June 2024 Medical Qs PDF

June 2024 Hussain - Sultan - Khalid - Fahad - Samado - Ryan - Turky - Saud-Hamza-Wagyu (Hassan) - Mahmood - AZA - MZA - Saeed - Bahbri - Shawli - Fahad - Maan June 2024 1- 23 yo female pregnant 28wks with fetal hydrops peak systolic flow 1.8mom on mca doppler cause ? A-anuplide B- diaphragmatic hernia C- anti-kell antibody D- cervical teratoma Hussain: C (Top Gs) Fahad: agree MZA: C Anti kell antibody, 9ar fe immunologic response, hemolysis lead to anemia then if sever leads to fetal cardiac failure,edema then to HYDROPS FETALIS Samado: Agree Shawli: Agree 2- Patient with anemia, He had Hemoglobin Low RDW high MCV low Rest was normal A-Thalassemia trait B-Iron deficiency anemia C-aplastic anemia D-anemia of chronic disease i think Hussain: B (the question is missing some info but i will chose iron deficiency anemia because of high RDW) Source: ‫ام اﻟﻘرى‬ Fahad: B (he should mention the reticulocyte or the RBC count) MZA: B med guard PIC Samado: Agree Shawli: Agree 3- 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 Hussain: A (Answer is by exclusion, as colonoscopy is normal so exclude A and bladder cancer doesnt present like this so exclude B) Fahad: A ( medgard) MZA: A - fixed the Q from med guard FILE Samado: Agree Shawli: Agree 4- A 21-year-old woman G2 P1001 presents to the Emergency Room with a severe lower abdominal pain for 1 day. Pain is dull and intermittent that last for 10-15 minutes and associated with nausea and vomiting. Examination confirms tenderness and guarding in the lower abdomen, it is more on right side and slight fullness in the right iliac fossa (see report). Blood pressure 90/60 mmHg Heart rate 110 /min Respiratory rate 13 /min Temperature 37.6° C Pregnancy Test: Negative. Which of the following is the most likely diagnosis? A. Acute cystitis B. Ovarian torsion C. Acute appendicitis D. Ectopic pregnancy Hussain: B (fullness is the key word, i wont chose appendicitis because the pain is intermittent, and i wont choose ectopic because obviously the pregnancy test is negative) Fahad: B (top Gs) MZA: B - fixed the Q from med guard FILE Samado: Agree Shawli: Agree 5- MVA case pt is bleeding profusely from the nose, there is decrease chest sound in the right side and dullness, pt have cyanosis. What is the next step in management? low BP A. Anterior and posterior nasal packing B. Chest tube C. Intubation and cervical spine care D. Venous access and blood Transfusion Hussain: C (always start with ABC, here the airway is clearly compromised) Fahad:C MZA: C, ABC approach Samado: C Shawli: Agree 6- A female infertile for 4 years, normal hormonal labs husbend with normal semen analysis Hydrosalpingogram showed blocked tubes bilateraly What is the Most Appropriate next step? A - Induction of ovulation B- In vivo fertilization ( IVF ) C - Intrauterine insemination ( IUI ) D -Laparoscopy and dye study Hussain: B (If tubes are blocked bilaterally then go for IVF, we only do IUI if the cause is cervical) Fahad : B (top Gs ) MZA: B check pic below from medguard same Q Samado: Agree Shawli: Agree 7- A 58-year-old healthy patient has a six-month history of central lower back pain. The pain is present on awakening, and without treatment, resolves after about 30 minutes. Acetaminophen seemed to help it resolve sooner. Morning examination showed mild paraspinal muscle spasm with no neurological changes (see report). MRI Lumbar: Mild lumbar spinal stenosis. Which of the following is the most appropriate management? A. Biofeedback B. Physical therapy C. Lumbar laminectomy D. Epidural steroid injection Hussain: B (Physical therapy is often recommended as a first-line treatment for mild lumbar spinal stenosis and associated back pain) Fahad : B MZA: B check pic below from medguard same Q Samado: B (medgard) Shawli: Agree 8- A 35-year-old-man presented to the Emergency Department with 5-day history of fever, shortness of breath and productive cough. Lung examination reveals dullness to percussion to approximately half of the lung ﬁeld on the right and his breath sounds are markedly diminished. Chest radiography, shows right lower and middle lobes consolidation with moderate pleural eﬀusion. Which of the following would indicate the need for tube thoracostomy? A. Pleural ﬂuid glucose below 60 mg/di B. Pleural ﬂuid PH more than 7.20 C. Pleural ﬂuid with more than 90% polymorphonucleocytes (PMNs) D. Pleural ﬂuid/ serum protein less than 0.4 Hussain: A (the question basically asks about the criteria for empyema, which is: 1- Pleural fluid glucose below 60 mg/dl 2- Pleural PH less than 7.20 3- Pleural WBC more than 50000 4- Pleural LDH more than 1000 5- positive culture or gram stain Source: ‫ام اﻟﻘرى‬ Fahad:agree MZA: A- med guard Samado: Agree Shawli: Agree 9- Patient with hypertension, heavy bleeding and anemia, what contraceptive she can use? A. Tube ligation B. IUCD mirena C. Condom D. OCP Hussain: B (Tube ligation is permanent so it is not desired, OCP are contra indicated because of HTN and they would cause adverse effects due to the estrogen, and condoms are not a reliable method. If they added copper IUD it will also be wrong because the patient hase heavy bleeding) Fahad: agree MZA: B pic below Samado: Agree Shawli: Agree 10- Pregnant lady what vaccine should she get at first visit: A- Influenza B- dTap Hussain: A (recall question, dTap is at the 3rd trimester) Fahad: A from wafa’a MZA: A Samado: Agree Shawli: Agree 11- 2 years old with UTI for admission, came with his mothers, further history reveals that he vomits anything he eats. BP is 85/60 (Approximately). What is the reason for admission? A-Vital signs B-Unable to tolerate food Hussain: B (i think it is obvious) Fahad:agree MZA: B Samado: Agree Shawli: Agree 12- Elderly Patient was decided to be for palliative care. He had hypocalcemia (around 1.2) and there was hypophosphatemia and low vitamin d. Management? A- IV calcium B- oral calcium C- cholecalciferol D- phosphor something Samado: A (smiliar Q in medgard) Fahad : A bahabri:A 13- A 22-year-old man presents to Emergency Department with 4-days history of fever, headache and confusion. On examination, Kenig's sign is present. Temperature 39 "c Cells 380 0-3 ful Total protein (Men) 0.8 0. 22-0.33 g/L Glucose 3.7 2.50-3.89 mmol/l CSF analysis: WBC differential count : 5% neutrophil and 90% lymphocytes. CSF Culture: Pending. Which of the following is the most appropriate intravenous treatment option? A. Ceftriaxane vancomycin and steroid B. Ceftriaxane and vancomycin C. Ceftraxone D. Acyclovir Hussain: D (High protein, high lymphocyte, and normal glucose, all go with viral etiology) Fahad: agree MZA: D pic below from med guard Samado: Agree Shawli: Agree 14- Newly married couple wife is worried because her husband is sickle cell trait what are the risk for future child to have the disease? A- high risk B- Low or nill risk if patient is negative Hussain: B (self explanatory) Fahad: agree MZA: B Shawli: Agree 15- Obese patient BMI 40 with CKD admitted, whats the appropriate anticoagulation? A. Enoxaparin 40 mg once daily B. Fondafarinux (dose mentioned) C. Heparin 7500 unit Every 8 hours D. Heparin 5000 unit Every 12 hours Hussain: C (memorize this) BMI < 30 with no kidney impairment: Enoxaparin 40 mg once daily BMI < 30 with kidney impairment: Heparin 5000 units every 12 hours (bid) BMI > 30 without kidney impairment: Enoxaparin 40 mg every 12 hours (bid) BMI > 30 with kidney impairment: Heparin 7500 units every 8 hours (q8hr) Fahad: agree MZA: C, what hussain wrote is great Samado: Agree Shawli: Agree (very nice abu ali) 16- Pt rt upper quadrant pain Positive for entamoeba histolytica Ct findings large 10x15 cm septate abscess What is the initial treatment A. Metronidazole B. Percutaneous drainage C. Ct guided aspiration Fahad: A MZA:A pic below Samado: Agree Shawli: Agree 17- case suspected to have renal stone, what is the best diagnostic tool? A- KUB x-ray B- US abdomen C- CT abdomen without contrast D- MRI abdomen Fahad:C ( top Gs) MZA:C pic below Samado: Agree Shawli: Agree 18- A pregnant woman came to the hospital with vagianl bleeding they discovered on MRI Placenta percreta. The hospital cannot tolerate this condition what you will do as a physician? A. Refer her with notifying department B. Refer her upon patient's request C. Discharge her with form of referral D. Discharge her and tell her to go to tertiary hospital Fahad; A topGs MZA: A - most reasonable answer based on giving choices Samado: Agree Shawli: Agree 19- 4 Months old with poor weight gain. At birth it was 3.3 kg then became 4 kg. His mother uses 2 spoons of milk in 90ml water, she feeds him every 3 hours. She’s 19 yo, that’s her first baby. Cause? A. Child neglect B. Anemia C. Inappropriate formula preparation D. Decrease feeding frequency Fahad: C MZA: C- For each 30ml of water, you need 1 level scoop of formula powder. Samado: Agree Shawli: Agree 20- A 42-year-old P3 is seeking an advice for the possibility of insertion of an intrauterine contraceptive device for family planning. The patient's history reveals that she became pregnant while using an intrauterine contraceptive device 4 years ago and in her second pregnancy; she underwent a cesarean section, which was complicated by post-partum ednometritis. Her menstrual cycles are irregular for the last 4 months with heavier flow than usual. Which of the following is an absolute contraindication to the insertion of an intrauterine contraceptive device? A. History of postpartum endometritis B. Previous pregnancy with an IUCD C. History of cesarean section D. Abnormal genital bleeding Fahad:D MZA: D book Samado: Agree Shawli: Agree 21- Elderly diabetic had major abdominal surgery came with fever after 72 hours T:38, O2:87 A- pneumonia B-subphernic collection C-pulmonary embolism D-atelectasis Fahad :A ( top gs → HAP) MZA: A Post -OP fever: Day 1 = atelectasis Day 3 = UTI & pneumonia Day 5 = DVT & PE Day 7 = wound infection > Day 7 = drug induced Samado: Agree Shawli: Agree 22- Case suspected to have renal stone, what’s the best diagnostic tool: A. KUB X Ray B. Ultrasound C. CT D. MRI Fahad : C MZA: C , CT-abdomen without contrast Samado: Agree Shawli: Agree 23- 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) illegible prescription D) Handwriting error Fahad : A MZA: A Samado: A Shawli: Agree 24- A Pediatrics patient was admitted to PICU with a subdural hematoma, The father said he fell from his bed, on PE the patient had ecchymosis on the buttocks and back, and he has a bilateral femoral fracture, What's the most likely diagnosis? A. Hematoma B. Pathological Fracture C. Battered child syndrome D. Osteoporosis Fahad : C MZA: C very common Q in every month “CHILD ABUSE” Samado: Agree Shawli: Agree 25-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 Fahad : ‫ﻧﻔس اﻟﻠﻲ ﻓوﻗﮫ‬ MZA: C very common Q in every month “CHILD ABUSE” Samado: Agree Shawli: Agree 26-Pt fall from hight present with deformed leg and open wound, was splinted whats next ? A-Oral Antibiotics B-traction C-external fixation D-urgent internal fixation Fahad : C MZA: C if it was IV antibiotic then it should have been next Open fracture approach IV antibiotics → close reduction → debridement → definitive with IM nail or external fixation if extensive soft tissue damage. Samado: Agree Shawli: Agree 27-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 Fahad : A MZA:A Samado: Agree Shawli: Agree 28-A 7-year boy diagnosed with measles, When his father was asked about the child Immunization record, he replayed that he does not believe in immunization. Which of the following is the most appropriate action? A. Inform the child protection team B. Consulit the hospital's clinical ethics committee C. Explain to the father the importance of immunization D. Ignore the father's response and focus on treating the child Fahad C MZA: C