November 2023 (Part 3)

SMLE Top Gs Team

Leader: Hasan
Correction team: Ma’an - Ayar - Alharbi - Mo Salah - Fadel - Mansour - Naif - Qutub - Abu
Da7em - Fida - Almatrafi - 3obad
Collection team: Zizo - Jan - Feras- Asim

Table of contents:
November 17-18 2023 ................................................................................................................... 2
November 19 2023 ...................................................................................................................... 44

‫ابداع وهللا‬

If the links to our channel became public:

https://www.youtube.com/shorts/FUe7PfAxSoQ?feature=share

Abo Ali: this is my last dance before my exam tomorrow, pray for me boys <3
 November 17-18 2023

1.‫توي تذكرت جاني زي هذا‬

‫ بس‬options ‫ كانت غير‬..
- emergency cs
- forceps delivery
- fentous delivery
-wait 1 hour more

Answer:
Fentous ofc

A 22-year-old primigravida presented at 38 weeks' gestation in labor. Vaginal examination

showed 7cm dilated cervix, full effacement and vertex. An hour later the obstetrician
noticed a loop of the umbilical cord below the fetal head.
On examination
Fetal Heart Rate 120 beat/min
Which of the following is the most appropriate immediate management?
A. Vacuum extraction
B. Cesarean section
C. Forceps delivery
D. Fetal monitoring

BB

2.Pregnant in 34 week of GA came with labor pain admitted, she had PROM 4 weeks ago ,
O/E cervix is 3 cm, there is clear liquor, Ask about next step?
A- Emergency CS
B- call Anastasia and deliver pt
C- Wait until 37 weeks
D- give her corticosteroids

BBBBB

3.‫اتذكرت جاني سؤالين‬

Patients have been on dialysis for years what is the most common cause of death I don't
remember the exact question or answer but I believe there was cardiovascular or dialysis
A patient will need dialysis in the next year what is the most common cause of death also
not 100% but I believe they were the same choices

Answer: cardiovascular
Agree
Agree
Agree
Agree
4.35y.o male brought to ER after road traffic accident , complaining of right side chest pain,
he is conscious, alert & oriented. Surgical emphysema in upper chest and neck. Chest X-
ray shows Rt sided pneumothorax &
pneumomediastinum. What is the diagnosis
A- Tension pneumothorax
B- Open pneumothorax
C- Tracheobronchial injury
D- Hemopneumothorax

Answer: C C C C C

5. Pregnant, twins onc cephalic and another is breach presentation, how to deliver?
- per vaginal
- CS

Answer: A A A A A

Almatrafi: it depend on the first one, if he’s breach go for C/S. if Cephalic > vaginal

Bonus question i don’t know if it comes or not for breech cephalic why CS?
To avoid twin locking

6. Patient came from india and complain of headache nausea and vomiting
On examination there’s neck stiffness
Csf result: high protein and normal glucose, lymphocyte
What is the most appropriate management?
1-RIPE
2-RIPE dexamethasone
3- RIPE acyclovir
4- RIPE antibiotics

Answer: JUST acyclovir

RIPE? This looks like viral meningitis
Bad recall
Almatrafi: 3, normal glucose goes more w/ viral
He just RIPED all the choices, 3 is closest or could be tb so B
In summary: if truly TB → 2
If viral → acyclovir only
Agree with HSN

7. A child with tonsillitis and painful swallowing, does not respond to Abx, what is the
most important investigation?

A. Lateral x-ray
B. Chest x -ay
C. abdominal US
D. CT scan

Answer: A can be initial investigation

possible PTA or RPA
Diagnostic is CT/MRI
D, I think most important is CT scan looking for deep neck infection

There is one with a mass and abnormal lymph nodes i agree for that.
This one is CT

Patient with congested throat symptoms, difficulty in swallowing and 2 cm palpable cervical lymph
nodes.
What is the most appropriate investigation?
A. Chest x-ray
B. Neck CT
C. Lateral neck x-ray
D. FNA of the lymph nodes

This one is x-ray

Reference: abo 3li

C
8.10-month-old Baby came with dehydration around 10 % deficit, has sunken eyes and
depressed fontanels and decrease teat Serum sodium most likely will be
A-High
B-Normal
C-Low

Answer: A A A A
Last peer review went with A
Secret scroll went with A

10.female patient with DM , HTN want to do Bilateral tubal ligation :

a - patient consent
b - both wife and husband consent
c - patient consent and ask her to inform the husband
d - preventative consen

Answer: c
If no medical indication B, if there is then C
C there is always and indication
Agree with m3n +1

11.Child 4 years , her mother told you she is always yelling and say No and hitting , what is
the diagnosis :
A- anxiety disorder
B- Depression
C- Mental retardation
D- Temper tantrum

Answer: D D D D D
With shbshb

12.40y women I think with Hx of DVT need to control her birth ?

A. Condom
B. IUD
C. Patches
D. OCP
Answer: B B B B B

13. - twin pregnancy what will increase mortality

A⁃ preterm
B ⁃ Cs
C ⁃ Vaginal
D ⁃ Instrumental

Answer: A A A A A

14. 156 - parents warring about their child tall and asking his tall will be like even after
puberty , what’s the miss information here ?
A. Siblings heights
B. Parents heights

Answer: B B B B B to calc mid-parental height

15. - patient with cirrhosis due to hepatitis C infection presented with ascites which not
respond to repeated paracetesis Which of the following is the appropriate
management
a - restrict fluid intake
b - avoid high protein diet
c - avoid high glycemic diet
d - restrict salt intake

Answer: D D D D D

16.pregnant in 3x week came with history of discharge, after speculum examination there
was fluid pooling from the fornix what your dx:
A-candidiasis
B-PPROM
C-bacterial vaginosis
D-trichomonas

Answer: B B B B B

17. Old Pt sever epigastric pain for 7 days relived by vomiting With history of painkillers use
for joint pain for 2 months what Dx
A- acute gastritis
B- esophagitis
C- perforated peptic ulcer

Answer: A A A A A

19. couple presented to the clinic complaining of infertility for the last 3 years. They asked
about the availability of a surrogate option in the hospital and whether it was legal in KSA.
Which of the following is the most appropriate option?
A) Tell them it is not an available option in this hospital
B) Refer him to another consultant with connections to surrogacy centres
C) Tell them it is illegal in Saudi Arabia
D) Give them appointment and read about the topic

Answer: A A (‫)ابو حسيبة‬

In another version it was clear the consultant didn't know if it was legal in saudi arabia or not, but
he was sure it was not available in the hospital so he should say what he knows
Depends on the case
If he mention in the Q that it’s not available then > A
DOCTOR not sure >D
Non of the above mentioned > C
I agree pick C if the question mentions that it is not available in the hospital.
It was always A, we got bamboozled

20. ‫ وال‬.28 ‫جاني سؤال وحدة فالويك‬RH- ‫ وزوجها‬+

‫اخترت انو نعطيها‬

Answer: good job

Nice

21. infant exclusively breastfed then was given cow milk, now at 9 months after introducing
some iron, containing food , there’s still a concern that the infant,
isn’t recovering enough iron what would you do?
A Add iron supplements
B switch to formula
C stop cows milk completely

‫ذا السؤال حجاني ومعه صورة بس نفس السيناريو‬.

‫ اخترت‬.‫وجاني مره صانيه برضو مع صورة وشألني ايش اتوقع بكون نازل‬

MCV

Answer: A A A A A
IDA is Microcytic anemia
22. Women afraid from cervical cancer because her freind has it What type of prevention
A-Primodial
B-Primary
C-Secondry

Answer: C (screening) C C C C

23. A medical intern was attending an operation and observed the surgeon preparing the
right side of the patient for an incision. He knew that the diseased kidney was on the left
side from studying the patient’s history. What should the intern do?
A) Call the chief intern
B) Tell the surgeon
C) Tell the attending nurse
D) Do nothing

Answer: B B B B B

24.Which is the high diagnostic test in asthmatic patient 10 years old ?

A-Spirometery
B-Xray

Answer: A A A A

25.15 year male doing an LP (not actually emergency procedure) u should ?

A- take consent from patient NOT assent from parents
B- Take consent from parents NOT assent from patient
C- Take permission from parents, assent from patient
D- you don’t need any cus it is an emergency procedure

Answer: C C C C C
Brain: If the question was exactly like this, I would pick C as it is the closest answer. Consent from
the patient and assent from parents is the most accurate answer as he has passed the age of
puberty according to the Saudi ethics handbook for residents

26.Patient is undergoing surgery and told the nurse she doesn’t want a blood transfusion.
During surgery, she looses a massive amount of blood and becomes hypotention.
What is the appropriate action?
1) start the blood transfusion
2) consult the ethics committee
3) respect her wishes
4) call the husband to obtain consent

Answer: A A A A A

27.A multiparous patient who had delivered 6 babies previously all of which through CS
now wants to deliver her 7th baby by CS, the doctors recommended tube ligation to prevent
serious complications with future pregnancies, what is the best action?
A. Take consent from her or her representitive
B. Take consent from her husband
C. Take consent from her and tell her to inform the husband
D. Consult ethics committee

Answer: C C C C C

28.Child with runny nose and pruritus in palate and nose when he sleeps , not mentioned
any triggers or risk factors ,what is the most likely the diagnosis?
A- allergic rhinitis
B- Rhinitis medicamentosa
Don’t remember the rest

Answer: A A A A

29.Pt female 54 case CHF symp controled on acei + furosemide just complianed of
intermittent dry cough what to do
A- Stop furosemide
B- Increase furosemide
C- Add inhaled agonist
D- Do pul function test

Answer: B B B B B
STOP ACE-I if in the choices.

30.Child with puffnass of eye progressive for 1week + protineuaea + stable + low albumin
Hx of 2 weeks rhinorrhea
A. Nephrotic
B. Nephritic
C. Proton enteropathy

Answer: A A A A A

31.case of neurofibromatosis ( café au lait spot and axillary freckles) , type of inheritance?

