1- BA pt.

presented to ED with silent chest and in respiratory distress what is of the following let
intubate him ?

A- SO2 <88 %

B- anticipated deteriotation

C- Using accessory ms.

D-

2- which of the following of fentanyl side effect can not be reveres by naloxone ?

A- rigid chest syndrome .

B- myosis

C- respiratory depression .

D-

3- Pt. in explosion and burned with throw out about 5 meter and he is standing . came to ED
awake and vitally stable and you wanna to intubate him which one of the following concerning to
do RSI in this pt. ?

A- sucx. will increase K level .

B- sucx. will increase ICP .

C- Etomidate with decrease BP .

D-

4- Old age man came by red crescent due to recurrent attack of syncope an ECG showed . What
is the most appropriate next step in management ?( 2 Q for the same picture first one what is the
diagnosis the second one what is the treatment )

A- Atropin 0.5 mg IV

B- pacer .

C- Beta blocker

D-

6- What is true about bacillus anthrax ?

A- caused cavity in lung .

B- hemorrhagic mediastinits

C- Gram negative non spore organism .

D-

7- What is true regarding appendicitis investigations tests ?

A- combination low WBC and CRP can rule out acute appendicitis .

B- Low WBS alone can exclude acute appendicitis .

C- Negative CRP has high positive predictive value to exclude acute appendicitis .

D-

8- Case of epigastric pain and radiating to the back with hx. of gall stone and nausea and
vomiting and fever Non alcoholic —> clear scenario of acute pancreatitis . Vitally staple except
febrile .

What is the most appropriate next step in management ?

A- ERCP

B- CT abdomen

C- Abdomen US .

D-

9- Knee dislocation and reduced what is true ?

A- ABI < 0.9 mandate surgical exploration .

B- All knee dislocation with presence pulse need either observation or CT angio.

C-All need surgical exploration .

D-

10- Young pt. has fracture in his humerus shaft what expecting associated injury ?

A- numbness in tip of index finger

B- numbness in tip of small finger .

C- unable to abduction of thumb .

D - unable to adduction ( or flex ) of the thumb .

12- Pregnant lady G5P4 in 14 weeks presented by the ambulance because she has sever
abdominal pain and PV bleeding . What is the most appropriate next step ?

A- Speculum examination to see the source of the bleeding

B- PV examination to see the os opening and conception product .

C- abdomen US to see the placenta previa

D- PV US to see the location of placenta to OS before the examination .

13 - Young boy presented to ED of his ankle twisted and he can not bear wt. X-ray done and
showed down what is the diagnosis ?

A- triplane fracture .

B- salter haris III

C- salter haris II

D- Unstable ankle dislocation

14- Cancer patient with hypercalcemia (Ca 14) .. most appropriate treatment is:

A. NS 0.9%.

B. Bisphosphonate.

C. Urine alkalization.

15- Which of the following an indication of imaging in UTI patient? A. Pregnant lady.

B. Elderly with comorbidity.

C. A patient who has foley’s cath.

D. Young guy with renal stone.

16- Which of the following drugs would be given intranasally in prehospital settings?

A. Fentanyl . C- glucagon 

B. Epinephrine. D- steroid

17- 22 years old male with sudden onset of testicular pain and swelling and redness, with hx. of
dysuria for 3 days back testes tender and swollen, absent cremasteric reflex, what’s your
immediate action?

A- scrotal US .

B- CT abdomen

C- Discharge of Abx.

D- Urgent urological consultation .

18- Elderly with abdominal pain , distention , constipaion and vomiting . x-ray done for him as
showed below what is the site of obstruction ?

A- sigmoid .

B- Cecum

C- small bowl .

D-

19- 50 y.o male presented to ED with hx. of severe nausea and

vomiting ( non bilious ) and severe epigastric pain . you tried to
insert NGT but failed . Pt. has hx. of para eseophegeal hernia and
confirmed. CXR done and showed down . what is the most likely
the diagnosis ?

A- gastric valvolus

B- Gastric outlet obstruction .

C- intestinal obstruction .

D-

20- 24. 60 years old male k/c chronic kidney failure, HTN on Lisinopril, DM. Presented with
vomiting and decreased urine output. He was discharged 4 days back on oral moxifloxacin for a
case of community acquired pneumonia.

Vitally stable (SBP 110) FNa 0.6%, BUN 60+, Cr 38 .. what is the most likely diagnosis?

A. Interstitial nephritis.

B. Acute Tubular Necrosis.

C. Pre-renal azotemia.

21- 18 months old girl. Her mother accidentally pulled her arm and lift her up. Patient couldn't move
her arm and she’s holding her forearm in slight flexion and pronation position. Which of the
following management is true ?

A- arm sling .

B- hyperpronation maneuver .

C- flexion - supination maneuver .

D-

26. A patient presented to you after he hit his finger with a hammer.picture below Best next
treatment is:

A. Trephination.

B. Remove nail.

C. Abx. and discharge .

D.

27- infants came to the hospital with this rash . he is stable . what is the appropriate
management ?

A- acyclovir systematic and topical

B- cuettry .

