MCQ Questions January 2025, PDF

January MCQ 2025 1. A 20-year-old man was hit by a car 2 hours ago. On examination his abdomen is distended, tense and tender. BP 100/70, HR 120, RR 30, T 35, Spo2 90% Which type of shock is the most likely diagnosis? A septic B cardiogenic C hemorrhagic D anaphylactic Answer: C (MG) 2. A 37-year-o...

January MCQ 2025 1. A 20-year-old man was hit by a car 2 hours ago. On examination his abdomen is distended, tense and tender. BP 100/70, HR 120, RR 30, T 35, Spo2 90% Which type of shock is the most likely diagnosis? A septic B cardiogenic C hemorrhagic D anaphylactic Answer: C (MG) 2. A 37-year-old man with a history of chronic duodenal ulcer presented to the emergency department complaining of frequent postprandial vomiting since 2 weeks. On physical examination, he was dehydrated with positive succussion splash when shaking the abdomen. Which of the following is the most expected acid base abnormality? A. Metabolic acidosis B Metabolic alkalosis C compensated metabolic acidosis D compensated metabolic alkalosis Answer: B(MG) 3. 75 year old female, on us she has fibroid 6*7 Which of the following is the most appropriate management 1-progestin 2-UAE 3-HYSTERECTOMY 4-I FORGET Answer: C Recall from GB A 51-year-old woman P6+2 presents with pelvic pressure, heaviness in the lower abdomen, and heavy menstrual bleeding. Bimanual pelvic examination revealed a firm, irregular, enlarged uterus is felt (see report). Pelvic Ultrasound: A large submucous fibroid 7x8 cm in size. Which of the following is the most appropriate management? A. Myomectomy B. Hysterectomy C. Endometrial ablation D. Progesterone therapy Answer: B 4. Newborn has clinical fractures of a syndrome, which of the following is tests you will do 1- torch screening 2-metabloic screening 3-chormosomal analysis Answer: C 5. A 38-year-old man with 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. Upper gastrointestinal endoscopy: isolated bleeding fundal varices which has been controlled by sclerotherapy. US: 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 (MG) 6. A 22-year-old woman presented to the clinic with 2 months history of polyarthralgia, skin rash, mucosal ulcers and fatigue. Her clinical examinations revealed malar rash over her face and active arthritis at several joints. Hb 100 (120-160 g/L female) Platelets count 100 (150-400) ×109/L WBC 3 (4.5-10.5 ×109/L) ESR 35 (2-10 mm/h female) Lupus anticoagulant positive Urea 5 (2.75-7.4 mmol/L) Creatinine 78 (44-115 umol/L) C-reactive peptide 5 ( 97th percen9le) and the length is 75 cm (50th percentile). Physical examination confirms pallor of the skin and buccal mucous membranes. There is also a systolic heart murmur and a palpable spleen. Test Result Normal Values (Hb 90 112-165 g/L, RBC 3.0 4.6-4.8 x 1012/L) What additional laboratory finding is most likely to be significantly lower than the normal value? A. WBC B. MCV C. Platelets D. Reticulocyte count Answer: B(MG) 138. Gravid women came with PROM you administered a beta- memetic tocolytics (terbutaline). what is the side effect? A. abdominal pain B. palpitation C. diarrhea D. bad odor Answer: B 139. A 1-year-old child is brought to the clinic with a high fever, cough and respiratory distress for 3 days. On auscultation of the chest, there are generalized fine crackles. Chest X-ray: Showed puffy infiltrates with ill-defined margins throughout both lung fields. Which of the following is the most likely diagnosis? A. Bronchopneumonia B. Acute epiglottis C. Bronchiectasis D. Cystic fibrosis Answer: A(MG) 140. 12 hours baby boy delivered and found to have jaundice and looks pale, jaundice increased at 36 house What you will do next : A-Osmotic fragility test B. GC6D C-Electrophesis D-Sicle test MG Recall A newborn presents with jaundice 12 hours after birth. At 36 hours a>er birth, the jaundice became worse and blood smear was performed (see image and lab results). Test Results Normal Values Hb 91 112-165 g/L, Reticulocyte 7 0.2-1.2 %, Total bilirubin 2800 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 (MG) 168. A 76-year-old man newly diagnosed with depression started on 30 mg amitriptyline each night. Shortly after the beginning of treatment, he complains of dizziness every morning.Which of the following is the most appropriate next step in management? A. Change to a selective serotonin reuptake inhibitor B. Advise to take the medication with food C. Advice to take the medication in the morning D. Change amitriptyline dose to 10 mg 3 times a day Answer: D(MG) 169. A 58-year-old man presented to the Emergency Department complaining of right iliac fossa pain for 5 days. Physical examination confirmed a tender mass in the right iliac fossa. The patient was admitted, treated non-operatively and discharged from the hospital after 7 days with complete recovery (See report). Ultrasound: Appendiceal mass without collection. Which of the following is the most appropriate next step? A. No further intervention B. Colonoscopy in 6 weeks C. Open appendectomy in 12 weeks D. Laparoscopic appendectomy in 12 weeks Answer: B(MG) 170. Mother brought her 18 months old child after he had an episode of flu like illness, developed red jelly stool, and what is the commonest site for his current presentation: A.ilioilial B.jejinojejinal C.iliocolon D.iliojejinal Answer: C 171. A 35-year-old man is evaluated during a follow-up visit. He is a known case of rheumatoid arthritis that is well controlled with prednisone 15 mg and hydroxychloroquine 400 mg daily. His physical examinations are unremarkable (see lab results). Which of the following is the most appropriate management? A. Taper prednisone and start methotrexate B. Taper prednisone and start ibuprofen C. Taper prednisone and start cyclosporine D. Continue his treatment Answer: A(GB) 172. A 21-year-old woman primigravida at 38 weeks' gestation is in active labor. Her cervix is 5 cm dilated and fetal vertex is at +1 station. The tocodynamometer is done (see image). What is the best description of the initial acid-base status of the fetus? A. Uteroplacental insufficiency B. Respiratory acidosis C. Metabolic acidosis D. Asphyxia Answer: B(MG) 173. Newborn just delivered, was found tuft hair in low back central Next: A. MRI spine B. Us abdomen C. Brain CT Answer: A Explanation: - Evaluating bone defects and/or neural tissue lesions and planning for surgery. 174. A 59-year-old woman undergoes a hysteroscopy secondary to her complain of abnormal uterine: bleeding for the last couple of months (see image). Which of the following is the most likely diagnosis? A- Adenomyosis B- Endometriosis C- Subserosal fibroid D- Endometrial polyps Answer: D(PIC) 175. A 29-year-old known cardiac patient receiving anticoagulants is seen in the clinic for contraceptive advice. Which of the following is the most appropriate contraceptive method? A. Progesterone pills B. Bilateral tubal ligation C. Intrauterine contraceptive device D. Combined estrogen-progesterone contraceptive pills Answer: A(MG) 176. Schizophrenic patient came to ER complaining of constipation and other abdominal symptoms. By imaging: There is hugely dilated colon 10 cm. What is the management? A- Urgent colectomy. B- left sided colostomy. C- decompression colonoscopy with rectal tube. Answer: C Other Recall 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. 177. A 40 years old male with history of smoking 5 pack- year came to ER with retrosternal chest pain radiated to neck (or shoulder), on exam his blood pressure is 159/92 On ECG has ST depression in inferior leads. Which of the following is the most *considerable * (not significant) risk factor for his condition? A- age B- smoking C- male gender D- hypertension Answer: B 178. A 60-year-old female patient with a right breast bloody discharge. What is the initial investigation? A- Ultrasound B- Mammogram C- Ductogram D- CT Answer: B Other Recall from MG A 32-year-old woman presented with.2-month history of left breast pain associated with bloody nipple discharge. Physical examination confirmed a normal left breast and axilla. Which of the following is the most appropriate initial breast investigation? A. MRI B. CT scan **C. Ultrasound D. Mammogram 179. A 19-year-old girl complained of recurrent painful menstruation that starts on day one of her menses and subsides between day 3 to 4. The pain is severe enough to affect her daily activities and school attendance. All investigations were negative. She was started on non-steroidal anti-inflammatory drugs, her pain severity became less and she was able to resume normal function during menses. The patent is still not satisfied and insisting to receive a stronger pain killer. Which of the following is an appropriate management? A. Addition of diazepam B. Counseling and education on self-care C. Addition of magnesium tablets orally D. Uterine tocolytics during pain episodes Answer: B(MG) 180. pt has abd trauma in Laparotomy, found multiple liver tear. Best next step? A- Perihepatic packing B- Rt liver A ligation C- Ligate any leak vessel Answer: A Recall from MG An unstable trauma patient has confirmed multiple liver lacerations. Which of the following is the most appropriate management? A. Right hepatectomy B. Perihepatic packing C. Right hepatic artery ligation D. Individual ligation of the bleed Answer:B 181. Child mile stone Motor: can walk back ground Speech 3-4 words Age per month? A- 9 B- 12 C- 15 Answer: C 182. Pt had RTA in er, only has a bruise 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 Answer: C 183. An 8-year-old girl with presents with sore a throat and a temperature of 38°C. History reveals, she has not received any childhood immunization. A clinical examination confirms a severely swollen and edematous neck region with enlarged cervical lymph nodes. Her pharynx is erythematous with bleeding spots when a swab is taken for culture. An inspiratory stridor is noted upon auscultation of the lungs. Which of the following is the most likely diagnosis? A. Streptococcal pharyngitis B. Diphtheria C. Pertussis D. Thrush Answer: A(MG) 184. Researchers want to conduct a study to see the relation between smoking exposure with asthma. They will let a TV host call patients with asthma and ask if they were exposed to cigarette smoke as children. Which of the following makes it a covert study? A) Personal data will be anonymous B) You're going to share analytic results with them C) They don't know what medication they were given D) Patients will not know their role in the study Answer: D 185. A 2-year-old is brought to the clinic with sore throat and high-grade fever for 5 days. On examination, he is febrile and mildly dehydrated. The pharynx and tonsillar area is congested along with inflammation of the mouth and lips associated with gingivitis. Lesions in the mouth and lips appear as whitish-yellow plaques with erythematous base. Which of the following is the most likely cause? A. Adenovirus B. Coxsackie virus C. Herpes simplex virus D. Epstein-barr virus Answer: C(MG) A 2-year-old child presents to the clinic with 3-day history of vesicular lesions on the lips, gums and anterior surface of the tongue and hard palate. On examination, child looks dehydrated with dry mucus membrane the lesions look extensive, painful with mild bleeding. According to the mother, she is not eating or drinking well because of the pain. Which of the following is the most likely diagnosis? A. Impetigo B. Gingivostomatitis C. Herpeic whitlows D. Eczema herpeticum Answer: B 186. A 70-year-old man known to have chronic obstructive pulmonary disease (COPD). Examination revealed evidence of cor pulmonale with a significant degree of lower limb edema. His FEV1 is 40% (see lab result). Which of the following interventions is most associated with increased survival? A. Heart-lung transplant B. Corticosteroid therapy C. Pulmonary rehabilitation D. Long-term oxygen therapy Answer: D(GB) 187. Pediatric one year old, presents with fever, nasal congestion, runny nose, cough, and mild shortness of breath. Lab tests show slight fever and elevated white blood cell count, with oxygen levels at 88-90%in this range. What is the best treatment option for this patient?" A- Reassures the patient B- Hospitalization with rehydration C- steroid with nebulizer D- Admit the for hydration, Mucus suctioning, and respiratory monitoring." Answer: D, Illusterated. The diagnosis is bronchiolitis. 188. A new e-research study on the gastritis patient and the use of 2 different NSAIDs. The participation in the study will be through an online interview. What is the ethical errors in there research? A. Privacy will be invaded B. Information gathering is not accurate C. Informed consent cannot be monitored D. Participant cannot get out of the interview Answer: A 189. A 12-year-old obese boy is being observed in the Paediatric Outpatient Clinic as he has short stature, purple striae over his abdomen and hips, and hypertension. Which of the following is the most important initial investigation? A. MRI of the brain B. Adrenal scintigraphy C. MRI of the adrenal glands D. Morning and evening cortisol levels Answer: D(MG) 190. 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 191. A 65-year-old patient is admitted for elective ventral hernia repair. He is diabetic and hypertensive for 10 years. Examination confirms raised JVP, bilateral basal crepitation on chest auscultation and pedal edema. What is the most appropriate next step in management? A. Open repair as scheduled B. Laparoscopic repair as scheduled **C. Surgery after optimization at later date D. No surgery unless presents with obstruction Answer: C(MG) 192. A surgeon asked nurse to give IV epinephrine and she said: "IV epinephrine". What type of communication is this? A) check back B) closed loop communication C) call out Answer: B 193. A 69-year-old man with a 40-pack-year smoking history, shortness of breath, weight loss, and a large left-sided pleural effusion. Thoracentesis reveals 1,500 mL of bloody fluid that is strongly exudative by Light's criteria. What is the most appropriate next step? A. Empirical broad-spectrum antibiotics B. CT with contrast C. Echo D. Blind pleuritic biopsy Answer: B 194. A 12-year-old boy comes to the clinic with symptoms of unnatural tiredness and exertional dyspnoea. He has a past history of myopia. On physical examination, he has scoliosis and a pectus excavatum. Height above the 90th percentile Weight below the 25th percentile Echocardiography: Mitral valve prolapse and dilata9on of the ascending aorta. Which of the following is the most likely diagnosis? A. Aortic dissection B. Marfan Syndrome C. Congenital syphilis D. CHARGE associaton Answer: B(MG) 195. A 3-year-old boy presents to the Paediatric Emergency Department with fever, headache and generalized muscular pain over the last 24 hours. The child appears sleepy and irritable. There are several spots on the buttocks and legs. Physical examination confirms stiffness of the neck. After performing a lumbar puncture, an intravenous infusion of penicillin G is started. Blood pressure 90/55 mmHg Heart rate 120 /min Respiratory rate 38 /min Temperature 39° C Oxygen saturation 95% on room air Test Result Normal Value: WBC 25 4.5-10.5 x 109/L CSF Culture: Gram Negative diplococci. Which of the following is the most likely late complication? A. Ataxia B Seizures C. Deafness D Cranial nerve palsy Answer: C(MG), with pic 196. Male patient present with history of appendix perforation. What's antibiotic you give A-gram positive organism. B-gram negative organism C-gram positive and anaerobic organism D-gram negative aerobes and anaerobes organism Answer: D 197. A 6-year-old child seen in pre-school screening clinic with normal growth and general health status.What are the recommended vaccines at this stage according to national program in Saudi Arabia? A. MMR.DTP.OPV B. MMR.HBV.DTP.HAV C. MMR,varicella, DTP.OPV D. MMR,varicella.OPV.PCV Answer: C(MG) 198. A new study was conducted to investigate the effect of HIV on mortality. The target group was recruited from hospitals and followed for 10 years to compare mortality between negative and positive HIV patients. What does ethics impose on this research? A) A considerable profit B) Frequent appearances on social media C) To have in its center the rights of the target group D) To have in its center the achievement of the hypothesis Answer: C 199. A 65-year-old man complains of a 2-month history of dysuria associated with the passage of cloudy urine with bubbling on micturition. He reports a 2-year history of recurrent left iliac fossa pain. Physical examination was unremarkable (see reports). Sigmoidoscopy: Narrowed sigmoid colon with intact mucosa. Cystoscopy: Erythematous area in the dome of the bladder. Which of the following is the most likely diagnosis? A. Ischemic colitis B. Diverticular disease C. Squamous cell carcinoma of the bladder D. Transitional cell carcinoma of the bladder Answer: A(MG) 200. An 8 months old boy presents with multiple pyogenic infection , otitis media and multiple pneumonia within the last year mother also complained of chronic diarrhea what is the appropriate diagnosis? A- c1 inhibitors test B- Immunoglobulins C- Small bowel biopsy D- Ch 50 test Answer: B(MG) 201. A 49-year-old woman is evaluated because of fa8gue and weight gain although she follows a daily diet control and exercises 3 times per week for 45 minutes. She has hypercholesterolemia requiring statin therapy. Her mother had hypothyroidism. On physical examination, she has dry skin, thyroid gland mildly enlarged with a diffusely nodular texture. Laboratory studies are with similar results for TSH and T4 were obtained 4 months ago (see lab results). Blood pressure 143/93 mmHg Heart rate 66 /min BMI 29 kg/m2 Test Result Normal Values Thyroid-Stimulating Hormone 7.0 0.4 - 5.0 pU/mL. Thyroxine (T4 free serum) 9.5 8.5 - 15.2 pmol/L Thyroid peroxidase an8body (TPOAb) 150 20/min C. Heart rate 100/min D. SpO2 95% Answer: A(MG) 468. A 33-year-old woman has been assessed in the Emergency Department with an acute exacerbation of asthma. Which of the following features is most likely to indicate a life-threatening attack? A. Failure to improve after nebulized salbutamol 5 mg B. Oxygen saturations of 94% on room air C. Peak flow of 30% best or predicted D. Respiratory rate of 28/min Answer: C(GB) 469. A child enters the clinic and says “Hi” to doctor turns to mother and asks for milk, then child tries to give milk to her doll. She points at her own mouth and says “mouth”. When mother wipes milk off doll, child says “me” and imitates the mother and gives the doll a hug. What is developmental age of the child? A) 12 b) 15 c) 18 d) 24 Answer: C(MG) 470. 