SMLE 2019

EXTRA AUGUST
Melody Blue August Collection
Last Updated 23 August [11:25 PM]
[This file will no longer be updated]
 Validated and double checked questions

RTA patient, hypotensive normal air entry with distant heart sounds.
x-ray multiple rib fractures and wide mediastinum. Dx?
• fat embolism.
• Cardiac tamponad

Beck’s triad: Hypotension, Muffled heart sounds and JVP

RTA patient with blood on urethral meatus. What will you do initially?
Cysturtherogram done.
• suprapubic cath.

Blood in urethral meatus indicates a urethral injury, so Foley catheter is contraindicated and we
go for suprapubic cathter

pt with a fib, treatment?

- Warfarin 2-3
- Warfarin 3-4

old patient with CHF and polymyalgia rheumatica. His labs are
High wbc, high lymphocytes otherwise normal. Dx?
- lymphoma.
- viral illness.
- CLL

Could be B or C, the clinical scenario lacks any additional information and many of CLL
patients are asymptomatic and diagnosed accidentally. So C is the most suitable answer.

- CSF findings of high lymphocyte and low glucose? Tb meningitis

- Schistosoma lead to? Pulmonary HTN

- Anal fistula in a pt with crohn’s disease what Abx to give?

Metroniadazole and Ciprofloxacin

BMJ

- Knee Swelling what Abx to give => Vancomycin

Incomplete Q but in general if this is about Septic arthritis empirical therapy the answer is
Vancomycin and Ceftriaxone.
Vancomycin for G+ve and Ceftriaxone for G-ve.
BMJ

- Obstructive sleep apnea? CPAP

Incomplete question, but in general CPAP is the first line treatment of most patients. “in case if
there is no anatomical lesions”

- Comminuted fracture tibia, posterior compartment pressure 35, what’s your management?
External fixing with leg elevation
internal fixation with leg elevation
Fasciotomy with leg elevation

I assumed this is a Tibial shaft fracture “since its the most common”
Comminuted Fracture is an indication for IM nailing, and compartment pressure is high so you
have to do fasciotomy.
 Orthobullets

- pt with UTI and right knee pain and left ankle pain, what treatment to give?
Question is not clear, but I think it’s a case of Reactive arthritis?
Treatment is NSAIDS 1st line and steroids 2nd line
For chronic cases go for DMARDs like Slufasalazine.

- facial palsy two cases:

first asking for the involved nerve? Facial nerve
second asking for treatment in pt came w/n 1 hour? corticosteroid

- post ERCP pt RUQ pain and vomiting, what of the following would decrease mortality?
IV fluid
Abx

Fluid is the correct answer, it is an essential part of the management and since patient is vomiting
you have to replace this lost fluid.

- 32 years female with bloody discharge from nipple next step?

mammogram
US
 BMJ

- pt with controlled hypothyroidism, asking about the dose during pregnancy?

Increase
continue same dose

in General its guided by TSH, in most cases you’ll increase it during pregnancy and measure
TSH every 4-6 weeks.

https://www.aafp.org/afp/2014/0215/p273.html

- most specific indictor for graves? Exophthalmos

They mean what the feature that can tells you this is Graves disease?
Pt with hx. Of retinal detachment surgery 7 day ago and he is going into surgery, whats used to
prevent DVT?
Enoxaparine
Pneumatic
mixed pneumatic and enoxaparine
aspirin

Pt with left Lateral neck mass on third triangle just below angle of
mandible, U/S thyroid normal and positive cervical lymph node
enlargement.
FNA: shows follicular thyroid cells. dx?
•- thyroid carcinoma
•- ectopic thyroid gland
•- apparent thyroid gland
•- thyroglossal cyst

I’ve asked R4 IM and confirmed this answer

Patient needed CS for her baby, and you tried to convince her, but she
refused, what will you do?
- Respect.
- Do SC.
- Consent from father.
Its her body she have the right to refuse, you cannot make an incision w/o her approval.

Patient needed CS for her baby, and you tried to convince her, but she
refused, what will you do?
- Respect.
- Do SC.
- Consent from father.

Its her body she have the right to refuse, you cannot make an incision w/o her approval.

- patien after MVA in ER with 2 ribs fractured and paradoxical chest movement how to manage :
-chest tube
-needle decompression

Incomplete Q, either can be done according to the scenario and patient presentation.

Abdominal X ray,, not sure if "NO free air underdiaphragm" or "No air fluid level"
‫ﺑﺲ اﻟﺰﺑﺪة اﻧﮫ طﺒﯿﻌﻲ‬
Next step:

Amylase
ABG
measure Ca
Measure Cl

Incomplete Q, but similar came before and asked about Ransons criteria? If this is the same here
answer is Calcium.
Double check it please
# 30 female smoker, subfertilty,
what is the risk factor??
- smoking
- subfertility

Similar Q came before it was about Endometrial Ca.

BMJ classifies subfertility as a strong risk factor, and they didn’t mention anything about
smoking. Not 100% sure, please ask OBGYN consultants if possible.

18 month baby the nurse noted he didn't receive vaccin the parents say "vaccine bad for boy
brain"
What to do?
- tell him about the benefit of vaccin.✅

Female with lower abdominal pain "bhcg was 2600" give her sc methotrexate after 1 week "bhcg
is 6500" wht ??
- salpingiostomy
- salpingioectomy
- continuou methotrexate
- ocp

Since medical treatment fail we go for surgery either Salpingectomy or Salpigiostomy.

If ruptures ectopic pregnancy, HD instability or the tube is severly damaged go for
Salpingectomy.
If the patient want to preserve her fertility go for Salpingiostomy.
IMO A is the most suitable answer here
“much more details is included in the choice between the two, but this is in general”

32 year old female on OCP for 12 years, developed gradual RUQ pain , CT was ordered, Hepatic
adenoma 5 cm diagnosed, how to manage ?
- stop OCP ✅
- Excision
- left hhepatectomy-
- liver transplant

#Child his older brother died sudden cardiac death when he go to work???!
_ pda
_ vsd
_ asd
_ hypertrophic cardiomyopathy ✅

18 month left knee swelling redness refuse to stand on her leg what is the next appropriate
investigation ??
- X-ray to left knee
- CBC
- Reassure
- Aspiration✅

If this is Septic arthritis, yes do Aspiration first. Xray is done only for baseline
management.

# HIV female pregnant on medication came and went advice ??

- Tell her the the medication don’t prevent transmitted.
- CS prevent transmitted✅
- She can can do breast feeding

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428890/
Note: make sure to see the last choice on the exam

# 76 man dignosis septic arthritis in knee joint, aspiration of joint done , the start antibiotics I
forget name of antibiotics” after 3 day result come from microbiologi that show staphylococcus
aureus resistant to cefoxitin, what the next step??!
- add gentamycin
- Start vancomycin
- Joint wash
-

This is case of MRSA, so we start Vancomycin.

1-Pt with malar rash with photosensitivity and artharlagia ,what test is used to confirm the DDx?
A – ANA B-DsDNA C- RF

It’s the most specific

2- PT developed facial and tongue swelling after Anti HTN medication?

A – Ranilapri. B- Bisoprolol

Angioedema is one of ACEI side effects

3- Long scenario about pt came with Sx of DKA what type of insulin you will give?
A – according to sliding scale B- Fixed rate Iv infusion C- insulin BID
4- Pt known case of Rheumatoid Arthritis came with RT knee swelling and pain how will U
manage?
Methotrexate

DMARDs like Methotrexate are 1st line

5- Pt with arthritis with past Hx of UTI (Reactive arthritis)

How to manage? A -Steroid B-

Treatment is NSAIDS 1st line and steroids 2nd line

6- Pt 35 YO female her mother died with breast cancer and her sister died with ovarian cancer
,what is the best screening modality for Breast cance?
A -BRCA Gene B- Mammography C- breast self exam
7- Long case, Flat T wave on ECG what do you find in urine:
A-High potassium
B-Sodium

Can this be a case of hyperaldosterinism? So high potassium in the urine?

Not sure

8- Pt known asthmatic with Flat T wave on ECG what medication can cause that ?
A- Salbutamol B- Salmetrol
SABA It causes hypokalemia
“Salmetrol is LABA”

9- Chlid came to the ED with gastroenteritis , U discharge him home after telling him to come to
the hospital if there is warning Sx? U are doing
A – safety Netting

10- Child drinking Cow milk 3 times a day with pallor ?

IDA (No B12 in choices)

13- Late complication of meningitis:

A-Seizure
B-Hearing loss
C-Facial nerve palsy
D-Ataxia

14- Long case of ITP with plt 32 how to manage?

A - IVIG and steroid B -Plt transfusion C- plasmapheresis
Note: Please read this guideline and read the q carefully in the exam
https://emedicine.medscape.com/article/202158-guidelines#g4

If he is asymptamatic and platlets more than 30, observation is the correct answer.
15- pt is taking UFH for PE after surgery. CBC was provided with Low platelet count what to
do?
A – Continuo heparine
B- Replace with Enoxaprine
C- stop Heparien and replace it with bivalirudin (another med with same sound)

Note: it depends on the time of thrombocytopenia

Type1: in the first 2 days ( observe and continue heparin)
Type2: 4-10 days after treatment ( then choose c)

16 – Pt came URTI the he developed abdominal pain and rash DDx?

HSP

17 – Side Effect from Furosemide?

Hypokalemia
18 -Pt 55 Yo smoker and came with breathlessness DDx?
COPD

19 – Diabetic came to the ED with well demarcated Erythematous lesion on the shin ? Erysepalis

20- Pt came with retrobulbar pain headache and fever?

Dengue Fever
Not sure of this one?
21- Pt came with gait instability and urinary incontince ,he is known case of Osteoarthritis and
had cervical laminectomy after cervical degenerative myopathy what is DDx?
A -Cauda Equina B- Recurrent Cervical Myopathy

I had the same question in my exam but the patient had urinary retention. So this might
be the same question but problem in recalling it, in this scenario it could be both A or B.
Anyway the history is suggestive of B.
22- Scenario of Parkinson ds ,where is the lesion?
Substantia Nigra

23- Man came with Ptosis , after examination Ice test and other test were +ve how to manage?
Pyridostigmine
This is Myasthania gravis disease

24 – a case of macrosomic baby and Complications?

