SMLE Ride Past Paper Questions (PDF)

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 SMLE Ride ~ By The Elites Q228) Child with bacterial meningitis. Mother concerned about her other children get infected. Which of the following could prevent it? A- antibiotics prophylaxis B- patient isolation C- treat the patient Answer: A, Amboss Q229) A 7-month-old presents with low-grade fever and a dry cough for the last 3 days. On examination, there is wheezing over both lung fields (see report). Heart Rate 127 /min Respiratory Rate 47 /min Temperature 38.9° C Chest X-ray: Hyperinflation and some infiltration. Which of the following is the most likely diagnosis? A. Asthma B. Sinusi9s C. Influenza D. Bronchioli9s Answer: D, MedGard2 Q907 Q230) Man with severe retrosternal chest pain. Similar episode that relieved by nitroglycerin ECG showed ST depression but recovered completely.Diagnosis? A- MI B- Unstable angina Answer: B, no evidence of MI. Similar question in MedGard2 Q32 Q231) Pt underwent a hernia repair operation 12 years ago. He now presents with signs of intestinal obstruction. Which of the following is the most likely cause??? A. Improper Repair B. Late Onset Crohn's C. Adhesions D. Cause Is Irrelevant To The Prior Surgery History Answer: C, Hamoud Q232) 13 months old pt. His mother noticed that he stopped smiling, low activity, fatigue. While examining the pt. he had multiple movements of neck flexion followed by extension of body & https://t.me/SMLERide SMLE Ride ~ By The Elites limbs lasting for 1-2 seconds in a repetitive pattern. EEG showed slow wave & multifocal spikes) What’s the diagnosis ? A- Juvenile myoclonic epilepsy B- Infantile spasms (West syndrome) C- Lennox-Gastaut syndrome Answer: B, Nelson Q233) Child with liver cirrhosis and confusion what to avoid? A- Protein B- Fat Answer: B, no resource except telegram channels. Even in case of hepatic encephalopathy, protein restriction should be avoided, UTD Q234) A 45-year-old woman has undergone a total abdominal hysterectomy and bilateral salpingo- oophorectomy for a benign reason. Immediately post operaton, she started to have acute vasomotor symptoms. Accordingly, she was counselled for hormone replacement therapy and agreed. Which of the following is the most appropriate hormone replacement therapy regimens? A. Transdermal estrogen only patches B. Levonorgestrel-releasing intrauterine device C. Cyclical estrogen and progesterone replacement D. Continuous estrogen and progesterone replacement Answer: C, MedGard2 Q815 Q235) woman presents with recurrent seizures and cognitive dysfunction. She is subsequently diagnosed with glioblastoma multiforme (see lab results). Which of the following is the most likely cause of her hyponatremia? A. Salt-wasting nephropathy B. Excessive water consumption C. Increased consumption of soft drinks D. Syndrome of inappropriate ADH secretion Answer: D, GameBoy Q236) 15-year-old pa9ent presents for a rou9ne check-up (see lab results). Test Result Normal Values RBC 5.3 4.4-4.8 x 1012/L https://t.me/SMLERide SMLE Ride ~ By The Elites WBC 68 4.5-10.5 x 109/L Hb 98 112-165 g/L MCV 69 80-95 fl MCHC 261 260-340 g/L Re9culocyte 1.0 0.2-1.2% Which of the following is the most likely diagnosis? A. Sickle cell anaemia B. B-thalassemia trait C. Iron deficiency anaemia disease D. Anaemia of chronic medical disease Answer: B, MedGard2 Q1016 Q237) A 40-year-old woman presents with progressive dyspnea, dry cough and reddish nodular skin lesion over both shins. On examina;on, she has palpable cervical lymph nodes and bilateral diffuse fine crepita;ons in both lungs (see reports). Chest radiograph: Diffuse bilateral inters;;al infiltrates with bilateral hilar lymph nodes enlargement. Purified protein deriva;ve (PPD): Negative. Cervical lymph node biopsy: Non-caseating granuloma. Which of the following is the next best op;on in management? A. Montelukast B. Prednisone C. Antituberculosis D. Salmeterol inhaler Answer: B, MedGard1 Q804 Q238) man came to the clinic for follow-up visit. He is diagnosed of iloecolonic crohn's disease started on steroid and pentasa for 3 months. He noticed perineal pain and discharges for 3 weeks duration. His abdominal symptoms are well controlled with no abdominal pain or diarrhoea. Examination was normal apart from 2 perianal fistula were seen (see lab results and report) - RBC 4 4.7-6.1 x 1012/L (Male) - Hb 11 130-170 g/L (Male) - Platelets count 421 150-400 x 109/L - WBC 7 4.5-10.5 x 109/L - ESR 36 2-10 mm/h (Male) - MRI Pelvis: Confirmed the presence of perianal fistulae. Which of the following is the best next step in management? A- Methotrexate https://t.me/SMLERide SMLE Ride ~ By The Elites B- Azathiporine C- Budesonide D- Infliximab Answer: D, MedGard1 Q291 Q239) 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, Similar Q in SMLE Brain ethics V4 Q240) 43 YO female presented with solitary thyroid nodule 4 mm, associated with neck pain. Her TSH and T4 are normal. What is the best next step? A. FNA B. US C. Follow up after 3 months D. Repeat Thyroid function tests Answer: B, UTD + Hamoud + ‫أم اﻟﻘﺮى‬ Q241) A 17-year-old woman comes at 39 weeks' gestation to the Emergency Department with no previous antenatal care. She delivered a healthy baby boy normally with no complications reported. Then she was given an injection of RhoGAM. What is the indication of RhoGAM? A. Mother is Rh- and the baby is Rh+ B. Father is RH+ and the baby is Rh- C. Mother is Rh+ and the baby is Rh- Answer: A, MedGard Q242) A 22-year-old woman attends the Women's Health Clinic for a postnatal examination. She delivered a full- term baby boy 6 weeks earlier and the infant is exclusively breastfeeding and shows a good latch and weight gain. She would like to have more children, but not within the next 2 years. She does not smoke cigarettes and not at risk for heart disease. She inquired about birth control methods. Which of the following methods is most appropriate? https://t.me/SMLERide SMLE Ride ~ By The Elites A. Depo-provera injection B. Transdermal patch C. Combined oral pill D. Vaginal ring Answer: A, GameBoy Q243) Known SCA and received blood transfusion 3 weeks ago. Now he came for his hepatitis A vaccine. You should: A-Give the vaccine B-Ask him to come after 3 months C-Ask him to come after 6 months D-Ask him to come after 9 months Answer: A, Safdar + MedGard2 Q1004 Q243) Newborn delivered with ventose due to malposition. While assessment in the nursery, a hematoma from bleeding below the periosteum confined within the margins of the skull sutures noted. Which of the following is the most likely diagnosis? A. Chignon B. Cephalohematoma C. Caput succedaneum D. Subaponeurotic hematoma Answer: B, MedGard Q244) A 26-year-old multiparous woman in labor is requesting pain relief. While in the lithotomy position, the obstetrician performs a pudendal nerve block, and injects a local anaesthetic into the sacrotuberous ligament close to the ischial spine. Which of the following structures will remain fully sensitive despite this pudendal nerve block? A. Urogenital diaphragm B. Perineal