pic below Samado: C Shawli: Agree 29-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 Fahad : C MZA: C Samado: Agree with MZA Shawli: Agree C 30-A patient with lower Gi bleeding was given (fresh blood per rectum) failed resuscitation with fluids and blood and the patient became unstable. What is the most appropriate next step in management? A-Give FFP B-Angiography C-Laparotomy D-Emergency colonoscopy Fahad : B from top GS MZA: B “failed resuscitation” - refractory instability next step Angiohraphy Samado: Agree with MZA Shawli: B Agree with MZA 31-A 25 year old women with mastalgia, headache and pain 8-10 days prior to her period affecting her attendance at work what is the diagnosis ? A. Endometriosis B. Leiomyoma C. Pelvic Congestion Syndrome D. Premenstrual Dysphoric Disorder Fahad : D ( from wafaa , it is sever type of PMS which affect the work ) MZA: D Samado: Agree Shawli: Agree 32-Type of sport recommended for premenstrual syndrome ? A. Aerobic B. Flexibility and mobility C. Stability and balance D. Coordination and agility MZA: A Samado: Agree Shawli: Agree 33-You were called to see a newborn in the nursery to evaluate him. He has prominent occiput, overlapping fingers, cardiac anomalies and rocker bottom feet. Chromosomal analysis is still pending. Dx? A- Patau syndrome B- Down syndrome C- Edward syndrome D- Turner syndrome Fahad : C MZA: C Pic below Samado: Agree Shawli: Agree 34-An 18-year-old man presents to the Emergency Department with 1-week history of euphoria, increased blood pressure, tachycardia, nausea, weight loss, psychomotor agitation, chills, sweating and visual hallucinations. Which of the following is the most likely diagnosis? A. Amphetamine intoxication B. Cannabis intoxication C. Acute schizophrenia D. Cocaine withdrawal MZA: A BOOK pic below Fahad :( from top gs ) A, I will provide a brief presentation for each choice in case the Q has variants: 1. Amphetamine Toxicity: Euphoria, increased energy, agitation, paranoia, hallucinations, tachycardia, high blood pressure, dilated pupils, nausea, vomiting, weight loss, insomnia, excessive sweating. 2. Acute Schizophrenia: Hallucinations, delusions, disorganized thinking, disorganized behavior, flattened affect, social withdrawal, impaired daily functioning. No prior history of substance abuse or drug use, and the symptoms tend to develop gradually 3. Cocaine Withdrawal: Irritability, fatigue, depression, anxiety, intense craving for cocaine, disturbed sleep, increased appetite, slowed activity, decreased energy, vivid dreams. History of cocaine use or abuse and may be in a period of abstinence or attempting to quit Samado: Agree Shawli: Agree 35-At which age can we give peanuts and eggs to babies to prevent the risk of getting allergic? A. 10 months B. 14 months C. 18 months D. 24 months Fahad : A → top gs says the ideal answer is 6 month MZA: A agree ideally at 6 months Samado: Agree Shawli: Agree 36-An 8 year old girl with persistent and continuous diarrhea, she drinks 3 pints of goat milk per day and is a fussy eater. Which of the following conditions explain her presentation? Labs: Hgb Low ,MCV high ,MCHC high. A- psychological Deprivation B- Giardia Parasitic Infection C- Aplastic Anaemia D- Hypothyroidism Fahad : B top gs MZA: B Pic below Samado: Agree Shawli: Agree 37-Y.O female presented to the emergency department with swelling that is located inferior and lateral to pubic tubercle with positive cough impulse. What is the type of this hernia? A- Femoral hernia. B- Direct inguinal hernia. C- Indirect inguinal hernia. D- Ventral hernia Fahad : A MZA: A pic below Samado: Agree Shawli: Agree 38-Trauma patient with widened mediastinum and trachea shifted to the rt What is the diagnosis? A. Massive hemothorax B. Pneumothorax C. Thoracic aorta rupture D. Spontaneous pneumothorax Fahad : C ( top gs ) MZA: C, widened mediastinum with shift to the RIGHT key word for thoracic aortic aneurysm rupture However widened mediastinum with shift to the left most likely ESOPHAGEAL RUPTURE Samado: Agree Shawli: Agree 39-patient with cirrhosis due to hepatitis C infection presented with ascites which do not respond to repeated paracentesis. Which of the following is the appropriate management? a - restrict fluid intake b - avoid high protein diet c - avoid high glycemic diet d - restrict salt intake Fahad : D (top gs explanation: initial treatment of ascited includes alcohol abstinence, salt restriction, and diuretics MZA: D sodium restriction to less than 2 grams per day is recommended in patient with ascites due to cirrhosis Samado: Agree Shawli: Agree 40-tracheomalacia gold standard diagnosis ِA- CXR B- CT chest C- fluoroscopy D- bronchoscopy Fahad : D MZA: D Samado: Agree Shawli: Agree 41-female with self-inflicted injuries on the wrist because she thought her therapist abandoned her. He claims she her voices but when asked her she denied. She caused problem between resident and psychiatrist and head nurse over her condition. What type of personality? A- Borderline personality B- Schizoid personality C- Obsessive Fahad : A MZA: A pic below Samado: Agree Shawli: Agree 42-Child in the clinic has pubic hair increases towards adult type? Dark scrotum, Tanner stage? A. II B. III C. IV D. V Fahad : C from mahdi MZA: C redding at stage 2 darkening at stage 4 Samado: Agree Shawli: Agree 43- A 65-year-old man known to have COPD presented to the Emergency Department with increasing dyspnea, cough, expectoration and fever. Initial assessment revealed fully conscious patient with mild distress, central cyanosis and bilateral wheezing on chest auscultation. The patient was started on high flow oxygen and salbutamol nebulizer but 1 hour later, his level of consciousness is reduced (see lab result) Test Result Normal Values ABG HCO3. 36 22-28 mmol/L ABG PCO2 9 4.7-6.0 kPa pH 7.18 7.36-7.45 ABG PO2 15 10.6-14.2 kPa Which of the following is the best initial step in management? A. Start mechanical ventilation B. Reduce oxygen flow C. Order brain CT scan D. Give naloxone Fahad : B (Medgard) MZA: B pic below Samado: Agree Shawli: Agree 44- Patient with pleural effusion transudates diagnosis? A) Pancreatitis B) Heart failure C) Pneumonia D) Malignancy Fahad |: B MZA: B - only 1 of the choices that is transudative the rest are exudative Samado: Agree Shawli: Agree 45-Pt with ascites and edema, severe muscle wasting, hyperkeratosis, lab show: slightly decreased glucose, significantly decreased albumin? A. severe protein deficiency (kwashiorkor) B. severe carbs deficiency (marasmus) C-Rickets D-Mild malnutrition Fahad : A MZA: A Kwashiorkor with edema Marasmus without edema- pic Samado: Agree Shawli: Agree 46-Case about old man known BPH he presented with difficulty voiding ,frequency ,urgency,incomplete voiding his in alpha blocker for 2 years what is the most appropriate next step ? A- adjust alpha dose B- suprapubic catheter C- intermittent sterile catheter D- transurethral resection of prostate Fahad : D MZA: D failed treatment “Not sure” Fahaddd: D TURP if refractory medical treatment (2 years alpha blocker) Samado: Agree D Shawli: Agree 47-Mother has her first child and he turned out to have sickle cell disease. She has since remarried and what’s to go for premarital testing. What is the first test you should do? A- Paternal hemoglobin electrophoresis B- Paternal chromosomal analysis C- Maternal hemoglobin electrophoresis D- Mixed biomarkers or something vague like it Fahd : A MZA: A pic below Samado: Agree with MZA Shawli: Agree C with fahad 48-Patient with pre-eclampsia, what will decrease? A. Plasma uric acid B. Plasma creatinine C. Plasma volume D. Serum urea Fahad : C from wafaa MZA: C Samado: Agree Shawli: Agree 49-Case of patient pulled out from fire Complain of hoarseness of voice, carbonaceous sputum, crackles on auscultation. What is the most likely diagnosis? A. Inhalation injury. B. Carbon monoxide poisoning. Fahad : A MZA: A Samado: Agree Shawli: Agree 50-Pt has past h/o stroke , now in physiotherapy , what type of prevention ? A-Primary B-Secondary C-Tertiary D-Rehabilitation Fahad : C MZA: C pic below Samado: Agree Shawli: Agree 51- Most affected nerve in patent ductus arteriosus (PDA) surgery? A. Phrenic Nerve B. Vagus Nerve C. Left Recurrent laryngeal Nerve D. Superficial Cardiac plexus Fahad : C from top Gs For surgeons, an anatomical marker of the patent ductus is the recurrent laryngeal nerve which loops posteriorly around the ductus and ascends behind the aorta en route to the larynx. The recurrent laryngeal nerve is often injured during surgical ligature of the ductus. MZA: C from book Samado: Agree Shawli: Agree 52- A 43-year-old man who is known to have chronic hepatitis B presents to the clinic for evaluation. He is asymptomatic with normal physical examination (see lab results and report). Test Result Normal Values RBC 5 4.7-6.1 x 1012/L (Male) 4.2-5.4 x 1012/L (Female) Hb 11.9 130-170 g/L. (Male) 120-160 g/L (Female) Platelets count 145 150-400 x 109/L WBC 3.9 4.5-10.5 x 109/L Direct bilirubin 17 1.5-6.5 mol/L Total bilirubin 21 3.5-16.5 mol/L Aspartate aminotransferase 89 12-40 IU/L Alanine aminotransferase 61 5-40 IU/L Alkaline phosphatase 160 39-117 IU/L US Abdomen: Showed mild coarse liver echotexture. Which of the following is the most appropriate treatment option? A. Entecavir B. Observation C. Lamivudine D. Pegylated Interferon Fahad : A MZA : A BOOK PIC BELOW Samado: Agree with MZA lamivudine has a higher rate of resistance development compared to entecavir Shawli: Agree 53- A 31-year-old 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. O02 saturation 20 C. Peak fiow rate CT-A if +ve -> Endovascular repair If +ve bronchogram or esophagram -> open repair Zone 2 and 3 if asymptomatic -> observe Zone 2 symptomatic -> immediate open repair Zone 3 symptomatic -> CT-A if +ve -> endovascular repair Unstable (expanding hematoma, uncontrolled hemorrhage) = ligation in all zones MZA: similar q pic below Samado: Agree 76- case presentation of imperforated hymen underwent hymenectomy using cruciate or annular incision asking about post operative management : A- Antibiotics B- Vaginal estrogen for 2 wks Fahad : B topGS :It is recommended that patients who are prepubescent apply topical estrogen due to the risk of spontaneous hymen reclosure after surgery. Abx are not given routinely MZA: B Pic below Samado: Agree 77- history suggestive of pericardial tamponade and shock asking about type of shock: A- hemorrhagic B- cardiogenic C- Hemorrhagic D- ANAPHYLACTIC MZA: B Pic below Samado: Agree 78-Case of anterior thigh deep laceration with heavy bleeding and unstable patient asking about what to do next? A- Direct pressure on the wound B- pressure above the wound on femoral artery C- apply tourniquet D. Iv ringer lactate Fahad : A MZA: A pic below Samado: Agree 79- Pt RTA has chest contusion, can shrug his shoulders but can't move his hands or legs, vital signs show hypotension What is the cause? A- cardiac tamponade B- neurogenic shock Fahad : B MZA: B another similar Q pic below Samado: Agree 80- child less than 5 yrs old presented with recurrent respiratory infections and diarrhea confirmed gairdiasis twice his brother has the same problems and he died before the age of 5 yrs what is the diagnosis : A- X linked agammaglobulinemia B- complement deficiency C- IgA deficiency Fahad : A MZA: A Samado: Agree 81-21 year old patient with right iliac fossa pain for 7 days on examination: palpable mass at the iliac fossa WBC high US done showing appendiceal mass with NO collection What to do: A) non interventional B) lap appendectomy C) open appendectomy D) exp laparotomy Fahad : |A Percutaneous drainage of large collections then schedules for an interval appendectomy in 6 weeks. Choose conservative if the collection is small. Go for colonoscopy in an old age patient. MZA: A, bad recall