SMLE 2019

15TH OF SEPTEMBER

Corrected By: Glory team

 15.9.19

1. Patient with symptoms of DI not responding to vasopressin ?

nephrogenic DI
central Di

2. Patient with Several reading of High blood pressure Investigation normal except
hypokalemia​ ?
essential HTN
primary hyper aldosteronism
polycystic kidney disease

3.Basal Skull fracture to jugular foramen what will be affected?

9,10,11

4.Elderly his son notices increase dyspnea hoarseness of voice ?

Cancer could be laryngocarcinoma , thyroid ,lung ,depends on case)

5. Lung cancer associated with superior vena cava syndrome ?

small cell carcinoma
squamous cell carcinoma
Adenocarcinoma
lymphoma
Over 80% of SVC syndrome cases are associated with lung cancer (particularly SCLC) and
non-Hodgkin mediastinal lymphoma.

6.Patient treated with iv fluid then have dyspnea bilateral basal crackle how to prevent?
R​eview of fluid balance

7. 12 months old persisted microcytic anemia after iron supplement electrophoresis

show high h2?
beta thalassemia
SCD
IDA

8.patient with drug over dose pinpoint pupil low oxygen next step?
full hx from family
mechanical ventilation
9.female with recurrent misscarge and D&C what is the cause of her current misscarge?
chromosomal anomaly’s
asherman
1st T, genetic anomalies
2nd T, cervical I.

10.13 old female with insulin resistance small cysts on ovary high androgen ?
stein leventhal syndrome (PCOS)

11.patient with shortness of breath after exercise no pain or chest tightness ?

equivalent angina

12.male with ECG showed heart block what is prognosis ?

need pacemaker
syncope attack

13. patient 2 days after leukemia treatment develop fever electrolyte disturbance
What is the Cause(TLS?)

mostly occurs after initiating cytotoxic treatment of ​ALL, AML, or NHL

Clinical features
Nausea, vomiting, and diarrhea
Lethargy
Hematuria
Seizures
Cardiac arrhythmias
Tetany, muscle cramps
Paresthesia
Hyperkalemia
Hyperphosphatemia
hypocalcemia
hyperuricemia

14. 15 year old pallor lethargy splenomegaly, prominent head.

Lab hemoglobin f 50 a2 30?
A thalassemia
B thalassemia
Sickle

15. cases of syncope al of the female ECG normal, physical exam is normal. What to do?
Holter
Echo
16. Alcoholic with 1 day of epigastric pain, vomiting and hematemesis. Previously
diagnosed with peptic ulcer.vitally stable. What is the diagnosis?
Acute pancreatitis* (hematemesis could be from the previous ulcer)
Chronic pancreatitis
Esophageal varices( stable )

17.Schizophrenia if compliant to medication and behavioral therapy and involve with

society. What is the best outcome?
70% case will be stable. (highest percentage)

18. 37 week pregnant CTG picture abnormal what to do?

C/s ( i think )

19. Air under the diaphragm. What to do?

Exploratory laparotomy
( no graham patch)

20.3 y/o child with painless rectal bleeding, what’s the dx

Could be juvenile polyp

21.ICU pt. On TPN and prolonged INR, how to manage?

Vit .k
TPN patients have 2 problems (1- bit K diff,2- liver failure) if the labs of the liver profile were
abnormal think of 2, if only PT and INR think of 1 and treat)

22. Pt with bilateral inguinal hernia how to manage?

N.B:Lap.herniotomy and hernioplasty
laparoscopy

23. Pt. With recurrent inguinal hernia how to manage ?

N.B:if first was open do lap. And the opposite.

24.Multipara with abdominal distention gets worse on leaning forward -ve cough impulse
, dx ?
N.B: divarication of recti

25.Post appendectomy with peritonitis how to manage

N.B: Abx first

26.Post appendectomy with seroma draining from the wound how to manage?
N.B: Dressing
27. Child with meningitis and lower limb rash dx?
N.B: neisseria meningitidis

28. Pt. With sx of depression for 2 years dx?

29. Best indicator for inhalation injury?

N.B: ​Striqdor or hoarseness of voice

which increase the work of breathing and may lead to respiratory fatigue with sub- and
suprasternal retractions.

30. Pt. Post dilation for achalasia presented with pain in chest and neck with emphysema
under skin + contrast leak management?
Boerhaave

31.Pt. With hx of repeated vomiting now presents with bloody vomit dx?
Mallory weiss

32.Management of bleach ingestion

Observation and X-ray then endoscopy ?

33 Over 6 Q about interpretation of pleural fluid analysis

34.midshaft hypospadias with hooded foreskin and chorde asking for name of surgery
N.B: ​Refer to urologist OR (TIP) operation.

35.HIV pt diagnosed with toxoplasmosis, how to treat?

N.B:pyrimethamine + sulphadiazine

36.is breast feeding safe in hep B +ve mother and vaccinated and immunised newborn
?​yes

37. Basal Skull fracture to jagular foramen what will be affected

38. Elderly his son notice increase dyspnea hoarseness of voice

39.ICU patient immobile for 8 months labs normal (pTH, phosphate, rest not given) whats
the cause of High ca:
Malignancy
Multiple myloma
Primary hyperpara
Immobility
40.Q isolated high ca+ in CKD (rest PTH normal) whats the cause ?
•Primary PTH
•Secondary
•Tertiary
•Forgot the last one but I coose it i think lol

41.Chronic Hep B with gradual jaundice abnormal labs (high alt, ast, alp, direct bili) + hep
dna low what’s next?
•Abx
•Steroids
•Biopsy
•Request anti delta antibody something

42.midshaft hypospadias with hooded foreskin and chorde asking for name of surgery
N.B: ​Refer to urologist OR (TIP) operation.

43.HIV pt diagnosed with toxoplasmosis, how to treat?

N.B:pyrimethamine + sulphadiazine

44.is breast feeding safe in hep B +ve mother and vaccinated and immunised newborn​?
yes

45. Basal Skull fracture to jagular foramen what will be affected

46. Elderly his son notice increase dyspnea hoarseness of voice

47. cases of blood smear?

Diagnosis either ITP OR TTP THEN ASKED TREATMENT

48.Cases COPD, doagnosis?​ ,

49.Old signed DNR? ​Respect fayher wish

50. Patient neck stifness CT Temptoal showed dicreased ....?

Abscess?
Herpes meningitis
Listeria
Penumoccocal

51.Pt after mastectomy she has numbness in inner side of the arm , with nerve affected?
Long thoracic nerve
Intercostal brachial
Medial pectoral
Thoracodorsal

52. 9years after trip to Africa come with headache , fever , neck stiffness , LP :
lymphocytosis , most common organism
Corona...
Cytomegalovirus
EBV
**N.B: MC virus are :ENTEROVIRUSES ( coxsacki,echo,polio) or HSV , VZV, EBV .

