SMLE cards

What differentiates between chronic or acute ischemic limb (they were talking about right leg History)?

Weird question

How to differentiate between hypovolemic shock and postpartum hemorrhage ?

A/Hemoglobin B/Hematocrit C/Increase Pulse D/Visual estimated blood loss

What's the most common side effect of DTP vaccine? •

a. low grade fever b. erythema over the injection site c-Seizures d-Cough

42 yo hx of molar pregnancy 2 years ago, she wants to conceive. What to do regarding her history:

A) early follow up in pregnancy B) contraception she shouldn't get pregnant

Bchg 108,000 Treated and under observation 1st week 700 2 week 300 3 week 180 4 week 70 5 week 300 What to do ??

1-Give MTX 2- Observing

When to stop the isolation in meningococcal meningitis?

24 h after starting antibiotic.

Patient has sudden onset unilateral facial paralysis. which medication is proven to reduce duration of symptoms?

A- Antiviral B- Steroids C- Antibiotic D- IV fluid

Patient with head injury, eye is opening to pain, inappropriate words, abnormal flexion, how can you consider this GCS level?

A- Mild B- Moderate C- Severe

SLE smoker with flared disease, what thing you ask the patient to do to decrease flaring?

A- Start smoking B- Stop smoking C- Smoke every other day D- Smoke once a week

255- Pt with basal ganglia bleed and decreased gag reflex, most appropriate way to initiate nutrition:

- gastrostomy - Jejonostomy - Paranteral nutrition - NGT

SLE on previous medication came now with active arthritis, what will you give?

A- Steroid B- Hydroxychloroquine C- Cyclophosphamide D- Mycophenolate Mofetil

100- Case of pregnant 16 weeks developed right side abdominal pain (did not specify upper or lower). Temp 37.8 Most common cause

A) gastritis B) pancreatitis C) cholecystitis D) appendicitis

65-year-old presenter to ER with sudden right side weakness 4 hours ago, what is the most important next step?

A- Thrombolytic B- Chest X-ray C- ECG D- CT brain

Pregnant lady had seizure and is unconscious, her baby is healthy, what to do?

A- mgSo4 B- Establish airway C- Fluids D-Urgent delivery

Child has PPD of 10 mm

A- negative B- Positive C- This test is not reliable anymore D-Borderline

Best indicator of chromosomal abnormalities in which week?

A-16 to 18wk B-18 to 22wk C-13 to 16wk D-24 to 28wk

2 years old and known SCA and scheduled for splenectomy • Which of following vaccine is the most important •

A-DTP • B-Hepatitis B C-Meningococcus• D-Varicella

• Known case of cystic fibrosis with recurrent chest infections • Most important vaccine •

A-DTP • B-Herophilus • C-MMR • D-Pneumococcus

Vaccine for 9 months old •

A-DTaP , HiB , Oral polio • B-Meningococcus , measles • C-MMR , Meningococcus • D-Pneumococcal , Hepatitis B

Which of the following vaccine can be given immediately after blood transfusion •

A-DTaP • B-MMR • C-Measles • D-Varicella

205- A patient is presented with jaundice. U/S shows a shrunken gallbladder with dilatation of intrahepatic ducts. What is the most likely diagnosis?

A- Acute Cholecystitis B-Gall Bladder Stone C-CBD Stone D- klatskin tumor

How to measure SLE severity?

- Anti-dsDNA - Low complement C3 and C4 (especially in lupus nephritis)

Pregegnant lady with dm in active labor ctg show abnormal fetal heart pattern which of the following is the most appropriate next step?

- Change maternal position - put an o2 mask - stop oxytocin - give tocolytic

Patient with dysuria and cloudy urine with bubbling for 2 months, he had history of recurrent left iliac fossa pain for the past 2 years, Colonoscopy done and showed: no diverticulosis or polyp, Cystoscopy done and showed: erythema on the dome of the bladder. Most likely diagnosis is?

- Diverticular disease + bubbling of urine and symptoms os UTI = colovesical fistula complication of diverticulitis

Treatment for neonatal meningitis

- Empirically: ampicillin + gentamycin and cefotaxime - Ampicillin for Group B Streptococcus and listeria - Gentamycin and cefotaxime to cover E coli and other gram negative

o Pyrazinamide adverse effects:

- Hyperuricemia - Most hepatotoxic

Child after RTA, have weak peripheral pulse, BP 70/40, Next step?

- NGT or OGT are not indicated at all - Intubation is indicated if patient cannot protect his airway which is not shown here, still I would choose it over the the other answers

o Ethambutol adverse effect

- Optic neuritis (affect acuity and color) (Ethambutol starts with an E, just like Eye)

Child with a presentation suggestive of septic arthritis. Causative organism?

- Staphylococcus Aureus - H.influnza

o Rifampicin adverse effects:

- Turn body fluid into orange color - CYP enzyme inducer (other medications will be metabolized faster) for example: if patient is taken warfarin they need to increase the dose of warfarin

Old age patient present with fresh blood per rectum, you did rectal examination and your finger full of blood, but anorectal colonoscopy was normal. CBC was: Hb 8. What is the investigation that has a high diagnostic value?

- Upper endscopy wrong because its LGIB - CT: without contrast has no yield - US: no indications - Tch 99: it can detect very slow bleeders LGIB approach: - Rule out UGIB (NGT inspiration) - Patient stable --> colonoscopy - Patient unstable --> angiography - Patient stable and source cant be identified by colonoscope --> angiography or Tch 99

o Isoniazid adverse effects

- Vitamin B6 (Pyridoxine) deficiency: leading to neurological symptoms+ sideroblastic anemia --> prevent this by supplying B6 prophylaxis - Drug induced SLE

313- 4. 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?

- uretre stone - appendicitis - pancreatitis - cholecystitis

85- Post RTA, abdomen mild tenderness all over, conscious oriented, Not rigid or severely tender abdomen Fast: positive for moderate fluid collection Bp: 90/50 He received 2L crystalloid without improvement What is next:

-Lavage -Exploratory laparotomy -Ct scan

188- 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

133- Newborn with right reducible inguinal Hernia , high riding testis ? Most appropriate management?

-Right inguinal herniotomy -Open repair -Mesh repair -Wait till 6 Yo

38 year old female came to Er as case of pylonephraitis and during admission to hospital clear Hx of PE and CT showed bilatral PE Vitaly unstable What the anticoagulant you will give ?

-heparin + warfarin -Enoxaparin -Thrombolytic -Apixaban Treatment of PE is always anticoagulant unless massive PE Massive PE: any PE that causes shock (unstable) Massive PE tx: thrombolytics unless high bleeding tendency (embolectomy)

Short Q Female patient has vitiligo in her vulva. What's the probable cause?

-over use of irritant -Drug reaction -Lymphocytic cells, attack, melanocyte -Malignant cells something

Case of Pelvic fracture. Imaging revealed: fracture in right upper part of right pelvis and extraperitoneal bladder injury, what is the management?

. Catheter for 14 days then repeat imaging

Refractory GERD:

. Failed treatment after optimal duration and dose (8 weeks - 40mg) + lifestyle modifications . First thing to do: scope . Normal: 24hours ph monitor to confirm GERD Esophagitis --> confirm the diagnosis of GERD Esophagitis --> manometry --> normal --> surgery

Pregnant lady on 30 weeks on antenatal care on U/S: finding fetus size decrease than before with oligohydramnios , doppler of umbilical artery find reversed diastolic flow mother denied any loss of fetus movement, what is the appropriate next step:

1) non-stress test 2) serial us after one week 3) serial doppler for umbilical artery after two weeks 4) kick fetal chart

Pt for elective lop Chole, Hx of ICU admission before 2 wks due to anterior MI when to do lap chole

1- After 6 weeks 2- After 6 months Time of elective procedure post MI: Dr.Abeidi: If you infarct today, your risk for re- infarction remains elevated and will only returns to the pre-infarct base line after six months. This is why all elective surgeries should be delayed till then Onlinemeded: Recent myocardial infarction (within 60 days) should be considered a contraindication to surgery. Within 90 days and the patient is ASA class 4. Myocardial infarction treated with drug-eluting stent (and dual-antiplatelet therapy) precludes surgery for 1 year (some cases warrant cessation of DAP T at 6 months, with resumption immediately after surgery). AHA: it appears reasonable to wait 4 to 6 weeks after MI to perform elective surgery.

51- 35 year old asymptotic lady is seen for counselling regarding her breast cancer screening. Her mother was diagnosed with breast cancer at age of 67 y and her sister was diagnosed with breast cancer at age of 45 y, She had no history of breast biopsies. What would you recommend for her screening?

1- Annual CBE and Mammogram alternating with breast US 2- Annual CBE and Mammogram alternating with breast MRI 3- Annual CBE and Breast US alternating with MRI until she reach 40 then you start with annual mammogram 4- Annual CBE and Mammogram

52- 50 year old asymptotic lady is seen for counseling regarding her breast cancer screening. Her 30 years old sister was recently diagnosed with breast cancer, and her mother diagnosed with breast cancer at age of 70. She had no history of breast biopsies. What would you recommend for her screening?

1- Annual CBE and Mammogram alternating with breast US 2- Annual CBE and Mammogram alternating with breast MRI 3- BRCA gene testing for her 4- BRCA gene testing for her sister

Patient k/c of low laying placenta previa and stable on follow up, came to ER today on week 33 or 32 with minimal bleeding and and stop at home what is initial step?

1- CTG 2- US 3- Bio physical profile 4- Emergency delivery The first thing to do in antepartum hemorrhage is US to exclude placenta previa. Then CTG. But she is already diagnosed with placenta previa, so I would go with CTG

214- 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

Pt immediately after Blood transfusion develop fever ( 38 ) and pain at site of transfusion I think :

1- Febrile nonhemolytic transfusion reaction 2- Acute hemolytic transfusion reaction 3- Allergic reaction 4- Anaphylactic transfusion reaction 5- Transfusion-related acute lung injury All of them can start immediately during the transfusion Febrile nonhemolytic transfusion reaction: - Fever only no other features - Common in pediatric Acute hemolytic transfusion reaction - Hypotension, hypoxia, dyspnea, or symptoms of hemolytic anemia (jaundice, dark urine) - Burning pain at the IV site Allergic reaction - Rash only no other features Anaphylactic transfusion reaction - Extracutaneous features, e.g., nausea and vomiting, shock, wheezing Transfusion-related acute lung injury Source Amboss

First line treatment of hypertension in pregnancy is?

1- Methyldopa 2- Labetalol 3- Hydralazine 4- Nifedipine

Preeclampsia what expected to be significantly decrease ?

1- Urea 2- Creatinine 3- Plasma volume 4- Platelets

314- Patiet with uretric stone measure 4mm in US . Stable Management

1- double J stent 2- conservative 3- ESWL

245- 100- Men had multiple gun shots bleeding from everywhere He is oriented opening his eye spontaneously obey command Vitals 80/60 Pules 133 RR 25 O2 88% How to manage him?

1- inserting 2 iv line 2- laparotomy 3- oxygen mask 4- CT

Admitted to the labor room. Patient received prostaglandin. patient massively bleed with stop in uterine contraction. What is the cause of her condition?

1- placenta previa 2- Uterine rapture 3- Placenta abruption 4- Prostaglandin hypersensitivity Typical scenario of uterine rupture! Patient on oxytocin or prostaglandin then sudden pause of uterine contractions!

A 19-year-old pregnant and did a home pregnancy test 8 weeks back. She came to the clinic to do an examination and they found out that the baby was dead at 5 weeks old, and she had black blood clot

1-Observation 2-Suction 3-Misoprostol 4-Expectant management Management of abortion - Expectant management (if ≤13 weeks GA): - Medical (up to 20 weeks GA) By two different medications mifepristone followed by misoprostol - D&C: if severe bleeding - infection - hemodynamic instability regardless of the gestational age

Pregnancy Uncontrolled diabetes Complications for baby after delivery

1-RDS 2-Hyperkalemia

• When I should worry about vaginal discharge in newborn?

1-if persists more than 2 weeks 2-If becomes yellow in color 3-There is foul smelling 4-Mixed with blood (? Child abuse) No answer

When should married women start to have pap smear screening?

1. 20-24 2. 25-29 3. 30-34 4. 35-39

118- A 57 year old man presents with 2 days of abdominal pain, nausea and vomiting. Examination revealed a distended, tympanic and mildly tender abdomen without rebound or guarding (see lab results and reports) Hb 153 (normal value 130-170 g/L) WBC 12.6 (high) Plain abdominal x-ray: multiple air-fluid levels CT scan: multiple dilated loops of small bowel with a transition point in the distal small bowel, with some adjacent fat stranding. Which of the following is the most appropriate next step in management?

1. Observation 2. Colonoscopy 3. Diagnostic laparoscopy 4. Exploratory laparotomy

Woman with hx of miscarriage, now in 7 weeks with vaginal spotting, no hx of passing tissue , on examination os is closed and no bleeding

1. Threatened abortion 2. Normal pregnancy 3. Incomplete abortion 4. Inevitable Abortion Physiologic bleeding in normal pregnancy in the first two weeks only

Pt in ICU received 15 units of blood, now blood coming out from NGT, incision, and cannula site

1. Transfusion reaction 2. Thrombocytopenia 3. Hypocalcemia dilutional thrombocytopenia

60- Lactating women present with right breast pain for 6 day. On examination , hot tender swelling lateral to the right areola. Pt started to take floxacillin Us/ Cystic lesion, thickened content , ddx could be galactocele, abscess, complicated cyst for correlation. What next

1. incision and drainage 2. repeated aspiration 3. Excisional biopsy

Pregnant her child school had an outbreak and she's afraid to get to her child or something which vaccine she should get ?

1/DtaP 2/Influenza 3/ Rubella 4/ Varicella

Upper GI bleeding approach

1st ABCD 2nd Octreotide pre-scope 3rd Ceftriaxone or cipro pre-scope --> reduce mortality 4th Definitive --> EGD PROPHYLAXIS --> BB

Patient known X linked aggamamglubminema • Which vaccines can be given to him •

A-DTaP • B-MMR • C-varicella • D-BCG DTAP is not live

99- 24-year-old male comes with RLQ pain, positive rebound tenderness after 2 hours of playing football. His WBC count 6 (normal), INR 1.1 (normal). Which of the following is the most appropriate next investigation?

A - CT abdomen B - No need for further investigation, and follow up after 1 week C - US or Xray

216- A case of chronic Hepatitis C presents with RUQ mass. Investigations show 6 x 6 cm hepatocellular carcinoma. What is the best management?

A - Chemotherapy B - Radiotherapy C - Transcatheter arterial chemoembolization (TACE) D - Surgical resection

180- An old male patient was admitted as a case of large intestinal obstruction. He underwent rigid sigmoidoscopy that showed a mass in the sigmoid region. A biopsy was taken and came back as adenocarcinoma. What is the best next step?

A - Colonoscopy B - CT abdomen C - MRI pelvis D - Sigmoidectomy

268- 29-year-old lady presents with central abdominal pain for three days, nausea and vomiting for one day. Her surgical history includes laparoscopic sleeve gastrectomy 6 years ago. Physical examination reveals dehydrated with distended abdomen and exaggerated bowel sounds. What is the likely diagnosis?

A - Incisional hernia B - Internal hernia C - Intussusception D - Adhesion

291- Elderly kc of htn well controlled c/o confusion and irritability. He was fine except when he injured his left thigh 5days ago and he was bed bound ever since. VS shows hypotension and o2 of 88% Also shows tachycardia and he has arrhythmia on ecg

A - PE B - cerebral infraction C - brain hemorrhage D - arrhythmia

Pediatric pt has referral from the village with typical unusual facial characteristics, short stature, heart defects present at birth, bleeding problems, developmental delays, and malformations of the bones of the rib cage •

A - Sotos syndrome • B - Noonan syndrome • C - Marfan syndrome • D - Dawn syndrome

243- A child 10 y was beaten many times on the face during a fight. A trial of endotracheal intubation has failed. How will you secure the airway?

A - Tracheostomy tube B - Cricothyroidotomy C - Orotracheal tube D - Nasopharyngeal airway

141- Post colonic surgery, a patient develops abdominal pain and distention. He is vitally stable. There is fresh blood and coffee ground aspirate from the NG tube. What is the diagnostic modality of choice?

A - Upper GI endoscopy B - Abdominal CT

121- Female post op with paralytic ileus. Labs showed hypokalemia. What is the best investigation?

A - Urine osmolarity B - Urine K C - Stool K D - ECG

46- 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

249- middle age found to have euvolemic hyponatremia , and small lung cancer ..all labs normal except Na was 115 what's the type of fluid replacement will give?

A - normal saline B - half NS C - hypertonic saline

A child came with his father for routine childhood evaluation. He can walk and hold a ball. He also can hold cubic and put them above one another. He can draw a line. What is the expected age for this child? •

A 15 months old • B 18 months old • C 1 year old • D-2 years Putting cubes 1year • Draw line: 12 year • Walk alone 1 year • Hold a a ball 15-18 months

193- 46 y.o male present with epigastric pain heavy dinking alcohol, Exam :mild epigastric tenderness previous multiple hospitalization Labs : amylase normal Bp. 110/69 Hr 110 Dx?

A- Acute pancreatitis B- chronic pancreatitis C- esophgial varisis D- pancratic psodocyst

Child with jaundice progressive deterioration in school performance and with high direct and total bilirubin ( most likely case of wilson) what is the next appropriate investigation? •

A 24 hour urine copper • B liver biopsy for copper • C-Ultrasound • D-CBC

Baby can name body parts and run unsupported? Age in months: •

A 24 • B 19 • C 17 • D 12 At the age of 18 months can start to point to body parts • At the age of 2 years can name many body parts

Child can walk steadily words point to body prts and say 5-6 words? •

A 24month • B 18 months • C-12 months • D-6 months 12 months (2-3 words) • 18 months (6 to 10 words • 24 months (50 words) • 36 months (100 words) • 48 months (400 words)

A 5 years old child presented with signs and symptoms of giardiasis, how to confirm the diagnosis? •

A 3 consecutive stool samples • B 3 samples on different days • C concentration method • D stool immunoglobulins

Baby smile cant sit supported but can raise his head. Age in months? •

A 3 months • B 5 months • C 7 months • D- 9 months 2 months: can raise head 4 months: sit supported Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

-Free playtime for the kids •

A 30 min • B 60 min • C 120 mins • D-180 mins

A child can walk alone and build a tower of 2 to 4 cubes. What is the expected age for this child? •

A 9 months • B 10 months • C 18 months • D 24 months Tower of 2-4 cubes: 1 year Walks alone 12-15 months

2-year-old complain of recurrent epigastric pain with occasional vomiting since 1 year • stool analysis is positive blood occult test what is dx: •

A Abdominal migraine • B Irritable bowel syndrome • C Inflammatory bowel disease • D - Gastritis with peptic ulcer

12-year-old complain of recurrent epigastric pain with occasional vomiting since 1 year otherwise, normal stool analysis is positive for blood and mucus and positive blood occult test what is dx: •

A Abdominal migraine • B Irritable bowel syndrome • C Inflammatory bowel disease • D Gastritis with peptic ulcer

Unbooked female came to the ED with labor, after investigation she has 100,000 colony bacteria of streptococcus and she has asthma with using salbutamol, what do you wanna give her now and after deliver?

A Ampicillin B. Oxytocin C. Other two drugs not related.

3 years old boy with barky cough, no inspiratory stridor , positive monophasic wheeze in auscultation , dx: •

A Bronchitis or bronchiolitis • B Tracheomalacia • C Laryngomalacia • D Bronchial asthma

Newborn with microcephaly and hepatospleenomegaly what best investigation? •

A Chromosomal • B congenital infection screening • C-Metabolic screening • D-Culture

greasy stools), abdominal cramps, bloating, fatigue and weight loss. Stool examination shows antigen to a trophozoite. Which is the most common diagnosis? •

A Chronic giardiasis • B Chronic amebiasis • C Carbohydrate intolerance • D-Shegella

• Female or Pediatric 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

265- A female patient went to obesity clinic for advice regarding surgical methods of weight loss. After full explanation by the surgeon, which of the following is the most efficient/effective way of weight reduction?

A) Intensive Exercise B) Lifestyle Modifications C) Orlistat

7-year girl with pubic hair growth, what is the best investigation? •

A FSH • B CT Scan • C LH • D The pelvic US

4 y.o child brought by his mom complaining if constipation since birth, his mom started high fiber food and stool softeners 1 year ago. He has one motion every week. No diarrhea or any symptoms of soiling. Doing PR examination - empty rectum with good anal tone - on withdrawing the finger there was gush of stool. What is the diagnosis •

A Hirschberg disease • B-Functional constipation • C-meconium plus • D-Volvlous

244- 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 and appears cyanosed with markedly distended jugular veins. Blood pressure 80/40 mmHg 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

Case of ectopic pregnancy, the ectopic size is less than 3.5 cm, BhCG is 2500 how will you manage?

A Medical B Surgical

What a 3 years old can do •

A Play ball with alternating feet • B Climb the stairs • C Draw triangle • D Knows the week days Know the days of the week 4 years • Copy triangle 6 years

a baby with abdominal distension and palpable bladder •

A Prune belly syndrome • B-Down syndrome • C-CHARGE association • D-Turner syndrome

15 months old brought by his parents, they were concerned about his development that only babbles and can't say 2-3 words yet, he passed neonatal hearing screening , what should you do? •

A Reassurance and come 24months • B Refer to ENT • C-Refer to audiometry • D-Normal variant

A worried mother brings her baby to check up and expresses concern of her child contracting TB from his grandfather. He had the BCG vaccine since birth but they're living with an elderly grandparent with pulmonary TB. What do you do? •

A Reassure the mother because there's no need to anything as the baby already had the BCG vaccine • B Do PPD skin test and request CXR and .. • C Start anti TB isoniazid and rifampin • D Start all 4 anti TB meds

348- 40Y/O female with 12-year history of varicosities, complaining of LL edema and heaviness when standing. Distal pulses are intact, and there is bilateral varicose in the great saphenous vein territory. What is your management?

A Sclerotherapy B Endovenous laser C Thermal ablation

3 yo with swelling behind the ear, and FNA showed was clear lymphatic fluid. What to do: •

A Surgery • B Sclerotherapy • C Radiotherapy • D Chemotherapy Most likely: Cystic hygroma According to Earth: Next step-> Sclerotherapy Definitive-> Surgery

A Q about an assessment tool that used in the developmental screening that can be done by the parents only without the help from the doctor •

A The Ages & Stages Questionnaires • B Battelle Developmental Inventory Screening Tool, • C Bayley Infant Neurodevelopmental Screen • D Child Development Inventory

Child with gi symptoms and positive secretin test? Dx

A Vimopma • B Gastrinoma • C Glucagonoma • D-Colon cancer

59- Female postpartum presented with breast pain on examination there was local erythema, tenderness and thinning of skin how will you manage?

A observation B incision and drainage C antibiotics

4days baby brought by his mother with cyanosis His labs: Hgb 214 (very high( Hematocrit 75% (very high( What is your management? •

A partial exchange transfusion • B Oxygenation • C Hydration and monitor • D No need for treatment

mother of 5 months old baby, asking about what he can do at his age at that age? •

A pincer grasp • B sit without support • C wave bye bye • D trying to reach objects

Newborn 2 months old, vomiting after feeding, otherwise all normal, growth normal. What is the most likely diagnosis? •

A pyloric stenosis • B physiological reflux • C pathological GERD • D-Duodenal artesia

Mother brought her child complaining of perianal itching and rice like coming out: •

A strongyloides infection • B enterobius vermicularis • C-Ascraris • D-Ameba

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 0.4 is more accurate

Mother who is Rh negative delivered a baby who is Rh + she was given Anti-D Ig 300 microg what does it cover ?

A) 15 ml of the whole fetal blood B) 30 ml of the whole fetal blood C) 10 ml of the whole fetal blood D) 30 ml of Rh(D) positive fetal RBCs

G3P2 with gestational age of 30. Came with rupture of membrane and has no contractions. What you'll give?

A) Ampicilin + oxytocin B) Dexa + nifedipine C) Dexa + magnesium sulphate D) Dexa + erythromycin + ampicilin

Patient with intermenstrual bleeding. What is the most appropriate investigation?

A) CBC B) TFT C) B-HCG D) US

Patient with uterine bleeding. What is the most appropriate investigation?

A) CBC B) TFT C) B-HCG D) US

Known case of Bicornute uterus, in leopold 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

274- Pt had decreased sensation and painful left leg while walking relieved with rest. Examination: Left leg palpable femoral and popliteal but distal are not palpable. Right leg: palpable femoral and popliteal. distal veins are not palpable. -What is the appropriate investigation?

A) CT angiography. B ) Vascular US. C) Conventional angiography. D) magnetic resonance angiography

A patient known to have rheumatoid arthritis take ibuprofen to relive the pain, recently he has epigastric abdominal pain. Which of the following should you advise him?

A) Continue on ibuprofen. B) Paracetamol. C) Aspirin. D) Steroid.

86- A 44 year old lady was hit by a vehicle, and brought to the emergency room conscious, on 100% 02, received 2 liters of normal saline and 2 liters of blood. Blood pressure 60/40 mmHg Examination confirmed abdominal rigidity. 145 beat /Heart rate min CXR and pelvic x-ray were normal. Which of the following is the most appropriate step?

A) DPL B ) FAST C) CT scan abdomen D) surgical exploration

Pregnant woman at 12th week gestation beta HCG is very high

A) Down syndrome B) molar pregnancy

88- A female get high energy accident (high velocity) with seat belt sign , On X- ray has chance fracture . What will associated with this fracture?

A) Duodenal perforation B) Gastric perforation C) Jejunum perforation D) Vena cava perforation

203- A 41 years old man underwent a laparoscopic cholecystectomy, 5 days back started to experience severe abdominal pain and distension. Examination revealed a tender and distended abdomen. Bp: 100\55 HR: 103 Temp:37.9 ,,revealed the presence of ascites. which of the following is the most appropriate management :

A) ERCP B) percutaneous drainage C) Exploratory laparotomy D) diagnostic laparoscopy

Pregnant in labour, she takes heparin, post delivery she has heavy bleeding? What to give?

A) FFP B) Portamine sulphate C) Vit K

23 years old female pregnant in her 28th week, pregnancy test was done at home. She presented with mild bleeding loss of fetal movement. She denied any passage of tissue or abdominal pain. Transvaginal US was done and showed pregnancy of 18 weeks and no heart beat. (No other information was provided about the cervix). What is your diagnosis?

A) Fetal Demise B) Missed Abortion C) Incomplete abortion

260- Lung node meassure 8mm asymptomatic what to do?

A) Follow up B) CT scan C) biopsy D) review previous x-ray

A 45 years old female patient with sarcoidosis came to the clinic with fatigue and pallor. The lab results showed low hemoglobin and high ferritin level, which of the following is the true type of anemia?

A) Iron deficiency anemia. B) Anemia of chronic disease. C) Hemolytic anemia.

Risk factor for preeclampsia

A) Maternal age B) Gestational age C) Multiple pregnancy

A medically free patient went for dental extraction then developed a petechial rash and Hemoglobin was high, erythropoietin low and Platelet was high.

A) Myelofibrosis. B) Essential thrombocytosis. C) Polycythemia vera. D) Von Willebrand disease.

28 y/o female, pregnant 35 GA presenting with decreased fetal movement, CTG was reassuring with fetal HR 130, then 1 hr. later CTG showing good variability. What is the best management for her?

A) Observe for 24 hr. B) Induction of labor C) C/S D) Discharge her with fetal kick chart

57 y/o female complaining of abnormal uterine bleeding she has an endometrial polyp, on US endometrial lining was 19mm, what is the definitive management for this patient?

A) Open hysterectomy B) Laparoscopic hysterectomy C) Hysteroscopy with polypectomy

57 y/o female complaining of abnormal uterine bleeding she has an endometrial polyp, on US endometrial lining was 19mm, what will you offer to this patient AT THIS STAG "next"?

A) Open hysterectomy B) Laparoscopic hysterectomy C) Hysteroscopy with polypectomy

A patient came to the clinic with numbness on his hands and legs. He is known case of vitiligo and hypothyroidism. The lab results showed macrocytic anemia, peripheral blood smear showed Hypersegmented neutrophil. The best way to manage the patient is:

A) Oral vitamin B12. B) IV vitamin B12 C) IM vitamin B12. D) Folate replacement.

A 9 years old child came with confusion and fatigue. The investigations showed microcytic anemia, iron studies showed low ferritin and elevated TIBC. Regarding iron replacement, which of the following is the best way?

A) Oral. B) IV. C) IM. D) Packed RBC.

A neonate 12 hours after normal vaginal delivery noticed to be jaundiced. The blood film showed microcytic hyperchromic cells. The best investigation to order is:

A) Osmotic fragility test. B) Pyruvate kinase level. C) Glucose 6 phosphate dehydrogenase enzyme. D) EMA. Hereditary spherocytosis Diagnosis: Eosin 5 Malemide (EMA) Binding Test

In cervical examination patient found to have lesion what to do:

A) Pap test B) RNA test C) cone biopsy D) Colposcopy directed biopsy

A patient with post-partum hemorrhage who was resuscitated then they found that there is persistent bleeding at several puncture sites what is the next important step?

A) Reversal of coagulopathy B) Oxytocin C) Prostaglandin

COPD patient came to clinic with bilateral lower limb edema and pulmonary hypertension. 02 sat was 86%, P02: 8.6, PC02: 7.5, which of the following is the appropriate management to give for the patient now?

A) Start oral furosemide B) Start Oxygen therapy C) Prednisolone therapy · Less then 88 % --> oxygen therapy · Another hint cor pulmonal · Other medications less indicated

PROM How to confirm its amniotic fluid?

A) Sterile speculum examination B) Abx C) chemical testing D) Fetal hormones

A 23 years old female came to you clinic complaining of vaginal bleeding out of her menses time. She has no other symptoms and no significant past medical or surgical history. PV and abdominal exam were normal. CBC: Hb: 11 -WBC: 7800 -PLT: 50000 Which of the following will be the most appropriate management?

A) Steroid. B) IVIG C) Rho D D) No need to treat.

24 years old G1P0, she has gestational diabetes which is controlled by diet only, and no other medical problems. She is in the 2nd stage of labor which last more than 2 hours, normal uterine contractions, baby's head comes down with each contraction and go back when uterus is relaxed, the mother's hip is maximally flexed, one nurse is applying suprapubic pressure, other nurse applying fundus pressure, the doctor decided to do episiotomy and deliver the posterior shoulder. Which of the following will cause delay in delivery?

A) Suprapubic pressure B) Fundus pressure C) Hip flexion D) Delivery of the posterior shoulder

A 26 years old pregnant lady known case of iron deficiency anemia on oral iron complaining of fatigue and headache. Last hemoglobin is 10, with microcyticanemia. What is the diagnosis?

A) Thalassemia. B) Iron deficiency anemia. C) Hypothyroidism. D) Physiological anemia.

A child came to the clinic by his parents with fatigue, he is in cow milk only nutrition. Laboratory investigation showed feature of microcytic anemia. What is the diagnosis?

A) Thalassemia. B) Sidroblastic anemia. C) Iron deficiency anemia. D) Nutritional deficiency.

A 73 years old man presented to Family medicine clinic with fatigue that has become progressively worse over the last several months. He is also has SOB when he walks up one flight of stairs. He has numbness and tingling in his feet. On examination he has decreased sensation of his feet. His Hemoglobin is 7 and MCV is 114 (elevated). What is the most appropriate next step in management?

A) Vitamin B12 level. B) Folate level. C) Peripheral blood smear. D) Schilling test. E) Methylmalonic acid level

A child presented to your clinic with his mother for regular follow up, the only new complain is epistaxis more than usual of his brothers. His past medical history reveals atopic dermatitis treated with topical steroid and multiple hospital admission due to infection. Which of the following is the diagnosis:

A) Wiskott-Aldrich syndrome. B) Idiopathic thrombocytopenia purpura. C) Kartagener syndrome. D) Cystic fibrosis. E) Drugs effect.

old male presented with severe asthma exacerbation on albuterol and long acting glucocorticoid, hx of admission 2 yrs ago On exam: respiratory distress and diffuse expiratory wheezing He Received systemic glucocorticoid and b2 agonist inhaler but no improvement.. Cxr : hyper inflation Ph 7.3 What to do next ?

A) admission to ICU B) discharge and reassurance C) discharge and follow up next day D) Admit to medical word · Life threating asthma characters: o Bad ABG: normal/ high co2, or normal/ low ph

A patient with pulmonary embolism that wants contraception. WHAT is the most appropriate contraceptive method?

A) condom B) IUD C) OCP D) POP

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 months • C) give vaccine at time, but half the dose • D)Consult infectious disease doctor Preterm baby should received the vaccine at actual age not the corrected age

107- 21 year old patient with right iliac fossa pain for 7 days on examination: palpable mass at the iliac fossa WBC high US done showing appendicieal mass with NO collection What to do:

A) non interventional B) lap appendectomy C) open appendectomy D) exp laparotomy

149- Patient have perforated duodenum what to do?

A) partial gastrectomy B) gastrojejunostomy C) patch omentum D) forget

36-year-old lady with secondary amenorrhea (elevated FSH & LH) which of risk or complication she might probably develop in the future?

A) risk of endometrial cancer B) risk of ovarian cancer C) risk of osteoporosis

years old boy presented to the pediatrician with a history of skin rash, the parents report that the symptoms had started with a single red spot over a small scratch and have spread over the last 4 days, there are several lesions on the cheek, trunk and upper limbs, physical examination confirms swollen LNs in the arm pits and groin, blood pressure 100\65 , Hr 80 , rr 24, temp 37.4 , what is the treatment?

A) steroid B) acyclovir C) abx D) antiseptic

0 years old boy presented to the pediatrician with a history of skin rash, the parents report that the symptoms had started with a single red spot over a small scratch and have spread over the last 4 days, there are several lesions on the cheek, trunk and upper limbs, physical examination confirms swollen LNs in the arm pits and groin, blood pressure 100\65 , Hr 80 , rr 24, temp 37.4 , what is the treatment?

A) steroid B) acyclovir C) abx D) antiseptic Treatment Although cat scratch disease usually resolves spontaneously most experts suggest treatment with macrolides to prevent complication of the disease

A 23-year-old primigravida presented at 32-weeks of gestation with seizure (see lab results), Blood pressure 160/110 mmHg Heart rate 78 /min Respiratory rate 18 /min Temperature 36.6°C Test : Protein +++' Which of the following is the most appropriate next step in management?

A) steroids B) diuretics C) hydralazine D) magnesium sulfate

Patient present with cottage cheese like vaginal discharge, itching and urinary symptoms, Asking about the treatment?

A) topical estrogen B) topical antibiotic C) oral anti fungal D) oral antibiotics

Pregnant in 27 GA, came with minimal bleeding us showed placenta totalis. What is the most imp Mx?

A)abx B)tocolytics C)steroids · Placenta previa o Painless bleeding - post coital bleeding o Management § Ideal: CS at 36-37 week § GA < 37w: No active bleeding - fatal good à expectant management · Admission and observation for 48 hours · GA< 34w: steroid · GA< 32w: mg sulphate § GA <37w: severe bleeding - fetal distress · Stabilization · Emergency CS

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

20-year-old male presents for a tuberculosis screening test. He has no risk factors for exposure and is otherwise well. What is the minimum what required for a positive test?

A- 10 mm B- 15 mm C- 20 mm D- 5 mm

A child came with ruptured spleen from severe head trauma • What is is the optimal time to give PCV vaccines after septectomy •

A- 2 weeks • B-4 weeks • C-8 weeks • D-12 weeks

A child came with ruptured spleen from severe head trauma • What is is the optimal time to give PCV vaccines after splenectomy?

A- 2 weeks • B-4 weeks • C-8 weeks • D-12 weeks

Patient with facial asymmetry, moth deviation, absence of forehead wrinkles, what's the nerve affected?

A- 2nd B- 5th C- 7th D- 10th

Case of stroke with MAP = 65 and intra-cranial pressure = 15, calculate the cerebral perfusion pressure?

A- 40 B- 50 C- 60 D- 70 Cerebral perfusion pressure = MAP - ICP

Patient can localize the pain, open eye to pain, say only sounds, what is the GCS level?

A- 8 B- 9 C- 10 D- 11

RTA patient eye respond to painful stimuli, localize the pain, groaning sounds, calculate GCS?

A- 8 B- 9 C- 10 D- 11

Which one of those with lobar pneumonia treated as outpatient?

A- 88 years, BP: 90/59, Temp: 40, RR: 20, pulse: 116 B- 88 years, BP: 88/60, Temp: 37, Pulse: 120, RR: 25 C- 50 years, BP: 80/60, Temp: 34, RR: 31, Pulse: 120 D- 55 years, BP: 100/90, Temp: 39.5, Pulse: 100, RR:30 D: only RR 30 = 1 Point = outpatient

How long time is taken for patches on chest x-ray of Lobar pneumonia to disappear?

A- A week B- 3 weeks C- 6 weeks D- 8 weeks · Consolidation Disappear after 6 weeks

Which of the following medications can exacerbates asthma?

A- ACEI B- Selective beta blockers C- NSAlDs D- Statins · Selective less likely to cause bronchospasm than nonselective

Patient suspected Tuberculous pleural effusion, what is the sensitive test that support your diagnosis:-

A- AFB of pleural effusion B- High lymphocytes in pleural effusion C- Low glucose in pleural effusion D- Elevated pleural fluid ADA levels ADA is the most sensitive for TB

A lady with manifestations of rheumatoid arthritis that has been progressed, what antibody is needed to confirm diagnosis?

A- ANA B- Anti- CCP (Anti-citrullinated protein antibodies) C- Anti-cardiolipin D- Anti RNP

36 years old G4P3+0 , 38 weeks , a case of polyhydramnios, you did ARM followed by vaginal bleeding and CTG showed fetal Bradycardia. What is the possible cause ?

A- Abruptio placenta B- placenta previa C- Vasa previa i. Painless vaginal bleeding that occurs suddenly after ROM ii. Fetal bradycardia or sinusoidal pattern

327- 82 year old male with very painful micturition what is the most approppriate management

A- Abx for uti B- Foley catheter C- Cysoscopy and turp

70-year-old male came with Mask face, bradykinesia, resting tremors, on examination: shuffling gate, what is the diagnosis?

A- Acute stroke B- Alzheimer disease C- Parkinson disease D- Age related changes

45-year-old female and non-smoker is found to have a lung nodule on CT. It appears to be composed of calcium and fat, what is the most likely cause?

A- Adenocarcinoma B- Hamartoma C- Mesothelioma D- Squamous cell carcinoma · Nonsmoker · Pulmonary hamartoma: contains fat and calcium

A 62-year-old man presents to the physician With cough for the last 7 months. He also complained Of hemoptysis, weight loss and constipation. He is a chronic smoker With a 40-year history. Laboratory tests reveal hypercalcemia. Chest x-ray shows hilar mass in the right lung. Which Of the following is the most likely diagnosis?

A- Adenocarcinoma B- Small cell carcinoma C- Squamous cell carcinoma D• Tuberculosis · Lung cancer presentation · Squamous cell carcinoma: hypercalcemia due to PTH related peptide

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) D- Immediate Delivery

69-year-old male known to have DM, present to ER with 4 days history of productive cough and tachycardia, on examination, oriented to time, person and place, chest examination revealed right lower lobe crepitation, RR: 23 'min, BF: 120/80, Temp: 38.5, WBC's: 12, BUN: 5 and Chest x-ray showed right lower lobe infiltration, Which Of the following is the most appropriate management?

A- Admit to general ward and start IV antibiotics B- Admit to ICU and Start IV antibiotics C- Start oral antibiotic and observe in ER for 24h D- Start oral antibiotic and follow as outpatient in 7 days · AGE 69 = 1 point: outpatient treatment D

62-year-old male known diabetic complaining of cough, SOB, fever, upon chest examination there is crackles, small pleural effusion on chest x-ray, diagnosed as pneumonia, which Of the following is considered as a poor prognostic factor?

A- Age B- DM C- Crackles D- Pleural effusion · Diabetes is the most appropriate one · Uncontrolled DM: poor healing, poor immune response

What are the type or precaution in both meningitis and pneumonia?

A- Airborne B- Contact C. Droplets D- No precaution needed

Patient with cough and hemoptysis, On auscultation there is consolidation On the right upper lung zone, chest x-ray showed right upper lobe cavity, which type of isolation to the patient you should apply?

A- Airborne B- Droplet C- Contact D- No need for isolation

46-year-old male came with 1st MTP joint pain for 12 hours, synovial fluid showed needle like crystals, negative birefringent, which medication you should NOT give in this acute attack?

A- Allopurinol B- Indomethacin C- Steroid D- Colchicine

88-year-old male known case Of HTN presented with unsteady gait, later he developed forgetfulness, what is the most likely diagnosis?

A- Alzheimer disease B- Frontotemporal dementia C- Normal tension hydrocephalus D- Creutzfeldt-Jakob disease

Old patient with signs of parkinsonism and also mentioned visual hallucination, what is the most likely diagnosis?

A- Alzheimer disease B- Vascular dementia C- Lewy body dementia D- Frontotemporal dementia

A 45-year-old patient present to the clinic with a three months history of stumbling weak grip, dysphagia, generalized and lower limb weakness, fatigability and tiredness and also had 2 episodes aspiration pneumonia, has brisk reflex and fasciculation, what is the most likely diagnosis?

A- Amyotrophic lateral sclerosis B- Myasthenia gravies C- Cerebral infarction D- Gillian barre syndrome

182- 65 years man presents to your clinic and looks weak , dehydrated, pale , thin and emacitaed. he complains of anal itching , discomfort from the pas few months. On examination, you find an anal mass that is 2 cm away from the anal verge , cauliflower like and friable. What is your most likely diagnosis?

A- Anal Cancer B- Rectal Cancer C- condyloma accuminatae

Hip pain in elderly, x ray showing osteophytes and narrowing, what is the most likely diagnosis?

A- Ankylosing spondylitis B- Osteoarthritis Of the hip C- Rheumatoid arthritis D- Osteoporosis · Elderly + osteophytes + narrowing à osteoarthritis

40-year-old male presented to clinic with history of back and buttock pain for 6 months, he claimed that pain is worsening with rest and improving with exercise, there is no Other joint involvement, what is the most likely diagnosis?

A- Ankylosing spondylitis B- Osteoarthritis of the hip C- Rheumatoid arthritis D- Osteoporosis · Back and buttock + worse with rest + improve with exercise + male --> inflammatory --> ankylosing spondylitis

22-year-old female presented to your clinic complaining of check rash that is photosensitive to sun exposure, she also gave history of on and off fever, fatigability and recent weight loss, what is the diagnostic test?

A- Anti-CCP B- Anti dsDNA C- CRP D- Anti-SCL70 Anti-smith is more specific to SLE

Pediatric patient with ptosis, diplopia with no fasciculation, symptoms worse through the day and improve next morning, what is the Of the disease?

A- Anti-bodies against thyroid peroxidase B- Anti-bodies against Acetyl choline receptors C- Anti-bodies against double-strand DNA D- Anti-nuclear antibodies

Pregnant patient known to have SLE controlled on medication, came for follow-up. she read about risk of having heart block for the baby because of lupus, what you will order to determine the risk of neonatal heart block?

A- Anti-dsDNA B- Anti-CCP C- Anti-smith D- Anti-SSA (Ro)

Pneumonia symptoms with medium Pleural effusion Of 25 ml, what to do?

A- Antibiotic with thoracentesis B- Antibiotic alone C- Antibiotic with acyclovir · All pleural effusion must be tapped · Medium size à tap it

Female patient admitted as a case of pulmonary embolism, Anticardiolipin antibody and lupus anti-coagulant is positive, she had 3 previous miscarriages, what is the diagnosis?

A- Antiphospholipid syndrome B- Factor V Leiden C- Hemophilia A D- Lupus cerebritis

93- 9 year old came with an 8 hours history of abdominal pain and nausea. What's the most common surgical emergency:

A- Appendicitis. B- intussusception. C- cholecystitis. D- pancreatitis.

A woman has previous abortion, and she was managed by D&C, and now after 1 year she is presenting with amenorrhea, what the diagnosis?

A- Asherman syndrome B- Sheehan syndrome

6 years old child and came becuae shie found accidently to have RBC in urine during routine urine analysis Mother said she was having exercise yesterday She looks healthy otherwise • Best action •

A- Ask for serum creatinine • B-Do Serum albumin • C-repeat urine analysis in few days • D-Send her for biopsy

19-year-old man known case Of poorly controlled epilepsy, he presented to ER with productive cough and fever, chest x-ray showed right upper lobe cavity with air fluid level, culture of sputum positive for aerobes and anaerobes, what is the source Of infection?

A- Aspiration C- Infectious mononucleosis D- Pneumonia · Aspiration due to poorly controlled epilepsy --> Air fluid: anaerobes --> abscess lung

Pregnant lady known case of SLE with a previous DVT, what to give?

A- Aspirin B- Enoxaparin C- Warfarin D- No anticoagulant needed

294- Patient with DVT then developed PE, ( no evidence of renal failure in the case) Which of the following most appropriate management

A- Aspirin B- Foundaparinux C- IV heparin (no enoxaparin) D- Revaorxaban

A young female presents with unilateral throbbing headache, her headache is associated with nausea and vomiting. She tells you that she is sensitive to light. Which of the following is used for acute treatment?

A- Aspirin B- Triptan C- Beta blocker D- 100% oxygen

296- Patient presented with DVT what regimen to use:

A- Aspirin 61 mg B- Enoxaparin 40 mg SC C- Fondaparinux 20 mg D- Hepatin 10,000 U IV

Which of the following conditions is associated with clubbing?

A- Asthma B- Bronchiectasis C- Pneumonia D- Pulmonary tuberculosis

A 48-year-old man presents to the physician with episodic daily productive cough of yellow foul smelling sputum associated with hemoptysis for the last two years. He denied any fever Or chest pain. Examination shows digital clubbing. Which Of the following is the most likely diagnosis?

A- Asthma B- Bronchiectasis C- Sarcoidosis D- Tuberculosis · Bronchiectasis presentation: chronic productive cough - baseline no fever no chest pain (unless exacerbation) - clubbing - hemoptysis · Causes: cystic fibrosis - Kartagener syndrome - severe or chronic infections (post TB) - COPD · Diagnostic: high resolution CT without contrast showing tram tract sign or signt sign · Most important treatment: chest physiotherapy . In exacerbation: antibiotic coverage to pseudomonas

Which Of the following is the most common cause Of chronic cough?

A- Asthma B- Gastroesophageal Reflux Disease C- Pneumonia D- Upper airway cough syndrome · Upper airway cough syndrome/ postnasal drip most common cause of chronic cough

One of the following is a criteria of SLE?

A- Autoimmune Hemolytic anemia B- Weight loss C- Fatigability D- Loss of appetite

30-year-old male diagnosed with Rheumatoid arthritis on methotrexate, what will be deficient?

A- B12 B- Folate C- Iron D- Vitamin B1

Case about ectopic pregnancy (they didn't mention the dx) ask about next step

A- BHCG quantitative B- BHCG qualitative C- Transvaginal Ultrasound

Pediatric patient presented With meningeal irritations signs and neck stiffness. they did CT scan which showed: low attenuation of the tempo-parietal area. what is the most likely diagnosis?

A- Bacterial meningitis B- Brain Abscess C- HSV meningitis D- Cryptococcus meningitis

Degeneration of which site in brain is the cause of Parkinson disease?

A- Basal ganglia B- Cerebellum C- Substantia nigra in midbrain D- Cerebral hemisphere

A 19-year-old female presents to the physician with malar rash, arthritis, oral ulcer. proteinuria. thrombocytopenia. positive ANA and anti- dsDNA. Which or the following is the most likely diagnosis?

A- Bechet's disease B- Reactive arthritis C- Sjogren syndrome D- Systemic lupus erythematosus

Which of the following decreases the inflammation in asthma?

A- Beclomethasone dipropionate B- Montelukast C- Salmeterol D- Theophylline · Beclomethasone = inhaled steroid = decrease inflammation

Patient have anxiety for 4 years and have asthma she noticed when she use salbutamol symptoms get worse, what to give?

A- Beta blocker B- Bupropion C- Sertraline · Sertraline has no effect on asthma and SSRI are the first line of therapy top treat anxiety disorders

25-year-old pregnant lady known case Of migraine, during pregnancy it improved. tried to reduce work stress. What is the best accomplishment Of preventing migraine attack?

A- Biofeedback B- Beta blocker C- Sumatriptan D- 100% oxygen

COPD and affected conscious level, low pH?

A- Bipap B- Mechanical ventilation · Acidosis + AMS = intubation

136- Post dilatation of esophageal stricture came back with chest pain and change of voice./ Patient after esophageal balloon dilation for esophageal varices started to complain of difficulty in breathing and voice change. What is the complication?

A- Bleeding B- Perforation C- Aspiration

70-year-old male suspected to have Alzheimer disease with memory loss for the last 1 year, which Of the following investigation we should do it?

A- Brian imaging (MRI) B- EEG C- ECG D- Skull X-ray

35-year-old female patient with severe unilateral knee joint pain, on exam it is erythematous, swollen, warm, patient also has fever, what is your next step in management?

A- Broad spectrum antibiotics B- Blood culture C- Drainage and debridement D- Joint aspiration Sudden pain + swelling in one joint + fever --> first do joint aspiration to exclude septic arthritis

27 weeks lady with hx of PPROM. The CTG is reassuring, normal CBC, she is medically free, she denies any uterine contractions. Management?

A- Corticosteroids B- Antibiotics C- Tocolytics D- Go for C/S Of all management of PPROM steroid is the priority here

Old patient developed productive cough, Fever, dyspnea, on examination: crepitation, CXR showed bilateral right middle lobe consolidation, lab: Reticulocyte Cold agglutination test, What is the diagnosis?

A- Bronchial asthma B- Atypical pneumonia C- Streptococcus pneumonia · Atypical pneumonia (mycoplasma pneumonia): cold agglutination test · Atypical pneumonia: all viral + legionella (GI symptoms + pneumonia + hyponatremia + CNS symptoms + outbreak + urine antigen) + mycoplasma (cold agglutination test) + chlamydia + staphylococcus (post viral) + klebsiella (alcohol) · Atypical pneumonia CXR: Bilateral infiltrate

A 23-year-old male known case of asthma presents with history of cough and night sweats for 3 months. Vital signs is normal. CBC and metabolic panel is normal. Chest x-ray shows right upper lobe cavitation which is not presented in last chest x-ray 6 months ago. What is the next step in management Of this patient?

A- Bronchodilator B- Isolate the patient in negative pressure room C- Isolate the patient in positive pressure room D- Antibiotic · Presentation of TB · First step in managing TB is isolating the patient: negative pressure room · Second step is to send sputum for diagnosis

Patient with RA and dyspnea, chest x-ray showed homogenous and well- defined nodule, what is the most likely diagnosis?

A- Bronchogenic cancer B- Pulmonary fibrosis C- Caplan syndrome D- TB · RA + nodule in lung in CXR + dyspnea + pneumoconiosis à Caplan syndrome · Other answers are wrong by exclusion

Patient want to stop smoking, he has HTN and epilepsy, what is the contraindicated drug?

A- Bupropion B- Varenicline C- Nicotine patch D- Nicotine gum

Patient came with fever and bloody sputum with lymph node enlargement, how to protect another?

A- By safety clothes B- By face mask C- Control of airdrop D- Control Of contact · Keywords leading to TB: bloody sputum - lymph node - fever · Airborne control

22-year-old KIC of systemic sclerosis developed acute renal failure, doubled the creatinine level and BP is 190/110, what is the appropriate treatment?

A- CCB B- ACEI C- Thiazide D- Diuretics

70-year-old smoker with dyspnea, left side chest pain, hemoptysis, characteristic digital clubbing and bilateral wrist pain, he also mentioned face swelling when sleeping and it goes after he wakes, decrease in quality Of voice, what is the most likely diagnosis?

A- COPD B- Asthma C- Bronchial cancer D- Bronchiectasis · Lung cancer presentation: old age - smoking history - dyspnea - hemoptysis - clubbing - facial swelling - voice change · Clubbing and wrist pain: hypertrophic osteoarthropathy · Voice change and facial swelling: superior vena cava syndrome

Smoking is the most common risk factor for?

A- COPD B- Hypertension C- Lung cancer D- Renal failure · Smoking is the most common cause of lung cancer

30- 32 y/o women presented to clinic complaining of left breast pain and nipple bloody discharge No family history of breast cancer Normal breast and lymph node examination Which of the following is most appropriate test?

A- CT B- MRI C- US D- Mammogram

96- Young female came to ER c/o RIF pain for 12 hours, on PE: there is tenderness in Suprapubic + RIF , and no rebound tenderness, WBC high 14k - US : inconclusive What is the next step ?

A- CT B- open appendectomy C- diagnostic laparoscopy D- Transvaginal US

77- Patient presents with stab wound to the abdomen. After wound exploration, you found anterior abdominal fascia penetration. His vitals were stable. What is your next step?

A- CT abdomen B- MRI abdomen C- Exploratory laparotomy D- Diagnostic laparoscopy

Healthy man came with lung nodule on chest x-ray, CT chest done and showed the nodule size is 7 mm, what is the next step?

A- CT after 3 to 6 month B- PET scan C- PET D- Review his last previous chest X-ray · Always review last chest x-ray · To know the progression and if it did exist before or its new

Bronchiectasis definitive diagnostic test?

A- CT chest with contrast B- Chest x-ray C- Sputum culture D- HRCT

281- 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

COPD patient with lower limb edema and hepatosplenomegaly Right heart failure signs, what to do to confirm diagnosis?

A- CXR B- Echo · Echo to diagnosed cor pulmonali

Patient came with right big toe inflamed and tender, upon history he is taking thiazide drugs regularly for management of hypertension, what is the name Of deposited material in the big toe?

A- Calcium pyrophosphate crystal B- Triple phosphate crystal C- Monosodium urate crystal D- Tyrosine crystal

Post-menopausal women present with itchiness and odorless discharge with vaginal excoriation what is the diagnosis?

A- Candidiasis B- trichomoniasis C- vaginosis D- atrophic vaginitis

The most common medication known to cause drug-induced lupus?

A- Ceftriaxone B- Hydralazine C- Vancomycin D- Paracetamol Drug induced lupus (Hydralazine, procainamide and isoniazid, Diltiazem, quinidine) = Anti-histone anti body Drug induced lupus is differ than drug exacerbate lupus flares like for example Trimethoprim- Sulphamethaxazole

A young male presented with altered sensorium. Fever and nuchal rigidity. CSF analysis showed high protein. high WBC' but normal glucose. what is the best management:

A- Ceftriaxone + Vancomycin B• Ampicillin C- Acyclovir D- Tazocin

Old age patient known case of osteoarthritis, HTN, DM and CKD, came asking for pain medication of joint pain, what to give?

A- Celecoxib B- Ibuprofen C- Tramadol D- Prednisone First two are NSAIDS and are contraindicated in CKD D not indicated in OA

Patient have difficulty feeding can not put fork to his mouth and had history of traffic accident, where is the lesion?

A- Cerebellum B- Cerebrum C- Substantia nigari D- Hippocampus

Pregnant, twins one cephalic and another is breech presentation, how to deliver?

