hours ago ctg shows fetal bradycardia what is most appropriate management? A- Stop oxytocin B- CS

34 y after rta … open eye with pain , makes sounds , localized pain 8 9 10 11

Child with 3 degree burn and 1% of genitalia surface affected: A- Refer to burn unit B- sterile wound ointment C- antibiotic ointment D- dressing and discharge

Answer is A Burns involving the face, hands, feet, genitalia, perineum, or major joints are an indication of referral to burn unit. Ref: Schwartz.

Case of pylori stenosis na 130 and low Cl much What to give: Npo Ng tube Iv NS 0.9 Iv bicarb

Pt with episodes of vomiting and hematemesis , EGD was done and it showed intestinal like metaplasia in distal esophagus: A- Esophagitis B- Plummer Vinson C- Mallory weiss D- Barret esophagus

Patient give birth to Rh positive baby, she took anti-D immune globulin during pregnancy, how much will give her after birth A. 300 B. 1000 C. 2000 D. No need

Child came with painfull red swollen hemiscrotum. On examination, mass was palpated with -ve cough impulse. The mass was tender and extended to the inguinal area. Left testes cannot be palpable. Which of the following is the most likely diagnosis? A- testicular torsion B- Epidydomorchitis C- Incarcerated inguinal hernia D- Testicular appendicular torsion

Patient had liver laceration and the patient is hemodynamically unstable. What to do? A- Right hepatectomy B- Perihepatic packing done C- Right hepatic artery ligation D- Ligation of the involved vessels

Ct hydatid cyst , ask about (most appropriate initial mx )? Ceftriaxone, surgery, albendazole

albendazole

Q- female patient k/c Renal failure + DM+ HTN, complaining of chest pain and SOB Lab: potassium 6 , what expected ECG changes ? 1- peaked T wave 2- peaked P wave 3- short PR interval 4- narrow QRS

Pediatric age pt presented with his mom to ED she said that her child ingested large amount of paracetamol (i think) the pt was healthy no signs of any toxicity on presentation, they observed the pt for 4 hours with no any change in health no signs and symptoms of toxicity, the mom then mentioned that she found some of the drug was spilled on his clothes and in the floor, what is next? A. Reassure B. Watch for another 4 hours C. Give antidote IV D. Gastric lavage

8 years old boy previously healthy, Presented with fever, bruising and pain on both legs. On exam he is pale, has ecchymosis & petechiae all over his trunk, neck & face. His labs: HgB 67 (low) WBC 28 (very high) Plt 40 (low) What is the appropriate diagnostic test? A- Bone Marrow Biopsy B- Coagulation profile C- Liver US (or CT liver not sure) D- forgot i think some blood test maybe C3 levels not sure

Thyroid nodule with High levels of calcitonin Associated with which tumor -medullary -papillary -lymphoma

Baby sit briefly, crawl , move object from hand to hand , but can't do pincer grasp , age ? A. 4 month B. 6 month C. 7 month D. 9 month

Pregnant lady 26 weeks gestation presented with large genital wart how you gonna manage? A)Cryotherapy B)Thermal C)Intralesional immuno … injection D) podophyllin

3 year old came to clinic with lethargy and failure to thrive Hg 88 Mcv 65 Normal RBCs Reticulocyte 5 Mch low What is the most appropriate management : A. Blood transfusion B. Im iron C. Oral ferrous sulfate D. Fortified formela

Co-morbid patient was admitted for some reason, was on salbutamol, spironolactone, aspirin, statin and metformin. K level: 2.5. What medication causes this lab finding: A- salbutamol. B- spironolactone. C- statin. D- Aspirin.

A Salbutamol reduces serum potassium levels by increasing the shift of extracellular potassium into the intracelluar space.

pf after PE stared on heparin ..labs show prolong PT and PTTT 1-stop and give …?!(i forget the drug name but start with L!) 2-continue 3-switch to theraputic dose of enoxaprin 4- stop and !!!

Croup case ( dignosis is not written) in ER + barking cough + Fever so norepinephrine nebulizer was given and temporary improved , what to add ? 1. Bronchdilation 2. Antibiotic 3. Steroids 4. Antipyretic ( not sure + no repeat norepinephrine dose)

Pregnant at 13 weeks of gestation with history or spontaneous fetal loss at 20 week. What is the most appropriate action to do? A- Regular F/U without specific intervention B- Cervical cerclage now

Child came with a potentially toxic dose of paracetamol. The physician requests an “Acetaminophen level”. The lab technician calls to report results. He says: “two” stops and pauses and then says ”one, three”. The nurse mistakenly writes it as “2.13” while the real result was “213”. The patient went into irreversible liver damage, which of the following explain the error that has happened? A) Doctor did not check B) Lack of communication C) Technician didn't check if the nurse got the number correctly D) Mishandling from the nurse.

Which of the following is true regarding single umbilical artery? A) Associated with maternal diabetes B) Major malformation in 80% of cases C) Low fetal mortality D) Associated with african race

Baby born on 35th week of gestation . His mother bring him for vaccination. which of the following is true: A) give the vaccine at time as schedule B) delay his vaccination 2 month C) give the vaccine at time but half the dose

Female patient with unilateral nipple dryness, crust and oozing discharge..bilateral breast ultrasound and mammography are normal. what is the next step? A. Follow up US in 6 month. B. Prescribe steroid ointment. C. Nipple biopsy D. Referral to dermatology

Patient K/C of cirrhotic liver disease with severe hematemesis. He is drowsy and disoriented. There is blood coming out of his mouth. What do to next? A - Intubation B - Octerotide C - IV fluid D- Endoscopy

Case of pancreatic cyst for 5 Ws with collection was 18 cm x 24 cm how to manage? A- Percutaneous drainage B- Endoscopic drainage C- Surgical drainage

5 years old girl with history of recurrent vomiting. What is the next initial management: -Notmal Saline -Ringer Lactate -Potassium Chloride

Plt were low, PT&PTT&INR all normal, high bilirubin and reticulocytes and low Hb (indicates hemolysis), creatinine was normal, your management: A.Steroids and IVIG B. Exchanged transfusion C. Platelet transfusion D. I don’t remember

Our case is Most likely TTP

Managment is

1- supportive. ( Iv fluid if indicated, correct Acid base imbalance and

electrolyte ).

2- Pex ( Plasma exchange ) and steroid.

RBCs transfusion if Hb is less or equal to 7.

Platlets transfusion only for severe bleeding or going for invasive procedure.

70-year-old male K/C of HTN with progressive decline in cognitive state, MRI showed Periventricular white matter Hyperintensities, what is the diagnosis? A- Vascular dementia B- Alzheimer disease

25 weeks pregnent ,sero-ve for rubella , when take vaccicine? A- now B- postpartum C- no need D- 3d trimester

Patient in a coma for 5 days. Initial method for feeding A- Gastrostomy B- NGT C- Central something (There was no Jejunostomy in the choices)

4 months* old girl, during Pneumatic otoscope unilateral non-purulent effusion and decrease tympanic membrane motility , no fever pr other symptoms, and no hx of previous infectious diseases, breast feeding very well and no use of pacifier , What’s the best next step? - use amoxicillin tx - use of amoxicillin and clavulanate - Observe and F/U for 48hrs - Refer for ENT to evaluation for tympanostomy tube (للاسف الشديد هذا السؤال جاء نسخ لصق تكرر كثير بالاشهر الماضية وكنت اعتقد انه bad recall )

Female has headache, mastalgia, and behavioral changes 10 days before her periods, and she is asymptotic for the rest of the cycle. What is the Dx? A. premenstrual tension syndrome B. pelvic congestion syndrome

Healthy female with perianal discharge at 3 and 7 oclock ( no mass, no vitals ), what are you going to order? A- MRI B- Colonoscopy

Which of a following is a cause of precocious puberty? • A-Addison disease • B-Hyperthyroidism • C-Congenital adrenal hyperplasia • D-DM • E-Turner syndrome

Patient after bariatric surgery presented to you with fever and mild abdominal pain, on examination you found abd tenderness, HR: 116, BP: normal. What is the possible cause for this presentation: Dehydration Leak Inadequate analgesia

Case about child with UTI طبعاً بس معطيك الفايندينق ماقاله What makes you suspect UTI? A. fever. B. leukocyte C. nitrite

Pediatric patient with shigella treatment: A. Amoxicillin B. Azithromycin C. Ceftriaxone

May present with abrupt cognitive decline and stepwise deterioration Asymmetric or focal deficits (e.g., hemiparesis) CT/MRI: multiple cortical and lacunar infarcts, white matter lesions

vascular dementia

Female 37 y/o did papa smear before 3 years ago and result was normal Regarding pap smear when she can do it? Annual pap smaer Pap smear for 5 years 3 negative result then no need pap smear Reassure and no more screening

Pt have melena fatigue in history he have dental tooth extraction for which he using iboprofen on ex pale Labs🧪: hb 8 maroon stool colour, management ? A-Normal saline B-Somthing with crytalloid flood C-Blood transfusion

5 years old boy picky eater and aggressive behavior. Came from low socioeconomic status. The mother mentioned that both his siblings have the same symptoms. (I'm sure) Labs: Hb: low MCV:low Lead: high Ferritin: low ...(Other labs) What's the diagnosis: -IDA -Thalassemia minor "trait" -hediatert spherocytosis

Child with posterior urethral valve what is the preferable diagnostic test: VCUG Iv pylogram

12 year old with testicular pain for 2 days. Vertical testes, tender apex, with skin changes. Most likely diagnosis? A-Epididymo-orchitis, B-torsion of testicular appendix C- testicular torsion

Child with productive cough, fever with stony dullness and crepation What is the diagnosis? Pleural effusion Lung colapse Bronchopneumonia

Old, forgetting famous figures, friends names, wife worried about AD, everything else normal: AD Benign forgetfulness

Bowel obstruction case , due to adhesion after surgery and she devolped it many times before all treated conservative but now there is genrlized tenderness and rigidity with metabolic acedosis and increase lactate:- 1- laparotomy 2- bowel rest and hydration

30 years old male ve diarrhea since 10 months no blood in the stool and the loss of weight 10 kg lab shows that microcytic anemia and thrombocytosis What’s best management for him 1-PPI 2-Loperamide 3-free gluten diet 4-Omeprazole

Child present with periumblical pain nausea and vomiting in the morning related to school and separation anaxity 1 stop school fo 3 month 2 involve the child with peers activity 3 start citalopram 4 othe psycho med

Thoracic tube insertion after 15 min 2L blood A) thoractomy B) chest tube

Sore throat + enlarged lymph node vaccinated up to date, organism ? A- Streptococcus pyogens B- H. Influenza

Child had a Contact with a person with flu-like symptoms, they did strep swab and it was negative what will you do while waiting for culture:- 1- Po steroid 2- Amoxicillin 3- supportive 3- ceftrixone

Psycho: Pt brought by his wife saying he is too sad, 3 months ago he bought expensive car and said he is rich, tx? Lithium Olanzipine

Lab technician give a result to nurse through the phone, said 2 then pause after that proceed 3 5 and the nurse wrote 2.35 but the correct one is 235, the patient had irreversible liver damage by this mistake, Cause of this condition ? A- Doctor did not check B- Lack of communication C- Technician didn’t check if the nurse got the number correctly D- Mishandling from the nurse

A six year old girl presenting to the pediatric emergency department with unstable gait and progressive difficulty climbing the stairs over the last 10 days the parents reported that the child has been “choking on her own saliva” the symptoms began was prickly sensation in the fingers and toes that developed to ascending and symmetrical there is a history of viral gastroenteritis three weeks before physical examination confirms the absence of the knee-jerk reflex CSF analysis of weighted protein concentration with normal cell count, nerve conduction test reduced velocity which off the following is most appropriate treatment: A.plasma exchange B.IVIG C.MTX D.steroids

9 y/o pt his mom complaining about he is wetting his bed since one month. He used to be dry since 7 years. The urine is foul smelling His lab showing high wbs and turbid in colour and showed nitrate Diagnosis ? A- UTI B- normal for his age C- nocturnal enuresis

36 with le- neck mass, 2x2xm in posterior angle of mandible US: normal thyroid, le- large LN with cysTIc component FNA: all smear shows follicular thyroid A- Metastatic thyroid cancer B- Apparent thyroid C- Ectopic thyroid D- Thryoglossal cyst

Child his parents moved him to another school and now he has difficulty making friends: -Dysthymia -Adjusment disorder -Hypomania

Female c/o urine leakage with cough, sneezing, exercise and with urgency. What type of incontinence does she have? A. Urge incontinence B. Stress incontinence C. Mixed incontinence D. Overflow incontinence

Nisseria meningitidis precaution a- droplet b- contact c- airborne d- cannot remember, maybe no precaution

Long case of COPD patient with oxygen saturation 88% and PHTN is 50 What improve survival? A) Long term oxgen B)oral steroid C) over night pulse oximeter

35 year old male have sudden SOB and chest pain was shifted to ICU, diagnosed with Massive PE (no vitals were mentioned) what is the next initial step: Heparin infusion TpA

Young Patient with abnormal uterine bleeding, diagnosed fibroid , Hb 7 What is the next step? - blood transfusion - Myomectomy

barking cough that is so severe causing cyanosis and the patient feels exhausted in between coughs , Post tussive vomiting. Dx: A- Bortedella pertussis ✅ How to diagnos? Nasopharyngeal swab ✅

احفظ

Patient with symptoms of MI presented to the ER in tertiary hospital. What is the most appropriate management? (No time mentioned) A: PCI B: thrombolytics

Patient presented with neck swelling, she is completely asymptomatic, neck US was done reveal a solid mass of 7 mm with regular margins, which of the following is the most appropriate next step? A. FNA cytology B. Thyroid scintigraphy C. Check TSH

Patient had a sigmoid polyp removed. They found on histopathology well differentiated adenocarcinoma and the margins are free from cancer. No lymph node or extention to muscularis. What is the. best next step? -Observation -Segmoidectomy -Segmental colectomy -Fulguration of the polyp site

After resection of a pedunculated polyp the results was benign adenoma and patient has no family history of colon cancer what to advice for reduction of colon cancer? A- Prophylactic sigmoidoscopy B- Prophylactic colectomy C- Annual colonoscopy D- Life style modification (healthy diet and exercise)

stop him but he continued to ignore his mother. Which of the following would you advise this mother? A) Ignorance B) Counselling C) Positive reinforcement D) Punish the child

Patient with hypertension, heavy bleeding and anemia, what contraceptive she can use? A. Tube ligation B. IUCD mirena C. Condom D. OCP

Pt after mastectomy she has numbness in inner side of the arm, with nerve affected? a- Long thoracic nerve b- Intercostal brachial c- Medial pectoral d-Thoracodorsal

61 years old male patient came for routine check up, his Echo showed constrictive LV hypertrophy and severely stenotic aortic valve. His ejection fraction is Normal. ECG is unremarkable. He is symptomatic. What is the most appropriate next step ? A-ballon valvuplasty B-ace inhibitor C-AV replacement D-follow up in 6 months

Female presented to The clinic with velvety, hyperpigemented lesions over her neck and axilla, she gave history of 2 years of trying to conceive but failed despite regular sexual intercourse, her periods where irregular. Which of the following is the cause of her hyperpigmented lesion? A. Acanthosis nigricans. B. melasma C. lichen planus

Acanthozia nigricans

Pregnant with hx of recurrent uti, asthma on SABA, she is on labour, what is the drug that should be administered during labour and delivery? A- Bethamethasone B- Ampicllin Forget the rest..

Pt with back pain and groins his pain is severe that he cannot stay still and keep rolling, he has hematuria urine analysis has blood and epithelial cells " no other investigations” , whats the diagnosis? الله يسعد اللي كتبه - uretre stone - appendicitis - pancreatitis - cholecystitis

New drug is being studied for it's effecacy, which of the following is the the highest evedence study? A. Randomized controlled trials (RCT) B. Systematic review c. cohort

A 4-month-old uncircumcised boy. He has low-grade fever. Many negative symptoms. He looks well and changed diaper multiple times. Temp: 39.1 Urine analysis: High WBC. Positive nitirte. Posiitve leukocyte. What is the most appropriate management? A. Oral cephalexin. B. Oral azithromycin. C. IV ceftriaxone. D. IV cefuroxime.

A, YOU CHECKED IT TWICE, ITS CORRECT

38- Patient with chronic limb ischemia, presented with sudden leg pain, diminished popliteal and distal pulses in right leg, and diminished distal pulse with intact popliteal in the left, what's the appropriate next action? A. Heparin B. CT angio C. US D. conventional angio

Pediatric age 6 years old Case about lower GI Bleeding with blood seen coming from ileocecal valve during colonoscopy A. Angiodysplasia B. Crohns C. Meckle diverticulum

C Painless lower GI bleeding is the most common symptom of Meckle’s diverticulum. Another Q: Best diagnostic tool? Nuclear scan as Radioisotope scan

Patient with Hip Fracture underwent Hip fixation repair surgery. What anticoagulant to give to prevent DVT? A) Enoxaparin Subcutaneous (SC) 40 mg daily B)Heparin 1000 units BID

16 YO came to ER after vomiting once with blood , she had recurrent N/V before her period in the last time there was slight blood with vomiting , after 4-6 hours they mention also ,all labs and exams are normal what you should so? A- admit her for observation B- reassure and ask to come if it recur again C- prepare for urgent EGD D- Discharge

Chronic kidney disease picture of iron def anemia and and high ferritin what is the treatment ? A Oral iron B erythropoietin C IV iron

24y/o male presented after chemotherapy for the treatment of colorectal cancer what electrolytes abnormality would you suspect? A- hypokalemia B- hypocalcemia C- hyponatremia D- hypomagnesemia

Old pt have painless heamaturia whats is most appropriate investigation 1 cystoscopy 2 us 3 ct

Primigravid come with labor for 4h Dilated 5 cm, effaced 80%, station +1 after 5h there is no change in cervix, and contraction occur every 3 min. and stay for 60 sec. What to do? A. Instrument use B. C/S C. IV oxytocin D. Wait for 2h

woman with dyspareunia and spotting fresh blood after intercourse . She had a history of warts on vulva with cryotherapy done 2 yrs back what is the site of the bleeding? a. valva b. vagina c. cervix uterus d. body of uterus

YOUR FOCUS TEAM SAYS C

Pt with vesicles and maculopapular rash in the right chest, how to diagnose? A- Blood culture B- Skin biopsy C- Skin swab for culture D- No further tests required

جاني في نوڤمبر الكيس كانت واضحة انها shingles No further tests required unless there’s a neurological symptoms in which we use PCR to diagnose it. ماكان فيه Neurological Symptoms. الاجابة D.

Patient smokes 20 cigarettes and vital signs show BP 140/92 Which of the following is the most considerable risk factor for MI ? A) Hypertension B) Smoking C) Age

HIV patient presented with neurological manifestation and diagnosed with toxoplasmosis, most appropriate management? -pyrimethamine and sulfadiazine -Doxycycline and clindamycin -Ceftriaxon and azithromycin

diabetic patient with gout. Which of the following drugs aggravates his arthritis? A: Lasix B: Plavix C: Aspirin D: Metformin

A surgeon conducting a research regarding new procedures. But before submitting he edited the results so it shows higher success rates. What is this action called? -Fabrication -Falcification -Plagiarism -Ghost writing

35 yrs pregnant,smoker,Hx of diabetes in family, the most important risk factor for her pregnancy: Age Smoking Diabetes

Pediatric patient presented with generalized seizure, hypoglycemia, ketones in the urine with characteristic odor. What is the dx? A. Galactosemia. B. Phenylketonuria. C. Maple syrup urine disease. D-Fatty acid oxidation defect

17y female with uterine bleeding, recurrent every 6to8 w,examined all things are normal what is ur management 1-reassurance 2-OCP 3-hystrectomy

46 Y/O G3P1 at 34 weeks’ gestation presented to antenatal clinic for regular check-up, she has unremarkable medical hx and uncomplicated pregnancy Braxton Hicks and non-pruritic cervical discharge. Her pre-pregnancy weight was 54.4 on examination cervical length was 33 mm. VS were given & I believe they were normal. Current weight: 52 Rubella AB: -ve ( Normal range is positive ) HBsAg: -ve Blood type: O+ Which of the following is the most appropriate next step? A. F/U after 2 weeks B. OGGT test C. Do rubella Ab test D. Give anti-D Ab

Many studies were done to test the outcome of something(i forgot), but the sample size is small, so a study was done collecting these data for a larger sample size to analyze them A. Cohort B. Meta analysis C. Cross section

Warfarin was not stopped by patient despite of the clear instructions, the nurse in the OR noticed that the patient did not stop the drug as instructed and informed the surgeon, so the surgeon postponed the operation: A) Adverse event B) Medical negligence C) Near miss D) Principle of totality

Typical case of intussusception asking about next initial step: A-NPO B-NGT decompression C-Iv hydration D-Surgery

Couple having infertility request surrogacy 1- inform couple hospital doesn’t provide the services 2- give appointment after few weeks and read about topic 3- illegal in saudi arbia 4- referal

couples with infertility ask about surrogate pregnancy which not allowed in ur hospital and u are not sure wither allowed in saudi or not? A. Warn them might not be allowed in ksa. B. appointment to check yourself and then tell them. C. Referral to colleague who can help to do it.

39 years old female who has three children and completed her family diagnosed as endometrioma which was removed 2 years ago, right ovary cyst she presented to the clinic with mild to moderate dysmenorrhea and dyspareunia during intercourse and chronic lower abdominal pain. Pelvic ultrasound shows: Left ovary endometrioma cyst 6x7 in size. A. Removal of cyst more than 10 in size B. Aspiration of cyst content under ultrasound guidance C. Immediate hysterectomy and salpingectomy oophorectomy D. Removal of cyst by laparoscopic ablation of endometrioma spots.

Female had breast cancer and did surgery for it, now wants to get pregnant What is the minimum time after breast cancer surgery to wait before getting pregnant? A- 3m B- 6m C- 2 years D- 5 years

Uncircumcised boy has fever which of the following is the most significant factor for UTI diagnosis? -uncircumcised -fever 38 -male

Elderly woman with left hip fracture What to do to prevent DVT? enoxaprin Asprin

39 years old female who completed her family, presented with abdominal pain with irregular periods. She had a history of right endometriosis of the right ovary 2 years ago which was managed with right oophorectomy. Imaging now shows 3 × 4 left ovarian cyst. What is the most appropriate management for her case? -Laparoscopic cyst drainage -Left oophorectomy -Total hysterectomy with bilateral salpingectomy and left oophorectomy

Pt came 4 days after hernia repair, with mild swelling and tenderness in the wound, with no more Sx or labs DX? A- Seroma B- Hematoma C- recurrent D- Wound infection

664-10 Yo female presented with RUO.pain for one week. Associated with jaundice, vomiting and diarrhea, she has a recent Mx of eating from outside, She has no Hx of drug. Which of the following test wil contirm her infectin ? A. HAV IgM B. HAV IgG C. HBSAg D. HCV RNA

A-Confirmatory testing

↑ Anti-HAV IgM antibodies: present in patients with active infection
- Usually detectable 5–10 days after exposure and 5–10 days before clinical symptoms develop

A child with typical celiac disease symptoms (weight loss, abdominal bloating, flattening of buttocks) , what is the most appropriate step? A- anti endomysial antibody B- duedenal biopsy C- other irrelevant (No anti Tga antibody)

Patient has grandiose delusions and hallucinations, what does he have ? Neurosis Psychosis

A 25 year old primigravida at 36 weeks gestation presented with feeling fatigue and unwell. She shortly developed shortness of breath and died. XRAY showed Enlargement of the cardiac silhouette What is the likely cause of her presentation? A) Amniotic Fluid Embolism B) Peripartum Cardiomyopathy

Sign of Rh alloimmunization A-Low middle cerebral artery peak systolic velocity B-skin edema and ascites

Pregnant lady 35 weeks gestation Known case of Bicornute uterus in leopoid manouver you found globally soft structure in 1&2 grib Fetal heart in the level of the umbilicus of the mother Fetal kicking felt in lower abdomen How you will deliver this baby? A) CS B) Normal vaginal C) Ventose D) Forceps

Carcinoid ulcer photo

JPG

Pregnant women in her 14 W , DM, HTN came to clinic ( no complain she’s coming for follow up) what to do Start folate Refer to dietitian Review her medication Don’t remember

Long scenario of elderly female that has back and she is stooping and bending her back while she walks to relieve the pain. What is the diagnosis? A- Lumbar spine stenosis ✅ B- Degenerative Lumbar spine

Pregnant female GA22, presented with bleeding, on examination there was soft dilated cervix, U/S showed normal fetal heart rate. Which of the following is the diagnosis? A. Threatened abortion B. Incomplete abortion C. Cervical incompetence

Young , obese , hirsiutim with irregular cycles next step ? A- Life style modification B- metformen

Famale have irregular periods diagnosed with PCOS what is the most sensitive test? A- testeron B-ACTH C-sex hormone binding globulin D-17-hydroxyprogsteron

Calculate the cerberal perfusion pressure of intercerinal of 15 and mean pressure of 65: -40 -50 -60 -70

COPD indication for oxygen therapy 2 reading of <7.3 ✅

Stage 3 renal disease, which of the following can be prescribe? A-nitrofuronation B-metformin C-lithium D-Warfarin

D, all other drugs are contraindicated in CKD

71 yo male came to clinic with 2 years’ history of slow progressive memory loss. Patient is able to perform activity of daily living such as dressing himself. He was kind but previous 3 months he was agitated and aggressive. The neurological and cardiovascular examinations were not done yet. What is the likely diagnosis for this presentation? A- Lewy Body dementia. B- Alzheimer’s disease. C- Multi-infarcts dementia.

Patient in labor, received MgSo4 and Epidural anesthesia. Fetus at -1 station. CTG picture showed minimal variation. What is the cause? A. MgSo4 B. Epidural C. Fetal head station

bleeding with and after defecation associated with discomfort and itching :- 1- anal fissure 2- hemorrhoid

Young Patient presented with migratory polyarthritis and subcutaneous nodules. What will confirm the diagnosis? A- High ESR B- High CRP C- blood culture D- ASO titer antistripsin

10 days, lethargic, with absent femoral pulse Dx Ballon Prostaglandin Ventricular septem.. Surgery

Pregnant 20 weeks with with two previous histories of preterm labor. Her current pregnancy is uneventful and her cervix is closed, cervical length is 30 mm and Positive fibronectin.

What will you do?

Immediate cerclage

Progesterone supplement

Patient came with vaginal discharge she have done CS with episiotomy 10 days ago , the obstetrician diagnosed her with UTI and described Abx , but she did not improve then she went to another obstetrician and he found infected vaginal swab , What is the medical error done by the first obstetrician? A. let the midwife assist him and depend on her B. doctor failed to follow the surgical safety protocol in the OR C. No communication between the 1st and 2nd obstetrician D. Genuine different assessment or diagnosis of patient case

Female underwent gyne surgery, massive bleeding occurred intraop and the doctor and his colleague decided she needs emergency hysterectomy to save her life What to do? A. Get consent from husband B. Do it without consent C. Ethical committee consent

RTA, GCS 8, decrease rt side air entry, intubated cervical emphysema, penumomediastinum, pneumothorax What is the Diagnosis Open or tension pneumothorax Tracheobroncial injury

Tracheobroncial injury

Marfan features what investigation to do to rule out life threatening complications Echo Eeg Ecg

Pt after fell down from hight present with open fracture and dirty , what the most appropriate next step in the management ? A- oral antibiotic B- open fixation C- surgical debridement D- external fixation

Answer is C. Remember the Management of Open fracture very well and also in sequence: 1- ATLS protocol and control the bleeding. 2- IV Antibiotics and Tetanus Toxoid. 3- Closed reduction and immobilization by a cast or splint. 4- ER Irrigation, Debridement and external fixation. Once the infection controlled and patient stabilized you can now go for OR to do: 5- Definitive Management by Open Reduction and Internal Fixation ( ORIF ) by IM nail or screws. This sequence is Very important. Whichever comes in the choices first choose it. Oral Antibiotics is not recommended it should be given Peripherally by IV line.

60 years old male patient k/c of hemorrhagic stroke 2 years ago presented to ER with crushing chest pain for 2 hours. ECG: ST elevation in lead Il, lead Ill, aVF. What is the most appropriate management? A. Aspirin B. PCI C. Unfractionated heparin D. thrombolytics

year-old women medically free with no personal or family history of cancer. Asking about when to to start colon cancer screening? A- no need for screening for her case B- Start now and every 5 years C- Start at 50 years with annual colonoscopy D- Strat at 50 with annual Fecal occult blood

D Recommended colon cancer screening tests for average risk patients: 1- Colonoscopy every 10 years 2- flexible Sigmoidoscopy, Air contrast barium enema every 5 years 3- Annual Fecal Occult blood Test ( FOBT ).

5 years old with stab wound in lower chest, has abdominal distension Fast shows free fluid in abdomen All vitals normal except O2 90 What is the most appropriate management: Thoracotomy Tube thoracostomy Expl lapratomy Angioembolization

c, badran says so shut up

7 years old girl with pubic hair and no other manifestation of puberty - normal - early puberty

Female presented complaining of low mood, feeling of worthlessness and other manifestations of depression. Which reuptake inhibitor should be prescribed? A. DOPA B. GABA C. Serotonin D. Acetylcholine

9-month Hx of MI came to clinic for smoking cessation he was in respiratory distress raised JVP nicotine tear in his hand what is the most appropriate drug? - A. Nicotine replacement therapy - B. Varenicline - C. Bupropion

B: 1- Most important initial step in smoking cessation is Motivational support to the patient. 2- Most effective drug is Varenicline and it’s also Safe in Cardiac Patients 3- If written in the Q ( Hospitalized patient ) Best option is Nicotine replacement therapy.

old man post op (i think colectomy) day 6, he has all the signs and symptoms of PE including sudden shortness of breath, hemoptysis, and others. ABG: results provided was showing respiratory alkalosis ECG: Right bundle branch block CXR: Slight atelactasis in the lower part of the left lung (not sure if it was right or left lung) What will you do? A- Echocardiogram B- CT angiogram

Man driving and hit his chest to the dash when stopped to avoid accident now he has a wide mediastinum:- 1- aortic rupture 2- pneumothorax 3- hemothorax

Case of wilson disease typically : A_ penicillamine B_ deferoxamine

COPD acute exacerbation. Quick drug to administer? A- Salmeterol B- Albuterol C- Ipratrobium D- Inhaled corticosteroid

Child with vesicles on trunk and back - Varicella - HSV

A case of Pancreatitis 5 weeks ago. Now she has epigastric tenderness and cannot tolerate food with vomiting each time. By ultrasound, you found large about 12X10 mass with thick wall and fluid inside which is heterogenous and non-liquefied. Labs: 346 amylase, Wbc 15k. What is the diagnosis? A. Pancreatic Pseudocyst B. Pancreatic Abscess C. Walled off pancreatic necrosis

C LESS THAN 4 WEEKS IF HETEROGENOUS ITS ACUTE NECROTIC COLLECTION, IF HOMOGENOUS ITS PERIPNCREATIC COLLECTION. IF MORE THAN 4 WEEKS HETEROGENOUS ITS WALLED OFF NECROSIS IF HOMOGENOUS ITS PSEUDOCYST

Deep inhury to calf muscles whuch nerve 1- tibial 2- siatic 3- common fibular

Pic of abrupto placenta with deceleration wants the mangment? CS

Patient presented to clinic with dry cough and exertional SOB after exercise, did spirometry and was normal, what to do? A- Repeat spirometry B- Methacholine challenge test FEV1 decrease to more than 20% C- Arterial blood gases D- Peak expiratory flow

Uncontrolled asthma patient present to the ER with asthma exacerbation, his last many reading of PEF was <450. Which of the following indicates severe asthma exacerbation? A-Respiratory rate >25 B-PEF <350 C-Heart rate > 100 bpm

45 years old female with retrosternal chest pain, dysphasia to liquids more the solids. What is best diagnostic method ? A-barium swallow B-oesophageal sphincter manometry C-endoscopy

11 month old boy presented due to massive amount of urine volume, and sever thirst. There were 3 episodes of dehydration NOT related to vomitting and diarrhea. Boys in his family have similar complain and symptoms. What is the most likely diagnosis? 1- Diabetes mellitus 2- Diabetes insipidus 3- Water intoxication 4- Nephrotic syndrome

pregnant women diagnosed with cardiomyopathy complains of mild symptoms that are not limiting her daily activity whats her NYHA class? 1 2 3 4

viral csf management

STOP EMPIRIC ABX AND GO SUPPORTIVE

Female patient with jaundice and pruritus and elevated AST and ALT, liver biopsy shows interphase hepatitis. What is the treatment ? -prednisone -Ursideoxycolic acid.

What is the age in month of child talk 6-10 words, know 2 body parts, immature pencil grasp? A-17 B-19 C-12 D-24

Answer is B. This Question came in my Nov. exam. The scenario was ( Points ) to 2 body parts not ( Know ) and another milestone of a 18m but I can’t recall.

Obese woman with infertility lab results within normal range except prolactin was 2000 A- IVF B- IUI C- bromocriptine D- clomid

Mother Para 1, Her child has sickle cell disease, she divorced and married again Came asking for counseling. - Multiple marker screening - Parental chromosomal study - Parental electrophoresis ✅ - Maternal electrophoresis

A patient with Anterior chest trauma with bruising in the sternum. Patient vitally stable, clear cardiac and respiratory exam, except for pounding pulse. ECG: Arrhythmia X-ray: Sternal Fracture. Echo: Normal What is the diagnosis: A. Pneumothorax B. Cardiac contusion C. Cardiac Tamponade D. Ventricular rupture

B: Arrhythmia on ECG and Sternal fracture Plus Non-complete Beck’s triad Makes the answer more with Cardiac contusion Triad JVP Muffled heart sound Hypotension

Pt in his 60’s came with flank pain and hematuria, tender mass in lumber region his vital BP= 160/90 What’s the most diagnostic investigation ? A-US B-CT abdomen ✅ C-MRI D-Radionuclides

case of interstitial pneumonitis most commonly associated with? A-Viral pneumonia B- Lobar pneumonia C- Bronchopneumonia D-Secondary tuberculosis

child with pica,pale,low socioeconomic state,low-haemoglobin,hand lead was 2 , iron profile was normal, x-ray report dense metaphyseal bands , what is the treatment? A. vit-K B. D-penicillamine C. Iron

36 Years old female came with sudden pain for 12 in right iliac fossa and periumbilical , there’s tenderness over right iliac fossa and suprapubic no rebound tenderness. In the lab there’s High WBCs what you will do? A. Transvaginal US. B. CT abdomen C. emergent appendectomy

Patient knowing for DM And HTN and history of right leg pain increased by exertion, on examination absent popliteal pulse on right leg Which one of the following indicates acute limb ischemia: A-intermittent claudication B-rest pain C-scar for iliofemoral bypass in left leg D-swelling

Patient with lung cancer and has SVC syndrome, what is the type ? -small cell lung cancer -squamous cell carcinoma

4 days Post op pt of AAA with low BP despite 2L NS. BP still low. (-/40). HR normal. Periphery warm. Type of shock ? - no other parameters are given- A. Hemorrhagic B. Septic C. Anaphylactic D. Neurogenic

8 years old girl presented with shortness of the breath , exercise intolerance and weight (not mention increase or decrease!!) Vital sign RR 40 HR 160 ECG OR ECH: normal (Question exactly like this no more info!!!) What’s the best test? -CBC -VBG -electrolytes -TFT

9 year old girle came with bloody diarrhoea dx as shigea what is antibiotic of choice: A. Azithromycin B. Ceftrixon C. Metronidazol

Young pt k/c of myeloid leukemia c/o fever for 1 Days PE unremarkable urine analysis normal blood culture and stool still pending, Vitaly stable Fever: 38.8 All lap within normal except Wbc: (1) Plt: (20 ) sure No other findings, What is the most appropriate management? A-Iv antibiotics B-Close observation C-iv antibiotic and viral agent D-Oral antibiotic and antifungal

A First Scenario is missing important info which is WBC is 1 ( Low ) that makes the scenario is about ( Neutropenic fever ). Neutropenic fever is managed by IV Antibiotics usually Meropenem and septic workup which is culture from every possible site of infection like, blood, urine, sputum, Csf.