44 year old lady was hit by a vehicle, and brought to the emergency room conscious, on 100% 02, received 2 liters of normal saline and 2 liters of blood. Blood pressure 60/40 mmHg Examination confirmed abdominal guarding, rigidity and generalized tenderness 145 beat /Heart rate min CXR and pelvic x-ray were normal. Which of the following is the most appropriate step? A- DPL B-FAST C- CT scan D- surgical exploration Answer: D 471. Child not immunized, 9 or 8 months, what to do: A. Refer to ID consultant B. Catch up C. Give all Answer: A 472. A 28-year-old Primigravida at 8 weeks of gestation is known to have chronic hypertension and presented to Antenatal Clinic. Which of the following antihypertensive medications is contraindicated? A. Labetalol B. Nifedipine C. Lisinopril D. Methyldopa Answer: C(GB) 473. A pregnant woman with preeclampsia has just delivered and has a lax uterus with moderate postpartum hemorrhage. Physical examination reveals no laceration or retained product of conception. Which of the following medical therapies is most recommended? A. 5 units of oral oxytocin B. 0.2 mg intravenous ergometrine C. 0.5 mg intramuscular ergometrine D. 20 units oxytocin in a 500 mL of D5W given intravenously Answer: D(GB) 474. A 30-year-old G2 Pl AO Ll at 33 weeks of gestation presented with decreased fetal movement. Obstetric ultrasound was performed. Which of the following is the most reassuring biophysical profile score (BPS)? A. BPS 6/10 B. BPS 8/10 C. BPS 9/10 D. BPS 12/12 Answer: B(GB) 475. A 55-year-old man known case of liver cirrhosis with ascites presented to the Emergency Department complaining of progressive non- specific abdominal pain for 6 days, which was associated with vomiting. Examination confirmed generalized abdominal. Blood pressure 100/55 mmH Test Result Normal Values: WBC 23.3 4.5-10.5 x 109/L. CT scan abdomen: Moderate ascites with cirrhotic liver. Which of the following is the most appropriate step in treatment? A. Antibiotics B. Observation C. Diagnostic laparoscopy D. Exploratory Laparotomy Answer: A(MG) 476. A 30-year-old woman in her first pregnancy had an ultrasound confirming Monochorionic Diamniotic twins.What was the time interval between ovulation and cleavage? A. 0-72 hours B. 4-8 days C. 9-12 days D. >12 days Answer: B(GB) Other Recall A 30-year-old woman in her first pregnancy had an ultrasound confirming Monochorionic Monoamniotic twins. What was the time interval between ovulation and cleavage? A. 0-72 hours B. 4-8 days C. 9-12 days D. >12 days Answer: C A 30-year-old woman in her first pregnancy had an ultrasound confirming Dichorionic Diamniotic twins.What was the time interval between ovulation and cleavage? A. 0-72 hours B. 4-8 days C. 9-12 days D. >12 days Answer: A 477. An individual who has received all 3 doses of hepatitis B vaccine and has never had hepatitis B virus infection. Which of the following serologic markers is expected to be positive? A. HBcAb B. HBsAb C. HBeAb D. HBeAb and HBsAb Answer:B 478. A 30-year-old woman G2 P1 L1 presented 3 days ago to the Emergency Room at 30 weeks gestation with preterm premature rupture of membranes. She was managed expectantly and today she started to have fever and abdominal pain. Which of the following is the most likely diagnosis? A. Labor B. Chorioamnionitis C. Placental abruption D. Cervical incompetence Answer: B(GB) Other GB Recall A 26-year-old woman presents at 29 weeks of gestation with prelabor premature rupture of membranes for 7 days. Examination revealed she is having lower abdominal pain, rigors, and fever with purulent, foul-smelling vaginal discharge. Which of the following is the most likely diagnosis? A. Chorioamnionitis B. Urinary tract infection C. Antepartum hemorrhage D. Lower respiratory tract infection Answer: A 479. A 45-year-old nurse working in the pulmonary clinic, complains of fever and a productive cough for the last 3 months. She has received 2 courses of oral antibiotics, but showed no improvement (see image).Which of the following is the most likely diagnosis? A. Pulmonary tuberculosis B. H. Influenza pneumonia C. Infectious mononucleosis D. Streptococcal pneumonia Answer: A(GB) 480. A 34-year-old multiparous woman presents at 37 weeks' twins gestation with regular contractions. Which of the following fetal presentations is favorable for vaginal delivery? A. Transverse-cephalic B. Cephalic-cephalic C. Breech-breech D. Breech-cephalic Answer: B(GB) 481. Which of the following infections causes maculopapular rash? A- Meningococcemia (petechial or purpric rash) B- Varicella zoster (vesicular rash) C- Lyme disease (erythema migrans) D- Measles Answer: D 482. Which of the following is a common cause of fever of unknown origin in patients with HIV? A- Brucella B- Mycobacterium complex C- Connective tissue disease D- Endocarditis Answer: B 483. A 45-year-old woman is evaluated for a 3-week history of progressive shortness of breath that limit her activities. Medical history is significant for asthma and moderate mitral regurgitation. Her only medication is an albuterol inhaler as needed. On physical examination, her vital signs are normal. Cardiac examination reveals a grade 3/6 holosystolic murmur radiating to the axilla Lungs are clear to auscultation. Which of the following is the most appropriate diagnostic test? A. Spirometry B. Transthoracic echocardiogram C. Transesophageal echocardiogram D. Helical (or spiral) computed tomography (CT) of the chest Answer: C(MG) 484. A 45-year-old smoker came to the clinic for his diabetes follow-up. During discussion, he acknowledged that smoking is not good for his health. He plans to quit this year. According to the Stages of Change Model, at what stage of change is this patient? A. Precontemplation B. Contemplation C. Preparation D. Maintenance Answer: B(MG) 485. A 4-year-old child presented with recurrent chest infection and poor growth. On examination, chest auscultation revealed inspiratory crepitation with expiratory wheeze and finger clubbing. Further exploration in the history revealed the presence of very offensive and greasy stools. Which of the following is expected to be further identified in the physical examination? A. Nasal polyp B. Gynecomastia C. Inguinal hernia D. Small joint swelling Answer: A (MG), Dx is Cystic Fibrosis 486. A 23-year-old primigravida presented at 29 weeks of gestation with eclamptic seizures. Which of the following is the most appropriate management? A. Phenytoin B. Nifedipine C. Hydralazine D. Magnesium sulfate Answer: D(GB) 487. Mother concern about her child which was diagnosed with gastritis and ask you what are the typical for gastritis? A-Pain worse with drinking warm milk B-Pain wake the child C-pain worse in the morning and relived by eating D-Pain go through the back Answer: B 488. A 61-year-old obese man presented with daytime somnolence, poor concentration, nocturia, and progressive shortness of breath. Examination reveals an obese patient with bilateral lower limb edema and normal vesicular breath sounds on lung auscultation. Which of the following is the most appropriate investigation to establish the diagnosis? A. Chest X-ray B. Sleep study C. Echocardiography D. High-resolution CT lung Answer: B(GB), Dx is OSA 489. A patient with multiple benign nevi. His father diagnosed with melanoma 7 months ago. he is worried about it. What will you do? A. Reassurance B. Excision all navi C. Refer to dermatologist Answer: C 490. A 65-year-old woman with long-standing chronic renal failure presents with aches and pains for 1 month. Physical examination is unremarkable apart from general pallor. (PTH was high, Low ca and low PO+4). Which of the following is the most appropriate next step in management? A. Oral calcitriol B. Oral vitamin D3 C. Oral vitamin D2 D. Calcitonin nasal spray Answer: A(GB) 491. A female who recently got married has been taking oral contraceptive pills (OCPs) even before her marriage. She wishes to continue taking OCPs, but her husband wants her to stop. What is the most appropriate approach? A) Patient consent is enough B) Both the patient and her husband should be consented C) The patient's consent should be taken after discussion with her husband D) Husband's consent is enough Answer: B 492. Burn scenario of pediatric pt 1% third degree burn on genitalia Mx ? A- Refer to burn unit B- Wound dressing Answer: A 493. A full term baby born to a diabetic mother is brought to the clinic for assessment. The baby was born by vaginal delivery. The Moro reflex is absent on the right side. Baby weight is 4.8 Kg. Which of the following is the most likely cause? A. Intracranial haemorrhage B. Neonatal hypoglycaemia C.Neonatal sepsis D. Erb's palsy Answer: D(MG) 494. A 29-year-old man is seen in the pre-employment clinic for routine exam. He is asymptomatic. Physical examination revealed a systolic murmur that heard at the apex. The murmur is augmented with sustained handgrip and reduced with Valsalva manoeuvre. Which of the following is the most likely cause for this murmur? A. Mitral regurgitation B. Aortic regurgitation C. Mitral stenosis D. Aortic stenosis Answer: A(MG) 495. A 70-year-old man, with no past medical history, presents to the Emergency Department 4 hours after the onset of a severe crushing substernal chest pain radiating to the neck and left arm. Electrocardiography: Significant ST-segment elevation in leads I, AVL, V5, and V6. Where is the most likely site of cardiac infarction? A. Anterior B. Inferior C. Lateral D. Posterior Answer: C(MG) 496. A 66-year-old man with hypertension comes to the clinic for a follow-up. He is currently taking a combination of losartan and amlodipine, which is failing to keep his blood pressure within target. Examination is unremarkable. His blood test and renal function profile were within the normal limits. What is the most appropriate next step assuming he has no relevant contraindications? A. Add ramipril 1.25mg od B. Add atenolol 50mg od C. Add doxazosin 1mg od D. Add indapamide MR 1.5mg od Answer: D(MG) 497. A 42-year-old P4+2 presented with severe, progressive secondary dysmenorrhea and menorrhagia. Pelvic examination demonstrated a tender, diffusely enlarged uterus (see report). Endometrial biopsy: Normal endometrium. Which of the following is the most likely diagnosis? A. Endometritis B. Endometriosis C. Adenomyosis D. Uterine sarcoma Answer: C(GB) MG Recall A 45-year-old P5005 woman is complaining of severe secondary dysmenorrhea and menorrhagia. Pelvic examination reveals the uterus is symmetrically enlarged and tender. Endometrial biopsy is normal. Which of the following is the most likely diagnosis? A. Leiomyomas B. Adenomyosis C. Endometriosis D. Uterine sarcoma Answer: B 498. A 30-year-old woman delivered her first baby 3 weeks ago and presented to the Emergency Room with fever, chills, and breast pain. Examination revealed the right breast is red, enlarged, and tender, with no fluctuation found (see lab result). Which of the following is the most appropriate next step? A. Reassure her and send her home B. Stop breastfeeding and her symptoms will improve C. Warm compressors and tight-fitting bra with enough analgesia D. Antibiotics to cover Staphylococcus aureus and do breast ultrasound to rule out abscess Answer: D(GB) 499. 