84/96 Questions

Topic
List
Code
 Family Medicine MCQs
[B.1 & B.2]
84/96 Questions

Analytics Regarding the Weeks

NUMBER OF QUESTIONS
25

20

15

10

0
Week 1 Week 2 Week 3 Week 4
Misc.
Topics Topics Topics Topics
Number of Questions 20 18 14 16 16
 Family Medicine MCQs
[B.1 & B.2]
84/96 Questions

Analytics Regarding the Topics

Predicted
No. of No. of
Topic No. of
Code Topic List Questions Questions Percent.
Importance Questions
in Block I in Block II
in Block III
1.1 Back Pain ★★★ 3 4 8.3% 4 ±1
1.2 Palliative Care ★ 2 1 3.6% 2 ±1
1.3 Diabetes ★★★ 3 4 8.3% 4 ±1
1.4 Alcohol Dependency ★ 3 0 3.6% 2 ±1
2.1 Referrals ★ 2 1 3.6% 2 ±1
Primary Prevention of
2.2 ★★★★ 5 3 9.5% 5 ±1
Cardiovascular Disease

2.3 Contraception ★ 1 2 3.6% 2 ±1

Feverish Child in the
2.4 ★★ 1 3 4.8% 2 ±1
Community

3.1 Chest Pain ★ 2 1 3.6% 2 ±1

3.2 Acute Confusion ★ 1 1 2.4% 1 ±1
3.3 Dizziness ★★★ 2 3 6.0% 3 ±1
3.4 Diarrhea ★ 3 1 4.8% 2 ±1
4.1 COPD ★ 4 0 4.8% 2 ±1
4.2 Anemia ★ 1 3 4.8% 2 ±1
A Child with Behavioral
4.3 ★★★ 4 1 6.0% 3 ±1
Challenges

4.4 Polypharmacy ★ 3 0 3.6% 2 ±1

Misc. (Previous
? Knowledge, PCC, Skill ★★★★★ 8 8 19.0% 9 ±1
Lab, Public Health)
 Block I MCQs
48/48 Questions
1.1

1.3

3.4
4.1

2.1

4.1

2.2
?

1.4

2.3
4.3

4.4

3.4
3.3

4.3

2.2

1.4
1.1

4.4
3.1

3.2

4.1

1.1
2.1

1.4

3.4
 ?

2.2

1.3

2.2
4.2

3.1

1.2

4.1
?

2.4

4.4

?
1.3

2.2

3.3
4.3

1.2

4.3
 Block II MCQs
36/48 Questions
1 Selective reporting in recognized endemic area is called? ?

A Class I

B Class II

C Class III

D Class IV

E Class V

60 years old diabetic patient known for 20 years , now

complaining of blurred vision, inability to control bowel and skin
2 rash, which of the following is the most appropriate next step (he
1.3
is not adherent to medications and microalbuminuria +ve)

A Adjusting oral hypoglycemic

B Insulin

C Referral to Ophthalmologist

D Referral to Nephrologist

E Life Style Changes

45 year old complaining of low back pain for three weeks, which
3 of the following will be the least important to ask?
1.1

A Is the pain increasing with walking?

B Is the pain increasing at night?

C History of cancer

D Is there fever more than 37.8

E Is he using corticosteroids
4 Which of the following is NOT a cause of secondary headache? 4.3

A Brain tumor

B Giant cell arteritis

C Primary Angle-Closure glaucoma

D Subarachnoid hemorrhage

E Migraine

5 Criteria for diagnosis of generalized anxiety? 3.2

A Restlessness, irritable, Sleep disturbance

B Depression and increased sleep

C Restless and increased sleep

D ???

E ???

6 rise erythropoietin hormone in?? 4.2

A cardiac failure

B CKD

C Anemia

D ???

E ???
 A baby came to PHC for vaccination and his blood results showed
7 that he is anemic,what you will do for him
4.2

A Give him oral iron supplements for 3 months

B Give him oral iron supplements for 2 weeks

C Send him home because he shouldn't take the vaccine now

D
E

Chose laboratory results that should not found in iron deficiency

8 anemia
4.2

A Low mean corpuscular volume (MCV)

B Low mean corpuscular hemoglobin concentration (MCHC)

C Low hemoglobin level

D Low serum ferritin

E Low total iron-binding capacity (TIBC),

49 year old male presented with lower back pain for 3 weeks,
9 nerve roots affected in sciatica are?
1.1

A L1 – L2

B L3 – L4

C L4 – L5

D L5 – S1

E S1 – S2
10 Management of mechanical back pain? 1.1

A Bedrest

B Conservative treatment

C Referral to MRI

D Referral to Neurosurgery

E Give him steroids

11 the peak incidence of back pain 1.1

A 20 – 30

B 50 – 69 years

C 60 – 70 years

D 30 – 55 year

E 10 – 25 years

40 years old male known case of bronchial asthma present with

12 chest pain increase with respiration, pain started after playing 3.1
football match. Most likely diagnose ?

A Musculoskeletal pain

B Pneumonia

C PE

D Typical Angina

E MI
 Regarding Emergency contraception , All the following is true
13 except:
2.3

A Copper IUD is the most effective form of emergency contraception

Copper IUD can prevent pregnancy when fitted up to 5 days after

B unprotected intercourse
EllaOne (Ullipristal acetate) can be used within 4 days after unprotected
C intercourse

D Levonorgestrel has high affinity to progesterone receptor, delaying ovulation

E Levonorgestrel can be used within 72 hours after unprotected intercourse

Woman newly diagnosed with diabetes with fasting glucose

14 120..hba1c 6% .. bp 140 over 90 ...microalbuminuria What to do
1.3

A decrease weight

B Referral

C Start ACE-I

D ???

E ???

Old pt with DM for 20 years. Non compliant. Witch of the

15 following is not an autonomic complication of DM?
1.3

A Less sensitive to MI pain

B Postural hypotension

C Legs claudication

D ???

E ???
 30 years old women complaining of recurrent lower abdominal
16 pain, mucus on stool but no fever or weight loss. what's your 3.4
diagnosis?

A IBS

B Gastroenteritis

C DKA

D IBD

E ???

35 years old male develop dizziness and palpitation, what test

17 should you do?
3.3

A ECG

B Thyroid function test

C Liver function test

D
E

40 year women presented to clinic with fullness intermittent

18 tittinus diagnosed with BPPV what is the treatment?
3.3

A Antibiotic

B Antipyretic

C special exercise

D ???

E ???
 31 years old female, complaining of Rt lower abdominal pain
19 increased in severity after 2 days, O/E there was a palpable mass. 2.3
She missed her period. What's the most likely diagnosis?

A Ovarian Cyst

B Appendicitis

C Ectopic Pregnancy

D IBD

E ???

22 years old female complaining of dizziness, dix hallike test was

20 positive, nystagmus observed was continues , symptoms were 3.3
mild. What is the most likely diagnosis:

A Visit bulgar neuritis

B Meniere syndrome

C Acoustic neuroma

D ???

E ???

21 Hepatitis B vaccination in which months 2.4

A 0,2,4,6

B 2,4,6

C 4,6,9

D 9,12

E 12
22 Measles vaccination 2.4

A Conjugated

B Inactivated

C Live attenuated

D Polysaccharide

E Recombinant

Child with non blanching rash, fever and he looks ill, with neck
23 stiffness
2.4

A Meningococcal Septicemia

B Measles

C UTI

D ???

E ???

24 All of them can be candidates for palliative care exept : 1.2

A 20 years immigrant with HIV .

B 44 years male with lung cancer

C 70 years male with scabies

D 6 years child with rare pediatric syndrome and will die with less than 1 years

E ???
 65 Y/o , male Patient with Hx of ACS ,have CHD and develop
25 crackels in chest , increased JVP ,
2.2

A carvedilol

B Furosemide

C Spironolactone

D Hydrochlorothiazide

E ???

all of the following activities are considered primary prevention

26 except:
?

A Water fluoridation

B Nutritional education

C Mumps, Measles, & Rubella vaccination for first-time pregnant females

D Pap smear screening

E Titanus vaccination for teenagers

Of the following factors listed, which is the most IMPORTANT

27 factor that indicates a successful smoking sessation for an 2.2
individual?

A Pharmacolgical therapy in the management plan

B Recurrent visits

C Doctor's advise for smoking quitting

D Behavioral therapy in the management plan

E Patient's desire for smoking quitting

 what is the primary purpose for family doctor to refer to
28 specialist??
2.1

A to assure the findings/diagnosis

B use accessory resource

C to protect the family doctor

D ???

E ???

29 the definition of outbreak ?

A Sudden increase in number of cases among small defined place

B
C
D
E

In x country records 400.000 pregnant women with iron

30 deficiency anemia This Called
?

A Insidious

B prevalence

C Odds ratio

D Risk Factors

E Incidence
31 Carelessness by professional person ?

A criminal negligence

B incompetence

C malfeasance

D malpractice

E misfeasance

A 66 year male have DM came to without appointment shouting

"I have blurred vision" the doctor try to calm him down but he
32 can't, he recently tired and divorce and haven't sleep. regard to
1.3
this information what is the barrier ?

A information overload

B psychosocial barrier

C language barrier

D physical barrier

E ???

33 X axis on ROC curve represent what: ?

A False Negative

B False Positive

C True Negative

D Positive Predictive Value

E Prevalence
34 At what time of the day you should take atorvastatin? 2.2

A ???

B ???

C ???

D ???

E ???

35 A good professional doctor should be all of the following except ?

A Make his patient's record available to everyone

B ???

C ???

D ???

E ???

A patient who missed a follow up appointment suggested by the

36 doctor and return back after one month for follow up , what is ?
the best response that doctor should do:

A Blame the patient for any complications that will have

B Confront the patient with missing the follow up

C Disappointing for follow up

D Refuse to follow up the patient

E Thank the patient for returning and stay supportive

Family medicine & Public health
Challenging Communication/ Counseling
To communicate with the patient appropriately to provide:

• Health education and counseling regarding certain health problem

Health education regarding a specific disease:

o
o
o
o
o the symptoms or the complication of the disease
o
o
o -monitoring
o ion or regular clinic follow up
o
o

• Smoking cessation! Review pages 133-140 ( Family medicine practical approach)

http://dhhs.ne.gov/publichealth/Documents/QL_FiveAs_Factsheet.pdf

http://apps.who.int/iris/bitstream/10665/112835/1/9789241506953_eng.pdf (Page 11-12)

Use the 5 As intervention to help patient in smoking cessation with proper communication

o Ask
o Advice
o Assess
o Assist
o Arrange
• breaking bad news

How to deliver a bad news to the patient with proper communication (SPIKES)

o Setting
o Perception
o Invitation
o Knowledge
o Emotion
o Summary and strategy
To communicate with colleagues in writing

• To write a proper referral form

The letter should be Concise, Relevant information, well arranged, clear and Accurate

• Items should be written in any referral letter:

o From-Family Practice clinic, center name

o Type of Referral
o - To Hospital name
o - To-Specialty department
o - Date
o - Patient name
o - Patient age
o - Patient sex
o - File Number
o - Chief complain
o - HPI
o -Relevant Past, drug, social and family history
o - Vital Signs -
o Relevant Physical Examination finding
o - Results of Laboratory investigation
o - Medications Given
o - Diagnosis
o - Reasons of referral
o Referring Physician / name and signature

• To write a sick leave

Items should be written in sick leave:

o Date
o Patient name - Patient age - Patient sex
o File Number- Name of the PHC clinic
o Number of the sick leave Days
o From date … to date….
o Physician name and signature
 Procedure/ Special Examination/ Acute care

http://www.taibahumbbs.com/wp-content/uploads/2017/09/Diabetic-Foot-Care-and-Examination-
Checklist-Final.pdf

http://www.taibahumbbs.com/wp-content/uploads/2017/09/DM-Educational-Guide.pdf

Video: http://www.taibahumbbs.com/wp-content/uploads/2017/09/Diabetic-foot-examination.mp4

http://www.taibahumbbs.com/wp-content/uploads/2017/10/ENT-Exam-Form.pdf

Interpret BMI and Central obesity evaluation (waist circumference)

http://www.taibahumbbs.com/wp-content/uploads/2017/10/Lipid-Profile-BMI-Interpretation-
Checklist-Form.pdf

Lecture: http://www.taibahumbbs.com/wp-content/uploads/2017/10/Dyslipidemias-and-Lipid-
Profile-Interpretation-Final.pdf

Video: https://www.youtube.com/watch?v=Q8lVm7EEcQc

Recommended target blood glucose level ranges

The NICE recommended target blood glucose levels are stated below for adults with type 1 diabetes,
type 2 diabetes and children with type 1 diabetes.

In addition, the International Diabetes Federation's target ranges for people without diabetes is stated. [

The table provides general guidance. An individual target set by your healthcare team is the one you
should aim for.

Target Levels Before meals At least 90 minutes after meals

by Type (pre prandial) (post prandial)
Non-diabetic* 4.0 to 5.9 mmol/L under 7.8 mmol/L
Type 2 diabetes 4 to 7 mmol/L under 8.5 mmol/L
Type 1 diabetes 4 to 7 mmol/L 5 to 9 mmol/L
Normal and diabetic blood sugar ranges

For the majority of healthy individuals, normal blood sugar levels are as follows:

 Between 4.0 to 6.0 mmol/L (72 to 108 mg/dL) when fasting

 Up to 7.8 mmol/L (140 mg/dL) 2 hours after eating
 For people with diabetes, blood sugar level targets are as follows:

 Before meals: 4 to 7 mmol/L for people with type 1 or type 2 diabetes

 After meals: under 9 mmol/L for people with type 1 diabetes and under 8.5mmol/L for people with type
2 diabetes
Blood sugar levels in diagnosing diabetes

The following table lays out criteria for diagnoses of diabetes and prediabetes.

Blood sugar levels in diagnosing diabetes

Plasma glucose test Normal Prediabetes Diabetes
Random Below 11.1 mmol/l N/A 11.1 mmol/l or more
Below 200 mg/dl 200 mg/dl or more
Fasting Below 6.1 mmol/l 6.1 to 6.9 mmol/l 7.0 mmol/l or more
Below 108 mg/dl 108 to 125 mg/dl 126 mg/dl or more
2 hour post-prandial Below 7.8 mmol/l 7.8 to 11.0 mmol/l 11.1 mmol/l or more
Below 140 mg/dl 140 to 199 mg/dl 200 mg/dl or more

Random plasma glucose test

A blood sample for a random plasma glucose test can be taken at any time. This doesn’t require as much
planning and is therefore used in the diagnosis of type 1 diabetes when time is of the essence.

Fasting plasma glucose test

A fasting plasma glucose test is taken after at least eight hours of fasting and is therefore usually taken
in the morning.
The NICE guidelines regard a fasting plasma glucose result of 6.1 to 6.9 mmol/l as putting someone at
higher risk of developing type 2 diabetes, particularly when accompanied by other risk factors for type 2
diabetes.
Oral Glucose Tolerance Test (OGTT)
An oral glucose tolerance test involves taking a first taking a fasting sample of blood and then taking a
very sweet drink containing 75g of glucose.

After having this drink you need to stay at rest until a further blood sample is taken after 2 hours.

