2022 Flashcards
(149 cards)
1
Q
A 22-years-old, married female, C/O irregular menses for 2 month. She is obese (BMI: 32)
What is the best initial management?
A
β-hCG: 1st thing to do in any female in reproductive age with amenorrhea/menses
irregularity is β-hCG to r/o pregnancy.
2
Q
35-years-old housemaid presented to ER by her guardian, he claimed that she drunk cleaning bleach (Clorox)
1 hr ago, unknown amount, she is asymptomatic, what you will do for her?
A
Drink water or milk
(Choose observation if available)
3
Q
20-year-old women, presented with irregular menstrual cycles.
(No mention of nipple discharge or visual sx), BMI: 27
Labs:
β-hCG—undetected
TSH, Prolactin, FSH & LH—all normal
Free Testosterone—4 (HIGH)
Fasting glucose—6.2 mmol/L
What is the most likely diagnosis?
A
✅B. PCOS → menses irregularity + HYPERandroginism + overweight + impaired fasting glucose
(111 mg/dL)
4
Q
Female patient C/O frequency, urgency & dysuria. She also mentioned that she has leakage of urine when
she coughs. You did a vaginal exam & you found mild cystocele. what is the best next step?
A
Urinalysis and culture
5
Q
Patient came for steroid injection in the knee. After the injection he lost his consciousness & developed jerky
movement in all the body, he was stressed about the injection, Dx?
Bp: 90/60
A
Vasovagal attack
6
Q
pregnant in 32 weeks gestation, with previous 2 lower segments C/S, complaining of mild painless vaginal
bleeding, her fetal heart rate was 150 bpm, CTG was reassuring, what to do?
A
D. observation and further investigations:
PainLESS vaginal bleeding in the 3rd trimester = placenta PREVIA, until proven otherwise
1st → trans-ABDOMINAL US
Definitive → TVUS
7
Q
15-year-old male with hx of acne, came and has many concerns & questions about his condition. what is the
best approach should the doctor do?
A
A. active Listening
8
Q
45-year-old male K/C of HTN on lisinopril, DM on metformin, overactive bladder on oxybutynin, came with
low mood, insomnia, loss of appetite started after he lost his son 3 months ago, which of the following will
you prescribe for him?
A
Fluoxetine
always start with SSRI in MDD, SSRI almost always the 1st line in all cases.
9
Q
Female patient with revealing clothes come and sit close to the doctor and talk with low voice and asking
about doctor’s personal life, what to do?
A
Call in a nurse
10
Q
Elderly (in the 60’s) with progressive hearing loss over 6 months, more in the right side. Examination:
whisper was impaired bilaterally. Rennie showed air conduction better than bone conduction bilaterally,
weber lateralization to the left. Dx?
A
D. Presbycosis (age-related hair loss):
Weber → Lateralization to Lt ear = either Lt ear obstruction (if Rinne was abnormal in the Lt) or Sensoryneural hearing loss in the Rt ear (as in our case)
11
Q
. Diabetic & HTN patient on meds, his Creatinine 211 µmol/L, GFR 29, what medication to stop?
A
A. Metformin:
- GFR ≤30: STOP metformin
- GFR 45-30:
o if the patient was already on metformin → ~continue with caution
o If not started yet on metformin → NOT recommended to initiate it
12
Q
12-year-old female with type 1 DM, came with generalized abdominal pain, diarrhea nausea & vomiting. she
is on basal-bolus insulin, stopped basal, and decreased bolus dose due to not tolerating food.
Vitally stable
O/E: moderate dehydrated, diffuse abdominal tenderness
ABG:
Ph—7.4, HCO3—20
Na, K—within normal
Urine analysis: +3 glucose, No ketones, no nitrite
what to do?
A
D. Resume insulin and observation: she is NOT in DKA or HHS, just resume her chronic Tx
13
Q
Patient presented with pleuritic chest pain, SOB. She is 5 days post cholecystectomy.
PH—7.47
PCO2—28
PO2—88
CXR normal
What’s most likely diagnosis?
A
PE
Pleuritic chest pain with recent SURGERY
Virchow’s triad: endothelial injury, stasis of blood, hypercoagulability
14
Q
case of alcoholic patient who have esophageal varices, with hx of hematemesis, which of the following drugs
prevent re-bleeding in this patient?
A
propranolol: Non-selective βB (propranolol) is the drug of choice for variceal bleeding 2°
PREVENTION
15
Q
70-year-old male, diagnosed with prostate cance, he rufuses all treatment modalities. The physician is
pushing him to accept hormonal therapy as he thinks it’s the best for the patient. What of the following
describes the physician approach?