‫وان وحدة من قرايبهم عندها نفس المرض والخيارات كانت فيها نوع ال‬ ‫جاني سؤال عليها بس‬typ ‫ من ضمنها‬typ1
Answer: both types are AD
AD
Agree

A 10-years-old child presents to the clinic with cutaneous manifestations. She had 7 cafe-
aulait spots, 2 neurofibroma and axillary freckles. Presence of nephew who had similar
lesions. Which of the following is the most likely diagnosis?
A. Neurofibromatosis type 1
B. Angiofibromata type 2

Same question asking about mood of inheritance?

A. AD
B. AR

32.Child come to the ER because of limping on one leg, upon examination the doctor
noticed the left leg
was flexed all the time and the child refuse to move it or to be examined by doctor Imaging
showed
joint erosion What's most likely the causative organism?
A- enterobacter
B - streptococcal pyogen
C- staphvlococcus aureus

Answer: C C C C C
33.rauma patient came complaining of chest pain. Trachea shifted to the left. He had
palpable subcutaneous emphysema and on auscultation reduced breath sounds in the right
hemothorax (exactly written like this hemothorax).
BP: 80/40
O2 not mentioned
What is the next management?
A- needle decompression
B- intubation
C- Chest Tube in right side

Answer: A
A
Almatrafi: B, https://t.me/c/1916163780/1106
A Tension pneumo, let’s not act like the exam is free of catastrophic typos
A for me, we debated this a bit between A (tracheobronchial injury) and B (tension pneumo)
A

34.A case of an 8-year-old child who is a known case of recurrent DKA. The health educator
explained the symptoms of DKA by saying “The child will need to urinate more, have a
fruity smell, have tummy pain and vomit”. What technique did the educator use?
A - Teach back
B- Plain language
C- Critical language
D- Collaborative communication

Answer: B B B B B

35.4 year old boy came to clinic with fever, rash, cervical lymphadenopathy and cracked red
lips?
What is the most likely diagnosis
Measles
Mumps
Rubella
Kawasaki disease

Answer: D 🏍️ D 🏍️
36.*43 YO* Patient was concerned about prostate CA. his father diagnosed with prostate CA
at age of 78. *His friend told him about a test to screen for prostate CA*. *He want you to
screen him.* DRE: soft, smooth and small prostate, palpable medial sulcus. What is the best
management?
A. Reaasurance<< telegram
B. DRE annyally
C. PSA after 2 weeks
D. Transurethral ultrasound

Answer: A A A A

37.A 45 year old man came for follow up for history of transient ischemic attack to clinic
and has history of HTN, DM and previous MI
Ecg shows atrial fibrillation
What is the next step in management ?
1. Cardioversion
2. Warfarin
3. Digoxin
4. Ask to follow up

Answer: 2 2 B 2

38.A patient came to ER has weakness and paresthesia in left leg with power of 2/5, other
limbs are normal, what is the cause?
A- Migraine
B-Right MCA infarction
C-Right ACA infarction
D-Basilar infarction

Answer: C C C C

39.12-Media developed sudden onset of cough and shortness of breath, the child had a
history of eating cereal, the family denied any history of fever or choke, xray was given.
Which of the following is the most likely the cause?
A. Pneumonia
B-Foreign body
C. Anaphylactic reaction

Answer: B B B B

40. 50-Lady with hx of breast cancer after treatment she what to get pregnant, what is the
duration recommended for her before getting pregnant?
2 year after chemotherapy

Answer:
T, reference → ayar
Not the most trusted reference but yeah
Best option we got unfortunately

41.Old female with history of epilepsy had seizure and fell down the stairs, presented with
back pain with urine and fecal incontinence and inner thigh pain, next appropriate
management?
A-EEG
B - MRI Lumbar
C Reassure as post-ictal state

Answer:
BBBB

42.Gestational diabetes what best measurement?

- 3 hour glucose at 24-28 weeks
- 75 g glucose at 24-28 weeks

Answer:
True
BB
43.22-8 yrs old referred due to moderate failure to thrive in divorce parent , lives w mother
who has social and financial issues and she’s on antidepressants works 6 days a week
What’s the most appropriate next step in management?
A. Reassurance
B. Increase caloric intake
C. TPN
D.Multidisciplinary team

Answer: D D D D

44.Women delivered by c/s 15 days ago she complins from vaginal bleeding what are the
most likely cause?
-Adenomyosis
-Endometriosis
-Retrain placenta
-Endometritis

Answer:
D cuz she has fever in the full recall, otherwise C , sorry hamza
Understandable, have a nice day
I agree if the question mentions fever/abdominal pain etc..
Agree with Maan and Hasan

46.4-17-year-old girl complained of anorexia nervosa was admitted for initiation of nutrition,
the blood samples revealed hypophosphatemia, hypokalemia, hypomagnesemia, what is
the cause of the laboratory investigation?
• Wrong protocol of nutrition
• Wrong test
• Refeeding syndrome
• Wrong kit in lab

Answer: C C C C

47.Newly married woman has been on her honeymoon for 1 week and is now complaining
of dysuria and frequency. What is the best treatment?
A. Ampicillin
B. Nitrofurantoin
C. Ciprofloxacin
D. Ceftriaxone

Answer: B B B B

48.3 month old coming with post-tussive vomiting, history of conjunctivitis a few days ago.
No history of diarrhea. Has basal crackles on auscultation?
A- Chlamydia pneumonia
B- Adenovirus pneumonia
C- Pertussis
D- Mycoplasma pneumonia

Answer: A A A A

50.Patient SLE on MMF and hydroxiclorquine and steroid ، Planning to get pregnant
what to do
A) stop MMF and add methotrexate
B) stop MMF and add azthioprine
C) continue

Answer: B B B B

51.12 years old with dysurea found to have klebsella colony 100000 from mid urine culture
A) no need to treat
B) treat as acute UTI
C) give embrical antibiotic

Answer: B (dysuria) B B B
_______________________
Re-- 5 y/o child came in pre school clinic, you found the right eye misaligned what to do?
A- Refer to pediatric optha next day
B- Urgent glasses
C-HIRSCHBERG corneal reflex test
D- detailed history about perinatal injury

Hasan: D D

52.Child with stain meconium stained aspiration and done ventilation what is the most
helpful?
A-Antibiotic
B-Nitric oxide

Answer: B B B B

53.Vaccine for 64 y/o (not sure but it 60s)

- MMR
- Dtap for adult
- pneumococcal

Answer: C C C C

54. 7 year old male presented to ER with epigastric pain agreviated by eating, nausea,
vomiting. During exam the child looks ill, can't stay in place. Labs: Hgb Normal Wbc high -
ESR high -Amylase high -Lipase high
Us: edematous pancreas, otherwise normalWhat is the appropriate step?

A- Full septic screen with iv antibiotic

B- NPO and fluid resistation with pain control
C- laparotomy

Answer: B B B B

56.35 male with stroke came with right sided weakness of the body equally ( half of the
body) which artery affected ?
A-MCA
B-ACA
C-basillar artery
D- spinal artery ( d iam not sure if it was on the choicses
‫ مايحرك رجله اليسار‬.‫ذا السؤال جاني بس كان يقول لي‬

Answer: A A A
A, if only his leg B

57.Mother has DM, baby with RDS he is having respiratory distress, and macrosomia.
What to do?
A- Ventilation and intubation
B-admit to NICU, glucose monitoring and observation
115-Patient with stab wound in the abdomen and he

Answer: B B B B
Explanation :

58.-Pt of gout ( Dx given) what will crystal appear ?

A-Needle shaped negative birefringence

Answer: A A A A

59.MVA distended neck veins decreased air entry and hyper resonance in the left side, GCS
8 pt is unresponsive , What is your urgent initial management?
A- needle decompression
B- endotracheal intubation
C- Neck immobilization
D- Chest tube

Answer:
B GCS is 8
New opinion: C, can be done in 5 seconds and will save you from a lawsuit by preventing cervical
spine injury
Umm ‫احس‬B
Still B :(
B
60.Child has a mild fever, vesical rash in trunk, hands, legs what will you found in labs?
- VZV IgM
- Mumps - HSV-1 - HSV-2

Answer: A A A A
61. POST APPENDECTOMY FEMALE CAME WITH LR ABDOMEN MILD TENDERNESS EX
NORMAL BY CT THERE IS 2*2 COLLECTION IN RETROCECAL: ??
EXPLORING LAPAROTOMY
PERCUTANEOUS DRAINAGE
LAPAROSCOPIC
CONSERVATIVE WITH ANITBIOTIC

Answer:
DDDD
Dont shout my G
AAAAAHH

62.Female with crying spells, she feels low and tried, before her menstrual cycle, it also
affecting her job, they advised her to do exercises , which exercise u advise her to do ?
A- aerobics
B- flexibility and mobility
C- balance and stable

Answer: A A A A

63.17 Years old female, no menstruation, normal testosterone, Normal breast development,
normal pubic hair?

B. Mayer Rokitansky Kuster Hauser syndrome (or Mullerian agenesis)

C. Complete androgen insensitivity

Answer: MRKH MRKH MRKH MRKH

17 Years old female, no menstruation, high testosterone, Normal breast development,

coarse pubic hair?
A. Mayer Rokitansky Kuster Hauser syndrome (or Mullerian agenesis)
B. Complete androgen insensitivity
C. Congenital hypothyroidism

17 Years old female, no menstruation, normal testosterone, Normal breast development,

normal pubic hair?
Anonymous Poll
A. Mayer Rokitansky Kuster Hauser syndrome (or Mullerian agenesis)
B. Complete androgen insensitivity
C. Congenital hypothyroidism
64.16 y/o female Patient with galactorrhea for 3 months and irrigular cycle for two months
had menarcahe at the age of 13. She is tanner stage 2
Whats the first test you will order?
⁃ Prolactin
⁃ LH

Answer: prolactin first i think / I agree

Abo Ali: Agree
A

65. Child presented with a picture of croup-341 improved on epinephrine but relapsed in 30
; mintues again what to give
A. Repeat epinephrine
B. Steroids
C. Salbutamol D. Antibiotics

Answer: A A A A

66.‫ سؤال حا طفل كان‬irritable،cyanosis ‫و‬cry

‫ايش أتوقع برضو اشوف‬
‫اخترت انه مايرضى يرضع‬

Answer:
True, it’s a case of heart failure in an infant.
True
Ok 🤔

67.
A female infertile for 4 years
normal hormonal labs
husbend
with normal semen analysis
Hydrosalpingogram showed blocked tubes
bilateraly
What is the Most Appropriate next step?
A - Induction of ovulation
B- In vivo fertilization ( IVF )
C - Intrauterine insemination ( IUI )
D -Laparoscopy and dye study

Answer: B B B B

68.25 years male with bilateral gyncomstia since he was 18 years what to do?
A-Reassuring
B-full endocrine and liver work up

25 years old male presents with gynecomastia since he was 18 that make him
uncomfortable swimming and going to the gym examination revealed level 4 gynecomastia
What is the most appropriate management ?
- endocrinology evaluation and liver function
- bilateral core biopsy
- reassures
- subcutaneous mastectomy

A due to the age (not going with physiological gynecomastia) and patient concern

A, the other one is an adolescent so you just reassure him.

