MARCH

SLE 2008
COLLECTED AND TRIED TO BE ANSWERD AND SENT BY
DR.ABULMALIK ALBAKER 2011
MED_ST99@HOTMAIL.COM
hepatocellulat hepatoma 1
metastesis
you have to find out how must know
paralysis : 2
: neuro
conversion disorder
ibs 3 -3
5 gastroenterology
11:15 10:00 -4
complicated
?? patient
-5
??hematoma
All features of tonsillar abscess except :
deviation of uvula to affected side:
central artery embolism all true except :
causes painful visin loss
retinal detachment painless with blurred vision
first ECG sign of acute pericarditis :
ST elevation
q waves
porlonged PR interval
In initial evaluation couples for infertility:
temperature chart :
semen analysis more than50 % live , motile, morphology ,,,,,,,,,,, count more than 20
million
refer to reproductive clinic...?

Erethema nodosum : best felt than see , TB ,IBD

painful red nodules treated by NSAIDs

initial Inx in small bowel obstruction :
Erect( MORE BEST ) & supine abdominal X- ray

child with eczema flare up he is on steroid and having itching disturb his
sleeping
my answer to give antihistamine or steroid cream ??

if angioedema --- epinephrine
Gold standard imaging in acute panceriatitis :
CT scan , if less than 48h no value , dx on clinical and albs
pregnant lady 28 wks with chlamyda infection :
azithromycin not pregnant
erythromycin in pregnant best treat partners if amox (best)
doxcyline not pregnant
common cause of male infertility: The most common cause is a low sperm count
primary hypogonadism, most common cause is klinefeter syndrome 47xxy
secondary hypogonadism
ejaculation obstruction
The most common congenital cause is Klinefelter syndrome

18years old boy with back pain investigation to do except :

CBC ?
ESR
X -ray
bone scan
if lytic lesion , bone scan is best
iron deficiency aneamia :
serum iron
ferritin( difference b/t chronic anemia TIBC
bone marrow ( best if not there ferritin )
Hypothyroidisim :
free T4
TSH
T4

in which group you will do lower endoscopy for patients with iron deficiency
aneamia in with no benign cause:
male all age group
children
permanupausal women & male more than 59 y
women + OCP

child with piece of glass, beans , battery deep in ear canal what to do:
no irrigation ,,,,,, , best pick with forceps
side effects of Levodopa :
dyskinesia
speech
fatal hepatic toxicity..?

Abnormal thinking: holding false beliefs that cannot be changed by fact

Agitation
Anxiety
Clenching or grinding of teeth
Clumsiness or unsteadiness
Confusion
Difficulty swallowing
Dizziness
Excessive watering of mouth
False sense of well being
Feeling faint
General feeling of discomfort or illness
Hallucinations (seeing, hearing, or feeling things that are not there)
Hand tremor, increased
Nausea or vomiting
Numbness

1- patient while he playing foot ball there is one come & pop his knee from

the lateral side ,come to the hospital ,

What is the most probably cut injury occur?
-medial collateral ligament
valgus force applied to a flexed knee may cause a tear of the medial meniscus. A varus force on a flexed knee with the
femur externally rotated may lead to a lateral meniscus lesion. According to Ricklin, the medial meniscus is attached more
firmly than the relatively mobile lateral meniscus, and this may result in a greater incidence of medial meniscus injury.

2- For this case the treatment is:

A- conservative
ACL: Results from a noncontact twisting mechanism, forced hyperextension, or
impact to an extended knee , + anterior drawer and Lachman tests. Rule out a
meniscal or MCL injury.
PCL: Results from forced hyperextension , + posterior drawer test .
Meniscal tears : Result from an acute twisting injury , Clicking or locking may be
present , Exam shows joint line tenderness and a + McMurrays test.

