▲ Some of the questions are longer in the exam than which written in this file ^with additional

Lab data^. We tried to write the relevant ones.

▼ better to study the questions topics rather than memorizing them. It could be repeated with
…. different scenarios.
❖ special thanks for all participant and collectors.

▼ ▲

❖
1. 67 years old female came for routine investigation. She was Asymptomatic and her vital
signs as follow:
BP 126/ 86
Heart rate: 88
Temperature: 36.8
Lab:
cholesterol 5mmol Normal <5
LDH 2.3
HDL 1.9
Which of the following is consider risk factor for developing heart disease?

A. Female gender
B. Diastolic blood pressure > 80
C. Cholesterol
D. Age > 65
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2. 29 years old patient came for pre job evaluation. He is asymptomatic
His ECG is showing

A. Normal ECG
B. First Degree AV Block
C. Second degree AV block Mobitz type 1
D. Second degree AV block Mobitz type 2

3. 45 years old male presented with history of chest pain radiating to both shoulders with
nausea and vomiting.
ECG obtained:

A. Anterior MI
B. Lateral MI
C. Inferior MI
D. Septal MI
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4. During periodic heath exam or pre employment visit. A patient was found to have systolic
murmur grade 3/6, which was in the left sternal border , increasing with standing associated
with physiological splitting of second heart sound . It was not radiating to the carotid. There
was normal apical impulse and no femoral delay
What is most likely causing this murmur?

A. Pulmonary stenosis
B. Tricuspid stenosis
C. Bicuspid aortic valve
D. Mitral valve prolapse

5. You are caring for a 38-year-old male patient who reports episodic chest pain. He reports that
the pain feels like “tightness,” and is located right behind his sternum, lasts less than 3
minutes, and is relieved with rest. He takes no medications, has no family history of coronary
disease, and has never smoked. His ECG in the office is normal.
Which of the following tests should be done to determine whether or not his chest pain is
due to ischemia?

A. Exercise ECG
B. Resting echocardiogram
C. Stress echocardiography
D. Radionuclide angiography

6. A patient with Rheumatic fever symptoms : joint pain ? inflammation, subcutaneous nodules
…..etc. . how to confirm diagnosis?
A. ASO titer
B. .
C. .
D. .

❖
7. Asthmatic patient presented with acute asthma exacerbation. He can’t complete a sentence.
Which of the following is indication for hospital referral?

A. PEF >70%
B. PEF 40-60%
C. PEF <40%
D. physical finding
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8. 19 year old, came complaining of cough and runny nose. On examination: there is mild
congestion of the throat. chest X-ray attached: normal

What is the most appropriate management?

A. doxycycline
B. clindamycin
C. cefuroxime
D. amoxicillin

9. A 25-year-old presents with sore throat. on examination: temperature 38. there is tonsillar
exudate, with anterior cervical lymph node. He denial cough.
what is the appropriate management?
A. oral penicillin
B. rapid antigen test
C. Symptomatic treatment with antipyretic
D. Throat culture

10. A construction worker presented with SOB and cough, on examination he had wheezing and
clubbing ..
what is the most likely diagnosis?

A. silicosis
B. asbestosis
C. Berylliosis
D. .

11. A case about old patient who is a heavy smoker, presented with productive cough.
On examination: there is bilateral wheezing, he is on LABA and antibiotic,
What you will add?

A. prednisolone
B. Theophylline
C. Montelukast
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12. A Child came with acute asthma exacerbation, he is using his salbutamol inhaler frequently
and his symptoms increase when he is at home, His father is a smoker.
What is the most appropriate step in management?

A. Family counseling
B. Increase dose of salbutamol
C. Add inhaler corticosteroids
D. Add long acting beta 2 agonist

❖
13. A 21-year-old know case of type 1 Diabetes, presented with this lab finding
HBs Ag +ve
HBs Ab -ve
HBc IgM -ve
Hbe Ag -ve
Hbe Ab +ve

What is most likely interpreting?

A. chronic infection
B. acute infection
C. post infection
D. immunized

14. 26 years old female patient was complaining of abdominal pain and bloating with diarrhea
changed to be loose sometimes
what is the next step ?
A. hydrogen breath test
B. abdominal us
C. anti-tissue transglutaminase antibody
D. fecal occult blood

15. A patient came with diarrhea. There is a history of use of amoxicillin antibiotics 2 weeks ago.
what investigation to order?
A. Stool culture
B. CBC
C. Clostridium difficile immunoassay
5

D. Stool analysis and ova

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16. 40 years old patient, known to have DM on Metformin, HTN and chronic osteoarthritis on
ibuprofen. 2 weeks ago, he complained of epigastric Abdominal Pain. O/E, abdomen is soft
and lax with mild tenderness in the epigastric pain.
What is the 1st step in management?
A. H Pylori testing
B. Stop ibuprofen
C. Start omeprazole
D. Endoscopy

17. A 34-year-old Female Complaining of RUQ abdominal Pain that radiates to the back. There
is history of previous same complaint.
Lab: ALT and AST: mild increase, Lipase and amylase: Normal
What is the most likely diagnosis?