Erb's palsy

25- Pic of Chloasma gravidarum

Note that Chloasma is the same as Melasma but in pregnancy

26- Pic of urethral cruncle

27- Pt with PE and hypotensive ,management ?
Alteplase

28- Pt with UTI and high creatinine which Abx is contraindicated?

Ciprofloxacin

Its nephrotoxic so avoid it here.

29 -Most common diagnosis of Pt with Fever from Sub-Saharan region?

Malaria

In the other hand Dengue fever is common in countries in the Southeast Asian and
Western Pacific regions, the Caribbean, Latin America.

‫اﻟﺷﻲء ﺑﺎﻟﺷﻲء ﯾذﻛر‬

32- child came for routine checkup U found a murmur that is late systolic changing with
position ?
innocent murmur
33- a child with murmur ,I think he was anemic?
treat the cause
Incomplete Q

34- Pt came with pleural affusion after 2 weeks from pneumonia infection what is the DDx?
Parapneumonic effusion

35- child came after RTA with blood coming through Ear?
Basal skull fracture

36- Pt fall from 4 meters he is vitally stable and GCS is 15 but he is complaining from Bilateral
heel pain what is the next step?
A - xray for Both Feet B- Pain management

38 – Long case of pancreatitis after ERCPs ,which of the following will increase the survival
rate of the pt ?
A – abx B- Ringer lactate

39- Low grade dysplasia with barret esophagus, how to manage?

A – Resection B – all other choices were medications
40-where do U find the level of uterus in pregnant lady?
A – medway between symphysis pubis and umbilicus
B -above Umbalicus

Depends on the GA

41 – case of molar pregnancy with US pic. Snowstorm appearance

48- Polymyalgia Rheumatic with fatigue ?

CLL

49-Hashimoto Thyroiditis associated cancer?

Lymphoma

50-mamngement of acute Migraine headache?

A- Aspirin B- triptan

We use Triptans in case of patient presented to ER with migraining symptoms as rescue therapy.
NSAIDs and aspirin can be used only if mild to moderate symptoms.
https://bestpractice.bmj.com/topics/en-gb/10/treatment-algorithm
51- management of Kawasaki ?
Aspirin

‫ھﺬا ﺳﺆال اﻓﺘﻜﺮه ﺟﺎﻧﻲ‬

Case of crohn disease did illieocecal resection after 5 days he started to have watery diarrhea 5
times/day
what are we gonna start with him?
A-Mesalamine
B-Cholystramine
C-Metronidazole
D- I dont know but not related i think

‫ﺣﺎوﻟﺖ اﺗﺬﻛﺮ اﻻﺳﺌﻠﺔ ﻓﻘﻂ اﻟﻠﻲ ﻣﺎﺗﻜﺮرت ﻣﻦ اﻟﺘﺠﻤﯿﻌﺎت‬

1- leukotriene receptor antagonist:

????
2- painless penis ulcer after travel and had unprotected sexual course:
A. syphilis
B. HIV
C.

3- lumper puncture show high protein and normal glucose and high lymphocyte and high
neutrophils:
A. tb meningitis
B. viral meningeaoencephaliis
C.

3- diagnosis of psoriasis :
A. clinical
B.
4- same scenario of doctor told nurse to mobilize pt but didn’t do, how to avoid:
better communication between nurse and doctor

8- profuse watery diarrhea?

metronidazole

9- young female in ER with right lower pain what first?

pregnancy test

11- female just delivered 2 weeks ago doesn’t want to get pregnant for 2 years, she is not smoker
with no cardiology disease risk:
A. vaginal ring
B. ocp
C. transdermal patch

13- child painful oral and tongue vesicles only which can’t eat, what is the virus?

This is most probably HSV (Herpetic gingivostomatitis)

Note that Koplik spots with measles are not painful.
But you need to look at other choices anyway

Incomplete question

16- HBV labs negative except for HbS antibody:

vaccinated

17- HBV diagnosis in pregnancy:

A. primary
B. secondary
C. tertiary

18- couples with infertility and when do workup the husband had HIV:
a. tell husband
B. tell wife
( no choice of telling both)

With these options we till him first.

18- histopathology showed transdermal :

A.ulcerative colitis
B. crohns disease
19- H. Pylori with malt lymphoma what to do:
A. gastrectomy
B. H.pylori eradication

21- mid esophageal mass:

A. adenocarcinoma
B. squamous cell carcinoma

Femal BMI 43+GERD how to reduce weight?

Roxn Y
Sleeve ?

Sleeve gastrectomy make GERD worse

-GS R4-
also neck injury in Zone 1 with subcutaneous emphysema what most appropriate next step ?

Incomplete Q

‫اذﻛﺮ ﺟﺎﻧﻲ ﺳﺆال‬

child with coca cola urine color since 1 week and when examine him he
has congested throat with ant LN what he have :
A-acute glomeuronephritis
B-igA nephropathy (answer)

Incomplete choices,
but in general IgA is after 1-3 days after URTI
PSGN is after 1-3 weeks of URTI
child with unilateral undescended testes found in inguinal canal , Tx: pedia
A. orchiectomy
B. Orchiopexy
C. Leave it for period of time ( I can’t remember how long)
D. Give him androgens ( testosterone )

Bronchogenic carcinoma of the lung how to diagnose: IM

A. Transesophageal endoscopy
B. Trans-tracheal endoscopy
C. Chest x-ray

I guess they mean bronchoscopy?

Male pt RLQ pain , diagnose as appendicitis with appendicular mass ,
abscess , most appropriate management ?
A. Percutaneous drainage
B. laparoscopy drainage then appendectomy
C. open drainage then appendectomy

Same case , RUQ PAIN cholecystitis , us show thick wall with multiple
stones , epicoloidal fluid .... Tx ? surgery
A. Percutaneous drainage
B. laparoscopy drainage then cholecystectomy
C. open drainage then cholecystectomy

If they mean peri-cyctic fluid answer should be Lap choly

Both answers confirmed by R4 GS
I took my exam today. There was a good amount of repetition.
Here the questions I remember.

Patient had postive babinski reflex and anemia and unsteady gait.
Hb: low
MCV high
With peripheral blood smear showing marcoyctic RBC and
What is the diagnosis?
B12 deficiency
Folate
Sideoblastic

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575440/

Patient had postive babinski reflex and anemia and unsteady gait. And Vitiligo.
Hb: low
MCV high
What is the treatment?
And Oral B12
Folate
IV B12
Child 2 years who developed pneumonia poor oral intake fever. What is the indication for
inpatient management of pneumonia in this age group ?
Poor oral intake was an option

Both can be used, it depends on the severity.

If Mild go with surfactant first
If severe go with NO first
Third day post op developed fever. What is the cause?
UTI
DVT
Abscess
Pneumonia

3 miles stone question

Child with joint pain and skin nodules. What else do you need to diagnose rheumatic fever?
ASO
ESR
CRP
Blood cultures that are positive

To diagnose rheumatic fever you need Evidence of GAS infection + 2 major (or 1 major and 2
minor). Evidence of GAS infection include positive throat culture or high ASO.
Biliary colic in a pregnant women . Management?
- second trimester lap cholecystectomy
observation was not in the choices
All choices were surgical

Short bowl syndrome developed seizure what electrolyte is responsible?

-hypoK
HyperK
HypoMg
Hypo PO

https://www.ncbi.nlm.nih.gov/pubmed/21519778

Patient with pneumonia was treated with antibiotics still is

What level to perform thoracosentesis? To sample plural effusion?
8-10 mid axillary
5 ics mid axillary

Traditionally, this is between the seventh and ninth rib spaces and between the posterior axillary
line and the midline. https://emedicine.medscape.com/article/80640-technique#c2
Pt on anti-Tb presented with gout falre, labs : high uric acid
Which anti TB is responsible for this presentation?
-Ethimbatol
-pyrazinmide
-Isonized
-Rifampicin

Vibreo cholera stool charactarstic?

- osmolar gap < 30

Placental abruptio at 30 week stable now. What would be the best initial drug?
Dexamethasone
Oxytocin
Terbutaline

ITP case with low platlets in the labs what would the bone marrow show?

Increase megakaryocytes

Mucocutanues bleed with the bone marrow result showed Increase megakaryocytes. What is the
diagnosis?
ITP

Child got beriberi what vitamin is he lacking?

- Vitamin B1 “Thiamine”

Ectopic pregnancy and the Beta HCG is 5000 what to do?

- Laparoscopic surgery
- Open surgery
- Medication

Upto 5,000 we can use MTX, this is in the borderline???

Ectopic pregnancy size 2*3 & beta HCG was less than 5000 whats the treatment?
Laparoscopic
Methotrexate

Pregnant with UTI what Antibiotics should be given?

Nitrofinitoin but don’t give it in the last 6 Gestational weeks (according to canada QB)
Ceftriaxone

Women had 3 miscarriages, what is she suffering from?

Antiphospholipid syndrome
Von wiliprand disease
Low protein C

Immune compromised child, which of those vaccines shouldn’t be given?

Zoster
HBV
IPV

Patient with HbsA +ve , HBcAB(IgG), HBe -ve What is the interpretation?
Chronic HBV
Immunity post infection
Immunity post vaccine
Child with multiple upper and lower respiratory tract infections and eczema?
Wiskot Aldrich

Women with intermittent asthma, only uses Salbutamol, but recently her condition got worst, she
has coughs more than 3 times a week, what to add to her medication regimen?
Ipratopium
Inhaled steroids
LABA

The best modality to diagnose Varicose veins is?

Douplex US
CT Venography ✅

Both can be correct?

I think they mean MRI venography not CT
https://emedicine.medscape.com/article/1085530-workup#c6
Child with repeated “tantrum”, how will you instruct his mom to deal with her child?
Do “time out” strategy
Doing whats he wants you to do
Can’t recall the rest

It makes sense?

