SMLE 2019

2ND OF SEPTEMBER

Corrected By: Glory team

Part 1: 2-8
Part 2: 9-27
SMLE , 2/9/2019

1- Diabetic ulcer in lateral malleolus ttt?
- surgical debridement ✅ ❓ ❓

2-CA colon screening age?
-colon 50 ✅

3-management of ductal breast cancer ?
Surgical excision ✅

4-Patient with bloody stained nipple discharge, you’re suspecting intraductal papilloma. What’s the next
step?
-. Excision ✅

5- consultant at OR and ask to prepare right kidney for surgery but the intern read in notes it is left
kidney what is the most appropriate action by intern?
- inform the consultant ✅

6-Before adrenal gland operation, what should you give the patient?
-Hydrocortisone ✅
If surgery for pheochromocytoma give him Alpha blockers pre-op

7- pt with history of Ocp use wat is associated with it?
- history of DVT ✅

8. duodenal perforation treatment
-simple closure with omental patch “Graham omental patch” ✅

9- charcoats triad ?
-acute cholangitis ✅

10-Pt had chest trauma nad 3⁄4 rib fracture , paradoxical chest movement ?
Management
•analgesia
• intubation and ventilation are usually required or high-concentration oxygen by mask

11. laparoscopic cholecystectomy come with discharge from middle management
A.daily dressing ✅
B- wound inspect
C- exploration

12. Neck mass ; biopsied showing (thyroid folicullar cells) ? ectopic thyroid ✅

13. .29 Years old male did sleeve gastrectomy 6 days ago, came to the ER complaining of persistent
vomiting since operation, on exam nothing significant, ABG normal ( there were numbers ) , US normal.
Best management?
-reassure ✅

14- Generalized cervical lymphadenopathy + mild tenderness + low grade fever. What's the most likely
diagnosis:
- Viral Infection ✅

15-A patient with achalasia. Repeated attempt of balloon expansion relapses again.
What is the management?
- myotomy✅

16- A 32 years-old alcoholic male patient is brought to the emergency department

with the history of vomiting large amount of bright red blood. Physical examination revealed
splenomegaly and ascites. Which of the following is the most likely source of bleeding?
- Esophageal varices.✅

17-case scenario of intussusception what is the gold standard investigation : - - barium enema ✅

18- after appendectomy a patient got abdominal infection by enterococcus faecium. He is allergic to
penicillin what are you going to give him: -vancomycin✅

19-pic of bowel obstruction with baby 2 week what is the treatment ? -Barium Enema ??❓ ❓ ❓

20- 16 years old female. Fever and Chronic diarrhea for 10 months Post meal Para
umbilical pain?
- Crohn’s disease ✅

21- 50 yrs man diabetic, well controlled had colon cancer surgery ( coloectomy) they kept him on insulin
and dextrose, after surgery by 2 days he became irritable, in shock, his electrolyte ( Na 129 ) ( K 3.2 )
urine and serum osmolality Normal, what's the Dx:
- fluid overload ❓ ❓

21- 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 ✅

22- 7 years old boy brought by his parents, he has nausea, severe vomiting for 20 minutes and now semi
comatose. The parents mentioned that he has same episode two weeks ago for 5 minutes without
deterioration in consciousness. On examination there is right testicular mass that does not
transilluminate with light.
What is the best action to do ?
- Surgical exploration. ✅

23-anterior abdominal stab wound , the omentum is bulging out through wound ?
-Exploratory laparotomy✅

24-Patient with stab wound what to do next ? – Local wound exploration✅

25-CT in truma important for : - retroperitoneal injury✅
26- contraindication to EVC Bicornate uterus ✅

27- Colon cancer screening:

50y✅

28- which vaccine to give in 2mo old baby? IPV hbv HIB PCV rota DtaP

29-down syndrome: most common cardiac anomaly associated with DS?:
-Endocardial Cushion Defect ✅

