8th of December

SMLE 2019
TH
8 OF DECEMBER
Glory Team
Please don't hesitate to contact us if you have any correction, comments or

suggestions.
Teamglory2020@gmail.com
Medicine: 2-30
Surgery: 31-43
Pediatric: 44-52
OB/GYN: 53-62
Glory Group 8th of december
1
Medicine:
After abx therapy had watery diarrhea for 2 days, generalized abdominal tenderness fever
and dehydration best next step ?
A.stool test for C.difficile
B.X-ray abdominal
C.Ct chest
Answer is :
Stool test conformity for c.difficile
Pediatric with Minimal change disease with nephrotic syndrome

Asking about the initial treatment to reduce proteinuria?
A.prednisone
B.ACE inhibitor
Answer is :A
Patient from the Mediterranean region with anemia and fever

What medication should not be given?
A.aspirin
B.acetaminophen
C.ibuprofen
D.glucocorticoids
Answer is : A !
Patient with 2 previous syncope episodes during in the bathroom

ECG was normal
Asking about next step?
A.reassure
B.holter monitor
C.bed tilt test
Answer is :B
Unclear question about patient who came with nausea and vomiting and found out to
have appendicitis
Q: pathophysiology in this case:
A.Low cardiac index
B.Vasoconstriction
C.I forgot the other choices
Answer is :B
COPD CASE, PFT showed FEV1/FVC low , FVC LOW , FEV1 low , in addition what you will
find ?
2
A.high residual volume .
B.low residual volume .
C.low total lung capacity .
Answer is :A
COPD on monotherapy , not controlled what to add?

A.ICS
Answer is :
Retro orbital pain , arthralgia and headache , lymphadenopathy for fever and myalgia?
A.Dunge
B.MERS
C.vereci
D.TB
Answer is : A
3
13 yrs old boy came with fever , night sweats, fatigue , non productive cough , ,
hemoptysis ? ‫ﻛﺬا ﺟﺎه اﻟﺴﺆال ﺑﺪون ﻫﯿﺴﺘﻮري‬
A.TB
B.Brucellosis
C.mycoplasma pneumonia
Answer is : A
What is the diagnosis?
Answer is : molluscum contagiosum
Long case : Rash , ANA 1:39 , ref 1:40, fever , arthritis and arthralgia , hyperferritinemia
990, ref 300, cardiac and pulmonary exams normal ddx?
A.SLE
B.RA
C.IE
D.Adult still disease
Answer is :D
Fever ,rash ,arthritis /arthralgia and hyperferritinemia>Adult still disease
PE indication for thoracentesis ?

A.located pleural fluid
B.glucose > 60
C. PH >7.3
4
Answer is :A
Patient who has numbness and pain on little finger and other finger i dont remember,
pain increased when he left his arm, dx:
A.Thoracic outlet syndrome
B.Carpal tunnel syndrome
Answer is :A
Patient diagnosed with hypothyroidism, given thyroxine after 2 weeks there is an

elevation in t4, what to do:
A.Con same dose and fu after 1 month
B.Decrease dose and fu after 1 or 2 months
C.Discontinue the drug and resume when t 4 decreased
D.The fourth option I don't exactly remember but include reducing the dose
Answer is: A
Pre-diabetic, what to to do beside exercise >150min:

A. Low glycemic index to produce weight loss 5-10%
B. Low fat diet to produce weight loss 5-10%
C. Metformin is more effective than diet modification
D. Low carbohydrate is better than low fat diet
Answer is :A
Patients complain of low mood since 2 months, he was given a new position as a
manager , he had a conflicts at work with employees and low mood, what to give him:
A.Ssri
B.Psychotherapy
Answer is :B
Pt with CKD have risk of DVT what to give ?

A. unfractionated heparin
B.warfarin
C.aspirin
5
D.LMWH
Answer is A
I also got the pathophysiology of celiac disease

What is the underlying pathology?
A.villous atrophy
Answer is :
One patient has to avoid food rich in potassium, what to avoid:

A.Grape
B.Cranberry juice
C.Green peas
Answer is :tomato
Percentage of adult saudi male smokers?

A. 21%
B. 37%
Answer is :A
Most appropriate management of mild luminal stenosis (MRI finding)in elderly 60 i

believe?
A. Laminectomy
B. Biofeedback
C. Physiotherapy
D. Injection of steroid
Answer is :C
Osteoarthritis, HTN , DM , CKD What to give

A. Celecoxib
B. ibuprofen
C. Tramadol
D. Prednisone
Answer is :C
Cured by splenectomy ?
A.ITP
B.Beta thalassemia
C.TTP
Answer is :A
Old age., aurose, but conscious ALL ex and invx normal also mri and ct normal :
A.Stroke
B.Subdural hematoma
6
Answer is: need more info Normal CT and MRI exclude stroke and subdural Ischemic stroke will
appear on MRI, Befor CT
18 y old , present with tachycardia sweating visual hacculinatio agitated psychomotor

euphoria weight loss
A.cannabis intoxication
B.amphetamine intoxication
C.cocaine withdrawal
D.schizo
Answer is :B
Patient with symptoms of hypothyroidism Labs (TSH high T4 low)- (Thyroid

peroxidase antibody high), She also complains of galactorrhea What
investigation you will order to reach diagnosis?
A. thyroid US
B. MRI pituitary
C. FNA
Answer is :B
Scenario of brucellosis FREE from neurological sx , Rx ?

A. Doxy + rifa
B. Doxy + strepto
Answer is :B
Lady complaining from heartburn, mainly at night after eating dinner and
lying on the bed, she used anti acidic syrup which somewhat work with her
poop, what is the best next step in the management?
A. lifestyle modification
B. PPI
Answer is :B
DM patient on Metformin 1g BID, random blood glucose and a1c still high, what to
modify in treatment:
A.increase metformin dose
B.give insulin
C.add _gliptin
D.add _glenide
Answer is :D
Case of 60 years old male medically free came for routine check up every thing is normal
he doesn't complain about anything, when u calculate his risk for 10 years risk of MI it
was 6.9 by score i don't remember what its name, what you will do for this patient :
7
A.CT angio
B.MRI cardiac
C.Statin
D.Stress Echo
Answer is: C
Calculate the score by using the framingham risk score
8
9
Pt post PTC has fever, on PR exam ant. Boggy mx ?

A. Percut.Drainage
B. IV Abx
C. IVparacetamol
Answer is :A
patient with heartburn taking antacids. She had rheumatic fever 1 week ago
and was started on aspirin. What side effect she can develop?
A. Constipation
B. diarrhea
C. dry mouth
D. galactorrhea
Answer is
In other recall patient uses antacid: so
If magnesium > diarrhea
If aluminium >constipation
Disease commonly cured by splenectomy :

A. thalassemia b
B. Thalassemia a
C. SCA trait
Answer is :HS or ITP
Patient developed symptoms of pneumonia associated with symptoms of

pleural effusion. Management:
A. Azithromycin & Ceftriaxone
10
B. Azithromycin, Ceftriaxone & thoracocentesis
C. Azithromycin, Ceftriaxone & Chest CT
Answer is :B
pt with vitiligo and convulsion ?

A. Hyper K
B. Hypo K
C. Hypomagnesemia
Answer is C
Pt with hypocalcemia symptoms, labs showed low vit d, low calcium, normal pth, what to
give?
• Oral calcium
• Iv calcium
• Cholecalciferol
Answer is :B
Indication for IV Ca :
●Symptoms (eg, carpopedal spasm, tetany, seizures)
●A prolonged QT interval
●In asymptomatic with Ca level less than 7.5
Pt with MI, what's the most important thing to determine seriousness (can't remember the
exact question)
A.LDH
B.HTN
Answer is : LDL is the most serious risk factor
Worst prognosis : DM
Most common risk factor : HTN
Dangerous/ serious: hyperlipidemia ( LDL)
Pic of down syndrome?

