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Medicin All Nov, Sep, Oct PDF
Medicin All Nov, Sep, Oct PDF
Medicin All Nov, Sep, Oct PDF
Patient complaining of epigastric pain, better with vomiting, worse with eating. He's
taking medications for her his joint pain. What's the diagnosis?
• Perforated peptic ulcer (Here is perforated so less likely) • Boerhaavesyndrome •
Gastritis✅
اﻟﻤﻌﺪةŒŽ • „ﻠﻤﺔ اﻟ† اﻧﻪ ﺷﺨﺺ ﻋﻨﺪە ﻗﺮﺣﺔ، ﻂ ﺗ|ﺒ~•ﺎل اﻋﺮاض ﻗﺮﺣﺔ اﻟﻤﻌﺪةyﺎﻟﻀu ﻫﺬەgastric ﻟﻤﺎ •ﻘﻮﻟﻚ اﺣﺲ
ﻗﻤﺔ اﻟﻤﻌﺪةŒŽ • ب اﻟﻢepigastric pain ﻟ~ﻪ ؟؟ ﻻن ﺣﻤﺾ اﻟﻤﻌﺪة •ﻄﻠﻊ ﻣﻊ اﻟﻬﻀﻢ واﻻ™ﻞ، و–—–ﺪ ﻣﻊ اﻻ™ﻞ
ﺎب اﻟﺮﺋ¨ﺴ~ﺔ ل ﻗﺮﺣﺔ اﻟﻤﻌﺪة ﻫﻮ اﺳﺘﻌﻤﺎل اﻟﻤﺴﻜﻨﺎتy ﺛﺎﻧ~ﺎ اﺳ، ﻌﺪ اﻻ™ﻞu اﻟﻘﺮﺣﺔ ﻓ~ﺤﺲ ب اﻟﻢ¤ ﻋ¢ Ž £ ~ﻓﺎﻟﺤﻤﺾ ﻳ
اﻻﻟﻢ ﻣﻦ ﻋﺎﺋﻠﺔNSAID ﻣﺜﻞ، وﻟ¨ﺲ اﻟﺒﻨﺎدولIbrufen ﻓﺎﻟﺴ|ﻨﺎر–ﻮا، ﻣﻌﺪة ﻓﺎﺿ~ﺔ¤–ﻠﺔ وﻋcوﺧﺎﺻﺔ ﻣﻊ اﻟﻤﺪة اﻟﻄ
ﻟﻮ „ﺎن ﻓ~ﻪ، ﻌﺪ اﻻ™ﻞ و„ﺎن ´ﺴﺘﻌﻤﻞ ﻣﺴﻜﻨﺎتu ﻂ •ﻘﻮﻟﻚ اﻟﻢyﺎﻟﻀu Gastric ulcer ﺑ|ﻨﻤﺎ، „ﺎن ﺑ~ﻜﻮن ﻫﻮ اﻟﺠﻮاب
perforater اﻟﻤﻌﺪةŒŽ • •ﻘﻮﻟﻚ اﻟﻢ ﺷﺪﻳ|ﻴ~ﺪ ﺟﺪا
sever abdominal pain
•Œ ، ﻫﺬا اول „ﻠﻤﺔperforater ﺛﺎ•¸ „ﻠﻤﺔ ﻣﻬﻤﺔ ﻫﻮsudden ﻓﺠﺎة ﻛﺬا وﻫﻮ ﺗﻤﺎم ﻣﺎ•ﺤﺲ ب ¼»ء اﻟﻢ ﺟﺪا ﻗﻮي
Ž Ž Ž
ﺎﻟﻤﻌﺪةu : Sudden sever abdominal pain غ دمÀ»ء ´ﺴﺘﻔ ¼
Ž ﺛﺎﻟﺚ.
ﻟﺬﻟﻚ اﻗﺮب اﺧﺘ~ﺎر ﻫﻮGastritiis ﻦ ﻻ ﺗﺨﺘﺎرواÄﻟ. ﺎﺑﻬﺎ ﻣﺴﻜﻨﺎتy وﺻﺢ اﺣﺪ اﺳ، ﺎﻻﻋﺮاض ﻫﺬەu ¢ Ž £ ~ﻧﻌﻤﺰﻣﻤﻜﻦ ﺗ
perforated .
.. . . .. . .
pt with history of peptic ulcer and +ve urea breath test. You started and finished the
treatment course. When you can re-examine the urea breath test?
A. at least 4 weeks ✅ B. at least 2 weeks C.at least 1 week D.examine now ( urea = ارﺑﻊ
ﺣروف = ارﺑﻊ أﺳﺎﺑﯾﻊ
🍒🍒urea breath test after finsh treatment course =at least 4 weeks 🍒🍒
......
🌹DM and HTN known case patient, presents with severe epigastric pain radiating to back
for 6 hours, CXR shows left air under diaphragm, most likely diagnosis: Perforated peptic
ulcer 🌹
….
🍓peptic ulcer patient with vomiting examination showed succession splash while shaking
the abdomen what acid base disorder he has:
metabolic acidosis
metabolic alkalosis compensated✅ metabolic acidosis
compensated metabolic alkalosis
n
= ر`ﻂalkalosis = ءmo = ﻞkﺲ =اiﺎﻟﻮزe اﻟ.
Succussion splash also known as a gastric splash, is a sloshing sound heard through the
stethoscope during sudden movement of the patient on abdominal auscultation. It reflects
the presence of gas and fluid in an obstructed organ, as in gastric outlet obstruction
🌹 Pt with history of PUD and he has joint pain which analgesic to give ?
A. Codeine. B. Paracetamol✅. C. Aspirin ﺎﻟﻤﻤﻌﺪةu ع ﻻن ﻋﻨﺪە ﻗﺮﺣﺔcﻣﻤﻨ
🍓Pt complete 2week of h pylori treatment today and come to ask you for test
eradication when to do it?After 4 weeks✅
....
🌹Regarding ppi after endoscopy: A. take for 24 hr B. 36 hr C. 48 hr D. 72 hr
How does PPI Help GI bleed?
PPIs reduce gastric acid secretion for up to 36 hours,41 thereby promoting healing of ulcers
and erosions as well as stabilizing thrombi and decreasing rates of GI bleeding in patients .
🌹pt with acut upper GI bleeding due to PUD=IV PPI for 72 hours🌷
...
🌹IV medication before upper endoscopy in upper gi bleeding patient? A. Vit K B.
Octreotide
...
🌹 Stomach varicocele before endoscopy what to give? Octeoride
…
🌹 pt did graham patch for gastric perforation, then he had esophageal bleeding, and ask
about the next appropriate step in management:
A.endoscopy stent ✅✅ B. Laparotomy C. Ct scan
..........
Pt with melena and labs show anemia , Normal upper and lower endoscopy . next step ?
capsule
....
🍓Pt with upper Gi bleeding, after initial ER management, what to give before endoscopy:
A. propranolol B. octreotide✅ C. VIT K D. vasopressin
........
🌹Highest diagnostic value test for achalasia ?
A. lower esophageal manometry B. UG Endoscopy
ﻫﺬاmanometry •ﻘ¨ﺲ:
measures muscle contractions
....
patient with achalasia. Repeated attempt of balloon expansion relapses again.What is the
management?- myotomy✅
¸ ﻟﻠﻀﻴﻖ ﻫﻮ ﻗﺺ ﻋﻀﻠﺔ اﻟﻤﺮيءوŽ • ﺎﻟﻮن ﻓﺎﻟﺤﻞ اﻟﺜﺎyﻟﻼن ﻣﻤﺎ ﻧﻔﻊ ﻣﻌﻪ اﻟ
..............
Pt alcoholic presented with hemoptysis and vomiting and abdominal pain:
A. Esophageal varices ✅✅ B. Acute pancreatitis C. Chronic pancreatitis D. Pancreatic
pseudocyst
Alcoholic cirrhosis ) prot HTN ) esophageal varices
........
-Patient presenting with Esophageal perforation post dilatation for achalasia, how will
you manage?
A-Surgical drainage and anastomosis ✅✅ B--Esophagectomty
🌹Esophageal perforation post dilatation for achalasia =Surgical drainage and anastomosis
🌹
.... ....
A 32 years-old alcoholic male patient is brought to the emergency department with the
history of vomiting large amount of bright red blood. Physical examination revealed
splenomegaly and ascites. Which of the following is the most likely source of bleeding? -
Esophageal varices.✅
... ..... ...... . ..
• Esophageal carcinoma management = ○Referral for possible esophageal resection ✅ ○
Antacids
ﻪ اﻟﻮرمu اﺻﺎÐŽﺌﺼﺎل اﻟﺠﺰء اÛ~ﺪ ﻻزم ﺟﺮاﺣﺔ او اﺳÙ اﺻﺎب اﻟﻤﺮيء اÐŽ ﻫﻨﺎ ﻋﻼج اﻟﻮرم ا.
-- ----- ----- -----
30)_ Forceful vomiting followed by severe central chest pain and nausea, subcutaneous
emphysema dx: esophageal rupture. ✅✅ اﻟﺼﺪرŒŽ • ءà á £ ﺐ اﻟﻢ ﺷﺪ•ﺪ و ﻣﻔﺎÞﺳ
……
Coffee floor emesis: A- GERD. B- H. Pylori C- Gastritis
ﺴﻤﻌﻮا „ﻠﻤﺔâ ( ﻟﻤﺎcoffe ground emesis ) او اﺣﻤﺮ ﺟﺪا، غ ﻛﺘﻞ دم ﻟﻮﻧﻬﺎ ﻣﻘﺎرب ﻟﻼﺳﻮدÀﻣﻌﻨﺎﻫﺎ ﺟﺎﻟﺲ ´ﺴﺘﻔ
ﻻن ﻣﻌﻨﺎﻫﺎ ﻓ~ﻪ ﻧ—–ﻒ ﻣﻦ اﻟﻤﻌﺪة او، ﻏﺎﻣﻖ وﻫﻨﺎ ﻧﺨﺎفesophages .
coffee ground vomitus, means that upper gastrointestinal bleeding is more acute or more
severe, for example due to Mallory–Weiss tear, gastric ulcer or Dieulafoy's lesion, or
esophageal varices,
gastritis.
...........
esophageal carcinoma? A.smoking B. barret esophagus ✅
......
male complaining of reflux and post prandial discomfort this a main complain in his family
What is the risk factor for cancer esophagus? Barrette esophagus ﺻﺢ
ﻪyéﺴâ ﻃﺎنè= ةÒçﺎر =ﺑu
...... ...... ......
🍓Pt vomit blood I think he has Varicose vein what to give him for decrease risk of
bleeding : B blocker
…
Long-term treatment to decrease risk of recurrent bleed `-blocker (e.g. nadolol)✅
• Repeat EVL/sclerotherapy • Nitrates • Follow-up
….
🍒 Elderly pt with Dysphagia to solid and liquid PR examination change in stool color .=
Esophageal ca
…
🍒 Smoker and On biopsy there is metaplasia of the esophagus what’s the management:
A. Refer for possible esophageal resection✅ B. Smoke stopping plan
🌹metaplasia mean pre.cancer = Barrett's esophagus = high grad dysplasia = endoscopic
ablation/resection, or esophagectomy + if low grade dysplasia, both surveillance and
endoscopic ablation/resection are satisfactory options.
.........
🍒To prevent esophageal bleeding in liver cirrhosis: BB🌹
…
🌹Alcoholic with negative Hx, vomits blood for 1 day, no epigastric tenderness Dx?
A. Esophageal varices B. gastric ulcer C. acute pancreatitis D. chronic pancreatitis
....
🌹Pt with esophageal bleeding, How to prevent? A. Nadolol B. Aspirin
ﻠﻮك ﻣﺜﻞ ﻣﺎ اﻧﻪ •ﻘﻠﻞ ﺿﻐﻂ اﻟﺪم ﻛﺬﻟﻚ •ﻘﻠﻞu ﺑ|ﺘﺎ
decrease portal pressure in patients with cirrhosis
ﻣﻦïŽ Ó – وrebleeding prevention .
....
Old man + smoking + esophageal show squamous cell with highly displasia next step?
A. Stop smoking B. surgical resection
†¼Ûﻞ ﻻ ﻳﻨy ﻃﻮل اﺷ~ﻞ اﻟ†ﻃﺎن ﻗ¤ ﻋñ • ç ﻃﺎن ﻣﺎ ﻳﻨﻔﻊ اﻗﻮﻟﻪ وﻗﻒ ﺗﺪﺧè ﺧﻼص ﺳﺎر ﻋﻨﺪە.
....
🌹Pt presented with many bouts of hematemesis after prolonged vomiting, Dx? A. Mallory
weis B. Esophageal varices
....
🌹Pt chronic alcoholic, complains of progressive dysphagia, he’s cachectic on Digital Rectal
Exsam there’s clots of blood with stool. Dx? A. Esophageal ca B. Acidic peptic disease C.
Pancreatitis
......
🌹A 40 year old man underwent endoscopic esophageal dilatation and was cleared to go
home post op day 2. He returns post op day 8 with retrosternal pain and fever (39°).
Esophageal perforation > endoscopic stent if mild
ﻋﻤﻞ، واﺿﺤﺔendoscopic esophageal = وﻣﻦ ﻣﻀﺎﻋﻔﺎﺗﻬﺎEsophageal perforation
....
🌹Elderly with severe epigastric pain increased at night, with metallic taste
A. esophagitis B. Esophageal cancer C. Boerhave..
ﻂ =اﻟﻤﺮيء •ﺪﺧﻞ ﻓ~ﻪ اﻻ™ﻞ ﻃﻌﻤﻪÏ =رmetallic
...
🌹Most common/important risk factor for esophageal cancer is: A. Heavy smoking B.
Barrett's esophagus
....
🌹child with GERD symptoms on metronidazole, omeprazole which drug to add?
Clarithromycin ✅🌹
–ﺎ اﻟﻤﻌﺪةÒçﻜﺘu –ﺾ ﻋﻨﺪەÀ •ﻠﻤﺢ اﻧﻪ اﻟﻤH.pylory وﻋﻤﻞ ﻟﻪGERD ، –ﻖ اﻟﺪزاءÀ–ﺎ اﻟﻤﻌﺪة ﻋﻦ ﻃÒçﻜﺘu ﻓﻼزم ﻧﻌﺎﻟﺞ
¸Ž ô اﻟﺜﻼ.
.........
The pt already on metronidazole and PPI what should you add?
A. clarithromycin✅ B. tetracycline C. sucralfate
Triple Rx :amoxicillin + clarithro + ppi
Quadruple Rx: metronidazole + tetracycline + bisthmus + PPI
.......
🌹Pt take 20 mg omeprazole no improvement of symptoms, urea breath
test negative : A. Increase dose of omeprazole ✔ B. Add clarithromycin
usually dose is 20 mg OD for 4 week if the Pt not fully healed after 4 weeks,treatment may
continue for another 4 weeks.
......
🌹What symptom makes you suspect eosinophilic esophagitis the most?
prolonged chewing of food
....
Case about Esophagitis in children = A_Worse night symptom B Excessive chewing✅✅
🌹Esophagitis in children =Excessive chewing 🌹
…..
In patients with reflux symptoms despite standard dose once daily PPI (eg, omeprazole 40
mg once daily), options include splitting the dose (eg, omeprazole 20 mg twice daily),
doubling the PPI dose (eg, omeprazole 40 mg twice daily), or switching to another PPI (eg,
lansoprazole 30 mg once daily)
....
Duodenal perforation treatment?
simple closure with omental patch “Graham omental patch” ✅ ✔
.. . ..
Cardiology
🍓 Patient Post MI with 2:1 AV block IV atropine given but did not work what to
give? pace maker
🌹 Elderly pt with CHF on ACE, spironolactone, furosemide, admitted for some reason I
forgot, upon admission she was on fluids? Labs show she’s
hypotensive with increased urea and creatinine and FENa 0.6 What to do?
A. Increase furosemide. B. Increase spironolactone C. Increase fluids carefully
🌹Patient with motor vehicle accident he have aortic injure and spleen laceration while
you preparing patient for transfer his blood pressure drops what to do
A-Transfer to center they have vascular surgeon
ﺎتSﻪ ﻟﻠﻌﻤﻠ:ﻒ ﻓﻮرا ﻧﻮدCF% % ﻻزم ﻧﻮﻗﻒ اﻟ، ﻣﺴﺘﻘﺮة ﻧﺰل اﻟﻀﻐﻂFGﺾ ﻏCBﻤﻮت ﻻن ﺣﺎﻟﺔ اﻟﻤ: راح، 6& % وﻗﺖ اﻗﻮم اﻧﻘﻠﻪ ل ﻣﺮﻛﺰ ﺛﺎ$& % ﻣﺎ.
B-Transfer to OR✅✅C-To ICU
وﻟﻣﺎ ﯾﺣﺻل ﻓﺷلright ventrical failler ھو اﻧﮫ ﺣﺻلpulmonary hypertenstion ﻣن اﺣد اﻻﺳﺑﺎب اﻟﻲ ﺗﻌﻣل
ﻣﺎ ﯾطﻠﻊ اﻻ ﻓﻘط ﻟﻣﺎ ﯾﻛون ﺣﺻل ﻓﻲventrical ھذا اﻻﻧزﯾم ﯾﺧرج ﻣن، BNP ﻓﻲ اﻟﺑطﯾن اﻻﯾﻣن ﯾرﺗﻔﻊ اﻧزﯾم اﺳﻣﮫ
Echo ﻻزم اﻋﻣل ﻟﮫ اﯾﻛواpulmonary hypertention ﻓﻠﻣﺎ ﻧﺷﺧص ﻣرﯾض اﻧﮫ ﻋﻧده، اﻟﺑطﯾن ﻓﺷل ﻓﻲ وظﺎﺋﻔﮭﺎ
right vent failler . ﺣﺗﻰ اﺳﺗﺑﻌد وﺟود
The most important serum markers for pulmonary hypertension are brain natriuretic
peptide (BNP) and NT-proBNP; strongly elevated values may suggest right ventricular
failure. The most important non-invasive diagnostic tool is echocardiography.
🌹 Which of the following is the most preventable cause of Dyslipidemia and Coronary
heart disease in women? A)Smoking. B)Diet✅. C)Physical inactivity
If no dyslipidemia answer is smoking With dyslipidemia Diet more important Avoid
saturated fat.
🌹Patient with mitral stenosis getting pregnant, what is the physiological change that
Happen in pregnancy affecting or leading to heart failure I can’t remember:?
A. Increased RBC B.Increased stroke volume✅✅
🍬stroke volume is the volume of blood pumped from the left ventricle per beat.🍬
ﯾﺳﺑب ﺿﻌف ﻓﻲ ﻋﺿﻠﺔ اﻟﻘﻠبstroke volum ف ﻣﻊ ﺗﺿﯾق اﻟﺻﻣﺎم و زﯾﺎدة
🌹patient with A fib. For 4 h and vitally unstable (HR= 140, with something else) how to
manage: A- amiodaron. B- electrical cardiversion ✅✅. C- digoxi
🌹 pt with 3month hx of left leg non pitting edema no history of surgery or trauma and
there is thickening skin and dark color ask about next investgo?A- venous duplex✅
ھذه ﺣﺎﻟﺔlymphedema ﻣﺛل ﻣﺎ ﻗﻠت ﺳﺎﺑﻘﺎ اذا ﺷوﻓﺗوا ﻛﻠﻣﺔnon pitting اول ﺷﻲء ﻧﺳﺗﻌﻣل، ﻓﻛروا ﻟﯾﻣف اﯾدﯾﻣﺎ
venous douplex ﻻﺳﺗﺑﻌﺎد وﺟودDVT وﻟﺗﺷﺧﯾصlymphedema ف اﻓﺿل ﺷﻲء ھوLymphgraphy
🌹CHF s/s with dilated both atria . Asking highly diagnostic value :
A. coronary angio B. echo C. cardiac ct
🌹Decrease mortality in HF: Enalapril
🌹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 C. PE D. MI
🌹Anterolateral MI, management? (Aspirin, BB, analgesia, nitroglycerin)
🌹 Supraventricular tachycardia= Carotid massage
🌹Inferior MI, What is next step? right lead
🌹best diagnostic test to detect ischemia :
A. stress Echo ( Approved)✅ B. CK
🌹Female in her fifties develops MI and she was asking about the best way to prevent a
reinfarction:asprine
🌹 coarctation of the Aorta (absence and delay of femoral pulse) confirmatory test:
A. ECho B. X ray C. CT angio
🌹- 57 ys old with atenolol 100 1st visit 160/100 2nd visit 158/95 then 160/99 ?
A. stop atenolol & start hydrochlorothiazide
B. Dec atenolol & start hydrochlorothiazide
C.Dec atenolol & start CCB D.Stop atenolol & start ACE
🌹 splinter hemorrhages below his nails= Infective endocarditis
🌹Post MI pt what to do: A. Open within 6 weeksB. Lap within 6 weeks C. Same within 6
months اﺳﺎﺑﻴﻊ٦ ﺷﻬﻮر واﻻﺧﺮى ﻗﺎﻟﺘﻮ٦{ﻌﺾ اﻟ–ﺘﺐ ﻗﺎﻟﺘﻮ
🌹Eledeely female with inferior MI, JVP raised, what is the cause
A.rt Ventricular infarction B.left V infarctionC. tamponade D. complete heart
🌹 primordial prevention? Risk factors prevention like in cardiac diseases.
• ç ﻣﺜﻞ اﻟﺘﺪﺧ، ﺪاﺋ~ﺔ =ﺣﻤﺎ•ﺔ اﻟﻨﺎس ﻣﻦ اي ر–ﺰك ﻳﺆدي ل اﻣﺮاض اﻟﻘﻠﺐy اﻟﻮﻗﺎ•ﺔ اﻟ¤ﻣﺜﺎل ﻋ
اﻟﺦ.. اﻟﺴﻤﻨﺔ، ñ
🌹Patient K/C of HTN on medication, with prostatic enlargement, no sign of malignancy,
Vitaly stable:A. Alpha blocker B. surgical
🌹Man is concerned about cardiovascular risk, the most important risk factor for
CVD= A-waist circumference 103cm. B. blood glucose 8 C. BMI 31
🍒Elderly pt have DM and HTN on anti hypertensive drugs he developed a productive cough
with greenish sputum and SOB ,What is the Cause induce this type of cough ?
A. hypertension B. medications C. heart problems✅
🍒Treatment of MI in none equipped hospital = : mona + thrombolytic
🍓VSD 2mm: = Observe🍓
🍓 Post MI = best for secondary prevention :“ without history “
A. bv physical exercise B. lower lipid C. smoking cessation.✅✅ء ﻻزم ﻳﻮﻗﻔﻪÔ Õ
o ﻬﻬﻬﻢ¹ﺬا ا¹ .
🌹Most preventable cause of DLP and CAD in female?
A. physical inactivity B. diet. C. poor quality sleep D. smoking✅
🍓Pt admitted as case of cardiac disease, during hospital course, he developed
something related to urinary catheter, what you will do to prevent that:
daily assessment of needs of urine catheter✅
🌹Elderly conscious, alert, oriented, receiving nsaids and codeine on urinary catheter, after
2 days he developed confusion and agitation, the nurse noticed cloudy urine, labs:T: 38.9
RR: 18 HR:99, What’s the most important thing to prevent this condition?
A. avoid codeine in elderly B. assess the daily requirements of urinary cath. ✅
🌹Old man fall down and has hx so they put for him FC due to immobility Given
paracetamol and Codeine for pain Then he develop fever And nurse noticed cloudy urine
Mx? A-Review the need for Foly cath✅
B-Request for member of the family turning the pt continuously
C-Codeine not good for this age group
🍓MI chest pain STEMI and no pci and you will transfer him, what to give prior to transfer :
A. give asprin , thrombolytic , bb , Nitroglyrcrn✅
B. give asprin , nnitroglycerin , bb.
......
🍓Chest pain after new exercise program? reassurance and re evaluate after I week
🍓patient with cannon A waves and raised JVP asking about the mx ?
A. ICD B. Permanent pacemaker ✅ pac –ﻌﺔè= ﻌﺔ „ﺎﻧﻮنuﻂ =„ﺎﻧﻮن =ﻃﺎÏر
🌹second heart block mobliz II = A. – syncope B. - permanent pacemaker✅
• ç رﻗﻢ اﺛﻨII ñ
ñ • ç = ﻣﻊ „ﻠﻤﺘPermaent وpace mark
🌹what is the most common case of death in pt with dialysis = IHD🌹
Prophylax Antibiotic
🌹 Patient going for elective hernia surgery. Known to have bicuspid + aortic valve and
prosthetic heart valve since 4 years. Best antibiotic prophylaxis?
○ Cefuroxime ○Amoxicillin ○ No prophylax is required✅
bicuspid aortic valve = no need to prophlax
🌹 Pt w/t mitral valve prolapse and she will undergo for thyroidectomy ..
A- Give amoxicillin to prevent infective endocarditis B- No need for prophylaxis ✅✅
🌹 62 yrs male idiopathic subvalvular hypertrophic aortic stenosis going for
dental extraction :
-Risk of endocarditis is 50% Ö-Risk of endocarditis is 12%
-Prophylactic AB not needed -After procedure AB is sufficient
ﺤﺘﺎج ل7 56 ا34 اﻟﻤﺮ، ﺐ ﻧﺮﻛﺰ )ﺎﻟﺴﺆوال# ﻃprophlaxsis antibiotic )$ % ﺪال ﺻﻤﺎم اﻟﻘﻠﺐ ب ﺻﻤﺎم (ﺻﻨﺎIY ﻋﻤﻠﻮا اﺳ56ء )ﺎﻻﺳﻨﺎن ﻫﻢ اN
O
6 ﻞ اﺟﺮاء ايIﻗ
، ﺔ#ﺔ ﻋﺎﻟIﺴkﺠﻴﻬﻢ ﺑ7 ﺔ ﺧﻠﻊ )ﺎﻻﺳﻨﺎن اﻧﻪ# اذا ﻋﻤﻠﻮا اي ﻋﻤﻠa6 ﺪﻟﻮا ﺻﻤﺎم اﻟﻘﻠﺐ ب ﺻﻨﺎIY اﺳ56 ﻻن وﺟﺪوا اinfective endocarditis ﻦ ﻫﻨﺎ اﻟﺴﺆوال ﻣﺎpﻟ
4
ﺎﺧﺬ ﻣﻀﺎد7 ﻣﻔﺮوض56„ ﻣﻨﻬﻢ ﻫﺬا اﻟﻤﺮض ا6 ﺪ ﻻﻳﻦ ﻣﺎ7ف ﻋ• ﺣﺴﺐ اﻟﺠﺎ. ﺛﺎل ﻋﻨﺪە ﺿﻴﻖ )ﺎﻟﺼﻤﺎم اﻻور| وﺗﻀﺨﻢ، a 6 ﻗﺎل اﻧﻪ اﻟﺸﺨﺺ ﻋﻨﺪە ﺻﻤﺎم ﺻﻨﺎ
4
‹ا ﺗﻄﻠﻌﻮا ﻋﻠﻴﻬﻢŽﺎﺧﺬ ﻣﻀﺎد ﺣﻴﻮي اذا ﺗﺤ7 ﻻزمa6 ‹ اﻟﺼﻤﺎم اﻟﺼﻨﺎŒﺔ ﻏ#ﻪ اﻣﺮاض ﺛﺎﻧ#ﺐ ﻓ# ﻃ، ﺔ اﻟﺨﻠﻊ#ﻞ ﻋﻤﻠ# ﺣﻴﻮي ﻗ:
🌷idiopathic subvalvular hypertrophic aortic stenosis = no need to antibiotic Prophylactic
before dental Extraction 🌷
🌹Patient with multi drugs use, with hyperkalemia 6.5, what drug to stop:
A. BB B. Aspirin C. ACE
🌹 Best drug to treat Pulmonary ht , without cardiac causes?
A. Furosemide B. Spironolactone C. Bb D. ACEI Answer is : CCB
🌹Decrease mortality in inferior-lateral MI hospital stay ? A. BB B. Warfarin C. Thizaid
...
🌹patient with CHF and DM and HTN not tolerating ACEi what to switch it
with? ARBS
🌹Patient with HV and LV dysfunction giv? A. BB. B. Digoxin. C. ARB
🌹She said the full scenario Is Young fainting with exertion Dilated cardiomyopathy No EF
mentioned New presentation no comorbidities: A. Options. B. CCB. C. BB. D. Diuretics
🌹CHF on acei and many medication for dm now stable and asymptomatic :
A. Add bb ✅ B. Add furudmide C. Add digixon
🍒Dm HTN and renal Failure on CCB, ACEI and thiazide and now hypertensive what to do
A. change thi to fursemid B. increase doses C. add BB ✅
🌹Man in early 30s with HTN, his parents and sister also have HTN, what’s the
best antihypertensive for him? A. BB B. ACEI C. CCB
🌹 Elderly women in her 70s with DM & HTN, normal renal profile, which antihypertensive
should be started? A. thiazide B. ACEI C. BB D. CCB
🌹Male came for presport screening asymptomatic Found to have LV enlarged , EF 40 , ECG
normal : A. Frusemide B. Follow up after 6 months C- ACEi
🌹Patient after MI treated with thrombolysis and discharged. Came back with tongue and
facial swelling, what drug causes this? A. Statin B. Atenolol C. ACEI
....
#Patient with HV and LV dysfunction give: A. BB B. Digoxin. C. ARB
# If HF + Afib and how to control rate? Digoxin
🌹 Pt with Afib and chf what's the appropriate drug to add?
A. digoxin. B. Adenosine. C. Lidocaine
#If EF < 40= ACE
…..
● 🌹Patient on ACE develop cough? Switch to losartan
….
induced angioedema: ACEI
….
🌹How to reduce protein in urine in nephrotic patients? ACEI
🍓 drugs used in a heart failure pt = Start by ACEI as the first line 🍓
🍓 pt known to have DM and HTN with proteinurea what is the most appropriate:
A. decrease protein in take B. give him ACEI✅
🌹Pre employment screening, pt has cardiomegaly on CXR, echo > left ventricle
enlargement and EF40%. What is the management ? ACEI as he has systolic HF
🍒Young man in pre employee clinic, medically free, echo done and showed EF = 40% but
no signs or symptoms of heart failure, what to do:
A. Give BB. B. Give ACE inhibitor✅ C. Repeat echo after 6 months
. .. . . .. .
🌹77 yo male known diabetic with history of MI now has HTN 170/110 what will u give
a. ACEI b. BB c. CCB d. Thiazides
...
🌹 Patient with diabetes and HTN and CHF was prescribed warfarin for presumed DVT now
has edema and investigations given. K=6.5 aptt high pt normal. He’s on ACEI , insulin and
furosemide .which med will u stop ? a. warfarin b. ACEI c. Diuretic d. Insulin
🌹77 yo male known diabetic with history of MI now has HTN 170/110 what
will u give? A. ACEI B. BB C. CCB D. Thiazides
🌹Pt has Heart failler and co morbidties and on multiple drugs.. he now stable only K+ = 6 ..
which drug you should stop now : A.BB B. ACEi ✅ C.Digoxin D. Heparin
🌹 Drugs decrease mortality in HF A. ACEI. B. Digoxin
🌹patient take ACEI, CCBs, thiazide , develop LL edma mainly , other Normal but in
investigation all RFT test deteriorated, what you will do
A- Stop ACEI B- Change thazide to frismide C- No change
ACEI not contraindicated in CKD
But suddenly elevated BUN and Creatinine > stop ACEI ,Because we don’t know about the
cause could be bilateral renal artery stenosis
......
🌹Patient with diabetes and HTN and CHF was prescribed warfarin fornpresumed DVT now
has edema and investigations given. K=6.5 aptt high pt normal. He’s on ACEI , insulin and
furosemide .which med will u stop ? A. warfarin B. ACEI C. Diuretic D. Insulin
„ﻠﻴﺘﻪ¤ •ﺤﺎﻓﻆ ﻋýÓ ﺣ. acei –ﺾ ﺳﻜﺮ وﺿﻐﻂ ﻧﻌﻄ~ﻪ ﻋﻼج اﻟﻀﻐﻂÀﻣ
🌹50 years male take antihypertensive : (ARBs, CCBs) , RFTs= Normal Which drug could be
taken in this case without C/I : A_ACEI B- Atenolol C_Thiazadin
.....
🌹two qs about prevention of re infarction : A- Anti platelet B- Surgery
🌹Female in her fifties develops MI and she was asking about the best way to prevent a
reinfarction: A-Use of aspirin for short duration B-Use of Calcium channel blocker
indefinitely C-Use of ACEI if she develops heart failure to prevent cardiac changes
...
