نسخة من Daily SMLE - February (SMLE B)

Daily SMLE - February (SMLE B)
Last update: 11 Feb, 9:15 pm
Warfarin did not stop by patient regardless of clear instructions, the nurse in OR noticed that the patients didnt stop the drug as instructed and
informed the surgeon , So the surgeon postponed the operation:
A- near miss
B- adverse event
C- medical neglicance
Ayab’s answer: agree on A
Patient with RA presented with hair loss and malar rash.+ve ANA. what's the most confirmatory test ?
A- anti smith
B- Anti DsDNA
C- Anti CCp
Ayab’s answer: agree on B (already diagnosed with RA. now we need to look for SLE)
• Single a in umbilical cord indicates?

A. Maternal diabetes
B. congenital malformations
Ayab’s answer: agree on B
young pt have appendiceal mass how to manage?

A. Open appendicectomy
B. Lap appendicectomy
C. I forgot other options
Ayab’s answer: bad recall
Pt with 2nd degree burn on both lower limbs 70kg, fluid with parkland formula
Ayab’s answer: 5 l in first 8 h, 5 L next 16 h—
BSA% = 36
Wt kg = 70
4x36x70 = 10080 /2 = 5040
• Ankle-brachial index is 0.3 in a patient with DVT, occlusion size is 3 cm, T?

A. Embolectomy,
B. stent,
C. tpa?
Ayab’s answer: need a better recall
If life threatening associated with Afib > tpa
Is it acute? Embolectomy
If chronic? Stent
50 years old male complained of right iliac fossa dull aching pain. Exam showed that he had right iliac fossa mass with positive cough
impulse. The examining doctor found a bluish tinge on the mass surface & the percussion tab was positive. The most likely diagnosis
is:
a) Right inguinal hernia
b) Right femoral hernia
c) Right vaginal Hydrocele
d) Cyst of morgagni
e) Saphena Varix
Ayab’s answer: Still confused. “A bluish ting let me go with E” otherwise typical to be A
Man undergoing esophageal dilation for achalasia came after 6 or 12 hrs with chest pain , subcutaneous crepitus and WBC 21k .
Management:
A- TPN
B- NGT
C- Stent
D- Drainage and surgery
Ayab’s answer: it depends on stability. If stable go with C. If not, go with D.
A 55-year-old man presents with fever and pain in the perineal region. Upon further questioning he also complains of frequency, urgency,
dysuria, and a decreased urinary stream. On physical examination his abdomen is soft, nondistended, and nontender. Digital rectal examination
demonstrates severe tenderness on the anterior aspect. Laboratory examination reveals leukocytosis and findings on urinalysis are consistent
with a bacterial infection. Which of the following is the most likely diagnoses?
a. Urinal tract infection
b. Benign prostatic by perplasta
c. Prostatitis
d. Pyelonephritis
Ayab’s answer: Agree on C
A 32-year-old man presents with an asymptomatic mass in his rt,. testicle, On emmination, the mass cannot be transilluminaled- ultrasound
showed a solid mass in the right testicle. Which of the following is the most accurate method in obtaining a diagnosis of testicular cancer?
a. Serum levels alpha phetoprotein and beta human chorionic gonadotrophin.
b. Percutaneous biopsy of the testicular mass
c. Incisional biopsy of the testicular mass through a scrotaeincision
d. Radical inguinal orchiectomy
Ayab’s answer: agree on D but not sure
5 years old girl presents to the Emergency Room with a history of severe abdominal pain, which is central and colicky, and repeated
vomiting. The pain is getting worse by movement. One examination, there is generalized guarding in abdomen, with more tenderness
toward the right iliac fossa , Tachycardia + WBcs= 15 + T=38 + ESR = 12 Which of the following is the most appropriate
counseling regarding this condition ?
A. Occurs 20% individual x
B. it's uncommon below 3 years old
C. Sausage shaped mass often palpable
D. Passage of redcurrant jelly stool confirmed the diagnosis
Ayab’s answer: C (Dr. Safder)- B (Dr. Abedi)
Pregnat lady kco of htn on hydrochlorothiazide and losortan , what you will do regarding her medication
A) cont same
B) stop both
C) cont hydrochlorothiazide and change lasortan to mytheldopa
: 19 y male with history of headach for 5 days and neck stiffness for two days With low grade fever for one month CSF analysis
Turbid Glucose normal range WBCs neut: 27 Lymph: 87 or 78 Protein not sure Diagnosis:
A bacterial meningitis
B viral meningioencephlitis
C TB meningitis
D fungal meningitis
Ayab’s answer: depend on values. It is easy.
11 month old child , brought by his parents they reported a 1 day history of fresh blood in stool associated with foul smell and dark brown stool
on examination the child was pale ( they didn't mention pain or any abdominal examination ) What's the best diagnostic tool :
A. barium enema
B. barium meal
C. radioisotope scan
D. US abdomen
Ayab’s answer: agree on C
A 65-year-old male comes to the clinic with a mild intermittent urinary flow reduction Rectal examination, urinalysis and prostate
specific antigen studies are normal (see report).Ultrasound prostate: Enlarged median lobe. Which of the following is the best way to
investigate?
A. Annual renal function monitoring
B. Periodic PSA measurement
C. Beta-blocker therapy
D. Cystoscopy
Lyeiomayma (dagnosis writtend) , what the the aproprate mangment ?

Ayab’s answer: it depends on the full case
‫ مولود الم عندها‬hepc + what ro give the bab

Ayab’s answer: Vaccine + Ig
Pt with HTN and has mid systolic murmur with S4 ?

A. Aortic stenosis
Female Pt hematuria and swelling of lower limbs , Hx HTN , Lab low albumin , high creatinine and BUN , UA : 5+ protein , 20 RBCs No Hx URTI
, or skin infections or any chronic illnesses or any drugs used . What's Dx ?
-A- Acute interstitial nephritis
-B - Acute glomerulonephritis
-C - Post renal - obstruction
-D - Acute - tubular - necrosis
associated with coarctation of the aorta?