Patient on NSAID developed perforated ulcer and repaired, after the repair he became agitated (he was hypoxic hypercapnic ) management? A- start him on 100 O2 B- Intubate and hyperventilate

Patient with sjogren syndrome which type of RTA: + Labs: Shows low K Normal Na A. RTA| B. RTAII C. RTA II D. RTA IV

Patient was sympathetic + old she did Pap smear and it shows invasive lesion. Best diagnostic value? - colposcopy - biopsy

If Next step > A

Best diagnostic > B

Baby term delivery (didn't specify CS or SVD). 4 hours later complaining from SOB , Tachypnea, Tachycardia with grunting A- Hyaline membrane disease preterm B- pulmonary "something". C- Meconium Aspiration syndrome D-Transient Tachypnea of the New born ✅

Pregnant 28 weeks came with bilateral breast mass it was movable and the size was3x4 cm, most appropriate next step? A-reassurance and follow up after delivery B- bilateral breast ultrasound C-Bilateral breast mammogram D-MRI

B, pregnancy doesn’t mean we don’t image the breast mass

Hyperthyroidism pt had 2 nodules, One is hot the other is cold. Most importantly immediate management! A- Antithytoid med B- Radioactive ablation C- lobectomy D- Total thyrodectomy

Anal pain and discharg, no visible mass or bulge, upon DRE there was palpable mass inside, which of the following is the most likely diagnosis? A) perianal fistula B) inter-sphincteric abscess

patient has appendicular abscess large 10*15 reaching the right flank there is also fecalith on the US what should u do A. Laparoscopic appendectomy B. Open appendectomy C. Percutanous drainage

Patient involved in motor vehicle accident. When paramedics first arrived, patient was oriented to time and place, GCS was 15. Soon after, patient lost consciousness. At the hospital, head x-ray showed temporal fracture. What the diagnosis? A. Subdural B. Epidural C. Basal fracture D. AV malformation rupture

9 m/o with eczema and has positive family history for eczema what is the most common site: A: upper back B: dorsalis of foot C: scalp, checks and forhead

Child with rash with cervical and occipital lymphadenopathy? Rubella Measles

28 years old patient with a family history of diabetes came for checkup. labs: Fasting blood glucose: 7.4 HbA1c: 6.3 what are you going to do? ⁃ repeat A1c in 6 weeks ⁃ repeat fasting ⁃ reassure ⁃ 75 OGTT

Elderly 70 years old with chest pain for 2 hours given aspirin, clopidogrel, Showing ECG: St elevation in leads V1-V5 A. Posterior mi ECG B. LBBB C. RBBB D. Ventricle tachycardia

husband has 2 siblings with SCD the wife not mentioned , what is the likelihood of affecting his children to be diagnosed with SCD? A. Very high B. Not at risk C. Low risk if mother negative ✅ D. Advice not to have children

46 yo female known to have varicose veins for 6 years presented with bilateral leg swelling and pain after prolonged standing No hx of claudication After examination there’s various veins in the great sephonus vein territory What is the investigation of choice: A. CT venography B. Venous duplex C. venous plethysmography D. No investigation required

Female Patient on icu urosepsis and septic shock, did not respond to ressisatuve mesures, he was started on norepinephrine but no response. Check labs below Right atrial pressure: Normal PCWP: Slightly high CO: Normal SVR: Normal What is the cause of her deterioration A-Adult respiratory distress syndrome B-Volume overload C-Cardiogenic edema

Pregnant lady came for check up at 20 weeks gestation High hba1c baby at risk of? Congenital malformations Chromosomal abnormality

patient with palpitation HR 265 ecg done show narow complex tachy cardia (no pic)? atrial fibrillation atrial fluter super ventricular tachy cardia ventricular tachycardia

Pregnant 9 weeks come with sever bleeding she says that there was gush of fluid and part on examination os is open and tissue is seen (incomplete abortion)what's most appropriate step? A-Expectant B-D&C

Neonate found to have ambiguous genitalia with high 17-Hydroxyprogesterone, where is the deficiency? A. 17-hydroxylase deficiency B. 21-hydroxylase deficiency C. 11-hydroxylase deficiency

Seasonal allergy, tearing eye, red, rhinitis, take anti histamine as needed, what do you want to add w saba: Daily oral anti histamine Laba and ics Ics

Pregnant 14 weeks GA, came to the clinic for booking she Is Diabetic and HTNsive, what would you do? Review medication Give Folic acid

Rectal . Bleeding, colonscopy revealed 1.3 adenoma,, Excition done revealed Tubular complete Excition.. Colonscopy follow up 3-6 3 years 5 years 10 years

A patient presents with a knife injury to the hand. On examination, the laceration reached the tendon and nerve. How will you repair this injury? A- Primary repair to injury structures B- Debridement with primary closure C- Debridement with secondary intention D- Debridement with Vacuum assisted closure (VAC

55 years old male, presented with exertional dyspnea and syncope, on examination he was found to have systolic ejection murmur that radiates to the carotids, on ECG there is left ventricular hypertophy. How would you manage this patient? A- antihypertensives with tight BP control B- refer for surgical correction C- give vasodilator D- give diuretic

when does stepping reflex disappear? 2 m 4 m 6 m 2 weeks

A patient with epigastric pain admitted to hospital, U/S shows gallstones with dilated CBD. Now he is stable and labs are normal except high amylase 250. What is the appropriate next step? A. ERCP B. CT abdomen C. cholecystectomy now D. cholecystectomy after 6 months

Long case of IBD, investigation show non continous lesion? A.crohns ✅ B.ulserative C.h.pylorai

Patient with rash on cheeks and white spots on inside cheek - mumps, measles

patient female elderly with symptoms of Orthopnea SOB PND, JVP, Bilateral basal crackles. S3. what is the diagnosis A- Pulmonary edema B- MI C- Mitral regurgitation D- Right sided heart failure

C badran says so

Newborn/infant with stridor worse when prone improves when supine, mother is concerned, what todo? A Start laser treatment B tell her it will resolve on its own by first birthday C Tell her it will get worse D-Do Laryngoscope

A 73 year old woman is brought to ER after a fall at home. She is diagnosed with left hip fracture (see lab results) Weight 82 kg Sodium 136 (normal) Potassium 4.2 (normal) Creatinine 68 (normal) What is the best order by the admitting orthopedic surgeon to prevent deep vein thrombosis? A. Aspirin 81 mg PO daily B. Enoxaparin 40 mg SC daily ✅ C. Fondaparinux 10 mg SC daily D. Heparin sulfate 10,000 units IV BID

Pregnant complain of recurrent stillbirth and positive pregnancy test which vaccine can give her! A- Rubella B- Influenza C- Measles D- Varicella

50-year old heavy smoker presented to the clinic for a regular checkup. He showed no interest in quitting smoking at all. Which of the following is the most appropriate action? A) Offer smoking cessation classes B) Nicotine replacement therapy C) Set a deadline to quit smoking D) Offer personalized advice Answer: D,

low CO and elevated CWP type of shock ? Cardiogenic, hypovolemic

Child with absent red reflex 1- mri brain 2- reassurance 3- eye examination under sedation

Patient with barking , flared nostrils, muscle retraction. etc. initial treatment? A. Fluid resuscitation 2. Epinephrine + steroid

Most imp in hx taking with pt complains of dysmenorrhea? Medical Surgical Family Menstural

CTG w/ prrolongrd decelation. Most appropriate to do? A) emergency CS B) hydration, reposition and assess in 20 mints

baby with noisy breathing and wheezing that improves when prone and increases when supine. What is the diagnosis? A. Laryngomalacia B. Tracheomalacia

51 yrs old women with symptoms and signs of meningitis Lab low glucose high ptn High wbcs بس ماحدد مين البري دومننت What’s the cuause ? Listera Strept pneumonia

30 weeks gestamon , she has lower abdominal pain with no bleeding or leaking if we suspect preterm labor , which of the following will confirm preterm labor ? A- History will be enough to confirm preterm labor B- Presence of contracaons C- SERIAL Pelvic examinaaon D- cervix length measurement

Asymptomatic (no constipation no urinate problems) pt with utrine prolapse grade discovered incidentally ttt? Observe Repair

41 weeks pregnant given pethidine and Phenagran. Cervix is dilated 9 cm. Meconium stained liquor is draining. CTG shown in the Picture: ( Not the same Pic but it was Prolonged Late deceleration ). Which of the following is the most appropriate next step in management? A- Give naloxone B- Watch and reassess after 30 mins C- change mothers position D- Increase oxytocin infusion.

Answer is C. This is non-reassuring CTG which requires uterofetal resuscitation measures the first one is to change the mother’s position.

Patient RTA with spine injury back pain , finding on examination : spine injury can not be ruled out , nurosurgary consultation done and waiting for them Question about most imports until the patient is fully assed ? 1- urgent full spine CT 2- maintain full spine immobilization

You are doing a thoracosentesis for a patient, at which level in mid axillary line you will place the needle? A- At 4th intercostal space B- At 5th intercostal space C- Between 6th and 7th intercostal space D- Between 8th and 10th intercostal space

28 year old female have neuropsychiatric SLE asking about the appropriate treatment: High dose steroid +cyclophosphamide High dose steroid + mycophonolate

High velocity trauma, pt hypotensive despite giving IV fluids. X-ray showed open book fracture. What is the most appropriate next step? A. Pelvic binder

RTA pt with maltipule mandbular fracutere with severe bleeding, uncontious, no vitales menstioned How would you mange his Airway? A. Laryngial mask B. Orotracheal C. nasotracheal D.Cricothyrotomy

Q-parkland formale 70kg with both lowerlimb burrn how to calcute? الخيارات كانت Ringer lactate 200ml/24 Normal saline 116/24houre Ringer lacte 5ml/6hours ,6ml/16h Ringer lactate 6ml/6h,5ml/16h

C, (70*36*4)/2= 5040ml 5040/2= 2520 ml ——1st 8 hours 2520/8= 315 ml/ hour 315/60 min/hour = 5.25ml/minute

Hypothyroidism clear Hx and labs with low Na (it was 129) normal 134 What to do next ? 1. Levothyroxine 2. treat the hyponatremia with hyper Na fluid

Pregnant with SC trait.complication ? -IUGR -UTI

UTI, the complications of SC trait isnt confirmed yet.

Elderly healthy medically free came for vaccines ? A. pneumococcal B. Meningococcal C. MMR

Neonatal jaundice, blood film was attached,,, i think i saw Bite cell What is test you will order to confirm?! Osmlarity fragility test G6PD..

G6PD enzyme analysis

Pt had RTA in er, only has a bruises in lower abdomen and abdominal pain, what is the most appropriate nest step ? Bp : 110/80 Temperature : 37.2 HR : 88 RR : 19 A. CT B. Fast C. Initial assessment and resuscitation D. Exploratory laboratory

lady mised period which most appropriate time of us A-11-13 weeks B-16 - 18 weeks C-18 - 22 weeks

Patient presented to you with goiter and signs of hyperthyroidism and TFT was like this: TSH: LOW, T4,3: High, thyroid antibodies are negative, what is the most probable cause: Primary TSH secreting adenoma Graves disease Multinodular goiter

C because antibodies are negative

Pt with systemic sclerosis ..comes with fatigue and dizziness Bp188/90 Renal impairment. What medications to add? A.Lisinopril B.Amilodipin C. BB

Old, post meno bleed, had 5cm fibroid in the past now having the same findings on us no chanege, what next? Observe Hystrectomy✅ Myomectomy Endometrial biopsy

Pt pain less defication, Blood in th stool. Biles reduced spontanius in 3 areas 3.7...._ Hb very low, Dx hemmorriid was given which of the following is Definitive management ? A. conservative manag B. fiber diet C. rubber band ligation D. hemorroidectomv

pregnant woman presented with massive vaginal bleeding from the abruption placenta and her Hgb: 8.6, BP 84\40, HR140. What is the best management to save her life? A- Admit to ICU B- Immediate Transfusion of 2 packs FF C- Call multidisciplinary and rapid response team (RRT)..✅

Hyperkalemia 6.5 in CKD patient, Most appropriate next step? (They put a pic of an ECG) A. Calcium gluconate B.insulin and salbutamol C. Dialysis

Patient presented with exercise intolerance and fatigue she was diagnosed with celiac disease 7 years ago, however she’s not complaint to gluten free diet. She started to take oral iron supplements 12 weeks ago after she was diagnosed with iron deficiency anemia. On examination the patient looks very thin, she have pale conjuctiva and nail beds and systolic murmur 2/6. Lab results iron low, ferritin low. How would manage this patient A- continue the same medications B- give oral iron on liquid preparations C- give IV iron preparations D- give oral iron tablets 3 times per day

Hx of asthma in labor with pph doctor did massage but didnt help she stil in bleeding Which of the following contraindications is the most appropite managment to her at this stage ? A- oxytocin B-misoprstol C-methylergonovine D- Carboprost

Case scenario about asthmatic child with resp distress with ABG before&after ttt The ph was 7.6 then become 7.3 I can't remember other reading what's ur management 1-intubate in ER 2_refer to PICU

patient with mitral stenosis what is the targete international normalized ratio? <1 1-1.5 2-3 >3

baby with drooling, aspiration after feeding , Coild NG tube in esophageal pouch: A- Hiatus hernia B- another answer but no esophageal atresia C- Tracheoesophageal fistula D- Choanal atresia

8 year old female with Heliotrope Rash and Nodules in Phalanges. Diagnosis? A) Juvenile Dermatomyositis ✅ B) Oligoarthritic JIA C) Systemic JIA

Old age pt with cardiomegaly. he's asymptomatic Echo showed: EF 40%. what is the best Mx A- digoxin B- Lisinopril ✅ C- echo after 6 months D- frusemide

Coca cola urine + rash + had congestion throat and lymphadenopathy (didn't specify the duration) Vitals (fever 38, Tachy) Likely dx? IgA nephropathy Acute glumornephritis Acute cholecystitis Not remembered

Couple came to the infertility clinic. Semen analysis was normal, cervical exam not done yet. The wife has regular menstrual cycles every 36-40 days. Investigations show monophasic basal temperature. What is the cause of infertility? A. Coital B. Vaginal C. PID D. Anovulatory

Child diagnosed of epelipsy on medication, what is true regarding his vaccincation? A- Give all. B- Don’t give live vaccincation. C- Hold Dtap.

39 year old female complaints of heartburn and regurgitations for 6 months burning is primary after eating and occasionally has chest pain, not associated with weight loss or lifestyle changes. the patient mentioned that she eats dinner 2 hours before going to bed and complains of heartburn primarily at night.. She's taking omeprazole 20 mg per day did endoscopy . She had distal esophagitis. her BMI is 28 What is the appropriate next step? A. add antacids twice per day B. ranitidine before bed C. advice weight loss D. refer for nissen fundoplicati

2 yr old child presented with facial swelling, sacral edema and labs shows hypo albumin + high cholesterol (protein uria not mentioned !) what ur diagnoses ? A-nephrotic synd B-protein malnutrition D and c are irrelvant

Male dr wants to examine a female patient and he asked the nurse to come with him what did the doctor practice ? A- privacy B- justice C- Nonmaleficence

A case with right leg embolism where you suspect it source: 1- right atrium 2- right ventricle 3-abdominal aorta

left atrium or ventricle. Right will go to heart

Pt after embryo transplant by 4 wks present with abdominal pain , what is the most likely cause ? Ectopic pregnancy

55 years old male, presented with exertional dyspnea and syncope, on examination he was found to have systolic ejection murmur that radiates to the carotids, on ECG there is left ventricular hypertophy. How would you manage this patient ? A- antihypertensives with tight BP control B- refer for surgical correction C- give vasodilator D- give diuretic

There was a case about elderly diabetic pt with 2 day history of abdominal pain , bloody diarrhea imaging was done showed thickning of descending and sigmoid colon with thumb appearance , what is the dx? A- uc B-crohn disease C-ischemic colitis D-acute diverticulitis

head trauma and coma for 5days best early way for feeding A. NGT B. central nutrition C. parental nutrition D. Gastrostomy

Brest lump solid irregular family history of cancer ? A) core needle biopsy B) FNA C) bilateral US

Patient known case of ITP who is currently pregnant. After the delivery she developed Postpartum hemorrhage. What to give the patient? A. Cryoceptate B. Fresh frozen plasma C. Packed RBCs

Another recall: Pregnant with recurrent UTI what to do? A- X ray B- US C- ureteroscopy D- cystoscopy and RET's

Case for sudden pain in the left leg associated with reduce sensation and color change? A-US B- Ct angio C- conventional radio ✅

b??

A female get high energy accident (high velocity), with seat belt sign, on X ray have chance fracture. What will associated with this fracture? A- Duodenal perforation B- Gastric perforation C- Jejunum perforation D- Vena cava perforation

A 55 years old male Known case of chronic peptic ulcer. Came with multiple vomiting attacks. On imaging there is a mass from ulcer obstructing gastric outlet. On Examination the Patient is Dehydrated. Which of the following is most common manifestation? A- High urinary K B- Hypokalemia C- Respiratory alkalosis C- Metabolic acidosis

B wrote this Question from my September exam. Answer is Hypokalemia. Gastric Outlet Obstruction can result in Hypokalemia, Hypochoremia, Metabolic alkalosis. Ref: UTD.

38 years old man presented with severe epigastric pain that worse with food, relived slightly by antacid Hg 12 Urea 8.4 Platelet 450 The rest unremarkable What is the most appropriate to establish diagnosis: A. Upper gi endoscopy B. H pylori antibody C. Ct abdominal D. Not sure ( barium )

45 years old female presented 1 week post operation of cholecystectomy with abdominal pain and mild jaundice. Labs: LVT: slightly elevated WBCs: high US: CBD: 9 mm What is the cause? -Something space bile leakage (not sure) -Intra-hepatic bile leakage (not sure) -Slipped clip of CBD

Which of the following indicate acute sever asthma ? A- ox less than 90 B- HR more than 100 C- pEF <200 ml D- can’t complete sentences in one breath (exactly like this)

Patient underwent left lower parathyroidectomy for primary hyperparathyroidism (adenoma). He presented 4 months later with depressed mood and fatigability. Both parathyroid hormone and calcium were high, what is the most common cause? A. Parathyroid hyperplasia B. Missed adenoma C. New adenoma D. Parathyroid cancer

Women came with severe abdominal pain radiating to the shoulder with abdominal tenderness. What is the best management? Pelvic MRI CT abdomen ✅ Liver function test

3m old, sneezing and runny nose, his bro had same symptoms: Rcv Influenza Para influenza

A doctor is ordering 75 OGT for a pregnant patient. Why did he order it? A- History of GDM In previous pregnancy B- age 25

1003- Calculate child pugh score: Albumin 30, INR 1.9, Bilirubin 30, Confused 1 week, Ascites A-Child A B-Child B C-Child C

Infant 8 month old with recurrent chest infection with Hx of vomiting.. And upon examination Dr so infant with arched back Asking about the most common cause? Obesity Prematurity Aspiration Forget

its gerd

55yo, dm controlled, 20 min loss of vision, normal vital: Ms Tia

tia

What anti diabetic medication can reduce mortality in DM patients A. Metformin B. Gliflozin C. Glipizide D. Acarbose

A 53 year old Male, known to have schizophrenia on medication, presented to ER with recurrent abdominal distention and constipation. Was normal on examination and vitally stable. Abdominal Xray: dilated colon lumen 10cm CT: No obstruction Best management? a-Decompression colonoscopy with rectal tube. b-emergency colectomy. c-Lt side colostomy. d-lower barium enema.

48 yo lady with diffuse goiter, high T4 low TSH, US show bilateral thyroid nodules , right 3x4 in size , left is 1x2 size what to do? A. FNA both B. FNA the larger one C. total thyroidectomy

Elderly 70 years old with chest pain for 2 hours given aspirin, clopidogrel .... Showing ECG: St elevation in leads V1-V5 A. Posterior mi ECG B. LBBB C. RBBB] D. Ventricle tachycardia

Inform infectious authorities with which infection? Mono Chlamydia Pneumonia Bac vaginosis

b, repeated

Female with vaginal discharge Grey, fishy odor , smear : show clue cells, diagnosis? A. Trichomoniasis B. Bacterial vaginosis C. Candida

pt with clamidia.tretment? Azithromicine penicillin amoxicillin

Another recall: 33yo male with painless swelling in the posterior triangle of his neck. On US thyroid is normal and the swelling has cystic component. FNA shows complete follicular cells. What is the most likely diagnosis? A. Apparent thyroid B. Metastatic cancer C. Ectopic thyroid D. Thyroglossal cyst

smell & positive ketone Diagnosis? A. Phenylketonuria B. maple syrup urine disease✅ C. Galactosemia

Child got pertussis infection, has two siblings 3 and 5 yrs, both up to date in vaccination: A: Give them both booster vaccine B: Chemo prophylaxis by Macrolide C: Give booster only if high risk D: close observation for signs and symptoms of infection

Took 3 doses of HB and never infected of HBV, what will his hepatitis b serology show? HBsAb, HBsAg

Typical case on nephrotic syndrome, ask about highly diagnostic test ( no renal biopsy ) A. Serum albumin B. US C. Urine total protein D. Electrolytes

patient on ibuprofen for RA now has severe epigastric pain erect xray show air under diphgram treatment? laprotomy or laproscopy (can't remember)

Patient after SVD found placenta failed to deliver and cannot extract. The patient refused hysterectomy. It was managed by ligating the placenta and started on Methotrexate therapy, whats the complication of this case? a. Bleeding b. Infection c. DIC

pt with maltipule mandpular fracuter with sever bleeding, uncontious, no vitales menstioned How would you mange his Airway? A. Laryngial mask B. Orotracheal C. nasotracheal D.Cricothyrotomy✅

Male, Smoker, diffuse wheezing, normal chest x-ray, what is the diagnosis? A- Pulmonary fibrosis B- Interstitial lung disease C- COPD D- Occupational lung disease

3m boy exclusive breastfeeding, mother worry about Iron deficiency anemia,U give her medical advice when to start oral iron prophylaxis After how month from now 1m 2m 6m

Typical case of preeclampsia, asking about which of the following clinical findings with this condition? A-elevated mother liver enzymes B-oligohydroamnios C-polyhydroamnios

A refer to Criteria for the diagnosis of preeclampsia in utd

16 year old , amenorrhea for 2 months and galactorrhea for 3 months , what is the most important investigation ? A-Prolactin B-Progesterone C-Oestrogen D-LH

Vessels effected in epidural hematoma: ⁃ Middle meningeal artery

8 years old child with lax joints and fingers Arachnodactyly what is the investigation that will protect him from life threatening condition? A. Echo B. Ecg C. Chest ct D. Brain mri

15 month boy came to ER complaining of abdominal discomfort, emesis, stool with blood and mucus on phisycal examination he has increase abdominal sound X-ray report shows obstractive bowel ( written like this ) A- give antibiotic B- Go to OR and do surgery C- Barium enema ✅ D- bowel rest, IV hydration and wait until symptoms gone

Female, p6, feel heaviness and discomfort on her pelvic region, exam showed mass coming from introitus , dx? A- Rectocle B- Cystocele C- Uterine prolapse D- Enterocoele

Child with Sand paper rash, sparing mouth. Most likely organism? A-Staph aureus B-parvovirus b19 C- herpes simplex virus 6 D-strept pyogenes

d, Scarlet fever = strep pyo

Pregnant with low risk pregnancy at 32 weeks came with vaginal bleeding, diagnosed as placenta abruption and managed conservatively , most appropriate next step? A- remain in hospital B- reclasify as high risk and f/u with US for fetal growth C-apply as low risk with f/u outpatient clinic D-apply as low risk and f/u with US for vaginal bleeding

Young male came afrer RTA and FSAT was order Which of the following most probably to found? A-pneumothorax B-subdural hematoma C-Hollow viscous injury D-interpertoneal free fluid

Pt sad I think then he diagnosed with cirrhosis who will tell the pt about his diagnosis? A- family B- nurse C- hospital administrator D- doctor

COPD patient with SOB in ER , only finding is PH 7.3 and he already took 1 dose of bronchodilator with no improvement what to do next ? Non invasive mechanical ventilation ✅ Give another dose of bronchodilator Give inhaled steroid (100% sure no choice mechanical ventilation )

patient with paracetamol toxicity came to ED after one day atidote N acetyle cystein no need in this stage

N acetylcestiene

diabetic pregnant with HbA1c 12 whats is commenst complication? congenital malformation polyhdraminos preeclampsia

Pregnant Patient Presents with Cottage Cheese Discharge. What is the Treatment of Choice? A. Oral Anti Fungal B. Topical Anti Fungal✅ C. Oral Antibiotic D. Topical Antibiotic

11 year old girl with exercise intolerance and weight (did not mention loss or gain) Hx is unremarkable and PE is normal bp:160/100 HR:130 T:36.6 O2: 95 ECHO shows normal heart function and anatomy. What is the most appropriate ? managment? 1- ABG 2-electrolyte level 3-CBC ??? (anemia ) 4-TFT????

i spy with my little eye: Slowly progressive, over ∼ 8–10 years Episodic impairment of memory Characteristic order of language impairment: naming → comprehension → fluency is a clinical diagnosis MRI Diffuse cortical atrophy Hippocampal atrophy CSF ↓ Beta amyloid ↑ Phosphorylated tau Neuritic plaques (amyloid beta peptides, mainly accumulating extracellularly) Neurofibrillary tangles (abnormally phosphorylated tau protein, which accumulates intracellularly)

Alzeheimers disease

10 y old girl complain of abdominal pain since *14* days On examination you found bruises over the abdominal and asked her what is these she told you she fall from bicycle … A- ct abdomen B- us abdomen C- laparotomy D- laparoscopic

Known case of GERD on 20 mg omperazole; partial improvement of the pain, but she had worsening of the symptoms at night. She was obese. Endoscopy showed esophagitis. Next step? A. Add antacid BID B. Ranitidine at bedtime C. Advice to lose weight D. Refer for fundoplication (plz focus this from the past, in my exam she wasn’t obese her BMI was 27, maybe consider over weight? anyways i still think C is the answer)

Mother came with her child for preschool Vaccination Which of the following is important Vaccine to give : A-RV B-OPV C-Meningococcal ( MCP4 ) D-Hib

Pediatric with recurrent infection with pyogenic bacteria pneumonia and otits media and recurrent dirrhea most important diagnostic test? - C1 inhibitors - Immunoglobulin

Child pt with decreased IQ, pica (eat dirt) < they wrote it :) With Hepatosplenomegaly ! Labs showed *Hypochromic microcytic anemias. What is the highest diagnostic labs? A- blood lead levels B- CBC with blood smear (they already do it ) C- Iron studies

Answer is A. This Q came to my exam in November. There was no Iron studies in the choices!! I don’t remember the Q exactly but the choices were wrong except for A which is diagnostic for lead poisoning since the child is Eating dirt and have low IQ.

boy circumcised mother said urine smell foul fever 39 for 1d what indicated uti in this pt A.Fever duration B.Being a male C.Fever 39 D.Age

60 y/o male,, progressive Ascites, fever, loss of weight, low SAAG.. This is the complete Q.. Dx 1.HF 2 liver chirrosis 3 pretonial TB 4 vaso oclusive

SLE pt on medication and present to the ER with urinary incontinence and lower limb weakness during examination you found hyperreflexia and paraplegia, what you will order ? -LP + MRI brain -LP + MRI spine -LP + CT brain -LP + MRI MRA MRV brain

B. Answer is LP and MRI of the spine. This is a case of Transverse myelitis as a neurological complication of SLE. Management is IV steroid and Cyclophosphamide.

Doctor did lap for appendicitis appendix not inflamed but removed as part of common practice, dr didn’t inform patient about this in pre op consent: Tell patient its part of standard procedure✅ Ask other dr to tell Dont tell Ask the ethics

32y female present with 4cm fibroadenoma with hyperplasia and atypia What is the most signeficant risk factor for breast cancer? A. Her age B. Present of hyperplasia C. Present of atypia D. Fibroadenoma size

Elderly has problem in urination ,back pain elevated PSA DX? A -Prostatic CANCER B- incontinence C- UTI

Elderly with abdominal pain amd abdominal distention, He shows signs of obstruction, on imaging there is air fluid levels and pneumobilia (air in biliary ducts), What's the next step in investigation? A- Gastrograffin test B- Barium swallow C- Abdominal CT ✅ D- US

Case about gun shot and the pt had pneumothorax. Tube thoracostomy was inserted after 15min there was blood in the under water seal drain (2L), what is the most appropriate thing to do? A - thoracotomy B- Tube thoracostomy C- CT chest

Baby jaundice, cataract, hepatomegaly how to confirm? Urine reducing✅ Hida Alpha 1 antitrypsin

Term Female came for labour , her prenatal history was urine culture (not vaginal swab for culture) positive 100000 GBS and asthma wich is managed by SABA , now what to give during labor and delivery? -Ampicillin ✅ -betamethasone

A celiac patient with skin rash. What is the most likely associated diagnosis? • A Psoriasis • B Dermatitis herpetiformis • C-Chicken pox • D-Pemiphagus vulagris

Fungal infection in pregnant lady how to treat? A. Oral antifungal B. Topical antifungal

Severe pain when going downhill but improve when bending forward ? Spinal stenosis ? Osteoarthritis

55+ M Known HTN Came with heart murmur radiating to carotid region.. What’s the best diagnostic method? A/ trans esophageal echo B/ ct angiography C/ cardiac catheterization D/ ecg

old patient came with subdural hematoma with signs of lateralization imaging revealed 13 mm shifting. his GCS 7/15 then was intubated and resuscitated what to do next A- iv mannitol B- elevate head of bed C-hyperventilate D- urgent craniotomy

12 years old with myopia, pectus excavate, congenital heart disease, Height > 90th percentile weight <50th percentile, Normal IQ. what's your diagnosis A- Marfan Syndrome B-Homocystinuria C-Soto's D-Alexander

Mother with child born premature 23 weeks and needs intubation and resuscitation but she refused. What to do? A. respect her wish B recuscitate

Vertex presentations.. How to diver Vavum CS Forcebs NVD

40 something year old female with menorrhagia What is you diagnosis? - endometrial polyp - submucosal fibroid

A a picture of homogynous US will come with this

newborn, w/ family Hx of primary immune deficiency: what to do? A- give BCG B- dont give BCG C- Give vaccine when he become adolescent D- give immunoglobulin

5 year old male presented with a history of URTI 2 weeks ago, now he complains of RUQ abdominal pain, no rebound tenderness. There is splenomegaly. HB: 7 Retics: High WBC: 16 Blood film: Normocytic normochromic anemia with target cells and inclusion bodies What is the most likely diagnosis? A- IDA B- Lead poisoning C- Acute appendicitis D- GI Infarction E- scd

survey

17 yrs Senario of primary dysmenorrhea severe pain affect on life and school attendance. She was on NSAID and pain become less severe, she able to go school and do her life activities.. most appropriate next step? 1-OCP 2-counseling and education of self care

12 Weeks pregnant, what will her blood test show? A. Decrease in serum creatinine B. Increase in plasma sodium C. Increase in plasma BUN D. Decrease in BUN

36 Year old male patient diagnosed with WPW and he is on BB but still uncontrolled. What to do? A- Add CCB B- Increase the dose. C- Give amiodarone. D- Radiofrequency ablation

Patient fell on outstretched hand, pain at anatomical sniff box, which bone fracture is it? A) Colles B) Scaphoid

47 yo woman came for screening: Pap Fecal occult Glucose Ct

patient presents with pain and an itchy anus after defecation, as well as painful defecation with streaks of blood in his s tool. What is the most likely diagnosis? A. Abscess B. Anal Fissure C. Thrombosed piles D. Fistula

Case of 3 years old he has breathing hold, no inspiratory stridor and monophasic wheeze and barking cough ? A- bronchiolitis B- Tracheomalacia C- Laryngomalacia D- Bronchial asthma

47 year old lady known to have hypertension, came for clinic, what screening test to do? Pap smear Fasting blood glucose ✅ Colon cancer

she is not obese, i would go for pap smear

12 years old boy came with supracondylar fracture and abscent of distal pulse , most appropriate mangment : Early k wire Elevate hands watchful waiting Surgical exploration ( sure there is no closes reduction )

Pt with sjograns disease , ask what causes HYPERKALEMIA in this pt? A- RTA 1 B- RTA 2 C- RTA 3 D- RTA 4

sjogren causes RTA TYPE 1, hyperkalemia present i RTA type 4

A male patient with Ulcerative colitis had several episodes of diarrhea for 7 days. Not associated with vomiting. Which of the following is the best fluid to give him ? A- Half Normal saline B- Ringers lactate C- Colloid

patient comes with cough, hemoptysis What is the initial action? a. Acid fast bacilli b. Chest X-Ray c. Isolation in a negative pressure room

Diabetic patient with pseudo hyper epithelialization in situ, what you should do: A. Amputate toe B. ulcer Debridement C. follow up D. Repeat biopsy

Patient underwent total hysterectomy with bilateral oophorectomy what to give her? A-Estrogen patch B-lUD C-OCP (Progesterone and estrogen) D- Progesterone only pills

A boy was playing football and felt sudden pain in his groin while kicking the ball or aiming to the goal smth like that, there is a swelling at the groin but no cough impulse and not reducible, vitals showed fever and wbcs were high, whats ur management? A. aspiration to rule out hematoma B. give analgesics and check after 8 hrs C. surgical exploration for hernia D. force reduction manually or smth like that

A pregnant patient GA around 37 or 38 weeks came with labour , with contractions and cervix dilated and effaced. A picture of urinalysis showing positive ketones and Proteinuria and glucose. No vitals mentioned, the did not mention if she has gestational diabetes or not. What is the most appropriate management? A- Induction of labour B- Discharge and follow as outpatient

📝📌Note to remember

When to deliver in case of Diabetes Mellitus? (ACOG)

- At 39+0 to 39+6 weeks if well-controlled glucose levels and no vascular disease;

- At 36+0 to 38+6 weeks if poorly controlled glucose levels or vascular disease (even earlier if severity of complications warrants earlier delivery)

- Expectant management beyond 40+0 weeks is not recommended

Delivery before maternal stabilization should be avoided!!

For this patient the correct answer is to manage the DKA (by insulin and hydration) and stabilize the mother!

-> Then induction of labor after correction of her status.!!

If IV insulin and hydration in the choices I would choose it. If not? IOL

حليتها على أساس ان قصدهم من كلمه the most appropriate انه وش مفروض اسوي بعد ما اعالج ارتفاع السكر؟ هل اتركها ولا اولدها؟ والجواب توليد

والاصح طبعا اني اعالج السكر المرتفع!!

Dr.wafa

Patient with signs and symptoms of hyperthyroidism , painful goiter , labs shows ESR : 58 , diagnosis : Subacute thyroiditis Sick euthyorid Others irrelvant

A Elderly patient with left lowr quadrant abdominal pain for few days associated with constipation and fever. What is the most appropriate next step? A- sigmoidoscopy B- colostomy with anastomoses C- explaratory laparotomy

If its diverticulitis case then CT
If volvulus then reduction by sigmoidoscopy

Ecg of hyperkalemia and the scenario mentioned the level of hyperkalemia asking about initial thing to give ? A- ca gluconate B- Insulin C- na bicarbonate

Case of croup what appropriate mx: Dexamethasone Predsnoloe Racemic epinephrine

14 YO male presented to ER with history of diarrhea for 3 months. Associated with abdominal bloating and loss of subcutaneous fat. What is the best treatment? A. Hydrolyzed diet B. Gluten free diet C. High caloric diet

33 ga came with fever , rigor loin, rigor and has had 2 uti this pregnancy what will you do ? mri pelvis x ray spetic screening

Hyperthyroid symptoms for 10 days, labs show high ESR 58, what is the most appropriate management? A-Methimazole B-Steroid C-PTU D-Radioactive Iodine

Female presented with the current attacks of palpitation / sweating and fear of Family gathering with another Sx ( I think social phobia) Management? 1-benzodiazepines 2-TCA 3-SSRI

Middle-aged female palpitaion and weight loss. On examination, there was irregularly irregular pulse and fine tremor. ECG showed Atrial fibrillation. Which of the following is Important investigation? A. Thyroid function tests B. CBC

pregnant in labour on at term. OE (describe breech . As head in funds and filix both hip and knee ) spine pf baby parrele to spine of mother. What is the lie.( Atention ask for lie not presentaion)??? A.longitudinall B.transverse. C.breach D.cephalic

Patient with renal impairment has the following findings (on dialysis I think) K 6.4or6.5 but definitely 6 ECG: Tented T wave A. Immediate hemodialysis B. Ca gluconate

patient complaining of chest pain, diaphoresis and other symptoms of Ml that started 2 hours ago. He has a history of ischemic stroke (2 months ago). what would you give him next? ] - Thrombolytic Therapy - Aspirin – PCI – Statin

42 man came to hospital complain of SOP, fever and fatigue for few days, physical examination rise JPV pulsus paradoxus And distant heart sound Which involve? A. Valves B. Pericardium C. Myocardium D. Coronary artery

Sickle cell trait, what’s the most common complication during pregnancy? A- IUGR B- Chest infection C- Preeclampsia D- UTI

25-year-old man presented to the Emergency Department with severe pain during and after defecation for 3 days associated with passage of a small amount of fresh blood after defecation. Physical examination confirmed an acute posterior anal fissure. Digital and proctoscopic examination were not performed due to the anal pain. Which of the following is the most appropriate management? A. examination under anaesthesia B. lateral internal anal sphincterotomy C. chemical sphincterotomy with diltiazem D. botulinus toxin paralysis of anal sphincter

C-Schwartz: first line management of Anal fissures is usually to minimize the trauma incidence by bulk agents, stool softeners, warm baths and analgesic cream. CCB ( as Diltiazem ) helps to heal the fissures and have fewer side effects. Failed Medical therapy? Lateral internal sphincterotomy is recommended.

Pt with high cholesterol, triglycerides and TSH. T4 was normal. What is the best medication for her Dyslipidemia? - Statin - Thyroxin - Niacin

Man with HCV and cirrosis presented with ascites , and his WBCs is high (>20 thousand ) the patient was unstable his BP is low what is your next step? -ABx -labroscopy -ex laboratomy

23-year-old Primigravida, 30 GA admitted as a case of threatened preterm labour. In which she received corticosteroids. What’s the rationale of giving it? A. VII injury B. Pneumothorax formation C. Incidence of hypoglycemia D. Respiratory distress syndrome

Case of child falling with open femoral fracture : A_ external fixation B_ internal fixation C_ surgical debridement D_forget 🤷🏻‍♂️

36 year-old female presented with left neck mass 2x2cm in posterior angle of mandible. US: Normal thyroid, left large LN with cystic component. FNA: All smear shows follicular thyroid What is the most likely diagnosis? A. Metastatic thyroid cancer B. Apparent thyroid C. Ectopic thyroid (in the pathway of thyroid ) D. Thryoglossal cyst

32 male patient, develop sever hypovolumic shock due to traumatic splenic injury, managed by splenectomy. In the operation he received 8 unit of blood, then transferred to the ICU. On the 3rd day he became febrile. Blood culture : positive for gram negative bacilli What is the most probable source of infection ? A- contaminated blood B- respiratory tract infection C- urinary tract infection D- from intestinal source

C Gram negative bacilli can be E.coli so UTI

45 year old male smoker had an adenoma removed from his colon. Pathology report shows a benign lesion. What advice should you give this patient to prevent him from getting colon cancer? A. Eat a low-fibre diet B. Eat a high-protein diet C. Colonoscopy every year D. Stop smoking and start exercising

After resection of a pedunculated polyp the results was benign adenoma and patient has no family history of colon cancer what to advice for reduction of colon cancer? A. Prophylactic sigmoidectomy B. Prophylactic colectomy C. Annual colonoscopy D. Lifestyle modification (healthy diet and exercise)

Tracheal deviation to the left and dullness on the right side:- 1-pleural effusion 2- pneumonia 3- pneumothorax

Patient with excessive vomiting electrolyte changes -hypokalemia -increase K in urine -metabolic acidosis -respiratory alkalosis

Male patient came with scalp open wound, after 6h assault, what wound management? A. Secondary closure B. Debridement with Primary closure C. Debridement with granulation D. Leave it for granulation

Patient came with new onset of LBBB ( given dx ) what to the most appropriate next step ? ⁃ Give carvidolol ⁃ Give warfarin ⁃ Give thrombolytic ⁃ Wait for the cardiac biomarkers results

What is true about celiac disease? A biopsy has no role in diagnosis B can’t affect adults C simple blood serology can confirm diagnosis D successful treatment of gluten free diet consider diagnostic

a gluten free diet shoud not be facilitated ithout proper diagnosis, biopsy HAS a role in ddx and it can affect adults, c by exclusion

Long case of patient flank pain. US of the kidney showed Hypoechoic acoustic shadow. Diagnosis? A. Blood clot B. Uric acid stone C. Renal papilloma (Didn’t catch the full name)

Child with Sx of tracheomalacia How to confirm the diagnosis? A) chest XR B) bronchoscopy C) Fluoroscopy

recurrent pregnancy loss in 1st. Trimester with Hx of theomebolism A- warfarin life long B- enoxaparin life long C- aspirin life long D- fandiprix life long

If pregnant or planning to get pregnant switch to enoxaprin

Pt with rheumatoid arthritis and got infected I think it was pneumonia Then after treatment pt have deteriorating kidney function with blood in urine What is the cause of deterioration of the kidney function pt was given cefuroxime for treatment of an infection 1) renal vasculitis 2) prerenal failure 3) immunecomplex glumriolonephritis 4) I think interstitial nephritis

A doctor used the Foceps, place it in wrong position and injured the stylomastoid bone, what is the result? A.Baby cannot close his left eyes B.Loss of taste in anterior ⅔\

This Q was repeated a lot.

Stylomastoid foramen is the place where the fibers of the facial nerve passes.

Responsible for ( Taste ) of the Ant 2/3 of the tounge.

Responsible of ms that closes the eye.

The recaller may have missed some important details in the Q.

If choice B says ( Sensation ) of the tounge not the taste it will be wrong. And the answer will be A.

If The injuried foramen is the left and choice A was Right eye it will be wrong because it’s ipsilateral and answer will be B.

Or: maybe it’s not a bad recall and both are correct.

3 months boy circumcised presented with febrile UTI … what the most appropriate management? 1-Renal US 2-MCUG

A diabetic lady presenting to the clinic asking about travelers diarrhea prophylaxis. Mild Cr Elevation, BUN is high, urea is high. What prophylaxis to give? A.Fluoroquinolones B. No need ✅ C. Probiotics D. Bismuth

If renal impairment with severe dehydration the answer is A.

Mild renal impairment is not an indication for travelers prophylaxis.

