Medical Case Studies & Questions (PDF)

25th of June – 2024 1) Which of the following measures would decrease the incidence of Sudden Infant Death Syndrome? A. Pacifier at bedtime. B. Sleep in a prone position. C. Soft sleeping mattress. D. Sleep position support device. Answer: A Source (Amboss): 2) A Child...

25th of June – 2024 1) Which of the following measures would decrease the incidence of Sudden Infant Death Syndrome? A. Pacifier at bedtime. B. Sleep in a prone position. C. Soft sleeping mattress. D. Sleep position support device. Answer: A Source (Amboss): 2) A Child (I think 3yrs) came with blood in his diapers for 2 days. There is no associated abdominal pain or constipation. He had a similar presentation 3 months ago. The physical examination shows pale conjunctiva and dry oral mucosa. Blood pressure 130/75 mmHg Heart rate 124 /min Respiratory rate 35 /min Temperature 37.4° C Which of the following is the most likely diagnosis? A. Juvenile polyp. B. Intussusception. C. Hirschsprung disease. D. Meckel's diverticulum. Answer: D Source (UpToDate): 3) A patient who had a vaginal delivery 3 months ago is complaining of fecal incontinence and passage of vaginal flatus. These symptoms have started 1 week postpartum. Which of the following is the most likely diagnosis? A. Hemorrhoids. B. Puerperal sepsis. C. Partial perineal tear. D. Recto-vaginal fistula. Answer: D Source (UpToDate): 4) Old patient, (I think 60Yrs) woman's recent pap smear yielded a result of Atypical squamous cells of undetermined significance (ASC-US). She was given topical vaginal estrogen for one month and was scheduled for another pap smear a week after the treatment cycle has completed. The second pap smear showed ASC-US as well. Which of the following is the most appropriate next investigation? A. Repeating pap smear after 6 months. B. Endometrial biopsy. C. HPV testing. D. Colposcopy. Answer: D Source (Dr.Wafaa file page 240): 5) 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. Vitals are within normal range. 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 Source (UpToDate): 6) Old female (I think 48 Y) patient suffers from several episodes of vaginal discharge and itching around the genital area. The discharge is white and curd-like. The patient's spouse does not have any related condition. Microscopy of the discharge revealed budding yeast and pseudohyphae. The patient's symptoms might be associated with which of the following conditions? A. Sarcoidosis B. Tuberculosis C. Diabetes mellitus D. Lupus erythematosus Answer: C Source (Dr. Wafaa’s file page 146): 7) Female pt 33 Y comes to the clinic complaining of recent onset of vaginal itching. OE: the vagina revealed a thick, odorless white cottage cheese-like vaginal discharge that adheres to the mucosa. recently finished a course of antibiotics for URTI. Dx ? A. Chlamydia B. Candidiasis C. Gardnerella D. Trichomoniasis Answer: B Source: Dr.Wafaa’s file page 146 (see the above picture). 8) Old pt 81 Y Female reports low back pain that began after a forceful coughing episode. Lumbar radiographs = features of a lumbar compression fracture. Most appropriate initial step? A. Prescribe nasal calcitonin. B. Prescribe acetaminophen C. Admit for vertebroplasty D. Infuse zoledronate Answer: B Source (UpToDate): Justification: Both Acetaminophen and calcitonin are correct answers. however, the question specified the most appropriate INITIAL STEP, which fits Acetaminophen 9) Hard sign for vascular injury in trauma pt ? A. Extensive fractures B. Skin color change C. Weak pulse D. Palpable thrill Answer: D Source (Mont Reid page 241): 10) Diabetic pt on metformin, Which GFR level metformin should be stopped? A. GFR 45-60 B. GFR 30-45 C. GFR less than 30 D. GFR less than 15. Answer: C. Source: Amboss; Diabetes mellitus. 