Académique Documents
Professionnel Documents
Culture Documents
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11-yr old sustained trauma to the chest present with severe short of breath with
cyanosis, his rt lung is silent with hyperresonance. The FIRST step to treat this pt:
a. O2 mask
b. Tube thoracostomy
c. CXR
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12- Patient with hypertension , DM, somking, which the following are most
important to be deal with :
obesity and HTN ???
smoking and obesity
smoking and HTN
13-baby with streptococcal pharyngitis:
- Ttt after 9 days carries no risk of GN
- Ttt effective in prevention of GN
- Clindamycin effective against gram ve organisms
all choices are wrong
14- Hx of trauma in DIP(finger hyperextention)with palm pain: (incomplateQ)
- Extraarticular fracture in DIP
- Intraarticular fracture in PID
- Superficial tendon tears
- Tendon profundus tear??
15-pt with pict of bilateral pneumonia , high grade fever , normal WBC . organism
causing that:
- Chlamydia pneumonae
- Leigonella sp. (cause neutropenia)
- Staph pneumonae
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16-ttt of cold induced urticaria:
- Cemitidine
-diphenhydramine.
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17-methyl-progesteron used for PPH what is contrindication :
Pregnant with asthma
Pregnant with hypertension
Pregnant with DM
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18-what is the most common cause of death in patients with Ludwig's angina?
sepsis
3
Sudden asphyxiation
rupture of the wall
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19- 4 days post c-section pt with profound hypotension
a-normal saline 5ooml IV with to big lines
b-dopamine
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20-Adult male during excercise he suddenly felt pain in the middle of his rt. Thigh
posteriorly. On exam. He has discoloration in the same site and mass in the
hamstring ms. No bone tenderness or palpable defect. Mx:
Surgery.
Splint.
Bandage.
Ice, elevation and bandage
Cast.
21-patient has complete ptosis in hih rt eye. pupil is out and down, fixed dilated.
restricted ocular movements. dx
a. 3rd n palsy.
b. 4th n palsy.
c. 3rd and 4th.
d. 6th n palsy
22-target lesion are found in erythema:
a-annular
b-marginatom
c-multiform
d-nodosum
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23-patient came with cervical carcinoma next investigation :
-cone biopsy
- Direct biopsy
-pap smear
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24- the best to give as DVT prophylaxis post surgery which is cost effective, safe
with high efficacy:
a) LMWH
b) Unfractioned Heparin
c) asprin
d) Warfarin
25-case of right hypocnodrial abdominal pain for 2 hours after eating for months
no fever no jaundice, no radiation and nothing suggistive of cholycytitis
what is the investigation
4
a- US
b- oral cholystogram
c- iv cholystogram
26-72- pt intubated ,the most reliable method to make sure for tube proper
position:
- 5 point auscultation bilaterally breathing heard
- CXR
27-23 years old female with regular menses. On US, she has a 7cm ovarian cyst.
otherwise everything is normal. dx:
a. corpus luteum cyst
b.follicular cyst
c.teratoma
d.another cancer
30- regarding paracetamol toxicity:
- Not toxic if dose exceed 150-180 mg
- Cause vomiting and neuropathy
- Therapeutic effect after 4 hours
- Use Deferoxamine
-the liver enzyme reach the max. Level 4-6 hours after ingestion
31- 22 yr, low HGB low PLT and high WBC , peripheral smear shows blast cell
with large nucleus and scant cytoplasm and some nucleoli -- positive
meyloperoxidase test and negative esterase , DDx:
- Acute lymphocytic
- Acute myelocytic
- Acute monocytic
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32- child with hyperemia and pulging of tym mem had previous history of
treated impetigo so ttt is:
- Cefuroxime
- Amoxicillin (not sure)
- Erythromycin
- Ceftriaxone
- Cephalexine
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33-child , urine odor like burned sugar:
- Phenylketonuria
- Maple syrup urine disease
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34-40 yo presented by hx of syncope when he do excurses and there was hix of
same complain when he on rest . and there is chest pain on ex. There was
ejection systolic murmur 2-4 degree most side is lower lf sternum not radiating to
5
other site increase when he lying down and there is non specific s and t changing
and there is lf atrium enlargement
Aortic stenosis
p.s
hypertrophic cardiomyopathy
constrictive cardiomyopathy
35-Pt. had chest pain and fainting , ECG shows st- elevation and significant Q
wave in -v4 and st-depression in inferior leads :
Ant. MI
Inf. MI
Pericarditis
Post. MI
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36-A patient with normal kidney function post MI. The troponin level will last for :
A. 48 h
B. 73 h
C. 24 h
D. 12 h
E. 8 h
37-In lung diseases like pneumonia, it usually affects certain site based on the
anatomy, this is more obvious in which of the following:
Right upper lobe
Right middle lobe
Right lower lobe
Left upper lobe
Left lower lobe
38-in lung diseases like pneumonia, it usually affects certain site based on the
anatomy, this is less obvious in which of the following:
Right upper lobe
Right middle lobe
Right lower lobe
Left upper lobe
Left lower lobe
39-Pt. above 40 , pregnant and ask you for down syndrome screening :
Triple test
US
Amniocentisis
Chorionicvillus
40-You received a call from a father how has a son diagnosed recently with DM-I
for six months, he said that he found his son lying down unconscious in his
bedroom, What you will tell him if he is seeking for advise:
a. Bring him as soon as possible to ER
b. Call the ambulance
6
54-40 ys female, multigravida, no sexual intercourse for 1 year bcz her husband
going abroad, C/O was intermenistrual bleeding with menorrhgia, provotional Dx:
Endometriosis
Endometrial CA ??
ch endometrites
this is a common age of DUB not sure of the answer but according to the choices
it is B
55-patient with bed sore involve skin and extend to fascia and muscle what a
grade
Grade1
Grade 2
Grade 3
Grade 4
56-patient with rhumatic heart disease and had mitral valve stenosis
Mitral vave diameter less than 1 mm
In order to maintain COP what will happen :
Left atrial hypertrophy and decrease pulmonary prusser
Left atrial hypertrophy and champer dilatation
RV hypertrophy and decrease pulmonary prusser
RV hypertrophy and champer dilatation
choices in other words
a. Dilatation in the atrium with chamber hypertrophy
b. Dilatation in the ventricle with chamber hypertrophy
c- atrium dilatation with decrease pressure of contraction
d- ventricle dilatation with decrease pressure of contraction .
57-55 years male with bleeding on examination have external hemorrhoid what to
do
advise him to remove it
do rigid sigmoidscopy
go home and visit after 6 months
do barrium enema
58-infant with high grade fever .. Irritable .. Look sick .. Complain of anuria 4 hour
with multiple petechiea and purpura on body .. He was tachycardic and
hypotensive DX
Renal fauiler
Septic shock
59-Verrryy long scenario of old age pt with DM, HTN, hx of multiple cardiac
attack, CVA, came for routine check up in PHC, u found bilateral opacification in
9
Vitiligo
taenia versicolor
92- attributable risk factor is :::???
measurement of exposed and not have the disease mius those exposed
and have the disease
93-29 years old male diagnosis as case of gastric ulcer , culture -ve h.pylori
pathology ve of cancer ttt:
proton pumb inhibitor
antihistamine
after 6-8 wk do endoscope after therapy
referral to surgery
94-32 years old with cystic mobile breast mass, no LN enlargement. What would
you do:
Aspiration with cytological evaluation
Reassurance
Fluroscopic biopsy
Mammography then discuss the options according to the new information
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95-Pt with hix of URTI for 3d then stat to develop rt. Ear pain rinnen test was
negative and wiber test (loud sound in affected side)
Mastoditis
O.M
O.E
96-3 months old baby brought by his parents complaining of abd. distention
bilious vomiting, constipation, the parents informed that the constipation has been
an issue since his birth
what is the single diagnostic investigation to do ??
barium enema
pain xray
??metery
rectal examination
97- A patient presents with long time history of knee pain suggestive of
osteoarthritis. Now he complains of unilateral lower limb swelling and on
examination there is +ve pedal & tibial pitting edema. What is the next
appropriate investigation?
a. CXR
15
b. ECG
c. Echocardiography
d. Duplex ultrasound of lower limb
98- patient came with MI 2 day after addmission develop. Sever
abdominal pain and bloody diarrhea DX
Ischemic colitis
- diffuse abdominal pain , bleeding per rectum and fever 38.3 c ,
preceded by urinary infection 3 weeks back treated with AB ,
diagnosis :
Ischemic colitis
Amoebic colitis
Pseudomembranous colitis
99- looong scenario about old male came with typical history of MI
all of the following can be used in the mX of this its except:
atenolol
heparin
sorry I couldn't remember the rest of the choices :(
100- Pt. with long hix of hyperthyroidism to screen about the complication of
hyperthyroidism do:
liver us
Ct brain
Bone scan (for osteoporosis)
101-to increase absorption of oral iron , give with:
- Vit C
- Vit E
- Zinc
- Ca
- Antacid
102- old, black macule on his back with irregular border and color variation :
- Sq cell carcinoma
- Basal cell carcinoma
- Melanoma
- Acanthic keratosis
103--cord prolapse at level L4-L5 the patient will presented by
a-painful calf muscle
b-absent ankle jerk
c-parethesis of knee joint
d-weak dorsiflextion
104-Old male with acute pancreatitis, (high glucose, low Ca)the appropriate
nutrition:
TPN
16
17
c- Pelvis X-ray
d- Thyroid or ( liver not sure ) function test
129-18month old boy came with bite by her brother what you will do ?
A) augmentin
B) titanus toxoid
C) suture
130-old pt with 2 years bone pain , lethargy , fatigue, wedding gait ,
came with table show high calcium and high phosphorus ;
A_ osteoporosis
B_ osteomalacia
C_ paget disease of bone
D_ metastases prostate cancer
E_ paraneoplastic syndrome
131-child with inferior and pain but with normal
movment of knee , no effusion on knee what the important thing to
do ;
A_blood culture
b-ESR
c_ASO titer
d-aspirate from knee joint
d-plain film on thigh
132-miliary TB caractarized by
a- spare lung apical
(b- septal line
c- multiple lung nudules
133-a man who has had MI you will follow the next enzyme
a) CPK
b) ALP
c) AST
d) Amylase
134-a child of parents who have TB, PPD test done for him and revealed 10 cm
induration, this is
strong +ve.
intermediate +ve.
weak +ve.
-ve
135-in aspirin overdose:
a) liver enzyme will peak within 3-4 hr
b) first signs include peripheral neuropathy and loss of reflexes
c) 150 mg/kg of aspirin will not result in aspirin toxicity
136-female pregnant has HIV +ve , what is the most accurate information to tell
her about risk of transmition to baby ;
A-likely transmtion through placenta
20
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145-you want to give varcilla vaccine in one no have vaccin before
antiparietal antibodies
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153-
...
Because the organsim develop resistant
Develop new antigenic drift
154- patient c/o low self steam and fatigue .. Lack of intersted and
concentration loss of sleaping , depressed mood for last 2 years what
DX
Dysthymic
155--lacteting mother complain of fever and breast tenderness and
redness diagnosed as bactrial mastitis what is ttt :
Continoue breastfeeding and hot compresser and antibiotic
Discontinue breast feeding and give antibiotic to mother and baby
156-the most common cause of nipple discharge in non lactating
women is ;
a-prolactenoma
b-hypothyroidism
c- breast CA
d-fibrocystic disease with ductal ectesia .
e ductal papiloma
157-with patient has fear ,SOB ,sweating when he is in automobile
DX
a-specific phobia
b-panic disorder
c-generalize anxiety disorder
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158-which of the following causes the highest maternal mortality in pregnancy
a. toxoplasma
b. hyperbilirubenia
c. pheochromocytoma
d.rubella
159-Old pt presented with abdominal pain, back pain, pulsatile abdomen what's
the step to confirm dx:
a. Abdominal US
b. Abdominal CT
c. Abdominal MRI
23
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160-The most common cause for chronic irregular rectal bleeding is:
Diverticulitis
Hemorrohids
Colon cancer
UC
161-the most common cause of excessive day time sleepiness is
1- circadian rhythm
2nacrolepsy
3-sleep apnea
162-the most common malignant tumor of parotid in childern
1-acinic cell ca
2- mucoepidermoid ca
3- adenocarcinoma
163- The useful exercise for osteoarthritis in old age to maintain muscle
strength and bone density
Low resistance, high repetition muscle training
Conditioning, low repetition muscle training ??
Walking and endurance muscle training
Low resistance and conditioning muscle training
164-pregnant with uterine fibroid , has no symptoms only abd. Pain ,
US showed live fetus ,,,,, What is the appropriate action to do:
Myomectomy
Hysteroectomy
Pain management
Pregnancy termination
165-Pt came with eye pain, watery discharge and light sinsitivity
Eye examination showed corneal ulceration. Her symptoms are
frequently repeated . Which of the folowing is triggring for recurrence
of her symptoms:
Dusts
Hypertension and hyperglycemia
Dark and driving at night
Ultraviolet light and stres
166-p.t taking a medication , came to the ER suspecting she has
overdose of her medication, her symptoms ( convulsion, dilated pupil,
hyperreflexia and strabismus) the medication is:
TCA
SSRI
Hypervitaminosis
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167-Pt complain of hearing voices from the microwave and refrigerator
24
Visual hallucination
Auditory hallucination
168- Old retired man having ansomnia only . Has no symptoms related
to anxity or depression .. U will give him :
Diazepam
If zolpidem is in choices it is more accurete
169-pt take cephalexin after tooth extraction for days
After that he develop profusre , green foul smilling diarrhea with low
grad fever . He has tachycardia and mild abdominal dist. Sigmoioscopy
showed white mucosal patches , what is the most ttt for this condition?
Clarythromycine
Vancomycine
Cephalosporine
Lineozides
170-pt with COPD came with couph , wheezing and greenish sputum
The causative organism:
H.influanza
Strep.pneumonia
Chlaymedia
Mycoplasma pneum.
171-what is the most effective measure to limting the complications in
COPD:
Pnumococcal vaccination
Smoking cescation
172-25 years old female came complaining of difficult hearing , she
mentioned that their a family history of early oncet hearing loss ( her
grandmother)
Oto. Exam was normal .. Weber and rinne tests result in ( bone
conduction is greater than air conduction ) ... Next action is :
Refer her for aid hearing
Tell her there is no avalible ttt
Refer her to otolaryngologist
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173-Old man came complaing of progressive hearing loss , it is mostly
profounded when he listining to the radio, he does not has any
symptoms like that before
Weber and rinne tests result in bilateral sensorineural hearig loss..
Diagnosis:
meniere's disease
Otoscelerosis
Noise induced deffnese
Hereditary hearing loss
25
4. IM aminoglycoside
180-a baby with blood in the stool and bought of crying and x ray
shows obstructive pattern.. looks like intussusception you will do:
a) surgery
b) Barium enema
c) observation
d) giv e IV fluids and let obstruction solve itself
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181-pt with nasal congestion, watery nasal discharge and
conjunctivitis, ttt:
a- oral antihistamine
b- Na cromoglycate
c- Topical steroid
d- ??
182-initial treatment of OA in adult who has knee pain bilaterally:
a- Opoid
b- Intraarticular steroid
c- Quadriceps strengthening exercise
d- ??
183-IV drug user has macular rash on palms ,splinter he, and
ophthalmoscope shows macules with clear center in retina DDx:
Syphilis
Infective endocarditis
184-patient with red eyes for one day with watery discharge
No itching or pain or trauma (nothing indicate allergy or bacterial infection)there is
conjuctival injection
visual acuity 20/20
what is next management
antihistamines
topical AB
No further management is needed
refer to ophthalmologist
topical steroids
if allergic rhinitis :topical steroid
second line:antihistamine
185-newborn apgar score 3 (cyanotic, limp, decrease breathing, HR
less than 60) your action:
- Volume expansion
- Chest expansion
27
- Ventilation
- Bicarbonate
186- pt presented with sweating, myosis, and garlic breath odor:
- Organophosphorus toxicity
- Cyanid toxicity
- Alchol
- DKA
- Cocaine toxicity
187-in rheumatic fever:
- Bacteria in blood
- Bacteria lodge in myometrium
- Skin invasion
- ???
188-86- female G3P0 , c/o infertility , have regular non heavy cycle,
trichomonus infection treated at age of 17 , previous 3 elective D/C in
first month gestation ,DDx:
- Asherman $
- Sheehan $
- Endometritis
- ???
189-40 yr heavy and intercyclical bleeding , not pregnant , does not on
OCP:
- Anovulatory cycle
- ????
190- smoker , CXR shows lung mass, hyponatremia and diluted urine:
- Heart failure
- SIADH
- Renal failure
- Conn's disease
191-common cause of AOM in all age groups:
- H influenza
- St. pneumonae
- ???
192-old, which fracture caused by trauma on outstreatched hand:
colle's Fx
193- female, malodor vaginal discharge, dysuria, normal urinalysis,
leukocyte and gram -ve diplococci :
- N gonerrhea
194- old, black macule on his back with irregular border and color
variation :
- Sq cell carcinoma
- Basal cell carcinoma
- Melanoma
28
- Acanthic keratosis
195osteoporosis risk
65 75 80
According to above graph:
- 18 % develop osteoporosis after age of 80
- 80 % of elderly have osteoporosis
- Age directly related to risk of osteoporosis
- Pt after 80 at high risk of osteoporosis
196- upper limb HTN , decrease lower extremities pulsation:
- Coarcutation of aorta
197- pain and swelling at first metatarsophalyngeal joint:
- Na urate crystals
- Ca phosphate crystals
- ???
198- pain and swelling at first metatarsophalyngeal joint:
- Na urate crystals
- Ca phosphate crystals
- ???
199- old, smoker , rectal bleeding , wt loss: >>>>Colorectal cancer
200- 45 years old female came to ER with acutely swollen knee +
ballotment patella .. The most important to do is:
MRI of the knee
Aspiration
Complete blood count
Rhumatoid factor
201- Pt came with a history of about 12 dayes duration severly red ,
swollen painful first metatarsophalangeal joint.. He is hypertensive with
inverted T wave on ECG ... The most appropriate meaure for diagnosis:
CBC
Uric acid level
Troponin level
C-reactive protein
202-Pregnant on iron supplementation throughout her pregnancy for
her anemia , now she come complaining of weakness and easy
fatigability
Her Hemoglubin 7 , MCV 60 .... What is the diagnosis?
Iron def. Anemia
Hypothyrodism
Vit B12 def.
Beta thalassemia
29
214-A patient with severe headache, behind the eye, 4 times in one week ? with
other symptoms
(i don't remember the whole scenario, it seems a cluster headache case, not
sure)
which drug is not useful in prophylaxis:
CCB (may be verapamil)
methysergide
valium
lithium
prednisolone
read about the prophylaxis of Migraine and Cluster
and if any one remember the scenario please write it here
215-Pt diabetic he has wound in his leg with poor healing , Exudate ,no sign of
inflammation the hyperglycemia cause poor wound healing by :
a- inhibit phagocytosis
B-stimulate bacterial growth
c-decrease immunity
220-perinatal mortality
A-include all stillbirth after the 20th wk of pregnancy
B- include all neonatal deaths in the firist 8wk of life
c-in clude all stillbirth and firist wk of neonatal deaths
d-is usually death per 10,000 live birth
228- pt with CHF and atrial fibrillation u add digoxin what is the effect
of it in this case :
a- decrease ventricular effecacy
b- unchanged COP
C- decrease HF
229-infant swallow coeeosive material came within half an hour to ER
drooling, crying what is the initial thing to do
activated charcoal
endoscopy
secure airway
2 cups of milk
230-svt ttt:
Digoxin
adenosine
231- malaria in a child:
a- crescent shape gametocyte of vivex is diagnostic in the stool
b- the immediate ttt primquine for 3 d
c- 72h tt t of malaria is suffeceint
d- the most common cause is falciparum
232-scaly purpule lesions in the face of a child the cause
a- staf. Aureus
b- beta haemolytic srept.coci
c- H. influenza
233- child >90% of the normal . < persentile hight with sever bowing of
legs what help u for diagnosis: (same question mentioned but different
choices)
a- lower extremeties x-ray
b- pelvic x-ray
c- cbc
d- alkaline phosphatase
234- ttt PE:
a- iv heparin
b- iv tpa
c- streptokinase
235- The most common side effect of long use of systemic
corticosteroids:
a.Asthma
b.Weakness in pelvic muscles
c osteoporosis
236-pt taking digitalis he developed sudden disturbance in vision yellow
discoloration and light flashes (thats what I remember from the question)
a.digitalis toxicity
b.retinal detachment
33
237- Pt has carotid bruit with occlusion 60% of the left carotid artery what
well u advice the pt
a.Asprin daily
b.Angiograpy
c. endartectomy
238-) What is the most specific test for syphilis:
a.TPI
b.FAAT
treponema antibody absorption test
239-) pt had history of hypertension and no medication taken he eats a
lot of meat with no fruit and vegetables on examination he was obese
BP:130/98 investigations she high cholesterol ,high trigelcride, low HDL
in which category u well put the pt for risk of IHD:
A
B
C
d
I forgot
I forgot
High
cholesterol
High
cholesterol
256-15y boy appear patch in rt lower leg these patch is clear center , red
in peripheral, no fever no other complain so diagnosis (there was a
picture with lesion in the groin area)
a-contact dermatitis
b-tinea corpora
c- lyme disease
d-psiorosis
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257- Man is complaining that he doesnt see the traffic signs well what is
the best way to measure the distance vision:
Snellin chart
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258- question about pt had pterygium what well you tell the pt:
-it is malignant
- needs surgery
in another word :regarding ptergium :
It indicate systemic disease
Will cause loss of vision
Treatment is surgery
I forgot the other choices read about the topic
259- Compelete loss of vision Lt eye, in pt with recent infarction?
a) Frontal
b) Parital
c) Cortex
d) Occipital
36
260- the commonest initial manifestation of increased ICP in patient after head
trauma is
1. Change in level of consciousness
2. ipsilateral pupilary dilatation
3. contralateral pupilary dilatation
4. hemiparesis
5. hypertension
261- Most accurate test for CTS ? carpal tennel syndrome
a) Tinels test
b) Phalens test
c) Nerve tapping numbness
There was no nerve conduction velocity.
