part1 2024.pdf

Part 1 Exam – 2024 Family Medicine 150/150 Questions Collected ‫ال تنسوا من قام بهذا العمل من صالح دعواتكم الطيبة بالتوفيق والتيسير‬ Questions written by many family medicine residents in Telegram (MOF Group)...

Part 1 Exam – 2024 Family Medicine 150/150 Questions Collected ‫ال تنسوا من قام بهذا العمل من صالح دعواتكم الطيبة بالتوفيق والتيسير‬ Questions written by many family medicine residents in Telegram (MOF Group) Collected & Edited by: Family Medicine Questions Shahad Hayaza Psychiatry Questions Saja AlSharif Statistics Questions Orthopedic Questions Reem AlManea Radiology Questions Pediatric Questions Sarah Almousa Gynecology Questions Mawadah AlGhamdi Internal Medicine Questions Dermatology Questions ENT Questions Fajer AlDulaijan Ophthalmology Questions ER Questions General Surgery Questions Orthopedic & Radiology: 1.Child with history of fall, presented with pain at the elbow (x-ray attached). Asking about what kind of injury can occur in his case: A. Radial head fracture B. Olecranon bursitis C. Biceps or triceps tendonitis D. Olecranon Apophysitis Answer: A 2. 2-years-old child, presented with acute hip pain and tenderness for 2 days, with history of low-grade fever. His gait is affected, no history of recent trauma or injury, no history of skin rash or UTI. Labs show (normal WBC, ↑ ESR). On examination: A hip is Flexed, ABducted, and Externally Rotated. (X-ray attached showing joint narrowing). Which of the following is the most likely diagnosis? A. Transient synovitis B. Septic arthritis C. Osteomyelitis D. SCFE Answer: A Transient synovitis: Low-grade fever, the patient is keeping the joint & ligaments in relaxing position FABER (Flexed, ABducted, and Externally Rotated), normal WBC, slightly ↑ ESR = transient synovitis more than SEPTIC arthritis according to Kocher’s criteria. 3. X-ray of shoulder anterior dislocation. What is the most appropriate next step: A. Oral analgesia B. Immediate reduction C. Referral to ortho D. Immobilization and cold compression Answer: B Similar recall: Male adolescents have shoulder dislocation and was re located and ask you when he can return to his usual activity for playing something? The question is in pretest Q NO.274 A. Immobilized for2-3 week then physiotherapy B. Wait (something to obtain MRI) C. No need for immobilization and resume usual activities D. Some surgical intervention Answer: A 4. 12 years presented with combined complete ulnar and radius fracture. X-ray attached. Which of the following if the most appropriate next step: A. Close reduction with splint B. Open reduction and internal fixation C. Close reduction with pinning D. Intramedullary nail fixation Answer: A 5. A patient comes to see you after a skiing accident 6 days ago. She reports twisting her left knee during a fall, feeling a “pop,” and swelling after 24 hours. She was able to bear weight immediately but did not ski for the rest of the trip. Her pain is now improved, and she is ambulating, but she says the knee feels unstable. On examination, she has a tense effusion in her left knee and is unable to extend her knee fully. Which of the following is the most likely cause of her symptoms? A. Posterior cruciate ligament (PCL) tear B. ACL tear C. Meniscal injury D. Medial collateral ligament sprain Answer: C Same question from pre-test with change in swelling after 24 hours instead of immediate swelling 6. Patient came middle age complain of lesion grow in hand over few months progressively and cause bothersome sensation not painful at the Dorsum of wrist pen light test showed transillumination +. Which of the following is the most likely cause of her symptoms? A. Ganglion cyst B. Lipoma Answer: A 7. 62 years old low back pain increases with walking, with lower limb weakness, what do you expect in exam? A. Positive Romberg test B. Positive leg raise test C. Numbness on the fifth toe Answer: A 8. Pediatric patient was brought to your care, not flexing his arm, history of being pulled by the hand while being in the stair, x-ray attached. Which of the following is the most likely diagnosis? A. Radial head subluxation Answer: A (case of nurse-maid elbow) 9. Case of patient fall on an outstretched hand, he was having tenderness in base of thumb (X-ray attached) what is the management? A. Short arm cast or splint B. Observation C. Forearm thumb spica D. Referral immediately to orthopedic Answer: C Forearm thumb spica: Scaphoid fracture → Forearm (short arm) thumb spica with thumb slightly ABducted toward radius 10. A guy had RTA and hit the dashboard with direct hit on one of his knees, by examination the leg looked shorter than the other leg with adduction and internal rotation position, what is the most likely diagnosis? A. Posterior hip dislocation B. Femur neck fracture C. Femur shaft fracture D. Intertrochanteric fracture Answer: A 11.Middle aged man with right hand mass on the lateral side started long time ago growing in size? Painful, with finger contracture, what is the most likely dx? B. Trigger finger C. Chondroma D. Dupuytren's contracture (this was the answer in the exam) Answer: C Another question from ABFM: A 43-year-old male sees you because of popping and clicking at the base of his index finger. On examination you note a nodule on the palmar aspect of the metacarpophalangeal joint with the finger flexed. Which one of the following is the most likely diagnosis? A. Calcific peritendinitis B. Dupuytren contracture C. Flexor tenosynovitis D. Rheumatoid arthritis E. Trigger finger Answer: E Trigger finger, which can be associated with diabetes mellitus, presents with locking, clicking, or popping at the base of the finger or thumb. The finger may lock when flexed. Treatment consists of corticosteroid injection or splinting, and surgery may be necessary. Calcific peritendinitis causes pain, tenderness, and edema. Dupuytren contracture is manifested as a palpable cord in the palm and is not associated with locking. Flexor tenosynovitis causes fusiform digit swelling and is associated with rheumatoid arthritis. Rheumatoid arthritis involves multiple joints 12. A 50-year-old male presents with difficulty straightening his left ring finger. Examination of the affected hand reveals a nodule of the palmar aponeurosis and associated fibrous band that limits full extension of the fourth finger. He is unable to fully extend both the metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joint, with MCP and PIP contractures estimated at 40° and 20°, respectively. Which one of the following would be the most appropriate management strategy? A. Observation until the PIP contracture is >90° B. Serial intralesional injection with a corticosteroid C. Cryosurgery of the fibrous nodule D. Referral for physical therapy E. Referral for surgical release of the contracture Answer: E This patient has Dupuytren’s disease with a contracture of the affected finger. Surgical release is indicated when the metacarpophalangeal joint contracture reaches 30° or with any degree of contracture of the proximal interphalangeal joint. Intralesional injection may reduce the need for later surgery in a patient with grade 1 disease, but not if there is a contracture. There is no evidence to support the use of physical therapy or cryosurgery. 