A- Cesarean section B- Normal delivery need revision

How to follow the progression in COPD patient?

A- Change in FEVI B- Change in FVC C- Change in oxygen saturation D- Number of exacerbations · Change in FEV1 à worsening of the disease

Old age patient known to have metastatic cancer and malignant pleural effusion due to malignancy, he did multiple pleural tap to relief symptoms but not improved, what will you do now?

A- Chemical pleurodesis B- Scheduled pleural tap C- Diuretics D- Home oxygen · In cancer patients part of the palliative therapy is chemical pleurodesis · These patients will have recurrence of pleural effusion · Chemical pleurodesis à closes the pleural space

20-year-old man presenting for a tuberculosis screen had a positive PPD, he is asymptomatic, what should the next step be?

A- Chest CT B- Chest x-ray C- Repeat PPD D- Sputum smear · Positive PPD or IGRA in asymptomatic patients à requires exclusion of active TB before starting anti-TB medications

20-year-old man presenting for a tuberculosis screen had a positive PPD test with significant chest x-ray changes for TB, what should the next step?

A- Chest CT B- Sputum AFB C- Repeat PPD D- IGRA · In patients with CXR findings + positive PPD --> confirmation of the diagnosis of active TB is required by sputum AFB · IGRA VS PPD o PPD is cheap and requires two visits and gets affected by BCG vaccination o IGRA is expensive and require one visit and doesn't get affected by BCG and accurate for immunocompromised patient

A 70-year-old male has long-standing bronchiectasis. What else beside medical treatment can benefit this patient?

A- Chest physiotherapy B- High-dose oxygen therapy C- Rigorous exercise D- Smoking cessation · Chest physiotherapy is the best for chronic bronchiectasis

Young female presented with dyspnea, low grade fever and arthralgia. On examination there was tender erythematous nodules on her shin, and on auscultation basal crackles. next?

A- Chest x-ray B- Steroid C- Blood culture D- Skin biopsy · Sarcoidosis: dyspnea, fever, arthralgia, tender nodule · CXR --> (bilateral hilar lymphadenopathy) Tx: Isolated asymptomatic pulmonary sarcoidosis: no treatment indicated Symptomatic or extrapulmonary sarcoidosis: First line: glucocorticoids

Female came to ER with lower abdominal pain and had adhesions in pelvis and hepatic area, what is the organism?

A- Chlamydia B-Bacterial vaginosis

Male smoker since 3-4 years has dyspnea, increased AP diameter of chest, FEVI/FVC ratio is less than 0.7, DLCO is low, FEVI/FVC mildly improved after administration of beta agonist, what is the likely diagnosis?

A- Chronic bronchitis B- Asthma C- Emphysema · DLCO low: emphysema · DLCO decreased in emphysema and intrapulmonary restrictive diseases . DLCO is normal in asthma and chronic bronchitis · TLC is high in COPD and asthma · TLC is low in restrictive disease · FEV1/ FVC ratio low in asthma and COPD · FEV1/ FVC ratio normal restrictive · FEV1 decreased in all · FVC is markedly decreased in restrictive Reversibility test positive = asthma

Which of the following is the best treatment for lung abscess?

A- Ciprofloxacin B- Clindamycin C- Macrolides D- Piperacillin-Tazobactam · Anaerobes: clindamycin · Pip/tazo also covers anaerobes, but in the exam use clindamycin

Meningitis in child with picture showed petechia. what you should give to his young brother as a prophylaxis?

A- Ciprofloxacin B- Rifampin C- Ceftriaxone D- Ampicillin

Parkinson disease, how to reach the diagnosis?

A- Clinical diagnosis B- CT brain C- MRI brain D- Lumbar puncture

Females with abnormal Pap smear and colposcopy diagnosed with invasive cervical cancer, what is the most appropriate next step?

A- Clinical staging B- Hysterectomy and chemotherapy C- Hysterectomy and radiotherapy

Female came complaining of headache and sudden painful loss of vision, Examination: loss Of vision in right eye. CT brain: pituitary hemorrhage, MRI brain: pituitary massive hemorrhage and compressing on optic chiasma and cavernous sinus. Best next step?

A- Close observation B- Medical therapy C- Inferior petrosal sinus sampling D- Urgent neurosurgery referral

139- 65 years old women, underwent elective colon resection. Day 5 post op she complained of abdominal pain & distention. While preparing her for CT scan, she had fresh blood & coffee ground in her NGT tube bag. Her vitals & HgB levels are normal. What is the most appropriate diagnostic test?

A- Colonoscopy B- CT scan C- Upper GI endoscopy D- Abdomen US

170- A patient presented to the clinic complaining only of perianal discharge (no abdominal pain or bleeding), on examination three sinuses were noted at the 3 5 7 o'clock positions. Proctoscopy was clear. What is the most appropriate next step?

A- Colonoscopy B- MRI C- Fistulogram D- US

175- A 46 years old asymptomatic man. His mother recently died of metastatic colon cancer. She was diagnosed with colon Cancer 5 years ago at age 69 years. Which of the following is the most appropriate colorectal cancer screening strategy for this patient?

A- Colonoscopy every 5 years B- Colonoscopy every 10 years C- CT Colonography every 10 years D- Fecal immunochemical testing every 5 years

Female heavy smoker (2packes/week) for the past 7 years. and since then show was doing Pap smear and all negative. and she had previously infected with benign warts. this time it shows LSLI, what will you do?

A- Colposcopy B- HPV DNA C- Pap smear

58 y/o female did Pap smear and showed (ASC-US), her treating physician prescribe for her topical vaginal estrogen for 1 month, she came back after that and Pap smear repeated and it was also (ASC-US ). What you will do for her?

A- Colposcopy B- Punch biopsy C- HPV testing D- No further investigations

35 years old female underwent thyroid lobectomy for hot thyroid nodule 3x3, 8mm papillary will defined focus was found distant to the lesion with no lymph or vascular invasion, what is the appropriate management?

A- Completion thyroidectomy. B- Follow up 3 months. C- RAI. D- Lobectomy

A case of ectopic pregnancy, plateau B-HCG for 3 weeks. What to do?

A- Consider methotrexate B- Reassure and follow up C- Salpingostomy or Surgical management

One of the following is a side effect of Rifampicin?

A- Constipation B- Red-brown body fluid discoloration C- Abdominal pain D- Numbness

One of the following is a side effect of Rifampicin?

A- Constipation B- Red-brown body fluid discoloration C- Abdominal pain D- Numbness

A patient underwent thyroidectomy, immediately developed shortness of breath and respiratory distress after extubating. Upon examination both vocal cord are in semi-closed position. What is the best next step to secure the airway?

A- Cricothyrotomy B- Re-intubate. C- Nasal canula. D- Bedside tracheostomy.

Patient With neck stiffness and fever. CSF analysis showed high protein. Low glucose. high WBCs 70% polymorphs. what is the cause?

A- Cryptococcus B. TB C. Viral D- Bacterial

289- Pregnancy typical DVT symptoms then developed PE, how to dx?

A- Ct B- D dimer C- V/Q D- Us for lower limbs

Which of the following decreases the risk of PPH in a C/S?

A- Curate uterus with sponge B- Fundal pressure C-Spontaneous separation of the placenta

Patient has SLE with neurological manifestation, patient already on corticosteroids, what to add now?

A- Cyclophosphamide B- Phenytoin C- Hydroxychloroquine D- Diazepam Severe SLE: Renal involvement - neuropsychiatry - cardiac Tx: Cyclophosphamide (preferred in neuropsychiatry ) Adverse effects: hemorrhagic cystitis (avoided by good hydration), azoospermia and anovulation If in a question renal involvement and Cyclophosphamide and Mycophenolate --> choose Mycophenolate

326- 67 years old male complaining of painless hematuria , whx is the diagnostic test?

A- Cystoscopy B- CT abdomen C- Iv pyelogram D- Us

Patient with LMP at 12 weeks while physical exam is at 19 weeks. US reveals molar. What is the management?

A- D & C B- Methotrexate C- Suction & Evacuation Molar pregnancy -> Uterine evacuation is for definitive diagnosis and treatment **if she presents with HEMOPTYSIS-> it means its Choriocarcinoma à answer will be admit for staging and chemotherapy (Methotrexate or dactinomycin)

Patient with DM and RA, has bone pain and hypercalcemia, high renal function test. What is the most likely diagnosis?

A- DM nephropathy B- Amyloidosis C- Membranous glomerulonephritis D- Lupus nephritis · By exclusion: due to the patient RA + hypercalcemia + high RFT à amyloidosis

COPD on pulmonary function test?

A- Decrease TLC, decreased FEVI/FEVC <0.7, increase VC B- Increase TLC , decrease FEVI/FEVC <0.7, decrease VC · DLCO decreased in emphysema and intrapulmonary restrictive diseases . DLCO is normal in asthma and chronic bronchitis · TLC is high in COPD and asthma · TLC is low in restrictive disease · FEV1/ FVC ratio low in asthma and COPD · FEV1/ FVC ratio normal restrictive · FEV1 decreased in all · FVC is markedly decreased in restrictive . Reversibility test positive = asthma

Patient diagnosed with Endometriosis. She is complaining of dysmenorrhea. Which of the following is the best first line medical treatment

A- Depo Provera injection B- Progesterone only pills C- Combined oral contraceptive

Mother just gave birth, exclusively breastfeeding, want contraception for 2 years?

A- Depo Provera injections B- POP C- OCP

Patient with ascending limb weakness with history of gastroenteritis 3 weeks back, what is the mostly prognosis Of these diseases?

A- Deterioration B- Resolve with weakness C- Full recovery D- Resolve with dysarthria

Best way to prevent stroke?

A- Diabetes control B- Prophylactic aspirin C- Blood pressure control D- No way of prevention

284- 35 years old patient come with medial leg ulcer. The most likely diagnosis is:

A- Diabetic B- Venous hypertension C- Atherosclerosis D- Buerger's disease.

An elderly man with a history of asthma, congestive heart failure and peptic ulcer disease is admitted with bronchospasm and rapid atrial fibrillation. He received frequent nebulizer Salbutamol and IV Digoxin, his regular medications are continued. 24 hours after admission his serum potassium is noted to be 2.8 mmol/l. Which of his medications is most likely caused his abnormality?

A- Digoxin B- ACE inhibitor C- Salbutamol D- Ranitidine · Salbutamol --> hypokalemia · Digoxin and ACEIs --> hyperkalemia

Which mother can give breastfeeding to her son?

A- Direct breastfeeding HIV mother B- Expressed milk HIV mother C- Direct breastfeeding TB mother D- Expressed milk TB mother · Direct breastfeeding in TB is contraindicated (duh) · Expressed milk is fine (TB doesn't transmit through milk) · HIV mothers cannot give their milk because there is risk of transmission.

253- Case of anterior thigh deep laceration with heavy bleeding and unstable patient asking about what to do next?

A- Direct pressure on the wound B- pressure above the wound on femoral artery C- apply tourniquet

Child complain of "unilateral scrotal swelling " does not transilluminate what next step ?

A- Discharge pt B- Give antibiotic C- Do laparotomy D- U/s

Asthmatic patient on SABA + LABA + high-dose ICS and oral steroid though she was uncontrolled, and the asthma is persistent. The patient uses aspirin and ibuprofen daily for her migraine. What is the most appropriate initial management?

A- Discontinue aspirin and ibuprofen and start Montelukast B- Order lgE and serum eosinophils C- Upper laryngoscopy D- CT chest · Aspirin and ibuprofen could be the main cause of not improving, discontinue them before and other intervention

COPD with Cor pulmonale what is the best thing to improve survival?

A- Diuretic B- Oxygen therapy · Diuretic doesn't not improve mortality

185- A 45 - year old patient complains of perianal swelling, fresh bleeding per rectum and weight loss over the last 3 months on examination, there is a mass 1 cm from the anal verge. She has no obstructive symptoms (see report), Biopsy: Adenocarcinoma. MRI abdomen: Localized lesion with craniocaudal extension of 3 cm with associated lymphadenopathy. 110/70 mmHg 96 / min 18 / min 36.6 ° C CT scan chest: No evidence of metastasis. Which of the following is the most appropriate treatment?

A- Diversion colostomy B- Low anterior resection C- Concurrent chemoradiation D- Abdominoperineal resection

104- During Lap cholecystectomy you found AAA 4.5 cm what you will do?

A- Do the surgery and FU with US B- Do the surgery and follow up with CTA C-Do CTA before the surgery

Management of chronic hypertension in pregnancy?

A- Methyldopa B- Labetalol C- Nifedipine D- Hydralazine

Patient with history of gastroenteritis took medication, now came with abnormal movements in head and eyes, what is the causative drug?

A- Domperidone B- Metoclopramide C- Ciprofloxacin D- Ceftriaxone

Young age patient with multiple neurological symptoms in different parts of the body, including eye symptoms and lower limb weakness, what is the best diagnosis test?

A- EMG B- NCV C- MRI brain and spine D- ECG

Patient with headache that comes and goes a lot during the last months and it is usually on the left or right sinus, she used over the counter analgesic and decongestants but didn't help, she complains now of severe headache, she's otherwise healthy with no symptoms, what will you order to confirm the diagnosis?

A- ESR B- CT of paranasal sinuses C- MRI brain D- MRI spine

Elderly patient with high-grade fever and left pleuritic chest pain and early clubbing, plural tap showed low pH, what is the diagnosis?

A- Empyema B- Chronic bronchitis C- Parapneumonic effusion D- Emphysema · Empyema vs parapneumonic o Empyema can cause clubbing o Empyema more toxic and sicker (bacteria infecting the pleura) parapneumonic effusion (inflammatory response to underlying pneumonia)

Patient with pleural effusion, pleural fluid analysis showed exudative pattern, he had positive gamma interferon release assay test, what is the most likely cause?

A- Empyema B- Mesothelioma C- Parapneumonic effusion D- TB pleural effusion · IGRA is for screening of TB · If positive confirmation is needed

143- Male patient in his 20s, present with sever epigastric pain for 6 hours, start suddenly. On examination there is diffuse tenderness, sluggish bowel sound. Labs: high WBCs, Amylase 300, Which of the following best initial diagnostic step?

A- Erect chest X-ray B- Abdominal X-ray C- Abdominal CT D- Abdominal US

Adult patient with meningitis. his sibling is allergic to the primary treatment given for prophylaxis, what to give him as a prophylaxis?

A- Erythromycin B- Vancomycin C- Ceftriaxone D- Cefuroxime

Patient underwent total hysterectomy with bilateral oophorectomy what to give her?

A- Estrogen patch B- IUD C- OCP (Progesterone and estrogen) D- Progesterone only pills Surgical menopause — In women who have undergone a hysterectomy and who are candidates for MHT, unopposed estrogen is given. Progestins are only given to women with an intact uterus to prevent endometrial hyperplasia and cancer

A middle-aged man present to the doctor with blurred vision and eye pain. He was recently diagnosed with tuberculosis. What is the cause of his symptoms?

A- Ethambutol B- Isoniazid C- Pyrazinamide D- Rifampin

Pediatric patient with manifestation of abscense seizure what is the appropriate treatment?

A- Ethosuximide B- Valproate C- Lamotrigine D- Carbamazepine

Elderly female diagnosed with breast cancer 3 years ago, presented now with SOB, chest x-ray done showed right side pleural effusion, what is the most likely cause Of pleural effusion?

A- Exudative plural effusion due to malignancy B- Exudative plural effusion due to empyema C- Transudate plural effusion due to malignancy D- Transudate plural effusion due to CHF

53- breast mass behind nipple, on US there is hypoecoich lesion cyst what next ?

A- FNA B- core biopsy C- exicional biopsy D- reassess after

Best way to deliver oxygen in COPD patient?

A- Face mask B- Nasal cannula C- Venture bag D- Non rebreather mask

Treatment of community acquired pneumonia?

A- Fluoroquinolone B- Azithromycin C- Tazocine D- Meropenem · Azithromycin: for young population · Old age + comorbid: fluoro

70-years old male patient known case Of HTN brought to ER by his son, his son reported that patient had change in behaviors beside his memory loss, he is fighting with every one in the street, what is the most likely diagnosis?

A- Frontotemporal dementia B- Dementia of Lewy body C- Parkinson disease D- Alzheimer disease

Frontal sinus headache, how to reach the diagnosis?

A- Full history and examination B- CT Paranasal sinus C- CT brain D- MRI brain

101- Female 16 week pregnant, came with right sided abdominal pain (RUQ) associated with nausea and vomiting. The doctor ruled out all pregnancy related abdominal pain. What's the most likely diagnosis?

A- Gastritis B- Pancreatitis C- Cholecystitis D- Appendicitis

209- 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

A 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. D- Administer Calcium Gluconate.

About 28 years old, came to ER with heavy vaginal bleeding, she is nulliparous, pregnancy test negative, no pain, regular cycle, but always with menorrhagia, how to stop the bleeding now?

A- Give conjugated estrogen B- Give progesterone C- Give GnRH D- Insert levenogestrel IUD

Pregnant 35w hypertensive came with sever headache, abdominal pain and feel dizzy

A- Give mg salfate and admission for delivery B- Give steroid and admission for delivery C- Give mg salfate and wait

In parapneumonic effusion, what is the Indication of chest tube?

A- Glucose < 0.4 B- Protein < 0.4 C- Ph < 7.2 D- 90% neutrophils Indications for chest in pleural effusion:- - Empyema: Ph < 7.2, glucose < 60, WBCs > 50,000, LDH > 1000, or positive culture and gram stain - Chylothorax - Pleural fluid loculation

Diabetic patient with severe unilateral knee joint pain, on exam it is erythematous, swollen, warm. Patient has fever, joint aspiration shows 55.000 WBCs, Culture was negative, crystals still pending. What is the diagnosis?

A- Gout B- Septic arthritis C- Pseudo-gout D- Reactive arthritis Presentation of septic arthritis --> joint aspiration --> culture negative but WBC > 50k which is diagnostic of septic arthritis

Pregnant female with Hypertension 140/90, no proteinuria, what is first line mx?

A- Methyldopa B- Labetalol C- Nifedipine D- Hydralazine

68-year-old male with adenocarcinoma of the lung presents with blurring of the vision. On examination, you note ptosis and miosis. What is the diagnosis?

A- Gustave's syndrome B- Horner's syndrome C- Hyponatremia D- Invasion of CNIII · Squamous cell carcinoma = Horner syndrome (miosis + ptosis + anhidrosis)

28-year-old male with lower back pain, erythematous and bilateral knee joint pain, laboratory results were of insignificant values, how to diagnose?

A- HI-A-B27 B- MRI spine C- CT spine D- Joint aspiration · Young male + back pain + erythematous bilateral knees à AS · Best to diagnose: MRI spine · HLA-B27: specific but not sensitive enough

Patient came with seizure and History of multiple sexual partners in past 6 years, what investigation you will order?

A- HIV B- Syphilis C- Hepatitis B D- Hepatitis C

Patient known to have SLE, came with pale skin and fatigue, Labs showed Hemoglobin: 10 (low) and ferritin: 600 (high), what is the cause?

A- Hemolytic anemia B- Iron deficiency anemia C- Anemia of chronic disease D- Aplastic anemia

Which vaccine is Contraindicated in eczema patient? •

A- Hepatitis B • B- Smallpox vaccine • C- BCG • D- Influenza

In pituitary adenoma, what is the vision affection?

A- Homonymous hemianopia B- Complete vision loss C- Bitemporal hemianopia D- Binasal hemianopia

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 Steroid D- Hydroxychloroquine and Azathioprine Hydroxychloroquine is the first line of therapy in SLE

A patient with lung cancer has a low serum PTH and high Calcium. What is this caused by?

A- Hyperparathyroidism B- Hypoparathyroidism C- PTH-related peptide D- SIADH · In PTH related peptide: o High calcium levels independent to low PTH o High levels of PTH related peptide o Low PTH levels · Squamous cell carcinoma o PTH-related peptide o Horner syndrome · Small cell carcinoma syndromes: o Cushing o SVC syndrome o SIADH · Adenocarcinoma o Clubbing · Large cell carcinoma o SVC syndrome

60-year-old male patient known case Of COPD diagnosed 10 years ago, He read that oxygen improve survival in COPD patient and asking to Start Oxygen, "'hat is the indication to Start home oxygen in COPD patient?

A- I reading ofPa02 < 55 in ABC' done out the time of attack B- 2 readings Of pa02 < 55 in A BG done Out the time Of attack C- Pa02 < SS in ABG done during the time of attack D- No indication for home oxygen in COPD patient

40s old female, with heavy bleeding came to ER, what to do?

A- IUD B- D/C C- Hysterectomy D- Mefenamic acid

20-year-old female presented to ER with status epilepticus for 5 min, with IV access, what is the first line?

A- IV Lorazepam B- Diazepam rectal C- Buccal midazolam D- Oral Midazolam

Patient known case of RA now presented with acute knee pain, swelling, redness and effusion, synovial fluid analysis showed WBC: 35000, culture pending, febrile and tender on examination, what to do?

A- IV antibiotic B- high dose IV steroids C- Intra-articular steroids D- NSAIDs

Man with history of reactive arthritis has another attack with joint aspiration showed 40000 WBC, neutrophils predominance. What is the initial management?

A- Ibuprofen B- Methotrexate C- Infliximab D- Sulfasalazine

Patient had knee pain, no trauma or fever but he is having also epigastric pain, which analgesia you will use?

A- Ibuprofen B- Paracetamol C- Aspirin D- Tramadol

Female with previous 2 preterm labor, now she is in 20 weeks of gestation and her cervix opened 30 mm, what you will do?

A- Immediate cervical cerclage B- Give tocolytic & wait C- Strict bed rest D- progesterone supplement

Ectopic pregnancy. Start methotrexate weak ago. Follow up result: D1 : BHCG 1000 D4: BHCG 1200 D7: BHCG 2200 What is the most appropriate next step?

A- Immediately laparotomy B- Second dose methotrexate C- Multiple dose methotrexate if in day 7 post methotrexate BHCG didn't drop 15% or more --> give another dose

336- Patient had surgery after 1 day he had diminished breath sounds in the left lower lobe how to manage?

A- Incentive spirometry B-Chest tube C-Needle decompression

Scenario about pt. On furosemide and Acei. Come with non productive cough whats the most appropriate next step ?

A- Increase furosemide B- Pulmonary function test C- Add inhaler D- Decrease furosemide · Bad recall, the answer will depend on more information · Other recalls include the patient is CHF · Based on the information and the answers: dry cough + CHF à increase furosemide · But if the choices included switch ACEIs to ARBs à this is more accurate · Increasing furosemide also if the patient is coming with overload symptoms + cough

Patient presented with feature of acute gout attack, what is the first line treatment?

A- Indomethacin B- Probenecid C- Allopurinol D- Febuxostat

SLE patient on medication, what vaccine you will give him?

A- Influenza B- Pneumococcal C- Meningococcal D- Rubella

Pregnant lady what vaccine should she get at first visit:

A- Influenza B- Tdap Depends on the gestational age if 1st or second trimester-> I would go with influenza if third trimester -> I would go with Tdap

Patient known to have multiple sclerosis came to ER with acute episode of lower limb weakness, which medication you will give?

A- Interferon B- IV Corticosteroids C- Oral steroid D- IVIG

35-year-old male with history of recent diarrhea came with lower limb weakness (ascending in nature), what is the best treatment for him?

A- Intravenous immunoglobulin B- IV Methylprednisolone C- Antibiotic D- Supportive treatment

Pregnant at 12 weeks, complaining of mild leg edema, blood pressure mildly elevated, Positive trace proteinuria

A- Methyldopa B- Labetalol C- losartan D-Captopril

Headache that is throbbing and unilateral aggravating with light and movement, what is the diagnosis?

A- Migraines B- Cluster headache C- Subarachnoid hemorrhage D- Tension headache

You are treating a 52-year-old woman With a 40-pack-year history Of smoking. She reports a productive cough that has been present for the last 3 to 4 months, beginning in the fall. She remembers having the same symptoms last year in the fall, and attributed it to a cold that she just couldn't kick. She does not have fevers, reports mild dyspnea when walking upstairs, and denies hemoptysis. Which Of the following is the most likely diagnosis?

A- Irritation of airways from cigarette smoke B- Chronic bronchitis C- Postnasal drainage due to seasonal allergies D- Lung cancer · Chronic bronchitis: heavy smoker + 3 months every year same time of the year + symptoms of COPD

A patient presented complaining of a sudden urge to void, frequent voiding's during the day and getting up to void more than once per night. She diagnosed as urge urinary incontinence. Which of the following considers the most appropriate management?

A- Kegel exercises B- Vaginal cones C- Oxybutynin D- Oxybutynin and Kegel exercises

Pregnant in 20w with HTN 160/90 what is the appropriate antihypertensive drug for her?

A- Labetalol B- Hydralazine C- Methyldopa D- Nifedipine

Ectopic pregnancy received MTX and gradually result in bHCG decreased, what is the next step?

A- Laparoscopy B- Give 2nd dose MTX C- observe

Child with foreign 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

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

Which of the following organisms a common cause of ventilator associated pneumonia?

A- Legionella pneumophilla B- Mycoplasma pneumonia C- Pseudomonas aeruginosa D- Streptococcus pneumoniae · Most common cause of VAP, HAP, and bronchiectasis patients: pseudomonas aeruginosa

27-year-old female found to have positive lupus anti-coagulant antibody, what type of anticoagulation would you offer?

A- Life-long Warfarin B- Life-long Enoxaparin C- Life-long non-vitamin K anticoagulant D- Life-long Heparin If patient is pregnant choose LMWH

218- case that was positive for Hep C, came now for follow up, labs show HCV Antibody + and HCV RNA negative What to do ?

A- Liver biopsy B- Liver ultrasound C- Repeat HCV RNA after 6m D- No need for further intervention

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 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 Indications for chest in pleural effusion:- - Empyema: Ph < 7.2, glucose < 60, WBCs > 50,000, LDH > 1000, or positive culture and gram stain - Chylothorax - Pleural fluid loculation

Asthmatic patient on SABA + LABA + ICS and still uncontrolled, what will you add in the management?

A- Low-dose oral prednisolone B- Leukotriene inhibitor C- Medium-release theophylline D- Inhaled ipratropium · Patient on SABA + LABA + ICS à next step leukotriene inhibitor

24 hours post operative patient has dyspnea and hypoxia, what is the cause?

A- Lower lobe atelectasis B- Pulmonary embolism · First 48 hours post op complications à atelectasis

Patient presented with worst headache in his life, negative CT brain, what is the next investigations?

A- Lumbar puncture B- MRI brain C- EEG D- Echocardiography

80-year-old male patient who had chest infection 4 weeks ago, initially improved on antibiotic, now worsened again with same complaint, chest x-ray showed right pleural effusion, what is the most likely diagnosis?

A- Lung cancer B- TB C- Parapneumonic effusion D- Pulmonary embolism · OM QURA answered this question C · Even though lung cancer and TB could present similarly

Case Of meningitis. CSF analysis showed picture Of tubercubus meningitis With high protein and glucose, What Will be the predominant type or Cell?

A- Lymphocyte B- Neutrophil C- Eosinophil D- Monocytes

Reduced variability is caused by?

A- Magnesium sulfate B- Epidural anesthesia CTG and intrapartum drugs: - Mg sulfate: minimal or reduced variability, mom delayed deep tendon reflexes, and respiratory depression - Oxytocin: late or prolonged decelerations + uterine hyperstimulation, --> uterine rupture --> baby bradycardia - Epidural analgesia: maternal hypotension -> uteroplacental insufficiency-> late or prolonged decelerations

Severe asthma, patient can not complete 1 sentences, inspiratory and expiratory wheeze, High Co2 and low 02, how you will manage?

A- Magnesium sulphate B- IV Theophylline C. Intubation and mechanical ventilation D- High flow oxygen · Life threating asthma --> will require intubation --> no enough time for Mg IV infusion · Life threating asthma characters: o Bad ABG: normal/ high co2, or normal/low ph o Cannot complete one sentence in more breath o Confused o PEFR < 33% o Silent chest

343- 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

Pregnant at 39 weeks now in labor during the delivery you noticed the amniotic fluid is mixed with dark black-green what is the cause of this color?

A- Meconium aspiration syndrome B- Fetal distress C- Placenta abruptio D- Preterm labour

SLE with arthritis on NSAIDs and hydroxychloroquine, not responding to NSAIDs, what to add?

A- Methotrexate B- Azathioprine C- Cyclosporine D- Paracetamol

66-year-old male Patient has a history Of polyarthralgia with pain in distal and proximal interphalangeal joint, no History of morning stiffness, medically free and no active arthritis, what is the management?

A- Methotrexate B- Finger splint C- Cyclophosphamide D- Treat as RA patient

Leukotriene Receptor Antagonists is the mechanism of action of which drug?

A- Montelukast B- Omalizumab C- Salbutamol · Montelukast: leukotriene receptor antagonist · Omalizumab: anti IgE

down syndrome with mild dysmorphic features •

A- Mosaicism B-Non disjunction C-Translocation D-Mutation Key word: mild

20-year-old female with transient vision loss during sport, no other symptoms, MRI brain: multiple hyperintense lesion in area, what is the most likely diagnosis?

A- Multiple sclerosis B- Brain lymphoma C- Brain vasculitis D- Neuropsychiatric SLE

24-year-old male medically free had URTI 2 weeks ago and now developed back pain, ascending lower limbs bilateral flaccid paralysis spreads from the lower to the upper limbs in a "stocking-glove" distribution and absent reflexes, what is the most likely diagnosis?

A- Myasthenia gravis B- Guillain-Barré syndrome C- Brain tumor D- Giant cell arteritis

Child aged 3 years old brought by his mother with episodes of crying, fever, productive cough and drooling of saliva. 1-2 weeks ago. mother reported that her child was complaining of bilateral conjunctivitis. Which of the following is the most causative organism?

A- Mycoplasma pneumonia B- Adenovirus C-Chlamydia D-Influenza

An 80-year-old who has been in the ICU for 4 days has developed pneumonia, what is the most likely organism?

A- Mycoplasma pneumoniae B- Neisseria meningitidis C- Pseudomonas aeruginosa D- Streptococcus pneumoniae · More than 48 hours --> HAP --> Pseudomonas aeruginosa

RA patient with severe symptoms not responding to methotrexate, hydroxychloroquine, what to add?

A- NSAIDs B- Adalimumab C- Cyclophosphamide D- Paracetamol

34-year-old male developed meningitis after swimming in a river. what is the most likely organism?

A- Naegleria fowleri B- Streptococcus pneumoniae C- Listeria monocytogenus D- Staphylococcus aureus

COPD patient developed sudden symptoms Of spontaneous pneumothorax, x-ray was done and showed 2 cm pneumothorax, management?

A- Needle decompression B- Chest tube C- Observation D- Aspiration · Pneumothorax due to underlying chronic disease (secondary pneumothorax), the only treatment is chest tube

Patient with malar rash, chest infection, anemia, renal impairment, low C3 and C4, what is the diagnosis?

A- Neonatal lupus B- Lupus nephritis C- Lupus cerebritis D- Anti-phospholipid syndrome

Pregnant bp 140/90 or 150/90 what to give ? "Exactly like this"

A- Nifedipine B- Hydralazine C-Metoprolol No labetalol in choices

Patient known case of COPD alert, has moderate respiratory distress. Sa02 93%, ABG showed hypoxia, hypercapnia and acidosis. What is the next step:-

A- Non-invasive ventilation B- Mechanical ventilation C- Increase Oxygen D- Decrease oxygen · Mechanical ventilation: no indications · Never increase oxygen more than 92%

In bacterial meningitis case, what do you expect to see on CSF analysis?

A- Normal glucose. High protein. Neutrophil predominance B- Low glucose. High protein. Neutrophil predominance C. Low glucose. High protein. Lymphocyte predominance D- Normal glucose, High protein. Lymphocytes predominance

Old male patient came with his brother, brother complaining of change in personality, mild forgetful, MRI show cortical atrophy, what is the most likely diagnosis?

A- Normal tension hydrocephalus B- Creutzfeldt-Jakob disease C- Alzheimer disease D- Parkinson disease

A 28 year old female known to have an ovarian cyst, came to your clinic asking about contraception, which of the following methods is most appropriate for her?

A- OCP B- Oral progestins only pills C- Vaginal ring D- Male condom

109- Patient presented with symptoms of appendicitis. Imaging: appendicitis, fecolith, appendicular abscess 10 x 15 cm reaching the flank. What is the management?

A- Open drainage B- Percutaneous drainage C- Open appendectomy with drainage D- Laparoscopic appendectomy with drainage

126- 75 years old male, came with inguinal hernia, irreducible and painful mildly, afebrile, no signs of inflammation :

A- Open repair with mesh B- Repeat hernia C- do nothing

SLE patient following in clinic. no symptoms. controlled on medication, she has high Urea. high Creatinine. high protein (nephritis) and RBC cast, what is your management?

A- Order Anti Ds-DNA B- Renal biopsy C- Repeat 24 hour urine protein D- Urine culture

- Pregnant at 38 weeks of gestation came with labor. Cervix effaced 80% dilated 6 cm and there is uterine contraction. Vaginal examination revealed palpation of nose, mouth and lips. CTG was reactive no abnormality (Doesn't mention anything about patient status or the duration of labor). , Which of the following is the most appropriate next step?

A- Order x-ray pelvimetry B- Augmentation of labor C- Cesarean section D- Monitoring of partograph

Old women with knee pain in the morning that relief with rest and increase with walking?

A- Osteoarthritis B- Rheumatoid arthritis C- Septic arthritis D- Psoriatic arthritis · Increase by walking + relieved by rest -> osteoarthritis

Patient with headache same as tension headache band like with stress, pain is lasted for one month and he is using paracetamol day after day. What is the type of headache?

A- Over use drug headache B- Subarachnoid hemorrhage C- Acute sinusitis D- Cervical spondylosis

Pregnant women with asthma, which tocolytics is contraindicated for her?

A- Oxytocin B- Carboprost

69- 61 years old women sustain MVA to here left chest brought to ER vitally stable no open wound admitted for observation, couple of hours later developed suddenly SOB only, initial CXR reveled 3-7 left ribs features. Repeated CXR showed well demarcated left lung infiltrate. What is the diagnosis?

A- PE B- flail chest C- cardiac contusion D- pulmonary contusions

Patient with pleural effusion which showed transudates, what is the most likely diagnosis?

A- Pancreatitis B- Heart failure C- Pneumonia D- Malignancy

55 years old patient was diagnosed with autoimmune thyroiditis, with a history of progressive enlargement of the right lobe of the thyroid. FNA report: malignant cells. Which of the following is most likely the type of thyroid malignancy?

A- Papillary. B- Medullary. C- Anaplastic. D- Lymphoma.

116- Pt after splenectomy surgery presented with with multiple episodes of intestinal obstruction Now complaining of abdominal destination pain rigidity sluggish bowel sounds Vitality stable X ray air fluid level What is the initial management?

A- Paracentesis B- gastrografin enema C- expl laparotomy D- NGT , analgesic, bowel rest

172- A patient with Crohn's disease treated with azathioprine and infixmab and other medication presented complaining of pus out from anal. Vital signs stable also no fever. what is the next step?

A- Pelvic MRI B- Broadly Antibiotic C- Swab and culture D- increase infliximab dose

232- 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

70 years old female with prosthetic heart valve on warfarin, has grade 3 pelvic organ prolapse. How to manage?

A- Pessary B- Sacrocolpopexy C- Le Fort Technique D- Hysterectomy According to Williams Gynecology&UTD: TREATMENT OF Pelvic organ prolapse Conservative management — is the first line option for all women with POP, since surgical treatment incurs the risk of complications and recurrence Surgical treatment — Surgical candidates include women with symptomatic prolapse who have failed or declined conservative management of their prolapse.

70 years old female with prosthetic heart valve on warfarin, has grade 3 pelvic organ prolapse. How to manage?

A- Pessary B- Sacrocolpopexy C- Le Fort Technique D- Hystrectomy

A 27 years old female known case of thalassemia major presented to the clinic complaining of abdominal pain for long time. She has no other complain and in good health. She receive a regular blood transfusion for the management of thalassemia. On the exam she has some skin pigmentation and mild hepatomegaly. Lab results showed elevated ferritin level. The next step on management should be:

A- Phlebotomy. B- Deferoxamine. C- Decrease Transfusion interval. D- Continue same management.

Patient with post TB bronchiectasis presents with cough, hemoptysis, chest x-ray showed right upper lobe cavitary lesions, what is the best initial next step?

A- Place patient in right lateral decubitus position B- Chest physiotherapy C- Antibiotics D- Urgent bronchoscopy

Patient known case of myasthenia gravis came to ER with myasthenic crisis, he is on pyridostigmine, what to do for him in ER?

A- Plasmapheresis B- IV Corticosteroids C- Antibiotics D- Aspirin + Plavix

Which Of the following is considered as exudative pleural fluid?

A- Pleural fluid protein/serum protein ratio < 0.5 B- Pleural fluid LDH/serum LDH ratio < 0.6 C- Pleural fluid LDH > two thirds the upper limit normal Of serum LDH D- Pleural fluid LDH > one third the upper limit normal of serum LDH In exudative protein and LDH is higher · Exudate if any of the following: - Pleural LDH/ serum LDH ---> >0.6 - Pleural protein to serum protein ---> > 0.5 - Pleural LDH > 2/3 the upper normal · Exudate causes: infection - TB - malignancy - pancreatitis - esophageal rupture - PE

Middle age male complains Of SOB, CNR evidence Of pleural effusion. Aspiration Of fluid to analysis was done. What statement Of the following confirm that the pleural effusion is exudative?

A- Pleural protein/serum protein is LESS than 0.5 B- Pleural LDH serum LDH is more than 0.6 C- LDH is more the 1/3 of upper limit In exudative protein and LDH is higher · Exudate if any of the following: - Pleural LDH/ serum LDH ---> >0.6 - Pleural protein to serum protein ---> > 0.5 - Pleural LDH > 2/3 the upper normal · Exudate causes: infection - TB - malignancy - pancreatitis - esophageal rupture - PE

A 23-year-old man Who is known to be HIV positive presents With a history Of mild fever, cough and difficulty breathing. A diagnosis of pneumonia is made. A transbronchial biopsy was ordered as the patient did not respond to antibiotic treatment, alveolar biopsy showed soap bubble like intra-alveolar exudates and small cyst like structures identified by silver stains, What was the most likely cause?

A- Pneumocystis carinii B- Aspergillus fumigates C- Chlamydia trachomatis D- Cryptococcus neoformans · Pneumocystis carinii: HIV + silver stains + small cyst + soap bubble + CD4 < 200

32-year-old female diagnosed with severe RAs rheumatologist decided to start TNF inhibitor as a treatment of choice, which diseases is a high risk this patient to get it as a recurrence?

A- Pneumonia B- Tuberculosis C- Septic arthritis D- HIV

70-year-old male patient came to your clinic complaining of bilateral shoulder pain in addition to bilateral hip pain, upon examination, power is 5 out of 5, on systemic review he gave history of unilateral headache at temple area, what is the most likely diagnosis?

A- Polymyositis B- Dermatomyositis C- Polymyalgia rheumatica D- Frozen shoulder

Patient with suspecting pulmonary TB effusion, what will confirm the diagnosis?

A- Positive AFB culture in pleural fluid B- Lymphocytes in pleural fluid · AFB for diagnosis · Lymphocytes give a clue but not diagnostic

Old patient with history of recent travel, came with difficulty getting aroused/awaken, he report multiple falls, examination showed no head wounds and skull is intact, what is the most likely diagnosis?

A- Post-concussion syndrome B- Chronic subdural hematoma C- Subarachnoid hemorrhage D- Brain tumor

55-year-old male known case of diabetes mellitus presented complaining of ptosis. inability to adduct, elevate and depress the right eye, double vision when looking laterally upon examination pupils are reactive bilaterally, what is the most likely

A- Posterior communicating artery aneurysm B- Cavernous sinus thrombosis C - 3rd nerve neuropathy D- Myasthenia gravis

Adult patient with bronchiectasis, he is on antibiotic and physiotherapy, presented with sputum, what to do?

A- Steroid B- Supine sputum suction C- Antibiotic D- Anti-viral · No rule of steroid · He is already on antibiotic · No rule of antiviral · Sputum suction is the best of all them (clean the medium)

10 months came with anemia , and found to have triphalanegal thumb Most likey cause

A-Fanconi Anemia B-Diamond blackman syndrome C-Iron deficiency anemia D-Down syndrome

COPD patient on salmeterol and albuterol, still not controlled as he needs to use albuterol more often now and he had multiple exacerbations in the last 6 months, what to give him for maintenance?

A- Prednisolone B- Tiotropium Oral Steroid (Prednisolone) not indicated for maintanance · Medications for COPD, stepwise escalation 1st LABA or LAMA (tiotropium) 2nd LABA & LAMA 3rd LABA & LAMA & ICS · SAMA: ipratropium --> decrease secretion in acute exacerbation more than other bronchodilation · Indications for intubation o Severe acidosis o AMS o Mouth full of secretion o Not responding of Non invasive after 2 hours

DM pregnant, what is the complication she has a similar chance of getting it as in normal pregnancy?

A- Preeclampsia B- Cystic fibrosis C- IUGR D- Polyhydroamnios

40 years old female, P4 with a history of tubal ligation 4 years ago after her last CS delivery. Her last Menstrual period was 6weeks ago. Presented to ER with vaginal spotting. NO abdominal pain O/E: OS is closed. Tenderness and fullness in her abdomen in RLQ. What is the best Initial investigation?

A- Pregnancy test B- US C- CT Abdomen

Hypertensive patient recently diagnosed as bronchial asthma, which medication you will stop?

A- Propranolol B- Amlodipine C- Captopril D- Perindopril · No selective BB --> propranolol

Patient with social anxiety and asthmatic, how to treat?

A- Propranolol B- Bupropion C- Psychotherapy CBT · A & B contraindicated

Patient diagnosed with Parkinson disease, her only complaint is right hand tremor that disturbs her manual activities, which medication to use?

A- Propranolol B- Levodopa/Carbidopa C- Amitriptyline D- Sertraline

102- Patient with appendicitis, when palpating the RLQ it causes pain in the LLQ. name of this Sign?

A- Psoas B- Rovsing C- Obturator D- Blumberg

66-year-old male Patient has a history Of polyarthralgia with pain in distal and proximal interphalangeal joint, no History Of morning stiffness, medically free and no active arthritis, what is the management?

A- Psoriatic arthritis B- Rheumatoid arthritis C- Hand osteoarthritis D- SLE · DIP and PIP --> no way RA · No morning stiffness à not inflammatory à hand osteoarthritis

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

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 · By exclusion: COPD à COPD not always has findings in CXR · A and B: findings in Xray · No occupation mentioned

Most hepatotoxic Anti-TB?

A- Pyrazinamide B- Ethambutol C- Isoniazid D- Rifampicin

Patient diagnosed with TB 2 months ago and started on 4 drugs anti-TB, presented to clinic for follow-up with signs Of gout, laboratory investigations showed increased uric acid level, what is the drug causing hyperuricemia?

A- Pyrazinamide B- Ethambutol C- Isoniazid D- Rifampicin

Which TB medication can cause numbness?

A- Pyrazinamide B- Ethambutol C- Isoniazid D- Rifampicin

24-year-old patient present with bilateral ptosis, proximal lower and upper limbs weakness Simpson test was positive and after doing edrophonium test there was rapid improvement o the ptosis, what is the most appropriate management.

A- Pyridostigmine B- Rivastigmine C- Physostigmine D- IV Corticosteroid

Patient with TB on drugs developed paresthesia, what is the treatment?

A- Pyridoxine B- Thiamine C- B12

Which of the following indicates life threatening asthma?

A- RR > 28 B- PF 30% of predicted C- Spo2 95% · PRF < 33% --> life threating

Female pregnant, polyhydramnios had ruptured membrane, on CTG persistent fetal bradycardia?

A- Rapid fetal descend B- Cord prolapse C- Anomaly Bradycardia + ruptured membrane --> cord prolapse

Old female with progressive joint pain during the day and Stiffness > 2 hours in the morning, wrist pain, elbow nodule. What is the most likely diagnosis?

A- Reactive arthritis B- Osteoarthritis C- Rheumatoid arthritis D- Ankylosing spondylitis · Progressive - stiffness > 30min - elbow nodule = rheumatoid arthritis · Reactive arthritis: can't see - cant pee - cant climb a tree

SLE patient have grade I (minimal) lupus nephritis, her BP is 150/90, what to do?

A- Reassure B- Steroid C- Control BP

Female, p6, feel heaviness and discomfort on her pelvic region, exam showed mass coming from introitus, dx?

A- Rectocle B- Cvstocele C- Uterine prolapse D- Enterocoele

Describe migraine headache?

A- Recurrent headache of < 4 hours B- Unilateral throbbing headache C- Aura following the headache D- Bilateral band-like headache

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

Relation between smoking and SLE ?

A- Relieve the symptoms B- No relation C- Exacerbate the symptoms D- Recommended not to stop

105- 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 Meckle's diverticulum C- Do open surgery and explore D- Close without doing anything

Patient presented with malar rash, mouth ulcer, arthritis. There was proteinuria low complements, which drug to give?

A- Steroid and Hydroxychloroquine B- Steroid and Mycophenolate mofetil C- Steroid and Methotrexate D- Steroid and Azathioprine Severe SLE: Renal involvement If in a question renal involvement and Cyclophosphamide and Mycophenolate --> choose Mycophenolate

Patient with symmetrical joint pain in PIP and MCP, morning stiffness for more than 30 minutes, what is the best management to give?

A- Steroid and methotrexate B- Azithromycin C- Hydroxychloroquine D- NSAIDs · Steroid to abort the flare · Methotrexate is first line of treatment

A 32 year old man is evaluated in the clinic because of an abnormal chest CT. That's revealed a small lung nodule (7 mm) without any other abnormalities. he is non-smoker and he is asymptomatic. Physical examination shows no lymphadenopathy and normal lung examinations. Hemoglobin 140(130 to 170), Platelets 300(150 to 400x10^5), White blood cells 8(4.5 to 10.5x10^9), ESR 11(2-10), Calcium 4(2.15 - 2.62). Which of the following is the most appropriate procedure to do next?

A- Repeat CT scan within 3 to 6 months (THE ANSWER) B- Pulmonary function test C- Biopsy of this lesion D- pet scan High risk: - Older (e.g., > 60 years) - Heavy smoking use (current or prior) - Large (e.g., > 8-10 mm) - Irregular (e.g., scalloped or spiculated) - Upper lobe - History of extrathoracic cancer Management of lung nodule: - High risk + size > 8mm --> biopsy - Low to intermediate risk + size >= 8mm --> PET-CT - Size < 8 mm --> CT surveillance for 2 years until resolve - Size increasing --> biopsy

34 years old women did pap smear show ASCUS what to do next?

A- Repeat pap. B- HPV C- Colposcopy D- Conization

Pregnant at 22 weeks gestational age oral glucose challenge test after one hour: high, after 2 hours: high, after three hours: high. What is next?

A- Repeat same test B- HgA1c C- Fasting blood glucose D- Random blood glucose

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 · Highly suspicious asthma with normal spirometry --> methacholine challenge test = FEV1 decrease more than 20% --> by inducing bronchoconstriction

Patient with double vision, when he look straight the left eye is deviated to nose side, Left eye cannot look laterally. which nerve is affected?

A- Right 6th cranial nerve palsy B- Right 3rd cranial nerve palsy C- Left 6th cranial nerve palsy D- Left 3rd cranial nerve palsy

A patient presented with history of hyperthyroidism and exophthalmos. TSH is low with High T4 and T3. On thyroid scan there is increase uptake and suggestive of thyroid nodular goiter (right sides 1/2cm), which of the following is the best management?

A- Right hemithyroidectomy. B- Subtotal thyroidectomy. C- Near-total thyroidectomy. D- Radioactive ablation. Near total thyroidectomy due to the presence of eye symptoms. Can't find near-total in the options? Go with total.

Patient complaining Of 4 months hearing loss, now come with 7th cranial nerve palsy, what is the most likely diagnosis?

A- Rumsy hunt B- Brain tumor C- Bell's palsy

A child with mild respiratory infection increase symptoms & fever, develop respiratory distress. X-ray shows lobar infiltration, CBC shows low HB and high Retic.

A- SCA B- Mycoplasma pneumonia C- pneumococcal pneumonia

Patient known to have rheumatoid arthritis with rheumatoid and arthritis of the hand joint with morning stiffness, he was treated for pneumonia 2 weeks ago. lab result showed high-titer of RF, thrombocytopenia and high WBCs. Bone marrow aspiration showed lymphocytosis, what is the most likely diagnosis?

A- SLE B- Felty syndrome C- Lymphoma D- TTP · Nodules à uncontrolled RA · Thrombocytopenia + leukocytosis + lymphocytes in bone marrow + very severe RA + high RF + pneumonia (indicates low immunity, possible neutropenia) = felty syndrome

Which one of the following improve survival in COPD patient?

A- Salbutamol B- Smoking cessation C- Oxygen therapy for all patient D- Prednisone Three things to improved survival in COPD patient? I - Smoking cessation 2- Vaccination 3- Home oxygen therapy if indicated Indications for home Oxygen therapy:- Pa02 < 55 or sa02 < 88% on RA Pa02 55-59 + (dependent edema, Hct > 56%, pulmonary hypertension) Nocturnal hypoxemia

About Exercise induced asthma, management?

A- Salbutamol pre exercise B- Salbutamol post exercise C- Salbutamol during exercise D- Prednisone pre exercise · Exercise induced asthma: use salbutamol 30 mins before exercise

Patient was diagnosed With pulmonary TB and started 4 drugs for the treatment. He has family history of ureteral stone. Patient presented with red urine. Lab: slightly decreased HB and PLT, What is the possible cause?

A- Side effect of medication B- Ureteral stone C- Effect of TB on blood · Side effect of medication is more likely than stones, since stones will present with severe pain

Which one of the following pneumoconiosis associated with TB or predispose to TB:-

A- Silicosis B- Farmer lung C- Asbestosis

Mechanism of action of DMARDs in rheumatological disease?

A- Slow the progression B- No effect C- Exacerbate course of disease D- Cure the disease

48-year-old female obese patient presented with uncomfortable sleeping, snoring, on examination there is cyanosis and hypertension, what is the best investigation?

A- Spiral CT chest B- Methacholine challenge test C- Spirometry D- Polysomnography · Obstructive sleep apnea: obese + resistant HTN + hypercapnia at night · Polysomnography (aka sleep study) · Treat by CPAP + weight reduction · Obesity hypoventilation syndrome= hypercapnia all day and night

9 months old came with pallor , SOB , massive splenomegaly. His Hb 3 gm/l Your next action

A- Splenectomy B-Blood transfusion C-Antibiotics D-Diruetics E-Salbutamol

Female coming back from east Asia, with hemoptysis, cough and night sweating for 2 months, with chest x-ray showed cavitation, what will you do next?

A- Sputum for acid fast bacilli B- Start anti-TB C- PPD test D- IGRA test · Presentation of TB · Never give empiric anti-TB · Wait for diagnosis: sputum AFB · PPD and IGRA only for screening in asymptomatic patients

Chronic smoker with dry cough and significant weight loss, on examination he has ptosis and Horner syndrome, what is the most likely diagnosis?

A- Squamous cell lung cancer B- Adenocarcinoma of the lung C- Lung metastasis D- Small cell lung cancer · Squamous cell carcinoma o PTH-related peptide o Horner syndrome · Small cell carcinoma syndromes: o Cushing o SVC syndrome o SIADH · Adenocarcinoma o Clubbing · Large cell carcinoma o SVC syndrome

Patient with RA, on methotrexate, was in remission, her Liver function tests previously was normal but upon this follow up, her LFTS were elevated, next Step ?

A- Start glucocorticoids B- Stop methotrexate C- Investigate for Hepatitis infection D- No relation between methotrexate and LFT

Patient K/C of HTN, diagnosed as TB and started on 1st line Anti-TB medications, he is on Lisinopril and Amlodipine for HTN, what is the most appropriate adjustment for his medications?

A- Stop Amlodipine B- Stop Rifampicin C- Decrease Lisinopril dose D- Increase Lisinopril dose

Patient diagnosed as TB and started on 1st line Anti-TB medications, he also has history of thromboembolism on Warfarin 2 mg PO daily, what is the most appropriate adjustment for his medications?

A- Stop Warfarin B- Stop Rifampicin C- Decrease Warfarin dose D- Increase Warfarin dose

A 28-year-Old man had been treated pulmonary tuberculosis With rifampicin, isoniazid. pyrazinamide and ethambutol for four weeks. Pre treatment liver function tests were normal but his most recent investigations revealed: serum total bilirubin 98 (0-18) Serum ALT 620 (5—45) serum AST 450 (5—45) serum alkaline phosphatase 720 (40-110) Which one of the following is the most appropriate next step?

A- Stop all treatment B- Stop ethambutol C- Stop isoniazid D- Pyrazinamide · Stop all treatment then do challenge test · Challenge test: after stopping the medications and LFTs normalizes --> start the medications again one by one to know which is causing the hepatic injury to be stopped completely

Patient presented with fever and SOB for 1 week on Methotrexate and Adalimumab, what is the most appropriate management?

A- Stop methotrexate, continue adalimumab and start Antibiotics B- Stop adalimumab, continue methotrexate and start Antibiotics C- Stop both and start Antibiotics D- Continue both and start Antibiotics

Most common organism causing lobar pneumonia?

A- Streptococcus pneumoniae B- Staphylococcus aureus C- Mycobacterium tuberculosis D- Pseudomonas aeruginosa · Most common cause of CAP is Streptococcus pneumoniae

3-year-old boy presents for TB screening. His father has pulmonary T B. His PPD is 10mm. What does this indicate?

A- Strong positive B- Strong negative C- Weak positive D- Weak negative · 10mm in patient from endemic areas or healthcare workers or comorbid or IV drug abuser or age less than 4 is diagnostic for latent TB · This patient has to risk factors: contact with patient with TB + he is 3 years old · General population: 15 mm is positive only · HIV patient - recent contact with ACTIVE TB <5 weeks - organ transplant à 5mm is positive Treatment for latent TB: - Isoniazid for 6 months (old guidelines 9 months) or - Rifampicin + isoniazid for 3 months or - Rifampicin for 4 months

Long case of a medullary thyroid cancer (diagnosis given) what is the appropriate management?

A- Sub total thyroidectomy B- Total thyroidectomy C- Hemithyroidectomy

Patient developed sudden onset headache when he was bending to take his keys from the ground, described it as worst headache-in-his-life, what is the most likely diagnosis?

A- Subarachnoid Hemorrhage B- Cluster headache C- Cervical spondylosis D- Migraine

25-year-old male patient with history of right knee pain and swelling, left ankle pain and swelling for 6 months, previous history of UTI 2 weeks prior to symptoms, received NSAlDs but no response, what to give?

A- Sulfasalazine B- Cyclosporine C- Paracetamol D- Antibiotics Reactive arthritis First line of treatment is NSAIDs Second line: Steroid - Sulfasalazine > Methotrexate

35-year-old female presented with unilateral peri-orbital headache, associated with lacrimation and rhinorrhea, she claimed that this headache occurs every year at the same time, what is the acute management?

