SMLE Exam Practice Questions PDF - Feb. 2025

DAY 1 to 4 Feb. From silent By Ma Q1- Which cardiovascular disorder is not associated with steatorrhoea? A. Congestive cardiac failure B. Constrictive pericarditis C. Left atrial myxoma D. Mesenteric vascular insufficiency Answer: C Q2- Agree Answer: A Distended bowel loop pointing to the right upper quadrant = Sigmoid volvulus coffee bean sign Q3- 🫘 Agree, full recall: A 60-year-old woman complains of pain in her right knee for the last 3 years. The pain is worse with activity and relieved by rest and analgesics. Physical examination reveals that she has a varus knee deformity and tenderness over the medial joint line (see image) Which of the following is the most likely diagnosis? A. Inflammatory arthritis B. Medial meniscus tea C. Septic arthritis D. Osteoarthritis Answer: D Q4- OK, read different ideas: Pregnant G3P2, 37 weeks with a history of C-section due to non-reassuring CTG. She is in labor with a 4 cm dilation. The presentation is breech. What is the absolute contraindication for ECV? (A) History of C-section (B) Active labor (C) Variable decelerations Answer: (C) Variable decelerations + Cord compression causes variable deceleration (another recall) A 23-year-old patient at 38 weeks of gestation is in active labor and diagnosed with cord prolapse. Which of the following is the most expected finding on CTG? (A) Accelerations (B) Late decelerations (C) Early decelerations (D) Variable decelerations and bradycardia Answer: (D) Variable decelerations and bradycardia CTG picture: Recurrent Variable decelerations This is CTG category II Managed by: In utero resuscitation measure e.g. lateral positioning of the mother, O2, IV fluid, stop oxytocin, administer tocolytic drugs, and surveillance ———————— Q5- Agree, its a picture question ‫سهاالت‬ Answer: D Another recall: A 16-year-old boy presents with a 4-day history of a rash over his legs associated with abdominal pain and aches in both knees. He had one bout of bloody loose bowel motions. Physical examination reveals an erythematous palpable rash extending up to his buttocks (see reports). Urinalysis: Moderate proteinuria Ultrasound kidneys: Normal Which of the following is the most likely diagnosis? (A) Churg-Strauss syndrome (B) Hemolytic uremic syndrome (C) Henoch-Schönlein purpura (D) Thrombotic thrombocytopenic purpura Answer: (C) Henoch-Schönlein purpura Q6- Ok see this scenario: A 3-year-old child seen in the clinic with fever and cough for 5 days following flu-like prodrome.On examination, he had decrease air entry and crackles over right lung middle zone. Chest X-ray is done (see image and lab results). Blood pressure 90/64 mmHg Heart rate 110 /min Respiratory rate 20 /min Temperature 36.6 C Oxygen saturation 97 % Test Result Normal Values Hb 12 165-195 g/l (Newborn) 112-165 g/l (Child) Platelets count 328 150400 x 109/L Neutrophils 80 40-60% WBC 22 4.5-13.5 x 109/L (2-10 years) 4.5-11.1 x 109/ (11 years-older adult) Neutrophils 84% (2.4-7.3 x 109/L) 30%-77% (2-10 years) (2.7-6.5 x 109/L) 40%-75% (11 years-older adult) Lymphocytes 15% (2.8-9.3 x 109/L) 26%-56% (Birth) (3.7-10.7 x 109/L) 20%-64% (1-23 months) Which of the following is the most appropriate management? A. Reassurance B. Bronchodilator and steroids C. Admit for intravenous antibiotics D. Discharge on amoxicillin for 7 days Answer: D Dx: CAP Fever and cough + localized crackles and decreased air entry + high WBC with neutrophilia (84%) suggesting bacterial infection likely caused by Streptococcus pneumoniae or other X-ray likely show localized consolidation in the right middle zone The child is STABLE sooo outpatient management : amoxicillin for 7 days When to admit? Hypoxia (SpO₂ < 92%). Severe respiratory distress. Hemodynamic instability. Dehydration or inability to tolerate oral intake. Q7- Ok A 26-year-old woman primigravida at 16 weeks' gestation presents to the clinic complaining of nausea and vomiting. Which of the following is the most likely cause of this condition? (A) Iron deficiency (B) Folate deficiency (C) Vitamin B12 deficiency (D) Physiologic anemia of pregnancy Answer: (B) Folate deficiency Pregnant + vomiting :) Extra info. Q8‫هذي الصوره جت‬ Pregnant 27 weeker with backache and fever 39 ‫تقريبا ً هذا اهم اشياء في السؤال‬ IOL CS ‫ اتوقع الباقي كان‬admission for Abx Oral Abx ? Likely this scenario: A 39-year-old woman primigravida presents at 39 weeks gestation for a routine visit. Physical examination is unremarkabie. Cervix is 2 cm dilated and 90% effaced, with the fetal vertex at 0 station. Urine dipstick is done (see image). Blood pressure 140/90 mmHg Which of the following is the most appropriate management option? A. Induction of labor B. Immediate cesarean section C. Admission to hospital for observation D. Outpatient observation till 40 weeks'gestation Answer: A Q9- A 60-year-old woman is attending the clinic complaining of post-menopausal bleeding for the last 3 months. She was found to have a uterine fibroid of 5 cm in size, noted in a recent ultrasound. Upon review of the previous medical records, the ultrasound performed 5 years ago showed the same size and location of the fibroid. Which of the following is the most appropriate next step in management? A) Myomectomy B) Hysterectomy C) Uterine artery embolization D) Obtain an endometrial sample Answer: D Q10- child of pyloric stenosis projectile vommiting. Ok, a lot of pyloric stenosis recalls ;) : A case highly suspicious of pyloric stenosis what is the diagnostic test ? A- X- ray B- Ultrasound C- Endoscopy Answer : B A 1-month-old boy presented to the Emergency Room with history of forceful. nonbilious vomiting. The mother is very concerned as he is her first baby and was delivered by caesarean section. He has no fever or diarrhea but seems hungry all the time despite her best efforts feeding him. On examination, he looks dehydrated and his weight did not change in comparison to his birthweight. His abdominal palpation revealed an olive on the right upper quadrant. Which of the following is the most appropriate immediate next step in the management? A. Upper GI series B. Prescribe promethazine C. Abdominal ultrasonography D. Correction of dehydration and electrolyte imbalance Answer : D A 2-month-old boy is brought to the clinic with non-bilious and progressive vomiting. The symptoms have developed 2 weeks prior and the episodes at vomiting have been increashg in frequently. He is now vomiting after every feeding. His weight fell from the 50th percentile to the 25th percentile on the growth chart. The fontanels are sunken and skin turgor was reduced. Physical examination shows a small, firm and movable mass located between the umbilicus and the sternum. Which of the following is the most likely laboratory result? A. Elevated sodium level B. A decreased haematocrit C. Elevated C-reactive protein D. Hypochloremic metabolic alkalosis Answer : D A 2-week-old infant presents with projectile, non-bilious vomiting that frequently contains clotted milk. After vomiting, the child still seems to be hungry. On examination, there is mild dehydration. A firm, non-tender and mobile hard 1-2 cm in diameter mass is palpable in the right upper abdominal quadrant at the lateral edge of the rectus abdominus muscle (see report). Heart Rate 95 /min Respiratory Rate 25 /min Temperature 36.7 °C Abdominal X-ray: Shows "single bubble' sign. Which of the following is the most likely cause? A. Gastroenteritis B. Pyloric stenosis C. Reyes syndrome D. Gastric mucosal atrophy Answer : B A 4-week-old neonate presents to the Emergency Room with persistent projectile vomiting. The mother mentioned that he is immediately show sign of hunger after vomiting, but he is not gaining weight as expected (see lab results). Test Result Normal Values Sodium 130 134-146 mmol/L Potassium 2.8 3.5-5.1 mmol/L Chloride 88 97-108 mmol/L Bicarbonate 26 21-28 mmol/L Which of the following is the most likely diagnosis? A. Intussusception B. Pyloric stenosis C. Intestinal obstruction D. Gastroesophageal reflux Answer : B A 5 weeks old and came with non-bilious vomiting. On examinations there is a mass at epigastric area Most likely cause A-Duodenal atresia B-Pyloric stenosis C-Hirshprung disease D-Volvulus Answer : B A 5-month-old baby was admitted with an inability to tolerate food and non-bilious vomiting over the past 2-days. On examination. he appears to be dehydrated. There is an olive shaped mass palpable in the epigastrlc region measuring 2 x 2 cm. Which of the following is the most appropriate management? A. Pyloromyotomy B. Balloon dilatation C. Gastrojejunostomy Answer : A A 5-week-old infant is brought to the clinic with a 3-week history or intermittent vomiting. After vomiting, the infant becomes very hungry and wants to feed again. Physical examination shows no alterations apart from a 2.50 kg weight loss (see lab results). Test Results Normal Valus Sodium 147 134-146 mmol/L Potassium 2.9 3.5-5.1 mmol/L Bicarbonate 32 21-28 mmol/L Chloride 89 97-108 mmol/L Which of the following is the most likely diagnosis? A. Gastric volvulus B. Cyclic vomiting syndrome C. Hypertrophic pyloric stenosis D. Intestinal malrotation with volvulus Answer : C A 6-week-old infant begins to exhibit forceful vomiting after each meal. The infant was born at term to a 23 year-old primigravida whose pregnancy was uncomplicated and ended with a normal vaginal delivery. No congenital anomalies are noted upon examination of the infant. Which of the following is the most likely diagnosis? A. Congenital duodenal atresia B. Necrotizing enterocolitis C. Hirschsprung's disease D. Pyloric stenosis Answer : D ———————— Q11- child vaccination see old vaccine Recalls: child came to his immunization appointment and his mother informed you that after his last vacc he developed SOB and fever, what to do ? A- give B- check previous vacc Answer: B mother brought her 3 months old child to the clinic concerned about giving him the scheduled vaccine due to a previous adverse reaction to the last vaccine he took which was skin rash fever and SOB lead him to be taken to the emergency and be treated, what will you do regarding this situation? A- Give the vaccine B- Check what was give to him the previous vaccine C- Don’t give him the vaccine Answer: B Q12- child come to ER with multiple fracture bruises his father told he fall from bed (child abuse) Full recall: A child is admitted to the PICU with a subdural hematoma. The father reports the child fell from his bed. On physical examination, the child has ecchymosis on the buttocks and back and bilateral femoral fractures. What's the most likely diagnosis? A) Hematoma B) Pathological fracture C) Battered child syndrome D) Accidental injury Answer: C Q13- case of asthmatic pt improper use of neublizr Full recall: A 3-year-old child with bronchial asthma on ventolin nebulizer at home as per needs. The mother expresses concern that the family cannot go out of the home most of the time because the nebulizer machine need electricity power source. Which of the following is the most appropriate counselling should be given? A. Agree and support their decision as the priority is asthma control B. Find someone to take care of asthmatic child if family goes out of the home C. Educate with clear instructions inhaler usage and advice to stop nebulizer D. Find out nebulizer machine with portability feature Answer: C Q14- baby crowling to the doctor put thing from hand to another incomplete grisp.which month Recall: Baby crawling to the doctor, but has weak pincer grip what is the age of