A.Trisomy 18
B.Trisomy 21
C.Trisomy 13
11
D.Normal ethical features
Answer is :B
women witDh a history of insomnia and crying for 5 days due to sibling death
what is the quick drug to used :-
A. lorazepam
B. fluoxetine
Answer is :A
Poor weight gain ( flat buttocks ) (((( what is the most (( appropriate ))
investigation )))) ?
A. Anti endo
B. Duodenal biopsy
Answer is: A for initial , B for confirmatory
Woman came back from Jeddah complaining of myalgia, headache &

retro-orbital swelling. What's the next step in management?
A. Steroids
B. antibiotics
C. supportive
Answer is :C
Patient with rheumatoid nodules and arthritis of the hand joints and morning
stiffness. He was treated for pneumonia two weeks ago. On labs, he had high
RF, low platelets and high WBC. And bone marrow aspiration showed
lymphocytosis. What is the most likely diagnosis?
A. SLE
B. Felty syndrome
C. lymphoma
Answer is :
Lymphocytosis in bone marrow indicates felty syndrome
But high WBC and absence of splenomegaly against it
Chronic hep B came with jaundice highly elevated liver enzyme it was about 500 600,
most appropriate next step
A. Alpha interferon
B. Biopsy
C. No antiviral drugs in the choices
Answer is:in another recall they mentioned anti delta which is right .
To exclude HDV .
Acilivir treated pneumonia precaution

12
A. Airborne
B. Droplet
C. Contact
Answer is :B
If MRSA >contact
Tuberous sclerosis pt ,What genetic test u will request ?

A. Whole axom
B. Specific gene request
C. Multiple genes
Answer is :C
10 November: Female in her fifties develops MI and she was asking about the best way to
prevent a reinfarction:
A. Use of aspirin for short duration
B. Use of Calcium channel blocker indefinitely
C. Use of ACEI if she develops heart failure to prevent cardiac changes
Answer is :C
Facial plethora and JVP distended, which of the following is associated with this
condition?
A. SLCC
B. Adenocarcinoma
C. Squamous cell carcinoma
Answer is A (SCLC)
scenario of elderly patient who had chest inf 4 weeks ago, initially improved on antBx,
now worsened again, CXR: right pleural effusion.Dx?
A. Lung cancer
B. TB
C. parapneumonic effusion
Answer is :C
Mitral valve stenosis, when do you consider it critical?

A. 1
B. 2
C. 3
D. 4
Answer is :A
25 y old male with c/o of excessive weight gain since 5 ys wt 90 BMI 34 examination
normal.
13
A. start orlistat
B. investigate endocrine cause
C. 2ry cause of obesity
D. diet and exercise
Answer is :D
Man is concerned about cardiovascular risk, the most important risk factor for
CVD
A. waist circumference 103cm
B. blood glucose 8
C. BMI 31
Answer is :B
patient 65 years old post massive surgery! Patient lost a lot of blood +patient have given
15 bage of RBC after time nurse notes that the patient start bleeding from iv and
nasogastric tube? What is the cause of the bleeding
A. von Willebrand disease
B. thrombocytopenia
C. blood reaction
D. don't REMEMBER not DIC
Answer is :C
Pt have high BP and mild BPH what to give?

A. ccb
B. bb
No alpha blocker in answers.
Answer is :A
Pt with bilateral hydronephrosis with dilated bladder and proximal urethra?

A. Posterior urethral valve
B. Ureteropelvic occlusion
Answer is :A
61 years old male patient presented with palpitation. ECG showed atrial fibrillation then
converted spontaneously to sinus rhythm what is the management?
IcompleteQ
Nurse came for work checkup, Asymptomatic with no hx of needle prick or blood
transfusion, She is Hep C antibody positive and Hep c RNA negative and normal Liver
enzymes what will you do:
Repeat after 6 months in high risk
14
Post PCI came with A-fib on warfarin and statin, what will you do?
A.Continue warfarin monotherapy.
B. Warfarin and two anticoagulant
C. Warfarin and two antiplatelets. (warfarin, aspirin and plavix.)
Answer is :C
70 years old lady, complains of jaundice, anorexia and weight loss.

CT abdomen was done and showed that 70% of the liver had multiple lesions Asking
about appropriate investigation:
A. Percutaneous biopsy
B. Colonoscopy
C. Not sure about the rest
Answer is :A
Patient kc of gerd. Taking esomeprazole 20 mg not improved what to do?

A.Increase dose
B.Switch to pantoprazole
Answer is :A
A Young male Presents with Altered sensorium, Fever, Nuchal rigidity And CSF
analysis shows: high protein, high cells, normal glucose :
A. Tuberculosis meningitis
B. Viral meningoencephalitis
Answer is :B
pt asymptotic with severely aortic stenosis what you will do?

A. follow up
B. aortic valves replacement
Answer is
If EF less than 50 > AVR
If EF more than 50> follow up
Patient diagnosed with major depression complaining of excessive thirst and

urination + she has cancer with lung mets. investigations shows hyponatremia
and low urine osmolality what's the dx:
A. DI
B. psychogenic polydipsia
C. SIADH
Answer is
It's incomplete we should do water deprivation test to differentiate between psychogenic
polydipsia and DI
15
patient take ACEI, CCBs, thiazide , develop LL edma mainly , other Normal but in
investigation all RFT test deteriorated, what you will do
A.Stop ACEI
B.Change thazide to frismide
C.No change
Answer is
If with acute RF >stop ACEI
If with CKD > switch to fursemide
Old age., aurose, but conscious ALL ex and invx normal also mri and ct normal :
A.Stroke
B.Subdural hematoma
Answer is
Could be post concussion syndrome
18 y old , present with tachycardia sweating visual hacculinatio agitated psychomotor

euphoria weight loss :
A.cannabis intoxication
B.amphetamine intoxication
C.cocaine withdrawal
D.schizo
Answer is :B
Case of 55 years old with Afib not mention any other details, what is best treatment for
him to prevent complications?
A. Aspirin
B. Heparin
C. Warfarin
D. No need treatment
Answer is D
Pt k/c of chronic kidney disease, presented with numbness and dec vibration sensation,
absent LL reflexes. On labs: high Cr, high K , MCV was low, whats most appropriate
management?
A.Hemodialysis
B.Vit B12
Answer is :A
Pt with high grade fever, tender cervical lymphadenopathy, exudate tonsils, next mx?
A.Swab culture
B.Rapid antigen detection test
Answer is :B
16
Female with ascites , pleural effusion, bilateral ovarian tumor, what help to determine the
Dx?
A. MRI
B. CT
C.Screening for genetic carcinoma
D. US
Answer is :D
2 week old patient diagnosed with congenital heart problem, now cyanosed, tachypnic,
fussy, Tx:
A.IV diuretic infusion
B.cardiac catheterization
Answer is
If associated with acute HF > IV diuretics
If associated with infection > treat the infection and reassess
Female 42 years hx varicose vein 20 years ago

Came to ER because of worms like swelling that is painful started 2 days ago ,
The most appropriate initial tx ?
A. Nsaids
B. Celaxen
C. Heparin
D. Abx
Answer is :A
65 y/o female with DVT which of the following factor indicate thrombophilia assessment
?
A.Age
B.Hx of OCP
C.Connective tissue disease
D.-ve FHx
Answer is :C
Smoker elderly with preserved femoral and popliteal pulse put diminished dorsalis
pedis, Mx ?
A. Localized thrombolysis
B. Heparinization and observer
Answer is :A
45 yrs old known smoker present with SOB.Pulmonary function test reveal FEV/FVC <7,
which improve slightly by bronchodilator, TLC Low. That indicates what:
A. bronchial asthma.
17
B. chronic bronchitis
C. interstitial lung disease
Answer is :B
Male came for presport screening asymptomatic

Found to have LV enlarged , EF 40 , ECG normal :
A.Frusemide
B.Follow up after 6 months
Answer is : start ACEI
Case of child with anemia and have 2 sister same condition they are at strict diet with
mild cbc shows anemia HB 3
Retics 3 mild elevated microcytic hypochromic microcytic
Ferritin is low 9
Diagnosis ?
A. SCA
B. Alpha thalassemia
C. IDA
Answer is :C
Patient with diarrhea, abdominal bloating and weight loss , symptoms increases with
gluten diet .... best nest step ?
A.Gastroenterology referral
B.Stop gluten diet
C.Resume gluten diet , and order celiac blood test
Answer is:C
Patient with HV and LV dysfunction give:

A.BB
B.Digoxin
C.ARB
Answer is
Incomplete
Old pt present with retrosternal chest pain with exertion relieved by rest, on PE all normal
except with S4, on ECG there is T wave inversion in lead V2-V5.
A. Stable angina.
B. Unstable angina.
C. NSTEMI
D. I can’t remember.
Answer is :A
Pt with difficulty in urination and back pain, w/ high prostatic specific agent?
18
A. Prostatic cancer
B. BPH
Answer is :A
Young Male has sister with polycystic kidney diseases how to screen or diagnosis if he
have it ? -
A.abdominal US
B.abdominal x-ray
C.anti-cystic something marker
Answer is :A
6th Cranial nerve affected:

A.Unable to abduct right eye
Answer is : A
Pt with multiple vomiting, ECG show flat t wave ?

