IFOM CSE Preparation Guide PDF

 How to use this file? 2 ‫بسم الله الرحمن الرحيم‬ ‫صل على سيدنا محمد وعلى آله وصحبه وسلم‬ ِ ‫اللهم‬ Ace Your IFOM coll...

 How to use this file? 2 ‫بسم الله الرحمن الرحيم‬ ‫صل على سيدنا محمد وعلى آله وصحبه وسلم‬ ِ ‫اللهم‬ Ace Your IFOM collection of IFOM recalls from 2023 - Aug 2024 Written by the greatest people of all time.  How to use this file? 3 Table of Contents How to use this file?............................................................................................................................................... 4 Immune, Blood and Lymphoreticular system................................................................................................. 6 Nervous system, special sense and Psychiatry............................................................................................ 14 Cardiovascular system......................................................................................................................................... 28 Respiratory system and ENT.............................................................................................................................. 39 Gastrointestinal system...................................................................................................................................... 49 Female reproductive, breast, pregnancy & puparium................................................................................. 61 Renal, urinary system & Male reproductive................................................................................................... 76 Musculoskeletal system/skin & Subcutaneous Tissue..............................................................................88 Endocrine system................................................................................................................................................ 101 Multisystem.......................................................................................................................................................... 110 Ethics.................................................................................................................................................................. 110 Biostatic..............................................................................................................................................................113 Epidemiology.....................................................................................................................................................115 Infectious diseases......................................................................................................................................... 117 Causative Organism....................................................................................................................................... 119 Toxicology.......................................................................................................................................................... 121 Miscellaneous.................................................................................................................................................. 122  How to use this file? 4 How to use this file? If you're considering applying for the IFOM CSE, please read this message carefully before using the provided file. It's VERY important to understand the study approach needed for the IFOM CSE. This work represents the collective efforts of hundreds of doctors and has been compiled with the intention of seeking Allah's reward as a sadaka jariyah. Here are some key points to clarify Is relying solely on this file sufficient to pass the IFOM CSE with a good grade? No, definitely not What are the primary sources for effective preparation for the IFOM CSE? UWorld, NBME STEP 2 CK blocks, and CMS forms. What is the purpose of this file? It covers the high-yield topics that have been frequently asked about in recent years, up to August 2024. Will the IFOM CSE always include these high-yield topics? No, not necessarily. There are three possibilities: Most questions may be similar to those in the file. Questions may cover the concepts in the file but in a different format. The exam could be entirely new with no high-yield topics. This scenario happens regularly (Happens in every window!). Should you depend solely on this file? No, absolutely not. Use it as a supplementary resource after studying the primary sources mentioned above. How should you use this file? Focus on understanding the concepts. Refer to UWorld Notes and UpToDate for each concept, and study them comprehensively. The high-yield topics in the file serve as guides to highlight commonly asked topics. These points are important to ensure we fulfill our responsibility to provide you with clear guidance on how to approach the IFOM CSE. One more important notice: Beware of scammers and individuals who attempt to profit by selling previous IFOM CSE high-yield topics, claiming to have topics from as far back as 2016. DO NOT fall for these scams. Do not pay anyone who demands money for something that is already freely available and not their original work. This file contains > 95% of the concepts from previous IFOM CSE, Insha'Allah. ‫ الله ّم فاشهد‬،‫إنّا بلّغنا‬  How to use this file? 5 and Lymphoreticular system  Immune, Blood and Lymphoreticular system 6 Immune, Blood and Lymphoreticular system 1. Elderly WITH fatigue, jaundice, malaise, in lab: Rouleaux formation, asking about the diagnosis? 2. 32-year-old female with long case (all leukemia sings) and Gum bleed- ing diagnosis? 3. A 65-year-old patient with WBC of 26, HB 14.3, plat. 280 and they were asking about what leukemia this is, he was asymptomatic. a. malignant proliferation of B cells b. malignant proliferation of T cells c. malignant proliferation of plasma cells 4. case of CLL DIAGNOSIS 5. A patient has CML and is on mycophenolate mofetil, he wants to travel. Antidiarrheal? 6. patient with autoimmune hypoparathyroidism and recurrent candidia- sis, asking about mechanism. Polyglandular autoimmune syndrome (Aire genre mutation) result in >? 7. Long stem about elderly complaining of bone pain, with vague symp- toms honestly. And then labs were given. He had anemia. Hypercalce- mia, Renal involvement, Anemia, Bone pain 8. 6-year-old girl presented with generalized lymphadenopathy, and on lab tests. She has low hemoglobin, white blood count and platelets. 9. Elderly patient with elevated WBCs, 96% were lymphocytes, what's the diagnosis? 10. Female 47y/0 with anemia, splenomegaly, WBCs 72,000 periph- eral Blood smear 11. question about monoclonal IgG spike with no end organ damage Monoclonal gammopathy of undetermined significance (mugs) Other options included Walden Strom.  Immune, Blood and Lymphoreticular system 7 12. Patient with CML on chemotherapy. Developed fever for 5+ days, and had neutropenia. Was prescribed IV cefepime but still not improv- ing. What to do? a. Continue antimicrobial and add antifungal b. Continue antimicrobial and add antiviral c. Discontinue antimicrobial and start antifungal d. Wait for culture results 13. Young patient with family history of facial and limb swelling, in his mother and grandmother. This is his 3rd episode this year. On lab: C3 is low. Asking about the diagnosis? 14. Patient with leukemia started on chemotherapy, what mecha- nism of his kidney injury? 15. Male patient coming from India, with flu-like symptoms. What to do next? 16. Male patient with otitis media and Sino pulmonary infections, also his male relative died from this, what to measure? 17. Child with long term fever 6 months not resolving and now again with joint pain and tenderness and has bicytopenia (RBC and platelet) and high lymphocytes next step in management? 18. confirm diagnosis of SCID? 19. Female with multiple sexual partners presented with dysuria. She has 2 previous Neisseria infection. patient had previous Meningitis (N. Meningitis) infection, how to diagnose? 20. 23yo with 4 pneumonias in the past and sinusitis basically they are telling you recurrent strep pneumonia. What to do? (It might be CVID so just know how to dx it) a. Complement assay b. Measure all immunoglobulin levels (Quantitative Antibody test) 21. Patient with repeated giardiasis. What immunoglobulin is defi- cient  Immune, Blood and Lymphoreticular system 8 22. Patient had meningitis with Neisseria and history of recurrent Neisseria infections. What is the mechanism of her disease (deficiency of which of the following)? a. Leukocyte adhesion b. Terminal complement 23. Recurrent infections and all immunoglobulins are dec, diagnosis 24. X- linked agammaglobulinemia most common organism of infec- tion 25. A patient with recurrent infections, he also had dysmorphic fa- cial features with wide nasal bridge they asked about the pathophysi- ology of the immunodeficiency >> 26. Question of a 6-month-old child with recurrent infections and saying he had 2 siblings who died due to the same condition. All Immu- noglobulins are given and they're all low. What is the mechanism of disease? a. Combined B and T cell b. B cell only c. T cell only 27. What are the causes of reactivation of VZV in elderly patient? 28. (No pic) vesicular rash, painful started on the chest, extended to the extremity, (shingles) what is the cause? 29. 30-year-old male who presents with fever, cough, and weight loss and has a CD4 count of 72, HIV-positive, PPD test is negative. cause of the negative PPD result? 30. A 5 years old child with fever, runny nose, and flue like symp- toms. Have history of recurrent infections of staph aureus and Serratia. On examination he has lymphadenopathy. Most likely diagnosis? 31. Patient with fatigue and microcytic anemia, both upper and lower endoscopy are normal, what to do next? (No colonoscopy in an- swers) 32. GI bleeding in elderly what would be found in blood? 33. Hereditary spherocytosis case, they gave a blood film and labs hemophilia A case WHAT TO GIVE?  Immune, Blood and Lymphoreticular system 9 a. Desmopressin b. FFP c. activated factor 8a 34. Patient with VT, what's the long-term treatment >> patient had thrombosis so he takes heparin, then he developed another thrombosis, what to do? 35. a long case, describes patient that took heparin, now started de- veloping Heparin Induced Thrombocytopenia (HIT). What to do next? 36. Patient had surgery and he was bleeding through the catheter, but fibrinogen was normal, BT was high a. depletion of vitamin K dependent factors b. other choices 37. Patient with prosthetic valve on warfarin, routine checkup, INR:4, he has no symptoms of bleeding. a. skip 1 dose and reduce the dose of warfarin V b. skip 1 dose and give vit K antagonist c. discontinue warfarin 38. Heparin-induced thrombocytopenia (HIT) case, mecha- nism>> there DVT 3-4 years back and he refused to take any medica- tion and now his wife convinced him to take the treatment. He now has varicose veins and moderate and severe LL edema what do you do? a. compression stockings V b. vein stripping c. elevation of the legs d. Warfarin therapy 39. Patient with DVT he's going to do a lobectomy for adenocarci- noma in 12 hours what's the best next step to manage DVT? a. compression stockings before and LMWH after surgery b. LMWH before and after c. IVC filter before and LMWH after 40. young man post hernial repair how to decrease risk for DVT?  