Agree

69. 20yo male patient came to ER complaing from abdominal pain. O/E there was inguinal
hernia that was tender and irreducible. On x-ray there was multiple air fluid level in
abdomen. + redness
What type of hernia?
A. Strangulated
B. Obstructed
C. Irreducible
D. Incarcerated

Answer: A A A A
You there in the back what does tender mean?
Man deadass said ‫ طري‬lmao, good ol days

70. Pregnant in cesarean section, you find 12 cm ovarian cyst, most appropriate:
a-cystectomy
-hysterectomy
-oophorectomy
-close and do nothing

Answer: A A, agree with this comment? Agree +1

71.81 year old man presented for memory loss and difficulty in recognizing his grandson,
he doesn’t have cardiovascular risk factors. He drinks alcohol occasionally Which of the
following is the diagnosis:
A- Alzheimer disease
B- lewy body dementia
C- Alcoholic induce encephalopathy
D- Parkinson

Answer: A A A A

72.Baby comes with recurrent chest infections and foul smelling stools., What else do you
expect to find?
A) nasal polyp

Answer: A A A. CF
yessir
73.The correct interpretation of CTG of these :
A-Cord compression causes early deceleration
B-Cord compression causes variable deceleration
C-Head compression causes late deceleration
D-Head compression causes variable deceleration

Answer: B B B B

74.Female Patient on icu urosepsis and septic shock, did not respond to ressisatuve
mesures, he was started on norepinephrine but no response. Check labs below
Right atrial pressure: Normal , PCWP: Slightly high , CO: Normal , SVR: Normal
What is the cause of her deterioration
A-Adult respiratory distress syndrome
B-Volume overload
C-Cardiogenic edema

Answer: new infilterate ARDS

A
A in the full recall this one sucks
A

75.Patient develop surgical emphysema neck

chest abdomen after ERCP, which organ was
injured or perforated?
A- esophagus
B- Stomach
C-pancreas
D- Duodenum

Answer: D D D D

76.patient who came to the ER has weakness and paresthesia in left leg with a power of 2/5,
other limbs are normal, what is the cause?
A- Migraine
B-Right MCA infarction
C-Right ACA infarction

Answer: B ‘’When it's 2 A.M., just go to sleep. Because nothing good happens after 2 A.M’’ ted
mousby
C ‫يسطا‬
C
C it is the 2AMitis yall he knows the answer
Oh shit I swear I meant C guys
Remember the homunculus
C

77.Nurse tell you about patient in ICU (in the case she talk about his history and recent
change and tell to come see him) what is this part of communication:
A. Situation
B. Background
C. Assessment

Answer: B

It’s all one single answer so that's that

A nurse informs you about a patient in the ICU. The nurse provides information about the
patient's history, recent changes, and recommends you to come see him. What is this part
of communication?

A. Check back
B. Situation, background, assessment, and recommendation (all in one answer) 👍
C. Close loop communication
D. Call out

ty

78.A 15 months old child is brought to the emergency department after having a generalized
tonic-clonic seizure that lasted approximately 5 minutes. The parents say that the child had
been previously well but developed cough and rhinorrhea earlier that day
with a temperature of 39.2 C. Which of the following is the most appropriate management?
A. Diazepam.
B. Phenytoin.
C. Head CT scan.
D. Control of the fever.
After having + lasted > means the patient is postictal and not in
active seizure =

Answer: D D D D
79.Post partum hemorage, which of the following is used to stop bleeding?
A- Misoprostol
B- Propofol
C-Mg Sulphate

Answer: if didnt mention the cause of PPH imma pick oxytocin not in choices then Misoprostol
A, i don’t think this one has OXy in it
A here
A
‫ وفي اشياء ثانيه نسيتها‬.‫ درجة وال منيتول‬30‫ ترفع اكثر من‬.‫ وش تسوي له‬head truma ‫جاني سؤال واحد‬80.

Answer: first think to do eleavte the bed

First thing to reduce the ICP?

Head elevation
Agree
Other recalls:

old patient came with subdural hematoma with signs of lateralization imaging revealed
13 mm shifting. his GCS 7/15 then was intubated and resuscitated what to do next
A- iv mannitol
B- elevate head of bed
C-hyperventilate
D- urgent craniotomy

stroke patient developed new weakness on ex papilledema CT finding: hemorrhagic

stroke. Most definitive Mx ?
1-Craniotomy and decompression
2-Iv mannitol
3 iv dexa

Abo Ali: 1 here actually

1

A patient who presented with signs of stroke and a CT shows subarachanoid

hemorrhage. He was resuscitated but he is still hypotensive. What is the next best step?
A. Craniotomy and evacuation
B. Iv mannitol

Abo Ali: B here actually

Elderly, came with severe headache to ER then suddenly deteriorated and decrease LOC
ct done was hematoma, best?
A. Admit to icu
B. Mannitol
C. Rush to OR and evacuate

Elderley patient comes to ER with severe headache then suddenly deteriorates with
decreased level of consciousness. CT showed hematoma.
What is the intial step to decrease ICP ?
A - Admit to ICU
B - Give mannitol
C - Evacuate in ER
D - head elevation

old patient came with subdural hematoma with signs of lateralization imaging revealed
13 mm shifting. his GCS 7/15 then was intubated and resuscitated what to do next
A- iv mannitol
B- admit ICU and observe
C- craniotomy
D- insert intracranial monitor

81.
a-phyntoin ‫ جا سؤال واحد كان عندو‬seizure ‫ايش اول شي بتعطيه‬
B-diazepa

Answer: benz – benz – pheny – GA

Agree +1
B

82. 2. Female she HAD postpartum hemorrhage 1 week ago bc she delivered a big baby, and
is presenting to you now IN THE CLINIC. What’s the most app. Managment?
A. Oxytocin
B. Misoprotsol
C. Carbo
D. Ergo
oxytocin ‫بس ماكان موجود‬

Answer:
Well..Misoprostol don’t ask why
Oh Ma’an joined my team, welcome
I joined too 😪

83. Diabetes Mellitus and Gestational Diabetes Mellitus

Patient with long term history of DM type 1 in 12 weeks of gestation. HbA1C 12. Which of
the following complication is most likely to happen?
A. Pre-eclampsia
B. Polyhydramnios
C. Congenital malformation
D. IUGR Correct

Answer: C C C C

84. Child came for vaccine dose parents told the doctor that he developed rash wheezing
taken to emergency What is the next step about the vaccination?
1Continue
2.Stop
3.Delay
4.check previous vaccination

Answer: 4 D 4 D

85. 17-year-old girl complained of anorexia nervosa was admitted for initiation of nutrition,
the blood samples revealed hypophosphatemia, hypokalemia, hypomagnesemia, what is
the cause of the laboratory investigation?
• Wrong protocol of nutrition
• Wrong test
• Refeeding syndrome
• Wrong kit in lab

Answer: C C C C

86. couple presented to the clinic complaining of infertility for the last 3 years. They asked
about the availability of a surrogate option in the hospital and whether it was legal in KSA.
Which of the following is the most appropriate option?
A) Tell them it is not an available option in this hospital
B) Refer him to another consultant with connections to surrogacy centres
C) Tell them it is illegal in Saudi Arabia
D) Give them appointment and read about the topic

Answer: A
A if it say that in the question, here C
D if the doctor is not sure
Agree with my uncle ma’an
In conclusion
“whether it was legal in KSA” → tell them it’s illegal
“It’s unavailable at ur hospital” → Tell them it is not an available option in this hospital
“U don’t know” → read about it
We just cracked one of the dumbest SMLE Questions of all time
SMLE Top Gs >>>>

Here it is C we apologize (‫)ابو حسيبة‬

87. Women with a family history of T2DM came at 21 weeks of gestation asking about
screening what you should do?
A-HgbA1c now
B-75g OGTT at 24-28 weeks

Answer: B B B B

88. A man with a early diastolic murmur heard best at the left sternal border increasing with
sitting forward
A-AS
B-AR ( aortic regurgitation )
C-MS
D-MR

Answer: B B B B

89. Head trauma patient was resuscitated and to be referred to hospital 40km away due to
low facility, what is your next step in management?
A-ct of the chest
B-chest tube
C-thoracotomy or needle decompression or other but i don't think it was the answer
D- call surgeon on duty of that hospital

Answer:
CDDD

90.
Pt with acute gastroenteritis
Vomiting many times
In the last 2 h it contained blood
NGT aspiration showed fluid with blood, diagnosis?
A-Mallory
B-Peptic u

Answer: mallory
AA

91. Patient came with history of heart failure and HTN, he is on ACE inhibitor,
hydroclorothiazide,and furosemide. He is complaining of Non-productive cough, vitals are
normal, which of the following is next step in managment?
A.discontinue furosemide.
B.Order pulmonary function test.
C.increase furosemide.
D.

Answer: C C C

92.Patient diagnosed as DM1 and started on aspart and glargine. Patient has episodes of
hypoglycemia and A1C is 7 or 6 not sure. What will you change in treatment?
A. Change to NPH twice daily
B. Stop aspart and only use glargine
C. Decrease the dose of aspart and glargine
D. Use mixtard insulin

Answer:
C C C (there are two recalls one both fasting and postprandial the other after sports only or
something)

93.Question recall not complete.Patient after cardiac or hypertensive cause stabilized and
discharged. Patient came and complaining of rash on neck, trunk and edema I think.What
medication caused reaction?
A. Ramipril
B. Aspirin
C. Forgot rest meditations

Answer: A A A

95.‫جاني سؤال عن الطفل اي عمر يفرق بين امه وابوه‬

Answer:
Well babies say mama and dada specifically at the age of 12months so could be that
Recognizing parents is at 2 months but that doesn’t necessarily mean knowing who is who?
I hope both don’t show up together
🤲

96.parient came with flame bruningher right arm,

The burning is circumstantial,
Upon PE: week right arm distal pulses.
What most appropriate next step?