262- Hx of Child has itching in his RT hand which increase in the night
described as linear fissures at their top there is blacknish
Scabias
263- Which of the following method is rapid and best for complete
gastric evacuation ? !!!! ...
a) G lavage
b) Manual induce V
c) Syrupe
d) Active charcoal
264- old male pt with hx of IHD, DM , HTN , dyslipidemia ,
family hx of heart disease ,,,,
lab showed :- LDL : 199 ,,,, HDL : 37
so , in this pt what is most dangerous Risk factor ?
a) Increased LDL
b) Decreased HDL
265- Old man psych pt , has halosination , aggressive bebaviour ,loss
of memory ,Living without care , urinate on him self , what is next step
to do for him ?
a) Give antipsychotic
B) Admit him at care center for elderly .
266-60 y/o male known to have ( BPH) digital rectal examination shows
soft prostate with multiple nodularity & no hard masses , the pt
request for ( PSA) for screening for prostatic ca what will you do ?
a)Sit with the pt to discuss the cons & rods in PSA test
b)Do trans-rectal US because it is better than PSA in detection
c) Do multiple biopsies for different sites to detect prostatic ca
267- Female com with lump in breast, which one of the following make
you leave him without appointment ?
a) Cystic lesion with serous fluid that not refill again
b) Blood on aspiration
c) Solid
37
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285-high grade fever, rigors ,painful hepatosplenomegaly:
malaria
visceral leshmania
toxoplasmosis
286- appropriate way to prevent spread of disease :
change human behavior
screening tests
287- first few words:
12 months
18 months
36 months
288-which of the following true about headache :"
-increase ICP at last of day
-normal CT may exclude subarachnoid hemorrhage
-amnursus fugax never come with temporal arteritis .
- neurological sign may exclude migraine
289- patient with typical sign of infections mononucleosis come with
abdominal pain and hypotension next step :
-abdominal CT and IV fluid
-antibiotic and IV fluid and and observation
290- patient with hypersensitivity skin at back take paracetamol and
develop vesicle at back extend to abdomen Dx :
Herpes zoster
291- picture of viral warts
292-pt in burn wll die due to :
-smoke inhalation
- trauma
293- elderly patient bedridden for long time what will you do :
-include family support
-IV valum
294- pt with dysphagia , weakness ,fasciculation ..:
-motor neuron disease
-polyneuropathy
295-Young male c/o pleurisy pain at rt side On EX there is only decrease
breath sound
tachypnia other wise normal and there is CXR I dont know if it is normal
or not But it seems to me normal what will you do?
a-discharge pt bez it is only viral plurzy
b-discharge him on Augmentine
C- I think refer him to pulmonologist
40
41
- Form
- content
306-pigmentation of OCP called:
melasma
307-old man did femoral popliteal bypass has 2 days of forgetting :
alzhiemer
vascular alzhiemer
308-clear scenario of turner syndrome (read about features of turner )
309- cause of death in inflamed burns :
-injuries
-inhalation of smoking
In flame burn , the most common cause of immediate death
1.hypovolemic shoke
2. septic shoke
3. anemia and hypoalbumin
4. smoke inhalation
5. associated injury
310-Atrial fibrillation +narrow complex+unstable pt (hypotensive):
cardioversion
311-epdiomology definition:
312-epdimology curve:
graphic registration of disease through a period of time
other choises :
a- Plotting number of cases on time line
b- Geographical places
c- Case with similar diagnosis
313-question in digoxin toxicity (read about):
314-child was playing and felt in the toy, his leg rapped and twisted he
dont want to walk since yesterday:
- ankle tissue swelling
- spiral tibial fracture 100%
- chip tibial fracture
- femur neck of the tibia freacture
42
/ uvitis / glaucoma
_ dust&pollens
_u/v light
_ stress
_ night accommodation
356- Patient with ARDS on ventilation developed pnemothorax..cause:
_ -ve pressure ventilation
_ central line
_ 100% O2
357- Lactational mastitis..Rx:
_ doxycycline
_ ciprofloxacin
_ ceftriaxon
_ gentamyecin
_ cephalexin
358- OCP that causes hyperkalemia:
cant remember the choices.
drospirenone
359- All are 1ry prevention of anemia except:
_ health education about food rish in iron
_ iron fortified food in childhood
_ limitation of cow milk before 12 month of age
_ genetic screening for hereditary anemia??
360-+ve leichman test:
ACL injury
361- Waking up from sleep..cant talk, no fever, can cough, normal vocal
cordsDx:
Functional aphonia
362- Patient with CML taking imatinib mesylate and odansetron for
nausea and vomiting presented with tachycardia,fever
Diphoresis and hyperreflexia Dx:
_ neuroleptic malignant syndrome
_ imatinib toxicity
_ odansetron toxicity
363- What is the most effective method to prevent the brucellosis
infection:
a. Treat the infected people
b. Immunize the farmers & those who deal with the animals
c. Get rid of all the infected animals
d. Pastralization of the diary products
364- PTS with history of infertility the first line of investigation for this
couple is >>>
semen analysis
48
vit D deficiency.
375-80 year old man complain of sever itching mainly in the wrist and b/w
fingers , with excoriation mark linear and superimposed by secondary
infection disturbing sleep, the pts newly finish 10 days course of
Antibiotics >>>>>>
Monilia
eczema
icythiosis
__________________________________________________________________________
__________________________
376- Live guard come to annual examination , no compliant , macular
dicloration, painless over the face , thers is history for exposure
unproductive to sun rays >>>>>
Sqamous cell carcinoma
377- Community problem of multiple chlymedia infection in the eye ,
best prevention method is >>>>
good water and good sanitation supply
378- Which IS considered abnormal & indicate fetal distress<<<
late deceleration
379- What is the vector for leshmania disease <<<<
sand fly
380- Child with URTI then complained from ear pain on examination there
is hyperemia of TM &+ve insufflations test he tri 2 drug no benefit what
is the bestTTT>>>
agmentine
azythromycin
ciprofloxacin
steroid
381- Infant in respiratory distress ,hypercapnia , acidosis & have rhinitis ,
persistent cough +ve aglutenation test & the doctor treat him by
ribavirin DX>>>
pertusus
RSV
382- Aluminum salt & salt will decrease absorption of <<<<
tetracycline
penicillin
383-40 yrs old male com with HX of smoking & alcohol intake for long
time complain of painless ulcer ,role out border on the lateral border of
the tongue DX<<<<<
SCC
lukoplakia
50
384- Old PTNs with osteoporosis TTT for HTN with diuretic that prevent
Ca loss complain of severe pain in big toe DX>>>>>
thiazide
__________________________________________________________________________
__________________________
385-Old male come with CHF & pulmonary edema what is the best initial
therapy>>>>
digoxin
frosamide
debutamine
386- Patient with HX of URTI & flash of light when he sneeze the cause
is>>>>
chemical irritation
mechanical irritation of retina
387- Adult with HTN what is the most common cause >>>>>
renal
essential
388- All of the following exaggerate the gastric ulcer except<<<<
decrease gastric empty time
use of tricyclic antideppresent
__________________________________________________________________________
__________________________
389- Sever pain in anatomical snaph box >>>>>
scavoid fracture
__________________________________________________________________________
__________________________
390-Child come to ER after ingestion of multiple iron tablet of his relative
&iron conc. In blood 700ml???? what is the best intervention>>>
gastric lavage
charcoal oil
iv defrroxamin
391-Patient with lacremation ,salivation, diarrhea, what is antidote<<<<
atropine
pralodexam
392- Child with recurrent UTI how to counsel him>>>
increase fluid intake
393- group of patient with lung cancer divided In tow group disease
&control>>>
case control study
394- Gouty arthritis -ve pirfringes crystal what is the mechanism>>>>
deposition of uric acid crystal in synovial fluid due to over saturation
51
395- Patient have of urethritis now com with lt knee urethral swap +ve
puss cell but ve for N.M, chlymedia>>>>
RA
riters disease
gonococcal
396-Pulled Elbow scenario the TTT>>>
immediate reduction supination
397- Which of the following indicate benign thyroid lesion>>>>
lymphadenitis
__________________________________________________________________________
__________________________
398- Young female, k/c of vitligo, came to the clinic with hx of hair loss, on
exam you found an area of4 cm devoid from hair, but the skin is normal
no redness or any abnormality in this area except hair loss, what does she
has:
a. Alopecia totalis
b. Alopecia areata
399- Young female came to your clinic complaining of skin rash involving
the whole body including the palms & soles after unprotected sexual hx,
what is your DX:
Secondary syphilis
400- Old man came to you with hx of anal pain, spastic in nature
associated with diaphoresis, tachycardia, which last for a few min.
bothering him more in the night, what does he has:
a. Thrombosis of external hemorrhoid
b. Goy syndrome
c. Proctalgia fugax
__________________________________________________________________________
__________________________
401- Female came with hx of sever abdominal pain, vaginal bleeding for 6
hours, amenorrhea for 8 wk, , O/E tachycardiac, hypertensive, tense
abdomen. what is the most likely site of the ectopic pregnancy:
a. Fallopian tube
b. Ovary
c. Peritoneum
d. Fimbria
402- Young pt was operated 1 year ago for small bowel perforation,
presented with hx of vomiting, constipation, abdominal distention, colicky
pain, what will be the appropriate investigation you will choose:
a. Barium swallow
b. Barium enema
c. Barium follow through
d. Double contrast study
52
403- Male came with hx of acute onset of knee pain with swelling, what
will be the most important investigation to do:
a. Arthrocentasis
b. Full CBC
c. Joint US
d. ????
404- Long scenario about child has sore throat & the culture showed
group A strepto, then he develop coca-colored urine, periorbital edema,
and headache what is the single most specific test to diagnose him with
post-strept acute GN:
a. BP more than 95% of normal
b. +ve strepto enzyme
c. Low C3
d. High creatine & urea
(the question is not new but here are the full choices)
405- Regarding case-control study which is true:
a. The number of control should be equal to the number of
diseased
b. It is forward study to the risk factor
c. It is backward study to the risk factor
406- Young pt came with hx of acute painful swelling of the first
metatarsophalangeal joint, redness, tenderness, fever 38c, what is the
etiology:
a. Staph aureus
b. Sodium urate deposition
c. Pyro phosphate calcium deposition
__________________________________________________________________________
__________________________
407- Child with barking cough dx to have croup, what is the causative
organism :
a. Parainflunza
408- Long scenario about 5 year old child otherwise healthy has cough,
fever, chest x ray shows infiltration of the middle & lower Rt lob, after 24
hour of receiving cefotaxime he develop complete Rt lung opasifcation,
what is the most likely causative organism:
a. Staph aureus
b. Strepto, pneumonea
c. Hib
d. Pseudomonas argenosa
In another word :
child pt. came with scenario of chest infection , first day of admission he
treated with cefotaxime , next day , pt state became bad with decrease
53
c. Metabolic acidosis
d. Met. Alkalosis
_____________________________________________________________
______________________
415-Long scenario about Pt with hyperkalemia 7.5, what will be your
FIRST action:
a. IV calcium gluconate
b-IV HCO3
416- Treatment of recurrent otitis media after multiple Abx course, with
bulging tympanic membrane:
a. Amoxicillin
b. Amoxicillin & clavulanic acid
c. Tazocin
d. IV ????
417- What is the serious sign in pregnancy:
a. Abdominal pain
b. Back pain
c. Leg swelling
d-Hyperacidity
418- Pt came to ER with his hand vist in the mid of his chest, what is the
most likely Dx:
a. Ischemic heart disease
b. Esophageal spasm
c. Pneumonia
419- After head trauma, the pt start to have disinhiption, agitation, and
restlessness what is the affected lob:
a. Prefrontal area
b. Temporal area
c. Occipital area
d. Parietal area
420- Which of the following suggestive of ovarian cyst rather than ascites
in percussion:
c. No local reaction
422-Pt
presented with multiple attacks of palpitation, chest pain,
numbness & tingling of the upper limbs & fearing from dying, no
abnormality detected by physical examination. What is the Dx:
Thyrotoxicosis
Panic attacks
Agoraphobia
Peochromocytoma
a 28 yrs. old lady , C/O: chest pain, breathlessness and feeling that she'll die
soon .. O/E : just slight tachycardia .. otherwise unremarkable .. the most likely
diagnosis is:
a- panic disorder
423- which of the following medication is safe during lactation:
Tetracycline
Chloramphenicol
Erythromycin
424- small child presented to ER with hx of sudden onset of groin mass,
painful, associated with vomiting, nausea, O/E groin mass tender, scrotal
swelling with multiple bleeding dots, cremastric reflex is preserve, what is
your dx:
a-Testicular torsion
b- torsion of appendix testis
c-scrotal hematoma
e-incarcerated hernia.
425- what is true about marasmus disease:
a. In contract to kwashorcoir, it affect the low socioeconomic stat
b. It is due to late weaning
c. It leads to growth retardation & wt loss
________________________________________________________________________
_________________________
426- picture of pt with htperpigmentation of the axilla, under the
flourcene wood's light it become pink what is the dx:
a. Fungal infection
b. Erthrasma
c. Acanthosis nigricans
d. ??????
(picture in kumar)
427- the most common cause of 2dry amenorrhea with high FSH & LH is:
56
a. Menopause
b. Pituitary adenoma
c. Pregnancy
d. ???????
a. 428-?????
428- female G3P3 post-partum 4wk treated for 3days with antibiotic ( I
forget it) for PID but no response & she still febrial , O/E by PV you found
a 10cm mass in the sac between the vagina & the rectum, tender,
fluctuating what will be your action:
a. Colpotomy
b. Laparotomy
c. Laparoscopy
d. D/C antibiotic & start another one
429- pt with hyperthyroidism ask you regarding the long term
complication of her disease, what will you do:
a. Bone density scan
b. Brain CT scan
c. ECG
d-Echo
430- pt with hypothyroidism, you start her on the levothyroxine, then she
came for follow up you found her TSH is high, what will you do:
a. Reduce the thyroxin and follow her after 6 months
b. Reduce the thyroxin and follow her after 2 months
c. Continue the same dose & follow up after 2 months
d. Stop the dose till the TSH become normal and follow up after 2
months
431- picture of large cervical lymph node, O/E multiple enlarged lymph
node, matted, non tendr, no skin changes, what is the dx:
a. TB lymphadenitis
b. Metastatic tumor
c. Lymphoma
d. Infectious mononucleosis
432- pt fall from 10 stairs, he develop nasal swelling, tenderness, skull Xray shows non displaced fracture of the nasal bone, what will you do:
a. Refer to the surgeon immediately.
b. Do brain CT scan
c. Reassure him
433- long scenario about pt with GERD responding partially to PPI,
endoscopy biopsy shows barret esophagus with mild severity, what will
be your action:
a. Esophagus resection.
b. Fundoplication
c. Increase the dose of PPI
57
434- child came with hx of one attack of tonic-clonic convulsion, & his
mother said that he has multiple attacks of febrile convulsion, what will
give her if her child develop another attack at home:
Phenytoin
Diazepam
Clonazepam
Phenol barb.
435--- 35 year old smoker , on examination shown white patch on the
tongue, management: leucoplakia
a. Antibiotics
b. No ttt
c.
Close observation
d- excision biopsy ( may answer ) the choice is not in alqasem
question
436-male singer with colon cancer stage B2 ; which of the following
correct ?
a- no lymph node metastases
b-one lymph node metastasis
c-2 ===
d-lymph node metastasis + distant metastasis
437--child swallowing battery in the esophagus management : (the
choices are complete)
-bronchoscope
- insert fly catheter
- observation 12hrs
Remove by endoscope
438-young male patient present to ER due to RTA with poly trauma ; the
beast way to maintains airway in responsive poly trauma patient is ;
A-orophargenial airway
b-nasophargenial airway
c-trachastomy
d-endotracheacheal intubations
439- Young patient with congested nose, sinus pressure, tenderness and
green nasal
discharge, has been treated three times with broad spectrum antibiotics
previously, what is your action? (chronic sinusitis)
a) Give antibiotic
b) Nasal corticosteroid
c) Give anti histamine
d) Decongestant
e)observation
440-long case patient with RTA with Blount trauma to abdomen . patient
undergo remove of distal small intestine and proximal colon , patient
58
come after 6 month with chronic diarrhea , SOB , sign of anemia , CBC
show megaloblastic anemia
What the cause of anemia :
A-folic acid deficiency
b-vit B12 deficency
c-alcohol
441- case infant has genital rash ( the rash spares genital fold ) not
response to antibiotics , most likely Dx;
A-candida albicans
b-napkin dermitis
c-contact dermatitis
d- atobic dermatitis
e- sebborich dermatitis
442--long senior patient came with chest pain , burning in character ,
retrsternal , increase when lying down , increase after eating hot food ,
clinical examination normal DX GERD
a-MI
b-peptic ulcer
c-GERD
d443- about fetal alcohol syndrome (read about)
444- the beast way to ttt pinged induce nervosa ( bullima
nervosa )
a-interpersonal psychotherapy
b-cognitive behavior therapy
c-pharmacotherapy
d445- old female came with scales aroud the areola ,she took steroid but
no benefit on examination normal and no masses what is your next step?
A-Antibiotics
B-anti-fungal
C- Mammography
446- patient come with diarrhea , confusion , muscle weakness he suffer
from which ? (hyponatremia)??
A-hypokalemia
B-hyperkalemia
c-hypercalcemia
447- Patient come with jundice , three days after the color of jundice
change to greenish what is the cause?
oxidation of bilirubin
59
448- Patient with Rhumatoid Arthritis he did an X-Ray for his fingers and
show permanant lesion that may lead to premnant dysfunction , what is
the underlying process?
substance the secreted by synovial
449- prevention of lyme disease , what is best advice to parents
insect repellents
prevention of Lyme disease :
Treat early disease with doxycycline , Prevent with tick bite avoidance
Light-colored
clothing makes the tick more easily visible before it attaches itself.
People should use special care in handling and allowing outdoor
pets inside homes because they can bring ticks into the house.
A more
effective, communitywide method of preventing Lyme disease is to
reduce the numbers of primary hosts on which the deer tick
depends, such as rodents, other small mammals, and deer.
Reduction of the deer population may over time help break the
reproductive cycle of the deer ticks and their ability to flourish in
suburban and rural areas.
Backyard patios,
decks, and grassy areas that are mowed regularly are unlikely to
have ticks present. This may be because of the lack of cover for
mice from owls and other raptors that prey on mice. The ticks also
need moisture, which these areas do not provide.
-The areas
around ornamental plantings and gardens are more hospitable for
mice and ticks. The highest concentration of ticks is found in
wooded areas.
Individuals
should try to prevent ticks from getting onto skin and crawling to
preferred areas.
Wearing longsleeved shirts and tucking long pants into socks is recommended.
Guineafowl
450--30-40 year male suffer from tenitus , vertigo , sensorconductal hear
loss diagnosis is
Miner's disease
60
451--patient 20 year old come with palptations ECG show narrow QRS
complexes and pluse is 300 bpm what is the true
Amidarone
452-40 years female complaining of thinking a lot in his children future,
she is alert, anxious, cant sleep properly, poor appetite, she always make
sure that doors in her home are closed, in spite of doors already closed,
provotional Dx:
OCD,
GAD
Schizo
453-Long scenario of restless leg syndrome(he didnt mention Dx in
scenario), 85 old male many times awake from his sleep bcz leg pain, this
pain relieved by just if he move his foot, but it recure, at rest,best
management:
Colazpin
Haloperidol
lorazepam,
one drug from dopamine agonist group forgot its name, its the right
answer.
Bromocriptin,opomorphine,cobegoline
454-best drug for von willbrand disease is:
fresh frozen plasma
cryoprecipitate
steroids
(he didnt mention vasopressin in choices)
455- Best fast management of acute hyperCalcemia is:
Iv fluid
frusamide
dialysis
456- Null hypothesis definition
457- Long scenario of a pt with melanoma in back, he is afraid of malignat
change, which one of the following indicate malignant melanoma:
>6mm,
irregular and invade the skin,
458- Best inv to visualize the cystic breast masses is:
MRI
CT
61
Mammogram,
US
459-Female pt new diagnosed as HTN pt, BMI 28, U sld advise her by:
Body wight reduction ALONE doesnt benefit her HTN
wt reduction and exercise may benefit him,
salt restriction well help to reduce the BP
460- Long scenario for pt smokes for 35 y with 2 packets daily, before 3
days develop cough with yellow sputum, since 3 hours became blood
tinged sputum, X ray show opacification and filtration of rt hemithorax,
DX:
Bronchogenic CA
acute bronchitis
lobar pneumonia
461-Pt with hypercholestrelemia, he should avoid:
Organ meat
Avocado
Chicken
white egg
462-5 y child diagnosed as UTI, best inv to exclude UTI comp:
Kidney US
CT
MCUG
IVU
463-6 y old boy, eat the paper and soil, best initial ttt is:
Fluoxetine
behavioral therapy,.
464-Baby said baba mama, pincer grasp, creeping well, sitting wth
support, estimate age:
6m
7m
8m
10m
465- Drug of choice for a schistosomaisis is:
Praziquanetilo
xaminiquine,
artemether
466-50 YEARS OLD FEMAL HAS HYPERTENSION ,COMPLAINING OF RIGHT
EYE PAIN ,HEADACH,FLUSHES LIGHT ,FLOTERS,SHE DID NOT TAKE HER
MEDICATIN TWO WEEKS BACK THE BLOOD PRESSURE IS 140\90
,ON EXAMINATION NON DAILATED PUPLE REACTIVE ,NO DECREASE EYE
VISION ,THERE IS CUPPING AND SLIGHT ARTERIOVENOUS NIPPING WHAT IS
YUOER MANAGEMENT:
62
A)REFERAL TO OPTHALMO
B)REASSURANCE AND TELL HER YOUR PROBLEM BENINGN
C)GIVE BEXOLO EYE DROPS
D)TREAT HER AS MIGREN HEADACH
___________________________________________________________________
_______
467-55 ys old male pt, presented with just mild hoarsness, on exam, there
was a mid cervical mass, best inv is:
Indirect laryngioscopy??
CT brain
CT neck
Biopsy
aspiration
__________________________________________________________________________
___
468-4 years old child, was diagnosed as SCD,so many times came to
hospitals with, dyspnia, dactylites , ( he put sign of acute crises ), the best
strategy for prolonged therapy is:
IV hydration fluids with analgesia
follow in Out pt clinic
refer to tertiary haem center.