A- Sumatriptan B- 100% oxygen C- NSAIDs D- Beta blocker

35-year-old female presented with unilateral peri—orbital headache, associated with lacrimation and rhinorrhea, she claimed that this headache occurs every year at the same time, what do we use as a prophylactic medication?

A- Sumatriptan B- 100% oxygen C- Verapamil D- Beta blocker

Best treatment of trigeminal neuralgia?

A- Sumatriptan B- Carbamazepine C- Prednisolone D- Naloxone

4 years old boy, developed large neck swelling on the left side. On exam it is large 10cm in size, US FNA showed clear lymphatic fluid What is the appropriate management?

A- Surgery B- Observation C- Chemotherapy D- Radiotherapy

36-year-old female patient with Salmon Rash, fever, arthritis and arthralgia, -ve ANA and high ferritin level and low Lymphocyte count, what is your diagnosis?

A- Systemic lupus erythematosus B- Rheumatoid arthritis C- Infective endocarditis D- Adult Still disease § Adult-onset Still disease: fever + salmon pink rash + polyarthritis + splenomegaly + polyserositis + negative serology + leukocytosis + ferritin high

A female patient underwent left thyroid lobectomy, post surgery she complaining of sever shortness of breath and pointing to her neck, what is the next step?

A- Take her back to OR. B- Bedside tracheostomy. C- Nasal cannula. D- Bedside wound exploration

Headache in child, band like, throbbing pain, with stress at school, what is the diagnosis?

A- Tension headache B- Migraine C- Subarachnoid hemorrhage D- Cluster headache

Patient with unilateral headache on temple area, laboratory results showed ESR: 112, what is the most likely diagnosis?

A- Tension headache B- Temporal arteritis C- Subarachnoid hemorrhage D- Cluster headache

71- 35y.o male brought to ER after road traffic accident , complaining of right side chest pain, he is conscious, alert & oriented. Surgical emphysema in upper chest and neck. Chest X- ray shows Rt sided pneumothorax & pneumomediastinum. What is the diagnosis

A- Tension pneumothorax B- Open pneumothorax C- Tracheobronchial injury D- Hemopneumothorax

Case of snow storm appearance of uterus on ultrasound, counsel the patient on:

A- This condition is highly malignant B- Risk of infertility must be addressed

Patient at 8 weeks gestation, presenting to the ED with vaginal bleeding and abdominal pain, her cervical OS is open and tissue can be see within the cervical os. What is your diagnosis?

A- Threatened abortion B- Incomplete abortion C- Inevitable abortion D- Complete abortion

63-year-old presented to ER with sudden left side weakness 6 hours ago associated with dysarthria, CT brain done showed acute ischemic insult, BP is 160/95, what is the most appropriate management?

A- Thrombolytic B- Aspirin C- Control his blood pressure D- Close observation

Typical presentation of Ml. Managed by Aspirin, Clopidogrel, Nitroglycerin, Oxygen. ( Acute coronary syndrome managment ) ECG shows: Sinus tachycardia and Left Bundle Branch Block ( Written ) Cardiac enzymes are pending. Which of the following is most appropriate next step in managment.

A- Thrombolytic therapy B- Wait for cardiac enzymes C- Lidocaine infusion D- CT Angiography · After initiating initial management for ACS next step is to ask: is this STEMI or N-STEMI to know the urgency of PCI o STEMI --> to PCI now--> if PCI not available in 2 hours give thrombolytics o N-STEMI --> PCI urgent but not now --> not indicated to give thrombolytics · STEMI is diagnosed only by ST elevation · LBBB can indicate STEMI, but recent guidelines do not consider LBB as equal to ST elevation --> so in this case it ECG findings are not specific · Next best step is to wait for cardiac enzymes results to confirm the diagnosis of N-STEMI

50-year-old lady, C/O urinary leakage especially when running. What test to do?

A- Tip test B- Bonne's test C- Cough stress test D- Uroflowmetry E- cystoscopy

The role of antihypertensive in pre-eclampsia?

A- To prevent maternal complication as stroke B- prevent IUGR C- prevent fetus demise

Patient with transient visual loss lasted less than 60 minutes and resolved without any intervention, normal CT brain, what is the most likely diagnosis?

A- Transient ischemic attack B- Acute stroke C- Multiple sclerosis D- Myasthenia gravis

Loss Of sensation in out 2/3 tongue

A- Trigeminal nerve B- Facial nerve C- Oculomotor nerve D- Optic nerve

22-year-old female patient known case of SLE presented today complaining of dysuria and suprapubic pain. urine analysis showed positive nitrite, what is the drug associated with SLE flare and you should avoid using it?

A- Trimethoprim-Sulfamethoxazole B- Ceftriaxone C- Cefepime D- Amoxicillin drug exacerbate lupus flares

A 67 y/o female with Hx of dry cough, Sob, and fatigue, treated with 2 courses of Abx but not improved. Cxr persistent infiltrate. Bronchoalveolar lavage shows Atypical cytology. What is the Dx

A- Typical Pneumonia B- Atypical C- Sarcoidosis D- Bronchogenic cancer

67-year-old female with history Of dry cough, SOB and fatigue, treated with 2 courses of antibiotics but not improved, chest x-ray showed persistent infiltrate, bronchoalveolar lavage shows Atypical cytology, what is the diagnosis?

A- Typical Pneumonia B- Atypical pneumonia C- Sarcoidosis D- Bronchogenic cancer · Nonresponding to antibiotic pneumonia ddx o Lung cancer o TB · Cytology: atypical cells à lung cancer

Which of the following positions of a patient in labor would most likely result in the development of a third or fourth-degree laceration?

A- Unrestrained legs and squatting B- Unrestrained legs and semi setting C- Unrestrained legs and in chair D- Restrained legs and stirrups

Case of with pneumonia admitted to ICU, what is the best empirical antibiotic with Azithromycin?

A- Vancomycin B- Ceftriaxone C- Augmentin Patient in ICU: start big guns (Vancomycin is one of them) · ICU and very sick patient: add vancomycin · Admitted patient: ceftriaxone + azithromycin

279- Diabetic patient walks for 300 meters then feels pain in his legs and must rest, What probably is the causes?

A- Varicose vein B- Arterial causes C- infection D- Diabetic neuropathy

70-year-old male KIC of HTN with progressive decline in cognitive state, MRI showed Periventricular white matter Hyperintensities, what is the diagnosis?

A- Vascular dementia B- Alzheimer disease C- Normal pressure hydrocephalus

45 year-old male diabetic patient presented with dull aching headache increase with straining and coughing, upon examination there is tenderness allover the eyebrows, what is the most likely diagnosis?

A- Viral meningitis B- TB meningitis C- Brain abscess D- Sinusitis

Which vitamin deficiency can mimic dementia symptoms?

A- Vitamin B2 B- Vitamin B9 C- Vitamin B12 D- Vitamin D

41- 4.5cm malignant phyllodes management ?

A- WLE B-mastectomy

Patient develop anaphylaxis to vaccination at 4- month schedule, Best actions •

A- Wait for allergy screening • B-Defer Hib • C-Defer hep B • D-Defer DtAP It would be wise to known which vaccines that patient has allergy or anaphylaxis before giving the vaccine

32-year-old women smoker with polyarthralgia. malar rash. fatigability and has positive ANA. she is on hydroxychloroquine and mycophenolate. 24 hours urine protein is high. which of the following nonpharmacological measure would help?

A- Weight loss O- Smoking cessation C- Low protein diet D- Reduce physical activity

Child with recurrent URTIs , eczema and thrombocytopenia both brother and uncle have the same condition? •

A- Wiskott Aldrich • B-Ataxia telangiectasia • C-Chronic granulomatosis disease • D-Hyper IgE syndrome

34 years female at 28 weeks with cough and difficulty in breathing , she appeared restless and uncomfortable on auscultation of the lung shows bilateral rhonchi, the nail bed and oral mucous membrane appear pale, she is allergic to dust, pollen, mold and animal hair. No hx of smoking. She reports that the symptoms began 2 days prior and started cough with clear color phlegm. All vital normal. What it's the most appropriate initial test?

A- X-ray B- Hgh C- Spirometry D- ABG Abdulrahman: The answer is C. This patient clearly has asthma exacerbation during pregnancy. This includes difficulty in breathing, bilateral rhonchi, normal vitals, cough with clear color phlegm, and hx of allergy (related to asthma in the case of atopy). There is a negative history of fever, unilateral auscultation findings, sore throat, fatigability, or a productive cough that is not clear. Asthma is the most common condition affecting the lungs during pregnancy. Up to 8 percent of pregnant women have asthma.

G31 known PPROM admitted on the 5th day she developed fever.. blah blah GBS 10000 how will you manage?

A- amoxi and genta then deliver B- amoxi and genta and observe

278- Old patient long history of leg claudication *for 2 months* , present with leg pain and ABI <0.3 and , *CTA show artery occlusion more than 3 cm* what to do?

A- amputation B- thrombolysis C- embolectomy

159- 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

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- anti-thyroid drug B- RT thyroidectomy C- Hemithyroidectomy D- radioactive iodine -Achieve euthyroid status first with an anti-thyroid medication -Then go for radioactive iodine -Or near total thyroidectomy if there is presence of eye symptoms or compressive symptoms

case mentioning that a child has "certain amount of" café 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

Women came vaginal itchiness test show flagellated cells what's the Diagnosis?

A- bacterial vaginosis B- candida infection C- trichomanias vaginalis D- E coli infection

Preterm 30 week, 80% effacement, 2 cm dilatation, stable mom and fetus. Admitted to labor. What to do?

A- call NICU and labor B- give dexamethasone, GBS swab, nifedipine and labor C- give dexamethasone and labor D- this is false labor

Which of the following is the indication of cervical cercalge

A- cervical length less than 30 B- Cervical length less than 35 C- cervical length less than 25 D- cervical length less than 20

39- Patient presented with a mass in the breast, which was growing according to her in the past several years, on Examiantion there was a 15x15 mass, upon doing fna It was a "cystosarcoma phyllodes" What is the appropriate management ?

A- chemo B- radio C- mastectomy D- MRM

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 PCOS Obese diabetic irregular menstruation chronic anovulation

200- Old patient came for elective cholecystectomy you find out he was admitted 2 weeks ago in icu for management of MI, what will you do?

A- do it in this admission B- delay it 6 weeks C- delay it 6 months D - no need to do it anymore

247- Patient came to ER after history of building burn, patient confused with burn of facial and nasal hair, what to do:

A- elective intubation B- ICU observation C- advice patient to take analgesia

How to know fetal weight intrapartum in 37w?

A- femur length B- head circumflex C-Biparietal diameter D- abdominal circumference

269- patient 3 days post sleeve gastrectomy, he is presented with mild RUQ pain, upon examination there was mild tenderness with no signs of peritonitis vitals: BP:100/80 HR:133 what is the cause?

A- gastric leakage B- sepsis C- decreased oral hydration D- inadequate analgesia

Ectopic pregnancy gave her methotrexate her Bhcg was 3100 after four days it became 3000 and after seven days it became 2900. What to do?

A- give another dose of methotrexate B- don't give C- observation if in day 7 post methotrexate BHCG didn't drop 15% or more --> give another dose

An infants found to have prolonged QT Syndrome associated and there is positive family history of similar problems • You should do •

A- hearing assessment B-Vision assessment C-Chromosomal test D-Thyroid function One of the causes of congenital prolonged QT interval also causes deafness

Pregnant HBs positive what will u give the baby in first 12 hrs ?!

A- hep b vaccine + immunoglobulins B -hep b vaccine only C-immunoglobulins only

Pediatric patient came to the emergency room with his parent after ingesting of cosmetic agent , he was crying and looked sick, what is the next step:

A- identify the AGENT B- establish the airway C- charcoal D- upper endoscopy ABCDE

Pregnant in first trimester, physiological changes during first trimester?

A- increased 20-25% blood volume B- increased 40-45% blood volume C- increased 60% blood volume

Pregnant in first trimester, what are physiological changes during pregnancy?

A- increased 20-25% blood volume B- increased 40-45% blood volume C- increased 60% blood volume

35 years old pregnant female at 42 weeks gestational age. No contraction, no cervical dilation. Fetal Ultrasound is reassuring, CTG showed acceleration with good variability (reassuring). What's the best management

A- induction of labor B- Reasses after 1 week C- immediate CS D- Labor augmentation

35 years old pregnant female at 41 weeks gestational age. No contraction, no cervical dilation. Fetal Ultrasound is reassuring, CTG showed acceleration with good variability (reassuring). Whats the best management

A- induction of labor B- Reassess after 1 week C- immediate CS D- Labor augmentation

246- 15 years old boy, was in burning house, He has carboneous sputum, hoarseness of the voice, lung crackle or creptation , whatis the most likely cause of his presentation?

A- inhalation injury B- carbon monoxide toxicity

342- 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

155- 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

36- 60 years old female came with bloody nipple discharge Most appropriate steps to her management:

A- mammogram annually B- start ultrasound C- MRI

32 week gestation she has preterm labor and rupture membrane. She was given steriods and abx what to give kman ?

A- mg sulphate B- oxytocin C- nifedipine D- indomethacin

173- 45-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

339- Burn patient, resuscitation done, which of the following reflect a good resuscitation has been achieved?

A- normalization of heart rate B- normalization of blood pressure C- Urine out of 0.6ml/kg/h D- Central venous pressure 12

Pt known case of Diabetes and hypertension she's on medication metformin bid and her symptoms is controlled her labs are normal except hgb is 8 what to add her?

A- nothing to add B- give iron C-Change D- vitamin b12 replacement

Umbilical hernia in a 10 months old baby. Management? •

A- observation and follow up • B- Surgery • C- X ray • D-Wearing belt Rule: umblical hernia in pediatrics is managed conservatively

300- Pt after fell down from height 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

Normal delivery and she did episiotomy the developed retroperitoneal collection 5x3, which was bluish and painful, what is the treatment?

A- packing B-aspiration C-surgical evacuation D-Observe

Woman had C-section. What is the best way to prevent adhesions?

A- perform the C/section before onset of labor B- add adhesion barrier consisting of oxidized regenerated cellulose before closing the wound C- closure of the peritoneum D- Add a layer the incision site

What DEFINES a uterine bleeding:

A- post coital B-scanty bleeding C- perfuse bleeding

- 69 years old female asymptomatic. On examination, there's grade 3 posterior vaginal wall prolapse. she denies any symptoms. Which of the following is the most appropriate managgement?

A- posterior colporrhaphy B- Conservative mx and observation C- surgical repair

most causes of Failure to thrive : •

A- psychosocial • B- cystic fibrosis • C- asthma • D-Celiac disease

Pregnant 10 weeks presented with history of cramps and vaginal bleeding at home with passage of tissue, now on exam the os is closed US empty uterus what's the most appropriate management?

A- reassure B- intravenous fluid C- D&C D- some drug I forgot the name I think it was a prostaglandin

G5P5 came with symptoms of stress in continuance what you suspect to find?

A- rectocele B- enterocele C- hyperactive urethra

Miscarriage in an old lady (~45yrs) she asked if her age had anything to do with her miscarriage:

A- risk of miscarriage is 3% at this age B- from 10 to 50% C- 80% D- no risk

Middle age Pt with papillary thyroid cancer , planned for total thyroidectomy how to follow up ?

A- serial post op US B- calcitonin C- TSH , T3 , T4 D- Thyroglobulin

3 years old boy came with fever and meningeal signs , petechial rash • Which of the following can prevent this condition •

A- series of vaccine started at 2 months • B-Series of vaccine started at age of 9 months • C-Vaccine at birth • D-Nothing will prevent this condition

169- 25 y/o women taking steroid for IBD C/O abd pain + billous vomiting O/E her abdomen is distended and tender in the right iliic fossa she had done colonoscopy 2 week ago which was normal, contrast barium showed : single stricture at terminal ileum, 1 cm from illiocecal valve. Which of the following is most appropriate management ?

A- strictureplasty B- right hemicolectomy C- coservitve management D- segmental resection with ileostomy

36 yo female diabetic on metformin, delivered a baby with congenital anomalies, she wants to conceive?

A- switch to insulin B- Genetic counseling C- Folic acid 400 mcg

318- 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

Pregnant lady, not sure about the gestational age. Presenting with signs and symptoms of hyperthyroidism. Which of the following is most contraindicated?

A- thyroidectomy. B- radioactive iodine. C- propranolol. D- methimazole.

76- Adult post RTA, was brought the ER in a tertiary hospital, patient is alert and conscious. CT done which showed: Injury to the thoracic aorta and splenic laceration with free fluid in the abdomen. (Not perisplenic). BP: 90/67. HR: 45 bpm. What's the next step?

A- urgent laparotomy. B- urgent thoracotomy. C- refer the patient to a hospital with vascular surgeon

70-year-old lady had a hysterectomy15 years ago now she has a very large vaginal vault prolapse which covers something I don't remember and reach the premium what is the appropriate treatment?

A- vaginal pessary B- Colpocleisis C- anterior posterior repair D- vaginal surgery something

Primigravida, during labor, cervix fully dilated, CTG show variable deceleration, patient have strong contraction and head is engaged (station 0), cephalic presenting part, what is the most appropriate management?

A- ventose B- forceps C- c-section D- wait 2 hours Ventose and forceps unless the CERVIX IS FULLY DILATED AND AT STATION +2 and BEYOND! The CORRECT answer is in utero resuscitation measure e.g. lateral positioning of the mother, O2, IV fluid, stop oxytocin, administer toocolytic drugs

292- Case of pulmonary embolism , hypotensive pt, and they mention *saddle emboli in CT*

A- warfarin B- enoxaprin C- thrombolectomy

A baby delivered and after cutting the umbilical cord he bled profuse Which factor affected

A-1 B-10 C- 12 D-13 Usually presented as heavy bleeding from umbilical cord

A baby delivered at home and presented to ER with heaving hematemesis Whcik of following factor might be dificieny

A-11 B-8 C-12 D- 10

5 years old child and unvaccinated. He came with fever , skin rash started from face and spread to the chest and trunk. He has conjunctivitis • This disease can be prevented by series of vaccines given at •

A-2, 4 , 6 months • B-9 , 12 , 18 months • C-, 9 , 12 , 18 months and 4 years • D-This disease is not preventable Measles: 4 Cs Cough, Coryza, and Conjunctivitis Coplik spots Measles vaccines: - 9ms - 12ms - 18ms - preschool

5 years old child and unvaccinated. He came with fever , skin rash started from face and sprat to the chest and trunk. He has enlarged occipital , post auricular and posterior cervical lymph node • This disease can be prevented by series of vaccines given at •

A-2, 4 , 6 months • B-9 , 12 , 18 months • C-12 , 18 months and 4 years • D-This disease is not preventable

3 years old with uncomplicated cystitis • How long ou should give antibiotic •

A-3 -5 days • B-5-7 days • C-7-10 days • D-10-14 days

Preterm child when should the screening for anemia to be done ?

A-3 months B-6 months C-12 months D-18 months

What age the child started to know few words •

A-3 months • B- 6 months • C-12 months • D-15 months 12 months: few words

6 years child came with fever , splenomegaly and there is is a history of eating unpasteurized milk His CNS , heart examination were normal Duration of treatment

A-3 weeks B-6 weeks C-12 weeks D-24 weeks . Brucellosis: gram negative coccobacilli - from milk · Brucellosis + arthritis (sacroiliitis) --> 12 weeks tx . Brucellosis + CNS/ Cardiac --> 6 months Tx . First-line therapy: doxycycline PLUS rifampin . Second-line therapy: doxycycline PLUS streptomycin

176- 43male have family history of colon cancer underwent sigmoidoscopy for polyp removal Histopathology showed tubular adenoma completely removed ..how to follow?

A-3-6 month B-3years C-5 years D-no need

Placenta previa when to do C/S?

A-36-37 wks B-38 c-39 D-40 Placenta previa o Painless bleeding - post coital bleeding o Management § Ideal: CS at 36-37 week § GA < 37w: No active bleeding - fatal good à expectant management · Admission and observation for 48 hours · GA< 34w: steroid · GA< 32w: mg sulphate § GA <37w: severe bleeding - fetal distress · Stabilization · Emergency CS

A other cane her with her child because he has nocturnal enuresis • When nocturnal enuresis should be alarming •

A-5 years • B-6 years • C-7 years • D-8 years

A mother came with her child for vaccines including DtAp vaccines. The durability of DtAP vaccine •

A-5 years • B-7 years • C-10 years • D-15 years

110- Infant crawel ,transfer object from hand to hand,had palmer grasp no • pincer lgrisp,age by month •

A-5 • B-7 • C-9 • D-12 Safader said 7 i think because no pincer grasp Pincer grasp at age 9 months Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Pregnant women previous 1 spontaneous abortion asking about the precentage of abortion happening in next pregnancy?

A-5% B-10% C-25% D-50%

A child with vesicoureteral reflux and decide to start antibiotic prophylaxis • How ling you should continue the prophylaxis •

A-6 months • B-12 months • C-18 months • D-24 months

When the colic should disappear •

A-6 weeks • B-12 weeks • C-24 weeks • D-36 weeks

42- 53y did mammogram now and was normal, when she should do again?

A-6m B-1y C-2y D-3y

4 years old voy and has history of recurrent bleeding Both PT and PTT are prolonged Which of following factors might be deficient

A-7 B-9 C-5 D-8 Common pathway: 10 5 2 1

Definition of fever of unknown origins

A-8 days B-14 days C-21 days D-28 days

A child known with hypertrophic cardiomyopathy • Which of the followings is the best option •

A-ACE inhibitors • B-Digoxin • C-Bea blockers • D-Hydralazine

In Down sydnrome which of the following is the most common tumor •

A-ALL • B-AML • C-CML • D-CLL

In Down sydnrome which of the following is the most common tumor •

A-ALL • B-AML • C-CML • D-CLL

25 years old woman and she received rubella vaccine • You asked her not to get pregnant for 2 months a but she got pregnant after 1 month from vaccine • Most likely outcome

A-Abortion • B-Congenital malformation • C- Not affected • The risk of damage to fetus is a hypothetical

41-year-old P5 +3 presented to the clinic complaining of abnormal uterine bleeding her Menstrual period is regular every 30-day associated with blood clots and pain that is not relieved by simple analgesic she had previous myomectomy, she is a known case of PCOS And her BMI is 40?

A-Adenomyosis B-Endometriosis C-Uterine fibroid D-Endometrial hyperplasia

A 2 years child came with cough with deep inspiration between cough , conjunctivitis , unvaccinated Most likely cause

A-Adenovirus B-Pertussis C-Chlamydia D-RSV

33 years old pregnant women presented with lower abdominal pain and moderate vaginal bleeding K/C of BA + epilepsy + smoker What is the highest risk factor for her condition?

A-Age B- Smocking C- Bronchial Asthma D-Epilepsy

Patient known with complement deficiency • Which vaccine he can receive •

A-All types of vaccines • B-Only killed vaccine • C-Only live vaccines • D-No vaccine

Normal vaginal delivery, Baby weight 4.2kg, Laceration reaching rectal mucosa, which degree:

A-First B-Second C-Third D-Forth

Pregnant who has a child with down syndrome. She's concerned about having another child with down syndrome. What is the best test to rule out down syndrome in the second trimester?

A-Amniotic fluid sample B- Chorionic villous sample C- Triple test - Chorionic Villi Sampling (CVS): is the procedure of choice for first trimester testing (between 10-13 weeks.) - Amniocentesis: is the procedure of choice for second trimester testing optimally performed (ACOG: between 15-20 weeks.), (Uptodate: between 15-17+6)

5 yeas old boy and known SCA and found came with respiratory distress ,fever and low oxygen saturation Which of following can prevent this condition

A-Antibiotic B-Folic acid C-Vaccination D-Hydroxyurea

329- 6 years old child and came becuae shie found accidently to have RBC in urine during routine urine analysis Mother said she was having exercise yesterday She looks healthy otherwise Best action

A-Ask for serum creatinine B- Do Serum albumin C-repeat urine analysis in few days D-Send her for biopsy

Which of the following drugs should be avoided in G6PD patients

A-Aspirin B-paracetamol C_Allopurniol D-Ibuprofen

A mother known HIV and delivered a baby • Which vaccine you will give at birth •

A-BCG and hepatitis B • B-Hepatitis B • C-BCG • D-None

An infant known with history of intussusception• Which vaccine is contraindicated •

A-BCG • B-Rota • C-MMR • D-Varicella

Patient with chronic abdominal pain • Which of following indicate organic cause •

A-Before sleeping time • B-Pain before awakening • C-Pain during daytime • D-Pian after exercise

8 years olg boy with nocturnal enuresis Urine analysis is normal • Your best initial action •

A-Behavior and modification thepay • B-Desmopressin • C-Alarm • D-renal US

Pregnant pt at 18 wks, she has a hx of recurrent fetal loss, Now came to ER due to sudden fetal parts expulsion What is the dx?

A-Bicornuate Uterus B-Cervical incompetence

• 6 years old boy with pubic hair , bone age 6 years , testicular size 2 cm , Serum DEAS slightly high • Most likely cause •

A-Brain tumor • B-Premature benign pubarche • C-Congenital adrenal hyperplasia • D-Testicular tumor

5 months old came with respiratory distress , cough , sneezing , frothy sputum and cyanosis. On examination: diffuse wheezing and basal lungs crepitation. Chest x ray: bilateral infiltrates • Most likely causes •

A-Broncholitis • B-Pulmonary edema • C-TB • D-Pneumonia

42 weeks in labor 7 cm dilated, meconium staining, regular and strong contractions CTG 100 fetal hearts?

A-C/S B- Augmented labor

Which of the following is the best test to assess coronary artery in patients with Kawasaki disease

A-CT B-Catheter C-Echo D-Cardiac enzymes Catheter is not recommended

- Pt comes with asthma exacerbation, personal PFR was 300 and now 200. HR 100, what is indication of his asthma severity?

A-Cant complete a sentence in one breath · Life threating asthma characters

-Septic shock case indicates adequate systemic perfusion?

A-Cardiac index B- Mixed venous oxygen saturation (SMV02) C-Central venous oxygen saturation (SCV02)

Patient known case of COPD complaining of SOB, palpitation, on examination there is irregular pulse, what is the treatment?

A-Cardioversion B- Adenosine C-Amiodarone · Amiodarone for MAT, and treat underlying disease

2-The most common eye manifestation in sturge weber syndrome •

A-Cataract • B-Glaucoma • C-Optic glioma • D-Squint • E-Retinoblastoma

A child diagnosed with meningitis and treated Which of the following is the likely most long term complication

A-Cerebral palsy B-Vision loss C-Hearing loss D-Mental retardation

Patient delivered without episiotomy, placenta was check and all parts were delivered, then pt had gush of blood coming, what is your next step?

A-Check uterine contraction B-Get blood for CBC C-Get blood for coagulation profile D-Evacuate the uterine

Pedia pt have tachypnea, runny nose, cough, slightly elevated fever, audible wheezing sound what is the definitive diagnosis:

A-Chest X ray B-Nasopharyngeal swab C-Sputum culture D-CBC

Pregnant in 8 weak gestation had miscarriages' in previous pregnancy's in 20 weak what should you do at this pregnancy

A-Close antenatal follow up B-Cerclage at 16 18 weak

3 years old girl and known Turner syndrome • Which of the following is the most common congenial heart anomaly •

A-Coarctation of aorta • B-Bicuspid aortic valve • C-TOF • D-Mitral valve prolapse

Female after SVD and after delivery of placenta she bleeds heavy amounts what you will do:

A-Collect sample and send for investigation B-Send to OR to open and see C-Blood transfusion with O - D-Send for blood cross-match

24 female did pap have abnormal results "exactly written like this they didn't no mention what is the result" What you will do?

A-Colposcopy B- Repeat pap after 3 months C- Reassurance

In 5 months, old child which of the following is most risk facto for recurrent UTI •

A-Constipation • B-Vesiocureteral relfux • C-Obstruction • D-Voidn dysfunction

A baby born recently. His brother died because of immunodeficiency • Best action •

A-Consult an immunologist • B-Defer live attenuated vaccines • C-Defer killed vaccine • D-Defer all vaccines

A child came with fever , sore throat. On examination there is hyperaemia. You start him on antibiotic but after 2 days rapid test came and was negative. You should

A-Continue antibiotic for total 10 days B-Stop antibiotic C-Ask for throat culture D-Test household contact

A child came with fever , sore throat. On examination there is hyperemia. You start him on antibiotic but after 2 days rapid test came and was negative. You should

A-Continue antibiotic for total 10 days B-Stop antibiotic C-Ask for throat culture D-Test household contact

6 years and did not receive any vaccine before • She should receive the following vaccines except •

A-DTaP • B-Rota • C-Varicella • D-MMR Catch up vaccines • For all children below 7 years • Need catch up all vaccine except rota vaccine if he is above 6 months • Need to catch up for all bacterial vaccine

A child has splenic rupture and will go for splenectomy • Which vaccines is the most important •

A-DTaP • B-Varicella • C-Pneumococcal vaccines • D-Meningococcus Both pneumococcal and meningococcal vaccine are important in patients with splenectomy • I choose pneumococcal because it is more common

4 years old child and has URTI and started on antibiotic for 4 days. He came today and found to have enlarged lymph nodes and congested throat. He is scheduled for vaccine today You should

A-Delay the vaccine for 1 month B-Let him finish the antibiotic and then give the vaccine C-Give the vaccine D-Ask another opinion Antibiotic does not interfere with efficacy of vaccine and children can take the vaccine while on antibiotic if clinically stable

12-month-old and supposed to have a scheduled vaccine. He mild diarrhea . What will you do? •

A-Delay the vaccine • B-Obtain a bacterial culture • C-Give the vaccine • D-Start antibiotic

Post menepause presenting with abdominal pain and dyschezia last menstrual period was 15 months ago what to give?

A-Depo Provera injection (Progestogen only) B- Conjugated estrogen pill C- OCP

5 years old with meningitis • Labs hyponatremia , and low serum osmolality • High urine Na and high urine osmolality • Diagnosis •

A-Diabetes insipidus • B-SIADH • C-Hypoaldestronism • D-renal failure

3 years child came with fever and tachypnea 20 per minutes , O2 saturation is 94 % • , not known to have any medical condition • You should •

A-Discharge e him on amoxicillin • V-Discharge him on augementin • C-Admit him for IV Cefitraxone • D-Admit him for IV fluid

• 3 years child came with fever and tachypnea 20 per minutes , O2 saturation is 94 % • , not known to have any medical condition • You should •

A-Discharge e him on amoxicillin • V-Discharge him on augementin • C-Admit him for IV Cefitraxone • D-Admit him for IV fluid

A child had a history of high fever and rash from previous DTAP vaccines. Now he is coming to receive 2nd dose of DTAP • You should

A-Don't give the vaccine • B-Do skin test • C-Give prophylactic paracetamol and give antihistamine if develop rash • D-Switch to DTP vaccine Local reactions and fever are common side effect from vaccines a nd are not reasons to delay or not to give vaccines

3 years old child and found to have abdominal mass and absent iris and undescending testicle •

A-Down syndrome • B-CHARGE • C-WAGR • D-Neurobalstoma

A 7 years old child with foul smell urine and fever • Most likey cause •

A-E coli B-Protius C-Enterobacter D-Staph

A child came with fever and pharyngitis , lymphadenopathy and developed a rash after amoxicin

A-EBV B-Diphtheria C-Scarlet fever D-Adenovirus

Which of the following allergy is contraindications for varicella vaccines •

A-Egg allergy • B- penicillin allergy • C-Gentamycin allergy • D-gelatin allergy

38years old female with non invasive carcinoma in cervix of young woman wishing to preserve fertility Best treatment:

A-Endometrial ablation B-Hysterectomy C- Cold knife conization D- Electrosurgical loop (LEEP)

147- 35 years old Adult male medically free presented to ER C/O several episodes of hematemesis for the first time, takes no medication, no family history of similar attacks, normal abdominal examination no guarding no tenderness , endoscopy done and showed dilated esophageal bleeding vessels with some adherent clots , Hgb : 9 Plt: 250 Alk: slightly decrease All other test were normal What is the Diagnosis:

A-Erosive gastritis B-PUD C-Mallory Weiss syndrome D-Esophageal varices

A child came with failure to thrive , microcephaly , sabre chin and Hutchinson teeth Best treatment

A-Erythromycin B-Cefuroxime C-Penicillin D- Doxycycline penicillin is the main treatment for syphilis

4 years old with oligoartuclar JIA and positive ANA • You should screen for anterior uveitis •

A-Every 3 months • B-Every 6 months • C-Every year • D-Every 2 years

4 years old with oligoartuclar JIA and positive ANA • You should screen for anterior uvetitis •

A-Every 3 months • B-Every 6 months • C-Every year • D-Every 2 years

A hild came with bone pain and bone X ray showed sun burst lesion in the distal femur at near epiphysis • Most likely diagnosis •

A-Ewing sarcoma • B-Osteosarcoma • C-Osteoid osteoma • D-Lymphoma Osteosarcoma: sunburst Ewing sarcoma: onion skin

Patient presenting with severe bleeding in 9th week of pregnancy, Os is open, doctor saw some tissue on the cervix. What is your management?

A-Expectant management B-D&C C-Oxytocin D-For Surgery Management of abortion - Expectant management (if ≤13 weeks GA): - Medical (up to 20 weeks GA) By two different medications mifepristone followed by misoprostol - D&C: if severe bleeding - infection - hemodynamic instability regardless of the gestational age

90- Patient underwent surgery after abdominal gunshot splenectomy pancreactomy removal of parts of intestine and did Hartman procedure. Second day he deteriorate what the most appropriate next step?

A-Exploration B-US C-X-RAY D-CT

158- Case of diverticulosis pt came with severe left iliac fossa pain and constipation, tenderness upon palpation Bp was normal temp was 37.6 Radiology image Collection of fluid 9x10 cm with inflammation of the sigmoid How would you manage

A-Exploratory laparotomy B-Sigmoidectomy and anastomosis C-Percutanous drainage

Which of the following organs most commonly affected in chicken pox

A-Eye B-Ear C-Lungs D-Liver

5 years old boy and found to have high creatinine , low platetls , low Hb and blood film showed fragmented RBC. History of diarrhea 1 week ago Best treatment

A-FFP B-Plasma exchange C-Supportive treatment D-Antibiotic HUS: renal - bleeding - MAHA

37- 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 nanage this patien?

A-Follow up after 6 months B-Core biopsy C-MRI breast

A mother delivered a baby who died shortly after birth and baby died because of hydrops fetalis Which of the following is the likely cause

A-G6PD B-Alpha thalassemia C-Beta Thalassemia D-Spherocytosis

6 months old with history of apnea , cyanosis , recurrent chest infections , vomiting and dyskentic neck while crying •

A-GERD • B-Pyloric stenosis • C-Whooping cough • D-Cow milk allergy

9 y/o child brought by his mom who's concerned about his short stature. His friends make fun of Him, Investigations show bone age of 7 years and low insulin like growth factor (IGF-1 Normal serum GH . How would you treat him? •

A-GH deficiency • B-Familial • C-Constitutional • D-Hypothyroidism

A child known to have cerebral palsy and has uncontrolled seizures and severe spasticity and now came for 6 months vaccines • Best action •

A-Give DtAP (acellular) instead of DTP • B-Defer both DtAP and DTP • C-Shift OPV to IPV • D-Give all vaccines Absolute contraindications to DTAP • Encephalopathy within 7 days • Progressive or unstable neurological disorders • Anaphylactic reaction to a previous dose

Mother is hepatitis B positive • Baby weight is 1.6 kg •

A-Give Hep B vaccine • B-Wait till weight reached 2 kg and then give vaccine • c-Check the hepatitis B status for the baby • D-Give both Hep vaccine and hepatitis B immunoglobulin

• SLE mother and she took rituximab during pregnancy she delivered a baby girl • For her baby you should •

A-Give Hepatitis B • B-Give BCG • C-Give both • D-Don't give anything Hepatitis is not live

Patient presented to ER after dog bite and was deep • He was vaccinated against rabies 1 month ago • What should you do •

A-Give Vaccine only • B-give immunoglobulin only • C-Give both vaccine and immunoglobulin • D-Clean the wound and discharge Rabies prophylaxes

30 years old pregnant and known inflammatory bowel disease and taking anti TNF and azathioprine • Regarding the vaccination for her bay •

A-Give both killed and live vaccines now • B-Give both killed and live vaccines at 6 months • C-Give live vaccines at 6 months • D-Give killed vaccine at 6 months If a pregnant taking biological agents like ant TNF in during pregnancy, then this is can affect the response of her baby to live vaccines and live vaccines should be given at 12 months (ideally ) but can be given at 6 months

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

A mother is unvaccinated, and she is concerned about tetanus neonatorum •

A-Give vaccine to mother after 72 hours of delivery • B-Give baby tetanus toxoid • C-Give infant DTaP • D-Give mother DTaP at 28 weeks of gestation

Preterm babies with birth weight 1.2 kg and nurse ask you regarding hepatitis B vaccines. Mother is hepatitis B negative • Best action •

A-Give when the birth weight 1.8 kg • B-At time of discharge • C-At 2 months of age • D-Give now with half doses

5 years old child and came with bleeding from mouth and seizures The medical stuents ask how to differntiate between DIC and TTP You will tell him

A-Go and read B-Fibrinogen degradation product and d dimers will be increase in DIC C-TTP tens to affect the kidney D-Fibrinogen will be low in TTP

23- Patient admitted to the ICU due to pneumonia then developed thyroid symptoms (hypo or hyperthyroid symptoms I don't remember, but no symptoms suggesting graves or subacute thyroiditis) Labs: TSH low T3 low T4 low What's the diagnosis?

A-Graves disease B-Sick euthyroid sickness C-Hashimoto thyroiditis D-Subacute thyroiditis

Which of following can happen years ago after measles vaccine •

A-Gullian barre syndrome • B-Spastic paraplegia • C-Brain tumor • D-Subacute sclerosing pan-encephalitis

6 years old cmae with brusies He looks healthy He has URTI 2 weeks ago Platelets 12 (low) , WBC and Hb normal The most likely diagnosis

A-HIV B-Leukemia C-SLE D-ITP

A child came with pallor and jaundice. His father and grand father are both known to have chronic hemolysis and underwent gall bladder removal What is the best test for diagnosis

A-Hb electrophoresis B-Sickle cell test C-Coombs test D-Osmotic fragility test Hereditary spherocytosis Autosomal dominant Osmotic fragility rest is helpful and diagnostic EMA test is the gold standard

A mother had ca child with SCA , she remarried again Which is the best to know the recurrence in baby

A-Hb electrophoresis for the husband B-Hb electrophoresis for the mother C-Chromosomal analysis D-G6PD

The new vision for Saudi Arabia 2030 aiming to prolong children life • Best way •

A-Health education • B-Clinic in every school • C-Antibiotic • D- Vaccination

Chime with meningitis came with his parents and has papilledema , parents are afraid of

A-Hearing loss B-Vision loss C-Cerebral palsy D-Heart failure I go with A too

5 years old came with high fever and low blood pressure and now on mechanical venitlator. He has bleeding from trachestomy Most likey cause

A-Hemophilia B-DIC C-TTP D-Liver disease

5-years old boy presents with recurrent epistaxis PTT 80 (30-40 seconds), PT 10 seconds (10-14 s) Bleeding time is prolonged The Dx:

A-Hemophilia A B-Hemophilia B C-Glanzmann syndrome D-Von-will brand disease In VWB disease: both PTT and bleeding time will be prolonged PTT: intrinsic pathway Bleeding time: platelet function Both effected due to deficiency in VWB factor (VWBF effect platelets function and factor 8 function)

a child came with fever and jaundice, History of travelling 1 month ago Best test

A-Hepatitis A IgG B-Hepatitis A IgM C-hepatitis B Ab D-Hepatitis C Ab Anti-HAV IgM antibodies: present in patients with active infection

Patient recently diagnosed with asemia major and • planning for regular blood transfusion Which of the following vaccine is mot important •

A-Hepatitis A • B- Hepatitis B • C-MMR • D- Varicella •

215- 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

4 years old came with URTI , high fever , droolling of saliva and multiple enlarged lymph node. He did not receive any vaccine • Which of following vaccine might prevent this condition •

A-Herophilus • B-Streptococcus • C-Diphtheria • D-Polio

Child is treated for eczema with topical steroid, comes to clinic with itching and pustular lesions on top of his eczema, arranged in grape like pattern. What is the most liklely organism that causes his superimposed infection?

A-Herpes simplex B-Staphylococcus aureus C-Group A streptococcus D-Neisseria Impetigo can be bullous or non-bullous. S. aureus cause bullous impetigo. S. aureus, S. pyogenes, or both cause non-bullous impetigo Source CDC

Which of the followings is an absolute contraindication to DTP vaccine •

A-History of allergic reaction to previous DTP vaccine • B-Crying for 3 hours • C- Controlled convulsion • D-Progressive encephalopathy within 7 days from previous DTP vaccines Absolute contraindications to DTAP • Encephalopathy within 7 days • Progressive or unstable neurological disorders • Anaphylactic reaction to a previous dose

17year old female, medically free, (athlete) gymnast in her class, breasts later and never menstruated, on developed examination she is tanner stage 5, but no menstruation, diagnosis?

A-Hypothalamic hypogonadism B-Transverse vaginal septum C-Gonadal agenesis D-Testicular feminization

6 years old girl came with breast enlargement and pubic hair • Most common cause •

A-Hypothyroidism • B-Central • C-Ovarian • D-Adrenal

Neonate came with lethargy , decrease capillary refill • Most common cause for this •

A-Hypovlumia • B-Septic • C-Cardiogenic • D-Obsructive

2 days old with seizures and hypertonia, reluctant to feed . CSF normal •

A-Hypoxic ischemic encephalopathy • B-Tetanus • C-Brain tumor • D-Meningitis HIE usually begins as hypotonia and progress to hypertonia in few months • Tetanus neonatorum: spasticity , lock jaw

Child with cerebral plasy and develp respiatory distress • What type of respiratory failure usually develop •

A-Hypoxic • B-Hypercapnic • C-Hypocapnic • D-Alkalosis

• Child with cerebral plasy and develp respiatory distress • What type of respiratory failure usually develop •

A-Hypoxic • B-Hypercapnic • C-Hypocapnic • D-Alkalosis

Female patient complaining of pain before menses and resolved in the third day of menses, how do you diagnose it?

A-Hysteroscopy B-Abdominal US C-Clinical symptoms

9 years old girl with Hb 7 , low MCV , and with loss of concentration You should give

A-IM iron B-IV iron C-Oral iron D-SC iron

12 months old Saudi boy and came for vaccination. • Which vaccines should be given •

A-IPV , MCV , PCV , MMR • B-MMR , OPV , MCV ,PCV • C-Varicella , OPV , MCV , PCV • D-Hib , MCV , OPV , MMR

• A child came for vaccinations , his brother known for immunodeficiency , which of the following vaccines should be delayed till to complete immunology assessment

A-IPV • B-Hib • C-DTaP • D-Varicella Live attenuated vaccines are generally contraindicated in immunocompromised patients All viral vaccines ate live attenuated except (HI HI): Hepatitis B and inactive polio Hepatitis A and inactive influenza • All bacterial vaccine are killed vaccines except TB ( BCG and typhoid )

• Which of the following vaccine should not be given to HIV patient •

A-IPV • B-Varicella • C-DTAP • D-Hepatitis B Although HIV stable patients can receive all vaccine with the except of OPV and BCG. Closest answer here is varicella because other choices are killed

A child with septic shock • Which of the following is the least likely important in management •

A-IV hydration • B-Steroid • C-Anibiotics • D-Vascoative drugs

6 yeas old boy and found to have pLT 15 , has URTI 2 weeks ago, he is otherwise looks well

A-IVIG B-Steroid C- Observation D-Anti D Need treatment with Intravenous immunoglobulin or steroid or Anti D History of trauma or severe headache Need or planned for major surgery Moderate Heavy Mucosal bleeding Life threatening bleeding (CNS or heavy GIT bleeding) If PLT below 30 and any of the following Active lifestyle No good follow up On anticoagulant drugs Known bleeding disorder

Patient with history of fever and eating uncooked meat . There is hepatosplenomegaly Best test

A-IgM B-Agglutination test C-X ray D- Stool analysis

A child diagnosed with impetigo. When he should be retuned to school

A-Immediately B-After 3 days of antibiotic C-After 1 week of antibiotic D-After 2 weeks of antibiotic

A child came unvaccinated because his parents don't believe in vaccination •

A-Inform health committee • B-Talk to parents • C-Inform child protection service • D-Ignore

6 years old girl and she received intravenous immunoglobulin because of Kawaski disease last week • Which of the following vaccine should be delayed •

A-Injectable flue • B-DTaP • C-MMR • D-Pneumococcal vaccines 3-11 month after IVIG • 6 months after PRBC • 7 months after FFP or platelets • Immediately after packer RBC blood products

6 years old girl and she received intravenous immunoglobulin because of Kawasaki disease last week • Which of the following vaccine should be delayed •

A-Injectable flue • B-DTaP • C-MMR • D-Pneumococcal vaccines • Live Vaccine show be delayed (especially MMR or varicella) • 3-11 month after IVIG • 6 months after PRBC • 7 months after FFP or platelets • 1 Immediately after packer RBC blood products

How to give hepatitis B vaccine •

A-Intradermal • B-Subcutaneous • C-Intramuscular • D-Nasal • As general rules • Live vaccines: subcutaneous • Killed vaccines: intramuscular • BCG: intradermal • Oral: polio , rota

How to give hepatitis B vaccine •

A-Intradermal • B-Subcutanous • C-Intramuscular • D-Nasal

9 month old came with pallor. He is exclusively breast feeding Hb 8 g/l , MCV 60 (N 80-95) , MCH 20 (27-33) , retics 1 % (2-3 %) Most likely cause

A-Iron deficiency anemia B-Thalassemia C-Vitamin B 12 deficiency D-SCA

3 months old baby and found to have pallor CBC : microcystic anemia , low MCV , low MCH and he is on breast feeding. Parents came recently from India

A-Iron deficiency anemia B-Thalassemia trait C-Sickle cell anemia D-G6PD Microcytic anemia + MCV low = thalassemia Its not IDA = age too young to develop IDA

A child from low socioeconomic status , poor weight gain , poor concentration ,CBC : microcytic hypochromic anemia normal PT , Normal PTT, Lead 2.5 mmol/l . X ray of the bones showed abnormal lines Best

A-Iron supplement B-Penicillamine C-Folic acid D- Vitamin K Lead poisoning

Pregnant in antenatal visit has hx of 4 first trimester abortions what is the highest diagnostic value?

A-Karyotyping B-hysteroscopy C-hysterosalpingography D-Pelvic us

238- A 36 y.o male known case of crohns for 10 years, presented to ER C/O abdominal pain, fever, vomiting and diarrhea, O/E there is abdominal tenderness. CT showed: 12×15 collection and ileo-jejunal fistula. How to manage?

A-Laproscopic drainage B-Percutaneous drainage C-Open drainage D-Open drainage with fistula resection.

A child with history suggestive croup and treated with steroid and epinephrine but not improved • Which is the next •

A-Lateral neck X ray • B-CT chest • C-Visulaized by laryngoscope • D-Chest xray

1 months old came with jaundice on exmiantion you found hepatomegaly and cataract • Best for diagnosis •

A-Liver biopsy • B-CT abdomen • C-Ultrasound • D-X ray

3 years old boy and found to have low Hb What is the first thing you want to loo for

A-MCV B-MCH C-Reticulocyte D-MCHC

Which of the following vaccine is a contraindicated in patients with egg allergy •

A-MMR • B-Flue vaccines • C-Varicella • D-Yellow fever vaccine Yellow = egg

A child received a blood transfusion recently • Which of the following vaccine should be delayed •

A-MMR • B-Measles • C-Varicella • D-DtAP • MMR can be given earlier after recent blood transfusion in case of measles epidemic

Which vaccine related to gullian barre sybdrome •

A-MMR • B-Neisseria • C-Flu vaccine • D-Hepatitis B

Pregnant came and asked about what vaccine to take in first trimester • Best answer •

A-MMR • B-Varicella • C-DTAP • D- Influenza

4 years old girl with breast enlargement and bone age 6 years • You should do •

A-MRI brain • B-Pelvis ultrasound • C-Abdominal X ray • D-CT brain

5 years old with testicular enlargement and pubic hair, bone age 7 years • What should you do first •

A-MRI brain • B-Ultrasound ovary • C-GnRH stimulation test • D-DHEAS

Neonate came with fever and poor feeding full septic screen done including lumbar puncture lumbar puncture + diplococci Management

A-Macrolide B-Ampicillin + gentamicin C-ceftriaxone D-Ciprofloxacin

Which of the following medication should ne avoided in patients with familial Mediterranean fever

A-Macrolides B-Amoxicillin C-Aspirin D-Cefuroxime

P regency woman with history of recurrent still birth and mother is concerned. Which of the following vaccines is advisable before planning to next pregnancy •

A-Measles • B-Rubella • C-DtAP • D-Varicella

Which of following is more suggestive of thalassemia rather than iron deficiency anemia:

A-Microcytic anemia B- high RDW C-Low serum iron D-Low TIBC E-Increase HbA2

Patient with severe abdominal pain with menstrual cycle (dysmenorrhea), affecting her work, what can you give?

A-Misoprostol B-NSAID C-Progesterone D-OCP

Patient with severe abdominal pain with menstrual cycle (dysmenorrhea), affecting her work, what can you give?

A-Misoprostol B-Paracetamol C-Progesterone D-OCP

Hypertension in children defined as •

A-More than 50th percentile for age and gender • B-More than 90th percentile for age and gender • C-More than 95th Percentile for age and gender • D-More than 99th Percentile for age age and gender • Most common cause for hypertension in children: renal diseases

Child came with maculopapular rash and rash disappeared after 3 days , large occipital lymph node

A-Mumps B-Measles C-Kawaki D-Rubella

Child came with maculpapular rash and rash disappeared after 3 days , large occipital lymph node

A-Mumps B-Measles C-Kawasaki D-Rubella

What is the antidote for aspirin: •

A-N-acetycystine • B-Sodium bicarbonate • C-Naloxone • D-Flumazeni

6 years old girl and never vaccinated. She wants to take varicella vaccine • Best action •

A-No need for varicella vaccine • B-Only one dose • C-2 doses with 12 weeks a part • D-2 doses with 4 weeks apart Catch up schedule for chicken pox vaccine • In children less that 7 years: 2 doses with 3 months apart • In children above 7 years: 2 doses with 4 weeks apart Varicella vaccine normal schedule: - First dose at 18 months - Second dose preschool

• 5 years old male and cmae with picture of nephrotic syndrome When to say he is steroid resistant •

A-No response after 2 weeks • B-No response after 4 weeks • C-No response after 8 weeks • D-No response after 12 weeks

• 5 years old male and cmae with picture of nephrotic syndrome When to say he is steroid resistant •

A-No response after 2 weeks • B-No response after 4 weeks • C-No response after 8 weeks • D-No response after 12 weeks

Patient is known nephrotic, and he finished steroid just now and wants MMR vaccine • What you will do •

A-No vaccines • B-Give the vaccine • C-Ask her to come back after 4 weeks • D-Ask her to come back after 7 weeks 4 weeks after stopping steroid • 12 weeks after stopping other types of chemotharpy • No live or killed vaccines after rituximab treatment for 6 months

Patient is known nephrotic, and he just finished steroid course and want MMR vaccine • What you will do •

A-No vaccines • B-Give the vaccine • C-Ask her to come back after 4 weeks • D-Ask her to come back after 7 weeks 4 weeks after stopping steroid • 12 weeks after stopping other types of chemotharpy • No live or killed vaccines after rituximab treatment for 6 months

6-year-old with post infectious GN • Most likely lab results will show •

A-Normal C3 and anormal C4 • B-Low C3 and low C4 • C-Low C3 and normal C4 • D-Normal C3 and low C4

A child came with ambiguous genitalia , low Na , hyperkalemia and hypoglycemia • 1st step •

A-Normal saline and glucose • B-Saline and hydrocortisone • C-Antibiotic • D-Saline

5 years old and known leukemia and chemotherapy syndrome on steroid for 6 weeks and came to you. He had a contact with a patient with chicken pox • What you do for him? •

A-Nothing • B-Varicella zoster immunoglobulin • C-Admit him to the hospital • D-Give him varicella vaccine In any immunosuppressed patients with a contact with chicken pox should receive varicella zoster immunoglobulin

20 y/o girl divorce came to clinic first visit, When to do pap smear;

A-Now B-1 year after at 21 years C-5 year D-No need

Patient known cancer and just finished his chemotherapy • Mother asked when to give MMR vaccine •

A-Now • B-After 3 months • C-After 6 months • D-After 12 months

8 years known leukemia and just finished his chemotherapy • Mother asked when to give MMR vaccine •

A-Now • B-After 3 months • C-After 6 months • D-After 12 months Live vaccines can be should be given wither 2 weeks before starting chemotherapy of after 3 months from stopping chemotherapy

344- Pt with face laceration ,repair was done and they use lidocaine Most common complications of lidocaine?

A-Nystagmus B-Ventricular tachycardia C-Drowsiness

3 years old came with low platelts 20 and has history of URTI 2 weeks ago. He has moderate nose bleeding What you should do next

A-Observation B-IVIG C-Steroid D-Ant D IVIG is the 1st line management in ITP if: History of trauma or severe headache Need or planned for major surgery Moderate Heavy Mucosal bleeding Life threatening bleeding (CNS or heavy GIT bleeding) If PLT below 30 and any of the following Active lifestyle No good follow up On anticoagulant drugs Known bleeding disorder

Case of pregnant lady in labor, vaginal examination revealed palpable orbital edge, nose, mouth and chin, what is the presentation?

A-Occipital B-Brow C-Face

Patient on tocolytic beta-mimetics (terbutaline) what is the most side effect?

A-Oliguria B-Palptation C-Abdominal pain D- Vaginal bleeding

A child came with history of ear pain . He is had a history of swimming and there is redness and tenderness over auricle Best treatment

A-Oral amoxicillin B- Topical neomycin C-Topical gentamycin D-IV ceftriaxone Otitis externa

An infant came with oral thrush , he does not look sick and feeding normally Treatment

A-Oral antifungal B-Topical antifungal C-Systemic antifungal D-IV antifungal

6 years came with high fever and loin pain , on examination he is looking toxic • Your antibiotic choice •

A-Oral augemetin • B-Oral cefuroxime • C-IV cefitraxone • D-IV gentamycin

12 years and wants to go for hajj, He is not vaccinated Patents asked for Neisseria prophylaxis

A-Oral azithromycin for 2 doses B-Oral Ciprofloxacin for 2 doses C-IM Ceftriaxone for 3 doses

12 years and wants to go for hajj, He is not vaccinated Patents asked for nesseria prophylaxis

A-Oral azithromycin for 2 doses B-Oral Ciprofluxaocilin for 2 doses C-IM Cefitraxone for 3 dises Oral Rifampicin for 4 doses (best( Oral ciprofluxacilin single dose IM cefitraxone for single dose

12 houls baby boy delivered and found to have jaudice and looks plae , jaudice increased at 36 hous What you will do next

A-Osmotic fragility test B-G6PD C-Electrophesis D-Sickle test

Pregnant in first trimester develop vaginal bleeding and LL quadrant pain, she denied any passage of tissue U/S shows : No sac either intrauterine or extrauterine , Dx ?

