‫بسم هللا الرحمن الرحيم‬

‫اللهم صل وسلم على سيدنا ونبينا محمد وعلى آله وصحبه أجمعين‬
‫اللهم ال سهل اال ماجعلته سهال وأنت تجعل الحزن اذا شئت سهال‬
‫التجميعات كلها من قناة سايلنت هللا يجزاكم خير جميعا‬
‫ عبدالهادي‬.‫ ملفات‬+ ‫النقاش في قناة سايلنت‬+ TOP Gs ‫التصحيح ( بعض األسئلة ) من‬
‫ و يارب هللا يكتب لنا ولكم الدرجات العالية في الدنيا واآلخرة‬،‫دعواتكم لي ولوالدي‬
‫هللا يكرمنا بالقبول هذا العام بحول هللا وقوته‬
Dr.B
: ‫مالحظة‬
‫ مساءا‬9 ‫األسئلة تم تجميعها من القناة الى الساعة‬
https://t.me/silent_2023m/34007 : ‫توقفت عند هذا السؤال‬

1- Bronchiolitis case stopped breathing twice before now present with usual symptoms
What is mx ?
- ventilation
- hydration support
- irrelevant
Ans:
Stable > B
Unstable> A

2- 52 years old woman came for routine screening for breast cancer Mammogram results
Overlapping densities in the upper quadrants of both breasts Coded as (BIRADS 0)
Which of the following is the most appropriate next step
A. Request Additional imaging should Follow up
B. Follow up at 6 months
C. Biopsy both breasts
D. Reassure and follow after 1 year
Ans: A

2- Paediatric patient present with abdominal pain Examination is unremarkable except for
hypertension US reveals a mass that extends toward midline, diagnosis?
- Wilms tumour
- Neuroblastoma
Ans: B

3- A 45-year-old sustained a knife injury to his left wrist. Examination confirms a clean
wound with division of the underlying tendons and median nerve. Which of the following is
the most appropriate management?
A. Debridement and primary closure
B. Primary repair of injured structures
C. Debridement and secondary closure
D. Debridement and secondary skin graft
Ans: B
4- A 9 months baby came with congenital heart disease but the parents doesn’t know what
exactly, when you examined the baby he had peripheral and central cyanosis what type of
congenital heart disease?
A- ASD
B- TOF
C- coarcotation of the oarta
D- PDA
Ans: B

5- Apendicular access
A-Redistribution of blood flow

6- 32 post CS 16 days , presenting with fever not repaondig to antipyritic and Abx, previous
multiple Cs with significant adhesion. Ct shows small bowl fistula l, which is appropriate
next?
1- NPO and start pancreatic and gastric secretion inhibitors
2- resect and anastimose
3- restrict to soft diet
Ans: A

7- 6 Y/O G3P1 at 34 weeks’ gestation presented to antenatal clinic for regular check-up, she
has unremarkable medical hx and uncomplicated pregnancy Braxton Hicks and non-pruritic
cervical discharge. Her pre-pregnancy weight was 54.4 on examination cervical length was
33 mm.
VS were given & I believe they were normal.
Current weight: 52
Rubella AB: -ve
HBsAg: -ve
Blood type: O+
Which of the following is the most appropriate next step?
A. FU after 2 wk

8- A 24-year-old pregnant woman primigravida at 30 weeks' gestaton complaining of lumps

in her breasts. On inspecton, these lumps are multple in number and all within the areola. By
palpaton, they seem to be small, superfcial, uniform in size, non-tender and sof. which of the
following is the most likely diagnosis?
A. Lactferous duct
B. Mondor's disease
C. Montgomery's follicles
D. Fibrocystc breast changes
Ans:

9- 29 week pregnant with bleeding , what type of bleeding

-intrapartum
-antepartum
-early postpartum
-Late postpartum
Ans:

10- 29 week pregnant and has ruptured membrane with bleeding , what type of bleeding
-intrapartum
-antepartum
-early postpartum
-Late postpartum
Ans:

11- New Recall 100%

19 years old primigravida complaing of abdominal cramps and vaginal bleeding or spoting.
LMP 6 weeks ago with positive home pregnancy test. Speculum examination closed os and
abdominal pain with cervical manipulation.
What’s appropriate next step?
A. CBC
B. Transvaginal assessment
C. Irrelevant (forgot)
D. Further deeper vaginal examination to rule out masses
Ans:

12- Senario of pregnant woman had passage of vesicles. What's the best next step?
A. ultrasound
B. B hcg
C. B hcg and ultrasound
Ans:

13- Pregnant had bleeding and on examination cervix was partially opened. Fetus HR and
everything normal. No passage of products of conception. What's the type ?
A - threatened
B- complete
C- incomplete
D- inevitable

14- case of female pt medicaly free came to Er complaining of sizure for (I don't remember
but less than 30 mint)What is most appropriate Next step
- Eeg
- Brain ct
- Brain mri
- Spin ct

15- Organophosphate Antidote ?

- Atropin
- n-acetyl
- naloxone

16- Compilation of meningitis

- deafness
- cranial nerve damage

17- Case of pediatric pt came for vaccination , and his mom told you he had rash, fever after
last vaccine What to do
- Give vaccine
- Delay
- Check previous vaccine
- Don't give

18- Pt underwent appendectomy and carcinoid tumor found at tip of appindex What's most
appropriate next step:
- Observations
- Right hemicolectomy

19-38 year old Female came for diabetes screening hba1c 5.5 Wheight 91 kg and height
160 what to give ?
A-insulin
B-metformin
C-glyburide
D-Acarbose

20- A 24-year-old pregnant woman primigravida at 30 weeks' gestaton complaining of lumps

in her breasts. On inspecton, these lumps are multple in number and all within the areola. By
palpaton, they seem to be small, superfcial, uniform in size, non-tender and sof. which of the
following is the most likely diagnosis?
A. Lactferous duct
B. Mondor's disease
C. Montgomery's follicles
D. Fibrocystc breast changes

21- Alcoholic and smoker. Asymptomatic.

Labs:
Very high ferritin
High iron
High transferrin saturation
High ALP
AST 147
ALT 76
Ultrasound: enlarged liver, no lesions. Whats the most likely diagnosis?
A- hemochromatosis
B- alcoholic hepatitis
22- New question. Patient known case of crohns, came with anal fissure. No abdominal pain.
Already on steroids, something and Selatra. What to add?
A- Azathioprine
B- Infliximab
C- Methotrexate
D- Bupropion

23- New question. Senario of traffic accident. What's the initial step?
A- secure airway
B- neck collar

24- Pregnant lady know to have fibroid 2* 3 and now in her 2 trimester came c/o abdominal
pain and fever ,O/E Cervix closed , unremarkable , What is the appropriate management to
do for her?
- CS
- Observation
- IOL

25‫ وجاني سؤال مريض ياخذ ادوية اللي افتكره‬asprin -metformin ‫ وجاء‬gout ‫ايش من االدويه اللي عمله كذا‬
Recall :
Which drug cause gout?
- lasix
- plavix
- aspirin
- metformin

25- Pregnant women on valproic acid, which of the following associated with it?
A. Polyhydraminos
B. Oligohydraminos
C. Neural tube defect
Ans: C

26- Case of ectopic pregnancy.

BP 95/58
Lives 80 km away from hospital.
BHCG 3000
Ultrasound showed the size was 2x3
Whats the absolute contraindication for medical treatment?
A- vital signs
B- her house location
C- lab findings
D- ultrasound findings

27-
‫اختباري اليوم الصباح جاني سؤال صراحة غريب بالنسبة ليا مو فاكرته كامل بس‬
Rt handed presented with pain and sausage like Left fingers , with irregular pitting nails ‫يعني‬
‫بتاكل اظافرها‬
what others symptoms you will find
Recall :
A young female presents with joint pain located in her distal interphalangeal joints and
knees. On examination, you notice that her fingers are sausage-shaped. Which of the

✅
following is expected to be seen in this patient?
A. Dermatologic problem
B. Pulmonary edema
C. SLE
Psoriatic arthritis : affecting mainly DIP , Family Hx of Psoriasis, ductulitis ( Sausage fingers)

28- 6 y.o (not sure) with low hgb faild iron supplements for 3 times mother sure given doses
and still low hgb
normal wbcs 10 normal RBC , what will help in definitive diagnosis ?
- BM aspiration
- Hgb electrophorisis
- iron level
- vit b12 level

Similarities🤝
A 36-year-old woman Para 1 comes to the clinic for genetic counseling. Her first child was
born with sickle cell disease. She has since remarried, and is requesting prenatal testing
according to the premarital requirements in the country. Which of the following is appropriate
to offer first?
A. Multiple markers screening

✅
B. Paternal chromosome analysis
C. Paternal hemoglobin electrophoresis
D. Maternal hemoglobin electrophoresis

A couple from Al-Ahsa Eastern Province of Saudi Arabia presents for antenatal booking. A
complete blood count and blood film is ordered. Accordingly, further assessment of the risk
to the fetus and to the pregnancy from the disease that is typified by the blood smear (see
image). What is a diagnostic test to be performed at preconception or early in prenatal care?
A. Serum iron

✅
B. Serum total bilirubin
C. Hemoglobin electrophoresis
D. Platelet-associated immunoglobulin G electrophoresis

A 26-year-old man has been diagnosed with sarcoidosis 2 years before, he now presents
with mild pallor (see lab results and report)

Test Result Normal Values

Hb 100 130-170 g/L
НСТ 0.29 0.42-0.52
MCV 79 80-95 fl
WBC 7.5 4.5-10.5 x 109/L
Platelet count 200 150-400 x 109/L ferritin 915 22-561 ng/L
Haemoglobin electrophoresis: Normal.

Which of the following is the most likely diagnosis?

A. Sideroblastic anaemia
B. Beta Thalassemia minor

✅
C. Iron deficiency anaemia
D. Anaemia of chronic disease

29- marfan syndrome (i think) how to exclude the most life threatening complications
Recall :
8 years old child with lax joints and fingers Arachnodactyly what is the investigation that will

✅
protect him from life threatening condition?
A. Echo
B. Ecg
C. Chest ct
D. Brain mri

30- something in pregnant with hydrops fetalis and increased in something + 1.18 MOM ??
what is the reason ?
Recall :
23 yo female pregnant 28wks with fetal hydrops peak systolic flow 1.8mom on mca doppler
cause ?
-anuplide

✅
- diaphragmatic hernia
- anti-kell antibody
- cervical teratoma

31- known hashimoto 25 years ago came with new onset ?enlargment and weight loss what
is dx?
- subacute thyroditis
- giotr

Recall :
A woman in her 50s , complaining of a huge thyroid swelling that is rapidly growing , with
associated weight loss . She has a history of hashimoto thyroiditis 25 years ago . What's the
most likely diagnosis ?
A.Hemorrhagic lymphoma
B.Subacute thyroiditis
C.Papillary carcinoma

32- baby of DM mother 6 hours old with mild tachypnia??? Transiant or RDS ?
Depends on the gestational age ?

another one
30 mints old product of 27 weeks emergency CS due mother issue with tachypnia + labord
breathing + chest ressison , apnea of preterm?
- transient
- RDS

33- 27 y o male victim of RTA presented to ER , conscious oriented , P/E : distended JVP ,
muffled heart sound , clear lungs , rt leg both fractures , vitals :bp:90/60 , RR : 22 , O2 : 82%
Chest x rays : increased heart shadow , whats the type of shock ?

