2017 Flashcards by Sultan Alqarni

58 years old with episodic chest pain with exertion relived by rest,
ECG done: normal, what next to do:

Exercise ECG

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Female patient c/o insomnia, irritability, palpitation for 3 moths,
she is taking amiodarone, fluoxetine for depression , Enalapril(?Ramapril!!) What next step:

TSH

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55 years old Man, K/C of DM, HTN came to ER with history of
Lt chest pain today morning radiated to Lt shoulder , He mentioned that he has had chest discomfort only with activity and relived by
rest before 3 months, but today he developed the pain when he was reading the newspaper.
V/S: stable, normal ECG: sinus tachycardia, normal Troponin,
What is the most likely dx:

Unstable angina

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62 years old male, k/c of HTN and Heart Failure on furosemide, have less than optimal control on his symptoms, there is worsening
of his symptoms with minimal activity ( going to bathroom), what is the best diuretic to be added:

Spironolactone

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68 years old female, recently diagnosed with uterine cancer,
presented to your clinic c/o: acute onset sharp chest pain,
increasing by inspiration, with left lower limb pain, and swelling,
V/S: BP 135/85, HR 117, RR:15, Temp: 37O/E: left calf muscle
swelling and tenderness .What is the most appropriate next step:

Start her on heparin before any investigation

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Post MI 5 years ago.. patient done coronary stent as well . p.t
taking aspirin & ACEI….what you will add :

B blocker Carvidilol

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48 years old pt with DM has fever with cough ( sypmptms of
pneumonia?) , xray shoes Rt lower pneumonia with plural
effusion( not sure ?) What is the most indicatror of poor prognosis?

Pt is diabetic
*other recalls of similar Q mentioned RR 32 and it was the answer

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24 years old female patient known case of asthma presented with
shortness of breath V/S: Temp: 36.4 , normal BP , PEFR 70% of
her beast, O/E: subcostal retraction with scattered wheezing in bilateral lung, she received salbutamol via nebulizer but no improvement , what is the appropriate treatment:

Corticosteroid

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56 years old ?? male complain of cough , fever and rigor for 2
days, crust colored sputum, Temp: 38.5, O/E: there is decrese sound in left lower lung, Xray shows lower left lobe infiltrate.The most likely organism is:

Streptococcus Pneumonia

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56 years old male presented with SOB for 5 days. Bilateral
lung crepitation up to the middle lungs, Holosystolic murmur best heard at apex radiated to axilla, ECG shows ST elevation on inferior leads, vital signs normal. What is the most likely dx that cause this new murmur?

Papillary rupture

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Old pt. with SOB , pink frothy sputum and cyanosis, on
exam chest bilateral crackles at the base, Most likely diagnosis

pulmonary edema

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48 years old female, k/c of DM type 2 , HTN, presented with
green tinged productive cough, fever and anorexia for the past 3
days, examination showed dullness on percussion and inspiratory crackles or RT lower lobe, Temp: 37.9, HR 79,RR: 18, CXR showed opacification at RT lower zone with air Broncho gram, what is the treatment:

Cefuroxime+Azithromycin

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30 year old female nurse had contact with +ve TB patient 3
months ago, She is asymptomatic, Chest x-ray was normal, PPD is +ve. What is the most appropriate to do ?

isoniazid for 6 month

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43 years old obese , c/o: night sweat, nocturia, day time
somnolence, What is the most possible complication :

Sudden death

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36 years old working at printing, c/o: cough ,SOB, O/E:
wheezing. He is worries that his illness may be associated with his work type. Which of the following confirm his worries:

Relive symptoms when he go to holidays

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48 years old smoker, productive cough with heavy sputum,
V/S: Ph: 7.4, Pco: 48, O2:78, What is the dx:

Chronic bronchitis

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case of alcoholic patient who have esophageal varices, with
hx of hematemesis , which of the following drugs prevent rebleeding in this patient:

propranolol

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40 y/o male with SINGLE episode of hematemesis, after 5
hours of 300mg Aspirin ingestion. Normal vital signs. Likely diagnosis;

Erosive gastritis

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69 years old male patient presented with history of 5kg weight loss in the last 2 month O/E: Abdomen : soft no palpable masses , Invx : Hgb 8.4 ,MCV 70 ,WBC : normal ,Platelet : normal .What is the most appropriate next step :

colonoscopy

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Premarital examination show hepatitis B positive. patient ask
about activity , How can you assess :

