1000 Prometric GP MCQ + Exp

New collection of MCQ other thanthe 1000 of ALQASEM: 1-initial regulation of BP in vascular system occur at : a- Arterioles b-Aorta and its branches c-Heart d-Capillaries e-Vein and venules ______________________________________________________________________ __ 2-hematological disease occurs in children treated with heparin and fresh frozen plasma what is the disease : A)hemophilia A B)hemophilia B C )VON WILL brand disease d)DIC thrombosis

3-Patient came with low iron and high AST and high MCV no megaloblasts in the blood wt is the Dx? Alcohol Vitamin B12defeciency Folic acid deficiency Due to drugs Patient with macrocytic anemia without megaloblast. What’s the most likely diagnosis: a. Folic acid b. Vitamin B12 deficiency c. Alcoholism 4- pregnant lady with hepatits, how to confirm dx : a- ALP B-SGOT C-WBC D-ESR E-……… __________________________________________________________________ 5-which of the following antidepressant drugs causes agitation, anxiety : triAD 1

tetraAD SSRI 6-PT WITH ASBESTOSISLEAD TO Plural calcification Plural effusion Or bilateral fibrosis 7-which of the folowing is the most radiosenstive testicular tumor a- semenoma b- yolc sac tumor c- germ cell tuor d- choriocarcinoma e- immature teratoma 8-ttt of pyoderma gangrenosum a- sys steroids b- methotrexate _________________________________________________________________ 9-ttt of foliculitis after shaving the bread a- oral steroid b- topical steroid c -oral antibiotics may be there was topical antifungal but no topical antibiotic choice 10- Baby in NICU has a heart rate of 300, good blood pressure level. What should u do: • DC shock • IV amiodrane • Digoxin • Carotid massage?? Newborn with 300 bpm , with normal BP , normal RR , what do you will do for newborn : (atrial flutter) imp.  Cardiac Cardiversion  Verpamil  Digoxin  Diltzam iv if you suspect atrial flutter : Consider digoxin if not already in use because it frequently increases the conduction ratio and decreases the ventricular rate. , Avoid adrenergic and atropinic agents during sedation or anesthesia for cardioversion. Ketamine is relatively contraindicated _________________________________________________________________________ _ 2

the cause of premature ventricular contraction? decrease O2 supply to the muscle decrease blood supply to the muscle the heart trying to beat fast __________________________________________________________________ 11-yr old sustained trauma to the chest present with severe short of breath with cyanosis, his rt lung is silent with hyperresonance. The FIRST step to treat this pt: a. O2 mask b. Tube thoracostomy c. CXR _________________________________________________________________ 12- Patient with hypertension , DM, somking, which the following are most important to be deal with : obesity and HTN ??? smoking and obesity smoking and HTN 13-baby with streptococcal pharyngitis: - Ttt after 9 days carries no risk of GN - Ttt effective in prevention of GN - Clindamycin effective against gram –ve organisms all choices are wrong 14- Hx of trauma in DIP(finger hyperextention)with palm pain: (incomplateQ) - Extraarticular fracture in DIP - Intraarticular fracture in PID - Superficial tendon tears - Tendon profundus tear?? 15-pt with pict of bilateral pneumonia , high grade fever , normal WBC . organism causing that: - Chlamydia pneumonae - Leigonella sp. (cause neutropenia) - Staph pneumonae _________________________________________________________________ 16-ttt of cold induced urticaria: - Cemitidine -diphenhydramine. __________________________________________________________________ 17-methyl-progesteron used for PPH what is contrindication : Pregnant with asthma Pregnant with hypertension Pregnant with DM 3

__________________________________________________________________ 18-what is the most common cause of death in patients with Ludwig's angina? sepsis Sudden asphyxiation rupture of the wall ____________________________________________________________________ 19- 4 days post c-section pt with profound hypotension a-normal saline 5ooml IV with to big lines b-dopamine __________________________________________________________________ 20-Adult male during excercise he suddenly felt pain in the middle of his rt. Thigh posteriorly. On exam. He has discoloration in the same site and mass in the hamstring ms. No bone tenderness or palpable defect. Mx: Surgery. Splint. Bandage. Ice, elevation and bandage Cast. 21-patient has complete ptosis in hih rt eye. pupil is out and down, fixed dilated. restricted ocular movements. dx a. 3rd n palsy. b. 4th n palsy. c. 3rd and 4th. d. 6th n palsy 22-target lesion are found in erythema: a-annular b-marginatom c-multiform d-nodosum _________________________________________________________________ 23-patient came with cervical carcinoma next investigation : -cone biopsy - Direct biopsy -pap smear __________________________________________________________________ 24- the best to give as DVT prophylaxis post surgery which is cost effective, safe with high efficacy: a) LMWH b) Unfractioned Heparin 4

c) asprin d) Warfarin 25­case of right hypocnodrial abdominal pain for 2 hours after eating for months no fever no jaundice, no radiation and nothing suggistive of cholycytitis what is the investigation a- US b- oral cholystogram c- iv cholystogram 26-72- pt intubated ,the most reliable method to make sure for tube proper position: - 5 point auscultation bilaterally breathing heard - CXR 27-23 years old female with regular menses. On US, she has a 7cm ovarian cyst. otherwise everything is normal. dx: a. corpus luteum cyst b.follicular cyst c.teratoma d.another cancer 30- regarding paracetamol toxicity: - Not toxic if dose exceed 150-180 mg - Cause vomiting and neuropathy - Therapeutic effect after 4 hours - Use Deferoxamine -the liver enzyme reach the max. Level 4-6 hours after ingestion 31- 22 yr, low HGB low PLT and high WBC , peripheral smear shows blast cell with large nucleus and scant cytoplasm and some nucleoli -positive meyloperoxidase test and negative esterase , DDx: - Acute lymphocytic - Acute myelocytic - Acute monocytic __________________________________________________________________ 32­ child with hyperemia and pulging of tym mem – had previous history of treated impetigo so ttt is: - Cefuroxime - Amoxicillin (not sure) - Erythromycin - Ceftriaxone - Cephalexine _________________________________________________________________ 5

33-child , urine odor like burned sugar: - Phenylketonuria - Maple syrup urine disease _________________________________________________________________ 34-40 yo presented by hx of syncope when he do excurses and there was hix of same complain when he on rest . and there is chest pain on ex. There was ejection systolic murmur 2-4 degree most side is lower lf sternum not radiating to other site increase when he lying down and there is non specific s and t changing and there is lf atrium enlargement Aortic stenosis p.s hypertrophic cardiomyopathy constrictive cardiomyopathy 35-Pt. had chest pain and fainting , ECG shows st- elevation and significant Q wave in -v4 and st-depression in inferior leads : Ant. MI Inf. MI Pericarditis Post. MI ________________________________________________________________ 36-A patient with normal kidney function post MI. The troponin level will last for : A. 48 h B. 73 h C. 24 h D. 12 h E. 8 h 37-In lung diseases like pneumonia, it usually affects certain site based on the anatomy, this is more obvious in which of the following: • Right upper lobe • Right middle lobe • Right lower lobe • Left upper lobe • Left lower lobe 38-in lung diseases like pneumonia, it usually affects certain site based on the anatomy, this is less obvious in which of the following: • Right upper lobe • Right middle lobe • Right lower lobe 6

• Left upper lobe • Left lower lobe 39-Pt. above 40 , pregnant and ask you for down syndrome screening : Triple test US Amniocentisis Chorionicvillus 40-You received a call from a father how has a son diagnosed recently with DM-I for six months, he said that he found his son lying down unconscious in his bedroom, What you will tell him if he is seeking for advise: a. Bring him as soon as possible to ER b. Call the ambulance c. Give him his usual dose of insulin d. Give him IM Glucagone e. Give him Sugar in Fluid per oral _____________________________________________________________________ 41- Pt. with headache and vertebral lesion (Moth-eaten),Investigation? - Bone scan - ………………………… - …………………………… 42­uveitis is treated by a-chloramphinicol drops b-tetracine drops and other choises i dont remember uveitis is treated with cycloplegic and steroid 43-Which drug can use in acute back pain Diazepam Alprozam Metoxelen 44-patint C/o menomentogia 6 month and pelvic pain .all investigatin and examinatin normal what is ttt Mafnemic Compined pill 45- pt was PDD –ve , know become + ve , there is no symptoms , normal x ray, the management : -Reassure -Rifambicin and INH for 6 month 7

-Streptomycine for 7 month _ rifambicin for 6 months __________________________________________________________________ 46_ pt was PDD –ve , know become + ve , there is no symptoms , normal x ray, the management : Isonized and rifampcin for 6 month Isonized for 6 month Isonized and rifampcin and streptomycin for 12 month the treatment of latent TB: 1-INH for 6-9 months 2-alternative is rifampicin 4-6 month 47_During blood transfusion , the pt develop fever and pain at infusion site – your action: -slow infusion+antibiotic -slow infusion + acetaminophen -stop infusion + crystalloid fluid - stop infusion+ mannitol+acetaminophen __________________________________________________________________ 48­To deffrentiate between sinua arythmia and atrial firbllation a- carotid massage b- Temporal artery massage c- Amidrone d- digoxin __________________________________________________________________ 49­A 35 yr old pt she is on phenytoin since she was 29 due to partial epilipsy she didn’t have any attack since. She want to stop taking the drug due to facial hair growth: a. It is reasonable to stop it now b. Stop it after 6 months c. Stop after 10 years d. Don’t stop it 50-Patient with seasonal watery nasal discharge, sneezing and nasal block. What should you give him as a treatment: • Topical steroid • Decongestants • Antihistamines • Systemic Steriods 51­child presented with decreased hearing for 1 year, on exam. there is fluid behind the ear drum and adenoid hypertrophy. In addition to adenoidectomy what will you do: 8

myringotomy. gromet tube insertion. antibiotics. __________________________________________________________________ 52-Pt. with perforated tympanic membrane ttt: Topical ABX Topical steroid Systemic ABX Systemic steroid 53_Pregnant lady presented with bleeding from gums. On exam, spleen in palpable 4 cm below the costal margin. Ix; platelets 50,000. Dx: HELLP. ITP Gestational thrombocytopenia Thromboembolic disorder. 54­40 ys female, multigravida, no sexual intercourse for 1 year bcz her husband going abroad, C/O was intermenistrual bleeding with menorrhgia, provotional Dx: Endometriosis Endometrial CA ?? ch endometrites this is a common age of DUB not sure of the answer but according to the choices it is B 55-patient with bed sore involve skin and extend to fascia and muscle what a grade Grade1 Grade 2 Grade 3 Grade 4 56-patient with rhumatic heart disease and had mitral valve stenosis Mitral vave diameter less than 1 mm In order to maintain COP what will happen : Left atrial hypertrophy and decrease pulmonary prusser Left atrial hypertrophy and champer dilatation RV hypertrophy and decrease pulmonary prusser RV hypertrophy and champer dilatation

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choices in other words a- Dilatation in the atrium with chamber hypertrophy b- Dilatation in the ventricle with chamber hypertrophy c- atrium dilatation with decrease pressure of contraction d- ventricle dilatation with decrease pressure of contraction . 57-55 years male with bleeding on examination have external hemorrhoid what to do advise him to remove it do rigid sigmoidscopy go home and visit after 6 months do barrium enema 58-infant with high grade fever .. Irritable .. Look sick .. Complain of anuria 4 hour with multiple petechiea and purpura on body .. He was tachycardic and hypotensive DX Renal fauiler Septic shock 59­Verrryy long scenario of old age pt with DM, HTN, hx of multiple cardiac attack, CVA, came for routine check up in PHC, u found bilateral opacification in both lenses, with decreasing of visual acuity, u will: Refer to lazer therapist refer to cataract surgeon refer to ophthalmologist follow up 60-patient on glaucoma medication for weeks came with SOB, cough the cause a- timolol b- betoxolol c- pilocarpin 61-Considerd positive mantux test in Erythema more than 5 mm in HIV patient Induration more than 10 mm in diabetic patient Induratin more than 5 mm in iv drug abuse Induration more than 10 mm in philpine man _________________________________________________________________ 62-old with bilateral hydronephrosis: - Stricture of uretheral meatus - Prostate enlargement - Bladder tumor 10

______________________________________________________________________ _ An 80 year old male presented with dull aching loin pain & interrupted voiding of urine. BUN and creatinine were increased. US revealed a bilateral hydronephrosis. What is the most probable Dx? a) Stricture of the urethra b) Urinary bladder tumor c) BPH d) Pelvic CA e) Renal stone __________________________________________________________________ 63-old man healthy felt in collapse before he collapsed there was epigastric discomfort , came with pain n the back, pulse 114, bp 140L…dx: Perforated peptic ulcer Leakage aortic aneurysm 64- in pt with RA to preserve joint function and movement: -disease modifying medication is sufficient - fish oil gives subjective improvement - cold (ice) compression and decrease joint movement _________________________________________________________________ 65-patient with breast cancer and metastasis came complain of tachycardia hypotension , engorged neck vein and SOB what is most next action D-dimer Ventlation prefusion scan Give fursamide and refer to do echo 66- 19 year old athlete, his weight increase 45 pound in last 4 months . in examination , he is muscular , BP 138/89 . what is the cause 1.alcohol 2. cocaine abuse 3. anabolic steroid use 67­Which antiviral drug causes fever and muscle pain: Acyclovir Oseltamivir Interferon Gancyclovir 11

68-5 yr-old baby presented with his parents with pallor his HB is 9, he has microcytic hypochromic anemia, no other complain .. what u'll do for him ?? iron therapy and close observation daily multivitamins with iron _________________________________________________________________ 69- patent with vaginal discharege ,suprabubic pain for 3 days ,fever and bilateral fornieces tenderness what is the Dx 1-apendicytis 2-acute salpyngitis 3-chronic salpingytis 70- patent is presented with SOB. On Xray he has cardiomegaly and rt. pleural effusion. pleural aspiration reveals: protein is <30, LDH <200 IU. dx: CHF. pneumonia. TB hyperproteinemia. 71-pt have mutiple risk factor , obese , HTN not on medication BP 130/90 , unhealthy diet, hyperlipediemia, lack exercise – which factors control improve survival: - Cholesterol, HTN, obesity ??? - Cholesterol, sedentary lifestyle , diet - Triglyceride, obesity, HTN - Low HDL, ??, ?? _________________________________________________________________ 72- 44- male old patient has S&S of facial palsy ( LMNL) ; which of the following correct about it; A- almost most of the cases start to improve in 2ed weeks b- it need ttt by antibiotic and anti inflammatory c- contraindicated to give corticosteroid d- usually about 25 % of the cases has permanent affection 73-pateints with appendicits what is most helpful to make DX Age Fever High WBC High sedmentation rate

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74-Child with high fever and after 2 day develop sorethorate on examination there is congested thorat and pharynx and white to yellowish papule on erthymatus base in mouth and lip what is most likly DX Coxsacki virus Herps simplix virus

75­ Which drug can not be use in acute cholysystits Naproxen Morphine Mepriden Acetamenophin Perdoxyphen _________________________________________________________________ 76­pt na 123, k 3 what to do a-normal saline with 20 meq kcl 80 cc/h b-normal saline with 5 meq kcl 20cc/h c-half normal saline with 20 meq kcl 80 cc/h d-half normal saline with 5 meq kcl 20cc/h 77­female after placement of IUD , she develop abdominal pain and watery brown discharge , 1, uterine rupture 2, bacterial vaginosis 3, pelvic inflammatory disease 78- Female with recent hx of IUCD insertion, coming withwatery brownish vaginal discharge & abdominsl pain what is th most likely dx: a. Uterine rupture B. Ovarian torsion C. Bacterial vaginosis D. Ectopic pregnancy NO PID here !!!!!! in alqaseem questions diagnosed as ectopic pregnancy not sure 79­ Rx. Of scabies in pregnant women: permethrin

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80- Profeational player came with history of truma on the lateral side of left knee , on examination there is swelling in the medial aspect of left knee , the diagnosis is : a- Medial collateral ligament spasm . b- Lateral collateral ligament spasm . c- Medial meniscus tear . d- Lateral meniscus tear 81- Patient he had multiple problem in his chest and he lives in crowded area what your action: a- Immunoglobulin b- H.influnza c-meningococal ____________________________________________________________________ 82- Pt came with cough , wheezing , his chest ascultation revealed monophonic sound , on xray ther is patchy shadows in the upper lobe+ low volum wirh fibrosis ,, he lives in a crowded place .. What is the injection shuold be given to the pateint's contacts : hemophe.influanza type b Immunoglobuline Menngioc. Conjugated C Basil calament .... !!? 83- young male complains of generalized skin lesions and redness, before that there is a hx of mouth and lips swelling for couple of days the its denied any hx of traveling or unusual exposure the is the Dx ? ?? urticarai coxsackievirus infection cold urticaria hot urticaria 84- paient suspected to have connective tissue disease what is most favurable to SLE Cystoid body in fundoscopy?? Cavitaion in lung +ve anti RNP Sever Ryundoe phenomena __________________________________________________________________ 85- pt with pycosis on medication developed rigidity and uprolling eyes , afebrile : - Tradive dyskinesia 14

- Malignant neuroleptic - Hypotonic 86-What you will find in patient with idiopathic autonomic insuffeciency? Orthostatic hypotension Horner syndrome Anhydrosis Palpitation Diaphoresis 87- What is true about hormonal contraception? Decrease breast Ca Decrease ovarian Ca Contraindecated in diabetic women Increase risk of ectopic pregnancy 88- Patient with colon cancer stage 3 and chemotherapy was prefered so when do you start it? As soon as possible When the lab results normalized After psychological preperation No need to start 89-young female complains of 6 weeks amenorrhea and history of VP bleeding for many days and by laparoscopy the is free fluid in douglas of pouch(I don't remember the exact NO.) what is the most probable cause?? rupture ectopic pregnancy 90-pregnant woman with UTI which is the best antibiotics to be given if she has no allergy? nitrofurantoin ampicillin sulfatrimethoprim tetracyclin aminoglycoside 91­Pt has a scaly hypopigmented macules on the chest and arms They seem even lighter under the sunlight,,, what is the ttt? (diagnosis Pityriasis alba or pityriasis versicolor) Topical steroid Na selinum 15

Topical antibiotics Oral antibiotics 25 years old male complaining from scaly lesion in his chest , then become hypopigmented , last 2 months in winter he spend his time neat to sea, by examination showed hypopigmented lesion over chest & arms Dx : Vitiligo taenia versicolor

92­ attributable risk factor is :::??? measurement of exposed and not have the disease mius those exposed and have the disease

93-29 years old male diagnosis as case of gastric ulcer , culture -ve h.pylori pathology –ve of cancer ttt: proton pumb inhibitor antihistamine after 6-8 wk do endoscope after therapy referral to surgery 94-32 years old with cystic mobile breast mass, no LN enlargement. What would you do: • Aspiration with cytological evaluation • Reassurance • Fluroscopic biopsy • Mammography then discuss the options according to the new information __________________________________________________________________ 95-Pt with hix of URTI for 3d then stat to develop rt. Ear pain rinnen test was negative and wiber test (loud sound in affected side) Mastoditis O.M O.E 96-3 months old baby brought by his parents complaining of abd. distention bilious vomiting, constipation, the parents informed that the constipation has been an issue since his birth what is the single diagnostic investigation to do ?? 16

barium enema pain xray ??metery rectal examination 97- A patient presents with long time history of knee pain suggestive of osteoarthritis. Now he complains of unilateral lower limb swelling and on examination there is +ve pedal & tibial pitting edema. What is the next appropriate investigation? a. CXR b. ECG c. Echocardiography d. Duplex ultrasound of lower limb 98- patient came with MI 2 day after addmission develop. Sever abdominal pain and bloody diarrhea ‫وفياشياتانيهنسيتها‬DX Ischemic colitis - diffuse abdominal pain , bleeding per rectum and fever 38.3 c , preceded by urinary infection 3 weeks back treated with AB , diagnosis : Ischemic colitis Amoebic colitis Pseudomembranous colitis

99- looong scenario about old male came with typical history of MI all of the following can be used in the mX of this its except: atenolol heparin sorry I couldn't remember the rest of the choices :( 100- Pt. with long hix of hyperthyroidism to screen about the complication of hyperthyroidism do: liver us Ct brain Bone scan (for osteoporosis) 101-to increase absorption of oral iron , give with: - Vit C - Vit E - Zinc - Ca - Antacid 17

102- old, black macule on his back with irregular border and color variation : - Sq cell carcinoma - Basal cell carcinoma - Melanoma - Acanthic keratosis 103--cord prolapse at level L4-L5 the patient will presented by a-painful calf muscle b-absent ankle jerk c-parethesis of knee joint d-weak dorsiflextion 104­Old male with acute pancreatitis, (high glucose, low Ca)the appropriate nutrition: TPN Regular diet with low sugar High protein ,high ca , low sugar Naso-jujenal tube 105- stroke with loss of smell, which lobe is affected : a- frontal b-parital c-occipetal d-temporal __________________________________________________________________ 106-Adult P.t recived a vaccine ( i don't remeber the name ) After that he complain of itching , tachycardia and SOB What is the ttt? IV hydrocortizone 500 mg SC epinephrine 107- polycythemia vera ttt: -Myelosupression -Plephotomy -X ray therapy __________________________________________________________________ 108-CHILD with eczema on 1% hydrocortisone what other medication u can add Dexamethazon Cyclosporine Tacrolimus 109-Pt with heartburn use antiacid for long time but not improve what is appropriate drug he can use H2 reseptor antagonist PPI …..ANTIACID 18

110-OSTIOMYLITIS start in Metaphysic Epiphysis Dyaphysis 111-Most benign cause of postmenopausal bleeding Cervical polyp Atrophic vaginitis 112-Pt came by hx os sudden eye pain burning vision photophobia and by ex. Small pupil and keretic cell on cornea and cell in humorus Ttt Cyclospoine + corticosteroid 113- which of the following is not a feature of normal ECG: -P wave is the repolarization of the atria 114- n normal puerperium.. -lekoria lasts for up to 4 weeks -the uterus can't be felt after the 1st week in abdomen epidural analgesia can cause urinary retention 115- best test to detect age of gestation is -LMP -U.S. 116­ibuprofen is contraindicated in -htn -dm -peptic ulcer 117-a pt with AF came with black stool (and i think hypotenstion)..dx is: -ischemic mesntry 118- Female with greenish vaginal discharge, red cervix(srawberry appearance). under the microscope it was a protozoa..Dx: a. Trchimoniosis ________________________________________________________________ 119­ Old man with left lower abdominal pain with fever and constipatin, imaging showed decreased the fatty shadows around distal colon, your next step: Double contrast IV antibiotic Control diet 120- Child with SCD, about pneumococcal vaccine - give 23 valent in high risk only - give heptavalent after 2 yr 19

- child with high risk give the vaccine along with antibiotics when exposed to infected ppl ) 121- Which of the following increases the quality of the randomized controlled study & make it stronger: a. Systemic Assignment predictability by participants b. Open Allocation c. Including only the participants who received the full intervention d. Following at least 50 % of the participants e. Giving similar intervention to similar groups __________________________________________________________________ 122- self breast examination: a. 3-5 day after period b. 7-10 day '''''''''''''''''' c. 2weeks '''''''''''''''' 123­right lung anatomy 1. one fissure 2. 7 pulmonary segment 3. no relation with azygus vein 4. 2 pulmonary veins 5. no sibson's fascia 124-antidepressant action starts within - 1 day - 1 wk - 2wk - 3-4 wk 125-child came with generalized body swelling, fever , dark urine with decrease urine output ,,, what is the most useful investigation for diagnosis: CBC Renal function test Abd. US Urine sedmintation test 126-a man with 2nd and 1st degree burn over his face and neck a) wash, cover all burns with Silver sulfadiazine, cover with sterile gauze, give IVfluid, antibiotic and tetanus toxoid and discharge home with daily dressing b) cover burn with Silver sulfadiazine, sterile gauze, oral fluid, and discharge home 20

c) doesn’t make sense d) doesn’t make sense e) Silver sulfadiazine, sterile gauze, IV fluid and admit to hospital 127-pateint with decrease lipido and weak erection ( or ejaculation) In investigation prolactin high , LH and FSH normal what is next step Brain MRI Abdomen and pelvic CT ‫اخترتالمارايبرينلاناتكثرسببللبرولتكتنيمياهوالبيتيوتريادينوما‬ Patient with Premature ejaculation + libido + Erectile dysfunction he is thin and looks sad, he is married for 26years obese and annoying wife, he came for treatment: A- Testosterone Injection every one week B- Sublingual Nitroglycerin 6h before intercourse C- SSRI D- ???? _________________________________________________________________________ ___________________________ 128­4 or 5 ( not sure ) brought by his parents with weight > 95th percentile , height < 5th percentile & bowing of both legs what is the appropriate management : a- Liver & thyroid function tests b- Lower limb X-ray c- Pelvis X-ray d- Thyroid or ( liver not sure ) function test 129-18month old boy came with bite by her brother what you will do ? A) augmentin B) titanus toxoid C) suture 130-old pt with 2 years bone pain , lethargy , fatigue, wedding gait , came with table show high calcium and high phosphorus ; A_ osteoporosis B_ osteomalacia C_ paget disease of bone D_ metastases prostate cancer E_ paraneoplastic syndrome 131-child with inferior and pain but with normal movment of knee , no effusion on knee what the important thing to do ; 21

A_blood culture b-ESR c_ASO titer d-aspirate from knee joint d-plain film on thigh 132-miliary TB caractarized by a- spare lung apical (b- septal line c- multiple lung nudules 133-a man who has had MI you will follow the next enzyme a) CPK b) ALP c) AST d) Amylase 134­a child of parents who have TB, PPD test done for him and revealed 10 cm induration, this is strong +ve. intermediate +ve. weak +ve. -ve 135-in aspirin overdose: a) liver enzyme will peak within 3-4 hr b) first signs include peripheral neuropathy and loss of reflexes c) 150 mg/kg of aspirin will not result in aspirin toxicity 136-female pregnant has HIV +ve , what is the most accurate information to tell her about risk of transmition to baby ; A-likely transmtion through placenta b-through blood cord c-hand contamion of mother d-by breast feeding 137-Female with dysurea, urgency and small amount of urine passed .. she received several courses of AB over the last months but no improvement .. all investigations done urine analysis and culture with cbc are normal .. you should consider: a) interstitial cystitis b) DM c) Cervical erosion d) Candida albicans 22

138-patient is presented with acute chlangitis, what you will do to alleviate the symptoms: IV antibiotics + gastric lavage. IV antibiotics + drainage of bile. hydration + chlolecystectomy. 139-Which of the following drugs prolongs QT interval as side effect? a. Respridone b. Clozaopine c. Amisulpride d. Aripiprazole e. Ziprasidone 140-Which of the following is a 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG CoA)? a. Statin b. Fenofibrate c. Niacin 141-picture of bulls in food ... In biosy there is epidermal lysis and on immunoflurescen: deposition of IgG DX Bulls pemphigoid Pemphigoid valgarius ______________________________________________________________________ ______________________ 142-perthes disease all except Can be presented with painless limp It always unilateral -how to calculate -143relative risk 144-- paient complain of infirtility 6 year ago and sever pain with cycle ( dysmeanorhea) DX Endometriosis Pelvic congestion Endometritis ______________________________________________________________________ ___________________ 145-you want to give varcilla vaccine in one no have vaccin before ‫كيفتعطيه‬ Two dose and 6 weak between 146-- pregnant not vaccinated against measls and mumps and rublla .. She exposed to rublla 3 day ago what you do 23

No treatment Immunoglobin Tell her no affected on her pregnancy if she take the vaccine 147- Pateint complian of diplopia , weakness , and frequant aspiration pnumonia in last 2 month ... In examination there is spascity and fasciculation DX Mythenia gravis Mythenia syndrome Motor neuron disease __________________________________________________________________ 148-child with low grade fever , sore thorat in examination there is lymph node enlarment but not tender and no exudate on phrynx DX It is most likly streptococcal than viral It is viral more than bactrial Most likly EBV 149-what is the. symptom Most likly occure with hiatus hernia Skin pigmentation The symptom increase with pregnancy 150- patient with bilateral eye redness . Discharge and tearing on examination cornea , lens all normal Nd tere is conactival follicle DX Acute conjunctivitis 151- child C/O fever , sore thorat all examination was normal What is the ttt : Cefruxime Ceftriaxone Give paracetamol and take pharynx swab _____________________________________________________________________ 152-- pateint C/o ictrus in skin and eye on investigation WBC 2500 plt 70,000 HG 7 lekocytosis 17% total bilirubin 51 and direct bilrubin 12 what is the test most likly positve +ve coomb's test In US obestructive billiary duct antiparietal antibodies ____________________________________________________________________ 153- ‫ناسيه كيف كان السؤال بس الخلهصه ان في مريض سالك ليش ياخذ فاكسين النفلونزا كل فتره ليه مافي‬ ‫ فاكسين يحميه طول العمر‬... Because the organsim develop resistant Develop new antigenic drift 154- patient c/o low self steam and fatigue .. Lack of intersted and concentration loss of sleaping , depressed mood for last 2 years what DX Dysthymic 24

155--lacteting mother complain of fever and breast tenderness and redness diagnosed as bactrial mastitis what is ttt : Continoue breastfeeding and hot compresser and antibiotic Discontinue breast feeding and give antibiotic to mother and baby 156-the most common cause of nipple discharge in non lactating women is ; a-prolactenoma b-hypothyroidism c- breast CA d-fibrocystic disease with ductal ectesia . e ductal papiloma 157-with patient has fear ,SOB ,sweating when he is in automobile DX a-specific phobia b-panic disorder c-generalize anxiety disorder ______________________________________________________________________ ___________________ 158­which of the following causes the highest maternal mortality in pregnancy a. toxoplasma b. hyperbilirubenia c. pheochromocytoma d.rubella

159-Old pt presented with abdominal pain, back pain, pulsatile abdomen what's the step to confirm dx: a. Abdominal US b. Abdominal CT c. Abdominal MRI _________________________________________________________________ 160­The most common cause for chronic irregular rectal bleeding is: Diverticulitis Hemorrohids Colon cancer UC 161­the most common cause of excessive day time sleepiness is 1- circadian rhythm 25

2nacrolepsy 3-sleep apnea 162-the most common malignant tumor of parotid in childern 1-acinic cell ca 2- mucoepidermoid ca 3- adenocarcinoma 163- The useful exercise for osteoarthritis in old age to maintain muscle strength and bone density Low resistance, high repetition muscle training Conditioning, low repetition muscle training ?? Walking and endurance muscle training Low resistance and conditioning muscle training 164-pregnant with uterine fibroid , has no symptoms only abd. Pain , US showed live fetus ,,,,, What is the appropriate action to do: Myomectomy Hysteroectomy Pain management Pregnancy termination 165­Pt came with eye pain, watery discharge and light sinsitivity Eye examination showed corneal ulceration. Her symptoms are frequently repeated . Which of the folowing is triggring for recurrence of her symptoms: Dusts Hypertension and hyperglycemia Dark and driving at night Ultraviolet light and stres 166­p.t taking a medication , came to the ER suspecting she has overdose of her medication, her symptoms ( convulsion, dilated pupil, hyperreflexia and strabismus) the medication is: TCA SSRI Hypervitaminosis ___________________________________________________________ 167­Pt complain of hearing voices from the microwave and refrigerator Visual hallucination Auditory hallucination 168- Old retired man having ansomnia only . Has no symptoms related to anxity or depression .. U will give him : Diazepam If zolpidem is in choices it is more accurete 169-pt take cephalexin after tooth extraction for days After that he develop profusre , green foul smilling diarrhea with low grad fever . He 26

has tachycardia and mild abdominal dist. Sigmoioscopy showed white mucosal patches , what is the most ttt for this condition? Clarythromycine Vancomycine Cephalosporine Lineozides 170-pt with COPD came with couph , wheezing and greenish sputum The causative organism: H.influanza Strep.pneumonia Chlaymedia Mycoplasma pneum. 171-what is the most effective measure to limting the complications in COPD: Pnumococcal vaccination Smoking cescation 172-25 years old female came complaining of difficult hearing , she mentioned that their a family history of early oncet hearing loss ( her grandmother) Oto. Exam was normal .. Weber and rinne tests result in ( bone conduction is greater than air conduction ) ... Next action is : Refer her for aid hearing Tell her there is no avalible ttt Refer her to otolaryngologist ________________________________________________________ 173­Old man came complaing of progressive hearing loss , it is mostly profounded when he listining to the radio, he does not has any symptoms like that before Weber and rinne tests result in bilateral sensorineural hearig loss.. Diagnosis: meniere's disease Otoscelerosis Noise induced deffnese Hereditary hearing loss 174-25 y wear glass 10 y and diagnosis DM type 2 when u do eye screen 4 her: 6m 12m 2y 5y 175-Pregnant women has fibroid with of the following is True: Presented with severe anemia Likely to regress after delivery Surgery immediately d. Presented with Antepartum Hemorrhage 176-70y male with osteoporosis the T score of bone density would be: 27

-3.5 -2 1 2 3.5 177­Pt G3 P3 all her deliveries were normal except after the second one she did D&C for retained placental parts, presented with amenorrhea after a period of irregular cycle, labs all normal except : high FSH, high LH, low estrogen DX: a- Asherman syndrome b- Ovarian failure c- Sheehan syndrome d- Turner $ 178-The most dangerous red eye that need urgent referral to ophthalmologist: 1.associated with itching 2. presence of mucopurulant discharge 3.bilateral 4.associated with photophobia 179­Neonate with mucopurulant eye discharge lid swelling and culture positive for gm –ve diplococcic , treatment (neonatal gonococcal conjunctivitis) 1.intravenous cephalosporin 2.topical sulfonide 3.oral floroquinolol 4. IM aminoglycoside 180­a baby with blood in the stool and bought of crying and x ray shows obstructive pattern.. looks like intussusception you will do: a) surgery b) Barium enema c) observation d) giv e IV fluids and let obstruction solve itself _________________________________________________ 181-pt with nasal congestion, watery nasal discharge and conjunctivitis, ttt: a- oral antihistamine b- Na cromoglycate c- Topical steroid d- ?? 182­initial treatment of OA in adult who has knee pain bilaterally: a- Opoid b- Intraarticular steroid c- Quadriceps strengthening exercise 28

d- ?? 183­IV drug user has macular rash on palms ,splinter he, and ophthalmoscope shows macules with clear center in retina DDx: Syphilis Infective endocarditis

184­patient with red eyes for one day with watery discharge No itching or pain or trauma (nothing indicate allergy or bacterial infection)there is conjuctival injection visual acuity 20/20 what is next management antihistamines topical AB No further management is needed refer to ophthalmologist topical steroids if allergic rhinitis :topical steroid second line:antihistamine 185-newborn apgar score 3 (cyanotic, limp, decrease breathing, HR less than 60) your action: - Volume expansion - Chest expansion - Ventilation - Bicarbonate 186- pt presented with sweating, myosis, and garlic breath odor: - Organophosphorus toxicity - Cyanid toxicity - Alchol - DKA - Cocaine toxicity 187-in rheumatic fever: - Bacteria in blood - Bacteria lodge in myometrium - Skin invasion - ??? 188-86- female G3P0 , c/o infertility , have regular non heavy cycle, trichomonus infection treated at age of 17 , previous 3 elective D/C in first month gestation ,DDx: - Asherman $ 29

- Sheehan $ - Endometritis - ??? 189-40 yr heavy and intercyclical bleeding , not pregnant , does not on OCP: - Anovulatory cycle - ???? 190- smoker , CXR shows lung mass, hyponatremia and diluted urine: - Heart failure - SIADH - Renal failure - Conn's disease 191-common cause of AOM in all age groups: - H influenza - St. pneumonae - ??? 192­old, which fracture caused by trauma on outstreatched hand:colle's Fx 193­ female, malodor vaginal discharge, dysuria, normal urinalysis, leukocyte and gram -ve diplococci : - N gonerrhea 194­ old, black macule on his back with irregular border and color variation : - Sq cell carcinoma - Basal cell carcinoma - Melanoma - Acanthic keratosis 195­ osteoporosis risk

65 75 80 According to above graph: - 18 % develop osteoporosis after age of 80 - 80 % of elderly have osteoporosis - Age directly related to risk of osteoporosis - Pt after 80 at high risk of osteoporosis 196­ upper limb HTN , decrease lower extremities pulsation: - Coarcutation of aorta 197­ pain and swelling at first metatarsophalyngeal joint: - Na urate crystals 30

- Ca phosphate crystals - ??? 198­ pain and swelling at first metatarsophalyngeal joint: - Na urate crystals - Ca phosphate crystals - ??? 199­ old, smoker , rectal bleeding , wt loss: >>>>Colorectal cancer 200- 45 years old female came to ER with acutely swollen knee + ballotment patella .. The most important to do is: MRI of the knee Aspiration Complete blood count Rhumatoid factor 201- Pt came with a history of about 12 dayes duration severly red , swollen painful first metatarsophalangeal joint.. He is hypertensive with inverted T wave on ECG ... The most appropriate meaure for diagnosis: CBC Uric acid level Troponin level C-reactive protein 202-Pregnant on iron supplementation throughout her pregnancy for her anemia , now she come complaining of weakness and easy fatigability Her Hemoglubin 7 , MCV 60 .... What is the diagnosis? Iron def. Anemia Hypothyrodism Vit B12 def. Beta thalassemia 203-baby who can name 4 colors .... His Age : 48 months ( 4 years ) ‫ـــــــــــــــــــــــــــــــــــــــــــ ـــــ‬ 204-Pt came after fight ( gunshot ) there is a pice of the omentum coming out from the wound . Vital signs ( HR 98 , BP 130/80, RR 18 ) .. What is the best action to do ? CT DPL Fast us Wound exploration Scheduled laprotomy 205- about which breast mass present with bloody discharge ? intraductal papilloma ______________________________________________________ 206- Most Dangerouse sign during pregnancy? 31

Vaginal bleeding 207- the most common cause of epistaxis in children is: Nasal polyps Self induced 208-one of the folowing manifest. As croup: Forigne body Pneumonia Common cold Asthma 209- clear scenario of varicocele ( bag of worms scrotum ) 210- scenario of glucoma in old pt ,, what is the best ttt? Acetazolamide + pilocarpine ( sure 100% ) 211- clear scenario of keratitis .. on examination there is dendritic ulcer: Herpes simplex keratitis _______________________________________________________ 212-Mass in the upper back .. with punctum and releasing white frothy material… a- It's likely to be infected and Antibiotic must be given before anything b- Steroid will decrease its size c- It can be treated with cryotherapy d- It must be removed as a whole to keep the dermis intact 213-Drug use in CHF with systolic dysfunction? Nifidepine* deltiazm* and two drugs from ACEI I forget their names * the 5th choice is one of B blocker* 214-A patient with severe headache, behind the eye, 4 times in one week ? with other symptoms (i don't remember the whole scenario, it seems a cluster headache case, not sure) which drug is not useful in prophylaxis: CCB (may be verapamil) methysergide valium lithium prednisolone read about the prophylaxis of Migraine and Cluster and if any one remember the scenario please write it here 32

