All Jun_2023
https://t.me/silent_2023m
____________________________________________‫_____________________________________دعواتكم‬
Patient with anemia symptoms.
Labs:
MCV: 68
RBCs: 5
RDW: 20%
Other labs are not valuable.
(No iron study)
What is the most likely diagnosis?
A- B12 deficiency
B- Thalassemia
C- Iron deficiency anemia
28 weak still birth with congenital anamoly , how will you know the Causes?
A-Placental saming
B- Cord sampling
C-Fetus sampling
30 years old male gymnastic well body builder complaining of scrotal hernia asymptomatic but the patient has
concerns about it , what to do?
A-herniotomy
B-herniorrhaphy
C-Observe
Young female presented with heavy vaginal bleeding has been diagnosed with uterine fibroid. Her hemoglobin is
7. What is the most appropriate next step?
A- Myomectomy
B- Correct the anemia
C- Combined Oral Contraceptive Pills
Pregnant female has PPROM at 31 weeks of gestation and got conservative treatment, now she comes at 35
weeks of gestation with labor. What is the most common neonatal complication for her condition?
A- Neonatal sepsis
B- Skeletal deformity
C- respiratory distress syndrome
Lung nodule 7mm no symptoms no risk factors
A. CT in 6 months
B. biopsy
C. surgery
D. reassure
1 of 51
Nurse tell you about patient in ICU (in the case she talk about his history and recent change and tell to come see
him) what is this part of communication:
A. Situation
B. Background
C. Assessment
A patient wants to give a doctor a gift?
A. Refuse
B. Accept
C. Accept and report to department
20 y.o healthy male. Acute left-sided chest pain. Stable. ECG normal. CXR is shown. Most appropriate treatment?
A. lncentive spirometer
B. Barium swallow study
C. Thoracotomy
D. Chest Tube
Company want to study subgroup of people for prevalence of Alzheimer's disease , what method used by the IRB
to check the ethical point
A. Utilitarianism
B. Skeptic ethics
C.Delogatory
A child says his name, feeds himself, separates easily from his parents (was written like this), and ride tricycle:
A. 2
B.3 yr
C.4
D.5
▪ Separates easily > 3yrs
▪ Know full name, age and gender> 3yrs
▪ Tricycle> 3yrs
Ptn underwent laparoscopic cholecystectomy then after pneumoperitoneum develop HR 40/min
What is the cause..
A- increase after load
B- rapidly dilatation of peritoneum
35 years old patient come with medial leg ulcer. The most likely diagnosis is:
A- Diabetic
B- Venous hypertension
C- Atherosclerosis
D- Buerger's disease
Pregnant in labour and take drug that decrease resp.distress syndrome..
A-aspirin
B-oxytocin
C-glucocorticoid
2 of 51
Pregnant with high tsh and constipation, cold intolerance what yo give...
A-propylthiouracel
B-thyroxin
Female with pco and hirsutism ..made a lot of cosmotics but no result..what to give.
A- metformin
B-finasteride
C-coc
Ref / amboss
Mother of diabetic child attends educational classes about hyperglycaemia and hypoglycaemia what is the
benefit..
A- increase self efficacy
B-increase dependent in daily activities
3 years old asthmatic child, mother is concerned as they are not leaving the house much as they must use the
nebulizer and it needs power source, what to advice?
A. The mother is right
B. Find a portable nebulizer
C. Educate about inhaler use and stop nebulizer
EARTH
Prevention type in patient diagnosed with stroke , now he is on physiotherapy and disease
prevention ?
A : tertiary
B: secondary
C: primary
D : rehabilitation without prevention
TYPE OF HEIGHT DELAY cause ?
A : hormonal
B : constitutional
Child with bone age greater than chronological age, what is the diagnosis?
A- Congenital Adrenal hyperplasia
B- Chronic renal disease
C- Hypothyroidism
D- Familial short stature
▫ If BA< CA = constitutional delay
▫ If BA> CA = pathological delay
▫ If BA=CA = Familial short stature
▫ BA=Bone age
▫ CA=Chronological age (actual age)
Mother brought her 9yrs child for short stature
Physical exam was normal
GH normal
FSH normal
TSH NORMAL
T3-4normal
3 of 51
Insulin like growth factor decreased
X ray: bone age of 6yrs
Dx?
A-Familial short stature
B-GH deficincy
C-Constitutional growth delay
what will be changed during pregnancy?
A : increased tidal volume
Pregnant with asthma what happens during pregnancy?
A.increase RR
B. Increase tidal volume
C. Increase resdual volume
D. Increase functional resdual capacity
UpToDate:
- RR remains unchanged
- Tidal volume is increased up to 40%
- Residual volume is decreased
- Functional residual capacity is decreased
Findings in a research report show that the incidence of a particular disease in Saudi Arabia
is higher in females than in males but the prevalence is equal in both females and males. How
can this be explained?
A) Fatality cases are higher in females
B) Fatality cases are higher in males
C) Females carry the disease for longer
D) Males carry the disease for longer
Pediatrics pt ( i forget age) admitted to PICU with subdural hematoma ( I think but im sure it's
a Brain bleed) , The father said he fell from his bed ( this all the hx ) on PE the pt. Had
4 of 51
ecchymosis on the buttocks and Back and he have bilateral femoral fracture , what’s the
diagnosis?
A) Hematoma
B) Pathological Fracture
C) Battered child syndrome
REF : AMBOSS
The doctors want to do Tube ligation ?
A: Take consent from her or her representative
B: Take concent from husband
C: Take consent from her and tell her to tell the husband
WHO surgical checklist safety ?
A: before admission, before skin incision, at discharge
B: before induction of anesthesia, before skin incision, before pt leave OR
C: before admission, before induction of anesthesia, before pt leave OR
D: before admission, before induction of anesthesia, at discharge
REF : WHO
MUSSLE AFFECTED IN ENURESIS ?
ANS : Detursos
4 months milestone ?
nurse called the doctor about a patient for an urgent medical prescription, he prescribed it ,
what’s the next thing to do .?
A : ask another nurse to approve it
RECALL: Patient with ectopic pregnancy presented with andominal pain , the nurse called the doctor he was busy
and asked her to give medication to the patient
1- ask another nurse to approve
2- give methotrexate
3- give paracetamol
4- Doctor cant prescribe over phone
Fluid maintenance for daily (weight 10kg)
A : 1000
1. For the first 10 kg: 100 mL/kg (10 kg x 100 mL/kg = 1000 mL)
2. For the additional weight up to 20 kg, add 50 mL/kg. However, in this case, the individual weighs only 10
kg. No need to add fluid for this range.
3. For weight above 20 kg, add 20 mL/kg. The individual weighs 10 kg, so there's no need to add any fluid for
this range either.
If there is a deficit u should calculate the deficit and add to Maintenance
Deficit = wyt loss 10
5 of 51
Burn What type of bacteria is causing the green discoloration?
Ans : Pseudomonas aeruginosa
Pregnant with high random blood sugar reading and fasting sugar. She’s at risk of what vaginal Infection? co
A. Candida
B. Bacterial vaginosis
Female pt with vaginal candida, which following disease she has?
A-DM
B- HTN
C- Epilepsy
38 GA have chlamydia infection during deliver baby … what most common acquired
concerning infection to new born ?
1-Eye
2-Liver
3-Ear
4-Lung
A physician was working on reasearch paper , before publishing it ,he made some changes
to some of the data and omitted other parts of his results. What is this action referred to?
A) Falsification
B) Fabrication
C) Plagiarism
D) Near miss
An elderly with end stage cancer c/o severe pain. The family asked the physician to give a
stronger analgesic or to increase the dose. The doctor explains that while it might help alleviate
the pain, it also might hasten their father’s death. Which of the following is this referred to?
A) Principle of subsidiarity
B) Principle of double effects
C) Principle of totality
D) Principle of informed choice
Patient couldn’t go through spontaneous vaginal delivery, and the fetus
is in distress, doctor want to do cesarean section but the patient refused and wanted second
opinion?
A : father opinion have priority
B: try to persuade her against her well!!!!!
C : wait for second opinion
Obstetricians should work emphatically to encourage a pregnant woman to accept a cesarean birth if the risk of
morbidity or mortality to the fetus is high.Without a doubt, court order should be sought as a last resort.
Indication to screen for gestational diabetes in early time at pregnancy ( 18 w gestation) ?
6 of 51
A:Husband Hx of diabetes
B: previous gestetional diabetes
C : previous baby with cleft lip
a researcher doing a study about incidence, prevalence and burden of diabetes mellitus after
insulin brought to the world as a therapy in 1960 which of the following is mostly found:
A.incidence decreased
B.prevalence increased
C.increased mortality
An 18-month child was brought to clinic for a regular checkup. The doctor
found out that the child had not taken any of his scheduled vaccines. He asked
the mother why and she replied “Vaccines will make my son retarded!”. What
is the appropriate action?
