.

RECALL SBA 14/9/2021

I/scenario about child collapse, in ECG given PR 270 what is the most common
tachycardia in children:

a /svt

b/ VT

c/ vf

d. sinus tachycardia

Answer: Sinus tachycardia

2/pt c/o chest pain no history of medications recurrent attacks of collapse, ECG
given what is the diagnosis:
I /mobtiz type I

2/mobtiz type 2

3/complete heart block

4/VT

5/AF

Answer:??
 3/young male having h/o recurrent priapism usually resolve spontaneously BUT
this attack take longer time Lidocaine given but no respond what is the next
management step:

I/corvosa cavernosa injection with phynilpherin

2/ice compression

c/ aspirate blood with needle

d/ refer immediately to urology

Answer: aspirate blood with needle

4/sickle cell anemia pt came with pain and sob what is not included in
management:

a /bronchodilator nebulizer

b/ antibiotics

c/ fluid

d/ analgesia
e/ corticosteroid

Answer: corticosteroid

5/young male pt c/o chest pain and Feeling worse when he is leaning forward or
lying flat, h/o viral illness and drugs use pt febrile what is the diagnosis:

a/ mi
b/ myocarditis

c/ valve disease

d/ rheumatic fever

Answer: myocarditis

6/scenario about heat stroke pt hypotensive, confused, dilated pupils temp: 42

what is appropriate management:

a /dantrolene

b/ immersion in ice water and cooling

c/ fan and exposure to cold weather

Answer: immersion in ice water and cooling

7/scenario about pt need muscle relaxation agent for procedures (Suxamethonuim)

why not to give him:

a/ hyperkalemia
b /hyperthermia

c /renal impermanent

d /bradycardia

e/ hypotension

Answer: hyperkalemia
 8/pt admission in ICU for local anesthetic toxicity what is the suspected
complication after many days:

a /hyperthermia

b/ pancreatitis

c/ infection

Answer: Pancreatitis

9/young female came to ER c/o generalized fatigue and dizziness hx separation

from her husband 3 month ago according to sad person score, what is the cause of
her symptoms:

a/ depression

b/ mania

c/ anxiety

d/ separation and divorce

Answer: Separation and divorce

.

10/ scenario about Somalia child pt c/o dysuria on examination there is blood in
underwear and loss of eye contact what is the diagnosis:

a/ FGM

b/ UTI

c/ sexual abuse
d/ Genital trauma

Answer: FMG (female genital mutation)

11/ pt came with h/o glandular fever and abdominal pain what's the test of
confirmation the diagnosis:
a / monospot test

b/ viral serology

c/ FBC

d/ abdominal u/s

Answer: monospot (according to the pt age and immunity)

12/ scenario about heart score which is not included in score:

1 / cardiac enzymes (troponin)

2/ history of heart disease

3/ peripheral artery disease

4/ stroke

5/obesity

Answer: Stroke
13/ Suxamethonuim cause prolong paralysis by what mechanism:

Answer: cholinesterase inhibitor

14/ 12 yrs. boy came with sever testicular pain and had similar attack before and
resolved spontaneously Doppler done and diagnosed as testicular torsion what is
the most common cause:

Answer: bell Clapper congenital deformity

15/ scenario about broad complex tachycardia &VT? What is the difference
between VT and SVT with aberrancy? Options included RBBB, fused P wave ?/
Answer: svt with aberrant Rbbb (answered by the source)

16/ scenario about baby had neonatal sepsis how to take the sample:

a / from both side to do culture

b/ urine for microscopy

c/ amount of sample should be more than I cc

d/ send the baby to NICU

Answer: amount of sample should be more than 1 cc

17/ 4 days baby distress after feeding what is the diagnosis:

a/ diaphragmatic hernia.

b/ congenital heart disease.

c/ perforation viscous

Answer: diaphragmatic hernia

18/ X-ray pic of child playing with remote and swallowing of magnetic battery
what is the management:

a/ discharge home with advice.

b/ admission for observation..

3/refer to pediatric

4/ prepare for laparotomy operation

Answer: prepare for laparotomy (multiple magnetic batteries )

19/ unconscious GCS 6 repeated attack of seizures 2times more than 30 mint what
is the initial step on management:

a/ anti convulsions drug

b/ hypertonic saline

c/intubate the pt

d/ investigation

Answer: intubate pt

20/3 days baby brought to ER with struggling of feed and distress on ex there is
murmur on auscultation what is the diagnosis:

a/PDA

b/ bronchiolitis

c/ Rubella infantum

c/ ASD

Answer: PDA

21/scenario about house fire pt cyanosed and hypotensive po2 normal lactate 7.7

What is the diagnosis?

a/ co poisoning

b/ cyanide poisoning
c/ methemoglobenima

Answer: cyanide poisoning

22/another 19-year-old female with hx of asthma presents to the Emergency

Department with increasing shortness of breath and wheeze. She has been using
increasing amounts of her salbutamol inhaler over the past few days. On
examination her respiratory rate is 35 breaths/min, heart rate 130 bpm and
saturations of 91 %. She is unable to talk on full sentences. She has widespread
wheeze throughout her chest on auscultation.

Her arterial blood gas shows:

PH : 7.48 (7.35-7.45)

Pa02 : 7.5kPA (11 -14)

PaC02 : 5.2 (4.5-6.0)

BE : -4 (-2 to +2)

How severe is this patient's asthma?

a/ Acute severe asthma

b/ Mild asthma

c/ Near fatal asthma

d/ Life-threatening asthma

e/ Moderate asthma
Answer: life threatening Asthma

23/ child had leg rash and hx sore throat 2 weeks ago what is investigation support
your diagnosis

1/ UA

2/ LP

3/ Fbc

4/ A Sot

Answer: urine analysis

24/a 33-year-old woman is admitted with sudden onset of shortness of breath
whilst shopping in the supermarket. She has no other symptoms but had a
laparotomy and removal of uterine fibroids 3 weeks ago. She has no other PMHx
and is a nonsmoker. Observations show a respiratory rate 26 pm, Sp02 94% in air
and heart rate 95bpm. On examination her chest is clear and heart sounds are
normal. There is no swelling or tenderness in her lower legs. What is the correct
Wells score for this patient?