13-Teenager part of sport team, presented w/ anterior knee pain increasing w/ movement and stair climbing, decrease by rest. O/E swelling and tenderness over tibial tubercle. Which of the following is the most likely diagnosis? A. Osgood-Schlatter disease B. Patellar tendinitis C. Pes Anserine Answer: A Similar question from ABFM: A 53-year-old female who typically jogs 8–10 miles per week presents to your office with pain on the anterior part of her left kneecap that increases with running and when she goes up or down stairs. She has been taking ibuprofen, 600 mg three times daily, with partial relief. Plain film radiographs are negative. Which one of the following is the most likely diagnosis? A. Iliotibial band syndrome B. Osgood-Schlatter disease C. Osteochondritis dissecans D. Patellofemoral osteoarthritis E. Patellofemoral pain syndrome Answer: E This patient presents with the classic symptoms of patellofemoral pain syndrome. The pain is in the anterior knee and increases during weight-bearing activities when the knee is flexed, as well as with prolonged sitting and descending stairs. Iliotibial band syndrome usually involves lateral pain and tenderness over the lateral femoral condyle. Osgood-Schlatter disease occurs in adolescents and is characterized by tenderness and swelling over the patellar tendon insertion at the tibial tubercle. Both osteochondritis dissecans and patellofemoral osteoarthritis would show abnormal findings on plain film radiographs. 14- 13-year-old male, 3m history of painful right leg swelling with weight loss and malaise, no fever no trauma. Examination shows hard swelling at right distal thigh with mild tenderness. Diagnosis? (imaging attached) A. Ewing sarcoma B. Osteosarcoma C. Osteochondroma D. Osteoid osteoma Answer: B (Sunburst appearance of lytic bone lesions) 15- Similar CT with sudden onset severe headache. Which of the following is the most likely diagnosis? A- SAH B- epidural hematoma C- subdural hematoma Answer: A Another recall: 20-year-old patient had trauma to the back of his head while playing football, he had severe headache and neck rigidity along with nausea and vomiting, what is the most likely diagnosis? A. SAH B. Meningitis C. Subdural hematoma D. Epidural hematoma Answer: A 16- A 34-year-old man presents after a high-speed motor vehicle crash complaining of SOB and abdominal pain. Chest x-ray is performed and shown. Which of the following is the most likely diagnosis? A. Pneumothorax B. Small bowel rupture C. Duodenal hematoma D. Diaphragmatic rupture E. Hemothorax Answer: D (gastric bubble in lung) 17- Patient presented with history of fever for 3 days, cough with sputum, SOB and 1 month history of (difficulty swallowing/ or choking). X ray attached. Which of the following is the most likely diagnosis? A. Pleural effusion B. Aspiration pneumonia Answer: B 18- Child with sinus problem. On examination: mouth breathing, long face, and high arched palate. What’s the highest diagnostic? (Needs better recall, this was difficult question) A. Caldwell’s view B. Parietoacanthial projection C. anterior rhinoscopy D. Answer: B? Psychiatry: 19. A 42-year-old male with a 20-year history of schizophrenia presents to the emergency department (ED) with acute agitation and aggressive behavior. The patient has a history of poor medication adherence and has not taken his antipsychotic medications for the past 2 weeks. On examination, the patient is yelling and appears threatening to the staff and other patients in the ED. Vital signs are notable for tachycardia and elevated blood pressure. Which of the following is the most appropriate initial management for this patient? A. Initiate oral olanzapine B. Administer intramuscular (IM) lorazepam C. Administer oral haloperidol D. Initiate physical restraints 20. A 35-year-old male presents to the emergency department 10 days after being involved in a motor vehicle collision. The patient reports he was the driver and his friend, who was the passenger, died at the scene. The patient reports experiencing persistent nightmares, difficulty sleeping, irritability, and anxiety since the accident. Which of the following is the most likely diagnosis for this patient's symptoms? A. Acute stress disorder B. Adjustment disorder C. Generalized anxiety disorder D. Posttraumatic stress disorder 21. A 28-year-old male presents to the emergency department reporting restlessness, teeth grinding, and skin excoriation on his upper arms. The patient discloses that he has been using illicit amphetamines for the past several months. An ECG performed in the ED shows sinus tachycardia with left ventricular hypertrophy. What is the most appropriate initial pharmacologic management for this patient's presentation? A. Propranolol B. Fluoxetine C. Bupropion D. Naloxone 22.A 65-year-old man presents to his primary care physician for a routine check-up. As part of the exam, a prostate-specific antigen (PSA) test is performed, which reveals an elevated PSA level. The physician immediately orders additional testing, including a prostate biopsy, which confirms a diagnosis of localized prostate cancer. During the follow-up visit to discuss the results, the physician states that given the patient's age and the stage of the cancer, the best course of action is to proceed with radical prostatectomy. The physician emphasizes that this is the most effective treatment and urges the patient to schedule the surgery as soon as possible, without thoroughly explaining the potential treatment options and their associated risks and benefits. Which of the following best describes the physician's approach in this scenario? A. Shared decision-making B. Informed consent C. Paternalism D. Autonomy 23. A 55-year-old man with a history of recurrent pneumonia presents to his primary care physician reported persistent cough, fatigue, and unintentional weight loss for the past 3 months. The patient expresses significant worry that he may have developed lung cancer, despite having a normal chest X-ray and CT scan performed 1 year ago. Which of the following is the most likely diagnosis? A. illness anxiety disorder. B. somatic disorder. 