body C. Rectum D. Vulva Answer: C, MedGard Q245) A 30-year-old woman is complaining of yellowish, fishy-smelling vaginal discharge and https://t.me/SMLERide SMLE Ride ~ By The Elites itching. Which of the following is the most likely diagnosis? A. Candida vaginitis B. Bacterial vaginosis C. Vaginal gonorrhea D. Vaginal trichomoniasis Answer: B, GameBoy Q246) A 34-year-old is inquiring about an effective reversible method of contraception. Which of the following is the most effective method of contraception? A. Vaginal ring containing hormone B. Female condom C. Male condom D. Spermicide Answer: A, GameBoy Q247) 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, GameBoy Q248) 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, MedGard https://t.me/SMLERide SMLE Ride ~ By The Elites Q249) An 18-year-old girl complains of severe lower abdominal pain and back pain on the first 2 days of her cycle every period. She has a regular cycle and is medically free. Which of the following is the most appropriate next step in management? A. NSAIDS B. Oral contraceptive pills C. Injectable contraceptive D. Intrauterine hormonal device Answer: A, GameBoy Q250) The World Health Organization (WHO) published the WHO Surgical Safety Checklist in 2008 in order to increase the safety of patients undergoing surgery. The Checklist consists of three phases of surgical procedure: A. Before admission, Before skin incision, at discharge from hospital. B. Before anesthesia, before skin incision, before patients discharge from hospital. C. Before anesthesia, Before skin incision, Before patient leaves operating room. D. Before admission, Before induction of anesthesia, Before patient leaves operating room. Answer: C, SMLE BRAIN Q251) A 23-year-old single woman presented with heavy menstruation during the first 4 days of her period for the last 2 years (see image and lab results). Which of the following is the most likely diagnosis? A. Pregnancy B. Ovarian cyst C. Endometrial cancer D. Uterine leiomyomas Answer: D, GameBoy Q252) An 8-year-old boy is brought to the clinic by his mother. She is concerned of bed- wetting overnight despite toilet training and compered to his sister when she was in his age with good control. Which of the following pelvic muscle is affected and possible target therapy? A. Rectus B. Detrusal C. Perianal D. Pelvic floor Answer: B, MedGard https://t.me/SMLERide SMLE Ride ~ By The Elites Q253) A 67-year-old diabetic patient admitted to Intensive Care Unit with sepsis and urinary tract infection. Blood culture revealed methicillin-resistant staphylococcus aureus. Which of the following is the most appropriate treatment option? A. Cefuroxime B. Vancomycin C. Gentamycin D. Flucioxacillin Answer: B, MedGard1 Q254) A 38-year-old man with a history of recurrent acute pancreatitis over the last 10 years presents with a 12-hour history of frequent episodes of vomiting fresh blood. Intravenous fluid resuscitation was initiated (see reports). Upper gastrointestinal endoscopy: Isolated bleeding fundal varices which have been controlled by injection sclerotherapy. Ultrasound: Splenomegaly, normal portal vein and thrombosed splenic vein. Which of the following is the most appropriate management? A. Splenectomy B. Portacaval shunt C. Distal splenorenal shunt D. Sengstaken blakmore tube Answer: A, MedGard2 Q255) A 2-year-old child diagnosed in the Emergency Room with pneumonia. The mother gave history of poor oral intake and vomiting for whatever orally introduced. Clinically, the child looks well with no distress. Blood pressure 88/56 mmH Heart rate 110/min Respiratory rate 23 /min Temperature 36.6 °C Oxygen saturation 95 % Which of the following reasons justifies the child hospitalization? A. Age of the child B. Vital signs findings C. Inability to take orally D. Primary diagnosis of pneumonia Answer: C, MedGard https://t.me/SMLERide SMLE Ride ~ By The Elites Q256) 33 YO female presented to the hospital complaining of fatigue, cold intolerance, weight gain and constipation for 4 months. her TSH is within normal range. what is the best next step: A. repeat thyroid function test after 4 weeks B. thyroid scan C. serum T4 D. Thyroid US Answer: C, MedGard1 Q320 Q257) 43 YO female presented with solitary thyroid nodule 4 mm, associated with neck pain. Her TSH and T4 are normal. What is the best next step? A. FNA B. US C. Follow up after 3 months D. Repeat Thyroid function tests Answer: C, MedGard2 Q380 TK: B, I think this question is different from ( MedGard2 Q380 ). Unlike this question, the patient did US in that question. They did not mention here that she underwent US, the 4mm size can be an incidental finding by other forms of imaging. Also it’s answered by ‫ أم اﻟﻘﺮى‬B MA: B Q258) Hematuria with flank pain, negative urine cultures and negative urine analysis except for blood. Next step? A) CT KUB B) cystoscopy C) antibiotic D) x-ray Answer: A, Q259) patient has fresh bright red rectal bleeding. He had 2 episodes of gastrointestinal bleeding from unknown location. What is the most appropriate step? A-Endoscopy B-Colonoscopy C-Sagretskin tube Answer: B, UTD https://t.me/SMLERide SMLE Ride ~ By The Elites Q260) Old female with history of epilepsy had seizure and fell down the stairs, presented with back pain with urine and fecal incontinence and inner thigh pain, next appropriate management? 29/20 A-EEG B - MRI Lumbar C Reassure as post-ictal state Answer: B, Amboss Q261) 6 year old with asthma exacerbation frequently what would you educate to prevent recurrence: A) environmental control B) patient skill in using spacer inhaler C) patient skill in using peak flow expirometry Answer: B, Abdulmajeed Q262) A 60-year-old man with liver cirrhosis presents to the Emergency Room with increasing ascites. He has no history of fever or decreased level of consciousness. His medications include spironolactone 50 mg/day and furosemide 40 mg/day. His physical examination confirms the presence of large ascites (see lab results). Which of the following is the most appropriate next step in management? A. Intravenous diuretics B. Therapeutic paracentesis C. Increase the dose of furosemide D. Transjugular intrahepatic portosystemic shunt (TIPS) Answer: B, GameBoy Q263) 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 spectrum penicillin B. granulocyte colony stimulating factor C. Fluoroquinolone D. 3rd generation cephalosporin Answer: A, Dalaan’s IM review https://t.me/SMLERide SMLE Ride ~ By The Elites Q264) A female patient went to obesity clinic for advice regarding surgical methods of weight loss. After full explanation by the surgeon, which of the following is the "most important factor lead to successful outcome? A- life style modification B- heavy exercise C- Surgery D- Low carb diet Answer: Weird phrasing of the question. However, I think they meant the one in the provided picture. Hamoud Q265) A drug approved by the FDA is prescribed by a doctor who is the shareholder of the pharmaceutical company. Which of the following terms best describes this scenario? A) Confidentiality B) Conflict of