A-Turner
B-patau
C-Edward
4 years girl the mother noticed her child have incontiance and defect 2 times on her pants there is also vaginal bruising and discharge which will
be the diagnosis
A-Vaginatist B-Ovarian disease C- Sexual abuse
Ayab’s answer: not sure but more with C
40 weeks GA pregnant lady with 12cm ovarian cyst.

A-observe
B- cystectomy
C- oophorectomy
Ayab’s answer: agree on A (regardless about the size. She is stable! And in 40 weeks, so after delivery will manage her)
• Child with liver symptoms but very toxic and ill, has fever, jaundice, scleral icterus, what’s the cause?
A. Hep A
B. B,
C. C,
D. D.
• A baby came to the clinic (1 yr old or something around that age) with his mom, she said that his sister has got a surgery 2 weeks ago (i think
splenectomy) and is now immunodeficient, what vaccine will you NOT give the BABY (who has an immunocompromised sis)?
A. MMR,
B. Varicella,
C. oral polio,
D. injectable influenza??
Diabetic patient with pseudo hyper epithelialization in situ, what you should do
A Amputate toe
B ulcer Debridement
C follow up
D Repeat biopsy
Ayab’s answer: Agree on D
Pt admitted as cas of pneumonia not improved with 2 abx

Xray :
Bilateral dens infltrate
Lavag :
Atypical cell
Whats mostly the reason ?
Atypical pnumonia
Bronchoginc cancer
Ayab’s answer: according to the Q. If there’s signs of malignancy (old age, loss of wight, and so on), but so far I agree with Atypical pneumonia.
• Thyroglossal cyst scenario, what’s the treatment?
Ayab’s answer:
Elective surgery excision (sistrunk)
Treat any active infection.
• A patient with a prosthetic valve who is about to do a dental procedure, she’ll take prophlactic antibiotics, against which organism?
A. Strep,
B. staph,
C. ecoli..
Ayab’s answer: against Viridans streptococci.
Patient with > 10000 wbc, what’s the organism?

A. Klebsiella
B. Staph
C. Ecoli.
Ayab’s answer: missed infm but: most common E. coli.
➢ Klebsiella: G-ve
➢ Ecoli: G-ve
➢ Staph: G+ve
• Child with hip joint pain and refuses touching it, what’s the organism?
A. S.aureus
Ayab’s answer: agree on A (a case of septic arthritis)
- Case Prolonged declaration :

A. Epidural anaesthesia
- case of sarcoidosis whats the mangment:

Ayab’s answer: it is corticosteroid
Case of Diverticulitis Dx is given ask about how to treat ?
1- A.B
2- I forgot the other options
Ayab’s answer: agree on Abx.
During the examination the doctor can feel the chin of baby?
A. - face
B. - Brow
Runs towards doctor, cannot use spoon, cannot use 3 words:

A. 15 m
B. 18 m
23 Y.O. male patient K/C of UC presented with 7-8 bouts of bloody diarrhea per day. Associated with fever and joint pain. O~E patient looks ill
and in pain. What is the best next step in management?
A. Oral budesonide
B. IV methylprednisolone
C. Oral 5-ASA
D. Azathioprine
TB. How to invest

A. 1.thin blood film
B. 2.thick blood film
C. 3.Ziehl-Neelsen (ZN) stain
Female in 30s or 40s has excised fibroadenoma, histopathology showed (forgot type of cells) with hyperplasia and atypia, which factor
suggests malignancy?
A- Age
B- presence of Atypia
C- presence of hyperplasia
D- can’t recall
Thoracocentesis?
A. 8 -10 midaxillary
50 yr female c/o menorrhagia for one year , she has fibroid 7x7 medical tx failed, what’s the most appropriate for her?
A. - hysterectomy
B. - uterine artery emobolizatin
C. - Hormonal IUD
Pregnant bp 140/90 or 150/90 what to give ? “Exactly like this”

A- nifidepine
B- hydralazine
C- methyldopa
No labetalol in choices
Femal has molar pregnecy bhcg at begining was (856 000)

On week one 560
Week 2. 360
Week 3 160
Week 4. 56
Week 5 1. Yes it is one
*numbers are not exactly same but somehow near
How you will follow the patient
A. Measurement at weekly interval
B. Measure at one month interval
C. Discharge from clinin ( sure was like this)
D. Repeat ultrasound
• Medicine given to decrease fibroid size?

A. GNRH
• Pregnant women 13th week, has a previous abortion at 20wks, now she has cervical shortness, man?
A. Cerclage (can be done between 11-13 weeks only).
2-Nurse come to the clinic with health screening

Test result:
Ppd 12 mm
3-What you will do ?
Nothing
Iszonide for 3 m
Izonide 6 m
All TB medicinion
Ayab’s answer: Agree on Isoniazid for 6 months
4-Prophylactics for pt on hemodialysis k/c of end stage kidney disease?

UFH
Enoxparin
Ayab’s answer: Agree on UFH (Renal imparmint)
5-Highest risk cancer for endometrical cancer?

Late manarche
Early menopause
DM
Progesterone tumor
No age in the choice
Ayab’s answer: Agree on DM
6 - absolute contraindications of inserting IUD ?

Gentile track bleeding
Postpartum endometritis
Ayab’s answer: Agree on bleeding
7 - indication of sever preeaclamsia ?

