Smle New Qs File

polymaylgia rumatica, what are the x-Ray finding ?
- calcification in joints
- forgot other choices
Answer : No thing (normal)
Routine radiographs of inflamed joints do not show abnormalities in patients with PMR. By
comparison, routine imaging by other techniques (such as ultrasonography [US], magnetic
resonance imaging [MRI], and positron emission tomography [PET]) can detect findings
suggestive of underlying inflammation in patients with PMR [30]. Over time, the synovitis of
PMR is never erosive. However, such advanced imaging is usually not required
(UpToDate)
allergic to dust, what is the test to comfirm asthma ?
- esinophile something
Answer : Allergen-specific IgE Antibody Test , the prick/puncture technique and
the intradermal technique
55 woman P5 , all svd,complains of ( case scenario

about uterine prolapse ), what test to do ?
- options of uro gyne tests
- speculum – next step
female in her 20s , came with dysuria, hematiria , no

suprapubic tendeness , what to do ?
- check for STD
- pylocyctogram
- urin analysis and culture
Answer : unclear question but usually start simple and non invesive to
dignose or role out most common disease such as urin analysis and
culture
derma: wheal, what is the type of urticaria ?

- cold urticaria
- solar urticaria
- nd two other type of urticaria I forgot
Answer :
baby with recurrent jaundice and multiple blood
transfusion, what causes the RBC to be destructed, blood
results show low RBC , DLT test normal and some other
laps and blood smear ( spirometric ,nuclutated ... )
- G6PHD
- other choices I can't remember
Answer : see algorithm below
What is biochemical defect in x linked agammagloubinemia !?
Answer :
X-linked agammaglobulinemia (XLA) is a rare genetic disorder discovered in 1952 that
affects the body's ability to fight infection. As the form of agammaglobulinemia that is X-
linked, it is much more common in males. In people with XLA, the white blood cell
formation process does not generate mature B cells,[2] which manifests as a complete or
near-complete lack of proteins called gamma globulins, including antibodies, in their
bloodstream. B cells are part of the immune system and normally manufacture antibodies
(also called immunoglobulins), which defend the body from infections by sustaining
a humoral immunity response.
Affects males 50% of the time if mother is a carrier for the gene. Children are fine until 6-
9 months of age. Present with recurrent infections with Streptococcus pneumoniae,
Hemophillus influenza, Mycoplasma pneumoniae, hepatitis virus, and enterovirus CNS
infections.
Most antibodies are gamma globulins. Antibodies are made mainly by plasma cells,
which are daughter cells of the B cell line. The Btk enzyme plays an essential role in the
maturation of B cells in the bone marrow, and when mutated, immature pro-B
lymphocytes are unable to develop into pre-B lymphocytes, which normally develop into
mature (naive) B cells that leave the bone marrow into the blood stream.
The disorder is inherited in an X-linked recessive fashion as the gene linked to it is on
the X chromosome) and is almost entirely limited to the sons
of asymptomatic female carriers.
What is the coreceptor for HIV virus with CD4 !?
- cd8
- Cd58
- CXCR4
Answer : CXCR4
What is biochemical deficiency in respiratory

distress syndrome in neonate!?(no surfactant in answers)
- shingomyelin
- Phosphate ......
Answer :
Pulmonary surfactant is a surface-active lipoprotein complex (phospholipoprotein)
formed by type II alveolar cells. The proteins and lipids that make up the surfactant have
both hydrophilic and hydrophobic regions. By adsorbing to the air-
water interface of alveoli, with hydrophilic head groups in the water and the hydrophobic
tails facing towards the air, the main lipid component of
surfactant, dipalmitoylphosphatidylcholine (DPPC), reduces surface tension.
Composition :
~40% dipalmitoylphosphatidylcholine (DPPC); ●
~40% other phospholipids (PC); ●
~5% surfactant-associated proteins (SP-A, B, C and D); ●
Cholesterol (neutral lipids); ●
Traces of other substances. ●
What is associated with major depression ?

- loss of eye contact
- Late awakening from sleep
- Hallucination
Answer : Late awakening from sleep
Sleep disturbances, including insomnia or sleeping too much (mayoclinic ) ●
Child with repeated polymicrobial chest infection , skin test positive for
candida antigen Blood test all normal except high IgG or IgM !?
Low lymphocyte. Lymph node biopsy showed : rudimentary germinal
centres . What is the pathophsyioloy of this disease!?
Answer : the diagnosis is Bruton Agammaglobulinemia
In the absence of BTK, B lymphocytes do not differentiate or mature. Without
mature B lymphocytes, antibody-producing plasma cells are also absent. As a
consequence, the reticuloendothelial and lymphoid organs in which these
cells proliferate, differentiate, and are stored are poorly developed. The
spleen, the tonsils, the adenoids, the Peyer patches in the intestines, and the
peripheral lymph nodes may all be reduced in size or absent in individuals
with X-linked agammaglobulinemia (XLA).
The protooncogene encoding for BTK has been cloned and its genomic
organization determined, allowing an in-depth analysis of the role of BTK and
other signaling molecules in B-cell differentiation. [1]
Mutations in each of the 5 domains of BTK can lead to disease. The single
most common genetic event is a missense mutation. Most mutations lead to
truncation of the BTK enzyme. These mutations affect critical residues in the
cytoplasmic BTK protein and are highly variable and uniformly dispersed
throughout the molecule. Nevertheless, the severity of disease cannot be
predicted by the specific mutations. Approximately one third of point mutations
affect CGG sites, which usually code for arginine residues. The putative
structural implications of all of the missense mutations are provided in the
database. [2, 3, 4, 5]
Man healthy , his wife has osteoporosis , he have repeated renal

stones , he takes multivitamins , all labs normal excepts High PTH.
what is the cause !?
-primary hyper para thyroidism
- Vit D toxicity
Answer : primary hyper para thyroidism
4 years old have decrease in head growth , has weird

hand movement ( wiringing) , lost expressive end
receptive language skills , lost his interest in his social
environment . what is the diagnosis?
-Autism
- Mental retardation
- Rett syndrome
Answer : Rett syndrome
Young male have epigastric pain , fullnes , nausea

pistprandial bloating for three years , his symptoms
appeared after he stayed in India for one year for
studying , symptoms are worse with food ,What is the
diagnosis !?
- Functional dyspepsia
- H pylori infection
- Esophageal ulcer
Answer : H.pylori infection: Epigastric pain, In chronic form it might
cause gastric ulcer which worsens with food.
NOTE: Functional dyspepsia: Classic postprandial chronic symptoms.
What is the enzyme used glycolysis !?

- pyrovate kinase
- Pyrovate carboxylate
- Glucose phosphatase
Answer : pyrovate kinase
A surgeon was doing nissen fundoplication and injured

the posterior vagal trunk which of the following is
affected:
Jejunum
Esophagus
Descending colon
Bladder
Answer : Jejunum
Vagus nerve branches in the abdomen
The gastric branches (rami gastrici) supply the stomach. The right vagus
forms the posterior gastric plexus and the left forms the anterior gastric
plexus. The branches lie on the posteroinferior and the anterosuperior
surfaces, respectively.
The celiac branches (rami celiaci) are derived mainly from the right vagus
nerve. They join the celiac plexus and supply the pancreas, spleen, kidneys,
adrenals, and intestine. (Medscape)
Post menopausal woman presented with vaginal bleeding

cervical and vaginal exam normal except for blood at the
cervical os what is ur next step:
Endometrial sampling
Pelvic ultrasound
Bhcg
Ca 125
Use transvaginal ultrasound for the initial study for patients at low risk for
endometrial cancer, and endometrial biopsy for those at high er risk
An 18 mo child presented by leg bowing and inability to

walk high ca, low phosphate, and high ALP whats the dx
Vit.d deficiency rickets
Hypophosphatesia
Familial hypophosphatemia
Answer :
Wrong question , in case ca was low or normal the answer will be
Familial hypophosphatemia
Which OCP causes hyperkalemia

Estradiol-levonorgestrel
Estradiol-drosperirenone
Answer : Estradiol-drosperirenone
Patient presented with fatigue and weight loss+ labs hb

12 platelets 200 wbcs 19000 and peripheral blood film
showed neutrophilia, basophilia, promyelcytes and
myelocytes. What's the next step:
Flow cytometry
Bone marrow bx and aspiration
Repeat cbc
Answer : Bone marrow bx and aspiration
Patient presented with eye redness and problem in vision

just during exams his visual acuity is 6/6 and normal eye
exam what does he have: ??? may be A or C
Astigmatism - is a type of refractive error in which the eye does not focus light evenly
on the retina
Myopia - Near-Sightedness
Hypermetropia (= Hyperopia) - Far-Sightedness
Anisometropia – In which the two eyes have unequal refractive power
16 wk pregnant presented with severe vomiting, abdominal distention
and small for gestational age. U/s showed snow storm. Bhcg 6. Whats
the dx
Choriocarcinoma
Complete mole
Partial mole
Parents of child noticed that he's sitting alone, not developing well,
playing with his toy, and have repetitive behavior what's ur dx
Global developmental delay
Autism
Answer : Autism
A child presented with difficulty in breathing and mild
fever parents indicated that he had 2 similar episodes two
wks ago what's ur 1st step
Observe
Fluids and supportive care
Inhaled steroids
Ventilatory support
Answer : Ventilatory support
A boy with recurrent infections his brother dyed when he

was 3yrs of age he has 2 sisters who are alive and well
what does he have
Combined immunodeficiency
X-linked immunindefeciency
Answer : X-linked immunindefeciency
What's the treatment of cold induced urticaria

Verapamil
Can't remember the rest
Answer : The first-line therapy in ColdU, as recommended by EAACI/GA2
LEN/EDF/WAO guidelines, is symptomatic relief with second-generation H1-
antihistamines. if standard doses are ineffective increasing up to 4-fold is recommended
to control symptoms.[22]
The second-generation H1-antihistamine, rupatadine, was found to significantly reduced
the development of chronic cold urticaria symptom without an increase in adverse effects
using 20 and 40 mg.
Most specific test for rheumatoid arthritis

Crp
Rf
Hla b27
Antidnase
Answer : anti-CCP
Child had URTI 2 weeks ago, presented with right upper
quadrant pain, Labs show high wbc, low hg and other labs not sure of
them Electrophoresis show inclusion bodies.. what's the diagnosis ?
-acute appendicitis
-sickle cell disease
-lithium
-gi infarct ??
Female patient presented with symptoms of urinary incontinence,, it's

associated with cough and stress,, patient tried to avoid it by
strenghting pelvic muscles while accidenlty urinating but it was of no
use... what to
do for her ?
- Pelvic strenghtning
-spling ???
Answer :stress incontinence , if the lifestyle modification and exsercise
fail , next step is pessaris or surgery (UpToDate)
75 years old male, asymptomatic, BM report shows increased
lymphocytes, immunohistochemistry shows positive cd19, cd5, cd6,,
whats' the treatment ?
a- No reatment
b- Rituximab + CVB
c- Rituxuman + prednisolone
d- Cyclophosmadie (this is the answer and it was
confirmed by hematology consultant)
answer : I am not sure but the writer said D
patient with SUDDEN SEVERE shoulder and neck pain with stiffness ,
also hip and lumber spine pain , also complain of fatigue and increase
sleepiness , ESR was 90.
1- cartilaginous tissue degeneration
2- antigen antibody mediated arthritis
3- soft tissue with giant cell arteritis (Polymylgia Rhuematica)
4- connective tissue disease something gold
patient known to have acquired immunodeficiency presented with

cough and night sweat , he did mentoux test which was negative but
culture was positive for tuberculosis what is most likely:
1- culture is false positive
2- mentoux is false negative
3- mentoux is not a screening test for TB
4 - the patient should be screened with heaf test.
Answer : mentoux is false negative
Goblet cells are mostly found in