interest C) Justice D) Non-maleficence Answer: B, SMLE Brain Q266) A 39-year-old G4 P3 at 12 weeks of gestation came for an ultrasound study. Ultrasound: Single viable fetus with cystic hygroma. Which of the following is the most appropriate step in management to be offered at this gestational age? A. Amniocentesis B. Chorionic villus sampling C. Termination of pregnancy D. Percutaneous umbilical fetal blood sampling Answer: B, GB Q267) A 53-day-old boy is referred to the Paediatric Clinic for investigation of anemia. He was bor full term and he is a known case of G6PD deficiency. On examination, both height and weight are in the 10th percentile, the rest of the examination is normal (see lab results). Test Result Normal Values Hb 70 112-165 g/L Platelet count 350 150-400 x 109/L Total bilirubin 25.1 30), and high LDL. Which one of the following parameters is an indicator of significant health risk? A) BMI B) LDL C) Waist to hip ratio D) Waist circumference Answer: D, Most likely, as it’s the only component of metabolic syndrome here. Q274) A 9 years old child came with confusion and fatigue. The investigations showed microcytic anemia, iron studies showed low ferritin and elevated TIBC. Regarding iron replacement, which of the following, is the best way? A- Oral iron B- IV Iron C- IM iron D- Packed RBC (blood transfusion) Answer: A, Safdar Q275) A 62-year-old man known diabetes and hypertension presents with 4-hour history of sudden le. leg pain, he had a history of le. leg pain a.er walking 200 meters that make him stop https://t.me/SMLERide SMLE Ride ~ By The Elites and is relieved by rest. He is on oral hypoglycemic and sta7n but not compliant to medica7on and has been smoking for the last 40 years. Pulse examina>on on the le. 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, Hamoud Q276) Male patient diabetic and smoker presented with ulcer on 2nd , 3rd and 4th left foot toes. He gave a history of superficial thrombophlebitis. Upon examination: he has absent dorsalis pedis and posterior tibialis pulse in both limbs , while popliteal pulse was intact. How would you manage the patient? A- Amputation of toes B- Longterm anticoagulant C- Surgical intervention? D- Ask patient to stop smoking with lifestyle modifications Answer: D, Hamoud Q277) Ankylosing spondylitis case or spinal stenosis Most appropriate test to diagnose ? A- HLA b27 B- MRI C- CT Answer: B, Davidson p1028 Q278) A 66-year-old man comes for follow-up. He has shortness of breath on exercise, which have increased over the past few months. He became unable to walk more than 200-300 meters on the corridor and cannot climb the stairs easily. He has history of hypertension and currently on amlodipine 5 mg OD and indapamide 2.5 mg OD. On examination, he has bilateral basal crackles and mild pitting ankle edema (see lab results). Blood pressure 188/96 mmH Heart rate 79 /min https://t.me/SMLERide SMLE Ride ~ By The Elites Test Result Normal Values Hb 133 130-170 g/L (Male) 120-160 g/L (Female) Sodium 138 134-146 mmol/L Potassium 4.2 3.5-5.1 mol/L Creatinine 133 44-115 mol/L Which of the following is the most appropriate next therapy? A- Spironolactone B- Furosemide C- Bisoprolol D- Lisinopril Answer: D, MedGard1 Q544 Q279) 62 year old with blood in urine and no any complain and urine analysis shows rbc, what is next step? A) cystoscopy B) prostatic biopsy C) repeat urine analysis Answer: A, Hamoud Q280) Pregnant 20 weeks with hx of biliary colic come with RUQ. US cholelithasis. just like this. Most appropriate management: A- ERCP B- lap cholecystectomy C- MRCP Answer: B, Similar Q in Hamoud Q281) 40’s female had fever, weight loss, for 6 months. They did US it showed a 3cm hepatic lesion. What is the risk factor? A- AFB B- HBV The recall is deficient. - In a similar recall with the same scenario the questions asked about the next step ( see attached Q ) → answer was triphasic CT - Another similar recall is attached https://t.me/SMLERide SMLE Ride ~ By The Elites Q282) An 90 year old male with long standing incisions hernia came to the ER complaining of feculent discharge from the wound and as well as ulcer and necrotic skin overlaying the hernia, what to do? A) laparotomy B) dressing C) laparoscopy Answer: A, UTD Q283) A man on treatment for multiple sclerosis, presents with acute onset diplopia, ataxia and weakness of the right hand (see report). MRI brain scan: New active lesions compared to previous scans. Which of the following is the best treatment for this development? A. Interferon B. I.V. corticosteroids C. I.V. immunoglobulin D. Oral corticosteroids Answer: B, MedGard2 Q46 Q284) A 42-year-old man complains of chest pain a\er being involved in a motor vehicle accident. Examination confirmed a patent airway, equal air entry on both sides of the chest, and distended neck veins. Blood pressure 88/45 mmHg Heart rate 110 /min Respiratory rate 30 /min Which of the following is the most likely diagnosis? A. Flail chest B. Cardiac tamponade C. Tension pneumothorax D. Simple pneumothorax Answer: B, MedGard2 Q409 Q285) Child with barking cough,received epinephrine and improved what treatment to give? A. steroid B. antibiotic Answer: A, Mahdi Q286) 65 year old man with difficult urinating associated with urgency, examination showed enlarged palpable prostate but without tenderness, what is most likely cause? https://t.me/SMLERide SMLE Ride ~ By The Elites A) urethral injury B) benign prostatic hyperplasia C) prostatic cancer Answer: B, UTD Q287) Old, LGIB, unstable, after blood transfusion still hypotensive a. angiography b. Colonoscopy Answer: A, Bailey & Love Q288) Cause has unilateral neck swelling in the RT side by investigations : hot thyroid nodule remaining of the gland cold TSH is low, T3, T4 high No LN enlargement (dx hyperthyroidism toxic nodule) What is the initial Treatment? A- antithyroid drug B- RT thyroidectomy C- Hemithyroidectomy D- radioactive iodine Answer: A, Hamoud file Q289) Mother brought child for vaccination. Last vaccine became ill tachypnea wheezing go to ER. What is the next step A- Check last vaccine B- Give C- Cancel D- Delay Answer: A, Safdar file Q290) patient came with hematemesis, has not happened before, no symptoms of liver cirrhosis, liver enzymes within normal range, what is most likely cause? A) mallory Weis tear B) esophageal varices C) peptic ulcer Answer: C, MedGard 1 Q574 https://t.me/SMLERide SMLE Ride ~ By The Elites Q291) 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 right side. 