….
🌹Patient k/c of heart failure, presented to ER with image of acute CHF (SOB,
orthopnea, PND, abdominal swelling, hepatomgaly and LL edema) Echo was done, showed
EF 40, what’s your management: A. Start spironolactone
B. Start Furosemide ✅✅ اﻟﺮﺋﺔŒŽ • ﻣﺘﺠﻤﻌﺔÐŽ ﻣﺪرات ﻋﺸﺎن اﻟﺴﻮاﺋﻞ اC. ACEI D. Nifedipine
.....
🌹HF pt on ( ACEI , bb , furosemid ) what to add ?
A. spironolactone✅ B. isosorbide dinitrate
🌹patient presented with sweating; dyspnea, palpitations and headache. She is
a known case of HTN and despite taking meds it’s not controlled. Imaging reveals
suprarenal mass. Which of the following meds will you give to control her HTN?
A. CCB B. alpha block C. BB D. ACEI
....
🌹Postural hypotension that caused by Beta block , what does prevent this side effect ?
A. Avoid airplane for for 2 w ✅ B.Avoid airplane for 4 w ñ • ç ﻠﻮك =„ﻠﻤﺘu =ﺑ|ﺘﺎñ
• ç ﻂ =اﺳﺒﻮﻋÏ ر.
🌹Female hypertensive and diabetic, on Acei, insulin, Metformin, she decided to get
pregnant soon. Labs: heavy proteinuria, Hga1c: 8 What’s your most appropriate advice for
her regarding diabetic control and fetal congenital malformations?
A.stop snacks and start 3 heavy meals a day.
B.switch ACEI to ARB’s
C.try to control her hga1c to normal or near normal as possible before pregnancy. ✅
🌹Patient on parenteral feeding developed weakness and convulsions what cause these
symptoms : A. hypokalemia B. hypomagnesemia
….
🌹Patient on (Total parenteral nutrition) devoloped weakness in the lower limps and
tremors what is the problem? A-Hyperkalima B-Hypomagnisemia✅ C-Hypoglycemia
((Possible complications associated with TPN include: Dehydration and electrolyte
Imbalances. Thrombosis (blood clots)
Mg ﻓﻤﻦﻓﻣن ﻣﺿﺎﻋﻔﺎت اﻟﻐذاء ھذا اﻧﮫ ﯾﺣﺻل ﺧﻠل ﻓﻲ اﻻﻛﻠﺗروﻻﯾت اي ﻧوع ﻣن اﻻﻟﻛﺗروﻻﯾت ھذا؟
mg ﻧﻔﻛر ﺑﺎلtremor ﻓﻠﻣﺎ ﯾﺳﯾر ﺿﻌف وmg , ﺑﺳﺑب اﻧﺧﻔﺎضconvultion ﻻن ﻣﺛل ﻣﺎ ﻗﻠﻧﺎ واﺣد ﺳﺎر ﻟﮫ
......
🌹pt in 20s c/o sharp pain centrally after activity for 3 weeks .. what next:
A- Reassure and follow up 1 week B- Nitrate C- Ibuprofen✅✅
ﻧﺎÒÓ( ﻟ~ﻪ ﻣﺎ اﺧA) , ﻻن •ﻘﻮﻟﻚ ﻋﻨﺪەsharp pain »ء ¼
Ž ﺛﺎﻧ~ﺎ ﻟ~ﻪ ﻣﺎﻗﻠﻨﺎ اﻧﻪ،! ﺪون ﻣﺴﻜﻦu اﻟﻢ ﺷﺪ•ﺪ ﻣﺎ ﻳﻨﻔﻊ اﻃﻠﻌﻪ
angina ﻣﺎﻋﻄﻴﻨﺎەýŽ • ﺎﻟﻘﻠﺐ •ﻌu nitrate ﺤﺔu اﻟﻢ اﻟﻘﻠﺐ او اﻟﺬ، اﺳﺎﺑﻴﻊ ﻣﺘﻮاﺻﻠﻪ٣ ﺛﺎﻧ~ﺎ •ﻘﻮﻟﻚ، Òçﻻن اوﻻ ﻋﻤﺮە ﺻﻐ
angina ﻌﺪ اﻟﺮاﺣﺔu دﻗﺎﻳﻖ و–ﺮوح اﻻﻟﻢ٥ ، ﺎﻟﻤﺪة ﻫﺬەu ﻣﺎ´ﺴﺘﻤﺮ.
🌹 pt in 20s c/o sharp pain centrally after activity for 3 weeks = Ibuprofen🌹
........
75 y/o male k/c of HTN, DM, Hx of TIA presented with palpitation. ECG demonstrated 75
bpm, irregular. What is the best next step? give anticoagulation (( susbect Atriall
fibbralantion ))
.............
female came complaining from sudden episodes of palpitations each 10-15 min that are
unrelated to any activity. You did ECG which was unremarkable. What is your next step?
A. Echo B. Stress ECG C. Holter monitoring ✅✅
•
ﺎت اﻟﻘﻠﺐ ﻣﺜﻞÏ@ ﻫﺬا ﺟﻬﺎز •ﻌﻤﻞ ﻗ~ﺎس ل ﻋﺪم اﻧﺘﻈﺎمECG ﺳﺎﻋﺔ24 ﻦ •ﻜﻮن ﺷﻐﺎل و–ﻘ¨ﺲ ﻟﻤﺪةÄﻂ ﻟyﺎﻟﻀu
ñ• ç ﺳﺎﻋﺔ ﻣﺘﻮاﺻﻠ٤٨ ﻌﻀﻬﺎÏ و.
🍒 complaining from sudden episodes of palpitations each 10-15 min that are unrelated to
any activity ==Holter monitoring🍒🍒
.....
patient with heart failure. Which of the following medication improve mortality?
A. ACEI (enalapril)* ✅✅ B. Digoxin C. Diuretic
..........
patient with chest pain for 2 hours. ECG showed ST elevation in V2-V4. Patient started on
Aspirin, Nitroglycerin, and O2. What is the definitive management?
A. Thrombolysis B. Angioplasty ✅✅
(PCI), also known as coronary angioplasty
🍒🍒chest pain for 2 hours. ECG showed ST elevation in V2-V4=PCI (angioplasty )
.... ......
patient with raised JVP, Hypotension, unclear heart sound, clear lung sounds. How to
confirm the Dx?
A. Echo ✅✅ B. CXR C. ECG
🍒raised JVP, Hypotension, unclear heart sound == coniform diagnosis = Echo🍒
🍒🍒epigastric pain and pulsatile abdominal mass = to confirm the diagnosis= CT with
contrast*🍒🍒
......
🍒🍒 pulsatile abdominal mass. What investigation you would order = Amylase🍒
…
🍒3rd block : ECG asking about management == pacemaker 🍒
…
🌹ECG show atrial Fib + lower limp edema and pain = LMWH
وﻫﻨﺎ ﺣﺼﻞ، –|ﻴﻊè ﺎر–ﻦ ﻣﻔﻌﻮﻟﻪy–ﻦ ؟؟ ﻻن اﻟﻬﻴÀﻧﺎ وارﻓÒÓ ﻟ~ﻪ ﻣﺎ اﺧDVT وﻧﺨﺎف ﻓﻮرا ﺗﺘﺤﺮك اﻟﺠﻠﻄﺔ وﺗﺮوح ﻟﻠﺮﺋﺔ ف
•ﺠ~ﺐ اﻟﻤﻔﻌﻮلýÓ ﺧﻤﺲ ا•ﺎم ﺣÐﻌﺔ اÏ–ﻦ •ﺤﺘﺎج ارÀاﻟﻮارﻓ. – ـ ـﻊè ﺎر–ﻦ ﻣﻔﻌﻮﻟﻪyﻫﻴ
…..
🌹ECG with Cannon a waves = pacemarker permenant 🌹
…
🌹Pt Elderly with hypertenstion + on routin cheak up and on cardiac exsam we found
there is (sever aortic stenosis ) and ( left ventrical failler ) with normal EF = PT
Asymptomatic = Aortic valve replacment
(Another Wronf choice = ACEI , beta block ; follow up 6 month = ﻠﻬﺎ ﺧﻄﺎااá ) .. 🌹
. . . ..
🌹Most important factor to do surgery in aortic stenosis? A.Pt symptoms ✅ B.Lt ventricle
hypertrophy
.............
🌹Aortic stenosis with left ventrical hypertrophy came 2 times once with medication name
and one time with out ?
A. control hypertension B. vasodilators C. valve plasty if symptomatic or low EF > AVR
....
🌹AS with LVH asymptomatic EF40 = A. Follow up in 6 months m B. AV Replacement
🌹Patient with typical chest pain ecg shows St depressed and troponin high dx ? Non
STeMi
....
🌹Pt diagnosed with wolff parkinson syndrome and he is on BB but still
uncontrols what to do : A. increase the dose of BB B. add CCB
....
🌹Middle age male presented to ER with retrosternal chest pain. ECG shows inferior wall
MI. He was put on morphine and sublingual glycerin infusion until finish prep. To move him
to cath lab. However pt became worse and deteriorated. What is the cause of pt
deterioration?
A. Rt ventricular ischemia B. Rupture of papillary muscles C. Cardiac tamponade
.....
🌹Picture of ECG: ( sinus node dysfunction) and long scenario , asking what you will need
for management later in complication or prognosis: pacemaker
…
🌹Old pt on captopril , ecg shows tall T wave .best next step? check k level
..
🌹Patient presents with vague symptoms ECG was done and it shows third degree heart
block What is the DEFINITIVE management for this patient?
A. Permanent pacemaker B. Implantable cardioverter defibrillator C. Oral theophylline
....
🌹Male patient loss his vision on left eye for 20 minutes then return to vision . In
history it was DM . What the Dx ?
A. Multiple Sclerosis.B. Retinal detachment C. Conversion disorder D. Transient ischemic
attack
...
🌹66 years old patient come with progressive difficulty breath . In history he is.being
treated for bronchogenic carcinoma . In P/E : JVP elevated , lung clear and heart sound
very quiet. What’s the confirmatory investigations ?
A. CXR B. Echo C. ECG DABG
...
🌹50 years old come with sudden severe retrosternal pain radiating to back. Within the
minutes he come unconscious . He is a smoker and history of HTN . What’s Dx ?
A. vasovagal attack B. PE C. tear of aortic intima D. acute myocardial infarction
الaortic dissection ﻫﻮ اﻧﻪ •ﺤﺼﻞtear ﻘﺔy ﻃŒŽ • intima ، اﻟﻌﻤﺮÒ£ﺐ ارﺗﻔﺎع اﻟﻀﻐﻂ وﻣﻊ ﻛÞﺴ7 •ﺤﺼﻞ،
و–ﻤﺘﺪ ﻟﻠﻈﻬﺮ ﻣﻦ وراà£ﻂ ﻧﺜﻞ اﻟﺴ|ﻨﺎر–ﻮا اﻟﻢ ﺷﺪﻳ|~ﺪ وﻣﻔﺎyﺎﻟﻀu –ﺾÀ•ﺠﺴﻚ اﻟﻤ
...
🌹drugs that increase survival in CHF=ACE
...
🌹Young pt c/o syncope attack during macturation and cough Examination and ECG normal
?? A. Holter monitor
B. Reassure and education
....
🌹Accurate test for LT ventricular dysfunction??
A. CRP B. CKMP C. Trop l D. BNP
....
● Elderly with hypertension on furosemide and ACEI, complains of substernal chest pain.
ECG confirms heart failure and left ventricular dysfunction. On examination his chest is
clear and no lower limb edema. His blood pressure is well controlled and heart rate is
normal on the lower side. the mostappropriate management?
A. add digoxin B. Add bisoprolol C. No need to add any medications D. Add ARBs
....
🌹Patient with dyslipidemia was prescribed a medication, after 10 days presented
complaining of face flushing and redness. Which medications he was prescribed?
A. niacin B. Cholestyramine C. Statin
D. Fibrate
ﻧﺎ´ﺲ =وﺟﻬﻬﺎ اﺣﻤﺮ
...
🌹 Pt have lead 2,3 avf and avl st elevation ask about next to order ? A_ R side lead ecg to
rule out posterior MI
.....
🌹Clear hx of acute pericarditis and with ecg tx? ibuprofen
….
🌹Pt with paroxysms of palpitations and other symptoms, ecg normal in the clinic, the next
step :
A. Holter B. stress ecg
....
102-Patient with pervious viral infection then pleuritic chest pain ecg shows diffuse ST
elevation and PR depression what to expect on chest exam? Pericardial rub ✅ ﻻن ﻫﺬە ﺣﺎﻟﺔ
pericarditis
…
ECG with tall T wave and potassium level 6.5 immediate action?
A-calcium gloconate✅ B- insulin C-dialysis D-sodium bicarbonate ((Hyperkalemia ===
treat by : ca )) „ﺎﻟﺴﻴﻮم
ﺑﻮﺗﺎﺳﻴﻮم =ﺑﻮﺗﺎﺳﻴﻮم و„ﺎﻟﺴﻴﻮم اﺻﺪﻗﺎء
…..
Elderly 60 female, palpitations, ECG normal. What to do? A- Stress ecg✅ B- Echo
...... ...... ....
Pt Pt has pleuritic chest pain on 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
N.B: Pluritc friction rub indicate pleurisity or pluritis Commonly in pneumonia , " pleuritic
friction rub" not cardiac.
…
ECG with tall T wave and potassium level 6.5 immediate action?
A-calcium gloconate✅ B- insulin C-dialysis D-sodium bicarbonate
#hyperkalemia ECG give = Ca gluconate.#
........
ECG shows inferior MI( Lead II + III + AVF ))
…
🍓Pt with chest pain , murmur, splinter hemorrhage “ Infective endocarditis??” what’s the
TTT:
A. ceftriaxone B. gentamicin C. ceftriaxone + vancomycin✅
.......
🌹 Something month old baby presented with fever, dyspnea, chest retraction O/E: there is
bilateral crepitations Apart from his post natal examination he found to have Pansystolic
murmur Xray: Cardiomegaly, bilateral lung infiltration What is the best next step ?
A. Surgical referral B. Diarutics ✅✅ C. Antibiotics then re-evaluation
.........
🍓 TB with chest pain for 2month. he has distended JVP, increases with inspiration. No
murmur
A. Constructive pericarditis✅ B. Cardiac tamponade
.....
🍒Best drug decrease mortality in HF = A. Digoxin B. Enalapril✅✅ C. Hydolizen
…
🍒Young male presented with fever had history of rheumatic heart disease, before this
admission he had a history of teeth extraction. On examination: murmur and splenomegaly
What is the Dx ?
A. Recurrent rheumatic fever B. Infective endocarditis ✅✅
….
🌹diffuse ST Elevation ,will find in exam: (pericarditis case)= A- murmur B- pericardial
rub C- canon a wave D- 4th heart sound
….
....
🌹 45 ys old lady last visit from 6 month was normal now C/o dyspnea 'LL oedema ascites
no murmur no fever distended jugular v with picture n curve ? A. pulmonary hypertension
B. tricuspid regurg C. restrictive pericarditis
Pulmonary HTN > core-pulmonale > signs of right-sided heart failure
🌹 Pt with signs and symptoms of dyspnea and pulmonary congestion, mentioned
the pulmonary artery pressure 35 mmhg, most likely cause:
A. constrictive pericarditis. B. pulmonary HTN (normal 8-20)
….
acute congestive heart failure management 1-oxygen 2-furosemide 3-ACEI 4-BB
....
🌹 Elderly with ejection systolic murmur, asymptomatic. His pressure gradient is 40 mmhg.
What’s the appropriate management?
A. balloon valvuloplasty B. Valve replacement
C. Evaluate by echo or exercise test (follow-up) {ﺎﻟﻌﻤﺮ ﻣﺎراح ﻳﺘﺤﻤﻞ اﻟﺠﺮاﺧﺎت²§ﻻن ﺧﻼص ﻛﺒ
ة²§اﻟ–ﺒ
....
🌹Elderly with ejection systolic murmur and asymptomatic. indicated surgical intervention?
A. patient’s symptoms B. Low pulse pressure C. Increase intensity of the murmur
...
🌹 Pt 16 years old male with faint/LOC after exercise, and ejection systolic murmur, echo
shows mildly dilated LV walls, most likely the cause of his symptoms/ or DX: A. AS B.
Hypertrophic/dilated cardiomyopathy
....
Just like the above case what is the right action to treat this murmur?
A-cathlap B-refer to cardiology C-valvotomy D-treat the the cause then reexaminations
✅✅
🌹Pt k/c of DM and HTN use ACEI and BB , CCB , Statin , then develop dry cough
for 3 month what drug stop = ACEI
...
🌹Atriall fibrillation which drug for sinus rhythm= Amedaron 🌷
…
2 weeks newborn with history of SOB and sweating in forehead what cardiac anomaly he
has?
a- PDA. b- VSD✅✅. c- TGA. d- ASD
Symptoms of PDA and VSD are similar, could be distinguished by physical examination but
the most common type of heart defect is ventricular septal defect (VSD) in USA.
🌹2 weeks newborn with history of SOB and sweating in forehead what cardiac anomaly he
has = VSD 🌷٠
..... ..... .....
A known hypertensive on different medications.He was recently diagnosed of Asthma.He
came in the Clinic for review of his drugs.Which of the following medication will likely be
stopped?
A.CCB. B.B blocker✅✅. C.Aspirin. D.Diuretics
🌹hypertensive recently diagnosed of Asthma = what medicantion will stopped = B
blocker🌷
* Beta blcoker Do bronchoconstriction*
.... .... ...
🌹pt has excacerbated by exercise what to give to maintain = inhalation steroid twise
with short acting when needed 🌹
…
Patient with old MI and HTN and asthma came due to acute onset since two
days, which made him stop his medications, his wife noticed he was feverish
and somnolent, physical exam showed diminished JVP, no basal crackles, No
abnormal heart sounds, ECG showed sinus tachycardia with a waves
indicating old MI ( as per the question) what is the most appropriate thing to do
next? A. 1- IV normal saline bolus B. 2- Atropine C. 3- dobutamine D. 4- IV beta blockers
…..
🌷 Wood worker ﻋﺎﻣل ﺧﺷبhas symptoms of asthma? serial test at work and home🌷
…
🍒Diagnosis of occupational asthma?
A-Skin prick test B-Specific lgE C-Peak flow rate at home and work ✅
..
🌹 Patients who take steroids at 12:00 - 3:00 - 6:00 complain that she cant
take it on this time for -some reason related to sleep- what is the management:
A. take at the same time, regardless of her sleep
B. take it after waking, 3 and 6 hours after that✅
🌹 Female taking steroids wants to change the medication so not to counteract with her
work: A. take same time B. no need to take it C. take it at wake up time, 3 hr then 6 hrs
ﻒ ﻧﻔﺲw&ﺺ ﺻ%ﺎﻟﺮﺋﺔ وﺳ‚ﺐ ﻟﻠﻤB ﻄﻠﻊ |ﻞ اﻟﺪم ﻓ}^ا~ﻢ2 ﻒ وﻣﺎﻗﺪرw ﻓﺴﺎر اﻟﻘﻠﺐ ﺿﻌ، ﻤﻦ2; اﻟﻘﻠﺐ اﻻ: < &ﺾ ﺣﺼﻞ ﻟﻪ ﻓﺸﻞ%ﻠﻤﺔ ﻣﻌﻨﺎﻫﺎ ﻣlﻫﺬە اﻟ
ﻪ ﻓﺮﺟﻊ ﻟﻠﺠﺴﻢwﻒ وﺗﺮا~ﻢ اﻟﺪم ﻓwﻤﻦ ﺳﺎر ﺿﻌ2 وﻻن اﻟﻘﻠﺐ اﻻ، •ﺪﻟﺖ ب |ﻠﻬﺎ ﺳﻮاﺋﻞŒﺎﻧﺔ ﻫﻮاء ﻟ‹ﻦ اﺳwﻠﻮا اﻟﺮﺋﺔ ﻣﻔﺮوض ﺗﻜﻮن ﻣﻠwﺪ ﻻن ﺗﺨ2ﺷﺪ
واﺻﺒﺢ اﻟﺠﺴﻢ |ﻠﻪ ﻣﻨﻔﺦ رﺟﻠﻪ |ﻠﻬﺎedema ﻄﻨﻪB وascitis وliver وspleen ﻪ ﺗﻀﺨﻢw ﺳﺎر ﻓ.
Cor-pulmonale= abnormal enlargement of the right side of the heart as a result of disease of the lungs or the
pulmonary blood vessels.
….
# Ckd with hyperkalemia of 6.6
A. – hemodialysis B. - Iv phosphate C. – insulin D- Iv Ca gluconate
….
🌹Elderly patient presented with SOB, placed on 100% O2 but still not improving, failed NS
challenge, vitally hypotensive and no fever, CXR showing bilateral lung infiltrates, what is
the cause of her SOB?
A. PE
B. Cardiogenic cause of lung edema ﺲ راح ﺗﺠﻤﻊ ﺳﻮاﺋﻞ و ﻋﻨﻈﻪ اﻧﺨﻔﺎض {ﺎﻟﻀﻐﻂéﻻن ﻗﺎل ﻓ}ﻪ {ﺎﻻ
C. Pulmonary pneumoniaﻣﺎﻋﻨﺪە ﺣﺮارة
D. Volume overload ﺎﻟﻀﻐﻂu ﺎ ﻣﺎ•ﻌﻤﻞ اﻧﺨﻔﺎضyﻏﺎﻟ
....
Murmur
🌹Pt on pre sport screening had wide fixed splitting of S2 and was diagnosed with ASD.
What to do = Reassure and discharge
( Not surgical intervention = Bez he is stable not complain of cyanosis, SOB ..etc )🌹
…
-Mid systolic ejection murmur , diagnosis? Pulmonary stenosis + Aortic stenosis.
….
🍒 23 year old female patient, history of ASD when she was 3 Years, now he has
decrescendo diastolic murmur, 2/6, on the left sternum, what is your diagnosis? A. Mitral
stenosis B. Aortic regurge C. Tricuspid regurg
.....
🌹case of cardio have ejection systolic murmur what the diagnosis? A- MR B- AR C-
Tricuspid stenosis D- pulmonary stenosis
....
60 y//o male with valvular disease, radiate to carotid? Aortic stenosis ✅
ﺸﻮﻓﻮنâ ﺪاu داﺋﻤﺎ وا: murmur radiate to carotid
ﻃﻮل اﺧﺘﺎروا¤ ﻋaortic stenosis .
¼ ¼
–ﺎنè( ﻄﻬﺎÏÀ ﻃ~ﺐ ﻧaorta –ﺎنè –ﺎن ﺿﺨﻢ •ﻐﺬي „ﻞ اﻟﺠﺴﻢ وﻛﺬﻟﻚè carotid ñ ¼ • ç ﺿﺨﻢ •ﻐﺬي „ﻞ اﻟﻤﺦ ﻓﺎﻻﺛﻨ
ŒŽ • ﺣﺼﻞ ﺿﻴﻖ، ﺎرy ﻛñ
• ç –~ﺎﻧﻴè¼ aorta Œ• ﻟﺬﻟﻚ راح ´ﺴﻤﻊcarotid ﺎرy اﺳﺎﺳ~ﺔ وﻛñ
Ž
• ç اﻳè¼ ñ
• ç ) ﻻن ﻫﻤﺎ اﻻﺛﻨ
...... .. . . .
Child with Continuous murmur, both systolic and diastolic? PDA ✅ ✔
PDA = Patent duct arterios
ƒ
ﻟﻤﺎ •ﻘﻮﻟﻚContinuous murmur اﻻmo ﻣﺎPDA , ﺸﻮﻓﻮنò اول ﻣﺎ، ﻣﺴﺘﻮاﻧﺎ-ﺲ ﺧﻠﻴﻨﺎ ﻋñ ﻓ}ﻪ اﺷ}ﺎء ﺛﺎﻧ}ﺔ
ƒ
Continuous murmur ﻃﻮل اﺧﺘﺎروا-ﺴﺘﻮل ود“ﺎﺳﺘﻮل ﻋã اﻟﺴmo ﻣﺎرﻣﺮ ﻣﺴﺘﻤﺮîo ƒ “ﻌPDA .
( = ر`ﻂPDA ) = = {ﺪءcontiunous = ﻣﺴﺘﻤﺮ
Õ Õ
`ﺎتöﺴ÷ﺴﻠﻤﻮا ﻟﻠﺼﻌò ﺴﺘﻤﺮوا )ﻓ}ﻪ وﻻò( ء ﻧﺎﺟﺢ ﻻزمÔ o ﻜﻮنwﺪﺋﻮن )ﻓ}ﻪ وxء (ﺗÔ o 👌 اي
........
🌹Patient 40 yo, complaining of sudden loss of consciousness at rest and activity in the
gym. P/E shows left para sternal ejection systolic murmur that increase on standing and
bearing forward with no radiation. ECG shows st and t wave changes. What is the dx? A.
Hypertrophic cardiomyopathy B. aortic stenosis
ﻟﻤﺎ •ﻘﻮﻟﻚmurmur ﻳ—–ﺪ ﻣﻊ اﻟﻮﻗﻮفstanding = ﻧﺨﺘﺎرhypertrophic cardio ﻻن ﻣﻊ اﻟﻮﻗﻮف •ﻘﻞ ةvenus
return •ﻘﻞÐŽﺎﻟﺘﺎÏ وleft ventricull fillin ﺎﻟﺪم ﻳ—–ﺪ اﻟﺤﻤﻞ ﻋﻠ~ﻪ وﺻﻮتu †´ اﻻñ • ç ﻄy وﻟﻤﺎ •ﻘﻞ اﻣﺘﻼء اﻟmurmur
ﺎلu دم „ﺎﻓ~ﺔŒŽ • راح •ﻜﻮن ﺟﺪا واﺿﺢ ﻻن ﻣﺎventrical •ﺤﺎول ﻳﺰود „ﻤ~ﺔ اﻟﺪمýÓﺾ ﺣyﺬل ﻣﺠﻬﻮد و–—–ﺪ اﻟﻨyﻓﺮاح ﻳ
ﻟﺬﻟﻚ ﺻﻮت اﻟﻤﺎرﻣﺮ ﻫ~ﻜﻮن واﺿﺢ.
....
🌹 ECG shows (LVH) what clinical findings you can see ?
A. murmur B. a wave C. fourth heart sound D. friction rub
ﻂÏ =رLVH = 4= = ﺛﻼث ﺣﺮوفFORTH
....
Normal asymptomatic pt came for check up .. stage 2 mid diastolic murmur:
A- Echo B- Antistrept O titer C- Other choices were investigation also
• ¼
ﺻﻤﺎم اﻟﻘﻠﺐŒŽ ﺸﻮﻓﻮا ﻣﺸ•ﻠﺔâ اي ﻣﺮةvalve »ء ﻫﻮ ا•ﻜﻮوووا Ž اﺧﺘﺎروا اول اولECHO .
🌹pt with stage 2 mid diastolic murmur for check up = Echo🌹
. . . .. . . . . .
🍒male presented with macro-orchidism, long face, wide ears, joint laxity, mid diastolic
murmur best heard at apex area. What is the Dx? Fragile X syndrome 🍒
.......
🍒Aourtic stenosis = systolic murmur radiated to carotid🍒
…
🌹HCOM: murmur increases with standing or valsalva + causes syncope, most common
cause of sudden death in young athletic
…
🌹 Mitral regurgitation (Pansystolic murmur) + splinter hemorrhage, the most likely
organism: strept viridins
ﻂÏ = رviri = ﻓ~ﺪﻳﻮاvidio ﺸﻮف ﻓﻴﻬﺎD mitral = ¸ ودمÓ ﻣ~ﺖ ﻣﻮhemohhrage
............
🍓Murmur increase with finger grasp =
Mitral regurge + Aortic regurge ✅
ƒ
ﺪ ﺻﻮتwÙ اي او`ﺠ}ﻜﺖ او اﻻﺻﺒﻊ اﻟﻤﻬﻢ ﺿﻤﺔ اﻟ}ﺪ {ﻘﻮة ﻳ-ﺾ “ﺪي {ﻘﻮة ﻋx ﻟﻤﺎ اﻗîo ƒ “ﻌmurmur اﻟﻘﻠﺐmo
وﺟﻮد =ﻣﻊ-ﺬا ﻋﻼﻣﺔ ﻋ¹ وregurge ﺳﻮاءmitral or aortic
Grasp = regurge . = increase .
...............
🍓Murmur decreased with finger grasp :
Aortic stenosis. + HOCM AND MVP.
ﺾ •ﺪي ﺻﻮت الy ﻫﻨﺎ اﻟﻌﻜﺲ ﻟﻤﺎ اﻗmurum •ﻘﻞ وﻋﻜﺲregure ﻫﻮstenosis .
ƒ
اﻟﺼﻤﺎمmo ) ﻘﻮة ﺻﻮت اﻟﻤﺮﻣﺮ (“ﻘﻞ )ﻣﻊ وﺟﻮد (ﺿﻴﻖu ﺾ •ﺪيy ﻟﻤﺎ اﻗýŽ • اﻟﻌﻼﻗﺔ ﻋﻜﺴ~ﺔ •ﻌ.
.........
🍓pt with mid diastolic rumbling murmur , what’s the cause: A. mitral stenosis✅ B. aortic
stenosis C. tricuspid stenosis
اذا ﺷﻮﻓﺘﻮاdiastolic ﻣﻌﻨﺎﻫﺎstenosis واذا ﺷﻮﻓﺘﻮاsystolic ﻣﻌﻨﺎﻫﺎregurge . ŒŽ • ﺣﺴﺐ اﻟﻤ•ﺎن ﻟﻮ ﻗﺎل¤ﺛﻢ ﻋ
apex ﻣﻌﻨﺎﻫﺎmitral ﻟﻮ ﻗﺎلrigh scond intercostal ﻣﻌﻨﺎﻫﺎaorta .
....
🍓pt with murmur radiating to the carotid artery, what’s the cause:
A. mitral stenosis B. aortic stenosis✅✅ C. tricuspid stenosis
اذا ﺷﻮﻓﺘﻮا „ﻠﻤﺔcarotid „ﻠﻤﺔÒç ﻏŒŽ • ﻻ ﺗﻔﻜﺮواaorta ﻌﺾu ﺎر ﻣﻊy ﻛñ
• ç –ﺎﻧè¼ .
......
🍓Case of murmur increase with supine postion? Innoncent murmur.
…
🍒elderly 2 murmur diastolic rumble murmur and diastolic decrescendo murmur what's
most likely dx?
aortic regurge✅
Decrescendo diastolic -> AR mid diastolic -> MS
.....
🍒2 day (Im not sure about day may be earlier) Post Mi complication with systolic murmur
that radiates to the axillary:
A. Papillary rupture ✅ B. Myocarditis
…
🌹20s age with Hx of TOF repair 12 years ago, presented with diastolic decrescendo
murmur best heard in left parasternal area and increased with inspiration? A-Tricuspid
regurgitation. B-pulmonary regurgitation✅ C-Mitral stenosis
…
🌹+Post MI come with harsh systolic murmur what's dx= Papillary rupture
🌻rupture= harsh
....
🌹Child noticed having cyanosis with feeding+ Holosystolic murmur was noted:
TOF ( Not VSD ).
= ر`ﻂtof ﻮﻟﻮا¹= ﺎت¹ﺸﻮò ﻠﻪ ﻓ}ﻪá “ﻜﻮن اﻟﻘﻠﺐholo = ﻠﻪá .
.....
-Mid diastolic murmur heard on the right sternal border,which valve diseased? Aortic
valve regurgitation (diastolic murmur )
....
🌹 Pt with femoral pistol shots , what is DX:= Aortic Regurgitation
û–ﺎن اﻻورè¼= ﻂÏ ﻓ~ﻤﻮرال ارﺗﺮي ر¤ﺴﻤﻌﻪ ﻟﻤﺎ ﻧﻀﻊ اﻟﺴﻤﺎﻋﺔ ﻋD ﺻﻮتýŽ • ﺴﺘﺎل •ﻌEc „ﻠﻤﺔ ﺑshot اﻟﺪم ﻟﻠﺠﺴﻢ
...
Diastolic murmur with pistol shot sound in the femoral artery?
A-aortic stenosis B-Mitral stenosis C-aortic regerg ✅✅ D-mitral regerg
• ç ﻓﺎﻻﺛﻨÒçﺎﻟﺮﺟﻞ ﻣﺮة ﻣﺮة ﻛﺒu Ð =واﻟ¼†–ﺎن اûاﻻور
• ç ﻄy ﻣﺮﺗñ
ﺎﻟﻤﻨﻄﻖ اﻟﺪم ﻟﻤﺎ ﻳﺮوحu ﺛﺎﻧ~ﺎ د•ﺎﺳﺘﻮﻟ~ﻚ، ﻌﺾy ﺑñ Ž
ح ؟ ﻣﻦ اﺳﻤﻬﺎc ﻣﻔﺘû ﻣﺶ ﻻزم •ﻜﻮن اﻻورû ﻟﻼور.