1- stomach
2- duodenum
3- ascending colon
4- rectum
Answer : ascending colon
The colon contains a larger percentage of goblet cells than the small intestine.
Treatment of tinea pedis

1- gentain violet
2- tantafpine antifungal cream (wrong spelling)
3- oral ketoconazol
4- terbinafine
Answer : Tinea pedis can be treated with topical or oral antifungals or
a combination of both. [9, 10, 11] Topical agents are used for 1-6 weeks,
depending on manufacturers' recommendations. Luliconazole, an
imidazole topical cream, is applied once daily for 2 weeks.
(Medscape)
Patient came with the presentation of excess salivation and difficult
breathing due to respiratory secretions. The patient has a history of
pesticide exposure and now he also have a ( garlic odor) What you will
give: (ORAGANOPHOSPHATE POISINING)
1- nesostagmine
2- pralidoxime
What are the CXR finding in miliary TB

1- pleural effusion
2- 2 to 3 small nodules ( exact wording)
3- small cavity
4- sparing the apacies
Findings are typical in 50% of cases. A bright spotlight helps to reveal
miliary nodules. Bilateral pleural effusions indicate dissemination
versus localized and unilateral pleural TB. This may be a useful
clinical clue. Nodules characteristic of miliary TB may be better
visualized on lateral chest radiography (Medscape)
PA and lateral chest x-rays demonstrate wide spread small (2-4mm) nodular opacities distributed
throughout both lungs.
Child presented with rash that started in the back then it was spread to
all his body, it was pustules others vesicular , the rash had truncal
distribution more than limb , what is the incubation period for this
organism
1- 5-11 days
2- 11- 21 days
3- 23 - 30 days
Answer : 11-21 days
Patient with heavy bleeding she did a hysterctomy, diagnosis was

confirmed with a histopathological exam of the tissue of hysterctomy,
which of the following is the best non invasive investigation to support
the suspected diagnosis.
1- office endometrial biopsy
2- pelvic MRI
3- pelvic CT
4- pelvic US
How to treat alcohol withdrawal ( no diazepam in the answers)?

1- disulfiram
2- propranolol
3- chlorodizepoxide
Answer : chlorodizepoxide (it is benzo group)
Child came with knee swelling or bleeding after mild trauma. Bleeding
time was abnormal and it was NOT corrected after we gave fresh
frozen plasma. Then bleeding time got back to normal after giving
platelet transfusion his platelet was 50. What does the patient has (PT
and PTT was not included in the question )?
1- VWF deficiency
2- HSP
3- thrombotic thrombocytopenic purpura (Not ITP)
4- weird syndrome name , can't remember
Impaired focus on the current function with disruption of vitals
physical activities. What condition have these characteristics?'
1- OCD
2 dissociative disorder
3- major depression
4- psychosis
Answer : most likely major depression
Old asthmatic patient came with urinary retention diagnosed with BPH
and he was found to have high blood pressure 180/110 ( exactly it was
that high) what to give now ?
1- IV Labetalol
2- propranolol
3- prazosin
4- something ends with lol , BBlocker ?
How to monitor the response of iron treatment

1- ferritin
2- reticulocyte count
3- hematocrit
Answer : reticulocyte count
treatment of non-inflammatory acne

1- retinoid acid
2- clindamycin
3- isosertonin
4- azelaic acid
Answer : topical retinoid acid
patient with a history of vertigo tinnitus with imbalance and hearing

loss what is the next investigation
1- CT temporal
2- MRI of cerebelloponitine " this is Acoustic Neuroma"
Mechanism of action of vitamin C

Answer : The chemopreventive action of vitamin C is attributed to two of its functions. It is a
water-soluble chain breaking antioxidant ( Ishwarial et at 1991). As an antioxidant, it
scavenges free radicals and reactive oxygen molecules, which are produced during metabolic
pathways of detoxificatio n. It also prevents formation of carcinogens from precursor
compounds (Block and Menkes, 1988). The structure of ascorbic acid is reminiscent of
glucose, from which it is derived in the majority of mammals.
A boxer who had multiple hits on his face and head, came with
increased intracranial pressure and these symptoms (tinnitus, vertigo)
which cranial nerve you want to check before CT brain to be done?
-facial
-oculomotor
-trochlear
-optic
Answer : optic
which of these components is acidophilic
-corticotrophic
-trophoyrophic
-lactotrophic
-gonadotrophic
Answer : lactotrophic
patient has painful big mass in the lower eyelid beside upper nose,
what is your management ?
-topical steroid
-Surgical drainage
-oral antibiotics
Answer : it is DACROCYSTITIS
long scenario) in brief, a boy with diarrhea (gastroenteritis and

dehydration symptoms) with no urine output (acute kidney injury).
And they gave you labs ( k: high, urea: high, sodium bicarbonate: low
and high creatinine) what is your immediate action ?
-dialysis
-normal saline
-NaHCO3
-antibiotics
Answer : NaHCO3
Ref: Correction of severe acidosis with bicarbonate administration,
which can be important as a bridge to dialysis. (MEDSCAPE)
what is the characteristic for von willebrand disease?

-prolonged ptt.
-prolonged bleeding time.
-decrease in factor VIII
Answer : prolonged ptt
What is the drug that increase seervival rate in aortic stenosis ?
1- digoxin
2- captopril
3- calciam channal blocker
‫يعن وين‬
‫ ? ي‬What is the pathology in huntigton syndrom
‫ايش بالظبط يزيد او يقل يف هذا المرض وين موقعها‬
1-something related to stratum whith nerotransmitter
deffect have look for it
answer : The most striking neuropathology in HD occurs within the
neostriatum, in which gross atrophy of the caudate nucleus and
putamen is accompanied by selective neuronal loss and astrogliosis.
Marked neuronal loss also is seen in deep layers of the cerebral
cortex. Other regions, including the globus pallidus, thalamus,
subthalamic nucleus, substantia nigra, and cerebellum, show varying
degrees of atrophy depending on the pathologic grade
What is the mechanism of diarrhea with patient has gardia infection ?

1- reduction of absorption
2- increase secretion of mucosal
Answer : reduction of absorption
this direct injury is an unlikely cause of the more extensive reduction
in microvillus surface area, the reduction in disaccharidase activities,
and the more pronounced abnormalities of villous architecture that
are seen in giardiasis.
What is the best investigation for determine sevirity of
asthma ?
1- PEFR
2-ABG
Answer : PEFR (Pulmonary function test)
23 year old man is complaining of polydpisa and polyurea and he is

worry and afraid about getting dm what is the best value for
diagnosis ? Typical senario and answer
1- 7.7
2-8
3- 9
4- 12
The diagnosis of diabetes in an asymptomatic individual can be established with any of the
following criteria: fasting plasma glucose (FPG) values ≥126 mg/dL (7.0 mmol/L), two-hour
plasma glucose values of ≥200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test
(OGTT), and A1C values ≥6.5 percent (48 mmol/mol) (UpTodate)
Boy coming to the ER complaing on the right side ,examination all

normal except hypertinsive , one day before he is fallen on right side
what is the most organ involved ?
1- right kidney
2- liver
Answer :Right kidney
Neonate born and after hours he is jaundice and he is

getting worse with time what is the diagnosis ?
1-G6PD
2-pyrivatkinase
Answer : G6PD
During bypass heart surgery the assistance asking about origin of right
coronary DOMINANT artery ?
1- posterior interventicualr
2-anterior septal
3- marginal
4- circumflex
Q about RAST test measure ??

A radioallergosorbent test (RAST) is a blood test using
radioimmunoassay test to detect specific IgE antibodies, to determine
the substances a subject is allergic to. This is different from a skin allergy
test, which determines allergy by the reaction of a person's skin to
different substances.
New born totally healthy with left thigh bruise all examination normal.
Prolonged pt, ptt Your dx:
* Hemophilia
* Factor 10 deficiency
* Idiopathic thrombocytopenic purpura
Answer: Factor 10 deficiency
A child with multiple plaques on his face, abdomen and

feet. What is the Diagnosis? In the q they mentioned something about
histoimmune and positive CD?
a) mycosis fungoides (THE CORRECT ANSWER),
b) Bowen disease
c) Basel cell carcinoma
women with DUB & Endomertioum biopsy shows: enmdometriam
hyperplasia This caused by?
a) Adrenal hyperplasia
b) Liver dysfunction
c) Local genetic mutation in the endomertirum
d) Peripheral percoser converted to estrogen
Beta Thalassimia:
a)Point mutation
b) Deletion
c)Insertion
d)Fragment shaft
answer : Point mutation
First degree relatives wants & want to know the risk about familial
hemochromatosis,the most appropriate investigation ?
a) Serum ferritin
b) Genetic test
c)Serum iron
answer : Serum ferritin and transferrin saturation
The 2011 guidelines from the American Association for the Study of Liver Diseases
regarding the appropriate cutoff levels for transferrin saturation (greater than 45
percent) and serum ferritin (greater than 200 ng/mL in men and greater than
150 ng/mL in women) for screening patients with iron overload are in general
agreement with the above-noted values
32 female c/o breast milk discharge and irregularmenses, ask about

investigation:
A tsh
B brain mri
C biopsy
Answer : TSH! (Uptodate mentions TSH as first intial test before brain
MRI!)
1- Relaxed muscle , with vigorous movement what will happen ?

* increase conversions of pyruvat to lactic acid – (NOT SURE)
* Decrease somthing !
* Decreas NADH/NAD
Male presented to the ER after MVA, serum phosphate level was

initially normal then he developed multi organ failure and increase in
the serum phosphate level, which organ is the responsible for this:
- Heart
- Liver
- Lung (If KIDNEY is there pick it, next LUNG 'RARE')
- Spleen
Pediatric age group, mass inner side of lower lip, non-tender, bluish in
colour, dx?
-Mucocele**
-Gingival cyst
-Ranula
-Epiula
Answer : Mucocele
2. 17 year old football player, hypopigmented lesions on trunk and
arm. Treatment:
-topical abx
-oral abx
-topical steroid
-selenium sulphate**
Answer : selenium sulphate
History of travel to Africa, came back to myalgia arthralgia. Vitals were

normal (no fever), what is the most likely?
Ebola
Yellow fever
Lassa fever
Chikungunya
Answer :most likely Yellow fever, however it is INCOMPLETE
Pediatric complaining of: Intermittent Dysphagia, retrosternal pain and

heartburn. Barium swallow showed: dilated esophagus. Synchronous
contractions, and gradual distal narrowing. diagnosis?
Achalasia
Diffuse esophageal spasm
GERD
Answer: Achalasia
Question about BPH, hypertensive but already on medication. What is

your management?
TURPT
Open prostatectomy
Alpha blocker**
15-year-old girl brought by her mother because she did not get her
period yet. On examination she has breast buds, normal pubic hair and
has increased in height the last year. Which one of the following will
support your diagnosis?
1. Onset of menstruation
2. Bone age estimation
3. Cant remember
School boy with itchy scalp, 10 other classmates affected, diagnosis?

Pediculosis capitis
Answer : Pediculosis capitis
In non-small cell lung CA, which of the following is a contraindication

to do surgery?
1. Stage IA
2. Stage IB
3. Peripheral lung lesion
4. SVC obstruction
Answer :
Contraindications for surgical resection of lung cancer
- FEV1 less than 1.5L for lobectomy ; 2.0L for pneumectomy

- mediastinal lymph node more than 1cm
- staging more than IIIB
- recurrent laryngeal nerve involvement
- malignant pleural effusion present
- proven metastasis
Absolute contraindications for surgery include:
patient refusal ●
metastases (CT scanning now detects metastases more frequently than a decade ago) ●
Relative contraindications include:
the cell type - small cell carcinoma are usually inoperable ●

poor respiratory reserve: ●
FEV1 > 1.2l is necessary for lobectomy, and > 1.8l for pneumonectomy o
a raised PaCO2 is a contraindication for surgery o
other disease - especially myocardial ●
mediastinal involvement ●
age - in patients over 70, surgery is usually inadvisable because the benefits are ●
outweighed by operative morbidity and mortality
Virulance factor of streptococcus ?

