Late SSST

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Sunday, November 18, 2018 6:12 AM
1. Women had all UTI symptoms for over 1 yr, no improvement with multiple antibiotics, all exams and labs normal
a. Interstitial cystitis
b. Traumatic uteritis
3. Chronic smoker and alcoholic, has painless mouth ulcer for 1 weak on the lateral quadrant of tongue 1x1cm that has indurated margins and bleeds on
scraping
a. Squamous cell carcinoma (I choose this)
b. Leukoplakia
c. Aphthous ulcer
4. Clear scenario of osteoporosis and gives a dexa score of 2.6 and he of vertebral fracture wants to know what is it classified as under who bone mass
criteria
a. Established osteoporosis (this is correct ans)
b. Osteoporosis
5. Contraindication for gastric lavage: no hydrocarbon choice

a. Drain clean fluid ( I choose this)
b. Castor beans
c. Aspirin
d. Diazepam
6. 2 scenarios of allergic rhinitis asking for 1st line vs best treatment

a. Antihistamine
b. Topical corticosteroid
c. Abx
d. Decongestant
(intranasal steroid)
7. Muscle responsible for thigh and leg flexion

a. Rectus femoris (help with rotation)
b. Biceps femoris (The main action is flexing of the lower leg at the knee.)
c. Sacco
Flexion of thigh (Psoas Major:Iliacus, Sartorius: Pectineus:)
8. Constipation on passing stool which muscles gets relaxed

a. Pubococcegys
b. Puborectalis
c. Iliococgeus
d. Puborectalis
9. HPV biopsy characteristic finding: kolinochyia
10. Most common cause of RHF = LHF
latest Questions Page 1

11. Left sternal border sustolic murmur in 72 yr old asymptomatic. No carotid radiatio. BP 122/60
a. Aortic sclerosis
b. Pulmonic valve stenosis
c. Flow murmur
12. Osteoporsis like scenario but bone pain and raised ALP = paget's disease
13. Skull fracture first step

a. Oral intubation
b. Lateral C-spine
14. Osteomyelitis chronic ends up into cancer

A. .basal cell
b. Squamous
Draining sinus lead to sequamous cancer
15. Uterine agony already tried oxytocin and hembate next step
a. Bimanual massage
b. Hysterectomy
c. Embolization of iia
d. Evacuation and curettage
Could trial of bimanual uterine massage before moving to embolization
16. Breast mass hard identified by mammography to be 2x3 and no palpable lymphondes.
A. Needle biopsy (if core biopsy will be correct)
B. Mastectomy
C. Senital node biopsy
D. Lumpectomy and radiotherapy
Do you know age of patient? She was around 45 y/o with no family Hx of breast cancer
17. Typist scenario but patient had numbness on dorsal side of hand involving the thumb, index and ring fingers, also patient had lose of dorsiflexion of
hand, asking what nerve is likely to be affected:
radial nerve
18. What gives false positive for sickle cell disease in sickling solubility test
A. Hemoglobin C ( I choose this)
B. Hemoglobin D
C. Increased plasma protein ( I think this is correct)
D. Anemia
20. Differ
21. Best treatment for bronchechstis ?

A. Physiothearpy
B. O2
C. Oral steroid
D. Ipratropium
E. SABA
22. 5 year old, no cough, he had no immunization, hard exudate on the tonsils, inspiratory stridor?
A. Pertussis

A. Pertussis
B. diptheria
C. staph aureus
D. strep pyogenes
23. the guy has anti- hbS+, what is his condition?

A. acute infection
B. chronic
C. immunized and infected
D. not immunized
( most likely C, as anti hbs mean either natural infection or vaccination)
24. typical scenario, patient presented with splenomegaly, jaundice , ankiocytosis rectiycyte cout = 9 high, mchc high by 2 ?
A. Hereditary spherocytosis
B. Autoimmune hemolytic
C. Biliary obstruction
D. Liver disease (something)
25. Patient with spinal stenosis?

A. Physiotherapy and pain management
B. Laminectomy
26. A long scenario about a patient haven't a gout attach they should several labs the patient has mild renal insufficiency and they want u to pick a best
drug to treat the condition.
A. Colchicine
B. Naproxen
C. Allopurinol
D. Probenecic acid
Pain at time of presentation
27. preferred method for testing hypersensitivity type 1

A. skin test
B. Prick
C. RAST
D. RIST
28. Patient complain of hand pain after bee sting , on examination: tenderness + Axillary lymph node enlarged, ( + picture: weal on forearm) what is dx:
A. Urticaria
B. Lymphangitis (my answer)
http://www.ncemi.org/cse/cse1105.htm
29. More admission of pneumonia from jan to march yearly , what’s that called?
A. Cyclic
B. Seasonal
C. Epidemic
30. Side effect of atropine

A. Broncho-constriction
B. Dry mouth

31. CML Scenario asking what's diagnostic
A. FISH BCR-ABL
B. Bone marrow biopsy
32. Pediatric case of DKA receiving IV fluids and insulin whats the most important compilation you need to monitor for: no Hypokalemia in the choices
A. Hypoglycemia
B. Cerebral edema
C. Hypernatremia
33. DKA Cases in adults asking the next step for a patient that just presented to the ER
A. IV fluids
B. Oxygenations
C. Hemodialysis
34. DKA Case in adult asking for next best step

A. IV bolus of 1L Normal Saline
B. Subcutaneous Insulin 0.1mg/kg
C. Potassium replacement
35. Allergic Rhinitis Case patient had been using loratadine asking for the best treatment
A. Topical corticosteroid
B. Decongestant
C. Antihistamine
D. Abx
36. Similar Scenario of Allergic Rhinitis Case but no previous treatment mentioned and asking the next step
Was main complain of the patient ? The patient gets seasonal allergies with watery eyes, nasal consuction, sneezing and
A. Antihistamine
B. Decongestant
C. Steroid
D. Abx
37. Females in her 30s is having dysmenorrhea & infertility for 6yrs which has been worsening and not responsive to NSAIDS, asking about the ideal
treatment
A. Leuprolide
B. Danazol
C. Levosterol. I think its this
38. Similar Case of dysmenorrhea & infertility asking for diagnosis

A. Endometritis
B. Endometriosis
C. Leiomyomata (no physical exam findings in scenario to support this)
D. Bicornuate uterus
39. Anemia child has had 3 trials of Iron supplements and yet no improvement, reticulocyte count was normal, whats the next step for diagnosis
A. Iron level & TIBC
B. Hb electrophoresis
40. Child with anemia and HbA2 levels were reported to be normal and what is your next step for diagnosis
A. Iron Level & TIBC
B. Gene study
C. Bone marrow biopsy
D. Electrophoresis
41. Patient has muscle weakness, edrophonium test shows improvement in muscle function, what will you use to treat the patient
A. Pyridostigmine
B. Physotigmine
42. Patient was diagnosed with Myasthenia gravis 3 months ago and started on neostigmine, today the patient has presented to the ER with worsening
muscle fatigue in eyes and face and on edrophonium test have muscle function is worsening , what is your next step to treat the patient
A. Replace Neostigmine with Pyridostigmine
B. Stop Neostigmine ( I picked this)
C. Start Plasmapheresis (didn't pick it cause patient's symptoms didn't seem severe enough and worsening on edrophonium test is more indicative of
medication overdose than myasthenic crisis).
(I think cholinergic crisis because no response after edrophonium)

43. Child had chickenpox a few days back and recently developed vomiting 3 days ago, today the child presented with neck rigidity, gait instability and I
think photophobia
A. Acute cerebellar degeneration (if there isn't any photophobia it's definitely this one)
Yes no sign of meningism (Acute cerebellar ataxia)
B. Meningoencephalitis (pick this it they mentioned symptoms like petechial rash and altered level of consciousness)
44. Muscle lateral site dorsal pedis

Answer: Extensor digitorm longus
Medial to it = hallucus longus, Lateral= digitorm longus
Its opposite (lateral to hallucis and medial to digitorm)
45. A man had multiple attacks of syncope over the past few months and he is currently asymptomatic and ECG is shown (It was complete heart block) his
vitals were given and his BP was almost normal but heart rate was like 45. They asked what's your next step in management
A. Atropine (I picked this)
B. Trans-Thoracic Pacemakers (this might be the correct choice since patient is asymptomatic currently and wouldn't need atropine)
46. Another ECG scenario with a Hx that sounded like HOCM, the patient had excretional syncope and recently had some sort of arrhythmia. The ECG was
shown and the question asked what the finding was
A. Sick Sinus Syndrome
B. Left Bundle Branch Block (I picked this)
C. Heart block
47. Case of Incarcerated Hernia = Refer to GS
48. Surgery in the posterior triangle

Great auricular nerve injury
49. Artery supplying the posterior nasal septum

Sphenopalatine
Sphenopalatine
50. Image showing an open fracture of the arm (Colle's)

A. Closed reduction with cast below Elbow
B. Closed reduction with cast above Elbow
C. Irrigation, surgical debridement & fixation
51. A pregnant women got an infection and she developed IgG for it and these igG were received by the fetus and now the fetus has immunity for this
disease, this is considered an example of which process
A. Active natural immunity (this is by getting the infection and developing immune response)
B. Active artificial immunity (this is by vaccination)
C. Passive natural immunity (I picked this choice, it's supposed to be maternally transferred like by breast feeding on during pregnancy)
D. Passive artificial immunity (This is supposed to be IVIG)
52. Working in a battery factory, semen analysis showed oligospermia, what’s the cause?
A. Lead (confirmed ans)
B. Nickel
C. Chromium
53. A couple complain of infertility is being worked up, what is the best initial test to order
A. Day 3 FSH & Day 21 Progesterone
B. Hysterosalpingogram
C. TSH & Prolactin
D. Semen Analysis (I picked this based on UWorld info)
54. A patient with Hx of bronchial asthma has been experiencing anxiety, palpitations, tachycardia, diaphoresis when he has to present in his work
meeting and often gets worried about it and try to skip it. He also mentions his symptoms are worse on the days he uses salmeterol for his asthma,
what is your treatment approach
A. Sertraline ( I picked this)
B. Amitriptyline
C. Propranolol (Didn't pick it cause of asthma)
D. Alprazolam (this might be a viable option too based on how consultants here still like to give it)

55. Burkitt lymphoma scenario asking what's the molecular mechanism
A. Over-expression of C-MYC
B. Over-expression of N-MYC
C. Increased expression of BCR
56. What triggers apoptosis

A. Tp53
B. BCL-2
57. Scenario of a patient having lichen planus only on the arms with no mucosal involvement, asking what is true regarding the disease course
A. Relapse & Remission
B. malignancy transformation
C. Automatic resolution (Confirmed in American Dermatology association guidelines)
58. Patient with classic symptoms of hyperthyroidism and he is having exophthalmos, which test is going to be diagnostic = Thyroid antibody wasn't in the
choices
A. Serum Thyroglobulin levels (I picked this its wrong this is cancer marker and not related to antibodies)
B. Serum TSH
C. Serum TSH, T3 & T4 ( I would pick this)
59. Dizygotic definition?

Answer: Dizygotic dichorionic diamniotic
60. Inside nucleolus

Answer: rRNA
61. Bond between RNG and tRNA?

Answer: Hydrogen bond
62. What is true regarding a liquid based pap smear

A. Sample taken from transformation zone
B. A spatula & brush are used
63. A 79 Y/O women has right hip pain that is aggravated by walking up and down the stairs, she has point tenderness on right hip, there is only limitation
of movement in abduction of the hip, no erythema, warmth or fluid felt on physical exam, what is your next step in management
A. Right Hip X-ray ( I picked this)
B. NSAIDs and Rest
C. Warm compress and physical therapy
64. Patient receiving chemo or radiotherapy what kind of anemia will they develop:
Aplastic
65. 65 Y/O old man present with complains of floaters and flashes in his left eye and he has loss of left inferior quadrant vision, what is the mechanism
A. Retinal detachment ( I picked this)
B. Diabetic retinopathy
C. Macular degeneration
66. Patient has used sulfa drugs 4 times and has developed a lesion on his penis describe the lesion
A. Blisters (fixed drug eruption)
68. Patient started a new medication and developed rashes all over the body including the hands and feet, what is the diagnosis
A. Fixed drug eruption ( I picked this)
B. Erythema multiforme ( I think this might be correct as this is diffused and occuring for first time, fixed is supposed to reoccur on same site and with each
administration of drug)
69. Women on fluoxetine for depression for years and now she is abnormally happy. Manic episode (bipolar). What to give?

Lithium as mood stabilize.
70. Elderly with prostatic cancer, had two DVT for the past 3 months. What to give as a preventive method?
A. Low Molecular Weight Heparin (Enoxaparin)
B. LMWH for short term, followed by warfarin ( I picked this)
C. Unfractioned heparin
71. Female fall of ladder, breath is labored, cyanosed with no breath sound heard over right side, Percussion is hyper resonant, management?
Answer: Needle thoracostomy
72. Aspirin toxicity?

Answer: Respiratory alkalosis followed by Metabolic acidosis
73. At delivery, cervix 4 cm and baby developed distress (FHR decreases 120 to 80), what type of anesthesia given to mother?
Answer: General anesthesia
74. 58 year old man comes for evaluation of his mental illness his main complaint is of recent memory loss and behavior changes
A. Vascular dementia ( I picked this)
B. Alzheimer
C. Hungitonon chorea
(nothing vascular as there is no risk factor ,like advanced age, HTN,DM, high BMI) No details mention in scenario only 2 lines were given.
75. Patient has infection with beta-lactamase resistant beta-hemolytic streptococci of throat, if amoxicillin is used what needs to be added to increase it's
efficacy
A. Clavulanic acid (I picked this)
B. Erythromycin
C. Gentamycin
76. Young female presenting with breast mass, No discharge, rubbery in consistently most likely diagnosis?
Answer: Fibroadenomas
77. What is the mechanism of OCP

A. Prevents ovulation by decreasing estrogen production
B. Prevents ovulation by increasing progesterone
C. Prevents fertilzation by increasing progrsterone
D. Prevents ovulation by preventing mid-cycle LH surge (I picked this)
78. Child started cow milk and then develops weakness fatigue anemia, hemoptysis & SOB, what's your management
A. Corticosteroid
B. Cyclosporine
C. Avoid cow-milk products
79. Antidote for Paracetamol =

NAC
80. Female diagnosed with intraductal papilloma what was the most likely presentation:
Serosanguinous nipple discharge
81. Patient has amenorrhea for 7wks develops RLQ pain and Hypotension, what is the most likely diagnosis:
Ectopic pregnancy
82. Trauma case with pancreatic injury and leakage into

A. Omentum Bursa
B. Subphrenic
C. Subhepatic
D. Gutter
83. female with wrist pain and +ve Finketstein test, treatment?
A. Thumb Spica
B. Volar Wrist Splint
C. Surgery
84. Longest phase of cell cycle

Answer: Interphase
85. Patient says that people in the Radio and TV stealing his idea and talk about him?
Answer: Thought Broadcasting
86. Post-test probability of a diagnostic test?

86. Post-test probability of a diagnostic test?
A. Likelihood test ( I picked this)
B. Positive predictive value
87. Anesthesia blocked Pudendal Nerve which one will not be affected?
Answer: Rectum
Other bladder
88. A study aims at exploring the association of high fat intake and prostatic cancer., Group 1 has prostatic cancer (1000) patients with 50 high fat intake,
group 2 doesn't have cancer (1000) pt with 10 high fat intake
Answer: OR = 5.2
89. In a cohort study on lubricant oil use and urinary bladder CA done over 20 years 10,000 exposed 10,000 non exposed 750 exposed got CA 150 non
exposed got CA Then they asked about the incidence in 1000 in one year?
Answer: 2.25
89. Lung cancer affected 80 of 100 smokers,6 of 500 nonsmokers. What is Relative risk?
Answer: 66:1
90. 3y Lactic Acidosis + Hyperalaninemia is deficiency of ?

A. Pyruvate Carboxylase
B. Pyruvate dehydrogenase ( I choose this)
91. car accident case with membranous urethra injury next step?
A. Suprapubic catheter
B. Urethral catheter
92. Snuff box pain indicates =

93. Answer: Scaphoid fracture
94. Mother bring child with hx of chewing toys, labs show transferrin slightly elevated, normal ferretin, normal iron binding capacity. pokliocytosis with
target cells what is your dx?
A. IDA
B. Sideroblastic anemia
C. Alpha thalassemia
94. Pt takes one dose of varicella vaccine, and after one year presents to your clinic. What to do next?
A. Give double dose
B. Give 2nd dose
C. Start over
D. Antibody test
95. obesity study BMI what else needed?

A. Dietary habit
B. Skin fold thickness
C. Abdomen circumference
D. Girth
96. dx of nodular goiter, e hyperthyroidism thyroid scan showing patch iodine absorption what is the best treatment ?
A. Surgery (it might be this)
B. Radio iodine ablation ( I choose this)
C. Anti-thyroid medications
97. patient unable to flex knee & thigh , affected muscle?

A. rectus femoris
B. biceps femoris (I picked this, not sure of other options)
C. sartorius
98. In patient with lower bowel obstruction what's the most common presenting symptom
A. Absolute Constipation (I picked this)
B. Abdominal Pain (this could also be correct)
C. Diarrhea
D. Flatulence
99. 35 Y/O Female G3P2 10 weeks pregnant has diabetic nephropathy plus chronic HTN (managed by oral labetalol ), she is presenting in the clinic and has
BP 160/95 and Proteinuria 3+ what is your management
A. Bed rest (I choose this)
B. Pregnancy termination
100. Fructose intolerance scenario what to eliminate from diet:

Fructose

Fructose
101. site incision of emergency tracheotomy?

A. Cricothyroid membrane
B. Thyrohyoid membrane
C. Cricoid cartilage
D. Hyoid bone
102. 40 Y/0 patient has a father with hemochromatosis and he wants to get screened, you did LFTs and there were 2X normal limit elevated what is the next
screening test you want to order: No serum transthyretin in the choices
A. Ferritin (I choose this)
B. Glucose
Transferrin saturation best
103. Patient with hemochromatosis presents to the ER, he has ascites, abdominal distention, elevated JVP, Hepatomegaly, what is the most likely diagnosis
A. Liver Cirrhosis ( I choose this, but hepatomegaly was confusing me, as cirrhosis should be shrunken liver)
B. Cardiac Failure (Elevated JVP)
104. GERD often damages the lower esophagus causing intestinal metaplasia, what is the normal epitheium type in the esophagus
A. Simple columnar
B. Simple Squamous
C. Stratified cuboidal
D. Stratified Squamous
105. Post abdominal hysterectomy has inconveniences (while micturition ):

A. Vesicovaginal fistula
B. Ureterovaginal fistula
C. Urethrovaginal fistula
106. Premature Baby is admitted in NICU he has a abdominal X-ray showing air in the intestinal lumen, what is the likely cause:
A. Infection (Necrotizing enterocolitis)
B. Perforation
C. Obstruction
107. Potts disease in spine and something about spreading to chest asking about nerve of spread through?
A. Anterior cutaneous
B. Lateral cutaneous
108. patient will go for surgery for ... And afraid of phrenic nerve injury, what is the site of nerve?
A. Anterior to medial scalene muscle
B. Anterior to Anterior scalene muscle
109. Plural Refereed pain to shoulder by

A. Costal
B. Mediastinal
110. Patients that received radio-iodine therapy should avoid pregnancy for how long
A. 4 months
B. 6 months
C. 9 months
111. Type of dye used to diagnose corneal Abrasion:

Fluorescent
112. Picture about dendritic herpes asking about the symptoms?

Answer: hypoesthesia
113. Agitated patient presented to the ER with dilated pupils, tachycardia, HTN & diaphoresis what is the most likely cause
A. Sympathomimetic overdose
B. TCA overdose
C. Anti-cholinergic OD
114. Tennis player. What is the most likely sided effected?

Answer: lateral epicondylitis
115. Bladder cancer was resected and tumor biopsy showed muscle layer. The tumor is considered as being comletely resected and how would you
proceed?
A. Intravesical BCG
B. Mitomycin C
C. Secondary cystectomy
D. Frequent surveillance

C. Secondary cystectomy
D. Frequent surveillance
If you mean invasion of muscle
116. Why is inulin used to determine GFR:

Freely filtered
117. Patient had a stab wound to the back and is unable to raise his shoulder and raise his arm over his head, what nerve is mostly like injured
A. Long thoracic nerve ( I choose this)
B. Axillary nerve
C. Accessory nerve
Shoulder shrug function of trapezius
118. Patient was hit on the head with a iron rod and he developed a depressed skull fracture and lost consciousness, on the way to the ER he has vomitied,
what is the first thing you will do for the patient?
A. Lateral C-Spine (I choose this but I think it's wrong, cause it doesn't say collar)
B. Oropharyngeal intubation
119. When we can say stillbirth?

A. 20
B. 24
C. 28
D. 32
120. Patient has had diarrhea for 3 days and loss of appetite and weakness, which substance in the body is elevated
A. C-peptide
B. Cytokine
121. Mother brought I child for vaccination, the child had a throat infection 4 days ago and was started on antibiotics and is doing well today with temp of
37.6C, how will you proceed
A. Vaccinate as per schedule
B. Wait until antibiotic therapy is over
C. Give everything except DPT
122. Which hormone is responsible for increasing insulin sensitivity in peripheral tissue
A. Leptin
B. Adiponectin ( I choose this)
123. What medication is given for refractory hiccups:

Chlpromazine
124. Patient underwent successful ECV at week 36, on re-evaluation in week 38 the fetus now has transverse lie, what is the reason for ECV contraindication
now
A. Failed 1st attempt
B. Fetal position
125. X-ray Showing Legg Calves
126. Causes of Visceral Leishmania:

Leishmania Donovani
127. Recurrent miscarriage =

3 or more

128. What will cause bone age difference
Answer: Congenital adrenal hyperplasia
129. Organism involved in animal bite:

Pasteurella multocida (no option of poly microbial)
130. Molecular level of ectopic pregnancy

= Early disappearance of zona pellucida
131. Female patient visting pshyciatric due to anxiety, she mention she gets stressted from her work and dealing with people, what is the best approach to
deal with her
A. Tell her to confront people that make her uncomfortable
B. Show empathy towards her plight while discussing her problems
132. Patient being treated for Hyperthyroidism develops recurrents infections what medication is she most likely on:
Methimazole (agranulocytosis).
133. Patient is receiving local spinal anesthesia which position allows for cephald migration of anesthesia
A. Anti-Trendenlburg
B. Trendelburg (I choose this)
C. Lateral
D. Supine (it might be this)
134. A 15 years old girl came with her mother to your clinic complaining of not having her menstrual period so far. There is no history of vaginal bleeding.
Physical exam showed breast budding and raised areola. Fine hair on labia was noticed. Her growth curve is normal and she has gained 5kg since last
year, What is your diagnosis?
A. Primary amenorrhea
B. Secondary amenorrhea
C. Constitutional delay ( I choose this)
135. 13yr old male visting peds, parents concered about puberty, he has 4.5ml testes, basically description given seemed like Tanner stage 3, what is your
management
A. Continue observation ( I choose this)
B. Check for testerone levels
C. Check for growth hormone
136. Patient being evaluated for virilization, they showed several labs, FSH, LH were normal, estrogen was slightly increased, testerone slightly increased
cortisol slightly increased. What labs will u order next
A. DHEA & DHEPA (some other adrenal androgen). ( I choose those as I suspected adrenal tumor causing virilization as cortisol is rasied)
B. Serum Glucose & Insulin sensitivity
137. Sickle cell picture with

Paraphimosis.
138. superficial temporal artery, the origin of this artery in which layer of scalp
= Answer : Connective Tissue
139. Patient at risk of osteoporosis what is initial management ?

A. dexa
B. Tsh , calcium , 25 hydroxy
C. 3. Calcium and vit d supplement
140. HSP case asking for management:

Supportive
141. Patient taking phosphodiester 5 inhibitor (viagra) what medication he needs to avoid
Nitrates
142. 12 hours old infant born with jaundice. Direct bilirubin: 36 (high) Which of the following is the most likely diagnosis?
A. Hemolytic anemia
B. Gilbert disease
C. Choledochal cyst
D. Criggler Najjar disease
143. Vulvular Carcinoma case where is the location:

Labia majora.
144. Lung Adenocarcinoma in situ is defined in the new guidelines as

A. Tumor less than < 2cm ( I think this is correct although source on internet say <3cm)
B. Broncho-alveolar carcinoma ( I choose this cause I remembered this in First-Aid)

A. Tumor less than < 2cm ( I think this is correct although source on internet say <3cm)
B. Broncho-alveolar carcinoma ( I choose this cause I remembered this in First-Aid)
145. Randomized control trial patient in the intervention group, left what to do ?
A. Remove patient from control group
B. Add patient to intervention group
C. Cancel the trial if 5% drop the research
D. Include those patients in result
146. A case with symptoms of appendicitis and patient had history of sore throat last week, physical exma signs of appendicitis were negative, what is your
diagnosis
A. Mesenteric adenitis
B. Appencitis
147. Patient takes daily opioids, NSAIDs and triptans for headache, if skips his meds, he develops headache:
Chronic medicine overuse headache.
148. On Snellen chart, if the patient is able to read till the 3rd line. What is the result?
A. 20/100
B. 20/70
149. Long scenario peripheral smear showed basophilic sippling

Sideroblastic anemia.
150. Best test to screen dyslipidemia in a 50yr old

A. Fasting Total Cholesterol (I choose this)
B. Fasting lipid profile
151. 55 Y/O Old male presents with 2 days history of left chest pain that was sudden in onset, has no aggravating or elevating factors and no previous hx,
patient is chronic smoker, severely obese with family hx of ischemic heart disease, he can't exercise due to obesity, what test will u order next (no ECG
in choices)
A. Coronary angiography ( I didn't choose it as 2 days pain without features of typical angina)
B. Exercise stress test
C. Resting Myocardial Perfusion Scan (I choose this)
152. Stylomastoid injury = Loss of anterior 2/3 taste sensation

It should loss of motor or facial expression related facial nerve
153. There was a long scenario of patient with amenorrhea, basically it was a pituitary mass causing pan-hypopituitarism, thyroid values will be low but TSH
will be normal which indicates an in appropriate response from the pituitary, also other things like FSH, LH were low
154. Best treatment for a prolactinoma in a female desiring fertility

A. Bromocriptine
B. Cabergoline
C. Radioabalation
D. Surgery
155. Rabies scenario guy had 1 previous vaccine what do u give him when he presents with dog bite:
2 doses of rabies vaccine.
156. Cherry red lips unconscious =

CO poisoning.
157. Humerus surgical neck fracture

Axillary nerve injury
158. What causes atherosclerosis in coronary arteries =

Oxidized LDL

159. Internal iliac artery injured during hysterectomy what organ is affected
bladder
160. Hemorrhage what is decreased as a compensatory response

Venous capacitance
1. Long scenario about experiment in rats with parasite resulting in cytokine to be increased =(IL-5 isn't there in the choices, I picked IL-6 cause its an acute
phase rectant)
a. IL-6 (IL-5)
b. IL-10
c. TGF-Beta
1. Analgesic that makes pain of cholecystitis worse =

Morphine
163. Which group of people was postpone for hajj in 2015 for MERS-CoA from the Saudi MOH?
A. Lactating women
B. Children above 12 years old
C. Elderly diabetic
164. Which group of people was postpone for hajj in 2015 for MERS-CoA from the Saudi MOH?
A. Lactating women
B. Children above 12 years old
C. Elderly diabetic
165. A patient came to discuss abt his movement disorder, he starts having an episode where he just extends in arms and doesn't respond = Catatonia.
166. which one is contraindicated for instrumental delivery

A. Breech
B. Cephalopelvic disproportion
C. Facial presentation
167. How Frequently is Self-Breast Exam recommended

A. Daily
B. Weekly
C. Monthly ( I choose this as it seemed reasonable)
D. Yearly
168. How early does mammography detect breast cancer:

By 2 years.
169. Infant not complaining of Respiratory symptoms exactly written like this
BP 170/70 , HR 300
A. Cardioversion shock
B. Vagal massage
170. 11 Child with epiglottis

A. 1- ICU and intubate
B. 2- give amoxicillin
C. 3- hydrocortisone IM
D. 4- irrelevant option
171. Hypothyroid, unresponsive to painful stimuli, labs: hyponatremia. Best rx?