A. Duodenal Ulcer
B. acute Pancreatitis
C. Acute Cholecystitis

18. Patient with epigastric pain that is increasing in the morning, the pain is relieved by food?

A. Peptic ulcer
B. Duodenal ulcer
C. Gastric ulcer

19. On a routine-screening: complete blood count, a 7-year-old is noted to have a microcytic

anemia. A follow-up hemoglobin electrophoresis demonstrates an increased concentration of
hemoglobin A2 7% .
What is the most likely diagnosis:

A. Alpha-thalassemia trait
B. β-thalassemia trait
C. Iron deficiency anemia
D. Sickle cell anemia
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20. A female Patient which is a known case of DM on metformin, came for evaluation for her
numbness. On examination: Absent ankle reflex and a positive Babinski sign
her MCV 106
What is most likely diagnosis?
A. Vitamin B12 deficiency
B. Hypothyroidism
C. Peripheral neuropathy
D. Folate deficiency

❖
21. A 20 year old man presented with fever, sore throat, and fatigue for one week. After 2 days
of illness, he took a friend's antibiotic and developed a red rash all over his body .He then
stopped the antibiotic. His oropharynx is mildly red without exudates, and he has multiple
lymphadenopathy and tip of spleen was palpable.
Which one of the following is the most likely management?

A. Referral for admission

B. Antibiotics
C. Antiviral
D. antipyretic and avoid sport

22. A patient came from South Africa, developed fever, headache , lethargy and fatigue. Which
of the following appropriate to establish diagnosis?

A. Thin and thick Blood film

B. CBC
C. ziehl neelsen stain
D. Blood culture

23. A 25-year-old male patient Presents with a purulent urethral discharge for one day. he had
unprotected sexual intercourse 3 nights ago.
In order to initiate empirical treatments while waiting laboratory test for this sexual
transmitted illness. What period do you need to know?

A. latent
B. exposure
C. infectious
D. incubation
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24. A 19-year-old male has an 7-mm induration , 2 days after a tuberculin skin test. His father
was recently diagnosed with tuberculosis. There are no other historical or physical
examination findings to suggest active tuberculosis infection and a chest radiograph is
normal.
Which one of the following would be most appropriate at this point?

A. Monitoring with annual tuberculin skin testing

B. Observation and repeat tuberculin skin testing in 3 weeks
C. Rifampin daily for 4 months
D. Isoniazid daily for 9 months

25. 60 years old patient came to you with history of headache and fever on examination T= 38 ,
and neck stiffness

CSF analysis:
WBC high (9) 70% lymphocytes
glucose is normal
protein is normal
normal opening pressure

What is the most likely diagnosis?

A. bacterial meningitis
B. viral meningitis
C. TB meningitis
D. Cryptococcal

26. A diabetic on insulin glargine and short acting insulin. He is feeling dizziness and has
sweating while he is walking on treadmill. Fasting blood sugar in morning 140mg/dl
what to do?

A. snacks before exercising

B. skip one dose premeal
C. decrease dose of insulin glargine
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D. Change to NPH
27. A diabetic patient, high A1c = ?11% , weight is 120 kg
How to start insulin?

A. 10 units short acting insulin

B. long acting insulin 30U . and short acting 10 U pre meals
C. insulin sliding scale
D. 20 units short acting insulin.

28. A 10-years-old girl complaining of Recurrent genital itching. She have Family history Of
type 2 DM. On Examination: there is acanthosis nigricans on her Neck and axilla. She have
Tanner Stage 3 breast development and stage 3 pubic hair , BMI>95th
What is your most likely diagnosis ?

A. Adrenal hypoplasia
B. DM type 2
C. Mycosis fungicides
D. MODY

29. You note a thyroid nodule in a 35-year-old African American woman who is not
demonstrating clinical features of thyroid dysfunction.
Which of the following patient characteristics, or features would increase your suspicion of
malignancy?