11) A child presented in a well-baby clinic, mother showed concern that she is only breastfeeding her baby and he may need supplements, the doctor told her she can give him iron next month, how old is the baby ? A. 1 mo B. 3 mo C. 6 mo D. 8 mo Answer: B. Source: Amboss; IDA in pediatrics and adolescents. 12) Pregnant 10 weeks complaining of biliary colic in the past 5 weeks Mx ? A. laparoscopic cholecystectomy now B. laparoscopic cholecystectomy after delivery C. laparoscopic cholecystectomy in second trimester D. laparoscopic cholecystectomy in third trimester Answer: C. Source: Dr. Hamoud file 13) Patient presented with symptoms of appendicitis. Imaging: appendicitis, fecolith, appendicular abscess 10 x 15 cm reaching the flank. What is the management? A. Open drainage B. Percutaneous drainage. C. Open appendectomy with drainage D. Laparoscopic appendectomy with drainage Answer: B Resources: UTD, Toronto notes, Mont Reid. 14) Female presented with back pain and fever, she was given NSAIDs and advised for bed rest at home, then presented with inability to move lower limbs, O/E tenderness on the midback. Spinal MRI: Diffuse discitis on T6. What is the most appropriate next step? A. Reassurance B. Specimen from T6 vertebra C. Brucella titer D. Bone marrow aspiration for culture. Answer: B. Source: UpToDate. 15) 55 year old diabetic female patient has to do elective cholecystectomy but she had an episode of myocardial infarction 6 weeks ago. What is the most proper course of action in this case? A. Open Cholecystectomy In Same Admission B. Laparoscopic Cholecystectomy C. Laparoscopic Cholecystectomy In 6 Months D. Observation Answer: B. Source: Dr. Hamoud file 16) 55 Y/O patient was diagnosed with autoimmune thyroiditis, with a history of progressive enlargement of the right lobe of the thyroid. FNA report: malignant cells. Which of the following is most likely the type of thyroid malignancy? A. Papillary B. Medullary C. Anaplastic. D. Lymphoma Answer: D Sources: Amboss; Hashimoto thyroiditis, thyroid cancer 17) 60 Y/O patient with fever and pulmonary infection has been admitted for 5 days, the patient is hypotensive with low cardiac output, low pulmonary capillary wedge pressure (PCP) and high systemic vascular resistance (SVR). What is the type of shock? A. Cardiogenic shock. B. Neurogenic shock. C. Septic shock. D. Hypovolemic shock. Answer: D. Source: Amboss; Shock. Justification: The vital parameters (SVR) in the question are more consistent with hypovolemic rather than septic shock. It could be due to third space loss. 18) A 62 Y/O male patient diagnosed with Inferior MI treated in hospital, 2 days after admission he is complaining of shortness of breath and has bilateral basal lung crepitation with pansystolic murmur radiating to the axilla, what is the most likely diagnosis? A. Right sided heart failure. B. Papillary muscle rupture. C. Ventricular septal defect. D. Cardiac tamponade. Answer: B. Source: Amboss and UpToDate. 19) Heart Auscultation is a key part of cardiac examination, some positions can change murmurs' characters, which of the following is a (Systolic murmurs increase with handgrip & decrease with Valsalva)? A. MR B. AS C. НОСМ Answer: A. Source: UpToDate. 20) A 36 Y/O pregnant lady presented with headache and nausea for 3 weeks, her LMP was 15 weeks back, blood pressure: 155/105 mmH, heart rate: 76 /min, weight: 51 kg, height: 160 cm, which of the following is the most likely diagnosis? A. Chronic (essential) hypertension. B. Gestational hypertension. C. Superimposed preeclampsia. D. Preeclampsia. Answer: A. Source: UpToDate. 21) A 35 Y/O patient came in with a medial leg ulcer. The most likely diagnosis is: A. Diabetic. B. Venous hypertension. C. Atherosclerosis. D. Buerger's disease (Thromboangiitis obliterans). Answer: B. Source: UpToDate. 22) Adult post RTA, was brought to the ED in a tertiary hospital, patient was alert and conscious. CT done which showed: Injury to the thoracic aorta and splenic laceration with free fluid in the abdomen. (Not perisplenic). BP: 90/67. HR: 45 bpm. What's the next step? A. Urgent laparotomy. B. Urgent thoracotomy. C. Refer the patient to a hospital with a vascular surgeon. Answer: A. Source: UpToDate. 