M- protin
Capsule
Endotoxin or exotoxin
‫ مدري ايش‬phosphatase ‫ش فيلو‬‫ي‬
Answer : S. pyogenes has several virulence factors that enable it to attach to host
tissues, evade the immune response, and spread by penetrating host tissue layers. [11] A
carbohydrate-based bacterial capsule composed of hyaluronic acid surrounds the
bacterium, protecting it from phagocytosis by neutrophils.[2] In addition, the capsule and
several factors embedded in the cell wall, including M protein, lipoteichoic acid, and
protein F (SfbI) facilitate attachment to various host cells. [12] M protein also
inhibits opsonization by the alternative complement pathway by binding to host
complement regulators. The M protein found on some serotypes is also able to prevent
opsonization by binding to fibrinogen.[2] However, the M protein is also the weakest point
in this pathogen's defense, as antibodies produced by the immune system against M
protein target the bacteria for engulfment by phagocytes. M proteins are unique to each
strain, and identification can be used clinically to confirm the strain causing an infection.
2-PPH with low BP and tachycardia the 1st thing to do :

*Ergotamine
*Ringer lactate
*Normal saline with something
patient diagnosed to have meckel's diverticulum, where is the most
common site :
* cecum
* duodenum
* jejunum
* ilium
Answer : ilium (MD is commonly present 90 cm from illio-cecal valve)
patient complains of skin mole, his father had them as well and
remove them but didn't know if its benign or malignant, the patient is
concerned that his mole is malignant, what will suggest the
malignancy ?
*irregular border that fades in color to be normal
*Equality of the color
Answer :
The relation between the femoral vein with the femoral artery in
femoral triangle:
1. Lateral (This is the answer If Q says relation of FA to FV)
2. Medial (This is the answer If Q says relation of FV to FA)
3. Anterior
Answer: femoral artery is positioned at the midinguinal point (midpoint between
the pubic symphysis and the anterior superior iliac spine); medial to it lies the femoral
vein
Amenorrhea, low prolactin, what to see in CT or MRI:

Sella turcica
Answer : EMPTY SELLA TRUCICA
Pic of diagram showing progress of diabetic nephropathy (GFR and

albuminuria) cases in years, then ask about the specific point of change
‫(او حاجه زي كدا‬: (
1. 10 year
2. 15 year
3. 20 year
4. 25 year
UNCCLEAR??
Child with scaly erethematous plaques with follicular hyperkeratosis
over elbows and knees . what is other area in the body more likely to
be affected ?
a- Eye
b- Adrenal
c- Heart
d- Kidney
what is the best non-invasive method to diagnose Adenomyosis

a- office sampling
b- u/s
c- MRI
answer : MRI (more sensitive and specific)
A definitive diagnosis of adenomyosis can only be made from histological
examination of a hysterectomy specimen. The preoperative diagnosis is suggested
by characteristic clinical manifestations (ie, menorrhagia and dysmenorrhea with a
uniformly enlarged uterus) in the absence of endometriosis or leiomyomas.
Both transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI),

especially T2-weighted images, are increasingly used for clinical decision-making.
Most common known side effect of steroid in children?

-Excitable behaviour!
-labail mood
-growth retardation
-intraoccular Hypertension
Answer : Excitable behaviour
Patients has decreased vision loss and went to optometrist and got
new glasses, one week he comes back with decreased vision with the
new glasses he was referred to ophthalmologist due to :
A- cataract formation
B- increases glucose in lens
C- increased sorbitol in lens
D- ????
Answer : increases glucose in lens
What is the precentage of untreated UTI to ascend to the
kidneys ?
A-0.5
B-5
C-50
D-0.05
I DO NOT KNOW
Patient with normal menses since puberty , normal exam
except ovarian mass
1-follicular cyst
2- ovarian carcinoma
3 - endometrial cancer
4- benign ovarian teratoma
Answer : missed Q but most likely benign ovarian teratoma
The cause of maternal mortality if happened during pregnancy ?

A-Syphilis
B-Toxoplasmosis
C-Biliary cholistasis
CONFUSING! NO CLEAR DATA, BUT (C) IS FATAL
Which anti TB cause vertigo?
- isniazide
- Rifampine
- Ethambutole
- Pyrzinamide
Answer : Streptomycin
1st responsible for Bp regulation :
- heart
- aorta
- arterioles
- capillaries
Answer :
Baroreceptor reflex : Baroreceptors in the high pressure receptor zones detect changes in
arterial pressure. These baroreceptors send signal s ultimately to the medulla of the brain
stem, specifically to the rostral ventrolateral medulla (RVLM). The medulla, by way of
the autonomic nervous system , adjusts the mean arterial pressure by altering both the
force and speed of the heart's contractions, as well as the systemic vascular resistance.
The most important arterial baroreceptors are located in the left and right carotid
sinuses and in the aortic arch
1- most common presentation in hemophelia:

**Hemiarthrosis ❤􀀀Or petechia1- most common
Answer : hamarthosis
Joint and muscle hemorrhage are the most common manifestations
of moderate and severe hemophilia. Petechiae usually do not occur
in patients with hemophilia because they are manifestations of
capillary blood leaking, which is typically the result of vasculitis or
abnormalities in the number or function of platelets. (Medscape)
case of bell's palsy, which nerve will be intact

1- massater
! ‫ ما اعرف السبيلينق‬2- bucceneter
3- orbicuaris oris
‫ الثانية‬4- orbicuaris
Answer: massater
Girls or boy i cant rememper , hit puperty till which age the
bone griwth will continue ?
•12 monthes
•24 m
•36 m
UNCLEAR, BUT ANSWERED AS (B)
Athelet , Foot pain , no hx of trauma :
•Tarsal tunnel syndrome
•Planter fasciitis
Answer : INCOMPLETE Q
CT abdomin shows renal tumor affecting calycial system with

lung multiple nodules?
Answer :Willm’s tumor
Mother with rh (-) father ( + ) first child ( +) now she is

pregnant whats the precentage to have child with rh ( + ) ?
25%
0%
50%
Answer : 50%
Side effect of levodopa ?
Htn “ cuz hypo not hyper”
n/v
answer : nousea and vomiting
suspecting HIV Eliza negative what to do next:

repeat eliza,
western blot
*** if test done after 6 weeks of exposure it’s –
Answer : Stop
what's the effect of niacin

-dec LDL
Answer : lowering LDL and increasing HDL
Child with Hx of stem cell transplant few months back, -34
brought to ER by his father because his brother developed
?checkin box this morning. What are you going to do
A. Acyclovir
B. Varicella vaccine
C. Varicella immunoglubin
D. B+C
Answer : Varicella immunoglubin
-Metformin action is enhanced in by which enzyme?

Answer : activation of AMP-activated protein kinase
Renal cell carcinoma marker?
Answer : M2-PK
Pronator teres syndrome ?
Answer: Medial nerve compression at elbow
-Malignant hypertension is?

Answer: A hypertensive emergency is a condition in which
elevated blood pressure (BP) results in target organ damage.
Pt got tibial fracture in his farm then did fixation then got
sepsis. The cause?
C.tetani!
c. perfergins
Answer : c. perfergins
-Postpartum bleeding gave IVF and add what?
Oxytocin!
Ergotamine!
Carbetocin!
Answer : Oxytocin or erogatamine (better answer)
-Turner syndrome risk to happen is?
1-2%!
NO IDEA
Q about final destination of proteins in cell cycle ?!!
Anaphase
Prophase
Cytokinesis
GOLOGI APPARTUS OR TELOPHASE!
What structure holding Uterus?

Answer : uterosacral ligaments
30 -years old female present to you in the clinic after ROM before one
hour which was clear fluid P/E: no vesicles in the vagina medical report
documents as pt has hx of recurrent HSV what is your management?
-proceed to C/S"
-IV acyclovir
First, perfrom a sterile speculum ex, then if positive PROCEED TO CS.
If negative SS EX, it's controversial.. either SVD or CS.
If pt is not in labour and EX is normal, but with known hx of HSV, obtain
a weekly cervical culture.
If pt is presenting with active lesions but not in labour, give IV acyclovir.
female has urine incontenince with stress condition (valsulva

maneuver,cough) Even with lithotomy she had incontenince:
Best managment?
1-B blocker
2-periurethral bulking!
3-Kegal exercise
pt has urine culture MRSA he is on antibiotic after fewa day develop
redness on face ,neck ?what is antibiotic?
1-pencillan
2-vancomycine
uretic stone prophylaxis >> disodium citrate(only this option)
** itʼs potassium citrate
-HCM which gene has the worst prognosis ( no options)
*** if itʼsHCM hypertrohic cardiomyopathy gene assoc
MYH7, MYBPC3, TNNT2, and TNNI3
Girls came with leg pain more in night examination is normal lab esr
and ana high rheumatoid ( my answer becz inflamatory marker is high
and ana is high also)
Growing pain
Ostoid osteoma✅
Osteosarcoma
Answer ostoid osteoma
Which one of these vaccines taken by intranasal route?
Zanamavir
Oseltamivir
10 yo child with acute rheumatic fever and cardiac involvement, how
long you will give him the prophylaxis?
1y
5y
10 y
15 y
Baby have depigmentation since birth and photophobia refractory

error nystagmus What the most likely complications?
-brine tumor
-skin cancer
-renal dysfunction
***This baby is a case of Albinism
Senario for ITP what you see in bone marrow?
Increase Megakaryocite
Nasal & and palate dryness due to obstruction of ?

- submandibular gland
- Submental
- Ptergoplatine
Ref: http://gradestack.com/Dr-Bhatia-Medical/A-patient-has-a-dry-eye/47-
3042-3163-15558-sf
Picture ( look like vesicle ) start as 1 only then spread to arm legs and ..
with lymph-node enlargement ?
- herps simplex virus
- Dermatitis herpetic form
- Varicella zoster
INCOMPLETE Q, BUT Verecila zoster is the closest since others are
blistering dx.
Case of patient tired peripheral blood show spherocytes, lab / low HGB
70 , low platelet less than 15 , TTT?
- platelet infusion
- Plasma exchange
- Iv acyclovir
B, DDx of spheroctyes in PBF:
ABO incompatibility ●
Hereditary spherocytosis - Splenoectomy ●

Hypersplenism – Caused by different DDx which generally improved ●
upon PE.
Burns - FAR ●
Immunohemolytic anemia – Steriods and IVIG ●
Hemolytic transfusion reaction – No hx of BT ●
Spider,bee,snake venoms – No hx ●
Septicemia – No supportive hx of toxic pt. ●

Hypophosphatemia – Remote possibilities ●
Case of gleumonephritis which of these strong support ur diagnosis ?

- streptozyme test
- Low C3
Indicate poor prognosis ?
- high calcium
- Low IgA
The above Q is may be about MM? Poor prognostic factors of MM include
the following:
Tumor mass ●
Hypercalcemia ●
Bence Jones proteinemia ●
Renal impairment (ie, stage B disease or creatinine level >2 mg/dL at ●
diagnosis)
Cough + corayza + conjectevitis , present with macculoppular rash in

palm and buttox , on examination there is pastule in tonsils, what other
physical signs will find in the patient?
- spot on sole of foot
- Swollen tonsile
- Scratch markers
- Diarrhea
It’s MEASLES, Diarrhea is a common complication.