A-Ovarian ectopic B-Complete abortion C-missed abortion D- Pregnancy of unknown location

Fungating mass from cervix highest diagnostic value:

A-Pap B-Colposcopy C-Biopsy D-Mri pelvis

A baby came with seizures , cataract , metabolic acidosis , there is urinary glucose and aminoaciduria •

A-Phenylketonuria • B-Maple serum urine disease • C-Galatosemia • D-Urea cycle defect

3 months old and found to have a Hb 9 g/l. He has no symptoms, MCV is normal and no family history of similar problems Most likely cause

A-Physiological anemia of infancy B-Iron deficiency anemia C-Fanconi anemia D-transient erythrocytopenia of childhood

3 months old and found to have low Hb , high MCV, he has café au lait spots and microcephaly Most likey cause

A-Physiological anemia of infancy B-Iron deficiency anemia C-Fanconi anemia D-transient erythrocytopenia of childhood

7 years old boy with type 1 DM. You found that's his weight and height is decreasing in the last few months • HbA1C 6 % • Which is the likely cause? •

A-Poor controlled DM • B-Hypothyroidism • C-Celiac disease • D-Growth hormone deficiency • E-Inflammatory bowel disease

A child develop gross hematuria 2 days after URT infection • Most likely cause •

A-Post infectious GN • B-IgA nephropathy • C-SLE • D-Nephrotic syndrome

• 6 years old girl and found to have hypertension and high creatinine , hematuria and currently has skin lesion • Most likely cause •

A-Post infectious GN • B-HSP • C-nephrotic syndrome • D-IgA nephropathy

Obese child mother complaining of hyperphagia on examination he had dysmorphic features + hypotonia + undescended testes. • What is the most likely diagnosis? -

A-Prader-Willi syndrome B-William syndrome C-Angelman syndrome D-Down syndrome

• In Saudi Arabia. The policy of vaccine to prevent

A-Q fever • B- Japanese encephalitis • C-Herpes encephalitis • D-Hemophilis influnza meningitis

Infant with macules on erythematous base in the back and trunk?

A-Reassurance B-Do skin biopsy C-Do septic work up D-Do CBC

9 years old girl , he bone age is 6 years, age has normal thyroid function test and low insulin like growth factor • Best action •

A-Reassurance • B-Give GH • C-Do chromosomal test • D-Ask for pelvis US

Neonate with vaginal mucoid discharge and concerned mother what to tell her? •

A-Reassure B-Take vaginal smear C-Hormonal investigations D-Swab culture • Vaginal discharge in newborn girls usually physiological and resolve within few weeks

How to decrease asthma excrcebration •

A-Receive influenzas virus vaccines • B-Carpeting the bed and play area • C-Change the humidity • D-Avoid pets

Female 27 years old, she is asymptomatic, her last pap smear was 3 years ago and it showed unconcerned squamous cells. What is the most appropriate thing to do?

A-Repeat pap with cytology B-No need and reassure C-Colposcopy D-Cervical swab

Most common virus cause of acute otitis media in pedia

A-Rhinovirus B-Echo virus C-Influenza D-Chicken POX Most common cause of acute otitis media in pedia is bacterial cause 1st Streptococcus pneumonia Hemophilus influenza Moraxella catarrhalis Most common viral cause for otitis media RSV most common Rhinovirus: 2nd most common

6 years old presented with maculopapular rash on the face and inner cheek there's white spots , most likely cause

A-Rubella B- Measles C-Roseola D-Scarlet fever Measles: 4 Cs Cough, Coryza, and Conjunctivitis Coplik spots Measles vaccines: - 9ms - 12ms - 18ms - preschool

A child with runny nose and fever which subsides and then rash appear all over his body starting from the face Most likely cause

A-Rubella B-Measles C-Roseola D-Chicken pox Roseola First fever then subside then rash Rubella: first lymphadenopathy then fever and rash from face downward Measles: First four Cs then fever and rash from face downward

The most common immunodeficiency in children: •

A-SCID • B-Agammaglobulinemia • C-Ataxia telangctacisa • D-Hyper IgE syndrome • E-IgA deficiency

Pt with pharyngitis for 2 days , what's the possible complication and on examination there is exudates Which of the following is a likely complicating

A-Scarlet fever B-Glomerulonephritis C-Rheumatic fever D-Meningitis

A neonate came at 3 weeks and you notice that he there is still remnants of umbilical's cord . Diagnosis •

A-Severe combined immunodeficiency • B-Ataxia telangiectasia • C-Leukocyte adhesion defect • D-HIV

• 5 years old boy and camr with recurrenct chest and skin infection and his brother died because of similar problem • Most likely diagnosis •

A-Severe combined immunodeficiency • B-Chronic granulamtotis disease • C-Hyper Ige Syndrome • D-Chedicak hegashi syndrome

• Which of the following is true regarding intssespicion •

A-Shock is the most common compilation • B-Required surgery immediately • C-Recuurence is common after surgery • D-Enema should be carried in cases of peritonitis

Which of the following disease can be cured by splenectomy

A-Sickle cell disease B-Thalassemia C-Spherocytosis D-G6PD

Which of the followings is the most common in Down syndrome •

A-Single simian crease B-Leukemia C-Seizures D-Hypotonia E-Low set ear

Which of the disease associates with hyposplenism

A-Spherocytosis B-G6PD C-Thalassemia D-Sickle cell anemia

A child with rash in the hand and mouth. What you would expect in examination

A-Spots on the foot B-Lymph node C-Neck stiffness D-High fever

A child with tympanostomy tube and has ear discharge and fever , he likes to swim Most likely cause

A-Staph aureus C-Streptococcus pneumonia C-Pseudomonas aeruginosa D-Moraxella catarrhalis

Patient 27wks in labor, cervix 6cm dilatation. What to give?

A-Steroid B-Abx C-Arbostan D-MgSo4

Patient with JIA and on methotroxate ans Adalimummab and develped serios infections Best action

A-Stop Adalimumamb B-Stop methotrexate C-Stop both drugs and give antibiotic D-Continue current treatment and give antibiotic

A child came with fever , splenomagally. He is known with congenital heart disease and had dental extraction few weeks ago Most common organism for this disease

A-Streptococcus virdans B-Staph aureus C-Staph epidermis D-Diphtheria

A child came with fever , splenomagaly. He is known with congenital heart disease and had dental extraction few weeks ago Most common organism for this disease

A-Streptococcus virdans B-Staph aureus C-Staph epidermis D-Diphtheria

Patient came with pharyngitis, rash begins in the groin, axillae, neck, antecubital fossa; Pastia's lines + may be accentuated in flexural areas 24 h, sandpaper rash becomes generalized with perioral sparing, non-pruritic, non- painful, blanchable treatment is

A-Supportive B- penicillin C-IVIG D- steroid

5 years old with developmental delay , recurrent infections and recurrent tetany,, Which of the following is the most common congenital anomaly

A-TOF • B-TGA • C-ASD • D-VSD

A child with tall stature , pecus excvatum lens dislocation, which of the following is the most common congenital heart anomaly •

A-TOF • B-Mitral valve prolapse • C-TGA • D-Coarctation of aorta

5 years old with seizures , normal creatinine , low platelets , low Hb and blood film showed fragmented RBC Most likely cause

A-TTP B-HUS C-DIC D-Hemophilia TTP: renal - bleeding - MAHA - fever - brain HUS: renal - bleeding - MAHA

FFP and heparin both can e used in

A-TTP B-ITP C-HUS D-DIC Common sense, in DIC bleeding and clots due to consumption of factors Tx: maintain hemostasis (heparin and FFP)

A mother brought her 6 months old child for DTaP vaccines , he has febrile convulsion due to DTaP vaccine • Best actions •

A-Tell her he needs the vaccine regardless type of reaction • B-Postpone for 3 months • C-Febrile seizure is not a contraindication for DTaP vaccines D-He should not receive the vaccine

A child came with pharyngitis and confirmed to have group A streptococcus and you start him on antibiotic. What you should do for household contacts

A-Test them with rapid test B-Treat them with penicillin C-Do ASO D-Nothing

317- 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

Child came with testicular swilling wasn't painful positive transillumination normal sensations in preanal area? •

A-Testicular torsion. B-Hematocele. C-Hydrocele. D-Indirect hernia exclusion: - torsion: painful - hematocele: negative transillumination (light cannot pass through the scrotum) - Indirect hernia: negative transillumination (light cannot pass through the scrotum) - hydrocele: positive transillumination (light can pass through the scrotum)

75- Trauma case (about pleural effusion on?) chest tube inserted. After 15 min there was blood in the water under seal the amount was 1500 mL, how to manage?

A-Thoracentesis B-Tube thoracostomy (chest tube) C-thoracotomy

Pregnant 31+5 weeks normal CTG + normal progression of labor 4 cm dilated then 5 cm 80% effaced. Management?

A-Tocolytics + steroids B-Prostaglandin C-Reassure

15 months with no symptoms and urine culture urine showed growth of 100, 000 CFU/ml of klebsiella pneumonia What should you do

A-Treatment with antibiotic B- Observation C-DMSA D-Do renal US Asymptomatic bacteria usually no needs for treatment

A boy born with feature rocker bottom foot, prominent occiput and congenital heart disease and dysmorphic feature:. •

A-Trisomy 21 B-Trisomy 18 C-Trisomy 13 D-trisomy 8

• Patient known with chronic granulomatosis disease • Which vaccine is contraindicated •

A-Typhoid • B-MMR • C-Hepatitis A • D-DtAP

A patient has history of fever and found to have murumuru. He had dental extraction few weeks ago. Urine showed RBC and protein and hypertensive • Most likely cause •

A-UTI • B-Glomerulonephritis • C-Nephrotic syndrome • D-Interstitial nephritis

5 years came with to Er and found to have high urea and creatinine • Which of following suggestive of pre renal rarher than renal •

A-Urine osmolality of 200 • B-Urine sodium of 10 mmol/l • C-Presence of casts • D-Presence of abdominal mass

Child with facial eczema and don't respond to topical low potency steroid • You should •

A-Use higher potency steroid B-Duplimab C-Tacrolimus cream D-Phototherapy mainstay Treatment for eczema • Hydration of skin

A child with vesicular lesion in chest and upper trunk Which antibody will be positive

A-VZV IgM B-HSV1 IgM C-HSV 2 IgM D-HIV IgM

A child came with fever and heart failure. He has a prosthesis valve. You suspect infective endocarditis Which of the following is the best empirical regimen

A-Vancomycin B-Vancomycin and rifampicin C-Vancomycin and gentamycin D-Vancomycin , rifampicin and gentamycin

5 years old boy with history of recurrent epistaxis PTT 80 s (30-40) , PT 10s (10-12) Normal bleeding time What is the likely diagnose

A-Von will brand disease B-DIC C-Hemophilia D-ITP E-Vitamin K deficiency Hemophilia X linked receive Hemophilia A: factor 8 Hemophilia B : factor 9 Lab: prolonged PPT only

12 months old and found to have abdominal mass that does not cross midline. Patient is hypertensive and there is proptosis • Most likely cause •

A-Wilms tumor • B-Neuroblastoma • C-Lymphoma • D-Leukemia

Parent come with their child male who have recurrent chest infection and they have another boy who died from one attack of chest infection , he has 2 sisters and healthy ? •

A-X-linked agammaglobulinemia B-Ataxia telangiectasia C-Chronic granulomatosis disease D-Hyper IgE syndrome

Pregnant with history of placental abruption 2 times before came in 3rd preg with same condition and severe bleeding she's on 37 week, when to admit patient?

A-admit now B- wait till next bleeding C-wait until determination of labor day D-discharge and reassure

3-day neonate with B hemolytic and catalse +ve what antibiotic give: I

A-ampicillin 2-gentamicin 3-ceftriaxone D-Macrolide

3-day neonate with B hemolytic and catalase +ve what antibiotic give: I

A-ampicillin B-gentamicin C-ceftriaxone D-Macrolide

Pregnant with placenta previa what's the common complication :

A-coagulation abnormalities B-postcoital bleeding

35- 35yo Female with RT bloody/or green nipple discharge mamo negative, us shows bilateral duct dilation and something on Rt breast ddx(IDP,duct ectasia etc..) next?

A-duct excision B-core needle biopsy C-galactography D-mastectomy

Pregnant with Rh-negative blood type her baby have Rh-positive blood type present with jaundice ask about Pathophysiology? •

A-fetal antibodies against maternal RBC • B-Maternal autoantibodies against fetal RBCs • C-A-fetal antibodies against paternal RBC • D-B-Maternal antibodies against fetal RBCs

57- Breast feeding mother with red swelling in the exam there redness tenderness but no Fluctuation What is most appropriate management?

A-flucloxacillin B-Aspiration C-I&D

66- Chest gun wound entry was lateral to left nipple and exit point below left scapula, patient 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 thoratom

Mother came for antenatal care and US shows week 32 reversed end diastolic blood flow:

A-follow up 2 week and reassess B-Immediate delivery now C-administer steroids 1 week and delivery D-NST The presence of REDV at any gestational age beyond 32 weeks should prompt consideration for immediate delivery

Pregnant in labor was induced by oxytocin, CTG showing late deceleration (pic). what to do to reverse condition?

A-give epidural anesthesia B-give morphine C-let mother sleep supine D-stop oxytocin lateral positioning of the mother, O2, IV fluid, stop oxytocin, administer toocolytic drugs.

210- A case of young male asymptomatic presented abnormal LFT. He is a smoker and drinks alcohol in the weeknds. Labs showed high AST ALT (2:1 ratio) 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

283- 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

Signs of fetal distress in CTG:

A-less contractions B-early declaration C-late declaration

newborn crying and refused feeding and the smell of his urine like burned sugar what is dx? •

A-pheoketonyrea • B-Maple syrup urine disease • C-Urea cycle defect • D-Fatty acid oxidation defect

3 months baby with eczema with a positive family history, what are that common sites involved at this age? - •

A-scalp • B-Flexor surface • C-Extensor surface • D-Buttocks • Eczema • In infants below 6 months : face and scalp • Between 6 months to 2 years : extensor surfaces of elbows and knees • Between 2-5 years : extensor in elbows and knees , wrist and hands , around mouth and eyes • Above 5years: flexor surfaces

Case of SLE and she is on Prednisolone, hydroxychloroquine and Mycophenolate Mofetil, she wants to become pregnant, what to do?

A-stop MMF and start MTX B-Stop MMF and start Azathioprine Safe drugs during pregnancy: - Glucocorticoids - Hydroxychloroquine - Azathioprine - Cyclosporine - Sulfasalazine - Tacrolimus - IVIG Contraindicate drugs: - Methotrexate - Leflunomide - Cyclophosphamide - Mycophenolate Mofetil

1 years old child with Vesicoureteral reflux grade 4 • Best action •

A-surgical intervention • B-Continue antibiotic prophylaxis • C-Intermittent antibiotic prophylaxis • D-Cystoscopy

62- 32 years old MVA. prominent neck veins and marked decreased breath sound on right side of the chest.

A-tension pneumothorax B- hemothorax C- cardiac tamponade

primigravida come to clinic with no symptoms, cervical opening, and intact baby pulse, what the type of abortion?

A-threatened abortion B-inevitable abortion C-incomplete abortion D-anembryonic pregnancy

Fever for 6days and tender splenomegaly, which culture is most importantly needed?

A-urine and stool culture - B-repeated blood cultures C-bone marrow smear culture D-Chest X ray Patients with fever and splenomgaly sfor less than 7 days should be suspected for infectious cause like: - Typhoid fever , - infective endocarditis - TB - brucellosis --> and repeated blood culture shoud be rpeated several times

Which of the following is true regarding UTI in infants (2-24 months) •x

A-urine bag should be collected for urine culture • B-3 days of oral antibiotic is enough • C-Renal Ultrasound be preformed after 1st febrile UTI • D-Voiding cystourethrogram should be done to rule out vesicoureteral reflu

Which of the following is true regarding UTI in infants (2-24 months) •

A-urine bag should be collected for urine culture • B-3 days of oral antibiotic is enough • C-Renal Ultrasound be preformed after 1st febrile UTI • D-Voiding cystourethrogram should be done to rule out vesicoureteral refulx

What is the time interval between ovulation and cleavage in dichorionic diamniotic twins?

A. 0-3 days B. 4-8 days C. 9-12 days D. >12 days

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 Day + 7 / Month +9

What is the most common type of murmur associated with rheumatic heart disease?

A. Aortic regurgitation B. Mitral regurgitation C. Mitral stenosis D. Pulmonary stenosis

Milestones , baby healthy run to the doctor , play a role model as his father ,can't complete a sentence , can't eat with spoon well, age ? •

A. 12 M • B. 18 M • C. 24 M • D. 36 M Run: 18 months Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Baby said hi when he entered the clinic, imitates his mother, feeds his doll, refers to himself "me" and say "eye" : •

A. 12 months • B. 15 months • C. 18 months • D. 24 months • Refer to me and know body part 2 years

Child that throws a ball at you and draws a straight line and stacks "few" cubes on each other (they didn't mention the number of cubes). What is the age? •

A. 12 months • B. 14 months • C. 18 months • D. 24 months Drawing line: 2 years

Child came to the clinic with his mother was having ball, the doctor asked him to throw the ball to him , he through it to the doctor and he went away to take the ball back • what is the developmental milestone of this child ?

A. 15 months • B. 24 months • C. 36 months • D. 48 months 15-18 month Throw and kick ball • 2 years aim for thown ball • 3 years catch ball with arms • 5 years catch ball with hands

What is the recommended age to start screening for HTN in low-risk population?

A. 19 B. 25 c. 35 D. 50 · Screening starts at age of 18

Patient with hemorrhoids that is reduced on its own. What's the grade?

A. 1st Degree B. 2nd Degree C. 3rd Degree D. 4th Degree 1st: Remain inside without protrusion 2nd: Reduced spontaneously 3rd: Reduced manually 4th: Irreducible

Infant with mother for routine checkup, when the mother put the baby he was laughing and when he saw the doctor he cried to reach his mother what is most likely his age •

A. 2 month • B. 4 month • C. 6 month • D. 8 month • Stranger anxiety started at 6 months

A baby setting unsupported. When the doctor spoke, the baby turned around, laughed and babbled to the doctor. How old is the baby? •

A. 2 months • B. 4 months • C. 6 months • D. 8 months Site unsupported: 6 months Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Baby ride tricycle , draw circle but can't draw square ? •

A. 2 years • B. 3 years • C. 4 years • D. 5 years

Child can know color but with difficulty in making square ? •

A. 2 years • B. 3 years • C. 4 years • D. 5 years Colors: 3 years Square: 5 years

. Child can run , say short stories , what is the age: •

A. 2 years • . B. 3 years. • C. 4 years • D. 5 years. 4 YEARS: • Language: Can tell a story

61- Lady with treated breast carcinoma. Didn't mention treatment given to her. When can she get pregnant?

A. 2 years. B. 9 months. C. 3 months. D. 5 years.

How many hours after beginning antibiotics for meningitis the patient should be isolated before discontinuing isolation?

A. 24 hours B- 1 2 hours C- 3 weeks D. 3 days

32 Y.O. male patient k/c of GERD on maximum dose on PPI with mild improvement. Endoscopy was done and it was normal. What is the best next step?

A. 24h PH monitoring study B. Nissen fundoplication C. Manometry D. Add H2 receptor antagonist Confirm GERD before jumping to anything

24 YO. male patient recently diagnosed with GERD and started on omeprazole 40mg. His symptoms are not improving. Endoscopy was done and it showed reflux esophagitis. What is the best next step?

A. 24h PH monitoring study B. Nissen fundoplication C. Manometry D. Add H2 receptor antagonist Esophagitis --> manometry to exclude motility diseases -=- > if normal --> surgery Another recall, has advice life style modifications --> go for it

65 years old female K/C of DM, HTN, TIA diagnosed with A-Fib. Calculate her CHA2DS2-VASc score?

A. 3 B. 4 C. 5 D. 6 · Score: o Age 65: +1 o HTN: +1 o D: +1 o TIA: +2 o Female: +1 Score= 6

19 YO male patient presented to the clinic asking to do DM screening because his friend did the screening. His BMI is 26.5. when should he start screening for?

A. 30 B. 35 C. 40 D. 45 · Overweight à screen at 35 years · Other normal people àat 45

Elective Cesarean section which week?

A. 36 B. 37 C. 38 D. 39

Elective Cesarean section which week?

A. 36-37 B. 38 C. 39 D. full term

• Child in the hospital play and come to his parents say stories , draw head and hands what is the age of this child ; ? ( common Q ) •

A. 3yrs • B. 4yrs • C. 5yrs • D.2yrs Man three parts: cross and circle = 4 years Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Which of the following cardiac murmurs is expected to decrease by Valsalva maneuver and with handgrip?

A. Aortic stenosis B. Aortic regurgitation C. Mitral stenosis D. Mitral regurgitation

infant sit in tripod position , role from prone to supine, reach object •

A. 4 mon • B. 6mon • C. 12mon • D. 24 mon 6 months: sit without support = tripod position Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

At what gestational age we start diabetes screening in a pregnant woman?

A. 4 weeks B. 12 weeks C. 24 weeks D. 34 weeks

Child sit and support his head, laughing and cooing :

A. 4 weeks • B. 6 weeks • C. 8 weeks • D. 16 weeks

hild that can raise his head slightly when prone and smiles. He has head lag when you pull him to sit. How old is he? •

A. 4 weeks • B. 8 weeks • C. 12 weeks • D. 16 weeks Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Brucellosis treatment duration?

A. 4 weeks. B. 6 weeks. C. 3 months. D. 6 months . Brucellosis: gram negative coccobacilli - from milk · Brucellosis + arthritis (sacroiliitis) --> 12 weeks tx . Brucellosis + CNS/ Cardiac --> 6 months Tx . First-line therapy: doxycycline PLUS rifampin . Second-line therapy: doxycycline PLUS streptomycin

Neurobrucellosis treatment duration?

A. 4 weeks. B. 6 weeks. C. 3 months. D. 6 months Diagnosis is Brucellosis Serology (initial): serum agglutination, ELISA. Confirmatory test: - Blood culture. - Bone marrow biopsy specimen and culture (gold standard) Antibiotic therapy First-line therapy: doxycycline and rifampin. Second-line therapy: doxycycline and streptomycin. Simple B= 6 week Neuro-B= 6 months Or till Clear CSF

Developmental milestones q: 500 words, hop on one leg ? •

A. 48 m • B. 36 m • C. 24 m • D. 60 m hop one leg: 4 years Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

174- 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

Pt had previous ectopic pregnancy asked about the percentage in the next pregnancy to be ectopic?

A. 5% B. 10% C. 30% D. 50 % if two or more --> 25%

What is the recommended age to start screening for osteoporosis?

A. 50-54 B. 55-60 c. 60-64 D. 65-69

Child who can understand few commands, points to what he needs, walks without support, crawl upstairs, his age in months? •

A. 6 M • B. 9 M • C.15 M • D. 24 M Walk or stand without support Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Baby wave his hand(bye bye) which developmental milestone age? •

A. 7 months • B. 9 months • C. 12 months • D. 15 months

Child can sit without support, Stands with support, say dada, crawl . What is the age of this child ? •

A. 8 months. • B. 10 months. • C. 12 months. • D. 15 months 9 months: stand with support - crawl Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Baby can walk when he held by one hand and good pincer grasp but he cannot put things in the bottle. What is his age?

A. 9 m • B. 12 m • C. 15 m • D. 24 m 9 months: walk/ stand with support Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Child can walk without support , crawling ,build 3 cubes point to something he interested in , so what is the age of the child ?

A. 9 month • B. 15 month • C. 2 years • D. 3 years Walk alone 12-15 months • 3 cubes 12 months • Points: 15 months • Crawling 9 months

91- Patient with penetrated neck in the zone 3 and he is having active bleeding , CTA report shows : Avascular injury what is the best management?

A. Open and primary repair B. Endovascular C. Open and ligation

BCL BCR gene associated with what ? •

A. ALL • B. CLL • C. CML • D. AML

5 years unwell with lower limb ecchymosis, positive cd10 (calla) ur diagnosis ?

A. AML • B. All • C. Hodgkin • D. Ebv

5 years unwell with lower limb ecchymosis, positive cd10 (calla) ur diagnosis ? •

A. AML • B. All • C. Hodgkin • D. Ebv

Which of the following is most frequently associated with infective endocarditis?

A. ASD B. VSD C. PDA D. Aortic coarctation · Most: VSD

Which of the following is least frequently associated with infective endocarditis?

A. ASD B. VSD C. PDA D. Sub valvular aortic stenosis

Woman was bathing her child and noticed a mass in his flank, which of the following investigations is most appropriate? •

A. Abdominal radiography • B. Abdominal CT • C. Abdominal MRI • D. Ultrasonography

131- Post laparoscopic hernia repair 7 days ago, came now because of pus coming out from the wound, you found 2*3 cm pus, and it is oozing from the wound, no fever in scenario, management?

A. Abx B. Drainage C. Drainage remove the mesh D. Open the wound and leave it open

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. she sense something in his neck What is the most likely diagnosis?

A. Achalasia B. Esophageal web C. Esophageal squamous cell carcinoma D. PUD Cancer: progressive dysphagia - anemia - age > 50

138- 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 something in his neck What is the most likely diagnosis?

A. Achalasia B. Esophageal web C. Esophageal squamous cell carcinoma D. PUD

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. What is the most likely diagnosis?

A. Achalasia B. Esophageal web C. Esophageal squamous cell carcinoma D. PUD Cancer: progressive dysphagia - anemia - age > 50

194- RUQ pain, for 12 hours, no fever, no jaundice. U.S findings " non thickened G.B wall with multiple gall stones, CBD is obsecured ", what's your diagnosis:

A. Acute Pancreatitis B. Obstructive jaundice C. Acute Cholecystitis D. Ascending cholangitis

270- 67 YO male admitted with MI. after two days of discharge he developed severe pain in his left leg. What is the most likely cause?

A. Acute arterial thrombosis B. Acute Arterial Embolus C. DVT D. Neuropathy

67 YO male admitted with Ml. after two days of discharge he developed severe pain in his left leg. What is the most likely cause?

A. Acute arterial thrombosis B. Acute Arterial Embolus C. DVT D. Neuropathy · Hard question, but: o Acute arterial thrombosis: likely to present with history of intermittent leg claudication and bilateral leg o Acute arterial embolus: § Most common cause of acute limb ischemia § No previous history of PVD § Sudden acute severe pain in the leg, § History of MI may indicate development of AFib leading to embolus to the leg or MI itself can cause embolus formation (mural thrombus formation) o DVT: MI hospitalization doesn't take more than a week, unlikely to develop DVT o Neuropathy: unlikely due unsuggestive history

37- A young female patient presents with abdominal pain, spasm of the lower abdominal muscles and copious amounts of vaginal discharge. There is positive cervical motion tenderness. Also, she is febrile What is the most likely diagnosis?

A. Acute cervicitis B. Acute salpingitis C. Appendicitis D. Cholecvstitis

A young female patient presents with abdominal pain, spasm of the lower abdominal muscles and copious amounts of vaginal discharge. There is positive cervical motion tenderness. Also, she is febrile What is the most likely diagnosis?

A. Acute cervicitis B. Acute salpingitis C. Appendicitis D. Cholecystitis

A child presented with 5 days of fever, oral mucosal lesions, cervical lymph node enlargement and limb edema. Lab results essentially normal. Drug of treatment?

A. Acyclovir B. Cefotaxime C. Ampicilin D. Aspirin Treatment of Kawasaki disease High dose of IVIG Aspirin

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 · DM + HTN: add ACEIs · HTN medications o First line HTN medications: ACEIs - CCB - thiazide o First line: CCB in age >55 yo o First line: ACEIs in age < 55 yo o African patients: CCB or thiazide o HTN + DM: ACEIs o HTN + CAD: ACEIs o HTN + CHF: ACEIs o HTN + CKD: ACEIs o HTN + hyperthyroidism: BB o BB are not the first line of treatment in treating HTN · If patient not controlled BP: o Add another first line medications o Still not controlled add another first line mediations o Still not controlled: maximize the doses o Still not controlled: consider secondary causes of HTN · Most common causes of secondary HTN o Age < 18: renal - aortic coarctation o Age< 40: thyroid - renal - fibromuscular dysplasia o Age 40-65: hyperaldosteronism - thyroid - OSA o Age > 65: renal artery stenosis · Pitfalls: o BB: is not used in acute decompensated CHF o CCB is contraindicated in CHF o ACEIs should not be used in AKI · BB (propranolol) is not used directly for treatment of HTN, other usage o Migraine prophylaxis o Essential tremor o Anxiety attacks and palpitations o Thyroid storm o Portal HTN (prophylaxis to esophageal variceal bleeding) o Infantile hemangioma · BB (labetalol) o Used as IV (rapid acting) in hypertensive emergency o First line in Pregnancy induced HTN (emergency - urgency (IV)- chronic(oral)) · BB in general: o First line of treatment as a rate control in AFib or atrial flutter or VT

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 · DM + HTN: add ACEIs

55 Y.O. Pt was diagnosed with GERD and was started on omeprazole 20mg. His symptoms is not improving, and he still complains of nausea. His P/E is insignificant . what is your next step?

A. Add ranitidine at bedtime. B. Refer him for upper GI endoscopy. C. Increase omeprazole to 40mg. D. Follow up after 2 weeks.

43 years old male known to have HTN started on ACEI and then his creatinine increased from 1.2 to 1.5. His potassium is high. What is the best next step?

A. Add thiazide diuretic B. Continue same regimen C. Switch to amlodipine D. Add beta blocker · ACEIs side effect include Hyperkalemia and AKI (by decrease renal perfusion) · If patient on ACEIs exhibited hyperkalemia or/ AKI à stop ACEIs immediately and switch to something else · In this patient: due to hyperkalemia only, we will stop ACEIs and switch to amlodipine (CCB) · Note: not any increase of creatinine will indicate stopping ACEIs, elevation more 30% than the baseline indicates stopping ACEIs (in this case its 25% elevation)

44 years women is complaining of severe dysmenorrhea and menorrhagia, pelvic examination reveals the uterus is symmetrically enlarged and tender. Endometrial biopsy is normal Which of following dx?

A. Adenomyosis B. Leiomyomas C. Endometriosis D. Sarcoma

Painless mild painless vaginal bleeding at 34 weeks, next step?

A. Admission B. C/S C. Steroid D. Antibiotic

Pregnant came with PROM 4 weeks ago and she came with low BP and low hb

A. Admit ICU under the OB CARE B. Rapid response team and multi-specialty C. Observation

27 YO pregnant female presented to ER with history Of fever, flank pain and rigors. Urinalysis showed positive nitrite and leukocyte. What is the most appropriate management?

A. Admit and start oral antibiotic B. Discharge home on ciprofloxacin C. Admit and start IV antibiotics D. Discharge home on nitrofurantoin Acute pyelonephritis >> IV ceftriaxone = admit If it cystitis , can be discharge with oral antibiotics

54 YO male k/c of peptic ulcer and +ve urea breath test. She was started on triple antibiotic therapy and finished the treatment course. When can you re-examine the urea breath test?

A. After 4 weeks B. After 2 weeks C. After one week D. Do the test now 4 weeks after stopping Abx And 2 weeks after stopping PPI

50 YO male presented with history of shortness of breath and fatigue. Admitted for DHE Upon physical examination you heard an early diastolic murmur and when you auscultate over the femoral artery you heard femoral pistol shot sound. What is the most likely diagnosis?

A. Aortic stenosis B. Aortic regurgitation C. Mitral stenosis. D. Mitral regurgitation · Early diastolic murmur: aortic regurgitation · Chronic aortic regurgitation signs o Pistol shot sound on the femoral area Traube signs o Water hammer pulse

42- 18year-old C/O vaginal pruritus & discharge 5 days ago, no fevers or abd pain. PEx: normal genitalia. speculum exam: thick vellow cervical discharge with easy bleed on touch. Cervical swabs done & reveal no organism on gram stain. most appropriate TTT?

A. Azithromycin and ceftriaxone B. Ceftriaxone onlv C. Azithromycin only D. Metronidazole only

325- 62 years old male with Benign Prostatic Hyperplasia (BPH), His BMI: 41, what is the risk of BPH in this case?

A. Age B. Obesity

Highest risk factor of endometrial cancer

A. Age B. PCOS C. smoking

Case of primary hyperparathyroidism. Which of the following is an indication to undergo elective parathyroidectomy?

A. Age >50. B. High PTH. C. Signs Of osteoporosis. D. Severe hypocalcemia. · Indications for parathyroidectomy in hyperparathyroidism: o Symptomatic (Stones, bones, abdominal groans, thrones, and psychiatric overtones) § Kidney stones - polyuria - polydipsia § Bone pain § Abdominal pain - constipation - acute pancreatitis - PUD § Arrythmias § Depression - fatigue o Asymptomatic § Serum calcium: 1 mg/dL higher than the normal upper limit § Skeletal indications · Osteoporosis à BMD T< 2.5 · Asymptomatic vertebral fracture § Renal indications · Renal stones · GFR <60 Age < 50

What is the mode of transmission of meningococcal meningitis?

A. Air born B. Contact C. Droplets D. Fecal oral

223- Picture of Two huge echinococcosis hydatid cyst but size wasn't mentioned, asking what most appropriate initial step?

A. Albendazole B. Surgical deroofing C. Percutaneous drainage D. Liver resection

50 years Old male comes to his physician complaining Of one month history Of decreased appetite, nausea, vomiting, epigastric abdominal pain and 6 kg weight loss. physical exam shows temporal wasting and jaundice. Which of the following is likely to be elevated in this patient?

A. Alpha fetoprotein B. Beta human chorionic gonadotropin C. CA 15-3 D. ca 19-9 9 looks like pancreas

he first 76 YO male came to the clinic for routine check up. His BP is 152/95 for time. What is the best management?

A. Ambulatory BP measurement B. Start anti hypertensive medication C. Measure BP twice later in the clinic D. Measure BP twice at home · Gold standard for diagnosis of HTN is ambulatory BP measurement · Exclusion o Don't start antihypertensive empirically o Measuring more than once in clinic is not recommended o Second best to ambulatory is home monitoring of BP, you need at least 12 reading and take the average to confirm the diagnosis

Child presented with Asthma exacerbation. The patient did not respond to beta 2 agonist. What is your next step? •

A. Aminophylline • B. Systemic steroid • C. Inhaled steroid • D. long acting B2 agonist

Child presented with erythematous pharynx, with cervical lymph nodes , low grade fever and hepatosplenomegaly

A. Amoxicillin B. Supportive antipyretic and fluids C. Do culture and sensitivity D. Give Acyclovir EBV infection Management is supportive Fluid and antipyics

Newly married woman has been on her honeymoon for 1 week and is now complaining of dysuria and frequency. How will you manage?

A. Ampicillin B. Nitrofurantoin C. Ciprofloxacin D. Ceftriaxone

Diabetic patient with pseudo hyper epithelializing in situ, what you should do:

A. Amputate toe B. Ulcer Debridement C. Follow up D. Repeat biopsy

287- Diabetic patient with pseudo hyperepithelialization in situ, what should we do?

A. Amputate toe B. Ulcer debridement C. Follow up D. Repeat biopsy.

277- 61 year old female known case of A. Fibrillation. Presented to the emergency department with 3-4 hours history of sever leg pain. On examination palpable femoral pulse and absent popliteal. Associated with diminished sensation and altered motor function. What is the most appropriate management ?

A. Amputation B. CT-A C. Embolectomy D. Catheter thrombolysis

286- Elderly smoker known case of poorly controlled DM comes with ulcers on tip of three of his toes, diminished dorsalis pedis bilaterally, however, intact popliteal pulse, what's the initial management?

A. Amputation B. Long term anticoagulation C. Immediate surgical intervention D. Diet modification and lifestyle changes

64- 28 years old patient came with severe perianal pain and swelling. On examination, there is 1x1 cm perianal swelling with tenderness. Vitals: normal, no fever. Labs: WBC 8 (normal). Which of the following is the most likely diagnosis ?

A. Anal fistula B. Anal fissure C. Perianal abscess D. Perianal hematoma

65 YO male admitted to ICU with hypotension requiring inotropes. He has warm extremities and neglected urine output for hours. What is the most likely type Of shock?

A. Anaphylactic shock B. Septic shock C. Obstructive shock D. Cardiogenic shock · Shock + warm extremities à distributive o Septic vs anaphylactic § Septic more likely since no mention of food or drug allergy

125- 76 years old male with reducible inguinal hernia and moderate pain, what's the treatment:

A. Open mesh repair B. Non-surgical procedure C. Simple repair

168- 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

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

Woman her husband has gonorrhea what's the most diagnostic for her?

A. Anogenital swap B. High vaginal swab C. Endocervical swap D. Urine culture

After delivery of the placenta by manual extraction contracting, Retroverted uterus happened but was back in place. Where was the placenta in the uterus?

A. Anterior B. Posterior C. Lateral D. Fundus

-30's years old women P6 (not mention complete her family) come with second degree pelvic organ prolapse cyctocele and rectocele, what is most appropriate management ?

A. Anterior and posterior colporraphy B. Anterior colporraphy C. Posterior colporraphy D. Manchester repair

What of the following decreases the risk of preeclampsia? (patient had hx of preeclampsia in her previous pregnancy)

A. Antibiotic B. Aspirin C. MgSo Prevention of preeclampsia -> Aspirin - Prevention of eclampsia -> Mgso

What of the following decreases the risk of eclampsia?

A. Antibiotic B. Aspirin C. MgSo4 Prevention of preeclampsia -> Aspirin - Prevention of eclampsia -> Mgso

Patient with PPROM at 27 weeks present with fever what will u do first?

A. Antibiotic B. steroids

338- A 56-year-old woman was exposed to chemical burns to her trunk. on arrival to the Emergency Department, she was conscious and alert. Examination showed 5 cm x 11 cm wound at her back with burned clothes and powder of chemicals on her clothes and skin Which of the following is most appropriate next step after removing her clothes?

A. Antibiotic. B. Powder sweeping C. Surgical debridment. D. Water irrigation for 30 minutes

234- 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

50 Y.O female known case of penicillin allergy came back recently from Egypt and presented to the ER with painful red lesions on the anterior shin of the right leg. she received antibiotics, next day developed abdominal pain, fever and watery diarrhea. What's the cause of her symptoms?

A. Antibiotics allergy. B. Clostridium difficile. C. Salmonellosis. D. Shigellosis. Tx of C.dif: oral fidaxomicin, oral Vancomyci, oral Metronidazole if severe, similar to above but make metro IV

66 Y.O pt was found to have MALT lymphoma on endoscopy, he is H Pylori +ve. what is the most appropriate next step?

A. Antibiotics. B. Partial gastrectomy. C. Total gastrectomy. D. Wide local excision. MALT lymphoma is related to h pylori à treat h pylori you treat MALT

Which of the following indicates compensated shock?

A. Anuria B. Confusion C. Hypotension D. pale peripheries Decompensated shock: Anuria - hypotension - confusion - cold extremities Compensated: oliguria - normo-tension - anxiety - pale extremities

67 years old male patient presented with SOB, orthopnea and PND for one month. O/E he has early diastolic murmur. Echo showed severe aortic regurgitation and EF 40%. Which Of the following is the best management for this patient?

A. Aortic valve replacement B. Follow up after 6 months C. Diuretics D. Ace inhibitors · Symptoms + EF 40% (less than 50%) + severe aortic regurgitation --> valve replacement · Any valve disease with symptoms --> replacement

A Child brought by his mother, she said that he chews his toys and eat the wall-paint. Laboratory work up reveals anemia. What is the dx?

A. Aplastic anemia B. IDA C. Sideroblastic anemia D. B12 deficiency

What is the appropriate rate of serum glucose reduction in a patient with DKA?

A. As fast as possible B. 9 mmol/L per hour C. 6 mmol/L per hour D. 3 mmol /L per hour

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 Blood diarrhea causes: . E.coli . Campylobacter jejuni . Salmonella . Shigella . Yersinia enterocolitica . and only one protozoa: Entamoeba histolytica

228- 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

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 Blood diarrhea causes: . E.coli . Campylobacter jejuni . Salmonella . Shigella . Yersinia enterocolitica . and only one protozoa: Entamoeba histolytica

Pregnant at 5 weeks gestation with heavy bleeding and clots, she has a hx of 5 previous abortions all her Previous abortions were at 2nd trimester, she had multiple D&C, what causes her current bleeding?

A. Asherman syndrome B. Cervical incompetence C. Chromosomal abnormalities

G3p0, A 25 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 abnormalities

32- 40 year old female presented with a left breast mass. US and Mammogram showed a complex mass. What is the next step in management?

A. Aspirate B. Core needle biopsy C. Excision D. Follow up 12 months from now

26 year old female presented with a tender breast lump. US was done and showed simple cyst. She does not have any family history for breast cancer. What is the best management?

A. Aspirate B. MRI C. Excision D. Antibiotics

77 YO female K/C of asthma on salbutamol and migraine on ibuprofen presented to the hospital with A-fib. What is the best management regarding anticoagulation ?

A. Aspirin B. Clopidogrel C. Aspirin + dipyridamole D. Oral anticoagulant · Easy question · All are not indicated in AFib · Except for oral anticoagulants · Let's calculate her CHADS2-VASC score o Age 65: +1 o Age 75: +1 o Female: +1 o Score: 3 o Warfarin or DOACs for life is indicated · CHADS2-VASC score explained o CHF: +1 o HTN: +1 o AGE 65: +1 o AGE 75: +1 o DM: +1 o Stroke or TIA: +2 o Vascular disease: +1 o Female: +1 · Score interpretation o 0 nothing o 1 maybe give oral anticoagulation o 2 or more: DOAC or warfarin o Warfarin only if valvular AFib or prosthetic valve · Target INR in warfarin therapy o 2-3 o But in AFib with prosthetic valve 2.5-3.5 is the best (if not mentioned in the exam go with 2-3)

295- 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

Late complication of meningitis?

A. Ataxia B- Seizure C- Deafness D- Weakness

54 YO male known to have DM and CKD, recently admitted for ACS. Presented now to the clinic for follow up. He has high creatinine and slightly high cholesterol, low HDL and high LDH. Which of the following medications you want to add to his treatment?

A. Atorvastatin B. Niacin C. Ezetimibe D. NO need to add anything · All ACS patient must be on high potency statins regardless of the LDH levels · This patient has already high LDH + ACS · He must be on statins for life for secondary prevention · All atherosclerotic disease must be on statins: stroke - IHD - PVD

Pediatric patient presented with recurrent syncope and palpitation. ECG: narrow complex tachycardia 250 - 290 beats per minute. Which Of the following is the most likely diagnosis?

A. Atrial flutter B. Atrial fibrillation C. Supraventricular tachycardia D. Ventricular Tachycardia · Narrow complex tachycardia: atrial source · Rate more than 200: most likely SVT than anything else

Pregnant with DIC and CTG normal no deceleration and good contract what to do?

A. Augment labor B. C/S C. Reassure · DIC + stable mom + IUFD à IOL · DIC + nonstable mom à CS · DIC + stable mom + good contractions à reassurance

Pt with hepatic benign tumor dx is hemangioma, decided to be managed Conservatively, but we should advise the patient to?

A. Avoid contact sport and trauma B. Loss weight C. Smoking cessation

18year-old C/O vaginal pruritus & discharge 5 days ago, no fevers or abd pain. PEx: normal genitalia. speculum exam: thick vellow cervical discharge with easy bleed on touch. Cervical swabs done & reveal no organism on gram stain. most appropriate TTT?

A. Azithromycin and ceftriaxone B. Ceftriaxone only C. Azithromycin only D. Metronidazole only

50 YO male recently discharged on ciprofloxacin for UTI, came back to ER with Hx of watery diarrhea for 2 days. Associated with abdominal pain but no vomiting or fever. Stool analysis: +Ve C.diff Toxin. Which of the following is the best treatment?

A. Azithromycin. B. Continue on ciprofloxacin. C. Metronidazole. D. Vancomycin.

During vaginal delivery, PPH with failed manual compression and oxytocin, and the patient is hemodynamically unstable (hypotensive) what you should do next?

A. B-lynch B. Artery embolization C. Artery ligation D. Hysterectomy In case of Vaginal Delivery Hemodynamically stable--> Bakri balloon, failed? --> Artery Embolization (ONLY if ), Hemodynamically unstable--> Laparotomy and Artery ligation, failed? --> Hysterectomy

During C/S, PPH with failed manual compression and oxytocin what you should do next?

A. B-lynch B. Bakri balloon C. Artery embolization D. Hysterectomy In case of cesarean section Hemodynamically stable --> B-Lynch, failed? --> Artery Embolization Hemodynamically unstable --> Laparotomy and Artery ligation, failed? --> Hysterectomy

During vaginal delivery, PPH with failed manual compression and oxytocin what you should do next?

A. B-lynch B. Bakri balloon C. Artery ligation D. Hysterectomy In case of Vaginal Delivery Hemodynamically stable--> Bakri balloon, failed? --> Artery Embolization (ONLY if ), Hemodynamically unstable--> Laparotomy and Artery ligation, failed? --> Hysterectomy

Which of the following will decrease mortality after inferior-lateral MI?

A. BB B. Warfarin C. Heparin D. Thiazide diuretics · After ACS, medications that decreases mortality: o Beta blockers § Specifically: cardio-selective: metoprolol - bisoprolol o ACEIs/ ARBs o Statins o Aspirin

Patient with ectopic pregnancy, her husband is in a military mission, she lives 80Km away from hospital, brought by her neighbor, US showed unviable fetus, absent heart rate, 4cm fetus, BHCG is 5000, what is the indication for surgical intervention?

A. BHCG B. Fetal heart C. Fetal size D. far away from hospital Or distance

Patient with ectopic pregnancy, her husband is in a military mission, she lives 80Km away fron hospital, brought by her neighbor, US showed unviable fetus, abscent heart rate, 4cm fetus, BHCG is 5000, Her vitals: BP 90/50, HR 110, T 35. What is the absolute contraindication for medical therapy in her condition?

A. BHCG B. Vital Signs C. Fetal size D. far away from hospital Or distance

Which of the following is the most modifiable risk factor for Ml?

A. BMI B. Smoking C. Age D. Family history · Age and family history are non-modifiable risk factors · Most important modifiable risk factor: smoking

Pregnant, now bp 140/90, platelets 90k, hx of previously severe preeclampsia. What indication here of severe preeclampsia?

A. BP B. platelets C. uterine contraction

- Patient presenting with yellowish to green vaginal discharge, strawberry cervix, what is the vaginal infection she has?

A. Bacterial vaginosis B. Trichomoniasis C. Candida D. Gonorrhea

A women presents with vaginal discharge. Microscopic reveals spores. What is the most likely diagnosis?

A. Bacterial vaginosis B. Trichomoniasis C. Candidiasis D. Bacterial infection

22 YO female presented with history of thin yellow to green vaginal discharge, burning sensation and dyspareunia. Examination revealed erythematous vulva and red inflamed friable cervix. Microscopic examination revealed flagellated protozoa. What is the most likely causative organism?

A. Bacterial vaginosis B. Trichomoniasis C. Gonorrhea D. Syphilis

White vaginal discharge but no rash, no odor. What is the organism/name of disease?

A. Bacterial vaginosis B. trichomoniasis C. candidiasis D. UTI

266- Patient Obesity wants weight reduction no other conditions all normal question ask what is the most important to do to decides the type of surgery?

A. Barium swallow B. Ct abdomen C. Ultrasound abdomen D. Upper gi endoscope

45 years old male presented to the gastro clinic with history of dysphagia to both solid and liquid for one year. Associated with regurgitation of food. What is the best diagnostic test?

A. Barium swallow B. OGD C. Manometry D. CT abdomen Case of achalasia: dysphagia to both - food regurgitations - age < 50 Initial: EGD Best: manometry

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

60 YO male K/C of chronic GERD for several years, upper Gl 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

The World Health Organization (WHO) published the WHO Surgical Safety Checklist in 2008 in order to increase the safety of patients undergoing surgery. The Checklist consists of three phases of surgical procedure:

A. Before admission, Before skin incision, at discharge from hospital. B. Before admission, before induction of anesthesia, at discharge from hospital. C. Before induction of anesthesia, Before skin incision, Before patient leaves operating room. D. Before admission, Before induction of anesthesia, Before patient leaves operating room.

A 56 year old multiparous patient on oral estrogen, complains of painless urine incontinence when coughing, sneezing or laughing for 1 year. On examination, there was mild vaginal atrophy and constrictor muscle laxity. Urinary incontinence is demonstrated in the lithotomy position with Valsalva maneuver Urinalysis: normal Which of the following would be the recommended management?

A. Beta blocker B. Kegel exercises C. Periurethral bulking D. Post-coital antibiotics

65 YO female known to have HTN and CHF controlled on perindopril and Lasix. Which Of the following should be added to his treatment?

A. Beta blocker B. Spironolactone C. CBB D. Digoxin · Not ER presentation · Patient with HTN and CHF · On furosemide and ACEIs · Based on NHYA classification: everyone with CHF must be on BB and ACEIs · Exclusion: o Spironolactone: indicated only if both BB and ACEIs were started and maximized and still patient is not improving o CCB: contraindicated o Digoxin: prescribed only if patient maximized all the first line treatment and still symptomatic, highly toxic, its never the right answer

BhCG 2500, 3cm, what is the contraindications for methotrexate ttt?

A. BhCg and ultrasound findings B. Far away from hospital C. Her vital signs

Pregnant 34 at labor in examination showed transverse presentation she want to know if she can do ECV Ultrasound shows bicornuate uterus with normal fetus What is the contraindication for ECV?

A. Bicornuate uterus B. Breech presentation C. Hx of previous cs

Newly married 22 years old comes to you for a regular follow-up for her gynecological health. She is medically free and has regular 28 day cycle, complaining of mobile breast lumps bilaterally that are painful right before meneses. Examination was normal. She wants to get pregnant, but she is worried about her breast lump. What is the screening test to be performed?

A. Bilateral mammogram B. Papanicolaou test C. Breast ultrasound

What is true about celiac disease?

A. Biopsy has no role in the diagnosis B. It does not affect adults C. Simple blood serology can confirm diagnosis D. Successful treatment with gluten free diet is consider diagnostic C is more right D is controversial

Patient with choriocarcinoma (scenario) : having uterus size more than GA+ hemoptysis. Next?

A. Biopsy the mass B. admit for D&E C. admit for staging and chemo D. admit for hysterectomy

Child with fever and left knee pain and swelling, most important investigation?

A. Blood culture B. Knee x-ray C. CBC D. Joint aspiration

Pertussis case "whooping cough"Ask about diagnosis and Investigation:

A. Blood culture B. Nasopharyngeal swab C-Neck X ray D-ECHO

child with fever and left knee pain and swelling. Most important single investigation?

A. Blood culture. B. CBC. C. Joint aspirate . D. X-ray Septic arthritis Best diagnosed with joint aspiration Most common cause: staph aureus

Baby came with absent Moro reflex he is born SVD to DM mother with weight 4.8 what's the nerve affected? •

A. Brachial plexus C5-C • B- spinal cord injury • C-Peripheral nerve injury • D-Brain hemorrhage Shoulder dystocia hints: DM mom, boy, 4.8kg (macrosomia) Brachial plexus injury is one of the complication to fetus from shoulder dystocia

58- breastfeeding woman presents with a localized mass on the right upper quadrant of her right breast with swollen axillary lymph nodes. What is the most likely diagnosis?

A. Breast abscess B. Mastitis C. Breast cancer D. Duct ectasia

21 year old female presented to your clinic with a 2 month history of right breast lump. It started as 2 cm in size oval shaped and mobile lump. The lump size fluctuate around menstruation. What is the diagnosis?

A. Breast cyst B. Normal breast tissue in young people C. Fibroadenoma D. Phyllode

9 days newborn come with jaundice only in the face not extended to the rest of the body.. otherwise he is healthy was delivered by NVD with no completing. and he was breastfed immediately. what is the cause of his jaundice? •

A. Breast milk jaundice B-Breast feeding jaundice C-ABO hemolysis D-Sepsis Breast milk jaundice: starts second week of life Breast feeding jaundice: starts first week of life

34 weeks GA presenting with heavy bleeding and contraction (no pain mentioned) Ultrasound showing fundal posterior placental with retroplacental fluid and baby in transverse lie, 3cm cervical dilatation. What to do ?

A. C/S B. Observation C. Tocolytics D. ECV

Pregnant female primigravida in labor for couple of hours, 6cm dilated, 80% effacement, 0 station, was managed with oxytocin and ruptured membrane for 20 hours. CTG showed late deceleration (see above pic) what is the appropriate mx?

A. C/S B. Stop oxytocin C. Amnioinfusion D. Ampicillin Prolonged active phase --> ROM and oxytocin still?--> CS

baby diagnosed with Cystic fibrosis. ..he has + sweat chloride test his brother is normal. to confirm diagnosis of cystic fibrosis.... •

A. CFTR gen in parent • B. CFTR in sibling • C. Chloride test. .parent • D. Chloride test in sibling

20-years-old primigravida 42 weeks with closed cervix. Induction of labor with prostaglandins gel was started. 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. SC terbutaline D. check cord prolapses Uterine tachysystole is one of the causes of fetal bradycardia. - Managed by: discontinue oxytocin or cervical ripening agents + administer tocolytics (e.g. terbutaline)

Pregnant in third trimester has vaginal prolapse grade2 ,CTG normal Vital normal what to do:

A. CS B. Reassurance C. induction of labor

Pregnant at 42week no contraction, you started prostaglandins as IOL and the patient started to have contractions. Now she is fully dilated cervix, station + 2, baby started to have bradycardia his heart rate was 75 you couldn't correct it what to do?

A. CS B. Start pushing and consider applying vacuum C. oxytocin

Pregnant patient in labor. O/E: the cervix is fully dilated for 2 hr, head in a station - 2, but the patient is got exhausted from pushing. What is your next step?

A. CS delivery B. Wait for another 2 hours C. Ventouse delivery D. Forceps delivery

83- Blunt trauma, stable patient, FAST showed intraperotineal fluid. Next step?

A. CT B. Ex lap

82- Patient after Motor vehicle accident at ER, vitally stable, on examination showed Lift hypochondrium tenderness and ecchymosis What is the Most Appropriate test:

A. CT B. FAST C. DPL D. Laparotomy

248- 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

95- 25 y.o female, married, with 12h of RLQ pain, N/V. Vitally stable. No labs provided. Next?

A. CT B. US C. Diagnostic laparoscopy D. Exploratory lap.

55 YO male underwent PTC for obstructive jaundice, after 24 hours of the procedure he developed hematemesis. His vitals are stable. What is the most appropriate next step?

A. CT abdomen B. OGD c. US D. Angiography PTC complication: haemobilia Hepatic artery fistula with biliary tree à hematemesis Tx: angiography to treat and diagnose

285- 56 years old woman presents to the clinic with a non-healing ulcer over her right lateral malleolus, she is hypertensive. pulse is normal and her local exam shows dark discoloration of the skin around the ulcer and viable ulcer bed, best next step is?