.....
Name of murmur that occurs when is severely sick and previously normal CVS exam: A-
Innocent murmur ✅
…
heard , the child CVS and chest exams were previously normal (prior visits) what is the
management of murmur?
A-Urgent echo B-Reexamine after these symptoms subsides ✅ C-Refer to cardio
pediatrician
ﺴﻤﻊ ﺻﻮت ﻣﺎرﻣﺎر ﻣﻦ اﻟﻘﻠﺐï ú
o } ﻟﻤﺎ اﻟﻄﻔﻞ “ﻜﻮن ﻋﻨﺪە ﺣﺮارة ﻃﺒ:
Normal” is another word to describe these murmurs. A normal murmur is just a noise
caused by blood flowing through a normal heart. ... For example, when the body's
temperature goes up, the blood flows faster. Doctors often hear heart murmurs when they
check children who have a fever.
.....
Long scenario about child have systolic murmur and laps with obvious anemia what is
that murmur?
A-innocen✅ B-Mitral regerg C-aortic stenosis D-pulmonary stenosis
... ........ ........ ......
Name of murmur that occurs when is severely sick and previously normal CVS exam: A-
Innocent murmur ✅
….
.....
Asthma
Bronchial asthma*
FEV1 low FVC low FEV1/FVC ratio low DLCO normal (or high) TLC normal (or high)
🌹Patient presenting with symptoms of obstructive lung disease. PFTs show decreased vital
capacity and decreased FEV1/FVC ratio.what is associated with this condition?
A. Increased lung compliance✅ B. Decreased lung compliance C. Weak respiratory muscles
🌹Female with 3 wks hs of productive cough With decrease both FEV and ratio
What other finding? A. Increase lung compliance B. Decrease lung compliance
🌹 Asthma medications in pregnancy, what to take and what to stop? Continue the same
ﺴﺘﺨﺪﻣﻬﺎ اﻟﺤﺎﻣﻞ آﻣﻦ ﻋﻠﻴﻬﺎâ ادو–ﺔ اﻻزﻣﺔ ﻋﺎدي
🍒 Elderly patient with hx of excessive smoking presented with 2 weeks history of dry
cough, nocturnal Spirometry showed decreased ratio FVC/FEF and decreased vital capacity.
What else would be associated?
A. increased Lung Capacity✅. B. Decreased Lung capacity C. Increase airway resistance
🍒 asthmatic patient, last OPD peak flow was 600, when to say it is acute sever asthma:
A- peak flow of less 250 ✅ B- O2 saturation 94%
🍒What indicates severe asthma? A. RR >25✅ B. HR >100. C. PEFR <300. D. O2sat <95%
🍒 patient’s PEF was 600, What is the indicator?
A. RR >20. B. HR >100. C. PEF <200✅. D. O2 sat <95%
🍒 Asthma salbutamol before exercise Not control ?add ICS🍒
…
🌹Patient using many drugs but he came with decreased K = salbutamol . 🌹
🌷Severe asthma (daily use of SABA and more than 2-3times night symptoms) on LABA and
ICS what to add? theophylline🌹
….
🌹Asthma management: The best initial test in an acute exacerbation: peak expiratory
flow🌹
.....
🌹The most accurate diagnostic test is pulmonary function testing ( Spirometry)🌹will
show a decrease in the ratio of forced expiratory volume in 1 second (FEV1) to forced vital
capacity (FVC).
…
🌹Asthma exacerbation after pneumonia tx? A. Ventolin + Antibiotic ✅
B. Ventolin + systemic steroid C. Systemic steroid + hydration D. Systemic
steroid + AB
ﻧﻠﺘﺠﺎ ل اﺳﺘﺨﺪامsystimic steroid 5 ¤ ﺣﺎﻟﺔ وﺣﺪة اذا اﺳﺘﻌﻤﻠﻨﺎ ﺟﻤﻴ|ﻴﻊ ادو–ﺔ اﻻزﻣﺔ وﻣﺸ|ﻨﺎ ﻋŒŽ • steps –ﺐÒÓﺎﻟu
•
ايŒŽ وﻣﻊ ﻫﺬا „ﻠﻪ ﻣﺎ
N.B: Empirical abx not recommended in acute asthma, but it’s used in suspected bacterial
sinusitis or pneumonia.
.............
🌹Asthma severe cant complete one sentence management? A.Cpap ✅ 🌹 B.Mechanical
ventilation
ﺎب ﻣﻦ اﻟﺸﻬ~ﺔ ﻣﺎ ﻧﻘﺪر ﻧﺘ•ﻠﻢ وﻧﻘﻮل ﺟﻤﻠﺔ وﺣﺪة „ﺎﻣﻠﺔy ﻧﺎ™ﻞ ﻛ¢ Ž £ ~ﺎب =ﻟﻤﺎ ﻧxﻂ =ﻛÏ ر.
.........
Best treatment for obstructive sleep apnea? CPAP
…
🌹 sleep apnea what is the treatment ? A. home o2 B. nasal cpap
..
🌹 He has HF and came with asthma attack then in ER they manag him with salbutamol and
he has decreased K what is the cause? Salbutamol 🌹 ﻂÏ = رsalb = ÐŽ = ﺳﻠﺐ ﺟﻤﻴﻊ اﻣﻮاK = „ﻠﺐ
، اقè.
............
🌹Copd patient not responding to Salbutamol what’s the next drug? Ipratropium
= ر`ﻂIpra ة =ﻣﺮض²ÿ اﺑﺮا =ﻋCOPD ¦ ƒ § ة )ﻳﻮﻗﻔﻮا ﺗﺪﺧ²ÿ¦ =ﻟﻌﻠﻪ (ﻋ
ƒ § ﺴ!ﺐ اﻟﺘﺪﺧñ ﻣﺎ وﺟﺪ اﻻ.
N.B: Salbutamol + ICS in asthma Salbutamol + Ipratropium in COPD
.......
🌹A child with worsening asthma father won’t quit smoking what should u do?
A. consult ethics B. refer to other doctor C. report it. ✅✅
.......
Male smoker since 3-4 years has dyspnea.Fev1/fvc is less than 0.7,Dlco is
low,FEV1/FVC mildly improved after administration of beta blocker
What is the likely dx: A. Chronic bronchitis. B. Asthma. C. Emphysema
….
🌹Child was having severe asthma exacerbation father won’t quit smoking =
A.treat the child and ignore father B.call child protection Answer is A then B
...........
🍓 Case about moderat asthma on saba and ics what add : Laba.( long acting ...
.........
🍓Case of copd it is sever and full secretion : invasive MV .
.........
🌹 smoker with recurrent respiratory infection and productive cough ?
chronic bronchitis ﺲ ﻛﺤﺔ ﺟﺎﻓﺔãﻻن ﻗﺎﻟﻚ ﻛﺤﺔ ﻣﻊ {ﻠﻐﻢ وﻟ
🍓pregnant women with asthma what tocolytics that C/I for her? A. Oxytocin B.
Misoprostol✅
ﺎ¹ع “ﺎﺧﺬö ﻓﻤﻤﻨ، وا “ﻌﻤﻞ ازﻣﺔ²ƒ § وا =ازﻣﺔ =ﻣﻦ اﺳﻤﻬﺎ ﻣ²ƒ § ﻣ.
.........
🌹 Young female came to the clinic complaining of episodes of SOB, wheeze and cough for
the last 6 months not related to certain provoker. She says that these episodes comes
suddenly and resolve suddenly. She used ventolin but improved slightly. Upon physical
exam she has equal air entry with no wheezing. She is not allergic to anything and no one in
her family has the same problem.All test were normal and spirometry is normal. What is
the dx ? A.foreign body B.vocal cord dysfunction C.asthma
🍒Patient came with Symptoms of asthma but( little improve with bronchodilator) dx:
Vocal cord dysfunction
🌹Female 20-something y/o with dyspnea intermittently resolves suddenly. Minimal
improvement with b agonist. Dx:
A. asthma B. Vocal cord paralysis
🌹. Acute sever asthma criteria
B. RR 20 ( more than 25 to say sever). C. HR 100 ( more than 110 to say sever)
D. PFR 200 (should to say sever belew 100). E. Inability to complete one sentence in one
breath ✅
.......
🌹 Sever asthma exacerbation ( in distress )how to manage :
A. theophylline B. Magnesium sulphate ✅
C. Intubation = ( we use intupantion when O2 less than 50 and co2 more than 50 ) D. Non
invasive MV
Magnesium sulfate for treating exacerbations of acute asthma in the emergency
department. In an asthma attack, the airways (passages to the lungs) narrow from muscle
spasms and swelling .
......
🌹case of acute asthma exacerbation what study is most accurate to monitor
improvement? A. ABGs B. PFTs
…
🌹 pt known case of asthma in-compliant on his medication came with sx of status
asthmaticus , his last PEF was 600 , whats of the following indication of severity “in this pt”
: PEF 250
…
- in case of acute asthma exacerbation what study is most accurate to monitor
improvement=Pulmonary function tests
. .....
🌹How treat moderate asthma : A. laba + ics B. ics + saba C. ipratropium
...
🌹Patient known case of asthma on albuterol , diagnosed as moderate persistent asthma
what you will add ? A. ICS. B. ICS and LABA as needed. C. Theophylline D. Montelukast
....
Q about asthma exacerbation: ventoline and steroid ✅ ✔
During an asthma attack, also called an asthma exacerbation give both short acting
(ventoline or albuterol) and steroid
..... .... ....
Q about Exercise induced asthma, management? Salbutamol pre exercise ✅ ✔
......
Q about asthma increased symptoms in the last month? add ICS ( Inhaled corticosteroids )
✅✔
🌹Asthmatic patient on SABA + steroid, free of symptoms for 1 year, next?
A. continue same management B. stop both medication
C. decrease steroid to half dose + SABA✅ D. add montelukast
🌹Pt pregnant with bronchial asthma have SOB and whezzes and some times have night
attacks of asthma : SABA AND ICS ✅ ✔.
…
243- A 55yr old chronic smoker with chronic non productive cough presented with stable
vitals. X ray done is normal.whats the likely diagnosis?
A.COPD✅✅ (chronic bronchitis) B.Idiopathic Pulmonary Fibrosis. C.Pulmonary fibrosis
🌷chronic smoker + chronic non productive cough + x.ray normal = COPD (chronic
bronchitis) 🌹
.... ....
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
🌷sinusitis and recurrent lower respiratory tract infections + bronchial aspirate had
pseudomonas aeruginosa =Cystic Fibrosis
..... ......
🌹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
….
🌹FEV/FVC < 70 and low DLCO, what is the diagnosis?
A-Bronchiectasis. B-Emphysema✅✅. C-COPD
🌹Bronchial asthma =
FEV1 low and FVC low FEV1/FVC ratio low DLCO normal or high and TLC normal or high🌹
🌹COPD FEV1 low FVC low FEV1/FVC ratio low (DLCO low in emphysema, normal or high in
chronic bronchitis ) TLC normal (or high) in both🌹
ﺣﻔﻈﻬﺎŒŽ • G اﺳﺎﻋﺪ„ﻢ ان ﺷﺎء
ƒ ƒ n
اﻻزﻣﺔ و: اوﻻCOPD ﺶ؟ž اmo ¦ § ﻛ²ﻠﻬﻢ ﻣﺸá
Asthma and COPD :
💎FEV1 + FVC FEV1/FVC ratio = LOW
💎 TLC = normal (or high) in both
• •
ŒŽ ﺴﺪادD ﻻن „ﻠﻬﻢ ﻋﻨﺪﻫﻢ اþŽ~ ﻃﺒ، ؟ÐŽ اول ﺛﺎﻧ~ﺔ ﻫﻞ ﻗﻠ~ﻠﺔ وﻻ ﻋﺎŒŽ ﺗﺪﺧﻞ اﻟﺮﺋﺔÐŽﺎﺧﺘﺼﺎر „ﻤ~ﺔ اﻟﻬﻮاء اu ﻫﺬا ﻣﻌﻨﺎە
ﻟﺬﻟﻚ ﻗﻠﻨﺎ، داﺧﻞ راح •ﻘﻞÐŽ اﻟﺸﻌﺐ ﻓﺎﻟﻬﻮاء اFev = low . اذا
FEV1 + FVC FEV1/FVC ratio = LOW
و „ﻠﻤﺔTLC ﻣﻌﻨﺎﻫﺎtotall lung capicity داﺧﻞ اﻟﺮﺋﺔ او ﻗﺪ ا´ﺶ اﻟﺮﺋﺔ ﻓﻴﻬﺎ ﻫﻮاء وﺣﺎﺻﻞ ﻟﻬﺎÐŽ „ﻤ~ﺔ اﻟﻬﻮاء اýŽ • •ﻌ
inflation اﻻزﻣﺔ والŒŽ • ، ﻣﻠ~ﺎﻧﺔ ﻫﻮاءýŽ • •ﻌcopd ﺐÞﺴ7) ﺗ—–ﺪ ﺣﺠﻢ اﻟﺮﺋﺔ ﻟ~ﻪ ؟؟ ﻻن ﻣﻠ~ﺎﻧﺔ ﻫﻮاء (ﻣﺤﺒﻮس
اذا. ﻓﺎﻟﺮﺋﺔ ﺣﺠﻤﻬﺎ زاﺋﺪ، ﻣﻮ ﻋﺎرف •ﻄﻠﻊ ﺑﺮةÒçﺴﺪاد اﻟﻬﻮاء ﻛﺜD اﻻ:
TLC = normal (or high) in both
ñ• ç ف اﺗﻔﻘﻨﺎ ان اﻟﻤﺮﺿcopd and asthma •ﻜﻮن ﻋﻨﺪﻫﻢñ • ç اﻻﺛﻨFVC ﻗﻠ~ﻠﺔ وTCL þ~ ﻋﺎﻟ~ﺔ او ﻃﺒ.
Ž
...
ŒŽ • ( ﻃ~ﺐ اﻻﺧﺘﻼف و–ﻦDLCO) ﻠﻤﺔ اﺧﺘﺼﺎرل6ﻫﺬە اﻟ:
(Diffusing capacity for carbon monoxide)
its mean (( is the extent to which oxygen passes from the air sacs of the lungs into the
blood. )).
ý• ف ﻣﻌDLCO : –ﺼﻼت اﻟﺮﺋﺔc ﺣŒŽ • ﻣﻮﺟﻮدةÐŽ اñ • ç „ﻤ~ﺔ اﻻوﻛﺴﺠ4 ﻣﺎý•(•ﻌAlveoli) ودﺧﻠﺖ ﻟﻠﺪم ؟،
Ž Ž
–ﺼﻼتc ﺗﻄﻠﻊ ﻣﻦ ﺣÐŽ اñ • ç „ﻤ~ﺔ اﻻوﻛﺴﺠýÓ( ﻃ~ﺐ ﻣalveoli) ﻟﻠﺪم ﺗﻘﻞ ؟؟
ﻟﻤﺎ ﺗﺨﺮب، –ﺼﻼت ﻫﺬەc اﻟﺤŒŽ • ) Òç ﻟﻤﺎ •ﻜﻮن ﻓ~ﻪ ﻣﺮض او (ﺗﺪﻣalveoli •ﻘﻞÐŽﺎﻟﺘﺎy ﻟﻠﺪم ﻓñ • ç ﻣﺎ ﻳﻮﺻﻞ اوﻛﺴﺠDLCO
، ﻋﻨﺪﻫﻢ ﻫﺬاŒŽ Ó ﻧﻼÐŽﺎﻟﺘﺎÏ و–ﺨﺮب اﺑﻮ ﺷ•ﻠﻬﺎ وÒç–ﺼﻼت ﻫﺬە ﺗﺪﻣc ﻃ~ﺐ ﻓ~ﻪ ﻣﺮض واﺣﺪ •ﺪﻣﺮ اﻟﺤDLCO ﻣﻨﺨﻔﺾ
ﻣﺎﻫﻮ ﻫﺬا اﻟﻤﺮض ؟ اﺳﻤﻪ:
Emphysema
ﻮ ﻛﺬا ﻣﺮض ﻣﻨﻬﺎ¹ ، ﺲ ﻣﺮض واﺣﺪ ﻓﻘﻂãﻮ ﻟ¹ ﻌﺎx ﻃfibrosis ﺎر ﺣﻘﻨﺎx ﻗﺪ اﻟﺴﺆوال واﻻﺧﺘ-ﺲ ﺧﻠﻴﻨﺎ ﻋñ .
ﻧﻌ}ﺪ ﻣﺮة ﺛﺎﻧ}ﺔ: DLCO •ﻜﻮن ﻗﻠ~ﻞ ﻣﻊ اي ﻣﺮض ؟......
Emphysema
• •
–ﺼﻼت واﻟﺪمc اﻟﺤñç ﺑñçﺎدل ﻟﻼوﻛﺴﺠy ﻟﻦ •ﺤﺼﻞ ﻋﻤﻠ~ﺔ اﻟﺘÐŽﺎﻟﺘﺎÏ–ﺼﻼت وcﻟ~ﻪ ؟ ﻻن ﻫﺬا اﻟﻤﺮض دﻣﺮ اﻟﺤ
ﻃ}ﺐDLCO –ﺔ ﻣﻊ اي ﻣﺮض؟c او ﻣﺮﺗﻔﻊ ﺷú o }•ﻜﻮن ﻃﺒ....
Asthma and chronin bronchlitis
اﻟﺸﻌﺐ اﻟﻬﻮاﺋ~ﺔ¤ﻫﺎ •ﻜﻮن ﻋÒç ؟ ﻻن ﻣﻦ اﺳﻤﻬﺎ اﻻزﻣﺔ واﻟﺘﻬﺎب اﻟﺸﻌﺐ ﺗﺄﺛþŽ~ ﻟﻴ|~ﻪ •ﻜﻮن ﻃﺒBronchi ¤وﻟ¨ﺲ ﻋ
–ﺼﻼتc( اﻟﺤAlveoli) ...
COPD
🌹Copd cor pulmonale whats best thing to improve survival ? A. Diuretic B. O2 Oxygen
therapy is great importance COPD
....
COPD patient with lower limb edema and hepatosplenomehay Right heart failure signs
What to do to confirm dx? -CXR Echo ✅✅✅ ïŽ Ó ﻣﻨﻄECG
....
What improves survival or reduce mortality in COPD? Smoking cessation ✅
…..
🌹Emphysema: low DLOC
‘ ﻋﻠﻴﻬﺎ داﺋﺮة ﻫﺬە اﺳﻤﻬﺎo اbronchovascular markings ﺎﺑﻬﺎy وﻣﻦ اﺣﺪ اﺳemphysema
🌹 Most common symptom of emphysema ?A.productive cough B.dry cough C.dyspnea
🌹 Scenario about a man with epilepsy poor controlled, have productive cough and fever
Asked about what the source of infection?
A- Aspiration B- TB C- Infectious mononucleosis D - Pneumonia
...
🌹COPD on PFT ?
C. decrease TLC , decreased FEV1/FEVC <0.7, increase VC
D. increase TLC , decrease FEV1/FEVC <0.7, decrease VC
....
🌹How to assess COPD severity/prognosis: FEV1
....
🌹 Indication of home therapy for copd pt:
A. wo reading of PaO2 less than 7.3. B. Less than 7.3 Kpa. C. 2 measurements Ko2 < 7
...
🌹best way to deliver oxygen in COPD pt?
A. Mask B. Nasal cannula C. Venture bag D. Non rebreather mask
...
🌹COPD patient developed sudden symptoms of spontaneous pneumothorax, x ray was
done and showed *2 cm* pneumothorax, mx? A. Needle B. Chest tube C. Observation
🍒Scenario of SBP mx: A. lactulose enema+ceftriaxone✅ B. furosemide+IV metronidazole
# Copd elderly admitted exerberation at night became aggresive disoreinted what the
nurse should do first:
-Call the duty dr for lorazepsm iv. -Restrain her
-Call family sit beside her
-elevate head of bed put nasal oxygen try to oreinted her about place and time ✅
......... ....... ....... .....
# Patient KNOWN COPD when do you start home oxygen therapy?
PO2 less than( 7.3kpa ) on two occasions
….
#COPD, affected conscious level, low pH? A- Bipap B- Mechanical ventilation ✅
......
COPD & heavy smoker hypoxia co2 retention patient drowsy? Mechanical ventilation.
…
COPD exacerbation and he is in coma, what to do? mechanical ventilation ✅ ✔
….
#COPD elderly patient presented to the ER distress and full of secretion how
you will manage =
A. CPAP. B. mechanical ventilation. C. Nasal oxygen. D. Aminophylline infusion
…..
🌹COPD pt came with respiratory functions detotriation and LOC with sever
secretions in the throat mx? A. cpap B. mechanical ventilation C. o mask
....
🌹COPd with signs of respiratory acidosis ? A.Mechanical ventilation
….
Absolute indications of mecanical ventilantion in severe acute asthma:-
-Coma ✅ -Respiratory or cardiac arrest -Refractory hypoxemia
اﻧﻪ¤ ﻋñ • ç ﺔ اﻟﺼﺤ~ﺤﺔ ﻻن ﻣﻦ اﻟﻤﻮﻗﻊ „ﻠﻬﻢ ﻣﺘﻔﻘu ﻣﻌﺮوف ا´ﺶ اﻻﺟﺎÒç ﻏcoma and arrest ﻣﻦ ﺿﻤﻦabsulte
indican
,….
Patient k/c of COPD alert, has moderate respiratory distress.SO2 93%, ABG showed
hypoxia, hypercapnia and acidosis. What is next step:
A. noninvasive ventilation✅✅. B. Decrease oxygen
C. Increase oxygen D. Mechanical ventilation (when O2 below than 88 ) .
.......
When to consider invasive MV?
➔ PaO2 < 40 mmhg. ➔ Ph < 7.25. (Acidosis) ➔ CO2 > 60 mmhg. ➔ Respiratory arrest.
➔ Cardiovascular collapse. ➔ Severe exacerbation with a lot of secretions.
......
🌹Copd acute exacerbation with a mouth full of secretions = invasive Mecanical
ventillantion .🌹
.........
Pt smoker and dyspnea and character of clubbing A.Copd B.Asthma C. Bronchial cancer
✅✅
ﻣﺮضcopd ﺐÞ ب ﻧﻔﺴﻪ ﻻ ´ﺴclupping –ﺾÀﻦ اذا ﺷﻮﻓﻨﺎﻫﺎ ﻣﻊ ﻣÄ ﻟCOPD ﺎﻟﺮﺋﺔu ﻃﺎنè ﻣﻌﻨﺎﻫﺎ ﺟﺎء ﻟﻪ
COPD = does not cause clubbing, but if clubbing is present in COPD, underlying lung cancer
and bronchiectasis must be ruled out 🍒🍒Pt smoker and dyspnea and character of
clubbing = Bronchial cancer🍒🍒
.......
Case of old smoker c/o cough, loss of nail bed angle? beonchogenic carcinoma
…
🍓Smoker pt, c/o with dyspnea and couph with hemoptysis, trachea wasn’t shifted, xray
showed massive right plueral effusion, whats the cause:
A. Heart failure B. T.B C. Brochogenic carcinoma with ipsilatral bronchus compression✅✅
. وﺛﺎﻧﻲ ھو ﻣدﺧن وﺛﺎﻟﺛﺎ ﻛﺣﺔ ﻣﻊ دم اﻟﺛﻼﺛﺔ ﻛﻠﮭﺎ ﺗﻣﺷﻲ ﻣﻊ ورم اﻟرﺋﺔplural effustion ﻗﻠﻧﺎ ﻛﺎﻧﺳﯾر ﻻن اﻟورم ﺑﯾﻌﻣل
🌹 smoker came with dyspnea and hemoptysis , examination and x ray showed positive
pleural effusion , but the trachea and the apex beat where not shifted ( ) ﻛﺬا ﻣﻜﺘﻮب. what
is the cause of non shifting trachea and apex beat ?
A. - transudate pleural effusion B. - TB pleural effusion
C. - cancer in the ipsilateral main bronchi ✅
🍒positive pleural effusion dyspnea and hemoptysis smoker= Cancer bronchio🍒
🍒Pleural effusion in patient has malignancy analytic Show Light criteria of pleural effusion,
High protein, and the pt have symptoms of malignancy?
A. Trans exudative due malignancy B. Exudative due malignancy
🍒A case of traumatic effusion what to find in CXR ? Effusions
🍒patient K/c COPD C/O SOB palpitation O/E irregular pulse Ttt?
A-Cardoversion B-Adenoseine C-Amiadrone ✅ ﻣﻨﺘﻈﻢÒçﺾ اﻟﻐyﻋﺸﺎ اﻟﻨ
🌷COPD C/O SOB palpitation O/E irregular pulse = Amiadrone🌹
......
🌹 smoker with recurrent respiratory infection and productive cough ? chronic bronchitis
Smoking is a strong hint for COPD + all other sx are seen in COPD
….
🌹 COPD function ==increases lung capacity
….
COPD Pulmonary function test:
A. Inc TLC, Dec FEV1/FVC, Normal VC. B. Inc TLC, Dec FEV1/FVC, Dec VC
…..
#COPD monitoring ? FEV1
….
🍒🍒COPD Best indication of disease progression ? FEV 1🍒🍒
…
🍓Know case of copd with cor pulmonale. which of the following will decrease mortality ?
A. oxygen mask therapy B. inhaled long acting beta blocker
C.Long term 02 therapy D.NPPV
🍎Common etiolog to cor pulmonary is COPD 🍎
….
🍓Smokers to non-smokers risk:-
Lung cancer: by 25 folds.
COPD:12 to 13 folds.🍓
Stroke and coronary
….
child with SOB and *Stony dullness* in percussion, what is the diagnosis?
Pleural effusion ✅ ✔
....... ............
🌹Burn with carbon monoxide inhalation how you will mange ?
Intubation and 100 oxygen
🍓- Patient was engaged in building fire has signs of inhalation injury ( nasal hair)
- admit to ICU for observation Correct answer : INTUBATION
..........
🍓COPD > ration less 70% and low DLCO what it the dx?
A. emphysema✅. B. bronchitis
.......
🍓obese snoring , lack sleep , sleep study done (OSA), how you will ventilate:=CPAP
....
🌹 Patient suspected to have left sided heart failure, had slightly positive BNP. What can
cause such condition? A. ACEI. B. Furosmide. C. COPD ✅
..
🍒smoker with non productive cough, fatigue and loss of 15% of weight what is the
diagnosis? A.COPD. B.Lung cancer ✅
......
🌹Smoker with productive cough=COPD
…
1Blood disorder
🍓 Patient with typical picture of Hsp asking about dx :
A. Vitamin c deficiency. B. Factor vll deficiency C. Hypersensitivity vasculitis
D. Drug Hypersensitivity reaction
🍓 patient 65 years old post massive surgery! Patient lost alot of blood +patient have given
15 bage of RBC after time nurse notes that the patient start bleeding from iv and
nasogastric tube? What is the cause of the bleeding
A. von Willebrand disease. B. thrombocytopenia. C. blood reaction
A 73-year-old man comes to the office with fatigue that has become progressively worse
over the last several months. He is also short of breath when he walks up one flight of
stairs. He drinks 4 vodka martinis a day. He has numbness and tingling in his feet. On
physical examination he has decreased sensation of his feet. His hematocrit is 28% and
MCV is 114 fL (elevated). What is the most appropriate next step in management?
a-Vitamin B12 level. b-Folate level. c-Peripheral blood smear.✅✅✅
d-Schilling test. e-Methylmalonic acid level.
Correct answer : C. Although a macrocytic anemia could be from B12 or folate deficiency,
direct alcohol effect on the bone marrow, or liver disease, the first step is a peripheral
smear.
….
🌷He drinks 4 vodka martinis a day, numbness and tingling in his feet His hematocrit is
28% and MCV is 114 fL (elevated). First step = Peripheral blood smear🌷
..... ..... ....
🌹Asymptomatic 3 months old baby, with CBC result of mild microcytic hypochromic
anemia, what is the diagnosis? Thlasimia trial ✅ ✔
🌹pt on Total parenteral nutrition give value of PT and INR what is the cause ?
A. DIC B. vitamin K deficiency ✔
🌹60 y/o patient blood transusion after 10 m developed pain in the site of canula and
difficulty breathing and is febril:
A_ Febril non hemolytic anemia. B_Hemolytic anemia . C_Allergic reacti
🌹 CLL patient on day 17 develops neutropenic fever, what will you do:
A. Septic screen B. Septic screen and start oral broad spectrum abx
C. Septic screen and IV broad Abx
Malaria
🍓 Malaria negative results what to do next
A. repeat thin. B. Repeat thick. C. Repeat after 48 h D- repeat every 8hrs for 43 hrs
🍓 Which anti malaria drug mostly malaria will be resistant for it :
A. Malarone. B. Atovaquone-proguanil. C. Mefloquine D. Chloroquine
🌹Malaria prevention sudan = give Mefloquine 🌹
🍓Case of pt came from africa w hepatosplenomegaly := malaria
🍓What is the peak time of west nile mosquito Infection ?
A. early morning ✅ B. Midday . C. Early night . D. Nigh
🌹35 indian male came for mecca then he developed convulsion intermittent, fever
breathing problem after 2 days What is this
A. Malaria B. Tb C. Yellow fever D. Influenza 🌻 Malaria present with CNS manifestatio
🌹pt came only with fever and hx of Southeast Asia ? A. malaria B. danger fever
🌹Most common cause of fever in subshara Africa? Malaria 🌹
🌻Sub saharan africa > malaria 🌻South east asia > dengue
🌹 Retro Orbital pain, joint pain , muscle pain , came from travel ?
A. dengue. B. chikunga. C. ebola. D. corona
🌹Young female presented with headache and fever,she recently came from
jeddah Labs shows low PLT , Low hemoglobin = Dengue
🌹Person wants to travel to malaria endemic area how to prevent malaria?
A- Chemoprophylaxis✅. B- not travel to endemic area. C- Vaccines
Chemoprophylaxis== use of drugs to prevent disease
🌹Malaria treatment: A. Quinine B.Mefloquine C.Artemisinin combination therapy
soldier going to southern of saudi arabia came for malaria prophylaxis :
Atovaquone / Proguanil 🌹 = رﺑﻂatov = اطﻮف ﺑﺎﻟﺤﺮم = ﻓﻲ اﻟﺴﻌﻮدﯾﺔ .
🌹Malaria prophylaxis? Malarone ھﻲ ﻧﻔس اﻟدواﺋﯾن اﻟﻲ ﻛﺗﺑﻧﺎھﺎ ﻓوق
🌹Malaria blood smear = M.falciparum 🌹.
🍒old pt with Chronic kidney disease present with labs show high WBC with arthritis= CLL
…
🌹 microcytic hyperchromic RBC = hereditary spherocytosis = Osmotic fragility test 🌹
ﻂ ﺣﺮفÏ رO ﻣﻦosmatic = ﺷ•ﻠﻬﺎ داﺋﺮةspherocytosis. –ﺔÀﺷ•ﻞ اﻟﺨﻼ•ﺎ داﺋ
. . . .. .
🌹 Parvovirus b 19 in sickle cell anemia = Aplastic crisis 🌹
…
18 Y has ALL. 17 days after chemo he develops fever around 38.7 C. No focus of infection
found. Labs shows: low WBC 0.6 (normal was 4-10x..), Neutrophil level 60% (normal 40-
60%), i’m not sure if he has low platelets as well, what you’ll do:
B. Blood urine... culture and paracetamol C. Blood, urine,... culture and PO Abx
D. Blood, urine,... culture and IV Abx✅✅✅
4 O
ﺎ7„ ﺟﻤﻴﻊ اﻟﺨﻼ6 ﻤﺎ ﺗﻌﻤﻞ ﻧﻘﺺ#ﺎ (و اﻟﻠﻮﻛ#ﻤ#ء ﻋﻨﺪە ﻟﻮﻛN
6 اولwbc , nutrophil ...etc , وﺗﻌﺪاد، ﻘﻮﻟﻚ ﻋﻨﺪە ﺣﺮارة7 ﻓﻬﻨﺎnutrophil • =ﻻن ﻫﻢ6#ﻃﺒ
ﻪ#• ﻫﺬا ﻣﻌﻨﺎﻫﺎ ﻓ6#ﻮﺻﻞ ﻟﻠﻄﺒž ﻓﻠﻤﺎ ﻳﺮﺗﻔﻊ و، ﻜﻮن ﻧﻘﺺ7 اﺻﻼ ﻋﻨﺪﻫﻢinfection ، وﻻﻧﻬﺎ ﻋﻨﺪﻫﻢ ﻧﻘﺺ )ﺎﻟﻤﻨﺎﻋﺔ وﺧﻄﺮ ﺟﺪا ﺟﺪا اﺻﺎﺑﺘﻬﻢ ب اي اﻧﻔﻜﺸﻦ
ﺪ وﻟ ﺲ دواء ﻓﻤﻮيžﺎﺧﺬوا اﺑﺮة ﻋ• اﻟﻮر7 ﻻزم
…..