Ref. http://emedicine.medscape.com/article/966220-clinical#b3
Which of chemodrugs will cause HTN + skin problem + pulmonary
fibrosis ?
- bleomycin
- Methotrexate
Psoriaform skin found in ?
- subacute SLE
- Acute SLE
- Chronic SLE
- Drug induce SLE
Ref. http://emedicine.medscape.com/article/1065657-clinical
Patient on anti epileptic and Heart failure medication presented with
signs of drug overdose and ECG showing dysarethmia ?
- digoxin
- SSRI
- Quinine
What is the early sign of increase intracranial pressure?
- Hypertension
- Unconscious (Change in LOC is the first earliest sign in increased ICP)
- Epailateral papillary ...
- Contralateral papillary ..
Sign of uncomplicated pneumothorax?
- symmetrical chest movment – PSP causes limited probs, and pts r often
unaware and may wait several days before seeking medical attention
- Syncorerance heart beat – UNCLEAR
- Increase breath sound on affected site – Not a sign of either Tension or S-
TPX
- Shifted of medistanum to other side – Sign of Tension PTX
Epilepsy patient present with shoulder dislocation ?
- subacromual posterior
- Subclonoidal anterior
- Inferior
Metformin mechansim of action

Decrease tyrosin kinase
Increase tyrosin kinase .
Decrease hepatic Glucose by production of stimulate hepetic AMP
activated portine kiness
Ref: AMP-activated protein kinase (AMPK) activity increases in response to
depletion of cellular energy stores, and this enzyme has been implicated in
the stimulation of glucose uptake into skeletal muscle and the inhibition of
liver gluconeogenesis.
35 yo came with a history of pre menstrual multiuble breast lumbs . She
said it goes after menstruation but on exam . She found to have multiple
lumbs with one dominant lump of 3 cm and LN exam is normal how
will u manange :
-Wait for the the next menstrual cycle and re-evaluate .
-fNA
Radilogy and mamogram .
Pregnant lady with histroy of 2 SvD with normal babies of 3kg. The
baby is breech and the head is flexed she found to have bicoranate
uterus . And the baby whight is 2kg . What is the contraindication for
external cephalic version ?
Babys whight
Flexion of the head
Bicornate uteus .
Hyperextended head
5 months old baby found to have developmental delay . What is
reassuring sign for the doctor?
Pincer grip .
Reach for objects. (Starts as 4 months of age)
Sits independently.
A 32 week pregnant lady . By ur exam u found her to be off date. What
serial clinical assessment u will do over the next 2 weeks ?
Maternal whight
Cardiographs
... I forgot the others
The 3 basic methods used to help estimate gestational age (GA) are
menstrual history, clinical examination, and ultrasonography.
17 years old from MVA, she was intubated but then she was severely
hemodynamically instable. What sign will warrant you?
Engorged IJV
Shifted trachea
Hypotension
Resistant ventilation
REF: Deterioration after intubation - DOPE:
Displaced ETT ●
Obstruction (anywhere along circuit) ●
Pneumothorax ●
Equipment failure (ventilator malfunction or disconnect) ●
Child with autoantibodies.. chances of getting dm 1..

40 %
60 %
80 %
100 %
Test Abbr Description Comments
Islet Cell ICA Measures a group One of the most common
Cytoplasmic of islet islet cell autoantibodies
Autoantibodies cell autoantibodies detected at onset of
targeted against a disease; detected in about
variety of islet cell 70-80% of newly diagnosed
proteins (Note: beta type 1 diabetics
cells are one type of
islet cell)
Glutamic Acid GADA Tests for Also one of the most
Decarboxylase autoantibodies commonly detected
Autoantibodies directed against autoantibodies in newly
beta cell protein diagnosed type 1 diabetics
(antigen) but is not (about 70-80%)
specific to beta cells
Insulinoma- IA-2A Tests for Detected in about 60% of
Associated-2 autoantibodies type 1 diabetics
Autoantibodies directed against
beta cell antigens
but is non-specific
Insulin IAA Autoantibody
Detected in about 50% of
Autoantibodies targeted to insulin;
type 1 diabetic children; not
insulin is the only
commonly detected in
antigen thought to
adults
be highly specific for
beta cells. IAA test does not
distinguish between
autoantibodies that target
the endogenous insulin and
antibodies produced
against exogenous insulin.
Nerve involved in tarsal tunnel syndrome? TIBIAL NERVE

Child with fever and productive cough .. having diarrhea 5 times per
day now .. tolerating oral rehydration ???
.. hospitalize
.. augmentin and discharge✅
.. stool analysis and culture
Atypical pneumonia? Azithromycin is the drug of choice for children with
suspected or confirmed Legionella disease
Prevention of dementia? ... I choose leisure exercises and ... not
medication were in choises .. just rehab like option
Patient on atenolol having erectile dysfunction .. ???

Change to enalpril✅
Add sildinafil
Stop all meds and observe
Vaccine contraindicated in progressive neuro problems in child
.. pneumococcal conjugate
.. hib vaccine
.. dtap
.. varicella
6 year old came to ur clinic with no vaccine history except bgg ( i never
read this vaccine except in this question in exam ) came to your clinic ..
what is appropriate vaccination for him on first clinic visit .. ( time of
clinic visit not mentioned .. mean now or before when he was
infant ) ??? To catch up?? Or to give 6 years vaccines?
..mmr opv varicella dtap --- 6 yrs vaccines
Mmr opv hib
Mmr opv hib hbv
Options were like this
Q: monochorionic twins in 27 week, one of them died, wt to do ?
A: wait for spontaneous delivery at any gestation
B: wait till 34 week and deliver
C: give steroid and deliver (my answer)
– Cutoff to deliver is 26 weeks as risk of DIC increases.
Q: best investigation in 1st trimester
A: cbc B: us (my answer!!).
Q: women is bleeding after delivery, and can't stop, wt to do
immediately ?
A: hysterectomy. B: something to apply pressure ( my answer !! ) I forgot
other choices
Immediately commence resuscitation. Raising the legs improves venous
return and is consistent with the positioning used to diagnose and treat the
underlying causes of bleeding. Administer oxygen and obtain intravenous
access. All intravenous lines started on the labor ward for other reasons must
be placed with cannulas of sufficient gauge if PPH develops.
-WAS (Wiskott-Aldrich Syndrome) syndrome typical symptoms
(diagnosis): Eczema, thrombocytopenia and pyogenic infections.
-WAS also mode of inheritance: X-linked recessive
‫ حاطين اسمائها‬Child with multiple infection viral , fungal, bacterial
defect in Cd4 -
-Ada deficiency
Oby surgery clamb the artery close to lateral vaginal wall what
structure maybe injured:
-Peudendal nerve
-ureter
Ocp mode of action :
-decrease estrogen to prevent the ovulation
-Decrease GTRH spur at the mid cycle
-increase prolactin
Combined oral contraceptive pills were developed to prevent ovulation by
suppressing the release of gonadotropins
-Long scenario about hydrocele typical :
-failure of obliteration of process vaginalis
-27 y Man with progressive enlarged testis no tenderness no urinary
symptoms no sexual hx for 6 months ( mostly tumor):
-Us and surgical referal
-Antibiotics
-Biopsy
-child with dental caries and yellow brown:
-antibiotic
-Systemic fluoride
-Diatery change
Noncavitated lesions can be arrested and remineralization can occur under
the right conditions. However, this may require extensive changes to the diet
(reduction in frequency of refined sugars), improved oral hygiene
(toothbrushing twice per day with fluoride toothpaste and daily flossing),
and regular application of topical fluoride
-girl with normal menstruation has overian mass 7 cm:
-Benign teratoma
-pco
-something malignant
Functional cysts?
Child fall no loc vomit twice cry complain of headache what should you
do:
-Ct
-Close observe
Pt on heparin what should be monitored:
-pt -inr (WARFERINE)
-ptt (HEPARIN)
Hemochromatosis has cirrhosis before 5 years came with pain and
jaundice : next step:
-us (The closest, as it's used to screen for HCC 'which probably be the dx)
-Cea (Colo-rectal CA Marker)
-Ca125 (Ovarian CA Marker)
Pt wear contact lens then c/o pain in rt eye and discharge what is the
organism ?
H.influenza
Acanthameba
Nesseria meningitis
Pnumococcal
Chlymedia
- pt eye drop and eye goes to medial side what nerve injury when try to
close the eye: 3 or 7 or 4
Polyuria, skin rash and retinal degenration what Dx? ???
Cardiac syncope what is characteristic for it?
Rapid recovery
Aura
Neurological defect
Old bilateral deltoid muscle weakness and neck stiffness and limiting of
movement:
Brachial plexus neuropathy
Neck stain
man with epistaxis High reticulocyte increase direct bili,
(agranulocytosis im not sure) what common to be seen in this
syndrome?
Positive direct coomb test (AIHA)
Most common symptom with hepatitis C?
Loss of appetite (+ve in both acute and chronic forms of HCV)
Flapping tremor (Chronic complicated)
Jaundice (+ve in Chronic form only)
HSP disease what is the immunoglobulin responsible?
IgG
IgM
IgA
IgE
which in inguinal canal is develop from the external oblique muscle?
External spermatic fascia
Internal spermatic fascia
Pt has hx transit angina pain. Now he is asymptomatic now doing well
but his ECG shows AF what your action?
Reassure
Give digoxin
Give anti-coagulation drug
Pt present to er intensive knee swelling with ballottement pattern next
step ;
- esr
- arthrocentesis
- cbc
Q of Barr (Barr body??) in XXX female (UNCLEAR)
A)1
B) 2
C) 3
D) 4
3 yrs old, sx of DM since 2 weeks decrease of wt 3 kg dysphagia,
recurrent urination what is the appropriate step to dx:
- HLA Dr 3
- Urine dipstick
the diagnosis of DM can be confirmed with a random (nonfasting) plasma
glucose concentration of 200 mg/dL or a fasting plasma glucose
concentration of 126 mg/dL (6.99 mmol/L) or higher.
59 days boy k/c of G6PD ....... long hx
Come for hg 7 what you will do?
1- BT
2- give iron
3- reassurance
4- give folic acid
Ref (Medscape): G6PD patients with chronic hemolysis or non-spherocytic
anemia should be placed on daily folic acid supplements.
female baby 18 month anemia. dx? INCOMPLTE
A. Homozygous b thalassemia
B. Homozygous a thalassemia
C. Carrier a thalassemia
BUT (A) is closer because approx. after 18 months HbF production reduces
and HbA cannot be produced.
What is The blood supply of SA node and AV node?

-SA node: The sinuatrial nodal artery (or more commonly sinoatrial nodal artery or
sinoatrial artery) is an artery of the heart which supplies the sinoatrial node, the natural
pacemaker center of the heart, and arises from the right coronary artery in around 60% of
people. In about 40% of cases, the sinoatrial artery is a branch of the left circumflex
coronary artery
-AV node: The blood supply of the AV node is via the Atrioventricular nodal
branch. The origin of this artery is most commonly (about 90% of hearts) a branch of
the right coronary artery, with the remainder originating from the left circumflex artery.
Central chest pain X-ray lt pleural effusion ecg st elevation in 4 leads

what is Dx
- MI (Could cause acute heart failure with plueral effusion!)
- Pericarditis (The closest possibility due to typical ecg + inf. Causes)
- Pneumothorax (REMOTE)
Pneumonia (Causes pleural effusion but not ECG changes) -
Low cost effect post operative ? LMWH
Before infleunza vaccine you have to ask if the child has allergy from?
Egg
Patient with hx if allergy and pain in the back went to clinic they give
him drug ( i forgot the name i think paracetamol) then he came next
day with viscles in back from midline to the lateral side ?
A. Xanthosis
B. Tenia corporus
C. Herpis zoster
patient came after bone fracture how to check the bone density after
treatment;
Vitamin D
Calcium
X-ray Pelvic and spine
High energy X ray (DEXA)
A pt with hypoK , HypoCL and hypoNa and HyperHCO3 i think with

some symptoms , what's the 1ry defect ?
A. NaCl
B. H excertion
C. H absorption
D. k
Pregnant lady on 20 weeks has active herpes what you gonna do?
Give acyclovir
Wait until 2 week and cs election gve befor delivary.
Erosion of gastric ?
1-occult bleeding
2-epigastric pain with generalized perotenitis.
The final distinction of protein is ?