A
C. Paternalism
بالمختصر: الطبيب يمارس “الوصاية” على المريض كما لو أنه والده أو ولي أمره
16
Q
A 41-year-old, presented with feelings of being “choked up”. The symptoms are rather constant and are not
made worse with swallowing. He denies that food is stuck in the throat, and he has had no recent weight
change. Eating and drinking help to relieve symptoms
The most likely diagnosis is:
A
. Globus hystericus: it is one of the forms of CONVERSION disorder (Similar Qs in Pretest)
❌other choices will have other sx such as: regurgitation, burning pain, dysphagia, halitosis
17
Q
Female with more than 3 years of low mood & loss of interest, MOST of the days, increasing before menses
and continue during menses, fatigue, hypersomnia, decreased eating, what is the diagnosis?
A
B. Persistent Depressive Disorder (PDD or PMDD) “formerly dysthymia”: met MDD criteria for
>2 years, most of the days.
18
Q
Male brought by his wife due to worries about his parents health, he goes to his appointments 1 hour early,
check his bank 3 time regularly. These symptoms are affecting his sleep, work, life relationship with his wife.
Best initial management?
A
Escitalopram (SSRI) is the best initial pharmacotherapy for GAD & MDD
19
Q
7-year-old boy came with parents with history of 2 weeks of intermittent limping, knee and hip pain. On
examination, there is pain with hip internal rotation and abduction. Imaging shows; femoral head deformity
with widening & flattening space, what is the most likely diagnosis?
A
Legg-Calve-Perthes disease
20
Q
2-year-old child, presented with acute hip pain and tenderness for 2 days, +ve Hx of low-grade fever.
Affected his gait, No hx of recent trauma or injury, no hx of skin rash or UTI
labs show (normal WBC, ↑ ESR)
On examination: A hip is Flexed, ABducted, and Externally Rotated.
(X-ray attached)
A
Transient synovitis
21
Q
Pregnant asymptomatic lady with +ve urine dipstick for bacteriuria
Treatment? (No mention of gestational age in the exam!)
A
Ampicillin
22
Q
Pregnant lady, GA 12 weeks came for antenatal care for the first time with previous history of GDM, what is
the best for her?
A
glucose tolerance
23
Q
. Pt with red eyes was stuck and can’t open them after waking up (picture attached), what is the treatment?
A
topical chloramphenicol (Abx)
24
Q
2-years-old child presented with 3 weeks hx of fever reaching 40˚C, her mother also noticed swelling of the
finger and rash on the face, no conjunctivitis. (picture attached)
what is the possible diagnosis?
A
(Still disease):
Symmetrical Juvenile rheumatoid arthritis
25
obese female presented with lump in lower abdomen below inguinal ligament and lateral to symphysis
pubis, firm, measuring about 3 cm, Not affected by pressure, cough impulse nor by lifting a heavy objects.
what is the most likely diagnosis ?
Femoral hernia: BELOW inguinal ligament & lateral to symphysis pubis, even if not induced
by cough!
26
5-year-old child, his height and weight are below 5th percentile, present with recurrent URTI and foulsmelling diarrhea.
What is the highest diagnostic method you will order?
Sweat chloride test is the best INITIAL test when CYSTIC FIBROSIS is suspected, followed by
genetic testing (CFTR gene on Chromosome 7
27
9-month-old boy with cough and fever, deteriorated over 3 hours, refuses to feed.
On exam: O2-sat: 93%, mild intercostal retractions, generalized wheeze and fine crackles.
Chest x-ray: normal
What is the most appropriate step in the management?
oxygenation and maintain hydration
<2y with URTI → respiratory wheezing = RSV BRONCHIOLITIS, need supportive Tx:
28
Patient K/C of DM and HTN for 10 years, C/O bilateral symmetrical numbness & burning sensation in the feet
On exam: his symptoms were provoked by a gentle touch sensation
Diabetic neuropathy
29
27 years old male came to clinic complaining of lower back pain that started this morning when he woke up
from the bed, he played football yesterday but doesn't recall any trauma or injury.
On exam: back tenderness lateral to L4 and L5. (no mention of neurological sx)
What is your management?
muscle relaxants and NSAID
30
34-year-old male with low back pain for 4 months. Pain interferes with daily activity. Which of the following
indicates further investigations?
Long duration of symptoms >6 wks warrants further investigations.
31
A 23-year-old female came with 2 days history of vomiting.
O/E: tenderness at the right iliac fossa & guarding. what investigation ?
US
any in *reproductive age* with suspected appendicitis after ordering β-hCG start with *US abdomen*
If US did NOT reveal (appendicitis signs) → go for CT, BUT make sure she is NOT pregnant (i.e., ❌do NOT
CT without -ve β-hCG❌)
32
you give a UTI case Bactrim but forgot to ask if they are allergic and they have an allergic reaction , which principal was violated
Primacy of welfare = non-harm
33
A pregnant mother in 38 gestational week, and her 3 years old child got exposed to chickenpox from her
daughter. Both the mother and child are susceptible. What should be given to them?
