SMLE Ride Past Paper

SMLE Ride ~ By The Elites From Day 7 to 12 December Q181) A 48-year-old woman is evaluated for persistent fever and flank pain. She was admitted several days ago for treatment of pyelonephritis. Her fever is persistent after 5 days of starting an appropriate antibiotic...

SMLE Ride ~ By The Elites From Day 7 to 12 December Q181) A 48-year-old woman is evaluated for persistent fever and flank pain. She was admitted several days ago for treatment of pyelonephritis. Her fever is persistent after 5 days of starting an appropriate antibiotic. Examination reveals tenderness over the left loin area, otherwise unremarkable (see report). Urine culture: Positive for Escherichia coli susceptible to the antibiotic that was already started. Which of the following is the most appropriate management? A. Kidney ultrasound B. Change the antibiotic C. Repeat urine culture D. Continue observation Answer: A, GameBoy Q182) A 44-year-old man is evaluated for an 8-month history of decreased libido and severe erectile dysfunction, including absence of morning erections. He and his wife would like to conceive. His medical history is otherwise unremarkable, and he takes no medications. On physical examination, vital signs are normal with unremarkable clinical examination (see lab results and report). Test Result Normal Values Thyroid-Stimulating Hormone 2.5 0.4 - 5.0 pU/mL Normal Follicle-stimulating hormone 1.2 5-20 IU/L low (Follicular phase) 15-35 IU/L (Mid cycle peak) 5-15 IU/L (Luteal phase) 50-100 IU/L (Postmenopausal women) 5-20 IU/L (men) Testosterone 4.2 10.4-41.6 nmol/L (Male) low 0.7-2.8 nmol/L (Female) Luteinizing hormone 1.0 3-15 U/L (Male) 5-22 U/L (Follicular phase) 5-22 U/L (Luteal phase) 30-250 U/L (ovulatory phase) > 30 U/L (Postmenopausal) Prolactin 1500 high , < 652 pmol/L (Male) < 870 pmoVL (Female) MRI of the pituitary: Reveals a 0.8-cm anterior pituitary mass consistent with an adenoma Which of the following is the most appropriate treatment? A. Testosterone replacement therapy B. Clomiphene citrate https://t.me/SMLERide SMLE Ride ~ By The Elites C. Cabergoline D.Sildenafil Answer: C, MedGard #1 Q328 Q183) A 24-year-old pa7ent with history of epilepsy, is brought to the Emergency Room with complaints of left shoulder pain. The shoulder contour is flat and the arm is fixed in adduction and internal rotation. Which of the following is the most likely type of shoulder dislocation? A. Inferior B. Subglenoid anterior C. Subcoracoid anterior D. Subacromial posterior Answer: D, MedGard #2 Q665 Q184) A 2-week-old newborn is brought to the clinic. The mother reports that her baby passes a small amount of unformed stool a\er each feed. The child is on breastfeed since birth. Which of the following is the most appropriate management? A. Prescription of lactose free milk B. Oral rehydration solution C. Reassure the mother D. Infant formula milk Answer: C, MedGard #2 Q1127 Q185) A 5-week-old boy presents with persistent progressive projectile vomiting. Which of the following is the most appropriate next step in management? A. Antiemetics B. Normal saline C. Ringer lactate D. Potassium chloride Answer: B, MedGard #1 Q924 Q186) 30-year-old woman presented with intermenstrual vaginal bleeding for 5 days. Which of the following is the most appropriate investigation? A. CBC B. Beta hCG and US C. Beta hCG https://t.me/SMLERide SMLE Ride ~ By The Elites D. Ultrasound Answer: B *The same question is in GB Q355 however, answer B is (TSH not US and Beta hCG) if it comes like GB, I will choose Beta hCG only and if it came like this I will choose both. Q187) 34 year old, her baby born with Single umbilical artery, what is the risk factors? A- Age B- Parity C- Multiple pregnancy “NOT gestation” D- Thyroid *I’m Sure 100% from choices Answer: C, Nelson + UTD Q188) A 35-year-old woman with heartburn and regurgitation for 6 months is referred for evaluation of chronic GERD symptoms. The patent states that she notes burning in her chest primarily after meals and occasionally experiences episodes of chest pain. She denies change in weight or lifestyle. She often consumes dinner 2 hours before going to bed. Her