Pt came with dyspnea and bilateral crackles un Auscultation , she also had diastolic murmur and
pounding pulse, whats the dx?
Aortic stenosis
Aortic regurgitation
Mitral regurgitation

Patient came with hymaptosis, and equal diminished breath sounds on lower lung fields.
CXT shows cavity. Whats your diagnosis?
TB Pleural effusion
Malignant pleural effusion

Patient came to ER with s/s of pituitary gland compression. What is the immediate management
in ER?
Immediate transsphenoidal decompression
Do pituitary labs

Patient with secondary Amenorrhea, milk let down, fatigue, hypotension whats the cause?
Problem in the pituitary

Milk “prolactin is the hint”?

Which of those structures pass the deep inguinal ring?

Illioinguinal nerve

Patient with battle sign indicate what?

Basal skull fracture

Patient had numbness in the lower eyelid and upper lips, what nerve branch affected?
Infraorbital nerve

Child has pain on his knee whenever he runs or done any sport, point of tenderness on the knee
joint confirmed.
osgood schlatter disease

Patient presented to ER with Maxiofacial fracture, how to give O2?

Oropharyngial
Nasopharyngeal
Tracheotomy
Facial injuries or fractures are one of the contraindications for oral or nasal airway, so we with
surgical airway management.

Mumps mostly affect?

Parotid
Lungs
Heart

1- most common complication of strep throat?

- Glomerulonephritis
- Rheumatic fever
- Scarlet fever

Confirmed by Peds ID consultant

2- 11 year old patient with MRSA what to give?

- Ceftriaxone
- Amoxicillin + Cluvenac
- Vancomycin
- Gentamicin

Most probable answer, but he have to tell you the disease to be 100% sure.

3- 4 years old with bacterial meningitis what to give?

- Vancomycin + Cefrtriaxone
- Augmentin
- Rifampicin + Ampicillin
- Another choice I can’t recall

4- 8 years old child who had a brother with Bacterial meningitis , what to give as prophylaxis?
- Rifampicin
- No need
- Ceftriaxone
- Cefotaxime

5- child with lobar pneumonia , gram stain shows gram negative rods
- Ceftriaxone
- Doxycycline

Tricky question, but this reference supports A

https://www.jwatch.org/id200312120000007/2003/12/12/gram-negative-bacteria-and-broad-
spectrum

6- child have an allergy towards egg, which vaccines shouldn’t be given?

- HBV
- MMR
- Yello fever
- OPV

7- child came toxic looking, mouth drooling (signs of epiglottis) what to do?
- Refer to ENT for urgent Intubation
- Immediate IV ABs
- IV fluid
- Discharge with oral Abs

Epiglottitis is a medical emergency, we need to intubate.

https://bestpractice.bmj.com/topics/en-gb/452/treatment-algorithm

Colon cancer screening in average risk? A.40y. B.50y. C.55y. D.60y

Mother has HBV after delivery, what you will give the baby before 12 hours:
A-HBV vacations just
B-HBV vacations +Immunoglobulin
C-Immunoglobulin

Not 100% sure though

https://www.sciencedirect.com/science/article/pii/S1386653216000445

Patent came with unilateral leg pain and edema , non-pitting , next :
A-Massage
B-bypass

This is most probably Lymphedema. 1st line is massage.

Child came with abdominal distension and vomiting just, other labs and clinical exam its
unremarkable, what do you think;

a-Hirschberg
b-Lactose intolerance
c-Pyloric stenosis

incomplete Q but seems like C.

best treatment for pregnancy smoking :

A-bupropion
B-nictone patch
C-CBH

Old patent came to primary health care for his lap, the doctor told him you have lung cancer , he
respond (( you are wrong)) , This represent?
A- Denial

Adrenal adenoma was diagnosed accidentally, Most common cause?

A- Subclinical Cushing
B- nonfunctional adenoma
https://www.bmj.com/content/360/bmj.j5674

A case of uterine fundal cancer and asked about lymph node drainage?
A-Par-aortic
B-Internal iliac

Patent with neck mass , when he do FNA you found medullary cancer , best treatment ;
A-Total thyroidectomy B-Partial thyroidectomy C – lobectomy
‫ اﺧﺘﺒﺎري اﻣﺲ اﻟﺨﻤﯿﺲ‬١١/٢٢

1/ most common vulvar neoplasm

- squamous cell carcinoma

3/ child came with greasy stool and .. (cystic fibrosis) what other manifestation :
- i think answer was sinusitis

Know other systemic manifestations of CF

4/ absolute CI for external cephalic version in a pregnant with hx of C/S :

- previous cesarian section
- anterior placenta
Both can be CI?! Depends on the scenario I guess, not sure though

5/ Which anti TB medication lead to increase the uric acid :

- Pyrazainamide

6/ retinoblastoma ask about dx

7/ blunt trauma case conscious and alert , there is bleeding coming out from ear dx :
- basal skull fracture
- suparchnoid hemorrhage
- subdural hematoma

9/ child with central cyanosis :

- TOF

4T’s: ToF, Truncus arteriouses, TGA, Tricuspid atresia

10/ case of meningitis ask about mode of transmission :

- contact
- air-born
- droplet

If he is asking about meningiococcemia, so its droplet

11/ case of TB ask about mode of transmission :

- contact
- air-born
- droplet

12/ pregnant was given Mgso4 overdose what is best next step :
- stop Mgso4
- give ca gluconate

First is you stop the drug then give Ca gluconate

14/ patient with ingrowing nail of toe what is most ..thing to do :

examine other toes

incomplete question

15/ 3 questions about milestones. ✅

16/ which drug cause SLE flaring ?

Long list of drugs that can cause it, anyway Sulfonamides came a lot in the Q bank.

18/ management of intraductal papilloma of breast >> excision

19/ old pt with hx of of loss 15% of his weight in last 4 months no hx of fever on examination >
there is mass dx :
- pancreatic cancer (the only cancer in answers)

20/ pregnant 34weeks came with ROM what is next best step in management :
- steroid
- antibiotic

If between 23-34 give steroids

21/ what is the best management for moderate bronchial asthma :

- SABA with steroid
- LABA with steroid

22/ what indicate severe asthma /

- RR > 25
Incomplete Question and answers

23/ child diagnosed with asthma, known to have bronchial asthma parents came with her mother
. father is smoker what to do :
- give SABA and steroid
- council them about smoking cessation

Incomplete Q, you need full scenario to decide

24/ screening of colon cancer age : 50

25/ female osteoporosis screening age i think she was low risk :
- 50-54
- 55-59
- 60-64
- 65-69

You need full scenario to decide the risk, but D if she have no risk factors
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal
/osteoporosis-screening1

26/ uterus cancer in fundus drain in which lymph node :

- Para-aortic

28/ pregnant with asymptomatic UTI tx :

- Doxycycline
- Nitrufurtonin

If 37 GA and less!!

31/ child with hypothyroidism since birth and positive family of hypothyroidism how to treat?
This is congenital hypothyrodisim, you need to give thyroxine?
‫اﻟﺴﻼم ﻋﻠﯿﻜﻢ‬
‫ اﻟﯿﻮم اﻻﺧﺘﺒﺎر‬٣١/٧
‫ ﻣﺎﻗﺮﯾﺖ ﻛﺜﯿﺮ ﻣﻦ اﻻﺳﺌﻠﮫ اﻟﻘﺪﯾﻤﮫ ﻓﻤﺎ اﻗﺪر اﺣﻜﻢ اذا ﻓﻲ ﺗﻜﺮار او ﻻ ھﺬا اﻟﻲ اﺗﺬﻛﺮ ﺣﺎﻟﯿﺎ‬.
A man with 2nd degree burn what iv to give and the does (dont remember his weight) the want
Normal saline
Lactate ringer(do not remember the doese)
Lactate ringer
Lactate ringer

In Burns use Ringer’s lactate

Tretment for bacterial meningitis (7yeas old)

Vanco-rifampin
Vanco-genta
...
...

About 60 yeas old women small mild abdominal hernia felt mildly with cough
Laparoscopic with mesh
Open with mesh
Simple ...
Observation

Brown vomiting after mechanical vent for 7 days:

A. Functional dyspepsia
B. Helicobacter gastritis (my Answer)
C. Esophageal gastritis

Stress ulcer is the correct answer

Confirmed by R4 IM
 Uncertain answers for further research

Liver lesion 20*15cm, Labs: show amoebic , what the best next step?
a-Percutaneous drainage
b- Open derange
C. Metronedazole

- pt came to ER after MVA hypotensive, having splenic laceration and aortic injury, what’s the
most appropriate next step?
thoracotomy
laparotomy

Q is not clear, but anyway thoracic aortic injury is common in blunt injuries like MVA.
So in this case we have to do Thoracotomy

9. child with fever, cough & productive sputum (provided a picture of CXR most likely
pneumonia, infiltration was only in the lower lobe of the right lung) asking about what would be
the finding in auscultation?
A)Absent of vocal breathing in the Right lung Zone
B)presence of bronchial breathing in the Right lung Zone
C) crepitation of the right Hemithorax
D) Ronchi of the right hemithorax

Vaccination at 2 month:
A-Ipv-hib-HBV-DTap
B-Opt-hib-HBV-DTap

A lady came back from jedah she has headache and myalgia. With a rash on ger face that started
few days back. What medication would you start her on?

Abx
Nsaid
Steroid

Infantcrawel ,transfere object from hand to hand,had palmer grasp no

pincelgrisp,age by month
A-5
B-7
C-9
8 yr old girl with pain abdomen. she is weak since birth, h/o
hepatomegaly, with jaundice… AST 1024 ALT 600 bilirubin 370
a. biliary stricture
b. liver cirrhosis
c. hepatic cholangiopathy
d. congenital liver failure

Case of meconium aspiration syndrome they did initial resuscitation and o2 was given. The pre
ductal pressure 8 and post ductal pressure was 9. What to do initially ?
Surfactant lavage
Nitric oxide

Cause of patient with acute illness (pancreatitis?) admitted into the ICU developed symptoms of
ARDS
Right heart pressure
Pulmonary pressure
Precappilar wedge pressure

Vaccines given at 1 year?