469- Long scenario for a pt came to ER after RTA, splenic rupture was
clear, accurate sentences describe long term management:
We give pneumococcal vaccine for high risky people just,
we sld give ABs prophylaxis if there Hx of contact even with
vaccination against pneumococcal,
pneumoccal vaccine should not be given at same time with MMR
470- Female pregnant, 32weeks of gestational age, diabetic, and she has
a Hx of full term fetal demise, but her DM now well controlled, and BPP
show no fetal distress,best management:
Wait for SVD
report a CS in 36 weeks
Teminate pregnancy
471- Triad of heart block, uveites and sacroileatis,Dx:
Ankylosing spondylites,
lumbar stenosis,
multiple myeloma
472-72 years old Man with loss of vision in one eye , jaw claudication :
Temporal arteritis .
63
> F..dermatic
487-> Recently diagnosed with DM type II , 32 years old , exercise for 8
weeks and BMI changed from 32 to 31 ..
Labs shown on table ? But no table !!!!!
> Continue exercise . My answer
> Start medication
488-74-year old female patient of Cushings syndrome, had hip fracture
falling off stool, what will you screen for while also treating her fracture:
Hyperparathyroidism
Osteomyelitis
Osteoporosis
Osteomalacia
489-Very long scenario about middle age man (50 years) with family
history of heart disease, active lifestyle, on self induced diet with 50% fat,
35% protein and 15 % carbohydrates, table showing labs, elevated LDL,
low HDL, elevated triglycerides and cholesterol, normal RFTs and all other
labs.
No risk of heart disease
Heart disease risk can be avoided by taking statins
Heart disease can be prevented by decreasing calorie intake
490-18 month old patient, parents were treating baby for flu-like illness
with fever with increased water intake at home, patient developed
generalized tonic-clonic convulsions, presented to you after 1 hour with
(description of post-ictal stage). Now baby becomes fully conscious.
What is the next most appropriate step?
rapid sponging to reduce fever
Give acetaminophen and antipyretics
Treat fever, Get MRI done and treat after result
491-9. Middle aged female patient with history of Stage 2 breast cancer
treated successfully, now presents with moderate to severe pain in left
leg, not relieved by lying down, pain on extension of leg and walking, O/E
Tender region in L3-L4 lower back. No Physical sign of cancer recurrence.
Last saw oncologist 2 years back. What is most appropriate scenario:
Refer to oncologist
66
Do DEXA Scan
Do MRI
Hospitalize and do neurology and oncology consultations
492-11. Baby present with weeping, shiny and crusting lesions around
mouth :
Impetigo
493-Male patient was advised to undergo Arterial Graft Bypass surgery at
other clinic after having episode of pain in leg, now is asymptomatic.
Came to you, Non-smoker, elevated cholesterol and early atherosclerotic
plaques on some descending aortal branches. What will you advise:
Undergo Bypass Grafting
Take medication to prevent formation of Arterial plaques
To undergo frequent arterial scans to see extent of disease.
494-1st line class of drugs against Post partum hemorrhage:
Uterine Contractile
Uterine Relaxant
495-Patient recovering from Viral Gastroenteritis, vomiting and diarrhea
abated but still having Anorexia. What will you advise:
Bananas
Rice cereal and apple juice Chopped pears
yougurt and .
Granola, .
496-Patient with idiopathic anovulation. What drug to give:
Clomiphene
Progesteron
LH
FSH
497-Description of PCOS. Mechanism of PCOS:
Androgen Excess
498-Prostitute with multiple sex partners presents with history of painless
vaginal sore which healed and did not leave scar. O/E has generalized
lymphadenopathy. What is your diagnosis:
Syphilis
__________________________________________________________________________
499-Female patient with wide-open eyes, tremors in hands that do not
diminish with intention, What investigation will you do:
Pituitary Scan
67
T4 Levels
500-Middle age patient alcoholic with H/O fullness in epigastric region and
mild pain, History of nausea and vomiting. Labs: Increased Serum
Amylase, Diagnosis:
Pancreatic Pseudocyst
Pancreatic Cystadenoma
Choledochal Cyst
Liver Cirrhosis
501-Which one of these patients with pneumonia will you treat as outdoor
patient:
a.
80 Year old with 104 F temperature, BR 24/min PR 126/min, BP
180/110
b.
60 year old with 102 F temperature BR 22/min PR 124/min, BP
160/110
c.
50 year old with 98 F temperature, BR 20/min. HR 110/min, BP
180/110
d.
80 year old with 96 F temperature, BR 18/min, HR 70/min, BP 110/80
http://pda.ahrq.gov/clinic/psi/psicalc.asp
according to pneumonia severty index calculator (class IV and V need
hospitalization class III depend on clinical judgment) the high blood
pressure is not involved in calculation.
a-classIII
B-classII
c-class I
D-class III
502-Long scenario of 28 year old male patient with symptoms of
Ulcerative Colitis+ anemia related to UC. Sigmoidoscopy revelaed
multiple polyps, Biopsy of polyps Carcinoma in situ. What is the most
definitive therapy that will be effective in the long-term:
1.
Correct Anemia
2.
Left hemicolectomy and Colostomy
3.
Total Colectomy and Ilectomy
4.
Removal of all polyps by Colonoscopy
503-Female patient came with hypertension, azootemia and GFR of 44.
What is her condition due to:
a. Pheochromocytoma
b.Renal artery stenosis
c.Renal Parenchymal Disease
(pheochromocytoma is excluded from the scenario
renal artery stenosis :1- Significant functional impairment of autoregulation,
leading to a decrease in the GFR, is not likely to be observed until arterial luminal
narrowing exceeds 50%
68
504- Patient comes with attack of Strep Throat, had history of previous
attack(RF), what is his chance of getting RHD now?
Nothing, he is immune due to previous infection.
100%
Needs Immunoglobulin to prevent re-infection.
50% chance of re-infection.
In the United States, rheumatic fever rarely develops before age 3 or after age 40 and is
much less common than in developing countries, probably because antibiotics are widely
used to treat streptococcal infections at an early stage. However, the incidence of rheumatic
fever sometimes rises and falls in a particular area for unknown reasons. Overcrowded
living conditions seem to increase the risk of rheumatic fever, and heredity seems to play a
part. In the United States, a child who has a streptococcal throat infection but is not treated
has only a 0.4 to 3% chance of developing rheumatic fever. About half of the children who
have had rheumatic fever develop it again after another streptococcal throat infection if it is
not treated. Rheumatic fever follows streptococcal infections of the throat but not those of
the skin (impetigo) or other areas of the body. The reasons are not known.
http://www.merckmanuals.com/home/childrens_health_issues/bacteri
al_infections_in_infants_and_children/rheumatic_fever.html
505-pediatric patient from developing country presented with muscle
wasting, weight loss and absent edema. What is the diagnosis:
Marasmus
Kwashiorkor
Muscle wasting syndrome
Marasmus:1-present of muscle wasting
2-body weight less than 80%of average weight.
3-absence of edema
4-increase prior to age 1
kwashiorkor: 1-presence of edema
2-increase in >18month
69
http://emedicine.medscape.com/article/1206147-overview#a0104
507-Picture of optic disc. (Looks like this:
http://www.revophth.com/content/d/cover_focus/i/1315/c/25316/)
What does it show?
a. Normal disc
b. Cupping of optic disc
508- Picture of Patients legs (calves) showing maculopapular rash. H/O
red rah appearing on extensor surfaces. Rash is tender to palpate but
does not blanch on pressure. What is the diagnosis:
Henoch-Schnolein Purpura
Polyarteritis nodusa
(emedicine)
______________________________________________________________________
509- Female patient comes with history of periorbital swelling, itching all
over body, O/E there is lymphadenopathy. Liver and spleen are enlarged.
What is the diagnosis?
a.Urticarial
b.Angioedema
c.Lymphoma??
510- Picture of base of mouth showing a white patch with sharplydemarcated edges. Patient is male, long- term smoker and chews
70
tobacco, presents with painless lesion in mouth. What is the next most
important step:
Topical Fluconazole
Biopsy
Wide surgical excision
Diagnosis is :leukoplakia:
1-painless white plaque
2-associated with smoking
3- on the mucous membranes of the oral cavity, including the tongue, but also other areas of
the gastro-intestinal tract, urinary tract and the genitals.
4-Tobacco, either smoked or chewed, is considered to be the main culprit in its development
5-5% to 25% of leukoplakias are premalignant lesions; therefore, all leukoplakias should be
treated as premalignant lesions by dentists and physicians - they require histologic evaluation or
biopsy (ref. wikepidia)
dehydration,accordingto"IrwinandRippe'sIntensiveCareMedicine."Theyworkbymakingthebody
eliminatefluidsthroughurine.Furosemideandhydrochlorothiazidearediureticmedications.
Sympathomimetics
Sympathomimeticdrugs,asstatedin"SynthesisofEssentialDrugs,"mimictheactionsofthebody's
sympatheticnervoussystem.Theyincreaseheartrate,openuptheairwaysandconstrictthebloodvessels.
Sympathomimeticdrugssuchasamphetamines,cocaineandephedrinecanleadtoheatstroke,becausethey
constrictthebloodvesselsanddonotpermitheatlossthroughbloodvesseldilation.Thisclassofdrugsare
alsoriskfactorsforheatstrokebecausetheyincreasetheamountofheatproducedwithinthebody
Antihypertensives
Antihypertensivemedicationsareusedtotreathighbloodpressureandalsoputindividualsatriskforheat
stroke.Examplesofdrugsinthisclassarebetablockerssuchaspropanololandcalciumchannelblockers.
Thesedrugsreduceheartrate,thestrengthwithwhichtheheartcontractsandtheamountofbloodpumped
outtothebody.Thisleadstodecreasedbloodflowtotheskinandareductioninthebody'sabilityto
eliminateheat.
Read more: http://www.livestrong.com/article/118891-medications-predispose-heatstroke/#ixzz1jMAxCHRd
http://www.livestrong.com/article/118891-medications-predispose-heatstroke/
512- CT of Brain picture. Scenario: Patient with sudden severe occipital
headache came to emergency.
Subarachnoid Hemorrhage
Intracerberal Hemorrhage
Meningitis
The classic symptom of subarachnoid hemorrhage is thunderclap headache (a headache
described as "like being kicked in the head", [4] or the "worst ever", developing over seconds to
minutes). This headache often pulsates towards the occiput (the back of the head).[
(wikepidia)
intracerberal hem.:Patients with intraparenchymal bleeds have symptoms that correspond to the
functions controlled by the area of the brain that is damaged by the bleed. [3] Other symptoms
include those that indicate a rise in intracranial pressure due to a large mass putting pressure
on the brain.[3] Intracerebral hemorrhages are often misdiagnosed as subarachnoid
hemorrhages due to the similarity in symptoms and signs. A severe headache followed by
vomiting is one of the more common symptoms of intracerebral hemorrhage. Some patients may
also go into a coma before the bleed is noticed.
513- Patient with severe pain in forehead, over nose and sides of face,
also present are shiny blisters on surface of forehead, face and nose.
What is the diagnosis:
Post-herpetic neuralgia
Varicella
Herpes Simplex
Herpes Zoster
72
Herpes zoster is a viraldisease characterized by a painful skin rash with blisters in a limited area on
one side of the body, often in a stripe. The initial infection with varicellazostervirus (VZV) causes
the acute (short-lived) illness chickenpox which generally occurs in children and young people.
Once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go
on to cause shinglesan illness with very different symptomsoften many years after the initial
infection. Herpes zoster is not the same disease as herpessimplex despite the name similarity (both
the varicella zoster virus andherpessimplexvirus belong to the same viral
subfamily Alphaherpesvirinae).
Varicella zoster virus can become latent in the nervecellbodies and less frequently in nonneuronal
satellitecells of dorsalroot, cranialnerveor autonomic ganglion,[1] without causing any symptoms.
[2]
Years or decades after a chickenpox infection, the virus may break out of nerve cell bodies and
travel down nerve axons to cause viral infection of the skin in the region of the nerve. The virus may
spread from one or more ganglia along nerves of an affected segment and infect the
corresponding dermatome (an area of skin supplied by one spinal nerve) causing a painful rash. [3]
[4]
Although the rash usually heals within two to four weeks, some sufferers experience residual
nerve pain for months or years, a condition called postherpeticneuralgia.
Herpes simplex:1-blisters containing infectious particles.
2-common infection may affect:1-face mouth(orofacial) 2-genitalia(genital herpes) 3hands(heraptic whitlow)
3-can cause herpes keratitis.
Varicella: is a highly contagious illness caused by primary infection with varicella zoster
virus (VZV).[1] It usually starts withvesicular skin rash mainly on the body and head rather than
at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring.
Post-herpetic neuralgia:
s a neuralgia caused by the varicella zoster virus. Typically, the neuralgia is confined to
a dermatomic area of the skin and follows an outbreak of herpes zoster (HZ, commonly known
as shingles) in that same dermatomic area. The neuralgia typically begins when the
HZ vesicles have crusted over and begun to heal, but it can begin in the absence of HZ, in which
case zoster sine herpete is presumed (see Herpes zoster).
The most likely answer is herpes zoster.
_____________________________________________________________________
514- Patient had fly in his eye. On removal of the foreign object what will
he need:
Topical corticosteroids
Topical Antibiotics
Oral corticosteroids
Oral Antibiotics
Answered based on the sle studing group couldnt find a ref.
515- Patient complains of discomfort in the eye. There is no discharge.
73
O/E with dye, a dendritic shaped ulcer is seen on the surface of the
cornea. What is the diagnosis:
Keratitis
Uveitis
A corneal ulcer, or ulcerative keratitis, or eyesore is an inflammatory or more seriously, infective
condition of the cornea involving disruption of its epithelial layer with involvement of the
corneal stroma.
(Wikepidia)
________________________________________________________________
516- A patient complains of 2 day history of stuck together lashes on
waking up. There is muco- purulent discharge. Anterior Chamber, uvea
and iris are clear. What is the diagnosis?
a.
Bacterial Infection
b.
Viral Infection
c.
Allergy
Bacterial conjunctivitis is usually a benign self-limiting illness, 1 although it can sometimes be
serious or signify a severe underlying systemic disease. Occasionally, significant ocular and
systemic morbidity may result.2
Epidemiology
This is one of the most common ocular problems seen in the community.3
In adults, bacterial conjunctivitis is less common than viral conjunctivitis; although
estimates vary widely, it is thought to account for no more than half of all cases of acute
infective conjunctivitis.4
It is most commonly caused by Staphylococcus spp., Streptococcus
pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.5
In children, bacterial conjunctivitis is more common than viral and is mainly caused by H.
influenzae,S. pneumoniae and M. catarrhalis.
Presentation
History
Relevant aspects of the history include:
Social aspect - has anybody else had it (family, school, work?) and are there issues about
staying at home during the course of the illness?
Findings
'Red eye' with uniform engorgement of all the conjunctival blood vessels.
Bacterial conjunctivitis may often be distinguished from other types of conjunctivitis by
the presence of a yellow-white mucopurulent discharge. Eyes may be difficult to open in
the morning, glued together by discharge.
There is also usually a papillary reaction (small bumps on the palpebral conjunctiva,
appearing like a fine velvety surface). The presence of follicles is more likely to indicate
viral conjunctivitis.
Bacterial conjunctivitis is usually bilateral (but often sequential). 3
Check visual acuity - this should be normal, other than the mild and temporary blur
secondary to the discharge which can be blinked or wiped away.
Is this bacterial?
It is not always easy to determine whether the patient's simple, acute conjunctivitis is bacterial
or not but this is important as it may determine the subsequent management plan. Ultimately,
swabbing the eye provides the most accurate diagnostic answer but it is clearly not practical to
do this for every patient. A study has shown that, in adult patients, there is a significant chance
that the infection is bacterial when there is a combination of: 4
A positive previous history of infectious conjunctivitis.
An itch present.
A mucopurulent discharge ('glue eye').
However, in severe, resistant, atypical cases or in immunosuppressed patients, swabbing for
culture and sensitivities is important.3
When patients describe their eyes glued together in the morning, this doesn't necessarily mean
that there is a purulent discharge. Viral and allergic conjunctivitis often result in lids that are
matted shut in the morning with mucopurulent material. However, these patients actually have
crusting of the lashes due to drying of tears and serous secretions, not the wet, sticky,
mucopurulent matting characteristic of bacterial conjunctivitis.
http://www.patient.co.uk/doctor/Bacterial-Conjunctivitis.htm
__________________________________________________________________________
517-Patient presents with red, peeling rash at back of ears, on limbs and
over body. What is the first line treatment?
Topical steroid
Oral Steroid
Oral Antibiotic
The diagnosis:scarlet fever :
The cutaneous rash, , lasts for 4-5 days, followed by fine desquamation, one of the most
distinctive features of scarlet fever. The desquamation phase begins 7-10 days after resolution of
the rash, with flakes peeling from the face. Peeling from the palms and around the fingers occurs
about a week later and can last up to a month or longer. The extent and duration of this phase are
directly related to the severity of the eruption.
Antibiotic therapy is the treatment of choice for scarlet fever.
75
??518- 50-year old accountant, sedentary lifestyle, BMI 30, takes irregular
meals; arteries show signs of early atherosclerotic changes. What will you
advise?
No meds necessary
Prescribe diet of 600 kcal/day and reevaluate in 4 months
Prescribe over weight diet and reevaluate in 6 months
??519-Mechanism of Action of drugs that inhibit Conversion of estriol to
estrogen. (I forgot the exact question but it mentioned about ovulation
and who inhibits conversion of esterone to estrogen?) Options were:
a. Aromatase inhibitors??
520-What drug reverses the effect of Benzodiazepines:
a. Flumazanil
Flumazenil (Anexate) is a competitive benzodiazepine receptor antagonist that can be used
as an antidote for benzodiazepine overdose.
521- pateint C/o ictrus in skin and eye on investigation WBC 2500
plt 70,000 HG 7 lekocytosis 17% total bilirubin 51 and direct bilrubin 12 what is the
test most likly positve
+ve coomb test
In us obstructive billiary duct
antiparietal cells antibodies
522-Pts have history of cervical incompetence pregnant at 8w what the
management?
Do circulage at 14-16w
523--child presented with anemia he have family history of thalassemia
what the most diagnostic test?
-measuring of HB A2
-bone marrow
-serum feriten
524-Fracture of elbow common injury of ?
Radial
525-_pts presented with pruritis hepatosplenomegaly lef supraclavicular
LN ?
Cholinergic pruratis
Lymphoma
526- the antipsychotic drug have less pyramidal side
effect is ?
76
There was significant optimism when they were first developed and it was thought that they
represented a breakthrough in the treatment of schizophrenia due to having less extra-pyramidal
side effects at therapeutic doses. The extra-pyramidal side effects has been the one significant set
of side effect that has led to poor compliance with antipscyhotic medication.
he common atypical antispychotic drugs include risperidone, olanzapine, quetipaine, aripiprazole,
zyprasidone, clozapine and amisulpiride.
http://www.understand-schizophrenia.com/atypical-antipsychotics.html
529-antidote of acetaminophen:
N-acetylcysteine.
??530-_pts with hypertension and cp of aortic dissection what the
management ?
531-wich true about hepatoma?(read about it)
77
Is common in female
Comes with Chronic liver disease
http://emedicine.medscape.com/article/197319-overview
532-The most powerful epidemiologic study is:
a. retrospective case control study
b. cohort study
c. cross-sectional study
d. historic time data
e. secondary data analysis
533- Evidence base medicine:
practice medicine as in the book
practice according to the department policy
practice according to available scientific evidence
practice according to facility
practice according to latest publish data
534- Pt had fever in the morning after he went through a surgery (I
couldnt remember the type of surgery). Whats your diagnosis:
Atelectasis if 0-2 days)
Wound infection
DVT
UTI
Post-operative fever
Days 0 to 2:
o Mild fever (T <38 C) (Common)
o Tissue damage and necrosis at operation site
o Haematoma
o Persistent fever (T >38 C)
o Atelectasis: the collapsed lung may become secondarily infected
o Specific infections related to the surgery, e.g. biliary infection post biliary surgery,
UTI post-urological surgery
o Blood transfusion or drug reaction
Days 3-5:
o Bronchopneumonia
o Sepsis
o Wound infection
o Drip site infection or phlebitis
o Abscess formation, e.g. subphrenic or pelvic, depending on the surgery involved
o DVT
After 5 days:
o Specific complications related to surgery, e.g. bowel anastomosis breakdown,
fistula formation
o After the first week
o Wound infection
o Distant sites of infection, e.g. UTI
78
535-23 yrs old female has mobile breast lump in the upper outer
quadrant of the left breast. Size= 2 cm and doesnt change with
menstrual cycle. Whats the most likely diagnosis:
Fibroadenoma
1-the most common benign breast mass in adolescent
2-easy to move with well defined edges
3-often in upper outer quadrent
4-not affected with menstrual cycle ,the affected with menstrual
cycle is cystic breast changes
536- Breast feeding in the full term neonate:
a. Increase URTI rate
b. No need for vitamin supplementation
c. Food introduce at 3 months
d. Increase GE rate
537-Which of the following organisms can cause invasion of the
intestinal mucosa, regional lymph node and bacteremia:
a. Salmonella??
b. Shigella
c. E. coli
d. Vibrio cholera
e. Campylobacter jejeni
538- Pt has saddle nose deformity, complaining of SOB,
hemoptysis and hematiuria. The most likely diagnosis is:
Wagners granulomatosis
http://en.wikipedia.org/wiki/Wegener's_granulomatosis
539-OCP:
a. Changes the cervical mucus
b. increase pre menstrual tension
c. Have a failure rate of 3 %
a.
Combined oral contraceptive pills were developed to prevent ovulation by suppressing the release
of gonadotropins. Combined hormonal contraceptives, including COCPs, inhibit follicular
development and prevent ovulation as their primary mechanism of action. [5][24][71][72][73]
b.
79
c.
Estrogen was originally included in oral contraceptives for better cycle control (to stabilize the
endometrium and thereby reduce the incidence of breakthrough bleeding), but was also found to
inhibit follicular development and help prevent ovulation. Estrogen negative feedback on the
anterior pituitary greatly decreases the release of FSH, which inhibits follicular development and
helps prevent ovulation.[5][24][71]
d.
(wikipedia)
540-Pt has 2 cm dome shaped mass in the dorsum of his hand. Its covered
by keratin. Whats the most likely diagnosis:
Basal cell carcinoma
Malignant melanoma
Keratoacnathoma
KA is that it is dome-shaped, symmetrical, surrounded by a smooth wall of inflamed skin, and capped with keratin
scales and debris.(Wikipedia)
541-Pt has hemorrhagic lesion in the mouth and papules in the face and back.