the baby with months? A. 6 B. 7 C. 9 Answer: C 6 months > raking (palmar) grasp 9 months > immature pincer grasp 12 months > mature pincer grasp Crawling > 9 months Milestones 9m; wave bye bye, immature pincer grasp, separation anxiety , begin crawl, stand holding furniture #milestone Q15- case of pneumonia answer oral amoxicillin (image) - See Q6 CAP - Oral Amoxicillin in UTI recalls: What would be the best treatment of an uncomplicated cystitis in a 5-year-old girl? A. Oral amoxicillin B. Oral sodium bicarbonate C. Intravenous ciprofloxacin D. IntramuscuIar ceftriaxone Answer: Here is A BUT if come like this: 4 month old baby, presented with signs of UTI, stable not dehydrated. Alert and feeding well. Urinalysis: Positive nitrite. Positive leukocytes. Fever: 39.1 What's the appropriate empirical antibiotic to be started? A- Oral azithromycin. B- oral amoxicillin C- IV Ceftrixone. D- IV Cefepime. ✅ Answer: Oral cephalexin which is correct *Or oral cephalosporine Q16- another case of pneumonia causative organism (streptococcus) I will put all Strept. Recalls not only that pneumonia hahaha: Which of the following is the most likely cause of lobar pneumonia in adults? A. Klebsiella pneumonia B. Haemophilus influenzae C. Staphylococcus pyogenes D. Streptococcus pneumonia Answer: D :‫هدية‬ A previously healthy 13-month-old girl has 2-day history of fever and increasing cough. She continued to be breastfed with no vomiting. Her immunizations are up to date., She is alert and mildly ill appearing. On examination, there is no grunting or chest retractions. There are crackles heard over the right lung base. The remainder of the examination findings are normal, She has no known allergies. Blood pressure 110/70 mmHg Heart rate 146 /min Respiratory rate.45 /min Temperature 38.6 °С Oxygen saturation 95 % Which of the following is the most likely pathogen? A. Moraxella catarrhalis B. Mycoplasma pneumoniae C. Streptococcus pneumoniae D. Haemophilus influenza type B Answer: C A 4-year-old girl presented to the clinic with history of fever for last 3 days associated with sore throat and decrease oral intake. She also has difficulty in swallowing solid food. Her vaccination is up-to-date. On examination, she has palpable cervical lymph node that is about 2 cm in size, tender and fluctuates Which of the following is the most likely causative organism? A. Pneumococcus B. Streptococcus pyogenes C. Staphylococcus epidermidis D. Haemophilus influenzae type B Answer: B A 51-year-old woman presented to the hospital with 2-days history of malaise and headache. The headache became more intense and was associated with pain in her neck. Her husband reported that she had also fever. She was previously well with no significant medical history. On examination, she looked unwell confused, febrile and with positive Kernig's sign. CT scan brain was normal. Lumbar puncture done (see lab results). Test Result Normal Values Colour Turbid colourless Celis 200 0-3 /yL Total protein (Women) 0.9 0.15-0.45 g/L Glucose 1.6 2.50-3.89 mmol Which of the folowing is the most ikely causative organism? A. Escherichia coli B. Listeria monocytogenes C. Streptococcus pneumoniae D. Staphylococcus pyogenes Answer: C A 55-year-old butcher accidentally cut himself at work. Later that night, he noticed some red lines radiating from the wound. Which of the following is the most likely cause? A. Brucella B. Klebsiella C. Pseudomonas D. Streptococcus pyogenes Answer: D A 62-year-old man presented with 2-weeks history of tiredness, dyspnea and 5-days history of fever. No previous surgical history. Cardiac exam shows pan-systolic murmur at the apex. Hands exam shows splinter hemorrhage on nails Temperature 38.8 °C Which of the following is the most likely causative organism? A. Staphylococcus epidermidis B. Enterococcus species C. Kiebsiella pneumoniae D. Streptococcus species Answer: D Case about post streptococcal glumeronephritis what is the responsible organism: A) Streptococcus pyogen B) Staphylococcus aureus Answer: A A 20-year-old woman presents with fever and pain in her right leg. On examination, her right leg is swollen, tender with multiple red streaks, and palpable inguinal nodes. Which of the following is the most likely causative organism? A. Bacteroides B. Enterococcus C. Klebsiella pneumoniae D. Streptococcus pyogenes Answer: D Patient presents with sandpaper rash followed by pharyngitis. What is the most likely diagnosis? A. Parvovirus B. Staphylococcus aureus C. Streptococcus pyogens D. Herpes simples Answer: C = GAS Characteristic of scarlet fever Unbooked female came to the ED with labor, after investigation she has 100,000 colony bacteria of streptococcus and she has asthma with using salbutamol, what do you wanna give her now and after deliver? (A) Ampicillin (B) Oxytocin Answer: A - If GBS bacteriuria at any colony count is detected during pregnancy, the woman is at increased risk of GBS colonization during labor. A notation should be made in her medical record, she should be made aware of her GBS status, and antibiotic prophylaxis should be administered empirically during labor based on the risk factor of antepartum GBS bacteriuria - Intravenous penicillin remains the agent of choice for intrapartum prophylaxis, with intravenous ampicillin as an acceptable alternative. ———————— Q17- case of endometriosis (image) This recall: 28-year-old woman presented with a history of secondary infertility for 4 years (see image). Which of the following is the most likely diagnosis? (A) Hydrosalpinx (B) Ovarian cysts (C) Endometriosis (D) Intra-abdominal adhesions Answer: C A 33-year-old woman, nulliparous, complaining of cyclic pelvic pain and dyschezia underwent diagnostic laparoscopy (see image). Which of the following is the most likely diagnosis? (A) Pelvic TB (B) Adenomyosis (C) Endometriosis (D) Pelvic inflammatory disease Answer: C And this is the picture: Q18- pt c/o fever swelling knee joint aspiration done answer septic arthritis Different recalls: A 30-year-old patient presents with history of pain and swelling of the right knee (see lab results). Aspirate of knee Test Result (Normal Values) Colour Yellow (Clear) Appearance Opaque (Transparent) Viscosity Variable (High) WBC 15.2 (< 200 /ml) PMNs 80% (> Ballon dilatation or surgical myotomy If contraindicated >> we can do Botuitulm injection , dinitrate.. Q105- Agree, have ischemic heart disease (Atherosclerosis) diffuse abdominal pain dilated small bowel and thinned wall PH 7.23 Sever acidosis Expect high lactate as well.. Answer: D NOT pancreatitis See this recall: A 40-year-old man with a history of hypertriglyceridemia presents to Emergency Room with 4- hour of sever epigastric pain, nausea, and vomiting. The pain was steady and radiate to the back. The patient was in pain and agitated (see lab results and report). Blood pressure 100/70 mmHg Heart rate 110 /min Respiratory rate 23 /min Temperature 38.3 °C Oxygen saturation 94 % Test Result Normal Values RBC 5 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 12 130-170 g/L (Male) 120-160 g/L (Female) HCT 39 0.42-0.52 (Male) 0.37-0.48 (Female) Platelets count 344 150-400 x 109/L WBC 16 4.5-10.5 x 109/L Alanine aminotransferase 97 5-40 IU/L Aspartate aminotransferase 87 12-40 IU/L Amylase 150 24-151 IU/L Lactate dehydrogenase 169 60-160 IU/L Lipase 30 0-160 IU/L Plain Abdominal X-ray: Showed an air-filled intestinal loop at left upper quadrant. Which of the following is the most likely diagnosis? A. Acute pancreatitis B. Bowel perforation C. Mesentric ischemia D. Diverticular disease Answer: A Q106: Agree Another recall with the same answer Dx : PTC and hematesis UGI Bleed. = Hemobilia (Bleeding in Biliary tract) Nest Step: Angiography to confirm and treat A 73-year-old woman underwent percutaneous trans-hepatic cholangiography for treatment of obstructive jaundice. 24 hours after the procedure, she started to have upper gastrointestinal bleeding (see lab results). Blood pressure 105/62 mmHg Heart rate 89 /min Respiratory rate 22 /min Oxygen saturaton 94 % Test Result Normal Values Hb 103 130-170 g/L (Male) 120-160 g/l (Female) WBC 7.8 4.5-10.5 x 109/L Which of the following is the most appropriate next step in the management plan? A. CT scan B. Endoscopy C. Ultrasound D. Angiography Answer: D Q107: Agree, SALT If hyponatremic pt ( Fluid restriction If Ascites of HF > Fluid restriction Q108- A 37-year-old man with type 1 diabetes mellitus presents to the office with history of prolonged hypoglycemia during intense exercise, despite eating a meal prior to the activity. He is using insulin glargine and insulin aspart with meals (see lab result). Test Result Normal Value HbA1C 7.0 4.7-5.6 % Which of the following is the most appropriate management of this patient's hypoglycemia on the days that he exercises? A. Decrease meal-time insulin aspart dose prior to exercise, continue insulin glargine dose B. Increase meal-time protein prior to exercise, continue current insulin doses C. Switch insulin aspart to a sliding-scale regimen, continue insulin glargine dose D. Discontinue insulin glargine, continue insulin aspart dose Answer: A Hypoglycemia related to exercise >> 1. Carbs b4 exercise 2. Decrease meal time insulin option A We don’t change glargine** UNLESS they @: fasting hypoglycemia >> (decrease the dose of insulin glargin ) or hyperglycemia >> (increase the dose of insulin glargin) If hyperglycemia related to meals or specific time >> change if rapid acting insulin Aspart If the 2 abnormal ? Change the 2 Q109: Agree if the size 2cm >> FNA Q110: Agree ARDS > diffuse bilateral infiltration CD4 count needed M.c Pneumocystis If CD4 > 200 >> Streptococcus pneumonia Q111: Agree full recall: A 38-year-old patient developed a painful swelling in the right lower quadrant of his abdomen after moving a heavy object. Examination confirmed a localized tender swelling in the right lower abdominal quadrant with negative cough impulse; it persisted even with contraction of abdominal muscles. Which of the following is the most likely diagnosis? A. Ventral hernia B. Appendicular mass C- Extraperitoneal lipoma D. Rectus sheath hematoma Answer: D Q112: A 21-year-old man with a recurrent history of wheezing and exertional shortness of breath when participating in exercises presents to the Emergency Room with increasing shortness of breath after an aerobic class. Examination reveals that he is having obvious difficulty in breathing with diffuse bilateral wheezes. Which of the following is the most effective treatment to be started in the emergency? (A) Intravenous corticosteroid (B) Inhaled salbutamol (C) Inhaled salmeterol (D) Inhaled fluticasone Answer: B Q113: A 32-year-old woman presents to the clinic with a 3-month history of lower back pain associated with morning stiffness lasting almost 1 hour, as well as joint pain affecting both knees and ankles bilaterally. She denied any history of skin rash or mucosal ulcerations. No history of fever. Clinical examination reveals limited lumbar spine movements and active arthritis at both knees bilaterally. She also has tenderness over the Achilles tendon (see lab results). Which of the following is the most likely diagnosis? (A) Reactive arthritis (B) Rheumatoid arthritis (C) Ankylosing spondylitis (D) Crystal deposition arthritis Answer: C Q114: A 50-year-old man with ischemic heart disease and diabetes presented to the emergency with severe pneumonia and was admitted to the intensive care unit (ICU). He was treated with a course of antibiotics. Three days after admission to ICU, he develops