HbA1c test for diabetes diagnosis

An HbA1c test does not directly measure the level of blood glucose, however, the result of the test is
influenced by how high or low your blood glucose levels have tended to be over a period of 2 to 3
months. Indications of diabetes or prediabetes are given under the following conditions:
 Normal: Below 42 mmol/mol (6.0%)
 Prediabetes: 42 to 47 mmol/mol (6.0 to 6.4%)
 Diabetes: 48 mmol/mol (6.5% or over)
 Prescribing and therapeutic

Week 1

Therapeutic lists Back pain: Identify the management plan for a patient with acute or chronic back pain
NSAIDs in the management of back pain Non-therapeutic measure in the management plan like
physiotherapy and manual therapy

Diabetes mellitus: Management plan for diabetic patient

Please refer to the therapeutic list from last year

Palliative care: Identify the different grades of pain management in palliative care NSAIDs role in the
management plan Opioiods (Morphine) use in palliative care Pharmacological treatment in symptom
control in palliative care including anorexia, vomiting, hiccup, ... etc.

Alcohol problems: Management plan against alcohol dependency Management of delirium tremens
Management of acute alcohol intoxication The role of vitamins (like Thiamin) in alcohol management
Benzodiazipines in alcohol management

Week 3

Revise the drugs of antihypertensive medications

http://gulfup.co/rdenwze96or9

 Ant lipids: Statin

HMG CoA reductase inhibitors, or statins are widely prescribed drugs. They are indicated for the
treatment of hipercholesterolemia, a condition that increases cardiovascular risk. Currently, the drugs of
this group that are available are:

o Atorvastatin

o Rosuvastatin

o Simvastatin

Clinical uses

 Hypercholesterolemia.
 Familial Hypercholesterolemia (Atorvastatin might be an exception)
 Coronary atherosclerosis
 Prophylaxis for coronary atherosclerosis

Adverse effects and contraindications

 HMG-CoA inhibitors are contraindicated in pregnancy. Limited evidence from animal and human
studies indicates that statins should not be taken during pregnancy
 Liver disfunction:Elevations of serum aminotransferase activity (up to three times normal) occur in some
patients. This is often intermittent and usually not associated with other evidence of hepatic toxicity. In
some patients, who may have underlying liver disease or a history of alcohol abuse, levels may exceed
three times normal. This finding portends more severe hepatic toxicity.
 A relatively common side effect of the statins (perhaps 1% of patients) is myositis,that is,infammation of
skeletal muscle accompanied by pain,weakness,and high levels of serum creatine
kinase. Rhabdomyolysis,i.e.,disintegration of muscle with urinary excretion of myoglobin and
kidney damage, is serious side effect. The risk of muscle damage is said to increase with
simultaneous use of the triglyceride-lowering fibrates.
Dose: Lecture: Calculate, Interpret BMI and Central obesity evaluation (waist circumference)
http://www.taibahumbbs.com/wp-content/uploads/2017/10/Dyslipidemias-and-Lipid-Profile-
Interpretation-Final.pdf

 Educate patient regarding the non-pharmacological management in case of sore throat

o Rest. And rest your voice.

o Drink fluids. Fluids keep the throat moist and prevent dehydration. Avoid caffeine and alcohol,
which can dehydrate you.

o Try comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water
with honey — and cold treats such as ice pops can soothe a sore throat.

o Gargle with saltwater. A saltwater gargle of 1/4 to 1/2 teaspoon of table salt to 4 to 8 ounces of
warm water can help soothe a sore throat. Gargle the solution and then spit it out.

o Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore
throat or sit for several minutes in a steamy bathroom.

o Consider lozenges or hard candy. Either can soothe a sore throat, but don't give them to
children age 4 and younger because of choking risk.

o Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can
irritate the throat
 Antibiotic used in case of sore throat
 Educate a patient regarding the antibiotic misuse

Antibiotics are important drugs. It would be difficult to overstate the benefit penicillin and other
antibiotics have played in treating bacterial infections, preventing the spread of disease and minimizing
serious complications of disease.

But there is also a problem with antibiotic medications. Drugs that used to be standard treatments for
bacterial infections are now less effective or don't work at all. When an antibiotic drug no longer has an
effect on a certain strain of bacteria, those bacteria are said to be antibiotic resistant.

The overuse and misuse of antibiotics are key factors contributing to antibiotic resistance. The general
public, doctors and hospitals all play a role in ensuring proper use of the drugs and minimizing the
development of antibiotic resistance.

What causes antibiotic resistance?

A bacterium is resistant to a drug when it has changed in some way that either protects it from the
action of the drug or neutralizes the drug. Any bacterium that survives an antibiotic treatment can then
multiply and pass on its resistant properties. Also, some bacteria can transfer their drug-resistant
properties to other bacteria — as if passing along a cheat sheet to help each other survive.

The fact that bacteria develop resistance to a drug is normal and expected. However, the way that drugs
are used affects how quickly and to what extent drug resistance occurs.

Overuse of antibiotics

The overuse of antibiotics — especially taking antibiotics even when they're not the appropriate
treatment — promotes antibiotic resistance. Antibiotics treat bacterial infections but not viral infections.
For example, an antibiotic is an appropriate treatment for strep throat, which is caused by the
bacterium Streptococcus pyogenes. It's not, however, the right treatment for most sore throats, which
are caused by viruses.

If you take an antibiotic when you actually have a viral infection, the antibiotic is still attacking bacteria
in your body — bacteria that are either beneficial or at least not causing disease. This misdirected
treatment can then promote antibiotic-resistant properties in harmless bacteria that can be shared with
other bacteria.

Common viral infections that do not benefit from antibiotic treatment include:

 Cold
 Flu (influenza)
 Bronchitis
 Most coughs
 Most sore throats
 Some ear infections
 Some sinus infections
 Stomach flu (viral gastroenteritis)
 Educate parent about the importance of vaccination in children

Top 10 Reasons to Protect Children Through Vaccination

• Parents want to do everything possible to make sure their children are healthy and protected from
preventable diseases. Vaccination is the best way to do that.

• Vaccination protects children from serious illness and complications of vaccine-preventable diseases
which can include amputation of an arm or leg, paralysis of limbs, hearing loss, convulsions, brain
damage, and death.

• Vaccine-preventable diseases, such as measles, mumps, and whooping cough, are still a threat. They
continue to infect U.S. children, resulting in hospitalizations and deaths every year.

• Though vaccination has led to a dramatic decline in the number of U.S. cases of several infectious
diseases, some of these diseases are quite common in other countries and are brought to the U.S. by
international travelers. If children are not vaccinated, they could easily get one of these diseases from a
traveler or while traveling themselves.

• Outbreaks of preventable diseases occur when many parents decide not to vaccinate their children.

• Vaccination is safe and effective. All vaccines undergo long and careful review by scientists, doctors,
and the federal government to make sure they are safe.

• Organizations such as the American Academy of Pediatrics, the American Academy of Family
Physicians, and the Centers for Disease Control and Prevention all strongly support protecting children
with recommended vaccinations.

• Vaccination protects others you care about, including family members, friends, and grandparents.

• If children aren’t vaccinated, they can spread disease to other children who are too young to be
vaccinated or to people with weakened immune systems, such as transplant recipients and people with
cancer. This could result in long-term complications and even death for these vulnerable people.

• We all have a public health commitment to our communities to protect each other and each other’s
children by vaccinating our own family members.

 How to counsel a leady regarding the best contraceptive choices

 All contraceptive methods

https://www.fphandbook.org/sites/default/files/fffpchapter7.pdf
Week 3

Pharmacological treatment

Antimotility agents are not indicated for infectious diarrhea

This medication is used to treat sudden diarrhea (including traveler's diarrhea). It works by slowing
down the movement of the gut. This decreases the number of bowel movements and makes the stool
less watery. Loperamide is also used to reduce the amount of discharge in patients who have undergone
an ileostomy. It is also used to treat on-going diarrhea in people with inflammatory bowel disease.
Loperamide treats only the symptoms, not the cause of the diarrhea (e.g., infection). Treatment of other
symptoms and the cause of the diarrhea should be determined by your doctor. Do not use in children
younger than 6 years

1- Analgesic
2- Antispasmodic

https://irritablebowelsyndrome.net/medications/antispasmotics-anti-muscle-spasm-medication-for-
ibs/

+ Buscopan http://chealth.canoe.com/drug/getdrug/buscopan

3- Antibiotic
 Acid lowering agent : Proton pump inhibitors : example Omeprazole

Iron treatment example Ferrous sulphate

Treatment of underling cause of confusion like this case it’s due to HYPONATERMIA (low sodium level)
so replacement of sodium will be main treatment.

Atrial fibrillation : Anticoagulant is important and antiarrhythmic medication

Drug Primary Half Main adverse effects Uses

Clearance life (hrs)

Class I ; Sodium Channel Blockers

Class IA agents; combined sodium and potassium channel blockade, intermediate kinetics of binding and dissociation

Quinidine Hepatic 6-8 hrs. Diarrhea, nausea, rash, Ventricular arrhythmias and atrial
(CYP450 3A4) cinchonism. Serious; torsade fibrillation (oral)
de pointe, hepatotoxicity,
myelosuppression

Class II; Beta Adrenoceptor Blockers

Β1 Selective
Acebutolol (membrane stabilizing and ISI)
Atenolol
Non (β 1) selective
Nadolol
Propranolol
Non Β selective and α receptor blockers
Carvedilol (used in heart failure management)
Labetalol (IV form is used in acute hypertensive crisis)
Class III; Potassium Channel Blockers

Amiodarone P450 CYP3A4 and 15140 Pulmonary, neurologic, Used for ventricular arrhythmias and atrial
CYP2C8 days hepatic, dermatologic and fibrillation
ophthalmic side effects and
complications
Class IV; Calcium channel blockers
Dihydropyridine; selective vasodilators acting on peripheral smooth muscles
Amlodipine
Felodipine
Verapamil
Week 4

Pain killer ( paracetmol, codine)

SSRI (Citalopram)

https://www.nhs.uk/conditions/ssri-antidepressants/

 Proton pump inhibitor PPI – (omeprazole)

https://beta.nhs.uk/medicines/omeprazole/

 Methylphenidate

+ Methylphenidate's mechanism of action involves the inhibition of catecholamine reuptake, primarily

as a dopamine reuptake inhibitor. Methylphenidate acts by blocking the dopamine
transporter and norepinephrine transporter, leading to increased concentrations of dopamine and
norepinephrine within the synaptic cleft. This effect in turn leads to increased neurotransmission of
dopamine and norepinephrine.

https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/

 Drug therapy used in treating COPD.

https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/treatment/

 Diuretic (Fursmide)

File antihypertensive agents (Week2)

 Aspirin

https://beta.nhs.uk/medicines/aspirin-low-dose/

 Antilipids: Statin (Atorvastatin)

Week 2

 Beta-bloker(Bisoprolol)

Week 2

 GTN spray 400mcg

 Levothyroxine

https://beta.nhs.uk/medicines/levothyroxine/

 Metformin

https://beta.nhs.uk/medicines/metformin/
 Gabapentin

https://beta.nhs.uk/medicines/gabapentin/

It is recommended as one of a number of first line medications for the treatment of neuropathic pain
in diabetic neuropathy, postherpetic neuralgia, and central neuropathic pain

 Isosorbide Mononitrate (ISMN) MR??

Isosorbide mononitrate (ISMN) is most commonly used in the management of angina and may be used
as an adjunct in congestive heart failure. Most patients are maintained on a modified release (MR)
preparation which is usually taken once daily in the morning to maintain a nitrate-low period and thus
minimise tolerance. Immediate release preparations may be difficult to obtain

should be include:

Date of assessment: _ /__/____

Hospital/Location: ....................... Patient gender: Male/ Female Patient age:.........

Check for allergies and intolerance:

Case Summary and Diagnosis:..................................................................................................................

Medication prescribed for the patient:

Drug Name Indication Dose Frequency Duration Route
#

Doctor name:

Signature:

Communicating information about medication with the patient

- fluency- Not missing essential steps or data

Family medicine MCQ
MED 35
nd rd
2 + 3 block
‫اول ﺑﻠوك ﻓﻲ اﻟراﺑط اﻟﺗﺟﻣﯾﻌﺎت‬
 Family medicine MCQ
2nd block

-1
Inflammatory bowel disease that affect mucosa only is
Ulcerative
Crohn
Lactose intolerance
Celiac disease
IBS

-2
Most effective helping smoking cessation
Brief advice
Opioid
Self help materials
Behavioral groups

-3
:Theoretical teaching and practical
Demonstration

-4
:month vaccines 12
PCV, OPV,MMR,MCV4 -

-5
Anxious Female on contraceptive presented with shortness of breath,
?what's most important symptom in PE
Dyspnea
Hemoptysis
Wheeze
Peluritic chest pain
.... S3-

-6
Patient came frome South Africa history of abdominal pain diarrhea with
: mucuse and blood, which investigation not need
CBC-
CT /Abdomen-
stool culture-

-7
a current smoker thinking to quite smoking in the next 6 months, and he
has no previous attempts of smoking cessation, in which stage of
?smoking cessation is he
Action -
Contemplation -
Maintaince -
Preparation -
Precontamplation -

-8
anxious woman age presented with SOB, she use COC, what is the 30
? diagnostic symptoms of PE
pleuryic chest pain -
Heomoptysis -
Dysnea -

-9
: Refer patient for suspected cancer except
.A-Female 45 with iron deficiency anemia
B-Male60 with iron deficiency anemia
C-Male 45 with abdominal pain weight loss
.D-Male 55 with bleeding per rectum

-10
:all of the following present in bacterial pharyngitis except
A-rhinorryea
B-Lymph node enlargement
.C-Exudate

-11
y/o male patient presented with headache that appears mainly at 42
night, associated with left red injected eye. Her wife mentioned that he
becomes aggressive at the time of headache. Developed 3-4 times per
.month, and he is normal between the attacks
A- migraine headache
B- cluster headache
C- Tention headache
D- paroxysmal hemicrania

-12
years with multiple bruising, which of the following doesn't suggest 7
?abuse
a) History matches the bruises

-13
A female patient not known to have HTM or DM the age of screening for
:lipid is
18
22
25
45
50
-14
What is the CORRECT about Pathophysiology of Alcoholic liver disease
?
ALT elevated than the AST -
chronic liver damage may become live cirrhosis-

-15
.According to smoking cessation all of the follwing INCORRECT expect
.The smoking cessation medication used for 12 weeks

-16
Patient with epilepsy on phenytoin. He has mild jaundice, MCV 130, Hb
was low and hypersegmented cell in blood smear. Platelet was 140 000
and reticulocycties 0.2
?What are the type of anemia
B12
Folic
Autoimmune hemolytic anemia

-17
Travel's diarrhea healthy man with history travel to African What is the
?treatment
Amoxicillin
Cpiroflaxin
Doxcyclin

-18
years complain of dizziness, intermittent tinnitus and full ear 40
diagnosis with benign paroxysmal positional vertigo what is
?mangment
Reassure patient and especial exercise

-19
Patient come with dizziness she described it as unsteady and fel her
balance off what is the term of this description
Disequilibrium
Vertigo
Syncope
Lightheadness

-20
What is the cofactors of duodenal ulcer
Alcohol use
Smoking
H.pylori infection
O blood group

-21
:Which of the following is correct about acute sinusitis
antihistamine is the first line treatment-1
purulant post nasal dirp in acute chronic sinusitis-2
frontal siuns is most affected-3
mucupurulant nasal discharge for3 days is indication for antibiotics -4

-22
Y/o , male Patient with Hx of ACS ,have CHD and develop crackels in 65
, chest , increased JVP

Furosemide
Spironolactone

-23
?What are the drugs causing hyponatremia
Acei, ppi, diuretics

-24
:According to the delirium tremens which sentence is Correct
Diazepam is recommenced in treatment-
It’s self limiting condition-
.It appears 1-5 days after heavy drinking -
-

-25
According alcohol dependence
a
Anemia due to iron deficiency so iron supplement is essential-
vit b 12 is essential due to korsakoff syndrome-
vit K essential to prevent DVT-
Cognitive behavior therapy in mild case of Alcohol dependence-

-26
Diabetic patient who is on metfomen but uncontrolled presented with
?symptoms of visual disturbances, ..... other symptoms
:What are the other symptom of autonomic neuropathy
Visual disturbance
Postural hypotension
Small muscle weakness

-27
What’s the correct regarding morphine for palliative care
naloxene is morphine antidote -
its containdicated due to respiratory distress -
reduce its effect with time -
it caused morphine adduction -
its used only in the hospital -
-28
Senior resident in elevator ask you that discharge Mr ... with HIV
are other health providers in the elevator medication while thrre
the resident action
Commitment of the confidentiality
Commitment of trust of patient
-

-30
Only if there is physical abuse
Only if the physician witness the abuse
If the physician has reasonable suspicion of child abuse

-31
The appropriate temperature degree to storage vaccination
8-2
8-4
10-4

-32
Absolute contraindications of combined oral contraceptives pills
Migraine with aura
Smoker 30 years

-35
All true about CKD except
Alkalosis and hyperkalemia.1
Endocrine anemia.3
Hypotension and edma due to over hydration.2
Bone disorder .4

-36
: Carelessness by professional
Criminal negligence
Malpractice
Malfeasance

-37
: Sciatica
L5-s1
L4-L5
L3-L4
 Block 3 Family medicine

1- The true statement about COpD :

Spirometry can not be diagnostic
Normal chest X-ray exclude COpD
Clubbing is feature of COpD pt
Ankle edema in sever chronic bronchitis
Absent of wheezing exclude COPD

2- not true about management of COpD :

1- antibiotics to treat infectious exacerbation of COpD
2- Flu vaccines every 5 years
3- SABA recommended to control acute condition
4- long term use of LABA show improve in COpD patient

3- Which of the following is red flag of chest pain: ?

