Questions from Earth, Faith, Jointly, SMLE-B

What we agreed on will be highlighted in Yellow

.‫ األسئلة ما زالت قليلة مع األسف‬،‫الصفحات كثيرة بس عشان التعليقات والملف من قوقل دوكيومنت‬
‫ دعواتكم‬..‫ وإن اسأت أو أخطأت فمن نفسي والشيطان‬،‫إن أحسنت فمن هللا‬

1- What is the percentage of adult Saudi male smoker??

1- 15%
2- 20%
3- 30 %
4- 51%
ruba B
Rawan Th: C
Ghaydaa: c
Meaad: C
Maha: male > 30% so C
overall % is B (20-25%)

2-Patient got rubella vaccine( doctor told her to avoid getting pregnant at least for 2
months). But she did get pregnant after 1 month. What is the most common possible
complication?
A- abortion in the first trimester
2- fetus dead in the third trimester
3- malformations
4- not remembered (NO EFFECT)
(But no nothing in the options )
Ruba :UTD
The MMR vaccine is not given during pregnancy because of a theoretical risk of live
vaccines to the mother or fetus, although data have not demonstrated a certain risk.
No congenital rubella syndrome-like defects (eg, hearing loss, cataracts, cardiac
abnormalities, bone lesions, growth restriction, and neurologic abnormalities,
including intellectual disability) have been observed in the offspring of women
inadvertently vaccinated just before or during pregnancy [13,16,129,130]. Similarly,
there were no adverse outcomes clearly attributable to measles following vaccination.
Termination of pregnancy after inadvertent vaccination should not be recommended
solely on the basis of a theoretical risk of embryopathy [16,131].
Rawan Th: According to UpToDate, there is no evidence that suggests congenital
anomalies(Congenital Rubella Syndrome) to mothers who were vaccinated between
2-6 weeks after conception. + nothing was mention about abortion. and regarding
the choice “ fetus dead in the 3rd trimester “ wouldn't be the answer and in case the
mom gets infected during the 3rd trimester which found to be a significant
relationship between getting infected during the 3rd
trimester of pregnancy and IUGR “”not fetus dead “”
Ghaydaa: agree with what the girls said it wouldn’t cause any significant adverse
outcome, it’s merely theoretical as per ACOG
Meaad: agree with all of you. none of the choices is correct
Afaf: agree

Maha: agree with all of you, there was a recall mentioned "no effect" and it's the right
answer. Rubella infection will cause these complications, rubella vaccine won't.

3-
Exactly the same picture in the exam.
Asking for diagnosis?
Answer: Henoch-Schonlein Purpura (HSP
Ghaydaa: ✅
Maha: agree

4- Urine incontinence while running, what is the test to confirm diagnosis ?

A- Uroflowmetry
B- Urodynamic test
C- cough test
D- tip test
ruba C
Rawan Th ( Dx is Stress incontinence, C is the answer)
Ghaydaa: C
Meaad: agree with C
Maha: C

5- 10 year old boy presented to the pediatric clinic with a history of skin rash. The
parents report that the symptoms had started with a single red spot over a small
scratch and have spread over the last 4 days . There are several lesions on the cheeks.
The trunk and the upper limbs. Physical examination confirms swollen lymph nodes
in the arm pits and groins
Blood pressure 100/65 mmHg
HR 80/min
Respiratory rate 24/min
Temp 37.4 c
Which of the following is the most appropriate treatment?
A)steroid
B)acyclovir
C)antibiotic
D)antiseptic
ruba C
Rawan Th > C ?Impetigo (not sure)
Meaad: C
Ghaydaa: c
Maha: C, the q came with this pic:

# Dx?
A)Impetigo
B) HSV
( cat scratch disease not mentioned)
ruba A
Rawan Th (A)> not sure
Meaad: A
Ghaydaa: not sure
Maha: A, tx is Abx.

6- Time of ovulation :
A)36 hours after LH surge
B)36 hours before LH surge
C)At time of LH surge
D) something related to estradiol
ruba A
Rawan Th (A)
Meaad: A
Afaf:A
Ghaydaa: A
Maha: A

7- Cause of Polyhydramnios
A) Down syndrome
B) bilateral renal agensis
C) IUGR
A if there’s no duodenal atresia
ruba another recalls :

⭕️ of these causes IUGR?

A Oligohydramnios
B Polyhydramnios
C Preeclampsia ✅

⭕️ gestational diabetes associated >>> with preeclampsia

⭕️ Polyhydramnios cause ?
A/ Anencephaly ✅
B/ Post term pregnancy
C/ Maternal ingested NSAIDs
D/ Posterior urethral valve

⭕️ Preeclampsia > platelets decreased

Rawan Th ( A )
Meaad: A
Afaf: A duodenal atresia
Ghaydaa: A (Other aneuploidies have also been associated with polyhydramnios,
most commonly trisomy 21, likely related to cases with duodenal atresia.)UTD
Maha: agree with Ghaydaa's note, although there was a recall mentioned "duodenal
atresia, as well as aneuploidy" and this is more accurate. For me it's D 🤪

8- Known case of asthma use inhaler steroids come with oral thrush what's treatment
A)Nystatin
B)Amphotericin b
ruba A
Rawan Th (A) > Repeated Q
Meaad: A
Afaf: topical nystatin
Ghaydaa: A
Maha: A

9- Female with vaginal discharge and in examination there is red strawberry cervix
I think there is cervical motion tenderness
A) chlamydia
B) neisseria gonorrhoeae
C) trichomoniasis vaginalis
ruba C
Rawan Th ( C ) > scanty yellow discharge, pruritus, devolped after Hx of intercours.
Mx: Metronidazole
Meaad: C
Afaf: C
Ghaydaa:C
Maha: C

10- male with gonerrhea , his wife present with discharge and itch what is the most
accurate dx swab :
A- Endocerix swab (Hacker..)
B- High Vaginal swab
ruba
Rawan Th (A)
Meaad: B, Uptodate : The preferred specimens are a first-catch urine for men and a
vaginal swab for women [53]. An endocervical swab is appropriate if the patient was
already undergoing speculum exam for other reasons.
Afaf:A
Ghaydaa:B, as meaad wrote UTD says vaginal !
Maha: it's B according to UTD + Dynamed, but I’ll go with A based on Hacker.

11- Q about calculation of Apgar score

12- Pt present with vaginal discharge, itching and urinary symptoms I think they also
mentioned that the discharge was cottage cheese like
Asking about the treatment?
A) topical anti fungal
B)topical antibiotic
C)oral anti fungal
D) oral antibiotyic
ruba
Rawan Th (A) > Dx: Candida Vaginitis Tx: Topical Miconazol (Anti-fungal)
Meaad: A
Afaf: i will chose A if pregnant if not I will go with C
Maha: I’ll go with oral unless if she’s pregnant then will go with topical.
BMJ— For uncomplicated infection, treatment with oral or topical azole antifungal
agents should be started.
UTD—

Ghaydaa: C, since they didn’t mention pregnancy (Initial treatment — We suggest

use of oral fluconazole, given that most women consider oral drugs more convenient
than those applied intravaginally.) UTD

13- 31 yrd old 10 months history of diarrhea with anemia and unintentional wt loss
no change appetite no blood in stool
What to give ?
A-anti diarrhea
B-anti biotic
C-anti parasite
D-gluten free diet
ruba D
Rawan Th (D) > Anemia, Vitamin D deficiency despite therapeutic dose of vitamin D
and pathological fracture “Osteoporosis” in young female > ALWAYS think of celiac
disease as top of your differential ( Clinics experience hehehehhe )
Meaad: IDK maybe there are missing informations, if not id go with D yes
Afaf:D
Maha: D
Ghaydaa: D

14- Pediatric case with UTI clear symptoms , fever 39 , mentioned that child look
unwell , asking about treatment :
A) oral antibiotic
B) iv antibiotic
ruba B
Rawan Th (B) > Clinical urosepsis indicates parenteral ABx in peds
Meaad: B
Afaf: Start with oral if pts is unstable and toxic apprance IV
Maha: B
Ghaydaa: B

15- child with pica,pale, low socioeconomic state , low hemoglobin hand lead was 2 (
that the unit of lead was mol/l)threm, iron profile was normal, x-ray dense
metaphyseal bands, (they mentioned splenomegaly in examination the Q but I forget
if it is positive or negative finding ) , what is the treatment? fpostisplenomegally
memtre
A- vit. K
B- D-penicillamine
C- Iron
Rawan Th (B) > Repeated Q
Meaad: B
Afaf : B
Maha: B
Ghaydaa: B

16-‫ سؤال عن‬UTI .. ‫؟ ايش اهم شيء في التحليل يدل على المرض‬
A-increase ESR
B-nitrate
C-increased WBC
ruba B
Rawan Th (B) > Repeated Q
Meaad: B
Afaf : B
Maha: B
Ghaydaa: B

