2023

Question 1

Patient came with hypopigmented patches with fine scales asking about causative organism (Tinea Versicolor)

Answer 1

Malassezia

Question 2

Soft palate ulcer and posterior throat with fever and rash in the hands and digits (Most likely hand,foot, and mouth disease)

Answer 2

antipyretics (supportive)

Question 3

Question explained the presenting history of the patient and the following picture was attached. Determine the diagnosis.

Answer 3

molluscum contagiosum

Question 4

Case presented with hyper pigmentation on the face as pic , what is the condition

Answer 4

melasma

Question 5

His of red pigmented lesion on the axilla , that turned brown ,wood light exam showed coral red- fluorescence what is the appropriate ttx ? (case of erythrasma)

Answer 5

Infection may be treated with topical and/or oral agents. First-line therapy is topical erythromycin or clindamycin, or fusidic acid cream or miconazole cream

Question 6

pt came middle age complain of lesion grow in hand over few months progressively and cause bothersome sensation, not painful at Dorsum of wrist penlight test show transillumination +ve, what is the diagnosis ?

Answer 6

Ganglion Cyst

Patient presents with a mass in wrist, sometimes painful
Most commonly caused by repetitive activity causing tear or degeneration in joint capsule or tendon synovial sheath
Treatment is observation or needle aspiration
Most common soft tissue tumors of the hand

Question 7

pt came middle age complain of lesion grow in hand over few months progressively and cause bothersome sensation, not painful at Dorsum of wrist penlight test show transillumination +ve , what is the management ?

Answer 7

Question 8

Patient came concerned about white colored pigmentation on the nail what is the name of the condition

Answer 8

leukonychia

Question 9

Pediatric patient , came with hx of fever , coryza and rash , examination as showed (showed kiplok spots , exact picture) , What is the diagnosis?

Answer 9

measles

Question 10

Pt complaining of hypopigmented lesion of the back (pitryiasis versicolor ) asking about the organism :

Answer 10

Pityriasis versicolor is caused by mycelial growth of fungi of the genus Malassezia furfur

Question 11

A 6-year-old girl presents to your clinic with a fever and rash as seen in the image above. Her mother states she has also had a headache, runny nose, and diarrhea over the past few days. Which of the following is the most likely diagnosis?

Answer 11

Erythema Infectiosum (Fifth Disease)

Most common in children aged 4–10 years
History of URI symptoms 3–4 days prior to rash
PE may show erythematous macular slapped-cheek rash
Adults present with arthralgia w/wo rash (not on cheeks)
Most commonly caused by parvovirus B19
Aplastic crisis in sickle cell patients

Question 12

A 6-year-old girl presents to your clinic with a fever and rash as seen in the image above. Her mother states she has also had a headache, runny nose, and diarrhea over the past few days. What is the management ?

Answer 12

The diagnosis is clinical and treatment is symptomatic. There is no vaccination that can prevent parvovirus B19 infection.
anti

Question 13

A 5-year-old boy is brought in to urgent care by his father for a bug bite on his hand. He recently went camping and remembers being bit by mosquitos. The majority of lesions have resolved, but a bite on his hand has now become yellow. He otherwise feels well with no fevers, rash, nausea, or vomiting. On exam, you note a single 0.5 cm honey-colored crusting lesion. Which of the following is the most appropriate treatment?

Answer 13

Question 14

A 13-year-old boy presents to the clinic with a one-week history of a pruritic rash on his feet. Physical examination reveals a vesicular eruption with underlying erythema over the medial aspect of his feet bilaterally. Potassium hydroxide preparation shows segmented hyphae on a background of squamous cells. Which of the following is the most likely diagnosis?

Answer 14

Tinea pedis

Question 15

a case about pediatric glaucoma , asking what to tell the parents ?

Answer 15

• it is associated with CYP1B1 gene
• most cases discovered within the first year of life
• Sign and symptoms Corneal enlargement High IOP

Question 16

(NEEDS BETTER RECALL ) hx of sudden floater in the eye with pic attached , what is the likely case

Answer 16

vitreous hemorrhage

Question 17

26 year old female patient came with eye symptoms , loss of color , loss of the superior vision of one eye, painful eye Investigation: all normal except high ESR
With fundoscopic picture attached: (A) is normal

Answer 17

Optic neuritis

Question 18

Pediatric Pt come with unilateral red eye, photophobia. Hx of leaf trauma 5 days ago., Diagnosis?