heartburn occurs mainly during the night. Physical examination is normal except for a body mass index (BMI) of 28 kg/m2. A complete blood count and metabolic panel are normal. The patent has been taking omeprazole 20 mg daily. An upper endoscopic examination is performed, and the appearance of distal esophagitis. Which of the following is the best next step? A. Add antacid twice/day B. Ranitidine at bedtime C. Advise her to lose weight D. Refer her for Nilsson Fundoplication Answer: B, MedGard #1 Q290 Q189) Diabetic pt asking about traveler diarrhoea prophylaxis labs results showed high uric and high RFT what to do ? A-probiotics B-fluoroquinolones C- no prophylactic Answer: C, UTD Q190) A 55-year-old man with a long history of smoking presents to the Emergency Room with exertional shortness of breath and a daily productive cough of 3-4 tablespoons of yellow sputum https://t.me/SMLERide SMLE Ride ~ By The Elites that has worsened over the last 3 days. No history of fever, chest pain, or hemoptysis. Chest examination reveals decreased breath sounds and scattered rhonchi. Which of the following is the most appropriate first-line inhaling agent to be started in an emergency? A. Ipratropium bromide B. Beclomethasone C. Salmeterol D. Tiotropium Answer: A, GameBoy Q191) Which level of prevention we apply when detecting a pregnant woman infected with hepatitis B? A. Primordial B. Primary C. Secondary D. Tertiary Answer: C, MedGard #1 Q1611 Q192) A 12-year-old boy comes to the clinic with multiple painful swollen joints with reduced range of motion. Examination shows multiple non-tender subcutaneous nodules. Which of the following would most probably confirm the diagnosis? A. Elevated ESR B. Positive blood culture C. High C-reactive protein D. Elevated antistreptolysin O titer Answer: D, MedGard #2 Q1254 Q193) 77 year old woman with poorly controlled long standing type 2 diabetes and hypertension is complaining of dizziness when standing up rapidly. Current medications include aspirin, atenolol, insulin, metformin and multivitamins. Sitting: BP 140/85 mmHg Standing: BP 115/80 mmHg HR 95/min (unchanged on standing) RR 18/min T 36.6 C Which of the following is the most likely explanation? A. Hypoglycaemia https://t.me/SMLERide SMLE Ride ~ By The Elites B. Medication side effect C. Autonomic neuropathy D. Left ventricular dysfunction Answer: C, MedGard #2 Q10 Q194) Family of a patient gave you a gift of a home cooked meal and cheesecake and a medical brooche A- accept B- refuse C- accept but inform medical director D- pay for the meal Answer: A, SMLE BRAIN Q195) A 54-year-old man known to have diabetes and hypertension presented to Emergency Department with 9-days history of cough, headache, shortness of breath and fever. Cough was productive of white sputum, which has become yellowish lately. On chest examina;on, wheezing, and right side crepita;on (see lab results and reports). Temperature 38 °C Test Result Normal Values Re8culocyte 8 0.2-1.2 % WBC 12 4.5-10.5 x 109/L Cold agglu8nin 8tre: 1:256 Chest X-Ray: Bilateral shadowing both lungs with more density on the right middle lobe. Which of the following is the most likely diagnosis? A. Bronchial asthma exacerba;on B. Streptococcal pneumonia C. Atypical pneumonia D. Exacerba;on of heart failure Answer: C, MedGard1 Q196) 60 Y/O female, had large amount of Maroon-colored stool, she is pale and tachycardic, abdomen is lax and soft and non-tender, what is the most appropriate management? A-NGT B- Angiography C- Colonoscopy D- Barium enema https://t.me/SMLERide SMLE Ride ~ By The Elites Answer: B (Mesentric ischemia), October file Q197) I think they said patient hypotensive not sure. patient has fresh bright red rectal bleeding. He had 2 episodes of bleeding from unknown location. What is the most appropriate step? A- Endoscopy B- Colonoscopy Answer: B, UTD Q198) Patient was admitted post motorcycle accident. He has lower abdominal pain and suprapubic tenderness, vitals were given and all are within normal range. Q: what’s ur next step in the management: A. Perform FAST B.Start initial assessment and resuscitation. C. CT with contrast D. X ray Answer: B, Hamoud