Child hop on one foot whats his age in weeks?

36 ms
48 ms -> 4 years
15 ms

A lot of questions regarding DVT prophylaxis and management I cannot recall correctly

Patient with Chronic limb Ischemia, can only walk about 100 meters before having
claudications, which management should be used to help him walk longer?

Combined antiplatlet therapy

Supervised exercise program ✅ (not sure)

Women with Femoral hernia how to manage?

Asthmatic child came to ER frequently and father was smoker and every time the doctor advice
him to quit smoking but he not listening and careless, child right now complain severe attack ,
what best to do ?
A.Call child protection.
B.Talk to the father about that habit.
C.Tell hospital ethics committee.
D.Ignore father respond and treat the chil
Not sure A or C

Patient has abdominal pain, during endoscopy, you find multiple antrum
ulcers, he not responded for medication, best intervention:
A-total Gastrostomy
B-Partial gastrostomy
C-vagotomy

Wolff-Parkinson white syndrome , not respond to treatment, next step :

A-Increase the dose
B-Radiofrequency
C-digoxin

Drug approval by FDA for tx of cancer haypercalcima :

A-denosumab
b-teripratide

Patent came with chest pain diagnosis as unstable angina , you give him BB,statin,aspirn, what
you will add:
a- Alteplase
b-clopidogrel
N.B: treat as in MI except for fibrinolysis

How prevent pph :

A-manual placenta extraction
B-put likes sponge inside to prevent bleed

CTG graph with VERY low variability, And the mother showed no symptoms of any
abnormality. Patient on Oxytocin, MgSO4, epidural. What is the cause?
A – Oxytocin
B - MgSO4
C – epidural

2/ newly married female came to antenatal care unit for routine check up
which of the following is the most important part to see in examination :
- abdomen
- vagina
- pelvic (something..)
- cervix

13/ patient did gastric surgery 2days ago came to ED with...

they didn't mention labs ..dx :
- sepsis
- bacteremia
- septic shock
- normal postoperative inflammatory response

27/ female with varicose veins want cosmetic procedure :

- ligation
- sclerotherapy
- endovascular stripping

10yeas old boy abdominal pain and diarrhea sometimes bleeding

With loss of weight
Ulcerative cloitis
Crohn disease

Mode of inheritance for x-linked dominant if the mother and father is a carrier

- Gall Bladder 0.6 mm or cm I forgot on routine investigation what next step to do =>
observation
or CT, there are more options

Female total abdominal hysterectomy and bilateral salpingo 35ml/h, everything normal,
doctor decided to discharge. oophorectomy, urine output In the similar case above, what of
the following will make the doctor decide not to discharge the patient?
A.absent of oral intake.
B.Fever.
C.analgesia.
D.low urine output
Answer: D
Because surgical procedure near ureter could affect it
In the question mentions the urin out put was 35 what’s the normal range!!
*Low* urine output is indication of not discharging patient. Normal is 0.5 ml/kg/h

*Elderly with black discoloration and elvated from epithelia surface what to give ?
Chemo
Radio
Bunch
Execiopn

17 years old c/o sever RLQ pain and fever

O/E +ve rebound tenderness , +ve muckberney pont ( all case lead to appendicitis ) *but in pic*
x-ray found clear ureteric stone , what to do ?
- Emergency appendectomy
- urgent urology consultations ✅
Young man, had a trauma to his 2nd finger while it was hyperextended, the man can't flex or
extend the distal phalanx, also the distal phalanx was tender to touch, but he can move the
proximal phalanx freely, he also reported feeling tenderness in his palm, where is the the injury ?
A) deep flexor dogitorum tendon (not sure of the the last 2 words)
B) superficial flexor digitorum tendon
C) distal interphalngeal joint
D) distal phalanx bone

‫"وﺣﺪة ﺳﻮت ﻋﻤﻠﯿﺔ ﻟﻠﻐﺪة وﺑﻌﺪ اﻟﻌﻤﻠﯿﺔ رﻗﺒﺘﮭﺎ اﻧﺘﻔﺨﺖ وﻗﺎﻋﺪة ﺗﻨﺴﻢ ھﻮاء وش ﺗﺴﻮي ﻟﮭﺎ‬
‫رﻗﻌﺔ ﺻﯿﻨﻲ‬
‫رﻗﻌﺔ اﻟﻤﺎﻧﻲ‬
‫ﺻﺎﺑﻮن وﻓﯿﺮي‬

limb ischemia what to do next?

venous ulcer

22- height below 90th and weight low, type:

A.nutritional
B. constitutional

23- hyperkalemia and vomiting ( no VBG or any labs labs ) what type:
A. metabolic alkalosis
B. metabolic acidosis
C. compensated metabolic alkalosis
D.compensated metabolic acidosis

20- lactating female with left breast tenderness .... and right left upper lateral quadrant mass and
lymph bode enlargement, diagnosis( not determine diagnosis of which breast):
A. breast abscess
B. breast cancer
12- children with tachycardia and tachypnea and cyanosis: what is going with diagnosis:
A.carotid venous increase

14- pic of us with empty uterus what to do:

A.waiting for 4 weeks
B. terminate pregnancy

10- 2 yrs child with heart failure follow up regularly with cardiologist, mother ask about the
feeding:
A. Eat same as healthy child
B. Eat less than healthy
C. Eat more than healthy

5- teacher with fear before each class and fear to mad a mistake in class:
A. social
B. mixed
C. specific

6- pt with hypothyroidism on treatment then increase dose: t4 normal and high TSH:
A. secondary hypothyroidism
B. ectopic thyroid- small dose

7- pt with non acth dependent adenoma:

A. preoperative flurosteroid
B. peri op corticostireos

‫ﻛﻤﺎن‬
Patient with abdominal pain and bloating, diarhhea, vomiting, weight loss, recuurent chest
infection(not sure), scattered crackle in chest
A- Acute pancratitis
B- Cronic pancaritis
C- Pancariatic pseudocyst
D- Pancariatic Carcinoma !!

- baby with congestive heart failure feeding :

A- Less than healthy infant
B- greater than healthy infant
C-i dont remember
D. Same as normal
E.duble normal

Not sure though, double check this please

case of unilateral leg swelling dark skin no risk factors of DVT non petting edema inv?
A- CT angio
B- Conventional Vengram i choose this
C- Duppler ultrasound
D- ‫ﻣﺎ اﻓﺘﻜﺮ ﺑﺲ ﻛﺎن ﻣﺎﻟﮫ ﻋﻼﻗﺔ اﻓﺘﻜﺮ‬
‫ وﺟﺎء ﻧﻔﺲ اﻟﺴﺆال ﺑﺎﻟﻀﺒﻂ ﺑﺲ ﻛﺎن ﻣﻮﺟﻮد ﺑﺎﻻﺧﺘﯿﺎرات‬lymphsa.graphy

Endocrine ‫ﻗﻠﯿﻠﺔ ﻟﻜﻦ ﻛﺎﻧﺖ ﻋﻤﯿﻘﺔ‬

DKA - Goiter-Prlactinoma management
Adrenal incidenteloma management

52- Nurse with +ve HCV antibodies and -ve HCV Ig M what to do?

- midshaft hypospadias with hooded foreskin and chorde asking for name of surgery?

- Diabetic foot ulcer showing psudo-(something) hyperkeratosis, what’s the best next step?
amputation or debridement or control DM
Gastric cancer 5 cm I think sarcoma in pylorus? what’s the treatment:
Total gastrectomy
Wide excision
Partial gastrectomy

Not sure

11- X-ray showing radio-opaque mass at McBurney’s point and rebound tenderness... what to do
next:
A-Appendectomy✅
B-CT without contrast
Note: Reed the senario well if it suggests appendicitis then go for appendectomy

37- Soldier with bilateral groin hernia how to manage ?

A -Lap with mesh B- Open with mesh

47- most common cancer in pediatric age? Leukemia

46- Drug approved by FDA for tx of Cancer hypercalcemia? Denosumab

Other ttt for hypercalcemia in malignancy: normal saline, calcitonin, bisphosphonate
Incomplete Q you need toher options to compare
12 - Management of a patient with gastrointestinal stromal tumor of the stomach 5 cm No
metastasis No lymph node enlargement ? In the body of
A- Gastrectomy
B- Wide local excision with Free margins✅ not sure
C- Radiotherapy and chemotherapy

30- Child can’t handle spoon well But he can walk up the stairs with one hand held What is his
age:
18 months

31-Pt came with pin prick sensation and loss of vibration sensation with loss of ankle reflex and
K was 5.5 and Creatinine was very high what to do?
A – Vitamin B 12 B – Dialysis c- Bicarbonate
Not sure read the senario well
42- pt pregnant with fundal height more the GA and hemoptysis DDx
?Choriocarcinom ?
 Incomplete and repeated questions or pics questions
Child can’t handle spoon well But he can walk up the stairs with one hand held What is his age:
18 months
24 months

43- A lot of cases with Ectopic pregnancy

44- 3 cases about Trichomonas management in different scenarios.

45- case about vaginal candidiasis

#
- Endometrial polyps ****
- Subserosal fibroid
# pt retrosternal chest pain ??????????
_ anterior mi
- Inferior mi ****
- Septal mi

Abdominal X ray,, not sure if "NO free air underdiaphragm" or "No air fluid level"
‫ﺑﺲ اﻟﺰﺑﺪة اﻧﮫ طﺒﯿﻌﻲ‬
Next step:

Amylase
ABG
measure Ca
Measure Cl
Female stopped menstruation for 8 weeks, came with severe pain followed by severe bleeding
for 6 hours, came to ER:
A. Ectopic
B. Threatened abortion
C. Complete abortion
D. Rupture uterus

Q Female came for HRT doctor doesn’t want to give?