A. The patients age

B. Slowly growing nodule
C. The patient's sex
D. persistent hoarseness

30. A 61-year-old white postmenopausal woman comes to your office for a routine health
examination. She has a history of osteoarthritis, and she smokes one pack of cigarettes per
day. She is on no medications. Her blood pressure is 120/80 mm Hg, BMI 27. The rest of her
physical examination is normal.
Which of the following is an established risk factor for osteoporosis?

A. BMI
B. current smoking
C. history of fragility fracture in first-degree relative
D. low calcium intake
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31. In a patient presenting with truncal obesity, hypertension, type 2 diabetes mellitus, hirsutism,
osteopenia, and skin fragility, which one of the following tests is needed to confirm the
diagnosis?

A. A dexamethasone suppression test

B. Aldosterone ratio
C. ACTH
D. Urinary free cortisol

32. Female patient with amenorrhea and history of weight gain.

Her lab investigation:
Testosterone 9
FSH 20
LH 60

What is most likely diagnosis?

A. PCOS
B. Hypothyroidism
C. CAH

33. Patient with poorly controlled DM , HTN and osteoarthritis

His BMI 45, HA1c 11%

what is most appropriate step?

A. GLP1
B. Bariatric surgery
C. Insulin
D. Orlistat

34. Diabetic patient with confusion, high blood sugar and no ketones in the urine
RBS= 35 mmol/L = 630mg/dl

what is most likely diagnosis?

A. HHS
B. DKA
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35. A 25-year-old female who is 3 months post-partum presents with multiple complaints,
including increasing weakness and fatigue, intolerance to warm environments, a weight loss
of 30 lb despite an increased appetite, difficulty sleeping, awareness that her heart is beating
faster and “pounding” in her chest, increasing restlessness and difficulty concentrating,
increased tremulousness, and a significant swelling in her neck. She takes no medication, has
experienced no recent trauma, and has not ingested large amounts of iodine. When you
examine her you find no exophthalmos or lid lag and no pretibial edema, but her skin is
warm, smooth, and moist. You also find a smooth, non-nodular, nontender, enlarged thyroid
gland, clear lungs, a resting tremor, and hyperactive reflexes. Laboratory testing reveals a
low TSH level, elevated free T3 and free T4, and high uptake on a radioactive iodine uptake
scan. Which one of the following is the most likely diagnosis?

A. Postpartum thyroiditis
B. Silent thyroiditis
C. Subacute thyroiditis
D. Graves disease

36. On routine physical examination, a 28-year-old woman is found to have a thyroid nodule.
She denies pain, hoarseness, hemoptysis, or local symptoms. Serum TSH is normal. Which
of the following is the best next step in evaluation?

A. Thyroid ultrasonography
B. Thyroid scan
C. Surgical resection
D. Fine needle aspiration of thyroid

37. A patient is known case of Diabetes Mellitus for 10 years came with tingling and burning
sensation. what is the most likely diagnosis?

A. diabetic neuropathy
B. Post herpetic neuralgia
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38. 40 year old man presents with a 3 day history of earache and dizziness , asymmetrical face
and loss of taste. on examination he has a right facial weakness.
Which of the following is the most likely diagnosis ?

A. stroke
B. Otitis media
C. Bell’s palsy
D. Ramsey hunt syndrome

39. Patient with absent ankle jerk. Can’t walk on his toes and there is loss of sensations of lateral
side of foot.
What is the affected dermatome?

A. S1
B. L4
C. L5
D. T12

40. 22 years old divorced female presented with on & off band-like headache mainly on the back
of the head for 3 weeks. Increase with emotional stress. Examination is normal.
What is the treatment?

A. SSRI
B. CCB
C. Sumatriptan
D. NSAID

41. A 12-year-old girl has an acute, recurrent, pulsatile headache localized behind the eyes that
tends to occur more frequently. She has no symptoms that occur prior to the headache; her
neurologic examination is normal.
What is the most likely diagnosis?

A. Tension headache
B. Migraine headache
C. Cluster headache
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❖
42. A 32-year-old woman has a long history of recurrent aphthous oral ulcers. on examination:
she has vulvar lesions and scar on her back.
What is the most likely diagnosis?

A. Herpes simplex
B. Coxsackie A virus
C. Behçet disease

43. 70-year-old female Complaining of unilateral headache with tenderness on temporal bone
and lacrimation, there is history of shoulder and neck pain. Lab: high ESR

A. Giant cell arteritis

B. polyarteritis nodosa
C. Migraine

44. A patient is complaining of bilateral knee pain , more on one side, with mild swelling, no
erythema or effusion, what most likely diagnosis?