similar type of Q below Samado: Agree 82- 16 year old girl throws up every menstrual cycle, this time she came to the ER because she threw up some blood , after throwing up she looks well and feels better Next step? A- Endoscopy B- Send home and tell her to come back if it happens again MZA: B MG 83- elderly Pt underwent PCI for MI 2 weeks ago now he present with acute cholecystitis when to do cholecystectomy : A- after 6 weeks B- after 6 months C- do it this admission D- no need to do it Fahad: B MZA: B MG Samado: Agree with MZA 84- Patient with croup, given epinephrine and cortisol but no improvement after one hour. How to confirm diagnosis in ER A-lateral chest X-ray B- laryngoscopy C- a different type of X-ray I forgot what it was Fahad : B MZA: B similar Q below Samado: Agree 85-old man with small proximal and interphalangeal joints pain and knee also. On exam he is in active arthritis. Most appropriate management? A- Methotrexate B- Hydroxychloroquine C- Methotrexate, hydroxychloroquine, prednisolone Fahad :C MZA: C Rheumatoid arthritis, active so must start steroid for bridging similar Q below Samado: Agree Methotrexate takes 6 weeks to be effective, so it must be taken with prednisolone 86- 2 month old Patient with fever runny nose, cough, bilateral wheezing in lungs (I think), looks fussy, his brother had runny nose and fever too how to confirm diagnosis A- chest X-ray B- sputum culture MZA:Bad recall similar Q below 87- 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 Fahad : A MZA: A with no risk 0.4mg (400 microgram) to 1 mg if high risk take 4mg daily Samado: Agree 88-SLE patient have arthritis, in steroid and hydroxychloroquine but no response, what to add: A - methotrexate B-azathioprine C_Cyclophosphomide Answer : A MTX is added as an immunosuppressant in cases of resistant arthritis Samado: Agree 89- When to do anomaly scan? A. 16 to 18wk B. 18 to 22wk C. 13 to 16wk D. 24 to 28wk Fahad : B Maan : B Samado: Agree 90- 12 year old boy saying he is very tall in his class, he has hyper flexibility of his joints, most important investigation to rule out life threatening diseases? A- echocardiography B- an abdominal investigation Fahad : A Maan: A Samado: Agree 91- A 46-year-old, G3P1+1 at 34 weeks’ gestation presented to antenatal clinic for regular check-up, she has unremarkable medical history and uncomplicated pregnancy Braxton Hicks and non-pruritic cervical discharge. Her pre-pregnancy weight was 54.4 on examination, cervical length was 33 mm. Current weight: 52 Rubella AB: -ve HBsAg: -ve Blood type: O+ Which of the following is the most appropriate next step? A. Follow up after 2 weeks B. OGGT test C. Do rubella Ab test / Repeat rubella screen D. Give anti-D Ab Fahad : A Maan : A Samado: Agree 92-20yo male patient came to ER complaining from abdominal pain. O/E there was inguinal hernia that was tender On x-ray there was multiple air fluid level in abdomen. What type of hernia? A. Strangulated B. Obstructed C. Irreducible D. Incarcerated Fahad: B Maan : B (see below) Samado: Agree 93- Placental abruption and fetal distress and ph 6 what improve mortality now? A. Mild hypothermia B. IV Fluid C. Electrolytes Fahad : A Maan : A (wafa) Samado: Agree 94-3 year old pediatric patient brought to the clinic, he has fever, headache, tonsillar exudates, purulent discharge and membranous layer on the posterior pharynx. Vitals: Unremarkable besides high fever. (That’s everything no additional info im sure).What is the causative organism: A. Corona B. Influenza C. EBV D. RSV Fahad : C Maan : C Infectious mononucleosis is a viral infection that primarily affects children and young adults. It is characterized by the classic triad of fever, pharyngitis, and lymphadenopathy. The presence of tonsillar exudates and a membranous layer on the posterior pharynx further supports the diagnosis. Samado: Agree 95- Pt came with symptoms similar to coronavirus and refused reporting because he afraid of losing his job? A.confirm diagnosis then reporting B.reporting within 24 hours C. Respect pt wish B ( SMLE BRAIN) Samado: Agree 96- First line treatment of hypertension in pregnancy is? A. Methyldopa B. Labetolol C. Hydralazine D. Nifdepine B labetalol is the first line treatment for htn in pregnancy Samado: Agree 97- 12 yrs old boy had red eyes , cough , coryza , his old brother had same symptoms 2 days ago. On ex congested pharynx with exudate ? A.streptococcus B.adenovirus C.CMV D. Infectious mononucleosis Fahad : B Maan : B Samado: Agree 98- Pregnant in third trimester, with abdominal pain and vaginal bleeding, abdominal exam shows a length less than the gestational age, CTG shows late decelerations, diagnosis? A. Placenta previa B. Vasa previa C. Placenta abruption Fahad : C Maan : C 99-Infant Mortality Rate has decreased to 4.28 in 2020 in Saudi Arabia. Which of the following figures are involved in this: A) Number of women in childbirths age B) Number of deaths in saudi arabia in 2020 C) children who died in 2020 and not completed their first year D) number of population in 2020\ Fahad : C Maan : C Samado: Agree 100- 75 year old man had reducible inguinal hernia for long time , now came with moderate pain ? A.simple repair B.open repair with mesh C.herniotomy D.leave him without surgery Fahad : D Samado: D Agree (TopGs) 101- Pregnant with uncontrolled diabetes, what is the most likely complication to happen to the baby after delivery? A. Respiratory distress syndrome RDS B. Hyperkalemia Samado: A Maan : A 102-18 month old present to the clinic with eye swelling for 2 days, associated with proptosis , limited eye movement and decrease visual acuity. Mother mentioned he missed 12 and 18 month vaccine What is the most probable diagnosis? A- orbital myositis B- Periorbital cellulitis C- orbital cellulitis D thyroid induced Samado: C Explanation : Limited eye movement and decrease visual acuity indicate damage to the contents of orbit which happens in orbital cellulitis Maan : C 103- 19 yrs old female present with right breast mass increasing rapidly 10*12 , tissue biopsy show malignant cell no lymphnode? A. Wide local exciton B.chemotherapy Forgot other option but no mastectomy there Samado: I thick its incomplete Qs Maan : question from medguard below ( 104- Pregnant lady, diabetic, 38 weeks in active labor and having DKA profile and fetus in distress (CTG that is suggested of bradycardia) what to do? A. Change the mother’s position of labor B. Stop and do C-section Samado: A. Explanation: Maan : A ‫ ﺳؤال ﻣﺷﺎﺑﮫ‬Medgard ‫ھذا ﻣن‬ 105- 15 years old boy present with deep pelvic pain and upper thigh pain while walking , ex there is moderate tenderness in anterior thigh with mild limitation of movement ? A.osteomyelitis B. Toxic synovitis C.septic arthritis D. Benign myositis of adolescence Samado:B Maan : B 106-A 70-year-old male presented with frank hematuria, He has no other urinary symptoms, and no fever, upon examination there was a palpable mass in the rectal examination of the prostate, urine analysis, culture and CT pyelogram all were negative only positive thing was RBCS in urine without WBCs or RBC Cast, what is the most appropriate next step that will lead to the diagnosis? A. Repeated urine culture B. Cystoscopy C. Antibiotics D. TRUS biopsy Samado: B Any patient with gross hematuria do urine cytology Microscopic hematuria =repeat urinalysis Elderly painless hematuria= cystocopy to role out bladder cancer MEDGARD ‫ﺳؤال ﻣﺷﺎﺑﮫ ﻓﻲ‬ 107- Pregnant at 20 weeks of gestation with HTN 160/90 what is the appropriate antihypertensive drug for her? A. Labetalol B. Hydralazine C. Methyldopa D-Nifidepine Samado: First line is A Maan : A 108- Doctor prescribe iron for pt ? How to write it ? A. 400 U OD B.400 U Daily C.400 unit daily D. four hundred unit daiy Samado: C Maan : C ( the recalls mention vitamin D) 109- Patient with long term history of DM type 1 in 12 weeks of gestation. HbA1C 12. Which of the following complication is most likely to happen? A. Pre-eclampsia B. Polyhydramnios C. Congenital malformation D. IUGR Samado: C, explanation : Maan : C 110-A 45-year-old woman is complaining of abnormal genital bleeding. Which of the following would highly suggest a uterine source of bleeding? A. Color of the blood B. Post-coital bleeding C. Scanty vaginal bleeding D. Profuse vaginal bleeding Samado: D explanation : Medgard 111- Case of cholangitis ( UQ pain , fever , jundice ) A.septic culture B.mrcp C.ercp D.hydration and antibiotics Samado: C (charcot's triad) ‫ اﻻﺟﺎﺑﺔ‬US‫ ﺑﯾﻛون ال‬US ‫ وﻓﯾﮫ‬initial ‫طﯾب ﻟو ﻗﺎل‬ Maan : C 112- A 40-Year-old female, with heavy vaginal bleeding came to ER, what to do? A. IUCD B. D&C C. Hysterectomy D. Mefenamic acid Samado: B Maan: B 113- Lady at 34 weeks of gestation, had previous one C-section, on pelvic exam only the cervix was 3 cm dilated on US placenta was anterior and laying low. Why is ECV contraindicated in this case? A. Gestational age B. Vaginal exam findings C. US findings D. The previous history of C-section Samado: C Maan : C ‫ﻓﯾﮫ ﺳؤال ﻣﺷﺎﺑﮫ ‪:‬‬ 114-50 yrs old female, last menstrual period before 7 years, complain of hot flashes ,that interrupt her sleep. what is the best investigation to confirm her condition ? A. FSH B. LH C. estrogen D.progesterone Samado: A Maan : A 115- In labor after 10 min of delivering the fetus, placenta is still not delivered she started bleeding? A. Primary PPH B. Secondary PPH C. Tertiary PPH D. Iatrogenic PPH Samado: A Maan : A 116- Diabetic with ulcer under big toe , hos HA1c is 7 , pripheral pulse intact in both LL ( dorsalis pedis ) What investigation he needs ? A Douplex B. Angiography C MRA Samado: ‫اﻟﺳؤال ﻧﺎﻗص ﺑس ھذا ﺣل ﻣﺷﺎﺑﮫ ﻣن‬ TOP gs 117- A 17-Years-old female came complaining of primary dysmenorrhea. How will you manage? A. COCPs B. NSAIDs C. Mefenamic acid Samado: B Maan: B 118-A 49 year-old smoker man has type 2 diabetes mellitus. morbid obesity and a recent diagnosis of symptomatic peripheral arterial disease. He is started on atorvastatin (Lipitor). offered a supervised exercise program and discussed smoking cessation and interventions. Which of the following should be recommended to prevent cardiovascular events? a. Aspirin b. Warfarin c. Atenolol d. Enoxaparin SC injection Samado: A Maan : A 119- A 32-year-old came to gynecology clinic for her dysmenorrhea. Which of the following is history evaluation is important? A. Medical B. Surgical C. Family D. Menstrual Samado:D 120.most toxic drug SSRI A.sertaline B. Citalopram C.fluxitine Samado: B (Medgard) 121. Dengue fever in Saudi Arabia A. Central B.west C.south D.east Samado:B (answered by Dr.Elaf) Maan : B 122- Percentage of GERD post tracheoesophageal repair A. 5 B.10 C.30 Samado: C Maan: C 123- pregnant had previous hx of preeclampsia+ IUGR.. what from option decrease preeclampsia? A.asprin B.multivitamin C.ferrous D.progesteron Samado: A Maan : A 124-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 Samado: A Maan : A 125- Couple came to the infertility clinic. Semen analysis was normal, cervical exam not done yet. The wife has regular menstrual cycles every 36-40 days. Investigations show monophasic basal temperature What is the cause of infertility? A. Coital B. Vaginal C. PID D. Anovulatory Samado: D Maan : D 126-Child 4y came to ER with barking cough and dyspnea. He had history of 2 days dry cough and runny nose On examination there was red throat , high pitched harsh sound when the patient is taking a breath and upon crying: what is the most likely cause Temperature: 39C A- viral B- allergic C- bacterial D- foreign body Samado: A Maan :A Explanation: Croup , key word : barking cough or brassy cough. Low grade fever , high pitch sound"hoarsness voice", stridor Age 6month _3 year Parainfluenza virus. Hx of URTI days before. Dx: physical examination Tx: if mild no stridor no hypoxia treat with dexamethasone. If moderate or sever treat with : Racemic epinephrine. 