A) Refer the mother for psychiatric assessment
B) Contact child protection services
C) Explain the benefits of vaccines to the mother
D) Contact the hospital ethics committee
Exzema distribution in 8 years old?
Flexors
czema site;
• less than 6M; scalp-face,
• 6M to 2-5 Y;extensors,
• 2 to 16 years; flexors,
• psoriasis site ; scalp
(Facial eczema not responded to low steroids; tacrolimus cream)
SLE most specific test?
case scenario about the pregnant lady with swelling in the left leg of the following is the best management?
A. Duplex and heparin
B. Duplex and heparin and IVC filter
C. Warfarin
Thin , tall , high arched palate, curved back , what's the syndrome ?
A : marfan
7 of 51
B: klinefelter
question about in Saudi they want to reduce the prevalence of dengue fever, which region should be targeted first
:
A. central
B. north
C. west
D. east
NIH: vailable information suggests that dengue fever is endemic in certain cities of Saudi Arabia, such as
Jeddah and Makkah, which are located in the western region
researchers study on 2 grounds of NSAID .. participatiant was in online interview
the ethics errors here ...
A. gathering information is not accure
B. privacy not valid
C. infomed consent will not be monitored
Mono mono twins. When did separation happen?
A) 0-72 hours
B) 3-7 days
C) 8-12 days
D) > 12 days
• D-D=0-3 days
• D-M=3-8 days
• M-M=8-13 days
severe dysmono with infertility for 6yrs :
A. endometriosis
B. adenomyosis
Patient on chemotherapy need relief of pain the neurs call the doctor to give him :
A. tell another nurse to approve
B. refuse
C. tell written consent
Child can skip , draw rectangle, count to 10 , age in years
A.2
B.3
C.4
D.5
5y; Tie his shoes, skipping, draw triangle
Baby 9 month I guess missed 6m and 9m vaccines due to traveling ..
A.Catch up vaccines
B. give all vaccines
CDC: The CDC provides a catch-up immunization schedule for children based on age whose vaccinations have been
delayed
8 of 51
A summary of recommendations for child/teen immunization indicates that for children lacking previous Tdap, Tdap
should be given routinely at age 11-12 years and older teens should be vaccinated on a catch-up basis.
Pt with paracetamol ingestion, doctor send the result and ask the nurse to write it done once it is resulted, the lab
tech calls the nurse and say 1 then pause then 25 So the nurse write it down 1.25 Instead of 125, as a result the pt
develop irreversible liver failure What is the error or who is wrong ?
1- dr didn’t check the lab once resulted
2- miscommunication between nurse and lab tech
3- the nurse didn’t write correctly
4- can’t remember
US picture of twins and say it's monochorionic diamniotic ,cleavage at which day ?
A) 0-72 hours
B) 3-7 days
C) 8-12 days
D) > 12 days
The question of the child with widening of the joints, I remember the question with numbers exactly:
Ca
2.2 (Normal 2.2 - 2.7)
Phosphate 2.1 (Normal 1.3- 2.3)
ALP >1000 very high
It was exactly like this, no PTH given
What is the most likely diagnosis?
A- Hypophosphatasia
B- Renal osteodystrophy
C- Vit D deficiency rickets
D- Familial hypophosphatemic rickets
9 of 51
Female came with yellow vaginal discharge and fishy smell as well, she also have itching, what is the cause of her
presentation:
A- Candida infection (white, cottage cheese-like discharge)
B- Bacterial vaginosis
C- Chlamydia infection ( sexually transmitted infection that can cause a thick, yellow discharge without a
smel)
D- Trichomonas infection ( yellow or green discharge with an unpleasant, fishy smell)
screening for asymptomatic bacteriuria in pregnancy:
a) 12 weeks
b) 20 weeks
c) 27 weeks
d) 31 or 32 weeks
Patient with HTN not responding for three anti hypertensive drugs on Ultrasound the one kidney is bigger what is
diagnosis
A Adrenal hyperplasia
B Renal artery stenosis
10 of 51
C Pheochromocytoma
15years old case of meningitis LP to be done what to do
A. Take consent form parents and assent from patient
B. take consent from parents and donʼt assent patient
C. no need for consent
D. consent patient only
Hepatitis B vaccine?
A. Live attenuated
B. Recombinant
C. Toxoid
D. Killed
CDC : The Hepatitis B vaccine is a recombinant vaccine
Patient has MI 6 weeks ago now he presented with dyspnea cough and frothy sputum with harsh systolic murmur
heard over the pericardium what is the diagnosis?
A- PE
B- Tricuspid regurgitation
C- papillary muscle rupture
D- can’t remember
58 years old male patient had Myocardial Infarction 6 weeks ago , presented to the ER with dyspnea cough and
frothy sputum with harsh systolic murmur heard over the precordium what is the diagnosis?
A- PE
B- Tricuspid regurgitation
C- papillary muscle rupture
D- ASD
yo female medically free. Her father had colon cancer at age 53. Her mother had breast cancer at age 43.
What's the appropriate screening for her:
A- Mammogram annually
B- Mammogram at age 40
C- colonscopy at age 50
D- Mammogram at 40 and colonscopy at 50
35 year old femal her dad has colon cancer when he was 55 and her mom had breast cancer when she was 43
asking about screening:
A she should do mammogram annually
B start mammogram at 40
11 of 51
C start mammogram at 40 and colonoscopy at 55
D colonoscopy
Pediatric present with macular rash adenopathy ,hepatomegaly,symmetrical and asymmetrical small and large
joint arthritis with ESR and CRP high DX?
A- psoriatic arthitis
B-systemic juvenile idiopathic arthrits
C-juvenile poly arthritis
D-puaci juvenile idiopathic arthritis
a patient will undergo weight reduction surgery, how to decide which type of surgery to do?
A- endoscopy
B- CT abdomen
C- barium study
D- abdominal ultrasound
Male patient had oil dissolvent injury to his index finger. On P/E mild tenderness when moving the hands and no
other abnormalities, what is your next step?
A) Oral antibiotic
B) Oral antibiotics and steroid
C) Elevate the hand and ice packing
D) Surgical management
A mechanic had an accidental injection of oil dissolving in his index finger Finger is red and swollen with mild
tenderness and normal joint movement, sensation is intact what to give:
1. Oral antibiotic
2. Oral Abx and steroids
3. Surgical management
4. Elevate the hand and ice packing
A patient has had an oil dissolvant injected by a mistake in his fingers what is the appropriate management?
1. Surgical removal of the dissolvent
2. Put ice and left it
3. Antibiotic
4. Steroids
65 with DM and HTN admitted for elective ventral hernia repair, on examination he has bilateral Basal crackles
and lower limb edema, what is most appropriate?
A-Open repair now
B-Laparoscopic repair now
C-Optimization then surgery
D-No surgery unless there's obstruction
65 years old man admitted for elective ventral hernia repair, K/C of hypertension and BA, upon examination
bilateral crepitation, ascites and bilateral edema, what to do?
A- Proceed with hernia repair.
B- Don’t repair unless obstruction has occurred
C- Delay until situation is controlled.
24 yo male presented with bulging that appears with cough and lifting heavy objects, on examination it was
inguinosacral and reducible. What is the dx?
A-Direct inguinal
B-Indirect inguinal
C-Femoral
12 of 51
D-Lonar or lacunar
Pregnant case of epilepsy for 2 years and poor control despite medication , what will you do?
- review the medication
Women with uncontrolled epilepsy for a while came for preconception visit, which of the following is the most
important?
A-Review medications
B-Folic acid
female diagnosed UC 6 years age came with concern about cancer screening
A - 8-10 years after diagnosis
Patient diagnosed with UC when to be screened for cancer?
A-Annually till age of 50
B-If there is mild inflammation
C-At time of diagnosis
D- 8-10 years after diagnosis
Patient selection and timing — In all patients with ulcerative colitis (UC) and Crohn disease (CD) involving one-third
of the colon or more, we perform screening colonoscopy eight years after disease or symptom onset to initiate
surveillance for colorectal neoplasia
pt recently diagnosed with HCV . came to start anti HCV treatment has viral load of 2 milion. no liver cirrhosis
signs. Labs shows only mild elevation in Liver enzymes
what to do next
1- Give Peg interferone
2- Entecavir
3- Sofo/ledi
4- discharge and see result after 3m
Pt reNNNEXT cently diagnosed with HCV. came to start anti HCV treatment has viral load of 2 million. no liver
cirrhosis signs. Labs show only mild elevation in Liver enzymes.
what to do next
1- Give Peg interferon
2- Entecavir
3- Ledipasvir-sofosbuvir
4- discharge and see result after 3m
24 years old male complain of Dysphagia to liquid more than solid , what investigation will help you to reach the
diagnosis ?
A- 24 Ph
B-Barium swallow
C-Endoscopy
24 years old male complain of Dysphagia to liquid more than solid , what investigation will help you to reach the
diagnosis ?
A- Manometry
B- 24 Ph
C-Barium swallow
D-Endoscopy
Patient presented with dysphagia to liquids more than solid Which is the most appropriate initial investigation?