A. thyroxine, intubate, 3%NS, steroid
B. Thyroxine, 3% NS
172. Type of hypersensitivity in autoimmune hemolytic anemia

A. type 1
B. type 2
C. type 3
D. type 4
173. Pregnant at 32 weeks GA, fundal height 28. What is the clinical assessment you will do every two weeks?
A. CTG
B. maternal weight
C. fundal height
D. abdominal circumference ( I would pick this if it mentioned fetal abdominal circumference)
174. Scenario polymyalgia rheumatica what is the treatment?

A. indomethacin

174. Scenario polymyalgia rheumatica what is the treatment?
A. indomethacin
B. Steroid
175. Child qith repeated OM, treated previously e Abx. Came again with OM, best rx?
A. Amoxicillin
B. Amoxiclav
176. Study about stroke, the medication decreases the mortality from 8% to 4%, in 10 years. What is the number needed to treat to prevent a death?
A. 10
B. 25
177. OCP prevent?

A. mid cycle gonadotropin surge and ovulation
B. release of estrogen and ovulation
A child ingested a toxic dose of medication of his relative what is the best to do?
1- gastric lavage (
2- activated charcoal
no duration or name of substance mentioned)
178. Eosinophilia, parasite burden:

A. IL4
B. IL5
179. 18 M old baby mother breastfed her for 9 M and introduced cow milk and solid food now she have watery stool and foul smelling and she’s 3 Kg Labs: HB
low RBC low whats the underlying cause?
A. A.GI infection
B. B.cow milk
C. C. Bone marrow abnormality
D. D. Low birth wight
180. anemia both direct and indirect coombs positive whats the tx ?
A. A.Ritximab
B. B.cyclourcbril
C. Other chemo
181. Patient on anti-retroviral meds Alveolar lavage showed gram negative bacteria stains growed after 5 days on white dry agar and showed acid fast test
positive
A. crybactruim jekan (negative for acid fast)
B. .Nocardia
C. actinmycin isreli (negative for acid fast)
182. boy plays and fall and twisted his leg and refuse to walk
A. spiral fracture of tibia
B. spiral fracture of femur
183. pregnant 34 weeks of gestation came with labor pain CTG reactive and HR 140, What’s the next step
A. Lecithin- test
B. Continues CTG testing
184. pregnant 34 weeks came with headache, double vision, and HTN
A. call anesthesia and deliver
B. Stabiles condition, MGSO4 and delver
C. stablise, give steroid, deliver
D. Stiblase wait untle 34 week and deliver

Sunday, November 18, 2018 5:30 PM
1. Preferred method for testing hypersensitivity type 2?

a. Skin test
b. Prick
c. RAST
2. Which of the following has high diagnostic value for gonorrhea?

a. PCR
b. Gram stain
c. NAAT
d. Culture
3. Baby with no head lag = Answer: 4 months

Babies develop from head to toe and in a proximal to distal pattern. According to About Kids Health, by 4
months of age, babies should show no signs of head lag
4. Tells stories, draw a body = Answer: 4 y/o
5. Fishy odor, positive whiff test, what test are you going to confirm with = Answer: Gram stain. Dx is bacterial vaginosis, confirm
by gram staining
6. ECG atrial flutter, treatment Warfarin?

Answer: In general, atrial flutter should be managed the same as atrial fibrillation. Because both rhythms can lead to the
formation of a blood clot in the atrium, individuals with atrial flutter usually require some form of anticoagulation or
antiplatelet agent
7. ECG, 2nd degree heart block, what are you going to do, Answer: Pacemaker Mobitz2, there is high risk of developing third
degree block, treatment is pacemaker Mobitz1: atropine
8. Patient hypertensive with gouty arthritis, treatment?

9. Colchicine
A. Ibuprofen
B. Intra articular corticosteroids
9. Two cystic fibrosis career parents risk of affected child = 1:4
10. Anaphylaxis type of hypersensitivity= Type I reactions (ie, immediate hypersensitivity reactions) involve immunoglobulin E
(IgE)– mediated release of histamine and other mediators from mast cells and basophils. Examples include anaphylaxis
11. Child with epiglottitis caused by H.Influenzae, treatment

A. Gentamicin
B. Ceftriaxone
Intravenous antibiotics such as ceftriaxone and possibly vancomycin or clindamycin is then given, If allergy to penicillin is present, co-
trimoxazole or clindamycin may be an alternative.
12. Bone tumor that arises from pelvis? Answer: The majority of tumors in the pelvis are malignant (metastases, myeloma,
chondrosarcoma, Ewing sarcoma, osteosarcoma, and MFH/fibrosarcoma)
Chondrosarcoma happens most often in people between 40 and 70. The hip, pelvis, leg, arm, and shoulder are common sites of
this cancer, which begins in cartilage cells
13. Most common skin manifestation with antimalarial drugs= Answer: Hyperpigmentation or itching,
In general: itching or pruritus
In skin: hyperpigmentation
14. Most common risk factor for fibroid?

A. Age
B. African race
C. Smoking
D. Multipara
Answer: Depends on choices.
Oct Quesion compiled Page 15

Answer: Depends on choices.
15. Malaria endemic region prophylaxis? Answer:

• Malaria prophylaxis areas with chloroquine-sensitive Plasmodium falciparum: Chloroquine phosphate, Hydroxychloroquine
sulfate, Atovaquone-proguanil, Mefloquine hydrochloride, Doxycycline hyclate.
16. Artery affect with hearth block = Right coronary artery
17. Most common type of study that risks a recall bias = Case control
18. Most common type of study that risks a publication bias? Answer: Meta-analysis
19. Most common type of study that risks a non-response bias Answer: Cross-sectional
20. Most common gene with hypertrophic cardiomyopathy = Answer: MHC

Most of the genetic loci in familial HCM encode one of the myocardial contractile proteins of the cardiac sarcomere the most
commonly involved genes are MYH7, MYBPC3, TNNT2, and TNNI3
21. PCOS have risk for which tumor Answer: Endometrial
22. Man complaining of ear pain, tympanic membrane clear when touching the pinna, it was tender. Diagnosis = Answer: Otitis
externa
23. Hemophilia mode of inheritance? Answer: X-linked recessive

hemophilia A and hemophilia B are inherited in an X-linked recessive pattern.
24. NF1 gene = Answer: 17q11.2

NF1 encodes the protein neurofibromin, a GTPase-activating protein, which primarily regulates the protein Ras.[6] NF1 is
located on the long arm of chromosome 17, position q11.2
25. Contraindication for breastfeeding?

A. HCV
B. HIV
C. Varicella
26. Picture of dendritic ulcer of cornea?
Answer: Associated with corneal hypoesthesia?

Herpes simplex keratitis, high recurrence rate can cause hypoesthesia
27. Interstitial lung disease with small non-necrotizing granuloma?

A. Sarcoidosis
B. Aspergillosis
C. Hypersensitive pneumonitis
28. 2-DM type 1 pregnant at 3rd trimester have an increased insulin requirement despite good control of her glucose level, what
is the mechanism causing her hyperglycemia?
A. Maternal hyperglycemia
B. Maternal hypoglycemia
C. Neonatal hyperglycemia
D. Neonatal hypoglycemia
29. young woman came to Primary health care for pregnancy counseling, she had chickenpox when she was a child. What will
you do to her?

you do to her?
A. Varicella immunoglobulin
B. Rubella antigen.
C. Give MMR vaccine
• “Do rubella titer for her in preconception .
• She already infected with cheickenpox she had natural immunity.
• Dont need to avoid exposure this Answer for pregnant came afarid of chekenpox a dvice her to Avoid exposure as she is
pregnant now.”
• I had it today and yes the answer is do rubella titer , there wasn’t even “avoid exposure” in the
• choices
30. Digoxin toxicity Answer: digoxin immune Fab (Digibind)
31. Child (boy) has cystic fibrosis his parents don’t have the disease what is the chance to have
a carrier daughter (Child sister) ;
A. 1:2
B. 1:25
C. 2:4
D. 2:3
32. Proximal Tibial fracture palpable peripheral pulse ABI: .85 what to do:
A. Angiography
B. Doppler US.
C. CT
33. which one of the following SSRI has the greatest risk in pregnancy?
A. Escitalopram
B. Fluoxetine
C. Paroxetine
D. Sertraline
34. ADHD diagnostic criteria according to ICD10 CLASSIFICATION, but I cannot remember the answers: But it was like
this :( number of feature and the description of it) for example:
A. 3 hyperactive, 3 inattentive, and other
B. 2 hyperactive, 3 inattentive
C. 2 hyperactive, 2 inattentive
D. 6 inattention 3 hyperactive 1 impulsive
35. Which one of the following patients has worst prognosis to, develops Steven Jonson:
A. HIV patient receiving sulfa group medication with unknown history?
B. Gouty arthritis patient with known sensitivity to all
36. Patient complain of hand pain after bee sting , on examination: tenderness + Axillary lymph node enlarged, ( + picture: weal
on forearm) what is dx:
A. Urticaria
B. Lymphangitis (my answer)
37. Which of the following integrates glucose and fatty acid metabolism
A. Pyruvate
B. Citrate
C. Lactate
D. Acetyl-CoA
38. DM pt , with chest pain for 3 days , dyspnea with exertion , history of URTI ECG depression Lab: troponin: high, What is the dx?
A. Myocarditis
B. MI
C. Constrictive peri
Acute myocarditis may mimic MI since chest pain, segmental wall motion abnormalities, and myocardial necrosis proven by
troponin elevation exist in both conditions.71,72 Smith et al reported the rate of troponin positivity as being 34% in a study
population with biopsy-proven myocarditis
39. Case scenario about female with past hx of PROM and now she is pregnant asymptomatic and ask about indication of
screening for bacterial vaginosis:
A. No indication

A. No indication
B. Screen at first trimester
C. Screen at second trimester
D. Screen at third trimester
40. Female with diffuse thyroid swelling and dominant single nodule , lab test result was increase in T4 and decrease TSH what
will you do:
A. Radionuclide scan
B. FNA
C. US
D. Thyroidectomy
41. Child presented with burn in the upper right extremity with bluster what is the degree of the burn?
A. 2nd degree more than 15%
B. 2nd degree less than 15%
C. 3rd degree more than 15 %
D. 3rd degree less than 15%
42. Stress incontinence symptoms in a patient who had evidence of urethral detachment, next step:
A. Bonny’s test
B. Urethroscopy
C. Cystoscope
D. Q-tip
43. pregnant women during labor, Iv oxytocin was given the CTG show variable and acceleration what will you do?
A. Stop oxytocin
B. Expectant delivery??
C. Change mother position
44. Colon cancer smoking RR = Answer: 6.6

45. Lung cancer smoking = Answer 70%
46. Prostatic cancer and high fat intake OR = Answer: 5.2
47. A study was done on breast cancer and smoking and alcohol, results shows, First group OR 1.4 (CI 95%: 1.0 – 2.0), Second
group OR 1.6 (CI 95%: 0.7 – 10.8) Which of the following is correct? : No Ans provided
48. Chronic granulomatous disease most common organism = Answer: Staphylococcus aureus
49. Pediatric DKA management Answer: Reference: Illustrated Textbook of Pediatrics

51. New born with meningitis, what’s the organism? Answer Listeria
52. Child came with olive mass and non-bilious vomit, what’s the diagnosis? Answer: Pyloric stenosis.
53. Ptx on aspirin for CAD. He had a sudden episode of severe epigastric pain that became generalized and guarding and
tympanic percussion & high amylase.
a. Perforated Ulcer
b. Acute Pancreatitis
54. DM T2 gene: 20, 12, 1, 2
55. Necrotizing fasciitis and gram+ve cocci in chains

A. piperacillin/ tazobacta
B. pipercillin/ clinda
56. On HTN medications with hypokalemia, what’s the cause?

A. thiazides
B. ACEI
57. Cushing scenario

A. 24 hour urine cortisol
B. AM cortisol only
Answer: 24 hour urine cortisol
58. Conn’s scenario with HTN and hypokalemia another symptom would be? salt carving
59. DI classic scenario. another symptom would be? Answer: Polyuria
60. Hypothyroidism and high TSH but asymptomatic & on meds

A. Continue same dose and f/u,
B. Stop med
C. Decreases dose
61. MG treatment = Answer: pyridostigmine
62. Knee reflex/patellar reflex scenario= Answer: L3-L4
63. Pt had encephalitis organism? Answer: Mumps

Encephalitis caused by varicella-zoster virus (VZV), EpsteinBarr virus (EBV), cytomegalovirus (CMV), measles virus, or
mumps virus: Rash, lymphadenopathy, hepatosplenomegaly,
and parotid enlargement
64. What is the most common cancer mets to stomach and stomach ca
A. breast then lung
B. stomach cancer metastases to liver then peritoneum then lung
65. Muscle lateral site dorsal pedis Answer: Extensor digitorm longus
Medial to it = hallucus longus, Lateral= digitorm longus

66. 75- 13 months old baby just finished his steroid dose, which one of these vaccines are you
going to give? Answer: don’t give MMR or varicella
67. Dorsal of hand which nerve cover it = Radial
68. Recurrence of UTI and you want to give Nitrofurantoin, what’s the duration and dose One dose for six month? Answer: Nitro
50-100 for 6-12 months
69. Pt have fever and knee pain on the lab after aspiration cloudy color, what’s your antibiotic of choice?
Answer:
Gram positive cocci – Vancomycin
Gram negative cocci - Ceftriaxone
70. Testicular torsion = Answer: Refer to surgery
71. Picture ulcer in mouth and the penis and the patient complain difficult eating due to pain of ulcer, what is the diagnosis?
A. Syphilis
B. Bechet disease
72. Syphilis-blisters = Answer: Pain less
73. Esotropia 25 degree, treatment Answer: Medical rectus recession

More than 15 PD: medial rectus recession
Less than 15 PD : eye glasses
74. Pic of corneal abrasion Answer: Ab ointment + eyepatch
75. Which one of the organisms is associated with contact lens induced corneal abrasions?
A. Pseudomonas
B. Streptococci
C. Staphylococci
D. Fungal
76. Infraorbital artery Answer: infraorbital artery is a branch of the third part of the maxillary artery. It runs through the inferior
orbital fissure, orbit, infraorbital canal then the infraorbital foramen
77. Mumps complication

Answer: Adults orchitis & Children meningitis
78. Pt have major depression takes paroxetine she’s pregnant

A. Stop drug
B. Continues drug and observe
79. Patient came from Ghana with neck mass Answer: Burkitt’s lymphoma
80. Best antiepileptic in pregnancy Answer: Levetiracetam
81. Best anti-psychotic in pregnancy Answer: Women taking the antipsychotics quetiapine, olanzapine, or risperidone during
pregnancy did not have higher rates of complications
82. Schizophrenia case, doctor notice the patient is staring at someone not in there, and says YOU CANT KILL ME? asking about
this symptom?
A. Delusions
B. Hallucinations

83. Patient on statin 20mg od , on routine exam Lipid profile was within normal except for TG, Asking about which lipid lowering
agent would you add :
A. Ezetimibe
B. Fenofibrate
C. Niacin
84. Pregnancy counseling, ask about how to asses of thalassemia in next pregnancy Answer: Amniocentesis
85. When to do OGGT in pregnant women which before pregnancy was in prediabetic range?
A. 12
B. 16
C. 20
D. 24
85. Q about mechanism of HDL protective effect on Heart, which enzyme is responsible?
A. Acetyl CoA
B. Cholesterol ester protein
86. Q about sudden painful loss of vision within mins to hours associated with very painful eye movement, fundoscopy showing
optic edema?
A. Multiple sclerosis
B. Trigeminal Neuralgia
87. Child with salmonella, asking about mechanism of Abx used? Answer: IV ceftriaxone
Ceftriaxone selectively and irreversibly inhibits bacterial cell wall synthesis by binding to transpeptidases, also called
transamidases, which are penicillin-binding proteins (PBPs) that catalyze the cross-linking of the peptidoglycan polymers forming
the bacterial cell wall.
88. Prophylaxis of child going to south east Asia with his father:
A. cipro
B. Doxycycline (if older than 8yrs this is correct)
C. Ceftriaxone (I would pick this)
89. Best modality to Dx Cervical spondylosis:

A. MRI
B. CT
C. conduction studies
90. Q about fever and rash all over the body with facial sparing?
A. Syphilis
B. Rocky mountain spotted fever (if this choice is there pick it)
91. Old patient complaining of generalized fatigue and tiredness specially in the morning with difficulty to stand from the chair ,
with weakness and stiffness?
A. RA
B. OA
C. Polymyalgia rheumatic
D. Polymyositis
92. Colle’s fracture in a child, your management?

A. Closed reduction with cast below Elbow??
B. Closed reduction with cast above Elbow
C. irrigation, debridement, fixation (pick this one if image of open fracture given)
93. Which of the following is a common cause of Cerebral palsy?

A. prematurity
B. perinatal Asphyxia
C. Low birth weight <1.5 kg
94. sensory hair loss with tinnitus and lightheadedness with fullness of the ear sensation, Answer: Meiners's disease
95. old patient with gastritis low mcv (case of IDA ), what’s your management?
A. IM iron

A. IM iron
B. Oral Iron
C. folate
96. 19 years old young patient presented ER with headache and lightheadedness with vomiting started 20 min ago ? what is your
next step?
A. Alcohol concentration
B. CT brain
96. Q ask specifically for Scabies Rx Answer: Permethrin cream and lindane lotion
97. Mechanism of action of Warfarin? Answer: Vit K ((vitamin K epoxide reductase))
98. safe hypoglycemic medication in pregnancy Answer: metformin ((You should avoid hypoglycemic agent during pregnancy))
99. End stage liver disease and fungus Answer: Caspofungin
100. Young couple try to conceive for 6 months? Answer: Try 6 more months
101. Working in a battery factory, semen analysis showed oligospermia, what’s the cause Answer: Lead
102. Women with BMI 11 and daily measure weight and denied hunger, which of the
following is right:
A. decrease amylase (this should be high)
B. hyperkalemia
Answer: Electrolytes are all low like Na ,K, Cl &Creatinine is high due to dehydration
103. OCD and ask about mechanism of drug Answer: increase availability of serotonin
104. known case of depression came to ER after ingestion of bottle of drugs he is comatose with dilated pupil what drug he
ingested? Answer: Amitriptyline
105. Biopsy was made for lung shows hemosiderin-laden macrophages What is the diagnosis:
A. EBV
B. Heart failure
C. pneumocystis jirovecii
106. Scenario about patient had symptoms restless, sweating, heat intolerance on examination pt is warm and have bradycardia
on apical auscultation what is the diagnosis:
A. Thyroid cancer
B. Multinodular goiter
C. Hyperthyroidism
D. Hyperparathyroidism
107. Triple GAA replication which diseases: Answer: Friedreich's ataxia syndrome
108. pathology and neurotransmitter affected in Huntington’s Disease: Answer: Huntington low GABA and high dopamine
109. lichen planus long term effect:

A. relapse and remission
B. malignancy transformation
C. Automatic resolution
111. Lichen Sclerosis what cancer can develop = Squamous cell carcinoma
110. Down syndrome association heart disease = Answer: AVSD
111. Dizygotic definition? Answer: Dizygotic dichorionic diamniotic
112. Confusion, anemia, deranged kidney function, peripheral blood smear showed schistocytes and fragmented RBCs, hemolytic
panel was elevated, antibodies of which is most likely implicated in the pathogenesis of the disease?
a. vWB
b. ADAMTS13
c. VIII

c. VIII
113. Myopic patient with glasses, got worse overtime? Answer Keratoconus
114. Contraindication of Circumcision? Answer Hypospadias
115. Pap smear screening? Answer: Transformation zone
116. Upper outer quadrant breast cancer, which lymph node is most likely affected?
A. Anterior axillary
B. Posterior axillary
C. Lateral axillary
117. Prolactinoma signs, which visual defect might be present? Answer: Bitemporal Hemianopia (( due to pressure on optic
chiasm
118. SCA child with severe hip pain? Answer: Avascular necrosis
119. How does a protein enter a peroxisome?

A. Folded using a C terminal
B. Unfolded using an N terminal
C. Unfolded using a C terminal
D. Folded using an N terminal
120. Asking about type of hip joint? Answer: ball and socket joint
121. What’s methylergonovine absolute contraindication?

A. Asthma
B. Hypertension
C. Diabetic
D. Ulcerative colitis
122. Ice craving? Answer: Pagophagia
123. HDL receptor in the heart? Answer SRB1
124. Gene associated with gastric cancer?

A. p53
B. CDH1
C. ABC
125. Picture of syphilis, what’s the treatment and the organism? Answer: Organism: Treponema pallidum + Rx: Penicillin G
126. Pathology of Osgood-Schlatter disease? Answer: inflammation of patellar ligament OR Traction apophysitis
127. Patient on chemo and radiation, what type of anemia? Answer: Aplastic
128. Most common cause of Neovascularization ?

A. Non-proliferative
B. Retinal detachment
C. Central macular atrophy
D. Answer: Neovascularization
1- CRVO
2- Diabetes proliferative type retinal neovascularization, or abnormal blood vessel growth in the retina, a hallmark of advanced
diabetic eye disease (proliferative diabetic retinopathy)
129. Infraclavicular mass what do for dx

A. CT??
B. Biopsy
130. Pt with left jaw mass, increased pain with chewing? What nerve is affected: Trigeminal
131. Patient on sulfa medication describe the rash? Blister

132. GERD Pt on omeprazole for 7 year whish worse in last 2 months , omeprazole not affected + dysphasia of solid food , what
dx?
A. Functional dysphasia
B. Acute gastritis
C. Barret esophagus
D. Hiatal hernia
133. Folic acid dose in pregnancy?

A. 0.4
B. 1
C. 2
D. 4
Answer: Lithium as mood stabilize.
135. Patient yelling and shouting and hit in the ER? Answer: Give Haloperidol (in case of delirium)
136. Elderly with prostatic cancer, had two DVT for the past 3 months. What to give as a preventive method? Answer: Low
Molecular Weight Heparin (Enoxaparin)
137. Most common polyps turn into malignant? Answer: Adenoma (Fmaiila adenoma polys FAP )
138. Onion skin reaction. What to do next? Answer: MRI, Ewing’s sarcoma
139. Which of following muscles pass through lesser sciatic foramen?

a. Pectineus
b. Obturator internus muscle
c. Quadratus femoris
d. Obturator externus
140. Asthma with migraine, what to give prophylaxis = Amitriptyline
141. Eye drops contraindicated in acute angle closure glaucoma = Answer: Brimonidine and Atropine
147. Preeclampsia given mgso4 and delivered, in examination: (after hours), Deep tendon reflex +1, HR 130,
Hypertensive. what is the cause?
a. MgSO4
b. Hemorrhage
c. Anesthesia
143. Child 8-month-old with recurrent fracture with blue sclera = Osteogenesis imperfecta
144. Female fall of ladder, breath is labored, cyanosed with no breath sound heard over right side, Percussion is
hyper resonant, management = Needle thoracostomy
145. Aspirin toxicity = Respiratory alkalosis followed by Metabolic acidosis
146. 8-month-old child with dry cough 3 days, on auscultation bilateral wheezes and mild infiltration. temp was 38.5 What is Dx?
a. Bronchiolitis
b. Bronchial asthma
148. Young female married, periumbilical pain then allover abdomen, high temp, Tender DRE, +ve psoas and obturator signs. What is
the dx?
A. Ectopic pregnancy
B. Acute appendicitis
149. At delivery, cervix 4 cm and baby developed distress (FHR decreases 120 to 80), what type of anesthesia given to mother = General
anesthesia
150. 4 months of generalized pain, chest pain, pale, history of use of new drug (didn’t mention the drug), now patient is very ane mic,
what is the most likely cause = Antibodies directed to drugs on surface of RBCs

what is the most likely cause = Antibodies directed to drugs on surface of RBCs
151. 179- 40 male in check up all normal but with his brother died from IHD what lipid level should achieve = Answer: 3.4 – 4.1 mmol
152. Patient involved in MVA, the impact especially in forehead examination forehead laceration & fracture, discharge from nose cl ear
positive glucose test (I think he meant CSF leak) Which cranial nerve affected?
A. Optic
B. Olfactory
C. Ophthalmic
D. Oculomotor
153. A patient came for ophthalmology check-up, has optic disc cupping, tonometry showed high IOP, what would u tell this patient?
A. Tonometry is sufficient
B. Do checkup for blood related members
C. Interventions may reverse these changes
154. High risk of menopause = Osteoporosis

Answer: If they mean early menopause the answer is ovarian cancer If normal age of menopause it causes a lot of problems like:
Osteoporosis, Heart disease
155. Young male present with history of fever for few days, with hot, swollen, tender skin of the lower leg, what’s the diagnosis =
Cellulitis
156. Fragile X syndrome feature: Macroorchidism
157. Para-follicular c cell origin of medullary carcinoma
158. Measles: 3Cs cough, coryza ,conjunctivitis + grayish spotin mouth koplik spot
159. Infantile colic: The duration of crying is >3 hours per day, and >3 days per week, > 3 weeks.
160. The most common type stone: Answer: Cholesterol

Cholesterol in gallbladder
Calcium in kidneys
161. Pt on TB medication with peripheral neuropathy , what is the vitamin to give him = Answer: Pyridoxine
162. Pt on Antipsychotics and developed eye pigmentation; caused by which drug?

A. Clozapine
B. Chlorpromazine
163. Pheochromocytoma associated with = MEN 2
164. Knee injury from lateral on football player what is the ligament +ve valgus stress = Medial collateral ligament (tibial)
165. knee injury before 4 hours with severe pain. What is the best initial thing to do= Xray
166. Most common cause of death in adult with SCD?

A. Aplastic crisis
B. Sequestration crisis
C. Vasooclusive crisis
D. Acute chest syndrome
167. Most common cause of cancer in pregnant women

A. Breast
B. Cervical
C. Uterine
168. Most common cause of vaginal bleeding?

A. cervix ca
B. cervix polyp
C. mensuration
169. incubation period of mump = 16-18 days

169. incubation period of mump = 16-18 days
170. Patient with low weight and height percentile, diarrhea and constipation, biopsy taken and showed Atrophy of villus of small
bowel. What is the diagnosis = Celiac Disease
171. Patient with impairment memory a CT of brain was done and showed Cerebral Atrophy and dilatation of ventricles. What is most
likely diagnosis = Alzheimer disease.
172. 70 years old female with DM type 2 and Hypotension, complaining of short and intermediate memory loss, annoyed by people,
prefer to stay home. What is the most likely diagnosis
A. Alzheimer’s disease
B. Vascular dementia
C. Pick's disease
D. Dementia with Lewy bodies.
173. Pregnant women brought to ED with massive vaginal bleeding, lower abdominal tenders, Low Vital signs, the attending decide to
terminate the pregnancy which one of the following is the *most appropriate action to take?
A. Take the consent of the wife only
B. No need for consent for emergency cases
C. Take consent of the husband
D. Take consent of both wife and husband.
174. Epileptic progeny woman asking about which one of the following has the highest effect on developing birth defects
A. Age of the mother
B. Taking benzodiazepine
C. Anticonvulsants
175. Diabetic woman with high-uncontrolled blood sugar planning to get pregnant and asking about which time has the highest risk to
develop birth defects?
A. Pre-perception
B. First trimester
C. Second trimester
D. Third trimester
176. Treatment of pyuria:

A. Ceftriaxone and doxycycline
B. Penicillin
C. Amoxicillin and clavulanic acid
177. Child presented with swelling, and electrical microscope showed fusion of podocyte (minimal change disease) what is the
treatment = Prednisone
178. Male presented with throbbing perianal mass after defection, mass is fluctuate, 2 cm, what is the most appropriating treatment.
A. sitz bath
B. Incision and drainage
C. Antibiotic
179. A case of painless enlarged testicular with swelling at lower abdomen. Negative trans-illumination? Inguinal hernia or testicular
cancer
180. A Question about Research ethics applying without consent

A. Ask your colleague
B. Follow your senior
C. Written complaint to hospital director
D. Contact with ethics commits in hospitals
181. 4 years old child brought by his mother to doctor, he introduced himself to doctor, said hello, he can name the objects, repl y with
clear sentences. Mother complained about her son sucking thumb habit. What is the best step of management?
A. Nail crib
B. Nail painting
C. Reward him if stop sucking thumb
D. Tell him to stop sucking thumb.