127- Morbidly obese patients came with irregular menses, 3-4 between each menses. Now she presents with menses for 10 days heavy and with clots, what could be the cause for the bleed? A- fibroid B- chronic anovulation C- coagulation disorder Samado: B Maan : B Explanation: Chronic anovulation, often associated with conditions such as polycystic ovary syndrome (PCOS), is a common cause of irregular menstrual cycles, where periods may be infrequent or occur with varying intervals. When anovulation occurs, the uterine lining may build up over time, leading to heavy and prolonged menstrual bleeding when menstruation eventually occurs. This can result in episodes of heavy bleeding with clots, as described in the scenario. While fibroids (Option A) and coagulation disorders (Option C) can also cause heavy menstrual bleeding, they typically do not present with irregular menstrual cycles as the primary symptom. Additionally, coagulation disorders may present with other bleeding symptoms beyond menstruation. Therefore, chronic anovulation is the most likely cause of the heavy and prolonged menstrual bleeding in this patient. 128- 30 years old female at 30 weeks of gestation, 2cm cervical dilatation 50% effacement with PPROM the doctor give her steroids and tocolytic drugs, what is the purpose of Tocolytic? A. Delay labor until steroids work B. Prolong pregnancy until 37 weeks Samado: A Maan : A 129- Child around 6 years (not sure maybe 8 ) night time tonic clinic with eye blinking , also in the morning when comb hair..? EEG : centrotemporal spike A-Rolandic B-Absence C-west syndrome D-Lenox- Samado:A Maan : A 130-Warfarin did not stop by the patient regardless of clear instructions, the nurse in OR noticed that the patient didn't stop the drug as instructed and informed the surgeon, So the surgeon postponed the operation? A. Adverse event B. Medical negligence C. Near miss D. Principle of totality Samado:C Maan : C 131- 25 years old female, G2P1, her labor was 2 hours long, baby came out before she barely made it to the hospital, baby weight was 3000. She started bleeding after delivery of the placenta, what is most likely the cause? A. Baby weight B. Prolonged labor C. Precipitous labor D- Grand parity Samado:C Maan : C 132- Pregnant at twenty something reduce fetal movements U/s show IUFD what’s your action ? (No bleeding ) A- Oxytocin B- Misoprostol C- D & C Samado: B Maan: B 133-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 Samado: C Maan: C Battered child syndrome = abuse 134- Nowborn preterm ?? Respiratory distress, meconium stained amniotic fluid ,, pre ductal oxygen 90th post ductal 88 CXR : I forget what the finding A-Nitric oxide B-Diuretics C-Surfactant Samado: A Maan : A 135- Question about child with symptoms of anemia , chronic diarrhea and wt loss High Mcv , low folate , low b12 -Celiac disease -Ulcerative colitis -Crohns disease Samado: C Maan : C 136- Gestational age 31 weeks, known to have PPROM admitted on the 5th day she developed fever and abdominal pain, GBS 10000 how will you manage? A. Amoxicillin and gentamycin then deliver. B. Amoxicillin and gentamycin and observe. C. Observe D. Find the cause of fever and treat accordingly Samado: A Maan : A 137- Women with epigastic pain and tenderness, vomiting……, high Amylase level 600 What support diagnosis ? A- CRP B- ESR C- ALT D- calcitonin Samado:A Maan : A 138- Child started to develop a sense of individuality. She recognizes strangers and frightens when separated from her parents? A- 6 B- 7 C- 10 D- 12 Samado:C Maan : C 139- Female 26 weeks with reduced fetal movement since 2 weeks. Abdominal exam show GA of 24 weeks, presented to ER, U/S done showed fetal demise. How to manage? A. IV oxytocin B. D&C C. Misoprostol vaginal pessaries Samado:C 140- A multiparous patient who had delivered 7 babies previously through CS now wants to deliver her 8th baby by CS, the doctor recommended tube ligation with future pregnancies, what is the best action? A- Take consent from her or her representitive B- Take consent from both her and her husband C- Consult ethics committee D- Take consent from her and tell her to inform the husband Samado:D Maan : D 141- Pts known HCV cirrhosis massive ascitis develop umbilical hernia he is asymptomatic but ia not comfortable with it A- do water something mesh B- do paracentesis then operate C- wait until control ascitits Samado: C Maan : C 142- Patient came to ER due to MVA was not oriented with GCS 8 , distended neck veins and breath sounds are markedly diminished on the right side , high JVP What is the first step in management ? A-Needle decompression B- intubation Samado: B? Maan: B ( not oriented = intubation first) Fahaddd: B (In SMLE, they religiously follow the sequence of “ABCDE” So in this case Intubation comes first, before needle decompression. SMLE unlike UTD) (Hamoud) 143-A 65-year-Old man known case of diabetes mellitus and hypertension presents to the Emergency Room with a 1-day history of vomiting fresh blood and melena. He is taking aspirin 81 mg daily. After fluid resuscitation. He was started on IV PPI. He underwent upper GI endoscopy, which revealed a 2 cm duodenal ulcer at the bulb with visible vessel seen. Endoscopic hemostasis was done using endo Clip Which of the following Is the recommended duration for IV PPI post endoscopic management? a) Oral PPI b) IV PPI for 48 hours then oral c) IV PPI for 72 hours then oral Samado: C (top Gs) Maan: C 144-Most common drugs used to treat PPH after Uterine atony? A.Oxytocin B.Carboprost C.Misoprostol D. Methylergonovine Samado: A 145- Scenario about DKA s &s , diagnosis not written with investigators severe metabolic high WBC acidosis normal saline infusion is initiated next step ? A- IV insulin B- IV ceftriaxone C- iv K D- iv bicarbonate Samado: A 146- Child with sudden squint what to do? A. Refer to ophthalmologist next day B. Imaging for space occuping lesion C. Reassurance and send home Samado:This question came with additional information: the child was having diplopia along with the squint which is a red flag > CT So the answer is B Maan : B 147- A 39-year-old woman, who Is a mother of 3 children and has completed her family, she is a known case of endometrioma in the right ovary that has been removed 2 years ago. She came to the clinic complaining of mild to moderate dysmenorrhea and deep pain during intercourse along with her chronic lower abdomen pain. Pelvic ultrasonography revealed the presence of left ovarian cyst measuring 6X7 cm that appeared to be an endometriotic cyst. Which of the following is the most appropriate next step? A. Removing the cyst when the size becomes more than 10 cm B. Aspiration of the content of cyst under ultrasound guidance C. Total abdominal hysterectomy and bilateral salpingo oophorectomy D. Removing the cyst laparoscopically with ablation of any endometriotic spot Samado: D Medgard Maan : D Fahaddd: D (MEDGARD) 148- A 23-year-old woman evaluated for dyspnoea and recurrent palpitation. She has a history of Fallot tetralogy repair at the age of 3. On cardiac examination, apex was normal with left parasternal impulse. S1 is single with grade 2/4 decrescendo diastolic murmur that increases with inspiration noted at left sternal border. Blood pressure 110/70 mmg Heart rate 94 /min Oxygen saturation 92 % Which of the following is the most likely diagnosis? A. Mitral valve stenosis B. Ventricular septal defect C. Tricuspid valve regurgitation D. Pulmonary valve regurgitation Samado: D Maan : D Explanation: Given the patient's history of Fallot tetralogy repair and the findings on cardiac examination, the most likely diagnosis is D Patients who have undergone repair of Tetralogy of Fallot are at risk of developing pulmonary valve regurgitation over time. The left parasternal impulse and the characteristic diastolic murmur increasing with inspiration at the left sternal border are consistent with pulmonary valve regurgitation. Additionally, the patient's oxygen saturation of 92% indicates some degree of right-to-left shunting, which is typical in cases of significant pulmonary regurgitation. 149-female with SCD presented with sudden onset paraplegia, and urine incontinence On pe hyperreflexia Best investigation: A-LP and MRI brain B-LP and Ct brain C- LP and MRI spine D- LP and MRI MRA MRV brain Samado:C (top Gs) Maan : C 150- A 47-year-old patient presents with 12-hour 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 Samado:A (top Gs) Maan : A 151- Child come with his mother with history of coughing and other symptoms, before. 3 days he chocked with popcorn or something like that, Next step : A- Rigid bronchoscopy B- Flexible laryngoscopy C- chest X-ray Samado: C ( if they ask about the most appropriate or most diagnostic then the answer is A) Maan : C 152- Lady in the 70s has type 2 DM on metformin 1 g BID had problem in naming and calling things lately. For example she says animal instead of cat when she sees a cat. She has no memory impairment or personality changes. Her family are worried about her. What is the most likely diagnosis? A. Vascular dementia B. Alzheimer’s dementia C. Frontotemporal dementia D. B12 deficiency with cognitive features Samado: A ( ‫)ﻻزم ﺗﻔﮭﻣوا ﻛل اﺟﺎﺑﺔ ﻣﺗﻰ ﺗﻛون ﺻﺢ ﻻن ﻓﻲ ﺳﺎﯾﻠﻧت ﯾﻘوﻟوا اﻟﺳؤال ﻓﯾﮫ اﺿﺎﻓﺎت‬ Maan : A 153- A 70-year-old man with hypertension, diabetes and aortic sclerosis was discovered to have atrial fibrillation on routine health check-up. He denies dyspnea, chest pain or palpitations. Which of the following drugs is recommended to prevent systemic embolization? A. Aspirin B. Warfarin C. Clopidogrel D. Rivaroxaban Samado: B MG ‹Maan : B Mahmood: B MG 154- A 70-year-old male presented with frank hematuria, He has no other urinary symptoms, and no fever, upon examination there was a palpable mass in the rectal examination of the prostate, urine analysis, culture and CT pyelogram all were negative only positive thing was RBCS in urine without WBCs or RBC Cast, what is the most appropriate next step that will lead to the diagnosis? A. Repeated urine culture B. Cystoscopy C. Antibiotics D. TRUS biopsy Samado: same as Q 106 155- Child brought by mother for vaccination , 4 days ago he develops tonsillitis and started antibiotics? A- Delay vaccines B- give vaccine C- post pone oral polio vaccine Samado: B Maan : B (antibiotic treatment is not a contraindication) 156-A 1-month-old baby is brought to the clinic with signs of constipation, abdominal distension, and bilious vomiting. The parents explain that constipation has been a problem since the baby's birth. Which of the following tests has the highest diagnostic value? A. Plain X-ray B. Rectal biopsy C. Anal manometry D. US abdomen Samado: B (Medgard) Maan : B 157- A 25-year-old man developed fever, malaise and rash on his palm and soles. He gave a history of painless ulcer on his penis 6 weeks earlier. Examination was unremarkable a part from generalised lymphadenopathy. Which of the following is the most likely organism causing his presentation? A. Coxiella burneti B. Treponema pallidum C. Staphylococcus aureus D. Chylamdia trachomatis Samado:B Painless ulcer on penis —> Dx. syphilis —> caused by treponema palladium Treated by Penicillin Maan : B 158- 5 day old newborn came with mother complaining of bruises on baby, pt and ptt prolonged, platelet level normal dx: A- Hemorrhagic disease of newborn B- ITP Samado: A (Top Gs) Maan : A 159- 20-30s male patient presented to ER complaining of Perianal painful lump for 12 hours , which he felt after passage of a hard stool. On exam 1*1 cm in size, Dome shaped, Bluish, tender swelling just beneath the perianal skin. Most appropriate Management? A- Conservative management B- Rubber band ligation C- lateral internal sphincterotomy D- Aspiration Samado: C (Hamza and Top Gs) Maan : C (only