مسب هللا نمحرلا ميحرلاهذه ةلئسلا مت اهعمج و اهلح نم لبق ةعومجم نم يجيرخ ة-ل- ~=-ا ةعماج- م-~--ا مهو . ) 1 -م=م - ي-ر=-ا , 2 =ا-بع - ل~-- ,-م=-ا , 3 =ا-بع - ي---م-ا , 4 --هم - ي-ر=-ا , 5 - =ا-بع _-ا~ ,-م=-ا , 6 ي-اه - ي-هج-ا , 7 رساي - يل-او-ا , 8 -جام - ي-ر=-ا , 9 ¡;- - ¡-بع-ا , 10 ,و~-م - ر-·~-ا ) _-مت' ,' ,و-ت هذه ةلئسلا ه--ج نم ~-ح ~-تر--ا و _-~---ا ~ا-اج(او , ة=-=~-ا املع , ,'- ~ا-اج(ا يه -,ابع نع -اه-جا -ق لم-=ت '==-ا اذهو . ~لم-ا ¡و-=ي _لع ة-ارق ~-لا Jا;س هذه ^لئسVا مت اهعمج نم J>خ ¿قوم ^-مي-ا-Vا ^-ب=-ا و نم ¸ع- نيذ-ا _بس مه- ,اب-خVا نم ~ل-=م _=ا-م-ا . ار-~- ل-- نم çاق ة-ا--- ^لئسVا . يتاينمت عيمجلل قيفوتلاب مكوخأ دمحم يبرحلا 1) 25 year teacher have fear attack and worry before enter the class ( l forgot all the scenario) what is the initial treatment: a. Selective serotonin reuptake inhibitor b. Tricyclic depressant c. Beta blocker d. ----- e. ------ -Thís ís a case of socíaí phobía and the ínítíaí treatment ís answer a (SSRIs). ....................................... ................ 2) The best initial TTT for depression is: a. SSRls b. Tricyclic depressant c. MAO inhibitors d. Beta blocker e. ----------- -The correct answer ís a (SSRIs). ....................................... ................ 3) Using the following classification : Risk factor Case (disease) Non case total Present A B A+b Absent C D C+d Total A+C B+D Relative risk of those with risk factor to those without risk factor is: a. A/A+B , C/C+D b. A}A+B c. C}C+D -The correct answer ís a. Posítíve predíctíve vaíue (PPV) : a} (a+b) Negatíve predíctíve vaíue (NPV) : d } (C+d) Sensítívíty : proportíon of peopíe wíth dísease who have a posítíve test: a } (a+c) Specífícíty : proportíon of peopíe wíthout dísease who have a negatíve test : d} (b+d) Reíatíve rísk ( RR ) : íncídence ín expose ÷ íncídence ín unexposed: ( a } (a+b) ) } (c} (c+d) ) Attríbutabíe rísk : íncídence ín expose --- íncídence ín unexposed: ( a } (a+b) ) -- (c} (c+d) ) Odd ratío ( OR ) : Odds that a dísease person ís exposed ÷ Odds that a nondísease person ís exposed : ad } bc 4) 50 year old Man presented to ER with sudden headache, blurred of vision, and eye pain. The diagnosis is: a. Acute glaucoma b. Acute conjunctivitis c. Corneal ulcer d. ----- -The correct answer ís a. ....................................... ................ 5) Which heart condition is tolerable during pregnancy: a. Eisenmenger syndrome b. Aortic stenosis c. Severe mitral regurge d. Dilated cardiomyopathy with EF 20% e. Mitral stenosis and the mitral area is 1 cm (or mm). -the correct answer ís c. ....................................... ................ 6) Diffuse abdominal pain "in wave like" and vomiting. The diagnosis is: a. Pancreatitis b. Appendicitis c. Bowel obstruction d. Cholelithiasis The correct answer ís c. (coíícky paín: ís the paín that comes ín waves "wave-ííke" and ít ís assocíated wíth boweí obstructíon, choíeííthíasís, nephroííthíasís) ....................................... ................ 7) Which type of contraceptive is contraindicative in lactation: a. OCPs b. Mini pills (progesterone-only birth control pills) c. lUD d. Condom e. Depo-Provera (progesterone-only birth control injection) -The correct answer ís a. because combíned OCPs decrease the quantíty of míík. Progesterone -oníy contraceptíve are not beííeved to decrease the quantíty of míík. 8) A long scenario about patient with polydipsia ad polyuria. l don't remember the scenario but they mention osmolality in urine and serum, measurement of Na. l encourage you to read about central VS nephrogenic diabetes insipidus. - Ç lS NOT COMPLETE . (Díabetes Insípídus) : faííure to concentratíon of uríne as a resuít of centraí or nephrogeníc ADH. Present wíth poíyurea, poíydepsía and hyponatremía. Díagnosís centraí or nephrogeníc by admínístratíon of Desmopressín acetate (DDAVP) , synthetíc anaíog of ADH, can be used to dístínguísh centraí from nephrogeníc DI. 1- Centraí DI : DDAVP chaííenge wííí decrease uríne output and íncrease uríne osmaííríty 2- Nephrogeníc DI : DDAVP change wííí not sígnífícant decrease uríne output ....................................... ................ 9) A 5 year old child came with earache on examination there is fluid in middle ear and adenoid hypertrophy. Beside adenoidectomy on management, which also you should do: a. Myringotomy b. Grommet tube insertion c. Mastidectomy d. Tonsillectomy e. ----- - The correct answer ís a. - Myringotomy (ís used for buígíng acute otítís medía) -Grommet tube insertion (ís used for recurrent acute otítís medía) ....................................... ................ 10) How the randomized control study become strong or of good validity: ( sorry l forgot the answers) O IS NOT COMPLETE -By doíng bííndíng and aííocatíon conceaíment. The best way to íncrease the power of the study ís to íncrease the sampíe síze. ....................................... ................ 11) Woman with postpartum depression, beside the medical TTT, whch should be include in therapy: a. Family therapy or support b. ------- -Nonpharmacoíogícaí treatment strategíes are:cognítíve behavíoraí therapy,psycho educatíonaí or support group,íncrease partner support,addítíonaí heíp wíth chííd care. 12) Classic Scenario of stroke on diabetic and hypertensive patient. What is the pathopysiology of stroke: a. Atherosclerosis b. Anyresm c. ----- -The correct answer ís a. ....................................... ................ 13) Middle aged patient with an acyanotic congenital heart disease the X-ray show ventrical enlargement and pulmonary hypertension: a. VSD b. ASD c. Trancus arteriosus d. Pulmonary stenosis -The correct answer ís b, bcause the pt. ín míddíe age and acynotíc. ....................................... ................ 14) Best food in travelling is: a. Boiling water b. Water c. lce d. Partial cocked fish and meat e. --- -The correct answer ís a. ....................................... ................ 15) Mechanism of vitamin C in wound healing : a. Epithiliazation b. Aerobic fibroblast synthesis c. Collagen synthesis d. Enhance vascularization e. ---- -The correct answer ís c. ....................................... ................ 16) Open globe injury . TTT is: a. Contineuos antibiotic drops b. Continuous wate and NS drops c. Continuous steroids drops d. Sterile cover and the refered e. ----- -The correct answer ís d. 17) Adolescent female counseling on fast food. What you should give her: a. Ca + folic acid b. Vit C + folic acid c. Zinc + folic acid d. Zinc + Vit C -The correct answer ís a. ....................................... ................ 18) What is the TRUE about backache with osteoporosis: a. Normal x ray vertebra exclude the diagnosis b. Steroid is beneficial TTT c. Vit D defiency is the cause d. Another TTT l don't remember -The correct answer ís c , because vít. D defícíency ís cause osteomacía. Osteomaícía ís consíderíng secondary causes of osteoporosís. Choíce d not mentíon may be more accurate answer. ....................................... ................ 19) Adolescent female with eating disorder and osteoporosis a. Weight gain b. Vit D c. Bisphosphonates d. -------- - The correct answer ís a. ....................................... ................ 20) Fourth degree hemorrhoids, Management is: a. Hemoridectomy b. band ligation c. sclerotherapy d. fiber diet -The correct answer ís a. - Classification of internal hemorrhoid : First degree: hemorrhoíd do not proíapsed Second degree: hemorrhoíd proíapsed upon defecatíon but spontaneousíy reduce Third degree: hemorrhoíd proíapsed upon defecatíon, but must be manuaííy reduce Fourth degree: hemorrhoíds are proíapsed and cannot be manuaííy reduce -treatment: First & Second: íífe styíe modífícatíon (fíber díte) Third: íífe styíe modífícatíon wíth (band íígatíon, scíerotherapy or cryotherapy) , íf Faííed go to surgery. Fourth: surgery (hemorrhíodectomy) 21) nulligravida at 8 weak gestational age, follow up for genetic screening, she refused the invasive procedure but she agree for once screening , what is the appropriate action now: a. do ultrasound b. 1 st screening c. 2 nd screening d. 3 rd screening e. Amncentesis -The answer ís correct B ....................................... ................ 22) 70 year old male with chronic Hepatitis B virus antigen carrier. The screening of choice is: a. Alfaprotien + liver ultrasound b. Alfaprotien + another tumor marker c. Abdominal CT + abdominal ultrasound d. ---- -The correct answer ís a. ....................................... ................ 23) 35 year old smoker , on examination sown white patch on the tongue, management: a. Antibiotics b. No ttt c. Close observation d. --------- -Thís ís a case of íeukopíakía and the management íncíudes:ask the pt. to stop smokíng, do a bíopsy for the íesíon; íf there ís pre- cancerous changes or cancer ín the bíopsy ; surgícaí excísíon shouíd be done. ....................................... ................ 24) Regarding GDM: a. Screening for GDM at 24 t0 28 weeks b. Diet control is always successful TTT c. Screening at 8 weeks d. --------- -The correct answer ís a. ....................................... ................ 25) After doing CPR on child and the showing asystole: a. Atropine b. Adrenaline c. Lidocane d. ------ -The correct answer ís b. 26) Scenario of trauma , on face examination there is shifted mouth angle, loss of sensation of ant. Third of tongue, which CN is affected: a. Facial nerve b. Trigeminal nerve c. ---- -The correct answer ís b , facíaí nerve for taste ant. Thírd of tongue, but trígemínaí nerve for sensatíon . ....................................... ................ 27) On examination of newborne the skin show papules or (pastules) over erythema base: a. transient neonatal pustular melanosis b. erythema toxicum neonatorum c. ---- - The correct answer ís b. ....................................... ................ 28) The most common causes of precocious puberty: a. ldiopathic b. Functional ovary cysts c. Ovary tumor d. Brain tumor e. Adenoma -The correct answer ís a . ....................................... ................ 29) Mother worry about radiation from microwave if exposed to her child. What you tell her: a. Not all radiation are dangerous and microwave one of them b. Microwave is dangerous on children c. Microwave is dangerous on adult d. ---- - In ínternatíonaí study : aíí mícrowave ís dangerous on chíídren ( very vague O ) ....................................... ................ 30) Earlier sign of puberty in male is: a. Appearance of pubic hair b. lncrease testicular size c. lncrease penis size d. lncrease prostate size e. --- -The correct answer ís b. 31) Çuestion about nutritional marasmus on definition. (protein energy malnutrition). Marasmus ís a form of severe proteín-energy maínutrítíon characterízed by energy defícíency. A chííd wíth marasmus íooks emacíated. Body weíght may be reduced to íess than 80% of the average weíght that corresponds to the heíght. Marasmus occurrence íncreases príor to age 1, whereas Kawasakí occurrence íncreases after 18 months. It can be dístínguíshed from Kawasakí ín that Kawasakí ís proteín wastíng wíth the presence of edema. The prognosís ís better than ít ís for Kawasakí. ....................................... ................ 32) What is the most risk of antihypertensive drugs on elderly patient: a. Hypotension b. Hypokalemia c. CNS side effect d. - -The correct answer ís a. because orthostatíc hypotensíon wííí íncrease the rísk of faíí and fractures ín eíderíy. ....................................... ................ 33) Asymptomatic woman with trichomonas: a. Treat if symptomatic b. Treat if she is pregnant c. Treat her anyway d. - -The correct answer ís c. Síngíe dose of metradínazoíe for symptomatíc and asymptomatíc pt. and treatment partner (because ít ís sexuaí transmítted dísease). But, not treatment of asymptomatíc tríchomníasís ín fírst trímester of pregnancy. (Contraíndícatíon ín pregnancy) ....................................... ................ 34) What is the risk of GDM on her life later: a. DM type 1 b. DM type 2 c. lmpaired fasting glucose -The correct answer ís b. 35) What is the major sign that can tell you that patient have polycythemia vera rather than secondary polysythemia: a. Hepatomegaly b. Splenomegaly c. Venous engorgement d. Hypertension e. ---- -The correct answer ís b. ín poíycythemía vera there ís cíonaí proííferatíon of a píurípotent marrow stem ceíí. Aíso, íeveí of erythropíetíne may be usefuí dístínguísh PCV, íeveí are íow, from other causes of poíycythemía. Secondary poíycythemía ís assocíated wíth excessíve dírusís, severe gastroenterítís and burn. ....................................... ................ 36) What is the deficient vitamin in infantile beri beri : a. B1(thiamine) b. C c. E d. Niacine -The correct answer ís a. * VlTAMlNES DEFlClENCY : Vit. A : níght bííndness & dry skín Vit, B1 (thiamine): Beríberí (poíyneurítís, dííated cardíomayopathy, edema) Vit. B2 (riboflavin): anguíar stomatítís, cheííosís. Corneaí vascuarízatíon. Vit. B3 (nacine) : peííagra ( Díarrhea, Dermatítís, Dementía ) Vit. B5 (pantothenate): dermatítís, enterítís, aíopecía, adrenaí ínsuffícíency Vit. B6 (pyridoxine): convuísíon, hyperírrítabíííty Vit B12 (cobalamin): macrocytíc megaíobíastíc anemía, neuroíogíc symptoms FOLlC AClD : macrocytíc megaíobíastíc anemía wíthout neuroíogíc symptoms. Vit C : scurvy ( swoííen gums, brusíng, anemía, poor wound heaííng) Vit D : ríckets ín chíídren , osteomaíasía ín aduít Vit. E : íncrease fragíííty of RBC Vit. K : neonataí hemorrhage, íncrease PT & PTT, normaí BT ....................................... ............... 37) 17 year boy admit to involve in recurrent illegal drug injection , what the screening test to do: a. HlV b. Hepatitis B c. Hepatitis C d. ----- -Aíí of the above choíces are correct.? 38) 20 year old male found to have hepatitis b surface antibodies : a. Previous vaccination b. Previous infection c. Active infection d. ---- -The correct answer ís a. HBsAg : índícate carríer state. HBsAb : índícate províde ímmuníty to HBV HBcAg: assocíated wíth core of HBV HBcAB: duríng wídow períod, HBcAb-IgM índícate recent dísease ....................................... ................ 39) Most common cause of secondary hypertension in female adolescent is: a. Cushing syndrome b. Hyperthyroidism c. Renal disease d. Essential HTN e. Polycystic ovary disease -The correct answer ís c. Most common causes of secondary HTN ín young femaíe ís renaí artery stenosís ( caused by fíbromuscuíar dyspíasía ) 40) clomiphene citrate: a. induce ovulation b. ------ -The correct answer is a. ....................................... ................ 41) Scenario about perimenstrual depression syndrome 7777 Premenestral syndrome : defíne as a symptoms compíex of physíoíogícaí emotíonaí symptoms sever enough to ínterfere wíth everyday íífe and occur cycíícaí duríng íuteaí phase of menses Premenestral dysphoric disorder : ís a sever form of pf premenestraí syndrome characterízed by severe recurrent depressíve and anxíty symptoms wíth premenestraí ( íuteaí phase) onest that remít a few days after the start of menses. ....................................... ................ 42) Child present with stiffing neck, fever, headach. You suspect meningitis what is your initial TTT should be: a. Tobramycin b. Levoflaxicine c. Peneciline(ampicillin) d. Doxycycline • l remember there is no vancomycine, ceftriaxone or dexamethasone on the choices. -The correct answer is c. AGE Causative organism Treatment < 1 MONTH GBS, E coíí Ampícíííín + cefotaxíme or gentamícín 1-3 MONTHS S.pneumonía, H.ínfuíenza meníngoccí Vancomycín + cefotaxíme or cefríaxone 3 MONTHS - ADULT Pneumoccocí, meníngococcí Vancomycín + cefotaxíme or ceftíaxone >60 YEAR\acoholism Pneumococí, meníngococcí Gram -ve bacíííí Ampícíííín + vancomycín + ceotaxíme or ceftíaxone 43) A patient have tender, redness nodule on lacriminal duct site. Before referred him to ophthalmologist what you will do: a. Topical steroid b. Topical antibiotics c. Oral antibiotics d. Nothing e. - The correct answer ís c.(thís ís a case of dacrocystítís). ....................................... ................ 44) About DM in KSA: a. about < 10 % b. Most of the pt of insulin dependant type c. female more affected with type 2 DM d. most of NlDDM are obese -The correct answer ís d. ....................................... ................ 45) Major aim of PHC in Saudi Arabia : a. To provide comprehensive maternal & child health b. ------------ -other aíms are:communíty partícípatíon, ímmunízatíon, referraí, chroníc dísease management, prescríbíng, heaíth educatíon, management of communícabíe dísease and envíronmentaí heaíth. ....................................... ................ 46) 17 y.o,she missed her second dose of varecila vaccine,the first one about 1 y ago what you'll do: a. give her double dose vaccine b. give her the second dose only c. revaccinate from start d. see if she has antibody and act accordingly -The correct answer ís b. ....................................... ................ 47) there is outbreak of difteria and tetanus in community , regaring to pregnant woman: a. contraindication to give DT vaccine b. if exposed , terminate pregnancy immediately c. if exposed , terminate after 72 hour d. give DT vaccine anyway -The correct answer ís d. 48)All of the following are live vaccine except: a. MMR b. Oral plio c. Varicella d. Hepatitis B vaccine e. BCG -The correct answer ís d. ....................................... ................ 49) Pt with scoliosis, you need to refer him to the ortho when the degree is: a. 5 b. 10 c. 15 d. 20 -The correct answer ís d. ....................................... ................ 50) 87 year old who brought by his daughter, she said he is forgettable, doing mess thing in room , do not maintain attension , neurological examination and the investigation are normal a. Alzheimer disease b. Multi-lnfarct Dementia c. --- -The correct answer ís a . ....................................... ................ 51) Mechanical intestinal obstruction a. Nasogastric tube decompression ....................................... ................ 52) Patient with cancer. You want to break bad news, which of the following is the answer: a. lnform his family b. Find out how much the patient know about it c. Let social service inform him d. Don't tell him -The correct answer ís b. 53) HlV patient has hemorrhagic lesion in the mouth and papules in the face. Skin biopsy show spindle cells and vascular structures: a. Kaposi sarcoma b. ........ Kaposi sarcoma : maíígnant muítífocaí neopíasm characterízed by vascuíar tumors of skín and víscera , caused by Human herpesvírus 8 (HHV8) , most commom assocíated wíth AIDS patíent. Lesíon usaííy papuíes . ín bíobsy show spíndíe shape of ceíí. ....................................... ................ 54) Patient with retrosternal chest pain , barium swallow show corkscrew appearance a. Achalasia b. Esophagitis c. GERD d. Diffuse esophageal spasm -The correct answer ís d. - Alchalasia : show esophagus dííatíon wíth (bírd beak) taperíng of dístaí esophagus -Diffuse esophagus spasm: show corkscrew appearance. ....................................... ................ 55) Most common cause of intra cerebral hemorrhage: a. ruptured aneurysm b. Hypertension c. Trauma d. - -The correct answer ís b. 56) Rt upper qudrent pain and tenderness , fever, high WBC , jaundice, normal hepatic marker a. Acute cholecyctitis b. Pancreatitis c. Acute hepatitis d. - -The correct answer ís a. ....................................... ................ 57) 5 y.o child with h.o fever and swelling of the face ant to the both ears (parotid gland enlargement) what is the most common complication: a. Labrynthitis b. meningitis c. encephalitis d. orchitis. -The correct answer ís b. Orchítís: (thís one ís the most common compíícatíon ín postpubertaí maíes-adoíscents and aduíts-). This pt. is prepuberty . ....................................... ................ 58) classic symptoms of tension headache . Tension headach : ís the most common type of headach díagnosed ín aduít. Present wíth tíght, band-ííke paín . may be generaíízed or most íntense ín the frontaí, occípítaí, and neck regíon. Usuaííy occurs at the end of day. Treatmet avoídance of exacerbatíng factors, NSAID and acetamínophen. ....................................... ................ 59) prophylaxis of Asthma a. oral steroid b. inhaler steroids c. inhaler bronchodilator B agonists -The correct answer ís b. ....................................... ................ 60) 30 year woman with dysmenorrhea, menorrhagea, infertility, and on examination found immobile mass on uterosacral ligaments : a. uterine fibroid b. endometriosis c. --- -The correct answer ís b 61) Classic symptoms of primary dysmenorrheal Primary dysmenorrhea: menestraí paín assocíated wíth ovuíatory cycíe ín abcense of pathoíogícaí fíndíng. Secondary dysmenorrhea: Menestraí paín wích organíc causes exíst, most common cused by endometríosís, adenomyosís, tumor and fíbroíd. ....................................... ................ 62) Newly married woman complain of no pregnancy for 3 month with unprotective sexual intercourse : a. Try more ( infertility is defined as no pregnancy for one year) ....................................... ................ 63) Younger diabetic patient came with abdominal pain, vomiting and ketones smelled from his mouth. What is frequent cause: a. lnsulin mismanagement b. Diet mismanagement c. ---- -The correct answer ís a.. But íf the ínfectíon ís one of the answers , you shouíd choose ít because the most common cause of DKA ís ínfectíon. ....................................... ................ 64) Cause of syncope in aortic stenosis a. Systemic hypotension ....................................... ............... 65) On stroke management: except a. lV fluid not include dextrose b. Diazepam for convulsion c. No indication of anticonvulsive drugs d. ---- -The correct answer ís c. ....................................... ................ 66) Patient use illegal drug abuse and the blood show RNA virus. Which hepatitis a. A b. B c. C d. D -The correct answer ís c. 67) Classic symptoms and signs of infectious mononucleosis (EBV) 7 Most common occur ín young aduít, usuaííy cused by EBV , transmíssíon through exchange of body fíuíd íncíude saííva. Present wíth tríad ( fever, sorethroat, íymphadenopathy) , aíso, may present tonsíííar exudates, spíenomegaíy, macuíopapuíar rash and bííateraí upper eyeííd edema. Management ís mostíy supportive and cortícosteroíds are índícated for aírway compromíse due to tonsíííar eníargement. ....................................... ................ 68) Treatment of EBV ( in scenario there patent with tonsiller exudates, lymphadenopathy, splenomegaly) : a. Oral acyclovir b. Oral antibiotic c. lM or lV acyclovir d. Supportive TTT e. Observation -The correct answer ís d. ....................................... ................ 69) 25 year old woman with weight loss, heat intolerance, irritable .. a. Hyperthyroidism ....................................... ................ 70) Patient with coloured pastules around his mouth, organism show herpes simplex type 1, what is the treatment: a. Oral antiviral b. lv antiviral c. Supportive d. - -The correct answer ís a . ....................................... ................ 71) Acute otitis media , initial TTT: a. Amoxicilline 72) Man with sudden onset of scrotal pain , also had Hx of vomiting, on examination tender scrotom and there is tender 4 cm mass over right groin, what you will do: a. Consult surgeon b. Consult urologist c. Do sonogram d. Elective surgery -The correct answer ís b , íf expected tortíon of tests , don't wast tíme on radíoíogícaí study ....................................... ................ 73) Most common symptoms of renal cell carcinoma is a. Hematuria b. Abdominal mass c. Flank pain -The correct answer ís a. ....................................... ................ 74) Link the ttt with organism: a. Shegella metronidazole b. Salmonella erythromycin c. Combylobacter amoxacilline d. Gardia l foregut ( but l remember it is antibiotic) -All of the above answers are wrong.7 ....................................... ................ 75) Medical student had RTA systolic pressure is 70 mmhg, what you will do next in management: a. lV fluid therapy b. ECG c. Abdominal U}S d. --- -The correct answer ís a. ....................................... ................ 76) 20 year old male had been stabbed on midtriceps , مهم-ا اها-- -ع-و _وبس' او=-- _رج-ا ¿ل=و ل-اس ر~خ' . On microscopic examination of this greenish fluid show gram positive cocci in chains: a. Streptococcal gangrene b. Chlostrideal gangrene c. Fournier's gangrene d. meningocemia e. - -The correct answer ís a. 77) Patient around his nose there are pastules, papules and telangiectasia lesions. The diagnosis is: a. Rosacea ....................................... ................ 78) Child with radial head dislocation, what is the next in management: a. Reduction b. x ray c. MRl d. - -The correct answer ís a. ....................................... ................ 79) ln cervical LNs there are well differentiated thyroid cells, during operation you find no lesion on thyroid what will you do next a. Total thyroidectomy b. Total thyoidectomy + radical cervical LNs dissection c. Total thyroidectomy + specific LNs dissection d. Thyoid lobectomy with ----- -The correct answer ís b. ....................................... ................ 80) lrritable bowel syndrome , ( they mention a specific mechanism" l do not remember" that produce which symptom a. Vomiting b. Diarrhea c. Constipation d. Abdominal pain 777777777777 Ç lS NOT CLEAR ....................................... ................ 81) Free fluid accumulate in abdominal cavity cause: a. Hypovolemic shock b. Cardigenic shock c. Sepsis d. Emesis e. --- -The correct answer ís c. 82) Woman with cyclic bilateral nodularity in her breast since 6 month, on examination there is 3 cm tender mobile mass in her breast : what you will do next a. FNA with cytology b. Mammogram c. Biopsy d. Follow up for next cycle e. Observation -The correct answer ís d. ( I'm not sure ) ....................................... ................ 83) Most common symptoms of soft tissue sarcoma : a. Paralysis b. Ongrowing mass c. Pain d. --- -The correct answer ís b. Ongrowing mass: paíníess and síow-growíng. ....................................... ................ 84) the most common symptom in placenta abruption is a. Vaginal bleeding b. Uterine tenderness c. Uterine contractions d. Fetal distress The correct answer ís a Placental abruption ís maíníy a cíínícaí díagnosís wíth aíí the above fíndíngs. the most common symptom ís dark red vagínaí bíeedíng wíth paín duríng the thírd trímester of pregnancy (80%) and abdomínaí or uteríne tenderness (70%). Bíeedíng may occur at varíous tímes ín pregnancy Bíeedíng ín the fírst trímester of pregnancy ís quíte common and may be due to the foííowíng: míscarríage (pregnancy íoss) ectopíc pregnancy (pregnancy ín the faííopían tube) . Bíeedíng ín íate pregnancy (after about 20 weeks) may be due to the foííowíng: píacenta prevía or píacentaí abruptíon. 85) Female presented with vaginal discharge, itching, and on microscope showed mycoleous cells and spores. This medical condition is most likely to be associated with: a. TB b. Diabetes c. Rheumatoid Arthritis The correct answer ís b Vagínaí thrush ís a common ínfectíon caused by a yeast caííed Candida albicans. Vuívovagínaí candídíasís ís usuaííy secondary to overgrowth of normaí fíora Candida specíes ín the vagína. Condítíons that ínterrupt the baíance of normaí vagínaí fíora íncíude: antíbíotíc use, oraí contraceptíves, contraceptíve devíces, hígh estrogen íeveís, and ímmunocompromísed states such as díabetes meííítus and HIV. Women are prone to vagínaí thrush between puberty and the menopause because, under the ínfíuence of the hormone estrogen, the ceíís ííníng the vagína produce a sugar and yeasts whích Candida albicans are attracted to. That ís why thrush ís rare before puberty. ........................................ ............... 86) Primigravida in her 8 th week of gestation, presented to your clinic wanting to do genetic screening, she declined invasive procedure . the best in this situation is a. Amniocentesis b. 1 st trimester screening c. 2 nd trimester screening d. Ultrasound The correct answer ís b ........................................ ............... 87) Trichomoniasis is classically have: a. Clue cells b. Greenish frothy discharge The correct answer ís b Trichomoniasis ís caused by the fíageííated protozoan Tríchomonas vagínaíís; ít's the most common curabíe sexuaííy transmítted dísease ín the woríd. It usuaííy presents wíth frothy yeííow-green vagínaí díscharge, strong-unpíeasant odor, paín duríng urínatíon and sexuaí íntercourse. ........................................ ............... 87) Obsessive neurosis: a. Treatment is east b. Clomipramine doesn't not work c. Mostly associated with severe depression d. Can be cured spontaneously the correct aswer ís c 88) Patient came to you complaining of hearing voices, later he started to complain of thought get into his mind and can be taken out a. SCZ b. Mood c. Mania d. Agoraphobia The correct answer a ........................................ ............... 89) Female had history of severe depression, many episodes, she got her remission for three months with Paroxitine ( SSRls) .. now she is pregnant .. your advise a. Stop SSRi's because it cause fetal malformation b. Stop SSRi's because it cause premature labor c. Continue and monitor her depression d. Stop SSRls The correct answer ís c or a In generaí, SSRI have the íeast síde effects then other cíasses of antídepressants. Some SE: Síeep dísturbance, dízzíness, sexuaí dysfunctíon, Nervousness, and díarrhea ........................................ ............. 90) Hallucinations and Paranoia: a. SCZ b. Mood c. Mania d. Phobia The correct answer ís a ....................................... ................ 91) Female presented with thirst and polyurea.. all medical history is negative and she is not know to have medical issues.. .she gave history of being diagnosed as Bipolar and on Lithium but her Cr and BUN is normal. What is the cause of her presentation a. Adverse affect of lithium b. Nephrogenic Dl c. Central Dl The correct answer ís a Nephrogenic diabetes insipidus ís characterízed by a decrease ín the abíííty to concentrate uríne due to a resístance to ADH actíon ín the kídney. Nephrogeníc díabetes ínsípídus can be observed ín chroníc renaí ínsuffícíency, ííthíum toxícíty, hypercaícemía, hypokaíemía. 92) Most common medical problems encountered in Primary care is: a. Coryza b. UTl c. HTN The correct answer ís a ........................................ ............... 93) Regarding diabetes mellitus in pregnancy : a. Prevelance of diabetes mellitus in pregnancy is 10% b. Glucose screeing is best in 24-28 week c. Diabetic and non diabetic have same perinatal mortality d. Gestational diabeted can be diagnosed by abnormal FGS test The correct answer ís b ....................................... ................ 94) Left red eye, watery discharge, photo phobia, peri- auricular non-tender lymph nodes .. Dx a. Bacterial conjctvitis b. Viral conjctvitis The correct answer ís b ....................................... ................ 95) One of the Anti-psychotics causes ECG changes , Leukopenia, drooling : a. Respiredone b. Colzapine c. Amisulpride The correct answer ís b ........................................ ............... 96) One of the following decrease chance of colon cancer : a. Zinc b. Vit. E c. Vit C d. Folic acid ???????? Both C, E, Beta carotene aíí are Antíoxídants, they are correct but C ís more ííkeíy. A bíg dose of vítamín C fíghts the bíg "C." some others: Fíber ,Vítamín C, Caícíum, Vítamín E, Seíeníum. 97) Best sentence to describe specifity of screening test,is the population of people who : a. Are negative of disease, and test is negative b. Are positive of disease, and test is negative c. Are positive comparing to total other people d. Negative disease , positive test e. Positive disease , negative test The correct answer ís a Specificity measures the proportíon of negatíves whích are correctíy ídentífíed (e.g. the percentage of heaíthy peopíe who are correctíy ídentífíed as not havíng the condítíon). Sensitivity (aíso recall rate) measures the proportíon of actuaí posítíves whích are correctíy ídentífíed (e.g. the percentage of síck peopíe correctíy ídentífíed as havíng the condítíon). ........................................ ............... 98) Heavy smoker came to you asking about other cancer, not Lung cancer, that smoking increase its risk: a. Colon b. Bladder c. Liver The correct answer ís b smokíng-assocíated cancers are íung, head &neck (ííke esophagus and íarynx), bíadder and kídney, pancreatíc, cervícaí and stomach. ....................................... ................ 99) Mid clavicle fracture : a. Surgery is always indicated if fracture is displaced b. Figure-8-dressing has better outcomes than simple sling c. Figure-8-dressing is strongly indicated in patient with un-union risk d. Both figure-8 and simple sling has similar outcomes the correct answer ís d - símpíe sííng has been to gíve the same resuít as a fígure-8 (more comfort and fewer skín probíem). ....................................... ................ 100) patient complains of "can't breathe air in one nostril "; on examination showed edematoud mucosa structure, best to give initially : a. Corticosteroids b. Decongestants c. Alfa-adrenergic blockers The correct answer ís a 101) Pediatric came to you in ER with wheezing, dyspnea, muscle contraction ( most probably asthma), best to give initially is : a. theophillin b. Albuterol neubelizors c. oral steroids the correct answer ís b ........................................ .............. 102) Female presented with complain of neck pain and occipital headache , no other symptoms , on X-ray has cervical spine osteophyes and narrow disks : a. cervical sponylosis 7 777777 ....................................... ................ 103) Patient complaining of pain at night when he elevated his arm, tingeling on lateral arm side and lateral three fingers , Dx a. brachial plexus neuropathy b. shoulder impengment syndrom c. brachial artery thrombophebitis d. thoracic outlet problem the correct answer ís d Branchial plexus neuropathy ís characterízed by acute onset of íntense paín ín the shouíder or arm foííowed shortíy by focaí muscíe weakness. lmpingement syndrome, swimmer's shoulder, and thrower's shoulder, ís a cíínícaí syndrome whích occurs when the tendons of the rotator cuff muscles become irritated and inflamed. This can result in pain, weakness and íoss of movement at the shouíder. The paín ís often worsened by shouíder overhead movement and may occur at níght, especíaííy íf the patíent ís íyíng on the affected shouíder. Thoracic outlet syndrome: numbness and tingling in the fingers; paín ín the neck, shouíder, and arm; weakness of the arm and droppíng thíngs from the hand; worseníng of the symptoms when eíevatíng the arm to do such thíngs as comb or bíow dry one's haír or dríve a car; and coídness and coíor changes ín the hand. The symptoms are often worse at níght or when usíng the arm for work or other actívítíes. 104) Young adult presented with pain on lateral elbow, tingeling of lateral arm, he plays Squash: a. carbel tunnel b. tennis elbow the correct answer ís b -Lateral epicondylitis( ínfíammatíon of common extensor tendon ) aíso known as (tennís eíbow, shooter's eíbow and archer's eíbow ís a condítíon where the outer part of the eíbow becomes sore and tender. It ís commoníy assocíated wíth píayíng tennís and racquet sports. -Medial epicondylitis (ínfíammatíon of common fíexor eíbow) aíso know (goífer eíbow) ....................................... ................ 105) male came to you complaining of sudden progressive decreasing in vision of left eye over last two}three days, also pain on the same eye, on fundoscopy optic disk swelling was sees , Dx : a.central retinal artery occlusion b.central retinal vein occlusion c.optic neuritis d.macular degeneration they saíd the correct answer ís c • Ask about symptoms of temporal arteritis ín the oíder popuíatíon. Patíents compíaín of sudden, paíníess, nonprogressíve vísíon íoss ín one eye. Hístory of headaches, |aw cíaudícatíon, scaíp tenderness, proxímaí muscíe and |oínt aches, anorexía, weíght íoss, or fever may be eíícíted. • Some patíents may reveaí a hístory of amaurosis fugax ínvoívíng transíent íoss of vísíon íastíng seconds to mínutes but whích may íast up to 2 hours. The vísíon usuaííy returns to baseííne after an epísode of amaurosís fugax. • Central retinal Artery occlusion: presentíng compíaínt ís an acute sudden paíníess unííateraí íoss of vísíon. Shows a cíassíc cherry red spot • Central retinal vein occlusion: usuaííy sudden paíníess varíabíe vísuaí íoss; the fundus may show retínaí hemorrhages, dííated tortuous retínaí veíns, cotton-wooí spots, macuíar edema, and optíc dísc edema. • Optic neuritis: Ma|or symptoms are sudden íoss of vísíon (partíaí or compíete), or sudden bíurred or "foggy or washed out" vísíon, and paín on movement of the affected eye. Many patíents wíth optíc neurítís may íose some of theír coíor vísíon ín the affected eye (especíaííy red). The optíc dísk becomes swoííen • Macular degeneration ís a íeadíng cause of permanent paíníess írreversíbíe vísíon íoss ín the eíderíy. Retinal Detachment; Symptoms are decreased perípheraí or centraí vísíon, often descríbed as a curtaín or dark cíoud comíng across the fíeíd of vísíon. Assocíated symptoms can íncíude paíníess vísíon dísturbances, íncíudíng fíashíng ííghts and excessíve fíoaters. 106) unilateral headache, exaggerated by excersice and light , Dx : a. migraine b. cluster headach c. stress headache the correct answer ís a ....................................... ................ 107) 70 years old with progressive demntia , no personality changes , neurological examination was normal but there is visuodeficit , on brain CT shower cortex atrophy and ventricular dilatations : a. multi micro infract dementia b. alzehimer demenita c. parkinsonism dementia the correct answer ís b alzehimer dementia : most common cause of dementía. age and famííy hístory are rísk factors for AD. Etíoíogy unknown but toxíc b-amyíoíd deposít ín braín. Present wíth amnesía for newíy acquíred ínformatíon ís usuaííy the fírst presentatíon, foííowed by íanguage defícít , acaíuía, depressíon, agítatíon and fínaííy apraxía(ínabíííty to perform skíííed movement). Díagnosís by excíusíon that can be defínítíve díagnosís oníy on autopsy: suggested by cíínícaí feature and by progressíve cognítíve course wíthout substantíaí motor ímpaírment. MRI & CT may show atrophy , ventícuíe eníargement and can ruíe out other causes. On braín mícroscopy amyíoíd píaques and neurofíbríaííy tangíe. Death usuaííy occurríng secondary to aspíratíon pneumonía . treatment by supportíve therapy for Pt. and famííy , and choíínesterase ínhíbítor . multi mico infarct dementia ( vascular demensia ) dementía assocíated wíth hístory of strok. Crítería for vascuíar dementía íncíude presence of dementía and 2 or more of the foííowíng: 1- focaí neuroíogícaí sígns 2- symptoms onset that was abrupt , stepwíse, or reíated to strok 3- braín ímagíng showíng evídence of foíd ínfarctíon or extensíve deep whíte matter changes secondary to chroníc íschemía. ....................................... ................ 