SLE 2010

COLLECTED AND TRIED TO BE ANSWERD AND SENT BY

DR.ABULMALIK ALBAKER 2011 MED_ST99@HOTMAIL.COM
31. inferior wall MI
leads 2.3.AVF

32-commonest cause of chronic renal failure:

a)HTN
b)DM
----------------------33-commonest cause of 2ry HTN:
a)pheochromocytoma
b)cushing's disease
c)renal artery stenosis
d)renal parenchymal disease
-----------------------34-pt with presyncope & tachycardia & Hx of old MI , on examination cannon a
waves in JVP, & ECG showed wide QRS complexes..most likely DX:
a)preexisting AV block
b)anterograde AV block
c)reentrant AV nodal tachycardia
d)bundle bransh block
I'm not sure about the answers
35-a football player presented with knee pain after a hit on the lateral side of his knee
on exam.>increased laxity on valgus stress
negative lachman & mcmurry's test...most likely Dx:
a)lateral meniscus tear
b)medial meniscus tear
c)ACL tear
d)MCL
------------------36-primigravida with Hx of smoking, presented with PV bleeding, she develpoed painless
labor & delivered, she was told that there was no abnormality with her or her

fetus...what's the most likely cause of her abortion:

a)cervical incompetence
b)fetal chromosomal abnormalities
---------------------37-pregnant (19wks GA) presented with PV bleeding & passing some tissues, on exam.
cervical os was opened (1cm) what's the Dx:
a)complete abortion
b)threatened abortion
c)incomplete abortion
d)missed abortion
-----------------------------38-a woman with cyclical (only with menses) bilateral breast masses which are tender &
about 1x2 cm , no palpable axillary lymph nodes wer found initial Rx:
a)OCP
b)danazol
c)surgical removal
---------------------39-primigravida (35wks GA) presented to the antenatal care with lower limb edema & BP
150/? what's your management:
a)duiretics
b)immediate CS
c)decrease salt intake
d)admission with meternal & fetal monitoring
-------------------40-commonest sign/symptom of placental abruption:
a)PV bleeding
b)uterine contractions

41-woman with 9weeks Hx of elevated erythematous wheals overall her body , she also
has lip swelling no Hx of recent travel or food allergy or drug ingestion, Dx:
a)chronic angioedema & urticaria
b)contact dermatitis
c)solar dermatitis
d)cholinergic dermatitis
------------------------42-a cuople (they're 25yrs old) came to your office after 6months of unprotected
intercouse & they wanted to be assesed for possible causes of infertility...what is your
management:
a)semen analysis
b)laparoscopy
c)wait & see
d)body temperatue chart
------------------------43-a man sits alone in a room ,looks as he is listening, then he start to nod & mutter &
talks
what's the Dx:
a)hallucination
b)delusions
44-All causes of hyponatremia except ::
Diabetis insipidus (DI)
45-Drug of choice for otitis media :
Amoxacillin
most common chromosomal abnormality is::46Down syn. (Trisomy 21)
47-Pt complain from diplopia nausea vomiting back pain:
Somatization disorder
48-Child with pain in one testis elevated on examination by doppler there is decrease
blood supply Dx :
Testicular tortion
49-Infant 6 m age with wheezing and respiratory distress ttt:
Bronchodilator
50-Pt with asthma came with difficulty in talking and silent chest ttt:
Iv aminofellin

51-pt said that aliens talk to him otherwise he is not complaining of anything...what's the
Rx:
a)antidepressants
b)antipsychotic
c)behavioral therapy
d)chloropromazide
------------------------51-elderly pt developed disorganized behavior, decreased attention, & impaired memeory
12 hrs post surgery (aortic femoral popliteal bypass) what's the most likely Dx?
a)delerium
b)alzeheimer's dementia
c)multi infarct dementia
--------------------------52-old lady came to your office with her daughter who said that her mother has behavioral
changes (agitation & aggression) & poor self care
u can't do approprite physical & neurological examination
what's your next step?
a)antidepressant
b)immediate referral to a geriatric physician
-------------------------53-60yrs old lady on estrogen, she developed vaginal bleeding what's the most important
action?
a)stop the estrogen
b)take endometrial sample
c)add progesterone
-------------------------54-physician careless about his duty considered as:
a)malpractice
b)criminal practice
c)malfeasance
d)nonfeasance
---------------------

55-nulligravida came with 5yrs Hx of oligomenorrhea ,on examination inflammatory acne

& hisutism ..what disease comes to your mind?

a)adrenal tumor
b)hyperprolactinemia
c)PCOD
d)hypothyroidism
----------------------56-you were with a consultant when he wrote ACEI for a pt who have documented allergy
to them, u suppose that he knows better , what commitment u had violated:
a)honesty to pt
b)professional competence
c)appropriate pt relationship
d)quality of care
e)maintaing trust
A pregnant lady presented with sudden right leg swelling57& pain(like DVT picture), what investigation u would do
. bed rest &impedance plethysmography
a-heparin . bed rest , impedance plethysmography
b-warfarin
c- venography, bed rest & heparin. bed rest, impedance plethysmography
d-inferior vena cava filterpresence
58-of anti-HBs indicates:
a)carrier state
b)infectivity
c)previous infection or vaccination
d)acute infection
------------------------59-old pt with hx of treated lung CA (i'm not sure about the question but I think he was
debilitated for some reason) presents with fever productive cough ,sputum showed G-ve
organism & the buffered charcoal yeast agar showed the organism..what's the organism:
a)klebsiella pneumonia
b)mycoplasma pneumonia
c)ureaplasma
d)legionella
--------------------------

