-3years old boy barky cough no inspiratory stridor , spells in between ,

positive monophasic

wheeze in ausculation , dx?? A. Bronchiolitis

B. Tracheomalacia
C. Laryngomalacia

D. Bronchoal asthma

-HCV treated with medication but still have cirrhosis what is most
appropriate f/u plan??

F/u with alpha feto protein

F/u with US every 6 months

-typical senario of Parkinson and they ask about what you will do to
confirm dx? Where is the lesion

Mri substensial nigra

-Skin lesion in case of celiac?

Dermatitis herpetiformis

-child with pica, hepatosplenomegaly and failure to thrive. Coming from

a low socioeconomic status family. HGB 8, Lead 2, PT high, PTT, INR,
?What’s the most appropriate treatment

A) Vitamin K

B) D-penicillamine

C) Iron supplements

-Pic of HSP. How to treat?

-Supportive

-Pic of a baby with stepping reflex.when it disappears?

moro reflex- dissapear by 6 months
rooting- 4 months
month 2

- yo female. She took her first dose of HPV vaccine 3 months ago. to 22
do at this visit today??

A. Schedule app after 3 months

B. No need to do anything at this visit C. Give 2nd dose at this visit
D. Repeat 1st dose

-Parameter for COPD prognosis??

FEV1

FEV1/FVC

-Diagnosis of COPD??

-increase TLC, decrease FEV1/FVC, decrease VC

-in brain CT or MRI i can’t remember, large ventricles with hyper dense
white matter what Dx??

-HUS

-CTG picture shows -variable deceleration

- Broncial asthma pt on salbutamol what to add??

-inhalation steroid

-Old pt with liver cirrohosis ,they asked what is higest risk factor
assoicted with it?? HCV

-best diagnostic test for asthma?

Spirometry

-most common site of intussusception ?

Ilocolic

-most common site of crohns disease ?

Ileum
- most common disease came with crohns disease??
ttt.
Perianal disease with Diarrhea- loperamide or cholysteramine
with fistula- ??
-stabbing wound with omentum protruding mangmant by ?

laparotomy

-post RTA patient with cervical emphysema, decrease air entry and
pneumomediastinum , whats is diagnosis?

open pneumothorax

tension pneumothorax

tracheobronchial injury

-Impetigo treatment ?
bullos and severe non bullos- cephalexin
Mupirocin non bullos mild- mupirocin

-Most common complication of pancreatitis ??

Psudocyst

-Long scrnario , female with bleeding . Dx??

extopic pregnancy

-21 y/o female with Endometriosis with heavy period ttt? OCP
POP
Hystrectomy

Laproscopic

-ECG second degree heart block mobtiz type 2 , ask about Dx?

Need pacemaker

-Young girl with pictures of ECG show 3th degree heart block ask about
Management?

Need pacemaker
HB
first degree second degree type 1- Atropin
second degree type2 and third degree- pacemakr or Epinephrine or Doubamine
- years divorced want to do pap smear when to advice?

now

after a year

after 2 year

-Child with conjunctivitis, cervical lymphadenopathy, fever and cracked

lips What is most likely diagnosis?

A. Wiskott aldrich

B. Kawasaki disease

-)Elderly k/c of liver cirrhosis due to HCV. (Long scenario with labs
?Which of the following is the screening method
A. Alpha fetoprotein every 3 months
B. Ultrasound every 6 months

-SAAG low level indicat?

-TB

- K/c of HCV, came with acsties, fever, abdominal pain Saag 1.2
High WBC
Treatment?

- metronidazole & Iv diuretic

- Enema lactlose & iv ceftrixone with metronidazole

-.....& Oral lactlose .3 -Propnalol + ascitec aspiration

-67 year-old male presents to the emergency department with

abdominal pain that radiates

to his back. He has a medical history of poorly controlled hypertension.

He also has a history

of atherosclerosis and had a myocardial infarction two years ago. He

smokes one pack of
cigarettes daily. His vital signs reveal: Temperature 37.3°C, Blood
,pressure 98/60 mmHg

Heart rate 116/min, Respiratory rate 22/min. The patient is diaphoretic.

Further physical

examination is significant for a pulsatile abdominal mass just above his

umbilicus that is

tender to palpation. The next step in this patient’s workup is?

CT >>> abdominal aortic aneurysm inittially: USG

-Pt presented with jaundice fatigue intermittent fever hx of traveling to

India , imagining show hypoechoic cyst ?

hydatid cyst

amoebic cyst of liver

Hypoechoic cyst

- morbid obesity for treatment what will u do before surgery ?

Endoscopy

-Case morbid obesity with hiatus hernia and GERD grade something

Which operation good for weight reduction?? Sleeve Gastrectomy

Roux en y gastric bypas

25 y/o pregnant 33 weeks has a ruptured ovarian cyst, it was an

emergency to shift her to OR and that was explained to her but she
refused surgery. What to do?

A. accept her refusal

B. force her into the OR

C. take consent from husband D. take consent from a relative

-20yrs married Female with “sudden “ huge abdominal pain ultrasound

shows 6 cm mass ( did not mention the place ) negative preg test??
A. Ectopic preg B. Ruptured cyst C. Appendicitis

D. Ovarian torsion

-case scenario of Wilson disease asking about dx??

-eye pigment with green brown ??

Wilson's disease inittiely: slit lamp examination, 24 hrs copper

Dx: liver biopsy
-wilson’s diseases, ttt?

penicillamine

-liver nodules what is the cause?? A. Aflatoxin

B. Lead toxin
C.Hepatitis b

D. Wilson disease

:Beckwith-Wiedemann and screening for liver cancer A- AFP

B- PSA if screening for wilms tumor: USG
Other long choice I don’t remember it

-Child with recurrent URTIs , eczema and thrombocytopenia both

brother and uncle have the same condition, what is the diagnosis?