Patient known case of polymyalgia rheumatica presents with malignancy
symptoms, what is the diagnosis ? CLL
🌹 known case of polymyalgia rheumatica presents with malignancy symptoms (weight
loss and other non-specific constitutional sx), what is the diagnosis ? Labs showed anemia,
low platelets and increased WBC (lymphocytes) = CLL
…
Neonate complaining of jaundice after 12 hours of delivery .. blood film and I think it show
microcytic hyperchromic RBC (hereditary spherocytosis ) What investigation you will order
? a) G6PD. b) Osmotic fragility test ✅Pyruvate kinase deficiency
🌷SCA patients take all vaccination after blood transfusion except MMR no if the
transfusion within the 11 months🌷
🍒5year old with wrist pain and ankle pain or bone cant remember and fever for one
week. == sickle cell == could be dactylitis or hand foot syndrome with SCA 🍒
🌹24y kc of SCA came with headache, lethargy, pallor, Lab: hg: very low, Reticulocytes:
high, what most likely diagnosis?
A.Splenic sq craisis B.Thrombotic crisis C.Hemolytic crisis ✅ D.Aplastic crisis
Sickler with pain and pallor , hbg low , reticulocyte high .. what type of crisis ?
A. hemolytic B. aplastic C. sequestration
اي ﻣرة ﺗﺷوﻓوھﺎ اﻋرﻓوا ان اﻟﺧﻼﯾﺎ اﻟﺣﻣرتء ﺗﻛﺳرت وﺧرج ﻣﻧﮭﺎ ھذه اﻟﺧﻼﯾﺎ اﻟﺷﺑﻛﯾﺔreticulocyte high ﻻن ﻗﺎل
🍒limps pain with chest sx asking about dx = SCD🍒
🌹SCA came with chest ,back and lower limbs pain what’s mostly dx?
A. PE B. acute chest syndrome
🌹SCD patient presents with hands and foots pain, the most important ongoing care is:
A. Penicillin and vaccines ✅ B. Iron C. Vit B12
ﻂ =ﻗﺪم و–ﺪÏ = رpencillin = وﺳﻄﻬﺎnice = ﻻزم ﻧ—–ﻦ اﻟﻘﺪم واﻟ~ﺪ و–ﻜﻮن ﺷ•ﻠﻬﺎ ﻧﺎ´ﺲ
........
🌹Child 6yrs c/o fatigue, pale ....Ix hb 5.6 retics high SCD+ve treatment?
A. Blood transfusions ✅. B. IVIM C. Steroid
.............
7 y/o presented to with SOB and fatigue Labs showed anemia + thrombocytopenia (no
WBC) Sickle screen was positive Which one of the following is the most important
investigation? A.Bone biopsy B.Ct abdomen C.Us abdomen D.Reticulocyte count ✅✅
..........
🌹Pt with respiratory distress and high fever also carsales , effected right lobe and low hb
and high Ritcs count and pulmonary systolic murmur what is the diagnosis:
A. Sickle cell anemia✅ B. Squsteration C. Pneumonia D. MI
Crisis of sickle cell patients , pale, low hemoglobin, no hepatosplenomegaly, type of crisis?
A. aplastic✅ B. sequestration
..........
🌹Sickle cell disease boy with pain in hands and foots. What is the initial management?
A. Iv fluid and analgesia B. antibiotic C. blood transfusion
....
🌹Sickle cell disease boy with severe abdominal pain, he looks pale and
fatigued, on P/E he has splenomegaly. Labs shows hemoglobin 3.2 gm/dl. What is the
initial management? A. Iv fluid and analgesia B. antibiotic. C. two pRBC transfusion
SLD=RBC
....
Sickle cell anemia boy Came with lethargy pallor and headache Dx?
A. Aplastic crisis. B. Sequestration crisis C. Thromboembolic crisis D. Hemolytic crisis
..
scenario of anemic pt. Lab showed *pancytopenia* dx:
A- aplastic anemia ✅ B- iron def. C- B12 def. pancytopenia = aplastic anemia
ﻣﺎﯾﻧﮭﺿمaplastic ﻟﺑﺎن = ﻟﺑﺎن ﻣﺛل اﻟﺑﻼﺳﺗﯾكPan = رﺑط = ﺑﺎن
.. . . . . .
Sickle cell disease patient. Present with crisis. Respiratory symptoms. Splenomegaly.
Hemoglobin 3.4 g/dl (iʼm sure of v'lue). Wh'tʼs the best initi'l step in m'n'gement?
- Splenectomy - IV fluid and analgesia ✅✅ - RBC tr'nsfusion
..
question with a description of blood smear that showd (crescent RBC’s) = Dx: Sickle cell
anemia.
.......... ......
🌹Sickl cell anemia with Hb 5= blood transfustion 🌹
......
Iron
🍒 Brittle Nails pict Dx? IDA🍒
…
Child only eat milk with little meat presented with microcytic hypochromic what is the
treatment? A.Multivitamins with iron B. Iron and re-evaluate after 4 weeks i think ✅✅
…
🌹 laboratory findings of Iron Defincy = All low except RDW,TIBS,transferrin are high 🌹
🌹 Child of iron ingestion came after several hour Iron 90, What you will do?
A. Iv desforoxmine ✅✅ B. N actylcystine C. Gastric lavage D. Activated charcoal
🌹pediatric with low mcv, mch = treatment
A. multivitamin with iron B.trial of iron supplement and follow up✅✅
🍒Case pt with bronze skin and long case with labs , what is important Investigation ?
A-liver boipsy to see iron ✅ B-serum copper C-urine something
🌹iron overdose before 4 to 5 hours and he was stable = Don’t need to give him at this
stage
🌹There was Same question but symptomatic ? IV deferoxamine🌹
🌹Iron overload is managed within 8 hours ? -Deferoxamine IV
🌹 In ER if pt is confused ( severe IDA ) best to give iron IV , IM respectively
🌹 Child *confused* and fatigued laps microcitic hypochromic anemia
low ferrtin high TIBC treatment A-oral iron B-Im iron C-iv iron ✅ ✔ D- packed RBC
🌹 pt pregnant have anemia and treat with iron supplements 't 20 week c'me with f'tigue
'nd tiredness hg low mcv low dx? A-IDA ✅✅ B-b th'l'ssemi'
🌹pregnant have anemia +hg low mcv low= iron defincy anemia 🌹
🌹Pt with anemia after two visit not improved with iron supplements what
test do? Hb electrophoresis
🌹Child appears pale hb 8 ,hypocromic microcitic=Trail iron and following-up 🌹
...................................
🌹severe case Glucose-6-phosphate dehydrogenase deficiency Treatment ?
Blood transfusions
اﺣﻤﺮ²§ ر`ﻂ =ﻋﻨﺪە ﻧﻘﺺ ﺷﺪ“ﺪ {ﺎﻟﺴﻜﺮ =ﻋﻄﻮە ﻋﺼ.:)
Treatment
• folic acid
• stop ofending drugs and avoid triggers
• transfusion in severe cases
............
ITP
🌹 After URTI child complain of bruises ,, lab show low platelet?ITP 🌹✅✅
🌹wich will cured after (splenoctomy)?
1_idopathic thrombocytopenia purpura ITP 2_ Herdetary spherocytosis
🌹curable by splenectomy?¸ ﻟﻤﺎ ﻧ—–ﻞ اﻟﻄﺤﺎلŽ á ﻣﺮض ﻳﺘﻢ اﻟﺸﻔﺎء ﻧﻬﺎ.
A. -Beta thalassemia B. -Alpha thalassemia C. -sickle cell D. -ITP✅
🌹Pt with fever and headeche . Pic shows shistocyte == TTP ✅Schistocytes are often
seen in patients with Thrombotic thrombocytopenic purpura🌹
🌹 picture of Schistocytes blood smear Young lady with 2 days history of fever and
headache. The patient presented only with petechial rash
Normal PT, aPTT, INR Thrombocytopenia
What is the most likely Dx ?
A. HUS ( must be E.coli infection )
B. TTP✅ (adult + Schistocytes+ fever and headache + petechial rash + Normal PT, aPTT,
INR = T T P)
C. ITP
D. DIC
Young lady with 2 days history of fever and headache. The patient presented only with
petechial rash. High [ PT, aPTT, INR ]. Low [ Platelet, Fibrinogen ]
A. HUS. B. TTP. C. ITPD. DIC ✅
„ﻠﻤﺔ اﻟ† ﻟﻬﺬا اﻟﻤﺮض ﻫﻮHigh [ PT, aPTT, INR ] +
Low [ Platelet, Fibrinogen ]
اﻟﺼﻔﺎﺋﺢ ﻗﻠ~ﻠﺔ ﻟﺬﻟﻚ •ﺤﺼﻞ ﻧ—–ﻒ
🌹2 qs about TTP with peripheral blood smear pic .. ask about Dx and then management =
Exchange transfusion
🌹 Patient with TTP scenario and labs. What’s the management ?
A. IVIG B. Blood transfusion C. Plasma transfusion
🌹 Patient done a major surgery which required 15 blood units, he afterwards started
bleeding from NGT, ETT, what is the dx? A. thrombocytopenia B.transfusion reaction
N.B: NO DIC in options
🌹Patient after surgery on blood transfusion developed bleeding from puncture site
what's diagnosis ? A.transfusion reaction B.DIC✅ C.thrombocytopenia
🌹23 y/o presented to ER with fever and hedache, on examination there was petechial rash
all over her body, vitally stable other than high temperature 38
🌹- First Q: Plt were low, PT&PTT&INR all normal, high bilirubin and reticulocytes and
low Hb (indicates hemolysis), creatinine was normal, your management:
A. Steroids and IVIG. B. Exchanged transfusion ✅. C. Platelet transfusion
اﻋرﻓوا اﻧﮫ ﻓﯾﮫ ﺧﻼﯾﺎ ﺣﻣراء ﻣﺗﻛﺳره وﻟﻣﺎ ﺗﻛﺳرت طﻠﻊ ﻣﻧﮭﺎ ھذه اﻟﺧﻼﯾﺎ اﻟﻲ، ﻋﺎﻟﯾﺔreticulocytes اذا ﺷوﻓﺗوا
واﻓﺿل ﺷﻲء ﻧﻌطﯾﮫ ﻧﻘل دم. Hemolysis = ﯾﻌﻧﻲreticulocyts اﺳﻣﮭﺎ
🌹 Second Q: Plt low, PT&PTT&INR all high, high bilirubin and reticulocytes and low Hb
(indicates hemolysis), low fibrinogen, creatinine was normal, you dx:
A. DIC✅✅. B. ITP. C. TTP. D. HIT
🌹 Third Q: Plt was very low (in 20s) and macrocytic anemia, all other labs were
normal, your dx: A. DIC B. TTP✅. C. ITP. D. HIT
🌷Plt were low, PT&PTT&INR all normal, high bilirubin and reticulocytes and
low Hb = Exchanged transfusion
🌷Plt low, PT&PTT&INR all high, high bilirubin and reticulocytes and low Hb (indicates
hemolysis), low fibrinogen = DIC🌷
🌹Plt was very low (in 20s) and macrocytic anemia =TTP🌷
.......................................
1Pulmonary
🍓 Proper ET position how to chick :
A. -co2 monitor B. -chest movement. C. -easy insertion.
🌷 Old patient, heavy smoker present with symptoms of Horner syndrome. what type of
cancer? squamous cell cancer
🌷-Patient with Pulmonary hypertension to be evaluated for chronic thromboembolism,
which investigation has the highest diagnostic yield?
A-V/Q scan✅✅ B-Echo. C-ECG D-Spirometry CT
🌹Old man + smoking + esophageal show squamous cell with highly dysplasia next step?
A. surgical resection. B. Stop smoking
🍒Cerebral palsy pt develops respiratory failure ( give ABG results wad hypoxemla ) , what
is the typop of Respiratory Failler ?
A-Hypoxiac RF ✅ B-Neurogenic RF C-Hypercabnic RF D-Hypocabnic RF
🍒Case senario about burn and soat in pt mouth and throat what to do ? intupation
🍓 Case of lung cancer: non smoker male with sx found nodule in the lung whats your next
step? Previous X-RAY
🌹56 Y/O non smoker , asymptotic . Discovered lung nodule during the Old x-ray
A. Come back after 6 months routine checkups , B. Repeat X-ray
🍓Dyspnea at night, sterna pain Midline mass compressed trachea :Lymphoma.
🍓Plural effusion site of thoracentesis :
A. 6th mid clavicular. B. 6th mid axillary. C. 9th mid axillary✅
ﻂÏ = رcentasis = ﺴﻌﺎâ= ﺳ|ﻨﺘﺎ.
🍓Pt came with lymph node enlargement his family concern about it to be cancer because
his son of uncle diagnosis before 3 weeks with lymphoma which think indicated biopsy:
A. It is size above 1 cm B. Came with hepatosplenomegaly
C. Tenderness. D. Fever✅
biopsy indicantion (especially if regional lymphadenopathy persistent >6 wk and/
or constitutional symptoms)Torrnot book.
Constitutional symptoms = fever, chills, night sweats, unexplained weight loss
..
.🍓After mechanical ventilation what will happen: A. hypercapnia B. hypocapnia ✅
🍓Bronchiectasis definitive dx test? HRCT ( High-resolution computed tomography(HRCT)
🍓 Smoker+hemoptysis or hoarseness =bronchogenic ca
🌹Pt came e mom ,, his cousin known case of leukemia Which lymph node enlargement
suspect ca?? Cervical of supraclavicular
pneumonia
🌹 A smoker patient presented with ???. O/E he had skin lesions in the back with some of
them being crusted. A CXR was done and showed bilateral infiltrates. How will you
manage? A-antibiotics✅✅ B-steroids C-acyclovir D-antiseptics
🌹2yrs old presented efever and cough and resp distress on exam there is
Bilateral Crackles. X ray showed both lung infiltrate e something I forget what is the
problem? Bronchopneumonia ✅
ﻧﻤﻮﻧ~ﺎ ﻣﻌﺮوف •ﻌﻤﻞ ﺻﻮت ﻣﺜﻞ ﻛﺮا™ﻠﺲ
🌹treatment of Community-acquired pneumonia? Fluoroquinolones
= ر`ﻂ =ﻧ}ﻤﻮﻧ}ﺎflu= ﻓﻠﻮﻧﺰا.
🌹Old patient develop productive cough , Fever ,Dyspnea On examination crepetion CXR
showed bilateral right middle lobe consolidationThey mention on lab Reticulocyte Cold
agglutination test What is the Dx
A. BA B. Atypical pneumonia C. Streptococcus pneumonia D. Exception of HF
🌹Most common organism causing lobar pneumonia? Strept pneumoniae
🍒 pt develop productive cough and fever given antibiotics he become ok then worsen
(SOB) sx x ray show pleural effusion dx ? A.para pneumonic effusion✅✅ B. TB C. empyema
🌹Patient has a sudden cyanotic episode while a family picnic he was previously healthy, EX
: cough and chest x ray they found trachea shifted to left , what could be the reason of
tracheal shifting :
A. Right middle lobe pneumoniaB. Right lung consolidation C. right lung collapse
...
Long scenario about pt had dialysis 3 day ago central line and now came again for dialysis
peripheral line nurse mentioned he had fever and infection in site of previous dialysis site
what to do ?
A_ culture and iv abx and stop dialysis B_ culture iv abx and remove the center line ✅✅
…
🌹51 yeard with fever, headache & neck pain= organism =Streptococcus pneumoniae 🌷
Pt with pneumonia coming with hypotension(90/60) and lethargy, pulse was 160 ,T38.5
. Dx A- sepsis B- septic shock✅
...
Pleural friction rub= Differential diagnosis = pneumonia
…
🌹what time taken for patches on x ray of Lobar pneumonia to disappear?
A.a week B.3 wks C.6 wks D.8 wks
Òçﻂ =ﺳﺘﺔ =د´ﺲ اﺑÏر
🌹 pt admitted to medical word with pneumonia pt is agetited, confused..?
A.put her in dark room alone B.keep the family C.start haloperidol D.start rispridan
🌹68 years old presented with fever, cough with yellowish sputum Oriented to TPP RR was
23, BP was normal Xray showed lobar pneumonia BUN was normal What is your
management?
A. Admit with ABx
B.ABx and discharge with 1 week follow up in the clinic ✅✅
C. Give ABx with 24h monitoring in the ER
ﻻزم ﻣﻀﺎد ﺣﻴﻮي، اﻟﻌﻤﺮŒŽ • Òçﻛﺒ
…
🌹"Interstitial pneumonitis" is a pathologic hallmark for: Viral pneumonia 🌹
Òçﻂ =اﻧﺘÏ رinter = وس •ﺪﻣﺮﻫﺎÒçﻔu ﺔuﺎﻻﺟﻬﺰة 🔛 اﻻﺟﻬﺰة ﻇﻌﺮزﺿﺔ ﻟﻠﺘﺼﺎu زر ﻣﻮﺟﻮد.
🌹features of lung cancer with SVO and ask about what type of lung cancer: Answer is:
non- small cell carcinoma 🌹
…
💐Scenario about croup, pt having barking cough, diagnosis? laryngotracheobronchitis 💐
…..
TB
🌹Tuberous sclerosis= multiple genetic screening
(( its autosomal dominant pattern of inheritance and can be caused by mutations in the
TSC1 or TSC2 gene .))
🌹Pt with TB. CXR revealed pleural effusion. How to knowledge the effusion is due TB?
A. Pleural protein over serum is < 0.3 B.Pleural LDH > 100 ✅
C. Pleural WBC > 1000 D. Pleural LDH over serum > 1/3
🌹 Indication for thoracentesis or chest tube in pt with pleural effusion:
A. protein to serum < 0.5. B. LDH to serum > 0.6. C. WBC > 1000
“ﻜﻮنLDH و% 60 ﻣﻦ², é اWBC 1000 ﻣﻦ², éا
🍒indication of thoracentesis?
A. Loculated pleural fluid. B. Ph more than 7.20C. Glucose more than 80
🍒Indication of thoracentesis? A. Glucose<60 also high PMN or PH less than 7.35
🍒Pleural effusion in RA ? Answer : glucose less than 1
Patient with ascites, he has a fever and low SAAG?
A. TB ✅✅ B. Cirrhosis ( high SAAG) C. CHD (high SAAG)
🌹Patient with ascites + fever +low SAAG = TB 🌹
Back pain + fever and xray showed calcified right sacroiliac joint, what's the most
appropriate test to order? a) PPD skin test b) Tube agglutination test
….
💐 patient with TB on drugs development paresthesia, treatment?
A. pyridoxine ✅✅ B. Thiamine C. B12
…
Which mother can give breastfeeding to her son?
A-direct breastfeeding HIV mother اB-expressed milk HIV mother
C-direct breastfeeding TB mother D-expressed milk TB mother ✅✅
…
Patient k/c of congestive heart disease and HTN on ACEI and Warfarin was diagnosed with
TB and started on 4 regimen what is true:
A/Increase Warfarin✅✅
B/Rifampicin should be stopped
Rifampicin may reduce the effects of warfarin Need to increase the dose.
............
TB patient he start to have some priks in the finger tips which been incresing what to do?
A-stop the medication B-give him pyridoxine ✅ ✔ C-give him cobalamin
….
Known case of TB after 3 months of starting antiTB medication there is elevation in LFT
what to do?
A-stop INH B-stop ethambutol C-stop rifampicin D-stop all drugs ✅✅
…
Patient on TB medications, comes for follow up after 3 weeks and shows
abnormal LFT, negative AFB, and resolution of TB symptoms, what to do?
A-Stop all drugs and repeat LFT in a week ✅✅
…..
💐TB medications has an increase in uric acid = Pyrazinamide 💐
ﻂÏ = رpyrazain = ران •ﺤﺘﺎج ﻟﻬﻢ (أﺳﺪ )•ﺨﻮﻓﻬﻢ ﻋﺸﺎن ´ﺴﻜﺘﻮاÒ• £ ( ﺑﺰران =اﻟAcid ) –ﺮة ﺻﺢè¼ ، 😂اﺳﺪ
... ..... ..
a house worker came from South Africa with bloody cough and x-ray showed cavitation
what will you do next ?
A) Give the Anti TB Med B) Do acid fact bacilli ✅
Patient post TB bronchiectasis presents with cough, hemoptysis. CXR shows right upper
lobe cavitary lesions. What is the best *initial* next step?
A- Place patient in right lateral decubitus position B- Chest physiotherapy ✅ ✔
….
🍒They asked also about pulmonary HTN grade 3 class = Fibrosis 🍒
…
🌹TB pt on meds, developed paresthesia.. what to give him?Pyridoxine
….
🍒 the type of lung cancer causing superior vena cava obstruction? Non small
cell carcinoma
🌹 Facial plethora and JVP distended, which of the following is associated
with this condition? SLCC
🍓 Case that seemed like obstructive sleep apnea. Obese patient with uncomfortable sleep
+ snoring. Has cyanosis and dyspnea best investigation= polysomnography
🍓 Sleep apnea: C-pap
🍒Patient with RA has increasing SOB and dry cough, cyanosis, clubbing, bibasal fine
crepitations = idiopathic pulmonary fibrosis🍒
🌹Patient has restrictive pattern, diagnosis? Lung fibrosis
🌹40 years old come to ER complain of SOB . He cigarette 20/day but otherwise
well. Spirometry show restrictive picture.DX A. pulmonary fibrosis B. asthms
🌹 Small lung Ca (forget if he has pain or not ) he will die before one year, ca is 3.5 normal is
1.1 what u will do for Him A. Iv normal saline. B. Iv dextrose. C. Sc Morphine(if he has pain)
🌹scenario of elderly patient who had chest inf 4 weeks ago, initially improved on antBx,
now worsened again, CXR: right pleural effusion.Dx?
A. Lung cancer. B. TB. C. parapneumonic effusion
…
#Primary prevention for TB?
A.Chemoprophylaxis B.vaccination C.Health education D. Treatment of exposure by ant tb
drugs.
…
🌹A case about a pt with pleural effusion and asks about the most
accurate test to detect TB: A. -ADA level >35. B. -AFB culture
🌹Pnuemonia symptoms and with meduim Plueral effusion :!@
A. Abx with thoracosentesis. B. Abx alone. C. Abx with acetmavir
🍒patient with s/s of pneumonia, rt. Side dullness on percussions and decreased air entry,
CXR showed middle and lower rt lobe consolidation with pleural effusion, dx?
pneomonia with parapneomonic effusion👍
🍒similar question but asking about management: IV abx + thoracocentesis✅
🍒Patient came with Fever, dyspnea, purulent cough yellow sputum , hemoptysis,
examination, marked dullness half of the right chest and decreased air entry also half of
the chest X ray: consolidation in middle and lower lobe, and moderate pleural effusion.
Best Management ?
A.IV ceftriaxone and metronidazole
B.IV, ceftriaxone and metronidazole and thoracocentesis ✅
C.Steroid
….
which of the following pneumoconiosis associated with TB or predispose to TB something
like this and the choices were : A. Silicosis B. Farmer lung. C. Asbestosis
….
Anti TB cause hyperuricemia? Pyrazinamide
…
Plural effusion case and has high interferon gamma dx?
A. Plural TB B. Pneumonia. C. Lung cancer. D. ILD
…..
Pt with TB. CXR revealed pleural effusion. How to knowledge the effusion is due TB?
A. Pleural protein over serum is < 0.3 B. Pleural LDH > 100
C. Pleural WBC > 1000 D. Pleural LDH over serum > 1/3
🌹Middle age male complains of SOB, CXR evidence of pleural effusion. Aspiration of fluid
to analysis was done. What statement of the following confirm that the pleural effusion is
exudative?
A. Plural protein/serum protein is LESS than 0.5
B. Plural pLDH/ serum LDH is MORE than 0.6
C. LDH is more the 1/3 of upper limit ..
.....
pt suspected Tuberculous pleural effusion , what is the sensitive test that support
your diagnosis :
A. AFB of pleural effusion B. High lymphocytes in pleural effusion
C. Low glucose in pleural effusion D. Elevated pleural fluid ADA levels
..
🌹Patient was diagnosed with pulmonary TB , and started 4 drugs for the treatment, he has
family history of ureteral stone. Patient presented with red urine. Lab ( slightly decreased
HB and PLT), What is the possible cause?
A. side effect of medication ✅✅ B. ureteral stone C. effect of TB on blood
🌹Elderly in ER with s&s of TB .. What is the initial action ? Isolation »ء ﻧﻌﺰﻟﻪ¼
Ž 🌹 اول
ﻂÏ = رTB ﻌﺪەyﺎ🤬 =ﺟﺎﻟﺲ ﻳﺘﻬﺎوش ﻣﻊ اﻟﻨﺎس ﻻزم ﻧﻌﺰﻟﻪ وﻧy¸ =ﺗŽ £ ¸Ž Ó .
.............
🌹pt on anti tb drug , has increased in liver enzyme after treatment , what should you do ?
stop all if more than 3 fold
.......
🌹pt has in x ray findings a cave in upper lung how this can transfer?
airborne because cavities in upper lungs = TB
........
🍓Long scenario regarding paitent with suspecting pulmonary TB effusion
confirming the diagnosis?
A. positive AFB culture in pleural fluid ✅ (acid-fast bacteria AFB) . B. lymphocytes in
pleural fluid
.........
🍓TB treatment and the drug cause High LFT = pyrazinamide is the most hepatotoxic.
…
🍓Anti TB drug cause neuropathy
Isoniazid = = ر`ﻂisolantion= iso ﺘﺌﺎبéﻋﺰل =اﻟﻌﺰل واﻟﻮﺣﺪة “ﺠ}ﺐ ﻣﺮض ﻟﻼﻋﺼﺎب واﻻ
........
🍓x ray of apical lesion and diagnosis? TB
…
● pleural TB most sensitive test:
A. Adenosine deaminase(ADA)= Sensitivity ﻂ =ادﻳﻦ =دﻳﻦ =اﻟﺪﻳﻦ ﺟﺪا ﺣﺴﺎس ﻣﺎﺣﺪ ﻳﺘ•ﻠﻢ ﻓ~ﻪÏر
B. AFB =Specificty
….
🍓Pt with suspected Tb pleural effusion which is the most sensitive:
A. + positive AF culture B. Low glucose C. High adenosine more than 45 IU دﻳﻦ =ﺣﺴﺎس
…
🌹Pt with previous TB and bronchiectasis came now with severe hemoptysis cxr show
🌹cavity of upper lobe = A. Chest physiotherapy✅ B. Pneumonectomy
🌹bronchiectasis case .. best diagnostic test: A- CT scan ✅✅✅. B- Bronchoscope.
🌹45 years old male patient smoker c/o dyspnea, hemoptysis, clubbing and other
features suggest bronchiectasis. What is the height diagnostic test of value?
A. CXR B. Bronchoscope C. high resolution CT
...........
🍒 TB with Plura effustion wich sensitive finding in tapping ?
A. LDH✅. B. ADH
🍒 Plura effustion analysis show interferon gamma Dx?
A. TB✅. B. mesothelioma. C. para pneumotic. D. empyema
🍒pt RA with Plura effustion which of following typical for RA ?
A. transudate. B. high PH. C. glucose less than 1✅. D. haemorrhage
will cause exudative effusion -> low glucose and pH
🍒Which of flowing risk for TB? A-Silicosis ✅ B-Asbestosis
…
🍒Before starting ant tb meds what to order =LFT
…
🌹 Pt on TB medication present with hyperuricemia and ask about the drug that cause it ?
Pyrazinamide = ﺎﻳﺮازu= ﻂÏ رpyraz = = ﺑﺮازuric= urin .
….
🌹another tb q ask what to do firs= Isolation 🌹
......
🌹Another tb q about mode of transfusion:= . Airborne 🌹
.....
🌹And another tb q and what's the management: = RIPE( the four drugs) .
= rifamycin isoniazid, pyrazinamide, and ethambutol.
... ....
🌹And another tb with parents have tb and child ppd is 10mm= Positive 🌹
..
🌹Indian with history of Tb presented with elevated JVP and hepatosplenomegaly:
. Constrictive pericarditis
.....
🌹Patient diagnosed with TB and stared on anti tb medications, which of the following
might increase his creatinine? A. -Isoniazid B. -rifampin✅ C. -ethambutol D. -pyrazinamide
......
🌹Indian patient known case of TB, he has tb bronchiectasis, came with fever, dyspnea
and massive hemoptysis, x-ray: right side infiltrate, What’s the best next appropriate
management? A.Pneumonectomy B.Chest tube
C.lateral decubitus position on the site of healthier lung.
....
🌹patient diagnosed with TB, What is the most important thing to do before starting
treatment: A. start B6 B. Do LFT
....
🌹TB How to Diagnose: Sputum culture
…
🌹 TB pt what is the medication increase liver enzymes ?! INH
..
🌹Patient with Signs of Symptoms of TB but they didn’t give the diagnosis, and he had
pleural effusion, what is the cause of his pleural effusion:Tubercles Pleural Effusion
…
🌹 Interstitial pneumonitis is characteristic for what?
A. Viral pneumonia B. Bacterial pneumonia C. TB D. Bronchopneumonia
...
Patient on ACEI,BB,CCB “I forgot the name of medication”and warfarin , dx with TB, on
quadra medication, what you will do:
A. Stop ACEI B. Increase dose of warfarin C. decrease dose of rifampicin
<
ﻻن دواءRifampicin ; ﻋﻼج: ﺴﺘﻌﻤﻞš 9: اT.B &ﻦ ﻓﻨﺤﺘﺎج ﻧﺰود اﻟﺠﺮﻋﺔ%ﻘﻠﻞ ﻣﻦ ﻛﻔﺎﺋﺔ دواء اﻟﻮارﻓ2 .
....
🌹pleural fluid analysis shows exudative fluid witn high gamma interferon level
dx? A. empyema B. mesothelioma C. TB D. paranumatic effusion
...
🌹diagnostic invx. for Trachomalsia? brochioscopy.🌹
…
Case of smoker with 3 months hx of dyspnea and productive cough
hemoptysis OE course crackles : Which have highest diagnostic value
A. PFT. B. High resolution CTÖ
1Renal disorder
🌷 Pt with bilateral hydronephrosis with dilated bladder and proximal
urethra? A. Posterior urethral valve B. Uretropelvic occlosion
🌹the best way to take sample of urine in UTI = A-Midstream sample ✅✅ B-24 hour ..
🌹Pt with aspirin toxicity, what is the most important next step in management:
A. activated charcoal B. urine alkalinization
🌹 Case of pyelonephritis + Nitrate in UA, what the best next step?
A. Oral Abx B. Iv Abx C. US of urinary
🌹Foley catheter for 4 days + pt took paracetamol and codeine, came later with fever and
the nurse noted a cloudy urine what is the cause? A. Codeine B.Foley catheter ✅✅
🌹Patient on foley catheter developed cloudy urine, how to prevent such events?
Daily check up for need of new foley catheter
🌹when we say this pt have ( resisitent to steroid in nephrotic syndrom ??
When 4 weeks with daily steroid and no response ) 🌹
)
ايW% ﺪ وﻣﺎ6وAB ـﻊ اﺳﺎﺑﻴﻊ ﻣﺘﻮاﺻﻠﺔ ﺳﺘQﺾ اﺧﺬ ار65 ﻟﻤﺎ &ﻜﻮن اﻟﻤ،ﺐ ﻓﺎ&ﺪة؟؟Fﺪ وﻣﻮ ﺟﺎﻟﺲ &ﺠ6وABﺾ ﻋﻨﺪە ﻣﻘﺎوﻣﺔ ﻟﻠﺪواء اﻟﺴﺘ65( ﻧﻘﻮل اﻧﻪ اﻟﻤ,( ﻣ% ) &ﻌ
ﻢfﻄQ5ﺎرات ﻣﻤﻜﻦ ﺗﺨFﻻن اﺧﺘ. ـﻊ اﺳﺎﺑﻴﻊQﺎ ارb اﺣﻔﻈﻮوو،. ﺔ وﻻ ﺗﺤﺴﻦY اﺳﺘﺠﺎ.