Palpitation
Chest wall tenderness
Cough
Fever

4- All correct about diarrhea except:

Chronic diarrhea is caused by viral infection
Decrease travel diarrhea caused by stress and anxiety from travel
IBS is commonest cause of diarrhea
Decreased frequency defined diarrhea

5- most common organism that 15-cause acute epiglottis is

H.influenza

6- 42 years old come for mechanical contraception. Which one can prevent STD and
contraception:
Male candom
Vaginal ring
Vaginal diaphragm

7- 50 years old man with excessive alcohol drinking in last 6 months, to avoid
weenick karakoff syndrome:
Vitamin b12
Vitamin b1
Vitamin c
Vitamin k

8- Which of the following not fundamental in palliative care:

Cure is goal
control symptoms
Social and supportive care is important

9- what is the peak age of lower back pain

35-50

10- what is correct regarding the pathophysiology of alcoholic liver disease

-AST increase mores than ALT

11- All in family medcine EXCEPT:

-Comprehensive approach
-High specialized care
-Continuity of care
-Preventive measures
- patient centerd care

12- Known DM , heart failure, eGFR = 38. He is only on metformin and he’s not
tolerated it. What is the most appropriate medicine :
Insulin
Pioglitazone
Glicazide
Insulin + pioglitazone
Alogliptin

13- 76 years old female patient complaining of UTI. She developed HR = 120 bpm,
hypotension, altered level of consciousness...
- Confusion
- Depression
- Mania
- ..
- ..

14- 26 y/o female patient is complaining of heartburn for 1 month which increased
by lying down, lf you suspect gastric erosion the most appropriate next step is:
- upper GI endoscopy
- H2 receptor antagonists & PPI and evaluate..
- swallow...
- CT
- US

15- Currently not smoker, stopped for 6 months

Action
Preparation
Maintained

16: 20 y/o female came complaining of bloody diarrhea, tenesmus, weight lose
UC
Hemorrhoid

17- For assessment of esophageal cancer which of following patient need uregent
referal for endoscopy (within 2 weeks )
Pt 55 with wt loss and heartburn
60 with presenst dyspsia despite ttt
Abdominal pain,nausea ,and vomiting
Abdominal pain with low platelet and nausea
Abdominal pain with low HBG

18 :A 4years old boy ,came to opd complaining of cough and sore throat for 4days
.on examination temp 37.1 ,ear clear ,throat slightly....... ,no laymphadopathy ,no
focal signs present .which of the following most appropriate investigation :
CBC
Throat culture
Test for strepococcal
Nothing at this time

19- child have mild iron deficiency anemia what is treatment :

give him oral iron till normalization then complete 2-3 months prophylaxis

20- in case of giant cell arteries management:

High dose steroid
Low dose steroid

21- A 65 yeas old male has a history of coronary artery bypass what is acceptable for
him:
* LDL less than 92

22- RVF all false except:??

* primary pulmonary HTN
Emphysema is not a cause
Ankle odema is not physical sign
RVF better prognosis than LFV

23- medications cause hyponatremia

-ppi-ACEi-diuretics
24- doctor listen skill
-important skill to comprehensive

25- A patient who missed a follow up appointment suggested by the doctor and
return back after one month for follow up, What is the best response that the doctor
should do:
A- Blame the patient for any complications that will have
B- Confront the patient with missing the follow up
C- Disappointing for follow up
D- Refuse to follow up the patient
C- Thank the patient for returning and stay supportive

26- absolute risk in nonsmoker 2 out 100 and the relative risk elevated 50% in
smoker group what the absolute risk in smoker group
2
3
4
5

27- what is wrong about DT

It appear 1-5 days after heavy drinking
Need hospitalization
Life threating condition
Associated with pyrexia

28- All of the following Cause acute confusion in elderly except:?

Drugs
Infections
Insomnia
Neoplasm

29- 54 years old take ARB and atorvastatin, he’s smoking and sit quit date
with 2 weeks from now, he wants to ask you if you can give him
medication to help him with quitting. Regarding smoking cessation
counseling what’s is correct of the following: ??
* Only physicians can perform smoking cessation.
* You can perform smoking cessation within typical 10 minutes office
visit.
* Patient with nicotine dependency consider having
acute illness
* Smoking cessation cannot be carried out on Telephone

30- a mother brought her baby’s who is 2months for PMC, according to KSA
vaccination schedule what is proper for her:
IPV,HBV,rotavirus,pcv,dTap,Hib

31- According to DM all following wrong except

Annual eye screening consider secondary prevention

32- major criteria for 7 weighted skin lesion

- irregular shape
- More than 7 mm
- Sensation
- Oozing

33- Dm patient her HBa1c 7 FBS 100 BP 150/88 her urine had microalbuminuria
Start ACEI
Refer to nephrology
 FAMILY
MEDICINE
BLOCK II
MED36
1. 54-year-old patient with blurred vision diagnosed with diabetic retinopathy,
what other microvascular complication?
A. MI
B. Peripheral neuropathy affecting the nerve sheath
C. Stroke
D. peripheral vascular disease

2. Regarding the diabetic patient mentioned above, what intervention is NOT

done first?
A. Start with metformin
B. Start with insulin
C. Nephrologist referral
D. Lifestyle modification

3. The sudden increase in number of cases in confined area is called:

A. Epidemic
B. Endemic
C. Outbreak
D. Pandemic

4. 55-year-old male, was diagnosed with pancreatic carcinoma with metastasis to

liver, all correct about palliative care in this case EXCEPT:
A. Achieving full cure is the gaol
B. Psychological needs should be managed actively
5. Which one of the following is CORRECT regarding the pathophysiology of
alcoholic liver disease:
A. Alcoholic liver disease is caused by hepatitis
B. AST is usually more elevated than ALT in alcoholic liver disease
C. Fatty liver is usually smaller due its shrinkage
D. Mallory antibodies present in the nucleus of hepatocyte

6. Which of the following is correct regarding delirium tremens?

A. Chlorpromazine is recommended for its management
B. Diazepam is recommendable for its management
C. It follows 1-5 days after heavy alcohol drinking
D. It rarely needs hospitalization

7. 25-year-old male complaining of chronic back pain. The pain worsened in the
morning and relieved 45 minutes after he wakes up. He had bloody stool and
investigation showed ulcerative colitis. The most likely diagnosis is:
A. Ankylosing spondylitis
B. Colon cancer metastasis to spine
C. Disk prolapse
D. Sciatica

8. 45-year-old male complaining of back pain after heavy lifting. Neurological

examination showed diminished sensation on the lateral side of right foot,
impaired Achilles’ tendon reflex, having difficulty in walking on the right leg toes.
You did MRI to him what nerve root is expected to be affected:
A. L3
B. L4
C. L5
D. S1
9. 78-year-old man complaining of low back pain due to metastatic prostate
cancer; which of the following is CORRECT:
A. Morphine could be administered orally, subcutaneous, IM, or parenteral
B. Morphine is absolute contraindicated in elderly due to respiratory
suppression
C. Morphine must be given in hospital
D. If the patient using morphine, he should stop NSAIDs

10. Which of the following is a sign or symptom most commonly found in early
osteoporosis?
A. Fatigue
B. Bone pain
C. Muscle pain
D. Usually asymptomatic

11. What is the difference between family medicine and general practice?
A. Family medicine as specialty, it is summation all other specialty
B. Family medicine treat illness as individuals and family, contrast to general
practice
C. General practise treats all types of patients, family medicine is more
specialized
D. There is no difference between general practise and family medicine

12. Regarding measles vaccination, it is considered:

A. Recombinant vaccine
B. Live attenuated
C. Polysaccharides vaccine
D. Conjugated vaccine

13. All of the following are routine investigations of hypertension EXCEPT:

A. Electrocardiogram
B. Urine and electrolytes
C. Lipid profile
D. Thyroid function tests
14. The absolute risk in a non-obese patient is 4-out of 100. The relative risk
elevated to 25% in obese patients, what is the absolute risk in an obese patient?
A. 3
B. 4
C. 5
D. 6

15. 66-year-old female; c/o pigmented lesion on her back. The diameter was 1
cm, regular dark brown in color, with irregular shape and inflammatory base &
oozing blood. The patient admitted that there is change in the size of lesion. She
denied any change in sensation. Regarding Weighted-7point checklist, what is the
score?
A. 4
B. 5
C. 6
D. 7

16. which of these symptoms usually absent in 7 year/o baby with streptococcal
pharyngitis?
A. Cervical adenopathy
B. Tonsillar exudate
C. High fever
D. Rhinorrhea

17. Which of the following regarding emergency conception is CORRECT?

A. Hormonal IUS is considered better than copper IUD
B. IUD can be on day 3 after episode of unprotected sex
C. Levonorgestrel used after 7 days after unprotected sex
D. Emergency contraceptive cannot be issued without prescription
18. 15-months feverish child: On examination: Patient looks ill, has purpuric rash
non-blanching, and neck stiffness. What is the most important diagnosis that
needs to be ruled out?
A. Bacteria pneumonia
B. Viral meningitis
C. Meningococcal septicaemia
D. Kawasaki disease

19. Which of the following is TRUE regarding Atorvastatin?

A. Best used in the morning
B. Increase KFTs as a side effect
C. Should be taken for 3 months and stop
D. Works by inhibiting HMGcoA reductase in the liver

20. Which of the following is CORRECT regarding contraceptives?

A. Can be used as a first line in women less than 18
B. Given IV every 12 months
C. Effectiveness with perfect use is 90.8%
D. Long term use is associated with accelerated bone loss

21. You are managing 56-year-old patient with diabetes type 2 and educating him
about the importance of exercise, which of the following regimens will you advise
him to do:
A. Brisk walking for 30 minutes, 5 days a week
B. Jogging for 30 minutes, 5 days a week
C. Strength exercises, 10 exercises
D. Strength exercises, 20 exercises
22. You are treating a patient whom is mentally competent but physically
incompetent; who will you share confidential information:
A. Children only
B. Parents only
C. Patient only
D. Spouse only

23. Regarding traveller diarrhea, which of the following is CORRECT:

A. Common cause of chronic diarrhea is irritable bowel syndrome
B. It is caused by eating or drinking contaminated food or drink
C. It is related to anxiety and stress of traveling
D. It decrease in frequency of stool

24. Which of the following is considered a red flag of acute chest pain?
A. High fever
B. Feeling faint
C. Heart burn
D. Dry cough

25. A 40-year-old with tinnitus, ear fullness, dizziness that is increased with
movement and was diagnosed with BPPV. Which of the following is
CORRECT?
A. Increases with moving head to the side
B. There is usually a clear cause
C. Epley manoeuvre can be diagnostic
D. 50 % of people are affected
26. Patient currently has a problem and is planning to quit in the following 6
months. According to stages of change, which stage is he in?
A. Pre-contemplation
B. Contemplation
C. Action
D. Maintenance

27. Vertigo of peripheral origins is most likely associated with which of the
following?
A. Ataxia
B. Diplopia
C. Dysphagia
D. Tinnitus

28. A 20 years old women presented with a severe lower abdominal pain and
vagina spotting her last menstrual period was 8 weeks ago. On physical
examination blood pressure is 100/70mm hg. Heart rate 100min and
temperature is normal. Abdominal examination reveals rebound tenderness in
the left lower quadrant. Which of the following is the most likely helpful in
diagnosis?
A. CT scan
B. Laparotomy
C. Ultrasound
D. Vaginal swab
29. 42-year-old male, presented with recurrence of gastritis, no previous history of
NSAIDS use, he has H pylori infection; which of the following is a suitable
investigation for him?
A. Urea breath test
B. The bacteria in gram +

30. 76-year-old female patient presented with UTI, no history of alcohol use or
medication, at the night she become restless, abnormal behaviour and
hallucination. The most likely diagnosis is:
A. Confusion
B. Dementia

31. What is the MOST IMPORTANT AND EFFECTIVE LINE of

management in irritable bowel syndrome?
A. Psychosocial support and diet modification
B. Diet in high calorie
C. Intensive and prolonged psychotherapy

32. Which of the following drugs commonly used in general practice and can
cause hyponatremia?
A. Analgesics
B. Antibiotics
C. Anxiolytics
D. Proton pump inhibitors
33. In BPPV: which treatment is considered effective:
A. Antidepressants
B. Anxiolytics
C. Diuretic: furosemide
D. Vestibular sedation: cyclizine

34. In Meniere disease; which one of the following helps in treatment:

A. Epley’s manoeuvre
B. Increase caffeine intake
C. Increase salt intake
D. Diuretics: thiazide

35. Which ethical principle states that communication between patient and a
provider should stay private?
A. Autonomy
B. Honesty
C. Consent
D. Confidentiality

36. All of the following are etiologic causes of iron deficiency anaemia EXCEPT:
A. Bone marrow aplasia
B. Infectious disease
C. Decrease iron in food
D. Malabsorption syndromes
37. 74-year-old male, known case of IHD, type2 diabetes, and peripheral
neuropathy; you referred him to rehabilitation centre; what type of prevention is
this?
A. Primary
B. Secondary
D. Tertiary

38. 7-year-old child presented to the ER with multiple bruises. Which of the
following is NOT indicative of child abuse?
A. Delay in seeking medical attention
B. Carelessness showed by parents/carers
C. The history matches the bruises pattern

39. Which type of anaemia is present commonly with patient who has chronic
renal failure?
A. Haemolytic anaemia
B. Aplastic anaemia
C. Normocytic normochromic

40. 59-year-old female known case of COPD, presented to hospital complaining

of worsening dyspnea. On examination; he was found to have bilateral wheezing
without crepitation, increased JVP and lower limbs edema. Most likely diagnosis?
A. COPD exacerbation
B. Cor pulmonale
C. Pneumonia
41. Which if the following indicats one of life-threating asthma criteria?
A. HR 90 beats/min
B. Oxygen saturation >94%
C. Peak expiratory flow rate near to 50 %
D. Silent chest on auscultation

