SMLE 2019

TH
16 OF DECEMBER

Glory Team

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

suggestions.

Teamglory2020@gmail.com

Medicine: 2-13
Surgery: 14-17
Pediatric: 18-22
OB/GYN: 23-25
Ethics: 26
GloryGroup 16th OF DECEMBER

Medicine
● Old patient with vomiting developed hemoptysis; what’s the best diagnostic test?
Answer is: ​Endoscopy

● Case of WPW management:

Answer is:
Tx for Wolff-Parkinson-White syndrome:
➔ Stable: procainamide
➔ Unstable: cardioversion
➔ Refractory: radiofrequency ablation

● Patient with recurrent episode of palpitations :

A. Echo
B. ECG
C. Holter monitor
Answer is: C, if one episode and ECG was normal you can reassure

● Pt took 20 pills of acetaminophen admitted with RUQ. Abdominal pain (didn’t

mention liver enzymes); what is the best management?
A. Follow up after 4 hours
B. Charcoal
C. N-acetyl-cysteine
Answer is: C

● Lab findings of HBsAg +ve and anti-HBc +ve

A. immunity due to active infection
B. Chronic infection
C. Immunity due to vaccination
Answer is: If IgG > B, if IgM > Acute

● Drug causing SLE flare ?

Answer is: Sulfa

● Management of pt diagnosed with SLE developed lupus nephritis ?

A. steroid + mycophenolate
B. steroid + methotrexate
C. steroid + cyclo
Answer is:
RENAL Involvement
GloryGroup 16th OF DECEMBER
➔ SLE with mild nephritis: corticosteroids ➔ SLE with severe nephritis (rapidly progressive,
diffuse proliferative, or severe proteinuria and active urine sediment) :
corticosteroid + cyclophosphamide

● 45 y/o male presented to you complaining of severe chest pain that started an
hour ago. He experienced a similar episode of chest pain twice about two weeks
ago, but it had resolved spontaneously.
A. MI
B. Anxiety
Answer is: B

● Smoker + horner syndrome type lung cancer :

Answer is : Squamous cell
Horner syndrome > Pancoast tumor > SCC

● Smoker with bronchogenic carcinoma type

Answer is: Squamous cell

● Chronic thromboembolic pulmonary hypertension* highest diagnostic yield

Answer is : V/Q scan
chronic thromboembolic pulmonary hypertension (CTEPH)
(V/Q) scan is the best initial imaging procedure of choice.
*If V/Q suggested positive CTEPH >* right heart catheterization and pulmonary angiography are
indicated to confirm pulmonary hypertension.
— Dr. Mohtadi
Full scenario
Patients with pulmonary hypertension, you Suspect chronic thromboembolic disease, What
would give the best diagnostic value
A. echo
B. catheterization
C. V/Q scan
D. spiral CT with contras

● Smoker + ​High​ dysplasia esophagus next step =

Answer is: surgical resection

● Smoker Lung cancer with hypercalcemia =

Answer is : sequams cell

● Female with infertility for 3 years, came to the clinic, anxious, worried depressed.
WOTF is positive body language:
A. eye contact
B. fiddling with hair
GloryGroup 16th OF DECEMBER
C. nail picking
D. scratching
Answer is: A

● Elderly k/c of BPH, asymptomatic, not on medications. Came to clinic with

multiple times of high BP readings. investigation: normal UA and no signs of
ventricular systolic dysfunction on echo What's the most appropriate advice?
A. book an appointment for BP determination
B. advice exercise
C. start him on Amlodipine ​CCB
D. start him on BB
Answer is: C

● Pt with left UC, presented with s&s of flare, what is the best next step in the
management?
A. Azathioprine
B. Sulfasalazine
C. oral budesonide
D. IV methylpred
Answer is: C, if severe attack > D

● Rt. Pleural effusion, what is the site for needle to get pleural fluid?
A. Midaxillary 6th
B. Midaxillary 9th
C. midclavicular 6th
D. midclavicular 9th
Answer is: B, ​Thoracentesis: 8th-10th mid axillary line.