1-cystol
2-RP
3-lysosom
About asthma manegment she is on luktrein since 6 month then come
with every day cuophing relieved by sulbutom in ER what you will give
her as mentanance?
1- oral steroid and SABB on needed
2-inhaled 2doses steroid and SABB on needed.
3-leuktrein and SABB on needed.
4-longe acting beta blocker and SABB on needed.
Asthmatic excasarbation come to the ER give him sulbutamol the

releaved and the PEF 70% what you will do next for mentanence ?
Ipratraupium
Inhaled steroid
Thyphelen
Mom com with daughter she is 9 old age and looking short her momes
also short The bone age is 7 years and her is the lab ? They gave all
normal except insuline like growth hormone is obvious below the
normal range ? The what you will do ?
Revolution after 1 year
Give growth hormone
Girl 18 years come with no menstraul cycle 2 month ago she is not
sexually active and on examination she feel tenderness on abdominal
what you will do ?
1-ultrasanography
2- do pregnancy test
Smoking women pregnancy what will be changes in her child 👶?

1-intrauterine growth restriction (small baby).
Miagrane and hypertension what is the best managment ?

B blocker
Mother is developed gestational dm in pregnancy then come after

giving birth at 6month the HA1C is 6.9 what is the managment ?
1-insulin
2-metformin
3-sulfenourea
4-pigletazone
Patient has night sweating Waight lose fever and has lymph node
enlargment on the subclavicular left lymph node what is the
diagnoses ?
1-bark at lymphoma
2-Hodgkin lymphoma
3-nonhodgkin lymphoma …. NOT SURE
Child with barking cough only! no fever or shortness of breath, vitals

are normal, management:
Moist oxygen
Nebulizer racemic acid
Antibiotics
Female with new onset Raynaud's phenomena and when do upper GI

endoscope found Gastric vascular ectasia (something like that) what is
positive in blood:
Anticentromer
Anti Scl70
Pt inhaling 3 nanogram of Cotton in a factory, eventually cotton will: ??

Engulfed by alveolar macrophages
Induce lung fibrosis
Trapped in mucocilliary system without reaching alveoli
Pt with pericarditis, what is the treatment:

Steroids
Antiviral
Antibiotics
Pt with myopia and chorioretinal degeneration, this is:

Physiological
Pathological
Which one of the following stimulates Melanosite stimulating
hormone:
Corticotropes
Others
Female with mass protruding from vagina:

Utero vaginal prolapse
Boy with animal bite (not mentioned which kind) he mostly will have:
B abortus
B melitensis
B others
Picture of upper eye lid swelling, and they gave history of eye pain and
tearing what else could be found:
Uveitis
Discharge
Scleritis
Patient with MRSA then started on ttt after which he got redness and
flushing of face neck and upper shoulders, what is that ttt:
Vancomycin
Others
Young lady with previous hx of chlamydial infection tried to conceive

for previous 14 months but she can't, her husband has normal semen
analysis and she didn't have any hormonal diseases, the next
investigation should be:
MRI
US
Hysteosulpigogrphy
Lady with Hx of PCO syndrome the best management is:

Weight reduction, metformin and clomiphin
Weight reduction, danazol and metformin
Other choices
Pic pt with scoliosis what to do?
- adms test (Clinical)
- X ray (Diagnostitc tool)
type of innate mechanism for extracellular bacteria? ?????
type of inheritance of intrahepatic cholestatic ....

1-AR
2- X linked
3- mitochondrial
primary immunodeficiency that expose the pt to recurrent of viral and

molds infection
1- T cell
2- B cell
3- complement defi
Injury to wernicke's area ,, the result will be :

1- can understand but can't speech
2-can't understand or speech or write
type of pulse in sever AR

1- pulsus paradoxicus
2- Pulsus bisphernus
long hx of man with ... systolic murmur at ... sternal border ... recently
what is the valve ‫ه الكلمة بس يغىم عليه ويقوم برسعة‬
‫ مدري وش ي‬develop
?affection
- AS
After 1 hour of MI symptoms which enzyme will elevated

- CK
- Troponin
IT'S MYPGLOBIN
PT with abdominal since 3 days or 3 weeks can't remember ...... with

labs show high eosinophil What is the causative organism?
- shestosoma hematopiom
- Girdia
- E coli
Pinpoint papule in the face of baby how to manage?

- Reassure
THIS IS KNOWN AS KERATOSIS PILARIS
Typical hx of SLE with urine cast dx?

1- sle nephropathy
Tongue is white during excision there is cord like ....., not important
What is the drug responsible of that?
- cortisone
20 yrs girl come to hospital after 20 mins of complain of light headiness

and headache,....When she went to the doctor she start complain of
peri oral numbness and fingers tingling
1- alcohol leveling
macrocytic anemia lab show high AST

- Alcohol abuse
nerve to behind ear and ... part of auricle

- Greater auricular
after eating or restaurant 6-9 hours many member complaint of

diarrhea and vomiting that resolve spontaneously other members go
to hospital due hydration which organism is responsible?
- salmonella
- staph aureus
NEED MORE DETAILES
20 yrs male with hx of hematuria proteinuria 6 gm, ...... what you will
see in renal biopsy ( hx of post strptococcus glomerulonephritis)
- membrane
- Minimal
- Post infection
mesingocapillaries ‫ش غريب ما اتذكره عدل‬‫ ي‬-
50 years Female, tall , thin with no comorbidity her mother die during
orthopedic surgery(replace of hip joint), she asked you about the risk ?
UNCLEAR Q
-bone something(my answer)
-bone something with exogenous estrogen
-exogenous estrogen
Female work as actor , present with mass that increase before menses ,
after taking FNA the result is yellow stain with no refilling again what is
the diagnosis?
-ANDI Aberrations of normal development and involution ( ANDI): a new perspective
on pathogenesis and nomenclature of benign breast disorder (my answer)
-phyllidus tumor
(Cystic change were not provided in the option)
7-long senario for 30 years female patien has manifestation of

hypothyrodism ( tirdness.....) Lab and vital sign were provided and it
show , low T4 , low 24hours urine cortison , low testesteron , low
somatomedin , low IGF . Beside thyroide replaceme what you will give.
- GH
- Steroid
long senario 18 months baby present with irritation and...., he was in
breast mild tall the age of 9 months , then on cow milk around one liter
daily, the mother notice bad smelling stool since 3days with change in
constancy ,he is pallor , labs were provided and show low HB. What is
the cause of child symptoms?
-cow milk?
-gastrointestinal infection? Stool discribtion, duration makes it more
likely
(Can not recall other options)
10-renal vein come from which part of inferior vena cava?

Subcardinal
Q1-Baby have depigmentation since birth and photophobia
refractory error nystagmus , What the most likely complications?
-brine tumor
-skin cancer✅
-renal dysfunction
***This a case of Albinism, complications are:

Skin cancer, sunburn ●
Reduced visual acuity ●
Social stigma ●
http://emedicine.medscape.com/article/1200472-followup#e2
Q2-What is the pathology in Huntington syndrome?
Huntington disease (HD) is an autosomal dominant, adult onset,
progressive neurodegenerative disease characterized by the triad of
abnormal movements (typically chorea), cognitive impairment, and
psychiatric illness. HD is caused by an expanded CAG repeat in the gene
that encodes the protein huntingtin on chromosome 4; this results in
progressive atrophy of the striatum as well as cortical and other
extrastriatal structures.
http://www.medscape.org/viewarticle/759292
Q3-Scenario for ITP what you see in bone marrow?

Increase Megakaryocytes
immune thrombocytopenic purpura (ITP) is a clinical syndrome in which
a decreased number of circulating platelets
(thrombocytopenia) manifests as a bleeding tendency, easy bruising
(purpura), or extravasation of blood from capillaries into skin and
mucous membranes (petechiae). most cases of acute ITP, particularly in
children, are mild and self-limited,
Biopsy in patients with ITP shows a normal-to-increased number of
megakaryocytes in the absence of other significant abnormalities.
So the answer is: increase in megakaryocytes .
http://emedicine.medscape.com/article/202158-overview
Q4-23 yo with agitation, dilated pupil, diaphorisis , tachycardia , what
toxicity?
-TCA
-Digoxin
-Sympathomymetic ✅
-Anticholenergic
Most likely is autonomic manifestations of serotonin toxicity, by the
definitions of autonomic you understand why
http://www.uptodate.com/contents/serotonin-syndrome-serotonin-
toxicity
Q5-malaria with 10% parasiremia what is the treatment?

Quinen
Fluroqoinine
Ans: Patients who have one or more of the following clinical criteria
(impaired consciousness/coma, severe normocytic anemia [hemoglobin
5%) are considered to have manifestations of more severe disease and
should be treated aggressively. So Quinidine gluconate14 plus one of the
following: Doxycycline, Tetracycline, or Clindamycin.
Current guideline of Malaria treatment
https://www.cdc.gov/malaria/resources/pdf/clinicalguidance.pdf
Q6- 77 yo male with early onset of dyspnea when moving 50 meters,

has left apical heave and loud audible systolic murmur most intense to
hear in left sternal border..
Sever mitral regurgitate

Calcified aortic stenosis
This scenario is not clear but check these site to gives u overview
http://www.blaufuss.org/arrow/ESM.html
http://emedicine.medscape.com/article/150638-clinical#b3
For me I will go for MS
Pt with hematuria and Aniridia " absence of the iris" what the dx ?
Wilms tumor, or nephroblastoma
WAGR syndrome related to Wilms disease
Scenario of a child with recurrent chest infection and sinusitis dx?
Cystic fibrosis (my answer)
Primary ciliary dyskinesia
Both answer may be correct
Primary ciliary dyskinesia
Ear, nose, and paranasal sinuses ●
Chronic persistent rhinorrhea, sensation of local fullness, and sinus pain o
Anosmia, nasal character of speech, and halitosis o
Recurrent acute otitis o
Chronic otitis o
Recurrent sinusitis o
CNS - Hydrocephalus in a few cases ●
Reproductive system [14] - Male infertility (common) ●
Lower respiratory tract ●
Chronic productive cough and respiratory distress, especially in infants o
Bronchospastic symptoms (eg, wheeze and cough), usually responsive to o
bronchodilator therapy
Recurrent or persistent atelectasis or pneumonia o
Cystic fibrosis
Patients present with a chronic or recurrent cough, which can be dry and
hacking at the beginning and can produce mucoid (early) and purulent (later)
sputum. Prolonged symptoms of bronchiolitis occur in infants. Paroxysmal
cough followed by vomiting may occur.
Recurrent wheezing, recurrent pneumonia, atypical asthma, pneumothorax,
hemoptysis, and digital clubbing are all complications and may be the initial
manifestation. Dyspnea on exertion, history of chest pain, recurrent sinusitis,
nasal polyps, and hemoptysis may also occur.
Usually cystic fibrosis present early in first year of life wither PCD no
specific year mentioned .in addition to that cystic fibrosis is not just one
system presentation it's include other's like GI and urogenital
manifestation.
8-Elderly with vasomotor rhinitis ?

Antihistamines
Decongested
Corticosteroid
Mild : Antihistamine and saline drop
Sever : Steroid and anticholinergic
Usually as the optimal tx is steroid
http://www.mayoclinic.org/diseases-conditions/nonallergic-
rhinitis/diagnosis-treatment/treatment/txc-20179179
1-metformin mechanism of action on muscle?