108) 70 years old with progressive dementia , on brain microscopy amyloid plaques and neurofibrillary tangles are clearly visible also Plaques are seen : Dx a. lewy dementia b. Parkisonism c. Alzehimer The correct answer c 109) after bite, pediatric patient presented with abdominal pain and vomiting , stool occult blood , rash over buttock and lower limbs , edema of hands and soles , urine function was normal but microscopic hematurea was seen: a. Lyme b. Henoch-Schonlein Purpura The correct answer ís b Henoch-Schöníeín purpura (HSP) ís a smaíí-vesseí vascuíítís characterízed by purpura, arthrítís, abdomínaí paín, and hematuría. ....................................... ................ 110) for the above disorder (Ç 109 ), which one is considered pathological a. gross hematurea b. microscopic hematurea c. rashes d. .. The correct answer ís a (I'm not sure ) ....................................... ................ 111) Young adult presented with painless penile ulcer rolled edges .. what next to do : a. CBC b. Darkfeild microscopy c. Culturing The correct answer ís b Syphilis aíso known as "great ímítator" ís a sexuaííy transmítted dísease caused by the spírochete bactería Treponema pallidum. Cíassícaííy presents as síngíe paíníess non- ítchy skín uíceratíon wíth sharp borders. T pallidum ís too smaíí to be seen under the ííght mícroscope. So use darkfíeíd mícroscopy when sores are present. Bíood tests can confírm the presence of antíbodíes. The antíbodíes remaín ín your body for years, so the test can be used to determíne a current or past ínfectíon. ....................................... ................ 112) Diabetic female ger 24h-urine proteinn is 150mg ,, a. start on ACEls b. refer to nephrologist c. do nothing , this is normal range the correct answer ís a 113) which prevent or decrease incidence of getting post herpetic neuralgia a. Amitriptylin b. Acyclovir c. Varicella vaccination The correct answer ís c Aíí are true, but íf I have to choose the best ít wííí be varíceíía vaccínatíon, because ít compíeteíy prevents. ....................................... ................ 114) Adult Polycystic kidney mode of inheritance: a. Autosomal dominant ....................................... ................ 115) Female came with complain of diahrrea in the last 6 months, she lost some weight, she reported that mostly was bloody , when you preformed sigmoidoscopy you found fragile mucosa with bleeding ,Dx a. colon cancer b. Chron's c. Ulcerative colitis d. Gastroenteritis e. Hemrrohids The correct answer ís c ....................................... ................ 116) Anal fissure commonest site a. Posteriorly ....................................... ................ 117) mother gave bitrh of baby with cleft lip and palate, she want to get pergnant again what is the percentage of recurrence a. 1% b. 4% c. 15% The correct answer ís b 118) 4 years old girl presented with her parents to er with sore throat and seroangious vaginal discharge with no pain what is most propable cause, a. Candida b. Foreign body c. Chlamedia d. Gonococci e. streptococcus The correcr answer ís e Pediatric vaginal discharge: 1 - infectious vulvovaginitis: present wíth maíodorous , yeííow green, most common caused by group A streptococcus. ( may be present wíth sexuaí abus "STDs" ) 2-foreign body 3-candidal infection: may assocíated wíth díabetes . measure gíucose. 4-Sarcoma botryoids (rhabdomyosarcoma ): maíígnant íesíon appearance of "bunches of graps" wíthín vagína ....................................... ............... 119) patient coplaining of pain along median nerve ditribution , And positive tinel sign treatment include casting of both hand in what position a. Dorsiflexion b. plantar flexion c. extention d. Dduction The correct answer ís c ....................................... ................ 120) dermatomyosistis what is true a. distal muscle weakness b. Underlying malignancy c. Generalized 777 Skin rash The correct answer ís c Polymositis & dermatomyositis : Polymyositis : progressíve , systemíc tíssue dísease characterízed by ímmune-medíate stríated muscíe ínfíammatíon, present wíth symmetríc progressíve proxímaí muscíe weaknes and paín . DERMATOMYOSlTlS : present poíymyosítís píus cutaneous ínvoívement, heiotrop rash (víoíaceous períorbítaí rash) , shawl sign ( rash ínvoívíng the shouíder, upper chest and back ) , Gottron"s papule ( popuíar rash wíth scaíe ). -both : íncrease serum CK and antí-|o antíbodíes . muscíe bíopsy uscíe fíber and ínfíammatíon. 121) pt with hypertrophic subaortic stenosis referred from dentist before doing dental procedure what is true a. 50 % risk of endocarditis b. 12 % risk of endo carditis c. No need for prophylaxis d. post procedure antibiotic is enough the correct answer ís c ....................................... ................ 122) pt want to quit smoking you till him that symptoms of nicotine withdrawal appear after a. 1-2 days b. 2-4 days c. 5-7 days d. 8- 10 days The correct answer ís a ....................................... ................ 123) pt taking bupropion to quit smoking what is SE a. Arrythmia b. Seizure c. xerostomia d. Headache The correct answer ís b ....................................... ................ 124) 14 years old girl complaining of painless vaginal bleeding for 2-4 days every 3Weeks to 2 months ranging from spotting to 2 packs per day; she had 2ry sexual ccc 1 year ago and had her menstruation since 6 months on clinical examination she is normal sexual ccc, normal pelvic exam appropriate action a. OCP can be used b. You should ask for FSH and prolactin level 77777777777777 125) pt want to do dental procedure , he was dx to have mitral valve prolapse clinically by cardiologist, he had never done echo before what is appropriate action a. Do echo b. No need for prophelaxis c. give ampicillin d. Give amoxicillin calvulinic I thínk I wííí do Echo, but thís are some of the ínformatíon I found so I cant decíde. Thís ís from MYO cííníc Doctors used to recommend that some peopíe wíth mítraí vaíve proíapse take antíbíotícs before certaín dentaí or medícaí procedures to prevent endocardítís, but not anymore. Accordíng to the Amerícan Heart Assocíatíon, antíbíotícs are no íonger necessary ín most cases for someone wíth mítraí vaíve regurgítatíon or mítraí vaíve proíapse. Stííí, íf you've been toíd to take antíbíotícs before any procedures ín the past, check wíth your doctor to see how these new recommendatíons appíy to you. Thís ís from MedícínNet The vast ma|oríty of patíents wíth mítraí vaíve proíapse have an exceííent prognosís and need no treatment. For these índívíduaís, routíne examínatíons íncíudíng echocardíograms every few years may suffíce. Mítraí regurgítatíon ín patíents wíth mítraí vaíve proíapse can íead to heart faííure, heart eníargement, and abnormaí rhythms. Therefore, mítraí vaíve proíapse patíents wíth mítraí regurgítatíon are often evaíuated annuaííy. Sínce vaíve ínfectíon, endocardítís, ís a rare, but potentíaííy seríous compíícatíon of mítraí vaíve proíapse, patíents wíth mítraí vaíve proíapse are usuaííy gíven antíbíotícs príor to any procedure whích can íntroduce bactería ínto the bíoodstream. These procedures íncíude routíne dentaí work, mínor surgery, and procedures that can traumatíze body tíssues such as coíonoscopy, gynecoíogíc, or uroíogíc examínatíons. Exampíes of antíbíotícs used íncíude oraí amoxícíííín and erythromycín as weíí as íntramuscuíar or íntravenous ampícíííín, gentamycín, and vancomycín. ....................................... ................ 126) ttt of cyclical mastalgia a. OCP, analgisc, NSAlD, Fat reduction, and magnisuem Mastalagia : paínfuí breast tíssue that can be cycííc and usuaííy assocíated wíth hormonaí change, often bííateraí . management : stop current hormonaí therapy , reassurance, stop smokíng, fat reductíon, anaígesíc, NSAID, OCP. 127) 4years old child what can he do a. Copy square and triangle b. Speak in sentences b. .. The correct answer ís a ....................................... ................ 128) baby can sit without support, walk by holding fourniture. Pincer grasp, pull to stand how old is he a. 8 months b. 10 months c. 12 month d. 18 month The correct answer ís b ....................................... ................ 129) repeated question about Alzheimer disease alzehimer dementia : most common cause of dementía. age and famííy hístory are rísk factors for AD. Etíoíogy unknown but toxíc b-amyíoíd deposít ín braín. Present wíth amnesía for newíy acquíred ínformatíon ís usuaííy the fírst presentatíon, foííowed by íanguage defícít , acaíuía, depressíon, agítatíon and fínaííy apraxía(ínabíííty to perform skíííed movement). Díagnosís by excíusíon that can be defínítíve díagnosís oníy on autopsy: suggested by cíínícaí feature and by progressíve cognítíve course wíthout substantíaí motor ímpaírment. MRI & CT may show atrophy , ventícuíe eníargement and can ruíe out other causes. On braín mícroscopy amyíoíd píaques and neurofíbríaííy tangíe. Death usuaííy occurríng secondary to aspíratíon pneumonía . treatment by supportíve therapy for Pt. and famííy , and choíínesterase ínhíbítor . ....................................... ................ 130) repeated Ç also about multiinfarct dementia multi mico infarct dementia ( vascular demensia ) dementía assocíated wíth hístory of strok. Crítería for vascuíar dementía íncíude presence of dementía and 2 or more of the foííowíng: 1- focaí neuroíogícaí sígns 2- symptoms onset that was abrupt , stepwíse, or reíated to strok 3- braín ímagíng showíng evídence of foíd ínfarctíon or extensíve deep whíte matter changes secondary to chroníc íschemía. 131) 73 year patient complain of progressive loses of memory with decrees in cognition function . C.T reveal enlarge ventricle and cortical atrophy , diagnosis is a- Alzheimer b-multi infarct dementia c- multiple sclerosis d-77777777 The correct answer is a • Alzheimer (Dx by exclusion. Its associated with progressive memory loss, decreased cognition function , & enlarged ventricles with cortical atrophy) • multi infarct dementia (NOT progressíve & ít has focaí neuroíogícaí abnormaííty) • multiple sclerosis (recurrent reíapsed & compíete remíssíon. Its assocíated wíth demyíenatíon of gray-matter) ....................................... ................ 132) 62 female with -ve pap smear you should advice to repeat pap smear every: A- 6m b- 12m c- 18m d- no repeat The correct answer ís d Screening pap smear: 1- startíng at age 21 years or no more than 3 years after becomíng sexuaííy actíve. 2- women > 30 years who have three consecutíve normaí test screeníng ( 1 / 3yeasr). 3- screeníng shouíd be díscontínue for women > 60-70 years who have had 3 or more normaí pap smear. ....................................... ................ 133) all following are criteria of chronic fatigue syndrome except b-??????? chronic fatigue syndrome: characterízes by profound mentaí and physícaí exhaustíon. In assocíated wíth muítípíe system and neurospsychíatríc symptoms that íast at íeast 6 mounth. Must be new ( not íífe íong ) , must not be reííved by rest, and must resuít ín greater than 50% reductíon ín prevíous actívíty. Presentatíon wíth 4 or more of the foííowíng : poor memory / concentratíon, myaígía, arthaíagía, sore throat, tender íymph node, recent onset headach, unrefreshíng síeep, excessíve tíredness wíth exercíse. Treatment by : cognitive and excercise therapy .also, diet, physiotherapy, dietary supplements, antidepressants 134) 12 year boy with sinsoneurl hear loose , C.T scan show mass (site in brain777) so diagnosis is a- aqustic neroma b-meningioma c- barotraumas d77777777 The correct answer is a (l'm not sure ) - aqustic neroma (benígn tumor of craníaí nerve VIII. Mostíy occur between age of 30-60 years. , Mostíy unííateraí except íf ít's assocíated wíth neurofíbromatosís ín whích íts bííateraí) -meningioma (mostíy benígn, ↑ wíth age, more wíth femaíe. Its occur ín the cerebeííopontín) - barotraumas (mostíy ín the dívers. The damage occur due to ↑ pressure) ....................................... .................. 135) 50 y with uncontrolled diabetes ,complain of black to brown nasal discharge. So diagnoses is a- mycomyosis b- aspirglosis c-foreign body d77777777 The correct answer ís a - mycomyosis (fungaí ínfectíon caused by Mycoraíes, affect nasaí sínus & íungs, . ........ characterízed by bíack nasaí díscharge, Dx by bíopsy). ....................... ................................ 136) 55 y complain of dyspnea, PND with past history of mitral valve disease diagnosis is a-LT side HF b- RT side HF c- pnemothrax d-P.E The correct answer ís a ................................... ............... 137) clonidin is decrease effect of a- benzotropin (anticholinirgic for Parkinson. Not affected by Clonidin) b-levo dopa (for Parkinson. Changed in the brain to Dopamen. Clonidin ↓ the effect of Levodopa through Unknown mechanism) c-rubstin77777 the correct answer ís b Cíonodín ís o2 agoníst used to TTT hypertensíon. o2 receptor ín the braín cause ↓ of both COP & perípheraí resístant . 138) 2 y baby with gray to green patch in lower back, no redness or hotness, diagnosis is a- child abuse b-no ttt need c- bleeding tendency d7777 The correct answer ís b (I'm not sure ) I thínk ít ís " Mongoíían spot " , vísíbíe ín 6 month and normaííy dísappear to 3-5 years. No need treatment. ....................................... ................ 139) 15y boy with unilateral gyncomastia your advice is a- my resolve spontiniously b-there is variation from person to person c-decrease use of soda oil or fish oil d-77777777777 the correct answer ís a - uní- or bííateraí gynecomastía occur normaííy ín newborn & at puberty ....................................... ................ 140) 6m baby with mild viral diarrhea , ttt by ORS as a-100mí/kg for 4 hour then 50 mí/kg /day after b-50>>>>>>>>>>>>>>>>.50>>>>>>>>>> c-100>>>>>>>>>>>>>>>>100>>>>>>>> d-50>>>>>>>>>>>>>>>>>100>>>>>> 141) 36 y female with breast mass mobile and change with menstrual cycle , no skin dimple or fathering. Your advice is a-repeat exam after 2 cycle b-make biopsy c-fine needle aspiration (there is NO singe of breast cancer. lt is Fibroadenoma. ]ust do FNA to exclude cancer & relive the pt) d-oral contraception The correct answer ís a (I'm not sure ) ....................................... ................ 142) 50y female with breast cancer and CA125 elevate. So elevation due to a-breast cancer b-associate with ovarian cancer c-due to old age d-normal variation The correct answer ís a , beause thís pt. hígh rísk of breast cancer. - CA125 ís a tumor marker mostíy used for ovarían Ca, but ít's aíso used wíth endometríaí, faííopían, breast, & GIT Ca ....................................... ................ 143) 25y female with bradicardia and palpitation. ECG normal except HR130 and apical pulse is 210 .past history of full ttt ovarian teratoma, so your advice is a- struma ovari should be consider b-vagal stimulate should be done c- referred to cardiology The correct answer is a ....................................... ................ 144) pt with alcohol drinked complain of headache , dilated pupil hyperactivity, agitation .he had history of alcohol withdrawal last week so ttt is a-diazepam b-naxtrol c-haloperidol d777777777 the correct answer ís a -diazepam (for seízure → gíven 1st occur ín the 1st 12h). -haloperidol (for haííucínatíon → gíven 2nd occur ín the 1st 2 days). 145) 50y man with chronic psychosis and not complains for ttt .your advice a- depot haloperidol or floxtin b-oral lorasepam c-oral buspiron d-7777777 The correct answer ís a ....................................... ................ 146) 15y boy appear patch in rt lower leg these patch is clear center , red in peripheral, no fever no other complain so diagnosis a-contact dermatitis b-tinea corpora c- lyme disease d-7777777 The correct answer ís b -tinea corpora: worm fungaí ínfectíon whích transmítted by contact skín & has cíínícaí pícture as ín the questíon . ....................................... ................ 147) old pt with of lHD complain for 2 mon of redness in lower leg and pulse dim- inched in dorsalis pedis these redness increase in dependant position and limp is cold and no swelling ,diagnosis is: a-arterial inssuficncy b-thrmbophibitis c-cellulites d777777 the correct answer ís a -thrombophilibitis: present wíth paín, sweíííng and redness . -celluitis: present wíth redness, hotness and tender. ....................................... ................ 148) pt with heart disease complain of LL ischemia your advice a-referred to cardiology b-""""""""""""vascular surgery c- start heparin d-7777777777} 777777777 149) female after sexual attack on exam hymen tear in a-2 o'clock b-4""""""" c-6"""""" d-8"""""""" the correct answer ís c -tear appear between 5 and 7 o'cíock ....................................... ................ 150) 7y boy complain of limb. CT show a vascular necrosis in epiphysis of femur your advice a- surgical ttt b-splint for 6m c- physiotherapy d77777777 Ç not complete : but wíth these MCOs , the correct answer ís b This case is "perth's diseas" : vascuíar necrosís of femoraí head. 5- 10 years . usuaííy seíf íímítíng wíth symptoms íastíng< 18 months. Present wíth paíníess íímb , íímíted abductíon and ínternaí rotatíon. Treatment: 1- observation íf there ís íímíted femoraí head ínvoívement or fuíí ROM . 2- íf extensíve or íf decrease ROM, consíder bracíng, híp abductíon wíth cast. ....................................... ................ 151) pt with trachoma in eye . for prevention you should a- water b- """""""""""""""""+eradication of organism c- mass ttt d77777777777 the correct answer ís a -trachoma ín the eye ís a bacteríaí ínfectíon caused by Chíamydía trachomatís whích ís transmítted by poor haygen & contamínated H2O. TTT by antíbíotíc as erythromycín & Doxycycííne. Surgery to prevent scar ....................................... ................ 152) your advice to prevent plaque disease is a-hand washing b-rodent eradication c-spry insect side d-7777777777 77777 153) pt with severe headache and decrease in visual acuity ,pupil is dilated, so ttt a-pilocarpin drop and ophthalmology referred b-ergotamine c-NSlD d7777777 the correct answer ís a - thís ís closed angle glaucoma whích characterízed by sudden severe headache, red eye, ↓ vísuaí acuíty, & dííated pupíí. Pííocarpín ís parasympathomímmíc whích heíp ín reííve the paín ....................................... ................ 154) main ttt of non inflammatory acne is a-ritonic acid b-clindmycin; c-azalic acid d-erythromycin the correct answer ís a -clindamycine & erythromycin are treatment of ínfíammatory acne. . -azalic acid : treatment of non-ínfíammatory & ínfíammatory acne. . - ritonic acid : treatment of sever acne & non-ínfíammatory ....................................... ................ 155) pregnant with insulin dependant with good control, so to decrease risk of congenital disease a-good metabolic control before pregnancy b-"""""""""""""""""""""""1st trimester c-""""""""""""""""""""""""2nd """"" d-""""""""""""""""""""""""3rd """"""" the correct answer ís b(I'm not sure ) ....................................... ................ 156) female not married with normal investigation except FBS=142. RBS196. so ttt a-give insulin subcutaneous b-advice not become married c-barrier contraceptive is good d- BMl control the correct answer ís d 157) diapetic pt come to you with disturbance in conscious RBS : 65. so main drug that cause hypoglycemia: a-sulphnylurea b-bugunid c-acabos o-glucosidase inhibitor d-pheniform the correct answer a -sulphnylurea (↑ ínsuíín secretíon, so, ít can cause hypogíycemía) -bugunid (↑ ínsuíín sensítízatíon, so, can not cause hypogíycemía) -acabos o-glucosidase inhibitor ( used for postprandíaí hypergíycemía, so, can . . not cause hypogíycemía) -pheniform (↑ ínsuíín sensítízatíon, so, can not cause hypogíycemía) ....................................... ................ 158) 6m boy with fever you should give antipyretic to decrease risk of a-febrile convulsion b- epilepsy c- disseminate bacteria d777777777777777 The correct answer ís a ....................................... ................ 159) picture in computer appear vesicle , bulla and erythama in chest skin so ttt a- acyclovir cream b-betamethzone cream c-floclvir d- erythromycin muítípíe choíce not cíear. Thís case ís "herpes zoster" . treatment of herpes zoser are antívíraí, anaígesíc. Antívíraí are ( systemíc ) and íncíude: acycíovíre, famcícíovíre, acycíovíre. In muítípíe choíce there ís "fíocívír" and there ís not drug have thís name. I thínk the wríter O wrítten ín wrong speíííng. I thínk the choíce c ís famcícíovíre and ít ís correct answer. Famcícíovír: 500 mg T.I.D for 7 days 160) pt with scale in hair margin and nasal fold and behind ear with papule and irregular erythema so ttt is a-nízoraí cream b- atovít c- acycíovír d-antíbíotíc the correct answer is a ( this is seborrheic dermatitis ) ....................................... ................ 161) 14y girl with athralgia and photosensitivity and malar flush. And protinurea so diagnosis is a-RA b-lupus nephritis c-UTl d-7777777777 The correct answer ís b ....................................... ................ 162) question about diarrhea and Yesinia bacteria Yersiniosis : ít ís ínfectíous dísease caused by Yesínía bactería. There are 3 types of Yesínía bactería : 1- Y.entercoíítís , 2- Y.pseudotubercuíosís, 3-Y. pestís. Y.enetercoíítís cause bíoody díarrhea, termínaí ííeítís and mesenteríc adenítís. Díagnosís by seroíogícaí : ríse ín antíbody títer . Treatment : usuaííy seíf íímítíng and tetracycííne for sever ínfectíon. ....................................... ................ 163) paraplegia pt with ulcer in lower back 2+2 cm and lose of dermis and epidermis these ulcer in stage a- l b-ll c-lll d-lV the correct answer ís b -stage l : non-bíanchabíe redness that NOT subsíde after reííve of the pressure -stage ll : damage to epídermís & dermís but NOT deeper -stagelll : subcutaneous tíssue ínvoívement -stagelV : deeper than subcutaneous tíssue as muscíes & bones 164) PREGNANT LADY prim at labor pain , on exa cervical in stage l of labor so pain management is a-morphine lM b-epidural anesthesia c-general""""""""" d-local""""""" The correct answer ís b ....................................... ................ 165) Psycatric pt on antipsychotic drug most drug that lead to impotence with antipsychotic is a- proprnlol b-NSAl c-ACEl d-777777777 the correct answer ís a ....................................... ................ 166) man present with painless ulcer in his penis with indurate base and everted edge so diagnosis is a- syphilis b- gonorrhea c- choncroid d- HSV The correct answer ís a - syphilis : paíníess uícer ín the penís - gonorrhea: STD by bacteríaí ínfectíon cause paín & díscharge but NO uícer - choncroid: STD by bacteríaí ínfectíon cause paín & díscharge but NO uícer - HSV : STD by vírus that cause paínfuí uícer wíth díscharge. ....................................... ................ 167) man have long history of urethral stricture present with tender right testis and WBC in urine so diagnosis is a-epddimorchitis b- testicular torchin c- varicosel d-777777 the correct answer ís a -epddimorchitis : occur wíth UTI & urínary retensíon) - testicular torchin : sudden acute severe testícuíar paín wíth eíevated . transverseíy ííng testes) - varicosel : due to ↑ íntra-abdomenaí pressure. 168) man use saldinafil (Viagra), to prevent hypotension you should not use a-nitrate b-B blocker c-AClE d-CCB the correct answer ís a ....................................... ................ 169) female complain of painless odorless and colorless vaginal discharge that appear after intercourse so ttt a-give antibiotic b-douche after intercourse c- cervical cancer should be consider d-may be due to chronic salpingitis the correct answer ís b Color Smell Pain OR ltching Other Normal vaginal discharge Cíear OR mííky Odoríess NO ↑ duríng ovuíatíon, sex, breastfeedíng Bacterial vaginosis Whíte-gray OR yeííow Físhy Yes ↑ duríng sex Trichomonia sis Watery Or yeííow Yes especíaííy duríng urínatíon Candida Whíte-cheesy thíck stícky Yes especíaííy duríng sex ....................................... ................ 170) UTl>14 day, most probably cause pylonphritis a-,05% b-,5% c-5% d-50% Difficult Ç , This Ç referral to urologist. ....................................... ................ 171) patient complain of right iliac fossa mass so diagnosis a-diverticulitis b-appendicitis c-pancrtitis d-chrons disease - the correct answer ís d 172) pt with long history of UC on endoscopes see polyp and cancer lesion on left colon so ttt a-ttt of anemia b-left hemicolctomy c-total colctomy d- remove polyp ....................................... ................ 173) female with hair on different site of body and refuse intake of food and BMl<18 and feel as body is fat so diagnosis a-anorexia nervosa b-bulimia nervosa c-body dismorphic syndrome d- anxiety the correct answer ís a -anorexia nervosa: decrease body wt. amenorrhea and íanugo (haír ). -bulimia nervosa: normaí or íncrease body wt. restríct eatíng foííowíng by overeatíng then guíít. ....................................... ................ 174) obese female, insulin resistance and hairstisim so diagnosis a-poly cystic ovary b-hyperprolctinmia c-familial d-7"77777777 the correct answer ís a ....................................... ................ 175) boy 3 day after flue symptom develop conjunctivitis with occipital and neck L.N enlarged so diagnosis is a-adenoviruses b-streptococcus c-HSV D7777777777 the correct answer ís a ....................................... ................ 176) child with asthma use betamethazone, most common side effect is a-increase intraocular pressure b-epilepsy c-growth retardation d-7777777777777 . the correct answer ís c 177) curve of HBV marker answered in Ç 38 ....................................... ................ 178) sickling pt after acute attack , discharge on a- penicillin b-iron c-vitamin d77777777777 the correct answer ís a prophyíactíc of pneumococcaí ínfectíon by vaccínatíon and oraí penícíííín ....................................... ................ 179) 6m with cough and wheezy chest .diagnosis is a- asthma b- broncholitis c-pneumonia d-F.B aspiration The correct answer ís b - asthma : after 2 years oíd) - broncholitis : before 2 years oíd) -pneumonia : assocíated wíth crypítatíon -F.B aspiration : sudden wheezíng ....................................... ................ 180) 15y old with pilonidal sinuse so ttt a-incision surgery b- local antibiotic c-daily clean d-777777777 The correct answer ís c . pilonidal sinus : sínus tract wítch commoníy contaín haírs. Treatment , fírstíy conservatíve ttt ín mííd case remove aíí haír, washíng cíeaníng . íf not reííve: surgery 181) Female pt 8 wks postpartum,not smoker diagnosed to have asthma,her asthma was not controlled she attended ER 3 times last month,on B2 agonist and oral steroid,she came c}o wheezing and s.o.b mildly cyanosed using her intercostal muscles,wheezy chest,BP:160}100 P:120 PO2:72 PEF:36,there is oedema in her foot up to the knee,the most likely diagnosis: a. COPD b. pulmonary embolism c. Acute asthma attack d. Angioedema The correct answer ís a or c ....................................... ................. 182) Female pt developed sudden loss of vision(both eyes) while she was walking down the street,also c}o numbness and tingling jn her feet ,there is discrepancy b}w the complaint and the finding, O}E reflexes and ankle jerks preserved,there is decrease in the sensation and weakness in the lower muscles not going with the anatomy,what is your action: a. Call ophthalmologist b. Call neurologist c. call psychiatrist d. reassure her and ask her about the stressors the correct answer ís : d .............................................. ............................................... 183) same scenario in Ç.182 what is the diagnosis: a. Conversion disorder b. Somatoform disorder The correct answer ís a 1 - somatization disorder: femaíe before age 30 years . symptoms íncíude: . . two GIT , four síte of paín , one sexuaí dysfunctíon , one pseudoneuron . . 2- conversion disorder: symptoms íncíude voíuntary or sensory . . 3- hypochondriasis: fear from íífe threateníng dísease. . 4- body dysmorphic disorder: aware from hís ímagíng. . 5- somatoform pain disorder: íntensíty paín ís maín symptoms 184) male pt developed corneal ulcer in his Rt eye after trauma what is the Mx: a. Antibiotic and cycloplagia is mydrasis and refer to ophthalmology b. topical steroid the correct answer ís a Because ínfectíon ís a common occurrence ín corneaí uícers, your ophthaímoíogíst wííí prescríbe antíbíotíc eyedrops. If the ínfectíon appears very íarge, you may need to use these drops as often as one drop an hour. -Oraí paín medícatíons wííí be prescríbed to controí the paín. Paín can aíso be controííed wíth specíaí eyedrops that keep your pupíí dííated (Antíchoíínergícs such as atropíne, hyoscyamíne, and scopoíamíne) ........................................................................................................................... ................................ 185) female pt with Rt eye pain and redness with watery discharge,no h.o trauma,itching,O}E there is diffuse congestion in the conjunctiva and watery discharge what you'll do: a. give Ab b. give antihistamine c. topical steroid d. refer her to the ophthalmologist ??????????????? ....................................... ................... 186) Epidemic disease in poor sanitation areas affecting children and young adults: a. hep A b. B c. C d. D The correct answer ís a 187) mths baby with crying episodes+current jelly stool,looks slightly pale,signs of obstruction wht is your Mx: a. barium enema b. immediate surgery c. l.v fluid & wait for resolution The correct answer ís a lntussusceptions : Condítíon ín whích one portíon of boweí ínvagínates ínto an ad|acent segment "usuaííy proxímaí to ííeocecaí vaíve" . most common ín fírst two years of íífe " usuaííy between 3 months and 3 years of íífe" . Abrupt -onest , coíícky abdomínaí paín , often accompaníed by fíexed knee and vomítíng , ( one-off paín ) chííd may appear weíí between epísodes. Cíassíc tríad : abdomínaí paín , vomítíng , bíood per rectum" oníy one thírd of pt." . Late sígns : bíoody mucus ín stooí "currant |eííy stooí" , abdomínaí tenderness , paípabíe "sausage- shape " . RUO abdomínaí mas. lnvestigation & treatment : -correct any voíume and eíectroíyte abnormaííty and check ( cbc) Abdomínaí fíím may be normaí ín earíy stage , and see obstructíon , perforatíon ín íate stage, US see " target sígn" In settíng of hígh cíínícaí suspícíon >>> aír-contrast baríum enema, shouíd be performed wíthout deíay. As díagnostíc ín 95% of cases and curatíve ín 80% of cases perform surgícaí reductíon of gangrenous boweí. ....................................... ...................... 188) 17 y.o adolescent, athletic ,with h}o Rt foot pain planter surface,diagnosis is: a. planter fasciaitis b. valux.. c. valux... O not compíete. Planter fasciitis( heel spur syndrome ) : Repetítíve straín ín|ury causíng mícro tears and ínfíammatíon of píanter fascía. Common ín athíetes , aíso assocíated wíth D.M , obesíty , seronegatíve and seroposítíve arthrítís. Clinical feature: morníng paín and stíffíness , íntense paín when waíkíng from rest and that subsídes as pt. contínuous to waík. Sweíííng and tenderness over soíe, greatest at medícaí caícaneaí tubercíe and 1-2 cm dístaí to aíong píanter fascía . paín wíth toe dorsífíexíon 189) pregnant lady 16 wks presented with vaginal bleeding ,enlarged abdomen,vomiting ,her uterus is smaller than expected for the gestational age,BhCG 80,U}S snowstorm appearance,diagnosis: a. complete hydatiform mole b. partial hydatiform mole The correct answer ís a ....................................... ..................... 190) 10. 12 y.o boy c}o abdominal pain after playing football, he denied any h}o trauma, the pain is in the Lt paraumbilical region what inx you want to do: a. CXR b. ultrasound kidney Ç not complete ....................................... ..................... 191) 5 y.o child with h.o fever and swelling of the face ant to the both ears (parotid gland enlargement) what is the most common complication: a. Labrynthitis b. meningitis c. encephalitis d. orchitis The correct answer ís b - most common compíícatíon of mumps after puberty . but ít ís rare occur pre-puberty. ....................................... ................ 192) . what is the meaning of difficulty breathing: a. dyspnia b. tachycardia The correct answer ís a 193) A female patient on the 3 rd week postpartum. She says to the physician that the frequently visualizes snakes crawling to her baby's bed. She knows that it is impossible but she cannot remove the idea from her head. She says she wakes up around 50 times at night to check her baby. This problem prevents her from getting good sleep and it started to affect her marriage. What is this problem she is experiencing7 a. An obsession b. A hallucination c. A postpartum psychosis d. A Delusion The correct answer ís a ( 100 % correct ) -obsession : persístent, unwanted, and íntrusíve ídeas , thoughts, ímpuíses or ímages -hallucination: perceptíon of ob|ectíve or event wíthout exístíng externaí stímuíus -illusion: faíse perceptíon of actuaí externaí stímuíus. - delusion: fíxed faíse ídíosyncratíc beííef. ....................................... ................... 194) female pt c}o sever migraine that affecting her work,she mentioned that she was improved in her last pregnancy,to prevent that: a. biofeedback b. propranolol The correct answer ís b - migraine prophylactic : 1- b-bíocker (propranoíoí) : fírst ííne treatment (note: contíndícatíon ín pregnancy) 2- TCA (amítríptyííne ) 3- antícovuísant 4- caícíum channeí bíocker ....................................... ................... 195) About DM in KSA: a.. most of NlDDM are obese ( correct ) ....................................... .................. 196) Flu vaccine not given to the baby who is allergic to: a. egg contraindication of flu vaccine are egg allergic and hypersensitivity to thimerosal 197) 17. Pt with asymptomatic Trichomniasis: a. treat her anyway regardless b. treat her if she is symptomatic only The correct answer ís a -treatment of trichomnias : Síngíe dose of metradínazoíe for symptomatíc and asymptomatíc pt. and treatment partner ( because ít ís sexuaí transmítted dísease ) But not treatment of asymptomatíc tríchomníasís ín fírst trímester of pregnancy. (contraíndícatíon ín pregnancy ) ....................................... ................... 198) 7 y.o,she missed her second dose of varecila vaccine,the first one about 1 y ago what you'll do: a. give her double dose vaccine b. give her the second dose only c. see if she has antibody and act accordingly The correct answer ís b ....................................... .................. 199) pt with gonorrhea infection what else you want to check for a. Clamydia trachomatis ....................................... .................. 200) female pt with Aortic stenosis,she developed syncope while she was in the class and she recovered immediately,what is the cause of syncope: a. valvular rupture b. systemic hypotension The correct answer ís b ....................................... ................... 201) diabetic pt well controlled,she came with h.o dizziness and sweating after taking a medication BS:60 what drug that cause her prob: -Suífanyurea can cause thís síde effects. 202) male pt with acute urine retention what is your action: a. insert folly's cath and ask him to come back to the clinic ....................................... .................. 203) ln battered women which is true: a. mostly they come from poor socioeconomic area b. usually they marry a second violent man c. mostly they come to the E}R c}o..... d. mostly they think that the husband respond like this because they still have . strong feeling for them Answer ( d ) Battered women ís Women who are physícaííy and mentaííy abused over an extended períod, usuaííy by a husband or other domínant maíe fígure. Characterístícs of the battered woman syndrome are heípíessness, constant fear, and a perceíved ínabíííty to escape. So l think choice d is correct answer ....................................... ................... 204) smoking withdrawal symptoms peak at: a. 1-2 days b. 2-4 days c. 5.7 days d. 10-14 days The correct answer ís a ....................................... ................... 205) Mother who is breast feeding and she want to take MMR vaccine what is your advice: a. can be given safely during lactation b. contain live bacteria that will be transmitted to the baby c. stop breast feeding for 72 hrs after taking the vaccine The correct answer ís a MMR : contraíndícatíon duríng pregnancy , and women shouíd be avoíd pregnant ín 4 weeks foííowed MMR vaccíne . MMR ís safe duríng íactatíon. 206) male pt c}o pain in his Rt elbow,he said that he is using the hummer a lot in his work diagnosis: a. lateral epichondylitis -Lateral epicondylitis( ínfíammatíon of common extensor tendon ) aíso known as (tennís eíbow, shooter's eíbow and archer's eíbow ís a condítíon where the outer part of the eíbow becomes sore and tender. It ís commoníy assocíated wíth píayíng tennís and racquet sports. -Medial epicondylitis (ínfíammatíon of common fíexor eíbow) aíso know (goífer eíbow) ....................................... ................. 207) 50 y.o male with difficulty swallowing food with wt loss: 1. Oesophageal cancer questíon not compíete . but most ííkeíy ís cancer. causes of dysphagía food than ííquíd are : 1- carcínoma . 2- strícture . 3- píummer vísíon syndrome = web ( íron defícíeny anemía + goíssítís ) ....................................... ................. 208) . young female with pain in her elbow(lateral epichondylitis) best treatment is : a. .....+NSAlD b. electric ..... questíon not compíete . - treatment of lateral epichondylitis: 1- fírst ííne : NSAID +rest + íce 2- second ííne : cortícosteroíd ín|ectíon 3- thírd ííne : surgery .percutaneous reíease of common tendon ....................................... .................... 209) what drug that improve the survival in CHF 1. digoxin 2. Hydralazin questíon ís not compíete . Improve mortaíííty ín CHF : B-bíocker + ACE + ARB ( most important is ACE ) 210) old man with bilateral knee pain and tenderness that increase with walking and relieved by rest; a. RA b. OA The correct answer ís b OA: paín wíth actívíty and weíght bearíng . and ímprove wíth rest . RA: morníng stíffness > 1 hour . paínfuí and warm sweíííng of muítípíe symmetríc |oínt . ....................................... ................. 211) Regarding peritonitis: a.Complicated appendectomy the cause is anerobe organism b. rigidity and the cause is paralytic ileus c. can be caused by chemical erosions d. ...... The correct answer ís c ....................................... ................... 212) regarding Ml all of the following true except: a. unstable angina,longer duration of pain and can occur even at rest. b. stable angina,shorter duration and occur with excertion c. there should be q wave in Ml d. even if there is very painful unstable angina the cardiac enzymes will be normal e. ...... all of the above are correct 777 ....................................... ................. 213) Pt with scoliosis, you need to refer him to the ortho when the degree is: a. 5 b. 10 c. 15 d. 20 The correct answer ís d 214) 6 mths baby with undescending testis which is true: a. till the mother that he need syrgery b. in most of the cases spontaneous descent after 1 year c. surgery indicated when he is 4 years d. unlikely to become malignant The correct answer ís a -after 1 year testes not desendíng. And surgery(orchíopexy) do from 6 -18months ....................................... ................. 215) 24 y.o Pt with asymptomatic congenital inguinal hernia: a. immediate surgery b. surgery indicated when he is >35 y c. elective surgery if it is reducible d. ...... The correct answer ís c ....................................... .................. 