A. CT angiogram B. Venous duplex US C. Arterial doppler US D. Conventional angiograph

45 YO obese female presented to the gastro clinic with history of jaundice and pruritic for 9 months. What is the best next step in evaluation?

A. CT liver B. Liver US c. MRCP D. Liver biopsy B If serology in choices à go with serology before US

308- 35 years old male victim of high speed MVA, was brought to ER. He's conscious alert oriented. BP 100/70. IV fluids was started. He's right lower limb in external rotation. What's your next step in management.

A. CT pelvis B. Pelvic binder application C. Right lower limb skin traction D. Operative fixation

87- Patient after RTA with sever lower back pain, what to do until the surgeon comes:

A. CT whole spine B. Flextion extension test C. Restriction of spine movement D. Pelvic binder

Patient came after 3 days after Roux-En-Y surgery complaining of fever chill and left shoulder pain, best diagnostic investigation? BP:90/50

A. CT with contrast B. Endoscopy C. Laparoscopy D. Exploratory laparotomy BP:90/50= MAP= 63 --> unstable --> Exploratory laparotomy

Patient came after 3 days after Roux-En-Y surgery complaining of fever chill and left shoulder pain, best diagnostic investigation? BP:90/60

A. CT with contrast B. Endoscopy C. Laparoscopy D. Exploratory laparotomy BP:90/60= MAP= 70 --> Stable --> CT with contrast before any intervention

267- 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. Endoscopy C. Laparoscopy D. Exploratory laparotomy

280- Elderly male known case of high blood pressure presented with lateral malleolus ulcer. What is the first test to do ?

A. CT-A B. ABI C. US duplex D. VT venogram

65 YO male presented to ER with severe right leg pain and absent pedal pulse. Which Of the following is the most diagnostic investigation?

A. CTA B. MRA C. Conventional angiography D. Ultrasound doppler · Most diagnostic: conventional angiography

66 years old male patient presented with progresive SOB. He is k/c of bronchogenic carcinoma. O/E: BP 88/59. JVP is elevated, lungs are clear and the heart sounds are very quiet. What's the most appropriate next step to confirm the diagnosis?

A. CXR. B. ECHO. c. ECG. D. ABG. · JVD + muffled heart sounds + hypotension --> becks tirade ---> cardiac tamponade --> obstructive shock · Best to diagnose any cardiac or pericardiac structures is echo

137- case of achalasia. What is the best management choice?

A. Calcium channel Blocker B. botulism toxin injection at LOS C. Pneumatic dilatation D. Lower esophageal myotomy

250- Hyperkalemia 6.5 in CKD patient, next step ?

A. Calcium gluconate B. insulin and salbutamol C. Dialysis

Case of PPH on oxytocin , while you manage the case you notice more bleeding(something like that) you examine her but the bleeding prevents you from determining the exact source of bleeding, what to do ??

A. Call for Help B. Misoprostol C. Oxytocin again D. Methylergonovine

18 weeks pregnant with cervical incompetence, history of previous fetal passage at 28 weeks. What is the management?

A. Cervical cerclage B. OCPs C. Follow up by serial us visits Cervical cerclage if: -> Her cervix now is <25mm, and now she is at <24 weeks of gestation (US indicated cerclage) OR -> She has a history or preterm birth, and now she is at 13 or 14 weeks of gestation (History indicated cerclage)

G2P0 20 weeks of gestation, with cervical incompetence (cervix length 30mm), what's the most appropriate management?

A. Cervical cerclage B. Strict bed rest C. Progesterone supplementation

68 Y.O. patient k/c of DM and HTN, presented to the hospital with chest pain for the past week. The pain is retrosternal and last for 15 min, increasing in intensity. ECG showed ST segment depression in lead VI-V4. The patient received statin, aspirin, b blocker, heparin, nitrate and captopril. What to add?

A. Candesartan. B. Clopidogrel. C. Amlodipine. D. Alteplase. · All patient coming to ER with the diagnosis of ACS à must receive loading dose of dual antiplatelets o Aspirin + clopidogrel · Management of ACS in ER o A must: Aspirin + clopidogrel (can also add nitrate) o After PCI: heparin or LMWH o Controversy: morphine + oxygen (only if spo2 < 90%) (supplementing O2 when there is no hypoxia can lead to increase in size of the infarct) o Can be delayed (but within 24hours): ACEI + statin + BB · Indications for alteplase: o STEMI if PCI is not ready in 2 hours o Massive PE (hypotension) o Ischemic stroke within window (4.5 hours) o Salvageable Acute limb ischemia

89- A 25 years old man was brought to the ER after being involved in a motor vehicle accident. He opened his eyes spontaneously and responded appropriately to verbal commands. His respiration wasz shallow and he had a left chest wall contusion. He was able to shrug his shoulders but unable to move his elbows or lower limbs. BP 80/40, HR 70, RR 30. Which of the following is the most likely cause of hypotension?

A. Cardiac tamponade. B. Internal hemorrhage. C. High spinal cord injury. D. Tension pneumothorax.

34 YO male presented to ER with hypotension and raised JVP with weak heart sounds after MVA. What is the type of shock?

A. Cardiogenic B. Hypovolemic C. Septic D. Obstructive · Obstructive shock causes: o Decrease diastolic filling § Cardiac tamponade § Constrictive pericarditis o Decrease venous return § Tension pneumothorax o Increase ventricular afterload § Massive PE § Aortic dissection § Aortic stenosis · Cardiogenic shock causes o MI --> most common o Arrhythmia o Heart failure o Myocarditis · Hypovolemic o Hemorrhagic § Trauma § Upper/lower GI bleeding § Postpartum o Non-hemorrhagic § Dehydration § Vomiting § Diarrhea § Burn § Third spacing (pancreatitis) · Distributive o Septic o Anaphylactic § Drug § Food § Bug bite o Neurogenic § Spinal cord injury (above T6) à Leading to sudden loss of sympathetic tone § Traumatic brain injury § Cerebral hemorrhage o Acute adrenal insufficiency

276- 39 year old male had a pelvic fracture from MVC rollover 2 months back that treated surgically. Before 2 hours he started to complain of sever left LL pain. Femoral pulses are intact. I.V heparin started and venous US is negative. What is the the best management?

A. Catheter thrombolysis B. Embolectomy C. Observation D. Amputation

Case of meningitis CSF culture showed methicillin resistant staph aureus. which type or antibiotics you should use?

A. Ceftriaxone B- Vancomycin C• Tazocine D• Ciprofloxacin

225- 36 old male at ER C/O Right abdominal Pain, O/E: fever, anorexia, weight loss, tenderness in RQ and Lower intercostal margines also patient is toxic Temp. 37.9 (I think but it was elevated) wbc high, bilirubin high US: cystic lesion without septates CT : homogenous (not sure) and "THICK WALL with Peripheral enhancement - What's most appropriate

A. Ceftriaxone B. Metronidazole C. Surgical drainage D. Percutaneous drainage

7 y/o with meningeal irritation, headache, and fever. CSF (high protein and low glucose and high neutrophils ). What youwill give the child?

A. Ceftriaxone and vancomycin and steroids B- Ceftriaxone and steroid C-Antiviral D-Steroid

13 y/o child Dx with DM1 3years back. Now come with no sign of puberty, what you screen annually? •

A. Celiac • B. GH • C. Ophthalmology • D thyroid function test This child has delayed puberty and likely to poor controlled DM and most likely he will have complications like eye or renal and need to be screened for then yearly Celiac and hypothyroidism are associations and not complications and need screened at diagnosis and 2 years and 5 years after diagnosis

Child with RTA had head injury, admitted to ICU. After 12hrs he give urine 100ml\h. Lab show : • Serum osmolarity : high • Serum Na : high • Urine osmolarity : low • What is the cause of this condition : •

A. Central diabetes insipidus • B. Renal diabetes insipidus • C. Fluid overload in the ICU • D. SIADH

Female 25 years old, presented to the ED with vaginal bleeding, nausea, and right lower abdominal pain and tenderness. History of open appendectomy due to perforated appendix. Her BP:90/50 HR:120 RR:25 What is the possible site of bleeding?

A. Cervix B. Uterus C. Fallopian tube

37weeks pregnant came with breech presentation what is your next step?

A. Cesarean section B. External cephalic version

DM pregnant lady 38 weeks in active labor and having DKA profile and fetus in distress (CTG that is suggested of bradycardia) what to do:

A. Change the mother's position of labor B. Stop and do C/S

122- Elderly female, presented to ER with symptoms of bowel obstruction and negative past surgical history. She is stable with distended soft and lax abdomen. What is the next step in management?

A. Chest Xray B. Abdomen Xray C. CT abdomen D. Groin examination

64- Trauma to axilla and lateral chest wall, fracture 4&5 ribs , while examination , suction sound was sourced from lacerated wound on fractured ribs (no vital data) , next:

A. Chest tube B. Intubation C. Urgent Thoracotomy D. Dressing three side

63- 25 year old female involved in a snowmobile accident. She is currently dyspneic with respiratory rate of 40 breath per minute. Breath sound are markedly diminished on the right side And raised JVP. Which of the following is the first step in the management.

A. Chest tube insertion B. Pericardiocentesis C. Needle decompression D. Chest x-ray

Baby with diaphragmatic hernia (pic provided) what is your management ? •

A. Chest tube. • B. Immediate Nasogastric tube C. Immediate hernia repair • D-Cardiac ECHO Congenital diaphragmatic hernia: - First resuscitation and stabilization before surgery - NGT to decompress - Might need intubation - ECMO .....

Child with sore throat and coryza 2 days ago came with difficulty swallow food what is the best investigation investigation you will order?

A. Chest x ray B. Ct scan C. Lateral neck x ray D-Echo Deep neck infection Lateral X ray is the initial investigation CT scan is the best

Child with sore throat and coryza 2 days ago came with difficulty swallow food what is best investigation you will order?

A. Chest x ray B. Ct scan C. Lateral neck x ray D-Echo Deep neck infection Lateral X ray is the initial investigation CT scan is the best

35- Which bacterial infection is associated with intrauterine device in PID?

A. Chlamydia B. Actinomyces isreli C. Gonorrhea

Which bacterial infection is associated with intrauterine device in PID?

A. Chlamydia B. Actinomyces isreli C. Gonorrhea

2 weeks old with conjunctivitis bilaterally , 2 weeks later chest x ray show lung interstitial lung infiltration:

A. Chlamydia trachomatis B. streptococcus C-Adenovirus D-Pertussis

Patient with HBs ag +ve , HBc ab lgG +Ve ,HBs ab —ve. Which Of the following best describe this patient result?

A. Chronic HBV infection B. Acute HBV infection C. Immunized after vaccination D. Immunized after previous exposure

Patient with HBs ag +ve , HBc ab lgG +ve ,HBs ab —ve. Which of the following best describe this patient result?

A. Chronic HBV infection B. Acute HBV infection C. Immunized after vaccination D. Immunized after previous exposure Approach to HBV serology: - HBsAg: evidence of an infection - Anti-HBs: indicates immunity from exposure or vaccinations - Anti-HBc IgM: active acute infection - Anti-HBc IgG: resolved or Chronic infection - HBeAg: active infectious replicating virus Treatment of HBV: - Acute: supportive only - Chronic: antiviral: tenofovir - entecavir

Female with cottage cheese like vaginal discharge, What will you give the husband?

A. Cipro B. Metronidazole C. No need D. Antifungal

211- Patient known case of ulcerative colitis did MRCP and showed intra and extra hepatic duct strictures, what is the diagnosis?

A. Cirrhosis B. Primary biliary cholangitis C. Primary sclerosing cholangitis

45 YO male had positive urea breath test and was started on PPI and metronidazole. Which of the following drugs should be added to his treatment?

A. Clarithromycin B. Tetracycline C. Ciprofloxacin D. Ceftriaxone

Which of the following is a side effect of ACE inhibitors?

A. Class B in pregnancy B. Hyperkalemia C. Diarrhea D. Productive cough · Side effects of ACEIs o Hyperkalemia o Dry cough o Angioedema o AKI . In pregnancy its class C first trimester, class D second and third trimester

Developmental milestone expected in a 3 year old? •

A. Climbs stairs • B. Catches ball with foot • C. hoping in one foot • D. Tell story Climb stairs like a child 1 year • Climbs a stair like adults and descent like children 2 years • Descent like children 3 years Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Primigravida 32 came with mild headache with no abdominal pain, or visual disturbance, Blood pressure 150/90, urine analysis +3 proteins, appropriate management?

A. Close outpatient after 1 week B. Admission and observe C. induction of labor D. C/S

306- 30 years old male victim of MVA was brought to the hospital with red crescent. He was diagnosed with right femur shaft close fracture. What is the definitive management?

A. Close reduction and fixation with External fixator B. Close reduction and fixation with Intra-medullary nail C. Open reduction and fixation with Plate & screws D. Casting

301- 31 years old male was involved in MVA. He had large wound and skin loss. He was diagnosed to have open left tibia shaft fracture. What is the definitive management?

A. Close reduction and fixation with Intra-medullary nail B. Open reduction and fixation with external fixation C. IV antibiotics, wound irrigation, splinting D. Wound exploration

Young patient did pap smear in screening and showed HISL, the biopsy showed carcinoma insitue, she wants to conserve her fertility

A. Cold knife (conization) B. Electrosurgical loop (LEEP) C. Cryotherapy D. Laser

349- Patient fell on outstretched hand, pain at anatomical sniff box, which bone fracture is it?

A. Colles B. Scaphoid

167- 47- year-old female presents with iron deficiency anemia. She has 3rd degree hemorrhoids. Which of the following is the most appropriate thing to do?

A. Colonoscopy B. Hemorrhoidectomy C. CT scan

153- 50 year old male patient presented to ER with massive lower GI bleeding, he is tachycardic. intravenous crystalloids resuscitation is started and standby PRBC units are ordered. What is the next step?

A. Colonoscopy B. NGT aspiration C. Activate massive transfusion protocol D. Consider RBC scan

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

Pap test came with high grade squamous intraepithelial lesion, next step is?

A. Colposcopy B. repeat pap test C. hysterectomy

Female 30-year-old her pap smear, result showed squamous cell ca (SCC), what to do next?

A. Colposcopy directed biopsy B. Repeat pap smear C. Total hysterectomy D. Neoadjuvant chemotherapy

Picture of ultrasound (as shown above) and patient presenting with minimal bleeding and she denied passage of anything & cervical os is closed, she's pregnant at 8 weeks

A. Complete abortion B. Threatened abortion C. Missed abortion D. Anembryonic sac

Pregnant suddenly at her mid second trimester came to ER complaining of gush of fluid + tissue passed out. What is the diagnosis?

A. Complete abortion B. cervical incompetence C. Incomplete abortion D. Threatened abortion Need more information: Complete abortion: passage of content + cervical os closed Incomplete abortion: passage of content + cervical os open + US findings of remnant tissue

Pregnant with suspicious cervical lesion, how to confirm the diagnosis or what is next?

A. Cone biopsy B. Colposcopy directed biopsy C. Pap smear D. Endocervical curettage

Pregnant of twins, one has increased nuchal translucency in Ultrasound. What will he have?

A. Congenital cardiac malformation (all chromosomal syndromes have cardiac disease) B. Turner syndrome C. Neural tube defect

A case of ASC-H. What to do?

A. Conization B. Colposcopy C. HPV D. Repeat pap

50 y/o female with vaginal wall prolapse grade 3, on medical treatment for 6 months with no improvement, what to do?

A. Conservative B. Surgical repair C. Follow-up with 3 months

195- A 37-year-old woman presents to the ER with a history of right upper quadrant pain side hours with nausea and vomiting. On examination there was a marked abdominal tenderness. Abdominal ultrasound demonstrates peri-cholecystic fluids, thick gallbladder wall with positive sonographic Murphy's sign. Which of the following is the recommended treatment?

A. Conservative treatment and interval cholecystectomy B. Insertion of percutaneous cholecystestomy tube C. Emergency laparoscopic cholecystectomy D. Emergency open cholecystectomy

Case of ectopic pregnancy treated by Salpingostomy. On regular follow up her BHCG was decreasing until the last three visits the BHCG results plateaued. BHCG was 3200 on the last visit (normal is less than 5000). How would you manage the case?

A. Consider giving Methotrexate B. Start OCP C. Surgical intervention D. Reassure

46 years Old male patient presented with SOB for 2 months. He is k/c Of TB. O/E: BP 112/77. He has distended JVP which increases with inspiration. NO murmurs. What's the most likely diagnosis?

A. Constrictive pericarditis. B. Cardiac tamponade. C. Pneumonia. D. Pneumothorax. · Chronic Dyspnea + TB + JVD with inspiration (Kussmaul sign) = constrictive pericarditis · It's not cardiac tamponade: no hypotension - no muffled heart sound - not acute

Patient came with heavy bleeding after doing evacuation the physician said it's dysfunctional vaginal bleeding what to do next?

A. D&C B. OCPs C. embolization D. hysterectomy

3- 50-year-old female diagnosed with stress incontinence, asking about definitive management?

A. Passery B. Tension free Vaginal Tape (Urethral sling test) C. Kelly plicatiom D. Burch procedure

Patient with a history of perforated ectopic and previous management , came now with lower abdominal pain . Pregnancy test Labs show: 18000 bhcg Hb low. How to mange?

A. Consult surgery for possible acute abdomen B. Misoprostol C. Surgical management after stabilization

48 YO. female patient diagnosed with type 2 diabetes. She started lifestyle modification with diet and exercise. After 3 months her HbA1c is 6.9. which of the following is the best next step?

A. Continue lifestyle modification. B. Sulfonylurea. C. Metformin. D. Insulin. Give another 3 months before starting medications, continue lifestyle modifications

54 years old male K/C of HTN, TIA, A-fib on warfarin. For the last 6 months there is no A-fib attack. ECG: regular sinus rhythm. What is the best management regarding warfarin?

A. Continue the same dose B. Decrease the dose C. Stop warfarin D. Add ASA Score 3: continue warfarin TIA: an indication for aspirin for life

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 Painful vaginal bleeding + uterine tenderness= placenta abruption. Also, polyhydramnios especially after rapid decompression is a risk factor for placenta abruption. Placenta previa and vasa previa are painless! Cord prolapse will not present with bleeding and tenderness.

7 y/o with meningitis signs, headache, fever. He and his family came from Africa recently. He also has sore throat and lymphadenopathy. CSF (normal protein, glucose and lymphocytes). What will you give the child?

A. Corona virus B. CMV C. EBV D. Hanta virus Most common cause of Viral meningitis is: Enteroviruses, especially coxsackieviruses Often associated with encephalitis (meningoencephalitis) Acyclovir is the only treatment for meningoencephalitis caused by HSV or VZV Other viral meningitis treated supportively

35 YO male presented with fever, rigors & weight loss for 10 days. He underwent prosthetic mitral valve replacement 1 month ago. Vitals: Blood pressure 90/70 mmHg, HR 100/min, Temp 38.70C. Echo showed small vegetation. What is the most likely causative organism?

A. Coxiella burnetii B. Staphylococcus aureus C. Streptococcus viridians D. Staphylococcus epidermidis Less than 2 month > B More than 2 month > C

A child with gum bleeding, erythema papules in mouth. Swab showed ( multinucleated giant cell ) on Tzanck smear , Which organism ?

A. Coxsackie virus B. Staphylococcus C. EBV D. Herpes simplex

Child presented with ulcers on mouth and gingiva erythematous based and pale in the center.

A. Coxsackievirus B. EBV C. Herpes D-Influenza

Patient was extubated after thyroid surgery and immediately developed shortness of breath and respiratory distress. Examination reveals that both vocal cords are in a semi- closed position. How will you secure the airway?

A. Cricothyroidotomy B. Tracheostomy tube C. Re-intubate the patient

Man from India has fever. neck stiffness and photophobia. With high protein. high lymphocytes and low glucose in CSF. What is this kind of meninges?

A. Cryptococcus meningitis B- Tuberculous meningitis C. Viral meningitis D- Aseptic meningitis

263- 55 yrs Patient is having 1cm lung nodule with ct evaluation for abdominal pain. patient has no respiratory symptoms. Patient is ex smoker for 10 years that stopped smoking 20 yrs ago

A. Ct 3-6 months follow up B. Surgical resection C. Transbronchial biopsy D. No follow up

Young Patint after MVA came with multiple Urethral injuries and open book femur fracture >> what is the most appropriate action ?

A. Ct nephron pylogram B. Retrograde pylogram C. Iv pylogram D. Insert folly catheter Retrograde pylogram = retrograde urthrogram Retrograde urethrogram: to rule out suspected urethral injury Treatment: Place suprapubic catheter to decompress bladder (diverts urine from the healing urethra and anastomosis)

321- 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

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 Retrograde urethrogram: to rule out suspected urethral injury Treatment: Place suprapubic catheter to decompress bladder (diverts urine from the healing urethra and anastomosis)

Patient after surgery received blood transfusion 15pRBCs. developed bleeding what's the most likely diagnosis ?

A. DIC B. Bleeding transfusion reaction. C. thrombocytopenia. D. Vonn Willebrand disease. Transfusion of RBCs only can cause DIC (blood has plasma and platelets too)

78- Young guy is stabbed in anterior abdomen in a fight after a football match. He presented to emergency with a 1 cm laceration that is 3 cm above umbilical. He has no pain and vitally stable. What is the best management?

A. DPL B. Wound exploration C. Laparotomy D. CT scan

26 YO. male patient diagnosed with DM and was started on insulin therapy. Now he presented with recurrent hypoglycemic attacks. What is the most likely explanation?

A. Dawn phenomenon. B. Somogyi effect. C. Honeymoon period. D. Hypoglycemia.

258- An elderly patient in ICU has bed sores with exposed necrotic skin and subcutaneous tissue. What is your management?

A. Debridement with a skin graft B. Debridement with assisted vacuum C. Debridement with primary closure D. Debridement & Dressing with secondary closure

• pt present with signs & symptoms of DKA. His Glucose is 34 mml. What is the goal in this management? •

A. Decrease glucose by 3 mml per hour • B. Decrease glucose by 6 mml per hour • C. the glucose level goal should be above 18 mml • D_Correct acidosis with bicarbonate

221- Smoker and obese patient, at imagining there is 4x4 cm hepatic hemangioma. What is the most important thing to advise the pt ?

A. Decrease high carbohydrate and fatty meals B. Stop smoking C. Eat diet rich in fiber D. Avoid excessive sport

220- Smoker and obese female patient on combined OCP, at imagining there is 4x4 cm hepatic hemangioma. What is the most important thing to advise the pt.?

A. Decrease high carbohydrate and fatty meals B. Stop smoking C. Eat diet rich in fiber D. Stop OCP

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

45 YO male known hypertensive (on lisinopril 20 mg and amlodipine 5 mg) and recent Hx of thromboembolism (on warfarin 2mg) presented with productive cough and hemoptysis for 2 months. MTB-PCR is +ve. He was started on first line anti TB medications. Which of the following adjustment should be made to his medications?

A. Decrease lisinopril dose B. Increase warfarin dose C. Increase amlodipine dose D. Stop rifampicin. · Patient on TB --> must be taking rifampin · RifAMPin --> AMPlifications CYP 450 enzyme in the liver --> any drug metabolized by this enzyme will be metabolized faster --> effect will be reduced --> just increase the doses of the other drugs --> in this patient its warfarin --> increase warfarin · So, if we did not increase warfarin --> patient will have risk to develop clots hence his underlying disease · Most commonly: o Warfarin o Oral contraceptive (estrogen) · Hint: never stop rifampin - never decrease the doses of any other medications

What is the pathophysiology of GDM?

A. Decrease uteroplacental blood flow during late pregnancy B. Human placental lactogen (human chorionic somatomammotropin)

Pregnant around 30 weeks who is a case of Rh alloimmunization, fetus was found to have anemia, Management?

A. Deliver immediately B. Duplex C. Fetal blood transfusion

46 YO. female patient presented with fever, retro orbital pain and arthralgia after coming back from travelling to southeast Asia?

A. Dengue fever. B. Malaria. C. Ebola virus. D. Yellow fever. Retro-orbital pain is characteristic for dengue If same Q whithout retroorbital pain >> malaria · High fever + retroorbital pain + arthralgia + maculopapular rash + ecchymosis + thrombocytopenia + hepatomegaly + Asia (e.g., Thailand) + leukopenia + neutropenia + high AST + high HCT = dengue

A child with painless neck nodule that moves up and down, moves up with tongue protrusion. What is the most likely diagnosis?

A. Dermoid cyst. B. Thyroid nodule. C. Thyroglossal cyst. D. Parathyroid nodule.

56 YO female presents to the hospital c/o abdominal pain and postural dizziness. She also noticed a scar on the back of her hand that is getting darker. On examination there is hyperpigmentation in the buccal mucosa. Her serum cortisol level is at lower normal limit. What is the best next step to confirm the diagnosis?

A. Dexamethasone suppression test B. Urinary catecholamines measurements C. 24-h urinary cortisol measurement D. ACTH stimulation test Presentation of adrenal insufficiency Stepwise endocrine testing in all patients. 1- Morning cortisol 2- Morning ACTH 3- ACTH stimulation test (highest diagnostic)

Cyanotic newborn with scaphoid abdomen. Heart sounds identified in the right side only. What's the most likely diagnosis? •

A. Dextrocardia with situs inversus • B. Transposition of great vessels • C. Diaphragmatic hernia • D. Hiatal hernia

22-year-old female patient presented With meningeal irritation signs. CSF showed: high WBC's. mainly lymphocyte, normal level of glucose, mildly elevated protein. your most likely diagnosis?

A. Diabetic coma B. TB meningitis C. Viral meningitis D. Bacterial meningitis

Newly diagnosed mother with GDM, what the first line management

A. Diet B. metformin C. Oral Insulin D.SC insulin wtf if oral insulin?!

59 YO. female Patient diagnosed with type 2 diabetes. Her HbAIc is 7.8. which of the following is the best initial therapy?

A. Diet and exercise. B. Sulfonylurea. C. Diet and exercise plus metformin. D. Metformin. A1c > 7.5%

2 years old female presented with fever, sore throat and cervical lymphadenopathy. She Wis started on amoxicillin then developed maculopapular skin rash. What is the most likely diagnosis?

A. Diphtheria B. Hodgkin lymphoma C. CMV D. Infectious mononucleosis

A woman presented with dyspareunia but denies any heaviness or urinary symptoms found to have a cervical mass on examination *attached photo, what is your Mx?

A. Discharge B. Follow up C. Excision at the clinic D. Pap smear

23 YO primigravida GA 12 weeks. Asymptomatic came for follow up at antenatal care clinic. Urine CIS: E.coli. Which Of the following is the most appropriate management?

A. Discharge home on ciprofloxacin B. Admit and start IV ceftriaxone C. No need to treat D. Discharge home on cephalexin

30 YO female medically free presented with jaundice for 2 weeks. No flapping tremors or stigmata Of chronic liver. AST 1400 ALT 1300 GGT70 Total bili 60. What is the best next step?

A. Discharge with FAJ B. Admit and start IV dextrose c. Order PT and INR D. Refer her for liver transplantation PT and INR and albumin and bili indicate the function status of the liver Patient cannot be discharged before knowing the cause Starting dextrose is useless Transplant at this stage is stupid too

A female pregnant with hypertension and proteinuria, she has right upper quadrant pain what is the reason?

A. Distended Hepatic Capsule B. Hepatic Rupture C. Gall Bladder Stone

Primigravida at 32 weeks GA with BP of 150/90 mmHg. There is edema of hands and legs. What to do?

A. Diuretics B. Tabs Labetalol C. Continued evaluation

340- Pt 28 with bleeding during defecation for two month In proctoscopy shows multiple polys , ur diagnosis ?

A. Diverticulosis B. Familia polyp C. Crohns

A pregnant lady at 37 weeks of gestation presented to the emergency department with rupture of membranes and she is known to have recurrent HSV vaginal infections, what is your next step?

A. Do C section B. Prepare for instrumental delivery C. Do vaginal examination D. Give acyclovir

40y/o female patient underwent PAP smear histopathology showed ASCUS, your next step?

A. Do HPV test B. Colposcopy. C. Re-evaluate after 6 months D. Surgery

8 weeks GA diagnosed as cervical incompetence, what to do?

A. Do cervical suture now B. Do cervical suture at 13-14 weeks C. Start beta mimetic drug D. Confirm with haggler dilator

A 35-vear-old female complaining of greenish discharge, cervix: red spots. What is the most appropriate treatment?

A. Doxycycline B. Metronidazole C. Trimethoprim-Sulfamethoxazole D. Ceftriaxone

A patient has a sudden onset Of seizure, he is medically free, has no family history Of epilepsy, and no history Of recent infection, he has never had any previous episodes Of seizures or loss Of consciousness, he is not on any medications, electrolytes and other blood tests were all normal, what is the next investigation that should done tor this patient?

A. ECG B- EEG C- Brain imaging D• Lumbar puncture

A LADY is pregnant at 7 weeks, she came to emergency room complaining of left iliac fossa pain and brownish vaginal discharge, your provisional diagnosis:

A. ECTOPIC B. APPENDICITIS C. IRRITABLE BOWEL D. Threatened miscarriage

27 YO 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. ELISA. B. HIV-I/HlV-2 antibody differentiation immunoassay. C. CSF Syphilis serology. D. Combination antigen/antibody tests. Screening tests - Combination antigen/antibody test: (almost 100% sensitivity). (1st screening test of choice). - ELISA (Antibody-only tests). (2nd choice) Confirmatory tests: - HIV-1/HIV-2 antibody differentiation immunoassay: (confirmatory test of choice). - Western blot (2nd choice).

202- A woman post lap cholecystectomy complaining of SOB and ascites confirmed by US. Management?

A. ERCP B. Abx C. Exploration D. Percutaneous drainage

198- 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

Patient with Cholelithiasis and the Common Bile Duct measure 12 mm, what to do?

A. ERCP --> 7mza says ERCP B. MRCP C. Cholecystectomy As per amboss: dilated CBD only with no evidence of acute cholangitis or elevated bilirubin --> MRCP I will choose MRCP --> need revision

Female had previous ectopic pregnancy want to conceive:

A. Early detection of pregnancy B. Folic acid therapy

Pregnant women 32 weeks complaining with vaginal bleeding, there is no history of contractions or cervical dilation. What is the type of bleeding?

A. Early postpartum bleeding. B. Late postpartum bleeding C. Antepartum bleeding D. Intrapartum bleeding

Pregnant women 32 weeks complaining with vaginal bleeding, there were also contractions and dilation. What is the type of bleeding?

A. Early postpartum bleeding. B. Late postpartum bleeding. C. Antepartum bleeding. D. Intrapartum bleeding

179- 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

Pregnant 37 week with BP 160/110 every thing else was normal Her BP during pregnancy was 120/90

A. Eclampsia B. Gestational HTN C. Preeclampsia

Pregnant lady 39W her routine BP throughout the pregnancy was 120/80 (normal) then suddenly became 150/90 what is the diagnosis?

A. Eclampsia B. Gestational hypertension C. Chronic hypertension D. Superimposed hypertension

Female 25 years old, presented to the ED with vaginal bleeding, nausea, and right lower abdominal pain and tenderness. History of open appendectomy due to perforated appendix. Her BP:90/50 HR:120 RR:25 What is the diagnosis?

A. Ectopic pregnancy B. Ovarian torsion C. Hemorrhagic cyst D. Abscess

324- 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

45 YO male patient presented to ER with repeated vomiting and hematemesis. past medical history is unremarkable. His labs is remarkable for mild anemia and elevated urea level. What is the most likely diagnosis?

A. Esophageal varices B. Mallory Weiss tear C. Erosive gastritis D. PUD Repeated vomiting and hematemesis à MW Mild anemia and elevated urea is expected Recall: alcoholic PUD: epigastric pain - NSAID use EV: jaundice or cirrhosis findings

76 Y.O. male patient presented to the hospital with transient loss of consciousness. BP 109/73, HR 40, regular. What is the best next step?

A. Electrical cardioversion B. Pacemaker placement C. IV atropine D. Verapamil · Bradyarrhythmia approach: o Unstable: § IV atropine: 3 doses up to 3 mg max § Not effective à pacemaker o Stable bradycardia asymptomatic --> monitor and observe

36 YO. male patient presented to the hospital With palpitation for 6 hours. BP 131/67, HR 122, regular. ECG is shown below. What is your next Step to manage this patient?

A. Electrical cardioversion. B. Carotid massage. C. IV adenosine. D. Verapamil. · Steps in approaching arrhythmia o Rate: tachycardia o QRS: narrow à atrial source o Rhythm: regular o P wave: absent o SVT: narrow complex regular atrial tachycardia with absent P wave · First step in stable SVT treatment: vasovagal stimulation: carotid massage

66 YO. male patient k/c of dilated cardiomyopathy came for routine check up, he is asymptomatic. BP 111/87, HR 140 irregular. ECG showed atrial fibrillation. What is your next Step to manage this patient?

A. Electrical cardioversion. B. Digoxin. C. Bisoprolol. D. Verapamil. · If patient with AFib and stable: rate control with either BB or CCB · BB vs CCB: o Cardio-selective BB (Metoprolol - bisoprolol - esmolol) if patient with CHF history o CCB (verapamil - diltiazem): if patient with asthma or COPD · Second step digoxin · Third step: amiodarone · If patient is unstable: shock them (Electrical cardioversion)

Pregnant at 33 weeks gestation has reversed flow of doppler artery of umbilical, what will you do?

A. Emergent CS B. Give steroids and wait for 1 wk C. Wait till 37wk

196- 30 y/o complaining of abdominal pain radiating to the back associated with vomiting; he did gastric sleeve 3 months back. US: gallbladder sludge with no stone; normal cystic duct EBC normal Amylase 700 What is the most appropriate investigation?

A. Endoscopic US B. Endoscopic sphincterotomy C. Laparoscopic cholecystectomy D. Open cholecystectomy

Morbidly obese patient is planned for bariatric surgery. What will you do before the procedure?

A. Endoscopy B. Colonoscopy C. CT abdomen D. Barium swallow

Patient with history of sleeve bypass with history of leak, present with severe pain and hypotension, next step?

A. Endoscopy B. US C. laparotomy D. Diagnosis laparoscopy Hypotension-> Unstable-> Immediate laparotomy

298- Old pt after rectal surgery he is not doing well after in the recovery he start to have leg pain he developed DVT from the popliteal to the femoral ..

A. Enoxiparen B. Heparin C. Warfarin D. IVC

146- 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 C. Gastritis D. Boerhaave syndrome

142- Patient who is on NSAIDS for joint pain, presented with sudden severe continuous abdominal pain. He denied any history of vomiting, constipation, diarrhea, and or hematemesis. The pain is located in the epigastric area with a feeling of Nausea. Upon examination. There is tenderness and rigidity, what is the diagnosis?

A. Esophagitis B. Acute gastritis C. Perforated peptic ulcer D. Boerhaave syndrome

199- Patient develop surgical emphysema neck chest abdomen after ERCP, which organ was injured or perforated?

A. Esophagus B. Stomach C. Pancreas D. Duodenum

33 YO female known case of TIDM and RA came to the hospital for regular follow up. She has been using NSAID to relieve symptoms of RA. Surgical Hx is significant for cholecystectomy done 2 years ago. O/E her BP is 162/95, her previous two readings were 156/89 and 159/91. Labs: Na 138, K 3.0, Cr 0.94. which of the following is the most likely cause of her HTN?

A. Essential hypertension B. Pheochromocytoma c. NSAID induced HTN D. Primary hyperaldosteronism Hypokalemia + hyponatremia + HTN = Hyperaldosteronism

Pregnant woman with history of preterm labor two times, presented with vaginal spotting What to give her?

A. Estrogen B. Progesterone C. Indomethacin D. Mg sulphate

31 female, came for pap smear when to do it?

A. Every 2yrs B. Every 3yr C. Every 5 years D. If 3 is negative, no need to re-screen again

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

Female with cervical lesion measuring 11mmx12mm with irregular borders, pap was done, no results yet, what to do?

A. Excise the lesion B. Biopsy C. Reassure until pap results are available D. HPV test

38- A woman with a left breast mass for 9months. Mammogram: speculated mass with suspicious microcalcification and axillary lymph node involvement, BI-RAD V (probable malignancy), next step?

A. Excisional biopsy B. core Biopsy C. Modified radical mastectomy

117- ER. Abdominal pain generalized 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 D. CT

Woman at 7 weeks came with abortion female denies passage of part of product after doctor examination show tissue product in cervix, clear scenario what is management?

A. Expectant management B. D&C C. Progesterone D. For surgery Management of abortion - Expectant management (if ≤13 weeks GA) - Medical (up to 20 weeks GA) By two different medications mifepristone followed by misoprostol - D&C: if severe bleeding - infection - hemodynamic instability regardless of the gestational age

Woman at 14 weeks came with abortion female denies passage of part of product after doctor examination show tissue product in cervix, clear scenario what is management?

A. Expectant management B. D&C C. Progesterone D. For surgery Management of abortion - Expectant management (if ≤13 weeks GA): - Medical (up to 20 weeks GA) By two different medications mifepristone followed by misoprostol - D&C: if severe bleeding - infection - hemodynamic instability regardless of the gestational age

157- 28 years old patient medically free presented to the ER with hx of abdominal pain nausea anorexia and lower quadrant abdominal pain vitally stable CT: diverticulitis with 20 ml fluid 2*2 cm What is the most appropriate management

A. Exploratory laparotomy with Sigmoidectomy B. Exploratory laparotomy with easy content C. Conservative IV antibiotics D. Diagnostic laparoscopy

237- Post appendectomy female came with LR abdomen mild tenderness Ex Normal By CT there is 2*2 collection in Retrocecal :

A. Exploring laparotomy B. percutaneous drainage symptomatic C. laparoscopic D. conservative with Anitbiotic

Pregnant women has Chlamydia infection, what is the most commonly infected part of the neonate?

A. Eyes B. Lungs

24 YO female presented with history of amenorrhea for 3 months. Her prolactin is high. What is the best next step?

A. Pelvic US B. Random cortisol c. Brain MRI D. Follow up after one month

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 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 / Repeat rubella screen D. Give anti-D Ab

43 YO female presented with solitary thyroid nodule 4 mm, associated with neck pain. Her TSH and T4 are normal. What is the best next step?

A. FNA B. Thyroid IJ/S C. Follow up after 3 months D. Repeat thyroid function test · All thyroid nodule approaches o Start with TFT o Second step: US o If hyperthyroidism is suggestive and US shows benign findings --> nuclear scan o If hypothyroidism and US shows malignant pattern --> FNA o FNA --> BATHESIDA I. Non-diagnostic --> repeat II. Benign --> FU III. Atypia --> repeat FNA IV. SUS --> hemi V. SUS --> hemi vs total VI. SUS --> hemi vs total o Total if: I. Medullary II. Anaplastic III. Lymph node IV. Size > 4 cm

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

Let's assume we had the same case with an US showing bilateral thyroid nodules. The right nodule being 3x4mm in size, and the left is 1x2mm. Next?

A. FNA both B. FNA the larger one C. total thyroidectomy D. Follow up with US Because both are smaller than 1*1cm.

3x4mm in size, and the other nodule is 1x2cm. Next?

A. FNA both B. FNA the larger one C. total thyroidectomy D. US follow up

A thyroid mass, TFT is not mentioned, US: large cystic mass with small solid mass, what is the best next step in management?

A. FNA from cystic. B. FNA from solid. C. US. D. Thyroid scan.

81- MVA came and resuscitation was done after that the patient deteriorated BP 90/60 what to do next?

A. Fast B. Ex lap

44- A 24-year-old lady presents with a hard, mobile, well-circumscribed painless left breast mass that has been increasing in size from the past few months and was NOT related to her menstrual cycle. The most like Diagnosis is?

A. Fat cyst B. Fibroadenoma C. Fibrocystic changes D. Phyllodes

4 years old with fever for 6 days , rash , you suspect Kawasaki disease following s not of the criteria:

A. Fever for 6 days B. Swelling in hands and foot C-Strawberry tongue D. Unilateral conjunctivitis Mnemonic Kawasaki: CRASH Burn Conjunctivitis (bilateral) Rash Adenopathy Strawberry tongue Hands and foot swelling Burn: Fever > 5 days

48- Multiple small breast masses bilateral get worse prior menses

A. Fibrocystic B. Fibroademoa

28 YO pregnant female diagnosed with UTI. Which of the following antibiotics is safe for her?

A. Flucloxacillin B. Ciprofloxacin C. Gentamicin D. Nitrofurantoin

Which of the following is the drug of choice for Amebiasis?

A. Fluconazole B. Albendazole C. Metronidazole D. itraconazole

Elderly patient with pelvic fracture and bleeding per rectum. Urethrogram - retroperitoneal urethral injury. Your management

A. Foleys catheter B. Suprapubic cystostomy C. Laparoscopic repair Suprapubic cystostomy = Suprapubic catheter --> indicated if urethral injury

Female patient wants to get pregnant. TSH high, T4 normal. What is the most appropriate management?

A. Follow up B. Give thyroxine now C. Give thyroxine during pregnancy D. Proceed to pregnancy without any management

50- 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

46 Y.O. male patient with Hypothyroidism on low dose levothyroxine for 12 weeks, still complaining Of Symptoms and her TSH is still high. What is the best next step?

A. Follow up after 3 weeks B. Increase the dose and follow up after 3 weeks. C. Increase the dose and follow up after 6 weeks. D. Increase the dose and follow up after 12 weeks.

61 YO. male Patient came for routine check up. His Echo showed concentric LV hypertrophy and severely stenotic aortic valve. His Ejection fraction is normal. ECG is unremarkable, and he is asymptomatic. what is the most appropriate next step?

A. Follow up in 6 months. B. AV replacement. C. Balloon valvuplasty. D. ACE inhibitors. · Patient asymptomatic + severe aortic stenosis + normal ejection fraction (more than 50%) --> follow up 6 months --> no need for valve replacement now Need revision

271- 65 YO male presented to ER with acute left lower limb pain for 3 hours. Associated with numbness and absent pulse. ECG: Atrial fibrillation. What is the best next step?

A. Heparin B. CT Angiography C. Arteriography D. U/S doppler

26 YO. female patient with HCV antibody positive and HCV RNA negative, Asymptomatic and all labs and LFTs are normal. What is the best next step?

A. Follow up with HCV RNA after 6 months. B. Repeat HCV RNA. C. No need for further testing. D. Start antiviral therapy. PCR negative + no symptoms + LFT normal Approach to HCV Positive HCV antibody --> next step PCR for HCV RNA to confirm PCR negative --> reassurance PCR negative + LFT abnormal --> repeat PCR after 6 months PCR negative + Symptomatic --> repeat now

How to do a Pap smear?

A. From transformation Zone B. From the Ectocervix C. From the endocervix

43 YO male felt drowsy while awaiting in the clinic waiting room. His blood sugar was low. What is the best management?

A. Fruit Juice B. Intravenous 5% dextrose C. Normal Saline D. Intramuscular glucagon · First line of treatment is oral fast glucose (fruit juice) · IV dextrose if patient unconscious or vomiting · Intramuscular glucagon if difficult access

Which of the following is expected to decrease mortality in a patient with heart failure?

A. Furosemide B. Lisinopril C. Digoxin D. Nitroglycerin · Medications that reduce mortality rate in CHF o ACEIs/ ARBs (lisinopril) o BB o Spironolactone o SGLT2 o BIDIL o ARNI o Controlling comorbidities

208- There was a question about a lady known case of gallstones for 15 years presented with abdominal pain and fatigue There was air in biliary system, what is the diagnosis?

A. Gallstone ileus B. Acute Cholecystitis C. Acute pancreatitis

145- Patient with history of vomiting for 24 hours due to food poisoning. He came today to emergency department complaining of hematemesis. Nasogastric tube was done and showed fresh blood. What is the most likely diagnosis?

A. Gastritis B. Dieulafoy lesion C. Peptic ulcer D. Mallory Weiss syndrome

254- A case of basal ganglia stroke, with difficulty in swallowing and absent gag reflex. History of losing weight. How to provide nutrition?

A. Gastrostomy B. Jejunostomy C. NGT

Newly married young woman came for routine check up gyne, highest diagnostic value?

A. General appearance B. Vaginal inspection C. Abdominal exam D. Pelvic digital exam

Lady is 34 wks. gestation, had a previous one C/S, on pelvic exam only the cervix was 3 cm dilated, on US placenta was anterior and laying low. Why is ECV contraindicated in this case?

A. Gestational age B. Vaginal exam findings C. US findings. D. The previous C/S

A Female at 31wks gestational age presented with cervical dilatation and no uterine contractions. What is the best thing to do?

A. Give Bed Rest B. Do A Cerclage C. Tocolytics D. Antibiotics

65 YO male known case of heart failure came with lower limb edema and ascites. He is on ACEI and furosemide. Examination revealed large ascites. Which of the following is the best next step?

A. Give IV diuretics B. Therapeutic paracentesis C. Increase the dose Of furosemide D. Add spironolactone · In this patient: overload symptoms --> give IV diuretics · Increasing the dose of oral furosemide is not enough in case of large ascites, IV furosemide is the best · Therapeutic paracentesis is indicated if failure of all medical treatment to relief ascites · Approach to decompensated heart failure o First decide how critical? § Hypotensive - cold extremities - AMS --> cardiogenic shock § Hypertensive - worsening overload status - warm extremities --> hypertensive heart failure vs acute flash pulmonary edema o Cardiogenic shock? § Keep MAP > 65 § First line: dobutamine § Second: milrinone o Warm and overloaded? § Lasix (furosemide) § Nitrate § Bipap/ Cpap: increase intrathoracic pressure--> decrease preload

Preganat c/o sever abdominal pain and uterine cotractions she was given 6mg Mg sulfate and the e contractions become normal then decrease the dose to 4mg, then she complained of shortness of breath. What to do?

A. Give her oxygen B. Change to left lateral position C. Stop Mg sulfate and give Ca gluconate Magnesium toxicity -> Deep tendon reflexes are lost, respiratory depression, and cardiac arrest - When toxicity occurs? The infusion should be stopped emergency correction with calcium gluconate

60 YO male post cholecystectomy 4 days ago presented to ER with chest pain started 4 hours ago and ECG showed STEMI. 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 · First thing to do after the diagnosis of STEMI is PCI · Unless if the hospital doesn't have open cath lab . Then give thrombolytic if not contraindicated

Pregnant in 2nd tri which vaccine?

A. H. influenza B. DTAP Depends on the gestational age if 1st or second trimester-> I would go with influenza if third trimester -> I would go with Tdap

151- 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

70 YO male developed intracranial hemorrhage and was admitted to ICU on mechanical ventilation. 3 days later he developed coffee ground emesis. What is the most likely cause?

A. H.pylori gastritis B. Dyspepsia C. Stress gastritis D. NSAID induced gastritis ICU + sick as shit patient + mechanical ventilation (highest risk) --> must be on high dose PPI to prevent stress ulcer (Cushing ulcer)

27 YO 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. CSF Toxoplasmosis testing. C. CSF Syphilis serology. D. Herpes simplex testing

A patient with acute salpingitis, she was treated with IV ceftriaxone but did not improve. What is the most likely causative organism?

A. HSV B. Neisseria gonorrhoeae C. Chlamydia trachomatis D. Adenovirus

What would you expect in pregnancy?

A. Hematocrit decrease by 20-25% B. Hematocrit decrease by 40-45% C. blood volume increase by 20-25% D. blood volume increase by 40-45%

25 years old female with thyroid nodule. TSH and T4 normal. FNA cytology done and according to Bethesda classification (Stage Ill). what is the most appropriate management?

A. Hemithyroidectomy. B. Repeat FNA C. Radioactive iodine. D. Total thyroidectomy.

Boy with glomerulonephritis ( hematuria ), after week he developed hemoptysis what is the dx ? •

A. Henoch schenolein Purpra • B. Goodpasture syndrome • C. Rapid deterioration • D. Ig A Nephropathy

65 YO male presented to ER with acute left lower limb pain for 3 hours. Associated with numbness and absent pulse. ECG: Atrial fibrillation. What is the best next step?

A. Heparin B. CT Angiography C. Arteriography D. US doppler · Acute leg pain + pulselessness + numbness + AFib = acute limb ischemia · ALI approach: o Hx and PEx suggestive of ALI o Ankle brachial index o Heparin (one of rare disease where empirical treatment given before any investigations) à heparin to prevent progression of the embolus o Radiological confirmation § CTA if not immediately threatened (no numbness - no paralysis) § Conventional angiography (definitive): if numbness or paralysis à to provide diagnostic and therapeutic value o Tx: revascularization if viable and threatened (within 6 hours) § Angiography: catheter directed thrombolysis - balloon angioplasty § Open: embolectomy o Tx: if not viable § Limb amputation o Complications § ALI à compartment à fasciotomy § Reperfusion injury à hyperkalemia - metabolic acidosis - rhabdomyolysis

272- 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

Patient developed DVT, had C-section 10 days ago. What to give?

A. Heparin B. IVC C. Thrombolytics D. Embolectomy

45 YO female presents three days after returning from Thailand complaining of severe muscle ache, fever and headache. On examination she has a widespread maculopapular rash. Blood results show the following: Hb 162 Plt 96 WBC 2.4 Malaria film: negative What is the most likely diagnosis?

A. Hepatitis A B. Japanese encephalitis C. Malaria D. Dengue fever Travel + fever = think about Malaria and denge fever Malaria is more common ( that's why they usually mention its -ve ) Low WBC indicated viral infection not bacterial Laboratory tests Leukopenia. Thrombocytopenia. ↑ AST. Hct elevated ≥ 20% of normal values (in DHF). Best test for confirming infection: serology (IgM, IgG).

28 YO female presented with jaundice for 2 weeks. Associated with fatigue and arthralgia for 11 months. She is not on any medications and she doesn't drink alcohol. O/E she has hepatomegaly. Viral hepatitis screening is —ve. AST 920 ALT 890 Alk phos 169 alb 30 Total bilirubin 26. what is the most likely diagnosis?

A. Hepatocellular carcinoma B. Primary biliary cirrhosis C. Autoimmune hepatitis D. Acute cholangitis Young female + arthralgia + AST and ALT way higher than biliary stuff =Autoimmune hepatitis Acute Hepatitis: young female - autoimmune disease - high ALT AST - ANA - ASMA PBC: middle age female - high alkaline phosphatase and GGT - AMA PSC: young male - UC - high alkaline phosphatase and GGT --> diagnosis by MRCP

114- 24 years old male medically and surgically free, presented with manifestation of intestinal obstruction, suspected to be small bowl obstruction, what is the most common cause?

A. Hernia B. Adhesion C. Meckel's diverticulum D. Malignancy

65 YO with liver cirrhosis is reviewed in clinic. Which one Of the following factors is most likely to indicate a per prognosis?

A. High Alanine transaminase B. High GGT C. Ascites D. High urea Poor prognosis cirrhosis · Ascites · Encephalopathy · Albumin · INR . Bilirubin

Female pregnant, what of the following true regarding Elevated BhCG?

A. High BhCg indicator of ectopic pregnancy B. High BhCg in second Trimester indicator of molar pregnancy C. High BhCg in second Trimester is the most sensitive marker of Down syndrome D. High Bhcg can cause depression of TSH

Female pregnant, what of the following is true regarding elevated BhCG?

A. High BhCg indicator of ectopic pregnancy B. High BhCg in second trimester indicator of molar pregnancy. C. High BhCg in second trimester is the most sensitive marker of Down syndrome. D. High Bhcg can cause elevation of TRH which causes hyperthyroidism

31 weeks came after having premature PROM 1 week ago, Picture of CTG showing decreased variability + variable deceleration On pelvic exam there's fluid around the os + open 4cm dilation (not sure about the number) What to do next?

A. High vaginal swab for culture B. C/S C. betamethasone D. MgSo4 Prompt delivery in: intrauterine infection - abruption - nonressuring FHR - cord prolapse

A 60-year-old female presented with hypertension, proximal muscle weakness, weight especially in the upper body and purple striae on the lower abdomen. Which of these tests gives a clue about the etiology of the most likely diagnosis?

A. High-dose dexamethasone suppression test. B. 24-hour urinary free cortisol. C. Low-dose dexamethasone suppression test. D. Midnight salivary cortisol. B-C-D all to diagnose Cushing A to know the etiology

307- 12 years old obese male presented to ER complaining of left hip pain after falling down. He can't weight bear. O/E the hip is slightly flexed and externally rotated. What is your working diagnosis?

A. Hip dislocation B. Septic hip C. Neck of femur fracture D. Slipped Capital Femoral Epiphysis

Pregnant G3P2 37 weeks with a history of CS because of nonreassuring CTG. She is in labor with a 4 cm dilation. The presentation is breech. What is the absolute contraindication for ECV?

A. History of CS B. Active labor C. Variable decelerations

26 Y.O. male patient presented to the hospital with syncope during a football game. His father had a sudden cardiac death at 37. O/E he has mid-systolic murmur heard best at the left lower sternal border. ECG is normal. What is the most appropriate next step?

A. Holter monitor B. Reassurance and education C. CXR D. ECHO · Syncope + family history of sudden cardiac death + murmur --> echo is the next step (typical presentation of HOCM)

26 Y.O. male patient presented to the hospital with repeated attacks of syncope during micturition and while coughing. His ECG is normal. What is the most appropriate management for this patient?

A. Holter monitor B. Reassurance and education C. Tilt table test. D. ECHO. · Repeated syncope after micturition or coughing --> vasovagal attacks · Vasovagal syncope: no need for further investigation --> reassurance and education

26 Y.O. male patient presented to the hospital with syncope. The attack is preceded by nausea, sweating and fear. His ECG is normal. What is the most appropriate management for this patient?

A. Holter monitor B. Reassurance and education. C. Tilt table test. D. ECHO. · Syncope preceded by nausea and sweating à vasovagal à reassurance and education · Tilt table if atypical presentation · Echo if ECG abnormal

• 56 years old male patient presented with fatigue, SOB, elevated JVP which increases with inspiration, ascites and positive shifting dullness. BP 102/67. which of the following has the highest diagnostic value for his condition?

A. Holter monitor. B. Cardiac CT. C. Coronary angiogram. D. Stress ECG. · Dyspnea + Kussmaul sign + ascites + normotension = constrictive endocarditis · Best to diagnose: cardiac CT (calcification in the pericardium)

A 30 yo woman G2 P1 at 34+2 weeks gestation presents to emergency room reporting painless vaginal bleeding. Immediately transvaginal ultrasound shows placenta completely overlying the cervical os. A fetus in cephalic presentation, and an amniotic fluid index of 14. The cervical appears long and closed on speculum examination. She has slow, continuous vaginal bleeding. Fetal heart is monitored (image missing) BP 110/78 HR 106 RR 14 Temperature 36.9C Which of the following is the most appropriate in management?

A. Hospitalization B. Betamethasone C. Caesarian section D. Magnesium sulfate

30y old female came for pap screening, all her past results were negative, now results show low grade squamous epithelial lesion. What's the appropriate next step?