Wiskott Aldrich

57 y/o female
complaining of abnormal uterine bleeding she has an endometrial polyp,
on US endometrial lining was 19mm, ?what will you offer to this patient
at this stage

A) open hysterectomy
B) laparoscopic hysterectomy
C) hysteroscopy with polypectomy

17 year old female, medically free, gymnast in her class, developed

breasts later and never menstruated, on examination she is tanner stage
5 but no menstruation, diagnosis??

A. hypothalamic hypogonadism
if stage 2 or 3: hypo hypo
B. imperforate hymen
C. gonadal agenesis
D. testicular feminization

64 years old male, HTN, DM, hyperlipidemia, what is his chad score??
CHF
A_2 HTN
Age >75
B_3 C_4 D_5 Diabetes

- *Murmurs*
)Q MR + vsd (pansystolic murmur
)Q AS (radiate to carotid
)Q MS (diastolic murmur and at apex

- neck injury in zone 3 , cta show’s vessel injury whts your next step?
ligation
primary suture
embolization

-patient with COPD exacerbation suffer of respiratory distress. ABG as

follow. How would manage it

PCO 8 - PaO 9 - Ph 7.2 - ??

Non invasive ventilation

Mechanical ventilation

- What is the most common cause of cirrhosis of the liver? Hepatitis C

Patient known case of peptic ulcer disease in medications but failed to

respond, uppe endoscopydone and revealed multiple ulcers in antrum.
What is the best treatment:??

A. Pyloroplasty and vagotomy

B. Total gastrectomy C. partial gastrectomy

-Scenario of a child with celiac disease, +ve anti-endomysial antibodies
and Antitransglutaminase antibodies (ATA), biopsy shows villous atrophy
what to do?

A- gluten free diet

B-gluten free diet for 6 months and then do biopsy again

-trauma with hypotension , x-ray : trachea shifted to the right ,

expanded lungs and widened mediastinum

What is the dx??

Massive haemothorax
Pneumothorax
Thoracic aorta rupture!! Not sure Spontaneous pneumothorax!! Not
sure

- malaria Plasmodium falciparum ٍRecurrent infections? Vivax

Female present for regular check up in clinic, she didn't remember when
was her last menstrual period, what is the most accurate way to
calculate the gastrointestinal age?

A-History and examination of utrus funds length B. Bitemporal lengths

C - Femur lenght
D. fetal crown-rump length

surgeon manipulated data to make the results support his new surgical
technique:

A-Fabrication

C- Falsification

child with pica, hepatosplenomegally and failure to thrive. Coming from

a low

.socioeconomic economic status family HGB low, Lead - 2 high , PT

normal
PTT normal , INR normal, Iron normal What’s the most appropriate
treatment? A. Vitamin K

B. D-pinicillamine
C. Iron supplements

Mom comes with her boy who drinks cow milk and solid food
complaining of fatigue. His labs showed only high RDW, no iron study
whats your diagnosis?

thalassemia trait

iron deficiency anemia

How to know fetal weight intrapartum? A- femur length

B- head circumflex

D- abdominal circumference

What is the appropriate vaccine to give to preschoolers? preschool: IPV,

DTaP , MMR , Varicella

patient came with heavy bleeding after doing evacuation the physician
said it’s dysfunctional vaginal bleeding what to do next?

A. D &C

B. OCPs

C. embolization D. hysterectomy

A mother brings her 6 month old child for a dTap vaccine, but she
informs you that he suffered from a febrile seizure after his last dose.
What will you do?

a. Tell her that her son needs to take the vaccine regardless of the
reactions

b. Postpone DTap for 3 months

c. Tell her that febrile seizure is not a contraindication of the vaccine and
give the vaccine now

d. Febrile seizure is a definite contraindication of DTap

Open fracture pic management , Of a child / radial ulnar fracture open?

Debridement and external fixation

years female has submucosal fibroid. She didn't complete her family 49
yet. How manage?

A. laparoscopic myomectomy

B. hysteroscopic resection

Child with Monophasic wheeze and barking cough with apnea spells in
between, what is the Dx?
laryngomalacia
asthma

Tracheomalacia

Bronchiolitis

yo girl presented complaining of SOB and exercise intolerance and 11

!weight. on examination there is gallops rythem

BP: high 150systolic

Hr: 160
RR:40
whats the best next management ? TSH

cBC Electrolytes Abg

years women is conplaing of severe secondary dysmenorrhea and 44

menorrhagia , pelvic examination reveals the uterus is symmetrically
enlarged and tender . Endometrial biopsy is normal

Which of following dx?

A.adenomyosis

B.leiomyomas C.endometriosis D.sarcoma

Typical case of endometrioss asking whats the best contraceptive method? Depo-
provera injection

Progestin only pill

ocp !!
Cadiac pt on anticoagulant ask about method of contraception?

A-IUD

B-Progesterone only
C-Compined progestrone and estrogen pill

When to diagnose pedia as hypertension?? A- bp > 120/80

B- bp > 150
C- >90% depends age and sex

D– >95% depends age and sex

gyn explain to the pt that HRT will not help her menopausal symptom at
this stage but the pt insist to have it what should doctor do??

A. Don’t give it to her refuse

B. give her C. refer he

Which of them have Mania ??

Bipolar disorder

Grandoise disorder

case of postpartum 5 days, mother is tearful and feeling sad.how to

manage ? A-wait for one week !! B- ssri .. other irrelevant options
Dx postpartum blues
A 15 year old girl presents with lower abdominal pain, diarrhea and
fever

She has mucus and blood mixed with her stool. The most likely°83
organism is??
A. amebiasis
B. Taenia saginata

C. Ascaris

case of patient SOB spontaneously and with exercise despite SABA ( her
only current rx) what to add??

inhaled cs
leukotriene other options

15. Female k/c IDDM pregnant at 12 week of gestation, her ha1c was
12%, she have a high risk

of developing which of the following? A) preeclampsia !!