. Immunoglobulin to the pregnant mother and vaccine to the sibling
34
Multiple studies correlate between exposure to smoking and risk of lung cancer. A family physician wants to
reach a conclusion from these studies. what type of study design to get a conclusion from these studies?
Systematic review
35
. 38-year-old obese male, with hx of night sweating, nocturia, day time poor concentration and somnolence.
What complication this pt at risk in the future?
Sudden death
Obese + daytime somnolence = OSA → cardiac diseases & sudden death!
36
G2P1 women in 36 gestational week, presented to ER after history of falling from 5 stairs, there is painful
vaginal bleeding. Patient currently vitally and clinically stable. Fetal heart sound present. No other
abnormality.
What is the most likely diagnosis?
placenta abruption
37
A lady 3 months postpartum with decreased concentration, sad mood, loss of interest (symptoms of
depression) for 1 month. The most commonly used validated screening tool for postpartum depression is?
Edinburgh Postnatal Depression Scale
38
19 years old, asymptomatic, wants to join school football team, labs showed:
+ve HBsAg
+ve HBcAb
-ve HBeAg
+ve HBeAb
-ve IgM
chronic infection
39
Patient chronic carrier of hepatitis B, asymptomatic. Ultrasound reveals multiple gallstone.
what is the most appropriate management?
A. reassurance and follow up
40
. Middle age man, came C/O flank pain that radiates to his testicles, had same episode last week that resolved
spontaneously, now the pain is not resolving.
Abdominal exam: no tenderness, during exam patient vomits and he can't stay still
Urinalysis showed: +1 blood
What is the most appropriate step in the management?
NSAID
41
68-year-old female, brought by her daughter with symptoms of low mood, hx of memory loss and low
concentration (oriented to person but not to time or place), not smiling and looks apathetic, no previous hx
of depression
mental status examination 14/30
What is the most likely diagnosis?
Alzheimer’s disease: cognitive impairment (MMSE 14/30) + memory loss
42
Child girl with hx of low stature, face pleiothora and hx of 2 previous UTIs, alnong with temporal and extremities fat pad, fine face hair line (growth chart attached)
What is the diagnosis?
Cushing syndrome
43
Patient came to the clinic with itchy lesion silver in color scaly in the knee, (I think he mention that something test: pinpoint bleeding with scratch), (picture attached). asking about diagnosis?
Psoriasis
44
Pregnant G3P2 with history of right leg swelling, +ve Homan sign, Right lower limb Doppler US done and showed DVT in the right leg.
What is the most appropriate management?
LMWH (such as Enoxaparin)
45
A 56-year-old woman with a long history of untreated hypertension is brought to the ER because of severe headache and confusion. The patient is oriented to person, but not to time or place. Her blood pressure is 230/140 mm Hg, pulse is 86/min, and RR is 18/min. Funduscopic examination reveals optic disk edema, and a dipstick test shows protein in the urine. Which of the following is the most appropriate pharmacotherapy?
Na Nitroprusside
46
56-year-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 → MR: CHF sx & MR murmur (HOLOsystolic best at the apex radiates to axilla)
47
Patient with dysphagia to both solid and liquids, chest pain, frequent regurgitation of undigested food. Not relived by PPI (attached barium study). What is the diagnosis?
Achalasia
48
30-year-old male, came with 2-days hx of photophobia, blurry vision of the left eye. Eye examination showed Tearing form left eye and unequal pupil reactivity. Patient is using topical retinoids, moisturizing and steroid to treat chronic psoriasis, which of the following is the most likely diagnosis?
Anterior uveitis
49
Pathological Samples were collected from Participants for a study, researchers decided to add another analysis on the same sample, which the participants were not consent on it.
In this case, explicit consent should be from:
Consent from IRB
50
40 years old patient, K/C of DM on Metformin, HTN and chronic osteoarthritis on ibuprofen. He is C/O 2- weeks hx of epigastric abdominal Pain.
O/E: abdomen soft lax with mild tenderness in the epigastric area. What is your initial management?
Start pantoprazole
51
29 years old married patient presented to FM clinic, no past history of STDs, speculum showed Erythematous cervix without any lesion
Pap smear taken report showed: Low Grade Squamous Intraepithelial Lesion. HPV: negative
What's the most appropriate next step?
Colposcopy: 25-29 y/o with LSIL → COLPOSCOPY, no need even to order HPV before 30 y/o
52
A 2-year child brought to the clinic with history UTI 2nd time. In the previous episode, he was treated with antibiotic after which he is improved. Currently, patient is clinically and vitally stable. Which of the following is the best next step in the management?