hypotension treated with hydration and inotropes. His liver function at the day of admission was normal, but the repeated one is abnormal (see lab results and report). Abdominal ultrasound: Unremarkable. Which of the following is the most likely diagnosis? (A) Ischemic hepatitis (B) ICU-related jaundice (C) Intravascular hemolysis (D) Acalculous cholecystitis Answer: A Hypotension Hx > increases ALT and AST Shocked liver Very common Q Q115: A 60-year-old man with hypertension presents to the Emergency Room with sudden onset of retrosternal chest pain, dyspnea, and palpitations for 2 hours. His past medical history is significant for a non-hemorrhagic stroke 2 months ago (see lab results and report). ECG: ST-segment elevation in leads II, III, and aVF. Which of the following is the most appropriate treatment? (A) Fibrinolytic therapy (B) Aspirin therapy (C) Unfractionated heparin (D) Percutaneous coronary intervention (PCI) Answer: D Q116: A 27-year-old G3 P2 AO L2 at 34 weeks of gestation with severe preeclampsia. Which of the following is the rationale behind giving antihypertensive medications? (A) Prevention of oligohydramnios (B) Reduce incidence of fetal demise (C) Reduce incidence of growth restriction (D) Decrease risk of maternal complications such as stroke Answer: D Q117: A 28-year-old Primigravida presented to the Antenatal Clinic for an Ultrasound scan. Ultrasound: Single viable fetus with significant lower levels of amniotic fluid (oligohydramnios). Which of the following is the most likely cause? (A) Chorioangioma (B) Duodenal atresia (C) Diabetes mellitus (D) Placental insufficiency Answer: D Q118- 0210. A 28-year-old Primigravida at 8 weeks of gestation is known to have chronic hypertension and presented to Antenatal Clinic. Which of the following antihypertensive medications is contraindicated? (A) Labetalol (B) Nifedipine (C) Lisinopril (D) Methyldopa Answer: C Q119- A 23-year-old G2 P1 at 40 weeks of gestation presented to the Emergency Room complaining of painful uterine contractions. Vaginal examination revealed cervical dilatation of 3 cm and 60% effacement. Upon admission to the Labor Room, she had a gush of clear fluid. Which of the following is the most likely diagnosis? (A) Preterm labor (B) Premature rupture of membranes (C) Spontaneous rupture of membranes (D) Preterm premature rupture of membranes Answer: C Q120- A 22-year-old PG at 30 weeks of gestation presented to the Emergency Room complaining of lower abdominal pain. Vaginal examination revealed cervical dilatation of 2 cm with 50% effacement. She was admitted to the Labor and Delivery Room. The consultant on duty decided to start her on oxytocin antagonist (atosiban) as a tocolytic. Which of the following is the rationale for using tocolytic therapy in this case? (A) Minimize the risk of infection (B) Prolong pregnancy until 37 weeks (C) Prevent preterm premature rupture of membranes (D) Delay labor to gain the maximum benefit from steroids Answer: D Q121- A 17-year-old primigravida presents to the Emergency Department complaining of mild vaginal bleeding and abdominal cramping. Her last period was 9 weeks ago, and she has a positive home pregnancy test (see report). Transvaginal Ultrasonography: Intrauterine gestational sac with a crown-rump length corresponding to 9 weeks' gestation with a positive heartbeat. Which of the following would be the most appropriate next step? (A) Pelvic assessment (B) Admit the patient for observation (C) Ultrasound for placental localization (D) Administer intravenous progesterone therapy Answer: A Q122- A 23-year-old woman found to be hepatitis B surface antigen positive at 14 weeks of gestation. Which of the following is the recommendation for the infant after birth? (A) Observation (B) Hepatitis B vaccination (C) Hepatitis B immunoglobulin (D) Both hepatitis B vaccination and immunoglobulin Answer: D Q123- A 33-year-old woman presented in preterm labor at 27 weeks of gestation. Examination revealed the cervix is 6 cm dilated. Which of the following is the most appropriate drug to be given? (A) Atosiban (B) Steroids (C) Antibiotics (D) Magnesium sulfate Answer: B Q124: A 38-year-old woman presents with pelvic pressure and menorrhagia. She was diagnosed to have a large uterine anterior wall fibroid of 10 cm in size. Ultrasound shows a distorted endometrial lining secondary to the fibroid. The patient was offered hysterectomy but she declined. Which of the following is the most appropriate alternative management? (A) Observation (B) Oral progesterone therapy (C) Uterine artery embolization (D) Non-steroidal anti-inflammatory drugs Answer: C Q125- Full recall: A 70-year-old man presented to Emergency Department with generalized fatigability. 2 days ago, he had CT brain with contrast for possible transient ischemic attack. Physical examination is unremarkable (see lab results). Blood pressure 130/70 mmhg Heart rate 76 /min Test Result Normal Values Hb 170 130-170 gl (Male) 120-160 g/L (Female) Urea 30.4 2.75-7.4 mmol/L Creatinine 378 44-115 umol/L Which of the following is the most likely mechanism for the renal impairment? A. Pre-renal azotemia B. Acute tubular necrosis C. Acute interstitial nephritis D. Acute glomerular nephritis Answer: B Q126- Agree Q127- Another recall with HYPERnatremia: A 50 year old woman with major depression; complains of excessive urination and thirst for 2 months. She had a right mastectomy 1 year ago. 3 months before, lung metastases was diagnosed. The physical examination is normal except for the surgical scar(see lab results). Blood pressure 115/75 mmHg Heart rate 80/min Respiratory rate 16/min Temperature 37.1° C Test Result Normal Values Sodium 150 134-146 mmol/L Potassium 3.8 3.5-5.1 mmol/L Urea 6.7 2.75-7.4 mmol/L Creatinine 111 44-115 µmol/L Fasting blood sugar 6.8 3.5-6.5 mmol/L 24 Urine Analysis Test Result Normal Values Osmolality 110 280-910 mOsm/Kg H20 Which of the following is the most likely diagnosis? A. Diabetes insipidus B. Adipsic hypernatremia C. Psychogenic polydipsia Answer: A Q128- Full recall: A 32-year-old man is evaluated in the clinic because of an abnormal chest computerised tomography (CT) scan that revealed a small lung lesion (7 mm) without any other abnormalities. He is non-smoker and he is asymptomatic. Physical examination shows no lymphadenopathy and normal lung examinations (see lab results) Test Result Normal Values Hb 140 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 300 150-400 x 109/L WBC 8 4.5-10.5 x 109/L ESR 11 2-10 mm/h (Male) 3-15 mm/h (Female) Calcium 2.25 2.15-2.62 mmo/l Which of the following is the most appropriate procedure to do next? A. Repeat CT scan within 3-6 months B. Pulmonary function test C. Biopsy of this lesion D. PET scan Answer: A Q129 Q130- Agree Q131 Q132- Agree Q133- Q about which medication causes hypokalemia Spironolactone Ranitidine Asthma medication Answer: C Chick this recall as well: A 5-year-old child managed in Paediatrics Intensive Care Unite for diabetic ketoacidosis with insulin infusion and fluid correction (see lab result). Test Result Normal Values Sodium 138 134-146 mmol/L Potassium 2.8 3.5-5.1 mmol/L Chloride 101 97-108 mmol/L Bicarbonate 22 21-28 mmol/L Which of the following is the most likely explanation of low potassium? A. Vomiting B. Insulin therapy C. Diuretics therapy D. Bicarbonate therapy Answer: B Q134- Q about pediatric patient with meningitis Neisseria meningities Hemophilus Influenza this recall? 4 months old boy with picture of bacterial meningitis What’s most common pathogen? A. Moraxella catarrhalis. B. Streptococcus pneumonia. C. Streptococcus pyogen D-Neisseria Answer: B 7 days neonate present with lethargy , irritability , fever , signs of meningitis which organism is causative : A-listeria monocytogenes B-strept pneumonia C-staph aureus D-N-meningitidis Answer: A Q135- Q patient shot in thigh gsc 8/15 what to do first A- Intubation B- Tourniquet Answer: A GCS 8 > indication to intubate Q136- Couple of questions about dvt and pe, choosing between Heparin enoxaparin warfarin tpa let's read different recalls: A 59-year-old man is evaluated in the hospital for progressive shortness of breath and hypoxia 20 hours after undergoing surgery for colonic adenocarcinoma with known liver metastases (see report). CT angiography: Shows a right lower lobe pulmonary embolism. Which of the following is the most appropriate initial treatment? (A) Warfarin (B) Enoxaparin (C) Rivaroxaban (D) Fondaparinux Answer: B AKA low-molecular-weight heparin *Post-Surgical Setting * PE > Immediate Anticoagulation Need * Cancer pt A 22-year-old man presented to the Emergency Room with left leg swelling and pain that started 2 days ago and is getting worse. It involves the whole left leg. He also complains of chest tightness and shortness of breath. Examination reveals left lower limb pitting edema extending to the thigh (see report). ECG: Sinus tachycardia. Which of the following is the most appropriate management at this time? (A) Aspirin (B) Clopidogrel (C) Warfarin (D) Unfractionated heparin Answer: D *Signs of DVT + Possible PE Immediate Anticoagulation need (A) and (B) are antiplatelet (C) requires time to reach therapeutic levels and requires bridging with a fast-acting anticoagulant like heparin A 32-year-old woman presents with pain in her hands and knees on and off for 2 months. She had 3 abortions in the first trimester. Examination reveals a rash over the nose bridge, swelling and tenderness of the small joints of the hands, and a warm, tender, erythematous swelling of the right calf that is 2 cm larger in circumference than the left (see lab results). Which of the following is the most appropriate venous thromboembolism prophylaxis in her case? (A) Lifelong warfarin therapy (B) Long-term enoxaparin therapy (C) Long-term unfractionated heparin therapy (D) Lifelong non-vitamin K anticoagulant Answer: A A 35-year-old man, who was medically free, was admitted to the Intensive Care Unit with massive pulmonary embolism. Which of the following is the most appropriate initial treatment? (A) Warfarin (B) Thrombolysis (C) Low molecular heparin (D) Direct thrombin inhibitor (dabigatran) Answer: B A 25-year-old woman non-smoker presents to Emergency Department with sudden onset of severe chest pain and shortness of breath. Her past medical history is significant for caesarean section 4 days ago. Her examinations show a distressed woman with oxygen saturation 92% but otherwise unremarkable. Chest radiography is unremarkable. Which of the following is the most appropriate management? A. Start warfarin B. Start thrombolytic drugs C. Start low molecular heparin D. Insert inferior vena caval filter Answer: C A 62-year-old man known diabetes and hypertension presents with 4-hour history of sudden left leg pain, he had a history of left leg pain after walking 200 meters that make him stop and is relieved by rest. He is on oral hypoglycemic and statin but not compliant to medication and has been smoking for the last 40 years. Pulse examination on the left reveals present femoral absent popliteal and distal, his right leg revealed intact femoral and popliteal but diminished distal pulses (see lab result and report). Test Result Normal Values Random Glucose 7 3.9-5.5 mmol/L ECG: Normal. Which of the following is the most appropriate next step? A. Heparin B. Morphine C. CT angiogram D. Vascular Ultrasound Answer: A A 66-year-old man recently underwent an anterior resection of the rectum and is making a slow recovery. He complains that in the middle of the night he has pain in the left calf. On examination, he has a tender left calf, which is slightly swollen and red (see report). Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturation 90 % Ultrasound Doppler: Deep vein thrombosis in the left popliteal region extending up to the common femoral junction. Which of the following is the most appropriate management? A. Heparin B. Warfarin C. IVC filter D. Enoxaparin Answer: D A 73-year-old woman is brought to Emergency Room after a fall at home. She is diagnosed with left hip fracture (see lab results). Weigh 82 kg Test Result Normal Values Sodium 136 134-146 mmol/L Potassium 4.2 3.5-5.1 mmol/L Creatinine 68 44-115 pmol/L What is the best order by the admitting orthopedic surgeon to prevent deep vein thrombosis? A. Aspirin 81 mg po daily B. Enoxparin 40 mg SC daily C. Fondaparinux 10 mg SC daily D. Heparin Sulfate 10,000 units IV BID Answer: B ———————————- February 5 Q137- Endometrial canser early menopause or dm or late menarche Full recall: A 40-year-old woman is complaining of abnormal uterine bleeding. She is known diabetic on oral hypoglycemic agent for 5 years and her menarche at the age of 13. The last 3 cycles were heavy, however, denies any weight loss or palpitation. Which of the following would make the highest risk of endometrial cancer? A. Late menarche B. Early menopause C. Diabetes mellius D. Progesterone secreting tumor Answer: C Q138- Extopic pregnancy 1000 1200 800 mx Full recall:.A 30-year-old woman at 6 weeks gestation is receiving methotrexate treatment for an ectopic pregnancy. The first dose of methotrexate 50 mg/m² IM was administered one week ago. The human chorionic gonadotropin (hCG) levels on days 1, 4, and 7 were as follows: Day 1: 1000 mIU/mL Day 4: 1200 mIU/mL Day 7: 800 mIU/mL Which of the following is the most appropriate next step in management? (A) Repeat beta-hCG in 1 week (B) Perform immediate surgical intervention (C) Administer a second dose of methotrexate (D) Admit for multiple methotrexate regimen Answer: A Read these recalls as well:.A 20-year-old woman at 6 weeks gestation is receiving methotrexate treatment for an ectopic pregnancy. The first dose of methotrexate 50 mg/m² IM was administered one week ago. The human chorionic gonadotropin (hCG) levels on days 1, 4, and 7 were as follows: Day 1: 1000 mIU/mL Day 4: 1200 mIU/mL Day 7: 1100 mIU/mL Which of the following is the most appropriate next step in management? (A) Repeat beta-hCG in 1 week (B) Perform immediate surgical intervention (C) Admit for multiple methotrexate regimen (D) Administer a second dose of methotrexate Answer: D.A 30-year-old woman at 6 weeks gestation is receiving methotrexate treatment for an ectopic pregnancy. The first dose of methotrexate 50 mg/m² IM was administered one week ago. The human chorionic gonadotropin (hCG) levels on days 1, 4, and 7 were as follows: Day 1: 1000 mIU/mL Day 4: 1200 mIU/mL Day 7: 2100 mIU/mL Which of the following is the most appropriate next step in management? (A) Repeat beta-hCG in 1 week (B) Perform immediate surgical intervention (C) Administer a second dose of methotrexate (D) Admit for multiple methotrexate regimen Answer: B.A healthy 20-year-old woman at 6 weeks' gestation with a diagnosis of ectopic pregnancy has received a first dose of methotrexate 50 mg/m² IM 14 days ago. The human chorionic gonadotropin (hCG) levels were as follows: Day 1: 1000 mIU/mL Day 4: 1200 mIU/mL Day 7: 800 mIU/mL Day 14: 500 mIU/mL Which of the following is the most appropriate next step in management? (A) Cease follow-up (B) Repeat beta-hCG in 1 week (C) Immediate surgical intervention (D) Administer a second dose of methotrexate Answer: B.The first dose of methotrexate 50 mg/m² was administered intramuscularly 14 days ago to a healthy 20-year-old woman at 6 weeks gestation with a diagnosis of ectopic pregnancy. The human chorionic gonadotropin (hCG) levels were as follows: Day 1: 1000 mIU/mL Day 4: 1200 mIU/mL Day 7: 1500 mIU/mL Day 14: 2210 mIU/mL Which of the following is the most appropriate next step? (A) Administer a second dose of methotrexate (B) Perform immediate surgical intervention (C) Perform a transvaginal ultrasound assessment (D) Administer a multiple methotrexate dose regimen Answer: C After methotrexate, the hCG levels are expected to decline by at least 15% between days 4 and 7 if the treatment is effective Here the hCG levels are increasing instead of decreasing >> ectopic pregnancy not responded to methotrexate Before deciding the next intervention like second methotrexate dose or surgery confirm the location and size of the ectopic pregnancy and check for any signs of rupture soo do >> transvaginal ultrasound.A 26-year-old woman was treated with methotrexate for an ectopic pregnancy. Her BhCG results are as follows: Baseline test was 3000 miu/ml on the day of the injection Day 4: BhCG was 3100 miu/ml Day 7: BhCG was 2900 miu/ml Which of the following is the most appropriate next step in management? (A) Immediate laparotomy (B) Reassure and continue monitoring (C) Administer a multiple dose regimen of methotrexate (D) Counsel for the possibility of administering a second methotrexate dose Answer: D.A 26-year-old woman was treated with methotrexate 8 days ago for ectopic pregnancy and presents to the Emergency Room with mild abdominal pain and vaginal spotting. Examination revealed a soft and non-tender abdomen. Her BhCG results show a drop from 1200 miu/ml on Day 4 to 500 miu/ml on Day 7. Which of the following is the most appropriate next step in management? (A) MRI of the pelvis (B) Immediate laparoscopy (C) Reassure and follow up (D) Administer a second methotrexate dose Answer: C Q139- Osteoarthritis pic See Q3 Q140- Endometriosis pic See Q17 Q141- Chronic heb b case Read these recalls: A 30-year-old asymptomatic woman presents to the clinic as pre-employment screening. Her examinations are unremarkable. Her laboratory tests revealed, positive HbsAg, anti-HBc (IlgG) and ant-HBe but negative anti-HBs and HBeAg Which of the following statements is the most accurate? A. She has acute hepatitis B B. She has chronic hepatitis B C. She has received hepatitis B vaccine D. She has been exposed to hepatitis B but now in recovery period Answer: B A 23-year-old woman was informed that her husband has chronic hepatitis B infection. She was worried that he had transmitted the virus to her. She is currently asymptomatic apart from fatigue. What is the first evidence of acute infection in her case? A. HBeAg B. HBsAg C. Anti-HB D. Anti-HBs Answer: B A 34-year-old pregnant woman, known case of chronic hepatitis B, comes to the clinic for counselling regarding the risk of hepatitis B transmission to her baby (see lab results and report). Test Result Normal Values Alkaline phosphatase 198 39-117 IU/L Alanine aminotransferase 120 5-40 IU/L Aspartate aminotransferase 67 12-40 IU/L Hepatitis B viral load: 1 million copies/ml. Which one of the following the baby should receive to reduce the vertical transmission risk? A. Hepatitis b vaccine B. Hepatitis b immunoglobulin C. Hepatitis b vaccine and immunoglobulin D. Hepatitis b vaccine, immunoglobulin and entecavir Answer: C ‫ياخذ كلو‬ A 40-year-old woman is notced to be jaundiced (see lab results). Test Result Ant-HBs Negatve Anti-НВс Positive HBs antigen Positive IgM anti-HBc Negative What is the patient's hepatitis B status? A. Chronic hepatitis B B. Acute hepatitis B infection C. Previous hepatitis B infection D. Previous immunisation to hepatitis B Answer: A IgM -ve means that the IgG +ve means chronic hepB hahaha A 43-year-old man who is known to have chronic hepatitis B presents to the clinic for evaluation. He is asymptomatic with normal physical examination (see lab results and report). Test Result Normal Values RBC 5 4.7-6.1 x 1012/ (Male) 4.2-5.4 x 1012/L (Female) Hb 11.9 130-170 g/ (Male) 120-160 g/L (Female) Platelets count 145 150-400 x 109/L WBC 3.9 4.5-10.5 x 109/L Direct bilirubin 17 1.5-6.5 pmol/L Total bilirubin 21 3.5-16.5 pmol/L Aspartate aminotransferase 89 12-40 IU/L Alanine aminotransferase 61 5-40 IU/L Alkaline phosphatase 160 39-117 IU/L US Abdomen: Showed mild coarse liver echotexture. Which of the following is the most appropriate treatment option? A. Entecavir B. Observation C. Lamivudine D. Pegylated Interferon Answer: A Hepatitis B → Entecavir Hepatitis C → Ledipasvir/sofosbuvir A 45-year old with chronic hepatitis B is noted to develop increasing jaundice for the last 2 weeks associated with fatigue (see lab results). Test Result Normal Values Direct bilirubin 28.43 1.5-6.5 pmol/L Total bilirubin 39 3.5-16.5 pmol/L Aspartate aminotransferase 345 12-40 IU/L Alanine aminotransferase 523 5-40 IU/L Albumin 34 34-56 g/L Total Proteins 60 60-84 Cc Hepatitis B DNA level Low Which of the following is the most appropriate next step in management? A. Start vitamin E B. Perform liver biopsy C. Start alpha interferon D. Request anti-Delta antibody Answer: D A 43-year-old man is known to have hepatitis B virus infection presented with fever and confusion. On examination, he is disoriented, has asterixis and positive shifting dullness (see report) Ascetic Fluid analysis. Showed serum albumin ascitic fluid gradient (SAAG) of 1.2 and 350 neutrophils. Culture is bending. Which of the following is the best management? A. IV diuretics and metronidazole B. Lactulose enema and IV ceftriaxone C. Oral Lactulose and sedation with diazepam D. High volume ascetic fluid aspiration and propranolol Answer: B ————————— Q142- Hepatitis c recurrent acites Idk check these recalls: A 62-year-old patient known case of chronic hepatitis C presented with abdominal pain and swelling. Examination showed ascites, abdominal tenderness and peripheral edema. Diagnostic ascitic tap done and revealed a neutrophil count of 400/mm (> treatment of choice to correct elevated INR and coagulopathy rapidly ————————————— Q143- Cervical incompetence case Check these recalls: This one come in Dec. : A patient is seen at 8 weeks' gestation in an Antenatal Clinic with a diagnosis of cervical incompetence. Which of the following is the most appropriate management? A. Insertion cervical suture the same week B. Confirm the diagnosis by Hegar dilator C. Insert cervical suture at 14 - 16 weeks D. Begin beta mimetic drugs Answer: C Others: A 23-year-old woman presents at 18 weeks of gestation with a sudden unexpected rupture of membranes followed by painless expulsion of products of conception. Which of the following is the most likely diagnosis? (A) Bicornuate uterus (B) Submucous fibroid (C) Intrauterine adhesions (D) Cervical incompetence Answer: D A 28-year-old woman G3 P0020 at 5 weeks' gestation presents with vaginal bleeding associated with some blood clots that has started 3 hours ago. She had been diagnosed with cervical incompetence in her 2 prior second-trimester abortions. A history of dilatation and curettage in her last abortion declared. On examination; the cervical os is open and no on-going bleeding. Which of the following is the most likely cause of her current diagnosis of vaginal bleeding? A. Luteal phase defect B. Asherman's syndrome C. Cervical incompetence D. Chromosomal abnormality Answer: D A 29-year-old primigravida presented at 22 weeks of gestation with mild lower abdominal pain. Abdominal examination reveals that the uterus is corresponding to the gestational age with positive fetal heart. Vaginal examination reveals a short soft cervix, which ls 1.5 cm dilated with herniation of fetal membranes. Which of the following is the most likely diagnosis? A. Septic abortion