Hypoglycemic Child with characteristics urine smell, +ve ketones and metabolic acidosis?

A) Phenylketonuria
B) maple syrup urine disease
C) Galactosemia

ECG Changes in hyperkalemia.

A) Peaked T wave
B) Narrow QRS
C) Prolonged PR interval
D) Peaked P wave

12- Patient presented with abdominal pain for 1 day intermittent, right sided pain and fullness and rigidity
Pregnancy test is negative (she was hypotensive and had fever)
A- Appendicitis
B- Ectopic pregnancy
C- Ovarian torsion

4 months old girl, during Pneumatic otoscope unilateral non-purulent effusion and decrease tympanic
membrane motility , no fever pr other symptoms, and no hx of previous infectious diseases, breast feeding
very well and no use of pacifier, What’s the best next step?
A- use amoxicillin tx
B- use of amoxicillin and clavulanate
C- Observe and F/U for 48hrs
D- Refer for ENT to evaluation for tympanostomy
tube

Big cyst in liver has multiple daughter cysts inside of it how would you manage
- surgical deroofing cysts

Diabetic and hypertensive what to start?

A. Acei
B. Diuretics

Pt with bilateral hilar lymphadenopathy, Lung biopsy done showed Non caseating granuloma, management ?
Observe
Steroid
Anti tb
DID NOT MENTION Ca LEVEL!
Indication to start oxygen therapy for copd
2 reading 7.3
2 reading 5.6
1 reading 7.8

Pt fall from height came with blood out from ear:

A. Mastoid
B. Basal skull fracture

Patient known case of RA on methotrexate and prednisoline and know presented with joint pain and on
examination she has tenderness , the question ask for the management:
A- Azathioprine
B-NSAID
C- start biologics

Patient presented with seizure and then gave the lab results
Na : 112
K : normal
Urine osmolality : normal
All labs are normal except Sodium and serum osmolality slightly low
What is the diagnosis :
A- Conn’s disease
B- Addisons disease
C- Cushion disease
D- SIADH

Infant boy US show bilateral hydronephrosis and thickened bladder wall . What’s the highly diagnostic
investigation ?
A-IV pyelogram
B-MCUG
C-DMSA

5 days Boy with single artery umbilical cord

A. Dm mother
B. Africa race
C. Low fetal risk
D. Risk of fetal malformation 80%

The charcot triad is to diagnose?

Cholangitis
A doctor used the Foceps, place it in wrong position and injured the stylomastoid bone, what is the result?
Baby cannot clos his eyes
Loss of taste in anterior ⅔
Woman came with neurolupus. What’s the first line treatment ?
A-corticosteroid and cyclophosphamide
B-IV corticosteroids
C-IV cyclophosphamide
D-cyclophosphamide

56 years old patient had an upper Gl bleeding due to esophageal varices and was given IV fluid. Which of the
following should be given to reduce mortality?
A. Vasopressin
B. Octreotide
C. Nadolol
D. Ceftriaxone

Patient came with vaginal discharge she have done CS with episiotomy 10 days ago , the obstetrician
diagnosed her with UTI and described Abx , but she did not improve then she went to another obstetrician
and he found infected vaginal swab , What is the medical error done by the first obstetrician?
A. let the midwife assist him and depend on her
B. doctor failed to follow the surgical safety protocol in the OR
C. No communication between the 1st and 2nd obstetrician
D. Genuine different assessment or diagnosis of patient case

Pt old his regular doctor transfured to another hospital he’s upset and wants medical record and referral to
his regular doctor
A- Convince him that there’s equally compitant doctors
B- Give report and refer him
C- Refuse
D- Calm him down and tell him to come tomorrow to decide

months old child came to clinic with his mother for taking hepatitis A vaccine, The mother tells you that he is
a know sickle cell disease patient and that he received blood transfusion 1 week ago, what to do?
A. Give vaccine as per schedule
B. Check his hep A serology first
C. Delay for one month
D. Delay vaccine for 6 months
\

Patient undergoing laparoscopic cholecystectomy, as they were inserting the tubes "laparoscopy equipment"
patient developed severe bradycardia 40 min/hr, What could be the cause?
A. Cold air inflation
B. Streching of the preitoneum

Another recall
Patient undergoing laparoscopic cholecystectomy . after creating pneumo pretonium and insertion of the
trochar the patient developed brady cardia What is the likely cause
A- Cold Gas insufflation
B. Rapid stretch of Parietal Peritoneum
Answer: B
61-Mother came with her child for preschool Vaccination, Which of the following is important Vaccine to give
:
A-RV
B-OPV
C-Meningococcal ( MCP4 )
D-Hib