A.hypokalemia
Answer is : A
Organophosphorus poisoning Q
WPW syndrome Q
Wiskott aldrich syndrome Q
Preventable factor for dyslipidemia and coronary heart disease in a “female”:

A.Diet.
B.Smoking.
C.Physical Inactivity.
Answer is :B
COPD pt ph 7.2 in severe distress:

Answer: Non invasive MV
No intubation in choices.
GAD Management:
A.Alprazolam
B.Naltrexone
Answer is
CBT or SSRI as initial treatment in adult
LE pt not on any medication now presenting with lupus nephritis (labs given), most
appropriate management?
A.Renal biopsy.
19
B.Other investigations.
Answer is :A
Initial Dx investigation for Alzheimer disease:

A.Brain MRI.
Answer is :A
RA with inflammatory knee swelling joint aspiration WBC 30000

Most effective management:
A.Intra-articular steroid
B.IV high dose steroid
Answer is
If he is not on DMARD we should start it
If the patient in DEMAND and have joint pain > Steroid
If the patient in DEMAND and complaining of joint swelling and pain > intra articular steroid
injection
Systemic steroid is combined with DMARD as initial treatment of RA flare up
Inferior MI ask about diagnosis.
Pt with Multiple vomiting times associated condition ?

A. hyponatremia
B.metabolic alkalosis
C.hypophosphatemia
Answer is :B
30s female cystic fibrosis , 4m hx of sever abd pain , high amylase, clubbing, O2 sat low
90s, most likely diagnosis:
A.acute pancreatic
B. chronic pancreatic
C.pseudocyst pancreatic
D.carcinogenic pancreatitis.
Answer is :B
60s female with SOB , orthopnea , PND , lower limb edema , raised Jvp, low sound apex
sound most likely diagnosis:
A. right side heart failed
B.PE
Answer is :CHF
20
4 days post c section prested with SOB classic s/s of PE what to give :
A.heparin
B.warferin
C.aspirin
Answer is: A ( enoxaparin )
Case of chronic diarrhea blood culture show c.diff what is the antibiotics ?
A. iv metro
B.oral vanco
C. oral bancilin
Answer is: B
Case of Community accouer pneumonia what is the abx

A.azithro
B.pancilin
C.metrao
Answer is :A
Patient with symptoms of dementia + gait disturbance

Asking about the diagnosis
A.alzheimer disease
B. fronto-temporal ataxia
Answer is :B
IBS what to do?

A.Avoid oil
B. Avoid lantil
C.Eat fruit
Answer is: B
Pt had chest pain recently come at rest?

A. Unstable
B.prinzmetal angina
C.Spasm
Answer is : A
-indian man Back from hajj with intermittent fever and vomiting :
A.yellow fever
Answer is
Incomplete
21
70yrs old he complain cant wake up from bed and have back pain with long standing
hypertension what reason of his condition??
A.Traffic accident
B.gun shot
C.blunt stab
D. falls
Answer is :D
Hx of business man travel to asia a lot with candida features

Most important serology is:
A.Hiv
Answer is :A
Multiple antrum ulcers , by Bx >H pylori what is the mx ?

A. start Abx
B. Chemo
C. Radiation
Answer is :A
pt c/o abd pain and vomiting , constipation By investigations> Collapsed colon and
bowel sound ttt contraindicated for this pt ???
A. NO
Answer is :A
Old patient with 3*4 dark elevated skin lesion at the ant of his thigh, what’s the next
appropriate step?
A. -excision
B. -Punchbiopsy
C. -Chemotherapy
Answer is :A
What is the most sensitive for TB pleural effusion?

A. LDH
B. Leukocytosis
C. pH
D. Adenosine deaminase
Answer is: :D
Female in her 60s; high Ca, high PTH, low PO4

Complains of bone pains + abdominal cramps relieved by drinking milk.
A. Milk-alkali syndrome
B. Primary hyperparathyroidism
C. Secondary hyperparathyroidism
D. Renal osteodystrophy
Answer is: B
DM, HTN, ESRD on dialysis. Best DVT prophylaxis:
22
A. Enoxaparin
B. Heparin
C. Mechanical
Answer is: unfractionated heparin
High grade esophageal dysplasia:

Refer for possible resection.
Answer is: A
Achalasia case: went for dilatation; post-op developed right lateral chest and neck
crepitations.
A. Esophageal stenting
B. Medical management
C. Surgery and repair
Answer is:
If associated with collection or sign of infection > surgical drainage

If patient surgical non candidate > stenting
If surgical candidate >surgical repair
Red-man syndrome: case of vancomycin. What to do?

Give at a slower rate.
Answer is:A
Elderly patient with controlled HTN and HF. Currently on ACEI and thiazide. What
medication would you add?
A. Furosemide
B. Carvedilol
C. Nifedipine
Answer is: B
Osteoporosis screening.
A. 65-69
B. 60-64
C. 55-59
D. 50-54
Answer is: A
Population cancer screening:

A. Ovarian
B. Colorectal
C. Oral
Answer is: B
23
Pregnant female and a k/c of asthma (on albuterol), complained of daily symptoms
and nocturnal symptoms (2x a week). The most appropriate management is:
A. Short-acting bronchodilator and ICS
B. Short-acting and oral steroid
C. Inhaled corticosteroid and long-acting bronchodilator
D. Long-acting beta-2 agonist and inhaled corticosteroid
(Options C and D were exactly written in this way)
Answer is:D
Moderate persistent >LABA +ICS
Hydatid liver cyst presentation with positive serology; however, they brought a CT and
you had to interpret the cyst characteristics.
A. Surgical deroofing
B. Albendazole therapy
C. Percutaneous drainage
Answer is: incomplete
Parkinson’s tremor:
A. Carbidopa/levodopa
B. Bromocriptine
Answer is: A
Patient with ACS and hyperlipidemia; best to add for secondary HTN:
A. ASA
B. Statins
C. BB
Answer is: C
24
Pt with hypertriglyceridemia came with epigastric pain radiating to his
back; hemodynamically unstable and other sx.
CT showed dilated lobe in left hypochondrium.
Labs: lipase and amylase within normal range
What is the most likely diagnosis?
A. Perforated ulcer
B. Pancreatitis
C. Lower lobe pneumonia
Answer is: B
Man in his 30s and a k/c of hypertriglyceridemia with severe abdominal pain for 8 hours
radiating to his back. X-ray showed no air fluid level. There is air in left bowel loop.
Pancreatic enzymes not elevated. What is the most likely diagnosis?
A. Chronic pancreatitis
B. Mesenteric ischemia
C. Bowel perforation
Answer is: acute pancreatitis
Old age pt with fresh blood per rectum; you did PR examination and your finger full of
blood; but anorectal colonoscopy was normal. CBC was given; Hb 8. What is the
investigation that has a high diagnostic value?
A. Upper GI endoscopy
B. Tch 99
C. CT
D. US
Answer is: B
Old patient k/c of DM and HTN complaining of rt lower limb pain and swelling. Femoral
pulse is intact, but the distal pulse is absent. What is the most appropriate management?
A. Embolectomy
B. Heparinization and catheterization
Answer is: B
A case of PE: pt with hx of one year MVA and paraplegia. Now he is hypotensive, and
angio showed DVT extending to the thigh. What is your management?
A. Thrombolysis
Answer is: A
25
Sinus infection with haemophilus influenzae. Treatment?
A. Steroid inhalation abx decongestant
B. Steroid anti-inflammatory
Answer is: abx
Patient received a blood transfusion after surgery and experienced bleeding at the
puncture site. What is the diagnosis?
A. Transfusion reaction
B. DIC
C. Thrombocytopenia
Answer is: B
Patient k/c of COPD presented to the ER with COPD exacerbation. What will help him?
A. CPAP
B. O2 mask
C. MV
Answer is: B
Poorly controlled diabetic pt came with right sided eye ptosis and difficulty in adduction
and elevation of right eye. Pupil reflex normal in both eyes and all other cranial nerves
are normal. What’s the most likely diagnosis?
A. 3rd CN palsy
B. Cavernous sinus thrombosis
Answer is: A (diabetic third cranial nerve palsy )
Picture of blood smear (I think it was spherocytosis): asking about what value do you
expect to be LOW?
A. Platelets
B. MCV
C. Reticulocytes
Answer is: B
Alzheimer’s pt with hallucinations; no organic cause. What medication to use?