24. A 35-year-old female presents to her primary care physician reporting a persistent low mood that has been ongoing for approximately 3 years. She describes her mood as consistently low, with periods of worsening symptoms during her menstrual cycle, and some improvement in mood after her periods. The patient denies significant sleep, appetite, or energy changes. Which of the following is the most likely diagnosis for this patient? A. Major Depressive Disorder B. Premenstrual Dysphoric Disorder (PMDD) C. Persistent Depressive Disorder (PDD) D. Bipolar Disorder 25. A 42-year-old man with a history of bipolar disorder presents to the emergency department reporting auditory and visual hallucinations that began approximately 6 months ago. The patient discloses that he has been using amphetamines more frequently during this period. Which of the following is the most likely diagnosis for this patient's current presentation? A. Bipolar disorder with psychotic features B. Amphetamine-induced psychosis C. Schizoaffective disorder D. Substance-induced mood disorder 26. A 55-year-old man has been a regular smoker for the past 20 years. His two teenage children have repeatedly urged him to quit smoking, citing concerns about his health. However, the patient reports that the idea of quitting has never crossed his mind. Which of the following stages of the Transtheoretical Model of behavior change best describes this patient's current status? A. Precontemplation B. Contemplation C. Preparation D. Action 27. An elderly 67-year-old patient is brought to the clinic by their family. The patient has a history of progressive memory loss and difficulty concentrating, with no reported history of depression. During the clinical assessment, the patient is noted to have a Mini-Mental State Examination (MMSE) score of 14 out of 30, indicating moderate cognitive impairment. The patient appears apathetic and not tearful. Which of the following is the most likely diagnosis for this patient's condition? A. Alzheimer's disease B. Vascular dementia C. Lewy body dementia D. Frontotemporal dementia 28. A 42-year-old patient presents to the clinic with a 2-day history of Dizziness, Nausea, irritability, Difficulty concentrating, and pins and needles sensation in the hands bilaterally. The patient reports that they had been taking a selective serotonin reuptake inhibitor (SSRI) medication for the past 6 months, but stopped the medication 5 days ago. What is the most likely causative medication in this patient's withdrawal symptoms? A. Citalopram B. Fluoxetine C. Paroxetine D. Sertraline The correct answer is C. Paroxetine (shortest half-life) 29. A 72-year-old patient presents with a 2-year history of progressive memory loss, difficulty with problem- solving, and personality changes. The patient's family reports that the patient has become increasingly forgetful, repeating the same questions, and has difficulty managing their finances. Which of the following is a major risk factor for the development of Alzheimer's disease in this patient? A. Advanced age B. Traumatic brain injury C. Diabetes mellitus D. Genetic factors 30. A 25-year-old patient with schizophrenia is interested in starting treatment with the antipsychotic medication clozapine. Clozapine is known to be highly effective for treating symptoms of schizophrenia. It causes potentially serious side effects; Before initiating clozapine therapy, which of the following tests should be performed on the patient? A. Liver function tests B. Electrocardiogram (ECG) C. Complete blood count (CBC) with differential D. All of the above 31.A 15-year-old female patient presents to the clinic complaining of acne. During the encounter, the patient speaks in a rapid, disorganized manner, frequently changing the subject and jumping from one topic to another without any clear connection. She discusses her acne but also brings up unrelated concerns about school performance, peer relationships, and family issues. How to manage? A. Prioritization. (The answer) 32. Parents come to your clinic and discuss their concerns regarding social media and its effects on health. You understand them. A. Empathy (The answer) B. Active Listening C. Trust Statistics: 33. Multiple studies correlate between smoking and lung cancer, family physician wants to conclude these studies, what type of study design? A. Systemic Review. (The answer) 34. A research team is interested in investigating the long-term effects of smoking. They decided to conduct a 10 year study to measure the incidence of asthma, among a group of workers Which study design would be most appropriate for this research question? A. Randomized controlled trial B. Case-control study C. Cross-sectional study D. Cohort study (The answer) 35. A study was done on the effect of regular exercise in the prevention of diabetes, what would affect the study’s validity? A. Loss of follow-up (The answer) 36. Forest plot (p value was 0.001) for studies on ovarian cancer and coffee consumption, asking which of the following is correct? (the picture is not the same at all, try to understand the concept) 37. A 42-year-old woman comes to your clinic for a routine check-up. During the visit, she expressed that she has been feeling anxious and worried about various aspects of her life. She reports constantly being preoccupied with concerns about her family's well-being, job, and financial situation. She mentions that these worries interfere with her ability to concentrate and sleep, and she feels that her quality of life has been significantly affected. What is the most appropriate management: A. Escitalopram. Pediatrics: 38. Child presented with repeated cough followed by post-tussive vomiting, his mother have a common cold 3 days ago. On reviewing child immunization, he has delayed some vaccinations. What vaccine could prevent this child’s presentation? Answer: Tdap 39. Mother brings her 2-month-old premature infant, born at 27th week of gestation. She is concerned about his growth and if he will ever catch up with normal babies. What advise should be conducted to the mother regarding gaining weight? B. Exclusive breast feeding C. Multivitamins D. Weaning at age of 4 months E. Adding artificial formula 40. A mother brough her 3 months old child with full thickness skin burn on his back, the mother said he was burned by rolling over floor heating grates. Which of the following will make you suspect abuse? A. Mother brought child to ED B. Unattended child C. Child cannot roll at this age D. Heater cannot cause full thickness burn 41. 