182. Diabetic patient complaint of lower limb burning, what is the best treatment?
A. Aspirin
B. pregabalin
C. Amitriptyline
183. Diabetic with deep ulcer what is the management?

A. Penicillin
B. Mepivacaine
C. Debridement and antibiotic
184. Abscess case at day 7 with sanguineous discharge at the site of suture, and when its probing place at suture site it showed
abdomen content? Answer: Fascial Dehiscence with evisceration
185. Injury to Superior laryngeal nerve will lead to. Answer: change in quality of the voice & difficulty to reach high tones (pitch)
186. Child not vaccinated with swelling at parotid radiating at jaw. Pain occurs during chewing. What is the most likely complicat ion?
A. Sterility
B. Encephalitis
C. Hearing loss
187. Female complaining of over production of hair in axilla, face and body. Her menarche at 12, normal secondary sexual
Characteristics. What is the diagnosis?
A. Adrenal congenital hyperplasia
B. mineral corticosteroid
C. Insensitivity of androgen.
D. overproduction of androgen
188. Patient presented with unilateral Headache associated with photopia. What is the most likely diagnosis = Migraine
189. Old diabetic female presented with left middle and ring pain at palmar surface she cannot extended wrist. Picture was attache d.
What is the diagnosis?
A. Diabetic sclerodactyly
B. Dupuytren's contracture
C. Ulnar nerve palsy
190. Most specific hormone to follow prognosis of treatment of Hypothyroidism?

A. Thyroxine
B. T4.
C. TSH
D. TRH
191. Mother had negative Rh and her husband had Positive Rh. First child born normal, what is the probability of the second child to
develop Rh+?
A. 0%
B. 25%
C. 50%
D. 100%
192. Patient presented with low Hb, Low MCV, Positive Coombs test, High Reticulocytes, High Bilirubin. What is the diagnosis =
Autoimmune hemolytic anemia (AIHA)
193. Patient with Secretion of milky like discharge from breast what is the next step of investigation= Answer: if female the next step is
pregnancy test. if male prolactin levels?
194. Old patient with had right body sided paralysis for 1 hour and then he returned to normal status what is the most likely diag nosis =
TIA
195. Reed Sternberg cells found in Hodgkin’s lymphoma
196. Which of the following will have elevated Gastrin = Zollinger–Ellison syndrome
197. Pregnant woman at 38 weeks, presented to ED with painful contracture, Rupture of member was 8 hours ago, and pelvic exam
showed clear fluid with dilatation of the cervix 3 cm what the next step is? Options were: A) Give AB. B) oxytocin. C) Give

showed clear fluid with dilatation of the cervix 3 cm what the next step is? Options were: A) Give AB. B) oxytocin. C) Give
morphine. D) Give naloxone.
198. Feature of intra-ductal papilloma = cause of nipple discharge (serous or bloody).
199. Child crying with dry cough, Hoarseness, and URTI, What is the appropriate next management
• mild symptoms: steroid.
• moderate to severe: racemic epinephrine.
• his is most probably a case of Croup, if the cough was absence and pt is hypoxic or drooling then it’s epiglottis and the best next
management is intubate.
• X-Ray is almost always the wrong answer to the next step.
200. Hyperthyroidism complication = Atrial fibrillation
201. Management of patient with generalized swelling and heart failure what is the appropriate drug = Furosemide
202. Patient developed swelling after Taking new HTN medication what is the most likely the drug = Amlodipine
203. What does the term distichiasis refer to?

A. Extra row of eyelashes
B. Discoloration of eyelashes
C. Inward growth of eyelashes
D. Absent part of eyelashes
204. A study was done on 2 groups control (non-smokers) and smokers followed up for 20 years to see the prevalence
of colorectal cancer. What is this type of study?
A. Case control
B. Cohort
C. Cross-sectional
D. Systemic review
205. What is the most common SIGN and SYMPTOM of ectopic pregnancy?
A. Uterine tenderness and back pain
B. Abdominal pain and tenderness
C. Vaginal bleeding
206. A Nissen fundoplication was carried out on a patient with a hiatal hernia. During the operation, the surgeon accidently injur es the
posterior vagal nerve. What organ will be affected?
A. Esophagus
B. Jejunum
C. Duodenum
D. Colon
207. A pediatric patient with projectile vomiting and an olive mass. What would be the most appropriate initial investigation to
perform?
A. H. Pylori testing
B. Sonography
C. X-ray
D. Endoscopy
208. An abdominal ultrasound study was performed on a female patient early in her gestational period which showed a low-lying
placenta. After several weeks later, an US
showed that the placenta might be adherent to the uterine wall. What will you order to confirm this?
A. CT
B. X-ray
C. MRI (some say this)
D. Transvaginal US (In MTB)

209. child with eye swelling, mucopurulent discharge, periauricular LN enlargement Gram stain showed: Gram negative diplococci ..
What is the treatment?
A. IV Cephalosporin
B. oral Gentamicin
C. Sulfonamide droplets
210. Eosinophilia + Parasite infection, which interleukin associated with it: IL 5
211. Trauma case with pancreatic injury and leakage into

A. Omentum Bursa
B. Subphrenic
C. Subhepatic
D. Gutter
212. Thyroid cancer responds more to Radioiodine more than others:

Medullary
Follicular
Papillary
213. Total Gastrectomy = Loss of Pepsin enzyme
214. GCS child, open eyes when doctor shout to him, crying and confused, moves withdrawal to painful stimuli Answer: 11
215. female with wrist pain and +ve Finketstein test, treatment?
A. Thumb Spica
B. Volar Wrist Splint
C. Surgery
216. Diabetic with Upper limb pain lasted for 20 mins then disappeared, what will help you?
A. BMI
B. CHAD2
C. ABCD2
217. CTG late deceleration = Placental insufficiency
218. labs showed Hypercalcemia and CXR: left hilar mass?

A. Adenocarcinoma
B. Squamous cell carcinoma
219. Old patient with multiple osteoid osteoma, complain of pain and Xray showed calcification?
A. Chondrosarcoma
B. Osteosarcoma
220. Case of Marfan syndrome features asking about heart abnormality associated with it Aortic Aneurysm
221. Longest phase of cell cycle Answer: Interphase
222. HIV case treated initially with Nucleotide analogue, what will indicate the effectiveness of the treatment = Viral load CD4
223. Gallstone developed Fever, RUQ pain, Jaundice treatment?

A. IV antibiotics
B. Surgery
C. Conservative
224. Patient says that people in the Radio and TV stealing his idea and talk about him = Thought Broadcasting

225. Lady came to the psychiatric clinic, when the doctor started to talk with her about psychosocial life she refused to answer him and
left the clinic and didn’t come back? = acting out
226. Baby with Central and Peripheral cyanosis

A. PDA
B. Tetralogy of Fallot
C. ASD
D. Coarctation of Aorta
227. 8 months girl start crying and screaming when any stranger tries to play with her?
A. Stranger anxiety, at 6 months
B. Separation Anxiety, 12 months separation
C. Specific Phobia
D. Normal
228. Child Transfer objects, Roll over, Crawl, but Can't Pincer Grasp?
A. 6m
B. 7m
C. 9m
D. 5m
229. Heroin addict, which drug used for immediate Rehab Answer: Methadone
230. Difference between delusion and delirium = Disturbance of consciousness
231. Husband has symptoms of depression for 2 weeks and history of being happy active and worked for hours? Answer: Bipolar
232. Best hypoglycemic for pregnancy = Insulin
233. In alcohol which one will be high?

A. GGT
B. ALP
C. ALT
234. False believes and unacceptable by the culture? Answer: Delusions
235. 12 y/o with symptoms of Myasthenia gravis asking about pathology = Answer: Anti-acetylcholine antibodies
236. Which antidepressant causes Tardive Dyskinesia Answer: Haloperidol + Olanzapine
237. Mother see Snakes in her baby's bed?

A. Hallucinations
B. delusions
C. Depression
D. Postpartum psychosis
238. Came to ER with Upper limb adducted and internally rotated = Answer: Posterior dislocation
239. Winged Scapula Which part of Brachial plexus injured = Answer: Root = Long thoracic nerve
240. If a researcher wants to start a study and wants only the subjects that do not have diabetes to participate. What will be hig h in the
test = Answer: Sensitivity
241. Post-test probability of a diagnostic test = Likelihood test
242. What is the equation of Relative Risk = Answer: A/A+B ÷ C/C+D
243. A study aims at exploring the association of high fat intake and prostatic cancer., Group 1 has prostatic cancer (1000) patie nts with
50 high fat intake, group 2 doesn't have cancer (1000) pt with 10 high fat intake = OR = 5.2
244. In a cohort study on lubricant oil use and urinary bladder CA done over 20 years 10,000 exposed 10,000 non exposed 750 expose d
got CA 150 non exposed got CA Then they asked
about the incidence in 1000 in one year = Answer: 2.25

about the incidence in 1000 in one year = Answer: 2.25
245. Lung cancer affected 80 of 100 smokers,6 of 500 nonsmokers. What is Relative risk reduction = Answer: 66:1
246. Typhoid Fever research question = Answer: 100
247. which one is contraindicated for instrumental delivery

A. Breech
B. Cephalopelvic disproportion
C. Facial presentation
248. Lactic Acidosis + Hyperalaninemia is deficiency of

A. Pyruvate Carboxylase
B. Pyruvate dehydrogenase
249. car accident case with membranous urethra injury next step?
A. Suprapubic catheter
B. Urethral catheter
250. CXR showed mass in the Rt hilar area asking if a Neoplasm which Vessel will be compressed?
A. Superior vena cava
B. Pulmonary artery
C. Subclavian vein
D. Aortic Ascending
251. case of Gout asking about the enzyme = Xanthine oxidase
252. patient known to have Osteoporosis and he takes Vitamin D, type of prevention?
A. Primary
B. Secondary
C. Tertiary
253. Emphysema case, which medication will decrease secretion without Bronchodilation?
A. Salbutamol
B. Montelukast
C. Ipratropium
254. Treatment of Erosive Gastritis = Answer: Omeprazole
255. Which is true about erosive Gastritis?

A. Symptoms after 12 hours from trigger
B. Symptoms after 2-5 days from trigger
256. Mother bring child with hx of chewing toys, labs show transferrin slightly elevated, normal ferritin, normal iron binding capacity.
pokliocytosis with target cells what is your dx?
A. IDA
B. Sideroblastic anemia
C. Alpha thalassemia
257. Cough, hemoptysis, saddle nose, hematuria, what is the most likely diagnosis = Wegner granulomatosis
258. Pediatric difficulty in learning = Dyslexia
259. Case of molar pregnancy. snow storm appearance = Complete mole
260. At a day-care center 10 out of 50 had red eye in the first week, another 30 developed the same condition in the next 2 weeks. What
is The attack rate (cumulative incidence)?
A. 40%
B. 60%
C. 80%
D. 20%
261. An adult came to you for varicella vaccine. How will you give it to him?

261. An adult came to you for varicella vaccine. How will you give it to him?
A. One dose now and one after 2 weeks.
B. One dose now and one after 3 months (for children)
C. One dose now and one after 6 weeks
D. just give one dose now
262. Pt takes one dose of varicella vaccine, and after one year presents to your clinic. What to do next?
A. Give double dose
B. Give 2nd dose
C. Start over
D. Antibody test
263. Female had previous vertebral fracture was diagnosed with osteoporosis and she is on (bisphosphonate drug) additional to Ca and
multivitamins, what to check for her?
A. Vitamin D
B. Ca
264. Children who are living in a poor country with poor hygiene will have a high risk to which type of hepatitis?
A. HAV
B. HDV
C. HEV
265. 32 y/o primigravida, hx of recurrent HSV infection every year, received chicken pox vaccine at 19 what to give?
A. Varicella titer
B. HSV immunoglobulin
C. MMR
D. Do nothing
266. what is the likely nerve injury in Nissan fundoplication = Answer: VAGUS
267. Pic of abdomen pelvic x-ray with contrast in bladder and ureters asking for dx = Answer: ureter showing stenosis
268. Obesity study BMI what else needed = Skin fold thickness
269. pic of red eye w long scenario- bilateral irritation, watery discharge associated pharyngitis n fever how to prevent spreading of
infection?
A. hand washing
B. wet patch
C. isolation
D. topical disinfectant
270. Dx of nodular goiter, e hyperthyroidism thyroid scan showing patch iodine absorption what is the appropriate tx?
A. Surgery
B. radio iodine ablation
C. FNA
D. Biopsy
271. months was on steroids now discontinued 1 week ago what vaccine to give
A. MMR
B. Dtap

272. patient c/o progressive weakness, choking on saliva for few months, sx began w/ tingling in toes and fingers with bilateral
ascending loss of sensation. what is the expected long term prognosis?
A. Respiratory failure
B. Progressive paralysis
C. Spontaneous resolution
273. Appropriate step in management in patient presenting to ER with lower GIT "hemorrhage". (no vitals no further hx just this)
A. GS consult
B. Resuscitation
274. Child dm on insulin BID, mother found him unconscious. what should she do next
A. call ambulance
B. transport to ER
C. IV glucagon
D. oral glucose
275. Infectious mononucleosis patient, sore throat fever splenomegaly, enlarged tonsils w exudate. What is tx?
A. iv acyclovir
B. oral acyclovir
C. empiric antibiotics
D. symptomatic
276. patient unable to extend knee, affected muscle?

A. rectus femoris
B. biceps femoris
C. sartorius
277. lower back pain, imaging negative what is tx?

A-injection steroids
B-Physiotherapy
Answer: Physiotherapy
278. 52y/o woman with family hx of breast cancer wants to know risk. Appropriate step?
A. mammogram every 2 years
B. Self- breast exam
C. refer to genetic clinic
Answer: mammogram every 2 years
Q344/ pneumpnia x ray asking about findings on auscultation?
Answer: Pneumothorax decrease air entry if pneumonaia bronchial breathing
279. female postmenopausal with vaginal spotting 4 months increase after intercourse, hx of MI and AF on warfarin. cause of bleedi ng?
A. endometriosis
B. warfarin induced
C. endometrial cancer
D. atrophic vaginitis
280. unilateral eye redness, discharge and irritation associate w pharyngitis. What is the cause?
A. bacterial conjunctivitis
B. viral
C. fungal
D. allergic
Answer: b ((Viral conjunctivitis is a highly contagious acute conjunctival infection usually caused
by adenovirus. Symptoms include irritation, photophobia, and watery discharge. Diagnosis is
clinical; sometimes viral cultures or immunodiagnostic testing is indicated.))
281. Female came to ER with constipation, lower abd pain, low appetite, feeling of abd fullness, bloating and anal discomfort with
occasional leakage of watery stool. next step in
management?
A. fecal disimpactement
B. opioid analgesic
C. C-laxative

C. C-laxative
282. 1 years old child no vaccinations, c/o night time severe "hacking" cough with high pitch
inspiratory noise, cyanosis during attack and is fatigued between attacks. What is the
Treatment? Answer: Intubation
283. child 2 yr old drinks 3 pints milk daily, fussy eater pale c/o diarrhea. labs show high
wbc, low everything else. what hx would help you reach dx.
A. Giardiasis infection?l
Aplastic anemia
SCA
Answer:
284. 34 y/o Pregnant diabetic lady came to the clinic at 30 week of gestation with controlled
DM , last pregnancy ended with full term stillbirth , what is your plan for this pregnancy?
A. induce labour immediately
B. wait for spontaneous labour induce labour at 36 weeks
C. wait for spontaneous labour
Normal pregnancy 38-42 unless there is indication for current pregnancy we take actions
285. Q357/ Pt came to ER complaining of diarrhea and abdominal pain, 2 weeks ago had URTI and
took cefaloxine , what to give?
A. erythromycin
B. cephalosporin
C. vancomycin
286. Pt has immunodeficiency with recurrent staph and candida infection, what is common
they present with:Answer: chronic candida
287. Premature menopause age Answer: 40
288. prolonged pregnancy defined as Answer More than 42 weeks
289. Pregnant in 34 w , regular contraction + cervix 1 cm , effacement 90, how to manage :Ivf +corticosteroids
290. Pt poor DM control + HTN with proteinuria and Edema, she is in 8th week of pregnancy what to do?
A. termination of pregnancy
B. bed restrict
291. Newborn with lethargy and urine smell like burned sugar :
A. phenylketonuria
B. Maple syrup urine disease
292. which drug is contraindicated in acute angle closure glaucoma?

A. Timolol
B. Pilocarpine
C. Methazolamide
Answer: timlol If with asthma
293. pt has facial flushing ,telangiectasia on face and neck ,bilateral wheeze, shortness of
breath , weight loss, Hepatology ,harsh systolic murmer at 2nd intercostal space and ( a-lot of
symptoms ) the doctor ordered urinary 5 hydroxyindole acetic acid. Which cell causes this. Answer: Enterochromaffin
294. site incision of emergency tracheotomy?Answer: Corcothyroidosuomy
295. what is name artery supply SA and AV node Answer: Right coronary
296. What is the most accurate investigation for Wilson syndrome? Answer: Biopsy then serum ceruloplasmin
297. Triple therapy for peptic ulcer? Answer amoxicillin, clarithromycin, and a proton pump inhibitor such as omeprazole
298. Treatment of trigeminal neuralgia. Answer: Carbmazabine
299. if you see Lowe lip SCC what lymph node should palpate

299. if you see Lowe lip SCC what lymph node should palpate
Answer: Submental+ submandibular
Central lower lip = submental
Rest of lower lip + upper lip = submandibular
300. lymph node drainage of testicular Answer: Para aortic
301. Prognostic factor of Small Cell Lung Cancer? Answer: Male gender carries a worse prognosis
302. bronchial asthma control with SAB2 agonist what add? Answer: Inhaled corticosteroid
303. Elderly with dementia and Neurofibratory= Answer: Alzheimer
304. patient was normal fainted and collapsed in themall just for seconds then return to his normal status, what is the diagnosis?
Answer: Vasovagal syncope
305. How heart increase the blood flow during working hard?
Increase heart beat
Dilated coronary
Increase pulmonary resistance
Dilated IVC
Answer:
306. patient had itching at ankle and toe with linear lesion what is the dx?
A-Tania cruis
B-Scabies??
Answer:
307. Patient came to ER he had sign and symptoms of sudden..?? Xray done showed
pulmonary congestion and enlarged heart the medical and social hx not known on ECG there
is AF HR180 no acute MI changes. What is appropriate investigation?
Echo??
308. Patient had vasomotor rhinitis w rhinorrhea alone. What will you prescribe?
Ipratropium
Steroid
Antihistamine
Answer: Ipratropium
309. Patient diabetic since 20 years on oral hypoglycemic. Laps shown normal fasting blood
glucose and random slightly high HBA1C within normal(6.1).LDL HDL and creatine was all
within normal except Microalbuminuria which was high 32 i think What will you do?
A. Raise dose of oral hypoglycemia
B. Add ACE
C. Switch to insulin
D. Add hypochloremic drug
310. Pt came to ER with muscle cramping and confusion with hx of vomiting 3 days back he is on hydrochlorothiazide. What is
electrolytes should be in your treatment? Answer: Potassium
311. Patient on omeprazole had GERD since years endoscopic done biopsy showed goblet cell at mucosa of lower third of esophagus.
What he will had? Metaplasia vs dysplasia
312. 10y child w upper ab pain no other symptoms normal appetite his father had peptic ulcer. Endoscopic was done and urea breath
test +ve. What is the organism?
A. Campylobacter Jejuni
B. Salmonella
C. H .pylori
313. Elderly* What is the predictor u can consider as risk of CAD

A. Occupation
B. Low education level??
C. Large Family member

C. Large Family member
314. 10y girl had bone marrow transplant since (unknown amount of time) father bring her sister as she started to have chicken box on
examination she is well w no rash What will you do?
A. Give her subtract acyclovir
B. Varicella IG
C. Varicella vaccine
315. Adult has sign and symptom of glomerulonephritis in lap showed RBC and PROTEIN in
urine CD (3) low. What is most likely cause?
A. Mesangial
B. Membranous
C. Poststreptococal
316. Child w sign and symptoms od nephrotic what is the investigation u will order to
confirm?
A. Urine analysis
B. 24hr urine protein
317. Infant age of months c/o bloody stool US shows donut sign What is the (best step) in management?
A. Radiographic reduction
B. IV hydration
318. Patient unresponsive and no breathing what first thing to do

A. Tow rescue of breath
B. Check pulse
C. CPR
319. Potts disease in spine and something about spreading to chest asking about nerve of spread through?
A. Anterior cutaneous
B. Lateral cutaneous
320. healthy patient with xanthelasmas in ankle. What gene responsible?

A. APOB100
B. LDL receptor
321. Sexually active with –ve screening test for HIV, when to repeat the test? Answer: after 12 weeks (3 months)
322. Otitis media, what is the complication in child?

A. Encephalitis
B. Hearing loss
C. Infertility
323. Recurrent otitis media in child took Abx, what should you give him?
A. Amoxicillin
B. Amoxicillin clavulanate
C. Ceftriaxone
324. 5 days old child full term all normal except puprura on rt thigh. increase pt and appt dx?
A. Hemophilia
B. Factor 10 deficiency
325. Newborn with eye discharge, treatment? Answer:

• Topical erythromycin (first day of newborn)
• IV cephalosporin (if 3-5 days due to gonorrhea)
• Oral erythromycin (if more than 5 days due to chlamydia)
326. Golf player developed medial epicondylitis, ttt = Answer: Refine golf
327. Pt take unfractionated heparin, how to follow him?

A. PTT
B. PT
C. Bleeding time

C. Bleeding time
328. Pt take warfarin, how to follow him?

A. PT
B. Bleeding time
C. INR
329. PCOS treatment = Weight reduction + Metformin + clomiphene (induction of ovulation)
330. What to do with metformin if patient want to become pregnant = Stop metformin and shift to insulin
331. Reason of OCP in not married women = Managing dysmenorrhea
332. Pt with hx of epilepsy came with shoulder pain, adduct or internally rotate the arm What
is the injury?
A. Inferior dislocation
B. Subacromial posterior dislocation
333. Female presented with defemenization " breast atrophy & deeping of voice" they found
to have ovarian cancer, dx? Answer: Sertoli Leydig cell
334. condyloma lata associated with which virus? Answer: Syphilis
335. recommendation A for colorectal screening age?

A. 35-45
B. 50-70
C. 40-60
336. Scenario came with details and they gave him drug the patient developed flush in
face. What Is the drug used? Answer: Vancomycin ((Yes red man syndrome = vanco ))
337. Female in labour in pain ask for intrathecal anesthesia what should you order?
A. Red blood cell
B. Platelets
C. Liver enzymes
338. Person got pricked by flower. What’s the organism Answer: Sophorotriose's
339. Vaginal Greenwich discharge with flagellated organism what is it? Answer: Trichomoniasis
340. In appendectomy what the artery we should ligate Answer: Appendicular artery (branching of superior mesenteric artery)
341. Upper lip something what glands we should check Answer: Submandibular
342. Loss of red reflex behind the pupil?

A. Retinoblastoma
B. Neuroblastoma
C. Cataract
Answer:
• Absent red reflex: Cataract
• White red reflex(leukocoria): Retinoblastoma
343. HIV with no opportunistic infections, reserve cells ? Answer: CD4
344. Severe combined deficiency after urti come with SOB and pale. Immediate management?
A. Fluid/Analgesic
B. antibiotics
C. Blood transfusion
345. Treatment of Kawasaki?

A. Aspirin
B. Morphine
C. IVIG

346. Pt with gallstones and jaundice, high ALT , ALP , amylase Treatment?
A. A- conservative
B. B- cholecystectomy
C. C- ERCP??
347. Female 42 y with dysfunctional Uterine bleeding mange for hysterectomy but she ask u to don’t tell her husband?
A. A- Informed consent
B. B- confidential
C. C- No harm
Answer: A
348. Generalized convulsions in ER what is the RT ?

A. Diazepam
B. phenytoin
C. phenobarbital
349. When we can say stillbirth?

A. 20
B. 24
C. 28
D. 32
350. A girl came to clinic with elbow flexed with pronation after her father pull her hand while up while it was extended, Which
ligament is injured ? Answer: Annular lig
351. Blood test to differentiate between DM1 and DM 2 ? Answer: C peptide
352. Patient with dry eyes how to use lubricant Answer: One drop
353. 50 old age, difficulty swallowing, more saliva,

A. Achalasia
B. Squamous
C. Dysfunction
354. multiple hyperpigmentation, decrease hearing, ataxia?

A. NF
B. Hemochroma
C. Multiple myeloma
355. type of reproduction in bacteria?

A. Conjugation
B. Transduction
C. Complementation
356. 18 yo, sudden dyspnea, pleuritic chest pain, HR 103, otherwise stable” not mentioned if he is in ER or OPD” ?
A. Immediate vent/perf scan
B. Immediate referral to ER
357. Associated with aggression and violence ?

A. High serotonin
B. Low serotonin
C. high endorphins
D. low endorphins
358. Pregnant came at 16 GA, founding that she is Rh - ve, what to do next?
A. A. - US
B. B. - Amniocentesis
C. Answer Antibody titer
From these options aminocentisi if antibody titer was option then go for it
Rh- lead to hypersensitivty type 2
359. 4 wk neonate, his head is alway in same direction, he cries when manipulating his Sterno. muscle?

359. 4 wk neonate, his head is alway in same direction, he cries when manipulating his Sterno. muscle?
A. Congenital torticollis
360. Typical down syndrome, asking about Asso. cardiac anomalies?

A. - Cushion = Answer: Atrioventricular sexual defect))
361. Case of dementia, then he developed delirium, what to do?

A. Haloperidol till symptoms disappears
B. keep his family with him
C. Dark room
362. Child came for vaccinations, he had diarrhea 3-4 times/day?

A. Delays all vaccines
B. Follow regular schedule
363. Case of Ruptured Becker cyst, READ ABOUT IT“ can't remember the qs, and the Dx is not mentioned” they ask about investigation s
A. CBC
B. US
Answer US +come with osteoporosis
364. HIV with intestinal obstruction, tumor is excised, what is it?

A. Hodgkin
B. lymphoma
Answer = NON Hodgkin
365. case of Abortion, blood leak, cervix closed?

A. Inevitable
B. Threaten
C. Complete
366. child, tetany, decrease Ca? Answer: 22q11.2 deletion syndrome (DiGeorge syndrome)
367. Typical case of Nephrotic syndrome with all Labs, asking about biopsy findings? Answer: fusion foot process
368. Old age, loin pain, Bilateral hydronephrosis, Cr 2.8 , “ not mentioned if he is smoker” ?
A. - pelvic cancer
B. - BPH (based on scenario)
C. - cancer bladder
D. - another type of cancer can’t remember
369. Productive cough for 2 wk, hepatosplenomegaly, normal CXR?

A. Bronchopneumonia
B. Miliary TB
370. male pt, case of osteoporosis and fractures, tx?

A. Alendronate
B. Vit d
371. most frequently sign and symptoms of abruption placenta?

A. Abd pain and tenderness
B. Back pain
C. Vaginal bleeding
372. Gyn-Case with positive Chandelier sign = PID ((This sign means Cervical motion tenderness seen in PID ))
373. 38 GA, fetal weight 2.6 kg, why it’s contraindication to do ECV?
A. Weight
B. Bicornuate uterus
C. Age
374. Case of ADHD asked about the treatment?

• Answer: First line is stimulants like amphetamine
• Second line is atomoxetine

• Second line is atomoxetine
375. Question about who needs surgery?

A. Option had Marfan pt,
B. pt with thoracic aneurysm >5cm
C. AAA is 5cm
376. Case of pt with sx headache when comb hair, sudden unilateral visual loss, no pain on bb, what to do first
A. CT
B. Steroid
C. Giant cell arteritis (temporal arteritis) Tx steroids
377. Case where a patient at his work got hit severely on his face and eyes with a foreign body, which affected his vision, pathol ogy
showed T cells and macrophages infiltrates Polymononuclear cells; Answer: Remove the foreign body + optical antibiotics
378. Case of female pt had IUD for two years developed abnormal brown discharge what's the organism?
A. C. Perforins,
B. Actinomyces Israeli
379. Question about an 18 months child with leg bowing, labs had high Ca and ALP options had familial hypophosphatemia, renal
something and Vit D rickets = Answer: Familial hypophosphatemia
380. Asked about medication acts on ADP on osteoclasts? → Alendronate?? Answer: ✔✔Anything that ends with –ate Usually they put
etidronate
381. Patient with vitiligo and low platelet and high liver enzymes? = Chronic Autoimmune hepatitis
382. Gene of mismatch DNA causing colon cancer?