60-old lady presents with sensorineural hearing loss in RT ear associated with dizziness,
loss of corneal reflex,facial numbness & tinnitus, MRI showed dilated internal auditory

canal ..most likely Dx:

a)acoustic neuroma
b)cholesteatoma
-----------------------------61-what's true about uterovaginal prolapse:
a)common cause of infertility
b)heaviness on erect position
--------------------------62-old man presents with flank pain, & interrupted voiding , renal US showed bilateral
hydronephrosis ,what's the most likely Dx:
a)bladder tumor
b)prostatic hyperplasia
c)renal stones
63-uncomplicated larg pnumothorax?
a)shifted tracha
b)synchornized click

64- A 14y female, with 6 month Hx of lower mid abdominal pain , the pain is colicky
radiate to the back and upper thigs, begin with onset of mense, and last for 2-4 d, she
missed several days of school during the last 2 months, by Px abd and pelvis normal,
normal 2ry sex development..
most likely Dx:
-primary dysmenorrhea.
- secondary dysmenorrhea .
Dysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe uterine
pain during menstruation. While many individuals experience minor pain during
menstruation, dysmenorrhea is diagnosed when the pain is so severe as to limit normal
activities, or require medication.
Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull,
nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by
several days or may accompany it, and it usually subsides as menstruation tapers off.
Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia.
Secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying
disease, disorder, or structural abnormality either within or outside the uterus. Primary
dysmenorrhea is diagnosed when none of these are detected.
The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the
umbilical region or the suprapubic region of the abdomen. It is also commonly felt in the
right or left abdomen. It may radiate to the thighs and lower back. Other symptoms may
include nausea and vomiting, diarrhea, headache, fainting, and fatigue. Symptoms of
dysmenorrhea usually begin a few hours before the start of menstruation, and may

continue for a few days.

65-old man lifts weight complain of sever headache BP150/95
he answers question and then become drowsy
diagnosis
a)subaracnoid hemorrhage
b)migrine
c)tension headache
66-pt loss taste in ant 2/3 of tongue and deviation of mouth which nerve affected
a)facial
b)trigeminal

67-eldrly women present with diarrhea, high fever & chills,dysuria other physical
examination is normal including no back pain,
Diagnosis:
A- bacterial cystitis.
B- Bacterial gastroenteritis.
C- Viral gastroenteritis.
d-pylonephritis
68-pt c/o menorrhagia with examination retroverted uterus with uterosacral ligament
tenderness
diagnosis:
a)endometriosis
b)adenomyosis
c)fibroid
69-Q1/child pt presented 2 u complaining of hony crust , yellow blusters .. :
a)Impetigo
70)old pt with hypothyrodism on thyroxin , (many symptoms ) , labs all normal ( TSH ,
T3 , T4 )except low CA , high phosphate , Dx:
A. Primary hyperparathyrodism .
B. Secondary hyperparathyrodism.
C. Uncontrolled hypothyrodism
The 2ndary PTH is elevated due to decreased levels of calcium or 1,25-dihydroxy-vitamin
D3. It is usually seen in cases of chronic renal disease or defective calcium receptors on
the surface of parathyroid glands .

71-Q/. brought to you the pulse less , low blood pressure , ECG showed AF , mangment :

a)CPR.
b)Cardioversion .

72-Q/ pt with presyncope & tachycardia & Hx of old MI , on examination cannon a waves
in JVP, & ECG showed wide QRS complexes..most likely DX:
a) Ventricular tachycardia .

73-Q / baby present with pain in the ear ,by examination there is piece of a glass deep in
his ear canal , the mother mention a history of a broken glass in the kitchen but she clean
that completely .... We treat that by:
A. Attempt irrigation removal??.
B. Attempt forceps removal.??
C. Attempt removal with a suction catheter.
D. Arrange prompt otolaryngology evaluation.
E. Instill acetone into the external auditory canal.

74- Q/ long home O2 therapy for pt with COPD :

when Po2 95 88 NOT TRUE
when po2 less than 88 NOT TRUE .
nocturnal only. TRUE IF NO ORTHER CHOICES

75-Q/ 36-syncope of pt is
waring symptoms .
76-scenario . Pt with metatarsal fracture , X- ray not show exact fracture , next
investigation :
A-US.
B-CT .
C-MRI.
MRI is useful in the assessment of metatarsal fractures and dislocations, soft tissue, the
plantar plate, structures of the capsule, the extent of marrow hyperemia, the exact number
of bones involved, and small chip fractures.
CT scanning is not essential for diagnosing metatarsal fractures. If CT is planned, it
should be performed in at least 2 planes: the coronal plane (perpendicular to the sole of
foot) and the axial plane (parallel to the sole). With the modern multisection scanners,
images can be acquired in 1 plane and reconstructed in other planes with fairly high
degree of resolution.