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, MedGard 2 Q518 Q292) what is screening age of diabetes in patient A) 30 B) 35 C) 40 Answer: B, UTD Q293) 20 years old married and has primary infertility for 1 year. Her cycle is scanty and irregular. What is the appropriate investigation? A- MRI of the pelvis B- Chromosomal analysis C- CBC Answer: B, GB Q328 Q294) Patients after motor accident stable and good air entry in both lungs he just have a pain in chest and Bruises skin of ribs. The chest move with cough (X Ray findings or diagnosis not mentioned). What is the next step: A- adequate analgesia B- Intubation Answer: A, UTD Q295) 50 y.o with menorrhagia used all medical ttt and failed. What to do : A.Hysterectomy B.Arterial embolisation https://t.me/SMLERide SMLE Ride ~ By The Elites Answer: A, similar to GB Q556 Q296) 45 female medically and surgically free + NO FAMILY HISTORY of colon cancer. Asked about colon cancer screening A.annual fecal occult blood B.colonoscopy every 10 years Answer: B (more correct), USPSTF Q297 ) Women week 8 present to the ER with history of mild abdominal pain , pass of tissue and blood 10h ago , the cervix open , US show 4x3 echogenic mass and normal uteres size diagnosis ? A- incomplete abortion B- complete abortion C- ectopic pregnancy Answer: A, Amboss Q298) A 20-year-old woman has a history of 3 first trimester abortions. She was diagnosed last year with pulmonary embolism (see lab results). Test Result Normal Values Prothrombin time 11 10-13 sec APTT 69 30-40 sec Platelets count 320 150-400 x 109/L Lupus anticoagulant positive Which of the following is the most likely diagnosis? A. Factor V Leiden B. Factor V deficiency C. Protein C deficiency D. Antiphospholipid syndrome Answer: D, MedGard 1 Q63 Q299) Patient multi grvida in pelvic exam ,with 70%effaced cervix and fetal station 0 What is the most appropriate next step? A) Check in 2 hours B) induction of labor C) cesarean section https://t.me/SMLERide SMLE Ride ~ By The Elites D) oxytocin Answer: A, no indication for CS or induction. Q300) Case of signs of ureteric stone, how to investigate? A-ct with contrast B-ct without contrast Answer: B, UTD Q301) An elderly man is brought to the Emergency Department with an altered level of consciousness after he fell down the stairs (see report). CT scan: Suggestive extradural hematoma. Which of the following arteries is most likely involved? A. Basilar B. Pontine C. Anterior cerebral D. Middle meningeal Answer: D, MedGard Q302) Young patient complains of irritability and crying before her menstrual periods. What non-pharmacological method would you advise her to do A- physical exercise B- yoga C- hot bath D-decaffeinated drinks Answer: A, Hacker Q303) An 18-year-old boy known to have grand mal epilepsy since childhood is brought to the Emergency Department after having repeated tonic-clonic seizures at home. He is compliant with his medication, which is sodium valproate. In the Emergency Department, he is unconscious and continuously convulsing. After oxygenaton and securing the airway, which of the following intravenous drugs should be administered? A. Phenytoin B. Diazepam C. Thiopental D. Phenobarbitone https://t.me/SMLERide SMLE Ride ~ By The Elites Answer: B, MedGard Q304) A 21-year-old woman with history of recurrent palpitations, light-headedness and 2 attacks of fainting. ECG showed short PR interval and Inferior leads Q waves. She was diagnosed as Wolf-Parkinson-White (WPW) syndrome. She was given atenolol with no response. Which of the following is the best management option? A. Digoxin B. Amiodarone C. Increase atenolol dose D. Radiofrequency ablation Answer: D, MedGard Q305) Man working in industry and exposed Radioactive liquid for all body What is your next step? A. Remove clothes B. Tell him to shower with warm water C. Wash him with lots soap D. Stay away from incident location Answer: D **1st is safety then pt stabilization (Decontamination & ABCDE) Q306) A 24-year-old woman just delivered her first baby with a birth weight of 2.7 kg while she was at 38 weeks of gestation. She is not known to have any medical or surgical history. She has a heavy gush of bleeding postpartum. Which of the following is the most likely diagnosis? A. Uterine atony B. Cervical injury C. Coagulation defects D. Retained placental fragments Answer: A, MedGard Q307) A 25-year-old man is undergoing appendectomy for acute appendicitis, upon entering the peritoneal cavity; the surgeon could not find the appendix. Which of the following is the most effective way to localize the appendix? A. Following the terminal ileum B. Palpating the ileocaecal valve https://t.me/SMLERide SMLE Ride ~ By The Elites C. Looking at the confluence of the tania coli D. Following the course of the right colic artery Answer: C, MedGard Q308) A 25-year-old primigravida presents at 15 weeks of gestation to the antenatal visit where blood and urine investigations were requested. Which of the following is the most expected finding? A. 20-25% increased hematocrit B. 40-45% decreased hematocrit C. 20-25% increase in total blood volume D. 40-45% increase in total blood volume Answer: D, GameBoy Q309) One of the goals for Saudi Arabia in 2030 vision is to improve the health by decreasing the preventable causes of death underage of 5 years group, this will be conducted through: A) Specialized hospitals B) Education C) Immunization D) Economic Answer: C Q310) A 62-year-old patent 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 ( 30 U/L (Postmenopausal) Prolactin 500 < 652 pmol/L. (Male) < 870 pmol/L (Female) Human chorionic gonadotropin 4 < 5 mlU/mL Which of the following is the most likely complication for this patient? A. She is at significant risk of endometrial cancer B. She is at increased risk for multiple gestation C. She is at increased risk of ovarian cancer D. She is at significant risk of osteoporosis Answer: D, MedGard Q327) A 40-year-old man, alcoholic and smoker is brought to the Emergency Department with a 4-hour history of severe upper abdominal pain radiating to the back. On examination, his abdomen is distended, tense, and tender. Digital Rectal examination confirms a collapsed empty (see image). Blood pressure 100/70 mmH Heart rate 110 /min Respiratory rate 20 /min Temperature 37 °C. Which of the following is the most likely diagnosis? A. Pancreatitis B. Pneumothorax C. Duodenal perforation D. Acalculous cholecystitis: Answer: C, MedGard Q328) hypertensive patient was prescribed Hydralazine 25mg by his physician. Instead he took Hydroxyzine 25mg. Which of the following is the likely type of error? A) Look-a-alike error B) Sound-a-alike error C) Illegal prescription D) Handwriting error Answer: A, SMLE BRAIN https://t.me/SMLERide SMLE Ride ~ By The Elites Q329) 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 of vomiting have been increasing in frequency. 