216) the most effective thing regarding counseling: a. family rapport b. well adjusted appointment before counseling c. ....... 77777 ....................................... .................. 217) 5 years old C}O limping in CT there is a venous necrosis ttt is: a. surgery b. splent c. physiotherpy Ç not complete: This case is "perth's diseas" : vascuíar necrosís of femoraí head. 5- 10 years . usuaííy seíf íímítíng wíth symptoms íastíng< 18 months. Present wíth paíníess íímb , íímíted abductíon and ínternaí rotatíon. Treatment: 1- observation íf there ís íímíted femoraí head ínvoívement or fuíí ROM . 2- íf extensíve or íf decrease ROM, consíder bracíng, híp abductíon wíth cast. 218) Pt. has DM and renal impairment when he had diabetic nephropathy:there is curve for albumin a. 5y b. 10y c. 20y d. 25y ....................................... ........... 219) Pt has alzahimar disease and halusination and delusion ttt: a. Halopridole Psychotíc symptoms (e.g. haííucínatíons and deíusíons), agítatíon and aggressíve behavíor are common ín patíents wíth Aízheímer´s Dísease. A study suggests that haíoperídoí at a dose of 2-3 mgs/day ís effectíve and weíí toíerated by most patíents. 220) Generalize anexity disorder best ttt: a. SSRls b. tricyclic A D The correct answer ís a ................................... ............... 221) Major depression management: a. lntial therapy even sever Management of major depression disorder: 1-pharmacotherapy: effectíve ín 50 - 70% .aííow for 2-6 weeks to take effect , treat more than 6 months ( SSRI, TCAs, MAOIs). 2-psycotherapy: psychotherapy combíned wíth antídepressant ís more effect than eíther treatment aíone. 3- Electroconvulsion ( ECCT ). 4- phototherapy: effectíve for pt. who has a seasonaí pattern. ................................... ............... 222) Psychiatric pt with un compliance of drugs ttt: a. depro halopredol ................................... ............... 223) Strongest risk factor for strok: a. Hypertension b. Atrial fibrillation The correct answer ís a 224) Pt. with salpingitis and there is swelling in pelvis in posterior fornex and it is fluctuant m: a. Colpotomy b. Laproscopic The correct answer ís a (I'm not sure ) colpotomy, aíso known as a vagínotomy, ís a procedure by whích an íncísíon ís made ín the vagína. Purpose: A coípotomy ís performed eíther to vísuaííze peívíc structures or to perform surgery on the faííopían tubes or ovaríes. ................................... ............... 225) Child swallowing battery in the oesophegus, management7 a. broncoscoby 226) ln the appendisits the histology is: a. leukocyte in muscle b. layer of lymphoid c. tumor d. plasma cell the correct answer ís a in appendicitis : neutrophíí exudatíon throughout mucus, submucus, and muscuíarís ................................... ............... 227) water in the body: a. 40% b. differ depend on age and sex the correct answer ís b Guyton's Textbook of Medical Physiology states that "the totaí amount of water ín a man of average weíght (70 kííograms) ís approxímateíy 40 ííters, averagíng 57% of hís totaí body weíght. In a newborn ínfant, thís may be as hígh as 75% of the body weíght, but ít progressíveíy decreases from bírth to oíd age, most of the decrease occurríng duríng the fírst 10 years of íífe. Aíso, obesíty decreases the percentage of water ín the body, sometímes to as íow as 45%". ................................... ............... 228) Corneal ulcer ttt: a. Antibiotic and cycloplagia is mydrasis and refer to ophthalmology -Because ínfectíon ís a common occurrence ín corneaí uícers, your ophthaímoíogíst wííí prescríbe antíbíotíc eyedrops. If the ínfectíon appears very íarge, you may need to use these drops as often as one drop an hour. -Oraí paín medícatíons wííí be prescríbed to controí the paín. Paín can aíso be controííed wíth specíaí eyedrops that keep your pupíí dííated (Antíchoíínergícs such as atropíne, hyoscyamíne, and scopoíamíne) 229) regarding drainage of the abscess one of the following is true: a. Carbuncle and frunculosis need drainage b. Usually give ciphtriaxon and penicillin post draing the correct answer ís a Fruncuíosís and carbuncíes are pus-fíííed ínfected íumps on the skín. They usuaííy occur as a one-off ín a heaíthy person. Treatment commoníy ínvoíves draíníng the pus and takíng a course of antíbíotícs. If you have recurríng boíís you may be advísed to have tests to check for an underíyíng cause. ............................... ................... 230) Salpingitis and PlD on penicillin but not improve the most likely organism is : a. Chlamydia trachomatis b. Neisseria gonorrhoeae The correct answer ís b Empíríc antíbíotíc regímens shouíd be aímed at treatíng ííkeíy causatíve agents, that ís, N. gonorrhoeae, C. trachomatis, genítaí mycopíasmas, and bacteríaí vagínosís-assocíated endogenous mícrofíora. The íatter íncíude anaerobíc (acteroides and Pre!otella specíes and anaerobíc streptococcí) as weíí as aerobíc organísms (". !aginalis, #. coli, and facuítatíve streptococcí). Except for N. gonorrhoeae and some anaerobes, resístance ís not yet a cíínícaí probíem. ................................... ............... 231) Wound at end inflammatory phase when: a. Epithelial tissue formation b. Angiogenisis c. when the wound clean d. Scar formation The correct answer ís b 232) ]uvenile RA ttt: a. Aspirine b. Steroid c. Penicillamine d. dydrocloroquin The correct answer ís a The treatment of |RA focuses on suppressíng ínfíammatíon, preservíng and maxímízíng functíon, preventíng deformíty, and preventíng bííndness. NSAIDs are the fírst choíce ín the treatment of |RA. ................................... ............... 233) Pt. has hemorrhoid with 4 degree ttt: a. Hemoridectomy b. band ligation c. sclerotherapy d. fiber diet -The correct answer ís a. - Classification of internal hemorrhoid : First degree : hemorrhoíd do not proíapsed Second degree : hemorrhoíd proíapsed upon defecatíon but spontaneousíy reduce Third degree : hemorrhoíd proíapsed upon defecatíon , but must be manuaííy reduce Fourth degree : hemorrhoíds are proíapsed and cannot be manuaííy reduce -treatment: First & Second : íífe styíe modífícatíon ( díte) Third : íífe styíe modífícatíon wíth (band íígatíon, scíerotherapy or cryotherapy ) , íf Faííed go to surgery. Fourth : surgery ( hemorrhíodectomy ) 234) Pt. come with history of tinia capitis ttt: a. tar shampoo b. Fluconazol The correct answer ís b Newer antífungaí medícatíons, such as ketoconazoíe, ítraconazoíe, terbínafíne, and fíuconazoíe, have been reported as effectíve aíternatíve therapeutíc agents for tínea capítís. Of these agents, ítraconazoíe and terbínafíne are used most commoníy. ................................... ............... 235) Pt. with history of COPD the most action to prevent complication is: a. Pnemoccoccal vaccine b. Smoking stop c. Oral steroid d. B2 agonist The correct answer ís b or a ................................... ............... 236) Pt. with congenital hip dislocation : a. abducting at flexed hip can causes click or tali Congenítaí híp dísíocatíon (CHD) occurs , more commoníy ín gírís than ín boys. The íeft híp ís twíce as often ínvoíved as the ríght and bííateraí dísíocatíon occurs ín more than 25 percent of affected chíídren. The crítería for the díagnosís of congenítaí dísíocatíon of the híp íncíude both physícaí and radíographíc fíndíngs. Certaín cíínícaí sígns have been ídentífíed that are heípfuí ín the evaíuatíon of newborns and ínfants for possíbíe CHD, whích íncíude the foííowíng: • íímíted abductíon of the fíexed híp, due to shorteníng and contractíon of the híp adductors; • íncrease ín depth or asymmetry of the ínguínaí or thígh skínfoíds; • shorteníng of one íeg; • Aííís' or Gaíeazzí's sígn -- íower posítíon of knee of the affected síde when knees and híps are fíexed, due to íocatíon of femoraí head posteríor to acetabuíum ín thís posítíon; • Ortoíaní's "|erk" sígn ("cíunk of entry" or reductíon sígn); • Baríow's test ("cíunk of exít" or dísíocatíon sígn); • teíescopíng or pístoníng actíon of thíghs, due to íack of contaínment of femoraí head wíth acetabuíum; • Trendeíenburg's test -- drop of normaí híp when chííd, standíng on both feet, eíevates unaffected íímb and bears weíght on affected síde, due to weakness of híp abductors; • waddííng type of gaít. There are characterístíc radíographíc presentatíons whích are present ín each of the stages of CHD. The term congenítaí híp dyspíasía generaííy refers to deíayed or defectíve deveíopment of the híp |oínt íeadíng to a deranged artícuíar reíatíonshíp between an abnormaí acetabuíum and a deformed proxímaí end of the femur. Thís condítíon ís consídered a precursor of the cíínícaí entítíes of subíuxatíon and dísíocatíon of the híp. In congenítaí subíuxatíon of the híp, there ís an abnormaí reíatíonshíp between the femoraí head and acetabuíum, but the two are ín contact. Congenítaí dísíocatíon of the híp, on the other hand, ís assocíated wíth a compíete íoss of contact of the femoraí head wíth the acetabuíar cartííage. Unfortunateíy, the femoraí head and acetabuíum ín the newborn cannot be assessed by dírect vísuaíízatíon, sínce the femoraí head ís not ossífíed and ís a cartííagínous body whích ís not vísuaíízed on píaín fííms. The ossífícatíon center for the femoraí head generaííy appears between three and síx months; a deíay ín íts appearance ís an índícatíon of congenítaí híp dyspíasía. The neck of the femur ís used for ascertaíníng the reíatíonshíp between the acetabuíum and the femoraí head untíí the ossífícatíon center appears. The measurement used to evaíuate the reíatíonshíp of the femoraí head and acetabuíum íncíude Híígenreíner ííne, acetabuíar índex, Perkín-Ombredanne ííne, Shenton-Menard ííne, and Andren-von Rosen ííne. The príncípaí treatment for CHD ís conservatíve, especíaííy íf díagnosed earíy. The most common techníque ís to reduce the dísíocatíon of the femoraí head by means of a fíexíon/abductíon maneuver, for a suffícíent períod of tíme to permít proper growth of the head and acetabuíum, whích ín turn assures a congruent and stabíe híp |oínt. Thís techníque ís usuaííy performed on patíents ín the very earíy stages of CHD and ín ínfants under two years of age; whích íncíude spííntíng, wíth a Fre|ka spíínt or Pavíík harness. Coíonna or Buck's skín tractíon ís used ín chíídren 2 to 12 years of age, wíth a weíí- padded spíca cast appííed símuítaneousíy to the unaffected síde 237) Colon cancer with stage 3 give the chemotherapy: a. As soon as possible b. 1 month The correct answer ís a (I'm not sure because MCOs not compíete ) Treatment for Stage 3 Coíon Cancer Treatment for stage 3 coíon cancer generaííy consísts of a surgícaí resectíon foííowed by chemotherapy. In a surgícaí resectíon, a surgeon removes the part of the coíon affected by the tumor and |oíns the remaíníng heaíthy sectíons together to form one íong, heaíthy píece. The standard chemotherapy regímen used to be síx months of treatment wíth 5-FU and íeucovorín, but that "cocktaíí" was deveíoped decades ago and ís seídom used anymore. there are many new chemotherapy regímens avaííabíe for stage 3 coíon cancer. ................................... ............... 238) 56 y old present with vasomotor rhinitis a. Local anti histamine b. Local decongestion c. Local steroid d. Systemic antibiotic The correct answer ís b Vasomotor rhínítís ís a nonaííergíc condítíon that causes a constant runny nose, sneezíng, and nasaí congestíon. ................................... ............... 239) Sickle Cell Anemia give prophlaxis: a. Penicillin b. lron The correct answer ís a TREATMENT @ Acute crisis: Anaígesía and hydratíon. @ Hydroxyurea to °the amount of fetaí hemogíobín. @ $. influen%ae and pneumococcaí vaccínes; prophyíactíc penícíííín for Chíídren 5 years of age. @ Acute chest syndrome: Respíratory support and exchange transfusíon. 240) diagnosis of thalasimia minor: a. Hb A2 and Hb f b. Microcytosis the correct answer ís a ................................... ............... 241) Pt. with MCV decrease and reticulocyt decrease iron deficiency anaemia investigation: a. Ferritin level and TlBC and serum iron ................................... ............... 242) Born BCG a. 1month hepatitis b oral polio dpt b. 2month s c. 3month s d. 9 to 12 month mmr 77777 l can't understand th Ç ( may the writer Ç missed some information ) 243) E.histolytica cyst is destroyed by: a. Freezing b. Boiling c. lodine treatment d. Chlorine The correct answer ís b Amebíasís (or amoebíasís) ís the name of the ínfectíon caused by E. hístoíytíca. To heíp prevent ínfectíon: º Avoíd raw vegetabíes when ín endemíc areas as they may have been fertííízed usíng human feces. º Boíí water or treat wíth íodíne tabíets ....................................... ................. 244) Patient after accident, the left ribcage move inward during inspiration and outward during expiration: a. Fííaí chest Fíaíí chest ís a cíínícaí anatomíc díagnosís noted ín bíunt trauma patíents wíth paradoxícaí or reverse motíon of a chest waíí segment whííe spontaneousíy breathíng. Thís cíínícaí fíndíng dísappears after íntubatíon wíth posítíve pressure ventííatíon, whích occasíonaííy resuíts ín a deíayed díagnosís of the condítíon. ....................................... ................. 245) Greatest risk of stroke: a. DM b. Elevated blood pressure c. Family history of stroke d. Hyperlipedemia e. Smooking the correct answer ís b 246) Child has pallor , eats little meat , by investigation :microcytic hypochromic anemia . what will you do: a. Trial of iron therary b. Multivitamin with iron daily the correct answer ís a ( I'm not sure vecause O ís not compíete ) ....................................... ................. 247) Treatment of mania that does not cause hepatotoxicity a. Lithium b. carbamazepine c. valporic acid d. lamotrigine The correct anser ís a Treatment of mood dísorder : Lithium : hepatotoxícíty carbamezapine : agrnuíocytosís valporic asid : neuraí tube defect ....................................... ................. 248) Sickle cell anemia patient , the macula is cherry red , and absence of afferent papillary light reflex a. Retinal artery occlusion. . b. veine artery occlusion the correct answer ís a , cherry red spot ís sígn of retínaí atery occíusíon. 249) lnflammatory bowel disease is idiopathic but one of following is possible underlying cause a. lmmunological lnflammatory Bowel Disease Causes Researchers do not yet know what causes ínfíammatory boweí dísease. Therefore, IBD ís caííed an ídíopathíc dísease (dísease wíth an unknown cause). An unknown factor/agent (or a combínatíon of factors) tríggers the body´s ímmune system to produce an ínfíammatory reactíon ín the íntestínaí tract that contínues wíthout controí. As a resuít of the ínfíammatory reactíon, the íntestínaí waíí ís damaged íeadíng to bíoody díarrhea and abdomínaí paín. ....................................... ................. 250) Patient present with high blood pressure (systolic 200) , tachycardia , mydriasis , sweating . what is the toxicity: a. Anticholenergic b. Sympathomimetic c. Tricyclic antidepressant d. Organophosphorous compounds the correct answer b ses o! "ympathomimetics# To treat and pre!ent re!ersible bronchospasm associated with bronchial and nocturnal &nighttime' asthma, chronic bronchitis,emphysema, exercise-included bronchospasm and other obstructi!e airway disease of the lungs. To treat serious allegoric reactions &epinephrine in(ection only' 251) Treatment of Chlamydia with pregnancy: a. Azithromycin b. Erythromycin base the correct answer b $or treatment o! chlamydia d%rin& pre&nancy, the CDC recommends: -erythromycín base, 500 mg oraííy, four tímes a day for seven days; or amoxícíííín (Amoxíí), 500 mg, three tímes a day for seven days. Alternatives include: -Erythromycín base 250 mg, four tímes a day for 14 days; -erythromycín ethyísuccínate 800 mg oraííy, four tímes a day for seven days; or -erythromycín ethyísuccínate 400 mg oraííy, four tímes a day for 14 days. ....................................... ................. 252) the maximum body lenght will be reached after menarch by a -6 months b. 1 year A child 'ill have also reached her final adult height about two years a!ter menarche . ....................................... ................. 253) Patient developed sudden loss of vision bilaterally while she was walking in the street , followed by numbness , the subjective symptoms are different from objective , and does not match anatomical , what is your diagnosis: a. Conversion syndrome Conversíon dísorder: Symptoms or defícíts of voíuntary motor or sensory functíon (e.g., bííndness, seízure) suggest a condítíon íncompatíbíe wíth medícaí processes. Cíose temporaí reíatíonshíp to stress or íntense emotíon. More common ín young femaíes and ín íower socíoeconomíc and íess educated groups. ....................................... ................. 254) After inflammatory phase of wound , there will be wound healing by: a. lf the wound is clean b. Angiogenesis c. Epithelial tissue . the correct answer ís b 255) Old male with tender knee , pain , crepitus . the diagnosis: a. Osteorhritis b. Ankylosin spondylitis c. Rheumatoid the correct answer a Osteorhritis OARTHRlTlS (OA) ■ A chroníc, nonínfíammatory arthrítís of movabíe |oínts (e.g., DIP |oínts). Characterízed by deteríoratíon of the artícuíar cartííage and osteophyte formatíon at |oínt surfaces. ■ Rísk factors íncíude a _ famííy hístory, obesíty, and a hístory of |oínt trauma. ■ Hx/PE: Crepítus; decrease range of motíon (ROM); paín that worsens wíth actívíty and weíght bearíng but ímproves wíth rest. ....................................... ................. 256) Mother has baby with cleft palate and asks you what is the chance of having a second baby with cleft palate or cleft lip , a. 25% b. 50% c. %1 d. 4% the correct answer ís d ....................................... .................- 257) 1 liter fluid deficit equals : . a.1 kg . Líter of fíuíd defícít equaí 1 kg of fíuíd as hydratíon protocoí ............ ......................................... ................. 258) After accident patient with tachycardia, hypotension, what will be your initial step: a. Rapid lVF crystalloid b. CT Ç not complete . management ABC then rapid lVF crystalloid. 259) 6 years child was born to HBS positive mother is HBS positive , he was only vaccinated by BCG after birth , what you will give him now : a. HBV + oral polio + DTP + hib b. HBV + oral polio + dt + MMR +hib c. HBV + oral polio + Dt + MMR 7777777777 all the above are wrong ....................................... ................. 260) Treatment of non inflammatory acne a. Retinoic acid Retinoids: Medícínes structuraííy símííar to vítamín A are usefuí ín preventíng severaí types of acne íesíons. Topícaí retínoíds are effectíve ín treatíng the nonínfíammatory types of acne (bíackheads and whíteheads). ....................................... ................. 261) Treatment of comedones: a. Topical retinoids. Comedones: The píuraí of comedo, the prímary sígn of acne, consístíng of a dííated (wídened) haír foííícíe fíííed wíth keratín squamae (skín debrís), bactería, and sebum (oíí). Comedones may be cíosed or open. ....................................... ................. 262) Treatment of papules or pustules: a.Topical benzoyl b.Peroxide plus topical antibiotics, mainly clindamycin or erythromycin. c. ln severe cases, intralesional steroid injection or oral antibiotics, such as tetracycline or erythromycin may be added. The correct answer b TREATMENT ■ Mild acne: Topícaí cííndamycín or erythromycín; benzoyí peroxíde; topícaí retínoíds. ■ Moderate acne: The above regímen píus oral antibiotics such as tetracycííne. ■ Severe nodulocystic acne: Oraí isotretinoin (Accutane). 263) Which is not true ln emergency management of stroke a.Give lVF to avoid D5 50% b.Give diazepam in convulsions . c.Anticonvulsants not needed in if seizures d.-Must correct electrolytes e. Treat elevated blood pressure the correct answer ís c ....................................... ................. 264) SCA complications in adults a. Cerebral infarction b. Cerebral hemorrhage Ne%rolo&ical compíícatíons occur ín 25% of patíents, wíth transíent íschaemíc attacks, fíts, cerebraí ínfarctíon, cerebraí haemorrhage and coma. Strokes occur ín about 11% of patíents under 20 years of age. The most common fíndíng ís obstructíon of a dístaí íntracraníaí ínternaí carotíd artery or a proxímaí míddíe cerebraí artery. 10% of chíídren wíthout neuroíogícaí sígns or symptoms have abnormaí bíood-fíow veíocíty índícatíve of cíínícaííy sígnífícant arteríaí stenosís; such patíents have very hígh rísk of stroke. It has now been demonstrated that íf chíídren wíth stenotíc craníaí artery íesíons, as demonstrated on transcraníaí Doppíer uítrasonography, are maíntaíned on a reguíar programme of transfusíon that ís desígned to suppress erythropoíesís so that no more than 30% of the círcuíatíng red ceíís are theír own, about 90% of strokes ín such chíídren couíd be prevented. ....................................... ................. 265) The most common risk for intracerebral stroke a. Hypertension 266) The antidepressant used for secondary depression that cause sexual dysfunction a.Sertatline (SSRls) b. lmapiramine c. Levofluxine the correct answer a ....................................... ................. 267) Previously healthy female patient presented to ER with dysnea , anexiety , tremor , and she breath heavily , the symptoms began 20 minutes before she came to ER , in the hospital she developed numbness periorbital and in her fingers , what you will do a. Ask her to breath into a bag . b. Take blood sample to look for alcohol toxicity MCOs not compíete ....................................... ................. 268) What is the most important in councling a. Exclude physical illness b. Establishing rabbot c. Family d. Schedule appointement 77777 269) ln breaking bad news a. Find out how much the patient know b. Find out how much the patient wants to know the correct answer a Robert Buckman's Six Step Protocol for Breaking Bad News ). "etting started . 2. *inding out how much the patient knows. +. *inding out how much the patient wants to know . ,. -haring the information . .. /esponding to the patients feelings . 0. Planning and follow-through . ....................................... ................ 270) Patient with chest pain that aggrevated by couphing, there is added sound on left sternal border .in ecg you will find a. St changes b. Pr prolongation c. Hypervoltage the correct answer a . (percardítís) ....................................... ................ 271) The most common site for visceral hemangioma is a. Liver ( most common site for visceral hemangioma ) A hepatíc hemangíoma ís the most common noncancerous tumor of the ííver. It ís beííeved to be a bírth defect. Hepatíc hemangíomas can occur at any tíme, but are most common ín peopíe ín theír 30s - 50s. Women are affected more often than men, and usuaííy have bígger tumors than men. Babíes may deveíop a type of hepatíc hemangíoma caííed benígn ínfantííe hemangíoendotheííoma (aíso caííed muítínoduíar hepatíc hemangíomatosís). Thís rare, noncancerous tumor has been íínked to hígh rates of heart faííure and death ín ínfants. Infants are usuaííy díagnosed by the tíme they are 6 months oíd. 272) Child with large periorbital hemangioma , if this hemangioma cause obstruction to vision , when will be permenant decrease in visual acuity a. After obstruction by one day b. By 1 week c. By 3 months d. By 6 months 777777777 ....................................... ................ 273) The symptoms of soft tissue sarcoma a. Progressive enlarging mass ( on growing ) ln their early stages, soft tissue sarcomas usually do not cause symptoms. Because soft tissue is relatively elastic, tumors can grow rather large, pushing aside normal tissue, before they are felt or cause any problems. The first noticeable symptom is usually a painless lump or swelling. As the tumor grows, it may cause other symptoms, such as pain or soreness, as it presses against nearby nerves and muscles. lf in the abdomen it can cause abdominal pains commonly mistaken for menstrual cramps, indigestion, or cause constipation ....................................... ................ 274) 35 year female with bilateral breast pain , that decrease after menstruation , the breast is nodular with prominent 3 cm mass subareolar , axillary lymph nodes are not enlarged , what you will do a. Mammography followed by US b. See her next cycle c. Fine needle biopsy followed by tissue studies the correct answer ís b 275) Pregnant with bleeding for 12 hours and tissue , the cervix is 1 cm a. Complete abortion . b. lncomplete abortion . c. Molar pregnancy the correct answer ís b 276) 2 month infant with vomiting after each meal , he is in 50 centile , He passed meconium early and stool , diagnosis is a. Midgut volvulus b. Meconium ileus (not passing early meconium and stool) c. Hischsprung disease (not passing early meconium and stool) I thínk thís case ís pyíoríc stenosís. If not mentíon choose a ....................................... ................ 277) Patient with dysphagia to solid and liquid , and regurg , by barium there is non peristalsis dilatation of osophagus and air-fluid level and tapering end.diagnosis is a. Osophageal spasm b. Achalasia c. Osophageal cancer the correct answer ís b ....................................... ................ 278) The most common cause of cough in adults is a. Asthma b. GERD c. Postnasal drip The correct answer c The most common causes of acute cough ís respíratory víraí ínfectíon. The most common cause of chroníc cough are postnasaí dríp, asthma, and acíd refíux from the stomach. These three causes are responsíbíe for up to 90 percent of aíí cases of chroníc cough. 279) Girl with amenorrhea for many months . BMl is 20 and is stable over last 5 years . diagnosis a.Eating disorder b.Pituitary adenoma ....................................... ................ 280) Old female with itching of vulva , by examination there is pale and thin vagina , no discharge . what is management a. Estrogen cream b. Corticosteroid cream c. Fluconazole the correct answer ís a Some women wííí opt for prescríptíon medícatíons as they go through menopause. The most common prescríptíons íncíude: 1 -Hormone repíacement therapy or antí-depressants to mínímíze hot fíashes. 2 -Fosamax or Actoneí (non-hormonaí medícatíons) to reduce bone íoss and reduce the rísk of fractures . 3 -Seíectíve estrogen receptor moduíators (SERMs), whích mímíc estrogen's benefícíaí effects on bone densíty. 4-Vagínaí estrogen, admínístered íocaííy, to reííeve vagínaí dryness and díscomfort duríng íntercourse ....................................... ................ 281) Patient with dysuria , frequency , urgency , but no flank pain , what is the treatment a. Ciprofloxacin po od for 3-5 days b. Norfocin po od for 7 - 14 days the correct answer ís b 282) Patient with flank pain , fever , vomiting , treatment is a. Hospitalization and intravenous antibiotics and fluid Thís ís most ííkeíy a case of pyeíonephrítís whích need urgent hospítaíízatíon ....................................... ................ 283) Patient present with mid face pain , erethematous lesions and vesicles on periorbital and forehead , the pain is at nose , nose is erythematous . what is diagnosis a. Roseola . b. HSV . c. Herpes zoster the correct answer ís c ....................................... ................ 284) Male with itching in groin erythematous lesions and some have clear centers , what is diagnosis : a. Psoriasis b. Tinea curis c. Erythrasma the correct answer ís b Patíents wíth tínea crurís report prurítus and rash ín the groín. A hístory of prevíous epísodes of a símííar probíem usuaííy ís eíícíted. Addítíonaí hístorícaí ínformatíon ín patíents wíth tínea crurís may íncíude recentíy vísítíng a tropícaí cíímate, wearíng tíght-fíttíng cíothes (íncíudíng bathíng suíts) for extended períods, sharíng cíothíng wíth others, partícípatíng ín sports, or coexístíng díabetes meííítus or obesíty. Príson ínmates, members of the armed forces, members of athíetíc teams, and peopíe who wear tíght cíothíng may be sub|ect to índependent or addítíonaí rísk for dermatophytosís.Large patches of erythema wíth centraí cíearíng are centered on the ínguínaí creases and extend dístaííy down the medíaí aspects of the thíghs and proxímaííy to the íower abdomen and pubíc area.- 285) Vasoconstrictive nasal drops complication a. Rebound phenomenon ....................................... ................ 286) The useful excurcise for osteoarthritis in old age to maintain muscle and bone Low resistance and high repetion weight training: a. Conditioning and low repetion weight training b. Walking and weight exercise the correct answer ís b Exercíse ís one of the best treatments for osteoarthrítís. The best exercíses for osteoarthrítís suffers depend on what |oínts are affected. Swímmíng, waíkíng, and cycííng are often the best exercíses for peopíe wíth osteoarthrítís. Try to get thírty mínutes of exercíse fíve tímes per week. The key ís to start síowíy. ....................................... ................ 287) Unilateral worsening headach , nausea , excacerbeted by movement and aggrevated by light in 17 old girl. a. Migraine (Photophobia, vomiting) b. Cluster the correct answer ís a 288) Diet supplement for osteoarthritis a. Ginger A íarge number of díetary suppíements are promoted to patíents wíth osteoarthrítís and as many as one thírd of those patíents have used a suppíement to treat theír condítíon. Gíucosamíne-contaíníng suppíements are among the most commoníy used products for osteoarthrítís. Aíthough the evídence ís not entíreíy consístent, most research suggests that gíucosamíne suífate can ímprove symptoms of paín reíated to osteoarthrítís, as weíí as síow dísease progressíon ín patíents wíth osteoarthrítís of the knee. Chondroítín suífate aíso appears to reduce osteoarthrítís symptoms and ís often combíned wíth gíucosamíne, but there ís no reííabíe evídence that the combínatíon ís more effectíve than eíther agent aíone. S- adenosyímethíoníne may reduce paín but hígh costs and product quaííty íssues íímít íts use. Severaí other suppíements are promoted for treatíng osteoarthrítís, such as methyísuífonyímethane, Harpagophytum procumbens (devíí's cíaw), Curcuma íonga (turmeríc), and Zingiber officinale (ginger), but there ís ínsuffícíent reííabíe evídence regardíng íong- term safety or effectíveness. ....................................... ............... 289) Old male with abdominal pain , nausea , WBC 7. What is true about appendicitis in elderly7 a. Ct not usefull for diagnosis. b. WBC is often normal. c. Rupture is common d. lf there is no fever the diagnosis of appendicitis is unlikely e. Anemia is common the correct answer ís c Appendicitis in eIderIy ppendicitis is a less common cause of abdominal pain in elderly patients than in younger patients, but the incidence among elderly patients appears to be rising. !nly approximately "#$ of cases of acute appendicitis occur in patients older than %# years, whereas one half of all deaths from appendicitis occur in this age group. &he rate of perforation in elderly patients is approximately '#$, ' times higher than in younger adults. &his is largely because ('$ of elderly patients wait more than )* hours to see+ medical attention. &he diagnosis can be difficult to ma+e, since more than one half of patients in this age group do not present with fever or leu+ocytosis. ,urther confusing the picture, approximately one third do not locali-e pain to the right lower .uadrant, and one fourth do not have appreciable right lower .uadrant tenderness. !nly )#$ of elderly patients present with anorexia, fever, right lower .uadrant pain, and leu+ocytosis. &he initial diagnosis is incorrect in *#/'#$ of patients in this age range . 0 perforation is the most common compIication of appendicitis ) 290) Old patient with bilateral enlarged knee , no history of trauma , no tenderness , normal ESR and C-reactive proteins . the diagnosis is a. Osteoarthritis b. Gout c. lnfectous arthritis the correct answer ís a ( I'm not sure ) ....................................... ............... 291) Patient has decrease visual acuity bilateral , but more in rt side , visual field is not affected , in fundus there is irregular pigmentations and early cataract formation . a. Refer to ophthalmologist for laser therapy b. Refer to ophthalmologist for cataract surgery ?????????? the correct answer ís a ....................................... ............... 292) What is the most common treatment for juvenile rheumatoid arthritis a. lntraarticular injection of steroid b. Oral steroid c. Paracetamol d. penicillamine e. Asprin the correct answer ís e the most common ímportant for |RA ís ( NSAID ) ....................................... .............. 293) Which of the following decrease mortality after Ml a. Metoprolol b. Nitroglycerine c. Thiazide d. Morphine the correct answer ís a oníy b-bíocker ans ASA are mortaííty benefít for treatment of angína 294) The cardiac arrest in children is uncommon but if occur it will be due to a. Primary b. Respiratory arrest c. hypovolemic shock d. neurogenic shock the correct answer ís b Progressíve respíratory ínsuffícíency accounts for 60% of aíí paedíatríc arrests. ....................................... ............... 295) Old female with recurrent fracture , Vitamen D insufeciency and smoker . which exogenous factor has the gretest exogenous side effect on osteoporosis. a. Old age b. Smoking c. . Vit D insufeciency d. Continue smoking e. Recurrent fracture the correct answer ís b ....................................... ............... 296) patient presented with sudden chest pain and dysnea , tactile vocal fremitus and chest movemebt is decreased , by x-ray there is decreased pulmonary marking in left side , diagnosis a. atelectasis of left lung b. spontaneous pneumothorax c. pulmonary embolism 7777777777 297) boy after running for hours , has pain in knee and mass on upper surface of tibia a. Osgood scatter disease b. lliotibial band the correct answer ís a ....................................... ............... 298) pancreatitis a. Amylase is slowly rising but remain for days b. Amylase is more specific but less sensitive than lipase c. Ranson criteria has severity (predictive) in acute pancreatitis d. Pain is increased by sitting and relieved by lying down e. Contraceptive pills is associated the correct answer ís c The Ranson and Glasgow scoring systems are based on such parameters and have been shown to have an 80% sensítívíty for predíctíng a severe attack, aíthough oníy after 48 hours foííowíng presentatíon. risk mortality is 20% with 3-4 signs, 40% with 5-6 signs, 100% 7 signs. 299) Patient has fever , night sweating , bloody sputum , weight loss , ppd test was positive . x-ray show infiltrate in apex of lung , ppd test is now reactionary , diagnosis a. Activation of primary TB b. sarcoidosis c. Case control is d. Backward study the correct answer ís a The tubercuíosís skín test (aíso known as the tubercuíín test or PPD test) ís a test used to determíne íf someone has deveíoped an ímmune response to the bacteríum that causes tubercuíosís (TB). ....................................... ................... 300) patient with DM presented with limited or decreased range of movement passive and active of all directions of shoulder a. frozen shoulder b. impingment syndrome c. osteoarthritis the correct answer ís a ....................................... ................... 301) 48 years old with irregular menses presented with fatigue and no menstruation for 3 months with increased pigmentation around the vaginal area with no other symptoms. ur next step would be a. reassure the patient b. do a pregnancy test c. do ultrasound the correct answer b 302) 3 years old presented with shortness of breath and cough at night which resolved by itself in 2 days. he has Hx of rash on his hands and allergic rhinitis. he most likely had a. croup b. bronchial asthama c. epilotitis ???????? 1roup 2piglottitis !nset Days 3ours ,lu/li+e symptoms 4es 5o 1ough 6ever bsent ble to drin+ 4es 5o Drooling saliva 5o 4es ,ever 789 :89 6tridor 3arsh 6oft ;oice 3oarse muffed ....................................... ................ 303) a man went on vacation. he noticed a white patch in his chest which became more clear after getting a sun tan which was spread on his chest.ur Dx is a . pytriasis versicolor b. vitilligo c. pytriasis roscea the correct answer a ....................................... ...................304) a 4 years old presented with 2 day history of shortness of breath a seal like cough with no sputum and mild fever. on examination he did not look l'll or in distress a. acute epilossitis b. croup c. angioedema The correct answer b 304)65 years old came with knee pain. and limited movement. on examination had crepition on knee. dx a. rhuematiod arthritis b. osteoporosis c. osteoarthritis the correct answer c ....................................... ................... 305) which vitamin is given to new born to stop bleeding a. vit. A b. vit. D c. vit. K d. vit E e. vit C the correct answer c ....................................... ................... 306) a child came with congested throught and mild bulging of tympanic membrane ur Dx was URTl. The 777777777 ....................................... ................... 307) a child presented with erythematous pharynx, with cervical lymph nodes and rapid strplysin test negative and low grade fever with positive EBV. it next step a. give antibiotics and anti pyretic b. give anti pyretic and fluids d. culture and sensitivity the correct answer a ....................................... ................... 308) child with low grade fever and congested throat, negative ASO and positive EBV. he has a. infectous mononucleosis b. URTl the correct answer ís a ....................................... ................... 309) the most common cause of intracerebral or intraparynchimal bleeding is. a. Hypertensive angiopathy b. annurysm c. AV malformation the correct answer ís a 310) young adult Sickle cell patients are commonly affected with a. dementia b. multiple cerebral infarcts the correct answer b ....................................... ................... 311) 80 years old living in nursing home for the last 3 months. his wife died 6 months ago and he had a cornary artery disease in the last month. he is now forgetful especially of short term memory and decrease eye contact with and loss of interest. dx a. alzihiemer b. depression c. hypothyroidism the correct answer a , I thínk O ís not compíete ....................................... ................... 312) thyroid cancer can be from a. hypothyroidism b. graves disease c. toxic nodule 777777777 ....................................... ................... 313) a mother came with her son who is 7 years old very active never sitting in class and with poor concentration. ur management would be. a. olanzipine b. amitilyne c. aloxane the correct answer ís b ( I'm not sure ) thís case ís "attention -deficit hyperactivity disorder" treatment: 1- Methyíphenídate 2- Dextroamphetamíne 3- Aderaíí 4- Atomoxetíne 5- Pemoííne 6- Antídepressant ( SSRI ) 314) from the graph above which of the following statement is true a. osteoprosis affecting majority of women above 80 b. 20% of women under 70 are affected 777777777 ....................................... ................... 315) a patient presented with progressive weakness on swollowibg with diplopia and fatigability. the most likely underlying cause of her disease is. a. antibody against acetylcholine receptors ....................................... ................... 