reasonable answer ) 160- 91 y/o male with abdominal distention tenderness all over abdomen no specific side not anything significant in lab what is most appropriate next step ? A. Colonoscopy B. Sigmoidoscopy C. US abdomen D. Digital rectal examination Samado: D (some people answered C, but I see D) Maan : D 161- Samado: same answer (medgard) 162- 30 year old female pregnant with new symptoms of dyspnea, productive cough and fatigue. Doppler US was negative what is the next test to do: A- cta B- d dimer C- spirometry D- ventilation and perfusion scan Samado: D It should be X-ray If the x-ray is clear the next step is V/Q If the chest X-ray wasn’t clear V/Q is useless and CTA is indicated Since they didn’t optioned us with X-ray , go with V/Q. But know this algorithm very well Maan : D 163. Mom came with her child became fatigue, yellowish discoloration of sclera , diarrhoea? A. hepatits A B. Heb B C. Heb c D. Heb D Samado: A Maan : A 164. Child , brassy cough , fever. Present to er. Pt impover after nebulized epinephrine.. but symptoms regain what next ? A.antibiotic B.dexamethasone C. Nebulized epinephrine Samado:C Maan : C (UpToDate) 165. Child present with sob , fever , monophasic wheeze ? A. Laryngomalsia B.trachiomalasia C.bronchits Samado:B Maan :B 166. Preterm baby , sob , sign of res distress ? A.hylain membrane disease B.TTN Samado: A Maan : A 167.ABOVE scenario management? A.surfactant B.CPAP C.antibiotics Samado: A Maan : A 168- 65 YO male presented to ER with severe right leg pain and absent pedal pulse. Which of the following is the most appropriate investigation? A. СТА B. MRA C. Conventional angiography D. Ultrasound doppler Samado: C is gold standard investigation (invasive one) A most appropriate D initial Maan : A 169- 38-year-old man has episodic chest pain. He states that the pain feels like tightness, located right behind his sternum, lasts less than 3 minutes, and is relieved with rest. He takes no medications. He has no family history of coronary disease and has never smoked. His ECG in the office is normal. What is the most appropriate test to exclude cardiac ischemia? A. Cardiac CT B. Exercise ECG C. Resting echocardiogram D. Creatine kinase enzyme Samado: B Maan : B 170- 23 yo female pregnant 28wks with fetal hydrops peak systolic flow 1.8mom on mca doppler cause ? A- anuplide B- diaphragmatic hernia C- anti-kell antibody D- cervical teratoma Samado: C Maan : C 171- Obese women her waist circumference is 125cm and hip circumference (don’t remember) about 100, (weight & height not mentioned) Labs: LDL: 4.3. (2.0-3.7) which of her ( markers ) is an indicator of significant health risk? A. LDL B. BMI C. Waist hip ratio D. Waist circumference Samado: D Maan : D 172- The WHO requested health related data with regards to a particular health issue affecting the population. Which of the following should KSA share with the WHO? A) Health indicator B) Health determinant C) Risk factors D) Case fatality Samado: A Maan : A 173- Pregnant with valvular lesion which is carry highest risk ِA- MR B- Ms C- AR D- AS Samado: B Maan : B 174-Patient developed a circumferential right forearm burn. sat in right digit is 86% ,Absent pulse.What is the appropriate action A- bedside escharotomy B- measure intra compartmental pressure Samado: A Maan : A 175- About a pediatric child that the treating physician have decided that he’s a candidate for DNR, which of the following is true about DNR: A- it’s a decision made by 3 consultants B- sharing with the parents the availability of the DNR decision C- it’s made by one consultant and 3 specialists Samado: A Maan : A 176- 9 y/o pt his mom complaining about he is wetting his bed since one month. He used to be dry since 7 years. The urine is foul smelling His lab showing high wbs and turbid in colour and showed nitrate Diagnosis? A. UTI B. normal for his age C. nocturnal enuresis Samado: A Bahabri: A Explanation: this is secondary enuresis and the most common causes are UTI and DM. The patient has UTI symptoms 177- Doctor prescribed warfarin for a women, in the next visit after one week he find that she is 10 weeks pregnant, what to do to prevent recurrence of this situation? A- Depend on graphic memory B- Tailor prescription to the individual C-knowing high-risk medications D-Knowing generic names Samado: B Bahabri: B Explanation: by tailor the prescription they mean ordering necessary labs and investigations before prescribing 178- Case of anorexia nervosa they will start her on enteral feeding she has Hypokalemia Hyponatremia Hypocalcemia Hypophosphatemia Hypomagnesemia (everything was Hypo) What’s the cause of this? A- wrong feeding method B- Refeeding syndrome C⁃ malabsorption Samado: B Bahabri: B Explanation: reefeding syndrome is characterized by massive insulin release that shift all of the electrolytes into the cell. This typically affects anorexia nervosa patients 179 A guy is taking ibuprofen for arthritis (or something) came complain of dark stool , or blood in stool ,SOB ,fatigue, fainting ,...etc Ex : hypotensive His labs Hb 87 What is the best management A- Blood transfusion B- Iv fluid C- Colloid Samado: B??? Bahabri: same question from medguard 180-A very long scenario of a child non vaccinated,with fever , ill looking and “hacking cough” and inspiratory wheeze, stridor A)pertussis B)Hib Samado: A Bahabri:same question from medguard 181- 2- they want to measure the affect on the prevalence of DM after introducing insulin’s A- increase DM incidence B- increase DM prevelance C- decrease DM incidence D- decrease DM prevelance Samado: B Bahabri: B, Insulin decreased death rate from diabetes which increased the number of people alive with DM ( see picture below) 182) Pt with ascites and edema, severe muscle wasting, hyperkeratosis, lab show: slightly decreased glucose, significantly decreased albumin A. severe protein deficiency (kwashiorkor) B. severe carbs deficiency (marasmus) C-Rickets D-Mild malnutrition Samado: A Bahabri:A Similar questions I found in medguard. 183- A 47-year-old woman presents to her primary care provider with Raynaud's phenomenon for 3 years, puffy fingers, a fingertip ulcer and difficulty swallowing. Past medical history is unremarkable. The patient does not smoke but drinks alcohol socially. Physical examination of her hands is shown, which of the following is most likely to be positive in this patient condition? A- Anti-smith antibody B- Anti-Scl-70 (anti-topoisomerase I antibody) C- Anti-DsDNA D- Anti-centromere antibody Samado: D Bahabri: D, good explanation below My explanation: the patient presents with symptoms and signs consistent with systemic sclerosis (scleroderma), particularly the limited cutaneous subtype, also known as CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia). Given her symptoms of Raynaud's phenomenon, puffy fingers, fingertip ulcer, and difficulty swallowing (indicative of esophageal dysmotility) 184- A lady with manifestations of rheumatoid arthritis that has been progressed, what antibody is needed to confirm diagnosis? A- ANA B- Anti- CCP (Anti-citrullinated protein antibodies) C- Anti-cardiolipin D- Anti RNP Samado: B Bahabri: B 185-Father +ve blood group, mother -ve, neonate +ve, 1st pregnancy after delivery prophylaxis cover…..? A-15% B-30% C-60% Samado: A Bahabri: 300 microgram anti-D covers 30ml of fetal blood, and 15 ml of fetal rbcs, so it depends on the question 186- Patient had a stab wound in the chest. Came with weak thread pulses, raised JVP, Equal Bilateral Air Entry in both lungs. What's the diagnosis? A. Pneumothorax B. Cardiac tamponade C. Pulmonary contusion D. Aortic Dissection Samado: B bahabri:B Source: hamoud Explanation: weak pulse and raised JVP are part of beck's triad, also A is ruled out because there is equal bilateral air entry 187-Patient came to smoking cessation clinic welling to quit smoking after buying nicotine patch and making appointment with you. What stage ? A- Action B- Preparation C- Contemplation D- Pre-contemplation Samado: B 188- Soldier going to southern Saudi Arabia. What is the best malaria prophylaxis? A- Atovaquone-proguanil B- doxycycline C- choloquine D- Mefloquine Samado:A Bahabri: same question in medguard 189- Patient post thyroidectomy had arm spasm during blood pressure measurement, what is your next step? A- Give analgesia B- Take blood pressure again C- Check calcium level D- Administer Calcium Gluconate Samado: C Bahabri: C Source: hamoud 190- A 5 year old childis brought to the clinic with a febrile illness with a cough and separate irregularly shaped rashes. He has not had any routine vaccinations. On physical examination, there is enlarged tender cervical lymph nodes. There are also erythematous maculopapular rashes behind the ear, face and neck and to a lesser extent on the trunk. Which of the following is the most likely diagnosis? A. Chickenpox B. Measles C. Mumps D. Rubella Samado: B Bahabri: found the question in medguard. 191- Samado: A Bahabri :A Explanation: normal GB rules out B, no jaundice rules out C, no change in bowel habits rules out D 192- A 39-year-old woman, who Is a mother of 3 children and has completed her family, she is a known case of endometrioma in the right ovary that has been removed 2 years ago. She came to the clinic complaining of mild to moderate dysmenorrhea and deep pain during intercourse along with her chronic lower abdomen pain. Pelvic ultrasonography revealed the presence of left ovarian cyst measuring 6X7 cm that appeared to be an endometriotic cyst. Which of the following is the most appropriate next step? A. Removing the cyst when the size becomes more than 10 cm B. Aspiration of the content of cyst under ultrasound guidance C. Total abdominal hysterectomy and bilateral salpingo oophorectomy D. Removing the cyst laparoscopically with ablation of any endometrotic spot Samado: repeated D Bahabri: D, confirmed Fahaddd: D (MEDGARD), Screenshot above 193-Case of neonate ader ventouse there bulging in head under periosteum within line of head sutures? A. Cephalohematoma B- caput hematoma Samado:A bahabri:A, found in medguard @ 194- Female ?? week gestational age, presented after period of missing clinics of pregnancy follow up, presented w profuse vaginal bleeding and no abdominal pain. Ctg normal heart rate and no contraction. A- Preterm labor B- Placenta abrupt C- Placenta previa D- uterine rupture Samado: C Painful -> Abrupt , painless -> prev bahabri:C Explanation:no contractions rules out A, no pain rules out B and D. 195- Patient came in with SOB and fatigue. He was stable. ECG: showed bradycardia (same pic dx not written), Next step in management? A- Cardioversion B- Atropine C- Aspirin D- Aspirin and clopidogrel (i think) Samado: B Bahabri: B, similar question found in medguard. 