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 hematocrit C. Elevated C-reactive protein D. Hypochloremic metabolic alkalosis Answer: D, MedGard Q330) A 31-year-old pa7ent presented with a 12-hour history of severe epigastric abdominal pain. Physical examination confirmed a tender abdomen with sluggish bowel sounds (see reports). Erect chest X-ray: Air under the diaphragm. Exploratory laparotomy: A 5x5 mm perforation in the anterior aspect of the 1st part of duodenum with peritoneal soiling. Which of the following is the most appropriate management? A. Distal gastrectomy B. Pyloroplasty with truncal vagotomy C. Simple closure with omental patching D. Pyloroplasty with high selective vagotomy Answer: C, MedGard Q331) 52 year old male medically free came to the clinic complaining of red urine associated with right flank pain, no dysuria no fever no other symptoms On examination: right flank tenderness and palpable rectal prostate ( written like this) Urine culture : negative Urine analysis: + erythrocyte - Nitrate - - wbc. What is the most appropriate next investigation : A- Urine cytology B- KUB CT C- retrograde urethrogram Answer: B, UTD Q332) 56 years old female has on and off vaginal spotting and dyparnonea what is the treatment? A- Progesterone https://t.me/SMLERide SMLE Ride ~ By The Elites B- Estrogen pill C- Estrogen cream Answer: C, GB Q333) 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, GB Q334) A worker came to ER 1hr after having a radioactive liquid spilled on him, what's the first thing to do? A. Remove his clothes B. Insure safety of the scene C. Wash with soap and water D. Stay away from incident site Answer: D, UTD Q335) 73y woman is brouth to ER after a fall at home. she is diagnosed with left hip fracture,wt 82kg NA:136(N)-K:4.2(N)-CR.68(N),What is the best order by the admitting orthopedic surgeon to prevent DVT : A. Asirin 81mg PO daily B. Enoxaparin 40mg SC daily C. Fondaparinux 10mg SC daily D. Heparin Sulfate 10,000 units IIV BID Answer: B, MedGard 1 Q1590 Q336) pt hearing voices from the refrigerator and toaster and she believes that the food is poison What is your diagnosis? A- Auditory hallucinations B-Delusion disorder https://t.me/SMLERide SMLE Ride ~ By The Elites Answer: A, UTD Q337) 2 hrs old new born 33 weeks born,with grunting and cyanosis. X-ray given RDS plus TOF.. Most appropriate. A. Urgent cardiology B. Endotracheal exogenous Surfactant Answer: B, UTD Q338) A 43-year-old woman with a history of pulmonary embolism 3 years ago is seeking an effective family planning method. Which of the following is the most appropriate method? A. Condom B. Dermal patches C. Intrauterine device D. Oral contraceptive pills Answer: C, GB Q339) child with pica, hepatosplenomegaly and failure to thrive. Coming from a low socioeconomic economic status family HGB low, Lead -2 high, PT normal PTT normal, INR normal, Iron normal What's the most appropriate treatment? A. Vitamin K B. D-penicillamine C. Iron supplements Answer: B, UTD Q340) 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. consent from both the wife and husband C. Take consent from her and tell her to inform her husband D. Consult ethics committee Answer: B, Brain ethics file https://t.me/SMLERide SMLE Ride ~ By The Elites Q341) 28 yrs pregnant 15 weeks came for routine antenatal care on US (normal viable fetus and cystic hygroma) what is the most appropriate to do? A- amniocentesis B-terminate the pregnancy C-chorionic villus sample D-Percutaneous umbilical fetal blood sample ‫ﺳﺆال ﻋﻦ ال‬ascitis ‫ ﺑﺲ ﻣﺎ اﻋﻄﺎك ال‬SAAG Answer: A (15 weeks), Amboss Q342) 48 yrs old female with abdominal distension (ascitis) ,had TB 10 yrs ago and treated well, investigation:- ascitic fluid :- WBCs 80 (mainly mesothelia) albumin 15 what is the cause of ascites?? A-TB B-liver cirrhosis C-heart failure D-malignant Answer: B, November file Q343) 40 yrs old man C/o groin & scrotal swelling with cough & standing for long time, on Ex +ive cough impulse and the swelling completely reduced when lying down, what type of hernia??[just this information] A-femoral B-direct inguinal C-indirect inguinal D-ventral Answer: C, Bailey & Love Q344) pt known case of crohn’s disease , post terminal ilium resection what is the most important neutrinos to be replaced?? A-thiamine B-vit B12 C-bile salts Answer: B, MedGard2 Q493 https://t.me/SMLERide SMLE Ride ~ By The Elites Q345) 47 years old female sexually active diagnosed with HTN for 5 years on medications BMI 37. What is the highest recommended screening A. Ct chest B. Pap smear C. Annual fecal blood D. Fasting blood glucose Answer: D, both B & D are correct, I go with D because she has high risk for DM. This recall used to come without the keyword ‘sexually active’, though I still go with D. OA: The question is pointing us towards diabetes because of the history of hypertension, her age, and the BMI. Also, she is considered to have high risk for developing DM according to UTD. Q346) A man presented with trauma to his chest (by a ball), he has severe tenderness on the chest with multiple bruises, the airways are patent, he is alert and conscious but his chest wall is unstable when he moves or tries to take a deep breath. Air sounds present bilaterally. Vital signs normal apart from saturation 86%. What is the most appropriate management? A. IV analgesia B. Mechanical ventilation C. Chest tube Answer: B, Hamoud A case of flail chest (crepitus palpation = broken ribs). Usually managed with analgesia and assisted ventilation but here the case demonstrates hypoxemia and needs mechanical ventilation. Q347) Folic acid dose for pregnant lady with no risk factors? A- 0.2mg B- 0.8mg C- 1.2 mg D- 0.4 mg Answer: B, According to UTD & WHO the dose should be 0.4 mg, and since it’s the lowest dose so choice A is wrong, I go with B. Q348) A 27-year-ald woman primigravida at 39 weeks" gestation has been in labor for a few hours. Her cervix is 6 cm dilated, 80% effaced, and fetal vertex is at 0 station. Membranes have been ruptured for 20 hours. and her labor is being augmented with oxytocin. Non-stress test is done https://t.me/SMLERide SMLE Ride ~ By The Elites Blood pressure 110/76 mmHg Heart rate 82 Imin Respiratory rate 18 imin Temperature 37.2 c Oxygen saturation 95 % Which of the following is the most appropriate management? A. Stop oxytocin B. C-Section C. Amnioinfusion D. Ampicillin Answer: A, MedGard 1 Q1417 Q349) Female k/c of recurrent pregnancy losses, Which of the following is a reliable predictor of pregnancy complications? A- lower limb edema B- abdominal pain C- vaginal bleeding Answer: C. Although both B and C can occur in case of pregnancy loss, I choose C as pregnancy loss can occur without abdominal pain as in cervical incompetence where it presents with painless cervical dilation and eventually pregnancy loss, UTD. Q350) Mother asking about the optimal age of IDA screening for children A- 4 months B- 12 months C- 18 months Answer: B, Mahdi Q351) Case about gun shot and the pt had pneumothorax. Tube thoracostomy was inserted after 15min there was blood in the under water seal drain (2L), what is the most appropriate thing to do? A - thoracotomy B- Tube thoracostomy C- CT chest Answer: A, Hamoud https://t.me/SMLERide SMLE Ride ~ By The Elites Q352) 5y/o child came in pre school clinic just to check for pre school, you found the right? eye misaligned what to do NEXT / initial? A- Refer to pediatric optha next day B- Urgent glasses C-HIRSCHBERG corneal reflex test D-detailed history that point out for possible perinatal trauma Answer: D, UpToDate Q353) Patient status 1 day post surgery, has diminished breath sounds. What is the management? A. Incentive spirometry B. Antibiotics C. Chest tube D. Needle decompression Answer: A, MedGard2 Q535 Q354) A 55-year-old man who has developed chronic kidney disease secondary to focal segmental glomerulosclerosis