- increase glucose uptake
-increase gluconeugensis
-fatty acid oxidation
Answered by one took 100 in internal medicine
28-A study was conducted on immunodeficiencnt children, to study

what type of infections they have viral or bacterial, we found that they
most of them had candida infection, and about 1/3 of them died even
after treatment, what's the disease they had?
SCID
Chronic granulmatus candidiasis
child came with abdominal mass, imaging showed renal tumor, the
patient has absent iris. What is the most likely diagnosis?
Wilms's tumor ans before
26/Pt with knee truma bleeding in cut with increase bleeding time .give
FFP not improved but improve with platelet transfusion?
1.VWD
2.TTP
3.DIC !
http://emedicine.medscape.com/article/206996-workup#c9
DIC – Prolong APTT and PT , improve by platelet
VWD – Prolong bleeding time and improve by FFP and platelet but FFP
should be in lager amount
layer in vein ) ‫ش زي كذا‬
‫ ( او ي‬15- the most old
1- intima
2- tunica media
3- externa
WTF ???
13- 22 years old irregular menses w abdominal pain started 7-8 after
menstruation , her menses7-9 days , 4-5 intercourse /week protected
by condom , she has high hygiene with Vaginal douche monthly after
menses what is the cause of symptom?
-number of intercourse
-Vaginal douche
-condom
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567125/
Di-deoxyneucleic acid used for :
Western blot
Southern blot
DNA sequence
https://en.wikipedia.org/wiki/DNA
NOT SURE
Cavernous hemangioma +pleural effusion
pleural hemangioma
In a normal pregnancy, the concentration of lecithin in the amniotic
fluid continues to rise. But the concentration of sphingomyelin
remains about the same throughout the pregnancy. Your provider
will compare the concentration of each surfactant to find out how
mature your baby's lungs are. The higher the lecithin concentration
compared with the sphingomyelin concentration, the more likely the
lungs are mature.
A. A value of less than 1.5T1 means that your baby's lungs are
immature. If born now, your baby may have breathing problems.
B. A value between 1.5T1 and 1.9T1 means that your baby may be at
risk for immature lungs and breathing problems.
C. A value of greater than 2T1 means that your baby has mature
lungs and is ready for life outside the womb.
Pediatric pt known case of ALL present to ER with fever and
pancytopenia (lab results were provided) what is your action?
- Blood transfusion
- Refer to oncology
- Start Abx
Because of most patients are neutropenic and immunocompromised
they are prone to infection .
Old pt present with angina symptoms , presyncope and plural

effusion, echo shows AS , valve is .75 mm , what is your
management?
- medical management
- Surgical repair
- Ballon valvoplasty
- Observation
Valvuloplasty can be considered in cases of severe heart failure or
cardiogenic shock for the following patients:
Patients with other comorbid conditions with a very short life ●
expectancy
Patients who refuse surgery ●
Patients with heart failure who need an urgent, major noncardiac ●
surgical procedure
Pregnant patients with critical aortic stenosis ●
http://emedicine.medscape.com/article/150638-treatment#d1
-Pt complaining of SOB on exertion and chronic cough, on ex there

is hepatomegaly, best test to determine the cause?
- a 1 antitrypsin level
- .....
- .....
- .....
ECHO --- Most likely to be cardiac cause " CHF "
-Common presentation of congenital heart disease?

- JVD
- Difficulty feeding
- Ascites
- ......
First is repository symptoms yet poor feeding can present
http://www.uptodate.com/contents/identifying-newborns-with-critical-
congenital-heart-disease
Most common type of Hodgkin lymphoma?
- lymphocytes predominant
- lymphocytes depleted
- mixed cellularity
- Nodular sclerosing
ttt if only barking cough without stridor or cyanosis

Mild croup: Cool mist from a humidifier and supportive tx
Pt had infection rustle methicillin resistance wt will u give him

Vancomycin
HPS case
Juvenile RA treatment –
Oligo: Intraarticular steroid
Poly: Mild : aspirin
Sever: Steroid
Autism case
‫حالة‬
behavior therapy- ‫ولد يأكل الورق ايش تعطونه‬
Pt with TB came with red eye photophbia?
Optic neuritis
Mask face , tremor, rigidity asking about dx ?
Parkinson
*garlic odor organism???????????
*SLE+ rash (papule, multiple, itchy, burning sensation,

erythematous) resolve after 24h leaving hyperpigmentation?
-discoid rash
-pityriasis rosarea
-urtecarial...
Answer is acute Cutaneous Lupus Erythematosus (ACLE)
Female post-delivery her child on excessively breast

feeding, menstruation resumed after10th month, becz of her other
child she and husband ask for contraception, what well you advice
them?
-depo provera
-ocp
-amenorrhea breast feeding till10th month
http://patient.info/doctor/postpartum-contraception
Down syndrome?
Endocardial cushion defects same as AVSD
Old patient come with abd pain and bloody diarrhea in radiograph
showed enlarge visceral with no air fluid level ?
Ischemic colitis
Signs and symptoms of ischemic colitis can include:

Pain, tenderness or cramping in your belly, which can occur suddenly ●
or gradually
Bright red or maroon-colored blood in your stool or, at times, ●
passage of blood alone without stool
A feeling of urgency to move your bowels ●
Diarrhea ●
Nausea ●
Patient on neostigmine but further evaluation showed drop eyelid ?

Stop neostagmin ( my answer )
Add pyrdostagmin
This a case of ocular MG so the tx is Immune suppression with steroids
is often the main therapy.
https://www.ncbi.nlm.nih.gov/pubmed/22037997
Psychiatric drug with Minimal abuse ?
Bupropion
Bupropion is a norepinephrine-dopamine reuptake inhibitor with a
chemical structure similar to amphetamine. It is FDA-approved for
treating major depressive disorder and nicotine addiction;3 however,
some clinicians have found it helpful during the initial treatment of
cocaine and methamphetamine addiction.
http://www.mdedge.com/currentpsychiatry/article/63972/addiction-
medicine/bupropion-label-treatment-cocaine-and
child with overdose of drug ( they didn't mention the drug )
what's the management ?
Activate charcoal ( my answer )
Answer: Gastric lavage considered if a patient has ingested a potentially
life-threatening amount of a toxin and presents within 1 hour of
ingestion, furthermore recent evidence suggests that activated charcoal
is more effective than induced emesis or gastric lavage for gastric
decontamination As a result, activated charcoal administration has
become the preferred method of decontamination for most poisons and
is most effective when administered early after the ingestion
https://www.google.com.sa/url?sa=t&rct=j&q=&esrc=s&source=web&c
d=9&cad=rja&uact=8&ved=0ahUKEwjVruOuitHRAhWHuhoKHcN3CGUQF
ghYMAg&url=http%3A%2F%2Fwww.qu.edu.qa%2Fpharmacy%2Fprogra
m%2FPharmD_internships%2Fpharmd_resources_Pediatrics%2FRef_16.
pdf&usg=AFQjCNHkJZYj368HLECb6dCCe5OnVKGXGQ&sig2=AkcHssPj4Q
ptNj6-_f3NhQ
Guideline for managing drugs overdose
child w foul smelling, seed like structure, mouth breathing, no hx
of fever
- 1 pulmonary disease
- 2 focal tonsillitis✅
Athletic run 3 k and suffered form leg pain not relieved by NSAID
or ice bag , x ray normal ?
- Stress fracture ✅
- Osteo sarcoma
http://emedicine.medscape.com/article/1270244-overview#a5
Describe neva, What is the evidence of neval hyperplasia?
-all of the above
- Change in color✅
- Irregular border
Could be all of above but read the explanation

Asymmetry: Unlike common moles, atypical moles are often
asymmetrical: A line drawn through the middle would not create
matching halves.
Border: While common moles usually have regular, sharp, well-defined
borders, the borders of atypical moles tend to be irregular and/or hazy
— the mole gradually fades into the surrounding skin.
Color: Common moles are most often uniformly tan, brown or flesh-
colored, but atypical moles have varied, irregular color with subtle,
haphazard areas of tan, brown, dark brown, red, blue or black.
Diameter: Atypical moles are generally larger than 6 mm (¼ inch), the
size of a pencil eraser, but may be smaller.
Evolution: Enlargement of or any other notable change in a previously
stable mole, or the appearance of a new mole after age 40, should raise
suspicion.
http://www.skincancer.org/skin-cancer-information/atypical-
moles/warning-signs-and-images
Microscopic pic show (ring neutrophils), what is the dx ?!

Malaria
Plasmodium falciparum ✅ (in trophosoite stage)
Oval
Valva
http://onlinelibrary.wiley.com/doi/10.1002/ajh.20356/pdf
preg 27 GA of twin one of them died what to do ?

-give steroid and deliver
-wait till 34 then deliver
- wait till 37
- do nothing i think
preg preeclampsia started on mg sulphate and hydralazine then

rr become 12 what to give ?
-narcan
-atropin
-ca gluconate
-naloxonewhich of the following lead to cirhosis.
budd chiari✅ , gilbert
18 years old male hx of RTA presented with basal skull
Fracture Reaching to the jugular foramen , Nerves were injured .
Which of the following muscles will not be affected ?
A-sternocleidomastoid muscle.
B-hyoglossus muscle
C-stylopharyngus muscle
D-trapezius muscle
Answer: B : Hyoglossus muscle
Explanation :
A and D - innervated by accessory nerve
B- innervated by Hypoglossal nerve
C- is innervated by Glossopharyngeal nerve
73 y.o male came with bilateral lower limb erythema with

scaling and crusting What's the most likely diagnosis ?
A-stasis dermatitis
B-pyoderma
C-cellulitis
Answer: A: stasis dermatitis
Pt complaining of RA s/s, which of the following is the most accurate

test for RA?
Anti-CCP
Patient presented with right knee pain and swelling,

arthrocentesis done :
Color : yellow
Viscosity: low
WBC: 15.2
Clarity: opaque
(Didn't mention anything about crystals in the aspiration)
What is the diagnosis ?
A-gout
B-septic arthritis
C-rheumatoid arthritis
D-pseudo gout
Answer: C
19- Child presented with heaves on examination, Ecg shows
RBBB On ECHO: right ventricle motion abnormality and right
ventricle hypertrophy What is the most likely cause?
A. Mitral prolapse
B. ASD
C. VSD
D. Coarctation of aorta
Answer C
first degree burn how to mange ?

- Apply butter
- Cold water
- Room temperature water
Answer C
what's the effect of niacin
-dec LDL
-Dec TGD
- inc HDL
- inc HDL
Answer C
https://www.ncbi.nlm.nih.gov/pubmed/18375237
35y women O/E they found 10*11 mm raised irregular mass on lateral
aspect of the cervix ..what to do :
A- excesion
B- taking biopsy from the mass
C - investigate for human papiloma virus
D - reassure her and wait for pap smer result
Answer B
Not sure about answer .
Diabetic pt complain of (something in the back) with

multiple discharging sinuses Dx:
Infected lymphoma
Lymphangitis
Carbuncle
Furuncle
Answer c
Lymphangitis usually associated with recurrent trauma to skin + lymph
nod
Carbuncle : is an abscess and its associated with DM
Anxious mother brings her 2 months baby having Hx of

diarrhea, crying too much, since 2 weeks, he was borne on the
36th week, breast fed but the mother started bottled milk 2
weeks ago, what is the cause of his abdominal pain:
Increase the gases
Neuro system still not fully developed
Decrease bowl prasylsia
Answer A
Pt had occipitofrontalis paralysis which branch of facial

nerve is affected:
Temporal
Buccal
Answer A
How to diagnose rib fracture

A-PA Chest x-ray
B-AP Chest x-ray
C-Oblique chest x-ray
D-Erect position x-ray
Answer C
Male works in cotton factory and the particle is 3 um what
could happen :
A- pass without any damage
B- trapped in distal airway leading to fibrosis
Answer B
Lady in labor, you can feel nasal bridge and orbital

ridge. Which one compatible with vaginal delivery?
Mentoanterior
Mentoposterior
Mentoposterior
Transverse mentoanterior
https://www.abclawcenters.com/practice-areas/prenatal-birth-
injuries/abnormal-position-or-presentation/face-presentation/
Man with Premature ejaculation. What to give?