A. Humen papilloma virus B. Colposcopy C. evaluate after 6 months D. Surgery .

58 YO male known to have HTN, and DM found to have proteinuria. Which of the following medications should be started?

A. Hydrochlorothiazide B. Lisinopril C. Propranolol D. Losartan · HTN + DM + proteinuria à Start ACEIs (lisinopril) · DM + proteinuria à Start ACEIs (lisinopril) à to protect the kidney

331- Patient with Cushing Syndrome with proven Right Adrenal Adenoma on MRI for resection, what is the peri operative management?

A. Hydrocortisone B. Fludrocortisone

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

What come with Turner syndrome ? •

A. Hypothyroid • B.DM type 2 • C. Addison's • D-Adrenal hyperplasia

patient can't take BCG vaccine Because he deficiency in •

A. IL-6 • B. TNF gama • C. IL-12 • D-CD19

Urine Dipstick pic with: +2 protein, very high glucose, +ve ketones in pregnant lady 39 weeks with effacement 90% and cervix dilation 2 cm, what is your most appropriate action?

A. IOL B. CS C. Expectant management · Induction recommended in DKA

Patient with cardiovascular disease, she wants contraceptive, what type of contraceptive appropriate for this patient?

A. IUD B. OCP C. POP (progestogen-only pill) D. Condom

Women with HTN what do you expect the complications?

A. IUGR B. Abnormal placental lining

41- A female with bilateral tubo-ovarian abscess came with very severe abdominal pain, what is appropriate management?

A. IV Antibiotic B. CT guided draining C. laparotomy

A female with bilateral tubo-ovarian abscess came with very severe abdominal pain, what is appropriate management?

A. IV Antibiotic B. CT guided draining C. laparotomy

43 YO male presented to ER with syncope and hypotension. ECG showed SVT. What is the best next step?

A. IV adenosine B. Defibrillation C. Cardioversion D. IV metoprolol · SVT + unstable (syncope or/and hypotension) = cardioversion · SVT + stable: o First: vasovagal maneuvers (carotid massage - ice pack - Valsalva) o Second: IV adenosine o Third: IV adenosine second dose · Defibrillation vs cardioversion: o All unstable tachyarrhythmias: cardioversion o Defibrillation: ventricular fibrillation - pulseless ventricular tachycardia

235- 25 year old male Pt 8th day post surgery with wound site redness & tenderness with purulent discharge.. most appropriate?

A. IV antibiotics B. CT abdominal C. open drainage D. exploratory laparoscopy

43 YO male medically free, recently came back from Africa, presented to ER with Hx of fever and confusion for 4 days. Thick and thin blood smear: plasmodium falciparum species Which Of the following is the best treatment ?

A. IV artesunate B. Doxycycline and Quinine C. Clindamycin and Quinine D. Chloroquine and Primaquine Confusion is alarming and IV treatment is indicated Malaria Approach o First line: artesunate + sulfadoxine + pyrimethamine o Second: artemether + lumefantrine o Severe: IV artesunate · Sx: o High spiking fever periodic o Headache o Thrombocytopenia o Hemolytic anemia o Hepatosplenomegaly o Jaundice o CNS · Severe: Impaired consciousness, shock, and abnormal bleeding are signs of severe malaria that requires immediate IV treatment.

110- 58 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

60 years-old man is admitted to the Coronary Care Unit with acute myocardial Infraction. His hemodynamic parameters 2 hours later are: bp 80/50 mmHg HR 40 /min Sp02 95% on room air. Which Of the following would be the most appropriate management?

A. IV atropine sulphate B. Normal saline infusion C. IV isoprenaline D. IV dobutamine · Any patient with symptomatic bradycardia first line of treatment is IV atropine · After the first dose if still not improving: repeat two more doses if needed ' IV fluid wont help: the problem is not from the tank, its from the pump

6 months uncircumcised pediatric UTI how to treat: •

A. IV ceftriaxone • B. IV cefepime • C. Oral Cefuroxime • D-Oral Augmentin Oral antibiotic is the first line treatment in upper and lower UTI • Antibiotic of choice: Oral cephalosporine: Cefuroxime Other choices : Augmentin , TMP?SMX , nitrofurantoin IV antibiotic can be given: • In neonates . Cant tolerate orally • Severely ill patients • Immunosuppressed patients • Patients with underlying renal disease

49 YO male presented with abdominal pain and diarrhea for 3 days. He was recently admitted for pneumonia and received tazocin for 5 days. Clostridium difficile PCR came back positive. What is the best treatment?

A. IV fidaxomicin B. IV metronidazole C. Oral vancomycin D. IV vancomycin

Pregnant woman at 15 weeks of gestation, came with severe bleeding and component seen in cervix. What is the most appropriate next management?

A. IV fluid and misoprostol B. IV fluid and expectant management C. IV fluid and D&C D. IV fluid and uterine message Management of abortion - Expectant management (if ≤13 weeks GA): - Medical (up to 20 weeks GA) By two different medications mifepristone followed by misoprostol - D&C: if severe bleeding - infection - hemodynamic instability regardless of the gestational age

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. Admit ICU and observe C. Craniotomy D. Insert intracranial monitor Uptodate Guidelines recommend surgical evacuation for pt with acute SDH who have clot more than 10mm or midline shift more than 5mm regardless of GCS score

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

Pregnant with 33-week gestation presented with severe headache protein urine +3, Bp 150/100, asking what to do?

A. Immediate C/S. B. delay for a week and give steroid. C. Admitted for observation preeclampsia with severe features which is managed by: <34 weeks = Admission + Corticosteroid + Magnesium sulfate (seizure prophylaxis) + IV Labetalol

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

38 week pregnant came in labor cervix was 10 cm dilated baby is in -3 station, CTG: bradycardia, poor variability with recurrent late deceleration, the mother developed abdominal pain and blood, what is the most appropriate next step (No CS in the choices)

A. Immediate laparotomy B. Observation C. Send to home and give follow up appointment

22 years old, female married never did pap smear before when to do it?

A. Immediately B. 3 years C. 5 years D. No need

Patient had HBsAg -ve, Anti-HBc IgG, Anti-HBs +ve. What is the diagnosis?

A. Immune because of vaccination B. Immune because of natural infection C. Chronic infection D. Acute infection

Ectopic pregnancy is a defect in which process?

A. Implantation B. Fertilization

115- A patient underwent a hernia repair operation 12 years ago, now presents with signs of intestinal obstruction. Which of the following is the most likely cause?

A. Improper Repair B. Late Onset Crohn's C. Adhesions D. Cause Is Irrelevant to The Prior Surgery History Most common cause of SBO: - Virgin abdomen: hernia - Hx of surgery: adhesion

A child with birth weight 3.5kg now weighing 3.1. Breastfeed every 4 hours . Advise to mother ?

A. Improve maternal nutrition B. Reassure that all is well C. Admit for full work up D-Add formula milk Physiological weight loss It is expected that newborns will lose some weight in the first 5-7 days of life. A 5% weight loss is considered normal for a formula-fed newborn. A 7-10% loss is considered normal for breastfed babies. Most babies should regain this lost weight by days 10-14 of life

128- Adult soldier with bilateral inguinal swelling with positive cough impulse what is the most appropriate management?

A. Laparoscopic repair B. Herniotomy C. Open hernia repair and mesh D. Observation

Lactating women present with right breast pain for 6 day on examination, hot tender swelling lateral to the right areola Pt started to take floxacillin Ultrasound showed Cystic lesion, thickened content, What next?

A. Incision and drainage B. Repeated aspiration C. Excisional biopsy D. Reassurance or antibiotic indications for aspiration: - Small < 5cm - single abscess - Normal skin over the lesion (not thin or gangrenous)

72 YO male K/C Of CHF on ACE inhibitors, spironolactone and furosemide. Presented with hypotension. Admitted and started on IV fluids. Labs shows increased urea and creatinine and FENa 0.6%. What is the best next step?

A. Increase furosemide. B. Increase spironolactone C. Increase fluids carefully D. Increase lisinopril · Patient have CHF and presenting with hypotension only without symptoms of overload + increase in creatinine and urea and FENa < 1% (meaning sodium is not being lost in urine) indicating acute (prerenal) kidney injury due to hypotension · Primary issue in this patient now is hypoperfusion of the kidney most likely due to shock (shock --> hypotension à decrease renal perfusion --> acute prerenal injury) · No fluid overload à fluid can be given safely if done carefully · The answer is to increase fluid carefully to improve kidney perfusion

171- 36 Y.O. male patient k/c of crohn's diseases on infliximab and Azathioprine. Presented with perianal swelling and tenderness. What is the most appropriate Management?

A. Increase infliximab dose and decrease frequency. B. IV antibiotics. C. Perianal swab. D. Incision and drainage.

36 YO. male patient k/c of crohn's diseases on infliximab and Azathioprine. presented with perianal swelling and tenderness. What is the most appropriate Management?

A. Increase infliximab dose and decrease frequency. B. IV antibiotics. C. Perianal swab. D. Incision and drainage. Infliximab won't take away the abscess Swab will show polymicrobial --> useless Crohn's complications · Swelling and discharge and tenderness --> perianal abscess --> I & D · Discharge only --> fistula --> MRI · Any fistula with IBD is complex --> will require MRI pelvis Most appropriate in IBD fistula is infliximab

45 years old female known case of hypothyroidism on levothyroxine with high TSH. The patient is scheduled for elective surgery. What is the most appropriate management?

A. Increase levothyroxine dose. B. Stop levothyroxine before the surgery. C. Postpone the surgery until euthyroid is restored. D. Proceed with the surgery and prescribe thyroxine after the surgery. never proceed with surgery until you achieve euthyroid status.

60 YO. female patient diagnosed with type 2 diabetes. She started metformin 1 gm BID. After 3 months her FBG is normal. RBS is normal. HbA1c is 6.9. which of the following is the best next step?

A. Increase metformin dose. B. Add glimepiride. C. NO need to change. D. Add DPP-4 inhibitor. · No need to change A1C < 7%

Physiological changes in pregnancy that can lead to heart failure in patient with mitral stenosis

A. Increase minute ventilation B. Increase RBC mass C. Increase renal plasma flow D. Increase plasma volume

44 YO female patient diagnosed with Hypothyroidism and started on levothyroxine 50mcg. After 2 weeks her TSH is 7.5 (high). What is the best next step?

A. Increase the dose and follow up after one month. B. Continue the same dose and follow up after one month. C. Continue the same dose and follow up after 12 weeks. D. Increase the dose and follow up after 12 weeks. · Follow up after starting thyroxin is after 6 weeks --> continue same dose and FU after one month

Healthy lady with Preterm labor what to give her?

A. Indomethacin B. magnesium sulfate C. Nifedipine D. Terbutaune or nitroglycerin Tocolytic choices First line: - Indomethacin < 32 weeks - Nifedipine <34 w - Terbutaline 32-34 w

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. Crohn's complications · Swelling and discharge and tenderness --> perianal abscess --> I & D · Discharge only --> fistula --> MRI · Any fistula with IBD is complex --> will require MRI pelvis . Most appropriate in IBD fistula is infliximab

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. Crohn's complications · Swelling and discharge and tenderness --> perianal abscess --> I & D · Discharge only --> fistula --> MRI · Any fistula with IBD is complex --> will require MRI pelvis Most appropriate in IBD fistula is infliximab

28 years old female with history of recurrent pregnancy loss. She comes now want to improve her immunity before trying to conceive. What you will give her?

A. Influenza vaccine B. Rubella vaccine C. Hepatitis D. B immunoglobulin

baby with recurrent infection tb, aspergillosis all type of infection with history of brothers death at 3 year with same pt give? •

A. Influenza • B. BCG • C. Varicella • D. Polio

Woman G2 P1 at 32 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 Preterm Labor: Regular uterine contractions with cervical before week 37 - ≥34 weeks of gestation --> Admitted for delivery! - <34 weeks of gestation --> betamethasone - Tocolytic -Magnesium sulfate before 32 weeks of gestation Prelabor Rupture of Membrane (PROM): rupture of membrane before labor after week 37 - Speculum Examination: Pooling of amniotic fluid in the posterior vaginal vault observed is the gold standard - Induction of labor - Expectant management for up to 12-24 hour - GBS Prophylaxis duration > 18hrs or fever 38C! Preterm Prelabor Rupture of Membrane (PPROM): rupture of membrane before the onset of labor < 37 week - Week 34-37: expectant management or immediate delivery - Week < 34: betamethasone - GBS prophylaxis - Tocolytic - Magnesium sulfate before 32 weeks of gestation Prompt delivery in: intrauterine infection - abruption - nonressuring FHR - cord prolapse

Patient known case of asthma on albuterol , diagnosed as moderate persistent asthma what you will add ?

A. Inhalation corticosteroid. C. Theophylline D. Montelukast A if no ICs + laba

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 She is still 5 cm dilated (latent phase) no need for intervention she can stay in the latent phase up to 20 hours. When to choose IV oxytocin? -> if rupture of membrane is mentioned in the question. To avoid infections, otherwise? NO INTERVENTION IN THE LATENT PHASE AT ALL

22 years old female pregnant, with pregnancy test positive at home, came with sever abdominal pain, in examination cervical is closed, there is fluid collection 15*13. Thin endometrium and empty uterus. what is the diagnosis?

A. Intact ectopic pregnancy B. Ruptured ectopic pregnancy C. Luteal phase

165- Patient with rectal bleeding 5 and 7 o clock, sclerotherapy done, what type of hemorrhoid treated?

A. Internal B. External C. Prolapse D. Thrombosed

309- Patient came after limb trauma, with severe pain and paresthesia between his toes and it was pale. X ray shows fractures, intercompartmental pressure was 35mmhg what to do?

A. Internal fixation B. Closed reduction C. External fixation D. External fixation with four fasciotomies

55 YO female post thyroidectomy complaining of hoarseness of voice and repeated episodes Of chocking. Which Of the following nerves is most likely injured?

A. Internal laryngeal nerve B. External laryngeal nerve C. Superior laryngeal nerve D. Recurrent laryngeal nerve · Unilateral RLN o Hoarseness o Aspirations · Bilateral RLN o Immediately after extubating, stridor, dyspnea · Superior LN o Cannot speak in high notes o Voice fatigue

108- 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 pregnant about 31 weeks presented with bleeding and cervix dilated 7 cm ( no mention of any contractions , What is the type of bleeding? -

A. Intrapartum B. Antepartum C. Post partum - Antepartum hemorrhage: Vaginal bleeding after 20 weeks of gestation that is unrelated to labor and delivery - Intrapartum hemorrhage: Vaginal bleeding occurring in the course of normal labor and delivery

70- Patient with blunt chest injury resulted in fracture in 3rd, 4th and 5th ribs in more than one site. What is the initial treatment?

A. Intubation B. Assisted ventilation C. IV fluid.

74- Post RTA patient complex femoral fracture and tension pneumothorax, chest tube inserted and transporting to higher center, in transit the patient is desatting and tachypnoeccardic what to do?

A. Intubation B. Nothing C. Check for bleeding form fracture site D. Confirm placement of chest tube

222- 50 years old with Ischemic Heart Disease (IHD), Diabetes mellitus (DM) Admitted to ICU with severe pneumonia and was treated with Antibiotics. After 3 days of admission, he developed hypotension and treated with hydration and inotrope, on admission lab was normal After 3 days, LFT was abnormal Total Bili is 20 (increased), very high AST and ALT (1000), mild increase in LDH, US done and showed unremarkable findings, what is the diagnosis?

A. Ischemic hepatitis B. Intravascular hemolysis C. ICU related jaundice D. Acalculous cholecystitis

Child brought by his father in wheelchair complaining of knee swelling and history of falling on his knee. What is the best investigation ?

A. Joint Aspiration. • B. X-ray. • C-ANA • D-ESR

312- Case suspected to have renal stone, what's the best diagnostic tool:

A. KUB X Ray B. Ultrasound C. CT D. MRI

Women deliver baby with Down syndrome, and she wants to know about future pregnancy. Which of the following is BEST choice of her?

A. Karyotype of infant B. Karyotype of infant and mother. C. U/S in next pregnancy D. Amniocentesis in next pregnancy

- 54 years old female presented to gynecology clinic complaining of dysuria and urinary incontinence, she stated that the leak is not related to specific activities and occasionally associated with cough. Upon investigation urinalysis and cultures were insignificant, However, urodynamic study showed: contracting bladder even with small amount of dripping. Which of the following is the most appropriate management?

A. Kegel exercise B. Anterior Colporrhaphy C. Anticholinergic agent D. Bladder Suspension According to the urodynamic study, the patient has Urgency urinary incontinence. Therefore the definitive treatment is Anticholinergic medications.

Para 4 urinary frequency with no leak work as loading heavy boxes to her shop, on exam there's a large bulge on the anterior vaginal wall.

A. Kegel exercise B. Vaginal pessaries C. anterior colporrhaohy

50 year old female, presented complaining of a sensation of pelvic pressure but no stress incontinence. Her work involves lifting heavy objects. On examination you find mucosa bulging through the vagina. What's the most appropriate management?

A. Kegel exercises B. Pessary C. Bladder neck fixation D. Colporrhaphy

207- 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

Pt known he asthmatic he is on SABA only came to ER with sob and now dx by (persistent moderate asthma) what you will add on his medication?

A. LABA B. ICS C. ICS and LABA

Preeclampsia scenario. What you ordered?

A. LFT B. Platelet C. Urinalysis First thing is to do urine analysis to distinguish gestational hypertension from preeclampsia

297- A 66 years old female admitted to general surgery ward after major rectal surgery, on the second day she developed leg swelling on the side of the operation. investigations showed DVT on the femoral vein. the best management to this patient is:

A. LMWH. B. Thrombolytic therapy. C. Warfarin. D. Inferior vena cava filter.

129- 30 years old male had open hernia repair few years ago, presenting now with reducible inguinal hernia on one side extending to hemiscrotum. what is the appropriate thing to now?

A. Laparoscopic repair with mesh B. Open repair C. CT abdomen D. US

84- 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

Patient had a salpingostomy, she is following up with the hcg every week, they noticed the hcg plateaued for 3 weeks on 3442, what's next?

A. Laparotomy B. OCP C. Methotrexate D. Reassurance

242- Patient involved in Road Traffic Accident (RTA) with multiple mandibular fracture with sever bleeding, unconscious, no vitals mentioned How would your mange his Airway?

A. Laryngeal mask B. Orotracheal C. Nasotracheal D. Cricothyrotomy

Patient involved in Road Traffic Accident (RTA) with multiple mandibular fracture with sever bleeding, unconscious, no vitals mentioned How would your mange his Airway?

A. Laryngeal mask B. Orotracheal C. Nasotracheal D. Cricothyrotomy RTA + facial fractures (mandibular) + unconscious = definitive airway = cricothyrotomy UPTODATE: Conditions associated with a difficult airway that may necessitate cricothyrotomy include massive hemorrhage, profound emesis, trismus, obstructing lesions (eg, tumor, polyp), upper airway occlusion (foreign body, edema, anaphylaxis), and a broad array of traumatic and congenital deformities

55 YO male patient recently diagnosed with DM presented with central weight gain of 12 kg over the last 2 months. Associated with fatigue and weakness. Patient also noticed the development of multiple bruises recently. On examination his BP is 157/94. His labs showed: high free urinary cortisol, high morning 8am cortisol level after administration of 1 mg dexamethasone at 11 pm, and low ACTH. What is the most appropriate next step in evaluation?

A. Late night salivary cortisol B. Brain MRI C. Adrenal CT D. Chest CT This is presentation of Cushing Diagnosed by two tests ACTH low --> adrenal disease --> CT adrenals if ACTH high --> do high dexamethasone suppression test --> if ACTH still high --> its ectopic --> do MRI/CT chest --> if ACTH dropped --> its from the pituitary --> MRI brain

161- 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.

34- A 35 year old lady presents with a left nipple bloody discharge, by imaging it was suggestive of Intraductal papilloma. What to do next?

A. Left Central Duct excision B. Observation C. Interval follow up imaging D. image guided biopsy

40 years old male with left neck mass, thyroid ultrasound done and showed 1.5*2 cm cold mass, FNA cytology revealed suspicious follicular neoplasm, which of the following the best initial management?

A. Left hemithyroidectomy. B. Repeat FNA. C. Prescribe thyroxine. D. Radioactive ablation Follicular neoplasm = Bethesda 4, so go for hemithyroidectomy.

323- 18 months child with left Undescended testes not palpable in the inguinal region, left one is there what's the most appropriate to do?

A. Left orchidopexy B. Diagnostic laparoscopy C. Wait till 3 years

Postmenopausal women with a history of fibroid "certain size" increased. What's the diagnosis "endometrium were 5 mm pt on tamoxifen"

A. Leiomyosarcoma B. Endometrial cancer C. Adenomyosis

191- Patient obese, history of jaundice for 1 week with anorexia and abdominal pain, examination showed right upper quadrant tenderness, no history of medication or disease, what is initial step?

A. MRCP B. Abdominal US C. CT D. Biopsy

40 years old with post coital bleeding and intermenstrual bleeding She had 3 pap smears positive and did a cystoscopy showed intraepithelial carcinoma ,What is the next step ?

A. MRI abdominal B. Cone biopsy C. LEEP D. CT abdomen chest pelvis

Ectopic pregnancy at 7 or 9 week, 4 cm mass. (Bhcg not mentioned). Mx?

A. MTX B. Surgical C. Observation

46 Y.O. male patient known to have HTN on amlodipine and losartan. His BP is not controlled. What is the best medication to add?

A. Lisinopril B. Indapamide C. Atenolol D. Spironolactone · Patient on CCB and ARBs and still not controlled à add thiazide (indapamide) · Exclusion o Lisinopril: its contraindicated to give ARBs and ACEIs together o Atenolol: BB are not the first line to treat HTN o Spironolactone: is not the first line to treat HTN

212- Young female suddenly developed jaundice and fatigue. She high ALP and high bilirubin. No splenomegaly or hepatomegaly. US: no finding. MRCP: multiple foci of stricture and dilatation. What is best initial next step?

A. Liver biopsy B. Antinuclear antibody C. Repeat US D. Colonoscopy

41 YO male veterinarian presents with 3 months history of lower back pain along with fatigue, change mood and behavior and with paresthesia. He is a nonsmoker, nonalcoholic with no significant past medical history. Examination shows hepatosplenomegaly and sacroiliac joint tenderness. Labs shows low Hgb. what is the best management?

A. Liver function test B. Serum agglutination test C. Tuberculosis skin test D. X-ray Sacroiliac joint Diagnosis is Brucellosis Serology (initial): serum agglutination, ELISA. Confirmatory test: - Blood culture. - Bone marrow biopsy specimen and culture (gold standard) Antibiotic therapy First-line therapy: doxycycline and rifampin. Second-line therapy: doxycycline and streptomycin.

While the obstetrician closes the caesarean incision, patient developed bleeding. What is the cause?

A. Liver hemangioma B. Spleen aneurysm C. Perforated peptic ulcer D. Mesenteric ischemia

Pregnant in labour at term. OE (Head in funds and both hip and knees are flexed ) spine of baby parallel to spine of mother. What is the lie?

A. Longitudinal B. Transverse. C. breach D. cephalic

Sickle cell anemia patient pregnant, antenatal complication associated with her condition?

A. Low birth weight (IUGR) B. Chest infection C. UTI

337- 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

Case of an asthmatic patient complaining of shortness of breath in supine with dysphagia, CT scan done and showed midline mass, what is the most likely diagnosis?

A. Lymphoma. B. Thymoma. C. Goiter. D. Lung nodule.

28 WEEKS PREGNANT (NUU), PRESENTS WITH GENERALIZED FATIGUS BLOOD PRESSSURE:162, PROTIN IN URINE3+, WHAT IS YOUR NEXT STEP?

A. MGSO4 B. LABETALOL C. METHYLDOPA

Which of these causes IUGR?

A. Oligohydramnios B. Polyhydramnios C. Preeclampsia

Soldier going to southern region of Saudi Arabia. What is the best malaria prophylaxis?

A. Malarone B. Atovaquone-proguanil C. Mefloquine D. Chloroquine

144- Male patient complains of episode of hematemesis. normal past medical history Labs show mild anemia, all labs are normal except elevated urea level in blood, what is the diagnosis?

A. Mallory Weiss syndrome B. Erosive gastritis C. Peptic Ulcer Disease

Pregnant with preeclampsia at 36 weeks, developed seizure. After stabilization you should give Mg Sulfate to?

A. Manage her seizure B. Prevent the seizure attack C. For fetal neuroprotection

73- Trauma patient with hypotension, X-Ray reveled: Trachea shifted to the right, expanded lungs and widened mediastinum. What is the diagnosis?

A. Massive hemothorax B. Pneumothorax C. Thoracic aorta rupture D. Spontaneous pneumothorax

45- 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

17 Years old female, no menstruation, normal testosterone, Normal breast development, normal pubic hair?

A. Mayer Rokitansky Kuster Hauser syndrome (or Mullerian agenesis) B. Complete androgen insensitivity C. Congenital hypothyroidism

17 Years old female, no menstruation, high testosterone, Normal breast development, coarse pubic hair?

A. Mayer Rokitansky Küster Hauser syndrome (or Mullerian agenesis) B. Complete androgen insensitivity C. Congenital hypothyroidism

Case of ectopic pregnancy Bhcg 3400, 3 cm what do?

A. Medical treatment B. Surgical

Pregnant women with brown spot in her face?

A. Melasma B. Chloasma

A child came with bilateral parotid swelling, and he is unvaccinated Most complication in child ,?

A. Meningitis... B. Encephalitis C. Orchitis D-Thyroiditis

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 D. Thyroglossal cyst

Which of the following medications is shown to reduce mortality in diabetic patients?

A. Metformin B. SGLT-2 c. GLP-I D. Glitazone

25 YO female pregnant women presented with history of sweating, heat intolerance and thyroid goiter. Her TSH is low. What is the best initial treatment?

A. Methimazole B. Thyroidectomy C. propylthiouracil D. Radioactive iodine · Best initial is PTU, in first trimester . Methimazole 2nd trimester

Ectopic pregnancy BHcG 3500, she is hypotensive and tachypneic. What is the most appropriate management?

A. Methotrexate B. Laparoscopy salpingectomy C. Laparotomy salpingectomy

Female with amenorrhea for 6 weeks, pregnancy test positive, presented with abdominal pain, (can't recall if there was bleeding or not), US showed no intrauterine pregnancy with minimal fluid in cul-de-sac and mass of 1.2 cm in tube. She was vitally stable. What's your action?

A. Methotrexate B. Salpingostomy C. Salpingectomy

A female patient diagnosed as ectopic pregnancy, where she lives far away from the hospital. Her B-HCG level is 6000 with an absent fetal heartbeat. What is the best management for her?

A. Methotrexate B. Surgical intervention C. Expectant management

Female had trichomoniasis. What's prophylactic for husband?

A. Metronidazole B. No need C. Doxycycline D. Azithromycin

Question about trichomoniasis treatment?

A. Metronidazole patient alone B fluconazole, C. Metronidazole patient & partner D. ceftriaxone

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 CTG and intrapartum drugs: - Mg sulfate: minimal or reduced variability, mom delayed deep tendon reflexes, and respiratory depression - Oxytocin: late or prolonged decelerations + uterine hyperstimulation, --> uterine rupture --> baby bradycardia - Epidural analgesia: maternal hypotension -> uteroplacental insufficiency-> late or prolonged decelerations

Patient on oxytocin, epidural and MgS04, preeclampsia. Her CTG: absence variability (or non-reactive). What's the cause?

A. MgS04 toxicity B. Oxytocin C. Epidural analgesia

Pregnant 34 weeks, vaginal bleeding open cervix 6cm, she has hypertension and proteinuria, CTG shows fetal bradycardia, what is the management?

A. MgSo4 and deliver B. stabilize and mgso wait until 37 week C. stabilize give steroid then labour

Placental abruption and fetal distress and ph 6 wt improve mortality now ?

A. Mild hypothermia B. IVF C. electrolytes

46 YO female patient presented to the hospital complaining from generalized muscle pain for 2 weeks. Associated with bone ache and epigastric abdominal pain. She noticed that her symptoms improve when she drinks a cup of cold milk. Ca+2 is normal. phosphate is low. Vit D3 is low. PTH within upper normal level. What is the most likely diagnosis?

A. Milk alkali syndrome B. Primary hyperparathyroidism C. Secondary hyperparathyroidism D. Tertiary hyperparathyroidism · Low vitamin D à Low calcium - low phosphate à activation of PTH à increase Calcium to normal level à phosphate stay low · Secondary hyperparathyroidism

23 years Old female with history Of ASD, found to have decrescendo early diastolic murmur 2/6 on the left lower sternal border. what is the most likely diagnosis?

A. Mitral stenosis B. Aortic regurgitation C. Tricuspid regurgitation D. Aortic stenosis · Decrescendo early diastolic + Left lower sternal (Erb's point) --> aortic regurgitation

49- 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

3 mo old boy with pic of bacterial meningitis What's most common pathogen?

A. Moraxella catarrhalis. B. Streptococcus pneumonia. C. Streptococcus pyogen D-Nesseria In babies below 3 month: GBS , E coli , lieteria Above 3 motnhs : Sterptococcus pneumonia , Hemophilus influnza , nesseria Treatment of bacterial meningitis - For neonates :Ampiclin , gentamcin , cefotaxime - For older than 3 months Cefitraxone , vancomycin and dexamehtasoe

B 3 mo old boy with pic of bacterial meningitis What's most common pathogen?

A. Moraxella catarrhalis. B. Streptococcus pneumonia. C. Streptococcus pyogenes D-Neisseria Treatment of bacterial meningitis For neonates : Ampicillin , gentamicin , cefotaxime For older than 3 months Ceftriaxone , vancomycin and dexamethasone

- Female with fishy-smell vaginal discharge, Analysis PH: 5.1, what type of cells will you find?

A. Multinucleated giant cells B. Overproduction of lactobacillus C. Single nucleated cells D. Granulated epithelial cells

56 YO. male patient going for elective hernia surgery. Known to have bicuspid aortic valve and prosthetic heart valve since 4 years. What is the best antibiotic prophylaxis before his surgery?

A. NO prophylaxis is required. B. Amoxicillin. C. Cefuroxime. D. Ciprofloxacin. · Indications for antibiotic prophylaxis for infective endocarditis, both must present: o High risk patients o High risk procedure · High risk patients o Previous infective endocarditis o Unrepaired cyanotic congenital heart disease o Prosthetic valve · High risk procedures o Dental procedure o Abscess drainage - diabetic foot debridement o Airway manipulation (tonsillectomy - adenectomy) · This patient is high risk but low risk procedure --> no need for prophylaxis

Pregnant and diabetes and hypoglycemic in ER and has to given glucose what the route that will give her and don't harm the baby?

A. Nasogastric B. Orogastric C. Peripheral venous D. Central venous

56 Y.O patient had an upper GI bleeding due to esophageal varices and was given IV fluid. Which of the following should be given to reduce mortality?

A. Omeprazole. B. Octreotide. C. Nadolol. D. Ceftriaxone.

45 years old man had MVA and presented with isolated head injury and coma for 5 days in ICU. Which of the following is the best initial way of feeding?

A. Nasogastric tube feeding B. Jejunostomy tube feeding C. Central line feeding D. Peripheral line feeding Initial is always NGT Later if indicated we do jejunostomy tube

92- Neck penetrating injury on zone 1 with emphysema, next step?

A. Neck exploration B. CT head and neck C. Angioembolization

A patient with Kawasaki features, what is the best indicator as poor response to IVIG?

A. Neutropenia B. High CRP C. Albumin D-Hypernatermia

Case of molar pregnancy with very high B-Hcg, treated and following up with her every week. B-hcg level given weekly, dropping until week 5 it was 1. What will you do?

A. Next week B-hCG B. Next month B-hCG C. Discharge. D. Give methotrexate.

Preterm labor at 31w, cervix closed what to give?

A. Nifidipine B. Terbutaline C. Indomethacin D. Mgso4

56 Y.O male patient known to have an allergy to penicillin and sulfa antibiotics presented with UTI. Which antibiotic is most appropriate?

A. Nitrofurantoin. B. Trimethoprim/sulfamethoxazole. C. Ampicillin. D. Cephalexin. Nitrofurantoin used in cystitis , never in pyelonephritis

Ectopic pregnancy managed with salpingostomy. Bhcg postoperative was 3500 . how to follow up the B HCG?

A. No need follow up B. Pelvic ultrasound C. Weekly measurements of B HCG until undetectable

After salpingectomy how to follow?

A. One bhcg to confirm decline B. Hystosaplingogram C. Weekly bhcg D. Pelvic ultrasound after 6 days

Female have regular cycle every 30 days her last period before 36 ,,, she received rubella vaccine before 3 weeks. She was asked not to get pregnant until 2 months of receiving rubella , But she got pregnant, what's the most likely pregnancy outcome?

A. Not affected B. Associated with congenital malformations

Case of ectopic pregnancy received methotrexate her bHCG were: on day 1 ( 3000) on day 4 ( 3100) on day 7 ( 2900 ) what to do next?

A. Nothing B. Surgery C. Multi dose methotrexate regimen D. Consider second dose of methotrexate if in day 7 post methotrexate BHCG didn't drop 15% or more --> give another dose

A woman was taking highly androgenic progesterone without knowing she is pregnant. What complication will her daughter face?

A. Nothing will change B. Hirsutism C. Masculinization D. Feminization

Patient has Ovarian cyst want contraception method:

A. OCP B. progesterone only pills C. IUD

55 years old male with history of GERD for 10 years controlled on PPI. Presented to the hospital with recent history Of dysphagia to solid food. What is the best next step?

A. OGD B. CT abdomen C. Manometry D. Barium swallow · Approach to dysphagia (first step is endoscopy, unless) o If prior history: esophageal cancer - radiation - caustic injury - surgery à barium swallow o If not à upper endoscopy +- biopsies § Normal endoscopy + dysphagia to both à manometry Normal + dysphagia to solid only à barium swallow

Patient diabetic and pregnant what's the most useful test that will determine prognosis for the baby?

A. OGTT B. fasting blood glucose C. glycosylated hemoglobin D. US nuchal translucency

which vaccine is contraindicated in HIV pt •

A. OPV • B. varicella • C. MMR • D-DTP Oral polio and BCG are absolute contraindicated in HIV patients Other live vaccines depends on the CD4 count and other clinical parameters

What is the most important preventable risk factor for Dyslipidemia and CAD in females?

A. Obesity B. Smoking C. Low sleep quality D. Physical inactivity · Most important modifiable risk factor: smoking

80- 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

38 weeks GA with Spontaneous rupture of membrane 24 hr ago, not in labour, reassuring fetal status, what to do?

A. Observation B. IOL C. C/S

231- 20 Patient diagnosed with acute pancreatitis 3 weeks ago, now present to ER Complain of mild abdominal pain and tenderness, US showed cyst measure 4 cm, how you will manage?

A. Observation B. Internal drainage C. External drainage D. Surgical remove

127- 65 years old female, with Asymptomatic femoral hernia. What is the most appropriate management?

A. Observation B. Open repair with mesh C. Laparoscopic repair

239- Patient post appendectomy, came for regular follow up post-surgery, no active complaints, on exam he has seroma which drains freely from the opening of the wound, no erythema no pain no fever, what is the appropriate management?

A. Observation B. Open wound exploration C. Regular wound dressing D. US guided drainage

303- 6 years old child present with supracondylar fracture. He's arm is deformed and he has no pulse. Reduction and fixation with k-wire done but still there is no pulse and the limb is pale and cold. What to do next ?

A. Observation B. Surgical exploration C. Doppler US D. CT angiography

Patient at 34 weeks of gestation with eclampsia. She was managed and stabilized. what is the most appropriate next step?

A. Observation B. Wait till week 37 and deliver C. Prepare for delivery D. Discharge home

112- 26 year-old male patient underwent appendectomy after signs and symptoms of appendicitis. Histopathology report: 1 cm carcinoid at tip of the appendix . What is the appropriate management?

A. Observation. B. Chemotherapy C. Radiotherapy D. Right hemicolectomy

113- 26 year-old male patient underwent appendectomy after signs and symptoms of appendicitis. Histopathology report: 2 cm carcinoid at Basie of the appendix . What is the appropriate management?

A. Observation. B. Chemotherapy C. Radiotherapy D. Right hemicolectomy

Pregnant 8 weeks with inevitable abortion they let her decide what she want after 15 min severe gush of blood coming out, what to do ?

A. Observe B. Mifepristone C. D&C D. Expectant management Management of abortion - Expectant management (if ≤13 weeks GA): - Medical (up to 20 weeks GA) By two different medications mifepristone followed by misoprostol - D&C: if severe bleeding - infection - hemodynamic instability regardless of the gestational age

24 years old female married not complaining of anything incidental finding of subserosal fibroid how would u manage? x

A. Observe and follow up after 6 months B. Myomectomy C. OCP D. Progestin

67- Patient sustained a chest stab wound injury, on examination there was Stony dullness over right chest and tracheal deviation to the left, what is the diagnosis?

A. Open pneumothorax B. Tension pneumothorax C. Massive Hemothorax

97- 27- year-old obese woman presents with right iliac fossa pain associated with anorexia, nausea, and vomiting. On examination, there is moderate right iliac fossa tenderness. Labs showed: leukocytosis, what is the most appropriate management?

A. Open surgery B. CT C. US D. Diagnostic laparoscopy

259- Few days after laparotomy, patient had pus discharge from the wound, for which it was opened to allow drainage. Few days later, wound looked healthy and with good granulation tissue. It was large and deep with intact abdominal fascia, no signs of infection. Most appropriate management?

A. Open the fascia B. Antibiotics C. Place a vacuum-assisted closure (VAC) device D. Wound debridement

30 years old man underwent appendectomy day 6 post-operative complaining of pain at the site of the wound. The wound was red, swollen, tender What will you do?

A. Open wound

236- A 42-year-old woman underwent an uneventful laparoscopic cholecystectomy, 2 weeks later, she present to the Emergency Department with vague abdominal pain. CT scan: Large collection in the subhepatic area. Which of the following is most appropriate next step?

A. Operative drainage B. CT-guided drainage C. Laparoscopic drainage D. ERCP with biliary stent placement

23 YO. male patient K/C of UC presented with 7-8 bouts of bloody diarrhea per day. Associated with fever and joint pain. O/E patient looks ill and in pain. What is the best next step in management?

A. Oral budesonide B. IV methylprednisolone C. oral 5-ASA D. Azathioprine Patient looks very sick à IV STEROID

Pregnant in labor and signs of meconium stain how to manage baby?

A. Oropharynex suction before deliver the body B. NICU after delivery C. TOCOLYTIC D. Intratracheal suctioning

A 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 Two different answers in this question: 1- Colon cancer: because it has grade A in screening and prevention (all adults age 50-75) 2- Abdominal Aortic Aneurism: because it mentions heavy smoker and AAA screening has grade B for screening and prevention (age 65-75 for men who ever smoked) Choose the right one for you

frican teen with jaw mass histopathology showed starry sky appearance (case of burkitt's lymphoma) what's that pathophysiology? •

A. Overexpression of c-myc • B. Overexpression of n-myc • C. Overexpression of Fab • D. Overexpression of k-ras

240- Patient with stab wound in anterior neck, he is Alert but in labs oxygen sat 82%. What to do?

A. Oxygen mask B. Cricothyroidotomy C. Endotracheal intubation D. Tracheostomy

Patient had PPH she is known case of asthma what medication you can't give her?

A. Oxytocin B. Carboprost C. misoprostol D. Methylergonovine

Most common drugs used to treat PPH after Uterine atony ?

A. Oxytocin B. Carboprost C. misoprostol D. Methylergonovine

Patient had PPH she is known case of HTN, what medication you can't give her?

A. Oxytocin B. Carboprost C. misoprostol D. Methylergonovine

Pregnant at term 38 weeks, with irregular uterine contractions, CTG with no acceleration or deceleration but normal variability, heart rate 140, cervix is 2 cm dilated, what to do next?

A. Oxytocin B. Prostaglandin C. C/S D. Observation Or send home Her CTG is Category 1 and reassuring. She is still 2 cm dilated (latent phase) no need for intervention.

PPH Medication?

A. Oxytocin 20 units mixed with 500ml D5 IV B. Ergo 0.5mg IM C. Ergo 0.2 mg IV

Pregnant 38 weeks. Diagnosed with preeclampsia and managed with magnesium sulfate. She's in labor and epidural anesthesia was started. Oxytocin infusion is started as well. Normal regular contraction. CTG picture: as shown above, What's the cause of this CTG finding?

A. Oxytocin infusion B. Magnesium sulfate infusion C. Epidural anesthesia D. Head position of the baby CTG and intrapartum drugs: - Mg sulfate: minimal or reduced variability, mom delayed deep tendon reflexes, and respiratory depression - Oxytocin: late or prolonged decelerations + uterine hyperstimulation, --> uterine rupture --> baby bradycardia - Epidural analgesia: maternal hypotension -> uteroplacental insufficiency-> late or prolonged decelerations

DM female otherwise all normal full term in delivery fetus had tachycardia how to prevent this?

A. Oxytocin's B. Change mother position C. Mg gluconate

46 Y.O. female patient k/c of chronic Hepatitis B, she has jaundice and lower limb edema. Laps shows high AST, ALT and HBV DNA. US shows micro-fibrotic changes. What is the most appropriate next step?

A. PEGylated interferon. B. Observation and follow up. C. Lamivudine. D. Entecavir Worsening symptoms + high DNA à Active chronic: entecavir or tenofovir

A young woman presents with fever and diffuse abdominal pain. On exam, the cervix and vaginal wall were normal with positive cervical motion tenderness. US shows no adnexal masses. Beta-HCG was negative. What is the most likely diagnosis?

A. PID B. Ectopic pregnancy C. Acute cervicitis D. Ovarian torsion

Nullipara with menorrhagia and dysmenorrhea, what is the type of contraceptive appropriate for this patient?

A. POP (progestogen-only pill) B. OCP C. Depo Provera Injection D. NSAID

case of hyperthyroidism and palpation. What will you do for her as initial management?

A. PTU B. Methimazole C. Propranolol

252- Adult fell from height complains of severe heel pain. He is conscious, oriented and has stable vitals. What is the next step?

A. Pain control B. Lower limb X-ray C. Pulse palpation

251- Male patient came to ER with right femur shaft fracture, Hemodynamically stable, no other injuries. what is your priority?

A. Pain management B. Blood control C. Maintaining function D. Decrease soft tissue trauma

103- Pt with appendicitis, during surgery the surgeon didn't find the appendix What is the most effective way to locate the appendix?

A. Palpate ileocecal valvd B. Follow terminal ileum C. Follow the confluence of the tenia coli D. Ileocecal valve

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 cm mass with thick wall and fluid inside which is heterogenous and non-liquefied. Labs: 346 amylase, WBC 15000. What is the diagnosis?

A. Pancreatic Pseudocyst B. Pancreatic Abscess C. Walled off necrosis DDx: Acute fluid collection: Duration < 4 weeks, CT: homogenous content Pseudocyst: Duration > 4 weeks, CT: thick wall homogenous content Acute necrotic collection: Duration < 4 weeks, CT: heterogenous content Wall of necrosis: Necrotizing pancreatitis, CT thick wall heterogenous content Abscess: CT: enhanced wall Tx: Acute fluid collection: observation Pseudocyst: only if symptomatic or large> 10 cm --> Internal drainage Wall off necrosis: percutaneous drainage

Patient had Pancreatitis 6 weeks ago, now complain of epigastric pain and tenderness, US revealed mass with thick wall and fluid, WBC high, what is the diagnosis?

A. Pancreatic Pseudocyst B. Pancreatic Abscess C. Walled off necrosis DDx: Acute fluid collection: Duration < 4 weeks, CT: homogenous content Pseudocyst: Duration > 4 weeks, CT: thick wall homogenous content Acute necrotic collection: Duration < 4 weeks, CT: heterogenous content Wall of necrosis: Necrotizing pancreatitis, CT thick wall heterogenous content Abscess: CT: enhanced wall Tx: Acute fluid collection: observation Pseudocyst: only if symptomatic or large> 10 cm --> Internal drainage Wall off necrosis: percutaneous drainage

229- 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 cm mass with thick wall and fluid inside which is heterogenous and non-liquefied. Labs: 346 amylase, WBC 15000. What is the diagnosis?

A. Pancreatic Pseudocyst B. Pancreatic Abscess C. Walled off pancreatic necrosis

68 YO male known to have ischemic heart disease came with history Of diffuse abdominal pain for one day. Abdominal x-ray showed dilated small bowel and thinned wall. Amylase 600 PH 7.23 What is the most likely diagnosis?

A. Pancreatitis B. Intestinal Obstruction C. Perforated ulcer D. Mesenteric ischemia Acidosis - old age - IHD - high amylase - diffuse abdominal pain

190- 70 yrs old man k/c of IHD, central abdominal pain vitally stable, amylase 600, WBC normal, abdominal x ray: dilated small bowl with thickened wall: what's the dx?

A. Pancreatitis B. Intestinal obstruction C. Perforated ulcer D. mesenteric ischemia

55 years old patient was diagnosed with autoimmune thyroiditis, with a history of progressive enlargement of right lobe of the thyroid. FNA report: malignant cells. Which of the following is most likely the type of thyroid malignancy?

A. Papillary B. Medullary C. Anaplastic D. Lymphoma Hx of Hashimoto? Think about both Papillary + Lymphoma Find out the other clue-> Rapid progressive? So it's Lymphoma

32 years old male with neck mass and dysphagia, US done and showed mass 2*3 cm, FNA cytology reveled hypercellular of large poorly cohesive spindle-like shape cells, labs showed high calcitonin, Which of the following is the most likely diagnosis?

A. Papillary. B. Medullary. C. Anaplastic. D. Follicular. Calcitonin? Medullary thyroid cancer.

50 YO female presented with polyuria and polydipsia. She has recently been started on escitalopram for depression. She also complained of constipation. Her labs are shown below: Calcium: high Phosphate: low Parathyroid hormone 5 (1.2-5.8) What is the most likely cause?

A. Parathyroid adenoma B. Multiple myeloma C. Metastatic cancer D. Parathyroid hyperplasia · PTH can be upper normal high in hyperparathyroidism · Parathyroid adenoma

347- 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

12 gestation with fundal hight 19 wks and bhcg270000 ( very high) most likely dx:

A. Partial mole B. Complete mole C. Ectopic

50-year-old female diagnosed with stress incontinence, asking about definitive management?

A. Passery B. Tension free Vaginal Tape C. Kelly plicatiom D. Burch procedure

124- 45 years old patient, came with history reducible hernia in inguinal area it pop out every two days with mild pain and he can manuel reducible it by his finger, then he suddenly developed severe constant pain in early morning in that area and came to hospital, on examination of the inguinal area and scrotum examination and he is free from both them and pain is disappear, Now just have persistent nausea and vomiting, what is the next step ?

A. Pelvic and Abdomen CT B. Hernia repair today after 2-hour C. Reassurance and discharge D. Hernia repair after 2 days

50-year-old female NO PAST SURGICAL NOR MEDICAL hx and she presented with complaints of urine incontinence with coughing and sneezing, most appropriate management?

A. Pelvic floor exercise B. Urethral sling C. Colporrhaphy D. Burch procedure

33 YO male presents to the hospital complaining of retrosternal chest pain which increases at night. Associated with unpleasant taste. What is the most likely diagnosis?

A. Peptic ulcer B. Esophagitis C. Gastritis D. Esophageal perforation GERD complications Chest pain PUD: epigastric pain

227- 45 yo man with returns from a trip to Mexico and develops fever, chills, and RUQ pain. WBC count is 20. US shows an intrahepatic fluid collection. CT scan shows 12 cm single abscess with a peripheral rim of edema. This condition is best treated with?

A. Percutaneous drainage and Abx B. Metronidazole C. Albendazole D. Surgical drainage

Young patient presented complaining of right upper quadrant pain. On examination there is RUQ tenderness and a palpable mass. Investigation showed Entamoeba histolyca, and there is abscess 12 x 14 cm with septation. What is the best initial management?

A. Percutaneous drainage. B. Metronidazole. C. Percutaneous aspiration. D. Surgical removal

Common complication AFTER uterine Evacuation?

A. Perforation B. Infection C. Bleeding D. Abscess Uterine perforation is the most common immediate complication of D&C. After the procedure -> Infection

Molar pregnancy case treated by dilatation and suction. What is the MOST COMMON early complication?

A. Perforation B. Pneumonia C. Amniotic fluid embolism

A pregnant woman at 32 weeks gestation presents with severe abdominal pain. she denies any abdominal bleeding. She has CRL of 34 weeks. Examination reveals a tender and tense uterus. what is the most appropriate next step?

A. Perform an US B. Cesarean section C. Check CTG The first thing to do in antepartum hemorrhage is US to exclude placenta previa. Then CTG.

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?

A. Periampullary Tumor B. Hepatocellular CA Courvoisier's sign: Palpable mass + painless + jaundice

Epidural anesthesia, what it's sparring?

A. Perianal B. Rectum

111- 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

261- 72 old male with 8 mm nodule in lung discovered 3 years ago incidentally Without symptoms. He did follow up for the last 2 years and also this year no change in the size and no symptoms what to do?

A. Pet scan B. Follow up C. No need to follow Up

Child 5 months, nurse said he has developmental delay in milestones, what would you do to reassure the mother ? •

A. Pincer grasp • B. wave bye bye • C. Reach things • C. Sit without supp

Most condition cause pregnancy DIC?

A. Placenta abruption B. Retained product of conception C. Placenta previa D. Congenital hemorrhagic disorders

Placenta in implanted in the uterine wall, what is that?

A. Placenta previa B. Placenta accrete C. Placenta increta D. Placenta perecreta Placenta Accrete: chorionic villi Attach to the myometrium Placenta Increta: chorionic villi Invade into the myometrium Placenta Percreta : chorionic villi Penetrate though the myometrium, penetrate the serosa

Third trimester Pregnant woman with vaginal bleeding, abdominal exam shows a Length less than the gestational age, CTG shows late decelerations, diagnosis?

A. Placenta previa B. Vasa previa C. placenta abrubtion

Third trimester Pregnant woman with abdominal pain and vaginal bleeding, abdominal exam shows a Length less than the gestational age, CTG shows late decelerations, diagnosis?

A. Placenta previa B. Vasa previa C. placenta abrubtion Its painful so its placenta abruption. Placenta previa and vasa previa are painless!

Pregnant lady during labor, CTG show fetal persistent bradycardia, what is the cause of her condition?

A. Placental insufficiency B. Congenital heart disease

135- 50 years old female presented to ER with sudden left lower chest pain and epigastric pain, after forceful vomiting. On examination there was decreased breath sound in the left lower chest What is the most likely concern?

A. Pneumonia B. Pneumothorax C. Aspiration D. Esophageal Perforation

50 YO female presented to ER with sudden onset of left lower chest pain and epigastric pain after forceful vomiting. On examination there is decreased breath sound in the left lower zone of the chest. What is the most likely diagnosis?

A. Pneumonia B. Pneumothorax C. Aspiration D. Esophageal perforation

68- 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

65- Patient had a stab wound in the chest. Came with weak thread pulses, raised JVP, Equal Bilateral Air Entry in both lungs. What's the diagnosis?

A. Pneumothorax B. Cardiac tamponade C. Pulmonary contusion

Patient had a stab wound in the chest. Came with weak thread pulses, raised JVP, Equal Bilateral Air Entry in both lungs. What's the diagnosis?

A. Pneumothorax B. Cardiac tamponade C. Pulmonary contusion Becks triad: 1- Distended JVP 2- Hypotension 3- Muffled heart sounds

Child came from Africa. complaining of weakness, he couldn't move his head and legs especially when he is prone. What is the dx?

A. Polio B. CMV C-EBV D-Influenza Polio virus can case weakness in both legs and the weakness is asymmetry

A child came to you with Café au lait spots in face and neck. Which of the following features can strengthen your diagnosis? •

A. Port-wine stain. • B. Axillary freckling • C-Ash leaf macules • D-Shagren bacth I got new question in the exam: information was Café au lait spots + Axillary freckling, what is the diagnosis: neurofibromatosis

Old lady medically free with difficulty defecation and constipation, during defecation she introduce her finger in the vagina to intiate movement, management?

A. Posterior colporrhaphy B. Anterior colporrhaphy C. Enterocele resection D. Hystrectomy

Pregnant present in 38 weeks in labor her BP 150/90 and elevated proteins /creatinine ratio. What is the diagnosis?

A. Preeclampsia B. Chronic hypertension C. Gestational hypertension D. Superimposed hypertension

Gestational diabetes most associated with?

A. Preeclampsia B. Polyhydramnios C. IUGR

Patient with long term history of DM type 1 in 12 weeks of gestation. HbA1C 12. Which of the following complication is most likely to happen?

A. Preeclampsia B. Polyhydroamnios C. Congenital malformation D. IUGR

Magnesium sulfate given to hypertensive pregnant to?

A. Prevent the seizure attack B. For fetal neuroprotection C. Reduce her BP

Women diagnosed as ectopic pregnancy asks what is the most common predisposing factor:

A. Previous tubal pregnancy B. Pelvic Inflammatory Disease PID

Bleeding after 4 hrs of delivery what type of PPH?

A. Primary B. Secondary

Female 36 year, at 15w GA came with hypertension 180/110 no proteinuria, what is the diagnosis?

A. Primary HTN. B. Pregnancy induced HTN. C. white coat syndrome. D. Eclampsia

Female 36 year, at 15w GA complaining of headache, blurred vision since 2 weeks ago ,with hypertension , what is the diagnosis?

A. Primary HTN. B. Pregnancy induced HTN. C. white coat syndrome. D. Eclampsia

In labor after 10 min of delivering the fetus placenta is still not delivered she started bleeding?

A. Primary pph B. Secondary pph C. Tertiary pph D. Iatrogenic pph

257- A patient presented with a knife injury to the hand. O/E: the laceration reached the tendon and nerve. How will you repair this injury?

A. Primary repair to injured structures B. Debridement with primary closure C. Debridement with secondary intention D. Debridement with Vacuum assisted closure (VAC)

A female patient present with heavy PV bleeding. Her bleeding is associated with pain and of large volume. Upon vaginal examination, you noticed pooling of blood. Pregnancy test is negative, her BP low, Labs: RBC low, Hb low What is your next step in management?

A. Progesterone B. Conjugated estrogen C. Blood transfusion

178- 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

119- 24 years old with history of appendectomy 5 years ago present with abdominal pain, distention , vomiting for 3 days Ct scan show obstruction signs And peritonitis , What's contraindicated in this patient?

A. Propofol B. Ketamine C. Sevoflurane D. Nitros Oxide

65 YO. male patient k/c of liver cirrhosis, presented with upper GI bleeding. after initial ER management with IV fluid, which of the following should be given before endoscopy?

A. Propranolol. B. Octreotide. C. Vitamin K D. Vasopressin.

Patient post delivery massage is done, oxytocin done. She was bleeding. On inspection you found it is due to laceration 2 cm you tried sutures but it's not possible due to perfuse bleeding from above, what is the most appropriate next step?