215-Pt diabetic he has wound in his leg with poor healing , Exudate ,no sign of inflammation the hyperglycemia cause poor wound healing by : a- inhibit phagocytosis B-stimulate bacterial growth c-decrease immunity ‫الخيرنسيته‬ 216-wt is non hormonal drug use to decrease hot flush in postmenuposal women: paroxitine _________________________________________________________________ 217- old pt complain of dull hip pain increase after walking and activity and it make pt wake up from sleep many time and(several hours) morning stifness whate is the mos DX a-osteoarthritis b-osteomlitis c-osteoprosis e-depression _________________________________________________________________ 218­ csf examination show high igG and anbnormal band cell on agarose gel electrophoresis whate is the DX a-muscular dystrophy b- multiple sclerosis ________________________________________________________ 219-senario of pt e GER since 10 years endoscopy done reveal lowgrade dysplasia of lower oesophagus whate is the next step 1-esophageal resection 2-fundoplication 3-rescreening in (i forget the time) the other choises I don’t remember please read about barrot esophegous 220-perinatal mortality A-include all stillbirth after the 20th wk of pregnancy B- include all neonatal deaths in the firist 8wk of life c-in clude all stillbirth and firist wk of neonatal deaths d-is usually death per 10,000 live birth

221-pregnant 41 wk on complete biophysical profile oligohydraminous is found whate is next step a-induction of labor 33

222-female came wuth vulval irritation the doctor told her to stop using bubble bath she stopped it but the irritation continues 0n examination the vulva skin was waxy like and specked appearance the dx is 1- psoriasis 2- atopic dermitites 3- contact dermitits 4- lichen planus 223-the mechanism of action of propylthiouracil is inhibits the enzyme thyroperoxidase 224- pt e hx of erythema and vesicle in the forehead but not affect the vision whate is the best managment 1-oral acyclovire and F/U 2-oral acyclovire and opthalmologist refere 225­ (Picture of a huge ulcer in the leg, the ulcer is red with raised edges)). Best option of management: -Topical steroids - Biopsy - Radiotherapy - Topical antibiotics 226­- pateint felt fatigue, SOB , angina like pain after doing excercise there is no thrombus done by cath. , he had aortic valve stenosis with less than ,7 cm what would u do : a- avoid exersion b- aortic valve replacement c- ttt with medication only 227­22y o female there is no breast development , amenorrhea , deep voice O-E mass over the ovary Dxx: a-thecoma b- germ cell tumor c- lyding cell tumor d- ovarri storma _________________________________________________________________ 228- pt with CHF and atrial fibrillation u add digoxin what is the effect of it in this case : a- decrease ventricular effecacy b- unchanged COP C- decrease HF 34

229-infant swallow coeeosive material came within half an hour to ER drooling, crying what is the initial thing to do activated charcoal endoscopy secure airway 2 cups of milk 230-svt ttt: Digoxin adenosine 231- malaria in a child: a- crescent shape gametocyte of vivex is diagnostic in the stool b- the immediate ttt primquine for 3 d c- 72h tt t of malaria is suffeceint d- the most common cause is falciparum 232-scaly purpule lesions in the face of a child the cause a- staf. Aureus b- beta haemolytic srept.coci c- H. influenza 233­ child >90% of the normal . < persentile hight with sever bowing of legs what help u for diagnosis: (same question mentioned but different choices) a- lower extremeties x-ray b- pelvic x-ray c- cbc d- alkaline phosphatase 234­ ttt PE: a- iv heparin b- iv tpa c- streptokinase 235- The most common side effect of long use of systemic corticosteroids: a.Asthma b.Weakness in pelvic muscles c osteoporosis 236-pt taking digitalis he developed sudden disturbance in vision yellow discoloration and light flashes (that’s what I remember from the question) a.digitalis toxicity b.retinal detachment 237­ Pt has carotid bruit with occlusion 60% of the left carotid artery what well u advice the pt a.Asprin daily 35

b.Angiograpy c. endartectomy 238­) What is the most specific test for syphilis: ‫ارجعوا للتختصارات‬ a.TPI b.FAAT treponema antibody absorption test 239­) pt had history of hypertension and no medication taken he eats a lot of meat with no fruit and vegetables on examination he was obese BP:130/98 investigations she high cholesterol ,high trigelcride, low HDL in which category u well put the pt for risk of IHD: A B C d I forgot I forgot  High High cholesterol cholesterol Sedentary life obese High BP 240­ pt came with PND and orthopnea an examination he has bilateral basal crepitation and pulmonary edema what is the diagnosis: a.left heart failure b.right heart failure 241-Likelihood ratio of a disease incidence is 0.3, mean: 1.large increase 2. small increase 3. no change 4. small decrease 5.large decrease 242­ I study done on 10,000 people for about 3 years in the beginning of the study 3,000 developed the disease and 1,000 on the end of the study what is the incidence: a. 10.3 b. 12.5 c. 30

243­ the most useful test to detect early pregnancy: a.urine pregnancy test (my answer) there was no serum BHCG in the chooses b.ultrasound 244- Pregnant lady which is hypertensive regarding methyldopa what well u tell her Methyl dopa better then lisnopril 36

(I couldn’t remember the other chooses) 245­treatment of gonrehea: Ceftriaxone 246­44 lady has previous history of DVT her husband doesn’t want to use condom what well u advice her: a.OCP doesn’t increase the risk. b.IUD is preferred in this case. c.she is unlikely to become pregnant 247-Pt covers the tv because he says that they see hem and well split on his face…… diagnosis: a.SCZ 248-A man has excessive worry form germs on his hand a. Specific phobia b.Agrophopia c.OCD 249-Scenario about premenstrual dysphoric disorder. (straight forward and they asked about the diagnosis 250-regarding group Astrept. Infection have lead to rhematic fever : a.blood dissemination b.by causing pharyngitis, tonsillitis. c.joint invasion. d.affect skin. e-reach endocardium 251- Child with positive gower sign which is the most diagnostic test : a.Muscle biopsy 252- child has allergy to dust what well u advice the family a.keep humidity of the house about….. b.cover his pillow with…. c.clean his clothe with warm water?? 253-child with congenital; heart disease his parents doesn’t know the name of the disease he has peripheral and central cyanosis: a.PDA b.tetrolgy of fallot. c.VSD D.left ventricular hypoplasia.

25437

Treatment of papillary thyroid cancer: (read about it) a radioactive iodine uptake scan b surgery 255- picture of herpes zoster (the same picture)

256-15y boy appear patch in rt lower leg these patch is clear center , red in peripheral, no fever no other complain so diagnosis (there was a picture with lesion in the groin area) a-contact dermatitis b-tinea corpora c- lyme disease d-psiorosis

_________________________________________________________________ 257- Man is complaining that he doesn’t see the traffic signs well what is the best way to measure the distance vision: Snellin chart _________________________________________________________________________ ____ 258- question about pt had pterygium what well you tell the pt: -it is malignant - needs surgery in another word :regarding ptergium :  It indicate systemic disease  Will cause loss of vision  Treatment is surgery I forgot the other choices read about the topic 259- Compelete loss of vision Lt eye, in pt with recent infarction? a) Frontal b) Parital c) Cortex d) Occipital 38

260- the commonest initial manifestation of increased ICP in patient after head trauma is 1. Change in level of consciousness 2. ipsilateral pupilary dilatation 3. contralateral pupilary dilatation 4. hemiparesis 5. hypertension 261- Most accurate test for CTS ? carpal tennel syndrome a) Tinels test b) Phalens test c) Nerve tapping numbness There was no nerve conduction velocity. 262- Hx of Child has itching in his RT hand which increase in the night described as linear fissures at their top there is blacknish Scabias 263- Which of the following method is rapid and best for complete gastric evacuation ? ‫!!!! ماعطاك وقت محدد‬... a) G lavage b) Manual induce V c) Syrupe d) Active charcoal 264- old male pt with hx of IHD, DM , HTN , dyslipidemia , family hx of heart disease ,,,,‫ومصايب كثيره‬ lab showed :- LDL : 199 ,,,, HDL : 37 so , in this pt what is most dangerous Risk factor ? a) Increased LDL b) Decreased HDL 265- Old man psych pt , has halosination , aggressive bebaviour ,loss of memory ,Living without care , urinate on him self , what is next step to do for him ? a) Give antipsychotic B) Admit him at care center for elderly . 266-60 y/o male known to have ( BPH) digital rectal examination shows soft prostate with multiple nodularity & no hard masses , the pt request for ( PSA) for screening for prostatic ca what will you do ? a) Sit with the pt to discuss the cons & rods in PSA test b) Do trans-rectal US because it is better than PSA in detection c) Do multiple biopsies for different sites to detect prostatic ca 267- Female com with lump in breast, which one of the following make you leave him without appointment ? a) Cystic lesion with serous fluid that not refill again b) Blood on aspiration 39

c) Solid d) Fibrocystic change on histological examination 268- Infant newly giving cow milk in 9 months old , closed posterior fontanel, open anterior fontanel with recurrent wheezing and cough , sputum examination reveal hemoptesis , x-ray show lung infiltration , what is your action ? a) diet free milk b)corticosteroid c) antibiotics heiner syndrome (milk induced pulmonary disease in infants) is a food hypersensitivity pulmonary disease that affects primarily infants. 269-In a certine study they are selecting the 10th family in each group,ahat is the type of study: imp.  systemic study  non randomized study  stratified study In statistics, stratified sampling is a method of sampling from a population. When populations vary, it is advantageous to sample each subpopulation (stratum) independently. Stratification is the process of members of the population into homogeneous subgroups before sampling. _________________________________________________________________________ ___________________________ 270-delusions definition: 271-giardiasis treatment: metronidazole 272- TTT of refractory hiccups? Chlorpromazine 273- TTT of miagrine? Sumatriptan If BB is 274-most common psychiatric condition come with mania ? paranoid grandiosity 275-patient with fever and fatigue prior to develop maculopapular then vesicle and pustule ? 40

HSV1 HSV2 Varicella 276- postmenopausal women at high risk of: osteoporosis 277- why SSRI best TTT? Effective and tolerable 278-compliance of prophylactive antiasthmatic drugs important to reduce airway inflammation reduce esinophil… 279-2 months amnorrhea refuse examination because she is tense and anxious what will do for her : FSH and LH US pelvis 280-60 years old patient has only HTN best drug to start with: ACEI ARB diuretics beta blocker alpha blocker _________________________________________________________________________ ___________________ 281- structure normally not palpable? LN 282-COPD pt not responding to bronchiodilator what well u add for hem : a.aminophiyline b.methylpredinselone 283-female complain of colourless itching vagina ,her partener complain of uretheral discharge ,cervical examination shows strawberry spots treat with: mecanozole cream estrogen cream progesterone cream douch

41

284-four year old child complain of bleeding from 4 months ,intermittent painless bowel movement good appetite after examination the examiner found blood on his digits: uc mickels diverticulitis juvenile polyps _________________________________________________________________________ ________________ 285-high grade fever, rigors ,painful hepatosplenomegaly: malaria visceral leshmania toxoplasmosis 286- appropriate way to prevent spread of disease : change human behavior screening tests 287- first few words: 12 months 18 months 36 months 288-which of the following true about headache :" -increase ICP at last of day -normal CT may exclude subarachnoid hemorrhage -amnursus fugax never come with temporal arteritis . - neurological sign may exclude migraine 289- patient with typical sign of infections mononucleosis come with abdominal pain and hypotension next step : -abdominal CT and IV fluid -antibiotic and IV fluid and and observation 290- patient with hypersensitivity skin at back take paracetamol and develop vesicle at back extend to abdomen Dx : Herpes zoster 291- picture of viral warts 292-pt in burn wll die due to : -smoke inhalation - trauma 293- elderly patient bedridden for long time what will you do : -include family support -IV valum 294- pt with dysphagia , weakness ,fasciculation …..: -motor neuron disease -polyneuropathy 42

295-Young male c/o pleurisy pain at rt side On EX there is only decrease breath sound tachypnia other wise normal and there is CXR I don’t know if it is normal or not But it seems to me normal what will you do? a-discharge pt bez it is only viral plurzy b-discharge him on Augmentine C- I think refer him to pulmonologist 296- aseptic meningitis early will found: a-lymphocytosis I can't remember the other choices sorry but you must read about the CSF analysis in aseptic meningitis and which cells present 297-Kernig's sign:Definition: 298- Diagnosting peritoneal lavage positive when 1000 RBC 50WBC ‫وخيارات للفسف مافتكرها كلها أرقام‬ 299- attributable Risk definition: 300- female with irregular cycle month and absent for two month with heavy bleeding: a-metroohaia b-menorraghe c-menometrogia d-polymenorrhagia 301-8month complaining of gastroenteritis loss of skin truger, sunken eye depressed anterior fontanel his dehydration is: 10% 20% 5% 302-Patient admitted as a case of emphysema, according to the vaccine what you will do a)give pneumococcal vaccine now b)give flu vaccine now c)give all vaccine 2week after discharge d)give flu vaccine now and pneumococcal vaccine 4week after discharge

303-17 years male while play football felt in his knee (turn over ) what injury 43

medial meniscus lig lsteral meniscus lig medial collateral lig lat collateral lig anterior crussate lig 304-pt. complain of joint. Stiffness, and high ESR, CRP: - Inflammatory condition of the soft tissue. - Immune complex deposite. 305-patient has tangential thought, circumstantial, what is the type of this condition: - Form - content 306-pigmentation of OCP called: melasma 307-old man did femoral popliteal bypass has 2 days of forgetting : alzhiemer vascular alzhiemer

308-clear scenario of turner syndrome (read about features of turner ) 309- cause of death in inflamed burns : -injuries -inhalation of smoking In flame burn , the most common cause of immediate death 1.hypovolemic shoke 2. septic shoke 3. anemia and hypoalbumin 4. smoke inhalation 5. associated injury 310-Atrial fibrillation +narrow complex+unstable pt (hypotensive): cardioversion 44

311-epdiomology definition:

312-epdimology curve: graphic registration of disease through a period of time other choises : a- Plotting number of cases on time line b- Geographical places c- Case with similar diagnosis 313-question in digoxin toxicity (read about): 314-child was playing and felt in the toy, his leg rapped and twisted he don’t want to walk since yesterday: - ankle tissue swelling - spiral tibial fracture 100% - chip tibial fracture - femur neck of the tibia freacture 315-which medication increase survival in COPD pt. : a-b agonist inhaler b-corticosteroid inh. c-oral corticosteroid D- continuous oxygen _________________________________________________________________________ ___________________________ 316- How much Na in 0.9 normal saline ? a- 30 b- 75 c- 90 d- 155 _________________________________________________________________________ ___________________________ 317-- Female with yeast vaginal discharge the treatment is: a. Meconazole cream for 7 days b. Fluconazole orally for one day c. Metronisazole orally for 7 days 318-- Secondary dysmenorrhea is: a) rare due to anovulation. b) due to gonadal agenesis c) always pathological 45

d) part of sheahan syndrome my answer 319- for with aggressive patient with rheumatoid arthritis: Methotaxtrate my answer

320- Greatest thing to prevent disease Genetic consulting Immunization Prevent environments .. Personal behavior?? 321- PT WITH POLYCYTHMIA VERA COMPLIN OF GENRALIZED PRURITTUS AFTER BATHING THE CAUSE IS : due to abnormal histamine release 322--

unwanted effect of antichlnrgic drugs :

a- Diarrhea b- Urine incontince c- Decrease intraocular pressure d- Blurred vision 323-question about stratified simple study:

324- Rubella Incubation Period 14 to 21 days sure 325-De Quervain Thyroiditis histopathology : the classic changes of granulomatous thyroiditis develop. This is characterized by aggregations of lymphocytes, large histiocytes, and plasma cells among damaged thyroid follicles. Multinucleated giant cells enclose pools or fragments of colloid, from which stems the designation giant cell thyroiditis. _________________________________________________________________________ ___________________________ 326- Nodular sclerosis Hodgkin disease 46

In nodular sclerosis Hodgkin disease (NSHD), which constitutes 60-80% of all cases of Hodgkin lymphoma, the morphology shows a nodular pattern. Broad bands of fibrosis divide the node into nodules. The capsule is thickened. The characteristic cell is the lacunar-type ReedSternberg cell, which has a monolobated or multilobated nucleus, a small nucleolus, and abundant pale cytoplasm. 327- Thyroid cancer associated with: Euothyroid Hyper Hypo graves

328- patient with recurrent pneumonia and productive cough , foul smelling sputum increase with lying down + clubbing: bronchectasis BA Pneumonia 329-) flu like sx since to days and now has red eye ( pic ) Dx:

Viralconjunctivitis / bacterial conjunctivitis

/ uvitis / glaucoma

330- young pt came to ER with dyspnia and productive tinged blood frothy sputum , he is known case of rheumatic heart dz , AF and his cheeks has dusky rash dx : Mitral stenosis CHF endocarditis 331- You r supposed to keep a child NPO he's 25 kgs, how much you will give for maintenance >> 1600 ml . First 10 kg X 100ml >> 1000 ml Second 10 kg X 50ml >> 500ml 47

Third 5 kg X 20 ml >> 100 ml Total = 1600 ml 332-) old pt take hypercalcemic drugs and developed gout what is responsible drugs >> frosamide thiazide 333- In pt with moderately sever acne valgarus best ttt Oral isotretinoin topical Retinoids Topical clindamycin oral antibiotics

334- which of the following TTT contraindication in asthmatic pt : Non-selective B blocker

335- case with 60 years old male with RT upper quadrant pain after dinner , most likely DX gallstone ; What is most appropriate inx to DX gall stone ? US Xray Barium 336- human bite to hand , most common hand position that proposed to infection ? Clenched hand dependent extended thump extended fingers 337- In chlamedia infection ttt is ? ( not mention pregnant or not ) Doxcycline Azithromycine Metroniadizole ( also, doxcy used ) 338- case cord like cheesy white adherent odour less vagina after use of antibiotic DX >>Candidiasis 48

339-)- malaria case , beside antiobtic how to prevent ? Kill the vector In another way : What is the most important prevention measures to be taken in the outbreak of malaria: a- Clothing disinfected & inspect for insect bite b- Clothing disinfected & prevent insect bite c- Eradicate the vector & inspect for insect bite d-Eradicate the vector & prevent the insect bite 340- Positive predicitive value : Definition ? " pt who has high Risk factor & +ev test " _________________________________________________________________________ 341- Most difficult method to prevented in transmission: Person to person / Vector / Droplet /Air flow 342- old pt, bedridden , with bactermia , organism is enterococcus fecalis , what the source of infection: UTI GIT pneumonia bed sores 343-) 4y girl, decrease head growth, decrease social intraction, decrease in language …etc: Rett's syndrome 344- case of Raynaud's phenomenon it was direct >> pallor then cyanotic then red finger without other clinical features . _________________________________________________________________________ _ 345- read about rebound hyperglycemia in DM ?? somogi and down phenomenon

346- During heart contraction,heart receive more blood by: _ coronary artery dilatation?? _ IVC dilatation 49

_ pulmonary vein constriction 347- Pt. with 1st and 2nd degree burn involving face and neck: All choices with no hospital admission except one which I choosed as the burn involves the face 348- In patient with rheumatoid arthritis: _ cold app. Over joint is good _ bed rest is the best _ exercise will decrease postinflammatory contractures 349- Pt after swimming pool(clear Dx of otaitis externa) Rx: _ nothing _ amphotericin B _ steroid _ ciprofloxacin drops 350- Patient with continous seizures for 35 min. despite taking 20 mg Iv diazepam..what to do?? _ give 40 mg IV diazepam _ give IV phenytoin _ give IV Phenobarbital 351-16 wk pregnant not known to have illness before has high BP..DX: _ preeclampsia _ chronic HTN _ gestational HTN 35 years prime 16 wk gestation PMH coming for her 1st cheek up she is excited about her pregnancy no hx of any previous disease. Her B/P after since rest 160/100 after one wk her B/P is 154/96 Most likely diagnosis : a- Pre eclempsia b- Chronic HTN c- Lable HTN d- Chronic HPT with superimposed pre eclampsia e- Transit HPT 352- y/o with mild epigastric pain and nausea for 6 months..endoscopy>lossof rugeal folds, biopsy> infiltration of B lymphocytes..treated with abx..cause: _ salmonella _ H.pylori?? 353- Young suddenly develops ear pain, facial dropping..what to do: 50

_ mostly will resolve spontaneously _ 25% will have permenant paralysis _ no role of steroids in another word: male old patient has S&S of facial palsy ( LMNL) ; which of the following correct about it ; A- almost most of the cases start to improve in 2ed weeks b- it need ttt by antibiotic and anti viral c- contraindicated to give corticosteroid d- usually about 25 % of the cases has permanent affection 354-2 month infant with white plenched papules in the face what to do: _ reassurance _ topical steroids _ abx 355- Recurrent watery discharge of eye, pain, sensitivity to light..on exam.> inflammation,ulceration of eye..cause: _ dust&pollens _u/v light _ stress _ night accommodation 356- Patient with ARDS on ventilation developed pnemothorax..cause: _ -ve pressure ventilation _ central line _ 100% O2 357- Lactational mastitis..Rx: _ doxycycline _ ciprofloxacin _ ceftriaxon _ gentamyecin _ cephalexin 358- OCP that causes hyperkalemia: cant remember the choices. drospirenone 359- All are 1ry prevention of anemia except: _ health education about food rish in iron _ iron fortified food in childhood _ limitation of cow milk before 12 month of age _ genetic screening for hereditary anemia?? 360-+ve leichman test: ACL injury 361- Waking up from sleep..cant talk, no fever, can cough, normal vocal cords…Dx: 51

Functional aphonia 362- Patient with CML taking imatinib mesylate and odansetron for nausea and vomiting presented with tachycardia,fever Diphoresis and hyperreflexia… Dx: _ neuroleptic malignant syndrome _ imatinib toxicity _ odansetron toxicity 363- What is the most effective method to prevent the brucellosis infection: a- Treat the infected people b- Immunize the farmers & those who deal with the animals c- Get rid of all the infected animals d- Pastralization of the diary products ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ 364- PTS with history of infertility the first line of investigation for this couple is >>> semen analysis 365- PTS with depression manifestations , what is the mechanism of the drug that you will prescribe >>>> increase availability of serotonin 366- women 52 year complaint of hot flush , dry vagina, loss of libido , loss of concentration , wt gain since hot flush , affect marital state >>>> estrogen Progesterone fluxatine _________________________________________________________________________ ___________________________ 367- Old pts with history of bilateral pain and crepitation of both knee for years now come with acute RT knee swelling , on examination you find that there is edema over dorsum and tibia of RT leg ,what is the best investigation for this condition >>>> Rt limb venogram 368- Standard deviations >>  Measure central tendency or variability  Measure extreme value  Measure validity 369- PTS 18 yrs , you prescribe for him retinoid gel will counsel him for >>>>> make your skin sensitive for sun light 52

370- What is the name of questionnaire that differentiate b/w primary and sleep apnea.??????? 371- Post partum female with recurrent attack of hearing loss , which diagnosed as conductive hearing loss , on CT the is dehesion in the of semi circular canal diagnosis >>>> otosclerosis miner's Tuberus sclerosis 372-most important investigation to diagnose maxillary sinusitis: CT Xray 373-child with bleeding from nose ,history no evidence of clotting abnormalty ,vitally stable .on eaxamination slow bleeding from posterior septum whats your action: do clotting study spray vasoconstrictive agents. 374- Child with posing head , bowing tibia ,,,, rickets ,,, what is the deficiency >>> vit D deficiency. 375-80 year old man complain of sever itching mainly in the wrist and b/w fingers , with excoriation mark linear and superimposed by secondary infection disturbing sleep, the pts newly finish 10 days course of Antibiotics >>>>>> Monilia eczema icythiosis _________________________________________________________________________ ___________________________ 376- Live guard come to annual examination , no compliant , macular dicloration, painless over the face , thers is history for exposure unproductive to sun rays >>>>> Sqamous cell carcinoma 377- Community problem of multiple chlymedia infection in the eye , best prevention method is >>>> good water and good sanitation supply 378- Which IS considered abnormal & indicate fetal distress<<< late deceleration 379- What is the vector for leshmania disease <<<< sand fly 53

380- Child with URTI then complained from ear pain on examination there is hyperemia of TM &+ve insufflations test he tri 2 drug no benefit what is the bestTTT>>> agmentine azythromycin ciprofloxacin steroid 381- Infant in respiratory distress ,hypercapnia , acidosis & have rhinitis , persistent cough +ve aglutenation test & the doctor treat him by ribavirin DX>>> pertusus RSV 382- Aluminum salt & …… salt will decrease absorption of <<<< tetracycline penicillin 383-40 yrs old male com with HX of smoking & alcohol intake for long time complain of painless ulcer ,role out border on the lateral border of the tongue DX<<<<< SCC lukoplakia 384- Old PTNs with osteoporosis TTT for HTN with diuretic that prevent Ca loss complain of severe pain in big toe DX>>>>> thiazide _________________________________________________________________________ ___________________________ 385-Old male come with CHF & pulmonary edema what is the best initial therapy>>>> digoxin frosamide debutamine 386- Patient with HX of URTI & flash of light when he sneeze the cause is>>>> chemical irritation mechanical irritation of retina 387- Adult with HTN what is the most common cause >>>>> renal essential 388- All of the following exaggerate the gastric ulcer except<<<< decrease gastric empty time use of tricyclic antideppresent _________________________________________________________________________ ___________________________ 389- Sever pain in anatomical snaph box >>>>> 54

scavoid fracture _________________________________________________________________________ ___________________________ 390-Child come to ER after ingestion of multiple iron tablet of his relative &iron conc. In blood 700ml???? what is the best intervention>>> gastric lavage charcoal oil iv defrroxamin 391-Patient with lacremation ,salivation, diarrhea, what is antidote<<<< atropine pralodexam 392- Child with recurrent UTI how to counsel him>>> increase fluid intake 393- group of patient with lung cancer divided In tow group disease &control>>> case control study 394- Gouty arthritis -ve pirfringes crystal what is the mechanism>>>> deposition of uric acid crystal in synovial fluid due to over saturation 395- Patient have of urethritis now com with lt knee urethral swap +ve puss cell but –ve for N.M, chlymedia>>>> RA riters disease gonococcal 396-Pulled Elbow scenario the TTT>>> immediate reduction supination 397- Which of the following indicate benign thyroid lesion>>>> lymphadenitis _________________________________________________________________________ ___________________________ 398- Young female, k/c of vitligo, came to the clinic with hx of hair loss, on exam you found an area of4 cm devoid from hair, but the skin is normal no redness or any abnormality in this area except hair loss, what does she has: a- Alopecia totalis b- Alopecia areata 399- Young female came to your clinic complaining of skin rash involving the whole body including the palms & soles after unprotected sexual hx, what is your DX: Secondary syphilis 55

400- Old man came to you with hx of anal pain, spastic in nature associated with diaphoresis, tachycardia, which last for a few min. bothering him more in the night, what does he has: a- Thrombosis of external hemorrhoid b- Goy syndrome c- Proctalgia fugax _________________________________________________________________________ ___________________________ 401- Female came with hx of sever abdominal pain, vaginal bleeding for 6 hours, amenorrhea for 8 wk, , O/E tachycardiac, hypertensive, tense abdomen. what is the most likely site of the ectopic pregnancy: a- Fallopian tube b- Ovary c- Peritoneum d- Fimbria 402- Young pt was operated 1 year ago for small bowel perforation, presented with hx of vomiting, constipation, abdominal distention, colicky pain, what will be the appropriate investigation you will choose: a- Barium swallow b- Barium enema c- Barium follow through d- Double contrast study 403- Male came with hx of acute onset of knee pain with swelling, what will be the most important investigation to do: a- Arthrocentasis b- Full CBC c- Joint US d- ???? 404- Long scenario about child has sore throat & the culture showed group A strepto, then he develop coca-colored urine, periorbital edema, and headache what is the single most specific test to diagnose him with post-strept acute GN: a- BP more than 95% of normal b- +ve strepto enzyme c- Low C3 d- High creatine & urea (the question is not new but here are the full choices) 405- Regarding case-control study which is true: a- The number of control should be equal to the number of diseased b- It is forward study to the risk factor c- It is backward study to the risk factor 56

406- Young pt came with hx of acute painful swelling of the first metatarsophalangeal joint, redness, tenderness, fever 38c, what is the etiology: a- Staph aureus b- Sodium urate deposition c- Pyro phosphate calcium deposition _________________________________________________________________________ ___________________________ 407- Child with barking cough dx to have croup, what is the causative organism : a- Parainflunza 408- Long scenario about 5 year old child otherwise healthy has cough, fever, chest x ray shows infiltration of the middle & lower Rt lob, after 24 hour of receiving cefotaxime he develop complete Rt lung opasifcation, what is the most likely causative organism: a- Staph aureus b- Strepto, pneumonea c- Hib d- Pseudomonas argenosa In another word : child pt. came with scenario of chest infection , first day of admission he treated with cefotaxime , next day , pt state became bad with decrease perfusion and x-ray show complete rt. Side opcifaction + hydrothorax , causative organism : Strepto. Pnem Staph. Aureus true if pnumothorax Hemophilus influenza type b Pseudomonas -child presented to ER with SOB on x-ray there is filtration on mid & lower zone on RT side after 24h of antibiotic pts become cyanosis the x-ray total lung collapse with medastinal shift what cause? H-influenza -pneummocystic carnia -streptoccouse pneumona 409- Regarding face suture, when should you remove it: a- After 3-5 days b- After 7-10 days (my answer) c- Only absorbable suture should be used 410- Pt with dysmenorria, infertility, not responding to naproxen, what cauld be the cause: 57

a- Endometritis b- Endometriosis 411- Pt complain of central lower back pain when he wake up at the morning, stay for 30 min without medication, with slight improvement brought by NSAID, investigation shows lumber spinal stenosis, and O/E we just found Para spinal muscle spasm, otherwise normal, what will you do: a- Physical therapy b- Steroid injection c- Surgery 412- Pt had hx of trauma to his nose 2 days ago, he came with hx of nasal obstruction & pain, O/E he has bilateral swelling (septal hematoma), what will you do: a- I &D b- Antibiotic 413- pregnant woman with past hx of DVT, what will you do for her: a- warfarin b- heparin c- enoxaparin d- no anticoagulant need e- aspirin 414- pt post cardiac arrest, poor tissue perfusion, inadequate ventilation, ABG shows low PH, normal pCO2, low HCO3, what is the explanation: a- Resp. acidosis b- Resp. alkalosis c- Metabolic acidosis d- Met. Alkalosis ____________________________________________________________ _______________________ 415-Long scenario about Pt with hyperkalemia 7.5, what will be your FIRST action: a- IV calcium gluconate b-IV HCO3 416- Treatment of recurrent otitis media after multiple Abx course, with bulging tympanic membrane: a- Amoxicillin b- Amoxicillin & clavulanic acid c- Tazocin d- IV ???? 417- What is the serious sign in pregnancy: a- Abdominal pain b- Back pain c- Leg swelling 58

d-Hyperacidity 418- Pt came to ER with his hand vist in the mid of his chest, what is the most likely Dx: a- Ischemic heart disease b- Esophageal spasm c- Pneumonia 419- After head trauma, the pt start to have disinhiption, agitation, and restlessness what is the affected lob: a- Prefrontal area b- Temporal area c- Occipital area d- Parietal area 420- Which of the following suggestive of ovarian cyst rather than ascites in percussion:

a- Dullness centrally & tympanic peripherally b- Dullness peripherally &tympanic centrally c­ Dullness all over d- Fluid wave e-Decrease bowel motion i) Shifting dullness 421- Q about sub dermal implantable contraception: a- Is has low compliance compared to OCP b- More side effect c- No local reaction

422-Pt presented with multiple attacks of palpitation, chest pain, numbness & tingling of the upper limbs & fearing from dying, no abnormality detected by physical examination. What is the Dx: Thyrotoxicosis Panic attacks Agoraphobia Peochromocytoma a 28 yrs. old lady , C/O: chest pain, breathlessness and feeling that she'll die soon .. O/E : just slight tachycardia .. otherwise unremarkable .. the most likely diagnosis is: a- panic disorder 59

423- which of the following medication is safe during lactation: Tetracycline Chloramphenicol Erythromycin 424- small child presented to ER with hx of sudden onset of groin mass, painful, associated with vomiting, nausea, O/E groin mass tender, scrotal swelling with multiple bleeding dots, cremastric reflex is preserve, what is your dx: a-Testicular torsion b- torsion of appendix testis c-scrotal hematoma e-incarcerated hernia. 425- what is true about marasmus disease: a- In contract to kwashorcoir, it affect the low socioeconomic stat b- It is due to late weaning c- It leads to growth retardation & wt loss ______________________________________________________________________ ___________________________ 426- picture of pt with htperpigmentation of the axilla, under the flourcene wood's light it become pink what is the dx: a- Fungal infection b- Erthrasma c- Acanthosis nigricans d- ?????? (picture in kumar) 427- the most common cause of 2dry amenorrhea with high FSH & LH is: a- Menopause b- Pituitary adenoma c- Pregnancy d- ??????? a- 428-????? 428- female G3P3 post-partum 4wk treated for 3days with antibiotic ( I forget it) for PID but no response & she still febrial , O/E by PV you found a 10cm mass in the sac between the vagina & the rectum, tender, fluctuating what will be your action: a- Colpotomy b- Laparotomy c- Laparoscopy d- D/C antibiotic & start another one 429- pt with hyperthyroidism ask you regarding the long term complication of her disease, what will you do: a- Bone density scan 60

b- Brain CT scan c- ECG d-Echo 430- pt with hypothyroidism, you start her on the levothyroxine, then she came for follow up you found her TSH is high, what will you do: a- Reduce the thyroxin and follow her after 6 months b- Reduce the thyroxin and follow her after 2 months c- Continue the same dose & follow up after 2 months d- Stop the dose till the TSH become normal and follow up after 2 months 431- picture of large cervical lymph node, O/E multiple enlarged lymph node, matted, non tendr, no skin changes, what is the dx: a- TB lymphadenitis b- Metastatic tumor c- Lymphoma d- Infectious mononucleosis 432- pt fall from 10 stairs, he develop nasal swelling, tenderness, skull Xray shows non displaced fracture of the nasal bone, what will you do: a- Refer to the surgeon immediately. b- Do brain CT scan c- Reassure him 433- long scenario about pt with GERD responding partially to PPI, endoscopy biopsy shows barret esophagus with mild severity, what will be your action: a- Esophagus resection. b- Fundoplication c- Increase the dose of PPI 434- child came with hx of one attack of tonic-clonic convulsion, & his mother said that he has multiple attacks of febrile convulsion, what will give her if her child develop another attack at home: Phenytoin Diazepam Clonazepam Phenol barb. 435--- 35 year old smoker , on examination shown white patch on the tongue, management: ‫ حالت‬leucoplakia a. Antibiotics b. No ttt c. Close observation d- excision biopsy ( may answer ) the choice is not in alqasem question 436-male singer with colon cancer stage B2 ; which of the following correct ? 61

a- no lymph node metastases b-one lymph node metastasis c-2 === d-lymph node metastasis + distant metastasis 437--child swallowing battery in the esophagus management : (the choices are complete) -bronchoscope - insert fly catheter - observation 12hrs Remove by endoscope 438-young male patient present to ER due to RTA with poly trauma ; the beast way to maintains airway in responsive poly trauma patient is ; A-orophargenial airway b-nasophargenial airway c-trachastomy d-endotracheacheal intubations 439- Young patient with congested nose, sinus pressure, tenderness and green nasal discharge, has been treated three times with broad spectrum antibiotics previously, what is your action? (chronic sinusitis) a) Give antibiotic b) Nasal corticosteroid c) Give anti histamine d) Decongestant e)observation 440-long case patient with RTA with Blount trauma to abdomen . patient undergo remove of distal small intestine and proximal colon , patient come after 6 month with chronic diarrhea , SOB , sign of anemia , CBC show megaloblastic anemia What the cause of anemia : A-folic acid deficiency b-vit B12 deficency c-alcohol 441- case infant has genital rash ( the rash spares genital fold ) not response to antibiotics , most likely Dx; A-candida albicans b-napkin dermitis c-contact dermatitis d- atobic dermatitis e- sebborich dermatitis

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442--long senior patient came with chest pain , burning in character , retrsternal , increase when lying down , increase after eating hot food , clinical examination normal DX ‫ السيناريو رايح مع‬GERD a-MI b-peptic ulcer c-GERD d443- about fetal alcohol syndrome (read about) 444- the beast way to ttt pinged induce nervosa ( ‫ ممكن يقصد‬bullima nervosa ) a-interpersonal psychotherapy b-cognitive behavior therapy c-pharmacotherapy d445- old female came with scales aroud the areola ,she took steroid but no benefit on examination normal and no masses what is your next step? A-Antibiotics B-anti-fungal C- Mammography 446- patient come with diarrhea , confusion , muscle weakness he suffer from which ? (hyponatremia)?? A-hypokalemia B-hyperkalemia c-hypercalcemia 447- Patient come with jundice , three days after the color of jundice change to greenish what is the cause? oxidation of bilirubin 448- Patient with Rhumatoid Arthritis he did an X-Ray for his fingers and show permanant lesion that may lead to premnant dysfunction , what is the underlying process? substance the secreted by synovial 449- prevention of lyme disease , what is best advice to parents insect repellents prevention of Lyme disease : Treat early disease with doxycycline , Prevent with tick bite avoidance  Light-colored clothing makes the tick more easily visible before it attaches itself. People should use special care in handling and 63

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allowing outdoor pets inside homes because they can bring ticks into the house. A more effective, communitywide method of preventing Lyme disease is to reduce the numbers of primary hosts on which the deer tick depends, such as rodents, other small mammals, and deer. Reduction of the deer population may over time help break the reproductive cycle of the deer ticks and their ability to flourish in suburban and rural areas. Backyard patios, decks, and grassy areas that are mowed regularly are unlikely to have ticks present. This may be because of the lack of cover for mice from owls and other raptors that prey on mice. The ticks also need moisture, which these areas do not provide. -The areas around ornamental plantings and gardens are more hospitable for mice and ticks. The highest concentration of ticks is found in wooded areas. Individuals should try to prevent ticks from getting onto skin and crawling to preferred areas. Long hair should be worn under a hat. Wearing long-sleeved shirts and tucking long pants into socks is recommended. Guineafowl