30-pyloric stenosis . what occurs the diagnosis ? - failure to thrive✅

31- prevention of meningitis
-droplet ✅

32- neonate born at home with umbilical bleeding ,, PT high, APTT high ,Bleeding Time normal ,Mx?
-Replace factor Xlll ❓ ❓
Hemorrhagic disease of newborn
Factor XIII doesn’t cause prolonged pt & ptt
It’s vit.k deficiency, if not in choices then factor X

33- esophgial adenocarcinoma treatment : -resection always ✅

34-Anal fissure treatment surgical Tx is lateral internal sphincterotomy ✅

35-Couple come by infertility after investigation done show bilateral fallopian
tube obstruction what will do
- Tell couple ✅

36- Preganat c/o sever abd pain and uterine cotractions she was given 6mg Mg
sulfate and the e contractions become normal then decrease the dose to 4mg Then complained of
shortness of breath What to do?
- after stop Mg sulfate give the Ca gluconate✅
First: Stop Mgso4

37- male complaining of reflux and post prandial discomfort this a main complain in his family What is
the risk factor for cancer esophagus? surgery
Barrette esophagus

38- unialateral neck swelling in the RT side by investigations : hot thyroid
nodule the rest cold thyroid No LN enlargement Treatment?
-Total thyroidectomy?❌
Start atinthyroid meds, if failed radioactive ☢ , the best definitive ttt is
surgical excision✅
39-1wk after return from Indonesia, patient c/o abdominal pain, tensmus, bloody diarrhea, vomiting by
investigations it was campylobacter infection
Treatment?
- Azithromycin✅
Supportive(hydration) most people with Campylobacter infection recover without specific treatment.
Azithromycin is needed only for patients who are very ill or at high risk for severe disease, such as
people with severely weakened immune systems, blood disorders thalassemia and
hypogammaglobulinemia, AIDS, or people receiving chemotherapy.

40- Trichomonas, and ask about ttt? -Metronidazole✅

41- female in reproductive age , come by an ambulance (RTA ) What 1st thing
have to do?
-check for pregnancy ✅

42- Child was brought to hospital with air way swelling and skin lesion all over
the body the mother stated that he was in a party at his friends house:
- Food allergy✅

43- Child with vascular malformation of lower limb , when to interfere :

A. Pain?✅
B. Claudication?
( Pain, pressure sores and ulcers, and possibly bleeding indicates rapid progression of AV
malformation)

44- Patient complains of polyuria low urine osmolarity after head trauma : central DI ✅

45- Patient has abdominal pain in school days

-encouraging her by giving positive comments about good stuff that she does ✅

46- Ectopic pregnancy 1- 3 cm and Bhcg 2600 -medical treatment (methotrexate ✅)

47- Pyloric stenosis what is electrolytes abnormalities: -hypochloremia hypokalemic metabolic alkalosis
✅

48- Baby with projectile vomiting and ugre to drink ( feeling hungry) -pyloric stenosis ✅

49- Patient involved in RTA was transmitted to near by limited facilities hospital
and the physician decided to refer him to advanced facilities hospital Patient is unconscious : What is the
most important thing he should be maintain :
-intubation ✅

50- what is the action of metformin in treatment of polycystic ovarian syndrome:
-reduce insulin resistance ✅

51- Screening for colorectal carcinoma in low risk patient: -50 years✅
52-28 years old female with normal pap smear 3 years old what to do : -Pap smear with cytology✅

53-Screening of pregnant women for hepatitis B virus . What type of prevention:

- Secondary ✅
54- The daily recommended activity for the child: -60 mins ✅

55-Treatment of pancraiatc pseudo cyst 10cm : ?surgey ❓ ❓

drainage if symptomatic ✅ note the size is more than 6 cm

56- father smokes and his child is asthmatic and you advices him but he’s seems
to be careless :
- inform child protection service✅

57- asthmatic patient his father is smoker:

- send the parents educational material about effect of smoking on their child
Asthma ✅