B. Threatened abortion C. Incomplete abortion D. Cervical incompetence Answer: D ————————————— Q144- Pregnant came to the ER today with moderate bleeding , what is the next step? A. Transfer to US B. Insert 2 large IV cannula C. Emergency delivery D. Pelvic examination Most likely this? 30-year-old 33 weeks' pregnant woman presented to the Emergency Room with lower abdominal pain and vaginal bleeding. Which of the following is the most appropriate next management step? (A) Caesarean section (B) Vaginal examination (C) Send patient for ultrasound (D) Insert 2 large gauge IV lines Answer: D Different Recalls: A 17-year-old primigravida presents to the Emergency Department complaining of mild vaginal bleeding and abdominal cramping. Her last period was 9 weeks ago, and she has a positive home pregnancy test (see report). Transvaginal Ultrasonography: Intrauterine gestational sac with a crown-rump length corresponding to 9 weeks' gestation with a positive heartbeat. Which of the following would be the most appropriate next step? (A) Pelvic assessment (B) Admit the patient for observation (C) Ultrasound for placental localization (D) Administer intravenous progesterone therapy Answer: A A 17-year-old primigravida presents to the Emergency Department complaining of mild vaginal bleeding and abdominal cramping. She missed her period along with a positive home pregnancy test, and her LMP was 6 weeks ago. Pelvic examination reveals an open cervical os with mild vaginal bleeding through the cervix. Which of the following would be the most appropriate next step? (A) Pelvic MRI (B) Transvaginal ultrasound (C) Repeat the HCG in 24 hours (D) Reassure the patient and evaluate in 10 days Answer: B A 19-year-old primigravida presents to the Emergency Department complaining of abdominal cramps and mild vaginal bleeding. Her LMP was 6 weeks ago, with a positive home pregnancy test. Pelvic examination reveals a closed cervical os with abdominal pain on manipulation of the cervix. Which of the following is the most appropriate next step? (A) Complete blood count (B) Transvaginal assessment (C) Perform a CT scan of the abdomen and pelvis (D) Perform a deeper pelvic assessment to rule out masses Answer: B An 18-year-old woman presents to the Emergency Room with mild vaginal bleeding. Her last menstrual period was 9 weeks ago. Examination revealed the uterus is palpable, soft, and reaching to just above the symphysis pubis. Which of the following is the most appropriate next investigation? (A) Abdominal X-ray (B) MRI of the pelvis (C) Pelvic ultrasound (D) CT of the chest, abdomen, and pelvis Answer: C A 30-year-old pregnant un-booked patient is presenting to the Emergency Room with vaginal bleeding, the patient denies any abdominal pain and did not feel the fetal movements for the last few hours, and she was finally able to attend to the Emergency Room, as she had no form of transport to the hospital. Abdominal examination reveals a 34 cm fundal height. Blood pressure 110/70 mmHg Heart rate 101/min Temperature 36.6 °C Which of the following is the most appropriate next step in management? A. Perform an ultrasound B. Perform laboratory tests C. Admit the patient to the ward D. Perform a pelvic digital assessment Answer: A ————————————— Q145- Adminster chicken box vaccine A chid? Pregnant? Check these chickenpox recalls: Case about 6 years child contact with child who have chicken pox the child asymptomatic what will we do: A/chicken pox vaccine B/ observation for few days C/give IVIG D/ give acyclovir Answer: A A 14-year-old has received all immunizations except chickenpox; but he has never had chickenpox. What varicella vaccination plan should be used? A. No vaccination required B. 1 dose of varicella vaccine C. 2 doses given 4 weeks apart D. 3 doses at 0, 1 and 6 months Answer: C A 28-year-old primigravida 8 weeks gestation woman attended her first antenatal appointment. During the history assessment, she reports that she never had chickenpox. A serum blood titer is drawn and is negative for antibodies. Which of the following is the next best step in management? A. Avoid exposure B. Varicella vaccination C. Prophylactic acyclovir D. Zoster immunoglobulin Answer: A ————————————— Q146- Patient with long term history of DM type 1 in 12 weeks of gestation. HbA1C 12. Which of the following complication is most likely to happen? A. Pre-eclampsia B. Polyhydramnios C. Congenital malformation D.IUGR Full recall: A 32-year-old G2 Pi AO at 12 weeks of gestation. She is a known case of IDDM for 12 years and attended the Antenatal Clinic. Which of the following will most likely increase markedly in this patient? (A) Preeclampsia (B) Polyhydramnios (C) Postpartum hemorrhage (D) Congenital malformations Answer: D Another recall am not sure about: Patient with long term history of DM type 1 in 12 weeks of gestation. HbA1C 12. Which of the following complication is most likely to happen? A. Pre-eclampsia B. Polyhydramnios C. Oligohydramnios D. IUGR Answer: A ————————————— Q147- Oral calcitirol for ckd pt Full recall: A 65-year-old woman with long-standing chronic renal failure presents with aches and pains for 1 month. Physical examination is unremarkable apart from general pallor (see lab results). Which of the following is the most appropriate next step in management? (A) Oral calcitriol (B) Oral vitamin D3 (C) Oral vitamin D2 (D) Calcitonin nasal spray Answer: A A 45-year-old woman known to have end-stage renal disease secondary to type 1 diabetes mellitus came to the clinic for a routine follow-up. She had no complaints but was found to have abnormal blood results (see lab results). Which of the following is the most appropriate management? (A) Sevelamer (B) Calcitriol (C) Cinacalcet (D) 25-hydroxy vitamin D Answer: B Calcitriol (active form of vitamin D) is used to manage secondary hyperparathyroidism in ESRD blablabla ————————————— Q148- PID case brown discharge with iud device Full recall: A 23-year-old woman who just recently had an intrauterine device fitted, complaining of watery brown vaginal discharge and abdominal pain. Which of the following is the most likely diagnosis? A. Uterine rupture B. Bacterial vaginosis C. Twisted ovarian mass D. Pelvic inflammatory disease Answer: D Q150- Look a like error ;) Q151- Henoch schenolin purpura case See Q5 Q152- Svt ecg A 45-year-old man presented to the Emergency Room with palpitations. Initially, he was conscious and oriented. His vital signs were as shown. After some time, he became less responsive, and his blood pressure dropped to 80/45 mmHg (see report). ECG: Supraventricular tachycardia (SVT). Which of the following is the most appropriate immediate action? (A) Pacemaker (B) Cardioversion (C) Propranolol (D) Radiofrequency ablation Answer: B SVT Stable > Carotid massage Unstable > Electrical cardioversion Non effective >>IV adenosine. (2nd step) A 14-month-old presents to Primary Clinic with recurrent syncopal attack, associated with worsening heart failure manifestation and poor growth. On examination, he has crackles all over the chest with palpitation and abnormal cardiac rhythm (see report). ECG: Showed narrow complex tachycardia of 250-300 beats/min. Which of the following is the most lkely diagnosis? A. Atrial flutter B. Atrial fibrillation C. Ventricular tachycardia D. Supraventricular tachycardia Answer : D ————————————— Q153- Nullpara and her husband failed conception after 1 year of attempts, husband has never fathered a child, What’s the appropriate next step: - refer to reproductive specialist - basal body temperature chart - Hysterosalpingogram - Semen Analysis Full recall: A 27-year-old nulliparous is concerned about not having conceived after a year of regular, unprotected intercourse. The patient denied any major medical illnessess and takes no medications. The patient's spouse is reported to be healthy but has never fathered a child. What is the most appropriate initial step in evaluation after history and examination? A. Referral to a reproductive specialist B. Basal body temperature charting C. Hysterosalpingogram D. Semen analysis Answer: A ‫عط الخبز خبازه او شي زي كذا‬ Q154‫علي‬ ّ ‫جاني سؤال واحد كان جديد‬ ‫ شخص طاح من مسافة واعطاني قيمتين وحدة‬arterial blood pressure I think ‫ونسيت الثانية‬ ‫ويسأل وش متوقع يكون الضغط في ال‬cerebral something ‫سوري على الباد ريكول‬ ‫الخيارات كانت‬ ٤٠ ٥٠ ٦٠ ٧٠ mmgh Full recall: Case of stroke with MAP = 65 and intra-cranial pressure = 15 Which of the folowing is the most likely cerebral perfusion pressure In mmHg? A. 40 B. 50 C. 60 D. 70 Answer: B CPP = MAP - ICP CPP = 65 - 15 = 50 cerebral perfusion pressure (CPP) is based on ICP if ICP increases cerebral blood flow will decreses which CauseS aItered LOC Q155- Angiography See Q106 Q156- TTN case Full recall: A term baby delivered by cesarean section, started to be tachypnic with nasal flaring and expiratory grunting. Chest X-ray showed fluid in the horizontal fissure. Blood pressure 60/35 mmHg Heart rate 140/min Respiratory rate 65/min Temperature 36.6 °C Oxygen saturation 92 % Which of the following is the most likely diagnosis? A. Pneumonia B. Meconium aspiration C. Respiratory distress syndrome D. Transient tachypnea of the newborn Answer: D Q157- Bacterial vaginosis pic Pic? A.34-year-old woman presented with profuse milky vaginal discharge. Ofice diagnosis demonstrates fishy odor (positive Whiff test). A wet-mount preparation of the discharge (see image). Which of the following is the most likely diagnosis? A. Mycoplasmas B. Trichomoniasis C. Bacterial vaginosis D. Vulvovaginal candidiasis Answer: C However scinario is clear 23-year-old woman presented with vaginal discharge with an unpleasant smell. Examination confirmed a homogenous grayish-white vaginal discharge that has a high PH. A saline wet preparation examination of the discharge showed "clue cells" and with application of potassium hydroxide a fishy smell was generated. Which of the following is the most likely diagnosis? A. Phthirus pubis B. Pediculosis pubis C. Candida albicans D. Bacterial vaginosis Answer: D A 30-year-old woman is complaining of yellowish, fishy-smelling vaginal discharge and itching. Which of the following is the most likely diagnosis? (A) Candida vaginitis (B) Bacterial vaginosis (C) Vaginal gonorrhea (D) Vaginal trichomoniasis Answer: B A 26-years-old woman presents with vaginal discharge that is characterized by a thin milky appearance with a fish-like odor. On examination, the vaginal pH of 4.5 was found. Which of the following is the most likely diagnosis? A. Trichomonas vaginalis infection B. Group B strep colonization C. Bacterial vaginosis D. Gonorrhea Answer: C Q158- new born boy the not mentioned if he pre or full term, and they not mentioned if delivered CS or vaginally, they didn’t mention O2 saturation or any vitals, but the mother has DM, the baby has mild tachypnea (written like this) what is the diagnosis, and there is x ray picture not clear - RDS - TTN - congenital pulmonary hypertension ‫ ممكن اللي يعرف كيف نجاوب هذا السؤال هللا يعافيكم تكرر كثير و هو بالنص ناقص و الصوره ماهي واضحه مافيها‬fluid fissure ‫مثال‬ 🙏 I think they should @ if the newborn is pre or full term + if delivered by CS Here is the closet recall: A term baby delivered by cesarean section, started to be tachypnic with nasal flaring and expiratory grunting. Chest X-ray showed fluid in the horizontal fissure. Blood pressure 60/35 mmHg Heart rate 140/min Respiratory rate 65/min Temperature 36.6 °C Oxygen saturation 92 % Which of the following is the most likely diagnosis? A. Pneumonia B. Meconium