Increase cr
Increase urea
Increase Na levle
No platelets on the choice
Same choices but with normal pregnant women at 12 week
Ayab’s answer: it is a bad recall.
9- ectopic pregnancy. Bhcg 3500 Size of ectopic pregnancy 3 cm:

She lives far away from the hospital
Unstable vital signs
+ q ask about what’s the absolute contraindications of methroxate in this case?
Bhcg and us finding
Lives away from the hospital
Vital signs
Ayab’s answer: it depends on the full Q.
Agree on unstable vital signs (IF IT IS UNSTABLE). If she stable go with “away from hospital”
‫ بشكل عام الميدسن مركز على‬asthma and

COPD
‫ متى نعطيه‬noninvasive ventilation ‫ و‬oxygen therapy ‫ و متى‬intubat
Ayab’s answer:
Note:
Long term O2 therapy: if the patient comes with cor pulmonale S/S.
Intubation: if hypoxic, hypercapnic, absent gag reflex.
Non-invasive: if alert, but hypoxic.
‫االختبار اكثر جا من تجميعات ديسمبر نسخ لصق‬

Ayab’s answer: OK thanks.
Q:Patient come with fistula at 7 position and will do fistulomy ?

Which midline will the surgen will start ?
A. Lateraly left side.
B. Anterion midline.
C.Posterior midline.
a patient who had right big toe pain and because of that “written like this” he was diagnosed with gout and treated with allopurinol.
He’s a known case of psoriasis. He presented now with right big toe pain, right ankle pain and bilateral knee pain and there was no
improvement with allopurinol. What’s the diagnosis? Labs shows high uric acid
A- active pseudo-gout arthritis
B- active gout arthritis
C- psoriasis arthritis
D- Osteoarthritis
19 Y.O girl newly diagnosed with type 1 DM , taking aspart and glargine , complaining of both fasting and postPrandial hypoglycemia, Alc and
fasting are with in normal range?
A- Stop both
B- Decrease the dose of both
C- Continue the same
D- Stop glargine and change aspart to sliding scale
A test for liver cirrhosis picked 200 cirrhotic out of 800 cirrhotic patients and 100 cirrhotic out of healthy individuals. What is the
sensitivity of this test?
25%
33%
67%
Ayab’s answer: agree on 25% (200/800)
Long scienario and lab , sum : infertility, erectile dysfunction, no morning erection, labs : FSH,LH, testosterone all low, prolactin high.
MRI show 0.8 cm adenoma what is the treatment:
A- testosterone replacement
B- cabergoline
Child 4 years old with asymptomatic umbilical hernia what's the treatment?
A- Reassurance
B- Surgical repair
28 y/o male presented to Er complaining of left testicular pain for 1 week , no urinary symptoms but clear urethral discharge on examination, he
has hx of sexual intercourse 3 weeks back. What is your management plan ?
A.Surgical exploration.
B.Ceftriaxone + Ciprofloxacin.
C.Augmentin + Ciprofloxacin.
D.Ceftriaxone + Doxycycline.
Ayab’s answer: agree on D
27 weeks GA, scanty vaginal bleeding. Us showed placenta previa totals. She's hemodynamiclly stable. Ctg normal. Appropriate management =
A-Oxygen
B-Steroid
C-Tocolytic
D-ABC
Risk factor of uterine cancer?

Late menardh at 17 y
Early menpose at40
Progestron contraceptive
Ayab’s answer: i guess that D is a right answer (Age or DM)
5mounth baby with vomiting abdminal examination epigastric olive like mass treatment
Pylimytomy
Observation
Ayab’s answer: agree on Pyloromyotomy
🛑Milestone of a child that

can jump on both legs makes blocks of 6, says 2 names and 2 wordi think
A. 1 year
B. 2 year
C. 3 year
D. 4 year
Ayab’s answer: agree on B (gross motor: jump. Fine motor: stacks up to 6 blocks. Speech development: 2 name/2word)
🛑Gravid women came with PROM you administered a beta-memetic tocolytics drug what is the side effect :
A- abdominal pain
B- palpitation
C- diarrhea
D- bad odor
mother concern about her kid about ADHD , he is quit in clinic :

A⁃ tell mother its normal his age
B⁃ It’s need assessment more with both his mother and his teacher .
🛑39 year old female presented with menorrhagia , US uterine examination revealed fibroid ,, where is it located
⁃ submural
⁃ Intramural
⁃ Subserosal
-Submucosal fibroid
Ayab’s answer: agree on Submucosa
Abruptio placenta 32wks and bleeding stopped your action?

A_admission and follow up in hospital
B_discharge and normal follow-up
C_high risk and follow-up with serial u/s
19- case of CS and complicated by heavy bleeding the Sargon can’t control it and do hysterectomy
A- do it without concent
B- ask other sergeon
C- ask health committee
D- try to observe and ask her husband
Ayab’s answer: agree on A (life-threatening condition)
Mean Arterial Pressure is 55, Intracranial Pressure 15, What’s the cerebral perfusion pressure?
MAP-ICP=CPP
55-15=40
ً ‫االرقام تختلف طبعا‬
Ayab’s answer: Ok
Researcher changed his results before publishing his paper. What's the name?
A. Falsification (manipulation)
B. Fabrication
C. Plagiarism
Placenta previa abnormal CTG what to do next?

‫ اسبوع اخترت مغنسيوم‬٣٠ ‫انا جاني‬
Ayab’s answer: Agree.
Wafa’s note:
DEPEND MAINLY ON WEEKS AND HEMODYNAMIC STABILITY
- Betamethasone-> she at 34 weeks
- C-section -> if she has a significant bleeding ≥34 weeks OR mild bleeding with category 3 fetal heart tracing.
- Magnesium sulphate if <32 weeks
C/s indicated between 36-37 weeks
Yellow green discoloration and husband has urethral discharge

- fluconzol
- other antifungal
- metronidazol
Ayab’s answer: agree on Metronidazole “trichomonas vaginaslis. Tx.: Metronidazole & treat sexual partenr(S)”
A young man has been admitted after being diagnosed with Ebola, and he is threatening to leave the hospital if you do not discharge him.
A. Call committee
B. Security
C. DAMA
You attended the surgery theater as an intern, ( some renal surgery ) and the surgeon was preparing to do the surgery on the right side, but you
knew from
the history that the diseased kidney is the left one. What should you do?
A- call the chef intern
B- tell the surgent
C - do nothing
Patient old with end stages cancer disease complining of sever pain and his children ask you to give him stronger pain killers you respect theirs
wishes but you told them that the pain killers may fasten the death of there father question in this case what the doctor do ?
Ayab’s answer: the answer is principles of double effects
You want to do surgery to a 15 y old , from where take the consent ;

A. Parents alone
B. Patient alone
C. Both of them
Ayab’s answer: the answer is Parents’ consent and ass the child
Scenario of suspicion Appendicitis and durning surgery appendix is normal , but you have to remove it even thow its normal , what to do ?
Ayab’s answer: the answer is:
- Remove it according the guideline, tell the patient, and look for Meckle
Ovarian cyst contraceptive ……COPS

Ayab’s answer: agree on IUD, if there’s no IUD, go with OCP
Antidote for paracetamol….