A. Osteoarthritis
B. Septic arthritis
C. Gout

45. Female teacher with fatigue of 4 months , macrocytic anemia and elevated ESR.

A. Rheumatoid Arthritis
B. Fibromyalgia
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❖

46. 60 years old Complaining of dizziness, fallen twice, no LOC. No abnormal movement. He is
known case of HTN, CKD, DM on low dose metformin, losartan, hydrochlorothiazide.
Na 132
K 3.2
Cr 120
A1c 7.5%

A. add sitagliptin
B. amlodipine
C. stop hydrochlorothiazide
D. stop metformin add gliclazide

47. A male patient is know to Have DM and HTN , on Maximum Dose of . Metformin ,
gliclazide, and valsartan . His Bp=150/89

What to add for him ?

A. Lisinopril
B. Metoprolol
C. Amlodipine
D. no change in medication

▼ ▲

48. 32 Years old Male, Complaining of abdominal pain, and vomiting, ... He did Gastric Sleeve
before 2 weeks ago.
What is you is the most likely diagnosis?

A. Afferent loop syndrome

B. Dumping Syndrome
14

C. GERD
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49. A 44-year-old woman is admitted to the hospital for acute right upper quadrant pain
consistent with biliary colic. Her symptoms have been present for 4 hours, and she also has
fever and a positive Murphy sign. She has a history of asymptomatic gallstones, identified
incidentally several years ago. Her laboratory evaluation is as follows:

White blood cell (WBC) 17.5 (H) with left shift

Aspartate aminotransferase (AST) 88 (H)
Alanine aminotransferase (ALT) 110 (H)
Alkaline phosphatase 330 (H)
Bilirubin (total) 3.2 (H)

What would the most appropriate step?

A. US of the abdomen
B. CT scan of the abdomen
C. MRI of the abdomen
D. Endoscopic retrograde cholangiopancreatography (ERCP)

50. You are seeing a 14-year-old boy who was brought emergently to your office after
developing severe testicular pain while weight lifting 3 hours ago. He had a sudden onset of
severe pain without fever, and has had associated nausea and vomiting. On examination, his
cremasteric reflex is absent, and when the patient is in the supine position, elevation of the
testis increases the pain.
Which of the following is the most likely diagnosis?

A. Epididymitis
B. Testicular torsion
C. Inguinal hernia
D. Orchitis

51. A 67-year-old male with past history of 20 years of smoking was evaluated for abdominal
aortic aneurysm and was found to be 4.2 cm. He is Asymptomatic.

What is appropriate approach for him

A. Reassurance
B. Referral for surgery
C. Repeat evaluation after 6-12 months
D. Abdominal CT
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52. 49 years old obese female patient presented with a lump in lower abdomen below inguinal
ligament and lateral to symphysis pubis. Not affected by pressure impulse “cough” , or by
lifting heavy object, what is the most likely diagnosis ?

A. Inguinal hernia
B. Femoral hernia
C. Lipoma
D. saphena varix

▼ ▲

53. You are seeing an 18-year-old boy who reports acute pain in the left posterior heel. His
symptoms occurred while he was playing intramural basketball for his college dorm’s team.
On examination, he has swelling and ecchymosis over the posterior left heel. He is unable to
walk normally and has a positive Thompson test. What is the most likely diagnosis?

A. Calcaneus fracture
B. Tarsal navicular bone fracture
C. Planar fascia rupture
D. Achilles tendon rupture

54. A 42-year-old woman presents with a history of falling on outstretched hand presented with
chief complaint of right hand numbness. Decreased sensation in the volar aspect of the little
finger inability to abduct the finger This presentation indicates a problem in which of the
following?

A. Radial nerve
B. Ulnar nerve
C. Median nerve
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55. You are seeing a 45-year-old woman who reports increasingly severe right foot pain for . She
has been trying to lose weight, and has recently started a walking regimen. She describes a
sharp pain in the inferior heel when weight bearing after a period of rest. With continued
movement, the pain improves, but becomes more dull and achy. She has tried anti-
inflammatory agents with only temporary relief.
Of the following, which is the best next step?

A. Right foot x-ray

B. Arch support
C. Physical therapy
D. Referral to a foot specialist

56. A patient comes to see you after a skiing accident 6 days ago. She reports twisting her left
knee during a fall, feeling a “pop,” and noting significant immediate swelling. She was able
to bear weight immediately, but did not ski for the rest of the trip. Her pain is now improved,
and she is ambulating, but she says the knee feels unstable. On examination, she has a tense
effusion in her left knee and is unable to extend her knee fully. Which of the following is the
most likely cause of her symptoms?