✅
-neurogenic
-cardiogenic
-hypovolemic
-hemorregic

34- Female pregnant came to antenatal visit and did GTT, familiy hx of T2DM
fasting elevated
1 hour normal
2 hour elevated
3 hour normal

35- Early in her gestation Next step:

- 75 g OGTT at 24-28 weeks
- 3 hour test at 24-28 weeks

Another recall :
A 27-year-old primigravida had a glucose tolerance test (see lab results). Patient's results
Normal Values
Fasting 5.7 3.3 to 5.5 Mmol/
1 hour 9.4 Less than 11.1 Mmol/
2hour 9.8 Less than 8.6 Mmol/I
3 hour 7.2 Less than 7.8 Mmol/
Which of the following is the next best step in management?
A. Take a random glucose level
B. Obtain a haemoglobin A1c
**C. Adjust the patient's diet
D. Repeat the GTT

36- A 20-day-old infant has non-fading yellow discoloration of the skin and pale stool that
began on the third day a\er birth. A week ago, the infant was diagnosed with normal
physiological jaundice and advised phototherapy (see lab results).
Test Result Normal Value Total bilirubin 150 < 19 umol/L Direct bilirubin 98 <10 mol/L which
of the following is the most likely diagnosis?
A. ABO incompatibility Rh incompatibility
C. G6PD deficiency T
D.Biliary atresia

37- 18 months child came with chronic diarrhea, loss of subcutaneous fat, abdominal
bloating, what diet should be prescribed?
A. Hydrolyzed diet
B. Gluten-free diet
C. High caloric diet
D. Fat-free diet

38- Patient having Diarrhea,

1- Metabolic Acidosis with Hyperkalemia
2- Metabolic Alkalosis with Hyperkalemia
3- Metabolic Acidosis with Hypokalemia
4- Metabolic Alkolosis with Hypokalemia

39- Child (8y?) likes to swim and presented with pain in her ear On examination pulling the
pinna triggered the pain and there is foul smelling discharge Managment?
1- oral amoxicillin
2- oral flucloxacillin
3- topical neomycin
4- topical steroids

40- Better recall: patient who had right big toe pain and because of that “written like this” he
was diagnosed with gout and treated with allopurinol. He’s a known case of psoriasis. He
presented now with right big toe pain, right ankle pain and bilateral knee pain and there was
no improvement with allopurinol. Labs shows high uric acid What’s the diagnosis?
A- active pseudo-gout arthritis
B- active gout arthritis
C- psoriasis arthritis
D- Osteoarthritis

Abdulrahman: I think the answer is psoriatic arthritis since he almost fulfills the criteria for
psoriatic arthritis (CASPAR) and might be missing more important info in the question. Even
though he has been diagnosed with gout, he has not been responding to his medications.
He has an established inflammatory articular disease + history of psoriasis (1 point) +
dactylitis (1 point). We are missing 1 point to confirm the diagnosis. The symmetrical joint
pain (bilateral knee pain) is what is throwing me off also. I hope the full question will be much
clearer for you.
Update: Another point of view from

41- Pt with fever rigirs back pain and hx of row milk consumption ask about treatment
Doycyciline+ streptomycin

Recall :
Patient with clear case of brucellosis. Hx of Drinking unpasteurized milk. Which if the
following is the first line treatment of brucellosis?
Doxycycline + Clindamycin
Doxycycline + Streptomycin
Ciprofloxacin + TMP-SMX
Rifampin + TMP-SMX
42- A child had history of fever and vomiting. came dehydrated, unconscious and acidotic.
CSF analysis:
high cells
high protein
normal glucose
1. tuberculin infection
2. viral meningitis
3. diabetic coma
4. salicylic acid toxicity

43- Patient after modified radical mastectomy, presented with numbness/Altered sensation in
the inner right upper arm, which nerve is injured?
A. Long thoracic nerve
B. intercostobrachial nerve
C. Pectoral nerve (i think it was medial pectoral)
D. Thoraco-something nerve

😎👇🏻
Full recall
A 50-year-old woman post-modified radical mastectomy, presented with numbness and a
burning sensation on the inner aspect of upper arm.
Which of the following nerves is most likely injured?
A. Thorcodorsal
B. Long thoracic

✅
C. Medial pectoral
D. Intercostobrachial

44- 30 women admitted In hospital she had elective adrenlectomy non acth
CushingConfirmed by Ct contrast right benign adrenal adenoma Whats appropriate mx ?
⁃ Pre op - hydrocortisone
⁃ Pre op phenodoypenzide
⁃ Post op mitotene
⁃ Post op fludrocortisone

45- Pregnant lady known to have hypertension on losartan, She comes to the clinic and
pregnancy test is positive.
Her BP 120/70
what you will do regarding her
medication
A- continue losartan
B- stop losartan
C- stop losartan and give methyldopa
D- stop losartan and give BB

46- Old male with unable to urinate for 12 hours with urgency Best management?
-Folys catheter and urine culture
-cystoscopy and prostatectomy
-ultrasound and abx
-another choice with prostatectomy

✅
47- thyroid swelling move with swallowing and protrusion of the tongue :
A- Thyroglossal cyst

48- A 28-year-old man is brought to Emergency Room with head injury after motor vehicle
accident, he is making incomprehensive sounds, open his eyes to painful stimuli and flexes
his limbs to painful stimuli, and his pupils react sluggishly to light.
What is his Glasgow Coma Score?
A. 5
B. 6
C. 7
D. 8

49- A 61-year-old man complains of indigestion that has been bothering him for the past 2
months. He has never had these symptoms before and he is eating and drinking well. He
says he has lost weight over this period. His bowel habits are normal and he does not
complain of any abdominal pains. Abdominal examination is normal. Blood tests including
full blood count, renal function, and liver function as well as C-reactive protein are normal.
Which of the following is the best management plan?
A. Urgent endoscopy
B. Routine abdominal ultrasound
C. Abdominal and erect X-ray today
D. Routine referral to gastroenterology

50- Pregnant and asthmatic. what will be changed during pregnancy?

A.increase RR
B Increase resdual volume
C. Increase tidal volume
D. Increase functional resdual capacity

51- truck driver presents with a Gluteal mass 3x 4cm , fluctuating, tender and red. What is

✅
the management?
A-I& D
B-abx
C-observation

52- A 30 weeks pregnant came with heat intolerance and other symptoms of
hyperthyroidism she was on carbimazole 15 mg
Labs:
TSH : low
T3,T4: High
what is the apropriate management?
A- Increase carbimazole dose to 20mg
B- Switch carbimazole with Propylthiouracil
C- Refer for thyroidectomy
D- Radioactive ablation
53- A 20-year-old woman presented to the Maternal Health Clinic with severe facial acne
and irregular menstrual bleeding. Examination shows fine hair growth on the chin, upper
back. breasts and lower abdomen. A pregnancy test is returned negative. She returns to the
clinic on the 5th day of her menstrual cycle and has a serum sample drawn for analysis (see
lab results). Test Result Normal Values
Follicle-stimulating hormone 10 5-20 IU/L Luteinizing hormone 28 5-22 U/L Prolactin 890 <
870 pmol/L
Testosterone 3.2 0.7-2.8 mol/L
Which additional laboratory values should be obtained?
A. Thyroid stimulating hormone and free T3 and T4
B. Progesterone and thyroid stimulating hormone
C. Dehydroepiandrosterone and androstenolone
D. Glucose tolerance and lipid profile

54- Old lady complaining of pain in calf and lateral aspect of her leg, she have spinal
stenosis. Where are the level of stenosis she have ?
A- L3-L4
B- L4-L5
C-L5-S1
D- S1-S2

55- Child with increasing jaundice, flapping tremor and decreased school performance. O/E
stigmata of chronic liver disease are present.
Which of the following is the most appropriate investigation?
A. Liver biopsy
B. Liver HIDA Scan
C. 24h urinary copper
D. Bone marrow biopsy
Next > urinary copper
Definitive > liver biopsy

56- 38 wks with contraction admitted to OR. GDM on diet BUT NO REGULAR ANTENATAL
F/U , Us: baby weight 4500 gm polyhydramnios, Whats the most imp to be available in (time
out period) ?
- Blood glucose monitor
- Availability of blood results
- Blood loss count

57- 61 years old women sustain MVA to here left chest brought to ER vitally stable no open
wound admitted for observation, couple of hours later developed suddenly SOB only, initial
CXR reveled 3-7 left ribs features. Repeated CXR showed well demarcated left lung
infiltarate. What is the diagnosis?
A- PE
B- flial chest

✅
C- cardiac contusion
D- pulmonary contusions
58- 60 years old post menopausal lady with heavy vaginal bleeding. What is the most likely

✅
cause?
- Endometrial polyp
- Submucosal fibroid
- Endometrial cancer
- Endometrial atrophy

✅
59- Hyperkalemia ECG finding ?
Ans: Peaked T wave

60- Old male diagnosed with terminal illness. Labs show high calcium, what is the

✅
management?
Ans: Normal saline

61- Down syndrome signs, what is the endocrine pathology?

- Hypothyroidism
- hyperthyroidism
- panhypopitutirism
- hypoparathyroidism

62- 15-Mother who is Rh negative delivered a baby who is Rh + she was given Anti-D Ig 300
microg what does it cover ?
A. 15 ml of the whole fetal blood
B. 30 ml of the whole fetal blood
C. 10 ml of the whole fetal blood
D. 30 ml of Rh(D) positive fetal RBCs

63- A long scenario about ectopic pregnancy then ask about the mortality rate ? Her BP was
around 90/60
A- <1%
B-10-15%
C-30-40%
D-60%

64- An 8-year-old child presents with short stature. What is the highest diagnostic value?
A. Mid-parental height
B. Arm circumference
C. Urine analysis

65- rta enlarging mediastinum normal air entry on auscultation

-aortic injury
-cardiac contusion
-pneumothorax

66- what will be changed during pregnancy?

A.increase RR
B. Increase tidal volume ✅
C. Increase resdual volume
D. Increase functional resdual capacity

67- 65 with Lichen sclerosis came for follow up a mass was found and a biopsy was taken
Histopathology will reveal
- adenocarcinoma
-adeno..
- sq ca
- melanoma

Full recall 👇🏻
A 67-year-old woman attended the Gynecological Clinic for the follow up of lichen sclerosus
diagnosed few years earlier.
Upon examination, a small mass measuring 0.5 x 0.5 cm was identified on her right labia
majora. Punch biopsy was taken from the lesion and sent for histopathology.
Which of the following is the most likely histopathological finding?

✅
A. Adeno-squamous carcinoma
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Melanoma

68- child 6 months old who is eager to drink, alert oriented depressed fontanelle,
sunken eyes normal vitals
Percentage of dehydration?
A- <5%

✅
B- 15%
C- 10%
D- 5%

69- 61 years old women sustain MVA to here left chest brought to ER vitally stable no open
wound admitted for observation, couple of hours later developed suddenly SOB only, initial
CXR reveled 3-7 left ribs features. Repeated CXR showed well demarcated left lung
infiltarate. What is the diagnosis?
A- PE
B- flial chest
C- cardiac contusion
D- pulmonary contusions

70- A 40-year-old drug addict man presents to the Emergency Department with 1-hour
history ofunconsciousness. On examination, he has pinpoint pupils and a respiratory rate of
8/minute. Which of the following is the most appropriate treatment?

✅
A. Atropine
B. Naloxone
C. Furosemide
D. N-acetylcystein

71- A 3-month-old girl presented to the Emergency Room with symptoms of paroxysmal
episodes of cough followed by whooping sound at the end. It is occasionally associated with
perioral cyanosis and post- tussive vomitng. History revealed that she did not receive her
2-month vaccine. Her mother has already given her 2 doses of antmicrobial treatment. What
is the gold standard method to diagnose this conditon? A. Blood culture
B. Serologic testng
C. Respiratory culture
D. Nasopharyngeal polymerase chain reacton

72- Burden of hypertension on population what study to use?