Pt had chemo session then developed signs of infection diagnosed as deep aspergillosis, What is the treatment
of choice for aspergillosis?
A.voriconazole

Pregnant lady 26 weeks gestation, presented with large genital wart, how you gonna manage?
A)Cryotherapy
B)Thermal
C)Intralesional immuno … injection
D) podophyllin

40-Pregnant lady 35 weeks gestation Known case of Bicornute uterus in leopoid manouver you found globally
soft structure in 1&2 grib Fetal heart in the level of the umbilicus of the mother Fetal kicking felt in lower
abdomen How you will deliver this baby?
A) CS
B) Normal vaginal
C) Ventose
D) Forceps
42-Newborn/infant with stridor worse when prone, improves when supine, mother is concerned, what to do?
A Start laser treatment
B tell her it will resolve on its own by first birthday
C Tell her it will get worse
D-Do Laryngoscope

43-Pt came with signs and symptoms of TB fever, hemoptysis and so on…You did x-ray and found cavitation,
What will you do next?
A-sputum AFB
B-start INH, rifampin, ethambutol and pyrazinamid
Pt known know case of diabetes Mellites came with abnormal liver function test LFTS were all high:
A- hemochromatosis
B- viral hepatitis
C- autoimmune liver disease
D- non -alcoholic fatty liver disease

42 man came to hospital complain of SOP, fever and fatigue for few days, physical examination rise JPV
pulsus paradoxus And distant heart sound Which involve?
A. Valves
B. Pericardium
C. Myocardium
D. Coronary artery
What is the treatment of brucellosis in adult (28 y/o)
A. Doxycycline and streptomycin
B. Doxycycline and cefriaxone
C. Rifampin and trimethprim-sulfamethaxazone
D. Rifampin and ciprofloxacin

53-Lady, with bruises and fracture bc her husband beat her, what to do?
A- educate about violence
B- inform authorities
C- talk to the husband

Pediatric age pt presented with his mom to ED she said that her child ingested large amount of paracetamol (i
think) the pt was healthy no signs of any toxicity on presentation, they observed the pt for 4 hours with no
any change in health no signs and symptoms of toxicity, the mom then mentioned that she found some of the
drug was spilled on his clothes and in the floor, what is next?
A. Reassure
B. Watch for another 4 hours
C. Give antidote

27-37 years old female her father has colon cancer when he was 55 and her mom had breast cancer when she
was 43, asking about screening?
A.She should do mammogram annually
B.Start mammogram at 40
C.Start mammogram at 40 and colonoscopy at 55
D.Colonoscopy at 50

29-Patient with Hip Fracture underwent Hip fixation repair surgery. What anticoagulant to give to prevent
DVT?
A) Enoxaparin Subcutaneous (SC) 40 mg daily
B)Heparin 1000 units BID

30-What type of polyp with highest risk of cancer?

A. Villous
B. Tubular
C. Tubulovillous

34-Case of hydated cyst and ask about definitive treatment?

A- albendazole
B- surgical deroofing
C- percutaneous drainage
D- liver resection

1-56 year old male with long standing heartburn, did endoscopy and showed barrette esophagus with low
dysplasia, what is the initial
A Esophageal resection
B Pantoprazole
C Renitadine

🟪
D Sucralfate

🟪
Barrett alone (metaplasia): PPIs and rescope every 2–3 years.
Low-grade dysplasia: PPIs and rescope every 6–12 months.
🟪 High-grade dysplasia: Ablation with endoscopy: photodynamic therapy, radiofrequency ablation,
endoscopic mucosal resection.
3-Case of stroke and complain of weakness in the arm leg and face, intact speech and sensation where’s the
damage?
A. Middle cerebral artery
B. Anterior cerebral artery
C. Mid basilar artery
D. Vertebral artery

9-Patient knowing for DM And HTN and history of right leg pain increased by exertion, on examination
absent popliteal pulse on right leg
Which one of the following indicates acute limb ischemia:
A- I forget but it’s suggestive for chronic limb ischemia
B- intermittent claudication
C- rest pain
D- scar for iliofemoral bypass in left leg

10-Pt had fibroid myomectomy, risk of placenta accreta?