aspiration C. Respiratory distress syndrome D. Transient tachypnea of the newborn Answer: D 30-minute-old, preterm at 27-week, delivered by emergency cesarean section for maternal reason have tachypnea, labored breathing and chest wall recession. Blood pressure 55135 mmHg Heart rate 135/min Respiratory rate 65/min Temperature 36.2 °C Oxygen saturation 86 % Which of the following is the most likely diagnosis? A. Pneumothorax B. Apnea of prematurity C. Respiratory distress syndrome D. Transient tachypnea of newborn Answer: C Q159- near miss Warfarin was not stopped by patient despite of the clear instructions, the nurse in the OR noticed that the patient did not stop the drug as instructed and informed the surgeon, so the surgeon postponed the operation: A) Adverse event B) Medical negligence C) Near miss D) Principle of totality Answer: C Q160- look like error Q161- border line Full recall A 23-year-old woman is admitted to the Psychiatric Unit after causing superficially lacerations to her wrists. The reason is that she felt that her therapist has abandoned her. She has depressed mood that varies by the hour. On admission, she claimed that she has heard a voice speaking to her, although she currently denies it. She caused a disagreement between the psychiatric resident and the nursing staff, who have conflicting views of her behaviour in the unit. Which of the following personality disorders is the most likely diagnosis? A. Antisocial B. Borderline C. Obsessive D. Schizoid Answer: B Q162- compulsion Full recall A 56-year-old woman presents to the clinic with history of constant counting of floor tiles, cars, items on a dinner plate, and words in a conversation. She is upset by the counting but becomes anxious and agitated when she tries to stop herself from counting. Which of the following is the most likely diagnosis? A. Delusion B. Obsession C. Compulsion D. Hallucination Answer: C Action = Compultion If thinks = Obsession Q163- teach back This? Child diagnosed with atopic dermatitis referred to Education clinic, the educator taught the mother how to handle the child , the mother was confused, so the educationer asked her to tell him how to handle the baby. What is the eduction tool that was used in this scenario? A-call out. B-teach back. C-Assure model. Answer: B Teach back: Method to confirm that you have explained information clearly and the patients,family, orcaregiver have a clear understanding of what you have told them. Q164- green tea ? I need green tea Wallah A cohort study was carried out comparing the association of green tea and black tea with diabetes. Over 10 years, the risk ratio of green tea (exposed) was 0.85 compared with black tea (unexposed). Which of the following is the correct interpretation? A) Green tea drinkers have a lower risk of DM B) Black tea drinkers have a higher of DM C) Getting DM Amongst both groups is not related D) The results happened by chance Answer: A Q165- physical abuse from her husband : inform authority Full recall: A 21-year-old primigravida at 34 weeks gestation was subjected to domestic violence by her husband, she was punched on the face, pushed in her abdomen and hit the floor. Fetal heart tracing is reassuring. No uterine contractions are present, and there is no vaginal bleeding. Ultrasound shown an intact placenta Blood pressure 110/70 mmHg Heart rate 76 Imin Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturation 95 % Which of the following is the most appropriate next step? A. Admit for observation and call the social worker B. Confirm what has happened with her husband C. Discharge and advice for bed rest D. Immediate cesarean section Answer: A A female patient presented to the doctor's office with signs of abuse. She told you the abuse was from her husband and told you not to tell her husband. What should you do? A) Threaten the husband with a police report B) Inform the police C) Respect the patient’s wishes D) Consult the ethics committee Answer: B Q166- tubal ligation consent : consent from her and her husband tubal ligation consent: A) take consent from BOTH wife and husband B) take from wife and tell her to inform husband Answer: A A multiparous patient who had delivered 6 babies previously all of which through CS now wants to deliver her 7th baby by CS. The doctors recommended tube ligation to prevent serious complications with future pregnancies. What is the best action? A) Take consent from her or her representative B) Take consent from her husband C) Take consent from her and tell her to inform her husband D) Consult ethics committee Answer: C Q167- falsification Full recall: A physician was working on a research paper. Before publishing the paper, he made some changes to some of the data and omitted other parts of his results. What is this action referred to? A) Falsification B) Fabrication C) Plagiarism D) Near miss Answer: A Q168- computarized drug prescription system Full recall: Patient coming from an endemic area for malaria. Later on, he was admitted to the hospital with Heart failure. Doctor did not ask the patient about travel or medication history. Thus, he ordered the nurse to give digoxin. Who is at fault? A) Computerized drug prescription system B) Nurse failed to write drug formularies C) Pharmacist who failed to check prescription D) Patient who did not bring his medicine pack/ report his medicines Answer: A Q169- the patient they don't know their role in the study Researchers want to conduct a new study to see the relation between smoking exposure with asthma, they will let a TV host call patients with asthma and ask if they were exposed to cigarette smoke as children and let them talk about their experience. Which of the following makes a covert study? A. Personal data will be anonymous B. You gonna share analytic results with them C. They don't know what medication they were given D. Patients will not know their role in the study Answer: D Q170- scenario of 5 year pediatric patient presented to clinic by his parent complaining of palpitaton on examination HR 265 other vitals normal.. What's the most important investigation to be done now: Chest x_ray ECG ECHO CBC Answer: ECG? Case of SVT Q171- scenario of pediatric Pt have migratory arthritis and rash which exaggerated after warm bath asking for diagnosis : Rheumatic fever this recall: 5 years old child came with arthritis and macular rash that increase after hot shower Most likely cause A-Systemic JIA B-Rhematic fever C-Brucellosis D-SLE Answer: B Q172- baby born at home : neonatal hemorrhagic disease 5-day-old boy at home to a 25 year-old primigravida at full term d bruising over the thigh. Examination is normal, except for a few bruises on the left thigh. Weight and height are at the 95 percentile for age (see lab results). Test Result Normal Values Prothrombin time 21 12-14 s APTT 66 30-40 s Platelet 280 150-450 Which of the following is the most likely diagnosis? A. Idiopathic thrombocytopenic purpura B. Neonatal hemorrhagic disease C. Deficiency of factor X D. Hemophilia Answer: B AKA Vit K deficiency Not Hemophilia bec. The Q (SHE) *delivered at home ‫االسئلة اللي تحت كلها حاطين سيناريو و طالبين ال‬diagnosis Q173- wisko aldrish syndrome Full recall: A 7-year-old boy has had recurrent upper and lower respiratory tract bacterial infections since infancy. On examination, he has eczema and areas of ecchymoses on his skin. His brother and a paternal uncle are similarly affected (see lab results). Test Result Normal Values Hb 108 112-165 g/L WBC 7.6 4.5-10.5 x 109/L Platelets count 40 150-400 x 109/L Which of the following is the most likely diagnosis? A. Severe combined immunodeficiency B. Bruton agammaglobulinemia C. Wiskott-Aldrich syndrome D. DiGeorge syndrome Answer: C Triad: Epistaxis >> platelet >> TTP Repeated Infection Atopic dermatitis Q174- wilms tumor Full 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 mmHg. Physical examination shows a well-thriving kid with a paipable firm mass in the right flank (see lab results). Test Result Normal Values Color Clear clear or light yellow Appearance Clear clear pH 6.5 4.3-8 Specific gravity 10201001-1030 Protein trace Absent Glucose absent Absent Ketones absent Absent Urobilinogen absent No more than 6 mg/day Nitrite absent Absent Erythrocytes 40 0-2 per high power field Hemoglobin +3 Absent Which of the following is the most likely diagnosis? A. Leukemia B. Lymphoma C. Wilms tumour D. Neuroblastoma Answer: C Q175- rubella Rubella recalls: A 6-year-old child presents with a low-grade fever, malaise, conjunctivitis, coryza, and a cough. Recently, a rash of discrete pink macules began on the face and extends to the hands and feet. Which of the following is the most likely diagnosis? A. Gonococcal bacteremia B. Toxic shock syndrome C. Reiter's syndrome D. Rubella Answer: D A 6-year-old child presents with malaise, fever, cough, nasal discharge, and conjunctivitis. Several days later the patient develops a maculopapular rash starting on the face and rapidly spreading to the rest of the body. Which of the following viruses is most likely the cause? A. Epstein-barr B. Coxsackie C. Vaccinia D. Rubella Answer: D During normal newbom exam, an absent red reflex in the eye and cardiac mummer are discovered. After interviewing the mother, she gave a history of viral infection during the first trimester. Which of the following infection can cause this? A. Rubella B. Syphilis C. Toxoplasmosis D. Cytomegalovirus Answer: A Baby with white eye reflex (Leukocoria) and murmur and blueberry rash A. Rubella B.CMV C. Toxoplasmosis D-Measles Answer: A Child came with maculopapular rash and rash disappeared after 3 days , large occipital lymph node A-Mumps B-Measles C-Kawasaki D-Rubella Answer: D read this and forget it : Measles (rubeola); 3 C's 1. cough, 2. coryza, 3. conjunctivitis, rash behind ear and Koplik’s spot (small, white spots that occur on the inside of the cheeks) Vs. Rubella; 3-day disease, rash start from face and spread downward, enlarged lump nodes: (retroauricular, cervical and post occipital ) Vs. Roseola; Fever then rash Q176- Congenital hypothyroidism A 2-Week-old boy is brought to the Paediatrics Clinic for a routine exam. The child was born at 41 weeks' gestation and has been exclusively breastfed. Physical examination continue large fontanels and an umbilical hernia. The muscle tone is reduced. The skin feels cool and dry and there is generalized jaundice. The infants tongue appeared large for his mouth. Which of the following disorders is most likely to be found? A. Congenital adrenal hyperplasia B. Congenital hypothyroidism C. Biotinidase deficiency D. Galactosemia Answer: B Q177- gingivostomatitis duo to herpes simplex A 2-year-old child presents to the clinic with 3-day history of vesicular lesions on the lips, gums and anterior surface of the tongue and hard palate. On examination, child looks dehydrated with dry mucus membrane the lesions look extensive, painful with mild bleeding. According to the mother, she is not eating or drinking well because of the pain. Which of the following is the most likely diagnosis? A. Impetigo B. Gingivostomatitis C. Herpetic whitlows D. Eczema herpeticum Answer: B Q178- infectious mononucluosis A 22-year-old woman previously healthy was admitted with 3-days history of fever, myalgia and pharyngitis. She gave history of 1-day macular rash over the trunk after she received amoxicillin from private clinic. On examination, she has generalised lymphadenopathy. Which of the following is the most likely diagnosis? A. Diphteria B. Hodgkin's disease