53. child with Pharyngeal congestion and cervical lymph node enlargement went to PHC
and was given Abx now he has rash ?
EBV
Cytomegalovirus

54. Elderly in ICU has bed sores with exposed necrotic skin and subcutaneous tissue
managment?
Deprivement with skin graft
Debriment with asseted vacum??
Depriment with primary closure

55. ICU pt with thick wall gallbladder and precystic fluid collection , no gallstones stones
?
Cholecystectomy
Cholecystotomy

56.child with ascending weakness (GBS) after viral infection, treatment?

IVIG
Steroid
Plasmaphoresis

57.pt post appendectomy ( not sure about duration ) now complain of sever anal pain and
inability to pass stool, by digital rectal exam doctor couldnt insert his finger beyond anal
verge due to pain ? ( no fever or bleeding)
Anal stenosis
Anal fissure
Preanal abscess

58. 2 years with knee joint swelling , and limitation of movement , most important
investigation?
Culture
Joint aspiration
59. child brought by his mother due to fatigue , Hb8.8 ?
Intermascular ferrous sulphate
Oral ferrous sulphate
Blood transfusion

60. ulcerative colitis ( history and imaging suggestive of megacolon ) management

- Iv immunosuppressive ( inflixmab not sure )
- Iv methylprednisolon
- Colon resection with ileostomy

61. Child 1 or 2 month mother compiling he is irritated and crying a lot and asking what’s
is the typical age of this presentation ​?
6 weeks
1 month
3 months
6 months

62.Disease has low prevelence in pupulation? What will be positive

false pos
fals neg
True pos
True neg

63. t wih mechinui intubated developed respiratiry distress

inhaled nitruc oxide
surfctan lavage

64. female with breech oresntation and bicirnat utrus

Cs
ventou
spontaneous

65. pt with pain with mensturation with bulky tender uterus

adenomyosis
endometriosis

66. paediatric throwing games and irrsbectful behaviors

time out
verbalthreat
spank

67. pt diagnosed with brichiactasis how to tell him about the diagnose
show him the report
tell him he has bronchiactasi
explain hr has damaged alveolar with infection

68. pt with heart failure ECHO showed constrective hyoetrphic left ventricle
diastolic heart failure ventricura hypetroph
restrictive cardiomyopathy
pericarditis

69 pt with hamematemisis with deudnal ulcer managed, then pt became drawsy, pco 75
intubat
oxygen

70. pt fully dilated for 2 hr, head in station - 2, pt got exhusted from pushing
Cs
wait 2 hours
ventous

71. indication of instrumental deliver pt with rhumatic feve and mitral stenosis , with hx of
herpis 1 year ago:
mitral stenis
herip

72.Vaccine contraindicated in pregnancy

zoster
hep B
meaning local

73.most common site for metastasis of colonic carcinoma

liver
lung
prostate

74.​pt well-controlled diabetic by exercise and metformin with normal Ha1c only has three
reading if bp 149/90
A- continue the same measures
B- ​add ACEI

75. what effect the function of clopidogrel

warfarin
SSRI
omeprazole
76.Other name of PCOS :​Androgen insensitivity syndrome or stein-leventhal syndrome

77. Pt with history if ICU admission and intubation 1 week ago with thyroid mass, TSH
low slightly t3 low t4 normal
subclinical thyroiditis
sick euthyroid

78.Pt switch history of antibiotics now with abdominal distention, invest:

difficile toxins in stool
upper endoscopy
Lower endoscopy
1st-line: oral vancomycin or oral fidaxomicin
2nd-line: oral metronidazole

79.Pt with vaginal bleeding and absent fetal movement, next step:
US
admission to ward
discharge

80.Pt post cholecystectomy with fever sign of ​atelectasis​ and fluid collection at the site
of gallbladder:
chest physiotherapy
percutaneous drainage

81.Pt come with brother with irritability, shouting on people and take pause between the
sentance
al zahaimar
frontotemporal dementia

82.Pt post MVS conscious then in the ambukane lost consciousness and dilated pupil
subdural hematoma
fracture base
rupture anurysm
Epidural hematoma

83. Pt worried and want to do hystrectom and go br admited

admit her to gain her confidence
calm her down and discuss her options

84.When to assess resistance to steroids in nephritic !

After 4 weeks

85.Old age patient complain of abdominal pain and tenderness

And X Ray showed multiple air-fluid levels
Ct with contrast show cut off dye at terminal ileum showing mass and target sign
- small bowel cancer
-late chron
N.B:cut off = skip lesion

85. Old age DM not Insulin dependent develop swelling at the back of neck abscess with
multiple openings discharge?
cellulitis
fruncule
Carbuncle

86.Pat complain of heartburn endoscope show multiple ulcers at antrum and malt and
h.pylori Ttt?
Surgery
H.pylori ttt

87. Pic of 2nd heart block

88.Pic of vaval carancul
89.Pic of Anembryonic pregnancy
90.Pic of uteroplacental insufficiency
91.Pic of head compression variability CTG
92.Pic of pleural effusion
93.Pic of air under diaphragm

94. 16 years old came with right lower quadrant pain with vomiting, on ultrasound there
was ​abdominal fullness​ Diagnosis?
Appendicitis
Torsion ovary

95.Egg allergy what vaccines not given?

Yellow fever or influanza v

96.6 year old girl mother complain of the girl has vginal itching and bleeding discharge?
Dx?
candidiasis
sexual abuse
foreign body N.B: IF there fecal incontenance = sexual abuse

97.Child with absent red reflex testicular torsion.

98.Wilm tumor case

99. Pat. At ER abundant poor hygiene, suspicious, aggressive
Dr think it’s behavioral disease and call psychiatric
psychosis
alzahimer
schizophrenia N.B :POOR hygiene = Schizophrenia

100.Squemous cell carcinoma in situ of vulva What to do?

Wide local excision

101.MALT LYMPHOMA ? What treatment

Abx

102.Classical case of Kawasaki dis in pedi

103.Classical case of hirshbrung dis in pedi

104. Case of boy with sever RDS and low globulin ... mother afraid about died because
have one boy same condition before two years but the two douters are normal
Dx: X- linked hypogammaglobulinmia

105. In ventral hernia mesh type :

Inlay
Outlay
Sublay
Underlay

106. Female with clear presentation of PCOS and they put some tests of PCOS in the
question and ask what would you order also ?
tst
I think prolactin
??
glucose and lipid profile

107. Women just had vaginal delivery and think that her child is going to not live long
even though the child is healthy?
postpartum depression
Postpartum psychosis
**N.B : Postpartum Depression with suicidal ideation**
108.Case of hernioplasty , fever , pus discharge, part of mesh exposed what’s would you
do?
abx
debridement and remove mesh
Open surgery laparotomy??