3- 50 or 55 Y.O patient present with unilateral shoulder, upper & lower limp
pain with morning stiffness of more intensity after wake up ,there is mild
fever & the patient is depressed :
Diagnosis:
A-R.A
B- Polymyalgia rheumatic ESR.
4- Male patient known case of DM II come with Hb A1C : 8% ,he is taking
metformin & glibenclamid, to regulate the blood sugar need :
A- ............insulin
B-............insulin
C- metformin & acarbose .
5- case scenario patient present with constipation ......Dx : hypothyroidism
To confirm that the patient has hypothyroidism:
A-T4
B-TSH
C-free T4
6- Case scenario (patient present with symptoms of hyperthyroidism,
tender neck swelling :
Diagnosis:
subacute thyroiditis , trated with NSAID AND STEROID
7- mother bring her baby to you when she complain of diaper rash , she
went to different drug before she come to you , she used 3 different
corticosteroid drug prescribed by different physician, ..........
the rash is well demarcated & scaly :
Diagnosis:
A-seborrheic dermatitis
B-contact dermatitis include labi wheras candida not
C-?
7- The treatment:
??avoid allergen and steroid for contact der
8- female patient manger since short time , become depressed , she said
she can't manage the conflicts that happen in the work between the
employees.
Diagnosis:
A-Depression.
B-Generalized anxiety disorder.
C-Adjustment Disorders

9- Case scenario (female patient present with excessive fear in her

children ....... ...) my opinion it is a case generalized anxiety disorder.
Treatment:
?

10- Patient before menstruation by 2-3 days present with depressed mood
that disappear by 2-3 day after the beginning of menstruation...
Diagnosis:
A-Premenstrual dysphoric disorder if sever symptoms (or premenstrual
syndrome ?).
11- Female patient breast feeding present with mastitis in upper outer
quadrant:
Treatment:
A-stope breast feeding & evacuate the milk by the breast pump.
B- Give.....antibiotic to the mother & antibiotic to the baby.
c- antibiotics with continue breast feeding
12- case scenario , baby present with unilateral deformity in the foot
appear when it is become the weight bearing is in the other foot but when
it is the weight bearing the deformity disappear ,the patient has defect in
dorsiflexion of that foot .......I think they are taking about ( club foot )
treatment :
A-orthopedic correction ...?
B-shoe....
C-surgery ....
TEV is caused by genetic factors such as Edwards syndrom 18 chromosome
serial casting, or splints called knee ankle foot orthoses (KAFO) first if no respons , surgery.
13- case scenario ( ....patient present planter fascitis)
Treatment: best with NSAID THEN INJ STEROID , HOT BATH
A-Corticosteroid injection.
B-silicon...
14- Patient present with retinal artery occlusion, which is wrong:
A- Painful loss of vision.
B-- Painless loss of vision.
15- Patient present with corneal abrasion:
Treatment:
A-Cover the eye with a dressing.
B-Antibiotic ointment put it in the home without covering the eye?
16- Patient present with epistaxis:
The best management:
- the patient leaning forward ,make pressure in the lower side of the nose .
17- Patient present with unilateral nasal discharge , foul smelling in the nose .
Most probably diagnosis:
- Adenoid
- Foreign body
The presence of unilateral foul smelling nasal discharge is always an indication of foreign body in the nose
- 18 months baby present that he only saying mama baba which is
abnormal for his age , no other symptoms or sign abnormal , first thing to

be asses :
- -hearing assessment .
- -developmental assessment .
19- Case scenario ,child present with rhinorrhea & sore throat for 5 days
present with middle ear perfusion, examination of the ear : no redness in
the ear
the cause of perfusion :
- otitis media because no pain .
- Upper respiratory infection.
20 Case scenario (patient known case of coronary artery disease, present
with a symptoms of it, to diagnose that patient has MI or not, by first ECG
and CARDIAC ENZYME
A- Exercise stress test .
B- Coronary angiography
C- Exercise....
21- Patient present with acute precarditis , In ECG we see EXCEPT :
- S-T segment elevation.
-q waves
-prolonged PR interval - t wave inversion st elevation
22-case scenario (patient present with carotid artery obstruction by 80%,
treatment by
- carotid endarterectomy.
- ........surgical bypass
If more than 70 % go to surgery
23- Patient present with generalized seizures not known case before of
any siuzer , no pervious history like that :
The most important thing to do now is:
- EEG. After that
- Laboratory test .in ER
If seizures are new-onset or if examination results are abnormal for the first time,
neuroimaging is required.
EEG is less likely to detect abnormalities if seizures are infrequent.
Electroencephalograms are an important tool in determining prognosis for future
seizures and should be strongly considered for all children with a first seizure
the EEG will be normal in 50% of patients following a first seizure
24- Case scenario patient present with carpal tunnel syndrome,
Treatment:
-corticosteroid injection
Splint the wrist in a neutral position at night and during the day if possible.
Administer NSAIDs.
Conservative treatment can include corticosteroid injection of the carpal
canal. - CTS
N.B they didn't mention a surgery in the MCQ