A) Decrease
B) Increased
C) Unknown
D) No risk

38 YO female presents to the clinic after finding of hilar lymphadenopathy on CXR. She has on and off
cough, but denies any fever, headache, n/v, weight loss all negative. Labs insignificant except for X-ray shows
confirmed bilateral hilar lymphadenopathy CT guided biopsy shows noncaseating granuloma What is the
best next step in management (They wrote “all labs were normal” and didn’t mention hypercalcemia)
A-Observe
B-Start prednisolone
C-Start azithromycin
D-Start anti TB medication

Newly married female came for routine chick up, Most important exame
Pelvic digital examination
Vaginal exam
Abdomenal us
General appearance
patient took 3 dose Hb and exposed to infection
will find in his serum
Hbc ab
hbe ab
hbs ab
hbsab +hbc ab

child with unilateral gynecomastia, tell him this is present in all men in some degree
reassure as it will resolve in years
cold comprss bandage
There was lack of invelonza vaccine which most important group to give?
A- school children
B- pregnant women
C- child with SCA

8 years old boy. Mother complained of poor training to bathroom which muscles is targeted in therapy?
A- Perianal
B- Pelvic floor
C- Rectus muscle
D- Detrusor

Pregnant women Last menstrual period 7th of May, she has regular period and is sure about it. What is the
Expected date of delivery?
A. 10 February next year
B. 10 December same year
C. 25 December next year
D. 30 February next year

- Patient came fracture and compartment syndrome, what’s the first alarming sign?
A. Absent pulse
B. Toe discoloration
C. Paresthesia

The government did a health campaign to encourage the consumption of low- fat products and a low salt
intake in order to prevent hypertension and diabetes. Why type of prevention is this?
A) Primordial prevention
B) Primary prevention
C) Secondary prevention
D) Tertiary prevention

full term born came with respiratory distress and chest X ray showed fluid in the fissures. He is born by
cesarean section. Most likely diagnosis
A-Transient tachypnea of newborn
B-Sepsis
C- Meconium aspiration
D-Hyaline membrane disease

Confirm test of molar pregnancy

Mri
Us
There was an option (US and BHCG)

17y female with uterine bleeding, recurrent every 6 to 8 w,examined all things are normal what is ur
management
1-reassurance
2-pco
3-hystrectomy

child had meningitis, and he contacted his brother & sister, what will give as prophylaxis ?
- penicillin + rifampicin 2 times
– penicillin
- Ciprofloxacin one dose
- Ceftriaxone 3 doses IM

Case of anemia , child had pica and abdominal pain and constipation Lead 2 Iron low TIBC high, Asking
about Tx ?
I think it’s lead poisoning
D peniccilmine

Folic acid porophylacsis for 27kg BMI, the choices were weird
0.2
0.8
4.5

Baby Preterm diliver (didn't specify CS or SVD). 4 hours later complaining from SOB , Tachypnea,
Tachycardia with grunting
1- Hyaline membrane disease
2- pulmonary "something"
3- Meconium Aspiration syndrome
4- Transient Tachypnea of the New born

Baby born in 38 week ( not preterm ) via C/S and after that develoe tachycardia and tachypnea and grunting
1- Hyaline membrane disease
2- pulmonary "something"
3- Meconium Aspiration syndrome
4- Transient Tachypnea of the New born

18 married girl when to start pap smear ?

At age 21

Pediatric known of having febrile seizures , had fever ( and maybe vomiting ?? )and mother started giving
him paracetamol every 4 hours because she was scared of him having seizures, on examination he was
jaundiced and had hepatomegaly
- hemolytic uremic synderome
- acute viral hepatitis
- paracetamol toxicity
- viral induced hemolysis ( something like this )

55 y.o Patient k/c smoker only. Presents with signs and symptoms of MI. ECG shows lead II,III,AVF
depression. Hist vitals are: BP: 150/92 Pulse: 99 Which of the following is the most considerable risk factor
for MI in this case?
A. HTN
B. Smoking
C. Age

MI Risk Factors:
• Most common: HTN
• Most serious/highest: DM
• Most considerable: Smoking
• Most preventable: Obesity

14ys girl with painless vaginal bleeding every 3 weeks to 2 months with NO clots or menstrual symptoms
examination show normal breast and pubic hair development what investigations you will order:
A- LH hormone
B- reassure
C- ultrasound

Pregnant with SC trait.complication ?

-IUGR
-UTI

New born what to examin?