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 MG Recall A 60-year-old man is evaluated because of fatigue, constipation and cold intolerance for the last 8 months. Medical history is significant for Hodgkin lymphoma treated with radiation therapy 3 years ago and there is no family history of thyroid disorders. On physical examination, he has dry skin with mild periorbital edema and normal thyroid exam (see lab results). Test Result Normal Values Hb 120 130-170 g/L (Male) 120-160 g/L (Female) Sodium 129 134-146 mmol/L Thyroid-Stimulating Hormone 5.0 0.4 - 5.0 U/mL. Which of the following will establish diagnosis of hypothyroidism? A. Repeat TSH measurement in 4 weeks B. Free thyroxine (T4) measurement C. Thyroid ultrasound D. Thyroid scan Answer: B(MG) 500. A 24 year-old male complaining of tender mass and redness in perianal area. He has history of recurrent presentations that end with spontaneous drainage. Abdominal examination normal. Perianal examination shows one fistula with redness and fluctuation mass. What is the most appropriate next step in management? A- CT pelvis B- Oral antibiotics with outpatient follow-up C- Needle aspiration D- Examination under general anesthesia Answer: A SMLE by Hamza Next Step → CT pelvis Best of Definitive → Examination under GA 501. An 7 month old with febrile illness and multiple episodes of diarrhea and vomiting upon examination ill looking and dehydrated patient. What is the earliest sign of early compensated shock ? A- pale and cold skin b- Hypotension C-anuria D-confusion Answer: A 502. In a prone position, an infant can left his head 45" off the examination table and moves his head from side to side while following an object. He smiles and coos when the doctor plays with him but cannot maintain a seated position. What is the age in months this child most likely at? A. 1 В. 3 C. 6 D. 9 Answer: B(MG) 503. What is the age in month of child walking steadily independently, talk 6-10 words, point to 2 body parts, immature pencil grasp? A-17 B-19 C-12 D-24 Answer: B 504. Pt pregnant G3 have history of 1st pregnancy: abortion in the first trimester 2nd pregnancy: normal 3rd pregnancy: preterm PPROM at at28 weeks Now she’s GA12 weeks asymptomatic and everything normal. What’s will be your most appropriate next step? A. Do abdominal cerclage before pregnancy B. urgent McDonald cerclage C. follow up as high risk pt to monitor risk factor D. reassurance Answer: C 505. Pt he had TB 10 years ago, which was treated completely with Anti-TB, He presented now with abdominal distention. All labs provided: - High LFT - Serum albumin High, Ascitic tap: * Peritoneal albumin 15 * WBC within normal (only mesothelial cells 130) A- TB ascites B- malignant ascites C- cirrhosis D- Pyogenic peritonitis Answer: C (UQU) 506. A 40-year-old man with paraplegia following road traffic accident one year ago is brought to the Emergency Department because of sudden onset dyspnea and chest pain. On examination, he is in severe distress and cyanosed. He has left parasternal heave and loud P2. Chest is clear to auscultation (see lab results and reports). Blood pressure 80/55 mg Heart rate 110 /min Respiratory rate 30 /min Temperature 36.6 'C Oxygen saturation 86 % Test Result Normal Values ABG HCO3- 22 22-28 mmol/. ABG PCO2 4.2 4.7-6.0 kPa pH 7.4 7.36-7.45 ABG PO2 8.6 10.6-14.2 kPa Echocardiogram: Dilated right ventricle with pulmonary artery pressure of 55 mmH. Venous Doppler: Confirmed DVT in the left leg extending to the thigh. CT angiogram: large filling defect on the pulmonary trunk sth like that. Which of the following is the best line of management? A. Insertion of vena-caval filter B. Alteplase infusion C-Enoxaparin D-Warfarin Answer: B(MG), Dx is Massive PE + Patient Unstable 507. Man who experienced a road traffic accident (RTA), had a lucid interval, and then lost consciousness, with a convex lesion found on CT scan, what is the most appropriate management? A- Shunt B- Craniotomy C- Mannitol D- Intubation Answer: B, Dx is Epidural Hematoma 508. mother came with her child for Dtap vaccine, he seized, her son has runny nose, cough, fever, diagnose with URTI (asking about vaccine) A. give now B. delay until his symptoms improve C. cancel D. give without pertussis part Answer: A 509. A 35 years old patient come with medial leg ulcer. The most likely diagnosis is: A- Diabetic B- Venous hypertension C- Atherosclerosis D- Buerger's disease Answer: B 510. What is the appropriate method to prevent adhesions in a pregnant woman with a history of previous difficult cesarean sections and scheduled for elective cesarean section? A) Maintain hemostasis B) Insert drain C) Perform Cesarean section before going into labor D) Administer antibiotics preoperative Answer: A 511. A 7-year-old girl is complaining of sore throat for the last 2 days. Today, she has developed fever of 38.7 °C when measured at home, which has been relieved by acetaminophen. On examination, she was found to have tender anterior cervical adenopathy and pharyngeal and tonsillar exudate. The rest of her physical exam is unremarkable. Which of the following is best next step toward diagnosis? A. Throat culture B. Echocardiography C. Rapid antigen detection test D. Fine needle aspiration for cervical adenopathy Answer: C(MG) 512. A 40-year-old man is evaluated in the Emergency Department for several episodes of hematemesis. He has no previous similar episodes. His history is unremarkable. He takes no medications. There is no jaundice or other signs of chronic liver disease. Abdominal examination reveals no tenderness, guarding, or rebound (see lab results). Blood pressure 105/65 mmHg Heart rate 110 /min Temperature 36.8 °C Test Result Normal Values: Hb 95 130-170 g/L (Male)120-160 g/L (Female) Platelets count 250 150-400 x 109/L WBC 12 4.5-10.5 x 109/L Prothrombin time 11 10-13 sec Alanine aminotransferase 30 5-40 IU/L Alkaline phosphatase 26 39-117 IU/L Blood urea nitrogen 14 2.8 to 8.9 mmol/L Creatinine 88 44-115 mol/L Which of the following is the most likely cause of his gastrointestinal bleeding? A. Erosive gastritis B. Peptic ulcer disease C. Esophageal varices D. Mallory-Weiss tear Answer: B(MG) 513. Child came with a potentially toxic dose of paracetamol. The physician requests an “Acetaminophen level”. The lab technician calls to report results. He says: “two” stops and pauses and then says ”one, three”. The nurse mistakenly writes it as “2.13” while the real result was “213”. The patient went into irreversible liver damage, which of the following explain the error that has happened? A) Doctor did not check nurse B) failure to communicate and pick up information C) Technician didn't check if the nurse got the number correctly Answer: B 514. Patient with anencephaly baby advised for pregnancy termination she said yes for termination, but the husband didn’t agree, what to do? A- Written consent from both B- Husband should be prevailed C- Wife should be prevailed Answer: A 515. A 75-year-old man admitted to Coronary Care Unit with acute MI, complicated with bacterial pneumonia, patient on tazocin for 12 days. Examination revealed abdomen severe tenderness in the right upper quadrant (see report). Blood pressure 100/60 mmH Heart rate 96 /min Respiratory rate 22 /min Temperature 38.3 °C Ultrasound abdomen: Distended gallbladder with thick wall and pericystic fluids, there is no gallstones. which of following is the most appropriate management? A. ERCP drainage B. Emergency cholecystectomy C. Change tazocin to meropenem D. US guided tube cholecystostomy drainage Answer: D(MG) 516. An 82-year-old woman admitted to the hospital for meningitis. Her CSF was obtained and Gram stain showed Gram negative cocco-bacilli. Which chemo-prophylaxis should be offered to her contacts? A. Rifampicin B. Ceftriaxone C. Ciprofioxacin D. Azithromycin Answer: A(MG) 517. female with flank pain and fever , confirmed to have pyelonephritis, she is taking the appropriate antibiotic since 5 days or 7 She still had fever 38 and there's tenderness on her right loin Urine culture: E. Coli which is sensitive for the antibiotic she is taking. What is the most appropriate next step? A- Renal US B- Change the antibiotic C- Close observation D- Repeat culture Answer: A 518. A 27-year-old primigravida presented at 36-weeks of gestation with headache, blurred vision (see lab result). Blood pressure 160/110 mmHg Heart rate 76/min Respiratory rate 18/min Temperature 36.8 °C Test Result Normal Values Protein ++ absent Which of the following is the most appropriate medication for acute treatment of hypertension? A.Clonidine B. Methyldopa C. Hydralazine D. Sodium nitroprusside Answer: C(MG) 519. A 27 years old healthy male presented with right sided weakness. He has significant femur fracture 1 week ago. 2 days ago has pulmonary embolism. Brain imaging shows left cerebral infarction. Which of the following is the most likely the cause of his presentation? A. Atrial fibrillation B. Carotid artery stenosis C. Patent foramen ovale D. Hypertrophic cardiomyopathy Answer: C(UQU) 520. A 27-year-old man sustains a single gunshot wound to the left thigh. In the ER, he is noted to have a large hematoma of his medial thigh. He complains of paresthesia in his left foot. On examination, there is pulsatile hematoma with weak pulses palpable distal to the injury and the patient is unable to move his foot. Which of the following is the most appropriate initial management of this patient? A. CT Angiography B. Immediate exploration and repair in OR C. Observation D. Bedside local wound exploration Answer: B 521. Patient with a gunshot wound to LUQ and the patient underwent splenectomy + distal pancreatectomy + partial colectomy 1 week ago. Now presents with abdominal distention and abdominal pain. On P/E, he has mild LUQ tenderness only. All vitals given in the scenario were stable except for 110-120 HR + 39.6°C T (I’m sure about the temp), what to do NEXT? A) US B) X-ray C) CT scan D) Exp laparotomy Answer: C 522. A 7-year-old boy presents with recurring upper abdominal pain and occasional vomiting after meals over the last 6 months. The child has not gained any weight since the beginning of the symptoms and has a loss of appetite. The father has a history of peptic ulcer. Physical examination confirms epigastric tenderness on palpation. A gastroscopy is performed and a biopsy is taken for microbiological testing. Treatment with metronidazole and a proton pump inhibitor is recommended. Laboratory findings are normal (see report). 