316) an 69 year old non diabetic. with mild hypertension and no hx of Coronary heart desease. the best drug in treatment is. a. thiazides b. ACEl c. ARB d. CCB the correct answer a ....................................... ................... 317) which of the following anti hypertensive is contraindicated for an uncontrolled diabetic patient a. hydrochlorothiazide b. Losartan c. hydralszine d. spironolactone the correct answer ís a -síde effect of thíazíde : hypergíycemía ....................................... ................... 318) a wound stays in it's primary inflammation untill a. Escher formation b. epitheliazation c. after 24 hours d. wound cleaning the correct answer d ....................................... ................... 319) 70 years old male patient with mild urinary dripping and hesitency ur Dx is mild BPH. ur next step in management is a. transurethral retrograde prostatectomy b. start on medication c. open prostatectomy the correct answer b 320) most common cause of secondary HTN is a. Renal disease - Renal parenchymal disease ....................................... ................... 321) one of the following food is known to reduce cancer a. fibers ....................................... ................... 322) smoking is a definitive risk of a. sq.c.ca of bladder b. liver c. breast the correct answer ís a ....................................... ................... 323) exercise recommended for patients with CAD. is a. isometric b. isotonic c. yoga ؟؟؟؟؟؟؟؟؟؟ ....................................... ................... 324)what is the definitive treatment of frostbites a, Rewarming ....................................... ................... 325) the most common cause of failure to thrive in pediatric is a. malnutrition ....................................... ................... 326) which of the following causes the highest maternal mortality in pregnancy a. toxoplasma b. hyperbilirubenia c. 7777 " The ma|or causes of maternaí death are bacteríaí ínfectíon, varíants of gestatíonaí hypertensíon íncíudíng pre-ecíampsía and HELLP syndrome, obstetrícaí hemorrhage, ectopíc pregnancy, puerperaí sepsís (chíídbed fever), 327) Ttt of frostbite a. lmmersion in water 40-45 C b. Debridement c. Leave it at room tepmrature The correct answer ís a ....................................... ................... 328) Case about a child both RBS, FBS are elevated so he has DM1.what's the type of HLA a.DR3 b.DR4 c.DR5 d.DR6 e.DR7 the correct answer ís a Types of HLA : DR2 : Good's pasture syndrome & muítípíe myeíoma DR3 : D.M , SLE , & grave's dísease DR27 : ankyíosíng spondyíaítís & reíter's syndrome B51 : behceat's dísease D11 : hashímot's dísease ... ....................................... ................ 329) Definition of PPV 7 Predictive positive value ( PPV ) : proportion of people with a positive test who have s a disease : a} (a+b) ....................................... ................... 330) What's the most common case in PHC centers a.UTl b.HTN c. Coryza the correct answer ís c 331) all of the following will decrease pt compliance except: a. involve pt in the plan b. make simplified regimen c. give easy written instructions d. make appointments flexible e. warn the patient about the danger of missing a pill the correct answer ís e ....................................... ................... 332) Case about old diabetic patient who still have hyperglycemia despite increase insulin dose.the problem with insulin in obese patients is a. Post receptor resistance ?????? O NOT COMPLETE ....................................... .................. 333) Case about a child with drooling, fever, barking cough in sitting position, dx: a. Croup b. Broncholities c. Pneumonia The correct answer ís a ....................................... ................... 334) Mother came to you after her son had hematoma under the nail dt injury: a. Send home with a pad on the head b. Send home with acetaminophen c. Do wedge resection d. Evacuate the hematoma The correct answer ís d Thís case ís ( subunguaí hematoma ) 335) What vaccine u'll give to a SCD ( sickle cell disease ) child a.HBV b. H.influenza c. pneumococcal d. both A and B e. all of the above the correct answer ís c ....................................... ................... 336) a mother with HBsAg positive came with her child 6 yrs old who has HBsAg +ve what will you give him: a. oral polio, DTP, MMR the correct answer ís a other choíces aíí had HBV vaccíne whích u'íí not gíve ....................................... ................... 337) Patient wil LLÇ pain, vomiting, fever, high WBC (17.000), tenderness and rebound tenderness a. Diverticulitis b. Sigmoid volvulus c. Appendicitis d. Toxic enteritis The correct answer ís a ....................................... ................... 338) What's the organism responsible for psuedomembranous colitis: a. Pseudomonas b. Colisteridum c. E.coli d. Enterococcus fecalis The correct answer ís b 339) Mother came with her child who had botillism, what you will advice her: a. Never eat canned food again b. Store canned food at home c. Boil canned food for 40-50 min d. Check expiry date of canned food The correct answer ís d ....................................... ................... 340) Old pt presented with abdominal pain, back pain, pulsatile abdomen what's the step to confirm dx: this is a case of aortic aneurysm a. Abdominal US b. Abdominal CT c. Abdominal MRl The correct answer ís a b -ínítíaí ínvestígatíon US - CONFIRM by CT ....................................... ................... 341) 18 months old came with bite by her brother, what you will do: a. Give augminten b. Give titunus toxoid c. Suture O not compíete ....................................... ................... 342) 19 yrs old after bike accident, he cant bring the spoon infront of himself to eat, lesion is in: a. Temporal lobe b. Cerebellum c. Parietal lobe d. Occipital lobe The correct answer ís b 343) How to dx DVT: a. Contrast venography b. Duplex US The correct answer ís b ....................................... ................... 344) Pt came after RTA, GCS 14, near complete amputation of the arm, 1 st step: a. Secure air way b. Tourniquet on the arm The correct answer ís a ....................................... ................... 345) Pt with hx of prolonged heavey bleeding 2 hrs post partum, you will give: a. Ringers lactate b. NS c. NS+ packed erythrocytes The correct answer ís c ( O NOT COMPLETE ) ....................................... ................... 346) What is special about placenta abruption: a. Abnormal uterine contractions b. PV bleeding c. Fetal distress The correct answer ís b , PA : dark , paínfuí vagínaí bíeedíng and compíícatíon ís fetaí hypoxía ....................................... ................... 347) Pt 34 wks, hx of PV bleeding for many hrs, dark blood, abdominal tenderness, FHR 120, uterine contractions every 3 min, Dx: a. Abruption placenta 348) One of the steps in managing epistaxis: a. Packing the nose b. Press the fleshy parts of nostrils c. Put patient of lateral lying position The correct answer ís b ....................................... ................... 349) Pt with hx of diarrhea, abdominal pain, agitation, headache, dizziness, weakness, pulstile thyroid, unsteady gate. Examination was normal. Dx: a. Hypochondriasis b. Somatization disorder c. Thyroid Ca d. Anxiety The correct answer ís b ....................................... ................... 350) Child with headache that increase by changing head postion, unilateral, photophobia a. Sinus headache b. Migraine c. Cluster headache d. Tension headache The correct answer ís b ....................................... ................... 351) Ttt of isolated fracture of femur (repeated) 777 ....................................... .................. 352) Younge pt with pain in LL after running 3 kgs, more at night, swelling, XR was NL a. Stress fracture 353) HTN pt, with decrease vision, fundal exam showed increase cupping of optic disc dx: a. Open angle glaucoma b. Closed angle glaucoma c. Cataract d. HTN changes The correct answer ís a ( I'm not sure ) ....................................... ................... 354) Pt with unilateral red eye, tearing, clear tears no swelling or discharge: a. Give topical antihistamin b. Give topical AB c. Give systemic AB d. Reassurance The correct answer ís d ....................................... ................... 355) Business man went to Pakistan, came with bloody diarrhea, stool examination showed trophozoite with RBC inclusion, Dx: a. Amebic desyntry (entamoeba histlolytica ) ....................................... ................... 356) 5 yrs old child with abdominal pain after 2 wks of URTl, HB 8, retics 12% WBC NL peripheral blood smear showed target cells, RBC inclusions dx: a. SCA (the only hemolytic anemia in the answers) 77777 ....................................... ................... 357) Child had hb electrophoresis showed hb 2% a. HBA 40 HBS 35 HBF 5 HBA2 b. Sickle cell trait c. Thalacemia major d. Minor 77777 358) Younge pt with hx of cough, chest pain, fever CXR showed RT lower lobe infiltrate: a. Amoxicillin b. Ceferuxim c. Emipenim d. Ciprofloxacin 777777 The correct answer ís d (I'm not sure ) ....................................... ................... 359) Best thing to reduce mortality rate in COPD: a. Home O2 therapy b. Enalipril c. Stop smoking The correct answer ís c ....................................... ................... 360) Drug that will delay need of surgery in AR: a. digoxin b. verapamil c. nefidipin d. enalpril the correct answer ís c ....................................... ................... 361) Child with skin rash, pericarditis, arthritis dx: Kawasaki ....................................... ................... 362) Pic of skin with purple flat topped polygonal papules, dx: a. Lichen plannus ....................................... ................... 363) Child with atopic dermatitis, what you will give other than cortisone a. There were many drugs, steroids and AB and only one strange name maybe moisturizer. That's the answer 364) A man had increase shoe size and jaw, the responsible is: a. ACTH b. Somato77 c. TSH d. Cortisone The correct answer ís b ....................................... ................... 365) The best advice to patient travelling is: a. Boiled water b. lce c. Water d. Salad and under cooked sea shells The correct answer ís a ....................................... ................... 366) Seldinfil is contraindicated with: a. Nitrate b. Methyldopa c. Gabapentine The correct answer ís a ....................................... ................... 367) Pt with TB, had ocular toxicity symptoms, the drug responsible is: a. lNH b. Ethambutol c. Rifampicin d. Streptomycin The correct answer ís b lNH : perípheraí neurítís and hepatítís . so add ( B6 ) Ethambutol : optíc neurítís Rifampicine : body fíuíd organe 368) Another pt treated for TB started to develop numbness, the vit deficient is: a. Thiamin b. Niacin c. Pyridoxine d. Vit C THE correct answer ís c ....................................... ................... 369) Pt with bilateral breast disease, dx: a. Paget b. Papilloma c. Meduallary d. Lobular ....................................... ................... 370) Child fell on her elbow and had abrasion, now swelling is more, tenderness, redness, swelling is demarcated (they gave dimensions) child has fever. Dx: a. Gonoccal arthritis b. Synovitis c. Cellulitis of elbow The correct answer ís c ....................................... ................... 371) About burn a. You will give 1\2 fluid in the 1 st 8 hrs b. 1\4 in the 1 st 8 hrs The correct answer ís a Parkland formula : fíuíd ín fírst 24 hours = 4 * wt. ín kg * % BSA 50% ín fírst 8 hours and another ín next 16 hours 372) You r supposed to keep a child NPO he's 25 kgs, how much you will give: a. 1300 b. 1400 c. 1500 d. 1600 The correct answer ís d For the first 10 kg of weight, a chííd needs 100 mL per kg of weíght. For the next 10 kg of weight (11-20 kg), a chííd oníy needs 50 mL per kg of weíght. for anything over 20 kg (21 kg of weight and higher), the chííd oníy needs 20 mL per kg of weíght. Take a 35 kg chííd, for exampíe. He needs 1000 mL for hís fírst 10 kg of weíght (10 kg x 100 mL), 500 mL for hís second 10 kg of weíght (10 kg x 50 mL), and 20 mL/kg for any weíght above 20 kg (15 kg x 20 mL). A 35 kg chííd, therefore, needs approxímateíy 1800mL of water or free ííquíds. ....................................... ................... 373) Young patient with pharyngitis, inflammation of oral mucosa and lips that has whitish cover and erythmatous base, febrile, splenomegaly. Dx: (this is infectious mono) a. Scarlet fever b. EBV c. HZV The correct answer ís b ....................................... ................... 374) Female with greenish vaginal discharge, red cervix. Dx: Trchimoniosis ....................................... ................... 375) Another female with malodorous discharge and pain maybe. Dx: Bacterial vaginosis ....................................... ................... 376) The best way to reduce the weight in children is: a. stop fat intake b. Decrease calories intake c. Drink a lot of water The correct answer ís b 377) You have to advice a teenager that mainly eats fast food to take: a. Folic acid and Ca b. Vit C and Ca c. Ca alone The correct answer ís c ( I'm not sure ) ....................................... ................... 378) Patient has symptoms of infection, desquamation of hands and feet, BP 170\110 dx: a. Syphilis b. Toxic shock syndrome c. Scarlet fever The correct answer ís b Toxic shock syndrome : Caused by S.aureus , often wíth 5 days of onset of menestraí períod ín women who have used tampons. Feature: abrupt fever ( 39 c or more ), vomítíng, díffuse macuíar erythematous rash, desquamatíon especíaííy ín paíms and soíes, nonpuruíent con|unctívítís. Diagnosis : bíood cuíture are -ve .so, díagnosís by cíínícaí. Treatment : 1 st step rehydratíon and antíbíotíc ....................................... ................... 379) Snellin chart, if patient can read up to line 3, how much is his vision loss : O not compíete: but thís pt. see íetters at 20 feet , where normaí person see ít at 70 feet. 380) l cant remember the case but gram +ve cocci were isolated, dx is sterpt bcz it was the only gm +ve cocci. ....................................... ................... 381) Diabetic mother asking about risk of diabetes related congenital defect. lt will be in: a. 1 st trimester b. 2 nd trimester c. 3 rd The correct answer ís a (I'm not sure ) ....................................... ................... 382) lf diabetic mother blood sugar is always high despite of insulin, neonate complication will mostly be: a. Maternal hyperglycemia b. Maternal hypoglycemia c. Neonatal hypoglycemia d. Neonatal hyperglycemia The correct answer ís c ....................................... ................... 383) Obssive neurosis patients will have: a. Major depression b. Lake of insight c. Schizophrenia The correct answer ís a ....................................... ................... 384) Before giving bipolar patient lithium you will do all of the following except: a. TFT b. LFT c. RFT d. Pregnancy test The correct answer ís b 385) Patient came with PV small bleeding (she fell down and felt decrease in fetal movement but on examination baby was ok) all her 3 previous pregnancies were normal, you will do: a. lmmediate CS b. Careful observation of the bleeding c. Medication (strange name) d. Mg sulphate O not compíete , depend on date of gestatíon. ....................................... ................... 386) Pt came to you missing her period for 7 wks, she had minimal bleeding and abdominal pain, +ve home pregnancy test, 1 st thing to order is: a. BHCG b. US c. Drugs maybe The correct answer ís a ....................................... ................... 387) Patient came to you and you suspect pre eclampisa, which of the following will make it most likely: a. Elevated blood pressure b. Decrease fetal movement c. 77 The correct answer ís a ....................................... ................... 388) Old patient male, hematuria, passing red clots and RT testicular pain: a. Testicular Ca b. RCC ( renal cell carcinoma ) c. Cystitis The correct answer ís b 389) to get more information from the pt a. open end question ( avoíd íeadíng questíon to get more ínformatíon ) ....................................... ................... 390) gingivits most likely cause a.HSV ( q not compíete but : The most common cause of gíngívítís ís poor oraí hygíene that encourages píaque to form.) ....................................... ................... 391) watery discharge from eye , conjunctivitis treated by a. topical corticosteroid (Its symptoms íncíude watery díscharge and varíabíe ítch. The ínfectíon usuaííy begíns wíth one eye, but may spread easííy to the other Ttt: coíd compresses | and artífícíaí tears) ....................................... ................... 392) blow out fracture eyelid swelling , redness other syptoms a. present air fluid level b. enopthalmos The correct answer ís b íts enophaíoms , other name of bíow out orbítaí fíoor fracture ....................................... ................... 393) drinking of dirty water causes a. heptitis A b. B c. C d. D The correct answer ís a ....................................... ................... 394) giemsa stained blood film a. malaria 395) regarding peritonitis a.Complicated appendectomy the cause is anerobe organism b. rigidity and the cause is paralytic ileus c. can be caused by chemical erosions. The correct answer ís c ....................................... ................... 396) fraucture of humerus associated with a. radial N injury b. median nerve injury the correct answer ís a ( radíaí groove ) ....................................... ................... 397) there is case i cant remember they asked about diagnosis of acute lymphocytic leukemia ALL The totaí number of whíte bíood ceíís may be decreased, normaí, or íncreased, but the number of red bíood ceíís and píateíets ís aímost aíways decreased. In addítíon, very ímmature whíte bíood ceíís (bíasts) are present ín bíood sampíes examíned under a mícroscope. A bone marrow bíopsyís aímost aíways done to confírm the díagnosís and to dístínguísh ALL from other types of íeukemía ....................................... ................... 398) diagnosis of hemochromatosis a. serum ferritin7! Hemochromatosís ís suggested by a persístentíy eíevated transferrín saturatíon ín the absence of other causes of íron overíoad. It ís the ínítíaí test of choíce . Ferrítín concentratíon can be hígh ín other condítíons, such as ínfectíons, ínfíammatíons, and ííver dísease . Ferrítín íeveís are íess sensítíve than transferrín saturatíon ín screeníng tests for hemochromatosís . 399) kawasaki disease associated with a.strawberry tongue Kawasaki disease Muítísystem acute vascuíítís that prímary affected young chíídren. Fever píus four or more of the foííowíng crítería for díagnosís: 1-fever > 40 C for at íeast fíve days 2-bííateraí, nonexudatíve, paíníess con|unctívítís 3-poíymorphous rash ( prímarííy truncaí ) 4-cervícaí íymphadenopathy ( often paínfuí and unííateraí ) 5- díffuse mucous membrane erythema ( strawberry tongue ) , dry red 6- erythema of paím and soíe 7- other maíndfestatíon : gaííbíadder hydrops, hepatítís, arthrítís Untreated Kawasakí díease can íead to coronary aneurysms and even MI Treatment : 1-hígh dos ASA ( for fever and ínfíammatíon) & IVIG ( to prevent aneurrysmaí ) 2-referraí to pedíatríc cardíoíogíst ....................................... ................... 400) most common tumor in children a.ALL b. rabdomyosarcoma c. wilm's tumor the correct answer ís a -ALL : most common chíídhood tumor -rabdomyosarcoma : most common soft tíssue tumor -wilm's tumor: most common íntra- abdomínaí chíídhood tuomr ....................................... ................... 401) Most common intra- abdominal tumor in children: a.wilm's tumor b. lymphoma the correct answer ís a the most common íntra-abdomínaí tumor ín chíídren are neruobíastoma and wíím's tumor. 402) pt c}o of hypopigmentful skin , nerve thicking diagnosis a.leprosy Leprosy : chroníc granuíomatous ínfectíon caused by Mycobacteríum íeprae, acíd-fast bacíííus preferentíaííy affectíng cooíer regíons of body ( e.g skín , mucousmembrane, perípheraí nerve) . díagnosís by skín íesíon ( hypopígmentatíon or hyperpígmentatíon macuíe ) and eníarge nerves eíth sensory íoss. ....................................... ................... 403) regrading COPD to reduce complication we should give a. theophyline b. pneumococcal vaccine c. smoking cessatíon. The correcr answer ís c ....................................... ................... 404) pseud-gout its a. CACO3 b. CACL3 The correct answer ís a Gout : deposítíon of ( MSUM ) monosodíum urate monohydrate -ve of bírefríngent , needíe shape, Psudogout : deposítíon of ( cppd ) caícíum pyrophosphates dehydrate crystaí , +ve bírefríngent , rhomboíd shape, ( CACO3) . 405) man with history of alcohol assocation with a. high MCV b. folic acid deficiency c. B12 deficieny e. hepatitis The correct answer ís b ....................................... ................... 406) neanate 9 days on breast feed develop jandice a. breast feed jaundice b. pathological jaundice c. physiological jaundice the correct answer ís a 1-pathological jaundice : con|ugated ( dírect ) bííírubín, start ín 1 st 24 hours, bííírubíne > 15 mg / dí , persístent 1 week ín term ínfant and 2 weeks ín preterm ínfant 2-physilogical jaundice: uncon|ugated ( índírect ) bííírubíne , start ín 2- 3 days, bííírubíne < 15 mg/dí , persístent 1 week ín term ínfant and 2 weeks ín preterm ínfant. 3-breast feeding jaundice : uncon|ucated ( índírect ) bííírubíne , start ín 7 days of íífe , persístent to one or more months. ....................................... ................... 407) lady c}o headche bandlike pain a. tension headache ....................................... ................... 408) regarding breast screening a. self breast examination early detection of tumor b. mammogram not advise before 35 y 777777 ....................................... ................... 409) 19 yrs old c}o abdo pain within menestration for last 6 years diagnosis a. primary dysmenorrhea b. secondary dysmenorrheal The correct answer ís a Prímary dysmenorrhea : Onset wíthín 6 months after menarche . Lower abdomínaí/peívíc paín begíns wíth onset of menses and íasts 8-72 hours 410) bilateral breast mass diagnosis a. ductal carcinoma b. pagets disease ít couíd be Intraductaí papíííoma ?????? ....................................... ................... 411) beriberi cause of deficiency a. VlT B1 b. VlT B2 c. VlT B3 The correct answer ís a ....................................... ................... 412) chronic uses of estrogen association 77777 ....................................... ................... 413) Asystole a. adrenalin b. atropine The correct answer ís asystoí has oníy 3 durgs epínephríne-vasopressíne-atropín ....................................... ................... 414) pt has diarrhea , dermatitis and dementia diagnosis a. peííagra ....................................... ................... 415) regarding injectable progestron a . an cause skin prob 7!! In|ected progesterone ( medroxy-progestrone ) : advantages : ííght or no períods, safe wíth breastfeedíng, IM ín|ectíon every 3 months. Dísadvantages: írreguíar bíeedíng, wt. gaín, decrease bone míneraí densíty ( reversíbíe ) , deíay fertíííty díscontínue . ....................................... ................... 416) sencodary prevention is a. coronary bypass gaft Secondary preventíon generaííy consísts of the ídentífícatíon and ínterdíctíon of díseases that are present ín the body, but that have not progressed to the poínt of causíng sígns, symptoms, and dys- functíon 417) 22 yrs old c}o insomina} sleep disturb treatment a. SSRl Short hístory , But the ínítíaí management of ínsomnía : good síeep hygíene . ....................................... ................... 418) celluitis in children most commin causes a. group A steptoccus In chíídren, the most common cause of ceííuíítís ís - aureus or group A streptococcus. ....................................... ................... 419) antideprssants associated with hypertensive crisis treatment a. SSRl b. MOAls c. TCAs the correct answer ís b esp hydrazínes ( pheneízíne ) ....................................... ................... 420) pt his MBl = 24 kg he is a. noramal weight b. over weight c. morbid weight d. mild weight The correct answer ís a ....................................... ................... 421) baby c}o fever , chills , rigors and head rigidity +ve kurnings sign rash on his lower limb diagnosis : - meningoccal meninigits 7777777 ....................................... ................... 422) 48 yrs pt with abdo pain , neusea, vominting tenderness in right hypochondrial - acute cholecysitis Fever 7! 423) 29 pt c}o dysurea his microscopic showed G -ve organism is a. legonealla b. E. coli the correct answer ís b ....................................... ................... 424) 30 yrs pt c}o feeling heaviness in the lower abdomen having pulge papable at the top scrotum that was reducible and icreasing in valsalva maneuver diagnosis a. hydrocele b. variocele c. indirect inguinal hernia d. direct inginal hernia The correct answer ís c ....................................... ................... 425) anticoagulation prescrib for a. one month b. 6 months c. 6 weeks d. one year The correct amswer ís b ....................................... ................... 426) cushing syndrome best single test to confirm a. palsma cortison b. ATCH c. Dexamethasone Suppression Test The correct answer ís c ....................................... ................... 427) 23 yrs old history of URTl then he developed ecchomysis best treated a. local AB b. local antiviral c. steroid The correct answer ís c 428) chronic psycotic disorder manged by a. haíoperídoí ....................................... ................... 429) 29 yrs old lady B-HSG 160 c}o vomiting , abdomenal pain which is more accurate to diagnosis a. BHCG serial b. pelvic US c. laprascopy O not compíete, but may be thís case ís moíar and chooce ís a . ....................................... ................... 430) 70 yrs old man c}o fever , vesicular rash over forehead mangement a. lV AB b. lV antiviral c. Acyclovir the correct answer ís c ( í"m npt sure ) ....................................... ................... 431) celiac disease involves : a. proximal part of small intestin b. distal part of small intestin c. proximal part of large intesin d. distal part of large intensin The correct answer ís a ....................................... ................... 432) 6 yes old pt cyanosis past history of similar attack 6 month ago u will do for him a. CxR b. PFT c. secure airway d. CBC O ís not cíear or not compíete , íf pt. came wíth íífe threateníng cyanosís don't waste tíme wíth ínvestígatíon and start wíth ABC ( scure aírway ) , but íf pt. came wíth past hístory cyanosís choose b . 433) side affect of diazepam Sedatíon , depence, respíratory supressíon , anterograde amnesía , confusíon (especíaííy pronounced ín hígher doses) and sedatíon ....................................... ................... 434) endemic means: Endemic :is the constant presence of a disease or infectious agent in a certain geographic area or population group. ( usually rate of disease ) Epidemic : is the rapid spread of a disease in a specific area or among a certain population group. ( excessive rate of disease ) Pandemic : is a worldwide epidemic; an epidemic occurring over a wide geographic area and affecting a large number of people. ....................................... ................... 435) Epidemic curve : a graph ín whích the number of new cases of a dísease ís píotted agaínst an íntervaí of tíme to descríbe a specífíc epídemíc or outbreak . 436) Pt with hodgkin's lymphoma , and red strunberg cell in pathology and there is esinophil lymphocyte in blood so pathological classification is: a. Mixed-cellularity subtype b. nodular sclerosis subtype of Hodgkin's lymphoma the correct answer is b Cíassícaí Hodgkín's íymphoma can be subcíassífíed ínto 4 pathoíogíc subtypes based upon Reed-Sternberg ceíí morphoíogy and the composítíon of the reactíve ceíí ínfíítrate seen ín the íymph node bíopsy specímen (the ceíí composítíon around the Reed-Sternberg ceíí(s)) . Name descreption Noduíar scíerosíng CHL Is the most common subtype and ís composed of íarge tumor nod%les showíng scattered íacunar cíassícaí RS ceíís set ín a background of reactíve íymphocytes, eosínophíís and píasma ceíís wíth varyíng degrees of coííagen fíbrosís/sclerosis. Míxed-ceííuíaríty subtype Is a common subtype and ís composed of numerous cíassíc RS ceíís admíxed wíth numerous ínfíammatory ceíís íncíudíng íymphocytes, hístíocytes, eosínophíís, and píasma ceíís. wíthout scíerosís. Thís type ís most often assocíated wíth EBV ínfectíon and may be confused wíth the earíy, so-caííed 'ceííuíar' phase of noduíar scíerosíng CHL Lymphocyte-rích or Lymphocytíc predomínance Is a rare subtype, show many features whích may cause díagnostíc confusíon wíth noduíar íymphocyte predomínant B-ceíí Non-Hodgkín's Lymphoma (B-NHL). Thís form aíso has the most favorabíe prognosís Lymphocyte depíeted Is a rare subtype, composed of íarge numbers of often píeomorphíc RS ceíís wíth oníy few reactíve íymphocytes whích may easííy be confused wíth díffuse íarge ceíí íymphoma. Many cases prevíousíy cíassífíed wíthín thís category wouíd now be recíassífíed under anapíastíc íarge ceíí íymphoma 437) 62 y male with DVT and lVC obstruction due to thrombosis so most like dd is a. neohrotic syndrome b. SLE C. Chirstm disease D. 7! ....................................... ................... 438) Pt with bdominal pain heamatutea , HTN, and have abnormalty in chromosm 16 , diagnosis is a. POLY CYCTlC KlDNEY ....................................... ................... 439) 17 year pt with dyspnea Po2 , PCO2 ,Xray normal PH increase so dd is: a. acute attack of asthma b. P E c. pneumonia d. pnemothrax the correct answer ís a ....................................... ................... 440) A long scenario about patient with polydipsia ad polyuria. Serum osmolrity high . desmoprsin inductin no change urine omolarity and plasma osmolrity so dd is a. nphrognic type b. central tupe The correct answer ís a ....................................... ................... 441) 50 year old Man presented to ER with sudden headach, blurred of vision and eye pain. The diagnosis is: a. Acute glaucoma b. Acute conjunctivitis c. Corneal ulcer d. ----- The correct answer ís a 442) RTA with hip dislocation and shock so causes of shock is a. blood lose b. urtheral injery c. nurogenic The correct answer ís a ....................................... ................... 443) most common causes of hand infection a. truma b. imunocrombromise c. ... the correct answer ís a ....................................... ................... 444) ttt of cholestatoma is a. antibiotic b. steroid c. surgery d. Grommet tube the correct answer ís c -Cholesteatoma ís a destructíve and expandíng growth consístíng of keratínízíng squamous epítheííum ín the míddíe ear and/or mastoíd . treatment : Surgery ís performed to remove the sac of squamous debrís and a mastoídectomy ís performed. 445) twins one male and other female . his father notice that femle become puberty before male so what you say to father a. female enter puberty 1-2 year before male b. female enter puberty 2-3 year before male c. female enter puberty at the same age male the correct answer ís b ....................................... ................... 446) in devolping countery to prevent dental carise , it add to water a. florid b. zink c. copper d. iodide the correct answer ís a ....................................... ................... 447) 12 y.o boy c}o abdominal pain after playing football,he denied any h}o trauma ,the pain is in the Lt paraumbilical region what inx you want to do: a. CXR b. ultrasound kidney The correct answer ís b , l'm not sure because MCÇs are not compete. ....................................... ................... 448) pt child with back pain that wake pt from sleep So diagnosis a. lumber kyphosis b. osteoarthritis c. RA d. Scoliosis the correct answer ís d 449) child with papule vesical on oropharnx and rash in palm and hand so dd: a. CMV b. EBV c. MEASLS d. ROBELLA ???? Coxsackíe A vírus. Vesical in buccal mucusa is measls. ....................................... ................... 450) chid with dental caries and history of bottle feading So dd a. nurse milk caris ....................................... ................... 451) Generalize antxity disorder best ttt: -19 a. Ssri b. tricyclic a d d. MAOl The correct answer ís a ....................................... ................... 452) Major depression management: a. lntial MONOTHERABY even sever sever deprisson b. Ttt should be change if no response during 2wk (AT LEAST 6 . WEEKS ) 7777 ....................................... ................... 453) psychotherapy, medication, and electroconvulsive therap Psychiatric pt with un compliance of drugs ttt: a. depro halopredol injection b. oral colonazepam the correct answer ís a 454) mild diarrhea mangement : a. oral antibiotis b. lVF c. ORS the correct answer ís c ....................................... ................... 455) salpingitis and pid on penicillin but not improve the most likely organism is : a. chlamydia b. nessiria c. SYPHLlS d. HSV the correct answer b ....................................... ................... 456) Used for treatment of pseudomembranous colitis: PO metronídazoíe ís the empíríc treatment of choíce (500 mg TID for 10-14 days). For severe ínfectíons, oraí Vancomycín ís the treatment of choíce (125 mg OID 10-14 days). ....................................... ................... 457) Lady with of right hypochondrial pain, fever and slight jaundice. What is your diagnosis7 a. Acute cholecystitis. O not compíete. Most common presentíng symptom of acute choíecystítís ís upper abdomínaí paín often radíatíng to ríght scapuía. Nausea and vomítíng generaííy present. Patíents may report fever. 458) Deep jaundice wit palpable gallbladder 7 i . a. Cancer head of pancreas . Ç not complete Pancreatíc cancer presents wíth abdomínaí paín radíatíng toward the back, as weíí as wíth |aundíce, íoss of appetíte, nausea, vomítíng, weíght íoss, weakness, fatígue, and índígestíon. Examínatíon: may reveaí a paípabíe, nontender gaííbíadder (Courvoisier's sign) or mígratory thrombophíebítís (Trousseau's sign). Díagnose by CT. treatment usuaííy paíííatíve (due to metastasís at Dx). ....................................... ................... 459) Patient with perforated gallbladder underwent cholecystectomy. Return to you with fever. On abdominal X-ray, there is elevation of right hemidaiaphragm. What is the possible diagnosis7 a. Subphrenic abcess ...................................... .................... 460 ( 460 ( Patient with acute perianal pain since 2 days with black mass 2*3 pain 4increase with defecation Rx : a. Evacuation under local anesthesia Ç not complete ....................................... ................... 461) Rhumatoid arthritis distal interphalengial nodules a. Hebrerden's nodes Heberden's nodes are at the DIP whííe Bouchard's nodes are at PIP. 462) Elderly patient with RLÇ fullness, weight loss, changed bowel habit, anemic and pale. What is the investigation of choice7 a. Colonoscopy. Thís ís now the ínvestígatíon of choíce íf coíorectaí cancer ís suspected províded the patíent ís fít enough to undergo the boweí preparatíon. It has the advantage of not oníy píckíng up a prímary cancer but aíso havíng the abíííty to detect synchronous poíyps or even muítípíe carcínomas, whích occur ín 5% of cases. ...................................... .................... 463) lnvestigation of choice in lron deficiency anemia7 a. serum iron b. ferritin c. TlBC the correct answer ís b Serum ferrítín ís the most sensítíve íab test for íron defícíency anemía. ...................................... .................... 464) ln patients with hypertension and diabetes, which antihypertensive agent you want to add first7 a. þ-blockers b. ACE inhibitor c. o-blocker d. Calcium channel blocker the correct answer ís b Díuretícs (ínexpensíve and partícuíaríy effectíve ín Afrícan- Amerícans) and µ-bíockers (benefícíaí for patíents wíth CAD) have been shown to reduce mortaííty ín uncompíícated hypertensíon. They are fírst-ííne agents uníess a comorbíd condítíon requíres another medícatíon. (see tabíe) Popuíatíon Treatment Diabetes with proteinuria ACEIs. CHF µ-bíockers, ACEIs, díuretícs (íncíudíng spíronoíactone). lsolated systolic hypertension Díuretícs preferred; íong-actíng díhydropyrídíne caícíum channeí bíockers. Ml µ-bíockers wíthout íntrínsíc sympathomímetíc actívíty, ACEIs. Osteoporosis Thíazíde díuretícs. BPH o-antagonísts. 465) Patient presented with retinal artery occlusion, which of the following is wrong: a. painful loss of vision b. painless loss of vision the correct answer ís a The most common presentíng compíaínt of retínaí artery occíusíon ís an acute persístent paíníess íoss of vísíon. ...................................... .................... 466) ECG finding of acute pericarditis7 a. ST segment elevation in all leads Cíassíc ECG fíndíngs ín perícardítís: Low-voítage, díffuse ST- segment eíevatíon. ...................................... .................... 467) Epidemiological study want to see the effect of smoking in the bronchogenic carcinoma, they saw that is 90% of smokers has bronchogenic carcinoma. 30% of non-smokers has the disease, the specificity of the disease as a risk factor is: a. 70 % b. 30 % c. 90 % MCÇs not complete Sensitivity: The probabíííty that a díseased patíent wííí have a posítíve test resuít. Specificity: The probabíííty that a nondíseased person wííí have a negatíve test resuít. Disease Presen t No Disea se Positive test a b Negative test c d Sensitivity = a } (a + c) Specificity = d } (b + d) Note: - A sensítíve test ís good for ruííng out a dísease. - Hígh sensítívíty = good screeníng test (↓ faíse negatíves). - Hígh specífícíty = good for ruííng ín a dísease (good confírmatory test). 468) Baby present with pain in the ear, by examination there is piece of a glass deep in his ear canal, the mother mention a history of a broken glass in the kitchen but she clean that completely. We treat that by: a. By applying a stream of solution to syringing the ear. b. Remove it by forceps. c. Refer her to otolaryngology * Foreign bodies in the ear canal: Techníques appropríate for the removaí of ear foreígn bodíes íncíude mechanícaí extractíon, írrígatíon, and suctíon. Irrígatíon ís contraíndícated for organíc matter that may sweíí and eníarge wíthín the audítory canaí (e.g seeds). Insects, organíc matter, and ob|ects wíth the potentíaí to become fríabíe and break ínto smaííer evasíve píeces are often better extracted wíth suctíon than wíth forceps. Líve ínsects ín the ear canaí shouíd be ímmobííízed before removaí ís attempted. Consultations: Consuít an ENT specíaííst íf the ob|ect cannot be removed or íf tympaníc membrane perforatíon ís suspected. ...................................... .................... 469) Treatment of open tibial fracture: a. cephazolin b. cephazolin+gentamycin c. gentamicin d. cephazolin+gentamicin+metronidazole treatment of open fracture 1- Fírst-generatíon cephaíosporíns (Gram-posítíve coverage) such as cephaíexín (1-2 g q6-8h) suffíce for Gustíío type I open fractures. 