A- endoscopy
B- barium swallow
C- US
D- biopsy
13 of 51
Mother has her first child and he turned out to have sickle cell disease. She has since remarried and what’s to go
for premarital testing.
What is the first test you should do?
A- Paternal hemoglobin electrophoresis
B- Paternal chromosomal analysis
C- Maternal hemoglobin electrophoresis
D- Mixed biomarkers or something vague like it
A Women came to clinic she’s divorced and will marry again. asking about the chance of getting another SCD child.
She has SCD child from her pervious husband. Which of the following is most appropriate in her case?
A- Paternal hemoglobin electrophoresis
B- Paternal chromosomal analysis
C- Maternal hemoglobin electrophoresis
D- Mixed biomarkers or something vague like it
9months infant mom started solid but until now still depend on breast milk . What to do :
1- iron supplement
2- advise mom to faster the solid food introduction
RTA patient with lower back pain and spinal injury has not ruled out yet you are waiting for the neurology
consultation what are you suppose to do before other investigations ?
1- pelvic binders
2- movement restriction
3- CT
4- spinal binder
12 years old found to have klebsiella with in 100,000 colony from mid stream urine, no sign or symptoms
1- no need for treatment
2- treat as acute UTI
3- give ABx as prophylaxis
4-repeats culture
post hernia repair with mesh, advise to :
14 of 51
1- 6months laxative
2-6months avoid heavy lifting
Pt with infertility and there is frank galactorhea come from the breast what you have to investgate
1-Prolactin in the serum
2-TSH
8 days old newborn for diabetic mother came with SOB and cyanosis, looks irritable and ruddy, no flu like
symptoms
RR 40-49
HR 169
Hb 24.1 (normal: 165-175) 241 not 24.1
Hct 0.75
Plt 120
Whats the diagnosis?
A. Polycythemia
B. RDS
8 days old newborn for diabetic mother came with SOB and cyanosis, looks irritable and ruddy, no flu like
symptoms
RR 40-49
HR 169
Hb 24.1 (normal: 165-175) 241 not 24.1
Hct 0.72 low
Plt 120
What is the most appropriate next management?
A. Echocardiogram
B. Partial exchange transfusion ((definitive bc more than 75 HCT + symptomatic))
C. Hydration, oxygenation, suction ((( initial next step)))
Surgeon presenting a new surgical method And he changed some facts to decrease error resulting from these
methods and to convince the audience What did he do?
A-plagiarism
B-Falsification
C-Fabrication
Forgot the 4th
At what age in months children typically manifest anxiety towards strangers?
A. 3
B. 6
C.8
D.12
15 of 51
A child starts to develop an awareness for strangers and separation anxiety. How old is the child in months?
a. 6 months
b. 7 months
c. 12 months
d. 24 months
• Stranger 6
• Separation 9
Pregnant smoker she couldnt stop smoking what to give?
Better recallS :
pregnant smoker useful tool for smoking?
A- Bupropion
B- Varenicline
C- Behavior therapy
D- Nicotine replacement therapy
Pregnant wants to quote smoking best way
A. CBT
B. Nicotine replacement
C. Buprine
Best way to stop smoking in pregnant is :
a. Behavioral way
b. bupropionA
c. Electronic smoking
d. Alternative to smoke
Pt involved in RTA ( i think ) came to er vitaly stable what to expect in FAST?
Free fluids
male involved in RTA in ER he is fully conscious and no abnormality in vital signs admitted for observation and a
FAST scan done ,.what do you expect to find
a. pneumothorax
b.major vessel bleeding in the thorax
c. Intra peritoneal fluid
Preterm male with low weight 1300g and has bloody stool.
He was diagnosed with necrotizing enterocolitis:
Which of the following is a risk factor for his condition?
A- male gender
B- low weight
C- bloody stool
Air in bowel wall; necrotizing enterocolitis (infection), risk factors; Premature, Weight below 1500g
menepause accidentally during examination we see 3rd dgree prolapse no urine incontenance what Tx?
Elderly with 3rd Dgree pelvic organ prolapse she is completely Asymptomatic , discovered during regular check up
what is the most appropriate for her?
A- observe
B- surgery (related to organ prolapse)
C- TIBSO and hysterectomy
D- give her hormone therapy
UTD: Indications for treatment — Treatment is indicated for women with symptoms of prolapse or associated
conditions (urinary, bowel, or sexual dysfunction). Obstructed urination or defecation or hydronephrosis from
chronic ureteral kinking are all indications for treatment, regardless of degree of prolapse . Treatment is generally
not indicated for women with asymptomatic prolapse
16 of 51
Pt with liver cirrhosis have UGIB what to give before endoscopy
A- octreotide
Cirrhosis with massive hematemesis, became drowsy and blood oozing out from his mouth: next step of
management
A-Blood transfusion.
B-Endotracheal tube
C-Inj octreotide
56 years old patient had an upper Gl bleeding due to esophageal varices and was given IV fluid. Which of the
following should be given to reduce mortality?
A. Vasopressin
B. Octreotide
C. Nadolol
D. Ceftriaxone
A 67 years old man with a known history of HCV cirrhosis admitted to the ER with a massive hematemesis. Variceal
bleeding is suspected. On examination, he is drowsy with tense ascites. BP 110/70, HR 86, So2 95%. Hb 8, INR high.
Which of the following management options has a great benefit in reducing this patient's mortality?
A. Octreotide.
B. IV Ceftriaxone.
C. Blood transfusion.
D. Pantoprazole infusion.
• Reduce mortality = IV ceftriaxone
• Prevent re-bleeding = BB
• Before endoscopy what will you give = Octreotide
Patient multiple trauma post RTA had to undergo open laparotomy because he was hemodynamically unstable.
Liver has multiple laceration what's the most appropriate step?
A. Perihepatic packing.
B. Hepatic resection
C. Partial hepatic resection with splenectomy
Trauma multiple liver laceration asking about most appropriate management not initial.
A-perihepatic packing
B-right hepatic artery ligation
C- individually ligate bleeding vessles
Laparotomy with multiple liver laceration management?
A. Perihepatic packing.
B. Right hepatic resection
C. Vessels ligation
Pringle maneuver: clipping the vessels during surgery to identify the source of the bleeding and for hemorrhagic
control. (Temporary)
RTA patient came to ER and goes throught exploratory laprotomy and you find multiple laceration of liver,
patient is unstabel
What will you do :
A-right hepatectomy
B-prehepatic packings
C-right hepatic artery ligation
D-individual hepatic artery ligation
Patient received 15 units of blood and started bleeding from ngt and puncture sites and other places, what's the.
Cause :
A. Hypocalcemia
17 of 51
B. Thromcytopenia
C transfusion reaction
D Von willbrand
Pregnant known diabetic 40weeks un eventful pregnancy, sudden fetal death, fetus was 2.6kg no obvious
anomaly, placental sample showed thrombi, what's the cause of the fetal death:
A. diabetes
B growth restriction
C placental abnormality
D I forgot maybe hypoglycemia
Long senario of a girl with alot depression symptoms and suicidal attempts, the doctor said she needs to be
admitted and she got very angry
What's the ethical principle behind wanting to admit the patient
A. Justice
B. Beneficence
C. Non malificence
The fourth option was really not related
A traumatic pt lost 25% of his blood..which of the following is the most suspected to be
effected first
A-Urine output.
B-Pulse pressure
C-Respiratory Rate.
D-Glasco-coma scale
patient lost 25% of his blood, what is expected to be decreased… ? i think the question means significantly
A- urine out-put
B- respiratory rate
C- GCS
D- Pulse pressure
Patient with chronic liver disease with acitees, came to clinic c/o reducable umbilical hernia, he only stated
discomfort no other symptoms, most appropriate management:
A. Paracentesis then open repair
B. Wait for ascites to resolve
C smth with mesh
Pt have liver cirrhosis with ascitis and present with umblical mass Hernia reducible and uncomfortable with that
what next
A_ do operation immediatly
B_do paracentesis and after that direct do operation
C_dont do operation
D_dealy untill ascitis controlled
60y pt with chronic liver disease and acitest came complaining with umbilical hernia How to treat it ?
A -Laprscopic hernial repair
B -Repair with waterproof mesh
C -Wait till acietest treated first
D -Do paracentesis and repair
UTD: “Prior to surgery, ascites should be minimized as much as possible with medical treatment.”
Patient on depression medication, c/o perianal pain (am not sure) , and other other urinary tract symptoms, he
cannot pass urine for the past 12 hours ,
A . Prostitis
B. Bph
18 of 51
C. Neurogenic bladder
I forgot the last option
Pt of RTA , he was treated in a small hospital, his vitals were stable, clear lungs
He did x-ray there was no pneumonia but there was wide mediastinum
You are gonna transfer him to a hospital that's 40km away, what will u do:
A. Chest tube
B. CT chest
C.?