13C-Urea-breath test: positive. Which additional medication should be added to the treatment? A. Clarithromycin B. Tetracycline C. Prednisone D. Sucralfate Answer: A(MG) 523. A 30-year-old woman underwent ovarian cystectomy. While the nurse was preparing the specimen to be sent to histopathology, there was a leak of thick fatty material from the cyst. Which of the following is the most likely diagnosis? A. Fibroma B. Thecoma C. Cystic teratoma=Dermoid cyst D. Granulosa cells tumor Answer: C(GB) 524. A 38-year-old primigravida at 33 weeks' gestation is diagnosed with small for gestational age fetus and reversed end-diastolic flow on umbilical artery Doppler. Which of the following is the most appropriate management? A. Repeat Doppler ultrasound in 1 week B. Immediate delivery by caesarean section C. Antenatal steroids and delivery within 1 week D. Repeat ultrasound growth assessment in 2 weeks Answer: C(GB) 525. A 52-year-old man with rheumatoid arthritis for 12 years. His current treatment consists of methotrexate 15 mg weekly and adalimumab 40 mg/2 weeks. He presented to the clinic complaining of fever and shortness of breath for 1 week. His chest examination revealed coarse crackles over the lower part of the right lung (see lab results). Which of the following is the most appropriate action to be taken on this visit? A. Hold adalimumab and start antibiotics B. Hold methotrexate and start antibiotics C. Hold his current treatment and start antibiotics D. Continue his current treatment and start antibiotics Answer: C(GB) 526. PPROM which protein could help establish the diagnosis? A- PP14 B- Placental alpha-1 micro globulin Answer B 527. A 25-year-old patient is diagnosed with diabetic ketoacidosis (see lab results). Blood pressure 80/50 mmHg Heart rate 140 /min Respiratory rate 26 /min Temperature 36.6° C Test Result Normal Values Random Glucose 52.7 3.9 - 5.5 mol/L Potassium 6 3.5-5.1 mmol/L Bicarbonate 5 21-28 mmol/L Which of the following is the best initial management? A. Dopamine drip to raise blood pressure above 90 mm/Hg B. 2L of normal saline with Kcl 20 mEq/L intravenously C. 20-unit regular insulin intravenously, followed by 5% dextrose in water at 200 mL/h D. Normal saline 2 L as an intravenous bolus and insulin intravenous infusion at 0.1 U/kg/hr Answer: D(MG) 528. A 27-year-old man presents to the clinic with 1-month history of low mood and lack of sleep. It was associated with weight gain, isolation and concentration impairment. His wife mentioned that he bought a very expensive car and thinking that he is wealthy man 3 months ago. He is very talkative and difficult to interrupt. Which of the following medications is the most effective for long-term management? A. Lithium B. Bupropion C. Olanzapine D. Mirtazapine Answer: A 529. A 53-year-old male patient with significant past medical history of ischemic heart disease came to ER with history of sever shortness of breath started suddenly. Other past medical history is unremarkable. Upon examination, the patient is conscious, oriented and distressed with respiratory rate of 31, pulse is 112, and SpO2 of: 88. Cr Clearance 27. normal Patient past history ihd, c/o sob not very severe goes with embolism. His bmi is 41 What do you give him A- Ufh 5000 bid B- Ufh 7500 g8 hours C- Enaroxpan 40 bid D- Fondaparinux Answer: B 530. A 31-year-old woman G2 P1 L1 had an uneventful pregnancy and went into spontaneous vaginal delivery. She delivered a healthy boy weighing 3000 g. After placental delivery, she started to bleed heavily. Which of the following is the most appropriate medication for managing her postpartum hemorrhage? A. Propofol B. Misoprostol C. Dexamethasone D. Magnesium sulfate Answer: B(GB) 531.What the most important information WHO should take the from national bank and ministry of health? A. Risk factor B. Health equipment C. Health determinet D. Health indicators Answer: D 532. An 8 months old child came to the clinic by his parent because of multiple pyogenic infectious, and streptococcus pneumonia and recurrent otitis media. His parent report that he has chronic diarrhea. What is the most appropriate investigation to establish the diagnosis? A-C1 inhibitor level B-immunoglobulin level C-small intestinal biopsy D- hemolytic CH50 somthing Answer: B 533. A 27-year-old woman with asthma has not had a severe attack for the last 3 months. However, she has a history of cough and wheezing 2-3 times each week. Which of the following is the most appropriate management? A. Ipratropium bromide B. Inhaled corticosteroid C. Salbutamol D. Salmeterol Answer: B(MG) 534. Mother in labor in active stage of labor you give her oxytocin after 2 hour you can see the scalp of the baby and his face is on the perineum and his sagittal fissure is on the left occipto anterior position. What is you management? A. ventos B. forceps C. CS D. wait one hour Answer: D Similar recalls primigravida woman during labor, complete dilatation for 2 hours. And take epidural. Fetal scalp can be seen in the introitus, Head is in the perineum in left occipital posterior. CTG reassuring. What will you do? - Outlet forceps - Vacuum - C section - Wait 1 hours Answer: D Lady in labor, Primigravida, and fetus in distressed FHR 70 BPM, station -2, fully dilated, good regular contractions, what will you do? A- Ventose B- Observe C- Reassurance D- Encourage to push Answer: D A 19-year-old G1 P0 at 42 weeks is admitted for induction of labor. Her antenatal care was uncomplicated. Examination revealed the cervix was closed and long. Prostaglandin E2 is placed vaginally. An hour later, she started to contract regularly, and the fetal heart dropped to 70 bpm and was not recovering. Her vaginal examination showed a fully dilated cervix and presenting part at +2. Which of the following is the most appropriate next step? A. Consider oxytocin B. Pressure the patient C. Take her for caesarean section D. Start pushing and consider applying ventouse Answer: D 535. A 21 years old is involved in a head-on collision as the driver of a motor vehicle. He is noted to be severely tachypneic and hypotensive. His trachea is deviated to the left, with palpable subcutaneous emphysema and reduced air entry in the right hemithorax. BP: 80/60. The most appropriate management: A- Needle decompression B- intubation C- Chest tube D- Iv line There was no mention of the level of consciousness or O2 Sat Answer: A MG Recall A 21-year-old man was brought to the Emergency Department following a motorbike crash, complaining of difficulty in breathing. On examination, he was conscious, oriented, dyspnoeic with reduced breath sounds and tympanic percussion over the left hemithorax. Blood pressure 90/55 mmH Heart rate 110 /min Which of the following is the most appropriate next step in management? A. Plain chest X-ray B. Endotracheal intubation and ventilation C. Needle decompression of left hemithorax D. Chest tube insertion in the left hemithorax Answer: C Top Gs Recall 21 years old is involved in a head-on collision as the driver of a motor vehicle. He is noted to be severely tachypneic and hypotensive. His trachea is deviated to the left, with palpable subcutaneous emphysema and poor air entry in the right hemithorax. The most appropriate first treatment procedure should be: a) Arterial puncture to measure blood gases. b) Stat chest x-ray. c) Intubation and ventilation. d) Needle thoracocentesis or tube thoracotomy prior to any investigations. e) Immediate tracheostomy. Answer: D 536. Newborn diagnosed with immunology as 46 XX ambiguous genitalia clitromegaly and fused labia, U/S show uterus and ovaries A. 46 XX true hermaphdite B. congenital adrenal hyperplasia C. Mixed gonadal dysgenesis Answer: B 537. 18- Milestones of a child, what is the age in months? Gross motor: walks backwards Fine motor: Eats with spons and knife Language: 5-6 words Social: plays with cubes (not sure about this one) Sure about everything (including choices) except social. A- 6 months B- 9 months C- 15 months D- 24 months Answer: C 538. Diabetic patient with coronary artery disease , which of the following in lipid profile is targeted? A - Triglyceride > 150. B - Total cholesterol < 250. C- LDL < 70. D - HDL > 70. Answer: C 539. A male neonate born by cesarean section at 31 weeks' gestation with birth weight 1300g. He has developed apnea, high gastric residual levels, and bloody stools. Necrotizing enterocolitis is suspected. which of the following features is associated with a higher risk for developing necrotizing enterocolitis? A. Male gender B. Bloody stool C. Cesarean section delivery D. Birth weight of less than 1500g Answer: D(MG) 540. Patient came with left hemiplegia, exam suggestive of stroke (did not mention time frame and whether going for tPA or not), what is the BP threshold to start antihypertensives? A- 220/120 B- 245/140 C- 150/90 D- 120/80 Answer: A 541. A 6-month-old infant develops a cough, coryza, fever, expiratory wheezing, grunting, tachypnea, rib retraction, and air trapping. Which of the following is optimal immediate treatment? A. Erythromycin B. Penicillin C. Steroids D. Oxygen Answer: D 542. A 25-year-old woman presented with dyspnea and cyanosis. Physical examination revealed elevated JVP with predominant a-wave and left parasternal heave. There is an ejection systolic murmur best heard in the left second intercostal space that increases in intensity during inspiration. An ejection click is also heard in the same area Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 20 /min. Which of the following is the most likely diagnosis? A. Aortic stenosis B. Coarctation of aorta C. Ventricular septal defect D. Congenital pulmonary stenosis Answer: D(MG) 543.A 27-year-old primigravida presented at 36-weeks of gestation with headache, blurred vision. Blood pressure 160/110 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.8 °C Test Result Normal Values Protein +++ absent Which of the following is the most appropriate medication for acute treatment of hypertension? (In my exam it didn’t say “acute treatment”, just most appropriate) A. Clonidine B. Methyldopa C. Labetalol D. Sodium nitroprusside Answer: B 544. A 47-year-old patient presents with 12 hours of severe pain and swelling of the right first metatarsophalangeal joint. On examination, the affected joint is erythematous and tender. Blood pressure 110/65 mmHg, Heart rate 105 /min, Respiratory rate 12 /min, Temperature 38°C. Which of the following is the most likely cause? A. Sodium urate crystals B. Staphylococcus aureus C. Disseminated gonorrhea D. Calcium pyrophosphate crystals Answer: A(MG), Dx is Gout 545. A 68-year-old man was admitted through the Emergency Department with a 24-hour history of sudden severe lower abdominal pain, associated with progressive abdominal distension and constipation. On examination, the abdomen was hugely distended, tympanic with tenderness over the left iliac fossa. Digital rectal examination confirmed an empty rectum. Test Result Normal Value: WBC 22 4.5-10.5 x 109/L Abdominal plain X-ray: Y-shaped shadow surrounded by a hugely distended colon arising from the pelvis. Which of the following is the most appropriate intervention? A. Fleet enema B. Colonoscopy C. CT with double contrast D. Sigmoid colectomy with end colostomy Answer: D(MG) 546. 