Answer 18

fungal corneal ulceration

Question 19

contact lens user , came with ? red eye , itchiness, tearing, fluorescein test -ve (?and sensation of foreign body) for 2 weeks

Answer 19

Giant papillary conjunctivitis
giant papillary conjunctivitis (GPC). GPC is a noninfectious inflammatory disorder that represents a reaction to lid movement over a foreign substance, such as contact lenses. It is characterized by foreign-body sensation on the upper tarsus, associated with formation of “giant” (>1 mm) papillae.
cobblestone appearance

Question 20

Elderly patients came with painless vision loss , they didn’t mention any chronic diseases, on examination: systolic murmur , and something else I didn’t remember. What is most likely the patient to have ?

Answer 20

-retinal artery occlusion

Question 21

case of corneal abrasion Child complaining of red eye and photophobia ( fluorescent stain +ve ) What is the appropriate management

Answer 21

1- foreign body removal
2- analgesia
3- Abx if dirty injury arithromycin

Question 22

Patient came with a headache, left red eye, blurred vision, right eye vision 20/20, left eye 20/100, dilated pupil with injected conjunctiva, diagnosis? ( Exact pic )

Answer 22

acute angle closure glaucoma

Treat fast: “time is optic nerve” * Avoid topical B blockers in COPD/asthma * Avoid acetazolamide in sickle cell disease or if sulfa allergy

Question 23

Case about children and adults is hearing loss. It can affect one or both ears at the same time. It may seem like you’re wearing earplugs, muffling the noises around you

Answer 23

Glue ear, or otitis media with effusion, happens when fluid collects in your child’s middle ear. The main symptom of glue ear is temporary hearing loss. Glue ear often occurs after ear infections, but it can also occur when a blockage affects your child’s Eustachian tube. Glue ear frequently goes away on its own, but some cases may require surgery

Question 24

Patient with history of fall down on the head , with hx of clear fluid coming from the nose , x-ray attached showing nasal bone fracture
x-ray attached (similar pic) what is the diagnosis

Answer 24

Ethmoid bone Fx

Question 25

Case of patient come with hoarseness and difficulty swallowing , history of heavy smoker Ex:non tender mass on neck

Answer 25

Laryngeal cancer

Question 26

Pt with sinusitis for 3 weeks and? high grade fever

Answer 26

Augmentin

Question 27

Patient diabetic came in with ear pain & itching , what’s the proper management

Answer 27

could be fungal OE - Itraconazole & paracetamol could be MOE -Ciprofloxacin-hydrocortisone

Question 28

patient with recent history of upper respiratory tract infection , presented complaining of ? 1 week history of ear pain and dizziness , ? and nausea Ask about the treatment ?

Answer 28

Vestibular neuritis: Treatment: based on the underlying cause Therapy is primarily supportive

Question 29

can’t remember the scenario well, pic of audiogram (same like this) asking about diagnosis Old patient complained of unilateral hearing loss, vertigo, ear fullness (no tinnitus mentioned or facial nerve symptoms) + nystagmus

Answer 29

Labyrinthitis: Clinical features Severe vertigo, nausea, and vomiting Hearing loss, tinnitus Nystagmus

Question 30

case of perforated ear , ttx?

Answer 30

Management is mainly supportive; consult ENT if there is hearing loss or vertigo. Instruct patients to keep the ear canal dry. Consider topical antibiotics if there is evidence of infection (e.g., otorrhea) or remaining foreign bodies

Question 31

Middle aged male pt came with hx of lower back pain no radiation no alarming signs , restricted lumber ROM Next step ( 3 weeks duration)

Answer 31

“Red flag” symptoms include saddle anesthesia, loss of bowel or bladder function, significant motor deficits, a history of trauma and concern for fracture, a history of spinal procedures in the last 12 months, fever, a history of intravenous drug use, a history of metastatic cancer, or unexplained weight loss. if none is present (Ibuprofen and muscle stretch exercises, promote activey)

Question 32

patient was alarmed by the appearance of the Swelling with mild “ pain or tenderness not sure which one “ of medial part of the clavicle for 1 month

Answer 32

Reassurance - this is a ganglion cyst

Question 33

A 42-year-old female came with right hand pain and stiffness in the right hand including multiple PIP and DIP joints, with one Heberden's nodule. Which of the following is the most likely diagnosis?