5 years old girl with history of recurrent vomiting. What is the next initial management: -Notmal Saline -Ringer Lactate -Potassium Chloride

A healthy young lady just delivered a baby 6 months ago. However, she tells you that she does not want to get pregnant for the next 2 years. What method of contraception will you recommend? a. Combined OCP b. Depo Provera injection C) male condom D ) vaginal ring

What the best way to reduce weight? 1-excessive exercise 2-low carb diet 3-life style modification 4-bariatric surgery

Elderly with Long history of diverticulosis, with sudden pain Ct showed thickend sigmoid fluid collection and air in peritoneum Stable Most important management? Colonscopy Exploratory lap Diagnostic lap Ct guided drain

elderly, epigastric pain for 3m, wt loss, jaundice and dark urine There was dilatation of intrahepatic and extrahepatic duct Labs: cholestatic picture (They did not mention if the gallbladder is palpable or shrunk :) ) A. Klatskin tumor B. Gall bladder cancer C. Ampullary cancer

patient diagnosed with schizophrenia and started treatment , what is true about his prognosis ? 5% have remission Most will have remission? 70% will have good quality of life 33% will reduce ssx

Highest risk factor for ednodemtrial ca?

untreated pcos,

40 YO female has heavy menstrual bleeding, came to the clinic and she was diagnosed as a dysfunctional uterine bleeding. what is the treatment -OCP -D&C - Hysterectomy

A The answer is OCP .. She came to clinic not ER , D&C will be the last option

38 YO female presents to the clinic after finding of hilar lymphadenopathy on CXR. She has on and off cough, but denies any fever, headache, n/v, weight loss all negative. Labs insignificant except for X-ray shows confirmed bilateral hilar lymphadenopathy CT guided biopsy shows noncaseating granuloma What is the best next step in management (They wrote “all labs were normal” and didn’t mention hypercalcemia) A. Observe B. Start prednisolone C. Start azithromycin D. Start anti TB medication

Male presents with peptic ulcer resistant to medications, with positive secretin stimulation test, what is the diagnosis? a) VIPoma b) Glucagonoma c) Gastrinoma

epidemiology of dengue fever which region is the highest western eastern northern

4 years old child came post URTI 2 days ago complaining of SOB Wheezing, RR 33, HR 100, O2 82% other vitals normal (not sure). Parents said that he had multiple previous hospitilization due to same reason . What is mangment ? A. ABx and systemic steroid B. IV fluid and ventolin C. Ventolin and systemic steroid D. ABx with something (I don’t think it was Ventolin)

Pregnant women Last menstrual period 7th of May, she has regular period and is sure about it. What is the Expected date of delivery? A. 10 February next year B. 10 December same year C. 25 December next year D. 30 February next year

Recommended frequency of pap smear for cervical cancer ? A- every 2 year B- every 3 year

Elderly with a lot of comorbidities her A1C is currently 7 but she was between 8-9 in the previous years so we had to add insulin above metformin that she was taking. She is presenting with distal symmetrical neuropathy. She is taking glargine, aspart, and lisinopril. What should be done/given? (No labs were given) A- tighter A1C control B- vitamin B12 C- amitriptyline

Patient with thyroid mass measuring 2*3 on one lobe, patient is asymptomatic, TSH and T4 are normal, Bethesda 4, what’s next step in management? A. Hemithyroidectomy B. Nodule excision C. Total thyroidectomy

Patient with Low TSH and high T3 and T4 Symptoms: palpitation and heat intolerance What’s the diagnosis ? 1- Thyrotoxicosis 2- sick euthyroid syndrome 3- Primary Hypothyroidism 4- something unrelated

DIC with: Uterine rupture Placenta privea Placenta abruption

hematemesis with abdominal pain first time no previous symptoms no medical hx no medication , all lab normal, dx? Gastritis , peptic ulcer, immune hepatitis, mallory weiss

Patient presented with abdominal pain for 1 day intermittent, right sided pain and fullness and rigidity Pregnancy test is negative (she was hypotensive and had fever) A- Appendicitis B- Ectopic pregnancy C- Ovarian tors

child came post URTI 2 days ago complaining of SOB Wheezing, RR 33, HR 100, O2 90%, other vitals normal (not sure). What’s most appropriate management? A. ABx and systemic steroid B. IV fluid and ventolin C. Ventolin and systemic steroid D. ABx with something (I don’t think it was Ventolin)

Case of native valve endocarditis what is best empirical treatment? A) Gentamicin B) Vancomicin C) Ceftriaxone D) Ceftriaxone and vancomicin

24 years old with history of appendectomy 5 years ago presented with abdominal pain, distention and vomiting for 3 days, CT scan revealed signs of intestinal obstruction & peritonitis. What agent is contraindicated in this patient ? A-propafol B-nitrous oxide C-sevoflurine D-ketamine

A long scenario of a female (26 Y.o) came with right lower quadrant pain with no rebound. WBC: High U/S: Inclusive What will you do next? A- Abdominal CT B- Diagnostic laparoscopy C- Open Appendectomy

Drug that decrease the incidence of diabetes ? -metformin -Liraglutide

patient on 4 anti hypertensive meds yet his BP is high Renal imaging Asymmetrical kidneys Choices -primary hyperaldosteronisim -renal stenosis -adult poly cyctic disease

6 years old child with long history of multiple lower respiratory infection and rhinitis admitted with respiratory symptoms bronchoscope done, sputum collection done and culture was positive for pneudomonus aergunosa and ? What is the cause 1-primary ciliary dyskinesia 2-cystic fibrosis 3-bronchial asthma 4-!

23 years old male, have proteinuria & was diagnosed with nephrotic syndrome 2ndry to minimal change in glomerulonephritis (written exactly like this). What is the most appropriate treatment to decrease protein levels in the urine? A- Prednisone B- ACEi C- No treatment needed D- forgot but irrelevant

pediatric patient came with pain and redness in Rt hemiscrotum , on examination , there is bulging or something like that extended from scrotum to inguinal area , tender , red , Rt testes not palpable , what is the Dx? A-testicular torsion B-testicular appedoges torsion C-epidydemoorchitis D-incarcerated inguinal hernia

D 4 Diseases that usually comes together in the choices Epididymo-orchitis Testicular torsion Appendicular torsion Inguinal hernia How Can I differentiate? Let’s take them one by one. ◻️ Epididymo-orchitis: - Gradual pain in the scrotum Usually >24h. - Tender edematous cord - Red scroutm - Fever, Dysuria, urethral discharge can be present - High WBCs and inflammatory markers. Mx: Antibiotics. ◻️Testicular torsion: - Scrotal pain less than 12 hours ( مهم ) لانه بعد ١٢ ساعه يصير Necrosis ومايحس بالالم. - Previous episode or trauma. - High riding testis ( Horizontal ) - negative phren sign and absent cremasteric reflex. - Low doppler flow Mx: Surgical exploration ASAP. ◻️Appendicular torsion: - Tenderness over the upper pole - Vertical ( Longitudinal ) testis - Blue dot sign Mx: NSAIDs and Rest. ◻️Inguinal hernia: - Mass extended to the groin.

60y old lady present with lower genital bleeding, she described it as Scanty and barely stain the pad , what is the source of bleeding A- Fallopian tube B- Ovary C- Uterus D- Genital tract

Pt have unilateral neck pain that increase and become like electeric shock from neck radiate to shoulder also develop weakness in the arm Whats cause? 1 cervical disc prolapse 2 polymyalgia rheumatica

Married for 3 years, off contraceptive since 18 months and still didn’t get pregnant A. IVF B. Induction ovulation C. Infertility investigation for both wife and husband D. Continue trying

Young female has a history of multiple miscarriages, came to complaining that she want to conceive and want to receive all types vaccinations. Her B-HCg is positive. What to give her? Measles Rubella Influenza

81 year old male presenting with memory loss and difficulty remembering grandsons name, medically free apart from occasional alcohol intake. What is the likely diagnosis of his presentation? A) Multi Infract Dementia B) Alzahimers Disease C) Alcohol Induced encephalopathy D) Parkinsonism with Dementia

CKD 2nd stage scenario, lab show LOW HB + <80MCV WHAT IS APPROPRIATE TEST TO DO IRON LEVEL Erythropoietien Bone marrow Reticulocyte

Female came to ER with sign and symptoms of appendicitis, appendectomy was done , surgeon discover the appendix was normal , what surgeon should be do ? A. Tellptwhathappenedandthatwasroutineandnocomplication B. Not tell the pt C. Write report about what happened and give it to hospital committee

Pregnant lady K/O SLE controlled on HQ, mycophenolate motefil. Asking about what drugs adjustment should be done? — stop Mycophenolate and give methotrexate — stop Mycophenolate and give azathioprine

The goverment is aiming for "Health for all" (not sure) with 2030 vision by decreasing the mortality rates among 5 years old children and younger. And that is achieved by: -Health education -Immunisations

37 weeks in active labor dialted 4cm intact membrane. CTG is normal except for recurrent variable deceleration. Next step? A. CS B. ROM C. Observe D. Give tocoloytics

Case of Malignant phyllodes tumor (Dx is writen). Mass size was 10x12 cm What is the most appropriate? Wide local excision Chemotherapy CT chest * with * contrast Radiotherapy

Chronic non bloody diarrhea+fatigue+microcytic anemia+thrombocytosis+wt loss 10 kg and no fever, tt? (That is it, no hints of any disease that I could find) 1- glutin free 2-metronidazole 3-ppi 4-loperamide

A young female on labor GA 38/40. Her pregnancy was normal, uneventful, with normal fetal development. The labor was normal but the was difficulty delivering the placenta which complicated with uterine inversion accompanied with vaginal bleeding 1200cc. Which of the following is the source of her bleeding? A- Trauma blood vessels B- Muscular injury and laceration C- Uterine muscles fail to contract

female with ovarian cyst what kind of oral contraceptive a-OCP b-progesterone only c-male condom d-vaginal ring

Female had gastroenteritis and she took metoclopramide that leads to involuntary movement facial grimace and tongue protruding what to give how to manage ? A. Diphenhydramine B. Epinephrine C. Cyproheptadine D. Tizanidine

Child with Supracondylar fracture, he has absent pulse, Next step? A, K-wire Fixation B, Explore

First step is Urgent reduction

If Hot and warm — K wire.

If Cold and pale — Exploration.

Here the answer is A.

8 weeks baby presented with fever, feeding difficulty, dyspnea and tachypnea for two weeks, she was healthy prior to her presentation apart from a pansystolic murmur, xray shows cardiomegaly and increased pulmonary vascular markings. What is the initial/next step? A- refer for surgical correction B- manage medically with diuritics C- icu with full course of abx?

Sickle cell trait, what is the most common complication during pregnancy? A-IUGR B-Chest infection C-Preeclampsia D-UTI

Elderly patient presented with retroperitoneal haemorrhage. History of Hodgkin lymphoma. What’s the diagnosis? A. Lymphosarcoma B. Liposarcoma C. Sarcoma

55 y.o Patient k/c smoker only. Presents with signs and symptoms of MI. ECG shows lead II,III,AVF depression. Hist vitals are: BP: 150/92 Pulse: 99 Which of the following is the most considerable risk factor for MI in this case? A. HTN B. Smoking✅ C. Age

Pregnant 20 weeks with with two previous histories of preterm labor. Her current pregnancy is uneventful and her cervix is closed, cervical length is 30 mm and Positive fibronectin. What will you do? Immediate cerclage Progesterone supplement

Pt k/z DM present with perianal painful swelling and us fever, T 38 on DR exam you found posterior fullness with mimimal discharge, Dx ? A-Abcess B-Perianal fistula C. Thromposed pile

Man come to the ER for poly Trauma and he was intubated after resuscitation admitted to the ICU what is the best approach to exclude cervical spine injury and remove neck collar? A. MRI neck B.Ap and lateral x-ray neck C. Clinical judgment D. Ct neck

scenarios about a child 2 years old with SOB and Expiratory wheeze and other respiratory symptoms he had a viral illness 2 days ago A.Respiratory monitoring for hypoxia B. Inhaled epinephrine and steroids C. Intubation and antibiotics D. SABA

Pt in his 60’s came with flank pain and hematuria, tender mass in lumber region his vital BP= 160/90 What’s the most diagnostic investigation ? A-US B-CT abdomen C-MRI D-Radionuclides

39.Female with vaginal discharge, examination reveals straw cells s A- BV B- CHLamydia C- Trichomonas vaginalis.

37-Patient after Motor vehicle accident at ER, on examination showed generalized tenderness What is the Most Appropriate management? A.CT B.FAST C.DPL D.Laparotomy

Pt present with constipation small intestine obstruction, imaging showed 3 stricture on the proximal ilium, Dx ? A-Crohns B-GI Stromal tumor C-Intestinal lymphoma

Child with low grade fever and sudden onset of stridor: A: epiglottis B: tracheitis C: tonsillitis

11 month old child, brought by his parents they reported a 1 day history of fresh blood in stool associated with foul smell and dark brown stool on examination the child was pale (they didn’t mention pain or any abdominal examination), What’s the best diagnostic tool: A- barium enema B- barium meal C- radioisotope scan D- US abdomen

C Painless lower GI bleeding is the most common symptom of Meckle’s diverticulum. Another Q: Best diagnostic tool? Nuclear scan as Radioisotope scan

Middle aged female patient with history of myomectomy. in operation note: they enter uterine cavity during surgery. What is the most likely developed in future pregnancy? A. Placenta previa B. Placenta acreta C. Placenta Increta D. Placenta percreta

Kayser-Fleischer Ring … ask about mx > D-penicillamine, MGSo4, iron supplement

65 years old man admitted for elective ventral hernia repair, K/C of hypertension and BA, upon examination bilateral crepitation, ascites and bilateral edema, what to do? A- Proceed with hernia repair. B- Don’t repair unless obstruction has occurred C- Delay until situation is controlled.

ذا جاني فالاختبار.. طيب عشان تفهمون ليش حطيت B ركزوا معي Smoking Obesity Diabetes COPD Asthma Congestive heart failure All of these are relative contraindications to elective ventral hernia repair. Relative contraindications means: You don’t repair the hernia unless incarcerated or strangulated. As elaborated in this case patient has asthma and signs of congestive heart failure. DrThawabah also agrees with this answer ✅.

78 YO post-op contaminated surgery. Admitted to ICU and given 6 L of crystalloid IVF and 1 PRBC in the last 12 h. Broad spectrum antibiotics were given. , CVP is 40”over fluid treatet = no hypoVoluimia” 8-12 Vitals: BP 70/45 HR: 125 T: 38.6 O2: 93% Labs: WBC 8 Most appropriate IV intervention: A-albumin B-2 L crystalloid fluid C-norepinephrine C-frusemide

Child with recurrent infections did chloride sweat test and it was positive, which complication is common in this condition? A- malignancy B- bronchiectasis C- lung emphysema

30 week GA pregnant woman had pprom 3 days ago, now presented with fever and abdominal pain, what is the mangement? A- gentamicin, ampicillin, deliver B- gentamicin, ampicillin, observe C- observe D- find the cause of fever and treat accordingly

2 week history of epigastric pain, fever and jaundic with BP 90/60 and amylase is 1400:- 1- pancreatitis 2- cholngitis

45 year old female is having amenorrhea since 6 months and want to get pregnant what is the appropriate test: FSH Endometrial biopsy US

Case of baby with Acetaminophen toxicity with s/s came after 1 day what to do ? A-Nac B-Charcoal

8 years old boy. Mother complained of poor training to bathroom which muscles is targeted in therapy? A- Perianal B- Pelvic floor C- Rectus muscle D- Detrusor

D , repeated

Mangmenent of polynephritis in pregnant Admission and Iv antibiotic, oral

At which age can we give peanuts and eggs to babies to prevent the risk of getting allergic? A. 10 months B. 14 months C. 18 months D. 24 months

5 years old boy dehydrated Sunken eye , skin turgor , delayed capillary refill etc.. the doctor establish IV access and take blood samples for electrolytes What your management? A- NS 20ml per Kg bolus B- start fluid maintenance waiting for electrolytes

10 weeks pregnant complaining of biliary colic for the past 5 weeks. What is the most appropriate management A - Laparoscopic cholecystectomy now B - Laparoscopic cholecystectomy after delivery C - Laparoscopic cholecystectomy in second trimester D - Laparoscopic cholecystectomy in third trimester

C : Biliary and Pregnancy: - If the pregnant women had first episode of “ Biliary colic” the Management is Conservative. - if the pregnant women had recurrent attack of biliary colic the management is Lap chole at the 2nd trimester. - If the pregnant women had first attack of “ Acute cholecystitis “ the management is Lap chole at the 2nd trimester. 1st trimester is always conservative management. If in 3rd trimester delay the procedure after the delivery.

Female just gave birth 2 weeks ago and was having GDM and family history of DM type2 and came for screening HBA1C was 5.5 Fasting was normal And she is obese What drug to give? Metformin Acrobose Glucagon-like peptide-1 Insulin

Diabetes millitus Risk ratio is 0.83 among patients who drink green tea (exposed) and patients who drink black tea (unexposed). A- green tea drinkers have lower risk of dm B- black tea drinker have higher risk of dm C- getting dm among both groups is unrelated/accidental D- no different between both are the same

38 GA have chlamydia infection during deliver baby … what most common acquired concerning infection to new born ? 1-Eye 2-Liver 3-Ear 4-Lung

History of Cardiac cause as ischemic heart disease. - Increased Pulmonary capillary wedge pressure PCWP. ( أهم حاجه ) - High vascular resistance.

Cardiogenic

55 year old patient with no comorbidities and no abnormal H (medically free) what to screen A. Colon cancer B. DM C. AAA D. Lung cancer

Very thin patient with BMI of 18 she says that she feels obese, presents with Amenorrhea, What is the diagnosis? A-Anorexia nervosa. B-BULIMIA

Pt have hx of trauma (MVA. and develope SOB with decrease air entry in the right side xray emphysema+ peumomediastinum Cause? 1 open pneumothorax 2 tension pneumothorax 3 tracheobronchial injury

female presented with left knee pain for 3 days there is swelling and fever Labs showed slighty high wbc and ESR high Joint aspiration showed leukocytosis i think 200 X ray left knee showed decreased joint space and osteophyte Diagnosis 1-septic arthritis 2-osteoarthritis 3-gout 4-rheumatoid arthritis

36 years old female came for routine check. The report was as follows: US: (can't remember the details) Comment: BI-RADS III / propably benign CT: multiple fibrous tissues with no calcifications How will you mnanage this patien? -Follow up after 6 months -Core biopsy -MRI breast

52 y/o , last menstrual 12 month ago..ect, What is the responsible for this condition? A- FSH B- Estradiol C- progesterone

Baby walk alone , crawel up stairs Draw 1 line point things follow simple commande? Age 6m 10m 15m 24 m

73 years old patient presented with new onset jaundice , weight loss and other symptoms , CT shows lesions in 70 % of the liver , most appropriate investigation : 1-Colonscopy 2- Upper GI endoscopy 3- Percutanous liver biopsy 4- Diagnostic laproscopy

Which of the following is true regarding necrotizing pancreatitis? A. increased lipolysis B. Hypoglycemia C. Decreased gluconeogenesis

Pt known case of dm , discharged after inguinal hernia repair, what it is your advise to him ? A) Abdominal plinder B ) avoid lifting heavy objects for 6 months ✅ C) laxitive or frusimode i cant remember

CBD dilated what to do ERCP MRCP IV fluid

Unvacinated child came with lymph node swelling and fever, when they tried to take culture there was bleeding from the throat, what is the most likely diagnosis ? -Diphtheria -H.Influenza -Streptococcus pneumo

20weeks Pregnant with pruritis and jaundice, Medically free, Elevated LFT , normal platelets, no mention for BP in Q. Likely diagnosis? A- Cholestasis of pregnancy ✅ B- Hepatitis C- Budd chiari D- HEELP syndrome

symptoms of GERD endoscopy done and shows esophagitis. What is the initial step? a. lifestyle modification b. Nissen fundoplication c. Esophageal manometry d. Ambulatory pH monitoring

d Esophageal impedance pH testing — Patients who fail twice daily PPI therapy should also undergo esophageal pH monitoring. Esophageal pH monitoring with impedance is preferred to wireless pH capsule and the traditional pH probe, as it has the advantage of detection of non-acid in addition to acid reflux

Patient with Cholelithiasis and the Common Bile Duct measure 12 mm, what to do? A. ERCP B. MRCP C. Cholecystectomy

20 years old lady(not 21 years) came for pap smere. Time?? A.now B.after 1 year C.after 3 years D.after 5 years

Cold thyroid nodule 3x3 was removed by thyroid lobectomy , 8mm papillary will defined focus was found distant to the leison, what is the appropriate? A. Complete thyroidectomy B. Follow up 3 months C .RAI

If 1cm or above —> A.

25 year old presented to ER after open wound to scalp 6 hour ago. Which of the following is for his wound management? A. Secondary suture B. Leave it to heal by granulation C. Debridement primary suture D. Debridement and Leave it to heal by granulation

Pt has long history of cardiovascular disease with chest pain, he was anxious. On examination: peripheral cyanosis, JVP around 8 cm above normal, nicotine stain on his fingers, he wants to quit smoking. What is the next step: A- Motivational therapy B- Bupropion C- Varenicline D- Nicotine replacement therapy

A: 1- Most important initial step in smoking cessation is Motivational support to the patient. 2- Most effective drug is Varenicline and it’s also Safe in Cardiac Patients 3- If written in the Q ( Hospitalized patient ) Best option is Nicotine replacem

Pt ( in his 60s or late 50s i dont remember) visiting preventive medicine clinic, he is healthy Asking what vaccine to give him ? -meningeococcal -mmr -pneumococcal -dtap

A 45-year-old smoker came to the clinic for his diabetes follow-up. During discussion, he acknowledged that smoking is not good for his health. He plans to quit this year. According to the Stages of Change Model, at what stage of change is this patient? A. Precontemplation B. Contemplation ✅ C. Preparation D. Maintenance

Child with jaundice and RUQ pain for 5 days and liver palpable below the costal margin by 5cm What confirm the diagnosis A.HBs antigen B Serum antibody C. HC antibody

The number of new-born deaths was 4.8 per 1000 in Saudi Arabia during 2020, What was needed to calculate this figure? A) Number of women in the reproductive age B) Number of child deaths in 2020 C) Population in mid 2020 D) Number of new-borns in 2020

d, number of child death is wrong as it isnt the same demographic

Drug abuser comes to er a lot, complains of issues but acts normal when nobody is looking. A conversion disorder B malingering

Young women complain of depression (and other symptoms) prior to her cycle every month it is effecting her work what to give her A- ssri B- medroxyprogesterone C- progesterone D- estrogen

Patient old with end stages cancer disease complaining of severe pain and his children ask you to give him stronger pain killers you respect theirs wishes but you told them that the pain killers may fasten the death of their father question in this case what the doctor do? Answer is: principles of double effects

Pt with previous hx of biliary colic come with RUQ or epigastric pain for 20 hours and elevated obstruction enzymes on US there is a Thick gall bladder wall and cbd:1.3 cm diameter:- 1- ERCP 2- lap chole

26 yr pt came to Er after a first episode of generalize tonic conic seizure ,labs & examination are normal ,no neurological deficit ,what to do next A.EEG B.ECG C.LP D.CT head

Pt with 4 months history of thyroid nodule. TSH low, T4 is high. US: 2X2 cm solid nodule. Your next step? A. FNA B. Thyroid scintigraphy scan

Typical case of organophosphate toxicity ask about dx and ttt

atropine

pt the fresh blood per rectal, they did NGT and it was greenish ,colonoscopy report show normal has no colorectal ca , what is next step ? A. upper GI endoscopy B. 99 tec

Recommendation that at which age if you present A peanut and eggs to the Child will decrease production of allergy? Age in month A. 10✅ B. 14 C. 20 D. 24

Patient came to the ER with signs and symptoms of myocardial infarction he was going for PCI, when the cardiologist was assessing his condition he notice the patient was depressed with low mood, the patient refused the PCI he demonstrated that he was capable good understanding of his conditions and the need for treatment still he refused.what to do A. Treat the patient regardless of the consent B. Refer the patient for psychiatric assessment then take the consent C. Respect the patient choice after discussing the reasons of refusing D. Take the consent from the patient relative

pt diagnosed with Parkinson's and hallucination which of the following is associated with a high risk of dementia? A. Irritability B. Difficulty finding the word C. forgetting a future appointment D. Forgetting places of things

What makes you suspect UTI? A. fever. B. leukocyte C. high nitrite

Time to get pregnant after breast surgery? 12m 6 m 3 m 2y

Patient with hyperthyroidism on anti thyroid medications for 10 months, still symptomatic. TSH: 0.1 and T4 was 27 I think. Best next step? A. Continue anti thyroid B. Subtotal thyroidectomy C. Near total thyroidectomy D. RAI or increase the dose of drug

SVT patient 200 is his heart rate what to do? A- defibrillation B- cardioversion C- propanalol D- Ablation

A patient came to ER (long scenario) he has weakness and Paresthesia in left leg with power of 2/5. Other limbs normal. What is the cause? A- Migraine B- Right MCA C- Right ACA D- Basilar

Macrocytic anemia in pregnancy with a picture of PBS:- 1- folate 2- B12 3- physiological anemia

Years old female medically & surgically free, with no family history of colon cancer, which colon cancer screening test iS appropriate for her? A. 5 years Colonoscopy B. Annual Fecal Occult Blood C. Annual sigmoidoscopy

B Recommended colon cancer screening tests for average risk patients: 1- Colonoscopy every 10 years 2- flexible Sigmoidoscopy, Air contrast barium enema every 5 years 3- Annual Fecal Occult blood Test ( FOBT ).

مریضھ اخدت تطعیم الروبلا من 3اسابیع ممكن یحصل ایھ A. favorable out come B. abortion C. congental anomaly increase 40

48 yo asymptomatic come for screening Hb1ac 7 FBG 7.1 mmol What is the diagnosis 1 pre-diabetic 2 DM T2 3 Impaired glucose intolrenace 4 MODY

A child has scrotal pain since 1 day, on exploration the cord was edematous and inflamed with red right hemiscrotum, what is the diagnosis? A. Testicular torsion B. Inguinal hernia C. Testicular appendages torsion D. Epididymoorchitis

Patient found to have anal fistula on 7 o’clock. Most common anal fistula internal opening is ? A. Left lateral B. Medial posterior C. Medial anterior

المريض بيسوي عملية استئصال لعنق المعده وقررو يخلون البيشنت على Total parenteral nutrition (TPN) Patient on TPN, what’s a common metablic abnormality? كان السؤال وش المتوقع بيحصل عنده من خلل في الالكترولايت الاختيارات جاتني كذا متأكد لان هالسؤال ذاكرته وصححته هنا بالقروب A- Hypokalemia B- hyprcalcemia C- hyponatremia D-Hyperphosphatemia

Answer is A. Patients on TPN are vulnerable to develop Refeeding syndrome. Refeeding syndrome is Characterized by several electrolyte abnormalities as: - High Glucose, and Chloride. - Low K, PO4, Mg. Ref: Thawabah course. Here’s a similar Q from thawabah files

Long scenario of Child came with CF symptoms -the dx not given- What else in examination you will find? A) Nasal polyps B) Indirect hernia C) Gynecomastia

mono mono twins cleavage : 8-13, 1-3, 13-14

Days old child with hypoglycemia & seizure & metabolic acidosis & characteristics smell & positive ketones, Diagnosis? A. Phenylketonuria B. Maple syrup urine disease ✅ C. Galactosemia

A 45 years old male smoker has an adenoma removed from his colon. Pathology report shows a benign lesion. What advice should you give this patient to prevent him from getting colon cancer? A. Eat a low-fiber diet. B. Eat a high-protein diet. C. Colonoscopy every year. D. Stop smoking and start exercising

D Let’s exclude: A- Should be high fiber diet. B- No relation. C- if there’s 5 or more adenomas.

Q stable SLE female came complaining of active sle ( polyarthritis for 1 week) A-prednisolone and MMF B-prednisolone and cyclophosphamide C- Prednisolone and methotrexate

Man come to the ER for poly Trauma and he has severe back and leg pain you suspected spinal cord injury , vitaly stable Initial management A- x-ray B- Wait neurosurgery consultation C- Ct D- Observation

Pt came with periumblical pain that radiated to RIF with nausea increase by cough diagnosis? Gastroentritis Appendicitis

PROM ,, 34 weeks What to give ? A- Tocolytics B- steroid C- antibiotic D- irrelevant

2 years boy signs of testicular torsion , redness pain , absent cremastric reflex , previous episode same sx2 weeks (I think ) A- Surgical exploration B- NSAID C- Antibiotic D- Testicular elevation

Child with cheek vascular anomaly What is the diagnosis? A. hemangioma B. lymphatic malformation C. venous malformation D. arteriovenous fistula

A 30 weeks pregnant has lower abdominal pain with no bleeding or leaking. If you suspect preterm labor, which of the following will confirm preterm labor? A. History will be enough to confirm preterm labor B. Presence of contractions in the CTG C. Pelvic examination D. Cervix length

Most common complication of hysterctomy? A. Infection B. Adhesion C. Hemorrhage D. Vginal discharge

65-year-old male , heavy smoker is coming for the Preventive medicine clinic. What is the most important screening test for him? A. Osteoporosis B. Colon cancer C. Abdominal Aortic Aneurysm

patient 41 week gestation given pethidine and pethergan (not really of the word) give you a CTG showing early / prolonged deceleration next step A- naloxone B- Watch and reassess after 30 mins C- change mothers position (maybe left lateral)

Most serious complication of rapid correction of Hyponatremia? -Hypernatremia -Central pontine myelinolysis

Premature delivery of 23weeks old with fetal congenital anomalies. After delivery he needed intubation and resuscitation. The mother who also works at the same hospital is refusing to resuscitate.? 1-do you respect her wishes 2-consult hospital ethical commute 3-continues with the resuscitation. 4- can’t remember

A before 24weeks respect after 24weeks continus with the resuscitation

Open fracture case , Iv antibiotics and tentnus prophylaxis is giving , next step ⁃ surgical debridment followed by intramedullary nail ⁃ Close reduction with external fixation

Typical signs and symptoms of renal colic , CT was done and showed 4 mm stone in the ureter , How will you manage? A - conservative B- double J stent

56 Y.O patient had an upper Gl bleeding due to esophageal varices and was treated with endoscopic sclerotherapy. What is the best long-term prophylaxis to decrease the risk of recurrent bleeding? A. Repeat sclerotherapy. B. Octreotide. C. BB . D. Ceftriaxone.

Mother came with her child for preschool Vaccination Which of the following is important Vaccine to give : A. RV B. OPV C. Meningococcal ( MCP4 ) D. Hib

Pt came with anal pain + hx of hemorrhodectoy before 2 month On exam doctors can't able to do P R due to severe pain what's cause ? 1 anal fissure 2 anal stenosis 3 heamarrhoid 4 anal sphincter

30-What type of polyp with highest risk of cancer? A. Villous B. Tubular C. Tubulovillous

Man lost weight/Dysphagia A-Barium swallow b- endoscopy other options not related

Trachiomalsia how to diagnose ? X-ray Floroscopy Bronchoscopy

Child sits in tripod position, reaches out to things, flips from prone to supine and vice versa, cannot hold cereal properly between two fingers how old is he? A- 3 months B- 6 months ✅ C- 9 months

unilateral neck swelling in the RT side by investigations : hot thyroid nodule remaining of the gland cold TSH is low, T3, T4 high No LN enlargement (dx hyperthyroidism toxic nodule) What is the initial Treatment? A- antithyroid drug B- RT thyroidectomy C- Hemithyroidectomy D- radioactive iodine

Q Breastfeeding mother with painful tender swelling positive fluctuation US showed ….. hypoechoic something A-Oral abx and aspiration ✅ B-Breast MRI C-Core biopsy D- Excision

The role of antihypertensive in pre-eclampsia? A- To prevent maternal complication as stroke B- prevent IUGR C- prevent fetus demise

37 years old female her father has colon cancer when he was 55 and her mom had breast cancer when shewas 43, asking about screening? A.She should do mammogram annually B.Start mammogram at 40 C.Start mammogram at 40 and colonoscopy at 55 D.Colonoscopy at 50

70s years old female with small mass of a slowly growing vulvar lesion that never heals. Black shaped. History of bleeding with trauma. Dx? A. Basal cell Carcinoma B. Fox-Fordyce disease C. Neurofibroma D. Syringoma

Women 33 weeks with severe placental abruption(written exactly like this), with IUFD and DIC, contraction with cervix is dilated 3 cm, how to manage? ( no vitals mentioned) 1- observation 2- augment labor 3- CS

Elderly woman woke up early with hot flashes, dizziness Vital Normal Labs normal except hypoNa+ was 114 ,your Xd ? Cannon’s Addison Cushion

Pregnant at 38 wk GA.long senario of HTN and hemolysis and low plt and high liver enzyme. Management? A.obseve B.emergancy deliver

Patient after Motor vehicle accident at ER, on examination showed generalized tenderness What is the Most Appropriate management? A.CT B.FAST✅ C.DPL D.Laparotomy

High fasting glucose, a1c 6.3 what to do? Repeat fasting 3m A1c 6w 75g oral✅ Do random

Trauma Pt with extra peritoneal bladder injury? A-Suprapubic catheter B-Urgent exploration and repair C-Catheter repair and assess after 2 weeks D-Catheter us after 2 weeks

Child after brain surgery devolved polyuria Laps : high NA and a lot of electrolytes disturbers but K normal no Keaton A) DI B) SIADH C) renal tube acidosis

Patient diabetic admitted to hospital on Metformin , which is best during hospitalisation : A. Metformin B. Sliding scale insulin C. Pre and post prandial insulin

Child with Heliotrope rash thikness over metcaropharygeal and muscle pain Juvenile dermatomyositis Scleroderma

Multipara pt, with history of CS - didnt say classic- due to breech presentation. Now term, in active labor and she has been fully dilated for 2 hours. Vertx station +3. Next step? A. Instrumental delivery B. C/S

Pt finish tx of h pylori today after 2 weeks using ppi when to do urea test A-After 2 weeks B-After 4 weeks

Post menopausal women present with itchiness and oderless discharge with vaginal excoriation what is the dx A- Candidiasis B- triachomniasis C- vagnosis D- atrophied vaginitis

Placental abruption and fetal distress and ph 6 wt improve mortality now ? A. Mild hypothermia B. IVF C. electrolytes

There was lack of invelonza vaccine which most important group to give? A- school children B- pregnant women C- child with SCA

Uti in pediatrics pt ? A- Fever 38 B- Duration of fever C- Uncircumsion D- not remembered

diagnosed as placenta abruption and managed conservatively , most appropriate next step? A- remain in hospital B- reclasify as high risk and f/u with US for fetal growth✅ C-apply as low risk with f/u outpatient clinic D-apply as low risk and f/u with US for vaginal bleeding

Female patients come to the doctor's office with signs of abuse. She told you the abuse was from her husband and told you not to tell her husband. What should you do? A. Threatensthehusbandbypolice B. Tell the police C. Do what the patient said to you Answer is B

Pregnant with completely normal pregnancy.they applied progesterone to induce labor suddenly there was fetal bradycardia 70HR and could not recover even after fluid and oxygen what should you do? CS Observation

51 years old woth haemorrhoid stage 3 Management: Colonoscopy Rubber band Haemorrhoidectomy

Lactating mother with localized swelling tenderness redness of the over lying skin Management -Abx -Percutaneous drainage -I and D\

failure to thrive with distended abdomen 1 cealiac 2 girdiasis 3 wiple still syndromes

DUODENAL ATRESIA

Child was in a farm then presented with signs organophosphate poisoning (didn’t mention dx) how to treat? Answer – atropine

tru

Pt diagnosis with STEMI, PCI not available, and BP 178/99, what medication to give? A. ASA, streptokinase, nitro,BB B. ASA, heparin, streptokinase,BB C. ASA,nitro,BB

Answer is B.

Thrombolytic should be in choices

Heparin should be in choices.

Exculde others that doesn’t have these 2 together.

Pregnant lady,41 GA in labor on epidural analgesia, mg sulfate for pre-eclampsia and oxytocin, CTG showed prolonged deceleration and the mother was hypotensive, most likely cause of the CTG finding: A. Mg sulfate B. Oxytocin C. Epidural analgesia

3yrs child , the mother noticed blood in his diaper for 2 days , no abdominal pain or constipation , he has similar episode 3months back .. what is the Dx ? A- juvenile polyp B- Michele’s diverticulum C- Intussusception D- hirschsprung disease

B Painless lower GI bleeding is the most common symptom of Meckle’s diverticulum. Another Q: Best diagnostic tool? Nuclear scan as Radioisotope scan

Female postpartum on ABx ( two drugs the names was given ) Due to endometriitis she came today with diarrhea and other symptoms , stool was positive for toxins bacteria what is your plan management? A- continuing same drugs B- Metranazole

A pregnant woman presented with massive vaginal bleeding from the abruption placenta and her Hgb: 8.6, BP 84\40, HR140. What is the best management to save her life? A- Admit to ICU B- Immediate Transfusion of 2 packs FFP C- Call multidisciplinary and rapid response team (RRT)

Whenever sending a research to the ethical committee, the reveiw proposal purpose is: A: giving friendly reveiw for your colleges B: to check the results after conducting the research C: to gain ethical approval before condecting the reesearch

Male patient came to ER with right femur shaft fracture, Hemodynamically stable, no other injuries. what is your priority? D.Pain management B. Blood control C.Maintaining function D.Decrease soft tissue trauma

Child came with parents walking doctor attract attention and throw ball and child throw back, draw a person with head feet and hand , imittate father 2 3 4 5

25-year-old female known case of epilepsy came with generalized tonic clonic seizure for 35 minutes and started on 20 mg IV lorazepam but did not respond, what are you going to give her next? A- IV Phenytoin B- IV Phenobarbital C- IV Steroid D- IV Fentanyl

Female with history infertility and previous abortion and try IVF two time with failure , she is having multiple uterine fibroid. Which of the following will help her the most to get pregnant A- Myomectomy B- Uterine artery embolization C- Medical therapy D- GNRH to decrease the size of fibroid

Patient on chemotherapy ttt for Non-Hodgkin lymphoma developed tumor lysis syndrome: A. Hypokalemia hypocalcemia B. Hypokalemia hypercalcemia C. Hyperkalemia hypocalcemia D. Hyperkalemia hypercalcema

Which of the following is true regarding single umbilical artery? A- Associated with african race B- Associated with maternal diabetes C- Major malformation in 80% of cases D- Low fetal mortality

Young pt with hiv admitted ICU for cough and fever and distress Xray show Acute respiratory distress syndrome No WBC no more information in the qs What is the causative agent? pneumocystis carinii Streptococcus pneumoniae

Pregnant in 38W GA, with polyhydramnios and PROM recently. Presented with painful vaginal bleeding and uterine tenderness, CTG finding shows persistent fetal bradycardia, what would be the cause? A.Cord prolapse B. Abruptio placenta C. Vasa previa D. Placenta previa

History of RTA, Spinal injury. - Bradycardia ( أهم حاجه ) - Warm extremities

Neurogenic

34 y/o female 30 gestation with painless vaginal bleeding, did vaginal examination found suspicious mass (see report) Report: US shows that the fetus corresponds to the Gestational age. What is the most appropriate next step? A. Colposcopy B. Cone biopsy C. Pap smear D. Endocervical curettage

5cm breast mass , thin breast : I&D Aspiration

* 1 month age asymptomatic baby with small defect 2mm (diagnosed with VSD accidentally during examination). How to treat? - watchful - start diuretic - surgical repair -cardiac catheterization

early diastolic murmur left upper sternal border Increase by pending forward and there was LVH, what is the most likely diagnosis? A) AR B) MS C) AS D) MR

GA15 what is the laboratory change for her A- Increase 20% plasma B- Increase 40% plasma ✅🤷🏻‍♀️

solve by Dr.wafa previously if dosen't specify WHAT occur in 1st trimester then answer will be B .