A. Intracompartmental pressre measurment

B. Escharotomy
C. Burn dressing, Iv fliud , irrigation

Answer: B B B

97.A child came with fever. On examination he has white vesicles around his mouth and
inside the gum, and small discrete cervical lymph nodes enlargement what is the causative
agent ?
A. Epistein Bar
B. Herpes simplex
C. varicella
D. Human papilloma

Answer: A A B
I am sure they mean b its 1 am…

98.‫برضو جاني سؤال نوع الڤاكسين حق طفل عمر سنه‬

Answer:
POMM: PCV, OPV, MMR, MCV4
Pomm
99.28 YO female presented with jaundice for 2 weeks. Associated with fatigue andarthralgia
for 11 months. She is not on any medications and she doesn't drinkalcohol. O/E she has
hepatomegaly. Viral hepatitis screening is -ve. AST 920ALT 890Alk phos 169 alb 30 Total
bilirubin 26. What is the most likely diagnosis?
A. Hepatocellular carcinoma
B. Primary biliary cirrhosis
C. Autoimmune hepatitis ß

Answer: C C C

100.‫ وجا سؤال وحدة عندها‬copd ‫وبنسوي لها عملية في صدرها وش نوع التخدير‬

Answer:
Pectoral nerve block
PNB
Agree
101.60 YO male K/C of chronic GERD for several years, upper GI endoscopy done for him
and showed metaplastic intestinal type mucosa, what is the most likely diagnosis A.
Barrett's esophagus
o‫وطالب مني ايش بعطي‬

Answer:
Pantoprazole
A
Agree
102.‫ ايش الڤاكسين الي تاخذه‬.‫جا سؤال وحدة حامل وولدها يروح المدرسة‬

Answer:
Influenza
yessir
the goal of saudi Arabia to decrease children death by 2030 is by
- vaccination
True

‫ اتوقع ايش بتسوين انا اخترت‬6‫ وكانت كبيرة حول‬ovarian cyst ‫حا سؤال مريضه فالعمليات شفتي‬103.
Cystactomy

Answer: no
Observe or leave ‫اسفين لك‬
Elderly female diagnosed with breast cancer 3 years ago, presented, now with SOB, chest
X-ray done showed right side pleural effusion, what is the most likely cause of pleural
effusion?
A- Exudative plural effusion due to malignancy
B- Exudative plural effusion due to empyema
C- Transudate plural effusion due to malignancy
D- Transudate plural effusion due to CHF

Answer: A A A

Patient with blunt chest injury resulted in fracture in 3rd, 4th and 5th ribs in more than one
site. What is the initial treatment?
A. Intubation
B. Assisted ventilation
C. IV fluid.

BBB

104.which drug is safe in Stable CKD stage 3

1- nitrofuinton
2- lithium
3- metformin
4- warfarin

Answer: 4 D D

105.‫ وجتني حالة وحدة‬pregnant with right abdominal

‫بس كذا‬
.‫الخيارات‬
Appendicitis
Cholycystitis
Pancreatitis

Answer: A A A

‫ وطلع‬mamogram ‫ وسوت‬family history of cancer ‫جا سؤال وحدك ماعندها‬106.

‫طالين متى تعيده‬

Answer:
Every other year - USPSTF
2 years
yessir
107.A 6-years-old boy who has been treated since infancy for eczema is coming now to be
evaluated for honey-colored crusted
lesion in antecubital skin area bilaterally.He has no fever but skin infection is suspected.
Which of the following is the most likely cause of the skin infection?
A. Coxsackie virus
B.Herpes simplex virus
C. Staphylococcus aureus
D.Group A streptococcus

Answer: C C C

108.Antepartum hemorrhage: Vaginal bleeding after 20 weeks of gestation that is unrelated

to labor and delivery.

Answer:
Yes
Yesn’t not

.‫ ويبدل االسماء وصعوبه يتذكر‬61 ‫ مايتذكر وحرفيا ً ينسى كذا االسماء ومايقدر يقولها عمره حول‬.‫جاني سؤال عن واحد قاعد ينسى‬109.
‫حرفيا ً بس كذا مافيه اي اعراض ثانيه‬
‫الخيارات كانت‬
- Alzheimer’s dementia
B- lewy body dementia
C- multi infarct
D- Prion disease

Answer:
Bad recall

ase about pt who had take vit supplements ( didn’t mention b12) and newly diagnosed with
TB and take anti TB for 3 month Now complain of tingling numbness of tip of hand What the
drug? (medicine)

A. Ethouxate
B. Pyrazmaide
C. Isonizsed
D. Rifapmcin

CC

Pregnant at 34 weeks with blurred vision, headache and her BP 170/90 What to do?

A. Stabilize + MgSo and wait till 37 weeks

B. Call anaesthesia now and deliver
C. Stabilize and give MgSo and deliver
D. Stabilized and give steroids then deliver

CC

110.Female has sle with osteoperosis.what is the cause

Avascular necrosis
Degenerative disease

Answer: A A A

111. oung female with ectopic pregnancy. What is the risk factor for ectopic.
A. induction of ovulation
B. Previous ectopic pregnancy
C. PID
D. IUD

Answer:
C (‫)ابو حسيبة‬
C ‫حمبولة‬
C

112. 65 YO male presented to ER with severe right leg pain and absent pedal pulse. Which
of the following is the most diagnostic investigation?
A. СТА
B. MRA
C. Conventional angiography
D. Ultrasound doppler

Answer:
A (‫)ام احمد‬
A scroll says so sorry
A

113.
• 6 years old presented with maculopapular rash on the face and inner cheek there’s white
spots in front of second molar tooth , most likely cause
• A-Rubella
• B- Measles
• C-Roseola
• D-Scarlet fever

Answer: B B B

114 - Picture of Down syndrome child (prominent forehead, crease in hand, macrognathia).
What is the most commonly endocrine-related disorder?
A) Hyperthyroidism
B) Hypothyroidism
C) Panhypopituatarism
D) Hypoparathyroidism

Answer: B B B

115. Worst headch he ever felt , nick stiffness , CT normal , no fever , most appropriate
investigation
1- MRI neck ‫شي زي كذا‬
2- MRI brain
3- LP
4-no need for any diagnosis something along those line

Answer: 3 C C

116.A child came with fever. On examination he has white vesicles around his mouth and
inside the gum, and small discrete cervical lymph nodes enlargement what is the causative
agent ?
A. Epistein Bar
B. Herpes simplex
C. varicella
D. Human papiloma

Answer: B B B

117.19 month old boy presented to the clinic with right lower eyelid swelling, erythema, and
tenderness for 1 day. He has fever reaching up to 38.5 with decreased appetite and activity.
He was given diphenhydramine without any improvement of the eyelid swelling.
denied any visual disturbances, diplopia or any other swelling.
Which of the following is the most likely diagnosis?

• Cellulitis
• Hypoproteinemia
• Allergic reactions
• Subperiosteal hematomas

Answer: A A A

118.A 30-year-old female, came with periorbital pain and reduced visual acuity. She has
lower limb motor compromise & impaired sensations on examination. She has hyperreflexia
and clasp knife rigidity. Diagnostic test/Best next step in management?

A. Brain & spine MRI

B. Myography
C. Nerve conduction study
D. CT brain

Answer: A A A
119.A new screening test for diabetes has a sensitivity of 90% and specificity of
80%, which of the following is the best interpretation?

A) 80% of non-diabetics had positive result

B) 80% of diabetics had positive result
C) The test was positive for 90% of diabetic patients
D) For each 100 positive test results, 90% were diabetics

Answer: C C C

120.Old, diabetic, presented to clinic c/o bad smell ulcer. What is the appropriate initial Mx?
A- debridement
B- Negative pressure wound therapy
C- Advanced wound care products

Answer: A A A
https://t.me/GSurgeryReview/251

121.Patient with clear case of brucellosis. Hx of Drinking unpasteurized milk. Which if the
following is the first line treatment of brucellosis?
Doxycycline + Clindamycin
Doxycycline + Streptomycin
Ciprofloxacin + TMP-SMX
Rifampin + TMP-SMX

Answer: B B B

122.37 years lady obese for to clinic for follow up ,what is the most recommended for her :
Fasting blood sugar
Colonscopy
Pap smear
‫هذا متداول له فتره بس باالختبار الستم واضح‬
‫جاوبت على حسب‬
Grade of screening recommendation

Answer: A A A
Reference: peer-review

123.Old women with hip pain increases with walk and At night after work +morning stiff for
several hours
DEPRESSION
OSTEOMYELITIS
OSTEOPROSIS
OSTEOARTHRITIS

Answer: D D D
124.
27-year-old obese woman presents with right iliac fossa pain associated with anorexia,
nausea, and vomiting. On examination, there is moderate right lilac fossa tenderness. Labs:
Leukocytosis. What is the most appropriate management?
A - Open surgery
B - CT
C - US
D - Diagnostic laparoscopy

Answer: B B B

125.6 years old was brought by his parents with history of sudden abrupt loss of
environmental awarness with lip smacking followed by sudden return to normal baseline.
Brain Imaging= Normal, EEG= 3-Hz spikes Which of the following is the most appropriate
diagnosis?
A) complicated febrile seizure
B) Absence seizure
C) Infantile spasm
D) cerebral palsy

Answer: B B B

126.‫ جاني سوال‬Female with painful neck swelling on exam tender thyroid
Labs shows : LOW TSH and High T4
Elevated ESR
Management?
Methimazole
PTU
Prednisone
‫الرابع نسيت وشو بس ما كان له عالقة‬

Answer:
Someone said the 4th choice was an NSAID which is the correct answer
K, but if no NSAIDS steroids ‫تحل محله‬
Oui
Agree

127.A 4 m old signs and symptoms of UTI and he mention the child is look well
What is the most appropriate treatment ?
A.Oral cephalexin
B.Oral Azithromycin
C.IV ceftriaxone

Answer: A A A

128,40s yo lady diagnosed with breast cancer underwent neoadjuvant chemotherapy then
mastectomy surgery, now started radiotherapy sessions, after 2 days comes with this labs
-Potassium 6.7
-Creatinine 730
-Uric acid (I don’t remember the exact number but it was high)
ONLY These 3 findings no mention of calcium or phosphate
What’s the cause of her labs
A- radiotherapy induced tumor lysis
B- no enough hydration during chemotherapy
C- glomerulonephritis
D- drug induced nephrotoxicity

Answer: A A A

129.Child with fever and sore throat, and there’s exudate membrane cover the tonsils, and
neck lymphadenopathy
A: Coronavirus
B: H Influenza
C: RSV
D: mononucleosis

Answer: D D D

130.Patient after delivery of healthy baby and after delivering the plasenta she developed
heavy bleeding, iv fluid resuscitation started and her vitals were:
Hypotensive
Tachycardia
No fever
Hemoglobin was low
Iron low
Ferritin was normal range
Platlets was low
Wich type of infusion would help stabilize the mother?
A ⁃ crystalloids
B ⁃ Iron infusion
C ⁃ Platletes infusion
D ⁃ Forgot the last one

Answer: C C C
131.22 yearFemale on warfarin what is type of contraseptive.
Progesteron pills
Cocp
Estrogen progesteron patch.
Tubal ligation.