450--30-40 year male suffer from tenitus , vertigo , sensorconductal hear loss diagnosis is Miner's disease 451--patient 20 year old come with palptations ECG show narrow QRS complexes and pluse is 300 bpm what is the true Amidarone 452-40 years female complaining of thinking a lot in his children future, she is alert, anxious, cant sleep properly, poor appetite, she always make sure that doors in her home are closed, in spite of doors already closed, provotional Dx: OCD, GAD Schizo 453-Long scenario of restless leg syndrome(he didn’t mention Dx in scenario), 85 old male many times awake from his sleep bcz leg pain, 64

this pain relieved by just if he move his foot, but it recure, at rest,…best management: Colazpin Haloperidol lorazepam, one drug from dopamine agonist group forgot its name, it’s the right answer. Bromocriptin,opomorphine,cobegoline 454-best drug for von willbrand disease is: fresh frozen plasma cryoprecipitate steroids (he didn’t mention vasopressin in choices) 455- Best fast management of acute hyperCalcemia is: Iv fluid frusamide dialysis 456- Null hypothesis definition 457- Long scenario of a pt with melanoma in back, he is afraid of malignat change, which one of the following indicate malignant melanoma: >6mm, irregular and invade the skin,… 458- Best inv to visualize the cystic breast masses is: MRI CT Mammogram, US 459-Female pt new diagnosed as HTN pt, BMI 28, U sld advise her by: Body wight reduction ALONE doesn’t benefit her HTN wt reduction and exercise may benefit him,… salt restriction well help to reduce the BP 460- Long scenario for pt smokes for 35 y with 2 packets daily, before 3 days develop cough with yellow sputum, since 3 hours became blood tinged sputum, X ray show opacification and filtration of rt hemithorax, DX: Bronchogenic CA 65

acute bronchitis lobar pneumonia 461-Pt with hypercholestrelemia, he should avoid: Organ meat Avocado Chicken white egg 462-5 y child diagnosed as UTI, best inv to exclude UTI comp: Kidney US CT MCUG IVU 463-6 y old boy, eat the paper and soil, best initial ttt is: Fluoxetine behavioral therapy,…. 464-Baby said baba mama, pincer grasp, creeping well, sitting wth support, estimate age: 6m 7m 8m 10m 465- Drug of choice for a schistosomaisis is: Praziquanetilo xaminiquine, artemether 466-50 YEARS OLD FEMAL HAS HYPERTENSION ,COMPLAINING OF RIGHT EYE PAIN ,HEADACH,FLUSHES LIGHT ,FLOTERS,SHE DID NOT TAKE HER MEDICATIN TWO WEEKS BACK THE BLOOD PRESSURE IS 140\90 ,ON EXAMINATION NON DAILATED PUPLE REACTIVE ,NO DECREASE EYE VISION ,THERE IS CUPPING AND SLIGHT ARTERIOVENOUS NIPPING WHAT IS YUOER MANAGEMENT: A)REFERAL TO OPTHALMO B)REASSURANCE AND TELL HER YOUR PROBLEM BENINGN C)GIVE BEXOLO EYE DROPS D)TREAT HER AS MIGREN HEADACH _________________________________________________________________________ _ 467-55 ys old male pt, presented with just mild hoarsness, on exam, there was a mid cervical mass, best inv is: Indirect laryngioscopy?? 66

CT brain CT neck Biopsy aspiration _________________________________________________________________________ ____ 468-4 years old child, was diagnosed as SCD,so many times came to hospitals with, dyspnia, dactylites , ( he put sign of acute crises ), the best strategy for prolonged therapy is: IV hydration fluids with analgesia follow in Out pt clinic refer to tertiary haem center. 469- Long scenario for a pt came to ER after RTA, splenic rupture was clear, accurate sentences describe long term management: We give pneumococcal vaccine for high risky people just, we sld give ABs prophylaxis if there Hx of contact even with vaccination against pneumococcal, pneumoccal vaccine should not be given at same time with MMR 470- Female pregnant, 32weeks of gestational age, diabetic, and she has a Hx of full term fetal demise, but her DM now well controlled, and BPP show no fetal distress,best management: Wait for SVD report a CS in 36 weeks Teminate pregnancy 471- Triad of heart block, uveites and sacroileatis,Dx: Ankylosing spondylites, lumbar stenosis, multiple myeloma 472-72 years old Man with loss of vision in one eye , jaw claudication : Temporal arteritis . 473-GDM with diagnostic GGT what will u do: -repeat GTT -diet -start with monotherapy -insulin then change to monotherapy -insulin test ____________________________________________________________________ 474- Lt sternal border murmur,ejection systolic, but not radiation to carotid: 67

>AS > PS . 475-commenst cause of failure to thrive: psychosocial?? allergy to milk and protein 476-child with umblical hernia: -sponteneous recovery before school age(: 90% disappear spontaneously during the first 5 years of life ____________________________________________________________________ 477-commenst cause of hearing loss in children: -chronic otitis media -dysfunction eschian tube -antenatal causes. 478-child with meningitis symptoms and no nuchal rigidty ,whats the next diagnostic investigation: CSF

479-patient given 3 liter 10% dextrose then started to develop confusion and leg cramps: hyperkalemia hypokalemia hypernatremia 480-table shows only hyponatremia and low plasma osmolality with normal urine osmolality : _inappropriate secretion of ADH -cushing syndrome -addison 481-german measles cause what: 482-man had gun shot to left lung with decrease breath sound, what well u do : -2nd midclavicular needle. -5th midaxillary needle -5th midaxillary tube. -ab. 483-> How did we differentiate between snoring and sleep apnea ? I think !!!!! Read about Sleep study chart ! > Michegan chart . My answer 68

> Different names of chart -_-" ____________________________________________________________________ 484-> Pt K/C of crohns , present with hip and Back pain , normal Ab Ex and hip ROM , what to do next : > Hip CT > Ab US > IVP > Abdominal CT > Renal US ____________________________________________________________________ 485- Patient with around Rt eye pain with tearing and headache , lid swelling , Dx : > Migrane with aura > Tension headache > Cluster headache . > Glucoma ----------------------------------------------------------------------------486- Recurrent swelling in the natal cleft with skin tract and recurrence , Dx : > Hydrandinitis suuporitiva . > Frunclosis . > F..dermatic 487-> Recently diagnosed with DM type II , 32 years old , exercise for 8 weeks and BMI changed from 32 to 31 .. Labs shown on table ? But no table !!!!! > Continue exercise . My answer 69

> Start medication 488-74-year old female patient of Cushings syndrome, had hip fracture falling off stool, what will you screen for while also treating her fracture: Hyperparathyroidism Osteomyelitis Osteoporosis Osteomalacia 489-Very long scenario about middle age man (50 years) with family history of heart disease, active lifestyle, on self induced diet with 50% fat, 35% protein and 15 % carbohydrates, table showing labs, elevated LDL, low HDL, elevated triglycerides and cholesterol, normal RFTs and all other labs. No risk of heart disease Heart disease risk can be avoided by taking statins Heart disease can be prevented by decreasing calorie intake 490-18 month old patient, parents were treating baby for flu-like illness with fever with increased water intake at home, patient developed generalized tonic-clonic convulsions, presented to you after 1 hour with (description of post-ictal stage). Now baby becomes fully conscious. What is the next most appropriate step? rapid sponging to reduce fever Give acetaminophen and antipyretics Treat fever, Get MRI done and treat after result 491-9. Middle aged female patient with history of Stage 2 breast cancer treated successfully, now presents with moderate to severe pain in left leg, not relieved by lying down, pain on extension of leg and walking, O/E Tender region in L3-L4 lower back. No Physical sign of cancer recurrence. Last saw oncologist 2 years back. What is most appropriate scenario: Refer to oncologist Do DEXA Scan Do MRI Hospitalize and do neurology and oncology consultations 492-11. Baby present with weeping, shiny and crusting lesions around mouth : Impetigo 493-Male patient was advised to undergo Arterial Graft Bypass surgery at other clinic after having episode of pain in leg, now is asymptomatic. Came to you, Non-smoker, elevated cholesterol and early atherosclerotic plaques on some descending aortal branches. What will you advise: Undergo Bypass Grafting Take medication to prevent formation of Arterial plaques 70

a. b. c. d.

To undergo frequent arterial scans to see extent of disease. 494­1st line class of drugs against Post partum hemorrhage: Uterine Contractile Uterine Relaxant 495­Patient recovering from Viral Gastroenteritis, vomiting and diarrhea abated but still having Anorexia. What will you advise: Bananas Rice cereal and apple juice Chopped pears yougurt and . Granola, . 496­Patient with idiopathic anovulation. What drug to give: Clomiphene Progesteron LH FSH 497­Description of PCOS. Mechanism of PCOS: Androgen Excess 498­Prostitute with multiple sex partners presents with history of painless vaginal sore which healed and did not leave scar. O/E has generalized lymphadenopathy. What is your diagnosis: Syphilis _________________________________________________________________________ _ 499­Female patient with wide-open eyes, tremors in hands that do not diminish with intention, What investigation will you do: 1 Pituitary Scan 2 T4 Levels 500­Middle age patient alcoholic with H/O fullness in epigastric region and mild pain, History of nausea and vomiting. Labs: Increased Serum Amylase, Diagnosis: Pancreatic Pseudocyst Pancreatic Cystadenoma Choledochal Cyst Liver Cirrhosis 501­Which one of these patients with pneumonia will you treat as outdoor patient: 80 Year old with 104 F temperature, BR 24/min PR 126/min, BP 180/110 60 year old with 102 F temperature BR 22/min PR 124/min, BP 160/110 50 year old with 98 F temperature, BR 20/min. HR 110/min, BP 180/110 80 year old with 96 F temperature, BR 18/min, HR 70/min, BP 110/80 http://pda.ahrq.gov/clinic/psi/psicalc.asp 71

3. 4. 5. 6.

according to pneumonia severty index calculator (class IV and V need hospitalization class III depend on clinical judgment) the high blood pressure is not involved in calculation. a-classIII B-classII c-class I D-class III 502-Long scenario of 28 year old male patient with symptoms of Ulcerative Colitis+ anemia related to UC. Sigmoidoscopy revelaed multiple polyps, Biopsy of polyps Carcinoma in situ. What is the most definitive therapy that will be effective in the long-term: Correct Anemia Left hemicolectomy and Colostomy Total Colectomy and Ilectomy Removal of all polyps by Colonoscopy 503­Female patient came with hypertension, azootemia and GFR of 44. What is her condition due to: a. Pheochromocytoma b.Renal artery stenosis c.Renal Parenchymal Disease (pheochromocytoma is excluded from the scenario renal artery stenosis :1- Significant functional impairment of autoregulation, leading to a decrease in the GFR, is not likely to be observed until arterial luminal narrowing exceeds 50% 2-Patients with documented or possible renovascular hypertension may experience progressive azotemia as a consequence of the renal ischemia and/or the persistence of significant hypertension. 3-Refractory hypertension (ie, poor control of blood pressure despite treatment with 3 or more antihypertensive agents) may occur. (emedicine)

renal parenchymal disease: 1- present with HTN. 2-the GFR OF 44>>>means chronic kidney disease stage 3 0) Normal kidney function – GFR above 90mL/min/1.73m 2 and no proteinuria 1) CKD1 – GFR above 90mL/min/1.73m2 with evidence of kidney damage 2) CKD2 (Mild) – GFR of 60 to 89 mL/min/1.73m2 with evidence of kidney damage 3) CKD3 (Moderate) – GFR of 30 to 59 mL/min/1.73m 2 4) CKD4 (Severe) – GFR of 15 to 29 mL/min/1.73m 2 5) CKD5 Kidney failure - GFR less than 15 mL/min/1.73m 2 Some people add CKD5D for those stage 5 patients requiring dialysis; many patients in CKD5 are not yet on dialysis

504- Patient comes with attack of Strep Throat, had history of previous attack(RF), what is his chance of getting RHD now? Nothing, he is immune due to previous infection. 72

100% Needs Immunoglobulin to prevent re-infection. 50% chance of re-infection. In the United States, rheumatic fever rarely develops before age 3 or after age 40 and is much less common than in developing countries, probably because antibiotics are widely used to treat streptococcal infections at an early stage. However, the incidence of rheumatic fever sometimes rises and falls in a particular area for unknown reasons. Overcrowded living conditions seem to increase the risk of rheumatic fever, and heredity seems to play a part. In the United States, a child who has a streptococcal throat infection but is not treated has only a 0.4 to 3% chance of developing rheumatic fever. About half of the children who have had rheumatic fever develop it again after another streptococcal throat infection if it is not treated. Rheumatic fever follows streptococcal infections of the throat but not those of the skin (impetigo) or other areas of the body. The reasons are not known.

http://www.merckmanuals.com/home/childrens_health_issues/bacte rial_infections_in_infants_and_children/rheumatic_fever.html 505-pediatric patient from developing country presented with muscle wasting, weight loss and absent edema. What is the diagnosis: 1 Marasmus 2 Kwashiorkor 3 Muscle wasting syndrome Marasmus:1-present of muscle wasting 2-body weight less than 80%of average weight. 3-absence of edema 4-increase prior to age 1 kwashiorkor: 1-presence of edema 2-increase in >18month muscle wasting syndrome:1-loss of weight. 2-muscle atrophy. 3-in older pt with chronic disease. (ref. wikepidia) The most suitable answer is :marasmus 506-Patient with decreased vision, also peripheral vision decreased, using tonometer pressure in right eye 24 mm and left eye 22 m. What is the mechanism: a.Obstruction in trabecular meshwork and ciliary muscle leads to pupillary blockage and drainage of aqueous humor. b.Obstruction at ciliary muscle leads to blockage in drainage of Aqueous Humor. In cases where POAG is associated with increased IOP, the cause for the elevated IOP generally is accepted to be decreased facility of aqueous outflow through the trabecular meshwork. Occurrence of this increase in resistance to flow has been suggested by multiple theories 73

http://emedicine.medscape.com/article/1206147-overview#a0104 507-Picture of optic disc. (Looks like this: http://www.revophth.com/content/d/cover_focus/i/1315/c/25316/) What does it show? a. Normal disc b. Cupping of optic disc 508- Picture of Patients legs (calves) showing maculopapular rash. H/O red rah appearing on extensor surfaces. Rash is tender to palpate but does not blanch on pressure. What is the diagnosis: 4 Henoch-Schnolein Purpura 5 Polyarteritis nodusa Henoch-Schoenlein purpura begins with a symmetrical erythematous macular rash on the lower extremities that quickly evolves into purpura. The rash may initially be confined to malleolar skin but usually extends to the dorsal surface of the legs, the buttocks, and the ulnar side of the arms. Within 12-24 hours, the macules evolve into purpuric lesions that are dusky red and have a diameter of 0.5-2 cm. The lesions may coalesce into larger plaques that resemble ecchymoses. Several cases of Henoch-Schoenlein purpura have been observed after varicella infections.

6 (emedicine) ______________________________________________________________________ 509- Female patient comes with history of periorbital swelling, itching all over body, O/E there is lymphadenopathy. Liver and spleen are enlarged. What is the diagnosis? a.Urticarial b.Angioedema c.Lymphoma?? 510- Picture of base of mouth showing a white patch with sharplydemarcated edges. Patient is male, long- term smoker and chews tobacco, presents with painless lesion in mouth. What is the next most important step: Topical Fluconazole Biopsy Wide surgical excision Diagnosis is :leukoplakia: 1-painless white plaque 2-associated with smoking 3- on the mucous membranes of the oral cavity, including the tongue, but also other areas of the gastro-intestinal tract, urinary tract and the genitals. 4-Tobacco, either smoked or chewed, is considered to be the main culprit in its development 5-5% to 25% of leukoplakias are premalignant lesions; therefore, all leukoplakias should be treated as premalignant lesions by dentists and physicians - they require histologic evaluation or biopsy (ref. wikepidia)

511- What drug is likely to cause heat-stroke as it inhibits sweating : 74

Orphanedrine Hyoscamine Sulfate

Hyoscamine sulfate Warnings: In the presence of high environmental temperature, heat prostration can occur with drug use (fever and heat stroke due to decreased sweating) http://www.drugs.com/pro/hyoscyamine-sulfate-elixir.html other drugs: Anticholinergics Cogentin and Artane are examples of anticholinergic drugs. They are both used in the treatment of  Parkison's disease. Medscape.com suggests that anticholinergic medications are involved in the  development of heat stroke. These drugs inhibit the body's sweating mechanism, leading to inadequate  heat elimination. Thermal Analyzer Leaders In Analytical Instruments Contact Us For Quality Products. www.Scinco.com Sponsored Links Neuroleptics Neuroleptic drugs are also known as antipsychotic medications. They are used to treat mental health  problems like schizophrenia and bipolar disorder. Some drugs in this class of psychiatric medications are  Haldol, Prolixin and Thorazine. According to "Goldfrank's Toxicologic Emergencies," antipsychotic drugs inhibit the body's normal response to heat. They reduce the body's ability to increase blood supply to the  skin for the purpose of heat elimination. Due to this, individuals taking medications from this drug class  may be at risk for heat stroke. Diuretics Robert Wood Johnson University Hospital reports that dehydrated individuals who cannot cannot sweat  enough to cool their body may experience heat stroke because their internal temperature may rise to  dangerously high levels. Diuretics are drugs that put individuals at risk for heat stroke because they  promote dehydration, according to "Irwin and Rippe's Intensive Care Medicine." They work by making  the body eliminate fluids through urine. Furosemide and hydrochlorothiazide are diuretic medications. Sympathomimetics Sympathomimetic drugs, as stated in "Synthesis of Essential Drugs," mimic the actions of the body's  sympathetic nervous system. They increase heart rate, open up the airways and constrict the blood vessels.  Sympathomimetic drugs such as amphetamines, cocaine and ephedrine can lead to heat stroke, because  they constrict the blood vessels and do not permit heat loss through blood vessel dilation. This class of  drugs are also risk factors for heat stroke because they increase the amount of heat produced within the  body 75

Antihypertensives Antihypertensive medications are used to treat high blood pressure and also put individuals at risk for heat  stroke. Examples of drugs in this class are beta­blockers such as propanolol and calcium channel blockers.  These drugs reduce heart rate, the strength with which the heart contracts and the amount of blood pumped out to the body. This leads to decreased blood flow to the skin and a reduction in the body's ability to  eliminate heat.

Read more: http://www.livestrong.com/article/118891-medications-predispose-heatstroke/#ixzz1jMAxCHRd

http://www.livestrong.com/article/118891-medications-predispose-heatstroke/ 512- CT of Brain picture. Scenario: Patient with sudden severe occipital headache came to emergency. Subarachnoid Hemorrhage Intracerberal Hemorrhage Meningitis The classic symptom of subarachnoid hemorrhage is thunderclap headache (a headache described as "like being kicked in the head", [4] or the "worst ever", developing over seconds to minutes). This headache often pulsates towards the occiput (the back of the head).[

(wikepidia)

intracerberal hem.:Patients with intraparenchymal bleeds have symptoms that correspond to the functions controlled by the area of the brain that is damaged by the bleed. [3] Other symptoms include those that indicate a rise in intracranial pressure due to a large mass putting pressure on the brain.[3] Intracerebral hemorrhages are often misdiagnosed as subarachnoid hemorrhages due to the similarity in symptoms and signs. A severe headache followed by vomiting is one of the more common symptoms of intracerebral hemorrhage. Some patients may also go into a coma before the bleed is noticed.

513- Patient with severe pain in forehead, over nose and sides of face, also present are shiny blisters on surface of forehead, face and nose. What is the diagnosis: Post-herpetic neuralgia Varicella Herpes Simplex Herpes Zoster Herpes zoster is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute (short-lived) illness chickenpox which generally occurs in children and young people. Once an episode of chickenpox has resolved, the virus is not eliminated from the body 76

but can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection. Herpes zoster is not the same disease as herpes simplex despite the name similarity (both the varicella zoster virus andherpes simplex virus belong to the same viral subfamily Alphaherpesvirinae). Varicella zoster virus can become latent in the nerve cell bodies and less frequently in nonneuronal satellite cells of dorsal root, cranial nerveor autonomic ganglion,[1] without causing any symptoms.[2] Years or decades after a chickenpox infection, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponding dermatome (an area of skin supplied by one spinal nerve) causing a painful rash.[3][4] Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia. Herpes simplex:1-blisters containing infectious particles. 2-common infection may affect:1-face mouth(orofacial) 2-genitalia(genital herpes) 3hands(heraptic whitlow) 3-can cause herpes keratitis. Varicella: is a highly contagious illness caused by primary infection with varicella zoster virus (VZV).[1] It usually starts withvesicular skin rash mainly on the body and head rather than at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring. Post-herpetic neuralgia: s a neuralgia caused by the varicella zoster virus. Typically, the neuralgia is confined to a dermatomic area of the skin and follows an outbreak of herpes zoster (HZ, commonly known as shingles) in that same dermatomic area. The neuralgia typically begins when the HZ vesicles have crusted over and begun to heal, but it can begin in the absence of HZ, in which case zoster sine herpete is presumed (see Herpes zoster). The most likely answer is herpes zoster.

_____________________________________________________________________ 514­ Patient had fly in his eye. On removal of the foreign object what will he need: 7 Topical corticosteroids 8 Topical Antibiotics 9 Oral corticosteroids 10Oral Antibiotics 11Answered based on the sle studing group couldn’t find a ref. 77

515­ Patient complains of discomfort in the eye. There is no discharge. O/E with dye, a dendritic shaped ulcer is seen on the surface of the cornea. What is the diagnosis: Keratitis Uveitis A corneal ulcer, or ulcerative keratitis, or eyesore is an inflammatory or more seriously, infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma.

a. b. c.

(Wikepidia) ________________________________________________________________ 516- A patient complains of 2  day history of stuck together lashes on waking up. There is muco- purulent discharge. Anterior Chamber, uvea and iris are clear. What is the diagnosis? Bacterial Infection Viral Infection Allergy Bacterial conjunctivitis is usually a benign self-limiting illness, 1 although it can sometimes be serious or signify a severe underlying systemic disease. Occasionally, significant ocular and systemic morbidity may result.2 Epidemiology  This is one of the most common ocular problems seen in the community.3  In adults, bacterial conjunctivitis is less common than viral conjunctivitis; although estimates vary widely, it is thought to account for no more than half of all cases of acute infective conjunctivitis.4  It is most commonly caused by Staphylococcus spp., Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.5  In children, bacterial conjunctivitis is more common than viral and is mainly caused by H. influenzae,S. pneumoniae and M. catarrhalis. Presentation History Relevant aspects of the history include: 

 

Nature of the problem: o Discomfort - burning or gritty but not sharp. o Pain - should be minimal; significant pain suggests a more serious diagnosis. o Vision - usually normal, although 'smearing', particularly on waking, is common. o Discharge - this tends to be thick rather than watery. o Associated symptoms such as photophobia which should be absent or, at most, mild. Significant photophobia suggests severe adenoviral conjunctivitis or some degree of corneal involvement. Contact lens wear: could this be (or lead to) a problem of the (vulnerable) cornea? Time course: onset, duration - where this is chronic, you may have to consider venereal disease in people at a sexually active age. 78

 

Use of over-the-counter medication: could this be a reaction to previously administered drops or ointment? Social aspect - has anybody else had it (family, school, work?) and are there issues about staying at home during the course of the illness?

Findings  'Red eye' with uniform engorgement of all the conjunctival blood vessels.  Bacterial conjunctivitis may often be distinguished from other types of conjunctivitis by the presence of a yellow-white mucopurulent discharge. Eyes may be difficult to open in the morning, glued together by discharge.  There is also usually a papillary reaction (small bumps on the palpebral conjunctiva, appearing like a fine velvety surface). The presence of follicles is more likely to indicate viral conjunctivitis.  Bacterial conjunctivitis is usually bilateral (but often sequential).3  Check visual acuity - this should be normal, other than the mild and temporary blur secondary to the discharge which can be blinked or wiped away. Is this bacterial? It is not always easy to determine whether the patient's simple, acute conjunctivitis is bacterial or not but this is important as it may determine the subsequent management plan. Ultimately, swabbing the eye provides the most accurate diagnostic answer but it is clearly not practical to do this for every patient. A study has shown that, in adult patients, there is a significant chance that the infection is bacterial when there is a combination of: 4  A positive previous history of infectious  An itch present. A mucopurulent discharge ('glue eye').

conjunctivitis.

However, in severe, resistant, atypical cases or in immunosuppressed patients, swabbing for culture and sensitivities is important.3 When patients describe their eyes glued together in the morning, this doesn't necessarily mean that there is a purulent discharge. Viral and allergic conjunctivitis often result in lids that are matted shut in the morning with mucopurulent material. However, these patients actually have crusting of the lashes due to drying of tears and serous secretions, not the wet, sticky, mucopurulent matting characteristic of bacterial conjunctivitis.

http://www.patient.co.uk/doctor/Bacterial-Conjunctivitis.htm _________________________________________________________________________ _ 517-Patient presents with red, peeling rash at back of ears, on limbs and over body. What is the first line treatment? Topical steroid Oral Steroid Oral Antibiotic

The diagnosis:scarlet fever : 79

The cutaneous rash, , lasts for 4-5 days, followed by fine desquamation, one of the most distinctive features of scarlet fever. The desquamation phase begins 7-10 days after resolution of the rash, with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later and can last up to a month or longer. The extent and duration of this phase are directly related to the severity of the eruption. Antibiotic therapy is the treatment of choice for scarlet fever. Penicillin remains the drug of choice (documented cases of penicillin-resistant group A streptococcal infections still do not exist). A first-generation cephalosporin may be an effective alternative, as long as the patient does not have any documented anaphylactic reactions to penicillin. If this is the case, erythromycin may be considered as an alternative.

??518- 50-year old accountant, sedentary lifestyle, BMI 30, takes irregular meals; arteries show signs of early atherosclerotic changes. What will you advise? 12No meds necessary 13Prescribe diet of 600 kcal/day and reevaluate in 4 months 14Prescribe over weight diet and reevaluate in 6 months ??519-Mechanism of Action of drugs that inhibit Conversion of estriol to estrogen. (I forgot the exact question but it mentioned about ovulation and who inhibits conversion of esterone to estrogen?) Options were: a. Aromatase inhibitors?? 520-What drug reverses the effect of Benzodiazepines: a. Flumazanil Flumazenil (Anexate) is a competitive benzodiazepine receptor antagonist that can be used as an antidote for benzodiazepine overdose.

521- pateint C/o ictrus in skin and eye on investigation WBC 2500 plt 70,000 HG 7 lekocytosis 17% total bilirubin 51 and direct bilrubin 12 what is the test most likly positve +ve coomb test In us obstructive billiary duct antiparietal cells antibodies

522-Pts have history of cervical incompetence pregnant at 8w what the management? circulage at 14-16w 523--child presented with anemia he have family history of thalassemia what the most diagnostic test? -measuring of HB A2 -bone marrow -serum feriten 80

524-Fracture of elbow common injury of ?

dial

5-_pts presented with pruritis hepatosplenomegaly lef supraclavicular LN ? Cholinergic pruratis Lymphoma 526- the antipsychotic drug have less pyramidal side effect is ? There was significant optimism when they were first developed and it was thought that they represented a breakthrough in the treatment of schizophrenia due to having less extra-pyramidal side effects at therapeutic doses. The extra-pyramidal side effects has been the one significant set of side effect that has led to poor compliance with antipscyhotic medication. he common atypical antispychotic drugs include risperidone, olanzapine, quetipaine, aripiprazole, zyprasidone, clozapine and amisulpiride.

http://www.understand-schizophrenia.com/atypical-antipsychotics.html 527-_old age presented with vesicular rash on thoracic tell the midline ? Herpes zoster

528--female came with her baby with history of fatigue palpitation and tremor due to? Postpartum anemia Hashimotos thyroiditis ______________________________________________________________________________________ __ a very short scenario)Female come to the clinic with her baby of 6 month , she had tremor and other sign I forgot it, which of the following is most likely dx ... Hashimoto Postpartum thyroiditis hypertyrodism, sub acute tyroditis hypothriodism Postpartum thyroiditis is a phenomenon observed following pregnancy[1] and may involve hyperthyroidism, hypothyroidism or the two sequentially. It affects about 5% of all women within a year after giving birth. The first phase is typically hyperthyroidism. Then, the thyroideither returns to normal or a woman develops hypothyroidism. The initial phase of hyperthyroid symptoms occurs transiently about two to six months postpartum[2]. Typical symptoms include fatigue, irritability, nervousness, palpitations, and heat

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intolerance. Hormonal disturbances during this phase tend to occur with lower intensity compared with the hypothyroid phase[2

529-antidote of acetaminophen: N-acetylcysteine. ??530-_pts with hypertension and cp of aortic dissection what the management ?

531-wich true about hepatoma?(read about it) Is common in female Comes with Chronic liver disease http://emedicine.medscape.com/article/197319-overview 532-The most powerful epidemiologic study is: d. retrospective case control study e. cohort study f. cross-sectional study g. historic time data h. secondary data analysis 533- Evidence base medicine: practice medicine as in the book practice according to the department policy practice according to available scientific evidence practice according to facility practice according to latest publish data 534- Pt had fever in the morning after he went through a surgery (I couldn’t remember the type of surgery). What’s your diagnosis: Atelectasis if 0-2 days) Wound infection DVT UTI Post-operative fever  Days 0 to 2: o Mild fever (T <38 °C) (Common) o Tissue damage and necrosis at operation site o Haematoma o Persistent fever (T >38 °C) o Atelectasis: the collapsed lung may become secondarily infected o Specific infections related to the surgery, e.g. biliary infection post biliary surgery, UTI post-urological surgery o Blood transfusion or drug reaction 82





Days 3-5: o Bronchopneumonia o Sepsis o Wound infection o Drip site infection or phlebitis o Abscess formation, e.g. subphrenic or pelvic, depending on the surgery involved o DVT After 5 days: o Specific complications related to surgery, e.g. bowel anastomosis breakdown, fistula formation o After the first week o Wound infection o Distant sites of infection, e.g. UTI o DVT, pulmonary embolus (PE)

535-23 yrs old female has mobile breast lump in the upper outer quadrant of the left breast. Size= 2 cm and doesn’t change with menstrual cycle. What’s the most likely diagnosis: Fibroadenoma 1-the most common benign breast mass in adolescent 2-easy to move with well defined edges 3-often in upper outer quadrent 4-not affected with menstrual cycle ,the affected with menstrual cycle is cystic breast changes 536- Breast feeding in the full term neonate: a. Increase URTI rate b. No need for vitamin supplementation c. Food introduce at 3 months d. Increase GE rate 537-Which of the following organisms can cause invasion of the intestinal mucosa, regional lymph node and bacteremia: a. Salmonella?? b. Shigella c. E. coli d. Vibrio cholera e. Campylobacter jejeni 538- Pt has saddle nose deformity, complaining of SOB, hemoptysis and hematiuria. The most likely diagnosis is: Wagner’s granulomatosis http://en.wikipedia.org/wiki/Wegener's_granulomatosis 539-OCP: 83

a. Changes the cervical mucus b. increase pre menstrual tension c. Have a failure rate of 3 % b. Combined oral contraceptive pills were developed to prevent ovulation by suppressing the release of gonadotropins. Combined hormonal contraceptives, including COCPs, inhibit follicular development and prevent ovulation as their primary mechanism of action. [5][24][71][72][73] c.

Progestogen negative feedback decreases the pulse frequency of gonadotropin-releasing hormone (GnRH) release by the hypothalamus, which decreases the release of follicle-stimulating hormone (FSH) and greatly decreases the release of luteinizing hormone (LH) by the anterior pituitary. Decreased levels of FSH inhibit follicular development, preventing an increase inestradiol levels. Progestogen negative feedback and the lack of estrogen positive feedback on LH release prevent a mid-cycle LH surge. Inhibition of follicular development and the absence of a LH surge prevent ovulation.[5][24][71]

d. Estrogen was originally included in oral contraceptives for better cycle control (to stabilize the endometrium and thereby reduce the incidence of breakthrough bleeding), but was also found to inhibit follicular development and help prevent ovulation. Estrogen negative feedback on the anterior pituitary greatly decreases the release of FSH, which inhibits follicular development and helps prevent ovulation.[5][24][71] e. A secondary mechanism of action of all progestogen-containing contraceptives is inhibition of sperm penetration through the cervix into the upper genital tract (uterus and fallopian tubes) by decreasing the amount of and increasing the viscosity of the cervical mucus.[73]

(wikipedia) 540-Pt has 2 cm dome shaped mass in the dorsum of his hand. It’s covered by keratin. What’s the most likely diagnosis: Basal cell carcinoma Malignant melanoma Keratoacnathoma KA is that it is dome-shaped, symmetrical, surrounded by a smooth wall of inflamed skin, and capped with keratin scales and debris.(Wikipedia)

541-Pt has hemorrhagic lesion in the mouth and papules in the face and back. He had SOB, fever, cough and mediastinal mass. What’s the diagnosis: a. Kaposi sarcoma b. KS lesions are nodules or blotches that may be red, purple, brown, or black, and are usually papular (i.e., palpable or raised). c.

They are typically found on the skin, but spread elsewhere is common, especially the mouth, gastrointestinal tract and respiratory tract. Growth can range from very slow to explosively fast, and is associated with significant mortality and morbidity.[16]

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d.

[edit]Skin

e. Commonly affected areas include the lower limbs, back, face, mouth, and genitalia. The lesions are usually as described above, but may occasionally be plaque-like (often on the soles of the feet) or even involved in skin breakdown with resulting fungating lesions. Associated swelling may be from either local inflammation or lymphoedema (obstruction of local lymphatic vessels by the lesion). Skin lesions may be quite disfiguring for the sufferer, and a cause of much psychosocial pathology.

f.

[edit]Mouth

g. h.

Intraoral AIDS-associated Kaposi sarcoma with an overlying candidiasisinfection

i.

Is involved in about 30%, and is the initial site in 15% of AIDS-related KS. In the mouth, the hard palate is most frequently affected, followed by the gums.[17] Lesions in the mouth may be easily damaged by chewing and bleed or suffer secondary infection, and even interfere with eating or speaking.

j.

[edit]Gastrointestinal

k.

Involvement can be common in those with transplant-related or AIDS-related KS, and it may occur in the absence of skin involvement. The gastrointestinal lesions may be silent or cause weight loss, pain, nausea/vomiting, diarrhea, bleeding (either vomiting blood or passing it with bowel motions), malabsorption, or intestinal obstruction.[18]

l.

[edit]Respiratory

tract

tract

m. Involvement of the airway can present with shortness of breath, fever, cough, hemoptysis (coughing up blood), or chest pain, or as an incidental finding on chest x-ray.[19] The diagnosis is usually confirmed by bronchoscopy when the lesions are directly seen, and often biopsied

(wikipedia) 542-In the neck, esophagus is: Posterior to the trachea Anterior to the trachea Posterior to vertebral column 543-High risk factor in CLL : Age Smoking History of breast ca History of radiation Factors that may increase the risk of chronic lymphocytic leukemia include:

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

Your age. Most people diagnosed with chronic lymphocytic leukemia are over 60.



Your sex. Men are more likely than are women to develop chronic lymphocytic leukemia.



Your race. Whites are more likely to develop chronic lymphocytic leukemia than are people of other races.



Family history of blood and bone marrow cancers. A family history of chronic lymphocytic leukemia or other blood and bone marrow cancers may increase your risk.



Exposure to chemicals. Certain herbicides and insecticides, including Agent Orange used during the Vietnam War, have been linked to an increased risk of chronic lymphocytic leukemia.

http://www.mayoclinic.com/health/chronic-lymphocyticleukemia/DS00565/DSECTION=risk-factors There are no other proven risk factors for CLL. The risk of getting CLL does not seem to be affected by smoking, diet, exposure to radiation, or infections.

http://www.cancer.org/Cancer/LeukemiaChronicLymphocyticCLL/DetailedGuide/leukemia-chronic-lymphocytic-riskfactors 544-Which of the following medications is considered as HMG-CoA reductase inhibitor: Simvastatin Fibrate All statins act by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A HMG-CoA reductase, the rate-limiting enzyme of the HMG-CoA reductase pathway, the metabolic pathway responsible for the endogenous production of cholesterol.