A. Familial polyposis
B. non-familial
C. MSH2
383. Ionizing radiation effect on DNA?

A. Depuration
B. Denaturation
C. Disruption of double helical structure
384. Pregnant 10 weeks with cervical incompetence what to do ?

A. Suturing at same time
B. Suturing at 16 weeks
C. Confirm with some test
385. Case of elderly did CBC 1 year back was normal and he has changing bowl movement and he increased his fiber intake and now
present with fatigue what is the cause? =
A. Age related
B. Due to changes diet
C. Change in bowel motion.
386. Factors decreasing colon cancer? Answer: Fibers
387. Someone lost his brother he is 52 y/o what to give him for short time?
A. SSRI
B. Benzodiazepines
388. Patient has croup with barking sound notice from parents, what is the diagnosis?
A. Tracheomalacia
B. Laryngotracheobronchitis
C. Laryngitis
389. Someone with mumps when child and did gallbladder removal and now has enlarged pain = Bacterial Sialadenitis
390. Ligament that cause dimpling on breast? Answer: Cooper ligament

390. Ligament that cause dimpling on breast? Answer: Cooper ligament
391. Breast cancer but no lymph nodes? = Radiation with lumpectomy
392. Leishmania drug of choice = Miltefosine
393. Forehead herpes = Antiviral and referral to ophthalmologist
394. HIV patient with oral and purple skin lesions what treatment?
A. Chemotherapy and radiation?? (Kaposi sarcoma?)
B. If you have an option to initiate HAART therapy with chemo pick that.
395. Baby at 4 month of age took vaccinations and developed anaphylactic symptoms and now he come for 6 months vaccine what to
do?
A. Skin
B. give vaccine but for DTP
C. don’t give or give all vaccine
396. 38 years old and had rheumatic fever 18 years ago and now present with joint pain and hematuria and fever and splenomegaly after
tooth extraction what’s dx?
A. Recurrence of rheumatic fever
B. Infective endocarditis
397. How GAS cause rheumatic disease?

A. hematogenous spreading??
B. cardiac invasion
C. joint deposition
D. pharyngitis
398. Ascites, pleural effusion and abdominal mass? (Meigs’ syndrome)

• Answer: Sex stromal cells tumor
• ovarian fibroma = Sex stromal cells tumor
399. Patient did Abdominal hysterectomy with bilateral oophorectomy for benign reasons and now complaining of vasomotor
symptoms?
A. Cyclic estrogens and progesterone
B. progesterone
C. If estrogen only option pick that
400. Patient on antidepressants and has decreased libido switch to what?

A. Fluoxetine
B. Bupropion
C. Amitriptyline
401. Anesthesia drug has sub anesthetic effect?

A. Ketamine
B. Benzo
402. 100 times morphine = Answer: Fentanyl
403. Pregnant recurrence of monosomy percentage?

40%??
Answer: Turner syndrome 30%
404. What will cause bone age difference? Answer: Congenital adrenal hyperplasia
405. Boy 18 years played basketball and then developed left paraumbilical tenderness?
A. Reevaluate after 24 hrs
B. CT
C. US
Answer: CT

406. Case of intestinal obstruction and ask management?
A. Decompression
B. Surgery
C. Laparotomy
D. Antibiotic
407. During stress the lymphocytes decrease due to increase Cortisol and catecholamine = Psychoimmunology
408. Old age has weakness in upper limb and UMNL signs and now present with MRI picture?
A. Spinal cord tumor
B. Spinal canal stenosis
C. Cerebral-vascular accident
409. Ann arbor stage : neck lymph node enlarge Inguinal LN enlarged ,spleen enlarge + fever , night sweeting , loss wt :
A. 2b
B. 3bs
C. 4b
D. 4bs
410. Child with enuresis wt initial Investigation ? Urine analysis / culture
411. 70 year old man with nose ulcer in, ( they mentioned something blue is Microscopy)
A. Basal cell cancer
B. Squamous cell cancer
C. Nevus dysplasia ( my ans)
412. Patient with symptoms of colon cancer they mentioned something about tyrosine kinase treatment and asking it work on what or
something like that (Sorry): epidermal growth factor receptor
413. Patient with eye discharge and history of URTI after a while the other became affected, they did rapid strep test and it was -ve What
true ?
A. He need to isolate himself so he does not spread the infection
B. test the wife for chlamydia
C. test for rheumatoid arthritis
D. Test for sarcoidosis
414. Patient with very painful mouth ulcer that prevent him from eating what to so :
A. Topical steroid
B. Oral antibiotics
C. Refer to oral surgery
415. what is the follicular tonsil nerve supply

A. Nasopalatine
B. Sphenopalatine
C. Lesser Palatine from V2
416. Bladder cystitis with hematuria with papilloma and calcification = bladder schistosomiasis
417. Symptoms of pulmonary HTN ?

A. Ascites, peripheral edema
B. Pulmonary edema
418. Greasy Rash on the forehead , behind ear , at the hair base , ask for treatment:
A. Augmentin
B. Mupirocin
C. ketoconazole 2%
419. diarrhea with DIC symptoms plus travel hx

A. Ebola
B. yellow fever
420. Case of AOM post URTI with previous HX of Impetigo treated with ABX what appropriate TTT:
A. Amoxicillin

A. Amoxicillin
B. Cefuroxime
C. Ceftriaxone
D. Erythromycin
421. Statistic: study done in 2 types of asthmatic drugs, many patients drop from the study due to adverse effects of one of the drug ?
What will you do in analysis ?
A. Discontinue if more that 5%
B. Add another group
C. Involve the dropout in the final analysis
422. Multiple quesstions about genes for SC anemia and thalassemia ( New questions )
• B-Thalassemia, is missence or nonsense point mutation of chromosome 11.
• A-Thalassemia, is deletion in chromosome 16.
• SCA CH 11.
423. Marasmus case Low carb and low protein (low calories)
424. Khawishor = (Brittle hair, only low carb , bloated abdomen)
425. Infant have oral thrush for one week. He received antibiotics after 5 days of birth because of
conjunctivitis, now how will you treat the thrush?
A. IV acyclovir
B. Oral steroid
C. Topical steroid
D. Nystatin
426. women with invasive cancer in cervix what to do ?

A. Clinical staging
B. Resection and chemo
C. Resection and radiation
427. Wt the cause of whos responsible of paroxysmal of nocturnal hemoglobinuria?

Answer benign familial hemoglobinuria
# PNH is the only hemolytic anemia caused by an acquired (rather than inherited) intrinsic defect
in the cell membrane (deficiency of glycophosphatidylinositol leading to the absence of
protective proteins on the membrane).[3] It may develop on its own ("primary PNH") or in the
context of other bone marrow disorders such as aplastic anemia ("secondary PNH"). Only a
minority of affected people (26%) have the telltale red urine in the morning that originally gave
the condition its name
428. Hepatitis C curative rate = Answer: 100%
429. Atypical pneumonia case “most common organism

• Answer : Legionella” if associated with diarrhea or CNS symptoms
• But common is mycoplasma
430. Influenza vaccine safe from = Answer : 6 month age
431. Nerve could be injured in thyroidectomy causing Hoarseness of voice

• Recurrent Laryngeal Nerve
• Most common nerve injury is superior.
432. Which layer of artery in has a role in IHD = intima (endothelium) innermost
433. Vitamin C deficiency affect which stage of wound healing = Collagen synthesis
434. Case scenario of Pheochromocytoma = Urine 24 hour catecholamines
435. HSP Tx = Supportive not in the option Go for Steroids

• ITP , TTP , DIC labs very imp
436. Malaria Replication = Target the DNA replication

437. Case scenario with Popcorn-like on X-Ray = Pulmonary Hamartoma
438. Primary Hyperparathyroidism labs findings = High Calcium + High PTH + Low phosphate
439. What is the first step in managing effusion associated with OM?
A. Grommet insertion.
Answer : If symtomatic myringotomy / If not wait
440. What is route of HAV transmission?

A. Sexually
B. Fecal-oral
C. Droplet
441. Individuals with negative HBsAg and a positive anti-HBs are recognized as?
A. Having acute hepatitis
B. Having chronic hepatitis
C. Naturally immune to hepatitis
D. Previously vaccinated
442. What is narrowest portion of urethra?

A. Spongy urethra
B. Prostatic urethra
C. Membranous urethra
443. Anti HCV

A. Start ttt imedetatly
B. Repeat if + and no action .
C. 3 time repeted if + start ttt .
D. Welstone HCV RNA
444. Girl come puberty than boy

A. 6-12 m earliest
B. 2-3 y earliest.
C. 1-2 after boy
445. Child with symptoms of leukemia in lab findings there’s positive myeloperoxidase & Esterase reaction negative what is the cau se :
A. Myeloid leukemia
B. Multiple myeloma
C. Lymphoma
446. 14 y/o child presented with abuse frem her ankle, there is vulva erythmatus and bruises ......., at which position the hymen suggest
penile penetration?
A. 2
B. 4
C. 6
D. 8
447. Why aspirin overdose cause hyperthermia = Uncoupling oxidation phosphorylation
448. What will help you to diagnose factitious fever?

A. Pulse rate
B. Urinalysis
C. Blood culture
449. baby dehydrated with 5% deficit. his weight 10. how much fluid you will give in 24h?
A. 1000
B. 1500
C. 2700
Answer : Deficit (5*10*10)+ maintenance (50/20/10) so B
450. Pediatric female pt with reapeated chest infections with strange names bacteria and pseudomonas ..etc. what she has?
A. Cystic fibrosis
B. Primary cilia dyskinesia (something like that)

B. Primary cilia dyskinesia (something like that)
451. Audiogram, male young has progressive hearing loss.

A. OM
B. Otosclerosis
C. Presbycusis
452. Pt had hx of D&C blabla she can't conceive.. mostly due to?
A. Kallmann
B. Asherman
C. Androgen insensitivity
453. Parkinson case was prescribed levodopa with carbidopa, why did they add the carbidopa ?
A. Decrease side effects of levodopa
B. Increase the effect of levodopa
454. Patient with urinary incontinence and bulging vaginal mass after prolonged delivery 4 years ago asking about the Dx?
A. Ureterocele
B. Urethrocele
C. Cystocele
455. 2 Croup cases , dx and treatment Answer: Croup is characterized by a "barking" cough, stridor, hoarseness, and difficulty breathing
which usually worsens at night. tx ( Steroids + epin. )/ Characteristic sign> dysphonia
456. 2 trichomoniasis asking about the dx Answer : Metronidazole
457. Diabetic going for surgery Answer: shift to insulin
458. Pain killer in cholecystitis? Answer: mepridine
459. Most common cause of hypertension in adolescence —>

A. Essential
B. Renal disease
460. MOA of emergency contraceptive Answer : Delay ovulation And for cupper IUD inhibit fertilization
461. Umbilical cord , single artery: associated with DM
462. Appendicitis pathology Answer : neutrophils invading muscularis
463. HTN ttt cause muscle cramps and weakness Answer : Thizide
464. Scabies Tx ? Answer :: Permethrin Or Ivermectin
465. Topical steroids for 6 months, what’s the side effect on the skin = Atrophy of skin
466. Asthma Tx that decreases mucus secretion = Ibratropium
467. Patient with colon cancer, after resection it was confirmed that it is adenocarcinoma. Which of the following will be highly expressed
on receptors ?
A. Platelet-derived growth factor
B. Epidermal growth factor
468. What is the Percentage of patients with untreated UTI for 14 days who will develop acute pyelonephritis?
A. 0.05%
B. 0.5%
C. 5%
D. 50%
469. hours old infant born with jaundice. Direct bilirubin: 36 (high) Which of the following is the most likely diagnosis?
A. Hemolytic anemia
B. Gilbert disease
C. Choledochal cyst

470. Athlete who run for ling distanced and used to vigorous exercises bought a new shoes them after a while complain of tingling
sensation and numbness over the toes and sole of right with the right arch of the foot. Which of the following nerves is affected?
A. Anterior tibial
B. Posterior tibial
C. Sural
471. hyper parathyroid, 2Q how treat ? Answer: Calcimimetic , Cinacalcet and surgery
472. 3part of maxillary artery , give which branch? Answer : Sphenopalatine artery
473. AB contraindication to pregnant = Answer : fluoroquinolone
474. Long case about malignant vulvar= Answer :Labia majors
475. Treatment of Burger disease Answer : - quit smoking
476. Complications of Pterygium ? Answer : decreases vision symptom / corneal scarring
477. Patient present with Nose green discharge, Treated with antibiotic come for second opinion?
A. Antibiotic
B. Antihistamine
C. Decongestant
D. Steroids
478. Nose bleed what is initial treatment?

A. Backward of head and compression of nose
B. Posterior packing
Answer: B (First compression then vasoconstrictor then go for nasal picking )
479. Patient present with chronic mouth ulcer for 10 years and polyarticular as symmetrical arthritis involve the knee elbow ankle for 2
to 4 weeks in last 2 years Present with fever and abdominal pain what is the diagnosis?
A. Bacet daises
B. Ulcerative colitis
480. Tumor on upper lobe of kidney what is the gene? Answer : VHL
481. Ovary follicular cell embryological origin? Answer : Germ something Celomic
482. He diagnosed with hypothyroidism but present with weight loss and hyponatremia and hyperkalemia other manifestation??
A. Buffalo
B. Stria
C. Hyperpigmentation
483. Heave and right ventricular hypertrophy and interventricular wall abnormality what is the diagnosis?
A. ASD
B. VSD
484. protein start transfer no membrane sequence ?

A. Er membrane
B. Cytosol membrane
C. Lysosome
D. Endoplasmic reticulum
485. Patient with Hay fever present with excoriated and crusted on face and elbow and
extensors?
A. Atopic dermatitis
B. Stasis dermatitis
C. Herpitiformis
486. Long histology report of lung cancer with picture * lung histology chromaffin stain What is the type ?
A. Squamous
B. Carcinoid

B. Carcinoid
487. Which of the following dermatology problem should investigate for cancer ? Answer: Erythema gyratum
488. Heart disease is more than the adjacent community what is the first question to ask for researcher?
A. Is the both community has the same health facility
B. Age is adjusted or something like that
489. pregnant lady with scabies. How to treat? Answer : Permethrin
490. Organophosphate antidote = Answer :Atropine + pralidoxime
491. 2y.o girl ingested a toy part , asking about the site of lung obstruction ? Answer : right main brunches
1050/ Read about Screening test for dyslipidemia
492. pt with painful nodule in anterior nose associated with facial flushing and telangiectasia , management ?
A. ointment betamethasone
B. oral doxycycline twice daily
493. Reason of using CT in case of abdominal trauma ?

A. confirm presence of active bleeding
B. to detect retroperitoneal injury
494. screening of dyslipidemia in person without risk factors to CHD

A. Every 1 year
B. 2 year
C. 3 year
D. 5years
495. Case of neonate with eye hemangioma and cause obstruction of eye do surgery after
A. 1 week
B. 1 month
C. 6 week
D. 1 day
496. What is target ldl in mmol/l in 55 years male with dm

A. 4.4
B. 2.5
C. 3.3
497. what is the aim from first antenatal visit

A. Date of pregnancy
B. To assess risk factors
C. to assess fetus growth
498. What is characteristic for AIDS ?

A. Generalized lymphadenopathy
B. Opportunistic infection
C. Chronic diarrhea
499. neonate in nursery how to prevent infection ?

A. Were gowns and shoes cover
B. Wash hand before and after exam
500. Which of the following can be found on smear in sickle cell disease? Answer: Howel jolly and inclusion Bodies
501. What is the triple antitoxin = Answer: Tetanus, diphtheria, and pertussis
502. which part of brain has the abducens nerve VI ? Answer : Pons
503. When to do b alpha fetoprotein in GA of pregnancy:

A. A. 15

A. A. 15
B. B. 17
C. C. 20
504. Prolong use of vasopressin in allergies rhinitis cause

A. Viral rhinitis
B. Vasomotor
C. Medicamentosa
D. Rhinitis sicca
505. Thalidomide causes? Answer: meromelia
506. Polyuria polydipsia, salt craving and ESRD in child? = Answer: Juvenile nephronophthisis
507. Child bitten by his brother?

A. Amoxicillin
B. Surgical suture
C. Tetanus
508. Case of endometriosis (dyspareunia, dysmenorrhea and posterity fornix tenderness) = Answer: levonorgestrel
509. What the clotting parameters associated with Antiphospholipid syndrome = Answer: prolonged aPTT
510. What cause rib notching in CoA? Answer: collateral of inferior intercostal artery
511. What is the investigation in case of leshminiasis? Answer: Blood film to show amastgoid
512. H pylori will inhibit which of gastric cells? = Answer: D cells
513. Bluish painless papule in in the inner surface of lower lip increase after eating? Answer: mucocele
514. If the patient present only with hoarseness. What will you do next? = Answer: Laryngoscopy
515. What is the stem cells of the trachea? = Answer: Glandular cells
516. What is the treatment of impetigo = Answer: Topical mupirocin or clindamycin
517. When child in W position. What that indicate = Answer: Femoral anteversion (Internal femoral torsion)
518. Patient present with garlic odor and excessive salivation. What is the antidote = Answer: Atropine or pralidoxime
519. What is the MOA of vitamin C? = Answer: hydroxylation of proline and lysine in collagen synthesis
520. Mid foot tenderness while walking and standing. What is the diagnosis? = Answer: Tarsal tunnel syndrome
521. Which group of people was postpone for hajj in 2015 for MERS-CoA from the Saudi = Elderly diabetic
522. Hip pain with collection and picture of septic arthritis what to do? Answer: Aspiration ((aspiration then ABx ))
523. Legg-Calve-Perthes disease complication? Answer: Avascular necrosis of hip
524. Angioedema after 1 day after strawberries allergy what to give?

A. Steroid
B. Antihistamine
C. Paracetamol
525. Patient works as a life guard and don’t put sunscreen or cover himself present with
multiple painless lesions?
Keratosis??
Melasma
Answer: Keratosis

526. 55 yrs old compile of urgency, frequency of uranation in day & night ?
A. A. Stree
B. B. hypertonic
C. C. postmenuposal incontince
527. Lowest fetal dose of TCA: 2gm
528. case of Child with bowed legs + lab finding Ca:8 P: 2.2 ALP : in hundreds
A. Hypophosphatemia
B. Ricteks
C. Vit D
D. Familiar hypophosphatemia
529. child with streptococcus pharyngitis on Abx how many days give him ?
A. 3
B. 5
C. 7
D. 10
530. SCA in VOC wt tx ?

A. Outpatient hydration and pain management
B. Admitted and pain management
531. about anaesthesia , they asked me about which position can increase cephalic
something “I can’t remember”? = Trendelenburg position
532. Mumps Case scenario with rash appeared 2 days ago then they asked me about sickleaves days >> infective period
for mumps =
5 days , so 5 days - 2 days rash appeared before = answer was 3 days sick-leave
533. Patient with +ve phalen’s test , then they asked me about position of hand ? = Answer was Extension
534. A pregnant lady at 30 week gestation came for her regular visit to checkup. She and her baby are normal and doing fine. On
examination you find a normal urine and BP of 160/100. Lab results of all her previous visits was: normal urine and BP of 120 /90.
How would explain these findings?
A. A. Chronic hypertension
B. B. Gestational hypertension
C. C. Pre-eclampsia
D. D. Eclampsia
535. Renin release from

A. A. effrent .
B. B. . afrent arteries
Answer : B From juxtaglumerular cells which are located in the Afferent
536. Ovary follicular cell embryological origin? Coelomic epithelium
537. A child when eat Seafood has itching and redness and goes after three hours what is it?
a. Limited anaphylaxis
b. other immunity problem
538. A case about abdominal pain and other sx ( I forgot )

A. Payer batch
B. Burner
C. Gland of lukerbak
D. Messner gland
539. Patient with cardiomyopathy has had hx of syncope on Atenolol for a long time with no sx, now presenting with presyncope and a 48
hours holter showed no arrhythmias. On Echo the septum is 23 mm and pressure gradient is 60 mmHg. What to do?
A. - Add Amiodarone
B. - Increase Atenolol dose
C. - Septal myectomy
D. - Implantable defibrillator

D. - Implantable defibrillator
540. Antacids activated by HCL = Sucrasulfate
541. Alcohol withdrawal treatment ? Answer : Chlordiazepoxide
542. Alzheimer’s e rash and angular cheilitis asked about vitamins? Answer: I chose B3 3D = Dementia, diarrhea, dermaitits
543. Hbsag -ve when to repeat test? Answer:

• If post exposure repeat after 6 m it will became chronic
• If post vaccination its post 2 months
544. Which causes loss of colour vision? Answer: Optic Atrophy
545. Scenario of sob & cough with « Crescentic lucency surrounding the peripheral aspect of the mass on x-ray what is the most likely
diagnosis ? answer : aspergillosis
546. Which pneumocystis disease precipitates TB ? Answer: silicosis, asbestosis...
547. Bacteroides fragilis treatment ? Answer: no metronidazole in choices so I chose clinda
548. Complications of temporal arteritis? Answer: complete loss of vision
549. Vasectomy case pt wanted to reverse it and there were antisperm antibodies asked about mechanism? = Antigen release.
550. Indian ink test positive in a patient with HIV what is the most likely diagnosis = cryptococcus neoforman
551. Fracture in tibia what is the nerve involved = Superficial peroneal nerve
552. Chronic Severe pancreatitis sign = elastase-1 in stool or stone, large cyst and stricture
553. MSH secreted by melanotropin
554. bee sting treatment = Topical steroid and antihistamine
555. Commonest infections by animals ? if bite: Pasteurella multocida
556. Most common cause of hospital infection = LTCF. Streptococcus pneumoniae is the most common pathogen
557. Which of the following acidophilic?(fungal) = somatotroph or lactotroph (mammograph)
558. Gas Gangrene treatment = Clindamycin + Piperacillin
559. methicillin sensitive = Coxlillin.
560. Mode of inheritance medellin = Thalaseemia
561. SCA case with limp what to do = IVF + Analgesia.
562. Incidence of prolonged labour = 10-15 %
563. Case of seborrheic dermatitis?what'streatment? Ketoconazole
564. When we do trabeculectomy ?

A. Congenital glaucoma
B. Open angle glaucoma
C. Close angle glaucoma
565. What is the procedure indicate for ptosis?

Mild --> Levator muscle resection:
Severe --> Frontalis suspention
566. Bilateral mass hydronephrosis and abdominal pain what is the diagnosis = Polycystic kidney

567. Cancer commonly associated with depression = Pancreatic
568. Child e blunt trauma imaging shoed coil spring appearance in terminal 2/3 of duodenum + high amylase what to do?
A. Nasojujenal nutrition
B. Parenteral nutrition
C. Exploratory laparotomy
D. Observation
E. Bowel rest with total parenteral nutrition for 2 weeks
569. Pt e hep A resolved came after months (i think 6) how liver biopsy will look like?
A. Normal
B. Necrosis periportal
C. Something central
570. Pt e first time psychosis, rx?

A. Olanzapine
B. Psychotherapy
C. Antipsychotic + psychotherapy*
571. Doctor can palpate orbital ridge nasal bridge mouth and chin, what’s presentation?
A. Mento ant?
B. Mento post
C. Right mento-transverse
D. Left mento-transverse
572. Symptoms of panic attack, what’s initial management = I went with breathing into paper bag
573. treatment of uncomplicated malaria caused by Plasmodium falciparum?

A. Artemether
B. Something with ..quine
C. lumefantrine
574. Case of OM with something in tympanic memb and fluid collectio?

A. Myringotomy
B. Amoxicillin
C. Grommet (my answer)
575. Child with spiral fracture & multible contusions in different healing stages and parents claimed he fallen from stairs = Child abuse
576. What’s the main indication of antipsychotics in schiz?

A. To enhance delusion
B. To increase social interaction
C. To enhance thinking ability
577. Most specific syx of MDD ?

A. Late morning awakening
B. Fatigue
C. Poor concentration
D. Avoid eye contact
578. Pt from africa e fever malaise and bloody diarrhea?

A. Giardia (my answer)
B. Entamoeba histolytica
C. Shegilla
579. A researcher wants to measure obesity in children. He included BMI and gender. What to add to asses risk of obesity?
A. Dietary habits
B. Girth measurement
C. HDL/LDL ratio
D. Skin fold thickness
580. KSA have implemented strong regulations regarding worker health cares, which of the following diseases if the worker had, he can't
work?

work?
A. A. HeB
B. B. HeC
C. C. HIV
581. Lysosomal traffiking regulator —> chediak hegashi syndrome

Triad of Partial albinism ; decrease phagocystosis ; nuropathy
582. Diarhhea in a group of ppl after a wedding symptoms start 8-12 hrs .. choices had staph aureus and e coli and
salmonella The answer is Cl. Perfenges (if not present: Salmonella)
583. Csf circulate in ...

A. subarachnoid
B. Epidural
C. Subdural
584. Patient with basal skull fracture some Jugular foramen nerve injury = spares Styloglossus, If hypoglossal foramen affected in basal
fracture 12 n which supply Styloglossus will be affected too
585. Case of hyperaldosteronism ( HTN hypokalemia) how to diagnose,?

A. Acth supp test
B. Dexamethasone supp test
C. Aldosterone renin ratio
D. Serum catchecholamine
586. Which will support diagnosis ( case of hyperaldosteronism) ?

A. Vitilligo
B. Striea
C. Hyperpigmentation
D. Polyurea
587. Enlarging uterus 18 weeks , amenorrhea for 12 weeks , raised bcg, small fetus?
A. Hydatiform mole
B. Incomplete hydatidiform mole
588. Which one of these patients with pneumonia will you treat as outdoor patient:
A. 80 Years old with 104 F temperature, BR 24/min PR 126/min, BP 180/110
B. 60 years old with 102 F temperature BR 22/min PR 124/min, BP 160/110
C. 50 years old with 98 F temperature, BR 20/min. HR 110/min, BP 180/110
D. 80 years old with 96 F temperature, BR 18/min, HR 70/min, BP 110/80
HIV bone marow suppression Zidovudi
*In SCA
One subunit is replaced ( my answer)
subunit deleted
Mutation
Answer= One subunit is replaced ((Point mutation
Question about pregnant say which is Indirect indicator for GBS infection
A- body temperature > 39
B- rupture of membrane > 18 hours
C- previous infant with GBS infection
D- pregnancy or (labor I don’t remember) < 38 weeks
Which of the following pelvis shapes is associated with deep transfers arrest
A- gynecoid
B- Android
C- anthropoid
D- palatyploid

Female patient didn’t have a known disease in the case presented with urgency , frequency
and dyuria physical examination showed suprapupic tenderness what is the cause there
was not cough
A- stress
B- hypertonic
C- hypotonic
D- sensory irritative
Female with amenorrhea secondary sex characteristic normal but absent uterus
A- mullrian agensis
Patient with malaria taking antimalarial I don’t remember which had symptoms they were
of anemia what enzyme is the cause
A- glucoses 6 phosphate dehydrogenase
Case about patient for check up and which lab is strongest risk for heart disease
A- ldl
B- hdl
C- total cholesterol
D- tag
Upper arm trauma loss of adductionof digit nerve injury

A- ulnar
B- medi
Case with heart symptoms on acultation ejection systolic murmur heard best at right upper
sternum
A- calcified aortic stenosis
B- mitral regurge
Main component of air blood barrier

A- pnemocyte I
B- pnemocyte II
Patient with symptoms there was eruthema modicum and x Ray showed bilateral lung
infiltrate with hilar lymph node .
A- sarcoidisis
Psychiatry question patient feels swatched from self and world not real
A - derealisation
Patient with crushing retrosternal chest pain something like that it ment to me very severe
pain other findings it looked to me MI
Mechanism of action of analgesic use
A- inhibition of cycloxygenase
B - agonist of CNS Mu receptors
Patient ask about driving post Myocardial infarction what to tell him
A- driving increase risk of recurrence
B- he can drive after 4 weeks
Prgnnant in labor recieved fentanyl now ferus heart rate droped and she is taken to OR or
delievery roo
In left lateral position and feel light headed what to do next
Ask for forceps
Some poistion i frogot irs name
Fentanyl
Ephedrine
Pt with pain abd. Pain and forinx tnderness recieved cefrtriaxone how ever she did not
improve, what is the organism:

improve, what is the organism:
C. Trachomatis
Chlamydia
Child with minigitis LP culture revealed G +ve cocci in pairs: what is the antibiotic
combination:
Vancomycin + cetriaxone
Penicillen + vancomycin
Q, which drug prevent clot formation

A.Clopidogrel
B.Heparin
C.Streptokinase
1-Female comes with irregular menses + vaginal bleeding in pap smear there’s endometrial
hyperplasia , she mentioned that bleeding started after becoming obese , what’s the cause ?
1-adrenal hyperplasia
2-gene in endometrium
3-hormones or substance related to obesity trasfered to estrogen peripherally.
5-patient managed by instrumental delievy comes with urine drippling and bulging in labia
majora what’s your next step ?
1-speculum examination
2-urodinamic study
3-retrograde cyatourethrogram
13- case of infante with cough , sneezing , fever , and spells while drinking milk his older
brother has the same symptom
what investigation to confirm the diagnosis
1-X-ray
2-throat swab
3-nasopharyngeal swab
4-bronchoacope
4-MCV with trauma after removing eye globe there’s CD4 what’s the reason
1-T-cell anergy
2-antigen release( I think this is the right answer )
Post MI autopsy what will u find in the brain:

Red neurones in hippocampus ( my answer)
Infarction in areas supplied by left MCA
40 yo male newly diagnosed with dyslipidemia what’s hormonal assay should you order:
Testosterone
Thyroid
Growth
Parathyroid
Whats the contraindication to do it again:

Failed 1st attempt
AFI > was 12
Position > was lateral
Age > 38 GA
Pregnant came with hx of absent fatal movement, and SOB

Labs:
High pt
High ptt
Normal fibrinogen
CXR: ground glass appearance

CXR: ground glass appearance
What’s the Dx:
Amniotic embolism
DIC
Amniotic embolism
Bell’s palsy, what muscle is unaffected??