file Q199) 4 year old comes with 1 month history of non-bloody diarrhea, it only occur in day time and not night, the patient appears well and no failure to thrive A. Toddler's diarrhea B. Rota virus C. salmonella virus Answer: A, UTD Q200) Which of the following organisms is most common cause of early onset neonatal conjunctivitis?? A-Trichomoniasis B-Chlamydia C-E.coli D-Toxoplasmosis Answer: B, UTD Q201) Child able to put 3 cubes on top of each other, walks, and crawls up the stairs, points to objects he wants, jargons and understands commands. Draws lines with crayons. How old is he? It wasn’t draw or copy it was put line with crayons https://t.me/SMLERide SMLE Ride ~ By The Elites A.9 months B.12 months C.15 months D.24 months Answer: C, MedGard 2 Q1186 Q202) Rta female when you talk to her she moans O2 sat 65% no other details A. Tracheostomy B. Nasotracheal t C. Endotracheal t D. Laryngeal mask Answer: C, Quick Recall Q203) 46YO Female pt not pregnant. She is obese presents with irregular periods 6 months ago No thing else. Which of the following is the most appropriate initial management? A- Endometrial ablation B- Endometrial biopsy C- Oral contraceptives D- CT Answer: B, GB Q356 Q204) 57 Year Old female complaining of abnormal uterine bleeding she has an endometrial polyp, on US endometrial lining was 19mm, what will you offer to this patient at this stage? A. Open hysterectomy B. Laparoscopic hysterectomy C. Hysteroscopy and polypectomy Answer: C, MedGard 1 Q1501 Q205) Baby 20 days with fatigue and fever 38.2 what to do ? A-ask the mother to come if he refuse feeding B- admission for observation C- admission for septic screen and AB D - reassurance i think Answer: C, UTD https://t.me/SMLERide SMLE Ride ~ By The Elites Q206) Postpartum women came complaining of breast pain and difficulty breastfeeding on exam there is no mass or fluctuation. A. Give abx that covers staph aureus and US to rule out abscess B. Discontinue breast feeding C. Discharge with good analgesia and supportive bra Answer: A, better recall in GB Q374 Q207) A patient with thyroid enlargement. TSH low. T4 high. An US showed solid nodules measuring maybe 2*2. What is the next step? A-Thyroid scan B-Fine needle aspiration C- Ultrasound Answer: A, MedGard 2 Q327 Q208) Mother brought her child for routine check up. The doctor played with the child as he threw a ball and the child catch it and threw it back to the doctor, the child can draw his brother head HANDS, and Feet After that the child undress himself for examination as the doctor ask him, after examination was done and while the doctor was speaking to the mother the child was playing with cubes and putting them above each other(he said many not detect the No. of cubes ) the child also was able to draw straight line. What is the age of this child A- 2 B-3 C- 4 years D- 5 Answer: C, (undress himself), similar MedGard 2 Q1174 Q209) Roll overs , sit briefly , transfer objects from hand to hand A. 2m B. 5m C. 7m Answer: C, MedGard 2 Q1182 Q210) Post alcoholic pancreatitis after 5 weeks.. patient had early satiety and postprandial vomiting , what is the most appropriate? A. US https://t.me/SMLERide SMLE Ride ~ By The Elites B. Barium meal C. ERCP D. Endoscopy Answer: A, UTD Q211) A case highly suspicious of pyloric stenosis what is the diagnostic test ? A- X- ray B- Ultrasound C- Endoscopy Answer: B, MedGard2 Q884 Q212) Periumbilical mass tender not reducible what to do A..observation B..us C..ct Answer: None, Hamoud Q213) 60 year old Pt. Post ventral hernia Surgery with mesh 6 years ago, Pt come with abdominal distension. On Radiographic imaging: Cut off sign in the ileum with target sign and soft tissue mass. What is the Diagnosis? A-late-onset Crohn’s B-adhesions with mesh C-small bowel cancer Answer: C, MedGard1 Q858 Q214) 55-Year-Old female, presented with abnormal uterine bleeding, she had history of myomectomy, x2 D&C, upon examination abdomen bulky with no tenderness, no adnexal masses. US showed endometrial thickness of 20mm, what is the most likely diagnosis? A. Endometrial cancer B. Leiomyoma C. Adenomyosis D. Endometriosis Answer: A, MedGard1 Q1386 https://t.me/SMLERide