B) polyhydramnios !!
C) Congenital anomaly

Pregnant with hypertension her BP 140/90 first line ttt?

Methyldopa

Hydralzaine Nifedipine BB

25 yrs old PRIMIgravida Patient with spontaneous abortion. Asking you

to address her concern about her next pregnancy what to do?

tell her spontaneous abortions can occur 10-15% of the time Tell her
never to get pregnant

do a full workup for reccurent pregnancy loss !!

-A lot of ob qs with ultrasound as the initial management (was very

obvious amongst the other options)

-patient (non-smoker btw) with a fhx of gerd presenting with heart burn
symptoms asking about why hat is the highest risk factor for
development of adenocarcinoma: ??
in general smoking
smoking if they specified Adenocarcinoma go with barret esophagus

barrets esophagus

-CD case asking about which part is most likely affected:??

ileum ..

colonic .. jejunal.. rectum

hepatitis c type 4 management??

Sofosbuvir + ledipasivr for 6-8 wks

Same mx for type 1,4,6
Ledipasivr

child Turcotte pugh score know it they will give you a scenario with
albumin, bilirubin, INR ascitic and hepatic encephalopathy status??
Check it by yourself :)
- GCS patient flexing to pain ,, opening eyes to pain,, incomprehensible
words 4 2 2

6..7..8

- newborn/infant with stridor wrose when prone improves when

supine..mother concerned what do?
Dx laryngomalacia
Give treatment...

tell her it will resolve on its own by first birthday

tell her it will get worse

Baby 8 weeks old was otherwise fine is coming today with fever, -
wheezy chest, tachypnea and cough for 4 days. He was otherwise well
apart from pansystolic murmur. CXR revealed increased
bronchovasculalr markings and increased heart size. What’s your
immediate action??

IV Abx
Steroids
Refer to surgery
Medical treatment with diuretics

Same scenario, what’s your diagnosis: B.A

C.F

VSD

ASD

What is dose for pregnant with folic acid deficiency in mg ?

4mg
0.4mg
What is dose for folic acid for pregnant with high risk for neural tube
defect?

4mg

infant exclusively breastfed then was given cow milk now at 9 months
after introducing some iron containing food , there’s still a concern that
the infant isn’t recovering enough iron what would you do?

1-add iron supplements

2- switch to formula

3- stop cows milk completelynor I don’t know some other irrelevant

options

-most common histopatholofic fewture associated with sigmoid cancer:

villous
-how can you prevent pre-ecmlampsia: aspirin

- stepping reflex when does it disappear? 2 months .. 4 months... 8

months

- syphilis boy came with characteristic lesion (there in penguins) how to

treat?
Penicilin
IV abx
IV anti-viral IV steroid

-Butcher sustained a knife injury while handling meat. He later saw

erythematous stristions coming out from the wound.what do you think
is the pathogen causing the infection?

Strep pyogenes and S.aureus

Klebsiella pseudomonas candida

Patient presented with pallor and fatigue. Based on the image what
should you give this patient to improve his condition?? Its typical ( iron
defe anemia )

iron vitamin b12

folate
other options

- Pediatric patients brining their child after ingestion of what’s presume

to be a toxic dose of paracetamol. I don’t remember what the q was
exactly but I think they asked about next most appropriate step and it
had NS (fluid resuc) .. and other relevant options but I chose fluid resuc
as next step( bad recall)

paracetamol toxicity in child come after 3 hour of ingestion with high

level of intoxication seen ?

activated charcol

n acetylcystaine

Paracetamol toxicity management:

<2 hours: Activated charcoal.
2-8 horus: Measure level then give Acetylecystine.
>8 hours: give Acetylecystine directly.
After one day observe and discharge if asymptomatic

- pregnant lady with abruptio placenta came with heavy bleeding hg 8.6
which of the following is the most measure that will save her life?
Transfuse 2 Packs of FFP

rapid response

team with multi-disciplinary approach

-Case with polyhydramnios and PPRM what should you check for now?

Cord prolapse

and other potions

- a child came with high fever for 6 days bilateral conjunctivitis cercial
lymphadenopathy characteristic rash on hands and feet??

Kawasaki

scarlet
other options
- case of testicular torsion very clear ... high riding testicle and
abdominal pain??

testicular torsion

- patient a child! with a swelling in the scrotum that can be reduced on

gentle pressure back so is it??

indirect inguinal hernia

direct inguinal hernia umbilical hernia

- Best way to manage simple COmmunity acquired pneumonia..??

azirhromycin

doxycycline.. ceftriaxone vanco

- Neuropsychiatric SLE management??

doxycycline and cyclophosphamide

other options not correct

7 years female with eyelid erythema and thickening of skin over

metacarpophalyngeal joints + proximal muscle weakness ??

Juvenile Dermatomyositis

- Scleroderma - SLE

- SLE clear case with malar rash and other suggestive symptoms what’s
the best serologic marker ?

Anti double stranded DNA antibodies

ANA most sensitive

RF others

- infant crying 3 time a week for 1-2 hours mother is concerned and can’t
sleep...what’s the best way to manage ? Reassurence

Behavioral therapy
oral colic drops other things

- sick euthyroid or euthyroid sick syndrome what’s true? Decreased t3

normal or decreased t4

high rt3

- surgery checklist goal question to optimize and reduce errors??

before anesthesia, before surgery, before leaving OR

- patient immune compromised what to avoid?

Varicell

Pertussis IPV

influenza

-SLE patient on methotrexate with deranged LFTs what’s important to

do?

Stop methotrexate

- pediatric patient with RA on methotrexate and adalimimab came with

a dirrheal infection with fever (seems bacterial) what do we do?