17- A 39-year-old male presents to the clinic with a 3- weeks history of painless neck
mass.on exam, the mass is located at level 2 ,not tender, measure 3*5 cm and hard.
What is the best next step in management?
A-CT with contrast (answered by heam oncologist)
B-US (is said with Bx, this would be the answer)
ruba A to exclude malignancy but Q ask for next I am not 100% sure
UTD :
Most neck masses in adults are neoplastic or malignant. Neck masses that are
noninfectious; have been present for ≥2 weeks or an unknown duration; and are
fixed, firm, >1.5 cm in size, and with ulceration of overlying skin are at increased risk
of being malignant. Additional findings on the history and physical examination may
also suggest a malignant etiology. Patients suspected to have a malignant neck mass
should be referred to a specialist and undergo contrast computed tomography (CT)
of the neck and biopsy of the mass.
Maha: B as next step
Meaad: A, American family physician: The initial diagnostic test of choice in an adult
with a persistent neck mass is contrast-enhanced CT,20 which provides valuable
initial information regarding the size, extent, location, and content or consistency of
the mass. Additionally, contrast media may help identify malignant lymph nodes that
are not enlarged and distinguish vessels from lymph nodes.
Ghaydaa:i think A( but i'll read more to be extremely sure)
18-Which of the following is the highest risk factor for
cerebral palsy
• A-Hypoxia
• B-Preterm
• C-Gestational diabetes
• D-Neonatal sepsis
Ruba B UTD :
Risk factors — In addition to prematurity and BW, which are important risk factors
for developing CP, numerous other prenatal and perinatal risk factors have been
reported (table 1), though for many of these risk factors, a causal relationship has not
been established [2,7-12]. Potentially modifiable prenatal factors that may contribute
to CP risk include heavy maternal alcohol consumption, maternal smoking, maternal
obesity, and infections during pregnancy [13-18]. CP is most often multifactorial, and
multiple risk factors coexist. (See 'Etiology' below.)
Afaf: most common is hypoxia and highest risk is preterm
Maha: B. UTD— Prematurity is the most common association; Perinatal hypoxia
and/or ischemia accounts for only a small minority of cases of CP.
Meaad: Agree with B
Ghaydaa: B ( The prevalence of CP at age 8 in the United States is 1.5-4 per 1000;
prevalence is much higher in premature and twin births. Prematurity and low
birthweight infants (leading to perinatal asphyxia), congenital malformations, and
kernicterus are causes of CP noted at birth.) nelson
Rawan Th: Agree with B

19- Pt came with perianal mass developed after hard stool passage 12 hours ago ,
mass was bluish , tender under skin of perianal area , about 1*1 cm , what is the
appropriate management ?
A. Needle aspiration
B. Conservative
C. Hemorrhoidectomy
D. Rubber band ligation
Ruba if less than 72hrs and sever pain I would choose B if more than 72 hrs lateral
internal sphincterotomy
Maha: Bluish? Is it thrombosed? Pt will be shouting of pain!
BMJ— For external haemorrhoids, or combined internal and external haemorrhoids
with severe symptoms, surgical excision may be the only effective treatment option.
This involves excision under either a general or regional anaesthetic. Asymptomatic
external haemorrhoids do not warrant invasive treatment but may be observed while
the patient follows dietary and lifestyle modification. In thrombosis of external
haemorrhoids, minimally invasive procedures such as de-roofing may be required for
symptom relief, which can be done under topical, regional, or general anaesthetic.
UTD— Thrombosis is usually associated with pain. Organization and resorption of
clot occurs within several days following thrombosis of internal or external
hemorrhoids, lessening the degree of pain. Conservative treatment of thrombosed
hemorrhoids is usually sufficient. Exceptions include those with severe pain and
thrombosed external hemorrhoids,
Meaad: i will go with B (by exclusion)
Ghaydaa: B
Rawan Th: B Agree with y'all, it should be excision of the hemorrhoid. One of the
other options to treat simple external hemorrhoids is incision and drainage but as
shown isn't that effective bc of the thrombotic ones are usually loculated.

20-Long scenario, Case of AAA undiagnosed and unstable pt what to do ?

Us
Laparotomy
Ct angiography
Ruba A
Maha: A, previous recall:
Patient came to ER then collapsed, abdominal examination showed plusetil
abdominal mass (undiagnosed of AAA before)
what to do?
A- CT
B- US
C- laparotomy
Answer: B
next step in unstable + undiagnosed pt is to do US
If +ve AAA > repair (endovascular or open approach)
Meaad: Agree with Maha
Rawan Th: Agree with US
Just to keep in mind other scenarios of AAA rupture:
Patient came with severe epigastric pain and abdominal tenderness and she
heared tearing in her abdomen, the patient is hypotensive with low Hb:
A. U/S
B. CT angio
C. Radioisotope scan
D. MRI
Answer (B)

Ghaydaa: A

21-Treatment of chrons controlled symptoms on steroid and another drug , came

with multi-fistula ?
What to give ? No abx in options
Infliximab
Azathropine
Methotrexate
Budesunide
Ruba A
Maha: A
Meaad: A
Ghaydaa: A
Rawan Th: A
22-Patient k/c of low laying placenta previa and stable on follow up, came to ER
today on week 33 or 32 with minimal bleeding and and stop at home what is initial
step?
— 1- CTG
— 2- US
— 3- Bio physical profile
— 4- Emergency delivery
Rawan Th: (A) According to UTD, the goal in managing patient with acutely bleeding
placenta previa is to maintain maternal hemodynamic stability by clinical assessment
and reviewing the vitals (which appears to be stable in this case) and to determine if
the emergency CS is indicated by assessing the fetal status throughout CTG, looking
for patterns that suggests hypoxemia, anemia,...ect
++Wafa explanation “The first thing to do in antepartum hemorrhage is US to
exclude placenta previa. Then CTG.
But she is already diagnosed with placenta previa, so I would go with CTG”
Maha: not sure, something makes me go more with US. I’m still with US 😁
Ghaydaa: agree with rwans note
Meaad: CTG

23-Patient persented with Hematemsis medical free, no hx of alcholic use , no hx of

medications
Acut pancreatit
Chronic pancreatitis > mainly comes with pain
Esophageal varicsis
Pancreatitc psodou

alcoholic > liver cirrhosis >esophageal varices

Maha: mallory weiss tear
Ghaydaa: i wouldn’t choose either 😓 a I saw a similar Q where the answers was
mallory weiss! , i'm not sure of this is abad recall or a different Q
Meaad: cant decide imp info missing

24-3years has intermittent loss stool, Only during day examination all normal Dx
A. Rotavirus diarrhea
B. Salmonella diarrhea
C. Toddler diarrhoea
D. Food allargeiy
Rawan Th:(C)Functional diarrhea in young children (sometimes known as "toddler's
diarrhea") refers to chronic diarrhea or loose stools in an otherwise healthy young
child with no underlying disease. This disorder can present as early as six months of
age and is characterized by four or more large, painless stools per day, progressing in
consistency from semisolid in the morning to loose as the day progresses. (UTD)
ruba C
Maha: C
Ghaydaa: C (Also known as functional diarrhea)
Meaad: C

25- 17 year old female, medically free, (athlete) gymnast in her class, breasts later
and never menstruated, on developed examination she is tanner stage 5, but no
menstruation, diagnosis?
A-Hypothalamic hypogonadism
B-Transverse vaginal septum
C-Gonadal agenesis
D-Testicular feminization
Rawan Th: A >Repeated Q
Maha: A
Ghaydaa: A
Meaad: A

26-A patient coming from an endemic area for malaria. On Quinine(or Quinidine?!).
Later on, he was admitted to the hospital with Heart
Failure. Doctor did not ask the patient about travel or medication hx. Thus, he
ordered the nurse to give digoxin. The patient went into deterioration.
How could it be prevented?
A. Computerized drug prescription system.
B. Nurse failed to write drug formularies.
C. Pharmacist who failed to check prescription.
D. Patient who did not bring his medicine pack/ report his medicines.
Rawan Th: A > Repeated Q
ruba agree
Maha: A
Ghaydaa: A

27-Patient with Parkinson and visual hallucination

Low body
ruba lewy body dementia
Maha: agree
Ghaydaa: agree, lewy body demnia.
Rawan Th : agree
28-Female GBS swab 100000, 2 cont in 10 minutes, cervix 7 cm , wt to do :
a. Oxytocin
B. Ampicillin
Rawan Th: B Wafa explanation”According to ACOG: If GBS bacteriuria at any colony
count is detected during pregnancy, the woman is at increased risk of GBS
colonization during labor. A notation should be made in her medical record, she
should be made aware of her GBS status, and antibiotic prophylaxis should be
administered empirically during labor based on the risk factor of antepartum GBS
bacteriuria. Intravenous penicillin remains the agent of choice for intrapartum
prophylaxis, with intravenous ampicillin as an acceptable alternative.”
Maha: B
Ghaydaa: B

29-COPD patient present with sob and hypoxia

Non invasive
Invasive

A better recall
Case of COPD , absent gag reflex (nothing about consciousness ) on sever respiratory
distress Ph:7.25
High pCO2 and low O
O sat: 83
What is your next best step:
A. Intubation and ventilation
B. Non invasive
Maha: A
Ghaydaa: A, Um alqura dr elaf said if the patient has severe acidosis <or=7.2
intubate, here its .25 but the absent gag reflex makes me lean more toward
intubation to protect the airway
Meaad: Agree with A

0 or more is considered normal ejection fraction

Ghaydaa:i couldn’t understand😓
Maha: ERROR
30.-Weakness or numbness in face and arms, lower limb normal which artery
affected:
A-Middle cerebral artery
B-Anterior cerebral
Rawan Th: A > Repeated Q
ruba agree A if legs are affected more choose B
Maha: A
Ghaydaa: A

31-A patient with renal failure presents with low calcium, high alkaline phosphatase,
and high PTH. What is the best form of vitamin D to give this patient?
A- Calcitriol
B- Vitamin D2
Rawan Th: A>Repeated Q
ruba agree
Maha: A
Ghaydaa: A

32-Pt. With hx pulmonary embolism 3 years want contraceptive drug

Other Q cardiac on anticoagulant drug
A. Dermal patch
B. OCP
C. IUD
Rawan Th: C>Repeated Q
Maha: C
Ghaydaa: C

33-18 years old married female want to do pap smear.