196-woman, who is 8 weeks postpartum, intermittent weakness of the upper and lower extremities, says, my arms feel weak after carrying the baby for a few minutes and I can’t lift him until I rest for some time. Yesterday evening, I couldn’t even get off of the toilet, but today, I feel fine. had episodes of blurry vision, pregnancy was complicated by gestational diabetes. Deep tendon reflexes and muscle strength of the bilateral upper and lower extremities are normal. What's diagnosis? a)myotonic dystrophy b)multiple sclerosis c) myasthenia gravis. d) diabetic amyotrophy Samado: C Bahabri: C 197- 53 year old man known liver(Full) cirrhosis present to the er with vomiting fresh blood for 5 h, on ex he is oriented and vitally stable What is the most appropriate medication: A-b2 agonist B-Adrenaline C-Octreotide D-Vasopressin Samado: C - To prevent bleeding before endoscopy>> octreotide - To prevent recurrncy>> BB - To reduce mortality>> i.v cefriaxone - To prevent ligation induced ulcer >> PPI bahabri:C,Similar question in um al qura below 198-45-year-old patient complains of recurrent episodes of upper abdominal pain for the past 2 week with fever. On examination, the patient is jaundiced, the abdomen abdomen is soft with marked tenderness all over Blo od pressure 90/60mmHg Heart rate 130 /min Respiratory rate 18 /min Temperature 38 °C indirect bilirubin 5 Direct bilirubin 20 Total bilirubin 25 Alkaline phosphatase 450 Amylase 1400 Ultrasound: CBD of 1.4 cm with dilatation of intrahepatic ducts. Which of the following is the most likely diagnosis? A. hepatitis B. cholangitis C. pancreatitis D. acute cholecystitis Samado: B (Medgard C) bahabri:C, found in medguard 199- 36 y.o man 9 days history of right iliac fossa pain,o/e right iliac fossa mass and tenderness, T 38.8, BP 100/58, HR 112 CT showed appendix abscess 15×18 cm Which of the following is a characteristic pathophysiology? A. Redistribution of blood flow B. Peripheral vasoconstriction C. Decreased cardiac index D. Bradycardia Samado: A The characteristic pathophysiology for an appendix abscess in this case would most likely be A. Redistribution of blood flow. This happens as the body tries to maintain blood flow to vital organs while limiting it to the inflamed area. Bahabri: A Reference: https://www.uptodate.com/contents/acute-appendicitis-in-adults-clinical-manifestations-a nd-differential-diagnosis 200-Pt has a hx of severe epigastric pain that started after eating fatty meal and resolved after 2 hours. Vitals normal Amylase I think was high What is the most likely diagnosis: A-peptic ulcer B-cholangitis C-biliary colic D-pancreatitis Samado: C Bahabri:C 201- Patient of Uc, came with diarrhea for 10 days On examination he has dehydration (I think he's hypotensive ) What is the acid base status for him? A- Metabolic acidosis B- Metabolic alkalosis C- Compensated Metabolic acidosis D- Compensated Metabolic alkalosis Ryan: B from top Gs:B, cant tell if compensated or not without ABG Bahabri: A Source: diarrhea causes normal anion gap metabolic acidosis according to amboss Samado: Agree with Bahabri Fahad : A 202- Baby of diabetic mother RDS , desating.. Most appropriate mangment A- Intubation and ventilation B- Iv fluid C- Nicu admission, glucose montring and observation ryan : C from silent Bahabri: C, found in mahdi Samado: C 203- Media developed sudden onset of cough and shortness of breath, the child had a history of eating cereal, the family denied any history of fever or choke, xray was given. Which of the following is the most likely the cause ? A- Pneumonia B- Foreign body C- Anaphylactic reaction Ryan: B from top Gs bahabri:B Samado: Agree 204- Preterm 29 wk / low oxygen, Best managment: A- Surfactant B- Cipap with 100% oxygen Ryan: A from silent bahabri:A Samado: Agree 205- Pt with Pancreatic cancer , developed LL swelling and erythema and pain Dx: A- Dvt B- Cellulitis C- Lymphagenitis Ryan : A from silent Bahabri: A, cancer is a risk factor for DVT Samado: Agree 206-Female known to have multiple panic attacks after last attack she felt disconnected and as the environment is strange A-Depersonalization B-Illusion C-Derealization bahabri:C, found in medguard Ryan: C from top Gs 207- Pediatric patient came with exercise intolerance /sob... On ex gollob rhythm / hypotension/ tachycardia What Investigations to be done: A- Electrolytes B- Abg C- Cbc Bahabri: found the question on telegram but the answer was thyroid function test 208- mother just give birth, exclusively breastfeeding want contraception for 2 Years? A-depo provera injections B- POP C- OCP Ryan: A from silent Bahabri: A, the injections only work for two years according to wafaa 209-Disease person 800.non disease are 800.test is carried out and 200 out of 800 diseased have positive results and 100 out of no disease have also positive result. What will be the sensitivity of the test. A. 25 percent B. 33 C.78 Ryan: A from silent bahabri:A, found an explanation on tele below. 210- Pregnant lady with sickle cell anemia Hx of hospitalizations due to painful conditions , 2 times in the past Best mangment in this pregnancy A- Simple blood transfusion (or exchange transfusion, not sure) B- Close follow up C- Hydroxyura D- Morphine Ryan: B from silent bahabri:B, according to amboss 211- Patient with CKD stage 3 What medication he can take safely: A- Nitrofurantoin B- Warfarin C- Metformin D- Lithium Ryan: B top Gs bahabri:B , found it in medguard Samado: Agree 212- 20 primigravida at 20 weeks gestation. Her past medical history is significant for mitral stenosis secondary to rheumatic heart disease as a child. What physiologic change places her at risk for the development of heart failure during pregnancy? ِA. Increase in RBC mass B. Increase in stroke volume C. Increase in minute ventilation D. Increase in renal plasma flow Ryan: B from top Gs Bahabri:B, confirmed Similar question from Walaa with plasma volume in the choices 213- 24-female irregular menses,with acne, hirsutism, ultrasound shows small cyst what is the diagnosis? A-gynacomastia B-ovariam cancer C-Kallman syndrome D-Stein Leventhal syndrome Ryan: D = PCOS from silent bahabri:D Samado: Agree 214- A 36-year-old man sustained a knife stab io the left side of his neck, below the cricoid cartilage (Zone I Examination confirmed diffuse neck subcutaneous emphysema. Blood pressure 110/70 mmHg Heart rate 90/min Respiratory rate 20/min Temperature 36.6 °C Which of the following is the most appropriate next step in management? A. Neck exploration B. Close observation C. CT of the neck and chest D. Interventional radiology embolization Ryan: C from silent bahabri:C, same question in hamoud Samado: Agree 215- Pt with pelvic fracture and resuscitated , had blood on urethral meatus Retrograde urethrogram : urethral injury What’s the most appropriate next step? A - Foley catheter B- laparotomy repair C- suprapubic cystostomy D- can’t remember but irrelevant Ryan: C from top Gs bahabri:C , same question in hamoud Samado: Agree 216- A 12-year-old presents with left sided lower abdominal pain. Examination confirms a slightly elevated, tender left testis with redness and edema of the scrotum.Which of the following is the most likely diagnosis? A. Testicular torsion B. Epididymo-orchitis C. Incarcerated inguinal hernia D. Torsion of a testicular appendage Ryan: A from silent Bahabri: A, same question in hamoud Samado: Agree 217- 4 yrs old boy presented with rectal prolapse. Parents said he had constipation and bulky stool for a few days. Last year he was admitted for pneumonia two times. His parents are healthy and he has one brother who is also healthy.What is the most appropriate initial diagnostic test? A. Chloride sweat test B. DNA, cystic fibrosis, transport gene C. Urine reducing substances D. Celiac’s screening Ryan: A from top Gs Bahabri:A, patient has cystic fibrosis. Sweat test is diagnostic. Samado: Agree 218-At which age can we give peanuts and eggs to babies to prevent the risk of getting allergic? A. 10 months B. 14 months C. 18 months D. 24 months Ryan: A from top Gs bahabri:A, BEFORE 12 months to prevent allergy Samado: Agree 219-58 year old man, smoker for most of his adult life, came to clinic for SOB, upon examination the angle of nail fold is lost What is the most likely Dx? A- COPD B- Bronchogenic cancer Ryan: B bahabri:B, COPD has no clubbing Fahaddd: Agree with bahabri (loss of angle rules out COPD) Samado: Agree with bahabri 220- 12 weeks pregnant woman with SLE taking Plaquenil (Hydroxychloroquine) and she is symptom free for 2 year, what is your advise regarding her medication? A- stop medication B- refer to rheumatologist to change medication C- switch to steroids D- continue same medication bahabri:D, hydroxy is safe during pregnancy Samado: Agree 221- Elderly patient with fever pleuritic chest pain and early clubbing , plural tap showed pH 7 , what is the diagnosis ? § A-Empyema § B-Chronic bronchitis § C-Parapneumonic effusion § D-Emphysema Ryan: A from silent bahabri:A, found it on medguard 222- old male known to have Schizophrenia & was started on Neuroleptic medication. Which of the following side effects put the patient on greatest risk? A- Seizures B- Akathesia C- MI D- Hyperthermia ryan : B from silent bahabri:B, found in hamza. Its a state of aggression and distress, 223- 35-year-old woman with heartburn and regurgitation for 6 months is referred for evaluation of chronic GERD symptoms. The patient states that she notes burning in her chest primarily after meals and occasionally experiences episodes of chest pain. She denies change in weight or lifestyle. She often consumes dinner 2 hours before going to bed. Her heartbum occurs mainly during the night. Physical examination is normal except for a body mass index (BMI) of 28 kg/m2. A complete blood count and metabolic panel are normal. The patient has been taking omeprazole 20 mg daily. An upper endoscopic examination is performed, and the appearance of distal esophagitis. Which of the following is the best next step? A. Add antacid twice/day B. Ranitidine at bed time C. Advise her to lose weight D. Refer her for Nilsson Fundoplication Ryan: C from top Gs Bahabri:B, confirmed Fahaddd: B (MEDGARD) 224- Patient with headache and fever, he has petechia, investigations showed low platelet and low hemoglobin and high erythrocytes what is the most appropriate managment: (With a picture of blood film showing schistocytes) A- IVIG and steriods B- Plasma exchange Ryan: B from silent and eilaf Bahabri: B, found it in medguard 225- Woman did some procedures (pelvic procedure) and then came complaining of urine from vagina during urination What is the dx? A. Vesicovaginal fistula B. Ureterovaginal fistula C. Urethrovaginal fistula Ryan: C from top Gs bahabri:C, found in wafaa 226- Old female with history of epilepsy had seizure and fel down the stairs, presented with back pain with urine and fecal incontinence and inner thigh pain, next appropriate management? A- MRI Lumbar B- EEG C- Reassure as post-ictal state Ryan: A from top Gs bahabri:A 227- CKD patient. Been feeling fatigued for the last 3 months. Hgb is low MCV and MCH normal No iron level in the question stem. Best appropriate next step in management? A- iV Iron B- SC erythropoietin Ryan: B from top Gs bahabri:B 228- Man with auditory hallucinations and grandiosity, what kind of disorder? A-neurosis B-psychoses C-personality D-conversion Ryan: B from silent bahabri:b 229- Old Pt hospitalized and prescribed tazocin for 12 days and then develop acute cholecystitis what’s the mgt : A/conservative cholecystectomy B/replace tazocin to meropenem C/laparoscopic drainage Ryan: A from silent Bahabri: found the complete question in medguard 230- Elderly male with persistent Afib. Known case of HTN and T2DM. Which anti thrombotic to give? A) Aspirin and clopidogrel B) Clopidogrel C) Warfarin D) Aspirin Ryan: C from silent bahabri:C Samado: Agree 231-A 20-year-old is suffering from vitiligo, which involves the vulva. Which of the following is the cause for this condition? A. Malignant changes of the keratocytes B. Allergic reaction from ingested drugs C. Result from overuse of irritants locally D. Autoimmune lymphocytic attack against melanocytes Ryan: D from silent bahabri:D,vitiligo is an autoimmune disease 232-A new campaign will be held, which one of the the following is recommended based on population A. lung cancer B. colon cancer C. oral cancer Ryan: B from silent Bahabri: B 233- 69 male with multiple readings of high BP: A.Life style modification and weight reduction B.Low salt diet C.Start anti hypertension meds Ryan: it should be according to the number but some answers A from silent 234- A 14-year-old presents with photosensitivity, a malar rash, joint pains and purpuric rashes on both legs. Urine examination shows red cells. Which of the following is the most likely diagnosis? A. Idiopathic thrombocytopenic purpura B. Rheumatoid