SSRI
Absence of moro reflex in right side of infant is due to.
A. Intracranial hemorrhage.
B. Neonatal hypoglycemia.
C. Neonatal sepsis.
D. Erbs palsy.
Child woke up screaming, nightmare and crying parents asked the child
he doesn’t remember anything what sleep stage?
A. 1
B. 2
C. 3
D. 4
Answer: c In the current rules, nrem stage 3 and nrem stage 4 are
combined as stage n3
Http://www.uptodate.com.sci-hub.cc/contents/stages-and-architecture-
of-normalsleep?
Confusional arousals, sleep terrors, and sleepwalking are the most

significant parasomnias associated with nrem sleep. They are also
termed disorders of partial arousal as they result from incomplete
arousal from nrem sleep. Typically, they occur at the transition from
deep nrem (stage n3) sleep into the lighter stages of nrem sleep (n1 or
n2) or into the awake state.
Http://www.uptodate.com.scihub.
cc/contents/sleepwalking-and-other-parasomnias-inchildren?
patient in postpartum hemorrhage, you want to give

methylergonovine
what's the relative contraindication to use it:
-asthma ✔
- Diabetes
- hypotension
http://reference.medscape.com/drug/methergine-methylergonovine-
343129#4
40 years old lady known case of hypothyroidism present with painfull

moving the right shoulder and can't raise the shoulder due to this
pain ,what's the most likely diagnosis:
-rotator cuff tear
- adhesive capsulitis ✔
- impengment syndrome
if you remove the pectoralis major muscle , what's gonna happen:
-loss of arm adduction "my answer 🙃 "
-loss of arm abduction
-loss of arm adduction and internal rotation✔
-loss af arm abduction and external rotation
Ans : C
female 34 years old presented with breast milk discharge and 9 period
a year, which of the following most likely she had:
-prolactinoma✔
HIV patient presented with "description for the retina cotton whool
spots and others retinitis" what's the most likely cause:
-CMV✔
-ethambutol
-MS
3-year-old child presenting with high Fever for the last 2 days, and
vomiting, refusal to eat, and red ears. Which of the following will help
you find the diagnosis?
a. CSF analysis
b. Blood culture
c. Urine culture
Not sure and no guideline or website elaborate such a condition
Elderly man admitted for pneumonia, developed fluctuating level of

consciousness and severely disturbed sleep/wake cycle, how to treat?
a. Regular Haloperidol until symptoms abate
b. Regular Risperidone until symptoms stop
c. Isolate him in a dark quite room
d. Allow a relative to stay
This is a case of delirium due to medical condition, causes are :
Acute infections:
Urinary tract infection. ●

Pneumonia. ●
Sepsis. ●
Viral infections. ●
Meningitis. ●
Encephalitis. ●
Cerebral abscess. ●
Malaria ●
Management is:
Haloperidol or olanzapine are preferred, using the lowest possible -
dose for the shortest possible time (normally a week or less). The
dose should be titrated gradually until symptoms are controlled.
Adult presented with chest pain and palpitation, ECG showed atrial
fibrillation Vitals: HR: 140 BP: 80/50 How to treat?
a. Digoxin
b. Synchronized Cardioversion
c. Beta blocker
http://emedicine.medscape.com/article/151066-treatment#d10
A 2-year child came to clinic with his mother, he scribbles circles, runs
around and climbs into chair, plays with his friends but does not share
his toys. He speaks 10 words. He names the picture you point to. What
is the best thing to tell his mom?
a. He is normal
b. Delayed social development
c. Delayed language development
he is normal since sharing toys begin in 4 y of age
A female with polycystic ovarian syndrome noticed hyperpegminted

skin in her neck and axilla, what is this abnormality called?
a. Acanthosis negricans
b. Linea nigra
Due to insulin resistance
7. K/C of Sickle cell Anemia presented with chest/back/hip pain. He
reports having previous episodes and was hospitalized for them. Now
in severe pain. What to do?
A. Give oral narcotics and follow up.
B. Admission with pain management.
C. Refer to tertiary hospital
Guideline for management of sickle cell crises
http://www.sichelzellkrankheit.de/Howard%20HbSS_ACS_ -2015-
British_Journal_of_Haematology.pdf
What Histopathological subtype of Hodgkin's lymphoma in which
lacunar Reed-Stienberg cells is associated with?
A. Lymphocyte Predominant.
B. Lymphocyte Depleted.
C. Nodular Sclerosis.
D. Mixed Cellularity.
https://en.wikipedia.org/wiki/Reed%E2%80%93Sternberg_cell
24 Year old mother had a child with suspected down syndrome, she's
asking if there is a chance of another child to have this disease, what
test will you order to help?
A. Karyotyping of child.
B. Karyotype both the mother and child
http://www.parents.com/health/down-syndrome/down-syndrome-
risks/
https://www.nichd.nih.gov/health/topics/down/conditioninfo/pages/di
agnosed.aspx
it should be parents only .
Patient have bilateral thin walled parenchyma of kidney?
(PCKD)
-When to reassure breast lump case ?
A benign mass is usually three-dimensional, mobile and smooth, has
regular borders and is solid or cystic in consistency. A malignant mass is
usually firm in consistency, has irregular borders and may be fixed to the
underlying skin or soft tissue.
http://patient.info/doctor/benign-breast-disease
When aspiration of clear fluid and does not refill ?

Breast cyst
When FNAC reveal finrocystic change? Apocrine metaplasia
Hypocalcemia ---- carpopedal spasm its pain in hand and feet on bp cuff
Child with DM type 1 what's the Mechanism of action of
the disease ?
a- Triglyceride uptake
b- Liver increase of fatty acid …etc ?
A case of xeroderma pigmentosum , whats the mech of

action ?
characteristic dry, pigmented skin. Xeroderma pigmentosum is a rare
disorder transmitted in an autosomal recessive manner. It is
characterized by photosensitivity, pigmentary changes, premature skin
aging, and malignant tumor development. [1] These manifestations are
due to a cellular hypersensitivity to ultraviolet (UV) radiation resulting
from a defect in DNA repair.
A girl presented with fatigue malaise after doing full investigation she
had +ve sickling test
a- Aplastic crisis
b- Vasoocclusive crisis
Not clear ?
A scenario of patient with anaemia , blood film showed

brown color ?
a- aplastic anaemia (Read) My answer
b- hemolytic anaemia (read)
not sure
A long case with barking cough that comes only at night
resolves whats dx ?
Spasmodic croup -a
https://www.drugs.com/health-guide/croup.html
It’s due to allergies and it worsening at night resolve in few hour
11 year old presented by painless lump in the neck associated with low
grade fever mild cough and generalized rash whats the dx
Infectious mononucleosis
Hodgkin lymphoma **
Streptococcal pharyngitis
Lyme disease
https://www.lymphomas.org.uk/about-lymphoma/what-is-
lymphoma/symptoms/symptoms-lymphoma-detail
old age patient smoker complains of white color toung that has an
ulcers, diagnosis?
*Squamous cell carcinoma
RULE (Red, Ulcerated, Lump, Extending for 3 or more weeks) is an aid to
diagnosis, The etiology of SCC appears to be multifactorial and strongly
related to lifestyle, mostly habits and diet (particularly tobacco alone or
in betel, and alcohol use).
Patient 3 cm lump in his upper back , slowly growing for years .

Physical examination : compressible , no erythema , there a punctum
in the middle that drain white foully smelling material , what is the
management !?
- Cryotherapy
- Total intact resection✅✅✅
- Antibiotic and resection
Epidermoid cyst: Incision and drainage is the recommended treatment
for inflamed epidermoid cysts, carbuncles, abscesses, and large
furuncles
Practice Guidelines for the Diagnosis and Management of Skin and Soft
Tissue Infections: 2014 Update by the Infectious Diseases Society of
America
http://cid.oxfordjournals.org/content/early/201 4/06/14/cid.ciu296.full
COPD exacerbation by Infection, patient has fever and greenish

sputum, what is the most likely microorganism? ( no pseudomonas in
the answers)
-staph. Aureus
-streptococcus pneumonie
-mycoplasma pneumonia
-homophiles influenza!
Haemophilus influenzae; Moraxella catarrhalis More common in pre-

existing structural lung disease (CF, bronchiectasis, COPD) and the
elderly Pseudomonas, Haemophilus, and pneumococcal species: May
produce green sputum reference: Kumar and Medscape
What drug is likely to cause heat-stroke as it inhibits sweating

Hyoscyamine Sulfate
https://www.drugs.com/pro/hyoscyamine-sulfate-tablet.html
What drug reverses the effect of Benzodiazepines:
Flumazanil .a
https://www.drugs.com/mtm/romazicon.html
Sudden sever generalized abdominal pain in a patient known to have A

Fib:
Mesenteric ischemia .b
https://sites.ualberta.ca/~loewen/Medicine/GIM%20Residents%20Core
%20Reading/ACUTE%20&%20CHRONIC%20ABDO%20PAIN/Diff%20Diag
nosis%20Abdo%20Pain.htm
scholar good syndrome ?!!!!
☺ ‫ شكله ضيع من االسئله‬, There is no syndrome like this
It's good syndrome:: primary immunodeficiency suspected in patients

who exhibit hypogammaglobulinemia,,,
Symptoms include frequent opportunistic infections involving the
sinuses and lungs, including severe CMV disease, P. carinii pneumonia,
and
mucocutaneous candidiasis,,, And these the most important in this
syndrome:: Decreased antibody level in
blood
90%
Mediastinal lymphadenopathy
90%
Neoplasm of the thymus
90%
Abnormality of the bronchi 90% of surfactant predominantly composed
of *Phosphatidylcholone
*Reference : essential Nelson* *Pediatric 7th edition page 210
koebner phenomenon is a skin lesions appearing on lines of trauma.