A- N_acetylene
A female patient with previous history of ectopic pregnancy. What puts this patient at a higher risk to develop in her next pregnancy?
A- History of ectopic pregnancy.(history of tubal pregnancy)
B- IUCD.
41 year old male veterinarian presents with 3 months history of lower back pain along with fatigue, change in mood/behavior, parasthesia. He is
a non smoker, non alcoholic, no significant past medical history. Exam shows hepatosplenomegaly and SI joint tenderness.
Labs show low Hb, high Platelets
Best next step
A- Liver function test
B- Tube agglutination test
C- Tuberculosis skin test
D- X-ray Sacrioliac joint
Ayab’s answer: agree on B (it is Brucellosis)
Hepatitis A vaccine after blood transfusion

A. As sechduale
B. After 3 m
Child had accident ,upper femur fracture 30 degree , how to manage:

Internal fixation
Open and plate fixation
Close reduction
Other choice
Ayab’s answer: the answer is dependent on the age:
Less than 6 months: pavlic harness
6 months to 5 years: spica cast
5 y - 11 years: Flexible IMN
Pt with active git bleeding ( hematemesis & melena) bl pressure 80 (normal 120-170)
What to do for life support :
A- Octreotide
B- Bl transfusion
Other 2 choices
Female with vaginal discharge Grey, fishy odor , smear show clue cells, diagnosis? :
A. Trichomoniasis
B. Bacterial vaginosis
C. Candida
A 2-month-old baby came to the pediatric clinic without any symptoms, what screening do you do at this age??
1- head circumference
2- lead poisoning
3- body mass index(BMI)
4- congenital syndrome
Child with recurrent URTIs , eczema and thrombocytopenia both brother and uncle have the same condition:
A-Wiskott aldrich B-Digeorge
Ayab’s answer: agree on A (classic triad: purpura, eczema, recurrent infection. + thrombocytobenia)
-African child with decrease oral intake , loss of subcutaneous fat , muscle waste , no edema?
A-kwashirkor B-marsmus C-dehydration
Child after upper respiratory tract infections and receive amoxicillin

A. Skin rash appear
B. Rublla
C. infectous mononucliosis
D. Infentaile eczema
1- A young man fell on an outstretched hand and there was pain at the anatomic snuff box:
A - Hamate fracture
B - Scaphoid fracture
2- Patient after d&c have symptoms of asherman syndrome what layer of endometrium affected
A-basal
B- functional
3- Adult soldier with bilateral inguinal swelling with positive cough impulse what is the most appropriate management
A - Laparoscopic repair
B - herniotomy
C - Open hernia repair and mesh
D - observation
Ayab’s answer: agree on C. BUT if there’s lap repair with mesh I’ll go with it.
4- 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
6- Most affected nerve in PDA surgery;

A. Phrenic N
B. Vagus N
C. Lt Recurrent laryngeal N
D. Cardiac plexus
7- Long scenario of elderly female that has back and she is stooping and bending her back while she walks to relieve the pain. What is the
diagnosis?
A- Lumbar spine stenosis
B- Degenerative Lumbar spine
8- Case of necrotising fasciitis scenario with discoloration and crepitation under skin asking about organism
A. group A streptococcus
9- Patient which psychotic symptoms was put on medication what is the patient at most risk for?
A- Hyperthermia
B- MI
C- Akathesia
10- Pt diagnosed with primary hyperparathyroidism ..partial parathyroidectomy done ..later came with signs and symptoms of
hyperparathyroid..what the cause??
A- new adenoma
B- missed adenoma
C- parathyroid hyperplasia
Ayab’s answer: it depends on the duration, if less than 6 months is missed adenoma.. If more than 6 months is new adenoma.
Q. 50 years old male DM - controlled, what kind of exercise should he do?

A) aerobic
B) strength
C) supervised scheduled exercise
D) unsupervised scheduled exercise
(The last two options were written close to this answer but can’t remember the exact words used)
41-Female with chronic diarrhea and iron deficiency anemia what is the food you should advise her to avoid?
A- Rice
B- wheat
Ayab’s answer: agree on B (food should avoid in Celiac patient: wheat, rye, barley, oats)
Pregnant, GA 13 or 14 weeks, was on folic acid entire 1st trimester, her pregnancy not complicated, however labs shows megaloblastic anemia
now, what to give her?
A) folic acid
B) ferrous sulphate
* can’t remember if there was an option as (folic acid + fe) together along with the above mentioned options.
Ayab’s answer: agree on
35 year old women complains of white vaginal discharge, what is the diagnosis:
A. HTN
B. DM
C. Cardiac failure
D. Hyperthyroidism
Ayab’s answer: agree on DM
* Initial investigation in alzahime

1/lp
2/MRI
Ayab’s answer: Initial? I’d go with a neuropsychological test such as MMSE or MCA. then MRI.
* Pt known to have cardiovascular disease and MI , admit to to hospital (to some reason im not remember ) in ICU, she developed after days liver
function abnormalities and become hypotension and jaundiced!! What the cause of that??
1/Ischemic Hepatitis
2/jundice induce ICU
* (Saide effect of ACI ) patient take many drugs for cardiovascular disease and he complain of edema in his tung and lips , what drug response in
thise??
1/B.blocker
2/elopril
3/Asprin
* Pt have RA on steroids and another drug (im forget what that) now he active arthritis, what to ad??
1/ adilumab (I choose )
* Anemia in sle ?
A/Hemolytic
* 38 gastitona high blood pressure low platelet protein in urine what to do ??
A-emergency dilever
2 forgotten another option
* Hows response to notify in Emergency status of COVID19?