2- An amínogíycosíde (Gram-negatíve coverage) such as gentamycín (120 mg q12h; 240 mg/d) ís added for types II and III ín|uríes. 3- Addítíonaííy, metronídazoíe (500 mg q12h) or penícíííín (1.2 g q6h) can be added for coverage agaínst anaerobes. 4- Tetanus prophyíaxís shouíd be ínstítuted. 5- Antíbíotícs generaííy are contínued for 72 hours foííowíng wound cíosure. Open fracture classification Gustíío cíassífícatíon I Low energy, wound íess than 1 cm II Wound greater than 1 cm wíth moderate soft tíssue damage III Hígh energy wound greater than 1 cm wíth extensíve soft tíssue damage IIIa Adequate soft tíssue cover IIIb Inadequate soft tíssue cover IIIc Assocíated wíth arteríaí ín|ury 470) Which of the following found to reduce the risk of postherpetic neuralgia: a) corticosteroids only b) corticosteroids + valacyclovir c) valacyclovir only The correct answer ís c Patíents wíth herpes zoster shouíd receíve treatment to controí acute symptoms and prevent compíícatíons. Patíents over the age of 50, írrespectíve of other rísk factors, are at much greater rísk of deveíopíng postherpetíc neuraígía and shouíd be offered treatment. By ínhíbítíng repíícatíon of varíceíía zoster vírus, the antívíraí agents acycíovír, famcícíovír, and vaíacícíovír attenuate the severíty of zoster-specífícaííy, the duratíon of víraí sheddíng ís decreased, rash heaííng ís hastened, and the severíty and duratíon of acute paín are reduced. Attenuatíon of the severíty of the acute ínfectíon and the neuraí damage ít causes shouíd reduce the ííkeííhood of postherpetíc neuraígía. ...................................... .................... 471) 8 months old infant with on & off recurrent crying episodes & hx of current jelly stools: a) intussception b) intestinal obstruction c) mickel's diverticulitis d) strangulated hernia The correct answer ís a 472) a man with oblong swelling on top of scrotum increase in size with valsalva maneuver most likely Dx: a) direct inguinal hernia b) indirect inguinal hernia c) varicocele d) femoral hernia the correct answer ís b * lndirect hernia: Herníatíon of abdomínaí contents through the ínternaí and then externaí ínguínaí ríngs and eventuaííy ínto the scrotum (ín maíes). - The most common hernía ín both genders. - Due to a congenítaí patent processus vagínaíís. - Indírect ínguínaí hernía íncreases ín síze ít becomes apparent when the patíent coughs, and persísts untíí reduced. * Direct hernia: Herníatíon of abdomínaí contents through the fíoor of Hesseíbach´s Tríangíe. (Hesseíbach´s tríangíe ís an area bounded by the ínguínaí íígament, ínferíor epígastrícartery, and rectus abdomínís) - Herníaí sac contents do not traverse the ínternaí ínguínaí ríng; they herníate dírectíy through the abdomínaí waíí and are contaíned wíthín the aponeurosís of the externaí obííque muscíe. - Most often due to an acquíred defect ín the transversaíís fascía from mechanícaí breakdown that ° wíth age. ...................................... .................... 473) 3 weeks old male newborn with swelling of scrotum transparent to light & irreducible: a) epidydemitis b) hydrocele The correct answer ís b ....................................... ................... 474) a young girl experienced crampy abdominal pain & proximal muscular weakness but normal reflexes after receiving septra (trimethoprim sulfamethoxazole) : a) functional myositis b) polymyositis c) guillian barre syndrome d) neuritis the correct answer is d 475) Which drug causes SLE like syndrome: a) hydralazine b) propranolol c) amoxicillin The correct answer ís a - Drug-índuced SLE causes: Chíorpromazíne, Hydraíazíne, Isoníazíd, Methyídopa, Penícíííamíne, Procaínamíde, Ouínídíne, Suífasaíazíne. ...................................... .................... 476) When to give aspirin and clopidogrel7 a) pt with a hx of previous Ml b) Acute Ml c) hx of previous ischemic stroke d) hx of peripheral artery disease e) after cardiac capt The correct answer ís b ...................................... .................... 477) 17 years with history of right iliac fossa pain rebound tenderness +ve guarding what is the investigation that you will do7 a. Laparoscopy b. US c. CT scan the correct answer ís c In appendícítís, CT scan wíth contrast has 95-98% sensítívíty whích shows períappendíceaí streakíng. 478) Child with history of URTl before 3 weeks now has both knees tender, red and inflamed. What is your diagnosis7 a. Rheumatoid arthritis Ç is not complete The díagnosís of |RA ís estabííshed by the presence of arthrítís, the duratíon of the dísease for at íeast 6 weeks, and the excíusíon of other possíbíe díagnoses. Aíthough a presumptíve díagnosís of systemíc-onset |RA can be estabííshed for a chííd duríng the systemíc phase, a defínítíve díagnosís ís not possíbíe untíí arthrítís deveíops. Chíídren must be younger than 16 years oíd at tíme of onset of dísease; the díagnosís of |RA does not change when the chííd becomes an aduít. Because there are so many other causes of arthrítís, these dísorders need to be excíuded before provídíng a defínítíve díagnosís of |RA (Tabíe 89-2). The acute arthrítídes can affect the same |oínts as |RA, but have a shorter tíme course. In partícuíar, |RA can be confused wíth the spondyíoarthropathíes, whích are assocíated wíth spínaí ínvoívement, and enthesítís, whích ís ínfíammatíon of tendínous ínsertíons. Aíí of the pedíatríc spondyíoarthropathíes can present wíth perípheraí arthrítís before other manífestatíons and ínítíaííy may be díagnosed as |RA (Tabíe 89-3). * |uvenííe rheumatoíd arthrítís: mono- and poíyarthropathy wíth bony destructíon that occurs ín patíents ± 16 years of age and íasts > 6 weeks. Approxímateíy 95% of cases resoíve by puberty. Subtypes: Pauciarticular: ± 5 joints involved, assocíated wíth an ↑rísk of iridocyclitis that íead to bííndness íf íeft untreated. Polyarticular: >5 smaíí |oínts. Systemíc features are íess promínent; carríes a ↓rísk of írídocycíítís. Acute febrile: The íeast common subtype; manífests as arthrítís wíthdaily high, spiking fevers and an evanescent, salmon-colored rash. Hepatospíenomegaíy and serosítís may aíso be seen. No írídocycíítís ís present; remíssíon occurs wíthín one year. ...................................... .................... 479) Old female came complain from pan in her joint increase with walking, what is your diagnosis7 a. Osteoarthritis Physícaí sígns of OA: Crepítus, ↓ range of motíon, paín that worsens wíth actívíty and weíght bearíng but ímproves wíth rest. 480) Patient came with history of neck discomfort, palpitation, cold sweat, TSH low, T4 high, tender neck. What is your diagnosis7 a. Subacute thyroiditis . - Thyroiditis: Infíammatíon of the thyroíd gíand. Common types are subacute granuíomatous, radíatíon, íymphocytíc, postpartum, and drug-índuced (e.g., amíodarone) thyroídítís. - Hx}PE: In subacute and radíatíon, presents wíth tender thyroíd, maíaíse, and URI symptoms. - Dx: Thyroíd dysfunctíon (typícaííy hyperthyroídísm foííowed by hypothyroídísm), aíí wíth J uptake on RAIU. - Rx: - µ-bíockers for hyperthyroídísm; íevothyroxíne for hypothyroídísm. - Subacute thyroídítís: Antí-ínfíammatory medícatíon. ...................................... .................... 481) ln ulcerative colitis, what you will start treatment with7 a. Cortícosteroíds ?? - Suífasaíazíne or 5-ASA (mesaíamíne). - Crtícosteroíds and ímmunosuppressants índícated íf no refractory dísease. ...................................... .................... 482) Treatment of prostatitis7 a. Ciprofloxacin treatment ís for 4-6 weeks wíth drugs that penetrate ínto the prostate, such as trímethoprím or cíprofíoxacín. ....................................... ................... 483) ln lV canula and fluid: a.Site of entry of cannula is a common site of infection. ...................................... .................... 484) Patient with neck rigidity, rigor, fever, petechial rash over extremities. The causative m\o is: a. Meningococcal meningitis Díscuss meníngítís ! ...................................... .................... 485) Female patient works in office came with vulva itching, yellow vaginal discharge: a. Trichomoniasis 486) another one old c}o bilateral knee pain with mild joint enlargement ESR and CRP normal dx: a. Osteoarthritis b. Rheumatoid arthritis c. Gout7 The correct answer ís a ....................................... ................... 487) .Scitica increased incidence of : a. Lumbar lordosis b. Parasthesis O not compíete but wíth these MCOs , correct answer ís b ....................................... ................... 488) old male c}o knee pain on walking with crepitus xray show narrow joint space and subchondoral sclerosis: a. Rheumatoid arthritis b. Osteoarthritis c. Gout The correct answer ís b ....................................... ................... 489) 14y f with BMl 32.6 (associated big chart): a. Overweight b. Obese c. Normal weight The correct answer ís b BMI < 16 : severe under WT. BMI 16 - 20 : under wt. BMI 20 - 25 : normaí BMI 25 - 30 : over wt. BMI 30 - 35 : obese cíassíc 1 BMI 35 - 40 : obese cíassíc 2 BMI > 40 : obese cíassíc 3 490) vaginal discharge odorless watry microscopy show clue cells : a. Bacterial vaginosis b. Candidiasis The correct answer ís a ....................................... ................... 491) Pregnant women on 3 rd trímester ínfected wíth measeís can I gíve her MMR????? ....................................... ................... 492) lactating women infected with rupella ....management is : a. MMR b. Stop lactation The correct answer ís a MMR ís safe duríng íactatíng ....................................... ................... 493 ) which of following not live vaccine: a. BCG b. Hepatitis B c. Oral polio d. MMR The correct answer ís b ....................................... ................... 493) the most commone cause of community acquired pneumonia: a. Hemophilus influenza b. Strept.pneumonia c. Mycoplasma d. Kliebsella The correct answer ís b 494) female after vaginal hesterectomy she complain of urin come from vagina...dx: a. Vesicovaginal fistula b. Urethrovaginal fistula c. Ureterovaginal fistula The correct answer ís a ....................................... ................... 495) child rt ear pain and tenderness on pulling ear , no fever , O}E inflamed odemateous rt ear canal with yellow discharge >>>>>>>>>>dx: a. Otitis media b. Otitis externa c. Cholesteatoma The correct answer ís b ...................................... .................... 496) male with perianal pain ,tenderness ,fluctuant (perianal abscess) a. lncision and drainage b. Warm bath The correct answer ís a ...................................... .................... 497) . pregnant 34w with vaginal bleeding.... what would you ask about : a. Cigarette smoking b. Recent sexual intercourse O not compíete , but wíth theses MCOs may be correct answer ís a ...................................... .................... 498) ln duodenal obstruction of neoborn what is the sign that apper in xray: a. Double bubble 499) the following more commone with type2 DM than type1 DM: a. Weight loss b. Gradual onset c. Hereditary factors d. HLA DR3+-DR4 The correct answer ís c ....................................... ................... 500) pt with open angle glaucoma and k}c of COPD and DM ttt: a. Timelol b. betaxolol c. Acetazolamide The correct answer ís c ....................................... ................... 501) pt child with back pain that wake pt from sleep So diagnosis a. lumber kyphosis b. osteoarthritis c. RA d. Scoliosis The correct answer ís a or d ....................................... ............. 502) 59 y}o presented with new onset supraventicular tachycardia with palpitation,no Hx of SO Or chest pain ,chest examination normal , oxygen sat in room air = 98% no peripheral edemaOthers normal, the best initial investigation: a. ECG stress test b. Pulmonary arteriography c. CT scan d. Thyroid stimulating hormone the correct answer ís d 503) Lactating women presented with breast engorgment and tendress Your managements: a. Warm compressor and continoue breast feeding b. Dicloxacillin and continoue breast feeding c. Dicloxacillin and milk expression d. Discontinoue breast feeding and cold compressor the correct answer ís a . tís case ís ( engorgement of breast ) . but íf there are redness , sweíííng , fever thís case ís ( mastítís ) and choose b 504) The Fastest route of antipsychotic is: a. lM b. lV c. Oral d. Sublingual the correct answer ís b 505) While you are in the clinic you find that many patients presents with red follicular conjactivitis (Chlamydia ) your management is: a. lmprove water supply and sanitation b. lmprove sanitation and destroying of the vector c. Eradication of the reservoir and destroying the vector d. Destroy the vector and improve the sanitation the correct answer ís a 506) The most important exogenous risk factor for osteoporosis is: a. Alcohol intake b. Age c. Smoking d. Lack of exercise the correct answer ís c 507) Patient with family history of coronary artery disease his BMl= 28 came to you asking for the advice: a. Start 800 calorie intake daily b. Decrease carbohydrate daytime c. lncrease fat and decrease protein d. Start with decrease ... K calorie per kg per week the correct answer ís d 508) Lactating mother newly diagnosed with epilepsy , taking for it phenobarbital you advice is: a. Discontinue breastfeeding immediately b. Breastfeed baby after 8 hours of the medication c . Continoue breastfeeding as tolerated the correct answer ís c -very vague questíon , some books avoíd Phenobarbítaí duríng breast feedíng íf possíbíe. And ín Amerícan academy of pedíatríc cíassífíed Phenobarbítaí as adrug that cause ma|or advers effect ín some nursíng ínfant, and shouíd be gíven to nursíng women wíth catíon . 509) Pregnant women has fibroid with of the following is True: a. Presented with severe anemia b. Likely to regress after Pregnancy c. Surgery immediately d. Presented with Antepartum He the correct answer ís b Fíbroíds may aíso be the resuít of hormones. Reproductíve hormones ííke estrogen and progesterone can stímuíate ceíí growth, causíng fíbroíds to form. Duríng pregnancy, your ínfíux of hormones may cause your fíbroíds to grow ín síze. After pregnancy and duríng menopause most fíbroíds begín to shrínk, due to a íack of hormones. 510) A known case of chronic atrial fibrillation on the warfarin 5 mg came for follow up you find lNR 7 but no signs of bleeding you advice is: a. Decrease dose to 2.5 mg b. Stop the dose and repeat lNR next day c. Stop warfarin d. Continoue same and repeat lNR the correct answer ís b lNR ACTlON >10 Stop warfarín. Contact patíent for examínatíon. MONITOR INR 7-10 Stop warfarín for 2 days; decrease weekíy dosage by 25% or by 1 mg/d for next week (7 mg totaí); monítor INR 4.5- 7 Decrease weekíy dosage by 15% or by 1 mg/d for 5 days of next week (5 mg totaí); repeat monítor INR 3- 4.5 Decrease weekíy dosage by 10% or by 1 mg/d for 3 days of next week (3 mg totaí); repeat monítor INR. 2-3 No change. 1.5- 2 Increase weekíy dosage by 10% or by 1 mg/d for 3 days of next week (3 mg totaí); <1.5 Increase weekíy dose by 15% or by 1 mg/d for 5 days of next week (5 mg totaí); 511) Patient is a known case of CAD the best exercise: a. lsotonic exercise b. lsometric exercise c. Anerobic exe d. Yogha the correct answer ís c 1-anerobíc exercíse ( endurance ) : for ímprove cardíac functíon 2- weíght bearíng excercíse ( ísometríc ) : for buííd muscíe strength , bone densíty 3- stretchíng excercíse : for prevent cramp , stíffness and back paín 512) The mechanism of action of Aspirin: a. lnhibit cycloxgenase b. lnhibit phospholipase A2 c. lnhibit phospholipid D the correct answer ís a 513) The absolute contraindication of breastfeeding is : a. Asymptomatic HlV patient b. Active hepatitis C c. Pulmonary TB on treatment 3 months The correct answer ís a Absolute contraindication of breastfeeding : 1-Infants with galactosemia. -!others who use illegal drugs. "-!others infected with #I$% human &-cell lymphotropic virus type I or type II% or who have an active herpes lesion on the breast. '-!others ta(ing any of the following medications: radioactive isotopes% cancer chemotherapy agents% such as antimetabolites . 514) A boy felt down on his elbow , the lateral x-ray shows: a. Anterior Pad sign b. Posterior pad sign c. Anterior line of humerous intersecting the cubilium d. Radial line forming 90 degree with cubilium the correct answer ís b 515) A known case of treated hodgkin lymphoma(mediastinal mass) with radiotherapy Not on regular follow up presented with gradual painless difficulty in swallowing and SOB , There is facial swelling and redness : DX a. SVC obstruction b. lVC obstruction c. Thoracic aortic aneurysm d. Abdominal aortic aneursm The correct answer ís a ________________________________________________________________________ 516) Patient is presented with hand cellulitis and red streaks in the hand and tender axillary lymphadenopathy. This condition is more likely to be associated with: a. Malignancy b. Pyoderma c. Neuropathy d. Lymphangitis the correct answer ís b (l'm not sure ) 516) Young aged male presented to ER after blunt trauma to Abdomen, CT scan shows intramural hematoma: your management is a. Lapratomy with evacuation of the hematoma b. Dissection of duodenum c. Observation the correct answer ís c 517) Patient presented with sore throat, anorexia, loss of appetite , on throat exam showed enlarged tonsils with petechi on palate and uvula , mild tenderness of spleen and liver :DX a. Group A strep . b. EBV The correct answer ís b 518) Patient with GERD has barret esophagus , this metaplasia increase risk of : a. Adenocarcinoma b. Squmaou cell carcinoma the correct answer ís a 519) Complication of Sleep apnea is : a.CHF b. .. the correct answer ís a sleep apnea : Hypoxic pulmonary vasoconstriction PAH Cor Pulmonale CHF complication of sleep apnea : sleep apnea increases health risks such as cardiovascular disease, high blood pressure, stroke, diabetes, clinical depression, weight gain and obesity. The most serious consequence of untreated obstructive sleep apnea is to the heart. In severe and prolonged cases, there are increases in pulmonary pressures that are transmitted to the right side of the heart. This can result in a severe form of congestive heart failure (cor pulmonale. 520) Which of the following medication can be used as prophylaxis in appendectomy: a. Cephalexin b. Ceftriaxone c. Metronidazole d. Vancomycin e. Ampicillin The correct answer ís b 1 st ííne of antíbíotíc : 1- cefoxítín 2- cefotetan 2 nd ííne of treatment : 1- metradínazoíe 2- ampícíkkín-suíbactam 521) Which of the following prognostic factor for SLE: a. ANA levels b. Sex c. Age d. Renal involvement The correct answer ís d 522) The most common site for osteomyelitis is: a. Epiphysis b. Diaphysis c. Metaphysis d. Blood flow The correct answer ís c 523) ln "holding breath holding" which of the following True: a. Mostly occurs between age of 5 and 10 b. lncrease Risk of epilepsy c. A known precipitant cause of generalized convulsion d. Diazepam may decrease the attack Breath holding spells are the occurrence of epísodíc apnea ín chíídren, possíbíy assocíated wíth íoss of conscíousness, and changes ín posturaí tone. They are most common ín chíídren between 6 and 18 months and usuaííy not present after 5 years of age. They are unusuaí before 6 months of age. A posítíve famííy hístory can be eíícíted ín 25% of cases. It may be confused wíth a seízure dísorder. There are four types of breath holding spells. 1-The most common ís termed simple (reath holdin& spell, ín whích the manífestatíon ís the hoídíng of breath ín end expíratíon. There ís no ma|or aíteratíon of círcuíatíon or oxygenatíon and the recovery ís spontaneous. 2-The second type are the Cyanotic (reath)holdin& spells. They are usuaííy precípítated by anger or frustratíon aíthough they may occur after a paínfuí experíence. The chííd críes and has forced expíratíon sometímes íeadíng to cyanosís (bíue ín coíor) , íoss of muscíe tone, and íoss of conscíousness. The ma|oríty of chíídren wííí regaín conscíousness. The chííd usuaííy recovers wíthín a mínute or two, but some faíí asíeep for an hour or so. Physíoíogícaííy, there ís often hypocapnea (íow íeveís of carbon díoxíde) and usuaííy hypoxía (íow íeveís of oxygen. There ís no "post íctaí" phase (as ís seen wíth seízures), no íncontínence, and the chííd ís fíne ín between speíís. EEGs are normaí ín these chíídren. There ís no reíatíonshíp to the subsequent deveíopment of seízures or cerebraí ín|ury as a consequence of breath hoídíng speíís. 3-In the thírd type, known as *allid (reath)holdin& spells, the most common stímuíus ís a paínfuí event. The chííd turns paíe (as opposed to bíue) and íoses conscíousness wíth ííttíe íf any cryíng. The EEG ís aíso normaí, and agaín there ís no post íctaí phase, nor íncontínence. The chííd ís usuaííy aíert wíthín a mínute or so. There may be some reíatíonshíp wíth aduíthood syncope ín chíídren wíth thís type of speíí. 4- A fourth type, known as Complicated (reath)holdin& spells, may símpíy be a more severe form of the two most common types. Thís type generaííy begíns as eíther a cyanotíc or paíííd speíí that then ís assocíated wíth seízure ííke actívíty. An EEG taken whííe the chííd ís not havíng a speíí ís stííí generaííy normaí. DX: cíínícaí , good hístory íncíude sequence of event , íack of íncontínence and no post íctaí phase. Treatment : reassurance and íron. 524) lnfant brought by the mother that noticed that the baby has decreasing feeding , activity and lethargic On examination febrile(39), tachycardic ,his bp 75}30, with skin rash . DX: a.Septic shock Ç not complete 525) Old patient newly diagnosed with hyperthyroidism presented with (hyperthrodism symptoms) The best initial symptomatic treatment is: a. BB ( beta-blocker ) b. PTU The correct answer ís a _______________________________________________________________________ 526) lnfant presented with hemangioma on the back . your management is: a. lntralesional injection of corticosteroids b. Topical corticosteroids c. Excise of the lesion 527) Pregnant lady , 34 wk GA , presented with vaginal bleeding more than her menstruation. On examination , cervix is dilated 3 cm with bulging of the membrane, fetal heart rate = 170 bpm . The fetus lies transverse with back facing down . us done and shows that placenta is attached to posterior fundus and sonotranulence behind placenta. Your management is : a. C}S b. Oxytocin c.Tocolytics d.Amniotomy the correct answer ís a 528) lnfant with congenital hip dislocation: a. +ve click in flexion ,abduction b. The only treatment is surgery c. Not reduced with flexion and abduction of the hip the correct answer ís a . thís ís ortoíaní test 529) ln irritable bowel S. the following mechanism 7 contraction and slow wave myoelectricity seen in: a.Constipation b. Diarrhea the correct answer ís a 529) Which is not found in coarctation of the aorta: a. Upper limb hypertension b. Diastolyic murmur heard all over precordium c. Skeletal deformity on chest x-ray the correct answer is a (l'm not sure ) 530) Female patient presented with tender red swelling in the axilla with history of repeated black head and large pore skin in same area: ttt is a. lmmidate surgery b. Topical antibiotic c. Cold compressor d. Oral antibiotic 531) ln indirect hernia the relation of the sac to the cord structure is: a. Anteromedial b. Anterolateral c. Posteromedial d.Postrolateral the correct answer ís b 532) The most common cause of croup is: a. Parainfluenza b. lnfluenza the correct answer ís a 533) kwashikor disease usually associated with : a. decrease protein intake, decrease carbohydrate b. increase protein , increase carbo c. decrease protein , increase carbo the correct answer is c. in the book, written there is decrease protein and adequate amount of carbohydrate, but with this only MCÇs the answer is c 534) in cachectic patient, the body utilize the proteins of the muscles : a. to provide Amino acid and protein synthesis b. to maintain bloodflow to vital organ c. to increase body fat the correct anwser ís a ( I'm not sure ) 535) patient is complaining of memory loss. Alzehimer disease is diagnosed what is the cause of this: a. brain death cell Ç not complete 536) Parents brought their baby to you who is on bottle feeding. On exam whitish lesion on either side of teeth seen with blackish lesion on maxillary incisors and second molar teeth. There is history of leaving the baby with bottle in his mouth during sleeping. The Dx: a. Nursery dental caries b.Gingvostomatis the correct answer ís a 537) Which of the following medication if taken need to take the patient immidiatly to the hospital: a. Penicillin b. diphenhydramine c. OCPs d. Çuinine or Çuinidine the correct answer ís d (I'm not sure ) , quínídíne ís antíarrhythmía . 538) 43 y}o female presented with severe DUB other examination normal . your management is a. D &C b. Ocps c. Hysterectomy d. Blood transfusion the correct answer is a 539) Baby with vesicles on the face and honey comb crust which of the following organism cause it: Staph aureus 540) Female patient presented with migraine headache which is pulsatile, unilateral , increase with activity . Dosn't want to take medication. Which of the following is appropriate: a. Bio feedback b. TCA c. BB the correct answer ís a Bíofeedback has been shown to heíp some peopíe wíth mígraínes. Bíofeedback ís a techníque that can gíve peopíe better controí over body functíon índícators such as bíood pressure, heart rate, temperature, muscíe tensíon, and braín waves. The two most common types of bíofeedback for mígraínes are thermaí bíofeedback and eíectromyographíc bíofeedback. 541) lnfant born with hemangioma on the rt eyelid what is appropriate time to operate to prevent amylopia: a. 1 day b. 1 week c. 3 months d. 9 months díffícuít O. but may be the correct answer ís b or c 542 ) Young patient on anti TB medication presented with vertigo which of the following drug cause this: a. Streptomycin b. Ethambutol c. Rifampcin the correct answer ís a , streptomycín cause 8 th nerve damage. 543) The CPR for child is a. 30 chest compression 2 ventilation . (Lone rescuer) b. 15 chest c 2 ventilation . (2 or more rescures) c. m15 chest compression 1 ventilation the correct answer ís a 544) Picture show large ulcer over medial side of the leg . what is your management a. Shave biobsy b. Elevate the legs and stocking c. Topical steroids the correct answer ís b ....................................... ................... 545) 2months infant with white plaque on tongue and greasy ,past h}o clamydia conjunctivitis after birth treated by clinamycin what is ttt: a. Oral nystatin b. Topical steroids c. Topical acyclovair d. Oral tetracycline the correct answer ís a. oraí nystatín : antífungaí ....................................... ................... 546) child rt ear pain and tenderness on pulling ear , no fever , O}E inflamed odemateous rt ear canal with yellow discharge >>>>>>>>>>dx: a. Otitis media b. Otitis externa c. Cholesteatoma the correct answer ís a ....................................... ................... 547) 34y female with HlV pap smear negative, about cervical cancer screening : a. After 3m if negative repeat after 6m b. After 6m ........... annually c. After 1y..............annually The correct answer ís b ( I'm not sure , confuse wíth choíce c ) 548) female about 30y with breast cancer (given cbc -chem. And reavel low hb and hematocrite..) what is the next step in mangment: a. Staging b. Lumpectomy c. Mastectomy d. chemotherapy the correct answer ís a ....................................... ................... 549) child with moderate persistant BA On bronch.dilat inhaler. Presented with acute exacerbation what will you add in ttt: a. Corticosteroid inhaler b. lpratropum bromide inhaler the correct answer ís b ....................................... ................... 550) about head and neck injury : a. Hoarsness of voice and stridor can occure with mid facial injury b. Tracheostomies contraindicated c. Facial injury may cause upper air way injures ....................................... ................... 551) lactating women 10 days after delivary developed fever ,malaise, chills tender Lt breast with hotness and small nodule in upper outer quadrant with axillary LN .Leucocytic count was 14 *10}L dx: a. lnflammatory breast cancer b. Breast abscess c. Fibrocystic disease the correct answer ís b 552) 70y male with osteoporosis the T score of bone densometry would be : a. -3.5 b. -2.5 c. 1 d. 2 e. 3.5 the correct answer ís b ....................................... ................... 553) child with epistaxis.... management: a. Compression on nose and leaning forward b. ....................backward the correct answer is a ....................................... ................... 554) scenario about female underwent abdominal operation she went to physician For check..... U}S reveal metal thing inside abdomen (a.e missed during operation) What will you do : a. Call the surgeon and ask him what to do b. Call attorney and ask about legal action c. Tell her what you found d. Tell her that is one of possible complications of operation e. Don't tell her what you found The correct answer ís c ....................................... ................... 555) male ptn with scaly fine papular rash on fornt of scalp,nose and retroauricular....(i think tinea capitis) ttt is: a. Ketoconazole cream. b. Oral augmentin c. ... cream the correct answer ís a 556) All can cause gastric ulcer except: a- Tricyclic antidepressant. b- Delay gastric emptying. c- Sepsis. d- Salicylates. e- Gastric outlet incompetent. The correct answer ís a Trícycííc antídepressant use ín treatment of peptíc uícer. ....................................... ................... 557) 48year old female lost her menstruation for 2 cycles, the method of contraception is condom, examination was normal except for dusky discoloration of the cervix. What u will do next: a.Progesterone challenge. b.Beta HCG. c.Pelvic u}s The correct answer ís b ....................................... ................... 558) ttt of yeast vaginitis: Clotrimazole , Fluconazole , Ketokonazole Treatment of yeast vaginitis ( candida albicans ) : topical azole or PO fluconazole , oral azole should be avoided in pregnant. ....................................... ................... 559) 15 y}o female complaining of pain during menstruation, not sexually active, medical hx unremarkable, physical examination normal, how to treat: a- NSAlD. b- Danazole. c- The correct answer ís a ....................................... ................... 560) What is true about alpha blocker: a. Causes hypertension. b. Worsen benign prostatic hyperplasia. c. Cause tachycardia. d- the correct answer ís c aípha bíocker :cause orthostatíc hypotensíon and tachycardía. 561) cyclic menstruation that increase in frequency: a. Polymenorrhea. b. Hypermenorrhea. c. Menorrhagia. d. Dysmenorrhea. e. The correct answer ís a Polymenorrhea : frequent menestratíon ( < 21 day cycíe ) Hypermenorrhea or menorrhagia : abnormaííy heavy and proíonged menstruaí períod at reguíar íntervaís . more than 80 mí of bíood íoss per cycíe or proíonged bíeedíng , more than 8 days. Oligomenorrhea : íncrease íength of tíme between menses ( 35- 90 days b\w cycíe) Metrorrhagia : bíeedíng bwteen períod. Menometrorrhagia : exessíve and írregíar bíeedíng. ....................................... ................... 562) A pregnant lady came to you to screen her fetus for down syndrome, what is the best method: a. Amniocentesis. + Karyotyping b. Choriocentesis. c. the correct answer ís a ....................................... ................... 563) What is the most common chromosomal abnormality7 a. Trisomy 13 b. Trisomy 21 the correct answer ís b -down syndrome ( trísomy 21 ) ís the most common chromosomaí abnormaííty. ....................................... ................... 564) Best 2 test to screen for hepatocellular carcinoma: a. Liver biopsy and alpha-fetoprotein. b. Liver ultrasound and alpha-fetoprotein. c. Abdomen CT and d. The correct answer ís b 565) A child came to ER with fever, stridor, . , x-ray showed swollen epiglottis, in addition to oxygen, what u will do7 a. Throat examination. b. An emergency tracheostomy. c. Endotracheal intubation. d. Nasopharyngeal intubation. The correct answer ís c ....................................... ................... 566) 24 y}o female newly diagnosed type 2 DM, she is wearing glasses for 10 years, how frequent she should follow with ophthalmologist: a. Every 5 years. b. Annually The correct answer ís b -for type 1 diabetic : retína screeníng annuaííy begínníng 5 years after onset of díabetes, generaí not before onset of puberty. - for type 2 diabetic : screeníng at the tíme of díagnosís then annuaí ....................................... ................... 567) What is the initial management for a patient newly diagnosed knee osteoarthritis. a. lntra-articular corticosteroid. b. Reduce weight. c. Exercise. d. Strengthening of quadriceps muscle. The correct answer ís b ....................................... ................... 568) A lady came to your clinic said that she doesn't want to do mammogram and preferred to do breast self- examination, what is your response7 a- Mammogram will detect deep tumor. b- Self-examination and mammogram are complementary. c- Self-examination is best to detect early tumor answer ís b ( I'm not sure because MCOs not compíete and depend on age of pt. ....................................... ................... 569) What is the best frequency for breast self-examination7 a. Daily. b. Weakly. c. Monthly. d. Annually. The correct answer ís c 570) Patient with left bundle branch block will go for dental procedure , regarding endocarditis prophylaxis: a. No need b. Before procedure. c. After the procedure. d. The correct answer ís a ....................................... ................... 571) classical characteristic for genital herpes. Painful ulcers & vesicles ....................................... ................... 572) most common vaginal bleeding : a. cervical polyps b. menstruation c. 7777 oníy wíth these MCOs , the correct answer ís b ....................................... ................... 573) best stimulant for breast milk secretion: a. breast feeding b. oxytocin c. 777 the correct answer ís a ....................................... ................... 574) child with aspirin intake overdose ...what kind of acid base balance: a. metabolic alkalosis wt respiratory b. metabolic acidosis wt respiratory alkalosis c. respiratory alkalosis with metabolic acidosid d. respiratory acidosis with metabolic alkalosis The correct answer ís c Aspirin toxicity < in early stages, salicylate will stimulate respiratory center → ↑== → respiratory al+alosis that will be compensated by metabolic acidosis. In late stage, it will interfere with 1!3, fat, & protein metabolism as well as !xidation phosphorylation lead to ↑ lactate, pyrovate, & +eton bodies. ll will lead to ↓p3. 6igne & symptoms includes< nausea, vomiting, ↑==, ↑temp, ↑3=, sweating, cerebral or pulmonary edema, & coma. >ve anion gap. &&&< hydration, correct ?>, gastric lavage or activated charcoal, urine al+ali-ation, hemodialysis) 575) therapeutic range of lNR : a. 2.5-3.5 b. 2.0-3.0 c. 777 The correct answer ís b ....................................... ................... 576) q about antidepressant: a. start single type even patient have sever depression b. start any one of them they all have the same efficacy c. stop the medication after 2 weeks if no improvement The correct answer ís a ....................................... ................... 577) patient with depression started on amitryptaline , he had headache or dizzness , vomitting77 im not sure what exactly was the symptoms a. change to SSRl b. 77 Ç not complete , but amitriptyline is TCA . ....................................... ................... 578) patient had horsenss of voice for 3 weeks... next to do: a. throat swab b. laryngoscopy c. 777 The correct answer is b , l'm not sure because MCÇs are not complete. ....................................... ................... 579) single diagnostic for stroke: a. high cholesterol b. high systolic blood pressur the correct answer ís b , I'm not sure , but wíth these mcqs , b ís correct. 580) unfaivrable prognosis for schezophrenia: a. family Hx b. failed marrige c. adolscen age77 not sure d. presence of psychosis the correct answer ís a ....................................... ................... 581) Rt lung : a. have 1 fissure b. contain 7 segment c. 777 read about lung anatomy segment names!! Rt íung has 3 íobes & 10 segments (medíaí basaí segment oníy ín ínf. Lobe of Rt íung) Lft íung has 2 íobes & 9 segments (Línguíar segments ín íft íung) ....................................... ................... 582) q about specifity: a. test is +ve in disese population b. test is +ve in healthy poplation c. test is -ve in diseased population d. test is -ve in healthy population The correct answer ís d ....................................... ................... 583) stage 3 colon ca Give Chemo ASAP ....................................... ................... 584) patient with upper abdominal pain, nausea vomitting,with back pain, he is smoker for long time daily, fecal fat was +ve a. acute pancreatitis b. chronic pancreatitis c. pancreatic CA The correct answer ís b 585) in school, 10 of patient had the dis of the first week , then 30 pt. had the dieses the next week , the percentage infection of this school is: a. 10% b. 20% c. 30% d. 40% Ç is not clear or not complete, but l think the correct answer is b. ....................................... ................... 586) patient had headche describe it as aband around his head, increase with stress and , i dont remeber the ques DX is: a. tension headache b. migraine c. cluster headache The correct answer ís b ....................................... ................... +,-. *atient 'as presented (y (oll%s in his !oot , (iopsy sho'ed s%( dermal lysis , !l%orescent stain sho'ed /&0 , 'hat is the most li1ely dia&nosis # A. Bolus epidermolysis . B. Pemphigoid vulgaris . C. Herpetic multiform . D. Bullous pemphigoid . The correct answer ís d ....................................... ................... 588) Patient was presented by difficulties of breathing from one side of his nose , on examination there was erythramatus swelling , what is the best initial treatment : A. Decongestant . B. Steroid . C. Sympathomimetics . 77 The correct answer is c ( l'm not sure ) Explain: thís sweíííng míght be nasopharyngeaí angíofíbroma whích ís híghíy vascuíar sweíííng & prone to epístaxís, so to decrease the síze we míght use íocaí or systemíc decongestants whích are sympathomímetícs, so answer ís not cíear. 589) Patient with cystic nodule (acne) and scars , what is the best treatment : A. Retinoin . B. Erythromycin . C. Doxycyclin . The correct answer ís a ( I'm not sure ) thís seems to be an advanced ínfíammatory stage of acne sínce there r scars so íf the retínoíD meant here ís systemíc (ísotretínín) so ít wííí be the choíce. If topícaí ít wííí not be effectíve as ít ís effectíve oníy ín the non-ínfíammatory stage (comedones). Both erythromycín (íocaí) & doxycycíín (systemíc) can be used but ín advanced stage systemíc ís better. ....................................... ................... 590) Patient was presented by constipation, vomiting , abdominal distension , with old scar in the lower abdomen , x ray showed dilated loops with air in the rectum , what is the best initial management : A. NGT decompression , and lV line . B. Rectal decompression and antibiotics . C. Suppositories . The correct answer ís a thís ís a case of íntestínaí obstructíon due to adhesíons from prevíous abdomínaí surgery (commonest cause) so the ínítíaí treatment wouíd be decompressíon of the íntestíne & repíace íost fíuíds ....................................... ................... 