He had SOB, fever, cough and mediastinal mass. Whats the diagnosis:
a. Kaposi sarcoma
1
KS lesions are nodules or blotches that may be red, purple, brown, or black, and are usually papular (i.e.,
palpable or raised).
They are typically found on the skin, but spread elsewhere is common, especially the mouth, gastrointestinal
tract and respiratory tract. Growth can range from very slow to explosively fast, and is associated with
significant mortality and morbidity.[16]
a.
[edit]Skin
Commonly affected areas include the lower limbs, back, face, mouth, and genitalia. The lesions are usually as
described above, but may occasionally be plaque-like (often on the soles of the feet) or even involved in skin
breakdown with resulting fungating lesions. Associated swelling may be from either
local inflammation or lymphoedema (obstruction of local lymphatic vessels by the lesion). Skin lesions may be quite
disfiguring for the sufferer, and a cause of much psychosocial pathology.
b.
[edit]Mouth
tttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttttt
a.
Is involved in about 30%, and is the initial site in 15% of AIDS-related KS. In the mouth, the hard palate is
most frequently affected, followed by the gums.[17] Lesions in the mouth may be easily damaged by chewing and bleed
or suffer secondary infection, and even interfere with eating or speaking.
80
c.
[edit]Gastrointestinal
tract
Involvement can be common in those with transplant-related or AIDS-related KS, and it may occur in the
absence of skin involvement. The gastrointestinal lesions may be silent or cause weight loss, pain,
nausea/vomiting, diarrhea, bleeding (either vomiting blood or passing it with bowel motions), malabsorption,
or intestinal obstruction.[18]
d.
[edit]Respiratory
tract
Involvement of the airway can present with shortness of breath, fever, cough, hemoptysis (coughing up blood),
or chest pain, or as an incidental finding on chest x-ray.[19] The diagnosis is usually confirmed by bronchoscopy when
the lesions are directly seen, and often biopsied
(wikipedia)
542-In the neck, esophagus is:
Posterior to the trachea
Anterior to the trachea
Posterior to vertebral column
543-High risk factor in CLL :
Age
Smoking
History of breast ca
History of radiation
Factors that may increase the risk of chronic lymphocytic leukemia include:
Your age. Most people diagnosed with chronic lymphocytic leukemia are over 60.
Your sex. Men are more likely than are women to develop chronic lymphocytic leukemia.
Your race. Whites are more likely to develop chronic lymphocytic leukemia than are people of other races.
Family history of blood and bone marrow cancers. A family history of chronic lymphocytic leukemia or
other blood and bone marrow cancers may increase your risk.
Exposure to chemicals. Certain herbicides and insecticides, including Agent Orange used during the
Vietnam War, have been linked to an increased risk of chronic lymphocytic leukemia.
http://www.mayoclinic.com/health/chronic-lymphocyticleukemia/DS00565/DSECTION=risk-factors
There are no other proven risk factors for CLL. The risk of getting CLL does not seem to be affected by smoking, diet, exposure to
radiation, or infections.
http://www.cancer.org/Cancer/LeukemiaChronicLymphocyticCLL/DetailedGuide/leukemia-chronic-lymphocytic-riskfactors
544-Which of the following medications is considered as HMG-CoA reductase
inhibitor:
Simvastatin
Fibrate
81
_______________________________________________________
545- Burn involved 3 layers of the skin called:
Partial thickness
Full thickness(entire dermis)
Superficial
Deep
__________________________________________________________________
546-Cherry red skin found in:
a. Polycythema
b. CO poisoning
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)79807X/fulltext
_________________________________________________________
547- Most serious symptom of CO poisoning is:
Hypotension
Arrhythmia
Cyanosis
Seizure
548-Patient with subconjuctival hemorrhage. What you will do for him:
Reassurance sure 100%
Send him to the ophthalmologist
549-Patient with renal transplant, he developed rejection one week post
transplantation, what could be the initial presentation of rejection:
Hypercoagulability
Increase urine out put
Fever
Anemia
Signs and Symptoms of Kidney Rejection
Fever over 38C or 100.4F
Decreased urine output
Weight gain over 2 pounds per day
Increased blood pressure
Pain over kidney
http://www.uihealthcare.com/topics/medicaldepartments/surgery/rejection/ind
ex.html
550- Pregnant lady in her 30 wks gestation diagnosed as having swine flu.
She has high grade fever and cough for 4 days and her RR= 25/min. what will
you do for her:
Give her Tamiflu 75 mg BID for 5 days
Refer her to ER for admission
Give her antibiotics
Refer her to OBGY doctor
82
551- Female patient has morning stiffness and pain involving the
metacarpophalengeal and proximal interphalengeal joints. Whats the likely
diagnosis:
Rheumatoid arthritis
552-DPT vaccine shouldnt given if the child has:
a. Coryza
b. Diarrhea
c. Unusual cry
d. Fever = 38
553-A female patient has clubbing, jaundice and pruritis. Lab results showed
elevated liver enzymes (Alkaline phosphatase), high bilirubin, hyperlipidemia
and positive antimitochondorial antibodies. Whats the most likely diagnosis:
Primary sclerosing cholangitis
Primary biliary cirrhosis
___________________________________________________________________
554-Shoulder pain most commonly due to:
Infraspinatus muscle injury
Referred pain due to cardiac ischemia
In acute cholecystitis
___________________________________________________________________
555-Female patient with fatigue, muscle weakness, parasthesia in the lower
limbs and unsteady gait. Do:
a. Folate level
b. vitamin B12 level
c. Ferritin level
___________________________________________________________________
556- Patient developed lightheadedness and SOB after bee sting. You should
treat him with the following:
d. Epinephrine injection, antihistamine and IV fluid
e. Antihistamine alone
557-Patient is 74 yrs old female complaining of pain and stiffness in the hip
and shoulder girdle muscles. She is also experiencing low grade fever and
has depression. O/E: no muscle weakness detected (Polymyalgia rheumatic).
Investigation of choice:
RF
Muscle CK
ESR
___________________________________________________________________
558- 2 yrs old boy with coryza, cough and red eyes with watery discharge (a
case of measles). Most likely diagnosis of the red eyes is:
Conjunctivitis
Blepharitis
559-foot ball player gt hurt by the football to the knee , on examnation +ve valgus
stress test, -ve macmerry and lachman test . he has:
1) tibial fracture
83
In addition, patients with ADPKD may have abdominal pain related to definitively or presumably associated conditions.
Dull aching and an uncomfortable sensation of heaviness may result from a large polycystic liver. Rarely, hepatic cysts
may become infected, especially after renal transplantation.
Abdominal pain can also result from diverticulitis, which has been reported to occur in 80% of patients with ADPKD
maintained on dialysis, probably from altered connective tissue. However, this rate has not been demonstrated to be
higher than the rate among other patients on dialysis.
Patients with ADPKD may be at a higher risk of developing thoracic aortic aneurysms. Abdominal aortic aneurysms
are not increased among these patients.
Pain may also develop for reasons completely unrelated to the underlying disease; thus, abdominal pain in patients
with ADPKD may be a diagnostic challenge.
Hematuria
Hematuria frequently is the presenting manifestation and usually is self-limited, lasting 1 week or less. Polycystic
kidneys are unusually susceptible to traumatic injury, with hemorrhage occurring in approximately 60% of individuals.
Mild trauma can lead to intrarenal hemorrhage or bleeding into the retroperitoneal space accompanied by intense pain
that often requires narcotics for relief.
Hypernephroma(renal cell carcinoma): wide range of symptoms can be present with renal
carcinoma depending on which areas of the body have been affected. [3] The classic triad
is hematuria (blood in the urine), flank pain and an abdominal mass.
561- Male patient working in the cotton field, presented with 3 wks Hx of
cough. CXR showed bilateral hilar lymphadenopathy and biopsy (by
bronchoscopy) showed non-caseating granuloma. Whats your diagnosis:
Sarcoidosis
Amylidosis
Histiocustosis
Byssinosis
Pneumoconiosis
Byssinosis, also called "brown lung disease" or "Monday fever", is an occupational lung
disease caused by exposure to cotton dust in inadequately ventilated working environments.
___________________________________________________________________
562-Pt presented with severe epigastric pain radiating to the back. He has
past hx of repeated epigastric pain. Social hx: drinking alcohol. Whats the
most likely diagnosis:
MI
Perforated chronic peptic ulcer
If pancerititis come in choises I dont know if it is better answer_
__________________________________________________________________
563-Erosive gastritisdont know
Happened within one week of injury
Happened within 24 hrs of injury !!!
_________________________________________________________________
564-In brainstem damage:
a. Absent spontaneous eye movement
b. Increase PaCO2
c. Unequal pupils
d. Presence of motor movement
Commonly, brain stem damage causes a loss of consciousness. It may be temporary or more extended. People
with severe brain stem damage can enter comas and persistent vegetative states with limited probability of
waking up again. Other people may be conscious and aware, but could have severe breathing problems,
abnormal heart rates, or balance disorders. More mild injuries may result in a staggering gait and sensory
impairments associated with interruptions to sensory signals.
Brain stem consisting of the midbrain, pons, and medulla, which extends downwards to become the spinal cord
Controls respiration and various basic reflexes (e.g., swallow and gag)
Absent pupillary light reflex
Corneal reflexes are absent
PaCO2 levels greater than 60 mmHg, 20 mmHg over baseline
566-35 yrs old male has SOB, orthopnea, PND, nocturia and lower limbs
edema. Whats the most common cause of this condition in this patient:
a. Valvular heart diease
b. UTI
c. Coronary artery disease
d. Chronic HTN
Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart
disease and the most common cause of heart failure.
http://www.mayoclinic.com/health/heartfailure/DS00061/DSECTION=causes
567-Female patient had carpopedal spasm after measuring her BP. This is
caused by:
Hypocalcemia
Causes of Carpopedal spasm:
The following medical conditions are some of the possible causes of Carpopedalspasm. There are likely to be other
possible causes, so ask your doctor about your symptoms.
Hypocalcemia
Parathyroidectomy
Ileostomy formation
Hyperventilation
Tetany
The recommendations of the ACC/AHA 2006 valvular heart disease guidelines for aortic valve replacement in patients
with valvular aortic stenosis are summarized below, in Table 5. [10] In most adults with symptomatic, severe aortic
stenosis, aortic valve replacement is the surgical treatment of choice. If concomitant coronary disease is present,
aortic valve replacement and coronary artery bypass graft (CABG) should be performed simultaneously.
Table 5. Recommendations for Aortic Valve Replacement in Aortic Stenosis(OpenTableinanewwindow)
Indication
Class
Patients with severe aortic stenosis undergoing coronary artery bypass surgery
Patients with severe aortic stenosis undergoing surgery on the aorta or other
heart valves
87
Patients with severe aortic stenosis and LV systolic dysfunction (ejection fraction I
< 0.50)
Patients with moderate aortic stenosis undergoing coronary artery bypass
surgery or surgery on the aorta or other heart valves
IIa
Patients with mild aortic stenosis undergoing coronary artery bypass surgery
when there is evidence that progression may be rapid, such as moderate-tosevere valve calcification
IIb
IIb
Asymptomatic patients with severe aortic stenosis and a high likelihood of rapid IIb
progression (based on age, calcification, and coronary artery disease) or if
surgery might be delayed at the time of symptom onset
Asymptomatic patients with extremely severe aortic stenosis (valve area less
than 0.6 cm2, mean gradient greater than 60 mm Hg, and jet velocity greater
than 5 m per second) if the patients expected operative mortality is 1% or less
IIb
AVR is not useful for prevention of sudden death in asymptomatic patients with
none of the findings listed under asymptomatic patients with severe aortic
stenosis
III
emedicine
573-Patient with untreated bronchogenic carcinoma has dilated neck veins,
facial flushing, hoarsness and dysphagia (SVC syndrome). CXR showed
small pleural effusion. Whats your immediate action:
a. Consult cardiologist for pericardiocentesis
b. Consult thoracic surgeon for Thoracocentesis
c. Consult oncologist(with radiotherapy symptoms improve)
the most common cause of SVC syndrome is bronchogenic carcinoma
574-Fixs method in determining cardiac output ;??
1 BP
2 o2 saturation in blood
COP = PR/ BP
575-3 year old boy with acute UTI .. first thing to do in such acute
thing ;??
a-Indwelling foley cather drain
b voiding cytctogram
c- cystoscopyd-US
576-- drug contraindication hypertrophic obstructive cardiomyopathy;
88
A_ digoxin
B_ one of b-blocker
Avoid digitalis because glycoside are contraindicated except in pts with
uncontrolled atrial fibirallation (emedicine)
577-- BPH pt with hypertension what to give;
alpha blocker
578-- posterior hip dislocation : ( from reconstruction)
A flexion , adduction
b- flexion abduction
c- extension, adduction
_posterior hip dislocation :the hip is flexed ,internal rotation,adducted
(emedicine)
__________________________________________________________________________
_________________________
579-- action of ocp : ( from reconstruction)
A - inhibition of estrogen then ovulation
B inhibition of prolactin then ovulation
d. inhibition of mid cycle gonadotropin then ovulation
580- 30 age women with sharp pain in the index finger increase with using
scissors or nail cut which cause sharp pain at the base of the finger in
matacarpophlyngeal joint and the finger become directed downward in
(mean flexed DIPj) and cause pain when try to extend the finger..
1-trigger finger
2-tendon nodule
3-dupetren contracure
4- mullet finger
loss of extensor tendon continuity at the DIPJ causes the joint to rest on
an abnormaly flexed position
the classic mechanism of injury is a finger held rigidly in extension or
nearly full extension(emedicine)
581-- itching scale in pack of knee . face and ant elbow :
A scapis
B eczema
c- contact dermitis
eczema:the earliest lesion affect anticubital and popliteal fossa
lesions are ill defined erythematous,scaly, patches and
plaques(emedicine)
582- mitral stenosis :
A diastolic high pitch
B - systolic low pitch
C- diastolic low pitch
89
flashes of light (photopsia) very brief in the extreme peripheral (outside of center) part of
vision
a ring of floaters or hairs just to the temporal side of the central vision
Although most posterior vitreous detachments do not progress to retinal detachments, those that do produce the
following symptoms:
a dense shadow that starts in the peripheral vision and slowly progresses towards the
central vision
the impression that a veil or curtain was drawn over the field of vision
91
straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved
(positive Amsler grid test)
central visual loss
(None of this is to be confused with the broken retina which is generally the tearing of muscle and nerve behind the
eye)
retinal artery occlusion:The most common presenting complaint is an acute persistent painless
loss of vision. In central artery occlusions, visual loss is central and dense. In branch artery occlusions, visual loss
may go unnoticed if only a section of the peripheral visual field space is affected.
A complete visual field defect suggests central retinal artery occlusion (CRAO).
The cherry red spot and a ground-glass retina are the classic findings but may take hours to develop.
Retinal vein thrombosis : Central retinal vein occlusion (CRVO) is essentially a diagnostic finding of
painless unilateral loss of vision. In some cases, this loss of vision is subtle in character, with intermittent episodes of
blurred vision. In other cases, it may be sudden and dramatic. The nonischemic type is often the more subtle of the
two, while the ischemic type is prone to the more acute clinical presentations.
Nonischemic CRVO - Subtle, intermittent visual loss; painless; mild-to-moderate visual loss
Ischemic CRVO - Acute visual loss; pain may be present; marked visual loss
BRVO is similar in presentation to CRVO. BRVO is often noted with an onset of blurred vision or visual field defect.
Vision loss may be subtle. Patients with small occlusions of a branch retinal vein may often be asymptomatic. Larger
obstructions can lead to significant visual loss. It is uniformly a unilateral disease. Nine percent of cases are bilateral.
Nonischemic central retinal vein occlusion
Patients with BRVO have retinal hemorrhages confined to the distribution of the retinal vein.
The ophthalmoscopic examination may note triangular and flame-shaped hemorrhages.
Mild obstruction of a branch may only show scant hemorrhage. Complete obstruction may have extensive
hemorrhage noted on examination, with cotton wool spots.
Diabetic retinopathy: In the initial stages of diabetic retinopathy, patients are generally asymptomatic; in
the more advanced stages of the disease, however, patients may experience symptoms that include floaters, blurred
vision, distortion, and progressive visual acuity loss.
Microaneurysms
Microaneurysms are the earliest clinical sign of diabetic retinopathy and occur secondary to capillary wall outpouching
due to pericyte loss. They appear as small red dots in the superficial retinal layers, and there is fibrin and red blood
cell accumulation in the microaneurysm lumen. A rupture produces blot/flame hemorrhages. Affected areas may
appear yellowish in time, as endothelial cells proliferate and produce basement membrane.
92
Flame-shaped hemorrhages
Flame-shaped hemorrhages are splinter hemorrhages that occur in the more superficial nerve fiber layer.
Cotton-wool spots
Cotton-wool spots are nerve fiber layer infarctions from occlusion of precapillary arterioles. With the use of fluorescein
angiography, there is no capillary perfusion. These are frequently bordered by microaneurysms and vascular
hyperpermeability.
Macular edema
Macular edema is the leading cause of visual impairment in patients with diabetes. A reported 75,000 new cases of
macular edema are diagnosed annually. This may be due to functional damage and necrosis of retinal capillaries.
Clinically significant macular edema is defined as any of the following:
Retinal thickening located 500 m or less from the center of the foveal avascular zone
(FAZ)
Hard exudates with retinal thickening 500 m or less from the center of the FAZ
Retinal thickening 1 disc area or larger in size located within 1 disc diameter of the FAZ
594-16 y/o female become deaf suddenly.. her mother become deafwhen
she was 30.. Dx:
a- otosclerosis 100% sure(autosomal dominant,positive family history)
b- acostic neuroma
c-tympanic perforation
595-major hazard in post-menepause: >>>>>>>>>>(all true )
a- osteoprosis>>i'm 90%sure
b- hot flush
c- deppresion
d- pelvic floor weakness
596-which of the folloing b- blocker .. havean alpha blocking effect :
>>>>>>>
a- metoprlol
b- atenalol
c- mesoprolol
a. xxxxxx lol
93
b. yyyyyy lol
labetalol and carvedilol (block beta and alpha)
597-theScreeningQuestionnaireto recognize primary snoring fros OSAS is :
..
a- otowaQuestionnaire
b- HorchoverQuestionnaire
c- .........
........ .a
598-ADHD Rx : >>>>> ADHD
a- olanzapine
b- atomixtin
cmethylphenidate,
magnesium pemoline
atomoxetine
dextroamphetomine
lisdexamfetamine
bupropion
venlafaxine
lmipramine
guanfacine
clonidine
599-patient with congistive heart failure and pulmonary edema, what is
the best treatment:
1-spronalctone
2-forsumide.
3
____________________________________________________________________
600-post partum women when she went back to work ,, she exposed
tothe sun and started to have brown discolortion in her face .. what is
thediagnosis:
1. uritcariA pigementosa (x)
melasma/chloasma (a patchy browen or dark brown skin discoloration,
that usually occurs on face and may result from hormonal
changes,generally found in sun exposed areas.
601-patient presented by left arm swelling , pain full axillary
lymphadenopathy ttt by ;
a- oral antibiotics (if only lymphadenitis)
b.IV antibiotics ??(if systematic symptoms)
602- which one of the following is prognostic factor for CML ;
a- age.
1
chromosomal abnormality
94
Shoulder arthritis can be one of three types of arthritis in the glenohumeral joint of the shoulder
Themainsymptomofshoulderarthritisispain;thisisduetothegrindingofthebonesagainsteachotherbecauseofthelackof
cartilage.Painusuallyoccursinthefrontoftheshoulderandisworsewithmotion.Peoplewithshoulderarthritiswillalso
experiencemoderatetosevereweakness,stiffnessdevelopingovermanyyears,andtheinabilitytosleepontheaffectedshoulder.
[edit]Diagnosis
Diagnosisissimple;usuallythedoctorcantellifyouhaveshoulderarthritisbyyoursymptoms,butheorshewillmostlikelyalso
takeanxrayorMRI.
[edit]
95
96
611- 14years old girl failed in math exam .. then she hadpalapitation ,,
tachypnea and paracethesia .. this is :
1-hyperventilation syndrome
2-conversion
1-hyperventilation 2-parasthesia 3-pscho problems 4-no organic causes.
612--child moved with his family to new city n he started to go tonew
school .. in the school he had low mood n doesn't want to interactive
withany activity .. this a case of:
1-hypomania
2-depression
612-origin of pancreatic carcinoma :
Ductal epithilum
Of all pancreatic cancers, 80% are adenocarcinomas of the ductal epithelium.
615- attak rate for school children whom developed pink eye ,
first day 10 out of 50 , second day 30 out of 50 :
20
40
60
80
attack rate=number of infected/total number of exposedx100=80
616- group of diseases include , cystic fibrosis , liver failure , the
cause is :
Alpha one antitrpsin def
617- sinus tachycardia and atrial flutter , how to differentiate :
Carotid art message
Temporal art message
Adenosine iv
618- ear pain , headache . purulent discharge , right side
weakness and loss of sensation , diagnosis :
Epidural brain abscess
97
Subdural hematoma?
Spinal column abscess
HZV
Ramsay Hunts syndrome
Description:
Unilateral herpes zoster infection of the geniculate ganglion (respectively n. Intermedius) with lesions of the external ear and oral mucosa.
The symptoms include facial paralysis, severe pain in the ear with a bloody serous discharge due to vesicles on the tympanic membrane.
source
http://www.ramsayhunt.org/epon.shtml
100
Read more:http://www.justmommies.com/articles/male-infertility.shtml#ixzz1k5jLlr00
__________________________________________________________________________
__________________________
643-18years old boy with back pain investigation to do except :
CBC ?
ESR
X -ray
bone scan
644- Hypothyroidisim :
free T4
TSH
T4
..
__________________________________________________________________________
__________________________
645-in which group you will do lower endoscopy for patients with iron
deficiency aneamia in with no benign cause:
101
c. VSUG
d-US
649-2 months old child complaining of spitting of food , abd examination
soft lax , occult blood ve , what you will do ?
Reassure the parents
Abd CT
650- baby with streptococcus pharyngitis start his ttt after two days he
improved, Full course of streptococcus pharyngitis treatment with
amoxicillin is : imp.