25-case scenario (..... patient present with SLE)

The least drug has side effect:

- methotrexate
- name of other chemotherapy
26- case scenario ( ....patient present with prostatitis , by culture gram
negative rode )
treatment :
- Trimethoprim and Sulfamethoxazole or flurqunilones
- ampicillin if suspected sepsis with gentamicin
- gentamicin if suspected sepsis with ampicillin
27- case scenario ( patient present with URTI, after 1 week the patient
present to have hematuria ,edema ....
most probably diagnosis:
- IgA nephropathy
- post streptococcus GN
Postinfectious glomerulonephritis : Oliguria, edema, hypertension,tea- or cola-coloredurine. 2- 6
weeks ttt supprtive
IgA nephropathy : hematuria , Normal C3 , ttt : Glucocorticoids

28- the most important diagnostic test for that is :

- Microscopic RBC
-Macroscopic RBC.
- RBC cast.
29- case scenario patient known case of hypercholesteremia ,BMI :31
Present with investigation, showing ( numbers ) :high total cholesterol ,high
LDL & high TG......
Of these investigation what is the danger one for developing coronary artery
diseas :
-LDL
Total cholesterol > 200 mg/dL, LDL > 130 mg/dL, triglycerides > 500 mg/
dL, and HDL < 40 mg/dL are risk factors for CAD

30- Case scenario patient present with acute pancreatitis ,best diagnosis by :
- MRI
- Contrast computed tomography
- X-ray
31- Case scenario patient present with 3 days history of bleeding per rectum ,
present of pain after defecation , by examination ( mass at 3 o'clock ) :
Treatment:
A-Put a sitz bath 5 time a day .
B- NSAID ointment locally .
C- ligate the mass then remove it .
Acute Fissure
very painful bright red bleeding especially after bowel movement
treatment is conservative: stool softeners, sitz baths

32- case scenario ( female patient present with Urticaria, there is a history of
swelling in the lip some times, diagnosis :
Diagnosis:
- angioedema ????around mouth
33- Q about peptic ulcer ,how to know if it is due H.pylori or not .
34- patient ,your diagnosis for hem is cancer ,how to break that bad new
for hem :
- see the patient how many know about the disease.
35- 55 Y.O male patient present for check up ,physical examination is normal
,lab investigation microcytic hypochromic anemia , Hb :9
the most likely cause to exclude is
- lymphoma.
- gastroenterology malignancy.
36-patient who is smoker the least disease to occur in him is :
-Urinary cancer.
- Colon cancer.
37- case scenario patient present with acute symptoms of bloody diarrhea ......
Diagnosis ,acute ulcerative colitis :
the initial treatment for this patient :
-corticosteroid therapy .
- methotrexate.
- 5-Aminosalicylic acid
-sulfasalzine
38- Pregnant women present with a mass in her mouth bleeding when brush her
teeth
by examination mass 3x2 cm, diagnosis :
- aphthous ulcer.
- .....cancer
- .....granuloma
Pyogenic granuloma during pregnancy, the form considered as a pregnancy tumor because of its emergence in the mouth
area, Pyogenic granuloma (also known as Eruptive hemangioma,Granulation tissue-type hemangioma,Granuloma
gravidarum,Lobular capillary hemangioma,Pregnancy tumor,Tumor of pregnancy , NO TTT