3-year-old child brought by his family immediately to ER with chocking while he was eating peanuts, when you see him in ER, he was still coughing. What’s the next step? A. Back Blow B. Abdominal Thrust C. Emergency Tracheostomy D. Try To Dislodge by Using Your Finger 42. A 5-month-old child presented with 3 days history of vomiting and diarrhea with poor oral intake. On exam: patient looking moderately dehydrated with dry mucus membranes. What is your management? A. Oral rehydration solution B. Bolus of isotonic fluid C. 5% dextrose in normal saline 43. Child with failure to thrive and weight loss, with foul smelling diarrhea, steatorrhea and fat cell in stool analysis. No history of travel or sick contacts. What is the diagnosis? Answer: Celiac disease 44. A mother came to the clinic with her baby reporting weight loss and chronic diarrhea. There is a rash on the extensors of upper extremity. He has positive tTG-IgA. Which of the following is the definitive test for diagnosis? A. Small bowel biopsy (answer) B. Anti tTG-IgA antibody C. Anti endomysial antibody 45. 4-year-old with abdominal mass growing oblique and crosses midline. Which of the following is the most likely diagnosis? A. Neuroblastoma (answer) B. Ovarian cyst 46. On a routine-screening complete blood count, a 7-year-old is noted to have microcytic anemia. A follow- up hemoglobin electrophoresis demonstrates an increased concentration of hemoglobin A2 7%. Which of the following is the most likely diagnosis? A. Alpha thalassemia trait B. B-Thalassemia trait (answer) C. Iron deficiency anemia D. Sickle cell anemia 47- 2-month-old boy with history of unstable hip joint, click sound with passive movement of one hip. (Barlow and Ortolani +ve). Most Appropriate Next Step: A. US (answer) B. Follow up after 2 weeks 48. 3-year-old child with cervical lymphadenopathy and cracked lips, swollen, and erythematous palms and soles, painless conjunctivitis, and other symptoms. What is your management? A. High dose aspirin B. IVIG (answer) C. Steroids D. Antibiotics 49. A 2-year child is brought to the clinic with a history of UTI 2nd time. In the previous episode, he was treated with antibiotics after which he improved. Currently patient is clinically and vitally stable. Which of the following is the best next step in the management? A. Voiding Cystourethrogram (VCUG) (answer) B. IV pyelogram C. Renal scintigraphy D. Cystoscope 50. 2-month-old infant, presented with her mother complaining of vigorous feeding followed by vomiting. Vomiting is non-bilious and non-projectile. He has failure to thrive. The question was not mentioning abnormal electrolytes. What is your diagnosis? A. Pyloric stenosis B. Poor feeding technique C. Cystic fibrosis D. Adrenal insufficiency 51. 6-year-old brought to the clinic for pre-school vaccines. What to give right now? A. DTap, MMR, OPV, Varicella (answer) B. DTap, IPV, Hib, Varicella C. DTap, Hep A, OPV, Varicella D. DTap, Hep A, MMR, Varicella, IPV Gynecology: 52. 30 years old newly married, coming for pap smear follow-up. No complaints, asymptomatic, no dyspareunia, no pruritis. On speculum exam scanty grey-yellowish discharge, odorless. with cervical reddish. Pap smear and high vaginal swap are normal. Which of the following is the most likely diagnosis? A. Cervical Polyp B. Cervical Ectropion C. Chlamydia Cervicitis D. Cervical Prolapse Grade 1 53. Female patient presented with blackening and thickening of the neck and axillary skin (acanthosis Nigricans picture attached). Blood pressure is normal. This is associated with which disease? A. PCOS B. Addison disease C. Pellagra 54. Case of molar pregnancy, 15 weeks pregnant with heavy vaginal bleeding, on examination uterus going with 20 weeks (examination larger for gestational age), anxious, agitated, heavy bleeding, with flushing. BP: 95/60 mmHg U/S absent fetal heart sound and cystic appearance of the uterus with 10 cm ovarian cysts bilaterally. Asking about appropriate management: A- Evacuation and Curettage B- Exploratory Laparotomy with Bilateral Cystectomy C- Intramuscular Methotrexate D- Oral Misoprostol 55- Pregnant want to vaccinate her 17 months old child (MMR and varicella). The child is currently receiving antibiotic for otitis media. What is your advice: A- Give both vaccines B- give MMR and delay varicella C- Delay till finish antibiotic D- Delay till mother deliver 56- Preconception care: healthy female, taking folic acid and multivitamins, pap smear one year ago was normal, decided to get pregnant. What to order for her? A- Folic Acid Level B- Anti IgG Rubella C- Repeat Pap Smear D- Hg Electrophoresis 57- 1st trimester pregnant, urine culture showed E. coli (sensitive to nitro, Bactrim, cephalexin and something). What to give? A- Nitro 5-7 days B- Ciprofloxacin for 5 days C- Trimethoprim D- Cephalexin 7-10 days 58. Another question about UTI in pregnancy, also in the first trimester (needs better recall), asking about Mx. A. Ampicillin B. Ciprofloxacin C. Cephalexin for 7-10 days D. Nitrofurantoin for 5 days 59. Young woman has been experiencing sudden, uncontrollable urination after cough or laughing. Which of the following is the most likely cause of symptoms? A- Neurogenic Bladder B- Urethral Incompetence C- Detrusor Instability 60- 45 years old female with heavy PV bleeding. She completed her family. US showed 12 mm endometrial thicknesses. What is your management: A- Endometrial Biopsy B- Hysterectomy 61. Female with 3 days history of nipple bloody discharge, no skin changes or breast/axially masses upon examination. Which of the following is the most common cause? A- Fibroadenoma B- Intraductal Papilloma C- Acute Mastitis D- Sclerosing Adenosis 62- Female with normal period? (not sure if normal or irregular), no hirsutism or acne. She gained 12kg over the past year. A1C was 6.1, TSH was 8, prolactin 920 (upper