When to do ?
A. now
B. At age 21
Rawan Th> B
Maha: B
Ghaydaa: B

34-Long scenario of acute cholangitis , then after pt was resuscitated with fluid and
antibiotic what should be done next ?
(VITALS WAS NOT MENTIONED )
US stone in gallbladder and dilated cbd
A.ercp
B.mrcp
C.cholecystectomy
Maha: A
Ghaydaa: A
Rawan Th: Agree A
Meaad: A

35-Sarcoma Biopsy most Diagnostic?

A. Incisional biopsy
B. Excisional
C. Needle core
ruba C
Maha: C
Ghaydaa: C (Biopsy — Histologic examination of a soft tissue mass is essential for
diagnosis and treatment planning. Our preferred method for obtaining tissue is with
a core needle biopsy, if technically feasible.) UTD
Rawan Th: C “Core needle biopsy is safe, accurate and economical and has become
the preferred technique for diagnosing soft tissue lesions’ Schwartz under sarcomas
topics
regarding incisional Bx only indicated if the core needle Bx is cant produce adequate
tissue for diagnosis or when finding on core needle bx is nondiagnostic
Meaad: agree with C

36. -58 years old woman with right thigh mass measured 5*6. Core biopsy shows
high grade sarcoma. What the most appropriate staging image?,
— MRI abdomen
— CT
— X ray
— bone scan
Maha: CT chest? Check for lung mets
Ghaydaa: Since there is no MRI alone, I will go with B for mets. because mri
abdomen is wrong! Still not extremely sure though🤭
(Imaging of the primary tumor — Our practice for the diagnostic workup of a soft
tissue mass includes cross-sectional imaging with magnetic resonance imaging
(MRI) for a primary extremity or trunk)
(Magnetic resonance imaging (MRI) is the preferred imaging modality for the
evaluation of soft tissue masses of the extremities, trunk, and head and neck, while
computed tomography (CT) is the most commonly used imaging technique for
retroperitoneal and visceral sarcomas.)
UTD
Rawan Th: Should be MRI for the thigh
According to schwartz; MRI is the most useful imaging modality for extremity
sarcomas because of its superior soft tissue contrast resolution and multiplanar
capabilities. if MRI is not available then CT is acceptable.
BTW Chest CT should be performed to evaluate for lung metastasis at presentation
and before any radical treatment
Meaad: not sure, will go with CT

37-Which lymph node indicate malignancy ?

— A. Cervical
— B. Supraclavicular
— C. Submandibular
Maha: B
Ghaydaa: B
Rawan Th: B
Meaad: B

38- patient c/o 4 months of hearing loss now come with 7 n palsy
— A. rumsy hunt
— B. brain tumor
— C. bell's palsy
Maha: A
Ghaydaa: A (Ramsay Hunt syndrome, which typically includes the triad of ipsilateral
facial paralysis, ear pain, and vesicles in the auditory canal or on the auricle
[125,126]. Ipsilateral altered taste perception and tongue lesions, hearing
abnormalities (decreased hearing, tinnitus, hyperacusis), and lacrimation occur in
some patients; vestibular disturbances (vertigo) are also frequently reported [126].)
UTD
Rawan Th: A
Meaad: A

39-91 year cancer everywhere and they can not detect primary site management
— A. Palliative comfort
— C. Biopsy
— D. Laparoscopy
ruba A
Maha: A
Ghaydaa: A
Rawan Th: A
Meaad: A

40-Pt with flushing, diarrhea, Rt ventricle hypertrophy.... Ask about initial test? ‫دائما‬
‫ينسي او نشوفه جديد النه يجي مرره طويل باالختبار‬
— A.-24h-urine of 5-hydroxy-indole-acetic acid 5HIAA
— us Abd-pelvic
Maha: A, start with labs then imaging
Ghaydaa: A, looks like he has carcinoid syndrome
(A preferred initial diagnostic test for carcinoid syndrome is to measure 24-hour
urinary excretion of 5-HIAA, which is the end product of serotonin metabolism)UTD

Rawan Th: Agree with Ghaydaa note

Meaad: A

41. 50 year old man present with dark patch on his anterior aspect of the thigh,
raised and irregular border: what's the next step?
— A. excision
— B. radiation
— C. chemotherapy
ruba A
Maha: A
Ghaydaa: A, because i think he has skin melanoma
(●Excisional/complete biopsy – An excisional/complete biopsy of suspicious lesions
with 1 to 3 mm margin of normal skin and extending to a depth to encompass the
thickest portion of the lesion is the preferred technique and should be performed
whenever possible) UTD
Rawan Th: A
Meaad: A

42. Man came complaining of pain in the medial side of the sole of the right foot what
is the diagnosis?
— A. achilles tendinitis
— B. something flexor retinaculum
— C. something extensor
Maha:
A will present with posterior pain, so it’s EXCLUDED.

Ghaydaa:
Similar Q from sep 2020 earth:Elider complain of flat foot pain in the medial aspect
of the sole, what is affected ??
- flexor retinaculum
- Extensor retinaculum
- Achilles tendon
- Spring ligament ✅

43. Case of hemiparesis due to previous infarct presented with seen CT infarct with
no clinical symptoms what to do?
A. Give thrombolytics
B. Embolectomy
C. LMWH
D. Warfarin
Maha: incomplete question!

44 Patient on warfarin developing% ICH %, INR: 3.9, what to give?

— FFP
— VIT K
— FFP-VIT k
Maha: C
Ruba C > if ICH give FFP and VITK
Ghaydaa: C
Rawan Th: C
Meaad: C

45- old male medically free except from episodic weakness and resolved after 10
mins and has Afib .. asking about the Tx:
— warfarin inr 2-3
— ASA
— warfarin int 3-4
Maha: A (as per CHADs score he will get 2 points (hx of TIA)) so we should start him
on warfarin, target INR will be 2-3.
Ghaydaa:A
Rawan Th: A
Meaad: A

46- Patient with jaundice and  fleiser  keiser  ring, they gave laps and ceruloplasmin
value i don't remember, what is the treatment??
— penicilamine
— deferoxamine
Maha: A
Ghaydaa: A
Rawan Th: A, Dx :Wilson dz
Meaad: A

47- Patient with Headache and rhinorhea, tearing, how will you prevent this?
— A. Verampil
— B. Oxygen
Ruba A
Maha: A for PPx, B for Tx. (Cluster headache)
Ghaydaa: A
Rawan Th: A
Meaad: A

48- 23 years MS case asking about best investigation?

— MRI
— echo TEE
Ruba A
Maha: A
Ghaydaa: A( MRI brain&spine)
Rawan Th: A
Meaad: A

49- 43 ys man came with his brother Compl changing his habits and behavior,
personality,forget most of events, even may forget what he ate for breakfast and
irritable ,he may leave you while you answering his question,condition is badly
progressive; diagnosis
— Vascular
— Frontotemporal
— Huntington's
Ruba B
Maha: B (especially if the personality changes started first)
Ghaydaa: B
Rawan Th: B
Meaad: B

50- Alzheimer chromosome mutation

— 14
— 15
— 18
ruba A
Maha: 21, 14, 1 (GOOGLE)
Ghaydaa: A ( Early studies in families with autosomal dominant AD used linkage-
based methodology to isolate relatively large culprit regions on chromosomes 1 [1],
14 [2,3], and 21 [4]. This facilitated the eventual identification of causative mutations
in the three genes: amyloid precursor protein (APP) [6], presenilin 1 (PSEN1) [7],
and presenilin 2 (PSEN2) [8,9].) UTD