A. Prostaglandin F2alpha B. Oxytocin again C. Suppurative treatment D. Explore the uterus and examine it

Primigravida woman just delivered spontaneously baby is delivered complete and intact. Massaging of the uterine is performed along with 20 units of oxytocin in 1000 of lactated Ringers fast drip. inspection of the genital tract, there's second degree laceration 2-cm left lateral vaginal wall, suturing is difficult because of bleeding from above the site of laceration. a soft, boggy uterine fundus Blood pressure 164/92 mmHg Heart rate 130 /min Which of the following is the best step in management?

A. Prostaglandin f2a B. methylergonovine C. manual exploration D. oxytocin 10 units again Medications used in PPH Management:: - Oxytocin (1st line) - Methylergonovine (2nd line, Contraindicated in preeclampsia and HTN) - Carboprost (hemabate) PG F2a (3rd line, Contraindicated in Asthma) - Misoprostol

colostrum in comparison to mature breast milk contains more ?

A. Protein B. fat C. Toxins D. Casein

230- 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. Labs: 346 amylase, Wbc 15k. What is the diagnosis?

A. Pseudocyst B. Abscess C. Walled off necrosis (Didn't specify homogenous OR heterogenous)

311- 25 years old presented to the ER after MVA with fracture of the lower limb. He underwent reduction and fixation with Intramedullary Nail. After operation he became confused and developed dyspnoea, petechiae and tachycardia. What is the most likely diagnosis?

A. Pulmonary embolism B. Sepsis C. Fat embolism D. Wound infection

150- Patient known case of peptic ulcer disease in medications but failed to respond, upper endoscopy done and revealed multiple ulcers in antrum. What is the best treatment?

A. Pyloroplasty and vagotomy B. Total gastrectomy C. partial distal gastrectomy (anterectomy)

17 YO. male patient presented with altered bowel habits for 4 years. He c/o 3-4 bouts Of foul-smelling diarrhea per day, containing indigestive food but no blood or mucus. He has abdominal distention and delay in secondary sexual characteristic. Which of the following investigations is most appropriate?

A. Quantitative stool fat B. Urea breath test C. Hydrogen breath test D. Anti tissue transglutaminase IgA antibodies

Patient with Sjogren syndrome which type of RTA: + Labs: Shows low K Normal Na

A. RTA| B. RTAII C. RTA II D. RTA IV

29 YO female presented with history of palpitation, weight loss, anxiety and irritability. Her TSH is low and T4 is high. Thyrotropin receptor antibodies came back positive. What is the most appropriate management?

A. Radioactive iodine B. Propylthiouracil C. Methimazole D. Thyroidectomy · Thyrotropin receptor antibody à graves --> methimazole · Graves' disease, one of the following enough for diagnosis o Diffuse goiter o Eye o Pretibial myxedema o Thyrotropin receptor antibody

35 years old male patient underwent US to neck for another reason and accidentally discover nodule in the right lobe, low TSH high T4, what is the proper investigation?

A. Radioactive iodine scan. B. Hemithyroidectomy. C. FNA. D. Follow up. Low TSH case. In other words, it's hyperthyroidism thus the next step is a thyroid scan

A pregnant woman presents with vague pain. US showing an ovarian cyst measuring 9 x 7 cm. How will you manage this patient?

A. Reassurance B. Laparoscopic drainage C. Immediate laparotomy D. Analgesia and Observation

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 and give Ca gluconate

132- Child 4 years old with asymptomatic umbilical hernia what's the treatment?

A. Reassurance B. wait until 5 years C. Surgical repair

183- Old male patient lethargic and pale with weight loss for 2 months, by Examination there was 2nd degree hemorrhoid + low hemoglobin, what's the diagnosis?

A. Rectal cancer B. Cecal cancer C. Hemorrhoids D. Sigmoid cancer

Pregnant 37 wks with IUFD, feeling guilty because she smoke 5 cigarettes / day, what to tell her?

A. Smoking not related to IUFD of IVF B. Smoking increase rate of IUFD C. Should stop smoking for future pregnancy D. Cause not known and need more investigation

76 YO female known to have T2DM (on metformin and glimepiride), CKD and IHD. she reports history of recurrent dizziness that improves with drinking juice. She is refusing insulin. Her BMI is 34 and her labs are shown below: HbA1C 8.7 RBS 210 Which Of the following is the best management?

A. Reduce glimepiride dose B. Substitute glimepiride with empagliflozin C. Add insulin D. Substitute glimepiride with sitagliptin glimepiride is sulfonylurea · In all patients with hypoglycemia due to sulfonylurea --> stop immediately!! · Cannot add insulin in this patient due to o A1C < 9 o Elderly with multiple commodities, risk of hypoglycemia out ways the risk of controlling A1C · Best option here is to give SGLT2, due to the benefits of CKD - IHD - reduce BMI

38- Patient received 5mg warfarin his inr is 7 , known case of AF ?

A. Reduce to 2.5 mg B. Same dose C. Stop warfarin D. Hold warfarin and repeat INR · If patient actively bleeding, stop and give vit k - FFP

62 YO. male patient K/C of liver cirrhosis secondary to Hep C has completed his treatment. Hep C RNA is —Ve. How will you follow this patient up?

A. Regular screening with AFP B. Regular screening with ultrasound C. Liver biopsy D. NO follow up is required

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.

45-year-old woman is investigated for weight gain. She had had been unwell for around four months and described a combination of symptoms including depression, facial male-pattern hair growth and reduced libido. During the work- up she was found to be hypertensive with a blood pressure Of 170/ 100 mmHg. Which one Of the following tests is most likely to be diagnostic?

A. Renin:aldosterone levels B. High-dose dexamethasone suppression test C. Low-dose dexamethasone suppression test D. 24 hr urinary metanephrines Presentation of Cushing syndrome To confirm the diagnosis you need two abnormal results of the following: - Free cortisol is measured in a complete 24-hour urine collection - Low-dose dexamethasone suppression test - Late-night salivary cortisol - Late-night serum cortisol After confirming cushing --> do ACTH levels High-dose dexamethasone suppression test: is to identify the cause/ etiology, of Cushing not to diagnose Cushing

262- 32 non smoker presented with lung nodule 7 mm otherwise normal except for ca 4 mmol :

A. Repeat CT scan within 3-6 months B. Pulmonary function test C. Biopsy of the lesion D. PET scan

- 25 years old female with thyroid nodule, TSH and T4 normal. FNA cytology done classified as Bethesda 3. What is the most appropriate management?

A. Repeat FNA. B. Lobectomy. C. Levothyroxine. D. Total thyroidectomy. Bethesda classification for cold thyroid nodules: 1 - repeat FNA 2 - follow up with US 3 - repeat FNA 4 - hemithyroidectomy 5 - near total is preferred over hemithyroidectomy 6 - near total thyroidectomy

Pregnant lady with one abnormal GTT reading (after 1 hr)

A. Repeat GTT B. Lifestyle modification C. Measure hg A1c Serum glucose concentrations are then measured after 1, 2, and 3 hours. The test is considered positive if two values are greater than established thresholds. I would choose lifestyle modification if she has 2 abnormal results not only one.

Female patient Pap smear done before 7 years ago result was atypical hyperplasia, Now came to clinic what to do:

A. Repeat Pap smear B. Colposcopy C. CT

Patient diagnosed with molar pregnancy did evacuation and curettage, bHcg monitoring after 1 month did not change (didnt increase or decrease) what to do?

A. Repeat evacuation B. Refer to oncology to start methotrexate C. Observe as long its not elevated

40 y Female with hx of Wart 7 or 10 years back, last pap smear normal, what is investigation u went to do in this visit?

A. Repeat pap smear B. Colposcopy

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.

56 YO 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. Nadolol. D. Ceftriaxone.

33 YO patient came back from Africa with jaundice and hepatosplenomegaly. His blood film was negative for malaria. what is the best next step?

A. Repeat thin blood smear. B. Repeat thick blood smear. C. Repeat after 48h. D. Repeat every 8hrs for 48 hrs.

33 YO female presented to the hospital complaining of fatigue, weight gain and constipation for 4 months. Her TSH is within normal range. What is the best next step?

A. Repeat thyroid function test after 4 weeks B. Thyroid scan C. Serum T4 D. Thyroid U/S · If normal TSH range à repeat after 4 weeks · Only do T4 if TSH high or low

30 years old pregnant women by in vitro fertilization (IVF) and diagnosed with ectopic pregnancy and scheduled of laproscopic removal of the prgnency. On US imaging: 4 cm tubal pregnancy on the right, and hydrosalpinx on the left. What is the management?

A. Salpingotomy on the right only B. Salpingectomy on the right only C. Removal of both tubes (Bilateral tuboectomy) D. Hysterosalpingography with contrast

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 · Such a patient without typical presentation + no specific changes on ECG + troponins normal = don't start management of ACS · Don't discharge the patient · Second set of troponins after 6 hours are indicated . Never do stress ECG in an acute presentation

72- 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

38 YO. pt was having GERD and on PPI 40 mg. His symptoms was controlled. He stopped the medication 4 months ago and now his symptoms is back again but worse. All labs and P/E is normal. what is your next step?

A. Resume same dose. B. Give higher dose PPI 80mg. C. Give ranitidine and PPI. D. Refer him for upper GI endoscopy. Note: Recurrence of GERD is not the same as refractory GERD

4. 1 month year old baby has yellowish discoloration( body and eye ) he was diagnosed with physiological jaundice. Total bilirubin 25, mainly indirect. What is the dx? •

A. Rh incomputable • B.ABO incompatible • C. c.najjar • D-Rotor syndrome

pediatric patient have meningitis, with close contact to his brother recently, Asking for what to give to his brother:

A. Rifampicin B. IVIG C-Steroid D-Penicillin

48 Y.O male presented with fever, headache, back pain and splenomegaly after drinking unpasteurized milk. Which of the following is the first line treatment for his condition?

A. Rifampicin + gentamicin. B. Doxycycline + rifampicin. C. Doxycycline + streptomycin. D. Rifampicin + streptomycin. Diagnosis is Brucellosis Serology (initial): serum agglutination, ELISA. Confirmatory test: - Blood culture. - Bone marrow biopsy specimen and culture (gold standard) Antibiotic therapy First-line therapy: doxycycline and rifampin. Second-line therapy: doxycycline and streptomycin. Simple B= 6 week Neuro-B= 6 months Or till Clear CSF

106- 35 YO male presented with typical picture of acute appendicitis. He was taken to OR for laparoscopic appendectomy. During OR the appendix appears normal with no inflammation. Both cecum and terminal ileum appears inflamed. What is the best action?

A. Right hemicolectomy B. Close without further intervention C. Appendectomy and refer the patient to gastroenterology D. Take biopsy of cecum and terminal ileum

35 YO male presented with typical picture of acute appendicitis. He was taken to OR for laparoscopic appendectomy. During OR the appendix appears normal with no inflammation. Both cecum and terminal ileum appears inflamed. What is the best action?

A. Right hemicolectomy B. Close without further intervention C. Appendectomy and refer the patient to gastroenterology D. Take biopsy of cecum and terminal ileum This patient seems like a Crohn's disease, diagnosis by colonoscopy Once appendicitis, always appendectomy

345- Patient had liver laceration and the patient is hemodynamically unstable. What to do?

A. Right hepatectomy B. Perihepatic packing C. Right hepatic artery ligation D. Ligation of the involved vessel

241- Patient with a stab wound in the right thigh and massively bleeding brought to the emergency department unconscious and O/E there is active bleeding. What is the most important next step to do ?

A. Ringer lactate iv fluid B. Blood transfusion C. Tourniquet on the thigh D. Orotracheal intubation

71 Y.O. male patient going for dental extraction. Known to have idiopathic subvalvar hypertrophic aortic stenosis . Which of the following is true?

A. Risk Of endocarditis is 50%. B. Risk of endocarditis is 12%. C. Prophylactic Antibiotic is not needed. D. Antibiotic after the procedure is sufficient. · Indications for antibiotic prophylaxis for infective endocarditis, both must present: o High risk patients o High risk procedure · High risk patients o Previous infective endocarditis o Unrepaired cyanotic congenital heart disease o Prosthetic valve · High risk procedures o Dental procedure o Abscess drainage - diabetic foot debridement o Airway manipulation (tonsillectomy - adenectomy) · Low risk patient but high risk procedure: prophylactic not needed

Baby with white eye reflex (Leukocoria) and PDA

A. Rubella B. CMV C. Toxoplasmosis D-Measles

Married women came in winter to OB /gyn clinic she want to conceive later what vaccine you should give her before conceive

A. Rubella B. Influenza C. varicella D. Tdap

Female her previous pregnancy is stellbirth and now she want to pregnant and ask the doctor about all the vaccines that she is need before conception and reduce the stillbirth ?

A. Rubella B. Varicella C. Influenza

A primgravida (at 28 weeks?) and a heavy smoker presented with severe vaginal bleeding and abdominal pain. Most likely cause is?

A. Rupture of fetal artery B. Uterine rupture C. Vasa previa D. Placental abruption

A 50-year-old female k/c of DM, HTN, HFrEF 30%. Came to the DM clinic for follow up. Her blood glucose is uncontrolled. She is currently on metformin. Which of these medications is considered the best add on therapy to control her blood sugar?

A. SGLT2 inhibitors. B. Meglitinides. C. Thiazolidinedione. D. DPP-4 inhibitors. Meglitinides = sulfonylureas · SGLT2 improve CHF mortality

- 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

A 34-year-old lady pregnant, complaining of amenorrhea, bleeding, and abdominal pain. β-HCG done showed levels of 1600, she was given methotrexate. One week later she still has severe abdominal pain despite analgesia. β-HCG done showed 6000 units. What is the best management?

A. Salpingostomy B. Salpingectomy C. Continue methotrexate D. Exploratory laparotomy The severe abdominal pain indicates rupture of ectopic pregnancy-> which is an indication of laparoscopic salpingectomy (unless hemodynamically unstable-> laparotomy)

18 (or 25 yo) female, worried about cervical cancer, she took her first dose of HPV vaccine 3 months ago. What is the best thing to do at this visit today?

A. Schedule appointment after 3 months B. No need to do anything at this visit C. Give 2nd dose at this visit D. Repeat 1st dose 9-14: 0.6-12 ,month 15-26: 0.2.6

13 YO male had type 1 DM and his family consulted you regarding the 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. D. No need for screening. · Screening of celiac in DM TYPE1: o At diagnosis o Every 2 years o Then every 5 years

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

256- 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

Case of pregnant female GA 30' present with abdominal pain and bleeding. What's the next step?

A. Send for US B. IV fluids

31- 37 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

184- Old patient who has constipation on and off with streaking of blood in the stool with no fulness in the rectum ( no mention of pain )?

A. Sigmoid cancer B. rectal cancer C. chronic hemorrhoid. D. cecal cancer

25 YO male presents with bloody diarrhea. A diagnosis of ulcerative colitis is suspected. Which part of the bowel is most likely to be affected?

A. Sigmoid colon B. Rectum C. Ascending colon D. Descending colon

45 Y.O male presented with fever, headache, back pain and pain at the right sacro-illiac joint. Which of the following is considered the gold standard for confirming the diagnosis?

A. Single blood culture. B. Repeated blood culture. C. Serological testing. D. Bone marrow aspiration culture. Diagnosis is Brucellosis Serology (initial): serum agglutination, ELISA. Confirmatory test: - Blood culture. - Bone marrow biopsy specimen and culture (gold standard) Antibiotic therapy First-line therapy: doxycycline and rifampin. Second-line therapy: doxycycline and streptomycin. Simple B= 6 week Neuro-B= 6 months Or till Clear CSF

Which of the following is most typically seen in 4 years old baby? •

A. Skip • B. Ride bicycle • C. Copy triangle and square. • D. Toilet trained Skip: 5 years Bicycle: 5 years Triangle: 6 years Toilet: 4 years Approach to milestones: Best to use is motor: 1 month: follow object to midline 2 months: Partially support head (raise head slightly when prone) 4 months: full Support head - sitting with support - role from prone to supine 6 months: Sitting without support 9 months: stand with support - crawl 1 year: stand without support 15 months: walk backward 18 months: run 2 years: Ascend stairs like adult 3 years: jump - descend stairs like adult - tricycle - circle 4 years: hoping on one foot - Cross - toilet 5 years: skip • square - bicycle 6 years: balance on each foot for 6 seconds - triangle

Woman has controlled hypothyroidism on 175 mcg levothyroxine. In the last 3 months, the doctor raised the dose to 200 mcg. She is otherwise normal (see labs). Labs: T4 (normal) T3 (normal) TSH= 17 (high). What is the best explanation for the lab findings?

A. Small dose. B. Poor compliance. C. Ectopic thyroid. D. Secondary hypothyroidism

A multiparous woman presents with pelvic fullness and the feeling of something coming out of her vagina. How do you establish a diagnosis?

A. Speculum exam B. Ultrasound C. Biopsy D. Computed tomography

A patient known to have sickle cell disease presented to emergency department complaining of both legs pain for three hours. Lower limb exam is normal with no sign of DVT. The abdomen and exam reveals spleen enlargement. Hemoglobin is 3.2 which of the following is the best next step :

A. Splenectomy B. Hydration C. Morphine sulfate D. Blood transfusion

346- 12- year-old received a nonspecific blunt trauma on his abdomen and later presented with generalized abdominal pain. Imaging of the spleen showed a 7 mm hematoma and 4 cm tear (grade 3). Your management is?

A. Splenectomy B. Spleen preserving surgery C. Conservative

310- 40 years old male victim of high speed MVA. He sustained Tibial shaft fracture. He is in severe pain, has absent dorsalis pedis and posterior tibial pulse, numbness in the lower limb What is the appropriate management?

A. Splint and elevation B. Urgent fasciotomy and External fixation C. Compartment pressure measurement D. CT angiography

What's the best way to deliver placenta in c section?

A. Spontaneous separation B. Fundus pressure C. manual removal

Best way to deliver intrauterine growth restriction fetus with reassuring CTG?

A. Spontaneous vaginal B. C-section C. Ventouse D. Forceps

Pregnant 34 week with preeclampsia, high BP 170 /100 what to give ?

A. Stabilize, MgSo4 and deliver B. Stabilize, corticosteroids and deliver

44 Y.O. male patient post prosthetic aortic valve replacement 7 days ago presented with history Of fever for 3 days. He was diagnosed with infective endocarditis. What is the most likely causative organism?

A. Staph epidermis B. Strep viridians C. Staph aureus D. Candida albicans · Post aortic valve replacement organisms based on the time o First 2 months à staphylococcus aureus o After 2 months à strep viridians · Native valve: o Staph viridians · IV drug abusers à right heart valve Staphylococcus aureus

65 YO male patient known to have liver cirrhosis and ascites, presented to ER with fever 39C and abdominal pain. Ascetic fluid shows WBC 400. What is the best next step in management?

A. Start IV ceftriaxone + lactulose B. Start furosemide. C. Start IV erythromycin. D. Therapeutic paracentesis. Antibiotic for SBP + lactulose to prevent constipation to prevent encephalopathy

66 Y.O. male patient presented with abdominal distention and +ve shifting dullness. Paracentesis was done: Ascetic fluid albumin 1.4, serum albumin is 3.9. What is the most appropriate management?

A. Start IV ceftriaxone. B. Start diuretics. C. Start IV erythromycin. D. Therapeutic paracentesis. SAAG: 3.9-1.4 = 2.5 SAAG= Serum albumin - ascetic albumin SAAG < 1.1 --> nephrotic - TB - pancreatitis SAAG > 1.1 --> Cirrhosis - CHF Ascetic albumin < 2.5 --> cirrhosis Ascetic albumin > 2.5 --> CHF

58 YO. patient k/c Of poorly controlled DM presented to the clinic c/o bilateral burning pain in his hands and feet. She is on insulin and her current Hba1c is 7. Her previous two readings are between 7-9. which of the following is the best next step?

A. Start amitriptyline B. Strict glycemic control. C. Follow up after 3 months. D. Add liraglutide. · Uncontrolled diabetes + peripheral neuropathy, first line: o TCA (amitriptyline) o SNRI o Gabapentin's (Lyrica)

19 YO female patient known case of TIDM presented to ER with abdominal pain for 12 hours. Associated with nausea and vomiting twice. Her labs are shown: blood glucose 630 mg/dL Ph 7.23 Hc03 15 Urine ketones ++4. Patient was started on IV fluid. What is the best next step in management?

A. Start fixed dose insulin B. Start fixed dose insulin and long acting insulin C. Start long acting insulin D. Start sliding scale insulin · The initial insulin dose should be 0.1 unit/kg, which is a fixed dose of insulin for all patients with DKA. · Sliding scale is used for controlling diabetes in out of DKA (hospitalized patients) .

320- Patient with pelvic fracture with extra peritoneal bladder injury, what is the appropriate management

A. Suprapubic catheterization B. Catheter Drainage for 2 weeks then reassess C. Catheter drainage for 2 weeks then repair

Lymph Node swelling and was clear lymphatic fluid in this swelling. What to do NEXT?

A. Surgery B. Sclerotherapy C. Radiotherapy D. chemotherapy Most likely: Cystic hygroma According to Earth: Next step-> Sclerotherapy, Definitive-> Surgery

61 YO. male Patient k/c Of DM, HTN came for routine check up and was found to have LV enlargement and EF Of 40% His ECG is normal and he is asymptomatic. what is the most appropriate next step?

A. Start spironolactone. B. Start Furosemide. C. Start ACEI. D. Follow up after 6 months. · Heart failure with reduced ejection fraction 40% or less · NHYA classification I Asymptomatic + structural heart abnormalities II Symptoms (dyspnea) only with exercise III Symptoms (dyspnea) with normal daily activities IV Symptoms (dyspnea with rest · Step wise medications depending on the NHYA classification I ACEIs/ARBs + BB II ACEIs/ARBs + BB ± spironolactone ± furosemide ± BIDIL ± ARNI ± SGLT2I III ACEIs/ARBs + BB ± spironolactone ± furosemide ± BIDIL ± ARNI ± SGLT2I IV Palliative or heart transplant · The rule is everyone with CHF regardless of the symptoms must be on ACEIs · Based in the information given above: this patient must be on ACEIs before starting anything else

71 YO. male Patient k/c Of CHF, presented to ER with SOB, orthopnea, PND, hepatomegaly and LL edema and basal crackles. what is your next step in managing his condition?

A. Start spironolactone. B. Start furosemide. C. Start captopril. D. Start nifedipine. · Typical presentation of acute decompensated congestive heart failure · Key words for the most accurate answer: ER decompensation CHF + fluid overload presentation + no mention of blood pressure + no mention of AMS à start furosemide · Exclusion: o Spironolactone: part of chronic management o Captopril: part of chronic management o Nifedipine: CCB is contraindicated in CHF

42 Y.O. male patient K/C of chronic Hep B presented with increasing jaundice and fatigue for the last 2 weeks. AST 345 ALT 523 Total bili 39 albumin 34, Hep B DNA level low. What is the most appropriate next step?

A. Start vitamin E B. Perform liver biopsy C. Start interferon alpha D. Send for anti delta antibodies HDV co exist with HBV Hint: hep B DNA low

Patient at 29 weeks, didn't feel fetal movement for 1 day, CTG was reactive, Biophysical profile was 8. What to do next?

A. Steroid and repeat Biophysical profile after 24 hours B. Repeat Biophysical profile at 1 week C. IOL D. Urgent CS Her CTG is normal and Biophysical profile 8 or 10 is normal.

Primigravida, preterm known case of DM 1 came with sever contractions and closed cervix What to give?

A. Steroids + insulin B. Steroids + insulin +tocolytics. C. Steroids and tocolytics D. Insulin and tocolytics

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

76 YO male patient presented to the hospital with inferior Ml and was managed by PCI. His current medications include warfarin for Atrial fibrillation and his cardiac medications. What is the best management regarding his anticoagulation therapy?

A. Stop warfarin and give aspirin B. Continue warfarin and give dual antiplatelet C. Stop warfarin and give triple antiplatelet D. Continue warfarin monotherapy · All patient with AFib + CHADS2-Vasc score > 1 à must be on warfarin for life unless contraindicated · All ACS patient must take dual antiplatelets initially, and continue on dual after stenting · In this case warfarin must not be stopped + patient must be on antiplatelets

130- 20yo male patient came to ER complain from abdominal pain. O/E there was inguinal hernia that was tender and irreducible. On x-ray there was multiple air fluid level in abdomen. What type of hernia?

A. Strangulated B. Obstructed C. Irreducible D. Incarcerated

Patient with a history of multiple D&C for recurrent miscarriages , she can't get pregnant, what is the endometrial layer removed?

A. Stratum compactum B. Stratum spongiosum C. Stratum functionalis D. Stratum basalis

51-year-old patient with fever, neck stiffness and photophobia. on examination: positive kerning sign, CSF gram stain showed gram positive cocci in chains.• what is the causative agent?

A. Streptococcus pneumonia B• Neisseria gonorrhea C- HSV D• Staph aureus

140- 70 years old male on Mechanical ventilation (MV) admitted to the ICU due to intracranial hemorrhage, 7 days later he developed ground coffee vomitus. What is the diagnosis?

A. Stress gastritis B. Helicobacter Pylori gastritis C. Dyspepsia

56 years Old female patient with hypothyroidism on thyroxine 175 microgame for 10 months, then the dose was increased to 200. Her lab shows high TSH, normal T4. what is the most likely explanation?

A. Sub-acute thyroiditis. B. Sick euthyroid. C. Hashimoto thyroiditis. D. Medication non-compliance.

23 YO female presented with tender thyroid swelling. TSH is high, T4 is low and ESR is High. What is the most likely diagnosis?

A. Subacute thyroiditis B. Hashimoto thyroiditis C. Sick euthyroid state D. Riedels thyroiditis · Tender = subacute

Long case of a medullary thyroid cancer (diagnosis given) what is the appropriate management?

A. Subtotal thyroidectomy B. Total thyroidectomy C. Hemithyroidectomy Indications for total thyroidectomy: 1- Medullary carcinoma 2- Anaplastic 3- Size 4 or more 4- Nodal involvement 5- Metastasis 6- Extra-thyroidal extension 7- Graves non-responsive to medications or with compressive symptoms or with ophthalmogy involvement

A patient post thyroidectomy then developed hoarseness of voice and aspiration. Which of the following is the injured nerve?

A. Superior laryngeal B. Inferior laryngeal C. Recurrent laryngeal D. External laryngeal.

A patient post thyroidectomy was unable to maintain a high-pitched voice. Which of the following is the injured nerve?

A. Superior laryngeal B. Inferior laryngeal C. Recurrent laryngeal D. External laryngeal.

282- 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

Trauma patient with extra peritoneal bladder injury, what next step in management?

A. Suprapubic catheter B. Urgent exploration and repair C. Catheter repair and assess after 2 weeks D. Catheter us after 2 weeks Catheter if extraperitoneal injury Suprapubic catheter: in case of urethral injury (blood from meatus) Urgent exploration repair: in case of Intraperitoneal injury

181- Elderly patient presented to OPD with change in bowel habit (constipation) and streaks of fresh blood on stool. Rectal exam revealed a mass. Colonoscopy and biopsy confirmed adenocarcinoma at 6 cm from anal verge. What is the next step in management?

A. Surgery B. CT chest and abdomen C. Neo adjuvant radiotherapy D. Chemotherapy

In a case of Ectopic pregnancy, B-HCG was 5000. What is management?

A. Surgery B. Methotrexate

224- scenario about hydatid cyst 10*13 with daughter cysts, what is the management?

A. Surgical deroofing B. Percutaneous aspiration C. Right hepatectomy

302- 5 years old child present with supracondylar fracture after falling down. He's arm is deformed, he has no pulse but the limb is warm and pink. What's the next appropriate step for management?

A. Surgical exploration B. Urgent reduction and K wire fixation C. CT angiography D. Splinting and observation

Female 25 years old, presented to the ED with Vague abdominal pain and amenorrhea for 2 months. History of open appendectomy due to perforated appendix 14 year ago. Her B-hCG 1800. Whats the most appropriate Management ?

A. Surgical intervention after stabilizing B. Gs review for acute abdominal C. Strong analgesic D. Methotrexate

Patient known to have Hepatitis b and chronic liver disease found to have liver nodule on ultrasound and CT was done Showed 6 cm HCC with high vascularity with normal Portal vein and no invasion He is well now with controlled ascites with medication His labs Albumin: 3.1 Bilirubin: very high 40, normal was up to 2 INR: 1.5 His ALT and AST were within normal What is the most appropriate next step in management?

A. Surgical resection B. Radiotherapy C. Transcatheter arterial embolization · Single mass less than 5 cm --> surgical resection · Single > 5 or multiple --> transcatheter arterial chemo embolization

148- Elderly patient, came with upper GI bleeding. Hx of PUD, recently completed ttt of H-Pylori. Endoscopy found arterial duodenal bleeding, failed to be controlled. Received 4 units of pRBCs, BP 110/60, pulse 12. Best surgical option ?

A. Suture bleeding B. Suture bleeding site and truncal vagotomy C. Truncal vagotomy and antrectomy

30 years old post partum woman admitted for right leg DVT and was started on enoxparin 80mg BID. Then she developed sudden onset dyspnea and right pleuritic chest pain, on PE; She was dyspneic and apprehensive, heart sound showed loud P2 and lungs were clear on auscultation, vital signs normal ABG: normal HCO3 and Po2, decreased PCO2 and high pH CT showed thrombus in right lower pulmonary artery Which of the following is most appropriate step in management :

A. Switch Enoxparin to sodium heparin B. Thrombolytic therapy C. Same management D. Thromboectomy

A 7-year-old boy presents to the pediatric clinic complaining of painless swelling of the left knee joint for the past three days. He reports that bright light has also been bothering him lately. The synovial fluid is found to be sterile, and a diagnosis of synovitis is recorded. On physical exam, the child is noted to have a saddle nose, peg-shaped upper central incisors, and a maculopapular rash. Eye exam reveals interstitial keratitis. It is noted during the exam that the child has difficulty hearing:

A. Syphilis B-Neisseria C-Toxoplasmosis D-Rubella

47 Y.O Female came with fatigue for 2 months associated with weight gain. She also complained Of amenorrhea for 6 months and bilateral milky breast discharge. What is the most appropriate next step?

A. TSH. B. Serum prolactin. C. Mammogram. D. Pituitary MRI.

Pregnant women doesnt have rubella vaccine what should do?

A. Take in second trimester B. Postpartum

315- 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

316- 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 pregnant female at 31+5 weeks of gestation, presents with preterm premature rupture of membranes. CTG shows several variable decelerations. What is the next step in management?

A. Tocolytics And Steroids B. MgSO4 C. Expectant Management D. Urgent Delivery Prompt delivery in: intrauterine infection - abruption - nonressuring FHR - cord prolapse

• pediatric newborn with purulent eye discharge , Culture showed gram negative diplococci , How to treat ? •

A. Topical antibiotic • B. Observation • C. IV Cephalosporin • D. IV Doxycycline

69 YO male presented to ER with history of recurrent exertional chest pain, progressive SOB and syncope. Echo showed aortic stenosis. What is the most appropriate management?

A. Tight control of HTN B. Aortic valve repair C. Aortic valve replacement D. Follow up · Indications for aortic valve replacement (one of the following) o Symptomatic aortic stenosis: dyspnea - syncope - angina o Asymptomatic but severe aortic stenosis + LVEF < 50% o Asymptomatic severe but going to cardiac surgery for something else · This patient: Symptomatic aortic stenosis: dyspnea - syncope - angina --> aortic valve replacement

Old male patient did total thyroidectomy he developed swelling in the neck with inspiratory stridor and Shortness of breath in the ward, how you will manage?

A. Thoracotomy B. Surgical evacuation C. Drainage

44 YO female presented with history of neck swelling for 3 months. She is asymptomatic. Examination reveled thyroid nodule 2x2 cm. what is the best next step?

A. Thyroid IJ/S B. FNA C. Core needle biopsy D. TSH

31 YO female known to have hyperthyroidism on carbimazole 20 mg presented to the clinic complaining of ongoing palpitation and anxiety with no improvement. What is the best next step?

A. Thyroid IJ/S B. FNA C. Increase carbimazole to 40 mg D. Radioactive iodine uptake test · Patient already diagnosed, no need to repeat any investigations · Only increase the dose to the maximum dose: 40mg · If patient on 40 and still no responding à RAIU ablation

24-year-old lady with rupture of membrane at 34 weeks gestation. What to do first?

A. Tocolytics B. Steroids C. Antibiotics

24 Y.O. male patient presented with bloody diarrhea for one month. Colonoscopy was done and showed continuous mucosal inflammation and ulceration reaching the splenic flexure. What is the most appropriate management?

A. Topical mesalamine. B. IV steroid. C. IV antibiotic. D. Topical and oral mesalamine.

Child presents with hip and groin pain. An US was done to reveal hip joint effusion. He is afebrile. What is the most likely diagnosis?

A. Toxic synovitis B. Benign acute myositis C. Osteomyelitis D. Septic arthritis Toxic synovitis = Transient synovitis 70% of cases preceded by URTI Mostly Clinical diagnosis Tx: NSAID + rest

304- 3 years old child fell down from a swing and sustained right femur closed fracture with 30 degree angulation. What is your management?

A. Traction and observation B. Application of pelvic Harness C. Reduction and fixation with intramedullary nail D. Reduction and spica cast application

305- 7 years old child fell down the stairs and sustained left femur closed fracture with 30 degree angulation. What is your management?

A. Traction and observation B. Reduction and fixation with External fixation C. Reduction and fixation with flexible intramedullary nail D. Reduction and spica cast application

56 Y.O. male patient presented to the hospital with fever and early diastolic murmur heard best at the LLSB. His ECG is insignificant. Which Of the following is more sensitive to make the diagnosis?

A. Transesophageal ECHO B. CXR. C. Transthoracic ECHO. D. Repeat ECG. · Most sensitive: transesophageal echo · Next step in structural heart disease: transthoracic echo

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 asymptomatic and the rest of her examination is normal. What is the best next step to confirm the diagnosis?

A. Transthoracic Echo B. Transesophageal Echo C. ASO titer D. Chest X-ray · Pansystolic + radiated to the axilla + apex à mitral regurgitation · Best next step to confirm for all valvular diseases (does not mean best to diagnose) à transthoracic echo

Female with vaginal discharge Grey, fishy odor, smear show clue cells, diagnosis?

A. Trichomoniasis B. Bacteria vaginosis C. Candida

Patient with hypertension, heavy bleeding and anemia, what contraceptive she can use?

A. Tube ligation B. IUCD Mirena C. Condom D. OCP

Which of the following HCV genotype is the most common in KSA?

A. Type 1 B. Type 2 C. Type 3 D. Type 4

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 diagnosis?

A. Typical Anginal B. Angina equivalent C. Pulmonary Embolism D. Myocardial Infraction · Not a typical presentation of ACS: dyspnea only, no chest pain · Troponins 0.09 are not significantly elevated · This is called angina equivalent

189- A 65 year old patient known case of Atrial Fibrillation presented to the ER complaining of severe diffuse abdominal pain for 4 hours. Elevated WBC. Vitally stable. What is the initial test?

A. US B. CT C. Diagnostic laparoscopy D. Unrelated

288- patient is hemodynamic unstable, present after he ate food with severe abdominal pain despite taking analgesic. He became confused and unconscious later in the hospital. Examination revealed: Tender and pulsatile mass in the abdomen, BP low. What is your most appropriate management?

A. US B. CT C. Exploratory Laparotomy

Pregnancy 7 weeks with vaginal bleeding. And no intrauterine or extrauterine sac

A. US after 2 days B. Reassurance C. Discharge home

30 y.o. mexican gentleman. C/O RUQ pain + fever x2wks. CT: non-rim-enhancing collection in Liver (right lobe). Serology Abs: +ve to Entamoeba histolytica. Management?

A. US guided drainage B. Metronidazole C. Surgical drainage D. Metronidazole+ Aspoiratio Initial treatment with metronidazole Indications for aspiration: -Localized in the left lobe -Pyogenic abscess -Multiple abscesses -Failure to respond to pharmacotherapy

60 YO male patient known to have DM AND HTN presented to ER with history Of abdominal pain and bloody diarrhea for one day. CT abdomen showed thump print Sign. What is the most likely diagnosis?

A. Ulcerative colitis B. Chron's disease C. Ischemic colitis D. Infectious colitis Thump print sign can occur with IBD and ischemic colitis Its more ischemic colitis: old age - HTN and DM - acute presentation and one day history à more susceptible to ischemia

36- A 25-year-old women had severe pelvic inflammatory disease 2 years ago that was treated by intravenous antibiotics. The isolated organism was chlamydia trachomatis. Since then, the patient was trying for pregnancy but failed to do so. She had normal regular period and normal analysis of her husband. according to previous questions, Which of the following investigations is recommended?

A. Ultrasound monitoring of her ovulation B. Magnetic resonance image of the pelvis C. Computed tomography of the pelvis D. Hysterosalpingogram

Pregnant women during vaginal delivery, what can make her has fourth degree perineal tear?

A. Unrestrained legs and squatting position B. Unrestrained legs and sitting on chair C. Restrained legs and use of forceps and other metallic instrument

34 YO male presented to the hospital with epigastric abdominal pain and vomiting for one week. H. Pylori testing was positive and he was started on triple therapy. How to confirm the eradication of H.pylori?

A. Urea breath test B. OGD and biopsy C. Stool antigen D. H.pylori antibodies Best: urea breath test for eradication Second: stool antigen

46 Y.O. female patient with long standing history of heartburn on self prescribed antacid. Now presented with dysphagia for one month. What is the most important investigation to order next ?

A. Urea breath test B. UGI endoscopy C. Barium study D. 24-hour PH monitoring GERD + dysphagia --> scope

33 YO male known to have HTN on amlodipine, hydrochlorothiazide and perindopril presents with high BP readings at home. He is asymptomatic. His labs are unremarkable except for low potassium Which Of the following is the best next step?

A. Urinary catecholamines measurement B. 24-h urinary cortisol measurement C. Measurement of aldosterone-renin ratio D. Renal doppler ultrasound Hypokalemia + refractory HTN (on three antihypertensive and still hypertensive) = Hyperaldosteronism

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. Urine Proteins C. Urine Ketones D. Urine Glucose Hyperemesis gravidarum -> dehydration --> Urine ketones

4- 60 years old this is her 2nd UTI in the last 6 months, feels a bulge in the vagina and has difficulty emptying her bladder, next?

A. Uroflowmetry B. Urodvnamic test C. Video Urodynamic D. Post voiding Residual volume

- 60 years old this is her 2nd UTI in the last 6 months, feels a bulge in the vagina and has difficulty emptying her bladder, next?

A. Uroflowmetry B. Urodynamic test C. Video Urodynamic D. Post voiding Residual volume A postvoid residual (PVR) urine volume is one method used to evaluate for urinary retention in patients with Pelvic organ prolapse.

Intrauterine device implantation patient have brown discoloration and abdominal pain. Whats the most likely diagnosis?

A. Uterine rupture B. Pelvic inflammatory disease

Woman in delivery bleeding not stop, she wants to conceive in the future, which structure you should ligate?

A. Uterosacral ligament B. External iliac artery C. Internal iliac artery D. Uterine vein

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

- Woman had 7 kids now she is complaining of a vaginal mass protruding more with cough what is the next step?

A. Vaginal speculum exam B. Retrograde Cystourethrogram

Diabetic patient presented with history of leg pain when he walks for 300 meters. The pain improve with rest. What is the most likely cause?

A. Varicose vein B. Arterial ischemia C. Infection D. Diabetic neuropathy · Intermittent claudication: PVD à arterial ischemia

Asthma exacerbation after pneumonia, what is Tx?

A. Ventolin + AB B. Ventolin + systemic steroid C. Systemic steroid + hydration D. Systemic steroid + AB

A 39-week pregnant patient, history of caesarean section, due to breech presentations, now she is in labor, with regular contractions 4 every 5 min, cervix fully dilated, full effacement, station +3, What is your management?

A. Ventouse delivery B. caesarian section C. examine her after 2 hours

Woman did some procedure (pelvic procedure but forgot what it was) and then came complaining of urine from vagina during urination(micturition (What is the dx?

A. Vesicovaginal fistula B. Ureterovaginal fistula C. Uretherovaginal fisula D. Rectovaginal fistula

177- What type of polypterm-1702 with highest risk of cancer?

A. Villous B. Tubular C. Tubulovillous

Female with suprapubic tenderness and non-purulent vaginal discharge Type of infection

A. Vulvar B. Vaginal C. Cervicitis D. Uterocervicitis

67 YO male diagnosed with peripheral artery disease. What is the best way to prevent cardiovascular events in the future?

A. Warfarin B. Heparin C. Aspirin D. Clopidogrel · Any atherosclerotic disease: PAD - stroke - CAD à must be on aspirin for life for secondary prevention · Most important risk factor to control in PVD o Smoking cessation

Molar pregnancy follow up of HCG?

A. Weekly until 3 negative B. Weekly then monthly for 6 month C. Monthly then weekly D. Monthly until negative

Which Of the following is the most important intervention to control HTN?

A. Weight loss B. Smoking cessation C. Healthy diet D. Exercise · All help to control o Weight loss: 1 mm Hg per kg reduction in body weight in overweight individuals --> most important o Diet: up to 11 mm Hg o Exercise: up to 8 mm Hg o Smoking cessation: not very clear how much it will control BP

Lady presenting with vaginal bleeding with fever 15 days after C/S. Most probable Dx?

A. Wound infection B. Retained products of conception C. Endometritis D. Mastitis Retained product of conception will present mainly with heavy bleeding Endometritis will give you in the history C/S and fever

Patient post foot crush injury with heavy object came with excruciating pain and pale cool limb, Best next step:

A. X-ray B. CT scan C. Compartment pressure First choice: fasciotomy Second: Compartment pressure measurement (if fasciotomy is not in the answers)

201- Post laparoscopic cholecystectomy, a patient was discharged home. He presented 4 days later with RUQ pain and fever. Examination revealed temperature of 38°C and tender fullness at RUQ. Labs showed high WBC level and normal Bilirubin and liver enzymes. Antibiotic therapy was started. What is the next step?

A. Xray abdomen B. US abdomen C. CT scan abdomen D. Tc-HIDA scan

26 Y.O. Indian male came to mecca and then after 2 days he developed fever, intermittent convulsion and SOB. What is the most likely cause?

A. Yellow fever. B. Dengue fever. C. Japanese encephalitis. D. Malaria.

20 years old pregnant woman presenting with lost of fetal movement followed by decrease urinary output and difficulty breathing Her labs are as follow: aPTT prolonged, Fibrinogen low, Platelets low, what is the diagnosis?

A. acute glomerulonephritis B. DIC C. Autoimmune thrombocytopenia purpura D. Acute amniotic embolism

Pregnant at 39 weeks, came with proteinuria Bp 140/90, what is your action?

A. admit and observation B. Labor induction C. Follow up and observe

12-month baby on otoscope exam there's no mobility of TM, and has fever and decrease feeding .He is breast feeding, no fever, no pacifier, it's unilateral what will you give?

A. amoxicillin B. amoxicillin-clav C. refer to ENT for tympanic tube D. ask him to come back again in 48 hours Indications for antibiotic treatment Any children less than 2 years Bilateral otitis media High fever Severe ear pain for 2 days No good follow up Known for craniofacial anomalies

12-month baby on otoscope exam there's no mobility of TM and has fever and decrease feeding .He is breast feeding, no fever, no pacifier, it's unilateral what will you give?

A. amoxicillin B. amoxicillin-clav C. refer to ENT for tympanic tube D. ask him to come back again in 48 hours" Age < 2 years + otitis media --> indications for amoxicillin

12 month baby on otoscope exam there's no mobility of TM, he is breast feeding,no fever, no pacifier, it's unilateral what will you give? •

A. amoxicillin • B. amoxicillin-clav • C. refer to ENT for tympanic tube • D. ask him to come back again in 48 hours" • There is no fever • No ear pain • No bulging or red tympanic membrane • This is otitis media with effusion • Need observation • And tube can be inserted if lasts more than 6 months or hearing problems

123- 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

27 years old female complaining of green vellow discharge that started after her niensuration, Upon examination: red lesions on cervix, What' sahe diagnosis?

A. atrophic vaginitis B. Bacterial vaginosis C. candidiasis D. trichomoniasis

Breastfeeding counseling is best done

A. before conceiving B. 1st trimester or prenatal C. Postpartum

Patient with cough and hemoptysis, On auscultation there is consolidation on the right upper lung zone. What will help in confirmation of diagnosis?

AFB sputum culture · Key words: hemoptysis - upper lobe consolidation · Other modalities for diagnosis: PCR - Culture

Pregnant in her 10th week, presented with nausea ,vomiting and abdominal pain and hemoptysis, her fundal height is (large for gestational age ,forgot the number), bhcg levels are extremely high, speculum exam showed irregular aggressive mass protruding from the cervix and liable to bleeding when touched, what's your next step in management?

A. biopsy the mass B. Dilatation and evacuation C. Staging and chemo D. Hysterectomy

264- Female smoker 50 pack/year had a lung nodule that was 5mm and after 9 months it became 10.5mm. She has no symptoms, normal physical examination , no LN enlargement, nothing at all. What to do next?

A. blind percutaneous biopsy B. Refer to thoracic surgery C. Bronchoscopy D. follow up after 6 month

Highest rate successful drug used in Postpartum Hemorrhage?

A. carboprost B. Oxytocin C. misoprostol D. Methylergonovine

120- 5 days post open appendectomy, signs of bowel obstruction, abd distention, bowel silent, (no vitals) most appropriate management

A. check electrolyte B. Rectal tube C. CT ? D. laparotomy

Pregnant 8 weeks came with very high HCG, severe vomiting and nausea, abdominal pain, and heavy bleeding, passed some vesicle, on vaginal examination you find some part of tissue and cervical os opening, uterine examination was bulk, abdominal was tender and more than 8 weeks, What is the diagnosis ?

A. complete abortion B. incomplete abortion C. threatened abortion D. complete hydatidiform mole

166- 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

9y old child , PTH high , ca high , came with bone pain tt ?

A. diuretics + Rehydration + bisphosphonate B. rehydration + diuretics + bisphosphonate C. rehydration + bisphosphonate + diuretics + statin D. bisphosphonate + Dehydration + diuretics Symptomatic hypercalcemia require urgent treatment: where hydration is the most important immediate step

Case of Choriocarcinoma with very very very high bhcg with hemoptysis ask about first thing to do?

A. evacuation B. radio C. chemo D. chest x Ray

160- 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

Case ectopic pregnancy ( history given) mother refusing OR. her B-hcg 3500 size of sac 3 non viable no signs of rupture. what will u do?

A. explain that failure is high B. treat medically but sign consent C. laparoscopy D. laparotomy

What makes you suspect UTI?

A. fever. B. leukocyte C. high nitrite

162- About a fistula with discharge, located posterior to anal sphincter what is your management?

A. fistulogram B. fistulotomy C. lateral internal sphincterotomy D. MRI

Diabetic mother came at 10 weeks what test will tell you the risk of chromosomal anomalies?

A. glycosylated hemoglobin B. US nuchal translucency

192- 45-year-old patient complains of recurrent episodes of upper abdominal pain for the past 2 week with fever. On examination, the patient is jaundiced, the abdomen abdomen is soft with marked tenderness all over Blood pressure 90/60mmHg Heart rate 130 /min Respiratory rate 18 /min Temperature 38 °C indirect bilirubin 5 Direct bilirubin 20 Total bilirubin 25 Alkaline phosphatase 450 Amylase 1400 Ultrasound: CBD of 1.4 cm with dilatation of intrahepatic ducts. Which of the following is the most likely diagnosis?

A. hepatitis B. cholangitis C. pancreatitis D. acute cholecystitis

Severe preeclampsia, acute management of HTN drug?

A. hydralazine B. Methyldopa C. Nifedipine D. Sodium nitroprusside

Clinical finding in pt with turner:

A. hypertonia + ankle clonus B. fold skin at nape of neck C. single palm crease D-Depressed nasal bridge

Post partum three months, came with hx of something that protruded from the cervix bleeding on touch, mx:

A. immediate D&C B. measure hcg after 1 week C. Biopsy D. Tests for metastasis

204- A 30-year-old woman who is 10-week pregnant and know case of gallstone presents to the Surgical Clinic complaining of recurrent attacks of biliary colic for the last 5 weeks. Which of the following is the most appropriate management?

A. immediate laparoscopic cholecystectomy B. laparoscopic cholecystectomy after delivery C. laparoscopic cholecystectomy in 2nd trimester D. laparoscopic cholecystectomy in 3d trimester

Which of the following is true regarding necrotizing pancreatitis?

A. increased lipolysis B. Hypoglycemia C. Decreased gluconeogenesis

41 Weeks pregnant with non-reassuring CTG and she has fibroid, what is the most appropriate step in the management?

A. induce the labor B. CS C. CTG daily Category 3 is an indication for urgent C/S As simple as that! - We can't induce labor (oxytocin) if she is category 2 The management of category 2 is to stop oxytocin)

Infertile women with irregular cycle and PCOS:

A. induction of ovulation with clomiphene B. Induction of ovulation with gonadotropin C. Use OCP to regulate her cycle

206- A 50 year old man presents with progressive jaundice, dark urine, and right upper quadrant pain and distention. On physical examination he has a palpable gall bladder. Imaging shows an enlarged gall bladder and dilated Intrahepatic duct. Amylase = 481. diagnosis is

A. klatskin tumorn B. Pancreatic cancer C. Cholecystitis D. Mirrizi's syndrome

Pregnant with massive bleeding from abruptio placentae. She is hypotensive and vitally unstable. What is the most appropriate thing to do to save her life?

A.admitted to ICU with obstetric team B.Admitted with different spacilized team C. 2 peripheral IV cannula and blood transfusion D. Rapid response team with multidisciplinary intervention

68- year-old man has been advised to undergo surgical treatment for a leg reducible inguinal hernia. What is the treatment?

A. laparoscopic repair B. simple open repair C. mesh open repair D. observation Hernia management summary: - Pediatric -> Herniotomy - All adult hernia cases -> Mesh repair Hernioplasty - Strangulated: Herniorrhaphy Open Vs laparoscopy: - Open: everyone - Laparoscopic: recurrent or bilateral

Treatment of moderate persistent asthma, What to add in addition to short acting b2 agonist?

A. low dose of ICS + LABA B. low dose inhaled b2 agonist

7 y/o unvaccinated boy presents with red erythematous irregular patches of rash that is around his neck and spreads down his back. What does he have?

A. measles B. Chickenpox C. Rubella D. Pertussis

scenario of anal fistula on 7 o'clock planning for fistulotomy asking about common are of internal able fistula

A. medial posterior B. medial anterior C. lateral D. supination

Pedia present with case of impetigo ask when can return to day care: •

A. not contagious return now • B. not contagious return after 3 days • C. contagious return after 5 days • D. contagious return when it gets dry The closest to the right answer is B Impetigo can return to school one day after starting treatment • Chicken pox can returned to school after all skin lesion are crusted are crusted • Measles can retun to school after 4-5 days of rash • Rubella retrun after 5-7 days of rash

Newborn circumcision , chordee and hooded foreskin + hypospadias ,how to manage? •

A. open circumcision B. plastibell circumcision C. Ultrasound D. referral to pediatric surgeon

child miss his vaccine for 4 and 6 months develop eye proptosis with painful addiction?

A. orbital myositis B. orbital cellulitis C. Per orbital cellulitis D- Eye candida

65 YO male presented with progressively enlarged thyroid mass. His labs showed increased calcitonin. What is the most likely type Of thyroid cancer?

A. papillary B. Medullary C. Follicular D. Anaplastic

Children with cough, fatigue, 2 time bloody vomiting, low grade fever, with dullness in percussion dx? •

A. parapneumonic effusion • B. pleural effusion • C. TB • D-Viral

66 Y.O female known to bronchial asthma on inhaled steroid underwent surgical of colorectal cancer. Following the surgery, she was shifted to the ICU due to low BR Her labs were given: K+:6 Na:130 glucose: 55. What is the most likely diagnosis?

A. post-op dehydration. B. Addison crisis. C. SIADH. D. Iatrogenic hypoglycemia Hypotension - hyperkalemia - hyponatremia - hypoglycemia = Addison crisis.

Most accurate method to make sure full placental separation?

A. pressure and massage uterus B. manual removal C. wait for spontaneous D. with a sponge

What is the MOA of emergency contraceptives?

A. prevent implantation B. prevent fertilization C. prevent ovulation D. delays fertilizations

67 YO male presented to ER with sudden severe epigastric abdominal pain for 8 hours. Associated with nausea and vomiting. on examination there is epigastric tenderness. Labs showed elevated amylase. Which of the following is most helpful to determine the disease severity?

A. procalcitonin B. ESR c. CRP D. ALT CT also Ranson criteria: LDH - AST - age - WBC > 18K - hyperglycemia - fluid loss - HCT- Ca - BUN - O2 - base deficit

17 yrs old female came C/O primary dysmenorrhea, How will you manage??

A/ COCPs B/ NSAIDs C/ Mefanimic acid

30 yrs female did pap smear shows LSIL, What is the next step?

A/ Coloposcoy B/ repeat pap after one year C/ HPV D/ Biopsy

186- Elderly female, asymptomatic maybe or just fatigued. Labs showed microcytic anemia what to do NEXT?

A/ Occult fecal blood B/ Endoscopy & colonoscopy

4 months old with proven pertussis infection on macrolide. His 3- and 5-years old siblings are vaccinated up to date. What is the proper action to prevent the siblings from getting the infection

A. prophylactic macrolide. B. booster vaccination against pertussis C. observe them for the possibility of developing the infection. D-Immunoglobulin

Patient ectopic pregnancy on methotrexate and bhcg elevated in day 4 and 7 what to do?

A. recheck bhcg after 48 hours B. recheck bhcg after one week C. salpingectomy D. discharge Failure of Medical Treatment: - When the B-hCG level plateaus or rises, fail to decrease adequately by 15% from days 4 to 7 post injection or the tube ruptures. - Managed by: o A repeat single dose of methotrexate (as indicated) o Surgical management (if maximum doses of methotrexate have reached or rupture of tubes)

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

Pt with ascites and edema, severe muscle wasting, hyperkeratosis, lab show: slightly decreased glucose, significantly decreased albumin, your •

A. severe protein deficiency (kwashiorkor) B. severe carbs deficiency (marasmus) C-Rickets D-Mild malnutrition

Pregnant at 34 weeks with blurred vision, headache and her BP 170/ What to do ?

A. stabilize + mg and wait till 37 weeks B. call anaesthesia now and deliver C. stabilize and give MG and deliver

Patient at 32 weeks presented with seizure and high blood pressure, what is the next appropriate?

A. steroid B. hydralazine C. magnesium sulfate D. Abx

Pregnant on epidural and oxytocin suddenly contractions stopped CTG Picture as shown above, what would you do?

A. stop oxytocin and immediate delivery B. stop epidural C. increase oxytocin D. change to lateral position and recheck after 20 mins CTG: Prolonged decelerations and stoppage of uterine contraction contraction stoppage! Which indicates uterine rupture

Female hypertensive and diabetic, on ACEI, insulin, Metformin, she decided to get pregnant soon. Labs: heavy proteinuria, Hga1c: 8, What's your most appropriate advice for her regarding diabetic control and fetal congenital malformations?