42. All of the following should be checked in case of uncontrolled asthma,

EXCEPT:
A. Check compliance medication
B. Check the inhaler technique
C. Check the persistent environment exposure
D. Check the basophil level

43. A 75-year-old patient presented with headache in the temporal area, pain in
the jaw that increased with chewing and lasted for 3 days. On examination, BP
170/100, neurological exam was normal, and positive tenderness in the temple
area. Which of the following is CORRECT regarding this patient?
A. The headache is a late onset of migraine
B. Simple analgesics should be prescribed before any investigation
C. ESR should be ordered for the patient
D. The headache has no significant complications

44. A patient with COPD developed tremor and palpitations, which of the
following medications might have caused his symptoms?
A. Ipratropium Bromide
B. Salbutamol
C. Theophylline
45. Patient with dyslipidemia, type 2 DM, MI 3 years ago, and newly diagnosed
CKD (eGFR=45), ACR moderately increased and presence of microalbuminuria:
A. ACEI and ARB in combination
B. Daily low dose aspirin
C. Statin
D. Insulin

46. Regarding physician- patient shared decision making:

A. The clinical should put a plan and treat the patient accordingly
B. Having a dialogue with the patient about his management goal
 MCQs Family Medicine and Public Health
Med37
(Block 1)
‫اﻷﻓﺿل ﺗﺗﺄﻛدوا ﻣن اﻹﺟﺎﺑﺎت‬
1- 56 year old woman presented with random blood glucpse of 220 mg/dl with
no symptoms. Which of the following is true about DM diagnosis?
a) An OGTT is needed to confirm her diagnosis
b) A second random blood glucose reading is needed to confirm her
diagnosis
c) This presentation excludes diabetes
d) This presentation is diagnostic of diabetes

2- A pakistani man was prescribed metformin for diabetes management. Which

of the following is true?
a) causes abdominal pain and diarrhea during start of medication
b) Causes hypoglycemia
c) Causes weight gain
d) Other newer oral hypoglycemics are better than metformin if patient can
afford it

3- 72year old, diabetic patient, on metformin and insulin, he had a lot of

hypoglycemic attacks last year, what is the HA1C target?
a) <8
b) <7
c) < 6.5
d) <11

4- Masquerade disease in Murtagh:

a) Depression
b) HTN
c) Abdominal pain

5- 75 year old man with terminal illness prostate cancer and bony metastases,
what is correct regarding his pain management?
a) morphine isnt given in end life care for the fear of addiction
b) morphine is kept as the last choice in end of life care
c) NSAID has no role at this stage
d) psychosocial and spiritual suppor can help in his pain control
6- 24 year old male presnted with elevated ESR, positive test for HLA-B27 and
bamboo spine on spine radiograph, whats the most likely diagnosis?
a) ankylosing spondylitis
b) multiple sclerosis
c) reiter syndrome digoxin toxicity
d) rheumatoid arthritis

7- 50 years man with upper leg pain increases with walking decrease with
setting with positive peripheral intact?
a) cludication
b) aortic aneurism
c) spinal stenosis

8- A builder who complain of lower back pain, moderate in severity, gradual in

course increased by heavy work and long standing relived partially by
paracetamol, What is the short term and long term management of acute back
pain:
a) Back education
b) Back support
c) Stay active and exercise regularly
d) Bad rest for at least 2 weeks

9- What is correct about Lumbar disc disease?

a) Involves L5-S1
b) Requries surgical treatment
c) Forward flexion of the trunk releves the pain
d) Treatment require

10- Regarding Alcohol what is true?

a) withdrawl symptoms worse at 48 hours
b) Thiamine def. occurs due to acute alchol intoxication
c) The most organ affected by thiamine def. is Liver
d) wernicke-korsakoff syndrome is due to thiamine Intoxication

11- 7 years old, chronic dry cough, recurrent attack, white sputum, have allergic
rhinitis, no hx of asthma or allergy, what is the common cause of chronic
cough?
a) Asthma
b) Postnasal drip
 c) bronchiectasis
d) GERD

12- Letter A ‫? ﺗرﻣز ﻻﯾش‬

a) Clear evidence from well-conducted, generalizable random-ized
controlled trials that are adequately powered

13- correct about break bad news?

a) All Information can affect his future adversely

14- Mesealse vaccines?

a) Live attenuated

15- Protective diet of CVD?

a) Fat Less3% of total intake
b) Fat Less30% total intake
c) Fat Less40% total intake
d) Fat Less50% total intake

16- Associated with secondary HTN?

a) Phechromacytoma
b) DM
c) Dyslipedimaia

17- 10 yr old boy w/sore throat. No dysnea, chest pain or cough. Temperature
38.6, throat Examination revealed tonsils exudate. No Lymphadenopathy
detected. Calculate modified centor?
a) 2
b) 3
c) 4
d) 5

18- 66-year-old female; c/o pigmented lesion on her back. The diameter was 1
cm, regular dark brown in color, with irregular shape and inflammatory base &
oozing blood. The patient admitted that there is change in the size of lesion.
She denied any change in sensation. Regarding Weighted-7point checklist, what
is the score?
a) 4
b) 5
c) 6
 d) 7

19- All the following is red flags of sore throat except:

a) candidaitis
b) presisitent fever
c) membrenous exudate

20- 30 year old female came to clinic with her baby (9 months old) and fully
breatfeeding, have amenorrhea. she ask about lactational amenorrhea method.
which one of the following factors reduce the effectivince of LAM?
a) her age
b) the baby age
c) full breast feeding
d) her amenorrhea

21- 40 year old male patient newly diagnosed with DM with no CVD risk and
given Metaformin and aspirin,aspirin give as ?
a) 1ry prevention
b) 2ry prevention

22- What correct regarding antihypertensive drug ?

a) Hyperkalima corrected by potassium sparing dirutic
b) Thiziad should given if a patient has a diet rich in potasium and
magnesium
c) Thizaid least potent anti hypertension drug and indicated when compaine
with heart failure
d) Loop diuretic are good first line management for HTN

23- For assessment of esophageal cancer which of following patient need

urgent referral within 2 weeks for endoscopy?
a) male patient 55 years present with weight loss and dyspepsia

24- You with senior resident in elevator and he said to “ don’t forget the HIV
prescription for Nassir before discharge him”
a) Confidentiality

25. About active listening which of the following is correct:

a) Eye contact not important
b) Active listening is a skill to develop
c) It doesn’t matter if the doctor sit or stand beside the patient
 d) Active and passive listening are the same
26. Major complication of ectopic pregnancy that cause dizziness:
a) Hypovolemic shock
b) IPD
c) Infertility
d) Uterine perforation

27- 70-year-old female with melena, and presyncope symptoms, hx for using
NSAID and upper endoscope show gastric ulcer
Most likely mechanism of gastric ulcer:
a) endothelial cell death
b) increasing production of acidity
c) anti-platelet.
d) inhibit cell repair

28- Patient quit smoking for more than 6 months but not 5 years , in which
stage he is
a) pre contemplation
b) contemplation
c) action
d) maintenance

29- 17 years old girl complaining of chronic diarrhea True about irritabile bowl
syndrom
a) Abdominal pain relived partialy by defication
b) Unexpected wight loss and animea

30- 48 female patient complains of episodic dizziness ,tinutes , hear loss form 1
year ago. she had attack every 1 to 2 weak that last 1 hours , she describe the
dizziness as she felt the room is spinning around her, What the diagnosis ?
a) Acute Labrynthites
b) Meniers disease
c) BPPV
d) Vestibular neuritis

31- 65 year old woman who is otherwise healthy underwent hip replacement
surgery ..... 2 days after surgery she started having hallucinations, she didn’t
have any psycological problem before ‫ وﻗﺑل اﻟﻌﻣﻠﯾﺔ ﻛﺎﻧت واﻋﯾﺔ ﺗﻣﺎﻣﺎ‬what is the
diagnosis?
a) Delirium
 b) Dementia

32- Male, 55 years old, come chest pain, what is the first step you do?
a) ECG
b) Cardiac enzyme

33- 40 y female admitted because she fall, She feel dizzy and unsteady when
she turns her head right, in examination normal CNS GAIT +sensory, no injury,
What is your management?
a) Epley maneuver
b) Refer to neurologist
c) Take betahistine
d) MRI brain

34- Patient present with symptoms of cluster headache, what is the

management?
a) Oxygen therapy

35- Drugs show increase cessation ?

b) Citalopram
c) Varenicline

36- 58 y male, complaining of substernal pain and dyspnea.

a) asprin
b) Propranolol
c) ACE

37- About family medicine which one is CORRECT?

a) consultation mean take from another cosultant to manage the patient
b) lack of comprehensive approach
c) Opportunistic health promotion …. Stott and Davis Model

38- ‫ﻣرﯾض ﺟﺎ ﻓﺎﻗد اﻻﺣﺳﺎس ﻓﻲ رﺟﻠو‬

He has macrocytosis and high MCV and hypersegmented nucleaus on blood
smear ‫?اﯾش اﻟﺗﺷﺧﯾص ﻣﺎاﻓﺗﻛر اﻟﺑﺎﻗﻲ ﺻراﺣﮫ‬
a) Vit b 12 deficiency
b) Vitamin C deficiency
c) Iron deficiency
39- DM Patient with HTN stage…. CKD the medical rehabilitation consider as ?
a) Primary prevention
 b) Secondary prevention
c) Tetiary prevention
d) Promordial
40- 17 old girl with cough during exercise for 4months recently has white
sputum. Next investigation?
a) CXR
b) SPIROMETRY
c) Albuterol trial

41- How to detect kidney disease in diabetic patient?

a) Serum creatinine
b) Albumin level
c) Creatinine albumin ration(ACR)
d) Urine analysis

42- male patient known case of COPD... bilateral edema, What cause of
dyspnea?
a) Bronchial asthma
b) COPD exacerbation
c) Cor pulmonale
d) Pneumonia
e) Pneumothorax

43- 7 years old child presented with multiple bruises. Which of the following is
NOT an indication of child abuse?
a) aggressive behavior.
b) late presentation.
c) delay seeking care
d) history matches signs and symptoms.

44- 34 year old female with menorrhagia, she has iron deficincey anemia,
regarding iron supplement treament what is Correct:
a) Acidic environment enhances iron absorption from GI.
b) Preferabble iron supplement taken with food.
c) Iron supplement should discontiniud if Hgb normal.

45- 21 years female patient have IBS what is red flag in diarrhea?
a) Travel over sea
46- 7 years boy came with his parents , his teacher report that he interrupt his
friends in school , cant set still in his chair , Has trouble keeping attention on
tasks, shout answers . ..... (‫ )ﻛﺎﻧت ارﺑﻌﮫ اﺷﯾﺎء‬, and had low grades in school , what
is the best management?
a) Behavioral therapy like social support, local parent-training and
Psychotherapy only
b) Antidepressants with Psychotherapy because its more effective
c) methylphenidate only
d) methylphenidate with psychotherapy because its more effective

47-Regarding to statin what is true?

a) safe for pregnant
b) give with fiber
c) if transaminases >=3 uper limit normal stop it
d) if creatinine kinase >5 uper limit normal continue

48- which of the following is one of international patient safety goals ?

a) avoid unnecessary documentations during admission.

b) communicate all the details of the case clearly with patient.
c) completeness of discharge reports of patient.
d) reduce patient’s waiting time.
 OSCE
( Block1)

Station 1 “SPIKES”:
Breaking bad news to patient with chronic back pain, diagnosed with
metastasized prostatic cancer to spine and liver
• What is cancer?
• Why there was back pain?
• What is the cause of jaundice?
• Why there was urinary symptoms?
• Options of treatment?
• Side effect of morphine, and if it causes constipation how to
manage it?
• where do you want to refer the patient?
• How the prostate cancer metastasizes to the liver?
• Can the patient cure from prostatic cancer completely?
• The patient was angry because he was diagnosed late so he wants
to complaint and he need all the reports about his condition.
Station 2 “History of sore throat”:
A history of 12-years -old female presenting with sore throat for 3 days.
- Taking detailed history including “cough, hoarseness of voice”
- Please not forget to ask about the ICE

After the history the doctor will show you this picture and ask you:
• To comment on picture “inflamed tonsils with bilateral exudate”
• Centor criteria?
• Will you give her antibiotic or not?
• What is the non-pharmacological treatment?
• Prevention and screening?
• Will you give her sick leaf or not?
Station 2 “Data interpretation”:
Scenario of 30-year-old male patient vegan and healthy have family history of
diabetes and symptoms of vitamin B12 deficiency, interpret his data:
Interpret hba1c (6%)? Impaired glucose
Interpret fbs (112)? Impaired glucose
What is provisional diagnosis? Prediabetes
LDL? High
HDL? Low
Cholesterol High
Triglycerides Intermediate
What is provisional diagnosis? Dyslipidemia
Waist circumference Hight
What is threshold in male circumference >102 cm in men
Calculate BMI? 28,
According to this interpretation what is the Metabolic syndrome
provisional diagnosis?
What is in picture 1 Xanthelasma

According to picture 2 1. Dyslipidemia with DM

what is indication of this drug? 2. Metabolic syndrome not controlled
with life style modification in 3
month

What is the contraindication of atorvastatin? 1. Pregnancy

2. Active liver diseases
What is investigation do before giving this 1- AST, ALT
drug? 2- Renal function test
According to CBC what is provisional Macrocytic normochromic anemia (vit B12
diagnosis? deficiency)
 Family medicine – B2
MCQ
Q1- NOT a manifestation of autonomic neuropathy:
- Leg pain
- Diarrhea
- Hypoglycemic unawareness

Q2- Which of the following is CORRECT regarding Morphine in palliative care:

- Naloxine is antidote
- Contraindicated in elderly due to respiratory depression.
- Morphine must be given in hospital
Q3-Sudden increase in number of Cases of Covid19 in Medina:
- Prevalence
- Outbreak
- Epidemic
Q4- 23 YO patient with sudden onset back and buttocks pain, INVESTIGATIONS negative for
rheumatoid factor, positive HLAB27, which of the following is the patient at greatest risk:
- Uveitis
- Thrombocytopenia
- Splenomegaly
- Xerostomia
Q5- 80 YO patient with hip pain, investigations: elevated ESR, DX: osteoarthritis, which of the
following is correct regarding osteoarthritis:
- Patient usually complain of morning stiffness 1-2 hours.
- Pain only on active range of movement of the joint
- Associated with history of trauma
Q6- 42 YO male, came to ED urgently, had 2 days of new onset backpain after he moved
furniture to the new home, raised leg test of left leg revealed replicating on the back,
neurological exam normal, what’s the most appropriate next step in management:
- CT with Contrast to spine
- Lumbar X-ray
- Rest and NSAIDS
Q7- 66 years old female, fell down and suspect to have osteoporosis, what’s the best test to
confirm DX?
- Serum calcium
- Dexa-scan
Q8-Regarding questions of asthma control test in adult:
- Ask about past 6 w have you had shortness of breath
- Ask about past 6 w have you had use inhaler or nebulizer
- CAT Score 20 or more mean well control

Q9-About drug in elderly, family doctor should do all except:

- Avoid prescribing before diagnosis
- Review medication regularly
- Start low dose then increase
- Start drug to treat side effect of another drug

Q10- 76 y /o male came with right side headache continuous and throbbing in nature preceded by
malaise and ....he has a hx of transit ischemia stroke on examination has tender in left temple
and high ESR ...
which of the following is a good treatment:-
- oral prednisolone
- oral anticoagulant
- oral antidepressant.

Q11- what is true about the diagnosis of ADHD?