● Patient with inferior MI treated at hospital then 2 days later come complain of SOB,
bilateral basal lung crepitation:
A. Papillary rupture
B. Acute Rt. HF
GloryGroup 16th OF DECEMBER
Answer is: A
Papillary muscle rupture:​ acute life threatening MR -> pulmo edema /hypoTN. Silnt or Soft
new murmur.
Intraventricular rupture​: early onset post mi. Harsh systolic murmur over llsb. Look for pulmo
HTN, right side hf.

● ICU patient for 2 weeks on parenteral nutrition All labs normal except INR 2s
A. DIC
B. VIT K deficiency
C. factor VII deficiency
D. Chronic liver disease
Answer is: B

● Old with productive cough , Fever ,Dyspnea + crepitation + bilateral right middle
lobe *Cold agglutination test positive:
A. Atypical pneumonia
Answer is: A,
Note: High reticulocytes and cold agglutination usually with mycoplasma pneumonia which is
atypical pneumonia.

● productive cough and fever given antibiotics he become ok then worsen (SOB) sx
x ray show pleural effusion dx ?
A. parapneumonic effusion
Answer is: A

● chest x ray they found trachea shifted to left :

A. right lung collapse
Answer is: ​right lung hyperinflation

● Case of lobar pneumonia with ​moderate effusion ​what is you mx :

A. Ceftriaxone and vancomycin with ​thoracocentesis
Answer is A

● Pt with central line and now had fever and infection in site of previous dialysis​ :
A. culture IV abx and remove the center line
Answer is A

● 51 year with fever, headache & neck rigidity = organism :

A. Streptococcus pneumoniae
Answer is A “most common cause”

● Pt with pneumonia coming with ​hypotension​ (90/60) and ​lethargy​, pulse was 160
,T 38.5​ :
GloryGroup 16th OF DECEMBER
A. septic shock
Answer is: A
Septic shock: sepsis with hypotension despite adequate fluid replacement.

● Pleural friction rub :

A. pneumonia
Answer is ​A
Pleural friction rub > purisity, pneumonia is a common cause.
Pericardial friction rub > Pericarditis

● what time taken for patches on x ray of Lobar pneumonia to *disappear* ?

A. 6 wks
Answer is: A

● pt admitted to medical word with pneumonia pt is agitated, confused:

A. keep the family
Answer is: A

● treatment of Community-acquired pneumonia?

A. Fluoroquinolones
Answer is: A outpatient= macrolide/ inpatient= fluoroquinolone

Management of community acquired pneumonia before results of the culture

A. Moxifloxacin 400mg IV one daily
B. meropenem iv every 8h
C. piperacillin and tazocin every 6 h
Answer is A
best antibiotic to treat community acquired pneumonia in healthy adults?
A. fluoroquinolones.
GloryGroup 16th OF DECEMBER
B. vancomycin
Answer is A

● Case of a cancerous pt did multiple pleural tap due to pleural effusion with no
improvement, next?
A. Chemical pleurodesis.
Answer is: A

● Patient know case of idiopathic ​bronchiectasis​.. presented c/o progressive SOB

over the past 2 month and dry cough on physical examination decreased airway
entry entry bilaterally with coarse crepitation "give :
A. Prednisone
Answer is: A

● Proper Pt position how check :

A. Co2 monitor
Answer is: A for intubation.

● CO2 poisoning hbco 40% tx:

A. Hyperbaric

● Burn case black soot over nostrils and mouth ​40%​ carboxyhemoglobin. (Carbon
monoxide toxicity):
A. Hyperbaric oxygen.
B. Intubation and ventilation with 100% o2.
C. 100% O2
D. Carbonic anhydrase inhibitors.
Answer is: C, Hyperbaric O2 is indicated but since there’s sign of inhalation injury > elective
intubation with 100% oxygen .