Vioiding Cystourethrogram (VCUG)
53
patient come with White coating erosive erythematous base lesion is seen in web space of toes (picture attached), what is the best treatment?
terbinafine: Tinea pedis (fungal infection btw the toes) → topical Terbinafine > topical azole
54
40 year old male came with complaining of bilateral hearing loss he had Examination hard to visualize the
canal and the tympanic membrane, he use ear pad during sleep for 3 years, (Audiogram attached, NOT the
same pic, but approximate). what is the most likely diagnosis?
. Cerumen impaction (earwax blockage): using ear pad hx + Audiogram shows Conductive Hearing Loss (CHL)
55
2-weeks-old infant with poor weight gain came for check up, O/E there is machinery murmur, at the upper
left sternal border and bounding pulse, dx?
. PDA
56
Patient had low mood and loss of interest in which his doctor prescribed a medication, presented with
history of dryness of his eyes and blurry vision, with Hx of urine retention, which one of these medications is
most likely causing his symptoms?
✅A. Amitriptyline (TCA) → anticholinergic S/E: dry eye, blurred vision (glaucoma), urinary retention,
tachycardia
57
22-year-old university student, patient experienced RECURRENT episodes of numbness /sweating /chocking,
in which she avoids classes out of fear of similar SYMPTOMS again?
panic disorder: recurrent sx without clear trigger + pt has fear of having the sx again
58
Case of patient fall on outstretched hand , he was having tenderness in base of thumb (X-ray attached) :
what’s is the management?
C. Forearm thumb spica: Scaphoid fracture
59
School age boy came after fight in school, vitally stable, on exam minimal left ear tenderness, fluctuant,
(picture attached) what to do?
referral for I & D: Auricular hematoma → I&D, if left UNTREATED → Cauliflower ear!
60
23-year-old was in RTA brought to ER. Responding to shouting commands. Hypotensive with chest bruises
What is your initial next step?
Ensure patent airway: always start with ABC → A = Airway! Do not jump
61
Adult Patient with ear pain for 5 days, he visited the clinic 2 days ago, and the physician assured him and
gave him amoxicillin, now he is still in pain. What is next step?
✅B. Amoxicillin/Clavulanic acid:
62
Obese HTN patient came C/O severe foot pain for 3 days. She can’t walk on it. There was no history of
trauma, (x-ray attached), what is the most likely diagnosis?
Acute gout: SUDDEN, severe pain (can’t walk) in the FOOT
63
Old pt came to ER C/O chest pain radiating to the left shoulder, he has same issue 3 times before pain with
exercise reliving by rest but today have chest pain while reading newspaper.
ECG: sinus tachycardia, Troponin: normal
Unstable angina
64
Patient with blindness mainly when he drives at night, C/O tunnel vision, his grandfather had lost his vision
when he was 50. (Image attached). What is the diagnosis?
Retinitis pigmentosa: tunnel vision + FHx + retinal black-brown deposits “bone spicules”
65
48-year-old female with irregular periods for the last 8 months presents with a feeling of hot flushes,
sweating, disturb sleep at night. What is the best description?
PERImenopause: she is 48 y/o (AROUND the menopause).
menopause age is 51
66
Mom bring her child who is on exclusive breastfeeding, he wasn’t on any supplements or medication. No
teeth eruption. Have bossing forehead. Bowing bone. (X-ray attached)
What is the diagnosis?
Rickets
67
Pt have trauma to elbow joint showing dislocation. complain of numbness and tingling sensation of volar
aspect of little finger and can't abducted the fingers. which of the following nerve injury?
Ulnar
68
A 55-year-old lady C/O bilateral wrist pain, fatigue and lathargy. O/E: wrist is warm, swollen and there is
decrease ROM in flexion and extension with boggy sensation
Rheumatoid arthritis
wrist pain + SYSTEMIC sx + anemia + ↑ ESR = RA
69
Female in 45-50 came with 3 months hx of lower moderate back pain, wake her up from sleep, weight loss 4
kg, no fever, no nocturia, no sweating
What is the highest diagnostic study?
mri
70
Case of family want to travel to Indonesia, came to ask you for travel diarrhea
loperamide (anti-diarrheal agent) for small diarrhea is enough.
If moderate → Azithromycin
71
A 5-year-old boy presents with confirmed rotavirus diarrhea. He is tachycardia and lethargic with sunken
eyes, poor skin turgor, and dry mucous membranes. Which of the following is the most appropriate next
step in management?
0.9 NS 20 mL per kg bolus
: the child is in SEVERE dehydration (CNS involvement: LRTHARGIC)
give BOLUS 20 ml/kg now! Bolus fluid always 0.9 NS or LR
72
55-year-old man with progressive weakness of his hands over period of 1 year, examination reveals wasting
of the muscles of the hands and forearms and fasciculation. There is hyperreflexia of his lower limbs and
upgoing plantar reflexes, normal sensation. Which of the following is the most likely diagnosis?