D. Call the on-call surgeon
40 Year-old male presented the emergency department with chest pain radiating to the back. Most probably
aortic dissection
( No vitals were provided in the question)
A- Echocardiography
B- Ct angiograhy
C- cardic isoenzymes
D- Abdominal US
Wide medistenum= aortic dissection
Diagnostic: CTA (gold standard)
This is my paraphrasing: a patient was being prepared for a surgery or a procedure , and there was something that
was not steralized properly, the nurse noticed and said stop now " .... Was not properly steralized"
What's the type of communication used :
A. Check back
B. Call out
C critical language
D. Closed loop communication
19 of 51
Woman delivered after she delivered the placenta she lost 1000cc of blood, uteres is firm , she is alert and I think
was stable ( no labs no other details in the question)
A. Atony ((Soft, enlarged, boggy ascending uterus = atony))
B. coagolapathy
C retained products of placenta
D. Genital laceration
Woman with dysuria, allergic to sulfa and penicillin what will you give her :
A. Tmp- sulfa
B. Nitro
C cefalaxin
D.ampicillin
20 of 51
1-Plasma volume in 15 weeks pregnant ?
A. 20% increas
B. 40%
2-Pregnant in her 15 GA came for Follow up, expected to have :
A- decrease Hemoglobin 20%
B- decrease hemoglobin 40%
C- decrease plasma volume 20%
D- decrease plasma volume 40%
3-Pregnant GA 15 weeks, what changes will happen ?
A-plasma volume increase by 20%
B-plasma volume increase by 40%
4- Same preveus Q bu with was in 1st trimester,was choics :
A- Increase hematocrit
B- Increase plasma volume 20%
C- Increase plasma volume 40%
G1 p0 at 28 wks gestation presented with membrane rupture 24h ago what is your management ?
A- Observation
B- IOL
C- emergency section
D- Or amnioinfusion
Patient past history ihd, c/o sob not very severe goes with embolism
His bmi is 40
What do you give him
A- Ufh 5000
B- Ufh 7500
C- Enaroxpan 40
D- Fondaparinux
AMBOSS : UFH
o Preferred in patients with unpredictable subcutaneous absorption (e.g., patients with
obesity, hypoperfusion)
Young Patient with solitary tender nodule on side of vulva :
A. Furncle
B. Bartholin cyst abscess correct ( Bartholin gland abscess)
C. Vulvar abcess
postmenopausal woman compaling of 1 year hx of recurrent vulvar itching associated sometime with blood streak
secretions , recently devolop pea size mass in the labia?
a) bartholin cyst
b )cystic adenosis
c) bartholin gland cancer
d) squamous cell cancer of vulva
What indicates upper urinary tract infection :
A- male
B- duration of fever
C- vomiting
D- temperature
21 of 51
Baby burn on his genitalia 3rd-degree estimated 1%
A. Refer to burn center
B. Dressing as outpatient
C. Sterile wound as inpatient
A baby of 12 years diagnosed with end-stage cancer, unfortunately, mets to the femur and backbone
DNR accepted by the doctor
What is your management to help at this stage
A- morphine
B- Intitrope support
C- Mechanical ventilation support
D- Nothing to do
Multiple vomiting :
Metabolic alkalosis with hyperkalemia
Metabolic alkalosis with hypokalemia
40y female k/c DM , what HTN treatment u will give her ?
A- ACEI
best ttt among DM drugs for decrease wt ?
A-Metformin
B-GLP
DM obese on life modifications his Alc 8 what to add
A-dulaglutide V is also GLP
B-DPP-4 inhibitors;
C-GLP-1 receptor agonists
D-SGLT2 inhibitors;
ANSWER: ALL is effective in weight reduction but LP is best outcomes,
Uptodate:
For patients in whom ASCVD predominates, particularly in the setting of higher A1C or motivation to lose weight, we
typically prescribe liraglutide, semaglutide, or dulaglutide.
22 of 51
️old male pt has HTN DM , currently have sever sudden abdominal pain , what most likely Dx ?
A-Mesenteric artery thrombosis/occlusion
66yo man, worsening abdominal pain over the last week, the pain started as vague lower abdominal discomfort
associated with nausea, anorehia and constipation, this morning he has sudden severe lower abdominal pain
accompanied by lightheadedness and an episode of vomiting, the pain initially improved but then gradually
intensified to involve the entire abdomen, his medical history is significant for coronary artery disease and
appendectomy, bowel sounds diminished, the abdomen is diffusely tender with guarding and rebound
tenderness, abdominal imaging is most likely reveal which of the following findings in this patient?
a. dilated small bowel with a transition zone
b. embolic occlusion of the mesenteric artery
c. free air in the peritoneal cavity
d. hematoma surrounding the abdominal aorta
pt has systolic harsh murmur radiated to carotid artery increase w/ pending forward
A-ASD
58 years old male patient had Myocardial Infarction 6 weeks ago , presented to the ER with dyspnea cough and
frothy sputum with harsh systolic murmur heard over the precordium what is the diagnosis?
A- PE
B- Tricuspid regurgitation
C- papillary muscle rupture
D- ASD
Patient has MI 6 weeks ago now he presented with dyspnea cough and frothy sputum with harsh systolic murmur
heard over the pericardium what is the diagnosis?
A- PE
B- Tricuspid regurgitation
C- papillary muscle rupture
D- can’t remember
MI anterior or inferior will lead to ischemia in Papillary muscle as it attached to inferior to septal wall , Ischemia with
the time healed with fibrosis >>> rupture later >>> MR >>> blood back to lung >>>> pulmonary edema >>> frothy
sputum…
pt has mid diastolic murmur ?
A-Ms
Mid diastolic murmur at Apex +Rumbling in nature & Increasing intensity in Expiration+Best heard in left lateral
decubitus position+ Loud S1+ Tapping apex beat= Mitral Stenosi
Hyperkalemia , the ECG will show ?
A-Tinted T wave
B-Tinted p wave
pt has chest pain for take >20 min not relieve with rest Trop I +ve no ECG changes , what’s the Dx ?
A-Unstable angina
B. Stable angina
C. STEMI
D. NSTEMI
Question about depressed ST but normal cardiac enzymes?
A. unstable angina
B. Stable angina
C. STEMI
D. NSTEMI
23 of 51
pt post viral infection, currently has hematuria , what’s the Dx ?
A-GN
B-Allergic interstitial nephritis
• Depends on the duration
• If early > IgA nephropathy
• If late “3 weeks” > PSGN
tumour lysis syndrome scenario , what’s the metabolic disturbance ?
A-Low phosphorus
B-High ca
C-High potassium
High K, high Ph, low C
female pt has a Hx of DVT treated , what u will give her ?
A-Warfarin
B-Enoxaparin
C-Heparin
D-No need
If she have a factor risk then > enoxaparin
If don’t so it will ( no need )
most common case of bleeding per rectum ?
A-Colon ca
B-Angio dysplasia
C-Diverticulosis
when u will repeat h.pylori after Triple ttt ?
A-1w
B-2w
C-1 month
old pt post op admitted on ICU for 2 w , right now He complaining of abdominal pain , what’s the Dx ?
A-Stress ulcer
middle age man c/o caugh hemoptysis on examination : no shifted trachea and x ray shows Lt pleural effusion ,
what the Dx ?
A-Tubeurcla effusion
B-Lung fibrosis
C-Lung ca
Middle aged + cough + hemoptysis + no fever+ uni lateral effusion (exudates) = lung cancer !!!!!
old pt smoking 1 pack for 30 y , c/o : productive cough , SOB , no loss of wt and other signs/symptoms of cancer ,
Dx ?
A-Emphysema
B-Chronic bronchitis
C-Lung cancer
24 of 51
UTD : Chronic bronchitis — Chronic bronchitis is defined as a chronic productive cough over a defined period,
classically for at least three months in each of two successive years, in a patient in whom other causes of chronic
cough (eg, bronchiectasis) have been excluded . It may precede or follow development of airflow limitation . This
definition has been used in many studies, despite the arbitrarily selected symptom duration. By age 35 to 40 years,
cigarette smokers may develop chronic bronchitis and start to have intermittent exacerbations of their symptoms
even in the absence of airflow obstruction
14 y male of has eczema , what the commonest site ?
A-Flexor
B-Face and Cheek
C-Extensor
• Answer is: A FLEXOR, why? He is 14 yrs old
• Face for babies below 6 months
• Extensor for peds from 6months to below 5 yrs
• Eczema location per age group: ▪ <6 months = face scalp
▪ 6m - 2y = ext. surface elbow knee
▪ 2y - 5y = same as above + hands wrist mouth eyes
▪ > 5y = FLEXOR surface
pt w/ CNS manifestations MRI shows :
A-neuritis
B-MS
Pediatric patient had a fall from 1 story high and direct trauma to the head, presents with hemotympanium No
loss of consciousness, no vomiting , neuro exam Normal Ear : Ruptured tympanic membrane with intact external
auditory canal Most likely bone fracture:
A-Mastoid B
B-Maxillary
C-Basal skull
child with supracondylar fracture and absent of pulse , what’s the initial step?