● Emphysema, progressive dyspnea. ABG high CO2 and high O2 Your

management:
A. intubation and hyperventilation ( not give high oxygen) Answer is: A
GloryGroup 16th OF DECEMBER

● Lung cancer + found nodule on the lung :

A. Ask about previous X.ray
Answer is: A

● Midline mass compressed trachea :

A. Lymphoma.
Answer is:
Other recall: Dyspnea at night, sternal pain, midline mass compressing the trachea
a. Thymoma
b. Goitre
C. lymphoma
D. lung cancer
If neck mass> goiter will be more accurate,
If middle mediastinum mass > lymphoma

● Pt came with lymph node enlargement with son of uncle diagnosis lymphoma
indicated biopsy :
A. Fever
Answer is:

● After mechanical ventilation what will happen:

A. hypocapnia (Decrease co2)
Answer is: A

● Bronchiectasis definitive dx test:

A. HRCT (High-resolution computed tomography)
Answer is: A

● Smoker + hemoptysis or hoarseness :

A. bronchogenic ca
Answer is: A

● Pt with leukemia Which lymph node enlargement :

A. Cervical
B. supraclavicular >> be careful with GI carcinoma
Answer is: A

😑
● Case of colangitis asking about diagnosis:
Answer is: go read

● ALL patients after treatment , asking about lab abnormalities:

answer is: hypocalcemia (tumor lysis syndrome)
GloryGroup 16th OF DECEMBER

● Case of patient with ​diarrhea​ asking about electrolytes abnormalities :

A. ​hypokalemia
Answer is: A

● Left eye ​unable to abduct,​when looking forward there’s squint towards the nose
which nerve affected:​
A. Left 6th
Answer is: A

● Which lung condition associated with developing TB ?

A. asbestosis
B. acanthosis
C. farmer's lung
can't remember the rest
Answer is: Silicosis

● COPD patient presenting with bilateral lower limb edema and pulmonary
hypertension. PO2 8.6, PCO2 7.5, pH within normal range Which of the following is
the appropriate management?
A. start furosemide
B. Start oxygen therapy
C. Prednisolone therapy
Answer is: B

● Multiple sclerosis, came with gait imbalance fatigue, blurry vision. MRI showed a
new lesion. What is the tx?
A. Azathioprine
B. High dose steroid
Answer is: B because its a flare up of the disease
By our amazing mohtadi ♥
Corticosteroids for acute attacks of MS.
Otherwise patient should be started with disease modifying therapy such as interferon or
Glatiramer acetate.

● Case of ​arthritis & malar rash, mouth ulceratio​n. Which of the following confirms
the dx:
A. Anti-Ds DNA
B. ANA
C. Anti-SSA
D. anti SSB
Answer is A, btw the ulcer should be painless and it’s part of the diagnostic criteria
GloryGroup 16th OF DECEMBER
● DDP4 inhibitor can be used safely in patients with renal disease?
A. Linagliptin
Answer is A

● ECG with ST elevation in lead 2,3, avf ​best management:

A. Heparin
B. PCI
C. Thrombolytic
Answer is B

● 50 years old man admitted in orthopedic due to fracture, and suddenly SOB. there
is ECG with picture of ​S1Q3T3​.
A. Pulmonary embolism
Answer is: A

● 20 years old patient with upper respiratory tract infection. Came with retrosternal
pain and ECG showed diffuse st elevation.
A. Pericarditis
Answer is: A

● Patient with epigastric pain. Not responding to h-pylori treatment. Endoscopy

shows multiple ulcers in the antrum and distal duodenum. Which of the following
test will help you to diagnose?
A. Urease breath test
B. Gastrin level high after injecting sectretin
Answer is B
Zollinger–Ellison syndrome
➔ Elevated Gastrin level
➔ Recurrent ulcers in unusual sites like 2nd part of duodenum
➔ PUD not responding to medications