23) 65 years old female, with Asymptomatic femoral hernia. What is the most appropriate management? A. Observation. B. Open repair with mesh. C. Laparoscopic repair. Answer: C. Source: UpToDate. 24) Old patient came in with subdural hematoma with signs of lateralization imaging revealed 13 mm shifting. his GCS 7/15 then was intubated and resuscitated what to do next A. IV mannitol. B. Elevate head of bed. C. Hyperventilate. D. Urgent craniotomy. Answer: D. Source: UpToDate. 25) Pediatric patient had a fall from 1 story high and direct trauma to the head, presents with hemotympanum No loss of consciousness, no vomiting, neuro exam: Normal Ear Ruptured tympanic membrane with intact external auditory canal. Most likely bone fracture: A. Mastoid. B. Maxillary. C. Basal skull. Answer: C. Source: UpToDate. 26) 18 months child with left Undescended testes not palpable in the inguinal region, left one is there what's the most appropriate to do? A. Left orchidopexy. B. Diagnostic laparoscopy. C. Wait till 3 years. Answer: B. Source: UpToDate. 27) 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-pinicillamine C. Iron supplements Answer: B The diagnosis of lead poisoning can be made by the elevated lead level, and the treatment will be chelating agents like pinicillamine. Source: UTD Note: we can find IDA as a concomitant finding in case of lead poisoning. Source: Nelson, P613 28) 23 years old female with history of ASD, found to have decrescendo early diastolic murmur 2/6 on the left lower sternal border. what is the most likely diagnosis? A. Mitral stenosis B. Aortic regurgitation C. Tricuspid regurgitation D. Aortic stenosis Answer: B Source: UTD 29) 5 Y/O patient complains of bleeding from nose and mouth with easy brusing. He had a past history of viral infection, what is the Dx? A. ITP B. Heamoplilia A C. HSP D. meningococcemia Answer:A Source: UTD 30) mother of asthmatic child is worried about the future of her child's case. What you will tell her? A. He will have asthma for the rest of his life B. Pediatric asthma may disappear by adolescence C. Pediatric and adult asthma are unrelated to each other D. His case will develop into chronic lung disease Answer: B His symptoms could be improved by adolescence and the symptoms may disappear. Resource: UTD 31) 3 months baby with eczema with a positive family history, the common sites involved at this age? A. scalp B. Flexor surface C. Extensor surface D. Buttocks Answer: A Source:UTD 32) Patient with symptoms of RA and active arthritis for the first time, what is the most appropriate management? A. Methotrexate B. Methotrexate + Hydroxychloroquine C. Methotrexate + Hydroxychloroquine + Steroid D. Methotrexate + Cyclophosphamide or Sulfasalazine Answer: C Resource: Um Alqura 33) 27 Y/O healthy male presented with right side weakness, he has significant femur fracture 1 week ago, 2 days ago had pulmonary embolism, brain imaging showed 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 Source:UTD,AMBOSS 34) Which of these is an indication for home oxygen therapy in COPD? A. 1 reading of Po2 < 7.8 kPa B. 2 readings of P02 < 7.3 C. 1 reading of Po2 < 8 D. 2 readings of Po2< 6.3 Answer: B Source: UTD, AMBOSS 35) Female patient diagnosed as Cough-variant asthma by methacholine challenge test LABA and ICS, initially improved then she came complaining of increasing cough for 2 months especially when she lay down and when she wake up with hoarseness of voice, how to manage? A. Omeprazole B. LABA C. Antitussive at night D. Repeat methacholine challenge test Answer: A. Justification: The patient already has asthma, however, this attack is due to GERD. Source: Amboss. 