March SLE 2009

COLLECTED AND TRIED TO BE ANSWERD AND SENT BY

DR.ABULMALIK ALBAKER 2011 MED_ST99@HOTMAIL.COM

1-mother come to you complaining of that her child not use his right arm to take things from her and he
keeps his arm in pronation position and fisted , How you will solve this orthopedic proplem :
1. orthopedic referral for possible surgical correction
2. rapid supponation of forarm
Nursemaids elbow : Radial head subluxation that typically occurs as a result of being pulled or lifted
by the hand. Presents with pain and refusal to bend the elbow. ttt : Manual reduction by gentle
supination of the elbow at 90 degrees of fl exion. No immobilization.
shaken baby syndrome, which can lead to intracranial pressure, swelling of the brain, diffuse
axonal injury, and oxygen deprivation; which leads to patterns such as failure to thrive,
vomiting, lethargy, seizures, bulging or tense fontanels, altered breathing, and dilated pupils.

Partial injury to the plexus is most common and occurs at the upper roots (C5-C6) resulting in
Erb's palsy. Weakness in shoulder abduction, external rotation, elbow flexion, and forearm
supination result in the characteristic waiter's tip posture of the upper extremity.

The least common form of plexus birth injury is Klumpke's paralysis involving the lower
spinal roots (C7-T1). Findings include absence of the palmar grasp reflex and weakness of
hand and wrist flexors as well as hand intrinsics resulting in a clawhand deformity

2-child with positive gower sign which is most diagnostic test :

muscle biopsy

3- pregnant , with history of DVT 4 years back < what will you give her :
1. aspirin
2. clopidogril

3. LMW heparin OR UFH

4 - female pt come with generalized abdominal pain by examination you found suprapupic tenderness ,
by PV examination there is Tenderness in moving cervix and tender adnexia diagnosis is :
pelvic inflamatory disease

3- pt female 43 years old , was healthy before , in the previous 3 month there is spotting of blood that
last for 2 days and stop what you will do for her
1. endometrial biopsy
2. TSH level
3. prolactin level

4. urine pregnancy test

4-young man come with headach he is discribing that this headach is the worst headach in
his life what of the following will be less helpful :
1. Asking more details about headach
2. do MRI or CT scan
3. skull x
4. LP
5-lady come to you complaining that she enter the home of her grandfather (old man ) and she found
that the things are not in its place and there is decrease of his memory but his personality intact CT
brain and all immaging are normal what you will suspect :
1. Alzehimer disease
2. multi infarct dementia
6-Q pt younge female has osteoporosis giving history of dietary habit low in calcium and vit D How
you will manage her :
give her vit D and ca supplement
7-Q Treatment of pt with yellowish vaginal discharge and itchy by swab and cultur it is Trichomonas
vaginalis which of the following is correct :
1. start treatment with metronidazol
2. start treatment with clindamycin
3. no need to treat husband
4. vaginal swab culture after 2 weeks
8-pt come complaining of ptosis diplopia dysphagia what investigation you will do for him :
antibodies to acetyl cholin receptors
9-pt give history of malaise, fatige and give history of decrease meat in her diet ,HGB was 9 and
hypochromic microcytic anaemia whatyou will give her :
1. Trail of iron therapy
2. iron and multivitamin
10-Q pt come to you with pain in posterior of neck and accipital area , no affection of vision , by
cervical x ray there were decrease of joint space : what is your diagnosis :
cervical spondylosis
Cervical spondylosis is a common degenerative condition of the cervical spine. It is most likely caused
by age-related changes in the intervertebral disks.
if compression of a nerve root emerging from the spinal cord may result in radiculopathy (sensory and
motor disturbances, such as severe pain in the neck, shoulder, arm, back, and/or leg, accompanied by
muscle weakness).
if Less commonly, direct pressure on the spinal cord (typically in the cervical spine) may result in
myelopathy, characterized by global weakness, gait dysfunction, loss of balance, and loss of bowel
and/or bladder control.
ttt : usually conservative in nature : NSAIDs , physical modalities, and lifestyle modifications

11-child brought by mother due to bleeding per nose , by examination you found many bruises in his
body ,over his back ,abdomen and thigh , what is your diagnosis :
Child abuse

12-pt come to you for check up , he has DM his blood sugar is well controled ,but his BP is 138/86 ,all
other physical examination show no abnormality including neurological examination ,he is following
regularly in ophthalmology clinic , What you will put in your plan to manage this pt :
Giving ACE inhibitor (( goal for BP fo DM : 130/80 ))
13-Qpt with hyperkalemia what abnormality you will see in ECG :
peaked T wave

S/S : malaise, palpitations and muscle weakness , metabolic acidosis ,

cardiac arrhythmia or sudden death, nausea, vomiting, intestinal colic,
areflexia, weakness, flaccid paralysis, and paresthesias
The combination of abdominal pain, hypoglycemia and hyperpigmentation,
often in the context of a history of other autoimmune disorders, may be
signs of Addison's disease, itself a medical emergency.

on ECG : tall, peaked T waves; a wide QRS; PR prolongation; and loss of P

waves, Can progress to sine waves, ventricular fibrillation , and cardiac
arrest.