______________________________________________________ _ 545- Burn involved 3 layers of the skin called: Partial thickness Full thickness(entire dermis) Superficial Deep __________________________________________________________________ 546-Cherry red skin found in: a. Polycythema b. CO poisoning http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)79807X/fulltext _________________________________________________________ 547- Most serious symptom of CO poisoning is: Hypotension Arrhythmia Cyanosis 86

Seizure 548-Patient with subconjuctival hemorrhage. What you will do for him: Reassurance sure 100% Send him to the ophthalmologist 549-Patient with renal transplant, he developed rejection one week post transplantation, what could be the initial presentation of rejection: Hypercoagulability Increase urine out put Fever Anemia Signs and Symptoms of Kidney Rejection Fever over 38°C or 100.4°F Decreased urine output Weight gain over 2 pounds per day Increased blood pressure Pain over kidney

http://www.uihealthcare.com/topics/medicaldepartments/surgery/rejection/in dex.html 550- Pregnant lady in her 30 wks gestation diagnosed as having swine flu. She has high grade fever and cough for 4 days and her RR= 25/min. what will you do for her: Give her Tamiflu 75 mg BID for 5 days Refer her to ER for admission Give her antibiotics Refer her to OBGY doctor 551- Female patient has morning stiffness and pain involving the metacarpophalengeal and proximal interphalengeal joints. What’s the likely diagnosis: Rheumatoid arthritis 552-DPT vaccine shouldn’t given if the child has: a. Coryza b. Diarrhea c. Unusual cry d. Fever = 38 553-A female patient has clubbing, jaundice and pruritis. Lab results showed elevated liver enzymes (Alkaline phosphatase), high bilirubin, hyperlipidemia and positive antimitochondorial antibodies. What’s the most likely diagnosis: Primary sclerosing cholangitis Primary biliary cirrhosis __________________________________________________________________ _ 554-Shoulder pain most commonly due to: Infraspinatus muscle injury Referred pain due to cardiac ischemia 87

In acute cholecystitis __________________________________________________________________ _ 555-Female patient with fatigue, muscle weakness, parasthesia in the lower limbs and unsteady gait. Do: a. Folate level b. vitamin B12 level c. Ferritin level __________________________________________________________________ _ 556- Patient developed lightheadedness and SOB after bee sting. You should treat him with the following: d. Epinephrine injection, antihistamine and IV fluid e. Antihistamine alone 557-Patient is 74 yrs old female complaining of pain and stiffness in the hip and shoulder girdle muscles. She is also experiencing low grade fever and has depression. O/E: no muscle weakness detected (Polymyalgia rheumatic). Investigation of choice: RF Muscle CK ESR __________________________________________________________________ _ 558- 2 yrs old boy with coryza, cough and red eyes with watery discharge (a case of measles). Most likely diagnosis of the red eyes is: Conjunctivitis Blepharitis 559-foot ball player gt hurt by the football to the knee , on examnation +ve valgus stress test, -ve macmerry and lachman test . he has: 1) tibial fracture 2) lateral meniscus tear 3) medial meniscus tear 4) lateral collateral ligament tear 5) medial collateral ligament tear . A foot ball player his knee was hit from the left lateral side, valgus test was positive; drawer test & Laschman test were negative. Which of the following was injured? a) Anterior cruciate ligament b) Posterior cruciate ligament c) Medial collateral ligament d) Lateral collateral ligament e) Medial meniscus 88

__________________________________________________________________ _ 560-Patient has bilateral abdominal masses with hematuria. Most likely diagnosis is: a. Hypernephroma b. Polycyctic kidney disease Polycyctic kidney disease: Pain— in the abdomen, flank, or back— is the most common initial complaint, and it is almost universally present in patients with autosomal dominant polycystic kidney disease (ADPKD). The pain can be caused by any of the following:     

Enlargement of one or more cysts Bleeding, which may be confined inside the cyst, or lead to gross hematuria with passage of clots or a perinephric hematoma Urinary tract infection (eg, acute pyelonephritis, infected cysts, perinephric abscess) Nephrolithiasis and renal colic Rarely, a coincidental hypernephroma In addition, patients with ADPKD may have abdominal pain related to definitively or presumably associated conditions. Dull aching and an uncomfortable sensation of heaviness may result from a large polycystic liver. Rarely, hepatic cysts may become infected, especially after renal transplantation. Abdominal pain can also result from diverticulitis, which has been reported to occur in 80% of patients with ADPKD maintained on dialysis, probably from altered connective tissue. However, this rate has not been demonstrated to be higher than the rate among other patients on dialysis. Patients with ADPKD may be at a higher risk of developing thoracic aortic aneurysms. Abdominal aortic aneurysms are not increased among these patients. Pain may also develop for reasons completely unrelated to the underlying disease; thus, abdominal pain in patients with ADPKD may be a diagnostic challenge.

Hematuria Hematuria frequently is the presenting manifestation and usually is self-limited, lasting 1 week or less. Polycystic kidneys are unusually susceptible to traumatic injury, with hemorrhage occurring in approximately 60% of individuals. Mild trauma can lead to intrarenal hemorrhage or bleeding into the retroperitoneal space accompanied by intense pain that often requires narcotics for relief.

Hypernephroma(renal cell carcinoma): wide range of symptoms can be present with renal carcinoma depending on which areas of the body have been affected. [3] The classic triad is hematuria (blood in the urine), flank pain and an abdominal mass.

flank mass is uncommon (10%) and is indicative of advanced disease. And I think the disese is unilateraral The best choise is polycystic kidney

89

561- Male patient working in the cotton field, presented with 3 wks Hx of cough. CXR showed bilateral hilar lymphadenopathy and biopsy (by bronchoscopy) showed non-caseating granuloma. What’s your diagnosis: Sarcoidosis Amylidosis Histiocustosis Byssinosis Pneumoconiosis Byssinosis, also called "brown lung disease" or "Monday fever", is an occupational lung disease caused by exposure to cotton dust in inadequately ventilated working environments.

__________________________________________________________________ _ 562-Pt presented with severe epigastric pain radiating to the back. He has past hx of repeated epigastric pain. Social hx: drinking alcohol. What’s the most likely diagnosis: MI Perforated chronic peptic ulcer If pancerititis come in choises I don’t know if it is better answer_ __________________________________________________________________ 563-Erosive gastritisdon’t know Happened within one week of injury Happened within 24 hrs of injury !!! _________________________________________________________________ 564-In brainstem damage: a. Absent spontaneous eye movement b. Increase PaCO2 c. Unequal pupils d. Presence of motor movement Commonly, brain stem damage causes a loss of consciousness. It may be temporary or more extended. People with severe brain stem damage can enter comas and persistent vegetative states with limited probability of waking up again. Other people may be conscious and aware, but could have severe breathing problems, abnormal heart rates, or balance disorders. More mild injuries may result in a staggering gait and sensory impairments associated with interruptions to sensory signals. Brain stem consisting of the midbrain, pons, and medulla, which extends downwards to become the spinal cord Controls respiration and various basic reflexes (e.g., swallow and gag) Absent pupillary light reflex Corneal reflexes are absent PaCO2 levels greater than 60 mmHg, ≥20 mmHg over baseline

565-fluxtin half life = 1-4 days 90

566-35 yrs old male has SOB, orthopnea, PND, nocturia and lower limbs edema. What’s the most common cause of this condition in this patient: a. Valvular heart diease b. UTI c. Coronary artery disease d. Chronic HTN Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure.

http://www.mayoclinic.com/health/heartfailure/DS00061/DSECTION=causes 567-Female patient had carpopedal spasm after measuring her BP. This is caused by: Hypocalcemia Causes of Carpopedal spasm: The following medical conditions are some of the possible causes of Carpopedal spasm. There are likely to be other possible causes, so ask your doctor about your symptoms. 

Hypocalcemia



Multiple blood transfusions



Parathyroidectomy



Ileostomy formation



Gastric resection with gastrojejunostomy



Hyperventilation



Tetany



Following thyroid surgery due to damage to the parathyroid glands

568- Patient known case of DM type 2 on insulin, his blood sugar measurement as following: morning= 285 mg/dl, at 3 pm= 165 mg/dl, at dinner time= 95 mg/dl. What will be your management: Increase evening dose of long acting insulin Decrease evening dose of short acting insulin Decrease evening dose of long acting insulin Increase evening dose of short acting insulin 569-Diabetic patient on insulin and metformin, has renal impairment. What’s your next step: 91

Stop metformin and add ACE inhibitor DM HTN patient with MI receiving metformin and diltiazem and other medication his creatine clearance is high .. you will do: a) add ACE inhbitor b) remove metformin (contraindicated in renal failure) c) continue same medication 570-4 weeks old male child with acute onset forceful non-billious vomiting after feeding. He is the first child in the family. He is gaining normal wt and looks hungry. What’s your diagnosis: Pyloric stenosis ______________________________________________________ 571- 1 week old infant presented with repeated forceful vomiting. What’s the diagnosis ???(the same history of pyloric stenosis but the age is 1 wk): Pyloric stenosis Duodenal atresia Volvolus Hirschprung 572-55 y/omale,, c/o angina and syncope on exertion ,, normal ejection fraction ,, normal coronary arteries ,, there is only calcified aortic valve with total area < .75 cm ,, the rest of examination and investigations are normal .. Wt is ur manag. : Avoid exertion Medical therapy Aortic ballon dilation Aortoc valve replacrment The only definitive treatment for aortic stenosis is aortic valve replacement. The development of symptoms due to aortic stenosis provides a clear indication for replacement. For patients who are not candidates for aortic replacement, percutaneous aortic balloon valvuloplasty may provide some symptom relief. [4] Medical treatment (such as diuretic therapy) in aortic stenosis may provide temporary symptom relief but is generally not effective long term. In truly asymptomatic patients with severe aortic stenosis, the issue of valve replacement is less clear.

The recommendations of the ACC/AHA 2006 valvular heart disease guidelines for aortic valve replacement in patients with valvular aortic stenosis are summarized below, in Table 5. [10] In most adults with symptomatic, severe aortic stenosis, aortic valve replacement is the surgical treatment of choice. If concomitant coronary disease is present, aortic valve replacement and coronary artery bypass graft (CABG) should be performed simultaneously. Table 5. Recommendations for Aortic Valve Replacement in Aortic Stenosis(Open Table in a new window)

92

Indication

Clas s

Symptomatic patients with severe aortic stenosis

I

Patients with severe aortic stenosis undergoing coronary artery bypass surgery

I

Patients with severe aortic stenosis undergoing surgery on the aorta or other heart valves

I

Patients with severe aortic stenosis and LV systolic dysfunction (ejection fraction < 0.50)

I

Patients with moderate aortic stenosis undergoing coronary artery bypass surgery or surgery on the aorta or other heart valves

IIa

Patients with mild aortic stenosis undergoing coronary artery bypass surgery when there is evidence that progression may be rapid, such as moderate-tosevere valve calcification

IIb

Asymptomatic patients with severe aortic stenosis and abnormal response to exercise (eg, hypotension)

IIb

Asymptomatic patients with severe aortic stenosis and a high likelihood of IIb rapid progression (based on age, calcification, and coronary artery disease) or if surgery might be delayed at the time of symptom onset Asymptomatic patients with extremely severe aortic stenosis (valve area less than 0.6 cm2, mean gradient greater than 60 mm Hg, and jet velocity greater than 5 m per second) if the patient’s expected operative mortality is 1% or less

IIb

AVR is not useful for prevention of sudden death in asymptomatic patients with none of the findings listed under asymptomatic patients with severe aortic stenosis

III

emedicine 573-Patient with untreated bronchogenic carcinoma has dilated neck veins, facial flushing, hoarsness and dysphagia (SVC syndrome). CXR showed small pleural effusion. What’s your immediate action: a. Consult cardiologist for pericardiocentesis b. Consult thoracic surgeon for Thoracocentesis c. Consult oncologist(with radiotherapy symptoms improve) the most common cause of SVC syndrome is bronchogenic carcinoma 574-Fixs method in determining cardiac output ;?? 1 BP 2 o2 saturation in blood 93

COP = PR/ BP

575-3 year old boy with acute UTI ….. first thing to do in such acute thing ;?? a-Indwelling foley cather drain b – voiding cytctogram c- cystoscopyd-US 576-- drug contraindication hypertrophic obstructive cardiomyopathy; A_ digoxin B_ one of b-blocker Avoid digitalis because glycoside are contraindicated except in pts with uncontrolled atrial fibirallation (emedicine) 577-- BPH pt with hypertension what to give; alpha blocker 578-- posterior hip dislocation : ( from reconstruction) A – flexion , adduction b- flexion abduction c- extension, adduction _posterior hip dislocation :the hip is flexed ,internal rotation,adducted (emedicine) _________________________________________________________________________ __________________________ 579-- action of ocp : ( from reconstruction) A - inhibition of estrogen then ovulation B – inhibition of prolactin then ovulation d- inhibition of mid cycle gonadotropin then ovulation 580- 30 age women with sharp pain in the index finger increase with using scissors or nail cut which cause sharp pain at the base of the finger in matacarpophlyngeal joint and the finger become directed downward in (mean flexed DIPj) and cause pain when try to extend the finger.. 1-trigger finger 2-tendon nodule 3-dupetren contracure 4- mullet finger loss of extensor tendon continuity at the DIPJ causes the joint to rest on an abnormaly flexed position the classic mechanism of injury is a finger held rigidly in extension or nearly full extension(emedicine) 94

581-- itching scale in pack of knee . face and ant elbow : A – scapis B –eczema c- contact dermitis eczema:the earliest lesion affect anticubital and popliteal fossa lesions are ill defined erythematous,scaly, patches and plaques(emedicine) 582-– mitral stenosis : A – diastolic high pitch B - systolic low pitch C- diastolic low pitch 583- chylmedia non pregent treatment : A – doxycycline Non-pregnant:azithromycin-doxycycline. Pregnant:erythromycin. 584- – difference between unstable and stable angina : A – necrosis of heart muscle B - …………………………….. Stable angina:the classic triad of angina consist of :substernal chest pain that is provoked by exertion and relieved by rest or nitrates. Secondary to myocardial ischemia not necrosis(necrosis in MI) Prescence of st segment eleveation in the absence of cardiac enzyme elevation. ASA and B blocker (mortility benefit in stable angina) Unstable angina:chest pain is newonset,accelerating, or occurring at rest.(occurs with less exertion,lasts longer,less responsive to medication) It signals the presence of possible impending infarction. Not associated with elevated cardiac markers but their can be st segment elevation. (first aid USMLE STEP 2) 585-- mechanism of destruction of joint in RA : A – swilling of synovial fluid B – anti inflamtory cytokines attacking the joint d- ………………. Synovial hyperplasia and endothelial cell activation are early events in the pathologic process to uncontrolled inflammation and consequent cartilage and bone destruction. 586-TB outbreak ..and one pt. come to doing tubercalin test andit's negative .. what to do?? a- BCG b- isonized c- give rifampicin 95

587-all of the following is extrapyramidal Sx exept ?? a- dyskinisia b- akathesia c- xxxxx esia e- clonic - tonic convulsion 588-female come to with 3 UTIs history in last 6 months,, what is your advise? a- wipe frome behinde to front afterdefecation b- take a bath insted of shaower. d- increse flude intake ??589-in newborn exam .. what is more dangerous ? a- hydrocele b- abcent femoral pulses d- CHD e- - breast with milk discharge (normal it's with' milk) ??590-12- 28 gestation in NICU 900 gram wighet .. otherwise normal .. what to do?? >>>> ‫دا‬ a- give hem milk orally b- glucose infusion (because they develop hypoglycemia) c- broad spectren antibiotic ??591-healthy child with pRBC in urin 15 cells/hpf .. what to do ..?? a- repeat urine analysis for blood and proten . b- urine cytology. c- Cystoscopy. d- Renal biopsy. 592-tebial tubercle pain .. in 13 y/o boyhaving growth spurt ...Dx? >>>> ‫ابحثوا عنه‬.. a- osgood fracture b- strees fracture f- ......... most likely Osgood –schlatter,condition occurs in active boys and girls from 9-16 the condition is self-limiting 593- old dibetic man with sudden unilateral visual loss .. thare ismultible pigmentation in retena with macular edema .. Dx??.. ‫لمزم تقهم الفروق بين‬ ‫هالربع خيارات دايم تجي في افسئلة الوفثا‬ a- retenal detachment ( wrong .. come with floters ) b- retinal artry occlosion ( wrong .. no chirry red spots ) c- retinal vien thrombosis ( my answer .. it'sfit with all data given ) e- dibetic retinopathy 96

retinal detachment:A retinal detachment is commonly preceded by a posterior vitreous detachment which gives rise to these symptoms: 

flashes of light (photopsia) – very brief in the extreme peripheral (outside of center) part of vision



a sudden dramatic increase in the number of floaters



a ring of floaters or hairs just to the temporal side of the central vision



a slight feeling of heaviness in the eye

Although most posterior vitreous detachments do not progress to retinal detachments, those that do produce the following symptoms: 

 



a dense shadow that starts in the peripheral vision and slowly progresses towards the central vision the impression that a veil or curtain was drawn over the field of vision straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved (positive Amsler grid test) central visual loss

(None of this is to be confused with the broken retina which is generally the tearing of muscle and nerve behind the eye)

retinal artery occlusion:The most common presenting complaint is an acute persistent painless loss of vision. In central artery occlusions, visual loss is central and dense. In branch artery occlusions, visual loss may go unnoticed if only a section of the peripheral visual field space is affected. A complete visual field defect suggests central retinal artery occlusion (CRAO).  The cherry red spot and a ground-glass retina are the classic findings but may take hours to develop.

 

Retinal vein thrombosis : Central retinal vein occlusion (CRVO) is essentially a diagnostic finding of painless unilateral loss of vision. In some cases, this loss of vision is subtle in character, with intermittent episodes of blurred vision. In other cases, it may be sudden and dramatic. The nonischemic type is often the more subtle of the two, while the ischemic type is prone to the more acute clinical presentations.  

Nonischemic CRVO - Subtle, intermittent visual loss; painless; mild-to-moderate visual loss Ischemic CRVO - Acute visual loss; pain may be present; marked visual loss BRVO is similar in presentation to CRVO. BRVO is often noted with an onset of blurred vision or visual field defect. Vision loss may be subtle. Patients with small occlusions of a branch retinal vein may often be asymptomatic. Larger obstructions can lead to significant visual loss. It is uniformly a unilateral disease. Nine percent of cases are bilateral. Nonischemic central retinal vein occlusion

 

Mild vision loss, usually better than 20/120 measured Rare afferent pupillary defect

97



Ophthalmoscopy findings consist of variable dot and flame hemorrhages in all 4 quadrants, optic nerve swelling, retinal vein engorgement and tortuosity, cotton wool spots are few Ischemic central retinal vein occlusion

  

Marked visual loss, usually 20/200 to only hand motion Afferent pupillary defect Ophthalmoscopy findings of extensive retinal hemorrhages in all 4 quadrants, optic disc is edematous, retinal vein markedly edematous and engorged Macular edema is often severe.  Bleeding may result in vitreous hemorrhage.  Retinal detachment may occur. Branch retinal vein occlusion   

Patients with BRVO have retinal hemorrhages confined to the distribution of the retinal vein. The ophthalmoscopic examination may note triangular and flame-shaped hemorrhages. Mild obstruction of a branch may only show scant hemorrhage. Complete obstruction may have extensive hemorrhage noted on examination, with cotton wool spots.

Diabetic retinopathy: In the initial stages of diabetic retinopathy, patients are generally asymptomatic; in the more advanced stages of the disease, however, patients may experience symptoms that include floaters, blurred vision, distortion, and progressive visual acuity loss.

Microaneurysms Microaneurysms are the earliest clinical sign of diabetic retinopathy and occur secondary to capillary wall outpouching due to pericyte loss. They appear as small red dots in the superficial retinal layers, and there is fibrin and red blood cell accumulation in the microaneurysm lumen. A rupture produces blot/flame hemorrhages. Affected areas may appear yellowish in time, as endothelial cells proliferate and produce basement membrane.

Dot and blot hemorrhages Dot and blot hemorrhages occur as microaneurysms rupture in the deeper layers of the retina, such as the inner nuclear and outer plexiform layers. These appear similar to microaneurysms if they are small; fluorescein angiography may be needed to distinguish between the two.

Flame-shaped hemorrhages Flame-shaped hemorrhages are splinter hemorrhages that occur in the more superficial nerve fiber layer.

Retinal edema and hard exudates Retinal edema and hard exudates are caused by the breakdown of the blood-retina barrier, allowing leakage of serum proteins, lipids, and protein from the vessels.

Cotton-wool spots Cotton-wool spots are nerve fiber layer infarctions from occlusion of precapillary arterioles. With the use of fluorescein angiography, there is no capillary perfusion. These are frequently bordered by microaneurysms and vascular hyperpermeability.

Venous loops and venous beading Venous loops and venous beading frequently occur adjacent to areas of nonperfusion and reflect increasing retinal ischemia. Their occurrence is the most significant predictor of progression to proliferative diabetic retinopathy.

98

Intraretinal microvascular abnormalities Intraretinal microvascular abnormalities are remodeled capillary beds without proliferative changes. These collateral vessels do not leak on fluorescein angiography and can usually be found on the borders of the nonperfused retina.

Macular edema Macular edema is the leading cause of visual impairment in patients with diabetes. A reported 75,000 new cases of macular edema are diagnosed annually. This may be due to functional damage and necrosis of retinal capillaries. Clinically significant macular edema is defined as any of the following:   

Retinal thickening located 500 μm or less from the center of the foveal avascular zone (FAZ) Hard exudates with retinal thickening 500 µm or less from the center of the FAZ Retinal thickening 1 disc area or larger in size located within 1 disc diameter of the FAZ

594-16 y/o female become deaf suddenly.. her mother become deafwhen she was 30.. Dx: a- otosclerosis 100% sure(autosomal dominant,positive family history) b- acostic neuroma c-tympanic perforation 595-major hazard in post-menepause: >>>>>>>>>>(all true ) a- osteoprosis>>i'm 90%sure b- hot flush c- deppresion d- pelvic floor weakness 596-which of the folloing b- blocker .. havean alpha blocking effect : >>>>>>> ‫ابحثوا عنها ليني صقعت اي شئ‬ a- metoprlol b- atenalol c- mesoprolol e- xxxxxx lol f- yyyyyy lol labetalol and carvedilol (block beta and alpha) 597-theScreeningQuestionnaireto recognize primary snoring fros OSAS is : ‫ وبعد بحث ينص فساعة بالنت لقيت افسم الكوفستشنير‬.. ‫فسوال ل تعليق‬ a- otowaQuestionnaire b- HorchoverQuestionnaire c- ......... g- ........ 598-ADHD Rx : >>>>> ‫ احفظ كل ادوية ال‬ADHD a- olanzapine b- atomixtin c,methylphenidate 99

magnesium pemoline atomoxetine dextroamphetomine lisdexamfetamine bupropion venlafaxine lmipramine guanfacine clonidine 599-patient with congistive heart failure and pulmonary edema, what is the best treatment: 1-spronalctone 2-forsumide. 3 ____________________________________________________________________ 600-post partum women when she went back to work ,, she exposed tothe sun and started to have brown discolortion in her face .. what is thediagnosis: 1- uritcariA pigementosa (x) melasma/chloasma (a patchy browen or dark brown skin discoloration, that usually occurs on face and may result from hormonal changes,generally found in sun exposed areas. 601-patient presented by left arm swelling , pain full axillary lymphadenopathy … ttt by ; a- oral antibiotics (if only lymphadenitis) b.IV antibiotics ??(if systematic symptoms) 602- which one of the following is prognostic factor for CML ; a- age. b- chromosomal abnormality in CML there is chromosomal translacation (Philadelphia) CML was the first malignancy to be linked with clear genetic abnormality. 603-baby sit e out support ,,crawling , walking by pulling up , age .. a- 12 month b- 10 month c- 9 month 604-18- patient came with left arm stiffness and pain , he cant abducted his arm .. dx a- subcromial bursitis b- glenohumoral arthiritis cd100

Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, coracoid (the acromial arch) and from the deep surface of the deltoid muscle. subacromial bursitis often presents with a constellation of symptoms called impingement syndrome. Pain along the front and side of the shoulder is the most common symptom and may cause weakness and stiffness. [4] If the pain resolves and weakness persists other causes should be evaluated such as a tear of the rotator cuff or a neurological problem arising from the neck or entrapment of the suprascapular nerve. The onset of pain may be sudden or gradual and may or may not be related to trauma. Impingement may be brought on by sports activities, such as overhead throwing sports and swimming, or over head work such as painting, carpentry or plumbing. Activities that involve repetitive overhead activity, or directly in front, may cause shoulder pain. Direct upward pressure on the shoulder, such as leaning on an elbow may increase pain. Night time pain, especially sleeping on the affected shoulder, is often reported. Localized redness or swelling are less common and suggest an infected subacromial bursa. The patient actively abducts the arm and a painful arc occurs between 80° and 120°.

Shoulder arthritis can be one of three types of arthritis in the glenohumeral joint of the shoulder

The main symptom of shoulder arthritis is pain; this is due to the grinding of the bones against each other because of the lack of  cartilage. Pain usually occurs in the front of the shoulder and is worse with motion. People with shoulder arthritis will also  experience moderate to severe weakness, stiffness developing over many years, and the inability to sleep on the affected  shoulder. [edit]Diagnosis Diagnosis is simple; usually the doctor can tell if you have shoulder arthritis by your symptoms, but he or she will most likely  also take an x­ray or MRI. [edit]

605-- 10 yr old boy , dx as persistent moderate asthma , came with exacerbation .. he is on bronchodialator q 4 hour,, how to manage this patient to control his disease ; a- no ttt needed b- inhaler corticosteroid c- anticholenergic 101

606-Which personality disorder is associated with inflexibility and perfectionism: a. Narcissistic personality disorder b. Borderline personality disorder c. Obsessive compulsive personality disorder d. Histrionic personality disorder 607-male fall from 10 stairs , on examination contusion over the nose .. ur action will be ; a- CT scan b- referred to ENT I think this is the correct answer bcz in exam I choose CT scan and it was wrong 608- treatment of somatization is ;(cognitive behavioral therapy is the best) a- reffered to pain clinic b- anti depressant 609-1- 50 yr old male, presented with yellowish discoloration of both eyes and body, fatigue … O|E nothing except jaundice , pallor , vitiligo .. investigation ; wbc; 2500 , hgb ; 7.5 , plt ; 51 .. LFT; elevation of total bilirubin and direct bilirubin.. Which one of the following is correct to complete this syndrome ; a- positive coombs test c- antibodies against parietal cells autoimmune hemolytic anemia: -antibodies directed against the persons own red blood cells -the primary illness is idiopathic ,secondary can result from many other illness (autoimmune) -evidence of hemolysis (incresse unconjugated bilurbin,decrease haptoglobin,increase lactic dehydrogenase) -specific investigation:positive direct coombs test. _________________________________________________________________________ ______________ 610-3 yr old ingested aspirin the best gastric decontamination is: a. Gastric lavage b. Activated charcoal c. Total bowel irrigation Activated charcoal to soak up aspirin in the stomach Laxative to cause bowel movements that help remove aspirin and charcoal from the body Other medicines may be given through a vein, including potassium salt and sodium bicarbonate, which helps the body remove aspirin that has already been digested. If these treatments do not work or the overdose is extremely severe, hemodialysis may be needed to remove aspirin from your blood.

611- 14years old girl failed in math exam .. then she hadpalapitation ,, tachypnea and paracethesia .. this is : 102

1-hyperventilation syndrome 2-conversion 1-hyperventilation 2-parasthesia 3-pscho problems 4-no organic causes. 612--child moved with his family to new city n he started to go tonew school .. in the school he had low mood n doesn't want to interactive withany activity .. this a case of: 1-hypomania 2-depression 612-origin of pancreatic carcinoma : Ductal epithilum Of all pancreatic cancers, 80% are adenocarcinomas of the ductal epithelium.

613-pt. using haloperidol , developed rigidity (dystonia) ttt : Antihistamine + anticholinergic 614- difference between primary and secondary hyperaldosteronism : Increase rennin in secondary Typically, renin levels are suppressed to less than 1 ng/mL/h in patients with primary hyperaldosteronism, and levels do not stimulate above 2 ng/mL/h with diuretics and upright posture. Because of this finding, some experts suggest that suppressed renin levels should be used as a screen for detecting primary hyperaldosteronism. However, in a 1993 series by Bravo, 30% of patients had renin levels that rose to greater than 2 ng/mL/h when appropriately stimulated by sodium deprivation.[3]

615- attak rate for school children whom developed pink eye , first day 10 out of 50 , second day 30 out of 50 : 20 40 60 80 attack rate=number of infected/total number of exposedx100=80 616- group of diseases include , cystic fibrosis , liver failure , the cause is : Alpha one antitrpsin def 617- sinus tachycardia and atrial flutter , how to differentiate : Carotid art message Temporal art message Adenosine iv 618- ear pain , headache . purulent discharge , right side weakness and loss of sensation , diagnosis : Epidural brain abscess 103

Subdural hematoma? Spinal column abscess HZV Ramsay Hunt’s syndrome Description: Unilateral herpes zoster infection of the geniculate ganglion (respectively n. Intermedius) with lesions of the external ear and oral mucosa. The symptoms include facial paralysis, severe pain in the ear with a bloody serous discharge due to vesicles on the tympanic membrane. source http://www.ramsayhunt.org/epon.shtml

619- all of the following drugs contraindiacted in breast feeding except : Tetracycline Chlorophenicol Erythromycin 620-– GERD diagnosis : By history only History and UG Endoscopy History and barium anema 621-old lady came to clinic as routine visit , she mention decrease intake of Ca food , doctor suspect osteoporosis , next initial investigation : DEXA Ca in serum , thyroid function test , vit.D According to family medicine doctor pt >65 start with DEXA 622- long case of hemochromatosis with liver cirrhosis and decrease weight last visit = 90 now 84 , next step investigation : Hepatitis C serology Alpha phetoprotein Abdominal ultra sound 623- pt with rheumatic fever after untreated strep infection after many years presented with Mitral regurge,the cause of massive regurge is dilatation of: 1. Rt atrium 2. Rt ventricle 3. Lt atrium 4. Lt ventricle 624- ibuproven contraindicated in : Gastric ulcer Hypertension 104

625- pregnant lady with cystitis , one of the following drugs contraindicated in her case : imp. Amoxicillin Ceftriaxone Flouroquiolone 626--female pt. with typical presentation of trichomons , ttt : Metronidazole _________________________________________________________________________ _ 627– classical case of candidal infection è itching , white discharge from vagina , ttt is : Miconazole Amoxicillin 628- one of following true regarding systolic hypertension : In elderly it’s more dangerous than diastolic htn Occur usually due to mitral regurge Defined as systolic , above 140 and diastolic above 100 ( combined systolic and diastolic 629- 8 years boy BMI = 30 weight and hight above 95 percentile , next step : Appointment after 1 year Refer to surgeon Life style modification

630– one of the following cause painful vision loss : imp. Central retinal vein thrombosis Retinal detachment They are painless the painful condition is optic neuritis 631- Pt with symptoms of Mild intermittent asthma , converted to mild persistant asthma and pt. on albterol U have to add : Long acting beta Short acting inhaled steroid _________________________________________________________________________ _ 632-Scenario for pt. with sever asthma , tight chest , tachypnea and Co2 = 50 , next step : Aminophylin ……. Intubation …… Short acting beta and discharge him 105

(in acute asthma give venolin+ipratropium promide(atrovent)) 633-18 month child with low grade fever , barking cough , inspiratory stridor your Dx : Acute trachyobronchitis (croup) Epiglottitis 634-Continuous murmur at left sternal area : Patent ductus arteriosus Mitral reg Aortic stenosis 635- most commo cause of otorrhea ???(check question 606 in alqasim) a) acute otitis media b)cholesteatoma(chronic otitis media) c)estichian tube dysfunction Patients with acquired cholesteatomas typically present with recurrent or persistent purulent otorrhea and hearing loss. Tinnitus is also common. 636- the average menstrual cycle is 28 days _________________________________________________________________________ ___________________________ 637-All features of tonsillar abscess except : deviation of uvula to affected side: 638-Erethema nodosum : painful red nodules 639- initial Inx in small bowel obstruction : Erect& supine abdominal X- ray 640- Gold standard imaging in acute panceriatitis : CT scan 641- pregnant lady 28 wks with chlamyda infection :(see 583) azithromycin erythromycin or amoxicillin. doxcyline(non pregnant) 642- common cause of male infertility: primary hypogonadism 106

secondary hypogonadism ejaculation obstruction ...Causes of Male Infertility Varicocele: Varicocele is a condition that affects approximately 40 percent of infertile males. It is caused by enlargement of the veins in the scrotum. If these veins are enlarged it can cause the temperature to increase. Increased temperature of the scrotum affects sperm production and sperm quality. Cryptorchidism: If the testes do not properly descend into the scrotom this is called cryptorchidsm. Cryptorchidism is fairly common in premature births and occurs in full term births at a much lesser rate. Usually this resolves itself within a few weeks, but sometimes corrective surgery is needed. Cryptorchism can seriously impair fertility rates. If both testes are affected the chance of a successful pregnancy is very small. Disease or illness: Diseases such as cystic fibrosis can affect male fertility. Men who have undergone chemotherapy or had sexually transmitted desases may also be at greater risk of infertility. Obstructions in the reproductive tract: Obstructions in the male reproductive system is another common cause of infertility. Men with obstruction problems are usually making sperm but it is not making its way outside of the penis. Common causes of obstructions are urinary tract infections, scarring from sexually transmitted disease, injury, vasectomy or anatomical defects. Injury: Accidents or sports injuries can cause damage to the male reproductive system resulting in infertility. Hormone Deficiencies: Deficiencies in male hormone production such as testosterone can affect sperm production. Doctors will usually ask questions about when puberty was started. The age at which males enter puberty can be an indicator of hormonal disorders. Medications: There are many medications that affect fertility and cause sexual disfunctions. It is important for a doctor to evaluate what medications a man is taking to determine the possible impact on his fertility. Retrograde Ejaculation: Retrograde ejaculation is caused when the nerves or muscles in the bladder do not work properly. What happens is sperm is transported backwards into the bladder instead of forward and out through the penis. Sometimes men will have cloudy urine after an ejaculation because of this. If you are having infertility issues it is important that both partners are evaluated. A doctor will do a thorough physical exam as well as evaluate the man's sperm. Men may be uncomfortable going in for an exam but it is really necessary that both partner's be evaluated during a fertility work up. Treatment options will vary depending on what the cause of his infertility is.

Read more:http://www.justmommies.com/articles/male-infertility.shtml#ixzz1k5jLlr00

_________________________________________________________________________ ___________________________ 643-18years old boy with back pain investigation to do except : CBC ? ESR X -ray bone scan 644- Hypothyroidisim : 107

free T4 TSH T4 .. _________________________________________________________________________ ___________________________ 645-in which group you will do lower endoscopy for patients with iron deficiency aneamia in with no benign cause: male all age group children permanupausal women women + OCP Upper and lower GI investigations should be considered in all post-menopausal female and all male patients where IDA has been confirmed unless there is a history of significant overt nonGI blood loss. In the absence of suggestive symptoms (which are unreliable) the order of investigations is determined by local availability. The appropriateness of investigating patients with severe co-morbidity or other reasons (in some circumstances advanced age), especially if the result would not influence management, should be carefully discussed with patients and carers when possible. http://www.bsg.org.uk/pdf_word_docs/iron_def.pdf 646- Patient with continous seizures for 35 min. despite taking 20 mg Iv diazepam..what to do?? _ give 40 mg IV diazepam _ give IV phenytoin _ give IV Phenobarbital when it reach to maximum dose of diazepam ( 20 mg ) or respiratory depression occurs , we start second line of ttt : phynetoin at the dose of 15 mg /kg ( usually 900 - 1000 mg ) or at ratio of 10 mg of phyenoin per 1 ml normal saline but not exceeding 100ml over 1- 2 hour ( not more than 50mg per minute ) ...... 108

647- A 56 yr old his CBC showed, Hb=11, MCV= 93 Ret= 0.25% the cause is: a. Chronic renal failure b. Liver disease c. Sickle cell anemia d. G6P dehydrogenase deficiency 648- 3 yr old with symptoms of acute urinary tract infection which of the following you would like to do in this acute state: a. Renal U/S b. Folly catheter c. VSUG d-US 649­2 months old child complaining of spitting of food , abd examination soft lax , occult blood – ve , what you will do ?  Reassure the parents  Abd CT 650- baby with streptococcus pharyngitis start his ttt after two days he improved, Full course of streptococcus pharyngitis treatment with amoxicillin is : imp.  10 days ( 9-11 days )  7days  14 days 651- Uncomplicated UTI ttt  TMP-SMX for 3 days  Ciprofloxacin 5 days 652- Facial injury suturing remove after? Imp.  24h  3 – 5 days ( most likely )  7 – 10 days  14 days 653- Lichen planus most common site ?  Scalp  Neck  Knee  Buttocks  As far as I know the common site will be near the wrist and the ankle but those sites were not one of the choices ? 654-One of the following condition does not cause hypokalemia  Metabolic alkalosis 109

 Furosemide  Hyperaldosteronism  Acute tubular necrosis  Diarrhea 655-Condition not associated with increase alpha feto protein  Breech presentation  Down syndrome  Gastroschisis _________________________________________________________________________ ___________________________ 656- Pt came with trauma to left eye by tennis ball examination shows anterior chamber hemorrhage you must exclude ?  Conjunctivitis  Blepharitis  Foreign body ( most likely )  keratitis 657- Pt talking to doctor and the pt look to his right side most of the time, when the doctor asked him why is that? He said that his mother is there but in fact no one is there, after asking the pt family they said that the mother died when he is child Dx?  Visual hallucination (Or may be the doctor is blind )  Auditory hallucination  psychosis _________________________________________________________________________ ___________________________ 658-Child after his father died start to talk to himself , walk in the street naked when the family asked him he said that his father asked him to do that , he suffer from those things 3 days after that he is now completely normal and he do not remember much about what he did Dx ???????????????????????  Schizophrenia ×  Schizoaffective ×  Schizophreniform ×  Psychosis  There was a fifth choice I do not remember it, I think they make from his father death a cause.  +ve symptoms: Hallucinations (most often auditory), delusions, disorganizedspeech, bizarre behavior, and thought disorder.  -ve symptoms: Flat affect, emotional reactivity, poverty of speech, lackof purposeful actions, and anhedonia. 110

    

 Schizophreniform disorder: Symptoms of schizophrenia with a duration of < 6 months.  Schizoaffective disorder: Combines the symptoms of schizophrenia with a major affective disorder (major depressive disorder or bipolar disorder). Axis I: Psychiatric disorders. Axis II: Personality disorders and mental retardation. Axis III: Physical and medical problems. Axis IV: Social and environmental problems/ stressors. Axis V: The Global Assessment of Functioning (GAF).

 Delusion: A fixed false idiosyncratic belief.  Hallucination: Perception of an object or event without an existing external stimulus.  Illusion: False perception of an actual external stimulus.  Evolution of EPS : 4 hours: Acute dystonia , 4 days: Akinesia , 4 weeks: Akathisia , 4 months: Tardive dyskinesia 659- Pt with foreign body sensation in the eye , after the removal of the foreign body it was insect ttt?  Local antibiotic  Local steroid  Systemic antibiotic  Systemic steroid 660- Q22/ Child with white yellow mouth lips lesion in erythmatous base with gingivitis Dx?  HSV ( most likely )  EBV  CMV _________________________________________________________________________ ___________________________ 661- Pregnant never did check up before, her baby born with hepatosplenomegaly and jaundice imp.  Rubella  CMV  HSV  Toxoplasmosis 662- Old Pt with abnormal ear sensation and fullness, hx of vertigo and progressive hearing loss , invx low frequency sensorial hearing loss Dx imp.  Acoustic neuroma 111

 Neuritis  Menieres disease Ménière’s Disease : o A cause of recurrent vertigo with auditory symptoms that affects at least 1 in 500 in the United States. More common among females . o Hx/PE: Presents with recurrent episodes of severe vertigo, h earing loss, tinnitus, or ear fullness, often lasting hours to days. Nausea and vomiting are typical. Patients progressively lose low-frequency hearing over years and may become deaf on the affected side. 663- The most difficult mode of transmission to prevent is  Person to person  Air droplet  Vector http://www.prep4usmle.com/forum/thread/32772/ 664- Pt took high dose of acetaminophen C/O nausea vomiting Lab increase alkaline phosphatase and bilirubin … which organ is affected?  Liver  Brain  Gastro 665- Female pt with hypothyroidism, TSH high But he did not give the total T4 nor free , pulse normal BP normal she is in thyroxin what you will do? Imp.  Increase thyroxin follows after 6 months  Increase thyroxin follows after 3 months  Decrease thyroxin follows after 6 months  Decrease thyroxin follows after 3 months 666- Pt with polycethemia vera the cause of bleeding in this pt is  Increase viscosity  Low platelets 

Thromboses and bleeding are frequent in persons with polycythemia vera (PV) and MPD, and they result from the disruption of hemostatic mechanisms because of (1) an increased level of red blood cells and (2) an elevation of the platelet count. There are findings that indicate the additional roles of tissue factor and polymorphonuclear leukocytes (PMLs) in clotting, the platelet surface as a contributor to phospholipiddependent coagulation reactions, and the entity of microparticles. Tissue factor is also synthesized by blood leukocytes, the level of which is increased in persons with MPD, which can contribute to thrombosis.