C- Abx. and discharge .

D-

28- 28. Which of the following differentiate pseudo addiction from true addiction?

A. Multiple allergies.

B. Prompt pain relief after giving medications.

C. Multiple files and prescriptions.

D. Command for specific medications.

29- 65 years old male, COPD, dyspnea for 1 week, increase sputum and increase SOB .

He's conscious and alert. VBG and CXR as his base line . Nebz. and steriod started

What is the best management?

A- IV ABx. and Admission .

B- ABx. and discharge

C- NIV

D-

30- Male patient was stabbed in his back presented with inability to move his left lower limb and impaired
sensation of his right lower limb .. what is the most likely diagnosis?

A. Central cord syndrome.


B. Anterior cord L1 syndrome.

C. Anterior cord T11 syndrome.

D. Brown Squared L1 syndrome.

31- Leukemia patient post-chemotherapy session from inserted central prephiral line one week
back presented with fever 39.

WBC 2 (neutrophils 25%). What's is the best option?

A- cefipime

B- cefipime + vancomycin .

C- ceprofloxacien + vancomycin

32- 36. Term-Pregnant 36 weeks, arrested, fundal height: 4 cm above the umbilicus, positive fetal
heart, What is the management?

A. Perimortem CS after second cycle of CPR.

B. 20 minutes ACLS protocol.


C. CS if no fetal heart tone.

33- A study was conducted on two groups of people. They want to study the effects of smoking
in developing cancer during the period of 1978 to 1989. What is the study type?

A. Case control.

B. Retrospective cohort.

C. Cross sectional.

34- 38. A patient was recently diagnosed with HIV and he told you not to tell his wife.. what to do?
A. Tell his wife.

B. Tell the wife’s mother.

C. Reassurance and offer help telling his wife.

D. Respect his wishes.

35- 19 years old male developed SOB and cough after hiking.

O/E he has bilateral basal crackles.

Which of the following is the most effective action?

A. Decent.

B. Acetazolamide.

C. Dexamethasone.

D. Oxygen.

36- Drug that prevent death but doesn't cure the disease, but controls its complications?

A. Increase incidence.

B. Decrease incidence.
C. Increase prevalence.

D. Decrease prevalence.

37- 13 years old female was hit with a metal object. Presented with upper lip simple laceration
and bleeding. she applied cold compressor. Shortly after that, she developed cheek swelling.
What is the most appropriate next step?

A. Antihistamine.

B. Epinephrine.

C. Facial CT.

38- 25 years old male k/c of hereditary angioedema presented with lip swelling.

What is appropriate management?

A. DDVP.

B. FFP.

C. Platelet.

D. Epinephrine.

39- HIV pt . presented with neurological symptoms and CT brain was negative . and CD4 < 100 .
LP showed high protein and high pressure what is the most likely the diagnosis ?

A- cryptoccous

B- toxoplasmosis

C- HIV encephalopathy .

D- lymphoma .

40- young pt. presents to ED after ingestion of satolol she was stable then BP dropped and ECG
developed as below .

what is the treatment ?

A- Mg sulfate 2 g IV

B- defebrelation

C- procanamid 15 mg /kg IV .

D- Beta blocker .

41- the same pt. in Q 40 after take the medication the ECG change and became like blew
what is the most appropriate management now ?

A- Ca. chloride 10% IV .

B- digoxin .

C- Amiodarone .

D-
42- Pt. presented to the ED with pleural effusion throacocethesis done and showed

Plural protein / serum protein < 0.5

plural LDH / serum LDH < 0.6

what is the most likely diagnosis according to light’s criteria ?

A- Congestive heart failure .

B- malignancy

C- PE.

D- para pneumonic effusion .

43- COPD pt. presents to ED with severe SOB and tachypnic and borderline BP high HR CXR
showed below what is the next most appropriate management ?

A- NIV

B- needle decompression

C- Nebz.

D-

44- Old age was admitted in hospital with pneumonia and discharged on moxifloxacine then came
back with worsen SOB and febrile and unstable vitally . Pt. intubated and CXR done for him
showed bilateral infiltration . which one of the following will decrease the mortality in MV for this
pt. ?

A- Low tidal volume .

B- Low RR.

C- High Platue pressure .

D-

45- BA pt. presented to ED and was severely distressed and not responding to the initial ttt. after
that the pt. is intubated what is the best MV setting for this pt. ?

A- RR 5 and TV 3 with I:E = 1:6

B- high plateau pressure

C- RR 10 TV 8 and I:E = 1:3

D-

46- HIV pt. presented to ED with hx. of fever and non productive cough and SOB . he is not
compliance to his medications .

CXR showed bilateral perihialar infiltration .

Vaitally stable except for fever and high RR .

VBG showed Pao2 75

what is the most appropriate management :

A- levofloxaicin

B- Bactrim + steriod

C- Bactrim .

D-

47- Prisoner came from jail with skin redness and swelling in his leg with purulent itching what is
the most appropriate management : ( there was a picture )

A- Bactrim

B- cephazoline

C- amoxicillin .
D-

48- Very clear case of Kawasaki disease.. best treatment to decrease the complication rate?