a. 1.0

b. 1.5

c. 3.0

d. 4.5

e. 9.0

Answer: 4.5
 25/43-year-old presents with l-day history of fresh hematemesis. He has had 3-4
vomits, each consisting of a mug full of fresh blood. He is alcohol dependent with
documented alcoholic cirrhosis and known to hepatology. Observations include
respiratory rate 24 bpm, Sp02 95% in air, heart rate 116 bpm, and BP 85/60 mmhg.
He is 85 kg. Blood results: Hb: 89

WCC: 12.3

Plt : 94

INR : 1 .2

Lactate : 4.3

Glucose : 5.6
 Which of the following initial intravenous fluid is the most appropriate for this
patient?

a. 20 ml/kg 0.9% saline

b. 500-1000 ml Hartman’s

c. 10 ml/kg 10% dextrose

d. 500-1000 m10.9% saline

e. 30 ml/kg Hartman’s

Answer: 500-1000ml saline .9%

26/ 87-year-old woman from a residential home with a 2-day history of diarrhea.
She has had 10 episodes of watery diarrhea but no vomiting. She complains of
colicky lower abdominal pain. She had a 5-day course of antibiotics for a chest
infection 2 weeks ago, but she cannot remember what they were called.
Observations show a respiratory rate 18 bpm, Sp02 95% in air, heart rate 89 bpm,

BP 146/89 mmhg, temp 36.8'C and BM 5.6 Examination reveals that her abdomen
s soft but there is generalized tender especially across her lower abdomen. What is
the most likely causative organism?
a. Rotavirus

b. E. coli

c.Campylobactor

d. clostridium difficile

e. Norovirus
Answer: C difficile

27/ a 22-year-old male who is a known IDDM presents to the Emergency

Department with polyuria, polydipsia and weight loss. His blood ketones are +++
and his blood glucose is 35.6 mmol/I. Intravenous access has been obtained and
blood tests taken the results of his venous blood gas and urea and electrolytes are
shown below:

PH: 7.05 (7.35-7.45)

Pa02: 12.4kPA (11 -14)

PaC02: 2.8 (4.5-6.0)

HCO3: 6 (22-24)

PaC02: 2.8 (4.5-6.0)

Sodium: 135 mmol/L (133-146)

Potassium: 4.2 mmol/L (3.5-5.3)

Urea: 5.5 mmol/L (2.5-7.8)

Creatinine: 88 Fimol/L (60-120)

Glucose: 38.6 mmol/L (4-7)

Chloride: 95 mEq/L (96-106)

What is the anion gap in this patient?

a.34.0

b. 38.2

c.44.2

d.165.4

e.330.9
Answer: 38.2 (Na +K) – (HCO3 +cl)

28/ a 69-year-old man presents with a 2-day history of vomiting and lethargy. He
is a type 2 diabetic and has known hypertension. Observations show a respiratory
rate 22 bpm, Sp02 95% on air heart rate 104bpm, BP 129/83, temp 37.8'C and a
BM 4.0.Venous blood gas:

pC02: 5.6 (4.5-6.0)

Be: -2.6 (-2 to +2)

Lactate: 2.3 ((2)

Na: 143 (133-146)

K: 7.3 (3.5-5.3)

Urea: 18 (2.5-7.8)

Glucose: 11.8 (4-7)

What is the next best step in this patient's immediate management?

a. Calcium Resonium orally

b. Magnesium IV

c. Insulin and dextrose IV

d. Calcium chloride IV

e. Repeat the blood sample

Answer: insulin and dextrose IV

29/ambulance with a 2-hour history of weakness and reduced sensation in her right
face, arm and leg. She has expressive dysphasia. There is no LOC, syncope, visual
disturbance or any seizure activity. PHx includes hypertension and atrial
fibrillation for which she received DC cardioversion last year. What is her
ROSIER scored?

Answer: 4

30/ A 39-year-old female patient is brought it following an explosion after rescuing

her dog from a house fire .On examination she is noted to have a hoarse voice and
be drooling. There is decreased air entry in the right base and there is a bleeding
gash over her right thigh. She has burns on her arms and face. There is an obvious
deformity to his wrist. Observations show heart rate 115 bpm, respiratory rate 35
bpm, Sat 92% on room air, BP 95/50 mmhg, temp 36.4 and a GCS 12/15 (E3 M5
V4). Her abdomen is tender in the RUQ. But here is no guarding. What is the
immediate priority?

a. Plastics review

b. ENT review

c. Orthopedic review

d. Anesthetic review

e. Surgical review

Answer: anesthetic review

31/previously wel13-week-old boy is brought to Paeds ED with a 5-day history of

diarrhea and vomiting. During this time he has been given only water on bad
advice, he last vomited over 24 hours ago. On triage assessment he appears alert
and interacts appropriately slightly miserable. He is mildly tachycardia with dry
lips, but observations including blood pressure are otherwise normal. He is found
to have a blood sugar level of 2.1 mmol/L and Ketones 1 .3 mmol/L. There is no
other significant past medical history, other household family members have
recently been unwell with similar symptoms. A capillary blood gas shows no
acidosis. What is the most appropriate management?

a. Immediately gain IV access, administer 2ml/kg 10% dextrose bolus followed by

a continuous maintenance infusion of dextrose

b. Give 5g Dextrogel orally, then recheck blood sugar in 15 mints

c. Take blood for hypoglycemia screen and admit under General pediatrics

d. Apply ametop, then give 5g Dextrogel orally

e. Apply ametop, then cannulate and administer 2ml/kg 10% dextrose IV followed
by a continuous maintenance infusion containing dextrose

Answer: give 5g Dextrogel orally, then recheck in 15 mints

32/A 22-year-old man presents with sudden onset of pleuritic chest pain, he is not
breathless and feels otherwise well. He has no significant past medical history and
is a non-smoker. Observations show a respiratory rate 18 bpm, Sp02 97%, heart
rate 72 bpm, BP112/63 mmhg and temp 36.5'C His chest x-ray confirms a small
right apical pneumothorax which is (2 cm) What is the most appropriate further
management step?