Q How to teach children about poisoning from food?
Answer is give daily lectures about the dangers of poisoning
Q CTG epidural anesthesia and mg and oxytocin Q
Q 1 month old doesn’t move (case of cong hypothyroid) give thyroxine for life
Q Chad2 score DM, HTN, Stroke, hyperlipid, CHD

Q epilepsy child on antiepileptic he is having suezure and he has complication and uncontrolled:
A. IPV to OPV
B. Defer DTP
C. Defer all live attenuated vaccines
D. Defer all vaccines
Q most common cause of shock in Pedia
A. Septic
B. Hypovolemic
Q 4 to 5 cases on CTG
Q vaccination for 1-year child
Q chronic granulomatosis syndrome
Q Felty syndrome case
Q cancer screening for cancer colon for a 40-year-old no family history everything is normal
when to screen (no 50 years)
A. 45
B. 55
C. 75
Q pseudo pancreatic cyst (answer is percutaneous drainage)
Q croup Sx, Organism
Q ectopic pregnancy (all was medical treatment)
Q Acute salpingitis with suprapubic pain and discharge and pain at fornices
Q want to get pregnant next winter what vaccine to take? (answer is rubella)
Q pregnant and has a son asks what vaccine to take (Answer is influenzas)

Q pain at anus 3 days doesn’t go continuous with mass 1*1 CM.

A. Piles
B. Abcess

Q cerebral palsy with hypotonia and crossed leg

Q about INR level
Q female taking progesterone she has PCOS taken for 5 years then stopped what she might have?
A. Osteoporosis
B. Cervical cancer
C. Endometrial carcinoma
Q lichen scelerosis increase risk of what cancer (answer is SCC)
Q one with ascites after drainage asking what med to use after to not have reacumulation
A. Spironolactone
B. Loop diuretics
C. Thiazide
Q pregnant just delivered has endometritis doctor prescribed cefotaxime and clindamycin she
started taking it for 7 days and during the treatment she had abdominal pain with watery diahrea
after culture showed bacteria with enterotoxin how to ttt?
A. Continue same treatment
B. Give metronidazole
Q male going for appendectomy and did not find appendix how to fing
A. Terminal ilium
B. Ileocecal valve
C. Follow tinea coli
Q diabetic nephropathy how to meausure
A. Albumin creatinine ratio
B. Microalbuminuria
Q patient for adrenalectomy what to give preop
A. Give hydrocortisone
B. Phenyldiazipine
QQ after gastrectomy what is the vitamin deficiency
A. Vitamin B12
Q female MVA, after stabilization after workup she was found to be pregnant when to give
Rhogam
A. RH +ve with abdomen trauma
B. RH -ve with abdominal trauma
C. RH +ve with wrist fracture
D. RH -ve with wrist fracture
Q cardiac anomaly in down
A. ASD
B. VSD
C. Coarctation
Q what is the fourth thing in the criteria to diagnose SLE
Q UTI cases all want next step all was Urine analysis
QDIC after pregnancy high pt ptt low fibrinogen
Q pregnant previous CS pregnant with twins twin A is breeach and B is Cephalic what is the
contraindication ECV:
A. Previous CS
B. Fetal presentation
Q70.Pregnant 30 weeks lower abdominal pain with proteinuria, BP: 142/88 low platelets and
high URIC acid What of the following indicate severe preeclampsia?
A.her BP
B.Low platelet (Answer)
C.abdominal pain
D.high uric acid

Q70Explainition:
Mild preeclampsia: high blood pressure, water retention, and protein in the urine.

Severe preeclampsia: headaches, blurred vision, inability to tolerate bright light, fatigue,
nausea/vomiting, urinating small amounts, pain in the upper right abdomen, shortness of breath,
and tendency to bruise easily.

Abdominal pain alone isn't specific for severe preeclampsia

If RUQ, epigastric pain it is true
See the site of pain (lower) so it will never be C
It is B!!!
And its Not A bcz

Cone Biopsy already done, it is diagnostic and to assess hormonal status.

No need for wide local Excision.
There is Hx of breast cancer + atypical hyperplasia; best is prophylactic mastectomy.

Child can throgh a ball ,drow a straight line , put logo toys upon each other
16months
14monthes

Child 14 or 12 months speake only 2 word

Ent referral
audiometry
Assurance

Practice test (25/7/2019):

1. female 50 YO , diabetic, she has sudden progressive pain in her left hand mainly middle &
ring finger extended to the wrist with passive extension , there was no fever, the fingers are
swollen & tender?, (picture provided), what is the dx?
A)DM sclerodactaly
B)compartment syndrome
C)infectious tenosynovitis
D)dupturyn contracture

2.pt with pancytopenia + hepatosplenomegaly , peripheral blood smear shows Reed Sternburg
cells. (classic hodjekin case) :
A)Hodjekin lymphoma
B)Non hodjekin lymphoma

3.which one of the following is a hinge joint?

A)elbow
B)wrist
C)shoulder

4.what is the type of hip joint?

A)Ball & socket
B)Ellipsoid
C)Pivot

5.pt with food poisoning, has bloody diarrhea, gram stain shows Seagull gram negative rods ,
oxidase & catalase positive, which microbe?
A)salmonella
B)shigella
C) type of Ecoli (HA O?smthing)
D)cambylobacter

6.when doing thyroidectomy, the surgeon damaged the external branch of the superior laryngeal
artery, what is the function that will be lost of Vocal cord?
A)Adduction
B)Abduction
C)sensation
D)Tension

7. 20 YO female pt, previously well, with defiminization signs ( deeping of voice, Acne &
hairsutism) , what is the most likely tumor that she has recently?
A)Granulosa cell tumor
B) Thecoma
C)sertoli leydig cell tumor

8.old man , had sudden syncopy with long history of HTN, has same attack s before but regain
his consciousness faster, this time her heart rate dropped & did not regain his consciousness ( pic
of ECG with heart block )
What you will do ?
A)IV lidocaine
B)IV Atropine
C)Cardioversion
D)inter thoracic Pacemaker

9. child with fever, cough & productive sputum (provided a picture of CXR most likely
pneumonia, infiltration was only in the lower lobe of the right lung) asking about what would be
the finding in auscultation?
A)Absent of vocal breathing in the Right lung Zone
B)presence of bronchial breathing in the Right lung Zone
C) crepitation of the right Hemithorax
D) Ronchi of the right hemithorax
10. female 20 YO with rubbery mobile mass in her right breast? What is the most likely
diagnosis?
A)Fibroadenoma

11.post partum lady has breast engorgement & tenderness, what is the best advice to give her?
A) warm compression & continue breast feeding
B) Cold Compression & Stop feeding
C) stop feeding
D) give Antibiotic or something \ not sure

12.breast feeding lady has fever & tender mass in her left breast. What is the best management to
give?
A)ciprofloxacin
B)Ceftriaxone
C)Cepholaxim
D)Gentamycin

13. another case of woman breast feeding, has tender mass in her breast. What is the best
management to give?
A)diclocillin & stop feeding
B) Diclocillin & continue to feed
C) another important choices that I forget

14.Child 5 YO, not vaccinated after his 10 month's vaccination. Came with swelling between the
ear & jaw, the swelling is bilateral & symmetrical , he has pain during eating. Which
complication he most likely will have ?
A)Encephalitis
B)hearing loss
C)facial paralysis

15. case of child with hepatosplenomegaly & fever ( same picture of peripheral blood smear)

What is the most likely diagnosis?

A)Malaria
B) Brucellosis
C)leukemia
D)leishmania

16. woman had C/S one week ago, came with serous discharge coming out from the surgery scar
, On examination of the scar, the abdominal content can be seen between the sutures & through
the scar. What most likely does she has?
A)wound dehiscence
B)Stitch smthing

17.elderly man with scalp tenderness & jaw claudication , ESR&CRP are elevated what is the
dx?
A)Temporal arteritis

18. pt came with sudden sever vertigo & vomiting that he is unable to walk. He also has
nystagmus & unable to fix his gase. There is no hearing loss, no cerebellar signs , what is the
most likely diagnosis ( I think his temperature was elevated but not sure)
A)Meniere's disease
B)Acute vestibule Neuronitis
C)Benign positional vertigo

19. pt with epigastric abdominal pain when he is hunger , the pain relieved when eating , test
positive for gram negative rod with flagella (H pylori) what is the best medications to give?
A) each choice has 3 different antibiotic ( triple medication for H pylori ) you have to know it by
hard because it was confusing.

20.child with UTI; fever & positive urinalysis for WBC, what you can give?
A)Amoxicillin with clavulanic acid
B)ceftriaxone with doxycycline

21. Married woman has vaginal itching & discharge with fishy odour ( most likely fungal)
A) Miconazol
B) all other choices were antibiotics which will not work with fungal infections

22. woman with vaginal discharge + positive Nucleic Acid Amplification test (there were other
clues to differentiate between the organism ) what is the most likely cause for this condition?
A) N. Gonorrhea
B)chlamydia

23. case of 12 YO child, presented with fever & both knee swelling with tenderness, he has
history of URTI 3 weeks ago .
A)Acute glomerulonephritis
B) Rheumatic fever
C)rheumatoid Arthritis
D) Acute pericarditis

24. child has one knee swelling & tenderness, he has also mouth lesion, urinalysis shows positive
RBC, Most important\appropriate investigation?
A)ANA
B)Anti Ds-DNA
C)Renal biopsy
D)Bone marrow aspiration

25.pt underwent mastectomy , then developed winged scapula, which nerve is most likely
affected?
A)long thoracic Nerve
26. baby with scaphoid abdomen, heart sound more prominent in the right side, & decreased
breathing sound in the left side , what is the dx ?
A)dextrocardia situs inversa
B) diaphragmatic hernia

27.Neonate (48hours old) has jaundice , Indirect Coombs test positive , Reticulocyte was positive
. what is the diagnosis?
A)ABO incompatibility
B)Gilbert syndrome

28. a primigravida mother, 13 week gestation, came with vaginal bleeding . her blood grouping
is A negative , platelets count is decreased. fetal heart sound intact . what you will do?
A) RHoGam
B)platelets transfusion

29. child coming with generalized swelling & puffiness around eyes, Labs shows
hyperlipidemia, hypoproteinemia & proteinuria (classic nephrotic syndrome case),
Electron microscopy shows diffuse podocyte effacement. What is the best treatment?
A)prednisolone

30.which of the following is a symptom of inter-ductal papilloma?