Masseter muscle

Friday, November 16, 2018 5:48 AM
Tongue Taste & Sensation
Fractures
Child with elbow trauma with xray which structure, affected: posterior pad
Fracture of distal radius & ulnar displaced outwards = Colles fracture
1. Open # of forearm in pediatric pt what is the initial Tx?

a. Closed reduction with cast above elbow
b. Closed reduction with cast below elbow (for closed fracture)
c. Surgical debridement, ... & fixation (my answer)
Ortho ^M Anatomy Page 56

c. Surgical debridement, ... & fixation (my answer)
2. Distal forearm F# = debridement and fixation I think the Q is about open fracture ..
3. Patient of MVE at ER came with broken tibia and an open wound of 1*2 cm, antibiotics and tetanus where given, he is stable? PIC of leg X-Ray and the
wound:- Open reduction nail fixation
4. Fracture in proximal tibia (with pic) what to do?

a. CT tibia (my answer)  Best for bone
b. MRI femur
c. Initial X-ray
Child with elbow injury x -ray attached what is the DX ? answer : Salter Harris
patient can’t extend hand after trauma: Radial nerve injury —> Spiral humerus
Tibial Fractures + Lower Limb

• Fibular neck → Common Peroneal nerve injury
• Loss of eversion → Superficial peroneal injury
• Loss of dorsiflexion (foot drop) + sensation between 1st & 2nd toe → Deep peroneal nerve
• Droop foot with medial foot loss of sensation nerve: Common peroneal if all the sensation is lost vs Deep per if just the big toe
and 2nd toe sensation id lost
• Loss of eversion + dorsiflexion → Common peroneal nerve injury
• Loss of inversion of foot → tibial nerve injury
• Muscle responsible for dorsiflexion = Tibialis anterior.
• Nerve Supply to posterior compartment of leg: Tibial Nerve
• Posterior hip dislocation= hip and leg in slight flexion, adduction, and internal rotation
• Anterior hip dislocation = Flexion, abduction, & external rotation
• Patient who can’t flex his knee, absent ankle reflex, where is the level of injury: L5 - S1
• The lateral rotators of the hip:- Superior gemellus, Inferior gemellus, Obturator externus, Obturator internus, Quadratus
femoris, Gluteus maximus, Piriformis
• Blood supply of gluteus maximus muscle: superior gluteal artery
• post tibial artery against what you feel – behind medial malleolus
•
Removing sutures: Face: 3-5 days. Scalp: 7-10 days. Trunk: 7-10 days. Arms and legs: 10-14 days. Joints: 14 days.
Lip Lymph Nodes:

• Middle lower lip = Submental
• Upper lip and Lateral lower lip = Submandibular
• Tumor in the lower lip, which LN you want to examine first: Submental then submandibular
LN of forehead:
A. Submandibular
B. Parotid
Injury in left eyebrow, which lymph node drain: parotid
Rib fracture what proper test: Oblique x-ray

Rib fracture what proper test: Oblique x-ray
Upper Limb
• Phrenic Nerve: Anterior to anterior scalene muscle
• Winged Scapula = Long thoracic nerve (C5,6,7), Serratus anterior muscle
• Axillary dissection/radical mastectomy = thoracodorsal nerve, latissimus dorsi muscle, unable to raise the trunk with the upper
limbs. Adduction effected
• Intercostobrachial nerve (sensory); Injury of this nerve results in a numbness in the lateral aspect of the axilla and the medial
aspect of the upper arm.
• Neck of humerus fracture = Axillary nerve injury/deltoid
• Fracture of shaft of humerus which nerve will be affected = Radial nerve → wrist drop
• Lateral epicondylitis [Tennis, Squash players]
• Medial epicondylitis [Golf}
• Little and ring finger = Ulnar nerve ..
• Median = ape hand
• Sensation of dorsum of hand is lost, which nerve is affected? Answer is:- radial nerve
• Ant compartment of forearm >> flexion of wrist and finger
Hematogenous osteomyelitis = Metaphysis
Muscle unlock knee joint: Popliteus
patient , complain of calf pain while running, which muscle is responsible: gastrocnemius
Splenic artery ligation which one will be affected: Fundus of stomach
Exercise
• Osteoarthritis: Conditioning and low resistance
• Osteoporosis: Weight bearing
• For aging to increase and maintain ms mass and bone density advice: high endurance distance walks and weight training
• Best exercise for patient with coronary heart disease: Isotonic.
• Isotonic —> means cardio
• Isometric —> means yoga
Tumor in cavernous sinus patient have diplopia and blurred vision which cranial nerve = abducent
Appendix artery? —> Superior mesenteric artery —> Ileocolic —> Posterior appendicular artery.
Dorsalis Pedis artery palpated:

• Lateral to Extensor hallucis longus tendon
• Medial to Extensor digitorum longus
Knee Injuries
• Patient had injury to lateral side of knee, had pain and swelling in medial side: Valgus test positive —> Medial (tibial)
collateral ligament injury.
• Varus test is positive —> Lateral (fibular) collateral ligament injury
Laryngeal Nerve Injuries

1. External laryngeal nerve Injury will affect → Tension of vocal cord.
2. Recurrent laryngeal nerve Injury will affect → Vocal Cord abduction
3. External laryngeal nerve: supply cricothyroid muscle --> phone the voice
3. Superior laryngeal nerve injury defect in of vocal cord

a. tensions
b. Sensation
c. Adduction
d. Abduction
Facial blood supply

• Blood supply of right cheek and infra-orbital area: Blood supply of right check is transverse facial artery while infraorbital area is
supplied by infraorbital artery
• facial artery --> angular artery
• maxillary artery --> infraorbital artery
• What is the vein that responsible of causing cavernous sinus thrombosis from nose? Ophthalmic
Horizontal Fissure: 4th Intercostal Space

Oblique Fissure: 6th Intercostal Space
Arthritis + myopathies
1. Polymyalgia Rheumatica: Bilateral stiffness, pain and tenderness in shoulder. [Differential from Polymyositis is +
weakness and High ESR compared to fibromyalgia]
2. DIP nodule —> Heberden's nodes.

2. DIP nodule —> Heberden's nodes.
3. PIP nodule —> Bouchard's nodes
4. Boutonniere deformity: Flexion of PIP & hyperextension of DIP
5. Hypothyroidism no passive or active move of shoulder: Adhesive capsulitis
6. Hypothyroidism/DM —> Adhesive Capsulitis: Shoulder pain, increased at night, decreased ROM.
7. osteoarthritis nodules = close to fingertip heberdens node + middle joint called bouchards nodes
8. rheumatoid arthritis on ttt:
a. steroids reduce post inflammatory contractures
b. exercise reduces contractions
c. physio good for effusion
9. stiffness with pain in shoulders and osteopenia:-

a. Bursitis if one shoulder
b. Arthritis if the tow shoulder
c. adhesive capsulitis
10. Old man, diabetic, complaining of shoulder pain, increases at night, on examination significant reduction in abduction and
external rotation. What's your diagnosis?
A. adhesive capsulitis
B. rotator cuff tear
C. bursitis
11. Long scenario about patient having hip pain and she has point tenderness.
A. Trochanteric bursitis (Greater trochanteric pain syndrome)
B. Septic arthritis of the hip
Type of (description) finger deformity with RA = Swan neck , Boutonniere
Legg-Calve-Perthes Disease
• 4-8 years is most common age of presentation

• Hip pain or painless limping, fixed flexion
• loss of internal rotation and abduction
• Trendelenburg gait (head collapse leads to decreased tension of abductors)
• crescent sign (represents a subchondral fracture)
Slipped Capital Femoral Epiphysis (SCFE)
• During period of rapid growth (10-16 years of age)

• slippage occurs though the hypertrophic zone of the physis

• slippage occurs though the hypertrophic zone of the physis
• SCFE x-ray, and scenario of a child with externally rotated his hip
Osgood Schlatter Disease
• Osteochondrosis or traction apophysitis of tibial tubercle

• self-limiting but does not resolve until growth has halted
• pain on anterior aspect of knee, exacerbated by kneeling
1. 19 yr athlete presented with Rt knee pain, no hx of trauma, O/E there is patellar tenderness:
A. Osgood syndrome = 10-15
B. patellofemoral syndrome
Ewing sarcoma
• <15 age
• t(11:22)
• diaphysis of long bone pelvis ribs and scapula
• responds to chemotherapy

Joint Types
• Hinge Joint: Elbow
• Ball & Socket: Hip Joint, Shoulder Joint
• Ankle joint: talus, tibia and fibula
Location for procedures

• Ideal spot for liver biopsy: 7th intercostal (7th or 8th intercostal space in midaxillary line)
• Chest tube: Mid-Axillary in 5th intercostal space
• Thoracentesis: between posterior axillary line and midline --> between 7 and 9 intercostal
• Needle thoracostomy: 2nd mid-clavicular line
1. In scalp layers where is blood vessels?

a. S
b. C (dense connective tissue)
c. L
d. P
What is the third layer of the scalp: Aponeurosis
1. Athlete with calf click and pain can't stand on tiptoe .. choices calcaneal (Achilles) tendon
3. Triangle bounded by hyoid bone and 2 bellies of digastric muscle?

a. submandibular triangle
b. Submental triangle
c. Posterior
4. Doctor was doing delivery I think by forceps by mistake he crushed content of stylomastoid foramen which of the following will be present in baby
a. loss closure of eyelid
b. loss taste sensation from anterior 2/3 tongue
c. Loss of sensation in left face
5. Stylomastoid foramen fracture, which nerve most likely affected: -

a. Trigeminal
b. Facial
6. Pt had fracture in jugular foramen and hypoglossal canal, which one of these will not be affected?
a. Answer is:- Anterior 2/3 taste of the tongue
7. Which muscle least affected with basal skull fracture ..?

a. Sternocledomastoid
b. Trapezius
c. If hypoglossal foramen affected in basal fracture 12 Nerve which supply styloglossus will be affected too
8. Injury to obturator nerve which muscle injured?

a. Quadriceps
b. Adductor longus
c. Adductor magnus
9. Tumor in somewhere in head compressing 3rd part of maxillary artery which branch is affected

9. Tumor in somewhere in head compressing 3rd part of maxillary artery which branch is affected
a. Sphenopalatine
b. middle meningeal
c. intraalveolar artery
10. Patient typist came complaining of chronic hand pain. Examination showed superficial palmar arch insufficiency. Which artery is responsible for her condition?
a. Ulnar
b. Radial
c. Median
d. Interosseous
11. Which of the following is indication for tonsillectomy

a. asymptotic enlarged tonsils
b. bacterial pharyngitis or tonsillitis
c. sleep apnea syndrome
12. Patient who exercise he have osteoarthritis on examination doctor heard crepitation in right knee there was fluid what to next
A. X-Ray both knees and treat with ibuprophen
B. aspirate the right knee fluid
13. about runner complain pain one q in sole,

A. Planter fasciitis
a. Achilles tendon rupture
b. forget
c. Forget
14. Pain at medial sole of foot, solider, what’s the cause?

a. Strain
b. Flexor
c. Extensor
d. Achilles tendon
14. Pain in heel when waking up, decreased by walking dx: Plantar fasciitis
15. Male has injury to his posterior ankle which structure affected: ACHILLES TENDONE
16. man playing and had knee injury with click sound and his tibia can move over femur = I chose ACL injury
17. Boy was playing football with barefoot and was injured in his sole, and doctor found that it is only superficial plantar injury which structure may be affected:-
A. posterior tibialis tendon
B. abductor hallucis longus
18. hyperextension injury developed pain in distal phalanx , tender palms , can’t flex dis-tal phalanx :
A. Rupture superfascialis tendon
B. Rupture profundus tendon
C. Extraarticular fracture of distal phalanx
D. Intra Articular fracture of middle phalanx
18. Loss of sensation in medical of foot, arch and sole entrapment of nerve = Tarsal Tunnel Syndrome
a. Posterior tibial
b. Anterior tibial
c. Femoral
d. Popliteal
19. Bell’s palsy, what muscle is unaffected = Masseter muscle
20. Mandibular injury with forceful closer of the jaw , which muscle responsible for that
A. Temporalis
B. Masseter
C. Pterygoid
21. Temporalis: elevation and retraction & Masseter: elevation and protrusion
A woman whose work includes typing on a computer for a long time developed pain and numbness over her hand. Pain is at the right hand palmar arch, and the test
is showing insufficient blood flow. What artery is occluded?
Anterior interosseous artery
Posterior interosseous artery
Radial artery
Ulnar artery
Insufficient palmar blood supply: Blockage of ulnar artery (superficial palmer branch)

Insufficient palmar blood supply: Blockage of ulnar artery (superficial palmer branch)
23. Pt head injury he can’t bring spoon by himself which lobe is affect ?
A. Temporal lobe
B. Occipital lobe
C. Parietal lobe
D. Answer: Cerebellum if not then check from temporal
24. A patient with pain in the hip increases with the up and down of the stairs and decreases when walking in the flat area what is DX ? Answer:
Plantar fasciitis
25. lesion described in lower lip of a child mucus membrane 1 mm painless

A. Mucocele
B. gingival cyst
Ranula when its in floor of mouth
26. why is duration of low back pain of importance:
A. short pain duration means biologic origin
B. localization and duration suggest outcome
C. localization and duration locate biologic origin
D. long duration means u can delay ttt
27. Which of following muscles pass through lesser sciatic Foramen?

A. obturator internus muscle
B. quadratus femoris
C. obturator externus
28. pt after a surgery in the posterior triangle of neck, developed loss of sensation on the skin of lower mandible and Lower part of the ear, nerve injured is:
A. Great Auricular nerve
B. Lesser auricular nerve
C. lesser occipital
29. What is the nerve supply of posterior belly of occipitofrontalis: posterior auricular branch of facial
30. Patient with chronic hand pain, Finkelstein's test positive, Phalen test negative. Thus DeQuervain Tenosynovitis
will you manage ?
A. Thumb spica splinting
B. Thumb and wrist spica/cast.
C. NSAIDS
31. Stenosing tenosynovitis (Trigger finger): NSAID --> steroid (best treatment) --> surgery
32. Picture Diabetic with hand pain a swelling for 2 days no history of trauma pain in the palm of middle and ring finger on passive extension attached picture
A. Dupuytren's contracture
B. Diabetes tenosynovitis
C. Compartment syndrome
• treatment NSAID then steroid
• if not surgical decompression or release
33. Diabetic patient with pain when she tries to stretch ring and middle finger. WBC normal. what's the diagnosis?
A. Diabetic dactylitis
B. Infectious tenosynovitis
C. Dupuytren’s contractures
32. Accident, patient was initially fine but then he has severe neck pain, what is the cause?
A. Cervical subluxation
B. Disc prolapse
C. Cervical spondylosis
Without trauma spngylosis
33. An elderly with no patient complains of left arm weakness. He does not have any other neurological complaints. He has positive Babinski and Hoffman’s signs. A
sagittal T2 weighted MRI was provided and showed cervical spinal segment stenosis, no masses, or enhancements. What is the most likely diagnosis?
A. Spinal cord tumor
B. Peripheral neuropathy
C. Cervical spinal cord stenosis
32. Pt with osteoarthritis has high risk to osteoporosis what will u give her:-
A. bisphosphonate (started if Dexa <2.5)
B. Calcium + vitamin D
33. Family history of osteoporosis, and a lady came to you scared about having osteoporosis what will you advise her? Estrogen post menopause? Vit D & Ca then

33. Family history of osteoporosis, and a lady came to you scared about having osteoporosis what will you advise her? Estrogen post menopause? Vit D & Ca then
Early life exercise
34. A pt with numbness in the index finger and difficult to raise arm above shoulder, what is the cause of this presentation =Thoracic outlet obstruction
35. Pain in mouth and ear while chewing, which nerve = Trigeminal nerve
36. Surgical evacuation of nail hematoma = Evacuate it if painful, if not painful then reassurance
37. Infant of dm mother present with absent morro reflex in one hand cause ? = erb'spulsy
38. Which type of fracture have multiple fragments?

A. Comminuted
B. Transvers
C. Spiral
39. Most common associated injury with scapular body fracture? Answer is:- Pulmonary contusion
• According to medscape and orthobullet :
• 1. Rib fx. (52%)
• 2. Pulmonary contusion (41%)
• 3. Pneumothorax (32%)
• 4. Clavicles fx. (25%)
40. A patient was diagnosed with scoliosis, based on the cobb angle, when to do an orthopedic referral?
A. 5 degrees
B. 10 degrees
C. 15 degrees
D. 20 degree
41. Pt with lung tumor presented with distended neck vein and edema , the tumor compress which part of mediastinum?
A. Superior
B. Anterior (more)
C. Posterior
• if they ask about the site of the SVC then its medial mediastinal
• but in SVC obstruction or enlargement and ask what mediastina will affect the superior
42. Patient who had left facial palsy, loss of taste in anterior left side and Schirmer’s test on the left side is positive. Where’s the injury site?
A. Distal to greater petrosal nerve
B. Proximal to greater petrosal nerve
C. Distal to Chordae tympani
43. Pediatric patient twist his right leg by toys then he can’t walk
A. proximal tibial fracture
B. distal tibial fracture
C. ankle something
44. pic of patients with scoliosis (very clear one). He has no symptoms and upon examination there is no tenderness or change in temperature. What would be the
next step for evaluating this patient?
A. X-ray
B. Adam’s test
45. Deep laceration in the anterior aspect of the wrist, causing injury to the median nerve the result is:
A. Inability to oppose the thumb to other fingers.
B. Drop hand
C. Claw hand
D. Carpal tunnel syndrome
eye in & Down >> 4h CN function
Patient with inferior alveolar nerve injury, what is the symptom: Paresthesia/numbness/paralysis of lower lip and teeth
Loss of sensation of lower eyelid and upper lip: Infra orbital n
47. ch nerve carries the referred pain of the parotid to the ear?
A. Vagus
B. Facial
C. Auriculotemporal
D. Trigeminal
48. Scoliosis when to refer to Orthoppedic : >20 If greater than 40 degrees not 20 20 if pts. Still growing
49. A patient sustains a basal skull injury during an MVA. Which one of these muscles will not be affected?
A. Styloglossus
B. Sternocleidomastoid
C. Trapezius

C. Trapezius
50. Pt with hx of epilepsy came with shoulder pain, adduct or internally rotate the arm What is the injury?
A. inferior dislocation
B. Subacromial posterior dislocation
51. Pain on passive stretching of the foot, which muscle ? Gastrocnemius ?
52. mastectomy and need to take flap from something which nerve or artery you will take with it? Inferior epigastric A
53. Main function of anterior compartment of forearm ? Flexion of elbow
54. Amylotrophic lateral sclerosis affect which part:

A. Lateral horn
B. Anterior horn
C. Posterior horn
55. Child have pain in both knees increase when going up and down stairs, improve when walking on flat surface, there is tenderness in the area below the knee
⁃ Osgood ?
⁃ Quadriceps something
56. 30- Pt with pain in the site of parotid gland, radiated to the ear, he also has pain while chewing, On investigation there is parotid gland duct obstruction Which
nerve is affected?
A. Facial nerve
B. Auriculotemporal nerve
57. Parents pull their child and had pain (Pulled elbow ) Which ligament is affected = Annular ligament of the elbow
58. young patient, healthy, medically free, back pain for 6 months does not improve with Nsaids, what imaging modality would you use? Xray, ct scan, mri, bone scan.
59. Man involved in RTA come t ER there was small wounds less than 2 cm X-ray show mid shaft tibia fracture what to do next ?
⁃ Reassurance & discharge
⁃ Internal fixation with IM
60. Child his X ray show green stick fracture he is stable what to do ?
- discharges
⁃ cast
61. A hip injury Q and asks about which ligament would prevent even more severe injury?
Left knee swelling and pain synovial fluid analysis: turbid WBC 15000 with PMNs 85% ( they did not put culture or Gram stain or crystals):
-Septic artheritis ( my answer but i think its wrong)
-Gout

-Psudogout ( I think this is the right answe

Hepatitis
HBsAg will be detected in an infected person’s blood an average of 4 weeks (range: 1–9 weeks) after exposure to the
virus. About 1 of 2 patients will no longer be infectious by 7 weeks after onset of symptoms, and all patients who do not
remain chronically infected will be HBsAg-negative by 15 weeks after onset of symptoms
Liver biopsy centrilobular = Hepatitis B,C

Liver biopsy periportal= Hepatitis A
HBV that progress to chronic: 5%

HCV that doesn't progress to chronic: 20%
Development of into chronic in 80%
Total cure rate of those with chronic hepatitis C is almost 98%
Liver zones affected by low blood supply: Central zone (zone 3) is the first to be affected.
Peripheral zone (periportal) has highest blood supply.
Hypoxia liver = zone 3
1. Pt with needle prick of hep C one year ago, wants to breastfeed wt is contraindication
a. Cracked nipple?
Aspergillosis = Air Crescent sign
Gas Gangrene
• Gas gangrene usually presents with sudden onset of severe muscle pain. Initially, the skin may appear pale and then rapidly develops a bronze appearance, followed by purple or red
discoloration. The skin becomes tense and exquisitely tender and may have overlying bullae.
Signs of systemic toxicity develop rapidly, including fever and tachycardia, followed by shock and multiorgan failure.
Infections Page 67
• Signs of systemic toxicity develop rapidly, including fever and tachycardia, followed by shock and multiorgan failure.
• Definitive diagnosis of gas gangrene requires demonstration of large, gram-variable rods at the site of injury. Histopathology demonstrates characteristic absence of acute inflammatory
cells. Gas in the soft tissue may be observed at the bedside and/or radiographically.
• Treatment of traumatic gas gangrene consists of aggressive and thorough surgical debridement together with antibiotic therapy. We suggest the following antibiotic regimen: penicillin (3
to 4 million units intravenously every four hours) together with clindamycin (900 mg intravenously every eight hours) (Grade 2B).
• For patients with penicillin allergy, clindamycin can be used alone.
MSSA Treatment: ,nafcillin, oxacillin, or flucloxacillin. A first-generation cephalosporin such as cefazolin is an acceptable alternative in patients with hypersensitivity to the preceding agents
1. Case of Necrotizing Fasciitis ( gram +ve cocci in chains) Ask about TTT all AbX?
A. Penicillin & clindamycin
B. Piperacillin and tazobactam
Cellulitis
• Most common organism: S.aureus, B-hemolytic streptococci
• Treatment: Cephalexin, Cefazolin IV
Malaria
• P. ovale and P. vivax can produce dormant hypnozoites
• Thick smear (Giemsa stain) for presence of organisms
• Thin smear (Giemsa stain) for species identification and quantification of parasites
• rapid antigen detection tests
• P. vivax, P. ovale: chloroquine (and primaquine to eradicate liver forms
• P. vivax, chloroquine resistant: atovaquone/proguanil + primaquine or quinine and doxycycline + Primaquine
• P. falciparum: Artemisinin combination therapy (e.g. Artesunate + doxycycline or clindamycin or atovaquone/ proguanil)
• Prophylaxis: Chloroquine 300mg once weekly & proguanil 200mg once daily ( start 1 wk before travel & continue for 4 wks after returning)
1. There was scenario about person came from Africa and has symptoms like fever, abdominal pain .... (not enough information)
A. yellow fever
B. Ebola
C. Dengue fever
D. No malaria in option
2. Someone went to africa, came back with headache, retrobulbar pain, arthritis and myalgia, he has a normal temperature:
A. Ebola
B. Yellow fever
C. Lassa fever
D. chikungunya
1. Most common side effect of anti-malaria medication:

A. Itching
B. skin pigmentation
1. Confirmed malaria pt, you will give chloroquine 300 for 2 days you would like to start with: Dose should be 600 mg as initial dose followed by 300 mg after 6-8 hours then 300 mg 24
and 48 hours from initial dose
A. chlorquine 300 now and 300 after 6 hours
B. ch. 300 now and 600 after 6 hours
C. ch 600 now and 300 after 6 hours
D. ch. 600 now and 600 after 6 hours
2. Visceral leishmania: Miltefosine

3. Treatment of cutaneous leishmaniasis.
A. Stibogluconate
B. nitazoxanide
4. Patient with hepatosplenomegaly and fever and give treatment then resolved and after 6-8 weeks came back with generalized plaques and papules:
A. dermal leishmaniasis
B. lepromatous leprosy
C. sarcoidosis
D. TB
5. Malaria in Children?
A. The most common cause is falciparum
B. 72h treatment of malaria is sufficient
C. The immediate treatment primquine for 3 days
D. Crescent shape gametocyte of vivex is diagnostic in the stool
Infections Page 68
D. Crescent shape gametocyte of vivex is diagnostic in the stool
6. parenteral Rx of falciparum malaria with 10% parasitemia

A. Artemether (artesunate if quinidine is contraindicated)
B. quinine
C. primaquine
7. Pt came from afric after 4 days developed symptoms; dx?