● IM resident doe got to close the curtain while examine the patient's foot what is
the ethical principle he broke?
A. Privacy
B. Dignity
Answer is: A

● Indian​ with Nausea and vomiting fever and jaundice and ​convulsion​?
A. Yellow fever
B. malaria
Answer is B
GloryGroup 16th OF DECEMBER
● Patient with cardiomyopathy now presents with sudden onset abdominal pain
exam soft amylase high
Answer is: mesenteric vascular occlusion

● 70 yrs old man k/c of IHD, central abdominal pain vitally stable, ​amylase 600,​ WBC
normal, abdominal x ray: dilated small bowl with thickened wall: what’s the dx:
A. Pancreatitis
B. Intestinal obstruction
C. Perforated ulcer
D. mesenteric vascular occlusion
Answer is:

The sentinel loop sign may aid in localizing the source of inflammation. For example, a sentinel
loop in the upper abdomen may indicate pancreatitis, while one in the right lower quadrant may
be due to appendicitis.

● HCV with 4 cm lesion, AFP High:

A. Chemo
B. Radio
C. Sx resection
Answer is: see note below

● Same Q HCV with 6cm lesion

A. Chemo
B. Radio
C. Sx resection
Answer is: see note below
HCC:
GloryGroup 16th OF DECEMBER
A- Non Cirrhotic:
➔ Less than 5cm : Resection
➔ 5 cm and more: TACE (TransArterial ChemoEmbolization)
​B- Cirrhotic:
➔ <2cm + Single mass + Child pugh A without Portal HTN: Resection
➔ HCCs masses Less than 3cm :RFA
➔ Larger Masses (>3cm) : TACE
➔ Milan Criteria For Liver Transplantation :
◆ Single mass + 5 cm or less
◆ 3 HCCs + 3 cm or less

● Risk factor for HCC

A. Aflatoxin
B. HBV
Answer is: B

● Pt had chronic ​constipation​ what you will give everything was normal ?
A. sena
B. lactulose
C. debulking agent
Answer is: C

● Patient with pyelonephritis now has saddle embolus PE, ​unstable​ what to do
A. Heparin and warfarin
B. Alteplase
C. IVC filter
Answer is: B
★PE
➔ If stable > Enoxaparin
➔ If stable and anticoagulants contraindicated > consider IVC filter.
➔ If unstable > thrombolytics
➔ If unstable and thrombolytics contraindicated > embolectomy.

● patient with CHF came for follow up he is on ACE, diuretic and PPI what to add X
ray normal
A. Nothing
B. BB
C. ARB
Answer is: B

● Patient known case of RA now presents with acute knee pain swelling, redness
and effusion showed WBC of 3500 cultures pending, febrile and tender on exam
what to do
GloryGroup 16th OF DECEMBER
A. IV abx
B. high dose IV steroid
C. Intra articular steroid
Answer is: A

● Pt with RA acute flare what to give

Answer is: NSAID

What’s the Best initial for symptomatic control > ➔ Nsaids (they work immediately to improve
inflammation).
● The most important in RA is to prevent progression of the disease :
➔ methotrexate to slow disease progression, neither Nsaids nor steroids stop RA progression.

When to use steroids?

➔ If acute flares not responding to Nsaids or as a bridge when waiting DMARDS to take effect,
DMARDS are much slower in onset of action than steroids.