Known SCA and received blood transfusion 3 weeks ago Now he came for his hepatitis A vaccine You should : A-Give the vaccine ✅ B-ask him to come after 3 months C-Ask him to come after 6 months D-Ask him to come after 9 months

known case of liver cirrhosis secondary to Hepatitis C has completed treatment. Hepatitis C RNA is negative. How will you follow up this patient? a. Regular screening with AFP b. Regular screening with ultrasound ✅ c. Liver biopsy d. No follow up is required

Child with HTN, ankle and around eye edema, proteniurea, what is the most important history?

A. Recurrent UTRI

B. Abdominal trauma last week

C. Impetigo last week

Answer: A! C is incorrect, PSGN after 2 wks of URTI or 4-6 wks after impetigo!

There was lack of invelonza vaccine which most important group to give? A- school children B- pregnant women C- child with SCA

Amenorrhea for 6-7 weeks. Did pregnancy test at home and it was positive. Came now for Dating of gestation: A- US after 3-4 weeks B- Believe home pregnancy test C- Quantitative Bhcg

3 ;time 11-13wk ][ACOG ;Ultrasound measurement of the embryo or fetus in the first trimester (up to and including 13 6/7 weeks of gestation) is the most accurate method to establish or confirm gestational age.

patient who presented with signs of stroke and a CT shows subarachanoid hemorrhage. He was resuscitated but he is still hypotensive. What is the next best step? A. Craniotomy and evacuation B. Iv mannito

31 female, came for pap smear when to do it? A. Every 5 years B. Every 1 year C. No need D. If 3 is negative, no need to re-screen again

which age can we give peanuts and eggs to babies to prevent the risk of getting allergic? A. 10 months ✅ B. 14 months C. 18 months D. 24 months

Crohns large collection at rt fossa obs sx most appropriate: Pc drainage Resection Non aperative Laproscopic dx

C to the hospital with a diagnosis of Ebola. After a few hours, the patient wanted to leave to "just buy a drink and come back" you refused to let him out but he insisted. Which of the following is the most appropriate action? A) Call security B) Refer him to the infectious disease department C) Sign him DAMA D) Consult hospital administators Answer: A, Ebola is a life-threatening disease which poses a major risk to the public. He must be kept in isolation until he recovers.

An 81 year old male presenting with memory loss and difficulty remembering grandsons name, medically free apart from occasional alcohol intake. What is the likely diagnosis of his presentation? A) MultiInfract Dementia B) Alzahimers Disease ✅ C) Alcohol Induced encephalopathy D) Parkinsonism with Dementia

...32 years old male, known to have rheumatoid arthritis. He is controlled on steroids & hydroxychloroquine. Physical Exam is normal. Which is the best treatment regimen for this patient? A- Taper steroids & start Methotrexate B- Taper steroids & start ibuprofen C- continue same management D- forgot but irrelevant

65 yrs old male complaining of sever Lower GI BLEEDING What is most common cause A- Angiodysplasia B- IBD C- Diverticulosis

Answer is C. This Question is written in Washington manual book for surgery.

A women known chronic hypertension came to prenatal care counseling with expected pregnancy, she is on hydrochlorothiazide and lisinopril? A. Stop both B. Stop lisinopril and start methyldopa C. Continue both D. Stop ACEI and continue thiazide

What is the most important preventable risk factor for Dyslipidemia and CAD in females? A. Obesity B. Smoking C. Low sleep quality

Scenario of MI with ST elevation in lead v5,v6,AvL and lead 1 : Lateral Anterior Inferior

Patient presented with fistula at 7 O’clock. What is the the internal opening? A: medial post B: medial ant C: straight line D: lateral left

Pt post thyridectomy developed aspiration and hoarsness, which nerve injured ? A. Superior laryngeal nerve B. Recurrent laryngeal nerve

33 man builder presented with swelling in the groin area comes and go for three years, positive something Inguinal, By examination the doctor can reduce it back throw the inguinal canal Management? A.Herniotomy B. Herniorhaphy C. Tension- free with mesh D. No treatment

60 years old pt known case of inoperable small cell carcinoma came with altered sensorium, electrolyte were within normal except Na =115 (hyponatremia), asking about type of fluid to give? A) NS B) Hypertonic Saline C) Half NS D) 5% dextrose

Depressed pt with high serum Na low urine osmolality? DI SIDAH

Patient with PAD has 100-meter claudication's, DM, heavy smoker, not getting better. How to improve his walking distance? A. Supervised exercise program B. Strict glycemic control C. Smoking cessation

Patient underwent some investigations as routine work up for his new job. Hepatitis serology was: Positive HbC-IgG, Negative Anti-HBe. Diagnosis? A. Chronic hepatitis B B. Vaccinated Hepatitis B C. Patient is recovering from Hepatitis B

Pt take 4 bags of blood then perioral tingling ANEThesia occur due to 1-citrate toxicity 2-hypocalcemia 3-hyperkalemia 4- hypomagnesemia

Young male baby came to well-baby clinic, upon examination his right testis was palpable in the inguinal canal and small in size and easily moved to scrotum, the left is normal, what is the cause? A. Ectopic testis B. Undescended testis C. Testicular torsion D. Retractile testis

Baby with vertex presentation … what the most appropriate way to deliver? 1-Cs 2-Spontaneous normal vagina 3-forceps 4-ventous

Sandifer syndrome infant case ask about risk incidence in : -Post- pertussis infection -low birth wight

assoc with gerd

t known case of DM1 came to ER ( with typical DKA ) and then they mentioned Diagnosed as DKA and IV fluid start what next to give : 1- IV insulin 2- Iv insulin as well as long acting insulin 3- SC insulin 4- sliding scale insulin

Albumin 30 Bilirubin 30 INR 1.9 Tens ascities Confused and decrease level of consciousness Calculate child score: A B C

12 years old found to have klebsella colony 100000 from mid urine no sign or symptom 1) no need to treat 2) treat as acute uti 3) give embrical antibiotic

Pregnant with seizure given 6 mg sulphate then decrease to 4mg. On Examination there is absent deep tendon reflex, what to do? A. Reassurance B. Re-increase Mg sulfate dose C. Stop Mg sulfate D. give Ca gluconate

Best test to see the glycemic control during pregnancy in the routine visit in pregnant with DM? - random glucose - fasting - hba1c

History of female with inablity to conceive for 3 years , in the last 6 months the her cycle become irreugular or abscent , Labs shows : TSH : 9.2 ( 0.5-5 N ), Prolactin: 140 ( normal less than 25 ), other labs are normal ( FSH and LH ) most likely diagnosis is ( exactly written like this ) : Hypothyroidism Hyperprolactinemia Hypopitutrism

Male pt complain of recurrent heartburn increase when lay down at night, he felt a bitter taste in his mouth when he was lifting weight at gym, diagnosis? A. Esophagitis B- PUD B. Gastritis C. Boerhaave syndrome

child had meningitis, and he contacted his brother & sister, what will give as prophylaxis ? A- rifampicin for 2 days BID B– penicillin C- Ciprofloxacin one dose D- Ceftriaxone 3 doses IM

A female patient presented with joint stiffness, she also has photosensitivity, malar rash with healed ulcers, her proximal muscle strength is 3/5. Labs ANA +ve Rheumatoid factor +ve CBC shows anemia Which of the following serves the highest diagnostic value? A-Anti DsDNA B-Anti CCP C-Anti RNP

A 2 years old boy who took BCG vaccine came with his mother becuase of his grandfather had open TB and they live in the same house, the boy asymptomatic but the mother worried what should you do? A- nothing since he took BCG vaccine B- PPD, X-ray and wait for the result C- IGRA, X-ray and give INH D- IGRA, X-ray and give 4 TB drug

Child presented with high grade fever and ear discharge. What’s the cause? A: viral B: bacterial

malaria recurrence which one A- falciparum B- vivax C- ovale D- malarie

b/c

40 yrs. Chronic diarrhea and significant weight loss for 10 months. No melena or bleeding. BMI is 18 Hb normal No fecal occult blood. Mx? A- Glutin free diet B- PPI C- Loperamide D- Metronidazol

If Giardiasis — Metronidazole If Celiac — Glutin free diet

lady mised period which most appropriate time of us A. 11-13 weeks B. 16 - 18 weeks C. 18 - 22 weeks

Patient has cough with yellowish sputum and had red streak in sputum for 2 days , high fever, CXR: right lower lobe lung infiltration ? A) community acquired pneumonia B) acute bronchitis C) TB D ) bronchiectasis

post neck surgery, Loss of sensation angle of mandible and lower pinna. Most likely injured Nerve?: a-great auricular, b-less occipital, c-great occipital d-third occipital nerve

Case of cough - conjunctivitis developed fever and Maculupapular rash all over the body Rubella Paravirus Don’t remember other choices

Symptomatic (menorrhagia)What is the common fibroid type ? Serosal Submucosal intramural

COPD patient came to clinic with bilateral lower limb edema and pulmonary hypertension. O2 sat 86% ,PO2 8.6, PCO2 7.5, pH above normal range Which of the following the appropriate management to give for the patient now A) start oral furosemide B) Start oxygen therapy C) Prednisolone therapy

77 years old patient came to the clinic and while the nurse was measuring her vitals found that she have irregular pulse. An ecg was done and showed she has presistant atrial fibrillation. She have migraine that she takes prn ibuprofen for she also have asthma which she occasionally takes salbutamol for. What to give the patient now ? A- Aspirin B- clopidogril C- Aspirin with dipyridamole D- oral anticoagulant

40 year old male presented complaining of multiple episodes of sudden fainting. He has exertion after exercise. On examination there is mid systolic murmur in the left sternal border. No radiation. Increase while standing and bear sitting. What is the most likely diagnosis? A- Aortic stenosis B- Mitrial stenosis C- Hypertrophic cardiomyopathy

An elderly with end stage cancer c/o severe pain. The family asked the physician to give a stronger analgesic or to increase the dose. The doctor explains that while it might help alleviate the pain, it also might hasten their father’s death. Which of the following is this referred to? A) Principle of subsidiarity B) Principle of double effects C) Principle of totality D) Principle of informed choice

25 yo medically free 38 GA , SVD = CTG: fetus heart rate 180 + early deceleration , what may lead to CS? 1- fetal HR 2- early deceleration 3- patient age

1 year old girl with lesions on face scalp trunk and extensors. That are itchy. She also has them on her cheeks, her parents say that it's crusty, cracky and weepy. A. infantile eczema B. idiopathic urticaria C. drug induced allergy D. early childhood eczema

56 year old male with long standing heartburn, did endoscopy and showed barrette esophagus with low dysplasia, what is the initial ? A Esophageal resection B Pantoprazole C Renitadine D Sucralfate

Contraindication to Mediterranean fever? A. Ibuprofen B. Acetaminophen C. Aspirin D. Amoxicillin *no macrolide in the choices

9 years diagnosed with shigella. What is the most appropriate antibiotic? A- Azithromycin B- Ceftriaxone C- Metronidazole D- Amoxicillin

Female with vaginal discharge Grey, fishy odor , smear : show clue cells, Treatment? A. Metronidazole B.Topical clotrimazole

hypertensive patient came with signs and symptoms of heart failure, which type of heart failure? diastolic dysfunction systolic dysfunction hypertrophy

Patient came normocytic anemia, fever, chest pain. Blood smear showed target cells and inclusion bodies, what’s the diagnosis ? A. Gi infraction B. Lead poisoning C. Sickle cell anemia D. Infection

Pt old his regular doctor transfured to another hospital he’s upset and wants medical record and referral to his regular doctor A- Convince him that there’s equally compitant doctors B- Give report and refer him C- Refuse D- Calm him down and tell him to come tomorrow to decid

Long case of a diabetic patient who also has gout. Which of the following drugs aggravates his arthritis? A: Lasix B: Plavix C: Aspirin D: Metformin

A pregnant woman GA 30 weeks with preterm labour was given a Tocolytic. What is the rationale behind giving tocolytics ? A- To Delay the delivery until 38 weeks B- To maximize the effect of steroids

child with fever, rash, edema, dry conjunctivitis, dx? A- Kawasaki

pregnant female GA 10 n/v, severe dehydration (all dehydration signs), white coating on tongue, recieved iv 10% glucose in NS, bp 90/60 which urine analysis confirms the dx? Glucose Wbc Protein Ketone (hyperemesis gravida present w ketonuria)

Case of stress incontinence. The patient want Most effective treatment: A- pessary. B- Burch procedure. C- transvaginal tension free tape.

Calculate the maintenance fluid for a child with 18kg in ml/hr

38 weeks GA, sever headaches, LL oedema, mieldy elevated LFT??? Not sure put there was Low platelets 45 What to do C/S Induction of labor Observe

Septic focus: Post op or Pnemonia and sepsis or Obstetrics complications and also fever. - Tachycardia - Increased COP ( أهم حاجه ) - Warm extremities.

Septic

adult 30s-year-old with hematuria and flank pain IVF» radiolucent filling defects US» hyperdense acoustic shadowings Dx? A. Uric acid stone B. renal tumor C. sloughed renal papillae

Case scenario about crohns came with perianal pain ,redness, flactuant mass what's ur management 1-I&D 2-MRI

Female smoker and obese with hepatic hemangioma 4*4 cm. Which of the following advice will you give her? A)Stop smoking B)Decrease weight C) Avoid highly competitive and contact sport ✅

Ptn take 4 bags of blood then perioral tingling¶thesia occur due to 1-citrate toxicity 2-hypocalcemia 3-hypkalemia 4- hypomagnesimia

Case of anemia , child had pica and abdominal pain and constipation Lead 2 Iron low TIBC high Asking about Tx ? Iron supplement Vit k lead poisoning

Cause of electrolyte disturbance in glioblastoma? A- Cerebral salt wasting syndrome B- Excessive consumption of water C- SIADH

Rational behind giving steroid before preterm labor? Respiratory distress syndrome

stop him but he continued to ignore his mother. Which of the following would you advise this mother? A) Ignorance B) Counselling C) Positive reinforcement D) Punish the child

Child who can jump on both feet, say two words sentence, compare two things how old is he: A. 2 years B. 3 years C. 4 years D. 18 months

Hyperkalemia 6.5 in CKD patient, next step ? A. Calcium gluconate B.insulin and salbutamol C. Dialysis

esophageal varices to prevent future recurrence/bleeding? BB H2 PPi No need

What heart murmur increases with prolonged hand grip and decrease with valsalva ? A-AR B-AS C-MR D-MS

60 YO male post cholecystectomy 4 days ago presented to ER with chest pain started 4 hours ago and ECG showed STEM. He was given Oxygen, morphine, aspirin, heparin and nitrate. What would you do after ER management? A. Give thrombolytics B. PCI ✅ C. CT angiography D. CABG

A 6 months old baby known case of G6PD came to hospital , on examination there is pallor conjunctive No mention of jaundice In labs HGb was only low There was no mention of reticulocyte No mention of iron profile Others labs was normal Diagnosis: A- physiological anemia of newborn B- thalasemia trait C - G6PD hemolysis

Case of patient with seizures K normal Na low plasma osmolarity low urine osmolarity normal (but was high normal) addison cushing conn siadh

Pt with endometriosis failed nsaid , what to give ? Ocp

yes

34 or 37 weeks with active labor , 4cm dilated, intact membrane. No vaginal bleeding. Abdominal pain is increasing in frequency. Uterus is tender. - all findings are just going with active labor- Next step? A. CBC 2. US 3. CTG

A young patient presented complaining of right upper quadrant pain. On examination there is RUQ tenderness and a palpable mass. Investigation showed Entamoeba histolytica, and there is abscess 12 x 14 cm with septation. What is your *initial next step* in management? A. Percutaneous drainage. B. Metronidazole. C. Percutaneous aspiration. D. Surgical removal

Pregnant bp 149/90 what to give ? A- Nifidepine B- Hydralazine C-Metoprolol No labetalol

labetalol

nifedipine

methyldopa

Patient post RTA, cyanosed, have profuse mouth and nose bleeding , open Femur fracture + presentation of pneumothorax Vital: hypoxic + Hypotensive What to do next A. Thoracostomy tube B. Intubation for MV with cervical stabilization or something C. Ant and post nasal packing D. Establish IV access and start emergency O- blood transfusion

Stab wound to the anterior abdomen. Vitally stable. What’s the most appropriate next step? A. DPL B. FAST C. CT abdomen D. Exploratory laparotomy “No local wound exploration”

C. CHOOSE local wound exploration if present the full choice (and not surgical exploration in the OR). You have to finish your physical examination before doing any sort of radiological or laboratory investigations or any type of intervention. If choice B was wound exploration using surgical methods in the OR, go for CT.

Pt complaining of dizziness after waking up, hot warm and flushes. Watery diarrhea , itching. On examination, Abdomen examination normal, Respiratory exam reveal wheezing, Cardiac exam (murmur maybe) I’m not sure but there is finding, What you will order ? A. Amylase and lipase level B. Us for the abdomen and the pelvis C. 5 hydroxyindolycytic acid (urine) ✅

C SEROTONIN SYNDROME

24 year old female came with abnormal papsmear, what will you do ? Colposcopy, repeat pap in 3 months , reassure

more info

Child with absent red reflex 1- mri brain 2- reassurance 3- ophthalmology referal for examination under sedation

But question about pt who had splenic laceration and thoracic aorta tear , and you are in a tertiary center and the pt collapsed what is your action : 1- do abdominal laparotomy 2- refer to vascular surgery

35-Chest gun wound entry was lateral to left nipple and exit point below left scapula, patint suddenly become worse w/ raised JVP , on auscultation Normal air entry and muffled heart sound, most appropriate management? A-fluid bolus B-Pericardiocentesis ✅ C-Immediate thoratomy

3 year old with mid-shaft femur fracture, angulation 30 degree. What is the Best management? A. Closed reduction & hip spica B. Open reduction & plate C. Open reduction & IMN

Copd patient presented with exacerbation he was fully conscious. He was started on high flow oxygen then he started to deteriorate with decreased level of consciousness. PH 7.18 PaO2 15 kpa . What is the initial thing you would do? A- intubation and ventilation B- decrease oxygen flow C- give salbutamol? D- give ipratropium?

A 37 GA pregnant presented with moderately sever bleeding(written like this) US done showed: placenta covering the cervical oss and a 32 pregnancy: What is the management: A- expectant management B- CS C- reassure

Pediatric, known case of congestive heart failure and hypertension presented with dyspnea on exertion And decreased exercise tolerance X ray showed cardiomyopathy: A- stat iv frusemide B- digoxin C- reassure as this is expected of disease

Most effective method to decrease stone formation in pt with hypercalcemia ? decrease ptn thiazide allopurinol decrease calcium intake

Pregnant lady came with SOB, she have Leg swelling , what is the most appropriate next step? A. CT PA B. Chest x-ray C. Doppler US of LL D. V/Q scan

36yo pregnant smoker with epilepsy and asthma , what is the risk factor for ( idont remember) pph or intrauterine bleeding? A asthma B smokeing C epilepsy D age

2 or 4 days old came to you with apnea. PE: machinery murmur + wide pulse. CXR: bilateral wet lung. Next initial treatment? A. Fluid restriction+ diuretic B. NSAID ( prostaglandins inhbitors).

Which of the following is the indication of cervical cerclage? A. Cervical length less than 30 B. Cervical length less than 35 C. Cervical length less than 25 D. Cervical length less than 20

baby with Ejection systolic murmur with click heard in the left second intercostal and left parasternal heave distended JVP and ejection systolic murmur increase with inspiration: A. AS B. coarctation of aorta C. VSD D. congenital pulmonary stenosis

The government did a health campaign to encourage the consumption of low fat products and a low salt intake in order to prevent hypertension and diabetes. Why type of prevention is this? A) Primordial prevention B) Primary prevention C) Secondary prevention D) Tertiary prevention Answer: B

b, repeated

A 58 year old female know case of diabetes Mellites came with abnormal liver function test which of the following most likely diagnosis ? • A-hemochromatosis • B- viral hepatitis • C- autoimmune liver disease • D- non -alcoholic fatty liver disease

Female pregnant first trimester, which one of the following blood chemistry will mostly appear ? A. Increase in plasma Na B. Decrease in creatinine C. Increase BUN D. Unchanged BUN

pt fall from 4m hight and state that he cant feel his lower extremetis, on PE he had warm extrimries. he was given 1L of crystalloid fluid which improves his BP, a CVP was placed to continue ressucitation and it showed CVP of 2mmgh BP 76/43 (not sure) (other vitals were given but can’t recall) which of the following is the best initial managment? - Crystalloid fluid resuscitation - blood transfusion - IV mannitol - IV steroid

G3p0, A2 now at 5 weeks presented with spotting on examination open os and no active bleed. History showed 2 abortions at 2nd trimester, last one with D&C diagnosed as incompetent cervix. Your diagnosis now for the third pregnancy of this patient? A- Asherman syndrome B- Incompetent cervix C- Chromosomal anomaly Answer: C (GA is 5 weeks)

What is the difference between Crohn and UC A- Noncaseating granulomas B- involved the colon C- Extraintestinal symptoms D- aphthous ulcer

An 81yo male presenting with memory loss and difficulty remembering grandsons’ names, medically free apart from occasional alcohol intake. What is the likely diagnosis for this presentation? A- Multi-infarcts dementia B- Alzheimer’s disease C- Alcohol induced encephalopathy D- Parkinsonism with dementia

Patient did proctocolectomy for UC after 12 hours fever, 110 HR, wbc 14000, did not mention source of infection A- sirs B- bacteremia C- sepsis D- severe sepsis

13 Y/O female brought by her mother who was concern about her daughter’s height. Upon examination there were know signs of pubic hair or breast development. Hight was 152 and weight was 37. No family hx of similar problem: A. Hormonal delay B. Familial delay C. Constitutional delay D. psychosocial delay

Child abdominal mass Extending toward midline & HTN only Wilm Neuroblastoma

young patient hearing voices for 3 months what is the diagnosis? a)brief psychotic disorder b) schizophrenia c) schizophrenia spectrum disorder

Pregnant delivered her baby at home, the baby has onle bruses , what is the dx? Invst show : normal plte and high pt and ptt A-Thrombophilia B-Itp C-Factor X def D-hemorrhagic disease of newborn

Stab wound to right chest, on examination there is distended JVP, decrease breath sound on the right side, subcutanous emphysema and trachea shift to the left, dx? Tension pneumothorax Massive hemothorax Spontanous pneumothorax Pericardial temponade

36) 70 years old, menopause, came seeking hormonal replacement therapy, and you explained that there is no benefit in her case, but she insisted, what you will do? A) Refer her to another gynaecologist B) Prescribe her the medication C) Refuse her the medication D) Consult the ethics department Ans C

Pt got burned by the grill, noticed greenish discharge What is the causative bacteria A) E coli B) klebsiella C) pseudomonas D) strep pyogenes

Renal and SLE management Hydroxy + cyclo Hydroxy +meth

A 50 year old sustained blunt trauma to the chest with persistent pneumothorax and significant air leak through double intercostal tubes most appropriate next procedure ? A. Reposition of ICT B. Prompt thoracotomy C. Endotracheal intubation D. Fiberoptic bronchoscopy

Patient on Double intercostal tubes and still there’s air leak? More likely to be Tracheo-bronchial injury and diagnosed by Brochoscopy. Ref: Thawabh.

Scenario of patient has sign and symptoms of meningitis , but he also has altered sensorium what’s the diagnosis: A- Bacterial meningitis B- viral meningitis C- Meningoencephalitis

Easy case about a surgeun decide to give blood transfusion because the patient is BLEEDING a lot suddenly in mid of the operation : 1- go take consent from ... 2- Do it without consent

Heroine

methadone

pregnant in 31 weeks presented to ER with labor pain, 4 weeks ago she was diagnosed with PPROM, now the the amniotic fluid is exposed, and she has 3 contractions in 10 min. What is the next step in management? A- High vaginal swap for culture and sensitivity B- IOL C- Augmentation of labor D- Fetal blood sampling for ph and liquor

Child presented with fever, jaundice, hepatomegally and RUQ tenderness. Liver enzymes were high. The mother gave her child paracetamol every 4 hours for his high temperature What is the most likely cause of this presentation? A) Hepatitis B) Paracetamol intoxication C) Autoimmune hepatitis

A mother of asthmatic child is worried about the future of her child’s case. What you will tell her? A. He will have asthma for the rest of his life B. Pediatric asthma will disappear by adolescence C. Pediatric and adult asthma are unrelated to each other D. His case will develop into chronic lung disease

child had meningitis, and he contacted his brother & sister, what will give as prophylaxis ? A- penicillin and rifampicin for 1 week B– penicillin C- Ciprofloxacin one dose D- Ceftriaxone 3 doses IM

Case of thrombocytopenia with postpartum hemorrhage what is the management one of the options fresh frozen plasma other options steroid

ffp

17year old female, medically free, gymnast in her class, developed breasts later and never menstruated, on examination she is tanner stage 5 but no menstruation, diagnosis? A. hypothalamic hypogonadism✅ B. imperforate hymen C. gonadal agenesis D. testicular feminization

Child with Heliotrope rash thikness over metcaropharygeal and muscle pain: Juvenile dermatomyositis ✅ Scleroderma

A long scenario of a pediatric with open fracture. You see his thigh covered with gauze full of blood. Hypotensive but awake and airway potent. What is the best next thing to do? A. Call surgery on call B. Give bolus NS ✅ C. Give morphine D. External fixation

A female didn't remember her LMP. How to know the the gestational age? A- Physical Examination B- Abdominal U/S at 18 weeks C- Tranvaginal U/S as early as possible

child presented with URTI symptoms two days ago, now has SOB what is the most common organism? A- RSV B- influenza C- parainfluenza D- adeno

Most appropriate for celiac: Duodenum biopsy Anti endomysial

When to screen pregnant lady for asymptomatic bacteruria? 1 at 12th week 2 20 3. 26 4. 36

32 y/o Obese woman complaining of irregular mensuration and chronic anovulation, endometrial sample showed: atypical complex hyperplasia .. what’s the most definitive treatment(complete scenario) ? - tamoxifen -Letrozole -progesterone -spironolactone

C The definitive = hysterectomy / the bast for her = progesterone

32- patient has appendicular abscess large 10*15 reaching the right flank there is also fecalith on the US what should u do A. Laparoscopic appendectomy B. Open appendectomy C. Percutanous drainage

Pregnant lady in 39 GA presented with cervical dilated 5 cm and clear amniotic fluid draining on speculum ex , regular and strong contraction CTG normal no acceleration or deceleration What’s your next step A- induction of labor B - augmentation C- reassurance and reassessment after 30-60 mint

Soldier going to southern region of Saudi Arabia. What is the best malaria prophylaxis? A. Malarone B. Atovaquone-proguanil C. Mefloquine D. Chloroquine

A young female patient presents to the emergency department with abdominal pain, vomiting, and fever. Physical exam reveals splenomegaly and mild jaundice. Ultrasound reveals pigmented gallstones. Which of the following is the most likely diagnosis? A. G6PD deficiency B. Thalassemia C. Hereditary spherocytosis D. Paroxysmal nocturnal haemoglobinuria

Victim in RTA who did Ureteroscope urethrogram and found injury in the bulbar, what do you want to do next? A. A-Suprapubic catheter B. B-Foley catheter

Mx of follicular cells in cervical LN? Refer to surgery LN dissection Aspiration

Pt came with signs and symptoms of TB fever hemoptysis and so on… You did x-ray and found cavitation What will you do next? A-sputum AFB B-start INH, rifampin, ethambutol and pyrazinamid

Pregnant ga14 hbv +ve what to give child after birth: Hbv ig Hbv vaccine Vaccine and ig Nothing

550-finding of biopsy in celiac disease? A- subtotal villous atrophy B- Crypt flattening

Pediatric patient had a fall from 1 story high and direct trauma to the head, presents with hemotympanium No loss of consciousness, no vomiting , neuro exam Normal Ear : Ruptured tympanic membrane with intact external auditory canal Most likely bone fracture: A- Mastoid B- Maxillary C- Basal skull

31w pregnant lady complains of small and slow vaginal bleeding, shes a confirmed case of low lying placenta, A-expectant management B- Biophysical profile C- CTG D- Emergency delivery 100% sure about the choices

C BECAUSE WE NEED TO SEE IF THERE IS FETAL DISTRESS OR NOT WHICH WILL AFFECT MANAGEMENT

23 y/o pregnant women came to antenatal clinic with hx of 2 preterm birth C/O vaginal spotting of blood , which of the following recommended tx ? A. Progesterone B. Estrogen C. Indomethacin D. MgSo4

Gastric bypass 4 months ago come with bowel obstruction with genrlized tenderness and postive rebound , leukocytosis, metabolic acedosis and increase lactate:- 1- laparotomy 2- gastrofraffen

Child with group A strep pharyngitis. What will you do with his brother? A. Observation ✅ B. Throat culture C. Throat swab for rapid antigen test D. Antibiotics

A you give penicillin prophylaxis to Patients with a history of acute rheumatic fever

Ectopic pregnancy case initial BhCG 2900, given methotrexate, one week later BhCG 6000 what to do: A- repeat methotrexate ✅ B- Diagnostic laparoscopy

Intermenstrual bleeding for 5 days, what is the most appropriate next step? A-Us B- Bhcg C- TSH

C wafa

Child Walk independently and have an immature pinsle grip say 6-7 word can name 2 part of his body 20 19 17 12

34 yo female medically free presented with painless non-tender mobile firm mass in the left lobe of thyroid, right is completely normal She have no symptoms and no history of radiation What to do next: A. Thyroid Tc99 scan B. FNA C. T3 level D. TSH

Female 27 years old, she is asymptomatic, her last pap smear was 3 years ago and it was normal. What is the most appropriate thing to do? A-Repeat pap with cytology ✅ B-No need and reassure C-Colposcopy D-Cervical swab

patient with rings in his eyes, wilson disease, hemochromatosis

Risk of MI in smokers compared to non smokers in folds ? A. 1 B. 2 C. 3 D. 4

4 y.o his went to doctor because parents recognize blood in stool this the only symptoms Then the doctor examined him and said it’s common and can be preventable: A- anal fissure ✅ B- hemorrhoids C- juvenile poly D- Intusseption

Abnormal kidney function ask about prophylaxix for travel diarrhea florqounolones conservative

CIPROFLOXACIN) THE PT HAS KIDNEY ISSUES, WE DON’T WSNT TO EXPOSE HIM TO DEHYDRATION AND POTENTIALLY AK

conservative if minimal kidney disease

Patient with schizophrenia, with both negative and positive symptoms how to treat ? -Clozapine -Fluphenazine

An 18 months old child diagnosed with congenital heart disease, presented to the ER with severe cyanosis and hypercyanotic spells. The mother mentioned that he was irritable and crying inconsolable for the past 1 hour and the cyanosis is getting worse. On examination, he looks cyanotic centrally with loud harsh ejection systolic murmur at the left sternal border. BP 100/60, HR 95, RR 28, Temp 37.8, So2 85%. Chest xray showing small heart with decreased pulmonary vascular marking. WHich of the following is the most appropriate management? A. Sedation and pain relief. B. IV diuretics bo;us. C. Immediate cardiac catheterization, D. IV antibiotics and total parenteral nutrition.

Most important inhaler treatment used in COPD exacerbation? A) Albuterol B) Salmetrol C) Ipratrobium bromide

Which of these is an indication for home oxygen therapy in COPD? A- 1 reading of Po2 < 7.8 kPa B- 2 readings of Po2 < 7.3 C- 1 reading of Po2 < 8 D- 2 readings of Po2< 6.3

Pt confirmed of ebola is saying either discharge me or i will leave on my own, what to do? A) Let him sign DAMA B) Call the security C) Call infection control D) Inform the ethical comity

25% blood loss what will decrease:- 1- pulse/blood pressure 2- urine output 3- RR 4-GCS

Labia majora hair not reaching mons pubis, non seperated breast bud and areola ask about Tanner stage Tanner 2✅

Patient’s family they don’t want from the doctor to share their patient’s disease to others, you have the right to share his disease if it is? reportable disease Other mcqs irrelevant

45, P6, chronic pelvic pain, menorrhagia US thick uterine myometrium and what is the definitive - hysterectomy, D&C give Gnrh agonist prior to surgery for fibroid to reduce size

Child examination: look to the wall , bend forward this examination of waht? Sexual abuse , scoliosis, rectum prolapse

3 day neonate with sudden cyanosis Egg on string and increase polmnary vascular marking? Pda Tga Tof

Pt complain of profuse discharge and tender vaginal fornix A. Acute salpingitis B. Acute cervicitis C. Appendicitis

a..

546- Mother came with her child for preschool Vaccination Which of the following is important Vaccine to give : RV OPV ✅ Meningococcal ( MCP4 ) Hib

Coild NG tube in esophageal pouch: Hiatus hernia Esophageal atresia Tracheoesophageal fistula Choanal atresia

A 67 year old male presents with insomnia, irritability and palpitations for 3 months. He is known to have HTN, depression and Atrial fibrillation. He is on amiodarone, fluoxetine, and enalapril. Although he complains of palpitations, he has no increased heart rate. Clinically, he is unremarkable. Vitally stable. What is the most appropriate next step? A. Add propranolol B. Do thyroid function tests ✅ C. Substitute antidepressant drug D. Refer to psych

4 yr Patient presents with meningitis what’s the cause: -meningococcal meningitis - pneumococcal meningitis

45 years old male or female, has a mass 5 cm in right upper limb, (MRI shows a mass from triceps) what to do next? A- Incisional biopsy B- Excisional biopsy C- Core needle biopsy D- PET scan

Abdulrahman: The answer is C. In another recall, it was suggested that the mass was a sarcoma in the triceps. Core needle biopsy is the standard now to diagnose sarcoma , previously it was incisional bx. Accuracy of core needle (trucut bx) is up to 85%.

Patient presented with pinna pain upon physical exam when pinna pulled out the patient felt pain in its site. What is the treatment? A. Topical neomycin. B. Oral neomycin

Child presented with 2 days history of fever on physical exam perforated tympanic membrane and pus in the external canal dx A. Acute otitis media B. Otitis media with effusion C. Chronic otitis media D. Acute otitis externa

Pregnant in 8wks GA, came to antenatal clinic with cervical incompetence diagnosis What’s your action ? السؤال كان كذا بالحرف الواحد بدون زيادة او نقصان A- suturing now B- confirm dx by hegar dilator C- suture in 14-16 wks

pregnant patient known HTN takes acei what to do? Stop, change

change

A couple came to you in clinic. One of them 25% carrier and other is healthy and the transmission of disease will increase with consanguinity. What is the type of inheritance? A- Autosomal Dominant B- Autosomal Recessive C- X-Linked Recessive

78 YO post-op contaminated surgery. Admitted to ICU and given 6 L of crystalloid IVF and 1 PRBC in the last 12 h. Broad spectrum antibiotics were given. , CVP is 40”over fluid treatet = no hypoVoluimia” 8-12 Vitals: BP 70/45 HR: 125 T: 38.6 O2: 93% Labs: WBC 8 Most appropriate IV intervention: A-Albumin B-2 L crystalloid fluid C-Norepinephrine D-Furosemide

Pregnant 28 weeks came with bilateral breast mass it was movable and the size was3x4 cm, most appropriate next step? A- reassurance and follow up after delivery B-bilateral breast ultrasound✅ C-Bilateral breast mammogram D-MRI

Female post partum with symptoms of hypothyroidism Lab show low T4 What is your next step ? Measure TSH Start tx with levothyroxin

Pregnant 30 weeks come with regular contraction 4 in 10 min, 2cm dilation 80% effacement, no fluid leakage or bleeding, what most appropriate? A. Steroid and anticipate delivery B. Steroid, tycolytic, GBS prophylaxis

Pt had chemo session then developed signs of infection diagnosed as deep aspergillosis What is the treatment of choice for aspergillosis? A.voriconazole B-meropenem

Patient had flank pain with dysuria, hematuria, and burning sensation Which of the following is the most appropriate next step? A. Renal US B. IV and Oral contrast CT C. Non contract CT D. Isotope

child with hypoglycemia & seizure & metabolic acidosis & characteristics smell & positive ketones, Diagnosis? A Phenylketonuria B Maple syrup urine disease C Galactosemia

Steady decline; typically over ∼ 8–10 years but more rapid progression is possible Visual hallucinations and parkinsonian motor disorders Attention impairment MRI Diffuse mild cortical atrophy Atrophy of substantia innominata and mesopontine gray matter SPECT: may reveal decreased occipital perfusion/metabolism Lewy bodies (intracellular aggregations of mainly α-Synuclein)

lewy body

23 week pregnant and length 30 mm

An immunocompromised patient presents with perianal painful swelling. Examination showed perianal painful erythematous fluctuant swelling with crepitus and foul smelling discharge. What is the most appropriate management? A- Surgical Drainage B- Aspiration of collection C- IV penicillin D- Polymyxin B ointment

infant came to well baby clinic, most urgent is? superficial sacral dimple absent femoral pulse autism

Patient came with new onset left bundle branch block (LBBB), was given aspirin, heparin what to the most appropriate next step ? A. Give carvidolol B. Give warfarin C. Do PCI D. Do ECHO

Pediatric case h/F sore throat & fever then 3 days he develops body rash on the thighs and buttocks.Lab finding suggest renal insult with anemia and normal Plat count) plus ll edema +black tea urine. A- post streptococcal GN B- HUS C- HSP (Henoch-Schonlein Purpura) ✅

Patient DM with MI on medication but i forgat i think on Aspein and netroghlycrine HA1C 12 What is the the most important meds for Hospitalization? Sliding scale insulin Postprandial and preparndial insullin

In some studies, treatment with such a basal-bolus insulin regimen was associated with better glycemic outcomes than sliding-scale insulin

Female on the 31 weeks gestation, has +2 edema and +3 proteinuria, her blood pressure elevated, presented to the ER with new onset tonic-clonic seizure and is now unconscious. What is the initial management to do? A- magnisum sulphate B- open and maintain airway

Went for myomectomy of subserosal fibroadenoma, but opened the uterus. Risk for placenta accreta? -increased✅ -decreased -Unknown -not affected

Old male had colorectal polyps and those polyps were excised in histopathology showed as tubular adenomas, when is the right time to be followed up for his case: 3 years 6 month 10 years 1 year

initial treatment of subacute thyroditis |: methimazole, RDA, bb

Female with amenorrhea for 3 months what is most appropriate ? A. Pregnancy test B. Us

4 months baby born preterm 33 weeks due to emergency cescrian section regarding his vaccines what is the most appropriate protocol to follow? A) give him vaccine according to his chronological age B) give him vaccines by his correct gestational age C) delay all vaccines D) other The answer always mentioned at recall wasn't there (give him as schedul)

45-year-old female with depression and breast cancer, underwent mastectomy. Labs showed hypernatremia and low urine osmolality. Which of the following is the cause? A. SIADH B. Diabetes insipidus C. Psychogenic polydipsia

38 YO female presents to the clinic after finding of hilar lymphadenopathy on CXR. She has on and off cough, but denies any fever, headache, n/v, weight loss all negative. Labs insignificant except for X-ray shows confirmed bilateral hilar lymphadenopathy CT guided biopsy shows noncaseating granuloma What is the best next step in management (They wrote “all labs were normal” and didn’t mention hypercalcemia) A-Observe B-Start prednisolone C-Start azithromycin D-Start anti TB medication

Severe asthma, patient can not complete 1 sentences, inspiratory and expiratory wheeze, High Co2 and low 02, how will you manage? or normal A- Mugnesium sulphate B - IV Theophillin C- Intubation and mechanical ventilation D- High flow oxygen

C RESP MUSCLE FATIGUE

child came in 6 month vaccination mother said he have anaphylactic reaction required hospital admission after 4 month vaccination but she don’t know what vaccine What should be done now? 1-do allergic test first 2-vaccination except for dtap 3-reassures and vaccinate 4?