Stop adalimumab.. stop methotrexate..

stop both drugs and give abx

continue current rx and give Abx

- what’s increases BNP? COPD

- what decreases BNP? obesity.. COPD.. heart failure .. hyperthyroidism

- patient presented with sx of hyperthyroidism + exophthalmous.. on all

test it shows hyperthyroidism and on thyroid scan there’s increase
uptake so was suggestive of thyroid nodulear goiter (right sides 1/2cm)
how to manage?

right hemithyroidectomy

subtotal thyroidectomy near total thyroidecromy radioactive ablation

- that case of infertility??

-Pediatric pt has referral from the village with tipical scenario of noonan
syndrome (unusual facial characteristics, short stature, heart defects
present at birth, bleeding problems, developmental delays, and
malformations of the bones of the rib cage)

A. Sotos syndrome

B. noonan syndrome

C. Marfan syndrome
D. Dawn syndrome
Down = low sitting ears and SHORT neck Noonan = webbed neck+
undescended testicles

-5Years old female C/O amenorrhea short neck the parents

below the level, what is the diagnosis?

Turner syndrome

17year old female, medically free, gymnast in her class,

breasts later and never menstruated, on developed

examination she is tanner stage 5

but no menstruation, diagnosis??

A) hypothalamic hypogonadism

B) imperforate hymen
C) gonadal agenesis
D) testicular feminization

17 yrs female, no menstruation , high testosterone , Normal

breast

development coarse pubic hair??

A. Mayer Rokitansky Kuster Hauser syndrome

B. complete androgen insensitivity C. congenital
hypothyroidism
-varicella which one will it affect the most..?? eye
ear
liver

lung

- qs with obv bacterial causin pathogen asking how to treat and it’s as
simple as??

IV abx

-severe PID since before patient with infertility for 2 years. Her husbands
semen analysis is normal and she has regular periods ... what’s usually
indicated In such patients?

Hysterisalpingogram

CT

- patient with cancer that can metastasize.. what’s the best modality?

CT chest abdomen pelvis

- patient could have lung cancer what’s the Modality with th hghhest
accuracy or most important (don’t remember) ?

Bronchoscopy.. PET.. PET: to check mestastasis to bone

CT !!

- elderly vaccine ?? pneumococcal

- what’s the optimal time after splenectomy to get vaccine?

2 weeks

- elderly with sx of BPH cannot urinate . how to manage intially?

Foleys catheter
- patient can’t urinate properly and hematuria high PRostate specific
antigen (PSA) and Alkaline phosphates (ALP) diagnosis??

prostate cancer

BPH others

-patient with renal failure presents with low calcium, high alkaline -
phosphatase, and high PTH. What is the best form of vitamin D to give
this patient??

A- Calcitriol

B- Vitamin D2 C- Vitamin D3

- patient with sx suggestive of bone age delay including “widening of the

end of the long bones” with normal calcium, normal phosphate, and
high ALP .. what’s the diagnoses??...

vitamin D deficiency tickets

hypophatasia hypophosphatemic rockets

renal osteodystrophy

- patches on skin suggestive of hemangioma and one large one over the
eyelid what should you do?

Referral to ophtholmology

reassure as it disappears by 5 yrs

tell mother it’ll get worse

- patient suspected case of meningitis for LUmbar puncture what’s the

action you should take ?

obtain both patients assent and parents consent

obtain parents consent without patients assent obtain patients assent

without parents consent do it anyways as it’s an emergency
- 7 year old boy short for his age with bone age delay but normal growth
velocity.. what should you do for him?

Lab Work up

reassure and tell parents he’ll catch up

other options

- when to screen UTI in pregnancy??

12 weeks

other options
- case in a male adult patient with fever and abdominal pain in the left
lower quandrant also some sx of Obstruction asking about most
probable cause??

diverticulitis

other not goood enough options

- MI with anterolateral ST elevations on ECG came came in after two

hours with chest pain to a Center that doesn’t have and can’t do
angioplasty (notice that isn’t PCI).. how to manage initially?

Aspirin heprain nitroglycerin and oxygen

streptokinase aspirin heprain nitroglycerin other options

- young child came back from farm where he was playing and had
poisoning meiosis increase lacrimation what’s the poisoning ??..
organophosphate poisoning

- patient came with a drug poisoning pin point pupils (htn bradycardia)
not sure what else sidenote:suggestive of opioid overdose how to
reverse effect?

Naloxon

- Patient had hypertension and fever has been hospitalized due to this
reason due to the fact that he’s he was diagnosed with confirmed and
infection end (it was implied that he was still being hospitalized for this
reason saying there’s no resolution but I’m not sure)what to what do
you think this patient has lactate is 3.6 ?

sepsis, I think

septic shock, bacteremia, SIRS

-Case of DKA ??

PT. COME FROM SUDAN WITH MALARIA, MX?? MEFLUQUINE

QUININE !!! if sever
HYDROXYQLUROQUINE

ARTEMISININS

-A lot of questions about labour some with premature rupture of

membranes and some of variable decelerations that are worrisome we
are in a high-risk patients or caesarean.

-some patient I think had a late deceleration. Asking which drug causes it
and it’s has oxytocin which I chose also had epidural magnesium
sulphate and I think another irrelevant option. Benzodiazepine

Status epilepticus treated with lorazepam and doesn’t improve what will
u give next??

Benzo

phenytoin

Phenobarb

-paediatric prophylaxis for rheumatic fever?

Ampicillin

ciprofloxafin Ceftriaxone

-Question of a patient who went to a TB endemic area not sure if

exposed I think I don’t know how to provide prophylaxis ??

isoniazid for six months

for three months and other options

-Case of a patient being treated with chemotherapy for cancer came

with a fever and no other signs and symptoms of infection only low
neutrophils hinting to febrile neutropenia?

IV antibiotics Meropenem

other options included fever reducing medication

steroids not correct

-One patient after RTA unstable it was an unrestrained injury meaning

no belt presented with abdominal distension and And other signs of
internal organ injury how do you manage this patient the question was
the best management..??

exploratory laparotomy !! computer tomography

Patient presenting to you with subcutaneous emphysema pneumo

mediastinum and pneumothorax what is the most likely cause I think the
patient but I’m not sure what is in an accident what is the most likely
cause options??