Immune, Blood and Lymphoreticular system 10 41. Patient with CML on chemotherapy. Developed fever for 5+ days, and had neutropenia. Was prescribed IV cefepime but still not improv- ing. What to do? a. Continue antimicrobial and add antifungal b. Continue antimicrobial and add antiviral c. Discontinue antimicrobial and start antiviral d. Discontinue antimicrobial and start antifungal e. Wait for culture results 42. Female with bleeding and low platelets and rash in lower limb. Attached peripheral blood pic showed schistocyte. Asking about the di- agnosis? 43. Male 20 years, did inguinal hernia repair, after 2 days scrotum got big History of prolonged bleeding after tooth extraction Platelets normal / PTT normal / Prolonged bleeding time, diagnosis? 44. Female 20 years, heavy bleeding with ecchymosis, Platelets = 7000, diagnosis? 45. Female had menarche at age of 12 now she is 17 presented with heavy period and increase in duration from 5 days to 8 days there is no family history of similar condition. Asking about the diagnosis? 46. [ITP case]. On labs he has 34k platelets and low WBCs low RBCs [pancytopenia]. What to do next (patient had no bleeds into joint or other signs of active bleeding, vitally stable) platelet count was 34,000 a. Platelet transfusion b. Bone marrow biopsy c. Observation 47. 60 years old Hgb = 18.5, Platelets 700, 000 What is the cause? 48. Patent came with facial plethora, vision changes, confusion and headache. HGB 20, platelets 300,000, WBC 22,000. What is a long-term complication? That could happen in this patent? 49. If pregnant women have a positive HsAg, what can reduce risk of hepatitis in the child? 50. Patient immunocompromised with pseudomonas infection what to expect in blood test?  Immune, Blood and Lymphoreticular system 11 51. Patient with blood smear shows rouleaux formation (multiple myeloma). What do you expect to see on urine? I think the question was "what is the reason behind his kidney injury or increase creatinine 52. patient with seizures and multiple rings enhancing lesions, what to do, test for? 53. decreased proprioception with peripheral blood smear image and lab images showing macrocytic anemia, cause? 54. other scenario includes a burn patient who had 3 reconstructive surgeries. Blood was noticed out from the NGT, low platelets, high Pt, PTT asking about the diagnosis 55. Sickle cell disease presented with shortness of breath and symp- toms of pneumonia, an x-ray there is wedge, shape, opacity what is the cause? 56. Septic arthritis what is the cause? Patient presents with pain and decrease ROM -> 57. 25 y/o Eye pain and redness for more than 1 week, took antimi- crobial drug and didn’t help him. Normal fluorescing test, diagnosis? 58. Patient had meningitis with Neisseria and a history of recurrent Neisseria infections. What is the mechanism of her disease (deficiency of which of the following)? a. phagocyte smth b. Protein c. Leukocyte adhesion d. Terminal complement 59. ITP presentation (bruises only and maybe heavy menstrual bleeding) asked about the mechanism 60. child presented with migratory arthritis, history of sore throat, 61. Aanti-streptolysin O titer high, what to give to prevent complica- tions? 62. SLE flare after finishing a prednisolone course, what to give? 63. pt. had a kidney transplant and is on immunosuppressants, de- veloped cancer cause? 64. Immunocompromised pt., which vaccine is contraindicated?  Immune, Blood and Lymphoreticular system 12 65. Pt developed DVT, her brother has a history of DVT also, the cause? 66. Infective endocarditis major risk factor? 67. Pt with pancytopenia post-chemo what to give transfusion? a. RBC b. Platelets c. leukocytes 68. Pathogenesis of VWD (Von Willebrand Disease). 69. Severe alcoholic with folate deficiency leading to macrocytic anemia. 13  Nervous system, special sense and Psychiatry 14 Nervous system, special sense and Psychiatry 1. Newborn with hypotonia, weak muscle tone, poor Apgar, his brother has facial drooping, weird shuffling gait, short stature, and his mater- nal grandfather similar + baldness and blue sclera. Asking about the diagnosis? 2. Case of ALS he had upper and lower neuron signs. upper limb weak- ness and lower limb Babinski. I think he was in his 50s. 3. Typical case of ALS, patient with pure motor symptoms in both upper and lower limbs, asking what drug to give? 4. Amyotrophic lateral sclerosis asking about location of lesions (the sce- nario mentions both UMN and LMN symptoms, mechanism? 5. A case of ALS, how would you diagnose? 6. Patient with pain on the lateral aspect of the right thigh, then it says he has sensory loss over like a circular pattern on the same spot. What's the diagnosis? 7. Lady with abnormal movement, her father had same disease> Asking about the diagnosis? 8. Pt with Huntington disease pathophysiology? 9. case recovered from hepatitis A two weeks ago and now have are- flexia and weakness only? The LL was more affected than the UL. Gradual loss of sensation and weakness starting distally on the lower limbs and less affected on the upper limbs plus facial weakness a. Parasitic infiltration of muscle b. Periventricular calcification c. IgA of artery d. focal peripheral demyelination 10. Pt presents with peripheral neuropathy post-gastrectomy cause? 11. Sciatica diagnosis 12. Peroneal nerve injury. 13. Diabetic pt. one leg amputated below knee; other leg developed boggy swelling (Charcot foot). 14. Female with high BMI, numbness of lateral thigh cause? 15. Case of Thoracic vertebral compression 16. case of peripheral neuropathy 17. Case about a man that had trauma. It says he had subdural he- matoma. Asking about the cause of intracranial pressure?  Nervous system, special sense and Psychiatry 15 18. Patient with dull headache, eye examination shows bulging, what's the cause? 19. Patients with features of Increased Intracranial Pressure. But symptoms were not very severe. He was conscious. CT showed a le- sion. What to do next? a. Hyperbaric Oxygen b. Intubate and hyperventilate c. reassurance (No Mannitol in options) 20. female patina with headache behind eye, nausea, family history of migraine, no lacrimation, bilateral papilledema Dx: intercranial hyper tension Next step? 21. post RTA, laceration of four head, confused agitated, stater vital, all normal, Ct shows diffuser cerebral edema Next step? 22. SIADH after RTA and basilar skull fracture mechanism? 23. headache on both side, family history of migraine, no thrumming no laceration no pain on temporal region diagnosis? 24. Male patient had trauma with ball, was initially okay than upon examination, vomited, felt dizzy and lost consciousness. Asking about the diagnosis? 25. A cause of epidural hematoma (patient had trauma then lucid in- terval then he was fine and a while after he had uncle herniation and Cushing reflux) the question was asking about what artery was com- promised? 26. Patient with symptoms that look like stroke, but mild. Asking what to do next? 27. Young man with episodes of collapsing and lip smacking for 2 minutes seen by his friends. He has no recollection of these events. a. Psychogenic seizures b. Complex partial seizures c. Simple partial seizures d. Atonic seizure 28. Pt with Cushing triad, (Increased intracranial pressure). 29. Patient presented with after a RTA with depressed skull fracture, pupillary examination showed a dilated right eye, not responsive to light with normal left eye, what to do next?  Nervous system, special sense and Psychiatry 16 30. A 4 years old female child was on the leader drinking milk when slipped and fall on the back not hitting the head, turned blue and stopped breathing for 30 seconds. Her father knows CPR so he started mouth-mouth and she became ok. In ER, she is active, playing nor- mally. What to do next? a. Discharge b. Ct c. Admit d. LP 31. Male patient, one side headache- over the temporal area, no nausea, no vomiting, no aura or photophobia, no throbbing, there is migraine in mother and sister, now he can't sleep from it asking for treatment? a. Sumatriptan b. Ibuprofen c. Diazepam 32. MS case and CT, next step? a. IV methylprednisolone b. IFN c. Rituximab 33. Patient with Multiple sclerosis, it says he was given medication to prevent acute remission. Now came presenting with bilateral inter- nuclear ophthalmoplegia. What to do now? 34. Patient with history of TB now developed signs of meningitis, what will be low in CSF? 35. Child with meningococcal meningitis (stiff neck, confusion, rash) Antibiotic choice? 36. Pt that was a military recruit now presented with signs of menin- gitis (fever, headache, neck stiffness). What's the bacteria type? 37. Case describing Meningococcal Meningitis; Fever, nuchal rigidity, etc. Asking what is the mode of protection? a. Airborne b. Droplet c. Others 38. pt. 47 years have headache with increasing nausea and vomiting on exam left hemiparesis and left pronator drift and left sensory defi- cit + bilateral papilledema?  Nervous system, special sense and Psychiatry 17 39. Right sided weakness with speech impairment, where is the le- sion? 40. Presentation of MS, on right gaze left eye had limited adduction and nystagmus in right eye. (Intranuclear ophthalmoplegia), Where is the lesion? 41. Elder patient presented with stroke, visual changes, dizziness, difficulty speaking but fluent which artery involved? 42. Weird long case honestly, I don't remember, asking about where the lesion was. It said he had positive Babinski; I think hyperreflexia in lower limbs too. Just know the lesion question well. a. Cervical b. Thoracic c. Lumbar 43. A female came with instability and clumsiness. She has upper body weakness so she can’t grip the object strongly, increase lower limbs reflexes. The lesion is most likely in? 44. Patient came with the complaints of inability to see the right side of her body and surrounding environment. The lesion is most likely in? (Homonymous hemianopsia) 45. female had seizure, before seizure she smelled something, where is the lesson? 46. Female patient with history of, blurry vision 2 weeks ago, re- solved, and nystagmus of the right eyes living in Europe Asking about the diagnosis? 