Female 20 years recently develop mass 2x2 cm that is oval in shape and smooth wall. what is your Dx? A - breast cyst B- fibroadenoma C - fibrocystic cancer D - intraductal carcinoma

child on leukotriene only, had multiple asthma exacerbation after exercise, admit to hospital and he was controlled by albuterol what will you give for long-term treatment? - Oral corticosteroid + SABA - LABA + SABA as needed - leukotriene + SABA - 2 daily ICS + SABA

Pt with chest pain and dyspnea and splinter hemorrhage what the organism that cause the symptoms? - Staphylococcus epidermidis -streptococcus species

Patient RA and develop pneumonia ( fever , SOB , high wbc and CXR confirm pneumonia ) what to do regarding her medication ? 1- continue both methotrexate and adlinamab and give Abx 2- stop both and give Abx 3- stop MTX any give Abx 4- stop adelinmab and give Abx

19 yrs old dysmenorrhea resolve on 3rd day and resolve after few , Sxs associated with sever pain radiated to upper thigh, she had this for several years and getting worse A- Primary dysmenorrhea✅ B- premenstrual C- secondary dysmenorrhea D- endometriosis

37y female htn,dm ,heavy smoker has a family hx of cancer colon,breast cancer what to do now 1_mammogram 2-colonoscopy 3-bronchoscopy

Ctg pic with case: Pregnant lady,41 GA in labor on epidural analgesia, mg sulfate for pre-eclampsia and oxytocin, CTG showed prolonged deceleration and the mother was hypotensive, most likely cause of the CTG finding: A. Mg sulfate B. Oxytocin C. Epidural analgesia

Child has fatigue and splenomegaly , Hb low,RBC low ,MCV low ,Retic normal ,Iron normal , What to replace in this case ? A.Iron B.B12 C.Folate D.Erythrocytes

D Answer is Erythrocytes. According to the other recalls the Iron profile was provided and it’s normal. Since the Diagnostic test of IDA is iron profile this patient doesn’t have IDA. So, replacing iron will have no rule in this case. A is excluded. Exclude Vit B12 and folate since the lab shows Low MCV. The only microcytic anemia that fits with this case is Thalassemia and to say wether major or minor we Need Hb electrophoresis. Note: if the scenario didn’t mention Iron profile and gives you hints like: - Drinking milk for a period of time - high RDW - Kolionychia and other signs of IDA Answer will be Iron ✅ بحسب خبرتي المتواضعه في الـ SMLE اذا جاتك الصوره غير والسيناريو غير اعتمادك على السيناريو هو افضل خيار. الصورة كأنّ فيها Hypersigmented neutrophil وتتعارض بشكل مباشر مع السيناريو.

12 year old with testicular pain for 2 days. Vertical testes, tender apex, with skin changes. Most likely diagnosis? A-Epididymo-orchitis, B-torsion of testicular appendix C- testicular torsion

B 4 Diseases that usually comes together in the choices Epididymo-orchitis Testicular torsion Appendicular torsion Inguinal hernia How Can I differentiate? Let’s take them one by one. ◻️ Epididymo-orchitis: - Gradual pain in the scrotum Usually >24h. - Tender edematous cord - Red scroutm - Fever, Dysuria, urethral discharge can be present - High WBCs and inflammatory markers. Mx: Antibiotics. ◻️Testicular torsion: - Scrotal pain less than 12 hours ( مهم ) لانه بعد ١٢ ساعه يصير Necrosis ومايحس بالالم. - Previous episode or trauma. - High riding testis ( Horizontal ) - negative phren sign and absent cremasteric reflex. - Low doppler flow Mx: Surgical exploration ASAP. ◻️Appendicular torsion: - Tenderness over the upper pole - Vertical ( Longitudinal ) testis - Blue dot sign Mx: NSAIDs and Rest. ◻️Inguinal hernia: - Mass extended to the groin.

35 years old mother with GA 33W she has an ultrasound which showed reversed end diastolic flow in umbilical artery. CTG was normal. what is your appropriate management: A. Immediate delivery by CS B. Follow up after 2 weeks C. give corticosteroids and deliver within 1 week D. deliver at 37 week

vaccination of 2 months? IPV, HBV, rota virus, Hib, PCV13, DTaP or bcg, hep b or mcv4

pregnant woman presented with massive vaginal bleeding from the abruption placenta and her Hgb: 8.6, BP 84\40, HR140. What is the best management to save her life? A- Admit to ICU B- Immediate Transfusion of 2 packs FFP C- Call multidisciplinary and rapid response team (RRT) D- Immediate Delivery

Child 6yrs old presented with history of 6month left knee and wrist pain with limitations of movement and especially morning difficulty movement Otherwise no systemic symptoms What is the most likely diagnosis? A. rheumatic fever B. reactive arthritis C. septic arthritis D. juvenile idiopathic arthritis

Female in labour,when do digital pelvic examination palpable the chin and nasal bridge of baby , what’s the presentation? A-cephalic presentation. B- breech. C-face

COPD Initial management? Smoking stop Sulbatamol inhaler

If it is on exacerbation then you go with SABA, if it is asking on maintenance and best approach outside exacerbation then you encourage the PX to stop smoking

Case of fever and sore throat , and there’s exudate membrane cover the tonsils? A— Coronavirus B— Infeunza C— RSV D— EBV

Child with widening of the joints, and delayed walking with numbers exactly like this: Ca 2.2, Phosphate 2.1, ALP 1030, It was exactly like this, no PTH given. What is the most likely diagnosis? A- Hypophosphatasia B- Renal osteodystrophy C- Vit D deficiency rickets D- Familial hypophosphatemic rickets

patient with mitral stenosis what is the targete international normalized ratio? <1 1-1.5 2-3 >3

Single artery umbilical cord, associated with: congenital anomalies Dm mother

Case of hydated cyst and ask about definitive treatment? A- albendazole B- surgical deroofing C- percutaneous drainage D- liver resection

Maintained 65 on vaso pressors and iv fluids: Sepsis Septic shock✅ Sirs Septecemia

Multiple small breast masses bilateral get worse prior menses Fibrocystic Fibroademoa

Two years old boy with signs and symptoms of celiac High celiac serology ?? Duodenal biopsy shows variable villous atrophy Whats next? - restrict gluten from diet - restrict gluten from diet and repeat biopsy after 6 months

Patient has leukemia and developed febrile neutropenia what's the treatment: vancomycin Meropenem cefuroxime Ceftriaxon

24y/o male presented after chemotherapy for the treatment of colorectal cancer what electrolytes abnormality would you suspect? A- hypokalemia B- hypocalcemia✅ C- hyponatremia D- hypomagnesemia

Patient did surgery after rectal perforation after 3 days developed a spiking fever, the surgical wound is clean and no discharge, upon Digital rectal exam you found boggy mass, WBC is high, what is the most appropriate action: IV ABX Us guided drainage

B e primary treatment of anorectal abscess is surgical drainage. Once diagnosed, all perianal and perirectal abscesses should be drained promptly; lack of fluctuance should not be a reason to delay treatment. Any undrained anorectal abscess can continue to expand into adjacent spaces as well as progress to generalized systemic infection.

patient with acute history (ithink over week) of dyspnea ,orthopnea come to ER with increase JVP and bilatral basal crackles what is the diagnosis? acute mitral regurgitation right side heart failure

Brownish-yellow ring visible around the corneo-scleral junction … what dx? Wilson disease ,hemochromatosis,

Patient fell on outstretched hand, pain at anatomical sniff box, which bone fracture is it? A. Colles B. Scaphoid

30 yr old female came to ER complain of sever right leg pain for 3 hours , intact femoral pulse but all pulses below are not palpable , ECG shows AFiP what is the most appropriate mngt ? A-femoral embolectomy B-catheter thrombolysis C-above knee amputation D- heparin and observe !!

Pt has rest tremor but when he move to pick something the tremor gone can manifest easily finger nose test with his right hand where is the lesion ? A- Right cerebellum B- Left cerebellum C- Left basal ganglia

PROM How to confirm its amniotic fluid? A. Sterile speculum✅ examination B. Abx C. chemical testing D. Fetal hormones

Male did cholecystectomy 1 week ago now he’s complaining of pain in the angle of mouth , vitally stable Temp is 38.8 - ct abdomen ithink - x-ray -AB -paracetamol

48 yo lady with diffuse goiter, high T4 low TSH, US show bilateral thyroid nodules , right 3x4 in size , left is 1x2 size what to do? A. FNA both B. FNA the larger one C. total thyroidectomy

5 month-old baby presents with bilateral groin swelling that has been present since birth. On examination, there are small bilateral inguino-scrotal swellings, which become prominent when the child cries. His abdomen is soft and non-tender. Which of the following is the most appropriate management? A - Herniotomy B - Lichtenstein repair C - Laparoscopic mesh repair D - Biological mesh placement

Positive gram stained diplococci meningitis tx: Vanc ceftriaxobe,ceftriaxone, ampicillin, meropenem

MRSA what you will give ? Vancomycin

77 years old female with Afib what anti thrombotic will you give (she has 3 points, 2= 77 years and 1=female):- 1- aspirin 2- direct oral anticoagulant

Nullipara with menorrhagia and dysmenorrhea, what is the type of contraceptive appropriate for this patient? A. OCP B. Depo Provera Injection

A, first line in AUB mx

Female 38 Y.O came to the clinic because her period being heavy bleeding and lasts for 10 days for the past few months. What to give? A- Oxytocin B- Carboprost C- Misoprostol D- Tranxemic acid

A male work in military training and he had hard trainings. ( بيلعب عليك انها رابدوميولسس) He presents with oliguria and multiple episodes of postural hypotension, anyways q was going towards AKI and he asked. • Which of the following would support hypotension causing AKI? • A. Fractional excretion of sodium > 2% • B. Bun/Cr >20% • C. Presence of red fragmented cell in urine

B if its rhabdomyolysis ikt would be c

Answer: C

-Urinalysis — The urinalysis is similar among patients with AKI due to either rhabdomyolysis or hemolysis. The standard urinary orthotolidine dipstick tests positive in the presence of heme from myoglobin or hemoglobin or due to red cells.

-In contrast to other forms of acute tubular necrosis (ATN), the fractional excretion of sodium is often <1 percent in patients with AKI from either hemolysis or rhabdomyolysis,

Pregnant without specifying in which gestational age ,, which vaccination she can take ? Influenza Rubella Dtap

29 yo female presented with severe epigastric pain radiating to the back she’s had sleeve gastrectomy 3 months ago. Physical examination revealed epigastric tenderness. Lab, Amylase high. Stable vitals USG was negative for biliary stones but positive sludge and normal biliary ducts. Most appropriate next step? A- Ultrasound endoscopy B- Something and pyloromyotomy C- Lap Cholecystectomy D- Percutaneous Cholecystostomy

. Rapid weight loss is associated with an increased risk of gallstone formation. This question describes a patient with central abdominal pain and elevated pancreatic enzymes. US confirms presence of stones or sludge (stones and sludge behave similarly)Since there is no biliary obstruction, endoscopic US and ERCP are both not indicated.

A patient with DVT with ankle-brachial index 0.3 and occlusion size 3 cm. Treatment ? A- Embolectomy B- Stent C- tPA D- amputation

this question is weird, as ABI is used for PAD and is not indicated for DVT, anyways in dvt w would tart DOAC or VKA and in case of PAD Endovascular or surgical revascularization. If you have a better recall pleae share

patient came to emergency with right femoral bleeding and pneumothorax , patient resuscitated and chest tube inserted and plan on transfer to trauma unit during transfer suddenly he became hypoxic , tachypnea, tachycardia what will you do? Check femoral injury Check chest tube placement rapid sequence intubation

A female with vaginal discharge and in examination there is "red strawberry cervix" A- Chlamydia B- Neisseria gonorrhoea C- Tricomoniasis vaginalis

Infant had conjunctivitis 2 weeks after delivery, then he started to have cough. He was afebrile chest x ray show lung (interstitial lung infiltration??) Labs were given and eosinophil was within normal A. Chlamydia trichromats B. streptococcus C. Adenovirus D. Pertussis

Sle with neurological symptoms (the patient in the question was already in steroid) Cyclophosphamide ✅ azathrioprine mycophenolate

For rare patients in whom an acute inflammatory etiology such as CNS vasculitis is strongly suspected or confirmed, immunosuppressive therapies such as high-dose intravenous ("pulse") glucocorticoids and intravenous cyclophosphamide

Typical case of osteoarthritis ( the diagnosis wan given ), Asking about how to confirm the diagnosis ? A- MRI of knees B- x-ray of bilateral knees C- no need for further investigation

60 YO male K/C of chronic GERD for several years, upper GI endoscopy done for him and showed metaplastic intestinal type mucosa, what is the most likely diagnosis? A. Barrett's esophagus B. esophagitis C. Plummer Vinson syndrome D. Mallory Weise tear

Case MULTIPLE PLEURA EFFUSION DUE TO squamous CELL CARCINOMA Every time she had a Pleura EFFUSION THORACENTEISS WAS DONE. NOW she present with Huge effusion. Asking for Next step? Chemical pleurodesis Ultrafiltration Low Na human albumin Diuretic

Morbidly obese pt with solmonance , necturia , SOB . Otherwise normal Vitals High BP Low o2 saturaion Others normal Asking about invg -sleep study -echo -CT angio

Elderly with vomiting, constipation, abdominal distention. Upon imaging they described a shape going towards the right upper quadrant, what’s the dx? -Rectosigmoid cancer -Sigmoid volvulus ✅ -obstruction -closed loop

Question about Meningitis, a 7-year-old patient infected with a gram- positive diplococcus.Treatment is: - A.Ceftriaxone - B.Penicillin + gentamycin - C.Gentamycin / - D.Gentamycin plus vancomycin\

you have limited influenza vaccine, which of the following demographic will you prioritise? — school aged children — pregnant women — isolated HTN adults — child with IDA

History of Hysterectomy complain of urine leak through vagina when urinate Ask about type of fistula A- urethrovaginal ✅

Female after trauma to anterioc chest clear breath sounds bilaterally with pounding pulse,distended jvp bp110/70 pulse 90 (nearly) A- Cardiac tamponade B- Cardiac contusions C- Tension pneumothorax D- Pleural effusion

B: Arrhythmia on ECG and Sternal fracture Plus Non-complete Beck’s triad Makes the answer more with Cardiac contusion Triad JVP Muffled heart sound Hypotension

After circumcision had profuse bleeding, Labs🧪 ⬆️ PTT INR: i think 1. Something but I don’t remember what to do ? A- tell parents that’s fine B- blood transfusion C- packing

which of the following is more specific for SLE A.Anti-dsDNA B.Anti-Smith ✅ C. AntiCCP

16 year old , amenorrhea for 2 months and galactorrhea for 3 months , what's the most imp investigation: A- Prolactin B- Progesterone C- Estrogen D- LH 100% sure of the choices

POP grade 3 on conservative managment with mild pelvic discombort what to do now? Conservative Reevaluat after 6 months

Scenario of child with tonic clonic seizure for 5 mins, Temp high what to give? -Diazepam✅ -phenytoin -paracetamol

diazepam

Patient came with one episode of hematemesis. He is vitally stable. No previous history of smoking, alcohol drinking, or medical illnesses. Liver enzymes are normal. No signs of chronic liver disease. Abdominal exam is normal. Whats the cause of this pt UGIB? A. PUD B. Mallory wise C. Variceal bleeding

years old child present with history of cough and shortness of breath, he doesn't improve on salbutamol many times, and his mother concerned about him, on examination, there was wheezing and decrease air entry in the right lower lung, nothing else, so what is the most appropriate next step? A. Bronchoscopy B. Fluoroscopy C. Anterior posterior and lateral chest x-ray D. CT scan

Answer: C Came to my exam, scenario was going toward foreign body aspiration. UTD— For patients with suspected FBA who are asymptomatic, or symptomatic but stable, the first step in the evaluation is to perform plain radiography of the chest.

30s y/o woman, married for about 4 yrs, and is being evaluated for infertility. Hx and exam unremarkable. What is the diagnostic test to be used to assess for tubal patency? A- Hystero-sonography B- Laparoscopy with tubal dye test C- Hysteroscopy D- abdomen CT

Old male have progressive dry cough for the past year and have no other complain or hint were mentioned, you were asked about the highest diagnostic test for such case: Pulmonary function test HRCT Broncoscopy biopsy Something else not relevant

Patient with otitis media, what is the causative organism ? -Coronavirus -Rhinovirus

Carbonaceous sputum:dx? Inhalation injury

Patient have menorrhagia and dysmenorrhea, on physical exam she have fullness or enlarged uterus (cannot remember) on Supra pubic area. I cannot recall if she is infertile or not What is the type of fibroid? A serosal B submucosal C intramural

Gravid women came with PROM you administered a beta-memetic tocolytics drug what is the side effect: A- abdominal pain B- palpitation C- diarrhea D- bad odor

Q. About young pt on/off bleeding PR from a grade II hemorrhoid (spontaneously returning), i think patient is also low hgb (hgb readings were in mg/dL, while reference range was in g/L so) What is the Definitive Managment? A- Conservative B- Angio something C- Band ligation D- Traditional hemorrhoidectomy

Tb meningitis what is the tx: A-Isoniazid, Rifampin, Ethambutol, Pyrazinamide, Dexamethasone B-Isoniazid, Rifampin, Ethambutol, Pyrazinamide C-Isoniazid, Rifampin, Ethambutol, Pyrazinamide,acyclovir

31 year female have pap smear negative in the last 5 year now also clear when to do it 1 after 1 year 2 after 3 year 3 after 5 year 4 no need

70 years old woman, sexually active, hysterectomy done before, and she complains of prolapse and enlarged vaginal opening, what is the appropriate procedure? A. sacrospinous fixation B. Ant and post colpoperineorrhaphy C. Manchester repair (Fothergill operation)

6 year old presented with increase lethargy, headache, sever gastroenteritis with blood Vitally stable Labs: RBC 3 low Platelets 50 low Bun 12 high Creatinine 160 high (There were more labs i forgot the rest) Urine Ketone positive Hb positive RBC 5 high Protein 2 Which of the following culture will be more diagnostic A- Stool B- Blood C- Urine D- CSF

HUS. Shigella toxin can be found in the stool.

History ot recurrent Upper abdomoinal pain , now cam with abndoonal pain , fever and jauundice , us show dailted CBD 1.4cm and intrahepatoc duct , dx? ⁃ hepatitis ⁃ Cholangitis✅ ⁃ Acute cholucystitis ⁃ Pancreatitis

Pt with breast mass , since 2 years , this mass growing , reach 15*15 cm Cystosarcoma , how to mange ? Simple mastectomy , there was no WLE

20 days old came with fever for 1 day and no focus of infection Temp 38.3 something like that 1- discharge home 2- tell the mother to came back when there is difficulty in feeding 3- admission to observe the fever and then discharge 4- start IV Abx after doing blood , urine and csf culture

Preschool anemia screening (with no symptoms only this statement) CBC: Low Hg High Retcs High RDW (>2%) what is dx: ] - - IDA - - thalasemia minor

What is the treatment of brucellosis in adult (28 y/o) A. Doxycycline and streptomycin B. Doxycycline and cefriaxone C. Rifampin and trimethprim-sulfamethaxazone D. Rifampin and ciprofloxacin

Pregnant 33w hypertensive came with seizures, labs shows proteinuria A- Give mg salfate B- Give steroid C- Give abs D- Give tocolytics

New born what to examin before discharge? A: Hearing B: Vision C: Hearing and vision

Pt was treated for pneumonia after 3 days he developed sob and cough x-ray done shows bilateral lung infiltrate PaO2/FiO2 was 180 what's the dx? A. ARDS B. MI C. atypical pneumonia

Patient came with asthma exacerbation previously PFR was 300, which of the following indicates severe asthma? A) cannot complete sentence in one breath B) PFR less than 200

25 years old breastfeeding woman with breast pain, tenderness, and swelling but there is no fluctuation What is your management? A. Aspiration B. Incision and drainage C. Antibiotic

Around 20 YO patient presented with breast mass that increased in size during the past year. On palpitation, a mobile mass was noted in the RLQ of right breast, measured to be around 8*10 cm. Skin thinning around the lesion was noted. What is the diagnosis? A. Mastitis B. Phyllode C. Fibroadenoma

female diagnosed with type 1 diabetes, she has been compliant with insulin since the diagnosis 2 months ago,.. with early morning hypoglycemia, What is this called? A. Somogyi phenomenon B. honeymoon period

Female patient complaing of menstrual irregularity,hypertension, Hirtusm With high androgen in the blood US shows multiple small cysts in the ovaries What is the most likely diagnosis? A— gynecomastia B— Kallmann syndromes C— klinefelter syndrome D— Stein-Leventhal syndrome

pt the fresh blood per rectal, they did NGT and it was greenish ,colonoscopy report show normal has no colorectal ca , what is next step ? A. upper GI endoscopy B. 99 tec

Pregnant delivered her baby at home, the baby has onle bruses , what is the dx? Invst show : normal plte and high pt and ptt A-Thrombophilia B-Itp C-Factor X def D-Hemorrhagic infants ( sometimes like this )

old with flank mass , best diagnostic: ⁃ MRI ⁃ CT ⁃ US

Case of patient pulled out from fire Complain of hoarseness of voice, carbonaceous sputum, crackles on auscultation. What is the most likely diagnosis? A. Inhalation injury. B. Carbon monoxide poisoning.

D : 4 Diseases that usually comes together in the choices Epididymo-orchitis Testicular torsion Appendicular torsion Inguinal hernia How Can I differentiate? Let’s take them one by one. ◻️ Epididymo-orchitis: - Gradual pain in the scrotum Usually >24h. - Tender edematous cord - Red scroutm - Fever, Dysuria, urethral discharge can be present - High WBCs and inflammatory markers. Mx: Antibiotics. ◻️Testicular torsion: - Scrotal pain less than 12 hours ( مهم ) لانه بعد ١٢ ساعه يصير Necrosis ومايحس بالالم. - Previous episode or trauma. - High riding testis ( Horizontal ) - negative phren sign and absent cremasteric reflex. - Low doppler flow Mx: Surgical exploration ASAP. ◻️Appendicular torsion: - Tenderness over the upper pole - Vertical ( Longitudinal ) testis - Blue dot sign Mx: NSAIDs and Rest. ◻️Inguinal hernia: - Mass extended to the groin.

patient with a history of radiofrequency ablation is at risk for hypothyroidism. He comes for a checkup and his labs show a TSH of 5 (Normal is 0.5 - 5.0). What will you do to establish a diagnosis A. Repeat TSH in 4 weeks B. Measure T4 levels C. Thyroid scan D. Thyroid US

previouss radiofrequency therapy is one of the indications to test for hypothyroidism, measuring T4 will help establish ddx

12 yr old boy obese Presented following trauma pain and limited movement internal rotation, there is an x-ray picture in the exam. A- Slipped upper femoral epiphysis B- Fracture neck femur C- Avascular necrosis

came with SOB , had DVT before , Cxr normal , what to give ? LMWH TPA

Need more information about the vital signs if the patient stable = LMWH

Hypotensive not stable ( TPA )

Patient k/c of UC complaining of diarrhea that happens 6-7 a day. What is the best fluid to give him? A: RL B:1/2 NS C: colloid

Neck penetrating injury on zone 1 with subcutaneous emphysema: A. Neck exploration B. CTA C. Angio embolization

honey colore skin lesion ask about the caustive organism?? A.fungl B.staph.aurus✅

Child presented with a croup and received the usual treatment with no improvement. What is the next step A- Lateral neck X- ray B- Chest inspiration and expiration X-ray C- Visualization by laryngoscopy D- Chest CT

To summarize:

- If the patient was treated with only one dose of epinephrine, give another dose (treatment of croup)

- If no improvement after 2 doses and the scenario suggests that the patient is still deteriorating, go for direct visualization by laryngoscope (to diagnose bacterial tracheitis and therefor start antibiotics)

- If the scenario suggest that he was treated as croup, got better, then came back with drooling, go for lateral neck x-ray (to diagnose epiglottis)

Associated with coarctation of the aorta? - Down syndrom - Edward - Patau - Turner

7 YO male presented to the hospital complaining of fever, bloody stool and tenesmus for 3 days. Abdominal examination reveled abdominal distention. What is the most likely diagnosis? A. Ascaris B. Amebiasis C. Giardiasis D. Rotavirus

acute leukemia patient, presented with fever after few days of chemotherapy. Found to be neutropenic. What is your next step in management? *Absolute neutrophil count <500 a. Septic workup and wait for results b. Symptomatic treatment with paracetamol c. Septic workup + oral antibiotics d. Septic workup + IV broad spectrum antibiotics

D First Scenario is missing important info which is WBC is 1 ( Low ) that makes the scenario is about ( Neutropenic fever ). Neutropenic fever is managed by IV Antibiotics usually Meropenem and septic workup which is culture from every possible site of infection like, blood, urine, sputum, Csf.

Woman G2 P1 atq32 weeks gestation presents to Emergency Department complaining of lower abdominal and back pain, which has increased in frequency and intensity over the last few hour Abdominal examination shows fundal height equals to 32 cm longitudinal lie fetus and cephalic presentation, Fetal heart was positive and cardiotocography is reactive with 29 uterine contractions per 10 minutes . Vaginal examination shows dilated cervix, 70 % effacement, -3 station and cephalic. Which of the following is the most appropriate step in management? A. Inform neonatologist, administer corticosteroids, and strict bed rest B. Inform neonatologist, administer corticosteroids, and hydrate the patient C. Inform neonatologist, administer tocolytics, and start intravenous antibiotics D. Inform neonatologist, administer intravenous antibiotics, and strict bed rest

Malaria prophylaxis for someone going for south saudi arabia atovaquone-proguanil ✅

Usually manifests between ages 40–69 Behavioral variant FTD (most common) → early changes in personality, apathy CSF: usually ↑ Aβ 1–42 PET or SPECT to reveal metabolic disorders in the frontal and temporal lobes MRI: atrophy of the frontal and/or temporal lobes Focal cortical atrophy

frontotemporal

Female patient complaing of menstrual irregularity,hypertension, Hirtusm With high androgen in the blood US shows multiple small cysts in the ovaries What is the most likely diagnosis? A) gynecomastia B)Kallmann syndromes C)klinefelter syndrome D) Stein-Leventhal syndrome

Down syndrome photo

JPG

Pt with fecal incontinence since vaginal delivery 3 months ago started 1 week post partum. Dx: A. rectovaginal fistula B. Partial perianal tear

40 y.o Patient 5 pack a year smoker only (100% sure it was 5 packs only). Presents with signs and symptoms of MI. ECG shows lead II,III,AVF depression. Hist vitals are: BP: 142/92 Pulse: 99 Which of the following is the most considerable risk factor in this case? A. HTN B. Smoking C. Age

Breast lump in the lower quadrant, core biobsy showed atypical duct hyperplasia how to manage? Follow up after 6 months Simple mastectomy Wide excision biopsy

Child presented with sandpaper like rash , he had URTI a week ago. What's the causative organism? A. Parvovirus B19 B. Streptococcus pyogenes C. Streptococcus pneumoniae

You want to do surgery to a 15 y old , from where take the consent ; A. Parents alone B. Patient alone C. Both of them D. Patient’s assent and parents’ consent ✅

53 years old male patient heavy smoker presented with SOB,cyanosis and distended JVP. The patient is heavy smoker for many years and wants to quit now. What is the *best* way to help him quit? A. Varenicline B. Nicotine replacement therapy C. Bupropion D. Behavioral therapy.

41 pregnant CTG showed deceleration (not mentioning early or late) what would you do? A- delivery B- US for BPP C- daily CTG D- US for amniotic fluid index

child had pica symptoms ((eat any thing like desert and some metal )) drink 1 cup of milk daily, and on examination had mild pallor only ( no splenomegaly ) *which of following has the highest diagnostic value? 1- lead screening 2- CBC+Blood smear 3- Ophthalmology screening

Patient came for routine f/u and did CT scan,accidentally found 1 cm lung nodule , he’s smoker. The mass was 1cm with sharp borders. No symptoms A- Biopsy B- Surgery C- No follow up D- Follow up ct 3 to 6 mo

A patient presented with moderate pleural effusion. What is the indication of chest tube insertion? A- Loculated pleural fluid B- Negative gram stain of the pleural fluid C- Glucose > 80 D- pH > 7.35

A patient with cirrhosis asymtpmatic came for regular follow up , he is for SCREENING for HCC. What Is the most DIAGNOSTIC TEST ? :)))) Alphafetoprotein US Triphasic CT

37 year old female primigravida at 34 GA, know to have multiple fibroids, presented now with abdominal pain and fever on examination: cervix is closed and no evidence of contractions. What is the most appropriate management? A- Observation B- Myomectomy C- CS D- Induction of labor

Answer is Observation. Best answer would be Pain management. Red degeneration of fibroid is a common complication in pregnancy causing abdominal pain and fever and it’s usually managed Conservatively by Pain reduction.

Pt did let neck surgery then develop numbness (or loss of sensation) in the lower part of pinna + left triangle of mandible. Which nerve is injured? A. Third occipital B. Great auricular C. Great occipital D. Lesser occipital

Male patient presented to the clinic for follow up and found to have systolic ejection murmur, denied any symtpoms. On Echocardiography, severe aortic stenosis, normal ejection fraction. Which of the following is the appropriate management? A. Aortic valve replacement B. Observation and follow up C. Angiotensin-Converting enzyme inhibitors

calculate fluid for 12 kg

44 ml

50 years old female want to know the risk of her age on miscarriage? -3% -no risk -80%

80%

Child with Spinal Muscular Atrophy. The pediatrician deemed he needs intubation. Both parents don’t want intubation as they had a son with the same illness who died. What do you do? A Call child protection B Search the internet for solutions of similar cases C Discuss with hospital ethics committee D Ignore both parents and intubate the child as this is an emergency ✅

Child who was severly ill, had pyrexia and irritability and vomiting, then developed purpuric rash that started in his face than disseminate to the rest of body. Diagnosis? Rocky mountain Meningioccemia

case of whooping cough (croup) and ask what u will find on auscultation ? prolonged inspiration prolonged expiration

Doctor was reviewing a patients file on the system and the patients cousin came and asked to see the information but the doctor refused what is this action called? A- privacy B- confidentiality C- autonomy D-consent

HELLP asking about the most appropriate management A-plasma exchange B-urgent delivery

A 63 years old male, not to have hypertension and is a smoker. Presented with retrosternal chest pain, localized and non radiating. ECG Showing ST Depression in Lead II, III and aVF. Blood Pressure: 156/93 Which of the following risk factors is strongly associated with his presentation? A- Smoking B- Hypertension C- Age D- Male Gender

MVA, oriented, obaing commands, , neck and back pain Can't move hands and legs BP 90/60 asking about what is the causes? Neurogenic Hypovolemic

Pregnant, C/O vomiting multiple times, dry mouth and oral thrush, decreased skin turgor, urinalysis ordered, what finding in UA will confirm the diagnosis? A. Urine leukocyte B. UrineProteins C. UrineKetones ✅ D. Urine Glucose

Answer is AntiRNP Mixed Connective tissue disease. Mixed Connective tissue disease: SLE RA ( +RF, Joint stiffness ) Dermatomyositis ( weakness and healed ulcer ) And others. SLE: Only SLE features.

(Pediatric patient) What is the early sign of compensated shock 1- anuria 2-hypotension 3-confusion 4-pale and cold skin

pregnant woman came with typical symptoms of DVT then she developed SOB in duppler US you found nothing what is your next step? A- D-dimer B- CTA C- v/q

A 58 years old patient known case of CKD, labs showed iron deficiency anaemia, What is the best way to manage ? A-start iron replacement B-start erythropoietin C-start him folic acid D-start iron then erythropoietin after correction of iron level

D BADRAN

Child known asthma came to er With exacerbation he was in severe distress with bilateral wheezing (he had hx of viral infection) what is most appropriate management? systmic steroid and Antibiotic Nebulizer and IVF Neb and antibiotic Nebulizer and systemic steroid

healthy young lady just delivered a baby 4 months ago. However, she tells you that she does not want to get pregnant for the next 2 years. What method of contraception will you recommend? a. Combined OCP b. Depo Provera injection ✅ c. Vaginal ring d. Transdermal patch

burn victim at the genital area 3 rd degree written in the question that it makes up 1 0% what do you want to do A- refer to burn unit B- treat as if an outpatient C- sterile dressing of some sort D-use topical omentum for burn

Young in 30s present with HTN for 3 months 160/100 and positive family history of HTN in father and brothers, high creatinine, urine analysis, positive protein, what to give? A) Beta blocker B) Alpha blocker C) ACEI

Case of baby with Acetaminophen toxicity with s/s came after 1 day (written like this) what to do ? A-Nac B-Charcoal C-Gastric .. something D-We cant do anything because its late presentation N-acetyl cysteine > more than 4 hours

Six years old girl presented with severe abdominal pain for hours ,for physical examination there is splenomegaly 6 cm below Labs show Hemoglobin 4.8 Platelet 45 Positive sickle cell What’s the most appropriate initial test? 1-Ultrasound 2-Reticulocyte 3-ANA

4 months baby born preterm 33 weeks due to emergency cescrian section regarding his vaccines what is the most appropriate protocol to follow? A. Decrease the dose of vaccines and give it as scheduled B. Give vaccines according to corrected age C. Schedule vaccination according to chronological age D. Create th schedule according to calculated weight

24 years old with history of appendectomy 5 years ago present with abdominal pain, distintion , vomitting for 3 days Ct scan show obstruction signs And peritonitis , Whats contraindicated in this patient A. Propofol B. Ketamine C. Sevoflorane D. Nitros Oxide

Old lady medically free with difficulty defecation and constipation, during defecation she introduce her finger in the vagina to intiate movement, management? posterior colporrhaphy Anterior colporrhaphy Enterocele resection Hystrectomy

4 years old child came with his afraid mother about his development , He can draw square, hop in one leg but loss his balance after i think 10 seconds, Tell story, But can’t use future senteces? - normal development at his age -delay in language -deley in motor

child presented with projectile vomiting, diagnosed with pyloric stenosis, what is the most appropriate next step? A. NGT B. NPO C. IV 0.9% Na bicarb

Side effect of Topical lidocane ? -Drowsiness -tachycardia -Nystagmus

38 y male complain of constipation for 2 days painful perianal whth positive crack on 6 clock Anal fissuer abscess

30 y/o Pregnant 30 gestation came with severe antepartum hemorrhage, CTG with deceleration, the mother BP 90/60 what is the appropriate next step: Steroids Observe CS

C AFTER STABILIZATION

You are assessing the development of a 6 month old baby, what gross motor you are expecting in this age? A- Sit without support B- Can roll from supine to prone ( Or prone to supine can't remember) C- Mature Pencil grasp D- Walk Steadily

Pt with hf due to lt vent. dysfunction on lasix , aspirin , statin everything else normal : what med to give next ? spironolactone digoxin hydralazine

BB BUT MAJORITY CHOSE A

infertility for 6 y with severe dysmenorrhea not treated by naproxen: Endometriosis endometritis leiomyoma

20-Pediatric age pt presented with his mom to ED she said that her child ingested large amount of paracetamol (i think) the pt was healthy no signs of any toxicity on presentation, they observed the pt for 4 hours with no any change in health no signs and symptoms of toxicity, the mom then mentioned that she found some of the drug was spilled on his clothes and in the floor, what is next? A. Reassure B. Watch for another 4 hours C. Give antidote

Case of child use Rifampicin ask about side effect?

Discoloration

women with a history of insomnia and crying for S days due to sibling death, what is the quick drug to use? A- Lorazepam B-SSRI

Baby jaundice, cataract, hepatomegaly how to confirm? Urine reducing Hida Alpha 1 antitrypsin

Coild NG tube in esophageal pouch: A- Hiatus hernia B- Esophageal atresia C- Tracheoesophageal fistula D- Choanal atresia

B If Resp Sx or fistula between trachea and esophagus was seen? C.

female in 28w found no cardic activity and fundal hight 18wk missed abortion fetal demise

Child with shigella, most appropriate Abx? A- Ceftrixaone B- Azithro C- Amoxicillin

Pt has high hba1c and was on insulin I think pt was started on met Forman what to check Creatinine Estimated glomerular filtration rate Microalbuminuria

35 years old female her father has colon cancer when he was 55 and her mom had breast cancer when she was 43, asking about screening? A.She should do mammogram annually B.Start mammogram at 40 C.Start mammogram at 40 and colonoscopy at 55 D.Colonoscopy at 50

30 year old woman asking for effective and reversible method of contraception which of the following is most effective? Vaginal ring containing hormone, m condom, f condom, spermicide

vaginal ring

65 year old with seizures for 3 days Labs: Sodium 112 (low) Potassium 3.9 (normal) Serum osmolality 240 (low) Urine osmolality 860 (HIGH) A- Inappropriate antidiuretic hormone B- Addison's disease C- Cushing’s disease D- Conn’s syndrome

RTA did CT then he became hypotensive CT finding: thoracic aortic injury and spleen laceration with free fluids in the abdomen A) expiatory labrotomy B) thoracotomy C) referral to a center with vascular surgeon I think

embrical ab used in fever in leukemic patient meropenum pepracillin tazobactam 2 others

both are correct acccording to utd

55 male K/C of DM came to PHC his HbA1C is normal now after using metformin for the past months, vital signs all normal except for BP: 151/90 (three readings) what to do for such patient: life style Continue on same regimen Use ACE inhibitor Add sulflnurea

Child pt with decreased IQ, pica (eat dirt) < they wrote it :) With Hepatosplenomegaly ! Labs showed *Hypochromic microcytic anemias. What is the highest diagnostic labs ] A- blood lead levels B- CBC with blood smear (they already do it ) C- Iron studies ??

This Q came to my exam in November. There was no Iron studies in the choices!!

I don’t remember the Q exactly but the choices were wrong except for A which is diagnostic for lead poisoning since the child is Eating dirt and have low IQ.