Tension pneumothorax !!! haemothorax pneumothorax

-pregnant lady 32 weeks gestation she is worried about no foetal

movement decreasing what is the best way to reassure and the best
test?

Non-stress test

-Patient with signs and symptoms of peritonitis and he is unstable what

is the required management??

exploratory laparotomy !! CT

-Patient with family or Mediterranean fever implied by history of fever

and similar occurrence in the family of which origin was Mediterranean
asking about which drug to avoid?

Amoxycillin !!
ibuprofen aspirin paracetamol

-Patient has respiratory symptoms and haemoptysis asking and he’s a

paediatric patient asking about what is most likely the reason most
likely??

Tuberculosis !! lung cancer

lobar pneumonia

Pediatric patient with sob and productive cough with white sputum for
one week that became yellow 3 days ago, on examination there's
bilateral crackles increased in the right middle lobe. On x ray report
there's bilateral pleural effusion withconsolidation in right middle lobe.
What is the most appropriate cause??

A. Excabitation of heart failure

B. Strept pneumonie

Pregnant female primigravida in labour for couple of hours, 6cm dilated,

80% effacement, 0 station, was managed with oxytocin and ruptured
membrane for 20 hours. CTG showed late deceleration (pic) what is the
appropriate mx??

A. C/S

B. Stop oxytocin

C. Amnion fusion

D. Ampicillin

Inferior MI was vitaly stable preparing for coronary perfusion suddenly

be hypotensive what is the cause Bp 80/40 PR 100 ??

RV infarction

Heart block

-child after RTA , admitted in ICU , labs show High serum osmo and low urine osmo Dx ?

A. Central DI
B. Nephrogenic DI C. SIADH

-75-year-old type 2 diabetic undergoes a bowel resection for colon cancer.

He is well priar to the operation with well-controlled diabetes and no other underlying
condition. The operation is successful and the patient is given postoperative insulin and IV
dextrose.

2 days after the operation he becomes very agitate

Na=low K=low Cr=low Serumosm:low Urineosm:normal

Which of the following is the most likely cause?

A.Water overload

B. Addison's disease

C. Diabetic nephropathy

D. SIADH

-Pts had seziure 3 days ago His labs all normal expect = Sodium is low 121, Potassium
normal, Serium osmolarity low Urine osmolarity normal Dx:

A-Siadh

B-Cushing disease
C-Conns disease
D-Addisone disease
Patient diagnosed with major depression complaining of excessive thirst and urination + she
has cancer with lung mets. investigations shows hyponatremia and low urine osmolality
what's the dx:

A. DI
B. psychogenic polydipsia C. SIADH

-Pt has equal weakness on the rt side of the face, rt upper n lower limb Lt side normal Where
is the lesion ??

Vertebral artery
Mid basilar artery
Penetrating branch of middle memingeal Anterior cerebral

-Case of stroke and complain of weakness in the arm leg and face, where’s the damage?

-Middle cerebral artery

-Anterior cerebral artery -Mid basilar artery

-Long case pt has fever, headache, petechie

There is pic ( fragmented RBCs), Low Hb, high Hct .. Low plts .. Cr I think was high How to
manage ( I spent considerable time on this case) ??
IVIG + steroid
Plasma exchange
Plts transfusion
Forgot the last one

-Female symptoms of anemia and fever , hb 10 , plt 60 Blood film : fragmented RBCs +
spherocyte ??

A. ITP
C heridetery spherocytosis B. TTP

-ECG there is obvious St elevation in lead V1-V4 , pt with typical chest main ?? Posterior MI
RBBB
LBBB

Pericarditis
May its medial cerebral artery

-Old pt after rectal surgery he is not doing well after in the recovery he start to have leg pain
he developed DVT from the popliteal to the femor???

Enoxiparen

Heparin Warfarin IVC

Pt fibroadenoma, after excision ( fibro sarcoma ) ?! Wt next??

No need for further intervention

Mastectomy Chemotherapy Close follow up

Vaginal bleeding, just spotting, pt stable, soft abdomen, close cervix??

Threatend abortion

Missed Complete

40 yrs heavy bleeding, endometrial thickening, wt do ?? D and C

OCP
Hysterectomy

-Primary dysmenorrhea management ??

Aspirin

-Pt with severe abdominal pain with mentural cycle ( dysmenorrhea) affect her work what
can you give??

A-Mesprostol B-Paracetamol C-Progesterone D-OCP

-Female pt compline of dysmenorrhea
What is the most valuable history to evaluate? A- family history
B- medical history
C- surgical history
D- menstural history

-Asthma pt how to council?!

Keep the humidity more than 50%
Place the carpets in living and playing rooms Wash the sheets with cold water
-how to low the asthmatic attack :??
1) carver at home
2) humid air at home
3) wash bed sheets with cold water 4)playing outside

-The baby of diabetec mother distressed, wt to do

Admit ICU

-year old woman known case of DM and knee osteoarthritis ,She has been using NSAID to
relieve her pain. She developed HTN, Na normal, K below borderline what do think the cause
of HTN??

Essential hypertension pheochromocytoma NSAID induced HTN

Primary hyperaldosteronism

-Pt fell on outstretched hand pain in the snuffbox, where is the fracture?! Other recall I
found it in 2018 bankQs Scaphoid
-Fall on outstretched hand : name of fracture?
Colles fracture

-Pt with Hx of ectopic pregnancy, wt to counsel

Follow up since early pregnancy

Don't get pregnant again Intrauterine insemination

-Female had previous ectopic pregnancy want to conceive 1- early detection of pregnancy
2- folic acid therapy

-Typical Parkinson case , where is the lesion :

Substantia nigra

-Patient with rest tumer, mask face, shuffling steps:

Parkinson’s disease

- typical senario of Parkinson and they ask about what you will do to confirm dx?