a. Aspirate with an 18 g cannula

b. Insertion of a Seldinger chest drain

c. Discharge and follow up with respiratory Outpatients

d. Admit to medicine for overnight observation

e. Observe in the ED for up to 4 hours

Answer: observe in ED for up to 4 hours

 33 / picture of child burn on both forearm child on pain what is non
pharmacological treatment for him:

1/ parents included with him

2/ play physician and attract with toys

3/ nasal di morphine
4/ refer to burn center

5/ dressing and cold compression

Answer: dressing and cold compression

34/ same scenario but the question about first line of pain management:

1/ nasal dimorphine

2/ diclofenac supp

3/ pracetmol

Answer: nasal dimorphine

35/ 24 ys male came to Er by partner c/o generalized fatigue with nausea and deep
jaundice abdominal pain mainly Rt upper vitally stable parameters elevated liver
enzymes what is the diagnosis:

1/ HB viral

2/ cholesistites

3/ biliary colic

4/ Gilbert syndrome

Answer: HB viral

36/ young female came with fever, vomiting, upper rt Q tenderness and she is
icteric what is the diagnosis:

1/ biliary colic

2/ acute cholangitis

3/ cholycystitis
4/ intestinal obstruction
Answer: acute cholangitis

37/ picture of male skin rash co abdominal pain, jaundice, and nausea he is
dependent on acetaminophen (Parcaetmol) what is the diagnosis:

1/ fulminant hepatic failure

2/ cholesistites
3/ HIV

Answer: hepatic failure

38/ scenario about pt with shoulder dislocation sedation by propofol pt in er room

and there is another pt need for the room what about action:

a / discharge the pt immediately

b/ wait for relative of pt to arrive and then discharge

c/ shifted to the ward

d/ discharge the pt when pain subside and all vitals retained to the base line

Answer: discharge pt when pain subside and vitals retaining to base line

39/ mother brought her son after his loss of consciousness at home but child active,
well and play normally what is the diagnosis:
1/ Brue
2/ choking

3/ congenital heart disease

4/ child abuse

Answer: Brue (age should be less than 1 yr. if not consider other options)

40/ RTA head trauma pt intubated and shifted to ICU after stabilization pt become
deteriorated, hypertensive and bradycardia what is initial step:

1/ mannitol iv

2/ hyper tonic saline

3/ raised the head 30 degree

Answer: raise the head of the bed 30 degree

41/scenario about TIA pt after what time can drive car:

1/ 1month

2/ 3month

3/ 6 month

4/ 1 year

5/ 5 year
Answer: 1 month

42/ pt came with epistaxis cautery done what is the most common complication of
him:

a/ hematoma

b/ septal perforation
c/ sinusitis

d/ bleeding

Answer: septal perforation (hematoma is commonest with prolonged nasal packing

and necrosis from excessive packing)

43/ A 68-year-old man is seen in ED majors with a 3-hour history of central chest
pain. He feels generally unwell and appears pale and clammy.
A repeat ECG is shown
a. Repeat ECG

b. Aspirin 300mg

c. STEMI Alert

e. transfer to the Emergency Room (ER) IV access

Answer: Aspirin 300 mg

44/ what is the diagnosis?? Patient received antibiotics but no improvement , what

is next step:

1/antibiotics iv
2/ aspiration

3/ refer to surgery

Answer: Tenosynovitis/ management refer to surgery

45/child trauma suspected hemohorax what is initial bed side investigation:

1/e fast

2/CT

3/x-ray

Answer: E fast

46/pt postpartum 7days came to ER with fever and fatigue what is the diagnosis:

1/hemolysis

2/septic shock syndrome

3/uremic shock syndrome

4/DIC

Answer: Septic shock syndrome

47/you are leading a trauma case of multiple casualties of road traffic accident, you
have a patient who has blunt abdominal trauma and lost cardiac output 45 min ago.
Surgical registrar wants to perform resuscitative thoracotomy, while you are
against it. Your consultant is busy in intubating a child from the same accident and
he is not to be disturbed, what will you do...?

a. continue resuscitation until your consultant is free

b. override the surgical registrar

c. arrange instruments for thoracotomy and ask the surgical registrar if you can
assist him
d. discuss with your team

Answer: discuss with your team

48/Patient SVT stable but nurse is struggling to measure BP because heart rate
over 200

A.Valsalva maneuver
b. DC shock

c. Iv adenosine

Answer: DC shock

49/ a paramedic has called you for advice on a baby who is dead in his home in his
cot, what should be done next...?

a. bring the baby to ED

b. call the police/authorities

c. leave the baby with parents and return

d. stay there until baby wellbeing authorities arrive

e. Call the GP to attend

Answer: call police / authority

50/old female on chemotherapy last session 10 days vitally stable, c/o dysuria what
is next step:

1/U&E

2/antibiotics after UA result

3/discharge home with advice

4/cbc..ua..Urea and electrolytes

5. iv fluid, antibiotics

Answer: cbc ..UA..urea and electrolytes

51/ old female she have breast cancer on immunosuppression therapy came to ER
co fatigue. Dizziness. Febrile and uti pt ask for antibiotics what is the appropriate
mange for her condition:

1/admission for observation

2/give antibiotics if indication

3/order for investigations first

4/oxygen... fluid ..iv antibiotics ..cbc .UA ...