- educational/psychosocial impairment is not important
- teacher observing report is enough for diagnosis
- only psychiatrist or a specialist can make diagnosis
- CT of brain is diagnostic

Q12-Why we can’t combine statin and fibrate

- increased risk hepatotoxicity
- increase risk of myopathy and rhabdomyolysis
- increased CVD
- D-increased cholesterol

Q13- Correct about Calcium channel blockers:

-Verapamil contra in first and second heart block
-Dihydropyridine cause increase in HR more than lower HR

Q14- patient with family history of CVD more benefits of reducing risk of CVD
-Statin
-Aspirin

Q15-BCG vaccine given at-

- 0
- 2
- 4
- 6
Q16- During consultation of contraceptive which of the following is correct:

- Combined OCP is not C/I in uncontrolled HTN

- age of 28 and smoking is C/I for combined OCP
- long term use of medroxyprogesterone acetate increase the risk of bone loss
- hormonal IUD causing increase blood loss in menstrual cycle.

Q17-3yo boy with fever rash, P/E: ill look, none blanching rash, neck stiffness. Dx is:
- Mengiococal septicemia
- Kawasaki disease
- ITP
- D

Q18-Treatment of Iron deficiency anemia :

- For 3-6 months
- Stop when anemia is corrected

Q19-Patient with HTN,DM, asking for a Drugs reduce the progression of CKD:
- ACEi
- Insulin

Q20-Pakistan patient didn't speak arabic :

- -Patient's responsibility to provide a translator
- Physician's responsibility to give the patients the information in an understandable way
- language is not barrier
Q21- Sensitive health problem best dealt with in:
- Counseling
- Mass media
- Lectures

Q22- best description of BIO PSYCHOSOCIAL MODEL:

Q23-Which of the following drugs cause HYPONATREMIA and should used with caution in
elderly?
- ACE inhibitors,ppi, diuretic

Q24- 34 yrs old travel to southeast Asia ,one week of arrival develop nusea , abdominal cramps
and watery diarrhea , no fever , blood , pus . Treatment of this patient :
- Oral rehydration only
- Prescribe amoxicillin
- Prescribe doxycycline for 5 days
- Symptomatic treatment with loperamide
Q25- Patient presenting with symptoms of epiglottitis ( Drooling of saliva,…. ) , What’s
causative organism?
- H. influenza B

Q26- 4 months baby missed his vaccination what to do?

- give him vaccination of 2months and after 4 weeks of 4 months vaccination then
after 4 weeks go like normal of 6 months vaccination
- Give him Vaccinations of 4 months then ask to return in 2 months, then ask to return
in 2 months.

Q27- 32 YO female came to ED with SOB, initial vitals: RR 28 breaths/min, she can speak in
full sentences saying “I can’t breath normally”, she had muscle cramping ‫او شيء كذا زي تشنجات في‬
‫يدها ورجلها اعتقد‬, chest auscultation + CXR normal, on re-evaluation: vital normal RR 18
What is the most probable diagnosis:
A) anxiety attack
B) Asthma exacerbation
C) Pneumothorax
D) Pleural effusion

Q28-42 YO male with chronic diarrhea, he had it for several years and lost 25 lb, the stool large
in volume, occasionally greasy, without blood, he had mild abdominal pain, On examination:
thin male with decreased muscle bulk and mouth ulcers, The best to diagnose is:
A) 72 hours fecal fat quantifier
B) CT abdomen w/contrast
C) small bowel biopsy
D) small bowel ‫نسيت‬

Q29-Acute confusion is definition of?

- Acute delusion
- Dementia
- Pseudodementia
- Delirium

Q30-Middle age female sudden onset dizziness, start with sitting up and lying down in bed,
normal neurological examination, no hearing loss, most likely dx is?
- Basal migraine
- Benign cerebellum tumor
- Brain stem ischemia
- Calcium debris in semi-circular canal
Q31- Which of the following is not a feature of heart failure?
- crackles in the chest
- Lower limb edema
- Hepatomegaly
- Claudication of the leg

Q32- 52 years old female patient known case of osteoarthritis ( Hb and hematocrit low) (iron
low) ( ferritin high) Reticulocyte count ‫مو مكتوب‬
‫ويبغى نوع االنيميا ؟‬
- Iron deficiency
- Anemia of chronic disease
- Hemolytic anemia caused by antibody
- Myelodysplastic syndrome

Q33- characters for Meiners disease:

- Hearing loss, tinnitus, vertigo

Q34- 45M presented with chest pain dyspnea on excretion, abnormal level specific to cardiac
abnormality:
- ECG
- cardiac enzymes
- pulse oximetry

Q35- Which of the following is correct regarding alcoholic hepatitis:

- ALT is usually more elevated than AST
- Chronic liver disease may lead to cirrhosis
- Mallory antibodies present in nucleus
- Fatty liver is usually smaller due to its shrinkage

Q36- Patient with Hx of Gout, which medications to stop

- ACEi
- Hydrothiazide
- Statin

Q37 -78 YO male presented with pigmentation on his face lesion is 8 mm and largest in
diameter, irregular in shape with oozing sign of inflammation, regarding to 7 points chick list
which is the major had 2 points?
- irregular shape
- presence of inflammation
- presence of oozing
- lesion
Q38-which of the following is correct regarding Sinusitis?
- A-Frontal sinus most commonly affected
- B-Post-nasal drip with chronic sinusitis

Q39- Patient couldn’t tolerate metformin, wants a medication that doesn’t affect her weight:
- SGLT2 inhibitors
- ACEi
- Sulphonylurea.
- BB

Q40- 5A’s of smoking cessation:

- Ask, advise, assess, assist, arrange.

Q41- Which of the following factors is most important to determaine success of smoking
cessation program:
- When doctor advise patient to quite
- Patient desire to quite
- Inclusion of behavioral modification strategies
OSCE

Station 1 Case1: Dx? Atopic dermatitis

3 Non-pharmacological treatments
2 pharmacological treatments
Case2: Describe what you see. (Herpes zoster)
What’s most likely Dx?
What other condition can the causative organism cause?
Case3: CBC interpretation.
Dx?
One investigation to confirm?
Treatment?
Cause?
How to confirm?

Station 2 Patient education – Back pain

Station 3 Occupational history

 Family Block
B3 – Med37

Answers:
Correct
Not sure
 1 60 y.o male complaints of sever back pain, tiredness,
thirst. Positive Bence Jones proteins in urine.
Diagnosis:
A Multiple myeloma
B diabetic neuropathy
C Ankylosing spondylitis
D Bone metastasis
Information

2 What is NOT true regarding palliative care:

A Aims for absolute cure
B Morphine contraindicated as it causes
respiratory center depressed
C Morphine cause drug addiction
D It must be in hospital
Information Murtagh

3 Drug used to improve alcohol withdrawal symptoms:

A Diazepam
B
C
 D
Information

NICE Guidelines <E-platform

4 What’s true about diabetes T1 and T2:

A Ketoacidosis is more common in T1
B T2 is autoimmune
C having Family history is significant in type 1 more
than type2
D
Information Murtagh

5 What’s true about palliative care:

A usually it is end of life care
B best to be held in hospital
 C used in ALL cancer patients
D Used ONLY for cancer patient
Information Murtagh

6 Which sentence related to alcohol dependency

correct?
A ALT more than AST
B Alcoholic liver related to acute hepatitis
C Fatty liver is usually smaller due its shrinkage
D Mallory bodies present in cytoplasm of hepatocyte
Information Recourse:
E-Platform Video

7 Regrading to pathological process, correct answer

is:
A Spondy related to spinal cord
B Spondylosis >> degenerative
C spondylolisthesis -> inflammation
D Spondylitis -> slipped
Information

E-Platform

8 What is correct regrading the oral hypoglycemic drug?

A Biguanides not use together with SU
B SGLT2 cause wight gain
C Sulfonylurea cause hypoglycemia
D TZD safe with HF
Informatio Murtagh
n

9 which statement are true regarding Lumber disc

disease :
A Relived with flexion
B Usually affect L5-S1
C Usually need surgical treatment
D Bed rest for 1 to 2 week
Information Murtagh

10 The best management plan for majeed, 45-year-old,

diabetic and no complication
A A1C should be less than 7% -
B HDL should be less than 40
C FBG should be less than 180
D Triglyceride level less than 294
Information

ADA guideline

11 Model help in Health seeking behavior

A Stott and davis model
B Pendleton
C Murtagh
D Neighbor model
Information Consultation lecture

12 Peak age of back pain

A 35-55
B 15-35
C 65-75
D >75
Information
Murtagh

13 Temp to vaccine storage:

A ( +2- +8 )
B (-2 - -4)
C (0- +4)
D (+4- +8)
Information E-Platform recourses
 14 Method of education, when the audience Passive
receivers?
A Counseling
B Demonstration
C Group discussion
D Lecture
Information

Health education introductory lecture

15 Cooper IUD can prevent pregnancy by all the

following except:
A Prevent ovulation
B Prevent implantation
C Inhibit ovum transport
D Inhibit sperm migration
Information Murtagh

16 absolute risk of CHD in non obese is 4/100

individuals, if risk increased by 25% in obese
individuals:
 A 5/100
B 2/100
C 6/100
D 4/100
Information

17 53y/o newly diagnosed HTN, what is initial evaluation:

A rest ECG
B Echo
C stress test
D
Informatio CBCL week 2
n

18 4yrs boy, fever, sore throat, non productive cough.

Feel fullness in his ears. 37.8 temp. No enlarged
lymph nodes. Ear exam normal and clear. Throat
exam: enlarged tonsils,No exudate. Most probable
diagnosis:
A viral pharyngitis
B acute otitis media
C streptococcus pharyngitis
D viral pneumonia
Information Murtagh

19 reading of first stage HTN according to AHA :

A 135/85
B 140/90
C 145/90
D 128/75
Information AHA guidelines

20 potential risk of COC:

A breast tenderness
B dysmenorrhea
C anemia
D Endometrial cancer
Information

Murtagh

21 What is correct about ACE-I?

A Improve survival and morbidity for CHF patients
B Cause hypokalemia and dry cough
C C/I in unilateral artery stenosis
D Mechanism of action convert angiotensinogen to
Angiotensin I
Informatio
n

Murtagh + Medscape

22 What case doesn't need referral?

A Female, 44 years, with IDA
B Age> 60 with IDA
C Age >50 with rectal bleeding
D Male ,Age>40 with unexplained weight loss and
abdominal pain
Information NICE guidelines
E-platform

23 Female 33 years present with painless left breast

lump discovered accidentally, in outer upper
quadrant, 2x2 cm, no skin or nipple change. What’s
the best action to do?
 A Urgent referral 2 weeks
B Reassurance
C Emergent referral to ER
D Do nothing
Information NICE guidelines

24 14 yrs male, fever 38.7, enlarged hyperemic tonsils

with exudate, no cough, dyspnea, chest pain,
lymphadenopathy.
A Empirical Abx
B No treatment needed
C Surgery
D Treat symptoms
Information Murtagh

25 You received a call form daughter of 75 y/o lady, her

mother was slightly off food yesterday, could not get
more information as she seem confused and she
never been confused before.You will make a home
visit, all these are the contents of your doctor’s
handbag except
A Pinard stethoscope
B Alcohol gel
C Blood test equipment
D Thermometer
Information E-platform

26 Patient traveling abroad what Most common disease

of international travelling?
A Diarrhea
B URTI
C
D
Information

27 Most effective helping smoking cessation

A Behavioral group
B Self-help material
C
D
Information

28 Female complaining of dizziness she feel surrounding

spinning when she mover her head to the RT side
Intermittent and last less than 10s. DDX :
A BPPV
B
C
D
Informatio
n

‫ للموقع‬٣٦ ‫ملخص‬

29 20 years male with Hx of anorexia, non bloody

diarrhea , weight loss 20 kg for 18 months , in
examination : diffuse abdominal pain , perianal
involvement, rectal examination: lateral
erythematous rectal wall . DX :
A Crohn’s disease
B IBS
C UC
D Bacterial dysentery.
Information

30 32 y/o female patient presented with anxious most

time from the past 9 months + difficult concentration
+ minor errors in work + difficult sleeping in night +
take Ca supplements + Normal Ex. And Iv.
A Generalized anxiety disorder
B hyperparathyroidism
C hyperthyroidism
D frontal lobe dementia
Information

Murtagh

31 59 years, male, Dizziness, what ddx to be missed:

A Cardiac disease such as arrhythmia
B BPPV
C HTN
D
Information

Murtagh ‫تم االعتراض‬

32 20 years male, 2 days diarrhea, no vomiting, fever,

bloody stool nor mucous. No hx of eating outside.
Normal examination & vital signs except for
BP90/70. Most appropriate management:
A maintained ORS
B Amoxicillin for 5 days
C loperamide
D Antiemetic
Information

33 55 male, present with angina, use BB, anti-lipid, PPI

and for erectile dysfunction: sildenafil. What is C/I:
A NITROGLYCERIN
B Morphine sulphate
C Unfractionated heparin
D Aspirin
Information

Murtagh

34 60 years old, history of anterior MI 3 months ago,

medication: ACEI and antiplatelet. Normal
examination and normal investigation.
Which medication of the following consider
secondary prevention of future MI:
A beta-blocker
B alpha-blocker
C Calcium channel blocker
D Nitroglycerin
Information

Murtagh

35 47 years old, male presented complaining of very dark

stool, and endoscopy showed Duodenal ulcer. Stool
antigen = positive H.pylori.
Which medication of the following included in the triple
treatment of H.pylori?
A omeprazole
B Ranitidine
C NSAID
D
Informati
on

36 you are doing a medical interview and you are facing

difficulty in communication. You can't understand
what brought the patient to the hospital.What is the
best way to manage this?
A Redirect the patient whenever he lost
B Ask direct questions
C Ask open questions
D Involve the patient in management plan
Information ‫تم االعتراض‬

37 which of the following is the lipoprotein that

responsible for diving lipid related CVD risk?
A LDL
B Cholesterol
C HDL
D
Information Dyslipidemia lecture
 38 all of the following are principles of family medicine
except
A Disease centered care
B Coordinate..
C comprehensive
D Continuing care
Information

Introduction to family medicine lecture

39 An important component of root cause analysis

(RCA) meeting to be successful ?
A A senior leadership must be attended
B Respect the patient confidentiality
C Arrange a suitable time for all physicians
D Ensure participants safety
Information ‫تم االعتراض‬

40 A 67 year-old male, with dyspnea, productive cough

for 6 months. Heavy smoker. Examination revealed
markedly bilateral wheezing. Which of the following
tests confirm the diagnosis of COPD?
A FEV1/FVC ratio <60% after bronchodilator
B PaO2 < 55 or SaO2 <88%
C
D
Information

GOLD

41 15 years-old female, fatigue, heavy menses, Hgb 8.9,

MCV 72. What to expect in investigations?
A Decreased iron, decreased ferritin, increased TIBC
B Increase iron, increase ferritin , increase TIBC
C Decrease iron , decrease ferritin , decrease TIBC
D Decrease iron, increase ferritin, decrease TIBC
Information Murtagh

42 Regarding Temporal Arteritis, all of the following

correct EXCEPT:
A unilateral visual loss
B Photosensitive, Facial macular rash on cheeks on
the side of the pain.
C pain in the jaw while eating.
D pain in hip and shoulder girdle
Information Murtagh
 43 55 yrs female recently diagnosed with diabetes. The
MOST effective screen test for diabetic nephropathy:
A ACR
B kidney US
C serum creatinine
D urine dipstick
Information ADA guideline

44 Known asthmatic patient, symptoms more than

2/week, use rescue inhaler more than 3/week,
symptoms on exertion, normal examination, he use
low-dose ICS. Next management would be:
A Medium-dose ICS
B Stop ICS, start LTRA
C ICS + LTRA
D
Information

45 According child abuse which is correct:

A Family doctors, no responsibility
B Learn signs and symptoms, help to deal with it and
recognize it
C Easy to recognize
D Observe and listen enough
Information
 46 Which drug increase survival in congestive heart
failure:
A ACE inhibitors
B PPI
C NSAID
D Beta blocker
Information

Murtagh

47 35 years-old female patient, married, known case of

depression, asthma and CKS, she presented
complaining of Migraine. What is the BEST preventive
TTT for her?
A Amitriptyline
B Propranolol
C Topamax
D Sumatriptan
Information

NICE guidelines

48 4 years-old child, presented to ER with broken

forearm with his baby-sitter, they tried to reach to
his parents they couldn’t. What is the best next step?
A Doctor should wait for the COURT approval to start
 !the management
B Doctor should NOT doing any thing and wait for the
parents’ consent.
C The baby-setter’s consent is sufficient.
D The doctor should start doing X-ray and managing
the child WITHOUT consent.
Information ‫تم االعتراض‬

OSCE:
Written Data interpretation
- Glucose; FBS, HbA1c, 2-hour tolerance> What’s your Diagnosis
(DM)
- Target of pre-prandial and 2-hr postprandial glucose.
- lipid profile interpretation, calculate BMI and classify it.
- Mention 6 CVD risk
- Mention 4 non-pharma management
- prescribed Metformin and 2 reasons ?
- Urine analysis interpretation + 2 Dx + Treatment
Case management (IBS)
- take history
- What’s Diagnosis
- What Investigations to order?
- Management 7 steps
Challenging communication (post MI health
education)
- Clarify the condition what’s MI, Risk factors, clinical picture
- Non-pharma management
- Investigations to order as follow-up
- Side effect (clopidogrel)
- When back to ordinary life activity, exercise, sexual life, work,
travel, driving.
-inflammatory pain pattern,uveitis??
Ankylosing spondylitis

2-vertical nystagmus +ataxia?