109. New born 6 hour complain of , meconium stained fluid he has Sob stable suddenly
develop Sever hypoxia preductal o2 sat. 91 and postducal o2 sat 88 or 87
What’s to do ?
surfactant lavage
NITRIC OXIDE

110. central +peripheral cyanosis CXR show small heart shape

What Dx??
TOF

111.Female in labor facial presentation what to do?

cs
instrumental delivery
normal delivery

112.HF DM pt presented complaining of vomiting and showed signs of dehydration as

well as signs and symptoms of overload ( JVP, edema, bilateral crackles, SOB)
how to manage :
Diuretics ( furosemide)
Iv fluid

113.Preterm neonate product of emergency CS due to maternal tachycardia .. developed

cyanosis after 30 mins, what is the diagnosis:
TTN
RDS
pneumothorax
? I couldn’t remember the last choice

‫ واﺧﻮاﺗﻬﺎ اﻟﺜﻨﺘﯿﻦ ﻋﻨﺪﻫﻢ ﻫﯿﺪك اﯾﺶ‬، ‫ وﻓﻮﻣﺘﻨﻖ وﺑﻠﻮر‬، ‫ ﯾﺠﯿﻬﺎ رﯾﻜﺮﻧﺖ اﺑﺪوﻣﻨﻞ ﺑﯿﻦ ﻣﻊ ﻫﯿﺪدك‬، ‫ ﺳﻨﻮات اﺗﻮﻗﻊ‬٧ ‫ ﺑﻨﺖ ﺻﻐﯿﺮه ﻋﻤﺮﻫﺎ‬،
‫اﻟﺪاﯾﻘﻨﻮزز ؟‬
iBD - ١
iBS
Abdominl migrine

114. Assessment for pri operative to decrease mortality + morbidity ?

Cardiology index
Anthesizia scoring
ASA score

115.Hx of appendectomy ​ ​Came with mild pain no nusuea CT showw 2.2 retrocecal
collection , next mx ?
Conservativ mx
ct drain
open drain

116.Breast cancer risk factor:

Early menarche
Late menopause
Age
? I couldn’t remember

‫ﺳﯿﻨﺎرﯾﻮ ﻗﺎﻟﻚ ﻋﻨﺪه ﺑﺎرﻛﻨﺴﻮن وﻋﻄﺎك اﻷﻋﺮاض ﺑﻌﺪﯾﻦ ﯾﺴﺄل ﻣﺘﻰ ﺗﻘﻮﻟﯿﻦ ﻫﺬا رﺳﻚ او دﻣﻨﺸﯿﺎ ؟‬
Word finding difficult
Memory loss
‫ﻣﺎﯾﻘﺪرﯾﻘﺮأ ﺟﺮﯾﺪة اﻇﻦ‬

117. Pt HTN , DM , HF came for hystrectomy , give NS before the operation due to
decrease oral intake , after operation she have respiratory distress and crackles , how u
will prevent this complications ?
Fiursmide 40 mg after operation 1 day
assessment of fluid status

118.The prevalence of the disease affect which value?

Sensitivity
Specificity
Likelihood ratio
Predictive value​ (i think that the correct one)

119.Breast > Phylloid tumer >​ WLE

120.Patient came to your clinic has COPD and refused to stop smoking what should you
tell him
Motivation him to stop
Call his family
Tell him not to come again

121.Case with low TSH , Low t3 . High t4

122. alot of chron’s cases

123. pregnant lady with chrons
Avoid mtx
alot of cases woth COPD

124. Rh positive parter when to al Rh negative pregnant lady when to give ? Or don’t give
? ​Give Rh if mother negativve and husband positive

125. Crone’s dis common site of gi ?

Jujnum
Ilum
Colon
Cecum

126.13 female short stature , ammenorrhea , broughted by her moum concering aboute
that her daughter disn’t develop pubic hair and breast ? Where is the problem?
hormonal problem
Constitustinal

127. adult male hx with fever , he is recently came back from South Africa, asking about
organism ?
Dengue or malaria

128 pregnant lady 10 wk ga , she developed last month manifistaion of flare up of

cholesetitis, planed for cholestectomy , when shouled go surgery ?
immediately
After delivery by somthing weeks.
delay to 2nd trimester

129. 32 y.o female develop left leg swelling with no risk factors of DVT + blue
discolotaion of her right leg , asking about best investigation ?
Venous doppler us
Arterial doppler
- Conventional angiography
- Something i didn’t recall

130.Breast cancer risk factor:

Early menarche
Late menopause
Age
Dely pregnency after 30
131. what is the most important characteristic of screening test for cancer ?
cheap
High sensitive
High specific
Fast result or somthing like that

132.ovarain cancer high grade treatment:

Surgery
Chemotherapy
surgery then chemo
surgery them radation

133.pap smear (screening) every?

by years (1 or 2 or 3 or..
At 21yrs , every 3 years

134.Child ate supplement pills 2 hrs ago now vomiting diarrhea abdominal pain. Vomitus
was black in color what does he have?
hypervitaminosis
iron toxicity
Hyperprotien

135. 2 months old child brought to ER with active seizure for > 5min he is already on
cardiac monitor and line access. History of febrile illness since 2 days now Temp 39.7
how to manage:
oral diazepam
IM diazepam
rectal diazepam
IV Lorazepam

136.Strawberry appearances in cervix —​>​Trichomonas

137. Preterm wt 1.7 kg when to give vaccinations > ​give all but delay HepB till 2kg

138.guillain barre syndrome prognosis in respirtory muscle :

Comblete recovery
Respirtory failure
Paralysis

139.Female é PPH give OXYTOCIN and UTRINE MASSAGE not stope nexte step:
B lanch sutcure
utrine artery ligation
hystroectomy
‫ﺷﻲ ﯾﻨﻌﻤﻞ ﻓﻲ اﻻرﺗﺮي ﻧﺎﺳﯿﻪ‬

140.most common TB drug causing hyperurcemia >​> ​pyrazinmide

141.Bilatral vaicosevain treatment?

sclerotheraby
ligation and elevat
endovascular ablasion

142. indicator of ovulation

High progesterone
High LH
N.B: 21 day progesterone Or high urinary LH
143.low in post operative :
Insulin
Gluconge

144. Pedia fracture 30% anterior angulation:

Traction and bed wrist
Closed reduction and IMnail
Closed reduction And screw

145. male , highest risk factor:

BMI more than 31
Waist circumference 100

146.most common risk in female:

diet
smoking
physical inactivity

147.Female smoker for 3 years + Hx of infertility + family Hx of diabetes ..

what is the highest risk ?
-smoking
-infertility
- family Hx of diabetes

148. GCS ( eye with painful stimulus, body movement with painful stimulus, noises )
1-5
2-6
3-7
4-8
149. PPH uterine massage done and bleeding not stop
1- b lynch suture
2- uterine artery ligation
Other choices?