10 days ( 9-11 days )
7days
14 days
651- Uncomplicated UTI ttt
TMP-SMX for 3 days
Ciprofloxacin 5 days
652- Facial injury suturing remove after? Imp.
24h
3 5 days
( most likely )
7 10 days
14 days
653- Lichen planus most common site ?
Scalp
Neck
Knee
Buttocks
As far as I know the common site will be near the wrist and the ankle
but those sites were not one of the choices ?
654-One of the following condition does not cause hypokalemia
Metabolic alkalosis
Furosemide
Hyperaldosteronism
Acute tubular necrosis
Diarrhea
655-Condition not associated with increase alpha feto protein
Breech presentation
Down syndrome
Gastroschisis
__________________________________________________________________________
__________________________
656- Pt came with trauma to left eye by tennis ball examination shows
anterior chamber hemorrhage you must exclude ?
Conjunctivitis
Blepharitis
103
Gastro
665- Female pt with hypothyroidism, TSH high But he did not give the
total T4 nor free , pulse normal BP normal she is in thyroxin what you will
do? Imp.
Increase thyroxin follows after 6 months
Increase thyroxin follows after 3 months
Decrease thyroxin follows after 6 months
Decrease thyroxin follows after 3 months
666- Pt with polycethemia vera the cause of bleeding in this pt is
Increase viscosity
Low platelets
Thromboses and bleeding are frequent in persons with polycythemia vera (PV) and MPD, and they result from
the disruption of hemostatic mechanisms because of (1) an increased level of red blood cells and (2) an
elevation of the platelet count. There are findings that indicate the additional roles of tissue factor and
polymorphonuclear leukocytes (PMLs) in clotting, the platelet surface as a contributor to phospholipiddependent coagulation reactions, and the entity of microparticles. Tissue factor is also synthesized by blood
leukocytes, the level of which is increased in persons with MPD, which can contribute to thrombosis.
Rusak et al evaluated the hemostatic balance in patients using thromboelastography and also studied the
effect of isovolemic erythrocytapheresis on patients with polycythemia vera. They concluded that
thromboelastography may help to assess the thrombotic risk in patients with polycythemia vera. [9]
Hyperhomocystinemia is a risk factor for thrombosis and is also widely prevalent in patients with MPD (35% in
controls, 56% in persons with PV).
Acquired von Willebrand syndrome is an established cause of bleeding in persons with MPD, accounting for
approximately 12-15% of all patients with this syndrome. von Willebrand syndrome is largely related to the
absorption of von Willebrand factor onto the platelets; reducing the platelet count should alleviate the bleeding
and the syndrome.
106
Children with overactive bladder or dysfunctional voiding, urethral obstruction, neurogenic bladder, ectopic ureter, or diabetes mellitus are
predisposed to cystitis.
If the urinalysis findings suggest cystitis, urine should be sent for culture and sensitivity.
Urethral obstruction may be associated with RBCs in the urine.
The presence of glucose suggests diabetes mellitus.
A random or first-morning specific gravity greater than 1.020 excludes diabetes insipidus.))
emedicine
The most commonly accepted cause of nocturnal enuresis, but also the most difficult to prove, is delayed functional maturation of the
central nervous system, which reduces the child's ability to inhibit bladder emptying at night.
...........
medscape
671- Old male pt came with fever, abd pain, diarrhea , loss of weight , +
ve occult blood , Labs shows that the pt infected with streptococcus bovis
, what you will do ?????
Give antibiotic
ORS
Abd X-Ray
Colonoscopy
Metronidazole
_Colonoscopy should be performed in all patients with S bovis bacteremia or endocarditis. (emedicine)
__________________________________________________________________________
_________________________
672-Mallory weiss syndrome
Mostly need surgery
Mostly the bleeding stops spontaneously
Associated with high mortality
673- Female pt around 35 years old, hx of thromboembolic disease, what
type of reversible contraceptive she can use imp.
OCP
Mini pills (no estrogen)
IUCD
674- Child with fever and runny nose, conjunctivitis and cough then he developed
Maculopapular rash started in his face and descend to involve the rest of the
body:this is case of measles
a. EBV
b. Cocxaci virus
c. Rubella virus
d. Vaccini virus
The first sign of measles is usually a high fever (often >104 o F [40o C]) that typically lasts 4-7 days. This prodromal
phase is marked by malaise, fever, anorexia, and the classic triad of conjunctivitis (see the image below), cough, and
coryza (the 3 Cs). Other possible associated symptoms include photophobia, periorbital edema, and myalgias.
Blanching, erythematous macules and papules begin on the face at the hairline, on the sides of the neck, and behind
the ears (see the images below). Within 48 hours, they coalesce into patches and plaques that spread
cephalocaudally to the trunk and extremities, including the palms and soles, while beginning to regress
cephalocaudally, starting from the head and neck. Lesion density is greatest above the shoulders, where macular
107
lesions may coalesce. The eruption may also be petechial or ecchymotic in nature.
http://labtestsonline.org/understanding/analytes/wbc/tab/test
__________________________________________________________________________
__________________________
680- The physiologic hypervolemia of pregnancy has clinical significance in the
management of severely injured , gravid women by:
108
The primary initial goal in treating a pregnant trauma victim is to stabilize the mother's condition. The priorities for
treatment of an injured pregnant patient remain the same as those for the nonpregnant patient.
Primary Survey
As with any other injured patient, the primary survey of the injured pregnant patient addresses the airway/cervical
spine control, breathing and circulation (ABC; volume replacement/hemorrhage control), with the mother receiving
treatment priority. Supplemental oxygen is essential to prevent maternal and fetal hypoxia. Severe trauma
stimulates maternal catecholamine release, which causes uteroplacental vasoconstriction and compromised fetal
circulation. Prevention of aortocaval compression is also essential to optimize maternal and fetal hemodynamics.
Pregnant patients beyond 20 weeks' gestation should not be left supine during the initial assessment. Left uterine
displacement should be used by tilting the backboard to the left or as a final measure, the uterus can be manually
displaced.
Hypovolemia should be suspected before it becomes apparent because of the relative pregnancy induced
hypervolemia and hemodilution that may mask significant blood losses. Aggressive volume resuscitation is
encouraged even for normotensive patients.
http://www.trauma.org/archive/resus/pregnancytrauma.html
In anemia of chronic disease without iron deficiency, ferritin levels should be normal or high,
reflecting the fact that iron is stored within cells, and ferritin is being produced as an acute
109
phase reactant but the cells are not releasing their iron. In iron deficiency anemia ferritin should
be low.[5]
TIBC should be high in genuine iron deficiency, reflecting efforts by the body to produce
more transferrin and bind up as much iron as possible; TIBC should be low or normal in
anemia of chronic disease.
b. Keratoconus .
688- Young male pt present e and pain for....... He denied any hx of Truma or any
medical illness before
On ex..RR32b/min. Pulse .....
Abdomen not tender or garding
By invx
WBC e in normal
K >5
Na......
RBS 23mmol
What most important invx:
U/s
ABG
urine dipstick
689- The best investigation for kidney function :
a- 24 h collect urine
b- Creatinine clearance
690- Patient came to you with small swelling under his eye , on examination he
have inflammation in lacrimal duct , you refer him to ophthalmologist before that
what you will give him ?
a- Topical steroid
b- Topical antibiotic
c- General antibiotic
691- What is true regarding spountinous abortion:
Can lead to infertility in future
Usually fused by any utrine abnormality
That occur on 2ed trimester
..
692- The best investigation for acute diveticolitis is
:
a- US
111
b- Barium enema
c- CT
d- Colonscopy
e- Sigmidscopy
Diverticulitis:
o
Chest X-ray with the patient upright can aid detection of pneumoperitoneum.
o
Abdominal X-rays may demonstrate small or large bowel dilation or ileus, pneumoperitoneum, bowel obstruction,
o
than for contrast enemas. When an abscess is suspected, CT scanning is the best modality for making the diagnosis and
following its course.
Because of risk of perforation, endoscopy is generally avoided in initial assessment of the patient with acute
diverticulitis. Its use should be restricted to situations when the diagnosis in unclear, to exclude other possible
diagnoses.
http://www.patient.co.uk/doctor/Diverticular-Disease.htm
693- Food poisoning , group of people came with diarrhea and vomiting diagnosis is:
a. Staphiloccous aureus poisoning
b- Salmonella poisoning
Usually if patients came with food poisoning after few hours of ingestion mostly the
cause is Staph due to preformed toxin, if they started to have symptoms after one
day of ingestion you are right compylobacter salmonella shigella or E. coli
694- Patient with Rhumatoid arthritis on hand X-Ray there is swelling what you will
do for him
a- NSAID
b. Injection steroid
c.
NSAIDs interfere with prostaglandin synthesis through inhibition of the enzyme cyclooxygenase (COX), thus
reducing swelling and pain. However, they do not retard joint destruction and, therefore, when used alone, are
not sufficient to treat RA
695- what is the drug that will preserve the histology in primary liver cirrhosis:
696- propylthiouracil drug contraindicated with :
*Maternal HTN
*Maternal DM
112
*Maternal asthma
697- Differant between uvitis and kertits
:
Dec visual acuty
Photophbia
Periorbiatl edma
in keratitis
Cillry flush
698- 55 y/o male,, c/o angina and syncope on exertion ,, normal ejection fraction ,,
normal coronary arteries ,, there is only calcified aortic valve with total area < .75 cm
,, the rest of examination and investigations are normal ..
Wt is ur manag. :
Avoid exertion
Medical therapy(for angina)
Aortic ballon dilation
Aortoc valve replacrment
699- 10 months old baby came to the clinic with his mother , she breastfeed him 3
times a day ,, she is known cace of epilepsy on phenobarbital,,,,,, What u going to
tell her final answer
Stope breastfeeding immediately
Weaning over 2 weeks period
Breastfeed after 8 h from taking the drug ??
Respond to what the mother and child wish
henobarbital in breastmilk apparently can decrease withdrawal symptoms in infants who were exposed ..
If phenobarbital is required by the mother, it is not necessarily a reason to discontinue breastfeeding. Monitor the infant for drowsiness,
adequate weight gain, and developmental milestones
i http://www.drugs.com/breastfeeding/phenobarbital.html
700- 65 yo male pt presented with history of backache and fatigue for the last 3
month , examination showed mild tenderness in lumbosacral region , initial
investigation revealed the following :
Hb 9
ESR 80
X ray spine showed osteolytic lesion, the most likely diagnosis is ......
Solitary myloma
113
711- 70 ys old with sever muscle pain , diarrhea , disorientation , he is in diuretic the
cause :
*hyponatremia
*hypokalemia
712- Newly diagnosed Type 2 diabetic advice for diet and exercise but still gain
weight , which medication you want to add
1.insuline
2. metformin
3. sulfonylurea
713- mucopurulent discharge :
bacterial conjunctivitis
714- HCC :
10 % with liver disease
115
Alcoholism
Hepatitis B
Aflatoxin
Hemochromatosis
Wilsons disease (while some theorize the risk increases,[4] case studies are rare[5] and
suggest the opposite where Wilson's disease actually may confer protection [6])
Sentinel loop sign:isolated dilatation of a segment of gut consisting of jejunum, transverse colon or duodenum. Colon cutoff
sign:gas distition rt colon that abruptly stopes in mid or LF colon due spasm adjacent to inflammation
734- baby with tonic clonic convulsions,what drug you'll give the mother
to take home if ther is another seizure:
Diazepam
phenytoin
Phenobarb
735- Significant DPL direct peritoneal lavage in diagnosis :
10 ml blood or 100,000 RBC or 500 WBC
A positive DPL in an adult classically requires one of the following
results:
RBC : > 100,000/mm3
blood : 10 ml
Amylase level (IU/L) : 20
Alkaline phosphatase level (IU/L) : 3
WBCs (per mm3) :>500
119
Slightly
Markedly Decrease
increased or increased d
Normal
Viral
Clear fluid Slightly
meningitis
increased or
Normal
Markedly
increased
Slightly Normal
increased
or Normal
Tuberculou Yellowish
s
and
meningitis viscous
Slightly
increased or
Normal
Markedly
increased
Increased Decrease
d
Fungal
Yellowish
meningitis and
viscous
Slightly
increased or
Normal
Markedly
increased
Slightly Normal or
increased decrease
or Normal d
__________________________________________________________________________
744- Patient with vomiting and diarrhea and moderate dehydration, how
to treat:
ORS only
745- in knee examination : +ve lechman test indicate injury :
Anterior cruciate ligament
746-2 weeks after delivery , mother said that the baby , he will die ,
baby lack healthy , what is diagnosis :??
Post partum no bonding
Post partum psychosis
Post partum depression
747- antidepressant in elderly :
Will take time to see effect
"I make sure that patients and their familywho I always try to includeunderstand how long it can take to
respond to an antidepressant. People need clear expectations. The drugs take longer to work in older people than
younger ones, usually 8 to 12 weeks. The longer they stay on the medicine, the more improvement they are likely
to see,"
http://www.health.com/health/condition-article/0,,20188909_2,00.html
121
750- old pt , e hx of MI 2 weeks back and discharge from hospital 24 hrs prior to his
presentation <<<came with sudden lower limb pain and numbness ,on ex the limb
pale , cold >>the other limb normal what is the DX :
a-Acute artery thrombosis
b- acute artery embolus
d. DVT
e. D- ???
751-7- Neonate with mass on his eye :
a-Neuroblastoma
b-Leukemia
122
(Neuroblastoma
is the most common extracranial solid tumor in infancy and the third most common
pediatric malignancy after leukemia and central nervous system (CNS) tumors.
It is an embryonal malignancy of the sympathetic nervous system arising from
neuroblasts (pluripotent sympathetic cells). Signs and symptoms of neuroblastoma
vary with site of presentation. Generally, symptoms include abdominal pain, emesis,
weight loss, anorexia, fatigue, and bone pain. At diagnosis, the site of neuroblastoma
is predictably age-dependent. Infants often present with compression of the
sympathetic ganglia in the thoracic region, which might result, for example, in Horner
syndrome (myosis, anhydrosis, and ptosis) or superior vena cava syndrome. Older
children typically present with abdominal symptoms because, as stated above, more
than 40% of neuroblastomas are adrenal in origin. Children who are preschool aged
should have working differential diagnoses for an abdominal mass, including
lymphoma, hepatoblastoma, rhabdomyosarcoma, renal cell carcinoma, and
neuroblastoma.
http://emedicine.medscape.com/article/988284-overview#a0104
Leukemia
is a type of cancer of the blood or bone marrow characterized by an abnormal
increase of immature white blood cells called "blasts".In most patients, a diagnosis of
leukemia has been made before presenting to an ophthalmologist. However, in some
patients, ocular symptoms and examination lead to a diagnosis of leukemia.Orbital
manifestations
o Leukemic cells may infiltrate the orbit during the course of acute or chronic leukemia.
Unusual orbital involvement with leukemia has been reported to include infiltration of the
lacrimal gland and drainage system, rectus muscles, and dermis.
o Orbital involvement in children is more common in acute leukemias, whereas orbital
involvement in adults is more common in chronic leukemias.
o The leukemic infiltrate may range from insignificant, where it is virtually asymptomatic, to a
space-occupying lesion with its concomitant symptoms.
o The patient may have proptosis, ecchymosis, chemosis, diplopia, visual disturbance, or
motility disturbances.
o In children, the orbital involvement is characterized by an acute and rapid process that may
be confused with orbital cellulitis. In general, these infiltrates are bilateral and do not destroy
bone. Granulocytic sarcoma of the orbit, also known as chloroma, is an extramedullary form
of myelogenous leukemia.
o Unilateral, painless proptosis develops over weeks to months prior to a diagnosis of
leukemia. Eyelid redness or violaceous discoloration may be present, which turns into
ecchymosis that may be confused with rhabdomyosarcoma or metastatic neuroblastoma. If
AML or CML is already present, then a rapid and fulminant bilateral proptosis is
characteristic.
o
o http://emedicine.medscape.com/article/1201870-clinical#a0217
123
SCABES>>superficial burrows
124
A subtle linear burrow accompanied by erythematous papules on the sole of the foot
in a child with scabies.
ATROFIC DERMATITIS>> red, flaky and very itchy. The skin on the flexural surfaces
of the joints (for example inner sides of elbows and knees) are the most commonly
affected regions in people.
125
754- CHILD SEVERLY ILL AND FEVER FOR 2 DAYS ANOREXIA NAUSEA
VOMITING THEN PETECHIA RASH APEAR IN TRUNK AND SPREAD
IN THE BODY ??
MEASELS
MENINGOCOCCAL MENINGITIS
MOUNTAIN FEVER
Varicella low grade fever for 2 days then rash in the trunk then it spread in the body
755- Patient on amitriptyline 30mg before bed time wake up with sever headache
and confusion what is the appropriate action ?
Shift him to ssri
Change the dose to 10mg 3time daily
756-Young patient with decrease hearing and familly history of hearing loss ear
examination normal rene and weber test revealed that bone conduction is more than
air conduction what would you do ?
Till him it is only temporal
Till him there is no ttt for this condition
Refer to audiometry
Refer to otolaryngologists
757- which one of these drugs causing hypertensive crisis when it is not
stoped gradually?
diltiazim>>Antidysrhythmics, IV; Calcium Channel Blockers,
colonidine>>Rebound hypertension on withdrawal
b blocker
Clonidine suppresses sympathetic outflow resulting in lower blood
pressure, but sudden discontinuation can cause rebound
hypertension due to a rebound in sympathetic outflow.
Clonidinetherapyshouldgenerallybegraduallytaperedoffwhendiscontinuingtherapytoavoidreboundeffectsfromoccurring.
Treatmentofclonidinewithdrawalhypertensiondependsontheseverityofthecondition.Reintroductionofclonidineformild
cases,alphaandbetablockersformoreurgentsituations.Betablockersnevershouldbeusedalonetotreatclonidinewithdrawal
asalphavasoconstrictionwouldstillcontinue
________________________________________________________________________________________________________
758- @1year old massive hepatosplenomegaly , brown skin nodule, lateral neck
lump investigation to diagnose
126
Ebv serology
Lp
bone marow aspiration
liver biopsy
759- child came with hematuria 15 RBC HPF , all examination normal what will you
do ?
a. urine cytology
b. renal bipsy
c cystosocopy
c. repeat urine for RBC and protein
760- 15 years old with palpitation and fatigue. Investigation
showed RT ventricularhypertrophy, RT ventricular
overload and right branch block what is the diagnosis :
a- ASD
b- VSD
Complications of VSDs include the following:
Heart block secondary to intracardiac repair
c- Coartaction of aorta
761- child came withor Toeing-In , set in W shape , when walk both feet and knee
inward with 20 degree , both femur inwarr rotation 70 degree <<like this """ what the
Dx :
a. metatarsus adductus
b-femoral anteversion (femoral torsion )>>
Femoral anteversion
Normalfemoralanteversionis40inthenewbornanddecreasesto10bytheageof8years.Theacetabulumisangledforward
15.Femoralanteversiondoesnotincreasetheriskofarthritisofthehip.Spontaneousimprovementintheanatomicpositioncan
occuruntilthepatientisaged8yearsandcanfurthercorrectbyimprovingthegaitthroughconsciouseffortuntiladolescence.
Femoral anteversion is the axial angle between the plane of the neck of the femur and
the femoral condyles. It can be clinically deduced by measuring the hip rotation.
Normal range of external rotation is 45-70, and internal rotation is 10-45. As femoral
anteversion increases, the amount of internal rotation increases and external rotation
decreases. These children can have as much as 90 of internal rotation and 0 of
external rotation. They sit in the W position with their legs turned out (a position not
attainable by normal adults), but they cannot sit cross-legged
c-???
762- anticoagulation prescribed for
- one month
- 6 months
- 6 weeks
- one year
127
Step 2
< 5 Rapidy
acting
beta2agonist
prn
5-11 Rapidy
acting
beta2agonist
prn
Low-dose ICS
12 y
or
olde
r
Step 3
Alternate
regimen:
cromolyn or
montelukast
Alternate
regimen:
cromolyn,
leukotriene
receptor
antagonist
(LTRA), or
theophylline
Step 4
Step 5
Step 6
Medium-dose
ICS plus either
long-acting
beta2-agonist
(LABA) or
montelukast
High-dose ICS
plus either
LABA or
montelukast
High-dose ICS
plus LABA
Alternate
regimen: highdose ICS plus
either LABA or
theophylline
Alternate regimen:
high-dose ICS plus
LRTA or
theophylline plus
systemic
corticosteroid
Low-dose ICS
plus LABA OR
Medium-dose
ICS
128
needed
Alternate
regimen:
cromolyn,
LTRA, or
theophylline
Alternate
regimen: lowdose ICS plus
either LTRA,
theophylline, or
zileuton
Alternate
regimen:
medium-dose
ICS plus either
LTRA,
129
patients with
allergies)
omalizumab for
patients with
allergies)
131
772- Gram stain reveal gram negative diplococcic (you must know about
causative org. of this type).
Ceftriaxone IM or cefepime PO one dose..(Nisseria gonorrhea) >>
is a species of Gram-negativecoffee bean-shaped diplococcibacteria responsible for
the sexually transmitted infectiongonorrhea.
ttt : ceftriaxone (a third-generation cephalosporin)
c) Pre-existing AV block
d) Anterograde AV block
e) Bundle branch block
cannon wave It is associated with heart block, in particular third-degree
(complete) heart block
777- The drug with the least side effects for the treatment of SLE is:
a) NSAIDs (correct)>>Common side effects of NSAIDs can include:
stomach upset
heartburn
diarrhea
fluid retention
132
nausea
vomiting
hair loss
bladder problems
decreased fertility
c)
swelling
increased appetite
weight gain
These side effects generally stop when the drug is stopped. It is dangerous (even life threatening) to
stop taking corticosteroids suddenly
stretch marks
infections
cataracts
stomach upset
___________________________________________________________________
778- A young male who is a known case of sickle cell anemia presented with
abdominal pain & joint pain. He is usually managed by hospitalization. Your
management is:
a) In-patient management & hospitalization
b) Out-patient management by NSAID
c) Hydration, analgesia, monitoring. (correct)
d) Narcotic opioids
133
___________________________________________________________________
779- A lot of bacteria produce toxins which are harmful. Which one of the
following is used in amiddirs:
a) Botulism??
b) Tetanus
c) Diphtheria
d) Staph aureus
780-
All
a)
b)
c)
d)
783- A hypothyroid pt on thyroxin had anorexia, dry cough, dyspnea & left
ventricular dysfunction. She had normal TSH & T4 levels, Hyperphosphatemia
& hypocalcemia. The diagnosis is:
a) Primary hypoparathyroidism
b) Secondary hypoparathyroidism xx
134
c) Hypopituitaritism
d) Uncontrolled hyperthyroidism
784-A 55 yr old man presenting with Hx of streakes of blood in stool and dull
pain on defecation that persists for half an hour after defecation, on
examination there was a 3x2 cm thrombosed mass at 3 oclock.What is the
management?
a) Sitz bath 5 times/ day.
b) Application of local anesthetic and incision.
c) Application of antibiotic
d) Band ligation and wait for it to fall
e) Application of local anesthetic ointment
_________________________________________________________________________
785- A 42 year old woman presented with a painful breast mass about 4 cm
in the upper lateral quadrant. It increases in size with the menstrual period.