🍓nephrotic and asking about which common type Answer is =
Minimal change > Pediatric FSGN > Adult
🍓Pt with nephrotic syndrome taking medication how can you know that the disease
remission ? A. Disappear Albumin in urine✅ B. Disappear of true edema
🌹Nephrotic syndrome first line Tx?Steroid 🌹
🌹Nephrotic pt, which of the following will decrease proteinuria = A. ACEI. B. prednisone✅
🌹Long case about a patient with edema Urine analysis: Oval fat body, some hyaline cast.
Occasional RBC case. B. Nephritic syndrome. C. NephrOtic syndrome. ✅✅
NephrOtic= Oval == ﺣﺮفO ¦ ƒ § = ﺳﻤFat
🌹When to consider a nephrotic syndrome is a cortisone resistant:
4 weeks of daily cortisone
%
ونF% G ﻪ اﻧﻪ ﺣﺼﻞ ﻣﻘﺎوﻣﺔ ﻟﻠ—ﻮرﺗSﺪا ﻫﻨﺎ •ﺴﻤqﺔ اq اﺳﺘﺠﺎ$& ون وﻣﺎF% G ـﻊ اﺳﺎﺑﻴﻊ ﻛﻮرﺗn اذا اﻋﺪﻳﺘﻪ ار، ـﻊ اﺳﺎﺑﻴﻊ وﻟ‘ﺲ ﺷﻬﻮرnﺘ•ﻪ اﻧﻪ ارŒﻧ
🌹 Typical case on nephrotic syndrome ask about highly diagnostic test =
A. . Serum albumin B. . Us. C. . Urine total protein✅ D. . Electrolytes
…
....
🌹Pt with urine leaking and can't control stream, bladder distend after voiding?
A. stress incontinence. B. overflow incontinence
C. Reflex incontinence D. urge incontinence
🌹Male pt with hx of right knee pain and swelling, left ankle pain and swelling, for
6 month. Previous hx of UTI 2weeks prior to symptoms, what to give?
A. methotrexate B. cyclosporin C. Sulfasalazine for(RA) D. Azithromycin
1Headache
🍓Clear case with headache that is thropining and unilateral aggravating with light and
movement : migraines .
🌹frontal sinus headache how to reach the diagnosis.
A. -full history and examination✅ B. -CT sinuses ﺎﻟﺘﻔﺼ~ﻞ اﻟﻬﺴﺘﻮريu »ء¼
Ž ﻻزم اﻋﺮف اول
🌹Female, with 6 months headache, unilateral, mild relieved to NSAID, now came with
nausea and vomiting, neuro and fundus examination normal, how to reach diagnosis?
A.CT B.MRI. C.Electroencephalogram D.Hx and examination l✅
........
🍓Patient with acute migraine What is the treatment? Triptan
ﺘﻮنéب ﺷﺎي ﻟﻴè¼ﻂ ﺻﺪاع ﺷﺪﻳ|ﻴ~ﺪ =اÏ ر. Triptan .
🌹 patient experience the worst headache this morning after trying to pick up his keys =
Subarachnoid hemorrhage 🌹 ﺻﺪاع ﻗﻮي ﺟﺪا، ﻠﻬﺎ¢ ¨6 © ﺎ#„ ﺣ6 4 ﻘﻮﻟﻚ ﺣﺴ ﺖ ب اﺳﻮء ﺻﺪاع ﻣﺮ7 ، ﻒ اﻟﻤﺦž‹4 4 ﻟ£ﻠﻤﺔ اﻟ¢ .
🍒 There was a tricky Q about pt develop sudden headache when he was bending to take
his keys from the ground, describe it as severe headache in his life which is the most likely
Dx? A. subarachnoid Hemorrhage✅ B. cluster headache .
🌹 A young female presents with unilateral throbbing headache. Her headache is associated
with nausea and vomiting. She tells you that she is sensitive to light. Which of the following
is used for acute treatment?A. Aspirin B. Triptan✅ C. B-Blocker D. O2
🌹headache in child band like , throbbing , with stress at school dx = Tension headch 🌹
.........
headache at 3 am with eye symptoms what is best prophylaxis ? Verapamil ✅
( Cluster headache = Verapamil = this drug is its calcium channek block , it can treat this
type of headch)
ﻣﻨﻄﻘﺔ وﺣﺪةŒŽ • ¢ • • • •
Ž £ • اﻟﺴﺪاعýŽ وﺣﺪة •ﻌñçﺎ ﻋy ﻣﺪﻣﻌﺔ وﺣﻤﺮاء وﻏﺎﻟñç ﺗﻜﻮن اﻟﻌñç اﻟﻌ¤ •ﺎﺛﺮ ﻋ، ﻓ~ﻪ ﺻﺪاع ﻣﻦ ﻗﻮﺗﻪ
؟ñ• ç •ﺠ~ﻚ ﻣﻌﻪ اﻋﺮاض ﺗﺼ¨ﺐ اﻟﻌÐ ا´ﺶ اﺳﻢ اﻟﺼﺪاع ﻫﺬا ا، ñ • ç ﺟﻨﺐ اﻟﺮأس وﻧﺎزل ﻟﻠﻌ¤ﻋ
Ž
Cluster headache .
🌹headache at 3 am with eye symptoms what is best prophylaxis=Cluster headache
=Verapamil = its calcium channek block 🌹 ÒÓﺎﻣ~ﻞ =ﻛﺮاﻣ~ﻼ و„ﺎﺳuاÒç =ﻓÒç =„ﺎﺳﺘÒç„ﻼﺳﺘ.
🌹Pt came with headache for 2 days 3 times in months between eyes (cluster headache)
A. ct B. Carfual history ✅
.......
🌹Answer is :Crohn's disease case with ilium 1 stricture in and ultrasound: how
to manage ? Management of crohn’s strictures
Single <5 cm without any complications > endoscopic dilatation.
Long ≥5 cm, multiple, diffuse or recurrent > Strictureplasty.
Complicated or multiple strictures within a short segment of the bowel, in ileocaecal
junction> Small bowel resection
🌹One come for consultation he is a smoker he said his brother have crohn's disease he is
afraid of he’s chance of having it ; what’s the risk factor:
smoking increases the chance of having it and smoker protective in UC
🌹 Pt has chron illeocecal since 3 months he started on steroid and pentasa from 3 weeks,
he is complaining of anal discharge and fistula what is the tx u wanna give him
A. Methotrexate B. Azathioprine C. Infliximab
🌹crohn's diseases patient with perianal abscess on infliximab and azithromycin. Mx?
A.Increase infliximab dose and decrease frequency B.IV antibiotics ✅✅ like =Cipro,
metro. C. perianal swab
🌹extraintestinal symptom of crohn Disease :
A- Erythema nodosum B- Erythema gangrenosum C- Erythema marginatum
🍒Pt that is taking steroid for her IBD crohn came with bilious vomiting abdominal
distention ,abdominal pain and tenderness in the RLQ area on imaging she has single
stricture I cm proximal ileocecal valve what you will do? ==crons strictuur (Resection) .
🍒 crohn came with bilateral anterior shin raised tender nodules = Erythema nodosum
… = ﻛﺮون =ﻣﻜﺮوﻧﺔnodosm = 🍝🍝🍝 ﻧﻮدل
🍒🍒weight loss over 2 months. Ilieal biopsy showed noncaseating granuloma = Crohn
..
🍒tender lesions on shin .....with what? A. coelia B. crohn✅erythema nodosum”
🌹 Women who has progressive Dyspnea and fatigue, on auscultation she has fine
crackles, while examining her legs she has tender red induration on her shin . What is the
best next step? A. Oral steroid B. Chest x ray ✅
Erythema nodosum= characterized by inflammation of the fat cells under the skin, resulting
in tender red nodules or lumps that are usually seen on both shins.
🍓 Case of bloody diarrhea biopsy shows transmural inflammation where is the most
common site ? ileum
🍓 common site for Crohn’s disease? ileum colon
🍓 patient with abd. pain, fever, endoscopy showed ulceration transmural but in patches
(not continuous), the lesion most likely affecting which part of GI :
A- jeujenum. B- ileum ✅✅== crohns C- colon D- Rectum
cronhs ...... اول ﻣﺎ ﺗﺷوﻓوﻧﮭﺎ اﻋرﻓوا ﻋﻠﻰ طول ﺗﺷﺧﯾص اﻟﻣرض ھوpatches* lestion* ﻧرﻛز ﺑﺎﻟﺳؤوال ﯾﻘوﻟك
🍓 Male with non bloody dirrhea, pale, oral ulcer? This is the exact question with no extra
info! A. Crohns = Oral ulcer > Crhons B. ilcerative C. IBS D. Celiac
ح {ﺎﻟﻔﻢvﻪ =ﻗwv ر`ﻂ =ﻛﺮون =ﻛ.
🍒Pt known case of crohn's did terminal ileum resection complain of diarrhea what to give?
A.B12✅✅ B.Prednisone. C.Azathioprine
Etiology Vitamin B12 Deficiency = crohn's.torrnot book.
🍓 Risk factor of crohn's disease? A. smoking B. being male
🌹Crohn's disease, the most common site ? A. Was written ileocolic not ileocecal “it is the same”
🌹Patient came with diarrhea in biopsy it is transmoral ask dx = Crohns
🌹 Poorly controlled diabetic patient care with right sided eye ptosis and difficulty
in adduction and elevation of Single stricture in terminal ileum 1 cm away from
ileocecal valve mange? A. stricturoplasty B. resection with ileostomy
🌹 -pt have chron and Anemia feature was? Vit B12
🌹Ulcerative colitis ercp done shows intra and extra hepatic bile duct strictures. What is the
dx? A. Primary sclerosing cholangitis B. primary biliary cirrhosis C. choledocal cyst
🌹Ulceritive colitis , investigations : A- TFT B- CT abdomen C- Celiac disease
🌹One had diarrhea and he lost wt becoz of that it was for 3 months Otherwise he is free U
would give him ? A. Anti biotic B. Anti diarrhea. C. Ante parasitic
🌹Young male patient care with chronic bloody diarrhea, joint pain and skin rash
what’s the most likely diagnosis? A. Crohn's B. UC C. IBS D. Enteric fever
🌹Pt With hx of UC , developed single stricture in 1cm proximal to iliocecal valve how to
Mx? - Right hemicolectomy - Observe - Resection of stricture✅
🌹- patient with history and physical examination of Ulcerative colitis asking about
common site of UC? A-Ilium B-Jejunum C-Rectum
……
1Autoimmune disease
🌷The following is a contraindication to IVIG A.Hypernatremia B.Anemia C.Increased CRP
🌹female patient with *positive Anticardiolipin antibody* and other symptoms, what is
the diagnosis? Antiphospholipid syndrome ✅ ✔
ﻟﻣﺎ اﺟﻲ اذاﻛر ﺷﺎﺑﺗر اﻟﻘﻠب ﻻزم اﺟﯾب ﻣﻌﮫ ﻓﺳﻔس ﻋﺷﺎن اﺗﺳﻠﻰ واﻧﺎ اذاﻛرanti phospho ) ( وanti cardio رﺑط
...... ..... .... ف ﻧﺟﯾب ﻓﺳﻔس، ﻻن ﺷﺎﺑﺗر اﻟﻛﺎردﯾوا ﺻﻌب وﯾﺑﻐﺎﻟﮫ ﺷﻲء ﯾﺳﻠﻲ
🌹Whats indicate poor IVIG response?
A. Anemia B. Neutropenia C. High CRP✅ D. Hypernatremia
🌹 –Guillain Barré syndrome trat by = intravenus immunoglobulin (not A- plasma
exchange or plasmapherases🌷
🌹 Pt with ascending limb weakness with history of gastroenteritis 3 weeks back
“ GBS “ what’s the prognosis of these diseases:
A. deterioration B. resolve with weakness C. full recovery✅
🍒peripheral muscular weakness history of infectious befor 3w? Guillain barre syndrome
…….
🍒 (Myasen gravies case ) pt well morning and deteriorating through out the day
Ask about pathophysiology of MG? autoantibodies to ach receptors ✅ 🌹
🍒male with typical m*y*asthenia gravis, what to prescribe:
A- rivastigmine B- ph*y*sostigmine ✅
🌹Bilateral ptosis, upper and lower limb weakness, Simpson test +ve, edrophonium test
performed and ptosis improved (I think), what medication to gave?
A. pyridostigmine ( myasins gravis).
…….
🌹 Vitiligo pathogenesis = Autoantibodies against melanocytes 🌹
🌹55 yo man diagnosed with acromegaly what investigation will be required in the future?
A. TTE B. colonoscopy (Acromegaly increase risk of colonic polyps and colorectal cancer
🌹Case about Acromegaly. what should be done for the patient ?
A _ Echo ✅✅ Bez risk of Heart failler. B.colonoscopy
🌹 Case about Acromegaly, what you will do for management?
Transphenoidal resection ✅ ✔ Transsphenoidal surgery is used to remove tumors of the pituitary gland
goodpasture , Wegener
🌹Tt of goodpasture syndrome dyspnea, cough, fatigue, hemoptysis, and hematuria?
A. Steroid B. Blood transfusions C. Cyclophosphamide
🌹Hx of recurrent sinusitis presented with hematuria = Wegener
🌹 Hematuria hemoptysis= Goodpasture syndrome
🌹AKI + hemoptysis + * recurrent sinusitis + saddle nose * = WEGNER
🌹AKI + hemoptysis = Goodpasture
🌹Nephritic syndrome clinical pic then develops hemoptysis what is the likely cause:
Goodpasture syndrom
4 Œ „ اﻟﺮﺋﺘ4 ﻒ ﻣﺘﻜﺮرž‹4 4 ‹ ﺑ4 Œ ﻳﺘﻤ: ﻣﺘﻼزﻣﺔ ﻏﻮدا
•¯ـ ـﻊ ﻟﻠž£ اﻻﻟﺘﻬﺎب اﻟ5¬ )ﺎﻻﺿﺎﻓﺔ إ
) ) 6
** ﻓﻬﻨﺎ اﻟﺮئ، ﺔFﻠlﺎﻟY ﻔﺮﺗﻚFﻨﺎ ﻗﺎﻟﻚ ﻛﺤﺔ ﻓﻴﻬﺎ دم و ﻋﻨﺪە ﻣﺘﻼزﻣﺔ ﻧb** ﻣﺘﻼزﻣﺔ ﻏﻮداW% اﻟﺮﺋﺔ ﻓﻜﺮ ﻓﻮراW% ﻠﺔfﺔ ﻣﻊ ﻣﺸFﻠlﺎﻟY ﻠﺔfاذا ﺷﻮﻓﻨﺎ ﻣﺸ
)
ﻣﺘﻼزﻣﺔ ﻏﻮداW% ﺔ ﻓﻴﻬﻢ اﻧﺮاض ﻓﻮرا ﻓﻜﺮFﻠlواﻟ
🌹IgA Nephropathy (Berger Disease)= Look for an Asian patient with recurrent episodes
ofgross hematuria 1 to 2 days after an upper respiratory tract infection (synpharyngitic).
This actually helps . Treat by 🍯🍯== Thirty percent will completely
resolve. ((Support )).🌹 but if there is ( sever protinuria gove ACEI. )
²§ ر`ﻂ =اﺳﻤﻬﺎ ﺻﻐIg ¦ ƒ § ﺲ ﻳﻮﻣñ= îƒ “ﻌIg + ﺣﺮفA = اول ﺣﺮوف اﻟﻬﺠﺎءUper resp = ء ﻓﻮقÔÕ “ﻘﻊ اول.
o o
Iga = Ig= 2 days = A = upper resp
...
🌹Goodpasture also presents with lung and kidney involvement just = Treat with
plasmapheresis and steroids. Cyclophosphamide can be helpfu🌹
/o ﺸò ﺸﻮف ﻣﻜﺮوﻧﺔ {ﺎﺳﺘﺎ {ﺎﻟﺠﺒﻨﺔ واﺷ}ﺎءï ﻟﻤﺎgood pasture = 🍝🍝 ﻧ÷ﻨﻔﺲ {ﻘﻮة ﻣﻦ اﻟﺤﻤﺎسlung ﺪءxوﻧ
-eﻖ اﻟwvﻞ ﻋﻦ ﻃkﺬا اﻻ¹ واﻟﺠﺴﻢ ﻳﺘﺨﻠﺺ ﻣﻦ، ﻞk ﻧﺎkidney
.......
🌹Wegener granulomatosis (WG), there is no upper respiratory tract involvement. But
there is skin, joint, GI, eye, or neurological involvement.🌹
🌹diagnosis and symptoms of granulomatosis with polyangiitis = is: Wegner’s:
Hematuria; hemoptysis; sinusitis & URTI. ✅✅✅
🌹Scenario of patient with hematuria, pulmonary hemorrhage ,recurrent sinusitis and
numbness in Rt Upper limb and Lt lower limb ( they didn't mention any Rash )
A. Polyarteritis nodosa. B. HSP C. Giant cell arteritis D. Granulomatosis with polyangiitis✅
......
Goodpasture also presents with lung and kidney involvement just
ƒ § ﻣ”ﺎﻧmƒ ﻮا ﻓﻘﻂ ﺣﺼﻞ ﻟﻪ ﻣﺸ”ﻠﺔwﻨﺎرÛﺸﻮﻓﻮە {ﺎﻟﺴò ﺬا اﻟﻤﺮض¹
ﻣﺜﺎل-eﻤﺎ {ﺎﻟﺮﺋﺔ واﻟ¹¦ ﻻ ﺛﺎﻟﺚ ﻟﻬﻤﺎ و o
(hemoptosis and hematouria ) = The best initial test is antiglomerular basement
membrane antibodies = Treat with plasmapheresis and steroids
……
🌹 IgA Nephropathy came after 3 days of URTI = Supportive
🌹 Child had urti one day next develop hematuria ?
A-psgn B-IgA nephropathy✅✅
🌹child with upper resp tract infection then devlop hematuria = IgA nephropathy ( Berger's
disease) 🌹
IgA . ﻋﻠﻰ طول ﻓﻛروا بhematuria وﺑﻌدھﺎ اﺻﺎب بupper resp infection اذا ﺷوﻓﺗوا
upper = = اول اﻟﺣروفA = رﺑط
SLE
🍓Pt with malar rash, chest infection , anemia , renal impairment, what’s the dx:
lupus nephritis
🌹 SLE on medication came with active arthritis =A. Steroid. B. Hydroxy. C. Cyclo
Mild to moderate > hydroxy. Severe > steroids
🍒🍒They asked about the mechanism of action of one DMARD : Slow the progression
(Disease-modifying anti-rheumatic drugs (DMARDs)
…
🍒🍒 Heart block? .SLE🍒
…
🌹 Which of following is coming with criteria of SLE = hemolytic anemia
🌹critairia of SLE ?? autoimmune Hemolytic anemia 🌹 ( Not wight loss)
…
🌹SLE Obese + on hydrochloqin + whats will less effective of treatment or poor pronosis ?
Smoking 🌹
…
🌹Pt have SLE with neurological manifestation, pt already on corticosteroids what to add
now = Cyclophosphamide ( Not Phenytoin) 🌹
…
🌹The most common medicines known to cause drug-induced SLE = Isoniazid.
Hydralazine.✅ ✔
...... ...... ....
🌹Coomb test diagnosis what? Autoimmune hemolytic anemia 🌹
…
🌹Relation between smoking and SLE ? exacerbate the symptoms 🌹
🌹Pt has SLE s&s and he cames with I think on urine there is RBCs or red cast= .Lupus
nephritis 🌹
..
🍓SLE symptoms with protein in urine the : Lupus nephritis
..
🌹Known case of SLE, asymptomatic for years i think, presented with lupus nephritis
manifestation, urine analysis normal, next step? A. US B. Renal biopsy
….
🌹Pt with RA, on methotrexate was in remission, her Liver function tests previously was
normal. But upon this follow up, her LFTS were elevated, next step?
A. Start glucocorticoids B. Stop methotrexate✅
🌹Obese women RUQ pain jaundice puritus know SLE on Hydroxychloroquine Gtt and
indirect high , AST: 700 ALT: 700 AlP: high Bright echogenicity Liver, They did a Biopsy and
they find (interface hepatitis with plasma cell) what what is management ?
A_Prednisolone B_Methotrexate
….
🍒Pt SLE nephritis What to give now = steroid + cyclophosphamide
......
🌹SLE with arthritis on NSAID , hydroxychloroquine what to add?
A. Methotrexate B. azathioprine. C. cyclosporine
..
🌹 Patient known SLE, came with pale skin and fatigue, Labs Hb 10(low)
and ferritin 600(high), what is the cause?
A. Hemolytic. B. iron deficiency anemia ÐŽاﻟﺤﺪ•ﺪ ﻋﺎ. C. anemia of chronic diseases\
🌹pt came with fever ,pleuritic chest pain and arthritis in small joints Labs.showed high
both CRP ER dx? A. SLE B.infective endocarditis C. RA with vasculitis D. PE
🌹Case of post viral petechiae and other symptoms, What to expect in bone marrow?
Increased megakaryocytes 🌹
Child 10 years old , abdominal pain , jaundice since 3 days Lab show high AST and ALT and
indirect bilirubin, Dx? a) Gilbert syndrome ﻦÏﺔ اﻟﺒ~ﻠﻮروyﺴD ﻦ ﻳﺮﻓﻊÄﺪ وﻟyÄ ﻻ ﻳﺮﻓﻊ اﻧ—–ﻤﺎت اﻟb)
Infective hepatitis ✅ ﺪ واﻟﺒ~ﻠﻮروبyÄﻳﺮﻓﻊ اﻧ—–ﻤﺎت اﻟ
🌹Child 10 years old , abdominal pain , jaundice since 3 days Lab show high AST and ALT
and indirect bilirubin= Infective hepatitis 🌹ﻦÏﺪ واﻟﺒ~ﻠﻮروyÄﻳﺮﻓﻊ اﻧ—–ﻤﺎت اﻟ
🌹 indicate prognosis in hepatitis: decreas Albumin + high INR +high bilirupin .
…..
🌹Recurrent axillary infection with multiple sinus most common cause?Hair follicle🌹
. . . . ..
Pt with DM and RA, has bone pain and hypercalcemia, high renal function test . What’s the
diagnosis? A. DM nephropathy B. Amyloidosis✅✅ C. Membranous GN
• •
ﻻن ﻣﺎدةamyloid ¤6 اﻟŒŽ ، „ﻞ ﻣ•ﺎنŒŽ ﺳﺐÒÓ اﻟﻤﻬﻢ اﻣ~ﻼ•ﺪ ﻫﺬا ﻳ، ﺖ ﻟﻪ اﻟﻢ ﻓﻴﻬﺎyé ﻓﺴ، ﺗﻄﻠﻊ ﻣﻦ اﻟﻌﻈﺎم
ﺐ ا´ﺶ اﻣﺮاض ﻣﻨﺎﻋ~ﺔ اﻫﻤﻬﺎÞﺴ7 ¢ Ž £ • ﺎyﺪ ﻏﺎﻟyÄ واﻟﻘﻠﺐ واﻟ، ¤6ﺎﻟu ﺐ ﻓﺸﻞÞﺴÛﺎﻟﺬات ﻓu RA
….
🍒Left eye unable to abduct, when looking forward there’s squint towards the
nose which nerve affected: left 6th🍒
....
Pediatric patient with eczema, bruising and repeated infections, his uncle and other male
relative has same problem, diagnosis? wiskott aldrich syndrome
🍒🍒eczema, bruising and repeated infections = wiskott aldrich syndrome 🍒🍒
ﺴﻜﻮتE ﻣﻊ و¢ ô
Ž £ • ÐŽ¸ اŽ = اﻟﺜﻼthrombocytopenia + Eczemia + repeated infection
............
Child with recurrent URTIs , eczema and thrombocytopenia both brother and uncle have
the same condition: Wiskott aldrich
..
child presented With recurrent chest infection and eczema and had family history of same
condition in uncle= Wiskott aldrich
…
🍒🍒child With unkonwn liquid paracetamol, patient was observed for 4 hours and was
stable, asymptomatic, what to do? observe for other 4 hours🍒🍒
..
1Rumatic RH
Question about rheumatoid arthritis and itʼs effect on pregnancy:
A) abortion✅ B) somthing antibodies C) retardation
# rheumatoid arthritis induce abortion.
🌹Patient with RA and has lung symptoms (dyspnea and other symptoms):
A. bronchogenic cancer B. Pulmonary fibrosis C. caplan syndrome ✅
🍒Caplan disease or rheumatoid pneumoconiosis) is a combination of rheumatoid arthritis
(RA) and pneumoconiosis that manifests as intrapulmonary nodules,🍒
🌹A lady with Rumatic arthritis that has progressed what marked is needed to confirm?
Anti- CCP (Anti-citrullinated protein antibodies)
.....
🌹What of these is the minor criteria of jones criteria of rheumatic fever :
Fever , arthralgia , Prolonged PR interval , High CRP and ESR , leukocytosis.
🍒What is of these criteria is minor jones criteria ?
A. syndenham chorea B. erythema marginatum C.fever✅
🌹multiple joint pain and subcutaneous nodules = Rheumatic fever = anti ASO 🌹
🍓Case of rheumatic fever with painful nodule.and fever and joint pain ///what
investigation to order = Culture Throat culture or ASO
most common complication after strep throat is: (rheumatic fever not in choices)
A- scarlet fever B- post strep. GN ✅✅ C- pharyngitis
.... .....
… Celiac…
🌹 Long scenario child with LL edema, periorbital, has fever and lethargy with dark urine
and protein in urine what else u would ask for?
a. history of sickle cell anemia b. impetigo 1 month back✅ c. recurrent uti
1Radiology
🌹 Case of 30 years old asymptomatic found accidentally lung mass
measured 7*8 mm everything is normal examination and Inx what most
appropriate management :A. Take biopsy. B. Repeat CT 3 to 6 month. C. Reassurance
🌹 Patient with headache that comes and goes a lot during the month and it is usually on
the left or right sinus she used over the counter analgesic decongestants but didn't help
she complains now of severe headache she's otherwise healthy with no symptoms what
will you order to confirm the diagnosis: A/ESR B/CT of paranasal sinuses✅ C/MRI
infection او، tumor طﯾب ﻟﯾﮫ طﻠﺑﻧﺎ اﺷﻌﺔ ؟ ﻋﺷﺎن ﻧﻌرف اﯾش ﺳﺑب اﻟﺻداع اﻟﻣﺳﺗﻣر واﻟﺷدﯾد ﯾﻣﻛن ﯾﻛون ﻓﯾﮫ
، c.t paranasal ﺛﺎﻧﯾﺎ ﻧرﻛز ﺑﺎﻻﺧﺗﯾﺎرات ھو ﺣدد، ﻓﻼزم اﻋﻣل اﺷﻌﺔ ﺣﺗﻰ اﺳﺗﺑﻌد وﺟود ﻣﺷﻛﻠﺔ وﺣﺗﻰ اﻛﺗﺷف اﻟﺳﺑب
وﻟﻠﻌﻠمC.T paranasal . ﺑﺷﻛل ﻋﺎم ﺑدون ﻣﺎﯾﺣدد ﻟﻲ اﻟﻣﻛﺎن ﻓﻧﺧﺗﺎرMRI ﻛﻣﺎن ﯾﺳﺎﻋدﻧﻲ ﺑس ﻻن ﻗﺎلMRI ﻻن
sinus headch .....ﺗﺷﺧﯾص ھذه اﻟﺣﺎﻟﺔ ﯾﺳﻣﻰ ب
🌹 Elderly with liquid dysphagia and ask about valuable diagnostic tool ? Endoscopy
🌹 pt with loss of wt and vague epigastric pain for 3 months and loss of appetite :
Endosopy✅ () اﺣﺘﻤﺎل ورم. CT Mri
🌹 Dr decided to manage the pt by US guided percuteness drainage, how should take
concent? GS resident. – Radiologist - Medical intern - Any one of medical team
.....
🌹) 70 y/o with multiple hepatic masses seen by CT, what is the next step =
Repeat CT. Biopsy. Colonoscopy ✅ MRI
ﻟﯾﮫ اﺧﺗرﻧﺎColonoscopy ﻻن ﻏﺎﻟﺑﺎ اﻻورام اﻟﻲ ﺗﯾﺟﻲ ﻓﻲ اﻟﻛﺑد ﺗﻛون ﺑﺳﺑبmetastasis ﯾﻌﻧﻲ ورم طﻠﻊ ﻣن ﻣﻛﺎن وﺣﺻل ﻟﮫ اﻧﺗﺷﺎر وﺧﺎﺻﺔ ﻟﻣﺎ ﻗﺎل
multible mass ف اﻧﺳب. ﻓﻣﻣﻛن اﺻل اﻟورم اﻟﻲ اﻧﺗﺷر طﻠﻊ ﻣن اﻟﻘوﻟون وﺣﺻل اﻧﺗﺷﺎر ﻟﻠورم وراح ﻟﻠﻛﺑد ﻓﻼزم ﻧﻌرف اﺻل اﻟورم ﻣن ﻓﯾن طﺎﻟﻊ
ﺑﺎﻗﻲ اﻻﺟوﺑﺔ ﻣﺎﻟﮭﺎ داﻋﻲ ﺧﻼص ﻋﻣﻠﻧﺎ. ﺟواب ھو ﻓﺣص اﻟﻘوﻟونc.t ﻟﯾﮫ ﻧﻌﯾده وﻟﯾﮫ ﻧﺧﺗﺎرMRI وﺧﻼص ﻧﺣﻧﺎ ﻋرﻓﻧﺎ اﯾش ﻣوﺟود ﺑﺎﻟﻛﺑد..... . . .. . . .
🌹Case of diaphragmatic hernia first step in order to diagnose? Cx ray✅✅
🌹patient with symptoms and signs of alcoholic and deep breathing initial test?
A.Alcohol concentration in blood✅✅ B. Patient rebreath in bag
🌹case of cardiac tamponade how to dx? -echo✅
🌹 Long scenario: Radiologist asked by the treating team to do Ct guided Fluid aspiration,
Who should get the informed consent? A- Radiologist✅ B- The resident from the treating
team C- The nurse
🍒 Pt 55 years old Dm and Htn complain of thigh swelling and tenderness have previous
history of trauma in same area before 3 month what is the initial investigation ?
A. us B. xray✅
- P'tient post resection and colostomy presents with spiking fever for 1 week. Chest is
clear. Abdomen is clear. Wound is clear. Fever 38.2 oC. Next step?
- CT abdomen✅✅. - Reassure
🌹 +40yo female presented with dyspnoea, dry cough, reddish nodules on both of her
shins, fine crackles on auscultation. What is the appropriate management?
A. Montelukast B. salmeterol C. Steroid
ﯾﻌﻣل اﻟﺗﮭﺎب ﺑﻛل ﻣﻛﺎن ﺑداﯾﺔ ﻣن اﻟﻌﯾن ﺗﻛون ﻣﺣﻣرة ﺛم اﻟرﺋﺔ ﺗﻌﻣل ﺿﯾق ﺑﺎﻟﻧﻔس وﻛﺣﺔ ﺟﺎﻓﺔ ﺛمsarcoidosis ﻣرض
ف اﻓﺿل، ﺣﻣراء ﻣؤؤﻟﻣﺔ ﺛم اﻟﻣﻔﺎﺻل ﺗﻌﻣل ﻓﯾﮭﺎ اﻟﺗﮭﺎبnodule ﺛم اﻟﺟﻠد ﺗﻌﻣل، اﻟﻛﺑد واﻟطﺣﺎل ﺗﻌﻣل ﺗﺿﺧم ﻓﯾﮭم
steroid ..=ﻋﻼج ﯾﻘﻠل ﻛل ھذه اﻻﻟﺗﻌﺎب
….
….
💐💐A man his chest x-ray shows opacity in the apical lobe, what to do? review previous x-
rays 💐💐
…
💐Where to put midaxillary Thoracentesis? 8th to 10th intercostal space 💐💐
…
🌹coarction of aorta ( radial pulse more than femoral whats the nexst = = X.ray
< _ ﻪ اﺧﺘﻼف <; اﻟﻨ•ﺾ ﺑw اول ﻣﺎ ¦ﺸﻮﻓﻮن اﻧﻪ ﻓradial and femoral ﺎ~ﻢ ﺗ«ﺴﻮﻫﺎ2 ا، ªﻪ ﻛﻮرا©ﺸﻦ اورw ﻓﻜﺮوووووا ﻓ. 🌹
¨ :
. . . ..
🌹Elderly with central line swab E coli what do: Remove central line. 🌹
🌹Gram positive grow from central and peripheral line what to do?
A. Remove line✅ B. give antibiotics
Embolism
🌹5 days post orthopedic surgery had sudden dyspnea and confusion on examination
shows rash on neck and on cxr bilateral lower lobe infiltrates .cause?
A. Fat embolism B. PE C. pneumonia
🌹Chronic kidney disease what to use=UFH
🌹Now Admitted for pneumonia, have hx of ESRD and do hemodialysis regularly , best
prophylaxis to her condition at the hospital ? A. UFH B. stoking C. LMWH
UFH ﻧﻌطﯾﮫanticoagulntion ﻣرﯾض ﻓﺷل ﻛﻠوري وﯾﺣﺗﺎج
16) Female has HTN / DM / end stage kideny disease on dialysis admeted due to
pneumonia / what is the best way for DVT prophylaxis ?
- enaxprin -UFH ✅. - fondanprix - compression stocking
........ ......
🌹patient with signs of acute limb ischemia. Peripheral pulses absent in right leg (dorsalis,
popliteal) and dorsalis pulse absent in left leg.
A-heparin and observe B-femoral thrombectomy C-catheter thrombolysis✅
Catheter-directed thrombolysis (CDT) is an endovascular approach to the treatment of
acute limb ischemia;
🌹old age male patient post RTA and stroke (did not mentioned if it was hemorrhagic
or not) that complicated with hemiparalysis since two years ago, presented to ER with SOB
and cough, diagnosis of PE was suspected, investigation was done showed massive PE (high
pressure in pulmonary veins, patient vitally was unstable) management=
A. IVC filter ✅ B. Heparin C. Warfarin D. Thrombolytic
🌹case of 55 y/o make pt known case of afib (nothing else mentioned in q)what would
prevent further complication? A. warfarin. B. heparin C. no drugs recommended. D. aspirin
🌹77 female with palpitation. Clinical assessment showed asymptomatic atrial fibrillation.
asking about the first drug that should be prescribed
A. Aspirin B. Clopidogrel C.Anti- coagulant ✅✅🌹
🌹 young Pt had Afib ( No DM , HTN, CVA ) ask about prophylaxis A. No need. B. Warfarin.
C. Heparin
🍒Old man 65 years, diabetic and hypertensive, came with atrial fib, most appropriate
management? A. aspirin and clopidogrel B. Aspirin C. Warfarin ✅ D. clopidogrel
🌹 Atrial fibrillation prophylactic: A) aspirin b) clopidogril C) warfrin✅
🌹 Old Pt K/C of DM and HTN complaining of Rt LL pain and swelling femoral pulse intact
and absent of distal pulse.=: A. embolectomy. B. Heparinization and catheterization
🍓 Case of peripheral artery disease Pt came with pain , reduce pulse, cold limb , no
sensation, decreas motor Most apporpeat next step?
A. Heparin B. Ct angiography C. Conventioal .... D. Duplex us
🍓 diabetic Pt concern about his foot wound that did not heal (wound was managed in
hospital 2 months ago) A1C: within normal, The cause of his problem?
A. Decrease blood supply..✅. B. poor compliance to medication
🌹Patient k/c diabetes and smokers with claudication for 100m when he goes to the
mosque, his femoral pulse is intact but distal pulse is diminished, what is most appropriate:
A- medical risk stratification B- surgical bypass of stenosis
C- endovascular repair of stenosis D- Smoking cessation with aggressive blood sugar control
1DVT and PE
🌹 old with DVT which of the following indicate thrombophilia test?
A. age. B. Hx of ocp use. C. Connective tissue disease “my answer” D. Negative family hx
🌹Px with first time PE , you will give anticoagulant for how long ?
A- 6 months B. 3 months
If Provoked > 3 months (immobilization, surgery, obese, pregnant, OCP, cancer)
If Unprovoked > 6 months
🌹Young lady with unilateral progressive leg swelling with no hx of surgery or prolonged
bed rest what is the most important question to ask in history:
A. History of smoking🌹 B. Family history of the same presentationC. History of fatigue
D. History of sleepiness
Smoking risk for DVT وﺧﺎﺻﺔ اﻟﻘﻠﺐ. ﺎﻟﺠﺴﻢR ﺎنPﺠ;ﺐ ﺟﻠﻄﺎت ب اي ﻣK ﺎﻻوﻋ;ﺔ اﻟﺪﻣ~•ﺔR ﺎﺛﺮK ءz{ y N
O xﺜﺜv اtuاﻟﺘﺪﺧ
🌹 Pt with pyelonephritis,DVT ..? A. enoxaparin B. we choic UFH renal injury
🌹Sign of DVT no family hx, Most important to ask in the history:
A. using OCP B. History of trauma
🌹Contraindication for thrombolytic therapy (absolute):
A. Intracranial hemorrhage 2 years ago ✅✅ B. Cardiopulmonary resuscitation for 10 mi
C. Pregnancy.
🌹 I don’t remember the scenario exactly but pts was on heparin with no obvious complain
but in the laps there’s thrombocytopenia:
A. Stop heparin and start argatroban✅✅ B. Continue and reassess after 6 hours
C. Stop and start warfarin ( = ﺧﻄﺎWarfarin should only be restarted when platelet count
>100 x 109/L)
Mangmant of Heparin-Induced Thrombocytopenia=
should prompt discontinuation of heparin and LWMH
Initiate anticoagulation with a non-heparin anticoagulant: e.g. argatroban, danaparoid,
fondaparinaux
🍒🍒Elderly male k/c of DM & IHD presented with severe abdominal pain on examination
no findings in the abdomen but peripheral pulse was irregularly irregular == Mesenteric
ischemia 🍒🍒
ﻗﺎﻟﻚirregular irregular ﻋﻨﺪەýŽ • •ﻌatrial fibrlantion ﺎﻟﺠﺴﻢ م وﻻنu ﺟﻠﻄﺎت ب اي ﻣ•ﺎنýŽ £ وﻣﻌﺮوف اﻧﻪ ´ﺴ
اﻟﺴ|ﻨﺎر–ﻮا ﻓ~ﻪ اﻋﺮاض ﻟﻞabdomen ﻣﻌﻨﺎﻫﺎ ﺣﺼﻞembolism ŒŽ • mesentric ñ • ç ﺎراﺷy–ﺎل ﻓﻴÀﺐ اﺗyéﺴ7 .
......
1Endocrine
🌹pt with turner + amenorrhea = FSH and LH ✅
🌹25 yrs old male referred from orthopedic clinic with fragility fracture, he has sparse
axillary and face hair. What inv. You will do?
A. Calcitonin B. Testosterone and gonadotropin C. Bone densitometry D. TSH
🍓pt k/c of depression complaining of excessive urination and thirsty for 2 months. She did
mastectomy but now she has mets to the lungs. In the labs there is hypernatremia
,hyperglycemia and the urine osmolality is *low* What is the cause:
A. Diabetes insipidus✅. B. SIADH. C. Psychogenic Polydipsia
🍒 Patient RTA with head trauma, increased urine output , decrease in Urine osmolarity
increased blood osmolarity? Central diabetes insipidus✅
🌹high Na and low osmolarity in urine = Diabetic insipedis . 🌹.....
وﺑﻌدھﺎ ﺳﺎر ﯾﺷﺗﻛﻲ ﻣن، ﺑﺳﺑب ﺣﺎدﺛﺔ او ﻏﯾره اي اﺻﺎﺑﮫ ﺑﺎﻟدﻣﺎغbrain ﻟﻣﺎ ﺗﺷوﻓون ﺣﺎﻟﺔ ﺷﺧص اﺻﺎب ﻓﻲDiabetes insipidus , اﻟﺗﺷﺧﯾص ھو
ﻛﺛﯾﯾﯾرpolyuria ﻟﻛن اﻟﻔﻛرة اﻧﮫ ﺳﺎر ﯾﺷﺗﻛﻲ ﻣن، ﻛﺎذب ﻻن ﻣﺎھو ﻣرض ﺳﻛر،( (ﺿروري ﺗﺣطون ﻓﻲ ﺑﺎﻟﻛم ﻣرض )اﻟﺳﻛري اﻟﻛﺎذبpolyuria)
ﯾرﺳل اﺷﺎرات ﻟﻠﻣﺛﺎﻧﺔ وﯾﺧﻠﯾﮭﺎ ﺗوﻗف اﺧراج ﯾورﯾن ھذا اﻟﮭرﻣون ﻛلurine وﺧﺎﺻﺔ ﻓﻲ اﻟﻠﯾل واﻟﺳﺑب اﻧﮫ ﻓﯾﮫ ھرﻣون ﺑﺎﻟﺟﺳم ﺳﺑﺣﺎن ﷲ ﯾﻣﻧﻊ وﯾوﻗف
ﻓﻠﻣﺎ ﯾﺣﺻل ﻟﻠدﻣﺎغ ﺿرر ﺑﺳﺑب ﺣﺎدث او ﺟﻠطﺔ ھذا اﻟﮭرﻣون ﺧﻼص ﻣﺎﻋﺎد ﯾطﻠﻊ وﻣﺎﯾﺳوي ﺑﻠوك ﻟﻠﻣﺛﺎﻧﺔbrain اﺳﺎﺳﺎ ﯾطﻠﻊ ﻣن ﻏدة ﻓﻲ، اﻧﺳﺎن ﻋﻧده
ﻓﯾﮫ ﺷﻲء ﻣﮭم ﺟدا ﯾﺟﻲ ﻣﻊ اﻟﻣرﺿﻰ ھذوﻻ وھو، : antidiuretic hormone ھذا اﻟﮭرﻣون اﺳﻣﮫ ﻣن اﺳﻣﮫpolyuria ﻓﯾﺳﯾر، urine اﻧﮫ ﺗوﻗف
ﻻن اﻟﺟﺳم ﻓﻘد ﺳواﺋل ﻛﺛﯾرة ﻓﺎﺻﺑﺢ ﻛﻣﯾﺔ اﻟﺻودﯾوم ﺑﺎﻟﻧﺳﺑﺔ ﻟﻠﺳﺎﺋل، اﻟﺟﻔﺎف ﺑﯾﺑب ﻛﺛرة اﻟﺗﺑول و ﺷﻲء ﺛﺎﻧﻲ ﻣﮭم وھو اﻧﮫ اﻟﺻودﯾوم ﯾﻛون ﻋﺎااﻟﻲ ﻟﯾﮫ ؟
Desmpressin........... ...... اوvasopressin . اﻟﻣﻔﻘود ﻋﺎاﻟﯾﺔ طﯾب اﯾش اﻟﻌﻼج ؟ ﻧﻌطﯾﮫ اﻟﮭرﻣون اﻟﻲ ﻣﺎھو ﻣوﺟود ﻓﻲ ﺟﺳﻣﮫ واﺳﻣﮫ
🌹Patient diagnosed with major depression complaining of excessive thirst and urination
+ she has cancer with lung mets. investigations shows hyponatremia
and low urine osmolality what's the dx:
A. DI = (hypernatrima + low osmo urin)
B. psychogenic polydipsia✅ (come with chronic mental illness hyponatrimai + low osm
urine)
C. SIADH = (hyponatrima+ high osmos urin)
🍒pt. Did retinal operation 7 days ago, now need DVT prophylaxis, what to give:
A- heparin B- enoxaparin C- mechanical compression ✅✅ D- A+ C
ةFGﺎﻟﺴﺎﻋﺎت اﻟ—ﺜq ة وﺟﻠﺲFGﺔ ﻛﺒSﻦ ﻟﻮ ﻋﻤﻠCﻨﻤﺎ اﻟﻬﻴ•ﺎر£ ﺑ، ﺘﺤﺮكC¡ و v % %
& ﻤ: ﻘﺪر: ، ﻄﺔSﺴx ŸGﺔاﻟﻌS اﻟﺸ•ﻜ$& ﺔSﻦ ﻻن ﻋﻤﻠCﺤﺘﺎج ﻫﻴ•ﺎر: ﻣﺎ
ﻘﺪر ﻳﺘﺤﺮك:ﺎت وﻣﺎSﺎﻟﻌﻤﻠq
🍒test of nephropathy in DM patient is by detecting which of the following:
A- urine albumin. B- GFR. C- protein creatinine ratio ✅
🍒DM patient on Metformin 1g BID, random blood glucose and a1c still high, what to
modify in treatment: A- increase metformin dose. B- give insulin. C- add _gliptin D- add
_glenide✅
ﻣﺎﻧﻔﻊMetformin ﻣﺎﻧﻔﻊ ﻧﺑدء ﻣﻌﮭم ب، اول ﺷﻲء ﻟﻌﻼج اﻟﺳﻛر ﺣﺳب اﻟﺟﺎﯾدﻻﯾن ﻧﻣﺷﻲ ﺑﺎﻟﺗرﺗﯾب ﻧﺑدء ﻣﻌﮭم ب رﯾﺎﺿﺔ وﻧﻘﺻﺎن وزن
_glenide. ﻣﺛلorall hypoglycima واﻟﺳﻛر ﻣﺎزال ﻋﺎﻟﻲ ﻧﺑدء ب ﺟرﻋﺔ
🍒Pt DM on oral hypoglycemic drugs and now his DM is controlled with BMI 30 and tried a
lot of dite and for long time on low carbs dite with no reduction of wt how to decrease wt :
_Herbal substance. _Briatric surgery _Dite regimen _Medical reduction of weight ✅ ✔
Beriatric Sx:
■BMI ≥40 kg/m2 without comorbid illness.
■BMI 35.0–39.9 kg/m2 with at least one serious comorbidity; (type 2 diabetes, fatty liver
disease, hypertension).
🌹Diabetic patient on metformin 500mg twice a day with Dec sensation on both
lower limbs ha1c: 8 , FBG: 216 give? A. sulfonylurea✅B. mixed insulin C.long acting insuln
🌹 Patient with family hx of type 2 DM came with, polyurea and FBS of 7.0, HbA1c of 7.1.
Dx? Type 2 DM
DKA
🌹Patient with severe diarrhea and vomiting. Labs provided showing metabolic acidosis.
whats sign is observed clinically? A. Kussmaul breathing✅ B. Low urine output
🌹An obese 15-year-old girl is brought to the emergency department by her parents due to
excessive thirst and urination for 1 week. Past medical history is unremarkable. Family
history is positive for type 2 diabetes in her father and sister. Physical examination reveals
moderate dehydration. Her random plasma glucose is 395 mg/dL. Plasma or urine ketones
are negative. Which of the following is the next investigation of this patient condition?
A. Autoantibodies to glutamic acid decarboxylase = its happen in
type 1 diabetes✅
🌹glycosuria + ketonuria + Sx of hyperglycemia = DKA start IV NS
🌹DM type 1 already in insulin ( glargine and another one) now came with DKA start with IV
which insulin give : A- IV insulin + long acting B_Regular
Regular ﻧﻌﺎﻟﺟﮭﺎ ﺑﺎﻟﺗرﺗﯾبDKA رﺑط= ﻟﻣﺎ ﻧﺷوف ﺣﺎﻟﺔ
🌻Start IV regular insulin 0.1/ kg
🌹 DKA patient, on iv insulin, be careful of? A. Hypoglycemia C. Cerebral edema ✅
🍒 case of DKA and Dr. give him ringer lactate and low insulin dose, What are you afraid of?
A. Cerebral edema ✅ B. hypoglycemia
🍓Child admitted by DKA and after receiving Iv fluid he is confused what is the diagnosis ?
Cerebral edema
🌹DKA case what the complication? Cerebral edema
🍓 DKA aftet IV fluid, what to do next? Give insulin🍓
21)_ Pt with symptoms of DKA and labs suggest DKA also was given in fluids. next: IV insulin
🌹DKA patient came to ER the initial step?
A-insulin and dextrose B-calcium gluconate C-sodium bicarbonate D-IV fluid ✅
🌹pt with DKA he starts to breath rapidly to buffer his acidosis through= carbon dioxide
(Dont choice monoxide) .
🌹Child DKA symptoms how to prevent: Listen to the child what he is worry about🌹
🌹Dm 1 diagnosed after DKA now blood sugar is stable and she is ready to be
discharged which regimen
A. - Only short acting without NPB B. - Short acting before meals and glargine
🍓Patient had strong hx of T2DM and had high fasting glucose and Hbalc of
6.5 asking about next step A. OGTT ✅ B. Hbalc after weeks C. Repeat fasting
🍓34 y /o Healthy man ask about risk of ischemic heart disease?
A. BM131 B. BP 135/80 C. two fasting glucose reading 9.5 then 9.4mmol ✅✅
1Thyroid , parathyroid
🌹Case of Parathyroid adenoma with hypercalcemia and low Phosphate, how to manage?
1-Rehydrate and stains 2-Rehydrate and diuretics ✅
3-Biphosphonate and diuretics and stains
N.b if mild to moderate rehydration and decrease oral calcium is enough
Diuretics = for sever hypercalcemia
If with bone changes or osteoporosis bisphosphonate
🌹Parathyroid adenoma with hypercalcemia and low Phosphate = Rehydrate and
diuretics🌹
🌹 Case of primary hyperparathyroidism. What is an indication to undergo elective
parathyroidectomy? - Age > 50 - High PTH. - Signs of osteoporosis✅
🌹 subclinical thyroiditis is hypo or hyper ? #subclinical thyroiditis is= hyperthyroidism
🌹 Pt with graves and eye symptoms, wt will increase eye dz in graves?
A. High free T 3,4. B. Male. C. Smoking!@
🌹2/25 years female with thyroid nodule TSH and T4 normal , FNA cytology done and
according to Besthesda classification ( Stage III ) what is the most accurate management :
a. hemithyroidectomy b.total thyroidectomy c. repeat FNA and observation ✅✅
d. radio active iodine
(( N.B: Betheseda score: 1,2,3 >> repeat FNA and observ. 4 >> lopectomy
5,6 >> total thyroidectomy )))
. (( ﻧﺷﯾل ﻛل اﻟﻐدة ﻓﺎﻟﺑﺗرﺗﯾب ﻧﻣﺷﻲ ﺣﺗﻰ ﯾﺳﮭل اﻟﺣﻔظ٥ ﺑﻌدھﺎ رﻗم، واﺣدlope ﻧﺷﯾل ﺟزء او٤ ﺑﻌدھﺎ رﻗم، ﻧﻣﺷﻲ ﺑﺎﻟﺗرﺗﯾب اول ﺷﻲء ﺑدون ﺟراﺣﺔ
🌹pt with hypothyroidism on thyroxine 175 microgm for 10 months dose increased to 200
after that lab showed TSH high , T4 normal. what is the diagnosis
a.sub acute thyroiditis. b.hashimoto thyroiditis✅ c. sick euothyroid syndrome
، ﻋﺎﻟﻲ ﻣﻌﻧﺎھﺎ ﻓﻲ ﻧﻘص اﻓراز ﻏدة اﻟﺛﺎﯾروﯾدtsh ﻻن ﻟﻣﺎ ﯾﻛونHypothiroid ﻛون ﻟﮫ ﻋﻼﻗﺔ بd ﻋﺎﻟﻲ ﯾﻌﻧﻲ ﻧدور ﻋﻠﻰ ﺟوابTSH 🌹طﯾب ھﻧﺎ
(( .. ھﺎﺷﯾﻣوﺗوا ھذا ﯾﻌﻧﻲ ھﺟوم ﻣﻧﺎﻋﻲ ﻋﻠﻰ اﻟﻐدة ادى اﻟﻰ ﺗدﻣﯾر اﻟﻐدة وﺑﺎﻟﺗﺎﻟﻲ )) ﻧﻘﺻﺎن اﻓراز اﻟﻐدة، haahimoto ﻓﺎﻟﺟواب
🌹Pt with. Hypothyroidism on low dose hormonal therapy, still complaining of symptoms?
A. Increase the dose + recheck 3 wks B. Increase the dose + recheck 6 wks
C. Decrease the dose + recheck 3 wks D. Dec the dose + recheck 6 wks
🌹Pt Newly diagnosed with Hypothyroidism, after 2 wks, TSH 7.5, what to do?
A. -increase dose. B. -continue the same dose F/U 1 month
🌹Women have tremor and palpitation and irregular irregular pulse dx as a fib by
ecg what to do first? Tyroid Function Test
🌹unialateral neck swelling in the RT side by investigations :hot thyroid nodule the rest
cold thyroid No LN enlargement Treatment? Start atinthyroid meds, if failed radioactive ☢
, the best definitive ttt is surgical excision✅
🌹Pt with constipation, behavioral irritability wrist x ray showed bone erosions. On lab:
PTH elevated, Ca elevated. Appropriate management:
A. Hydration, diuretics, bid phosphate✅. B. Hydration, diuretics, statin
🌹Female with calcium high, PO4 low vitamin D low. = A. 1ry hyperPTH B. 2ry hyperPTH
ﻣن اﺳﻣﮭﺎ ﺳﻛﻧدري، ﯾﻛون اﻟﻛﺎﻟﺳﯾوم واﻟﻔوﺳﻔﺎت ﻋﺎﻟﻲscondry اﻟﺑراﯾﻣﺎري ﯾﻛون ﻛﺎﻟﺳﯾوم ﻋﺎﻟﻲ واﻟﻔوﺳﻔﺎت ﻣﻧﺧﻔض ال
. ﯾﻌﻧﻲ اﻻﺛﻧﯾن ﻋﺎﻟﯾﯾن
🍓patient with fracture , very high PTH w calcium was at the upper limit of the normal and
phosphate was normal What is important to do :
A. 24 h urine ca , B. sestimabi scan ✅ C. ALP
Sestamibi scanning is the preferred way to localize diseased parathyroid glands prior to an
operation. ... This very mild and safe radioactive agent is injected into the veins of a patient
with parathyroid disease (hyperparathyroidism) and is absorbed by the
overactive parathyroid gland.
🌹Recurrent fracture + high PTH + multiple renal stones. Investigation?
C. Ca urine D. IVP E. ALP F. Sestamibi scan
Recurrent fractures + renal stones are absolute indication for surgery
🌹Parathyroid hormone is high + high calcium And low vit D = primary parathyroidism
cause PTH and Ca high.
🌹 Patient with a history of kidney stone 2 weeks ago His labs showed hypercalcemia ,
hyperparathyroid , hypophosphatemia Urea and creatinine elevated What is the cause of
hypercalcemia ?
A-Primary hyperparathyroidism B-Secondary hyperparathyroidism
C-High 1,25 dihydroxycholecalciferol
ﻟو اﻻﺛﻧﯾن ﻋﺎﻟﯾﯾن اﻟﻲ ھم اﻟﻛﺎﻟﺳﯾومprimary , واﻟﻔوﺳﻔﺎت ﻣﻧﺧﻔض اﻻﺛﻧﯾن ﺿد ﺑﻌض ﯾﻌﻧﻲhyppercacium ﻻن ﻗﺎﻟك
scondry....واﻟﻔوﺳﻔﺎت ﻣن اﺳﻣﮭﺎ اﻻﺛﻧﯾن ﯾﻌﻧﻲ
🌷bone resorption asking about the cause, they gave increased PTH and Ca + high
phosphat ? Tertiary hyper parathyroidism🌷
🌷secondary hyper parathyroidism = (high PTH+low ca + high phosphat) .
🌹Patient with a BMI of 40, she doesn’t c/o visual disturbance, no hypothyroid symptoms,
she came with lab works of: TSH high, prolactin normal, FSH and LH are abnormal. What is
the possible cause? A.non-functioning prolactinoma B. Hypothyroidism ✅✅🌹 C. Morbid
obesity
🍒clinic signs of hypothyroidism and TSH 5 , which is in the normal range. best next step to
diagnose her thyroid disease? A. repeat the test after few months. B. T4 ✅
🍓A 50 year old patient presents with complaints of insomnia and palpitations. He had a
history of Afib to which he takes Amiodarone. He is on SSRI, ACE and 2 other medications.
Upon examination everything is normal, BP normal, HR normal, What is your next step?
A. Add B-blocker. B. Check TSH and T4✅. C. Change his psychiatric medications
D. Refer to psychiatry clinic
🍓management of Graves’ disease with exophthalmos not responding to antithyroid for
10 months:
A. Subtotal thyroidectomy✅ B. Near total thyroidectomy
C. Radio iodine therapy D. Continue antithyroid medication
🍓Hashimoto’s disease associated with :
A. lymphoma✅ B. Papillary cancer C. Follicular cancer D. Medullary cancer
🍓Elderly with signs and symptoms of hypothyroidism he had a history of radiation before
3 years .thyroid examination was normal in labs TSH 5 (0.4-5) What will you wil do to
establish the diagnosis?
A. REPEAT the TSH after 4weeks B. Free T4✅✅ C. Thyroid us D. Thyroid scan
🍒Pt with dyspnea and dysphagia symptoms increased during sleep with neck enlargement
dx: A. goiter✅. B. lymphoma. C. thymoma
🌹Palpantion + neck discount with TSH high + T4 low + ESR high : subacute thyroditis
🌹Patient known with hypothyroidism presents to your office accusing no symptoms but
showing you lab results where TSH levels are elevated. She has been on thyroid hormone
replacement therapy initiated two weeks ago. Which of the following is the correct
approach? A. Continue same dose and follow up in 4 weeks ✅✅🌹🌹
=ار` ـﻊ اﺳﺎﺑﻴﻊ4 ﻪxﺸž ﺪ ﺷ”ﻠﻬﺎwر`ﻂ =ﻏﺪة اﻟﺜﺎﻳﺮو
🍓Female in mid 40 came with neck swelling for 2 months, with decrease in weight
complains of stoped menstrual cycle for 6months and milky discharge , what investigation
you will order ? A. Thyroid US✅ B. Ovary US C. Mammogram D. Ultrasound something..
......
🍓DKA complicantion? cerebral edema🍓
🌹Diabetic tight control for past year Hba1c 5.8 before that Hba1c was 9-10, complaining of
leg pain and loss of sensation, asking about tx? Vitamin B12 ✅
🌹One additional question about vitiligo patient, what further investigation you would ask
for? Intrinsic factor level✅
🌹Patient with macrocitic anemia and preipheral neuropathy low B12 normal folic acid
what should you check? A-TFT. B-LFT. C-intrinsic factor ✅✅. D-KFT
🌹Alcoholic with + babinski sign + blood smear was given ( couldn’t find a similar picture)
What is the cause? A. Alcohol B. Hypothyroidism C. B12 deficiency ✅✅ Babi = B12
🌹Pt complain of tingling sensation which of the following is decrease ? B12
🌹pt generalized fatigue and palpitations with vitiligo and absent reflex and low
B12 Low HB normal folic acid ? A.oral b12 B.oral ferrus C.folic acid D.parenteral B12✅
.
🍒high tsh, normal t4, high ESR ? Subclinical thyroiditis
اﻗﻮل ان ﻫﺬا اﻟﺸﺨﺺ ﻋﻨﺪەýÓ( ﻣsubclinic hypo) اذا „ﺎنTSH ﻦÄ وﻟ، ÐŽ ﻋﺎااT4 Or T3 وﻟ¨ﺲ ﻣﻨﺨﻔﺾþŽ~ﻃﺒ|ﻴ
ŒŽ • ﺲ7 اﻟﻔﻜﺮة، ÐŽ او ﻋﺎTSH ﻳﺘﺎﺛﺮ ﺑ|ﻨ•ﺎÐŽ ﻫﻮ اT3 .4 4 Ó
Ž ﻧﻔﺲ ﻣﺎïy ﺗ. 🍒🍒
Subclinical hypothyroidism occurs when TSH levels are slightly elevated but T3 and T4 are
normal.
🌹 Subclinical hypothyroidism Asymptomatic , everything is normal :
A. start treatment B. wait abd reevaluate after 6M✅
🌹Patient taking levothyroxine. Labs showed patient still hypothyroid. What's your
management
A. Increase dose and follow after 3 week
B.increase the dose and follow after 6 weeks ✅✅
ﻂÏ = رthyroid = اﺳﺎﺑﻴﻊ٦ ﻌﺪu ﻌﺔu ﺣﺮوف =ﻣﺘﺎ٦
....................
🍒Young patient low BMI and short with no hair growth or breast budding. Which type of
pubertal delay? A- chromosomal. B- constitutional✅🍒
و|ﻤﺎن. ﻈﻬﺮ اﻟﻄﻔﻞ ﻗﺼ_^ اﻟﻘﺎﻣﺔwﻤﻞ ﻃﻮل ﻓÀ ﺗﻮﻗﻒ اﻧﻬﺎ ﺗ، ; ﻧﻤﻮا ﻟﻠﻌﻈﺎم ﻧﻔﺴﻬﺎ: < ﻫﻮ ﺗﺎﺧﺮ ﻣﺆﻗﺖ، ; ﻧﻤﻮا وﻃﻮل اﻟﻄﻔﻞ: < ﻫﺬا اﻟﻨ»ع ﻣﻦ اﻟﺘﺎﺧﺮ
ﻋﻼﻣﺎتpuberty ﺗﺘﺎﺧﺮ
Constitutional delay : (CGD), the most common cause of short stature and pubertal delay, typically have retarded
linear growth within the first 3 years of life. .
………………….
diabtic and macrocosmic child and has deformity which kind of deformity (hand )baby has :
= Erbs palsy
..............
Pt with oseoarthritis and with cervical degenarative dos and did cervical discectomy now
he has (bladder uncontrol ) = what is the cuses ??
cervical discectomy ( Not quda eqina Bec case not say there is pain radiat to leg , loss
senstion , loos stool ...etc )
. . . .. .
🌹Benigh prostatic hyperplasia = Alpha block🌹
…
Hyperprolactinemia
🌹Pt with history of thyroid nodules also she have milky discharge from the breast and
amenorrhea since 6 m lab results show that TSH high t 4 high What to do next?
A.MRI ✅ ( To exclud pitotary adenom) B. US thyroid
🍒 Patient had TSH high, T4 high what images to do next?
A. MRI brain ✅pitotary gland tumor B. thyroid ultrasound
🌹 Married 3 years ago with irregular menses and milk expressed manually .. next step:
A- b-HCG B- prolactin✅✅ 🌹irregular menses and milk expressed = prolactine level 🌹
🌹 pt complain of erection, Thyroid hormone normal
A- hyper pituitary C- macro adenoma prolactinoma D- micro adenoma prolactinoma✅
🍬Micro adenoma > hyperprolactin > erectile dysfunction
🌹 female patient care with bitemporal hemianopia and obstructive symptoms
(prolactinoma) *definitive* management A- transsphenoidal resectionÖ B. bromocriptine
🌹Patient on management for hyperprolactinemia .. when to indicate brain mri=
A. Blurry vision B. Double d value of prolactin C. Bilateral breast discharge
🌹Pt with symptoms and sign of hyperthyrodism and prolactenemia . Labs show elevated
TSH and T4 . Next step in mx :- Answer is: Brain MRI 🌹
🍒Pt with history of thyroid nodules also she have milky discharge from the breast and
amenorrhea since 6 m lap result show that TSH high t 4 high Prolactin level 6000 very high
What is the most appropriate management?MRI
Adrenal disease
🌹Long scenario with low BP and hyperkalemia + hyponatrima dx = addisons diaeas (
adrenal insuffincy)🌷
🌹Long scenario with High BP and hypokalemia + hypernatrimia dx = primary
hyperaldosteronism🌷
🍒Male patient medical free , BP 150/90 Lab: normal na , low k ask about Dx ?
A-Primary HTN B-Primary hyper aldosterone ✅. C-Addison disease
🌹Female complain of fatigue and she has scar turned hypo pigment (dark) , Addison case
he ask what test to do= synth Test
🌹woman who had a wound , started to get very dark. Hypotension too First test : A.
synacthen B. cortisol C. dex suppression
🌹Female patient who has dizziness when standing and noticed a scar on the back of the
hand that is getting darker( only these symptoms) , how to confirm ?
A. Cortisol level B. synacthen test ✅ C. suppression test
🍒 Female with hypotension ,hyper k+ , hyponNa , dark line in hand scar what next?
A-dexamethasone suppression test B-cortisol level C-syntchan test D- Morning serum
cortisol levels
_Best initial test == Morning serum cortisol levels: < 3 μg/dL.
_Confirmatory test == ACTH stimulation test (cosyntropin test
🍒htn and abdominal swelling and palpitations and inv has high catecholamines (2100)=
alpha blockers
🍒HTN don't respond to medication adrenal mass = alpha blocker 🍒
🍓pt with hypertension 220/110 not responding to home medications,
abdominal CT show adrenal mass , catecholamine is very high , asking about
management : A. alpha blockers ✅✅= pheochromocytoma
🍒patient with hypertension, hight catecholamines and *adrenal mass* on US, what is the
treatment: A- alpha blockers ✅pheochromocytoma. B- beta blockers C- CCB
ﻂÏ = رadrenal
🍒 (lethargy, hyperpigmentation). Confirmation of addison disease?