Induced by: skin trauma. Associated with: psoriasis, vitiligo and lichen
planus
Patient known case of DM come with pustule on the inner fold in gluteal
region they did drainage after that there is sinus and after peroid he
came with the same thing what is the cause ?
1- furuncle
2-Carbuncle
3- hidradenitis suppurativa
Not sure
Pt was taking anti TB meds and now he present with red eye and pain
along with photophobia what the dx ?
Bacrtial conjunctivitis
Viral conjunctivitis
Uveitis
Optic neuritis
https://www.drugs.com/sfx/ethambutol-side-effects.html
Case of IDA along with upper GI symptoms include dysphagia what the
dx ?
Plummer vision syndrome
Long scenario about 40 y pt female she has secondary dysammonrhra
and heavy bleeding they decided to do hysterectomy, so which of these
modalities r non invasive and they done for the pt by team?
US
CT
MRI
Non invasive biopsy
Not sure
5-Marker for acute liver failure?<<<<
This a hug topic to summarize pls check the link
pt have back pain , lumbar spin tenderness and have high renal
function test , high IGG , low IGM and IGA
most likely Multiple myeloma
Pregnant in labor everything normal except tender cervix during

examination what to do?
intra venous AB
intra labor antibiotics
pregnant with vaginal bleeding and everything was normal what do
you ask pt about?
Last sexual intercourse ,,
In complete ??
The anesthetic agent of choice in bronchial asthma:
A Nitrolls oxide
B Halothane
C Cyclopropane
D Chloroform
Ans. B
Halothane
Halothane produces maximum bronchodilatation in asthmatics so it is
the inhalational agent of Choice
Young pt have severe pain during defection followed by bleeding and

relief after 4 h
-hemaroyid
-anal fissure
http://www.healthline.com/health/anal-fissure
Which of these vitamins r involved in degeneration of spinal cord lead
to sensory and motor manifestation ?
Vit b6
Vit b12
Vit b1
Vit E
Pt came from sudan I guess and they suspected malaria wt of these inv
most specific and sensitive?
Malaria rapid test
Malaria antibodies
Blood film
RDTs performed by the health facility staff were 91.7% sensitive and
96.7% specific. Microscopy was 52.5% sensitive and 77% specific.
Case of ESTABLISHED OSTEOPOROSIS wt to give ?
Calcitonin
Biphsphnate
To prevent another fracture
http://www.uptodate.com/contents/osteoporosis-prevention-and-
treatment-beyond-the-basics
Female pt she done tube ligation 4 y back , current complain is she has
period which was 6 week back now she intermitted spotting of blood ,
V/E there is no blood normal cervix and close os wt the next step ?
CT
Laproscapy
Pregnancy test
Due to failure of ligation which can cause subsequently to pregnancy
Pregnant at the at the time of delivery was given epidural when she
was 6 cm dilated , later she was given fentanyl!! And started pushing
later she started to have light headiness and she was laying on her side
wt will u do for her
1-Ask the nurse to bring forceps
2-Give fentanyl again
3-Give ephedrin
4- Do her a position with weird name
Usually if there is fentanyl overdose we will give naloxone ?
hemorrhagic cystitis
Mensa is an prevention of hemorrhagic
cystitis
http://emedicine.medscape.com/article/
2056130-treatment
When to screen about congenital

hypothyroidism
A- at birth by cord blood
B- after 1 week
C- after 1 month
D- after 6 months
Updated AAP Guidelines on Newborn Screening and Therapy for
Congenital Hypothyroidism recommend the screening of all infants
should be performed between two and four days of birth. If this is not
possible, testing should be performed before discharge or within seven
days of birth.
Scenario of patient with preclampsiea then ask what is the most
important test should be done
A- blood pressure monitoring and respiratory rate
B- LFT and platelet
C- urinalysis and proteinuria
D- creatinine and BUN
since the scenario didn’t make a diagnosis of preeclampsia there for
urine for protein is mandatory in addition that 24 h protein in urine is
determine the severity of the disease
5- what is the most clinical sign associated with pulmonary

hypertension
A- central cyanosis
B- pulmonary edema
‫ مش متأكدة منو ناسية‬C- stroke
D- lower limp edema and acaitis
http://www.aafp.org/afp/2001/0501/p1789.html
Not sure
50 or 40 years female 1 day after chemotherapy and broad spectrum
antibiotics developed painful vesicular rash in the breast
A- rubella
B- measles
C- varicella zoster
60 yrs old patient with missed teeth and white patches in the marginal
of tongue not relived by ?? also he had rash with ulcer
A- nurofibramatosis
B- dysplasia
C- vascular malformation
idk
First antenatal visit of a woman in her 10th week gestation what to
do?*
Assess fetal size or like that
Assess risk factors
Determine the fetal age or like that
Usually do complete exam + ultrasound for detection of fetal heart
*Female taking paracetamol 500mg bid daily presented with liver
enzymes elevated and hepatomegaly *
-alpha 1 antitrypsin deficiency
- liver damage due to paracetamol
- hepatitis i guess
Incomplete Q ??
What is the early sign of acute hepatic failure:?
Hepatic encephalopathy
Palmar erythema
Raynoud phenomenon i guess
Spider naevi
Not sure but first sing is portal hypertension ascites
Old man with imbalance and SNHL what's the most useful order*
MRI cerebello-pontine
Auditory brainstem response
CT temporal bone
Old male pt visit surgical OPD c/o tiredness and change in bowel habit.
He tried to improve his bowel change by increase Roughage in diet.
Lab: macrocytic anemia and before this issue lab was normal.
What is the cause of this tiredness?
*Age
*Gender
*Change in diet
Answer is: Change in bowel habit
child came with knee swelling or bleeding after mild trauma. Bleeding
time was abnormal and it was NOT corrected after we gave fresh
frozen plasma. Then bleeding time got back to normal
after giving platelet transfusion his platelet was 50. What does the
patient has ? (PT and PTT was not included in the question )
1- VWF deficiency
2- HSP
3- thrombotic thrombocytopenic purpura (Not ITP)
4- weird syndrome name
Most likely is 1 , it has been answered previously
Child with atopic dermatitis next to steroids
Answer methotrexate
Which of the following genes is associated with atheroscelerosis, but

linked with polygenetic Alzheimer's disease as well?
A) Melyiod protien B.
B) Apolipoptotein E. (🌠 )
C) Presenilen 1.
D) Presenilen 2.
8 y/o child presented with hip pain, limbing, stiffness for the past 5
months. He denied any history of trauma. O/E there was a fixed flexion
deformity of 30 degrees with limited internal rotation. Vitals were
normal. What is most likely?
A) Developmental Dysplasia of the Hip.
B) Slipped Capital Femoral Epiphysis.
C) Legg-Calve-Perthes disease.(🌠 )
D) Missed septic artheritis.
Not Sure
6 months old baby presented with jaundice, seizure, irritability and

vomiting. He has been breast-fed during his first 3 months of life, ever
since he has been started on commercially available milk formula.
More recently, his mother introduced friut juices into his diet.
Investigations revealed postive urine reducing substances. What
element should not be included in his diet?
A) Galactose. (🌠 )
B) Fructose.
C) Phenylalanine.
D) Irrelevant choice.
Runner felt pain anterior to the heel which worsens in early morning
but gets better throughout the day, what is your Dx?
A) Plantar faciaitis. (🌠 )
B) Calceneal heel spur.
C) Calceanal Fracture.
Pregnant lady on her 24th week of gestation with a significant medical
history of DM II on insulin with nephritis, chronic HTN controlled on
medications. O/E her fundus height was 25 cm, otherwise
unremarkable PE. What complication is more likely?
A) Pre-Eclampsia.
B) Shoulder dystocia.
C) Stillbirth.
D) Large-for-Gestational-Age infant. (🌠 )
DM can increase the risk of preeclampsia especially with nephritis
4 y/o child brought by his parents to pediatric outpatient clinic with

them complaining of his massive uncontrolled appetite during the last
18 months. Weight was above 95th percentile, while height was below
5th percentile. Mother reported that her son was failing to thrive
during his first two years, beside the fact that he was developmentally
delayed compared to his siblings until he caught up late. O/E he had a
high forehead, broad nose, small peripheries (Hands and Feet). What is
the cause behind his symptoms?
A) Genetic. (🌠 )
B) Metabolic.
C) Nutritional.
Increasing in weight and decrease in height along with hx of FTT
38 y/o lady presents with intermittent vaginal bleeding for the last 3
months after sexual intercourse in particular. Speculum examination
revealed a normal looking cervix and vulva.However, pap smear
depicted a squamous cell carcinoma. What would be the most
appropriate next step?
A) Neo-adjuvent chemotherapy.
B) Radiotherapy.
C) Colposcopic-directed biopsy. (🌠 )
In regard to vulvar cancer, which of the following is the principle in

diagnosing it?
A) Clinical, through history of HPV.
B) Histopathological, through biopsy. (🌠 )
C) Radiological, through pelvic US.
30 y/o lady presents with productive cough, chest pain and fever for
the last one week. O/E decreased air entry on the right side, presence
of bronchial breathing. X-ray revealed a wide opacity on the right side.
Culture was methicllin-sensetive, which of the following is the most
suitable drug for her?
A) Amoxcicillin.
B) Cloxacillin. (🌠 )
C) Pipercillin.
D) Penicillin G.
5 y/o boy presents with tender, swollen, painful testicle. O/E there was
absent cremaster reflex. Which of the following Dx is right one?
A) Epididemo-orchitis.
B) Testicular torsion. (🌠 )
C) Irrelevant choice.
D) One more irrelevant choice.
An old man, presents to the ER with the complaint of painful Rt eye

associated with nausea. O/E the Rt eye was injected, with semi-dilated
pupil. Lt eye was normal. What is the correct Dx of these?
A) Uveitis.
B) Primary open-angle glaucoma.
C) Acute angle-closure glaucoma. (🌠 )
A study aims at expolring the association of cigarette smoking and risk of

IHD. Results were as follows (Numbers are not exact, but for clarification
matter):
- Non-smokers: 0.1.
- Mild smokers: 1.
- Heavy smokers: 2.
- Extensive heavy chain smokers: 5.
Which of these is true about this study findings?
A) Risk-Association relationship.
B) Dose-dependant relationship. (🌠 )
C) Irrelevant choice.
D) One more irrelevant choice.
# N.B: Rest of the questions are either repeated or easy-to-answer new
ones

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polymaylgia rumatica, what are the x-Ray finding ?

55 woman P5 , all svd,complains of ( case scenario

female in her 20s , came with dysuria, hematiria , no

derma: wheal, what is the type of urticaria ?

What is biochemical deficiency in respiratory

~40% other phospholipids (PC); ●

~5% surfactant-associated proteins (SP-A, B, C and D); ●

Cholesterol (neutral lipids); ●

Traces of other substances. ●

What is associated with major depression ?

Sleep disturbances, including insomnia or sleeping too much (mayoclinic ) ●

Man healthy , his wife has osteoporosis , he have repeated renal

4 years old have decrease in head growth , has weird

Young male have epigastric pain , fullnes , nausea

What is the enzyme used glycolysis !?

A surgeon was doing nissen fundoplication and injured

Post menopausal woman presented with vaginal bleeding

An 18 mo child presented by leg bowing and inability to

Which OCP causes hyperkalemia

Patient presented with fatigue and weight loss+ labs hb

Patient presented with eye redness and problem in vision

Answer : Ventilatory support

A boy with recurrent infections his brother dyed when he

What's the treatment of cold induced urticaria

Most specific test for rheumatoid arthritis

Female patient presented with symptoms of urinary incontinence,, it's

patient known to have acquired immunodeficiency presented with

Goblet cells are mostly found in

Treatment of tinea pedis

What are the CXR finding in miliary TB

Patient with heavy bleeding she did a hysterctomy, diagnosis was

How to treat alcohol withdrawal ( no diazepam in the answers)?

Answer : chlorodizepoxide (it is benzo group)

How to monitor the response of iron treatment

treatment of non-inflammatory acne

patient with a history of vertigo tinnitus with imbalance and hearing

Mechanism of action of vitamin C

long scenario) in brief, a boy with diarrhea (gastroenteritis and

what is the characteristic for von willebrand disease?

What is the mechanism of diarrhea with patient has gardia infection ?

23 year old man is complaining of polydpisa and polyurea and he is

Boy coming to the ER complaing on the right side ,examination all

Answer :Right kidney

Neonate born and after hours he is jaundice and he is

Q about RAST test measure ??

Answer: Factor 10 deficiency

A child with multiple plaques on his face, abdomen and

32 female c/o breast milk discharge and irregularmenses, ask about

1- Relaxed muscle , with vigorous movement what will happen ?

Male presented to the ER after MVA, serum phosphate level was

History of travel to Africa, came back to myalgia arthralgia. Vitals were

Pediatric complaining of: Intermittent Dysphagia, retrosternal pain and

Question about BPH, hypertensive but already on medication. What is

School boy with itchy scalp, 10 other classmates affected, diagnosis?

In non-small cell lung CA, which of the following is a contraindication

- FEV1 less than 1.5L for lobectomy ; 2.0L for pneumectomy

the cell type - small cell carcinoma are usually inoperable ●

Virulance factor of streptococcus ?

2-PPH with low BP and tachycardia the 1st thing to do :

Amenorrhea, low prolactin, what to see in CT or MRI:

Pic of diagram showing progress of diabetic nephropathy (GFR and

what is the best non-invasive method to diagnose Adenomyosis

Both transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI),

Most common known side effect of steroid in children?