A. stop snacks and start 3 heavy meals a day. B. switch ACEI to ARB's C. try to control her hga1c to normal or near normal as possible before pregnancy. D. Increase dose of ACEI

Female patient present in the emergency with lower abdominal pain and bleeding, ultrasound done and a 3cm ectopic pregnancy found in the ovarie. The B-HCG was 15000. from the above history what will make the medical treatment contraindicated

A. the size B. the abdominal pain C. B-HCG level

154- 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

33- 55 years old female came with bilateral breast pain + bilateral green discharge from multiple ducts. Imaging: Multiple dilated ducts, not suspicious. What to do?

A. us guided needle biopsy B. Interval follow up imaging C. Galactogram D. MRI breast

Patient 34 GA, came after hx of fall at home with abdominal tenderness and noticed reduced fetal movement, 4cm cervix and 80 effacement. Fetal heart rate 150, and moderate abnormal utrine contractions every 3 to 4 minutes. Whats diagnosis?

A. vasa previa B. placenta abruption C. placenta previa D. latent phase

43- Female in her 47 , single, positive family history of breast cancer. Underwent routine mammography which showed bilateral increased density and glandular pattern. Core needle biopsy showed atypical ductal hyperplasia. What's the appropriate management?

A. wide surgical excision. B. Simple mastectomy

273- 55 year old male diagnosed with acute lower limb ischemia. I.V heparin and l.V fluid fluid started. What is the most appropriate next step in this patient management ?

A. СТ-A B. DSA C. US-Duplex D. Immediate embolectomy

275- 65 YO male presented to ER with severe right leg pain and absent pedal pulse. Which of the following is the most diagnostic investigation?

A. СТА B. MRA C. Conventional angiography D. Ultrasound doppler

290- Patient did heamorrhoidectomy 2 weeks ago now came with sob ( given ecg but was not clear) What is the confirmatory test?

A..spiral ct B..echo C..ecg D..dimer

7 y/o with meningeal signs, headache, and fever. He and his family came from Africa recently. He also has sore throat and lymphadenopathy. CSF (normal protein and normal glucose and lymphocytosis). What you will give the child

A.Coronavirus B.CMV C. EBV D-Hantavirus

Patient obese, history of jaundice for 1 week with anorexia and abdominal pain, examination showed right upper quadrant tenderness, no history of medication or disease, what is initial step?

Abdominal US First step done for any RUQ pain investigation is RUQ U/S

219- A patient with cirrhosis and his dr. want to screen him for Hepatocellular carcinoma, what is the best diagnostic test?

Abdominal US Triphasic CT

Charcot triad is specific for which disease?

Acute ascending cholangitis (jaundice + fever + RUQ pain)

A patient underwent a hernia repair operation 12 years ago, now presents with signs of intestinal obstruction. Which of the following is the most likely cause?

Adhesions

Patient had an episode of Calculus cholecystitis recovered from the attack now in hospital and asking about what's next?

After approx. 6 weeks of resolution of symptoms, the local inflammatory changes have likely resolved, thereby decreasing operative risks and complications.

Picture of Two huge echinococcosis hydatid cyst but size wasn't mentioned, asking what most appropriate initial step?

Albendazole

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?

Always start with TSH since thyroid cancer usually doesn't cause hyperthyroidism so if TSH is low --> likelihood of cancer is low

Patient post RTA chest X-ray shows 3rd ,4th ,5th 6th rib fracture with no pneumothorax what is the next step?

Analgesia Flail chest or rib fracture: main management is to give analgesia

156- 65 yrs old male complaining of sever Lower GI BLEEDING What is most common cause

Angiodysplasia IBD Diverticulosis

51 years old female medically & surgically free, with no family history of colon cancer, which colon cancer screening test is appropriate for her?

Annual Fecal Occult Blood

197- Pt has RUQ pain radiating to the scapula, nausea and vomiting, U/S shows small gall bladder stones & 5 mm polyp, what is the management?

Lap chole. Observation Radical cholecystectomy Repeat US after 3 months

Patient presented with dysphagia to liquids more than solid, which is the most appropriate initial investigation:

As per uptodate and amboss and um qura the answer is Endoscopy Initial Mx for dysphagia for everyone is endoscope

25 yeas old breastfeeding women with breast pain tenderness and swelling but there is no fluctuation What is your management?

Aspiration

56- Lady with fibroadenoma underwent excision Histopathology result: fibroadenoma + invasive ductal carcinoma What is the management?

A— Radiotherapy B— Chemotherapy C— Mastectomy D— High risk screening protocol

152- 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

A 47-year-old woman presents to her primary care provider With Raynaud's phenomenon for 3 years, puffy fingers, a fingertip ulcer and difficulty swallowing. past medical history is unremarkable. The patient does not smoke but drinks alcohol socially. Physical examination Of her hands is shown. which of the following is most likely to be positive in this patient condition?

A• Anti-smith antibody B- Anti-Scl-70 (anti-topoisomerase I antibody) C. Anti-DsDNA D- Anti-centromere antibody

22-year-old patient with typical symptoms or meningitis, culture showed gram cocci in chains. What is the appropriate treatment?

A• Ceftriaxone, Vancomycin and Dexamethasone B- Ceftriaxone. Vancomycin. Ampicillin and Dexamethasone C- Tazocine and Dexamethasone D- Tazocine. Vancomycin and Dexamethasone

Patient has contact with patient confirmed to has meningitis, which antibiotic as a prophylaxis you should give?

A• Ciprofloxacin B- Linezolid C- Augmentin D- Cefuroxime

A Woman presents to the Emergency Room With a I-week history of fever, dysuria, and flank pain. She is admitted to the hospital after fluid resuscitation total Of 6 liters Of isotonic saline and started on IV antibiotics. She also requires a low dose or norepinephrine to maintain her blood pressure. The day after admission. she complains Of shortness or breath and requires 5 liters of oxygen, oxygen saturation is 91% after this management. Chest X-ray confirms alveolar infiltrates. Bedside evidence left ventricular dysfunction, Blood pressure 78/34 mmHg. heart rate 125 Respiratory rate 25 Temperature 38.6, Oxygen 95%, Which Of the the likely diagnosis?

A• Diffuse alveolar hemorrhage B -Cardiogenic pulmonary edema C- HAP D- Acute respiratory distress syndrome · ARDS: a new bilateral infiltration in absence of cardiogenic edema + respiratory distress presentation

58 yr old complaining of fatigue and shortness of breath for 4 months, on P/E confirmed non tender right iliac fossa mass. (See labs) Hb was 66 (normal >130)

A⁃ Colonoscopy B ⁃ Abdomen US C ⁃ Percutaneous biopsy D ⁃ CT Colonoscopy as work of cancer

Patient hypertensive with proteinuria on labetalol she's 32 weeks, fundal height 28. what will commonly occur with IUGR?

a. oligohydramnios b. polyhydramnios

Adult soldier with bilateral inguinal swelling with positive cough impulse what is the most appropriate management?

Laparoscopic repair Hint: laparoscopic repair indications: bilateral - recurrent

Patient of stab wound measuring 2 cm penetrating injury with omentum coming out, patient is vitally stable, CT report negative findings, Next step management:

Laparotomy

Woman almost full term diagnosed as active labor now. She had clear fluid discharge before her contraction or labor starts, what is the DX?

a. preterm premature ROM b. premature ROM c. preterm ROM

A 24-year-old lady presents with a hard, mobile well-circumscribed painless left breast mass that has been increasing in size from the past few months and was NOT related to her menstrual cycle. The most like Diagnosis is?

Bad recall I think the diagnosis should be Phyllode (Not related to her menstrual cycle + Increasing in the size) Fat cyst = fat necrosis: Nontender periareolar mass with irregular borders Breast skin retraction, erythema, or ecchymosis Fibroadenoma: Usually, a well-defined, mobile mass Most commonly solitary Nontender Rubbery consistency Has a relation with menstrual cycle Fibrocystic changes: Premenstrual bilateral multifocal breast pain Tender or nontender breast nodules Clear or slightly milky nipple discharge Intraductal papilloma: Solitary lesions (also known as central papilloma) Most common cause of bloody or serous nipple discharge Palpable breast tumor close to or behind the nipple or areola Large, central lesion Phyllodes tumor Painless, smooth, multinodular lump in the breast, with an average size of 4-7 cm Variable growth rate: may grow slowly over many years, rapidly, or have a biphasic growth pattern Need revision

Patient obese and tried to lose weight with diet and exercise but failed. His BMI 43, and his HA1C is 8.5, What is the most appropriate advice?

Bariatric Surgery

A patient underwent sigmoidoscopy found sigmoid lesion, histology report: Sigmoid Adenocarcinoma with free margin with no invasion to mucosa. What is the next step?

CT abdomen in any cancer, 1st diagnosis: biopsy, 2nd staging (imaging), 3rd treatment, 4th survalince If colon cancer causing obstruction --> first remove the obstructing part (sigmoidectomy) before the diagnosis or the staging because bowel obstruction can cause death if perforated

Best way to assess patient spine after Road Traffic Accident?

CT spine

Case of right flank pain hematuria pain full micturition can't recall best next step:

CT without contrast

Patient with penetrated neck in the zone 1 and is bleeding what is the best management?

CTA Neck penetrating trauma management Stable patient: CTA Unstable or Hard signs: Exploration Need revision neck trauma

· When to scope GERD

Cancer presentation o Onset age > 60 o GI bleed symptoms o IDA o Weight loss o Anorexia o Dysphagia o Odynophagia o Vomiting o GI cancer in first relative

40 years old woman with no pain but you noticed jaundice. She has high direct bilirubin and high ALT what is your diagnosis?

Carcinoma in head of pancreas

Patient sustained a chest stab wound injury, on examination there was Stony dullness over right chest and tracheal deviation to the left, what is the diagnosis?

Massive Hemothorax

Young patient underwent open appendectomy, stayed in hospital for 2 days post op and it was uneventful stay. Came back on the 8 the day with surgical site pain on examination abdomen was soft and lax, tender in opposite with redness noticed, what would be your next step?

CT abdomen it seems like SSI post OP, CT abdomen done to rule out deep infections. treatment include: opening the wound + wound care + systemic antibiotic if deep collection: require IV ab + percutaneous image-guided drainage

Patient had central abdominal stab wound, he is vitally stable, what's next?

CT abdomen Approach to abdominal trauma - Stable vs unstable --> unstable + positive FAST or/and peritoneal sign or/and evisceration --> laparotomy - Stable --> CT with contrast

COPD and Cardiology

COPD can cause right side heart failure, cor pulmonale and pulmonary HTN Diagnosis:- Echocardiography COPD is associated with MAT (Multifocal atrial tachycardia) Treatment:- antiarrhythmic and treat the underlying cause

Obese snoring, lack sleep, sleep study done showed OSA, how you will ventilate?

CPAP

14 years old female with epigastric abdominal pain since a month was complaining that it is affecting her life, on exam patient had multiple bruises in abdomen when asked about it, she said it appeared after she fell over her cycle 18 days back, next investigation is?

CT

Case suspected to have renal stone, what's the best diagnostic tool:

CT

Patient after Motor vehicle accident at ER, vitally stable, on examination showed Lift hypochondrium tenderness and ecchymosis What is the Most Appropriate test:

CT

Patient had Blunt trauma, patient is stable, FAST showed intraperitoneal fluid. Next step?

CT

94- Child with clear case of appendicitis, most appropriate investigation to reach diagnosis?

CT US

A female get high energy accident (high velocity) with seat belt sign , On X-ray has chance fracture, what will associated with this fracture?

Chance fx + Seat belt sign = Duodenal perforation

Old patient in Intensive Care Unit (ICU) with acalculous cholecystitis, what is the best management for him?

Cholecystostomy tube --> patient sick as shit and not fit for OR

Patient had a RTA and present to the ER, initially was oriented and asking about water and then he became confused his blood pressure was 80/60, Heart Rate 140, what stage of hemorrhagic shock he is in?

Class three Class three vs class four Class four: volume >2000 - HR >140 - absent urine output Similarities: RR> 30 - hypotension - confusion Class three vs class two Class two: Normal BP but decrease pulse pressure Class one everything normal

Child presents with hip and groin pain, US done and revealed hip joint effusion. He is febrile. What is the most likely diagnosis?

Clinical features of acute toxic synovitis: Transient acute unilateral and transient hip or groin pain Children may limp or refuse to bear weight on the affected side Possibly limited range of motion (mostly to the extreme abduction and internal rotation position) and tenderness on palpation Recent upper respiratory tract infection in approx. 70% of the patients (Im not sure why is the patient febrile)

12- year-old boy injured with supracondylar fracture and distal radial pulse absent, which of the following is the appropriate next step in management?

Closed reduction First step for supracondylar fracture is urgent reduction After that it will depend on the perfusion to limb: Pale and cold ——- surgical exploration Warm and pink —— k wire

Inferior lateral Injury to the knee causing fracture of head of fibula, Which nerve could be injured?

Common peroneal nerve

45-year-old male smoker presented with fever, cough and respiratory distress, yellowish sputum. on exam there is Bilateral Crepitations and wheezing, he is febrile, chest x-ray showed both lung infiltrate, what is the problem?

Community acquired pneumonia · No mention of recent hospitalization history

28 years old patient medically free presented to the ER with hx of abdominal pain nausea anorexia and lower quadrant abdominal pain vitally stable CT: diverticulitis with 20 ml fluid 2*2 cm What is the most appropriate management

Conservative systemic antibiotic (oral) Treatment of diverticulitis is based on the following: - Uncomplicated: localized inflammation (thickening of the bowel) but no collection (abscess) --> treatment: Conservative systemic antibiotic (oral) - Complicated: abscess - obstruction - perforation --> IV antibiotic for all CT-guided percutaneous drainage for abscesses > 4 cm Emergency colectomy in patients with generalized peritonitis

Indian with history of TB presented with elevated JVP and hepatosplenomegaly, what is the most likely diagnosis?

Constrictive pericarditis · Pericarditis causes: autoimmune - viral - TB

Asthma medications in pregnancy, , she is using SABA per needed, what to take and what to stop?

Continue the same management · SABA and asthma medication are not contraindicated in pregnancy

A woman with a left breast mass for 9 months she underwent Mammogram and it showed: spiculated mass with suspicious microcalcification and axillary lymph node involvement, BI-RAD V, next step?

Core biopsy

Patient underwent hernia repair with mesh, came now complaining of pain extending to the thigh associated with numbness and paresthesia, what to do?

Depends on the time of the presentation: -If the patient present within 2-4 weeks post-surgery: NSAID -If persists for 3 months, this indicates neuralgia, and treated by nerve block

Elderly known case of poorly controlled DM comes with ulcers on tip of three of his toes, diminished dorsalis pedis bilaterally, what's the initial management:

Debridement

Patient presents with a scalp laceration which occurred 6 hours ago. How will you repair this injury?

Debridement with primary closure

· Risk factor o Most important cause of IHD:

Diabetes

18 months child with left Undescended testes not palpable in the inguinal region, left one is there what's the most appropriate to do?

Diagnostic laparoscopy: when the testes is not palpable in the inguinal area (to find it)

Elderly smoker known case of poorly controlled DM comes with ulcers on tip of three of his toes, diminished dorsalis pedis bilaterally, however, intact popliteal pulse, what's the initial management?

Diet modification and lifestyle changes

Elderly presented complaining of 2 months Hx of dysuria, cloudy urine. He's also complained of 2-months Hx of LIF pain. (See report) Sgimoidoscopy: construction in the sigmoid with intact mucosa Cystoscopy: Erythremtus Lesion at the dome of the bladder. Which of the following is most likely the diagnosis?

Diverticular diseases Explanation: - Diverticular disease + bubbling of urine and symptoms os UTI = colovesical fistula complication of diverticulitis

Patient undergoes esophageal dilation for achalasia came after (6 or 12 hours) with chest pain, subcutaneous crepitus and labs showed WBC 21000, what is your management?

Drainage and surgery Surgical management since the patient has high WBC which indicates sepsis Esophageal perforation management is either surgical or nonsurgical

How to defrinitaite between benign vs malignant ovarian tumor?

E. Hypoechoic F. Bilateral G. Cyst with septate

Patient is toxic, Temp. 37.9 (it was elevated) WBC high, bilirubin high, US: cystic lesion without septates CT: homogenous (not sure) and "THICK WALL with Peripheral enhancement what's most appropriate Management?

Emergent stent chole I think about pyogenic liver abscess, not sure about that NEEDS REVISION

76 years old male with reducible inguinal hernia and moderate pain, what's the treatment:

Non-surgical procedure

Neck penetrating injury on zone 1 with emphysema, next step?

Emphysema is not a hard sign Rules of neck penetrating trauma: - If unstable --> surgery - If hard signs --> surgery - If zone 2 --> surgery (need revision) - If zone 1-3 --> CTA and bunch of investigation Hard signs: - Artery: Expanding hematoma - severe bleeding - FND - Airway compromise - Hematemesis

50 years old with Ischemic Heart Disease (IHD), Diabetes mellitus (DM) Admitted to ICU with severe pneumonia and was treated with Antibiotics. After 3 days of admission, he developed hypotension and treated with hydration and inotrope, on admission lab was normal After 3 days, LFT was abnormal Total Bili is 20 (increased), very high AST and ALT (1000), mild increase in LDH, US done and showed unremarkable findings, what is the diagnosis?

End organ damage after septic shock

pancreatic pseudocyst, one is 18 cm x 24 cm or 17 cm , how to manage ?

Endoscopic drainage DDx: Acute fluid collection: Duration < 4 weeks, CT: homogenous content Pseudocyst: Duration > 4 weeks, CT: thick wall homogenous content Acute necrotic collection: Duration < 4 weeks, CT: heterogenous content Wall of necrosis: Necrotizing pancreatitis, CT thick wall heterogenous content Abscess: CT: enhanced wall Tx: Acute fluid collection: observation Pseudocyst: only if symptomatic or large> 10 cm --> Internal drainage Wall off necrosis: percutaneous drainage

Patient with Symptoms and sign of bowel obstruction, On the way to CT he has Upper GI bleeding Next step in management:

Endoscopy

Patient with Hip Fracture underwent Hip fixation repair surgery. What anticoagulant to give to prevent DVT?

Enoxaparin: DVT Prophylaxis dose: 40 mg SQ once daily DVT treatment dose: 1mg/kg every 12 hours or 1.5/kg daily Unfractionated heparin DVT prophylaxis dose: 5000 units SQ every 8-12 hours

Trauma patient, currently well. lucid interval reported by paramedics, now he is deteriorating. Most likely diagnosis?

Epidural hemorrhage Lucid interval = epidural hemorrhage

Male patient in his 20s, present with sever epigastric pain for 6 hours, start suddenly. On examination there is diffuse tenderness, sluggish bowel sound. Labs: high WBCs, Amylase 300, Which of the following best initial diagnostic step?

Erect chest X-ray to exclude perforation and air under the diaphragm

50 years old female presented to ER with sudden left lower chest pain and epigastric pain, after forceful vomiting. On examination there was decreased breath sound in the left lower chest What is the most likely concern?

Esophageal Perforation

18 years male came with STAB wound injury next to umbilicus with small opening clean and bleeding stopped, vitally stable with normal lab results, CT scan report showed: small splenic laceration with minimum fluid surrounding it, what is the best definitive management?

Exploratory laparotomy Hamza answer: Wound closure, because he is stable and splenic injuries managed nonoperatively, but he missed the point of the question, this patient came with a stab wound, where the peritoneum was violated, which always managed surgically Indications for surgery: - Unstable with penetrating trauma sign or positive FAST - Evisceration - Signs of peritonitis - Air under the diaphragm Need revision

Patient came after limb trauma, with severe pain and paresthesia between his toes and it was pale. X ray shows fractures, intercompartmental pressure was 35mmhg what to do?

External fixation with four fasciotomies

Case of multiple gastroduodenal ulcers with UGIB, asking about what lab test to do:

Fasting Gastrin

54- Women in her 50's with hard non tender immobile breast lump with tethering and red skin, dx?

Fibroadenoma Duct ectasia Carcinoma of breast Breast cyst

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?

First thing in ALI is heparin before the imaging

Elderly patient with small lung nodule (<8 mm), he is asymptomatic, not smoker, no family history of cancer, no constitutional symptoms, your next step is?

Follow up with CT scan First thing to do is compare with prior imaging less than 8 mm --> follow up 6-12 months 8 mm or more --> F/U in 3months if growing --> biopsy

28 years old female came to the clinic complaining of on and off painless rectal bleeding, she had anal swelling that reduced spontaneously, Anoscopy showed hemorrhoids on 3,7,11 o'clock with active bleeding. Labs showed anemia, Hemoglobin was 8.8, what is the most appropriate management?

For all hemorrhoid first Mx is trial of conservative therapy if failed then depend on the type 1-3: band ligation 3-4: hemorrhoidectomy BUT if there were low hemoglobin or persistent bleeding, definitive Mx is indicated initially

There was a question about a lady known case of gallstones for 15 years presented with abdominal pain and fatigue There was air in biliary system, what is the diagnosis?

Gallstone ileus

Pleural effusion in rheumatoid arthritis?

Glucose less than 1

· Risk factor o Most common cause of IHD: o Most important: diabetes o Most important to control after first episode: smoking Most common cause of death in ERSD is IHD

HTN

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?

Hemithyroidectomy

293- 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

All anti-TB medications are:

Hepatoxic

55- 32y female present with 4cm fibroadenoma with hyperplasia and atypia What is the most significant risk factor for breast cancer?

Her age Presence of hyperplasia Presence of atypia Fibroadenoma size

24 years old male medically and surgically free, presented with manifestation of intestinal obstruction, suspected to be small bowl obstruction, what is the most common cause?

Hernia

27- year-old obese woman presents with right iliac fossa pain associated with anorexia, nausea, and vomiting. On examination, there is moderate right iliac fossa tenderness. Labs showed: leukocytosis, what is the most appropriate management?

I dont agree with this reasoning CT is the most appropiate Tender abdomen is never an indication for Laproscopy

· Risk factor Most common cause of death in ERSD is

IHD

Lung Cancer 5CM nodule diagnosed with squamous cell carcinoma after biopsy Next step to do before surgery?

Imaging for lung cancer staging: PET-CT SCAN

Young female came to the clinic complaining ofepisodes of SOB, wheeze and cough for the last 6 months not related to certain provoker She says that these episodes comes suddenly and resolve suddenly. She used Ventolin but improved slightly. Upon physical exam she has equal air entry With no wheevzing_ She is not allergic to anything and no one in her family has the same problems. All test were normal and spirometry is normal. What is the diagnosis?

In this question: all asthma ques are negative + Ventolin is not working = vocal cord dysfunction (asthma mimickers)

Truck driver with severely painful gluteal swelling, management?

Incision and drainage

Patient thought to have appendicitis and did appendectomy, pathology lab shower carcinoid tumor 1 cm, what to do additionally?

Incomplete question Indications of right hemicolectomy: - If more than 2 cm - At the base of the appendix - Mesothelium invasion - Lymphadenopathy - OR any carcinoma If non of the above --> observation

A scenario about hydatid cyst measuring10*13 in Right lobe with daughter cysts, what is the most appropriate definitive management?

Initial albendazol definitive surgical

Patient presented with jaundice, US shows a shrunken gallbladder with dilatation of intrahepatic ducts. What is the most likely diagnosis?

Klatskin tumor

Patient with anal fissure not responding to drug, what procedure is most suitable for his condition?

Lateral internal sphincterotomy

Surgeon want to treat child diagnosed with PDA. During procedure, the surgeon is at risk to injure? •

Left Phrenic Nerve • Vagus Nerve • Left Recurrent Laryngeal Nerve • Hypoglossal nerve

Most affected nerve in patent ductus arteriosus (PDA) surgery?

Left Recurrent laryngeal Nerve

Before starting anti-TB medications, what you will order?

Liver function tests

Patient post trauma has distended neck vein that does not move with respiration in well his cardiac output 2.5 liter, what is the type of shock?

Low cardiac output (normal is 5 liter per minute) + distended vain could be obstructive or cardiogenic (need more information)

A 60 years old patient with difficulty swallowing liquid, pain on swallowing, and regurgitation. What is the most diagnostic test?

Lower esophageal sphincter manometry Dysphagia approach: - First: barium swallow - Best: if dysphagia to both: manometry - Best: if to solid only: barium swallow - Best if GERD: 24 hours ph monitor

Elderly female that has back, and she is stooping and bending her back while she walks to relieve the pain. What is the diagnosis?

Lumbar spine stenosis Spinal stenosis: - Exacerbated by walking - Relieved by bending forward Need revision for DDx

Patient Has ischemic heart disease came with sudden severe abdominal pain in the left iliac fossa and tenderness, HCo3 normal, low PH

Mesenteric ischemia

36 years old patient with left neck mass, 2x2xm in posterior angle of mandible US: normal thyroid, left large LN with cystic component FNA: all smear shows follicular thyroid, what is the diagnosis?

Metastatic thyroid cancer

Male in his 20s has fever, epigastric pain jaundice there is epigastric tenderness, abdominal US showed hypodermic mass with peripheral enhancement, what is the management?

Metronidazole Most likely amebic liver abscess

Patient 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 management?

NGT Patient in ICU and need feeding but there is risk of aspiration (Duration <4 weeks) --> NGT Patient duration > 4 weeks + risk of aspiration --> Jejunostomy Patient duration > 4 weeks + no risk of aspiration --> gastroestomy Patient with basal ganglia disease --> Jejunostomy no matter the duration

30 years old patient has hyperthyroidism, taking anti thyroid drugs, she presents with exophthalmos, US showed nodule in right lobe 2*2, nuclear study showed diffuse uptake, the diagnosis is toxic nodular thyroid. What is the most appropriate management?

Near total thyroidectomy From the answers: - Right hemithyroidectomy not usefull since its diffuse disease - Subtotal thyroidectomy is no longer done, always the wrong answer - Near total thyroidectomy indicated if failure of medical treatment of contraindications of radioablation (exophathlus is a contraindcation to radioablation) - radioablation: exophathlus is a contraindcation to radioablation

A child has scrotal pain, on exploration the cord was edematous and inflamed with red right hemiscrotum, what is the diagnosis?

Need more info Need revision

Adult with Hypertension and DM has 2 months history of Small perianal painful swelling, His Blood Pressure (BP) is: 160/100?

Need more vitals to diagnose Abscess: fever and swelling and discharge

An elderly patient in ICU has bed sores with exposed necrotic skin and subcutaneous tissue. What is your management?

Need revision

Exacerbation of COPD, best management?

Non-invasive mechanical ventilation

Child presents after trauma. CT scan shows minimal abdominal fluid collection and grade 3 splenic injury, patient stable, what is the management?

Non-operative

45- year-old male patient underwent appendectomy after signs and symptoms of appendicitis. Histopathology report: tip of the appendix carcinoma. What is the appropriate management?

Observation Indications of right hemicolectomy: - If more than 2 cm - At the base of the appendix - Mesothelium invasion - Lymphadenopathy - OR any carcinoma

Post-appendectomy, 2 cm carcinoid found on the tip of the appendix, what is your management?

Observe and follow up

Patient with asthma symptoms that are not controlled although he uses Bronchodilators, corticosteroids, & LABA. His PFTs are 75% before the use of a bronchodilator and 95% after using it. What to do?

Observe how he uses the inhaler

Anterior duodenal perforation case, what is the management?

Omental (graham) patch

Patient diagnosed with acute pancreatitis 3 weeks ago, now present to ER Complain of mild abdominal pain and tenderness, US showed cyst measure 4 cm, how you will manage?

One of the indications for treating pancreatic pseudocyst is: Symptomatic cysts --> internal drainage

65 years old female, with Asymptomatic femoral hernia. What is the most appropriate management?

Open repair with mesh

30 years old man underwent appendectomy day 6 post-operative complaining of pain at the site of the wound. The wound was red, swollen, tender What will you do?

Open wound Post op SSI abscess first thing open the wound + give AB

Inhaled Corticosteroids: Adverse Effects

Oral candidiasis

Male victim of gunshot to the thigh, pale and unconscious, BP 90/60 pulse 130, next step?

Orotracheal intubation A before C

Patient with stab wound in anterior neck, he is Alert but in labs oxygen sat 82%. What to do?

Oxygen mask Always start with oxygen mask in resuscitation

Patient came fracture and compartment syndrome, what's the first alarming sign?

Paresthesia Early features: pain then paresthesia Absent pulse and discoloration is a late feature

The best test in acute asthma exacerbation in ER is:

Peak expiratory flow

Patient work in wood factory came to you complaining of chest tightness and cough in work, those symptoms resolved during weekend, what to do?

Peak flow meter at home and at work Symptoms occurring at work, not at home à something at work causing allergy à Peak flow can help to lead to the diagnosis of Asthma · Exclusion: o A is used after the diagnosis of allergic asthma to know what allergens can cause hypersensitivity o B is used also to after the diagnosis of asthma, IgE mediated asthma

Thyroid Cancer case had mixed component solid and cystic, total size 2*3cm, solid 2 cm What best modalities to reach the diagnosis?

People choice was Core biopsy of the solid mass because the other choice was FNA from the cystic mass Always FNA is the right answer when talking about thyroid but in this instance I'm not sure

Patient had liver laceration and the patient is hemodynamically unstable. What to do?

Perihepatic packing

Most common cause of pneumonia in HIV patient: If CD4 < 200

Pneumocystis Jirovici or carinii

25 years old man history of laparoscopic appendectomy 10 years ago, present to ER with sudden abdominal pain and vomiting, mild generalized tender, vitally stable, abdomen X-Ray shows multiple air fluid level and dilated loop in certain point, what is next step in management?

Presentation of SBO due to adhesions post surgery, best diagnostic tool: CT with IV and oral contrast

Patient known case of ulcerative colitis did MRCP and showed intra and extra hepatic duct strictures, what is the diagnosis?

Primary sclerosing cholangitis

A 55-year-old man presents with fever and pain in the perineal region. Upon further questioning he also complains of frequency, urgency, dysuria, and a decreased urinary stream. On physical examination his abdomen is soft, nondistended, and nontender. Digital rectal examination demonstrates sever tenderness on the anterior aspect. Laboratory examination reveals leukocytosis and findings on urinalysis are consistent with a bacterial infection. Which of the following is the most likely diagnoses?

Prostatitis Fever + LUTS + pain in anterior PR + Leukocytosis + urinalysis bacterial findings Tx: antibiotics oral for 6 weeks

Adult fell from height complains of severe heel pain. He is conscious, oriented and has stable vitals. What is the next step?

Pulse palpation First make sure neurovascular is intact before doing anything

Pt on 4 Anti TB develop high Uric acid which medication cause that

Pyrazinamide · TB medications side effects o All of them hepatoxic o Rifampicin: turn body fluid into orange color - CYP enzyme inducer (other medications will be metabolized faster) o Isoniazid: causes vit b6 deficiency leading to neurological symptoms + sideroblastic anemia à prevent this by supplying B6 - drug induced SLE o Pyrazinamide: hyperuricemia - most hepatotoxic o Ethambutol: optic neuritis (affect acuity and color)

A 32-year-old man presents with an asymptomatic mass in his right testicle, On examination, the mass cannot be transilluminated ultrasound showed a solid mass in the right testicle. Which of the following is the most accurate method in obtaining a diagnosis of testicular cancer?

Radical inguinal orchiectomy

Football players during a pass developed sever Right iliac fossa pain and swelling / irreducible, what is the management??

Rectus sheath hematoma Management: Supportive (IV fluid, hematoma compression etc..) If unstable + Expanding hematoma: Laparotomy

Most common virus cause of acute otitis media in pedia

Rhinovirus Echo virus Influenza Chicken POX Most common cause of acute otitis media in pedis is bacterial cause - Streptococcus pneumonia - Hemophilus influnza - Moraxella catarrhalis Most common viral cause for otitis media - RSV most common - Rhinovirus: 2nd most common - Other viruses Adenovirus Echo virus

Patient with typical signs and symptoms of TB, what is the management?

Rifamycin, Isoniazid, Pyrazinamide and Ethambutol RIPE

Traumatic patient presented to ER with Profuse bleeding from nose and mouth, cyanosed with decreased breath sound on right side of the chest. Mostly was unstable Which of the following is the most appropriate next step.

Right chest thoracostomy

Traumatic patient presented to ER with Profuse bleeding from nose and mouth, cyanosed with decreased breath sound on right side of the chest. Mostly was unstable Which of the following is the most appropriate next step

Right chest thoracostomy (chest tube) hemothorax and pneumothorax are correctable cause of deteroition done chest tube done before intubation (need confirmation) chest tube before giving blood or fluids

45- year-old male patient underwent appendectomy after signs and symptoms of appendicitis. Histopathology report: tip of the appendix carcinoma. What is the appropriate management?

Right hemicolectomy

26 year-old male patient underwent appendectomy after signs and symptoms of appendicitis. Histopathology report: 2 cm carcinoid at Basie of the appendix . What is the appropriate management?

Right hemicolectomy Indications of right hemicolectomy: - If more than 2 cm - At the base of the appendix - Mesothelium invasion - Lymphadenopathy - OR any carcinoma

Patient with abdominal pain, vitally stable, imaging shows: increase thickness of sigmoid and thumb print due to edema. What is the next step?

Thumbprinting is a sign of infection/ inflammation --> should we do colonoscopy to an inflamed colon?

Patient had stab injury in front of R or L ear loop near or below angle of mandible there oozing of blood, on examination patient is conscious and alert, what is the next step?

Rules of neck penetrating trauma: - If unstable --> surgery - If hard signs --> surgery - If zone 2 --> surgery (need revision) - If zone 1-3 --> CTA and bunch of investigation Hard signs: - Artery: Expanding hematoma - severe bleeding - FND - Airway compromise - Hematemesis

Patient fell on outstretched hand, pain at anatomical sniff box, which bone fracture is it?

Scaphoid

Patient have Fever, high WBC, lactate is 3, mean arterial pressure was 65 and was maintained on vasopressin, what is best describe his condition?

Septic Shock

Facial plethora and JVP distended, which of the following is associated with this condition?

Small cell lung cancer · Squamous cell carcinoma o PTH-related peptide o Horner syndrome · Small cell carcinoma syndromes: o Cushing o SVC syndrome o SIADH · Adenocarcinoma o Clubbing · Large cell carcinoma o SVC syndrome

· Risk factor o Most important to control after first episode of IHD:

Smoking

33 years old pregnant women presented with lower abdominal pain and moderate vaginal bleeding K/C of BA + epilepsy + smoker What is the highest risk factor for her condition?

Smoking Age Asthma Epilepsy This is Placental abruption. Smoking is one of the risk factors. Also, maternal age >35 is a risk factor. (our patient is 33) and still even if she was >35 years of age, smoking is a stronger risk factor than the age.

A 45-year-old with history of pancreatitis, then recurrent vomiting, + upper GI bleeding After resuscitation what should be done Splenomegaly, normal portal, thrombo-splenic. He became stable afterinjection of sclerotherapy, which of the following best way to management?

Splenectomy

Post RTA patient had lower back pain and unable to move, management done while waiting for the consultant?

Stabilize the back

Q about lesion in labia majora in post-menopausal female showed dysplasia (carcinoma in situ I think) what to do:

Steroid cream Local excision Vulvectomy Repeat test after 6 months

Most common cause of pneumonia in HIV patient: If CD4 > 200

Streptococcus pneumoniae

70 years old male on Mechanical ventilation (MV) admitted to the ICU due to intracranial hemorrhage, 7 days later he developed ground coffee vomitus. What is the diagnosis?

Stress gastritis/ ulcer

Patient presented to the ER with Right thigh swelling and hotness, past medical history reveled that the patient had Atrial Fibrillation, what is the best definitive management?

Stupid bad recall or its actually a stupid question

Elderly Patient come with severe headache to ER then suddenly deteriorated and decrease level of consciousness CT done was hematoma, best Management?

Surgical evacuation Initial: IV mannitol and head elevation The best: Evacuation

You attended the surgery theater as intern, (some renal surgery) and the surgeon was preparing to do the surgery on the right side, but you knew from the history that the diseased kidney is the left one. What should you do?

Tell the surgeon Duuh

Cirrhotic patient complicated came with portal hypertension, came with upper GI bleeding due to varices diagnosed by Upper Endoscopy, what to give after resuscitation?

Terlipressin

Patient did a right inguinal hernia repair month ago, now presenting with a shrunken right testicle. What is the cause of his presentation?

Testicular artery ligation Testicular artery ligation vs Thrombosis of pampiniform plexus Thrombosis of pampiniform plexus: cause ischemic orchitis which is painful and the duration usually within one week which leads to testicular atrophy Testicular artery ligation can cause testicular atrophy but it takes longer to develop and not painful

Something years old patient came with history with middle line neck swelling that move up and down with tongue protrusion what is the diagnosis?

Thyroglossal cyst

GCS Question (confused, open to sound, localized pain)?

The case has: 12 points = moderate How not to forget: GCS 8 intubate --> severe Best eye response (4) No eye opening Eye opening to pain Eye opening to sound Eyes open spontaneously Best verbal response (5) No verbal response Incomprehensible sounds Inappropriate words Confused Orientated Best motor response (6) No motor response. Abnormal extension to pain Abnormal flexion to pain Withdrawal from pain Localizing pain Obeys commands

65 male known case Atrial Fibrillation Presented with severe abdominal pain on examination there was abdominal tenderness her labs showed 23000 WBC what to do?

This case is most likely mesenteric ischemia: - Afib --> embolus --> acute mesenteric ischemia embolism - Stable --> all patients require CTA to know the artery obstructed and the area infarcted - Non-stable: laparotomy + embolectomy +- bowel resection - Give patient heparin

79- 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

Patient post Motor Vehicle Accident (MVA) complains of Shortness of Breath (SOB), while examining the patient there was signs of respiratory distress and distended neck veins. Chest examination reveals hyperresonance. What is the next step in management?

To diagnose tension pneumothorax you need hypotension

Patient with History of pancreatitis months ago, now referred to surgery clinic for mild abdominal pain what is the initial investigation?

U/S is the initial for any RUQ presentation Best CT with contrast

213- patient admitted in CCU after MI, complicated by pneumonia, during admission he had RUQ pain, US showed pericholecystis fluid with thick GB wall, Mx?

US guided cholecystostomy tube Urgent open cholecystectomy

A26 year old male came to ED with epigastric pain relieved by eating and worsening by fasting, which of the following next step in first investigation?

Urea breath test

Victim in RTA who did Ureteroscope urethrogram and found injury in the bulbar, what do you want to do next?

Urethral injuries indicated Suprapubic catheter to divert the urine from the urethra and decompress the bladder

Patient with Pulmonary hypertension to be evaluated for chronic thromboembolism as a cause of pulmonary HTN, which investigation has the highest diagnostic yield?

V/Q scan · Chronic PE causing pulmonary HTN: VQ scan · Acute PE: spiral CT

Antiphospholipid syndrome

Venous or arterial thrombosis Persistent & unexplained thrombocytopenia Recurrent fetal loss Detected by: Lupus anticoagulant test Anticardiolipin antibody ELISA Anti-B2 glycoprotein-I ELISA

Patient had unilateral testicular painful swelling for 1 day, on exploration red scrotum viable but cord edematous, what is the diagnosis?

Viable but inflamed: Epididymoorchitis

Healthy patient done a routine checkup, imaging reveled a polyp in the gall bladder measuring 0.6 cm, what's next step?

You are not gonna do the surgery --> call Surgical consultant Cholecystectomy is the treatment of choice for patients who have biliary colic or complications (eg, pancreatitis). In asymptomatic patients, the decision to undergo cholecystectomy rather than surveillance imaging with transabdominal ultrasound is based on the presence of risk factors for gallbladder cancer (polyp size, the presence of primary sclerosing cholangitis)

COPD and oxygen?

Your optimum target in COPD patient with c02 retention is to keep saturation 88-92% Non-invasive mechanical ventilation (Bipap and C-pap) should be conscious and alert Invasive mechanical ventilation --> if patient is comatose, altered level of consciousness, has risk of aspiration (mouth full of secretion)

What is the method to detect TB is sputum?

Ziehl-neelsen staining

Percentage of maternal death worldwide due to post partum hemorrhage?

a) 10% b) 15% c) 20% d)25%

Mother has baby with cleft palate and asks you what is the chance of having a second baby with cleft palate or cleft lip: •

a) 25% • b) 50% • c) 1 % • d) 4%

Regarding injectable progesterone, which one of the following is correct?

a) Can cause skin problems b) Associated with irregular bleeding and weight gain. c) Decrease in bone mineral density (reversible). d) Delayed fertility after discontinuation (one shot can last 10 months

• Risk factor of sudden death syndrome includes all of the following, EXCEPT: •

a) Cigarette smoking during pregnancy • b) Old primigravida • c) Crowded living room • d) Prematurity • e) Small gestational age

33 years old female came to you at your office and her pap-smear report was unsatisfactory for evaluation, the best action is:

a) Consider it normal & D/C the pt. b) Repeat it immediately c) Repeat it as soon as possible d) Repeat it after 6 months if considered low risk e) Repeat it after 1 year if no risk

Pregnant unbooked present with painless vaginal bleeding, fundal high 34 weeks. She lives far away and has difficulty in transport. What is the most appropriate thing to do?

a) Corticosteroid induction b) Deliver by CS c) US d) Admit to ward

47- A 46-year-old female presents with a painful mass 1x2 cm in the upper outer quadrant of the left breast. There are areas of ecchymosis laterally on both breasts. There is skin retraction overlying the left breast mass. What is the most likely diagnosis?

a) Fat necrosis b) thrombophlebitis c) hematoma d) Intraductal carcinoma e) sclerosing adenosis

35-Year-old pregnant lady with fetal death and DIC, her cervix is 4cm dilated, (her vitals are normal), what is the management?

a) Induction of labor b) Urgent CS · DIC + stable mom + IUFD à IOL · DIC + nonstable mom à CS · DIC + stable mom + good contractions à reassurance

35-Year-old pregnant lady with fetal death and DIC, her cervix is 4cm dilated, (her vitals show hypotension), what is the management?

a) Induction of labor b) Urgent CS · DIC + stable mom + IUFD à IOL · DIC + nonstable mom à CS · DIC + stable mom + good contractions à reassurance

34 wk preeclamsia pt came with epigastric pain, headache, blurred vision .. non stress test reassuring mx ?

a) Mg sulf + delivary b) mg and wait for 37 wk c) Call anesthesiologists for deliver preeclampsia with severe features which is managed by: ≥34 weeks = IOL after stabilizing the mother + Magnesium sulfate (seizure prophylaxis) + IV Labetalol

Female patient with Cardiomyopathy and using heparin (or anticoagulant). What contraception is most appropriate for her?

a) Pop b) Depoprovira c) IUCD d) OCP

7 months old boy presented with history of interrupted feeds associated with difficulty in breathing and sweating for the last 4 months. Physical examination revealed normal peripheral pulses, hyperactive precordium, normal S1, loud S2 and Pansystolic murmur grade 3/6 with maximum intensity at the 3rdleft intercostal space parasternally. The MOST likely diagnosis is: •

a) Small PDA (Patent ductus arteriosus). • b) Large ASD (Atrial septal defect). • c) Aortic regurgitation • d) Mitral regurgitation. • e) Large VSD (Ventricular septal defect).

226- 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

What is the medication for seizure in pregnancy?

a- Diazepine b- Phenytoin c- Magnesium sulfate d- Lorazepam

One month boy came for vaccine. His older sister (6 years old) had renal transplant and now is on immunosuppressive medication. Which vaccine is contraindicated for the boy? •

a- MMR • b- Oral polio • c- Salk polio • d- Influenza

187- 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.

Pregnant nullipara what vaccine should you give her

a-Influenza b-DTaP c-Rh immunoglobulin Depends on the gestational age if 1st or second trimester-> I would go with influenza if third trimester -> I would go with Tdap

19 year old pt found accidentally lump in her throat she did tsh was normal and did FNA was inadequate;

a-Repeat FNA b-Scan c-Remove thyroid d-Follow up

GBS vaginal swab screening in pregnant women

a. 15 weeks b. 25 weeks c. 35 weeks d. 40 weeks

When to start HPV SCREENING for cervical cancer

a. 20-24 b. 25-29 c. 30-34 d. 35-39

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 abnormalities

Old with k/c of HTN, Hyperthyroidism and AFib c/o palpitations. He is on fluoxetine, amiodarone and something else For HTN and AFib. what to do?

a. B-blockers b. Change antidepressant medication Afib + hyperthyroidism + palpitations: all indicating use of BB

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, what's the complication of this case?

a. Bleeding b. Infection c. DIC Most commonly is severe vaginal bleeding (53%). Followed by sepsis "which can lead to DIC" (6%).

A 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

Old lady with uterine fundal mass. (Uterine CA) underwent surgery. What lymph nodes to resect?

a. External iliac lymph node b. Internal iliac lymph node c. Deep inguinal lymph node d. Para-aortic lymph node

14 years old boy comes to your clinic with swollen lips. He has similar episodes since 3 or 5 years. Deficiency of which of the following caused his presentation? •

a. Factor D • b. Anaphylatoxin inhibitor • c. C1 esterase inhibitor • D-Factor 8

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

A pregnant woman came with abdominal pain and back pain and visual disturbance. Her blood pressure is 145/92 mmHg. Her lab shows (uric acid high, platelet 70k). What is a severe feature of preeclampsia for this condition?

a. Her abdominal pain b. Her blood pressure c. Platelet count d. uric acid

A female patient her LMP was 6 weeks ago presented with mild abdominal pain. Vitally stable, Closed OS. US shows no intrauterine pregnancy, but a 3 cm sac in the fornix area with no cardiac activity, BhCG was 3000. what is you management?

a. Medical management b. surgical management c. medical and surgical management d. Medical management given that she has access to the hospital

Pregnant lady 32 weeks GA is worried that her baby stopped moving. What is the next more appropriate step for this case?

a. Non-stress test b. Biophysical profile c. Pelvic examination d. Pelvic US For reduced fetal movement: Nonstress test (First) Then-> biophysical profile (US)

217- 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

299- patient with recent rectal surgery comes to you with absent pulses up to the femoral area. How will you manage such a case?

a. Unfractionated heparin b. Enoxaparin c. IVC filter d. Thrombolysis

134- man did an operation for a ventral hernia. What will you tell him?

a. Use laxatives or stool softeners for 6 months b. Do not lift heavy objects for 6 months c. Wear a hernia belt for 3 month

40- women with 11*12 breast mass, examination showed no palpable LN. Core biopsy was taken and showed malignant phyllode tumor, what's the next appropriate step?

a. WLE b. PET scan c. Chest CT without contrast d. Simple mastectomy

Pregnant patient came with Hx of vaginal bleeding and 3 years try to conceive with infertility what is the next step in management:

a. coagulation profile request b. vaginal examination c. know the cause of being infertile for 3 y

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

Neonatal lupus serology

anti-SSA/Ro and anti-SSB/La Baby can present with heart block

A primigravida patient presented in labor. O/E: the cervix is 5cm dilated and the fetus is in a station O with cephalic presenting part and this state for 4 hours even the oxytocin had been taken. CTG Picture as shown above. what is the management for this patient?

b. stop oxytocin c. immediate CS d. Wait for 2h e. instrumental delivery variable deceleration CTG is category 2 and is managed by in utero resuscitation measure e.g. lateral positioning of the mother, O2, IV fluid, stop oxytocin, administer toocolytic drugs.

Case with history of blood coming from ear and perforation tympanic membrane, what is the cause?

basal skull fracture

A 65-year-old male comes to the clinic with a mild intermittent urinary flow reduction. Rectal examination, urinalysis and prostate specific antigen studies are normal (see report). Ultrasound prostate: Enlarged median lobe. Which of the following is the best way to investigate?

case of BPH

322- post MVA with urethral injury , what next : (i'm sure no suprapupic tube in choices)

cystoscopy folly catheter retrograde urthrogram fluoroscopic cystogram

About a fistula with discharge, located posterior to anal sphincter what is your management?

fistulotomy

Obese female patient diabetic and hypertensive, started on lifestyle modification for weight reduction but she failed, her height: 173 cm, Weight: 126 kg, what is the most appropriate intervention?

has all the indications for surgery

319- Male with enlarged non painful scrotum. Tranllumination test was positive

hydrocele Cyctocyle

56 years old woman presents to the clinic with a non-healing ulcer over her right lateral malleolus, she is hypertensive. pulse is normal and her local exam shows dark discoloration of the skin around the ulcer and viable ulcer bed, best next step is?

location: above the ankle, Pigmentation, normal pulse all lead to venous

Patient found to have anal fistula on 7 o'clock. Most common anal fistula internal opening is ?

medial posterior

· Graves' disease, one of the following enough for diagnosis:

o Diffuse goiter o Eye o Pretibial myxedema o Thyrotropin receptor antibody

List of medications contraindicated in asthma patient

o Non-selective Beta blockers o Carboprost o Bupropion o Adenosine o NSAIDs

· Tap all patients with pleural effusion, except:

o Size < 1cm o Typical signs and symptoms of CHF

Pt diagnosed as Acute pancreatitis 3weeks ago now come to ER C/O.. mild abdominal tenderness.. On us there is cyst measured 4Cm how you can manage?

observation diagnosis is: Acute fluid collection DDx: Acute fluid collection: Duration < 4 weeks, CT: homogenous content Pseudocyst: Duration > 4 weeks, CT: thick wall homogenous content Acute necrotic collection: Duration < 4 weeks, CT: heterogenous content Wall of necrosis: Necrotizing pancreatitis, CT thick wall heterogenous content Abscess: CT: enhanced wall Tx: Acute fluid collection: observation Pseudocyst: only if symptomatic or large> 10 cm --> Internal drainage Wall off necrosis: percutaneous drainage

Post left thyroid lobectomy female patient complaining of sever shortness of breath after the surgery and pointing to her neck, what is next step?

open sutured wound and evacuated in ward

A patient presents with pain and an itchy anus after defecation, as well as painful defecation with streaks of blood in his stool. What is the most likely diagnosis?

painfull defection + blood streak = anal fissure

Most common cause of hospital acquired pneumonia and ventilation associated pneumonia is

pseudomonas aeruginosa

328- 7year-old boy came with his parents complaining of asymptomatic hematuria. Otherwise the patient is healthy. Urinalysis showed: RBSs, which of the following is the most appropriate next step?

repeat urinalysis Urine cytology Renal Biopsy Cystoscopy

An old male patient was admitted as a case of large intestinal obstruction. He underwent rigid sigmoidoscopy that showed a mass in the sigmoid region. A biopsy was taken and came back as adenocarcinoma. What is the best next step?

sigmoidectomy in any cancer, 1st diagnosis: biopsy, 2nd staging (imaging), 3rd treatment, 4th survalince If colon cancer causing obstruction --> first remove the obstructing part (sigmoidectomy) before the diagnosis or the staging because bowel obstruction can cause death if perforated

6 year old child present with supracondylar fracture after falling down. He's arm is deformed, he has no pulse. Reduction and fixation with K-wire done but still there is no pulse and the limb is pale and cold. What to do next?

surgical exploration First step for supracondylar fracture is urgent reduction After that it will depend on the perfusion to limb: Pale and cold ——- surgical exploration Warm and pink —— k wire

SABA side effects

tremor, tachycardia, palpitations, hypokalemia

5 year old child present with supracondylar fracture after falling down. He's arm is deformed, he has no pulse but the limb is warm and pink. What's the next appropriate step for management?

urgent reduction and K wire fixation First step for supracondylar fracture is urgent reduction After that it will depend on the perfusion to limb: Pale and cold ——- surgical exploration Warm and pink —— k wire

Patient came with SOB, upon examination there is Velcro like breathing, this breathing is characteristic for?

velcro-like rales --> Idiopathic pulmonary fibrosis

Polyarthritis

· Inflammatory o Decrease by walking - increase by rest · RA o Most common in MCQ questions o Affecting small joint, in the hand, sparing DIP o One of the criteria > symptoms more than 6 weeks o Chronic not controlled RA: § Nodules § Hand deformities o RF and ACPA (anti-CCP) à for diagnosis only, not useful in severity nor in flare o Seronegative RA: negative all serology but typical presentation o Seronegative has better prognosis o ESR and CRP: for acute attacks (flares) o Subtypes and complications of RA § Caplan syndrome: lung nodule + dyspnea + RA § Felty syndrome: neutropenia + splenomegaly + arthritis § Adult-onset Still disease: fever + salmon pink rash + polyarthritis + splenomegaly + polyserositis + negative serology + leukocytosis + ferritin high § Lymphoma · Viral arthritis o Preceded by viral infection o Similar joint distribution, mimic RA, except it resolves after 6 weeks o Most common virus: parvovirus · Osteoarthritis o Old age · Psoriatic arthritis o Hx of psoriasis, nail pitting, sausage fingers (dactylitis) · Ankylosing arthritis o Male, back pain, uveitis · Enteropathy arthritis o Associated with IBD · SLE o Joint pain usually is not the main complaint

The most accurate diagnostic test for asthmatic patient is:-

· Most accurate = most diagnostic à spirometry (pulmonary function test) · Peak flow meter: for progression of the disease - severity of acute attack - compliance - follow up à not diagnostic · IgE for specific type of asthma that require specific type of medications

Patient presenting with symptoms of obstructive lung disease. PFTs show decreased vital capacity and decreased FEVI/FVC ratio. what is associated with this condition?

· Obstructive lung disease à increase lung compliance

20-year-old has moderate asthma for 6 months, on SABA and low dose ICS, he has Stridor and wheezing symptoms that are present during playing basketball in college, best next step?

· Stridor is not presentation of asthma · Stridor indicates upper lung airway disease · The answer to refer to ENT · Asthma mimickers o Vocal cord dysfunction: inspiratory tracheal sounds o Eosinophilic granulomatosis with polyangiitis: asthma + airway disease + p anca + high eosinophilia

20 yrs old, has persistent moderate asthma for 6 months, on SABA LABA ICS, he has STRIDOR , symptoms are especially present at basketball in college, best next step?

· The answer to refer to ENT · Stridor is not presentation of asthma · Stridor indicates upper lung airway disease · Asthma mimickers o Vocal cord dysfunction: inspiratory tracheal sounds (stridor) o Eosinophilic granulomatosis with polyangiitis: asthma + airway disease + p ANCA + high eosinophilia

A 5 years old child presented with signs and symptoms of giardiasis, how to confirm the diagnosis?

• A 3 consecutive stool samples • B 3 samples on different days • C concentration method • D stool immunoglobulins

Newborn deliver and pediatric DR doing General examinati assessment and do found nasal depress What do you do next.? Or what's the investigation

• A Chromosomes test • B TORCH test • C Blood culture • D C1

A mother is unvaccinated, and she is concerned about tetanus neonatorum

• A-Give vaccine to mother after 72 hours of delivery • B-Give baby tetanus toxoid • C-Give infant DTaP • D-Give mother DTaP at 28 weeks of gestation

fluid required to give for 11 months old boy , 10 KG, loss 5% of his body fluid?

• A. 1000 • B. 1500 • C. 2500 • D-3000

BCL BCR gene associated with what ?

• A. ALL • B. CLL • C. CML • D. AML

Child with arthritis , fever, epistaxis, gingival bleeding, results : platelets : is low , Hb is : low , whays the investigation ?

• A. Bone marrow aspiration • B. Electrophoresis • C. Anti dsDNA • D. ANA