58- HF diagnosed and on ttt, now comes with SOB otherwise every things are
normal, what you want to add?
-ACEI ( according to his current medication)
-
59-murmur of AR? And where is the location?
-diastolic, decrescendo murmur heard best at the lower left sternal border ✅

60-Patient RTA with head trauma and polyuria, Osm low in urin and high in
blood, dx?
-DI✅

61- pulsating abdominal aorta surgery -AAA ✅

62- pt have rash after use herbal medication -allergic contact dermatitis? Not contact since it’s
medication

63- pt with placenta abruption low BP? -Multi-disciplinary team ✅

64- Doctor tell nurse to move bedridden pt nurse forget to tell other - poor communication ✅

65- What cause severe dysmenorrhea -endometriosis ✅

67-Mother his baby die what you will do

-Let the mother take some time with his baby✅

68- Mother of diabetic child stop giving him insulin and said he didn’t need this
what stage
-Denial ✅
69- Newborn with nasal flaring and subcostal retraction? -respiratory distress syndrome ✅
incomplete scenario

70- Pt postmenopausal want HRT − refuse to give✅

71- Pt with level of iron > 700 what to do ? -IV deferoxamine ✅

72- Pregnant 15 week have BP 170/100 what is the cause - essential HTN ✅

73- Common complications after UTR -Glomerulonephritis ✅ scarlet commoner

74-20/young patient die during exercise what is the Dx ? -Hypertrophic cardiomyopathy✅

75- Osteoarthritis screening start - =>65?✅

76- Precaution for dm pt with apical lesion ? ( TB ) – airborne ✅

77- Child preschool age has VSD 2mm , asymptotic , what will you do -Watchful and waiting ✅

78-A boy with throat thrush, fever and weak Which vaccine will you not give
- Varicella ✅ ❓ ❓
(Assuming that they wrote weak immunity)

79- when u stop metformin ? -less than GFR 30 ✅
80- pt has irregular menses with acne and hirstuism what is the cause? – PCOS ✅

81-case of cardiac tamponade how to dx? -echo✅

82- postmenabousal with urine incontince what is the first ttt? -excersice program for pelvic muscle for
8 week ✅

83- pt with fx in femur come with dysnea and low o2 sat after internal fixation ,
xray show bilateral infiltration what is the cause ?
-fat embolism ✅

84- pregnet smoker what will help her stop ? - behavioural therapy ✅

85-pte hiv u will tell whom ? -Pte or his wife ?

-Tell patient first ✅

86- 2yrs old presented e fever and cough and resp distress on exam there is
Bilateral Crackles. X ray showed both lung infiltrate e something I forget what is the
problem?
-Bronchopneumonia ✅

87. Post menopausal have bleeding 2 month. do endometrial biopsy Thickness
15mm and you want to do histrectomy next ?
- Take verbal concent?
- written consent ✅

88- COPD & heavy smoker hypoxia co2 retention patient drowsy? - Mechanical ventilation

89- Parent come with their child who have recurrent chest infection and they have
another child who died from one attack of chest infection ask about Dx ? -X-linked gammaalbuniemia✅

90- Pediatric case of meningitis, what prophylaxis should be given to surrounding

people?
-rifampicin ✅

91-Can’t close his eye in one side what nerve affected?
-Facial Nerve ✅

92- 50 years old male known case of Hypertension, came with acute palpitation,
pulse rate about 140, high BP, normal O2, conscious, what’s next step in management?
- adenosine( ( not clear ❓ ❓

93- Patient 50 yrs. Old. Came for. Routine check. Up visit, by CXR you. Find. Solitary
Cheast nodule. About 2*3 patient is asymptomatic ,what is most useful thing to
ask. About
-Ask about old CXR. ✅

94-A 12-year-old girl presents to her pediatrician for a sore throat. Her symptoms began approximately
1 week ago after she attended a sleepover.
Since then she experienced a sore throat and noted a temperature of 101°F (38.3°C). She denies a cough
but has noticed increasing fatigue and difficulty swallowing due to pain. On physical exam, she has
anterior cervical lymphadenopathy and patchy tonsillar exudates and swelling. What
complication could he develop?
-Scarlet fever✅ ❓ ❓
 ✅ ✅ ✅
2nd day of september part 2