150. patient started on oxacillin and don culture first one was gram+ve coocus and gram
-ve coccus after 3 days culture change and become staphylococcus resistant how will
you manage ?
1- add genta
2- start vanco
3- cont. oxacillin

151.2 months old child brought to ER with active seizure for > 5min he is already on
cardiac monitor and line access. History of febrile illness since 2 days now Temp 39.7
how to manage:
- oral diazepam
- IM diazepam
- rectal diazepam
- IV Lorazepam

152.traveller to southsaudi what prophylaxis ?

atovaquine/progunail
mefloquine

153.Menopause have itching in vulvua and bleeding after duration she have pea like size
,DX ?
Vulvula carcinoma
Bartholin cycte

154.Pt DX with MS >> have acute attack of diplopia , weakness , ..... sumptmes of MS ,
what’s the max ?
- iv steroid
- interferon
- oral steroid

155.Pt with Tuburus sclerosis , asking about ‫ﺷﻲ ﺑﺎﻟﺠﯿﻨﺎت ﻧﺴﯿﺖ واﷲ‬
- single gene
- multiple gene
-
156. Which one of these is the most appropriate mesh type for ventral hernia?
A. Inlay
B. Onlay
C. Sublay
D. Underlay

157.Patient with SVT, he's stable. Which one of these will indicate dose adjustment of the
adenosine?
A. Dipyridamole
B. CKD

158. Female postpartum came to the hospital with chest pain then died suddenly what is
the most likely cause?
MI
Postpartum cardiomyopathy

159.Q/kid with IBS before school how to manage ?

Encourage Increase fruits
N.B:** not all fruits( fruits rich in fructose better to avoided ) only fruit fiber-rich , high fiber , avoid
lentis & oil **

160. Case about diabetes diet many choices ? ​I chose ​low glycemic index ​.

161.diet of pancreatitis ?​ Don’t remember choices good but there was ​low fat diet

162. Bowel obstruction Best investigation ?

Abdominal x-ray
163. admitted for ectopic after 3 weeks bhcg is platua (remains the same) ? What to do ?
admit patient for surgery again
do nothing it will go
Normal
Hysterectomy
**N.B: again if not contraindicated **

164.Patient with high fasting blood glucose and h1c 8.1 what is next:
-2h glucoses tolrance test
-random blood glucose
- h a1c after 6 weeks
N.B: start ttt
165. Mi before 6 weeks , now want to do surgery ?
Do it now
Wait till 6 months post MI
166. Pt with achlesia did dilataion then i think hemodynamics unstable , image show
leakage what mx ?
- surgical drain and repair my choise
- Esophageal injury >> endoscopic stent

167. Skin someothing irregular border came to clinic what to do ?

Excision
Bunch biopsy
Chemo
Radiatio
N.B: ​if melanoma Excisional biopsy , if not punch

168. Chest truma having pneumothorax they put a thoracostomy tube then after that
they found 2 liter of blood , mx ?
laprotomy
thoracotomy
thoracostomy

169.Female patient with mass in labia majora what is the type

squamous ?
Adenocarcinoma

170. Female patient with 5 oclock swelling ?

Bartholin ?
don’t remember

171. Around 15 years old came with his mother to the clinic with a skin lesion since
childhood , what the mx ? < that it
- radio
- follow up
- excision
N.B:if cosmotic > excision
172. ECG with senior of pericaditis , Mx ?
- Ibuprofen

173. Female sudden chest pain + throat tightness + wheezing + little relief with B.D , and
she is ok Dx ?
-asthma
- vocal cord Dysfunction

174. Doudonal perforation what to do ?

Omental patch ​…

175. Some one with gerd endoscopy shows esophagitis ?

-manometry
-nessen fundoplication
Ppi didn’t work
Most appropriate next step
**N.B:if after highest dose of ppi > nessen fund.

176. There was mass in breast with cancer ?

-simpe mastectomy
-wire localization excision ( literally written like this !)

177. Pt came to ER after cholycyctectomy , Abdominal pain and fever US show Fluid and
CBD 9 mm , what is the diagnosis
Injery to CBD
Stone CBD
‫اﻟﺒﺎﻗﻲ ﻧﺴﯿﺖ‬

178. Pt came with leg injury and there was bin deformity High caHigh PTH??
PTH adenoma
2ry hyperPTH
3ry hyperPTH

179. Pt with Left ventricular dysfunction , he is on medication statin , aspirin !! mx ? ‫وش‬

‫ ﯾﺒﻲ ﻧﻌﻄﻲ ﻟﻞ‬LVH
digoxin
ACEI
-
-
180. ‫ ﻫﺬا وش ﯾﺴﻤﻰ ؟‬، ‫اﺛﻜﺲ ﻗﺎل اﻟﺪﻛﺘﻮر ﻟﻸﻫﻞ اﻟﺤﯿﻦ ﺑﺠﻠﺲ ﻣﻌﻜﻢ وﺑﻘﻮﻟﻜﻢ اﻟﺘﺸﺨﯿﺺ واﻟﺒﺮﻗﻨﻮزز وﺑﻌﺪه اﺳﺘﻘﺒﻞ أﺳﺌﻠﺘﻜﻢ واﺟﺎوﺑﻜﻢ‬
‫اﻟﺨﯿﺎرات‬
- improving communication
- give information care
-
-
181. the risk of smokers to get lung cancer in percentage:
10?
15
5
** N.B: 15-30
182. Drug you can give in pt with CKD stage 3
-Nitrofurantion
-Metformin
-warfarin?
-lithium

183. Sinario of child withABG and hx of DKA ?​ ​Cerebral edema

184. pregnancy have fever and not seek medical advice , ?

My answer ​neglect

- ‫ ﺳﺆال ﺛﺎﻧﻲ اﯾﻜﺘﻮﺑﻚ ﺑﺮﯾﻘﻨﯿﻨﺴﻲ وﻗﺎل ﺟﺖ ﻟﻠﻤﺴﺘﺸﻔﻰ ﻣﻊ ﺟﯿﺮاﻧﻪ ﻻﻧﻪ زوﺟﻪ ﺷﻐﻠﻪ ﺑﻌﯿﺪ ﻣﺎﯾﻘﺪر‬،
- ​admite pt

185. SLE ‫ و‬liver mass ‫ و‬jaundice ‫ وش‬ttt

Prednisone
methotrexate

186. Pt DX with GAD diffculty sleeping , to ?

- halpiradol

**N.B: CBT, SSRI

187. Patient was having CS , and while they were closing sudden severe bleeding started
what is the cause?
Perforated ulcer
Spleenic anuerysm
Liver hemangioma