A. Motor neuron lesion: There is a mixture of *lower* motor neuron signs in the upper *arms*
& *upper* motor neuron signs in the *legs* → Motor Neuron Disease particularly (Amyotrophic Lateral
Sclerosis type)
73
70 years old man diagnosed with colorectal cancer with poor prognosis, and asked you not to tell his wife.
His son catch you in the lift and asked you about his father situation, what will you do?
do your best with the family to encourage open discussion
between the family members
74
Child presented to ED with Drooling and refuse eat, what to do as next step?
Intubation: this is EPIGLOTTIS, the pt might deteriorate → INTUBATE
75
You are seeing an 18-year-old boy who reports acute pain in the left posterior heel. His symptoms occurred
while he was playing intramural basketball for his college dorm's team. On examination, he has swelling or
ecchymosis over the posterior left heel. He is unable to walk normally, positive Thompson test. What is the
most likely diagnosis?
Achilles tendon rupture
76
Diabetic patient with 30% ejection fraction, he’s on metformin & glipizide,
Came with bilateral lower limb edema up to mid-thigh. What would you add to this patient?
Empagliflozin
77
3-year-old child brought by his family immediately to the ER, with choking while he was eating peanuts,
when you saw him in ER he was still coughing. what’s the next step?
B. abdominal thrust (Heimlich maneuver): >1 y child with choking
back blow → if <1 y
78
Pregnant at the end of first trimester. Came to the clinic for f/u, asymptotic, last TDaP dose 2 y ago in her
previous pregnancy. She received influenza vaccine one month ago.
what vaccine she should receive during this pregnancy?
TDaP during 27-36 week: the only 2 vaccines indicated during EACH pregnancy are TDaP &
Influenza. She already received influenza vaccine one-month ago.
79
Young female complaining of abdominal pain, relieved after defecation. Have episodes of constipation
followed by diarrhea. These sx were associated with stressful event. there’s change in stool form or
frequency , what is the most likely diagnosis?
IBS
80
. Male, K/C of asthma, presented with history of progressive cough worsen at night with change in voice, no
other symptoms, normal exam. what’s most likely to confirm the diagnosis?
B. Esophageal PH monitoring: this pt has CHRONIC cough mainly at night (when he lies down) +
extra-esophageal sx (Δ in voice due to larynx microaspiration) = GERD → EGD is initial investigation (not
necessary for diagnosis), BUT the CONFIRMATORY investigation is pH-monitoring
81
A teenager female brought by her parents with abnormal posture (picture, not the same + x-ray attached)
idiopathic scoliosis
82
Female, obese, K/C of DM uncontrolled on metformin & glyburide, does NOT want weight gain, what to add?
SGLT2-i (-gliflozins)
83
. Pt presented to you, he is worried about extra beat he had in ECG, another doctor told him not to worry &
this is normal. The patient also was afraid of lung cancer previously, and he treated in the past from
pneumonia, and preoccupied about his health, Dx?
Illness anxiety disorder
84
construction worker presented with SOB and cough, on examination he has wheezing and clubbing. (CXR
attached) what is the diagnosis?
Asbestosis
85
Patient with ankle twist, he bears weight immediately after trauma, +ve tenderness in the inferior border of
the lateral malleolus, what is the best management?
B. dressing and crutches for the ankle
86
child with hx of skin allergy after eating egg.
What of the following would make him susceptible to further allergic complications?
. influenza
87
Patient with chronic hx of painless bleeding & itching for 6 months previously painless anal bleeding but now
painful within 24 hours, Exam: painful anal mass
Thrombosed hemorrhoid
88
. 35-year-old Pregnant lady, G5P4, she in labour, Cervix dilated 5 cm and 40% effacement
CTG: normal fetal heart rate (reassuring), which stage is she in?
A. First
89
30 years old female with hx of numbness and weakness in hands bilaterally, resolved spontaneously with
gradual onset of parasethia in the foot bilaterally in the past 3 weeks. She also has onset of right eye pain
with movement associated with cloudy vision and diplopia.
MRI report showed: oval shape periventricular lesions
Most likely diagnosis is:
Multiple sclerosis
90
60-year-old male, DM patient, with hx of productive cough & fever for few days.
BP: 110/60
RR: 20
CXR report > lobar consolidation.
What is the best management?
C. Cefuroxime + Azithromycin
91
middle age man C/O dysuria and frequency, no fever. DRE revealed enlarged tender prostate.
what the is the most likely diagnosis?
prostatitis
92
pt his lab shows high prolactin level. His medications include risperidone, HTN medication, DM medication
and dyslipidemia meds. which of following cause increased prolactin level?
Risperidone
93
A 59-year-old female, came to clinic C/O headache and blurred vision. On exam: scalp temporal area
tenderness. lab show ESR:120
diagnosis?
temporal arteritis (Giant cell arteritis “GCA”): in 50 + Headache + temporal tenderness →
give STEROID 1st (to prevent blindness) → then biopsy
94
child came to clinic complain of fever and sore throat, temp: 38.7˚C, no cough, on exam he has tonsillar
exudate and anterior cervical adenopathy what your management?
Penicillin, or
* Amoxicillin (❌NOT Augmentin)
❌Azithromycin: not preferred as 1st agent, can be used if there is β-lactam allergy
95
What is the developmental milestones of baby gets into the sitting position with help, and rolls from prone
to supine?
4 months
❌6 months → sits alone w/o support due to LUMBAR SUPPORT
❌9 months → he should be started CRAWLING
96
female pregnant on labor, cervix by exam was dilated 3 cm, The pt ask for female doctor to deliver her. what
to do?
respect he’s wishes and call another female colleague
97
middle age man came to ER complain of sudden severe left flank pain Radiate to groin with Nausea &
vomiting, no fever, no dysuria.
urine dipstick showed > hematuria.
Which of following highest dx value?
Non-contrast CT: this is a case of URETRIC STONE (URETEROLITHIASIS) wether the question
about INITIAL or DIAGNOSTIC, it is the same → non-contrast C
98
Female K/C of paranoid schizophrenia came to ER with her sister complain of visual hallucinations and her
sister told you 1 week ago she had dry eye, cannot urinate and cold/warm cervical area?
anticholinergic delirium
:pt on antipsychotic presented with anticholinergic S/E (DRYNESS):
dry eye, blurred vision, urinary retention, glaucoma, ↓ sweating + hallucination (delirium).
99
32 Years old Male, C/O dizziness, tiredness, abdominal pain, vomiting,
his pain increases after eating. He underwent gastric sleeve 2 wks ago.
What is you Diagnosis?
Dumping Syndrome
100
A 19-year-old male has a 7 mm induration 2 days after a tuberculin skin
test. His father was recently diagnosed with tuberculosis. There are no other
historical or physical examination findings to suggest active tuberculosis
infection. chest radiograph is normal.
Which one of the following would be most appropriate at this point?
Isoniazid daily for 9 months
❌(there was NO choice of Rifampin for 3-4 months)
101
Pt came after scorpion sting c/o pain at sting site, examination showed erythema and swelling. He
also has vomiting and abdominal pain. What is the most appropriate next step?
A. Scorpion anti-venom: ALTHOUGH, Tx depends on the country/area & scorpion type.
However, this is grade 3-4 scorpion envenomation (vomiting) → most likely needs antivenom
102
48-year-ola man, who works in a company, has a lot of works to be done, but he can’t let others to
finish them because he thinks it will not be perfect, this also affects his relationship with his wife
OCD personality disorder
103
Adolescent male present with acute left-sided pleuritic chest pain increased by breathing, chest and
CVS examination normal except for tenderness at level of left 3rd rib, what is the most likely dx?
Costochondritis: chest pain reproducible by palpation
104
A 63-year-old postmenopausal female came with vaginal bleeding, last pap smear was normal. Next
step?
Endometrial biopsy
105
dyspnea + Pleuritic chest pain improves by leaning forward and there is friction rub on exam. Which
of the following would prove the diagnosis?
Diffuse ST elevation on ECG
Dx → Pericarditis: diffuse ST elevation + PR depression (more
sensitive)
106
A child presented to the clinic with his parents with repetitive talk in the clinic and other autistic
behavior (The child does not play with a group of children, and play in one manner, dose’t have eye contact.
What’s the most appropriate management?
Behavior therapy
the cornerstone of Autism Spectrum Disorder (ASD) management is
BEHAVIORAL therapy.
107
Pt complaining of lesion in his foot (picture attached), what is the appropriate management?
Reassure and follow up
: lateral malleolus callus
108
54-year-old female on α-blocker and another medication, has irregular menses, fatigue + nipple
discharge, no visual changes
Labs:
TSH: high 14
FT4: low
Prolactin: high
FSH & LH: normal
What is the most likely cause of her problem?
Hypothyroid
109
14-year-old female with normal 2ndry sexual changes, her mother is afraid that her daughter didn’t
started menses yet, mother menarche is 13 y. What is the most likely diagnosis?
Reassurance may the menses start this year and f/u after 1 yr
110
54-year-old male K/C of HTN well controlled on lisinopril 5 mg and has a FHx of DM
Labs:
Cholesterol: high
LDL: 4.3 mmol/L (high)
Triglyceride: 3.4 mmol/L (high)
HDL: ??
What to give? (Missing info!)
Statin
111
patient C/O vertigo when he roll in the bed, lasts about 20 sec then dizzy for 2h. He has FHx of
otosclerosis, what's next step in diagnosis?