arthritis C. Aplastic anaemia D. Lupus nephritis Ryan: D from 2 sources bahabri:D 235-30 weeks pregnant came with PPROM there is no symptoms associated except for leakage of water what you will give : A- Steroid with Nifedipine B- Steroid with MgSo4 C- Steroid with ampicillin+erythromycin D- Oxytocin Ryan: C from silent Bahabri:C,source wafaa 236-female with recurrent Abortion in first trimester asking about appropriate investigating not mentioned in anything in scenario except recurrent abortion A. transviginal ultrasound B. Karyotyping C. laparoscopy D. CT Ryan: Mostly B ‫اﻟﻣﺧﺗﺻر ﻣن ذا اﻟﻣرﺟﻊ ان ﺗﺣط اﻣﺎ‬ Karyotyping ‫او‬ Hystroscopy ‫ ﻻن اﻟﺳﺑﺑﯾن ﺻﺢ ال ھﻲ‬mutation ‫ او‬uterine anomaly ‫ ﺑس ﻋﺷﺎن ﺑﺎﻟﺧﯾﺎرات ﻣﺎ ﻓﯾﮫ اﻻ‬karyotyping ‫اﺻﻼً ﻓﮭﻲ اﻟﺻﺢ‬ 237- A 10-year-old boy complains of chronic watery diarrhea and abdominal discomfort. His diarrhea is mixed with blood and mucus sometimes. He has lost weight during the past 3 months and reports on/off joint pain. His CBC is consistent with anemia (Hb 8.7). Which of the following is the most appropriate initial step in management? A. Blood transfusion B. Corticosteroids C. 5-aminosalicylic acid D. IV broad-spectrum antibiotics bahabri:C 238-A 45-year-old woman presented with postprandial right upper quadrant abdominal pain, nausea, and emesis for few days that became persistent for the last 20 hours (see lab results and report). Blood pressure 110/70 mmHg, Heart rate 87 /min Temperature 37.2 °C Test Result Normal Values WBC 11 4.5-10.5 x 109/L Direct bilirubin 9.5 1.5-6.5 mol/L Total bilirubin 18.5 3.5-16.5 mol/L Alkaline phosphatase 463 39-117 IU/L Ultrasound: Cholelithiasis, gallbladder wall thickening, and a common bile duct of 12 mm. Which of the following is the most appropriate management ? A. Endoscopic retrograde cholangio pacreatcogram (ERCP) B. Magnetc resonant cholangio pacreatcogram (MRCP) C. Laparoscopic cholecystectomy D. Conservatve treatment Ryan: A from silent bahabri:A found in medguard 239- 45 years male came to hospital complaining of sob fever fatigue for few days, on examination revealed high jvp, pulsus paradoxus, distended heart sound auscultation revealed clear lung Lab Bp 90/55, Hr 120, Rr20, Temp 36.6. Ecg show: Low voltage QRS. Xray :Increase cardiac silhouette. What is the cardiac area is involve ? A. Valves B. Pericardium C. Myocardium D. Coronary artery Ryan : B from silent bahabri:B 240- A 25-year-old man developed fever, malaise and rash on his palm and soles. He gave a history of painless ulcer on his penis 6 weeks earlier. Examination was unremarkable a part from generalized lymphadenopathy. Which of the following is the most likely organism causing his presentation? A. Coxiella burneti B. Treponema pallidum C. Staphylococcus aureus D. Chylamdia trachomatis Ryan: B from silent Bahabri:b, same question in medguard 241-Couples are infertile and the husband has frozen sperms in the clinic and then the husband died, then the wife go to the clinic want to use this sperms. A- Must be three consultation and then can use it B- should the family of husband agree C- She can't use a sperms of dead person D- she can use it if there was consent from her husband Ryan: C from silent bahabri:C 242-Term baby just delivered admitted to NICU due to respiratory issues and retrosternal restriction. He covered with meconium staining and amniotic fluid. What is the most beneficial ? A- nitric oxide B- fluid C- steriod D- antibiotics Ryan: A from silent BAHABRI:A, same question in mahdi 243- 4 years old has shaft of femur fracture with 30 degree angulation A- Retraction and bed rest B- Closed reduction with hip spica C- Open reduction with external fixation D- Open reduction with internal fixation Ryan: B from silent Bahabri: B, according to hamoud under 5y treat with hip spica 244-Pregnant with congenital aneuploidy, 3 consultants told her to abort, she agrees but her husband refuses.. what’s the most app action ? A- Mom’s decision shall prevail B- father’s decision shall prevail C- contact ethics committee D-Informed consent from patient and her husband Ryan: D from silent Fahad : D 245-Female has headache, mastalgia, and behavioral changes 10 days before her periods, and she is asymptotic for the rest of the cycle. What is the Dx ? A. premenstrual tension syndrome B. pelvic congestion syndrome C. Endometriosis D. PID Ryan: A from silent bahabri:A, case of PMS 246- Child found to be drunk a bottle of paracetamol without knowing the specific amount , came to ER , he is okay for 4 hours what will you do next ? A- discharge him and giving his parents the instruction B- waiting for another 4 hours C- give him n-acetylcysteine Ryan: A from silent bahabri:A, found the question in medguard 247-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 B) Lack of communication C) Technician didn't check if the nurse got the number correctly D) Mishandling from the nurse Ryan: B from silent bahabri:B, lack of communication from both sides. 248-A child and his brother have sore throat and enlarged tonsils and bilateral red eyes, what’s the diagnosis? ( the question was around these two presentations only and no other symptoms to help differentiate) A. Kawasaki B. Adenovirus pharyngitis C. GAS Pharyngitis Ryan: B from silent bahabri:B Explanation:kawasaki has more sym ptoms and GAS doesnt present with red eyes. 249- I think its anew case about child 8 yrs coming complaining of heletrope rash around his eyes and skin lesions in the dorsal metatarsal joint of the hand ( its aguttern papules which is not mentioned in the Q by name ) and proximal myopathy need the diagnosis? A- juvenile dermatomyositis B- systemic sclerosis C- morphea D- SLE Ryan: A from silent bahabri:A Explanation:heliotrope rash is a characteristic of dermatomyositis 250-diabetic withe hyperglycemia and ketone in urine ? A- mixed insulin B- sliding scale C- iv insulin Ryan: C from silent bahabri:C, patient has DKA 251- 29 yr married pt with positive Pap smear showing ASCUS what next ? A- repeat Pap smear B- colposcopy C- HPV test Ryan: C from silent Bahabri: C Explanation: above 25 with ASCUS yo must check the HPV status according to wafaa 252-23y absent ms for 8 w came with 2 d of heavy bleeding us normal ? A- miscarriage B- an ovulatory cycle Ryan: B from silent Bahabri: A case incomplete , i found this in medguard 253- 24 yr pt with abnormal Pap smear what next ? A- HPV test B- colposcopy C- repeat Pap smear Ryan: B from silent Bahabri: they didnt say what the abnormality is 254-Chest nodule before operation need ? A- radio therapy B- chemotherapy C- nothing Ryan: C unless there’s PFT Bahabri: answer should be PFT, if its not an option choose C 255- 34 yr O pt coming with vulvar lesion what next ? A- HPV B- pelvic CT C- colposcopy Ryan: C from silent BAHABRI:C, a visible lesion is an indication for colposcopy according to wafaa 256-Pregnant at 12 weeks Her first pregnancy ended up with spontaneous abortion (they didn’t mention which trimester) Her 2nd pregnancy was PPROM at 28 ws Her third pregnancy was normal what to do ? A- Argent macleod cerclage B- Abdominal cerclage C- Follow up in family medicine clinic D- Follow in high risk clinics Ryan: D from silent Bahabri: d 257- 25 yr married pt fearful from breast cancer and dow mammogram and was normal and there is no family hx of BC or ovarian cancer what is appropriate for she ? A- Pap smear B- pelvic and abdominal CT C- CXR D- repeat mammogram Ryan: A from silent bahabri:A, above 21 start cervical cancer screening 258-Rule of acyclovir in pregnancy ? A- increase mother’s immunity B- prevents virus from crossing placenta C- decrease transmission to baby Ryan: C from silent bahabri:c 259-Veggie her milk will be Deceased or absent in A- vit b12 B- vit b6 C- iron Ryan: A from silent BAHABRI:A, vegetarians are deficient in vitb12 260- Also I think new Q too about primigravida pt with uneventful pregnancy deliver a baby of about 2.2 k and she develops severe bleeding after that what you think the cause? A- uterine atony B- bleeding disorder C- retained tissues of placenta Ryan: A bahabri:A, most common cause 261- Pregnant lady, presents to ED with 6 hours complain of clear fluid release for 6 hours pelvic Examination on shows pooling at the posterior fornix A. ruptured membrane B. Normal vaginal discharge C. Bacterial vagin Ryan: A from silent bahabri:A 262- Scenario of sickle cell disease crisis asked about organism that associated ? A- Streptococcus pyogens B- Barvo B19 C- staph aureus Ryan: B from silent bahabri:B, FOUND IN medguard 263- Another scenario of SCD crisis or something like that and ask about which can prevent conditions ? A- azithromycin B- steroid C- hydroxyuria Ryan: C from silent Bahabri:c, found in mahdi 264- A 57-year-old man with known history of asthma, congestive heart failure and peptic ulcer disease was admitted with asthma exacerbation and rapid atrial fibrillation. He was managed with nebulized salbutamol, IV digoxin, and his home medications was continued (ACE inhibitor, Ranitidine, Spironolactone). 24 hours later, his serum potassium is noted to be 2.8 mEq/L. Which of the following medications is the most likely to cause this abnormality? (Q edited from MG book) A. Digoxin B. Ranitidine C. Salbutamol D. Spironolactone Ryan: C from silent AZA: C from MG book 265- A 45-year-old man was being inves7gated for hypertension. He was prescribed a drug for his lipid disorder but returned 1 week later with intense face flushing a\er taking the tablet prescribed. He was then advised to take a full dose of aspirin 3 7mes daily instead of a low dose once daily. This gave complete relief (see lab results). (Q edited from MG book) Tests at first visit Test Result Normal Values Cholesterol (HDL) 0.72 7.35 C. Glucose >80 D. Negative Gram stain of pleural fluid Fahad : A Um alqura Ph less than 7.2 Glucose less than 60 363- A 55-year-old woman presents to the clinic for her regular follow-up. 6 months ago, she presented to Emergency Department with palpitations and dyspnea and was diagnosed to have atrial fibrillation. She is currently asymptomatic with no palpitations. Her medical history is also significant for a transient Ischemic attack and hypertension. Her medications are warfarin, metoprolol and candesartan, Her physical examination is unremarkable, Her most recent electrocardiogram shows normal sinus rhythm. Which of the following is the most appropriate management? A. Continue warfarin B. Discontinue warfarin C. Continue warfarin and start aspirin D. Discontinue warfarin and start clopidogrel Fahad : A MG book 364- A 17 year old developed febrile neutropenia and shock post chemotherapy for lymphoma. Which of the following is the most appropriate initial antibiotic? A. meropenem B. vancomycin C. cefuroxime D. caspofungin Fahad : A Risk factors for MRSA and/or a complication associated with a high risk of MRSA infection then add vancomycin 365-A 30-year-old primigravid woman presented at 24 weeks of gestation with fatigue, face rashes oral ulcers and joints pain of both her wrists. On examination, painful metatarsal joints with swelling were detected (see lab result). Blood pressure 130/80 mmH Test Result Normal Values Protein + absent Which of the following is the most likely diagnosis? A. Osteoarthritis B. Rheumatoid arthritis C. Carpal tunnel syndrome D. Systemic lupus erythematosus Fahad : D MG book 366-A 30-year-old overweight man presents to the general physician with 6-month of intermittent epigastric burning pain. He has also noted that for the past 2 months he has been experiencing episodes of nausea, an unpleasant taste in the mouth, hoarseness, and a nocturnal cough. Which of the following is the most likely diagnosis? A. Peptic Ulcer B. Atypical angina C. Chronic cholelithiasis D. Gastroesophageal reflux disease Fahad : D MG book 367- Case of abruptio placenta in vaginal delivery the patient then develop severe vaginal bleeding the doctor note oozing blood from needle site, Initial management? A. correction of coagulopathy B. internal iliac artery ligation C. uterine packing D. Sepsis. Fahad : A Wafa: She is bleeding from the puncture sites → suspecting DIC → FFP and consider cryoprecipitate 368-A 40-year-old man with Gastro Esophageal Reflux Disease presents to the general physician with 3-month history of intermittent retrosternal burning pain, worse on bending, nausea, regurgitation with an unpleasant taste in the mouth, and a nocturnal cough. The patient has been using over the counter antacids with no relief. Which of the following is the most appropriate course of action? A. Surgery B. Antibiotic C. Life style modification D. Proton pump inhibitors Fahad : D MG book 369- Warfarin did not stop by the patient regardless of clear instructions, the nurse in OR noticed that the patient didn't stop the drug as instructed and informed the surgeon, So the surgeon postponed the operation? A. Adverse event B. Medical negligence C. Near miss D. Principle of totality Fahad : C A near miss is an event where the patient could have been in harm but it was avoided due to chance or some other event. 