A)Low-dosed exame tha son suppression test. B)_ Urinary cortisol C)_ Synacthentest(ACTH
stimulation test) ✅
🌹Orthostatic hypotension, weight gain 5kg per week dizziness, scar in her hand, dark scar
in examination, what investigation confirm diagnosis?
A.Low dose dexa test B.Cortisol level C.24 h free cortisol, urinary D.Synchian test ✅
Cushing disease
🌹 Refractory hypokalemia?
A. Asses aldosterone and renin ratio B. Start spironolacton
🌹 20y old athletic gain 25 kg in the last 4 month with highly muscolanized upper
limb n acne ? steroid anabolic
🌹A 32-year-old woman presents with irregular menses for the last several years. She has
gained 18 kg over the past 2 years and feels that most of the weight gain is in her face,
neck, and abdomen. She also notes bruising without significant trauma, and difficulty
rising from a chair. She was diagnosed with type 2 diabetes and hypertension a year ago.
Which of the following is the first-line investigation for this patient condition?
A.24-hour urinary free cortisol ✅✅🌹
🍒A patient presents with signs of Cushing disease, Labs: ACTH low, Cortisol 8 AM high CT
pelvis: 5 CM mass in adrenal gland What is the most appropriatemanagement?
A. Surgical resection✅ B. Mitotane therapy C. Pituitary transsphenoidal surgery
🍒Preoperatively what to give a patient known case of Cushing syndrome? Steroid
🍓Cushing with 24h cortisol high. ACTH was low. Next
A. MRI B. CT pelvic✅
If ACTH high > go for high dose dexa to differentiate between ectopic Cushing or pituitary
If low > CT adrenal
ر`ﻂ =اﻟﻐﺪة ﺗﻘﻊ ﺗﺤﺖlower .
🌹Pt with cushing's signs and symptoms, positive 24h urine cortisol , lab shows
low ACTH, your management:
A. brain MRI(if high ACTH) B.Abdominal CT C. overnight dexamethasone test
ﻂÏ=رACTH low= ﻣﻊLower ﺗﺤﺖýŽ • =•ﻌabdomen
ﻟﻮ ﻗﺎلhigh ACTH = ﻓﻮق =ﻧﻌﻤﻞ ﻟﻪýŽ • •ﻌbrain
🌹Cushing case what is the initial test to diagnose: dexamethasone suppression test or
24h urine cortisol
....
🌹Cushing case what is the confirmatory test: 24 urine cortisol or dexamethasone
suppression or late night salivary cortisol
....
🌹A 60-year-old female presented with hypertension, proximal muscle weakness, weight
gain especially in the upper body and purple striae on the lower abdomen. Which of these
tests gives a clue about the etiologyof the most probable diagnosis?
A. High-dose dexamethasone suppression test ✅💐💐🌹
B. 24-hour urinary free cortisol
C. Low-dose dexamethasone suppression test
D. Midnight salivary cortisol
ﻂ =ﻋﺸﺎن ﻧﻌﺮف ﺳ!ﺐ اﻟﻤﺮضw رetiology = ²§ﻴÛ = “ﺤﺘﺎج {ﺤﺚ ﻛﺜHigh dose .
🌹🌹Case about resistant glucose tolerance with high glucocorticoids level, what is the
diagnosis? Cushing Syndrome
1Heptic dis
🌹30 yo Female patient medically free suddenly start feeling fatigue and
jaundice. She denied drug use. Liver examination not remarkable. Laps
show ALT + AST more than (2500) “sure” , Albumin low All liver
enzymes very bad What to do ?
A. send her home B. admit + Iv fluid + analgesic C. observe in ER D. refers her to liver
transplantation
🌹 30 Y.O female with jaundice and yellow sclera started 2 weeks ago. No flapping tremor
or stigmata of liver failure. LFTs: High AST(1400), ALT(1300), GGT (70?), Bilirubin High
direct and. Indirect. US: biliary strictures and dilatation. Next step in management? A.
discharge with F/U. B. admit and start iv dextrose. C. order PT & INR
D. refer to liver transplant
🌹Young female has jaundice , leathergy , arthralgia , on labe result high LFt and alkaline
phosphatase What is the diagnosis A. Autoimmune hepatitis B. Primary biliary cirrhosis
🌹Chronic Hepatitis B, symptomatic, laps show high AST ALT and US shows
micro-changes. How to manage?
A. peglyted interferon✅ for chronic Heb B and c B. observation and follow up C.Lamividrin
🍒pt known case of chronic HBV present with elevated LFT and direct and total bilirubin
What most appropriate treatment: A. Entecavir B. Pegylated interferon✅✅ C. Lam
🌹Pt with positive hepatitis C has lesion on liver = hepatocellular carcinoma
🌹Hepatocellular carcinoma screening for patient with Ascites:
A. Alphafetoprotin ( if not present us ) B. Triphasic CT
🌹Hepatocellular carcinoma Tx: Surgical resection
🌹Health worker had needle prick + risk of having HCV = 3% ﺎﻟﻤ~ﺔu ﺛﻼث ﺣﺮوف ﻣﻊ ﺛﻼﺛﺔ
🌹 HCV and the contraindications of breastfeeding = If crackles in the nipples🌷
🌷hepatitis c drug = sofobuvir/ledipasvir = if not on choice select = Interferon🌷
🌹 Case of HCV Ab +ve but RNA -ve, not drug abuser pr blood transfusion:
. No need further Mx .
🌹 Most common type of genotype of HCV in saudi arabia ? 4 ( HCV = ﺛﻼث ﺣﺮوف =ﻣﻊ
ﻌﺔÏ) ﺟﻴﻨﻮاﺗﺎ•ﺐ ﺳﺎرت ار
🌹 known case of HCV with ascites + neutrophil 400 & other symptom , ttt:
A- IV antibiotics B- Paracentesis
spontaneous bacterial peritonitis = اﻋرﻓوا ﺗﺷﺧﯾص اﻟﺣﺎﻟﺔ250 ﻓوقneutrophill اذا ﺷوﻓﺗوا ال
🌹Patient known to have liver cirrhosis and ascites, developed fever and abdominal pain +
high WBC , Next step ? A- antibiotics B- diagnostic laparoscopy C- urgent laparotomy
🍓Case of ascitis with liver cirrhosis lab : wbcs > very high No more information in this Q
Ask about management ? Antibiotics✅(Bacterial pertoinitis)
🌹 case with abdominal fluid and High SAAG what will u do?
A. Tapping B. antibiotics C. diuretics ﻄﻦyﺎﻟu ﻣﺘﺠﻤﻌﺔÐŽﻋﺸﺎن ﻧﻄﻠﻊ اﻟﺴﻮاﺋﻞ ا
🌹 Alcoholic patient with Cirrhosis have multiple hypodense lesions in the liver?
A-HCV B-Hepatocellular carcinoma ✅ ✔
HCV+Cirrhosis+Hepatocellular carcinoma * * اﯾش ھم ؟، ﻓﯾﮫ ﺛﻼث ﺗواﺋم ﯾﺟوا داﺋﻣﺎ ﻣﻊ ﺑﻌض
F* G ﻌ2 ﺗﻠ"ﻒAﺪ ا.- ﻣﻊ اﻟﺰﻣﻦ ﻳﺘﺤﻮل اﻟ، ( )
* ﺼﺎب ب ﻓﺎﻳﺮس2 ﺪ ﻟﻤﺎ.-(ء اﻟ
* ﻃ"ﺐ اولCirrhosis ف، ﺸﻔﻴﻨﺎQﻌﺎﻓﻴﻨﺎ و2 O ﺪ.-ﻃﺎن اﻟM Aﻃ"ﺐ ﻟﻮ ﻣﺎ ﻋﺎﻟﺠﻨﺎ ﻫﺬا اﻟﺘﻠ"ﻒ ﻳﺘﺤﻮل ا
ﻘﻮﻟﻚ اﻟﺴﺆوال اﻧﻪ اﻟﻤ[\ﺾ ﻋﻨﺪە ﺗﻠ"ﻒ2 Cirrhosis A ﻓﻤﺎ ﻋﺎﻟﺠﻨﺎ اﻟﺘﻠ"ﻒ ﺗﺤﻮل ا، (
* ﻻن ﻣﺎﺟﺎء ﻟﻪ اﻟﺘﻠ"ﻒ اﻻ ﻣﻦ ﻓﺎﻳﺮس، (
* ﻣﺎﻳﻨﻔﻊ اﺧﺘﺎر ﻓﺎﻳﺮسHepatocellular carcinoma
، multiple hypodense lesions وﺧﺎﺻﺔ ﻋﻨﺪەxyﺪون ﺗﻔﻜv ﺸﻮﻓﻮﻧﻪu اول ﻣﺎcirrhosis ﻣﻌﻨﺎﻫﺎ
🌹 pt with hCV present with hx of weight loss , CT done shows irregul'r nodule th't occupies
70% of liver , wh'tʼs your next step ?CT MRI. Endoscopy. Perctounous biopsy ✅
. biopsy ﺛم ﻧﻌﻣلc.t ف اول ﺷﻲء ﻧﻌﻣﻠﮫ، liver cancer ﺛم ﯾﺗﺣول اﻟﻰliver cirrosis ﻓﺎﯾرس ﺳﻲ ﻣﻊ اﻟوﻗت ﯾﻌﻣل
🌹 What improves mortality in liver cirrhosis with esophageal varices and
bleeding : A. octreotide. B. IV ceftriaxone!@
🌹 Patient k/c of HepC came with esophageal varices , ten asicitis and
drowsy . Which drugs will reduce mortality?
A. Pantoprazole infusion. B. Octreotide C. IV ceftriaxone D. Blood transfusion
🌹 Pt with sign & symptoms of liver cirrhosis + upper GI bleeding. HGB 8.5.
After stabilize the pt, What is the appropriate management?
A. Blood transfusion. B. Upper GI endoscopy. C. BB
🌹 Pt with ascites when we take ascitic fluid sample for examination we found E coli what is
the cause? perforation
...
🍓pt with ascites and abdominal pain , E-coli was found in ascitic fluid , what’s mechanism
of bacteria to found in peritoneum “ no perforation” : = translocation
…
🌹Detecting HBV +ve pregnant women is the type of prevention?
A. Premodal B. Primary C. secondary
• ç = „ﻠﻤﺘscondry
ﻂÏ = رhepatitis B = ñ
...
🌹 hepatitis related symptoms with hep b serology findings (hep b surface antigen
positive and anti-core IgG positive) asks about his hep b status:
A. Chronic infection B. Previous exposure C. Immunization (Core + IgG = Chronic. )
🍒Hep B, surface Ag negative, CORE AB and surface AB positive
A.Immunized due to resolved Infection✅ B.Immunized due to vaccination C.Acute
🌹Hepatitis B acute infection marker? A. HBsAg B. HBeAg C. Anti-HBs
NB: HBeAg for activity and if positive indicate acute infection.
*ﻂ =ﺣﺎد =ﺻﻌﺐ =صÏ =رS
....
🍒Pt with 11 m hx of abdominal pain fatigue presented with 2 wks hx of jaundice ? what to
ordi ? A-HAV lgm B-hHBV IGG ✅. C- HCV AB
…
🌹What type is Hepatitis B vaccine? A. inactivated B. live attenduated C. recombinan
…
🌹Pt chronic hepatitis B, came with jaundice and RUQ pain, lab show high liver
enzymes (ast>alt), most appropriate next step: Hepatitis D antigen/antibody
.....
Husband k/c of hepatitis B the wife is hep B -ve , she worries about sexual relationships:
What you tell her? 1) wear condom before ejection✅✅ 2 ) use OCP 3) reassurance
…
🌹Detecting hep B pregnants types of prevention?
A.Primary B.Primordial C.Secondary D.Tertiary
b ﺷﻛﻠﮫ ﻛﺎﻧﮫ وﺣدة ﺣﺎﻣلB ﺣرف. A. B .c = scondry . ﺛﺎﻧﻲ اﻟﺣروفB رﺑط = ﺣرف اﻟﺑﻲ
hepatitis B serology with positive anti HBc (igg) and HB surface antigen
A-Chronic Hepatitis B ✅ﻣﻜﺮرB-Acute hepatitis B
🌹hepatitis b serology with positive =Chronic Hepatitis B🌷
….
🌷hepatitis c drug = sofobuvir/ledipasvir = if not on choice select = Interferon🌷
…
Pt with Chronic hepatitis C and ascites ttt? A. spironolactone and durtics. B. Tapping
..
Schistosoma mansoni case, cardiac or pulmonary complication but can't recall the details.
Best diuretic for ascites? • Loop✅✅. • Thiazide. • Osmotic
🌹Hepatic cirrhosis due to hepatitis B + ascites + lower limbs edema + basal lung
crepitations + slight hypoalbuminemia + good renal function. Management?
A.Furosemide + spironolactone
🍒 long case on medication “insulin, ACE,spironolactone” patient have high potassium what
causes of high potassium? spironolactone ( drug induce hyperkalemia)
🌹Case typical with nausea , lethargy , vomiting , Lab are : HTN , high potassium,
low Na , Hypoglycemia what is the most appropriate step :
A. IV fluid with insulin B. cortisone with something C. flantadin (Addison dis)
🍒 Chronic hep B came with jaundice highly elevated liver enzyme it was about 500 600,
most appropriate next step
A. Alpha interferon. B. Biopsy. C. No antiviral drugs in the choices D- Request anti delta
…
17 years old male known IV drug abuser, came for a check up, asymptomatic. What will you
screen for? A. HIV B. Hepatitis B
🌹Nurse get infected with hepatits b , she is HBs ag And HBV rNA negative , what is your
next step ? A. no further investigation B. us. C. aminotransferase test
If HBs ag positive >C If HBs negative>A
…
- nurse get infected with hepatits b , she is HBs ag Incomplete And HBV rNA negative , what
you've next step ?
- no further investigation - us - aminotransferase test D- follow up closely with LFT’s
…
🌹jaundice patient with: + HBS antigen +anti hepatits b C IgM What the Dx? Chronic
infection
…
🌹known case of chronic Hep B presented with jaundice and fatigue Labs showed
worsening ALT + AST and protein what will would you do?
A.Initiate Alpha interferon ✅ ﻋﻼجB. Liver biopsy (No CT) .
…
🍓Pt had hepatitis B cirrhosis that is stable and they incidentally found a mass in the liver
asking what's the treatment ? A. anti viral B. liver transplant ✅ C. chemo
…
🍓autoimmune hepatitis lab= elevated lgG🍓
…
🌹 screening the mother for HBs what type of prevention? a. 1ry b.2ry c. 3ry d. primordial
🌹 2ry prevention of diabetes= a. healthy lifestyle (primary prevention) b. screening for
cases✅ c. immunization (primary prevention) (screen = scondry )
…
🌹Hep c and cirrhosis. How to tell this is progressing to hepatocelular carcinoma
Ultrasound 🌹
🌹While the obestitratian close the cesarian incision , Pt developed bleeding . What is the
cause ;- A.Liver heamangioma ✅🌹 B.Spleen anyresm C.Intestinal anyresm
🌹 wilson’s diseases, ttt?
A. Iv Defroxamin. B. penicillamine ✅ penicillamine chelates copper
•
ŒŽ •ﻤﺴﻚcopper و–ﻄﻠﻌﻪ ﺑﺮة اﻟﺠﺴﻢ.
Kayser-Fleischer Ring associated with? Wilson’s disease „ﻠﻤﺔ اﻟ† ﻟﻤﺮض4 Ž
Ser = Son
🌹 anaemia is seen in copper deficiency= Sideroblastic🌷
1Skin
🌹skin lesions in the back with some of them being crusted. +bilateral infiltrates = give
antibiotic 🌷
🍓Rash in male age 40 want management antibiotic , steroid . Platelt supporive care ✅
🍓Most common location for Basal cell carcinoma : A. Face B. breast C. lower limb
🍓pt have rash after use herbal medication -allergic contact dermatitis?
Not contact since it’s medication
🍓 24 yr old female uses herbal cream on her vulva noticed redness itchiness and
tenderness around the area of application: - Allergic contact dermatitis.
🍓elderly pt with swelling of the back of neck with multiple opening and discharge and
redness , what’s your diagnosis: A. carbuncle✅ B. furuncle C. abscess D. cellulitis
🍓Female with progressive pain and redness on left hand with History of knife prick :
A. cellulitis✅. B. gas gangrene C. necritizing fasiaitis
1Bacteria
Brucellosis
🌹Treatment on brucellosis? doxycycline and rifampin for 6-8w.
🌹Brucellosis Treat? A.Doxycycline and clindamycin B.Doxy and streptomycin(first line)
.🌹Brucellosis in joints only. Doxycycline treatment for how long? A. 6 weeks B. 6 moth
🌹Neurobrucellosis on rifampin and (another AB I think doxycycline).., ask about duration
of Tx: 6 month
🌹Nurobrucellousis treatment durantion = 6month to 12 month
🌹If it is without neuro manifestation it’s = 6-8 week
🌹Man presented with fever, headache, and back pain, with right sacro-illiac joint pain,
what is the infecting organism: A. Syphilis B. Brucellosis ✅
🌹Case of diarrhea or something came from India, Most common causative org?
A. Rota B. E. Coli. C. Cols. Perfrigins
Pt with hx of rheumatic fever came to hospital after 19 days with fever?
A. Recurrent Rheumatic fever. B. Bacterial endocarditis. C. Mitral valve flotter
🌹An elderly man surgically free with fever and new systolic murmur and signs of
infective endocarditis. What is the organism? staph aureus
🌹Most common cause of Gastroenteritis after eating steak from local restaurant?
E Coli.✅🌹
● 1-6 hours —> (staph. aureus)
● 12-48 hours —> (salmonella, e.coli)
● 48-72 hours —> (shigella) campylobacter
● > 7 days —> (giardiasis, amoebiasis)
🌹Patient was of clindamycin and another antibiotic came with watery diarrhea
asking about management = Metronedazole ...
🌹case in women white discharge +psudophyte in microscopic? Cndida
. white (= ﺑﺷرﺗﮭم ﺑﯾﺿﺎءcandida) اﻟﻧﺎس اﻟﻲ ﻣن ﻛﻧدا: رﺑط
🌹Trichomonas, and ask about ttt? -Metronidazole✅ واÒÓﺗﺮا™ﻤﺎت =ﺗﺮﻛﺾ =وراء اﻟﻤ
🌹prosthetics valve repairs after 4 c'me with picture of IE what bacteria '?
A-st'ph 'ureus B-staph epidermis ✅✅. C-strep vird'n
P....... ﻣﻊP ﻧﺣﻔظﮭﺎ ﺣرف، e*p*idermis ﻏﺎﻟﺑﺎ ﯾﺟﻲ ﻣﻌﮫ ﺑﻛﺗﯾرﯾﺎp*rosthetics valve* اﻟﺻﻣﺎم اﻟﺻﻧﺎﻋﻲ
🌹Patient 1 month after valve replacement, what organism?
A-Step varidans. B-S.Epidermatic✅ C-Staph auras
🌹Generalized cervical lymphadenopathy +وmild tenderness + low grade fever. What's the
most likely diagnosis: - Viral Infection .✅ﺻﺦ
🌹15 year old girl presents with lower abdominal pain, diarrhea and fever (38°C). She has
mucus and blood mixed with her stool. The most likely organism is?
A. amebiasis B. Taenia saginata C. Ascaris D. One more worm
🌹Elderly with catheter with positive culture: Check urine catheter daily 🌹
🌹Elderly pt with lower abd pain and couldnt urinate for many what management?
foley catheter, if acute urinary retention 🌹
🍓 Fever, pharyngitis , maculopapular rash in trunk , lemphadenothathy , dx?
A. Infectious mononucleosis ✅ B. CMV C. Hodgkinlymphoma D. dighteria
🍒Adult with positive kernig sign what is the causative agent :Sterpt🍒
….
🍒🍒scenario about impetigo, asking about organising? Staph aureus 🍒🍒
…
🍓pt came from Egypt with leg tender red lesion in rt leg and she had penicillin allergy,
you give her Ab , in second day she developed N/V and diarrhea watery=Wt the Dx
A. salmonella B. Ab allergy C. worsen gastroparesis D. C diffeclis✅
🌹 50 yo Female came back from Egypt, known case of penicillin allergy ,presented to the
ER because of painful red lesions on the anterior shin of the right leg, she received
antibiotics, next day developed abd pain, fever and diarrhea. What’s the cause of her
symptoms? A. antibiotics allergy. B. Clostridium difficile✅. C. Salmonellosis
💐💐Patient with C difficle, what's the cause = omeprazole 💐💐
🍒Patient on clindamycin developed diarrhea, stool analysis: c.diff Toxin, management?
A.Continue same medication B.Azithromycin C.Metronidazole✅
No vanco on choice
1Drugs
🌹 Furosemide SE: = hypokalemia
🌷 Pt with signs of Hypocalcemia , chovestic sign : A. oral Ca B. IV Ca
🌷 acetaminophen ingestion they mother says that the bottle had a small
amount and he spilled some of it on his clothes after 4 hours
observation in ER he is still stable A. Watch for another 4 hours
🌹 Chronic pain medication?A- Acetaminophen b-Opioid c-Ibuprofen
ﻧرﻛز ﻗﺎلchronic وﻟﯾسacut ﺑﺎﻗﻲ اﻻدوﯾﺔ ﻣﺎﯾﻧﻔﻊ اﺳﺗﻌﻣﻠﮭﺎ ل ﻓﺗرة طوﯾﻠﺔ ﻟﮭﺎ اﺿرار ﻣﻧﮭﺎ ﻋﻠﻰ اﻟﻛﻠﻰ واﻟﻣﻌدة.
🌹 1)_Cyclosporine use for? Steroid sparing agent
ﻂ ﺣﺮفÏ رS ﻣﻊsteroid وsparing
....... ..... ....
🌹 High K = give ca gluconate K = Ca
🌹On chemo then develop fever = culture +iv ABx
🌹sinus infection with haemophilus influenza treatment ?
A. steroid inhalation abx decongestant B. steroid anti inflammatory
🌹Most effective method to decrease stone formation in patient with hypercalcemia?
A. decrease protein B. thiazide C. allopurinol D. decrease calcium intake
🌹A lady who lost her close friend in grief and complaining from trouble sleeping Which is
the best treatment ?
A. Imipramine. B. Chlorpromazine. C. Lorazepam✅ ( trouble sleeping) D. Fluoxetine
ﻂ =ﻟﻮرا =ﻧﻮم =اﻗﻔﻞ اﻟﻨﻮر =ﻋﺸﺎن اﻧﺎم ز–ﺎدةÏ ر.
........
🌹What medications should not be taken with Plavix(clopidogrel)?
A. omeprazole✅. B. statin. C. SSRI
🍒 pt with MI ( give imfomtatlon and vitals signs with increase JVP ) , what is the tx of shock
-A-Abx B-doptanim ✅
🍒 pinpoint pupil treatment = Nalxon
🍓Low grade fever ,o2 sat 88 , hypotension 90/50 what is the initial step of management?
A. Iv fluid B. O2✅ C. Antipyretic .......ABC management...
🌹man wants to stop smoking after his father getting a lung cancer, he is a known case of
seizure disorder compliant on carbamazepine, which one from the following he can't use?
A. Electronic cigarettes B.bupropion ✅ ﺸﻨﺠﺎتâ ﻳﺰودC. NRT D. varenicline
# wants to stop smoking + has Epilepsy = Dont give bupropion 🚫
🌹Pregnant lady known asthmatic was on salbutamol only before pregnancy and was
controlled, During pregnancy, she started experiencing daily symptoms and once a week
night symptoms, Which of the following treatments would you give?
A. ICS with short acting bronchodilators C. ICS with long acting bronchodilators
D. ICS with long acting beta 2 agonist✅
🌹Poorly controlled asthmatic patient developed hypertension which drug is CI:
A. beta blocker B. CCB ﻠﻮك ﺑ~ﻌﻤﻞu ﺑ|ﺘﺎbronchoconstruction
Over dose of beta blocker asking about antidote? Glucagon
🍓patient presented with decreased reflexes, numbness and vitiligo (B12 def) what to
give: A. oral B12. B. Im B12✅
🍒Thiazide helps in decreasing urinary calcium > calcium stones in kidney
🍒Allopurinol > decrease risk of uric acid stones in kidney
.........
🌹pt with penicillin allergy what abx to give him : clarithromycin or ciprofloxacin
.........
🌹Asymptotic UTI after delivery : No need🌹 ﺧﻼص وﻟﺪت ﻣﺎ &ﺤﺘﺎج،
🍒🍒Pt happen to her chemical burn during resuscitations they remove her close and
found chemicals powder what next step? swiped the powder. 🍒🍒
🌹Female patient has chemical burn all back area what to do in ER ?
A.sweep chemical powder✅ B.wash by clean water for 30 min (if lqiuid)
…
🍒Amiodaron Side effect = bradycardia, photoxicity, thyroid toxicity, lung fibrosis 🍒
..
💐Allergy after CT contrast=Epinephrine💐
…
Paracetamol toxicity presented after 1 day with symptoms of RUQ pain and nausea next:
= N-Acytocloin
🌹case of young girl medically free symptoms of migraine what give her?
NSAID 🌹
...
💐External ear infection ttt?? Topical neomycin (Not orall)💐
🍒Young female after swimming pool, painful red ear pinna?Topical neomycin
🌹Patient with inflammation of external ear with hx of swimming management:
A. oral amoxicillin B. topical neomycin
...
...... .....
1Antibiotic
🌷-candida manage? Trecoazole cre'm topic'lly
🌹 SLE flair with UTI what drug not to give to this patient:
A. Cephalexin. B. Amoxicillin C. Nitrofurantoin D. Sulfamethoxazole
🌷Antibiotics contraindications in CKD? Nitrofurantoin & Fosfomycin🌷!@
🍒 patient k/c renal impairment cannot give him? . nitrofurantoin
🍒 Pt with CKD( chronic kidney dis) and UTi ttt?
A)_Nitrofr ﻠﻮي6 ﻣﺮض اﻟﻔﺸﻞ اﻟ¤ﻫﺬا ﻣﻤﻨﻮوووع ﻋ
B)_ Cipro ✅ ✔ ف اي اﺣﺪ ﻋﻨﺪە ﻓﺸﻞ „ﻠﻮي و–ﺤﺘﺎج ﻣﻀﺎد ﺣﻴﻮي، ﺪyÄ–ﻖ اﻟÀﻫﺬا اﻣﻦ ﻻن ´ﺴﺘﻘﻠﺐ ﻋﻦ ﻃ
وﻟ~ﻜﺲÒ£ﻧﻌﻄ~ﻪ دواء ﺳﻴ
🌷 Which drug can safy taken in ckd ( Chronic kidney disease ) stage 3 :
- Metformin - nitrofurantoin - Lithum - Wafrarin
🌷 when to stop metfromin in di'betes if GFR is? Less than 30 (stage 4)
🍓Man with flank pain , dysuria - UTi what you’ll give ? Nitro
🍓patient known to have an allergy to penicillin and sulfa group present with
UTI which antibiotic will choose ?
A. Nitro ✅ UTI = NIT. B. trimethoprim/sulfamethoxazole i C. cephalexin D. ampicillin
🌹Otitis Media signs and symptoms asking about the treatment: Amoxicillin/Clavulanic
🌹Patient presented with diarrhea for two weeks. Stool showed trophozoites (giardiasis)
What is the treatment:= Metronidazole
واÒÓ اﻟﺤﻖ ارﻛﺐ اﻟﻤýÓ–ﺖ ﺧÀﻂ =ﺟ~ﺎردا =ﺟÏ =رmetro.
.......
🍓Which antibiotics can cause prolonged QT interval: = Erythromycin
Infectivev endocarditis with valve involves what Ab to give:. Vancomycin + ceftriaxone✅✅
🌹 pseudomembranous colitis management = vancomycin 🌹
ﻂ =ﻣ¼†وب ﻓﻤﺘﻮاÏ = رvanco = ﺎت ﻫﺬەÏ اﻟﻤ¼†و¤ﺬب واﻻﺷﺎﻋﺎت ﻋÄ اﻟÒôﺎﻟﻘﻮﻟﻮن وﺗﻬﻴﺞ =ﻳﻮە •ﺎ ﻛu •ﻌﻤﻞ اﻟﺘﻬﺎب
psudo .
🌹 Treatment of clostridium difficile: IV Vancomycin ✅
= ﻣﻊ اﻧﮫ ﺻﻌب ﻧوﻗﻔﮫ ﻻن طﻌﻣﮫclose = رﺑط = ))ﻓﺎﻧﻛو = 🥤🥤 ﻓﯾﻣﺗوا = ھذا اﻟﻣﺷروب ﻣﺿر ﺟدا ﻻزم ﻧوﻗﻔﮫ
)) =ﺻﻌبdifficilt =difficult ﺣﻠو
🌹old man tender abd bloody stool take amoxicillin from 3 wks dt UTI sigmoidoscopy
inflamed mucose with plaque like lesions?
A. ischemic colitis B. pseudomembranous colitis✅
🌹pt come from indonisia present with bloody diarrhia diagnosis with ( camylobactiria ) =
Azithromycin 🌹
🌹 Campylobacter jejuni treatment ?
A. Ceftriaxone. B. Azithromycin ✅ C. Metronidazole D. Fluconazole
ﻂ =„ﺎﻣ~ﻠﻮا =ﺟﻤﻴ~ﻠﺔ =ازﻫﺎرÏ🌻🌼 رazethro
….
🌹Spontaneous bacterial peritonitis treatment? IV ceftriaxone
…
🍒baby on otoscope exam there’s no mobility of TM, he is breast feeding,no fever, no
pacifier, it’s unilateral what will you give? A. amoxicillin ✅✅. B. amoxicillin-clav
..
......
🍒🍒H pylori case on ppi and ....azole what you add ? Clarythromycin 🍒🍒
..
Empiric Abx for infective Endocarditis = Vanco and Gentamicin
…
…
🌹sever allergey to vancomycin = stop vancomycin then give cefatriaxon 🌹
🌹just rash happen due to vencomycin = continue with vancomycin but with slow infustion
rate ( Bez its mild allergy not need to stope vanco cont with slow infustion 🌹
🌹The same scenario asking about stage or phase of paracetamol toxicity, she was
complainig of abd pain,nausea and vomiting = 1✅✅ 2. 3 4
🌹Mean Arterial Pressure is 55 , intracranial pressure 15. What's the cerebral perfusion
pressure? 40 (55_15)
🌹Dyslipidemia screening age MAN: A. 18 B. 25 C. 35 D. 50
🌹Dyslipidemia screening age femal:45
🍓 How many quality years does smoking take from a somker?10
🌹 You have a population, 800 have liver disease and 800 dont have it. The test shows 200
of those with the disease to be positive. What is the sensitivity? A. 25%✅B. 33%C. 50%
🌹 What is the percentage of male smokers in Saudi arabia: 25%
1CNS
🌹Elderly with positive bilateral rinne's test and Weber test is better on the
right ear. What is the diagnosis?
A. Conductive hearing loss of right ear B- left sensorineural hearing loss.
🌹patient with sinusitis did scope that injures the nerve that caused loss of sensation of
lower eyelid and superior lip what is the nerve injured ? Infraorbital
🌹 Old pt with hx of recent travel , came with difficulty getting aroused/awaken, he
report multiple falls, examination shows no head wounds and skull intact , most likely
diagnosis:? A. post concussion syndrome B. chronic subdural hematoma
🌹- 50 yo pt with 3wk H of fatigue and tiredness and tonge and lower limb
fasciculation . Dx?A.myasthenia gravis C.motor and neuro disorder✅ D.mono neuropathy
🌹 A woman presents with left sided facial twitching and spasticity throughout her body;
she also has unilateral tongue fasciculation. diagnosis is A. myasthenia gravis .b B.
Myasthenic syndrome. C. Mononeuropathy. D.Motor neuron disease
🌻Spasticity > upper motor neuron
🌻Fasisculation> lower motor neuron
🌻both features upper and lower > amyotrophic lateral sclerosis
🍒Case of stroke came in 4 hours what is the most important next step ?
A-asprin B-ct scan ✅✅ C-mri brain ...