Dix-hallpike maneuver: is the best DIAGNOSTIC step to dx BPPV → Tx: Epley maneuver (not
diagnosis),
112
Young patient presented with left testicular pain associated with left flank pain and nausea,
examination showed high riding left testis when compared to the right one
What is the next step?
✅A. US doppler: is the best initial test to see vascularization to dx testicular TORSION
(painFULLLLL, TENDER, high-riding in horizontal lie testis) → immediate SURGERY w/i 6 hrs
113
male (in 50s) DM and HTN for 8 months on lisinopril 5 mg, his BP 148/92, mildly high cholesterol,
came for follow up. What you will do regarding his BP (according to JNC 8)?
Increase lisinopril to 10 mg: DM & HTN above the goal (>140/>90) → ↑ the dose
114
Diaper rash involve the groin flexors folds (NOT THE SAME pic)
ask about treatment?
Clotrimazole (or any topical azole): involve the groin = diaper CANDIDIASIS
Zinc oxide → IRRITANT diaper dermatitis
115
Female in her 50’s came with itchy erythematous rash plaques with bulla, no fever, (picture
attached) ask about diagnosis?
Bullous pemphigoid: tense bullae in elderly patient
116
54 years old known to have DM, C/O chronic hx of decreased vision, later on he developed central
vision loss (picture attached)
Macular degeneration
117
Patient C/O red eye with tearing and itching, (picture attached), what is the diagnosis?
Entropion: eyelid is rolled inward
118
Elderly patient presented with history of bilateral knee pain when walking, not responding to
painkiller and PT, (x-ray is attached), what is the next step in management?
Referral to bilateral Total Knee Replacement (TKR): VERY SEVERE osteoarthritis (OA)
119
A 12-year-old obese boy presents to your office complaining of gradually increasing hip pain that
radiates to the groin and knee. Physical examination showed that the boy in pain and the hip in the position
of abduction and external rotation.
What is the most likely diagnosis is?
Slipped capital femoral epiphyses (SCFE): OBESE male >10y, loss of Internal Rotation only, Xray slipped epiphysis
120
young male came presented with shoulder pain after trying to pull something (shoulder X-ray
attached) What is the next appropriate step?
Reduction
121
15-year-old female, losses 30 Kg in the last year. Her BMI now is 15 and she still thinks that her body
is too heavy. What is the diagnosis?
Anorexia nervosa low BMI
122
man came to ER C/O abdomen pain, constipation and vomiting for few days, no fever.
O/E: no tenderness or guarding, but there is distention and hyperactive bowel sound. past hx includes
appendectomy 5 years ago.
what is the most appropriate next step ?
NPO, IV fluid and NGT decompression:
123
Child came with mid line neck mass, Move with toung protursion and with sowlling (picture
attached), What’s your diagnosis?
thyroglossal cyst
124
67-year-old male, K/C HTN and he is smoker, came with hypogastric mass, on examination painful
pulsatile mass below the umbilicus, abdominal bruit by auscultation. What is the next step? (No symptoms
of abdominal/flank pain)
Next /1st → US
* Suspected ruptured AAA “SYMPTOMATIC” (abdominal/flank/back pain ± ↑HR, ↓BP or
retroperetonial hemorrhage) → CT or MRA
* BEST (pre-OP) → CT angio
125
58-years-old female with history of fibroid not responding to medical treatment, she is for
hysterectomy with oosalpingectomy and hormonal replacement therapy, you want to start her on estrogen
therapy. What to ask in the personal or family history?
Thromboembolic event: HRT (with ESTROGEN) → ↑ VTE risk (DVT & PE)
126
Young male pt , athletic presented with rash in back, the condition increased during summer,
(picture attached), asking about the diagnosis?
pityriasis versicolor
127
Diabetic on insulin glargine + short acting insulin, he feel dizziness and sweating while he walks on
the treadmill, his fasting blood surge in morning is 140 mg/dL, what to do?
snacks before exercising
128
A 61-year-old white postmenopausal woman comes to your office for a routine health examination.
She has a history of osteoarthritis, and she smokes one pack of cigarettes per day. She is on no medications.
Her blood pressure is 120/80 mm Hg, BMI 27. The rest of her physical examination is normal. (Not sure if
mentioned +ve FHx)
Which of the following is an established risk factor for osteoporosis?
history of fragility fracture in first-degree relative,
otherwise B. Smoking would be the correct answer
129
20-year-old divorced female, presented with on/off band-like headache mainly on the back of the
head for 3 weeks. Increases with emotional stress. Examination is normal.
What is the treatment?
NSAID
130
A 3-year-old girl swallowed a button battery. Plain radiographs demonstrate that the battery is
lodged in the esophagus. Which one of the following is the most appropriate next step in management?