A. ACL tear
B. Posterior cruciate ligament (PCL) tear
C. Meniscal injury
D. Medial collateral ligament sprain

57. You are seeing a 16-year-old high school football player to discuss a recent injury. Last
night, during football practice, he dislocated his shoulder. His trainer took him to an urgent
care where an x-ray confirmed the diagnosis. They relocated his shoulder and put him in a
sling. This is the first time he has dislocated his shoulder. Which of the following represents
the most appropriate next steps?

A. If his range of motion is normal, allow him to return to play without restriction.
B. Immobilization until an MRI can be obtained.
C. Referral for physical therapy as soon as possible.
D. Immobilization for 2 to 3 weeks, then begin physical therapy.
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58. A 35-year-old female patient presents to your office complaining of acute low back pain. She
reports she was folding laundry last night and felt a sharp pain in her left lower back which
quickly progressed to a severe pain with movement. She is unable to stand up straight today
without excruciating pain. She has no past medical history and takes no chronic medications.
On examination today, she has no bony tenderness to palpation, positive left paraspinal
muscle spasm, reduced active range of motion, negative straight leg raise test, and normal
muscle strength and neurologic examination.
What is the best course of action for this patient?

A. Bed rest for 2 to 3 days

B. X-ray of the lumbar spine
C. Referral to physical therapy
D. Start a daily NSAID and muscle relaxant

59. 16 years old boy complaining of knee pain that increase when going upstairs or downstairs
Examination show no effusion or instability and no joint line tenderness Knee radiographs
normal Which of the following is most likely diagnosis?

A. patellae chondromalacia
B. Osgood–Schlatter disease
C. .
D. .

60. A 12-year-old male obese patient is brought to your office with-a 3-week history of left groin
pain that is most bothersome after she participates in gym class at her middle school. She
does not recall a specific injury and does not participate in extracurricular sports. She had an
upper respiratory infection about a month ago but has otherwise been well. An examination
reveals a BMI at the 95th percentile for her age. Her vital signs are within normal limits. A
musculoskeletal examination is remarkable for limited internal rotation of the hip.
Which one of the following is the most likely diagnosis?

A. Adductor muscle strain

B. Apophysitis of the anterior superior iliac spine
C. Legg-Calvé-Perthes disease
D. Slipped capital femoral epiphysis
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61. patient fall on outstretched hand one day prior to his presentation with this X-ray
What is appropriate management?

A. Open reduction and internal fixation

B. Close reduction
C. Cast
D. sling

Colle’s fracture management

62. Shoulder pain at night . Limited ROM with passive movement. history of trauma ?

A. frozen shoulder
B. Rotator cuff tear
C. Adhesive capsulitis
D. Impingement

63. Male come after one day of trauma to ankle, present with foot pain , he is able to bear weight
with mild pain , on exam there are bruises and swelling over lateral side of ankle joint and
tenderness in anterior edge of malleolus
What is your initial step of management?

A. radiography of right ankle

B. immobilization with boot
C. MRI of ankle
D. trength and exercise for ankle

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▼ ▲
64. You are seeing a 67-year-old man who is following up in your office 2 days after being
involved in a motor vehicle collision. He was the restrained driver and was going 45 mi/h
when he ran into a car that was stopped in front of him. Thankfully, he denies head injury or
loss of consciousness. He was ambulatory after the event and only had slight neck pain, but
was taken to the emergency department for evaluation. They released him that evening
without any imaging studies. On follow-up with you, he denies neck pain or numbness and
tingling in his extremities. His range of motion is appropriate for his age. What testing, if
any, should be done at this time?

A. No testing is needed.
B. He should have C-spine radiographs.
C. Topical analgesia
D. He should have an MRI of the neck.

65. A 3years old girl swallowed a button battery. Plain radiographs demonstrate that the battery
is lodged in the esophagus.
Which one of the following is the most appropriate next step in management?

A. Expectant management
B. Endoscopic removal
C. Ipecac for therapeutic emesis
D. Activated charcoal

66. You are evaluating a 56-year-old generally healthy man who is seeing you after finding
blood in his urine. He denies pain, dysuria, frequency, or urgency. He is a smoker.What is the
most likely cause of his hematuria?
A. Acute prostatitis
B. UTI
C. Urinary stones
D. Bladder carcinoma
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67. A 34-year-old man presents after a high-speed motor vehicle crash. Chest x-ray is performed
and shown
Which of the following is the most likely diagnosis?