Another recall: Young year old man with appendicitis was treated conservatively with antibiotics. He now presents with an appendicular mass with no collection. How will you manage this case? A. Interval laparoscopic appendectomy after 12 weeks B. Interval open appendectomy after 12 weeks C. No further intervention needed D. Colonoscopy after 6 weeks

Patient came to the clinic and had heavy menstrual bleeding. After furhter evaluation the gynecologist diagnosed her as dysfunctional uterine bleeding. What is the initial management? D&C OCP Hysterectomy Other type of procedure “No IUD or tranexamic acid”

Answer is C. 15 months with these Sx? Could be wither IBD, amebiasis, or intussusception. I will go for Barium enema to confirm the diagnosis of intussuception. Currant jelly stool is a mixture of blood and mucous and sloghed mucosa. ( Amboss ) In intussusception X ray will show a intestinal obstruction which is non specific finding. next step would be US Conformatory is Enema. Management will be: Fluid, electrolyte correction and Non- operative procedure by enema either with fluid or with air. But Not to wait for the Sx to be gone you must act because it’s a mechanical problem, waiting for Sx to be gone will not be helpful. When to go for OR? - Failed enema 3 times. - signs of peritonitis - Unstable patients.

typical case of diabetic ketoacidosis with abdominal pain fluid was administered what next? Iv insulin Bicarbonate D5

Incapacitating symptoms prior menstrual cycle, interference in daily lifettt? A. Ssri B. Ocp C. Transvaginal progestrone D. Estrogen patch

Pt. Post. Surgery admitted to ICU for MV his COP:25ml. And pul. Wedge pr. Elevated 20 What is the type of shock - cardio - hypovol

A Cardiac out put is low causing shock

Sit without support, Crawl, hold things between thumb and index finger, walks around furniture, pulls up to be standing, say dada: A- 8 B- 10 C- 12 D- 14

What of the following decreases the risk of eclampsia? A- Antibiotic B- Aspirin C- MgS04✅

Child has intussusception with sausage mass , patient well and stable Most appropriate treatment? -surgical reduction -warm hydrated water enema under US

warm hydrated water enema under US

Patient smoker with dyspnea on exertion relieved by rest, he is anxious with nicotine staining on fingers, what is the best drug for quitting smoking? A) verancline Bupropion C) Nicotine replacement D) advice and behavioral

A pregnant woman is undergoing an operation and told the nurse she doesn’t want a blood transfusion beforehand. Now she has severe bleeding and became hypotensive. Which of the following is the most appropriate action? A) Start the blood transfusion now B) Consult the ethics committee C) Take the consent from the patient before she loses consciousness D) Take consent from the husband

Typical symptoms of croup, how to manage? Answer: Dexa and epinephrine

True

65 man underwent splenectomy. When can he take "Pneumococcal" vaccine? -After 2 days -After 1 week -After 2 weeks -After 1 month

3y.o Child brought by his mother bc she noticed he is pale, he is a picky eater and drinks a lot of milk , same problem with his older siblings. CBC microcytic anemia. Iron profile: only TIBC was provided and it was very high 700, Dx?: A- IDA B- A Thalssemia C- B12 def (not sure this one was in the choices) D- Anemia of Chronic disease

Baby came with clear picture of UTI and urine analysis showed UTI. Mum said she had these symptoms multiple times. What to do? A-Renal US B-Voiding cystourethrogram C-Renal US and cystourethrogram✅ D-I think the last one was reassurance

Scenario of abdominal pain and vomiting, X-ray showing air fluid level. (intestinal obstruction). which of the following is appropriate next step? A. Laparoscopy B. Laparotomy C. NGT

Pedantric patient with signs of sever dehydration ( sunken eye etc). Low bp. What are you going to give him? A. NS B. NaHco3 solution

long scénario with ABG : PH 7.55 , HCO3 43, PaCO2 22, PaO2 92..? 1- uncompensated metabolic alkalosis 2- both metabolic and respiratory alkalosis 3- respiratory alkalosis with compensated metabolic 4- metabolic alkalosis with compensated respiratory

Collection of fluid 9x10 cm with inflammation of the sigmoid How would you manage A-Exploratory laparotomy B-Sigmoidectomy and anastomosis C-Percutanous drainage

73 year old man know case of ischemic heart disease presented with sever abdominal pain for 10 hours , he also vomited 3 times , on auscultation, the bowel sound was hyperactive , ( I think he also has high WBCs but not sure ) , what is the diagnosis: A- mesenteric ischemia B- intestinal obstruction

Answer is Medical therapy. ( she’s Now pregnant ) UTD: Operations on the uterus is best to be avoided in the pregnancy due to risk of bleeding, Uterine rupture and pregnancy loss. Note: if she’s not pregnant and wishes to preserve fertility answer is Myomectomy.

six year old girl presenting to the pediatric emergency department with unstable gait and progressive difficulty climbing the stairs over the last 10 days the parents reported that the child has been “choking on her own saliva” the symptoms began was prickly sensation in the fingers and toes that developed to ascending and symmetrical there is a history of viral gastroenteritis three weeks before physical examination confirms the absence of the knee-jerk reflex CSF analysis of weighted protein concentration with normal cell count. Nerve conduction test reduced velocity which off the following is most appropriate treatment: A- plasma exchange B- IVIG C- MTX D- steroids.

Female came with white vaginal discharge and itchiness : Candida Bacterial vaginosis Trichomas Gonorrhea

64 years old, male, abominal pain with bloody diarrhea O / E: left lower abominal tenderness Ct showed 2x2cm (20ml) collection in the sigmoid: 1 diagnostic laproscopy 2 expl lap 3 antibiotic and observatiom 4 us guided aspiration

Inpatient management with broad-spectrum IV antibiotics is recommended.
CT-guided percutaneous drainage for abscesses > 4 cm
Emergency colectomy in patients with generalized peritonitis

Child with pneumonia and vomiting can’t tolerate oral intake, he look well no distress but the vital showing hypotension You will admite because he: -Vital signs (hypotension) -can’t tolerate oral

Old male with dyspepsia . Wt loss Dx given MALT asking about treatment H pylori eradication Chemotherapy Radiotherapy Surgury

Risk for GBS in the baby: A-Prom 6hrs B-Gdm mom C-preterm D-baby Twins

Protocol — With this approach, the presence of one or more of the following risk factors is used to identify patients who should receive antibiotic prophylaxis in labor to reduce the risk of having an affected infant [43-48]:

●Intrapartum fever ≥100.4°F (≥38°C)

●Delivery before 37+0 weeks of gestation

●Rupture of membranes ≥18 hours

●Previous delivery of an infant affected by GBS disease

●GBS bacteriuria in the current pregnancy

81 yo woman DM, HTN on medications at risk or known to have DVT asking about prophylactic for DVT? A. Aspirin 81 mg oral B. Enoxaparin 40mg SC Forgot other choices

A case about female who has signs and symptoms of both acute cholecystitis and obstructive jaundice due to stone in the common bile duct. There were no signs of acute pancreatic. Us: revealed multiple stones in the gallbladder and a stone in the common bile duct: What is the appropriate management: ERCP Open surgery Lap chole percutanous drainage

Paediatric Cushing features (obesity + purple stretch marks in the abdomen + HTN), Initial management? • A Head CT • B Adrenal scintigraphy • C Adrenal MRI • D Early morning and evening serum cortisol ✅

pediatric pt come to ER with hx of tonic clonic seizure duration 3 min 1 hour ago , hx of fever and runny nose 3 days ago. Every thing is normal even temp. Appropriate Tx? Paracetamol , diazepam, phenytoin

mom came to pediatrion with exclusef breast feeding and doctor advise iron advise next month.age of baby now?? A.1 B.2 C.3

A patient with pulmonary embolism that wants contraception. WHAT is the most appropriate contraceptive method? A) condom B) IUD ✅ C) OCP D) POP

23 male presents with sudden onset of RLQ pain while playing tennis 3 h prior. Vitals temp 37, HR 97, BP 124/79 mmHg , O2 99% . P/E absent bowel sounds, RLQ tenderness and rebound, firm mass noted in that area. Most appropriate step in management? — CT abdomen — US abdomen — X ray — Discharge with analgesics and follow up

What of the following decreases the risk of preeclampsia and IUGR? A. Antibiotic B. Aspirin C. MgSo

Malaria knows to reoccur after treatment? All 4 given ( ovale,viviax, malaria,falciparum)

VIVAX

30s y woman asking for effective and reversible method of contraceptive, which if the following is the most effective: A.Vaginal ring containing hormones B. Female condom C. Male condom D. Spermicide

32 years old male, known to have rheumatoid arthritis. He is controlled on steroids & hydroxychloroquine. Physical Exam is normal. Which is the best treatment regimen for this patient? A- Taper steroids & start Methotrexate B- Taper steroids & start ibuprofen C- continue same management D- forgot but irrelevant

patient with CHADsVAS score of 4 (you calculate it yourself) she was already on warfarin what to do? A.cont. warfarin B.cont. warfarin and add aspirin C.stop warfarin

GCS calculation Eye open to sound. Localise pain..confuse 1. Mild 2.moderate 3.severe

37 yo male have spider nevi over righ thigh want to do cosmotic examination normal pulse and no varicosity what investigation to do? 1-no need 2- venous duplex 3- venous CT angio 4- venous plethysmography

Down 4 months with cardiac symptoms and 2/6 systolic murmur with wide splitting of S2 and biventricular hypertrophy 1-AVSD 2-VSD 3-PDA 4-COA

Female came with persistent elevated liver enzymes for 6 months Lab : Very high ALP more than AST and ALT Bilirubin high MRCP : multiple strictures intraheptic duct What is your next step ? A- liver biopsy B- colonoscopy C- ANA

An 18-month child was brought to clinic for a regular checkup.Thedoctor found out that the child had not taken any of his scheduled vaccines. He asked the mother why and she replied “Vaccines will make my son retarded!”. What is the appropriate action? A) Refer the mother for psychiatric assessment B) Contact child protection services C) Explain the benefits of vaccines to the mother D) Contact the hospital ethics committee

pregnant lady with history of preterm labor twice, presents with vaginal spotting what to give her, indomethacin, mg sulphate, estrogen

progesterone.

elderly man with CKD DM, HTN Cr 150 normal to 115 k 6.8 Complained of fatigue and nausea Asked what to give Bicarbonate D5 and water Diuretics Ca gluconate There was no ecg or other symptoms

A case ask about the electrolyte disturbance post chemo , TLS ? Hypo k , hypo ca Hyper k , hyper ca Hypo k , hyper ca Hyper k , hypo ca

survey

Patient with subcutaneous nodules, and knee pain and swelling, what do you need to confirm the diagnosis? A. elevated ESR B. elevated CRP C. Blood Culture D. ASO titer ✅

RA pt on methotrexate for 15 year, present with left knee red hot swolen in joint asp ( wbc 35,000 , culture pending ) next ? A- IV abx B-Iv steroid C-Intraarticular steroid

Pregnant 8 wk, known case of cervical incompetence A- Cerviclage now B- Cerviclage at 14-18 wk C- terbutaline D- Nothing

A female pregnant with hypertension and proteinuria, she has right upper quadrant pain what is the reason? A. Distended Hepatic Capsule B. HepaticRupture C. Gall Bladder Stone

Pregnant came with dyspnea on examination she has lower limp edema. What is the most intial diagnostic A- Lung perfusion scintography B- Duplex for leg C- D dimer D- Cta

Which one of the following indicates Rheumatoid arthritis in pleural effusions? A- ph >7.6 B- Glucose <1mmol ✅ C- Transudative

2 week history of epigastric pain, fever and jaundic with BP 90/60 and amylase is 1400:- 1- pancreatitis 2- cholngitis

62 old has 2 days of fatigue, tired and 5 days of fever, cardiac examination : reveled pansystolic murmur at apex and splinter hemorrhage in nails. Which of the following is organism is the cause? A.Staphylococcus epidermidis B.Enterococcus species C.Klebsiella pneumoniae D.Streptococcus species

child came with signs of moderate dehydration. You start him on ORS. Which of following is the best step? A-Lactose free formula B-ORS for 1 day and then normal formula ✅ C-ORS for 5 days then, normal formula D-IV fluid

55 yrs old man smoking after endoscopy with family Hx of esophageal cancer the found they found he have esophgeal cancer which of the following has high risk factor ? 1- barrett esophagus 2- smoking

child chest trauma no air in one side abd distended hypo tensive what next Trachestomy Chest tube Ct or us

Streptokinase antidote: A. Factor VIII concentrate B. Vitamin K C. Protamine D. Aminocarpoic acid

Old lady clinical presentation of pylonephritis Culture was done show E. coli Already on I’ve abx susceptible to the E. coli for 5 days now with no improvement What to do 1. Kidney us 2. Repeat culture 3. Change abx 4. Observe

Wheezing, Urticaria and allergic Sx. - History of Bee sting, allergic medication or allergic food.

Anaphylactic

Young Patient presented with migratory polyarthritis and subcutaneous nodules. What will confirm the diagnosis? A A- High ESR B B- High CRP C C- blood culture D D- ASO titer

Most common drugs used to treat PPH after Uterine atony ? A. Oxytocin B. Carboprost C. misoprostol D. Methylergonovine

Child presented after 1 week of bloody diarrhoea with edema and renal inpairment( labs given there is hypertension and impaired renal analysis) Asking what culture should help in diagnosis 1-urin 2-blood 3-stool 4-LP

Patient 40 years old underwent colectomy for Four hours and on the next day , he had abdominal discomfort with fever and leukocytosis . What is Diagnosis ? - sepsis - bacteremia - SIRS - Severe sepsis

Pregnant woman was on oral iron for 12weeks Still her labs IDA what you will do ?? Continue oral Iv iron Blood transfusion

the doctor forgot to close the curtain while Examining the patient. what was neglected? A-patient's privacy, B-patient's dignity, C-patient's autonomy

PREGNANT W/ PLACENTA ABRUPTION +DIC+IUFD MX? CS D&C AUGMENT DELIVERY, EXPECTANT

Trauma patient with isolated head trauma and coma for 5 days what’s the method for nutrition in the first period A. NGT B. Central line C. Peripheral line D. Gastrostomy

70 old male with forgetfulness, progressive gradually for 2 years.. devolop signs of aggression and violence after he was calm ,caring ,and kind: A.Lewi body B.Alzheimer’s C.Vascular dementia

DM obese on life modifications his A1c 8 what to add A-dulaglutide B-DPP-4 inhibitors; C-GLP-1 receptor agonists D-SGLT2 inhibitors; .

Ctg variable deceleration

jpj

Immunocomprimised patient present with painful perianal mass, showing flucutation , crepitus and foul smelling , most appropriate treatmemt is : 1- Penecillin G infusion 2- Surgical debridement 3- Aspiration 4-Forget but irrelvant ( No other Abx or drainge at all )

Man diagnosed with appendicitis due to rigidity and abdominal tenderness During the surgery the appendix was fine, what to do now? A- Remove the appendix and close B- Look for meckles diverticulum C- Do open surgery and explore D- Close without doing anything

B Note: If you schedule for appendectomy and during the procedure you found normal appendix: 1- look for other DD as: Meckel’s diverticulum, PID… 2- If open —> do Appendectomy If lap —> NO Appendectomy. 3- if you found inflammation in terminal ilium —> refer the patient to Gastroenterology for IBD evaluation.

neurofibromatosis ? Autosomal dominant

Pregnant around 30 weeks who is a case of Rh alloimmunization, fetus was found to have anemia, Management?

Neurogenic shock case Best initial treatment: - iv fluids - O- blood - steroid

Pt have white coated tounge that removed with scratch and treated with nystatn what is diagnosis 1 erythymetus candidiasis 2 leukoplakia 3 oral thrush

Patient with epilepsy, Most common shoulder dislocation? A. Inferior B. Supraacronym C. Posterior D. Anterior

3 months infant with red tender left hemiscrotum. There’s a bulge in the scrotum extending to the inguinal region. The left testes is not palpable. Which of the following is the most likely cause? Testicular torsion Epididymitis Incarcerated inguinal hernia Testicular appendages torsion

45 years male came to hospital complaining of sob fever fatigue for few days, on examination reveal high jvp, pulses paradouxe, distended heart sound auscultation reveal clear lung Lab Bp 90/55 Hr 120 Rr20 Temp 36.6 Ecg show: Low voltage Xray : Increase cardiac silouette What is the cardiac area is involve? 1- valves 2- pericardium 3- myocardium 4- coronary arteries

Man diagnosed with appendicitis due to rigidity and abdominal tenderness During the surgery the appendix was fine, what to do now Remove the appendix and close Look for meckles diverticulum Do open surgery and explore Close without doing anything

Patient of stab wound measuring 2 cm penetrating injury with minimal bleeding and partially omentum exposed, patient is vitally stable, CT report negative findings, Next step management: A. Observation B. Close the wound C. Leave the wound open D. Laparotomy

Patient came for routine f/u and did CT scan,accidentally found 1 cm lung nodule , he’s smoker. The mass was 1cm with sharp borders. No symptoms A-Biopsy B-Surgery C-No follow up D-Follow up ct 3 to 6 mo

Pt with bronchogenic carcinoma, presented with progressive SOB, on P/E there’s elevated jvp, clear lung and quiet heart sounds. What will confirm your dx: A. CXR B. ECHO C. ECG

Patient with ascites, paracentesis showed high saag >1.1 What is the diagnosis? A-TB B-nephrotic syndrome C-liver cirrhosis

Patient did proctocolectomy for UC after 12 hours fever, 110 HR, wbc 14000, did not mention source of infection A- sirs B- bacteremia C- sepsis D- severe sepsis

76 years old male, present with retrosternal chest pain with exertion relieved by rest, on examination S4 was heard. ECG showed T wave inversion in lead V2-VS What is the diagnosis? •A-Stable angina •B-unstable angina •C-NSTEMI •D-STEMI

B, new onset angina

26 yr pt came to Er after a first episode of generalize tonic conic seizure ,labs & examination are normal ,no neurological deficit ,what to do next A.EEG B.ECG C.LP D.CT head

head trauma and coma for 5days best early way for feeding NGT central nutrition parental nutrition gastrostomy

NGT

old female medically & surgically free, with no family history of colon cancer, which colon cancer screening test iS appropriate for her? A. 5 years Colonoscopy B. Annual Fecal Occult Blood C. Annual sigmoidoscopy

Malaria falciparum

jpj

Mother came with her child for preschool Vaccination Which of the following is important Vaccine to give : A. RV, Rota , MMR B. OPV, Tdab, MMR, Varicella ✅ C. Meningococcal ( MCP4 ), PCV, Tdab D. HepA, OPV, MMR, Tdab,

A 20 Y/O has a cyst that contains jelly like material on vestibule: A: candida B: Hidradenitis suppurativa C: Vestibular mucinous cyst

Mother in labor who has chlamydia trachomatus infection, which of the following organ is more likely to be affected in her baby ? -lung -ear -eye

Female patient is being treated for her proteinuria after having nephrotic syndrome due to minimal change disease. Which of the following medications is used to decrease proteinuria? A. Prednisolone B. ACEI C. spironolactone

Child with diarrhea came for vaccinations? A- give all B- defer all C- all except dtap D- all excep OPV

38 YO female presents to the clinic after finding of hilar lymphadenopathy on CXR. She has on and off cough, but denies any fever, headache, n/v, weight loss all negative. Labs insignificant except for X-ray shows confirmed bilateral hilar lymphadenopathy CT guided biopsy shows noncaseating granuloma What is the best next step in management (They wrote “all labs were normal” and didn’t mention hypercalcemia) A-Observe✅ B-Start prednisolone C-Start azithromycin D-Start anti TB medication

6 years old girl presented with abdominal pain and dark tea-like urine. She had history of sore throat 2 weeks ago. What's the diagnosis? -Kidney stone -Pylonephritis -Glumerulonephritis

child few months old with congestive heart failure signs and murmur and interrupted feeding. Most likely diagnosis? -VSD -TOF -ASD

child with signs of appendicitis confirmation by us ct

A 56-year-old patient presents with left lower quadrant pain and a change in bowel motion. Upon examination, the patient has a fever and left lower quadrant tenderness. Imaging showed thickened bowel. What is the Treatment? A. Conservative with broad-spectrum antibiotics. B. Colonoscopy. D. Laparoscopic Colectomy.

Cant surure from bleding above: Manual exploration Oxy Prostaglandin f2a Methylergo

Female patient using warfarin).Whatcontraceptionismostappropriate for her? a) Pop b) Depoprovira c) IUCD d) OCP

Findings in a research report show that the incidence of a particular disease in Saudi Arabia is higher in females than in males but the prevalence is equal in both females and males. How can this be explained? A) Fatality cases are higher in females B) Fatality cases are higher in males C) Females carry the disease for longer D) Males carry the disease for longer Answer: A,

50 yo F. Chronic lower abdominal pain and bleeding Imaging shows: fibroid What’s the most appropriate management? A. Hysterectomy B. Combined OCP C. myomectomy D. Dilation and curettage

Soldier heavy exercise asked about type of kidney injury Pre renal AKI or Rhabdomyolysis ✅ WHICH CAUSES= ACUTE TUBULAR NECROSIS

An elderly with end stage cancer c/o severe pain. The family asked the physician to give a stronger analgesic or to increase the dose. The doctor explains that while it might help alleviate the pain, it also might hasten their father’s death. Which of the following is this referred to? A. Principle of subsidiarity B. Principle of double effects C. Principle of totality D. Principle of informed choice

case looks like PUD maltoma upon endosopy tx? -h.pylori eradication -radio -chemo

MRI of large fibroid and mensterural bleeding hg 7 what’s next step in management? A correct anemia B. Ocp C. Myomectomy

Patient P4 came for contraceptive method. Patient had regular cycle but increase in bleeding recently. Hx of CS, and endometritis after the second CS which has been treated. Which of the following is contraindication for IUD? A. Hx of endometritis B. Abnormal bleeding C. Other things not relevant I couldn't remember

B The C/Is are: 1- Anatomic abnormalities and in the uterus ( Fibroid, bicurnicate, endometrial or cervical cancer ) 2- Unexplained Uterine bleeding 3- Endometritis or pelvic infection in the past 3 months. You should pay attention to the time of endometritis in the scenario: If > 3mth Choose Bleeding If < 3 months Choose Endometritis if Bleeding is explained by another cause. If ( Unexplained bleeding ) written like this in the scenario? It’s 100% the correct answer.

70 y/o male has cognitive impairment reported by his relative , Do MRI with finding (i think say white mater and hyper tense or something) but there is hypo?! A- Vascular cognitive dementia B- Alzheimer’s disease C.lewe body demantia

Pt C/O left lower abd pain with fever ( case of diverticulitis) What is the most appropriate next step ?? A- Conservative or observation B- Colonoscopy C- Discharge on oral Abx D- Admission and start IV Abx

Stepping reflex when disappear 1- 2 months✅ 2- 4 months 3- 6 months 4- 8 months

child with sore throat and fever that increase with time for 2 weeks , he had same complaain before 3 weeks and dental extraction before 2 months also have purpura rash in lower limb and confirm a systolic murmur best heard at the apex radiating to the axilla. Urine dipstick showed : Mild protienuria and microscopic hematouria What is the most likely diagnosis? A. Infective endocarditis B. Group A streptococcus

Answer is A. Dental extraction and new heart murmur is typical for infective endocarditis. According to safdar: infective endocarditis can cause glumerulonephritis as well.

Patient came complaining of bone pain, fatiuge, the symptoms resolve after drinking milk. Lab: ( I am sure about the result ) Ca: High phosphate:Low PTH: high Vit D: 25 ( normal range 25-90 ) A- primary hyperparathyroidism B- secondary hyperparathyroidism C- milk alkali syndrome D- idiopathic hypercalcemia

Patient with anal fissure not responding to drug, what procedure is most suitable for his condition? A. Lateral internal sphincterotomy B. Anal curettage

One of the goals for Saudi Arabia in 2030 vision is to improve the health by decreasing the preventable causes of death underage of 5 years group, this will be conducted through: A) Specialized hospitals B) Education C) Immunization D) Economic development

10 kg child with 5% defcient how much fluid? 1100 1500 1750

Deficit (mL) = weight (kg) x % dehydration x 10

Symptoms of angina; getting worse over time and occurs at rest A- unstable angina B-Prinzmetal angina C-Heberden angina

19 y male with history of headach for 5 days and neck stiffness for two days With low grade fever for one month CSF analysis Turbid Glucose normal range WBCs neut: 27 Lymph: 87 Diagnosis: A bacterial meningitis B viral meningioencephlitis C TB meningitis D fungal meningitis

سارة الشريف, [7 Dec 2022 at 9:05:58 AM]:

Answer here regarding the previous recall from dr.mohammed which misss very important point in original Q it is change in sensorium 》 This very important key for viral meningioencephlitis + Glucose normal never present with Bacteria or TB or fungal all three have low glucose.

Answer is : B

Woman her husband has gonorrhea what’s the most diagnostic for her? A. Anogenital swap B. High vaginal swap C. Endocervical swap D. Urine culture

The answer is C Gonorrhea: Endocervical swab Candida: High vaginal swab

What would see in 15 weeks of gestation: 20% increase in plasma volume 40% increase in plasma volume 20% increase in hct 20% decrease in hct

pancreatitis high amylase what is the most marker which indicate severity CRP PROCALCITONIN ESR

crp

55 years old male, presented with exertional dyspnea and syncope, on examination he was found to have systolic ejection murmur that radiates to the carotids, on ECG there is left ventricular hypertophy. How would you manage this patient ? A- antihypertensives with tight BP control B- refer for surgical correction C- give vasodilator D- give diuretic

An 8 year old girl with persistent and continuous diarrhea, she drinks 3 pints of goat milk per day and is a fussy eater. Which of the following conditions explain her presentation? Labs: Hgb Low MCV high MCHC high A- *psycological* Deprivation B- Giardiasis Parasitic Infection C- Aplastic Anaemia D- Hypothyroidism

Polyhydrominous then spontaneous ROM and persistent fetal bradycardia: هذا الريكول بالحرف الواحد -cord prolapse -placental insufficiency -head compression

9-month Hx of MI came to clinic for smoking cessation he was in respiratory distress raised JVP nicotine tar in his hand what is the most appropriate drug? - A. Nicotine replacement therapy - B. Varenicline - C. Bupropion

15 months child with severe GERD with sandifer phenomenon Most appropriate cause of his condition A/obesity B/post pertussis infection

Preterm or low birth weight will be the right answer

endometrial hyperplasia with atypia unfit for surgery what’s your management 1) chemo 2) radio 3) continued progesterone 4) forgot but was wrong

Which of the following is the most reliable investigation to detect DKA in DM1 patients ? acetoacetate acetone b-hydroxybutric acid c-glucose level

He is exclusively breast feeding 2 week ago his mother started to introduce fruit and fruit juice, since that , pt started vomiting, irritable, On examination: Hepatosplenomegaly Distended abdomen Generalized jaundice * • Urine: positive reducing substances • A Tyrosinemia • B galactosemia • C Alpha 1 anti trypsin def • D congenital fructose intolerance

Patient took vancomycin then develop rash , flush and redness what to do ? 1- stop vancomycin 2- decrease infusion rate 3- decrease the dose

dislocation of shoulder in epileptic pt Anterior Subchricoied Anterior subglenoied

Answer is: Posterior dislocation of the glenohumeral joint due to falling

Child 2 yrs old with fever and reduced feeding and crying excessivly for 1 day no focus of infection mother denies any vomiting or diarrhoea on examination there was redness and no light reflex on ear tympanic membrane which of the following is the most appropriate intial management? A) steroids B) Amoxicillin C) refer to surgery D) other very un relvant option

child with Open fracture case , Iv antibiotics and tentnus prophylaxis is giving , next step ⁃ surgical debridment followed by intramedullary nail ⁃ Close reduction with external fixation

-less than 6 month >pavlik harness ✅

-6month to 5 years > hip spica✅

-5 to 11 years > flexible titanium nail or plates✅

-more than 11 years > rigid nail✅

4 years old with mid-shaft femur fracture, angulation 30 degree. What is the Best management? A. Closed reduction & hip spica B. Open reduction & plate C. Open reduction & IMN

A 80 y/o on dialysis for 10 years with HTN. Labs show high urin. What could be the cause of the death: A: High k B: CVD C: Anemia D: Uremia

607- 418- Mom came to pediatrion with exclusef breast feeding and doctor advise iron advise next month. age of baby now? A.1 B.2 C.3

Newborn develop tachypnea , tachycardia and cyanosis… what do you expect else? 1-difficulty feeding 2-jaundice 3-ascites

Female with back pain and decrease sensation in left calf and lateral side of the left foot, what is the level of spinal stenosis A. L3-L4 B. L5-L5 C. L5-S1 D. S1-S2

An infant with SCA presented to the ER with fever, cough, URTS. On Examination there is a murmur. Hemoglobin is 4. What is your next step in investigating this murmur? - Correct the underlying issue and reexamine - Admit to NCCU

Case of hyponatremia: Long case with symptoms of lethargy and many other symptoms. Lab showed Na level 118 What to give? Normal saline Hypertonic saline Half-normal saline

survey

25 female with right lower quadrant pain suprapubic no rebound tenderness leukocytosis Us inconvlucive: Tvus Ct Dx lapro Ex lap

d amboss

14 years old came with sever sudden scrotal pain and on examination high riding and sever tenderness on palpate.. dx? A. Testicular torsion B. Orchitis C. Hydrocele

A:4 Diseases that usually comes together in the choices Epididymo-orchitis Testicular torsion Appendicular torsion Inguinal hernia How Can I differentiate? Let’s take them one by one. ◻️ Epididymo-orchitis: - Gradual pain in the scrotum Usually >24h. - Tender edematous cord - Red scroutm - Fever, Dysuria, urethral discharge can be present - High WBCs and inflammatory markers. Mx: Antibiotics. ◻️Testicular torsion: - Scrotal pain less than 12 hours ( مهم ) لانه بعد ١٢ ساعه يصير Necrosis ومايحس بالالم. - Previous episode or trauma. - High riding testis ( Horizontal ) - negative phren sign and absent cremasteric reflex. - Low doppler flow Mx: Surgical exploration ASAP. ◻️Appendicular torsion: - Tenderness over the upper pole - Vertical ( Longitudinal ) testis - Blue dot sign Mx: NSAIDs and Rest. ◻️Inguinal hernia: - Mass extended to the groin.

Pregnant women with history previous pregnancies with ICU admissions and multiple blood transfusions recently delivered newborn with severe anemia and high reticulcytes. Most important part in the history: A- Mother’s blood group B- Gestational age

GA 10 n/v, severe dehydration (all dehydration signs), white coating on tongue, recieved iv 10% glucose in NS, bp 90/60 which urine analysis confirms the dx? Glucose Wbc Protein Ketone (hyperemesis gravida present w ketonuria)✅

Stranger anxiety and separation anxiety A. 4months B. 6 months C. 10 months D. 12 months

pregnant 12week have cervical lesion what to do 1-pap smear 2-cone biopsy 3-colposcopy 4-?

GCS calculation Eye open to sound. Localise pain..confuse 1. Mild 2.moderate 3.severe

55 years old female came with bilateral breast pain + bilateral green discharge from multiple ducts. Imaging: Multiple dilated ducts, not suspicious. What to do? -us guided needle biopsy -Interval follow up imaging -Galactogram -MRI breast

infant or child!! with pneumonia and atelectasis, what is best Investigation: a) fluoroscopy b) rigid bronchoscopy c) flexible bronchoscopy d) x-ray

60 y/o Patient was discharged from cicu after 2 weeks of having mi, the patient have another appointment with elective cholecystectomy. When should he do it? A. Upon discharge B. 6 weeks C. 6 months D. Until symptoms resolve

rauma pt diminished breathing opening on the axillary and you can hear squeaking or bubbling from the opening: A- chest tube insertion B- thoracostomy D- Dressing three side

three side dressing

Three years old baby boy presents to the ER with multiple bruises and the also mother and the mother tells you that this is because she fall when she try to catch her baby? -Ignore the mother and treat the baby -Tell the mother to complain to police or child abuse -Treat the baby and tell the child protection

Young asthma pt has symptoms after exertion but now present at the clinic asymptomatic. Spirometry was done and was inconclusive. What’s the next step? A- repeat spirometry B- methacholine challenge test D. Give corticosteriods

Child with a presentation suggestive of septic arthritis. Causative organism - Staphylococcus Aureus - H.influnza

Patient presented to the ER with diarrhea, nausea, vomiting, salivation, lacrimation and abdominal cramps. What do you suspect? A) Organophosphate poisoning ✅ B)Paracetamol poisoning C) Aspirin D)Penicillin

burn victim at the genital area 3 rd degree. written in the question that it makes up 1 %. what do you want to do? A- refer to burn unit B- treat as if an outpatient C- sterile dressing of some sort

CT scan of abdomen with liver cyst. Patient was tested for positive Echinococcus granulosus. What to do initially? A. Albendazole B. Metronidazole

newly diagnosed pregnant lady with GDM whats first line management? Diet, metformin, oral insulin, sc insulin

diet

Crohns large collection at rt fossa obs sx most appropriate: Pc drainage✅ Resection Non aperative Laproscopic dx

you have limited influenza vaccine, which of the following demographic will you prioritise? 1- child school 2- pregnant women 3- isolated htn adult 4 - iron defecncy anemia child

pregnant women

Patient fell on outstretched hand, pain at anatomical sniff box, which bone fracture is it? A) Colles B) Scaphoid

ECG :heart block , SVT

jpj

Old age male pt present with colon cancer S&S + low Hgb ( Diagnosis not given) What the intal test ? - occult fucal blood - colonscpoy

Patient knowing for DM And HTN and history of right leg pain increased by exertion, on examination absent popliteal pulse on right leg Which one of the following indicates acute limb ischemia: A- I forget but it’s suggestive for chronic limb ischemia B- intermittent claudication C- rest pain D- scar for iliofemoral bypass in left leg

61 patient with DM HA1C below 7 other examination all normal “eye, urine and sensation” Blood pressure 149/90 of 3 times Newly diagnosed wants to start Antihypertensive Med what to add ? A) no change B) Add ACE C) Add gliptin D) add others

A patient has had an oil dissolvant injected by a mistake in his fingers what is the appropriate management? 1. Surgical removal of the dissolvent ✅ 2. Put ice and left it 3. Antibiotic 4. Steroids

30 something year old lady presented 1 week after birth with Bilateral crackles and dyspnea What is the likely cause? 1- MI 2- Pericarditis 3- Peripartum Cardiomyopathy

3 Same recall: Best investigation? A- Echo * B- Chest x ray and ECG

"Patient came with pain on defecation for 5 days, he has history of hemmoridectomy 12 months back, examination was not done as it was painful touching the anal verge, what is the most likely diagnosis? Anal stenosis Anal fissure ✅ Anal abbesse "

patient female elderly with symptoms of Orthopnea SOB PND, JVP, Bilateral basal crackles. S3. what is the diagnosis A- Pulmonary edema B- MI C- Mitral regurgitation D- Right-sided heart failure

[c] (symptoms goes with lung congestion> LSHF > MR can be the cause )

case mentioning that a child has “certain amount of” cafe au lait spots and axillary freckling and many other features and his cousin has this as well, what type of inheritance is that condition? A- autosomal dominant B- autosomal recessive C- x linked

2 weeks post partum presented with pan systolic murmur radiating to the axilla, temperature is 37.6 c What’s the diagnosis: A- Infective endocarditis B- peripartum cardiomyopathy C- MI

A patient is diagnosed with cancer, what is the aim of the multidisciplinary team approach? A-Compassion B-optimizing patient outcomes C-leading heavy emotional conversations D-judgement free discissions

Case of 3 years old he has breathing hold, no inspiratory stridor and monophasic wheeze and barking cough ? A- bronchiolitis B- Tracheomalacia ✅ C- Laryngomalacia D- Bronchial asthma

After ERCP for management of obstructive jaundice patient develop abdominal pain and examination reveals distended abdomen with nick, chest, and abdominal emphysema, which one most likely injured during this procedure: A- esophagus B- trachea C- duodenum D- stomach

Long Case of plural effusion, what’s the indication for throcatomy? (They mean in general) Exudative fluid with 90% PMN Less than 60 glucose 2% protein less Ph More than 7.2

full term born came with respiratory distress and chest X ray showed fluid in the fissures. He is born by cesarean section. Most likely diagnosis A-Transient tachypnea of newborn B-Sepsis C- Meconium aspiration D-Hyaline membrane disease

A, fluid in fissures in full term infant delivered bxy c section

20-years-old primigravida 42 weeks with closed cervix. Induction of labor with prostaglandins passery was inserted. Her CTG was "fetal HR 140-160" after 1 h fetal HR 80 and uterine contraction last 2 minutes, most important step in management? A) CS B) Oxygen mask C) Remove prostaglandin passery D) Check cord prolapses

lactating mother unilatral nipple inversion. US : duct dilation 3.5 cm. What is the Dx : A-Breast cyst B-Breast cancer C-Duct ectasia ✅ D- breast abscess

Patient with anal fissure not responding to drug, what procedure is most suitable for his condition? A. Lateral internal sphincterotomy . B. Anal curettage C. Lateral External sphincterotomy.

A- Schwartz: first line management of Anal fissures is usually to minimize the trauma incidence by bulk agents, stool softeners, warm baths and analgesic cream. CCB ( as Diltiazem ) helps to heal the fissures and have fewer side effects. Failed Medical therapy? Lateral internal sphincterotomy is recommended.

Pregnant 28 weeks came with bilateral breast mass it was movable and the size was3x4 cm, most appropriate next step? A- reassurance and follow up after delivery B-bilateral breast ultrasound C-Bilateral breast mammogram D-MRI

Eldry k/c HTN DM smoker since 40 years Underwent thromplysis for stenosis in hospital , HA1c = 7 What the risk condition could be happened during his admission!? -stroke -bleeding -PE -MI

2 week newborn on breastfeeding . Has small amount of watery diarrhea after each feeding? - Reassurance - congenital lactose intolerance

reassurance

fever. scaterd lesion. trunk and extremities rash. 1 measls 2 brucella 3 rubell 4 hsv

Shock patient with chart showing (cardiac output 2.5L) ( PVR is very very high ), what type of shock : A- Cardiogenic B- Septic C- Hypovolemic D- PE

Hx of pancreatitis 8 weeks ago came with psudocyst 10 cm in size, no signs of infection, how to manage? A) Laparoscopic drainage B) Percutanus drainage C) Observation D) Excisions of cyst

Pt came with shock and in ICU. He has low oxygen saturation despite 100% oxygen flow. Pulmonary artery pressure 13/3 ( low). CXR: bilateral lung infliltation. Dx? A. ARDS B. PE

patient with alcoholic liver disease has ascitis and gave me labs of serum albumin and ascitis albumin? gardient was 1.6 acute pancreatits- portal hypertention nephrotic syndrome - congestive heart failure

Amenorrhea for 9 months, obese hirsutusm In lab done prolactin What you want to do in addition? -Thyroid hormone -Diabetes test and lipid profile

15 month old boy came to the ER complaining of abdominal discomfort, emesis, stool with blood and mucus on physical examination he has increased abdominal sound. X-ray report shows obstructive bowel ( written like this ) A- give antibiotic B- Go to OR and do surgery C- Barium enema D- bowel rest, IV hydration and wait until symptoms gone

Case of HELLP Syndrome, patient was refered from another hospital and came with headache. BP: 160/.. , high AST and ALT. What is the appropriate management? - Immediate C-section. - Induction of labor as delivery is anticipated.

Scenario of Pediatric with history of 2 episode of pneumonia , FTT, rectal prolapse . FH negative. What is the most appropriate management ? ⁃ sweat chloride test ⁃ CFTR gene for sibling✅

?? Shouldn’t we diagnose the kid himself?