36) Pregnant with asthma what happens during pregnancy? A. Increased respiratory rate B. Increased tidal volume C. Increased residual volume D. Increased functional residual capacity Answer: B. Source: Amboss. 37) Diabetic patient admitted to hospital with community acquired pneumonia, what other empirical antibiotic should be given in addition to Azithromycin? A. Vancomycin B. Moxifloxacin C. Ceftriaxone D. Meropenem Answer: C Source: UpToDate 38) Patient with Hep C cirrhosis. Dietary modification? A. Sodium restriction to less than 2 g B. Fluid restriction C. Protein restriction D. Carbs Answer: A. Source (Kumar): 39) 31 Y/O man with asthma complaining of increasing wheeze in the past few hours. He rarely attends asthma clinic and his previous best peak flow readings has been 400 L/min. Which of the following would suggest acute severe asthma? A. Co2 saturation < 95% B. Respiratory rate > 20 C. Peak fiow rate 130) so low Best appropriate next step in management? A. IV Iron B. SC erythropoietin Answer: B Source: AMBOSS Justification: Iron therapy can be considered if the transferritin saturation is < 30% and ferritin < 500 ng/mL, this is not mentioned in the scenario + being symptomatic and having low HB favours the initiation of erythropoietin-stimulating agents 45) Elderly patient, Dm, HTN, IHD, present with leg pain and absent doralis Pedis pulse, ankle brachial index 0.3 CTA show 3cm popliteal artery occlusion, appropriate management? A. amputation B. thromboemboliectomy C. heparin D. aspirin Answer: C Source: Bailey and Love + AMBOSS Justification: The best initial management in Acute limb ischemia is heparin infusion (like this case), then the management will be directed by Rutherford’s classification of Acute limb ischemia rather to amputate or revasularization 46) 23 years old female presented to ER with hx of 4 attacks of tonic clonic seizure in the past 3 hours without regaining consciousness. She is a known case of epilepsy, not compliant to medications. What is the first line management in this case? A. Benzodiazepine B. propfol C. phenytoin infusion D. phenobarbital Answer: A Source: AMBOSS 47) 19-month-old boy presented to the clinic with right lower eyelid swelling, erythema, and tenderness for 1 day. He has fever reaching up to 38. with decreased appetite and activity. He was given diphenhydramine without any improvement of the eyelid swelling. denied any visual disturbances, diplopia or any other swelling. Which of the following is the most likely diagnosis? A. Cellulitis B. Hypoproteinemia C. Allergic reactions D. Subperiosteal hematomas Answer: A Source: illustrated Justification: typical cellulitis symptoms. 48) 32 Y/O male came to the clinic and fear about having melanoma since his father got diagnosed whit it 8 month ago. The patient is nonsmoker nonalcoholic & had multiple benign nevi. what should you do for this patient? A. Reassurance B. Follow up 12 months C. excision D. Refer to dermatologist Answer: D Justification: This patient has family history which is a strong risk factor and has precursor lesions (the benign nevi) therefore the overall picture is worrisome and requires further evaluation. Source: UpToDate and Amboss 49) A 29 Y/O woman complaining of a heavy vaginal discharge for the past 2 weeks. The discharge was thin and a greyish white color with a slight fishy vaginal odor. On examination, a copious, thin, whitish discharge is seen adherent to the vaginal wall. Vaginal pH 5.5 Which of the following is the most appropriate treatment? A. Metronidazole B. Oral diflucan C. Tetracycline D. Doxycycline Answer: A Source: AMBOSS Justification: she has bacterial vaginosis 50) A 45 Y/O man with several months of worsening dyspepsia. He denies any history of diarrhea, fever, or weight loss. He has no medical problems. He was prescribed pantoprazole 40 mg daily with no relieve of his symptom (see reports). Upper GI endoscopy: Showed multiple antral superficial ulcers. Biopsy: organism. Revealed mucosa-associated lymphoid tissue (malt) lymphoma with numerous H.pylori. CT scan of abdomen and chest: Normal. Which of the following is the best management option? A. Chemotherapy B. Radiotherapy C. Gastrectomy D. H.pylori eradication Answer: D Source: AMBOSS Justification: Malt lymphoma can be gastric which is caused by H.pylori or Nongastric, which is caused by autoimmune diseases. 