normal mentioned in exam was 880). However, no galactorrhea or CNS symptoms were mentioned. What is the most appropriate next step: A- Lifestyle Modification and Consider Metformin B- Start Levothyroxine C- Bromocriptine and Taper Every 5 Days 63- Female 16 weeks pregnant presented with pregnancy larger for gestational age (20 weeks in examination). This is associated with severe nausea, vomiting, weight loss, and palpitation. B-HVG mentioned as 288.00. TSH was 0.004 and positive thyroid receptor antibody (Tr-AB). Which of the following is the most likely diagnosis? A- Molar Pregnancy B- Graves’ Disease 64- Young female complaining of lower adnominal pain associated with vaginal discharge, and fever (38). On examination: there was adnexal tenderness. What is best Tx regimen? A- Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days B- Ceftriaxone 250 mg IM in a single dose PLUS metronidazole 250 mg orally twice a day for 14 days C- Cefotetan IV plus doxycycline 65- Pregnant came to clinic during influenza season and ask about vaccination (she already take the flu vaccine this year). A- Intranasal Influenza B- Tdap in 27-36 weeks C- MMR D- IM influenza 66- Pregnant Lady in the first trimester came complaining of nausea, vomiting, and palpitations. Labs: - Low TSH 0.06 - High T4 - Anti-TPO positive And long list of labs What’s the most likely diagnosis? A- Hyperemesis gravidarum B- Graves’ disease C- Molar pregnancy D- Gestational transient thyrotoxicosis 67- 33 years old female presented with menstrual irregularities associated with Dysmenorrhea and Dyspareunia. Pelvic exam normal except of para-umbilical tenderness. Her sister has same condition. What’s the most likely diagnosis? A- Endometriosis B- PID C- Chronic uterine fibroid D- 68- Women her last period was before 7 weeks. Presented with vaginal spotting & acute lower abdominal pain, O/E abdomen tenderness, what is the most likely diagnosis? A- Ectopic Pregnancy B- Ovarian Torsion C - Threatened Abortion 69. A 32-years-old woman, G2P1, at 27th weeks of gestation, presented to the emergency department with complaints of nausea, and vomiting. She also reports a severe headache and visual disturbances. Vital Signs: Blood pressure 160/100 mmHg Laboratory: hemoglobin is low, Platelets are low, proteinuria +++ Which of the following you will be order? A- Echo B- Liver Enzyme C- Creatinine And Urea 70- Pregnant at 3rd trimester presented with itchy rash involving peri- umbilical area and arm. Rash described as bulla and something else, (NOT EXACT PICTURE but similar). Which of the following is the most likely diagnosis? A- Pemphigoid Gestationis B- Polymorphic Eruption of Pregnancy C- Lichen Planus 71- Female patient presented with green vaginal frothy discharge, cervix showed multiple micro-petechiae (i.e. strawberry cervix). Which of the following is the most likely diagnosis? A- Trichomonas B- Fungal C- Bacterial Vaginosis D- N.Gonorrhea 72. G4P1, had her first child 9 years ago, followed by 3 miscarriages, labs revealed normal FSH and LH, positive anticardiolipin antibody and lupus antibody. What is the most likely diagnosis? A- Necrotizing Vasculitis B- PCOS C- antiphospholipid syndrome D- Premature Ovarian Failure 73- Pregnant lady, 38 weeks, came with vaginal bleeding and lower abdominal pain. She has history of polyhydramnios; On examination: palpable mass. What is the most likely diagnosis: A-Placenta Abruption B- Placenta Previa C- Macrosomia 74. 29 years old married patient presented to PHC clinic, no history of STDs, speculum showed erythematous cervix without any lesion. Pap smear taken; report showed: Low Grade Squamous Intraepithelial Lesion. HPV: negative What is the most appropriate next step? A. Colposcopy B. Cryotherapy C. Repeat Pap smear in 6 months D. Repeat Pap smear in 12 months Family Medicine: 75- 50 years old k/c of HTN controlled on med, no mention of DM, came for routine visit, his father had diabetes, no premature CVDs mentioned. Lipid profile all mentioned in mmol, LDL around 168, TG 325, No ASCVD risk mentioned. Asking about management? A. Fibrate B. Niacin C. Statin D. Lifestyle and Diet modifications then Repeat Lipids In 2-3 Months 76. There was a question about Tx of tension headache and the answer was NSAID. (Straightforward question) 77- Male patient known to have DM & HTN, on Metformin, gliclazide and valsartan. BP 150/89. What is your management? A. Lisinopril B. Metoprolol C. Amlodipine D. No Change in Medications 78- Female Patient known case of DM on metformin, came for evaluation for her numbness, absent ankle reflexes, and positive Babinski sign, with anemia, her MCV 106. What most likely diagnosis? A. Vitamin B12 deficiency B. Hypothyroidism C. Peripheral neuropathy D. Folate deficiency 79- Male (in 50s) k/c of DM and HTN for 8 months on lisinopril 5 mg, his BP 148/92, mildly high cholesterol, came for follow up. What will you do regarding his BP (according to JNC 8)? A. Increase Lisinopril to 10 Mg B. Reduce Lisinopril Dose To 2.5 & Add Thiazide C. Reassess After 2 Weeks and Lifestyle Modifications D. Continue the Same as he is on The Goal 80- 52 years old patient, hypertensive and smoker, with past history of stroke. Came for follow-up after his stroke. What could be done as tertiary prevention? a) Smoking cessation program b) Treat hypertension c) Colon cancer screening d) Stroke rehabilitation program 81- A 61-year-old postmenopausal woman came to your office for a routine health examination. She has a history of osteoarthritis, HTN, and she smokes one pack of cigarettes per day. She is on thiazide medications. Her blood pressure is controlled, BMI 27. The rest of her physical examination is normal. Which of the following is an established risk factor for osteoporosis? A. BMI B. current smoking C. HTN D. Thiazide 82- 58-year-old male seen in FM clinic. He reports weight loss over 3 months, but his history is otherwise unremarkable. On examination his abdomen is soft with no palpable masses, PR examination is normal. His blood tests show: Hemoglobin: 8.0 g/dL, MCV 70. Which of the following is the most appropriate investigation for this patient? A-Colonoscopy B-US C-Upper GI endoscopy D- Abdominal X ray 83- 20 years old patient came with recurrent seasonal SOB and cough, 2 attacks per week, no cough at night. He is not on medications. He has a family history of atopy. What to give? A. LABA as monotherapy is a treatment option B. Budesonide- formoterol is NOT