188. Pediatric age yllowish descolration + abdominal pain

Labs show high indirect bilirubin and liver enzymes high ,DX ?
Gilbert
infective heptits
-chlecystis
-pancreatis
‫اﺣﺘﺮت ﺟﻠﺒﺮت ﻗﻠﺖ ﻋﺸﺎن ان داﯾﺮﻛﺖ ﻣﺮﺗﻔﻊ‬

189. Baby with mucous vaginal discharge What is your mangment !

reassurance
190. Pt wih mechinui intubated developed respiratiry distress
-Inhaled nitruc oxide
-surfctan lavage

191. female with breech oresntation and bicirnat utrus

- cs
- ventou
-spontaneous

192. - pt with pain with mensturation with bulky tender uterus

​- adenomyosis
- endometriosis

193. - paediatric throwing games and irrsbectful behaviors

A- time out
B- verbalthreat
C- spank

194. pt diagnosed with brichiactasis how to tell him about the diagnose
A- show him the report
B- tell him he has bronchiactasi
C- explain hr has damaged alveolar with infection

195. pt with heart failure echo showed constrective hyoetrphic left ventricle
A- diastolic heart failure ventricura hypetroph
B- restrictive cardiomyopath
C- pericarditis

196. pt fully dilated for 2 hr, head in station - 2, pt got exhusted from pushing
A- cs
B- wait 2 hours
C- ventous

197. indication of instrumental deliver pt with rhumatic feve and mitral stenosis , with hx
of herpis 1 year ago:
A- mitral stenis
B- herip

198. Vaccin cintraindicated in pregnancy

A- zooster
B-hep B
C- meningo cocal

199. most comon site for metastasis of lcolonic carcinoma

A- liver
B- lung
C- prostat
200. pt well controlled diabetic by exercise and metfirmin with normal Ha1c, only has
three reading if bp 149/90
A- continue the same measures
B- add ACEI

201. what effect the function of clopidegril

A-warfarin
B- SSRI
C-omebrazole

211. Pt with history if icu admission and intubation 1 week ago with thyroid mass, tsh low
slightly t3 low t4 normal
A-subclinical thyrodiitis
B-sick euthyroid

212. Pt swith hystory of antibiotics now with abdominal distention, invest:

A-c defecil tixins in stool
B- uooer endoscopy
C- lowe endoscopy

213. Pt with vaginal bleeding and absent fetal movement, next step:
A-us
B- addmission to ward
C- discharge

214.Pt post cholystectomy with fever sign of atlactesis and fluid collection at tge site of
gall bladder​:
A- chest physiotherapy
B- percutaneous drainage

215.Pt come with brother with irritability, shouting on people and take pause between the
sentance
A-alzahaimar
B-frontotemporal dementia

216. Pt post mva consiouse then in the ambukane lost consciousness and dilated pupil
A- subdural hematoma
B- fracture base
C-rupture anurysm
d-Epidural hematoma
217. Pt worride and want to do hystrectom and go br admited
A- admit her to gain her confidence
B-calm her down and duscyss her options
218. indicate of severity of asthma
-​ RR > 25 >

219. Pt have only mild pain with Pancreatic Psudocyct

‫ﻣﺎﺟﺎﺑﻮا اﻟﻔﺘﺮه وﻻ ﺣﺠﻢ اﻟﺴﯿﺴﺖ وﯾﻘﻮل ﻟﻚ وش ﺗﺴﻮﯾﻦ ﻟﻪ ؟‬
-Excision cyst
- observe
-laproscopic drain
- percutuse drain
N.B: Endoscopic if not in choices > percutanous

220. #limb sarcoma :type of biopsy ?

Core biopsy
Excisional biopsy
221.Pt with HTN ,Tx?
CCB‫اﺧﺘﺮت‬
BB
ACEI
**N.B: Depends on comorbidities
222.Percentage of smokers in KSA
A. 21%
B. 37%
C ???
D ???
**N.B : >21
223. 15 y o pt with (acute meningitis) and u want to take LP, from whom u will take
consent?
A. Consent from parents
B. From pt
C. From both
D. No need to take consent cuz it’s emergency

224. When to do lap cholecystitis in pregnancy?

A. now
B. 1st trimester
C​. 2nd
D. After delivery

225. Bt with painless jaundice and high direct bilirubin and total bilirubin
A pancreatic cancer
B. Acute cholecystits
C. Hepatitis
D ?????

226. Pregnant physician has a preterm baby with multiple congenital anomalies and she
asked not to resuscitate her baby, what will u do?

A. Respect
B. Refuse her request and resuscitate
C…

227.Complication of pharyngitis?
Scarlet fever
Glomerulonephritis

228. Barking cough (croup) diagnosed ?

-Clinical
-pharyngeal swab

229. Someone traveled to Africa came paralyzed?

- polio
-corona
-ebola

230.pt came with recurrent sinusitis and infertility(‫ ﻓﯿﻪ ﻣﺸﻜﻠﻪ‬sperm)‫؟‬

Cystic fibrosis
Kartegnar syndrom

231.Hx of gastritis after That developed neurological symptoms , mx ?

- IVIG
- plasma exchange
232.Hx of viral miningtis of a child ask about the organism ?
- rota virus
- adenovirus
- rhinovurus
- Entero virus
233: ‫ ﻣﺮﯾﺾ ﺟﺎء ب‬ITP ‫اﻟﻤﻨﺠﻤﻨﺖ؟‬
Splenectomy
Prednisone
**N.B: if adult > prednisone
‫ ﻣﺎﻛﺎن ﺑﺎﻟﺨﯿﺎرات‬IgIG

234.Pt have VSD 2mm ,mx ?

- watchful and waiting

235.: Short stature with classic presentation of turner 1ry amenorrhea webbed neck What
causes her short height ?
-endocrine syndrom
-chromosomal syndrome
-constutional
-familial
236.Question the said egg on string , wt pt have ?
- TGA
237. Long seniario (leed pipe ) with type of colitis ?
- ulcertive colitis

238.Pt have prurtis + jundice +I think they mention something about ULcrtive colitis , DX
?
- primary sclerosing chlonigitis

239. ‫ اﻣﻪ ﺟﺎﯾﻪ ﺗﺸﻜﻲ ﻣﻦ ﻗﺼﺮ ﻗﺎﻣﺘﻪ ؟ ﺑﺎﻟﺘﺤﺎﻟﯿﻞ ﻛﻞ ﺷﻲ ﻃﺒﯿﻌﻲ ﺣﺘﻰ‬٩ ‫ ﻃﻔﻞ ﻋﻤﺮه‬GH ..
‫ﻣﺎﻋﺪا‬
Insulin-Like Growth Factor ‫ وﯾﺴﺄل وش اﻟﺴﺒﺐ ؟ ﺻﺮاﺣﻪ اﺣﺘﺮت‬: ‫ ﻣﺎﺟﺎب ﻃﺎري اﻻﺑﻮﯾﻦ وﻃﻮﻟﻬﻢ‬.. ‫ﻛﺎن ﻧﺎزل‬
Constitutional
Familie
Hormonal