51) A 9 Y/O boy brought to the clinic by his mother. She is concerned of bed-wetting overnight for one month. He was dry since age of 6 years and the mother gave history of fever and foul smell of his urine recently. Urine dipstick done (see lab result). Blood pressure 90/60 mmH, Heart rate 76 /min, Respiratory rate 18 /min , Temperature 37.6 °C, Test Result Normal Values, Color dark yellow clear or light yellow Appearance cloudy clear, Specific gravity 1030 1001-1030, Nitrite present Absent, Leukocytes 7 0-3 per high power field. Which of the following is the most likely diagnosis? A. Nocturnal enuresis B. Urinary tract infection C. Improper personal hygiene D. Normal pattem at this age Answer: B Source: Illustrated Justification: typical symptoms, it’s not obvious from the question if nitrite of leukocytes esterase is positive, but one of them is positive and this aids the diagnosis of UTI along side the clinical picture 52) A 2-month-old infant present to Emergency Room with cough, sneezing, circumoral cyanosis occasional with frothy secretion from mouth for the 3 days. On examination, she looks well with moderate tachypnea and intercostal retraction. Chest reveals scatted rhonchi and crackles all over but good air entry. Blood pressure 80/50 mmH Heart rate 138 /min Respiratory rate 48 /min Temperature 36.6 °C Oxygen saturation 91 % Which of the following is the most likely diagnosis? A. Bronchiolitis B. Heart failure C. Bronchial asthma D. Gastrosophageal reflux Answer: A Source: Illustrated, P305 53) 67 Y/O diabetic patient presented to ER having sepsis and severe UTI, the patient was severely ill and found to have methicillin resistant staph aureus, what would be the appropriate antibiotic? A. Cefixime B. Gentamycin C. Flucloxacillin D. Vancomycin Answer: D Source: Toronto, P735, sepsis and septic shock 54) A pregnant woman presented to the clinic and after an ultrasound checkup. you confirm the fetus is dead. What is your immediate action? A. Inform the patient B. Inform her relative C. Do further testing Answer: A Source: SMLE Brain 55) A 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 Source: SMLE Brain 56) A multiparous patient who had delivered 6 babies previously all of which through CS now wants to deliver her 7th baby by CS. The doctors recommended tube ligation to prevent serious complications with future pregnancies. What is the best action? A. Take consent from her or her representative B. Take consent from her husband C. Take consent from her and tell her to inform her husband D. Consult ethics committee Answer: C Source: SMLE Brain 57) A pregnant woman presented to the clinic. She is a high gravida and has done previous cesarean sections. She has metastatic cancer and her doctor advised for the termination of the pregnancy but her husband is refusing. What is the appropriate action? A. You need both consent from her and husband B. Only need her consent C. Only need her consent and she should inform her husband D. Obtain consent from a representative Answer: C Source: SMLE Brain 58) A child is admitted to the PICU with a subdural hematoma. The father reports the child fell from his bed. On physical examination, the child has ecchymosis on the buttocks and back and bilateral femoral fractures. What's the most likely diagnosis? A. Hematoma B. Pathological fracture C. Battered child syndrome D. Accidental injury Answer: C Explanation: Battered Child Syndrome: This term is used to describe physical abuse in children, often resulting in multiple and recurrent injuries at various stages of healing. Injuries