47. Pt complains of ankle give away, decreased sensation in the lower leg, and movement, history of sudden vision loss a year ago, di- agnosis? 48. MRI picture (it clearly had lesions scattered in space) + long sce- nario typical of MS 49. A Patient with UMNL in the lower limbs and LMNL in the upper limbs. Positive Babinski sign but decreased hand grip. His gait is okay except that it is not balanced when he turns around. They asked which part is affected? a. Cervical spinal cord b. Thoracic spine c. Peripheral nerves d. Lumbar spine  Nervous system, special sense and Psychiatry 18 e. Patient with left hemi-ballistic arm and leg movements, they at- tached a CT scan pic that is marked with letters and asked to lo- calize the lesion on the CT scan) 50. PT with bitemporal hemianopia where is the lesion? 51. Elderly male patient - lost in own neighborhood. Asking about the diagnosis? 52. Patient came to ER for suicidal ideation (not brought by police or someone) he had 10 visits to ER before because of alcoholism and sui- cidal ideation. His alcohol level is O, he mentioned that he was going to jump from a height but instead he decided to go to ER, what should you do? a. Contact the family to get involved b. Wait in ER tell the suicidality ideation resolve. c. Admission to psychiatric ward d. Admission to medical ward 53. Frontotemporal dementia (change in behavior mainly, memory was not affected much). 54. Lewy body dementia (some Parkinsonism features). 55. Stroke diagnosis. 56. 80-year-old came for follow up, he has bilateral delay tendon re- flex, Asking about the cause? 57. 70-year-old forgets how to come back from the store he went to for 40 years and recall 2 objects out of 5 58. Question describing elderly bought by family member because he's starting to forget recent events and getting lost. Classic Alzheimer presentation. Asking about diagnosis. Options included all types of Dementia. 59. Parkinson induced by drug 60. Case of Parkinson's disease what sings do they also have? 61. Case of confusion in elderly due to infection asking for diagnosis 62. Patient with unilateral facial weakness, not hearing on one side 3 years this is happens when he turns suddenly turn, falling. Asking about the diagnosis?  Nervous system, special sense and Psychiatry 19 63. 52-year-old female with conductive hearing loss, says that her mother got the same condition when she was 50. What's the diagno- sis? a. Otosclerosis b. Presbycusis 64. Young pt. present with progressive spastic paresis He born and raised in Jamaica but now live in US any way on the exam he had posi- tive Baranski and colon is in lower limb a. 1 chronic botulism b. GBS c. post Piolo syndrome d. HTLV1 65. Baby one day after birth with spastic hand when tapped on face it twitches. What is the cause? a. tetanus botulism// b. Hypoparathyroidism 66. Afebrile seizure 67. A case of a boy with ADHD what would u give 68. a patient with a history of ADHD, is taking methylphenidate, has insomnia irritability, asking about the cause 69. patient cleaning his hands quite often, school kids make fun of him and he is distressed by his own action (ego dystonic) asking about the management (OCD). 70. A patient who keeps writing letters to politicians to stop selling and eating meat as he thinks that eating meat will kill people, his wife mentions that his daily life is normal and he is socializing well, she is not complaining of any behavior, his mood is euthymic a. Delusional disorder b. Schizophrenia c. Bipolar disorder 71. MDD straightforward. 72. Older patient around 77, her son brought her because she be- came irritable, not enjoying spending time with her friends or family, losing weight, likes to be alone, cognitive mild impairment, otherwise normal diagnosis? 73. Male with MDD symptoms, lost interest, can’t focus, and has feelings of disconnection; next question to ask  Nervous system, special sense and Psychiatry 20 74. Asthmatic patient with recent exacerbation, needing steroid doses, presenting with low mood, and other symptoms typical MDD - diagnosis? 75. Young girl, her mom brought her, she slept only 4 hours, stopped playing basketball and thinks she is better than them, night time writes novels, has a boyfriend and often has sexual intercourse. Her grade dropped low. Her speech is pressured Diagnosis? a. Bipolar b. MDD c. Anxiety drug abuse 76. Young female Patient came complaining about anxiety. She used to ask her boyfriend every time are you going to leave me. She is leav- ing to attend a conference and she is worried about her saying that she was always a worrier. She has multiple worries on examination. What to give? 77. A patient less than 3 weeks ago traveled to some wild area and saw wild animals, that time received typhoid, yellow fever, hep A vac- cine and Mefloquine as prophylaxis. Now having vivid dreams and nightmare and nervousness, asking for a diagnosis? a. s/e mefloquine b. s/e HibA. vaccine c. s/e yellow fever vaccine d. GAD 78. ADHD - pt. complained of not being able to sleep and restless? 79. Question describing a patient having anxiety symptoms for 15 years. He is very worried. Asking about what is the suitable pharmaco- logic next step. a. Psychotherapy b. Benzodiazepines, c. there was a weird drug ending with lopram (Not escitalopram) So I chose it thinking it was an SSRI as treatment for Generalized Anxiety Disorder. But I'm not sure 80. Question about an elderly whose wife died 4 years ago. He has features of depression but not fulfilling criteria for Major Depressive Disorder. Asking for diagnosis. I don’t remember the options.  Nervous system, special sense and Psychiatry 21 81. patient has features of depression, also not fulfilling criteria for MDD. It tells you at the end that the patient has a diagnosis of termi- nal illness (Pancreatic cancer). What is the diagnosis? a. Major depressive disorder b. Mood disorder related to medical condition 82. An elderly man whose main complaint is that he cannot sleep well. But the entire history was focused on the fact that he is very worried about his age and his relationship etc. and his worried thoughts are what’s keeping him up at night. What is the treatment? a. CBT b. Melatonin SSRls was not in the options 83. An old woman with a description of Alzheimer's, asking about what the earliest signs of the disease are? a. Irritation b. Apathy c. Self-isolation d. Social disengagement 84. Description of man coming from the military with PTSD. What’s the treatment? 85. Old lady describing herself as sad and depressed what drug to give 86. Kid in class who is not disruptive, has his grades low, and ap- pears to be day dreaming, he doesn't participate in class. He says he doesn't like it and does not want to go to school. Case does not men- tion anything about him having symptoms at home. During mental state examination, child is easily distracted. What is the diagnosis? a. ADHD b. Absent seizure 87. 9-year-old with absence seizures, treatment? 88. Child that developed Febrile seizure for the first time, then re- solved. What to do? 89. child with Staring episodes and spike-wave patterns on an elec- troencephalogram absence seizure? 90. A person who had a previous car accident and struck his head in the driving wheel for 3 weeks, he avoids driving or raiding car and  Nervous system, special sense and Psychiatry 22 prefers to walk. He has normal life with normal job. Most likely diag- nosis? 91. A case of depression in an elderly patient? a. Citalopram b. Antipsychotics c. Anticonvulsants 92. A case of bipolar 93. A 7 years old child, his teacher mentioned that he does not fo- cus, distracted easily, jumps all time, unable to stay still, interrupts her all time and hyper-talkative, at the hospital he does not sit still and keep playing with the devices. Most likely diagnosis? 94. Case of Alzheimer's disease 95. Alzheimer disease Tx? 96. 68 years old patent presented with pill rolling, bradykinesia, shuffling gate, and rigidity, what is the best treatment for the patent? 97. Pt with Parkinson’s disease, asking what the issue was (mecha- nism of disease)? 98. A 72 years old male was brough by his son due to memory loss. Patents keeps forgetting daily event. And daily activity. He got 1 word out of 5 in the mental test. Other tests are unremarkable. What medi- cation to be given? 99. Parkinson disease question. 72 years old man he is having masked facies and decreased arm swing when he walks etc. very typi- cal presentation. Asking about the treatment? a. Carbidopa-Levodopa b. Ropinirole c. Entacapone d. Amantadine 100. Parkinson disease, easy one (Scenario included slow movements, lack of facial expressions) 101. A father brough his 4 years old daughter. She does not listen to what she does unless he takes her doll. he mentioned that she ate a candy in the store and he is afraid she is stealing. In the clinic she is calm, answering doctor questions. examination is normal? 102. Older patient came with her son. Her son is concerned about her memory loss. she is not able to answer question due to memory loss and confusion. Her son said that she doesn’t sleep at night and keep  Nervous system, special sense and Psychiatry 23 roaming around. She reported that she fell twice and stood by herself unassisted there are multiple ecchymosis in her body of a various healing stages. what to do next? a. Haloperidol b. Zolpidem c. Refer to physical therapy d. Refer to social worker 103. Pt had a car accident in the past, now has palpitations, diaphore- sis, dyspnea whenever wanting to drive a car, diagnosis? 104. Female came to the clinic with the complain of constant worry- ing. She stated that she is worrying most of her life. She cannot con- centrate and keep worrying about her children although everything is fine. She also worries about her finance but she is in a stable condi- tion. What is the most likely diagnosis? 105. Postpartum female with euphoria and she came to the clinic, started crying and she said “my husband wants to kill my child”, next appropriate step? 106. PTSD they do CBT what next step 107. GAD patient worries about his life and it's affecting his job, how to manage? a. Buspirone b. Clozapine c. Desensitization d. Cognitive behavior therapy 108. Patient coming willing to quit smoking after consultation 109. 30 years old male willing to stop smoking. He had a previous at- tempt with symptoms of restlessness and irritability. What is the best medicator? 110. Patient came to the hospital complaining of fatigue and gastric pain for 6 months, He stated that his wife died 8 months ago. He is al- ways tearful and can’t sleep at night without her. He sometimes be- lieves that it is better if he dies as well and he deserves the pain. He doesn’t like to do the things he used to do before. What is the most likely diagnosis? 