Rusak et al evaluated the hemostatic balance in patients using thromboelastography and also studied the effect of isovolemic erythrocytapheresis on patients with polycythemia vera. They concluded that thromboelastography may help to assess the thrombotic risk in patients with polycythemia vera. [9]



Hyperhomocystinemia is a risk factor for thrombosis and is also widely prevalent in patients with MPD (35% in controls, 56% in persons with PV).

112



Acquired von Willebrand syndrome is an established cause of bleeding in persons with MPD, accounting for approximately 12-15% of all patients with this syndrome. von Willebrand syndrome is largely related to the absorption of von Willebrand factor onto the platelets; reducing the platelet count should alleviate the bleeding and the syndrome.

667- Pt k/c of SCA , the doctor planning to give him pneumococcal vaccine which true ?  Pt need antibiotic when there is hx of contact even with vaccine ( most likely ) 668-50 years old pt complaining of episodes of erectile dysfunction , hx of stress attacks and he is now in stress what you will do ?  Follow relaxation strategy  Viagra  Ask for invx include testosterone 669-Rx. Of scabies in pregnant women: Permethrin and sulfur solutions 670- Child with enuresis, what is the most important single test you will do ? Urine analysis  IVP  US  Blood culture 

Urinalysis is the most important screening test in a child with enuresis. Children with cystitis usually have WBCs or bacteria evident in the microscopic urinalysis. Children with overactive bladder or dysfunctional voiding, urethral obstruction, neurogenic bladder, ectopic ureter, or diabetes mellitus are predisposed to cystitis. If the urinalysis findings suggest cystitis, urine should be sent for culture and sensitivity. Urethral obstruction may be associated with RBCs in the urine. The presence of glucose suggests diabetes mellitus. A random or first-morning specific gravity greater than 1.020 excludes diabetes insipidus.)) emedicine The most commonly accepted cause of nocturnal enuresis, but also the most difficult to prove, is delayed functional maturation of the central nervous system, which reduces the child's ability to inhibit bladder emptying at night. ........... medscape

671- Old male pt came with fever, abd pain, diarrhea , loss of weight , + ve occult blood , Labs shows that the pt infected with streptococcus bovis , what you will do ?????  Give antibiotic  ORS  Abd X-Ray Colonoscopy 113

 Metronidazole _Colonoscopy should be performed in all patients with S bovis bacteremia or endocarditis. (emedicine) _________________________________________________________________________ __________________________ 672-Mallory weiss syndrome  Mostly need surgery Mostly the bleeding stops spontaneously  Associated with high mortality 673- Female pt around 35 years old, hx of thromboembolic disease, what type of reversible contraceptive she can use imp.  OCP Mini pills (no estrogen)  IUCD 674- Child with fever and runny nose, conjunctivitis and cough then he developed Maculopapular rash started in his face and descend to involve the rest of the body:this is case of measles a. EBV b. Cocxaci virus c. Rubella virus d. Vaccini virus The first sign of measles is usually a high fever (often >104 o F [40o C]) that typically lasts 4-7 days. This prodromal phase is marked by malaise, fever, anorexia, and the classic triad of conjunctivitis (see the image below), cough, and coryza (the “3 Cs”). Other possible associated symptoms include photophobia, periorbital edema, and myalgias. Blanching, erythematous macules and papules begin on the face at the hairline, on the sides of the neck, and behind the ears (see the images below). Within 48 hours, they coalesce into patches and plaques that spread cephalocaudally to the trunk and extremities, including the palms and soles, while beginning to regress cephalocaudally, starting from the head and neck. Lesion density is greatest above the shoulders, where macular lesions may coalesce. The eruption may also be petechial or ecchymotic in nature.

675-Avascular necrosis detect clinically AFTER 1/ 3 month 2/ 6 month?? 3/ 9 month 4/ 11 month 5/ 15 month 676- - 5 yr old adopted child their recently parents brought him to you with white nasal discharge. He is known case of SCA. What you will do to him: a. Give prophylactic penicillin 114

b. c. 677  

Wound, with greenish discharge, Gram + ve in long chain? Streptococcus Proteus Chlamydia

678- Female pt present with dysuria, urine analysis shows epithelial cast  Contaminated sample  Chlamydia urethritis Kidney disease  Cervical disease 679- During the third trimester of pregnancy , all of the following changes occur normally except Decrease paco2 Decrease in wbcs Reduced gastric emptying rate Diminshed residual lung volume Diminshed pelvic ligament tension Pregnancy in the final month and labor may be associated with increased WBC levels.

http://labtestsonline.org/understanding/analytes/wbc/tab/test _________________________________________________________________________ ___________________________ 680- The physiologic hypervolemia of pregnancy has clinical significance in the management of severely injured , gravid women by: Reduced the need for blood transfusion . Increase the risk of pul. Edema . Complicating the management of closed head injury Reducing the volume of crystalloid required for resuscitation Increasing the volume of blood loss to produce maternal hypotention General Approach to the Trauma Patient

The primary initial goal in treating a pregnant trauma victim is to stabilize the mother's condition. The priorities for treatment of an injured pregnant patient remain the same as those for the nonpregnant patient. Primary Survey As with any other injured patient, the primary survey of the injured pregnant patient addresses the airway/cervical spine control, breathing and circulation (ABC; volume replacement/hemorrhage control), with the mother receiving treatment priority. Supplemental oxygen is essential to prevent maternal and fetal hypoxia. Severe trauma stimulates maternal catecholamine release, which causes uteroplacental vasoconstriction and compromised fetal circulation. Prevention of aortocaval compression is also essential to optimize maternal and fetal hemodynamics. Pregnant patients beyond 20 weeks' gestation should not be left supine during the initial assessment. Left uterine displacement should be used by tilting the backboard to the left or as a final measure, the uterus can be manually displaced.

115

Hypovolemia should be suspected before it becomes apparent because of the relative pregnancy induced hypervolemia and hemodilution that may mask significant blood losses. Aggressive volume resuscitation is encouraged even for normotensive patients. http://www.trauma.org/archive/resus/pregnancytrauma.html

681- Anemia of chronic disease will show imp.  high ferritin high iron low TIBC  Low ferritin low iron high TIBC high ferritin low iron low TIBC ( this Q may come with ferritin or without )  Low ferritin high iron low TIBC _________________________________________________________________________ ___________________________682- Iron deficiency anemia will show  Low ferritin low iron low TIBC Low ferritin low iron high TIBC  high ferritin low iron low TIBC  Low ferritin high iron low TIBC 



In anemia of chronic disease without iron deficiency, ferritin levels should be normal or high, reflecting the fact that iron is stored within cells, and ferritin is being produced as an acute phase reactant but the cells are not releasing their iron. In iron deficiency anemia ferritin should be low.[5] TIBC should be high in genuine iron deficiency, reflecting efforts by the body to produce more transferrin and bind up as much iron as possible; TIBC should be low or normal in anemia of chronic disease.

683- Establishing to diagnosis shock must include: Hypoxemia Hypotention Acidosis Increase vascular resistance Evidance of inadequate organ perfusion(FROM ATLS) 684- 35 yo male pt K/C of allergic rhinitis and bronchial asthma poorly controlled presented with history of skin rash ,diffuse severe abdominal pain and hand joints pain for 2days , on examination there are diffuse purpuric skin rash and small joint tenderness with mild effusion , the most likely diagnosis is ... Churg strauss syndrome 116

685- 65 yo female pt who has a 10y history of symmetrical polyarthritis is admitted to the hospital , examination reveals splenomegally, ulceration over lateral malleoli and synovitis of the wrists, shoulders and knees . initial investigation shows WBC 2500 ,the most likely diagnosis is .... Felty's syndrome !! _________________________________________________________________________ _ 686- Patient with history of AF + MI , the best prevetion for stroke is : ? a- Warfarin d- Surgery procedure e- c- Shunt 687- What is the side effect of steroid on the eye ? a- Glaucoma . b- Cataract .(POSTERIOR SUBCAPSULAR CATARCT) AND GLAUCOMA IN THOSE WITH FAMILY HISTORY c- Keratoconus . 688- Young male pt present e and pain for....... He denied any hx of Truma or any medical illness before On ex..RR32b/min. Pulse ..... Abdomen not tender or garding By invx WBC e in normalK >5Na...... RBS 23mmolWhat most important invx:U/sABG urine dipstick 689- The best investigation for kidney function : a- 24 h collect urine b- Creatinine clearance 690- Patient came to you with small swelling under his eye , on examination he have inflammation in lacrimal duct , you refer him to ophthalmologist before that what you will give him ? a- Topical steroid b- Topical antibiotic c- General antibiotic 691- What is true regarding spountinous abortion: Can lead to infertility in future Usually fused by any utrine abnormality That occur on 2ed trimester.. 692- The best investigation for acute diveticolitis is :a- US b- Barium enema c- CT 117

d- Colonscopy e- Sigmidscopy o o o o

o

Diverticulitis: Chest X-ray with the patient upright can aid detection of pneumoperitoneum. Abdominal X-rays may demonstrate small or large bowel dilation or ileus, pneumoperitoneum, bowel obstruction, or soft tissue densities suggesting abscesses. Contrast enemas: limited value; findings suggestive of diverticulitis include extravasated contrast material outlining an abscess cavity, intramural sinus tract or fistula. CT scanning with intravenous, oral or rectal contrast: sensitivities and specificities for CT are significantly better than for contrast enemas. When an abscess is suspected, CT scanning is the best modality for making the diagnosis and following its course. Because of risk of perforation, endoscopy is generally avoided in initial assessment of the patient with acute diverticulitis. Its use should be restricted to situations when the diagnosis in unclear, to exclude other possible diagnoses.

http://www.patient.co.uk/doctor/Diverticular-Disease.htm 693- Food poisoning , group of people came with diarrhea and vomiting diagnosis is: a- Staphiloccous aureus poisoning b- Salmonella poisoning Usually if patients came with food poisoning after few hours of ingestion mostly the cause is Staph due to preformed toxin, if they started to have symptoms after one day of ingestion you are right compylobacter salmonella shigella or E. coli 694- Patient with Rhumatoid arthritis on hand X-Ray there is swelling what you will do for him a- NSAID b- Injection steroid c­

NSAIDs interfere with prostaglandin synthesis through inhibition of the enzyme cyclooxygenase (COX), thus reducing swelling and pain. However, they do not retard joint destruction and, therefore, when used alone, are not sufficient to treat RA

695- what is the drug that will preserve the histology in primary liver cirrhosis: 696- propylthiouracil drug contraindicated with : *Maternal HTN *Maternal DM *Maternal asthma 697- Differant between uvitis and kertits: Dec visual acuty Photophbia Periorbiatl edma in keratitis Cillry flush 118

698- 55 y/o male,, c/o angina and syncope on exertion ,, normal ejection fraction ,, normal coronary arteries ,, there is only calcified aortic valve with total area < .75 cm ,, the rest of examination and investigations are normal ..Wt is ur manag. :‫مكرر‬ Avoid exertion Medical therapy(for angina) Aortic ballon dilation Aortoc valve replacrment 699- 10 months old baby came to the clinic with his mother , she breastfeed him 3 times a day ,, she is known cace of epilepsy on phenobarbital,,,,,, What u going to tell her final answer Stope breastfeeding immediately Weaning over 2 weeks period Breastfeed after 8 h from taking the drug ?? Respond to what the mother and child wish henobarbital in breastmilk apparently can decrease withdrawal symptoms in infants who were exposed .. If phenobarbital is required by the mother, it is not necessarily a reason to discontinue breastfeeding. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones i http://www.drugs.com/breastfeeding/phenobarbital.html

700- 65 yo male pt presented with history of backache and fatigue for the last 3 month , examination showed mild tenderness in lumbosacral region , initial investigation revealed the following : Hb 9 ESR 80 X ray spine showed osteolytic lesion, the most likely diagnosis is ...... Solitary myloma 701- medical therapy in ectopic pregnancy >>> methotrexate _________________________________________________________________________ _ 702-Best for diagnosis E.P>> serial beta HCG _________________________________________________________________________ _ 703-True about DUB >> can occure in adolescent girls 704-Best anti HTN in pregnancy >> hydralazine methyldopa is the first line in treatment of pregnancy _________________________________________________________________________ _ 119

705-Pregnant ,, smoker ,, h/o trauma >> dark red vaginal bleeding ,, FHR 150 uterine contractions ...diagnosis : Uterine contusion Abruption _________________________________________________________________________ _ 706-MC cause of 2ry amenorrhea e high LH & FSH >> menopause _________________________________________________________________________ 707-MC cause of milk discharge in non lactating women >> prolactinoma _________________________________________________________________________ _ 708-RTA case found damage of sup femoral artery 5cm in diameter , do : *end to end anastmosing of the artery *artery graft *venous graft _________________________________________________________________________ _ 709- Pt after URTI later on develop proximal muscle weakness , most probably: *gurean barre syndrome.?? *osteoarthritis .?? 710- pt have normal Na , Cl , urine PH ALL electrolyte were normal except HCO3 was low : ( serum PH not mention ) *met acidosis ( not sure ) *met alkalosis *res acidosis *res alkaloso .?? (compensated) _________________________________________________________________________ 711- 70 ys old with sever muscle pain , diarrhea , disorientation , he is in diuretic the cause :*hyponatremia *hypokalemia 712- Newly diagnosed Type 2 diabetic advice for diet and exercise but still gain weight , which medication you want to add 1.insuline 2. metformin 3. sulfonylurea 713- mucopurulent discharge : bacterial conjunctivitis 120

714  

HCC : 10 % with liver disease with chronic liver diseases never come with smoking

 Hepatocellular carcinoma (HCC, also called malignant hepatoma) is the most common type of liver cancer. Most cases of HCC are secondary to either a viral hepatitide infection (hepatitis B or C) or cirrhosis (alcoholism being the most common cause of hepatic cirrhosis).[1]  Compared to other cancers, HCC is quite a rare tumor in the United States. In countries where hepatitis is not endemic, most malignantcancers in the liver are not primary HCC but metastasis (spread) of cancer from elsewhere in the body, e.g., the colon. Treatment options of HCC and prognosis are dependent on many factors but especially on tumor size and staging. Tumor grade is also important. The main risk factors for hepatocellular carcinoma are: 

Alcoholism



Hepatitis B



Hepatitis C (25% of causes globally)[3]



Aflatoxin



Cirrhosis of the liver



Hemochromatosis



Wilsons disease (while some theorize the risk increases,[4] case studies are rare[5] and suggest the opposite where Wilson's disease actually may confer protection [6])

Type 2 Diabetes (probably aided by obesity)[7] Ocp,tobacoo  

Hepatocellular carcinoma (HCC) most commonly appears in a patient with chronic viral hepatitis (hepatitis B or hepatitis C, 20%) or/and with cirrhosis (about 80%). These patients commonly undergo surveillance with ultrasound due to the cost-effectiveness. In patients with a higher suspicion of HCC (such as rising alpha-fetoprotein and des-gamma carboxyprothrombin levels), the best method of diagnosis involves a CT scan of the abdomen using intravenous contrast agent and three-phase scanning (before contrast administration, immediately after contrast administration, and again after a delay) to increase the ability of theradiologist to detect small or subtle tumors. It is important to optimize the parameters of the CT examination, because the underlying liver disease that most HCC patients have can make the findings more difficult to appreciate.

121

715- female with problem in school -manula removal of her hair (baldness) : ((Trichotillomani ))) Trichotillomania is hair loss from repeated urges to pull or twist the hair until it breaks off. Patients are unable to stop this behavior, even as their hair becomes thinner.

716- pregnant 6 days in CS - staining in her throbs from abdomen : Fascial dehiscence 717-16 week , polydipsia polyurea , less than 126 mg fasting ,, 6.8 : impaird DM IFG: ( 6.1-7.0 mmol) IGT : ( 7.8-11.1 mmol/l, 2h after 75g ) - First step: One-hour 50-g glucose challenge test; venous plasma glucose is measured one hour later (at 24–28 weeks). Values ≥ 140 mg/dL are considered abnormal. - Next step: Confi rm with an oral three-hour (100-g) glucose tolerance test showing any two of the following: fasting > 95 mg/dL; one hour > 180 mg/ dL; two hours > 155 mg/dL; three hours > 140 mg/dL. 718- Pancreatitis : increase by lying down 719-50 years , back pain , x ray sowed lytic lesion : bone scan 1-bone marrow biopsy 2-protien electrophoresis of blood and urine>paraprotien 720- exaggerated reflex in jaw , no fasculation , diffi clty in swallowing : pseudobulbar palsy Pseudobulbar palsy results from an upper motor neuron lesion to the corticobulbar pathways in the pyramidal tract. Patients have diffi culty chewing, swallowing and demonstrate slurred speech (often initial presentation). Individuals with pseudobulbar palsy also demonstrate inappropriate emotional outbursts. S/S : * Speech is slow, thick and indistinct - Gag reflex is normal, exaggerated or absent - Tongue is small, stiff and spastic - Jaw jerk is brisk - upper motor neuron lesion of the limbs - Dysphagia (diffi culty in swallowing) - Labile affect –Dysarthria Uncontrollable laughing or crying Bulbar palsy refers to bilateral impairment of function of the lower cranial nerves IX, X, XI and XII, which occurs due to lower motor neuron lesion either at nuclear or fascicular level in the medulla oblongata or from bilateral lesions of the lower cranial nerves outside the brainstem.[1] S/S : 122

dysphagia (diffi culty in swallowing) - diffi culty in chewing - nasal regurgitation slurring of speech - choking on liquids - Nasal speech lacking in modulation and diffi culty with all consonants - Tongue is atrophic and shows fasciculations Dribbling of saliva - Weakness of the soft palate, examined by asking the patient to say aah - The jaw jerk is normal or absent - The gag reflex is absent - lower motor neuron lesions of the limbs. 721- High senstive & specific for urolithasis : CT scan 722- child in ER , with dyspnea , tachy pnea , subepiglottic narrowing in x-ray : If thumb sign : epiglottitis , if steeple sign : croup CROUP Diagnosis : A frontal X-ray of the neck is not routinely performed, but if it is done, it may show a characteristic narrowing of the trachea, called the steeple sign. The steeple sign is suggestive of the diagnosis of CROUP , but is absent in half of cases. 723- female with breast cancer :before 5 years received chmeotherpy . diagnosed now CLL , causes of CML : risk factor . The etiology is unknown, although there is some genetic contribution, as fi rstdegree relatives of patients with CLL are three times more likely than others to develop a lymphoid malignancy. Primarily affects older adults (median age 65); the male-to-female ratio is 2:1. 724- antipsychotic drug side effect for onset : 4 hours: Acute dystonia , 4 days: Akinesia , 4 weeks: Akathisia , 4 months: Tardive dyskinesia (often permanent) _________________________________________________________________________ _ 725- chronic use of alcohol : first drug to give pt : thiamine . . All patients being treated for AW should be given 100 milligrams (mg) of thiamine as soon as treatment begins and daily during the withdrawal period. http://pubs.niaaa.nih.gov/publications/arh22-1/38-43.pdf _________________________________________________________________________ _ 726-female with vaginal bleeding , abdominal pain : first Inx : US 123

Vaginal Examination 727-stroke pt , most propable cause :  Polycethmia vera  Sickle ceLl anemia  2 ry polycethmia . _________________________________________________________________________ _ 728-old male , back pain , ex is normal : gave him steroid , come again with vesicle from back to abdomen : VZV 729- Female , Rt hand , lateral two radial styloid processes pain , since month increase progressively , CS , ttt of De Quervain Tenosynovitis +ve Finkelstein test initial ttt :  Nerve decomperrison  cast upper joint  cast with thumb raised  Initial treatment for DeQuervain's syndrome is nonoperative : first thumbspica splint , NSAIDS may also be of value , corticosteriod injection into the first dorsal compartment may provide sustained relief . o In one study, Weiss et al. reported that injection was just as effective in DeQuervain's syndrome as splinting alone or splinting combined with injection. In another study of 63 patients, 71% of patients had sustained relief of their symptoms with one first dorsal compartment injection. 730- male with auscultation , not clear , left sterna border , scratching sound , vein distened in neck , muffled heart sound : Cardiac tamponade percarditis 731- Acanthosis Nigricans associated with : polycystic ovary syndrome 732- celiac disease which not cause it : rice&corn oat wheel gluten 733- old man with generalized abdominal pain T:38.2,abscent bowel sound,x ray:dilated small bowel and part of the transverse colon,no fluid level:  Pancreatitis  perforated peptic ulcer  bacterial colitis  intestinal obstruction 124

 Sentinel loop sign:isolated dilatation of a segment of gut consisting of jejunum, transverse colon or duodenum. Colon cutoff sign:gas distition rt colon that abruptly stopes in mid or LF colon due spasm adjacent to inflammation

734- baby with tonic clonic convulsions,what drug you'll give the mother to take home if ther is another seizure:  Diazepam  phenytoin  Phenobarb 735- Significant DPL direct peritoneal lavage in diagnosis :  ≥10 ml blood or ≥100,000 RBC or ≥ 500 WBC A positive DPL in an adult classically requires one of the following results:  RBC : > 100,000/mm3  blood : 10 ml  Amylase level (IU/L) : ≥20  Alkaline phosphatase level (IU/L) : ≥3  WBCs (per mm3) :>500  the presence of enteric/vegetable matter 736-Initial management for Frostbite patient :  Debridement  b.blocker  corticosretoid  immersion in 40 C . 737- Patient with ACEI , was not uncontrolled , what do will add to the patient :  B.Blocker  ARBs  CCBs  Thiazide  Frusemide _________________________________________________________________________ _738- Patient with HTN , discovered DM 2 ,what the medication will add to him :  Blocker  ARBs  CCBs  Thiazide  ACEIs 739- Patient with hypertensive retinopathy grade 2 AV nicking , normal BP , no decrease in vision , with cupping of optic disc , what will do do the patient :  Reassurance , the problem is benign 125

 Convert hitm to ophthalmologis  Laser operation 740- Patient with sudden skin eruption over face and neck then palm and sole ????????  Erythema multiform  Drug eruption  Measles If syphilis is there it is more accurate 741-100 - Patient witn BA , using B.agonist if needed , now become more sever , attacks come 5 times in week., you will give patient , I expect Moderate persistent  Low dose steroid inhaler  Oral steroids  Ipratorpium bromide  Long acting B.agonist  Large dose steroid inhaler 742- One of them causes conductive hearing loss :  Acute ottis media  Syphillis  Meneria disease 743- CSF : normal protein , decrease glucose , turbid in color :  Viral menengititis  Tubercular meningitis  Pyogenic meningitis  Encephalitis ___ Cause Appearanc Polymorphonucle Lymphocyte Protein Glucose e ar cell Pyogenic Yellowish, Markedly Slightly Markedly Decrease bacterial turbid increased increased increased d meningitis or Normal Viral meningitis

Clear fluid

Tuberculous Yellowish meningitis and viscous Fungal Yellowish

Slightly increased Markedly or Normal increased

Slightly Normal increased or Normal

Slightly increased Markedly or Normal increased

Increased Decrease d

Slightly increased Markedly

Slightly

126

Normal or

meningitis

and viscous

or Normal

increased

increased decrease or Normal d

_________________________________________________________________________ _ 744- Patient with vomiting and diarrhea and moderate dehydration, how to treat:  ORS only 745- in knee examination : +ve lechman test indicate injury : Anterior cruciate ligament 746-2 weeks after delivery , mother said that the baby , he will die , baby lack healthy , what is diagnosis :??  Post partum no bonding  Post partum psychosis  Post partum depression 747- antidepressant in elderly : Will take time to see effect "I make sure that patients and their family—who I always try to include—understand how long it can take to respond to an antidepressant. People need clear expectations. The drugs take longer to work in older people than younger ones, usually 8 to 12 weeks. The longer they stay on the medicine, the more improvement they are likely to see,"

http://www.health.com/health/condition-article/0,,20188909_2,00.html 748- children on chemotharpy , he developed septicemia after introduce IV canula , what is causative organisms : imp.?? Hib Psudeomonas?? E.coli strept klebsiella 749- 1-2012 pt came e" painful rectal spasm , diaphorisis , tachycardia at night what the DX : a- thrombosed hemorhoid b- Proctalgia Fugax c- >>syndrome Proctalgia fugax (or levator syndrome) is a severe, episodic, rectal and sacrococcygeal pain.[1] It can be caused by cramp of thepubococcygeus or levator ani muscles.[2 It most often occurs in the middle of the night [3] and lasts from seconds to minutes,[4] an indicator for the differential diagnosis of levator ani syndrome, which presents as pain and aching lasting twenty minutes or longer. In a study

127

published in 2007 involving 1809 patients, the attacks occurred in the daytime, (33 percent) as well as at night (33 percent) and the average number of attacks was 13. Onset can be in childhood, however, in multiple studies the average age of onset was 45. Many studies showed that women are affected more commonly than men. [5] During an episode, which sometimes occurs after orgasm, the patient feels spasm-like, sometimes excruciating, pain in the anus, often misinterpreted as a need to defecate. Simultaneous stimulation of the local autonomic system can cause erection in males. Because of the high incident of internal anal sphincter thickening with the disorder, it is thought to be a disorder of the internal anal sphincter or that it is a neuralgia of pudendal nerves. It is recurrent and there is also no known cure. However, some studies show effective use of botulinum toxin, pudendal nerve block, and calcium channel blockers. It is not known to be linked to any disease process and data on the number of people afflicted varies, but is more prevalent than usually thought. The pain episode subsides by itself as the spasm disappears on its own, but may reoccur. [4] Sometimes there is a drop in blood pressure that may cause loss of consciousness and possible injury. Staying down is suggested if in bed and laying down is recommended.

750- old pt , e hx of MI 2 weeks back and discharge from hospital 24 hrs prior to his presentation <<>the other limb normal what is the DX : a-Acute artery thrombosis b- acute artery embolus d- DVT e­ D- ??? 751-7- Neonate with mass on his eye : a-Neuroblastoma b-Leukemia (Neuroblastoma is the most common extracranial solid tumor in infancy and the third most common pediatric malignancy after leukemia and central nervous system (CNS) tumors. It is an embryonal malignancy of the sympathetic nervous system arising from neuroblasts (pluripotent sympathetic cells). Signs and symptoms of neuroblastoma vary with site of presentation. Generally, symptoms include abdominal pain, emesis, weight loss, anorexia, fatigue, and bone pain. At diagnosis, the site of neuroblastoma is predictably age-dependent. Infants often present with compression of the sympathetic ganglia in the thoracic region, which might result, for example, in Horner syndrome (myosis, anhydrosis, and ptosis) or superior vena cava syndrome. Older children typically present with abdominal symptoms because, as stated above, more than 40% of neuroblastomas are adrenal in origin. Children who are preschool aged should have working differential diagnoses for an abdominal mass, including lymphoma, hepatoblastoma, rhabdomyosarcoma, renal cell carcinoma, and neuroblastoma.

http://emedicine.medscape.com/article/988284­overview#a0104 128

Leukemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts".In most patients, a diagnosis of leukemia has been made before presenting to an ophthalmologist. However, in some patients, ocular symptoms and examination lead to a diagnosis of leukemia.Orbital manifestations o

Leukemic cells may infiltrate the orbit during the course of acute or chronic leukemia. Unusual orbital involvement with leukemia has been reported to include infiltration of the lacrimal gland and drainage system, rectus muscles, and dermis.

o

Orbital involvement in children is more common in acute leukemias, whereas orbital involvement in adults is more common in chronic leukemias.

o

The leukemic infiltrate may range from insignificant, where it is virtually asymptomatic, to a space-occupying lesion with its concomitant symptoms.

o

The patient may have proptosis, ecchymosis, chemosis, diplopia, visual disturbance, or motility disturbances.

o

In children, the orbital involvement is characterized by an acute and rapid process that may be confused with orbital cellulitis. In general, these infiltrates are bilateral and do not destroy bone. Granulocytic sarcoma of the orbit, also known as chloroma, is an extramedullary form of myelogenous leukemia.

o

Unilateral, painless proptosis develops over weeks to months prior to a diagnosis of leukemia. Eyelid redness or violaceous discoloration may be present, which turns into ecchymosis that may be confused with rhabdomyosarcoma or metastatic neuroblastoma. If AML or CML is already present, then a rapid and fulminant bilateral proptosis is characteristic.

o o

http://emedicine.medscape.com/article/1201870-clinical#a0217

752- Pt with 3 month hx of feeling like depression, recently employ what you will do: a- Tricyclic b c-Psychotherapy support 129

d- Moi the recommended treatment for adjustment disorder is psychotherapy ___________________________________________________________________________________ _______________________________

??753- WRIST WITH PAPULOVESICULAR RASH 12 ‫صوره‬ CHICKEN POX >> Chickenpox is usually diagnosed clinically on the basis of the characteristic rash and successive crops of lesions. Small, erythematous macules appear on the scalp, face, trunk, and proximal limbs, with rapid sequential progression over 12-14 hours to papules, clear vesicles, and pustules and subsequent central umbilication and crust formation. Vesicles may appear on the palms and the soles and on the mucous membranes, together with painful, shallow, oropharyngeal or urogenital ulcers. Intense pruritus commonly accompanies the vesicular stage of the rash.

Vesicular eruption on the trunk demonstrating papules, vesicles, and crusts

Dewdrop on rose petal characteristic vesicle of chickenpox

SCABES>>superficial burrows

130

A typical linear burrow on the flexor forearm

A subtle linear burrow accompanied by erythematous papules on the sole of the foot in a child with scabies.

Erythematous papules and papulovesicles on the flexor wrist.

ATROFIC DERMATITIS>> red, flaky and very itchy. The skin on the flexural

surfaces of the joints (for example inner sides of elbows and knees) are the most commonly affected regions in people.

Flexural involvement in childhood atopic dermatitis.

Dermatitis herpitiform>>is characterized by grouped excoriations; erythematous, urticarial plaques; and papules with vesicles.

Classic vesicles of dermatitis herpetiformis.

131

754- CHILD SEVERLY ILL AND FEVER FOR 2 DAYS ANOREXIA NAUSEA VOMITING THEN PETECHIA RASH APEAR IN TRUNK AND SPREAD IN THE BODY ?? MEASELS MENINGOCOCCAL MENINGITIS MOUNTAIN FEVER Varicella low grade fever for 2 days then rash in the trunk then it spread in the body 755- Patient on amitriptyline 30mg before bed time wake up with sever headache and confusion what is the appropriate action ? Shift him to ssri Change the dose to 10mg 3time daily 756-Young patient with decrease hearing and familly history of hearing loss ear examination normal rene and weber test revealed that bone conduction is more than air conduction what would you do ? Till him it is only temporal Till him there is no ttt for this condition Refer to audiometry Refer to otolaryngologists 757- which one of these drugs causing hypertensive crisis when it is not stoped gradually? diltiazim>>Antidysrhythmics, IV; Calcium Channel Blockers, colonidine>>Rebound hypertension on withdrawal b blocker Clonidine suppresses sympathetic outflow resulting in lower blood pressure, but sudden discontinuation can cause rebound hypertension due to a rebound in sympathetic outflow. Clonidine therapy should generally be gradually tapered off when discontinuing therapy to avoid rebound effects from  occurring. Treatment of clonidine withdrawal hypertension depends on the severity of the condition. Reintroduction of  clonidine for mild cases, alpha and beta blockers for more urgent situations. Beta blockers never should be used alone to treat  clonidine withdrawal as alpha vasoconstriction would still continue ______________________________________________________________________________________________________ __

758­ @1year old massive hepatosplenomegaly , brown skin nodule, lateral neck lump investigation to diagnose Ebv serology Lp 132

bone marow aspiration liver biopsy 759- child came with hematuria 15 RBC HPF , all examination normal what will you do ? a urine cytology b renal bipsy c – cystosocopy c repeat urine for RBC and protein 760- 15 years old with palpitation and fatigue. Investigation showed RT ventricularhypertrophy, RT ventricular overload and right branch block what is the diagnosis : a- ASD b- VSD Complications of VSDs include the following: Heart block secondary to intracardiac repair

c- Coartaction of aorta

761- child came withor Toeing-In , set in W shape , when walk both feet and knee inward with 20 degree , both femur inwarr rotation 70 degree <> Femoral anteversion Normal femoral anteversion is 40º in the newborn and decreases to 10º by the age of 8 years. The acetabulum is angled forward  15º. Femoral anteversion does not increase the risk of arthritis of the hip. Spontaneous improvement in the anatomic position  can occur until the patient is aged 8 years and can further correct by improving the gait through conscious effort until  adolescence. 

Femoral anteversion is the axial angle between the plane of the neck of the femur and the femoral condyles. It can be clinically deduced by measuring the hip rotation. Normal range of external rotation is 45-70°, and internal rotation is 10-45°. As femoral anteversion increases, the amount of internal rotation increases and external rotation decreases. These children can have as much as 90° of internal rotation and 0° of external rotation. They sit in the W position with their legs turned out (a position not attainable by normal adults), but they cannot sit cross-legged

c-???

762- anticoagulation prescribed for - one month - 6 months 133

- 6 weeks - one year 763- child with moderate persistant BA On bronch.dilat inhaler. Presented with acute exacerbation what will you add in ttt: Corticosteroid inhaler Ipratropum bromide inhaler

children with asthma are divided into 3 groups based on age: 0­4 y, 5­11 y, 12 y and older.

For all patients, quick-relief medications include rapid-acting beta2-agonists as needed for symptoms. The intensity of treatment depends on the severity of symptoms. If rapid-acting beta2-agonists are used more than 2 days a week for symptom relief (not including use of rapid-acting beta2-agonists for prevention of exercise induce symptoms), stepping up treatment may be considered Stepwise Approach to Asthma Medications Intermittent Asthma Age Step 1 < 5 y Rapidacting beta2agonist prn

Persistent Asthma: Daily Medication

Step 2 Step 3 Low-dose inhaled Medium-dose corticosteroid ICS (ICS) Alternate regimen: cromolyn or montelukast 5-11 Rapid- Low-dose ICS Either low-dose y acting ICS plus either beta2LABA, LTRA, agonist or theophylline prn OR MediumAlternate dose regimen: cromolyn, leukotriene receptor antagonist (LTRA), or theophylline 12 y Rapid- Low-dose ICS Low-dose ICS or acting plus LABA OR older beta2Medium-dose agonist ICS as Alternate Alternate needed regimen: regimen: lowcromolyn, LTRA, dose ICS plus or theophylline either LTRA,

Step 4 Medium-dose ICS plus either long-acting beta2-agonist (LABA) or montelukast

Step 5 High-dose ICS plus either LABA or montelukast

Step 6 High-dose ICS plus either LABA or montelukast; Oral systemic corticosteroid

Medium-dose High-dose ICS High-dose ICS plus ICS plus LABA plus LABA LABA plus oral systemic corticosteroid Alternate Alternate Alternate regimen: regimen: regimen: high- high-dose ICS plus medium-dose dose ICS plus LRTA or ICS plus either either LABA or theophylline plus LTRA or theophylline systemic theophylline corticosteroid Medium-dose High-dose ICS High-dose ICS plus ICS plus LABA plus LABA (and either LABA plus consider oral corticosteroid omalizumab for (and consider patients with omalizumab for Alternate allergies) patients with regimen: allergies) medium-dose ICS plus either 134

theophylline, or LTRA, zileuton

135

pt is a known case of moderate intermittent bronchial asthma. He is using ventoline nebulizer. He develops 3 attacks per week. The drug to be added is: a) Increase prednisolone dose b) Add long acting B agonist c) Add ipratropium >>Anticholinergic bronchodilator d) IV aminophylline __________________________________________________________________ _ 764- A 20 years old male who is a known asthmatic presented to the ER with shortness of breath. PR 120, RR 30, PEFR 100/min. examination revealed very quite chest. What is the most propable management? a) Nubelized salbutamol b) IV aminophyline c) Pleural aspiration d) Hemlich maneuver e) Chest drain

765- about crohn's disease are true : Inflammation Involve superfacial layer of intestine Involve sigmoid and rectum if (“skip lesions”). 136

Decrease incidence of colon cancer The rectum is often spared. Transmural infl ammation is seen. (correct) 766- old age male with h/o of gastric acidity relieved by antiacids ,now he c/o forceful vomiting at night of food content >>>>> dx: Gastric outlet obstruction?>>is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach.