A. Ebolla
B. Yellow fever
C. River nile
D. Dengue
Otitis Media
1. Case of OM with something in tympanic membrane and fluid collection?
a. Myringotomy
b. Amoxicillin
c. Grommet (my answer)
2. Otitis Media = Most common cause for brain abscess. (seeding through the nose)
3. Red bulged tympanic membrane ear downwards

a. otitis media
b. otitis externa
c. mastoiditis ( ear downward and outward)
4. Pt present with hearing loss where his voice is louder at the affected ear:-
A. otitis media (with effusion)
B. Otitis externa
C. Furuncle of the war canal
D. Presbycusis
Rashes
1. herpangina: Fever, headache, painful mouth ulcer, coxsackie A
2. Tinea pedis: Topical antifungal.
3. Incubation period of mump: 16-18 days
4. Infectivity period in Rubella before the after the rash in days?
a. Three
b. Five
c. Seven
d. Nine
stills disease = triad of arthritis with salmon colored rash and fever
1. Typhoid fever ?Faint, salmon-colored, blanching maculopapular rash usually seen on the trunk and chest
Urinary Tract Infections
1. UTI bacteria grows in both antiseptic and detergent?

a. Proteus
b. Pseudomonas (my answer)
c. E coli
Klebsiella if pseudomonas
2. Uncomplicated cystitis in a child: oral amoxicillin
Infectious diarrhea
Bloody diarrhea causes: CHESS:
• Campylobacter,
• Hemorrhagic E.coli:
• Salmonella:
• Shigella (1-7 days): azithromycin (1st), Ampicillin & TMP-SMX
• Entamoeba 2-4weeks:
• Giardia 1-14 days:
4. Gram -ve bacilli, oxidase -ve motile= Salmonella
5. Patient eat chicken from restaurant last week and presented to ER with bloody diarrhea there was seagull shape in peripheral blood smear, gram negative bacilli, oxidase and catalase positive
what’s the organism
a. E.coli 125
b. Shigella
c. Salmonella
d. Campylobacter jejeni
6. Treatment of salmonella that is chloramphenicol resistant

a. another dose chloramphenicol
b. Ciprofloxacin only
c. Ciprofloxacin and ampicillin
7. Treatment of salmonella in 4 years child:

a. Ceftriaxone
b. Chloramphenicol
Infections Page 69
b. Chloramphenicol
c. Ciprofloxacin
5. Amoeba prevention
a. hand washing
b. don’t eat undercooked vegetables
c. There was no boiling, wash vegetables
6. After dinner a group had watery diarrhea only No vomiting and fever
A. What’s the causative organism?
B. Clostridium perfringens
C. Salmonella
D. Staphylococcal enterotoxin
1. complication of mumps:
a. Meningitis
b. Encephalitis (only if meningitis wasn't a choice)
2. Most common complications of measles ?

a. Meningitis
b. Encephalitis (SSPE)
3. complication of bronchiolitis ?
a. Pneumonia
b. Epiglottis
4. late complication of meningitis

a. Deafness
b. secondary seizure
5. Most common cause of Hospital infections

a. Staph Aureus
b. Hand of staff
6. Bacteroides fragilis treatment = Metronidazole, carbapenems, tigecycline, beta-lactam/beta-lactamase inhibitor combinations

(e.g., Unasyn, Zosyn), and certain antimicrobials of the cephalosporin class, including cefoxitin.
7. Case of gunshot infected with Bacteroides fragilis, ttt?

A. Aztreonam
B. Clindamycin
C. Doxycycline
D. Gentamycin
1. Antibiotic for epididymoorchitis

a. Ceftriaxone
b. Doxycycline
2. Take injected influenza vaccine and developed influenza, what would you tell him?
a. killed vaccine doesn’t cause symptom
b. live vaccine carries the risk for developing the disease
c. this vaccine cause influenza like symptoms
3. Lymphocyte cell reservoir of latent HIV:-

a. CD 8
b. Macrophage
c. CD4 T cell
4. Child presented with rhinorrhea dry cough. During examination he found to have tonsillar injection and he has clear chest,
Body Temp: 38.8 or 38.2 (not remember). What are you going to do:
A. Oral cephalosporin
B. Oral erythromycin
C. Admit and give IV antibiotic
D. Paracetamol and get culture from the tonsils
Centor criteria
5. Child 5 weeks year old came with cough and shortness of breath his mother notice that he has stopped his breathing twice on
examination there is fever and suprasternal recession what are going to do :
A. -IV steroid
B. -Ventilatory support
C. -Supportive care and hydration
D. -Salbutamol
9. Child 8 year old came from Africa to ER complaining of muscle spasticity and neck stiffness he cannot lift his head above CSF
reveals normal but lymphocytosis what is the most likely to be the cause of his presentation :
A. -Poliovirus
Infections Page 70
A. -Poliovirus
B. -CMV
C. -Corona
D. -EBV
10. group A or B streptococci: Answer: Penicillin If allergy Clindamycin
11. Treatment of seasonal allergic rhinitis: -

A. Inhaled corticosteroid
B. Anti-histamine ..
C. Decongestant ..
12. What is the best to prevent Post herpetic neuralgia (long case of the scenario, you have to know the diagnosis? The case is
acute, did not devolved post herpetic neuralgia yet)?
A. Acyclovir
B. Corticosteroids
C. Corticosteroids and Acyclovir. (it's used but it is not affective)
• Answer should be acyclovir in 1st 72 hours of onset of disease
13. Chlamydia of eye: Erythromycin or doxycycline oral : 5-14 days in newborns

14. whipple disease = for the first two weeks ceftriaxone or penicillin, Bactrim for one year
15. Severe Dysuria with child > WBCs 16000 ..etc something indicates Emergency case
A. I chose Cephalosporin high dose single Inj
B. Other choices were orally incomplete
16. Pediatric patient came with fever and Swollen knee, painful and restricted range of motion, he has history of URTI 2 weeks
ago, he has leukocytosis and high ESR (the only thing against rheumatic fever is that ASO titer is not high), what is the
diagnosis?
A - Septic arthritis
B - Rheumatic fever
17. Case of bilateral nasal greenish discharge +/- pain, tried 3 antibiotics but still recurrences, patient ask for 2nd opinion
A. Give antihistamine
B. Antibiotics
C. Corticosteroid
D. Other drug
Explanation: missing info but if he must give inhaler steroid if he not given along with ABX (amoxicillinclavulanic acid
+moxifloxacin + clarithromycin + mitrodianzole)
18. HIV screening was negative when to repeat?

A. After 3 months
Screening for homosexual every 3 months
19. most common cause of brain abscess?

A. skull injury
B. nasal infection
20. Which one of the anti TB medications cause tinnitus, imbalance

A. Streptomycin
B. INH
C. Pyrazinamide
D. Ethambutol
21. Toxoplasmosis criteria to Dx =

2 fold increase of igG
22. pt with varicella in ophthalmic devision what is the best treatment to prevent post therapeutic neuralgia?
A. acyclovir
B. Oral steroid
C. IV steroid
D. Acyclovir + steroid
23. A 10 year-old has just recovered from Rheumatic Fever. Because of rapid diagnosis and completed treatment, there was no
resulting heart disease. The family is advised that antibiotic prophylaxis should be continued for period of time. For how long
should this antibiotic be taken?
A. 6 months
B. 3 years
C. 6 years
D. 11 years
24. Most common cause of viral encephalomeningitis

A. Enterovirus
B. Mums
25. Pt recieced blood in 1975, he may get which type of hepatitis ?

A
C
D
E
B
26. Case of gastric mass
Infections Page 71
26. Case of gastric mass
A. US
B. H. Pylori tests
27. what is the pathophysioligy of rhumetic fever?

When disseminated to bones
when spread to the blood
when lodge into myocardium
Pharyngitis or molecular mimicry ( choose if there)
28. Child with symptoms of URTI come to the ER due to dry cough increase at night preventing the patient from sleep not relive
by elevation of the head in Examination there is fever
A. croup
B. epiglottis
C. Bronchiolitis
D. Asthma.
29. CDC utilizes a test called the Brucella microagglutination test (BMAT), a modified version of the serum (tube) agglutination
test (SAT), that can detect antibodies to Brucella species – abortus, melitensis or suis. ... For a diagnosis to be made using
serology, two serum samples are required.
Infections Page 72
Saturday, November 17, 2018 2:11 AM
Immunization
1. Vaccine that is not given if patient or any contact is immunocompromised: Oral Polio Vaccine (OPV)
2. Varicella vaccine
A. Now and within 6 weeks (adults)
B. now and after 6 months
C. 3 doses within 6 months
• If less than 12 = at least 3 months apart
3. Which vaccine is given to baby in 9 months? Answer is:- Measles and MCV
4. BGC contraindicated: IL-12 or INF-Y deficiency or TNF-A
5. Child has allergy from egg what vaccine not to give him?
A. Yellow fever + influenza vaccine
○ MMR is no longer contraindicated in egg allergy
6. Pediatric px take 4 month vaccine have anaphylaxis, what you do in next vaccine
A. skin allergy test
B. give all except DTP
C. Give him vaccine with one hr observation.
7. Eczema Which vaccine not to give:- Answer is:- Small pox
8. Vaccine contraindicated for pt with eczema and atopic dermatitis

A. Measles
B. Yellow fever
C. Rubella
D. Influenza
8. Patient seizure what should u do regarding vaccination = Give all but DTp
Diphtheria, tetanus, whole-cell pertussis vaccine (DTP) is associated with increased risk
for seizure during the immediate postvaccination period.
8. Patient presented to ER after dog bite which was deep, he already receives 1 dose of rabies vaccine 1 month ago, what to do? Give 2 dose of vaccine
9. scenario of a man that presented after a dog bite. They could not catch the dog. 18 months ago he took rabies vaccine before going to South Africa. Upon
examination his wound looked deep. Which of the following is the best management?
A. give 2 doses of rabies vaccine
B. give rabies immunoglobulin
C. give immunoglobulin and vaccine
Deep = grade 3 = both
bite give : vaccine and immunglublin
9. 13 months dis not receive MMR and now is available, what to do:- Answer is:- Give him now
10. A 6 years of positive HBV mother not taken any vaccine except BCG after delivery. What will you give him:
A. A) Hepatitis B virus +Polio+ DPT +Hib.
B. B) Hepatitis B virus + Polio + DT + MMR +HiB
C. c Hepatitis B virus + Polio + DT + MMR.
D. D) Hepatitis B virus + MMR+DPT + Hib.
11. Minimum interval between hepatitis A vaccine in weeks?

A. 2
B. 4
C. 6
D. 8
• I have seen 6 month mentioned
12. anxious father brought his son who is immunocompromised after he was in contact with his brother who developed chicken pox. Upon examination the boy was
asymptomatic and no further findings. What to do next?
A. Reassure
B. Acyclovir
Immunization Page 73
B. Acyclovir
C. Varicella immunoglobulins
13. Patient with seasonal watery nasal discharge, sneezing and nasal block. What should you give him as a treatment:
A. Topical steroid
B. Decongestants
C. Antihistamines (1st)
D. Systemic Steroids
14. Starting age of influenza vaccine = 6 months
14. Obstruction in one side of the nose, what is the ttt?

A. Local decongestant ..
B. Corticosteroid
15. Best effictive method to prevent allergen is :

A. antihistamine
B. epinephrine
C. corticosteroids
D. avoid allergen
16. Innate immunity = Complement, Phagocytosis, inflammatory process
17. Child known case of Leukemia undergo bone marrow transplant his brother develop chicken box what to give the child ?
A. Varicella vaccines
B. Varicella immunoglobulin
C. Varicella vaccines & immunoglobulin
18. Young patient come with red eyes & tearing for 1 day no hx trauma , allergy no other associated symptoms
⁃ Reassurance
⁃ Antibiotics
Child with ssx of cow milk intolerance

Milk free diet ( exact choice)
Hydrochortisone
Cromolyn sodium
RAST test detects

Many IGE choices
One IgG choice
Skin allergic something
Food elergy help in diagnosis

Serum esinophil
Detailed history
Skin biopsy
Hepb screening post exposure
One year old child and his sister is immunodeficiency what to avoid
Vercilla
MMR
Oral polio
Influnza
Immunization Page 74
Prolonged Labor: 10-15 % Although Uptodate says 20%

Average age of menopause: 51
Turner what percentage of second baby with turner 30%
Decrease OCP: Anti-Convulsants
Increase OCP: Anticoagulants.
Prognosis of breast cancer: identified first by LN, second by tumor size
PMS = emotional symptom in 2nd half
Uterine dysfunctional bleeding = OCP NSAID, Tranexamic acid  Levogastrol ablation hysterectomy.
What in OCP cause facial hair = levonorgestrel
prolonged pregnancy percentage = 3-12%
CTG Conditions:
• * Early decelerations —> Head compression.
• * Variable decelerations —> Cord prolapse.
• * Late decelerations —> Placental insufficiency
OBY Page 75
Fetal Presentation
1. Doctor can palpate orbital ridge nasal bridge mouth and chin, what’s presentation?
A. Mento ant → SVD
B. Mento post → CS
C. Right mento-transverse
D. Left mento-transverse
2. Pregnant in delivery, can feel the nose, chin and orbital ridge of baby. —> Face presentation → Induction with Oxytocin and SVD
3. Brow presentation —> can feel nose, eye and forehead
4. Pregnant on delivery you can feel the orbital ridge the chin the nose. what to do
A. continue observation
B. induction with oxytocin
C. Do CS
D. I don't know
brow presentation: head partially extended (requires C/S)

■■ face presentation: head fully extended
◆◆mentum posterior always requires C/S, mentum anterior can deliver vaginally
5. Which of the following pelvis shapes is associated with deep transverse arrest
A. Gynecoid (best shape to deliver)
B. Android (male)
C. Anthropoid
D. Palatyploid
6. Increasing dysmenorrhea associated with?

A. Copper IUD
B. levonorgestrel IUD
7. A Pregnant woman at 5 weeks of gestation. Cervical incompetence was diagnosed. What will you do next?
A. Cerclage at 12-13weeks
B. Cerclage now
C. Progesterone pills
D. Prompt delivery
8. A case with abdominal pain and amenorrhea symptoms were going toward ectopic in the question the bhcg was in 2000 the doctor gave her methotrexate. But later she came back again and
her bhcg now is 6000 what is the management
A. exploratory laptoscopy
B. methotrexate again
C. Salpingectomy
D. Salpingostomy
6. Question about pregnant say which Indirect indicator for GBS infection is
A. body temperature > 39
B. Rupture of membrane > 18 hours
C. Previous infant with GBS infection
D. pregnancy or (labor I don’t remember) < 38 weeks
7. Pregnant in labor received fentanyl now fetus heart rate dropped, and she is taken to OR for delivery, In left lateral positi on and feel light headed what to do next
A. Ask for forceps
B. Fowler/Trendelburg position ( only if ephedrine option not there)
C. Fentanyl
D. Ephedrine (IV fluids + Ephedrine)
8. How to prevent a high level of anesthesia?

A. Anti-Trendelenburg
OBY Page 76
A. Anti-Trendelenburg
B. Trendelenburg
9. Pregnant 41 week came for induction of labour. She has some mucoid blood tinged discharge from vagina and cervix dilated ( i don't rememb er how much) what is the next step
A. Artificial rupture of membranes ( if cervix dilated > 4cm)
B. Oxytocin
C. Balloon Catheter ( cervix < 3cm)
10. Still birth which week ?

a. 20
b. 22
c. 24
d. 26
11. Female taking tamoxifen/raloxifene, it will decrease the risk of breast cancer by = at increased risk grade B & not at increased risk grade D
A. High
B. Moderate
C. Low
D. Non
12. Patient failed ECV at 36wks and fetus is vertical, what's the contraindication to do ECV again:
A. Failed 1st attempt
B. AFI > was 12
C. Position was lateral
D. Age > 38 GA
13. In late deceleration , 90% effacement , what to do !

A. - SVD
B. - CS
C. - vacuum
D. - forceps
14. bleeding in napkin only while whipping in the bathroom, us normal , pelvic scope
normal , where is the lesion ?
A. Cervix
B. vulva
C. urethra
D. Pelvic
15. Breast pain under riola and outer no mass ?

A. Ductile
B. Fibrocystic
C. Carcinoma
D. Ductal ectasia
16. Female patient 40 years with breast lump. Mammogram and Ultrasound are normal: Check after 2 cycles
17. Uterine fibroids risk factors → 1. Age, 2. African race
18. Bicornuate Uterus → Breech presentation.
19. 22 years old Intra-ductal papilloma what’s the best next step?
A. Mammogram
B. Ductogram
C. Cytology of the discharge
• Next step is cytology, diagnostic test is Ductogram .
• US then Ductogram
• Simple mammography should be performed in all patients complaining of bloody or serous PND before Ductography especially if t hey are aged 35 years or over
20. Breast engorgement and tenderness in a new mother you will advise her
A. Warm compressor and continue breastfeeding
B. Cold compressor and continue breastfeeding
C. Doxycycline and continue breastfeeding
D. Doxycycline and stop breastfeeding
21. 38 weeks pregnant with progressive painful contraction and watery discharge for 8 vs 18 hours and cervical dilation of 3 cm what to give
A. Penicillin
B. Morphine
C. Oxytocin
D. Naloxone
22. female pregnant in her 24 week , came to you for her first prenatal visit , lab are provided all were normal except that the Hgb is slightly low ( I think it was 10) , what will you do ?
A. Nothing
B. Folate
C. Vit B
D. Iron
23. 24 years old G1P0, she has gestational diabetes which is controlled by diet only, and no other medical problems. She is in th e 2nd stage of labor which last more than 2 hours, normal uterine
contractions, baby's head comes down with each contraction and go back when uterus is relaxed, the mother's hip is maximally flexed, one nurse is applying suprapubic pressure, other nurse
applying fundus pressure, the doctor decided to do episiotomy and deliver the posterior shoulder. Which of the following will cause delay in delivery?
A. suprapubic pressure
B. fundus pressure (original answer)
C. hip flexion
OBY Page 77
C. hip flexion
D. delivery of posterior shoulder
24. G3P2+0. Her first visit was on the 20th week of gestation. She has history of two premature deliveries. Her cervical length w as 30 mm. what is your appropriate management?
A. Strict bed rest
B. Terminate her pregnancy
C. Immediate cerclage;
D. Inject her with progesterone (similar question but this is answer there)
25. Clear case of PCOS FSH, LH and testosterone level were provided in the question, what would you like to order?
A. T4 and prolactin
B. DHEA
C. Glucose tolerance and lipid profile
26. Pt with Mass in the ovary?

A. Ovarian cyst
B. Struma ovaria
C. Granulosa cell tumor
27. Old female came with a history of fecal incontinence and fecal leakage, she feels heaviness
on her lower abdomen, examination reveal full tens abdomen. What is your next step?
A. give laxative
B. fecal dis-impaction (removal)
C. discharge home
28. 27 week gestation with diamniotic twin one of them died what to do?
• Answer is:- Wait until 34 then deliver ..
• If Mono --> Wait until 28 weeks then deliver ..
• If Di --> Weekly close monitoring then deliver at 34 weeks ..
29. In order to increase hyperbaric in cephalad position = Trendelburg position
30. to prevent high anesthesia Anti Trendelenburg
31. On palpation of lateral fornix, which organ you feel:- Ovary
32. Case of placental abruption in third trimester how to manage?

• CS →threatened maternal and fetal stability +near term >36wk
• VD→ mother and fetus stable +near term >36wk.
33. thalassemia diagnosis before birth = I chose chorionic villous sampling, Answer should be CVS at 11-14 weeks or amniocentesis at 16 weeks
34. Pregnant baby 24weeks by ex 25weeks is known DM .htn. DM nephropathy risk of baby
A. Still birth
B. Large baby
C. Shoulder dystocia
35. 5 years old with signs of puberty breast bud and smell but no acne or clitoral hypertrophy = Dihydroprogesterone phosphate
36. Female with clear dx of stress incontinence c/o heaviness in her genitalia P/E shows mass in the anterior
vaginal wall, Dx?
A. Urethrocele
B. Cystocele
37. Female patient has vaginal discharge, vaginal and mouth ulcers, she also has tender cervical and inguinal lymphadenopathy. He r spouse is free of symptoms.
What does she have?
A. Herpes simplex
B. Syphilis
C. Lymphogranuloma venereum
38. 24-year-old female with incontinence associated with urgency, frequency, dysuria day and night. On examination tenderness over Supra pubic area.
A. Stress
B. Hypoactive
C. Hyperactive
D. Sensory / Irritant
14. What is the most frequent sing and symptom with abruptio placenta?
A. Uterine tenderness
B. Fetal distress
C. Vaginal bleeding
15. Normal pregnancy in the 2nd trimester is characterized by all of the following EXCEXPT:
A. Decreased fasting plasma glucose
B. Elevated fasting plasma glucose (I think this one)
C. Elevated postprandial plasma insulin
D. Elevated postprandial plasma glucose
E. Elevated plasma triglycerides
16. The prevalence of gestational diabetes in the general population is about:

A. 4%
B. 2%
C. 10%
D. 20%
OBY Page 78
17. An abdominal ultrasound study was performed on a female patient early in her gestational period which showed a low -lying placenta. After several weeks later, an US showed that the
placenta might be adherent to the uterine wall. What will you order to confirm this?
A. Ct scan
B. X-ray
C. MRI
D. Transvaginal US
18. Best to diagnose Meigs syndrome

a. Tumor markers
b. Histopath
c. MRI
19. Study on postmenopausal women with ( continuous estrogen, combined OCP , placebo ) what is exceeded risk ? Uterine cancer , t hromboembolism, cervical ?
20. 18 YO girl , no menses for 2 months , not active sexually , examination was difficult due to pain and Pt was tense , what’s t he next ? Pregnancy test , FSH & LH , reassure and come again after 3
months ?
21. Pregnant at 16 or 20 week , Rh negative what to do ? Indirect coomb test
22. What is associated with increased risk of mortality in women (pregnant I think )
A. pheochromocytoma
B. Maternal age
Cervical incompetence less than

10
20
30
40
Prgnnant in labor recieved fentanyl now ferus heart rate droped and she is taken to OR or delievery roo
In left lateral position and feel light headed what to do next
Ask for forceps
Some poistion i frogot irs name
Fentanyl
That question about trendlenburge position

Child with minigitis LP culture revealed G +ve cocci in pairs: what is the antibiotic combination:
Vancomycin + cetriaxone
Penicillen + vancomycin
Pregnant 41 week came for induction of labour. She has some mucoid blood tinged discharge from vagina and cervix dilated ( i dont remeber how much) what is the next step:
Artfecial rupture of membranes
Oxytocin (my answer)
Catheter
ECG pic wolf parkinson very unclear

Choices LBBB, sick sinus , wolf parkinson, tachycardia and postural hypotension
Pregnant 30ws everything normal except for rupture of membranes what to do

Liquor biochemistry
Pelvic examination
OBY Page 79
Milestones
• Prone to Supine = 4 months
• Baby sit briefly, crawl, move object from hand to hand , but no pencil grasp: 7 month
• Say few words at the age of which :
• millstone no assist pincer grasp = 8-12 months
• Delayed milestones at 12 months = can't crawl or can't sit
• Milestone of driving a tricycle: 3 years
• Milestone of drawing a straight line: 2 years.
• can reach object with hand, laugh with no more head: 16weeks/4months.
• 4 yrs = tell story
1. 6 months child which of the following gross motor milestone he can have
a. sit unsupported
b. stand holding furniture
c. roll from prone to supine
d. roll from supine to back
2. Mother brought her 3 years old to see his language development he can communicate easily something like this and 75% of his speech is understandable he asks questions frequently
a. developmental expressive aphasia
b. something dysfluency I think speech
c. normal development for age
Tanner Staging
Expected child height:

Boy: (Father+ Mother)/2+13
Girl: (Father+ Mother)/2–13
Most sensitive age to steroids: Answer: 24 months — 96 months (2-8 Years)
Age of Intussusception: Answer: 6 months to 36 months (up to 3 years).
1. Child with barking cough (croup) wt is complication?

a. Epiglottitis
b. Meningitis (if pneumonia not present)
2. Child Case of malabsorption with low bicarb low k high creatinine weight on low percentile Wt is pathophysiology?
A. Hydrogen excretion
B. Chloride absorption
DD are :
• CF its wrong as acidosis in cf its alkalosis
• Barter and Gitelman its normal creatinine
• Mostly this RTA type 1: Hypokalemia, Acidosis metabolic, Recurrent stone formation elevated RFT, It has defect in distal tubules in hydrogen excretio n
3. parents brought their child to pediatric worried about his infrequent bowel motion and fatigue, on examination the liver was one finger below the lower costal
margin, labs showed low Na, K, (forgot rest of labs), what's the reason for this condition?
A. impaired hydrogen ion execration
Peds Page 80
A. impaired hydrogen ion execration
B. impaired chloride absorption
4. Mother changing her child diaper multiple times a day, he is underweight

Labs: normal cholride, low K, low Na
Dx?
A. Chloride losing diarrhea
B. Chronic pancreatitis
C. Proximal renal tubular acidosis ✅(not so sure, it comes with Fanconi anemia so read about it may be this child having Fanconi anemia)
D. Distal renal tubular acidosis
3. Child with tea urine , fatigue , abnormal movement , parents note skin eruption for ( unknown number of days) ?
A. PSGN
B. HUS
C. IPT
D. HSP
E. Answer: TTP
5. 7 years old boy with unilateral joint swelling and epistaxis and fatigued weight 5th percentile and height 10th percentile wh at you will do= A case of leukemia
A. Bone marrow biopsy
B. DsDNA
C. RF
6. It is frequent to have epistaxis in cold weather due to thinning of blood vessels, answer most probably is to check capillary fragility .. but also vitamin C deficiency
interfere with collagen synthesis
7. child toke 25 ml of paracetamol, concentration is 100 MG/ML, the child weight is 15 Kg, height was provided too. The patient took the drug 6 hours ago, now he is stable,
what to do?
A. Observation
B. Activated charcoal (given if within 4hrs of ingestion)
C. Gastric lavage
D. N-acetylcystine (NAC) (not given beyond 24hrs)
Minimum toxic doses of acetaminophen for a single ingestion, posing significant risk of severe hepatotoxicity, are as follows:
• Adults: 7.5-10 g = 15-20 pills
• Children: 150 mg/kg; 200 mg/kg in healthy children aged 1-6 years
• The toxic dose it depends on the syrup oral 160mg5mL ( every 5 ml there will be 160 mg )
8. Calculate GCS for a child, eye closed put open when called, withdrawal to pain, confused.
A. 9
B. 10
C. 11
D. 13
9. Case child with trauma, swelling in post nasal septum, what to do: -
A. x-ray
B. nothing
C. medical ttt
D. incision and drainage if isn’t there go for x-ray or!!
10. Retinoblastoma affect vision, optic nerve is intact, what is the management: -
A. Systematic invasive Chemotherapy
B. External beam radiation therapy
11. posterior epistaxis management: nasal packing
12. Initial step to do for epistaxis

A. pressure on the carotids
B. tampon on the nostrils
C. press the anterior part of the nose
13. Child with epistaxis. He had previous episode 3 months ago. What is the initial step in management?
A. Posterior nasal packing
B. Cauterization
C. Nasal solution (I forgot its name)
D. Tilting the head backwards and applying pressure on the nose.
14. Young man came with nasal bleeding from posterior septum not known to have any medical disease or bleeding disorder MANGEMENT is.
A. Tampon in posterior septum
B. Screen for blood and coagulation
C. Inject septum by vasoconstrictor
D. Spray anesthetics or vasoconstrictor
13. Steroid sensitive Minimal change disease occur mostly at which age?
A. 15 - 36 months
B. 48 - 96 months
C. 6 - 15 months
D. 1-8 years
Peds Page 81
14. Preterm (23-25) weeks, successfully resuscitated. His birth weight 0.9 kg Labs:
pH slightly acidic by one point
Pco2 normal
Po2 normal
They didn't mention the LFT or jaundice
What's the appropriate management:
A. Enteral feeding
B. Phototherapy
C. bicarbonate infusion
15. Rheumatic fever case and asking about usual presentation?

A. urinary urgency and frequency and fever
B. fever and small joint pain
C. knee and pelvic pain and fever
16. month baby with mild viral diarrhea, ttt by ORS as:
A. 50 ml/kg for 4 hour then 100 ml/kg /day after
B. 100 ml/kg for 4 hour then 100 ml/kg /day after
C. 50 ml/kg for 4 hour then 50 ml/kg /day after
D. 100ml/kg for 4 hour then 50 ml/kg /day after
17. Child presented with petechiae and his platelets is 15 , otherwise healthy. What will you do for him?
A. Splenectomy
B. IVIG
C. Observations
D. steroid
13 years old child his parents bring him to you concerning of his hight & his sexual development in examination hight is normal his testes 4. Something cm no scrotal
pigmentations & fussy pubic hair
⁃ Reassurance
⁃ MRI
⁃ Testosterone level
Child with innocent murmur description and going for oral surgery wt to do
Reassurance
Give antibiotics
Postponed surgery
Peds Page 82
Trauma
Trauma Case, Decreased breath sounds, hypotension & tachycardia:
A. Needle Decompression
B. ABC
Antiphospholipid Syndrome
1. Which one of these patients with pneumonia will you treat as outdoor patient?
A. 80 Years old with 104 F temperature, BR 24/min PR 126/min, BP 180/110
B. 60 years old with 102 F temperature BR 22/min PR 124/min, BP 160/110
C. 50 years old with 98 F temperature, BR 20/min. HR 110/min, BP 180/110
D. 80 years old with 96 F temperature, BR 18/min, HR 70/min, BP 110/80
2. 14 years old with microcytic hypochromic anemia with normal ferritin and normal Hb A2 what to do next
A. Iron level and TIBC
B. Gene study
C. Bone marrow biopsy
CBC ( it was only hypo + RDW is N ) what else u should order

- Hb electro
- Bone marrow
- Serum ferritin and TIBC
- genetic testing
3. High GGT and amylase and triglyceride what is the cause?