Answer: A A A

132.How clear the cervical site for pt with RtA in ICU:

Ct
Mr cervical.
Mri brain.
Latral A xray cervical

Answer: A A A

134. When to give pneumococcal vaccine after splenectomy?

Answer: 2 weeks 2 weéks

Agree
135. Unconscious patient who needed Catheterization and her husband is out side of the
city, how to get consent?
A-Over the phone
B-wait for him to come

Answer: A A A
What if an imposter answered though?

136. Dilated cardiomyopathy, edema, which medication?

Digioxin
Acei
BB

Answer:
Diuretic actually
Diuretic, or could be the Afib question

137. Patient with dysphagia to solids only

What to do ?
A. Manometry
B. Endoscopy
C. Barium

Answer: B B B

138.Married Female who was discovered to have an adnexal mass, her last period was 2
weeks ago, pregnancy test negative, denied use of ocp, Stable
What is the diagnosis?
A)Ectopic pregnancy
B) follicular cyst

Answer: B B B

139. Hepatitis B :
HBsAg +
HBsAB -
HBcAB IgG +
HBeAG +
HBeAB -
What is the status of the patient?
A-Acute infection
B-Chronic
C-Recovery phase of the infection
D-Vaccinated

Answer: B B B
140. A child with dirty clothes, parents don’t remember his vaccination, type of abuse?
Neglect
Emotional
Physical
Financial

Answer: A A A

141. 7 years female with eyelid erythema , heliotrope rash and thickening of skin over
rashmetacarpophalyngeal joints + proximal muscle weakness :
A)Scleroderma
B) SLE
C)Juvenile Dermatomyositis
D)Rhumatic fever

Answer: C C C

142. Mother who is Rh negative delivered a baby who is Rh+ she was given Anti-D Ig 300
microg what does it cover?
A. 15 ml of the whole fetal blood
B. 30 ml of the whole fetal blood
C. 10 ml of the whole fetal blood
D. 30 ml of Rh(D) positive fetal RBCs

Answer: B B B

143. Recurrent paracentesis

What to do ?
A-Restrict sodium
B- restrict protein

Answer: A A A

144. 40 yo male presents with inguinoscrotal swelling، in examination swelling was

seperatable from the testes Positive cough test, What is the diagnosis?
A.epididymal cyst
B.spermatocele
C.scrotal hernia

Answer: C C C
145. - Pt post- splenectomy, c/o left chest and abdominal pain, increased with inspiration,
on examination it was tender and chest had reduced air entry to in the left side. On
percussion Lt side dullness What’s the diagnosis:
A) Lower lobe pneumonia
B) Subphrenic abcess
C) Super post splenectomy sepsis

Answer: B B B

146. A child ( in months ) with no left testis in scrotum

What to do ?
A-laparoscopic diagnostic
B-Reevaluate at the age of 3 years

Answer:
A?
If it was not felt on examination then yeah diagnostic laparoscopy.
If felt, orchidopexy

148. A test was done to 800 who have the disease and 800 who don’t have the disease, The
test was positive in 200 of those who have the disease, and was positive in 100 of those
who don’t have the disease, What is the percentage of sensitivity?
A-25
B-70
C-50

Answer: A A A

149. 13-month baby came to the clinic with right nondescending right testes, on
examination: one left testes, the inguinal canal is normal, scrotum normal, no redness or
tenderness, what is the next step?
A. Wait for 3 years
B. Exploratory laparoscopy
C. Left orchiopexy
D. Right orchiopexy

Answer: B B B
‫سؤالين عليها مره ايش نوع االنيميا ومره ايش اتوقع يكون نازل‬
Plasma exchange not platelet transfusion

November 19 2023

1-A 67-year-old female with Hx of dry cough, SOB, and fatigue, treated with 2 courses of
Abx but not improved. CXR persistent infiltrate. Bronchoalveolar lavage shows atypical
cytology. What is the Dx?
A. typical pneumonia
B. Bronchogenic cancer
C. Atypical pneumonia
D. Sarcoidosis

Answer: B B

2-Trauma patient. Vitally was stable. FAST done was positive. What is the next step?
A. Gastric lavage
B. CT abdomen
C. Laporatomy

Answer: B B
3-A 6-day-old baby came with jaundice since 5 days ago, and labs show increased LFTs,
The parents are one cousin, which of the following is the most likely cause?
A. Galactosemia
B. ABO incompatibility
C. G6PD deficiency
D. Biliary atresia

Answer: A/D
Maan: If no mention of the pale stool/ worsening by phototherapy which indicates B then A
Agree with Ma’an

Baby Jaundice pale stool Dx

A- Rh incompatibility
B- ABO incompatibility
C- G6PD deficiency
D- Biliary Atresia

Answer: D

Newborn baby has yellowish discoloration that is not fading for five days. Previously was
diagnosed to have physiological jaundice and so phototherapy was started, which of the
following is the most likely cause?
A. ABO incompatibility
B. Rh incompatibility
C. G6PD deficiency
D. Biliary atresia

Answer: D

4-23 days old presented with 2 days history of lethargy and decreased feeding, pale stool,
and jaundice. He was diagnosed on day 3 with physiological jaundice and treated with
phototherapy and improved, no CBC. Bilirubin T150, Direct 98, what is the Diagnosis?
A. ABO Incompatibility
B. Rh incompatibility
C. biliary atresia
D. milk jaundice

Answer: C, missed the recall up for sure it is obstructive jaundice, the full recall no improvement.
C

5-Case of SLE, Hemoglobin electrophoresis: normal, Ferritin: High, Reticulocyte: High,

Lactate dehydrogenase: high, Haptoglobin: low, very low hbg, high alkaline phosphatase.
What is the most related anemia with this condition?

Answer: Hemolytic anemia

Agree
6-Milestone question:
A child can sit unsupported, crawls, says baba,

Answer: 9 9

7-man involved in burn accident, he has 2nd degree burn to his both lower limbs.
Weight 70 kg
Using Parkland formula, which of the following is most appropriate fluid resuscitation?
A. Lactate ringer's 5 L over 1st 6 hrs then 5 L over next 16 hrs

Answer: A A

8-Female, 27 years old complaining of green-yellow discharge that started after her
mensuration, Upon examination: red lesions on cervix, What’s the diagnosis?
A. Atrophic vaginitis
B. Bacterial vaginosis
C. Candidiasis
D. Trichomoniasis

Answer: D D

9-Intrauterine device implantation patient has brown discoloration and abdominal pain.
What’s the most likely diagnosis?
A. Uterine rupture
B. Pelvic inflammatory disease
C. Bacterial vaginosis

Answer: B B

10-A 24-Year-old female complaining of severe abdominal cramps during menses not
relieved by NSAIDs and history of infertility for 6 years, What is the most likely diagnosis?
A. Adenomyosis
B. Endometriosis
C. Uterine leiomyoma

Answer: B B

11-Cause of electrolyte disturbance in glioblastoma?

A. Cerebral salt wasting syndrome
B. Excessive consumption of water
C. SIADH
Answer: K K

12-Patient has heavy bleeding and usually changes tampon 15-30 times/day, recently she
has been engaged in intercourse with multiple partners to conceive, on examination:
retroverted uterus, decreased uterine mobility, and tender uterosacral ligament with
nodularity. What’s the diagnosis?
A. PID
B. Endometriosis
C. Leiomyoma
D. Adenomyosis

Answer: B B

13-When does give pt Anti HTN ?