a treatment option C. Low daily ICS is a treatment option D. Daily salmeterol-fluticasone (as needed) is good for its rapid action 84- A 35-year-old healthy male came worried about his risk as his father died from heart disease at his 50s. He is asymptomatic, his lab results reveals, elevated LDL, total cholesterol, TG and low HDL, otherwise, unremarkable. What is your next step? A- Dietary modification B- Start statin C- Start fibrate D- Start niacin 85- 54-year-old female on α-blocker and another medication, she has irregular menses, c/o fatigue and nipple discharge, with no visual changes. Labs: TSH: high (14), T4: low, Prolactin: high. FSH & LH: normal What is the most likely cause of her problem? A- Hypothyroid B- Prolactinoma C- Side effects of medications D- 86- 12-year-old female with type 1 DM, came with generalized abdominal pain, diarrhea, nausea & vomiting. She is on basal-bolus insulin, stopped basal, and decreased bolus dose due to not tolerating food. Vitally stable. O/E: moderate dehydration, diffuse abdominal tenderness. ABG: Ph—7.4, HCO3—20 Na, K—within normal Urine analysis: +3 glucose, no ketones, no nitrite. What is the most appropriate next step? A. Oral metronidazole B. Oral glucose with fluid C. Admission and start insulin infusion D. Resume insulin and observation 87- Clear case of obstructive sleep apnea. Asking about Dx. 88- Diabetic on insulin glargine + short acting insulin, he is complaining of dizziness and sweating while he walks on the treadmill, his fasting blood sugar in morning is 140 mg/dL, what to do? A. Snacks Before Exercising B. Skip One Dose Premeal C. Decrease Dose of Glargine D. Change to NPH Dermatology: 89. Case of diaper rash involving skin folds. Asking about treatment? (Not the exact pic) A- Topical nystatin B- Topical hydrocortisone C- Oral fluconazole D- Topical mupirocin 90. Diabetic patient, known case of COPD, presented to the clinic complaining of this rash associated with itching. He used emollient and topical (not sure of the cream), with no improvement. (Similar picture attached). What is your Dx? A. Tinea corporis B. Psoriasis C. Erythema multiforme D. Pityriasis rosea 91. A 28 years-old pregnant female came for family physician concerned regarding the health of her fetus; she is pregnant in 10th week. She was on isotretinoin and stopped it once she knew that she is pregnant 1 week ago. What to do? A. Measure isotretinoin level in blood B. Fetal echocardiogram C. 5 mg Folic acid D. Close follow up with blood pressure monitoring 92. Young male pt, athletic presented with rash in back, the condition increased during summer, (Exact picture attached), asking about the diagnosis? A. Tinea Corporis B. Pityriasis Rosea C. Pityriasis Versicolor D. Pityriasis Alba 93. Child with two days history of painful rash on the hand (vesicles on erythematous base). Patient feels fatigued and feverish?. He has a history of abscess and drainage. Picture attached. What is your management? (Not the same image but very similar). A. Valacyclovir B. Topical Mupirocin C. Topical Lidocaine D. Topical Steroids (Not Sure) 94. General Surgery: 95. You are evaluating a 30-year-old male patient in the office with hematochezia. He has had chronic constipation and reports bright red blood from his rectum associated with extremely painful bowel movements. After defecation, he complains of a dull ache and a feeling of “spasm” in the anal canal. The pain resolves within a few hours. On external examination, no abnormalities are noted. Which of the following is his most likely diagnosis? A. Anal Fissure B. Thrombosed External Hemorrhoid C. Internal Hemorrhoid D. Thrombosed Internal Hemorrhoid E. Perianal Abscess 96. 23-year-old was in RTA brought to ER. Responding to shouting commands. Hypotensive with chest bruises. What is your initial next step? A. Ensure Patent Airway B. Endotracheal Tube C. Oxygen Supplementation D. Lab Tests 97. Patient presented with abdominal pain associated with increase bowel sounds. He has episodes of abdominal pain before, however, this morning his pain is severe. His past medical history is remarkable for partial sigmoid resection for diverticulosis 20 years ago and appendectomy. What is the most appropriate next step in Mx? A. Laxative B. Enema C. Surgical Referral 98. Male patient presented with RLQ pain; it started 5 days ago as mild generalized abdominal pain. He has no fever, no bleeding per rectum, and no weight loss. Normal WBC. CT report (stricture at ileocecal area & 2 mm or cm? with thickening of ilium). What is the diagnosis? A. Colorectal Cancer B. Ulcerative Colitis C. Crohn’s Disease D. Diverticulitis 99. Young patient presented with testicular pain started after being hit by a football on his testicles. Pain relived by elevation of testicles, and he has normal cremasteric reflux. No fever. What is your Diagnosis? A. Testicular Torsion B. Epididymitis C. Testicular Appendages D. Hydrocele 100. Young male patient presented with bright bleeding per rectum after defecation, per-rectal examination was normal and there are no skin tags around the anus. What is the most likely diagnosis? A. Hemorrhoid B. Anal fissure C. Rectal Prolapse D. Rectal adenoma 101. Young patient presented with left testicular pain associated with left flank pain and nausea, examination showed high riding left testis when compared to the right one. What is the next step? A. US doppler B. Normal Ultrasound C. Antibiotics D. IVF & analgesia 102. Obese female presented with lump in lower abdomen below inguinal ligament and lateral to symphysis pubis, firm, measuring about 3 cm, not affected by pressure, cough impulse nor by lifting a heavy object. What is the most likely diagnosis? A. Inguinal hernia B. Femoral hernia C. Lipoma D. Saphena varex 103. Patient presented with severe epigastric pain radiated to the back with vomiting. No nausea, no fever, no other symptoms. Labs: ▪ CBC normal ▪ Lipase normal What is the most likely diagnosis? A- Acute Pancreatitis B- Perforated Viscus C. D. 104. Female patient presented with acute epigastric pain radiating to the back associated with nausea and vomiting. The US showed multiple gallstones in the gallbladder, What is the most likely diagnosis? A- Gallstones pancreatitis (the answer) 105. Patient presented with RUQ pain, nausea, vomiting, and jaundice. This is not the first time he has experienced these symptoms but this time it is more severe. Murphy sign is positive. He is afebrile. - AST mildly high - ALT mildly high - No mention of ALP - Lipase was 350 (high) What is the most likely diagnosis? A. Acute Pancreatitis B. Acute Cholecystitis C. Acute Hepatitis D. Acute Cholangitis Emergency Medicine: 106. 