A. Pneumothorax
B. Small bowel rupture
C. Duodenal hematoma
D. Diaphragmatic rupture

68. You are evaluating a 30-year-old male patient in the office with hematochezia. He has had
chronic constipation, and reports bright red blood from his rectum associated with extremely
painful bowel movements. After defecation, he complains of a dull ache and a feeling of
“spasm” in the anal canal. The pain resolves within a few hours. On external examination, no
abnormalities are noted.
Which of the following is his most likely diagnosis?

A. Anal fissure
B. external hemorrhoid
C. Cron’s disease
D. Thrombosed internal hemorrhoid

69. You are evaluating a 63-year-old man who complains of abdominal pain, distention, nausea,
and vomiting, It began rather suddenly this morning, though he has had mild pain
for several days. His past history is significant tor a partial sigmoid resection for
diverticulosis and an appendectomy at age 23. On examination, he is afebrile, his mucous
membranes are dry, but he has no orthostatic symptoms. His abdomen is dis tended and
diffusely tender, and hisbowel sounds are hyperactive. Which of the following is the most
appropriate management?

A. Surgical referral
B. Enema
C. Laxatives
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70. A 36-year-old female who is in excellent health presents for a routine physical examination.
Family history reveals that the patient’s mother and grandmother died of breast cancer at the
age of 50 years.
Which of the following statements best describes this patient?

A. Referral for BRCA mutation.

B. Mammogram annually starting at 50
C. Breast self-examination
D. Tamoxifen

71. A 22-year-old woman is seeing her physician with complaints of breast pain. It is associated
with her menstrual cycle and is described as a bilateral “heaviness” that radiates to the axillae
and arms. Examination reveals groups of small breast nodules in the upper outer quadrants of
each breast. They are freely mobile and slightly tender.
Which of the following statements is most accurate?

A. Reassurance
B. Ultrasound
C. Mammogram
D. FNA

▼ ▲

72. 2 years old child with crying spells and cyanosis. The mother noticed him one time closing
his knee to the chain with cyanosis when ever he is upset , on examination child growth
parameters are normal with systolic ejection murmur at the left mid and upper sternal border
Chest radiograph

What is most likely cause of this child presentation?

A. Tetralogy of Fallot
B. Crying spells
C. VSD
D. PDA
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73. 24 child on breast feeding cannot run and cannot walk up and down stairs has dental caries,
growth in 3rd percentile, hypotonia , lab hypocalcemia ,hypophosphatemia , high parathyroid
hormone , high alkaline phosphatase

What is the most likely diagnosis?

A. Hyperparathyroidism
B. Vitamin D deficiency rickets
C. inborn error of metabolism
D. Congenital Adrenal insufficiency

74. 12 month old child presented with repeated cough followed by post tussive vomiting, his
mother had a common cold 3 days ago, and on reviewing child immunization he was delayed
with some vaccinations.

What is the most likely missed vaccination?

A. H. influenza
B. Dtap
C. Pneumococcal
D. MMR

75. A 2 year old child is complaining of anal itching mainly at night , on examination: anal
erythema. stool analysis: 3 consecutive samples were normal.

What is the management?

A. mebendazole once
B. albendazole and repeat after 2 weeks
C. stool culture
D. Antihistamine

76. A 5-year-old boy presents with confirmed rotavirus diarrhea. He is tachycardic and lethargic
with sunken eyes, poor skin turgor, and dry mucous membranes.

Which of the following is the most appropriate next step in management?

A. 0.45 NS 100 mL per hour drip

B. D5 0.45 NS 10 mL per kg bolus
23

C. 0.9 NS 100 mL per hour drip

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D. 0.9 NS 20 mL per kg bolus

77. A 2-year-old presented with 3 weeks history of fever reaching 40
C, the mother also noticed swelling of the finger and rash on his
face، no conjunctivitis….

What is the most likely diagnosis?

A. Kawasaki disease
B. Juvenile rheumatoid arthritis
C. septic arthritis
D. Rheumatic Fever

78. 4 years old is passing hard stool every 3-4 days. Upon PR exam found to have poor tone and
fecal impaction, he was growing normal and he passed stool in the first day of life.

What is your next step ?

A. dietary modification
B. Hypothyroidism
C. Rectal enema and biopsy

79. 7 years old female presented with her mother .The mother was concerning about breast
enlargement and development. on examination you found breast development with pubic hair
and normal neurological examination.

what is most likely etiology of this child presentation?

A. Idiopathic
B. Brain tumor
C.
D. .
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80. 6 months old baby came to the emergency department,
have a history of cough, runny nose and SOB. On
examination: Intercostal retractions, bilateral wheezing .
CXR is attached.

What most appropriate management?