TTT : C BIG K : FIRST Calcium , Bicarbonate , Insulin , Glucose

,Kayexalate , Dialysis If sever

14-man change his job , he must in new job to talk in front of 50 persons , he feels that he cannot do
this and he send his frind to do that in stead of him who can you help him
1. propranolol
2. Biofeedback
-

ttt of Social phobias: CBT, SSRIs, low-dose benzodiazepines, or -blockers (for performance
anxiety) may be used.

Glossophobia or speech anxiety is the fear of public speaking.

Adjustment disorder (AD) is a psychological response to an identifiable stressor or group of

stressors that cause(s) significant emotional or behavioral symptoms that do not meet criteria
for anxiety disorder, PTSD, or acute stress disorder.

ttt : psychotherapy

15-Boy12 years old come to you complaining of that he worries about himself because he see that his
frinds has axillary hair andhe is not like them , about sexual maturity of boys what is first feature :

1. testicular enlargement , in females breast buds

2. penile elongation
3. hair in axilla
4. hair in the pupic area

16-come with precordeal pain ECG ST segment elevation pt given aspirin and nitrate , but no releive of
pain what next step you will do :
give morphin IV
17-Q pt female giving historry of menorrhagia since last 3 month ,her HB = 8 ,What is the first action
to do :
1. endometrial biopsy
2. hospitalization for blood transfusion

There are a number of indications for obtaining an endometrial biopsy in a non-pregnant woman:

Women with chronic anovulation such as PCOD .

to rule out endometrial hyperplasia or cancer.

In women with AVB, the biopsy may indicate the presence of abnormal lining such as endometrial
hyperplasia or cancer.

with suspected uterine cancer, the biopsy may discover the presence of cancer cells .

TVUD If the endometrial lining is less than 5 mm thick on sonography, i unusual to encounter
endometrial cancer.

The test is usually done in women over age 35..

18- old lady (50) giving history of (postmenopausal symptoms) , hot flushesbest drug to reduce these
symptom is :
1. estrogen only
2. progestron only
3. combined pills (estrogen and progesteron )

4. VENLAFAXINE OR CLONINDINE OR HRT IF NOT COMBINED PILLS

HRT (combination estrogen and progestin):
19-PREGNANT LADY GIVING HISTORY OF INCREASED BODY WEIGHT ABOUT 3 KG
FROM THE LAST VISIT AND LOWER LIMB EDEMA TO CONFERM THAT SHE HAD
PREECLAMPSIA :
MEASURING BP
20-pregnant lady (g1p0)(13 week) she looks anexious ,but she is happy about her pregnancy her blood
pressur is 142/96 she do exercise 4-5 times / week she denies that she has any previous medical
problem : what is diagnosis:
1. pre echlampsia MORE 20 WEEKS
2. pregnancy induced hypertension ( MORE 20 WEEKS )
3. chronic hypertension ,
- Gestational hypertension (formerly known as pregnancy-induced hypertension): Idiopathic hypertension without
signifi cant proteinuria (< 300 mg/L) that develops at > 20 weeks gestation. As many as 25% of patients may go
on to develop preeclampsia.
-Chronic hypertension: Present before conception and at < 20 weeks gestation, or may persist for > 12 weeks
postpartum. Up to one-third of patients may develop superimposed preeclampsia.

-Preeclampsia: New-onset hypertension (SBP 140 mmHg or DBP 90 mmHg) and proteinuria (> 300 mg of
protein in a 24-hour period) occurring at > 20 weeks gestation.
- Eclampsia: New-onset grand mal seizures in women with preeclampsia.

21-Pt has car accident which of the following trauma you will hapen to him :
1. tamponade of the heart
2. flial chest
3. pneumothorax
4. all of the above
tension pneumothorax, open pneumothorax, massive hemothorax, flail chest, cardiac
tamponade, aortic disruption Dx by aortaography , diaphragmatic tear, and esophageal injury.

22-pt come with trauma of the chest, on inspection you found one segment withdrown inside in
inspiration and go out side during expiration : what you suspect ;
Flial chest
TTT : O2, narcotic analgesia. Respiratory support, including intubation and mechanical ventilation

23-Lactating mother has mastitis in outer upper segment in left breast, what is best mangement :
1. stop breast feading from that side and evacuate milk by sucktion pump
2. continue breast feeding from that side with antibiotics and local heat application
24-Q best treatment of acut cystitis :
1.ciprofloxacin
2. norfloxacin
3. Erythromycin

25-The investigation of high sensitivity and specificity of urolithiasis :

1. IVP
2. X RAY abdomen after CT scan
3. US
4. MRI
5. nuclear scan.
- IVP considered the standard imaging modality for urinary tract calculi. In past
-Sensitivity (95-100%) and specificity (94 to 96%) with the use of non-contrast helical CT.
- Primary treatment for symptomatic urolithiasis is extracorporeal shock-wave lithotripsy.
- ultrasonography should be used as a first study
26-Q pt come to ER with weak rapid puls , what to do :
1. give him 2 breath
2. do CPR (2breath / 30 compression).
3.wait until team of resuscitation come