Brainstem
CN8

3-most commen organism for acute sinusitis?

GABHS
E.COli
Streptococcus pneumoni
4- low serum sodium, urine osmolality 420 serum osmolality 80 what’s the diagnosis?
- SIADH
- hyponatremia
- diabetes insepidous
- hyperglycaemia
5- who is capable of giving consent?
- 14 y o boy with a fractuare came with his parents
- disoriented patient from an accident
- 18 y o pregnant woman going to labor
- 32 y o man retarded came for elective surgery
6- sore throat criteria
7- melanoma criteria : whats the major criteria?
- irregular shape
8- abosoulte risk of cancer in non smokers 4-100 if the risk in smokers increased by 100%
whats the relative risk in smokers?
-8
9- Pregnant woman came with hypotension, ectopic pregnancy and rupture of fallopian tube
whats the immediate management?
- IV recussitation and antibiotic then wait
- salpingectomy and blood transfusions
‫ ﺑﯾﺷﻧت ﺣﺎﻟﺗﮫ ﺳﯾﺋﺔ ﻣرة واھﻠﮫ طﻠﺑو ﯾﺳووا‬١٠-euthanasia
Whats the correct statement?
- euthanasia is illegal in KSA

-11smoking cessation stage

-12question about steps of evaluate risk
-13medication used for prophylactic migrane “patient has asthma”
-14medication used for withdrawal symptoms of alcohol with hallucinations
15- patient with knee pain and LBP the pain increases with movement and decreases with
rest , she doesn’t have morning stiffnes.. she also have (pain?) in interphalangeal joints
What is she expected to have?
-DIP has bouchers nodules
-PIP has heberdens.. nodules
- normal ESR
- positive rhamtoid arthritis
16- patient want to quit alcohol and want supplemintation, what would you recommend ?
- thiamin and vit c
- thiamin and folic acid
17- which of the following diseases should be reported to WHO within 24h?
- cholera
18- 12 months old baby, what vaccines to give him ?
- MCV4, MMR, OPV, PCV
19- which of the following anti-diabetic drugs would prescribe for a patient who has ( 3
things ) CV risk, wants to reduce his weight and ...
- SGLT 2
- DPP 4
- sulfonylurea
- thiazolidinediones

20-migraine headache,uncontrolled HTN,angina…prophylactic treatment contraindicated

!???
Sumatriptan
Acetaminophen
Aspirin

21-treatment of ADHD
Inhibit reuptake dopamine
Stimulating metabolism of NE
22-hb low,mcv high ,neurological sign???
B12 deficiency
23-55 male patient diagnosed with HTN ,creatinine 2…..
Treatment??
CCB
ACE

24-which stage????Decided to cut in next 30 days

Action
Preparation
Contemplation
25- for safety purposes this drug is not indicated for monotherapy:
- SABA
- LTRA
- LABA
26- one of the goals of international safety ..? is :
- decrease patient’s waiting list
- decrease paper work in admission
- communicate all information correctly to the patient

27- 5 steps of risk management

-identify, analyze, action, monitor, control

28- contraindications of OCP —> migraine with aura

29- which of the flowing affect LAM —? The baby age
 Family medicine (B2) med 38

1. Feature distinguish family medicine practice ?

2. Mother brings her 1 years son for vaccination, he didn’t not receive any vaccine except at time of birth,
What will you advice her?
- Catch up immunization schedule

3. ‫ﺣق اﻟﻠﻲ ﻟﻣﺎ ﻧﺳوي دورات ﻟﻠﻧﺎس و ﻋﻠﻰ ﺣﺳب اﻟﻔﺋﺔ اﻟﻣﺳﺗﮭدﻓﺔ ﻧﺧﺗﺎر ﻛﯾف ﺗﺻﯾر اﻟدوره‬

‫ﺑﻌدﯾن اﻟﺳؤال اﻧو ﻟﻣﺎ ﻓﯾﮫ ﻗروب ﻣن اﺷﺧﺎص وﺗﺑﻐﻲ ﺗﻌﻠﻣﯾﮭم ﺳﻛﯾل ﻛﯾف ﺗﺳوي اﻟدورة‬
- Demonstration
- Group discussion
- Lecture

4. correct matching (drug with its compelling indication)?

- ACE and heart failure
- DM and B blockers
- CKD and diuretics
- ARBs and pregnancy

5. What is true regarding fundamental component of palliative care?

- no need to tell the patient his information in order not to get upset
- absolute cure is the goal-
- emotional, spiritual support to him and his family

6. 33 Y.O male, Healthy, Non smoker, presented to you for evaluation of his chronic cough, it started 8
weeks ago, he went for urgent care and they gave him antitussives and bronchodilators but he didn't
improve, 1 week later, he went there again and they gave him a course of azithromycin but it didn't worn
too, the cough persisted and didn't improve, he said that his cough increase with laying down to sleep
and associated with sore throat. And it increases when he drinks caffeine.
What is the most likely diagnosis?
- Asthma.
- Chronic Bronchitis.
- GERD.
- Pertussis.

7. 52 Y.O female , known case of RA, came to you after 1 month for post operative follow up after surgery
for removal of prosthetic knee joint after joint infection and osteomyelitis. You ordered a CBC:

WBC: 8000

Hgb: 9.5

MCV: 85
Hct: 27%

Plt: 450000

And there was low serum iron, high serum ferritin, normal transferrin receptor. What is the most likely diagnosis?

- Anemia of chronic disease.

- Hemolytic anemia duo to antibiotic.
- Mylodisplasia duo to RA.
- Acute blood loss duo to surgery.

8. Most common couastive origanism of maxillary sinusitis in adult ?

- Fungus
- gram negative becteria
- gram postive becteria
- viral

9. patient have DM2 and HTN take metformin 500mg BID and 5mg XL gliclazide, then he start to have
increase attacks of hypoglycemia, how should we manage him?
- Stop gliclazide and monitor glucose level
- Stop metformin and monitor glucose level
- switch from gliclazide to (glimepiride ٢mg)
- don’t do any things

10. patient has alcoholic liver disease and devolop cirrhosis , he has ecchymosis and increase prothrombin
time, how to manage?
- Vitamin k

11. 30 year old female with recurrent attacks of diarrhea. Loose stools. No fever or blood in stool.
Examination and vital signs normal. What is the management?
- lactulose
- metronidazole
- codien
- Meevin

12. 34 year old female with internment attack of vertigo, fullness in the right ear, lasting 1 hour, associated
with progressive right ear hearing loss, not using any medication, no hx of recent trauma. What is the
diagnosis ?
- BPPV
- Vestibular neuritis
- Meniere diseases
- Cholesteatoma

13. 24 years old male healthy complain of sever back pain associated with severe right leg pain, increase with
activity. After he lifting heavy weight, On Examination: We found paresthesia in L4-5, What is most
diagnosis ?
- Ankylosing spondylitis
 - Metastatic cancer
- prolapsed intervertebral disc

14. A 35 year old woman with 3 kids wants to delay pregnancy for 6 months. You checked her file she’s
healthy with no medical diseases, what do you recommend?
- compination ocp
- copper IUD
- mirna ring
- subdermal implant

15. drugs cause hyponatremia?

- PPI , ACEI , Diretics

16. pt have long time sweat in palm and sole what should we important ask in history?

- mild HTN
- hypothyroidism
- Hyperparathyroidism
- alcohol

17. 6 month child immunocompromised or had severe allergy?

- Don't give BCG , OPV , Measles

18. diagnose HTN with only one reading?

- 42yr female 153/93
- 188/93
- 177/83

19. -investigate for postural hypotension ?

-check BP setting then standing after 10 min, ask about symptoms
-check BP setting then standing at 2 min , ask about symptoms

20. ttt of ADHD ?

- methylphenidate

21. scenario case of cluster headache and what is the management?

- 100% oxygen

22. 70 y/o, HTN and Coronary artery disease. Elevated creatinine and gfr of 45. Six month ago his gfr was 55.
Which of the following describe his kidney function?

-CKD as his gfr persisted low for more than 3 months.

23. 24 female with with wheezing +sob after excersie and symptoms increase with cold what reduces her
symptoms:
 -inhaler b2

24. 43 years old male complains of sweeting palm of hand and foot with long standing. Most important
question in history:

-Presence of Mild hypertension

-Presence of alcohol use

-Presence of hypothyroidism

-Presence of hypoparathyriodism

25. 68 years old smoker complain of shortness of breath on exertion and at rest. you observed he has barrel
chest. you noticed pursed lip and leans forward on the office desk. on examination you noticed decreased breath
sounds and distant heart sounds. what is the most sensitive diagnostic parameter on spirometry?

-FEV1/FVC

-FEV1

-TLC

-RV

26. which of the following realted to anemia:

- b12 deficiency anemia related to neurological symptoms

- high transferritin in IDA

27. Pt k/c of diabetes on multiple medications to control his blood glucose and blood pressure. He presents
with symptoms of heart failure. What medication could be responsible for this presentation?

28.Which of the following vitamins you would give for alcoholic patient?

-Vitamin B1

- Vitamin B3

-Vitamin B6

-Vitamin B12
 29.Most adverse drug reactions(ADR) in elderly seen in:

-cardiovascular drugs and analgesic

- cardiovascular drugs and antibiotics

-gastrointestinal drugs and analgesic

-gastrointestinal drugs and antibiotics

30.what is the role of the doctor in abuse?

-neglects

-observe

-report

31. Which of following patients you would treat him with antibiotics ?

-fever, no cough and swollen lateral cervical lymph nodes

- fever, no cough and swollen posterior cervical lymph nodes

32.Which of the following should be reported within 24 hours?

-any epidemic

-TB

-HI meningitis

33. Case about smoker wants to quit next in the next month. He considered in stage:

-precontemplation

- contemplation

-preparation

-maintenance

34.Which of the following is not a goal of international safety?

-identity patients correctly

-investigate patients correctly

-identify high alert medications

 35.77 year old with dementia and delirium. Which of the following related to delirium?

36. Which of the following is a principle in family medicine?

-comprehensive

-disease center care

37. Case about Male patient came complaining of epigastric burning pain. He is non smoker. No history of
NSAID use. Not known to have any allergy. Investigation reveals positive H.pylori. How would you manage?

-omeprazole+Clarithromycin+amoxicillin

38. Which of the following patient you would refer him?

-A 40 years old male with weight loss and dyspepsia

-A 57 years old male with IDA

39.spread of COVID-19 in many countries is:

-pandemic

-epidemic

-outbreak

writing OSCE (8 questions):

-thyroid function test

-BMI

-prediabetic interpretation

College OSCE:

-writing referral letter

-history taking (UTI case)

Med38 FM, block 3:

1. Male complaining of lower back pain radiate to buttocks, there is morning stiffness
decrease with exercise, also there is night time pain what is the most useful investigation
test to determine the diagnosis?
- ESR
- Rheumatoid Factor
- HLA-B27 ✅

2- 40 years old male with chest pain localized in the fourth intercostal space with tenderness
, increases with inspiration , ECG normal , no diaphoresis or nausea , examination normal
- costochondritis ✅
-pnumonia
-asthma
-eosophegial spasm

3- Patient has hyponaremia, urine osmalirty..../ serum osmalirty ....

what is the cause of hyponateemia
- Dibetis insbedus
- Hyperglycemia
- SIADH ✅

4- the most common test used in follow up for asthma?

- PEFR✅
- spirometry

5- Which if the following indicats one of life-threating asthma criteria?

A. HR 90 beats/min
B. Oxygen saturation >92 %
C. Peak expiratory flow rate near to 50 %
D. Silent chest ✅

6- A 37 year old female obese complaining of polyuria and polydipsia, fasting blood glucose
135 and 137 on seperate occasions what is next step to confirm:
-measure C peptide
-measure insulin
-no need✅

7- Mr ayman is 55 years old with history of myocardial infraction 1year ago came with
intermittent pain in the muscles of his legs after walking for more than 100 meters you
suspect it to be of diabetes. What the m pathophisology of complication of diabetes this
condition:
- Macro vascular ✅
- Micro vascular
- periphral Neuropathy

8- Red flag for headache?

- meningism ✅
- BP 130/80
-
9- What true about iron supplements in IDA?
- parenteral iron for unable to absorb oral iron ✅
- oral iron appropriate for inflammatory bowel disease
- for chech the response the RBC count increases from 2-5 day
- can cause psychological symptoms

10- Patient with confusion investigating show Na: 124, K:5.4, uria:.., kidney function normal,
what is the cause of her confusion?
- Hyponatremia ✅
- high potassium
- kidney failure

11-Which patient referal to palliative care?

- 35 yr old with severe progressive cystic firbrosis✅

12- Patient complain of left knee joint pain with redness, hotness, fever, decrease joint
movement, X ray showed space narrowing with esteophytes, synophial analysis showed high
WBC, what his diagnosis ?
- septic arthritis ✅
- Severe osteoarthritis

13- Patient complain of vertical nystagmus?

- brain stem ✅
- eight nerve

14. 70 year old man known case of arthritis you prescribed indomethacin to control his pain,
then you noted that NSIDE induce GI bleeding, what other drug do you add to reduce the
risk of bleeding ?
- Omeprazole ✅
- Declofenac
- Cimetidine

15- 55 year old male With recurrent retrosternal pain radiating to left arm
It’s been 9 months this happed come with exercise.
MI
Unstable
Stable angina ✅
Pericarditis

16- Patient has severe osteoarthritis what is the correct about his pain management:
- exercise to strengthen the joint is more effective than rest ✅
- therapeutic US is more effective than exercise

17-best drug cession of smoking for patient with anxiety and depression ?
-Vernicline
- Bupropion
- Nicotine patch ✅

18- What is true about delirium tremor?

- usually need hospitalization ✅
19-symptoms of dizziness and which of the following consider a peripheral vertigo
diagnosis?
- tinnitus ✅

20- Patient with fasting blood glucose 110, HA1C: 6, BMI > 30, next initial management?
- Exercise and life style modification ✅
- hypoglycemia drug
- order OGTT

21-which of the following suggest less serious problem in case of back pain
-continious pain and pain in night
-pain in morning more than>45 minutes
-fever >37.8
-pain in lumbosacral✅

22- 22 year old diahrrea for 10 days after travel first investigation?
- Cbc with differential
- Stool analysis and culture✅

23- What are true about the elder with multiple drugs?
- Check the drug prescriptions every 3 - 6 months✅

24- Patient in palliative, wanted to high dose morphine to end her life, depressed?
- refer to psychological doctor ✅

25- First step in elder abuse?

- Document facts as you hear or see ✅

- Keep yourself safe

- Report
- Refer

26- True about Family medicine?

- Family medicine emerge as a result of fragmentation of health system ✅
-Small surgical procedure preferred to be done in hospitals
- many cases need referral

27: typical alcoholic liver disease picture:

- ALT>GGT
- GGT>ALT ✅
- high albumin
- low ALP

28: True about using long term LABA ^

*alone*
- very good rescue inhaler
- reduce bronchial secretion
-reduce the inflammation
- associated with higher rate of mortality✅

29- which drug for long term Improvement in COPD:

Anticholinergic ✅
B agonist
Inhaled corticosteroids

30- female k/c of hypertension she diagnosed with heart failure, she has not been diagnosed
with heart failure before, what is an initial test for new heart failure:
Echocardiogram✅
Cardiac catheter
Stress test
Holter monitor

31- 3 year child complaint of SOB, 3 attacks of SOB in last year, on examination nasal flaring,
expiratory wheeze bilateral, what the diagnosis?
- Asthma✅

32- 55 yr old male complain of chronic cough for 10 year duration, he smoker for 35 year, on
examination was obese, hypertension, and bilateral wheeze, on investigation FEV1/FVC ratio
after bronchodilator < 70, what in the diagnosis?
- COPD✅

33: Patient is welling to stop smoking in the next 6 months what is the stage ?
- contemplation✅
- precontemplation
- action
- preparation

34: Female recently graduated has anxiety symptoms Best treatment:

-Advise her to avoid meeting her friends
- CBT✅
- move to another city

35: The cell responsible of the antigenic effect in the bronchus

-Mast cell ✅
-Basophil
- epithelial cell
-lymphocyte

36: 34 years old male, not known to have any medical illness complained of substernal
chest pain, increase with eating, especially large meal at evening, increase with lying flat and
cause night waking, associated with hot/sour taste in mouth, it started one mounth ago, he
gained 20Ib in the last 2 year.
What is the next step ?
A. gastrodudnoscopy
B. Echocardiography
C. Trial of therapeutic PPI✅

37: absolute risk CHD of non obese is 4 in 100 concider absolute is ⬆ by 50% in obese .
What would the absolute risk of obese individual to develop?
- 2 in 100
- 3 in 100
- 6 in 100✅
- 8 in 100

38: 9 months male infant immunization vaccine?

- MMR & DPT
- Meals & PCV
- MMR & OPV
- Meals & MCV4✅

39- which of the following is correct regarding step of strategy and summary in setting of
bad news
A- addressing the patient emotion is an important part of this step.
B- invite patients to ask if she has more questions ✅

40- 37 years old female married best screening test

A- Pap smear and blood pressure ✅
B-mammogram and fasting sugar reading
C-lipid profile

41: what should be avoided while a writing a referal letter ?

1- detailed patient history ✅
2- medications and interventions done
3- the diagnosis you suspected
4- examination findings

42: 55 years old patient, presented for his routine check up, his blood pressure reading in
the past 2 weeks , 170/101 , 169/95, 171/…, he’s a non smoker and physically active what is
the appropriate antihypertensive drug to use?
1- ACEI
2- ACEI + thiazide ✅
3- CCB
4- thiazide

43: 53 years old male patient regularly visits his nephrologist as he has CKD , his BP readings
are high
What is the best medication:
-ACE✅
-Ca channel blocker
-thiazide

44: 9 years old boy with sore throat 3 days no cough or Rhinorrhea
no exudate no other symptom
What is the best management: amoxicillin
penicillin
antiviral
supportive teatment✅

45: 35YR nurse working shirts married for 15 yrs, last pregnancy was 4 years pregnancy had
DVT and history of recurrent UTI
-cocp
-injectable
-cupped IUD ✅
-POP

46:correct about COP

-cause menstrual problems
-cashes eczema and itchiness
-Main action is inhibition of hypothalamic and pituitary function leading to anovulation✅

47: correct about long term use of COP

- decrease cervical cancer
- decrease endometrial cancer ✅
- increase ovary cancer
- decrease bone

48- 7y old boy with sore throat, fever and chills,tonsils exudate , anterior lymphadenopathy,
what is the appropriate treatment:
-Amoxicillin✅
-antiviral
- erythromycin
 MED39-Block 1

MCQs
1. You are counseling a 23-year-old woman who is interested in starting COC pills.
Which of the following is true regarding risks associated with COC use?
a. Users of COC pills have an increased risk of ovarian cancer.
b. Users of COC pills have an increased risk of endometrial cancer.
c. Users of COC pills have an increased risk of venous thromboembolism.
d. Users of COC pills have an increased risk of hemorrhagic stroke.

2. A 29-year-old obese woman with type 2 diabetes mellitus is asking you about
progestin-only pills as a method of contraception. Which of the following is true?
a. Progestin-only pills are contraindicated in women with diabetes.
b. Progestin-only pills would increase her risk of thromboembolic events.
c. Progestin-only pills increase her risk for ectopic pregnancy.
d. Progestin-only pills should be taken every day

3. Married couple presented wanting emergency contraceptive after they had

unprotected sex 5 days ago, they don't want any children until after 2 years from
now what will you do?
a. too late for contraceptive measures
b. IUD
c. Levonorgestrel pill

4. Patient with heart failure has been successfully treated with diuretic, what is the first
line of management for reduced ejection friction heart failure?
a. ACEI
b. Beta blocker
c. Nitrate
d. NSAID

5. Apart from low sodium, ramipril can cause which another electrolyte imbalance?
a. Hypernatremia
b. Hyperkalemia
c. Hypokalemia

6. which of the following statements are TRUE in relation to Atrial fibrillation:

a. The distinguishing feature of AF is variability in the R-R intervals
b. AF is more common in females
c. Contraindications anticoagulant
d. Transoesophageal echocardiography (TOE) should be done to exclude a
structural cardiac abnormality

7. Young female patient lost 20 kg in last year, thinks she is obese, very active in
participate on social and school activities, menses irregular, on examination
hypothermia and brady cardia. Most probable diagnosis:
a. Bulimia
 b. Anorexia nervosa
c. Depression
d. Hyperthyroidism

8. Traveler diarrhea empirical treatment:

a. ciprofloxacin
b. erythromycine
c. metrondizole

9. A 26-year-old male college graduate is seeing you for an office visit. He is concerned
that he may have adult attention-deficit hyperactivity disorder (ADHD). Which of the
following is true regarding this condition?
a. The symptoms are likely to be more pronounced in adults as compared with
children.
b. Children diagnosed with ADHD commonly continue to have symptoms into
adulthood.
c. Sleep disturbance is a distinctive feature of adult ADHD.
d. Appetite disturbance is a distinctive feature of adult ADHD.

10. Patient has chronic low back pain from 5 years, what is the most common causes of
low back pain?
a. Lambosacral strain of injury
b. Inflammatory
c. Metatstitc
d. Multiple myeloma

11. Migraine prophylactic treatment in asthmatic:

a. Sumatriptan
b. Topiramate
c. Propranolol

12. 6-month vaccine:

a. HIB, hepB, BCG, DTaP, rota, OPV, IPV, PCV

13. Patients complaining of polyuria, polydipsia,Hba1c ( normal) , fasting glucose 215…

what is correct regarding this patient?
a. The hba1c is not diagnostic and use only for follow-up
b. The patient need OGTT to diagnose him
c. his fasting glucose is diagnostic
d. refer to endocrinologist to confirm the diagnosis

14. screening for diabetic nephropathy test and when:

a. ACR annually

15. most likely for elderly physical abuse:

a. back of neck bruises
b. forearm bruises
 c. forearm excoriation
d. face bruises

16. A 68-year-old man complains of fatigue. He has a history of hypertension, well-

controlled with hydrochlorothiazide. He’s recently lost 30 lb on a high protein, low
carbohydrate diet. He drinks 2–3 beers daily and smokes half pack of cigarettes daily.
Laboratory evaluation reveals a macrocytic anemia and vitamin B-12 deficiency.
What is the most likely cause?
a. Side effects of hydrochlorothiazide
b. High protein diet
c. Low carbohydrate diet
d. Inadequate vitamin B-12 absorption

17. A patient known case of COPD hospitalized, what is the best treatment to decrease
the time of hospitalization and decrease further exacerbation?
a. antibiotic & LABA Only
b. Antibiotics & LABA & anti mucolytic only
c. Antibiotics & LABA & LAMA & short steroids for (5-7 days)
d. Antibiotics & LABA & LAMA & long steroids for (14-17 days)
18. You are seeing a 45-year-old woman who saw you 2 weeks ago because she felt
fatigued. Her evaluation revealed previously undiagnosed type 2 diabetes, and she
made today’s appointment to discuss the next steps. She was on time for her 10:00
appointment, but because of a com- plicated patient, you didn’t get into her room
until 11:15. When you walk in, she appears extremely angry. How should you
approach this situation?
a. Acknowledge her anger with a statement like, “You seem furious”
b. Be empathetic, understanding that her anger is likely displaced and a
reaction to her new chronic illness
c. Explore the reasons for her anger if she brings it up
d. Explain the situation with a statement like, “My last patient was very
complex, and he really needed my attention”

19. Vertical nystagmus and ataxic gait:

a. Brainstem
b. Vestibular nerve
c. Labyrinthine

20. ABG in COPDD patient (result of the test, normal values not included):
a. Respiratory acidosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis

21. Patient included in palliative care:

a. Patient with pneumonia
b. Patient with COPD and heart and kidney failure
c. Patient with fracture
 d. Elderly with asymptomatic prostate cancer at early stage

22. Correct regarding drugs in elderly

a. Decrease gi absorption

23. Withdrawal definition:

24. Patient long use of NSAID, has angular stomatitis what is the deficiency:
a. Iron
b. Folic
c. B12

25. patient known case of diabetes, CHF, HTN, on metformin 500 mg and ACE-I , and
diuretic.. what is the ttt to add to this patient according to the guidelines?
a. SGLT2
b. DPP

26. Diabetic hypertensive patient what is recommended blood pressure according to

JNC:
a. <140/90
b. <135/85
c. <130/80

27. Smoker, symptoms of chronic bronchitis over 3 months in last 2 years, what test will
you do:
a. Office spirometry
b. CT

28. Best medication for high ASCVD:

a. Statin
b. ACEI

29. 5 yo male patient with her mother complaining of fever, her child looks ill, talking
differently, drooling, not eating for last 24h.What is the diagnosis?
a. epiglottis

30. - patients 7y.o came with fever for 7 days , polymorphous rash, bilateral
conjunctivitis, …( symptoms of Kawasaki disease )
a. Kawasaki disease
b. Hand foot syndrome
c. Scarlet fever

31. 21 years old patient complain of fatigue and swollen red tonsils, with a whitish-
yellow membranous exudate, swollen uvula and petechiae on the soft palate:
a. EBV(mononucleosis)
b. Diphtheria
c. GABHS
 d. Candida

32. Organism in peritonsillar abscess:

a. GABHS

33. smoking education patient is not willing to quit what can benefit him the most for
behavioral benefit:
a. Risk of having CVD in 10 years
b. benefit of quitting in next year
c. Ask open end Qs about the causes
d. prescribing varenicline if not contraindicated

34. what is best oral diabetic medication for cardiorenal benefit:

a. SGLT2

35. scenario of diabetic patients with abnormal kidney function test egfr60. What is the
best drug to add to prevent diabetic nephropathy?
a. Ace-I
b. SGLT-2

36. Patient with gangrene, the doctor took a picture of the wound for educational
purposes, what is true?
a. Tell the patient the need of the picture is educational and ask for consent
b. Tell him the importance and no need for consent
c. toe is a part of the body that doesn’t need consent
d. -take the picture without the patient knowing

37. Young girl fall from stairs and when has been examined she was will, the doctor
reassure the mother and tell her if she lost consciousness or vomited bring her
directly to ER, what consultation model did he used?
a. Neighbor model
b. Murtagh model
c. Byrne and Long model
d. Calgary model

38. What is wrong about Swiss model of safety

39. Antidiabetic choice for obese patient

a. SGLT2

40. Your friend planning to travel abroad, what is disease of concern in international
traveler:
a. Diarrhea

41. Withdrawal symptoms:

a. Anxiety
b. Dry mouth
42. Pain not likely to be from cardiac origin:
a. Increase with respiration
b. Radiate to left arm
43. Most effective psychologic and therapeutic management in alcohol patient for long
term benefit:
a. Acamprosate - motivational model.
b. Disulfiram -
c. Naltrexone - CBT
d. Topiramate – social behavioral group

44. Newly graduate from college and has anxiety symptom, what to do?
a. Refer to psychologist
b. CBT
c. Yoga

45. Elderly fall in bath in her daughter house, deny loss of consciousness, examination
show only tenderness at hip, which of the following most important for diagnosis:
a. Need more history
b. MRI of hip
c. Full chemistry investigation
d. ECG

46. Patients have risk favorite for the occurrence of the disease, what's mean?
a. They have susceptibility
b. They are presymptomatic

47. Scenario child with left ankle inflamed then resolved, now left knee pain and limping,
10 days ago he had pharyngitis What is true about?
a. Affects Small joint
b. Affects symmetrical joints
c. Migratory joints
d. Affects joints for more than 3 months

48. True about mechanical back pain?

a. Worse in night
b. Improve in daytime
c. It’s due to injury
 OSCE

Station 1: Data interpretation

- Lipid profile: diabetic patient, smoker, obese
High (LDL, total cholesterol, TG)
Low (HDL)
Q: interpret the results
Q: 3 non-pharmacological advice
Q: which drug you will give him and its strength?
Q: Mention 2 tests you will order because of the side effect of the drug.

- Urine dipstick interpretation

Dark urine
Turbid
High WBCs
Positive (nitrite, L E)
Bacteria: Many
Pregnant women 13 weeks:
(Urgency, frequency, lower abdominal pain for 2 days)
Q1: interpret the results.
Q2: diagnose?
Q3: support the diagnosis from the history.
Q4: 3 non-pharmacological advice?
Q5: antibiotics (dose, duration, name)?

Station 2: Case management

History taking + how to use the inhaler
Asthma patient for 2 years, came because worsening of symptoms last week
Questions: medication contraindicated in asthma

Station 3: Community medicine

Smoking cessation consultation:
5As? In details
Nicotine dependence (heavy smoking index?
Stages (which stage is the patient)?
Withdrawal symptoms and how to manage?
Pharmacological (NRT, drugs)
Non - pharmacological advice?
1. Prophylactic of migraine for asthmatic patient:
1. Anticonvulsants—> topiramate
1. Urgent referral within 2 weeks
a. age 55 + weight loss
2. Friction rub
a. pericarditis
3. Most sensitive for iron deficiency anemia
a. serum ferritin
4. Suspected alcoholic liver disease
a. high GGT
5. Epidemic Or endemic
6. Swiss model
7. 24 years old male, after lifting heavy Objects—> Back pain 6 weeks, what is
diagnosis
a. Muscle strain
b. Vertebral fracture
8. Patient came to you and you suspecting inflammatory origin back pain
a. spondylitis
9. Exercise 150 minutes of moderate and strength activity for 1 day
10. Relief his symptoms?
a. Dyspnoea: Morphine
11. Patient’ s daughter doesn’t want him to know about his condition even he
have the capacity to make a decision
a. Autonomy: the right to know his condition
12. Vaccination is ?
a. secondary prevention
b. Primary prevention
13. Thyroid cancer medication in diabetic patient:
a. GLP-1, Dulaglutide
14. Copper IUD used as emergency within
a. 5 days
15. levonogestrel:
a. up to 72 hours after unprotected sexual intercourse
16. 70 years old she was okay before she develop fever and signs of systemic
infection she became confused, What is the reason?
a. Delirium
b. Dementia
17. Pseudomonas membrane on colonoscopy?
a. Diverticulitis,
b. E. Coli
c. Clostridum difficle
18. Patient have alternative between diarrhea and constipation
a. Antispasmodics and fibers
19. Patient have neurological symptoms for 8 months progressive, on examination
she is pale, which of the following is true?
a. The patient must go under CT scan,
b. MCV will be over 100
c. Hyposegminetd neutrophils
20. Patient is trying to stop smoking which of the following will he benefit from the
most?
a. Ask him about smoking cessation at each visit
21. Patient have CVD or heart which of the following will benefits from the most
a. Smoking cessation
22. Patient is 35 years old, healthy weight BMI 23, do exercise, FBG is normal at
which of the following you should screen him?
a. After 3 years
b. When he became 45 years old
23. Patient 24 years, have wheezing and shortness of breath on exercise, increase
during cold weather, which of the following she benefits from?
a. Inhaler anticholinergic
b. inhaler B agonist
c. Oral
24. Vaccination at 2 months years old include which of the following
a. Measles
b. Mumps
c. Polio
25. 2 years old child, the normal capillary refill is less than?
a. 1 second
b. 2 second
c. 3 second
26. Child have sore throat, cough, temperature 37.1 C, what is the management
a. No further investigation
b. Antibiotics
27. Occupational history, patient have biological hazard, which of the following you
have to ask about?
a. Incubation period, methods of transmission and chemoprophylaxis
28. Which of the following is non modifiable risk factor of
a. Smoking
b. Old age
c. DM
29. All of the following is Triptan contraindications except?
 a. CVD
b. Lung cancer
c. Uncontrolled Hypertension
d. Recent use of MOA inhibitors in the past 2 weeks
30. What is the disease come in different age groups
a. ADHD, bipolar, conduct
b. ADHD, childhood depression, antisocial

31. Which of the following is consider psychological abuse

a. Threats to harm
32. Tension type headache
a.
33. TB Patient takes isonized what supplements to
give
a. Vitamin d
b. Calcium
c. pyridoxine
34. In communication with patient and you have a
bad news what should you start with
a. Start with you telling the patient you
have bad news
35. Patient is old age have trouble and unstable gate
which of the following he would benefit from
a. Prescribe medication 4 or more
b. Doing chi TI pose to help with balance
36. Patient is 52 years old on DEXA scan which indicates osteoporosis?
a. T score < -2.5
b. Z score <– 2.5
37. Female Patient have vertigo for few seconds, no vomiting, no tinnitus which of
the following is treatment?
a. Epley maneuver
38. Patient is on OCP, right axis deviation on ECG, what is the diagnosis
a. Pulmonary embolism
39. Patient came for assessment before operation you must ask her about
a. Over the counter
b. OCP use
40. Women had falls, vertigo, no nausea, vomiting, hearing loss, or tinnitus , she had
diplopia?
a. Adams stocks attack
b. Cervical osteophytes
41. Patient have heart failure and albuminuria, best antidiabetic drugs:
a. Canfaglozin
42. Fever, rash, neck stifness
a. Meningococcal disease
43.
 MED 39 Block 3

1-couples came for discussion of oral contraception options including pros and cons,
they are both healthy with no contraindications of contraception , which model of
communication is this
A-counselling
B-consultation
C-health promotion
D-health education

2- Which of these models used in clinical risk analysis and management

A-health belief model
B-Swis cheese model
C-precede proceed model
D-hypertheoretical model

3- Patient with symptoms of DM which of the following test can confirm the diagnosis
(repeated for 2 times)
A- Fasting blood glucose >128
B- HbA1c > 6.4
C- OGTT > 164
D- Random blood glucose >220

4- A change in the KSA immunization scheduled, the new one is at:

A. 6 months
B. 0 and 6 months
C. 24 months
D. 2 months

5- Pap smear screening which type of prevention?

A- Primordial
B- Primary
C- Secondary
D- Tertiary

6- When delivering bad news to the patient with accompany which behavior the
physician should take ?
A- Request the accompany to leave the room for privacy
B- acknowledged the presence of the accompany and assess the patient privacy
C- feel comfortable as their someone to support the patient
D- Request the accompany to leave for no additional questions

7- Mechanism of action of biphosphonate

A. Decrease bone absorbtion
B. Increase bone formation
C. Increase GI absorption of calcium
D. Mimic estrogen effect on bone
8-Women 40 y/o new diagnosed with T2DM History of the depression, venous
insufficiency
BMI 33 BP128/76 HA1c 9.2 FBG 268 A/C ratio was elevated GFR was 70 What is the
best initial management of this patient?
A- Insulin
B- Metformin + GLP
C- Metformin + glicazide
D- Metformin + TZD

9-42 year old male complaining of 2 days back pain after moving furniture, inc with
walking dec with rest , sharp pain , electric like , vitally stable , radiate to the left leg ,
when he was asked to describe the pain he put his has on the lumbar region
A- Rest and NSAID
B- Lumber CT
C- consult neurosurgery
D- ultrasound

10- 60 yaer old lady with end stage ovarian cancer

How to screen if she had depression
A. Anhedonia
B. Fatigue
C. Ansomnia
D. Loss of appetite

11- What is true regarding iron supplementation in case of IDA and UC

A- give it oral
B- give it parenteral
C- RBC level increase ??

12-which of the following is true about prevention of retinopathy in newly diagnoses

T2DM:
A- daily aspirin will reduce the risk of retinopathy
B- no effect of lowering hbA1c on reduce risk of retinopathy
C- hypoglacemia is the main risk of retinopathy
D- annual dilated eye examination being at diagnosis

13- 22 years old male patient came complaining of low back pain for 3 weeks, he is
athlete and exercise regularly, he denied inciting event, does not have pain on
movement, the pain is not radiating anywhere else, you suspect spondylolisthesis
which of the following woud be indication of urgent referral?
A. Numbness in the left great toe.
B. Radicular pain in the right leg.
C. Pain worsening with movement and improve with rest.
D. Recurrent fevers.

14- most important side effect of SGLT2i

A - edema and weight gain
B- dry cough
C- Urinary tracy infection
D- symptomatic hypoglycemia

15- A 49 years old woman, perimenopausal seeing you after her fractured wrist. Past
medical history significant for oral contraceptive pill use for 20 years, obesity, Graves'
disease. She breastfeeds her children 6-months for each.
What components of the patient’s history put her at increased risk of Osteoporosis?
A. Breastfeed
B.Obesity
C. Graves' disease
D. Oral contraceptive pill

16- Which of the following is true according to palliative care

A- Euthansia is illegal in Saudi Arabia

17- 21 years old female had unprotected sex with her partner. She wants to have an
emergency contraceptive. She performed a Pap smear and examination and the result
was normal. Which of the following is true regarding this case?
A- ECPs contraindicated in Heavy smoking
B- Don't prescribe ECP If pap smear / chlamydia was positive
C. ECPs can be prescribed in The phone without examination
D. ECPs are contraindicated in pregnancy because it’s abortifacient

18-

19-Maryam has migrain headaches and has CVD, which of the following
contraindicated in maryam headache
A. Acetaminophen
B. NSAID
C. Aspirin
D. sumatriptan

20- sever asthma in ER oxygen saturation

A. <90%
B. >94%
C. 90-95%

21- 53 years old patient, have cough for 6 weeks that become worse at night. He
denies shortness of breath, sputum production, chest pain, wheeze. He takes antacid
1-2 daily. And he takes hydrochlorothyazide for HTN and aspirin. His wife mention that
he have snoring and hacking. Which of the following could be a cause for his
symptoms?
A- antihypertensive medication
B- GERD
C- CHF
D- Lung cancer
22-16 years old Heavy menstrual bleeding her mother brings her to the clinic saying
she notice her being fatigue and tired, MCV 71 (low).Hematocrite normal .TSH normal.
What is the diagnostic investigation to do?
A: ferritin level
B: B12
C: hemoglobin electrophoresis

23- 67 YO man, smoker, has features that suggested COPD, recommended smoking
cessation.
which of the following will decrease the mortality and severe morbidity
A- annual chest CT.
B- annual chest X-ray.
C- hepatitis vaccine.
D- pneumococcal vaccine.

24- Which of the following is associated with high triglycerides level?

a. AKI
b. Hyperthyroidism
c. T2DM
d. Weight loss

25- A 67-year-old man comes to the surgery with chest pain. It is central, feels heavy
and radiates to his jaw and left arm. Also complains of nausea, palpitations, and
diaphoresis. He has never had any heart problem, but was advised to start a statin a
few weeks back by his GP. He has no indigestion and takes no medications other than
amlodipine for blood pressure. He has no foreign travel and has been well until this
morning. What is the most likely diagnosis?
A- MI
B- Bronchopneumonia
C- GERD
D- PE

26- A 17 y student complains of palpitation, Feeling tense and on edge with irrational
fears of one month duration
Which of the following neurotransmitters is involved:
A- Dopamine, Serotonin, Noradrenaline, GABA
B- Dopamine, Serotonin, Noradrenaline, Glucagon
C- Dopamine, Serotonin, Noradrenaline, Oxytocin
D- Dopamine, Serotonin, Noradrenaline, Thyroglobulin

27- Male presented with cramping abdominal pain and mild bloody diarrhoea for 6
days, one of his family has the same condition. Stool analysis shows positive
campylobacter.
The best next step in management:
A. Immediate antibiotic
B. Immediate antiviral
C. Go back to work immediate
D. No treatment is usually needed

28- A 50Y.O female returned from Africa since 10 days complaining of diarrhea started
3 days ago. Her sister has been diagnosed with celiac disease.
What is the first diagnosis should be considered:
A-
B- Irritable bowel syndrome
C- traveller diarrhea
D- celiac disease

29- Spinning sensation with a history of resolved upper respiratory tract infection. No
tinnitus, hearing loss, nausea or vomiting. Diagnosis is?
A- Vestibular neuritis
B- BPPV
C- Meniere disease

30- 60 years old male patient diabetic on metformin and gliclazide and have a history
of confusion and trouble walking for 2 hours, Temperature 36.8, BP 140/90, HR 119.
The patient arousable, not oriented doesn’t follow the commands and can move his
legs and arms and his blood glucose is 50. What is your first immediate management
for the case:
A. Glucagon
B. Mannitol
C. CT scan
D. Lumbar puncture

31- Which of the following is not considered type of physical abuse:

A. Blaming
B. Deprivation of contact
C. … Restraint
D. Threatening of Harm

32- What is true regarding injectable contraception (depot) ?

A- first line for females less than 18 years.
B- needs to be injected every 12 months.
C- effectiveness with perfect use 90 %.
D- Causes accelerated bone loss

33- Indications of neuroimaging in migraine?

A. Chronic migraine
B. Confusion and papilledema
C. Onset above 35 years old

34- What is the equation to calculate BMI

A- weight (Kg) ÷ Height (m)2
B- weight (Kg) ÷ Height (cm)2
C- Height (m)2 ÷ weight (Kg)
D- Height (cm)2 ÷ weight (Kg)
35- A 30 year old bakery has just been diagnosed with occupational asthma. What is
the most appropriate management plan by an occupational physician for the patient?
A- Health surveillance for the other employees
B- Redeployment or change work location
C- Respiratory protective equipment for the patient
D- Salbutamol when symptomatic

36- 38 years old Black african male newly diagnosed hypertension came to your
clinic. You explained diet and exercise to him. What is used to treat hypertension?
A- ACEs
B- CCB (Amlodipine)
C- Thiazide

37-A 5 years old patient brought by his mother after 24 hours of talking strangely and
drolling has no appetite and didn’t drink, which of the followings is included in the
management plan for this child:
A-Short acting beta agonist
B- IV ceftriaxone
C- Oral ampicillin
D- Supplemental oxygem

38- 65 Y.O female patient presented with history of confusion for 2 days. She is
known case of HTN and Dyslipidemia, well controlled by amlodipine and atorvastatin.
They added ibuprofen for arthritic joint pain and omeprazole for heartburn.
Her investigations were normal apart from hyponatremia.
What is best first line of management.
A-stop amlodipine and give ramipril and paracetamol
B- stop atorvastatin and amlodipine and give paracetamol
C- stop Omeprazole and amlodipine and continue ibuprofen
D- stop omeprazole and ibuprofen and give paracetamol

39- 36 year old female came to the clinic for COCP, which of the following is an
absolute contraindication for COCP in this patient:
A. Smokes 16 cigarettes a day.
B. Undiagnosed vaginal bleeding.
C- BMI > 35
D- Gallbladder disease

40- 15 month old child presented complaining of fever and skin rash. On examination,
he is ill-looking with purpuric non-blanching skin rash and neck stiffness. Which of
the following must be excluded?
A) Bacterial pneumonia
B) meningococcal septicemia
C) kawasaki disease

41-66-year-old female; c/o pigmented lesion on her back. The diameter was 1 cm,
regular dark brown in colour, with irregular shape and inflammatory base & oozing
blood. The patient admitted that there is a change in the size of the lesion. She denied
any change in sensation. Regarding the Weighted-7 point checklist, what is the
score?
A. 4
B. 5
C. 6
D. 7

42-which medication is the most frequently used to lessen the effects of alcohol
withdrawal?
A- morphine
B- Atenolol
C- diazepam
D- paroxetine

43-Patient with severe chronic and uncontrolled asthma, which of the following drugs
can be added to high dose ICS to control his condition?
A- anti inerlukin
B- low dose formoterol
C- SABA

44- 20 years old female with anxious, refuse coping her family demand, GP want to
explore her anxious, he found that she is shy,what is the appropriate behavior?
A- Calm listening with no distracted movements.
B- Listen to the patient but interrupt any time you want to
C- Lean back in the chair with crossed arms and legs

45- Which of the following at the highest risk to dignose as MI:

A- 60 Y.O man Hx angioplasty, chest radiate to the neck and diaphrosis

46- A 40 years old man presents with substernal chest pain for 12 hours. Pain is
constant and increases with cough and inspiration and relieves with leaning forward.
Pulse is 120b/m. BP is 110/70mmHg. Examination revealed distant heart sounds.
Lungs are clear. ECG shows diffuse Saddle shaped ST segment elevation. Chest X-ray
is normal.
Structure most likely to be injured in this case:
A.Pericardium
B. Myocardium
C. Aortic intima
D. Esophageal sphincter

47- Which of the following drugs used in COPD patient, should monitor for
hypokalemia as a side effect, espicially when combined with diuretic
A- Aminophylline
B- Theophylline
C- LAMA
D- SABA
48- Child complained of rhinorrhea two weeks ago, fever started 2 days ago, on ear
examination: bulging of tympanic membrane with fluid level. Back of the throat is
erythematous. He seemed fine and playful.
A- acute otitis media
B- Chronic otitis media