C. Infectious mononucleosis D. Cytomegalovirus infection Answer: C EBV Reaction after Abx Q179- infectious adenovirus ? A 3-month-old boy presented to the Emergency Room with history paroxysmal episodes of cough associated with an inspiratory whoop and possessive emesis. It is associated with fever,conjunctival redness and diarrhea. His immunization is up to date. Which of the following is the most likely diagnosis? A. Pertussis B. Adenovirus infection C. Mycoplasma pneumonia D. Chlamydia trachomatis pneumonia Answer: B Q180- bronchiolitis management It is supportive management BUT also depend on the scenario: if: A 2-month-old infant presents to Emergency Room with bronchiolitis required non-invasive mechanical ventilation as a respiratory support. Which of the following is the most appropriate destination? A. Admission to paediatric word B. Admission to neonatal care unit C. Observation in emergency department D. Admission to paediatrics critical care unit Answer: D A 6-month-old infant with cough and fever diagnosed as bronchiolitis. On examination, she had mild distress with intercostal retraction and chest auscuitation reveals diffuse crackles Blood pressure 92/67 mmHg Hear rate 145 /min Respiratory rate 56 /min Temperature 36.6 °C Oxygen saturation 89 % Which of the following is the best management? A. Admit for oxygen and hydration therapy B. Send home with instruction when to come back C. Admit for antibiotics and oxygen administration D. Admit for bronchodilation and steroid management Answer: A Q181- scenario of pertussis (diagnosis wasn't mentioned) asking about best investigation to confirm the diagnosis Full recall: A 1-year-old girl presents to the Paediatrics Emergency Department at night with episodes of loud cough and refusal to feed. There is a history of upper airway infection with nasal congestion and sneezing over the last week. She has not recerved any routine immunizations. During the physical examination, there are repetitive violent fits of a hacking cough that-are followed by forceful, high-pitched inhalations and accompanied by facial cyanosis. Between attacks the girl appeared exhausted and apathetic. Heart rate 150/min Respiratory rate 60/min Temperature 36.6° C Oxygen saturation 92% on room air Which of the following diagnostic test would be most appropriate? A. Nasopharyngeal swabbing B. Sweat chloride test C. Chest radiography D. Serologic testing Answer: A Q182- pediatric Pt start sense of individuality developed stranger anxiety and now have separation anxiety.. Age in month ?? _6 _7 _10 _12 Most likely = Child started to develop sense of individuality. She recognize strangers and frightens when separated from her parents. A- 6 B- 7 C- 10 D- 12 Answer: C Stranger > 6 months Separation> 9 months ——————————— Q183- management of febrile neutropenia: extended spectrum penicillin Full recall: A 17-year-old man developed febrile neutropenia and shock post-chemotherapy for lymphoma. Which of the following is the most appropriate initial antibiotic? (A) Meropenem (B) Vancomycin (C) Cefuroxime (D) Caspofungin Answer: A A patient with acute leukemia recently underwent allogenic bone marrow transplantation. After 2 weeks, she was neutropenic and developed a fever and cough. She was diagnosed with invasive aspergillosis based on radiological and microbiological assessment. Which of the following is the most appropriate treatment? (A) Rifampicin (B) Valaciclovir (C) Tigecycline (D) Voriconazole Answer: D This pt at high risk for invasive fungal infections >> aspergillosis commonly affects immunocompromised pt esp. those with prolonged neutropeni 1st line >> Voriconazole Patient with febrile neutropenia on Ceftazidime did not improve for 72 hours What to add? A- Ceftriaxone B- Tazobactam C- Sulfamethoxazole D- Vancomycin Answer: D After chemotherapy therapy developed fever A.Fluoroquinolones B. Third generation cephalosporin C extended spectrum penicillin Answer: C Young adult admitted to isolation. Bone morrow biopsy showed AML M5. One day before start of chemotherapy he developed fever. Vitals normal. Temperature 38.9 C Hgb low platelet low wbc low PMN low What antibiotics would you start the patient on? A. Extended penclin spectrum B. granulocyte colony stimulating factor C. Fluoroquinolone D. 3rd generation cephalosporin Answer: A Q184- Long Case scenario pt have throbbing + dull pain A. myelinated nerve fibers A B. myelinated nerve fibers b C. Unmyelinated nerve fibers A D. Unmyelinated nerve fibers C Answer: D Q185- Primary trigeminal neuralgia ( q write sign of TN ) ? a. Multiple sclerosis b. Romatica c. Parkinson Answer: A Q186- Which blood test to evaluate acetylsalicylic acid? ( Aspirin) a. INR b. PT c. APTT d. BT Answer: D aspirin affects platelet function >> prolongs bleeding time BT but does not alter coagulation factors PT, APTT, or INR Q187- Stabbing headache in frontal and ant toothache 2-3 times day continue for 48 hrs a. Migraine b. Cluster Headache c. Tension Headache d. Sinusitis Answer: D going with sinusitis, frontal sinus involv. And maxillary sinus as well Q188- ‫ جاني هالسؤال بدون مايذكر‬stony dullness, ‫واحترت فيه صراحة‬ without stony dullness? Tension Pneumothorax? A young man was brought to the Emergency Department after he was hit in the chest while playing football. On examination. he was dyspnoeic and drowsy with GCS 11/ 15. Tracheal shifting to the left and raised JVP were noted. He has barely audible breath sounds on the rightside. Blood pressure 80/50 mmHg Heart rate 130 /min Respiratory rate 32/min Temperature 36.6 "C Oxygen saturation 90 % Which of the following is the most likely diagnosis? A. Flail segment B. Cardiac tamponade C. Pulmonary contusions D. Tension Pneumothorax Answer: D Q18936 old male at ER C/O Right abdominal Pain, O/E: fever, anorexia, weight loss, tenderness in RQ and Lower intercostal margines also patient is toxic Temp. 37.9 (I think but it was elevated) wbc high, bilirubin high US: cystic lesion without septates CT : homogenous (not sure) and "THICK WALL with Peripheral enhancement - What's most appropriate A. Ceftriaxone B. Metronidazole C. Surgical drainage D. Percutaneous drainage Answer: D Q1902y Pediatric patient presented in ER with low grade fever and (brassy cough!) not barky. What is the appropriate initial management ? A- exposure to cool humidified air B- prednisolone (0.4) C- dexamethasone (0.6) D- racemic epinephrine Answer: C Q191- Agree subcutaneous emphysema and pneumomediastinum and Dx by bronchoscopy Q192- Agree see this recall: 8 years old boy presented to the emergency department with fever, headache and sore throat for 2 days, in examination there was enlarged tonsils with exudate and pharyngeal petechiae. He had enlargement of anterior and posterior cervical and submandibular lymph nodes, *spleen is palpable 3cm below the costal margin*.Rapid strep test was negative BP: 100/65 T: 39 Others normal What's the most appropriate next step in management? A. spot test for infectious mononucleosis B. viral culture for adenovirus С. СВС D. influenza test Answer: A Q193- A 45-year-old woman presented with itching of the vulva. On careful inspection in a bright light, an elevate localised watery red lesion measuring 0.5 cm was seen. She is diagnosed is vulvar intraepithelial neoplasia with carcinoma in situ. Which of the following is the best management? A. Vulvectomy B. Laser therapy C. Chemoradiati D. Local superficial excision Answer: D Q194- Long scenario asking about management of trachea bronchial injury (diagnosis wasn't mentioned) Ok, Tracheobronchial Injury Similar to tension pneumothorax, but has signs of subcutaneous emphysema and pneumomediastinum. Diagnosed by a bronchoscopy (gold standard) Q195- A patient who had a vaginal delivery 3 months ago is complaining of fecal incontinence and passage vaginal flatus. These symptoms have started 1 week postpartu Which of the following is the most likely diagnosis? A. Hemorrhoids B. Puerperal sepsis C. Partal perineal tear D. Recto-vaginal fistu Answer: D Q196- Agree Q197- Agree Full recall: An 18-year-old woman presented to the Emergency Room with spasms of hands along with twitching around the mouth. Her general physical and systemic examination was unremarkable except for pallor, dental caries and small body built. She had prolonged QT interval on ECG (see lab results), Test Result Normal Values Calcium 1.6 2.15-2.62 mmoVL Phosphate, inorganic 0.7 0.82-1.51 mmo/L Parathyroid hormone (intact PTH levels) 4.5 1.1-5.3 pmol/L 25-Hydroxy Vitamin D3 (Women) 10 25-90 nmol/L Which of the following is the most appropriate initial treatment approach? A. Oral calcium B. Cholecalciferol C. Intravenous calcium D. Oral phosphate supplementation Answer: C Q198- Agree Q199- Agree Q200- Agree Q201- Agree, Wiskott aldrich syndrome triad; low platelets, Eczem and Recurrent URTI Q202- Full recall: 30-year-old woman is referred by a medical clinic with a complaint of vulvar pain. Examination reveals one ulcer on the left lower labia majora. The lesion has a ragged edge, necrotic base, and palpable adenopathy on the left inguinal region. Which of the following is the most likely diagnosis? (A) Syphilis (B) Chancroid (C) Herpes simplex (D) Bartholin cyst abscess Answer: B Q203- Agree, skin tethering Q204- Agree, Bethesda IV Q205-‫ وجالي بعد احس‬APGAR score Full recall‫احس هذا ال‬ A paediatrician is called to attend a caesarean section delivery at 38 week‘s gestation baby. On delivery, the neonate does not cry immediately, appears cyanotic and floppy. After drying, suctioning and stimulating the baby under the radiant warmer, the following evidence is recorded at 5 minutes (see table). Heart rate 120 beats per minute Breathing Irregular, gasping Reflex irritability Coughs, and cries with stimulation Activity Arms and legs flexed, little movement Appearance Rosy with blue extremities What is the most accurate Apgar score? А. 6 B. 7 C. 8 D. 9 Answer: C Q206- A 30-year-old woman in her first pregnancy had an ultrasound confirming Monochorionic Monoamniotic twins. What was the time interval between ovulation and cleavage? (A) 0-72 hours (B) 4-8 days (C) 9-12 days (D) >12 days Answer: C Q207- Full recall: A 39-year-old primigravida attended her routine prenatal visit at 39 weeks‘ gestation. She denied any headache, visual changes, nausea, vomiting or abdominal pain. Urinalysis was negative for protein (see lab results). Vital signs at this visit: Blood pressure 160/90 mmHg Heart rate 84 /min Vitals signs at all other visits: Blood pressure 120/70 mmHg Heart rate 68/min Test Result Normal Values HCT 0.34 0.37-0.48 Platelets count 165 150-400 x 109/L Alanine aminotransferase 12 5-40 IU/L Aspartate aminotransferase 22 12-40 IU/L Which of the following is the most likely diagnosis? A. Eclampsia B. Chronic hypertension C. Gestational hypertension D. Superimposed preeclampsia Answer: C other recall: A 24-year-old primigravida is found during antenatal care at 22 weeks gestation to have a blood pressure of 140/95 mmHg in 2 different measurements documented 4 hours apart. Her urine test for protein was negative and she was asymptomatic. Which of the following is the most likely diagnosis? A. Preeclampsia B. Chronic hypertension C. Gestational hypertension D. Transient hypertension of pregnancy Answer: C Q208- Agree Q209- Decreased ‫هذي الصورة كان السؤال وش الي متوقع يكون‬ Most likely this: A 12-month-old boy is brought to the clinic with a complaint of decreased appetite. The child was born at 36 weeks' gestation and has been fed with cow's milk formula since the age of 9 months. The body weight is 13.6 kg (> 97th percentile) and the length is 75 cm (50th percentile). Physical examination confirms palior of the skin and buccal mucous membranes. There is also a systolic heart murmur and a palpable spleen (see image and lab results). Test Result Normal Values Hb 90 112-165 g/L RBC 3.0 4.6-4.8 x 1012/L What additional laboratory finding is most likely to be significantly lower than the normal value? A. WBC B. MCV C. Platelets D. Reticulocyte count Answer: B Q210- ‫جاني نفس هذا السؤال لكن كانوا ضايفين سطر انه‬ When you aspirate mass : mucoid / mucus secretion A 14-year-old patient presented with a painless neck swelling. Examination confirmed a midline neck swelling below the hyoid bone that moves up and down with swallowing. Which of the following is the most likely diagnosis? A. Cystic hygroma B. Thyroglossal cyst C. Midline dermoid cyst D. Submental lymphadenopathy Answer: B February 6 Q211- ‫) هذا السؤال من ملف (برين لالثكس‬ ‫ المفترض الجواب‬А ‫وال شرايكم ؟