A. Alcohol induces
B. Hypertriglyceridemia
C. Pancreatitis
4. Which of the following is A cause of physiological hypoxemia?

A. Ventilation perfusion mismatch
B. Pulmonary Flow shunt
C. Decrease oxygen alveolar diffuse
D. Hypoventilation (or high altitude)
5. Patient medically free with no diabetes with Family 244_2 7 hx of CABG for heart disease asking about ideal ldl lipid profile for him?
A. 4-3
B. 1.9-2.6
6. 40 y/o female Newly diagnosed with diabetes, what investigation is indicated?

A. HPV
B. HAV
C. pneumococcal
IM^J GS Page 83
C. pneumococcal
Answer: HBV ( People with diabetes have higher rates of hepatitis B than the rest of the population.) + pneumococcal . Ref CDC
7. old patient with gastritis low mcv (case of IDA ), what’s your management?
A. IM iron
B. Oral Iron
C. folate Something else
8. What is the most common lesion in perianal area above 50s.

A. Anal fissure
B. Hemorrhoids
9. Pregnant healthy 12 w spleen palpable gum bleeding ,

A. Platelet 15
B. ITP
C. Gestational thrombo
D. Thromboembolic
10. a case of ITP platelet was 15k what is the next step in management ?
A. IV gamma globulin
B. Platelet transfusion
C. Splenectomy
First line : steroid / In children its IVIG, Second line : IVIG, Third line : Splenectomy
11. Male patient presented with history of palpitations but he has no chest pain or syncope the last attack was yesterday it takes about 10 min then resolved. Echo done
for him it was normal . ECG picture there is finding but i could not get it what are going to give him :
A. Digoxin
B. Verapamil
C. Propranolol
D. Aspirin
12. Patient presented with aspiration in the last week and he has tongue fcsiaulation and and upper and lower limp spasticity and weakness what is the most likely
diagnosis :
A. -Mononeuropathy
B. -Myasthenia gravies
C. -Myasthenic syndrome
D. -Motor neuron disease
13. Patient with urge incontinence what initial investigation

A. urodynamic study
B. Urethrocystogram
C. Residual urine
D. If Urine analysis go with that
Initial urinanalysis, then residual urine, best urodynamic
14. Pt with aortic valve calcification, less lumen 0.72.. Near syncope on exertions, murmur over left sternum. Tx:
A. balloon aorto valve stent
B. medical Rx
C. aortic valve replacement
D. avoid exertion
• If aortic valve area is less than 0.8 cm2 (normal 2.5-3 cm2) or if EF less than 50% then choose aortic valve replacement
15. man came from mountain less than 0°c with cold bilateral black legs what to do:-
A. rapid exposure to hot air
B. immerse both legs in warm water
C. debridement and removal of black skin
• First thing rewarm to know the real extend of dead tissue, some area could recover with rewarming and regain blood supply
16. Patient presented with Multiple organ failure, his phosphatase in normal level, after one day his phosphate level decrease, which organ is responsible for his
condition?
A. Liver (if not mechanically ventilated)
B. Kidney
C. lung
D. Heart
17. Patient heavy smoker with signs of cancer + hypercalcemia which cell responsible:
A. Kulchitsky’s: (contain calcitonin = hypercalcinemia hypocalcemia)
B. Brush
C. Clara
18. Heavy smoker presented with Resp symptoms and lymphadenopathy above his rt clavicle, what is the origin cell?
A. Clara
B. Brush
C. Goblet
IM^J GS Page 84
C. Goblet
18. 17 years old with chronic diarrhea Labs showing macrocytic hypochromic anemia what you will do
A. Gluten free diet
B. Antibiotics
C. Immunosuppressant
 Should be microcytic anemia not macrocytic
19. Patient c/o fever, productive cough, x-ray picture show right lower lung opacification and obliteration of right costophrenic angle what you'll find on examination?
A. Crepitation’s on both lungs
B. Absence of vesicular breathing sounds of right lower lobe
C. Presence of bronchial breathing bilaterally
20. A patient was surgically treated for a papillary bladder tumor. What should be given next?
A. Intravesical BCG
B. Radiotherapy
C. Mitomycin C: low risk mitomycin
21. Athlete presented with swollen calves and hematuria. He had URTI three weeks ago. Urine analysis was normal except for T colored urine and hemoglobin (different
version) in urine. What is the treatment? A case of rhabdomyolysis
A. Hydrocortisone
B. Diclofenac sodium
C. Isotonic saline
D. Antibiotic
22. Screening for bladder ca:

A. Early screened ca will reduced the mortality and morbidity ..
B. Urine biomarker is the available now for screening
C. Screen all even if asymptomatic
D. No recommendation for screening (answer in different version)
In old guideline no screen, if not there choose urine biomarker
23. Most common S/S of hyperthyroidism what you will find =
a. lid retraction
b. Preorbital myxedema
24. Pt with signs and Sx of hyperthyroidism and swelling in the neck, lab showed hyperthyroidism and no TPO result, what will you find in the pt:-
A. Lid retraction
B. Pretibial myxedema
24. Adenocarcinoma in situ of the lung:- Less than 3 Cm vs less than 2cm
25. DLCL tx:-

A. CHOP
B. Rituximab (some versions have this)
C. CHOP + Rituximab
26. Hurthle Cells found in

a. Hashimoto
b. Follicular carcinoma
27. Pt with polydipsia and polyuria. Lab: Na increase, Cr normal, What’s the diagnosis?
A. Central DI
B. Nephro DI
C. SIADH
28. Migraine prophylaxis in asthmatic:

A. B blocker
B. Verapamil
C. Amitriptyline
29. Dyslipidemia screening:

A. Fasting triglycerides
B. LDL
C. Fasting total cholesterol
 Urine
 **Dyslipidemia screening = total cholesterol +HDL
 LDL used but expensive
30. case of old patient with reduced sounds on carotid auscultation and high BP?
A. May be carotid stenosis and this is a carotid bruit ..
B. AS
31. pt had head trauma with weakness, numbness, headache and dilated pupils dx: epidural hematoma
IM^J GS Page 85
31. pt had head trauma with weakness, numbness, headache and dilated pupils dx: epidural hematoma
• uncal or Transtentorial hernia leading to CN3 palsy, PCA compromise and false localization sign ipsilateral paresis with blown pupil, down and out gaze and
contralateral homonymous hemianopia
32. Patient have colon polyp hyperplasia on colonoscopy progressive quickly when repeat colonoscopy other time?
A. after 3 weeks
B. after 6 weeks
C. Q2-6months
Colonoscopy screening interval:
• hyperplastic polyp --> 10 y
• 1-2 adenoma --> 5y
• 3-10 adenomas --> 3y
• >10 adenomas --> <3y
33. High risk to develop endocarditis?

A. VSD
B. TOF
34. What’s the Treatment of steroid resistant Bechet?

A. Colchicine (cutaneous)
B. Interferon alpha (if mucocutaneous)
C. Hydroxychloroquine
D. Azathioprine (Refractory Arthritis)
35. Patient has hyperthyroidism symptoms with cardiac arrhythmia.what is most common type:
A. AF (final)
B. SVT
C. VT
D. Ectopic beat
• Explanation most common in hyperthyroidism is sinus tachycardia, most common in gravis is AFIB
36. Male with lower abdominal pain. He give history of a mass in scrotum that returns when laying down for few weeks. Patient is stable. Examination shows irreducible,
tender inguino-scrotal mass with -ve cough impulse. What is type of hernia
A. Irreducible.
B. Incarcerated
C. Strangulation
D. Perforated
Acute presentation: strangulation
37. known osteoporotic patient on VIT D and zoledronate for last 3 years lab results all normal ( Ca, ALP, phosphate ) but only raised PTH what is next appropriate ?
A. Teriparatide
B. Serum calcium level
C. serum phosphate
38. What is the recommended interval for screening a healthy 35 years old man lipid profile with no family HX of cardiac diseases ?
A. one year
B. two years not sure 100%
C. 3 years
D. 5 years
39. Alcoholic patient complains of bones pain progressive for 2 years, there is lab results and X-ray findings in the question. What is your dx?
A. osteoporosis
B. osteomalacia
C. cancer metastasis to the bones
D. Paget disease of the bone
40. Patient with bilateral hand nodules and he is sad that he has bone lost in his joints. What’s the cause of bone loss?
A. Product produced from synovial cell/fluid
B. Increase pressure in joint space
41. Treatment of acute hepatitis B?

A. Lamivudine not recommended in new guideline
B. Interferons
C. observe ( I believe this is ans)
42. Pediatric patient with type 1 DM found unconscious in the bathroom, his parents are calling you and they tell you he missed his insulin dose what do you tell
them?
A. Give insulin
B. Give Glucagon injection
C. Give oral fluid mixed with sugar
43. a 30-year-old man presented with a painful mouth ulcer that started 2 days ago, the pain increases with eating and drinking. You confirmed it was a 1 cm mouth
ulcer. Which of the following is the appropriate management?
A. oral antibiotics
IM^J GS Page 86
A. oral antibiotics
B. oral steroids
C. Triamcinolone dental paste
D. refer to oral surgery
44. Female with thyroid nodule, TSH normal, you did FNA but wasn't conclusive, what to do?
A. repeat FNA
B. thyroid scan
C. Surgical removal
45. 57 years old came for checkup he has normal BP. Elevated cholesterol and blood sugar. Regarding his BP when do you want to see him again?
A. 3 months
B. 6 months
C. 12 months
D. 24 months
46. The effectiveness of ventilation during CPR measured by

A. Chest rise
B. Pulse oximetry
C. Pulse acceleration
D. Blood pressure
47. years old with lumbar region pain radiate to lower abdomen and thigh, associated with nausea, worse in morning:
A. Renal stone
B. UTI
C. lumbar muscle strain
D. epididymoorchitis
48. Left Hemiplegia, MRI at T2 shows hyperdense area in the rt. Side of the brain. Which of the following will worsen the patient prognosis?
A. Blood glucose < 6.5
B. Blood pressure < 140
49. Patient with lung cancer, you want to see the lymph nodes involved or not, to decide the treatment What is the best?
A. MRI
B. Perfusion
C. CXR
D. PET
50. Case of cholecystitis (with labs showing high amylase) Ttt?

A. Conservative
B. ERCP
C. Lap chole
D. GI Endoscopy
51. CXR of pt with opacity in the lower right lobe of the lung with fever cough and purulent sputum What will you find on auscultation over that area
A. Absent vesicular
B. Absent vesicular
C. Crackles
D. Ronchi
52. Duration of chemotherapy maintenance in ALL: 2-3yrs

53. Women with chronic back pain + financial problem : amitriptyline
54. Heavy alcoholic and heavy smoker, came with mid clavicular mass, what to do?
A. CT scan of the neck
B. Excisional biopsy
C. Needle biopsy
D. Laparoscopy
Best step : excisional biopsy, depend in scenario
55. Case with low Na, low K What to give?
A. NS + 20 Kcl
B. half NS + 20 Kcl
56. Elderly come for check up, you found high blood pressure, what to do?
a. Follow up after 6 m
b. 24 Ambulatory blood pressure monitoring
57. Elderly with acute urinary retention, best treatment is:

A. - Cystoscopy and TURP (if best)
B. - Semi-urgent prostatectomy
C. - Urethral Cath and culture (if acute)
D. - Urine culture & sent home
58. Diabetic and HTN on ACE inhibitor and other antihypertensive with orthostatic hypotension (they mention the BP while sitting and standing and the difference more
IM^J GS Page 87
58. Diabetic and HTN on ACE inhibitor and other antihypertensive with orthostatic hypotension (they mention the BP while sitting and standing and the difference more
than 20mmHg ) What the cause of this presentation?
A. Medication
B. Autonomic neuropathy
59. 55 years with cough and bloody sputum on Ex ronchi ,wheezing and crepitation Hx of the same attack
A. lobar pneumonia
B. TB
C. acute bronchitis
D. COPD
60. DM same Q but lipid profile were too high which test you’ll order
A. fasting BS
B. liver function
Look for TFT before
61. an ild patient with diffused abdominal pain and guarding what will be elevated? Tsh, AST, ALT, Leukicytes.
62. patient young died while jogging what to do for his brother? Pacemaker, genetic testing (out of was give genetic testing)
Defibrillator (could be give for management)
63. Elderly taken 75 mu of thyroxine for hypothyroidism for 6 months,he miss one dose .his lab are normal what is the most appropriate dose by mcg
A. 25
B. 50
C. 75
D. 100
64. Elderly with bone pain in examination there is bone tenderness especially the spine . labs including high IgG & creatinine but low igA
⁃ multiple myeloma
⁃ Metastatic cancer
Patient anemic receive hematic treatment come after 2 day complaining of dark stool
⁃ iron dextran
⁃ Ferrous sulfate
Hemosidrin laden association with ?

⁃ Rheumatic fever
⁃ CMV
⁃ Pneumocystis jiroveci
Pt with abdominal pain diffuse no other ssx Xray dilated loops especially transvere colon and no gas
Temp. High
WBc high
Tacycardic
Wt dx
Acute pancreatitis
Acute cholecystitis
Perforated PU
Acute MI
Side effect of bupropion used in smoking sceation

Xerostomia
Seizure
Headache
Tonsillitis days of treatment (repeated 2times)

7
10
Diabetes + feet pain treatment

Gabapentin, pregabalin
Schizophrenia + drowsiness confusing Time place and person and muscle rigidity treatment
Dizapam (catatonic symptoms)
Ssri
Benzotropine
if its going with acute dystonia answer: benzotropine
Very very hard q about early changes with congestive heat failure
65. Leukemia pt taking ...mab treatment and fluoxetine Came with mydriasis and fever and other ssx The cause is :
Neurolyptic syndrome
..mab toxicity
Ssri toxicity
Sepsis
Pt with hyperthyroidism + painful large thyroid ttx

Radioactive iodine
PTU ( if no observation aviable to relive symptoms)
Methamedazole
IM^J GS Page 88
Observation ( if its was in options)
2- Study about Dm and its relation to exercise something like that .. what affect validty of study ?
Incidence of dm
Loss follow up
Prevelance of something sorry I can’t remember
Loss follow up
Child with ssx of leukemia and gene CALLA postive
AML
CALLA for ALL
Old age with lymadenopathy

CLL
Lymphoma HN and NHL
Infectious mononucleosis
Child with hemolytic sxx but labs shows low plt low WBC low hemoglobin's
Aplastic anemia
SCD
Best way to collect urine ( no age mentioned)

Supra pubic aspiration
Urine bag
Midstream urine
Catheter
How to describe arterial bleeding during surgery

Red marron steadily
Brigth red steadily
Red marron pulsatile
Bright red pulsatile
Pic of nail xray painful hematoma

Remove nail
Triphenation or smothing of nail
Refere to surgery
Baby came to u with sore throat, You obtain culture and send the baby home, the culture grows meningococcus, u call the parents and they say their baby
is asymptomatic, what will you do?
10 days oral ampicillin
One dose intramuscular ceftriaxone
Intravenous Gentamycine
14 days Oral amoxicillin
Case of bladder tumor, by exam it looks low grade, 2*2, completely rescicted, on specimen exam there muscle, next ?
Mitomycin
BCG
2ry cystectomy
Repeat cystoscopy
Pt with flue like symptoms, lab shows high AST, ALT, billrubin, dx ?
Hep A
IM^J GS Page 89
Gilbert
Shoulder gunshot, develop SOB and decrease air sounds treated by Chest-tube, next do ?
Chest CT
Reexamin chest
Cervical Osteoarthritis confirmed by Xray, pt came with inability to rotate, flex neck to one side, dx ?
Cervical spondolysis vs spondylolisthesis
Baby with eye gonorreha, tx ?

Iv Cephalosporin
2-5 days gonorrhea
Enteric fever?
Cipro ✅
For children ceftriaxone
Tx of non inflamatory acne ?

Iso..
Topical Retonic acid
Pt with AS, ask about mechanism of SOB ?

Obstruction
Pulmonary congestion
Pulmonary somthenig ,,
Increase venous resistance
RA with nodule in distal ?

Heberdan
Case of diarrhea, i think dehydration, best next step?

Electrolyte
Give bolus
Young male with Rhinorrhea and obstructed nose, ex show pale swelloed infeiror turbinate, dx?
Allergic rhinitis
Acute sinustis
Adenoid
Common paranasal malignancy
Maxillary most common cause ( sinusitis, malignancy)

Loss sensation or numbness over lower lid, maxilla and upper lip after surgery or trauma, which nerve ?
Infeiror Orbital
Sorethroat, enlarged congested tonsils with exudate with disphagia, no cough, what will hlep in relive swalloing pain?
Prednisolon
Acetaminophen
Ibuprofen
Asprin
Most common appendicitis complication :
IM^J GS Page 90
Psedocyst
Necrosis
Abscess
Radiosensitive thyroid:
Papillary
follicular
Salmonella tx for ped?

Ceftriaxone
Milestone of four color, dress by little help, Hope on one leg?

4 years
Ophtha pt with high blood pressure and on fundus examd showed exudates what will be the needed diastolic
110/100 in 12
110/100 in 1-2 days
90/80 in 12 h
90/80 in 1-2 days
3-Increase insulin sensitivity ?

-lepton
Adiponectin
7-SLE Pt have anemia and dec.platelet 90 , next ?

Platelet & RBC transfusions
AB
Steroid
Cyclosporin
t with lung cancer with histopathology show: neast of polygenal cell and granular easinophils ... and somatostatin.
- squamous cell cancer ✅

- Adenocarcinoma (Glandular pattern on histology, often stains mucin ⊕)
- Hamartoma
- Carcinoid tumor
Pt with stress in continuance and urethral detachment , what is the high diagnostic test?
- Q-tip test
- Cystoscope
Old Pt with rheumatoid arthritis and bilateral lower limb pigmentations ?
- pyoderma ✅
- Stasis dermatitis
bilateral : stasis dermatitis
Infant with pic of rash in the neck fold , diagnosis?
- candida intertrigo ✅
If they show cheese something : candida
IM^J GS Page 91
Seborrheic dermatitis
Pt with white erythematous in plate, what’s treatment ?

- Tinidazole
- Miconazole ✅
Pt come from India with fever, splenomegaly and rash , diagnosis?
- leishmaniasis ✅
- Tb
- Sarcoidosis
transmitted by sand-fly
Cutaneous leishmaniasis (also known as oriental sore, baghdad boil)i s the most common form of leish-maniasis affecting humans caused by (e.g., L. major and L.tropica) Visceral leishmaniasis (VL),
Visceral leishmaniasis (VL), also known as kala-azar caused by (e.g., L. infantum and L. donovani)
Uncomplicated cutaneous leishmaniasis Topical application (Sodium stibogluconate)
complicated cutaneous leishmaniasis (miltefosine) Agents with activity against
visceral leishmaniasis (VL) include amphotericin B, pentavalent anti-monial drugs,
Pt has poor compliance to school and do not attend family or friends gathering for 1 year. 3 months ago she started to talk to one and “psychosis
symptoms” what is her diagnosis?
Schizophrenia
Schizoeffective
Delusions
70 y/o male, presented with history of tiredness and change of bowel habits . Recently he changes his diet, he became eat more fibre.
5 y ago he have normal blood test ( no anemia ) today: Lab: low Hg and low MCV, Film: microcytic hypochromic anima
What’s the cause of tiredness?
A. Changes in bowel Habit
B. Changes diet
C. Eardly age
D. gender
which study is more accurate?

RR=.., CI=
RR CI
New research Q: study to assess new test for H.pylori done in clinic. 70 have positive test by new test of 100 have positive culture. 100 have negative test
by new test of 400 have negative culture. what is the specificity percent?
answer: 75
17 years old , he run 00 KG. day after, He complain of pain in the right leg that is not relieved by analgesics. Examination show tenderness in anterior upper
tibia with mild swelling. X-ray is normal. What is the diagnosis?
a. Osteoid osteoma
b. Stress fracture
c. osgood Schlatter
Vaginal discharge, +NAAT test, >10 PMNs in swap
Vaginal discharge, strawberry cervix, > 3 PMNs in swap
post menstrual syndrome definition?

a. behavior and physical symptoms in second half of the menstrual cycle
b. behavior and physical symptoms in first half of the menstrual cycle
c. behavior symptoms
Epidemiological study want to see the effect of smoking in lung cancer: 90% of lung cancer patients are smokers while 30% of those who don’t have the
disease are smokers. The specificity of smoking as a risk factor is:
IM^J GS Page 92
disease are smokers. The specificity of smoking as a risk factor is:
70%
10%
30%
40%
A cohort study of smoking and lung cancer was conducted in a small island population. There were a total of 1,000 people in the study, and the study was
conducted over a ten year period. Four hundred were smokers and 600 were not. Of the smokers, fifty developed lung cancer. Of the non-smokers, 10
developed lung cancer. What is the Relative Risk?
0.7
75
7.5
8.5
Post-test probability is plotted in?

A. Forest plot
B. Nomogram
C. ROC plot (PPV and most sensitive)
Answer: Nomogram
Female during cycle get breast mass in examination show bilateral mass with discharge in right breast has mass mobile?
reexamination next cycle
Take sample from discharge
Mammogram and FNA
A patient medically free came to the emergency department with acute eye pain and headache, nausea and vomiting. management?
a. Acetazolaminde
b. Timolol
.. all choice was glaucoma medication
management of salmonella (lactose non-fermenting, gram negative bacilli producing greenish colony, Oxidase positive bacteria ) in 5 years old?
a. Ciprofloxacin
b. Chloramphenicol
ceftriaxone for children pick it if is there
sudden dizziness attack for 30-40 min, associated with nausea, vomiting, tinnitus and hearing loss. normal brain image.
a. Acoustic neuroma
b. Neuritis
c. Meniere disease
Q2\ case of acuumadtive esiotropia management >>
Glasses (>25DD --> medial recession)
Q3\ on ophthalmology name Herpetic Keratitis ...?
follicular conjunctivitis (viral)
Q14\patient took neuroleptic drug to treat his schizophrenia what Side effect most common to occur ?
Akathesia
Q19\Orthopedic case of 13 yrs old boy felt down and got traumatized came e forearm swelling and pain X ray pic provided Something special on x ray that
is the growth plates are widely separated ?
Salter Harris fracture
Q28\Which of the following reduce some type of cancers ?

Fibers
IM^J GS Page 93
sepcific for colon cancer: fiber
All other cancer: vitamin D
Q41\pregnant on labour 4cm dilated 90%affacment fetal , +1, heart rate drop 140 to 80 ansthesia choice:
General anesthesia
42\vaginal fornix lateral what to palpate ?

Ovaries
50 male presented with history of sore throat hoarseness of voices for 3 month , not sure about fever. he smoked 2 pact/day,
always chewing gum nuts in Ex: have neck mass wha is most appropriate step now?
a. antibiotic and analgesia
b. steam inhalation
c. saline gargle solution
d. surgery and radiotherapy
42 y/o came to clinic for breast ex, in Ex : 4*4 cyst .. her cousins have breast cancer what you will do?
a. mammogram
b. FNA
c. excision biopsy
d. re exam after menstruation period (not mention in Q anything about menstruation period)
Goblet cell more in :

-stomach
-duodenum
ascending colon
• Terminal ileum
Lap in pt e anorexia nervosa :
- high amylase ✔
-low createnin
SE of neuroleptics:
Catatonia (it treats it)
Numbness in lower eyelid:

-inferior orbital from maxillary N
HF , jvp raised , ankle edema

MOA
- block renal k- NA absorbtion
cholenirgic
furosemide for patient block renal K-Na absorbtion
pacemaker
nitroglycerin iv with epinephrine
DM
IM^J GS Page 94
Chandida
Bacterial vagainosis
Genoorea
tip of toe
Doctor asses witch nerve ?
Femoral
Tibial
Fibular
Commen
IM^J GS Page 95
Measure of Variability:
• Range; the difference between highest and lowest score (for small data) ..
• Variance: the degree of spread within distribution (stable measure)
• Standard deviation: measure how the average score deviated away from the mean (most stable measure) ..
• Range: the difference between highest and lowest score (for small data) ..
Epidemic vs Endemic
• Endemic refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area ..
• Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area ..
556/- lung cancer Specificity = 70%

557/- Urinary bladder CA Incidence = 2.25
558/- MERSA Relative risk = 66.1
559/- Prevalence 292.5
560/- Prostatic Cancer OR = 5.2
Number needed to treat = 14
Thyoid incidence = 100
Bladder cancer Cohort study done, 10,000 exposed to risk factor, 750 develop disease, 10,000 not exposed, 150 develop disease . What is the incidence =
45 per 1000
Attack rate = 80%
1. survival time!! Exposed rate: 3, Non-exposed: 2; What’s true

A. NNT: 20
B. NNH: 20
C. Risk ratio .7
D. Expected patient event = 2
2. What is explanation of CI 95%?

A. amount of uncertainty associated with a sample population estimate (the mean or proportion) of a true population
3. Cohort study – 2 groups: one of them exposed to patient with positive MERSA and the
other group is not exposed to these patients. What is the ratio of exposed to nonexposed?
A. 44:1
B. 55:1
C. 66:1
4. Epidemiological study want to see the effect of smoking in lung cancer: 90% of lung cancer patients are smokers while 30% of those who don’t have the disease are smokers. The
specificity of smoking as a risk factor is:
A. 10%
B. 40%
C. 30%
D. 70%
E. 90%
5. In a cohort study on lubricant oil use and urinary bladder CA done over 20 years 10,000 exposed 10,000 non exposed 750 exposed got CA 150 non exposed got CA Then they
asked about the incidence in 1000 in one year: 2.25
6. Bladder cancer Cohort study done, 10,000 exposed to risk factor, 750 develop disease, 10,000 not exposed, 150 develop disease . What is the incidence? 45 per 1000
7. A study aims at exploring the association of high fat intake and prostatic cancer., Group 1 has prostatic cancer (1000) patients with 50 high fat intake, group 2 doesn’t have
cancer (1000) pt with 10 high fat intake:-
A. OR 0.52
B. OR 5.2
C. RR 0.52
D. RR 5.2
7. Research q about typhoid fever, in population you have 80 patient each 4 years in average population of 20,000 so what's the incidence in 1 year with 100,000 population?
A. 16
B. 100
C. 160
D. 400
8. Non response bias, What is this study?