A. Haloperidol
B. Olanzapine
Answer is: B
Old pt with hx of recent travel; came with difficulty arousing/awakening. He reports

multiple falls; examination shows no head wounds. Skull is intact. What is the most likely
diagnosis?
A. Post-concussion syndrome
B. Chronic subdural hematoma
Answer is: most likely A but see the pic to understand why
26
Multiple falls means subdural hematoma
Arousing awaking goes with post concussion.
Recent history + difficulty arousal and awakening > post concusion.
Symptoms of subdural hematoma

●Headache
●Vomiting
●Weakness
●Numbness
●Trouble walking
●Slurred speech or being unable to speak
●Acting less alert than normal
●Dizziness
●Confusion or trouble thinking
●Sleepiness
●Seizures
27
30 y/o male came with dyspnea, chest pain, PND, orthopnea. On examination there is a
pansystolic murmur; Gallop S3 with displaced apex; no significant medical hx. Most
appropriate next step?
A. CXR and ECG
B. Echo
Answer is: A
If they asked about initial choose A
Dyslipidemia screening:
A. 18
B. 25
C. 30
D. 50
Answer is: B
What indicates a lymphoma?

A. Hepatosplenomegaly
B. LN > 1 cm
Answer is: fever
Symptoms of DKA. What will you find in labs?

A. Low insulin
B. High renin
Note from the scribe of this document: Please collect your choices properly… what is C
supposed to mean?!
Answer is: A
Patient with food poisoning; then developed jaundice. What will you do?
A. HAV Ab
B. HAV ag
C. HBV
Answer is: HAV IgM
Old lady with lower limb pain that increases when walking downhill or walking a long
distance. Most likely diagnosis?
A. Lumbar spondylosis
B. Lumbar
Answer is: lumbar stenosis
Something that reflects systemic pressure?

A. Central venous pressure
B. Pulmonary wedge pressure
Answer is: A
28
Young patient has recurrent UTI, stones and electrolyte disturbances. On imaging he had
bilateral kidney enlargement with multiple variable sized thin-walled cysts throughout the
parenchyma. What is the diagnosis?
A. Medullary sponge kidney
B. PKD
Answer is: A
Symptoms of OA in fingers; distal and proximal interphalangeal joints. Management?

A. MTX
B. Steroid
C. Weight reduction
D. Finger splint
Answer is: D
Osteoarthritis, HTN, DM, CKD. What to give?

A. Celecoxib
B. Ibuprofen
C. Tramadol
D. Prednisone
Answer is: C
COPD PFT result:

A. Increased TLCO, decreased FEV/FVC, increased vital capacity
B. Increased TLCO, decreased FEC/FVC, decreased vital capacity
Answer is: :B
Patient on parenteral feeding developed weakness and convulsions. What is the cause of
these symptoms?
A. Hypokalemia
B. Hypomagnesemia
Answer is:B
If there is hypophosphatemia its better
52 y/o male k/c of DM II and RA; presented with back pain. Investigations revealed
slightly elevated serum calcium; RFT was impaired (high creatinine and BUN). What is
the most likely dx?
A. Membranous GN
B. Primary amyloidosis
C. Diabetic nephropathy
Answer is: A
29
Patient with sarcoidosis. Hct decreased; ferritin high; MCV 79 (normal is from 80). What
kind of anemia do you expect?
A. Anemia of chronic disease
B. IDA
Answer is: A
Pt k/c of asthma non-compliant with meds came with sx of status asthmaticus. His last
PEF 600. Which of the following is an indication of severity in this patient?
A. PEF 250
B. HR 100
C. RR 20
Answer is: incomplete
18 y/o presented with tachycardia; sweating, visual hallucinations; agitated;

psychomotor euphoria; weight loss
A. Cannabis intoxication
B. Amphetamine intoxication
C. Cocaine withdrawal
D. Schizophrenic
Answer is: B
List of questions with no choices:
40 y/o man received a blood transfusion after surgery. Few mins later he developed pain
at site of transfusion; fever and chest tightness. What is the diagnosis?
Patient with TB and he had pleural effusion. How to know that pleural effusion is due to
TB?
A 60 y/o man presents to his primary care physician with hip pain and hearing loss. He
denies any trauma to the hip or any recent changes in his meds. He also notes his hat fits
tighter than before. Physical examination is unremarkable. Laboratory testing is
significant for an elevated alkaline phosphatase level in the setting of normal serum
calcium, phosphate, and parathyroid hormone.
● 2 questions about C. diff pseudomembranous colitis (same as previous months).

● RPGN pathophysiology (same as previous months)
● Vitiligo pathophysiology (same as previous months)
30
Surgery
25YO Pt with vomiting, RLQ pain, rebound tenderness no fever no leukocytosis
Xray showed stone in ureter?
A.urgent urology consultation
B. appendectomy
C. CT without contrast
D. US for gallbladder
Answer is : C
Patient diabetic and hypertensive came with claudication sx in his buttocks area that is
increased upon physical activity.
CT angio showed iliofemoral insufficiency
What’s the most appropriate management?
A.Iliofemoral bypass
B.Axillobifemoral bypass
C.Vasodilation therapy
Answer is :A
Complex pain syndrome after carpal tunnel surgery, what will you do?
A.physiotherapy
B.analgesics
Answer is :A
patient 65 years old post massive surgery! Patient lost alot of blood +patient have given
15 bage of RBC after time nurse notes that the patient start bleeding from iv and
nasogastric tube? What is the cause of the bleeding
A. von Willebrand disease
B. thrombocytopenia
C. blood reaction
D. don't REMEMBER not DIC
Answer is : C
Post open appendectomy with pain in wound site , you see pus oozing from the site of
surgery what to do next?
A.percutaneous
B.us abd
C.abx
D.open surgery
Answer is : B
31
Pt with HTN, DM with well demarcated non tender swelling ?
A.erysipelas
B.lipoidica diabeticorum something
Answer is : A
To prevent renal stone in hypercalcemia:

A.Thiazide
B.Penicillamine
C.Forgot the other two
Answer is : A
What indicate poor prognosis in acute pancreatitis with elevated liver and pancreatic
enzymes and hematocrits ?
A.Lipase >600
B.Amylase > 500
C.Hematocrit> 44%
D.Forgot the fourth on
Answer is : C
an 18 years old boy was playing in the gym came with acute pain, features of obstruction
and on c-ray air fluid level , absent cough impulse ?
A.strangulated hernia
B.obstructed hernia
Answer is :B
32
16/ old with fever and RUQ pain and jaundice, No lab or radiology available:
A. Reassure and send home
B. Emergency consult a surgeon on phone
C. ask for lab results & tell him to come back tomorrow
D. admit to hospital & evaluate
Answer is : B
Patient after surgery on blood transfusion developed bleeding from the

puncture site what's diagnosis ?
A.transfusion reaction
B.DIC
C.thrombocytopenia
Answer is : B
Pt post PTC has fever, on PR exam ant. Boggy mx ?

A. Percut.Drainage
B. IV Abx
C. IV paracetamol
Answer is : A
Symptomatic on PPI, no improvement UGE done endoscopic finding go with esophageal

mucosal injury : reflux esophagitis, best next ? ‫ﻛﺬا ﺻﯿﻐﺔ اﻟﺴﺆال‬
A.PH monitoring
B.life style
C.nissen fundoplication
D.Resection
Answer is :A
Pt K/C of DM and take steroid for asthma after surgery admitted to ICU , lab : glu2.3 , ref
3, normal Na and other labs was normal, rarson for admission?
A.DKA
B.adrenal insufficiency
C.Conn's syndrome
D.no cushingin the answer :
Answer is :B
20 ml oozing from site of surgery after appendicitis

A.Dressing
B.Explore
C.Lap diagnostic
D.Laparotomy
Answer is :A
33
Retinoblastoma pic with absent reflex wt to do
A.Refer to ophtha
Answer is :A
25 year old female, presented with abd pain, chronic diarrhea, family hx of crohn's
disease all labs normal , normal abd x-ray next investigation :
A.Upper GI endoscopy
B. anorectal manometry
C.fecal calprotectin
D.biopsy
Answer is:
Pt for elective lap coly found to have stomach mass, what to do ?

A.stop the presger
B.cholecystectomy
C.removal of mass
D.both mass and choly
Answer is :B
After complicated ERCP, surgical emphysema at abdomen chest and neck, most likely
injured
A.Gastric
B.Esophagus
C.Duodenum
D.Trachea
34
Answer is :C
Young patient have mild tenderness on his right upper abdomen + vomiting no mention
of fever patient was stable vitality , US finding : Multiple stone in GB with normal GB wall
. Your next step of management :
A. IV antibiotic
B. lap cholecystectomy
C. MRCP
Answer is B
Old patient with 3*4 dark elevated skin lesion at the ant of his thigh, what’s the next
appropriate step?
A. -excision
B. -Punchbiopsy
C. -Chemotherapy
Answer is :A
eldery with appendicitis , now he has appendicular mass what is nxt ?