Mri brain atrophy in MRI

-62 yrs, diabetic with pneumonia n sepis Which indicates bad progonsis ??

Age

Pleural effusion DM
High WBCs

Pt has night sweating, fever, haemoptysis --> TB

Neutopenic sepsis, total 1 n 10% neutrophils

Give IV antibiotics

Give IV antibiotics n anti fungal Give IV antibiotics n anti viral

-A mother brings her 6 month old child for a dTap vaccine, but she informs you that he
suffered from a febrile seizure after his last dose. What will you do?

a. Tell her that her son needs to take the vaccine regardless of the reactions

b. Postpone DTap for 3 months

c. Tell her that febrile seizure is not a contraindication of the vaccine and give the
vaccine now

d. Febrile seizure is a definite contraindication of DTap.

-Pt suspected MERSCov2 Does not want his illness to b known cuz he does not want to loose
his job, and the infection control department in the hospital want a report about the case ,
wt will u do !?

Wait for the result and then report

Report as suspected case within 24 hrs

Patient with ebola and wants to leave if you dont discharge him, how do you deal with him?

1-Call security

2-make him sign papers to leave

-the father who does not want the vaccination??

Explain to him

-the pregnant one who didn't want the blood and about to faint in the operation,? I think
respect her order

-doctor manipulated data in his research to produce better results. What is this called? A-
Falsification.
-A child came with potential toxic dose of paracetamol. The physician requests an
“Acetaminophen level”. The lab technician calls to report results. He says: “two” stops and
pauses and then says: ”one, three”. The nurse mistakenly writes it as “2.13” while the real
result was “213”. The patient went into irreversible liver damage. What was wrong here? A.
................

B. Poor communication

C. Nurse who failed to repeat the result and double check she got the accurate
result.

D. Lab technician who didn’t repeat or double check that the nurse heard him and recorded
correctly

Malaria pic of course??

plasmodium falciparum

S/E of amytriptaline??

Drowsiness. Blurred vision. Constipation. Dry mouth

-Which tocolytic causes patent ductus arteriosus ?? Nifidipine

Arbostan
Endomethacin !!!

Rotidrone

-Pt 27wks in labour 6cm dilatation wt to give?! Steroid

Abx
Arbostan

MgSo4

-ECG pic, wt is the prognosis ??

I choose he will need pacemaker

-Pt 18months vaccinations according to the national program, he had IVIG for kawasaki Wt
not to give ??
-Measles
-Dtap

Baby when put on examining table, laughs outloud n when the doctor comes he reaches his
mother how old is he?!

-senrio of vaginal discharge and unpleasant smell + clue cells, dx ?

A- bacterial vaginosis

-fishy smell scretion with clue cells?

A. bacterial vaginosis >>>Ttt is Metronidazole
-Post menepause with dyschezia last menstrual period was 15 months ago what to give? A-
Depo vera injection
B- Conjecated estrogen pill
C- Congecated estrogen pill

D- OCP

30 yo lady with endometriosis, tried NSAIDs with no improvement. Next? A. Oral

progesterone.
B. Combined oral contraceptives.
C. laparoscopic fulguration.

D. Hysterectomy with bilateral salpingoophorectomy

-Endometriosis laparoscopic pic

-Crohn's removal of terminal ileum wt to give

b12

iron
-The sensitive enzyme for left ventricular stretch?! Ck
Troponin T
BNP
-Young pt tachycardic 256 wt to do next?
ECG
Troponin
Echo

- Old dm in ICU multiple ABX with high liver enzyme?? Viral hepatitis
drug induce hepatitis
ischemic hepatitis

Pt in ICU, became hypotensive

Then has increased liver enzymes wt is the reason? Ischemic hepatitis
Other 3 options

- Child with history off febrile seizures came to ER complaining of jaundice , vomiting ,
drowsy in the history the mother was afraid from the febrile seizure , he gave her child every
4 hours an antipyretic : What’s the cause of the jaundice : ??

paracetamol toxicity

-paracetamol toxicity in child come after 3 hour of ingestion with high level of intoxication
seen ?

activated charcol

n acetylcystaine
Pt stab wound in the neck, actively bleeding US done and there was an injury in zone 3 Wt
will u do?? zone 3
unstable heavy bleeding- exploration
Exploration stable- endovasculer embolization

Vessel ligation

Primary closure

-pic of HSP Dx ??
-pic of HSP what is the management ?

A- conservative

B- B- antiviral C- Aspirin

-Impetigo picture came with a scenario. Asking about: Dx?

Impetigo

-Same scenario Rx?

A. Antibiotic

B. Acyclovir C. Steroid
first USG
-12 ys child with abdominal pain and vomiting with investigation? Abd Xray !!

-male with massive lower gi bleeding what is the most likely dx ? cecal cancer
diverticulosis

angiodyplasia

-Old pt, hypertensive, with left hemiparesis for 10 days! Imaging showed area of infarction,
what to give??

Aspirin

Apixaban Warfarin

How long you treat brucellosis ? 24weeks..3wk.. 6wk

-Pt liver cirrhosis with tender ascites Which of the following drug is best to prevent
recurrance ??

Aldosterone antagonist

Loop diuretic Osmotic diuretic

Which one of the following pt most likely to exhibit cyanosis? check pulse? Not sure
New born with truncus arteriosus

18months with muscular vsd

7 y/o with asd

-Best way to deliver oxygen for COPD patient ;? Oxygen mask

Nasal cannula Rebreather mask Venturi mask

What indicates a chest tube in a parapneumonic effusion? a. Negative culture

b. Serosangeous effusion
c. Glucose > 60

d. pH <7.2 indicates

A patient with pneumonia on medication presents with a parapneumonic effusion. The

pleural pH is 7.1. What is your next action?

a. Continue medical treatment

b. Chest tube drainage with antibiotics

c. Small pigtail drain with antibiotics

-RTA patient with dyspnic with chest pain and SOB, O/E conscious oriented, decrease
breathing sound Detect invastion to gasteric wall Detect Liver Mets Must Menstion the site ,
Here is symptomatic by pain Zone 3 in the neck , CTA must be done followed by
embolisation Tensionon the LT side and tympanic, abdominopelvic exam normal, vitals spo2
90% other vitals within normal best step in management:??