240. Marfan syndrom classic presentaion ?​ What investigation would like to assess?
trans esophageal echocardiography
xray
ct
241. Pt have fx and absent distal pulse , mx ?
K wire
elevation of the leg
Fasciotomy
** N.B: if ask about Next step >> Elevation of leg
242. DM pr with poor healing ulcer , cause ?
- ​decrease blood supply

243. Pt have fracture and absent pulse , mx ?

K wire
elevation
Exploration

234. Pt have macroorchidism , joint laxity , ear larg , cognitive disability ?

Fragile x syndrome
235. Sings of turner ask about diagnosis ?
Kerotyping

236. Antiphosophlipd syndrome >​ reccurent miscarriage

237. Dm and htn presented with leg swelling to the er , previously came with leg pain
when walking 300m , after examination bilateral absent distal pulse ? Most appropriate
next step?
-venous us
-ct angiogram
-MRA
-Catheter

238. What is the cause of IUGR ?

GDM
Oligo
Poly

239.Deep thigh pain + morning stiffness + pain at night preven from sleeping
osteoarthritis
osteomyelitis
osteoporosis

240. Old pt with kidney disease they give him contrast

acute tubular necrosis

241.tracheomalacia diagnosis by ‫؟‬

Bronchoscope

242. TB pt have red urine ?

I chose side effect medication
Rifampine

243‫ﺟﺎء ﻛﻤﺎن اﯾﺶ اﻛﺜﺮ ﺷﻲ ﯾﻤﯿﺰ اﻟﺪوان ﺳﻨﺪروم‬.

Hypotonia
Palm crease
**N.B: Single palmar creases as unique feature
Hypotonia as most common abnormality
244.
‫ ﻛﻤﺎن ﺟﺎﯾﺐ ﻣﺠﻤﻮﻋﻪ ادوﯾﻪ واﯾﺖ واﺣﺪ‬leukotriene receptor antagonists medications list
‫​ ﻃﺒﻌﺎ اﻟﺠﻮاب‬montelukast​?????
245.
‫ ﺟﺎء ﺑﯿﺸﻨﺖ ﯾﺎﺧﺬ‬clopidogrel ‫اي ﻣﻦ اﻻدوﯾﻪ ﯾﻘﻠﻞ ﻣﻔﻌﻮﻟﻪ‬
Beta bloker
Warfarin
Digoxin
Omeprazole

246. ‫ اي دواء ﯾﻘﻠﻞ‬mortalty in CHF ‫ﻃﺒﺒﻌﺎ اﻟﺤﻮاب‬

ACEi

247. Pt came with knee swelling and erythema, cannot moves it +uveitis..
‫ ﻋﻤﻞ ﺗﺤﻠﯿﻞ ﻟﻞ‬ANA -ve
What we do with uveitis ?
-Follow up
-Ophthalmologist
**N.B: if -ve every 6 months

248.Hand fists and crossed legs?

Spastic Cerebral palsy

249.Patient recieved vericella vaccine only one dose , and he didnt continue? What to
do?
- Give him 2nd dose
- Check antibody

250.Brucellosis duration of treatment?

6wks Doxycycline +rifampine ,
If neurobrucelosis > 6m -12months until CSF clears up
251.Patient with petrussis , his brothers where in contact with him ( not sure if they are
vaccinated or not) what to do?
- Observe
- Vaccinate them
- Dont do anything
- Abx

252.Child with projectile vomiting what to start?

- NS
- NACL
- RL

253.Lady with mitral stenosis , asthma and herpes the doctor did forceps delivery
Why did the doctor do forceps ?

Because of mitral stenosis

254.Patient with polymyalgia rheumatica, have hematological changes like raised

lymphocytes count ​—> ask about associated diseases: it was​ CLL​

255.Elderly patient with pulstile epigastric mass feels in deep palpation, what you will
order in lab? ​Answer: ​Amylase ​

256.Tea colored urine + lower limb rash + malar rash + RBC cast in urine, what is your
diagnosis? ​—> ​Lupus nephritis ​

257.Patient with history of recurrent lower abdominal pain presented with perihepatic
adhesion, what is the causative organism?
Chlamydia

258. Female after 2 weeks of hernia repair come with discharge + exposed mesh .. how
you will manage ?
A) Antibiotics
B) Anticoagulant
C) daily dressing
D) explore and open wound with daily dressing without remove the mesh
Note: If there were an option to expose and remove the mesh, it would be more appropriate.

259. (Age not dictated properly) __ y/o, male, RTA; presented with Raised JVP, decreased
tactile fremitus on the left side of the chest, and decreased breath sounds; patient was
unconscious. What’s your immediate step​?
A) Thoracostomy
B) Thoracotomy
C) Needle thoracocentesis (i guess this)
D) pericardiocentesis
260. Indian man came for Hajj; presented with intermittent fever, drowsiness, abdominal
pain, nausea and vomiting what’s the most likely diagnosis?
A) malaria
B) yellow fever

261. A patient with vegetation presented with back pain and fever. Onexamination, there
is tenderness and signs of sacroiliitis, what’s your diagnosis?
A) TB
B) Brucellosis

262. 55 years man with symptoms of meningitis, what's the commonest organism?
A. S. Pneumonia ​

263. Mumps usually affect which organ in the children?

A) Liver
B) lung
C) parotid

264. Patient admitted for pyelonephritis; developed DVT. How we will prevent PE ?
A) Enoxaparin
B) warfarin and aspirin
C) IVC filter
Note:
Stable pt without renal insufficiency: LMWH or fondaparinux
Renal failure pts OR pts that still require thrombolysis: UFH
265. case of clear Testicular Torsion, what’s your next step?
A) US
B) Surgical exploration

266. At the age of 1 year, what’s the vaccine that should be taken?
A) PCV, OPV, MMR, MCV4
B) Hepatitis A
C) Hib, MMR, dtab, Varicella

267. Pt had angiography leg >> then developed a mass below inguinal ligament , partially
movable, irreducible and pulsatile:
A) Saphena varix
B) Pseudoaneurysm
C) Femoral hernia

268.What prevents variceal bleeding and its recurrence ?

A. Nadalol

269. Down syndrome pt. with splitting 2nd Heart sound ?

A. ASD
Note:
VSD: ​pansystolic murmur at left lower sternal border
ASD​: wide fixed split S2
PDA: ​continuous machine-like murmur
Mitral stenosis:​ mid-diastolic murmur, best heard at the apex
Mitral regurg: ​holosystolic murmur; Hyperdynamic apex beat displaced laterally & inferiorly; left
parasternal heave due to left atrial expansion; S3; murmur radiates to axilla; ↑ with grip
Aortic stenosis: ​crescendo-decrescendo systolic murmur at the aortic area; radiating to the
neck
Coarctation of aorta​: systolic murmur at left 2nd intercostal space; radiates to the back

270. Pt. with cystocele. What is the investigation?

A. Speculum

271. 65 yr asymptomatic pt with severe aortic stenosis + normal EF ? Mx ?