Trauma patient in hospital . When to give him vaccine of PCV

A.2days
B. one week
C.2weeks

---

Pregnant lady in 15 WK gest comes with marked upper & lower limp
oedema.
BP 150/95 What is your best management?
A.complete evaluation
B.atenolol

Note :Edema happens in normal pregnancy but upper & lower could be
significant

----
54.pt had cancer family ask dr to give him a high dose of analgesic but
dr say it will had adverse effect! What kind of something he did ihave no
clue about this ?
A. totality
B. duble effect
C.informed.

Note : Principle of double effect If he has cancer or critically ill

---
Pt e deep wound 10 cm in front of thigh. What's your best next step
A.tourniquet at level of femoral
B.torniquet above wound level
C.apply good pressure at wound site
D.call vascular surgery doctor

-----

Child e dehydration. Mother told after he received ORS he was better

but when she offers his food he started to vomit again. Managment??
A.give ORS for 24hr after this start to give food
B.give ORS for 5 days after this start food
‫وا﮲ﺣﺘٮ﮵ﺎرات ا﮲ﺣﺮ ى‬

----

Pt econtinious vomiting&Dehydration
X ray shous multiple air fluid levels on exam there is swelling in groin
destended& tender on touch.
Diagnosis
A.Strangulated hernia
B.obstructed hernia
‫ﻰ‬ ‫وا﮲ﺣﺘٮ﮵ﺎر ٮ﮵ﻦ ٮ‬
‫﮴ﺎٮ ﮲﮵‬

-----

4 years can
# can prent square&triangle
Note :
Sequare 5
Sequare 5
Triangle 6
4 years > circle

------

‫﮳ﺣﺎت ﺻﻮرة‬ECG ‫ ﮲ڡٮ﮵ﻬﺎ‬MI ‫ف‬lead ll, lll, Avf

‫ﻰ‬‫ اﻟﺴﺆال ﻫﻞ ﻫ﮵‬anterior ‫وﻻ‬
inferior ischaemia
-----

‫﮳ﺣﺎ‬ctg ‫ ﻟﻮاﺣﺪه‬on labour

‫ﻫﻞ ﻫ ﻮ‬
variable deceleration
early deceleration

----

‫﮳ﺣﺎت ﺻﻮرة اﺷﻌﻪ ﮲ڡٮ﮵ﻬﺎ‬strangulated intestinal obstruction in 52yrs man e

long history of constipation
Site of strangulation
A.rectum
B.transverse colon
B.transverse colon
C.sigmoid colon

Note : Most common valvuls there for the answer could be C

-----

A case e exacerbation of Raumatoid Arthritis symptoms. Labes shows

high WBC ,Best management?
A.high dose steroid
‫﮳ﺪٮ﮵ﻞ اﻷٮ﮲ﺴﺐ ﻟﺤﺎﻟﻪ دي‬
‫ دوروا اٮ﮵ﻪ اﻟٮ‬.‫وادو ٮ﮵ﻪ أ﮲ﺣﺮ ى‬
Note :
If mild nsaids
If severe steroids
-----

Pt 28 yrs e symptoms of celiac disease symptoms. Which part of

intestin is almost affected?
A.ilium
B.colon
C.jujenum ( Proximal intestine )

Note : Terminal ileum in crohn

-----

Pt gust after thyroidectom develop large swelling in her neck. Affect

breathing
Best next step management??
A.do tracheostomy
B.open sutures on road
‫ﻰ‬ ‫وا﮲ﺣﺘٮ﮵ﺎر ٮ﮵ﻦ ٮ‬
‫﮴ﺎٮ ﮲﮵‬

----
30yrs Femal Pt e PCO obese comes to you she doesn't want to get
pregnant what is action?
A.give metformin
B.progesterone only bills
C.combind estrogen & progesteron

-----

Pt e thyroid nodule hard e ultrasound report Next step??