A)Plain x Ray

B)Needle decompression

C)Chest tube

Patient present to ER after RTA, with SOB, in examination the tracheal shifted to the right
side, in chest X-ray, the lungs are expanded and winded mediastinum. What is the diagnosis.
A. Tension pneumothorax

B. Cardiac tamponade C. Plural effusion

D. Raptured esophagea

30 weeks abdominal pain bleeding and CTG normal , normal contraction ?

Abruption

Previa Preterm labor

Pregnant women 32 weeks complaining with vaginal bleeding (I think there were also
contractions and dilation).??

A. Early postpartum bleeding. B. Late postpartum bleeding. C. Antepartum bleeding.

D. Intrapartum bleeding

pregnant Woman presented with lots of fetal movement followed by out with decrease
urinary and difficulty breathing Ptt prolonged, fibrongen was below normal , platelets low

A-acute glomerulonephritis
B-DIC
C-autoimmune thrombocytopenia purpur D-acute amniotic embolism !!

Preganant at 39 wks now in labour during the delivery you noticed the amnotic fluid is mixed
with Dark black-green what is the cause of this colour ?

fetal aspiration

fetal distress !

placenta abruption preterm labour

A long scenario and in the end, gave only the hyperkalemia lab , what is th finding :??

A-Peak T wave

B-Peak w ave C-Narrow QRS

mild SOB?

Nyha type2

-22 month infant with right inflamed red hemi scrotum, on examination there was red firm
irreducible painful scrotal swelling which is extended to left inguinal region. Left testis
couldn't be palpated. What is the diagnosis?

A. Torsion appendix testis.

B. Testicular torsion

C. Epididymo orchitis. D. inguinal hernia

-Child came to ER with DKA symptoms, Started IV fluids, What to givenext? His K normal
Slightly elevated bicarbonate High glucose??

A-Start IV insulin

B-Start K
C-Start bicarbonate
-Female pt did left lower parathyrodectomy then she had fatigue and elevated parathyroid
hormon What is the cause??

A) new adenoma

B)missed adenoma

C)parathyroid hyperplasia D) parathyroid caner

-pelvic organ prolapse case, ant bulging mx?

Pessary

Colporrhaphy Exersice Forget

Calculate GCS pt with open eye for pain, inappropriate word, and flex to pain? 5.. 6.. 7.. 8

-Newly diagnosed DM1 given insulin now has hypoglycemia, why?

Honeymoon

-patient removed calculi from kidney by surgery then they found out she has E coli what can
this cause?

Sepsis

Bacteremia

-warfarin did not stop by patient regardless of clear instructions, the nurse in OR noticed
that the patients didn’t stop the drug as instructed and informed the surgeon, So the
surgeon postponed the operation:??

near miss

adverse event medical neglicance

-Surgery safety checklist: according to WHO??

A-Before anesthesia, before skin incision, before leave OR.

B-before admission, before anesthesia, before discharge c- before OR, during operation, at
recovery room

-Child with dysphagia liuqed only first investigation??

1- barium swallow

2-upper gi endoscop

-UTI management in patients allergic to penicillin, sulfa drugs and shellfish. What is the
antibiotic?
A. Nitrofurantoin.

B. Ampicillin.

-baby just delivered after CS and looked disstress and meconium staining ...... , what is the
management?

A- surfactant lavage

B- nitric oxide

C- chest tube D - diuretics

-38 weeks CS baby with tachycardia and grunting?

TTN

nurse work in pulmonary clinic with Productive Cough and fever in x ray > patchy infiltrate >
and not respond to AB the organism:??

streptococcus pneumonia strepto group b

strepto group a Mycoplasma pneumonia

-child (1year I think ) with eczema symptoms in scalp and extensor areas what is the dx??.

infentile eczema

early childhood eczema

-Pic of rooting reflex and when to disappear?

4 month

- chancroid picture

-senrio of vaginal discharge and unpleasant smell + clue cells, dx ?

bacterial vaginosis
bacterial vaginosis ttt ?? Metronidazole

-The GOVERNMENT did campagon to encourge low fat products and low salt in order to
prevent HTN and DM. What kind of prevention?

Primordial

Primary
-Screening of HBV during pregnancy? Primary
Secondary

-old patient came with subdural hematoma with signs of lateralization imaging revealed 13
mm shifting. his GCS 7/15 then was intubated and resuscitated what to do next?
iv mannitol
admit ICU and observe craniotomy
insert intracranial monitor

-Female with menorrhagia and dysmenorrhea and try to get pregnant since 2 year? -
Adenomyosis
- Endometriosis

-Endometriosis most acceptable dx method? MRI

Laparoscopic
US

30 years female with endometriosis not respond to NSAID what is the next step mx (not
mention if desire to be pregnat or no) ??

- OCP

- POP
- Total Hysterectomy

-A year back Hx of trauma and patient is paraplegic came now with SOB and Cough
diagnosed as PE with DVT and patient is HD unstable??

Exoparien

TPA

IVC

Patient with a history of perforated ectopic and previous management , came now with
lower abdominal pain Negative pregnancy test Labs show : 18000 bhcg Hb low How to
mange?

- consult surgery for possible acute abdomen - misoprostol

- surgical management after stabilization

Adnexal tenderness usually occurs in the ovary or fallopian tubes. Examples of adnexal
masses include:

ovarian cysts .. ectopic pregnancies.