✅B. Endoscopic removal: as long as it is in the esophagus (even if asymptomatic). If past
esophagus → expectant management
131
2-year-old child, C/O anal itching mainly at night, on examination: anal erythema.
stool analysis (3 consecutive samples): no ova, no blood, no pus
what is the management?
albendazole and repeat after 2 weeks
132
A 45-year-old woman who reports increasingly severe right foot pain for 2 weeks. She has been
trying to lose weight, and has recently started a walking regimen. She describes a sharp pain in the inferior
heel when weight bearing after a period of rest. With continued movement, the pain improves, but becomes
more dull and achy. She has tried anti- inflammatory agents with only temporary relief. Of the following,
which is the best next step?
Arch support / shoe inserts / foot orthosis: this is a typical case of Plantar Fasciitis
133
pregnant in 11 weeks gestation, came with slight vaginal bleeding. closed cervical os. +ve fetal heart.
threatened abortion
134
you are conducting a research on gastroenteritis, the control group of 600.
If (p-value <0.01), Which of the following values represent p value and means that the result is due to
chance?
10% = 0.1 (>0.01 “p-value”) and anything > p-value means the results are by CHANCE
135
You are studying the association btw electronic smoking & COPD. Best study to reduce confounding?
Randomization
136
Patient received flu vaccine, what type of prevention?
Primary
137
We conducted a study to compare the risk in 2 population. In 500 people، 400 where affected. And
in the control group of 500, 100 were affected. In the gastroenteritis group, calculate the absolute risk
reduction?
A. 60:
ARR Simply: the DIFFERENCE in the risk btw the 2 groups:
ARC = the AR of events in the control group.
ART = the AR of events in the treatment group.
ARR (absolute risk reduction) = ARC – ART
= |(100/500)-(400/500)|
= |-0.6|X100 = 60
138
17-year-old female came with irregular periods last month and amenorrhea for 2 months, when
should you ask about sexual activity?
If it is relevant to her care
139
Adult patient had burn involving his entire right arm and right leg. What would be an accurate
percentage of the area involved?
27%: Right arm = 9%, Entire leg = 18%
140
A female, nonsmoker, with history of controlled seizure on carbamazepine. What’s the best contraception for her?
Levonorgestrel IUD
Carbamazepine is an enzyme inducer (⨁ CYP3A4 “liver metabolism enzyme”) → affects hormonal levels
(make them metabolized faster), which will ↓ their efficacy. So OCP and progestrin pills are wrong ❌
141
A study was done on the effect of regular exercise in prevention of diabetes. Which of the following
will affect the validity of the study?
Loss of patient follow up
142
55-year-old female postmenopausal complaining of vaginal dryness and dyspareunia, O/E; there is
decrease in hair pale pink vagina, loss of rugae. what is the most likely diagnosis?
B. Atrophic vaginitis: postmenopausal + vaginal dryness & dyspareunia → Tx:
* 1st → topical moisturizer
* 2nd → local estrogen
143
nurse accidentally got pricked with a needle of an HIV patient, which of the following is considered
to have the highest risk for transmission?
Depth of the injury
144
A patient is traveling soon. He will be traveling to a rural area in Saudi Arabia and staying there for 3
months. He asks you about prevention of amebiasis. Which of the following is the most effective strategy for
prevention?
Avoid uncooked vegetables: amaebia needs HEAT to be KILLED, not only washing hands!
145
3 year old child with cervical lymphadenopathy and cracked lips, swollen, and erythematous palms
and soles, painless conjunctivitis, and other symptoms. What is your management?
IVIG
Tx: IVIG + aspirin high dose
146
58-year-old man, diabetic patient complains of an ulcer in his right foot. Physical examination reveals
a 1 cm irregular ulceration over the right metatarsal head, surrounded by an area of black gangrenous skin.
The patient is admitted for right foot amputation. Which of the following measures would have been most
effective in preventing this complication?
Appropriate self-care of feet
147
Patient (in the 50-60s) with back pain increased by movement, decrease reflexes of the lower limb,
x-ray shows degenerative changes, wide base gait, no incontinence, normal sensation.
what is the most likely diagnosis?
Lumbar stenosis: elderly with back pain EXACERBATED by movement + normal sensation but
delayed reflexes ( reflex estimates the spinal CORD response). degenerative changes on X-ray
148
24-year-old female asthmatic, follows for HTN, standing BP and sitting BP difference is lower than 10
systolic and 5 diastolic.
Vitals:
BP: 148/90
HR: 90
RR: 12
Electrolytes:
Na—146
K—2.9
What's most likely diagnosis?
Conn's disease (HYPERaldosteronism): ↓ K + borderline-↑ Na → HTN
149
Child came with few month history of skin lesion on dorsum of hand (picture attached). What is the
diagnosis?
Cutaneous wart