Note:
Management of severe AS in asymptomatic pt:
1st line: ​Clinical and echo f/u or ​referral to surgery
Surgical referral indicated when
- EF < 50%
- Undergoing other cardiac procedures/surgeries (e.g. CABG or other valvular surgery)
 - AHA: ↓ exercise tolerance and/or exercise-induced ↓ in bp
If the pt doesn’t undergo surgery, then ​echo every 6-12 months + regular clinical follow-up.

272. Child with Down syndrome; what is the most striking feature ?
A. simian crease
B. hypotonia
C. Small toe

273. 22 YO, female, complaining of breast pain before menstruation; on examination

there is no mass. She wishes to get pregnant. What’s your next step ?
A) Breast US
B) CT
C) Pap smear

274. 3 years old Down syndrome child came to your clinic. How to assess him?
A) individualize chart
B) Down syndrome chart
C) normal chart

275. Newborn presented with his mother; about to take vaccine. Mother is concerned
because her previous child died and she is not sure of the cause but thinks it was due to
immunodeficiency. What is the appropriate action regarding her newborn’s vaccine now?
- give HBV only
- stop all vaccines for now until immunology team do the work up
- take the usual vaccine for his age then do immunology workup

276. Long case of female child with pubic hair growth ONLY no axillary hair, normal
looking genitalia and no breast buds. other examination was normal. What is the
diagnosis?
- pre adrenarche
- precocious puberty
- primary adrenal hyperplasia

277. For how long is the immunity of pertussis vaccine?

- lifelong
- need a booster after 5 years
- need booster after 10 years
Note: Disease >> 20 years; Vaccine >> 10 years

278. Which of the following drugs did malaria become resistant to?
- mefloquine
- chloroquine
- primaquine
279. Seizure patient came with shoulder pain.. what type of dislocation?
- posterior dislocation

280. Long case .. and the question: what is the most common cause of death in
hospitalized patients ?
- MI
- PE
- stroke
Note: not sure

281. Gentleman with high grade fever chest pain pleural tap reveals ph < 7 Dx:
. Pneumonia
. Empyema
. Tuberculous effusion
. Malignancy

282. pediatric pt came for the next visit of vaccine; the mother said he have redness and
swelling from the last time he received his vaccines; what is your action ?
- give him
-defer DTP

283 .Another with laparotomy > they found intraperitoneal fluid K+ of 6.6; what to give ?
A- Iv fluid
B- IV Insulin with dextrose
Note: Calcium gluconate

284. Neonate with purulent discharge from his ear , tympanic membrane was immobile,
baby is exclusively breastfeeding, not using a pacifier ?
A- Observe & follow up 48 hr
B- ENT referral for possible tube insertion
Note:
If > 6 mo old: reassess after 24-48 h
If < 6 mo old: give abx (amoxicillin)
If > 6 mo w/ suspected AOM: abx
If effusion w/ recurrent infections: ENT referral for myringotomy or tympanostomy tube

285. infant with congenital hypothyroidism. What to give?

A- Thyroxine for life
B- thyroxine for 1m
286. post menopause women ?
A. LH
B. FSH
C. Estrogen
D. Progesterone

287. - Pregnant pt. came with sx of asthma what to do?

A. Spirometry
B. CXR

288. 22 YO, female, complaining of breast pain before menstruation, in examination there
is no mass; She wishes to conceive. What’s your next step ?
A) Breast US
B) CT
C) Pap smear

289. Asymptomatic pt with irregular cervical polyps, your next step?

A) Polyps excision at the clinic (i guess)
B) pap smear
C) HBV

290. Baby present to ER with DKA; after IV fluids, patient went comatose (sign of brain
edema); what’s the correct way to resuscitate DKA patient with fluid deficit ?
A) Fluid resuscitation in 24 hour
B) 6 hours
C) 12 hours
Note: Fluid resuscitation in 24 h; electrolyte replacement in 48 h (especially Na)

291. Most common cause of vulvar cancer ?

- adenocarcinoma
- SCC

292.What Is the lie of the fetus ?

A. Longitudinal
B. Complete
C. Incomplete
D. Frank

293. What are the contraindications of;

● propofol
● Nitrous oxide
● Ketamine
Note: self study
294. Pt wearing revealing clothing + talks in seductive way and the nurse doesn’t speak
her language
A. bring a nurse who speak the same language​

295. MOA of metformin in PCOS

A. Decreases insulin resistance

296. Endometrial hyperplasia with atypia + menopause ,MX ?

- oral progesterone
- hysterectomy

297. Pregnant pt , fetus died and she is going through AP + DIC , cervix dilated 6 cm ,
your next mx ?
- vaginal delivery
- CS
- total abdominal hysterectomy
Note:
No DIC present: ​Delivery must be deferred for a number of days to allow for an appropriate
grief response to begin.
Or if the pt wishes conservative management, follow weekly serial DIC lab tests.
90% of pts start spontaneous labor after 2 weeks.
Mode of delivery:
- If < 23 wks + no fetal autopsy indicated: D & E
- If ≥ 23 weeks: IOL w/ vaginal prostaglandin

****​CS IS ALMOST NEVER APPROPRIATE FOR DEAD FETUS*****

298. Calculate maintenance of 18 KG

A. 56

299.Infertility with Tubal blockage:

-tell wife
- husband
- both

300. Refuse CS with risk of fetus death

- VD
- refer to another doc
- hospital committee
301. Which one of these is the most appropriate mesh type for ventral hernia?
A. Inlay
B. Onlay
C. Sublay
D. Underlay

302. Trauma with seatbelt injury, CT was done, what do you expect to see?
A. Stomach perforation
B. Duodenal perforation
C. Isolated jejunum outblow

303. Patient with SVT, he's stable. Which one of these will indicate dose adjustment for
the adenosine?
A. Dipyridamole
B. CKD

304. Patient with exertional dyspnea and syncope. Was found to have aortic stenosis
40%. What to do?
A. Diuretics
B. Control blood pressure
C. Aortic valve replacement
D. Valvuloplasty
Note: Balloon valvuloplasty in children; and VR in elderly.