111. Teenage girl with low BMI, poor diet, hypotensive, and tachy- cardic; diagnosis  Nervous system, special sense and Psychiatry 24 112. 6-year-old girl with new disruptive behavior, lack of sleep, flight of ideas; diagnosis 113. Patient taking haloperidol, then started developing symptoms (Fever, autonomic dysfunction). CK was high. What is the diagnosis? 114. A patent started using Haloperidol, he developed feeling of rest- lessness, he keeps moving his leg and when asked he say “I just do that”, most likely diagnosis 115. Patent with occipital headache and flashing in the eye with visi- ble tender temporal artery, ophthalmological exam normal. What is the factor associated with poor prognosis? 116. Middle aged lady, with temporal headache, jaw claudication, what's the next best step? 117. Headache that is around the eye with tears of the eye NSAIDs not helping DX? 118. Patient with shoulder weakness and pain. High ESR and CK. Diag- nosis? 119. Schizophrenic patient on clozapine has leukopenia and fever what next? 120. Patient with seizures after the episode, he presents with 6N palsy dx? 121. female pt. with numbness and tingling of hand increase at night, resolve when she shaking hand (CTS) cause? 122. Lady with pain in cheek happens when chewing when touching her cheek etc. basically classical description of trigeminal neuralgia. How to treat? 123. patient started a new job he's wearing a heavy belt with tools is complaining of loss of sensation at the lateral aspect of his thigh 124. Trigeminal neuralgia case asking about the treatment? 125. neurogenic incontinence + Fecal incontinent Mechanism? 126. Old patient present after a left MCA infarction, with neurological deficit. Patient had a previous 8 hours right side weakness month ago. He has uncontrolled HTN, DM, Left carotid bruit. What is the most im- portant risk factor for the stroke? 127. seizure and after treatment she had aphasia and other symptoms What to do next? 128. Questions about meningitis know the CSF findings and the infec- tious agents in Each age group  Nervous system, special sense and Psychiatry 25 129. signs of meningitis with temporal lobe involvement. CF analysis showed normal protein, glucose, high Lymphocytes. Tx? a. Acyclovir, ceftriaxone and vancomycin b. Penicillin, ceftriaxone and vancomycin 130. Meningococcal meningitis what to give close contacts 131. patient with Upper Respiratory tract infection, otoscopy shows bulging tympanic membrane with redness has had a febrile seizure, what is the most appropriate next step in addition to antipyretics? 132. female patient with leg weakness, she had multiple previous epi- sodes of neurological symptoms that are disseminated in TIME AND SPACE.: 133. child with seizures and urinary and fecal incontinence and drool- ing (I believe it was organophosphate toxicity, others don't make sense) abnormal neurotransmitter = 134. Alzheimer disease question vs normal aging. 135. patient with long standing HIV have neuropathy what to give, Patient with progressive vision loss that improves with pinhole->Glau- coma? Cataract? 136. Child presented with polydipsia, polyuria, urinalysis shows gluco- suria, cause? 137. Pt with neurological disorder has recurrent aspiration pneumo- nia 138. First time seizure, electrolytes, EEG normal, how to manage? 139. Patient with muscle weakness when wanting to sleep/wake up basically description of sleep paralysis. Also had excessive daytime sleepiness. Asking about the most likely cause? 140. Picture of child with right eye abducted. Asking about the diag- nosis? 141. Typical Wernicke’s encephalopathy symptoms (Ataxia, Gaze Palsy) in an alcoholic patient asking about the cause? 142. Raccoon eyes and clear discharge from the ear after an acci- dent?  Nervous system, special sense and Psychiatry 26 143. Kid who fell and then presented with vomiting and a large hema- toma on physical exam. What to do he was stable (epidural hema- toma lucid interval) a. Admit and observe b. Skull x-ray c. IV fluids No CT head option. No discharge option. 144. Post RTA, lacerations all over the body, including the head, pa- tient GCS 12hr 120 what is the next step? a. What Give mannitol through jugular line b. Give hypertonic saline through subclavian line c. Neck stabilization, and give fluids  Nervous system, special sense and Psychiatry 27 Cardiovascular system  Cardiovascular system 28 Cardiovascular system 1. Pt diagnosed with hypertension, started on ACE inhibitors, creatinine is high, what next? 2. Patient with antiphospholipid present with arterial thrombosis what to give? 3. Patient with LL edema better in the morning worse at the end of the day, clear chest, Asking about the diagnosis? a. venous insufficiency b. DVT 4. Elderly has 2-month lightheadedness when he stands in the morning, what is the pathophysiology for symptoms? 5. patient with 2 DVTs, 2 Abortions and now presenting with signs of arterial thrombosis of the other limb indicating a case of Antiphospholipid antibody syndrome, the question asked about what would you expect to find on lab tests? 6. Case of upper Gi bleeding what to administer after initial resuscitation? 7. Patent with watery diarrhea on examination he has a dry mucous membrane, increase skin turgor. His Bp is normal, capillary refill 3 seconds. Next step in management? 8. Pregnant woman in her 20 weeks gravid 2 para 1 presented to the hospital with painful and swelling calf on examination there is edema and redness, warmth. Doppler US showed thrombosis. what is the best pharmacological option for her? 9. A child was playing in the garden 15 minutes ago, developed pruritic skin rash along with shortness of breath and inspiratory stridor, oxygen therapy was pro- vided, what other medication to be given? a. Epinephrine b. Oxygen supplementation c. Fluids 10. Pt had a cardiac catheterization, creatinine increased after the procedure, what could have been done to protect the kidneys? 11. Pt diagnosed with hypertension, mechanism of artery stenosis? 12. Infective endocarditis risk? 13. PDA (neonate with continuous murmur), Recurrent infections what to do next?  Cardiovascular system 29 14. Pt with a history of coronary artery disease, post-MI, asking what medication to give? 15. COPD with corpulmonale, next investigation? 16. Patient weeks post-ortho surgery presents with SOB and lab ab- normalities; possible acid-base abnormality a. fat embolism. b. pulmonary embolism 17. 35 year old with BMI 30 and TG 150 which was the same from last visit 3 months ago and LDL 140 HDL 45 what to give? a. nothing and reassess after 1 month b. atorvastatin c. Reassess after 6 months 18. Patient with mitral valve replacement surgery, she has a dental procedure, what antibiotic would u give as prophylaxis? 19. Trauma patient who became quadriplegic, hypotensive with bradycardia indicating. He was given saline but vital signs remained unchanged type of shock? 20. Patient with elevated Jugular venous pressure, hypotension, crackles indicating shock? 21. Patient with antiphospholipid present with arterial thrombosis what to give? 22. Old patient with a stroke, he was found to have a 75% carotid stenosis on the right and 90% carotid stenosis on the left, what would u do next for management? 23. Patient post MI and cardiac catheterization with bp 160/90, what to give before discharge? a. digoxin b. nifedipine c. amiodarone d. Beta blockers 24. A patient with a brief loss of vision (he’s old and hypertensive) what would you do next? 25. A case with ECG changes (tall/peaked T waves) asking for diagnosis?  Cardiovascular system 30 24. A case of supra ventricular tachycardia (showed the ECG) what’s the best next step? 25. A case of digoxin toxicity (yellow blurry vision), what would be an additional finding in this patient? a. hyperkalemia b. hypokalemia 26. A patient presented with decompensated CHF (pulmonary edema and lower limb edema and he had a fluid coming out if his mouth that’s pink in color) he was given furosemide, what else would u do? a. Insert foley’s catheter b. place a chest tube. 27. Patient had a bypass graft then a couple of days later presented with purulent pericarditis how do you treat? 28. A patient after RTA, he was the unrestrained driver, he had hy- potension and bruising all over the chest wall, on CXR he had a wid- ened mediastinum what is injured? 29. Down syndrome baby echo shows biventricular hypertrophy which heart defect you will find it in echo: a. Pulmonary valve stenosis b. Complete AV canal c. ASD secundum d. PDA 30. Female patient is found to be hypertensive, and after lifestyle modification and exercise and weight loss she came back with a bp of 170/90, there was a palpable bruit (I think she also had a family history of HTN in her mom and sister) diagnosis? 31. scenario of acute rheumatic fever + holosystolic murmur at apex radiating to axilla dx? 32. Patient is afraid of developing HTN, he has a stressful job, plays tennis in the weekend, smokes marijuana in the weekend, eats bal- anced food of fruits and vegetables but eats more red meat than fish or chicken, what is the thing that will reduce his risk more? a. find less stressful job. b. exercise daily. c. abstinence from marijuana  Cardiovascular system 31 d. eat fish more and less red meat 33. A man with exertional chest pain then progressed to pain at rest, ECG is normal, what's next step? a. Stress echo b. 24hr ambulatory ECG, c. Coronary calcium scan 34. A newborn with down syndrome and respiratory distress, ECG findings mentioned and echo showed biventricular hypertrophy, what is the to be found in echo? 35. long standing Atrial fibrillation (more than 48-hours) with ECG showing absent p waves asking about the most appropriate next step: a. warfarin. b. cardioversion. c. control rate with diltiazem or β-blockers and anticoagulant if du- ration is > 48 hours. 36. ECG strip with ST elevation of leads 2,3, AVF. Which artery is in- volved? 37. Hypertensive emergency, with papilledema pic treatment? 38. question about coarctation of aorta Ex: Pt with high blood pres- sure in upper extremities and low blood pressure in lower extremities, dx? coarctation of aorta. Ex: coarctation of aorta (mechanism in in- creasing hypertension): a. Activation of the renin-angiotensin-aldosterone system b. Restricts the flow of blood through the aorta leading to elevated blood pressure in the areas upstream of the constriction. 39. patient with MVP will undergo dental cleaning asking about prophylaxis? a. no prophylaxis indicated b. vancomycin c. azithromycin d. doxycycline. 40. Mitral stenosis clear one, what to do a. echo b. exercise test c. ECG.  