Answer : oxygen... fluid ..iv antibiotics ..cbc .UA

52/ double fang marks of a venomous snake bite pic? Patient’s vitals were okay,
and had a rash around the wound. Venomous snake bite have two fang marks. No
there were no systemic upset, they only showed pic of the fang mark
a.Antivenom

b.Antihistamines

c.Analgesics

Answer: antivenom

53/you are in a restaurant and you notice a child who is 18 months old presented
with choking episode. He is gasping and unresponsive. What is your next course of
active?

a. 5 rescue breath

b. 5 back blow and chest thrust

c. 5 back blow and abdominal trust/

d. encourage coughing

e. start CPR

Answer: 5 rescue breathing

54/ 35 years old lady developed sudden onset occipital headache associated with
multiple episodes of vomiting. She is currently on OCP. She just had her hair wash
in the local saloon yesterday. What is the most likely causes?

a. subarachnoid hemorrhage
b. stroke

c. venous sinus thrombosis

d. vertebral artery dissection

Answer: venous sinus thrombosis

55/ 12 years old boy presented with abdominal pain and vomiting. Blood gases
revealed severe metabolic acidosis and high blood glucose and ketone. What is
your insulin regime?

a. IV Insulin 20 unit stat dose/SC insulin

b. 10 unit stat dose/IVI insulin

c. 0.05 unit/kg/hour/ IVI

d. insulin 0.1 unit/kg/hour)

Answer: 0.05 unit / kg /hr

56/ which of the following is the earliest sign of compartment syndrome?

a. pallor of skin

b. pain on passive stretch

c. loss of distal pulses

d. paresthesia of limbs
Answer: pain on passive stretch

57/ what is CPR rate

Answer 100- 120 / min

58/scenario of traumatic pt asking about posterior border of safe triangle of chest

drain:

1/pectoralis muscle

2/seratus anterior

3/base of axilla

4/lattisimus dorsi

Answer: lattisimus dorsi

59/scenario about pt diving having decompression sickness what is not included in

symptoms of this sickness:

1/joints pain

2/headache

3/weakness in arms and legs

4/dizziness
5/itching

Answer: itching

60/scenario about baby 2ys come with harsh cough what is the organism cause of
this diagnosis:

1/syncytial virus
2/para influenza virus

4/influenza type b

5/E-coli

Answer: para influenza virus

61/old male came with chest pain radiated to the shoulder Ecg given what is the
artery affected:
1/Rca

2/LCD

3/Lad

4/Lad and Lcx

Answer: LAD answered by the source

62/. Needle prick injury, HIV and risk factor?

A. Sub- Saharan travel

B. Blood transfusion in UK before 1991

C. Blood transfusion in USA

D. semen splash

E. Anal intercourse

Answer: Sub-Saharan travel hx??

63/ female pt involved in RTA came with pelvic fracture she is hypotensive what
is appropriate action, x ray shown:

1/activate massive transfusion protocol

2/pelvic binder

3/refer to orthopedic

4/ CT pelvic
Answer: pelvic binder

64/8 weeks pregnant came with fresh vaginal bleeding many days diagnosed as
inevitable abortion in the Ob clinic bp 86/62 fluid ongoing what is the next step in
management:

1/ refer to OBG

2/blood transfusion

3/tranximaic acid

4/anti D

5/speculum exam

Answer: speculum exam

65/pt pregnant 32 weeks with vaginal bleeding Rh -ve what appropriate step in
management:

1/ Anti D

2/blood transfusion
3/ tranximaic acid

Answer: anti D
66/ RTA, pt is pregnant 28 weeks she is hypotensive and not stable started all
management for her. According to the fetus how to asses and manage:

1/ if the fundus below umbilical this indicates of unviable baby

2/the palpable part of fetus in abdomen indicated of operation

3/ abdominal u/s by ob specialist

Answer: if the fundus below umbilical this indicates of unviable baby

67/pregnant 30 W came to Er co flushing, nausea, severe headache, double vision

the gp review her notes not found any report of pregnancy follow up what is pt
having:

1/ pre eclampsia

2/pituitary apoplexy
3/ venous thrombosis

Answer: pre eclampsia

68/husband rushed to ER by pregnant wife she is in labor delivered in Er baby not

cry and not breath what is the initial step management of new borne:
1/start CPR

2/dry baby

3/ refer to pediatric

4/ intubate the baby

Answer: dry baby

69/ female 37 WKs delivered in Er baby not breathing watch clock, dry and put in
wet towel according to pediatric live support guideline what is the next step:

1/ Asses the color, tone, reflexes

2/ shout for help

3/ refer to pediatric

4/ intubate the baby

5/ Suction the fluid

Answer: Asses the color, tone, reflexes

70/ young female 19 ys came worried to Er by her son he became distress after
eating,, on examination pt having weak cry what is the action :

1/ 5 back blow 5chest thrust

2/5back blow5 abdominal thrust

3/ 5 rescue breathing
4/ start CPR

Answer: 5 back blow, 5 chest thrust (according to age)

71/ scenario about septic arthritis what is most common organism:

1/ s.aureus

2/ s. pyogens

3/ epidermis

Answer: S aureus

72/ pt co joints pain and swelling fluid aspiration done for him and their positive
crystal and no microorganism in culture what is the diagnosis:

1/ reactive arthritis

2/septic arthritis
3/ gouty arthritis

4/ pseudo gout

5/anklosing spondylitis

Answer: pseudo gout

73/a 21 years female, syncope, 2nd time, feeling flushed and anxious before the
attack

ECG Brugada

A. A systole

B. VT

C. AF

D. Mobtiz ll

E. Complete block

Answer: polymorphic VT
74/ECG shown below what is best management

Answer: magnesium sulphate? Answered by the source (torsade de pointe)

75/ COPD (low pH, low o2, high pco3, high hco3) what is the interpretation

A. Acute on chronic

B. Respiratory acidosis with partial metabolic compensation

C. Resp. Failure type l

D. Resp. Failure type II

E. mixed

Answer: respiratory failure type 2

76/ Unclear Pelvic pedia X-ray: no trauma, limping:

Answer: trethowan sign? Answered by the source

77/ young male opiate toxicity GCS 6 start naloxone he became better after second
dose GCS 8 but nurse tell you the pt start deteriorated again what is the next step:

1/ concern naloxone infusion

2/ intubation and ventilation

3/ sodium bicarbonate

4/ shifted to ICU

Answer: concern naloxone infusion

78/ pt having Hx thyroidectomy c/o oral numbness and abnormal movement what
is the cause of her condition:

1/ hypocalcaemia

2/ hypomagnesaemia

3/ thyroid crisis

Answer: hypocalcaemia

79/ old female came with bradycardia 35 p/ mint bp 95/ 70 atropine 3mg given and
noradrenaline. ECG given in scenario what is the next step:

1/ admitted her for permanent pacing

2/external pacing

3/ refer to cardiologist

4/ Repeat atropine

Answer: external pacing

80/ young male came with back pain radiated to lower limp with weakness and
paresthesia on ex there is ankle jerk what other finding support your diagnosis:

1/ S3 S4 loss of sensation

2/ S1 dermatome absent
Answer: S1 dermatome absent

81 /young lady post-partum period not obstructed labor c/o lower limb numbness
with generalized weakness and she doesn't pass stool for many days just flatus
vitally stable what is the diagnosis:

1/ couda equina

2/ multiple sclerosis

3/ myasthenia gravis

4/ intestinal obstruction

Answer: couda equina

82/ baby brought to Er after collapsed at home wt 12 kg Ecg given torsade

depointe (long QT) what is the initial treatment for him:

1/ magnesium 480

2/ Amiodarone
3/ Adrenaline

4/ synchronized DC shock 1j

Answer: magnesium sulphate 480

83/ pt came with hypothermia tm 28c haw give him adrenaline ECG done and
show non shockable Rhythm:

1/ 1mg after inserted line

2/ 1mg adrenaline after tm became 35

3/ adrenaline after 3rd shock

4/ after rewarming and tm become 30

Answer: after rewarming and temp become 30 degree

84/ 9 wks baby vomiting after any feed loss of wt investigation done for him there
is hypochlormaic metabolic alkalosis what is the diagnosis:

1/ pyloric stenosis

2/biliary atresia

3/ congenital heart disease

Answer: pyloric stenosis

85/scenario about RDS what is the absolute contraindication of NIV

* given all option of relative contraindication:

1/ ph 7.15

2/ confusion/ agitation

3/ cognitive impairment
4/ Gcs less than 8

5/ fixed upper airway obstruction

Answer: fixed upper airway obstruction

86/ pt came with renal colic not tolerated NSAIDS according to nice guidelines
what is the first line management:

1/ parcetmol iv

2/ diclofenac

3/ opiates

Answer: paracetamol IV

87/scenario about pt with Anterior shoulder dislocation and there's wound in the
wrist what is the method of reduction without traction

Answer: Kocher’s method? Answered by the source (wrist wound)

88/ old pt over dose repeated charcoal no benefit and not improved what is the
medication causing this condition:

1/ lithium

2/ paracetmol

3/ propranolol

Answer: lithium
89/ pt ingestion fertilizers came with excessive lacrimation and bradycardia what is
appropriate treatment:

1/Atropine

2/ procyclidine

3/ charcoal

4/ gastric lavage

Answer: atropine

90/ old pt came with confusion, agitation and aggressive speaking against staff
members with abnormal gait, what is the diagnosis:

1/ Delirium

2/ intoxication

3/ alcohol withdrawal

4/ delusional delirium

Answer: delirium

92/ young 32 male came agitated, fever, diaphoresis altered mental state with
rigidity what is the diagnosis:

1/ malignant hyperthermia
2/ neuroleptic malignant syndrome
3/ meningitis

4/ serotonin syndrome

Answer: Neuroleptic malignant syndrome

93/ 25 female came to Er confused, lethargy, fever, abnormal vision and non-
blanching rash appear in the lower limp what is diagnosis:

1/ meningococcal septicemia

2/ auto immune TTP

3/ henoch scolein purpura

Answer: meningococcal septicemia

94/ pt hypotensive in shock try all peripheral

iv what is other side should be :

1/ io

2/ femoral

3/ subclavian

4/ inter jugular
Answer: IO

95/ scenario about what is the common side of fracture in child abuse:

1/ skull fracture

2/ long bone fracture (femur)

3/spine fracture

Answer: long bone fracture (femur)

96/ scenario about cluster headache by new guidelines what is treatment:

1/ Aspirin

2/metoclopramide

3/6mg sumatriptan

Answer: sumatriptan 6 mg

97/ 4 month baby x-ray of fracture shaft of humerus what is the indication of non-
incidental trauma:

1/ vitamin D deficiency

2/ immobile child
3/ this type of fracture inspected in this age

Answer: immobile child

98/pic of pt with goiter c/o palpitation HR 240 what the initial medication for her:

1/ bisoprolol

2/ iodine

3/ amiodarone

4/ digoxin

Answer: bisoprolol

99/scenario about pt aggressive and intoxication, diazepam given to him what give
to him after?

Answer: Fomepizole

98/ pic of old male 70 ys dog bite in the mouth laceration wound in lower lip he is
un sure about tetanus immunization why give him immunoglobulin: because:

1/ age of him

2/ he is unsure about immunization

3/ prone wound need immunoglobulin

4/ the side of the bite

5/ all dog bite need immunoglobulin

Answer; age of him

100/ old pt came distress and confused having ho sleep apnea, plan for intubation
when evaluate him found the distance between mandible and floor mouth 2fingers
what make this pt difficult to intubate:

1/ sleep apnea

2/ distress

3/ distant between mandible and mouth 2finger

Answer: answer: distance between mandible and mouth 2 finger

101/ what is the best method to differentiate needle in vein or artery:

1/ Abg

2/ waveform

3/ ultrasound guide the tip of cannula in side

4/ color of blood
Answer: ultrasound guide the tip of cannula

102/ 10 ys boy came with anaphylactic shock what the adrenaline dose:

Answer: 0.3 mg IM (0.3ml 1:1000 solution

103/diagnosis? Or muscle involved or Nerve

Answer: winging of scapula, serratus anterior, Long thoracic Nerve

104 /trauma pt difficulty breathing which of the following would most indicated to
need for intubation and mechanical ventilation:

1/ hoarse voice

2/low o2 saturation

3/ inspiratory stridor
Answer: hoarse voice

104/scenario about pt with variceal bleeding what is the drug decrease mortality:

1/terlipressin

2/tranximaic acid

3/Vit k

4/antibiotic

5/Blackmore tube

Answer: terlipressin

105/scenario about pt with upper GI bleeding hypotensive and vitally unstable

fluid and Resuscitation started for him and he needed transfusion how you will
give him:

1/5Rbc unit 5 FFP

2/10units Rbc

3/10unit Rbc 5units platelets

4/10unitsRbc 5 units Ffp

Answer: 10 whole blood OR RBC UNITS for 24 hours or 4 RBC units in 1hr +
Tranexmic acid in 3 hrs. window
106/ 8ys boy came with scalp wound he is hemophilia A plan for transfusion what
to write in sheet of hematology lab:

1/FFP 2uints

2/platelets with complex factors

3/RBCs

4/factor 8
Answer: factor 8

107/young female co abdominal pain and diarrhea many days after eating cold
meat outside tm 38 other vitals was normal what is the causative organism:

1/campylobacter

2/norovirus

3/Rotavirus

4/Giardia lamblia

Answer: listeria (reheat meat clostridium or S aureus, cereus for reheat or cold rice,
staphylococcus for cream products

108/young female came to Er co lower limb weakness and paralysis what is the
diagnosis:

1/Gillian barre
2/central cord syndrome

3/myasthenia gravis

4/conusmedilarus

Answer: Gillian barre syndrome

109/ scenario about head trauma pt GCS 14 and become 8 pt deteriorated with
rapid breathing what is the initial management step:

1/intubate and ventilate him

2/mannitol infusion

3/hyper tonic saline

4/dexamethasone

Answer: intubate and ventilate

110/ 25ys female go festivals with friends she is dancing. Punched in her face
many times after that c/o upward gaze in the Rt eye what is the diagnosis:
1 / Rt rolling of inferior rectus muscle.

2/ zygomatiac bone fracture.

3/ subarachnoid hemorrhage

4/ blow orbital fracture

Answer: entrapment of inferior rectus, orbital fracture

111/ pic of young female having burn and complicated came with severe pain what
is the appropriate management for her condition:
I /faciotomy

2/analgesia and antibiotic

3/drainage and debridement

4/refer for surgery

Answer: faciotomy

112/ what type of fracture?

1/ salter Harris type 1

2/ salter Harris type 2

3/ salter Harris type 3

4/ salter Harris type 4

Answer: salter Harris type 3

113/ diagnosis? Headache with vomiting and severe sudden painful vision loss

Answer: Glaucoma

114 / 122/scenario about pt anaphylactoid reaction vitally stable and no signs of

shock what’s support anaphylactoid reaction opposed to anaphylactic shock:

1/ pt with mild symptoms

2/ pt not on shock and vitally stable

3/ ho allergic reaction

4/ onset and recovery

Answer: hx of allergic reaction

115/ mallampati score?

a.1

b.2

c.3

d.4

Answer: Grade 2
116/ in picture what D means

A. Dead space ventilation

b. Ascending explatot ' phase

c. End-tidal co2

d: Descending inspiratory phase

Answer: end tidal co2

117/17 ys male co testicular pain on examination theirs blue dot sign on tests, what
the diagnosis?

1 / testicular appendage torsion

2/ torsion of hydiated of morgana.

.3/ epididmorchaitis

Answer: testicular appendix torsion.

118/ child having cyanotic spells after eating food, diagnosis?

a.Asd,

b.vsd,

c.pda
Answer: VSD?? If no cyanotic congenital is mentioned

119/what type of fracture?

a. Denis -weber type b fracture

b. Denis weber type A

c. maisonneuve fracture

d. pilon fracture

Answer: Maisonneuve fracture

120/ what's the diagnosis

a. fracture of 5th MC base

b. fracture of 4th MC base

c. fracture of hamate

d. carpometacarpal dislocation of 5th digit

Answer: carpometacarpal dislocation of 5th digit

121/what is the diagnosis:

I/ preilunate fracture

2/ lunate fracture

3/ scaphoid fracture

4/ wrist drop

Answer: lunate fracture

122/ 18 YS with capacity hypoglycemic 1.5 then became 5.7, need to go home and
refuse admission what is your action?
Answer: discharge after capacity check

123/ the husband brought known lewy body dementia wife to ED and due to busy
ED, he took his wife back home without treatment. Next day she is dead. What
action to complete death certificate:

a. write death certificate from Gp,

b. inform police

c. call the social service

d. nurse on triage from file and notes of pt

e. take Ho from her husband and complete death certificate

Answer: nurse on triage from file and notes

124/ patient with advanced certificate, what criteria?

Answer: should has capacity when making it.

125/ diagnosis? Mechanism of inury

Answer: lisfranc injury. Rotational (twisting) movement on planter flexed foot or

axial force
126/ what is the diagnosis

I/colles fracture

2/ Barton fracture

3/ montage

4/fracture radioulnar joint

Answer: colles fracture

127/ diagnosis:

a. posterior glenuhumeral dislocation

b. sternoclavicular dislocation

c. anterior glenuhueral dislocation

e. acromioclavicular subluxation

Answer: posterior glenuhumeral dislocation

128/ fracture after trauma pt cannot adducted his thumb what is the synonymous of
this presentation:

1/ dychin fracture

2/ forment sings

3/colles fracture

4/ Smith fracture
Answer: forment sign

129/ pt with maisonneuve fracture what is most appropriate step on management:

1/ immediate reduction

.2/ slab and follow up

3/ immediate refer to orthopedic to fixation on OR

Answer: immediate refer to orthopedic for fixation in OR

130/child limping and in pain what is the diagnosis?

a. Perthes disease

b. soft injury

c. transit synovitis

e. SUFE

Answer: Perthes disease

131/ 7 ys boy c/o pain and stopped he do sport for many days ago what is the
diagnosis:
I / Osgood schlatter disease

2/ avulsion of tribal tuberosity fracture

3/ patellar fracture

4/ fracture femur

Answer: Osgood schlatter disease

132/posterior knee dislocation what is the most common structure injured:

I/ popliteal artery

.2/popliteal nerve

3/femoral artery

Answer: popliteal artery

133/5 years child fall down, what is the diagnosis

1/supracondylar fracture

2/fracture head of radius

3/radioulnar dislocation

Answer: supracondylar fracture

134/ what is the most vessel affected:

1/ radial nerve.