such as subdural hematomas and bilateral femoral fractures typically suggest severe and repeated force, which is consistent with physical abuse rather than an accidental fall. 59) 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 Source: SMLE Brain 60) A doctor agreed that the patient needs to abort the child due to chromosomal anomalies, but the father refused. What is the appropriate course of action in this situation? A. Doctor's consent enough B. Mother's consent prevails C. Father's consent prevails D. Consult ethics committee Answer: C Source: SMLE Brain  26th of June - 2024 1) A patient k/c of rheumatoid arthritis and taking immunosuppressant drugs, which vaccine will you give? A. BCG B. Oral polio C. Varicella D. Influenza Answer: D (all other vaccines are live-attenuated). Source (UpToDate): 2) A schizophrenic patient came to the 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 colestomy. C. decompression colonoscopy with rectal tube. Answer: C. Source (Abeidi’s Review page 86): 3) Pt will go through surgery, when to give Antibiotics: A. post operative. B. during surgery. C. preoperative. D. I don’t remember. Answer: C Source (UpToDate): 4) Female with facial pain but no rhinorrhea. Diagnosis of sinusitis made suspected Haemophilus influenza. What would be your management? A. Antiviral, topical steroids, topical decongestants B. Topical decongestant, broad spectrum antibiotic C. Topical steroid, antibiotic, anti-inflammatory Answer: C Decongestant is NOT recommended in Bacterial Sinusitis. Source: Amboss and Torronto notes page 420. 5) 35. Old lady, know HTN, DM, presented with epigastric pain radiating to the back, and heart burn for past 2 months, not relieved by antacids (Ranitidine).. otherwise she looks health, no abdominal tenderness, ECG shows sinus tachycardia ( I guess). Vitals BP 150/90: A. Aortic Dissection. B. Perforated peptic ulcer. C. MI. Answer: BAD RECALL 6) Pt always think there is alien in his back yard when he is out from home, even though he knows its not possible, he's always thinking about the idea brought by these aliens. pt came to you with fear that he is going to be "insane" what is his condition? A. Obsessions B. Compulsions C. Hallucinations D. Delusions Answer: A. Source (Review Psychiatry Questions for SMLE p38): 7) Which of the following pleural fluid analysis is an indication for chest tube insertion in plural effusion? A. Glucose > 0.4 B. Protein < 0.4 C. Negative gram stain D. pH < 7.2 Answer: D. Source (Dr.Elaf course - pulmonology slides - 44): 8) High BMI, hirsutism, cycle abnormalities" dx written as PCOS" she doesn't want to be pregnant tx? A- Metformin B- OCP C- spironolactone Answer: B Source (Hacker’s page 395): 9) Woman rh negative, gave birth to rh+ baby, she took anti-D in the 28th week GA. What to do now? A. 300 microgram B. 1000 microgram C. 2000 microgram D. no need Answer: A Source (Hacker’s page 206): 10) Case of pulmonary embolism, hypotensive pt, and they mention *saddle emboli in CT* A. Warfarin B, Enoxaprin C. thrombolectomy Answer: C (thrombolytic therapy is more accurate). Source (Davidson page 619-621): 11) Patient came with SOB and fatigue. He was stable. ECG: (same pic, Dx not written). Next step in the management? A. Cardioversion B. Atropine C. Aspirin D. Aspirin and clopidogrel (I think) Answer: B. Source: UpToDate. 12) This picture with a scenario of an open wound fracture that is stable and has already received antibiotics. What do you want to do next? A. Closed reduction with above knee cast B. Closed reduction with below knee cast C. Open reduction with intramedullary nail D. Debridement with intramedullary nail Answer: D. Justification: Open fractures must be irrigated and debrided Source: UpToDate. 