51- 45 women underwent a surgery to hysterectomy and bilateral salpingo-

oophorectomy After that had patient have vaso-motor symptoms , then need a
hormonal replacement : What hormones recommend for her ?
A. cycle replacement combined estrogen and progesterone
B. Estrogen hormone IUD
C. Progesterone only
D. Trans-dermal estrogen patch only
ruba D : wafaa :
📝📌Note to remember
Surgical menopause — In women who have undergone a hysterectomy and who are
candidates for MHT, unopposed estrogen is given. Progestins are only given to
women with an intact uterus to prevent endometrial hyperplasia and cancer
Maha: D, as she has no uterus so we need estrogen hormonal replacement therapy no
need for progesterone.
Ghaydaa : D
Rawan Th: Agree
Meaad: D

52-‫ بعد العمليه المريض جاه‬Paralitic illus ‫؟ ايش االنفستقيشن الي نسويه‬
A- Urin k
B-not remember
Maha: serum K, then ECG
Previous recall:
Postop 6 days with nausea vomiting and abdominal distention and cant pass stool
Labs show hypokalmia
What investigation you need to order
A- urine analysis
B- ECG
C- urine K
D- Stool k
Answer: B!
Ghaydaa: agree, it should be ECG.
Rawan Th: Agree
Meaad: Agree about ECG

53- 46 Y/O G3P1 at 34 weeks’ gestation presented to antenatal clinic for regular
check-up, she has unremarkable medical hx and uncomplicated pregnancy Braxton
Hicks and non-pruritic cervical discharge. Her pre-pregnancy weight was 54.4 on
examination cervical length was 33 mm.
VS were given & I believe they were normal.
Current weight: 52
Rubella AB: -ve
HBsAg: -ve
Blood type: O+
Which of the following is the most appropriate next step?
A. F/U after 2 weeks
B. OGGT test
C. Do rubella Ab test / Repeat rubella screen
D. Give anti-D Ab
Ghaydaa: A (by exclusion)
Maha: no need for anti-D since she's O+, no point of repeating rubella antibodies as
it won't change unless if she got infected or received the vaccine, we do GDM
screening at 24-28 wks and she's 34 now. So will end up by A!
Although the dec weight is concerning..
Meaad: id go with A too

54- Female pt complaining of

amenorrhea for 4 months
T4 low
Prolactin 200
What the dx
A- primary hypothyroidism
B- hyperprolinemia
WE ALL AGREED ON B
Ghaydaa: B
Maha: B, but they should mention high TSH
Rawan Th: B
Meaad: B

55- Stage 1 sarcoidosis case, what’s the best next step?

A. Observation
B. Steroid
Ghaydaa:A
Meaad: A

Maha: A
UTD— When to observe without tx:
1. Asymptomatic patients with stage I radiographic changes.
2. Asymptomatic patients with stage II radiographic changes and normal or
mildly abnormal lung function (mild restrictive or obstructive findings with
normal gas exchange).
 3. Asymptomatic patients with stage III disease and normal or mildly abnormal
lung function.

56- indication for thoracentesis:

A. glucose less than 60
B. pH more than 7.2
C. PMN more than 90%

Another recall
Long Case of pleural effusion,
What's the indication for thoracotomy? (They mean in general)
A. Exudative fluid with 90% PMN
B. Less than 60 glucose
C. 2% protein less
D. Ph More than 7.2
Maha: idk they keep recalling the q as indication of thoracentesis while the actual q is
asking about the indications of chest tube!!! We do thoracentesis for ALL pts with
pleural effusion unless C/I or CHF.
So the answer will be B.

Another recall from Earth July:

Indication of thoracentesis
A-loculated
B-ph < 7.2
C-Glucose < 60
(Answer: C)
*Thoracentesis = Each pleural effusion > 1cm= (except typical signs and symptoms
of heart failure)
*Indications for chest tube in pleural effusion:-
Chylothorax
Pleural fluid loculation
Empyema Ph < 7.2, glucose < 60, WBCs > 50,000, LDH > 1000 or +ve culture and
gram stain)
Ghaydaa: agree
57- COPD patient in acute exacerbation on oxygen, oxygen level improving and CO2
is high, what to do?
A. increase O2
B. Reduce O2 >>AMER
Maha: B
Another recall from August:
COPD pt on high flow o2 3 L with O2 saturation 93% , develop acidosis and
hypercapnia, what will you do ?
A. decrease O2 flow
B. mechanical ventilation
C. increase O2 flow
D. CPAP
Answer is: A
Ghaydaa: agree

58- Pt known to have emphysema, undergo some GIT operation (lap choly i think),
then pt is complaining of progressive dyspnea. ABG: high CO2 and high O2 Your
management:
A. intubation and hyperventilation
B. give high oxygen

Another recall ( earth sep 2020)

Pt known case of emphysema, came with hematemesis they did endoscopy and it was
controlled,then pt is complaining of progress dyspnea.
ABG: low ph, high CO2 and high O2.
What is your most appropriate management:
A) intubation and ventilation
B) give high oxygen
C) give sodium bicarbonate
D) Dexamethazone
Ghaydaa: A
Maha: if there's BiPAP I'll go with it, otherwise the answer will be A.
Rawan Th: How low the PH is? If 7.2 and less, or if the patient is clinically not okay;
eg: alter mental status, or in severe distress to the point he can't complete the
sentence then intubation is indicated. other than that I would go with BiPAP.

Indications for mechanical intubation:

⁃ Alter mental status
⁃ Sever RD, PO2<55 even if the PH is 7.30
⁃ PH<7.20

Indication of non-invasive ventilation (e.g BIPAP) , if:

-severe dyspnea
-respiratory acidosis (low PH, high CO2)
-persistent hypoxemia despite O2 supply

CI for BiPAP:
⁃ Alter mental status bc it needs patient effort
⁃ Angular stomatitis or oral infection

Indications for long term oxygen:

⁃ Individual w/o cor pulmonale, O2 sat<88% and po2 <55
⁃ With cor pulmonale: o2 sat<89% and po2 <59

Increase survival rate:

⁃ Oxygenation
⁃ Lung transplant
⁃ Smoking cessation

Meaad: A

59- Patient complaining of productive cough, HRCT findings bronchiectasis how you
will convey this diagnosis to the pt:
A. Explain X-ray findings
B. Read the CT report to him
C. Explain that he has inflammation in the air tubules with some damage
D. Tell him that he has bronchiectasis
Ghaydaa: C
Maha: C
Rawan Th: C
Meaad: C

60- 40-year-old patient presents for a health screen. He is asymptomatic. Chest X ray
shows a unilateral calcified nodule on the upper zone of his lung. What is the likely
diagnosis?
A. Hamartoma (nodule with "popcorn" calcification and fat)
B. Adenoma
C. Granuloma
Ghaydaa: C (Endemic fungi (eg, histoplasmosis, coccidioidomycosis) and
mycobacteria (either tuberculous or nontuberculous mycobacteria) (image 4) are the
most frequently recognized causes of infectious granulomas presenting as a
pulmonary nodule. While not pathognomonic, they classically appear as a well-
demarcated and fully-calcified or centrally calcified nodule (image 5).

Maha: C, agree with Ghaydaa's note

Rawan Th: Agree, C
Meaad: Agree

61- pt has pleuritic chest pain on the left side, P/E reveals a pleuritic friction rub.
What is the next step?
A. 12 leads ECG
B. CT chest
C. CXR
D. ECHO, refer to cardio
Ghaydaa: A ( to look for pericarditis)
Maha: A, next will be ECG, though we should do the other investigations as well.
Rawan Th: A
Meaad: A

62- Pertussis with severe vomiting, most complications?

A. Pneumonia
B. Pneumothorax
C. Dehydration
Maha: A (i think the q wasn't the most common complication..)
Rawan Th: A, According to UTD “The most common complications of pertussis
infection include apnea, pneumonia, and weight loss secondary to feeding difficulties
and posttussive vomiting”
Ghaydaa: agree
Meaad: A

63- 18 months old child known case of eczema. His parents said he woke up at night
and coughed for a while with barking cough, no URTI Sx, a similar episode happened
6 months ago, what is the diagnosis?
A- Spasmodic croup
B- asthma
Maha: A
Rawan Th: A
Ghaydaa: A
Meaad: A
Another recall from Safdar's files:
2 years old with a history of atopic dermatitis and inspiratory stridor.
Most likely diagnosis
• A- Laryngomalacia
• B- Epiglottitis
• C-Spasmodic croup
• D-Rickets
The answer is C.

64- 18 months with a picture of bronchiolitis, developed several episodes of apnea.