77-Q / pregnant lady came to antenatal clinic for routine checkup , her Glucose tolerance
test was high glucose , diagnosed as gestational DM , mangment :
insulin.
a-Nutritional advice .
b-Oral hypoglycemic agent .
c-Repeat GTT .
d-Hg A1c
78-baby having HIV of a mother having HIV also , most not receive vaccine :
Oral Polio vaccine .
79-baby brought to you after he ingested drug tablets from there relatives house ,
manegment ( no time in the Q):
Gastric lavage .
80-Q / a young girl experienced crampy abdominal pain & proximal muscular weakness
but normal reflexes after receiving septra (trimethoprim sulfamethoxazole) :
a)functional myositis
b)polymyositis
c)guillian barre syndrome
d)neuritis
SIDE EFFECTS
The most common adverse effects are gastrointestinal disturbances (nausea, vomiting,
anorexia) and allergic skin reactions (such as rash and urticaria). FATALITIES
ASSOCIATED WITH THE ADMINISTRATION OF SULFONAMIDES, ALTHOUGH
RARE, HAVE OCCURRED DUE TO SEVERE REACTIONS, INCLUDING
STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS,
FULMINANT HEPATIC NECROSIS, AGRANULOCYTOSIS, APLASTIC ANEMIA,
OTHER BLOOD DYSCRASIAS, AND HYPERSENSITIVITY OF THE
RESPIRATORY TRACT (SEE WARNINGS).
Hematologic
Agranulocytosis, aplastic anemia, thrombocytopenia, leukopenia, neutropenia, hemolytic
anemia, megaloblastic anemia, hypoprothrombinemia, methemoglobinemia, eosinophilia.
Allergic
Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, allergic myocarditis,
erythema multiforme, exfoliative dermatitis, angioedema, drug fever, chills, HenochSchonlein purpura, serum sickness-like syndrome, generalized allergic reactions,
generalized skin eruptions, photosensitivity, conjunctival and scleral injection, pruritus,
urticaria, and rash. In addition, periarteritis nodosa and systemic lupus erythematosus
have been reported.
Gastrointestinal
Hepatitis, including cholestatic jaundice and hepatic necrosis, elevation of serum

transaminase and bilirubin, pseudo-membranous enterocolitis, pancreatitis, stomatitis,

glossitis, nausea, emesis, abdominal pain, diarrhea, anorexia.
Genitourinary
Renal failure, interstitial nephritis, BUN and serum creatinine elevation, toxic nephrosis
with oliguria and anuria, and crystalluria.
Metabolic
Hyperkalemia, hyponatremia.
Neurologic
Aseptic meningitis, convulsions, peripheral neuritis, ataxia, vertigo, tinnitus, headache.
Psychiatric
Hallucinations, depression, apathy, nervousness.
Endocrine
The sulfonamides bear certain chemical similarities to some goitrogens, diuretics
(acetazolamide and the thiazides), and oral hypoglycemic agents. Cross-sensitivity may
exist with these agents. Diuresis and hypoglycemia have occurred rarely in patients
receiving sulfonamides.
Musculoskeletal
Arthralgia and myalgia.
Respiratory System
Cough, shortness of breath, and pulmonary infiltrates
Miscellaneous
Weakness, fatigue, insomnia.
81-female brought to you after she ingested high dose of paracetamol tablets 8 hours back
, manegment ( no time in the Q) :
N-acytylcystine
82-h/o pt presented with preg+leg swelling
1-plethysmography,bed rest,heparin
2-venogram,bed rest,heparin.

83-most imp factor in smoking ttt

desire of pt to stop smoking??

84-h/o pt presented with dysurea,no flank pain
cystitis

10

85-one of the most risk factor for acute coronary synd

decrease HDL level
86-h/o pt presented with wheezing,6 months old baby
bronchodilator
87-h/o pt presented with silent chest and asthma
aminophylline
88-h/o pt presented with SCA ,SEVER PAIN,WHAT IS THE MANAGMENT
1-painkeller,iv fluid,observation??
2-blood transfusion.
3-admission the pt??
-------------------------------------------------------------89-the bactrial toxin use as ttt
botulism
90-contraindicated vaccine w HIV pt
polio
91-intelectual ability of child mesure by
CNS examination
93-1st line for ttt SLE with low side effect
1-NSAID
2-methotrexat

94-peptic ulcer common with

pain change with eating

95-all indication for endoscopy except

normal male more than 45 yrs old
96-acute otitis media creteria

11

-not should be w effusion

-rapid sign and symptom
97-h/o pt presented with moderate asthma
salmetrol
98-O2 supplay
supportive ttt
99-h/o pt presented with cyanosis,SOB,chest clear
humulecke maneuver
100-most cause of URTI
RSV

COLLECTED AND TRIED TO BE ANSWERD AND SENT BY

DR.ABULMALIK ALBAKER 2011
MED_ST99@HOTMAIL.COM

12