Cardiovascular system 32 41. asking about dx blindness in one eye? 42. mitral stenosis question dx? 43. RTA patient whose sternum has hit the wheel steering indicating a Blunt chest trauma, X-ray shows with widened mediastinum dx? 44. Symptoms of Acute heart failure, with Hgb of 8.6, in addition to diuretic what to give? a. fluids b. Packed RBCs c. platelets 45. Patient with previous rheumatic fever now with signs of heart failure, atrial dilation, diastolic murmur? 46. Patient with lower limb swelling, DVT is confirmed with doppler U/S, what is the management: a. LMWH b. Warfarin c. Thrombectomy 47. Patient with history of MI underwent catheterization, now pre- senting with chest pain, cold extremities, high PCWP, low cardiac index and CVP 8. Asking about the diagnosis? 48. Patient with history of OSA, with LL edema, asking about mecha- nism of action of his edema? 49. Patient with BPH, on medication, developed orthostatic hypo- tension. Asking about mechanism of hypotension? 50. Female, murmur of aortic stenosis, fainted, what to do next? 51. Patient with heart failure. BP: hypotensive. What is your next step? 52. Patient with history of chest pain, increase with activity and de- crease with rest. Today developed continuous chest pain, not released. Asking about the diagnosis? 53. Young obese male patient works as a truck driver. ECG showed STEMI. Asking mechanism of his MI? 54. ECG of pericarditis. dx & ttt? 55. Heavy alcoholic patient with dilated cardiomyopathy and hyper- tensive. Asking about the cause of cardiomyopathy? 56. murmur increase with Valsalva and dec with squatting sudden loss of consciousness while playing card 57. ventricular tachyarrhythmias  Cardiovascular system 33 58. 11 y/o boy with marfan syndrome with systolic click and mild aortic dilation what is the most complication in 10 years? 59. Female 63 y/o history of COPD, smoker, lower limp edema, right sided heavy, what is the cause of the edema? 60. Afib. ECG, how to prevent stroke? 61. male patient 60 y/o he has epigastric pain after eating and walk- ing relived by rest (staple angina). Next step?? a. ECG b. echo c. exercise test 61. HTN patient, recently diagnosed with DM, what to give? 62. Trauma patient, becks triad, echo shoed fluid (Cardiac tam- ponade) what is the next step management? 63. Acute decompensated hf presentation =Cardiogenic shock pa- rameters? 64. 60 y/o History of mi 2 days ago, In the hospitalized sudden chest pain, new systolic murmur, Next step evaluation? a. Echo b. ECG 65. Child with VSD not following presented with signs of failure. the mechanism? 66. female with sudden loss of vision Did carotid arty duplex show stenosis more than 70%, Next step? 67. murmur increase with Valsalva and dec with squatting? 68. Patient with signs and symptoms of cardiogenic shock. How would the CO, PCWP, and SVR be? a. High CO, Low PWCP, Low SVR b. Low CO, High PWCP, High SVR c. High CO, Low PWCP, High SVR 69. 15-years-old boy with a sedentary lifestyle whose 35-years-old dad died one month ago because of myocardial infarction. On lab test he has high total cholesterol and LDL (in the 200s not more than that). After advising on diet modification, what is the next step? a. Start statin b. Start cholestyramine c. Reexamine in 1 year  Cardiovascular system 34 d. Start physical activity 70. Fixed splitting of S2 with the P2 component louder. a. ASD b. VSD c. AS d. MR 71. Heart failure description in an old woman, asking what’s the cause of the symptoms. a. diastolic dysfunction b. Myocardial ischemia c. Myocarditis d. Renal ischemia 72. Description of a young man with ankylosing spondylitis. HLA- B27+. What’s the cardiac complication? a. Aortic insufficiency b. Aortic stenosis 73. Case of hypertension asking what drug to start them on. a. Beta blocker b. CCB c. ACE inhibitors was not in the options. 74. Atrial fibrillation with mitral valve involvement Tx? 75. IE prophylaxis: Patient with valvular disease undergoing colonos- copy what is prophylaxis a. no need b. ceftriaxone 76. Elderly woman with new signs and symptoms of CHF. she needs to sleep on more pillows. On examination she’s noted to have kypho- sis. What’s the most likely cause of her symptoms? a. Dec thoracic compliance b. Increased ERV c. Increased FVC 77. Question about elderly who is getting awake from sleep more of- ten than usual. He is taking diuretics as part of his Hypertensive man- agement. He forgets 2 out 5 objects when doing mental state examina- tion. Asking about the reason why he wakes up more often.  Cardiovascular system 35 a. dementia, b. diuretic use c. Normal aging 78. Elderly patient, presenting with exertional syncope, and question describing typical murmur of Aortic stenosis. Diagnosis? 79. Man in his 30s, question is saying that he has no medical history of heart diseases in his family. Had LDL less than 190 but total choles- terol more than 200. Asking what’s the next step/test to do for assess- ment of cardiac risk a. Ambulatory ECG b. Echo c. nothing indicated now 80. Post MI patient that deteriorated, with pulmonary edema, asking about diagnosis. Key here is they said new murmur over the apex was heard 81. Lady with chest pain that changes with position. relieved with leaning forward ECG shown with diffuse ST elevation. Diagnosis? 82. Patient that underwent valve repair now came presenting with fever and new murmur (Infective endocarditis), asking about the mechanism of disease? a. Lymphocytic infiltration b. Macrophage adhesion 83. Patient had loss of consciousness, he had hemodynamic instabil- ity and ECG was shown with clear arrhythmia. What to do? 84. Patient had previous Myocardial Infarction, asking what to do to prevent recurrence? a. Betablockers, b. CCBs, c. ACE d. ARB 83. Smoker that developed shortness of breath, has lower limb edema, crackles heard, what to do next? a. chest Xray b. ECG c. echo 84. Man, that is scheduled to have a central line. What is the best thing to do to protect him?  Cardiovascular system 36 85. Case of a child with a murmur, he was a preterm, it literally tells you at the end his has PDA. What to give him? a. Indomethacin b. Prostaglandin E1 86. Lady who has BP of 130s/80s. Is a bit overweight, what’s the best next step in her management? a. Weight loss b. Betablockers 87. 2yo baby coming from vacation where they ate street food, has GI symptoms and wheezing and BP was 70, and they provided a picture of rash all over (looked macular and hyperpigmented), how to treat? 88. young patient with holo-systolic murmur 3/6, at the apex He get tired easily, what is the cause? 89. AFIB patient he is stable, what will be the management a. CCb diltiazem b. beta blockers c. arb 90. Patient presented with hematemesis and melena. Patient had episodes of recurrent infection. He was hypotensive 70/50, and he took Warfarin with INR 3.1 what is the next step in management? a. saline infusion 0.9 b. antibiotic course c. packed RBCs 91. Patient came after an episode of syncope, SOB, Lung crackles. Cardiac examination showed a diastolic murmur at the apex. ECG was normal. Echo showed a left arterial mass attached by stalk. What is the most likely cause of the presentation? 92. Young pt. after MVA came to ER with diffuse left chest pain, EKG showed multiple premature ventricular complexes. 93. A 25 years old male after Motor accident, auscultation of the chest is normal, cardiac exam is unremarkable. Abdomen shows bruises with tenderness in examination. FAST assessment shows in- trabdominal bleeding, patent is hypotensive. PCWP and Systemic vas- cular resistance will be: a. Decrease  Cardiovascular system 37 b. Increase 94. A 30 years old patient with BP of 190/160, presented with sud- den confusion, blurry vision and headache, papilledema what is the di- agnosis? 95. ECG showing inverted p wave at lead 1 with history of recurrent infection a. Kartagener b. CF 96. Classic Beck triad presentation: distant heart sounds + elevated JVD + hypotension. What’s the cause? 97. Patient with signs and symptoms of sepsis. How would the car- diac output, PCWP, and SVR be? a. Low CO. High PCWP. Low SVR b. High CO, Low PWCP, Low SVR 98. Terazosin & tamsulosin cause orthostatic hypotension Cardiovascular system 38  Respiratory system and ENT 39 Respiratory system and ENT 1. baby was 1 minute vigorously moving and had peripheral cyanosis + on lips what’s best intervention: a. ET tube insertion b. ET suction of aspirated amniotic fluid c. CPAP d. Observe Oxygen mask 2. A question about a lady who underwent surgery and developed com- plications 3 days after. Surgical wound is healing well. Chest X-ray was attached (similar to the picture to the right). What was the cause? a. Atelectasis b. Pneumonia c. UTI d. ARDS 3. Pt with respiratory failure symptoms on 100% oxygen,88% saturation with nonbreathable mask, what to do? 4. Pt works as a shipyard and developed respiratory symptoms, X-ray shows pleural effusion and thickening, diagnosis? 5. Pt with a history of TB exposure, PPD negative, what is the reason? 6. Pt went to Hong Kong, present now with hemoptysis? 7. Poor asthma control, which maintenance decrease exacerbations? 8. Old man develops pneumonia post-seizure; cause? 9. Management of tension pneumothorax. 10. ABG question: young male presented after car accident. CT was attached and I think it was pulmonary contusion. He was desatting. RR was 20. Was asking what you expect to find on ABG patient was dysp- neic (alkalosis more likely) a. Hypoxemia with respiratory acidosis b. Hypoxemia with respiratory alkalosis c. Hypercapnia with Resp Alkalosis d. Hypercapnia with Resp Acidosis  Respiratory system and ENT 40 11. Man with respiratory symptoms, he used to work with ships all his life, supradiaphragmatic calcifications a. Asbestosis b. interstitial lung disease 12. 30 years, bus driver for long distances, sudden onset pleuritic chest pain, fever 38, CXR atelectasis on left lower lobe, ABGs PH 7.44, CO2 33, O2 65, next step? 13. RTA case patient shocked, chest trauma, jugular venous pressure was high, cause a. - cardiac tamponade. b. - Cardiac contusion c. - Pulmonary contusion 14. Other scenario of pulmonary contusion describes a consolidation that is restricted to one part of a lung lobe, I am not sure if it is the same question or not). 15. Poor asthma control, which maintenance decrease exacerba- tions? 16. Pathophysiology of ARDS >> 17. Patient with pneumonia not getting better and large pleural ef- fusion what would you do (parapneumonic effusion) management 18. Patient with SIADH and lung cancer a. large cell lung cancer b. adenocarcinoma c. bronchial cancer d. small cell lung cancer 19. Patient with chronic intermittent cough that is worse at night for 2 years what to do 20. A young man was practicing basketball suddenly developed left sided chest pain he is a smoker daily for 5 years, on examination there was dec. vocal Tactile dec sounds on Left, asked what's the most ap- propriate best next step a. CT angiography, b. Ventilation perfusion lung scan, c. CXR  Respiratory system and ENT 41 21. 