What’s the appropriate management?
A. Supportive
B. Ventilatory support
C. IV methylprednisolone
Maha: A
Ghaydaa: A (Infants and children with severe bronchiolitis require assessment in the
emergency department and usually require supportive care in the inpatient setting.
Supportive care and anticipatory guidance are the mainstays of management of
severe bronchiolitis. ) UTD
Rawan Th: A
Meaad: A

65- child came with post URTI complaining of SOB Wheezing, RR 33, HR 100, O2
90%, other vitals normal. What’s most appropriate management?
A. ABx and ventolin
B. IV fluid and ventolin
C. Ventolin and systemic steroid
Maha: C, looks like viral not pneumonia
Another recall from Earth June:
Asthma exacerbation after pneumonia, what is Tx?
A. Ventolin + AB
B. Ventolin + systemic steroid
C. Systemic steroid + hydration
D. Systemic steroid + AB
If pneumonia treated then B, otherwise we should start both acute asthma
exacerbation mx (SABA+systemic steroid) + pneumonia mx (abx)
Ghaydaa: agree
Meaad: Agree

66- patient with fever and productive cough and right lower and middle lobe
consolidation, best therapy>
A. start azithro + ceftriaxone
B. azithro + ceftriaxone +oseltamivir
C. azithro + ceftriaxone + thoracentesis (if mentioned pleural effusion this is correct)
Maha: A, esp if they mentioned mild-moderate pleural effusion then we can give abx
only. Most probably it's para pneumonic effusion, we can start abx for pneumonia if
the pt isn't improving then we can consider doing something for the pleural effusion.
Rawan Th: Agree with Maha’s note “ Azithromycine covers atypical bacteria and
ceftriaxone covers gram negative bacteria” as an initial management. no need for
antiviral medications clearly it's pneumonia.
Ghaydaa: agree
Meaad:A
67- 10 years old boy with puffy eyes for 1 week with a history of recent infection, no
edema, no urine changes and labs completely normal. what to give him?
A. antihistamine
B. strong steroid
C. renal biopsy
Maha: I'll go with steroid, but I don't think they would write it in the exam as "strong
steroid" there's no such thing. This is a bad recall, as they ask about "what to give
him" so they want treatment not investigation.
Rawan Th: A
Ghaydaa: A( steroid)
Maha: A
Meaad: A

68- Mother is strictly vegan and she is breastfeeding her baby asking what deficiency
baby will have?
-Vit b12
Maha: A
Rawan Th: A
Ghaydaa: A
Meaad: A

69- Pediatric case, came with conjunctivitis, staccato cough, no diarrhea cxr shows
lung infiltration, labs: esinophilia
-adenovirus
-chlamydia
Ghaydaa: B
Maha: B
Rawan Th: B
Meaad: B

70- Woman came for infertility counseling, in history she's having dysmenorrhea,
what is the cause ?
-Endometriosis
Maha: A
Ghaydaa: A

71- Antibiotics contraindicated in pregnancy ?

- ciprofloxacin
- ceftriaxone
Rawan Th: A
Maha: A
Ghaydaa: A
Meaad: A
72- Old male with a history of chronic retrosternal chest pain and exertional dyspnea,
after 3 weeks he started to complain about the same problem but now he is still
sitting on chairs or reading a book at night.
A- Unstable
B- prinzmetal
Maha: A
Ghaydaa: A ( old, exertional sx progressed to rest sx so a)
Rawan Th: Agree
Meaad: A

73- Pedia case of a child drooling , unstable ?

Ct chest
X ray
Laryngoscope in the OR
Maha: C, epiglottitis, unstable pt > OR
Ghaydaa: c
Rawan Th: Agree
Meaad: agree

74- Case of juvenile dermatomyositis

Maha:
Previous recall:
7 years female with helitrope rash over eyelids and erythema and thickening of skin
over metacarpophalangeal joints
+ proximal muscle weakness, dx?
A. Juvenile Dermatomyositis
B. Scleroderma
C. SLE
Answer :A
Ghaydaa: agree
Meaad: A

75- Sle case asking about marker anti Smith and anti ds DNA was in the options
● Maha: anti-smith most specific, anti-DsDNA is specific as well as it correlates
with disease activity
Ghaydaa: agree
ruba true um alquraa

76- Solid food pediatric

4
5
6
9
‫كذا جتني الخيارات‬
Maha: 4-6 months, if both there then we’ll choose 4.
Ghaydaa: A

77- After delivery baby 8 hrs bleeding

A. Early postpartum hemmoragh
B. Late postpartum hemmoragh
C. Antipartium hemmoragh
D. Intrapartum hemmoragh
Maha: A
Rawan Th: A (within the 1st 24 hrs)
Ghaydaa: A
Meaad: A

78- Old age patient has Dm and Htn and has ventral hernia and came for elective
repair for the hernia. What to do???
Stabilize the pt then do surgery
Maha:
previous recall:
Pt smoker htn and dm for 10 years come to elective surgery ventral hernia repair
In Ex u found rise JVP and lung crepitation، what to do :
A- delay surgery
B- no surgery till become obstructing
C- lap surgery at this visit
D- open surgery at this visit
Answer: A, Decompensated heart failure. Elective surgeries should be deferred till
patient condition is optimized.
Ghaydaa: agree
Rawan Th: 100% agree
Meaad: Agree

79- Pediatric patient brought by his parents; X ray showed widening of the ends of
his bones (growth plates): Calcium (low) PTH (mildly high) Alkaline phosphatase
(very high) What does the patient have?
A. Hypophosphatemia
B. Primary hyperparathyroidism
C. Vitamin D deficiency rickets
D. Renal osteodystrophy
Maha: D, ‫جاوبه دكتور بيديا من الحرس هو اللي كاتب السؤال وقال ذا هو الجواب ومقصده إن دي هو اللي سبب‬
‫ شنسوي عاد‬.‫الريكتس‬
Rawan Th: C
Ghaydaa: C
Ruba C
Meaad: if nothing in the scenario suggestive of renal disease ill go with c

80- Neonate with seizure with normal glucose level , high Hb and RBC ,and the
seizure stopped spontaneously (‫) يعني وقفت من نفسها بدون تدخل‬
What is the management?
A- oxygen
B- fluid
C - dextrose
D- lorazepam
‫متأكده انه الجلكوز كان نورمال‬
Maha: B, neonatal polycythemia > supportive tx
Ghaydaa: not extremely sure but B,
high Hb& RBC>polycythemia>seizure
Rx: iv fluid
Rawan Th: Agree
Meaad: B

81- Pt had RTA 6 months ago and have quadriplegia, came today with 2 hrs MI sx
what is the most appropriate management?
A- streptokinase, bb, aspirin,heparin
B-bb aspirin heparin
C-
D-
Maha: A
Ghaydaa: not sure but A, do give bb in acute management? Or when the patient is
discharged?
Rawan Th: it is CI to give BB in acute settings, otherwise I would go with A

82- What is the minor effect of DTaP vaccine?

A-fever
B-site reaction
C
D
Ghaydaa: erythema at the site of injection
Maha: agree with Ghaydaa
Rawan Th: the other terminology is “arthus-type” so hx of reaction after a previous
dose of DTap is a CI
Generally speaking: Absolute CI: Anaphylaxis, Encephalopathy ( coma, decreased
LOC or prolonged seizure) within 7 days of the administration of previous DTap
dose.
Meead: agree

83- Women 33 year old undergo renal surgery and during the surgery they found
incidental polyp 5*5 in size , what’s most appropriate action ?
1- myomectomy
2- leave it
3- abdominal CT
Maha: B
Ghaydaa: B
Rawan Th: B
Meaad: B

84- 32 years old women with amenorrhea since 6m labs was done and shows “ TSH
very slightly elevated and prolactin markedly elevated “ what’s ur dx ?
1- hypothyroidism
2- prolactinoma
Ghaydaa: i need numbers but since prolactin is markedly elevated i think its B
Maha: same as Ghaydaa
Meaad: agree with ghayda

85- Minimal time to get pregnant after hernia repair

Ghaydaa: 6 as dr thawba said, the best is 12 months
Rawan Th: minimal 6, best 12 months
Maha: minimal 6 months, best 12 months.
Meaad: Agree with maha

86- Q about dx of HTN choices were >

1- 2 reading in clinic
2- 2reading home measurement
3- ambulatory BP

Other recall
Elderly was completely healthy except for elevated BP for the first time
A. Ambulatory BP measurement
B. Start anti HTN
C. Measure the BP two times later on in the clinic >>correct choice
Ghaydaa:
(Ambulatory blood pressure monitoring (ABPM) is considered the “gold standard”
in determining out-of-office blood pressure.)
(we suggest home blood pressure measurement as the initial strategy to confirm the
diagnosis of hypertension in most patients)
UTD
Ruba :Measure the BP two times later on in the clinic
“JNC 8”
Pre-HTN: 130-139 << Ambulatory BP monitor
Stage 1: 140-159 << Ambulatory BP monitor
Stage 2: ≥160 << Initiate Treatment immediately

“AHA”: All initiate ttt at BP ≥130/80 if w/ comorbidities e.g. DM, CHF, IHD,…
Rawan Th:
Maha: agree with the notes.

87- A patient with psychiatric symptoms and you decide to start neuroleptic
medication. What is the side effect that can develop?
A-Hyperthermia
B-Myocardial infarction
C-Seizure Akathisia
Ghaydaa: akathisia
Ruba C
Rawan Th: C
Maha: C
Meaad: C

88- 4 yo boy presented with fever and low abdominal pain. Mother complains that
his urine has a foul smell. UA: gram +ive bacteria >100,000. What of the following
could be the cause?
- E.coli
- Klebsiella pneumoniae
- Proteus mirabilis
- Staph aureus
Ghaydaa: all the given choice are gram -ve !!
Ruba agree with maha
Maha: If negative A
If positive D
‫البعض يقول جات بسؤالين مختلفة وهللا أعلم بالريكول‬

89- patient came to the hospital, after history and examination you suspected his
symptoms are similar to MRSA Cov, the patient feared loss of his job if the doctor
reported the case in hospital. What should you do:
A- confirm the diagnosis then report
B- report within 24 h
Ghaydaa: B (MERS-CoV is a category I reportable infectious disease (within 24 hrs).
All healthcare facilities must report suspected cases through Health Electronic
Surveillance Network (HESN).)
https://www.moh.gov.sa/CCC/healthp/regulations/Documents/MERS-
CoV%20Guidelines%20for%20Healthcare%20Professionals%20-
%20May%202018%20-%20v5.1%20%281%29.pdf
Ruba : B
Rawab Th: Agree with y’all, B
Maha: B
Meaad: Agree

90- Pt known he asthmatic he is on SABA only came to ER with sob and now dx by
(persistent moderate asthma) what you will add on his medication
1 LABA
2 ICS
3 ICS and LABA
4 forget
Rawan Th: C “Step-up approach”
ruba agree
Ghaydaa: agree
Maha: Agree
Meaad: C

91- Case about osteoarthritis then asking about.. How to confirm osteoarthritis
A- no need
Forgot the others
the diagnosis of OA is a clinical based but best modality for early OA is MRI
Ghaydaa: A since its a clinical diagnosis
Rawan Th: Agree
(UTD) Peripheral joint OA may be diagnosed confidently on clinical grounds alone if
the following are present:
●Persistent usage-related joint pain in one or few joints
●Age ≥45 years
●Morning stiffness ≤30 minutes
If one of these criteria isn't present, then further investigation is needed!
Maha: agree

92- A patient presented to the derma clinic. She has a skin lesion 1x2 cm
(no details provided) on her left forearm since she was a kid. What would you do?
— F-u
— Laser
— Excision
Ghaydaa: A ( no malignant feature, present since childhood, no changes are
mentioned so ithink follow up is the right answer)
Rawan Th: agree
Maha: agree

93- Skin something irregular border skin came to the clinic. What to do ?
A. Excision
B. Punch biopsy
C. Chemo
D. Radiatio
— if melanoma Excisional biopsy , if not punch
Ghaydaa: A ( similar to a previous Q in the file)
ruba agree
Maha: A, repeated somewhere

94- Pt with malignant melanoma in his cheek hot to get him complain to the
treatment?
A. It has serious symptoms
B. take time Collect information then till him so that he can trust u

Previous recall (MAY)

70 yo man, present with skin change, report revealed malignant melanoma. Who can
make the pt comply with your medical advice ?
A. this is a serious issue.
B. you are professional so he trusted you
C. explain to the pt by medical term.
D. take time to tell him and try to gain his trust
Ghaydaa: D
ruba agree
Rawan Th: Agree
Maha: D
meaad; d

95- Pt after repair of abdominal aortic aneurysms. Despite fluid resuscitation vitals
are still unstable. There’s negligible urine output since he was on Foley catheter one
hour ago. Periphery was warm to touch. BP: 90/.., HR:120, RR:38, temp:36.6, type
of shock:
A. Septic
B. Hemorrhagic
C. Cardiogenic
D. Anaphylactic
Ghaydaa: A
ruba agree
⭕️Only In Cardiogenic Preload is high ⬆️
⭕️Only in Distributive C.O is high⬆️
⭕️Only in Distributive SVR is low⬇️
Rawan Th: Agree
Maha: A

96- Elderly 60 years old with 2 days fever, anorexia, vomiting, diarrhea, JVP not
seen, cold extremities. WBC high, BP 85/60, best initial management?
A. ABx
B. Diuretic
C. Dopamine
D. Normal saline
Ghaydaa: D
Ruba agree first start with NS
Rawan Th: D, Hypovolemic shock The priority of immediate hemodynamic support
is aggressive fluid resuscitation to achieve euvolemia.
Maha: D
meaad; D

97- Pt with psoriasis.. best regarding bathing?

A. No soap
B. Coconut oil better than
C. Olive oil
Ruba A
Rawan T: patient education toUse unscented thick moisturizing creams and
ointments to keep the skin from getting too dry.
Meaad: A
Maha: A,
Similar question:
Child with scaly pruritic skin rash in the cheeks, scalp, extensors surfaces
What is the mainstay of treatment?
A)vitamin D
B) antibiotic
C) phototherapy
D) encourage skin hydration
The answer for me is D.
98- 20 years old with a skin tag/lesion of 1-2 cm in forearm, no changes since birth,
(no further descriptions or colors of the lesion). Management?
A. Reassure
B. Laser
C. Biopsy
Ghaydaa: A
ruba agree
Rawan: ‫ لو مر عليكم اسئلة مككرة في الملف نحذفها‬،‫مكرر فوق‬
Maha: A

99- Skin lesion irregular and dark over the knee

A. punch biopsy
B. Chemo
C. Radiation
D. Wide local excision
Ghaydaa: if we’re suspecting melanoma> excisional biopsy but D is not setting right
with me! Why wide ?? it should be narrow!
(Narrow margin excision allows for the assessment of the entire lesion without
compromising subsequent, wider surgery or potential staging with the sentinel
lymph node biopsy technique)UTD
Rawan Th:
Maha: Depends on the size & site, my notes:

100- Case of child with anemia and have 2 sister same condition they are at strict diet
with
A. oral ferrous
Answer is: A mild cbc shows anemia HB 3 Retics 3 mild elevated microcytic
hypochromic microcytic Ferritin is low 9 Diagnosis ?
— Scd
— Ida
— Alpha thalassemia
Maha: what the hell is this
Ghaydaa: i have no clue

101- SCD case with hematocrit 2

— Blood Trans
— Plasmapheresis
Ghaydaa: i need more information
Maha: incomplete q
Previous recalls:
A child known to have sickle cell disease presented to emergency department
complaining of abdominal pain. An examination the liver was enlarged and the
spleen was 6cm below the costal margin. There was Palor and fatigue on the last
week. Investigation revealed hemoglobin was 5, and both elevation direct And
indirect bilirubin. The next step should be
A. Regular blood transfusion
B. splenectomy
C. Hydroxyurea
D. Fluidsandanalgesia

A patient known to have sickle cell disease presented to emergency department

complaining of both legs pain for three hours. Lower limb exam is normal with no
sign of DVT. The abdomen and exam reveals spleen enlargement. Hemoglobin is 3.2
which of the following is the best next step
A. Splenectomy
B. Hydration
C. Morphine sulfate
D. Bloodtransfusion

102- Female exclusively breastfeeding want contraception for 2 years

A. Depo provera injection
B. Pop
C. Ocp
Ghaydaa: A>>> 2 years ?
Maha: A, see this:

103- Pregnant 15 GA kco epilepsy on phenytoin last attack 6 years ago came
antenatal visit
A. Continue same >>>earth ,
B. Stop phenytoin
C. Refer to neurologist to stop medication
we agreed on C
Ghaydaa: C, not extremely sure
Maha: C, but not sure also
Meaad: C
Rawan Th: C

104- 3 years old child had a drug composed of (na) but convulsions were not
controlled. What drug must take in hospital
A. Diazepam
B. Lorazepam
C. Phenytoin
D. Phenobarbitone
ruba B
start with lora then diazepam then phenytoin then phenobarbital
1- IV Lorazepam ( 2 times )
2- rectal rout
3- phenytoin
4- general anasthesia
Ghaydaa: B

Maha: B
Rawan Th: B
Meaad: B

105- dengue fever is more common in ksa in:

A-east
B-west
C-South
D-North
ruba B
Rawan Th: Agree
Ghaydaa: B
Maha: B
Meaad: B

109- Female pt bleeding and cervical os is SEMI-open and patient denies passage
What does this indicate?
Complete
Inevitable
Threatened
Missed
open OS so B
Rawan Th: B
Ghaydaa: B
Maha: B
Meaad: B

106- pt with second degree uterine descent and cysto rectocele what your
managment
1 Posterior colpoperineorrhaphy
2 Fothergills operation(Manchester op. )
3 Anterior colporrhaphy
Maha: B,

107- Patient came with symptoms of TB And isolated with open TB in next day found
also has HIV what your actions
1 treat both
2 Consider is pneumocystis carinii
3 treat HIV until cd 4 improved
4 treat TB alone to prevent inflammatory reconstruction syndrome
‫بالتجميعات كان فيه خيار و االغلب كان مجاوبه انه الجواب الصح و ما كان موجود باالختبار‬
‫ كان‬treat TB then HIV after 3 month
i would choose D
Ghaydaa:( we agree with the United States Department of Health and Human
Services (DHHS) and the American Thoracic Society (ATS)/United States Centers for
Disease Control and Prevention/Infectious Diseases Society of America (IDSA),
which recommend "integrated ART" (eg, within two to eight weeks after initiating
anti-TB therapy) rather than "sequential ART" (eg, after completion of
antituberculous therapy) for all HIV-infected patients with active TB [1,5]. ART
initiation should not be delayed until the completion of TB treatment; this approach
has been associated with increased morbidity and mortality)UTD
Maha: D, answered by Medicine + ID consultants. My notes:
Meaad: D

108- ‫في سوال جاني بالهيئة و كان بدون تحاليل بس هستري من المريض و كان السيناريو سطرين‬
Pt ( mostly female i forget) came to er with abdominal pain central radiate to back
within 24 or 12 and has history of cholelithiasis more than one attack
What is dx
1 acute cholecystitis
2 acute pancreatitis
3 maybe peptic ulcer
4 forgot
Ghaydaa: B
Maha: B
Rawan Th: B
Meaad: B

109- pt severe vomiting ECG show flat T wave what u expect in urine?
A. aciduria.
B. high K.
C. high na.
D. alkaline urine
A
Ghaydaa: A
Maha: A
Meaad: A

110- Patient i think with cancer and very dry mouth! What will the labs show? (And
they provided labs and i only remember he had hyperkalemia)
-hypocalcemia
-hypercalcemia
-hyponatremia
-hypernatremia
A
Maha: A
Rawan Th: A, dehydration can cause hypocalcemia
Ghaydaa: A
Meaad: Tumor lysis syndrome? A

111- Septic shock case indicates adequate systemic perfusion?

A. Cardiac index
B. Mixed venous oxygen saturation
B
Maha: B
Ghaydaa: B
Meaad: B
Rawn Th: B

112- Pt with absent distal pulses, palpable popliteal pulses, diminished sensation,
altered motor response, diagnosed with afib
A. Upper knee amputation
B. Thrombolytic therapy
C. Femoral artery embolectomy
D. Heparinization and observe
Maha: initial next step will be heparin for all type of ALI, scenario is more with
immediately threatened, so the answer is B

Ghaydaa: B
Meaad: B
Rawan Th: B

113- Case of knee injury The tibia contradicts to femur What is the ligament get
injured?
A- anterior ligament
B- posterior ligament
C- lateral Collateral ligament
D- Medial collateral ligament
A ‫ خربان‬anterior ‫ شغال و ال‬posterior ‫ رجعت لورا و بالتالي‬femur ‫الن ال‬
Maha: A
Ghaydaa: A
Meaad: A
Rawan Th: A

114- surgeon doing Cholecystectomy and found stomach mass ?

A-Cholecystectomy and stomach mass resection
B-Only cholecystectomy
B
Maha: B
Ghaydaa: B
Meaad: B
Rawan Th: B
115- Woke up 2h before can’t speak (image of CT showing hypodense lesion) what to
give?
A- TPA
B-enoxaparin
C-Aspirin
Maha: if the scenario was like this, we don’t know what’s the last time he was good,
then this is ‘Woke up stoke’ and the answer is aspirin.
‫ إنه السيناريو كان جاي المريض نام من ساعتين وتو‬،‫بس السؤال حسب اللي أعرفهم من أوقست وكذا احد قلّي نفس الكالم‬
‫ فكان الجواب وقتها‬contraindications for tPa ‫صحي يعني عارفين متى آخر وقت كان كويس وما كان عنده أي‬
.‫ ألن لساعه بالويندو‬tPa ‫إنه حنعطيه‬
Ghaydaa: C
Previous recall: A 67 year old male is brought to the ED by his wife saying that he
developed weakness and dysarthria after he woke up.She says that he went to sleep
having no complaints, then woke up 2 hours later with symptoms of weakness and
slurred speech. O/E power 2/5 on the left side and 5/5 on the right side.
CT picture included and shows hypodensity in the right hemisphere.
What is management?
A- Aspirin
B- Clopidogrel (Plavix)
C- rTPA (Recombinant tissue plasminogen activator)
D- Heparin

116- Pt known AF on amidaron start to develop palpatation and tremur what

investigation shuold done:
A-ECG
B-TSH
C-ECHO
B
Maha: B
Ghaydaa: B
Meaad: B

117- Patient presented with Hematemesis medical free, no hx of alcoholic use , no hx

of medications, Endoscopy done show dilated vessels something on esophagus ?
• A-Acute pancreatitis
• B-Chronic pancreatitis
• C- Esophageal varicsis
• D- Pancreatic psodou
Maha: C by endoscopic findings 🤷🏻‍♀️
Ghaydaa: agree
Meaad: C
Rawan Th: C
118- patient presented with symptoms of MI 2 hours ago and it’s anterolateral on
ecg; management?
A- aspirin,streptokinase, heparin and beta blockers
B- aspirin, streptokinase, nitroglycerin and beta blockers
A
Maha: A
Previous recall:

And yes we can use heparin with tPa, ref >>:

Ghaydaa: agree
Meaad: A

119- A 65-year-old heavy smoker is coming for a general examination.. What is the
best screening test for him?
A- Osteoporosis
B-Colon cancer
C- AAA
C
Maha: C
Ghaydaa: C
Meaad: both B and C are correct! level of evidence for colon cancer is A, for AAA is
B.. so idk wallah im confused
Rawan Th: C

120- Which of the following is correct in the management of major depression?

-Start any medication as they are all equal in efficacy
-Start with one drug and check response in 2 weeks
-Stop medication when symptoms resolve
-Change medication if patient does not respond
Maha: not sure but I would go with B.
UTD— Among patients with unipolar major depression who start antidepressants,
improvement is often apparent within one to two weeks.
We generally treat unipolar major depression for 6 to 12 weeks before deciding
whether antidepressants have sufficiently relieved symptoms.
Ghaydaa: agree with maha notes
Meaad: B
Rawan Th: B

121- Patient wants to travel. All his LFTS high. What to give?
A-no prophylaxis needed
B-Fluoroquinolone

A
Maha: A, no need
Ghaydaa: A
Meaad: A
Rawan Th: A

122- White vaginal discharge but no rash/itch mentioned. What is the

organism/name of disease?
WTF ?
Maha: BV? thin whitish discharge with no itchiness.
Organism: Gardnerella vaginalis
Disease: Bacterial vaginosis
Ghaydaa: yes i think it’s bacterial vaginosis/Gardnerella vaginalis
Rawan Th: Agree

123- Female has abdominal bloating , diarrhea and .... she believes he got better after
stop gluten diet and sx resolved completely, what u will do
A. Resume gluten and do serum test
B. No need for continue gluten diet
C. Refer to dieticians
D. Refer to gastroenterologist
Maha: A
Ghaydaa: A
Meaad: A
Rawan Th: A

124- Baby in distress i think cyanosed

Gave him 100% o2 but still the sat is 80%.
What to do?
A- intubate
Maha: another recall:
Child with signs of respiratory distress, tachypnea and unequal chest rise , put on
oxygen100% but still his o2 sat 88%:
A- need Intubation & Mechanical ventilation
B- not remember
Answer is A.
Ghaydaa: A
Meaad: A
Rawan Th: A

125- Brucellosis in joints only. Doxycycline treatment for how long?

A- 6 weeks
B- 6 months
3 months !
Maha: general sx (flu like..) > 6 wks
Joint sx > 12 wks (3 months)
Neuro sx > at least 6 months
Ghaydaa: agree with maha’s notes

126- What is the cause of poor wound healing in controlled DM:

A- Peripheral neuropathy
B- Poor blood supply
C- infection
D- Callus
B
Maha: B
Ghaydaa: B
Meaad: B
Rawan Th: B

127- Pt after repair of abdominal aortic aneurysms. Despite fluid resuscitation vitals
still unstable. There’s negligible urine output since he is on Foley catheter one
hour ago. Periphery was warm to touch. BP: 90/.., HR:120, RR:38, temp:36.6, type
of shock:
A. Septic
B. Hemorrhagic
C. Cardiogenic
D. Anaphylactic
Maha: A
Ghaydaa:A, repeated

128- A case if a pt with femur fracture after an accident, vitally stable, there is an
obvious deformity.
What is the most important management:
1- analgesia for pain
2- decrease bleeding
3- decrease soft tissue injury
4- maintaining normal joint function
*they didn't mention an open fracture or bleeding or joint involvement*
Maha: A
Ghaydaa: not extremely sure but A
Meaad: agree with A as he is vitally stable
Rawan Th: A

129- Patient underwent mastectomy , complaining of numbness on the medical

aspect of arm , nerve injury ?
A. Long thoracic
B. Musculoskeletal
C. Intercostobrahial
D. Axillary
C
Maha: C, see the pic for review:

Ghaydaa: C
Meaad: C
Rawan Th: C

130- patient with medical leg ulcer RF ?