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(MG) 547. A 50 year-old man becomes disoriented on the 4th post-operative day of abdominal aortic aneurysm repair. Vital signs remain outside of normal limits despite attempts at fluid resuscitation. He has passed a negligible volume of urine since he was catheterized one hour ago. His peripheries are warm to the touch. - Blood pressure 90/40 mmHg - Heart rate 140 /min - Respiratory rate 36 /min - Temperature 36.6 °C What type of shock is the most likely diagnosis? A. Septic B. Cardiogenic C. Hemorrhagic D. Anaphylactic Answer: A(MG) 548. A 17-year-old girl complained of anorexia nervosa was admitted for initiation of nutrition, the blood samples revealed hypophosphatemia, hypokalemia, hypomagnesemia, what is the cause of the laboratory investigation? A. Wrong protocol of nutrition B. Wrong test C. Refeeding syndrome D. Wrong kit in lab Answer: C 549. A 4-year-old boy previously healthy came to the clinic with history of limping for the last 2 days. On physical examination, he is keeping his left leg flexed and refusing to move it or allowing anyone to touch it. Imaging is showing effusion of the left hip. Blood pressure 90/61 mmH Heart rate 126 /min Respiratory rate 29 /min Temperature 38.8 °C Oxygen saturation 98 % Which of the following is the most likely causative organism? A. Enterobacter B. H. Influenzae C. Group B streptococcus D. Staphylococcus aureus Answer: D(MG), Dx is Septic Arthritis 550. A 60-year-old man presents to Emergency Department with altered sensorium. He was recently diagnosed to have inoperable small cell carcinoma of the lung. On examination, he is euvolemic. Blood pressure 110/70 mmHg Heart rate 76 /min Test Result Normal Values: Sodium 115 134-146 mmol/L Potassium 3.8 3.5-5.1 mmol/L Urea 4.3 2.75-7.4 mmol/L Creatinine 76 44-115 mol/L. Which of the following is the best initial management? A. 5% dextrose B. Normal saline C. Hypertonic saline D. D. Half normal saline Answer: C(MG), Dx is Symptomatic Hyponatremia 551. Patient developed a circumferential right forearm burn. sat in right digit is 86% , weak pulse ( not absent pulse).What is the appropriate action? A- bedside escharotomy B- measure intra compartmental pressure Answer: A 552. An 8-year-old boy presents to the Pediatric Clinic with weakness, headache, nausea and anorexia that began 1 week before. Physical examination shows pitting edema, grade 2+ on the edema scale, over the eyelids and ankles. There is pallor of the skin, mucous membranes and nail beds. A 24-hour urine collection reveals a urine production of 20 ml per hour while the boy's bodyweight is 27 kg. the urine appears dark brown. Temperature 38.6° C What clinical history would be most important for the diagnosis? A. Diagnosed sickle cell disease B. Recurrent urinary tract infections C. Abdominal trauma 1 week before D. Impetigo contagiosa 1 month before Answer: D(MG), Dx is Post-Strepto GN 553.A 17-year-old man presented to Emergency Room with right lower quadrant pain and anorexia. Examination revealed tenderness and rebound tenderness at Mc Burney's point (see image, lab result and report). Heart rate 92 /min, Temperature 38.2 °C Test Result Normal Values WBC 21.3 4.5-10.5 x 109/L Abdominal X-ray: Round 1.5 cm Radio opaque area at right iliac fossa. Which of the following is the most appropriate next step? A. Appendectomy B. Urgent urology consult C. Non contrast CT abdomen D. Ultrasound of the gall-bladder Answer: A(MG) with Pic 554. A 40-year-old presents with a right breast lump that has been present for 2 years. On examination, there is firm lump about 4 x5 cm in the inner quadrant, overlying skin is normal and no palpable axillary nodes. Trucut biopsy: Cystosarcoma Phylloides, Which of the following is the most appropriate management? A. Chemotherapy B. Radiation therapy C. Wide local excision D. Simple mastectomy Answer: C(MG) 555. A 2-month -old bay presents to the Pediatric Emergency Department with coughing, wheezing and rapid breathing for the last 2 days. The infant was born at 38 weeks' gestation; his birth weight is 3.5 kg and now weighs 5.2 kg. He had developed a runny nose, irritability and difficulties feeding without having to pause several times. His 3-year-old brother has a cold with fever and cough. Physical examination shows a prolonged expiratory time, nasal flaring and subcostal retractions. Cardiac auscultation results are normal and the spleen and liver are of normal size for the child's age. Blood pressure 86/58 mmH Heart rate 146 /min Respiratory rate 56 /min Temperature 38.6° C Oxygen saturation 96% on room air Which of the following is the most appropriate next step in making a definitive diagnosis? A. Chest X-ray B. Throat swap C. Bronchoscoy D. Nasopharyngeal aspirate Answer: D(MG), Dx is Bronchiolitis 556. A 20-year-old woman presents with a lump in the right lower quadrant of her breast that has been present for the last 2 years. The lump was initially small but over the past 6 months has constantly been growing in size. On examination, the mass measures 8 × 10 cm, is mobile and not attached to underlying muscles. Overlying skin is thinned out due to pressure effect of the mass. There are no signs of surrounding inflammation or infection. Which of the following is the most likely diagnosis? A. Mastitis B. Phyllodes C. Galactocele D. Fibroadenoma Answer: B(MG) 557. A 20-year-old woman complains of the recent onset of a swelling in her left breast. Examination confirms a smooth walled oval shaped mass measuring 2x2 cm. Which of the following is the most likely diagnosis? A. Breast cyst B. Duct ectasia C. Fibroadenoma D. Carcinoma of breast Answer: C(MG) 558. A 23-year-old woman presented with breast tenderness, abdominal bloating, and food cravings. She has a 6-month history of tiredness, anxiety, emotional lability, difficulty concentrating and insomnia. There are no menstrual irregularities or prodromal life stressors. The symptoms recurred on a regular basis during the week leading up to the menstrual period but completely resolve within the first 3 days of menses. The patient felt totally incapacitated when symptomatic, and the symptoms adversely affect personal and professional life. Which of the following is the best-evidenced treatment? A. Selective serotonin uptake inhibitors B. Oral medroxyprogesterone acetate C.Progesterone vaginal suppositories D.Transdermal estrogen patches Answer: A(MG) 559. A 40-year-old healthy man came to the clinic requesting a screening colonoscopy. He is asymptomatic with no family history of colon cancer. Clinical examination is unremarkable. Test Result Normal Values RBC 4 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 13.3 130-170 g/L (Male) 120-160 q/L (Female) Platelets count 321 150-400 x 109/LWBC 4 4.5-10.5 x 109/L Based on the latest recommendation from local and international gastroenterology associations, what is the recommended age of screening colonoscopy for this average risk patients? A. 45 B. 55 C. 65 D. Order for him now Answer: A(MG) The same case but different choices A. Now and repeat in 5 years B. Start in 50 Answer: B 560. A 30-years-old hospitalized woman post cesarean section was treated for 6 days with clindamycin and cefuroxime for post-partum endometritis when she developed profuse, watery diarrhea, cramping abdominal pain and fever. An enzyme immunoassay of the stool revealed the presence of a bacterial enterotoxin. Which of the following is the most appropriate treatment? A. Ciprofloxacin B. Metronidazole C. Amoxicillin plus clavulanate D. Continue the same medication Answer: B(MG) 561. A 22-year-old woman previously healthy was admitted with 3-days history of fever, myalgia and pharyngitis. She gave history of 1-day macular rash over the trunk after she received amoxicillin from private clinic. On examination, she has generalized lymphadenopathy. Which of the following is the most likely diagnosis? A. Diphtheria B. Hodgkin's disease C. Infectious mononucleosis D. Cytomegalovirus infection Answer: C(MG) 562. A 77-year-old man with a history of ischemic heart disease is seen in the Hypertension Clinic. He is taking 4 anti-hypertensives drugs. Physical examination is unremarkable. Abdominal ultrasound shows asymmetrical kidneys. Blood pressure 169/99 mmHg, Heart rate 79 /min. Which of the following is the most likely diagnosis? A. Renal artery stenosis B. Cushing's syndrome C. Primary hyperaldosteronism D. Adult polycystic kidney disease Answer: A(MG) 563. A 55-year-old woman complains of abdominal pain, distension, and bilious vomiting. On examination she is pale, dehydrated, abdomen is soft, distended, with hyperdynamic gut