is reviewed in the clinic. His renal function is deteriorating. Haemodialysis is planned to start soon (see lab result). Test Result Normal Values Creatinine clearance 10 70-103 mol/L What is the preferred method of access to start Haemodialysis? A. Arteriovenous graft B. Arteriovenous fistula C. Tunelled venous catheter D. Non-tunelled venous catheter Answer: B, MedGard1 Q744 Q355) 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 https://t.me/SMLERide SMLE Ride ~ By The Elites Answer: D, MedGard2 Q403 Q356) A 45-year-old woman has undergone a total abdominal hysterectomy and bilateral salpingo- oophorectomy for a benign reason. Immediately post operaton, she started to have acute vasomotor symptoms. Accordingly, she was counselled for hormone replacement therapy and agreed. Which of the following is the most appropriate hormone replacement therapy regimens? A. Transdermal estrogen only patches B. Levonorgestrel-releasing intrauterine device C. Cyclical estrogen and progesterone replacement D. Contnuous estrogen and progesterone replacement Answer: C, MedGard2 Q815 Q357) A 38-year-old multiparous woman presented with a 3-year history of abdominal bulging. Physical examination confirmed a diffuse smooth midline bulge on attempting to lean forward, with negative cough impulse (see report). CT scan of abdomen: No intra or extra-abdominal mass lesion, and abdominal fascia is intact with no visible defect. Which of the following is the most likely diagnosis? A. Spigelian hernia B. Incisional hernia C. Divarication of recti D. Transversalis muscle weakness Answer: C, MedGard2 Q420 Q358) An 11-year-old pa9ent presents with increased thirst, hunger and urinary frequency. The pa9ent has had nothing to eat or drink for 3 hours before the clinic visit. examina9on is unremarkable (see lab result). Blood pressure 110/70 mmH Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6° C Test Result Normal Value Random Glucose 25.5 3.9-5.5 mol/L Which of the following is the most likely cause? A. Elevated renin B. Elevated insulin C. Decreased insulin D. Absence of glucagon Answer: C, MedGard2 Q1169 https://t.me/SMLERide SMLE Ride ~ By The Elites Q359) A 55-year-old man is evaluated 2 days after having an episode of left arm weakness without pain that lasted 5 minutes. He is now asymptomatic. He has type 2 diabetes mellitus and dyslipidemia. Medications are aspirin, insulin, and atorvastatin. Physical examination shows that no carotid bruits or cardiac murmurs are heard on cardiac auscultation, and all other physical examination findings are normal (see report). Electrocardiogram: Normal sinus rhythm with no ST-segment or T-wave changes. Which of the following is the most appropriate initial imaging test? A. Transesophageal echocardiography B. Carotid duplex ultrasonography C. CT angiography of the neck D. MRI of the brain Answer: B, GB Q360) pregnant in 35w come with rupture of membrane and poling of amniotic fluid in posterior fornix what is placenta marker for rupture of membrane A- Placental alkaline phosphates B- Placental alpha microglobulin Answer: B, Hacker Q361) 12 years old boy with recurrent hurt burn and pain in epigastrium pain for 1 years and vomiting ?the mother also had complained from heartburn. what is the initial investigation for these boy A- Barium swallow B- Amylase and lipase C- Endoscopy Answer: C, Dalaan’s IM review Q362) Female 12 weeks g4p3, her first pregnancy was 8w abortion, second was full term normal vaginal delivery, 3rd was 30weeks preterm premature rupture of membrane, what will you do for her now? a- abdominal cerclage b- macdonald cerclage c - close high risk follow up D- follow up normally with family medicine Answer: C, since cerclage is in week 13/14 https://t.me/SMLERide SMLE Ride ~ By The Elites Q363) A 15-month-old infant has been ill for the past 12 hours with apparent abdominal discomfort, emesis, and the passing of bloody mucous per rectum. The infant is sightly pale. On examination, found to have an increased bowel sounds. The abdominal film shows an obstructive pattern. Which of the following is the most important step of management? A. Bowel rest and IV hydration untfl resolution B. Intravenous antibiotics C. Immediate surgery D. Barium enema Answer: D, MedGard2 Q1130 Q364) pregnant female, on examination amniotic fluid was noted to have a dark green color. What’s the most appropriate action to be done during delivery? A) immediate NICU transfer B) Immediate endotracheal intubation C) Oropharyngeal suction before delivering the rest of baby Answer: A, Wafa Q365) A 3-week-old infant brought to the emergency room by his concerned mother as he stopped breathing for 20-25 seconds during which his lips and tongue appeared bluish. The episode ended when the mother vigorously stimulated her child and he started crying. His perinatal history is unremarkable and there is no history of choking, coughing or congestion before the episode. best Management ? A. Order full lab workup. B. Admit to the hospital for observation C. Refer to child protective services D. Direct laryngoscopy to rule out foreign body ingestion Answer: A *Since the patient is considered at high risk, he should be admitted for investigations not for observation. All the labs should be ordered so we can exclude serious diagnosis. Q366) Pediatric patient vaccinated BCG. His mother considered because he contracted with TB person. A. Do nothing because he is already vaccinated. B. Request PPD, order CXR and wait C. Request IGR, order CXR and start Isoniazid D. Something …. And start 4 anti TB https://t.me/SMLERide SMLE Ride ~ By The Elites Answer: C, Safder Q367) 35 year old asymptotic lady is seen for counselling regarding her breast cancer screening. Her mother was diagnosed with breast cancer at age of 67 y and her sister was diagnosed with breast cancer at age of 45 y, She had no history of breast biopsies. What would you recommend for her screening? A- Annual CBE and Mammogram alternating with breast US B- Annual CBE and Mammogram alternating with breast MRI C- Annual CBE and Breast US alternating with MRI until she reach 40 then you start with annual mammogram D- Annual CBE and Mammogram Answer: D, Hamoud Q368) A 32-year-old patient became pregnant through in-vitro fertilization. She is now 7 weeks pregnant and is scheduled for laparoscopic surgical excision of an ectopic pregnancy (see report). Ultrasound: Presence of a right-sided 4-cm ectopic pregnancy and a left tubal hydrosalpinx. Which of the following is the most appropriate procedure? A. Right-sided salpingotomy alone B. Right-sided salpingectomy alone C. Excision of both right and left tubes D. Intraoperative methotrexate injection Answer: C, GameBoy Q369) A 3-year-old boy is brought to the clinic by his mother because he was not eating well, and had distended abdomen. Recently he appeared reluctant to walk and lost weight. On examination, he looks pale, with hypertension and distended abdomen. MRI abdomen, confirmed the presence of large upper abdominal mass extending toward the midline Which of the following