305. 16 year old girl with irregular menstrual cycle. She was uncomfortable and agitated.
What is her problem?
A. Mood
B. Behavioral

306. ICU patient developed cholecystitis. What's your management?

A. Cholecystectomy

307. Down syndrome what will you find ?

A. High bHCG
B. High inhibin
Note: Low AFP; Low estriol; High bHCG; high inhibin A.

308.Which of the following less likely be a cause of down syndrome:

A. -mosaicism
B. -Translocation
C. -Meiosis disjunction
D. -Meiosis non junction
309. Esophagus; high grade dysplasia?
A. Refer for resection

310.Which of the following is a common cause of vomiting in infant:

A. -celiac disease
B. -cyclical vomiting syndrome
C. -other options

311. Mother presents her infant who is vomiting between meals; worried for her infant ,
examination unremarkable , DX?

312.infant vomiting , everything is normal mx ?

A. Tell the mother elevate head after meal

313.When to say infant ?

A. - less than 1 year
B. - less than 1 month
C. - 2 year

314. Female pt with Cushing symptoms and Signs

Labs: low cortisol at 8 am
ACTH: normal , DX?
A. ectopic ACTH
B. Cushing syndrome

315.Most common heart anomaly in down syndrome?

A. AVSD

316.What is the Brucellosis and neurobrucellosis treatment?

Note:
If brucellosis: 6-8 wks
Neurobrucellosis: 6 mo

317.Ttt of migraine headache

A. Sumatriptan
Note: mild = NSAIDs; severe= -triptan

317. 9 months child brought by his parent; complain of umbilical hernia which is
increasing when he’s crying and disappear when he’s sleeping,
What’s your next step in management?
A. follow up & delay surgery until 3- 6 years
B. do immediate surgery
318. CKD patient wants to avoid high potassium food , what to avoid?
A. Tomatoes
B. Green beans

319.what is the metabolic abnormality in diarrhea

A. ​metabolic acidosis ​

320. what is the gross motor of 6 month old baby?

A. -rolls from prone to supine
B. -rolls from supine to prone
C. -sit with support

321. child with signs of Cushing and question asked what is the diagnostic modality?
A. -pelvic US
B. -MRI brain
C. -Can recall the other 2 options
From editors:
midnight salivary cortisol level + low dose dexamethasone suppression test

322. case of an adult pt. With cushing; with the labs of ACTH and suppression test and
asking about the modality to diagnose? Read about the test to know the cause is it brain
or adrenal …
A. -brain MRR
B. -Abdominal CT
Note:
If ACTH high + not suppressed after high-dose dexamethasone >> suspect ectopic; do chest
CT
If ACTH high + suppressed after high dose dexamethasone >> pit. Adenoma; do brain MRI

323. 5-8 m old baby boy came with fever and vomiting; diagnosed with UTI; what is the
most likely option that goes with him having UTI?
A. -male gender
B. -age
C. -fever

324. case of HELLP syndrome asking the diagnosis?

325. Down syndrome pt asking about vaccinations schedule

A. - delay all live vaccines
B. - delay Dtap
C. - Give IPV instead of OPV
326. Elderly pt with HF and elective Hernia repair:
A. - do Surgery after optimization of his condition
B. - do Surgery when hernia is obstructed

327. Child with resp distress:

A. pH low
B. CO2 normal
C. Bicarb normal
D. O2 low

328. Pregnant with HF sx ( SOB, LL edema, lung crepitations​)

A. viral myocarditis
B. Peripartum cardiomyopathy

329.50 yo severe Retrosternal chest pain since 2 weeks, pain on and off for short periods
A. Anxiety
B. MI
C. GERD
D. Pancreatitis

330.parapneumonic pleural effusion case, indication if thoracostomy drainage

1. 80% PMNs
2. Glucose <60

331. Pt with echolalia, echopraxia and mood changes

Treatment?
Note: ​benzodiazepine (ddx: catatonia)

332.Most common site of basal cell cancer

A. Face

333.most common site for ERCP injury

A. Pancreas

334.Old pt with parkinsonism and gait disturbance and cognitive dysfunction and visual
hallucination…
A. Lewy body dementia

335.Case of hiatal hernia what is the most important treatment?

A. Surgery
B. PPI
C. Weight loss
Note: unsure
336.Case of some one uee PPI no symptoms stop it symptomatic what is the
managemen​t?
A. Give the same PPI

337.What makes the stool color black; he is on H.pylori meds I think asking which one of
the meds causes this?
A. Bismuth

338. Sigmoid volvulus management?

A. Rectal tube followed by elective surgery (resection)

339. what is the nerve supply in upper lip?

A. Infraorbital

340. what is the lymph drainage of the fundus of the uterus?

A. Para-aortic

341.Case of varicose vein asking about Tx

A-endothermal ablation
B-sclerotherapy
Note: if bilateral, A. If unilateral, B.

342.Case of CKD asking about which of the following food high in potassium ( I don’t
remember the exact scenario )
A-tomato ( my answer)
Note: Tomato; banana; spinach

343.Q about diverticular ructi > mild abdominal pain ,P/E -ve cough impulse
Note: multiparous women

344. 18 months old asymmetric breast enlargement, advanced bone age

No pubic hair or body odor
What to do :
A. Pelvic u/s
B. MRI brain
C. Chest CT
D. ACTH
345. 2 years old with breast enlargements no pubic hair or adult body odour

A. Precocious puberty
B. Central precocious Puberty
C. Premature breast enlargement
D. Premature adrenarche

346. Pt 12 h post laparotomy surgery developed 12 ml wound discharge:

A. *ABx
B. *dressing
C. *wound exploration
D. *CT abdomen
Note: 12 hrs is too early for wound infection; B is the most appropriate answer.

347.Pt after discharge came for follow up there is wound discharge what is next
A. * wound inspection
B. * Wound exploration
C. * Daily dressing
D. * CT abdomen

348. 2 months old with large tongue and other signs of hypothyroidism and family history
of autoimmune diseases
Labs show : hypothyroidism
what to do ?
A. *thyroxine for 1 months
B. *lifelong thyroxine
C. *asses after 1 month
Note: thyroxine for 1 mo and then assess TSH

349.UC Colitis most common part affected?

A. Rectum

-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------
 Pictures in the exam:
● Late deceleration —> placenta insuficency
● Inferior MI ECG
● CTG pics with the same scenario with all types
● Melasma
● Iron deficiency anemia (nails)
● Normal CTG —> Reassuring
● Impetigo

Topics to read:
● Vaccinations
● case of heart block
● many cases of abortion
● the next step in case of placenta previa
● cases ectopic pregnancies asking about treatment
● Vit.k deficiency
● Hernia
● Croup and Epiglotitis ( management and Dx)
● Case of meningitis meds what is the antibiotics?
● Breach prensntaion
● Hypoxic resp failure
● Hyparcapnic resp failure
● Hypocapnic resp failure
● Neuro resp failure
● GERD
● physiology
● esophagus reflex
● pyloric stenosis
● ‫وﻣﺘﻰ ﯾﻘﻮﻟﻮن‬
● types of shock Parkland formula, maintenance , deficit calculation