‬ This is the scenario that I know: A 15-year-old boy is a suspected case of acute meningitis was rushed to the Emergency Room by his parents. The pediatrician decided to do a lumber puncture. Which of the following is the most appropriate next action? A. Take parent consent but not patent assent B. Take patient assent but not parent consent C. Take both patient assent and parent consent D. Do not take patient assent or parent consent because it is an emergency case Answer: C Q212- Patient after gi surgery developed toxic shock sydrome what is expected finding ‫الجواب االخترتو‬ Anaerboic celluar respiration ‫وال شي قريب ليه‬ A 30-year-old woman underwent an exploratory laparotomy for a perforated duodenal ulcer. Post-operatively she developed septic shock syndrome. Which of the following is the most common physiological response? A. Hypokaiaemia B. Respiratory acidosis C. Cellular anaerobic respiration D. Increase giomerular filtration rate Answer: C Q213- ‫جاني هذا بس دي كان كل واحد بخيار مختلف‬ ?? Q214- 40 ‫جاني هذا السؤال بالضبط بس العمر كان‬, and has history of smoking for 5 years So, 40 years old male with history of smoking 5 pack- year came to ER with retrosternal chest pain radiated to neck (or shoulder), on exam his blood pressure is 159/92 On ECGhasSTdepression in inferior leads Which of the following is the most *considerable * (not significant) risk factor for his condition? A- age B- smoking C- male gender D- hypertension Answer: A not known HTN excluded D, smoking is the most importan/significant not the most considerable so it excludes B. Age is the most powerful independent risk factor according to Davidson in CAD, especially that in other recalls the patient’s in his 50s. AR: I think the answer is B as long the patient is younger than 50y. Q215- Agree Q216- A 10-year-old boy is diagnosed with acute rheumatic fever with cardiac involvement. For how many years is rheumatic fever prophylaxis recommended for this child? A. 1 B. 5 C. 10 D. 15 Answer: B + An 18-year-old girl is recently diagnosed to have rheumatic fever with carditis. Echocardiogram showed mild mitral stenosis with mild regurgitation. To what age the rheumatic fever prophylaxis is recommended? A. 40 B. 28 C. 23 D. 21 Answer: A Q217- A 9-year-old boy who presents to the Emergency Department with fever, headache, sore throat, and vomiting. He recently arrived from Africa with his parents. On examination. he shows abnornal reflexes, stiff neck and difficulty in lifting his head and legs when he was lying flat on his back. His laboratory investigations show a clear CSF with lymphocytosis, normal glucose level, and normal protein level. No bacteria were seen. Which of the following is the most likely organism responsible for his illness? A. Poliovirus B. Coronavirus C. Cytomegalovirus D. Epstein-Barr virus Answer: A Q218- Answer: D Q219- Agree ‫‪Q220-‬‬ ‫‪Agree‬‬ ‫‪ searum ceritine‬جاني هذا السؤال بس ب ميدقارد الجواب ناقص ف ماعرف ايش الصح‪ ،‬بس اخر خيار كان ‪Q221-‬‬ ‫‪Answer: Serum creatinine‬‬ ‫‪Q222-‬‬ ‫‪Agree‬‬ ‫‪Q223-‬‬ Q224- A 22-year-old complains of a 2-day history of right sided chest pain and dyspnoea. It started during landing from a long flight. On examina7on, he is tall, breath sounds are absent on the right side and percussion note is resonant (see report). CXR: Right pneumothorax. Which of the following is the most appropriate ini>al management? A. Thoracentesis B. Tube thoracostomy C. Thoracoscopic blebectomy D. Conservative management Answer: B Q225- Q226- Q227- Q228- Q229- Q230- Q231- Q232- Q233- Q234- Fever, thrombocytopenia, hemolytic anemia and normal coagulation tests + scattered petechiae >> Thrombotic Thrombocytopenic Purpura (TTP) 1st line >> plasma exchange Q235- Agree Q236- PPROM at 31 week treated conservatively, she is in laber at 35 week Which of the following complications most common A. Sepsis B. Respiratory distress syndrome Bad recall we need full recall, however here are some recalls about RDS: A 27-year-old woman presented at full term at labor, she was having uncontrolled diabetes during this pregnancy. Which of the following neonatal complications will most likely increase? (A) Hyperglycemia (B) Low Hemoglobin (C) Low erythropoietin levels (D) Respiratory distress syndrome Answer: D A 23-year-old primigravida is admitted with threatened preterm labor at 30 weeks' gestation and has received antenatal corticosteroids. Which of the following is the rationale behind corticosteroid administration in this case? (A) VII nerve damage (B) Pneumothorax formation (C) Incidence of hypoglycemia (D) Respiratory distress syndrome Answer: D A 30-minute-old, preterm at 27-week, delivered by emergency cesarean section for maternal reason have tachypnea, labored breathing and chest wall recession. Blood pressure 55135 mmHg Heart rate 135/min Respiratory rate 65/min Temperature 36.2 °C Oxygen saturation 86 % Which of the following is the most likely diagnosis? A. Pneumothorax B. Apnea of prematurity C. Respiratory distress syndrome D. Transient tachypnea of newborn Answer: C Q237- 50 something female asthmatic and alcoholic presented with bone pain that prevents her from preforming activities BMI :31 What is one of the risk factors of osteoporosis that necessitate doing the screening test ? A. Obesity B. Alcoholism C. Hypercalcemia D. Short duration steroid use Answer: B Q238- Which of the following indicates compensated shock? A. Anuria B. Confusion C. Hypotension D. pale peripheries Answer: D Compensated shock; cold and paleperipheries Q239- 68y old admitted for seaver lower abdominal pain ass with distension on exam the abdomen hugely distended and tympanic digetal rectal ex empty rectum abd X ray show Y shape shadow surrond by huge colon. What is the most appropriate next step? Colonoscopy Double contrast ct Sigmoid Colonctomy with end colostomy Full recall: A 68-year-old man was admitted through the Emergency Department with a 24-hour history of sudden severe lower abdominal pain, associated with progressive abdominal distension and constipation. On examination, the abdomen was hugely distended, tympanic with tenderness over the left iliac fossa. Digital rectal examination confirmed an empty rectum (see lab result and report). Test Result Normal Value WBC 22 45-105 x 109/L Abdominal plain X-ray: Y-shaped shadow surrounded by a hugely distended colon arising from the pelvis. Which of the following is the most appropriate intervention? A. Fleet enema B. Colonoscopy C. CT with double contrast D. Sigmoid colectomy with end colostomy Answer: D Q240- Agree Q241- Child 5 months, nurse said he has developmental delay in milestones, what would you do to reassure the mother? A. Pincer grasp B. wave bye bye C. Reach things C. Sit without supp ✅ Full recall: A 5-month-old baby referred to the doctor from the Well-Baby Clinic. His mother is concerned because he could not pass the developmental screening tests done by the nurse. What is the best developmental test would help the doctor to reassure the mother? A. Waves goodbye B. Has pincer grasp C. Sits independently D. Reaches for objects Answer: D Q242- 19 year old presenting with increased erratic behavior. For the past 4 months he has believed that people on the television can hear his thoughts. He also claims to have supernatural powers and has acted on them. What's the most likely diagnosis? A) schizophrenia B) conversion syndrome C) manic episode of bipolar disorder D) cyclic depression Answer: A 🔥 Q243- New short case, Which of the following features is most suggestive of a lesion in the medulla? ? 1- Ophthalmoplegia 2- Abulia 3- Upper motor neuron facial weakness 4- Horner’s syndrome Answer: 4 🔥 Q244- New Old pt I think 60 years old man presented with Legs swelling and with puffiness of face for 1 week ago. pt noticed decrease urine and frothy urine. Which of the following is the most appropriate management ? 1- family hx is very important 2- hx of Diabetes Mellitus is important. 3- Need proper examination for Autosomal Kidney Disease 4- Kidney Biopsy usually showed Acute Tubular necrosis Answer: 2 Q245- A 4-month-old child who has had failure to thrive, chronic diarrhea, a variety of rashes, and recurrent serious bacterial, fungal, and viral infections ?? A. Bruton's agammaglobulinemia B. Severe combined immune deficiency C. Common variable immunodeficiency D. DiGeorge syndrome Answer: B Q246- Child presents with fever, vomiting and diarrhea on exam of chest there is reduced air entry to right side and murmur was heard , the child CVS and chest exams were previously normal (prior visits) what is the management of murmur? A. Urgent echo B. Reexamine after these symptoms subsides C. Refer to cardio pediatrician D. ECG Answer: B 🔥 Q247- New 60 years old man has hx of htn for 5 years. On medication ( Hydro chlorothiozide 2 g/day ) He complained from repetitive vomiting for 3 days and examination showed that his bp was 95/170 JVP is low pulse with 110 / min with posture Hypotension Others were normal which of the following is the best to correct the Hypotension ? A- IV Normal Saline B- Treat with DSW C- IV Albumin D- Fresh frozen plasma Answer: A Q248- Answer: C for me read this: 12-year-old complain of recurrent epigastric pain with occasional vomiting since 1 year stool analysis is positive blood occult test what is dx: A Abdominal migraine B Irritable bowel syndrome C Inflammatory bowel disease D - Gastritis with peptic ulcer Answer: D 🔴🔴 Q249- ‫موجود سؤال مشابه بميد قارد لكن مو نفس الخيارات‬ ‫جاء سؤال جديد ماسبق شفته‬ New Q: what vaccines should the newborn receive after delivery? A. BCG and HBV B. BCG alone C. HBV alone D. Irrelevant Answer: A Most likely the q about old guidelines Q250- ‫جاني هذا‬ give February 7 Q251- female patient came complaining of swelling of the dorsum of the hand with redness, she said she had knife prick prior to the swelling, what’s the diagnosis: A) cellulitis B) gas gangrene C) necrotizing fasciitis Full recall: A 40-year-old woman presented with progressive redness over the dorsum of the le\ hand associated with pain and fever. She gave a history of a knife prick at the aﬀected area 3 days ago. Temperature 37.9 °C Which of the following is the most likely diagnosis? A. Cellulites B. Carbuncle C. Gas gangrene D. Necro7zing fascii7s Answer: A Q252- Q253- Laryngomalacia scenario: inspiratory stridor, worse on feeding, better with lying prone. No failure to thrive Next best step? A- Reassurance B- Flexible bronchoscopy Answer: A ——————

SMLE Exam Practice Questions PDF - Feb. 2025

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