A. appendectomy in 12 weeks(lap)
B. open appendectomy 12 weeks
C. colonoscopy in 6week
Answer is :C
Pt with thyroid nodule and hyperthyroidism lab , radioactive iodine shows the nodule hot,
but all the remaining thyroid is cold. Initial Management:
A. hemithyroidectomy
B. tota ectomy
C. anti hyperthyroid drugs
D. radioactive ablation
Answer is :C
Case of RUQ pain and tenderness jaundice elevated total bilirubin not mention direct or
indirect on US multiple GB stones no pericystic fluid CBD is dilated 1cm
High WBCs he didn't mention fever in the Q
A. Ascending cholangitis
B. Acute cholecystitis
C. Choledocholethiasis
D. Acute pancreatitis
Answer is :B
Typical case of appendicitis since 6 days alvarado score I calculate it 6 or 5

Leukocytosis
RLQ tenderness
35
Nausea and vomiting
Anorexia, most appropriate next step
A. US
B. CT
C. surgical exploration
Answer is :C
Look for more symptoms cuz could more symptoms so if Score less than 7:
If adult >CT
Children and pregnant >US
RTA intubated best way to clear cervical spine?

A. CT
B. MRI
C. Lateral X ray
Answer is :A
pt did herinal repair with mesh 12y ago and came by obstruction sign and no sign hernia
repair ?
Pt after burn develop jaundice, RUQ pain, dilated gall blader with tgickned walk and
precolyctic fluid, next step:
A. Colostomy tube
B. Cholecystectomy
C. MRCP
Answer is :A
Post Cholecystectomy with after surgery develops epigastric tenderness in ex decrease

air entry on Rt side
On us / there's a collection 15*12 in the gallbladder fossa
A. Observation
B. Percutaneous aspiration
C. Physiotherapy
Answer is :B
After fight there an injury in front of ear left ear at the mandibular angle 2 cm wound
oozing blood come out what most appropriate management
A. surgical exploration
B. observation
C. Ct angio of neck
Answer is :A
Neck zones management:
1- if you find any of the hard signs >>> go directly to OR
2- according to the neck zone :
36
Zone 1 and 3 >> CTA
Zone 2:
Stable >> CTA
Unstable >> Exploration
*Zone I and Zone III >* CTA

‼unless there is :
- Active bleeding
- Expanding hematoma
- subcutaneous emphysema /air
*Zone II :-*
*if asymptomatic >*
CTA,
*if symptomatic >* Surgical exploration

37
40 years old patient complain of frequent itching anal , post defecation pain . What’s Dx ?
A. anal fissure
B.perianal fistula
C. perianal hematoma
D.internal hemorrhoid
Answer is :A
Old patient history of vomiting with palpable mass imaging finding Y shape
next app action?
A. Fleet enema
B. Ct
C. Sigmoidoscopy
D. Colonoscopy
Answer is :C
Indication thoracentesis:
A. glucose less than 60
B. Ph more than 7.2
C. PMN more than 90%
Answer is :A
Indications for chest tube insertion in a patient with educative pleural effusion is when it is an
empyema
Indications are:
Aspiration of frank pus
Positive gram stain of aspirated fluid
Positive culture of aspirated fluid
*Low pleural fluid ph of less than 7.2*
*Low pleural fluid glucose of less than 40- 60 mg/dL*
38
Patient post RTA with warm peripherals Which type of shock?
A. Cardiogenic
B. Septic
C. Neurogenic
Answer is :incomplete
Post RTA patient oriented ask about type shock

A. Hypovolemic
B. Cardiac
C. Neurological
D. Septic
Answer is :C
Female (obese) with typical appendicitis:

Right iliac pain and tenderness
Nausea and vomiting
Loss of appetite
Leukocytosis
What is the proper management?
A.Abdominal CT
B.Abdominal US
C.Exploratory laparotomy
D.Open appendectomy
Answer is: D because she is obese
Typical presentation of appendicitis no need for investigation.

We do laparoscopic surgery but if not mentioned > open is accepted
39
Clinical presentation of acute cholangitis. How to manage?
A.ERCP
B.Laparoscopic cholecystectomy
C.Exploratory laparotomy
Answer is: A
Patient presented 3 weeks after sleeve gastrectomy with increasing abdominal pain.
What do you do?
A. Endoscopy
B. Exploration
C. Drainage
Answer is: CT if not barium swallow
If the patient is unstable >laparotomy
Pt few days post-cholecystectomy developed inspiration chest pain, LUQ pain and
tenderness with dull percussion. Temp 38; basal crepitations. What is the most likely
diagnosis?
A. Subphrenic abscess
B. Lower lobe pneumonia
Answer is: A
Pt accidentally on MRI adrenal adenoma with no symptoms only mass about 5 cm. What
is the next step?
A. Medical ttt
B. Observation
Answer is: adrenalectomy
Pt post PTC has fever, on per rectum and by exam there was antiroir Boggy (which mean
large) . What is ur management?
A. Percutaneous Drainage
B. IV Abx
C. IV paracetamol
Answer is :A
A 24 year old lady presents with a hard, mobile, well-circumscribed painless left breast
mass that has been increasing in size from the past few months, and was NOT related to
her menstrual cycle. The most like Dx is
A. fat cyst
B. Fibroadenoma
Answer is : phyloid carcinoma
40
Patient in his 50s presents with intermittent weakness of urination for months.
Normal PSA and urine analysis. Examination of prostate: median lobe enlargement.
Best management:
A. Periodic PSA (best relative)
B. Renal ultrasound annually
Answer is: A
30 y/o complaining of abdominal pain radiating to the back associated with vomiting; he
did gastric sleeve 3 months back.
US: gallbladder sludge with no stone; normal cystic duct
EBC normal
Amylase 700
What is the most appropriate investigation?
A. Endoscopic US
B. Endoscopic sphincterotomy
C. Laparoscopic cholecystectomy
D. Open cholecystectomy
Answer is: B
Single stricture in terminal ileum 1 cm away from ileocecal valve. Management?

A. Stricturoplasty
B. Resection with ileostomy
Answer is:A
If the patient unstable or having sign of peritonitis >resection
Patient admitted for thyroid surgery because of progressive compression symptoms.

Hemithyroidectomy done; biopsy showed 8 mm papillary carcinoma. What next?
A. Radioablation
B. No need for further evaluation
C. Complete thyroidectomy
Answer is: B
Patient with trauma and exposure of nerves and muscles. Management?

A. Debridement with primary closure
B. Debridement with secondary closure
C. Debridement with delayed skin graft
Answer is: C
Graves disease with exophthalmos NOT responding to antithyroid medication for 10

months. Next step?
A. Subtotal thyroidectomy
41
B. Near-total thyroidectomy
C. Radioiodine ablation
D. Continue antithyroid medication
Answer is: D
Benign ovarian cyst characteristics:

A. Hypoechoic
B. Ilateral
C. Multilocular with thick septation
Answer is: A
Post open appendectomy case with pain in the wound site. On examination, you see pus
oozing from the site of surgery. What will you do next?
A. Percutaneous drainage
B. US abdomen
C. IV abx
D. Open surgery
Answer is: B
Patient is going to undergo lap chole and incidental found AAA size 4.5 WhAt you are
going to do?
A.Do surgery follow up by US
B. Do surgery follow up by CTA
C.Do CTA before surgery
Answer is : A
Cervical Lymph node show follicular cell what the cause:

A.Ectopic thyroid
B.follicular thyroid cancer
C.papillary thyroid cancer
Answer is : C
Pt 33 yr with DM,HF (sing and symptoms of cholecystitis with pericystic fluid in Us) what
the next
A.delay lap chole 2-3 month
B.Emergency lap chole with taping
Answer is : A
Male adult with perianal swelling and discharge, then ruptured ,Dx:
A.Anal fissure
B.hemorrhoid
C.anal abscess
D.fistula
Answer is : D
42
Sarcoma Biopsy most Diagnostic:
A.Incisional biopsy
B.Excisional
C.Needle core
Answer is : C
Case of patient undergo hemithyroidectomy for symptomatic thyroid nodule.