370-A 28-year-old man presented with a 2-year history of reducible right inguinal hernia that became painful for 16 hours. It is associated with progressive abdominal distension, and vomiting. Physical examination confirmed a distended abdomen, exaggerated bowel sound, and a tender right inguinal swelling with red discoloration of the overlying skin (see lab result and report). Test Result Normal Value WBC 9.8 4.5-10.5 x 109/L Erect abdominal X-ray: Multiple air fluid levels. Which of the following is the most likely hernia complication? A. Irreducible B. Obstructed C. Incarcerated D. Strangulated Fahad : D Obstruction signs + Red discoloration of the overlying skin = Strangulated MG book 371- Father brought his Infant 6 month I guess to ED complaining of a head hematoma that does not cross the midline. The father said (he fall from his bed)..during the physical examination there were multiple frx in left arms and left thigh. What the most appropriate diagnosis? A. Pathological frx B. Abuse parents C. Battered child syndrome D. Normal Fahad : C Battered child syndrome is defined as the collection of injuries sustained by a child as a result of repeated mistreatment or beating. If a child's injuries indicate intentional trauma or appear to be more severe than could reasonably be expected to result from an accident, battered child syndrome should be suspected. 372-A 25-year-old underwent an open appendectomy for a perforated appendix 8 days ago and returns for follow-up. On examination, there is a seroma formation at the wound site, which is draining freely through a gaping wound. There are no signs of surrounding inflammation. Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18/min Temperature 36.6 °C Which of the following is the most appropriate treatment? A. Antibiotics B. CT scan abdomen C. Regular wound dressings D. Ultrasound guided drainage Fahad : C Hamoud, A case of a serous fluid collection called seroma which simply needs regular wound dressing. 373- Type of sport recommended for premenstrual syndrome? A. Aerobic B. Flexibility and mobility C. Stability and balance D. Coordination and agility Fahad : A SILENT, Repeated. 374-A 55-year-old woman presents with sudden left eye visual loss for 20 minutes. The vision returned to normal after this episode. History reveals, she has diabetes mellitus. The physical examination is normal. Blood pressure 125/75 mmHg Heart rate 75/min Respiratory rate 16/min Temperature 37.2° C Which of the following is the most likely diagnosis? A. Multiple sclerosis B. Retinal detachment C. Conversion disorder D. Transient ischemic attack Fahad : D MG book 375- Hemiplegia on ONE side the face and arm and leg equally affected and sensation intact which artery? A- MCA B-ACA C- mid basilar artery D- vertebral artery Fahad : A NOT ACA BECAUSE ARM AND LEG EQUALLY AFFECTED. 376-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 Fahad : B MG book 377- A 31-year-old man with asthma complaining of increasing wheeze in the past few hours. His medication history suggests a lack of compliance. His best peak flow measurements in previous consultations have been 600 L/min. Which of the following features suggests acute severe asthma in this patent? A. A peak Flow rate of 250 L/min B. Respiratory rate >20/min C. Heart rate 100/min D. SpO2 95% Fahad : A MG book RR >30 HR 120 Spo2 0.4 b. Protein < 0.4 c. Negative gram stain d. pH 20 B-Previous history of gestational diabetes C-Others Mahmood B GDM in the previous pregnancy is a major RF for GDM in the next pregnancy. 725-18 month old boy, presented with cyanosis in his mouth and lethargic, cxray small cardic shadow and no pulmonary (something, shadow ?! I forgot) what to do? A-Analgesia and O2 B-Thora something Mahmood A patient has tetralogy of falot and these are “tet spells” 726-Dehydrated pt what will you find in his urine ? A-Increased Na 727-Mother brought his 9th month child to well baby clinical he did not receive any previous vaccine, his mother believes fact that the vaccine will harm his child, after she read and educated about the benefits of the vaccination then convinced, she told to the physician just give my child the necessary vaccination. Which of the following are the necessary vaccination to his age 9th month: A- DTaP B-DTaP, BCG, IPV, OPV C)measle, DTaP, BCG, IPV, OPV D- DTaP, measle, OPV, PCV Mahmood C Mahdi Give him the 9 month old vaccines + catchup his missed vaccines. Personally i would just choose the longest answer 728-A pregnant woman came to the hospital with vagianl bleeding they discovered on MRI Placenta percreta. The hospital cannot tolerate this condition what you will do as a physician? A- Refer her with notifying department B-Refer her upon patient's request C- Discharge her with form of referral D-Discharge her and tell herto go to tertiary hospital Mahmood A 729-A new screening test for diabetes has a sensitivity of 90% and specificity of 80%, which of the following is the best interpretation? A- 80% of non-diabetics had positive result B-80% of diabetics had positive result C- The test was positive for 90% of diabetic patients D-For each 100 positive test results, 90% were diabetics Mahmood C 730-A child presents in the emergency room with diabetic ketoacidosis (DKA), but the physician only provided hydration and discharged the patient. The patient's condition worsened afterward. What type of medical error is this? A-Error of omission B-Error of commission C- Error of documentation D- Error of interpretation Mahmood A Commission is doing something wrong. Omission is failing to do something right, in this case he did not give the patient insulin after hydration. 731-A pregnant woman came to the hospital with vagianl bleeding they discovered on MRI Placenta percreta. The hospital cannot tolerate this condition what you will do as a physician? A- Refer her with notifying department B-Refer her upon patient's request C- Discharge her with form of referral D- Discharge her and tell herto go to tertiary hospital A 732-A new screening test for diabetes has a sensitivity of 90% and specificity of 80%, which of the following is the best interpretation? A-80% of non-diabetics had positive result B- 80% of diabetics had positive result C- The test was positive for 90% of diabetic patients D-For each 100 positive test results, 90% were diabetics C 733-Seat belt sign Ct show lumber vertebra fracture Expected to see in ct abdomen? A-Stomach perforation B-Duodenal perforation C-Only jejunal perforation Mahmood B 734-Case of cystic fibrosis next appropriate investigation ? Sweet chloride 735-Strict vegan pregnant want to fed her baby breast feeding only. Which vitamin should be deficit in baby ? A-Vit B6 B-Vit B12 C-Vit D Mahmood B amboss Read last line 736-4 year present by her mother with develop breast ? Premature breast 737-Case with symptom of UTI (dysuria) per rectal examination tender prostate ? Prostatitis 738-Pateint receive 4 L of blood transfusion after MVA what complication ? A-Hypokalemia B-Hypocalcemia C-Hyperalbuminemia Mahmood B 739-Women complaine of lower gi bleeding on examination There is third degree haemorrhoid ? Refer for surgery 740-Patient with depression complain of polyuria and dyspepsia Osmolality decreased and hyponatremia Dx? A-Diabetes insipidus B-SIADAH C-Psychogenic polydipsia Mahmood C 741- What increases mortality ? A-CS B-VD C-Oligohydramnios D- preterm Mahmood D this is twin sac picture 742-Female 40 something years old, C/O urine incontinence + Urgency No other symptoms or abnormal examination or invest..Best diagnostic test ? A-Cystoscopy B-Urofowmeter C-Urodynamic Mahmood C wafa Urge incont = urodynamic study 743-liver cirrhosis+ ascitis Comatose Na+ 126 Initial ttt? A-NS 45% B-FURESMIDE C-D5% Mahmood B 744-ESRD+Pericardial effusion Initial ttt ? A-Pericardiocentesis B-Dialysis Mahmood A if hemodynamically unstable, B if stable 745-obese male+venteral hernia Best surgery to control his weight ? A- roux en y bypass 746-Pt of MVA in tertiary hospital Head traumaStable Xray >> 2-5 ribs fracture lt side You want to reffer it to trauma center 40 km Next step ? A-Chest tube B-Call the trauma center and surgeon oncall C-Ct chest Mahmood B MG 747-Eldery with DKA Lethargy for 2 days Normal vitals High WBCs High Temp ABG with acidosis Next step ? A- insulin B-Iv antibiotcs Mahmood: A 3eb 3la ely fahm al so2al 748-What is the most likely diagnosis for an elderly woman experiencing difficulties in naming objects without memory impairment or personality changes? A- Alzheimer's disease B- Vascular dementia C-Lewy body dementia D- Parkinson's disease ‫ﺟﺎ ﻧﻔس اﻟﺳﯾﻧﺎرﯾو ﺑس ﯾﺳﺄل‬ 749-What area whould be affected in brain MRI ?? A-Caudate lobe atrophy B-Hippocampal atrophy C-Temporal atrophy D- Small vessles somthing 📍 Mahmood A,C psych file First to be affected in Alzheimer == memory (forget appointment ,forgetting where he » put things) » Symptoms suggest severity of dementia == Difficulty finding word Lewy body dementia: Dementia+ Parkinsonism (rigidity bradykinesia, mask face and » static tremors) + visual hallucination Pick disease : » Atrophy of frontal and temporal lobe Dementia+ Severe personality changes Huntington disease : Autosomal dominant with anticipation 📍 Triad (dementia, personality changes and chorea) Normal pressure hydrocephalus : Enlarged ventricle Normal pressure Triad (dementia, urine incontinence and gait ataxia) » Rx== SHUNT Vascular dementia (MULTI INFARCT) : Risk factor== hypertension Association == focal deficit 750-Varicella zoster infection the child is exposed 2days ago and Asymptomatic brought by his mother she is afraid A-Give vaccine B-Reassure C-Give ivig D-Give acyclover Mahmood A Healthy child > contacted chickenpox > asymptomatic = Vaccine Immune compromised > contacted chickenpox > asymptomatic = IVIG Symptomatic (they'll state that they have the disease or mention symptoms) = Acyclovir 751-PT presented with history of 2days abdominal pain not specified I think Gall bladder stones in US with Percholesistic fluid 1*1 temb 38 wbc very high A-Emergency lap chole B-Labchole after 2months C-conservative D- something like aspiration of fluid Mahmood A mahdi 752-Pediatric child who cannot use spoon well ,wolk upstairs supported can't make a sentence of 3words A-15m B-18m C-6m Mahmood B 753-Tender prostate..prostatitis Loin mass +weight loss in 65 old male I think what is the most appropriate investigation A-CTabdomen B-MRI abdomen C-US abdomen Mahmood A 754-Child with pneumonia asked about management A-oral and discharge B- iv and admission

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