767- which drug increase incidence of reflux oesophagitis: Thiophylline (correct) Amoxicillin Metoclopramide Rantidine Lansoprazole _________________________________________________________________________ _ 768- which drug cause hypertensive crises when used with tyramine : SSRI Tricyclic antidepressant MAOI (correct) 769- old ptn with HTN and migrane ttt: B blockers (correct) ACE I Ca blockers 770- the most common fracture in osteoporosis : ( I couldn’t remember the age) Spinal fractures (compressed vertebrae)are the most common osteoporotic-related fractures

Colles fracture (if prior 75 y) Fracture neck of femur shaft of femur hip fracture(if over 75y) 771- male ptn with scaly fine papular rash on fornt of scalp,nose and retroauricular……..(i think tinea capitis) ttt is: Ketoconazole cream… Oral augmentin ……… cream tinea capitis : single or multiple patches of hair loss, sometimes with a 'black dot' pattern (often with broken-off hairs), that may be accompanied by inflammation, scaling, pustules, and itching. Treatment : oral antifungal agent; griseofulvin is the most commonly used drug, but other newer antimycotic drugs, such as 137

terbinafine, itraconazole, and fluconazole have started to gain acceptance. dx : Wood's lamp examination 772- Gram stain reveal gram negative diplococcic (you must know about causative org. of this type)……. Ceftriaxone IM or cefepime PO one dose..(Nisseria gonorrhea) >> is a species of Gram-negativecoffee bean-shaped diplococcibacteria responsible for the sexually transmitted infectiongonorrhea. ttt : ceftriaxone (a third-generation cephalosporin)

773- A side effect of L-Dopa: a) Dyskinesia (correct) b) .. c) .. d) .. 774-Aspirin & clopedogril indicated for: a) A 55 year old man with acute coronary syndrome. b) A 65 year old man with hx of MI c) A 65 yo man with stroke. d) A 65 yo man with CHF e) After cardiac catheterization ?? 775-Plavix & aspirin used for: a) Pt with previous history of ischemic stroke b) Pt going for angiogram c) MI d) Acute coronary syndrome _________________________________________________________________________ _ 776- A pt who is a KCO posterior MI presented with syncope. Examination showed canon (a) wave with tachycardia, unreadable BP & wide QRS complexes on ECG. The diagnosis is: a) Atrioventricular re-entrant nodal tachycardia b) Ventricular tachycardia if the individual has a past history of a myocardial infarction, congestive heart failure, or recent angina, the wide complex tachycardia is much more likely to be ventricular tachycardia

c) Pre-existing AV block d) Anterograde AV block e) Bundle branch block cannon wave It is associated with heart block, in particular third-degree (complete) heart block

777- The drug with the least side effects for the treatment of SLE is: 138

a) NSAIDs (correct)>>Common side effects of NSAIDs can include: 

stomach upset



heartburn



diarrhea



fluid retention

b) Methotrexate>>Immunosuppressant drug. Side effects may include: 

nausea



vomiting



hair loss



bladder problems



decreased fertility



increased risk of cancer and infection

c)

Corticosteroid>>Short-term side effects of corticosteroids include:



swelling



increased appetite



weight gain These side effects generally stop when the drug is stopped. It is dangerous (even life threatening) to stop taking corticosteroids suddenly Long-term side effects of corticosteroids can include:



stretch marks



weakened or damaged bones (osteoporosis and osteonecrosis)



high blood pressure



damage to the arteries



high blood sugar (diabetes)



infections

139



cataracts

d) Hydroxychloroquin >>Side effects of anti-malarials can include: 

stomach upset



damage to the retina of the eye (rare)

__________________________________________________________________ _ 778- A young male who is a known case of sickle cell anemia presented with abdominal pain & joint pain. He is usually managed by hospitalization. Your management is: a) In-patient management & hospitalization b) Out-patient management by NSAID c) Hydration, analgesia, monitoring. (correct) d) Narcotic opioids __________________________________________________________________ _ 779- A lot of bacteria produce toxins which are harmful. Which one of the following is used in amiddirs: a) Botulism?? b) Tetanus c) Diphtheria d) Staph aureus 780-

All the following cause hyponatremia except: a) DKA b) Diabetes insipidus<
781- Warfarin is given to all the following except: a) Young male with Atrial fibrillation & mitral stenosis b) Male with AF & cardiomyopathy c) Male with AF & prosthetic heart valve d) Elderly male with normal heart (correct)

140

782-. A 24 Y/o man presented with 4 month Hx of diarrhea with streaks of blood & mucous. Ulcerative colitis was confirmed by colonoscopy. The initial therapy for this patient:(481) a) oral corticostreiod xx b) azathioprine c) infleximabe d) 5-Aminosalicylic acid e) Sulfasalazine Sulfasalazine has been a major agent in the therapy of mild to moderate UC for over 50 years. In 1977, Mastan S. Kalsi et al. determined that 5aminosalicylic acid (5-ASA and mesalazine) was the therapeutically active in sulfasalazine.[citation needed] Since then many 5-ASA compounds have been developed with the aim of maintaining efficacy but reducing the common side effects associated with the sulfapyridine moiety in sulfasalazine http://emedicine.medscape.com/article/183084-treatment#aw2aab6b6b2

783- A hypothyroid pt on thyroxin had anorexia, dry cough, dyspnea & left ventricular dysfunction. She had normal TSH & T4 levels, Hyperphosphatemia & hypocalcemia. The diagnosis is: a) Primary hypoparathyroidism b) Secondary hypoparathyroidism xx c) Hypopituitaritism d) Uncontrolled hyperthyroidism 784-A 55 yr old man presenting with Hx of streakes of blood in stool and dull pain on defecation that persists for half an hour after defecation, on examination there was a 3x2 cm thrombosed mass at 3 o’clock.What is the management? a) Sitz bath 5 times/ day. b) Application of local anesthetic and incision. c) Application of antibiotic d) Band ligation and wait for it to fall e) Application of local anesthetic ointment ________________________________________________________________________ _ 785- A 42 year old woman presented with a painful breast mass about 4 cm in the upper lateral quadrant. It increases in size with the menstrual period. Examination showed a tender nodularity of both breasts. What is the management: a) Hormonal treatment with oral contraceptive pills b) Hormonal treatment with danazol?? xx c) Lumpectomy d) Observation for 6 months 787141

786- A 48 year old man complaining of right lower quadrant pain, bleeding per rectum, nausea & vomiting. What is the best pre-operative investigation? a) Air contrast enema b) Fecal occult blood c) CBC d) … 788- Which of the following indicate large uncomplicated pneumothorax: a) Symmetrical chest movement. b) Increase breath sound c) Dull percution note. d) Tracheal deviation (correct) e) Cracking sound with each heart beat __________________________________________________________________ _ 789-. A pregnant woman, multigravida, 38 weeks gestational age presented with glucosuria. Gestational diabetes was confirmed by glucose tolerance test. The next step is: a) Repeat Glucose tolerance test b) Cesarean section c) Diet adjustment d) Start sliding scale insulin 790-A young primigravida, 35 weeks gestation, had BP of 140/90, headache, proteinurea & lower limb edema. What is the best management: (dx preeclampsia) a) Oral labetolol b) Diuretics c) Low sodium diet d) Immediate C.section e) Admission & observation of feto-maternal condition (correct) _____________________________________________________ 791- A 30 yo lady in the third trimester of her pregnancy developed a sudden massive swelling of the left lower extremity extending from the inguinal ligament to the ankle. The most appropriate sequence of work up & treatment: a. Venogram, bed rest, heparin b. Impedance plethysmography, bed rest, heparin c. Impedance plethysmography, bed rest, vena caval filter d. Impedance plethysmography, bed rest, heparin, warfarin e. Clinical evaluation, bed rest, warfarin 792-Elderly female married since 30 years had fever, chills, dysurea, and diarrhea. No back pain. The diagnosis is: 142

a) Acute bacterial cystitis b) Acute pyelonephritis >>In acute pyelonephritis, the classic triad of fever, costovertebral angle pain, and nausea and/or vomiting may be present, although they may not necessarily occur together temporally.

c) Bacterial gastroenteritis d) Viral gastroenteritis __________________________________________________________________ _ 793- A young female patient who is an office worker presented with itching in the vagina associated with the greenish-yellowish vaginal discharge. Examination revealed red spots on the cervix. The diagnosis is: a) Trichomoniasis (correct)Women with trichomoniasis frequently report a frothy yellowish-green vaginal discharge b) Candidiasis>>whitish or whitish-gray cottage cheese-like discharge

c) Gonorrhea d) Gardnerella vaginalis 794- Uterovaginal prolapse: a) Increase heaviness in erect position (correct) b) More in blacks c) A common cause of infertility d) .. 795- A patient presented with fatigue, loss a petite & bloody urine. She gave History of sore throat 3 weeks back. The most likely diagnosis is: a) hemorragic pyelonephritis b) Post streptococcal GN(correct) c) Heamorragic cystitis d) membranous GN e) IgA nephropathy __________________________________________________________________ _ ?? 796- A child of an HIV positive mother. He is not immunized. Which of the following vaccines should not be given to him? a) Live oral polio b) DTP c) MMR d) Hepatitis B __________________________________________________________________ _ 797- A child swallowed his relative's medication. What is the best way of gastric decontamination? ???????????? ‫ا‬ a) Gastric lavage b) Total bowel irrigation (whole bowel wash) 143

c) Syrup ipecac d) Activated charcoal>>(correct) For most medication ingestions, singledose activated charcoal is the modality of choice for gastrointestinal decontamination. This treatment can generally be used up to 1 hour after ingestion of a potentially toxic amount of medication

‫افي المذكرة صجونا بالقابستريك لافاج مع البسبرين‬ __________________________________________________________________ _ 798-The commonest chromosomal disease is: a) Down syndrome (Trisomy 21) (correct) b) Klinfelter syndrome c) Turner's syndrome ?? 799-A young girl pt had URTI 1 week ago & received septra (trimethoprime + sulphamethoxazole). She came with crampy abdominal pain & proximal muscle weakness. The diagnosis is:(the same question in alqasem but other choises)474 a) Polymyositis b) Gullian parre syndrome c) Intermittent porphyria d) Periodic hypokalemic paralysis e) Neuritis 800-All the following are present in otitis media except: a) Signs & symptoms of inflammation b) Signs & symptoms of effusion c) High grade fever d) Pain 801-Best ttt for chronic pain management: Ibuprofen >> NSAIDare most beneficial in cases of acute pain, or flare-ups in patients with

chronic pain. NSAIDs are excellent at treating inflammatory conditions including tendonitis, bursitis, and arthritis.

acetaminophen (correct)>>in cases of chronic pain, no inflammation is at the site of the pain, and thus Tylenol may be an appropriate treatment choice.

In general, NSAID use is limited for patients with chronic pain because of concerns about the development to stomach problems

naproxen 802- CPR: 2 breaths raise the chest, you can DC shock 3 successive times, cardiac massage in aortic stenosis 40%recovery 144

803­ Lump in the bake with punktem not increase in size for year when doctor press it the punctum came discharge yellow fuel smell Remove to avoid rapture in derm?? Antibiotic first then remove 804­ T score of 70 years old osteoprotic male is : T-score of greater than minus-1 is considered normal. A T-score of minus-1 to minus-2.5 is considered osteopenia, and a risk for developing osteoporosis. A T-score of less than minus-2.5 is diagnostic of osteoporosis

-3 (correct), -2 , 2, 3 _________________________________________________________________________ _ 

805-retinal detachment all of the following are true EXCEPT: a) can lead to sudden loss of vision b) more in far sighted than near sighted (correct)>> When looking at patients

who already have retinal detachments, you begin to see some interesting trends. Many of these patients are myopic (near-sighted). Myopic eyes are physically larger and longer than normal eyes and have thinner retina at the periphery this thin retina is more likely to break forming small holes and tears that may progress to a detachment This thin retina is more likely to break, forming small holes and tears that may progress to a detachment

c) follow cataract surgery d) if you suspect it sent for ophthalmologist 806- A 40 year old man who become sweaty with palpitation before giving a speech in public otherwise he does very good at his job, he is having: a) generalizes anxiety disorder b) performance anxiety (correct) c) agoraphobia d) depression 807- A man is brought to the ER after having seizure for more than 30 min the most initial drug you will start with: a) IV lorazepam (correct)>> initial treatment due to its relatively long (2–8 hour) duration of action when injected, and its rapid onset of action, which is thought to be due to its high affinity for GABA receptors and to its low lipidsolubility which causes it to remain in the vascular compartment

b) IV phenobarbital 145

c) IV phynetoin d) IV haloperidol _________________________________________________________________________ _ 808- A women who lost her husband 2 weeks ago she is unable to sleep at all you will give her: a) floxitine b) diazepam c) halperidol d) amytriptaline _________________________________________________________________________ _ a 65 yrs old lady came to your clinic with Hx of 5 days insomnia and crying ( since her husband died ) the best Tx. For her is : a- lorazipam b- floxitein c- chlorpromazine d- haloperidol 809-17 year pt with dyspnea Po2 , PCO2 ,Xray normal PH increase so dd is - acute attack of asthma (correct) -PE - pneumonia -pnemothrax 810- Picture of rash which appear pink on wood light: -erythrasma>>is a macular brown area with few symptoms, most often found in the

armpits or groin. It is caused by overgrowth of diphtheroids of the normal skin flora. These areas fluoresce coral PINK under long-wave ultraviolet radiation (Wood's light).”

Fungal infection 811-RTA pt with femur fx , he has laceration of the femoral artery .. What to do : 1- end to end anastomosis 2- prosthetic graft 3-arterial graft 4- venous graft

__________________________________________________________________ _ 812- Psycho pt swallow open safety pins,, x-ray show pins in the small intestine,, what your next step: 146

-do emergent surgery(correct)>>Very sharp or pointed objects may perforate the GI tract (sewing needles are notorious). Therefore, such objects should be endoscopically removed from the stomach. If such an object has passed into the intestines, early consultation with a surgeon is recommended. Objects that are too long (eg, >6 cm) or too wide (eg, >2 cm) to pass through the pyloric sphincter should be removed from the stomach.

-reassurance and discharge -admitt and observe the pt 813-Theophylline interfere with absorption of: -names of antibiotics rifampin,ciprofloxacin,clarithromycin,erythromycin __________________________________________________________ ?? 814- A child presented with respiratory distress & accessory muscle contraction. What is your treatment? a) Oxygen b) Bronchodilator c) IV corticosteroid d) IV Theophylline ?? 815- A child presented with dysphagia, sore throat, postnasal drip, drooling of saliva, rhonchi & fever of 38.50c. The treatment is: a) Hydrocortisone injection immediately b) Call otorhinolaryngology for intubation c) Admit to ICU d) Give antibiotics & send him home 816- A child was treated for otitis media with 3 different antibiotics for 6 weeks but without improvement. Which antibiotic is the best treatment: a) Amoxicillin?? b) Penicillin c) Cepahlosporin (ceprofloxacin) d) Amoxicillin + Clavulonic acid>> e) Erythromycin + sulfamethoxazol 818- A 70 year old female brought to your clinic by her daughter. The daughter said her mother’s memory deteriorated in the last 2 years. She can cook for her self but sometimes leave the oven on. She can dress herself but with difficulties. The daughter mentioned that her mother’s personality changed into a more aggressive person(pt has Alzehimer's disease). According to this history what is your appropriate management? a) Prescribe diazepam for the daughter and haloperidol for the mother b) Refer the mother into chronic illness institute c) Refer the mother to geriatric clinic (correct) d) Immediate hospitalization _________________________________________________________________ _ 819- A man was intent as if he is listening to somebody, suddenly started nodding & muttering. He is having: ???????? 147

a) Hallucination (correct)>>is a perception in the absence of a stimulus b) Delusion>>is a false belief held with absolute conviction despite superior evidence

c)

Illusion>>distortion of the senses, revealing how the brain normally

organizes and interprets sensory stimulation d) Ideas of reference>>Ideas of reference and delusions of reference involve people having a belief or perception that irrelevant, unrelated or innocuous phenomena in the world refer to them directly or have special personal significance

e) Depersonalization 820- A 45 yo lady was complaining of dizziness, sensory neural hearing loss on her left ear (VIIIth nerve palsy), tingling sensation & numbness on her face, loss of corneal reflex. MRI showed a dilated internal ear canal. The diagnosis is: a) Acoustic neuroma>>any unilateral sensorineural hearing loss is caused by an acoustic neuroma until proven otherwise

http://emedicine.medscape.com/article/882876-overview#a0112 b) Glue ear c) Drug toxicity d) Herpes zoster e) Cholesteatoma 821- A pt had hairline metatarsal fracture. The x-ray was normal. What is the 2nd line? a) CT scan b) MRI(correct)>>MRI is sensitive for the diagnosis of fractures, it is not required, because plain radiographic findings are fairly sensitive and specific. MRI is useful in the assessment of fractures and dislocations, soft tissue, the plantar plate, structures of the capsule, the extent of marrow hyperemia, the exact number of bones involved, and small chip fractures MRI is more sensitive than radiography and even scintigraphy in the early diagnosis of stress fractures, because it shows bone marrow edema exquisitely. MRI may be used to differentiate stress fractures from early degenerative changes and early stress fractures from synovitis

c) US d) .. 822- A Case scenario about a male patient present with prostatitis (prostatitis was not mentioned in the question ), culture showed gram negative rodes. The drug of choice is: a) Ciprofloxacin (florqinlon)>>(correct) b) Ceftriaxone c) Erythromycin d) Trimethoprime e) Gentamicin 823- A pt complaining of left flank pain radiating to the groin, dysurea, no fever. The diagnosis is: 148

a) Pyelonephritis >>It can cause high fever, pain on passing urine, and abdominal pain that radiates along the flank towards the back. There is often associated vomiting

b) Cystitis c) Renal calculi >> (correct) The hallmark of stones that obstruct the ureter or renal pelvis is excruciating intermittent pain that radiates from the flank to the groin or to the genital area and inner thigh

824-A 10 yo boy presented with a 5 days history of skin lesion which was scaly & yellowish. The diagnosis is: a) Tenia corporum>> (ringworm,[1]tinea circinata,[2] and tinea glabrosa[1]) is a superficial fungal infection (dermatophytosis) of the arms and legs, especially on glabrous skin, however it may occur on any part of the body.enlarging raised red rings with a central area of healing (ringworm). The same appearances of ringworm may also occur on the scalp (tinea capitis), beard area (tinea barbae) or the groin (tinea cruris, known as jock itch or dhobi itch). Other classic features of tinea corporis include: 

The edge of the rash appears elevated and is scaly to touch.



Sometimes the skin surrounding the rash may be dry and flaky.



Almost invariably, there will be hair loss in areas of the infection

__________________________________________________________________ ___________ 825- A mother brought her baby & was complaining of diaper rash. She used cornstarch, talc powder, zinc ointment & 3 different types of corticosteroids prescribed by different physicians but with no benefit. The rash was well demarcated & scaly with satellite lesions. The most likely diagnosis: a) Candidal rash (correct) >>fungal infection b) Seborrhic dermatitis>>present with scaly, flaky, itching red skin ,affect sebaceous gland-rich areas of skin ttt:1/antifungal 2/anti-inflammatory 3/ topical steroid .. c) Allergic contact dermatitis>>ttt : corticosteroid 826-A child presented with honey comb crust lesion. Culture showed staph aureus. The diagnosis is:(539) a) Impetigo (correct) b) .. c) .. d) .. 149

827-. A pt presented with a 6 week history of itching & redness all over the body with wheals. Which type of urticaria this pt has: a) Chronic urticaria. (correct) >>Chronic urticaria (also known as "Ordinary urticaria"[1]) is defined as the presence of evanescentwheals which persist for 6 weeks or more

b) Solar urticaria c) Allergic urtecaria d) .. 828- A middle age man presented with sever headache after lefting heavy object. His BP was high. He was fully conscious. Examination was otherwise normal. The most likely diagnosis is: a) Subarachnoid hemorrhage b) Central HTN c) Tension headache d) Migraine e) Intracerebral hemorrhage 829- You were working in a clinic with a consultant who prescribed a drug that was contraindicated to the pt (the pt was allergic to that drug) but you didn't interfere & assumed that he knows better than you do. Which of the following you have violated: a) Professional competence b) Quality of caring of patient. (correct) c) Honesty. d) Pt relationship e) Maintaining trust __________________________________________________________________ _830- Physician's carelessness is known as: a) Malpractice (correct) b) Criminal neglect c) Malfeasance>>‫ارتكاب عمل محضور‬ d) Nonfeasance >>‫التقصير‬ 831-.The most important factor in attempt of successful cessation of smoking is? a) The smoker’s desire to stop smoking . (correct) b) The pharmacological agents used in the smoking cessation program. c) Frequent office visits. d) Physician’s advice to stop smoking e) Evidence of hazards of smoking 832- For health education programs to be successful all are true except : a- human behavior must be well understood b- Information should be from cultural background 150

c- Doctors are only the health educators(correct)>>health educator is “a

professionally prepared individual who serves in a variety of roles and is specifically trained to use appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health of individuals, groups, and communities

d- Methods include pictures and videos (mass media) e- Involve society members at early stage 833- a 27 yrs. old female C/O abdominal pain initially periumbilical then moved to Rt. Lower quadrant … she was C/O anorexia,nausea and vomiting as well .. O/E : temp.38c , cough , tenderness in Rt lower quadrant but no rebound tenderness. Investigations : slight elevation of WBC's otherwise insignificant .. The best way of management is: a- go to home and come after 24 hours b- admission and observation(correct) c- further lab investigations d- start wide spectrum antibiotic e- paracetamol what is the most likely diagnosis for the above patient ? a- mesenteric lymph adenitits b- acute appendicitis (correct) c- peptic ulcer 834- a 24 yrs old pt. came for check up after a promiscuous relation 1 month ago .. he was clinically unremarkable, VDRL : 1/128 … he was allergic 2 penicillin other line of management is (dx syphilis ): a- ampicillin b- amoxicillin c- trimethoprim d- doxycyclin (correct) >>Doxycycline and tetracycline have been used

Tetracycline, erythromycin, and ceftriaxone[27] have shown antitreponemal activity in clinical trials; however, they currently are recommended only as alternative treatment regimens in patients allergic to penicillin

_________________________________________________________ _ 835-a 24 years old female pt. C/O : gray – greenish discharge , itching .. microscopic examination of discharge showed : flagellated organism … most likely diagnosis is : a- trichomoniasis ( trichomonas vaganalis )(correct) 151

836- a 43 yrs. old female pt. presented to ER with H/O : paralysis of both lower limbs and parasthesia in both upper limbs since 2 hours ago .. she was seen lying on stretcher & unable to move her lower limbs (neurologist was called but he couldn't relate her clinical findings 2 any medical disease !!! ) when history was taken , she was beaten by her husband … the most likely diagnosis is : a- complicated anxiety disorder b- somatization disorder c- conversion disorder (correct)>>is a neurosis marked by the appearance of

physical symptoms such as partial loss of muscle function without physical cause but in the presence of psychological conflict

d- psychogenic paralysis e- hypochondriasis the best treatment for the previous case is : a- benzodiazepines b- phenothiazine c- monoamine oxidase inhibitor d- selective serotonin reuptake inhibitor e- supportive psychotherapy (correct) 837- a 58 yrs. old male pt. came with HX of fever, cough with purulent foul smelling sputum and CXR showed : fluid filled cavity … the most likely diagnosis is : a.abscess>>Presence of air-fluid levels b- TB c- bronchieactesis >> _____________________________________________________________________________________ ________________________________

838- a patient ( known case of DM ) presented to u with diabetic foot ( infection) the antibiotic combination is : a- ciprofloxacin & metronedazole _________________________________________________________ _ 839- a young pregnant lady (Primigravida) , 32 weeks of gestation came to you C/O : lower limbs swelling for two weeks duration .. she went to another hospital and she was prescribed ( thiazide & loop diuretic ) .. O/E : BP : 120/70 , mild edema , urine dipstick : -ve and otherwise normal…. The best action is : normal

152

a continue thiazide & stop loop diuretic b- cont. loop diuretic & stop thiazide c- stop both d- continue both and add potassium sparing diuretic e- cont. both & add potassium supplement 840- a 17 yrs. old football player gave HX of Lt. knee giving off .. the most likely diagnosis is : a

Lat. Menisceal injury b- medial menisceal injury c- lateral collateral ligament d- medial collateral ligament e ant. Curciate ligament (correct)

841- a 10 yrs. old boy presented to clinic with 3 weeks HX of limping that worsen in the morning .. this suggests which of the following : a- septic arthritis>>patient with rapid onset of joint pain b-leg calve parthes disease>>Legg–Calvé–Perthes syndrome is characterized by

idiopathic avascular osteonecrosis of the capital femoral epiphysis of the femoral head leading to an interruption of the blood supply of the head of the femur close to the hip joint Onset of pain may be up to 4 hours after inactivity. Knee pain is felt in the back of the knee rather than in the front, not unlike a localized charley horse. This lasts for an hour or so and returns nightly on inactivity

c- RA??>> Morning stiffness and a limp that is worse in the morning suggest juvenile rheumatoid arthritis

http://www.medscape.com/viewarticle/490135_4 d- a tumor e- slipped capital femoral epiphysis >>

is a medical term referring to a fracture through the physis (the growth plate), which results in slippage of the overlying epiphysis. Symptoms are waddling gait, loss of motion in the hip joint, externally rotated foot, pain in the knee / groin / hip and shortening of the hip. In up to 20% of cases slippage is bilateral. the knee starts to get sore about 2-4 months before the actual hip goes. the pain in the knee can come and go.

842-a 38 yrs old female … came to you at your office and her pap smear report was unsatisfactory for evaluation .. the best action is :

153

a- consider it normal & D/C the pt. b- Repeat it immediately c- Repeat it as soon as possible d- Repeat it after 6 months if considered low risk e- Repeat it after 1 year if no risk ?? 843-- a 62 yrs. old female pt. a known case of osteoporosis & on 1 alpha + Ca supplement .. her lab works shows normal level of PO4, Ca & ALP … her X-ray shows osteopenia with SD = -3.5 …. The best action is to : a- continue on same medications b- start estrogen c- start estrogen & progesterone d-add alevdonate ( bisthmus phosphate) 844- a 17 yrs. old school boy was playing foot ball and he was kicked in his Rt. eye .. few hours later he started to complain of : double vision & echymoses around the eye .. the most likely Dx. Is : a- cellulites b- orbital bone fracture (correct) c- global eye ball rupture e- subconguctival hemorrhage 845- a 35 yrs old female pt. C/O : acute inflammation and pain in her Lt. eye since 2 days .. she gave Hx of visual blurring and use of contact lens as well … O/E : fluorescence stain shows dentritic ulcer at the center of the cornea .. the most likely diagnosis is : a- corneal abrasion b- herpetic central ulcer >>Herpes virus cause a dendritic ulcer c- central lens stress ulcer d- acute episcleritis e- acute angle closure glaucoma 846-a 25 yrs old Saudi man presented with Hx of mild icterus , otherwise ok .. hepatitis screen : HBsAg +ve , HBeAg +ve , anti HBc Ag +ve (this should be core anti body, because core antigen doesn’t leave hepatocyte to the blood "prof. Yasawi" ) , the diagnosis : 154

a- acute hepatitis B?(correct) b- convalescent stage of hep. B c- recovery with seroconversion Hep . B d- Hep B carrier e- chronic active Hep. B Serological test findings at different stages of HBV infection and in convalescence anti-HBc Stage of infection

HBsAg

antiHBs

IgG

IgM

HBeAg

antiHBe

+

-

-

-

+ or -

-

+

-

+

+

+

-

-

-

-

+

-

-

-

-

+

-

-

-

+

-

+++

+ or -

-

+

+

-

+++

+ or -

+

-

-

++

++

+ or -

-

+

late incubation period

acute hepatitis B or persistent carrier state

HBsAg-negative acute hepatitis B infection

recovery with loss of detectable anti-HBs

healthy HBsAg carrier

chronic hepatitis B, persistent carrier state

HBV infection in recent past, convalescence

155

HBV infection in distant past, recovery

recent HBV vaccination, repeated exposure to antigen without infection, or recovery from infection with loss of detectable anti-HBc

-

+ or -

+ or -

-

-

-

-

++

-

-

-

-

847-8 wk Primigravida came to you with nausea & vomiting choose the statement that guide you to hyperemesis gravidarm : a- ketonia (correct) b- ECG evidence of hypokalemia c- Metabolic acidosis d- Elevated liver enzyme e- Jaundice ?? 848-60 year old male was refer to you after stabilization investigation show Hgb 8,5 g/l , hect. 64% , RBC 7.8 , WBC 15.3 & Plt. 570 Diagnosis : a- iron def. Anemia b- Hgb pathy c- CLL d- 2ry polycythemia e- Polycythemia rubra Vera ?? 849-Pregnant women G4P3+1 on GA 10 wk came to you with IUCD inserted & the string is out from O.S what is the most important measure : a- leave the IUCD & give A.B b- leave the IUCD & send to Ob/ Gynaecologist to remove c- leave the IUCD d- do laparoscopy to see if there is ectopic preg. e- Reassurance the pt

156

850-30-Placenta previa excludes : a- Pain less vaginal bleeding b- Tone increased of uterus (correct) c- Lower segmental abnormality d- Early 3rd trimester 851-Pregnancy test +ve after : a- one day post coital b- 10 day after loss menstrual cycle (correct)>>qualitative hCG test .Doctors often order these tests to confirm pregnancy as early as 10 days after a missed period

c- One wk after loss menstrual cycle ______________________________________________ 852-- 45 year old female complaining of itching in genitalia for certain period, a febrile, -ve PMH, living happily with here husband since 20 year ago on examination no abdominal tenderness , erythema on lower vagina , mild Gray discharge no hx of UTI . pyleonephritis Most probable diagnosis: a- Vaginitis (correct) b- Cystitis c- CA of vagina d- Urithritis ( non gonococal )

Common Types of Vaginitis Disorder

Typical Symptoms and

Criteria for Diagnosis

Microscopic Findings

Differential Diagnosis

Signs

Bacterial

Gray, thin, fishy-

Three of the

Clue cells,

Trichomonal

vaginosis

smelling discharge,

following: Gray

decreased

vaginitis

often with pruritus

discharge, pH

lactobacilli,

and irritation; no

> 4.5, fishy odor,

increased

dyspareunia

and clue cells

coccobacilli

Thick, white

Typical discharge,

Budding yeast,

Contact irritant or

discharge; vaginal

pH < 4.5, and

pseudohyphae, or

allergic vulvitis

and sometimes vulvar

microscopic

mycelia; best

Chemical

pruritus with or

findings*

examined with 10%

irritation

K hydroxide diluent

Vulvodynia

Candidal vaginitis

without burning, irritation, or dyspareunia

157

Trichomonal

Profuse, malodorous,

Identification of

Motile, flagellated

Bacterial

vaginitis

yellow-green

causative

protozoa, increased

vaginosis

discharge; dysuria;

organism by

PMNs

Inflammatory

dyspareunia;

microscopy*

erythema

(occasionally by

vaginitis

culture) Inflammatory

Purulent discharge,

pH > 6, negative

Increased PMNs,

Erosive lichen

vaginitis

vaginal dryness and

whiff test, and

parabasal cells, and

planus

thinning,

characteristic

cocci; decreased

dyspareunia, dysuria;

microscopy

bacilli

usually in

findings

postmenopausal women

*Culture is needed if microscopic findings are negative or symptoms persist.

853-20 year lady come to ER with Hx of Rt sever lower abdominal pain with Hx of amenorrhea for about 6 wk the most serious diagnosis of your deff. Diagnosis could reach by: a- CBC b- ESR c- U/S of the pelvis (ectopic pregnancy) (correct) d- Plain X-ray e- Vaginal swab for C/S _________________________________________________________ _ 854-Pt had arthritis in two large joint & pansystolic murmur ( carditis ) Hx of URTI the most important next step: (dx rheumatic fever) a- ESR b- ASO titre (correct but I'm not sure ) >>ASO is a test used to detect streptococcal antibodies directed against streptococcal lysin O. An elevated titer is proof of a previous streptococcal infection. c- Blood culture?>>Blood cultures are obtained to help rule out infective endocarditis, bacteremia, and disseminated gonococcal infection. N.B : Throat culture remains the criterion standard for confirmation of group A streptococcal infection. 855-women complain of non fluctuated tender cyst for the vulva . came pain in coitus & walking , diagnosed Bartholin cyst . what is the ttt: 158

a- incision & drainage b- refer to the surgery to excision (after you reassure her) c- reassurance the pt d- give AB ______________________________________________________ 856- 42years old male presented with history of sudden appearance of rash – maculopapular rash – including the sole,& the palm, the most likely diagnosis is : a- syphilis b- erethyma nodosum c- erythema marginatum d- pitryasis rocae e- drug induced 857- years old lady on tricyclic antidepressent feels dizzy on standing, resolves after 10-15 minutes on sitting, decrease on standing, most likely she is having : a- orthostatic hypotension>>Orthostatic hypotension, also known as postural hypotension, is a form of hypotension in which a person's blood pressure suddenly falls when the person stands up or stretches. The decrease is typically greater than 20/10 mm Hg,[2] and may be most pronounced after resting. The incidence increases with age.

_______________________________________________________ 858- what is the most appropriate treatment for the above patient : a- antiemetic b- antihistamine c- change the antidepressant to SSRI d- thiazide diuretics e- audiometry _________________________________________________________ 859- 23 years old lady with one month history of nasal discharge & nasal obstruction, she complained of pain on the face, throbbing in nature , referred to the supraorbital area, worsen by head movement, walking,& stopping. On - -- --------- examination , tender antrum with failure of transillumination ( not clear ), the most likely the diagnosis is:

159

a- frontal sinusitis (we can NOT trannsiiluminate it) b- maxillary sinusitis?? c- dental abscess d- chronic atrophic rhinitis e- chronic sinusitis 860-the cardiac arrest in children is uncommon but if occur it will be due to primary respiratory arrest (correct) hypovolemic shock neurogenic shock 861- Middle aged patient with an acyanotic congenital heart disease the X-ray show ventrical enlargement and pulmonary hypertension: a. VSD?? b. ASD c. Trancus arteriosus>>cyanotic CHD d. Pulmonary stenosis>>cyanotic CHD 862- role of surgery in. Stage C2 colon cancer ? Curative Palliative Diagnostic Exploratory Stage 0 Tis, N0, M0: The cancer is in the earliest stage. It has not grown beyond the inner layer (mucosa) of the colon or rectum. This  stage is also known as carcinoma in situ or intramucosal carcinoma.

Stage I T1­T2, N0, M0: The cancer has grown through the muscularis mucosa into the submucosa (T1) or it may also have grown into  the muscularis propria (T2). It has not spread to nearby lymph nodes or distant sites.

Stage IIA T3, N0, M0: The cancer has grown into the outermost layers of the colon or rectum but has not gone through them (T3). It has  not reached nearby organs. It has not yet spread to the nearby lymph nodes or distant sites. 

Stage IIB T4a, N0, M0: The cancer has grown through the wall of the colon or rectum but has not grown into other nearby tissues or  organs (T4a). It has not yet spread to the nearby lymph nodes or distant sites. 

Stage IIC T4b, N0, M0: The cancer has grown through the wall of the colon or rectum and is attached to or has grown into other nearby  tissues or organs (T4b). It has not yet spread to the nearby lymph nodes or distant sites. 

Stage IIIA One of the following applies.

160

T1­T2, N1, M0: The cancer has grown through the mucosa into the submucosa (T1) and it may also have grown into the  muscularis propria (T2). It has spread to 1 to 3 nearby lymph nodes (N1a/N1b) or into areas of fat near the lymph nodes but not  the nodes themselves (N1c). It has not spread to distant sites. T1, N2a, M0: The cancer has grown through the mucosa into the submucosa (T1). It has spread to 4 to 6 nearby lymph nodes  (N2a). It has not spread to distant sites.

Stage IIIB One of the following applies. T3­T4a, N1, M0: The cancer has grown into the outermost layers of the colon or rectum (T3) or through the visceral  peritoneum (T4a) but has not reached nearby organs. It has spread to 1 to 3 nearby lymph nodes (N1a/N1b) or into areas of fat  near the lymph nodes but not the nodes themselves (N1c). It has not spread to distant sites. T2­T3, N2a, M0: The cancer has grown into the muscularis propria (T2) or into the outermost layers of the colon or rectum  (T3). It has spread to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant sites. T1­T2, N2b, M0: The cancer has grown through the mucosa into the submucosa (T1) or it may also have grown into the  muscularis propria (T2). It has spread to 7 or more nearby lymph nodes (N2b). It has not spread to distant sites.

Stage IIIC One of the following applies. T4a, N2a, M0: The cancer has grown through the wall of the colon or rectum (including the visceral peritoneum) but has not  reached nearby organs (T4a). It has spread to 4 to 6 nearby lymph nodes (N2a). It has not spread to distant sites. T3­T4a, N2b, M0: The cancer has grown into the outermost layers of the colon or rectum (T3) or through the visceral  peritoneum (T4a) but has not reached nearby organs. It has spread to 7 or more nearby lymph nodes (N2b). It has not spread to  distant sites. T4b, N1­N2, M0: The cancer has grown through the wall of the colon or rectum and is attached to or has grown into other  nearby tissues or organs (T4b). It has spread to at least one nearby lymph node or into areas of fat near the lymph nodes (N1 or  N2). It has not spread to distant sites.

Stage IVA Any T, Any N, M1a: The cancer may or may not have grown through the wall of the colon or rectum, and it may or may not  have spread to nearby lymph nodes. It has spread to 1 distant organ (such as the liver or lung) or set of lymph nodes (M1a). 

Stage IVB Any T, Any N, M1b: The cancer may or may not have grown through the wall of the colon or rectum, and it may or may not  have spread to nearby lymph nodes. It has spread to more than 1 distant organ (such as the liver or lung) or set of lymph nodes,  or it has spread to distant parts of the peritoneum (the lining of the abdominal cavity) (M1b).

863- a patient with a large nodule in the nose which is painful and talangectasia on the face you will give: a) deoxycycline (correct) b) clindamycin c) retenoid 161

864-18 years old not sexually active came to your clinic complaining of missed 2 period with sever abdominal pain on examination abdomen can't examine because sever tenderness what you will do ? Pregnancy test Ultrasound progesterone 100 mg for 10 days 865- Which of the follwing drug used in mycardial infaction to prophylaxsis against arrythmia ? Metoprlol Adenosin Atropin Ca Channel blocker _________________________________________________________________________ _ 866­ In a day care center10 out of 50dovelop red eye. another 30 develop same condition in the next 2 week , what is the attack rate a) 40% b) 60% c) 80% d) 20% The term is defined as the number of exposed persons infected with the disease divided by the total number of exposed persons

So 10+30/50 =80 867­ Elderly patient who was smoking 2pack /day for 35 years complaing of shortness of breath X ray done show plural effusion plurocentesis show PH less than 7 What is the diagnosis ? Cardiopulmonary edema Empyema Brochogenic carcinoma 868­most specific and sensitive Ix for renal stone KUP IVP U/S CT (correct)>>All stones are detectable on CT scans except very rare stones composed of certain drug residues in the urinesuch as from indinavir.