A) blood discharge
B) presence of a mass

31.most common cause of FTT?

A)Milk & protein intolerance
B)psychosocial
C)Asthma
D)Cystic Fibrosis

32.lady 29 YO has a history of greasy stool that is difficult to flush, & recurrent chest infection,
she has past mediacl history of pneumothorax in child hood. What is the most likely diagnosis?
A)cystic fibrosis

33.pt came with complaining of ptosis, with downward & outward deviation of the eye, also he
has fixed dilated pupils , what is the cause?
A)3rd nerve palsy
B) 3rd & 4th Nerve palsy
C)4rd & 6th Nerve palsy

34.child came with chemosis, proptosis & limitation of the eye movement, what is the dx?
A) Hordeolum
B) periorbital cellulitis
C)trauma to the eye
D) retinoblastoma
35.pt with unilateral throbbing pain with aura like symptom & photophobia , what is the Dx?
A)tension headache
B)Migraine

36.pt with unilateral throbbing pain diagnosed with migraine , needs treatment but doesn’t want
to use a daily medications, what you can give her?
A)triptan
B)Beta blocker
C)other medications I cant recall

37.pregnant woman in her 34 week gestation, has PROM (for long period), now came with
uterine contractions & dilated cervix 3 cm, what is the best treatment to give?
A)Penicillin
B)Oxytocin
C)naloxone
D)Morphine

38. pt came with blood vomiting & dark colored stool, Hx of NSAID use , what is most likely
dx?
A)Peptic ulcer
B) esophageal varices
C)Mallory weiss syndrome

39.diabetic Pt want to go for surgery, He is on Glipizide. What is the best action for diabetic
patient should be taken peri-operativly
A)change Glipzide to metformin
B)change Glipzide to insulin

40. Diabetic pt has burning sensation of the foot , what you will give him?
A)ibuprofen
B)Pregabalin
C)dm medication I think?

41.pregnant in her 13 week gestation, she has hyperthyroidism, what do you want to give her?
A)Propylthiouracil
B)Methimazole

42. How to monitor thyroid treatment ?

A)Free T4
B)free T3
C)TSH

43. in case of pregnancy , what is the most important period when you should have a controlled
glycemic level in order to avoid congenital malformation of the fetus?
A)pre-conception
B)first trimester
C)2nd trimester
D)3rd trimester

44.epileptic mother, what is the most likely risk that will be on the fetus ?
A)Risk of antiepileptic medication
B)Risk of benzodiazepine
C)Increased seizure for the mother
D)Effect of seizure in the baby

45. Woman with general pruritus & itching, dx?

A) primary biliary cirrhosis
B) primary sclerosing cholangitis
46. Fever, jaundiced, RUQ pain, ultrasound evidence of dilated bile duct. What is the dx?
A)acute cholecystitis
B)Acute cholangitis

47. Classic Celiac disease case; +ve Anti Tissue transglutaminase. What is the treatment?
A)Gluten Free diet

48.Lady 39 YO , has 3 years history of diarrhea, biopsy of intestine shows Villous Atrophy, what
is the best management?
A)Gluten free diet

49.child has profuse watery diarrhea, then developed sever vomiting , what is the electrolyte
imbalance that he will have?
A)Hyponatremia
B)Hypernatremia
C)Hyperkalemia
D)Hyperglycemia

50. Most important thing that increase Hospital acquired infection?

A) Low compliance of Hand Hygiene

51.Mother is A- & Father is A+ , their first baby was healthy, what is the percentage to bring the
second baby having an (A+ ) blood grouping?
A)100%
B)50%
C)25%
D)15%

52.primigravida 12 weeks gestation , has lower abdominal tenderness , O/E she has adnexal
tenderness; with dropped heart rate & Blood pressure , what is the diagnosis ?
A)Ruptured ectopic pregnancy
B)Ruptured appendicitis
C) Ruptured Ovarian cyst
53.which muscle is passing through the lesser sciatic foramen;
A) obturator internus
B) Obturator Externus

54. lady with Urine incontinence , you gave her Oxybutilin , what is the mechanism of action for
this drug?
A) activate alpha adrenergic receptor
B)activate Beta adrenergic receptor
C)block nicotinic receptor
D) Block muscarinic receptor

55.Hypertensive pt on anti-hypertension drug, has LL edema , also weakness? what is the

causing drug?
A)Amlodipine
B) ACE inhibitor

56.young pt has attacks of headache which relieved after a while, she has also one episode of
diplobia , which was relieved spontaneously , now the pt is coming with one eye blindness
What is the best investigation to do?
A) MRI brain
B) CAT scan

57.old pt, has orthopnea, PND, increased JVP, crackles on Auscultation, LL edema, what is the
best mediction to give?
A) Furosemide
B) ACE
C)Beta Blockery

57. Dyslipidemia case, labs shows elevated TG, LDL, & cholesterol . & low level of HCL. What
is the treatment?
A)fibrate
B)Niacin
C)Rosuvastatin
D)Simvastatin

58. classic Alzheimer case; loss of memory & on brain MRI there is enlarged ventricles &
cortical Atrophy. What is the dx?
A)Alzheimer's disease
B)Parkinson
C)Lowy body dementia

59.elderly with loss of short & intermediate memory, can be frustrated & annoyed easily. has
low mood & want to be alone most of the time. Mini mental exam : 22/30. What is the dx?
A)Pick disease
B)Lowy body dementia
C)vascular dementia
D)Alzheimer's disease

60. Case of urge incontinence , what is the best investigation for her case?
A)Urodynamic study
B)Cystourethrogram

61.case of child with UTI, what is the most appropriate investigation?

A)KUB
B)ultrasound
C)MCUG

62.female came with mastalgia that is aggravated with each menstrual cycle, what is the beast
management?
A)reevaluate after menstrual cycle

63.female came with vaginal discharge & itching , investigation shows that there's no infection
of vagina. What is the best management?
A)give antibiotic
B)refer to sexual transmitted disease clinic
C)reassurance

64. case of DVT in pregnant woman ( calf tenderness etc), what is the best diagnostic test?
A)duplex venogram
B)Venography study
C)D-Dimer

65.child came with labored breathing & tachypnea , he has weak cry with hoarse voice , what is
the best management ?
A)Oz mask
B)intubation
C)calm the baby & reassure him
D) Mist something…

66.man came with scrotal swelling & tenderness for the past 3 days, he has fever & urinalysis
goes with UTI, what is the dx?
A)epididmo-orchitis
B)testicular torsion

67. man came with painless scrotal swelling , non-tender , reducible, increases when lifting
heavy objects. What is the best next step in management?
A)Scrotal U/S

68.pt has unilateral throbbing pain which not relieved with 4 tablets of paracetamole?
A)Migraine
B)Tension Headache
69.pt with (description of incarcerated hernia) with signs of trapped abdominal content , what is
the treatment?
A)Surgery

70.female pt with serous nipple discharge, has regular menses . what is the next step?
A)Prolactin assay
B)thyroid function test
C)Brain MRI

71.woman 45 YO, has left breast mass, & nipple bloody discharge done mammogram which
shows 1.5 cm mass that has no micro-calcification, next step?
A)Cytology of the discharge
B)MRI of the breast
C)Core biopsy

72.woman found to have squamous cell carcinoma of the cervix, pap smear done , but the
transformation zone was not clearly seen , what you will do?
A)Cone biopsy
B)Repeat pap smear

73.to prevent obesity in children, what is the best intervention that can be done ?
A)physical activity & normal diet
B)low fat diet
C)multidisciplinary intervention for the family

74.pt has recurrent peptic ulcer, investigation shows tumor in the tail of the pancrease secreting
gastrin mainly, what is the dx?
A)Zollinger Ellison syndrome

75.which of the following structures can form the ankle joint?

A)last end of tibia with calcaneus & fibula
B)distal tibia , fibula & talus
C)medial & lateral malleoli

76.hemophila A pt came with large knee swelling & epistaxis , labs shows decreased level of
factor 8, what is the treatment?
A) give factor 8
B)FFP

77. Drug for ascites & LL edema pt

A)Spironolactone
B)Thiziade

78.best & important measure to prevent patient from falling?

A)fall risk assessment
B)wet floor signs
C) give sedative & hypnotics for the pt

79. you singed a patient for DNR , but the family want to revise it. You have a meeting with the
family about the DNR decision, what you will do ?
A)explain & discuss with them why DNR
B)consult the hospital ethics committee
C)you have to do the DNR regardless of the family opinion
D) ask colleagues what to do ?

80.child has normal developmental age, but she still sucking her thumb what is the best action to
do?
A)Nail polish
B)reward when not to do so
C)continuously tell her not do

81.child who can smile, coo, & can support his head when pulling to set . what is his
developmental age in WEEKS?
A)4
B)8
C)12
D)16

82.child 10 months old came in the clinic, he is setting without support in his mom's lab, not
crawling or creeping yet. He pick up a pen from the table & hold it between thumb & forefinger,
he says mama, & when leaving he waves( good bye) to the doctor
Which of the following development domain he is delayed in?
A)Language
B)gross motor
C)fine motor
D)social

83.child 2YO ,runs in the clinic, can climb the stairs, he says 10 words, & can name the pictures
when pointed at it. The child is playing with his friends but he does not want to share his toys.
The mother is concerning about her child, what you can tell her?
A)Normal developmental for his age
B) delayed in social developmental domain

84. pregnant woman, has vaginal bleeding, you decided to terminate the pregnancy, who can sign
the consent?
A)the pt her self
B)husband can sign on behlf of her
C)both of them should sign the consent
D)no need for the consent it is an emergency
85.a representative of one of the drugs company came to you to give you an offer, trip to
somewhere & 10 SR percentage for each drug etc. what is the right action to do?
A)Accept the offer
B) Refuse the offer
C)consult hospital human resources (HR)

Post-op pt ... treated with unfractionated heparin ... after five days developed petechia, Normal
PT/PTT >> Dx?