1/ WuhanCity in China
2/any country have COVID19
3/WHO
Ayab’s answer: agree on WHO
* tuomer lysis syndrome

A/hyperkalemia , hypocalcemia
* Q about hydited cyst first line Rx?

Ayab’s answer: agree on Medication
36 old male at ER C/O Right abdominal Pain , O/E : fever, anorexia , weight loss , tenderness in RQ and Lower intercostal margines
also patient is toxic Temp. 37.9 ( I think but it was elevated ) wbc high, bilirubin high US : cystic lesion without septates CT :
homogenous (not sure) and “THICK WALL with Peripheral enhancement what’s most appropriate Mx :
A. Early laparoscopic cholecystectomy
B. Emergent stent chole
C. Cholecystectomy after 3 months
6 Years old child with nausea, vomiting, headache & visual disturbance worsening over the past 6 weeks.
Symptoms provoked at early morning & late night, and improved by walking.
What is the diagnostic test?
A- Brain MRI.
B- Abdominal US.
C- Muscle biopsy.
D- CT (i forgot where).
hypokalemia + hypocalcemia with flat T wave ( next management)

Labs : very high urea & creatinine
1- dextrose
2- ca2 gluconate
3- ca2 resonium
4- renal replacement
Infant came with significant ASD. What to do regarding treatment.

No symptoms were mentioned
Came exactly like this
A-repair within 3 - 5 years
B-repair within 1st 8 weaks
C-No need to repair as it will resolve spontaneously within 5 years
25 years old patient presented to emergency with tachycardia hr 225 , intial his bp was 110/80 then droped to 80/60 , whats the most
appropriate next step
A ) amiodarone
2 ) cardioversion
Ayab’s answer: agree on B (unstable)
Long senario , labs given showing high potassium , asking about what you could see in ecg
A) prolnged pr interval
B) st elevation
C ) peaked t wave
Ttp picture , asking about whats the most appropriate next step
A ) plasma tansfusion
B ) plasma exchange
Contaceptive method in patient with history of PE:

Ayab’s answer: agree on IUD
6 years old patient came with history with middle line neck sweeling that move up and down with tounge protrusion
A ) brachial cyst
B) thryoglossal cyst
C) zenker divertculum
Pediatric patient presneted with. History of fever of 9 days , non prurlent conjuctivitis , carked lips , what is the most likely diagnosis
A) measele
B) kawasaki
10 years old pateint came with history of feeling his heart beats , on examination : hr was very high 225 otherwise everything is normal , what
would be your next step
A) echo
B) xray
C ) 12 lead ecg
military man presntwd with bilateral inginal hernia , what would be your mangment
A) open repair with mesh
B) lap repair with mesh
pregent 34 w came with prom , how would you manage

A) tocolytics
B) corticosteroids
C) abx
D) surfactant
Best diagnostic method for endometriosis

Ayab’s answer: agree on Laparoscopy
pedaitic patient having fever now came for vaccine , what should you
A) proceed
B) delay till he finish his abx course
young patient underwent open appendectomy , stayed in hospital for 2 days post op and it was uneventful stay. Came back on the 8 th day
with surgical site pain . On examination abdomen was soft , lax , tender in op site with redness noticed , what would be your next step
A) exp laprotomy
B) open draninage
C) ct abdomen
D ) oral abx
Whats the most coomon cause of infective endocarditis

A) streps species
B) staph aureus
Ayab’s answer: agree on B (but not sure 100%)
How to calculate expected day of delivery