Histopathology report: colloid nodule 3-4 cm. Papillary cancer is measured 8 mm from
center. What are you going to do next:
A.Follow up
B.Complete thyroidectomy
C.Radioablation
Answer is : A
Post lap chole presented after few days with abd distension and ascites and abd pain
what will u do?
A. open
B. lap
C. tapping
Answer is :
Incomplete but:
if with collection drain
If patient unstable > laparotomy
30 year-old has a large indirect inguinal hernia sac that is reducible with
mild effort. Bowel sounds are heard in the hernia sac. This hernia is the result of
which of the following?
A. A defect in the abdominal wall with protrusion of abdominal contents through the  internal
inguinal ring, canal and external ring
B. A traumatic defect in the abdominal wall
C. A congenital defect in the abdominal wall allowing protrusion of abdominal contents through
the inguinal canal
Answer is : A
70 years old lady, complains of jaundice, anorexia and weight loss.

CT abdomen was done and showed that 70% of the liver had multiple lesions Asking
about appropriate investigation:
A. Percutaneous biopsy
B. Colonoscopy
C. Not sure about the rest
Answer is : A
List of questions with no choices:

Li
Elderly pt with symptoms of BPH and there is a reflux in both ureters (right and left) and
ask about ttt? (all choices were surgeries)
43
Pediatrics:
Case of pediatric patient known to have Seizure, came with syndromic feature hypotonia
large head asking for vaccinations:
A.Give all
B.Stop all live vaccine
C.Stop Dtap
Answer is : C
Child e Nephrotic syndrome What medication to avoid in management:

A.aspirin
B.amoxicillin
C.acetaminophen
D.ibuprofen
Answer is : D
CP patient with SOB, and ..., asking about type of respiratory failure, O2
43, Co2 35 (was normal):
A. hypoxic RF
B. hypocapnic RF
C. hypercapnic RF
D. Neurogenic RF
Answer is : A
Child with DKA scenario managed and developed signs of cerebral edema, q was about
the fluid replacement (very complicated q)
??
A 6 years old girl brought by her mother to the clinic, she is malnourished and in poor
hygiene, the mother say it’s too hard because she is looking after the kids and they have
low socioeconomic state, your action:
A . report mother to child protection services
B . use only close questions
C .encourage mother to use her own words
Answer is : refer for social worker
Newborn come with SOB -the only symptom- (Radiological report: hyper lucency of the
left upper lobe compress on the lobar bronchi and shifted the mediastinum to the right )
The only information given is radiological report without pic .. what is the management :
A. thoracotomy
B. Platelets
C. thoracostomy
Answer is : needle thoracostomy
44
Baby who diagnosed with TOF, what u will see:

A.Pda
B.Vsd
C.Coarctation of aorta
Answer is :V
Child with intussusception what’s the most appropriate management

A. NGTwithparenteralnutrition
B. Warmedsalineenemausguided
C. NGTandreductionbygravity
Answer is : B
Children with cough, fatigue, 2 time bloody vomiting, low grade fever, with dullness in
percussion dx?
A. something pneumonia
B. pleural effusion
C. TB
D. Bronchiectasis
Answer is : B
Case about a child with increased water consumption and going to the toilet, not to
mention Urine and serum osmolality, not mention any electrolyte, with no response to
water deprivation test, no other complain:
A. central DI
B. peripheral DI
C. SIADH
D. medical terminology sound like drinking too much water
Answer is : B
What mechanism leads to least incidence of down’s syndrome:

A. Mosaicism
B. Meiosis nondisjunction
C. Meiosis disjunction
Answer is : A
Child needs non invasive MV (BiPAP). Where do you administer it?

A.ER
B.Pediatric ward
C.Pediatric ICU
D.Neonatal ICU
Answer is : C
Cause of CROUP: 45
A.Parainfluenza virus Treatment:
A.supportive
Answer is :A
Confirmation of pertusis:
- nasopharyngeal swab PCR
Answer is :A
Stubborn child, how can the mother deal with him?

A.time out
B.scolding
C.verbal warning
Answer is : A
Acute onset cough , seezing , hoarseness ,chest tightness , dyspnea ,mother said
He was at a party with hx of allergy , what is the most appropriate tt ?
A.adrenaline
B.diphenhydramine
C.prednisolone
Answer is :A
Child with maculopapular rash, hepatomegaly

Splenomegaly and lymphadenopathy?
Answer is : EBV infection
Child with stiff neck , gait and walking abnormality chicken infection , diagnosis ?
A.meningoencephalitis
B.acute cerebral ataxia
Answer is : B
Child difficulty feeding failure to thrive diagnosis made as eosinophilic esophagitis ,

higher value Q to ask in hx?
A.difficulty swallowing
B.allergy hx
C.excessive chewing
Answer is : C
4 months old came to vaccine , have mild diarrhea?

A.give all except OPV
B.don't gove
C.give all
D.delay
46
Answer is : C
4 months old vaccine IPV ,HBV,Hib,Dtap
Indicate remission in nephrotic syndrome ?

Answer is :
Urine albumin less than 4mg/dl for 3 conservatives early morning sample.
Steroids resistance of nephrotic syndrome?

A.when 4 weeks daily with steroid and no responde
B.when 8 weeks
C.12 weeks
D.1 year
Answer is : A
DkA aim of management of glucose was 30 mmol?

A.glucose decrease 3mmol/hr
B.glucose decrease 6 mmol/hr
C.rapid decrease in glucose
D.aim to keep glucose not more than 18 mmol
Answer is : A
Dka in neonate needs of glucose is?

A.2ml/kg D10
B.2ml/kg D12.5
C.10 ml/kg D10
D.4 ml/kd D12.5
Answer is :A
Congenital Qt prolongation presented with pneumonia which antibiotic we should avoid:

Answer is :macrolide
2 yrs Child with bloody diarrhea , microhematuria , skin rash

Lap show low hg low plt :
A.Itp
B.Ttp
C.Hus
Answer is :C
Child diagnosed with Measles father doesn’t believe in vaccines:

A.Treat child ignore father
B.Correct father myths
C.Call ethical committee
D.Call child prepared
47
Answer is :B
Case of child with anemia and have 2 sister same condition they are at strict dite with
mild cbc shows anemia HB 3
Retics 3 mild elevated microcytic hypochromic microcytic
Ferritin is low 9
Diagnosis ?
A. SCA
B. Alpha thalassemia
C. IDA
Answer is :C
child with supracondylar fx with loss of pulse what is the best next step?
A. Surgical exploration
B. Observation
C. Closed reduction
Answer is :C
Child loss 1 kg, fatigue despite increase in appetite and thirst, diaper changed multiple
times, Glucose 25 what will confirm dx?
A. Glucose glycinate
B. Urine dipstick
Answer is :B
2 months baby came with clear symptoms of hypothyroidism +ve family hx of immune
disease Lab was high TSH and normal T3 T4
A. give levothyroxine for 1month
B. give levothyroxine for life
C. prednisone for 6 months
D. reassure:B
Answer is B
Child with Nephrotic syndrome What medication should be avoided in management ?

A. aspirin
B. amoxicillin
C. ibuprofen
Answer is :C
9yrs old with RLQ pain and rebound tenderness what's confirmatory test?
A. US abdomen
B. MRI abdomen
C.CT abdomen
Answer is :A
48
Exact case, this is the only information given: Child presented with pallor and
failure to thrive. Labs as follows: Hb low, retics 5%, MCV low What is the most
appropriate management:
A. blood transfusion
B. intramuscular iron
C. oral iron
D. (also another form of iron)
If the Hb less than 5dl or hematocrit less than 15 % >blood transfusion

Otherwise we give Iron supplement
2 yr with pic meningitis neck stiffness cant flex legs and head together knee reflex intact
came from Africa analysis CSF : viral, I think there was sore throat or white spots in the
mouth
A. corona
B. polio
C. coxsackie
D. EBV
Answer is :D
Most common cause of vomiting in pediatrics :

A.celiac ds
B.Uti
C.DKA
D.cyclic vomiting syndrome
Answer is :B
A baby who has a hx of atopic eczema, has a history of cough during nights, it is
increasing with time, his parents are worried, dx:
A.Bronchial asthma
B.Pneumonia
C.I dont remember the other choices
Answer is :A
Children minutes exercise:

A.60 min
Answer is : A
49
4 y/o boy brought by his mother. Examination reveals multiple cafe-au-lait spots.
The mother says “it’s a common birthmark in our family”. What is your best
action?
A.Send her for genetic counseling
B.Educate her on NF type 1
C.Confirm the diagnosis with genetic studies
D.Reassurance
Answer is: A
Egg allergy; vaccine contraindicated:

A.Yellow fever vaccine
Answer is: A
15-month-old patient with recurrent chest infections; with a family hx of brother

with similar condition who passed away at the age of 10 months. Which of the
following vaccines do you defer until he is seen by an immunologist?
A.Varicella
Answer is: A
Pediatric child can role play asking what developmental age?