869-Side effect of atropine : Dryness of the mouth Adverse reactions to atropine include ventricular fibrillation, supraventricular or ventricular tachycardia, dizziness, nausea, blurred vision, loss of balance, dilated pupils, photophobia, dry mouth and potentially extreme confusion, dissociative 162

hallucinations and excitation especially amongst the elderly. These latter effects are because atropine is able to cross the blood-brain barrier. Because of the hallucinogenic properties, some have used the drug recreationally, though this is potentially dangerous and often unpleasant 870- diastolic" blowing" murmr best to heard in the left sternal border increasing with squating imp. AS AR (correct) MS MR MVP Valve incompetence allows backflow from aorta to ventricle. Descriptio Caused by rheumatic heart disease, n endocarditis, aortic diseases (Marfan’s syndrome, medial necrosis), syphilis, ankylosing spondylitis, dissection, cardiac trauma. Heard with diaphragm, patient Type and sitting and leaning forward; AustinDetection Flint murmur heard with bell; ejection click heard in 2nd intercostal space Early diastolic, high pitch, blowing, Findings often with diamond-shaped on midsystolic murmur, sounds often Examinati not prominent; duration varies with on blood pressure; low-pitched rumbling murmur at apex common (Austin-Flint); early ejection click sometimes present. In left ventricular hypertrophy, prominent prolonged apical impulse down and to left Pulse pressure wide; water-hammeror biferiens pulse common in carotid, brachial, and femoral arteries. 163

Heart Sound S1 soft; S2 split may have tambourComponen like quality; M1 and A2 often ts intensified; S3-S4 gallop is common. 871- the most lethal injury to the chest is pneumothorax rupture aorta (correct)>>Rupture of the thoracic aorta is the most lethal injury following blunt chesttrauma

flail chest cardiac contusion 872- lethal injury to the chest after motor accident: puncture lung spontaneous pneumothorax rupture aorta (correct) flail chest all of the above _________________________________________________________________________ __ 873-in acute abdomen the type of respiration is: rapid and shallow (true) rapid and deep slow and shallow slow and deep _________________________________________________________________________ __ 874- pregnant female complaining of constipation what is the managment : tell her to to stop taking the iron supplements give her fibers give her bulking agents – all of the above Eat high-fiber foods such as whole-grain cereals and breads, brown rice, beans, and fresh fruits and vegetables every day. Adding a couple of tablespoons of unprocessed wheat bran (available at health food stores) to your cereal in the morning and following it with a glass of water can help, though it may take a few days before you notice a difference.  Drink plenty of water – at least six to eight glasses a day. A glass of fruit juice every day, especially prune juice, can also be helpful. Some people find that drinking a warm liquid right after waking up helps get things moving.  Exercise regularly. Walking, swimming, riding a stationary bike, and yoga can all help ease constipation and leave you feeling more fit and healthy.  Your bowels are most likely to be active after meals, so make time to use the bathroom after you eat. Listen to your body. Never put off going to the bathroom when you feel the urge.  If your prenatal multivitamin contains a large dose of iron (and you're not anemic), ask your healthcare provider about switching to a supplement with less iron.

164



If the measures above don't help, talk to your caregiver about taking an over-the-counter fiber supplement or stool softener.

_________________________________________________________________________ _ 875­ patient has terminal ovarian carcinoma came to u complaining of dull aching abdominal pain when u did xray u found a 10 cm metalic clamp what will u do : Call your lawyer for advice lol call the surgeon for advice no need to inform the patient since she is terminal and would not find out about it inform the patient and inform the surgeon and tell her it will dissolve most likely in a ..... (certain abount of time dont remeber i think it was a month ) (correct) 876­which one of the following Rx has lowset risk of tardive dyskinesia: Clozapine >>clozapine has been shown to have a lower risk of tardive dyskinesia than older antipsychotics

chloropromazine haloperidol ___________________________________________________________ 877-family came to you complaining that their son sees humans as (something... objects i think it was innate objects not sure ) and plays alone and doesn’t play with other children and says "you" when he wants to say "I" which one of the following should not be done for the management of this Patient: narcoleptic medication high ..... care program in school mood stabilizers 878-patient male suddenly had bahevoral and cognitive imparment and now sees a monkey in the room most likely Dx :  schizophrenia  Dementia like in parkinsonisim  delrium  depression _________________________________________________________________________ ___________________________ 879-which of the following is correct about use of systemic retiniods : *teratogenic(correct) _________________________________________________________________________ ___________________________ 880-bupropion is contraindicated in which of the following : 165

*Hx of eating disorder ( Contraindicated in bulemia sure ) (correct) bupropion should not be prescribed to individuals with epilepsy or other conditions that lower the seizure threshold, such as alcohol or benzodiazepine withdrawal, anorexia nervosa, bulimia, or active brain tumors.

881-8TB outbreak ..and one pt. come to doing tubercalin test and it's negative .. what to do?? a- BCG b- isonized c- rifampin 882- baby with congugated hyperbilirubinemia: Biliary atresia(correct) ABO comp G6PD 883­ ld with URTI what is the most helpfully sign that it is viral: Colorless nose discharge

Clinically significant rhinorrhea is more characteristic of a viral infection rather than a bacterial infection. In viral URI, secretions often evolve from clear to opaque white to green to yellow within 2-3 days of symptom onset. Thus, color and opacity do not reliably distinguish viral from bacterial illness.

_________________________________________________________________________ _ 884-child with picture of SCA he should be maintained on : Penicillin and folic acid (correct) 885-signs of androgen excess and ovarian mass , most likely tuner : Sertoli-Leydig cell tumour (correct) 886-girl with hirsitism , deep voice , receding hair line : Androgen excess (correct) 887- pregnant in the third trimester came with pain less vaginal bleeding : Placenta previa(correct) 888­ picture of child with red rash on flexor surfaces : Atopic dermatitis (correct )

Flexural involvement in childhood atopic dermatitis. 166

______________________________________ 889- child with round palpable red rash on his right leg no pain or itching for long time : - granuloma annular - tenia corpora -erythema nodosum -migratory __________________________________________________________ 890- the goal of early management of inflammatory acne: - to prevent physical scar -to prevent spread of infection 891- prevention of malaria Eradication of vector and protect against bites (correct) http://www.netdoctor.co.uk/diseases/facts/malaria.htm 892- case of TB , what knd of injections u will give the contacts : BCG 893- a picture of Snelling chart the q was how far should the patient stand : 3m 6m (correct) 9m 894- pt with epistaxis , what is the most apropriate initial management : Tampon , direct pressure on the soft part of the nose , (correct) do nothing . 895- Sickle cell anemia patient non painful loss of vision in left eye, on examination afferentflame sing and macula get??, what is the cause? - Retinal detachment - Central retinal Artery occlusion - Central retinal Vein occlusion - ??? 896- Patient with Obsessive compulsive disorder we need to: A Decrease serotonin in the blood B Increase Serotonin in the blood C Increase sensitivity D Decrease synthesis 897- Patient came to ER complain of pluratic chest pain and SOB. On Examination the left lung is hyper resonant and no breath sound. What is the diagnosis: 167

A B C D E 898A B C

Pulmonary effusion Pneumonia MI Cardiac Temponate Pneumothorax (correct) Treatment of Pruritic Folliculitis: Topical Antibiotic Oral Antibiotic Oral steroid Treatment Pruritic folliculitis of pregnancy is typically treated like mild acne. Benzoyl peroxide has been used with some success, but antibiotics are not needed. Oral antihistamines are useful to treat the itching.

http://dermatology.about.com/cs/pregnancy/a/prurfoll.htm _________________________________________________________________________ __ 899-51 year old male Hb7 MCV 112 AST 250 with Giant cells, whats the diagnosis: A B12 deficiency anemia B Folic acid deficiency anemia C Alcoholic anemia D Thalasemia E Iron deficiency Anemia 900- Patient was diagnosed to have Otitis media today you examined the patient he is fine tempanic membrane is no longer erythematus but there is collection of fluid behind it, whats your next step: A Do Nothing B Decongestion C Antibiotics 901- Patient complaining of vetligo and he must hold something while walking and sitting down, This is found in 75% of patients taking : A INH side effect B Penicillin side effect C Streptomycin side effect (correct) D Allergy to penicillin E One more drug side effect _________________________________________________________________________ __ 902-9year old boy cam to PHC with URTI and swap was taken and sent home, after 5 days the result was Group A streptococcus and then you called the family and they told you the boy is fine and no symptoms whats you next step: A Give Ceftixim IM one dose B Penicillin for 7 days C Penicillin for 10 Days 168

D Do Nothing 903-After start ttt of depression for Pt. who show improvement, the risk of suicide : Increase  Decrease (correct)  The same after and before ttt  Will not suicide at all 904-the symptom/sign that comes 2ry rather than presented symptom in panic pt.  tachycardia  epigastric pain  chest pain  phobia 905-Mechanism of Action of drugs that inhibit Conversion of estriol to

estrogen . (I forgot the exactquestion but it mentioned about ovulation and who inhibits conversion of esterone toestrogen?) Options were: aAromatase inhibitors synthesis of estrogens starts in theca interna cells in the ovary, by the synthesis of androstenedione from cholesterol. Androstenedione is a substance of moderate androgenic activity. This compound crosses the basal membrane into the surrounding granulosa cells, where it is converted to oestrone or oestradiol, either immediately or through testosterone. The conversion of testosterone to oestradiol, and of androstenedione to oestrone, is catalyzed by the enzyme aromatase. Oestradiol levels vary through the menstrual cycle, with levels highest just before ovulation.

906-year old female patient of Cushings syndrome, had hip fracture falling off stool, what will you screen for while also treating her fracture: Hyperparathyroidism Osteomyelitis Osteoporosis Osteomalacia 907-Drug table given each with3-4drugs, question which group causes hyperuricemia. ABCD (I choose the group which had anti-neoplastics.)

The principal drugs that contribute to hyperuricemia by decreased excretion are the primary antiuricosurics. Other drugs and agents include diuretics, salicylates, pyrazinamide, ethambutol, nicotinic acid, ciclosporin, 2-ethylamino-1,3,4-thiadiazole, and cytotoxic agents 169

908- Child 3 weeks ago had chicken pox, came to ER c/o sob, x-ray shows enlarged epiglottis, what is the cause? - Hemophlus influ, type b - Diphtheria pertusis - Rubella - Measles 909-2 years old child fall down in homein x-ray there is spiral # in radial bone the best management : -call pediatric. -call orthopedic. -splint. -open for fixation. 910-female married since four month and she noticed her husband washing his hand several times the most likely diagnosis: obsessive compulsive disorder 911-pt. admitted with pneumonia and the vaccine for this pt. is: -pneumonia with H.influnza -influenza alone. -pneumonia alone. 912-pt. have peptic mass the most common organism for infection: -H pylori -HPV -HIV 913-pt have swelling in lower eye lid and the lid was erythemic and edemoutis with hair inside make corneal ulcer the dx: -entropic. -extropic 914-evidence based medicine: -as in text book. -according to departmental policy. -according to latest published articles. -according to strong scientific evidence. 915-16 wk GA with ++glycosuria FBS:4.4, 1Hr PP 8.2 , 2Hr PP 7.2: -renal glycosuria?? -GDM. -K.M syndrome 916-what is the best source of iron in a 3 month old infant? -breast milk. -low fat cow milk. -yellow vegetables. -fruit. -iron fortified. 170

917-#pt with bilateral infiltration in lower lobe (pneumonia )which organism is suspected : -ligonella -klibsella -strept pnemoniae - staph -pnemococcus pnemonia 918- 33 year old make C/O of pain in his lip and right check . Pain was stabbing like triggered with touch. O/E, cranial nerves were intact , The best Rx Is: a- Oxcrazepine b- Propanol c- Ergotamine d- Lithium 919- Avoid with abnormal ALT >>(read about hyperlipidemia drug) ?!! HMG coA 920-isolated closed Fracture femur treatment is:

a- internal fixation with plate b- Internal fixation with antegrade intramedullary locked nail ( Sabiston 17th ed page 563 )?? c- External fixation with intramedullary locked nail d- traction & balance e- cast around hip

The method of fixation of femoral shaft fractures has become fairly standardized. The treatment of choice for closed fractures and types I through IIIA open fractures is closed, locked IM nailing. In contrast to open reduction methods, this practice reduces bleeding and soft tissue disruption at the fracture site. These minimally invasive techniques reduce perioperative stress and decrease the incidence of infection and nonunion.

921-27 yr old lady primi 35 wks pregnant, presented with mild Pre-eclampsia , BP 140/? Edema in her hands & feet, best treatment is: f- Immediate delivery g- Diuretics h- Send home? i- Hospitalize & materno-fetal monitoring ( this is the most likely answer

Johns hopkins manual of gynecology and obstetrics 3rd ed Pages 183-184 Mild pre-eclampsia i. If the pregnancy is >37 weeks, then the patient should be managed as follows: 171

1. If cervix is favorable (or patient is noncompliant), then proceed to induction of labor. 2. If cervix is unfavorable (bishops score <6), then close maternal and fetal observation is essential. a. Fetal—Ultrasound for growth/AFI, and, if reassuring, no further sonography is required barring a progression in symptoms or signs of poor fetal growth or distress; NST/BPP 1 to 2 times per week. b. Maternal—Weekly evaluation and laboratory testing, as described earlier. Weekly cervical exam—when favorable proceed to induction of labor. Despite an unfavorable cervix, induction of labor should be initiated by 40 weeks' gestation. ii. Similarly, if the gestational age is >34 weeks and is accompanied by progressive labor, preterm premature rupture of membranes, abnormal fetal testing, or growth restriction, the patient should also be delivered. iii. Outpatient management. Some compliant patients with mild preeclampsia (BP <150/100, 24-hr urine protein <1 g, no symptoms, normal liver transaminases and platelet count) can be followed from home. 1. Outpatient management with decreased physical activity. Strict bed rest is not recommended (3). P.183 2. No antihypertensives—not shown to improve perinatal outcome (14) 3. Monitoring for symptoms of pre-eclampsia; daily kick counts 4. At least, weekly blood pressure checks and physical examinations that evaluate for signs of worsening preeclampsia 5. Nonstress test/biophysical profile 1 to 2 times per week; ultrasound for growth/AFI every 3 to 4 weeks 6. Laboratory testing: baseline 24-hour urine protein collection and weekly laboratory testing for platelet count, liver enzymes, and serum creatinine iv. Inpatient management. Management of these patients is essentially the same, but monitoring is more intensive by hospital personnel.

922-Not use in the prevention of preeclampsia with + protein urea & LL edema : j- Admission &bed rest k- Diuretics ( if you are understanding the underlying physiology you will exclude this answer ) l- Non-stress test m- Regular sonogram of baby 923-

172

40 yr old male with 4 days history of sudden eruption over the entire body including palms & feet : n- erythema nodosum o- erythema multiforme p- pit. rosea There is no enough information to diagnose the case as whether it is itchy or not but generally speaking it is either Pityriasis rosea ( more likely) or Sec. Syphilis but it is rare now and in 75% it doesn’t involve face ____________________________________________________________ _ 925-urticaria, all true EXCEPT: q- can be part of anaphylactic reaction r- is not always due to immune reaction s- always due to deposition of immune complex in the skin ( due to increase permeability of capillaries ) t- due to ingestion of drug u- due to ingestion of strawberry

926-10 yr old boy woke up at night with lower abdominal pain, important area to check: v- kidney w- lumbar x- rectum y- testis (the Q is not clear for me but it seems to be related to testicular torsion or something in inguinoscrotal area

927-All are true about hoarsness in adult , EXCEPT :

z- due to incomplete opposition of the vocal cord aaif > 3 weeks : need laryngoscopy abif due to overuse, advise to whisper a few weeks accommonly seen in bronchus Ca adfeature of myxedema I can't judge _______________________________________________________________ _ 928- years old boy for evaluation of short stature. His height is of 6 year old & bone scan of 5.5 years ,, Dx is: aesteroid therapy afgenetic agconstitutional ahhypochondroplasia (not sure) 173

ai- hypothyroidism ( not mentioned in our exam) _______________________________________________________________ 929- Diagnosis of Alzheimer confirmed by: CT brain EEG Neurological examination None of the above(investigation is aimed at excluding other treatable causes of dementia, as histological confirmation of Dx usually occurs only after death Davidson's 19th 1173

930-12 yr old girl with malaise, fatigue, sore throat & fever. On examination:

petechial rash on palate, large tonsils with follicles, cervical lymphadenopathy & hepatosplenomegaly. All are complications EXCEPT: Aplastic anemia Encephalitis Transverse myelitis Splenic rupture Chronic active hepatitis

931-1 month old with massive hepatosplenomegaly, bluish skin nodules, & lateral neck swelling, the next step is: CBC lumber puncture Do EBV serology BM scan ( It seems to be congenital Leukemia) Liver biopsy

932-8 month old baby came with dehydration, fever 40 C, poor feeding &

convulsions. depressed ant. Fontanelle, vomiting, & crying with red ears. No neck stiffness. Her 3 yr old brother is asymptomatic. What is the most important investigation to do: Blood culture CBC & differential CSF examination ( Our Prof. told us that british says if meningitis crosses your mind do LP ) provided that C/P is not specific in this age Chest xray Urine analysis

933-17 year old boy presented to the ER complaining of sudden onset of

abdominal pain & leg cramps, he had history of vomiting2 days ago, he was dehydrated . 174

Na = 150 , K = 5.4 ,, glucose = 23mmol The best initial investigation is CBC Blood culture ABG ( tha Dx is DKA) Urinanalysis (dipstick) U/S Iremember that this option was Serum amylase ____________________________________________________________ _ 934-young age male presented after RTA with injured membranous urethra , best initial ttt is : Passage of transurethral catheter Suprapubic catheter Perineal repair Retropubic repair Transabdominal repair

935-young male presented to ER with a stab wound in his abdomen , u should:

should Explore the abdomen observe patient & not explore if vitals remain stable Exploration depend on U/s Exploration depend on DPL Exploration peritoneum penetrated ____________________________________________________________ ____ 936-Contraindication of gastric lavage if the ingested material is: Aspirin diazepam Dry clean (clorex) Corrosive Castor beans Vit D

937-65 year male presented with 10 days Hx of hemiplagia , CT shows : infarction , he has HTN. He is on lisonipril & thiazide , 2 yr back he had gastric ulcer . ttt that U should add : continue same meds Aspirin 325 aspirin 81 warfarin dipyridamole ( Antiplatlet agent) 175

938-All of the fallowing are criteria of subarachnoid hemorrhage EXCEPT: Paraplegia ( Davidson's 19th 1162) confusion nuchal Rigidity Due to berry aneurysm rupture Acute severe headache ____________________________________________________________ ____ 939-After infarction , the patient become disinhibeted , angree & restless . The area responsible which is affected: premotor area temporal area pre- frontal area ( Davidson's 19th 1148)

940-All are true about the best position in hearing the murmurs, EXCEPT: supine : venous hum sitting : AR sitting : pericardial rub ( opinion : according to my knowledge no special position for it to be accentuated) supine : innocent outflow obstruction Lt lateral in : MS

941-All are true about the best position in hearing the murmurs, EXCEPT:

supine : venous hum sitting : AR sitting : pericardial rub ( opinion : according to my knowledge no special position for it to be accentuated) supine : innocent outflow obstruction Lt lateral in : MS ____________________________________________________________ _ 942-3 year old child needs oral surgery & comes to your clinic for checkup. On examination 2/6 continuous murmur , in upper Rt sternal borders that disappear with sitting , next step: Give AB prophylaxis Ask cardiology consult Clear for surgery Do ECG 176

943-Glue ear

Managed by grommet tube ( Nelsson 19th 1955) Lead to sensorineural hearing loss Pus in middle ear Invariably due to adenoid

944-12 months baby can do all except: Walk with support one hand Can catch with pincer grasp Can open drawers Response to calling his name Can play simple ball

945-max dose of ibuprofen for adult is : 800 if they mean by dose 1600 3000 3200 per day

946-Regarding SEM (standard error of the mean): SEM is observation around the mean Standard deviation is measure of reliability of SEM Is bigger than SD Is square root of variance Standard deviation advantage can be math manipulated standarderror is as a measureof the precision of the sample mean.

947- Indications of surgery in crohn’s disease internal fistula external fistula intestinal obstruction Stagnant bowel syndrome ____________________________________________________ 948-45 yr old lady presents with nipple discharge that contains blood. What is the MOST likely Dx: ductal papilloma ducta ectasia fibroadenoma duct CA

949-after aspiration of cystic mass in the breast the result was clear fluid, next step a-Send the aspirated content for cytology and if abnormal do mastectomy 177

b-Reassure the patient that this lump is a cyst and reassess her in 4 weeks c-Book the patient for mastectomy as this cyst may change to cancer. d-Put the patient on contraceptive pills and send her home

950-after 2 wks ant. wall MI , old age female developed sudden leg pain , it is pale & pulsless. Dx : acute arterial thrombus acute arterial embolus DVT Ruptured disc at L4-5 with radiating pain Dissecting thoraco-abdominal aneurysm ____________________________________________________________ _ 951-a 34 yr old divorced lady complains of 15 months amnorrhea , FSH very high , Dx : Pregnancy ovulation Premature ovarian failure Hypothalamic lesion Pituatary microadenoma

952-he developed severe pain over the wound site , with foul smelling discharge , his temp is 39 & HR is 130/min . Gram stain showed G+ve rodes with terminal spores , ttt Massive IV pencillin V clostridium antitoxin wide surgical debridement chlormphinicol wide surgical debridment & Massive pencillin V

953-ectopic pregnancy, all true EXCEPT: 20% ovarian doubling HCG useful clinical tool empty uterus + HCG before 12 wks is Dx laparascopy can dx it ________________________________________________________ _ 954-a 28 yr lady with 7 week history of amnorrhea has lower abdominal pain , home pregnancy test was +ve , comes with light bleeding, next step: Check progesterone HCG Placenta lactogen 178

Estrogen Prolactin ____________________________________________________________ _ 955-All causes hyperprolactenemia, EXCEPT: pregnancy acromegaly methyldopa allopurinol Hypothyroidism __________________________________________________________________________________________________ ______

956-complication of long term use of steroid: asthma Breast CA Other Ca myopathy in pelvic girdle osteomalacia

957-All are complications of long term use of phenytoin, EXCEPT: Ataxia osteoporosis Osteomalacia Macrocytosis

__________________________________________________________________________________________________ __

958-physiological cause of hypoxemia hypoventilation improper alveolar diffusion perfusion problem(ventilation-perfusion mismatch) elevated 2.3 DPG>>increase o2 supply in the blood.

959- A 15 yr old boy came to your clinic for check up. He is asymptomatic. His

CBC showed: Hb 118 g/l WBC 6.8 RBC 6.3 (high) MCV 69 (low) MCH (low) Retic 1.2 (1-3)% what is the most likely diagnosis? Iron deficiency anemia Anemia due to chronic illness β-thalssemia trait Sickle cell disease Folic acid deficiency ____________________________________________________________ _ 179

960-Hb electrophersis done for a patient shows HbA1=58% , HbS = 35% , HbA2 = 2% , HbF = 5 % , Dx : Thalasemia minor Thalasemia major Sickle cell trait Sickle cell anemia Sickle cell thal.

961-first sign of LSHF orthopnea dyspnea on exertion pedal edema PND chest pain

_______________________________________________________________________________________ __

962-all can cause congenital infection IUGR, EXCEPT: Rubella CMV Syphilis HSV II Toxoplasmosis ____________________________________________________________ 963-75 yr old female with 2 days hx of MI is complaining of abdominal pain , vomiting , bloody stool . X-ray shows abd distension with no fluid level , serum amylase is elevated. Dx : Ulcerative colitis acute pancreatitis Ischemic colitis Diverticulitis ____________________________________________________________ _ 964-CCB drugs like verapmil , dilitazem, nifedipine are effective EXCEPT: Prinzmetal angina Hypertension Atrial tachycardia Ventricular tachycardia Effort angina ____________________________________________________________ _ 180

965-a 5 day old child vomited blood twice over the last 4 hr , he is healthy , active & feeding well by breast , Dx : esophigitis esophageal varices gastritis duodenal ulcer cracked maternal nipple

_________________________________________________________________ __

966-5 yr old seen in ER presented with fever & sore throat , which of the fallowing suggest viral etiology : Presence of thin membrane over the tonsils Palpable tender cervical LN Petechial rash over hard or soft palate absence of cough Rhinorrhea of colourless secretion

967-The following are complicationsof laproscopic cholecystectomy EXCEPT: Bile leak Persistent pneumoperitonium shoulder tip pain ascites Supraumbilical incisional hernia ____________________________________________________________ _ 968-one of the fallowing drug combination should be avoided :(the same in alqaseem but all choises are here) Cephaloridine & paracetamol Penicillin & probenicid Digoxin & levadopa sulphamethaxazole & trimethoprim tetracycline & aluminum hydroxide

969-40 yr old male presented to ER with 6 hr hx of severe epigastric pain, radiating to the back like a band , associated with nausea . No vomiting , diarrhea. No fever . On examination he was in severe pain & epigastric tenderness. ECG was normal, serum amylase was 900 u/l, AST & ALT elevated double the normal. Which of the following is the LEAST likely precipitating factor for this patient: Hypercalcemia chronic active hepatitis 181

chronic alcohol ingestion hyperlipidemia cholelithesis 970-Which of the following not transmitted by mosquitoes Rift valley fever Yellow fever Relapsing fever (caused by ticks) Filariasis Dengue fever __________________________________________________ 971-A on-opaque renal pelvis filling defect seen with IVP , US revels dense echoes & acoustic shadowing , The MOST likely Dx: blood clot tumor sloughed renal papilla uric acid stone crossing vessels

972-coarctation of the aorta in commonly associated with which of the following syndromes? A)down b)turner c)patau d)Edward 973-46 yr old female presented for the third BP reading, high blood pressure 160/100 . she is not on any medication. Lab investigation showed Urea: normal Creatinine: normal Na=145 (135-145) K= 3.2 (3.5 – 5.1) HCO3= 30 (22-28) What is the Dx? Essential hypertension Pheochromocytoma Addison’s Disease Primary Hyperaldosteronism ____________________________________________________________ _ 974-32 yr old lady works as a file clerk developed sudden onset of lower back pain when she was bending to pick up files, moderately severe for 3 days 182

duration. There is no evidence of nerve root compression. What is the proper acrion: Bedrest 7-10 days Narcotic analgesia Early activity with return to work immediately CT for lumbosacral vertebra 975-fracture of rib can cause all except: pneumothorax hemothorax esophageal injury liver injury

976-anal fissure more than 10 days, which is true: Loss bowel motion Conservative management Site of it at 12:00 ____________________________________________________________ 977-after delivery start breast feeding :as soon as possible 8 hrs 24 hrs 36 hrs 48 hrs

978-All are true for the prescripsion of antidepresents ttt for patient with

depression & somatisation disorders, EXCEPT: Smaller doses may needed in elderly potential side effect should not explain 2 the patient , b/c he will develop it fluoxetine safe for elderly _______________________________________________________________ _ 979-the most specific investigation to detect pulmonary embolism is : perfusion scan pul angiogram ventilation scan CXR _______________________________________________________________ _ 980-obstructed labor, which is true: common in primi 183

excessive caput & molding are common signs most common occipto- ant can not be expected before labor ______________________________________________________________________________________________________ __

981-45 year old female come to the ER complaining of Rt hypochondrial pain which increases with respiration , on Ex there is tenderness over the Rt hypochondrium, Next investigation is X-ray US of upper abdomen CT

982- a 48 hour old newborn infant in critical care unit with respiratory distress and jaundice.HB 9g/dl, retic 4%,. Maternal Hx of previous normal term pregnancy without transfusion,blood typing shows hetero specifity between mother and child.Indirect Coombs test +ve.the most probable Dx is a- Sickle cell disease b- Thalassemia c- Maternal – fetal blood mismatch d- Hereditary genetic disease e-septicemia. 983­a disease lasts 2-3 wk with fatality rate 30%: a-incidence=prevalence. b-incidence >prevalence. c-incidence
e-norfloxacin. 986-Colle’s fracture: a-distal end of the radius. b-scaphoid fracture. c-around the elbow. d-head of the radius. 987-a child fell on an out-stretched hand and flexed elbow,exam showed swelling around the elbow with no radial pulse, best management : a-closed reduction. b-closed reduction then check radial pulse. c-open reduction.(because of the vessel involvement best way by open repair) d-cuff and collar for 3wks. 988-most common association with acanthosis nigricans: a-hodgkin lymphoma b-non-hodgkin lymphoma. c-Internal malignancy. d-DM e-insulin resistance. 989-xanthoma: a-on lateral aspect of the upper eyelid. b-hard plaque. c-around arterioles. d-is not related to hyperlipidemia. e-deposited in dermis. 990-patient suspected to have brain abscess,the most important q. in the history is : a-frontal sinusitis. (contiguous suppurative focus (45-50%) b-ear discharge. c-head injury. d-bronchioctasis. e-Hx. of vomiting. 991-the following are true about H. pylori except: a-related to gastric outlet incontinence. b-can cause gastritis but not related to duodenal ulcer. c-can be eradicated by ampicillin and metronidazole. d-there will be histological improvement after eradication. e-it can split urea. 992-60 Y/O lady on OCP 21 days a month having recurrent vaginal bleeding(spotting) after the stop of estrogen, best Tx: a-endometrial Bx. 185

b-papsmear of the cervix. c-add progestone . d-stop estrogen. e-abdominal US or laproscope. 993-most common site of gonococcus infection in females in: a-cervix. b-posterior fornix. c-urethra. 994-post D&C the most common site of perforation is the: a-fundus b-ant.wall of the corpus c-post. Wall of the corpus. d-lat.wall of the corpus. e-cervix. 995-regarding typhoid fever, all are true except: a-fever and red spots appear on the same time .(fever first then rash) b-can be completely eradicated even in the prescence of gall stones. c-transmitted by food ,milk and water. d-can be treated by quinolones. 996-high output HF causes include all except: a-anemia. b-MR. c-AV fistula. d-pagets disease. 997-a middle aged man having black spots on his thigh for years, it is starting to become more black with bloody discharge,the best management is to: a-wide excision.(malignant melanoma ttt) b-incisional Bx. c-cryotherapy. d-radiotherapy. e-immunotherapy. 998- Old patient .. stopped smoking since 10 years … suffering from shortness of breath after exercise but no cough … and there was a table Fev1=71% Fvc=61% FEV1/fvc=95% Tlc=58% What's the dx? a- Restrictive lung disease b- Asthma 186

c- Bronchitis d- Emphysema e- Obstructive with restrictive 999-its c/I to stop preterm delivery in the following condition: a-aminochoronitis. b-placental abruption. c-preeclampsia. d-A&B. 1000­PPH happens more commonly with: a­multiple pregnancies.(due to increased risk of uterine atony) b­anemia. c­preterm delivery. d­antithrombin iii deficiency. 1001­Before you start instrumental delivery it is important to check if there is : a­face presentation. b­CPD c­breech presentation. d­cord prolapse. 1002­in occipitoposterior malpositioning of the fetal head ,all of the following are true  except: a­10% of all vertex deliveries. b­it causes significant delay of labor duration compared to the anterior presentation. c­andriod pelvis is a predisposing factor. d­flexion of the head helps the rotation to the ant. Position. 1003­important tools for listening to a patient include: a­using tools for asking. b­imagination. c­using similar words and expressions as the patient. d­a sense of humor. e­all of the above. _________________________________________________________________________ _ 1004­the mechanism of action of heparin: a­activation of antithrombin iii _________________________________________________________________________ _ 1005-Cover one eye onother go laterally? Strabismus Ambylobia 3rd nerve palsy 187

1006-a 6 year old girl presented with low grade fever and arthralgia for 5 days. She had difficulty in swallowing associated with fever 3 weeks prior to presentation.physical examination revealed a heart rate of 150/min and pansystolic murmur at the apex. There was no gallop and liver was 1 cm below costal margin. The most likely diagnosis is: a-bacterial endocarditis. b-viral myocarditis. c-acute rheumatic fever. d-pericarditis. e-congenital heart failure. _________________________________________________________________________ _ 1007- What is the most common congenital hear disease associated with rheumatic heart disease ? Asd Vsd Coacotation of aorta 1008- Child with URTI then complained from ear pain on examination there is hyperemia of TM &+ve insufflations test he tri 2 drug no benefit what is the best TTT>>> ugmentine azithromycin ciprofloxacin steroid??

1009-Our target hb A1C >> in DM 6 8 9 10 1010­Check pt after RTA; LOC 1011­3m baby with hx of broncholities >> 188

cause RSV 1012­ - Coronary artery disease atherosclerosis inside artery or lumen ?!! _________________________________________________________________________ _ 1013- Heart receive blood through >> aorta constrict IVC dilate Increase pul resistance _________________________________________________________________________ _ 1013- Pt fall from stairs >> no air entry Mange by ; ENdotracheal entbation , oxygen , 1014­Most common cause of otitis media all age >> staph strept . pneumonia 1015-child with proptosis , red eye , restrict eye movement , normal examination: Orbital cellulitis 1016- Psychosis postpartum ?!! insidious onset common usually suicide 1017­ HTN with hyperaldosternism ?!! spironlCtone 1018­ Patient admitted as a case of emphysema, according to the vaccine what you will do a)give pneumococcal vaccine now b)give flu vaccine now c)give all vaccine 2week after discharge d)give flu vaccine now and pneumococcal vaccine 4week after discharge

189

1019- what is most sensitive for DX of duodenal ulcer : a- Epigasteric pain starting 30-60 min after the meal b- Epigasteric pain staring immediately after a meal c- Increasing of pain when lying supine d- Pain radiating to the back 1020- The greatest method to prevent the diseases : a- Immunization b- Genetic counsling c- Enviroment modefication d- Try to change behavior of people toward health?? e- Screenig 1021-/least effect on tardia dyskinesia : a. halipridol b.respridol clozepine _________________________________________________________________________ ___________________________ 1022-pt received varicella vaccine after 30 min he developed itching ….. treatment is : Subcutenous epinephrine 1023-case scenario pt with HZV ttt : a. acyclovir for 3-5 days b. acyclovir and refer for ophthalmology 1024- pt with hirshitism , obese , x ray showed ovary cyst she wants to

convieve best treatment : Clomophine citrate. 1025- adolescent with asymptomatic hernia : a.surgical is better than medical ttt b.contraindication to do surgery in reducible hernia c.can cause hypoinfertilty 1026- pt use antacid ,complain of vomiting and pain due to : a. GERD 1027- scenario about ectopic pregnancy B-HCG 5000 hemodynamically stable ttt: a.observation b.medical. c.laproscopy d.laprotomy. _________________________________________________________________________ ___________________________ 1028-effect of niacin is : 190

a.decrease uric acid . b.hypoglycemia c.increase LDL d.increase HDL e.increaase triglyceride _________________________________________________________________________ ___________________________ 1030-pt with DM and obese ,plane to reduce his wt is : a.decrease calori intake in day time b.decrease calori and increase fat c.decrease by 500 kcal/kg per week d.decrease 800 per day _____________________________________________________________________________________ ________________________________ 1031-Romberg sign lesion in : a. dorsal column b. cerebellum c. visual cortex

1032-ttt to increase fetal Hb in sickle cell disease : Hydroxurea

1033-angioedema due to use of : B blocker ACEI _____________________________________________________________________________________ ________________________________ 1034-fetal distrees in : a.early deceleration b.late deceleration

1035- Pregnant Teacher in her 20th week reported 2 of her student developed meningitis. Prophylactic Treatment: a) Observe for the sign of meningitis b) Meningitis Polysaccharide vaccine c) Ceftriaxone 500mg PO once d) Cefuroxime 250 mg IM or IV once e)Rifampicine 600 mg BD for 2 days 1036- treatment of erosive gastritis ? a-Antibiotics b- H2 blocker c- depend on the pt situation d- total gastroectomy e- sucralfate ______________________________________________________________________________________________________ __

191

1037-Patient 2 h after delivery have sever vaginal bleeding initial management ? Ergometrin Ringerlactate solution Blood transfusion 1038- Patient with digoxin toxcicty the most important to give ? Immune fab k 1039- female pt , with RTA ,she has bilateral femur fracture >>>like this scenarion , systolic blood pressure 70 >>>what will you do: a-Iv fluid b- blood tranfusion c1040- Long hx of pt with recurrent vomiting for 2 days Heamocrit 65 the doctor can report this result caused by Cytokine Glucagon C r protin Apoprotein 1041-secondary amenorrhea a-due to gonadal agenesis b-sheehan's syndrome c-It is always pathological 1042­ pt with DM and obese ,plane to reduce his wt is : a.decrease calori intake in day time b.decrease calori and increase fat c.decrease by 500 kcal/kg per week d.decrease 800 per day 1043-chickpeas.kidney beans and lentils contain which element of following bromide chromium iron selenium

192

1044­ what food causes bleeding in a patient on anticoagulates garlic spinach avacados ginko 1045­ Patient on asprin, phenyton for sizuers came to clinic for rotein follow up, on examination she has bilateral painless lymph nodes, no other symptoms or signs, lymph node biopsy showed hyperplasia. DDx: A- chronic lymphocytic leukemia. B_hodgkin lymphoma C- TB D-??? most likely it is side effect of phenytoin 1046­ Pt complaining of hypotension & bradycardia. Electrolytes show: dec.Na, & inc. in the following K,Cl,Urea. So the cause of this is: a. hyponatremia b. hyperkalemia c. hyperchloremia d. uremia 1047­old pt ,she have MI and complicated with ventricula tachycardia , , then from that time recive Buspirone he came with fatige >>>>normotinsive , pulse was 65 what INX must to be done a- thyroid function b- liver and thyroid 1048- patient with hypopigmented macules.loss of sensation.thickend nerves.diagnosis was leprosy.which type tuberculoid lepromatous borderline Loss of sensation is a feature of tuberculoid leprosy, unlike lepromatous leprosy, in which sensation is preserved.) Emedicine 1049­ An active 64-year-old male complains of dysphagia. Endoscopic biopsy confirms esophageal squamous cell carcinoma. A predisposing factor to this condition is: 193

a) Hiatus hernia b) Achalasia c) esophageal varices d) Diffuse esophageal spsm e) Mallory-Weiss syndrome

1050- ulcer on the nose with averted edges basal cell ca herper simplex 1051- Boy with nocturnal enurisis psychotherapy fail to show result yo will sart him on : Imipramin vassopressin Imipramin guanfacin Clonidin vasopressin Clonidin guanfacin 1052- pt 2 para 2 gravida had pco took cyclic progestrone,she is ona increased risk of endometrial cancer cervical dysplasia hip fracture _________________________________________________________________________ _1053- smelling sputum increase with lying down + clubbing 1-bronchectasis 2- ba 3- pneumonia 1054-2.female presented to er with HCL burn on her face there was partial thickness burn.management irrigation with water irrigation with soda bi carb immidiate debridement 1055-young female with left sided abdominal pain.no dysuria or change in bowel habit.history of hysterectomy 4yrs back but ovaries and tubes were preserved.on ex abd tender but no guarding.inv show leucocytosis and few pus cells in urine.there was also history of unprotected coitus with multiple partners. i didnot get the scenario well but i think it was salpingitis. management consult surgeon 194

oral antibiotics diagnose as ulcerative colitis _________________________________________________________________________ _ 1056-a picture of JVP graph to diagnose.patient had low vol pulse,low resting bp.no murmr.pedal edema. constrictive pericarditis tricuspid regurg tricuspid stenosis pulmonary hypertension _________________________________________________________________________ _ 1057-treatment of psoriasis: topical steroid _________________________________________________________________________ _ 1058-picture of pelvic x ray what is diagnosis normal paget disease spondylitis osteoporosis 1059- pt with vomiting, constipation pain and distention past history of appendectomy 7 month ago dX 1- mechanical IO 2- ileus 1060- In Pedia ,,IV fluid (LR) can be given at age: A 3 months B 8 months C 12 months D 24 months 1061- old aged female with atypical squamous cells of undetermined significance (ASCUS) on pap smear, started 30 day ttt with estrogen & told her 2come back after 1 weak, & still +ve again on pap smear, what's next: - vaginal biopsy - endometrial biopsy - syphilis serology coloposcopy and cervical biopsy cone 195