21 years, Co2 68, Po2 98, Hco3 24. Explain his ABG reading: (resp acidosis) a. Decrease ventilation b. hyperventilation, c. Oxygen toxicity d. A child with sickle cell disease her parents are concerned be- cause her uncle died of pneumococcal infection, what would u do to prevent that? a. ceftriaxone once monthly b. amoxicillin daily 22. Patient had splenectomy and took one of the pneumonia vac- cines, what else would u give? 23. patient with progressive shortness of breath with CT showing honeycomb appearance, asking about diagnosis? 24. patient with alcohol and valium poisoning, and ABG revealing respiratory acidosis asking about mechanism? 25. Tuberculous pleural effusion, labs for pleural fluid attached indi- cating an exudate with high adenosine deaminase. In addition, the his- tory mentions fever and weight loss, night sweats. 26. PE after colectomy in colon cancer patient. 27. during central catheter patient has shortness of breath and blood pressure of 86/60. No breathing sounds heard on the left side of the chest what is the next step? 28. Complications of CVC: a. pneumothorax, b. DVT, c. infection. 29. question post operatively complication/ other scenario included a patient with puncture wound that shows exudate, other parameters showing septic shock with an Xray showing radiopaque patches and asking about the cause of these patches?  Respiratory system and ENT 42 30. Asthma first step treatment: first step: SABA second step: low dose ICS third: low dose ICS+LABA or medium dose ICS fourth: medium dose ICS + LABA fifth: high dose: ICS + LABA sixth: high dose ICS + LABA + oral CS 31. Patient on opioids with respiratory rate of 6 and ABGs show hy- percapnia, acidosis and low Po2, mechanism? 32. RTA patient with massive Pneumothorax features, tracheal devi- ation and low saturation. Asking about the management? a. Chest tube b. endotracheal intubation 33. Patient after femoral surgery sudden onset chest pain, tachycar- dia, tachypnea with accentuated P2 but no petechial rash. a. PE b. Fat embolism 34. Patient with burn involving upper face, neck chest, also inner side of nose and mouth. What is the next step? a. Intubate b. ppv c. oxygen cannula 35. Which medicine is contraindicated in asthmatic patient? 36. COPD heavy smoker patient, will have hip replacement in 30 days. what is next? 37. Pt smoker presenting with hemoptysis + constitutional symp- toms. CT scan showed right upper lobe nodule 3 cm. bronchoscopy show 3cm lesion. Asking about the diagnosis? a. Bronchial carcinoma b. small lung cancer c. adenocarcinoma 38. Asthmatic female patient willing to stop smoking but has symp- toms of agitation. She is non complaint with OCP pills. What to give? a. Nicotine patch b. nicotine tablets 39. Indication for intubation given ABG Pa O2 < 60 and PaCo250  Respiratory system and ENT 43 40. Patient undergoing radiation to lungs, presenting with pleural ef- fusion, they ask what will confirm his condition (findings in chest ex- amination)? a. increased tenderness upon percussion b. Decreased tactile fremitus 41. Patient on opioid, elderly, COPD, respiratory rate 6, asking for mechanism of respiratory distress? 42. Newborn in respiratory distress, normal pregnancy, ROM >10hours, his oxygen 87%, low Apgar score. After applying O2 therapy, saturation improved. Asking about mechanism of action in his condi- tion? 43. elderly patient with nasogastric tube, got pneumonia What could prevent this? 44. COPD what to do on discharge 45. vaccine after splenectomy? 46. Patient old I think smoker presented with cough SOB, etc., x ray showed tumor originating from pleura and pleural effusion, he worked in industrial ship in his 30s for 1 year 47. Multiple Fracture of femur, did fixation, then he got conduction and shortness of breath, tack apnea and tachycardia, macules on the chest >> fat embolism >>>>>resp distress, neurological signs, skin pete- chia 48. co poisoning 49. 3-year boy case of drowning and then pt. develop respiratory distress what is the mechanism? 50. Pt with Bloody sputum, cough, hemoptysis and wt. loss, o/e he has large right plural effusion and atelectasis with mediastinal devia- tion to right 51. Pt has SOB after CVC placement, Absent breath sound on the left of the thorax asking about mechanism>> Cause? 52. COPD with respiratory distress on 8L oxygen and o2 % 84 and on treatment what to do next 53. asthma pt. with symptoms, coughing after running, how to diag- nose 54. pt. with recurrent chest infection and has an infection now a CT chest given what is Mechanism? (Bronchiectasis) 55. Pneumothorax case, how to confirm diagnosis?  Respiratory system and ENT 44 56. Qs about sudden hemoptysis and lung mass. Showed nothing? 57. pneumonia case and stable patient treatment 58. 72 years old male with recurrent aspiration pneumonia came with a new case of pneumonia he is a smoker and he drinks 3 glasses of wine at night his speech is normal gag reflex is normal what most ef- fective one thing to do to prevent future aspiration pneumonia? 59. A 47 years old male presented with shortness of breath and pro- ductive cough. Patent had previous similar but milder cases. He is smoker with 2 pack a day for 40 years. Examination reveal crackles bi- laterally. Patent was managed accordingly. What pharmacological op- tion can be given in this patent case for long term management? 60. A 75 years old patient presented with cough and shortness of breath. He is smoker with pack a day for 10 years. Chest examination shows diffuse crackles. Spirometry shows a FEV1 of 60 and FEV1/FVC ratio 0.9 (N>0.8), most likely mechanism of this patent condition? 61. Patient presented with shortness of breath and productive cough, he is known to have asthma on medication, on presentation pa- tent has severe dyspnea his ABG shows: ph. 7.37, Co2 27, O2 85, what is the cause of his co2 reading? > 62. Patient came with shortness of breath after Tb treatment. On ex- amination: decrease breath sound at the lower right hemithorax, dull- ness on percussion, decrease tactile fremitus. What is the most likely cause? Young male developed shortness of breath suddenly while studying, he had a similar symptom previously but milder, he has also crepitus sensation on exam most likely diagnosis? 63. Patient with pneumonia and gram-negative rods?? 64. Question about a young lady having features of pneumonia, it says she had recurrent episodes for a couple of years. Then it says X ray shows thickened bronchus or something like that. a. Chloride channel problems b. immune deficiency  Respiratory system and ENT 45 65. Patient had an accident. Then stem explaining he had a flail chest. Question asking what is the cause of his hypoxia? a. Right heart failure b. Low Preload c. Increased Central venous pressure d. Ventilation Perfusion Mismatch 66. Patient came to Emergency because he lost consciousness for 10 seconds after a coughing bout. Question also says he didn't eat break- fast today. a. Hypoglycemia b. Autonomic insufficiency c. Tussive syncope 67. Young guy had an infection. Then stem saying he had reduced breath sound on one chest, dull on percussion. Then Pleural tap result given. causes of Pleural effusion 68. Patient with lung cancer, developed one of the paraneoplastic syndromes. Developed Cushing’s features. Asking what is the most probable cause? 69. Clear ARDS case following surgery, X ray was shown. Questions wanted the diagnosis 70. Patient that is a heavy smoker, more than 30 years I think, with fever and features of pneumonia. He had reduced breath sound at the base of the long and increase vocal fremitus, What’s the diagnosis? a. Pneumonia b. COPD c. Asthma 71. Patient with Kyphosis. Asking about Pulmonary function test Pa- rameters (TLC, FEV1, etc.) 72. Smoker that developed shortness of breath, and has wheezes heard. What to next? 73. Typical COPD case, asking for the spirometry expected to be found 74. Kid presenting after bee sting with wheezing and stridor and urti- caria. What is the cause of his stridor? a. Laryngeal edema b. Bronchospasm  Respiratory system and ENT 46 75. Patient presenting with Asthma. He was given ipratropium, and oxygen and is about to be discharged what is the appropriate oral pharmacotherapy? 76. Scuba dived and died a. pulmonary embolism b. air embolism c. fat embolism 77. Description of a patient with asthma and he got better on inhaler therapy. What would you expect to see on spirometry? 78. Patient with COPD exacerbation, ABG show very low PO2 next step? a. Oxygen. b. Ceftriaxone 79. Lady having severe burning pain in her chest and left arm. Long stem, at the end it says she had crepitus in the chest. a. Ruptured trachea b. Mediastinitis c. necrotizing fasciitis ENT 80. A baby presented in the winter with a cold and URTI a. RSV b. rotavirus c. ARDS 81. A child with runny nose and congestion, they did however throw in that the drainage was bilateral and PURULENT. All classmates had similar symptoms. Cause? a. RSV b. Rhinovirus 82. A case of bacterial rhino sinusitis asking for treatment a. Amoxicillin clauvlate b. ceftriaxone c. doxycycline 83. 30-Year-old with seasonal allergy during spring runny nose and watery eye otherwise healthy what to give? a. antihistamine b. antibiotics  Respiratory system and ENT 47 84. Patient with nasal congestion, runny nose, postnasal drip and er- ythema of the pharynx and basically cold symptoms 85. Patient with high BMI, snoring at night and sleepy during the day, also hypertensive dx 86. Patient with fever, drooling of saliva, better in tripod position (epiglottitis) which vaccine would prevent this condition. 87. case of bacterial tonsillitis, how to confirm? 88. Patient with a long history of smoking, has hoarseness of voice, works as a telemarketer. Picture of larynx shown with a lesion. Asking what to do next? a. Biopsy b. Voice training c. stop smoking and reexamine in a month d. Give steroids and reexamine after a while 89. Question about a young boy with what seems to be a cold flu. Saying that tympanic membranes are bulging a bit. What to do next? 90. Otitis media with mastoiditis scenario, asking about source of infec- tion?  Respiratory system and ENT 48 Gastrointestinal system  Gastrointestinal system 49 Gastrointestinal system Congenital and developmental anomalies 1. a young man (19 YO?) known case of cystic fibrosis and exocrine pan- creatic insufficiency. now has excess urination and thirst. Presenting with a high random blood glucose. What is the next step to confirm the diagnosis? a. 2h OGTT b. Anti-GAD c. Anti-islet antibody 2. pt. with CF, Recurrent infection, foul smelling stool, weight loss, diar- rhea what is the cause of the diarrhea? (Mechanism) 3. Case of choledochal cyst in a child 4. A neonate was doing fine until breastfeed when he choked and started coughing, developed shortness of breath with crackles in the chest, mist likely diagnosis (pathophysiology)? 