A. Dm
B. Htn
C. Age ?
D. Purger disease
B
Maha: this is the correct recall:
ulcer on medial side of the leg. most likely cause
1- DM
2- Age
3- Burger disease
4- venous htn
Answer is venous htn.
Ghaydaa: agree
Meaad: D
131- young man with multiple episodes of vomiting, last one was bloody, vitally
stable, what's the most appropriate treatment?
A. Conservative management
B. Upper GI endoscopy
C. Sengstaken tube
D. PPI
Maha: A, Mallory Weiss tear.
Ghaydaa: A
Meaad: A
Rawan Th: A

132- Old patient long history of leg claudication *for 2 months* , present with leg
pain and ABI <0.3 and , *CTA show artery occlusion more than 3 cm* what to do?
A- amputation
B- thrombolysis
C- embolectomy
D-enoxaparin
intracatheter thrombolysis
Maha: B, answered by a vascular surgeon.
Ghaydaa: B
Meaad: B

133- meningitis scenario, CSF findings: (low Glucose, high lymphocyte)

A- tuberculous meningitis
B- viral meningitis
A
Maha: A
Ghaydaa: A
Meaad: A

134- Case of RA with multiple inflamed joints on methotrexate and steroid what to
add:
A- biological agent
B- azathioprine
C- add another conventional DMARD
A
Maha: A, adalimumab.
A
Ghaydaa:A
135- PE with DVT and patient is HD unstable
A. Exoparien
B. TPA
C. IVC
D. Start with UFH then switch to TPA
B
Maha: B
Ghaydaa: B
B

136- A child presented with sinusitis and recurrent lower respiratory tract
infections.Mcs of bronchial aspirate had pseudomonas aeruginosa.Whats the
diagnosis?
A.Cystic Fibrosis .
B.Primary ciliary dyskinesia.
C.Kartagener's syndrome
A

Maha: A
Ghaydaa: A
Meaad: A

137: Incidental lung nodule that grown 5mm since 6 m + smoker what to do، 5mm
after fu became 10
A-blind aspiration
B- Refer to thoracic surgery
C- Bronchoscope
Maha: Biopsy, see this recall:

If no biopsy option, then bronchoscope as the pt is smoker i.e. central cancer, so will
take the biopsy through bronchoscopy.
Ghaydaa: biopsy
Meaad: C
Rawan Th: C

138-An old patient underwent rectal surgery, developed DVT, what is the
management?
A-Enoxaparin
B-Heparin
C-Warfarin
D-IVC
A
Maha: if it’s the same old question, pt developed DVT immediately in the recovery
room so I’ll go with IVC, otherwise LMWH (answer A)
Ghaydaa: agree with maha
Meaad: Agree with maha
Rawan Th: Agree

139- Pregnant has hx of type 2, but her labs r fine, also has family hx of type 2, ttt?
A. insulin
B. metformin
Maha: A
Ghaydaa: A
ruba the safest in pregnancy
Meaad: A
Rawan Th: A

140-MRI picture of fibroid, they mentioned the diagnosis as (subserosal fibroid),

asking how are you going to manage it?
A- Myomectomy.
B- Hysterectomy.
C- COPs.

Maha: if that was the case, idk but I might go with myomectomy ‫😂 عشان مرتاحة له‬
Ghaydaa: depends on the presenting complaint and fertility desire 🤷‍♀️
Meaad: id go with OCP as first line 🤷‍♀️
Rawan Th: Agree with Mead, as mentioned in Hacker

another recall :
MRI of large fibroid and menstrual bleeding hg 7 what’s next step in management?
A. correct anemia
B. Ocp
C. Myomectomy
Maha: A
Ghaydaa: A
A then C
Meaad: A
Rawan Th: A

141. Tb symptoms and culture taken. Which has highest value for dx:
a. Zein nelson stain
b. Cogo red somthing
c. Thin blood film
d. Thick blood film
Meaad: A
agree
Ghaydaa: A
Rawan Th: A

142. Treatment of lymphangitis ?

Penicillin
Cloxacilin
Erythromycin
Meaad: B
Ghaydaa: B
Rawan Th: B
Maha: A & B the same, but I’ll go with A
Another recall

Answer: A
142. Woman 28 weeks Ga came to antenatal care , she is rh negative but not
sensitized , her husband is rh positive , what do do ?
Give anti rh
Repeat antibody every 2 weeks
Meaad: A
Ghaydaa: A (Anti-D prophylaxis should be administered during the 28th week of
gestation and within 72 hours following the birth of an Rh-positive baby.) amboss
Rawan Th: Agree
Maha: agree

143. Pediatric case bronchiolitis vs bronchiolitis obliteran

A previous recall

5 month old infant with coughing, sneezing and circumoral cyanosis for 3 days.
Recurrent frothy sputum around the mouth. On examination there are diffuse?
rhonchi all over the chest and basal crackles but good air entry bilaterally. Chest x-
ray shows bilateral infiltrates.
What is the most likely diagnosis?
1- Bronchiolitis
2- Heart failure
3- Pneumonia
4- Bronchiolitis Obliterans
Ghaydaa: A
Maha: agree

144. Female in her 60s came to er with acute abdomen that became more severe on
the last few hours
Us: solitary cystic adrenal complex mass 5cm by 6cm , what to do ?
No vitals was mentioned
A- MRI pelvic
B- Laparotomy
C- Observation
D- Can't recall
Meaad: B
Ghaydaa: B (someone in dr obaidi channel said it was an Adnexal mass)
Rawan Th:
Maha: agree

145. Dm pt in his 60s came with acute lower limb ischemia signs (numbness ,
reduced pulse and pain ) what is next step?
Heparin
Duplex
Thrombolysis
Thrombectomy
Meaad: A
Ghaydaa: A
Rawan Th: A, then B
Maha: A

146. Man in his 30s was holding something heavy then he got a pain in RLQ , on
examination there was irreducible mass , tender, negative cough test , mass still
persists even with muscle contraction
What is the diagnosis?(no mentioning of cardiac disease or anti coagulant )
A- Ventral hernia
B- Rectus sheath haematoma
C- Non relevant other 2optiona
Meaad: B
Ghaydaa: B
Rawan Th: B
Maha: B

147. TibIal open fracture picture (like the one in penguin with x ray showing the
fracture )
What is treatment ?
A- Debridement and internal fixation
B- External reduction and external fixation
C- External reduction and below knee cast
Meaad: A
A with External fixation( according to dr al-somali external fixation is indicated in
cases of 1)large wound 2)extensive soft tissue injury 3)compartment syndrome, To
reduce the risk of infection. Non is mentioned here so i think internal fixation is the
right choice )
Ghaydaa:A
Rawan Th: A
Maha: A, debridement + Abx
148. Female in 20s has diabetic present with confusion. The patient has a long
history of type 1 diabetes. She also complains of periorbital swelling, rhinorrhea and
black necrotic spot over the face. labs show glucose 600 mg/ dl and ketones. Ct scan
shows obliteration of all the sinuses. Which of the following is the causative
organism?
A. Rhizopus oryzae
B. Candida albicans
C. Moraxella catarrhalis
D. Staph. Aureus
Meaad: A
A repeated
Ghaydaa: A(Rhino-orbital-cerebral mucormycosis case due to Rhizopus organism)
Rawan Th: A
Maha: A

149. Woman 35 years old , smoker 10- 15 cig per day , has history of sub fertility and
has family history of diabetes, which is the strongest factor for the fertility ?
A-Age
B-Hx of subfertility
C-Family hx of dm
D-Smoking
Meead: Age
age
Rawan Th: Age
Maha: Age for females, smoking for males

150. Elderly was completely healthy except for elevated BP for the first time
A. Ambulatory BP measurement
B. Start anti HTN
C. Measure the BP two times later on in the clinic
D. Measure BP two time in home
Meaad: C >> white coat HTN
Ghaydaa: C
Maha: C

151. Child started to develop sense of individuality. She recognize strangers and
frightens when separated from her parents.
-6
-7
- 10
- 12
Meaad: D
Ruba: fear of stranger start at 6m , separation anxiety at 12 m so choose 12m
Ghaydaa: D
Maha: D, agree with Ruba’s note

152. Inr target in mitral stenosis ?

2.5_ 3.5
therapeutic 2-3
Ghaydaa: agree with ruba
●We recommend long-term oral anticoagulation (with vitamin K antagonist; target
International Normalized Ratio 2.5, range 2.0 to 3.0) in patients with MS who have a
prior embolic event, left atrial thrombus, or paroxysmal, persistent, or permanent
atrial fibrillation (AF).
( UTD)
Maha: agree

●Pictures : open fracture , hsp , falciparum malaria, digoxin toxicity ecg and you can
get the diagnosis from text of question , svt ecg , late declaration

153- 42 years old female complaining of amenorrhea, night sweat and flushing for
the last 6 months. What is the most likely diagnosis?
A- Hypothyroid
B- Hypoprolactinemia
C- Congenital adrenal Hyperplasia
D- Pheochromocytoma
D?
Maha: D by exclusion, tho not sure about the amenorrhea. This could be early
menopause?!

154- Vaccination : which vaccine can be given in immune deficient >>dtap

Milestones >> 2 or 3 q
Ethics all repeated
155- There was a question about 20 yrs female c/o intermittent crampy abdominal
pain and alerted bowel habits pain relive by defection which can be constipations and
other times loose and watery content, and after defecation still feel not empty her
gut, what is the appropriate management
A/ h.pylori test
B/ abd ct
I don’t recall other options
Maha: C or D :) looks like IBS.