53 years old male presented with Intermittent chest pain lasts for 1-5 minutes, central, pressure like, increased with walking, when upset, and after large meal. Pain relived by rest. ECG picture was attached (not clear but most likely normal). What is the most likely diagnosis? A. Esophageal Spasm B. Angina Pectoris C. PE D. MI 107. Patient after insect bite developed stridor and urticaria. BP: 90/56 mmHg. What is the next step: A. IM atropine B. IM adrenaline C. IV 200mg hydrocortisone D. Oral antihistamine 108. Patient presents with severe flank pain, can’t sit still on the stretcher because of pain. This morning had hematuria in urine. - HR: 104 - BP: 150/92 Most appropriate initial step: A. Urology referral B. Abdominal CT C. US D. NSAIDS 109. Patient with pulsating hypogastric mass radiating to bilateral groin. Most appropriate next step is: A. CT Angiography B. CT abdomen and pelvis with contrast C. Ultrasound abdomen D. MRI angiography 110. You are seeing a 54-year-old man who is following up in your office 2 days after being involved in a motor vehicle collision. He was the restrained driver when he ran into a car that had stopped in front of him. Thankfully, he denies head injury or loss of consciousness. He was ambulatory after the event and only had slight neck pain but was taken to the emergency department for evaluation. They released him that evening without any imaging studies. On follow-up with you, he has mild neck pain but denied numbness or tingling in his extremities. His range of motion is appropriate for his age. What is the next step that should be taken at this time? A. Neck support B. He should have C-spine radiograph C. Topical analgesia D. He should have an MRI (or CT?) of the neck. 111. 18-months old baby, +ve family history of atopy, came complaining of wheezing bilaterally but more in the left side, softer breath in left side. What is the most appropriate next step? A. Amoxicillin B. CXR C. Nebulized salbutamol every 4 hours D. Immediate referral for hospital admission ENT: 112. Diabetic patient with this exact picture asking about Tx. A- Cleaning and topical antifungal drop B- Oral anti-fungal C- Oral antibiotic 113. Heavy smoker for 20 years presented with hoarseness for 3-4 months. Otherwise, physical exam is unremarkable. Asking about investigation: A. Direct Laryngoscope B. Thyroid US C. PAN CT D. Lateral X-ray neck 114. Patient with uncontrolled asthma on steroid inhaler presented with nasal polyposis (nasoscope picture was attached). What is appropriate management? A. Intranasal Steroid and Oral Montelukast B. Oral Steroid and Intranasal Steroid C. Loratadine + Regular Nasal Irrigation 115. Female with uncontrolled asthma presented with 3 months of nasal discharge, congestion and loss of smell. What is appropriate management? A. Nasal Ipratropium B. Oral Loratadine and Nasal Irrigation C. Oral Montelukast and Nasal Mometasone D. Oral Prednisone and Nasal Mometasone 116. 25 years old patient, presented with sore throat, tonsillar exudate, and anterior cervical lymphadenopathy. He has no cough. His temperature was 38. What is your next step? A. ASO B. Throat culture C. Antibiotic 117. Patient with history of sinusitis presented with the attached picture (septal perforation in picture), he has history of chronic arthralgia and skin lesion. No mentioning of hematuria or renal involvement in the scenario. What is the diagnosis? A. Leprosy B. Wegener Granulomatosis C. Rhinoscleroma 118. No recall for the exact scenario but it was a description of Meniere disease. The exact picture was attached. Asking for Dx: A. Otitis Media B. Otosclerosis C. Meniere Disease Ophthalmology: 119. 4 years old presented with 10 days of nasal congestion and rhinorrhea with symptoms of conjunctivitis. The inner eyelid showed follicles-like lesions of the cornea and corneal neovascularization. Siblings have same symptoms at home. What is the most likely diagnosis? A. Trachoma B. HSV Keratitis C. Gonococcal Conjunctivitis D. Orbital Cellulitis 120. Female Patient recently receiving Tx for polymyalgia rhuematica, presented with painless loss of vision in superior visual field associated with unilateral headache and tenderness in the temporal area. High ESR. What is the most likely diagnosis: A- Optic Neuritis B- Central Retinal Artery Occlusion C- Central Retinal Vein Occlusion D- Anterior Ischemic Optic Neuropathy 121. Pediatric patient was having eye pain and eyelid swelling (clear description of orbital cellulitis), what is the most appropriate next step: A. Orbit CT B. Eyelid Swab C. Skull X Ray D. Topical Antibiotic 122. Adult female with history of watery discharge. Now presented with lower eyelid swelling and redness. Picture attached. What is the most likely diagnosis: A- Dacryocystitis (the answer) 123. 30-year-old male, came with 2-days history of photophobia, and blurry vision of the left eye. Eye examination showed Tearing form left eye and unequal pupil reactivity. Patient is using topical retinoids, moisturizing and steroid to treat chronic psoriasis, which of the following is the most likely diagnosis? A. Trachoma B. Anterior uveitis C. Chronic glaucoma D. papilledema 124. Patient with red eyes were stuck and can't open them after waking up (picture attached), what is the treatment? A. Topical Chloramphenicol B. Topical Antihistamine C. Sodium Comedogenic D. Topical NSAID 125. Patient had low mood and loss of interest in which his doctor prescribed a medication, presented with history of dryness of his eyes and blurry vision, with history of urine retention, which one of these medications is most likely causing his symptoms? A. Amitriptyline B. Fluoxetine C. Clomipramine D. Venlafaxine 126. Diabetic presented with clear presentation of macular degeneration. Exact picture attached. Which of the following is the most likely diagnosis? A- Wet Age-Related Macular Degeneration B- Dry Age-Related Macular Degeneration C- Proliferative Diabetic Retinopathy D- Non-Proliferative Diabetic Retinopathy Internal Medicine: 127. 30 years old female presented with diarrhea and bloating for 6 months, increased by some foods, No nausea or vomiting. She is very concerned. Which of the following factors need to further evaluation? A- Chronicity of Symptoms B- Rectal Bleeding C- Alternative Diarrhea and Constipation D- 128. Question about migraine prophylaxis and answer was CCB (simple and straightforward) 129. 