A.140/90
B.220/120

Answer: Ischemic B, Hemorrhagic A

Yessir

14-31.Male patient came from India RUQ pain .. on and off fever for 3 weeks . raised LFT ,
high WBC (Neurtrophol 70% Lymphocytes 20%) . image showed homogenous hypoechoic
mass in the liver.
a) hydatid cyst
b) TB abscess
c) amebic abscess

Answer: C C India/Mexico

15-A 38 years-old female presents to the clinic after finding of hilar lymphadenopathy on
CXR. She has on and off cough but denies any fever, headache, N/V, weight loss all
negative. All investigations were insignificant except for CXR showing bilateral hilar
lymphadenopathy. CT-guided biopsy shows non caseating granuloma. What is rhe best
next step in management?
A. Observe
B. Start prednisolone
C. Start azithromycin
D. Start anti-TB medication

Note: In another recall there was hypercalcemia which was the indication to start prednisolone,
otherwise the answer is A. Make sure to know the other indications (It was mentioned in Um
Alqura, I think pulmonology video)

Answer: A ty
A, focus

16-
Answer: A

17-
Answer: A

18-
Answer: B
19-
Answer: B

20-
Answer: A

21-
Answer: D

22-
Stress ECG in another recall
Answer: A

23-
Answer: A

24-
Answer: B, HFpEF

25-
Answer: A

26-
Answer: B

27-
Answer: B
28-
Answer: 4
We agreed on D, even Hamoud changed his answer
https://t.me/SurgeryByHamoud/108

29-
Answer: They come separate, stop MGSO$ first
Agree

30-
Answer:
2 years from USPSTF
USPSTF says every other year so 2

31-
Answer: C

32-Newborn baby has just been delivered. And they want the Apgar Score.
He is pink with blue extremity,
the pulse <100,
Breathing Irregular, gasping
Reflex irritability Coughs, and cries with stimulation
His extremity has some flexion
What is the Apgar score?
A-6
B-7
C- 8
D- 9

Answer: A A

33-child presented for PHC to take MMR vaccine

Child has URTI symptoms, congested throat, with fever 38.9 and slightly ill looking(written
like that)
1-Give MMR vaccine now
2-delay MMR until his symptoms resolved

Answer: 2 2
Well i answered delay in my last exam and i'm sticking with it
Don’t worry i checked CDC and the cut-off to delay is 38.3 degrees, you can check our OCTOBER
files
34-Q. An infant boy underwent an ultrasound which shows bilateral hydronephrosis and a
thickened bladder wall. What is the highest yield diagnostic investigation?
A. IV pyelogram
B.MCUG
C. DMSA
D. Renal US

Answer: B B

35-Case of couples complain of infertility. Hystrosalpingogram is normal. What is the (next)

investigation ?
- pelvic US
- semen analysis
- FSH and LH

Answer:
B should be the first one really
yeah

36-Case of pediatric pt , came with SOB

HR: 256
( case of SVT )
What is the most diagnostic
- ECG
_ echo
Answer: T T

37-Case of complicated Pyelonephritis ( fever , pain … ) , urine analysis postive nitrate and
WBC
What to do
A. US
B. KUB

Answer: A A

38-A 50-year-old woman presented with few months history of feeling dizziness when
getting out of bed she also feels very warm and flushed. She visited the Emergency Room
several times with frequent episodes of abdominal cramps and watery diarrhoea over the
past year. She gave a history of itchy skin. On examination, she has a 2/6 systolic murmur
at left lower sternal border, chest examination reveals wheezing, abdomen was
unremarkable. Laboratory results and stool cultures were normal.
Which of the following is the most appropriate next step in diagnosis?
A. Ultrasound abdomen and pelvis
B. Double contrast barium enema
C. Serum lipase and amylase level
D.Urine for 5-hydroxindoleacetic acid.

Answer: D D carcinoid

LP culture orgamisn ‫ حق ال‬result‫الزم تحفظو ال‬39-

+ve diplococci = Strep pneumo
-ve diplococci = Neisseria meningitidis
+ve coccobacilli = Listeria (Bacilil)
-ve coccobacilli = H.Flu

Nice.

40-During labour the midwife suggested a mediolateral episiotomy.

What is the advantage of mediolateral epesiotomy:
A. Easy repair
B. Less infection
C. Tighter introites
D. Decrease 4th degree anal tear

Answer: D D

41-A 60-year-old man presents with abdominal distension dyspnea and orthopnea, The JVP
is markedly elevated and fails to descend during inspiration. Lower limbs showed massive
pitting edema up to the thighs. Heart sounds are normal. There are bibasilar crackles on
lung auscultation. Abdominal examination showed hepatomegaly and positive shifting
dullness Echocardiogram: Both atria are dilated. Left and right ventricles are normal in size
and LVEF is 60%. No valve lesions.
Which of the following has the highest diagnostic value?
A. Holter monitor
B. Cardiac CT scan
C. Coronary angiogram
D. Exercise ECG testing

Answer: B B

42-asks about the reason of abortion in the 8th week of gestation?

A. Chromosomal abnormality
B. Cervical incompetence

Answer: A A

43-2 months old child with failure to thrive and cyanosis and poor feeding, murmur,
which of the following is appropriate next?
A. increase caloric intake
B. Refer to a cardiologist
C. Refer to gastroenterologist

Answer: B B

44-A child vomiting what is the electrolyte abnormality?

A. Hypokalemic hypochloremic metabolic alkalosis

Answer: T T

45-4 yrs old boy presented with rectal prolapse. Parents said he had constipation and bulky
stool for a few days. Last year he was admitted for pneumonia two times. His parents are
healthy and he has one brother who is also healthy.
What is the most appropriate initial diagnostic test?
1. Chloride sweat test
2. DNA, cystic fibrosis, transport gene
3. Urine reducing substances
4. Celiac’s screening

Answer:
A, followed by CFTR
A
46-Patient done from surgery, after extubation started coughing and other symptoms, what
to do?
A. Repair the injured nerve
B. Intubation again

Answer: B B
Patient was extubated after thyroid surgery and immediately developed shortness of breath and
respiratory distress; Examination reveals that both vocal cords are in a semi-closed position. How
will you secure the airway?
A. Re intubate the patient
B. Tracheostomy tube
C. Cricothyroidotomy

https://youtu.be/lBqYAW1tWD4?si=mopdb9ltsZiocNLm

47-Huge fibroid, menorrhagia, stable, was advised to do hysterectomy but the patient
refused, what’s the most appropriate treatment? (No myomectomy in the choices )
A. Oral progesterone
B.

Answer: Uterine artery embolization

Agree
48-Female had h/o CS years ago
Everything normal, has constipation, vomiting and abdominal pain for 2 days.
Doctor order CT for her in ER
Which of the following you will order:
A. CBC
B. INR
C. Pregnancy test
D. Renal function

Answer: C C

49-A child with a sore throat and coryza 2 days ago came with difficulty swallowing food
what is the investigation you will order?
A. Chest x-ray
B. CT scan
C. Lateral neck x-ray
D. Echo

Answer: C C
Safder answered B saying it’s an abscess but i see no strong indication of that
Ma’an >>

50-Patient with medial leg ulcer, what is the high risk to cause that?
A. DM
B. HTN
C. Age
D. Buerger's disease

Answer:
Venous HTn then Age
Ok

https://t.me/SmleByHamza/350

51-11 year old boy came with sever scrotal pain no history of trauma
Examination show unilateral swelling tender, hot, and red testes tender to touch
What should you do next ?
- Exploration
-Laparotomy
-Cold compress

Answer: A A

52-child on inhaled corticosteroid with picture of candidiasis oral infection. How to treat?
A ⁃ nystatin
B ⁃ Itraconazole
C ⁃ Amphotericin B

Answer: A A

53-An infant boy underwent an ultrasound which shows bilateral hydronephrosis and a
thickened bladder wall. What is the highest yield diagnostic investigation?
A. IV pyelogram
B.MCUG
C. DMSA
D. Renal US

Answer: B B

54-Patient with liver cirrhosis on examination there was umbilical hernia and ascites the
skin was thin over hernia and prominant veins in abdomen what is the managment
A- delay hernia repair until ascites gone
B- paracentesis then open hernia repair
Other options was Excluded

Answer:
A, control first then operate
Agree

55-Acute Rheumatic fever ass with?

MR
AS
MS
AR

Answer:
A because they said acute here, if it is just RF in general then MS.
MR

56-10 years old had a tonsillectomy 5days ago and he has been bleeding since. Dx:
1- infection
2- coagulopathy
3- foreign body
4- incomplete removal

Answer:
A in First two weeks, Then Coagulopathy.
A

57-Female around 30s there is groin bulge that reduces with negative cough test , *reducing
point* below and lateral to the pubic tubercle dx ?
Femoral
Direct
Indirect

Answer: A A

58-Pt dm sever neck pain ( or left arm pain radiate to neck ) tropnine I normal , ECC non
specific t wave changes. ?
Repeat tropinie I after 6 hrs
Right sided ecg

Answer:
Start aspirin and nitro
Yeah Eilaf (and us) changed the answer
59-MVA SPEED 130 km with seatbelt, abdominal pain stable pt what to do ?
Fast
Ct abdomen

Answer: B B

60-Pt of sing and symptoms of TB what first thing to do ?

Acid fast bacilli
Isolation on negative pressure room

Answer: B B

61-6 yrs female diagnosed with asthma for 3 yrs not controlled , recurrent ER visiting , the
doctor was too busy to refer the patient and there family to education department for
education the difference between inhelar and nebulizer, what will be the effects?
- Increase adverse event

Answer: T T

62-2 week old baby was doing fine but now presenting with poor feeding, fatigue, basal
crackles?
, pansystolic mumur at the lower left sternal border:
- atrial spetal defect
- ventricular septal defect
Coa
PDA

Answer: B
VSD

63-Pic of child with distended abdomin and the case is typical of heisenberg disease
Answer:
Oh say it ain’t so the GOAT has his own disease🫡

Bro deadass said heisenberg disease LMAO

64-

Answer:
T

uncontrolled asthma and bad smell stool , what is the most appropriate test ‫جاني سؤال عن‬65-
to do
Answer: Sweat test
Agree

66-Tonic clonic sizure what you will see in EEG

Answer:
Depends on the case if it’s Rolandic or infantile
Centrotemporal spikes and chaotic pattern (hypsarrhythmia) RESPECTIVELY

67-‫ جاني سؤال عن‬uncontrolled asthma and bad smell stool , what is the most appropriate test to
do
‫الخيارات‬
1- swet cloride
2- chest ct
3 - upper and lower scope

Answer: 1 1

68-26 old pt irritability crying and has breast tenderness 1 week before menstrual period
What's the appropriate exercise for her case ?
- aerobic
- flexible and mobility
- balance and stability
- coordination and agility

Answer: A A

69-A child with tonsillitis and painful swallowing, does not respond to Abx, what is the
most important investigation?
next step ‫جاني هذا السؤال وكان طالب‬

Answer: Lateral neck x-ray?

probably

70-Old Patient with inability to urinate and by digital exam you found that he has enlarged
prostat , what is the management
A.Antibiotic
B.Cystogram and surgical management
C.Catheter and urin culture

Answer: C, another one below ,, C

Explanation :
Reference : D

71-Child with wet of his bed at 9 years old , he stopped to do this since he was 6 , it’s
associated with urinary tract infection what is the manegement

Answer:

9 y/o pt his mom complaining about he is wetting his bed since one month. He used to be dry since 7
years. The urine is foul smelling His lab showing high wbs and turbid in colour and showed nitrate
Diagnosis?
A. UTI
B. normal for his age
C. nocturnal enuresis
I think this one but here about dx

72-Vaccine of pre school

Answer: DOVeM
Dtap, OPV, varicella, MMR

73-Milestone
Baby girl say hi to the doctor , and play with her doll , she says mouth, no and mama how
old is she
24
15
18

Answer: A A
74-Child with signs and symptoms of pneumonia and creptation in aoscultation what do
you need to confirm diagnosis?
A.Chest xray
B.Sputum culture

Answer: A A

75-What do we screen at age of 50

Answer:
Colon
yes

76-First line dirutic in ascites

Answer:
Spironolactone

77-26 Y.O. female patient with HV antibody positive and HCV RNA negative,
Asymptomatic and all labs and LFTs are normal. What is the best next step?
A. Follow up with HCV RNA after 6 months.
B. No need for further testing
C. Start antiviral therapy.