Patient with recurrent episode of dizziness has ejection systolic murmur, heard at the left sternal border. Murmur increase with bending and standing Echo showed left atrial enlargement. What’s the diagnosis? A) Aortic stenosis B) Pulmonary stenosis C) Hypertrophic cardiomyopathy D) Restrictive cardiomyopathy

38 y/o female at her 20th week of gestation presenting with vaginal spotting with no hx of trauma her blood group is O-, she is vitally stable. US showed normal size fetus with long cervix. What will you do for her ? A) Give anti-D B) Discharge home C) observation D) continue on her multivitamins

2 months Baby came for diarrhea and no vomiting, his mother is afraid that he’s dehydrated what is the best advise? A-oral rehydration ✅ (not sure) B-milk change

Pediatric patient come with one week history of fever and cough and physical examination there is decrease air entry and crepitation, percussion there is stony dullness What’s the most likely diagnosis? -Pneumothorax -Pleural effusion

mother of 5 months old baby, asking about the reflex at that age? A pincer grasp B sit without support C wave bye bye D trying to reach objects

Typical signs and symptoms of PCOS. High BMI In addition to weight reduction what is the initial step? A- Danazol and metformin B- Metformin and clomiphenate C- IVF and salicylic acid D- Laparoscopic ovarian wedge resection and something else

A 41 wk gestation female came for IOL or agumention what agent is used to help in cervical repining ? A-oxytocin B-prostaglandin

2nd degree burn in both lower limb weight 70kg, calculate fluid in parkland formula? 4*70*(18*2) each leg is 18

81 yo woman DM, HTN on medications at risk or known to have DVT asking about prophylactic for DVT? A. Aspirin 81 mg oral B. Enoxaparin 40mg SC Forgot other choices

C 4 Diseases that usually comes together in the choices Epididymo-orchitis Testicular torsion Appendicular torsion Inguinal hernia How Can I differentiate? Let’s take them one by one. ◻️ Epididymo-orchitis: - Gradual pain in the scrotum Usually >24h. - Tender edematous cord - Red scroutm - Fever, Dysuria, urethral discharge can be present - High WBCs and inflammatory markers. Mx: Antibiotics. ◻️Testicular torsion: - Scrotal pain less than 12 hours ( مهم ) لانه بعد ١٢ ساعه يصير Necrosis ومايحس بالالم. - Previous episode or trauma. - High riding testis ( Horizontal ) - negative phren sign and absent cremasteric reflex. - Low doppler flow Mx: Surgical exploration ASAP. ◻️Appendicular torsion: - Tenderness over the upper pole - Vertical ( Longitudinal ) testis - Blue dot sign Mx: NSAIDs and Rest. ◻️Inguinal hernia: - Mass extended to the groin.

A pregnant with previous normal delivery has low hbg. She has a hx of frequent hospitalizations 1-2 every year. now no chest syndrome or vasoocclusive crisis. What is the most appropriate management? A: Observe B: Blood transfusion C: Exhange transfusion D: hydroxyurea

A OR B

30 y old male came with dyspnea, chest pain, PND and orthopnea. On examination: pansystolic murmur Gallop S3 with displaced apex, no any significant medical history. Most appropriate next step: A- Echocardiography B- Chest x-ray and ECG C- Beta blocker D- Lasix

next step is establishing diagnosis, B

Patient post thyroidectomy had arm spasm during blood pressure measurement, what is your next step? A-Give analgesia B-Take blood pressure again C-Check calcium level ✅

69- 6 YO known case of congestive heart failure, present in ER with SOB after playing, HR : 200 other examination normal, ask about apportiate mangment. A- iv fursamide B- observation as symptom expected of his diagnosis.

Patient did major pelvic surgery for ovarian cancer, after 3 days the patient developed hypoxia, what is the cause?

atelectasis

A 50 years old female no past surgical and medical history, presented with complaints of urine incontinence with coughing and sneezing, Most appropriate management ? A-urethral ring B-coloporrhaphy C-pelvic floor exercise D-burch procedure

another case copd patient and she has urine leakage while coughing asking about which type of incontinence in this pt? A- Stress incontinence l B- Urge incontinence C- Mixed incontinence

12 year old with testicular pain for 2 days. Vertical testes, tender apex, with skin changes. Most likely diagnosis? A-Epididymo-orchitis, B-torsion of testicular appendix C- testicular torsion

Shoulder was flat, adducted, internally rotated, Type of dislocation - inferior, subacriomal, anterior subacromal posterior,

female thyroid nodule 4 cm accidental discovery TSH normal T4 normal FNA unclear what do do next ? A) repeat FNA B) F/U Clinically

65 YO female presented with history of progressive solid and liquid dysphagia for 9 months. Associated with vague epigastric abdominal pain after eating. Her labs are all normal except for mild anemia. He sense somthing in his neck What is the most likely diagnosis? A. Achalasia B. Esophageal web C. Esophageal squamous cell carcinoma D. PUD

Patient with liver disease What is the most important prognostic factor? A. Albumin B. Bilirubin C. Prothrombin D. ALT

229. 43YO male known case of hepatitis B infection presented with fever and confusion, examination reveled disorientation, asteraxis and positive shifting dulness Ascetic fluid analysis: SAAG= 1.2 Neutrophils= 350 or 320 Culture bending What is the most appropriate treatment? - IV diuretics and metronidazole - Lactulose enema and IV Ceftriaxone - High ascetic fluid aspiration and propranolol

RA patient contry on hydroxychloroquine and steroid with abnormal fasting blood sugar and HA1C? Taper steroid and give methotrexate Taper steroid and give adalimumab Continue Sim management

survey

63 year old man present with Hx 1 year of dry cough and exertional dyspnea, Digital clubbing, bilateral reticular opacity, bilateral basal rales. Diagnostic test? 1-Trans-bronchial biopsy 2-HRCT 3-diffusion PFT 4-Serum ACE level

Patient with inferior MI who is vitaly stable preparing for coronary perfusion. He suddenly became hypotensiveBp 80/40 PR 100. what is the cause? A: RV infarction B: Heart block C: LBBB

a child who Alternates feet when walking up and down the stairs Pedals a tricycle understand gender differences. 2 years 4 years 4 years

3 years

36 male presented with hypertension (high blood pressure reading given) he have a family history of hypertension and both his sisters have hypertension He have high ceriatinin and protein in urin How will you manage? 1-ACEI 2-alpha blocker 3-beta blocker 4-?

Adult with Crohn’s disease present with painful perianal mass and tender with positive fluctuations next? Abx Incision and drainge

One of the following is a side effect of Rifampicin? A- Constipation B- Red-brown body fluid discoloration C- Abdominal pain D- Numbness

Case of congenital adrenal hyperplasia, Child born with ambiguous genitalia, 17-hydroxyprogesterone was high. Which pf the following is the mode of inheritance? A. Multifactorial B. Autosomal recessive C. X-linked D. Autosomal dominant

A female presented with back pain and fever, she was given NSAIDs and advised for bed rest at home, then she presented with inability to move her lower limbs, O/E there was tenderness on the midback. Spinal MRI: Diffuse discitis on T6, What is the most appropriate next step? A- Reassurance B- Specimen from T6 vertebra C- Brucella titer D- Bone marrow aspiration for culture

اذا جا كذا بالضبط B اذا كان واضح ان معاه Brucellosis الاجابه C Vertebral discitis{b] -MRI [most sensitive and specific test for diagnosis] -biopsy [ for histologic confirmation and to obtain a culture of the causative organism.]

Mother concerned about her child how have abnormal face and mouth movements during sleep mid temporal spikes in eeg? A-Rolandic syndrome B-meningitis C-juvenile myoclonic epilepsy D-encephalitis

y/o male on MV in ICU due to intracranial hemorrhage, 7 days later he developed ground coffee vomitus. What is the Dx? A- Stress gastritis B- H.pylori gastritis C- Dyspepsia

Case of back pain and the diagnosis was written (Lumbar Spinal stenosis). What is the first step in management? A. Lumbar laminectomy B. Physiotherapy C. Epidural analgesia

Patient diagnosed with MRSA and started on vancomycin 1000 mg over 72 hs ( in 20 mins infusion ). Immediately he developed rash and itching in his trunk. What is the best next step ? A. Continue but slow infusion rate B. Stop vancomycin and write in the file as anaphylactic C. Change vancomycin to cephazolin 1000mg D. Continue but Decrease the dose

Case with all shock parameters and ask for the type ? There was very high wedge pressure Cardiogenic

Baby abounded by his mother as he's result of out of wedlock pregnancy Pediatric surgeon asses him he has inguinal hernia decided he need inguinal hernia repair. Pt need: consent What's appropriate next step? A .refer the police B. refer to social worker C. you do the consent for the baby D. call the ethical committee

Most effective contraception ? Male Condom Female condom Spermicide Hormonal vaginal ring

2 weeks post thyroidectomy came with high tsh how to manage? - reevaluate after 2-3 months Increase or decrease the dose

27 years old man came to the clinic with family history of sister with adult polycystic kidney disease , how u will screen him? A- US B- polycystin-1 antibodies level C- Biopsy

Pregnant in labor and they started her on epidural analgesia then suddenly uterine contractions stoped despite oxytocin infusion What’s your next step ? A- immediate emergency CS B- Stop Epidural anesthesia pump infusion C- Reposition the mother and assess after 20 minutes D- oxytocin infusion

iv abx

2 month old baby at the clinic what to do? A. BMI B. Head circumference ✅

Female pregnant with recurrent late deceleration and fetal bradycardia and dilated 6cm what to do ? - Emergency CS - Reassure - Induction

Lady, with bruises and fracture bc her husband beat her, what to do? A- educate about violence B- inform authorities C- talk to the husband

Pt has rest tremor but when he move to pick something the tremor gone, but can’t do finger nose test with his right hand where is the lesion ? A- Right cerebellum B- Left cerebellum C- Right hemisphere

Post RTA patient had lower back pain and unable to move, management done while waiting for the consultant? A. CT spine B. Back stabilization

case of prom at 37 weeks when to give antibiotics? A- prior to delivery B- Post partum

child had meningitis, and he contacted his brother & sister, what will give as prophylaxis ? - penicillin + rifampicin 2 times – penicillin - Ciprofloxacin one dose - Ceftriaxone 3 doses IM

50 years old male patient, alcoholic, with Abdominal pain and palpable gallbladder, weight loss, scenario suggestive of malignancy. Liver enzymes acceptable except for significantly high ALP. Diagnosis? Periampullary Tumor Hepatocellular CA

Male presents with peptic ulcer resistant to medications, with positive secretin stimulation test, what is the diagnosis? a) VIPoma b) Glucagonoma c) Gastrinoma

Child had a viral illness 2 days ago came with shortness of breath on examination there was wheezing with increased expiratory phase what will you do? A- antibiotic and nebulizer B- nebulizer and steroids C- steroids and antibiotics

treatment of brucellosis in adult? A-Doxycycline and streptomycin B-Doxycycline and cefriaxone C-Rifampin and trimethprim-sulfamethaxazone D-Rifampin and ciprofloxacin

54 YO female medically free came to the clinic for routine checkup. Her cardiac examination revealed grade 4 pansystolic murmur heard best at the apex and radiate to the axilla. She is symptomatic and the rest of her examination is normal. What is the best next step to confirm the diagnosis? A. Transthoracic Echo B. Transesophageal Echo

51 years old female medically & surgically free, with no family history of colon cancer, which colon cancer screening test is appropriate for her? A. 5 years Colonoscopy B. Annual Fecal Occult Blood C. Annual sigmoidoscopy

ld male with Copd investigation to start long term oxygen ttt A. 2 reading po2 <6.3 B. 1 reading po2 <7.3✅ C. 1 reading po2 <8

Pt diagnosed with pneumonia and transferred to ICU Vitals showed BP of 80/50 Hb 95 ( normal 130 and above) What’s your initial treatment ? A- Dopamine B- 1000ml normal saline C- pRBCs

Patient has done a myomectomy for fibroid of 5 cm, on examination you found that the endometrial layer has been involved… What is the risk of placenta accreta if she get pregnant. Increase Decrease Unknown Unaffected

12 months old child came to clinic with his mother for taking hepatitis A vaccine, The mother tells you that he has sickle cell disease and that he received blood transfusion 1 week ago, what to do? A. Give vaccine as per schedule B. Check his hep A serology first C. Delay for one month D. Delay vaccine for 6 months

stroke patient developed new weakness on ex papilledema CT finding: hemorrhagic stroke. Most definitive Mx ? 1-Craniotomy and decompression 2-Iv mannitol 3 iv dexa

A baby came with repeated vomiting ( i think he was 12 month old) and the mother told you there is abnormal smell in urine. What is the cause of vomiting? A- UTI B- DKA

Pt with diffuse thyroid enlargement on exam there is 1 nodule in each lobe, labs showed hyperthyroidism what will you do? A. Thyroid scan. B. FNA from both nodule

Mile stone (patient speak few words, name body part, imitate his mother) what is the age? 18m 24m

A patient with renal failure presents with low calcium, high alkaline phosphatase, and high PTH. What is the best form of vitamin D to give this patient? A- Calcitriol B- Vitamin D2

60 yo F Known DM and HTN Came with chest pain for 3 hours Other info I forgot Vital signs “I don’t remember were significant numbers” Investigation: Ecg t wave inversion in leads 5,6 trop 10 What’s the most likely diagnosis? A/ stable angina B/ unstable angina C/ MI

كان فيه سؤال موجود لاب واحد فقط كان high lactate A. Sepsis B. Septic shock C. Bacteremia

Long case with Kayser–Fleischer ring and low Ceruloplasmin how to treat? A- Penicilliamine ✅ B- EDTA

year-old male patient k/c of DM, HTN and PAD, presented with severe claudication, admitted to the hospital as a case of acute limb ischemia and received thrombolytic therapy. Which of the following is a cause of death during hospital admission? A. Bleeding B. Hemorrhagic stroke C. Pulmonary embolism D. Myocardial infarction

patient presented with lower abd pain 4 days ago he has hx of wood injury at same location examination revealed lethargic patient with purulent discharge from site of injury in lower right abdomen what is next in mx A. ct abdomen✅ B. culture and sensitivity of secretion C. us

Pregnant I don’t remember gestational age but she was less than 34 weeks, presented with lower back pain and uterine contractions on vaginal Examination there was 1 cm cervical dilation with 70% effacement, how to confirm the diagnosis:- 1- repeat vaginal Ex after 2h. 2- US to see cervical length

Patient with sore throat fatigue and shortness of breath and productive cough with whitish sputum, sometimes there's bloody streaks. X-ray: normal with no conselidation. What's the diagnosis? A- bronchitis B- Hemorrhagic telagictasia C- respiratory distress

There was lack of invelonza vaccine which most important group to give? A- school children B- pregnant women C- child with SCA

Bethesda 4 > hemithyroidectomy, FNA, total thyroidectomy

female after MVA admitted for observation was vitaly stable x ray showed fracture in 3and7 rib …then she devolution shortness of breath (only) ..what is the cause ? 1-flial chest 2-PE 3- tension pneumothorax 4?

Elderly with sudden pain in leg ,change of color and paresthesia Most important management CTA Embolectomy Streptokinase Below knee amputation

اللي قاعد يسأل عن ابروتش للlimb ischemia

بشكل عام، اي مريض جاي اكيوت كيس limb ischemia، اول شي نعطيه IV heparin بغض النظر عن اي حاجة في الكيس

بعد كذا نشوف حسب حالة المريض

Stage 1 “Viable limb” -> only heparin

Stage 2a “marginally threteaned” (loss of sensory) -> cath thrombolysis

Stage 2b “immediately threatned” (loss of sensory + motor) -> embolectomy

Stage 3 “paralysis” -> amputation

Non-Hodgkin lymphoma on Tx developed tumor lysis syndrome: A. Hypokalemia hypocalcemia B. Hypokalemia hypercalcemia C. Hyperkalemia hypocalcemia D. Hyperkalemia hypercalcema

Pt involved in RTA with isolated head injury, he remains in coma for 5 days after the accident, what is the appropriate to resuscitate him in early managment ? A- NGT B- Gastrostomy tube feeding C- Central line D- Peripheral line

What considered the Best score on biophysical profile? A- 8/10 B- 9/10 C- 12/12

A 45 year old female came for colon cancer screening. No family history of any cancer. What is the best screening to decrease the risk of colon cancer for her case: -Colonoscopy annually -Colonoscopy every 5 years -Start colonoscopy screening at the age of 50 -Do colonoscopy now and ... (Not sure)

male had type 1 DM and his family best time to start celiac screening. Which of the following is the best advice? A. Screen at diagnosis then every 5 years. B. Screen at diagnosis then every 2 years. C. Screen annually. later o n every 3 tears. D. No need for screening.

40 years old female known case Bronchial asthma, allergic rhinitis, came with poor control despite she takes inhaled steroids and oral steroids and no improvement , she also takes aspirin and ibuprofen for a reason joints pain. on examination nasal polyps , chest wheezing, what is the management? A- stop aspirin and start Montelukast B- chest CT C- IgE and eosinophil level D- Direct view with laryngoscope

Patient with chronic limb ischemia, presented with sudden leg pain, diminished popliteal and distal pulses in right leg, and diminished distal pulse with intact popliteal in the left, what's the appropriate next action? A. Heparin B. CT angio C. US D. conventional angio

A اذا كان فيه خيار مثلا oral cefuroxime هو الاصح او لا؟ لكون فيه احتمالية renal involvement بسبب temp اكبر من 39 المرجع up to date

Case of PUD what is the important test to reach the diagnosis? A- endoscopy B- h. Pylori Antibody

Victim of RTA came with pelvic fracture and there’s blood in the urethra and has retopretonial fluid, next step? A- Folley catheter B- suprapupic catheter C- laparoscopy D- laparotomy

patient with low serum sodium and high urine osmolarity? siadh di

13 years old female with 10 month history of diarrhea, post prandial periumbilical pain, weight loss, some times bloody diarrhea : Chronhs disease Peptic ulcer disease Others are irrlevanct

Active rheumatoid arthritis what is the management? A- Methotrexate B- methotrexate hydroxychloroquine C- methotrexate hydroxychloroquine and steroid✅

21.lady with sever dysmenorhea(endometriosis)not lpmrove with NSAD what to give? A.cocp✅ B.gnrh

70 old male with forgetfulness, progressive gradually for 2 years.. devolop signs of aggression and violence after he was calm ,caring ,and kind: A. Lewi body B. Alzheimer’s C. Vascular dementia

PRESCHOOL CHID WILL WENT TO SPLENOECTOMY, WICH VACCINE SHOULD HE TAKE ? A) RUBELLA B) VARICELLA C) H. INFLUNZA D) MEALESES

Long clinical scenario of a middle aged man with generalized acute abdominal pain, mainly epigastric, vomiting Exam: epigastric tenderness Investigation: air under diaphragm distended loops Amylase was 270 What’s is the best diagnostic investigation? A/ abdominal u/s B/ abdominal CT C/ upper gi endoscopy D/ barium swallow E/ barium enema

Pregnant lady gestational age 35 week mentioned there is no fetal movement They have done ct was reassuring they mentioned cervical dilation of 1cm, -2 station Mild contrition everything is normal? -Observation and continue CTG monitoring -discharge home -C\S -nduction of labor

Recurrent sinopulmonary infections and recurrent gastroenteritis with giardiasis, his brother died due to infections and weight+ hight below 3 centile and no lymphadenopathy:- 1- omenn syndrome 2- X linked agammaglobulinemia 3- SCID

Treatment of simple cystitis (fever and painful micturition )in 5 yr old 1- IM ceftrixone 2- oral amoxicillin 3- IV cipro

Patient with face laceration, gives lidocaine before management wt Side effects of this medication - Drowsiness - Nystagmus

neonate with polyhydrminos history and coiled endotracheal tube What's the most common complication of the surgery lead to voice change ? GERD Bleeding Perforation

83 y/o presented with abnormal uterine bleeding started 8 month ago, Hx of 3 abortions, and Hx of myomectomy, in examination bulky uterus: Pic: endometrium thickening 13 mm What is the Dx: A- endometrioma B- uterine atrophy C- endometrial cancer

Child have dry non purulent conjunctivitis, cracked red lips, erythema (I think trunk, sole, hand) what's the diagnosis? A- Kawasaki disease B- Rubella C- Measles

40-A child came with signs of moderate dehydration. You start him on ORS. Which of following is the best step? A-Gluten free formula B-ORS for 1 day and then introduce normal food C-ORS for 5 days then introduce normal food D-IV fluid

diabatic pt and obese (i think bmi was 41 )failed to reduse weight 1-diabetic drug for reducing weight 2-bariatric surgery

18 years old irregular menstrual, BMI 34 what to do Metformin Lifestyle and exercise

Pt with abdominal bloating and positive endomysial antibody and jejunal biopsy shows flat mucosa:- 1- celiac 2- lactose intolerance

old age i think 52 y/o , last menstrual 12 month ago..ect, What is the responsible for this condition? A- FSH B- Estradiol C- progesterone

Aspergillosis treatment? Rifampicin voriconazole

Copd exacerbation what is the best drug to relieve symptoms quickly 1-salmeterol 2-albuterol 3-corticosteroids 4-ipratrupiom

Sickle cell patient what true regarding her folic acid supplement during pregnancy ? Give 5 mg folic acid in first trimester 5 mg in whole pregnancy

Male k/c of acute pancreatitis came with abdominal pain in RUQ In US : gallbladder stone and dilated CBD What is your management A- laparoscopic cholecystectomy B- ERCP ✅ C- ABx D- MRCP

pregnant woman came with typical symptoms of DVT then she developed SOB in duppler US you found nothing what is your next step? A- CXR B- CT C- v/q

20 y male pt came to the ER with 2 months hx of bad personal hygiene , echolalia , echopraxia , muttering , good memory what drug to give him ? A. oxcarbazepine B. venlafaxine C. lithium D. amisulpride

Patient diagnosed with Ulcerative Colitis 6 years ago. when to be screened for colon cancer? A. Annually till age of 50 B. If there is mild inflammation C. At time of diagnosis D. 8-10 years after diagnosis ✅

most poorly prognostic in pregnancy? AR AS MR MS

Yes there was a nurse in pulmonary clinic w they kept her xray she had like cavitation in the upper right lung and she was suffering from fever, rigors and productive cough with no improvemet on 3 months antibiotic course. Which bacteria is involved? Strep pneumo Tb Morixella catarrahlis H. Influenza

A 27 year old pregnant lady, GA 39 came with a gush of watery fluid. On speculum exam there were pooling of fluids in the vaginal vault. A Nitrazine test shows a PH of 7. Which of the following is another highly diagnostic test for this condition? A- indigo carmine injection in to the amniotic sac B- Methylene blue injection in to the amniotic sac C- US to assess the amount of amniotic fluids D- Fern test

patient received immunization against Hep B, what do you expect his serology to be? HBs AB+ HBc AB + Hbe AB + HBs Ag +

HBs AB +

GBS vaginal swab screening in pregnant women a. 15 weeks b. 25 weeks c. 35 weeks d. 40 weeks

Sever diarreha for 5 days what electrolytes seen : Metabolic acidosis hyperkalemia Metabolic acidosis hypokalemia Repairatory acidosis hyperkalemia Respiratory alklosis hypokalemia

65 y o heavy smoker, medically and surgically free , coming for screening in general practitioner, which of the following Highest important risk factors for screening : -DM -Colorectal Cancer -HTN -Abdominal Aortic Aneurysm

A 35 year old car driver crashed into a concrete block without a safety belt on. Thirty minutes after and on the way by ambulance to the hospital he begins to become breathless. On administration of 100% oxygen there is not much improvement in this condition. On arrival at the Emergency Department he has lost consciousness (GCS 8) and appears cyanosed with markedly distended jugular veins. Blood pressure 80/40 Heart rate 120 /min Respiratory rate 34 /min Temperature 36.6 c Oxygen saturation 60% on room air What immediate action should be taken? A. Intubation and 100% oxygen B. Rapid infusion of crystalloid C. Needle decompression D. IV 0.2 mg adrenaline

Hypocalcemia symptoms (twitching…etc) and ECG shows prolonged QT:- 1- oral calcium 2- IV calcium

Child present with right inguinal hernia Most appropriate management? Herniotomy Open repair with mesh Observe until age 6 y

Pregnant 10 weeks k/c of gallstones presented with recurrent attack when to do cholecystectomy A- now B- elective and appointment after one week C- after delivery D- no need

22 y female admitted with pulmonary hemorrhage and golomerunephratis hx of sinisitis and numbness in right upper limb and left lower limb Dx : Giant cell arthritis Hsp Granulomatosis with polyangitis

Pt is presented with sudden Hemoptysis. Endoscopy was done and it shows gastric varices What to give A. IV PPI✅ B. Octeride

2 years old baby, before 3 weeks had blood transfusion after acute sickle cell attack. His mother bring him for hib A vaccination : A_Give vaccine ber schedule B_ wait 3 months C_ wait 6 months D_ (don't remember)

Pregnant in third trimester presented with bleeding, cervix was 7cm dilated. Whats the type of bleeding? A- post partum B- antepartum C- intrapartum ✅

A breast feeding women with an indurated wound on her breast. Most likely pathogen? - S. aureus - S. pyogenes

Female in 33 w present with multiple follicle around the areola of nipple smooth round and painless A. Montgomery’s Follicles B. breast cyst C. Lactiferous duct D. Mondor's disease

Child with Sx of tracheomalacia. How to confirm the diagnosis? A) chest XR B) bronchoscopy✅ C) Fluoroscopy

Patient known case of CHF and DM on insulin, ACEI and Furosemide and now came with signs of DVT and started on heparin. Labs: K: 6 Slightly prolonged PTT and INR Which of the following drugs you will stop at this stage? A- Heparin B- Insulin C- ACEI D- Furosemide

Case of fever and sore throat , and there’s exudate membrane cover the tonsils? - Coronavirus - Infeunza - RSV - EBV

Menorrhagea with fibroid where is Most Common location ? Intramural ubserosal

intramural

55 year old involved in MVA and sustained a blunt trauma to his abdomen. He his hypotensive 90 / 63 and HR 104. He is not responding to fluid. FAST is negative for fluid in pericardium, chest or abdomen. What is the next best step ? A. Laparotomy B. CT scan C. DPL D. FAST

pt with prosthetics mitral valve , going for dental procedure which prophylactic would you give ? A- ampicillin B- doxycycline C- ceftrixone

24 years female diagnose with endometriosis she took NSAID but no benefits. What is Most appointment mx? A- ocp ✅ B- Ablation C- Hytsterectomy.

8 years old boy colony culture shows that he have klebsiella pneumoniae from midurine clean catch What’s your management? -not require treatment -Repeat culture later -Treated as acute UTI -Prophylactic therapy

a case of child after brain surgery Na177 i forget the exact lab for urin sorry 1-central DI 2-SIADH 3-4-?

What is an indication for dialysis? -Potassium of 6.5 despite 3 trials of medical treatment -Decrease urine output

A 63 years old male presented with one episode of hematemesis. On examination, he has spider angioma and bilateral gynecomastia with splenomegaly. Blood pressure 100/60 Labs showing Hematocrit: 0.23 (0.4-0.6) Hemoglobin: 85 (130-170) What is the most appropriate next step after initial resuscitation with IV fluid? A. Abdominal X-Ray. B. Upper GI endoscopy. C. Nasogastric tube insertion. D. Blood transfusion

Bilateral lower limb edema and raised jvp:- 1- cirrhosis 2- nephrotic 3- cor pulmonale

An elderly man with a case of HF came with dyspnea, palpitation. He is on captopril. He was started on furosemide and symptoms got better. What should be added next for this patient A. Digoxin B. Carvedilol C. Amlodipine D. Cant remember

most reassureing biophysical profile A- 6\10 B- 8\10 C- 9\10 D- 12\10

Patient in her 30s is considered about cancer. Her mother was diagnosed with breast cancer, while her sister had ovarian cancer. What to do to for her? (Did not mention when her mother and sister were diagnosed) A. Mammogram now B. Mammogram at the age of 40 (BRCA was NOT in the choices)

2 year old baby boy uncircumcised came with fever, rigor and has emesis once, start at morning Fever : 39.1 What will indicate upper urinary tract infection more ? A) being male B) duration of fever C) temperature 39.1 D) vomiting

C UTD: Probability of UTI increase when: -Age is less than 12 months -Fever of 39 or more -Uncircumcised -Being a female. -Duration of 48h or more.

Child came with drooling saliva and toxic appearance etc What is your management? A- refer to ENT for tonsillectomy B- icu for intubation then septic work up C - do septic work up and give ABx as outpatient D- observation

12 y boy presented with 2 days of tenderness in upper pole of right testis with right scrotal inflammation (redness …),the testis is in longitudinal position (no high riding testis) diagnosis? A-Testicular torsion B-Appendicular torsion C-Cry..orchitis D- Hydrocele

Middle age Pt with papillary thyroid cancer , planned for total thyroidectomy how to follow up ? 1- serial post op US 2- calcitonin 3- TSH , T3 , T4 4- Thyroglobulin

Patient came with sob , cough Cxr showed pneumonia and 25ml pleural effusion , inital step? -iv abx - diagnostic thoracocentesis

TTN xray showed fluid in fissure , ask about dx

ttn

Chrons pt came with pain and swelling in and purulent discharge that come out only with pressure on It , what is next ? A- increase infliximab does B- IV abx C- I & D D- percutaneous drain

Child with face swelling and sacral edema with abnormal liver test and proteinuria Dx? A-CHF B-Chronic liver disease C-Nephrotic syndrome D- Low protein diet

38 YO female presents to the clinic after finding of hilar lymphadenopathy on CXR. She has on and off cough, but denies any fever, headache, n/v, weight loss all negative. Labs insignificant except for X-ray shows confirmed bilateral hilar lymphadenopathy CT guided biopsy shows noncaseating granuloma What is the best next step in management (They wrote “all labs were normal” and didn’t mention hypercalcemia) A-Observe✅ B-Start prednisolone C-Start azithromycin D-Start anti TB medication

45 y\o female medically free present with flank pain, fever what is the treatment: Ciprofloxacin Ceftriaxone

56 YO male k/c of DM and HTN on hydrochlorothiazide, his BP is still not controlled. What is the best next step? A. Add ACEI B. Add CCB C. Increase hydrochlorothiazide dose D. Add BB

Patient came fracture and compartment syndrome, what’s the first alarming sign? A. Absent pulse B. Toe discoloration C. Paresthesia

parasthesia is the first sign

Patient presented with psychomotor agitatiom, grandiose delusions, auditory hallucinations, flight of ideas and lack of insight, what does he have ? A) Neurosis B) Psychosis C) Personality disorder

Patient came with diverticulitis which was managed after few days he had perianal pain during rectal examination there was anterior bogginess, what will you do? Incision and drainage Antibiotics

Patient with greysh vaginal discharge (odorless) and spores on microscope? A-candida. B-TRICHOMONAS

3 years old asthmatic child, mother is concerned as they are not leaving the house much as they must use the nebulizer and it needs power source, what to advice? A. Tell the mother not to leave house B. Find a portable nebulizer C. Educate about inhaler use and stop nebulizer

C LESS THAN 4 WEEKS IF HETEROGENOUS ITS ACUTE NECROTIC COLLECTION, IF HOMOGENOUS ITS PERIPNCREATIC COLLECTION. IF MORE THAN 4 WEEKS HETEROGENOUS ITS WALLED OFF NECROSIS IF HOMOGENOUS ITS PSEUDOCYST

Case of Heart failure patient on Candesartan, atorvastatin, furosemide. His BP is 128/90 What medication do you add? A-BB ✅ B-No need for treatment

Patient, hypertensive, came with history of stroke 10 days ago. He has left side hemipersis. He was started in physiotherapy and anti-htn medications. What are you going to add? A. Aspirin B. Apixaban

months old child came to clinic with his mother for taking hepatitis A vaccine, The mother tells you that he is a know sickle cell disease patient and that he received blood transfusion 1 week ago, what to do? A. Give vaccine as per schedule✅ B. Check his hep A serology first C. Delay for one month D. Delay vaccine for 6 months

14 years old came with sever sudden scrotal pain and on examination high riding and sever tenderness on palpate.. dx? A. Testicular torsion B. Orchitis C. Hydrocele

5 years old girl, has uti what is most appropriate treatment A amoxciline B iv ciprofloxacin C im ceftraxon

17year old female, medically free, gymnast in her class, developed breasts later and never menstruated, on examination she is tanner stage 5 but no menstruation, diagnosis? A. hypothalamic hypogonadism ✅ B. imperforate hymen C. gonadal agenesis D. testicular feminization

Patient present with 2 cm solid thyroid nodule on ultrasound, what is the most appropriate next step? (This is the full Question no other details) A- Repeat US in 6 months B- Thyroid scan with iodine C- Fine needle biopsy D- Tru cut needle biopsy

What causes interstitial pneumonia / Interstitial pneumonitis? A-Viruses B- tuberculosis C- bacteria (Atypical pneumonia)

43male have family history of colon cancer underwent sigmoidoscopy for polyp removal Histopathology showed tubular adenoma completely removed ..how to follow? 1-3-6 month 2-3years 3-5 years 4-no need

Type of vitamin D in rickets D1 D2 D3 D4

Patient hx stillbirth, trying to get pregnant doesn’t want stillbirth currently bhcg positive, asking to give all necessary vaccine to her - influenza RUBELLA

2 years boy signs of testicular torsion , redness pain , absent cremastric reflex , previous episode same sx2 weeks (I think ) A- Surgical exploration B- NSAID C- Antibiotic D- Testicular elevation

A 4 Diseases that usually comes together in the choices Epididymo-orchitis Testicular torsion Appendicular torsion Inguinal hernia How Can I differentiate? Let’s take them one by one. ◻️ Epididymo-orchitis: - Gradual pain in the scrotum Usually >24h. - Tender edematous cord - Red scroutm - Fever, Dysuria, urethral discharge can be present - High WBCs and inflammatory markers. Mx: Antibiotics. ◻️Testicular torsion: - Scrotal pain less than 12 hours ( مهم ) لانه بعد ١٢ ساعه يصير Necrosis ومايحس بالالم. - Previous episode or trauma. - High riding testis ( Horizontal ) - negative phren sign and absent cremasteric reflex. - Low doppler flow Mx: Surgical exploration ASAP. ◻️Appendicular torsion: - Tenderness over the upper pole - Vertical ( Longitudinal ) testis - Blue dot sign Mx: NSAIDs and Rest. ◻️Inguinal hernia: - Mass extended to the groin.

a, add 9 m 7 d

pregnant lady 30 weeks gestation known case of Rh alloimmunization the fetus found to have anemia what the management delivery duplex fetal blood transfusion

breast feeding mother found unilateral mass on the lower outer quadrant of right breast (i think 3x3 cm) it was erythematous and hot on palpation. Mildly tender. Most appropriate management? A. Antibiotic B. Dressing and drainage C. ....? biopsy D. Aspirationand...?

8 days Post thyroid surgery. Patient had swelling in the neck and difficulty breathing. What will you do? Ans: Open sutures in the ward

Pregnant what indicate ongoing bleeding? Decrease utine output Hypotension Tachycardia

Healthy female with perianal discharge at 3 and 7 oclock ( no mass, no vitals ), what are you going to order? A- MRI B- Colonoscopy

If K/c of Crohns? MRI If not? Colonoscopy first Fistulas can be the first presentation of CD.

60 YO male with difficulty passing urine for the past 6 months. He also complains of back pain. PSA was very high (Above 100. Diagnosis? A. Benign prostatic hyperplasia B. Prostate cancer

Child missed his second dose of varcicella vaccine. He took the first dose 1 year ago. Which of the following will insure full immunization? Check varicella Ab levels Repeat first dose Give SECOND dose Repeat the whole series

child with bilateral knee pain diagnosed with JIA, what type is it? Oligo Systemic Poly

Lady, with bruises and fracture bc her husband beat her, what to do? A- educate about violence B- inform authorities✅ C- talk to the husband

Pregnant 🤰 in labour was induced by oxytocin, CTG showing late deceleration with picture, What to do to reverse condition ? A- change mother position to sleep supine B- give epidural anaesthesia C- weird word CEASING oxytocin but i chose it

Same q came in same exam with different options (sever acute asthma) A- ox <95 B-HR>100 C-PEFr <300 D- RR > 25

Patient with whooping cough, cause is: viral bacterial

Primary infertility with scanty irregular cycle and very high FSH, most important work up? A-FSH/LH in urine I think B-CBC C-Pelvic US D-chromosomal analysis

Patient presented to the ER with abdominal pain. Physical exam showed tenderness in RLQ with mass on deep palpitation. What to do next? (No vitals provided, WBCs was normal) A. CT abdomen B. Exploratory laparoscopy

Pic of meningococcemia rash asking what complication will occur? Hearing loss

6,7,8 nerve

c/P of adenomysis what is definitive treatment? hysterectomy nsaid

pregnant 31 weeks came with uterine contraction and cervix closed what to give A- Nifedipine B- Terbutaline C- Indomethacin D- Corticoseroid

Pediatric patient presented with abdominal pain and jelly like stools , right quadrant mass ( case of intussusception ) what's the diagnostic test ? A. Abdominal x - ray . B. Abdominal CT . C. Abdominal US . D. Contrast enema

An 18-month child was brought to clinic for a regular checkup. The doctor found out that the child had not taken any of his scheduled vaccines. He asked the mother why and she replied “Vaccines will make my son retarded!”. What is the appropriate action? A) Refer the mother for psychiatric assessment B) Contact child protection services C) Explain the benefits of vaccines to the mother D) Contact the hospital ethics committee

Patient hospitalized with pancreatic cancer presented with unilateral leg tenderness erythematous and swelling Dx A- Cellulitis B- DVt C- Acute ischemia

A 60 years old patient after 10 minutes of blood transfusion developed pain in the site of the cannula, difficulty breathing, and is febrile. What is the most likely blood transfusion reaction? A. Febrile non-hemolytic anemia B. Hemolytic anemia C. Allergic reaction D. Acute hemolytic reaction

25 years old Patient came to ER with SOB after exercise, he had history of intermittent SOB, on exam there are wheezing in all chest, most appropriate treatment? A-inhaled salmeterol B-inhaled fulticasone C-IV cortisone D-IV magnesium sulfate

this patient came to the er, he hasn’t been diagnosed with asthma nor is he taking any medication for it, A and B are LABA and we wouldn’t give iv steroid as first line. First thing we do is give O2 and SABA(albuterol) and oral corticosteoids if no response

Tumur lysis syndrome type of electrolyte .distirbance : 1-Hypocalcemia Hyperkalemia 2-Hypercalcemia Hypocalemia

37 weeks in active labor dialted 4cm intact membrane. CTG is normal except for recurrent variable deceleration. Next step? A. CS B. ROM C. Observe D. Give tocoloytics

Child with forigen body aspiration (peanut) and doctor prepare him to do bronchoscopy, where did you expect its location? A- Larynx B- Trachea C- Right main bronchus D- Left main bronchus

A 40-year-old women presented to the Clinic. She has a strong family history of cancer where both mother and sister died of cancer. BMI 31 kg/m2. Which of the following is the most appropriate counselling? A. Be physically active B. Maintain a healthy weight C. Limit consumption of fast food D. Meet nutritional needs through diet alone

Diabetic type 1 had dka,, on discharge what is the best regimen: ⁃ Twice nph ⁃ Once mix?? ⁃ Basal bolus with once glargine ⁃ Short acting before meals and no long acting agent

50 years male returned from vacation ,drowsy, poor concentration,difficult awaking from sleep ,he described multuple falls. all labs and brain images are normal Post concussion syndrome Chronic subdural hemorrhage

A case pointing to VSD in a less than 2 years old child ( not sure). He is presenting with symptoms of heart failure (irritable, diaphoresis with feeding, dyspneoa, other signs of lung congestion). In laps oxygen saturation was lower than normal and there was mild respiratory acidosis. Xray showed increased vascular markings. What is the appropriate management: Supportive with diuretics Intubation with antibiotics Reassurance And i don’t remember the last choice

how to assess Down syndrome growth ? A. Stander growth chart B. Down syndrome growth chart ✅

New couple, husband has sibling with SCA , husband had screening and he is sickle cell triat , the wife is never tested, what the risk of have child with SCA? ⁃ High risk ⁃ No risk ⁃ Low risk and can be nill if the wife not effected✅

39years old patient with symptoms of SLE, arthritis and malar rash, what medication should be started ? A-Hydroxychloroquine and Mycophenolate mofetil B-Hydroxychloroquine and Methotrexate C-Hydroxychloroquine and azathioprine D-Hydroxychloroquine and steroid

Patient with hyperthyroidism and palpitations, heat intolerance.next step Propriouracil Methimazole???? Carbimaxole Propranolol?????