is the most likely diagnosis? A. Wilms umor B. Neuroblastoma C. Hodgkin lymphoma D. Non-Hodgkin lymphoma Answer: B, MedGard1 Q1081 https://t.me/SMLERide SMLE Ride ~ By The Elites Q370) Female in 33 w present with multiple follicle around the areola of nipple smooth round and painless A. Montgomery’s Follicles B. breast cyst C. Lactiferous duct D. Mondor's disease Answer: A, Hamoud Q371) 27- year-old *obese* woman presents with right iliac fossa pain associated with anorexia, nausea, and vomiting. On examination, there is moderate right iliac fossa tenderness. Labs showed: leukocytosis, what is the most appropriate management? A. Open surgery B. CT C. US D. Diagnostic laparoscopy Answer: B, MedGard2 Q335 Q372) Young year old man with appendicitis was treated conservatively with antibiotics. He now presents with an appendicular mass with no collection. How will you manage this case? A. Interval laparoscopic appendectomy after 12 weeks B. Interval open appendectomy after 12 weeks C. No further intervention needed D. Colonoscopy after 6 weeks Answer: A, Hamoud Q373) 24 years old with history of appendectomy 5 years ago present with abdominal pain, distintion , vomitting for 3 days Ct scan show obstruction signs And peritonitis , Whats contraindicated in this patient A. Propofol B. Ketamine C. Sevoflorane D. Nitrous Oxide Answer: D, Hamoud Q374) case of achalasia. What is the best management choice? A. Calcium channel Blocker https://t.me/SMLERide SMLE Ride ~ By The Elites B. botulism toxin injection at LOS C. Pnuemonatic dilatation D. Lower esophageal myotomy Answer: D, Hamoud Q375) 70 years old male on Mechanical ventilation (MV) admitted to the ICU due to intracranial hemorrhage, 7 days later he developed ground coffee vomitus. What is the diagnosis? A. Stress gastritis B. Helicobacter Pylori gastritis C. Dyspepsia Answer: A, Dr Elaf Q376) A 53 year old Male, known to have schizophrenia on medication, presented to ER with recurrent abdominal distention and constipation. Was normal on examination and vitally stable. Abdominal Xray: dilated colon lumen 10cm. CT: No obstruction. Best management? A-Decompression colonoscopy with rectal tube. B-emergency colectomy. C-Lt side colostomy. D-lower barium enema. Answer: A, Hamoud Q377)15 years old boy, was in burning house, He has carboneous sputum, hoarseness of the voice, lung crackle or creptation , whatis the most likely cause of his presentation? A- inhalation injury B- carbon monoxide toxicit Answer: A, Hamoud Q378) Pt had RTA in er, only has a bruises in lower abdomen and abdominal pain, what is the most appropriate nest step ? Bp : 110/80 Temperature : 37.2 HR : 88 RR : 19 A. CT B. Fast C. Initial assessment and resuscitation D. Exploratory laboratory https://t.me/SMLERide SMLE Ride ~ By The Elites Answer: C, Hamoud Q379) Few days after laparotomy, patient had pus discharge from the wound, for which it was opened to allow drainage. Few days later, wound looked healthy and with good granulation tissue. It was large and deep with intact abdominal fascia, no signs of infection. Most appropriate management? A. Open the fascia B. Antibiotics C. Place a vacuum-assisted closure (VAC) device D. Wound debridement Answer: C, UTD Q380) post MVA with urethral injury , what next : (i’m sure no suprapupic tube in choices) A- cystoscopy B- folly catheter C- retrograde urthrogram D- fluoroscopic cystogram Answer: C, UTD Q381) A pregnant woman came to the hospital with vaginal bleeding they discovered on MRI Placenta percreta. The hospital cannot tolerate this condition what you will do as a physician? A) Refer her with notifying department B) Refer her upon patient's request C) Discharge her with form of referral D) Discharge her and tell her to go to tertiary hospital Answer: A, Brain ethics file Q382) A 23-year-old woman, a known case of idiopathic thrombocytopenic purpura, delivered at 39 weeks of gestation, and her delivery was complicated with postpartum hemorrhage. Which of the following is the most appropriate management? A. Cryoprecipitate B. Fresh frozen plasma C. Packed red blood cells D. Platelet concentrate infusion Answer: D, GameBoy https://t.me/SMLERide SMLE Ride ~ By The Elites Q383) 62 Y/O male K/C of AF presented C/O diffuse abdominal pain for 8h, O/E: mild abdominal tenderness, no vitals, wbcs 21 Most important investigations A- abdominal ultrasound B- abdominal CT C- diagnostic laproscopy D- MRI Answer: B (intestinal ischemia), UTD Q384) 24Y/O male MVA, no external bleeding, decrease air entry on the left side BP: 60/40 SpO2: 76 Most appropriate? A- Tracheostomy B- pericardiocentesis C- chest tupe D- needle decompresion Answer: D, pneumothorax Q385) 23 female stope cotraception for 18month, she want to ger pregnant, Next step? A- IVF B- clomiphene induction C- continue trying D- infertility investigation for her and her husband Answer: D, UTD Q386) 4Y/O boy has Hx UTI 2times, physician want to do test for kidney scarring? A- ultrasound B- MCUGB C- DMSA Answer: C, UTD Q387) 49yo male, smoker for 20 years, what is the best method for screening? A.. low dose chest CT B. Bronchoscopy https://t.me/SMLERide SMLE Ride ~ By The Elites C. CXR Answer: A, USPSTF (tho not indicated) Q388) Child entered the clinc walking carrying a ball the doctor asked to see his ball the child throw the ball to the doctor and then spread his hands to get the ball back, he can draw a straight line. age in months? A- 9 B- 12 C- 15 D- 18 Answer: D, MedGard2 Q1189 Q389) Pt came to the clinic to follow up after his laparoscopic appendectomy. Histopath result: inflamed appendix and 2cm Carcinoid tumor in the base, what is the appropriate management? A, right colectomy B, nothing Answer: A, Hamoud Q390) A 46-year-old women with schizophrinea presents to the clinic with 1-month history of abnormal orofacial movements. She has been prescribed amisulpride 600mg for many years and procyclidine 5 mg daily. Which of the following is the most likely cause? A. Tardive dyskinesia B. Catatonic phenomenon C. Cerebrovascular accident Answer: A, MedGard2 Q139 Q391) Thyroid mass 3*4 on the left lobe. The patient was only complaining from the mass that was moving with swallowing. They did FNA and the results was :malignant cells suggesting papillary carcinoma. What is the Mx: A- Left lobectomy B- left lobectomy and isthmectomy C- subtotal thyroidectomy D- total thyroidectomy Answer: D, Abdulqader https://t.me/SMLERide SMLE Ride ~ By The Elites Q392) A woman with locally invasive breast cancer underwent neoajuvant chemo then mastectomy then radiotherapy, 2 days after radio her renal functions became abnormal Potassium, Creatinine and uric acid were all HIGH. Dx ? A-Radiotherapy induced tumors lysis B-Poor hydration prior to chemotherapy C-Membraneous glomerulonephritis D-Drug induced toxicity Answer: A, Q393) Female in her 20s presented with altered bowl habits for last 4 months ( not sure if exactly 4 but it is there for months) last 2 weeks she is also noticed mucus with stole , she also feels relieved after defecation , her family history: her father was diagnosed with