Answer: B B

78-A patient with epigastric pain admitted to hospital, U/S shows gallstones with dilated
extrahepatic duct. Now he is stable and labs are normal except
high amylase 250.
What is the appropriate next step?
A. ERCP
B. CT abdomen
C. cholecystectomy now
D. cholecystectomy after 6 months

Answer:
Debated but going with A especially if it’s the one where the CBD is 1.2 etc..
ERCP https://t.me/SmleByHamza/293

79-7-9 days post chlocystectomy, patient presented to ER complains of pain at the angle of
mouth
what’s the management
temp: 38.8
A. x ray
B. ct
C. antibiotic
D. analgesic
Answer: C C

80-Urine / +VE for Urine-reducing substances test (normal negative “written like this “)
Which of the following has the HIGHEST DIAGNOSTIC VALUE?
A. HIDA SCAN
B. urine-reducing substances test
C. Coombs test
D. alpha antitrypsin test
‫ كان بالسؤال والخيارات‬b ‫الجواب‬

Answer: B B

81-29-week pregnant, preterm Which tocolytic increase

• risk of patent ductus arteriosus:
• A-Ritodrine
• B-Atosiban
• C-Nifedipine
• D- Indomethacin

Answer: D D

82-‫في سوال غريب اول مره يمر علي‬

male known case of ischemic heart disease presented with chest pain 2 days post lapcholy
examination shows irregular pulse
‫طالب‬
most mean investigation
- ECG
- CT angiogram

Answer: A A

83-female present with infertility for 3 years

TSH within normal
FSH 4 high
LH 9 high
prolactin 2500 ‫( والطبيعي‬٨٠٠) very high
treatment?
- Clomiph
- Bromocriptine
- IUI
- IVF

Answer: B B
84-Uti in pediatric how to treat
Oral amoxicillin
Im ceftriaxone
Iv ceprofloxacin

Answer: A A

85-New options?
Malignant Phylloid, next step ?
A.WLE
B.Chemotherapy
C.CT chest with contrast
D.Immunohistobio hormonal receptor assay

Answer: C C

86-‫سؤال مشابه بس فكرة مختلفة‬

80 years old male only have hypertension came to the hospital due to visual hallucination
along with attack of hypoglycemia and dysphagia and decrease sweating, the memory is
intact. he is only on amlodipine what is the diagnosis?
A- Alzheimer’s dementia
B- lewy body dementia
C- multi infarct
D- Prion disease

Answer: B B
Explanation :
Reference :

87-Child can tell short story , draw body part , ride tricycle , undress him self ,Age ?
A- 3
B- 4
C- 5
D- 6

Answer: B, 3 body parts

B, It’s tell a story for me

88-41-Patient underwent lap chole for multiple gallstones 7 days ago, presents with vague
abdominal pain. On US there is fluid around the gallbladder (something like that) and the
CBD is 9 mm. What is the most
likely diagnosis or cause?
A. CBD injury
B. Retained stone in CBD
C. Sub-hepatic collection

Answer: B B
89-30 week old child, at 6 week old developed grunting and RDS
A. Chest xray
B. Blood culture
C. Blood culture and abx
D. Blood glucose

Answer:
A?
A for me

90-Patient presented with s/s of intestinal obstruction

Xray show pneumobilia
A. Gall stone ileus

Answer: T T

91-patient did hernia repair with mesh

Days later
Pus coming out of the wound and part of the mesh :-
A. Wound drainage and remove the mesh

Answer: T T

92-Trauma case patient is consious and oriented he has pneumothorax with chest pain
Vitally stable ( didnt mention oxygen sat )
Next step
A. Intubate
B. Needle decompress

Answer: B B

93-COPD case, clear as the sun is clear right now,

He has absent gag reflex
Next step
A. Intubate
B. Non-invasive ventilation

Answer: A A

94-Another COPD case asking about diagnosis he has increase AP diamater

A. Emphysema
B. Chronic bronchitis

Answer: A A

95-Incidental fibroid finding 5x5 cm

A. Conservative
B. Myomectomy
C. Artery embolization
D. OCP
‫هذا تكرر مرتين بنفس الخيارات‬
No reassure in the choices

Answer: A A

96-
‫هذا نفسه جاني لكن زياده عليه‬
Patient has excrutiating pain for 4 hours
‫وباقي الكيس نفسه‬

Answer: A A

97-Child with cirrhosis, what nutrient to restrict:

A)Vitamins and minerals
B)Proteins
C)Fats
D)Carbs

Answer: C here i believe because it is just cirrhosis

Goddammit; OK here C
The case of hepatic encephalopathy is PROTEIN (‫ اعرف واحد جاب‬100)

98-9 months came for vaccine what is contraindicated this visit?

dont give if
A-moderate or severe acute illness (according to CDC, delay vaccine until illness resolve)
B- penicillin allergy
C- currently on antibiotics
D- recently exposed to infectious disease

Answer: T T
Explanation :
Reference :

99-30 wk pregnant came for check up , Have mid systolic murmur radiate to carotid in left
eternal border with no diastolic sound
— physiological murmur of pregnancy
— AS
— MS

Answer: B B

100-Q/ A young male with history of sexual activity presented with gonorrhea, what to do ?
- Blood culture
- Urine culture
- Urethral swab

Answer: C C

101. Mid age man with a bulging mass from the inguinal area for about 1 year now came
with pain.
On P/E abdominal exam and groin were noraml
Vitals stable
What is the next step in management ?

CT
Discharge
Laparotomy
Don’t remeber third but its not X-ray 100%

Answer:
A i believe it is the same one in Hamzah’s file
CT

102. Target blood pressure according to JNC guideline

<140
<130
<150

Answer: A if nothing is mentioned because only medically free 60 or older are set at 150

The case is usually +60 and medically free so <150

HTN BP goals (JNC8):

All patients (even with DM or CKD) < 140/90 mm Hg
60 years or older goal < 150/90

103.

Elderly women known DM HTN has a history of IHD years before.

Came complaining of increasing shortness of breath, increased when she lay down. No
chest pain, no other complains.
Vitals normal
( The question came with 2 clear pictures that I am 100% sure about)
First picture ECG showing ST-elevation in leads 2,3,avf, v5, and v6 only.
The second picture chest x-ray showed pulmonary edema.
What is the cause of this patient complaint
A. Acute coronary disease
B. Pulmonary edema
C. Pulmonary Embolism
I forgot the other 2 options but no pericarditis.

‫جاني ذا السؤال وكان كذا‬

In examination/ auscultation: bilateral diffuse crackles

Answer: Edema
The Q with two pics → pulmonary edema (‫ اعرف واحد جاب‬100)
104. Patient experiences chest discomfort that was relived by rest, later it got worse and
isn’t relieved. He went to the ER and developed another episode while he was there and was
given nitroglycirin and it relieved his pain.
Cardiac enzymes are negative
ECG shows 0.2 anterolateral ST depression that quickly normalized.
DX?
Myocardial infarction
Unstable angina

Answer: T T

105. pregnant was not vaccinated for chickenpox, they check her serum antibobies it was
negative
What it the best action
⁃ Avoid exposure
⁃ Give the vaccine
⁃ Give her immonuglubilin

Answer: A A

106. Target BP in ischemic stroke

220/110
240/120

Answer:
A even though it is /120😅
220/120

107. ‫جاني سؤال بيديا طفل يعرف يرسم خط مستقيم ويرتب االشياء فوق بعض واشياء ثانيه يسويها نسيتها‬
‫؟ والسؤال كم عمره‬
- ‫نسيت اول خيار‬
- ٩ ‫شهور‬
- ١٢ ‫شهر‬
- ١٨ ‫شهر‬

Answer:
2 years but closest is 18M here
Agree

108. Patient have perforated anterior duodenum what to do?

A) partial gastrectomy
B) gastrojejunostomy
C) patch omentum
D) forget
Answer: C C

109. 10- 45 years old female known case of hypothyroidism on levothyroxine with high TSH.
The patient is scheduled for elective surgery. What is the most appropriate management?
A. Increase levothyroxine dose.
B. Stop levothyroxine before the surgery.
C. Postpone the surgery until euthyroid is restored.
D. Proceed with the surgery and prescribe thyroxine after the surgery

Answer: C C

110. Pt developed sudden onset headache when he was bending to take his keys from the
ground , described it as the worst headache In his life , what is the diagnosis ?
A Meningitis
B cluster
C tension
D Subarachnoid Hemorrhage

Answer: D D

111. A mother of 6 years old healthy boy brought him to the clinic with concerns about
vaccination since he came in contact with a child with chickenpox 2 days ago. What will be
your next step in management?
(This is the full recall, no further information mentioned)
A. Observe for few days
B. Give acyclovir
C. Give IVIG
D. Give varicella vaccine

Answer: D
rip ma’an disappeared into the abyss

112. Question about management of ectopic pregnancy after providing size. It was 3 cm.
I don’t remember if it mentions B hcg or not.

Surgical or methotrexate

Answer: MTX
Size less than 4
HCG less than 5000
Methotrexate or medical treatment

113. 2 months old baby with signs of HF what to do for his failure to thrive?
Refer to cardio
Refer to gastro
High caloric diet

Answer: A

114. 50 y old man complained of reducible swelling / lateral and inferior to pubic tubercle?
- femoral
- direct inguinal
- indirect inguinal

Answer: A

115. Patient with previous hx of IHD, DM, HT experiences chest discomfort FOR 3 DAYS
worsening at rest. While in ER improving with nitroglycrin yet still CP is there
Cardiac enzymes are negative
ECG shows 0.2 anterolateral ST depression that quickly normalized.
DX?