13) A 73 year old woman is brought to the ER after a fall at home. She is diagnosed with left hip fracture (see lab results) Weight 82 kg Sodium 136 (normal) Potassium 4.2 (normal) Creatinine 68 (normal) What is the best order by the admitting orthopedic surgeon to prevent deep vein thrombosis? A. Aspirin 81 mg PO daily B. Enoxaparin 40 mg SC daily C. Fondaparinux 10 mg SC daily D. Heparin sulfate 10,000 units ÍV BID Answer: B. Source: UpToDate. 14) Male patient came from India with RUQ pain. on and off fever for 3 weeks. raised LFT , high WBC (Neutrophils 70% Lymphocytes 20%). Image showed a homogeneous hypoechoic mass in the liver. A. Hydatid cyst B. TB abscess C. Amebic abscess D. Pyogenic abscess Answer: C. Justification: Patient came from an endemic area of amebiasis in addition to fever pattern. Source: Page 287, Davidson’s Principles and Practice of Medicine. 15) RUQ pain, for 12 hours, no fever, no jaundice. U.S findings " non thickened G.B wall with multiple gallstones, CBD is obscured ". what's your diagnosis: A. Acute Pancreatitis B. Obstructive jaundice No Charcot triad, and the findings are not relevant for C. Acute Cholecystitis cholecystitis. Biliary pancreatitis would be more accurate. D. Ascending cholangitis Answer: A. Justification: by exclusion, There is no jaundice so cannot be obstructive jaundice, the wall of gallbladder is not thickened, so it is not acute cholecystitis, in addition to the absence of Charcot triad which deny ascending cholangitis. The only reasonable option here is acute pancreatitis with the presence of gallstones as a risk factor. 16) 65 yrs old male complaining of severe Lower GI BLEEDING. What is the MOST common cause: A. Angiodysplasia B. IBD C. Diverticulosis Answer: C. Source: UpToDate and page 782 of Davidson’s Principles and Practice of Medicine. 17) 142- Patient who is on NSAIDS for joint pain, presented with sudden severe continuous abdominal pain. He denied any history of vomiting, constipation, diarrhea, and or hematemesis. The pain is located in the epigastric area with a feeling of Nausea. Upon examination. There is tenderness and rigidity, what is the diagnosis? A. Esophagitis B. Acute gastritis C. Perforated peptic ulcer D. Boerhaave syndrome Answer: C. Justification: The onset, severity and presence of rigidity support perforation. Source: UpToDate. 18) 101- Person after MVA with fracture in the tibia the xray picture looks really bad with dislocated tibia and small fragments and the 2nd picture from there is a small wound but no bone protruding out, what to do? A. Discharge on abx B. closed reduction with external fixation C. Surgical debridement with intramedullary nail Answer: C. Justification: seems like an open fracture which requires debridement and immobilization. Source: UpToDate. 19) Pregnant lady in 16w with multiple vomiting history in her 1st trimester, her last cbc showed low HB and high MCV with the following picture (sure same this picture), what is the cause of her anemia? A. IDA B. Folate C. B12 Answer: B. Justification: the picture shows hypersegmented neutrophils which can be seen in both vitamin B12 and folate deficiencies m, however, folate deficiency is more common in pregnancy. Also, there are no typical features of B12 deficirncy Source: UpToDate 20) Female pregnant, polyhydramnios had ruptured membrane, on CTG persistent fetal bradycardia? A. Rapid fetal descend B. Cord prolapse C. Anomaly Answer: B. Source: Dr Wafaa’s FILE 21) Pregnant at 7 weeks with vaginal bleeding, no intrauterine or extrauterine sac on US, what is the most appropriate management? A. US after 2 days B. Reassurance C. Discharge home Answer: A Resource: Dr: Wafaa file P193 22) Pregnant lady 32 weeks GA is worried that her baby stopped moving. What is the next more appropriate step for this case? A. Non-stress test B. Biophysical profile C. Pelvic examination D. Pelvic US Answer: A Source: Dr: Wafaa file P23 23) G2P0 20 weeks of gestation, with cervical incompetence (cervix length 30mm), what's the most appropriate management? A. Cervical cerclage B. Strict bed rest C. Progesterone supplementation