Ayab’s answer: +1Y / -3M / +7D
Patient came in rta intiay was oreinted and asking about water ans then he. Become confused his bp was 80/60 hr 14 , ag what stage of
hemorrhagic shock he is
A) 1
B)2
C) 3
D) 4
open book pelvic fracture , what is the best solution type to give
A) ns
B) rl
C ) d5 10%
patient came fracture and compatent sydrome , whats its the fist allarming sign
A) absent pulse
B) toe discoloration
C) parasthesia
( there was no pain in the choices
A neonate 12 hours after normal vaginal delivery noticed to be jaundiced. The blood film showed microcytic hyperchromic cells. The best
investigation to order is:
A) Osmotic fragility test.
B) Pyruvate kinase level.
C) Glucose 6 phosphate dehydrogenase enzyme.
D) EMA.
A 61 years old female complaining Typical sign and symptoms of pulmonary cancer, bilateral pleural effusion, and pleural fluids was
taken and showd the result (forgot), what is the cause of her pleural effusion?
A-Exudate leads to malignancy
B- transudate leada to malignancy
C- exudate leads to HF.
D- transudate leads to empyema
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
female complaining of abnormal uterine bleeding she has an endometrial polyp, on US endometrial lining was 19mm, what will you offer to this
patient at this stage?
A) open hysterectomy
B) laparoscopic hysterectomy
C) hysteroscopy with polypectomy
A 24 year old lady presents with a hard, mobile, well-circumscribed painless left breast mass that has been increasing in size from the past few
months, and was NOT related to her menstrual cycle. The most like Dx is?
A-fat cyst
B-Fibroadenoma
C-Fibrocystic chang
D-Intraductal papilloma
47 yo abnormal uterine bleeding. Describe interval between episodes as less than 21 days. Next appropriate step
A.Total abdominal hysterectomy
B.Endometrial sample
C.Progesterone (pill think)
D.IUCD
3 years child came with fever and and tachepneia. 30 per minutes , O2 saturatin is 92 % , not known to have any medical condition You should
A-Disharg e him on amoxicoin
V-Disharge him on augementin
C-Admit him for IV Cefitraxone
D-Admit him for IV fluid
10 years old came with history of fever, weight loss, high wbc, hb 9, high PLT, elevated esr and -ve ANA, dx?
A. SLE
B. Leukemia
C. Systemic juvenile idiopathic arthritis
D. IBD
Ayab’s answer: agree on C (Dr. Safder)
Patient k/c hep b. Imaging of the abdomen showed solitary liver nodule but no lymph node involvement. Biopsy confirms HCC 5*5.
How to treat. *
Chemo
Rad
Resection
Patient with ovarian tumor during surgery after excision nurse was carrying the tumor and there was spillage of fatty tissue what is the tumor ?
A.Thecoma
B.Granulosa tumor
pt after SVD found placenta can not extract and refused hysterectomy then ligate placenta and started MTX , what’s the complication
of this case ?
A-Bleeding
B-Infection
C-DIC
Traumatic patient presented to ER with Profuse bleeding from nose and mouth , cyanosed with decreased breath sound on right side of the
chest. Mostly was unstable Which of the following is the most appropriate next step.
A-Right chest thoracostomy
B-Intubation
C-IV fluid resuscitation and O type blood transfusion.
Ayab’s answer: from those choses agree on B
Old patient I think, with cardiac sign and symptoms, on examination there was pansystolic murmur crescendo-decrescendo radiated to the
carotid artery (100% sure), what is the most likely diagnosis?
A- Tricuspid
B- Mitral regurgitation
C Aortic stenosis
D -Mitral stenosis
Pregnant woman c/o jaundice and pruritus ALP 700 AST 100 ALT 85. what's the dx?
A. Cholestasis of pregnancy
B. Budd chiari syndrome
C. Viral hepatitis
Old pt DM- HTn cardiac dis, long senario. And all treatment given and stable on thrombolytic, What is the most common cause of death during
his hospital stay:
A. bleeding
B. stroke (throbolytics)
C. PE (hospitalization)
D.MI
6 y girl with reddish urine, she had constipation for 2 weeks, then became inconteinent. On examination there is abdominal tenderness no
organomegaly, labs : normal wbc, low rbc.
Urine analysis: leukocytosis, erythrocytosis, +++ blood , what the dx ?
A- UTI
B- HSP
C- AIHA
D- PSGN
36 with left neck mass, 2x2xm in posterior angle of mandible

US: normal thyroid, left large LN with cystic component
FNA: all smear shows follicular thyroid
1. Metastatic thyroid cancer
2. Apparent thyroid
3. Ectopic thyroid
4. Thryoglossal cyst
Pt in ICU received 15 units of blood, now blood coming out from NGT, incision, and cannula site
1. Transfusion reaction
2. Thrombocytopenia
3. Hypocalcemia
4. Forgot
A 8-year-old boy's parents complain that he has episodes where he blinks multiple times and becomes okay after that..he is conscious and
responsive during those episodes. The most likely diagnosis is
A. Tic
B. ADHD
C. Tourette’s
12 weeks GA pregnant women with uncontrolled diabetes mellitus her glycated Hemoglobin was around 8 , which of the following will
increase drastically:
A. -Preeclampsia
B. -Congenital malformations
C. -Polyhydroiaminos
I don't remember
Burn case black soot over nostrils and mouth 40% carboxyhemoglobin.
(Carbon monoxide toxicity):
A. Hyperbaric oxygen
B. Intubation and ventilation with room air.
C. Intubation and ventilation with 100% o2.
D. Carbonic anhydrase inhibitors.
The uterus is inverse after delivery of the placenta what is the site of insertion to be like this shape?
A. Fundal
B. Anterior
C. Posterior
D. Lateral
Healthy lady want came for preconceptions clinic what is the amount of folic acid in mg for her ?
-1
-5
-10
-15
Old patient came for elective cholecystectomy you find out he was admitted 2 weeks ago in icu for management of MI, what will you do?
A- do it in this admission
B- delay it 6 weeks
C- delay it 6 months
D - no need to do it anymore
15 years old female had exploratory laparotomy due to rupture of appendix, on day 8 the patient didn’t improve after the operation And was
Intubated ,on physical examination the abdomen was distended the patient whent to do CT scan suddenly started to bleed from her mouth
what is the dx:
A-Hemophilia
B-idiopathic thrombocytopenic purpura
CTG
‫جاء صوره وفيها‬variable and late deceleration
‫وكاتب وش التشخيص‬
1-early
2-late
3-variable
4-combined
4 ‫اخترت‬
50 yo woman, history of dizziness when waking up from the bed, feels warm and flush, itchy skin, abdominal cramping and watery diarrhoea.
O/e 2/6 systolic murmur, wheeze. Abdomen normal
Stool analysis and culture normal. (No other data were provided) What to do next ?
A. Abdomen and pelvic us
B. Barium enema
C. Serum amylase and lipase
D. 5 hydroxyindoleacetic acid in urine
4 month kenictrus with neurological sequelae?

A. Ataxia
B. Spastic
C. Hypo or hyper tonic (not sure)
D. Another option
Female (forgot age but not old) Secondary amenorrhea for 8 months (exactly like this)
What most appropriate management?
A. Pregnancy test
B. Pelvic Us
C. Full history
D. Clinical examination
Female 30 week gestational age, regular antenatal follow ups, presented w profuse vaginal bleeding and abdominal pain. Ctg normal heart rate
and regular contraction.
(No other details)
A. Labor
B. Preterm labour
C. Placenta abrupt
D. Placenta previa
Trauma patient during surgery found multiple liver lacerations. Pt unstable.