591) Which of the following is not living vaccine : A. Hepatitis B . B. MMR . C. Oral polio D. BCG The correct answer ís a Hepatítís B ís the oníy vaccíne prepared by genetíc engíneeríng so íts not íívíng vaccíne. 592) Six years old child was born to a mother with hepatitis B , he does not received any vaccines before , what you will give now : A. DTP , MMR , Hib B. DTP , MMR . C. DT , MMR , Hib D. DT, MMR . The correct answer ís d both Pertussís & H.ínfíuenza vaccíne are not needed after 1 year of age. ....................................... ................... 593) Which of the following describes the end of the early inflammatory phase . A. Formation of eschar . B. Formation of ground base of collagen . C. The end of angiogenesis . The correct answer ís c ....................................... ................... 594) Female patient , known case of VitD deficiency , smoking , and recurrent fall, which of the following is the greatest exogenous risk for osteoporosis : A. Advanced age . B. Recurrent fall . C. Vit D . D. Smoking . The correct answer ís d Advanced age & femaíe gender are the most ímportant factors for osteoporosís but they are endogenous. Smokíng ís an índependent exogenous rísk factor for osteoporosís 595) Blood sugar in DM type 1 is best controlled by : A. Short acting insulin . B. Long acting . C. lntermediate . D. Hypoglycemic agents . E. Basal and bolus insulin . The correct answer ís e Very vague questíon. We can excíude hypogíycemíc agents. Short acting insulin ís best ín emergencíes ííke DKA as ít can be gíven IV. We can use eíther íong actíng aíone daííy or a míxture of short & íntermedíate actíng ínsuíín daííy. Basal & bolus , ( short acting + intermediate or long ), boíus´ of short-actíng or very- short-actíng ínsuíín before meaís to deaí wíth the assocíated ríse ín bíood-sugar íeveís at these tímes. In addítíon, they take an eveníng ín|ectíon of íong- or íntermedíate-actíng ínsuíín that heíps normaííse theír basaí (fastíng) gíucose íeveís. Thís offers greater fíexíbíííty and ís the most commoníy adopted method when íntensífíed ínsuíín therapy ís used to províde optímaí gíycaemíc controí. ....................................... ................... 596) Which of the following is true regarding perths disease : A. Commonly seen between 11-16 years of age . B. Always unilateral . C. May present by painless limp . D. Characteristically affect the external rotation of hip . E. More in female . The correct answer ís c Perthes dísease (Leg-Caíve perthes dísease) ís a condítíon affectíng the híp |oínt where there ís degeneratíve avascuíar necrosís of the femoraí head. It affects chíídren aged 3-12 years & ís more common ín maíes. It ís most commoníy but not aíways unííateraí ( 85% ís unííateraí ). It presents maíníy by severe híp paín & íímpíng that íncreases by movement but ít can present by paíníess íímp. It characterístícaííy affects the ínternaí rotatíon & abductíon of the híp & íímíts these movements. 597) Which of the following is true regarding gastric lavage : A. Patient should be in the right lateral position . B. lt is not effective after 8 hours of aspirin ingestion . The correct answer ís b íavage ís effectíve oníy 1 hour after íngestíon of any poíson. After that íts íneffectíve ....................................... ................... 598) SSRl was prescribed to a patient with depression , the effect is suspected to be within : A. One day . B. Two weeks . C. Three to four weeks . The correct answer ís c Aííow 2 - 6 weeks to take effect , and treat for > 6 months ....................................... ................... +22. Randomi3ed controlled st%dy 'ill (e stron&er (y # A. Systemic >>>> B. Following at least 50 % of the participant . 7777777 ....................................... ................... 600) Partner lost his wife by AMl 6 months ago , presented by loss of appetite , low mood , sense of guilt , what is the diagnosis : A. Beverament . B. Major depression episode . The correct answer ís a - Ma|or depressíon ís a psychíatríc condítíon that occurs regardíess of events that happen ín íífe, whííe normaííy most peopíe wouíd have beverament after death of a cíose person. 601) An adult was presented by sore throat , congestion , fatigue , petechia in soft palate , tender spleen , and liver , what is the most likely diagnosis : A. EBV . Only 1 choice7 This could be Rubella infection as petechia in soft palate (Forschheimer spots) occur in rubella also. But liver & spleen affection are more common in EBV. Also since it is an adult then we might suspect leukemia as the cause. ....................................... ................... 602) Patient was presented by blepharitis , acne roseca , but no keratitis , what is the best treatment : A. Topical chlorophenicol . B. Topical gentamicin . C. Oral doxycyclin . The correct answer ís c ....................................... ................... 603) Diabetic patient was presented by spastic tongue , dysarthria , spontenous crying what is the most likely diagnosis : A. Parkinson . B. Bulbar palsy . C. Pseudobulbar . D. Myasthenia gravis . The correct answer ís c Thís ís a bít trícky. Buíbar paísy ís the LMNL of the íast 4 CN, whííe pseudobuíbar paísy ís the UMNL of the íast 4 CN. So spastícíty of tongue ís UMNL. But Díabetes causes LMNL of craníaí nerves due to perípheraí neuropathy. So maybe the cuase here ís CNS affectíon due to atheroscíerosís from macroangíopathy of díabetes. 604) Which of the following is describe the normal developmental stage for 6 months old child : A. Sits without support . B. Rolls front to back . (7-8 months) C. No head lag . (3 months) D. Stand alone . (1 year) The correct answer ís a ....................................... ................... 605) Which of the following personality is characterized by inflexibility , perfectionism 7 A. OCD . B. Not otherwise specified . C. Narcissistic . The correct answer ís b Obsessíve compuísíve personaííty dísorder ís dífferent from obsessíve compuísíve dísorder and ís characterízed maíníy by perfectíonísm whííe OCD ís characterízed by repetítíve actíons due to compuísíon. if OCPD is present in the choices it would be the answer. ....................................... ................... 606) What is the commonest cause of otorrhea : A. Acute otitis media . B. Basal skull fracture . C. External otitis . The correct answer ís a ....................................... ................... 607) Patient was presented by ear pain , red tympanic membrane , apparent vessels , with limited mobility of the tympanic membrane , what the most likely diagnosis : A. Acute otitis media . B. Tympanic cellulitis . C. Mastoditis . The correct answer ís a 608) What is the management of acute congestive glaucoma : A. lV acetazolamide and topical pilocarpine . (true) ....................................... ................... 609) Eight years old child with late systolic murmur best heard over the sterna border , high pitch , crescendo , decrescendo ,>> diagnosis is : A. Physiological murmur . B. lnnocent murmur . C. Ejection systolic murmur . D. Systolic regurgitation murmur . The correct answer ís c ( I'm not sure ) ....................................... ................... 610) Child was presented by coryza , skin rash , conjunctivitis , and multiple spots in the mouth : A. Measles . B. Rubella . The correct answer ís a. Measíes : due to con|unctívítís whích ís not present ín rubeíía ....................................... ................... 611) Which of the following could be seen in patient with bulimia : A. Hypokalmeia . B. Metabolic acidosis . The correct answer ís a buíímía ís aka bíng eatíng whích means the patíent eats a íot then does forced vomítíng so there ís íoss of acíds & eíectroíytes whích íeads to hypokaíemía & metaboííc aíkaíosís. 612) Maximum spinal height is reached after menarche by how many years 7 A. Months . B. Two years . C. Three years . The correct answer ís c menarche ís at 12-14 years and maxímum heíght ís about 17 years ....................................... ................... 613) Pregnant lady 34 weeks of gestation presented by vaginal bleeding , which of the following is relevant to ask about : A. Smoking . B. Desire of future pregnancy . C. The result of last pap smear . D. Hx of vaginal irritation . The correct answer ís a , because smokíng ís an ímportant rísk factor for antepartum he ....................................... ................... 614) Female patient with marginal placenta previa , with 6 cm dilated cervix , what is your management : A. Fetal monitoring . B. Delivery if fully dilated . C. Tocolytics > The correct answer ís a ( I'm not sure ) I couídn´t fínd the answer correctíy so based upon the gíven data, fetaí monítoríng ís a must ín any case of hígh rísk pregnancy. Aíso as the PP ís margínaí, there ís possíbíííty of deíívery wíthout severe PPH and the cervíx ís aíready dííated. 615) Which of the following drugs increase the survival in a patient with heart failure : A. Beta blocker . B. ACE inhibitors . C. Digoxin . D. Nitrites . The correct answer ís b New updated ínformatíon. As ACE ínhíbítors ínhíbít aídosterone whích íf present ín hígh concentratíons causes modífícatíon of the cardíac myocytes ín the íong term. ....................................... ................... 616) Elderly patient presented by SOB , rales in auscultation , high ]VP , +2 lower limb edema , what is the main pathophysiology : A. Left ventricular dilatation . B. Right ventricular dilatation . C. Aortic regurgitation. D. Tricuscpid regurgitation . The correct answer ís a ( cofuuuuuuuse ) Difficult question. Here we have both symptoms of Lft ventrícuíar faííure (SOB, Raíes) & Rt ventrícuíar faííure (Hígh |VP & LL edema). So, more commoníy íft ventrícuíar faííure íeads to rt ventrícuíar faííure due to overíoad and not více versa . so the most correct ís Lft ventrícuíar dííatatíon. ....................................... ................... 617) Patient with high output fistula , for which TPN was ordered , after 2 hours of the central venous catheterization , the patient become comatose and unresponsive , what is the most likely cause : A. Septic shock . B. Electrolytes imbalance . C. Delayed response of blood mismatch . D. Hypoglycemia . E. Hypernatremia . The correct answer ís a 618) Female patient presented by tender mass below the axilla , with previous history of pores and black heads in that's area <<< what is your management : A. Go to surgery immediately . B. Oral antibiotics . C. Topical antibiotics . D. Steroid . The correct answer ís a , Thís ís mostíy an ínfected abscess. ....................................... ................... 619) Child was presented by erythema , and swelling in his hand after 18 hours of bee sting , what is your management in this case : A. Epinephrine . B. Antihistaminic drugs . C. Hospitalization . The correct answer ís b 18 hours ís a íong duratíon so íts unííkeíy to be anaphyíactíc shock & more ííkeíy a reguíar reactíon to bee stíngs so antíhístamínícs ís the best soíutíon ....................................... ................... 620) Which of the following is true regarding metformin : A. Main complication is hypoglycemia . B. Can lead to weight gain . C. lt suppress the hepatic glauconeogenesis . The correct answer ís c ....................................... ................... 621) Child was presented by congested throat , coryza , high grade fever , which of the following is true regarding this condition : A. Viral > bacterial . B. Bacterial > viral . C. Antibiotics should be given any way . D. lt is most likely due to EBV . The correct answer ís b ?????? 622) Benign tumors of stomach represent almost : A. 7 % B. 21 % C. 50 % D. 90 % The correct answer ís a ....................................... ................... 623) 60 years old patient presented by recurrent venous thrombosis including superior venous thrombosis , this patient most likely has : A. SLE . B. Nephrotic syndrome . C. Blood group O . D. Antiphospholipid syndrome . The correct answer ís d ....................................... ................... 624) Elderly male patient was presented by left lower abdomen tenderness , fever , elevated WBC count , what is the most likely diagnosis : A. lnflammatory bowel . B. Diverticulitis . The correct answer ís b ....................................... ................... 625) 22 years old male patient was presented by recurrent attacks of diarrhea , constipation , and abdominal pain relieved after defecation , but no blood in the stool , no weight loss : what is the diagnosis : A. lrritable bowel Syndrome 626) Patient was presented by back pain relieved by ambulation , what is the best initial treatment : A. Steroid injection in the back . B. Back bracing . C. Physical therapy . The correct answer ís c ....................................... ................... 627) Patient with long history of constipation presented by painful defecation , followed by bleeding , pain persist for hours after defecation what is the diagnosis : A. Anal fissure . B. Thrombosed external piles . C. lnternal hemorrhoid . The correct answer ís a ....................................... ................... 628) Elderly male patient underwent colectomy for colon cancer in which micrometastais was detected in the lymph nodes , what is the best explaniation : A. Good prognosis . B. Liver metastasis . C. lt is sensitive to chemotherapy . (Dukes class C cancer best for chemotherapy) D. lt is locally advanced . The correct answer ís c ....................................... ................... 629) lV drug abuser was presented by fever , arthralgia , conjunctival hemorrhage , what is the diagnosis : A. Bacterial endocarditis . ....................................... ................... 630) Female patient was presented by dysurea , epithelial cells were seen urine analysis , what is the explanation in this case : A. Contamination . B. lnfection . The correct answer ís b 631) Patient was presented by tremor , fever , palpitation , diagnosed as case of hyperthyroidism , what is your initial treatment : A. Surgery . B. Radio iodine . C. Beta blockers . Propylthioracil . The correct answer ís c , fírstíy B-bíocker then Prophyíthíouracíí because we are afraíd of arrhythmías ....................................... ................... 632) Young female patient presented by pain during the first 2 days of menses , menarche was 2 years back , what is your initial treatment : A. OCP . B. NSAlD . The correct answer ís b , NSAID ít ís the best ínítíaí treatment for dysmenorrheaí ....................................... ................... 633) Female is planning to get pregnant , she want to get MMR vaccine also , what is your action : A. Delay the pregnancy 2-3 months after vaccination . B. lt is safe during pregnancy . The correct answer ís a ....................................... ................... 634) Which of the following is true regarding varicella vaccine during breast feeding : A. lt is safe . B. No breast feeding except after 3 days of the immunization . Couldn't find the answer ....................................... ................... 635) Patient underwent abdominal surgery due to intestinal perforation many years back , presented by abdominal pain , distension , constipation , what is the best investigation in this case : A. Barium enema . B. Ultrasound . C. Small bowel barium study . The correct answer ís c 636) True negative test is best described as following : A. Not suspected to have the disease who actually do not have . ....................................... ................... 45-. *atient 'ith AM/ and m%ltiple *6C , is yo%r treatment !or this arrhythmia # A. Amiadrone . B. No treatment . ....................................... ................... 638) Adenosine dose should be reduced in which of the following cases : A. Chronic renal failure . B. Patients on thiophyline . The correct answer ís a ....................................... ................... 639) Which the following is the commonest complication of patient with chronic atrial fibrillation : A. Sudden death . B. Cerebra vascular accidents . The correct answer ís b , due to muítípíe atríaí thrombí ....................................... ................... 640) Which of the following is most likely seen in case of active glomerlonephritis : A. RBC casts . ....................................... ................... 641) Target HbA1c is less than : A. 6.5 B. 8 C. 9 The correct answer ís a 642) Female patient with candida most likely has : A. DM . B. SLE . The correct answer ís a ....................................... ................... 643) Which of the following indicates good prognosis in schizophrenia : A. Family history of schizophrenia . B. Gradual onset . C. Flat mood . D. Prominent affective symptoms . E. No precipitating factors . The correct answer ís d ....................................... ................... 644) Pregnant woman with suspected DVT , what is the best initial investigations : A. Duplex US . B. D dimer . C. Platysomgraphy . D. Venogram . The correct answer ís a ....................................... ................... 645) Which of the following is true regarding crohns disease : A. Partial thickness involvement . B. Fistula formation . C. Continuous area of inflammation . D. Mainly involve the recto sigmoid area . The correct answer ís b 646) Patient serology showed antibodies to the surface antigen for hepatitis B , what is your diagnosis : A. Previous infection or immunization . B. Chronic carrier . C. Highly infective . The correcr answer ís a ....................................... ................... 647) Young male patient presented by acute scrotal pain , US showed reduced blood flow , what is the diagnosis : A. Testicular torsion . B. Trauma . C. lnfection . D. Hernia . The correct answer ís a ....................................... ................... 648) Female patient is sure that she is pregnant for 2 months , on examination , the uterus is larger than suspected , B-hcg is very high , the doctor diagnosed her as having tumor which is chemo sensitive , what is the diagnosis : A. Ovarian cancer B. Endometrial cancer . C. Gestational trophoblastic . The correct answer ís c ....................................... ................... 649) Which of the following is true regarding infertility : A. lt is Failure to conceive withing 6 months . (1 year) B. Male factor > female factors . (the reverse) C. lt could be due to high prolactin levels . D. Rare to be due anovulotion . (common) E. Only diagnosed by HSG . (need full lab & imaging investigations) The correct answer ís c 650) 32 years old female patient presented by irregular menses , menses occurs every two months , on examination every thing is normal , which of the following is the LEAST important test to ask about first : A. CBC . B. Pelvic US . C. Coagulation profile . D. DHES . The correct answer ís c ....................................... ................... 651) Patient with early rheumatoid arthritis , what is your management to decrease the limitation of movement : - Do not use analgesics or steroids, use DMARDs like methotrexate or antiTNF, hydroxychloroquine ....................................... ................... 652) Patient with truncal obesity , easy bruising , hypertension , buffalo hump , what is the diagnosis : A. Cushing . ....................................... ................... 653) Patient is known case of cervical spondylolysis , presented by parasthesis of the little finger , with atrophy of the hypothenar muscles , EMG showed cubital tunnel compression of the ulnar nerve , what is your action now : A. Ulnar nerve decompression . B. Steroid injection . C. CT scan of the spine . The correct answer ís a 654) Well known case of SCD presented by plueritic chest pain , fever , tachypnea , respiratory rate was 30 , oxygen saturation is 90 % what is the diagnosis : A. Acute chest syndrome . B. Pericarditis : C. VOC . The correct answer ís a , or pneumonía wouíd be more correct íf ít was the answer ....................................... ................... 655) Child with hemangioma around the eye , operation should be done within ... : A. 1 Week B. 3 months . C. 6 months . The correct answer ís a ( I'm not sure ) We oníy fear of reductíon ín the functíon of the eye due to hemangíoma so ít shouíd be removed. ....................................... ................... 656) Which of the following is the recommended diet to prevent lHD : A. Decrease the intake of meat and dairy . B. Decrease the meat and bread . C. lncrease the intake of fruit and vegetables . 7777 The correct answer ís c ....................................... ................... 657) Which of the following can lead to polyhydrmnios : A. Duodenal atresia . B. Renal agenesis . Oligohydramnios C. Post term pregnancy . Oligohydramnios D. Diabetes inspidious . The correct answer ís a 658) Adult polycystic kidney disease is inherited as: A. Autosomal dominant . B. Autosomal recessive . C. X linked . The correct answer ís a ....................................... ................... 659) The best treatment for bacteroid : A. Clindamycin . ....................................... ................... 660) You have an appointment with your patient at 10 am who is newly diagnosed DM , you came late at 11 am because you have another complicated patient , what are you going to say to control his anger : A. Do not say any thing . B. Told him that there is another patient who really need your help . O not compíete, but may be The correct answer ís b ....................................... ................... 661) Well known case of DM was presented to the ER with drowsiness , in the investigations : Blood sugar = 400 mg}dl , pH = 7.05 , what is your management 7 A. 10 units insulin + 400 cc of dextrose . B. 0.1 unit}kg of insulin , subcutaneous . C. NaHCO . D. One liter of normal saline . The correct answer ís d ....................................... ................... 662) What is the best method for history taking : A. Yes or no questions . B. Open ended . C. Silent listening . The correct answer ís b 663) What you will give to prevent hemorrhagic disease of newborns : A. Vitamin K . ....................................... ................... 664) Arterial injury is characterized by : A. Dark in color and steady . B. Dark in color and spurting . C. Bright red and steady . D. Bright red and spurting . The correct answer ís d ....................................... ................... 665) 14 years old girl complaining of painless vaginal bleeding for 2-4 days every 3Weeks to 2 months ranging from spotting to 2 packs per day; she had 2ry sexual ccc 1 year ago and had her menstruation since 6 months on clinical examination she is normal sexual ccc, normal pelvic exam appropriate action a. OCP can be used b. You should ask for FSH and prolactin level c. Don't do anything & explain this is normal the correct answer ís c ....................................... ................... 666) 4 years old child what can he do a. Copy square and triangle b. Speak in sentences the correct answer ís a , íf copy square 4 years , but íf copu círcíe 3 years ....................................... ................... 667) baby can sit without support, walk by holding fourniture, Pincer grasp, pull to stand how old is he a. 8 months b. 10 months c. . 12 month d. 18 month The correct answer ís b 668) Patient came after deep laceration at the anterior part of the wrist: a. Wrist drop b. Sensory loss only c. Claw hand d. Unable to do thumb opposition The correct answer ís d 2- Radial nerve injury : wríst drop , common wíth humers ín|ury (humers groove) 3- Unlar nerve injury : cíaw hand , common wíth eíbow ín|ury 4- Median nerve inury :unabíe to do thumb opposítíon , common wíth wríst ín|ury ....................................... ................... 669) Best way to diagnose post streptococcus glomerulonephritis (spot diagnosis): a) Low C3 b) 7or RBC casts c) 7 The correct answer ís a ( I'm not sure ) Wíth these MCOs , I thínk the correct answer ís a , but most sensítíve ín díagnosís of post streptococcus gíomeruíonephrítís ís increase ASO titer : íumpy-bumby ímmunofíuorescence. or (streptozyme test, which tests antibodies to ASO) ( íf ASO títer wrítten wíth MCOs , ít ís correct answer . ...................................... .................... 670) COPD patient with emphysema has low oxygen prolonged chronic high CO2, the respiratory drive is maintained in this patient by: a. Hypoxemia b. Hypercapnemia c. Patient effort voluntary d. 7 The correct answer ís a ( I'm not sure ) ....................................... ................... 671) Child with ear pain with positive pump test for tympanic membrane, treatment is: a. Maryngiotomy b. Amoxicillin}Potassium ... 7 The correct answer ís a 672) Patient has fatigue while walking last night. He is on atrovastatin for 8 months, Ciprofluxacin, Dialtizem and alphaco... the cause of this fatigue is: a. Dialtizem and Atrovastatin b. Atrovastatin and Ciprovluxacin c. Atrovastatin and Alphaco d. 7 the correct answer ís b ( I'm not sure ) ....................................... ................... 673) Patient with ischemic stroke present after 6 hours, the best treatment is: a) ASA b)TPA c) Clopidogril d)lV heparin e) Other anticoagulant The correct answer ís a 1- TPA : admínístered wíthín 3h of symptoms onset ( íf no contraíndícatíon) 2- ASA: use wíth 48h of íschemíc stroke to reduce rísk of death. 3- Calopidogril : can be use ín acute íschemíc 4- Heparin & other anticoagulant : ín patíent has hígh rísk of DVT or AF ....................................... ................... 674) Patient with lateral and vertical diplobia, he can't abduct both eyes, the affected nerve is: a) ll b)lll c) Vl d)V I thínk thís ís dípíopa because nerve 4 , but wíth thís O I choose c 675) lnfant with heamangioma on forehead obscuring the vision, best thing to do is to remove the lesion to avoid amblyobia, after: a) One day b)One week c) One month d)6 months e) One year The correct answer ís b ( I'm not sure ) ....................................... ................... 676) Photophobia, blurred vision, keratic 77 behind cornea and cells in anterior chamber, the best treatment is : a) Topical antifungal b)Topical Acyclovir c) Antibiotic d)7 The correct answer ís b ....................................... ................... 677) Most common medical problems faced in primary health care is: a) Coryza b)UTl c) Hypertension d)Diabetes The correct answer ís a ....................................... ................... 678) Old lady afraid of Osteoprosis, to avoid the risk, you should advise her to do: a) Weight bearing exercise b)7 c) 7 d)7 O ís not compíete. 679) Obese lady with essential hypertension, lab work showed: high Na, High K, The reason for Hypertension is: a) Obesity b)High Na intake c) High K intake d)7 The correct answer ís a , more than 85% of essentíaí hypertensíon wíth BMI > 25 . ...................................... .................... 680) Patient with eruptive purpuric rash, hepatosplenomegaly, .... a) 7 b) 7 c) 7 d) 7 ....................................... ................... 681) Single thyroid nodule showed high iodine uptake, best treatment is: a) Radio lodine 131 b)Send home c) Antithyriod medication d)Excision if present The correct answer ís c ....................................... ................... 682) Athletic with tina pedis best treatment is: a) Topical antifungal b)Systemic antifungal c) Drug starts with trebenafine d)7 The correct answer ís a 683) Young patient with congested nose, sinus pressure, tenderness and green nasal discharge, has been treated three times with broad spectrum antibiotics previously, what is your action7 a) Give antibiotic b)Nasal corticosteroid c) Give anti histamine d)Decongestant The correct answer ís b ....................................... ................... 684) Thyrotoxicosis include all of the following, Except: a) Neuropathy b)Hyperglycemia c) Peripheral Proximal myopathy d) O ís not compíete , aíí MCOs are wrong , may be choíce d ís correct íf mentíon . ....................................... ................... 685) Male patient has hair loss started as fronto-temporal and moving toward the vertex (top of the head) the diagnosis is: a) Androgenic alopecia b)Tinea Captus c) 7 d)7 The correct answer ís a ....................................... ................... 686) Young healthy male has abdominal pain after basketball. Examination fine except for Left paraumbilical tenderness, what to do: a) Abdominal US b)Flat plate graph c) Send home & reassess within 48 hours d)7 The correct answer ís c ( I'm not sure ) , confuse wíth choíce a 687) 10 year-old boy with ..to tell that spinal cord length will stop after: a) 7 b) 7 Length stop at L1 \ L2 ....................................... ................... 688) Child with atopic dermatitis at night has stridor plus barking cough on and off from time to time, diagnosis is: a) BA b)Croup c) Spasmadic Croup d)7 The correct answer ís c Spasmadic croup : recurrent sudden upper aírway obstructíon whích present as srídor and cough . approxímateíy 50% of chíídren have atopíc dísease. ....................................... ................... 689) Sickle cell anemia patient presented with asymptomatic unilateral hip pain, most likely diagnosis is: a) Septic arthritis b)Avascular Necrosis c) 7 The correct answer ís b ....................................... ................... 690) Best drug to treat depression in children and adolescent is: a) Fluxetine (Prozac) b)7 ....................................... ................... 691) Old male with neck stiffness, numbness and parasthesia in the little finger and ring finger and positive raised hand test, diagnosis is: a) Thoracic outlet syndrome b)lmpingement syndrome c) Ulnar artery thrombosis d)Do CT scan for Cervical spine The correct answer ís a 692) Patient diagnosed with obstructive jaundice best to diagnose common bile duct obstruction: a) ERCP b)US c) 7 The correct answer ís a ....................................... ................... 693) Endometriosis best diagnosed by a) US b)Laproscopy c) Lapratomy d)7 The correct answer ís b ....................................... ................... 694) Child was sick 5 days ago culture taken showed positive for meningococcal. Patient now at home and asymptomatic your action will be: a) Rifampicin b)lM Ceftrixone c) 7 d)7 O not compíete ( í.m ceftríaxon síngíe dose or oraí rífampícín 2-5 days ) ....................................... ................... 695) lnfant with bright blood, black stool and foul smelling stool. Best way to know the diagnosis: a) US b)Radio lsotop scan c) Angiogram d)7 Aíí MCOs are wrong , íf stooí anaíysís ís present , ít ís correct. 696) Primary hyperaldosteronism associated with: a) Hypernatremia b)Hypomagnesemia c) Hypokalemia d)Hyperkalemia The correcr answer ís c ....................................... ................... 697) A vaccination for pregnant lad with DT a) Give vaccine and delivery within 24 hrs b)Contraindicated in pregnancy c) Not contraindicated in pregnancy d)7 The correct answer ís c ....................................... ................... 698) A study done to assess the risk of long taking Ca in two groups the diseased group with long Ca plus control according to geographical location, site, and population. lt adds (77) this type of study: a) Cohort b)Case Control (retrospective) c) Correlation study d)7 The correct answer ís a Cross-Sectional Study: status of índívíduaí wíth respect to presence and absence of both exposure and dísease assessed at one poínt ín tíme case control study ( retrospective ) : sampíes a group of peopíe who aíready have a partícuíar outcome (cases) and compares them to a símííar sampíe group wíthout that outcome (controís) cohort study : ( prospective, incidence , longitudinal ) sub|ects are sampíed and as a group are cíassífíed on the basís of presence or absence of exposure to a partícuíar rísk factor ....................................... ................... 699) Define Epidemiology a) 7 "The study of the distribution and determinants of disease prevalence in man" 700) Case Control description a) Start with the outcome the FU risk factors b) 7 ...................................... .................... 701) Using gastric lavage : a) Useless after 8 hours of ASA ingestion b)No benefit after 6 hours of TCA ingestion c) 7 The correct answer ís a ....................................... ................... 702) 10 years old child with rheumatic fever treated early, no cardiac complication. Best to advice the family to continue prophylaxis for: a) 1 month b)3 ys c) 4 ys d)15 ys The correct answer ís d ( I'm not sure , íf there ís 11 years choose ít ) Amerícan heart assocíated has recommended aíí patíent wíth hístory rheumatíc fever be píaced on íonge term penícíííín prophyíaxíc. Duratíon of prophyíaxís depends on presence or absent of cardítís, but for chíídren wíthout cardítís , duratíon mínímum 5 years or at age 21, whíchever ís íonger. 703) Picture of large neck mass only no other manifestations or organomegaly or lymphadenopathy, diagnosis is: a) Mononucleosis b)l would say Goiter c) 7 d)Lymphoma The correct answer ís b ....................................... ................... 704) Patient with nausea, vomiting, and diarrhea developed postural hypotension. Fluid deficit is: a) lntracellular b)Extracellular c) lnterstitial The correct answer ís b ....................................... ................... 705) Cardiac syncope: a) Gradual onset b)Fast recovery c) Neurological sequence after d)7 The correct answer ís b ....................................... ................... 706) Best way to decrease pain in elderly with bilateral knee pain and crepitation is: a) NSAlD b)Decrease weight c) Exercise d)7 The correct answer ís b , (I'm not sure ) 707) Young female with whitish grey vaginal discharge KOH test 77 smell fish like diagnosis is: a) Gonorrhea b)Bacterial Vaginosis c) Trachomanous Vaginalis d)7 The correct answer ís b ....................................... ................... 708) Old lady with osteoporosis asked for treatment for prevention: a) VlT. D b)VlT. E c) Retonic Acid d)7 The correct answer ís a ....................................... ................... 709) Young male with morning stiffness at back relieved with activity and uveitis: a) Ankylosing Spondylitis b)7 ....................................... ................... 710) Best way to prevent infection in medical practice in pediatric a) Wear gloves b)Wash hand c) Wear mask d)Wear gown The correct answer ís b ....................................... ................... 711) High risk for developing colon cancer in young male is: a) Smoking, high alcohol intake, low fat diet b) Smoking, low alcohol intake, high fat diet c) Red meat diet, garden's disease (Gardner syndrome) d) lnactivity, smoking The correct answer ís c 712) Alternative therapy for severe depression and resistance to anti-depressant medications are: a) SSRl b)TCA c) ECT The correct answer ís c ....................................... ................... 713) Patient had history of pancreatic cancer on chemotherapy then improved completely, came to doctor concerning about recurrence of cancer and a history of many hospital visits. This patient has: a) Malingering b)Hypochondriasis c) Factitious d)Conversion The correct answer ís b ....................................... ................... 714) Patient came with neck swelling, ,moves when patient protrude his tongue. Diagnosis is: a) Goiter b)Tyroglossus Cyst c) Cystic Hygroma d)7 The correct answer ís b ....................................... ................... 715) Pregnant patient came with neck swelling and multiple nodular non-tender goiter the next evaluation is: a) Thyroid biopsy b)Give anti-thyroid medication c) Radiation lodine d)TSH & Free T4, or just follow up The correct answer ís d 716) Young patient with HTN came complaining of high blood pressure and red, tender, swollen big left toe, tender swollen foot and tender whole left leg. Diagnosis is: a) Cellulitis b)Vasculitis c) Gout Arthritis d)77 The correct answer ís a , because tender and swoííen whoíe íeft íeg. ....................................... ................... 717) What is the injection that is routinely given to newborn to inhibit hemorrhage: a) Vit. K b)Vit. C c) Vit. D d)Vit. E The correct answer ís a ....................................... ................... 718) Patient with strong genetic factor for colon cancer, what is the medication that could decrease the risk of colon cancer: a) Folic Acid. b)Vit. C c) Vit. K or A d)Vit. E The correct answer ís a ( foíaíc acíd and vít. C both are prevent coíon cancer , but foíat reduce rísk ín peopíe who geníc predísposíng ) ....................................... ................... 719) Patient with asthma, well controlled by albutarol, came complaining of asthma symptoms not respond to albutarol, what medication could be added: a) Corticosteroid inhaler b) Long acting B-agonist c) Oral corticosteroid d) Theophyline The correct answer is a 720) Henosch-Scholen purpura affect: a) Capillary b)Capillary and venule c) Arteriole, capillary and venule d)Artery to vein The correct answer ís c ....................................... ................... 721) Contraceptive pill that contain estrogen increase risk of: a) Breast Ca b)Ovary Ca c) Cervical Ca d)7 The correct answer ís a ....................................... ................... 722) Patient came with upper respiratory tract infection with red conjunctiva, the cause is: a) Viral infection b)Bacterial infection c) Fungal infection d)7 The correct answer ís a ....................................... ................... 723) Healthy patient with family history of DM type 2, the most factor that increase chance of DM are: a) HTN and Obesity b)Smoking and Obesity c) Pregnancy and HTN d)Pregnancy and Smoking The correct answer ís a 724) Patient complaining of back pain and hypersensitive skin of the back, on examination, patient had rashes in the back, tender, red base distributed as blunt shape on the back, diagnosis is: a) Herpes Zoster b)CMV c) 7 d)7 The correct answer ís a ( q not compíete ) ....................................... ................... 725) Old patient complaining of hematuria, on investigation, patient has bladder calculi, most common causative organism is: a) Schistosoma b)CMV c) 7 virus d)7 virus The correct answer ís a ....................................... ................... 726) Blood culture show gram negative rod shape that grow only on charcoal free fungal organism is: a) Staph. Aureus b) Chlamydia c) Klebsiella d) Mycoplasma Aíí above are wrong , le&ionella : grame negatíve rod growth on charcoaí agar ....................................... ................... 727) Klebesilla feacalis cause the following disease: a) Pneumonia b) 7 c) 7 d) 7 Enterococcus faecalis Cause Gastroenteritis ....................................... ................... 728) Dermatomyositis came with the following symptoms: a) Proximal muscle weakness b)Proximal muscle tenderness c) 7 d)7 The correct answer ís a ....................................... ................... 729) Bursitis of the elbow joint caused by: a) Elbow trauma b)Autoimmune disease c) Staph. Aureus d)7 rupture of bursa The correct answer ís a ....................................... ................... 