A-Conservative
B-ORIF = Open reduction and internal fixation
25 of 51
C-reduction
12 year old boy injured with supracondylar fracture and distal radial pulse absent , which of the following is the
appropriate next step in management?
A-K wire
B-intramedullary nail
C-surgical exploration
D-Closed reduction
old male patient with Lt inguinal hernia , how u will ttt ?
A-Open herniotomy
B-Laparoscopic operation
middle age pt Dx as b/L hernia ?
A-Laparoscopic harniotomy
Adult hernia cases are repaired through hernioplasty , except in : bilateral and /or recurrent, obese
Open repair is preferred
If previous repair was open, go for laparoscopic on the opposite is true
Surgical indications :
In Complicated hernias :
Incarcerated irreducible
obstructed sbo only (constipation )
strangulated : ischemia necrosis , skin is tender red
Non surgical treatment is preferred in asymptomatic or very minimal sx without signs of complications
Except for : femoral hernia in adults is treated surgically in all cases even asymptomatic ones
Inguinal hernias is children (herniotomy )
post sleeve 3 days , pt came to ER C/O : abd pain , what u will do ?
A-US
B-CT
knife stabbing on zone 3 of the neck , how u will treat it ?
A-Endo vascular repair
MVA c/o: chest pain , SOB and absent Lt chest sound ,what u will do ?
A-Chest tube
pt Dx as ureteric stone 4mm first time visit ER
, what ur treatment ?
A-Conservative
B-Do operation
26 of 51
child pt in low socioeconomic status with large abdomen , what is the cause ?
A-Sever protein deficiency (kawashoirkor)
B-Sever carbohydrates deficiency (marasmus)
Pt with ascites and edema, severe muscle wasting, hyperkeratosis, lab show: decreased glucose, decreased
albumin
A. severe protein deficiency
B. severe carbs deficiency
C-Rickets
D-Mild manutrition
parents warring about their child tall and asking his tall will be like even after puberty , what’s the miss
information here ?
27 of 51
A-Siblings heights
B-Parents heights
40y women I think with Hx of DVT need to control her birth ?
A-Condom
B-IUD
C-Patches
D-OCP
40y women G4P4 , her last daughter age 8
And LMP before 6 month , what u will check ?
A-FSH
B-TSH
Recall :
A 45 year old woman with 6 months amenorrhea wants to get pregnant what do order :
A- FSH and LH
B- Endometrial biopsy
preg women has vaginal bleeding , some fleshy content passed , on examination : open os
U/S: show beats , Dx?
A-Incomplete abortion
preg women has vaginal bleeding , denied any content passed away , on examination : open os , visible/palpable
something
U/S: show beats , Dx?
A-Inevitable abortion
1)Patient with severe abdominal pain with menstrual cycle (dysmenorrhea), affecting her
work, what can you give?
A-Misoprostol
B-Paracetamol
C-Progesterone
D-OCP
📝📌Note to remember (ACOG)
Management of Primary Dysmenorrhea
- NSAID (first line)
- OCP (second line, if a trial of NSAIDs does not provide adequate relief of dysmenorrhea symptoms)
Patient present with cottage cheese like vaginal discharge, itching and urinary symptoms, Asking about the
treatment?
28 of 51
A) topical estrogen
B) topical antibiotic
C) oral anti fungal
D) oral antibiotics
Vaginal yeast infection
- Clinical presentation: White, crumbly, and thick (cottage cheese-like) discharge. Odorless
- Microscope: Pseudohyphae on KOH
- Treatment: Topical azoles or nystatin or Oral fluconazole
Topical if she’s pregnant
Oral if she’s not pregnant
Female with vaginal discharge Grey, fishy odor, smear show clue cells, diagnosis?
A. Trichomoniasis
B. Bacteria vaginosis
C. Candida
Bacterial vaginosis
- Clinical presentation: Gray/milky discharge. Fishy odor
- Microscope: Clue cells
- Treatment: Metronidazole
- Post-menopausal women present with itchiness and odorless discharge with vaginal excoriation what is the
diagnosis?
A- Candidiasis
B- trichomoniasis
C- vaginosis
D- atrophic vaginitis
Child with croup recevied epniphrnie and he improved. What next?
A. Antibotic
B. Steroid
Pediatric patient diagnosed as croup in the ER, he was given the proper management, but after 1 hour he did not
improve. What is the appropriate management?
A-exposure to cool humidified air
B-prednisilone (with dose)
C-dexamethasone (with dose)
D-racemic epinephrine
Child with croup recevied epniphrnie and he improved. What next?
A. Forget
B. Prednisone 0.2
C. Dexamethasone 0.05
D. Ventolin
D
Child 6yrs old presented with history of 6month left knee and wrist pain with limitations of movement and
especially morning difficulty movement Otherwise no systemic symptoms What is the most likely diagnosis?
A. rheumatic fever
B. reactive arthritis
C. septic arthritis
D. juvenile idiopathic arthritis
infant exclusively breastfed then was given cow milk, now at 9 months after introducing some iron, containing
food , there’s still a concern that the infant, isn’t recovering enough iron what would you do?
A Add iron supplements
29 of 51
B Switch to formula
C Stop cow's milk completely
D-Add Vitamin
18 month present with abdominal bloating and loss of subcutaneous fat..what diet should u prescribed ?
A. High calorie
B. Gluten free
C. Partial hydrolysed formula
D. Forget the option
Growth chart indicating failure to thrive.
4 years old child came post URTI 2 days ago complaining of SOB Wheezing, RR 33, HR 100, 02 82% other vitals
normal (not sure. Parents said that he had multiple previous hospitilization due to same reason. What is
mangment ?
A. ABx and systemic steroid
B.IV fluid and ventolin
C. Yentolin and systemic steroid
D ABx with nebulizer ventolin
[look like asthma case triger by viral infection >SABA and systemic steroid ]
2 year old child presented after a viral infection 2 weeks ago (or days I forgot), he presented complaining of SOB,
and dyspnea, upon examination he has wide spread crepitation and prolong expiratory wheezing, she had similar
attacks in the past that lead to
(they didn’t say he has a history of asthma), what is the management?
I think he was slightly hypotensive
But O2 sat was low
A- antibiotics and fluids
B- steroids and B2 agonist
C- fluids and steroids
Child 12 years old complaining of abdominal pain since 1 year and sometimes heartburn, other wise he is
completely normal, his mother have hx of chronic abdominal pain?
A-Omeprazole
B-Steroid
C-Azithromycin
D-Hypoallergenic diet
Case of Eosinophilic esophagitis
Child with epigastric pain, heartburn..., mother has the same problem, best to confirm?
A-Endoscopy
1-year-old child came with fever and cough for 4 days. URTI presented with increased hypoxia and severe
respiratory symptoms, in auscultation, there were fine crackles in the bilateral lungs and Puffy infiltrates in both
lungs what Dx?
A) Bronchopneumonia
B) Cystic fibrosis
C) Tuberculosis
D) Bronchiolitis
If no Bronchiolitis in choices, then it is Bronchopneumonia
30 of 51
4years old came with URTI, high fever, drooling of saliva and multiple enlarged lymph node. He dod not receive
any vaccine Which of following vaccine might prevent this condition
A-Hemophlius
B-Streptococcus
C-Diphteria
D-Polio
Non-immunized pts
Drooling of saliva= Acute epiglottis = H.influenza Type B
Drooling of saliva+ enlarged LN= Diphtheria = Diphtheria toxin
Low grade fever= Croup
High grade fever= Acute epiglottis, Diphtheria, Bacterial Tracheatitis.
10 year old child presented with abdominal pain and diarrhea sometimes bloody, he had weight loss in the last 3
months, he also complain of joints aches and pain, on exam he looks pale
Laps:
Na low
K low
Hg 8
Albumin low
What is the most likely diagnosis?
A.Celiac disease
B.Cron’s disease
C.Ulcerative colitis
D.Colonic dysentry
Patient with vaginal bleeding, and the diagnosiswas Uterine fibroid What is that most common site?
A-cervical
B- Intramural
Most common uterine fibroid location?
A- Submuocus
B- Intramural
C- Sub serosal
Most common fibroid: Intramural
Most common type of fibroid that causes BLEEDING: Submucosal
Case with signs of suden onset intestional obstruction?
A-Hernia
B-Mekel’s diverticulium
24 years old male, medically and surgically free , presented with manifestation of intestinal obstruction, suspected
to be small bowel obstruction
What is the most common cause
A) adhesion
31 of 51
B) Meckels diverticulum
C)Malignancy
The commonest cause of small bowel obstruction in people with previous abdominal surgeries, is adhesions.
In patients with virgin abdomen, it is hernia.
Case with 6 h abdominal pain, vomiting once , by examination, mild suprapubic and lt illic fossa tenderness
A-Discharge with analgesics
B-CT abdomen
Yellow white vaginal discharge ,, +ve leucotye , Rx
A-Metronidazole
B-vaginal culture
Case of painful defection with failed medical treatment ,,
A- Lateral intermiontoy
-Patient complaining of pain during defection (Anal fissure ) what you will do for her ?
A. anal diltation
B. Diltiazem Cream initial management
C. Botox injection
D. Internal lateral sphincterctomy most effective treatment for anal fissure after failure of medical management
Botox injection :in case of failure of initial medical management in patient at risk of fecal incontinence
Age to introduce peanut base and egg option was
A-10
B-12
Recommendations that at which age you can give a peanuts and eggs to the Child will decrease production of
allergy? Age in month
A 10 months
B 14 months
C 20 months
D 24 months
milestone question came to clinic w parent dr ask him to throw ball and he catch it back , draw straight line option
was
A-15
B-18
Age of start iron supp is
A- 4 month
mother notice rice like in baby diapers:
Answer is Something vermcularis
The ministry of health do an activity for observe and gather the other health authorities something like this option
was :
32 of 51
A. Active surveillance
B. Infection control
C. Primary prevention
D. I forgot the 4th
coarctation of aorta common in ?
A- Turner
Patient 12 years old with HTN and DM and dyslipdemia on medication which of the following has the greatest
impact to decrease BB in this case ?
1-physical activity
2-smoking cessation
3-DASH diet ( low fat , high fruit and vegetables)
immunodeficiency wht vaccination is contraindicated ? Option was
A. Varciella
B. IPV
parotid swelling option was
A. Mumps
B. EBV
Post RTA unconscious multiple face fracture and sign of brain injury all vitals stable fist thing to do?
A. Secure airways
B. Stabilize cervical spine
C. Blood transfusions
D. Iv fluid
Pt Dm2 on diet and exercise control , recent HBA1c is7,2
What to do ?
A. Reassure him
B. Start metformin
C. Tell him that he’s at high risk of heart disease
multiple laceration what's the most appropriate step?
A-Perihepatic packing
Risk factor for osteoporosis?
A. Hypercalcemia
B. Short period using NSAID
Child history of knee and wrist pain with limitations of movement diagnosis?
A. rheumatic fever
B. juvenile idiopathic arthritis
8 yrs old failure to thrive in divorce parent , lives w mother and she’s on antidepressants medication what to do?
A. Reassurance
B. Increase caloric intake
33 of 51
Contraception in female complain of heavy menss option was ?
A. mirne IUD
B. COC
C. progesterone pills
Definitive tx of urine incontenanc ?
-Vaginal free tape
Old pt came with Rt leg pale & absence of peripheral pulse , irregular irregular radial pulse , what is the source of
thrombus ?
A- Lt atrium
B- thoracic aorta
C- abdominal aorta
Pregnant lady with active hepatitis b , What will you give tha baby after birth ?
A- hepatitis b vaccine
B- hepatitis b vaccine and IG
C- IG
Pregnant lady with leg swelling and sing of DVT , SOB what best the next ?
A- chest X-ray
B- Doppler US
What may indicate UTI in lab results ?
Nitrit
child on inhaled corticosteroid with picture of candidiasis oral infection. How to treat?
A ⁃ nystatin
B ⁃ Itraconazole
C ⁃ Amphotericin
frank galactorrhea in 35 yr old lady with irregular menses. Next investigation?
A ⁃ thyroid
B ⁃ Prolactin
C ⁃ Forgot
ethics : pt need bypass cabg operation after no use from theombolytic and pci. She is not concious. Husband out
of city and need consent from him
A⁃ wait for him
B ⁃ Take consent by phone
C⁃ Let him choose a local guardian till he arrives
definitive management for adenomyosis?
⁃ hysterectomy
child can hold head but need support for sitting and can reach mouth
A⁃ 3 months
34 of 51
B ⁃ 7 months
50 yr old on metformin and gliclazide. Hbalc 5.8 and other labs normal. Asked what to do
A ⁃ reassure
B ⁃ Tell him he has increased risk of cvs
resident examined pr abdx without closing curtain
A ⁃ dignity
B ⁃ Privacy
child new onset strabismus ?
A ⁃ call neurosurgery immediately
B⁃ Refer opthalmo peds next day
7 yr old with pubic hair rest normal
A⁃ normal
B ⁃ Prepubertal adrenarche
C ⁃ Cah
asthma exacerbation with high co2 ?
A ⁃ intubate
qs on crohn most common site
A ⁃ colon
B ⁃ Rectum
C ⁃ Ileum
D ⁃ Jejunum
scenario dvt prophylaxis in CKD
A⁃ stockings
B ⁃ Enoxapain
C⁃ Ufh
pt on amitryptiline at night 30 mg and gets dizzy morning. Manage ?
A ⁃ divide doses
B ⁃ Forgot the rest
chronic hep b for review, asymptomatic but high lfts. Manage?
A- observe
B- entecavir
ethics: what to do before conducting a research
- ethical review on proposal
prego with moderate dull pain, US showed 4 cm cyst
A- observe
B- cystectomy
C- laparotomy
D- laparascopy
HIV wat vaccine not to give
35 of 51
A- varicella
B- hep b
C – dtap
Case of cirrhotic patient having esophageal varices and presented with upper GI bleeding. Hemoglobin was 8.5.
What is the most appropriate next step after initial fluid resuscitation?
A- blood transfusion
B- Upper Gi endoscopy
C- Nasogastric tube insertion
Subclinical hypothyroidism case. Examination: no goiter. Labs: TSH: 15 (high), T4: 6 (within normal limits). Most
appropriate next step?
A- US of the neck
B- Start thyroxine replacement
Patient with absent fetal heartbeat on ultrasound, which of the following is best to use for chromosomal analysis?
A- Umbilical cord sampling
B- Amniotic fluid
C- Fetal cord blood
D- Placental tissue
27 years old healthy male presented with right sided weakness. He has significant femur fracture 1 week ago. 2
days ago has pulmonary embolism. Brain imaging shows left cerebral infarction. Which of the following is the
most likely the cause of his presentation?
A. Atrial fibrillation
B. Carotid artery stenosis
C. Patent foramen ovale
D. Hypertrophic cardiomyopathy
Typical presentation of tension headache. The patient was playing games more than 3 hours and he sleeps lately.
What is the most appropriate action?
A- Paracetamol
B- Reassurance
C- Lifestyle modification
Case of clear turner (no doubt), hight in the 5th percentile and wight in the 90th
A- constitutional stature
B- endocrine stature
C- syndromic stature
8 years old boy. Mother complained of poor training to bathroom which muscles is targeted in therapy?
A- Perianal
B- Pelvic floor
C- Rectus muscle
D- Detrusor
8 yrs old failure to thrive in divorce parent, lives w mother and she’s on antidepressants medication what to do?
A. Reassurance
B. Increase caloric intake
36 of 51
Other option was not related
39 weeks of gestation, gush of fluid how Confirm amniotic leak:
A. Methylene blue stain
B. Another stain
C. Ultrasound assessment
D. Microscopy of ferning cells
Pt with Productive cough. Pain in the chest. Blood in their sputum. Weakness and fatigue. Which has highly
diagnostic? I think pt with TB so ..
a. Zein nelson stain
b. Thin blood film
c. Thick blood film
41 week pregnancy primi came for follow up.. NST .normal study no maternal comorbidity ..next step
a) induction of labour by oxytocin (Induction of labor by oxytocin at 42 weeks of pregnancy.)
b) induction of labour by Arm
c) follow up in 7 days
d ) don't remember
A mother comes with her 9-month old baby girl. She took all vaccines and now comes for the planned vaccinations
of 9 months:
A measles, mumps, rubella
B measles, meningococcal conjugate
C Hib, dtap
D last option is wrong
CDC : Haemophilus influenzae type b (Hib) vaccine and Diphtheria, tetanus, and acellular pertussis vaccine (DTaP) are
recommended at 9 months of age
A 10-days old boy presents in the ER after circumcision with 5-hours of bleeding from the operation site, what is
the best step to do?
A applying pressure on the operation site
B exploratory surgery
C blood transfusion
D not relevant
A 12-year old boy presents on the outpatient clinic with sob during playing football. Patient needs sometimes to
stop playing to regain his breath. Physical examination shows healthy pt with expiratory wheezing bilateral, what
is the best initial therapy:
A inhaled corticosteroids
B Albuterol
C salmeterol
D montelukast
Patient presents on the outpatient clinic for following up his DM2. His history is free except DM2. He is ok
metformin (forget the dosis) two times a day. Hba1c is 6.9. What is the best thing to do:
A increase metformin dose
B same management
C add gliclazide
D add insulin
37 of 51
A 32-year old woman G6P5 presents at 38 week of gestation with labor. After delivery of the fetus and the
placenta, she starts to bleed profusely, what is the risk factor for the postpartum hemorrhage:
A. parity
Forget other options but I think that this is the correct answer between the other options
Female multi gravida just delivered a baby weighing 3000g after 16 hs, Which of the following is a risk factor for
developing postpartum hemorrhage?
A. Fetal Macrosomia
B. Prolonged labor
C. Grand parity
Female patient just delivered a baby weighing 3000g. Which of the following is a risk factor for developing
postpartum hemorrhage?
A) Fetal Macrosomia
B) Precipitous labour
C) Grand parity
For conclusion:
 Grand multiparity: patients who have had ≥5 births (live or stillborn) at ≥20 weeks of gestation.
 Long duration of labor: Prolonged labor requires that, in the face of regular uterine contractions, the cervical
dilation is <6 cm for a duration of >20 h in a primipara or >14 h in a multipara. in this case, it is 16 hrs in a
multipara women, which is abnormal.
 Marcoscomic baby: 3000 g (which is normal). Macrosomia is >4000-4500g
 Multiple gestation: The patient is delivering one baby only. There is no mentioning of twins.
Male patient presents at the ER after MVA and starts to shouts at the medical staff due to acute right pleural pain
and right limb pain. Given vitals are still stable (at the edge of being hypotensive, tachycardic, tachypenic), what is
the first thing to do:
A establish IV access
B CT scan of the chest
C pain killers
D ultrasound of the right limb
According to the American College of Surgeons, establishing IV access is a critical first step in the
management of acute pain in trauma patients
Child with meningitis symptoms. Culture reveals bacterial infection, what do you expect to see in the CSF:
A increases leukocytes, decreased glucose, normal protein
B increases neutrophils, normal glucose, increased protein
C decreased neutrophils, decreased glucose, increased protein
D increased neutrophils, decreased glucose, increased protein
A 12-year old boy presents at the ER with neurological sx (not sure). Pediatrician wants to do lumbar puncture,
from where should he take consent:
A form parents and patient assents
B from patient and parents assent
C from both parents and patient
D no need because it is emergency
Young lady, not married with hirsutism, pcos (and high BMI, not sure) presents after multiple failed cosmetic
treatments. What is the first line pharmacotherapy to be prescribed?
A metformin
B coc
Forget other options, and I don’t know if they’re relevan
38 of 51
Young female patient presents with migraine headache sx like unilateral, lasting few hours, photo- and
phonophobic What is the best medication to prevent such headache episodes:
A paracetamol
B sumatriptan
C ibuprofen
Forget last option, but it is not beta blocker
14-year old girl with anorexia nervosa admitted to the hospital for ENTERAL feeding. On day 3 lab shows all
electrolytes low (incl. Calcium, natrium, potassium and phosphorus). What is the reason behind this electrolytes
findings? this patient have also failure to thrive
A mistake in/not following enteral feeding protocol
B refeeding syndrome
C malabsorption
D forget
Male with known history of seizure and use of anti seizure medication (but he is nonadherent) presents to the
emergency department with seizure sx
What is the FIRST line management?
The used anti seizure medication was not mentioned
A valopric acid (not mentioned if it’s oral or iv)
B benzodiazepines (not mentioned if it is oral or iv)
C phenytoin infusion
D forget but it is a medication without mentioning if it’s oral or iv
Child diagnosed with thyroglossal cyst. The mass was on the midline of the neck with 1 or 2 cm in diameter. What
is the management?
A expectant
B surgical removal
C fine needle aspiration
D forget
Women K/C of liver cirrhosis, + ascites, confused.
Na level: 126 (normal 135 to 145)
Potassium level: within normal range
Glucose: 8 (normal 3.9 to 5.5 mmol/L)
A) Furosemide
B) 0.45% Normal saline
C) Normal saline
D) D5 NS
Gold standard for INTUSSUSSCDPTION
A-CT CONTRAST
B-ABD USS
C-ABD X-RAY
D-CONTRAST ENEMA
AFTER ENDOMETRIAL BIOPSY IN A 27yr old and ATYPICAL HYPERPLASIA SEEN, next management
A-TAMOXIFEN
B-PROGESTRONE. ONLY
C-OCP
D-HYSTERECTOMY
39 of 51
A CHILD WITH AMBIGUOUS GENITALIA ( from the explanation)
What’s the inheritance pattern
A-Autosomal dominant
B-Autosomal recessive
C-X linked
Commonest causes of tonsillitis in children
A-CORONA VIRUS
B-INFLUENZA
C-RDV
D-EBV
A long case description of rheumatic arthritis, commonest heart valve disease
A-Mitral stenosis
B-Mitral Regurgitation
C-Aortic stenosis
D-Tricuspid regurgitation
A case of cardiac surgery because of valvular defect, a known hypertensive also
Bp 80/50, PR 120, .. temperature not given
Cardiac output increased, reduced peripheral vascular resistance, asking type of shock
A-Cardiogenic
B-Hypovolemic
C-Septic
A 3yr old child with fever and cough , not Inip looking , nil shortness of breath, right lower lobe crepitation, temp
38 Which organism:
40 of 51
A-Morexell catarhalis
B-Strept pneumonia
C-Staph aureus
A 7 yr old child with wheezing, SOB, cough , had initial admission for similar illness. Temp 36.6, Spo2 80
Best management
A-Ventolin tablet
B-Ventolin nebulisation + antibiotic
C-Ventolin nebulisation + steroid
D-Ventolin
A 30yr old male involved in severe MVA ,sustained several injuries, conscious,told the doctors the story of the
accident and how he was feeling , bp 70/50,Sp02 80 , appropriate next step
A. IVF
B. Blood transfusion
D. Supplemental Oxygen
A 55 yr old female a known hypertensive and diabetic, stable normal blood pressure and good glycemic control,
bilateral lower limb pain aggravated after walking 500m but relieved at rest ., asking about possible cause
A. Injury to the legs
B. Peripheral vascular disease
C. Varicose veins
A case of 25yr old not sure but not upto 30yrs female with right Ovarian cyst . asking of best contraception for her
A. Progestin only
B. OCP
C. Condom
Antibiotics of choice for prophylaxis in Rheumatoid arthritis?
A question about a hypertensive and diabetic on Enalapril, Aspirin, developed bleeding and swelling at the
proximal and distal phalanges, asking for the drug that will likely cause it
A. Aspirin
B. Metformin
C. Enalapril
A girl of 13 yr old with short stature , has webbed neck asking of cause of short star tire
A. Familial
B. Poor diet
C. Syndromic short starture
The Q more features with teurner syndrome
Apart from wbbed neck, other features of Turner’s syndrome was in the question
patient with cirrhosis due to hepatitis C infection presented with ascites which not respond to repeated
paracetesis Which of the following is the appropriate management
a - restrict fluid intake
b - avoid high protein diet
c - avoid high glycemic diet
d - restrict salt intake
39? y/o female patient with breast mass painless , mobile , firm , smooth no cyclic change
41 of 51
Dx ‫؟‬
a - ductal adnenoma
b – fibroadenoma
30 s female patient ................. [ with suspicious breast mass on imaging ]
most appropriate investigation :
a - FNA
b - core biopsy
c - excesional biopsy
case of post appendectomy carcinoid mass on histopathological [ small size ]
appropriate management
a - follow up
b – hemicoloectomy
case of post appendectomy carcinoid mass on histopathological [ 2*3 cm ? size]
appropriate management
a - follow up
b - Right hemicoloectomy
case of asthmatic child with frequent attacks education of concern
a - immunization
b -Spacer use
c - avoidance of triggers
Case of febrile UTI in child appropriate treatment
a - ciprofloxacin
b - amoxicillin
c - i.v cefuroxime
Case of child with parking cough , inspiratory and expiratory wheeze
Concerned symptom :
a - wheezing
b - tachypnea
c – cyanosis
Case of child ( unvaccibated ) presented with proptosis , painful eye movement Dx
a - preorbital cellulitis
b - orbital cellulitis
c - extraocular myositis
case of CAH inheritance
a - multifactorial
b - AR
c – AD
which of the following is effective contraceptive method
a - male condom
b - female condom
c - vaginal hormonal? ring
d – spermicide
42 of 51
Case of 16 years old with pain relatedto menstrual cycle
appropriate management :
a – NSAIDs
valvular intraepithelial carcinoma in situ Management
a - valvectomy
b - superficial excision
Case of senile valvitis Management:
a. topical estrogen cream
Question about time of vaccination with live vaccine in pregnant :
a-postpartum
Case of cervicitis with sex partner diagnosed with gennorhea
----- Site of sample :
a - high vaginal
b – endocervical
Case of alcoholic female patient with acute epigastric pain ( acute pancreatitis )
Investigation :
a - procalcitonin
b - aldehyde ....
Case of child with coma , acidosis , dehydrated , CSF with high cellular and normal other components
Dx
a - ascetylacid poisoning
b - Bacterial
c – viral
Old female patient with knee joint pain , swelling , mild fever , joint aspiration show( wbc = 260,000) , CBC ( wbc
12000 ) , X-ray show osteophytes ...... Dx :
a - septic arthritis
b - O.A
c - Rheumatoid Arthritis
Case of rheumatoid arthritis with dyspnea , cyanosis , clubbing >>> Dx
a- lung fibrosis
female patient with DM , HTN want to do Bilateral tubal ligation :
a - patient consent
b - both wife and husband consent
c - patient consent and ask her to inform the husband
d - preventative consent
HBsAge +ve , IgM HBc -ve , HCV Ig G + ve >>> Dx
43 of 51
a - acute hepatitis B infection
b - chronic hepatitis B infection
c - previous hepatitis B infection
d - post immunization
you treat old age female patient .... relative give you gift of traditional meal
a - accept
b - inform the facility Administration
c – refuse
a child fall down from about 1 meter ? presented with skull fracture, Bilateral femoral fracture , skin finding??
..... dx
a - pathological fracture
b - Barrter syndrome
Doctor examine diabetic patient with students without closing the door
a – privacy
asthmatic child with frequent attacks ..... his father refused to stop smoking in the house ...... what to do
a - ..... authority ?
b - advise about vaccination
asthmatic child .... of consern in education
a - how to use the spacer
Case of median nerve injury post stab wound in the shoulder... clean wound
Management :
a - immediate suturing
In normal pregnancy what is expected to be decreased as far as I remember it was asking specifically about pt in
1st trimester:
a-Uric acid
b-Creatinine
I don’t remember rest
Pt came with rectal bleeding .dr did SIGMOIDOSCOPY OR ANOSCOPY i don’t remember which one and was
positive of ulcer 10 cm from anal verge what is next to do ?
a-Colonoscopy
• Tumor lysis syndrome what is the electrolyte abnormalities?
a-hyperkalemia hypocalcemia
There is a q about someone who had MVA and came with neurogenic shock after resuscitation he improved what
is the next step
a- Iv crystolloid
b-Blood transfusion
44 of 51
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Scenario of Infective Endocarditis post tooth extraction dx
case about adenovirus infection
post natal depression?
Vaginal paoriases how to confirm?
Where to place thoracocentesis?
Pt with pentrated neck in third zone Ct showed avascular injury Tx?
Paracetamol toxicity?
Iron ingestion ( toxicity )?
When is IUD contraindicated?
diabetes millets with vaginal discharge , what’s the organism?
premenstrual tension syndrome?
electrolyte disturbance in pyloric stenosis ? And Best investigation ?
hirshuspring case management ?
Q ask about HCV grading they gave a sinario ..
femur fracture in 4yrs …Tx?
Barrett child syndrome??!
Metochlopramide antidote?
Some Q about ask what diagnosis :
o Bacterial vaginosis
o Trichomoniasis
o Candida
Two Q about shock
porcelain gb management?
acute cholecystitis management 24 hrs of symptoms ?
near miss, q
look a like q
closed loop communication q
how to write vit d order ?
asthma: add ics to meds. Another qs was on ics and saba prn-> add laba
scenario kwarahirkor ?
positive reinforcement q for tantrum
scenario dvt management ?
the scenario abt meds when to take at 9 12 and 15 hrs ?
vivax recurrence
soldier going to somehwere for malaria prophylaxis
dengue where most in ksa ?
Management of placenta previa in 31w??
Vaccinations in preschool ?
fracture case hint in the question (Battle sign )? Dx
Monoclonic monoclonic time ?
Opioid antidote ?
Paracetamol toxicity ?
What indicates UTI (NITRATE)?
Gestational week and type of test for screening of Gestational diabetes ?
case about molar pregnancy treatment ( diagnosis not given, but there is hunt in case : imaging showing
snow storm appearance) ?
Cause of PPH ?
clear nephrotic syndrome scenario , need Dx
clear as sun UTI scenario , need Dx?
clear case of pancreatitis
There was Qs about the stepwise approach of dysphasia
45 of 51
‫? ‪When u will give oral , or IV iron replacement‬‬
‫•‬
‫شركة هاتعقد مؤتمر عن شئ معين واحضرت دكتور اللقاء محاضرة مقابل مبلغ مادى‪...‬‬
‫‪ .A‬يرفض‬
‫‪ .B‬ام يقبل‬
‫‪ .C‬ام يقبل لكن يكون له والء كامل للشركة‬
‫كان فى سؤال طفل ‪ 7y hyperactive‬و ‪ stressless‬وبيتكلم بسرعة وعنيف فكيف نقلل المشاكل هذه ‪: ..‬‬
‫‪-preschool examination‬‬
‫‪-decrease video games and television‬‬
‫سؤال‪ endometriosis‬مكرر ( صورة وحالة)‪.‬‬
‫سؤال التهاب مهبل جرثومي ماهو العالج؟‬
‫سؤال طفل تعرض لرد فعل تحسسي شديد بعد أخذ لقاح ماذا تفعل في الجرعة الثانية؟‬
‫سؤال امرأة حامل اسبوع ‪ ٨‬عنق رحم مغلق وكتلة جنينية ضمن الرحم وهناك نزيف مهبلي متوسط‪ ،‬مانوع االجهاض؟‬
‫سؤال رجل لديه نزف هضمي سفلي غزير وحضر للطوارئ‪ ،‬والخيارات نقل بالزما طازجة او تسريب نورمال سالين او تنظير كولون اسعافي او‬
‫استئصال؟‬
‫سؤال رجل تلقى لقاح التهاب كبد بائي ولم يتعرض لعدوى مانوع االضداد المتوقع وجودها لديه؟‬
‫سؤال امرأة سلبية الريزوس وطفلها ايجابي هل يعطى ‪ anti D‬لألم او للجنين او لألثنين او اليعطى ابدا؟‬
‫سؤال رجل لديه ساركوئيد لعامين ثم لديه ‪ anemia‬ماسبب فقر الدم؟‬
‫سؤال رجل لديه اصابة على مستوى الفص االيمن للكبد ونزيف غزير اليتوقف ‪..‬ماالتدبير؟‬
‫سؤال امرأة تريد التمنيع وزوجها يرفض‪ ..‬كيف تتعامل مع ذلك؟‬
‫سؤال طفل يراجع بمشاكل تنفسية ووالده اليتوقف عن التدخين بجانبه و اليستجيب للنصائح الطبية ‪ ...‬كيف تتعامل؟‬
‫سؤال عن رجل لديه اعراض تنفسية ماهو االجراء االول الذي ستطلبه له؟‬
‫سؤال عن كيفية تحديد انذار ‪ ( copd‬نسبة ‪ ،o2‬عدد نوبات بالسنة‪ ، fiv 1 ،‬نسبة ‪ ) fiv1/fvc‬؟‬
‫سؤال طفل بأعراض تنفسية‪ ..‬ماالعامل المسبب؟‬
‫‪46 of 51‬‬
Pictures
Female with dyschazia, pain before menstruation and
infertility and laparoscopy was performed (finding in the
picture), what is the diagnosis?
DX:
A- adenomyosis
C- PID
C- endometriosis
Dx: Sigmoid volvulous
Newborn with jaundice at first 12 hour What the best
investigation
A.Coomb
B.Osmotic fragility test
C.Blood count with electrophoresis
D.G6pd
A neonate 12 hours after normal vaginal delivery
noticed to be jaundiced. The blood film showed
microcytic hyperchromic cells. The best investigation
to order is:
A) Osmotic fragility test.
B) Pyruvate kinase level.
C) Glucose 6 phosphate dehydrogenase enzyme.
D) EMA
Baby born sc full term asking about
treatment?
47 of 51
asking about treatment?
asking about diagnosis?
Growth chart look like this
And senario of. :
18 month present with abdominal bloating and loss of
subcutaneous fat ..
what diet should u prescribed ?
A. High calorie
B. Gluten free
C. Partial hydrolysed formula
D. Forget the option
What is the increase mortality and morbidity?
preterm delivery
Vaginal delivery
CS delivery
twin pregnancy what will increase mortality ?
A⁃ preterm
B ⁃ Cs
C ⁃ Vaginal
D ⁃ Instrumental
48 of 51
Came with it , bleeding
sometimes after trauma
What is the management .?
49 of 51
Labia ulcer or abscess
I don’t remember
(‫)الصوره كانت حقيقيه و اوضح من هذي‬
(Black female genitalia)
1-TTN
2-PE on ECG
3-OPEN fracture
4-STEMI
5-IDA
6-case of hydrated cyst + CT abdomen w/o contrast showed : cysts on liver , how treat it ? Albendazole
7-Transient tachypnea of the newborn
8-bowel perforation
9-ECG shows st elevation on II III avF , so Dx STEMI , in ER managed so what’s the nest step ? PCI
10-Gardnerella vaginalis (bacterial vaginosis)
11-SVT
13-common bile duct dilate – Mangemt ERCP
14-Boot sign > TOF
15-TTN
16-RDS
17-Failure to thrive
18-SVT ecg
19-Ecg for Mi what part ?
50 of 51
20- xray pulmonary edema and diagnosis
21- scfe picture and hx
22- CXR of neonate with distress ( preterm ) >>> respiratory distress syndrome
23- ECG of STMI with apex systolic regurgitation >>>Dx > mitral regurgitation
24- Condylomatalata (valvua )
51 of 51