2/ coIatral artery

3/ median nerve

4/ ulnar nerve

5/ ulnar artery

Answer: radial artery

135/ what is treatment

1/ oral acyclovir

2/ gancyclovir

3/ciprofloxacin

4/ corticosteroid

Answer: gancyclovir

136/what is associated symptom;

1/irregular pupils
2/pain on accommodation

3/purulent discharge

4/ permanent visual loss

Answer: pain on accommodation

140/scenario about pt hyperkalemia 6.1 no ECG changes what is the appropriate

management:

1/salbutamol with insulin and glucose

2/calcium chloride

3/potassium sparing diuretics

Answer: salbutamol with insulin and glucose

141/pt hypokalemia what is management:

1/potassium supplementation

2/iv fluid

3/magnesium 2 mg

Answer: magnesium if low first and oral if low hypokalemia or iv infusion when
severe
142/female pt did hyperthyroidism on carbimazole? There is pic of throat she
cannot swallow what is the action to do for her:

1/throat swab

2/CBC

3/antibiotic

Answer: CBC agranulocytosis

143/scenario about facial trauma pic given what is the initial step:

1/refer to ICU

2/coricothyrodotmy for ventilation

3/ventilation with bag valve mask

4/bring trolley for difficult intubation

Answer: bring trolley for difficult intubation

144/young male came with palpitation PR 230 Ecg given SVT other vitals normal
what is first step to manage him:

1/vagal maneuver

2/adnosine6mg

3/adnosine12mg
 4/amiodarone300mg

Answer vagal maneuver

145/

ECG of pt c/o chest pain what is the diagnosis:

1/complete heart block

2/trifiscular

3/cardiac tamponade

Answer: trifascicular block

True Trifascicular Block:

• Right bundle branch block

• Left axis deviation (Left anterior fascicular block)
• Third degree heart block
146/ 7 years boy c/o nut allergy and not eating for long time came to Er with skin
rash and vomiting what is the cause:

1/food allergy

2/viral illnesses

3/IgE

Answer: viral illness

147/ female c/o abdominal pain in parameters .k 2.1, and x-ry given (pseudo
obstruction) what is the diagnosis:

1/ colon malignancy

2/ perforation viscous

3/ileus small bowel obstruction

Answer ileus small bowel obstruction

148/ scenario about 4ys boy came with bradycardia after ingestion of bisoprolol
tablets what is given to him immediately:

1/ glucagon

2/ atropine
3/ DC shook
Answer: Glucagon

149/ scenario about dabigatran antidote:

Answer: Idarucizumab

150 / scenario about dabigatran mechanism of action:

Answer: thrombin inhibitor

151/ scenario about 15 Kg baby how to give him maintenance fluid:

1/1.5 L
2/ 6 liters

3/ 4 L

4.1250 ml

5. 5 L

Answer: 1250ml
152/ scenario about 4 ys baby what is the size of ETT:

1/ 5

2/ 4

3/4.5

4/7

Answer: 4.5

153/ scenario about pt hyperemesis gravidarum given fluid and metoclopramide

developed extra pyramidal manifestation .what drug should be given to her
symptoms

1/ diazepam

2/ haloperidol with promethazine

3/procyclidine

4/benzotropin

Answer: procyclidine

153/ another scenario about anaphylactic shock pt given adrenaline 2 times what's
the meaning of biphasic shock:

1 / adrenaline 2 times

2/ relapse of shock after respond

3/ not Improvement after adrenaline
4/ refractory shock and another protocol of management

Answer: relapse of shock after respond

154/p65 ys male with tongue and lip swelling having Hx hypertension and off
treatment what's

Diagnosis:

1/ allergic reaction

2/ angioedema

3/ stings bite

4/ epiglottitis

5/ genetic
Answer: angioedema (ACE inhibitor)???

155/scenario about pt of Central vertigo HINTS examination done for him

What’s finding in skew?

1/ directional nystagmus

2/ unidirectional nystagmus

3/ torsional and beating towards the lower most ear

Answer: directional nystagmus

156/old male came with fever and Sob pt become unconscious and intubated

He is improved and want to shift him to lCU after mint pt become deteriorated
chest x-ray done show ETT in Rt main stem bronchus what's the action:

1/ withdraw ETT from Rt upper tape

2/ re intubate the pt
3/ ventilation with bag valve mask

4/ remove the ETT and ventilated the pt

Answer: withdraw ETT from Rt upper tape

157/young male came to ER stabbing wound between scapula CNS ex found

contralateral loss of vibration and touch with ipsilateral loss of pain, tm and motor
what's diagnosis:

1/ brown sequard syndrome

Z/ conus medularis

3/ central cord syndrome

4/ paraplegia

Answer: brown sequard syndrome

158/young female came with fever, vomiting, upper rt Q tenderness and she is
icteric what is the diagnosis:
1/ biliary colic

2/ acute cholangitis

3/ cholesistites

4/ intestinal obstruction

Answer: acute cholangitis

159/scenario about old male diabetic in er in AKI what's drug responsible:

1/ codeine

2/ metformin

3/ simvastatin

4/ ACE inhibitor

Answer; NSAIDs

160/pt came with chest trauma CT done having lung contusion what most common
complication has associated with his condition:

1/ massive hemothorax

2/ ARDS

3/ aortic dissection

Answer: ARDS

161/ young pt came with pneumothorax 3 cm c/o breathlessness what's appropriate

step of management:

1/ 28fr drainage

2/ needle aspiration

3/ 02 and discharge

4/ admitted 24h for observation

5/ selindrberg chest drainage

Answer: selindrberg chest drainage

162/ trauma pt. came with open wound in its side of the chest dressing done and
start fluid and stabilize the pt., he became distressed and unwell what's suggested
happen and found

1/ after dressing of wound become tension

2/ trachea shifted to the it side

3/ wide mediastinum

4/ dull on percussion

Answer: after dressing become tension

163/old man came to ER by cervical collar and neck pain on examination there is
upper weakness 4/5 and loss of sensation above the lesion MRI done what's
diagnosis:

1/ Central cord syndrome

2/ upper motor neuron lesion

3/ quada equina

4/ osteoarthritis in spine

5/ stroke (CVA)

Answer: central cord syndrome

164/ scenario about head trauma pt what's not an indication to do CT in I h:

1/ deterioration level of consciousness

2/ active seizure

3/ sings of basal skull fracture

4/ episodes of vomiting

5/ high mechanism of collusion

Answer: high mechanism of collusion

165/ pt came with hemolysis start blood transfusion cannula in the left arm pt
become deteriorated and c/o pain in the side of iv line what's the cause of pain:

1/ over load in side of transfusion

2/ hemolytic reaction

3/ anaphylactic reaction

4/ infection and sepsis in the cannula side

Answer: acute hemolytic reaction

166/ pt came cyanosed, tachycardia and pin point pupils what's cause of his
symptoms:

1/ CNS abnormalities and RS depression due to opiate

2/ pulmonary construction due to cannabis

3/ alcohol over dose

4/ anti depression drug reaction

Answer: CNS abnormalities and RS depression due to opiate

167/ young male co chest pain with SOB CTPA done diagnosed as PE start o2

, analgesia, anti-coagulant .pt fit and no an Hx of risk of bleeding what's next step
management:

1/ Alteplase
2/ unfractionated heparin

3/ refer to cardiopulmonary center

4/ LMWH

Answer: LMWH( ALTEPLASE if not stable)

168/suspected covid case covid pcr negative, condition since 6 weeks, x ray chest
with complete scattered opacification, fine crepitauons, what to give

1/ Augmentin + clarithromycin

2/ furosemide

3/ fluconazole
4/ oseltamivir

5 / amoxicillin

Answer: furosemide) (Answered by the source)

169/ - what suggest sepsis in neonates,

Answer: CRT equal or more 3 seconds??

170/ hx of dental extraction and inability to swallow, diagnosis?

Answer: Ludwig's angina

171/ scenario about pt fainting and fever with tachycardia diagnosis as thyroid
storm and shifted to ICU what is appropriate step on management:

1/ IV fluid

2/ hydrocortisone

3/ beta blockers

4/ iodine supplements

Answer: beta blockers

172/ Pt known HIV with sob and cough picture given, what is the treatment
Answer Pneumocystis jiroveci, treatment Co-trimoxazole

173/ scenario of post CPR, how to confirm death in cardiac arrest pt:

1/ no gag reflex

2/ no peripheral pulse

3/ no breathing

4/ watch patient for 5 mints

5/ vestibuleocular reflex

Answer: vestibule-ocular reflex

To perform death confirmation:

1. Wash your hands and don PPE if appropriate.

2. Confirm the identity of the patient by checking their wrist band.

3. Inspect for obvious signs of life such as movement and respiratory effort.

4. Assess the patient’s response to verbal stimuli (e.g. “Hello, Mr Smith, can you
hear me?”).

5. Assess the patient’s response to pain using one of the following methods:

• Apply pressure to the patient’s fingernail.

• Perform a trapezius squeeze.

• Apply supraorbital pressure.

6. Assess the patient’s pupillary reflexes using a pen torch: after death, the pupils
become fixed and dilated.
7. Palpate the carotid artery for a pulse: after death, this will be absent.

8. Perform auscultation in an attempt to identify any heart or respiratory sounds:

• Listen for heart sounds for at least 2 minutes.

• Listen for respiratory sounds for at least 3 minutes.

The recommended amount of time to listen for heart and respiratory sounds can
vary, but it is generally accepted that a minimum of five minutes of auscultation is
required to establish that irreversible cardiorespiratory arrest has occurred. 1

9. Wash your hands, dispose of PPE appropriately and exit the room, making sure
the relevant doors and/or curtains are closed/drawn behind you.

174/ Scenario about trauma pt central vein access inserted for him pt came in
shock after stabilize 10 mint pt become deteriorated what do you suggest happen to
him x-ray given:

1/ internal bleeding (hemothorax)

2/ arrhythmia

3/ infection

4/ catheter mal position

5/ nerve injury

Answer internal bleeding (hemothorax)

175/ 11 ys boy liming x-ray given what is the diagnosis:

Answer slipped upper femoral epiphysis

174/ male pt came with one side numbness in the face what is initial management
pic given:
1/ CT brain

2/ prednisolone 20 mg

3/ antibiotic

Answer: prednisolone 50-60 mg

175/ old pt came to Er with worsening pain in both hand pt kown RA pic given
what's abnormality seen:
1/ buchards nodes

2/ deformity of thumb

3/ swan neck

4/ boutonnieres

Answer: Z deformity of the thumb

176/ scenario about human bite what is appropriate management:

1/ co amoxiclav

2/ dressing and discharge

3/ x-ray and refer to ortho

4/ analgesia with drainage.

.5/ no need medication

Answer: analgesia with drainage

177/ scenario about pt cut wound pic given indication to give tetanus toxoid
vaccine:
1/ devitalized tissue

.2/ wound need surgical intervention

3/ open fracture
4/ prone wound

5/ wound contaminated with foreign body

Answer according to pt age

178/ young male drug abuser pic given what is the diagnosis:

1/ Lt oculomotor palsy

2/ Rt oculomotor palsy

3/ Rt abducens nerve

4/ Lt Optic

Answer: Rt oculomotor nerve

179/ pt with permcath on dialysis having fever and shivering what is the initial step
on management:

1/blood culture from both side of arms

2/culture from the side of permcath

3/ antibiotics and fluid

Answer: culture from permcath

180/ patient with hx of lymphoma patient received radiotherapy 10 days ago and
came with fever and dysuria, you have been busy in ER, she ask u to review her.
What the appropriate action,

1/ ask junior doctor to see her

2/ check her immediately

3/ ask nurse to collect urine sample

Answer: ask nurse to collect sample??

MISCELLANEOUS

181/Paracetamol curve

182/Carbnography what is meaning (hypoventilation??)

183/HHE , fluids

184/Patient with ITP

185/ Other Q about HIV Post exposure who needed HIV prophylaxis, Hx of two
men in relation (answer anal intercourse)
186/Question about ossification center

Good Luck