27-Q ptwith acute abdomen you will find :

1. rapid shallow breath
2. rapid prolonged breath
b/c DKA causes acute abdomen so metabolic acidosis,rapid and shallow. wherears , respiratory
acidosis,shallow and slow .
28-most common side effect of atropine :
1. brady cardia
2. dryness of mouth
Most common side effects due to antimuscarinic action
29-pt come with metabolic acidosis ,she take drug overdose of which of the following :
salicylate

30-about hepatitis b vaccination scheduling for adult :

3 doses only

31-about : female patient came with sever vaginal bleeding

what is the approptiate initial management??
RESUSCITATE : O2 , IV FLUID , ABC ,IF NOT STOP progesterone & estrogen
last one is blood transfusion
32-child present (picture of duschene muscular dystrophy
muscle biopsy
DMD :An X-linked recessive disorder resulting from a deficiency of dystrophin, a
cytoskeletal protein. -Onset is usually at 35 years of age. - Pseudohypertrophy of the
gastrocnemius muscles.
-Dx : CK , EMG , MUSCLE BIOPSY. - TTT : Physical therapy
33-drug that cause metabolic acidosis (anion gab =18 )
aspirin
34-the question was which of the following does not co-relate with the finding of hyperkalemia
except :
and the options were
1-Peaked T wave
2-broad QRS complex wide not broad
3-increased P-R interval
4-Sine wave pattern
5-absent P wave
35-another question pt with hypertension by fundoscopy there is cupping of optic disc , what will you
suspect :
1. hypertensive retinopathy
2. open angle glaucoma
3.

angle clousure glaucoma

Grade 1 : Generalised arteriolar constriction - seen as `silver wiring` and Vascular tortuosities.
Grade 2 :As grade 1 + AV nicking or Nipping

 Grade 3 : As grade 2 + cotton wool spots and flame-haemorrhages

Grade 4 : As above but with swelling of the optic disk (papillodema)
Posterior vitreous detachment is the most common cause of the acute onset of floaters.
36-What of the following will not help you in diagnosis of multiple sclerosis
1.
2.

visual evoked potential

CT scan

3.

LP

4.

MRI

5.

McDonald criteria

37-Most common cause of chronic hypertension :

1.
2.

DM
Hypertension

3.

interstitial renal disease

38-Pt 18 months old boy , with history of current jelly stool diagnosis : intussusseption

39-another question : female 13 years old , come complaining of mass in her left breast in lower outer
quadrant , it is soft tender about 2cm in size , pt denies its aggrevation and releaving by special
condition her menarch is as age of 12 , what is diagnosis :
1-Fibroadenoma
2- Fibrocystic disease

another question : pt has serious disease how y u will conduct this bad news for him :
1. give him clues that he has serious disease
2. To ask him how much he know about disease
3. till him immediatly that and go away t
4. Not to till him
40-Another question , Pt with dysphagia ,ptosis ,diplopia what investigation you will ask :
anticholeinesterase antibodies

41-pt 62 years old female complaining of pruritis of pupic area , with bloody discharge she use many
treatment but no improvement , then she develope pea shape mass in her labia , she went to you to
show you this mass what will come to your mind as diagnosis :
1. Bartholin cyst
2. Bartholin gland carcinoma
3. Bartholin gland abcess

42-years old male come to you complaining of discomfort in anal area , constrictino of anal sphinctor ,
spots of fresh bright red blood after defication , blood staining on toilet paper after using it you will
suspect :
Hemorrhoids

43-i think also about anal fissure but in Q no pain and also in the choices no anal fissure also the spots
of fresh blood come at end of defecation which is more with hemmorrhoids but in anal fissure blood
will apear as streak on the stool
44-pregnant (28 week ) she sit with child , this child develop chickenpox , she come to you asking for
advice , you found that she is seronegative for (varicella) antibody , what will be your management :
give her(VZIG) varicella zoster immunoglobulin
give her acyclovir
give her varicella vaccin
wait until symptom apear in her
45-pt 32 years old come to you worries about one of his moles , giving history that his father had moles
, excisional biopsy done to him but now he has metastasis in lungs , bones and liver , what will come to
your mind about malignant change of mole :
irregular border
presence of thim in the thigh
omogenous colour
The ABCDEs of melanoma:
Asymmetric ,Irregular Border , Irregular Color , Diameter > 6 mm ,Evolution: changing or new lesion

46-- female pt diagnosed as polymialgia rheumatica , what you will find in clinical picture to support
this diagnosis :
osteophyte in joint radiograph
tenderness of proximal muscle
weakness of proximal muscle Very high ESR
47- 40 years old male come to you complaining of sudden joint swelling , no history of trauma , no
history of chronic diseas what is the investigation you will ask :
CBC
ESR
MRI of knee joint
rheumatoid factor
48-pregnant with hyperthyroidism what you will give her :
propylthiuouracil
Radioactive iodine

COLLECTED AND TRIED TO BE ANSWERD AND SENT BY

DR.ABULMALIK ALBAKER 2011 MED_ST99@HOTMAIL.COM