52 years old patient with prolonged uncontrolled BP, LL edema, and S3 heart sound. Which of the following is the most likely diagnosis? A. Dilated Cardiomyopathy B. Hypertrophic Cardiomyopathy C. Restrictive Cardiomyopathy D. Takotsubo 130. Patient came from South Africa, develop fever, headache, lethargy and fatigue. On examination, he has palpable splenomegaly (typical case of malaria). Which of the following appropriate to establish diagnosis? A. Thin and thick Blood film B. CBC C. Ziehl Nelsen stain D. Blood culture 131. A 19-year-old male has an 8-mm induration 2 days after a tuberculin skin test. His father was recently diagnosed with tuberculosis. There are no other historical or physical examination findings to suggest active tuberculosis infection and a chest radiograph is normal. Which one of the following would be most appropriate at this point? A. Monitoring with annual tuberculin skin testing B. Observation and repeat tuberculin skin testing in 3 weeks C. Isoniazid daily for 9 months (the answer) D. Another irrelevant choice (was not a drug) 132. On a routine-screening complete blood count, a 7-year-old is noted to have microcytic anemia. A follow-up hemoglobin electrophoresis demonstrates an increased concentration of hemoglobin A2 7%. Which of the following is the most likely diagnosis? A. Alph thalassemia trait B. β-thalassemia trait C. Iron deficiency anemia D. Sickle cell anemia 133. Case of painful and single penile ulcer associated with green discharge and inguinal lymph node enlargement. Which of the following is the most likely diagnosis? A. Chancroid B. Herpes Simplex Virus C. Syphilis D. Chlamydia 134. Pediatric patient presented with prolonged diarrhea with blood & mucous, no history of travel, labs showed +RBC, and leukocyte in stool. Patient is afebrile; however, he has weight loss (more information were mentioned in the real scenario, needs better recall). Which of the following is the most likely diagnosis? A. Amebic or Entamoeba B. Liver Abscess C. Campylobacter Disease D. Enterocolitis E. Salmonellosis 135. 60 years old patient came to the clinic with history of headache and fever. On examination, T:38 & neck stiffness. CSF analysis: - WBCs high (70% lymphocytes) - Glucose is normal - Protein is normal and normal opening pressure. Which of the following is the most likely diagnosis? A. Bacterial Meningitis B. Viral Meningitis C. Tb Meningitis D. Cryptococcal 136. 68-year-old female, brought by her daughter with symptoms of low mood, history of memory loss and low concentration (oriented to person but not to time or place), not smiling and looks apathetic, no previous history of depression. Mental Status Examination: 14/30. Which of the following is the most likely diagnosis? A. MDD B. Alzheimer ‘s disease C. Parkinson disease 137. 26 years old female patient was complaining of abdominal pain and bloating with diarrhea. What is the most appropriate next step: A- Hydrogen Breath Test B- Abdominal US C- Anti-Tissue Transglutaminase Antibody D- Fecal Occult Blood 138. Patient with Epigastric that increase in the morning. Pain relieved by food. Which of the following is the most likely diagnosis? A- Peptic ulcer B- Duodenal ulcer C- Gastric ulcer 139. Pregnant lady presented with RUQ pain, scleral icterus, cough, and fever (38) Labs: ▪ elevated ALT, AST, and ALP. ▪ Elevated bilirubin. ▪ Normal lipase and amylase ▪ High WBC Which of the following is the most likely diagnosis? A- Chronic Cholecystitis B- Cholangitis C- Pancreatitis D- Amebic Liver Abscess 140. 32 years old male patient came to ER complaining of chest pain radiating to the shoulder, he has same pain 3 times before. Pain increased with exercise and relieved by rest. Today, he has the chest pain while reading newspaper. ECG: sinus tachycardia. Troponin: normal. Which of the following is the most likely diagnosis? A- Unstable Angina B- Non-STEMI C- Stable Angina D- Variant Angina 141. Construction worker presented with SOB and cough. On examination, he has wheezing and clubbing. (CXR attached). Which of the following is the most likely diagnosis? A. Silicosis B. Asbestosis C. Berylliosis 142. Case of history of frequent attacks of MI, with history of shortness of breath and lower limb edema. Which of the following is the most likely diagnosis? A. CHF B. Core Pulmonale 143. Dyspnea + Pleuritic chest pain improves by leaning forward and there is friction rub on exam. Which of the following would prove the diagnosis? A. Diffuse ST elevation on ECG B. CXR C. ASO titer D. ECHO 144. Case of diabetic type 1 patient came with generalized abdominal pain & mild dehydration. Labs showed slightly high glucose, normal pH, no ketones. (Labs not showing DKA) What to give this patient to manage his symptoms? A. Oral metronidazole  B. IV fluid/ normal saline C. Admission to adjust insulin D. ORS / oral hydration therapy 145. Patient came with recurrent seasonal SOB and cough, 2 attacks per week. She is not on medications. She has family history of atopy. What to give this patient to manage her symptoms? A. Medium Potency ICS + LABA B. Medium Potency ICS + Leukotrienes C. Oral Corticosteroid+ LABA D. Theophylline E. Inhaled Corticosteroid 146. 147. Patient came with unilateral Headache, radiating to neck and shoulders. Tender scalp on examination. Which of the following is the most likely diagnosis? A. Migraine B. Giant cell arteritis C. Polyarteritis nodosa D. Polymyalgia rheumatica 148. Adolescent male presented with acute left-sided pleuritic chest pain increased by breathing, chest and CVS examination are normal except for tenderness at level of left 3rd rib. Which of the following is the most likely diagnosis? A. Pericarditis B. Costochondritis C. Arthritis D. Sternoclavicular subluxation 149. 19-year-old with right elbow and left knee pain. The pain progress in next day to left elbow and right ankle, has heart murmur, with nodules on elbows. What is the best test to confirm the diagnosis? A- Rheumatoid Factor B- Ant Streptolysin O Titer C-ANA D-Aspiration from Left Elbow 150. Male patient was diagnosed with HIV, he is asking you not to tell his wife, what are you going to do: A-Tell Wife B-Give Contraceptives Advice C-Protect Confidentiality D-Alert Health Authority 150 out of 150 ---- ‫رب العالمين‬ ِّ ‫الحمدهلل‬