Myocardial infarction
Unstable angina

Answer: B, repeated

116. 20yo male patient came to ER complaing from abdominal pain. O/E there was inguinal
hernia that was tender and irreducible. On x-ray there was multiple air fluid level in
abdomen. + redness
What type of hernia?
A. Strangulated
B. Obstructed
C. Irreducible
D. Incarcerated

Answer:
A

117. 51 female with meningitis

Csf analysis given, its bacterial
Whats the organism?
No gram stain given
L.mono
S.pneum.
E.coli

Answer: B is the most common

118. . 38 wks with contraction
admitted to OR. GDM on diet BUT NO REGULAR ANTENATAL F/U
Us: baby weight 4500 gm polyhydramnios
Whats the most imp to be available in (time out period) ?
Blood glucose monitor
Availability of blood results
Blood loss count

Answer: Blood glucose monitor

Mo salah just scored a 90th minute winner right here https://t.me/c/1935988625/13640

Child with congested throat and low grade fever what is the most common cause?
Acute Tonsilitis
Acute Epiglottitis
Viral Croup

119. 731-Typical scenario of divirticulitis (LLQ pain, fever ...) On CT there was 9*10 cm
collection with thick edema of the sigmoid wall and multiple diverticula
A) sigmoidoscopy
B) percutaneous drainage
C) sigmoidectomy with primary anastomosis

Answer: B , it depends on hinchey’s classification

Answer: B i agree

120. Open inguinal hernia repair in COPD patient?

A-Local anesthesia
B. Spinal anesthesia
C. General anesthesia
D. Ilioinguinal nerve block

Answer: D
Explanation :
Reference : TOP Gs PR

121. i think the answer is obsession it’s an irrational fear rather than a delusion (fixed belief)

Answer:

A female patient counts the number of floor tiles and the number of steps she walks. She is
aware of her problem and when she tries to stop she gets mad and irritated. What is the
diagnosis?
- Delusion.
- Obsession.
- Compulsion.
- hallucination.

Answer is C

122. Obese women 28 years old came with clear case of appendicitis ( Alvarado score 6 or 7
not sure )
Didn’t mention any thing about pregnancy or GYN condition. What is appropriate?
A- Abdominal US
B- CT ABDOMIN
C- Laparoscopy

Answer: B
123. 5 or 8 y/o Pt with sore throat, cervical lymphadenopathy, fever, no mention of cough,
exudate on tomsils, RADT was negative:
-Throat culture
- Oral penicllin V
No monospot test in the options

Answer: A

124. 8 years old boy presented to the emergency department with fever, headache and sore
throat for 2 days, in examination there was enlarged tonsils with exudate and pharyngeal
petechia. He had enlargement of anterior and posterior cervical and submandibular lymph
nodes. Rapid strep test was negative
BP: 100/65
T: 39
Others normal
What’s the most appropriate next step in managemen?
A- spot test for infectious mononucleosis
B- viral culture for adenovirus
C- CBC
D- influenza test

Answer: A

125. Pregnant 18 GA
The doctor requested OGTT
What the reason the doctor requested early .
A- previous history of GDM
B- family history of T2DM

Answer: A

126. A 57-year-old man presents with 2 days of abdominal pain, nausea, and vomiting
Examination revealed a distended, tympanic and mildly tender abdomen without rebound or
guarding
Hb: 15
WBC: 12
X-ray:
Multiple air-fluid leveis.
CT scan:
Multiple dilated loops of small bowel with a transition point in the distal small bowel, with
some adjacent mesenteric fat stranding

A. Observation
B. Colonoscopy
C. Diagnostic laparoscopy
D. Exploratory laparotomy

aNSWER: exploratory laparotomy

128. Child came back from Africa with fever, headache, sore throat, vomiting, on
examination: neck stiffness, weakness and can’t elevate his head and legs when lying
supine
CSF analysis given).
Glucose normal
Protein normal
Lymphocytes
what's the organism
A-Polio
B-Cytomegalovirus
C-Ebstein bar
D- corona virus

Answer: A

130. 6 yr boy, has URTI 2 wks ago, and on brushing his teeth he started to bleed,
plt =15000
Best action to do?
- IVIM
- steroid
- observation

Answer:
Checked UTD and NELSON
Both IVIG and Prednisone are 1st line
Will go with IVIG here (SAFDER)
131. A company wants to know the effects of a drug that is approved and reported in
multiple studies. The drugs’s effects are available in the literature.
What is highest level of evidence to investigate this drug?
-RCT
-Systematic review of RCTs
-Cohort studies
-Pharmaceutical company something

Answer: B

132. Typical case of meningitis with altered sensorium

Glucose normal
Lymphocyte 73
Neutrophils 23
A. Tuberculos meningitis
B. Viral meningoencephalitis

Answer: B

133. A pregnant lady with cholestatic picture at third trimester

What tests of the following is highly diagnostic
-Liver enzymes
-Coagulation profile

Answer: A
134. Case of vaginal candiasis with vaginal itchiness what to give
Vaginal miconazole
Oral metronidazole

Answer: A
Oral antifungal
Topical if pregnant

135. A 47 year old lady came to PHC

She is obese AND was diagnosed with HTN since years
What to do for screening ?
DM
Pap Smear

Answer: A

136. Pregnant in her 20s medically free, with mid systolic murmur on the right side of the
sternal boarder radiating to the carotid?

Aortic stenosis
Physiologic murmur of the pregnancy
Mitral regurgitation
Mitral stenosis

Answer: A

137.Pedia with squint what to do?

Hirschberg test

Answer: HISTORY, if not in the choices then this test sure

138. Father diagnosed melanoma and now son has some nevi what to do?
Refer him to dermatologist

Answer: true

139 . 75 years old male admitted for cough and shortness of breath, kc of heart failure,
previous history of DVT and creatinine now is 22 (below normal) what type of prophylaxis?

Enoxaparin 40 sc daily
No need
Heparin 7500 q8
Heparin 5000 q12
Answer: A

140.

Pediatric pt given oral abx didnt work and this is his xray
Tb
Exactly same picture

Answer: TB
Explanation :
Reference :

141. Pediatric patients K/C of Ulceractive colitis, presented C/O multiple attacks of diarrhea
had severe dehydration w/ non distended soft abdomen. What acid base distrubance you
suspect?
( 100% sure no ABG or Vitals)
- Metabolic acisosis
-metabolic alkalosis
- compensated metabolic alkalosis
- compensated Metabolic acisosis

Answer: A

142. Mother blood negative and baby positive, the mother taken Anti D at 24w, after delivery
how much we give the mother Anti D?
A- 300
B-1000
C-1500
D- Don't give

Answer: A
143. 28 years old man had RTA
Presented with:
Femur fracture
Decreased breath sound in right chest
Profusely bleeding from his mouth and nose
they didn’t mention LOC
What is the most appropriate initial management:
- Anterior and posterior nasal packing for the nose
- Endotracheal intubation
- Thoracotomy for right sided hemothoraz
‫ نسيت الباقي بس ماكان فيه‬Coricothyrotomy

Answer: Endotracheal intubation

144. Patient with congested throat symptoms, difficulty in swallowing and 2 cm palpable
cervical lymph nodes.
What is the most appropriate investigation?
A. Chest x-ray
B. Neck CT
C. Lateral neck x-ray
D. FNA of the lymph nodes

Answer: C

https://t.me/c/1882025696/915
Reference: some dumb guy on MED18 SMLE Channel + ‫ابو حسيبة‬

145. Patient with vaginal hematoma presentation

Painful lump
How to manage?
- surgical evacuation
- aspiration
- antibiotics

Answer: A
146. Which type of malaria have high risk of recurrent in the community?
A-falciparum
B-P. vivax
C-P. oval

Answer: B

147 .
Cervical bleeding whats the feathers to diagnose it? > post coital True

Toxoplasmosis encephalitis with HIV pt treatment >

A-leucovorin + Pyrimethamine
B- pyrimethamine and sulfadiazine this one

Niacin syx > flashed face true

148. Picture of
-bacterial vaginosis
-RDS
-Endometriosis

149. Patient mass right kedny vomaitng abdominal pain ?

Enema
CT
US

Answer: CT

150. Elderly man, underwent rectal surgery recently

Presented later with unilateral pain.. etc
And was diagnosed with DVT
What is the management?
- Enoxaparin
- Streptokinase
- IVC filter
- Warfarin

Answer: A

151. Patient presented with polyp (1.3 cm) (Tubular)

What is true regarding his colonoscopy screening

- every 3-6 months

- every 3 years
- every 5 years
- every 10 years

Answer: B

152.
Answer: D

153. What is the bacteria cause Rheumatic Fever?

GAB GBS?

Answer: Group B beta hemolytic streptococci

154. ‫ الصور كانت‬bradycardia

Inferior MI
CVS risk scor

Answer:

155.
Pt with left vetticular failure what is the first Line TTT

Ace BB
Hyrdalazine BB
Duritics BB

Answer: A
156. Patient with Incarcerated Hernia with ulcer and fecoleth Dischare What is the TTT( ‫كانت‬
‫)ستيبل‬
Laparotomy
MRI
Laprscopy

Answer: A

157. Mother come to the health centre complain of baby 18 month a lot of time hunger and
feeding a lot milk and eat dirt what is the most appropriate dignostic test
A. Lead screening
B. CBC and blood semar
C. X-ray
D. Iron stud

Answer: B

158. Women 52 old no menstruation 12 months

What expected be low
Estrodial
Progrestone
Testrone
FSH

Answer: A, focus please

High → FSH

159. Mother come with baby 6 months com complain

Pancytopinea
And organmegly
what is most likely diagnosis Leukemia;
acute Myeloid
Chronic myeloid
acute lymphoblastic
acute non lymphoblastic

Answer: C; ALL

160. women go for fibroids remove

What is the give to to decrease fibroids size
Ocp
Progstone
IUD
GnRH injection

Answer: D

THIS IS THE LAST Q I WILL SOLVE IN THE FILE, YOU CAN FIND MY ANSWERS ON SILENT
STARTING FROM THIS QUESTION https://t.me/silent_2023m/21770

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