1062-advise to pt. to avoid food high in cholestrol - liver chicken tuna egg white 1063- pt with meniere disease advised to take low salt no caffiene low salt high caffiene high salt no caffiene high salt low caffeine 1064- most common psychiatric condition come with mania ? paranoid grandiosity 1065- bad breath smell with seek like structure, no dental caries & Ix are normal, what's the likely cause: - cryptic tonsillitis - Sojreen's synd. 1066- 24 y. Female with new Dx of DM2, she weared glasses for 10 years, you will advice her to follow ophthalmic clinic every: - 6 months - 12 months - 5 years - 10 years 1067- - normal child ,he want to walking , he have brother dead after walking , what of the following must be excluded before walking ??? a-PDA b-VSD C-hypertrophic cardiomyopathy D-!!! 1068- The best ttt for binge eating disorder: - cognitive - behavioral therapy - problem - solving therapy - interpersonal therapy _

196

1069- female pt ,KCO rheumatic heart , diastolic murmur ,complain of aphasia and hemiplegia , what will you do to find the >>>etiology<<< of this stroke: a-MR angiography b-Non-contrast CT c-ECHO D-ECG E-carotid doppler 1070- A case of a patient with polycythemia and develop itching after taking a bath .. a. increase histamine sensitivity b. abnormal histamine release 1071- pt with DM and obese ,plane to reduce his wt is : a.decrease calori intake in day time b.decrease calori and increase fat c.decrease by 500 kcal/kg per week d.decrease 800 per day 1072­ the most common complication following hemorrhoidectomy is : a. fecal impaction b. bleeding c. urinary retention d. infection

1073­ Pediatric came to you in ER with wheezing, dyspnea, muscle contraction (most probably asthma), best to give initially is: 1. theophylline 2. Albuterol nebulizers 3. oral steroids 4. oxygen 1074- ld man presented to u complaining of rectal pain mostly at night with itching .. what is the Dx: a. Hemorrhoids b. Gay bowel syndrome c. Proctalgia fugax 1075- 28 yrs old known case of sickle cell anemia hospitalized two times in the last two months because of abdominal pain, this time he present with abdominal pain, back pain, and chest pain.. what will you do: 197

a. Hospitalize the patient and give him analgesics and observe him b. give him IVF and treat him as an outpaient c. Referred the patient to Tertiary center specialized in his problem d. Give analgesics e. blood transfusion _________________________________________________________________________ _ 1076- diabetic pstient with ulcer in foot , not healing , not infected , high ? blood glucose a- high blood glucose stimulate bacteria to grow b- decrease phagocytosis c- dec. Immune system 1077­ on flow cytometric analysis of a sample of fetal thymus a certain population of cells is identified that is positive for both cd4 and cd8 cell surface Antigens . These cells are best characterised as which of the following cells ?! A- immature cortical T lymphocyte . B- mature cytotoxic T lymphocyte. C- mature helper T lymphocyte. D- antigen presenting cells. E- Natural killer (NK) cells . 1078- A case of a man who ride a motorcycle and make an accident then had a basal skull fracture .. he developed a loss of taste, and loss of sensation in the Anterior 2/3 of the tongue, and deviation of the angle of mouth .. if u will choose one nerve injury .. which nerve u will choose: a. CN I (Olfactory) b. CN III (Oculomotor) c. CN V (Trigemenal) d. CN VI (Abducens) e. CN VII (Facial) 1079- dysfunctional uterine bleeding : a. most common in postmeneposal women b.adolesent 1080- celiac disease severe form involve 1. proximal part of small intestine 2. distal part of small intestine 3. proximal part of large intestine 4. distal part of large intestine 198

1081- pt with moderatly sever acne valgarus best ttt oral isotretinoin topical retinoid topical clindamycine oral antibiotic 1082- Contraindicated in acute glaucoma management: a. Pilocarpine b. Timolol not sure c. B-blockers, CA inhibitors, NSAID, Mannitol d. Diprovin ?? e. contraindicated drugs(topiramate antiepliptic ,steroid eye, tricyclic antidepressant,Parkinson drugs,atropine,antispasmolytic ,antipsychotic D.... it is DIPIVEFRIN (alpha agonist). Used in open angle glucoma and contraindicated in acute angle glaucoma The same question came to my friend and the choices were: Pilocarpine - Timolol Dorzolamide - Flvin...(and this was the answer)

1083­ a colorectal carcinoma that invades the submucosa and has two positive lymph nodes and no metastasis is : a. stage 1 b. stage 2 c. stage 3 d. stage 4 1084- long case Pt.obese and newly Dx by FBS> 126 with long list of lab come to me in the exam screen all normal including liver function test On examination: pt had palpaple midly enlarge liver what you will give him: a) Biguanieds b) Sulphanylurea 1085- what is the definition of insomnia? inability to have immediate sleep when you are very tired disturbance of sleep cycle?? inability to get sleep even if you take medication 199

disturbance of sleep rhythm that person sleepy at daytime and insomnic at night 1086- which of the following is the first test that should be performed in a patient with lower GIT bleeding? a. nasogastric aspiration b. anoscopy c. proctoscopy d. colonoscopy 1087­pt with constipation . He had previous surgery in the past ( there is X- ray ) a- surgery for obstruction b-rectal decompression c- treatment of Ileus 1088­ yr old in his normal state of health presented with decrease visual acuity bilaterally without any defect in visual field his VA Rt eye= 20/100 VA Lt eye=20/160 fundoscopic exam showed early signs of cataract and drusen with irregular pigmentations. No macular edema or neovasculirization. The appropriate action beside antioxidants and Zn is: a. Refer the pt for emergency laser therapy b. Refere the pt for cataract surgery c. See the patient next month d. No need to do anything 1089- Male patient present with exercise intolerance, HG is 9 and MCV is 78 and positive fecal occult test. Upper GI scope show chronic gastritis. How u treat him: • Oral iron? • IV iron • Blood transfusion 1090­ Newborn, 28 w, 900 g, successfully resuscitated in delivery room , then in NICU he had PH 7.35, Pco2 42, Po2 63, what to do first: • IV bicarbonate infusion • Phototherapy • IV vancomycin • Start entral feeding glucose infusion

200

1091­ female pt ,KCO rheumatic heart , diastolic murmur ,complain of aphasia and hemiplegia , what will you do to find the >>>etiology<<< of this stroke: a-MR angiography b-Non-contrast CT c-ECHO D-ECG 1092­ female with positive urine pregnancy test at home what next to do: Sreum beta HCG CBC 1093­ Infant in respiratory distress ,hypercapnia , acidosis & have rhinitis , persistent cough +ve aglutenation test & the doctor treat him by ribavirin DX pertusus RSV 1094- ptn with pharyngo tonsilities he took antibiotic and improved in 2 days
1095­ 43y old female with irregular menses 3m back & 1-2d spotting what is next to do: US Human chorionic gonadotropin Placental ,,,,,,,,, ,,,,,,,,,,,,,,,,,,, FSH LH 1096­ Drug that will delay need of surgery in AR: a. digoxin b. verapamil c. nefidipine d. enalpril

1097-Notching on the lower edges of the fourth to the ninth ribs indicate enlarged intercostal arteries eroding the lower border of the ribs in cases of coarctation of the aorta 1098­- An outbreak of TB as a prophylaxis you should give : a) Give BCG vaccine b) Rifampicine c) Tetracycline d) H. influenza vaccine 201

1099­n old man who had stable angina the following is correct except: a) angina will last less than 10 min b) occur on exertion c) no enzymes will be elevated d) will be associated with loss of consciousness

_________________________________________________________________________ _ 1100-5 yr old adopted child their recently parents brought him to you with white nasal discharge. He is known case of SCA. What you will do to him: a) Give prophylactic penicillin

_________________________________________________________________________ _ 1101­a

patient with acne of several appearances open .. closed .. red .. it is most

likely: a) obstructive b) inflammatory 1102­70 yr old presented with wt loss, fatigue, anemia , upper quadtrant pain without any previous history, the stool sowed high fat he is a known somker: a) Acute pancreatitis b) Chronic pancreatitis c) Pancreatic carcinoma

1103­ ATRIBUTED risk: Difference btw incidence in exposed and incidence in non exposed 1104-tricky case:: young female with pain during menstruation and mood ‫ بس لما قريتها مضبوط طلعت‬PMS ‫ركزوا في الكيس لول وهله حسبت قصدهم على‬ A) 1 ry dysmenorrheal

1105-gush of bleeding in 9th month: a) Placenta privia

1106-best way in advance age to increase bone density in OA: a) Walking ................ b) High repletion and low resistance

1107-pt ttt from endocarditis likely of recurrence :

12% 1108- psycatric pt see alien talke to her and insertion of idea: Start antipsychotic ttt

1109- best way to kill dust mite

Wash sheet and clothes in hot water _____________________________________________________________________________________ ________________________________ 1110- which one make you relief when you aspirate a Brest mass: Clear serous fluid in the needle _____________________________________________________________________________________ ________________________________ 1111- mastitis with lactation: Cont. brest feeding 1112-pt. with celiac spore best diet: Gluten free 202

_____________________________________________________________________________________ ________________________________ 1113-Farmer with allergic conjunctivitis in spring and he can't avoid working what to advice to do at night a) Cold eye compression sure  b) Other not include antihistaminic 1114-To measure the cognition in old pt: a) Clock test b) Memory test my answer but I think A is the right answer  c) Other I did't remember

1115-0-Blue swelling below tung or inside lower lip: A. Ranula _____________________________________________________________________________________ ________________________________ 1116-pt with elevated TSH and elevated T3,T4 2ry hyperthyroidism _____________________________________________________________________________________ ________________________________ 1117- Reflux esophegitis: Mimic heart dis. _____________________________________________________________________________________ ________________________________ 1118- Barrit esophagus how to precced: f/u endoscopy for ............... to look for change in metaplasia ‫ينسيت مدة الفولو اب وينسيت الختيارات بس دورت ع الاجابه وطلعت صحيحه حتى الاجابه مو بالنص‬ ‫مكتوبه بس في اختيار شبه اللي كتبتو‬

1119-- About lyme to educate parents Wear long clothes to avoid bite my answer _____________________________________________________________________________________ ________________________________ 1120- Child with elbow and knee pain with decrease ROM ..in the back < 1cm red macule Lyme dis. ‫فكرت اينه اللي في الظهر عضة الجرثومه والله اعلم‬

1121-- 19 y.o yong male with good body and well muscular with bad mouth brith c/o Acne: He use anabolic steroid 1122- Child his mother let him to go to bathroom befor sleeping and avoid drinking befor sleep this mangment of: Enuresis

1123-Pt with meningitis what to give initially: Penicillin 1124- pt with liver dis. Jaundice Bx showed fibrosis which diet is good for him: Low protein diet not sure 203

1125-2months infant with white plaque on tongue and greasy ,past h/o clamydia conjunctivitis after birth treated by clinamycin what is ttt: a. Oral nystatin b. Topical steroids c. Topical acyclovair d. Oral tetracycline

1126-psycatric pt . with liver imparment best to give ?: a) lithum

1127- man walking in street and saying bad words to stranger , he is not aware of his conditiond he kept doing that as if he asked to , what is the description : a. flight of idea b. insertion of idea c. loosening of association ‫شكيت في الجابه ب بسبب المكتوب بالحمر بس اتخترت الجابه التخيره؟؟؟‬

1128-a mother came with her son who is 7 years old with poor concentration. Lack of intelligence and play and repeat some of his action .....................forget the rest a) Autism b) Hyper active disorder ‫في شي في السؤال تخلني اشك في الجابه التانيه بس نسيت اش هي‬

1129-pt with vesicle in mouth with gingivits and also vesicle in arm and leg most likely cause a.HSV type 1 b. HSV type 2

1130-early symptom of heart failure : a) b) c) d)

Orthopnia PND Palpitation Chest pain

1131-young adult obese with snoring when sleeping and some time get up from sleeping Best mangment : a) Reduce wt b) tonsillectomy _____________________________________________________________________________________ ________________________________ 1132- young adult in endemic area cripitation bilaterally with monopheseal sound in auscultation what to give vaccination : a) Hemophlous influenza b) Meningococcal _____________________________________________________________________________________ _______________________________ 1133- pt with frothy hemoptysis, palpitation >>>>>>>>>>> forget the rest it's long scenario a) Mitral stenosis b) Congestive heart failure c) CAD 204

Mitral stenosis cause frothy hemoptysis on cardiac exam>>middiastolic murmur in apex and malar rash on cheek Congestive heart failure is an important cause of pink frothy hemoptysis on cardiac exam>> S3+ basal crept.

1134-most benign vaginal bleeding: a) b) c) d)

Cervical polyp Myomyoma Endometrial hyperplasia I forget the exact sentience but it's related to dryness in menopausal women (atrophic vaginitis) ‫كل الختيارات باثولواجيكال ما عدا الخير‬ 1135- non hormonal ttt of premenopausal flushes: paroxitine

1136-mother after delivery have bad mood , depression , crying a lot for only 1 week , but she is o.k now Dx: A. Maternal blues (transiet condition) B. Post partum psychosis

1137- pt with pruritic foliclitis best ttt: A. Local antibiotic xx _____________________________________________________________________________________ ________________________________ 1138- pt. e hair loss in the rt. Temporal area. On examination there is elevated mass with come spacious yellow crust: ‫مني فاكره الكيس بالظبط‬ A. Spacious cyst ‫حااجه مزي كدا‬ B. Tricotelomania

1139-young male athletes with palpitation and............. maybe syncope and the fail

to do for Him something.......i'm sorry : A. Hypertrophic cardiomyopathy _____________________________________________________________________________________ ________________________________ 1140- which one of the congenital heart dis. Have least complication with............... I think endocarditis: A. ASD B. VSD C. PDA

1141- child fall from stairs came with mild injury to the nose, no bleeding and edema in the nasal sputum , ttt : a- Nasal packing b- Reassure c- Analgesia d- Refer to ENT

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1142- eye exam. corneal ulceration. her symptoms freq. repeated.. which on of the following is triggring for recurrence of her symptoms: 1- Dusts & pollen 2-HTN & hyperglycemia 3-dark and driving at night 4-ultraviolet light & stress ( this is the answer 100 % ) 1143- What is special about placenta abruption: a. Vaginal bleed b. Fetal distress c. Uterus pain and back pain d. Abnormal uterine contraction 1144- 24 Y/o man presented with 4 month Hx of diarrhea with streaks of blood & mucous. Ulcerative colitis was confirmed by colonoscopy. The initial therapy for this patient: a)oral corticostreiod b)azathioprine c)infleximabe d)5-Aminosalicylic acid e)Sulfasalazine 1145- I study done on 10,000 people for about 3 years in the beginning of the study 3,000 developed the disease and 1,000 on the end of the study what is the incidence: 100 12.5 10.5 0.1 1146- 45 years old female came to ER with acutely swollen knee + ballotment patella .. The most important to do is: MRI of the knee Aspiration Complete blood count Rhumatoid factor 1147- peritioial lavage when to say the amount is suffusion : 2 l blood 1000 wbs \ rbs 500 wbs 1148- 19- What best explain coronary artery disease: a- Noatherosclerosis b- Fatty deposition with widening of artery c- Atherosclerosis with widening of artery 1150­ Incidence is calculated by the number of: A. Old cases during the study period. 206

B. New cases during the study period. C. New cases at a point in time. D. Old cases at a point in time. E. Existing cases at a study period. 1151-9- secondary prevention one true: a- physician screening quetionaire about the use of tobacco is sufficient b- the screening of colon cancer is insufficient c- the screening of breast cancer is decreasing d1152-Which drug contra indication in cluster headache ? a. Buperbion b. Lithum c. valium 1153-Most common cause of recurrent tonsillitis is : - Group a beta hemolytic streptococcus - The other choises are virusis.. parainfelunsa rhinovirus.. http://en.wikipedia.org/wiki/Rhinovirus

1154-Child with leukemia he has septicemia from the venous line the organism is: a) E coli b) GBS c) Pseudomonas 1155-Baby born & discharge with his mother , 3 weeks later he started to develop difficulty in breathing & become cyanotic what is most likely DX : a- VSD b- Hypoplastic left ventricle c- Coarctaion of aorta d- Subaortic hypertrophy 1156-Man who is having a severe pain on his big toe with knee pain and examination revealed negative perferingent crystals: a) uric acid deposit secondary to synovial fluid over saturation b) Ca pyrophosphate secondary to synovial fluid over saturation 207

1157­ 6 years old child presents with straddling gait and in ability to stand or walk without support, he is irritable with vomiting 3 times, he has a history of chickenpox 3 weeks ago. O/E all are normal except resistance when trying to flex the neck, what is the most likely diagnosis: • Fradrich's ataxia • Acute cerebellar ataxia • Meningioecephalitis • Gullian Barre syndrome http://en.wikipedia.org/wiki/Acute_cerebellar_ataxia_of_childhood#Etiology

1158-a man fell down from the ladder, c/o SOB ( and i think cyanosis ), on exam breath sounds are decreased even in the right side ( this is how they wrote it !! ), u will do : needle thoracotomy insert endotracheal tube other options i forgot 1159­ Which of the following is true regarding antepartum (third trimester ) hemorrhage : a- Can be caused by polyhydrominos b- Rare to be associated with hypofibrogenemia c- Cervical problems are a major cause 1160­case infant has genital rash ( the rash spares genital fold ) not response to antibiotics , most likely Dx; A-candida albicans b-napkin dermitis (diaper dermatitis) c-contact dermatitis d- atobic dermatitis e- sebborich dermatitis 1161- Male patient complain of excruciating headache, awaken him from sleep every night with burning sensation behind left eye, lacrimation and nasal congestion. What is effective in treating him : • • • •

Ergonavine Sumatriptan SC Methylprednisolone NSAID

1162-34 yo female presented with cough , dyspnea for months , exam show cervical adenopathy and hepatomegally . To confirm the likely diagnosis you will do .. 208

1- liver biopsy 2- bronchoscopic lung biopsy 3-scalene nodal biopsy 4- ACEI level.

yes, lung biopsy to confirm the diagnosis of sarcoidosis. 1163-Fresh frozen plasma in what case ? a- Hemophilia a b- Hemophilia b c- Von willbrand d- Dic e- Coagulopathy form liver disease 1164-which of the following cause hirsutism ? a- Anorexia a- Digitalis b- clomiphine citrate d- OCP ______________________________________________________________________________________________________ _

1165­ pt with epilepsy came with Lt shoulder pain , on examination flattened contour of the shoulder, fixed adduction with internal rotation .. ur DX ?!!? a- Inferior dislocation b-subacromal post Dislocation c-subglenoid ant dislocation d- subclavicle ant dislocation e-sub…….. ant dislocatio

1166­pt with asthma on daily steroid inhaler and short acting B2 agonist what category: a- Mildintermittent b- Mildpersistent 209

c- Moderate d- Sever 1167­Pt with active hepatitis what medication should not to give : a- Ranitidine b- Heparin c- Atrovastsin

1168-A man who is having severe vomiting and diarrhea and now developed leg cramps after receiving 3 liters of dextrose .. he is having: a) hypokalemia b) hyponatremia c) hyperkalemia d) hypernatremia 1169-Pneumococcal vaccine : A not recommended in healthy child B cant be given with MMR C cant be given to child less than 2 years D if given to sickler and exposed to infection has to take pencilin 1170-Long scenario for pt smokes for 35 y with 2 packets daily, before 3 days develop cough with yellow sputum, since 3 hours became blood tinged sputum, X ray show opacification and filtration of rt hemithorax, DX: Bronchogenic CA acute bronchitis lobar pneumonia 1171-Post partum female with recurrent attack of hearing loss , which diagnosed as conductive hearing loss , on CT the is dehesion in the of semi circular canal diagnosis >>>> otosclerosis miner's Tuberus sclerosis 1172- True about dermatomyositis : 1-associated with inflammatory bowl dz 2-indicate underlying malignancy 3-present as distal muscle weakness 210

1173- newborn presented with conjunctivitis and O.M , whats the treatment i guess this is a case of infection with chlamyedia intrauterine , they asked about several AB there is no dyoxycyclin nor erythromycin 1174- Differences Btw dementia and delirium (read about it ) i picked Amnesia !! 1175- about shoulder that is Adducted and internally rotated (what is the mechanism of dislocation) 1-Anterior subclavicular 2- Ant 3-Post 4-POst 1176- anteriolateral placenta , term pregnancy , can't be felt when examiner admit his finger through the Cervix : 1-Low set placenta ?? 2-Marginal 3-normal 4-complete placenta previa 1177- Tinea capitis RX. 1-start Nystatin 2-wood's lamp (true) 1178- Rosacea case (redness patch on face with talangectasia ) what is the ttt Dyoxycyclin 1179- child smile at 1- at birth 2- 1month 3-2 months 4- 6 months _________________________________________________________________________ _ 1180- pt has GERD for 5 years , now EGD reveals >> columnar cell surrounded by Sq cell 1- Sq .c.c 2-Adenocarcnoma 3-barret esophgous 1181- old pt , has loin pain , U/S reveals bilateral hydroneprosis , whats the cause : 1-prostate cancer 2- bladder cancer 3- urethral stricture 1182- infertile women for 3 years with dysparunia 1- endometritis 211

2- Salpengitis 3-endometriosis (True) 1183-difficult consultation : 1- use medical term 2- open ended Q 3-close Ended Q = True 41184- hematology case … prophral blood smear reveals target cell =SCD 1185-old pt with progressive weakness of hand grip , dysphagia , …. 1-MG dz 2- Mysthenia gravis sx . 1186­ male singer with colon cancer stage B2 ; which of the following correct ? a- no lymph node metastases b-one lymph node metastasis c-2 === d-lymph node metastasis + distant metastasis 1187­ Young boy presented to the ER with inguinal mass, pain and vomiting. O/E the mass is tender to touch, erythemetous skin over scrotum, (blue dotes) in the pole of testis, intact cremasteric reflex , Dx is : a- Testicular torsion b- Testicular hematoma c- Incarcerated herniad-torsion appendix of testis 1188­ A middle age man presented with severe headache after heavy lifting objects. His BP was high. He was fully conscious. Examination was otherwise normal. the most likely diagnosis is: a) Subarachnoid hemorrhage b) Central HTN c) Tension headache d) Migraine?? e) Intracerebral hemorrhage 1189­ PT WITH UTI ALLERGIC TO SULFA AND PENICILLIN ? NITROFUNTON CEPHLAXINSMT 1190- bad breath smell with seek like structure, no dental caries & Ix are normal, what's the likely cause: - cryptic tonsillitis - Sojreen's synd. 212

1191- use of antibiotic in acne : A - to prevent spread B- to decrease scaring 1192- a 38 yrs old female … came to you at your office and her pap smear report was unsatisfactory for evaluation .. the best action is a- consider it normal & D/C the pt. b- Repeat it immediately c- Repeat it as soon as possible d- Repeat it after 6 months if considered low risk e- Repeat it after 1 year if no risk 1193- Mass in the upper back .. with punctum and releasing white frothy material… a- It's likely to be infected and Antibiotic must be given before anything b- Steroid will decrease its size c- It can be treated with cryotherapy d- It must be removed as a whole to keep the dermis intact?? 1195- A pregnant lady full term presented with agitation and change level of consciousness she is having difficulty breathing: a. Pulmonary embolism?? b. Pulmonary edema c. Amniotic fluid embolism 1196-Pt presented with nausea and vomiting and nystagmus with tinnitus and inability to walk unless he concentrate well on a target object. His Cerebellar function is intact: a. Benign positional vertigo b. meniere's disease c. vestibular neuritis

1197-tympanic mem. perforation in cases of cholesteotoma are commonly situated in : a- anterior part of mem. tensa b- centre of mem. tensa c- posterior superior segment d- posterior inferior segment of the tympanic membrane 1198­Peripheral neuropathy can occurin all except: a) Lead poisoning 213

b) DM c) Gentamycin d) INH 1199-child with 2 * 2 cm hair loss at the temporal area , normal examination , microscopic examination of hairs arround the area show clubbed and attenuated hairs , the diagnosis is : a- tinea capitus b- alopecia areata c-Trichotillomania d- Telogen Effluvium e-? 1200- What is the most important in councling a. Exclude physical illness b. Establishing rabbot c. Family d. Schedule appointement 1201-year old had an episode of rheumatic fever without any defect to the heart. The patient need to take the antibiotic prophylaxis for how long: a. 5 months b. 6 years c. 15 years IF :Rheumatic fever with carditis but no residual heart disease (no valvular disease†) 10 years or until age 21 years (whichever is longer).......IF: Rheumatic fever without carditis 5 years or until age 21 years (whichever is longer) http://www.aafp.org/afp/2010/0201/p346.html

1202­ Pt daily asthma , nothing at night, using herbal for 2 months with no improvement : inhalation salbutamol(the best answer) , high dose steroid inhaler , ipratrubium 1203- when an a cyanotic middle age adult has roentgenographic evidence of enlarged pulmonary arteries and increased lung markings, most likely diagnosis is: a) Ventricular septal defect(according to sle studing) b) Coarctation of aorta c) Pulmonary valvular stenosis d) Atrial septal defect e) Truncus arteriosus 214

1204-all of the following will improve the patient compliance except: a-making the appointment convenient? b-simplify the regimen c-writing the instructions clearly d-tell about the danger of missing doses e-involve the patient as active participant 1205- drug of choice of genaralized anexity dis. Is: -acetalopram -bubropione -buspirone -beat blocker 1206- Uric acid in body how the body removed by a-increase co2 execreation of uric acid in urin b-increase metabolism of uric acid in liver c-execretion of uric acid by lung In humans and higher primates, uric acid is the final oxidation (breakdown) product of purine metabolism and is excreted in urine

1207- A man travelled to Indonesia and had rice and cold water and ice cream. He's now having severe watery diarrhea and is severely dehydrated. Most likely he has: A. V. Cholera B. C. Difficile C. C. Perfringens D. Dysentery? E. Shigella 1208- Newborn has vomiting after every meal intake. The examination was normal and the only abnormality was dehydration. No other clinical signs. No tests ordered yet. What will you do? a- Order abdominal CT b- Reassure the parents c- Refer to GS d- Discharge on ORS 1209- child with SOB and runny nose came with fever (38 ) all the sign of respiratory distress there .. There is diffuse wheezing on the chest with prolonged expiration and inspiratory cracles ,, diagnosis: -viral pneumonia -bronchiolitis -croup -bacterial pneumonia 1210- pt came with fatigue , w.t loss and diarrhea .. He recived a blood transfusion when he was in kenea .. He has low grad fever .. The vitals 215

are stable .. Skin EX. There is contagiosum mollosum in groin ( i guess it written like this ) .. There is generalized lymphadenopathy and palpable liver ,, what is the diagnosis: -secondary syphilis -persistent chronic hepatitis B -HIV -acute lymphoma. 1211- the best description of the lesion in herpes : -soft tender chancer -firm non-tender chancer -raised tender papule -vesicle with fluid material -................ 1212- penis numbness after sitting for long time Pudendal Nerve Entrapment 1213- What is the organism that will growth in the agar in a sample from a cat bite ?! salmonella bacteroid species ?? streptococcus 1214­ 5 y/o child had abdominal blunt trauma, doctor confirm presence of intramural hematoma in 1st and 2nd parts of duodenum, high amylase, Mx ? a- CT-guided hematoma drainage b- duodenal resection c- exploratory laparoscopy d- don't remember.. I think conservative 1215­ pt with recent Hx of URTI , develop sever conj. Injection with redness, tearing , photophopia , So, what is TTT ? a)Topical ABx b) Topical acyclovire c)Oral acyclovire d) Topical steroid photophopia is caused by adenovirus treated by topical steroid

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1216- Pt came with mild abdominal pain, headache, oral ulcer, joint pain,thrombophlebitis of leg Ulcerative cholitis SLE Behchet 1217- Patient with echolalia, echopraxia, poor hygiene, insomnia, and weird postures. Treatment? (catatonia) A. Lithium Benzodiazepines are the first line of treatment

1218- 43 yr old lady complaint about non itchy;white nonsmelling vaginal discharge after intercourse;she z nt using any contraceptive or vag douche;what z diag?? A;prescibe azithromycine b;local steroids c;local antifungal d;vaginal douche e;do nothing 1219- If a patient of Magrine head ache has nt been treated;which condition do u suspect the patient will develope?? A.hearing loss b.depression c.dysphagia d.loss of vision 1220- a lady patient otherwise healthy complaint a hissing sound n her ears at night during sleeping;her bedroom is sound proof and no noise coming from outside. Diagnosis? A;migrine b;otosclerosis c;otitis media with effusion d;tinnitis 1221- acute diarrhea with epithelial infiltration E- coli Salmonella Cholera Rota virus Shigella 1222- Boy presented with painless neck mass, 5-week history of fatigue, generalized pruritis, and mild cough. Dx? A. Hodgkin's lymphoma 217

B. Lyme's C. Infectious mono 1223- what is the organism hat cause meningitis in college dormities : 1-h.influenza 2- nisseria gonorrhea 3- strep. pneumonia 4- staph. aureus Neisseria meningitidis bacteria (meningococcal disease) 1224- a 19 yr sexually active lady came for her annual check up:she z otherwise healthy using no contraceptive;her pap smear and all investigations are normal;what will u suggest regarding her next check up??? A;afer 6 months b;after 1 yr c;after 3 yrs d:after 5 yrs 1225- 6 yr old school going boy complaaint abt itchy scalp;n school his 10 friends have the same problem:wt z ur diag?? A;lice (Pediculus humanus capitis) b;tinea capitis c:seborric dermatitis d:scabies _________________________________________________________________________ _ 1226- Nonmedical treatment of premature ejaculation?? the use of acupuncture 1227- A 54 YO female with chronic pelvic pain is found to have a right sided ovarian mass. After the initial evaluation, surgery is planned to remove the mass. To avoid excessive bleeding during the surgery , the surgeon should ligate which of the following structures? A) Round ligament B) Suspensory ligament C) Ovarian ligament D) Transverse Cervical ligament E) Mesosalpinx Suspensor ligament of ovary contains the ovarian artery, ovarian vein,[1] ovarian plexus,[4] and lymphatic vessels.[3]

1228- leukemia with blast cells: AML ALL 218

CML CLL 1229-cloboma when to do the operation>> 1stwk, 3month, 1 year 1230- Table with investigation Na 112 Osmolality 311 low What is the diagnosis? a- Conn’ssyndrome b- Cushingsyndrome c- SIADH(the only choice with low na) d-Diabetes insipidus 1231- Female wants a temporary contraceptive method, which one is recommended by research? A) OCP B) IUCD 1232­ pt sustained major traum came to Er 1st thing to do open air way give 2 breath open airway remove foreign body 2 breath fowlled by chest compression chest com after feeling pulse 1233­ PT DYSMENORRIA – DYSPARUNIA –INVERTED UTERUS ??????? ADENOMYOSIS -ENDOMETRIOSIS -UTERINE LIOMATAUTERINE CARCINOMA 1234­In moderate to severe asthmatic patient , u will find all the following EXCEPT : A PO2 <60 B PCO2 > 60 C low HCO3 D IV hydrocortisone will relieve symptoms after few hours E dehydration 1235­12 year old female , non pruritic annular eruption in the right foot for 8 months , looks pale and not scaling , no response to 6 weeks of miconazole A discoid lupus erythramotosis 219

B erythema nodosum C tinea corporis D granulomatous annulare E choricum marginatum?? 1236­A man who bought a cat and now developed watery discharge from his eyes he is having: a) Allergic conjuctivitis b)Atopic dermatitis c)cat scratch disease 1237­Senario about wilson (kayser-fleischer ring, low ceruloplasmin)Rx: A)desferrioxamine B)penicillamine 1238­effective ttt of mastalgia ? a- Caffeine b- OCP “ “ c- tamoxifen d-danazol 1239­Pt with abdominal pain and distension with vomiting and constipation. He has mild symptoms of dehydration. There is evidence of air in the rectum. The Rx: a. Rectal decompression with IV antibiotics b. Nasogastric tube with IV isotonic fluid c. Systemic antibiotics 1240-5 months old baby , in ER with sudden abdominal pain , pain last 2-3 min with intervals of 10-15 mins between each attack : A- intussesption B- infantile colic C- appendicitis 1241­Patient with a scenario going with liver cirrhosis with acsites, diet instructions: High carbs, low protein Sodium restriction 1242­ which of the following is used in minor burn: a- apply cold water b- apply room temperature water?? c- debridement 1243­Pt presented with severe hypothyroidism & serum sodium = 108. What do u do? a- Intubate, give 3% sodoium then treat hypothyroidism status 220

b- treat hypothyroidim & monitor S.NA level every 6 hours c- Give 3% sodium, hydrocortisone & treat hypothyroidism status 1244­pt. with primary biliary chirhosis wich drug helps the histopathology of the liver: - Steroid - Interferon - Ursodiol _________________________________________________________________________ _ 1245-patient complaining of gradual loss of vision & now he can only identify light. Which of the following is the LEAST cause of the problem ? a retinal detachement b central retinal artery embolism ?? c vitreous hemorrhage d retinitis pigmentosa e retrobulbar neuritis 1246- Patient with DM and HTN, gradually decreasing vision. Eye exam shows maculopathy, Treatment: A. Panretinal photocoagulation B. Photocoagulation of macular area 1247- Child presented with gum and nose bleeding and bruising all over the body after an episode of URTI. Dx: 1) Henoch Scholein Purpura 2) Idiopathic thrombocytopenic purpura 3) Vitamin K deficiency 4) Hemophilia _________________________________________________________________________ ___________________________ 1248-Patient on isoniazid for TB prophylaxis, what test should be regularly done: 1) Spirometry 2) LFT 3) RFT _________________________________________________________________________ ___________________________ 1249-Child presented with jaundice, vomiting, hepatomegaly.. etc. What hepatitis virus is more likely to be the cause: 1) A 2) B 3) C 4) D 221

1250- Regarding strep pharyngitis: same as q13 put choices are complete 1) No treatment should be given until strep infection is proven. 2) Treatment has no effect on rapidity of solution of infection 3) Treatment prevents post-strep glomerulonephritis 4) Treatment can be postponed for 9 days 5) Clindamycin is the drug of choice _________________________________________________________________________ ___________________________ 1251-. What could cause painful vision loss: 1) Acute close angle glaucoma 2) Retinal detachment 3) Retinal vein occlusion 4) Retinal artery occlusion 1252- Female patient with hirsutism, obesity, infertility. US shows multiple ovarian follicles. Dx: 1) Klinefelter’s syndrome 2) Asherman’s syndrome 3) Kallman syndrome 4) Stein-Leventhal syndrome other name of PSO 1253-. HbA1c is useful in: 1) Adjustment of insulin 2) Monitoring diabetic control on day-to-day basis 3) Longer term diabetic control monitoring 1254-. Child with iron toxicity, best way of management: 1) Gastric lavage 2) Ipecac syrup 3) Magnesium citra Forgot the rest of choices, but there was no deferroxamine or charcoal. _________________________________________________________________________ ___________________________ 1255- Patient presented with typical symptoms of hyperthyroidism. What’s the most effective and rapid way to relieve symptoms: 1) Propranolol 2) PTU 3) Radioactive iodine 4) Surgery 1256- Young patient with unremarkable medical history presented with SOB, wheeze, long expiratory phase. Initial management: 1) Short acting B agonist inhaler 2) Ipratropium 3) Steroids 222

4) Diuretic 1257-Patient with moderate persistent BA, on short acting B agonist and low dose steroid inhaler. What will be the next step: 1) Add long acting B agonist to steroid 2) Increase dose of steroid 3) Theophylline 4) Ipratropium 1258-young male has a painless mass in the testis that is increasing with time what is your advice: US and consult surgeon 1259-drug binds to the bile and prevent its reabsorption: cholystramine 1260-female patient on antiepliptic drugs wants to become pregnant what well you tell her regarding eplipsy: use of antiepliptic has risk of fetal malformation epliptic attacks affects the fetus 1261-pt has solid dysphagia best for diagnosis: endoscopy +biopsy 1262-pt has DM2 and HTN an CCB+metformin+glyburide+statin still having increase BP what is your advice: add ARBs increase CCB dose start thiazide 1263-In cervical LNs there are well differentiated thyroid cells, during operation you find no lesion on thyroid what will you do next A. Total thyroidectomy B. Total thyoidectomy + radical cervical LNs dissection C. Total thyroidectomy + specific LNs dissection D. Thyoid lobectomy with ----223

e-thyroid lobectomy and isthmusthectomy and removal of all local enlarged lymph nodes (new choice not in alqaseem q) 1264-a young healthy male complain of sleep apnea on examination there is only enlarged tonsils mangment: adenoidectomy reduce weight 1265-long scenario about young male with spoon shaped nails: iron deficiency anemia 1266-Which of the following radiological feature is characteristic of military TB? Sparing of lung apices Pleural effusion Septal lines Absence of glandular enlargement Presence of small cavity 1267-Pt with sudden cardiac arrest the ECG showed no electrical activities with oscillation of QRS with different shapes. The underlying process is: a. Atrial dysfunction b. Ventricular dysfunction c. Toxic ingestion d. Metabolic cause 1268-An old patient presents with historyof uncontrolled HTN and DM . his hand is big and tall in examination bulsitale abdominal mass. What is the diagnosis? A. Peptic ulter B. GERD C. aortic aneurysm D. marfan syndrome?? 1269-in Window period of hepatits B 1) HBc 2) HBs ag 3) HBs antibody HBc Ab ( IgM )

224

1270­Children while he was playing a football , the ball hit his hand from lateral fingers, after a while the children complaing pain and swelling on those fingers and painful middle finger with hyperextension of interphalengial joint, swelling was more in the DIP and IP Joints , also , there was pain on his palm, what is the most likely cause: Rupture of profound ms in hand Rupture of superfacial ms Intra articular interphlengial joint fracture Extra articular rupture of flexor digitorum profundus 1271­

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