A. Aspirin.

B. IVIG.

C. Antibiotic.

D. Exchange transfusion.

49- Young male patient, c/o SOB, palpitation and sweating all happened before getting to the
class to give a lecture.. he is saying “I would die” .. what is the most likely diagnosis?

A. agophopia

B. Panic attack.

C. Malingering.

D. Depression.

50- girl k/c of seizure disorder presents to ED with AMS and sleepy and GI symptoms after
conflict with her family .

she ingested unknown medication intentionally and vitally stable lab. investigation within normal
except high ammonia level .

what most likely she ingested and cause these manifestations ?

A- carbamezabien

B- phenetoyn

C- Valproic acid .

D-

51 -young male pt. brought by ambulance after found him unconscious in the street and GCS 9
and vitally stable

gave him naloxone and D 50 but still no improvement . what is the most appropriate next step in
management ?

A- NS IV bolus .

B- CT brain .

C- intubation .

D-

52- Girl presents to ED after hx. of ingested unknown medication and unknown doses . She has
no past medical hx. . Vital sign was hypotension( 80/45) and bradycardia (45) and low RR (10)
afebrile . her pupils is 4 mm and non reactive bilaterally . RBS 2.9 ( normal range 2.2-4.8)

what is the most likely she ingested ?

A- propanolol

B- clonidine

C- verapamil

D-

53- Pt. ingested his grand mother medication and came to ED with abnormal vision and lethargic
with the following ECG what is the appropriate management ?

A- cardio version .

B- degoxine antedote .

C- pace maker .

D-

54- Pt. presents to ED with severe headache then decrease LOC and very low GCS and pinpoint
pupils bilaterally and decorticate posturing . where is the most likely the cause ?

A- epidural hg.

B- subcortical hg.

C- internal carotid artery dissection

D- cerebellar hg.

55- Old age male presented to ED with hx. sudden onsent of vertigo and unsteady gait and
nausea and vomiting with vertical nystagmus . In ED her received meclizine for vertigo but
improved mildly . CT brain done and was negative .

What is the most appropriate next step in management ?

A- Admission and MRI of brain .

B- discharge on meclezine .

C- ASA .

56- Case of TIA and high ABCD2 score which of the following is the effective ttt. to decrease the
morbidity in TIA ?

A- aspirin

B- warfarin

C- LMWH

D-

57- Pt. started on LMWH then he back to hospital and has leg swelling and erythema (DVT) what
is the most appropriate treatment ?

A- Stop LMWH and warfarin

B- stop LMWH and take warfarin

C- IVC filter

D- stop both LMWH and warfarin and start fundoprainx.

58- To limit conflict of interest?


A. Extend contact with the patient. B. Extend period of admission.

C. Explain your financial interests.

59- old man presents to ED with bullous skin rash and no mucous membrane involvement and
negative nikolosky . what is the most likely diagnosis ?

A- pemphigus vulgarise

B- bullious bemphogoid

C- TEN

D-

60- Old man came from arizona , USA , one week ago presents with skin rash in his ankle and
wrist that spreads to his trunk associate with headache and decrease LOC . the rash is the as
showed down . what is the most likely the
diagnosis ?

A- menengiococcimia

B- west nile virus .

C- Rocky mountain spotted fever .

D- rubella



61- During doing RSI for pt. paralytic agent given already and pt. paralyzed already what is next
step in RSI ?

A- pretreatment .

B- positioning .

C- placement of tube .

D-

62- During do intubation in cardiac arrest pt. the colorimetric showed

as picture below after first breath . what is the most appropriate next
step ?

A- Extubation .

B-chest x-ray and suction .

C-give six breath then see.

D-

63- pregnant lady 28 weeks presented to ED with hx. of seizure and given Mg sulfate but still
seizing after maximum treatment . what is the most appropriate next step in management ?

A- CT brain .

B- Call oB for CS .

C- give IV benzodiazepine .

D- intubation .

64- 50 years old male presented to ED with LLQ pain and fever . and no past medial hx. pt. looks
mildly in sick and V/S stable except febrile . PE show has LLQ tenderness and CT abdomen done
for him and the report is : inflammation of pericolonic fat with fluid collection and thickening of the
bowel wall

what is the most appropriate next step in management ?

A- ABx. and discharge .

B- Admission for bowl rest only

C- discharge with instruction of bowl rest .

D- Admission + Abx. + Bowl rest + surgical consultation for drainage

65- Peidatric pt. presented to ED after ingestion of his father medication of his gastric problems
( Peptobismol ) pt. asymptomatic his blood gas showed

PH : 7.2 , HCO3 : 14 , Pco2 : 25 .

what is the most appropriate next step in management ?

A- digiband

B- NaHCO3

C- hemodialysis

D-

66- pediatric pt. came to ED due to his parents saw him woke up from sleep with generalized
convulsion last minutes then has grimacing then return back to sleep in ED the pt. is fine and
sleeping . what is the most likely the diagnosis ?

A- roland’s epilepsy syndrome .

B- myoclonic seizure .

C-

D-

67-