A. Cross sectional
B. Cohort
C. Case-control
9. Retrospective Case-Control: Recall bias
Research Page 96
10. Relative Risk (RR): a/(a+b) / c/(c+d)
11. Odds Ratio = (ad)/(bc)

• Risk of developing disease in the exposed group divided by risk in the unexposed group
12. Antiplatelet which decrease stroke mortality with have evidence decrease from 8% to 4% in 10 years ? What number we need to prevent to treat stroke ?
A. 4
B. 5
C. 10
D. 25
Answer: NNT maybe /8-4 =4 / 1÷4 =0.25 ×100 = 25
13. 76-year-old female who takes aspirin. What is the rate of protection from stroke to the risk of developing ulcer?
A. 4%
B. 8%
C. 9%
D. 10%
11%F-12%M = above 70.
8%F-9%M = above 60.
1. The number of URTI cases per 1000 population this year is 117 case, The average number of disability from work is 2.5 days. What is prevalence of disability per 1000: 292.5
[100% in research]
2. study done to study relation between OCP usage and DVT, 1500 had DVT, 8500 as control group no DVT. 20 had DVT from those use d OCP and 50 had DVT from control group.
Calculate morbidity rate in 1000 population:
A. incidence rate is 15
B. prevalence is 150
C. Incidence rate is 150
D. prevalence rate is 15
15. Study about DM 10.000 sample and 2000 have DM, during the study 1000 developed DM. What is the incidence rate?
A - 10% ..
B - 12% ..
C - 20% ..
Answer is:- 12.5%
16. study with least bias

A. cohort
B. cross sectional
C. case control
D. case study
17. What determines how precise the study is?

A. P value
B. Confidence interval
C. Relative risk
D. Odds ratio
18. At a day-care center 10 out of 50 had red eye in the first week, another 30 developed the same condition in the next 2 weeks. What is The attack rate (cumulative incidence)?
A. 40%
B. 60%
C. 80%
D. 20%
19. There is a study to the effect on intensive insulin regimen in the reduction of neuropathy in the patient, the results are as following: Event in the regular insulin regimen:0.092
Event in the intensive insulin regimen:0.022 Which of the following is correct?
A. Patient expected event rate:0.07
B. Odd ratio is 4.2
C. Number needed to harm:7
D. Number needed to treat::14
1/(0.092-0.022)= 14, number needed to treat
20. you were conducting a randomized control trial, some of the participants left your study. How will you deal with this situati on?
A. ask people from the other randomized group to leave
B. abandon the study if more than 5% of the participants leave
C. include the values of the participants that left in your final statistical analysis
21. question about specificity 300 negative in 400 population and 70 positive in a 100 population = 300/330=91%
22. Researcher comparing two groups. The end point of the study is survival rate. What parameter he would benefit mostly from?
A. Absolute risk reduction
B. Odds ratio
C. Relative risk
23. Why do we randomize the sample in research?
Research Page 97
23. Why do we randomize the sample in research?
A. To make sure outcome is actually a result of our intervention
B. To have minimal difference in variables between the groups (I think this is the ans)
24. Event risk 0.092 - Event risk 0.02 What can you get out of it?
A. OR
B. Number needed to treat
C. Number needed to harm
25. Likelihood ratio of a disease incidence is 0.3 mean:

A. Small decrease
B. Large increase
C. Small increase
D. No change
26. Q about screening tests and diseases:

A. short asymptomatic stage
B. continues screening
C. invasive screening test
D. incurable diseases
Research Page 98
Pharma + facts
least risk of EPS: clozapine are the preferred agents in

Other: Quetiapine, iloperidone, Pimavanserin
Pt on neuroleptic antipsychotic, most common SE = Akathisia
Benzodiazepines for Insomnia: lorazepam 0.5mg bd/tid, temazepam 10-20mg nocte, alprazolam 0.25mg
bd/tid , Zoldeipam
Antipsychotic cause eye pigmentation: Thioridazine
Prognosis of Schizophrenia: 50-60% bad prognosis (30% good prognosis)

SSRI that usually causes weight gain and ED —> Sertraline
Most common SSRI causes overdose is --> Citalopram
Most common SSRI causes toxicity (Serotonin Syndrome) is --> sertolie then fluoxetine
Most common SSRI causes side effect is --> Fluvoxamine
Best treatment for Anxiety —> Escitalopram.
most potent SSRI is Fluoxetine
What is the best or most effective anti-psychotic in children and adolescent?

• Answer could be clozapine or olanzapine.
ADHD diagnostic criteria

• onset before 7
• duration >6months
• diagnosis no later than 16 years
• 6 inattentive 3 hyperactive 1 impulsive
Most potency antipsychotic = Benperidol
1. Which one of the antipsychotic drugs is most likely to cause weight gain ?
1. Ziprasidone.
2. Olanzapine (or Clozapine)
3. Quetiapine.
4. Aripiprazole
2. Most antipsychotic to cause involuntary movement?

a. Risperidone
b. Haloperidol
c. Lorazepam
3. Most specific syx of MDD ?

a. Late morning awakening
b. Fatigue
c. Poor concentration
d. Avoid eye contact
Psy Page 99
4. Bad prognosis for schizophrenia?
a. Family Hx
b. In young
c. Acute
5. Alzheimer developed agitation + hallucination

a. Bupropion
b. Haloperidol
c. Olanzapine
d. There’s no risperidone
6. What is the lowest toxic dose of TCA?

A. 500mg
B. 1g
C. 2g
D. 3g
7. Normal thing you suspect among all elderly for there cognitive impairment , what to
suspect in ur test ?
A. low IQ
B. hearing loss related to age
8. All elderly with cognitive deficit, they should be investigated for:

A. Brief IQ test.
B. Wechsler memory scale
C. Hearing assessment.
D. Involuntary Movement.
Patient with delirium, isolate him in dark room or let him with his family?
10. long case: patient with extended right arm and flexed left arm, not able to move them:
-dystonic
-catatonic
11. Elderly lost his soupse after illness before 2 months, he has low mood, insomnia Dx?
A. Major depression
B. Minor depression
C. Cyclothymia
D. Bereavement
12. Alzheimer drug hepatotoxic = Rivastigmine vs Tacricin
Young female work as teacher have fear in the beginning of each class & she always think some educational mistakes will
occur soon or later
⁃ specific phobia
⁃ Mix phobia
⁃ Social phobia
⁃ Pain attack
Young male afraid of Moro vehicle that increase Gradually he feel like he can not look at them any mores and he have
palpitations, & sweating
⁃ PTSS
⁃ Specific phobia
⁃ Panic attack
Female have eczema be cause she can not stop washing her hands even if they are clean if she did not wash them she will feel
distress what is the treatment?
Psy Page 100

distress what is the treatment?
⁃ Psycho- education
⁃ Exposure & prevent response
⁃ SSRI
Child not paying attention during classes, not complete his home work or any task assigned to him which defects he have ?
⁃ Attention
⁃ Hyperactive
Specific phobia what increase

Aspartate
Adenosine
Acetylcholine
Norepinephrine
Psy Page 101

Cystic Fibrosis
1. CF chance of brother to get disease is:- Answer is:- 2:8

2. Chromosome 7q
3. Healthy parents with son of Cystic fibrosis, healthy 17-year-old daughter. What’s the chance of having a daughter with CF?
A. 1 in 2
B. 2 in 4
C. 1 in 25
Metformin
1. Metformin MoA in muscle

A. Increase secretion of glucagon
B. Reduce glucose reuptake
C. Increase the gluconeogenesis
D. Increase fatty acid oxidation
1. Mixture of goblet cells and intestinal cells where was the tissue taken from?
a. Duodenum
Basic Science Page 102

a. Duodenum
b. Ileum
c. Esophagus
d. Colon
2. What moves molecules in and out of the cell nucleus?

A: Cytosolic ATP
B: Nuclear ATP
C: Nuclear GTP (GTP-binding nuclear protein Ran?)
D: Cytosolic GTP
3. How are proteins transported into the peroxisome?

A. Folded through N-terminal
B. Folded through C-terminal
C. Unfolded through N-terminal
D. Unfolded through C-terminal
4. Protein transport inside the cell End in:-

a. Endoplasmic reticulum√ and if there lysosome choose it
b. Golgi Apparatus
5. Young male with muscle weakness. What is the enzyme deficient?

A. Alpha glucosidase (Pompe disease)
6. A patient with Emphysema what’s the driving force?

A. Co2
B. O2
C. Hypoxia
D. Hypercapnia (I think this one)
7. What type of lipid that sphingosine from?

A. Lectin
B. Cephalin
C. Ceramide of choline
8. a protein with start sequence but no membrane trafficking signals. What is the fate of this protein?
A. Lysosome
B. endoplasmic reticulum
9. patient came with muscle weakness and pain. Cannot stand on his leg. Biopsy showed glycogen complex
compounds with absence of myofilaments and sarcoplasmic organelles. What is deficient?
A. Aldolase
B. 1-a glucosidase
C. tyrosine kinase
10. Difference between HbA1C and unmodified hemoglobin?
11. Metanephrogenic blastema give what:

A. major calyx
B. Minor
C. I don’t remember it
D. pelvis of kidney

Intrinsic Factor = Parietal cells
Somatotroph or Lactotroph = Acidophilic
Chronic Granulomatous disease = NADPH oxidase
Brunner's gland: Submucosa of duodenum
Benign Gastric cancer percent: 7
Cystic fibrosis rash = acrodermatitis enteropathica
Vein thickest layer = Tunica Adventia
Artery thickest layer = Tunica Media
Heart anomaly LEAST associated infective endocarditis = ASD
Limited scleroderma = Anticentromere
Diffuse scleroderma = Anti Scl 70
DM1= DR3, chromosome 11q23, chromosome 6
DM2 = HLA-DR4, Chromosome 20
Thyroid carcinoma arise from parafollicular cells -medullary carcinoma
Marfan Syndrome = Aortic Root Aneurysm
Dementia treatment in general: Rivastigmine.
Gene related to DM: HLA-DR4
Gene related to RA: HLA-DR4
OCP that cause increase in K —> Drospirenone
Interferon Gamma —> Helps increase phagocytosis killing
rRNA —> Made in nucleolus.
mRNA —> Made in nucleus.
Gastric ulcers —> ABO A
Duodenal ulcers —> ABO O
Potassium citrate is the treatment of choice for the prevention of recurrence of uric acid calculi.
Ringworm stain: KOH
Vestibular neuritis: Vertigo but no hearing loss
Labyrinthitis: Vertigo + hearing loss
Celiac Disease = chromosome 6
Kulchitsky’s: (contain calcitonin = hypercalcinemia hypocalcemia)
Gene for IBD = chromosome 16 -NOD2, ATG16L1
Common site for celiac= duodenum
Receptor for HIV = CCR5/CXCR4
Sexual reproductive of bacteria process called = Conjugation
Sex pilus: plasmid
PCKD 1 = Chromosome 16
PCKD 2 = 2 Chromosome 4
Hypoglycemic agent may present with hypoglycemia = glyburide
Chemotherapy drug act on CCG = cell cycle = methotrexate
Bleomycin = G2 Phase
Glipizide is insulin secretagogues
Hearing loss most often occurs at higher frequencies.
Noise-induced (occupational) HL is classically seen at 4000 Hz.
Hereditary nonpolyposis colorectal cancer = EPCAM gene
Status epilepticus: Benzo Phenytoin Barbital
Enzyme in case of multiple myeloma: ADAR1
normal induction for asthmatics --> propofol
status asthmatics --> ketamine
Posterior epistaxis artery = Sphenopalatine
pectoral major inj > loss of adduction + medial rotation
normal LDL = Less than 100 mg/dL (2.59 mmol/L) — Optimal. 100-129 mg/dL (2.59-
3.34 mmol/L) — Near optimal, above optimal. 130-159 mg/dL (3.37-4.12 mmol/L) — Borderline high.
Gene for Bechet dis: HLA B51
What is the type of bond between mRNA and tRNA = Hydrogen bond

What is the type of bond between mRNA and tRNA = Hydrogen bond
B-Thalassemia, is missence or nonsense point mutation of chromosome 11.

A-Thalassemia, is deletion in chromosome 16.
SCA CH 11
Anal pruritus due to Enterobius vermicularis

tape test. treat by pyrantel or bendazole
Cutaneous larva migrans= Ancylostoma and nectar treat by: pyrantel or bendazole
Lactic acid + hyper alanine = Pyruvate Carboxylase

Lactic acid + hyperammonia = Pyruvate Carboxylase
Lactic acid alone = Pyruvate kinase
Pyruvate to lactate = lactate dehydrogenase
Phosphopyruvate to Pyruvate = Pyruvate kinase
Pyruvate to citrate = Pyruvate decarboxylase
Hyperchylomicronemia = Lipoprotein lipase or apolipoprotein C-II deficiency

Familial hypercholesterolemia = Absent or defective LDL receptors, or defective ApoB-100
Dysbetalipoproteinemia = Defective ApoE
Hypertriglyceridemia = Hepatic overproduction of VLDL
Epidural = Lens shape

Subdural = Crescent shape
HTN Retinopathy
• stage 1 - artery wall thickening
• stage 2- AV nippling
• stage 3- cotton wool, flame hemorrhage and exudate
• stage 4-optic nerve swelling
Diabetic ulcer grades

stage 1 - superficial
stage 2 deep ulcer (muscle and ligament)
Stage 3- deep ulcer with abscess and osteomyelitis
Stage 4- dry gangrene
Stage 5- wet gangrene, whole foot
Most normograph used for positive predictive value: Roc curve

In a ROC curve the true positive rate (Sensitivity) is plotted in function of the false positive rate (100-
Specificity) for different cut-off points of a parameter

Herpes Simplex Keratitis
Sx associated with herpes and the answer was hypoesthesia (decrease corneal sensation)
1. Herpetic lesion in eye:-

a. Answer is:- scleritis and Episcleritis ..
b. Ant.uveitis √ I would go with this
2. Eye keratitis with cell in aqueous fluid and other symptoms, treatment? a case of uveitis
A. Antiviral
B. Steroid
C. Acetazolamide
3. Pic. Of dendritic corneal keratitis, What will be the associated condition:-

A. scleritis and episcleritis
B. Ceratitids & retinitis
C. Optic neuritis
D. Ant.uveitis
4. Pic of eye under fluorescent light (blue) with a lesion at cornea which is blue too, Hx That the pt Got injured by her
daughter nail:-
A. abrasion
B. Ulcer
C. Laceration
D. Herpes
Acute angle closure glaucoma
Trabeculectomy = Open-Angle Glaucoma

Contraindicated drugs in AACG: Atropine, Cyclopentamine, Epinephrine, brimonidine
Trabeculectomy for Open angle glaucoma closed by Laser iridotomy
Chlazion Vs Stye
Optha Page 107

Chlazion Vs Stye
1. Case of picture, Upper eye lid stye redness and painful, what's the diagnosis = Stye
2. Chalazion pic common to be associated with : discharge , blepharitis was not in the options
448 – Stye in eye, what is the commonest sign = decreased vision

Discharge= The first sign of a stye is a small, yellowish spot at the center of the bump that develops as pus
and expands in the area
Entropion vs Ectropion
1. Description of eyelid which rolled inward:

a. Entropion
b. ectropion
Def of Distichiasis: abnormal growth of lashes from the orifices of the Meibomian glands on the posterior lamella of the tarsal
plate(presence of a double row of eyelashes )
1. A patient came for ophthalmology check-up, has optic disc cupping, Tonometry showed high IOP, what would u tell this patient?
a. Tonometry is sufficient ..
b. Do check-up for blood related members .
c. Interventions may reverse these changes
2. Esotropia 25-degree next step

A. fundus exam my answer
B. Orthoptic treatment
C. Exercising prism
Optha Page 108

C. Exercising prism
D. Medial rectus recession
3. orbital pseudotumor...whats the management

A. Radiation
B. surgical excision
C. Irradiation
D. systemic steroid (correct answer)
4. Cherry red spots in Retina —> Retinal artery occlusion
5. questions about normal ppl with good vision exam recommendation when to do vision screening
A. annually from 30
B. Twice till 50
C. Once from 30 to 39
D. Every 10 years till age of 60
• In asymptomatic pt (40-54-year-old) evaluate every 2-4 years,
• if from 55 to 64 years evaluate every 1-3 years
• if 65 or older evaluate every 1-2 years
6. Treatment of high myopia is:- phakic Intra Ocular Lens
7. Most common side effect after cataract surgery

A. Endophthalmitis
B. Pre conjunctival he
• The most common is posterior subcapsular opacifications if not in the choices then go for A
• Complication of cataract: retinal detachment is the most common
8. patient complaint of red eye and decreased vision in left eye since 3 days, in examination, there are ciliary flush, not fully reactive pupil and floaters in
anterior chamber. What is the diagnosis:
A. Uveitis
B. Glaucoma
C. Retinitis
D. Keratitis
9. Case of patient with progressive painless visual loss -8 6/18 is it

a. Physiological
b. Pathological
c. Curvature Index alized area sta
10. Male with blunt trauma of the eye from a tennis ball, what must u exclude first
a. Foreign body
b. Increased Intraocular pressure.
11. A patient is presenting to the ER with sudden onset of proptosis with eye pain and swelling. Eye movements were limited and painful, and vision was
normal. What is your diagnosis?
A. Orbital cellulitis Corticosteroid, Vanco + Ceftriazone
B. Cavernous sinus thrombosis CST, CT & LP
12. Infant 6-24 months what is the most common organism may cause orbital cellulitis?
A. Haemophilus influenza if they mention in the Q the violaceous (purple ) If not then its staph
B. Younger than 6 months( group a streptococcus or listeria or E.coli)
13. Old female HTN, did not take her medications for two days came to you with flashes of light and flatters, eye examination shows: arteriovenous
crossing, ..., what is your action? Diagnosis is retinal detachment .
A. Referral to ophthalmology (I think this is the answer)
B. Give b-blocker eye drops (they mention the name)
C. Reassure
14. Wedge shape opacity + amblyopia:- Answer is:- cataract .. √ (cortical)
15. myopic patient with glasses got worse overtime = keratoconus
16. Most common cause of Painful loss vision = Optic neuritis
17. when cover the left eye the right eye goes laterally (cover test), what is the most serious complication ?
A. strabismus
B. nystagmus
C. Amblyopia
Optha Page 109

18. Management of severe ptosis?
A. Levator Muscle repair
B. Frontalis muscle suspension
19. Old male had reduced vision 6/18 both eyes and wear glasses but after short period he does not see clearly, ophthalmoscopic examination reveal retinal
degeneration and some white spots. What is the type of myopia
a. Physiological enhanced (Age related macular degeneration)
b. Pathological
c. Indexed
20. Case of Pterygium in the eye , Asking what will be true about this lesion :
a. It is a pre-malignant lesion
b. It could lead to loss of visual acuity because of scarring of cornea
21. Esotropia 25 degree asking treatment → medial recession
22. Viral conjunctivitis associated with:

A. Papilla
B. Follicles
23. patient has painful eye, red tearing, with sensitivity to light. He had similar episodes of these symptoms in past. On examination, there is inflammation
of cornea and ulcer. Which of the following can trigger the symptoms again?
A. dust and pollens
B. UV light
C. driving at night
24. 65-year-old man who had progressive decline in his vision for 6 months. Presented to the ED complaining of sudden right eye pain associated with redness.
Upon examining the visual field, he was only able to see the doctor's hand motion. His pupils were dilated, fixed and white in color. Which of the following
explains his symptoms?
A. malignant glaucoma
B. advanced rubeosis iridis
C. optic atrophy
D. intumescent cataract
25. lacrimal gland tumor will cause proptosis in the eye in which direction?
A. down and in
B. down and out
C. up and in
D. up and out
26. Asthmatic with itching of the eye

A. Vernal conjunctivitis
B. Viral conjunctivitis
C. Bacterial conjunctivitis
27. Pic shows eye with corneal abrasion ask about treatment = double patch + local Ab.
28. Patient with severe viral conjunctivitis what to give topically?

A. Antibiotics
B. Corticosteroid
C. Antiviral
29. HIV pt has cotton wool flamed shape hrg and neovascularity; due to what
A. HIV
B. Toxo
C. Ethambutol
D. Rubella
Pt with eye manifestation ( exophthalmos pulsing and thrombing )

Cavernous sinus thrombosis
Hyperthyrodism
Child in picnic suddenly develop SOB

Pneumothorax in right lung
Hyperventilation on right and shifted trachea to left side
Optha Page 110

Optha Page 111
Seborrheic dermatitis
Seborrheic dermatitis is a chronic, relapsing, and usually mild form of dermatitis of unknown origin occurring in areas rich in sebaceous glands (scalp, face, upper trunk, intertriginous
areas); indirect evidence supports a pathogenetic role for the Malassezia yeast
For patients with mild seborrheic dermatitis of the scalp without inflammation (dandruff), we suggest treatment with antifungal shampoos (ketoconazole 2%, ciclopirox 1%)
Scalp inflammation or facial involvement = Topical steroid
1. Dandruff + yellow breezy rash = seborrheic dermatitis

2. athelete. rash sunexposure pityriasis versicolor
Drug Reaction
Fixed drug eruption manifests with a characteristic erythematous to violations, sometimes edematous, macule or plaque, which may become bullous in the center. This lesion always occurs at the same
localization in less than 2 days on reexposure to the culprit drug
Lichen Planus
• Histopathology: Hypergranulosis, thickened epidermis, band of lymphocyte at the dermoepidermal junction
1. Lichen planus on skin asking what the expected prognosis?

A. Lifelong recurrent and relapse
B. Automatic resolution over the time
C. Permeant effect
2. Lichen planus = PPPP; Purple, polygonal, pruritic and papule
2. Lichen Planus commonest site —> Mouth (and mucus membranes). Then Wrists, ankles, nails and scalp
Derma Page 112

2. Lichen Planus commonest site —> Mouth (and mucus membranes). Then Wrists, ankles, nails and scalp
Psoriasis
1. Erythematous groin lesion with central clearing = Psoriasis. Closed thing Erythema annulare centrifugum
2. Vit A + Vit D + steroid --> local

3. methotrexate or tacrolimus + PUVA --> systemic (greater than 15%)
ACNE
1. Non-inflammatory acne: Retinoic acid
2. Inflammatory acne:
○ (mild-moderate): Topic benzo-peroxide → Topical vitamin A → Topical Abx → Oral Abx.
○ (severe-cystic-lesions): Isotretinoin
3. Acne superficial, deep and pustules?

A. Inflammatory
B. Infected
C. Obstructed
1. SLE patient presented with acute erythema and itching (Not sure about it ) it takes about 24 then resolved and hyperpigmentat ion left thereafter what is the diagnosis :
A. Discoid lupus
B. Mastocytosis
C. Vasculitis purpura
2. Children in school all having itchy scalp, what is the most likely diagnosis: -
A. Tenia capitis
B. Scabies
C. Answer should be scalp pediculosis → treatment ivermectin scabies --> permethrin
Rosacea = metronidazole --> erythromycin --> doxycycline
3. Case of blepharitis with hx of acne rosacea , what will you give?

A. Oral clindamycine
B. Oral erythromycine
C. Topical clindamycine
D. Topical erythromycin
3. - vitiligo wont to marriage what is treatment. Continue treatment or laser

• If not stable and increasing in size then continue the same ttt ..
• If there’s no new attacks :
• Patches —> skin
• Global —> melanocytes transfer
• If there’s new attack :
• No benefits from above treatement so continue same medications
4. lesion should investigated of malignancy: erythema gyrum
5. Scenario of a pediatric patient with persistent pink colored elevated lesions on her foot. They're non pruritic and not scaly . She used topical antifungal for 6 weeks with no benefit. What's
the diagnosis?
A. erythema chronicum migrans
Derma Page 113

A. erythema chronicum migrans
B. Granuloma
C. discoid lupus
D. erythema nodosum
6. A 17 year-old football player presents with an area macular hypopigmentation on the trunk and arms. The areas seem even lighter with su n exposure. What is the most appropriate treatment
regimen for this patient?
A. Topical steroid cream
B. Selenium sulphate
C. Oral antibiotics
D. Topical antibiotics
7. with atopic dermatitis on steroid what to add ? Tacrolimus ?
8. Obese with lesions in gluteal region : hidradenitis suppurativa
3-Child with swelling in head or fohead with loss of hair around it

-Aplasia cutis
-kerions or something like that
Derma Page 114

Important Tests :
1. Adom tesdt - Scoliosis
2. Allen test - ABG Analysis
3. Aldehyde test - Leprosy
4. Phosphate test - Pasteurization
5. Patch test - Allergic Reaction
6. Tourniquet test - Dengue
7. Urea Breath test - H.Pylori
8. Schick test - Diphtheria
9. Dick test - Scarlet Fever
10. Rothers test - Acetone in Urine
11. Hey test - Bile Salt Urine
12. Smith test - Bile Pigment Urine
13. Benedict test - Urine Glucose
14. Kveim test - Sarcoidosis
Figures to review Page 115

14. Kveim test - Sarcoidosis
15. Rinne & Webber test - Hearing
16. Direct Coomb test - Hemolytic Anemia
17. Ischiara test - Color Vision test
18. Snellen Chart test - Distance Vision
19. Confrontation test - Central and Peripheral Vision
20. Jegar's type Card test - Near Vision
22. Schiling test - Vitamin B12 Absorption
23. Histamine test - Leprosy
24. Roller Over test - Pre-Eclampsia
25. Fern Test or Nitrizine test - leakage of Amniotic fluid
26. VDRL test - Syphilis
27.VMA (Vanellyl Mandelic Acid) - Pheochromocytoma
28. Glucose Tolerance test - Diabetes Mellitus
29. Glycosylated Hemoglobin /Hb1AC test - Diabetes Mellitus
30. Water Deprivation test - Diabetes Insipidus
31. Treadmill / Stress test - Heart Function
32. Triple test - Down Syndrome
33. D-Dimer test - Measuring Clot formation (DVT, PE, DIC)
34. Trendelenburg test - VericoseVein
35. Phallen /Tinnel test -Carpal Tunnel Syndrome
36. Gold QuntiFeron test -Tuberculosis
37. Bangle Test - Protein Energy Malnutrition
38. Tensilon test -Myasthenia Gravis
39. Romberg test -Neurological Function / Balance or Gait
40. Knee Kiss test -Meningitis in Children
41. Tzank test - Herpes Genital or Vericella
42. Frie test -Lymphogranuloma inguinale
43. Widal test - Typhoid (on2ndweek)
44. Weilfelix test - Typhoidfever

44. Weilfelix test - Typhoidfever
45. Bonny test /Marshall test - Stress Incontinence
46. Binnet test - Intelligence Quotient
47. Sweat Chloride test - Cystic fibrosis
48. Hanging Drop test - Cholera
49. Paul Bunnel test - Epstien Barr Virus
50. Shake test /Bubble test - Surfactant and Fetal Lungs Maturity
51. Rubin test - Patency of Fallopian Tube
52. Tape test - Pin Worm
53. Ortho Tolidin test - Check Chlorine in Water
54. Dexa Scan - Bone Metabolic Disease (eg.Osteoporosis)
55. Heel to Shin test - Body Coordination Test
56. Halo test - CSF Leakage
57. Dexamethasone Suppression test - ACTH or Pituitary / Adrenal Gland Tumor
58. Arthrocentesis - Joint Inflammation and Infection
59. Holter Monitoring - 24 Hours ECG Monitoring in Dysrhythmia
60. Pulmonary Function test - Measure Lung Volume and Capacity (By-Spirometer)
61. SGOT & SGPT (AST/ALT) - Liver Function Test
62. PAP’s Smear - Cancer of Cervix
63. Creatinine Clearance test - Estimation of GFR
64. Wood's Light Examination - Superficial Infection of Skin
65. Burrow Ink test - Scabies / The Itch
66. Braden Scale - To Measure integrity of Bed Sore.

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Could trial of bimanual uterine massage before moving to embolization

21. Best treatment for bronchechstis ?

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23. the guy has anti- hbS+, what is his condition?

25. Patient with spinal stenosis?

27. preferred method for testing hypersensitivity type 1

30. Side effect of atropine

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34. DKA Case in adult asking for next best step

38. Similar Case of dysmenorrhea & infertility asking for diagnosis

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44. Muscle lateral site dorsal pedis

47. Case of Incarcerated Hernia = Refer to GS

48. Surgery in the posterior triangle

49. Artery supplying the posterior nasal septum

50. Image showing an open fracture of the arm (Colle's)

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56. What triggers apoptosis

59. Dizygotic definition?

60. Inside nucleolus

61. Bond between RNG and tRNA?

62. What is true regarding a liquid based pap smear

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72. Aspirin toxicity?

77. What is the mechanism of OCP

79. Antidote for Paracetamol =

82. Trauma case with pancreatic injury and leakage into

84. Longest phase of cell cycle

86. Post-test probability of a diagnostic test?

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90. 3y Lactic Acidosis + Hyperalaninemia is deficiency of ?

92. Snuff box pain indicates =

95. obesity study BMI what else needed?

97. patient unable to flex knee & thigh , affected muscle?

100. Fructose intolerance scenario what to eliminate from diet:

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101. site incision of emergency tracheotomy?

105. Post abdominal hysterectomy has inconveniences (while micturition ):

109. Plural Refereed pain to shoulder by

111. Type of dye used to diagnose corneal Abrasion:

112. Picture about dendritic herpes asking about the symptoms?

114. Tennis player. What is the most likely sided effected?

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116. Why is inulin used to determine GFR:

119. When we can say stillbirth?

123. What medication is given for refractory hiccups:

125. X-ray Showing Legg Calves

126. Causes of Visceral Leishmania: