SMLE 2019

TH
19 OF DECEMBER

Glory Team

Please don't hesitate to contact us if you have any correction, comments or

suggestions.

Teamglory2020@gmail.com

Medicine: 2-7
Surgery: 8-9
Pediatric: 10-12
OB/GYN: 13-17
Ethics: 18-19
Glory Team 19th-December

Medicine
● What’s the most recommended to screen in asymptotic adults ?
A. colon
B. skin
C. thyroid
D. bladder
Answer is: A, colorectal

● 65 y/o women come for annual check up found to have harsh ejection
systolic murmur which propagated to the neck.
What’s the following factors that decide the time of surgery?
A. low pulse pressure
B. Intensity of murmur
C. patient symptoms
D. left ventricular hypertrophy
Answer is: C

● 45 years old male come with sudden onset of unilateral peripheral facial
nerve weakness 1 hour ago . He is no medical illness or no on any
medication.
What’s the following shorten his symptoms?
A. antiviral therapy
B. thrombolytic therapy
C. glucocorticoids therapy
D. hyperbaric oxygen therapy
Answer is: C
Glory Team 19th-December
● 45 years old women with diabetes come to the ER with fever, flank pain,
dysuria . She is allergic to penicillin. On examination, there was flank
tenderness. T 39 , WBC 17 ( 4.5 - 10.5 normal ) , urine culture > 100,000
cfu/ml E. Coli
What’s the absolute contradiction?
A. piperacillin/tazobactam
B. cipro
C. meropenem
D. ceftriaxone
Answer is: A

● What’s the drug that is useful to reduce stone formation in hypercalciuria ?

A. thiazide diuretic
B. allopurinol
C. penicillamine
D. dietary calcium restriction
Answer is: A

● Pt in ICU with necrotizing pancreatitis for 4 weeks what metabolic response

will be present in this Pt
A. Hypoglycemia
B. Lipolysis
C. Increase insulin resistance
D. Decrease gluconeogenesis
Answer is: B (increase lipolysis)

● When screening of osteoporosis on bone measurement test for women?

A. 50-54
B. 55-59
C. 60-64
D. 65-69
Answer is: D

● How to diagnose pt with psoriasis as he is having erythematous base

batches with scales?
A. Clinically
B. Iodine
C. biopsy
D. forget ​(but it wasn’t related)
Answer is: A
Glory Team 19th-December
● Melanoma biopsy:
A. Superficial
B. Deep
C. Punch biopsy
Answer is: Melanoma: ​excisional biopsy
For sarcoma: most appropriate > needle core biopsy, gold standard > incisional biopsy

● TTP asking the ttt:

A. plasma exchange
B. platelet transfusion
Answer is: A

● Cardiac tamponade symptoms without mentioning the dx, asked the best
imaging:
A. Echo
B. X ray
Answer is: A

● Resting tremor , shuffling gait; mask face :

A. Parkinson
B. Alzheimer
Answer is: A

● After blood transfusion bleeding at the site fever and i think chest
symptoms:
A. Febrile Hemolytic rxn
B. Non febrile hemolytic rxn
Answer is: A

● Crohn on medication not controlled what to add:

A. Azathioprine
Answer is:
Glory Team 19th-December

● Clear case of TB ask about next step

A. Start antibiotics
B. Send sample for AFB
C. Start anti TB
D. Steroid
Answer is: B

● Pt with non pitting edema, how to investigate:

A. Venous duplex
B. MRV
Answer is: A​ initially, lymphoscintigraphy is the gold standard

● Business man used to travel to far east; presents with fever

lymphadenopathy and oral candida.
A. HIV
B. Brucellosis
Answer is: A.

● Lethargy with past hx of Polymalgia rhumatica and ischemic heart disease,

what is the cause?
A. CLL
Answer is: A

● HTN in low risk man

A. 35
Answer is: 18 yrs

● Pleural effusion
A. Glucose < 60
Answer is: A

● Patient with advanced breast Ca, had kussmaul respiration (they explain
the sign):
A. Dilated cardiomyopathy
B. Obstructive cardiomyopathy
C. Restrictive cardiomyopathy
Answer is: C
Glory Team 19th-December

● Pt with low back Pain and raw milk ingestion, how to confirm diagnosis:
A. Serum agglutination test
B. Sacroiliac joint X-ray
Answer is: A

● 25 y/o Pt on examination palpable kidney with ​distended lower abdomen​,

by VUG bilateral hydronephrosis + dilated proximal part of urinary bladder,
which is likely diagnosis:
A. Polycystic kidney
B. Ureteropelvic junction
C. Something cancer
Answer is: could be prune-belly syndrome

List of Incomplete Questions:

● S&S of Wilson’s disease (Kayser-Fleischer rings) what is the diagnosis?
Answer is:

● Long scenario and with extensive labs:

Options were: TTP, ITP, DIC, the answer was DIC know different lab values for each

● CHA2DS2 score calculation, trick was that they gave S&S of CHF in the
history and they said he’s know case of DM and history of TIA
Answer is:
Glory Team 19th-December
● Infiltrates and signs of cardiac failure
A. Right-sided heart failure
Answer is:
Glory Team 19th-December

Surgery
● Femur fracture with 30 degree anterior angulation, no close reduction in
options
A. open reductions with plates
B. open reductions with intramedullary nails
C. surgical exploration
Answer is: B

● Child’s hand picture with distal radial fracture with angulation and
deformity with lesion. What is the next management?
A. close reduction with below elbow cast
B. close red with above elbow cast
C. surgical fixation
Answer is: C (lesion it’s wound, open fracture)

● Causes of bradycardia in a patient who underwent laparoscopy:

A. Cold gas insufflation
B. Stretch of parietal peritoneum
Answer is: B

● Management of low-lying fistula ​(Fistoloctomy was not in the answers!)​:

A. Fistolotomy
Answer is: A for simple fistula

● Sclerosing agent is used for:

A. Internal hemorrhoid
B. External hemorrhoid
C. Hemorrhoids with thrombosis
Answer is: A

● 58 years old woman with right thigh mass measured 5*6. Core biopsy
shows high grade sarcoma. What the most appropriate staging image?
A. bone scan
B. MRI abdomen
C. CT chest
D. Right thigh plane X-RAY
Answer is: C
Glory Team 19th-December
● 55 women come with difficulty in breathing after 6 hours of total
thyroidectomy. Examination confirmed the presence of large neck swelling.
What’s the most appropriate next step in management?
A. Tracheostomy
B. Epinephrine injection
C. Open wound suture in ward
Answer is: C

● 40 years old diabetes male come with painful perianal swelling with fever
for the last 3 days. T 38 , WBC was 16 , neutrophil was 80 , random glucose
was 6.5. What’s the DX ?
A. Anal fissure
B. Perianal abscess
C. Hemorrhoid
D. Thrombosed piles
Answer is: B
Glory Team 19th-December

Pediatric
● Child with stridor worse when prone, improved on supine position:
A. Subottic stenosis
B. Laryngomalacia
C. Nasal atresia
Answer is: B

● Prominent forehead low line hair cardiac anomalies:

A. Down syndrome
B. Turner syndrome
Answer is: B

● 12 year complain of bleeding gum after urti 2 weeks ago , PTT,PT normal ,
in the blood smear : megakaryocyte, platelets count 20 very low, ( clear
case of ITP) what is the best next management ?
A. Steroids
B. Abx
C. Splenectomy
D. Blood transfusion
Answer is: A

● For ADHD child it's important that the parents focus on the positive
behavior and ignore the bad behavior, what is the best way to do that:
A. Positive reinforcement
B. Parents training
Answer is: A

● Parents didn't vaccinate their child:

A. Explain the benefits
Answer is: A

● Child fall, bleeding from ear:

A. Basal skull fracture
Answer is: A

● What is warning sign for newborn:

A. Tooth eruption
Glory Team 19th-December
B. Absence of distal pulse
Answer is: B, by exclusion

● Child suffered from infections i think ,but the key word is “his brother and
his uncle had the same condition “:
A. Wiscot aldrich syndrome
B. Bruton agammaglobulinemia
C. DiGeorge syndrome
Answer is: B, if with dermatitis and thrombocytopenia > A

● Child for circumcision u found urethra on the back side​:

A. Refer to pediatric surgery
B. Plastibell
Answer is: A

● In managing an infant of mother with diabetes who requires a high level of

glucose infusion concentration up to 20% to control hypoglycemia. What’s
the most appropriate route?
A. orogastric tube
B. nasogastric tube
C. central venous catheter
D. Peripheral venous catheter
Answer is: C

● 4 years old boy come with history of decreased appetite and activity for
last month, he lost significant weight since last outpatient visit. What’s the
most common cause of cancer in such a patient?
A. lymphoma
B. leukemia
C. neuroblastoma
D. retinoblastoma
Answer is: B

● 2 years old baby has Lt eye red reflex what to do ?

A. Sedate her and let the opthamologist examine her
B. reassure
C. normal development
Answer is: A

● Mother concerned about her childs hight, everything was normal​ ?

Answer is: ​calculate parents hight to estimate the child’s “adult hight”
Glory Team 19th-December
● Same scenario as above (red reflex); what is the diagnosis?
Answer is: retinoblastoma

● a child has leg abnormal shape and delayed walk, Ca high ,alkaline
phosphatase high normal PO4?
A. vitamin D deficiency rickets
B. x linked familial hypophosphatemia ricks
C. renal dystrophy
D. hypophosphatasia
Answer is: D

● Child presented with active s&s of Ricket , only vegetarian, which Vit
supplement should he receive?
A. Vit A
B. Vit D
C. Vit E
D. Vit k
Answer is: B

● 4y/o boy , diagnosed with meningitis ,LP done result: gram positive cocci
started empirical Abx;(I do not remember) , then started with specific ABx
have resistance , Note : (MRSA treatment​)
A. Vancomycin.
B. Ceftriaxone
C. Continue empirical
Answer is: A

● Uncircumcised baby will be at risk of what?

A. Increase infection
Answer is: A (UTI)

● UtI in 2 months uncircumcised baby

A. Oral ceft
B. Iv ceft
Answer is: B

● Baby came with vomiting for 2 weeks Progressed He was healthy before Ep
signs with dehydration/ apart from having pansystolic murmur, What to
do?
A. icu admission for catheterization
B. Iv ab then reavalute
C. Refer to surgery
Answer is: ​IVF, if febrile and no IVF > B
Glory Team 19th-December

Obstetrics and Gynecology

● 25y females have symptoms prior to her period and subside 2 days after
starting menstruation, These symptoms led to decrease her activities in
work, increased absences, increase visits to ER What is the most affective
or symptoms diagnose her symptoms
A. irritability
B. Mood swings
C. Depressed mood
Answer is: B

● Vaginal secretion fish odor gray what do you expect to see in the test:
A. Hyphae
B. epithelial cells
Answer is: B

● 60 year old complain of postmenapuse bleeding, she is HTN,DM , BMI 40 ,

on examination no tenderness no adnexal mass no enlargement:
A. Endometrial ca
B. Endometriosis
C. Fibroid
D. Adenomyosis
Answer is: A

● 40 year old DM,HTN, BMI 35, complain of vaginal bleeding between her
periods, she has regular periods every 30 days , on examination there was
no adnexal mass , but the uterus was big and tender :
A. Endometrial ca
B. Endometriosis
C. Fibroid
D. Adenomyosis
Answer is: D

● Pt with ectopic had BHCG 2,500 , treated medically then on follow up BHCG
was 6000, what to do next?
A. Salpingostomy
B. Salpingectomy
C. Repeat metho
D. Exploratory laparotomy
Answer is: A
Glory Team 19th-December
● Female pregnant on 33 weeks , G8 , had multiple deliveries which required
blood transfusion.what we do to prevent this ?
A. active 3rd stage management
B. elective c/s on 38
C. prepare for crystalloid iv for postpartum
D. delivery on the OR
Answer is: A

● Episiotomy reaches to anal musocsa?

A. 1st degree
B. 2nd degree
C. 3rd degree
D. 4th degree
Answer is: D

● Amenorrhea mild hair on face “ pelvic exam normal”

A. Pcos
B. Hyperthyroid
C. Hypothiroid
Answer is: A

● 17 yrs old girl she developed breast later than her friends, she was the last
one, on exam she is tanner V , normal breast and pubic hair, ​no
menstruation yet​:
A. Pituitary
B. Bicornuate uterus
Answer is: ​Could be constitutional delay if not in choices > A

● Girl started her menstruation 8 months ago, but her period is irregular now
what is the cause:
A. Hormon (or Endocrine) abnormality
Answer is: A

● How to confirm diagnosis of psoriasis on vulva:

A. Biopsy
B. Clinical
Answer is: A
Glory Team 19th-December
● Twin A breech twin B cephalic, the reason for CS:
A. Child presentation
Answer is: A

● Pregnancy is palpated best:

A. Just above pubic
B. Mid distance bw pubis and umbilicus
C. Around umbilicus
D. Above umbilicus
Answer is: A

● Pregnant present to ER with ( vaginal spotting ), cervix closed, not passing

tissue, no vaginal discharge:
A. Normal pregnancy
B. Thretaened abortion
C. Inevitable
D. Incomplete abortion
Answer is: A (If early GA)

● 20 yrs married Female with “sudden “ huge abdominal pain ultrasound

shows 6 cm mass ( did not mention the place ) negative preg test:
A. Ectopic preg
B. Ruptured cyst
C. Appendicitis
D. Ovarian torsion
Answer is: D

● 17 yrs girl girl dysmenorrhea affects daily activity, she is on medication

and she is improved that she is back to daily activities, she still wants more
medications:
A. Life style
B. OCP’s
Answer is: A

● 27 years old women come with abnormal uterine bleeding the interval
between onset of episode less than 21 days, heavy and prolonged. BMI 21
What’s the best next step in management?
A. thermal ablation
B. GNRH injection
C. endometrial sample
D. oral contraceptives
Answer is: D
Glory Team 19th-December
● 25 years old woman delivered a boy. In inspection of the umbilical cord
single artery was noticed.
What’s the following associated with above finding?
A. maternal diabetes
B. african race
C. low foetal mortality
D. major foetal malformation in 80%
Answer is: A

● 35 years old nullipara treatment on hyperprolactinemia past year.

When pituitary imaging indication ?
A. prolactin level twice normal
B. persistent galactorrhea
C. blurred vision
D. pregnancy
Answer is: A

● Case of PPH on oxytocin , while you manage the case you notice more
bleeding(something like that) you examine her but the bleeding prevent
you from determining the exact source of bleeding , what to do ??
Answer is: ​if initial bolus oxytocin was given > we will give it as infusion with higher dose

● PPH not responding to oxytocin and massage what you will do next:
A. B-lynch sutures
B. Hysterectomy
C. Uterine Vessel ligation
D. Angioembolization
Answer is: D

● women come to ER 15 days after CS complain of persistent vaginal

bleeding. BP 110/70, HR 85, T 38.1. What’s Dx?
A. mastitis
B. endometritis
C. wound infection
D. retained products of conception
Answer is: D

● Pic CTG with late decelerations primegravida in labor cervix thick , give
progesterone gel after 1 hr reguler conraction lasting for 2 minutes What’s
is best next mang ?
A. Emergency cs
B. Left latral postion
Answer is: B
Glory Team 19th-December
● Female mid 30s with DVT and history of 2 spontaneous abortions what is
the diagnosis?
A. Antiphospholipids syndrome
Answer is: A

● female mid 30s nulliparous, presented to the ER with Hx of vaginal

bleeding 6 hours ago and RLQ pain and drowsiness. Past medical Hx she
had appendectomy when she was 14 years old. On examination she had
RLQ tenderness, what is the diagnosis?
(No VS, didn’t mention anything about rebound tenderness and no labs)
A. ectopic pregnancy
B. ruptured ovarian cyst
C. Others aren’t related
Answer is: A

● same exact scenario but she wasn’t drowsy and no bleeding but the rest is
the same with past surgical Hx and it included labs showing high b-hCG
1000 management method.
Answer is: Methotrexate

● Pregnant patient has abdominal pain; fever; no labs

A. Pancreatitis
B. Appendicitis
C. Cholecystitis
Answer is: B

● PID wht next ?

A. Hysterosalpingography
Answer is: A

● Newly married couple came for infertility Woman is healthy. Husband

healthy has 1 causin diagnosed with Dawn What to do ?
A. Try more
B. Sperm count
Answer is: A, ​Infertility: inability of a couple to conceive despite 1 year of unprotected sex .

● pregnant pt with large warts in vaginal , best management

A. Cryotherapy.
Answer is: A

List of Incomplete Questions:

● UtI during pregnancy ( focus on which term )
Glory Team 19th-December
Ethics & Biostatistics
● What measurement is used for prevention of obesity on dm prevalence:
A. Relative risk
B. Attributable risk
Answer is: A

● Husband have HIV:

A. tell patient
B. tell Hospital community
C. don’t tell patient
D. repeat the test
Answer is: A

● Preterm 23 week with fatal congenital anomalies, mother doctor and

advised do not resuscitate what you will do?
A. Do not resuscitate
B. Ignore mother and resuscitate
Answer is: A

● Female came with revealing clothes; you don’t understand her language:
A. Ask help from another colleague
Answer is: ​Request for nurse who speaks the same language

● Patient came for appendectomy; in the surgery you found that the
appendix is normal and you removed it as per protocol:
A. Tell the patient it was part of the original procedure
B. Ask your colleague to tell the patient
C. Do not tell him
Answer is: A

● Elderly with cancer in last stages who signed dnr, you are about to do high
risk surgery:
A. Do not do it because he will die anyway
B. Do it and let him sign a high risk paper
Answer is: B
Glory Team 19th-December
● A lady came with her son u see her son was not taken care of , when u
asked she said they are poor and she has a lot of kids she cannot take care
of them:
A. Social worker
B. Ask her more questions and try to know more details
Answer is: A

● Abandoned child u will do surgery, how to take consent:

A. Social worker
B. Ethical committee
C. Hospital administration
Answer is: B

● Couple came to fertility center Lady infertile:

A. Tell wife
B. Tell husband
C. Tell both
D. Tell relative
Answer is: C

● You want to intubate child, parents refused coz his brother died​:
A. Intubate
B. Ethical committee
C. Do not intubate
Answer is: A