colorectal cancer after the age of 60 her lab : All normal except Hb: 110 What is your diagnosis: A) gastroenteritis B) colorectal cancer C) irritable bowel disease D) ulcerative colitis Answer: C, MedGard1 Q300 Q394) 46-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, SMLE Brain Q395) 50 years old female came with hot flashes and insomnia , what is the first line Management ? A. soya B. hormonal replacement therapy C. Antipsychotic drugs D. life style modification https://t.me/SMLERide SMLE Ride ~ By The Elites Answer: D, GB Q396) Patient underwent lap chole for multiple gallstones 7 days ago, presents with vague abdominal pain. On US there is fluid around the gallbladder (something like that) and the CBD is 9 mm. What is the most likely diagnosis or cause? A - CBD injury B - Retained stone in CBD C - Sub-hepatic collection D- slipped clips Answer: B, MedGard1 Q855 Q397) A 58-year-old man with chronic obstructive pulmonary disease (COPD) is ready to be discharged home after acute exacerbation of the disease. Which of the following parameters indicate offering long-term oxygen therapy? A. 1 arterial blood gas measurement with p02 < 7,7 kPa B. 2 arterial blood gases measurements with p02 < 7.3 kPa C. 1 arterial blood gas measurement with p02 < 8.0 kPa D. 2 arterial blood gases measurements with p02 < 6.3 kPa Answer: B, MedGard1 Q665 Q398) A 25-year-old woman had a severe pelvic inflammatory disease 2 years ago that was treated by intravenous antibiotics. The isolated organism was chlamydia trachomatis. Since then the patient was trying for pregnancy but failed to do so. She had a normal regular period and a normal seminal analysis of her husband. Which of the following investigations is recommended? A. Ultrasound monitoring of her ovulation B. Magnetic resonance image of the pelvis C. Computed tomography of the pelvis D. Hysterosalpingogram Answer: B, MedGard1 Q56 Q399) New mom brought her 4 months old baby concerned about his growth his weight at birth and current weight were given in the question, she feeds him 2 table spoons of formula in 90 ml of water every 3 hours, the mother is 19 year old and this is her first child. what is the cause of failure to thrive? A. Neglect https://t.me/SMLERide SMLE Ride ~ By The Elites B. improper formula preparation C. Decrease feeding D. celiac disease Answer: B, Nelson Q400) A 57-year-old man presents with 2 days of abdominal pain, nausea, and vomiting Examination revealed a distended, tympanic and mildly tender abdomen without rebound or guarding Hb: 15 WBC: 12 X-ray:Multiple air-fluid leveis. CT scan: Multiple dilated loops of small bowel with a transition point in the distal small bowel, with some adjacent mesenteric fat stranding Which of the following Is the most appropriate next step in management? A. Observation B. Colonoscopy C. Diagnostic laparoscopy D. Exploratory laparotomy Answer: D, MedGard1 Q839 Q401) 21 years old came with generalized abdominal pain with nausea and vomiting. He is a heavy smoker on examination the abdomen is the scaphoid and rigid blood pressure 110/70 heart rate 105 temperature 38.5 Oxygen saturation 95% which of the following is most appropriate next step? A-upright chest x-ray B-Erect abdominal x-ray C-Abdominal Ultrasound D-Abdominal CT Answer: A, Bailey & Love Q402) Patient came with Abdominal pain, fever, generlized tenderness, history of open laparotomy 10 years ago, abdomen distended, imaging: multiple air levels and distended small bowel, no vitals, what is the best step? A. Exp laprotomy B. Diagnostic laparoscope C. Abx D. CT https://t.me/SMLERide SMLE Ride ~ By The Elites Answer: D, Hamoud Q403) A 21-year-old woman presented with an abnormal vaginal discharge, burning on micturition, and blood spotting for the past 2 months. On genital examination, there was an eroded and friable (strawberry appearance) cervix, with a yellow-green mucopurulent discharge (see report). Lab Testing: >10 PMNs per oil immersion field. Which of the following is the most likely diagnosis? A. Gardnerella vaginalis B. Trichomonas vaginalis C. Neisseria gonorrhoeae D. Chlamydia trachomatis Answer: D, MedGard Q404) A 30-year-old woman G2 P2002 at 32 weeks' gestation presents to Emergency Department complaining of lower abdominal and back pain which has increased in frequency and intensity over the last few hours. Abdominal examination shows fundal height equals to 32 cm, longitudinal lie fetus and cephalic presentation. Fetal heart was positive and cardiotocography is reactive with 2-3 uterine contractions/10 minutes. Vaginal examination shows 1 cm dilated cervix, 70% effacement, -3 station and cephalic. Which of the following is the next step to confirm the diagnosis? A. Continuous cardiotocography. B. Lecithin-sphingomyelin ratio. C. Repeat vaginal assessment in two hours D. Cervical length assessment by ultrasound scanning Answer: C, MedGard Q405) After spontaneous vaginal delivery of P2 woman, she had primary postpartum hemorrhage due to uterine atony. Which of the following is considered the standard of care? A. Oxytocin B. Ergonovine C. Carboprost D. Misoprostol Answer: A, MedGard Q406) A 34-year-old multiparous woman presents to the Maternal Health Clinic at 28 weeks' gestation with coughing and difficulty in breathing. She appeared restless and uncomfortable. https://t.me/SMLERide SMLE Ride ~ By The Elites Auscultation of the lung fields shows bilateral rhonchi. The nail beds and oral mucous membranes appear pale. She is allergic to dust, pollen, mold and animal hair. There is no history of smoking. She reports that the symptoms began 2 days prior and had started with coughing up clear-colored phlegm. Blood pressure 124/72 mmHg Heart rate 120 /min Respiratory rate 24 /min Temperature 37.5° C oral Which of the following tests is initially most appropriate? A. Spirometry B. Chest X-ray C. Arterial blood gas levels D. Hemoglobin estimation Answer: A, MedGard Q407) A 45-year-old woman complains of dysphagia to liquids, retrosternal pain on swallowing and regurgitation of food. Which of the following has the highest diagnostic value? A. Barium swallow B. CT with contrast C. Upper gastrointestinal endoscopy D. Lower esophageal sphincter manometry Answer: D, MedGard Q408) A 40-year-old man with Gastro Esophageal Reflux Disease presents to the general physician with 3-month history of intermittent retrosternal burning pain, worse on bending, nausea, regurgitation with an unpleasant taste in the mouth, and a nocturnal cough. The patient has been using over the counter antacids with no relief. Which of the following is the most appropriate course of action? A. Surgery B. Antibiotic C. Life style modification D. Proton pump inhibitors Answer: D, MedGard Q409) A 20-day-old infant has non-fading yellow discoloration of the skin and pale stool that began on the third day after birth. A week ago, the infant was diagnosed with normal physiological jaundice and advised phototherapy (see lab results). Test Result Normal Value https://t.me/SMLERide SMLE Ride ~ By The Elites Total bilirubin 150 < 19 umol/L Direct bilirubin 98