Adnexal tenderness try to concive ?? bad recall !!!

Painless penile ulcer= syphilis

-Pt stab wound in chest. Increased jvp, difficulty to breath. EBAE, muffled heart sound?

- cardiac tamponade

65 years with abdominal pain and ischemic heart disease ??

Mesenteric ischemia
-Case I don’t remember the details but there was blood coming from ear and perforation
tympanic membrane?

- basal skull

- subarachnoid hemorrhage RTA Pt with battle sign ?? Fx base of skull

- A victim of an RTA presented with blood at the meatus. A Ureteroscope urethrogram was
done and showed injury to the bulbar urethra. What is the next step?

Suprapubic cystostomy

Lady lower back pain when leaning forward improved?

Lumber spinal stenosis

hyponatremia and hypervolemia pedal edema bilateral crackle?? I don’t understand

diuretics !!

5NS 1NS

-Woman at 42 years age no family hx of breast what test screen now? US

Mammogram
Colonscopy

patient had subcutaneous nodules, fever and arthritis. Which of the following confirms the
diagnosis?

A. High CRP
B. Positive culture
C. High ESR
D. Positive antistreptolysin titer

-Cystic fibrosis mode of inheritance :???

Autosomal recessive

-Child with leukemia on chemotherapy had contact with another child with chickenpox what
appropriate to do?

Give varicella vaccine.

Oral acyclovir for 7 days.
Give immunoglobulins.
Stop chemotherapy for 14 days

-child presents with hip and groin pain. An US was done to reveal hip joint effusion. He is
afebrile. What is the most likely diagnosis?

Toxic synovitis
Benign acute myositis Osteomyelitis
Septic arthritis

-pt fall down from 3 m,has open fracture in his rt foot , looks dirty wound. What first thing to
do ??

Antibiotics

External fixation

Debridement !!

6. Pediatric patient brought by his parents. X ray showed widening of the ends of his bones
(growth plates) Calcium (low) PTH (mildly high) Alkaline phosphatase (very high) What does
the patient have?

Hypophosphataemia primary hyperparathyroidism

vit D deficiency rickets

renal osteodystrophy

high grade fever +Respiratory distress + drooling + tripod?

Epiglottis

Same scenario investigation ?

Lateral neck xray

Red nipple discharge mammography showed intraductal papilloma ??

Core biopsy

Mastectomy

-Patient with family or Mediterranean fever implied by history of fever and similar
occurrence in the family of which origin was Mediterranean asking about which drug to
avoid?

Amoxycillin

ibuprofen
aspirin ( some doctor say this ) !! paracetamol

-Pt has resistany HTN on 4 medication and found on US to have one small kidney, dx?

Renal artery stenosis

polycystic kidney disease

-Elderly with GERD not respond to PPI what is the next step ? manometry
24h monitoring PH
lifestyle modification.

nissen fundoplication

-Gerd with distal esophigigtis what most appropriate to do next :

Bid antacids

Rantadine Surgery

Pap smear show ascus??

HPV testing

Colposcopy
(2 ascus > colop , if only 1 > hpv)

2- syphyls labia only Dx

3. Ctg normal
4. Ctg variable deceleration
5. baby hand open fracture
6- leg fracture open
6. Impetigo chin
7. digoxin toxicity ECG
8. Falciparum, stems with all malaria options but different species
9. ECG unstable angina
10. Heart block- mobitz type 2 need pacemaker

1. Double effects
2.
3. camping to reduce HTN > primary
4. screening of HBV > secondary prevention
5. Camping for low salt diet primordial;
6. Poor comunication with nurse for dose
7. Or checklist 2 question
8. Falsification
9. sub dural hematoma what is the definitive Tx manitol – craniotomy -
hyperventilation
10. dementia Dx
11. Parkinsons dx 2 questions
Parkinsons location of lesion > substansia nigra
12. Migraine throbing pain acute treatment > triptans
13. Milestone- 3 year > catch ball with leg – walking – 3 cubes – trace triangle
14. Milestone >scenario and need timing ( child walk and play and put 3 cubes
)10-12-15-24 month
15. Introduce peanut > 10 month
16. Iron screening > 12 month
17. 2 cases of iron deficiency anema need treatment ( ask what is increase in
IDA > habtaglobulin or TIBC or ferritin or iron
18. Pica case with lead 2 > treatment > d-penecillamin
Case of sjogren syndrome type of ATA with hypokalemia > type one is the
right answer
19. child 7 year with bleeding in terminal ilum fresh blood > crohn –
angiodysplasia – mecklediverticulum- peptic ulcer
20. Testicular torsion 2 cases Dx and Tx easy
21. hernia post surgery want to be pregnant > 12 month
22. how to Dx trachiomalacia > bronchoscope – x-ray – ct -
23. women take Hpv vaccine and came after 3 month > give her second dose
24. Hpv screening age ( she is 18 year ) > came after 3 year
Women medically free age 45 want to do colon cancer screening > came after
five year or do it now or no need for screening at all
25.
26. Celiac disease 2 question ( baby have symptoms and you think it is celiac
you advice him to do ggluten free diet and Sx relive what to do > stop diet –
refer to ditetion – refer to gastroenterology
27. Thyroglossal cyst easy ( mass move with tongue protrusion and swallowing
28. Women bleeding PPH 5 question ( what is the syndrome after PPH ) how
to treat PPH
give scenario of PPH and ask what is the cause ( laceration – coagulopathy –
decrease contraction )

29. Prom comes after 4 weeks with clear fluid and gest age 33 i think, i choose
take swab for culture
Women in labor contraction and pain what to do next ( US –speculum to see
cervix open or not – aminocentesis ) easy
30. Gauze left in vagina, comes with fever 10 days postpartum dr gives
paracetamol and send back, she goes to other obstetrician and she tells her.

DONE BY DR.SAAD