HBe Ag

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30 y/o ,female teacher, c/o: abdominal pain and diarrhea, had +ve anti Endomysial Ab. , Most likely Diagnosis :

celiac disease

IgA anti-endomysial antibodies are found in 90% coeliac patients

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The Most common cause of HCC in KSA is:

Hepatitis B

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Young male with ophthus ulcer and abdominal mass with
diarrhea and “there is pic of Barium enema with cobble stone appearance” , what is the diagnosis

Crohn’s

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case of surgeon who got needle stick with Hepatitis C patient,
after 3 months he is testing +ve with HCV Ab ,What is the
Percentage to have chronic HCV:

95% ??

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56 Y.O. post subtotal gastrectomy cause of gastric malignancy , what vitamin will be deficient:

Vitamin B 12

K/c of liver cirrhosis , came with malaise and confusion , on examination , oriented to person but not time or place, Low grade fever, Ascites. What to the best next step to do ?

ascetic tap

38 years old women had RUQ pain increase after eat since 2 days, and on Examination she had to stop breath for moment with palpation, investigation: normal except for Temp: 38. What is next step:

Initial treatment to , newly diagnosed osteoarthritis:

Exercise

48 Y.O. female k/c. of Rheumatoid Arthritis , c/o of shortness of breath , on ex. Bilateral diffuse rhonchi , what is the most likely diagnosis :

Fibrosing alvelolitis

Acute knee pain X-ray shows reduced joint space and chondrocalcinosis ,

Psuedogout

30 years old male with 4 month history of low back pain, no other associated symptoms, pain interfere with daily activity, Most significant factor is: (Ankylosing spondylitis??)

Duration of symptoms

53 years old man came with low back pain, patient was given NSAID for 4 months but no improvement, what is the next step:

X-ray and MRI

female patient about 50 yrs having 3 children with normal vaginal delivery , C/o of frequency , polyuria , have cystocele in anterior vaginal wall , she developed urine lacking while cough or laughing, what is next to be done :

Stress urine test

73 yo male complaining of weak urinary stream , feeling of incomplete emptying, terminal dribbling. Invx: 35g prostate gland with no calcification.What is the appropriate mx

Tamsulosin

case of DM on Metformin and glibenclide, High creatine and GFR is 29. What is the drug to stop:

Metformin

68 Years old male, K/C of DMII , was started on Amitriptyline for ?peripheral neuropathy , C/O acute onset decrease urine output for few days , ? with difficulty initiation of urine , and drippling , ?Cr. Was normal , what is the best thing to do next

In and out urine catheter

31y. Male c/o left flank pain radiate to testicle take about 1 hr. then improved. He had same complaint in past week and resolve spontaneously. He has blood in urine (hematuria) .this morning. On Ex. Pt. vomitus and lying on stretcher.Vital:R.R:24, H.R:102 And the remaining within normal. Next step:

Abdominal CT

Case about man for knee injection , had attack pf loss of consciousness , followed by brief moment of generalized convulsion, then wake up with BP 80/60 mmHg ...he experience worry during knee injection

vasovagal syncope

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

NSAID

47 years old male c/o: vomiting , dizziness and joint pain for 1 day, patient alert but confused, his speech is slurred, he has intension tremor with movement and has ataxia when mobilized, has nystigums with lateral gaze, BP: 142/89, other V/S within normal,What is dx:

brain stem infarction CVA

52 y.o truck driver gave hx of being in cold environment for several hours ,Came with V/S: BP 90/70 , bradycardia , hypothermia ( Temp:30), RR: 24. What is 1st step in the management" i'm not sure " Pt staying outside in a cold weather came with temp:30, HR low management

Rapid rewarming

35 years old housemaid presented to ER by her guardian, her guardian claimed that she drunk cleaning bleach (Clorox) 1 hour ago, and amount is unknown, she is asymptomatic, what you will do for her

Drink milk and water

Old patient HTN , not taking medication, BP 230/110, examination : edama of optic disc,1st management:

Na nitroprusside

patient post RTA , conscious have tenderness in left hypochondrium , US show peri splenic fluid, Vital signs were normal “ I don’t remember the values “ ,what best to do next :

Abdominal CT

46 years old complain of pain in the sole of his foot for several weeks , especially in morning then improve with movement, aggravated by stairs walk dx ?

planter fasciitis

27 yo female, one month polyuria, thirst, craving to ice. Normal vital signs, 24 h urinary collection. Low osmolarity 150, and 10 L urine normal (1-21) Appropriate next step

Vasopressin challenge test

52 Y.O. male came with vague abdominal pain, with hx of polyuria and polydipsia , ? hx of recurrent urine stone , lab works showed Ferritin : High “ ? 700ng/ml” , What lab investigation you will order:

Transferrin saturation

Q about patient return from travel ( Jeddah), after 2 days he developed fever, headach & malaise , after 3 days he developed generalized rash, labs WBC :2200 , Plt. 75,000 , Hgb 12.5 . What is the most likely dx:

Dengue fever

Q about antibiotic of patient having diarrhea after return from Asia:

ciprofloxacin

lymphoma patient on chemotherapy, which vaccine is NOT contraindicated:

diphtheria

Patient with asymptomatic single cervical lymph node, normal Chest x ray , what you will do?

FNA

20 years old female has Breast mass, 2*2 cm extremely mobile breast lump in outer quadrant, (fibro adenoma?) What to do next:

Follow-up outpatient

40 years old female underwent abdominal ultrasound as part of clinical trial and found to have gall stone .What is the most appropriate management

observation

Most common type of hernias in female

Indirect inguinal hernia

case of has vomiting, abd pain, distention, high bowl sound Post appendectomy 2 or 3 years, now came with nausea what is the Dx?

Intestinal obstruction

40 years old c/o Acute pain in anal area, there was past history of prolonged painless bleeding per rectum ( with sensation swelling?) and pruritus in anal area for 6 months ,What is the Dx:

Thrombosed external hemorrhoid

51 years old women presents to the office with a 2 day history of RUQ pain, colicky abdominal pain, as well as nausea and vomiting. Examination shows significant pain with palpation in the RUQ. Laboratory findings include an elevated WBC count ,ALP, bilirubin level. The most likely dx:

acute cholecystitis

45 diabetic patient with RT foot ulcer,?? Cm ulcer over metatarsal with black discoloration around it , which of the following most effective of preventing this:

Proper self-care and monitor of her foot

60 years old patient c/o> low back pain radiated to both lower limb aggravated by walking and relieve by sitting and leaning forward, straight leg raising test was negative, what is the DX:

spinal stenosis

37 years old female complain of Rt shoulder pain, pain increase at night when sleep at affected site with normal range of movement :

Adhesive capsulitis

female patient have history of asthma and taking oral steroid ,complain of groin pain, what is the Dx:

Avascular necrosis caused by the use of corticosteroids

Pt. is runner with pain in metatarsal, for week after sport and pain increasing what is the dx:

stress fracture

43 year old female c/o low back pain for 3 weeks not responding to NSAID affecting physical activity

Xray & MRI

37 years old with history of several months of radial wrist pain, with no history of trauma. finkelstein test +ve, grind test is negative, and tenderness over distal radius> Which one of the following would be most appropriate at this point:

thumb spica , wrist splint

22 years old married, have irregular period presented with light spotting, what is investigation for her:

B HCG

Pregnant lady with GA 34 , presented with generalized extensive pruritic vesicular rash and fever , what is the best thing at this time

Oral acyclovir

pregnant in 3rd trimester c/o painless spotting ,and patient to start feel less fetal movement

referral for Hospital Admission

34 years old single lady with night sweat, 4 months amenorrhea, previously, she had hx of last 1 year with irregular menses every 2 months, recently had symptoms of feeling hot, irritability, on examination : no skin pigmentation or breast changes ,what to do next

FSH

30 years old healthy married women in the clinic for conception work up, she is married for 4 years, used contraception for 2 years, and stopped 1 year ago, what to do next:

Husband semen analysis

G2P1 , GA 32 weeks , with hx of previous C/S because of Preeclampsia and fetal distress , asking if there is possibility to try vaginal delivery in this pregnancy , what u should tell her :

Vaginal delivery if she had previous low transverse c/s

pregnant lady in 12 weeks come for ANC had past medical history of GDM, what to do during this visit:

2hr 75 OGTT

HTN drug that contraindicated in pregnancy:

Enalapril

20 years old female having 1 child came for asking you about pap smear, what you will council her:

Do pap smear after 1 year

a 42 y/o G4P3+1, present for her well-women examination, she has had three vaginal deliveries and one c/s for breach. She states her cycles are regular and denies any Sexual transmitted dis., she reports occasional migraine headaches and had a serious allergic reaction to anesthesia as a child when she underwent a tonsillectomy. , BP: 142/89, which of the following is the most appropriate contraceptive method for this patient?

IUCD

Pt has heavy period and dyspareunia with tender midline lower abdominal tenderness, pain occurs with menstruation ,Her sister have same complaint. What is the dx:

Endometriosis

A 45 years old female patient complain of vaginal dryness , itching , on examination : few pubic hair and pale

A trophic vaginitis

Lady , postpartum for 2 months c/o breast pain, breast engorgement and erythema, low grade fever ( fluctuated ????? not sure) , what is the most appropriate management ?

education about breast feeding ?? in simillar questions the answer was oral abx and continue breastfeeding given that the case is mastitis but it is not an option in the recall here ??

9 years old female presented with short stature, she is was always the shortest in her class 10, she is smart and doing well at school .. parents are concern that she never get to stage puberty .. investigation shows delayed bone age, rest of examination was normal, normal parent height with normal age of puberty case of short stature, what is the dx:

Constitutional short stature

Child rolls TO side from Prone

2 yrs old with girl came with limping and Rt hip pain, not allow to touch, rest in flexion, abduction and external rotated position, refuse to change position, febrile and irritable, Temp: 38.5, x-ray hip normal, what best next test to do:

Blood culture

14 years sustained hit on back of head while playing, have severe headache, neck stiffness, one time vomiting, loss consciousness for 1-2 minutes, what is the most likely dx:

Sub arachnoid hemorrhage

child itching at night and rash around anus; what is dx

Pinworms

Mother is concerned about her 2 year-old child , who doesn’t say any word, poor eye contact, not responding to his parents when the call his name, and playing with train game for ever , Blood works normal , Hearing test normal , what is the diagnosis :

Autism spectrum disorder

Pedia case with scenario of leukemia, Best diagnostic investigation, multiple lymphadenopathy and bruising , Diagnostic test:

Bone marrow biopsy

5 months old infant with rhinorrhea and wheezy chest , temp 37... dx?

bronchiolitis

4 year old boy c/o attack of diarrhea and bloating when he eat cheese at breakfast.. The mother state that his younger sister have the same complain. Next step :

lactulose hydrogen breath test

11 year old boy with fever up to 39, joint pain, SOB when walking or 4 days, 2 days ago he had RT knee pain , today improved. Today c/o: RT ankle Lt knee . o/e: holosystolic murmur , no gallop, tonsil with erythema exudates. What of the following confirm the diagnosis?

ASO titer

7 years old case of primary enuresis, never had complete dryness at night, pt willing to achieve wet bed and pt go to summer camp and insist , what to do:

Desmopressin

mother noticed her child 9 years old boy became very thirsty at night and excessive urination, the child looks ill, V/S: HR 170 . BP80/50, dry mucus membranes, RBS: 400 mg/dl. What is the best next test:

20 ml/kg of Isotonic normal saline

12 months old baby c/o acute cough , SOB and cyanosis after 30 min of lunch meal , no swilling , no skin rash and no lip drooling , dx :

Foreign body aspiration

Child 9 years old, c/o of cough and fever , CXR showed diffuse reticular lines , what is the best abx :

Azithromycin

The most effective strategy for prophylaxis in travel is:

Avoid eating uncooked and untreated water

Married lady in 20s vaccinated for MMR today and want to get pregnant, What is the duration to get pregnant:

4 weeks

Married lady in 20s vaccinated for MMR today and want to get pregnant, What is the duration to get pregnant:

4 weeks

35 years old lady want to reduce weight, how to achieve weight loss

Work with her for agreed plan of diet and exercise

doctor had injured him self with contaminated needle after surgical procedure, the blood in not known for blood borne disease, And the doctor is vaccinated for Hep b before, what to do:

Test the doctor and the patients for blood born disease

25 years old male have laceration on arm, he took dT vaccine before 5 years, what is the recommendation regarding Td vaccine:

every 5 years if contaminated wound

Which type of Health care model in critical care setting?

Doctor centered

group of the student study conducted in 1996 for relation of BMI and CAD in period between 1979 to 1984 ,what is the type of study:

retrospective cohort

drug x was studied and result that it decrease HBA1c in the patient:

disease based medicine

Family physician participating in medical event for improved effectiveness & health care organization, Best way to describe this participation?

Advocate or collaborator not sure

a drug that prevent death but doesn’t improve the disease:

increase prevalence

study was conducted to determine if there is a difference between smokers and non smokers in the systolic blood pressure (in mm Hg). A total of 100 persons were asked about their smoking status and their blood pressure was measured. Which statistical test of significant is most appropriate?

Student T test

patient with disease X had a test that show: sensitivety of test is 95% , Specificity 90%, PPv 85%, NPP: 80%,What does mean if positive test in patient X:

95 patinet most likely have X

In a study , to measure drugs effectiveness to decrease stroke, the results of study .RR = .95 , Confidence interval ( CI ) = 0.86 - 1.1 , What is the correct answer :

statistically not significant

Total population 1150 Diseased (anemia) 448 Cured 123 Still having disease 325 Measure the current prevalence??

0.28 , current diseased / total population

Epidemiologist want to measure the rate of death of new corona cases among health care in KSA,What is the best describe the measure?

Case fatality

65 years old man Quadriplegic secondary to RTA, he is fine and health, with normal cognitive function, presented to the hospital with pneumonia , pt was admitted and treated well, on the day upon discharge, the treating consultant said that He should be DNR and pt should sign, which of the following is true according to medical fultlity:

Pt should NOT be DNR because of medical futility

70 years old man diagnosed with colorectal cancer with poor prognosis, and asked you not to tell his son, His son asked you about his father situation , what you will do:

do your best with the family to encourage open discussion between the family members

The best description of continuity of care :

emphasis the quality of care

Pt with prostate ca refused hormonal therapy. Doctor trying to push him to start the hormonal treatment because he thinks it is beneficial for him. The act of the doctor best described as:

Paternalism

Pt with prostate ca refused hormonal therapy. Doctor trying to push him to start the hormonal treatment because he thinks it is beneficial for him. The act of the doctor best described as:

Paternalism

When you want to success in consultation with Adolescence patient . how to take best history:

a-active listening

34 yrs uncontrolled dm, REFUSED to stop eating sugar and said that his father has DM for 27 yrs and still eating sugar. Which stage of change mode he is now?

pre contemplation

study was conducted on a group of people and after the pathological samples were taken from the participant, the researcher decided to do another study with the same samples but was not included in the first consent that taken before

Take consent from RIP

foot dorsiflexion affected , what sensory affected :

Dorsum of the foot (L5)

female with pelvic pain , dyspareunia sx of PID , what antibiotic to give :

Ceftriaxone 250 mg IM state + doxycycline 100 mg for 2 weeks

3 months infant , presented with SOB and cyanosis , with pan systolic murmur & sx of hepatomegaly 4 cm below costal margin , bilateral lower lung crepitation, what to do next

Diuretic

18 year old man , he is thin and tall present with chest pain with inspiration and examination reduce lung sound to one side next

X ray chest

Pregnant lady , GA 32 weeks , presented with sudden left leg swilling , calf tenderness , what is the best Mx :

Low molecular weight heparin

4 years girls with hx of watery diahrea and abdominal pain. There is no one of the family with similar illness. The diahrea after 2 days (not sure) became bloody. On ex patient mild dehydrated with abdominal gaurding but no distension. Which of the following is the inital step:

Urea & electrolyte

2 years old boy , brought by his parents , after he sipped and hit his head , he lost his consciousness , then waked with abnormal movement , he is now awake , but still drowsy , with ?2 episodes of vomiting , what to do next :

Head ct

12 yo boy , presented with Lt hip pain and limping , on ex . limited abduction and adduction , Hip x-ray showed ? winded joint space , what is the possible dx

legg-calvé-perthes disease

2017 Flashcards

(124 cards)