Hearing
Vision
Hearing and vision
Calculte Apgar score: Pink body, blue extermities, Heart rate : less than 100, Respiration: weak cry, Some
movement in flexion, Reflux: some muscle ( cant remember this part well). Apgar score is:
A- 3
B- 5
C- 7
D- 9

What is the cause of This CTG:

MgSu
Epidural

(the mum was hypotensive)

8- A pregnant 10 weeks GA woman the cervix dilated ( 3 cm i think) tissue passed out , in examination the cevix
was open ?
A. Inevitable abortion
B. cervical incompetence
C. Incomplete abortion
D. Threatened abortion

15- A pregnant woman presented with massive vaginal bleeding from the abruption placenta
and her Hgb: 8.6, BP 84\40, HR140. What is the best management to save her life?
A- Admit to ICU
B- Immediate Transfusion of 2 packs FFP
C- Call multidisciplinary and rapid response team (RRT)
17- Symptoms of epiglottitis, what is the organism?
A. H.influenza type B

20- The government did a health campaign to encourage the consumption of low- fat products
and a low salt intake in order to prevent hypertension and diabetes. Why type of prevention is
this?
A) Primordial prevention
B) Primary prevention
C) Secondary prevention
D) Tertiary prevention

22- A Child came with a potentially 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, which of the following explain the
error that has happened?
A) Doctor did not check
B) Lack of communication
C) Technician didn't check if the nurse got the number correctly
D) Mishandling from the nurse

26- A physician was working on a research paper.Before publishing the paper,he made some
changes to some of the data and omitted other parts of his results. What is this action referred
to?
A) Falsification
B) Fabrication
C) Plagiarism
D) Near miss

27- baby 2 years old, shout and say NO. Which of the following would you advise
this mother?
A) Ignorance
B) Counselling
C) Positive reinforcement
D) Punish the child

Better recall: 2.5 y/o boy keeps yelling NO (and some other like this) what will you
advise the parents?
A- Ignorance
B- Counseling
C- positive reinforcement
Answer is positive reinforcement.

28- An elderly with end stage cancer c/o severe pain. The family asked the physician to give a
stronger analgesic or to increase the dose. The doctor explains that while it might help alleviate
the pain, it also might hasten their father’s death. Which of the following is this referred to?
A) Principle of subsidiarity
B) Principle of double effects
C) Principle of totality

41- Organism for septic arthritis?

A- Staph aureus

43- 8 years old boy. Mother complained of poor training to bathroom which muscles is targeted
in therapy?
A- Perianal
B- Pelvic floor
C- Rectus muscle
D- Detrusor

45- There was lack of invelonza vaccine which most important group to give?
A- school children
B- pregnant women
C- child with SCA

52- Female with vaginal discharge Grey, fishy odor , smear : show clue cells, diagnosis?
A. Trichomoniasis
B. Bacterial vaginosis
C. Candida
^^^The Q was about the Treatment

Patient with multiple painful genital ulcers

HIV
Hepes
Others and no syphilis in chices

56- trauma pt diminished breathing opening on the axillary and you can hear squeaking or
bubbling from the opening:
A- chest tube insertion
B- thoracostomy
C- Dressing three side

64- 30 y old male came with dyspnea, chest pain, PND and orthopnea. On examination:
pansystolic murmur Gallop S3 with displaced apex, no any significant medical history. Most
appropriate next step:
A- Echocardiography
B- Chest x-ray and ECG
C- Beta blocker
D- Lasix

75- 6 years old child presents with palor and organomegaly investigations shows pancytopenia (
this is the hole case )
A- acute myeloid
B- acute lymphoblastic
C- chronic myeloid

A 6-month-old female child brought by her mother because of skin lesions on the extensor surfaces, scalp, with
sparing of the diaper area. Lesions were erythematous with plaques over it. What is the mainstay of treatment?
A* Vitamin D.
B* Phototherapy.
C* Ensure good hydration of the skin.

BIRAD 4 what is next?

Biopsy was one of the choices

Patient diabetic admitted to hospital on Metformin , which is best during hospitalisation :

A. Metformin
B. Sliding scale insulin
C. Pre and post prandial insulin

Child with recurrent UTI Which test will to look for renal scarring?
MCUR
US
DMSA

29-Patient with Hip Fracture underwent Hip fixation repair surgery. What anticoagulant to give
to prevent DVT?
A) Enoxaparin Subcutaneous (SC) 40 mg daily
B)Heparin 1000 units BID

40-Pregnant lady 35 weeks gestation Known case of Bicornute uterus in leopoid manouver you
found globally soft structure in 1&2 grib Fetal heart in the level of the umbilicus of the mother
Fetal kicking felt in lower abdomen How you will deliver this baby?
A) CS
B) Normal vaginal
C) Ventose
D) Forceps

Patient with poor LV ejection fraction taking ACEI and furosemide still the BP is not conreolled what to add?
CCB
BB

Long scenario of then they say they put him on angiotensin receptor ll blocker, which is the most probably drug that
the pt was given?
1. Cardivol
2. Irbesartan
3. Amidarone
4. Lisinopril (I think)

Answer is 2
Fragility test
Inferior MI then —— right sided ECG