A.FNA
B.lobectomy
‫ﻰ‬ ‫وا﮲ﺣﺘٮ﮵ﺎر ٮ﮵ﻦ ٮ‬
‫﮴ﺎٮ ﮲﮵‬

-----

Pregnant lady e symptoms of bacterial vaginosis managment??

‫ا﮲ﺣﺘٮ﮵ﺎرات ﻣﻦ ﺿﻤﻨﻬﺎ‬
A.Local imidazole
B.Metronidazole
‫ﻰ‬ ‫وا﮲ﺣﺘٮ﮵ﺎرات ٮ‬
‫﮴ﺎٮ ﮲﮵‬

----

Neonat e lumber puncture +diplococci

Managmt??
A.ceftraixon&vancomycin
B.ampcillen +gentamicin
‫وا﮲ﺣﺘٮ﮵ﺎر ٮ﮵ﻦ ٮ‬
‫﮴ﺎٮ﮲ﻰ‬
----

Neonat Mal full term comes e symptoms poor feeding & others.what is
to save him from liability of diagnosed necrotizing enterocolitis
A.male sex
B.full term
C.young age

Note : Usually it happens in preterm

It can happen in full term but less frequent
------

Pregnant BA pt. On inhalers therapy & leukotrin receptor antagonist

Giving ox sat & others means she is controlled But she is concerned
about
safty of druges on pregnancy...??
A.reassure her & continue medicationes

Note : SABA and low dose inhaled corticosteroids safe .

-----

Hard sign of internal bleeding in trauma pt

A.skin colour changes
B.week pulse
Note :
----

Pregnant e uti which drug contraindicated

A.ciprofluxacin
‫﮳ﻌﺎ ﻫﻮ ﻣﻤﻨﻮ ع ف اﻟﺤﻤﻞ‬
‫ﻃٮ‬

----

Kawasaki management?
A.intra venous gamaglubulines

-----
Kawasaki sign?
A.bilateral red eyes

-----

Lady e her husband comes to you she want iud insertion but husband
wants her to get pregnant refuses insertion... What to do??
A.contraciption decision is mutual
‫﮴ﻪ‬
‫دا اﻟﲇ ا﮲ﺣﺘﺮٮ‬

-----

Means nephropathy is present in DM pt

A.proutinurea

----

Pt e DKA under ttt. Develope dyspnea exam basal crakesWhat should

you do to avoid happening of this case?
A.good reviw fluid demands of the body ( fluid overload )

Note: They overhydrated him This may cause HF & pulmonary

congestion.

-----

12yrs child e fever. Ferritin 3 what is expected in her bone marrow

A.hypoplasia
B.megaloblast
‫وا﮲ﺣﺘٮ﮵ﺎرات ا﮲ﺣﺮي‬
‫وا﮲ﺣﺘٮ﮵ﺎرات ا﮲ﺣﺮي‬
Note : If IDA
Hyperplasia

------

Patient 40-50 years old presented with post coital bleeding , weeks ago
she was treated for genital wart by electrocautery what is the source of
bleeding?
Uterine cervix
Uterine body
Vulva
Vagina

-----

Case of severe C.diff diarrhea what to give:

Iv metronidazole
Oral vancomycin
Note :
Mild » oral metro
Severe » oral vanco
Toxic megacolon » Iv metro + oral vanco
-------

Case of liver cyst (echinoccosis) treatment ?

Albendazole
Surgery
Note : if failed B
--------

Fever for 6days and tender splenomegaly, which culture is most

importantly needed?
-urine and stool culture
-repeated blood cultures
-bone marrow smear culture

Note :
j. No itʼs only fever & tender splenomegaly: Malaria, Typhoid,
Infective endocarditis.
k. fever for 6 days could it be a clue ( sustained fever ) so Typhoid
k.
answe Bone narrow culture BUT