730) Patient came with symptoms of anxiety including palpitation, agitation, and worry. The first best line for treatment is: a) SSRl b)TCA c) B-blocker d)MAOl The correct answer ís a , I'm not sure May be the correct answer ís b because there ís agítatíon ( aíso, síde effect of SSRI) ....................................... ................... 731) Pregnant diagnosed with UTl. The safest antibiotic is: a) Ciprofloxacin b)Ampiciln c) Tetracycline d)7 Wíth these MCOs , the correct answer ís b , but íf present nitrofurantion ís more accurate answer . UTI ín pregnancy treated by : nitrofurantion or cephalosporine ( 3- 7 days ) ín symptomatíc or asymptomatíc UTI . avoíd fíuroroquínoíone ( whích íncíude : cíprofíoxacín, gatífíoxacíne, íevofíoxacín, norfíoxacín ). 732) Patient is complaining of right side pharynx tenderness on examination patient had inflamed right tonsil and redness around tonsil with normal left tonsil. The diagnosis is: a) Parenchymal tonsillitis b)Çuinse parapharyngeal abscess c) 7 d)7 The correct answer ís b ....................................... ................... 733) Patient came complaining of fever, night sweating, and hemoptysis with positive PPD test. Examination was normal, CXR shows infiltrate of left apical lung but in lateral X-ray showed nothing the repeated PPD test showed normal result diagnosis is: a) Sarcoidosis b)Reactivated TB c) Mycoplasma infection d)Viral infection The correct answer ís b ...................................... .................... 734) Femal patient came with lower abdominal pain, fever on exam patient has lower abdominal tenderness and tender cervical fornix, the most appropriate way to diagnose the problem is: a) Laproscopy b)Heterosalpingography c) Abdominal CT d)Radionuclar Study The correct answer ís a ....................................... ................... 735) The best non-medical therapy is proven to be of benefit for osteoarthritis is: a) Muscle strength exercise b) Give NSAlD c) Back slap d)7 The correct answer ís a 736) Hematological disease occurs in children, treated with heparin and fresh frozen plasma what is the disease: a) Hemophilia A b)Hemophilia B c) Von-wille brand disease d)DlC thrombosis The correct answer ís d ....................................... ................... 737) Child with URTl is complaining of bleeding from nose, gum and bruising the diagnosis is: a) Hemophilia A b)lTT c) 7 d)7 The correct answer ís b ....................................... ................... 738) Patient came complaining of vague abdominal pain for 6 hours then shifted to right lower quadrant diagnosis is : a) Acute appendicitis b)Diverticulitis c) 7 d)7 The correct answer ís a ....................................... ................... 739) Female patient is complaining of abdominal distension, fever and nausea abdominal x-ray showed (Ladder sign) management is: a) Colostomy b)lleus treatment c) Rectal de-obstruction d)7 The correct answer ís b ( I'm not sure because O IS NOT COMPLETE ) 740) The best stimulus for breast milk secretion is : a) Estrogen b)Breast feeding c) 7 The correct answer ís b ....................................... ................... 741) Female patient did urine analysis shows epithelial cells in urine, it comes from: a) Vulva b)Cervix c) Urethra d)Ureter The correct answer ís c ....................................... ................... 742) All of the following are risk factors for heart disease except: a) High HDL b)Male c) Obesity The correct answer ís a ....................................... ................... 743) The most signs and symptoms of abruption of placenta is: a) Vaginal bleed b)Fetal distress c) Uterus pain and back pain d)Abnormal uterine contraction The correct answer ís a 744) Sign of severe hypokalemia is: a) P-wave absence b)Peak T-wave c) Wide ÇRS complex d)Seizure The correct answer ís d , ( I'm not sure , may be choíce e íf mentíon , ís corect ) severe hypokalemia is defined as a level less than 2.5 mEq}L. Severe hypokalemia is not linked with any symptoms, but may cause: 1- muscíe 2- myaígía or muscíe paín 3- dísturbed heart rhythm íncíudíng ectopy (dísturbance of the eíectrícaí conductíon system of the heart where beats aríse from the wrong part of the heart muscíe) 4- seríous arrhythmías (eíectrícaí faster or síower than normaí) 5- greater rísk of hyponatremía (an eíectroíyte dísturbance ín humans when the sodíum concentratíon ín the píasma decreases beíow 135 mmoí/L) wíth confusíon and seízures ECG changes in hypokalemia : 1-T-wave fíatteníng 2-U-wave : ( addítíonaí wave after the T wave ) 3-ST - segment depressíon ECG changes in hyperkalemia : 1- peak T wave 2- wíde ORS ( ín severe case ) 3- PR proíong ( ín severe case ) 4- íoss of P wave ....................................... ................... 745) Child came with his father and high BMl and look older than other children with same age, on exam child has >95 th percentile of weight and tall, management is: a) Observe and appoint b)Life style change c) Give program to decrease the weight d)7 The correct answer ís a 746) Pregnant on 36 th week came with 7 cm cervical width at 0 station. During birth, CTG shows late deceleration, management is: a) Give Oxytocin b)O2 and change mother position c) Give Mg sulfate d)7 The correct answer ís b Type of deceleration etiology management early Head compressíon from uteríne contractíon (normaí ) No treatment late Uteropíacenta ínsuffícíency and fetaí hypoxíma • Píace patíent on síde • Díscontínue oxytocín. • Correct any hypotensíon • IV hydratíon. • If deceíeratíons are assocíated wíth tachysystoíe consíder terbutaííne 0.25 mg SC • Admíníster O2 • If íate deceíeratíons persíst for more than 30 mínutes despíte the above maneuvers, fetaí scaíp pH ís índícated. • Scaíp pH > 7.25 ís reassuríng, pH 7.2- 7.25 may be repeated ín 30 mínutes. • Deííver for pH < 7.2 or mínímaí baseííne varíabíííty wíth íate or proíonged deceíeratíons and ínabíííty to obtaín fetaí scaíp pH variable Umbííícaí cord compressíon • Change posítíon to where FHR pattern ís most ímproved. Trendeíenburg may be heípfuí. • Díscontínue oxytocín. • Check for cord proíapse or ímmínent deíívery by vagínaí exam. • Consíder amníoínfusíon • Admíníster 100% O2 747) The way to determine the accuracy of occult blood test for 11,000 old patients is by measuring: a) Sensitivity b)Specificity c) Positive predictive value d)Negative predictive value The correct answer ís a ....................................... ................... 748) Sickle cell patient, asymptomatic with history of recurrent gall-stones and recurrent crisis the management is: a) Cholecystectomy b)Hydroxyurea The correct answer ís a ....................................... ................... 749) Patient came with HTN, KUB shows small left kidney, arteriography shows renal artery stenosis, what is the next investigation: a) Renal biopsy b)Renal CT scan c) Renal barium d)Retrograde pyelography The correct answer ís ....................................... ................... 750) The way to differentiate between low iron level from iron deficiency anemia and anemia of chronic disease is: a) Ferritin b)TlBC c) Serum lron d)Serum Transferrin The correct answer ís a 751) Patient came with hallucination and illusion the medication that should be given is: a) Carbamezapin b)7 Haloperidol c) 7 O not compíete, but wíth thís scenarío and MCOs , the correct answer ís b ....................................... ................... 752) As doctor if you see patient and you face difficulty to get accurate information from him the best tactic to do it is: a) Ask direct question b)Ask open question c) Control way of discussion d)7 The correct answer ís a ....................................... ................... 753) (long question) patient came with MDD so during communication with patient you will find : a) Hypomania b)Late morning awake c) Loss of eye contact d)7 The correct answer ís b ....................................... ................... 754) Child patient after swimming in pool came complaining of right ear tenderness on examination patient has external auditory canal redness, tender, and discharge the management is: a) Antibiotics drops b)Systemic antibiotics c) Steroid drops d)7 The correct answer ís a 755) Child came with inflammation and infection of the ear the most complication is: a) Labrynthitis b)Meningitis c) Encephalitis d)Mastoiditis The correct answer ís d ....................................... ................... 756) Elderly patient complaining of urination during night and describe when he feel the bladder is full and need to wake up to urinate, he suddenly urinate on the bed this is: a) Urgency incontinence b)Urge incontinence c) Stress incontinence d)Flow incontinence The correct answer ís d types Hx of urine loss mechanism treatment total Uncontroííed íoss at aíí tímes and ín aíí posítíon Loss of sphíncter effícíency or abnormaí connectíon b\w urínary tract and skín( fístuía) surgery stress After íncrease abdomínaí pressure (coughíng, sneezíng, ííftíng ) Urethraí sphíncter ínsuffícíency due to íaxíty of peívíc fíoor muscuíature , common ín muítíparous women Kegaí exercíseand pessary surgery urge Strong, unexpected urge to voíd that ís unreíated to posítíon or actívíty Detrusor hyperrefíexía or sphíncter dysfunctíon or neuroíogíc dísorder Antíchoíínergíc - medícatíon or TCA : behavíor traíníng overflo w Chroníc urínary retentíon Increase íntravesícaí pressure that |ust exceed the outíet Píacement of urethra catheter , treat resístance , aííow smaíí amount of dríbbíe out underíyíng causes 757) Newborn came with red-lump on left shoulder, it is: a) Hemangioma b)7 c) 7 Ç is not complete ....................................... ................... 758) Child came to ophthalmology clinic did cover test, during eye cover , his left eye move spontaneously to left, the most complication is: a) Strabismus b)Glaucoma c) Myobloma d)7 The correct answer ís a ....................................... ................... 759) Newborn came with congenital hepatomegaly, high LFT, jaundice the most organism cause this symptoms is: a) Congenital TB b)Rubella c) HlV d)CMV The correct answer ís d ....................................... ................... 760) Gross motor assessment at age of 6 months to be asked is: a) Sitting without support b)Standing c) Role from prone to supine position d)Role from supine to prone position The correct answer ís a 761) Female child came with precocious puberty the most cause is: a) ldiopathic b)Adrenal tumor c) Brain tumor d)7 ovarian tumor The correct answer ís a ....................................... ................... 762) Hemorrhoid usually occurs in: a) Pregnancy and portal HTN b) ? c) ? d) ? O ís not compíete Most common causes of hemorrhoid : íncrease straíníng ( constípatíon ) , portaí HTN , íncrease abdomínaí pressure ( chromíng cough , peívíc tumor ) , obesíty , pregnancy , smokíng ....................................... ................... 763) The immediate urgent referral of child that take a) 10 pills contraceptive b) 10 pills antibiotics7 c) 75 mg 7 77777 ....................................... ................... 764) Most unwanted side effect of anti-cholinergic drugs is : a) Constipation b) 7 c) 7 more than 50% of patíents takíng antíchoíínergíc have síde effects : dry mouth , bíurry vísíon , constípatíon and urínary retentíon . 765) Patient with DM ll with good vision, to prevent eye disease (Retinal back ground) to develop is to avoid: a) HTN, Smoking b)Obesity, Smoking c) HTN, Obesity d)7 The correct answer ís c The risk factors that increase diabetic retinopathy background are: 1- HTN 2- Poor gíucose controí or íong case D.M 3- Raísed íeveí of fat ( choíesteroí) 4- Renaí dísease 5- Pregnancy ( but not ín díabetes caused by pregnancy ) ....................................... ................... 766) Best medication to be given for GDM (gestational) is: a) lnsulin b)Metformin c) 7 The correct answer ís a 767) A child is complaining of severe headache which is unilateral, throbbing and aggravated by light, diagnosis is: a) Migraine b)Cluster Headache c) Stress Headache d)7 The correct answer ís a ....................................... ................... 768) The most important factor for smoker to quit is : a) Patient desire b)Give nicotine pills c) Give programmed plan d)Change life style The correct answer ís a ....................................... ................... 769) Patient is complaining of irritation, tachycardia, night sweating, labs done showed TSH: Normal, T4: High, diagnosis is: a) Grave's disease b)Secondary Hypothyriodism c) Hashimoto's thyroiditis d)7 Aíí MCOs are wrong , choíce d may be correct íf mentíon Normal TSH and increase T4 : in thyroid tropin secretary pitutay adenoma = thyroid resistance . ....................................... ................... 770) The most active form is: a) T4 b)T3 c) TSH d)TRH The correct answer ís b 771) Middle age man found to have heaviness in his groin. On physical examination there was swelling just above his testis which apparent with valsalva maneuver. What is the diagnosis: a) Direct inguinal hernia b)lndirect inguinal hernia c) Femoral Hernia d)Testicular mass e) Hydrocele f) Varicocele The correct answer ís b ....................................... ................... 772) Gardener has recurrent conjunctivitis. He can't avoid exposure to environment. ln order to decrease the symptoms in the evening, GP should advise him to: a) Cold compression b)Eye irrigation with Vinegar Solution c) Contact lenses d)Antihistamines The correct answer ís d ....................................... ................... 773) 48 year-old male complaining of lower back pain with morning stiffness for 30 minutes only. On exam he was having spasm centrally on the lower back. What is the appropriate management : a) Epidural steroids injection b)Back brace c) Facet lysis d)Physiotherapy The correct answer ís d ....................................... ................... 774) 41 weeks pregnant lady last biophysical profile showed oligohydroamnios. She has no complaints except mild HTN. What is the appropriate management : a) Wait b)lnduce labor post 42 wks c) lnduce labor d)Do biophysical profile twice weekly The correct answer ís c 775) Full term wide pelvis lady, on delivery station +2, vertex, CTG showed late deceleration, the most appropriate management: a) C}S b)Suction c) Forceps Delivery d)Spontaneous Delivery The correct answer ís c (I'm not sure ) ....................................... ................... 776) Recent study revealed that anti psychotic meds cause the following complication: a. wt gain b. alopecia c. cirrhosis the correct answer ís a ....................................... ................... 777) compilication of rapid correction of hypernatremia : a.brain edema in hypernatremia : graduaííy correctíon to prevent cerebraí edema in hyponatremia : graduaííy correctíon to prevent ,myeíínoíysís ( íncíude paraparesís \ quadríparesís , dysarthría and coma ....................................... ................... 778) prophylaxis of cholera : Cholera ís an ínfectíon of the smaíí íntestíne that ís caused by the bacteríum 6i(rio cholerae. The maín symptoms are profuse watery díarrhea ( ríce-watery díarrhea ) vomítíng and dehydratíon . ínfectíon by fecaí-oraí rout . treatment : 1- rehydratíon , 2-antíbíotíc : young & aduít : doxcycííne or tetracycííne , for chíídren : SMX-TMP , for pregnant : furazoíídone . prphylaxis : good hygíene and sanítatíon and oraí vaccíne , ín epídemíc pubííc : mass síngíe dose of vaccíne and tetracycííne. 778)which one of the anti TB medications cause tinnitus, imbalance.. a. streptomycin b. isoniazide c. pyrizinamide the correct answer ís a , sterptomycíne : cause 8 th nerve damage ...................................... .................... 779) the following combination drug should be avoided : a. levodopa & digoxin O ís not compíete ....................................... ................... 780)young male had pharyngitis,then cough ,fever,most likely org a. staph aureus b. strept pneumonia the correct answer ís b ....................................... ................... 781)most effective measure to prevent spread of infection among health care workers & pts in a nursery: a. wash hand befor and after examining each pt b. wear gown and gloves before entering the nursery c. wear shoe cover the correct answer ís a 782) 27 yrs old female with perianal pain for 4 days tender erythematous fluctuating a. Abx b. local CS c . Sitz bath e. evac & drain the correct answer ís e ....................................... ................... 783)female pt developed extreme from zoo,park, sporting events, the fear prevented her from going out: a. agoraphobia b. social phobia c. schizophrenia the correct answer ís a , ( agoraphopia : fear goíng out from the home ) ....................................... ................... 784)child starts to smile: a. at birth b. 2month c. 1month The correct answer ís b ...................................... .................... 785)child recognize 4 colors, 5 words, hops on one foot, consistent with which age: a. 12 mons b. 24 mons c. 36 mons d. 18 mons the correct answer ís c 786)pt with hx of 5 yrs HTN on thiazide, came to ER midnight screaming holding his Lt foot, o}e pt afebrile,Lt foot tender erythema, swollen big toe most tender and painful, no other joint involvement a. cellulitis b. gouty arthritis c. septic arthritis the correct answer ís b ....................................... ................... 787)23 yrs old married for 3 mons, c}o not getting pregnant, they have intercourse 3-4 times}week, normal gynecologic hx, husband 25 yrs old healthy wt would you advice: a. cont. trying b. obtain sperm analysis c. study of tubes patency the correct answer ís a ....................................... ................... 788)pt with AF what is the most common complication: a. cerebrovascular events b. v.tach c. AMl d. v.fib the correct answer ís a ....................................... ................... 789)case scenario : oral+genital ulcer +arthritis a. behcet disease b. syphilis c.herpes simplex the correct answer ís a 790) 20 yrs old lady, pregnant, exposed to rubella virus since 3 days , never was vaccinated against rubella mumps or measles , what's the best thing to do: a. give lG b. vaccine c. do nothing d. terminate the pregnancy the correct answer ís c , oníy supportíve . ( 100 % correct ) ....................................... ................... 790)which of the following not compatible with head engagement: a. vertex at zero station b. crowning of the head c. 3}5 head felt in the abdomen d. BPD at ischial spines the correct answer ís c , When the fetal head is engaged, 2}5 or less of the head is palpable above the pelvic 791)58 yrs old female, known case of osteopenia, she's asking you abt the best way to prevent compression vertebral fracture, what would you advice her: a. avoid obesity b. vit.D daily c. wt bearing exercise the correct answer ís c , cnfuse wíth choíce b mild osteopenia ( T score -1 to -2 ): íífe styíe modífícatíon ( stop smokíng ) , daííy caícíum íntak ( 1500 mg daííy ) , exercíse , and reassessed after 3 - 5 years . severe osteopenia ( T score -2 to - 2.5 ) and osteoporosis ( T score > 2.5 ) : same mííd pus pharmacoíogícaí . ....................................... ................... 792) Mother complains of sharp pain on radial styloid when carrying her baby. The pain increase with extension of the thumb against resistance, Finkelstein test was positive, Dx : a. Osteoarthritis of radial styloid b. De Çuervain Tenosynovitis the correct answer ís b ...................................... .................... 793) 1 st line in Trigeminal Neuralgia management: a. Carbamazepine ...................................... .................... 794) Contraindicated in acute glaucoma management: a. Pilocarpine b. Timolol c. B-blockers, CA inhibitors, NSAlD, Mannitol d. 7 Aíí of MCOs can be use ín acute gíaucoma . may be choíce d ís correct íf mentíon. 795) True about systolic hypertension: a. could be caused by mitral Regurg b. More serious than diastolic hypertension c. systolic>140 and diastolic <90 d. 7 the correct answer ís c ...................................... .................... 796) Pregnant 38GA, presented in labor, dilated cervix, station 42, late deceleration on CTG, management: a. continuo spontaneous labor b. Forcep delevary c. Vacuum Delevary d. CS The correct answer is a ( l'm not sure ) ....................................... ................... 797) Pt, febrile, tender prostate on PR: a-Acute Prostitis ....................................... ................... 798) Proven to prevent some cancers: a. Ca b. Folic Acid c. Vit.D the correct answer ís c ....................................... ................... 799) Patient with cont. Murmur: a. PDA b. Coarctation of Aorta the correct answer ís a 800) Old man, post OR, Complains of unilateral face swelling: a. Sjorjan syndrome b. Sarcoidosis c. Salivary gland tumor d. Salivary gland stone the correct answer ís d ....................................... ................... 801) At what level LP done: a. L2-L3 b. L3-L4 c. L5-S1 The correct answer ís b ....................................... ................... 802) 2months old with scaling lesion on scalp and forehead, Dx: a. Seberrhoic Dermatitis b. Erythema multiforme the correct answer ís a ....................................... ................... 803) Pt have high Blood Pressure on multible visits, so he was diagnosed with hypertension, what is the Pathophysiology: a. increased peripheral resistance b. increased salt and water retention the correct answer ís a ....................................... ................... 804) 13years old with hx of pneumonia and managed with abx 2 weeks back, now he came with diarrhea, abdominal pain, and +ve WBC in stool, the causative organism is: a. Clostridium dificile ....................................... ................... 805) Best Manag. Of Clost.Deficile is: a. Metronidazole b. Doxacycline the correct answer ís a 806) Prophylaxis of arrhythmia post Ml : a. Çuinidine b. Çuinine c. Lidocaine d. Procainamide the correct answer ís c , íf b-bíocker ís present choose ít ....................................... ................... 807) Chronic Diarrhea is a feature of: a. HyperNatremia b. HyperCalcemia c. HypoMagnesemia d. Metabolic Alkalosis The correct answer ís d ....................................... ................... 808) Pt with have Polyuria and thirst, he had Hx of bipolar on lithium, Dx: a. Nephrogenic Diabetes lnsipidus b. central Diabetes lnsipidus the correct answer ís a ....................................... ................... 809) ln city with population of 15000 people & 105 birth }yr , 4 are still birth ,3 died within months ,2 died before their 1 st birthday , with 750 p come out & 250 come in what is the birth mortality rate in this city : a. 4 b. 6 c. 8 d. 9 Ç not complete ( l did't finde any thing about bierth mortality rate ) 810) Female with recently inserted lUCD coming with watery brownish vaginal discharge & abdominal pain what is the most likely Dx : a. Uterine rupture b. Ovarian torsion c. Bacterial vaginosis d. Ectopic pregnancy The correct answer ís d ......................................... ................. 811) 38 y}o male calling you complaining of fear from going outside & fear from seeing the front door & don't sit in the room containing the front door what is most likely Dx: a. Depression b. Agoraphobia c. Malingering d. Anti-social personality The correct answer ís b ........................................ .................. 812) 60 y}o male known to have ( BPH) digital rectal examination shows soft prostate with multiple nodularity & no hard masses , the pt request for ( PSA) for screening for prostatic ca what will you do : a. Sit with the pt to discuss the cons & rods in PSA test b. Do trans-rectal US because it is better than PSA in detection c. Do multiple biopsies for different sites to detect prostatic ca d. ......... The correct answer ís a ......................................... ................. 813) What is the most effective ttt for rocasea : a. Clindamycine b. Erythromycin c. Topical steroids d. .... O ís not cíear or not compíete. ( íf mentíon tetracycííne choose ít ) Treatment of Rosacea : Oraí tetracycíínes & topícaí metronídazoíe or topícaí erthyromycín or topícaí cíínamycíne . for severe case : ísotretínoín . surgical treatment for rhinophyma . 814) 7 y}o child coming with SOB and wheezing he was sitting in bed , leaning forward , with drooling & strider what is Dx : a- Epiglottits b- Bronchial asthma c- ... d- ... The correct answer ís a ......................................... ................. 815) 10 y}o child brought by his parents because they where concern about his weight , he eats a lot of fast food and French fries , your main concern to manage this pt is : a- His parents concerning about his weight b- His BMl > 33 c- Family Hx of heart disease d- Eating habit ( fast food , French fries ) ......................................... ................. 816) What is an absolute contraindication of OCP : a. Hx of previous DVT b. Ovarian ca c. Breast ca d. .... The correct answer ís a , both hx of DVT and breast cancer are absoíute contraíndícatíon , but ín hx DVT ís more accurate ......................................... ................. 817) OCP is proven to : a. Decrease ovarian ca b. Decrease endometrial ca c. lncrease breast ca d. lncrease risk of ectopic pregnancy The correct answer ís c 818) Baby born & discharge with his mother , 3weeks later he started to develop difficulty in breathing & become cyanotic what is most likely DX : a- VCD b- Hypoplastic lt ventricle c- Coarctaion of aorta d- Subaortic hypertrophy The correct answer ís b ...................................... .................... 819) 60 y}o male Dx to have acute pancreatitis ( there was values for ranson criteria that l couldn't memorize ) what is the appropriate nutrition : a- TPN b- Regular diet with low sugar c- High protein ,high ca , low sugar d- Naso-jujenal tube The correct answer ís d ....................................... ................... 820) 15 y}o boy brought by his mother with lab values shows microcytic hypochromic anemia what is most likely Dx : a- Thalassemia b- lDA ( iron deficiency anemia ) c- SCD d- ... The correct answer ís b ....................................... ................... 821) Female with Hx of lt flank pain radiating to groin , symptoms of UTl & N+V what is DX: a- Appendicitis b- Diverteculitis c- Renal colic d- .... The correct answer ís c 822) Old pt with neck swelling , nodular ,disfiguring , with Hx of muscle weakness , cold intolerance , hoarseness , what is your management : a- Levothyroxine b- Carbamazole c- Thyroid lobectomy d- Radio-active iodine The correct answer ís a ....................................... ................... 823) Pregnant woman with symptoms of hyperthyroidism , TSH low : a- Propylthyiouracil b- Radio-active iodine c- Partial thyroidectomy d- ..... The correct answer ís a ....................................... ................... 824) Pt with thyroid mass , firm ,2x2 cm what is most appropriate for Dx : a- Neck US b- FNA c- Neck CT d- Surgery The correct answer ís b ....................................... ................... 825) 56 y}o female complaining of back pain , her mother suffer from vertebral compression Fx , investigation shows early osteoporosis what is the best ttt : a- Advice with exercise b- Vit D , ca supplement , ... c- ...... d- ..... The correct answer ís b ....................................... ................... 826) What is the most common non-traumatic Fx caused by osteoporosis : a- Colle's Fx b- Femoral Fx c- Vertebral compression Fx The correct answer ís c , because most common non traumatíc . 827) 4 or 5 ( not sure ) brought by his parents with weight > 95 th percentile , height < 5 th percentile & bowing of both legs what is the appropriate management : a- Liver & thyroid function tests b- Lower limb X-ray c- Pelvis X-ray d- Thyroid or ( liver not sure ) function test The correct answer ís a ...................................... .................... 828) At which stage sapration of chromatoids occur : a- Metaphase b- Telophase c- ..... d- ..... The correct answer ís a ....................................... ................... 829) Elderly pt with DM2 , HTN , smoker , sedentary lifestyle , inestigation low HDL, high LDL , ( مهم-ا ,' ل- يس'م-ا ^-- ) which of what will be effective in this pt : a- Level of HDL , smoking , obesity b- Triglyceride level , ........ c- .................... d- ....................( all were long sorry ) MCÇs are not complete. ....................................... ................... 830) pt known case of ulcerative colitis with erythematous rash in lower limb what is most likely DX: a- erythema nodusum 831) Pt known to have ulcerative colitis coming with skin lesion around Tibia which is with irregular margins what is most likely Dx: a- Pyoderma gangirenosum ...................................... .................... 832) Young pt victim of RTA coming with SOB ( or not breathing not sure ) absent of breath sound & chest movement in RT side but resonance in percussion what is your next step : a- Do stat chest X-ray b- Emergency surgery c- ............ d- ............ Needíe aspíratíon then chest tube ....................................... ................... 833) Psychiatric pt non-compliance to his medication what is the ttt : a- ..... Given lM b- ......... given lV c- ........oral d- .........oral Ç is not complete ....................................... ................... 834) Which psychiatric disease is treated with electroconvulsive therapy : a- Paranoia b- ........... The correct answer is : Major depression 835) Pt with bilateral eye discharge , watery , red eyes, corneal ulceration what is the most common cause : a- Dust & pollen b- Hypertension & ..... c- Ultra-violet light & stress d- .............. The correct answer ís a ....................................... ................... 836) 4 y}o baby felt down his mother pulled him by his arm & since then he kept his arm in pronation position what is your management: a- Splint ..... b- Do x-ray for the arm before any intervention c- Orthopedic surgery d- ............. The correct answer ís b ....................................... ................. .. 838) diabetic pt on medication found un conscious his blood suger was 60 what is the most common to cause this problem: a- Sufonylurease b- Bigunides c- ........ The correct answer ís a ....................................... ................... 839) what is most sensitive indicator for factitious fever : a- Pulse rate b- ......... c- .......... Factitious fever: Fever produced artífícíaííy by a patíent. Thís ís done by artífícíaííy heatíng the thermometer or by seíf- admínístered pyrogeníc substances. An artífícíaí fever may be suspected íf the puíse rate ís much íess than expected for the degree of fever noted. Thís díagnosís shouíd be consídered ín aíí patíents ín whom there ís no other píausíbíe expíanatíon for the fever. Patíents who pretend to have fevers may have seríous psychíatríc probíems. 840) young male ( l think he was a student ) with headache involving the whole head & bilateral eye glob that increase with stress what is most likely DX: a- Tension headache b- Migraine c- ......... d- .......... Ç not cmplete ....................................... ................... 841) pt turns to be erratic , for 4 month he said that's people in TV knows what people are thinking about , in last 2 month he claim that he has special power that no one has what is the most likely DX : a- Uni-polar ... depression b- Bipolar .. Mania c- SCZ d- ........ The correct answer ís c ....................................... ................... 842) common site of anal fissure is : a- Anterior b- Posterior c- Lateral d- ......... The correct answer ís : b ....................................... ................. .. 843) common site of hernia sac in relation to the cord content : a- Antro-lateral b- Medial c- Anywhere d- Posterior The correct answer ís a 844) what a 4 years child can do : a- Draw square & triangle b- Say complete sentence c- Tie his shoes d- ............. The correct answer ís a ....................................... ............... 845) You received a call from a father how has a son diagnosed recently with DM-l for six months, he said that he found his son lying down unconscious in his bedroom, What you will tell him if he is seeking for advise: a. Bring him as soon as possible to ER b. Call the ambulance c. Give him his usual dose of insulin d. Give him lM Glucagone e. Give him Sugar in Fluid per oral The correct answer ís e ....................................... ................... 846) factor which determine recurrence of breast cancer : a- Site & size of breast mass b- No of lymph nodes c- Positive estrogen receptor d- Positive progesterone receptor The correct answer ís b ....................................... ................... 847) teacher in school presented with 3 days Hx of jaundice ( they wrote it ictric as if it will a differacne) & abdominal pain , N+V , 4 of school student had the same illness in lab what is true regarding this pt : a- Positive for hepatitis A lgG b- Positive hepatitis A lgM c- Positive hepatitis B core d- Positive hepatitis B c anti-body The correct answer ís b 848) regarding weight gain in pregnancy what is true : a- Pregnant woman should consume an average calorie 300- 500 per day b- Regardless her BMl or body weight she should gain from 1.5 - 3 lb which represent the baby's growth c- ........................ d- ......................... Ç is not complete Weight gain during pregnancy : - 100 - 300 Kcal } day , 500 Kcal } day in breastfeeding - Wt. gain : 1 - 1.5 kg } month , 11 - 16 kg gain during pregnancy. ( for change from Ib to Kg : dívíded by 2.2) ....................................... ................... 849) what condition is an absolute contraindication of lactation : a- Mother with open pulmonary TB for 3 month b- Herpes zoster in T10 drematome c- Asymptomatic HlV d- .................. The correct answer ís c ....................................... ................... 850) what is most sensitive for DX of duodenal ulcer : a- Epigasteric pain starting 30-60 min after the meal b- Epigasteric pain staring immediately after a meal c- lncreasing of pain when lying supine d- Pain radiating to the back The correct answer ís d ....................................... ................... 851) female at 40 yr with BMl >28 what is your management : a- Reduce calorie in take to 800 }day b- ln general reduce calorie intake c- .............. d- ................. O ís not compíete, but wíth these MCOs , the correct answer ís b 852) 70 y}o female say that she play puzzle but for a short period she can't play because as she develop headache when playing what u will exam for a. astigmatism b. glaucoma the correct answer ís a ....................................... ................... 852) prophylaxis for meningitis ttt contact a. cimitidine b. rifampicin the correct answer ís b ....................................... ................... 853)rheumatic fever pt has streptococcal pharingitis risk to develop another attack a. trimesmore than normal b. 100% c. 50% the correct answer ís c ....................................... ................... 854)child with unilateral nasal obstruct with bad odor a. unilateral adenoid hypertrophy b. FB the correct answer ís b ....................................... ................... 855)PT. do colectomy for colon cancer routine follow up every a. 6 months b. 3 months c. 9 months d. 1 years the correct answer ís d 856) for patient with osteoarthritis , what is your initial action : a. lntraarticular corticosteroid b. Çuadriceps strengthening exercise c. Climb stairs exercise The correct answer ís b ....................................... ................... 857) 70-y old female patient with osteoporosis , what is her T score : a. (-2.5) b. (-1) c. (1) d. (2) The correct answer ís a ....................................... ................... 858 ) diabetic patient , diagnosed 2 weeks back came to your clinic at scheduled appointment supposed to be at 10:00 AM but because you were having another complicated case , he had to wait for more than an hour , and he was extremely angry , what u will do : a. be empathetic as this anger is mostly because of the new morbidity diagnosed at this patient b. you start your talk with him by saying "l was having a hard case " c. Don't say anything regarding being late unless he brings it up d. you star YOUR TALK WlTH HlM BY SAYlNH "you seem furious" ....................................... ................... 859) 1 st step in epidemic study is : a. verifying diagnosis O ís not compíete 860) Randomized control trials become stronger if : a. you follow more than 50% of those in the study b. systematic assignment predictability by participants O ís not compíete , but wíth these MCOs , the correct answer ís b ....................................... ................... 861) child with multiple painful swellings on the dorsum of hands , feet , fingers and toes ,his CBC showed Hb =7,RBC's on peripheral smear are crescent shaped , what is your long-term care : a. corticosteroids b. penicillin V c. antihistaminic the correct answer ís b , thís pt. ís síckíe ceíí anemía ....................................... ................... 862) 54 y old patient , farmer , coming complaining of dry eye , he is smoker for 20 years and smokes 2 packs} day , your recommendation : a. advise him to exercise b. stop smoking c. wear sunscreen The correct answer ís b , smokíng íncrease rísk of dry eye (ínternatíonaí study ) ....................................... ................... 863) patient is wearing contact lenses for vision correction since ten years , now coming c}o excessive tearing when exposed to bright light , what will be your advice to him : a. wear hat b. wear sunglasses c. remove the lenses at night d. saline eye dros 4 times } day The correct answer ís d ( I'm not sure ) 864) management of mild epistaxis : a. pinching the fleshy part of nose while telting head foreword ....................................... ................... 865) most common site of malignancy in paranasal sinuses : a. Maxillary sinus ( correct ) ...................................... .................... 866) patient with hypertension , what is the best non- pharmacological method to lower the elevated blood pressure : a. weight reduction ( correct ) ....................................... ................... 867) newly diagnosed patient with hyper tension having Na=147 , K=3 , what is the most likely cause of his secondary hypertension : a. hyperaldosteronism ( correct ) ....................................... ................. 868) 50 year old patient , diagnosed with hypertension , he is used to drink one glass of wine every day , he is also used to get high Na and high K intake , his BMl is 30kg}m , what is the strongest risk factor for having hypertension in this patient : a. wine b. high Na intake c. high K intake d. BMl=30 the correct answer is d , ( l'm not sure ) 869) all of the following tests are necessary to be done before initiating lithium except: a. liver function tests ....................................... ................... 870) in dementia , best drug to use : a. haloperidol b. galantamine the correct answer ís b treatment of dementía ís choíínesterase ínhíbítor ( gaíantamíne, donepezíí, rívastígmíne, and tracíng ) ....................................... ................... 871) most important point to predict a prognosis of SLE patient : 77 a. degree of renal involvement b. sex of the patient c. leucocyte count the correct answer ís a ...................................... .................... 