Answer 33

Osteoarthritis

Question 34

MRI Achilles tendon rupture , with Positive Thompson test MRI pic attached

Answer 34

Conservative treatment is usually the treatment of choice for elderly, inactive individuals, or those who are high-risk surgical candidates (multiple or severe comorbidities). Early surgical repair is considered for active, healthy patients, or those with a complete Achilles tendon rupture.

Question 35

Pediatric patient was brought to your care , not flexing his arm , history of being pulled by the hand while being in the stair x-ray showing

Answer 35

radial head subluxation (pulled elbow )

Question 36

2 months old boy with hx of unstable HIP joint click sound with passive movment of one hip (DDH) > investigation

Answer 36

(HIP US) Screening with imaging is recommended up to 6 months of age only if one or more of the following risk factors are present Breech presentation at birth Positive family history of DDH Clinical features of DDH

Question 37

Case of ankle sprain , with swelling in the malleolus , on exam , there is tendered on the ANTERIOR SIDE of the malleolus what is your management :

Answer 37

Question 38

57 Female has forefoot pain, burning sensation, Increase by wearing thigh High heel Tenderness on 3th and 4th metatarsal

Answer 38

Morton neuroma

Question 39

Post total hip replacement 2 weeks ago , complain of foot drop and high step foot what is the diagnosis?

Answer 39

Sciatic nerve injury

Question 40

Patient with Mid clavicular shaft none-displaced fracture, management

Answer 40

Sling

Question 41

Female pt postpartum 3 months ago came with symptoms of loss of interest and sad mood, decreased concentration

Answer 41

postpartum depression

Question 42

Case of anorexia nervosa, while nurse was taking the vital signs she said I would prefer to die rather than trying food disorders program, when physician asked her about suicide she refused to answer the questions, what would be the Next step?

Answer 42

develop safety plan with the patient

Question 43

A pediatric patient was brought by his family , they stated that he is Always carrying sanitizer and growing fear of germs. Avoid public bathrooms, what would be the first treatment?

Answer 43

exposure with response prevention (ERP)

Question 44

Patient with delusion about his company steeling his thoughts for 6 month (no mania symptoms) no hallucination , has been enjoying sometime going out with his friends ; no depressive symptoms what is the diagnosis

Answer 44

delusional disorder

Question 45

Bipolar case of hypomania and then mania, what is the most appropriate treatment (not mentioned of initial or first line treatment)

Answer 45

-lithium

Question 46

Patient came to the clinic in tears and felt depressed and hopeless . He was fired from his job 2 months ago . Still thinks about his job . enjoys hobbies and sitting with family and friends, what is the diagnosis ?

Answer 46

adjustment disorder

Question 47

(NEEDS BETTER RECALL )PTSD , Mid 20s male, with poor sleep He witnessed his brother's death in a car accident 2 months ago. What is the initial treatment:

Answer 47

First-line: psychotherapy with or without adjunctive pharmacotherapy [7] Trauma-focused cognitive-behavioral therapy Exposure therapy (e.g., showing war veterans images of war, returning to the scene of an accident) Cognitive processing therapy

Question 48

patient k/c of schizophrenia, with recent increase haloperidol dose from 2.5 to 10 mg come with tachycardia 120 -, confusion , stiffness what to measure to confirm your diagnosis?

Answer 48

CK Neuroleptic malignant syndrome (NMS), a potentially fatal syndrome characterized by hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability, reported with antipsychotic agents, including haloperidol. [ref] Immediately discontinue therapy and initiate supportive and symptomatic therapy if NMS occurs.

Question 49

Pt on Fluoxetine , Came complaining of erectile D what is your management

Answer 49

Change or add bupropion or mirtazapine

Question 50

anorexia nervosa case about a female visited the clinic and you diagnosed her with anorexia nervosa , treatment?