sounds. She was diagnosed with gallstone disease 10 years ago (see report). Blood pressure 140/90 mmHg Heart rate 120 /min Temperature 36.7 Test Result Normal Values Hb 100 120-160 g/L Platelets count 125 150-400 × 109/L WBC 18.6 4.5-10.5 x 109/L CT scan: Air in the biliary system. Which of the following is the most likely diagnosis? A. Cholangitis B. Pancreatitis C. Cholecystitis D. Gallstone ileus Answer: D(MG) 564. A 22-year-old man presents with altered sensorium for the last 2 days and headaches for 5 days, with a history of fever for the preceding month. On examination, there is nuchal rigidity. Test Result Normal Values: Hb 100 130-170 g/L WBC 11 4.5-10.5 x 109/L Glucose, fasting 7.22 3.5-6.5 mmol/L Cerebrospinal Fluid: Test Result Normal Values Appearance turbid clear Cells 240 0-3 /uL, Total protein 3.6 0.22-0.33 g/L Glucose 2.7 2.50-3.89 mol/L Neutrophils 23 0-1% Lympocytes 73 0-1% Which of the following is the most likely diagnosis? A. Septicaemia B. Tubercular meningitis C. Phylogenetic meningitis D. Viral meningoencephalitis Answer: B(MG) 565. A 45-year-old man involved in a motor vehicle accident with an isolated head injury, remains in coma for 5 days after the accident.Which of the following is the most appropriate feeding method in the early stage of management? A. Gastrostomy tube feeding B. Nasogastric tube feeding C. Central parenteral feeding D. Peripheral parenteral feeding Answer: B(MG) 566. A 40-year-old Healthy Primigravida with a history previous deep venous thrombosis. Which of the following is the most appropriate management? A. Aspirin B. Heparin C. Enoxaparin D. No anticoagulation Answer: D(MG) 567. A 54-year-old woman complains of a left breast mass that has been present for 9 months. Physical examination confirmed a 3 x 3 cm firm fixed mass at the left retro-areolar area with associated nipple retraction. Bilateral breast mammogram: Speculated mass at left retro-areolar region associated with suspicious clustered microcalcifications. There are multiple pathological left axillary lymph nodes. Findings coded as BI-RADS V (Probably Malignant). Which of the following is the most appropriate next step in management? A. Excision biopsy B. Needle core biopsy C. Staging CT and bone scan D. Modified radical mastectomy Answer: B(MG) 568. A 23 years old college student was brought to the psychiatric outpatient clinic with 3 months history of persecutory delusions hearing voices commenting on his actions and disorganized behavior without disturbance of mood then returning to normal with no medication. Which of the following is the most likely diagnosis? A schizophreniform disorder B brief psychotic disorder C delusional disorder D schizophrenia Answer: A(MG) 569. A 20-year-old nulliparous healthy married woman presents to the clinic requesting contraception. She has a history of menorrhagia and occasional dysmenorrhea. No family history of note. Which of the following is the most appropriate contraception method? A. Progesterone only pills B. Depo-Provera injection C. Combined oral contraceptive pills D. Non-steroidal anti-inflammatory drugs Answer: C(GB) 570. A 34-year-old Pregnant G3p2 k/c of Multiple gestational hypothyroidism and control thyroxine her baby has single umbilical artery. what is the cause? A- Maternal age B- Multiple gestation C- Parity D- hypothyroidism Answer: B 571. A 12-month-old boy is brought to the clinic with a complaint of decreased appetite. The child was born at 36 weeks' gestation and has been fed with cow's milk formula since the age of 9 months. The body weight is 13.6 kg (> 97th percen9le) and the length is 75 cm (50th percentile). Physical examination confirms pallor of the skin and buccal mucous membranes. There is also a systolic heart murmur and a palpable spleen (see image and lab results). Test Result Normal Values: Hb 90 112-165 g/L, RBC 3.0 4.6-4.8 x 1012/L What additional laboratory finding is most likely to be significantly lower than the normal value? A. WBC B. MCV C. Platelets D. Reticulocyte count Answer: B(MG) with Pic 572. A 29 y/o male came to ER thought to have acute appendicitis went to ER for appendectomy they did gridiron incision and found the appendix normal. what should the surgeon do? a. insert drain and close b. look for Meckel's diverticulum c. do a midline incision and remove appendix d. remove appendix and close abdomen Answer: B 573. Which of the following is the most appropriate management of an asymptomatic umbilical hernia in a 4-year-old? A. Reassurance B. Local cauterization C. Surgical correction D. Elastic support to the mid-abdomen Answer: C Other MG Recall A 2-month-old baby is brought to the clinic because of umbilical bulge that appears when child is crying. Examination revealed 1 cm reducible umbilical hernia. Which of the following is most appropriate treatment? A. Observation B. Hernia sling C. Surgical repair D. Delayed surgical repair at age of 6 months Answer: A 574. During a routine check-up, a child shakes hands, knows his name, gender and age. He can dress with help and ride a tricycle. He points to red colours when asked to do so but had difficulty copying a square. What is the age in years this child most likely at? A. 2 B. 3 C. 4 D. 5 Answer: B 575. A 50-year-old man presented to the Emergency Department following a fail from 20 feet, on arrival he has a Glasgow Coma Scale of 8 with no external sign of injury. Mean arterial pressure 65 mmHg Intracranial pressure 15 mmHg. Which of the following is the most likely cerebral perfusion pressure in mmHg? A. 40 B. 50 C. 60 D. 70 Answer: B 576. A lady has a waist circumference 125 and hip circumference 108, obese LDL: HIGH HDL: normal 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 577. A 75-year-old woman presents with a 7-day history of severe pain in the epigastrium. The pain is relieved by vomiting and becomes worse when ea>ng. History confirms that she has been taking medication for joint pain for the last 2 months. Which of the following is the most likely diagnosis? A. Esophagitis B. Acute gastritis C. Boerhaave's syndrome D. Perforated peptic ulcer Answer: B(MG) Notes:Esophagitis= mettalic test in mouth Acue gastritis =7day relived by vomiting Boerhaave syndrom = rupture of esophagus and subcutaneous emphysema Perforated peptic ulcer=sudden severe pain within hours with rigidity and guarding and unstable VS 578. A 25-year-old woman complained of swelling on one side of the labia. The swelling was first noticed 24 hours ago and has not improved despite warm tub soaking. There was a non- tender 3 cm slightly mobile cystic mass at approximately 7 o'clock on the right side of the vaginal introitus. Blood pressure 110/70 mmg Heart rate 76 /min Respiratory rate 18 /min Temperature 37° C Which of the following is the most likely diagnosis? A. Bartholin cyst B. Vulvar myoma C. Vaginal adenosis D. Skene's duct cyst Answer: A(MG) 579. A 23-year-old woman with frequent panic attacks, presents to clinic complains that during her last attack 3 days ago she felt that she was disconnected from the world, as if the environment is strange. Which of the following would best describe her feelings? A. Illusion B. Derealisation C. Dull perception D. Depersonalization Answer: B 580. A 54-year-old menopausal woman presents with a history of involuntary urine leaks with urgency. The complaint occurs at any time during the day or night, without warning. There is no clear association between leaks and any specific activity, with occasional association with coughing and laughing. Physical examination is unremarkable. Urinalysis and culture are negative. Urodynamic study shows spontaneous bladder contractions even with small bladder filling. Which of the following is the most appropriate treatment? A. Kegel exercises B. Anticholinergics C. Bladder suspension D. Anterior colporrhaphy Answer: B(GB) 581. Child with headache, bloody diarrhea, generalized edema, gastroenteritis (something) Labs:Blood - low platelet - high cr Urine- ketone+ve- protein +ve- blood +ve(case of HUS).What test to do reach diagnosis? A-urine B-blood C-LP D-Stoolculture Answer: D, (Mahdi) 582. 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(MG) with Pic 583. A woman comes to the clinic for having a history of increasing pelvic pain, which is cyclic in nature and increasing in intensity just before menses. Which of the following is an acceptable method for diagnosing endometriosis? A. Magnetic resonance image B. Diagnostic laparoscopy C. Endometrial biopsy D. Ultrasound Answer: B(MG) with Pic 584. A 65-year-old heavy smoker is coming for a general examination. What is the best screening test for him? A- Osteoporosis B-Colon cancer C-AAA Answer: B 585. A 23-year-old woman is brought to the Emergency Department after she ingested 15 tablets of paracetamol in a suicidal attempt 6 hours earlier. Activated charcoal is administered by the Emergency doctor. Which of the following is the best next option in management? A. Hyperbaric oxygen B. N-acetylcysteine C. D-penicillamine D. Hemodialysis Answer: B(MG) 586. A 56-year-old woman was exposed to chemical burns to her trunk. On arrival to the Emergency Department, she was conscious and alert. Examination showed a 6 cm x 11 cm wound at her back with burned clothe and powder of chemicals on her clothes and skin. Which of the following is most appropriate next step after removing her clothes? A. Antibiotics B. Powder sweeping C. Surgical debridement D. Water irrigation for 30 minutes Answer: B(MG) 587. 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(GB) 588. A mother bring her child for 6 month vaccine, she mentioned that she took him to ER because had a bad allergy with SOB and tongue swelling after last vaccine ? A- Give vaccine B- Cancel vaccine C- Check previous vaccine Answer: C 589. 