A.2
B.3
C.4
D.5
Answer is :A
2 weeks old presentes with a hx of vomiting after 1 hr from feeding and passes
stool 3x per day. Upon examination, a small upper abdominal mass was felt.
Asking about initial investigation?
A.Barium swallow
B.Abdominal US
C.Abdominal X-ray
D.CT-abdomen
Answer is: B
A 12 y/o boy presents with maldigestion. He has greasy foul smelling diarrhea
and is having trouble gaining weight. He also feels lethargic most of the time.
BMI: 16; Hb low. Which of the following is the best diagnostic test?
50
A.24 hr stool fat collection
B.Anti-endomysial antibodies
C.Lactulose breath test
Answer is: B
Child needs non-invasive MV (BiPAP). Where do you administer it?

A.ER
B.Pediatric ward
C.Pediatric ICU
D.Neonatal ICU
Answer is: C
24 months old child came to clinic with his mother for taking hepatitis A vaccine, The
mother tells you that he is a know sickle cell disease patient and that he received
blood transfusion 1 week ago, what to do:
A. Give vaccine as per schedule
B. Check his hep A serology first
C. Delay for one month
D. Delay vaccine for 6 months
Answer is : A
Kid with inspiratory stridor, mild respiratory distress, hoarseness of voice, barking
cough which of the following is concerning symptoms: -
A. Tachypnea
B. Expiratory stridor
C. Nasal flaring
D. Blue lips
Answer is : D
Pediatric I don’t remember the age came with decrease appetite to food very pale very
tired she does not eat well she have IDA nail I think her hb was 9 all the lab lead to IDA *
very tiered but not lethargic with all the sx of anemia *WHAT TO GIVE
A. transfuse RBC
B. ORAL FERROUS
C. IV iron
Answer is : B
7 years old (age is correct) RLQ pain, vomiting, decrease in appetite, no bloody stool was
mentioned, which of the following is right about dx:
A. Not common < 3 years
B. Happen in 2% of population
51
Answer is : A
Child with mild fever and bilateral conjunctivitis and abdominal pain subsided 2 weeks
ago now on x-ray follow up you found bilateral lung infiltration, most common pathogen?
Moraxella catarrhalis
Streptococcus pyogen
Adenovirus
Answer is : C
A Young male Presents with Altered sensorium, Fever, Nuchal rigidity And CSF
analysis shows: high protein, high cells, normal glucose :
A. Tuberculosis meningitis
B. Viral meningoencephalitis
Answer is : B
53
OB/GYN:
CTG similar to this , what the cause ?

A.MG SULFATE
B.EPIDURAL
C.OXYTOCIN
Answer is :A
PPH case , massage done , oxytocin done, in inspection you found it is due to laceration
2 cm you tried sutures is not possible , tt ?
A.prostaglandin F2alpha
B.oxytocin again
C.suppurative tt
Answer is : exploration repair
54
Type of incontinence ?
Signs and Sx of PCOS asking about what lab findings will be there?
A.FSH to LH ratio 1:3
Answer is :A
A lady goes to preconception clinic, what to give?

A.Iron
B.Zinc
C.Folic acid
Answer is :C
When is it the best time for ovulation?

A.36 hrs before LH surge
B.36 hrs after LH surge
C.At the time of the surge
Answer is : B
55
A lady goes to preconception clinic, she has epilepsy poorly compliant, what to do?
A.Reassure
B. Review meds
Answer is :B
Pt with pcos, doesn't want to get pregnant, what to give?

A.Metformin
B.Progesterone only pills
C.Combined estrogen and progesterone pills
Answer is C
A woman came with menopause symptoms, what to check to confirm the diagnosis?
A.FSH
B.LH
C. Estrogen
D. Progesterone
Answer is : A
Long scenario question about bilateral ovarian carcinoma asking about what type of
ovarian tumor is associated with CA-125 ?
A.stromal cell
B.germ cell
C.epithelial cell tumor
Answer is : C
2 previous preterm deliveries, now she’s 20wk pregnant and cervical length is 30mm,
management:
A.Immediate cerclage.
B.Follow up.
Answer is :progesteron
HPV genital warts in pregnancy:

A.Cryotherapy
B.Intralesional interferon
I don’t remember other choices.
Answer is :A
Female came complains of headache + sudden painful loss of vision, Examination: loss
of vision in right eye. CT brain : pituitary hemorrhage MRI brain: pituitary mass,hge +
compressing on optic chiasma & cavernous sinus. Best next step?
A. Close observation
B. Medical therapy
C. Inferior petrosal sinus sampling
56
D. Urgent neurosurgery referral
Answer is :D
2 previous preterm deliveries, now she’s 20wk pregnant and cervical length is 30mm,
management:
A.Immediate cerclage.
B.Bedrest.
Answer is :progesteron
Pregnant , c/o vaginal spotting, i dont remember the GA , but its the first trimester sure,
everything on examination was normal, os closed:
A.Complete bed rest
B.Terminate the pregnancy
C.Go back to normal life activity
Answer is :A
Pt with stress incontenous and urgent to void what’s the recommended first line
treatment?
A.Kegel exercise 8 weeks
B.antimuscarinic drug for 8 weeks
Answer is :A
11w pregnant with sever vomiting high BHCG and snow storm appearance on US,
diagnosis?
A.partial molar pregnancy
B.complete molar pregnancy
C.ectopic pregnancy
Answer is :B
Mother in the third trimester on biological agents for crohn’s advice her about vaccines:
A.Don’t give at all
B.Stop all vaccines until 6 months
C.Delay live vaccine until one year
D.Give all
Answer is :B
Pregnant with Rt abdominal pain clear from gyne:

A.pancreatitis
57
B.appendicitis
C.cholecystitis
D.ectopic pregnancy
Answer is :A
Complications of evacuation of molar pregnancy:

A.perforations
B.bleeding
C.amniotic thrombus
Answer is :B
During labor episotomy done, tear reachs the anal mucosa, what degree of tear:
A.First
B.Second
C.Third
D.Fourth
Answer is :D
Female came complains of headache + sudden painful loss of vision, Examination: loss
of vision in right eye. CT brain : pituitary hemorrhage MRI brain: pituitary mass,hge +
compressing on optic chiasma & cavernous sinus. Best next step?
A. Close observation
B. Medical therapy
C. Inferior petrosal sinus sampling
D. Urgent neurosurgery referral
Answer is :D
Commonnest Contraindication intrauterine device?

A.Abnormal bleeding
B.Pid
C.Ectopic pregnancy previous iud
D.Endometritis
Answer is :A
Female presented with sharp abdominal pain for 1 week. Hx of amenorrhea for 2 months.
Smoker. Hypotension, tachycardia, bhcg: 1800, all other investigations normal.
Management:
A. administer strong analgesia
58
B. Administer misoprostol
C. Refer to surgery to rule out acute abdomen
D. Laparotomy
Answer is :D
Pt with hx of 2 times stillbirth , asking how to prevent this problem in the next pregnancy,
she misses her period 2 months, she trying to conceive for 6 months , HCG is elevated :
A. Rubella
B. Varicella
C. Influenza
Answer is :A
Pregnant 42 week admitted to induce labour, everything normal, later fetus had
bradycardia what to do?
A. Oxygen Mask
B. Changmotherposition
C. Urgentcs
Answer is :stop oxytocin
A case of concealed abruptio at 34+2 days what next ?

A. US
B. Cardiotocography
C. IOL
D. CS
Answer is :A
pregnant 39 weeks in labor on epidural anesthesia and oxytocin but there is no
contraction with persistent bradycardia what to do ?
A. Stop infusion of epidural anesthesia
B. Stopoxytocin
C. GiveMgSo4
D. CS
Answer is :A
A patient had two previous second trimester abortions with dilation and curettage
presents in her
early first trimester with bleeding and passage of clots. What is the cause?
A.cervical incompetence
B.chromosomal anomalies
C.asherman syndrome
Answer is : B
If multiple D/C > asherman syndrom

59
A primigravida (at 28 weeks?) and a heavy smoker presented with severe vaginal
bleeding and abdominal pain. Most likely cause is
A. Rupture Of Fetal Artery
B. Uterine Rupture
C. Vasaprevia
D. Placenta Previa
Answer is : abruptio placenta
Pt with high grade fever, tender cervical lymphadenopathy, exudate tonsils, next mx?
A.Swab culture
B.Rapid antigen detection test
Answer is :B
Female with ascites , pleural effusion, bilateral ovarian tumor, what help to determine the
Dx?
A. MRI
B. CT
C.Screening for genetic carcinoma
D. US
Answer is :D
Lady who has urine leak when sneeze, cough, laugh, and urge to void, what type of
continence:
A.Urge continence
B.Stress con
C.Mixed con
Answer is : C
Old lady diagnosed with valvular cancer in situ:

A.Vulvectomy
B.Wle
Answer is
If valvular carcinoma in situ > TTT is by either WLE , laser ablation or skinning
vulvectomy
The most common vulvular cancer?