SMLE Ride ~ By The Elites Q215) Child presented with projectile vomiting, diagnosed with pyloric stenosis, what is the most appropriate next step? A. NGT B. NPO C. IV 0.9% Na bicarb D. US Answer: I guess there’s a mistake in the options as we give NS only or 0.45 NS+D5. If there are no mistakes I’ll choose B. Q216) Which of the following will increase CO2 elimination in a mechanically ventilated pt? A-Decrease RR B-Increase RR C-Decrease tidal volume D- Increase inspired O2 Answer: B, Q217) years old, came with history reducible hernia in inguinal area it pop out every two days"interval" with mild pain and and he Manuel reducible it by his finger, then he suddenly developed severe "constant" pain in early morning in that area and came to hospital, on examination of the inquinal area and scrotum examination and he is free from both them and pain is disappear Now just with persistent nausea and vomiting next step ? A. Pelvic and Abdomen CT B. hernia repair today after 2 hour C. Reassurance and discharger Answer: A, Hamoud Q218) Patient with PAD has 100-meter claudication's, DM, heavy smoker, not getting better. How to improve his walking distance? A. Supervised exercise program B. Strict glycemic control C. Smoking cessation Answer: A, MedGard1 Q882 Q219) Which of the following are typical of gastritis? A- Pain worse on drinking warm milk B- Pain which wakes the child from sleep https://t.me/SMLERide SMLE Ride ~ By The Elites C- Pain worse first thing in the morning and relieved by eating D- Pain going through to the back Q220) Child pt presented to ER with left chest Stab wound after fight in school with some boys , he is well & doctor do thoracocentesis then the child be hypotensive ,,, which of the following is most likely next step in management??? A-Thoracotomy B-Chest tube C-Exploratory laparotomy D- Intubation Answer: B, Hamoud and Hamza Q221) Case of lump in breast with tenderness and fluctuations، With high fever. Next step? A- Core needle B- Excision biopsy C- No management *Forgot the last choice but sure no incision and drainage Answer: The last option is either I&D or aspiration, choose it. Hamoud Q222) 80 year old woman with prosthetic valve replacement and stage 3 pelvic prolapse? Appropriate tt? A- pessary B- sacrocolpopexy C- colpocleisis D- vaginal hysterectomy Answer: A, GB Q223) History of seizure attack Received diazepam after 35 min with no improvement? A- iv phenytoin B- iv phenobarbital Answer: A, MedGard2 Q49 Q224) Pregnant women presented with vaginal bleeding and said she passed some tissue, didn’t mention the cervix. What is the type of abortion? A- complete B- incomplete https://t.me/SMLERide SMLE Ride ~ By The Elites C- inevitable D- threatened Answer: B, GB Q225) 60 year old female, last menses 12 years back. Presented with abnormal uterine bleeding, suspected to be due to intrauterine polyps. US thickness 13mm. what is the most appropriate management? A. Endometrial ablation B. Laparoscopic hysterectomy C. Vaginal hysterectomy D. Polypectomy Answer: D (Hysteroscopy and polypectomy), MedGard1 Q1501 Q226) old man pt with end stage metastatic prostate cancer & worsening skeletal pain in back and bilateral LL. He has already experienced disease progression with anti-hormonal therapy. He is refused further chemotherapy He received the maximal dose of radiation to spine and metastatic lesions. He controlling his pain with NSAID but now requires short acting narcotics almost every 4 to 6 hrs. He is requesting a long acting medication for his pain His current health does not include pharmacy benefit. O/E: no neurologic findings. Labs are normal. Which of the following is the most cost effective choice for long acting analgesia ???? A- Pethidine B- Transdermal fentanyl C- Long acting morphine D- Long acting oxycodone Answer: C, Bailey & Love MA: Agree + new question. Q227) healthy young lady just delivered a baby 4 months ago. However, she tells you that she does not want to get pregnant for the next 2 years. What method of contraception will you recommend? A. Combined OCP B. Depo Provera injection C. Vaginal ring D. Transdermal patch Answer: B, Wafa https://t.me/SMLERide