Examination showed a tender nodularity of both breasts. What is the
management:
a) Hormonal treatment with oral contraceptive pills
b) Hormonal treatment with danazol?? xx
c) Lumpectomy
d) Observation for 6 months
787786- A 48 year old man complaining of right lower quadrant pain, bleeding per
rectum, nausea & vomiting. What is the best pre-operative investigation?
a) Air contrast enema
b) Fecal occult blood
c) CBC
d)
788- Which of the following indicate large uncomplicated pneumothorax:
a) Symmetrical chest movement.
b) Increase breath sound
c) Dull percution note.
d) Tracheal deviation (correct)
e) Cracking sound with each heart beat
___________________________________________________________________
789-. A pregnant woman, multigravida, 38 weeks gestational age presented
with glucosuria. Gestational diabetes was confirmed by glucose tolerance
test. The next step is:
a) Repeat Glucose tolerance test
b) Cesarean section
c) Diet adjustment
d) Start sliding scale insulin
135
c) Bacterial gastroenteritis
d) Viral gastroenteritis
___________________________________________________________________
793- A young female patient who is an office worker presented with itching
in the vagina associated with the greenish-yellowish vaginal discharge.
Examination revealed red spots on the cervix. The diagnosis is:
a) Trichomoniasis (correct)Women with trichomoniasis frequently report a
frothy yellowish-green vaginal discharge
b) Candidiasis>>whitish or whitish-gray cottage cheese-like discharge
c) Gonorrhea
d) Gardnerella vaginalis
794- Uterovaginal prolapse:
a) Increase heaviness in erect position (correct)
b) More in blacks
c) A common cause of infertility
d) ..
795- A patient presented with fatigue, loss a petite & bloody urine. She gave
History of sore throat 3 weeks back. The most likely diagnosis is:
a) hemorragic pyelonephritis
136
___________________________________________________________________
798-The commonest chromosomal disease is:
a) Down syndrome (Trisomy 21) (correct)
b) Klinfelter syndrome
c) Turner's syndrome
?? 799-A young girl pt had URTI 1 week ago & received septra (trimethoprime
+ sulphamethoxazole). She came with crampy abdominal pain & proximal
muscle weakness. The diagnosis is:(the same question in alqasem but other
choises)474
a) Polymyositis
b) Gullian parre syndrome
c) Intermittent porphyria
d) Periodic hypokalemic paralysis
e) Neuritis
800-All the following are present in otitis media except:
a) Signs & symptoms of inflammation
b) Signs & symptoms of effusion
c) High grade fever
137
d) Pain
801-Best ttt for chronic pain management:
Ibuprofen >> NSAIDare most beneficial in cases of acute pain, or flare-ups in patients with chronic
pain. NSAIDs are excellent at treating inflammatory conditions including tendonitis, bursitis, and
arthritis.
acetaminophen (correct)>>in cases of chronic pain, no inflammation is at the site of the pain,
and thus Tylenol may be an appropriate treatment choice.
In general, NSAID use is limited for patients with chronic pain because of concerns about the development to
stomach problems
naproxen
802- CPR:
2 breaths raise the chest,
you can DC shock 3 successive times,
cardiac massage in aortic stenosis
40%recovery
803- Lump in the bake with punktem not increase in size for year when doctor press
it the punctum came discharge yellow fuel smell
Remove to avoid rapture in derm??
Antibiotic first then remove
804- T score of 70 years old osteoprotic male is :
T-score of greater than minus-1 is considered normal.
A T-score of minus-1 to minus-2.5 is considered osteopenia, and a risk for developing osteoporosis.
A T-score of less than minus-2.5 is diagnostic of osteoporosis
-3 (correct),
-2 ,
2,
3
__________________________________________________________________________
c) agoraphobia
d) depression
807- A man is brought to the ER after having seizure for more than 30
min the most initial drug you will start with:
a) IV lorazepam (correct)>> initial treatment due to its relatively long (28 hour) duration of
action when injected, and its rapid onset of action, which is thought to be due to its high affinity for GABA
receptors and to its low lipidsolubility which causes it to remain in the vascular compartment
b) IV phenobarbital
c) IV phynetoin
d) IV haloperidol
___________________________________________________________________
_______
808- A women who lost her husband 2 weeks ago she is unable to sleep
at all you will give her:
a) floxitine
b) diazepam
c) halperidol
d) amytriptaline
___________________________________________________________________
_______
a 65 yrs old lady came to your clinic with Hx of 5 days insomnia and crying
( since her husband died ) the best Tx. For her is :
a- lorazipam
b- floxitein
c- chlorpromazine
d- haloperidol
809-17 year pt with dyspnea Po2 , PCO2 ,Xray normal PH increase so dd is
- acute attack of asthma (correct)
-PE
- pneumonia
-pnemothrax
810- Picture of rash which appear pink on wood light:
-erythrasma>>is a macular brown area with few symptoms, most often found in the armpits or groin. It is
caused by overgrowth of diphtheroids of the normal skin flora. These areas fluoresce coral PINK under longwave ultraviolet radiation (Wood's light).
Fungal infection
811-RTA pt with femur fx , he has laceration of the femoral artery .. What to do :
1- end to end anastomosis
2- prosthetic graft
3-arterial graft
4- venous graft
139
___________________________________________________________________
812- Psycho pt swallow open safety pins,, x-ray show pins in the small intestine,,
what your next step:
-do emergent surgery(correct)>>Very sharp or pointed objects may perforate the GI
tract (sewing needles are notorious). Therefore, such objects should be endoscopically
removed from the stomach. If such an object has passed into the intestines, early
consultation with a surgeon is recommended. Objects that are too long (eg, >6 cm) or
too wide (eg, >2 cm) to pass through the pyloric sphincter should be removed from
the stomach.
e) Depersonalization
820- A 45 yo lady was complaining of dizziness, sensory neural hearing loss
on her left ear (VIIIth nerve palsy), tingling sensation & numbness on her face,
loss of corneal reflex. MRI showed a dilated internal ear canal. The diagnosis
is:
a) Acoustic neuroma>>any unilateral sensorineural hearing loss is caused
by an acoustic neuroma until proven otherwise
http://emedicine.medscape.com/article/882876-overview#a0112
b) Glue ear
c) Drug toxicity
d) Herpes zoster
e) Cholesteatoma
821- A pt had hairline metatarsal fracture. The x-ray was normal. What is the
2nd line?
a) CT scan
b) MRI(correct)>>MRI is sensitive for the diagnosis of fractures, it is not
required, because plain radiographic findings are fairly sensitive and specific.
MRI is useful in the assessment of fractures and dislocations, soft tissue, the
plantar plate, structures of the capsule, the extent of marrow hyperemia, the
exact number of bones involved, and small chip fractures
MRI is more sensitive than radiography and even scintigraphy in the early
diagnosis of stress fractures, because it shows bone marrow edema
exquisitely. MRI may be used to differentiate stress fractures from early
degenerative changes and early stress fractures from synovitis
c) US
d) ..
822- A Case scenario about a male patient present with prostatitis
(prostatitis was not mentioned in the question ), culture showed gram negative
rodes. The drug of choice is:
a) Ciprofloxacin (florqinlon)>>(correct)
b) Ceftriaxone
c) Erythromycin
d) Trimethoprime
e) Gentamicin
141
b) Cystitis
c) Renal calculi >> (correct) The hallmark of stones that obstruct the
ureter or renal pelvis is excruciating intermittent pain that radiates from the
flank to the groin or to the genital area and inner thigh
824-A 10 yo boy presented with a 5 days history of skin lesion which was
scaly & yellowish. The diagnosis is:
a) Tenia corporum>> (ringworm,[1]tinea circinata,[2] and tinea
glabrosa[1]) is a superficial fungal infection (dermatophytosis) of the arms
and legs, especially on glabrous skin, however it may occur on any part of
the body.enlarging raised red rings with a central area of healing
(ringworm). The same appearances of ringworm may also occur on the
scalp (tinea capitis), beard area (tinea barbae) or the groin (tinea cruris,
known as jock itch or dhobi itch).
Otherclassicfeaturesoftineacorporisinclude:
Sometimes the skin surrounding the rash may be dry and flaky.
___________________________________________________________________
__________
825- A mother brought her baby & was complaining of diaper rash. She used
cornstarch, talc powder, zinc ointment & 3 different types of corticosteroids
prescribed by different physicians but with no benefit. The rash was well
demarcated & scaly with satellite lesions. The most likely diagnosis:
a) Candidal rash (correct) >>fungal infection
b) Seborrhic dermatitis>>present with scaly, flaky, itching
red skin ,affect sebaceous gland-rich areas of skin
ttt:1/antifungal 2/anti-inflammatory 3/ topical steroid ..
c) Allergic contact dermatitis>>ttt : corticosteroid
826-A child presented with honey comb crust lesion. Culture showed staph
aureus. The diagnosis is:(539)
a) Impetigo (correct)
b) ..
c) ..
d) ..
827-. A pt presented with a 6 week history of itching & redness all over the
body with wheals. Which type of urticaria this pt has:
142
b) Solar urticaria
c) Allergic urtecaria
d) ..
828- A middle age man presented with sever headache after lefting heavy
object. His BP was high. He was fully conscious. Examination was otherwise
normal. The most likely diagnosis is:
a) Subarachnoid hemorrhage
b) Central HTN
c) Tension headache
d) Migraine
e) Intracerebral hemorrhage
829- You were working in a clinic with a consultant who prescribed a drug that
was contraindicated to the pt (the pt was allergic to that drug) but you didn't
interfere & assumed that he knows better than you do. Which of the following
you have violated:
a) Professional competence
b) Quality of caring of patient. (correct)
c) Honesty.
d) Pt relationship
e) Maintaining trust
___________________________________________________________________
830- Physician's carelessness is known as:
a) Malpractice (correct)
b) Criminal neglect
c) Malfeasance>>
d) Nonfeasance >>
831-.The most important factor in attempt of successful cessation of smoking
is?
a) The smokers desire to stop smoking . (correct)
b) The pharmacological agents used in the smoking cessation program.
c) Frequent office visits.
d) Physicians advice to stop smoking
e) Evidence of hazards of smoking
832- For health education programs to be successful all are true except :
a- human behavior must be well understood
b- Information should be from cultural background
c- Doctors are only the health educators(correct)>>health educator is a
__________________________________________________________
835-a 24 years old female pt. C/O : gray greenish discharge ,
itching .. microscopic examination of discharge showed :
flagellated organism most likely diagnosis is :
a- trichomoniasis ( trichomonas vaganalis )(correct)
144
physical symptoms such as partial loss of muscle function without physical cause but
in the presence of psychological conflict
d- psychogenic paralysis
e- hypochondriasis
the best treatment for the previous case is :
a- benzodiazepines
b- phenothiazine
c- monoamine oxidase inhibitor
d- selective serotonin reuptake inhibitor
e- supportive psychotherapy (correct)
837- a 58 yrs. old male pt. came with HX of fever, cough with
purulent foul smelling sputum and CXR showed : fluid filled cavity
the most likely diagnosis is :
a.abscess>>Presence of air-fluid levels
b- TB
c- bronchieactesis >>
_______________________________________________________________________________________
______________________________
idiopathic avascular osteonecrosis of the capital femoral epiphysis of the femoral head
leading to an interruption of the blood supply of the head of the femur close to the hip
joint
Onset of pain may be up to 4 hours after inactivity. Knee pain is felt in the back of the
knee rather than in the front, not unlike a localized charley horse. This lasts for an
hour or so and returns nightly on inactivity
c- RA??>>
Morning stiffness and a limp that is worse in the morning suggest juvenile rheumatoid arthritis
http://www.medscape.com/viewarticle/490135_4
d- a tumor
e- slipped capital femoral epiphysis >>
is a medical term referring to a fracture through the physis (the growth plate), which
results in slippage of the overlying epiphysis. Symptoms are waddling gait, loss of
motion in the hip joint, externally rotated foot, pain in the knee / groin / hip and
shortening of the hip. In up to 20% of cases slippage is bilateral. the knee starts to get
sore about 2-4 months before the actual hip goes. the pain in the knee can come and
go.
842-a 38 yrs old female came to you at your office and her pap smear report
was unsatisfactory for evaluation .. the best action is :
a- consider it normal & D/C the pt.
b- Repeat it immediately
146
d- Hep B carrier
e- chronic active Hep. B
Serological test findings at different stages of HBV infection and in convalescence
anti-HBc
Stage of infection
HBsAg
anti-HBs
IgG
IgM
HBeAg
anti-HBe
+ or -
+++
+ or -
+++
+ or -
++
++
+ or -
+ or -
+ or -
++
a.
847-8 wk Primigravida came to you with nausea & vomiting choose the
statement that guide you to hyperemesis gravidarm :
a- ketonia (correct)
b- ECG evidence of hypokalemia
c- Metabolic acidosis
148
149
a- Vaginitis (correct)
b- Cystitis
c- CA of vagina
d- Urithritis ( non gonococal )
Microscopic Findings
Differential Diagnosis
Signs
Bacterial
Three of the
Trichomonal
vaginosis
smelling discharge,
following: Gray
lactobacilli, increased
vaginitis
discharge, pH
coccobacilli
irritation; no
dyspareunia
Candidal
Budding yeast,
Contact irritant or
vaginitis
pseudohyphae, or
allergic vulvitis
microscopic
mycelia; best
Chemical irritation
without burning,
findings*
Vulvodynia
irritation, or
K hydroxide diluent
dyspareunia
Trichomonal
Profuse, malodorous,
Identification of
Motile, flagellated
Bacterial vaginosis
vaginitis
yellow-green
causative
protozoa, increased
Inflammatory
discharge; dysuria;
organism by
PMNs
vaginitis
dyspareunia; erythema
microscopy*
(occasionally by
culture)
Inflammatory
vaginitis
Purulent discharge,
pH > 6, negative
Increased PMNs,
Erosive lichen
planus
thinning, dyspareunia,
characteristic
cocci; decreased
dysuria; usually in
microscopy
bacilli
postmenopausal
findings
women
853-20 year lady come to ER with Hx of Rt sever lower abdominal pain with
Hx of amenorrhea for about 6 wk the most serious diagnosis of your deff.
Diagnosis could reach by:
150
a- CBC
b- ESR
c- U/S of the pelvis (ectopic pregnancy) (correct)
d- Plain X-ray
e- Vaginal swab for C/S
__________________________________________________________
854-Pt had arthritis in two large joint & pansystolic murmur ( carditis )
Hx of URTI the most important next step: (dx rheumatic fever)
a- ESR
b- ASO titre (correct but I'm not sure ) >>ASO is a test used to detect
streptococcal antibodies directed against streptococcal lysin O. An
elevated titer is proof of a previous streptococcal infection.
c- Blood culture?>>Blood cultures are obtained to help rule out infective
endocarditis, bacteremia, and disseminated gonococcal infection.
N.B :
Throat culture remains the criterion standard for confirmation of group A
streptococcal infection.
855-women complain of non fluctuated tender cyst for the vulva . came pain
in coitus & walking , diagnosed Bartholin cyst . what is the ttt:
a- incision & drainage
b- refer to the surgery to excision (after you reassure her)
c- reassurance the pt
d- give AB
______________________________________________________
856- 42years old male presented with history of sudden appearance of rash
maculopapular rash including the sole,& the palm, the most likely diagnosis
is :
a- syphilis
b- erethyma nodosum
c- erythema marginatum
d- pitryasis rocae
e- drug induced
857- years old lady on tricyclic antidepressent feels dizzy on standing,
resolves after 10-15 minutes on sitting, decrease on standing, most likely she
is having :
151
_______________________________________________________
858- what is the most appropriate treatment for the above patient :
a- antiemetic
b- antihistamine
c- change the antidepressant to SSRI
d- thiazide diuretics
e- audiometry
_________________________________________________________85
9- 23 years old lady with one month history of nasal discharge & nasal
obstruction, she complained of pain on the face, throbbing in nature , referred
to the supraorbital area, worsen by head movement, walking,& stopping. On -- --------- examination , tender antrum with failure of transillumination ( not
clear ), the most likely the diagnosis is:
a- frontal sinusitis (we can NOT trannsiiluminate it)
b- maxillary sinusitis??
c- dental abscess
d- chronic atrophic rhinitis
e- chronic sinusitis
860-the cardiac arrest in children is uncommon but if occur it will be due to primary
respiratory arrest (correct)
hypovolemic shock
neurogenic shock
861- Middle aged patient with an acyanotic congenital heart disease the X-ray
show ventrical enlargement and pulmonary hypertension:
a. VSD??
b. ASD
c.
Trancus arteriosus>>cyanotic CHD
d. Pulmonary stenosis>>cyanotic CHD
152
Stage I
T1-T2, N0, M0:Thecancerhasgrownthroughthemuscularismucosaintothesubmucosa(T1)oritmayalsohavegrowninto
themuscularispropria(T2).Ithasnotspreadtonearbylymphnodesordistantsites.
Stage IIA
T3, N0, M0:Thecancerhasgrownintotheoutermostlayersofthecolonorrectumbuthasnotgonethroughthem(T3).Ithasnot
reachednearbyorgans.Ithasnotyetspreadtothenearbylymphnodesordistantsites.
Stage IIB
T4a, N0, M0:Thecancerhasgrownthroughthewallofthecolonorrectumbuthasnotgrownintoothernearbytissuesororgans
(T4a).Ithasnotyetspreadtothenearbylymphnodesordistantsites.
Stage IIC
T4b, N0, M0:Thecancerhasgrownthroughthewallofthecolonorrectumandisattachedtoorhasgrownintoothernearby
tissuesororgans(T4b).Ithasnotyetspreadtothenearbylymphnodesordistantsites.
Stage IIIA
Oneofthefollowingapplies.
T1-T2, N1, M0:Thecancerhasgrownthroughthemucosaintothesubmucosa(T1)anditmayalsohavegrownintothe
muscularispropria(T2).Ithasspreadto1to3nearbylymphnodes(N1a/N1b)orintoareasoffatnearthelymphnodesbutnot
thenodesthemselves(N1c).Ithasnotspreadtodistantsites.
T1, N2a, M0:Thecancerhasgrownthroughthemucosaintothesubmucosa(T1).Ithasspreadto4to6nearbylymphnodes
(N2a).Ithasnotspreadtodistantsites.
Stage IIIB
Oneofthefollowingapplies.
T3-T4a, N1, M0:Thecancerhasgrownintotheoutermostlayersofthecolonorrectum(T3)orthroughthevisceralperitoneum
(T4a)buthasnotreachednearbyorgans.Ithasspreadto1to3nearbylymphnodes(N1a/N1b)orintoareasoffatnearthelymph
nodesbutnotthenodesthemselves(N1c).Ithasnotspreadtodistantsites.
T2-T3, N2a, M0:Thecancerhasgrownintothemuscularispropria(T2)orintotheoutermostlayersofthecolonorrectum(T3).
Ithasspreadto4to6nearbylymphnodes(N2a).Ithasnotspreadtodistantsites.
T1-T2, N2b, M0:Thecancerhasgrownthroughthemucosaintothesubmucosa(T1)oritmayalsohavegrownintothe
muscularispropria(T2).Ithasspreadto7ormorenearbylymphnodes(N2b).Ithasnotspreadtodistantsites.
Stage IIIC
Oneofthefollowingapplies.
T4a, N2a, M0:Thecancerhasgrownthroughthewallofthecolonorrectum(includingthevisceralperitoneum)buthasnot
reachednearbyorgans(T4a).Ithasspreadto4to6nearbylymphnodes(N2a).Ithasnotspreadtodistantsites.
T3-T4a, N2b, M0:Thecancerhasgrownintotheoutermostlayersofthecolonorrectum(T3)orthroughthevisceralperitoneum
(T4a)buthasnotreachednearbyorgans.Ithasspreadto7ormorenearbylymphnodes(N2b).Ithasnotspreadtodistantsites.
153
Stage IVA
Any T, Any N, M1a:Thecancermayormaynothavegrownthroughthewallofthecolonorrectum,anditmayormaynothave
spreadtonearbylymphnodes.Ithasspreadto1distantorgan(suchastheliverorlung)orsetoflymphnodes(M1a).
Stage IVB
Any T, Any N, M1b:Thecancermayormaynothavegrownthroughthewallofthecolonorrectum,anditmayormaynothave
spreadtonearbylymphnodes.Ithasspreadtomorethan1distantorgan(suchastheliverorlung)orsetoflymphnodes,orithas
spreadtodistantpartsoftheperitoneum(theliningoftheabdominalcavity)(M1b).
863- a patient with a large nodule in the nose which is painful and
talangectasia on the face you will give:
a) deoxycycline (correct)
b) clindamycin
c) retenoid
864-18 years old not sexually active came to your clinic complaining of missed 2
period with sever abdominal pain on examination abdomen can't examine because
sever tenderness what you will do ?
Pregnancy test
Ultrasound
progesterone 100 mg for 10 days
865- Which of the follwing drug used in mycardial infaction to prophylaxsis against
arrythmia ?
Metoprlol
Adenosin
Atropin
Ca Channel blocker
__________________________________________________________________________
866- In a day care center10 out of 50dovelop red eye. another 30 develop same
condition in the next 2 week , what is the
attack rate
a) 40%
b) 60%
c) 80%
d) 20%
The term is defined as the number of exposed persons infected with the disease
divided by the total number of exposed persons
So 10+30/50 =80
867- Elderly patient who was smoking 2pack /day for 35 years complaing of
shortness of breath X ray done show plural effusion plurocentesis show PH less
than 7
What is the diagnosis ?