A. Hydration and oxygenation
B. Iv fluid
C. salbutamol nebulization

81. A 13-year-old female presented with her mother who is

concerning about that she is not menstruating yet. In history
you found that she is always the shortest one comparing
with her colleagues. By examination you found low set
hairline, thick skin fold in the neck, high arched palate and
turner stage 3 & scattered pubic hair.

What is the most likely diagnosis?

A. Turner syndrome
B. Down syndrome
C. Marfan syndrome
D. .

82. 7 years old child is recently diagnosed with chicken pox , the mother came worrying about his
one year old brother which may become infected.

What most appropriate advice?

A. Antivirals
B. Antibiotics
C. Immunoglobulin
D. Contact precaution until lesions are crusted
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83. A Patient had bluish white macules with
erythematous oral mucosa, two days later an
erythramtous generalized macular rash
developed, which began on forehead and
progressed to involve the entire body, he has
upper respiratory symptoms, cough ,
conjunctivitis and fever.

What is the most likely diagnosis?

A. Measles
B. Rubella
C. Coxsackie virus
D. Scarlet fever

84. A mother brings her 2-month-old infant. He is a premature infant who was born at 27th week of
gestation. The mother is concerning about the growth of her baby as compared to other children.

What advise should be conducted to the mother regarding gaining weight?

A. exclusive breast feeding

B. multivitamins
C. weaning at age of 4 months
D. adding artificial formula

85. A newborn infant is noted to have bilious vomiting, non-projectile approximately 24 hours
after birth. On examination, there are active bowel sounds and some visible peristaltic waves
but no abdominal distention.
Which of the following would most likely account for this child's vomiting?

A. Volvulus
B. Pyloric stenosis
C. Tracheoesophageal fistula
D. Duodenal atresia
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86. A 4-year-old child came with runny nose and barking cough. on examination: inspiratory
stridor and suprasternal recession.

what is the most likely diagnosis?

A. Croup
B. epiglottis
C.
D. .

87. 6 months old child came with irritability, diarrhea with blood and mucous . on examination
you felt upper abdominal mass.
What is the next step in management?

A. air contrast enema

B. Meckel scan
C. stool culture

88. 28 days newborn came Ch fever, vomiting, diarrhea on examination poor suckling reflex. what
is the most appropriate management?

A. Full septic workup

B. Abdominal us

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89. An old postmenopausal lady came with vaginal bleeding; last pap smear was normal.
What initial step in management?

A. Transvaginal US
B. Endometrial biopsy
C. Repeat Pap smear
D. Colposcopy

90. Females patient with symptoms of irritability for the last 8 months , the symptoms occur 5
days before period and resolve 3rd day of mensuration , with affection on her performance

What is most effective treatment?

A. SSRI
B. Exercise
C. Relaxation techniques
D. .

91. You are evaluating a 20-year-old woman complaining of vaginal discharge. She reports
vaginal itch and white discharge. She has no history of vaginal infections in the past and has
never been sexually active. Examination shows a white discharge with vulvar erythema. A
KOH preparation of the discharge demonstrates spores and pseudo hyphae.

Which of the following will relieve the patient’s symptom of itching ?

A. single dose of oral fluconazole

B. Oral metronidazole 500 mg bid for one week
C. Oral clindamycin
D. Boric acid od for 2 week 28
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92. You are reviewing the results of a recent Pap test you performed on a 29-year-old female
patient. Last month, her cytology was low-grade squamous intraepithelial lesion (LSIL).
HPV was negative

What is the next best step?

A. Repeat cytology immediately

B. Repeat cytology in to 6 months
C. Repeat cytology in 12 months
D. Colposcopy

93. A pregnant women 11 weeks , came with slight bleeding , on Us closed cervical Os.
What is the most likely diagnosis?

A. threatened abortion
B. missed abortion
C. complete abortion
D. incomplete abortion

94. 30 Years old Woman Known to Have Migraine Headache, came to your clinic asking for
Contraception. She is 6 weeks postpartum.

What is the best and highly effective method of contraception for her ?

A. Combined oral contraceptive pills

B. IUD
C. depo provera
D. Spermicide

95. Pregnant Lady in 26 weeks have high blood pressure , BP: 156/95.
in investigation : All normal , no Protein in Urine...

What is the most likely diagnosis?

A. mild pre-eclampsia
B. essential HTN
C. Gestational HTN
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96. Pregnant Lady on 16 week of Gestational, presented forantenatal visit with the following lab:
FBS= 7.3
A1c = 6.9%
What is the most likely diagnosis?

A. Type 2 DM
B. Gestational DM
C. Impaired fasting glucose
D. Normal pregnancy

97. pregnant lady came for antenatal care follow up visit , she is 16weeks pregnant and did lab
last week
Investigation = Urine analysis
nitrite +ve , leukocyte +ve

What is your Management?

A. antibiotic
B. drink more water
C. cranberry juice
D. Repeat urinalysis

98. 58 years old female patient with sleep disturbance, irritability, vaginal dryness, dyspareunia,
and hot flushes. Her last mensural period was 14 month ago, what is most likely diagnosis?

A. Perimenopause
B. Menopause
C. Depression
D. Pre-menopausal

99. 58 years old female with history of fibroid not responding to medical treatment , she is for
Total Hysterectomy - Bilateral Salpingo-oophorectomy. You want to start her on estrogen
therapy. What to ask in the personal or family history?

A. Endometrial carcinoma
B. Thromboembolic event
C. Cardiac event
D. Endometriosis
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100. Old female patient with uterine prolapse, which of the following indicates progression of
the prolapse?

A. Anal incontinence
B. Pelvic pressure
C. Pelvic pain
D. Constipation

101. A pregnant lady 38 weeks came with vaginal bleeding and lower abdominal pain On
examination: tense abdomen.

what is the most likely diagnosis?

A. placenta abruption
B. placenta previa
C. macrosomia

102. A Women had her last menstrual period 7 weeks ago. Came with vaginal spotting
bleeding and acute lower abdominal pain she is on IUD. O/E abdominal tenderness.

What is the most likely diagnosis?

A. ectopic pregnancy
B. ovarian torsion
C. Threatened abortion

103. G2,P1 Pregnant female received her flu vaccine 3 months back, received tetanus toxoid
in her previous pregnancy 2 years ago, what should you give her ?

A. Influenza
B. Tdap in her 27 weeks.
C. MMR
D. No vaccination is needed
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104. 32 years old male patient have a positive history of smoking and one of his family
member had MI at age 50, what investigation you will order?

A. Lipid profile
B. low dose CT
C. HA1c
D. PSA

105. A male patient was diagnosed with HIV, he is asking you not to tell his wife , what are
you going to do ?

A. tell wife
B. give contraceptives advice
C. protect confidentiality
D. alert health authority

106. A healthy woman came to the clinic asking how to prevent infection (influenza) from her
friends, what is your advice?

A. Hand washing
B. zinc supplements
C. take vitamin C

107. father concerned about his child and stuff from social media about vaccination. the
physician was lessoning……. what type of communication?

A. Active listening
B. Empathy
C. Trust

108. You are performing a medical interview with a patient and having some difficulty
obtaining accurate information regarding the events that brought him into the office. Which
of the following physician communications tactics leads to the collection of the most
accurate information?

A. Controlling the interview with more directive questions

B. Using medical terms that the physician feels the patient can understand
C. Redirecting the patient if he/she strays from the relevant points
32

D. Using open-ended questions

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109. Child brought by his father, the father said that he fall from the bed before 3 days but did
not loss his consciousness. O/E you found multiple bruising in her back, and thigh . What is
the most appropriate next step?

A. Do head CT
B. Discharge the child after proved proper treatment
C. Call protective child services for suspected child abuse

110. 60 years old Male Diagnosed With Pancreatic Cancer , his Son Told You Don't Till him
because he will not tolerate this News , What you will Do ?

A. Don't till the Pt

B. till his Wife to till him
C. ask the patient about the why to receive the News

111. Patient received flu vaccine, what type of prevention?

A. Primary
B. Secondary
C. Tertiary
D. Primordial

112. A question about electronic medication program?

A. increase doctor satisfaction

B. decrease chronic disease drug consumption
C. decrease drug error

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113. Best study to reduce confounding ?

A. Randomization
B. Validity
C. Confounding bias
D. Screening

114. Forest blot chart , odd ratio and CI with antihypertensive drug in chart what is the best ?

A. ACEI
B. ARB
C. CCB
D. Thiazide diuretics

115. similar question about PPV calculation

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116. You are conducting research on gastroenteritis, the control group of 600. P value < .01
Which of the following values represent p value and means that the result is due to chance?

A. 1%
B, 0.1%
C. 10 %
D. 0.01%

117. We conducted a study to compare the risk in 2 population in 500 people 400 where
affected and in the control group of 500, 100 were affected. Calculate the absolute risk ratio?

A. 60
B. 80
C. 35
D. .

118. .

119. .

120. .

‫دعواتكم لكل من ساهم في جمع األسئلة‬

35

Part 1 collection 2019 Group

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