● COPD came with exacerbation low O2 82%, acidosis, cyanosis throat full of
secretion what to to
A. Oxygen mask
B. Intubation
Answer is: B

● Young pt with bloody diarrhea colonoscopy showed multiple polyps

A. FAP
B. UC
Answer is: B

● Patient wanna go to south Saudi what to give for malaria ppx

A. atovaquone/proguanil
B. Mefloquine
C. Chloroquine
Answer is: A

● IBD not responding to RX what to ve

A. CBT
B. Psychotherapy or analysis
C. Amitriptyline
Answer is: C, they mean IBS ‫اﻛﺘﺒﻮا اﻟﺴﻮال زﯾﻦ اﺛﺎﺑﻜﻢ اﷲ‬

● Calculate the CHADS2 score for a 64 year old male, diabetic, hypertensive with a
history of stroke.
A. 2
B. 3
C. 4
D. 5
Answer is: Self study
GloryGroup 16th OF DECEMBER

Surgery
● Pt with painless rectal bleeding
A. abscess
B. sinus
C. hemorrhoid
Answer is: C, unless thrombosed it will be painfu.

● Pt presented after an RTA; liver is 70% lacerated. What to do?

A. Right lobectomy
B. Right hepatic artery ligation
C. Ligate bleeding vessels only
Answer is: if stable: conservative, if not: Packing then ligate the bleeder.

● Nodule in the left lobe of the thyroid since 3 years with no lymphadenopathy.
Report: (??)
A. FNA
Answer is: incomplete.

● Nodule in the left lobe of thyroid; biopsy revealed follicular carcinoma (Bethesda
IV); no lymphadenopathy.
A. Left hemithyroidectomy
B. Total thyroidectomy
Answer is: A

● pt with hepatitis presented with perforated ulcer now he has high INR 2, low PLT
and low hgb what to give him before OR
A. Plt
B. Blood
C. Vit K
D. Cryoprecipitate
Answer is: B
GloryGroup 16th OF DECEMBER
● Post operative has dyspnea and hypoxemia :
A. lower lobe atelectasis
Answer is: A

● Orotracheal intubation how i know i'm on the normal position :

A. continuous capnography
Answer is: A

● Breast mass, lost weight with pleural effusion, most likely?

A. Exudate
Answer is: A

● Male 30 year after road traffic accident came with distended abdomen. ​Tender and
cold limb, JVP flat​. Blood pressure 80/50. HR 137.
A. Septic shock
B. Cardiogenic
C. Hemorrhagic
Answer is: C

● Chromosome for alzheimer

A. 15
B. 17
C. 21
Answer is: C

● Female with recurrent fainting episodes, skin pigmentation, hypoglycemia. What

is the specific test to order?
A. Cosyntropin
B. 1 mg dexamethasone
C. Cortisol level
Answer is : A
The most specific test for Addison disease is the Cosyntropin test >> Cosyntropin is synthetic
ACTH, in normal people it should cause a rise in cortisol level.

● Pt with s/s of GERD, last vomit was bloody. Endoscopy revealed multiple ulcers
(case of zollinger) what is the most app?
A. Fasting gastrin level
B. Calcium
C. Vasoactive intestinal polypeptide
Answer is: A

● Male patient presenting with sudden epigastric pain, examination showed

sluggish bowel sounds. Amylase level was 300. Which of the following is best
next investigation?
A. erect CXR
B. Abdominal CT scan
C. Abdominal x ray
D. Abdominal US
Answer is: A
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● Bethesda 4, there was no lobectomy:

A. Heimithyroidectomy
B. Nodule removal (or sth)
Answer is: A

● question about liver lesion PT complaining of rt abdominal pain for 3 m / report

shows / ​hypervascular​ ​lesion​ , lab shows increased AFP :
A. HCC
B. hepatocellular adenoma
Answer is: A

● Patient bleeding from ​angiodysplasia​ left side

A. Left hemicolectomy
B. Angio-embolization
C. Endoscopic laser ablation
Answer is:

● After lap choly, pt came back with jaundice and RUQ pain, us shows minimal fluid
and CBD measures.... ALP was high?
A. Retained stone
B. CBD injury
Answer is: A
Post cholecystectomy patient came with jaundice, high ALP, u/s shows 9mm
CBD(dilated), most likely diagnosis:
A-retained CBD stone
B-CBD injury

● Old lady with femoral hernia:

A. Open with mesh
B. Lap repair (didn’t say with mesh)
Answer is: A
GloryGroup 16th OF DECEMBER

● 20 years old female with breast mass 3x4 freely mobile not attached to the skin ?
A. Fibroadenoma
Answer is A

● Mother has difficulties with breastfeeding because of inverted nipple

A. fibroadenoma
B. carcinoma
C. cyst
D. duct ectasia
Answer is: D

● Guy was carrying heavy thing and suddenly felt lower abdominal pain/ swelling
not changing in size with muscle contraction or something like that low Hgb
Answer is: Rectus sheath hematoma

● Hydatid cyst with multiple daughter cysts management:

A. percutaneous drainage
B. Surgical de-roofing
Answer is: B

● Single hydatid cyst with calcification management:

A. percutaneous drain
B. Surgery
C. Metronidazole
Answer is: B

● Elderly presenting with a picture of ascending cholangitis . What's the best

management?
A. ERCP
B. Lap chole
C. Percutaneous cholecystostomy
Answer is: A

● Male patient presenting with sudden severe epigastric pain, he has a positive
history for chronic use of NSAID for controlling knee pain.
Which of the following is the best next investigation?
A. erect CXR
B. abdominal X-ray
C. Abdominal US
D. Abdominal CT
Answer is: A
GloryGroup 16th OF DECEMBER

Pediatric
● Newborn with sudden SOB, CXR showed right upper hyperlucency with
mediastinal shift to the left. What’s the next step in management?
A. intubation
B. thoracotomy
C. thoracostomy
D. oxygen mask
Answer is: C

● Pt with frontal bossing with labs showed low vitamin D and calcium; which of the
following will give high hint to the diagnosis?
A. X-ray showing cupping of epiphyseal
Answer is: A

● Case of IDA 15 yo.

A. Oral iron
B. IV iron
Answer is: A

● Kid spitting what is a red flag?

Answer is: A

● FTT
A. Kid with nephrotic syndrome now presents with vomiting clear with food and abd
distention
A. Gastritis
B. Peritonitis
Answer is: B

● 13 month old girl with suspected pneumonia (it did say that) long scenario, RR 35,
to be admitted, reason for admission?
A. Age
B. RR 33
Answer is:
Admit the child if pneumonia with one of the following:-
➔ Apnea or grunting
➔ Oxygen sat < 92%
➔ Poor feeding
➔ RR: > 70 in infant, > 50 in older
➔ Inability to tolerate oral
➔ comorbidities (chronic lung disease, asthma, DM).
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● Child c/o fever ​sore throat coryza​ for 4 days then start pink macular rash on face
then arm and leg and before ​rash start there was a small white patch in mouth​;
what’s your diagnosis?
A. Measles
Answer is: A

● Picture of a baby with distended abdomen on exam undescended testis bilateral

hydronephrosis and distended bladder.​.
A. Prune belly syndrome
Answer is: A

● Infant with greenish vomiting then yellow on PE distension

Answer is: ​Surgical abdomen long list of ddx please try to remember the full scenario.

● Kid need CPAP where to treat him

Answer is: PICU
Kids need ??

● What is the component of ToF

A. Lt ventricular hypertrophy
B. Pulmonary stenosis
C. Aortic stenosis
Answer is: B

● Neurofibromatosis type 2 inheritance :

A. X-linked
B. AD
C. AR
Answer is: B

● Baby with bloody diarrhea what to do

A. Barium enema
B. Surgery
Answer is: Incomplete
➔ If intussusception suspected > US
➔ Polyp, IBD > colposcopy
➔ Meckles diverticulm > technetium-99m

● Kid with +ve kernig's sign, local hand seizure what to give
A. Ceftriaxone vanc and steroid
B. Ceftriaxone vanc
C. Ampicillin
D. Gentamicin
Answer is: A
GloryGroup 16th OF DECEMBER