154
Cardiopulmonary edema
Empyema
Brochogenic carcinoma
868-most specific and sensitive Ix for renal stone
KUP
IVP
U/S
CT (correct)>>All stones are detectable on CT scans except very rare stones
composed of certain drug residues in the urinesuch as from indinavir.
intercostal space
flail chest
cardiac contusion
872- lethal injury to the chest after motor accident:
puncture lung
spontaneous pneumothorax
rupture aorta (correct)
flail chest
all of the above
__________________________________________________________________________
_
873-in acute abdomen the type of respiration is:
rapid and shallow (true)
156
Drink plenty of water at least six to eight glasses a day. A glass of fruit juice every day, especially prune
juice, can also be helpful. Some people find that drinking a warm liquid right after waking up helps get things
moving.
Exercise regularly. Walking, swimming, riding a stationary bike, and yoga can all help ease constipation and
leave you feeling more fit and healthy.
Your bowels are most likely to be active after meals, so make time to use the bathroom after you eat. Listen
to your body. Never put off going to the bathroom when you feel the urge.
If your prenatal multivitamin contains a large dose of iron (and you're not anemic), ask your healthcare
provider about switching to a supplement with less iron.
If the measures above don't help, talk to your caregiver about taking an over-the-counter fiber supplement
or stool softener.
__________________________________________________________________________
875- patient has terminal ovarian carcinoma came to u complaining of
dull aching abdominal pain when u did xray u found a 10 cm metalic
clamp what will u do :
Call your lawyer for advice lol
call the surgeon for advice
no need to inform the patient since she is terminal and would not find out
about it
inform the patient and inform the surgeon and tell her it will dissolve most
likely in a ..... (certain abount of time dont remeber i think it was a month
) (correct)
876-which one of the following Rx has lowset risk of tardive dyskinesia:
Clozapine >>clozapine has been shown to have a lower risk of tardive dyskinesia
than older antipsychotics
chloropromazine
haloperidol
___________________________________________________________
877-family came to you complaining that their son sees humans as
(something... objects i think it was innate objects not sure ) and plays
alone and doesnt play with other children and says "you" when he wants
to say "I"
157
which one of the following should not be done for the management of this
Patient:
narcoleptic medication
high ..... care program in school
mood stabilizers
878-patient male suddenly had bahevoral and cognitive imparment and
now sees a monkey in the room most likely Dx :
schizophrenia
Dementia like in parkinsonisim
delrium
depression
__________________________________________________________________________
__________________________
879-which of the following is correct about use of systemic retiniods :
*teratogenic(correct)
__________________________________________________________________________
__________________________
880-bupropion is contraindicated in which of the following :
*Hx of eating disorder ( Contraindicated in bulemia sure ) (correct)
bupropion should not be prescribed to individuals with epilepsy or other conditions
that lower the seizure threshold, such as alcohol or benzodiazepine withdrawal,
anorexia nervosa, bulimia, or active brain tumors.
881-8TB outbreak ..and one pt. come to doing tubercalin test and it's
negative .. what to do??
a- BCG
a. isonized
b. rifampin
882- baby with congugated hyperbilirubinemia:
Biliary atresia(correct)
ABO comp
G6PD
883- ld with URTI what is the most helpfully sign that it is viral:
Colorless nose discharge
Clinically significant rhinorrhea is more characteristic of a viral infection rather than a
bacterial infection. In viral URI, secretions often evolve from clear to opaque white to
green to yellow within 2-3 days of symptom onset. Thus, color and opacity do not
reliably distinguish viral from bacterial illness.
__________________________________________________________________________
884-child with picture of SCA he should be maintained on :
Penicillin and folic acid (correct)
885-signs of androgen excess and ovarian mass , most likely tuner :
Sertoli-Leydig cell tumour (correct)
158
______________________________________
889- child with round palpable red rash on his right leg no pain or itching
for long time :
- granuloma annular
- tenia corpora
-erythema nodosum
-migratory
__________________________________________________________
890- the goal of early management of inflammatory acne:
- to prevent physical scar
-to prevent spread of infection
891- prevention of malaria
Eradication of vector and protect against bites (correct)
http://www.netdoctor.co.uk/diseases/facts/malaria.htm
892- case of TB , what knd of injections u will give the contacts :
BCG
893- a picture of Snelling chart the q was how far should the patient stand
:
3m
6m (correct)
9m
894- pt with epistaxis , what is the most apropriate initial management :
Tampon ,
159
http://dermatology.about.com/cs/pregnancy/a/prurfoll.htm
__________________________________________________________________________
_ 899-51 year old male Hb7 MCV 112 AST 250 with Giant cells, whats the
diagnosis:
A. B12 deficiency anemia
B. Folic acid deficiency anemia
C. Alcoholic anemia
D. Thalasemia
E. Iron deficiency Anemia
900- Patient was diagnosed to have Otitis media today you examined the
patient he is fine tempanic membrane is no longer erythematus but there
is collection of fluid behind it, whats your next step:
A. Do Nothing
B. Decongestion
C. Antibiotics
160
.
(I forgot the exactquestion but it mentioned about ovulation and who inhibits
conversion of esterone toestrogen?) Options were:
aAromatase inhibitors
synthesis of estrogens starts in theca interna cells in the ovary, by the synthesis of
androstenedione from cholesterol. Androstenedione is a substance of moderate
androgenic activity. This compound crosses the basal membrane into the surrounding
granulosa cells, where it is converted to oestrone or oestradiol, either immediately or
through testosterone. The conversion of testosterone to oestradiol, and of
androstenedione to oestrone, is catalyzed by the enzyme aromatase.
Oestradiollevelsvarythroughthemenstrualcycle,withlevelshighestjustbeforeovulation.
906-year old female patient of Cushings syndrome, had hip fracture falling off
stool, what will you screen for while also treating her fracture:
Hyperparathyroidism
161
Osteomyelitis
Osteoporosis
Osteomalacia
907-Drug table given each with3-4drugs, question which group causes
hyperuricemia.
ABCD
(I choose the group which had anti-neoplastics.)
The principal drugs that contribute to hyperuricemia by decreased excretion are the
primary antiuricosurics. Other drugs and agents include diuretics, salicylates,
pyrazinamide, ethambutol, nicotinic acid, ciclosporin, 2-ethylamino-1,3,4-thiadiazole,
and cytotoxic agents
908- Child 3 weeks ago had chicken pox, came to ER c/o sob, x-ray shows
enlarged epiglottis, what is the cause?
- Hemophlus influ, type b
- Diphtheria pertusis
- Rubella
- Measles
909-2 years old child fall down in homein x-ray there is spiral # in radial
bone the best management :
-call pediatric.
-call orthopedic.
-splint.
-open for fixation.
910-female married since four month and she noticed her husband
washing his hand several times the most likely diagnosis:
obsessive compulsive disorder
911-pt. admitted with pneumonia and the vaccine for this pt. is:
-pneumonia with H.influnza
-influenza alone.
-pneumonia alone.
912-pt. have peptic mass the most common organism for infection:
-H pylori
-HPV
-HIV
913-pt have swelling in lower eye lid and the lid was erythemic and
edemoutis with hair inside make corneal ulcer the dx:
-entropic.
-extropic
914-evidence based medicine:
-as in text book.
-according to departmental policy.
-according to latest published articles.
162
921-27 yr old lady primi 35 wks pregnant, presented with mild Pre-eclampsia , BP
140/? Edema in her hands & feet, best treatment is:
163
f.
g.
h.
i.
Immediate delivery
Diuretics
Send home?
Hospitalize & materno-fetal monitoring ( this is the most likely answer
164
iv.
922-Not use in the prevention of preeclampsia with + protein urea & LL edema :
j. Admission &bed rest
k. Diuretics ( if you are understanding the underlying physiology you will
exclude this answer )
l. Non-stress test
m. Regular sonogram of baby
92340 yr old male with 4 days history of sudden eruption over the entire body
including palms & feet :
n. erythema nodosum
o. erythema multiforme
p. pit. rosea
There is no enough information to diagnose the case as whether it is itchy or not
but generally speaking it is either Pityriasis rosea ( more likely) or Sec. Syphilis
but it is rare now and in 75% it doesnt involve face
_____________________________________________________________
925-urticaria, all true EXCEPT:
q. can be part of anaphylactic reaction
r. is not always due to immune reaction
s. always due to deposition of immune complex in the skin ( due to increase
permeability of capillaries )
t. due to ingestion of drug
u. due to ingestion of strawberry
926-10 yr old boy woke up at night with lower abdominal pain, important area to
check:
v. kidney
w. lumbar
x. rectum
y. testis (the Q is not clear for me but it seems to be related to testicular
torsion or something in inguinoscrotal area
________________________________________________________________
928- years old boy for evaluation of short stature. His height is of 6 year old & bone
scan of 5.5 years ,, Dx is:
ee.
steroid therapy
ff.
genetic
gg.
constitutional
hh.
hypochondroplasia (not sure)
ii. hypothyroidism ( not mentioned in our exam)
_______________________________________________________________
929- Diagnosis of Alzheimer confirmed by:
CT brain
EEG
Neurological examination
None of the above(investigation is aimed at excluding other treatable causes
of dementia, as histological confirmation of Dx usually occurs only after
death Davidson's 19th 1173
930-12 yr old girl with malaise, fatigue, sore throat & fever. On examination:
petechial rash on palate, large tonsils with follicles, cervical lymphadenopathy &
hepatosplenomegaly. All are complications EXCEPT:
Aplastic anemia
Encephalitis
Transverse myelitis
Splenic rupture
Chronic active hepatitis
931-1 month old with massive hepatosplenomegaly, bluish skin nodules, & lateral
neck swelling, the next step is:
CBC
lumber puncture
Do EBV serology
BM scan ( It seems to be congenital Leukemia)
Liver biopsy
932-8 month old baby came with dehydration, fever 40 C, poor feeding &
convulsions. depressed ant. Fontanelle, vomiting, & crying with red ears. No neck
stiffness. Her 3 yr old brother is asymptomatic. What is the most important
investigation to do:
Blood culture
CBC & differential
166
CSF examination ( Our Prof. told us that british says if meningitis crosses
your mind do LP ) provided that C/P is not specific in this age
Chest xray
Urine analysis
933-17 year old boy presented to the ER complaining of sudden onset of abdominal
pain & leg cramps, he had history of vomiting2 days ago, he was dehydrated .
Na = 150 , K = 5.4 ,, glucose = 23mmol
The best initial investigation is
CBC
Blood culture
ABG ( tha Dx is DKA)
Urinanalysis (dipstick)
U/S Iremember that this option was Serum amylase
_____________________________________________________________
934-young age male presented after RTA with injured membranous urethra , best
initial ttt is :
Passage of transurethral catheter
Suprapubic catheter
Perineal repair
Retropubic repair
Transabdominal repair
Aspirin 325
aspirin 81
warfarin
dipyridamole ( Antiplatlet agent)
940-All are true about the best position in hearing the murmurs, EXCEPT:
supine : venous hum
sitting : AR
sitting : pericardial rub ( opinion : according to my knowledge no special
position for it to be accentuated)
supine : innocent outflow obstruction
Lt lateral in : MS
941-All are true about the best position in hearing the murmurs, EXCEPT:
Do ECG
943-Glue ear
Managed by grommet tube ( Nelsson 19th 1955)
Lead to sensorineural hearing loss
Pus in middle ear
Invariably due to adenoid
949-after aspiration of cystic mass in the breast the result was clear fluid, next
step
a-Send the aspirated content for cytology and if abnormal do mastectomy
169
b-Reassure the patient that this lump is a cyst and reassess her in 4 weeks
c-Book the patient for mastectomy as this cyst may change to cancer.
d-Put the patient on contraceptive pills and send her home
950-after 2 wks ant. wall MI , old age female developed sudden leg pain , it is pale
& pulsless. Dx :
acute arterial thrombus
acute arterial embolus
DVT
Ruptured disc at L4-5 with radiating pain
Dissecting thoraco-abdominal aneurysm
_____________________________________________________________
951-a 34 yr old divorced lady complains of 15 months amnorrhea , FSH very high ,
Dx :
Pregnancy
ovulation
Premature ovarian failure
Hypothalamic lesion
Pituatary microadenoma
952-he developed severe pain over the wound site , with foul smelling discharge ,
his temp is 39 & HR is 130/min . Gram stain showed G+ve rodes with terminal
spores , ttt
Massive IV pencillin V
clostridium antitoxin
wide surgical debridement
chlormphinicol
wide surgical debridment & Massive pencillin V
____________________________________________________________________________________________________
959- A 15 yr old boy came to your clinic for check up. He is asymptomatic. His CBC
showed: Hb 118 g/l WBC 6.8 RBC 6.3 (high) MCV 69 (low) MCH (low) Retic 1.2 (13)% what is the most likely diagnosis?
Iron deficiency anemia
Anemia due to chronic illness
-thalssemia trait
Sickle cell disease
Folic acid deficiency
_____________________________________________________________
960-Hb electrophersis done for a patient shows HbA1=58% , HbS = 35% , HbA2 =
2% , HbF = 5 % , Dx :
Thalasemia minor
Thalasemia major
Sickle cell trait
Sickle cell anemia
Sickle cell thal.
171
orthopnea
dyspnea on exertion
pedal edema
PND
chest pain
_________________________________________________________________________________________
___________________________________________________________________
966-5 yr old seen in ER presented with fever & sore throat , which of the
fallowing suggest viral etiology :
Presence of thin membrane over the tonsils
Palpable tender cervical LN
172
as soon as possible
8 hrs
24 hrs
36 hrs
48 hrs
978-All are true for the prescripsion of antidepresents ttt for patient with
981-45 year old female come to the ER complaining of Rt hypochondrial pain which
increases with respiration , on Ex there is tenderness over the Rt hypochondrium,
Next investigation is
X-ray
US of upper abdomen
CT
982- a 48 hour old newborn infant in critical care unit with respiratory
distress and jaundice.HB 9g/dl, retic 4%,. Maternal Hx of previous
normal term pregnancy without transfusion,blood typing shows
hetero specifity between mother and child.Indirect Coombs test
+ve.the most probable Dx is
a- Sickle cell disease
b- Thalassemia
c- Maternal fetal blood mismatch
d- Hereditary genetic disease
e-septicemia.
983-a disease lasts 2-3 wk with fatality rate 30%:
a-incidence=prevalence.
b-incidence >prevalence.
175
c-incidence<prevalence.
d-incidence=1/2prevalence.
e-has no relation.
__________________________________________________________________________
984-what is the least effective AB of the following to staph. Aureus:
a-clindamycin.
b-erythromycin.
c-amoxicillin.(over 80% of staph aureus are resistant to penicillin)
d-vancomycin.
985-35 y/o presented with left iliac pain and dysuria, mangment include
all the following:
a-blood C+S
b-microscopy of urine.
c-IVP.
d-urine C+S
e-norfloxacin.
986-Colles fracture:
a-distal end of the radius.
b-scaphoid fracture.
c-around the elbow.
d-head of the radius.
987-a child fell on an out-stretched hand and flexed elbow,exam showed
swelling around the elbow with no radial pulse, best management :
a-closed reduction.
b-closed reduction then check radial pulse.
c-open reduction.(because of the vessel involvement best way by open
repair)
d-cuff and collar for 3wks.
988-most common association with acanthosis nigricans:
a-hodgkin lymphoma
b-non-hodgkin lymphoma.
c-Internal malignancy.
d-DM
e-insulin resistance.
989-xanthoma:
a-on lateral aspect of the upper eyelid.
b-hard plaque.
c-around arterioles.
d-is not related to hyperlipidemia.
e-deposited in dermis.
990-patient suspected to have brain abscess,the most important q. in the
history is :
a-frontal sinusitis. (contiguous suppurative focus (45-50%)
176
b-ear discharge.
c-head injury.
d-bronchioctasis.
e-Hx. of vomiting.
991-the following are true about H. pylori except:
a-related to gastric outlet incontinence.
b-can cause gastritis but not related to duodenal ulcer.
c-can be eradicated by ampicillin and metronidazole.
d-there will be histological improvement after eradication.
e-it can split urea.
992-60 Y/O lady on OCP 21 days a month having recurrent vaginal
bleeding(spotting) after the stop of estrogen, best Tx:
a-endometrial Bx.
b-papsmear of the cervix.
c-add progestone .
d-stop estrogen.
e-abdominal US or laproscope.
993-most common site of gonococcus infection in females in:
a-cervix.
b-posterior fornix.
c-urethra.
994-post D&C the most common site of perforation is the:
a-fundus
b-ant.wall of the corpus
c-post. Wall of the corpus.
d-lat.wall of the corpus.
e-cervix.
995-regarding typhoid fever, all are true except:
a-fever and red spots appear on the same time .(fever first then rash)
b-can be completely eradicated even in the prescence of gall stones.
c-transmitted by food ,milk and water.
d-can be treated by quinolones.
996-high output HF causes include all except:
a-anemia.
b-MR.
c-AV fistula.
d-pagets disease.
997-a middle aged man having black spots on his thigh for years, it is
starting to become more black with bloody discharge,the best
management is to:
a-wide excision.(malignant melanoma ttt)
b-incisional Bx.
c-cryotherapy.
d-radiotherapy.
177
e-immunotherapy.
998- Old patient .. stopped smoking since 10 years suffering
from shortness of breath after exercise but no cough and
there was a table
Fev1=71%
Fvc=61%
FEV1/fvc=95%
Tlc=58%
What's the dx?
a- Restrictive lung disease
b- Asthma
c- Bronchitis
d- Emphysema
e- Obstructive with restrictive
999-its c/I to stop preterm delivery in the following condition:
a-aminochoronitis.
b-placental abruption.
c-preeclampsia.
d-A&B.
1000-PPH happens more commonly with:
a-multiple pregnancies.(due to increased risk of uterine atony)
b-anemia.
c-preterm delivery.
d-antithrombin iii deficiency.
1001-Before you start instrumental delivery it is important to check if
there is :
a-face presentation.
b-CPD
c-breech presentation.
d-cord prolapse.
1002-in occipitoposterior malpositioning of the fetal head ,all of the
following are true except:
a-10% of all vertex deliveries.
b-it causes significant delay of labor duration compared to the anterior
presentation.
c-andriod pelvis is a predisposing factor.
d-flexion of the head helps the rotation to the ant. Position.
1003-important tools for listening to a patient include:
a-using tools for asking.
b-imagination.
c-using similar words and expressions as the patient.
d-a sense of humor.
178
__________________________________________________________________________
__________________________
1030-pt with DM and obese ,plane to reduce his wt is :
a.decrease calori intake in day time
b.decrease calori and increase fat
c.decrease by 500 kcal/kg per week
d.decrease 800 per day
_______________________________________________________________________________________
______________________________
1031-Romberg sign lesion in :
a. dorsal column
b. cerebellum
c. visual cortex
1032-ttt to increase fetal Hb in sickle cell disease :
Hydroxurea
1033-angioedema due to use of :
B blocker
ACEI
_______________________________________________________________________________________
______________________________
1034-fetal distrees in :
a.early deceleration
b.late deceleration
1035- Pregnant Teacher in her 20th week reported 2 of her student developed
meningitis. Prophylactic Treatment:
a) Observe for the sign of meningitis
b) Meningitis Polysaccharide vaccine
c) Ceftriaxone 500mg PO once
d) Cefuroxime 250 mg IM or IV once
e)Rifampicine 600 mg BD for 2 days
1036- treatment of erosive gastritis ?
a-Antibiotics
b- H2 blocker
c- depend on the pt situation
d- total gastroectomy
e- sucralfate
________________________________________________________________________________________________________
1039- female pt , with RTA ,she has bilateral femur fracture >>>like this scenarion ,
systolic blood pressure 70 >>>what will you do:
a-Iv fluid
b- blood tranfusion
c1040- Long hx of pt with recurrent vomiting for 2 days
Heamocrit 65 the doctor can report this result caused by
Cytokine
Glucagon
C r protin
Apoprotein
1041-secondary amenorrhea
a-due to gonadal agenesis
b-sheehan's syndrome
c-It is always pathological
1042- pt with DM and obese ,plane to reduce his wt is :
a.decrease calori intake in day time
b.decrease calori and increase fat
c.decrease by 500 kcal/kg per week
d.decrease 800 per day
1043-chickpeas.kidney beans and lentils contain which element of following
bromide
chromium
iron
selenium
1044- what food causes bleeding in a patient on anticoagulates
garlic
spinach
avacados
ginko
1045- Patient on asprin, phenyton for sizuers came to clinic for rotein follow up, on
examination she has bilateral painless lymph nodes, no other symptoms or signs,
lymph node biopsy showed hyperplasia. DDx:
A- chronic lymphocytic leukemia.
B_hodgkin lymphoma
C- TB
D-???
most likely it is side effect of phenytoin
183
1052- pt 2 para 2 gravida had pco took cyclic progestrone,she is ona increased risk
of
endometrial cancer
cervical dysplasia
hip fracture
___________________________________________________________________
_______1053- smelling sputum increase with lying down + clubbing
1-bronchectasis
2- ba
3- pneumonia
1054-2.female presented to er with HCL burn on her face there was partial thickness
burn.management
irrigation with water
irrigation with soda bi carb
immidiate debridement
1055-young female with left sided abdominal pain.no dysuria or change in bowel
habit.history of hysterectomy 4yrs back but ovaries and tubes were preserved.on ex
abd tender but no guarding.inv show leucocytosis and few pus cells in urine.there
was also history of unprotected coitus with multiple partners.
i didnot get the scenario well but i think it was salpingitis.
management
consult surgeon
oral antibiotics
diagnose as ulcerative colitis
___________________________________________________________________
_______
1056-a picture of JVP graph to diagnose.patient had low vol pulse,low resting bp.no
murmr.pedal edema.
constrictive pericarditis
tricuspid regurg
tricuspid stenosis
pulmonary hypertension
___________________________________________________________________
_______
1057-treatment of psoriasis:
topical steroid
___________________________________________________________________
_______
1058-picture of pelvic x ray what is diagnosis
normal
paget disease
spondylitis
osteoporosis
185
- 5 years
- 10 years
1067- - normal child ,he want to walking , he have brother dead after walking ,
what of the following must be excluded before walking ???
a-PDA
b-VSD
C-hypertrophic cardiomyopathy
D-!!!