Answer 50

Question 51

Qs about child , mother was considered that he is not responding to commands , patient was heard repeating phrases were said in the clinic , also was avoiding eye contact what is your diagnosis

Answer 51

autism

Question 52

Pt with multiple complain despite normal physical exam and investigation, ( somatization ) Asking about management

Answer 52

schedule regular visit with the same doctor

Question 53

ER case after accident Findings: facial lacerations Echymosis on chest and abdomen, BP LOW, next step ?

Answer 53

do GCS assessment (ABCD approach)

Question 54

pic of CT scan (scenario about headache and morning vomiting and ataxia) what is your diagnosis

Answer 54

Hydrocephalus

Question 55

Patient brought to the ER with a history of gasping, pulse and blood pressure can’t be obtained, with VT showing on ECG (ECG similar pic ), what’s your immediate action?

Answer 55

depends on the hemodynamic stability of the patient . in this given seniro the patient is unstable so Immediate defibrillator , if no plus start CPR

Question 56

Hypertensive pt came with active epistaxis , despite anterior packing the pt still bleeding What is the management ?

Answer 56

posterior packing

Question 57

Renal trauma case what imaging you choose ?

Answer 57

General indications for imaging in GU trauma include: Blunt and/or penetrating abdominal trauma Penetrating back and/or flank trauma Injury mechanism consistent with possible genitourinary trauma Modalities: e.g., CT with IV contrast, retrograde urethrogram

Question 58

chemical eye burn case. Your next step

Answer 58

irrigation with water

Question 59

patient came with head trauma , periorbital swelling and otorrhea , asking about diagnosis?

Answer 59

Basilar skull fracture

Question 60

38 yrs old male ,His father died at age of 50 due to ruptured AAA, his brother also has AAA partially repair, Patient is smoker half pack/day for 25 years , (BMI 32) What would be the best beneficial intervention?

Answer 60

Smoking cessation

Question 61

patient presented with hx of constipation of 6 months , stool became thin , DRE : no masses ; positive occult blood test , what is the cause?

Answer 61

rectal cancer

Question 62

patient known case of ulcerative colitis have been complaining ?abd pain , ?constipation x-ray attached , what is the diagnosis :

Answer 62

toxic mega colon

Question 63

pregnant lady presented with RUQ pain , scleral icterus, cough Fever, elevated ALT , AST ,and ALP and bilirubin Normal lipase and amylase high WBC Fever was 38

Answer 63

Cholangitis (Charcot triad: fever + abd pain + jaundice)

Question 64

DM pt with scrotal painful enlargement, ? fluctuating + fever There was scrotal pain and erythema and perineum mass fluctuating just below scrotum 39 fever treatment:

Answer 64

surgery referral for incision and drainage

Question 65

pt man 27 years have came with dysuria and mild tenderness of testis, not mention sexual intercourse what is the most likely organism :

Answer 65

E. coli

Question 66

Patient came with numbness in the hands and feet , and memory loss , there is a history of gastric bypass. What is most likely deficient ?

Answer 66

B12

Question 67

patient came to the clinic for evaluation, he mentioned a father history of post appendectomy bleeding that needed blood transfusion your patient done labs showing normal HB , PLt level , and PTT , but increased bleeding time What should you assess for

Answer 67

Von willebrand

Question 68

(NEEDS BETTER RECALL)patient came with ? previous hx of URTI 2 weeks ago with history of ?(headache , hematuria , flank pain ,nausea and vomiting labs showing : normal plt number , ?creatinine and urea normal , frank hematuria what is the cause

Answer 68

IgA Vasculitis Henoch-Schönlein purpura

Question 69

Pt in 50s With uncontrolled DM2 Has orthostatic hypotension measured at office And other autonomic dysfunction With bph Sx, what is the preferred modality for treatment of his condition ( it was 1st line treatment)

Answer 69

Finasteride ( 5 alpha reductase inhibitor)

Question 70

Patient with Mid clavicular shaft none-displaced fracture, management?

Answer 70

sling

Question 71

(not exact pic )Husband brings his wife due to an episode of tonic-clinic seizure for the first time, he was previously healthy. CT of brain mass what to do?

Answer 71

Toxoplasmosis ag

Question 71

Pt with hypertension ,labs all normal except of (low K level ), imaging done and found to have adrenal mass, Best medication for him ?

Answer 71

-Spironolactone

Question 72

2 year old boy was at playing room then he suddenly developed SOB , on exam you notice wheeze , Spo2 92 Suprasternal retraction What is the most appropriate initial next step?

Answer 72

- Chest x ray

Question 73

NEEDS BETTER RECALL) Pt with symptoms of tb for 4 weeks came with x-ray pictures of pleural effusion fever and night sweating Vitally stable o2 sat was 92% What to do next?

Answer 73

-Emergent thoracentesis

Question 74

Patient for HBV investigation: Hepatitis serology: HBsAg negative , HBeAg negative , HBeAb negative , HBcIgM positive, HBsAb negative HBV DNA positive What is the diagnosis:

Answer 74

Acute infection, window

Question 75

Man with accident flank and hip pain and ecchymosis and bruise at the iliac crest and flank .. vital stable Next appropriate step in diagnosis

Answer 75

ct of abdomen + contrast

Question 76

Young female with thyroid nodule on examination, TSH , T3 & T4 were normal , Us showed 3 cm hypoechoic mass Appropriate next step ?

Answer 76

FNA

Question 77

50 year old male patient/c of DM came to ER with history of confusion, vomiting labs showed blood sugar level of 49 (>800) , PH normal , bicarbonate , normal all other labs were normal except for mild hyponatremia what is your diagnosis

Answer 77

high osmolarity

Question 78

female with hx of using corticosteroids for along time Osteoporosis PIC of DEXA scan showing osteoporosis of vertebrae DEXA and osteopenia of hip and something else

Answer 78

Osteoporosis with high risk vertebrae fracture

Question 79

60 year old male patient . known case of atrial fibrillation with history of ? transient right sided weakness that was resolved spontaneously investigation showed :Right carotid showed 60% stenosis,%, left 40% stenosis Next step to prevent recurrence?

Answer 79

Apixaban medical treatment needs to be adjusted prior to intervention , patient has a-fib with high Chads2-vasc score , need anticoagulant

Question 80

Female Pregnant ,9 week gestation age , with nausea and vomiting no abdominal pain ,no diarrhea mildly dehydrated What test to order

Answer 80

urine ketone body

Question 81

-Malar rash with sun exposure sparing nasolabial fold , Morning stiffness , Labs show + blood in urine What is most likely to be positive:

Answer 81

ANA

Question 82

patient complain of excessive sleeping and sometime sleep involuntary, after flying from city to another , what is the condition

Answer 82

Circadian Rhythm changing

Question 83

adult patient came with hx of frontal bossing, Bowing of tibia ; high ALP , high Ca, normal vit D ( cotton wool on x ray )

Answer 83

paget's disease

Question 84

A 54-year-old man with long-standing diabetes develops redness, pain, and swelling of his left lower extremity. Examination shows a 15 cm by 7 cm area of nonfluctuant, nonelevated erythema and swelling over the anterior aspect of the left lower extremity. He also has scaling and erythema between his toes consistent with a fungal infection. Vital signs are within normal limits. Which of the following is the most likely diagnosis?

Answer 84

Cellulitis

Question 85

A 54-year-old man with long-standing diabetes develops redness, pain, and swelling of his left lower extremity. Examination shows a 15 cm by 7 cm area of nonfluctuant, nonelevated erythema and swelling over the anterior aspect of the left lower extremity. He also has scaling and erythema between his toes consistent with a fungal infection. Vital signs are within normal limits. What ABX to use?

Answer 85

dicloxacillin

Question 86

-pt known case of acne , on oral clindamycin and topical ? retinoids came with hx of Watery diarrhea tinged by blood.what is your diagnosis?

Answer 86

C. diff treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile. [ref]C. difficile infection (CDI) and C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) reported with nearly all anti-infectives, including clindamycin, and may range in severity from mild diarrhea to fatal colitis

Question 87

child take shower when he felt dizzy, had Syncope while hot bath and hx of syncope with urinating ? no syncope after activity :what is your diagnosis?

Answer 87

neurocardiogenic syncope

Question 88

Child with sore throat, dysphasia and splenomegaly. rapid streptococcal antigen test -ve :Asking for treatment?

Answer 88

supportive treatment

Question 89

Question about nerve palsy

Answer 89

abducens nerve palsy (6th)

Question 90

patient with difficulty swallowing for the last 1 week and presented with sob + pic of pneumonia (fever , sputum) x-ray attached shows:

Answer 90

aspiration pneumonia

Question 91

middle age female hx of fatigue and lower limb edema non pitting and rash bilateral , vitals tachycardic and low BMI, what is next to do pic attached , what to measure :

Answer 91

TSH A rare dermatological feature of Graves disease that manifests as nonpitting edema and skin thickening, typically in the pretibial areas.

Question 92

case scenario of male in 40-50 (I think),can’t remember the complaint but 2 of his brothers had kidney problems in their 30 , CT attached (similar to this). Asking about his diagnosis

Answer 92

Poly cystic kidney

Question 93

Answer 93

she is at risk of having another febrile seizure

Question 94

Q about which indicates a bad prognosis of pneumonia? RR the scenario was 32

Answer 94

Respiratory rate 32

Question 95

A 40-year-old woman has double vision, fatigue, weakness, and spastic paraparesis. Physical examination reveals optic atrophy, nystagmus, dysarthria, and cerebellar deficits in the limbs. Flexion of the neck produces electric shock-like sensations that run down the back. Which of the following is the most appropriate diagnostic study for this patient’s condition?

Answer 95

MRI of the brain

Question 96

A 40-year-old woman has double vision, fatigue, weakness, and spastic paraparesis. Physical examination reveals optic atrophy, nystagmus, dysarthria, and cerebellar deficits in the limbs. Flexion of the neck produces electric shock-like sensations that run down the back. MRI ATTACHED, WHAT IS THE DIAGNOSIS ?

Answer 96

Multiple Sclerosis - MRI shows periventricular lesions

Question 97

A 26-year-old woman reports a history of amenorrhea for the past year. She has also had an increased amount of milky discharge from her nipples over the past several months and has lost all interest in sex for the past 6 months. She reports no drug or medication use other than occasional over-the-counter analgesics for frequent headaches. A physical examination confirms the presence of an easily expressed milky niple discharge, as well as vaginal dryness. A pregnancy test is negative. Which one of the following tests would be most appropriate at this point?

Answer 97

Serum prolactin level - A pregnancy test is an appropriate first step in the evaluation of a woman with amenorrhea and galactorrhea who is not taking medications. If the test is negative, hyperprolactinemia should be suspected. Prolactin levels can be elevated because of medications, a pituitary adenoma, hypothyroidism, or a mass lesion compromising normal hypothalamic inhibition. Elevated prolactin levels inhibit the secretion and effect of gonadotropins.

Question 98

Case about pneumonia calculate the CURB 65 ?

Answer 98

Question 99

A 10-day-old male infant is brought to the ED by his mother for difficulty feeding. Whenever he breastfeeds, he becomes extremely agitated, and his skin color turns bluish-gray. The infant was born at 39 weeks gestation, and the mother did not receive prenatal care other than a doctor’s visit during the first trimester to confirm and date her pregnancy. Labor lasted for 24 hours and resulted in a vaginal delivery at home. Cardiac examination of the infant reveals a palpable right ventricular impulse. A harsh, systolic, decrescendo-crescendo murmur is auscultated at the left mid to upper sternal border. Peripheral pulses are normal, and there is no hepatomegaly. Which of the following is the most likely diagnosis?

Answer 99

Tetralogy of Fallot

Question 100

middle age male with HF symptoms EF less 40 he is on ACE aspirin and statin HR 80 BP normal What medication to add

Answer 100

Carvedilol

Question 101

pt with heart failure symptoms what you do initially

Answer 101

BNP

Question 102

exposure to varicella to sibling one of them infected what to do for The 1 year old ?

Answer 102

Question 103

(needs better recall )Dm woke up and complains of decreased vision in the top half of his right eye Last measured HA1c was 9.1

Answer 103

Vascular retinal ??

Question 104

Married man with pic of painless penile ulcer no travel no mention of sexual intercourse out the marriage

Answer 104

- investigate the partner Ulcers associated with syphilis, LGV, and granuloma inguinale are usually painless

Question 105

53 y old new case of dyspepsia what investigation to order?

Answer 105

h pylori test

Question 106

pt came with signs and symptoms of heart failure and showed congested x ray and was asking what to do initially

Answer 106

bnp

Question 107

A child brought by his father due to a recent fall, on examination multiple bruises with different stages of healing were identified. What is the first/initial step of management? (Hx of child abuse (fall down with multiple bruises in different healing stages) Initial thing to do:

Answer 107

ensure child safety

Question 108

4 months old Exclusively breastfeed Mother wants to continue but asks if he needs anything What to give

Answer 108

vitamin D sup

Question 109

5 year old , came for Pre school vaccines what to give right now

Answer 109

DTap, MMR, OPV, Varicella

Question 110

3 months child came with undescended testes, right can be felt high but can not be brought to scrotum, and the left testis was seen in the abdomen

Answer 110

mostly 90% it will descend by the age of 1 year

Question 111

Common cold 2 year old

Answer 111

Nasal saline + humidifier steam .

Question 112

60 years Female pt retired teacher came for regular check up no active complain She did mammogram, pap smear and lipid profile 2 years ago all normal And did colonoscopy 4 years ago was normal What to do at this visit?

Answer 112

mammogram

Question 113

Pregnant 27 weeks with strong contractions 3 minutes apart, Dilated 3 cm , effacement 70%, positive GBS culture , asking for most appropriate next step:

Answer 113

- IM Betamethasone

Question 114

Pregnant woman 12 weeks G2P1 normal pregnancy. Fist child delivered by C/s because of cephalopelvic disproportion, she has high BMI 35, and she has positive family history her brother and father have T2DM. She came at her first antenatal visit. This pregnancy she gained 4 kilograms investigation should do for her at this visit

Answer 114

Glucose tolerance challenge test

Question 115

Female with 2 years amenorrhea and mentioned MRI show suprasellar something High FSH High LH, Prolactin :normal , Ask about diagnosis:

Answer 115

premature ovarian failure

Question 116

case of vaginal discharge , off white , ph alkalosis , clue cells, not pruritic what is the cause

Answer 116

bacterial vaginosis

Question 117

Pregnant lady 27 week b/p: 150/ Previously: 110/70, normal labs , and urine analysis

Answer 117

gestational HTN

Question 118

25-year-old woman who is currently breastfeeding her 1-week-old newborn presents to the clinic with breast pain. She also reports general malaise, fevers, and chills. Physical exam reveals a firm, erythematous, tender, and swollen area on her left breast. Her blood pressure is 123/84 mm Hg, heart rate is 93/min, and oral temperature is 38.3°C (101°F). Which of the following antibiotics is appropriate for the treatment of this patient?

Answer 118

oral Abx : Dicloxacillin

Question 119

case of postpartum day 2 with breast pain

Answer 119

refer to lactation proper education

Question 120

a woman G1P1 complains of nipple pain with breastfeeding after examination you find there is erythema only. What is your next step ?

Answer 120

Education about breastfeeding technique

Question 121

19 year old with hx of irregular menstruation described as heavy bleeding, frequent, ? Intermenstrual bleeding. hx of irregular bleeding , for the last 3 years, it was regular before that. Age of menarche is 12

Answer 121

if irregular shape then Uterine fibroid if globular uterus enlargement then Adenomyosis

Question 122

Patient with depression began on citalopram not improved switch to fluoxetine slightly improved but still sleep 12hrs , and ? not feeling energetic patient reluctant to change fluoxetine as some benefit

Answer 122

add bupropion

Question 123

Male pt middle age medically free not smoker , His labs all within normal range Lipid profile within normal (no mention of LDL level)

Answer 123

do LDL level now

Question 124

pt came with back pain progressive with red flags, she did MRI showed Metastasis, you ordered another investigation to confirm.asking about pt how to receive the bad news

Answer 124

What's your idea about what you have?

Question 125

patient came with overdose of 34 pills of 500 mg of paracetamol , came 12 hours after ingestion , vitally ? what to do next

Answer 125

admission for n-acetylcysteine

Question 126

-Asthma exacerbation , was on Low Dose ICS , in ER Took PRN SABA improved slightly , SPO2 92%. Still have bil. Wheezing, What is next step?

Answer 126

Oral steroid LABA

Question 127

female follow-up regarding asthma, 2 night attacks per week, she is on SABA and low inhaler steroid What to give :

Answer 127

B.Low steroid + LABA

Question 128

– Prophylactic for migraine

Answer 128

BB

Question 129

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

Answer 129

Referral for BRCA mutation