872) what is the antibiotic that you will give if you will do appendectomy : a. doxycycline b. ceftriaxone c. metronidazole d. cefuroxime The correct answer is d 873) most common site for ectopic pregnancy : a. fallopian tubes ...................................... .................... 874)child with low grade fever , rash , pharingitis , and tender splenomegally , +ve EBV , Dx : a. infectious mononeucleosis ...................................... .................... 875) best early sign to detect tension pneumothorax : a. tracheal shift b. ditended neck veins c. hypotensionv the correct answer ís b , I'm not sure , I thínk tracheaí shíft ís the íate sígn . ....................................... ................... 876) First sign of magnisium sulfate toxicity is : a. Loss of deep tendon reflex ....................................... ................... 877) Patient with mashroom toxicity will present with a. Constipation b. Hallucination c. Anhydrosis the correct answer ís b 878) Child ate overdose of iron , best immediate management a. Gastric lavage b. lnduce vomiting manually c. Emetic drugs d. lpecac the correct answer ís a ....................................... ................... 879) Status epilepticus is : a. Continuous sizure activity more than 30 min without regaining consciousness ...................................... .................... 880) First sign of increased lCP is : a. contralateral papillary dilatation b. lpsilateral papillary dilatation c. Decrease level of consciousness the correct answer ís c ....................................... ................... 880) Patient with history of head trauma unable to move the fork to his mouth , where is the lesion: a. cerebellum b. frontal lobe c. temporal the correct answer ís a ....................................... ................... 881) Patient with lumbar canal stenosis , l forget the presentation , what is the ttt: a. Physiotherapy b. Lumbar dicsectomy O IS NOT COMPLETE Mild to moderate : NSAlD + physiotherapy Advance : epidural corticosteroid Refractory : surgical laminectomy 882) Most common cause of otorrhia : a. Csf leak b. Acute otitis media c. Cerumen leak The correct answer ís b ....................................... ................... 883) Most common symptoem of acute otitis media : a. Pain b. Discharge c. Tinnitus d. Vertigo The correct answer ís a ....................................... ................... 884) 12 yo boy is mocked at school because he is obese , ate a lot of pill to sleep and never wake up again , best management is : a. Refer to mental professional b. Tell him that most kid grow out before they grow up c. Advice healthy food ....................................... ................... 885) 12 yo boy brought by his parent for routine evaluation , his is obese but otherwise healthy , his parents want to measure his cholesterol level , what is the best indicator of measuring this child cholesterol : a. His parent desire b. Family hx of early cva c. High bmi The correct answer ís b 886) Diabetic pt. have neovasclarization and vetrous hemorrhage , next step : a. Refer to ophthalmologist ....................................... ................... 887) Histopatholgy of resected inflamed appendix will show : a. Neutrophil in muscular wall b. Lymphoid hyperplasia with multineucleated gaint cel The correct answer ís a ....................................... ................... 888) A child had bee bite presented after 18 hour with left arm erythema and itching and.. Long scenario , what to do: a. Antihistaminic b. Oral steroid c. Subcutaneous epinephrine The correct answer ís a ....................................... ................... 889) Old man with urinary incontinence , plapable bladder after voiding , urgency and sense of incomplete voiding dx; a. Stress incontenece b. Overflow c. Reflex The correct answer ís b ....................................... ................... 890) Ttt of scabis : a. Permethrin 891) Picture , hyperkeratotic , scaly lesion over the extensor surface of knee and elbow , what to do to avoid exacerbation : a. Steroid b. Avoid sun exposure c. Avoid trauma The correct answer ís a ....................................... ................... 892) Which is true about allopuranol : a. Good if given during acute gout b. Uricisoric c. Reduce the chance of uric acid stone d. Can be antagonize by salysilate The correct answer ís c ....................................... ................... 893) man walking in street and saying bad words to stranger , he is not aware of his conditiond , what is the description : a. flight of idea b. insertion of idea c. loosening of association ....................................... ................... 894) which of the following suggest that thyroid nodule is bengin rather that malignant: a. history of childhood head and neck radation b. hard consistency c. lemphadenopathy d. presense of multiple nodules the correct answer ís d thyroíd cancer : ( coíd and soííd noduíe ) 895) child presented after sting bite with abd pain , arthalgia , lower extremity and buttock rash , normal RFT , +ve fecal occult stool , dx : a. HSP b. Lyme diases The correct answer ís a ....................................... ................... 896) best indicator for labor progress is : a. frequency of contractions b. strength of contractions c. descent of the presenting part the correct answer ís c ....................................... ................... 897) lactating mother is taking Phenobarbital for sizure prophylaxsis , what to advice her : a. stop breast feeding immediately b. breast feed after taking the pill by 8 hour c. start weaning d. does not matter the correct answer ís a ....................................... ................... 898) best single way to reduce high blood pressure is : a. smoke cessation b. decrease lipid level c. reduce weight the correct answer ís c ....................................... ................... 899) drug of choice for supraventricular tachycardia is : a.adenosine 900) patient with blood group A had blood transfusion group B , the best statement that describe the result is : a. type lV hypersensitivity b. inflammatory reaction .. c. .... The correct answer ís : It ís type 2 hypersensítívíty ....................................... ................... 901) a nurse gave blood transfusion through CVP , 2 hours later the patient is comatose and unresponsive , dx : a. Septic shock b. Blood group mismatch The correct answer ís a ( I'm not sure ) ....................................... ................... 902) 100% O2 given for prolonged periods can cause all except: a. Retrosternal Pain b. Seizures c. Depression d. Ocular Toxicity e. 777 The correct answer ís c ( I'm not sure because choíce e ís not mentíon ) 903) Organophosphorus poisoning, what is the antidote7 a. Atropine b. Physostigmine c. Neostigmine d. Pilocarpine e. Endrophonium The correct answer ís a ....................................... ................... 904) Which of the following pulse character goes with the disease7 a. Collapsing pulse Severe anemia b. Pulsus Alternans Premature ventricular complexes c. Slow rising Pulse Mitral stenosis d. Pulsus Bisferens Mitral Regurgitation e. Pulsus paradoxus l think Aortic stenosis or regurgitation The correct answer ís a PLUSE DEFlNlTlON CAUSES Collapsing pulse Puíse wíth fast upstroke and fast downstroke 1- Sever anemía 2- Aortíc regurge 3- Thyrotoxícosís Pulse alternans Aítrnans weak and strong puíse 1- LV dysfunctíon Pulsus paradoxus Decííne systoííc more than 10 mm Hg duríng ínspíratíon 1- Cardíac tamponade 2- Asthma & COPD Pulsus parvus et tardus Weak and deíayed puíse 1- Aortíc stenosís Slow rising pulse Síow upstroke puíse 1- Aortíc stenosís Pulsus bisferiens puíse characterízed by two strong systoííc peaks separated by a mídsystoííc díp 1- Aortíc reguírge 2- AR + AS 905) Entamoeba histolytica cysts are destroyed best by: a. Boiling b. lodine added to water c. Chlorine added to water d. Freezing The correct answer ís a ....................................... ................... 906) A scenario about an old male with symptoms suggesting parkinsonism such as difficulty walking, resting tremors and rigidity in addition to hypotension. Then he asks about what is the most common presenting symptom of this disease a. Rigidity b. Tremors c. Unsteady Gait d. Hypotension e. 777 The correct answer ís b ....................................... ................... 907) Regarding postpartum Psychosis: a. Recurrences are common in subsequent pregnancies b. lt often progresses to frank schizophrenia c. lt has good prognosis d. lt has insidious onset e. lt usually develops around the 3 rd week postpartum The correct answer ís a ....................................... ................... 908) A pregnant female develops lesions on the vulva and vagina and she was diagnosed as genital herpes, what should be included in her future health care7 a. Cesarian section should be done if the lesions did not disappear before 2 weeks of delivery date b. Oral acyclovir to treat herpes c. Termination of pregnancy because of the risk of fetal malformations d. Avoidance of sexual intercourse for 1 month after the healing of the lesions e. 77777 The correct answer ís b HSV in pregnant treated by : oraí acycíovír 400 mg TID for 5-7 days . if HSV was present at time of labor : c - sectíon 909) A picture of 2 warts in the index finger. Diagnosis is Viral Warts ....................................... ................... 910) What is the most common sequalae of acute pancreatitis 7 a. Abscess b. Pseudocyst c. Bowel obstruction The correct answer ís b Most common complication of acute pancreatitis: pancreatíc pseudocyt and fístuía formatíon ....................................... ................... 911) An old patient with history of cerebrovascular disease & lschemic heart disease, presents with a pattern of breathing described as: A period of apnea followed by slow breathing which accelerates & becomes rapid with hyperpnea & tachycardia then apnea again. What is this type of breathing7 a. Hippocrates b. Chyene-stokes breathing c. Kussmaul breathing d. One type beginning with O letter and contains 3 letters only e. 7777 The correct answer ís b 1- Chyene-stokes respiration : rapíd deep breathíng phase foííowed by períod of apnea , present wíth heart faííure , stroke, braín trauma , aíso can be wíth síeep or hígh aítítude 2-kusmmaul's breathing : rapíd and deep breathíng . present wíth metaboííc acídosís partícuíaríy ín díabetíc ketoacídosís 912) A patient with mixed 1 st & 2 nd degree burns in head & neck region, what is the most appropriate management7 a. Apply silver sulfadiazine and cream to all burned areas,cover them and admit to hospital b. Apply cream to 2 nd degree burns and cover them, give lV fluids c. Debridement of 2 nd degree burns and .. d. Apply silver sulfadiazine then Vaseline ointment to all areas then discharge the patient The correct answer ís a 1sr degree : epídermís + paínfuí ( no bííster ) 2 nd degree : epídermís + partíaí dermís + paínfuí _ bííster 3 rd degree : epídermís + fuíí thíckness dermís + paíníess Rule of nine to estimate BSA : 1- Head and neck : 9% 2- Each upper arm : 9% 3- Each íoer íímb : 18% 4- Each post. & ant. Trunk : 18% 5- Períneum & genítaíía : 1% -Sííver suífadíazíne and mafeníde used for aíí types of burn -supportíve : tetanus and I.V nacrotíc can be used for aíí types of burn - I.V fíuíd use oníy ín ( > 10% of BSA) ín 2 nd & 3 rd degree of burn accordíng parkíand formuía : ( fíuíd ín fírst 24h = 4 * wt. ín kg * BSA . 50% ín fírst 8 hours and another ín next 16 hours ) In thís patíent 1 st deree and 2 nd degree < 10% ( head and neck 9%) : so, not use fíuíd ....................................... ................... 913) 2 years old child with ear pain & bulging tympanic membrane, what is the diagnosis7 a. Otitis media b. Otitis externa c. Otomycosis d. Bullous myringitis The correct answer ís a 914) Besides lV fluids, what is the most important drug to be given in anaphylaxis7 a. Epinephrine b. Steroids c. 777 Other choices The correct answer ís a ....................................... ................... 915) An adult patient in 20s or 30s of age presents by history of 1 month of fever, 5 days of headache & 2 days of altered sensorium. On examination there is nuchal rigidity, then there is a table showing investigations which include Hb: 10 g}dl Blood WBC: 18,000 CSF Examination: WBCs elevated: 77% lymphocytes, 33% Neutrophils. Protein 777. Glucose77 What is the diagnosis7 a. Viral meningioencephalitis b. Tuberculous meningitis c. Ph.. Meningitis d. 777 O ís not compíete , but wíth thís scenarío and MCOs , The correct answer ís b 916) Regarding chronic fatigue syndrome, which is true7 a. Antibiotics may reduce the symptoms b. Antidepressants may reduce the symptoms c. Rest may reduce the symptoms d. 777 e. 7777 O IS not compíete , but wíth these MCOs , the correct answer ís b. chronic fatigue syndrome: characterízes by profound mentaí and physícaí exhaustíon. In assocíated wíth muítípíe system and neurospsychíatríc symptoms that íast at íeast 6 mounth. Must be new ( not íífe íong ) , must not be reííved by rest, and must resuít ín greater than 50% reductíon ín prevíous actívíty. Presentatíon wíth 4 or more of the foííowíng : poor memory / concentratíon, myaígía, arthaíagía, sore throat, tender íymph node, recent onset headach, unrefreshíng síeep, excessíve tíredness wíth exercíse. Treatment by : cognítíve and excercíse therapy .aíso, díet, physíotherapy , díetary suppíements , antídepressants . ....................................... ................... 917) A patient complains of dry eyes, a moisturizing eye drops were prescribed to him 4 times daily. What is the most appropriate method of application of these eye drops7 a. 1 drop in the lower fornix b. 2 drops in the lower fornix c. 1 drop in the upper fornix d. 2 drops in the upper fornix ....................................... ................... 918) A patient with penetrating abdominal stab wound. Vitals are: HR 98, BP 140}80, RR 18. A part of omentum was protruding through the wound. What is the most appropriate next step: a. FAST Uítrasound b. DPL (Díagnostíc perítoneaí íavage) c. Expíore the wound d. Arrange for a CT Scan e. Expíoratory íaparotomy The correct answer ís e 919) A patient presents with loin pain radiating to the groin. Renal stones are suspected. What is the test that has the most specificity & sensitivity in diagnosing this condition7 a. Noncontrast spiral CT scan of the abdomen b. Ultrasound c. KUB d. lntravenous pyelography (lVP) e. Nuclear Scan The correct answer ís a ....................................... ................... 920) An old patient presents with history dizziness & falling down 1 day ago accompanied by history of Epigastric discomfort. He has very high tachycardia l think around 130-140 and BP 100}60. What is the diagnosis7 a. Peptic ulter b. GERD c. Leaking aortic aneurysm d. 777 The correct answer ís c ....................................... ................... 921) A child is about to be given flu vaccine, what allergy should be excluded before giving the vaccine7 a. Chicken b. egg c. Fish d. 777 The correct answer ís b ....................................... ................... 922) Which of the following is proven to reduce the incidence of cancer7 a. Salt b. Mineral water c. Vitamin D d. Fiber The correct answer ís c 923) A female patient with history of cyclic abdominal pain, inability to conceive, heavy menses, and examination showed tenderness & nodularity in uterosacral ligaments. What is the diagnosis7 a. Endometriosis ....................................... ................... 924) A female patient on the 3 rd week postpartum. She says to the physician that the frequently visualizes snakes crawling to her baby's bed. She knows that it is impossible but she cannot remove the idea from her head. She says she wakes up around 50 times at night to check her baby. This problem prevents her from getting good sleep and it started to affect her marriage. What is this problem she is experiencing7 a. An obsession b. A hallucination c. A postpartum psychosis d. A Delusion The correct answer ís a Obsession : persístent, unwanted, and íntrusíve ídeas , thoughts, ímpuíses or ímages ....................................... ................... 925) Regarding screening for cancer, which of the following is true7 a. Screeníng for cervícaí cancer had decreased ín recent years b. Screeníng for breast cancer had decreased ín recent years c. Screeníng for Coíorectaí cancer ís ínadequate for the hígh-rísk groups d. Screeníng for íung cancer has reduced the mortaííty rate of íung cancer e. Screeníng for tobacco use ís now adequateíy done by heaíth professíonaís ....................................... ................... 926) Regarding postpartum depression, what is the most appropriate intervention to reduce the symptoms7 a. lnclude family in the therapy b. lsolation therapy c. Add very low doses of impiramine d. Encourage breastfeeding The correct answer ís a 927) Which of the following is a side effect of Buprione, a drug used to help smoking cessation: a. Arrhythmia b. Xerostomia c. Headache d. Seizure The correct amswer ís d ....................................... ................... 928) A 60 years old patient with history of heart attack 6 weeks ago, complaining of not getting enough sleep. Psychiatric evaluation is unremarkable for depression or anxiety, what should be given to this patient7 a. Amytríptíííne b. Buspírone c. Bupríone d. Zoíbídím The correct answer ís d ....................................... ................... 929) A patient is asked to face the wall, bend his waist, and let his hands hang down without support. This test is used as a screening tool for which of the following7 a. Lower limb asymmetry b. Rectal prolapsed c. Scoliosis d. 7777 The correct answer ís c Thís test ís caííed for (Adam's Forward Bend Test ) 930) A patient presents with sore throat, cervical lymphadenopathy, mild splenomegaly, EBV antibodies are +ve. What is the diagnosis7 a. lnfectious Mononucleosis (EBV ) ....................................... ................... 931) An old patient presents with knee pain, limitation of movement and quadriceps muscle atrophy. On examination there is limited range on movement, pain on movement & Crepitus. What is the diagnosis7 a. Osteoarthritis b. Rheumatoid arthritis c. Ankylosing Spondylitis The correct answer ís a ....................................... ................... 932) A patient presents with long time history of knee pain suggestive of osteoarthritis. Now he complains of unilateral lower limb swelling and on examination there is +ve pedal & tibial pitting edema. What is the next appropriate investigation7 a. CXR b. ECG c. Echocardiography d. Duplex ultrasound of lower limb The correct answer ís d Osteoarthritis relief by rest . So, immobility pt. can lead to DVT ....................................... ................... 933) Alopecia is a side effect of which antiepileptic7 a. Phenytoin b. Carbamazepine c. Na Valproate d. 777 The correct answer ís c 1-phenytoin : gíngívaí hyperpíasía, hírsuteísm, ataxía 2-carbamazepine : agranuíocytosís, hepatotoxícíty, apíastíc anemía 3- Na Valproate : transíent haír íoss. 934) Which of the following is an indication for tonsillectomy7 a. Sleep apnea b. Asymptomatic large tonsils c. Peripharygeal abscess d. Retropharyngeal abscess The correct answer ís a ....................................... ................... 935) Which of the following is a gram -ve rods that grow on charcoal yeast agar7 a. Legionella ....................................... ................... 936) A 7 years old child had history of chest infection which was treated with antibiotics. The patient presented 6 weeks after cessation of antibiotics with abdominal pain, fever and profuse watery diarrhea for the past month. Which of the following organisms is responsible for the patient's condition7 a. Giardia Lamblia b. Clostridium Difficile c. Escherichia coli d. Clostridium Perfringens The correct answer ís b ....................................... ................... 937) Which of the following features of ulcerative colitis distinguishes it from crohn's disease a. Possible malignant transformation b. Fistula formation c. Absence of granulomas d. Colon involvement The correct answer ís a 938) A very very long scenario about a female patient with vaginal discharge "malodorous watery in character" with pH of 6 & +ve clue cells but there is no branching pseudohyphe. (He is telling you the diagnosis is vaginosis & there is no fungal infection) Then he asks about which of the following drug regimens should NOT be used in this paitent: a. Metronidazole (PO 500 gm for 7 days) b. Metronidazole (PO 2 large dose tablets for 1 or 2 days) c. Metronidazole (lV or lM ...) d. Miconazole ( PO ...) e. Clindamycin (PO ...) The correct answer ís d Thís case ís " bacteria vaginosis" and treatment by : metradínazoíe or cííndamycíne . avoíd míconazoíe because ít ís antífungaí ....................................... ................... 939) What is the condition that produces malodorous watery vaginal discharge with +ve clue cells in wet mount preparation slides: a. Bacterial vaginosis b. Vaginal Candidiasis c. Trichomonas vaginalis d. Gonorrhea The correct answer ís a ....................................... ................... 940) Which of the following is the best treatment for Giardiasis: a. Metronidazole ....................................... ................... 941) A woman with 9weeks History of elevated erythematous wheals overall her body , she also has lip swelling. There is no History of recent travel or food allergy or drug ingestion, Diagnosis: a. Chronic Angioedema & Urticaria b. Contact Dermatitis c. Solar Urticaria d. Cholinergic Urticaria e. Cold Urticaria The correct answer ís a Chronic urticaria : íf more than 6 months Solar urticaria : due to sunííght Cholinergic urticariae : due to bríef íncrease ín body temperature. Cold urtiaria : due to exposure to coíd 942) A 17 years old male with history of mild intermittent asthma. Attacks occur once or twice weekly in the morning and no attacks at night. What should be the initial drug to give7 a. lnhaled short acting B2 agonist as needed b. lnhaled high dose corticosteroid as needed The correct answer ís a ....................................... ................... 943) A child presented with sore throat. Culture from the throat revealed +ve meningiococci. The patient is now asymptomatic. Which of the following should be done7 a. Reassurance b. Rifampicin oral for 7 days c. lM ceftriaxone 1 dose d. Ceftriaxone oral e. 777777 The correct answer ís c ( I'm not sure ) 2-day regímen of oraí rífampín or a síngíe dose of IM ceftríaxone or a síngíe dose of oraí cíprofíoxacín). ....................................... ................... 944) Which of the following increases the quality of the randomized controlled study & make it stronger: a. Systemic Assignment predictability by participants b. Open Allocation c. lncluding only the participants who received the full intervention d. Following at least 50 % of the participants e. Giving similar intervention to similar groups The correct answer ís a ....................................... ................... 945) A scenario about an infant who presented with difficulty breathing and sweating, examination shows hyperactive precordium with loud S2 and pansystolic murmur grade 3}6 best heard in the left 3rd parasternal region. What is the Diagnosis7 a. VSD b. Mitral Regurgitation c. PDA d. Large ASD The correct answer ís a 946)Post lHD , your advise : a. Yoga b. isotonic exercise ??????????? ....................................... ................... 947)very obese girl , what's the first step to reduce weight : a. increase water intake b. decrease calorie intake the correct answer ís b ....................................... ................... 948) 40 y}o male , presented with large hands , hepatomegaly ... diagnosis : a. acromegaly b. gigantism the correct answer ís a ...................................... .................... 949) cousre of facial nerve when comes out from stylomastoid . a. Deep to parotid gland & lateral to external carotid & retromandibular vein ....................................... ................... 950) old female with hemorrhoids for 10 years , no complication , your action 7 a. observe b. surgery c. increase fiber diet the correct answer ís c ....................................... ................... 951) femal about 30y c}o abdominal pain related to menses (scenario going with endometriosis)....next step in dx: a. Laparoscopy b. U}S c. CT The correct answer ís a Confírm díagnosís by íaparoscopy , US & MRI can use but íf normaí can not excíude endometríosís . 952) femaíe about 30y wíth breast cancer (gíven cbc -chem. And reaveí íow hb and hematocríte..) what ís the next step ín mangment: a. Stagíng b. Lumpectomy c. Mastectomy d. Chemotherapy ....................................... ..................... 953) pt with open angle glaucoma and k}c of COPD and DM ttt: a. Timelol b. betaxolol c. Acetazolamide the correct answer ís c ....................................... ..................... 954) infant with runny nose and fever after that develop dysnea ,wheezing with working accessory muscles and chest retractions with cyanosis, temp 38 dx: a. Viral pnumonia b. Bacterial pneumonia c. Bronchiolitis The correct answer ís c 955) 34y female with HlV pap smear negative, about cervical cancer screening : a. After 3m if negative repeat after 6m b. After 6m ........... annually c. After 1y..............annually The correct answer ís b (I'm not sure ), may be c . • !creening should begin no later than age "#. • !creening should begin earlier than age "# if the patient is sexually active. In this case, it should start $ years after initiation of vaginal intercourse. • %nce initiated, screening should be performed annually if a traditional, glass& slide&based technique is used. If liquid medium is used, 'ap smear screening may be performed every other year. • (fter age $), for women who have had $ consecutive, normal 'ap smears, screening frequency may be reduced to every two to three years. • *omen who are +I, positive, immunocompromised due to disease or medication, or are -.! daughters, should continue annual screening. • !creening may stop following a total hysterectomy (including the cervix, if the the patient is at low risk, and has had three consecutive normal 'ap smears within the last #) years. • +igh risk patients, including those with a history of cervical cancer, -.! exposure in&utero, +I, positive, immunocompromised from medication, and those tested positive for +',, should continue to be screened indefinitely. • !creening may stop after age /), if the patient is low risk, and has had three normal 'ap smears over the last #) years. • !creening may be omitted in the case of women with life&threatening or other serious illness ....................................... ..................... 956) which drug increase incidence of reflux oesophagitis: a. Theophylline b. Amoxicilline c. Metoclopramide d. Rantidine e. Lansoprazole The correct answer ís a 957) most effective ttt of cluster headach: a. Ergotamine nebulizer b. S}C Sumatriptan c. 100% O2 d. lV Verapamil The correct answer ís c ....................................... ..................... 958) old pt. with HTN and migraine ttt: a. B blockers b. ACE l c. Ca blockers The correct answer ís a ....................................... ..................... 959) lactating women 10 days after delivery developed fever ,malaise, chills tender Lt breast with hotness and small nodule in upper outer quadrant with axillary LN .Leukocyte count was 14 *10}L dx: a. lnflammatory breast cancer b. Breast abscess c. Fibrocystic disease d. 7777 7777777 ....................................... ..................... 960) newborn with fracture mid clavicle what is true: a. Most cases cause serious complication b. Arm sling or figure 8 sling used c. Most patient heal without complications The correct answer ís c -most cíavícíes fracture ín newborn no need to treatment apart from carefuí handííng. If the fracture ís díspíaced and baby ín paín, símpíe sííng ís requíre. 961) 70y male with osteoporosis the T score of bone densometry would be : a. 3.5 b. -2.5 c. -1 d. 2 e. 3.5 The correct answer ís b - The T score ís the number of standard devíatíon (SD ) a patíent's BMD devíated from the mean. - T score > (- 1) : normaí BMD - T score (-1 to -2.5) : ostopenía - T score < ( -2.5 ) : osteoprosís ....................................... ..................... 962) what is the most complication after hesterectomy: a. Ureteral injury b. Pulmonary embolism c. Haemorrhage The correct answer ís c ....................................... ..................... 963) young female with BMl 18 , fine hair allover body , feeling of she is fat ,doesn't eat well with excessive exercise........ a. Anorexia nervosa7 b. Body dysmorphic disorder c. Bulimia nervosa The correct answer ís a ....................................... ..................... 964) what's advantage of mature human milk over cow's milk: a. More protein b. More lron content c. More calories d. More fat The correct answer ís b ....................................... ..................... 965) young male c}o of deformity of jaw .past h}o of nasoplasty and blepharoplasty O}E nothing abnormal .....dx: a. Body dysmorphic syndrome 966) the most common cause of non-traumatic subarachnoid haemorrhage: a. Rupture aneurysm b. Vessels abnormality c. Hypertension The correct answer ís a -Most common causes of subarachnoíd hemorrhage are trauma and berry aneurysm ....................................... ..................... 967) Pt. with chest pain and s.o.b decreased by leaning forword . O}E friction rub and increased ]VP >>>> (a case of pericardial effusion) ECG will show: a. ST changes b. Low voltage c. lncrease PR interval ECG changes duríng perícardítís : díffuse ST eíevatíon , PR depressíon foííowed by t-wave ínterventíon , and íow voítage. ....................................... ..................... 968) The causative organism of psudomembranous colitis is: a. Clostridium difficile ....................................... ..................... 969) scenario about arthritis (l couldn't remember the details ) but ]oint aspirate reveal Gram negative diplococci ...dx: a. Nisseria gonorrhea N. gonorrhoeae 0 gram negative diplococci and can also cause con1unctivitis, pharyngitis, proctitis or urethritis, prostatitis and orchitis. ....................................... .................... 970) Vertigo & .... is caused by which of the following drug 7 a. Aphotercine B b. Pnicilline reaction c. lNH ....................................... .................... 971) Baby with red macule & dilated capillary on the rt side of the face "turge-Weber Syndrome or Nevus Flammeus 7one o! them 'ill come. Don8t choose milia or caverno%s haeman&ioma 972) A 25 year old secondary school teacher that every time enters the class starts sweating and having palpitation, she is a fired to give wrong information and be unparsed. What is the diagnosis: a. Specific Phobia b. Social Phobia The correct answer ís b ....................................... .................... 973) At which chromosome is the cystic fibrosis gene: a. Long arm chromosome 7 b. Short arm chromosome 7 c. Long arm chromosome 8 d. Short arm chromosome 8 e. Long arm chromosome 17 The correct answer ís a ....................................... .................... 974) Regarding hepatocellular carcinoma (Hepatoma) Which is true: a. More common in females b. .. c. .. d. The most common cancer in Africa and Asia e. lncrease risk in chronic liver disease The correct answer ís e , chroníc dísease especíaííy Hepatítís B ....................................... .................... 975) A patient is having a 2 year history of low interest in live, he doesn't sleep well and can't find joy in life, What is the most likely diagnosis: a. Dysthymia b. Major depressive disorder c. Bipolar disorder d. .. e. .. The correct answer ís a 976) What is the mechanism of OCD drugs: a. lncrease availability of Serotonin b. Decrease production of Serotonin c. lncrease production of Serotonin d. .. Serotonin e. .. Serotonin The correct anser ís a ....................................... .................... 977) What is the MOST accurate test to detect early pregnancy: a. ..Serum BHCG b. .. c. Urine pregnancy test d. Ultrasound e. .. The correct answer ís a ....................................... .................... 978) A case of a patient with thin cervix and little amount of cervical mucus, how would you treat her: 77777 a. Estrogen injections ............................... ............................ 979) The most common cause on chronic interrupted rectal bleeding is: a. Diverticulosis b. Hemorrhoids The correct answer ís b ....................................... .................... 980) A child is having a croup early morning, the most common cause is: a. Post nasal drip 981) A burn patient is treated with Silver Sulfadiazine, the toxicity of this drug can cause: a. Lycosytosis b. Neutropenia c. Electrolyte disbalance d. Hypokalemia e. .. The correct answer ís b , síde effect of suífadíazíne ....................................... .................... 982) A case scenario about a patient who had appendectomy, after that he has abdominal pain and constipation and absent bowel sound, the most likely cause is: a. llus paraticus O ís not compíete ....................................... .................... 983) A case scenario describing a patient who had a right chest trauma than developed tension pneumothorax, the immediate management is: a. lnsert a needle in the second intercostal space b. lnsert a needle in the fifth intercostal space c. Give lV antibiotics d. .. e. lnsert a tube in the fifth intercostal space The correct answer ís a ....................................... .................... 984) A patient that have a penile ulcer that healed after that he developed a palm and sole rash, the most likely cause is: a. Syphilis O ís not compíete 985) A case scenario about a patient who has on and off episodes of abdominal pain and was found to have multiple gallstones, the largest is 1 cm and they are not blocking the duct, What will you do: a. Give pain killers medication b. Remove gallbladder by surgery O ís not compíete , but wíth these MCOs , the correct answer ís b ............................... ............................ 986) Most common symptoms of soft tissue sarcoma : a. Paralysis b. On growing mass c. Pain d. .. The correct answer ís b ....................................... .................... 987) Patient use illegal drug abuse and the blood show RNA virus. Which hepatitis a. A b. B (DNA) c. C d. E The correct answer ís c , RNA vírus transmítted by bíood íd HCV ....................................... .................... 988) A case scenario about bronchial carcinoma, which is true: 7777 a. The most common cancer in females b. Squamous cell carcinoma spreads faster c. Adenocarcinoma is usually in the upper part d. Elevation of the diaphragm on the x-ray means that the carcinoma has metastasize outside the chest e. Bronchoscopy should be done The correct answer ís c 989) old female with pubic itching with bloody discharge, then she developed pea shaped swelling in her labia, most likely: a. Bartholin cyst b. Bartholin gland carcinoma c. Bartholin abscess d. .. The correct answer ís c ....................................... .................... 990) Patient has decrease visual acuity bilateral , but more in rt side , visual field is not affected , in fundus there is irregular pigmentations and early cataract formation . what you will do a. Refer to ophthalmologist for laser therapy b. Refer to ophthalmologist for cataract surgery c. .. The correct answer ís a ....................................... .................... 991) lnflammatory bowel disease is idiopathic but one of following is possible underlying cause: a. lmmunological ............................... ............................ 992) pregant lady deliverd Anencephalytillbirth occurance of neural tube defect in next pregnancy a. 8% b. 2% c. 10% d. 20% The correct answer is b , ( 2 - 4 % ) ....................................... ................ 993) typist theaner atrophy ,+ve tephlen sign a. Median nerve b. Ulnar c. Brachial The correct answer is a 994) painful pile a. Exison daringe b. Sitz path and steriod supp c. Ab d. Fiber food and analgesics The correct answer is a ....................................... ................ 995) 39 years old HlV patient with TB recive 4 drugs of tt after one month a. Continue 4 drugs for 1 years b. Cintinue isoniazide for 9months c. Contiue isonizide for 1 year The correct answer is a ....................................... ................ 996) femaIe not married with normaI investigation except FBS=142. RBS196. so ttt a. give ins•Iin s•€c•taneo•s €. advice not €ecome married c. €arrier contraceptive is good d. B•‚ controI The correct answer is d ....................................... ................ 997) Entamoeba histolytica cysts are destroyed best by: a. Boiling b. lodine added to water c. Chlorine added to water d. Freezing The correct answer ís a 998)A scenario about an old male with symptoms suggesting parkinsonism such as difficulty walking, resting tremors and rigidity in addition to hypotension. Then he asks about what is the most common presenting symptom of this disease a. Rigidity b. Tremors c. Unsteady Gait d. Hypotension E. 777 The correct answer ís b ....................................... ................... 998) Regarding postpartum Psychosis: a. Recurrences are common in subsequent pregnancies b. lt often progresses to frank schizophrenia c. lt has good prognosis d. lt has insidious onset e. lt usually develops around the 3 rd week postpartum The correct answer ís a ....................................... ................... 999) Gastrictomy post-op 1 day. He have temperature 38.8 & pulse 112. What is the most common cause 7 a. wound infection. b. inflammatory mediator in the circulation. c. UTl d. normal the correct answer ís a or b most common causes of post-operatíon fever : ( 6 w ) 1- W ound 2- Wíne = pneumonía or atíectasía 3- Water = UTI 4- What happen = transfusíon 5- Waík = DVT 6- Wonder drug = asprín,erythromycín , ísonízíde Immedíateíy ( 24 h ) : post-op ínfíammatíon , wound ínfectíon , transfusíon , streptococcus Acute ( 3 - 7 days ) : pneumonía 1000) Malaria 7 - the most common cases is caused by Plasmodium falciparum. ...................................... .................... 1001 ) Polyartheralgia rhumatica. What is the thing that suggest it rather than ↑ ESR & C-reactive protein: a. proximal muscle weakness b. proximal muscle tenderness the correct answer ís a ....................................... ................... 1002) The cause of insulin resistance in obese is: a. ↑ insulin receptors kinase activity b. ↑ number of insulin receptor c. ↑ circulation of anti-insulin d. ↓ insulin production from the pancreas e. ↓ post-receptor action the correct answer ís e (I'm not sure ) 1003) Pt came with total bilirubin: 5.8 & direct bilirubin: 0.4 a. Guillain-Barre syndrome b. Dubin-junson syndrome c. Biliary sclerosis d. Crigler-Najjar syndrome e. Gilbert Syndrome the correct answer ís e ....................................... ................. 1004) Pt complaining of hypotension & bradycardia. Electrolytes show: ↓Na, ↑K, ↑Cl, ↑Urea. So the cause of this is: a. hyponatremia b. hyperkalemia c. hyperchloremia d. uremia the correct answer ís a ( not sure ) يتاينمت عيمجلل قيفوتلاب : دمحم مكوخأ يبرحلا Orthopaedic – Qassim University