5. Inguinal hernia (small bulge increase with strain and disappear with ly- ing down) asking about the mechanism of the condition? 6. Male newborn around 6 weeks old I think with projectile vomiting as soon as he feeds and visible peristalsis. 7. Hypertrophy of the pyloric muscle. Pyloric stenosis straight forward Biliary tract disorders 1. Baby with jaundice and direct bilirubin =4, total bilirubin = 5, RUQ Ul- trasounds shows intrahepatic biliary ducts proliferation. 2. Middle aged female with jaundice and pruritis, has positive AMA anti- body (Primary biliary cholangitis). What to measure next? a. LDH b. Fasting lipid profile  Gastrointestinal system 50 3. Case of dyslipidemia with xanthelasmas Tx? (Primary biliary cholangi- tis) a. fenofibrate b. Ursodeoxycholic acid 4. Pt with presentation of acute cholangitis (RUQ pain, jaundice, fever, sever hypotension), what to do next? 5. Female 30y 7 days ago she did cholecystectomy, then came with ab- dominal pain with high fever, jaundice, RAQ pain with guarding, Lap = direct bilirubin = 5.6 (acute cholangitis) Asking about cause of jaun- dices? 6. Primary biliary cirrhosis/cholangitis presentation (jaundice, pruritus), treatment? Hepatic disorders 1. Hyperpigmented skin and very high sugar and ferritin and iron and low TIBC. Dx? 2. An alcoholic presented with palmar erythema, jaundice, spider angio- mas and ascites what’s the diagnosis? 3. Patient had symptoms of acute viral HBV, asking for serology 4. Pregnant patient visited her family in Egypt, now in Denmark with jaundice, fatigue, nausea. Asking about investigation to do? 5. Patient presenting with liver cirrhosis. asking what will be low? a. ALT b. AST c. albumin d. bilirubin 6. Pt have cirrhosis, now have ascites and fluid overload, mechanism of dis- ease:  Gastrointestinal system 51 a. increase hepatic blood flow b. increase vascular oncotic pressure 7. clinical scenario of spontaneous bacterial peritonitis (ascitic neutro- phils >=250), what to do next? give what antibiotic? Gastroesophageal disorders 1. Description of achalasia - patient presenting with difficulty swallowing and not being able to do so without drinking large amounts of water, barium swallow showed symmetric narrowing of lower esophagus ta- pering down. (They described the bird beak sign) a. Achalasia b. Adenocarcinoma c. GERD 2. A case of achalasia and + FOBT, what to do next? 3. Picture of achalasia asking about the mechanism.? 4. patient with food regurgitating and long-standing achalasia (15 years) and heavy smoker, what to do.? 5. pt. with vomiting then had one episode of bloody emesis and hemody- namic stable, what’s the next step? 6. Pregnant woman with GERD, already on calcium carbonate. Still sympto- matic. What to do? a. add ranitidine b. Sucralfate 7. Patient with clear GERD symptoms; heart burn, abdominal pain, etc. Given some form of Antiacid, what to do next? 8. Patent with central chest pain burning sensation, he tried calcium car- bonate and it relieves the symptoms, now the symptoms become more  Gastrointestinal system 52 frequent. She wakes up with sore taste in her mouth. The best management to do next? 9. male with severe GERD heart pain Endoscopy showed redness of the Lower esophagus Next step in management? 10. A male with epigastric pain worse after food, he’s a smoker and an al- coholic, endoscopy showed ulcer in the duodenum, what’s the cause? 11. Elderly patient with epigastric pain, endoscopy showed erosive ulcers with clean base, before he had history of gastric problems and - H. Pylori on histology. What to give? 12. H. Pylori he took omeprazole, what to add? 13. coffee ground vomiting, taking ibuprofen for osteoarthritis Cause? 14. patient with history of PUD and upper GI bleeding suggesting a bleed- ing ulcer, after giving IV fluids, a drug was given, what is the mechanism of action of this drug? 15. A 21 years old male who drank a lot of alcohol in the past day, came home and vomited severely. he woke up with a central chest pain on exami- nation he had tenderness to the epigastric area with air crepitus on ausculta- tion. What is the most appropriate nest step? 16. Long standing Gerd for 15 years, she started ranitidine 6 months ago. Now she has dysphagia, barium swallow shows a stricture in the esophagus, next step: a. Dilation of the stricture b. Endoscopy with biopsies 17. Pt diagnosed with worsened GERD, has dysphagia, next step? 18. Pt presents with Mallory-Weiss syndrome (history of repetitive vomit- ing).  Gastrointestinal system 53 Intestinal and colorectal disorders 1. 37 y o female, 1-year hx of abdominal pain with cramps, since few days her pain became on RLQ, with palpable tender mass, tachypnea, tachy- cardia, SBP 100 FOBT +ve, Dx? 2. Intermittent abdominal cramps, mucus mixed with her stools, mild ten- derness to palpation of RLQ; no distention, guarding, or rebound. Occult blood is positive. Dx 3. young patient with lower abdominal pain + aphthous ulcer + prolonged diarrhea, dx? 4. Middle aged man, frequent diarrhea not bloody, History of painful deifi- cation, in examination perianal tag Dx? 5. Patient with mild ulcerative colitis (daily diarrhea and fresh blood pre rectum), he had no abdominal pain on palpation, colonoscopy shows ery- thema and ulceration of the whole colon what would u give 6. A 17 years old boy was treated previously with amoxicillin clavulanic an- tibiotics for otitis media. Presented with bloody diarrhea. colonoscopy showed inflamed colonic mucosa with crypt abscess. What is the most likely diagnosis? 7. elderly patient with lower GI bleeding, hemorrhoids and microcytic ane- mia, asking about the most appropriate next step colonoscopy (Same scenario in IFOM SELF ASSESSMENT). 8. Patient with episodes of constipation and diarrhea, everything else is normal, dx? 9. patient with navel (umbilical) pain, that shifted to right lower quadrant, there was McBurney point tenderness. What’s the diagnosis? 10. Young girl with severe abdominal pain started a few days ago. It was periumbilical. It is now in the lower quadrants. On examination her ab- dominal muscles are tense and she has guarding but no rebound tender- ness. Pain in the right on PR examination, there was a tender mass felt on the right on PR. Her urinalysis shows WBCs. d a. appendicitis b. UTI c. Ovarian cyst d. Diverticulitis 11. Patient with abdominal pain started at umbilicus now at RLQ, addition- ally nausea and vomiting. Dx? and asking for mechanism?  Gastrointestinal system 54 12. 10 years old presented with abdominal pain at the lower right quad- rant previously was in periumbilical area associated with vomiting. On examination he had a RLQ tenderness with guarding. Next step in man- agement? 13. appendicitis with typical presentation, next step of investigation? 14. Typical appendicitis case, patient refuse surgery, what antibiotic to give? 15. Patient with a history of bypass (CABG/Aortic repair) presents with Currant jelly stools (he was old) asking for diagnosis? 16. A 57 years old female presented fever, with diffuse abdominal pain and guarding. She had an aortic repair surgery 5 days ago. Proctosig- moidoscopy showed gray discoloration are. Most likely diagnosis? 17. Pt presents with pain, bloody diarrhea after sepsis and hypotension, dx? 18. Describing ischemic colitis. What will you do next? 19. Afib, with severe abdominal pain, and positive fecal occult blood test, diagnosis? next step? 20. Patient with two previous abdominal surgeries presented with ab- dominal pain and they gave an X-ray she had colonic dilation throughout the whole thing, all electrolytes were normal a. adhesions b. pseudo-obstruction 21. patient 5 days after accident with fracture at 6+7rib come with short- ness of breath after straining for stool, CXR show opacification at lower left lung and ultrasound shows fluid collection in the subdiaphragmatic areas and pelvis, examination shows abdominal tenderness at the upper quadrants bilaterally blood pressure 90/60: Diagnosis? a. splenic rupture b. Bowel Perforation 22. Patient had rash on his ear, scalp and elbow, I think it was psoriasis, they were asking he’s at risk for which of the following diseases 23. Long case about patient with vague symptoms, but at the end de- scribes that he had guarding. X ray shown which looks like Air Under dia- phragm. What to do next? 24. Tricky question explaining that a patient had a massive rectal bleed. He had chest pain and ECG changes. After giving him IV fluids and Packed RBCs, the chest pain subsided. Colonoscopy was done, but there was too  Gastrointestinal system 55 much blood they couldn’t visualize a source. It says NG tube shows only clear substance and no blood. What to do next? a. CT scan of the abdomen b. Upper GI endoscopy 25. pt. with family history of colon ca of her mother and brother, now she has LGIB and colonoscopy show a polypoid mass, dx I’m not sure if this was written but there was a pt. who had episodic severe pain once every few months and now has fever + bleeding + low Hgb. also had bloody diarrhea. I thought it’s probably diverticulosis that persisted and became diverticulitis. Crohn’s maybe was also in the options, idk. Mesenteric ischemia.? 26. An old man. with iron-deficiency anemia, endoscopy and colonoscopy showed nothing, what’s the best next step? a. capsule endoscopy b. CT pelvis and abdomen c. MRI Pelvis and abdomen 27. The Q was asking about the mechanism of diarrhea in an infant (4 months) that is severely dehydrated due to vomiting and diarrhea, no hx of exposure or travel provided. a. Decreased luminal colloids b. Increase overall sodium levels c. Increased cAMP activity d. Colon vesicular fistula case. Pancreatic disorders 1. Pancreatitis with high triglyceride 10k + high lipase, has a family history of familial hypertriglyceridemia, next step of mx? a. Plasmapheresis b. Insulin c. Heparin  Gastrointestinal system 56 d. Meropenem 2. 30 years old with epigastric pain radiating to the back associated with nausea and vomiting, amylase is 1377, what is the most likely diagnosis? 3. pancreatitis, high AST Worst prognosis? 4. Post ERCP pancreatitis case 5. Patient with severe epigastric pain indicating pancreatitis, lab results show triglyceride levels of 3500, Dx? 6. A case of pancreatitis with high lipase 7. questions about acute pancreatitis Alcohol induced. 8. Pt presents with acute pancreatitis (Pain and lab) next? 9. CT scan of someone with jaundice and weight loss, had spider angiomas / erythema as well, duration for more than a month. Diagnosis? Tumors of the GI tract 1. Patient had colon cancer and had a surgery for resection, during sur- gery they found the mass has extended to the muscular layer and there were 2 positive lymph nodes what is the treatment plan 2. Old lady with painless jaundice (pancreatic cancer) next step of investi- gation? 3. patient with diarrhea, she was kept without oral intake and diarrhea remained, CT scan shows 1.5 cm pancreatic mass, what is the most likely di- agnosis? 4. elderly pt. with low bp and high glucose confused CT scan was done, what would you see? >Pancreatic mass 5. Clear case of elderly with jaundice and abdominal mass, CT was even given, what’s the diagnosis?  Gastrointestinal system 57 6. A 70 years old female presented with pruritic skin and icterus in her eye she complains of dark urine and clay stool along with unintentional weight loss, patent has no other symptoms. Most likely diagnosis? 7. Patient with Infective Endocarditis. Culture of blood showed S.bovis or- ganism. What is the next step? 8. Elderly patient had weight loss recently. He said he developed difficulty swallowing, that started with solids first, then everything. What’s the di- agnosis? a. Esophageal cancer b. Achalasia c. Esophageal Diverticula 9. 72 years old female presented with abdominal pain. Unremarkable exami- nation. Occult blood test was positive. Next step? 10. Patient who is around 40 years old had a father diagnosed with Colorec- tal cancer at I think 45. What to do next? 11. Pt 50 years old, with anemia, low MCV, what to do? Miscellaneous 1. question about confusion in elderly, unable to perform daily activities, took codeine at the dentist underlying cause of confusion? infection? consti- pation? 2. Case of upper Gi bleeding what to administer after initial resuscita- tion?  Gastrointestinal system 58 3. Patient with blunt abdominal injury. Has ecchymosis on the mid abdo- men. Patient is hemodynamically stable. What’s the next step in manage- ment? 4. Post RTA with right side lower iliac pain fast scan showed intra perito- neal fluid d.t rupture of? 5. Classical pyloric stenosis case, asking what you would find in labs. They specifically asked for pH, K+ & Chloride if each is high or low 6. secondary bacterial peritonitis (PML = 300) TTT 7. Patent presented with jaundice, spider angioma and clubbing, with ab- dominal pain and fever, ascetic fluid showed elevated WBC of 620? how to manage? 8. Pt. with sickle developed a splenic infract 6 weeks ago now has a LUQ pain and fever, left pleural effusion most likely diagnosis? 9. Pt with acute pancreatitis, developed complications (Increased LFTs, ascites). Disorders of nutrition 1. 3-week-old baby cry and arch his back after feeding, depending only on breast milk, birth weight was 3kg, 30gm increase in wt since birth. What's the management? a. stop breastfeeding and change to lactose free formula. b. Abdominal US. c. Upper git series investigations. d. Reassurance  Gastrointestinal system 59 2. 6 months infant what to do recommend? Cereal tests for …… 3. patient did partial gastrectomy have microcytic anemia what could prevent? 4. Female patient with Chron’s disease. What vitamin would be deficient? 5. Female patient complaining of unsteady gait upon close of her eyes, now she is using carri- ers for walking that she borrowed from friend. No history of surgery. Drinking 3 -4 glasses of wine daily. Upon examination gait based and can stand, but when closing her eyes, she falls. Memory preserved. What to do next? a. B12 levels measurement. b. alcohol level measurement 6. Patent with stomatitis and glossitis, hair loss, impaired wound healing what is the defi- ciency? 7. Confirmation of HHS (Hyperosmolar Hyperglycemic State) via what test? 8. Man with non-bloody, non-mucoid diarrhea post-eating, no travel or eating out history; cause. 9. Triglycerides >600, treatment? (Fibrate or statin?) 10. A patient treated for TB (isoniazid, pyrazinamide, and rifampin) now has peripheral neu- ropathy, what supplement would have prevented this? 11. Homeless patient for like 2 years. Lost significant amount of weight, came with gum bleeding, bruises on the leg as well, it said he was an alcoholic but he stopped like 6 months ago, Labs were given he had anemia, and MCV was 89. What’s the deficiency? a. Folate, b. Vitamin B12 c. Vitamin C  Gastrointestinal system 60 pregnancy & puparium  Female reproductive, breast, pregnancy & puparium 61 Female reproductive, breast, pregnancy & puparium Reproduction + STDs 1. PCOS increased risk for which cancer? 2. PCOS and obese, increased risk for which metabolic disease 3. An 18-year-old sexually active, she was 100kg and her BMI was 38, other than screening for STIs what is the best next step? a. HPV vaccine b. Measure lipids in serum. c. Measure fasting glucose. d. Pap smear 4. Patient with wrist and knee pain, sexually active, has lower limb pus- tules, what investigation do u do next? 5. Clear case of endometriosis 6. An infertile woman trying to conceive presents with presented with lower abdominal pain and fever and cervical motion tenderness 7. A patient with secondary amenorrhea because she had D&C a while back and progesterone test showed no withdrawal bleeding 8. An 8-year-old female with early puberty tanner stage 4 and had her menses, she had an adnexal mass probably a tumor what was the diag- nosis? 9. An 18-year-old girl that wants contraception because she will start be- ing sexually active a. Condoms b. progestin implants c. spermicide, d. cervical cap e. Abstinence 10. A case of cystitis or UTI and they're asking about the investiga- tion a. Urinalysis b. Urine culture 11. 71-year-old female had bilateral salpingectomy and hysterec- tomy they're asking about when we do a pap smear for her  Female reproductive, breast, pregnancy & puparium 62 12. Patient with amenorrhea for 2 and a half months then got her period and it was heavy what’s the cause 13. CAH case (she had high 17 hydroxyprogesterone) and they were asking about the diagnosis. 14. Female patient with mucocutaneous and heavy menstrual bleed- ing, platelet count was almost 30,000. ITP management (corticoster- oids). 15. Female with virilization (description mentioned a pubic hair with male pattern) asking about the diagnosis (nonclassical CAH). 16. Contraception question about a patient with hypertension a. estrogen containing contraceptive method b. Levonorgestrel c. Intra-uterine device 17. Secondary amenorrhea due to ovarian failure. 18. Hypertensive patient came for preconception counselling 19. Infertility question for a couple who cannot conceive, the history mentions extensive dilation and curettage indicating Asherman’s syn- drome, the option was formation of adhesions within the uterine cav- ity. 20. Mucopurulent discharge from cervix causative organism chla- mydia 21. Genital HSV treatment, straightforward. 22. Patient with postcoital bleeding, pelvic examination shows cervi- cal mass bleeding on touch, what’s the diagnosis? 23. Patient age, 11 when to give HPV vaccine? a. At Menarche b. now c. when sexually active UW: HPV vaccination is recommended; it is typically administered to those age 11-26 but can be given from age 9 to 45. 24. Primary dysmenorrhea makes her miss school and acetamino- phen provide slight relief. What next? 25. Case describing PPH: Uterine Atony. 26. Clue cells treatment?  Female reproductive, breast, pregnancy & puparium 63 27. 13-year-old girl had menarche two months ago she had comedo- nes and papules no pustules next step. a. Benzoyl peroxide b. Reassurance 28. Pt infertility for many years stopped OCPs for 6 years, obese sed- entary lifestyle, smoker, hysteroscopy showed bilateral tube obstruc- tion, what could have prevented this? 29. dark brown vaginal spotting not related to menstrual cycle hystsonography revealed filling defect, best next step? 30. 31 years old with symptoms of menopause (one was hot flushes), What test is used to confirm the diagnosis? 31. Patient with vaginal discharge, wet mount shows flagellated or- ganisms (indicating Trichomoniasis) management? 32. A female patient with chronic pelvic pain, deep dyspareunia, U/S findings show normal anatomy, pelvic examination shows right ad- nexal tenderness: a. PID b. Endometriosis 33. Preconception counseling of a female patient and her husband. Her husband is a known case of CF, they are asking about the probabil- ity of their child having CF. I chose that it cannot be determined as the patient (the mother) has an unknown carrier state. Other options in- cluded (25%, 75%) 34. 47 years woman 2ry amenorrhea for 5 years with balding, hir- sutism, Clitoromegaly, adrenal mass what's the next step in investiga- tion. a. Send for testosterone and DHEA b. Send for 17 hydroxyprogesterone. c. measure FSH, LH, Prolactin 35. 40s with painless vaginal bleeding/spotting. Endometrial biopsy was done and showed adenomatous endometrial hyperplasia without atypia. What is next step? a. Progestin b. Hysterectomy c. laparoscopy d. ablation  Female reproductive, breast, pregnancy & puparium 64 36. 17 years old female with lower abdominal pain 3 days prior to menses occurrence and 2 days after period, taking NSAIDs not effec- tive, asking about the cause? a. Endometriosis b. leiomyoma c. adenomyosis 37. 30 years old female with known seizure disorder on carbamaze- pine asking for contraception. She is not hypertensive, not smoking not consuming alcohol what type of contraceptive to give. a. Depot medroxyprogesterone b. progestin only pills c. OCP d. vaginal ring 38. Patient with mucopurulent discharge, cervix that is friable. She has multiple sexual partners and now using condoms. No organisms on investigation. What Antibiotic to give? 39. Picture of Bartholin duct cyst. Asking about next step? 40. Uterine atony patient, still not resolved after resus and oxytocin, she is asthmatic, what to give next? 41. Pt with history of radiation therapy to lumbar area, high FSH, pe- riod decreasing over year. What is the cause? 42. Contraception in 42 y/o female, heavy smoker, HTN. 43. Newborn baby girl presents with enlarged breast and vaginal bleeding what to do 44. Post coital bleeding 30 y/o, bleeding ulcer on cervix what next step? 45. patient 52 y/o female history of very large fibroid with sever pel- vic pain What is the cause? 46. female patient 54 y/o presented with vaginal bleeding with his- tory of PCOs. BMI 34 Endometrial biopsy showed atypical endometrial hyperplasia (carcinoma) What the cause of this? 47. female with dysmenorrhea and dyspareunia (endometriosis) treatment? 48. Female used emergency contraceptive after condom was rup- tured. she missed her period. BhCG negative, what's the cause? 49. mucopurulent discharge from cervix causative organism:  Female reproductive, breast, pregnancy & puparium 65 50. If pregnant women have a positive HSAg, what can reduce risk of hepatitis in the child? 51. 21 years old