A.Scc
B.Bcc
Answer is : A
60
Multiparous patient came with presentation of cystocele (bulging mass). How to confirm
diagnosis?
A.Urodynamic studies
B.Retrograde cystourethrogram
Answer is:
Late decelerations indicate:

A.Uteroplacental insufficiency
Answer is: A
Pregnant complains of vomiting multiple times; dry mouth with white plaque “I’m not
sure”.; decreased skin turgor; urinalysis ordered. What finding in UA will confirm
diagnosis?
A. Leukocyte
B. Proteins
C. Ketones
D. Glucose
Answer is: C
Premenstrual syndrome (affect her performance at work). What is the main aspect of
this?
A. Irritation
B. Depression
C. Anxiety
Answer is: A
Postmenopasual with AUB for long time and sx of atrophic vaginitis. Best investigation
to establish diagnosis:
A. Endometrial biopsy
B. US-guided biopsy
C. Laparoscopy
Answer is: A
PPH not responding to uterine massage and infusion 20 oxytocin. What is next?
A. Give 10 unit 10 oxytocin
B. Another medication
C. Hysterectomy
Answer is: A
Common complication of uterine evacuation:

A. Perforation
61
B. Infection
C. Bleeding
D. Abscess
Answer is: C
35 y/o female her mother had breast cancer and sister had ovarian cancer. What the best
screening test for her?
A. Breast US
B. Mammogram
C. CT pelvis
Answer is: B
Woman presented to ER 15 days after CS complaining of persistent vaginal bleeding. BP

110/70; HR 85; T 38.1. What is the diagnosis?
A. Mastitis
B. Endometritis
C. Wound infection
D. Retained products of conception
Answer is: D
Female came to pregnant k/c ulcerative colitis before 3 yrs on mesalamine. Recurrent
attack last one before 3 m.
A. Delay pregnancy for 3 mo
B. Delay pregnancy for years
C. She cant be pregnant now because she is sick and baby is not complete
Answer is: Incomplete
PPH not responding to oxytocin and massage what you will do next :
A.B lynch
B.Hysterectomy
C.Uterine Vessel ligations ?
D.Angioembolization
Answer is : A
An unscheduled pregnant 34 y/o comes to ER with vaginal bleeding

On physical exam you see her tummy is 34 inches
But the rest of her is asymptomatic and she is doing well.
What’s the most appropriate thing you’ll do?
A. Lab tests
B. Ultrasound
62
C. Admit to ward
D. Pelvic exam
Answer is : B
PPH not responding to oxytocin and massage what you will do next :
A. B lynch
B. Hysterectomy
C. Uterine Vessel ligations
D. Angioembolization
Answer is : A
30 Y.O female with jaundice and yellow sclera started 2 weeks ago. No flapping tremor or
stigmata of liver failure.
LFTs: High AST(1400), ALT(1300), GGT (70?), Bilirubin High direct and indirect
US: biliary strictures and dilatation
Next step in management?
A. discharge with F/U
B. admit and start iv dextrose
C. order PT & INR
D. refer to liver transplant
Answer is : C
Urine Dipstick pic with: +2 protein

Very high glucose +ve ketone In pregnant lady 39 wk with effacement 90% and cervix
dilation 2 cm, what is your most appropriate action?
A. IOL
B. CS C
C. expectant management
Answer is : A
Pt post partum you found laceration in lateral vaginal wall, boggy uterus on palpation,
with bleeding, management:
A.IV oxytocin
B.other surgical...
Answer is : A
36 weeks pregnant presented with constant abdominal pain, progressive, O/E tense
abdomen, tender, uterus corresponds to 34 weeks of gestation, Cervix closed:
A. Abruptio placenta
B. Placenta previa
C. Vasa previa
Answer is : A
63
Topics:
-MULTIPLE QUESTIONS ABOUT COPD MANAGEMENT
-KAWASAKI DISEASES , PERTUSSIS, epiglottis, (whooping , barking cough), post manposal
bleeding and post parting bleeding, small bowel obstruction
- oxytocin hyperstimulation syndrome with CTG
- MgSO4
- abruptio placenta
- SCC of vulva
- preeclampsia
- threatened abortion

8th of December

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

8th of December

Uploaded by

Copyright:

Available Formats

SMLE 2019

Please don't hesitate to contact us if you have any correction, comments or

Pediatric with Minimal change disease with nephrotic syndrome

Patient from the Mediterranean region with anemia and fever

Patient with 2 previous syncope episodes during in the bathroom

COPD on monotherapy , not controlled what to add?

What is the diagnosis?

Answer is : molluscum contagiosum

PE indication for thoracentesis ?

Patient diagnosed with hypothyroidism, given thyroxine after 2 weeks there is an

Pre-diabetic, what to to do beside exercise >150min:

Pt with CKD have risk of DVT what to give ?

I also got the pathophysiology of celiac disease

One patient has to avoid food rich in potassium, what to avoid:

Percentage of adult saudi male smokers?

Most appropriate management of mild luminal stenosis (MRI finding)in elderly 60 i

Osteoarthritis, HTN , DM , CKD What to give

18 y old , present with tachycardia sweating visual hacculinatio agitated psychomotor

Patient with symptoms of hypothyroidism Labs (TSH high T4 low)- (Thyroid

Scenario of brucellosis FREE from neurological sx , Rx ?

Pt post PTC has fever, on PR exam ant. Boggy mx ?

Disease commonly cured by splenectomy :

Patient developed symptoms of pneumonia associated with symptoms of

pt with vitiligo and convulsion ?

Pic of down syndrome?

Woman came back from Jeddah complaining of myalgia, headache &

Acilivir treated pneumonia precaution

Tuberous sclerosis pt ,What genetic test u will request ?

Mitral valve stenosis, when do you consider it critical?

Pt have high BP and mild BPH what to give?

Pt with bilateral hydronephrosis with dilated bladder and proximal urethra?

70 years old lady, complains of jaundice, anorexia and weight loss.

Patient kc of gerd. Taking esomeprazole 20 mg not improved what to do?

pt asymptotic with severely aortic stenosis what you will do?

Patient diagnosed with major depression complaining of excessive thirst and

18 y old , present with tachycardia sweating visual hacculinatio agitated psychomotor

Female 42 years hx varicose vein 20 years ago

Male came for presport screening asymptomatic

Patient with HV and LV dysfunction give:

6th Cranial nerve affected​:

Pt with multiple vomiting, ECG show flat t wave ?

Preventable factor for dyslipidemia and coronary heart disease in a “female”:

COPD pt ph 7.2 in severe distress:

CBT or SSRI as initial treatment in adult

Initial Dx investigation for Alzheimer disease:

RA with inflammatory knee swelling joint aspiration WBC 30000

Systemic steroid is combined with DMARD as initial treatment of RA flare up

Inferior MI ask about diagnosis.

Pt with Multiple vomiting times associated condition ?

Case of Community accouer pneumonia what is the abx

Patient with symptoms of dementia + gait disturbance

IBS what to do?

Pt had chest pain recently come at rest?

Hx of business man travel to asia a lot with candida features

Multiple antrum ulcers , by Bx >H pylori what is the mx ?

What is the most sensitive for TB pleural effusion?

Female in her 60s; high Ca, high PTH, low PO4

High grade esophageal dysplasia:

If associated with collection or sign of infection > surgical drainage

Red-man syndrome: case of vancomycin. What to do?

Population cancer screening:

Alzheimer’s pt with hallucinations; no organic cause. What medication to use?

Old pt with hx of recent travel; came with difficulty arousing/awakening. He reports

Recent history + difficulty arousal and awakening > post concusion.

6th Cranial nerve affected:

Pt for elective lap coly found to have stomach mass, what to do ?

Zone I and Zone III > CTA

if symptomatic > Surgical exploration