Management?
A. Perihepatic packing
B. It love hepatectomy
C. Artery ligation
Researcher conducted a research study about incidence, prevalence and burden of DM after the invention of insulin therapy in 1960.
What most likely was his finding? (No other data in question)
Decrease incidence
Decreased prevalence
Increased incidence or prevalence not sure
4th option don't remember
Ayab’s answer: agree on Increase prevalence
Elderly patient bed-bound due to basal ganglia hemorrhage. Weight loss. Emaciated. Can't eat difficult swallowing. Weak muscle of
mastication. What is the best way to initiate feeding?
A. Parenteral nutrition
B. Nasogastric nutrition
C. Something gastric
D. Something jujenum
Trauma patient. Vitally was stable. FAST done was positive next step?
Gastric lavage
Ct abdomen
Laporatomy
Ayab’s answer: agree on CT
60 y/o male. DM. Came with LUTS. Diagnosed as BPH. What is the condition related to?
A. Age
B. DM
C. Hyperandogenemia
Young SLE female pt on treament. Developed urinary incontinence, hypereflexia, paraplegic or paresthesia. (Sx mostly neuro) what the most
important test to do immediately?
A. Lumber puncture & MRI brain
B. Lumbar puncture & ct brain
C. Lumbar puncture & MRI spine
D. Lumbar puncture, mri spine, MRI brain
Pt post parathyroidectomy (I think), bone pain and other. Low calcium. Despite Mx Ca still low what to do next?
A. Check magnesium level
When you say nephrotic syndrome resolve?

A- After 3 successive negative urine analysis
B- After 5 successive negative urine analysis
C- After resolve edema
3-481-Trauma patient, currently well. lucid interval reported by paramedics, now he is deteriorating. Most likely diagnosis?
A -Epidural hematoma
B -Subdural hematoma
C -Base of skull fracture
5-The operation is successful and the patient is given postoperative insulin and IV d extrose. 2 days after the operation he becomes very
agitated. Which of the following is the most likely cause?
A.Water overload
B. Addison's disease
C. Diabetic nephropathy
D. SIADH
Ayab’s answer: ??? need a better recall
Pt on heamodylasis developed Infective endocrdaitis MERSA type start on vanco 1000mg (20 ml infusion per hour ) then deeloped symptom’s
appear like allergic reaction
A. - stop vanco an labeled as allergic to vanco
B. - decrease vanco dose
C. -decrease vanco infusion rate
D. - change vanco to other medication
Patient came to A&E with TB, what do you do?

⁃ standerd percation
⁃ Airprone
⁃ Droplet
Ayab’s answer:
TP: airborn
Pneumonia & meningitis are droplets
Patient obese, hx of jandace for 1 week with anaroxia and abdominal pain, o/e right upper quadrant tenderness, no hx of medication or disease
What initial step?
A. -MRCP
B. -abdominal us
C. -ct
D. -biobsy
Ayab’s answer: agree on C (Abdominal US have limited benefit on obese patients)
Patient k/c/o htn, dm, ckd on diyalisi admitted for pneumonia, how to prevent thromboembolism
A. -UFH
B. -enoxoprin
C. -compressor stocking
Ayab’s answer: agree on UFH
13 boy post splenectomy. When to give pneumococcus?

Ayab’s answer: 2 weeks after the operation.
Doctor while taking a history, He found history of severe dysmenorrhea. What would be likely the cause?
A-Ovarian thecoma
B-Ovarian fibroma
C-Endometriosis
D-Leiomyoma
pic: Late deceleration CTG what is the cause?

A. placental insufficiency
• A case of COPD with increased AP diameter?

A. Emphysema
• Nephrotic syndrome case that’s deriorated, dx?

A. Perotonitis
• A diabetic patient Type 1 controlled everything normal but BP 150/90, what to add?
A. ACE inh (not sure).
• Milestones : 2 years, 18 months (also child with pincer which the answer should be 9 months but in the options 10 months was the closest
answer).
• Aspergillosis T? Me..azole
Ayab’s answer: agree on IV voriconazole
• SLE patient with neurological symptoms (seizures), t?

A. Cyclophosphamide
• A patient with fever, SOB, tachypnea for 2 days.. he usually gets wheezing, SOB (i think he has asthma), whats the treatment now?
A. ventolin & antibiotics (asthma+pneumonia treatment).
• MVA pt came with bleeding from eardrum?

A. Basal skull fracture
• Scenario of sever asthma, what indicates that its severe?

A. RR>30.
• COPD prognosis?
A. FEV1
• Clue cells?
A. Bacterial vaginosis
• HSP pic
• Rifampin SE?
a. Changes body fluids color
• An old pt who’s on ACEi, CCB, & warfarin, came with a TB scenario and now is put on RIPE medication, what medication adjustment should
be done?
A. Increase warfarin dose,
B. stop ACEi
C. stop CCB
D. stop rifampin
• Indication for COPD home oxygen Th?

A. pO2 <7.3 on 2 occasions
• A girl who’s on low mood, increased appetite, sad, irritated that usually happens before her menstruation & she has abdominal pain
associated with her menstruation that affects her social life, what treatment to put her on?
A. OCP, s
B. elective serotonin uptake inh, ..
Ayab’s answer: agree on B from these options.
• A pt with dysmenorrhea, what should be asked about?
A. Family h,
B. menstruation,
other options i dont remember.
• PPH? Uterine atony

Ayab’s answer: ? All I know is that it is the most common cause of PPH.
• A patient with PPH case who was controlled and then suddenly she started bleeding from all venipuncture sites, what to do?
A. Oxytocin
B. treat congenital coagulation disease
C. lynch B suture
Ayab’s answer: agree on B (a case of DIC)
• A pt with large ears, long face, macroorchidism, joint laxity, mitral valve prolapse, dx?
A. Fragile X syndrome
B. hurler syndrome,
C. hunter syndrome
• A young boy who has diff joint pain (one in hip and one in wrist, that is mostly severe in the morning and goes away with walking, dx?
A. Idiopathic Juvenile..
• Child with pika, lead is elevated, T?

A. penicillamine
• Horizontal fissure on CXR in a pt whos term and developed tachypnea....?

A. ARDS,
B. transient tachypnea of newbown
• A patient with testicular pain (horizontally lying testicle) with normal scrotum, mildly elevated, next step?
A. doppler US
B. pain management
C. scrotal exploration.
• Child with recurrent UTI and by voiding cystourethrogram (showed a pic with one-sided), whats your diagnosis?
A. Left renal agenesis
B. vesicoureteric reflux
• 2 years old with 2 red spots on on the legs and one larger red spot on the eyelid, man?
A. Referral to ophthomology(answer),
B. reassure,
C. tell the mom it goes away at 5 yrs.
• Hereditary spherocytosis picture, what will you order?

A. Osmotic fragility test (ans)
Ayab’s answer: agree if they asked about the initial test, the confirmatory is EMA
• Baby with a rash, both parents have eczema, where do you think the location of the rash will be?
A. On the face and scalp.
Ayab’s answer: agree on Flaxor
• Foul smelling sputum + clubbing?

A. Bronchioectasis
• Hypotension, JVD, muffled heart sounds?

A. cardiac tamponde
• Patient 65 (i dont rmmbr the age exactly but abovr 60) with DM and hypertension (i think) that are controlled. His lipid panel is (low HDL and
high LDL) what should be added to his meds? Niacin, atorvustatin (i chose this), other drugs..
• Patient who’s diabetic, develops liver symptoms, dx?
A. Nonfatty alcoholic jaundice,
• Patient with asthma symptoms that are not controlled although he uses Bronchodilators, corticosteroids, & LABA. His PFTs are 75% before
the use of a bronchodilator and 95% after using it. What to do?
A. Observe how he uses the inhaler
• When to check bacteruria in pregnancy?

A. At 12th week
• Child came to clinic and the doctor advised his parents to start iron supplements next month, how old is the child now?
A. 3 months
• A child who plays in the farm or garden something like that, he has increased saliva, tearing, diarrhea, sweating.. dx?
A. Orghanophosphate toxicity.
Ayab’s answer: agree on A (antidote: atropin)
• Early sign of compensated shock?

A. Pale and cold skin.
• What decreases mortality rate in esophageal varrices?

A. IV ceftriaxone
• Female patient 45 (or 43) years old came for checkup, everything is normal, BMI is high (30 i think), what to do?
A. Pap smear
B. fasting blood glucose
• What increases the risk of gestational diabetes mellitus?

A. Previous pregnancy with GDM
B. BMI = 20
• A patient with GDM, what’s the baby at risk of?

A. Polyhydromnios
B. oligohydromnios
Long Scenario about RA, asking about sensitive test?

A- Anti CCP
B- ANA
C- Can’t remember
D- Can’t remember
* Calculate CHAD score in this pt?

• Apgar score q
* PICTURE
1/SVT ECG
2/Bacterial VAGINOSIS
3/PERFORATED DUODENUM (air under diaphragm)
4/skin tag
5/Open fracture
6/CTG
7/HSP
8/faliure to thrive (centile chart)
pic of hsp
Pic of falciparum palsmodium
Pic of sigmoid valvlous

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Daily SMLE - February (SMLE B)

Last update: 11 Feb, 9:15 pm

• Single a in umbilical cord indicates?

young pt have appendiceal mass how to manage?

• Ankle-brachial index is 0.3 in a patient with DVT, occlusion size is 3 cm, T?

Lyeiomayma (dagnosis writtend) , what the the aproprate mangment ?

‫ مولود الم عندها‬hepc + what ro give the bab

Pt with HTN and has mid systolic murmur with S4 ?

associated with coarctation of the aorta?

40 weeks GA pregnant lady with 12cm ovarian cyst.

Pt admitted as cas of pneumonia not improved with 2 abx

Patient with > 10000 wbc, what’s the organism?

- Case Prolonged declaration :

- case of sarcoidosis whats the mangment:

Runs towards doctor, cannot use spoon, cannot use 3 words:

TB. How to invest

Pregnant bp 140/90 or 150/90 what to give ? “Exactly like this”

Femal has molar pregnecy bhcg at begining was (856 000)

• Medicine given to decrease fibroid size?

2-Nurse come to the clinic with health screening

4-Prophylactics for pt on hemodialysis k/c of end stage kidney disease?

5-Highest risk cancer for endometrical cancer?

6 - absolute contraindications of inserting IUD ?

7 - indication of sever preeaclamsia ?

9- ectopic pregnancy. Bhcg 3500 Size of ectopic pregnancy 3 cm:

‫ بشكل عام الميدسن مركز على‬asthma and

‫االختبار اكثر جا من تجميعات ديسمبر نسخ لصق‬

Q:Patient come with fistula at 7 position and will do fistulomy ?

Risk factor of uterine cancer?

🛑Milestone of a child that

mother concern about her kid about ADHD , he is quit in clinic :

Abruptio placenta 32wks and bleeding stopped your action?

Placenta previa abnormal CTG what to do next?

Yellow green discoloration and husband has urethral discharge

You want to do surgery to a 15 y old , from where take the consent ;

Ovarian cyst contraceptive ……COPS

Antidote for paracetamol….

Hepatitis A vaccine after blood transfusion

Child had accident ,upper femur fracture 30 degree , how to manage:

Child after upper respiratory tract infections and receive amoxicillin

6- Most affected nerve in PDA surgery;

Q. 50 years old male DM - controlled, what kind of exercise should he do?

* Initial investigation in alzahime

* Hows response to notify in Emergency status of COVID19?

* tuomer lysis syndrome

* Q about hydited cyst first line Rx?

hypokalemia + hypocalcemia with flat T wave ( next management)

Infant came with significant ASD. What to do regarding treatment.

Contaceptive method in patient with history of PE:

pregent 34 w came with prom , how would you manage

Best diagnostic method for endometriosis

Whats the most coomon cause of infective endocarditis

How to calculate expected day of delivery

36 with left neck mass, 2x2xm in posterior angle of mandible

4 month kenictrus with neurological sequelae?

Trauma patient during surgery found multiple liver lacerations. Pt unstable.

When you say nephrotic syndrome resolve?

Patient came to A&E with TB, what do you do?