6 years old boy with pubic hair , bone age 6 years , testicular size 2 cm , Serum DEAS slightly high. Most likely cause ? A-Brain tumor B-Premature benign pubarche C-Congenital adrenal hyperplasia D-Testicular tumor Answer: B 590. A child presents to the clinic for pubertal assessment. He had pubic hair filling out towards adult distribution and darkening of scrotal skin. Which stage of puberty he reached according to Tanner staging? A. I B. III C. IV D. V Answer: C(MG) GB Recall A 13-year-old healthy girl is brought by her mother with concerns about not yet starting menstruation. Examination reveals sparse hair covering the labia majora, not extending onto the mons pubis. She has developed breast buds and papilla and areolar enlargement, with no separation in contour between the breast and areola. Which Tanner stage would this girl be assigned to? A. Tanner stage I B. Tanner stage II C. Tanner stage III D. Tanner stage IV Answer: B 591. A 23-year-old man known to have Hodgkin's lymphoma, undergoing chemotherapy, developed tumor lysis syndrome. Which of the following is the most likely expected disturbance? A. Hypokalemia and hypocalcemia B. Hypokalemia and hypercalcemia C. Hyperkalemia and hypocalcemia D. Hyperkalemia and hypercalcemia Answer: C(GB) 592. A 45-year-old man with a diagnosis of gastrosophageal reflux disease who is taking a maximum dose of pantoprazole for several weeks presents to the clinic with heartburn that is minimally improved with treatment. The patient verified that he is taking the medication 30 minutes before meals. He takes no other medications. His physical examination is unremarkable. Upper endoscopy findings are normal. Which of the following is the most appropriate next step in the management? A. Repeat endoscopy B. Barium esophagogram C. Esophageal manometry D. Ambulatory pH impedance monitoring Answer: D(MG) 593. 5yr viral infection attacks he is on SABA two times no improvement mx? A. ICS B. oral steroids C. leukotriene D. cough sedative Answer: A 594. Folic acid dose for pregnant lady with no risk factors? A- 0.2mg B- 0.8mg C- 1.2 mg D- 4 mg Answer: B (wafa) 595. A 38-year-old man presents to the clinic with a history of hearing voices coming from the toaster and refrigerator, warning that all the food is poisoned. Which of the following is the most likely diagnosis? A. Delusional thinking B. Visual hallucination C. Disorganized thinking D. Auditory hallucination Answer: D(MG) 596. A 27-year-old man presents to the clinic for a routine check-up. On examination, he kept looking to the right frequently. When questioned, he said, "My mother is there, but no one can see her except me." He claims that she comes and goes, even though the family indicates she died when the patient was a child. Which of the following is the most likely diagnosis? A. Delusion B. Visual hallucination C. Auditory hallucination D. Episode of disorganized thinking Answer: B(MG) 597. Patient was extubated after thyroid surgery and immediately developed shortness of breathing and respiratory distress, Examination reveals that both vocal cords are in a semi closed position. How will you secure the airway? A- Re intubate the patient B- Tracheostomytube C- Cricothyroidotory Answer: A 598. A 22-year-old 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(GB) 599. Which of the following is most appropriate management of penetrating zone 3 neck vascular injury? A. Vascular ligation B. Open primary repair C. Open vascular bypass D. Endovascular intervention Answer: D(MG) 600. A 36-year-old man presented to the Emergency Department with a history of right iliac fossa pain for 9 days associated with fever and vomiting. Physical examination revealed tender abdominal mass in the right iliac fossa with sluggish bowel sounds (see report). Temperature 39 °C, CT scan: Appendicular abscess, 15 x 18 cm in size, in the right iliac fossa. Which of the following is a characteristic pathophysiology? A. Redistribution of blood flow B. Peripheral vasoconstriction C. Decreased cardiac index D. Bradycardia Answer: A(MG), Dx is Septic Shock 601. What is the Folic acid quantity for a healthy lady wants to conceive and with no prior diseases or disorders? A. 1 mg B. 5 mg C. 10 mg D. 15 mg Answer: A 602. The dose of iron that prescribed to the pregnant A) 1000 B) 2000 C) 3000 D) 4000 Answer: A 603. A 23-year-old woman with systemic lupus erythematosus (SLE) presented to the clinic with a 3- month history of lower-extremity swelling and shortness of breath. She has not had chest pain, palpitations, or fevers. On physical examination, she has jugular venous distention and engorgement with inspiration. Heart sounds are distant; a prominent early diastolic sound without gallops or murmurs is heard. Breath sounds are normal. Abdominal examination reveals shifting dullness. Pitting edema to the level of theknees is noted (see lab results). Blood pressure 110/70 mmHg Heart rate 95 /min Respiratory rate 25 /min Temperature 36.6 °C Oxygen saturation 90 % Test Result Normal Values Hb 90 130-170 g/L (Male) 120-160 g/L (Female) Platelets count 450 150-400 x 109/L WBC 3 4.5-10.5 x 109/L Creatinine 150 44-115 mol/L Albumin 28 34-56 g/L Complement C3 0.5 0.7-1.5 g/. Complement C4 0.1 0.15-0,45 g/L. Aspartate aminotransferase 100 12-40 IU/L Alanine aminotransferase 94 5-40 IU/L Which of the following SLE association most likely explains the current condition? **A. Constrictive pericarditis B. Myocardial infarction C. Liver failure D. Renal failure Answer: A(MG) 604. A 14-year-old girl has a 6-month history of lower mid-abdominal pain colicky in nature, radiating to the back and upper thighs. It often begins with onset of menses which lasts for 2-4 days. She has missed several days of school during the last 2 months because the severity of pain. Physical examination is normal for abdomen and pelvis. Normal secondary sexual development is also noted. Which of the following is the first step in management? A. Nonsteroidal anti-inflammatory drugs B. Oral contraceptive pills C. Acetaminophen D. Clomiphene Answer: A(MG) 605. Female complaining of breast tenderness, severe depression, inability socialize, anxiety, crying, and its affecting her and her work. It starts 1 week before menses disappear in 3 day, what is the most appropriate management? A. Transdermal estrogen patch B. SSRIs C. OCP Answer: B 606. 36 year old male after road traffic accident presented with chest ecchymosis. HR normal, BP normal, RR normal ECG: Arrythmia “written like that no image” Chet x-ray:Sternal fracture What is the most likely cause? A-Aortic disruption B-Cardiac contusion Answer: B 607. A 2-year-old boy is brought to the Pediatric Emergency Department. The mother reports that the boy has become increasingly irritable and feeble over the last 2 days. He has passed very little urine and his skin has become pale. The mother had consulted the pediatrician 2 weeks before because the baby had suffered from bloody diarrhea, vomiting and high fever. Symptomatic treatment with acetaminophen and probiotics had been started. Physical examination shows mild petechia on the lower extremities. Urinalysis reveals microhematuria and mild proteinuria (see lab results). Test Result Normal Values Hb 73 112-165 g/L INR 1.1 0.9-1.2 WBC 48.6 4.5-10.5 x 109/L Platelets count 95 150-400 x 109/L MCV 86 80-95 fl MCH 30 28-33 pg/cell RBC count 3.3 4.6-4.8 x 1012/L. Prothrombin 7me 12 12-14 sec APTT 34 30-40 s Which of the following is the most likely diagnosis? A. HUS B. ITP C. TIP D. DIC Answer: A(MG) 608. A 25 years old male presented with rectal bleeding, weight loss, and abdominal pain. His mother and sister has same condition. Guaiac stool test: +ve What is the diagnosis? A. UC B. FAP Answer: B MG Recall A 28-year-old man presented with a 2-month history of frequent attacks of bloody stools. Physical examination was unremarkable. Proctoscopic examination showed multiple rectal Polyps. Colonoscopy: Colon and rectum were carpeted with polyps, multiple biopsies were taken. Which of the following is the most likely diagnosis? A. Ulcerative colitis B. Diverticulosis coli C. Familial adenomatous polyposis D. Human Papilloma virus process Answer: C 609. A 39-year-old man presents with shortness of breath for 2 weeks. The symptoms associated with activity and relieved by rest. He is otherwise healthy, takes no medications and denies chest pain or pressure. Which of the following is the most likely diagnosis? A. Classical angina B. Anginal equivalent C. Musclo-skeletal pain D. Myocardial infarction Answer: B(MG) 610. A 31-year-old woman G2 P1 L1 had an uneventful pregnancy and went into spontaneous vaginal delivery. She delivered a healthy boy weighing 3000 g. After placental delivery, she started to bleed heavily. Which of the following is the most appropriate initial step in managing this patient? A. Start blood transfusion with O negative blood B. Send blood tests and manage accordingly C. Take her to the operating room for surgical management D. Call for help and make sure there is cross-matched blood Answer: D(GB) 611. A 62-year-old diabetic woman was admitted to the Intensive Care Unit with pneumonia and sepsis. Chest X-ray: Right lobe consolidation and pleural effusion. Which of the following most likely indicates a poor prognosis? A. Age B. Diabetes mellitus C. High white blood cell count D. Pleural effusion on chest X-ray Answer: B(GB) 612. A 44-year-old woman presented with heavy vaginal bleeding (see lab results). Which of the following is the most appropriate next step in management? A. Hysterectomy B. Mefenamic acid C. Insert hormonal IUD D. Dilatation and curettage Answer: D(GB) 613. A 26-year-old woman primigravida at 16 weeks' gestation presents to the clinic complaining of nausea and vomiting. Which of the following is the most likely cause of this condition? A. Iron deficiency B. Folate deficiency C. Vitamin B12 deficiency D. Physiologic anemia of pregnancy Answer: B(GB) 614. A 45-year-old man was being investigated for hypertension. He was prescribed a drug for his lipid disorder but returned 1 week later with intense face flushing after taking the tablet prescribed. He was then advised to take a full dose of aspirin 3 times daily instead of a low dose once daily. This gave complete relief (see lab results). Tests at first visit Test Result Normal Values Cholesterol (HDL) 0.72