🍒Female patient presented with lethargy Ct scan shows area of hypodensity in the
frontotemporal lobe A. brain abscess. B. herpes encephalitis ✅
¤]ﺲ =ﺷﺎف اﺳﺪ وﺿﻊ •ﺪە ﻋÀ ﻫfrontal وﻫﺮب
🍒 Pt has change in behaviors what’s the Dx, = Frontotemporal dementia
🌹 patient c/o 4 months of hearing loss now come with 7 nerve palsy
A. rumsy hunt B. brain tumor C.bell's palsy
https://www.ncbi.nlm.nih.gov/m/pubmed/17300646/
🌹pt with paraplegia and high ca = immobilization
🌹Management high ca = A. normal saline B. albumin and normal saline C. forsmid iv
🍓pt with facial asymmetry , moth deviation, absence of forehead wrinkles , what’s the
nerve affected: A. ll B. V C. Vll✅ D. X
🌹 Double vision, when he look straight the lt eye deviated to nose side, Lt. eye cannot look
laterally? A. Rt. 6 CN palsy. B. Rt. 3 CN palsy. C. Lt. 6 CN palsy✅. D. Lt. 3 CN palsy
🌹Case of dm pt with sx of 3rd nerve palsy (ptosis, double vision when looking laterally)
Dx? Dm 3rd nerve neuropathy
🌹Pt with 6th nerve palsy can't abduct his left eye with diplopoa : Left 6th nerve plasy
🌹) _ ( Left eye unable to abduct) , when looking forward there’s squint towards the nose
which nerve affected: - left 6th
🌹right eye. Pupil reflex normal in both eyes and all other cranial nerves are
normal diagnosis? A. 3rd cranial nerve palsy B. cavernous sinus thrombosis
🌹Patient has sudden onset unilateral facial paralysis. Which medication is proven to
reduce duration of symptoms? -Steroids ✅
sudden onset unilateral facial paralysis = ((Bell palsy)) = treat by = steroid .
اﻟﻮﺟﻪfgﺪ =ﺳhوfmﻐﻄﻴﻬﺎ =ﺳﺘh وﺟﻬﻪ وfgﺴd ﻞ واﺣﺪ وﺟﻬﻪ ﻧﺼﻪ ﻣﺸﻠﻮل =ﻻزمVﺎﻟﻤﺮض =ﻧﺘﺨO ﻂ اﻟﺪواءJIﺗﻌﺎﻟﻮا ﻧ
🍓elderly k/c of HTN with gradual loss of cognitive function, especially executive function
on imaging there is *diffuse* periventricular white matter hyperintensity what us the
cause: B. Vascular✅ C. Alzheimer.
🌹old male patient came with his brother, brother complaining of change in
personality,mild forgetful, MRI show cortical atrophy : Answer:Alzheimer disease ✅
🌹Long scenario about Alzheimer then MRI show: atrophy of hippocampus
and temporal lobes.
🌹Vascular dementia: history of major atherosclerosis risks DM, HTN, Smoking,
hyperlipidemia🌹
🍓Recent memory loss and behaviour changes /multiple brain infarct: Vascular Dementia
🍒elderly hypertensive and has cognitive changing , MRI brain showing: periventricular
hyperintensity : vascular cognitive impairment
🌹Elderly with unsteady gait, later he developed forgetfulness
A. Alzheimer disease B. Frontotemporal dementia
C.Normal tension hydrocephalus✅🌹 D. Cruetzfelt jakob disease
🌹Old M, drowsy and forgetful, Hx of femoral embolization 12 hrs ago. Ddx?
A- Alzheimer's, B- Lewy body dementia, C- multiple infarct dementia✅
ﺎﻟﻤﺦ ﻓﺴﺎرB ﻣﻮت اﺟﺰاء9ﻪ ﺟﻠﻄﺎت ﺻﻐ_^ة وادت اwﺪ راﺣﺖ ﻟﻠﺪﻣﺎغ وﻋﻤﻠﺖ ﻓw©ﺎﻟﻘﺪم ﻣﺘﺤﺮﻛﺔ وﻻﻧﻬﺎ ﻣﺘﺤﺮﻛﺔ اB اﻟﺠﻮاب ﻻن ﺟﺎت ﻟﻬﺎ ﺟﻠﻄﺔ±: } ﻣﻨﻄ
parkinsonism
🌹 Patient with nephrotic syndrome , abdominal pain what is the complication that
happened? Peritonitis (Peritonitis is a complication in nephrotic syndrome)
Meningitis
🌹 Meningitis with pic showed pateci ask what to give his brother? Rifampin 🌹
🌹 pediatric Prophylactic antibiotic for relative of child with meningitis =-Rifampicin
🌹80 old with meningitis , what you give people contact with him:
Ciprofloxacin ( Dont choice Rifampin) bez he is old .
ﻋﻠﻴﻬﻢÒ£ ﻧﺼÒ£وا =ﺻÒ£ﺎر اﻟﻌﻤﺮ ﻧﺨﺘﺎر ﺳﻴyﻛ
🌹 What to give Pilgrims against african meningitis ? cipro
🌹 15 years old case of meningitis LP to be done what to do:
A-Take consent form parents and assent from patient ✅ Òç ﺳﻨﺔ ﻟﺴﺔ ﺻﻐ١٥ ان
B-take consent from parents and donʼt assent patient D-consent patient only
🌹 15month with b'cteri'l meningitis tx? Vncomycin + ceftrixone ﻓﻤﺘﻮا و ﺳﻔﻦ =ﻋﺸﺎن ﻧﺘﻌﺮف
؟ñ• ç =ﻣﻨñ
• ç اﻧﺖ ﻣﻦ ﻓ
🍓22 years old pt e typical meningitis culture show gram + cocci in clusters. ask about ttt?
A. ceftra, vanco and steroid B. ceftra and vance
🍓Gram negative coccobacilli in meningitis: A. Ciprofloxcine B. Ceftraxione ✅
🍒drug for meningitis + endocarditis= Ceftriaxone + vanco For both
🌹 3 day old with sx meningitis and csf analysis (Beta hemolytic and catalase +ve ) ,
empirical therapeutic : Ampicillin
1Shock
Old age female DM HTN admitted to ICU due to urosepsis and septic shock Vitals low PB
SpO2 84 temp 38 HR 120 given O2 and not improve Cardiac examination is clear High WBCs
X Ray shows bilateral lung infiltrate what is the case of her respiratory problem ?
A. ARDS. B. Cardiogenic shock. C. Hypovolemic shock D. Fluid overload
female after RTA, congested neck veins and muffled heart sound, what else would make
the prognosis worse: A- BP 88/50 ✅✅ == (tamponade)
🌹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
🌹After repair patient had got Shock iv fluid resus failed warm extremities and hypotension
which type? Septic.
🌹chest pain did heart surgery, in shock with high cardiac output and decreased
peripheral resistance? A. Septic ✅✅ B. Cardiogenic C. Hypovolemic D. anaphylactic
🌹long scenario about SIRS with labs?
A. sepsis B. severe sepsis C. SIRS. D. bacteremia
الSIRS ýŽ • •ﻌSystemic inflammatory response syndrome = ﺐÞﺴ7 „ﻞ اﻟﺠﺴﻢ ﺣﺼﻞ ﻓ~ﻪ اﻟﺘﻬﺎبýŽ • •ﻌ
اﻧﻔﻜﺸﻦ او ﺣﺼﻞburn ـﻊÏ وﻟﻬﺎ ارcriatira :
🌻fever >38.0°C or hypothermia <36.0°C
🌻tachycardia >90
🌻tachypnea >20 breaths
🌻WBC= >12,000/l or low WBC leucopoenia <4,000
اﻗﻮل اﻧﻪ ﻋﻨﺪەîn ﻃ}ﺐ ﻣSepsis ؟ اذا ﻓ~ﻪ ﻧﻔﺲ الcritira ﺎﻟﺴ|ﻨﺎر–ﻮا ﻗﺎﻟﻚ ﻋﻨﺪەu+ ﻨﺎﻫﺎé ﻛﺘÐŽ اinfection .
اﻗﻮل ﻋﻨﺪەîn ﻃ}ﺐ ﻣsever sepsis ؟ ﻧﻔﺲ ﻋﻼﻣﺎت الsepsis ﺲ ﻗﻠﻨﺎ7 ﻂyﺎﻟﻀu sever ﻏﺸﺎن اﺣﺪ اﻻﻋﻀﺎء
• • ç اﺗ|ﻨÒçÄ ﻗﺎﻟﻚ ﻣﺜﻼ اﻟý••ﻌ
وﻇﺎﺋﻔﻬﺎŒŽ ﺎﻟﺠﺴﻢ ﻓﺸﻞu (organ dysfunction) او ﻗﺎﻟﻚ¤6 ﻣﻌﻨﺎﻫﺎ ﺣﺼﻞ ﻓﺸﻞ اﻟÐŽ ﻋﺎñ Ž
•
ﺪyÄ اﻟŒŽ ﻓﺸﻞýŽ • ﺪ ﻋﺎﻟ~ﺔ •ﻌyÄوﻇﺎﺋﻒ اﻟ.
اﻗﻮل ﻋﻨﺪەîn ﻃ}ﺐ ﻣseptic shock ŒŽ • ﺲ ﻧﻀ~ﻒ „ﻠﻤﺔ وﺣﺪە اذا ﺷﻮﻓﺘﻮﻫﺎ اﻋﺮﻓﻮا دﺧﻞ7 ؟shock 4 Ž و
Hypotenstion .
.....
🌹 type of shock in patient Hit by car and after 3 hour suddenly has distended abdomen?
A.hypovolemic ﻒwÙ✅ ﻧ
🌹mva case with tachy + hypotention + low pulmonary wedge presser = type of shock =
hypovolemia 🌹
🌹pulmonary wedge pressure: low,
high systemic vascular resistance Type of shock? A. Hypovolemic B. Cardiogenic
🌹 IHD & DM pt e week pulse. What type of shock you suspect = Cardiogenic
ﺾ ﻣﺼﺎب بwv; ﻻن اﻟﻤ n
o ﻣﻨﻄiscemic heart dis .
🌹heart failure , septic and uroseptic shock develop hypoxia , bilateral crepitation Giving
fluid and inotrop still have hypoxia on mechanical ventilation = Cardio-pulmonary 🌹
ICU paitent with diabetic , heart failure , septic and uroseptic shock develop hypoxia ,
bilateral crepitation Giving fluid and inotrop still have hypoxia on mechanical ventilation?
I think what is the cause of this hypoxia??
a-Ards b-Cardio-pulmonary ✅✅ c-Volume overloud
ﺤﺼﻞ# ﻓ، ﻢ°„ اﻟﺮﺋﺔ ﻓﻴ©‹ا6 4 ﻣﻮﺟﻮد56ﻞ اﻟﺪم ا¢ ﻄﻠﻊžﺾ وIkﻢ اﻟﺴﻮاﺋﻞ )ﺎﻟﺮﺋﺔ اﻟﻘﻠﺐ ﻣﻮ ﻗﺎدر ﻳ°ﻪ ﻳ©‹ا#ﺤﺼﻞ ﻓﺸﻞ ﻓ7 اﻧﻪ ﻋﻨﺪە ﻓﺸﻞ )ﺎﻟﻘﻠﺐ وﻟﻤﺎ، ﺳﺎر ﻣﻌﻪ56ا
4 Œ ﻟﻮ ﻋﻜﻴﻨﺎ ﻟﻪ اوﻛﺴﺠ³© ﺣ، ﺎاااﻧﺔ ﺳﻮاﺋﻞ#ﺪ ﺟﺪا )ﺎﻟﻨﻔﺲ ﻻن اﻟﺮﺋﺔ ﻣﻠ7ﻟﻪ ﺿﻴﻖ ﺷﺪ
¶ﺪة )ﺎﻟ¯ﻼم اﻟﺤﺎﻟﺔµ اﻟ، ﻪ ﻣﺪرات ﺗﻄﻠﻊ اﻟﺴﻮاﺋﻞ#¬ اﻟﻌﺎﻟﻢ ﻣﺎ ﻫﻴﻨﻔﻊ ﻻزم ﻧﻌﻄ
ﻫﺬە ·ﺴ¸ بcardio _ pulmonary ﻣﺸ¼ﻠﺔ ﺣﺼﻠﺖ )ﺎﻟﻘﻠﺐ أﺛﺮت ﻋ• وﻇﺎﺋﻒ اﻟﺮﺋﺔ³6 4 ﻌ7 .
🌹Case of cardiogenic shock .. ?decrease cardiac output✅🌹
🌹 Scenario about old female with cardiogenic and ischemic heart disease,, asking about
type of shock she had? cardiogenic shock ✅ ✔
🌹 other Scenario about trauma and hemorrhage,asking about type of shock?
Hypovolemic shock ✅ ✔
Spinal shock occurs during the acute phase following spinal cord injury and is a
Neurogenic shock, part of spinal shock, consists of severe bradycardia and hypotension
🌹Paintnt MVA,hypotensive tachycardia tachypnia can shrug the shoulder but cant
move elbow or lower extremities
the cause of this hypotension = upper spinal injury 🌹
1Psycatric
🌹Patient parents complain of signs and symptoms of schizophrenia in their son
What treatment option is appropriate:
A. Oxcarbazepine << bipolar. B. Amisulpride << treat Schizo
🌹Psychiatric patient you ask him “ do you think you have mental illness “ this is
Called = insight
🌹Patient with insomnia worsening sad mood, low self esteem, hopelessness for 2 year ?
A. Depressive disorder B. Organic depressive disorder C. Minor depression D. Dysthymia
🌹family leave him with his friends in party, then returned back home with SOB and
swelling. What is the cause = (Food allergy) give Adrenalin🌹
🌹 Female come to ER complining from her neighbor ( abuse her) and talk with hem
even he doesn’t in ER Dx -Dulsions and hallsuntion
🌹 Sleep disorder:
• Stage 1 > easily awake. • Stage 2 > deeper stable diff to awake. • Stage 3 > deeper, GH.
• Stage 4 > dream 🌷stage 4 = dream 🌷
🌹 O male, lost his partner, he is in bad & depressed mood and for 2 months. Dx?
A- Minor depression. B- Major Depression. C- bereavement✅✅
ﺷﻬﻮر٣ –ﻦ اوÀ ﻣﻦ ﺷﻬÒôÙ ﻟﻮ „ﺎن ا، ﺘﺌﺎبÙ ﻫﺬا ﻣﺎ ﻧﻄﻠﻖ ﻋﻠ~ﻪ ﻣﺮض ا، ﺘﺌﺎبÙ ﺣﺰن واŒŽ • ~ﺪ ﺑ~ﻈﻞÙ اŒ•واﺣﺪ اﺑﻮە ﺗﻮ
ف ﻟﻮ ﺣﺎء ﺳﺆوال وﻓﺎة، –ﻦÀ ﺣﺴﺐ اﻟﻤﺼﺎدر ﺷﻬ¤ وﻓﺎة او ﻓﻘﺪان ﺷﺨﺺ ﻋŒŽ • ة اﻟﺤﺰنÒÓﺘﺌﺎب ﻻن ﻓÙﻧﻘﻮل ﻋﻠ~ﻪ ا
ة ﺣﺰنÒÓﺴﻤ~ﻪ ﻓD –ﻦÀ ﺷﺨﺺ وﻇﻞ زﻋﻼن وﻣﻜﺘﺌﺐ ﻣﺪة ﺷﻬbereavement .
🌷lost his partner he is bad & depressed mood for 2 month == bereavement🌷
🌹 Women after peaten by her husband and came to police , what is the most common
cause of domestic violencersfq q ? ﻋﻨﻒ ﻣ
- cultural background - Socioeconomic state ✅ ±: } =ﻣﻨﻄÏ: ﻣﺴﺘﻮى اﻗﺘﺼﺎدي واﺟﺘﻤﺎ- Beliefs about the
right of the other gender
🌹 7 y Child with vomiting dx as schools phobia and GAD tx? CBT + SSRI
🌹) Patient presented to you with loss of apathy and delusions what’s the treatment
A) TCA. B) TCA + cognitive behavioral therapy C) cognitive behavioral therapy ✅
ﻠﻤﺔ6 ﻫﺬە اﻟapathy ﺎﻻە وy ﻣﻌﻨﺎﺗﻬﺎ ﻻ ﻣcognitive ﻂ ﺑ|ﻨﻬﻢÏÀﻓﻤﻦ اﺳﻤﻬﺎ ﻧ. ﻣﻌﻨﺎﻫﺎ ادراك.
Dx is Delusional disorder , Delusional symptoms + apathy = schizophrenia most likely which
treated by antipsychotic not antidepressants
🌹)_ Pt thinks that aliens are in the backyard he knows they don’t exist, but is
overwhelmed by the idea. He feels he’s going crazy dx: Obsessions✅
🌹14 years old was investigating his father's death then he said that he saw his dead father
then he walked naked suddenly when asked why doing so said that his father told him to do
so and his proud of him his symptoms was for 3 days What is the diagnosis of this patient?
A. Schizophrenia B. Schizoform C. Schizoaffective D. Acute psychosis
»ء ﺣﺎد وﻣﺆﻗﺖ¼
Ž ﻴﻮتÙ ا.
🌹Patient came to ER recurrently with palpation and fearing of die (no sweating
or loss of consciousness) A. Panic disorder✅ B. Agoraphobia
🌹 OCD case clear Lady check doors and oven and kids school things many times, can't
sleep if did not do that ?
A. anxiety B. OCDوﺳﻮاس ﻗﻬﺮي
🌹Patient with recently depressed after being promoted to manager, what to do?
A. TCA B. SSRI C. Psychotherapy
🌹pt with RA, diagnosed with something, doctor to want to start steroids Pt afraid of side
effect of steroids , what should you do ? A. Enforce the need of steroids
B. tell him you will die if you did not take them C. tell him the SE are not serious
Answer is : C By exclusion plz check last answer in the exam
🌹 depressed pt and doctor ask the pt (do you think that's you have mental illness) the
doctor assess? A. insight B. judgment C. guilt
🌹 Male with asthma has sx of social phobia he said his sx aggravated or increased with his
inhaler ? -sertraline 🍒
🌹؟؟ñ • ç ﻄﻞ ﻓﻬﻮا ف اي ﻣﺮﺣﻠﻪ دﺣyﺾ ﻗﺮر وﺧﻄﻂ ﯾQÀ و„ﻞ ¼» واﻟﻤñ
• ç ﺣﻠﻮ ﺧﻄﻮرة اﻟﺘﺪﺧè¼ واﺣﺪ اﻟﺪﻛﺘﻮر
Ž
A_Precontemplation B_contemplation C_Preprantion
🌹 Women sabling die cry for 5 day not sleep for 2 days, what short course management?
A. Fluxatine B. Imytriptand C. Clonacolam D. Flurazepam ✅
🍓 Auditory hallucination + think of food poisoning.. Dx ?
A. Delusion B. auditory hallucination
vote: delusional disorder doesn't cause psychosis, it's Fixed unshakable beliefs
🍒 other is paased away , he said she is present and no one can see her
A. delusionB. visual hallucinations✅
🍒pt with feeling of grandiosity + hallucination + delusion, What he has !?
A. neurosis. B. psychosis✅. C. personality disorder
🍒A patient presents with auditory and visual hallucinations for the *first time*. most
appropriate treatment? A. Olanzapine B. SSRI. C. CBT. D. Antipsychotic plus CBT ✅
🍓Girl depressed as she feels abandoned by her therapist , admitted , on admission hears
voices then denies that she did , caused conflict between doctors: (answer is type of
personality disorder ): Borderline personality.
Vaccine
🌹vaccines contraindicated for immuncompramised baby? live attitude🌹
🌹Pediatric Pt with seizures what vaccine not to give? : DTaP 🌹 ﻌﻤﻞ «ﺸﻨﺠﺎت: ﺔS¬ﻣﻦ اﻋﺮاﺿﻪ اﻟﺠﺎﻧ
🌹Dtap vaccine “least” risk factor A. Fever 38.4 B. Redness C. Rash
🍓New born you want to give vaccine , the mother told you that she had a new born died
after vaccination due to immune dif, what you will do :
A. Give BCG B. Dont give BCG✅ bez its live vaccin. C. Give immunoglobulin
🍓Adolescent has missed the second dose of varicella vaccine, what will you do now:
A. measure varicella antibodies B. give double the missed dose C. give the same dose✅
🌹57 year with CAD which vaccine? influenza ( Dont choice hemophila influnza , there is
diffrent
🌹Hepatitis b post exposure prophylaxis? IVIG + vaccines if un immunized.
🌹Pretem baby 1.7 kg asking about vaccines?? delay HBv🌹
🌹Note: Premature infant should be vaccinated as full term with exception of HBV vaccine
if his / her weight less than 2 grams ( give HBV vaccine after one month from birht )🌹
🌹SLE patient on immunosuppressive, which vaccine should be taken by the patient:
Annual influenza
🌹Mother has gastroenteritis and breast feeding her child (4months old) Coming for
vaccines: A-delay vaccines B-give hep b only C-give OPV only D-give them all ✅
🌹What type of food we must ask about sensitivity before vericella vaccine?
A-milk. B-egg ✅✅ C-chicken D-rice
🌹Egg sensitivity he should not get which vaccine? yellow fever ﻟﻮن اﻟﺒ~ﺾ اﺻﻔﺮ ﻓﻤﻦ اﺳﻤﻬﺎ
🌹Patient known SLE on immunosuppressive agents which vaccine is recommended?
Annual influenza ✅✅ ﺻﺢ „ﻞ ﺳﻨﺔ •ﺎﺧﺬوﻫﺎ
🌹Child brought by father complained of Measles, you knew from history that he didn't
take Vaccines? A- educate father✅ B- treat child and ignore father
🌹Trauma patient in hospital . When to give him vaccine of PCV ( Pneumococcal conjugate
vaccine ) : A.2days. B. one week. C.2weeks✅ Tow = Truma ¸Ž Ó ¸ ﻣﻊŽ Ó ﺣﺮف
🌹Which vaccine contraindicated in immuncompromise patient == varicella
🍓pregn'nt 't third tri she is chrons pt on azithropine+biological agent ask about her child
vaccines ? A-give 'll. b-del'y till 3 month C-delay till 6month✅
🍓1year vaccine include: OPV, MMR, MCV , PCV
🍓 Patient known SLE on immunosuppressive agents which vaccine is recommended?
A-do not give live attenuated vaccine ✅ ✔ B-Varicella C-MMR
🌷Small box vaccine is contraindicated in patient with psoriasis and contact dermatitis🌷
¸ ﻻن راح •ﻌﻤﻞ ﻟﻪŽ • ﺷﺨﺺ ﺛﺎŒŽ • ) Òç ﻟﻮ (ﺑﻮﻛﺲ ﺻﻐýÓ_ ﺣ
Ž ع ﺗﻌcﻂ =ﻣﻤﻨÏر
حÀﺎﻟﺠﻠﺪ و ﻗu ﻣﺸﺎ™ﻞdermtitis and psorisisi
🌷crohn's pt on azathioprine + biological agent want child vaccines = delay till 6month🌹
🌷A 6 year old who never received vaccination except BCG at birth he is hepB+ve ,what
vaccines should he receive now? A- Polio. B- hib. C- dtp✅✅. D- mmr
🍓 HBV nurse vaccine what to give her ? - immunoglobulin ✅
🍓 6m old baby k/c of epilepsy, on anticonvulsants, regarding vaccinations:
A-Stop all vaccinations B-Switch opv to ipv C-Don’t give dtap✅✅D-Don’t give live vaccines
🌷pregnant with crohn's on biological drug and steroids= dely live vaccine 6 months🌹
🍓 Contraindicated vaccines in pregnancy A-•meningococcal. B-•varicella ✅✅ C-•influenza
🌹Hep B = recombinant vaccine = Hepatitis B Vaccine (Recombinant)
🌹URTI with lymph node enlargement for child who missed vaccine:
A- Strept. Pneumonia. B- Pertussis D- Diphtheria✅
🌹Pneumonia vaccine in elderly?
• PPSV23 only • PCV13 first, followed by a dose of PPSV23 ²§ﺎ اﻟ–ﺒ¹ {ﻌﺪ²§ء اﻟﺮﻗﻢ اﻟﺼﻐÔÕ
o اول
• PPSV23 first, followed by a dose of PCV13 • Or 13 then 23
🌹-child have vesicles and rash and have immune deficiency what to do for his brother?
a-Immunoglobulin ﻋﺸﺎن •ﻘﻮي اﻟﻤﻨﺎﻋﺔb-Avoid skin contact
….
🌹 What is the fovarble place for AV fistula?
A-brachial artery basalic vein B-brachial artery cephalic vein
C-radial artery basalic vein D-radial artery cephalic vein ✅✅✅
🌹 Q about renal impairment with arteriovenous anastomoses or shunt
A- arteriovenous B- brachiocephalic C- radiocephalic ✅✅
🌹55 man hypertensive and has renal insufficiency. He is evaluated for AV fistula , no
history of trauma or AV malformations in his non dominant hand , what type of fistula
should be offered for him first=A-Brachiocephalic B-radiocephalic C-baslocephalic.
Patient diagnosed with CKD now he is coming in outpatient clinic and you decided to start
him on hemodialysis, his crt is 10, what best method of access
to start hemodialysis?
A. Arteriovenous graftÒç ﺟﺮاﻓﺖ ﻣﺸﺎ™ﻠﻬﺎ ﻛﺜﻴB. Arteriovenous fistula
C. Tunneled venous catheter D. Non tunneled venous catheter
🌹2 Pics of child’s hand with distal radial fracture with and angulation and Deformity with
small lesion. What will you do: Closed reduction with below elbow cast
.....
🌹 Patient had thenar muscle atrophy however his sensation was intact over that area,
what nerve injury is most likely? A. Radial B.Median ✅✅ C. Axillary D. Ulnar
.........
🌹 Hypothenar atrophy but sensation intact? Ulnar injury
HIV
🌹 27 year old with history of confusion for 2 days and seizure for 5 hours . he is not
oriented to time place person . he has history of unprotected sex for 6 years ,serum
cryptococcal antigen positive , what is appropriate test to do :-
A. HIV serology B. csf toxoplasmosis C. csf syphilis D. herpes
● HIV with splinter Hge ? Endocarditis
🌹Business man having unprotected sex previous 6 months presented with seizures, cough
..etc. Investigations show cryptococcus neoformans. What's the patient having? HIV ✅
🌹unprotected sex = cryptococcus neoformans = HIV🌹
🌹Active HIV pregnant woman, advice:
A-Safe to breastfeed while taking medications
B-Advise for c/s to reduce chance of baby getting infected ✅✅
🌹pt result came back HIV +ve who came prior for infertility assessment:
A-Tell the patient✅ B-tell the wife
🌹HIV patient developing CNS problem what to give? sulfadiazine and pyrimethamine
🌹positive cryptococcal antigen ,with hx of unprotected sex : A. hiv B. syphilis
🍓business man used to travel to east complaining of cough and lymphadenopathy and
oral candida what is dx:
A. toxoplasmosis
B. HIV✅✅Yeast infections in the mouth, oesophagus and other mucous members are
common in people who are infected by HIV.
🌹 Man come to your clinic complaining of oral thrushes and generalize fatigue and
lymphadenopathy for 2 weeks on forthar history he said the he traveled for several time
what is the most likely diagnosis?
A.hiv ✅ B. measles C. malaria D. syphlis
🌹Painless penile ulcer= syphilis
1Bone
🌹Sharp, shooting pain of neck radiated to shoulder and jow dx? Cervical disk prolapse
🌹 Patient shoulder pain radiate to arm and tingling loss of sensation and
no reflexes: A. cervical disk prolapse. B. MS. C. rheumatica myalgia
🌹A 40-year-old “veterinarian” man :) coming in with headache neurological
signs and symptoms, agitation and mood changes and irritability. Tenderness in the right
iliac fossa.Remembers having fever two weeks prior to onset of symptoms. What is the
most appropriate management?
A. tuberculin test B. X-ray right iliac joint C. Amphylline test (or something similar)
....
🌹Elderly Female with back pain, dexa scan shows: -1.9 lumbar spine, -2 hip, CT
shows compress fracture:..
A. Osteoporosis B. Osteopenia
🌻Dexa findings goes with osteopenia <1.0->2.5 but there’s compression fracture gose with
osteoporosis (dexta should be <2.5)
(Normal Dexta >1.0)
....
Elderly Pt with back pain, Bone density tests result Spine - 2 Peripheral - 1.9 What is dx A.
Osteoporosis B. Osteopenia✅ ()ﺗﺼﺤﻴﺢ
....
🌹 Paper like cells of bone marrow ? gaucher disease= =ﺷﻖ اﻟﻮرﻗﺔ²§ ﺟﻮﺷ.
🌹doctor ask pt to face wall lean bend forward and let his arm unsupported, examining
what? A. scoliosis B. child abuse C. rectal prolapse
🍓 Case with sarcoma in thigh how to now the metastasis: C.T for chest
Sarcoma metastatic commenly to > Polumnar . Sarcoma = chest
🌹Old Patient with cancer complaining of sudden onset back pain , best next step:
A - MRI B- steroid +MRI
🍓 70 years with lumber stenosis treatment : Physiothyrphy > NSAID > Surgey
🍓 Elderly man with bilateral knee pain increases at night and with rest on examination
there's no effusion, erythema, swelling. What is next investigation is: A. Bilateral x ray ✅
B. MRI C. bone density
🍓 Patient in his 30s with right knee swelling Joint aspiration showed Yellow, turbid,
positive mucin clot test, 15 WBC, 90% PMN (no mention of crystals) What’s the most likely
diagnosis? A. septic arthritis B. Rheumatoid arthritis C. Gout D. Pseudogout
🌹 case of Young pt rt knee pain erythema lines I don’t recall lesion swelled up and hot
(case of cellulitis probably), What’s the organism ? A. bacteriod. B. S pyogen ✅✅
🍓Another one old women with knee pain in the morning the relief with rest and increase
with walking = osteoarthritis .
OA > Releafe by Rest and worse by activitys
RA> Releafe by Activity and worse by Rest.
🌹66 yo Patient has a history of polyarthralgia with pain in distal and proximal
interphalangeal , no hx of morning stiffness + medically free no active arthritis ?
A. Methotrexate B. Finger splints✅✅ C. Cyclophosphamide
Osteoarthritis Inexpensive splints worn nightly can reduce the pain of hand osteoarthritis.
🌹 -Hip pain in elderly, x ray showing osteophytes and narraowing:
A-Osteoporosis B-Osteoarthritis✅✅
....
🌹Pt with compressive fracture with Dexa scan result what’s the diagnosis?
A. Osteomalacia B. OsteoporosisC. Osteopenia D. paget
🌹 81 female Patient complaining of back pain after cough, x ray showed compression
fracture; what is the initial step in management?
A. Intranasal calcitonin B. Paracetamol C. Admit for surgery D. Iv bisphosphonate
🌹Cervical osteoarthritis not improved will on NSAID drugs ?
A. Soft cervical collar Physiotherapy> nsaids> soft cervical collar> ice> Injectible Steroids.
🌹 Pt 75 y/o with hip pain increases with activity +mainly severe before sleeping , but she
has morning stiffness for several hours :A. Osteoporosis✅ B. Osteomyelitis C.
Osteoarthritis
🌹Elderly Pt with back pain, Bone density tests result Spine - 2 Peripheral - 1.9 What is dx
A. Osteoporosis ✅ B. Osteopenia
🌹Long case : Rash , - ANA , fever , arthritis and arthralgia , hyperferritinemia ddx ?
A. SLE B. RA C. IE D. Adult Still disease
ﻣﺮضadult still ﻫﻮ ﻣﻦ اﺣﺪ اﻧﻮاعjuvinal arthritis •ﺤﺼﻞ ﻣﻌﺎﻫﻢrash + arthrits + fever
....
🍓 5As for smoking: Ask, Advise, Assess. Assist, and Arrange
🌹27 ys old female 10 ys smoking oral lesion like ulcer the same from 4 month
Stain as initial = Biopsy to confirm
🌹a man will visit an area endemic for onchocerciasis for one week chance to be
infected? B.mild✅ C.moderate D.high
……
Duodenal perforation x. Ray :
….
🌹Which test is appropriate to study 5 different types of exercise given to obese ladies over
a period of time and follow their BMI
A. cohort B. cross sectional. C. case control. D. clinical trial !@
🌹Admitted patient suddenly develops fever and low blood pressure, Central line site
shows erythema and swelling what's your action:
A. draw blood for culture change the line and resume dialysis
B. draw blood for culture remove the line and start abx
🌹 If incidence is the same, what would increase the prevalence of a disease?
A. more accurate diagnostic tests. B. better coping with the disease C. Loss of follow up
🌹 pt walks around saying inappropriate stuff to people, what’s his problem?
A. preservation. B. train of thoughts!@
🌹 What indicates adequate Resuscitation?!@
A. Normalize BP. B. Central venous pressure 12. C. Normalize H
…..