Male 20 something has fever, epigastric pain .jaundice there is epigastric tenderness By abdominal US there is hypodermic mass with peripheral enhancement ((liver abscess diagnosis not given) what is the management: A.metronidazole B. Percutaneous drainage C. Surgical drainage D.antibiotic or follow up not sure

Child 10 years old came complaining of abdominal pain and diarrhea examination showed jaundice and splenomegaly what type of hepatitis ? A B C E

Child presented with cough, conjunctivitis, coryza and fever. He has rash the started from the head then extended to the rest of the body A: rubella B: reiters syndrome C: Toxic shock syndrome D: long name

8 weeks old baby come with hx of poor feeding, chest wheeze and fever, he was fine 2 weeks before that according to the mother, chest x ray cardiomegaly increase lung vasculature and bilateral lung infiltration . On PE palpable liver below costal margin and pansystolic murmur What is the most appropriate next step in management? A- refer to cardio B- Diuretic C- IV abx and reevaluate later

Middle-aged patient presented complaining of RUQ pain, no jaundice no altered stool or urine color. On U/S: GB stones with normal wall thickness and no signs of inflammation, CBD is obsecured. Which of the following is the most likely the diagnosis? A. Pancreatitis B. Cholecystitis C. Obstructive jaundice D. Small bowel obstruction

Scenario of patient has ovarian cancer and Ascites with high CA125 , and ask you how to stage the cancer ? A- surgical staging B - Ascitic staging C - CT chest , abdomen and pelvis.

A patient with Crohn’s disease treated with infliximab and azathioprine presented complaining of the perianal pain for 5 days .. on examination there is purulent discharge.. and induration with erythematous. Vital signs are stable and there is no fever. Labs show high WBCs What is the next step? A. Increase dose of infliximab and decrease frequency B. Percutaneous drainage C. Broad IV Antibiotic D. Swab and culture

Female diagnosed with bilateral DVTs and she has history of 2 still births Labs: Prolonged APTT (no other labs provided) What is the diagnosis: A. Antiphospholipid syndrome B. Protein S deficiency C. Protein C deficiency

This patient was using IUD before, but she got pregnant nonetheless. Delivered with C-Section. Then she developed endometritis. Which of the following represent contraindication: A- previous CS B- history of Pelvic infection C- history of contraceptive failure D- genital bleeding

D The C/Is are: 1- Anatomic abnormalities and in the uterus ( Fibroid, bicurnicate, endometrial or cervical cancer ) 2- Unexplained Uterine bleeding 3- Endometritis or pelvic infection in the past 3 months. You should pay attention to the time of endometritis in the scenario: If > 3mth Choose Bleeding If < 3 months Choose Endometritis if Bleeding is explained by another cause. If ( Unexplained bleeding ) written like this in the scenario? It’s 100% the correct answer.

...Newborn/infant with stridor worse when prone improves when supine, mother is concerned, what to do? A Start laser treatment B Tell her it will resolve on its own by first birthday ✅ C Tell her it will get worse D-Do Laryngoscope ...

Hx of pancreatitis 8 weeks ago came with psudocyst 10 cm in size, no signs of infection, how to manage? A) Laparoscopic drainage B) Percutanus drainage C) Observation D) Excisions of cyst

30 yo primigravida, 30 GA diagnosed with preeclampsia What’s antihypertensive drug is CI? A. Nifedipine B. Captoppril C. Methyldopa D. Hydralazine

Most common cardiac anomaly in Down syndrome: 1-ASD 2-VSD 3- coarctation of aorta 4- cushions defect

56 year old male with long standing heartburn, did endoscopy and showed barrette esophagus with low grade dysplasia, what is the initial A Esophageal resection B Bantoprazole C Renitadine D Sucralfate

anti-tb causing peripheral neuropathy? - INH

Potassium 6.5 creatinine 440 A- dialysis B- Ca gluconate

Female with lower abdominal pain for 6 hours with N/V, on exam there is suprapubic tenderness and left lower Quadrant, pregnancy and Urinalysis are normal: A. Abdominal x ray B. Laparoscopic exploration C. CT abdomen D. Discharge with analgesia

Most appropriate for celiac: Duodenum biopsy✅ Anti endomysial

25 year old male with grade 4 gynecomastia, what to do? -endocrine screening✅ -surgery to remove

Baby with kernicterus and has neurological sequelae. what you will expect on his physical examination? A- Spasticity B- Ataxic C- Hypotonia 4- Dyskinetic

Female pregnant with SOB and dyspnea exam reveals lower leg swelling what to do? A. V/Q scan B. CXR C. Lower leg compressive US D. CTPA

P.t known case of RA controlled on HCQ 400mg and Prednisone 15mg Well controlled for period ( forget ) All labs include LFT ( N ) EXCEPT ( high FBG and HbA1c ) - what’s your next action : A- taper Steroid and start MTX B- taper steroid and start Ibuprofen C- continue same Mx

Patient on her 30s have lesion on her nipple, she did mammogram (they mentioned the report with details, nothing was worring) it was negative, no lymps on the clinical exam but she have nipple ulcerated with scales and oozing. No nipple discharge What is the most appropriate management for her? - dermatology consultation - biopsy - repeat mammogram? - local steroid ointment - follow up for 6 weeks or 6 months (cannot remember)

12 yo girl c/o epigatric pain for one year not on med free Her mom have the same prob Examination. showed mild epigastric tenderness Lab: (mucous + blood )present (written like that) : What is appropriate treat ?? Additional info from my exam: The patient had retrosternal burning sensation and occasional vomiting. 1- omeprazol 2- azithrom 3-ceftrix 4- hypoallergenic diet Answer: A

⁃ post MVA with urethral injury , what next : (i’m sure no suprapupic tube in choices) ⁃ cystoscopy ⁃ folly catheter ⁃ retrograde urthrogram ⁃ fluoroscopic cystogram

Female with vomiting sometimes during menses , presented with 1 vomit episode with small streak of blood, she is now doing well non tender abdomen asymptomatic How to manage Send stool sample for hpylori Urgent endoscopy Send home and tell to comeback when symptoms return

Child with Sx of tracheomalacia. How to confirm the diagnosis? A) chest XR B) bronchoscopy C) Fluoroscopy

Early deceleration

JPG

Young male patient has a history of exposure to HBV infection , US was done and showed multiple nodular lesions in his liver. His PCR for HBV is negative, what is the next step? No need for follow up Abdominal and Chest xray Alfa fetoprotein test Anti Delta antibodies

Patient has popliteal venous thrombosis, went for sleeve surgery , post op medication : warfarin and enoxaparin What is the appropriate INR السؤال جا زي كدا بالزبط مافي معطيات زياده A) 1-1.9 B) 2-3 C) 3.1-4 D) No monitoring needed

A child ingested a caustic material. Had episodes of nausea and vomiting. Which of the following is most appropriate? Activated charcoal Establish airway

Pelvic Fracture with injury to membranous part of urethra. Blood seen in external meatus. What is the most appropriate action? A. Cystoscopy B. Folly’s Catheter C. Suprapubic catheter ✅ D. CT pelvis

Female patient with yellowish fishy vaginal discharge and itching ? -Bacterial vaginosis -Trichomoniasis -Candidiasis Exactly like this (100% sure )

Female pregnant first trimester, which one of the following blood chemistry will mostly appear ? A— Increase in plasma Na B— Decrease in creatinine C— Increase BUN D— Unchanged BUN

In a patient with suspected transient Ischemic attack full recovery should take place within: - A. 6 Hours - B. 12 Hours - C. 18 Hours - D. 24 Hours - E. 48 Hours

DM Rt leg swelling .. Angiography showed diffuse disease 2 days later developed firm tender partially mobile swelling irreducible nonexpansile below the inguinal crease .dx ? A. Psoas abscess B. Saphena varix C. Femoral hernia D. Pseudoaneurysm

Child came with cough for 3 days after choking some seed in PE there is wheezing in the right side they provide x ray chest showing ( right side hyperlucence no inhaled parts or anything just hyperlicence ) Asking for diagnosis? Anaphylaxis Foreign body Asthma attack

Patient with fever and cough and SOB Plural fluid shows high gamma interferon A-TB B-mesothelioma

3yr old brought to ER after RTA diagnosed with massive intra-abdominal bleeding and severe splenic injury underwent a exploratory laparotomy and splenectomy. Which vaccine to give? A. Meningococcal ✅ B. OPV C. VARICELLA

Recurrence in malaria which P common ?

P vivax

Case of molar pregnancy (very high Bhcg...), what is the highest diagnostic test?? A. US ✅ B. Direct biopsy

60 y post tb bronchiectasis with massive hemopttysis and crepitation in right scapular area wof initial management A/sedation B/positional right lateral decubitus

Calculate the maintenance IVF for pediatric pt weight 18kg..

1400

Pleural effusion. Which of the following indicates therapeutic thoracocentesis - Glucose level - Protein level - Loculated pleural effusion

Long case I don’t recall. DRE showed empty rectum with fresh blood. What to do next? A. Proctoscopy B. Colonoscopy

Patient 77 years on 3 antihyperiensive medication, still not controlied, US was done and show Asymmetrical kidney hat is your dx? A - adult PCKD B - Renal artery stenosis C- Other choices unrelated at all

9 month old child presented with rash noticed by parents , both parents had eczema before What is the typical site according the child age ? A- upper back B- diaper area C- scalp , cheeks, forehead D - dorsum of feet

most common cause of OM viral bacterial fungal

60 year old male with epigastric pain and weight loss 10% over 8 months. What the initial mangament: A. Abdominal us B. Gastroscopy ✅ C. Empirical h. Pylori ttt D. Trial of ppi 6 weeks

Case of cholecystitis: Pt presented with severe abdominal pain , after 3 days every thing returned to normal . Us done and showed multiple stones what you will do ? A. cholecystectomy before discharge B. cholecystectomy after 6-8 weeks

Pt who is allergic to penicillin which of the following is contraindicated A-Ceftriaxone B-Tazocin ✅

What of the following decreases the risk of preeclampsia? A. Antibiotic B. Aspirin C. MgS04

Female P7 G7 in her 30's has PPH after labour for 7 hours whats the reason? A- prolonged labour B- grand parity C- multiple gestation

History of RTA, Bleeding. - low PCWP. - High vascular resistance.

Hypovolemic

Newly married female came for routine chick up Most important exame Pelvic digital examination Vaginal exam Abdomenal us General appearance

4 months old girl, during Pneumatic otoscope unilateral non-purulent effusion and decrease tympanic membrane motility , no fever pr other symptoms, and no hx of previous infectious diseases, breast feeding very well and no use of pacifier, What’s the best next step? A- use amoxicillin tx B- use of amoxicillin and clavulanate C- Observe and F/U for 48hrs D- Refer for ENT to evaluation for tympanostomy tube

D Answer is D. This is an Otitis media with effusion ( Serous ) Let’s exclude: A and B and C if the presentation was acute Otitis media You will give the patient Amoxicillin and evaulate after 48h. Ref: 2 ENT consultants.

Recently diagnosed DM1 after DKA Upon discharge from hospital which insulin regiment well describe A- nph insulin twice daily B- only bouls basal insulin C- only postprandial insulin D - mixtrad insulin

hemiplagea on ONE side the face and arm and leg equally affected and sensation intact which artery? A- mca B- aca C- mid basillar artery D- vertabral artery

Recommendation that at which age if you present A peanut and eggs to the Child will decrease production of allergy? Age in month A. 10 B. 14 C. 20 D. 24

Child came with choking attack for 4m Cxr shows atelaciasis and pneumona what’s the best modality to diagnose Rigid bronchoscopy Flexible bronchoscope Cxr

which test to order in celiac disease with poor compliance A. Anti-tissue Trans. B. Duodenal biopsy C. Anti Endomysial antibodies D. Food diary

Child recurrent sinupulmonary infections; had repeated gardiasis 4 times; brother died young; A-omenn syndrome B- X-linked agammaglubemia C- SCID

K/C of ILD present with dyspnea lower limb edema elevated jvp pulsatile hepatomegaly left parasternal heave and Loud p2 What you will find on ascultation ? aortic regurgitation Tricupesd regurgitation Mitral regurgitation Pulmonary regurgitation

Patient presented with cardiac symptoms, previous rheumatic fever ,there is severe mitral stenosis and ejection fracture less than 45 What’s the proper management? -Mitral valve replacement -Follow up after six months

4 days after abdominal surgery presented with hypotension despite fluid resuscitation and warm periphery Temp is 36.6 (no other clues infos or labs) Diagnosis? Septic shock Cardiogenic shock Anaphylactic shock Hemorrhagic shock

Female with abdominal pain doctor order CT for her what is your next most important test ? A- pregnancy test hCG

sjogren syndrome which type of RTA: + Labs: Shows low K Normal Na A. RTA| B. RTAII C. RTA II D. RTA IV

Newly diagnosed diabetic type 2 patient come at appointment and the doctor came late when he entered the clinic he was very angry what should the doctor do 1-aknowledge patient anger 2- refuse to treat him 3- show empathy to newly diagnosed dm patient

Pregnant female 8 weeks pregnant Present e abdominal pain and bleeding Examination open cervix and tissue in the vaginal seen Dx Complete abortion Threatened abortion Incomplete abortion Inevitable abortion

anemia and unintentional weight loss although no change appetite and no blood in stool , What to do next ? • A-anti diarrhea • B-anti biotic • C-anti parasite • D-gluten free diet

11 yr old child presented with hip joint pain he has history of URTI But denied any fever, rash , or any complications , the child is febrile ! What is the organism ? A- G B strepto B- staph aureus

Male presented with retro chest haveness + sweeting ECG : sinus tachycardia +LBBB that's new and wasn't there before. Troponin pending A- give lidocan B -give thrombotic C -do exercises ecg D -wait for cardiac results

Child has face burn … 20% wight 12 kg How much will give daily flouid ? A- 1000 B-1100 C-1200 D- I don’t remeber the number

patient with chronic constipation, she mentioned that she needs to push the vagina backwards to relieve the constipation, what is the best management ? - Removal of the enterocele - Anterior Colporrhaphy - posterior Colporrhaphy - I don't remember the 4th option

Case and ask what's child pugh score Tense ascites (3) Confusion (3) 120 bilirubin (3) Inr 1.9 (2) Albumin 30( 2) ? Class A Class B Class C

A physician was working on a research paper. Before publishing the paper, he made some changes to some of the data and omitted other parts of his results. What is this action referred to? A) Falsification B) Fabrication C) Plagiarism D) Near miss

A patient came to ER (long scenario) he has weakness and Paresthesia in left leg with power of 2/5. Other limbs normal. What is the cause? A- Migraine B- Right MCA C- Right ACA D- Basilar

Patient came with pain on defecation for 5 days, he has history of hemmoridectomy 12 months back, examination was not done as it was painful touching the anal verge, what is the most likely diagnosis? Anal stenosis Anal fissure ✅ Anal abbesse

male presents to ER with RUQ pain, fever, chills and rigors and SOB. He is three weeks post laparotomy for perforated duodenal ulcer. On examination, he is febrile and tender in the right hypochondrium. Chest X atelectasis with some pleural effusion. What is the most appropriate next step : A-CT chest B-Abdominal Ultrasound C-Exploratory laparotom D- Antibiotics

Post thyroidectomy due to toxic multi nodular goiter came due to persistence hypocalcemia he used oral and iv calcium and still having presisnts hypocalcemia what is the next step ? A- give oral ca B- give iv ca C- give recombinant PTH D- check hypomagnesia

boy circumcised mother said urine smell foul fever 39 for 1d what indicated uti in this pt A.Fever duration B.Being a male C.Fever 39 D.Age

C UTD: Probability of UTI increase when: -Age is less than 12 months -Fever of 39 or more -Uncircumcised -Being a female. -Duration of 48h or more.

At what gestational age we start diabetes screening in a pregnant woman? A. 4 weeks B. 12 weeks C. 24 weeks D. 34 weeks

Pt KCO SLE came with fatigue. Hgb low. Ferritin 500 ( high), reticulocyte 7 ( high) ,LDH ( high), haptoglobin low. MCV wasn’t provided. What type of anemia is he most likely has now? A. Haemolytic B. Anemia of chronic dissease

Pregnant 39w with blurry vision and headache and positive protein in urine next ? Admit for labour Steroid

Old patient with altered lvl of consiousness fell from the stairs, was brought to ER, done CT for him showing epidural hematoma. Asking about most likely affected artery: A. Pontine B. Basilar C. Anterior cerebral artery D. Middle meningeal artery ✅

Which of the following associated with increase risk of endometrial cancer? - nullparty - underweight - oral progesterone - family hx of thyroid cancer

Child recurrent sinupulmonary infections; had repeated gardiasis 4 times; brother died young; A-omenn syndrome B- X-linked agammaglubemia C- SCID

Pt known know case of diabetes Mellites came with abnormal liver function test LFTS were all high: A- hemochromatosis B- viral hepatitis C- autoimmune liver disease D- non -alcoholic fatty liver ✅disease

45 years old male or female, has a mass 5 cm in right upper limb, (MRI shows a mass from triceps) what to do next? A- Incisional biopsy B- Excisional biopsy C- Core needle biopsy D- PET scan

Middle aged,Medically surgically free , came with epigastric pain and abd. Distended, Examination: tympanic abdomin + tenderness. Radiology : pneumobelia ( exactly) Diagnosis? A. Small bowel volvulus. B. gallstone ileus.

Steroids 15 mg daily and on hydroxy maintaing remission. A known case of RA. what would u do? There was an increase of blood glucose or hba1c not sure which one of them ( but there was an increase 1) taper pred and give metho 2) taper pred and give ibuprofen 3) taper pred and give cyclosporin

A Penicillin-allergic child was given doxycycline and now has developed a skin rash. Which of the following has occured? A— Medication error B— Prescription error C— Avoidable adverse effect D— Unavoidable adverse effect

A six year old girl presenting to the pediatric emergency department with unstable gait and progressive difficulty climbing the stairs over the last 10 days the parents reported that the child has been “choking on her own saliva” the symptoms began was prickly sensation in the fingers and toes that developed to ascending and symmetrical there is a history of viral gastroenteritis three weeks before physical examination confirms the absence of the knee-jerk reflex CSF analysis of weighted protein concentration with normal cell count nerve conduction test reduced velocity which off the following is most appropriate treatment: 1-plasma exchange 2-IVIG 3-MTX 4-steroids

30 year old female pregnant with new symptoms of dyspnea, productive cough and fatigue. Doppler US was negative what is the next test to do: A: cta B: d dimer C: spirometery D: ventilation and perfusion scan

4 years old with rickets which type of vit d D1 D2 D3 D4

Case of constrictive pericarditis whats the best imaging Ecg Echo Ct

Child paracetamol ingestion 24hours later what is the stage? Stage2 (24-72h) ✅

Urine incontinence while running, what is the test to confirm diagnosis ? A- Uroflowmetry B- Urodynamic test C- cough test D- tip test

child i think 3 year old came with moderate dehydration due to vomiting and diarrhea(sunken eyes, loss os skin trigor ...) What do you expect to see in his labs ? A-hypoglycemia A-hyponatremia C-hypernatremia D-?? I dont recall i saw hypokalemia in options !

46 yrs old man presents with one day history of abdominal pain, vomiting and hematemesis. He is a heavy alcohol drinker. He has previously been admitted with peptic ulcer and is receiving PPI. On examination he has tenderness over epigastrium BP 110/69 HR 112 What is the diagnosis? - acute pancreatitis - chronic pancreatitis - esophageal varices - pancreatic pseudocyst

8 years old boy. Mother complained of poor training to bathroom which muscles is targeted in therapy? A- Perianal B- Pelvic floor C- Rectus muscle D- Detrusor

78y/o male presented with change level of consciousness and fever , lumber puncture was doe show CSF gram +ve bacilli , hem catalase +ve , how will you treat ? A-ceftriaxone + vancomycin + steroid B- ceftriaxone + ampicillin + vancomycin C- ceftriaxone + vancomycin + ampicillin D- ampicillin

Chronic HBV , elevated enzymes , what to do? A- Screen for delta B- interpheron alpha

Maintained 65 on vaso pressors and iv fluids: Sepsis Septic shock Sirs Septecemia

Pcos case single doesnt want to get pregnant A- metformin B- ocp

A child ingested a caustic material. Had episodes of nausea and vomiting. Which of the following is most appropriate? Activated charcoal Establish airway

Wof is the most important before reduction? Analgesia Eaxamine pulse

Child presented with a croup and received the usual treatment with no improvement. What is the next step A-deaxamethason B-epinephrine

Patient had MVA and he is confused, open his eyes to speech and can localize pain, what is the GCS ? -Mild -Moderate -Severe

Calculate fluid for pt going to surgery 12kg? First 10 kg x 100= 1000 2 kg x 50 = 100 Total 1100.

Post laparoscopic sleeve with intestinal obstruction ,what is the most likely cause ? -Adhesions -Internal hernia

23 years female primigravida she did pregnant test at home and become positive then after that she have moderate vagina bleeding and she came to ER they they work for her ultrasound they confirm the pregnancy what’s the best next management? -Ultrasound to localize the placenta -Progesterone therapy

Patient came to the ER with signs and symptoms of myocardial infarction he was going for PCI, when the cardiologist was assessing his condition he notice the patient was depressed with low mood, the patient refused the PCI he demonstrate good understanding of his problem to the doctor what to do? A- Treat the patient regardless of the consent B- Refer the patient for psychiatric assessment then take the consent C- Respect the patient choice after discussing the reasons of refusing D- Take the consent from the patient relative

A patient presented with mid diastolic murmur that was best heard at the apex. early diastolic decrescendo murmur A: MS B: AR C: Pulmonary stenosis D: tricuspid stenosis

MVA stable positive FAST? CT Laprotomy

10 month old child with 3 days fever, vomiting, corpus watery diarrhea, on exam lethargic, cold and pale, tachycardia and mild tachypnea, which of the following will diagnose the case? A - stool antigen B- stool leucocyte C- serum viral culture D- serum antidbodi

40 years old male presented to ER with shortness of breath for two weeks. relieved by rest and increased with exertion. No Chest Pain and No palpitations. No Sweating. Troponin: 0.09 (Normal < 0.04). What is the most likely considerMI . diagnosis? A. Typical Anginal B. Angina equivalent C. Pulmonary Embolism D. Myocardial Infraction

6 YO patient brought by his parents to the hospital because they noticed yellowish discoloration of the sclera. Symptoms started around a week ago. What is the type of hepatitis he has? (No hint at recent travel of needle sticks or eating from contaminated place) A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D

Woman in delivery bleeding not stop, she wants to conceive in the future, which structure you should ligate? - external iliac artery - internal iliac artery - Uterosacral ligament - uterine vein

Case of RUQ pain and jaundice elevated total bilirubin and WBC on US multiple GB stones no pericystic fluid CBD is dilated 1cm High WBCs (no mention fever of in the Q) A. Ascending cholangitis B. Acute cholecystitis C. Choledocholethiasis D. Acute pancreatitis

Pregnant woman at 12 week gestation known to have seizure disorder on phenytoin (last seizure attack 6 years ago), what to do about her medication? A- switch the medication B- continue the medication C- decrease the dose D- increase the dose

Pregnant 39 weeks (not sure of the week) did ultrasound. Report showed significant increase in amniotic fluid (polyhydroamnios) “written exactly like this” What is the most likely cause? Anencephaly Post-term pregnancy

Child presented with a picture of croup improved on epinephrine but relapsed in 30 mintues again what to give ; Repeat epinephrine Steroinds Salbutamol Antobiotics

Mother came with infant to the the clinic. When she put her baby on the examination table he starts laughing. When the doctor approaches the baby he squeals and reach for his mother: which month is the baby: 2 4 6 8

pregnant woman came with typical symptoms of DVT then she developed SOB in duppler US you found nothing what is your next step? A- CXR B- CT C- v/q not sure D-observe

Pt come with violence, which imbalance responsible for violence? A- Low serotonin B- high serotonin. C- low endorphin. D- high endorphin

Picture of late deceleration, the patient will have: -Head compression -Cord compression -uteroplacental insufficiency

36 Y.O. male patient k/c of crohn's disease on steroid and 5-ASA, presented with purulent perianal discharge and was diagnosed with perianal fistula. What is the most appropriate management? A. Infliximab. B. Methotrexate. C. Azathioprine. D. Perianal swab.

Patient is suspected to have posriasis in the valva , highest diagnostic tool? A-Biopsy B-scrach with hydroxyde C-something iodine D- Clinical diagnosis

A Paoriasis is a Clinical diagnosis but when vulvar lesions are present biopsy becomes the diagnostic tool in this situation. Ref: UTD. جاني فالاختبار.

Patient on renal disease and decreased GFR and need to dialysis in next year, What is the risk of death ☠️ for this patient ? A-renal failure B-coagulpathy C-cardiovascular disease

A 66 years old patient did CT angio 4 days ago, he cMe today complaining of oliguria and abnormal renal function, What is he having ? A-UTI B-Renal cortical necrosis C-Acute tubular necrosis D-Renal stone

A female underwent caesarean section and consent was obtained. Patient later developed massive bleeding that was not being controlled by medical management and hence a decision for hysterectomy was made by the two consultants. However, no consent for hysterectomy has been obtained. What will the surgeon do? A) Obtain consent from the husband B) Perform the hysterectomy without consent C) Consult the ethics committee D) Do not perform the hysterectomy

A 30 something woman, 30 weeks of gestation came for follow up and you found out on ultrasound that the fetus is dead. What to do: You tell the mother You tell the relatives You do further testing And I don’t remember the last one

6 years old girl presented with abdominal pain and dark tea-like urine. She had a history of sore throat 2 weeks ago. What's the diagnosis? -Kidney stone -Pylonephritis -Glumerulonephritis

Another similar question: Baby uncircumcised have fever, Q: what is the indicator that increases the probability of the baby having UTI? A- Duration of fever B- uncircumcised C- Fever of 38.1 D- Being a male

B UTD: Probability of UTI increase when: -Age is less than 12 months -Fever of 39 or more -Uncircumcised -Being a female. -Duration of 48h or more.

Child sits in tripod position, reaches out to things, flips from prone to supine and vice versa, cannot hold cereal properly between two fingers how old is he? A- 3 months B- 6 months ✅ C- 9 months

Case of Cystic fibrosis (not written) treatment A- Prendisolone B- iv bronchodilator C- IVIG

The government did a health campaign to encourage the consumption of low- fat products and a low salt intake in order to prevent hypertension and diabetes. Why type of prevention is this? A) Primordial prevention B) Primary prevention C) Secondary prevention D) Tertiary prevention

b, can you explain the difference between primordial and primary prevention?

Pedia. (Not sure about age) presented with peteical rash all over his body with fever and pale + bil. Leg pain Hb : low Plt. : low WBC: high What is the most appropriate inv. ? -BM aspiration - Electrophoresis

Normal vaginal delivery, Baby weight 4.3kg, Laceration reaching rectal mucosa, which degree ? 1. First 2. Second 3. Third 4. Forth

Schizophrenia patient who took neuroleptic medication for her psychosis. Which of the following is side effect of her medication? A. Sizure B. Akathisia C. Hyperthermia D. Myocardial Infraction

nfant with esophagitis diagnosis written in Q , ask about treatment : ⁃ PPI oral ⁃ fundplication surgery

a..

2 year old child having red-brown urine, recently had a respiratory infection (URTI?), highest diagnostic test? A-Low complement C4, B-low complement C3, C-high complement C3, D-high complement C4

Hormone that confirm ovulation Estogen Progesterone Fsh Lh

progesterone, LH will indicate timing of ovulation

33 yrs old male complain of painful anal swelling no fever ,no discharge ,normal white cell count . examination 2*2 tender swelling A/Prolapsed pile B/Haematoma C/Anal fissure

50+ male known hypertensive Came with acute retrosternal Sternal chest pain radiating to the back. O/e Bp was low normal chest clear and cvs clear Abdomen palpable mass What is most likely diagnosis? A/ MI B/ thoracic aortic rupture

Female pt with vaginal candida, which following disease she has? DM, HTN or epilepsy.

immunocompromised baby, what of the following is contraindicated vaccine : A_ Varicella B_hib B C_dtop (i think)

Another case of a child with (abdominal pain) high testicle horizontal in position however scrotum was normal and not inflamed next step - scrotum exploration - US testicle - other choiceses medical

: 2 days old baby brought to the hospital because of reluctant to feed and seizure since last night. On exam the baby weight is 3Kg, inactive, has a generlized increased tone. CSF: clear, Glucose 3 mmol (normal 2.8-5), protein 0.22 (normal 0.22-0.33), cells 10 (normal up to 10). Which of the following is the most likely diagnosis? A. Neonatal sepsis B. Neonatal tetanus C. Hypoxic ischemic encephalopathy D. Pyogenic infection

DM with history of IHD. your goal in management A-triglyceride less than 150 B- Cholestrol <240 C- LDL less than 70 D - HDL more than 70

C= Goals : Cholesterol < 200 Triglyceride < 150 HDL >40 LDL < 100 ، Cardiac patient <70

A six year old girl presenting to the pediatric emergency department with unstable gait and progressive difficulty climbing the stairs over the last 10 days the parents reported that the child has been “choking on her own saliva” the symptoms began was prickly sensation in the fingers and toes that developed to ascending and symmetrical there is a history of viral gastroenteritis three weeks before physical examination confirms the absence of the knee-jerk reflex CSF analysis of weighted protein concentration with normal cell count nerve conduction test reduced velocity which off the following is most appropriate treatment: 1-plasma exchange 2-IVIG 3-MTX 4-steroids

patient with aortic sclerosis what should you give for prophylaxis of A.fib: A- warfarin B- aspirin C- Rivaroxban

Patient with perforated appendicitis after surgery had pus from wound, pain localized to the surgical site. No guarding no fever what best initial treatment is: A. Antibiotics B. Open drainage. C. Imaging guided drainage D. Wound exploration

What is the AB that use in ICU patient have pneumonia: A. Vancomycin B. Azithromycin C. Ceftoxime D. Amoxicillin

Lung Cancer 5CM nodule diagnosed with squamous cell carcinoma after biopsy Next step to do before surgery? Chem Radio PFT CT/PET AFTER 3 Month

Female 27 years old, she is asymptomatic follow up annually , she did pap smear 3 years ago and it was normal . What is the most appropriate thing to do now ? A-Repeat pap with cytology B-reassure C-Colposcopy D- genital and pelvic examination

Child 6yrs old presented with history of 6month left knee and wrist pain with limitations of movement and especially morning difficulty movement Otherwise no systemic symptoms What is the most likely diagnosis? A) rheumatic fever B) reactive arthritis C) septic arthritis D) juvenile idiopathic arthritis

Old Cirrhosis scenario give chemistry labs and asked directly child pugh score A B C Not applicable in cirrhosis

Pt with A fib and his rate is controlled how to control a sinus rhythm? Beta blocker Amiodarone

Case of toxic megacolon what to do: Colonscopy Ct with double contast Fleet enema

32 w pregnant lady in 3rd trimester was complaining of palpitations and sweating and heat intolerance along being restless she have notice alarge goiter but no dyspnea or difficult swallowing and change in both orbits that became more prominent. ECG - sinus tachycardia. TSH 0.1 ( low ) , T4 10 ( high ). Thyroid Scan showed diffuse homogenous uptake. Anti-Thyroid Stimulating Antibody is pending. what is your next step for management ?* Thyroidectomy Radio-active Iodine Therapy Methimazole Propylthiouracil

pt with MI discharged from the hospital then come back with facial and tongue swelling, which drug is responsible ??? A. ACEI B. BB C. Statin D.Aspirin

Patient came with vaginal discharge she has done Vaginal delivery with episiotomy 10 days ago, the obstetrician diagnosed her with UTI and prescribed Abx, but she did not improve then she went to another obstetrician, and he found infected vaginal swab, What is the medical error done by the first obstetrician? A) Let the midwife assist him and depend on her B) Doctor failed to follow the surgical safety protocol in the OR C) No communication between the second and first obstetrician D) Genuine difference assessment or diagnosis of patient case

In labor, loop of cord above head of fetus: Cs Conservative All other were not likely

pt with hx of ectopic pregnancy.now pregnat. asking about the risk of geting ectopic? A.5% B.20%✅

it should be 10%

Stab wound to the neck and injury to Zone 3. There was active bleeding. They did not mention if stable or not. There was no Vitals. What is the most proper initial management? A. Open repair B. Endovascular repair C. Artery ligation (Im sure about these choices)

42 Yr old brought by his brother to the clinic. He is irritabile and arguing و كلام كتير معناه انو مجحش و عصبي ومو طايق شي Diagnosis Frontotemporal dementia Alzheimer Parkinson

Elderly kc of htn well controlled c/o confusion and irritability. he injured his left thigh 5 days ago and he has been bed bound ever since. vitals shows hypotension and o2 of 88% Also shows Sinus tachycardia and he has arrhythmia on ecg. Dx? A - PE B - cerebral infarction C - brain hemorrhage D – arrhythmia

A In this case ; due to left thigh injury > Fat from the inside of a broken long bone > PE

What you will give to decrease risk of Respiratory distress syndrome? Glucocorticoids

Child had chocking a while back and he is coming with persistent Right lower lobe atelectasis and pneumonia. What to do ? -Rigid bronchoscope -Flexible brinchoscope

98-Female GBS swap 100000, 2 count in 10 minutes, cervix 7 cm, wt to do: A. Oxytocin B. Ampicillin Answer:B

6 m boy presented with abnormal movement and yellowish discoloration for 1 week. He is exclusively breast feeding 2 week ago his mother started to introduce fruit and fruit juice, since that, pt started vomiting, irritable, On examination: Hepatosplenomegaly, Distended abdomen Generalized jaundice * Urine: positive reducing substances (normal is negative). Dx? A Tyrosinemia B galactosemia C Alpha 1 anti trypsin def D congenital fructose intolerance

case of pregnant for C/S. Prior to the operation she told the nurse she doesn’t like to get blood transfusion. Later when they delivered the placenta she bled profusely and started to faint. What will you do next? A) call the husband and take permission from him B) order blood and transfuse to her C) call the hospital ethics committee D) take permission before she loses consciousness

d, survey

Female pregnant at 36 wks c/o abdominal pain that is increase in intensity and constant, denies any bleeding, examination tender tense abdomen , 38 cm fundal hight. What is the Dx ? A- true labor B- false labor C- Abruptio placenta D- fibroid red degeneration

50 y/o female present with uterine spotting, no history of wt loss, most probable cause: Endometrial Hyperplasia Endometrial hypoplesia Uterine cancer

which valvular heart disease has the worst outcome in pregnancy? A)Mitral regurgitation B)Mitral stenosis C)Aortic stenosis D)Aortic Regurgitation

Rt sided dullness with hypotension and increase respiratory rate:- 1- tamponade 2- pneumothorax 3- hemothorax 4- pul contusion

Pelvic Fracture with injury to membranous part of urethra. Blood seen in external meatus. What is the most appropriate action? A. Cystoscopy B. Folly’s Catheter C. Reteograde uretrogram D. CT pelvis

Screening for liver cancer in hepatitis c pt - alpha feto protein -ultrasound

70 years old male did gastric resection due to gastric cancer, presented 4th post op with chest pain /SOB/diaphoresis,w/ a lot of of comorbidities ECG: ST elevation in lead v2 and V5 What’s appropriate management 1-Thrombolytic therapy 2-Warfarin 3-apixaban 4- primary angioplasty

Infant with Absent red reflex, cataract diagnosis? A- Rubella ✅ B- Toxoplasmosis

64 years old male previous history of ischemic stroke last month he’s known case of diabetes hypertension dyslipidemia presented with cardiac symptoms ECG picture shows ST elevation What’s the most appropriate management? Thrombolytic therapy CT angiography Urgent ct coronarography

Asymptomatic smoker for 30 years how to screen? A- CXR B- Low dose CT

You have seen a 37 year old female in your clinic with left breast lump. After completing your consult you decided to perform a biopsy. what is the best type of biopsy to be done? A. True-cut biopsy B. Incision biopsy C. Excision biopsy D. FNA

Child came with a coca-cola urine, he also has a history of fever for 1 week, his throat is congested and cervical lymph nodes are palpable, what is the likely cause? IgA nephropathy Acute glomerulonephritis Alport syndrome

Patient came with severe epigastric pain and abdominal tenderness and she heared tearing in her abdomen, the patient is hypotensive with low Hb: A. U/S B. CT angio C. Radioisotope scan D. MRI

Child presented with sandpaper like rash , he had URTI a week ago. What's the causative organism? A. Parvovirus B19 B. Streptococcus pyogenes C. Streptococcus pneumonia

ER. Abdominal pain generlized tenderness hx of open laparotomy 10 years ago abdomen distended imaging multiple air levels distended small intestine fever no vitals what is the best? A. Exp lap B. Diagnostic laparoscope C. Abx

Answer is CT scan ✅ This is a classic Question about adhesions. They usually paints the scenario with Hx of surgical abdomen ( Laparotomy, sleeve, appendectomy ) and then presents with intestinal obstruction symptoms and multiple air levels on x ray. CT scan is the preferred step in the approach to diagnose the adhesions. This exact Question came to one of my colleagues and CT scan is present among choices ✅

Old, post menopausal bleed, had 5cm fibroid in the past now having the same findings on us no chanege, what next? Observe Hystrectomy Myomectomy Endometrial biopsy

Rectocele pic with case: lady complains of pain and leakage of mucus, what’s the dx? A- rectocele B- hemorrhoids

nurse did PPD test result is 12mm next? INH for 3 months INH for 6 months Rifampin, isoniazid, pyrazinamide, ethambutol

Female on the 31 weeks gestation, has +2 edema and +3 proteinuria, her blood pressure elevated, presented to the ER with new onset tonic-clonic seizure and is now *unconscious*. What is the initial management to do? A- magnisum sulphate B- open and maintain airway

The transmission of maternal antibodies to the foetus in pregnancy 🤰 is a way of ? Passive nature immunity

55 yrs old male DM type 2 C/o left arms weakness for 5 hour then improved before 2 days Now on examination everything normal no carotid beruit except new cardiac murmur noticed on auscultation( am not sure about the murmur other people said it was stated in the Q) What is the initial investigation ? A- TEE B- Carotid dupler C- Carotid Ct angio D- MRI brain

MVA contusion, distended JV, BP 90/60. Lung bilateral equal air entry. Dx? A. Cardiac tamponade B. Cardiac contusion

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