39- case scenario ,patient present with intestinal obstruction :

Investigation to be done:
- X-ray supine & erect position.
- c-scan

40- Neonate baby present with rash over the face & trunk& bluster formation ,
Diagnosis:

- Erythema toxicum
41- Female patient present with itching in the vagina associated with the
vaginal discharge , PH : 5 , no Trichomonas infection , pseudohyphae by culture
diagnosis :
- physiological discharge .
- Candida infection .
42- female patient present with thick vaginal discharge color..... . no itching
,vaginal examination by speculum normal ,PH : 4
Diagnosis:
-physiological discharge
43- case scenario ( patient who is known case of hepatitis B ,Investigation
shows:
high alkaline phosphates & aminotransferase
HBs Ag : +ve
HBs ab : -ve
Diagnosis:
-obstruction of biliary tract ??
44-epidemiological study for smoker said there is 10,000 smoker in the area , at
start of the study there is 2000 , at the end of the study there is 1000 , the
incidence of this study is :
A- 10% ,,,, 1000 / 10000
B- 30%
Incidence proportion (also known as cumulative incidence) is the number of new cases within a specified
time period divided by the size of the population initially at risk. For example, if a population initially contains
1,000 non-diseased persons and 28 develop a condition over two years of observation, the incidence
proportion is 28 cases per 1,000 persons, i.e. 2.8%.

45- epidemiological study want to see the affect of smoking in the bronchogenic
carcinoma , they saw that is 90% of smoker has bronchogenic carcinoma .
30% of non smoker has the disease , the specificity of the disease as a risk
factor is :
-70%
-90%
46- female patient complaining of thirsty & drink a lot of water & frequent
urination ,
she has a history of diagnosed as bipolar since ( 2 week ) ,start with a
medication
of lithium,
- psychogenic polydipsia.
- central diabetes insipidus.
nephrogenic diabetes insipidus .
Lithium-induced nephrogenic DI may be effectively managed with the administration of amiloride, a
potassium-sparing diuretic often used in conjunction with thiazide or loop diuretics.

47- case scenario female patient present with lower abdominal pain ( or back
pain)

2-3 day before menstruation, then 2-3 day after beginning of it :

Diagnosis:
-primary dysmenorrhea.
- secondary dysmenorrhea .
48-eldrly women present with diarrhea, high fever & chills, other physical
examination is normal including back pain is normal ,
Diagnosis:
A- Pyelonephritis.
B- Bacterial gastroenteritis.
C- Viral gastroenteritis.
49- Patient taking antidepressant drug, (names of a drug I cant remember it but
what I remember it a drug of hypertension &.....)
the antidepressant drug make drug drug interaction with one of the following
drug :
- Non of the above.
50- Patient present with sever bronchial asthma which of the following drug ,
not recommended to give it :
A- Sodium gluconate .
B- Corticosteroid (injection or orally? )
C- Corticosteroid nebulizer.
51- baby present with pain in the ear ,by examination there is piece of a glass
deep in his ear canal , the mother mention a history of a broken glass in the
kitchen but she clean that completely .... We treat that by: no irrigation
A- By applying a stream of solution to syringing the ear.
B- Remove it by forceps.
52- Case scenario.... baby (<2 years age ) present with a history of URTI ....
nasal discharge after that
complicated to wheezing , & there is rales in the end inspiratory & early
expiratory phase ,prolonged expiratory phase , sever respiratory distress ,using
the accessory muscle in respiration.
Diagnosis:
A-Viral pneumonia.
B-Bronchilitis.
C-Bacterial pneumonia.
53- Mother bring her baby to you when he present with hematoma in his nail,
How to manage this patient:
A-No need things & ask him to go to the home.
B-bring a sharp metal ( & ) press in the middle to evacuate the Hematoma.
C-remove the nail.
54- in the initial evaluation for infertility:
A- Temperature chart.
B- Semen analysis.
C- Refer to reproductive clinic.
D- Urine analysis to detect the ovulation .

55-side effect of levodopa :

- fatal hepatic toxicity .
- fatal renal toxicity.
-dyskinesia
-speech
56- patient present to you , when you see his case , you discover that patient
has terminal stage of chronic illness , how to manage this patient :
- make him go to the home.
57- All features of tonsillar abscess except :
deviation of uvula to affected side:
58-Erethema nodosum :
painful red nodules treated with NSAIDs not steroids
59 child with eczema flare up he is on steroid and having itching disturb his
sleeping:
management :
- ointment
- antihistamine??
60-pregnant lady 28 wks with Chlamydia infection :
-azithromycin ( single dose )
-erythromycin ( this point ,what I remember was not present )
- Doxycycline
- 2 points of 2 drug of oinolon group
61- common cause of male infertility:
-primary hypogonadisim : kilnfelter syndrome _____ turner syndrome in female
-secondary hypogonadisim
-ejaculation obstruction
62-18years old boy with back pain investigation to do except :
CBC ?
ESR
X -ray
bone scan
63- iron deficiency anemia :
-serum iron
-ferritin
-TIBC
64 -In which group you will do lower endoscopy for patients with iron deficiency
anemia in with no benign cause:
-male all age group
-children
-permanupausal women
-women + OCP
65- female patient known to you since 3 years ago has IBS , she didnt agree

with you about that ,you do all the investigation nothing suggestive other than
that , she want you to refer her .
at this case ,what you will do
- ..............you will response to her & refer her to the doctor that he is want .
- ...........you will response to her & refer her to the doctor that you are want .
66- one of your female patient has complicated case ,come to you & give him
other appointment for F/U , when he came her appointment was at 10:00 &
didnt inter to you except at 11:15 , she was angry because of that , what you
will do now :
- Empathy with the patient &........
-empathy with the patient &........
- .................... told to the patient you have other complicated case must inter before you .
67- female patient present to you complaining of sudden paralysis, she has
a history that husband anointed her (or happen that in the clinic ?)
Physical examination including neurological examination is normal
Diagnosis:
-Conversion disorder
THERE IS Q. ABOUT URTI CAUSEDD BY RSV
HOW TO TREAT THE KNEE INJURY I THINK BY KNEE BRACE NOT INJECTION OF
STEROID
GIRL WITH 1RY DYSMENORRHEA AND U WILL GIVE NSAIDS
in question 7 i think it was mension that there was stellate lesion
??
patient came with scrotal swelling what investgation to do:
U/S
there was a question about baby with melanoma:
wide exision and follow up
refer to dermatology
.....
young lady with pelvic pain and menorrhgia ex. shwed uterine mass?
dx.
uterine fibroid
adenomyosis
endometriosis
best inx:
U/S
laproscopy

tennis elbow treatment:

NSAI
NSAIDs + restrict activity ( lateral epicondyle )

PPH management :
oxitocin infusion
mesoprosto
management of obesity in ? 10 years boy:
multifactorial
Young man with plurisy best management:
NSAIs
acetaminophen
cortisone
there Q about patient with diabetes and hyper tension... which one of anti
hypertensive madication you wanna add first
1.ACE
2.b-blocker
3.ca-channel blocker
4.alpha-bloker

then if patient stil hypertensive what the next choice.........?

1.b-bloker
2.thiazide
3.ARB
4.ca-channel blocker
reccurent abortion at 19 week , normal fetus (without any congenetal
anomalieis
-cervical incompetence
vaginal itching , white discharg not offensive
candida
vaginal itching , white discharg [b] offensive[/B
bacteial vaginosis

Paget disease :
- Normal ca and po4 , high ALP
Bechat disease :
Painful ulcer in mouth and gentialia
Best prophylaxis for sickle cell anemia :
Pencillin

Otitis externa : ear tragus painful ---Otits media if persistent effusion FOR 3 months --- myringotomy
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COLLECTED AND TRIED TO BE ANSWERD AND SENT BY

DR.ABULMALIK ALBAKER 2011
MED_ST99@HOTMAIL.COM