- Ecological
- Cross sectional
- Interventional

73- Ptn take 4 bags of blood then perioral tingling& parathesia occur due to
1-citrate toxicity
2-hypocalcemia
3-hypkalemia
4- hypomagnesemia

74- In the OR, the surgeon said” charge nurse hang another bag of blood” the nurse replied”
hanging the bag” and did it, What’s the type of communication?
A-call out
B-closed loop communication
C-Situation ,assessment , Background
D- Hand off

75- Elderly pt fell down on his leg 2 weeks ago from that time he was bed ridden presented
with shortness of breath and dyspnea and found to have high renal profile Which of the
following if found in the urine indicates that he is suffering from cholesterol embolism?
A) granural cast

✅️
B) hyaline cast
C) esinophiluria
D) RBS cast

76- young patient underwent open appendectomy , stayed in hospital for 2 days post op and
it was uneventful stay. Came back on the 8 th day with surgical site pain . On examination
abdomen was soft , lax , tender in op site with redness noticed , what would be your next
step?
A) Exploratory laparotomy
B) open drainage
C) CT abdomen
D ) oral Antibiotics
77- 61 years old women sustain MVA to here left chest brought to ER vitally stable no open
wound admitted for observation, couple of hours later developed suddenly SOB only, initial
CXR reveled 3-7 left ribs features. Repeated CXR showed well demarcated left lung
infiltarate. What is the diagnosis?
A- PE
B- flial chest

✅
C- cardiac contusion
D- pulmonary contusions

78- Newborn with hyperterolism and nasal bridge depression elevated epicanthal fold and
palpebral fissure

✔️
What is the next step
A. Chromosomal analysis
B. Metabolic screening
C. TORCH
D. Skeletal survey

79- Screening for asymptomatic bacteriuria during pregnancy

- 12w
- 26w
- 32w

80- Child with 7 cafe au lait spots 5 axillary freckles, his mother said his nephew has the
same disease. What’s the inheritance mode?
A- autosomal dominant
B- autosomal recessive
C- X-linked dominant

81- 38 year old Female came for diabetes screening hba1c 5.5 , Wheight 91 kg and height
160 what to give ?
A-insulin
B-metformin
C-glyburide
D-Acarbose

Pt came with shockLow cardiac output, low wedge pressure High vascular resistance
What type of shock?
- Cardiogenic
- ⁠Septic
- ⁠Hypovolemic

82- A 72-year-old man presented with acute sever chest pain with an ECG revealing St
segment elevation 11,1,AVF, leads was treated with thrombolysis but 2 days later acutely
unwell with sever dyspnea. On examination, he has loud systolic murmur at the apex, which
radiates to the axilla and bilateral crackles at the base of the lungs.
Blood pressure 90/60 mmHg
Heart rate 100/min
Respiratory rate 25 / min
Oxygen saturation 88 %
Which of the following is the most likely diagnosis?
Myocarditis
Cardiogenic shock
**C. Rupture papillary muscle
D. Acute Rt sided heart failure

83- A girl is experiencing changes in the voices she hear And she thinks they're able to '
suck out her thoughts':
A- schizophrenia
B- Mania
C- Mood disorder
Ans: A

84- An 8-year-old boy presents to the Emergency Department after a fall on his left forearm.
On examination, there was swelling and a deformity with a 1 cm wound on the volar aspect
of his forearm Which of the following is the first step in management?
A. Closed reduction and below elbow cast
B. Closed reduction and above elbow cast

✅
C. Discharge the patient with oral antibiotics
D. Surgical debridement, irrigation, and fixation

85- Woman diagnosed with cystasarcoma phylloids , tumor is 15*15 cm , management:

- Radiation
- Simple mastectomy
- Neoadjuvant chemo
- Modefied mastectomy

86- 34 years old female present with gluteal swilling which was in exam found hotness,
redness and tender upon touch measurement show 3*4 cm abscess what is the most
appropriate management?
A. Antibiotic
B. Incision and drainage
C. US
D. Needle aspiration

87- Child 8 years old, has dysuria , burning micturition his physician did for him mid stream
urine culture show +ve Klebsiella pneumonia (>100,000 colonies/ml) , what to do for him?
1- Start on prophylactic Abx
2- Repeat culture later
3- Treat him as case of UTI
4- Observation
88- Pregnant lady have placenta previa totalis which of the following carry significant risk
factor for her?
- Dm
- HTN
- Smoking
- Multiple gustation

89- A woman was bathing her child and noticed a mass in his flank, which of the following
investigation is most appropriate?
A. Abdominal radiography (XRAY)
B. Abdominal CT
C. Abdominal MRI
D. Abdominal radiography and ultrasonography
I chose CT cause it asked for most appropriate not initial

Recall:
A 4-year-old girl is brought to the clinic because her mother had felt a mass in the abdomen
last night when she was bathing her. She has been otherwise well with no weight loss, fever,
or bone pain. Her blood pressure is 130/80 mmH. Physical examination shows a
well-thriving kid with a palpable firm mass in the right flank (see lab results).
Test Result Normal Values
Color Clear clear or light yellow
pH 7.0 4.3-8
Specific gravity 1010 1001-1030
Protein Absent Absent
Glucose Absent Absent
Ketones Absent Absent
Nitrite Absent Absent
Hemoglobin +*+ Absent
Leukocytes Absent 0-3 per high power field
Erythrocytes 50 0-2 per high power field
Which of the following is the most appropriate next step in her diagnostic work-up? A. Plain
abdominal radiography
B. Abdominal computed tomography
C. Abdominal magnetic resonance imaging
**D. Plain abdominal radiography and abdominal ultrasonography

90- Pt stable with 5x3 ectopic fallopian pregnancy and bHCG 5000, how would you
manage?
A. Medical
B. Laparoscopy
C. Observation
B?

91- Persistent hypokalemia despite IV replacement >

Check mg levels
92- A12-month-old boy is brought to the cllnic witha complaint Ci decreased appetite. The
child was bom at36 weeks' gestation and has been fed with cow's mik formula since the age
of 9 months. The body weight is 13.6 kg ( > 37th percentile) and the length is 75 cm (50th
percentile). Physical examination confims pallor of the skin and buccal mucous membranes.
There is also
systolic heart murmur and a palpable spleen (see image and lab results)
Hb 90 112-165 g/L
RBC 3.0 4.6-4.8 x 1012/

What additional laboratory finding S most likely to be significantly lower than the normal
value?

✅💯
A: WBC
B. MCV
c. Platelets
D. Reticulocyte count

93- A5-year-old child presents to the Emergency Department witha 4-day history of malaise,
poor oral intake. diarhoea, and decreased urine output, Physical examination confirms a
tachycardia, xerostomia and sunken eyes (see lab results).
Blood urea nitrogen 14.9 1.8 to 6.4 mmol/l
Creatinine 180 27-62 umoll
Potassium 5.5 3.5-5.1 mmol/l
Bicarbonate 14 21-28 mimol/l
Which of the following is the most appropriate management?
A Dialysis

✅💯
B. Diuretics
C. Normal saline
D. Nahco3 solution

94- There was a question, baby borned with a lot of congenital deformities what are you
going to do for him?
- chromosomal analysis
- congenital analysis
- irrlevent

95- A question about post partm female, Came with sob murmur chest pain etc she is still
alive not dead , What is the dx ?
- postpartum pericardium something
- other cardiac causes

Recall:
A 29-year-old woman presents to the Emergency Department complaining of being unable
to sleep flat for the last 2 nights due to difficulty in breathing. She has just delivered 1 week
earlier. Physical examina7on confirms a laterally displaced apex beat and the presence of a
third heart sound. The jugular veins were distended and bilateral lung crackles could be
easily heard. Which of the following is the most likely diagnosis?
**A. Peripartum cardiomyopathy
B. Pulmonary embolism
C. Mycordial infarc7on
D. Pneumonia

96- Patient known case of Type 2 DM, BMI: 30, HbA1c: 8, what will reduce risk of renal
failure?
A. Smoking
B. Glycaemic control
C. WT reduction
D. ‘not sure if BP control was the last option or not’

97- Question about copd patient came with acute attack , You give him oxygen he started to
deteriorate ,What INITIAL thing you will do?
- stop O2
- intubation
- Non invasive intubation

98- 35 year old female recently deliverd a baby 2 weeks ago presented to the ER with chest
pain for 1 day, associated with exertional SOB, no fever, no pnd, no orthopnea. On
examination she looked ill.
Vitals
Bp 120/79
HR 110
T 37
O2 - 88%
Fev - normal
Fvc - normal
Fev/fvc - normal
Dlco - low
A- pneumonia
B- Heart failure
C- Acute bronchitis
D- pulmonary embolism

99- old uncontrolled HTN presents with orthopnea, PND, LL edema, elevated JVP, echo
showed left ventricular hypertrophy with normal ejection fraction what is the diagnosis ?
A. left ventricular diastolic dysfunction
B. restrictive cardiomyopathy
C. silent MI
D. constrictive pericarditis

Recall:
A 68-year-old woman is admitted to the hospital with first episode of acute heart failure. She
has
a history of hypertension treated with a thiazide diuretic. An echocardiogram reveals no
evidence of valvular disease and no segmental wall motion abnormalities. Left ventricular
hypertrophy is noted, and her ejection fraction is 55%.
Which of the following is the most likely cause of her heart failure?
A. Hypertrophic cardiomyopathy
**B. Diastolic dysfunction
C. Systolic dysfunction
D. High-output failure
————-

A 60-year-old man with poorly controlled hypertension presents with exertional dyspnea and
occasional paroxysmal nocturnal dyspnea. No chest pain or palpitation. On examination, he
is
comfortable at rest; the JVP is 3 cm above sternal border, loud A2 and left ventricular $4, no
murmur (see reports).
Blood pressure 160/100 mmH
Heart rate 76 /min
Respiratory rate 18 /min
Oxygen saturation 95 %
Electrocardiogram: Shows sinus rhythm and left ventricular hypertrophy.

Echocardiogram: Normal cardiac chambers size, concentric left ventricular hypertrophy and
normal left ventricular ejection fraction.
Which of the following is the most likely diagnosis?
**A. Left vntricular diastolic dysfunction
B. Restrictive cardiomyopathy
C. Silent myocardial ischemia
D. Constrictive pericarditis

—————-

A 38-year-old Indian man presents with progressive dyspnea for 3 months. He has past
history of old tuberculosis. He has no other medical problems and not on any medications.
His JVP was elevated and rises further on inspiration. Cardiac examination was normal with
no murmurs.
Blood pressure 105/60 mmH
Heart rate 120 /min
Oxygen saturation 93 %
Which of the following is the most likely diagnosis?
A. Myocarditis
B. Corpulmonale
C. Cardiomyopathy
**D. Constrictive Pericarditis

——————

A 23-year-old woman with systemic lupus erythematosus (SLE) presented to the clinic with a
3- month history of lower-extremity swelling and shortness of breath. She has not had chest
pain, palpitations, or fevers. On physical examination, she has jugular venous distention and
engorgement with inspiration. Heart sounds are distant; a prominent early diastolic sound
without gallops or murmurs is heard. Breath sounds are normal. Abdominal examination
reveals shifting dullness. Pitting edema to the level of the knees is noted (see lab results).
Blood pressure 110/70 mmHg
Heart rate 95 /min
Respiratory rate 25 /min
Temperature 36.6 °C
Oxygen saturation 90 %
Test Result Normal Values
Hb 90 130-170 g/L (Male)
120-160 g/L (Female)
Platelets count 450 150-400 x 109/L
WBC 3 4.5-10.5 x 109/L
Creatinine 150 44-115 mol/L
Albumin 28 34-56 g/L
Complement C3 0.5 0.7-1.5 g/.
Complement C4 0.1 0.15-0,45 g/L.
Aspartate aminotransferase 100 12-40 IU/L
Alanine aminotransferase 94 5-40 IU/L
Which of the following SLE association most likely explains the current condition?
**A. Constrictive pericarditis
B. Myocardial infarction
C. Liver failure
D. Renal failure

100- 30 weeks pregnant came with PPROM there is no symptoms associated except for
leakage of water what you will give :
-Steroid with Nifedipine
-Steroid with MgSo4
-Steroid with ampicillin+erythromycin
-Oxytocin

101- Female she HAD postpartum hemorrhage 1 week ago bc she delivered a big baby,
and is presenting to you now IN THE CLINIC. What’s the most appropriate anagment?
A. Oxytocin ?
B. Misoprotsol
C. Carbo
D. Ergo

102-A 60-year-old woman complains of left nipple discharge that is spontaneous, blood
stained and recurrent for the past 6 months. Physical examination was normal (see reports)
Bilateral Breast Mammogram: Normal.
Breast Ultrasound: Bilateral ductal dilatation, there is a 12 mm left intraductal lesion,
suggestive of intraductal papilloma.
Which of the following is the most appropriate next step in management?
A. Discharge fluid cytology
B. Left central duct excision
C. Image guided core biopsy
D. Short interval follow-up imaging
103- 61 years old women sustain MVA to here left chest brought to ER vitally stable no open
wound admitted for observation, couple of hours later developed suddenly SOB only, initial
CXR reveled 3-7 left ribs features. Repeated CXR showed well demarcated left lung
infiltarate. What is the diagnosis?
A- PE
B- flial chest
C- cardiac contusion
D- pulmonary contusions

104- Patient kco dudenal ulcer presented with sever abd. Pain and postprandial vomiting .
X ray showed air under diaphragm , Vitals : BP 90/70, What the initial ttt ?
- Colloid IV
- NS
- KCL

105- Postpartum lady presented with unilateral breast pain, the breast is tender non
fluctuating, she is breastfeeding, what would you do?
A- Ask her to stop breastfeeding
B- Use warm compress and tight clothes
C- Give antibiotics and US to investigate the possibility of abscess

106- 81 years old presented with memory loss and drinks and forgetting his grandson's
names he is otherwise healthy however he drinks alcohol occasionally?
A. Alzheimer disease
B. Alcoholic encephalopathy
C. Parkinson’s

106- Case about an infant have hypotonia , large tongue , ventral or umbilical hernia with
and hepatosplenomegaly and jaundice what is the diagnosis?
- hypothyroidism
- galactosemia

107- Pregnant lady in 31 weeks have preterm labour what is the most appropriate next step
management?
- MgSo4
- Steroid
- CS
- IOL

108- 32 year old man kco duodenal ulcer, presented with 2 week history of vomiting. On
examination he was severely dehydrated. With abd ex. Showing shifting dullness .
Which of the following is the most likely acid-base abnormality?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Compensated metabolic acidosis
D. Decompensated metabolic alkalosis
Recalls :
A 37-year-old man with a history of chronic duodenal ulcer, presented to the Emergency
Department complaining of frequent postprandial vomi7ng since last 2 weeks. On physical
examina7on, he was dehydrated with posi7ve succussion splash when shaking the
abdomen. which of the following is the most expected acid-base abnormality?
A. Metabolic acidosis
**B. Metabolic alkalosis
C. Compensated metabolic acidosis
D. Compensated metabolic alkalosis

A 32-year-old man who is known to have ulcera7ve coli7s, presented to Emergency

Department with a history of frequent a]acks of watery diarrhea for 10 days. On
examina7on, he was severely dehydrated with non-distended, so\ abdomen. Which of the
following is the most expected acid-base abnormality?
**A. Metabolic acidosis
B. Metabolic alkalosis
C. Compensated metabolic acidosis
D. Compensated metabolic alkalosis

A 55-year-old woman known to have chronic duodenal ulcer, presented to the Emergency
Department with history of frequent vomi7ng for 2 weeks. Examina7on revealed
dehydra7on, with distended upper abdomen and normal bowel sounds (see report). Upper
Gastrointes7nal Endoscopy: Severely narrowed pylorus due to chronic pep7c ulcer disease.
Which of the following is the most expected?
A. High urinary potassium
B. Respiratory alkalosis
C. Metabolic acidosis
**D. Hypokalaemia

109- 70 yrs old man k/c of IHD, central abdominal pain vitally stable, amylase 600, WBC
normal, abdominal x ray: dilated small bowl with thickened wall: what’s the dx?
A. Pancreatitis
B. Intestinal obstruction
C. Perforated ulcer
D. mesenteric ischemia

110- A 27-year-old man admitted to the Intensive Care Unit 4 weeks ago with severe
infected necrotizing pancreatitis. He underwent several interventions for sepsis control and
drainage of collections. He is on mechanical ventilation and inotropes.
Which of the following metabolic responses is most expected?
A. Reduced insulin resistance
B. Reduced gluconeogenesis
C. Increased lipolysis
D. Hypoglycemia
111- Patient 10 weeks pregnant home test, she came with bleeding and upon examination
cervix was dilated and vesicles coming out,
What is the next step?
A. ultrasound
B. bhcg
C. ultrasound and bhcg

112- A 45-year-old woman with chronic history of knee pain in which she is on oral
analgesics. She presented with acute abdomen, peritonitis and hemodynamic instability. and
underwent exploration laparotomy. Finding was: perforated duodenal ulcer. Which of the
following is the procedure of choice to treat her perforation?
A. Simple closure with omental panch
B. Biopsy, simple closure with omental patch
C. Truncal vagotomy and antrectomy
D. Highly selective vagotomy with omental patch

113- 2 months old Child started to wake up in the middle of the night crying since last two
weeks, the doctor told the parents it is common up to :
- 2 months
- 3 months
- 6 months
- 36 months

114- A 20-year--old woman presented to the Maternal Health Clinic with severe facial acne
and irregular menstrual bleeding. Examination shows fine hair growth on the chin, upper
back.breasts and tower abdomen. A pregnancy test is returned negative. She returns to the
clinic on the 5th day of her menstrual cycle and has a serum sample drawn for analysis (see
lab results).
Test Result normal Values
Follicle-stimulating hormone 10 (5-20 IU/L)
Luteinizing hormone 28 (5-22 U/L)
Prolactin 890 < 870 pmol/L
Testosterone 3.2 (0.7-2.8 nmol/L)
Which additional Laboratory values should be obtained?
a. Thyroid stimulating hormone and free T3 and T4
b. Progesterone and thyroid stimulating hormone
c. dehydroepiandrosterone and androsterone
d. Glucose tolerance and lipid profile

115- A 65-year old post-menopausal woman complains of on and off vaginal bleeding that
started 2 months ago. The amount of bleeding is mild to moderate of fresh blood. The
woman is diabetic.hypertensive and obese. she has used hormone replacement therapy to
control post menopausal symptoms.
Body mass index 37 kg/m2
Which of the following investigations is essential to establish the diagnosis?
a. pelvic magnetic resonance Image
 ✅
b. Pelvic ultrasonography
c. Endometrial biopsy
d. Tumor markers

116- Copd came with progressive SOB and cough , he was conscious then start to be
confused and loss of conscious O2 89% , ABG show
PH 7,19
PaO2 low
PaCo2 high
What is the next appropriate management ;
1) non invasive positive ventilation
2) reduce O2 flow
3) MV
4) reduce O2 flow

Recall:
A 65-year-old man known to have COPD presented to the Emergency Department with
increasing dyspnea, cough, expectoraton and fever. Inital assessment revealed fully
conscious patent with mild distress, central cyanosis and bilateral wheezing on chest
auscultaton. The patent was started on high fow oxygen and salbutamol nebulizer but 1 hour
later, his level of consciousness is reduced (see lab result) Test Result Normal Values ABG
HCO3. 36 22-28 mmol/L ABG PCO2 9 4.7-6.0 kPa pH 7.18 7.36-7.45 ABG PO2 15
10.6-14.2 kPa Which of the following is the best inital step in management?
A. Start mechanical ventilation
**B. Reduce oxygen flow
C. Order brain CT scan
D. Give naloxone

An elderly man, known to have COPD is brought to Emergency Department with severe
respiratory distress, cyanosis and drowsiness. His upper airways were full of secretons (see
lab results). Blood pressure 90/60 mmH Heart rate 110 /min Respiratory rate 18 /min
Temperature 38.0 °C Oxygen saturaton 74 % Test Result Normal Values
ABG HCO3 36 22-28 mmol/L ABG PCO2 7.99 4.7-6.0 kPa pH 7.24 7.36-7.45 ABG PO2
8.99 10.6-14.2 kPa Which of the following is the best opton in management?
A. Nasal CPAP
**B. Mechanical ventlaton
C. Aminophylline infusion
D. Oxygen administraton via face mask

117- A 42-year-old man presented to the Emergency Department complaining of a 12-hour

history of severe epigastric pain. Physical examination confirmed upper abdominal
tenderness
WBC 14.5 4.5-10.5 x 109/L
Amylase 254 24-151 IU/L
Erect chest X-ray: Normal.
Which of the following is the most appropriate next step in management?
A. Abdominal CT scan ✅
B. Abdominal ultrasound
C. Exploratory laparotomy
D. Urine analysis for amylase

118- A 36-year-old man presented to the Emergency Department with a 24-hour history of
central abdominal pain associated with abdominal distension, vomiting and constipation. He
had an appendectomy 7 years ago. Physical examination confirmed diffuse abdominal
distension, mild abdominal tenderness with exaggerated bowel sounds.
Amylase 288 24-151 IU/L
WBC 11.4 4.5-10.5 X 109/L
Erect X-ray: Multiple air fluid with dilated small bowel.
Which of the following is the most approprate investigation?
A. Abdominal ultrasound

✅
B. Exploratory laparotomy
C. Abdominal computed tomography
D. Laparoscopic abdominal exploration

119- Female 26 weeks with reduced fetal movement since 2 weeks. Abdominal exam show
GA of 24 weeks, presented to ER, U/S done showed fetal demise. How to manage?
A. IV oxytocin

✅
B. D&C
C. Misoprostol vaginal pessaries

120- A 25-year-old woman presents with a 6-hour history of lower abdominal pain
associated with nausea and episode of vomiting. Examination confirms minimal tenderness
in the suprapubic and left iliac fossa region. Urine dipstick and pregnancy tests are normal.
Blood pressure 110/70 mmHg
Heart rate 76 /min
Temperature 36.6 °C
Test Result Normal Values Hb 110 130-170 g/L
WBC 9 4.5-10.5 x 109/L
Neutrophils 50 40-60%

✅💯
Which of the following is the most appropriate management?
A. US abdomen
B. Abdominal X ray
C. Diagnostic laparoscopy
D. Discharge on oral analgesics
“‫ جاء هذا السؤال بدون خيار‬ultrasound “
‫ اتوقع كان فيه‬CT

121- Old female with upper gi symptoms, Fecal occult blood test positive Colonoscopy
normal, What to do?
Ans: Esophagogastroduodenoscopy

122- Middle East respiratory syndrome-related coronavirus (MERS-COV) has a case fatality
of 37.5%. What is the interpretation of this data?
A. 37.5% of the population susceptible to get MERS-COV
B. 37.5% of newborns will get MERS-COV
C. 37.5% of people infected with MERS-COV will die
Ans: C

123- a child presents with persistent fever not relieved with paracetamol around 6 days
associated with bilateral nonexudative conjunctivitis, strawberry tongue, cervical
lymphadenopathy 1.5 cm, rash in extremity, what is the Dx?
A. Kawasaki
B. SLE
C. Rubella
D. Measles
Ans: A

124- 8-year-old patient immunization schedule unknown, came with fever and neuro
symptoms, examination revealed bilateral tender and enlarged parotid glands and pain with
neck flexion, what is the causative cause?
A. EBV
B. CMV
C. Mumps
D. Measles
Answer: C

125- case was very clear known case of RA on medication complaining of SOB and

✅
dyspnea clubbing on examination ,velcro like crackles was heard
A- Idiopathic pulmonary fibrosis

126- 45 male came to the ER 12 hours ago complaining of vomiting fresh blood, he has a
history of 10 years recurrent peptic ulcer. Upper endoscopy showed Estates multiple ulcers
dista Z one is in the 4th part of duodenum. What is the best diagnostic value ?
A- Calcium B- Parathormone
C- Fasting serum gastrin
D- Vasoactive polypeptide
Ans:

127- 2 month anxiety, irritability, insomnia, weight loss .

Importance
A - social phobia
B- major depression
C- secondary depression
D- GAD
Recall:
A 55-year-old man presents to the clinic with 2 months history of anxiety, irritability,
impotence, difficulty in sleeping, and a weight loss of 10 kg. There is no evidence of marital
disharmony or any external causes for the pa7ent's anxiety. The physical examina7on was
normal. Which of the following is the most likely diagnosis?

✔️✔️✔️
A. Social phobia
B. Major depression
C. Secondary depression
D. Generalized anxiety disorder

128- Pt diagnosed with antiphspholipd syndrome Tx?

- lifelong warfarin
-non-vitamin K anticoagulants

129 - year-old man had a crush injury to his lef leg afer a heavy object fell on it, 5 hours prior
to presentaton. He was complaining of severe pain in his leg. Examinaton revealed a
conscious and alert patent. His lef leg was cold with delayed capillary reflling. Blood
pressure 116/67 mmHg Heart rate 95 /min Respiratory rate 23 /min Oxygen saturaton 95 %
Which of the following is the most appropriate next step?
A. Angiography
B. CT angiography

✅
C. Duplex ultrasound
D. Compartment pressure
Ans:

130- 15 years old came for routine check up

His lab
Low hemoglobin
Low MCV
High WBCs 68
What is the type of anemia
A. SCA
B. Thalassemia titer
C. Anemia of chronic disease
Ans: ?

131- Female with infertility for 3 years her lab normal the husband lab also normal ,
induction of ovulation by clomiphene for 3 months Most appropriate management
A. IVF
B. Induction of ovulation by gonadotropins
Ans: ?

132- Patient with history of SOB and weight loss for 6 month no past history of TB or HIV ,
x-ray pleural effusion, thoracocentesis 1500 ml blood fluids Strong exudate in light criteria
What is the appropriate management?
A. Systematic Antibiotics
B. Systematic steroid
C. CT with contrast
Ans:

133- Female pregnant in 34 weeks have contraction every 4 min and vaginal bleeding heavy
than her menstrual period , cervical os 4 cm , Fetus in transverse lie , Us placenta in
posterior fundes , Fetal heart rate 170 , What is the appropriate management?
A. Observation
B. C/S
C . ECV
D. Administration of tocolytic

Recall:
A 34-week pregnant woman presents in labor with contractions occurring every 4 minutes,
she also has vaginal bleeding which is heavier than normal menstrual flow. The fetus is in a
back- down position, transverse lie, and the cervix is dilated 3 cm with bulging membranes.
The fetal heart rate is 170 bpm. The sonography showed a posterior fundal placenta with a
retroplacental sonolucent area. Which of the following is the most appropriate initial
management?
A. Administration of a tocolytic agent
B. Oxytocin augmentation
**C. Caesarean section
D. Amniotomy

134- Male patient came with abdomen pain on PE pain above umbilical
Normal vitals
Normal lab
WBCs 14
What lab will order
A. CL level
B. Ca level
C. Amylase level

Recall:
A 70-year-old man presents with abdominal pain. Examination revealed a pulsatile
abdominal mass felt on deep palpation with mild tenderness just above the umbilicus (see
lab results and report).
Blood pressure 110/70 mmH
Heart rate 76 /min Respiratory rate 14 /min Temperature 36.6 °C Oxygen saturation 99 %
Test Result Normal Values RBC 6.0
4.7-6.1 x 1012/L (Male)
4.2-5.4 x 1012/L (Female)
Hb 135 130-170 g/L (Male)
120-160 g/L (Female)
HCT 0.42 0.42-0.52 (Male)
0.37-0.48 (Female)
Platelets count 155 150-400 x 109/L
WBC 13.5 4.5-10.5 x 109/L
Sodium 136 134-146 mmol/L
Potassium 4 3.5-5.1 mmol/L
Bicarbonate 25 21-28 mmol/L
Upright chest x-ray: No air under diaphragm.
Which the following is the most appropriate lab investigation to be ordered next?
A. Cl level
**B. Amylase level
C. Calcium level
D. Arterial blood gas

135- 7-year-old boy is brought to the clinic with the complaints of mild abdominal pain,
constipation and aggression. The mother told the physician that he is used to eating tissue
paper and chipped off wall paint
Hb 74
MCV 70
Peripheral blood smear: Microcytic hypochromic. Which of the following is the most likely
type of anaemia?
A)Aplastic
B)Pernicious
C)Haemolytic
D)Iron deficiency

136- A 9 year-old child presents with a fever and sore throat assoclated with bilateral knee
pain. The laboratory investigation shows a high sedimentation rate.
Which ol the following is the most llkely diagnosis?
A. Juvenile rheumatoid arthritis
B. Osgood-schlatter disease

✅💯
C. Infectious mononucleosis
D. Acute rheumatic fever

137- Pediatric pt with epistaxis what to do ?

1.lay down
2.sit and for ward
3.sit with head up
Ans:

138- Pregnant in cs there is ovarian cyst 12cm

1.cystectomy
Ans:

139- A 6-month-old infant presents to the Emergency Room with sudden apnea and collor
change. The mother gave history of recurrent vomiting, and multiple chest infection. On
examination, he looks failing to thrive with dystonic neck posturing while crying. Which of the
following considers as high-risk case for the above disease?

✅💯
A. Obese baby
B. Preterm infant
c. Post pertussis infection
D. Following inguinal hernia repair
Ans:

140- A 44-year-old man with HBV cirhosis presents with increasing abdominal girth, lower
limb edema, and 10 kg weight gain over the last 3 months. On examination, he has jaundice
and moderate ascites (see lab results and report).
Sodium 132 134-146 mmol/l
Potassium 3.8 3.5-5.1 mmoll
Creatinine 65 44-115 umolll
Albumin 30 34-56 g/L
Total bilirubin 25 3.5-16.5 pmol/l
Ascetic fluld analysis: showed an albumin level of 12 g/L and neutrophil count of 180/ul.
In addition to salt-restricted diet, what is the best next step in management?

✅💯
A. Trans-jugular Intrahepatic Portosystemic shunt
B. Furosemide and spironolactone
C. Large-volume paracentesis
D. Terlipressin and albumin
Ans:

141- A 70-year-oid man was hospitalized 6 days ago for a 4-day history of acute leg
ischemia treated with angioplasty and stenting. He is nov asymptomatic. He has a history of
stage 3 chronic kidney disease and hypertension that is well-controlled with diltiazem and
captopril. Other medications are aspirin and clopidogrel. On physical examination, the
patient is afebrile and normal blood pressure. The remainder of the examination is
unremarkable (see lab results).
Creatinine 140 44-115 umolil
Total Cholesterol 5.9 <5.1 mmol/l
LDL (cholesterol) 4.9 4.0 mmol/l
Which of the following is the most appropriate therapy for secondary prevention of
cardiovascular disease in this patient?
A. Niacin

✅💯
B. Ezitimibe
C. Rosuvastatin
D. No additional treatment
Ans:

142- A 56-year-old man presents with epigastric pain, bloating and weight loss. Gastroscopy
showed antral mass and biopsy is taken (see reports). Helicobacter pylori breath test:
Positive.
Biopsy report: Mucosa-Associated Lymphoid Tissue lymphoma (MALToma).

✅💯
Which of the following is the next step in management?
A.. Eradication therapy for H. Pylori
B. Referral for gastrectomy
c. Chemotherapy
D. Radiotherapy
Ans:

143- A 28-year-oid woman comes to the clinic for a check-up. She believes that she is
allergic to wheat; her symptoms of abdominal bloating and loose stool have improved over
the past few months by eating a gluten-free diet.
Which of the following is the most appropriate advice to her?
A. Dietician referral
B. Gastroenterology referral

✅💯
C. No need to Continue on gluten-free diet
D. Resume eating gluten diet to do celiac screen
Ans:
144- A 35-year-old woman G5 P4004 in labor and has been fully dilated for the last 2 hours.
Maternal exhaustion is noted after pushing etforts for the last hour. She is not on epidural
analgesia and the cardiotacogram shows category 1. Abdominal examination shows an
average size fetus of 2.7 kg. cephalic presentation with 4/5 palpable head. On pelvic
examination, the cervix is fully dilated and 100% effaced with -3 station.
Which of the following is the best next step?

A. Cesarean section ✅💯
B. Forceps dellvery
C. Ventose delivery
D. Reassess in 2 hours
Ans:

145- A 7-year boy diagnosed with measles, When his father was asked about the child
Immunization record, he replayed that he does not believe in immunization.
Which of the foliowing is the most appropriate action?
A. Inform the child protection team

✅💯
B. Consulit the hospital's clinical ethics committee
C. Explain to the father the importance of immunization
D. Ignore the father's response and focus on treating the child
Ans:

146- A 40-year-old woman presented with heartburn at the epigastric and retrosternal
areas„, and symptoms of regurgitation. The patient has tried conservative measures,
Including proton pumps inhibitors with no Improvement in symptoms (see report).
Endoscopy: Erythema of the esophagus consistent with reflux esophagitis.
Which of the following is the most appropriate next step?
A. Manometry study

✅💯
B. 24-hour pH monitoring
C. Lifestyle modification
D. Nissin's fundopiication
Ans:

147- Pt with DM came with toe ulcer and discharge, the toe is warm swollen tender, dorsalis
pedis and post tibial PALPABLE popliteal pulse can be felt.What is most appropriate test
A. CT with contrast
B. duplex Us
C. MR angiography
D. Conventional angiography
most appropriate > A
Next > b

148- Pt RTA high speed 130 wearing seat belt. What initially will you do ?
- Ultrasound abdomen
- CT abdomen
- Abdomen xray
Ans:
Pt stable: CT
Pt unstable: US

149- Question about RTA , Fast positive .Patients in pain and vitally stable What are you
gonna do ?
- laparotomy
- CT
- DLP
- x-ray

150- Women was in a car crash, broken ribs 5-7 with no signs of hemothorax or
pneumothorax. vitally stable in er then suddenly complained of shortness of breath only,
examination normal. chest x-ray repeated ( mid lobe confined infiltration)
-flail chest
-cardiac tamponade
-pulmonary contusion
Ans:

151- Female old age came complaining of vaginal bleeding. On investigation there was a
5cm fibroid, when compared to previous us hasn’t changed in size nor location.
What is the most appropriate investigation?
-myomectomy
-hysterectomy
-endometrial biopsy
Ans:

152- 36 male previously healthy. complains of cough with whitish sputum, on occasions with
blood streaks. Chest X-ray normal
-bronchitis
-hereditary hemorrhagic telangiectasia
Recall:
153- Woman who tried IVF and got ectopic pregnancy. On imaging there was tubal
pregnancy on the right and hydrosalpinx on the left. What is the management?
-Salpingostomy on the right only
-excision of both tubes
-Methotrexate

154- Question about a man has HTN well controlled, and HF also controlled known
dyslipidemia, recently he had stroke now he is okay , His medication has everything except
Statn, Question asking what are you gonna add
- Acei
- BB
- Statn
Ans:

155- 36-year-old lady with secondary amenorrhea (elevated FSH & LH) which of risk
or complication she might probably develop in the future?
A. Risk of endometrial cancer

✅
B. Risk of ovarian cancer
C. Risk of osteoprosis
Ans:

156- Woman who tried IVF and got ectopic pregnancy. On imaging there was tubal
pregnancy on the right and hydrosalpinx on the left. What is the management?
-Salpingotomy on the right only
-excision of both tubes
-Methotrexate
Ans:
TopG> A
Wafa> B

157- Pregnant lady just delivered a baby.

O/E: of the newborn:
multiple petechial rash on skin.
Labs (baby)
Hb was low (not sure)
plt 4
WBC 5
US head of baby
grade 1 intraventricular hemorrhage
Mother plt= 315
What is the Dx?
A) congenital cytomegalovirus
B) alloimmune thrombocytopenia
C) immune thrombocytopenia purpura
Ans:

158- Time of screening for anomaly in weeks:

A. 10-14w
B 16 -18w
C. 18-22w

159- A -week pregnant woman presents with a prenatal ultrasound finding of cystic hygroma.
Which of the following diagnostic procedures would be most appropriate to confirm the
diagnosis and assess for associated chromosomal abnormalities?
A) Amniocentesis
B) Chorionic Villus Sampling (CVS)
C) Abdominal Ultrasound
Ans:

📝📌Note to remember (ACOG)

Chorionic Villi Sampling (CVS): is the procedure of choice for first trimester testing (between
10-13 weeks.)
Amniocentesis: is the procedure of choice for second trimester testing optimally performed
(ACOG: between 15-20 weeks.), (Uptodate: between 15-17+6)

160- Question about a woman has bilateral green discharge done mamo gram nothing
suspicious What are you gonna do ?
- follow up
- excision
- core needle

161- Female her age is 17 and has primary amenorrhea, testosterone is high. What is DDx:
Androgen insensitivity

162- question about a child easily bleed has many bursis what are you gonna do for
investigation to reach diagnoses
- bone marrow
- coagulation
- CBc

163- Question about female only has hair in her pubic what is the dx?
ANS: premature adrenarche

164- Case of pelvic organ prolapse grade , ask about management

Recall:
70 years old female with prosthetic heart valve on warfarin, has grade 3 pelvic organ

✅
prolapse. How to manage?
A- Pessary
B- Sacrocolpopexy
C- Le Fort Technique
D- Hystrectomyg

165- Case of iron deficiency anaemia ask what you will increase ?
Ans: total iron-binding capacity

166- Lupus with nephrotic manifestation, ask about dignosis ?

Ans: Lupus nephrotis

167- question about missed abortion In her 8 weeks , stable :

- misprotosl
- laparotomy
- laparoscopic
- hypertonic normal saline infusion
No conservative option
Ans: A?

168- A 4-year-old gin 5 brought to the Paediatrics Emergency Department with vomiting and
lethargy. The parents report a weight loss of 1 kg over the last 2 weeks. There has been Ittie
appetite, but a lot of thirst and frequent urination. The child appeared sleepy and iritable.
Physical examination confirmed dry mucous membranes and a generally reduced skin tone.
After running several exams, the paediatrician started IV treatment with ringer lactate plus
added electrolytes and a low-dose insulin infusion (see lab results).
pH 7.27.36-7.45
Glucose 20 3.5-5.5 mmol/l
Which of the following complications should be observed?
A. Hypoglycemia
B. Kidney failure
C. Cerebral edema
D. Metabolic alkalosis
Ans: C

169- A 14-month-old boy is brought to the clinic with severe gram-positive bacterial
pneumonia, was referred to the hospital by the family physician. This is his third infection in 4
months. He has 2 healthy sisters aged 3 and 5 years. The family lost a boy at 10 months of
age to bacterial pneumonia 6 years ago. The family doctor has sent along some blood test
results that shows low all classes of serum immunoglobulin levels, few B cells, but normal
numbers and functioning of T cells.
Which of the following is the most likely diagnosis?
A. Transient hypogammaglobulinemia of infancy
B. Common variable hypogammaglobulinemia
C. CD4 Genetic/metabolic/metabolic defect
D. X-linked hypogammaglobulinemia
Ans: D

170- A 47-year old man presents with intermittent chest pains for the past 2 days. He
complains of worsening pain. On examination, he tachycardic and sweaty. ECG is done.
Blood pressure 133 /81 mmHg
What does the ECG show?
A. Pasterior myocardial infarction
B. Right bundie branch block
c. Ventricular tachycardia
D. Left bundle branch block
Ans:D

171- A12-month-old boy is brought to the cllnic witha complaint Ci decreased appetite. The
child was bom at36 weeks' gestation and has been fed with cow's mik formula since the age
of 9 months. The body weight is 13.6 kg ( > 37th percentile) and the length is 75 cm (50th
percentile). Physical examination confims pallor of the skin and buccal mucous membranes.
There is alsosystolic heart murmur and a palpable spleen (see image and lab results)
Hb 90 112-165 g/L
RBC 3.0 4.6-4.8 x 1012/
What additional laboratory finding S most likely to be significantly lower than the normal
value?
A: WBC
B. MCV
c. Platelets
D. Reticulocyte count
Ans: B

172- A5-year-old child presents to the Emergency Department witha 4-day history of
malaise, poor oral intake. diarrhoea, and decreased urine output, Physical examination
confirms tachycardia, xerostomia and sunken eyes (see lab results).
Blood urea nitrogen 14.9 1.8 to 6.4 mmol/l
Creatinine 180 27-62 umoll
Potassium 5.5 3.5-5.1 mmol/l
Bicarbonate 14 21-28 mimol/l
Which of the following is the most appropriate management?
A Dialysis
B. Diuretics
C. Normal saline
D. Nahco3 solution
Ans: C

173- Pregnant 28w bp 140/90 what to give?

A. Nifidepine
B. Hydralazine
C. Metoprolol
Recalls:
A 27-year-old primigravida presented at 36-weeks of gestation with headache, blurred vision
(see lab result).
Blood pressure 160/110 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature
36.8 °C Test Result Normal Values Protein ++ absent Which of the following is the most
appropriate medication for acute treatment of hypertension?
A. Clonidine
B. Methyldopa
**C. Hydralazine
D. Sodium nitroprusside

A 39-year-old G6 P5005 Is seen in the Antenatal Clinic for routine check-up at 22 weeks of
gestation. Her blood pressure found to be 140/90 mmH and no proteinuria. Which of the
following is the most appropriate treatment?
**A. Methyldopa
B. Verapamil
C. Nifedipine
D. Hydralazine

177- Pt with 3 previous pregnancy with seizure and double vesion

140/90 ‫واالن ناسيه باالسبوع كم وضغطها‬
‫السؤال ايش نعطيها ؟‬
Ans: MGso4
‫ناسية االختيارات‬

178-
‫ هذا السؤال جاني امس عنده‬active
bleeding and unconscious
- Patient with a stab wound in the right thigh and massively bleeding brought to the
emergency department unconscious , Hypotensive O/E there is active bleeding.
What is the most important next step to do ?
A. Ringer lactate iv fluid
B. Blood transfusion
C. Tourniquet on the thigh
D. Orotracheal intubation

179-
7 ‫كان فى سؤال طفل‬y hyperactive ‫ وبيتكلم بسرعة وعنيف فكيف نقلل المشاكل هذه‬..
-preschool examination
-decrease video games and television

📍
Recall:
June question
7-year-old child is reported to be hyperactive, restless, talks rapidly, and has violent
outbursts. What intervention can help mitigate these issues?
A- Regular preschool examinations
B- Decreasing time spent on video games and watching television
C- Parenting classes for behavior management
D- Special education resources
Answer is C
Question about mitigate method.
Preschool examination and collateral history for identifying and diagnosing
Video games and watching television by studies has no role in violence and regular parental
ways can escalate the issue
Special educational resources can be used later to the parents and child after confirmation
the mental issue.
180- 18 months child with right Undescended testes not palpable in the inguinal region, left
one is there what’s the most appropriate to do?
A. Left orchidopexy
B. Diagnostic laparoscopy
C. Wait till 3 years

181- Child reccurent infection with streptococcus pneumonia and otitis media and Abdominal
diarrhoea ask of best investigation
A) c1 esterase
B) immunoglobulin
C) Intestinal biopsy

182- Partial molar pregnancy confirmed histopathologically.

How will you follow up:
- weekly us
- weekly bhcg
- monthly us
- monthly bhcg

183- A case of Antiphospholipid syndrome what is the best anticoagulant

- Life-long warfarin
- Life-long enoxaparin
- Life-long UFH

184- 5? yo child with conjunctivitis, nasal discharge low grade fever cough, after several
days rash started from the head and spreads to the body
Rubella
EBV
coxsackie
vaccinia

185- 48-Morbidly obese pt with solmonance , necturia , SOB . Otherwise normal

Vitals
High BP
Low o2 saturaion
Others normal
Asking about invg
-sleep study
-echo
-CT angio
-don’t remember

186- Female in her 30s, present with fatigue for one week, on examination Splenomegaly,
Mildly high liver enzymes
Very high LDH,
Low haptoglobin,
Normal platelets,
Spherocytes are seen in blood smear. hemoglobin was 9.7. No family history of
spherocytosis. What is the management?
A. parenteral iron
B. hydroxyurea
C. corticosteroids
D. Blood transfusion

187- Pt with ectopic pregnancy , treated with ( salpingectomy or salpingotomy ) , has platue
phase of Hcg for 3 weeks ( about 3000 ) , what to ?
- Laparotomy
- Consider MTX injection
- Continue follow up

188- Patient came after 5 days of emergency appendectomy for perforated appendix. Now
came not looking well, febrile, wound discharge and tenderness. On exam: fluctuant mass
Management:
A. open drainage
B. antibiotic
C. Diagnostic laparoscopy
D. Laparotomy

189- Icu pt has sacral ulcer necrotic and subcutaneous fat exposed
A.Primary closure

✅
B.Debridement with primary graft C.Debridement with primary closure
D. Debridement with vacuum assisted closure

190- Wich cardiac valve lesion with worst outcome

AS
MS
MR
AR

191- Electrocardiography:
Significant ST-segment elevation in leads I, AVL, V5, and V6.
Where is the most likely site of cardiac infarction?
A.Anterior
B. Inferior
C. Lateral
D. Posterior

192- Case with sign of down syndrome

VSD
ASD

193- Case of pregnant women with IDA,,, what is the most indication for parenteral iron ?
A: constipation
B: twin pregnancy
C : ….
D: moderate and severe anemia

194- Child has atopic dermatitis, and you explain to the mother how to manage this
condition, she appears confused, so you ask her “what is the management of dermatitis?”
And she says she mentions it, what is the form of communication?
A- SBAR
B- closed loop
C- teach back
D- Assure

195- case of barking cough (croup) and ask what u will find on auscultation ?
A- prolonged inspiration with narrowing of subgluttic fold
B- prolonged inspiration due to hyper inflation of lung
C- prolonged expiration

196- Man play football then he faint mutilple similar episode for him everthing is normal
What is the dx?
- Hypertrophic cardiac

197- Young man came with feeling unwell You did examine him everything is good what HR
= 256 , What test will help you establish the dx?
- ECG
- Echo
- CT chest

Recall :
An 8-year-old boy was brought to the ER because he was complaining of chest pain and
feels that his heart is pounding. HR 256 BPM. Which of the following is the most appropriate
next step in management?
A-Cardiac enzymes

✅
B-Echocardiography
C-12 lead ECG
D-X-ray

198- A 42-year-old P3 is seeking an advice for the possibility of insertion of an intrauterine

contraceptive device for family planning. The patient's history reveals that she became
pregnant while using an intrauterine contraceptive device 4 years ago and in her second
pregnancy; she underwent a cesarean section, which was complicated by post-partum
ednometritis. Her menstrual cycles are irregular for the last 4 months with heavier flow than
usual. Which of the following is an absolute contraindication to the insertion of an intrauterine
contraceptive device?
A. History of postpartum endometritis
B. Previous pregnancy with an IUCD

✅
C. History of cesarean section
D. Abnormal genital bleeding
199- 78 YO male post-op contaminated abdominal surgery. Admitted to ICU and recieved 6
L of crystalloid IV fluid and 1 PRBC in the last 12 hours. Broad spectrum antibiotics were
administered.
Vitals:
BP 70/45
HR: 125
T: 38.6
O2: 93%
Labs:
WBC 8
Most appropriate IV intervention:
A-Albumin
B-1 L crystalloid fluid
C-Norepinephrine
D-Furosemide.

200- Painless bleeding during defecation :

A) anal fissure
B) hemorrhoids

201- painful bleeding during defecation :

A) anal fissure
B) hemorrhoids

202- An 8-week-old infant presents to the clinic with fever, wheezing, coughing, poor feeding
and poor weight gain for the previous 2 weeks. Before this, she had been well. Her routine
neonatal examination had been normal apart from pansystolic murmur at lower left sternal
edge. On examination, tne liver was enlarged below costal margin (see report):
Blood pressure 95/50 mmHg
Heart rate 85 Imin
Respiratory rate 34 Imin
Temperature 38 c
Oxygen saturation 92 %
Chest X-Ray: Showed cardiomegaly and increase pulmonary vascular marking with bilateral
patches in the lung. Which of the following is the most appropriate next step in
management?

✅
A. Referral for surgical intervention
B. Medical treatment with diuretics
C. Admit to ICU for diagnostic catheterization
D. Full course of IV antibiotics then re- evaluate

203- Young male patient did hemorrhoids operation 12 Months ago, currently he complains
of sever anal pain that interfere with defecation, digital rectal exam (DRE) did not complete
due to severe pain, what is the diagnosis?
A. Fissure
B. Thrombosed hemorrhoid
C. Intersphincteric abscess
D. Anal stenosis

Recall :
Full recall
A 25-year-old presents with a 2-week history of severe perianal pain and an inability to pass
stool for the last 2 days. History confirmed a haemorrhoidectomy 12-mothns ago.
On examination, he is uneasy and in distress.
On rectal examination, finger could not be passed beyond the anal verge due to severe pain.
Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 18 /min Temperature
36.6 °C
Which of the following is the most likely diagnosis?

✅
A. Anal fissure
B. Anal stenosis
C. Anal carcinoma
D. Intersphincteric abscess

204- Case of extradural hematoma , lucid interval , which artery involved ?

- middle meningeal artery

205- Management for COPD mMRC 2 (Modified Medical Research Council)?

A. Combined Salmetrol + fluticasone
B. Phosphodiesterase-4 (PDE₄) inhibitors + Salmetrol + fluticasone
C. Albutarol as needed + Salmetrol+ pulmonary rehabilitation
D. Albutarol as needed + fluticasone

206- Old patient drawsy, no ecg change ,, K: 6,5

What is the most initial management :
A: iv normal saline
B: insulin and dextrose
C: iv chloride
D : dialysis

207- A 35-year-old man presented with fever, rigors and weight loss for 10 days. He
underwent Mitral valve replacement by prosthetic valve a month ago. Echo showed small
vegetation. Blood pressure 90/70 mmHg, Heart rate 100 /min, Temperature 38.7 °C Which of
the following organisms is the most likely to be responsible for his presentation?
A. Coxiella burnetii

B. Staphylococcus aureus

✅
C. Streptococcus viridans
D. Staphylococcus epidermidis

208- Patient known case of hypertension came complaining of progressive SOB increase at

✅
night + bilateral crepitation
A.HF
B.asthma
C.pulmonary fibrosis
209-Old patient hx of HF with HTN, dilated cardiomyopathy and Afib, Decrease EF, what is

✅
the most appropriate management?
A. Digoxin
B. CCB
C. Beta-blocker (not cardioselective)

210- Female patient with fecal incontinence and vaginal flatus since vaginal delivery 3

✅
months ago started 1 week post partum. Dx:
A. rectovaginal fistula
B. Partial perianal tear

211- Lady with urine leak when she cough or sneeze she denies any urgency frequency or
dysuria What will you see in examination?
A-paravaginal defect
B-rectocele

✅
C-enterocele
D-hypermobile urethra

212- Woman comes in from MVA and admitted due to head injury. Put on NGT and folly
catheter inserted. X ray of chest is normal. A few days later she wakes up and she’s oriented
and talking to doctors. Labs shown and all are normal except high fever. Next best step in
management
A) head MRI

✅
B) Chest CT
C) check catheters

213- Patient with chronic liver disease with acitees, came to clinic c/o reducable umbilical
hernia, he only stated discomfort no other symptoms, most appropriate management:
A. Paracentesis then open repair
B. Wait for ascites to resolve
C. smth with mesh

214- 6-female presented with back pain and fever, she was given NSAIDs and advised for
bed rest at home, then she presented with inability to move her lower limbs, O/E there was
tenderness on the midback. Spinal MRI: Diffuse discitis on T6, What is the most appropriate
next step?
A- Reassurance
B- Specimen from T6 vertebra
C- Brucella titer
D- Bone marrow aspiration for culture
‫ يعني هذا اخر سؤال كنت أتمنى أشوفه عالعموم قوو قلبكم واستخيرو‬B or C

215- 18 months baby presented to the ED with fever, watery diarrhea and frequent vomiting
for past 2 days. He is on regular formula and family diet. No family member with similar
symptoms. He looks unwell, lethargic, dehydrated.
Labs:
Hgb 13 normal
WBC 15 high
Lymphocyte 7 high
PMN cells normal
Stool analysis:
Watery yellow
Erythrocyte, leukocytes, epithelial cells all negative
What is the most likely diagnosis ?
- Food poisoning
- Cow milk allergy
- Viral acute gastroenteritis
- Eosinophilic gastroenteritis

216- A Baby was already discussed to put under DNR but DNR order was not completed.
Now he is in arrest:
A- Do CPR then complete
B- Do CPR then rediscuss with the family
C- Do not do CPR
D- Do CPR after the physician order one

217- A 66-year-old woman with severe COPD is admitted with 4 days of dyspnoea and
cough. She is alert, in moderate respiratory distress, and has an oxygen saturation of 93%
on 3 L/min supplemental oxygen. A chest radiography demonstrates no consolidation. She
receives intensive bronchodilator therapy and systemic steroids (see lab results).
Test Result Normal Values
ABG PCO2 8.8 4.7-6.0 kPa
pH 7.28 7.36-7.45
ABG PO2 9.9 10.6-14.2 kPa

✅
Which of the following is the best next step in the management?
A. Non-invasive ventilation
B. High flow oxygen
C. Nonrebreather mask
D. Intubation and mechanical ventilation

218- A young woman has tender cervix usually after her period On PE there is green yellow
discharge and tender red erthymia on the cervix What is the dx ?
- Trachomatis
- candida
- atrophy
- cancer

219- 6-year-old boy presents to the Outpatient Department with frequent and brief episodes
of rapid eyes blinking for 2 weeks. The episodes are not associated with pain, redness,
tearing or discharge. During the episode, he communicated well with his parents. The
physical examination shows normal visual acuity.Which of the following is the most likely
diagnosis?
**A. Tic disorder
B. Petit mal seizure
C. Dry eye syndrome
D.Tourette syndrome

220- Mother with failure to progress and fetal distress Dr deside cs she refused cs
and ask for another opinion what will do
A. respect wish and wait for another opinion
B. father consent has priority
C. attempt persuade against her well
D. consent of both spouses should taken before another opinion
Answer:
AAA

221- 21-hypertensive patient was prescribed Hydralazine 25mg by his physician. Instead he
took Hydroxyzine 25mg. Which of the following is the likely type of error?
A) Look-a-alike error
B) Sound-a-alike error
C) illegible prescription
D) Handwriting error

222- B A 69-year-old man known to have diabetes mellitus, presented to Emergency

department with 4-day history of productive cough and tachypnea. On examinaton, oriented
to time place and person. Chest exam revealed right lower lobe crepitaton. Respiratory rate
23 /min Temperature 38.5 °C Test Result Normal Values WBC 12 4.5-10.5 x 109/L Urea 5
2.75-7.4 mmol/L Chest X-Ray: Right lower lobe infiltrate. Which of the following is the most
appropriate management approach?
A. Admit to general ward and start IV antbiotcs
B. Admit to Intensive care unit and start IV antbiotcs
C. Start oral antbiotcs and observe in Emergency Room for 24 hours
D. Start oral antbiotcs and see in outpatent clinic in 7-days

223- Trauma Pt calculate GCS

Inacomphirsive sounds, eye open to painful stumli, flexion for pain
5
6
7
8

224- A 22-year-old man underwent an open left inguinal hernia mesh repair 2 weeks ago,
presented with continuous discharge from the surgical wound. Examination confirmed a 2x3
cm pus- discharging wound with part of the mesh exposed.
Which of the following is the most appropriate management? A. Systemic antibiotic

✅💯
B. Wound debridement
C. Wound drainage and mesh removal
D. Open entire wound for daily drainage

225- Pregnant with DM type 2, has HbA1c of 12!!! Which of the following risks will increase
drastically in her?
A.pre eclampsia
B. Congenital malformation

226- Case of pyloric stenosis what you will fined :

A. Hyperkalemic
B. Hypochloremia
C. Metabolic acidosis

227- 24 year old primegraveda , there is Contraindication for NVD must be CS , her doctor
told her that , but sherefuse CS , doctor till she will have still berth and still insisting to go
with VD .
1 / refer to psychiatric
2/ give her analgesia and do CS
3/ respect her wishes and do what she want
4/ inform the father and take his consent .

228- 50 yr female c/o menorrhagia for one year, medical management has failed. US shows
a fibroid 7x7 cm Most appropriate management:
A- hysterectomy
B- uterine artery embolization
C- Hormonal IUD
D. Oral progesterone I think

229- A boy was playing football and felt sudden pain in his groin while kicking the ball or
aiming to the goal smth like that, there is a swelling at the groin but no cough impulse and
not reducible, vitals showed fever and wbcs were high, whats ur management?
A) aspiration to rule out hematoma
B) give analgesics and check after 8 hrs
C) surgical exploration for hernia
D) force reduction manually or smth like that

230- Female present with dyspnea , there is ejection systolic murmur with ejection click,
heard best at the left 2nd intercostal space there is left parasternal heaves and murmur
increase with inspiration what is the diagnosis?
A. Aortic regurgitation
B. Congenital pulmonary stenosis
C. Tricuspid Regurgitation
D. Mitral Stenosis
231- Patient presents with active neuropsychiatric lupus.What you should start
- IV cyclophosamide
- IV cortosteroids
- Cyclophosphamide + cortosteroids
- Rituxamab + corticosteroids

232- Pregnant lady, presents to ED with 6 hours complain of clear fluid release for 6 hours

✅
pelvic examinaLon shows pooling at the posterior fornix
A. ruptured membrane
B. Normal vaginal discharge
C. Bacterial vagin
233- Mother brought child for vaccination Last vaccine became ill and taken to er
What is the next step
- check last vaccine
- give
- cancel
- delay
(Not exactly sure of the exact wording of the answers)

234- Carcinoma (in ovaries I think) in 15 or 18 weeks of pregnancy 3 dr. and consultant
recommend terminating pregnancy. Husband refuses. From whom should take consent?
(Sure about options)
A. patient alone.
B. Patient and tell her to tell her husband
C. both
D. Husband alone.

235- Old male patient presents with hematuria and right flank pain, no dysuria, no history of

✅
similar episodes or history of stones.
⁃ CT KUB
⁃ Cystoscopy

236- Old male patient with painless hematuria (no mention of right flank pain) no dysuria or

✅
history of renal stones, Urine analysis only shows RBC, Cultures negative :
⁃ cystoscopy

237- Primary dysmenorrhea not responding to NSAIDS = OCPs

Endometriosis not responding to NSAIDS = OCPs

238- Which of the following are most consistent with the diagnosis of acute rheumatic fever?
A. Fever, Roth spots and ischemic stroke

✅
B. Malar facial rash, joint aches and fever
C. Chorea and multiple painful joint swelling
D. Fever, cough and purulent sputum

239- 6 yr child has gastroenteritis. Mother says this the 3rd time he has it, and is asking
about protection of of siblings
-antibiotics
- probiotics
- frequent Hand wash
- avoid daycare

240- A 45 years old female known case of RA on NSAID for 6 months presented to ER with
severe abdominal pain with rebound tenderness and slight fever, what you will order to
confirm the diagnosis?
Abdominal US
Abdominal CT
Chest X-ray
Abdominal MRI

241- Pregnant lady in 31 weeks have preterm labour what is the most appropriate next step
management?
- MgSo4
- Steroid
- CS
- IOL

242- Question about a copd patient who came with acute attack You give him oxygen he
started to deteriorate.What INITIAL thing you will do?
- stop O2 (REDUCE )
- intubation
- Non invasive intubation

243- 32 year old man kco duodenal ulcer, presented with 2 week history of vomiting. On
examination he was severely dehydrated. With abd ex. Showing shifting dullness .
Which of the following is the most likely acid-base abnormality?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Compensated metabolic acidosis
D. Decompensated metabolic alkalosis

244- 61 years old women sustain MVA to here left chest brought to ER vitally stable no open
wound admitted for observation, couple of hours later developed suddenly SOB only, initial
CXR reveled 3-7 left ribs features. Repeated CXR showed well demarcated left lung
infiltarate. What is the diagnosis?
A- PE
B- flial chest

✅
C- cardiac contusion
D- pulmonary contusions

245- In the OR, the surgeon said” charge nurse hang another bag of blood” the nurse
replied” hanging the bag” and did it.What’s the type of communication?
A-call out
B-closed loop communication
C-Situation ,assessment , Background
D- Hand off

246- . Pregnant and asthmatic. what will be changed during pregnancy?

A.increase RR
B. Increase tidal volume
C. Increase resdual volume
D. Increase functional resdual capacity
247- A 45-year-old sustained a knife injury to his left wrist. Examination confirms a clean
wound with division of the underlying tendons and median nerve. Which of the following is
the most appropriate management?
A. Debridement and primary closure
B. Primary repair of injured structures
C. Debridement and secondary closure
D. Debridement and secondary skin graft

248- Female with Breast abcess just delivered a baby a few days ago , on 4 days course
antibiotic without improvement and the doctor still suspect breast abcess
A. change antibiotics
B. encourage breastfeeding
C. stop breastfeeding
D. Do US and call GS for review

249- Pregnant had bleeding and on examination cervix was partially opened. Fetus HR and
everything normal. No passage of products of conception. What's the type ?
A - threatened
B- complete
C- incomplete
D- inevitable

250- 45 year old male known case of HTN , DM , Decrease attention and cognitive, he is on
Aspirin antihypertensive and statin, Vitals given all was normal even BP, what to do?
1.EEG
2. This symptom due to medication use
3.anti-psychotic
4.pelvic Us

251- 45 female came with post-coital bleeding and pain on vaginal examination there’s a
1x2cm cervical lesion (or mass) ask what is the most appropriate next step ?
A- pap test
B- Pelvic CT
C-Pelvic MRI
D-punch biopsy

252- The mother of asthmatic child is worried about the future of her child’s case. What you
will tell her?

A. He will have asthma for the rest of his life

B. Pediatric asthma will disappear by adolescence
C. Pediatric and adult asthma are not correlated to each other

253- 2-week-old girl presents with persistent vomiting since birth. She vomits about 1 hour
after feeding. She passes stool 3 times per day. The physical examination shows a small
non-tendermass in the epigastrium.
Blood pressure 95/55 mmH
Heart rate 135 /min
Respiratory rate 35 /min
Temperature 37.1° C
Which of the following is the most appropriate investigation?
A. Barium swallow
B. Abdominal X-ray
C. Abdominal CT scan
**D. Abdominal ultrasound

254- Hiv patient in hospital developed ARDs ,What is the most likely organisms?
Ans: Jirovecii

255- Gastric outlet obstruction what do you expect to see in ?

- Metabolic acidosis hyperkalemia
- -Metabolic acidosis hypokalemia
- Metabolic alkalosis hypokalemia
- Metabolic alkalosis hyperkalaemia

✅✅
256- Baby at 7 weeks with intermittent vomiting, dehydrated :
A- Hypertrophic pyloric stenosis
B- Cyclic vomiting syndrome
c- Gastric volvulos

intermittent vomiting for a long time i think like for months, he gets hungry after each time
and eats again.
and in physical exam nothing is remarkable, he has no further weight loss except 2kg after
birth, what's the diagnosis:

🌟
the same choices, the last last choice was -midgut volvulus and intestinal malrotation
It is a clear case of pyloric stenosis .

257- A child knows the colours and can articulate words properly, what is the age of the
child?

✅
A-3 years
B-4 years
C-5 years
D-6 years

✅✅
258- Fall down on ankles , or heels, what to check ?
Ans: Pulse first

259- Dilated CBD >> ERCB and antibiotic

260- Bed wetting , which muscle is targeted ?

Ans: Detrosor

261- subphrenic abcess

262- A 6-month-old infant presents to the Emergency Room with sudden apnea and color
change. The mother gave history of recurrent vomitng and multple chest infecton. On
examinaton, wasted and underweight infant, with failure to thrive and dystonic neck
posturing while crying. Which of the following contribute to the disease?
A. Hypertrophy of the pyloric muscles
B. Hypertrophy of the esophageal muscles
C. Inappropriate relaxaton of the upper esophageal sphincter
**D. Inappropriate relaxaton of the lower esophageal sphincter

263- Painless hematuria > cystoscopy

264- cystorectocele= Ant&post colpoperineorrhaphy ✅

Related recall :
30's years old women P6 (not mention complete her family) come with second degree
pelvic organ prolapse, also have cyctocele and rectocele , what is most appropriate
management ?
- vaginal hystrectomy
- anterior colporraphy

✅
- posterior colporraphy
- Manchester repair

✅
Note:

✅
-Cystocele only = anterior colpoperineorrhaphy

✅
- Rectocele only= posterior colpoperineorrhaphy

✅
-cystorectocele= Ant&post colpoperineorrhaphy
- both of them + uterine prolapse=fothergill's operation ( manchester)

265- SLE with seizure , what to give in addition to steroid ?

Ans: Cyclophosphamide

266- RTA came with femur fracture what is your priority?

- stop bleeding
- relive pain
- fix fracture
- somthing irrlivent
Related recall :
A 32-year-old man fell from his motorbike and broke his femur. Which of the following is
most essential before reduction?
A. Give sedation
B. Give analgesia
C. Call the operating room
**D. Examine his peripheral pulses

267- Child brought by mother for vaccination , 4 days ago he develops tonsillitis and stated
antibiotics?
- Delay vaccines
- give
- post pone oral polio vaccine

✅
268- Child angry say no yelling hitting his mother
a.Temper tantrom
b.Deporesion
c.Major anxity disorder
d.Anxity with depression

269- 37-year-old woman G8 P7017 at 36 weeks' gestation has history of recurrent

postpartum that required blood transfusion. She has no significant medical problem. Which
of the following is the most appropriate preventive measure at delivery?
A. Deliver the patient in the operating room
B. Perform an elective cesarean section at 38 weeks gestation
**C. Perform active management of 3rd stage of labor
D. Give the patient preload of crystalloid fluids while in labor to overcome the possible post-
delivery hypovolemia

270- young adult was being treated with Ceftriaxone for acute salpingitis and pelvic
inflammatory
disease without benefit.
Which of the following is the most likely diagnosis?
A. Adenovirus infection
B. Herpes virus infection
C. Neisseria gonorrhea infection
**D. Chlamydia trachomatis infection

271- Pregnant with polyhydraminos what is associated with:

A trisomy 21
B PUV
C post term
D Anencephaly

272- 77-year-old man with a 7-years history of Parkinson disease reports hallucinations,
confusion and worsening motor function. On physical examination, he is akinetic and rigid
with no tremor, He has prominent gait disorder and postural instability.
Which of the following symptoms is most strongly associated with an increased risk for
dementia?
A. Increase irritability
B. Word-finding dificulty
C. Trouble recalling appointment times ✔︎
D. Difficultyreadinganarticleinasinglesitting

Recalls :
Case of Parkinson disease, which of the following factors presents in patients who are at risk

✅
of developing dementia
A- Forgetting future appointments
B- Word finding with talking

4) Elderly with symptoms of dementia what is the earliest symptom confirm the diagnosis?
A- Irritability
B- Difficulty finding words

✅
C- Forgetting places of things
D- Forgotten future appointment

what is the Symptom suggest severity of dementia:

A- Increase irritability
B- Difficulty finding word
C- Forget appointment
D- Difficulty in reading
A vs B
Individuals lose the ability to respond to their environment, to carry on a conversation and,
eventually, to control movement. They may still say words or phrases, but communicating
pain becomes difficult. As memory and cognitive skills continue to worsen, significant
personality and mood changes may take place and individuals need extensive care.
Sultan: I am still going with forgot words

Pt with alzheimer's disease what is the most dangerous symptoms:

✅
A- can’t finish reading articles on one setting
B- Forgot words
C- Forget appointment

Case of Parkinson disease, which of the following factors presents in patients who are at risk

✅
of developing dementia
A- Forgetting future appointments
B- Word finding with talking

Elderly with symptoms of dementia what is the earliest symptom confirm the
diagnosis?
A- Irritability
B- Difficulty finding words

✅
C- Forgetting places of things
D- Forgotten future appointment

pt diagnosed with Parkinson and hallucination which of the following is associated

with high risk of dementia:

✅
A. Irritability
B. Difficulty finding word
C. forgetting future appointment

273- Child around 5 years with chronic abdominal pain and diarrhea bloody and weight loss
and lab results (low hb high ESR....) Which of the following is the most important think to trial
manage first
1. Metronidazole
2. Corticosteroids
3. Gluten free diet
4. 5-aminosalicylic acid
Recall :
A 10-year-old bay presents to the clinic complaining of abdominal pain, frequent diarrhea
that is some7mes bloody, and pain usually accompanying defeca7on. His mother noted that
he has lost weight over the last three months since the onset of the problem. The boy also
has aches and pains of his joints. On examina7on, he looked ill, pale, with a so\ abdomen,
no tenderness or organomegaly (see lab results).
Blood pressure 110/70 mmH Heart rate 100 /min Respiratory rate 16 /min Temperature 38.6°
Test Result Normal Values
Sodium 132 134-146 mmol/L
Potassium 3.2 3.5-5.1 mmol/L
Crea7nine 31 27-62 mol/L
Blood urea nitrogen 5.6 1.8 to 6.4 mmol/L Hb 82 112-165 g/L
C-reac7ve pep7de 1.1 0-0.5 mg/di
Albumin 32 36-52 g/L
Which of the following treatments should be tried first? A. Metronidazole
B. Cor7costeroids
C. Gluten free diet
**D. 5 amino salicylates

274- 45 Women want to be pregnant again, her last normal pregnancy was 15 years ago,
she has amenorrhea since 6 months , what you will order for her ?
LH and FSH
Thyroid function test
HysteroSalpingogram
US for pelvis

275- 23-year-old female came to ER with RIF pain for 12 hours. Examination: tenderness in
supra-pupic area and RIF and no rebound tenderness, WBC: 14. US : inconclusive
What is the next step?
CT scan
Open appendectomy
Diagnostic laparoscopy
Transvaginal Us
276- A 33-year-old woman delivered vaginally with right mediolateral episiotomy. An hour
later, she was found to have an expanding 7 x 5 cm bluish, tense, and painful swelling of the
perineum.Which of the following is the best management?
A. Packing
B. Aspiration

💯
C. Observation
D. Surgical evacuation

Qs as Pics:
Ans: D
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