● 6 months with signs of GER

A. ppi
B. refer to surgery
C. tell the mother that it will disappear when he grow
D. tell her to place him semisupine after feeding and bepuping (burping?)
Answer is: D
● At what age does this reflex disappear?
A. 2 months
B. 4 months
C. 6 months
D. 8 months
Answer is: A

● 2 yo developed (?) has a history of URTI and fever for 2 weeks; now pt presented
complaining of ​cough​.
On examination there were Rt lung middle zone crackles and just below it, it was
stony dullness​ on percussion; what could be the cause?
A. bronchopneumonia
B. pleural effusion
C. abscess
Answer is: B

● A 5 y/o child with ​absent red reflex ;​ there is an abdominal mass. Urinalysis
showed presence of RBCs.
A. Neuroblastoma
B. Wilms tumor
Answer is: ​could be ​WAGR​ syndrome
GloryGroup 16th OF DECEMBER

● A case of meningitis in a 15 months baby , CSF fluid analysis showed gram

positive cocci in clusters. What’s the appropriate antibiotic?
A. ampicillin
B. Vanco
C. Vanco and ceftri
D. Ampicillin and gentamicin
Answer is: C

● Another q about a child: mother discovered abdominal mass accidentally.

A. Wilms tumor
Answer is: A if flank and doesn’t cross the midline, if midline > neuroblastoma

● 16Y F short stature <5th percentile, short neck, low hairline and hypertension,
both parents short what’s the dx
A. Hypothyroidism
B. Hypopituitarism
C. Familial short stature
Answer is: Turner

● Child with bronchiolitis received supportive treatment. What is the next action?
A. Admit to PICU
Answer is: Observe in ER

● Which vaccine is contraindicated in an SLE patient who is now on

immunocompromised medication (immunosuppressants?)?
Answer is: Live attenuated vaccine.

● What is a complication of tonsilitis?

Answer is: Scarlet

● Baby his parent diagnosed TB and his test result 10mm after 72h its mean?
A. Baby is infected
Answer is: A

● Preterm​ baby, developed ​dyspnea​ and ​tachypnea​. What’s the most common
cause?
A. ARDS
B. Tachypnea of the newborn
C. Meconium aspiration
Answer is: A
GloryGroup 16th OF DECEMBER

● 3 yo child came with fever, difficulty swallowing? Membranous purulent exudate

on tonsils. What is the most likely causative organism?
A. Coronavirus
B. EBV
C. RSV
Answer is: B

● Pt had skin lesions with being crusted. CXR showed bilateral infiltrates.
A. Abx
B. Acyclovir
Answer is: B, varicella pneumonia
Smoker and on examination he is afebrile. There are crackles in the chest and vesicular rash
with some crusting on the upper trunk. There is bilateral infiltrates on CXR report. What is you
the best next treatment.
A. ​acyclovir
B. ceftriaxone and azithromycin
C. prednisolone

● 2yrs with fever and cough + Bilateral Crackles. + lung infiltrate

A. Bronchopneumonia
Answer is: A

● 11 years old girl came complaining of right ear pain with foul smelling discharge
after swimming in the community pool. Pulling on the pinna produces pain. What
is the Mx?
A. topical steroid
B. topical neomycin
C. oral steroid
D. oral amoxicillin
Answer is: B
GloryGroup 16th OF DECEMBER

Obstetrics and gynecology

● 56 y.o female being treated with ​Tamoxifen​ for breast ca, years ago there was a
uterine fibroid measures 2*3. Now on US, it’s 5*6 and endometrial thickness of
5mm, dx?
A. Endometrial adenocarcinoma
B. leiomyoma
C. leiomyosarcoma
Answer is: C

● Lymph drainage of the funds of the uterus

A. Para aortic
B. Internal iliaca
Answer is: A

● Another female with no menses; short webbed​ ​neck

Answer is: Turner syndrome

● Pregnant with twins, hx of previous C/S, baby A is vertex, baby B is cephalic,

which of the following is the cause for C/S?
A. babies presentation
B. Previous C/S
Answer is: B

● 60 y/o female with AUB, which of the following is the best next investigation?
A. endometrial biopsy
B. Pelvic US
C. Abdominal x-ray
Answer is: A

● Pregnant woman, GA 34 with a picture of pre-eclampsia. Which of the following

clinical findings might be present with intrauterine growth restriction?
A. polyhydramnios
B. Oligohydramnios
C. Elevated maternal liver enzymes
Answer is: B

● Abruptio placenta with DIC, what’s the most appropriate management?