Patient post MI developed palpitation >> ECG >> wide QRS suggests bundle branch block ((
asking for Dx ))

COPD exacerbation (( hypoxia, acidosis, hypercapnia 7.99 )) >> management (( face mask,
mechanical ventilation, ...... ))

COPD pt developed , c/m only from left pleuritic chest pain, Pneumothorax 2cm btw chest wall
and pleura >> Q.management (( needle aspiration, chest tube, observation, ......))

pregnant lady known case of asthma, on LABA, ICS, SABA (( uncontrolled/late night attacks ))
>> Q. Management

Pt with left Lateral neck mass (( third triangle just below angle of mandible )) ... U/S thyroid
normal and post.cervical lymph node enlargement , on specimen it’s shows follicular thyroid
cells >> dx. (( thyroid carcinoma, ectopic thyroid gland, apparent thyroid gland, thyroglossal cyst
))

7y old female started breast development, and pubic hair start to appears and acne >> dx. ((
ovarian tumer, central ....., gonadotropin, ....... ))

Type of HBV vaccine >> (( live, attenuated, recombinant, ...... ))

Pt with hx. Of retinal detachment surgery 7 day ago and he is going into surgery.... >> Q. Wt to
used to prevent DVT (( enoxaparine, pneumatic, mixed pneumatic and enoxaparine, aspirin?))

Immunocomprimised pt, his younger brother developed chicken box >> how to manage him ((
vaccine, IVIG, nothing, ? ))

Hydated cyst and eccinococcus cyst >> Q.management

Pt after head trauma he couldn’t make the spoon reach his mouth to eat >> where is the lesion ((
temporal, parital, occipital, cerebellum ))

Child after period of illness (( can’t remember is URTI or GI )) developed symmetrical lower
limb ascending weakness >> (( GBS ))

DM, Lateral malleus ulcer with distal pulse >> Q. Investigation

DVT w/o distal pulse >> Q.investigation

Female, unilateral leg swelling, progressive, pitting edema >> Q. Investigation

Child with bilateral inguinal hernia >> Q.management

Pt. After going into open hernia repair .. developed bulging mass with cough same area >>
Q.management

Which of the following indicate searching for organic cause in a child>> (( peri umbilical
abdominal pain, last more than 10 min, around morning, before sleep time ))

Mechanism of action pf metformin >> (( decrease insulin resistance, increase blood glucose
consumption, increase insulin secretion .... ))

TWICE: Child with nephrotic syndrome >> Q.management

Child develop seizure >> Q.treatment (( IV lorazepam, intra nasal diazepam, rectal diazepam ....
))

SLE pt develop seizure >> Q.drug (( cyclophosphamide, hydroxycholoroquine, ..... ))

Description of a patient with 3 symptoms of SLE >> Q. Wt the fourth symptom of the 11
according to (RHEUMATOLOGY, SLE organization) to diagnose this pt with SLE >> (( type of
rash can’t remember, RF positive, hemolytic anemia, .....))

Mass found in the liver, suspecting HCC >> Q. Wt the most risk for it (( HBV, aflatoxin, ...... ))

Child with mass in his left flank, UA shows hematuria >> Q. dx (( wilms tumer, neuroblastoma,
......))

child with Hx. Of URTI two weeks ago, developed glomerulonephritis >> Q. Dx.
Rapidly progressive glomerulonephritis >> Q. Histo (( crescent shape formation, IgA deposition,
..... ))

4y old child came with his parents for umbilical hernia >> Q. Wt to do (( reassurance, repair ......
))

4months Child with mid-shaft hypospadias, came for circumcision >> Q. Wt u will do (( do it,
not possible since they will use it for the repair,......))

Meningitis case, LP shows gram-ve diplococci, he is close to his brother >> Q. How u will
manage his brother (( oral rifampine ..... ))

Pregnant routine screening with UA suggest infection >> (( asymptomatic UTI ))

Pregnant 28w, with UTI >> Q.which antibiotic can’t be used (( nitrofurantoin, fluoroquinolones,
amoxicillin, .... ))

Pregnant ( early pregnancy ), allergic to penicillin developed UTI >> Q. Treatment ((

cephalosporin, fluoroquinolones, nitrofurantoin, amoxicillin ))

Pt with dorsum of the left hand numbness over the thump+index and middle finger what nerve is
affected
Radial
Median
Ulnar
Axillary

10 month baby had umbilical mass reducible with cough what management
Surgery
Observation

6 week pregnant came with mild vaginal bleeding and passing of fetus with open cervix+ tissue
around cervix
Threatened abortion
Missed abortion
Complete
Inivetable

15 month boy refused to walk and want his parents to hold him he stepped over toys and twisted
his leg What Dx
Fracture at the end of Rt tibia
Fracture at the end of Rt fibula
Rt Knee injury
Proximal tibial fracture

Dm pt had nephropathy what the urine finding

Hyaline cast
Rbc cast

Asthmatic child came to ER frequently and father was smoker and every time the doctor advice
him to quit smoking but he not listening and careless, child right now complain severe attack ,
what best to do ?
A.Call child protection.
B.Talk to the father about that habit.
C.Tell hospital ethics committee.
D.Ignore father respond and treat the chil

child with repeated vomiting, labs: low k, low na, low cl, high PH, diagnosis?
A. intussusception
B.pyloric stenosis.
C. volvulus
D.GERD.
Answer:B

5 years old child with unilateral undescended testes Tx?

A.orchiectomy
B.Orchiopexy (answer)
C.observation.
D.Give him testosterone
15month child with bacteria meningitis what ttt? vancomycin and ceftriaxone

Colon cancer screening?50

Case clear femoral hernia ?
Case clear wiskot adlrich syndrome ?
All types abortion?
Postmenapousal ask for HRT ?refuse
Case clear croup?
Case TTP?
Pt with anal pain after defecation and same fresh blood what is the cause?anal fissure
Child come with his uncle with report from school his family died at RTA the teacher said at
report the child is silent and staring to nothing until call him what child has?dissociation my
answer #
Case of cardiac tamponade how to do? Echo
Pt with coagh and fever what percution to take?
Pt with sign trichomenosis what is the ttt? Metronidazole
Case clear pcos
Stress incontenence ttt? Kegal excercise
Food rich in k should be avoided in hemodialysis pt? tomato
Case at 32week bp140/90 protein +3 ctg reactive? Cs my answer
Becterial meningitis most common organism? S.pnumonia
Dx hbv case start treatment his wife negative ask about sex? Use condomes
Pregnant in 32 weeks came with night sweating cough productive with hemoptysis how to
confirm dx?sputum culture
Pregnant ask level of uterus?‫ﻧﺴﯿﺖ ﻓﻲ ﻛﻢ اﺳﺒﻮع‬
Trumatic vaginal delivery baby show dark swelling on scalp confined limited by skull
suture?cephalohematoma my answer
Pt with exudeat on tonsilli most common compliction?
Paradoxical breathing with multiple ribs fracture?
Case clear of measl?
After cardiac bypass surgery the pt is hypotension and high cardiac output what is the dx?
Rhumatoid arthritis ‫?اﯾﺶ ﺗﺴﻮي ﻟﺮﺋﮫ‬
Aspirin toxicity management?
Case eye goes to nose?6cranial nerve
‫ اﻻﺛﯿﻜﺲ ﻛﻠﻮ ﻣﻜﺮر ھﺬا اﻟﻠﻲ ﻗﺪرت اﻓﺘﻜﺮه ﺳﺎﻣﺤﻮﻧﻲ ع اﻟﺘﺄﺧﯿﺮ‬$

From here down incomplete

4qs about breast masses

17/ question about dx >> fibroadenoma other Q dx >> mastitis

Case clear vsd ?

Ectopic pregnancy treatment ? methotreaxate
Treatment pyloric stenosis?
Case clear Turner syndrome?
Pregnant c/o genital wart? cryo

‫ ◌ً ﺗﻘﺮﯾﺒﺎ‬١٠ :

1/ sinusoidal CTG >> fetal anemia ✅

2/ down syndrome baby >> trisomy 21 ✅

3/ ultrasound of postmenopausal ~was written in pic that ( endometrial thickness 13 )

next best step >> endometrial biopsy ✅

4/ one pic ECG >> left bbb (bundle branch block) ✅

5/ pic of cervical lesion hx of postcoital pain with no bleeding or tenderness what is best nest
step in management?

6/ blood smear for child with anemia.

7/ pic of herpes zoster. ✅

8/ x ray of perforated duodenal ulcer. ✅

‫ھﺬي اﻻﺳﺌﻠﮫ اﻟﻲ ﺣﺎوﻟﺖ اﺗﺬﻛﺮھﺎ‬

‫ﺑﺎﻗﻲ اﻻﺳﺌﻠﮫ ﻣﻜﺮره ﻣﻦ اﻟﺘﺠﻤﯿﻌﺎت‬
‫ ﺳﺆال ﻣﻜﺮر‬١٥٠ ‫ﺗﻘﺮﯾﺒﺎ ﺟﺎﻧﻲ‬

‫ دﻋﻮاﺗﻜﻢ وﺑﺎﻟﺘﻮﻓﯿﻖ ﻟﻠﺠﻤﯿﻊ‬..%

29/ 3 question about dx and tx of

tichomonas / Bacterial viginosis / chlamydia
32/ cafe-au-late spot in patient with family members of same thing what to do next ?
- council about neurofibromatosis
30/ 2 questions about 2 thyroid nodules next step in management answers :
- fine needle aspiration
- total thyrodectomy
- subtotal thyrodectomy
- radioactive iodine therapy

8/ 3 question with same answers about :

- mitral stenosis
- mitral regurgitation
- aortic stenosis
- aortic regurgitation