1068- The best ttt for binge eating disorder:
- cognitive - behavioral therapy
- problem - solving therapy
- interpersonal therapy
_
1069- female pt ,KCO rheumatic heart , diastolic murmur ,complain of aphasia and
hemiplegia ,
what will you do to find the >>>etiology<<< of this stroke:
a-MR angiography
b-Non-contrast CT
c-ECHO
D-ECG
E-carotid doppler
1070- A case of a patient with polycythemia and develop itching after taking a bath ..
a. increase histamine sensitivity
b. abnormal histamine release
1071- pt with DM and obese ,plane to reduce his wt is :
a.decrease calori intake in day time
b.decrease calori and increase fat
c.decrease by 500 kcal/kg per week
d.decrease 800 per day
1072- the most common complication following hemorrhoidectomy is :
a. fecal impaction
b. bleeding
c. urinary retention
d. infection
1073- Pediatric came to you in ER with wheezing, dyspnea, muscle contraction
(most probably asthma), best to give initially is:
1. theophylline
2. Albuterol nebulizers
187
3. oral steroids
4. oxygen
1074- ld man presented to u complaining of rectal pain mostly at night with itching ..
what is the Dx:
a. Hemorrhoids
b. Gay bowel syndrome
c. Proctalgia fugax
1075- 28 yrs old known case of sickle cell anemia hospitalized two times in the last
two months because of abdominal pain, this time he present with abdominal pain,
back pain, and chest pain.. what will you do:
a. Hospitalize the patient and give him analgesics and observe him
b. give him IVF and treat him as an outpaient
c. Referred the patient to Tertiary center specialized in his problem
d. Give analgesics
e. blood transfusion
__________________________________________________________________________
1076- diabetic pstient with ulcer in foot , not healing , not infected , high
? blood glucose
a- high blood glucose stimulate bacteria to grow
b- decrease phagocytosis
c- dec. Immune system
1077- on flow cytometric analysis of a sample of fetal thymus a certain population
of cells is identified that is positive for both cd4 and cd8 cell surface Antigens .
These cells are best characterised as which of the following cells ?!
A- immature cortical T lymphocyte .
B- mature cytotoxic T lymphocyte.
C- mature helper T lymphocyte.
D- antigen presenting cells.
E- Natural killer (NK) cells .
1078- A case of a man who ride a motorcycle and make an accident then had a
basal skull fracture .. he developed a loss of taste, and loss of sensation in the
Anterior 2/3 of the tongue, and deviation of the angle of mouth .. if u will choose one
nerve injury .. which nerve u will choose:
a. CN I (Olfactory)
b. CN III (Oculomotor)
c. CN V (Trigemenal)
d. CN VI (Abducens)
e. CN VII (Facial)
188
1083- a colorectal carcinoma that invades the submucosa and has two positive
lymph nodes and no metastasis is :
a. stage 1
b. stage 2
c. stage 3
d. stage 4
1084- long case Pt.obese and newly Dx by FBS> 126 with long list of lab come to
me in the exam screen all normal including liver function test
On examination: pt had palpaple midly enlarge liver what you will give him:
a) Biguanieds
b) Sulphanylurea
1085 what is the definition of insomnia?
inability to have immediate sleep when you are very tired
189
a-MR angiography
b-Non-contrast CT
c-ECHO
D-ECG
1092- female with positive urine pregnancy test at home what next to do:
Sreum beta HCG
CBC
1093- Infant in respiratory distress ,hypercapnia , acidosis & have rhinitis ,
persistent cough +ve aglutenation test & the doctor treat him by ribavirin DX
pertusus
RSV
1094- ptn with pharyngo tonsilities he took antibiotic and improved in 2 days <the full
course of antibiotic should be for:
1- 5 days
2-7 days
3- 14 days
4- 10days
1095- 43y old female with irregular menses 3m back & 1-2d spotting
what is
next to do:
US
Human chorionic gonadotropin
Placental ,,,,,,,,, ,,,,,,,,,,,,,,,,,,,
FSH
LH
1096- Drug that will delay need of surgery in AR:
a. digoxin
b. verapamil
c. nefidipine
d. enalpril
1097-Notching on the lower edges of the fourth to the ninth ribs indicate enlarged
intercostal arteries eroding the lower border of the ribs in cases of
coarctation of the aorta
1098-- An outbreak of TB as a prophylaxis you should give :
a) Give BCG vaccine
b) Rifampicine
c) Tetracycline
d) H. influenza vaccine
1099-n old man who had stable angina the following is correct except:
a) angina will last less than 10 min
b) occur on exertion
c) no enzymes will be elevated
d) will be associated with loss of consciousness
__________________________________________________________________________
191
1100-5 yr old adopted child their recently parents brought him to you with white nasal
discharge. He is known case of SCA. What you will do to him:
a) Give prophylactic penicillin
__________________________________________________________________________
1101-a
patient with acne of several appearances open .. closed .. red .. it is most likely:
a) obstructive
b) inflammatory
1102-70 yr old presented with wt loss, fatigue, anemia , upper quadtrant pain without
any previous history, the stool sowed high fat he is a known somker:
a) Acute pancreatitis
b) Chronic pancreatitis
c) Pancreatic carcinoma
b. insertion of idea
c. loosening of association
1128-a mother came with her son who is 7 years old with poor
concentration. Lack of intelligence and play and repeat some of his
action .....................forget the rest
a) Autism
b) Hyper active disorder
1129-pt with vesicle in mouth with gingivits and also vesicle in arm and leg
most likely cause
a.HSV type 1
b. HSV type 2
1130-early symptom of heart failure :
a) Orthopnia
b) PND
c) Palpitation
d) Chest pain
1131-young adult obese with snoring when sleeping and some time get up from
sleeping
Best mangment :
a) Reduce wt
b) tonsillectomy
_______________________________________________________________________________________
______________________________
1132- young adult in endemic area cripitation bilaterally with monopheseal sound in
auscultation what to give vaccination :
a) Hemophlous influenza
b) Meningococcal
_______________________________________________________________________________________
_____________________________
1133- pt with frothy hemoptysis, palpitation >>>>>>>>>>> forget the rest it's long
scenario
a) Mitral stenosis
b) Congestive heart failure
c) CAD
Mitral stenosis cause frothy hemoptysis on cardiac exam>>middiastolic murmur in
apex and malar rash on cheek
Congestive heart failure is an important cause of pink frothy hemoptysis on cardiac
exam>> S3+ basal crept.
194
d) I forget the exact sentience but it's related to dryness in menopausal women
(atrophic vaginitis)
1135- non hormonal ttt of premenopausal flushes:
paroxitine
1136-mother after delivery have bad mood , depression , crying a lot for only 1
week , but she is o.k now Dx:
A. Maternal blues (transiet condition)
B. Post partum psychosis
1137- pt with pruritic foliclitis best ttt:
A. Local antibiotic xx
_______________________________________________________________________________________
______________________________
1138- pt. e hair loss in the rt. Temporal area. On examination there is elevated mass
with come spacious yellow crust:
A. Spacious cyst
B. Tricotelomania
1139-young male athletes with palpitation and............. maybe syncope and the fail
to do for
Him something.......i'm sorry :
A. Hypertrophic cardiomyopathy
_______________________________________________________________________________________
______________________________
1140- which one of the congenital heart dis. Have least complication with............... I
think endocarditis:
A. ASD
B. VSD
C. PDA
1141- child fall from stairs came with mild injury to the nose, no bleeding and
edema in the nasal sputum , ttt :
a- Nasal packing
b- Reassure
c- Analgesia
d- Refer to ENT
1142- eye exam. corneal ulceration. her symptoms freq. repeated.. which on of the
following is triggring for recurrence of her symptoms:
1- Dusts & pollen
2-HTN & hyperglycemia
3-dark and driving at night
4-ultraviolet light & stress ( this is the answer 100 % )
1143- What is special about placenta abruption:
a. Vaginal bleed
195
b. Fetal distress
c. Uterus pain and back pain
d. Abnormal uterine contraction
1144- 24 Y/o man presented with 4 month Hx of diarrhea with streaks of blood &
mucous. Ulcerative colitis was confirmed by colonoscopy. The initial therapy for this
patient:
a)oral corticostreiod
b)azathioprine
c)infleximabe
d)5-Aminosalicylic acid
e)Sulfasalazine
1145- I study done on 10,000 people for about 3 years in the beginning of the study
3,000 developed the disease and 1,000 on the end of the study what is the
incidence:
100
12.5
10.5
0.1
1146- 45 years old female came to ER with acutely swollen knee +
ballotment patella .. The most important to do is:
MRI of the knee
Aspiration
Complete blood count
Rhumatoid factor
1147- peritioial lavage when to say the amount is suffusion :
2 l blood
1000 wbs \ rbs
500 wbs
1148- 19- What best explain coronary artery disease:
a- Noatherosclerosis
b- Fatty deposition with widening of artery
c- Atherosclerosis with widening of artery
1150- Incidence is calculated by the number of:
A. Old cases during the study period.
B. New cases during the study period.
C. New cases at a point in time.
D. Old cases at a point in time.
E. Existing cases at a study period.
1151-9- secondary prevention one true:
a- physician screening quetionaire about the use of tobacco is sufficient
b- the screening of colon cancer is insufficient
c- the screening of breast cancer is decreasing
d1152-Which drug contra indication in cluster headache ?
a. Buperbion
196
b. Lithum
c. valium
1153-Most common cause of recurrent tonsillitis is :
- Group a beta hemolytic streptococcus
- The other choises are virusis..
parainfelunsa
rhinovirus..
http://en.wikipedia.org/wiki/Rhinovirus
1154Child with leukemia he has septicemia from the venous line the organism
is:
a) E coli
b) GBS
c) Pseudomonas
1155-Baby born & discharge with his mother , 3 weeks later he started to
develop difficulty in breathing & become cyanotic what is most likely
DX :
a- VSD
b- Hypoplastic left ventricle
c- Coarctaion of aorta
d- Subaortic hypertrophy
1156-Man who is having a severe pain on his big toe with knee pain
and examination revealed negative perferingent crystals:
a) uric acid deposit secondary to synovial fluid over saturation
b) Ca pyrophosphate secondary to synovial fluid over saturation
1157- 6 years old child presents with straddling gait and in ability to stand or walk
without support, he is irritable with vomiting 3 times, he has a history of chickenpox
3 weeks ago. O/E all are normal except resistance when trying to flex the neck, what
is the most likely diagnosis:
Fradrich's ataxia
Acute cerebellar ataxia
Meningioecephalitis
Gullian Barre syndrome
http://en.wikipedia.org/wiki/Acute_cerebellar_ataxia_of_childhood#Etiology
1158-a man fell down from the ladder, c/o SOB ( and i think cyanosis ), on
exam breath sounds are decreased even in the right side ( this is how
they wrote it !! ), u will do :
needle thoracotomy
insert endotracheal tube
other options i forgot
1159- Which of the following is true regarding antepartum (third trimester )
hemorrhage :
a- Can be caused by polyhydrominos
197
a- Inferior dislocation
b-subacromal post Dislocation
c-subglenoid ant dislocation
d- subclavicle ant dislocation
e-sub.. ant dislocatio
1166-pt with asthma on daily steroid inhaler and short acting B2
agonist what category:
a- Mildintermittent
b- Mildpersistent
c- Moderate
d- Sever
1167-Pt with active hepatitis what medication should not to give
:
a- Ranitidine
b- Heparin
c- Atrovastsin
1168-A man who is having severe vomiting and diarrhea and now developed leg
cramps after receiving 3 liters of dextrose .. he is having:
a) hypokalemia
b) hyponatremia
c) hyperkalemia
d) hypernatremia
1169-Pneumococcal vaccine :
A not recommended in healthy child
B cant be given with MMR
C cant be given to child less than 2 years
D if given to sickler and exposed to infection has to take pencilin
1170-Long scenario for pt smokes for 35 y with 2 packets daily, before 3 days
develop cough with yellow sputum, since 3 hours became blood tinged sputum, X
ray show opacification and filtration of rt hemithorax, DX:
Bronchogenic CA
acute bronchitis
lobar pneumonia
1171-Post partum female with recurrent attack of hearing loss , which diagnosed as
conductive hearing loss , on CT the is dehesion in the of semi circular canal
diagnosis >>>>
otosclerosis
miner's
Tuberus sclerosis
199
1192- a 38 yrs old female came to you at your office and her pap smear report
was unsatisfactory for evaluation .. the best action is
a- consider it normal & D/C the pt.
b- Repeat it immediately
c- Repeat it as soon as possible
d- Repeat it after 6 months if considered low risk
e- Repeat it after 1 year if no risk
1193- Mass in the upper back .. with punctum and releasing
white frothy material
a- It's likely to be infected and Antibiotic must be given before
anything
b- Steroid will decrease its size
c- It can be treated with cryotherapy
d- It must be removed as a whole to keep the dermis intact??
1195- A pregnant lady full term presented with agitation and change level of
consciousness she is having difficulty breathing:
a. Pulmonary embolism??
b. Pulmonary edema
c. Amniotic fluid embolism
1196-Pt presented with nausea and vomiting and nystagmus with tinnitus and
inability
to walk unless he concentrate well on a target object. His Cerebellar function is
intact:
a. Benign positional vertigo
b. meniere's disease
c. vestibular neuritis
1197-tympanic mem. perforation in cases of cholesteotoma are commonly
situated in :
a- anterior part of mem. tensa
b- centre of mem. tensa
c- posterior superior segment
d- posterior inferior segment of the tympanic membrane
1198-Peripheral neuropathy can occurin all except:
a) Lead poisoning
b) DM
c) Gentamycin
d) INH
1199-child with 2 * 2 cm hair loss at the temporal area , normal examination ,
microscopic examination of hairs arround the area show clubbed and attenuated
hairs , the diagnosis is :
a- tinea capitus
b- alopecia areata
c-Trichotillomania
202
d- Telogen Effluvium
e-?
1200- What is the most important in councling
a. Exclude physical illness
b. Establishing rabbot
c. Family
d. Schedule appointement
1201-year old had an episode of rheumatic fever without any defect to the
heart. The
patient need to take the antibiotic prophylaxis for how long:
a. 5 months
b. 6 years
c. 15 years
IF :Rheumatic fever with carditis but no residual heart disease (no valvular disease)
10 years or until age 21 years (whichever is longer).......IF: Rheumatic fever without carditis
5 years or until age 21 years (whichever is longer)
http://www.aafp.org/afp/2010/0201/p346.html
1207- A man travelled to Indonesia and had rice and cold water and ice cream.
He's now having severe watery diarrhea and is severely dehydrated. Most likely he
has:
A. V. Cholera
B. C. Difficile
C. C. Perfringens
D. Dysentery?
E. Shigella
1208- Newborn has vomiting after every meal intake. The examination was normal
and the only abnormality was dehydration. No other clinical signs. No tests ordered
yet. What will you do?
a- Order abdominal CT
b- Reassure the parents
c- Refer to GS
d- Discharge on ORS
1209- child with SOB and runny nose came with fever (38 ) all the sign of
respiratory distress there .. There is diffuse wheezing on the chest with prolonged
expiration and inspiratory cracles ,, diagnosis:
-viral pneumonia
-bronchiolitis
-croup
-bacterial pneumonia
1210- pt came with fatigue , w.t loss and diarrhea .. He recived a blood transfusion
when he was in kenea .. He has low grad fever .. The vitals are stable .. Skin EX.
There is contagiosum mollosum in groin ( i guess it written like this ) .. There is
generalized lymphadenopathy and palpable liver ,, what is the diagnosis:
-secondary syphilis
-persistent chronic hepatitis B
-HIV
-acute lymphoma.
1211- the best description of the lesion in herpes :
-soft tender chancer
-firm non-tender chancer
-raised tender papule
-vesicle with fluid material
-................
204
1218- 43 yr old lady complaint about non itchy;white nonsmelling vaginal discharge
after intercourse;she z nt using any contraceptive or vag douche;what z diag??
A;prescibe azithromycine
b;local steroids
c;local antifungal
d;vaginal douche
e;do nothing
1219- If a patient of Magrine head ache has nt been treated;which condition do u
suspect the patient will develope??
205
A.hearing loss
b.depression
c.dysphagia
d.loss of vision
1220- a lady patient otherwise healthy complaint a hissing sound n her ears at
night during sleeping;her bedroom is sound proof and no noise coming from outside.
Diagnosis?
A;migrine
b;otosclerosis
c;otitis media with effusion
d;tinnitis
1221- acute diarrhea with epithelial infiltration
E- coli
Salmonella
Cholera
Rota virus
Shigella
1222- Boy presented with painless neck mass, 5-week history of fatigue,
generalized pruritis, and mild cough. Dx?
A. Hodgkin's lymphoma
B. Lyme's
C. Infectious mono
1223- what is the organism hat cause meningitis in college dormities :
1-h.influenza
2- nisseria gonorrhea
3- strep. pneumonia
4- staph. aureus
Neisseria meningitidis bacteria (meningococcal disease)
1224- a 19 yr sexually active lady came for her annual check up:she z otherwise
healthy using no contraceptive;her pap smear and all investigations are normal;what
will u suggest regarding her next check up???
A;afer 6 months
b;after 1 yr
c;after 3 yrs
d:after 5 yrs
1225- 6 yr old school going boy complaaint abt itchy scalp;n school his 10 friends
have the same problem:wt z ur diag??
A;lice (Pediculus humanus capitis)
b;tinea capitis
c:seborric dermatitis
d:scabies
__________________________________________________________________________
1226- Nonmedical treatment of premature ejaculation??
the use of acupuncture
206
1227- A 54 YO female with chronic pelvic pain is found to have a right sided
ovarian mass. After the initial evaluation, surgery is planned to remove the mass. To
avoid excessive bleeding during the surgery , the surgeon should ligate which of the
following structures?
A) Round ligament
B) Suspensory ligament
C) Ovarian ligament
D) Transverse Cervical ligament
E) Mesosalpinx
Suspensor ligament of ovary contains the ovarian artery, ovarian vein,[1] ovarian plexus,[4] and
lymphatic vessels.[3]
UTERINE
CARCINOMA
1234-In moderate to severe asthmatic patient , u will find all the following EXCEPT :
A PO2 <60
B PCO2 > 60
C low HCO3
D IV hydrocortisone will relieve symptoms after few hours
E dehydration
1235-12 year old female , non pruritic annular eruption in the right foot for 8 months
, looks pale and not scaling , no response to 6 weeks of miconazole
A discoid lupus erythramotosis
B erythema nodosum
C tinea corporis
D granulomatous annulare
E choricum marginatum??
1236-A man who bought a cat and now developed watery
discharge from his eyes he is having:
a) Allergic conjuctivitis
b)Atopic dermatitis
c)cat scratch disease
1237-Senario about wilson (kayser-fleischer ring, low ceruloplasmin)Rx:
A)desferrioxamine
B)penicillamine
1238-effective ttt of mastalgia ?
a- Caffeine
b- OCP
c- tamoxifen
d-danazol
1239-Pt with abdominal pain and distension with vomiting and
constipation. He has mild symptoms of dehydration. There is
evidence of air in the rectum. The Rx:
a. Rectal decompression with IV antibiotics
b. Nasogastric tube with IV isotonic fluid
c. Systemic antibiotics
1240-5 months old baby , in ER with sudden abdominal pain , pain last 2-3 min with
intervals of 10-15 mins between each attack :
A- intussesption
B- infantile colic
C- appendicitis
1241-Patient with a scenario going with liver cirrhosis with acsites, diet instructions:
High carbs, low protein
Sodium restriction
208
1) A
2) B
3) C
4) D
1250- Regarding strep pharyngitis: same as q13 put choices are
complete
1) No treatment should be given until strep infection is proven.
2) Treatment has no effect on rapidity of solution of infection
3) Treatment prevents post-strep glomerulonephritis
4) Treatment can be postponed for 9 days
5) Clindamycin is the drug of choice
__________________________________________________________________________
__________________________
1251-. What could cause painful vision loss:
1) Acute close angle glaucoma
2) Retinal detachment
3) Retinal vein occlusion
4) Retinal artery occlusion
1252- Female patient with hirsutism, obesity, infertility. US shows
multiple ovarian follicles. Dx:
1) Klinefelters syndrome
2) Ashermans syndrome
3) Kallman syndrome
1) Stein-Leventhal syndrome other name of PSO
1253-. HbA1c is useful in:
1) Adjustment of insulin
2) Monitoring diabetic control on day-to-day basis
3) Longer term diabetic control monitoring
1254-. Child with iron toxicity, best way of management:
1) Gastric lavage
2) Ipecac syrup
3) Magnesium citra
Forgot the rest of choices, but there was no deferroxamine or charcoal.
__________________________________________________________________________
__________________________
1255- Patient presented with typical symptoms of hyperthyroidism.
Whats the most effective and rapid way to relieve symptoms:
1) Propranolol
2) PTU
3) Radioactive iodine
4) Surgery
1256- Young patient with unremarkable medical history presented with
SOB, wheeze, long expiratory phase. Initial management:
1) Short acting B agonist inhaler
210
2) Ipratropium
3) Steroids
4) Diuretic
1257-Patient with moderate persistent BA, on short acting B agonist and
low dose steroid inhaler. What will be the next step:
1) Add long acting B agonist to steroid
2) Increase dose of steroid
3) Theophylline
4) Ipratropium
1258-young male has a painless mass in the testis that is increasing with time what is
your advice:
US and consult surgeon
1259-drug binds to the bile and prevent its reabsorption:
cholystramine
1260-female patient on antiepliptic drugs wants to become pregnant what well you tell
her regarding eplipsy:
use of antiepliptic has risk of fetal malformation
epliptic attacks affects the fetus
1261-pt has solid dysphagia best for diagnosis:
endoscopy +biopsy
1262-pt has DM2 and HTN an CCB+metformin+glyburide+statin still having increase
BP what is your advice:
add ARBs
increase CCB dose
start thiazide
1263-In cervical LNs there are well differentiated thyroid cells, during operation you
find no lesion on thyroid what will you do next
A. Total thyroidectomy
B. Total thyoidectomy + radical cervical LNs dissection
C. Total thyroidectomy + specific LNs dissection
D. Thyoid lobectomy with ----e-thyroid lobectomy and isthmusthectomy and removal of all local enlarged lymph
nodes (new choice not in alqaseem q)
1264-a young healthy male complain of sleep apnea on examination there is only
enlarged tonsils mangment:
adenoidectomy
reduce weight
1265-long scenario about young male with spoon shaped nails:
iron deficiency anemia
211
212