A. C/S
B. Expectant management
GloryGroup 16th OF DECEMBER
C. Augment labor
Answer is: C ​if labor is progressing as mentioned in previous recalls

● At 34 weeks pregnant with PROM what to give her

A. Tocolytic
B. Abx
C. Steroid
Answer is: C

● Another PROM how to confirm

A. Speculum examination
B. Chemical ferning test
Answer is: A

● 14 yo F with secondary sexual characteristics stage V pubic hair and breast but
have had menstruation yet
Answer is​: ​Transverse vaginal septum

● 32 GA, Mild bleeding due to placenta previa, with Hx of multiple CS in the past.
What to do now?
A. Expectant management
B. Cs now
C. Amniocentesis for lung maturity
Answer is: A
Placenta previa
➔ Less than 34w: admission & conservative if mother and fetus are stable.
➔ Scheduled CS: if the mother stable after fetal lung maturity has been confirmed by
amniocentesis, at 36 weeks gestation.

● Pregnant lady third trimester with UTI what’s Tx

A. TMP
B. Cipro
C. Nitro
D. Ampicillin
Answer is: D

● Pregnant female with ​gastroenteritis​, What antibiotic is contraindicated in

pregnancy?
A. Ciprofloxacin
B. ceftriaxone
Answer is: A

● 30 years old female pregnant with UTI GA 10 weeks, ask about the treatment?
GloryGroup 16th OF DECEMBER
A. Nitrofurantoin
B. Ciprofloxacin
C. Ceftriaxone
Answer is: A

● Pt with mild vaginal bleeding, 8 week, unremarkable P/E except for minimal
brownish discharge (or sth) , os closed. US CRL 7 week. What’s most app?
A. Complete bed rest
B. Resume daily activity
Answer is: A

● chronic HTN in pregnancy, with no proteinuria. 1 is 7 GA, the other is 22 GA with

the same choices:
A. Methyldopa
B. Hydralazine
C. Atenolol
Answer is: A

● Patient last PAP 7 years ago which was negative and history of genital warts now
her PAP is positive for ASCUS what to do
A. HPV
B. Colposcopy
Answer is: B
GloryGroup 16th OF DECEMBER

Ethics & Biostatistics

● Abundant baby, doctor said do inguinal repair now
Answer is: Take-consent from ethical-committee

● Mother refused C/S that will be safe for the baby

A. Respect her desire
B. Vaginal deliver
C. Force the patient to have a C/S
Answer is A

● Reason for increase violence from intimate partner

A. At holiday
B. After retirement
C. During pregnancy
D. After family visit
Answer is: C

● Child need intubation but parents refused because previously his brother died
with similar situation
A. consult hospital ethics committee
B. search internet for similar cases
Answer is: intubate the pt

● patient need cs due to fetal distress but she refuses, what to do ?

Answer is: respect

● Surgeon forget infected guz in patient during operation, what to do

Answer is: Tell pt and apologize

● 18 months baby came with family, nurse inform doctor that patient never was
vaccinated in the file since birth, the parents refuse vaccines and say “ vaccines
damages the baby brain)
what is the appropriate action?
A. Refer parents to psychiatry
B. contact ethical committee
C. Explain about the vaccines and the great side of it
Answer is: C
GloryGroup 16th OF DECEMBER

You’re all awesome! Keep it up!