1.‫ ﺳﺆال ﻋﻦ‬asymptomatic adult screen recommendation

Bladder cancer
Colon cancer
Lung cancer
Skin cancer
2.child ear panna and ear diacharge ask treat...
Amoxicillin
2pictuer if impetigo ‫واﺿﺤﮫ‬
4.picture of cholasma in pregnant ‫واﺿﺤﮫ‬
5..‫ ﺣﺎﻟﮫ‬placenta abroptia ‫ ﺟﺎﯾﮫ‬emergency room ‫ ﺑﯿﺴﺎل اﯾﮫ إﻟﻠﻰ ﺗﻌﻤﻠﯿﮫ ﻋﻠﺸﺎن‬save for patient
‫ اﻻﺧﺘﯿﺎرات‬admission in sicu with obsetractian service
‫&& ﺑﺎﻗﻰ اﻻﺧﺘﯿﺎرات ﻣﺶ ﻓﺎﻛﺮھﺎ‬
٦..‫ ﺣﺎﻟﮫ ﺗﺎﻧﯿﮫ‬contraindcation of external cephalic ‫ﻓﻰ ﺻﻮره ﺣﺎﻟﮫ طﻮﯾﻠﮫ وﺳﯿﻨﺎرﯾﻮ ﻛﺎﻣﻞ ﻋﻨﮭﺎ‬
٧..patient has headache in frontal lobe ‫ وﺳﯿﻨﺎرﯾﻮ طﻮﯾﻞ ﺗﻔﮭﻢ ﻣﻨﮫ اﻧﻮا‬sinusitis ‫ﻓﻰ اﻻﺧﺮ ﺑﯿﺴﺎل ﻋﻦ‬
investigation
8 child 3 year for chick up you find echymosis in lapia major ‫ وﺣﺎﺟﺎت ﺗﺎﻧﯿﮫ‬ask about diagnosis
‫ ﻣﻦ ﺿﻤﻦ اﻻﺧﺘﯿﺎرات‬sexual abuse
‫&&& اﻟﺒﺎﻗﻰ‬

‫أﻏﺴﻄﺲ‬
1-Pt with malar rash with photosensitivity and artharlagia ,what test is used to confirm the DDx?
A – ANA B-DsDNA C- RF

2- PT developed facial and tongue swelling after Anti HTN medication?

A – Ranilapri B- Bisoprolol

3- Long scenario about pt came with Sx of DKA what type of insulin U will give?
A – according to sliding scale B- Fixed rate Iv infusion C- insulin BID
4- Pt known case of Rheumatoid Arthritis came with RT knee swelling and pain how will U
manage = Abx

5- Pt with arthritis with past Hx of UTI (Reactive arthritis)

How to manage? A -Steroid B-

6- Pt 35 YO female her mother died with breast cancer and her sister died with ovarian cancer
,what is the best screening modality for Breast cance?
A -BRCA Gene B- Mammography C- breast self exam

7- Long case, Flat T wave on ECG what do you find in urine:

A-High potassium
B-Sodium

8- Pt known asthmatic with Flat T wave on ECG what medication can cause that ? A-
Salbutamol B- Salmetrol

9- Chlid came to the ED with gastroenteritis , U discharge him home after telling him to come to
the hospital if there is warning Sx? U are doing
A – safety Netting and other choices I cant remember

10- Child drinking Cow milk 3 times a day with pallor ? IDA (No B12 in choices)
11- X-ray showing radio-opaque mass at McBurney’s point and rebound tenderness... what to do
next:
A-Appendectomy
B-CT without contrast

12 - Management of a patient with gastrointestinal stromal tumor of the stomach 5 cm No

metastasis No lymph node enlargement ? In the body of
A- Gastrectomy
B- Wide local excision with Free margins
C- Radiotherapy and chemotherapy

13- Late complication of meningitis:

A-Seizure
B-Hearing loss
C-Facial nerve palsy
D-Ataxia
14- Looong case of ITP with plt 32 how to manage?
A - IVIG and steroid B -Plt transfusion C- plasmapheresis

15- pt is taking UFH for PE after surgery -CBC was provided with Low platelet count what to
do?
A – Continuo heparine
B- Replace with Enoxaprine
C- stop Heparien and replace it with bivalirudin (another med with same sound)

16 – Pt came URTI the he developed abdominal pain and rash DDx?HSP

17 – Side Effect from Furosemide? Hypokalemia
18 -Pt 55 Yo smoker and came with breathlessness DDx?COPD
19 – Diabetic came to the ED with well demarcated Erythematous lesion on the shin ? Erysepalis
20- Pt came with retrobulbar pain headache and fever? Dengue Fever
21- Pt came with gait instability and urinary incontince ,he is known case of Osteoarthritis and
had cervical laminectomy after cervical degenerative myopathy what is DDx?
A -Cauda Equina B- Recurrent Cervical Myopathy
22- Scenario of Parkinson ds ,where is the lesion? Substantia Nigra
23- Man came with Ptosis , after examination Ice test and other test were +ve how to manage?
Pyridostigmine
24 – a case of macrosomic baby and Complications =Erb's palsy
25- Pic of Chloasma gravidarum
26- Pic of urethral cruncle
27- Pt with PE and hypotensive ,management ? Alteplase
28- Pt with UTI and high creatinine which Abx is contraindicated? Cipro
29 -Most common diagnosis of Pt with Fever from Sub-Saharan region?Malaria
30- Child can’t handle spoon well But he can walk up the stairs with one hand held What is his
age: 18 months

31-Pt came with pin prick sensation and loss of vibration sensation with loss of ankle reflex and
K was 5.5 and Creatinine was very high what to do?
A – Vitamin B 12 B – Dialysis c- Bicarbonate
32- child came for routine checkup U found a murmur that is late systolic changing with
position ? I think this is innocent murmur
33- a child with murmur ,I think he was anemic ?treat the cause
34- Pt came with pleural affusion after 2 weeks from pneumonia infection what is the DDx?
Parapneumonic effusion
35- child came after RTA with blood coming through Ear? Basal skull #
36- Pt fall from 4 meters he is vitally stable and GCS is 15 but he is complaining from Bilateral
heel pain what is the next step?
A - xray for Both Feet B- Pain management
37- Soldier with bilateral groin hernia how to manage ?
A -Lap with mesh B- Open with mesh
38 – Long case of pancreatitis after ERCPs ,which of the following will increase the survival
rate of the pt ?
A – abx B- Ringer lactate
39- Low grade dysplasia with barret esophagus ?how to manage
A – Resection B – all other choices were medications
40-where do U find the level of uterus in pregnant lady?
A – medway between symphysis pubis and umbilicus B -above Umbalicus
41 – case of molar pregnancy with US pic
42- pt pregnant with fundal height more the GA and hemoptysis DDx
?Choriocarcinom ?
43- A lot of cases with Ectopic pregnancy
44- 3 cases about Trichomonas management in different scenarios
45- case about vaginal candidiasis
46- Drug approved by FDA for tx of Cancer hypercalcemia? Denosumab
47- most common cancer in pediatric age? Leukemia
48- Polymyalgia Rheumatic with fatigue ?CLL
49-Hashimoto Thyroiditis associated cancer? Lymphoma
50-mamngement of acute Migraine headache? Aspirin
51- management of Kawasaki ?Aspirin
52- Nurse with +ve HCV antibodies and -ve HCV Ig M what to do?

AUG 22
PICTUER:
Urethral caruncle
Late decelerations & Early decelerations
HSP
an embryonic pregnancy
Peak T wave ECG

Medicine:
- Chron + UC
- PUD
- Esophegitis (Reflux)
- Liver disease: iron and copper overload, hepatitis
- Hematology!: Anemia and bleeding disorders.
- Cardio (HF, Heart block, AS, Diastolic murmur with change in apex)
- Pneumonia
- Pleural effusion
- PE and DVT (management, presentation S1Q3T3, pre-OP)
- 3 questions about TB medication SE (Uremia, neuropathy and it’s management)
- VasovegalSyncope episode on a young female (Reassure of do Echo)
- ASCVD and management
- Ostheoarthritis vs paget vs oseoprosis
- 2Q Tumour lysis syndrome

Surgery: Hardest part

- Read about the spleen (lacerations, thrombosis treatment, complications after splenectomy)
- Vascular (Afib limb ischemia)
- Have a good brief knowledge about ortho (I suggest first Aid) especially fracture management
and compartment syndrome
- Bleeding management (Trauma, Upper and lower GI)
- Hernia: Femoral.
- Breast: Abscess presentation, mastitis management, fibroadenoma (twice), Birad IV
management
- Thyroid Post-Op complications> SOB and swelling: open the wound
-
OB-Gyn: ‫ﺛﻘﯿﻞ دم‬
- Cancer management (ovarian, cervical ... etc)
- safe to deliver of breastfeed in HIV
- Vaginal discharge (All of it)
- Pregnancy screening tests and their timing (DM, pregnancy timing)
- HTN
- Valvular benign diseases
- 2Q ECV CI
- 10 Q about Ectopic, if failed management what to do?
- 1Q about abortion
- CTG (not only the usual ones we know cover the CTG very good)

Pediatrics: few questions

- >12 months milestones
- ITP
- Infection and management
- Vaginal discharge: reassure
- GI Surgery: Intussusception
- and Hirschsprung
- Urology: Posturethral valve
- Eczema on steroid not controlled: Teach the family or give other meds
- Croup
- innocent murmur
- Broncholitis
- Epiglotitis
- Meningitis
- CHD

Ethics: Repeated, I had new ones but they were easy

- Rt and left kidney.
- Drug and pt had allergy
- Couple problems: OCP, Hepatitis, HIV
- New: Respecting DNR in elderly (he wrote my life is not worth living on his bed sheets)
- Nurse speaking the language
- Bed sore and lack of communication
- Ebola: call the security
- Fetal death: keep him near his mom
- New: Father mad at his douter cuz she want to get into support: use frontal communication to
know more details or something like this? You seem mad what happened, I understood that you
are worried, I have been through that myseld.

Pictures:
- Heart block
- Candida
- distended neonate abdomen (the clues were in the question)
- CTG

Notes: Read the question quickly before the question scenario. Sometimes you don’t need to read
the labs.
Sleep sleep sleep and eat good amout of food
Take your break 14 mins bt each session. Never review anything during your break. (Consider 2
minutes for security part)