Patient c/o choking every time he eats, where is the tumor :

-Piriform fossa
-Subglottic area

In order of frequency of occurrence of malignant tumours of hypopharynx:

1. 1. Piriform sinus: 60%

2. 2. Post cricoid area: 30%
3. 3. Postertior pharyngeal wall: 10%

Pt came to ER c/o hypopyon what’s the diagnosis?

- Corneal ulcer
- conjuctivits

Pt with knee trauma complaining of locking and joint line pain with positive MacMurray test,
which of the following has no effect on operation decision:
-Site of the injury
-Type of the injury
-Duration of the symptoms. (not sure)
-The amount of the effusion
Pt with posterior compartment syndrome of the leg which of the following is true regarding this
patient:
- hypertension is a risk factor
-Intracompartment pressure >30 is a cutt-off for the diagnosis
-Coagulation is a risk factor
- The will increase with passive planter flexion
- diabetes is a risk factor
7 yo with congenital horner syndrome, what is most characteristic manifestation regarding this
disease :
-Iris heterogeneous
- ptosis
-Miosis
- anhydrosis
- amblyopia
- A 5 year old male with recurrent otitis media. He has this procedure done (see picture) you
are following him now as the primary care physician.
what is the most common complication of this procedure?
A. Dislodgment
B. Pain
C. hearing loss
D.Otorrhea
Persistent perforation
An 55-years old man came to your office complaining of right nasal obstruction with recurrent
epistaxis, see his PNS CT (‫)ﻧﻔس اﻟﻠﻲ ﻓﻲ اﻟﺳﻼﯾدات‬
A. MRI
B. Biopsy
C. FESS
D. FNA
E. Maxillectomy
A 34 year old female patient has difficulty in hearing for few years now, Her ear exam is
essentially normal. This is the audiogram:
which is the best recommendation?
A. Hearing Aids
B. Antibiotics for 10 days
C. Myringotomy & Grommets insertion
D. Stapedectomy
E. MRI
Posterior knee fracture PT can’t do dorsflextion
L4L5 ‫اﻟﺟواب‬
Patella fracture treatment
ORIF
2 2 years child with learning difficulties, otoscope exam showed dull TM , which of the following
is the most important investigation:?
-Pure tone audiometry
-Tempanogram
-Mastoid xray
-Nystagmogram
Palpable gab in the knee knee
Primary tendon repair
What is the type of thoracolumbar injury is least associated with neurological deficit?
-fracture dislocation
-chance fracture
-burst fracture
-compressor fracture
-hangman fracture
Cannot planterflex, posterior knee dislocation.
Tibial nerve injury
Cervical protection?
Hard collar
10 cm open fracture with mild contamination what is the gastello classification:
Type II
You are a resident at alnoor hospital called to assess traumatic patient with GCS 11 and need to
clear cervical injury which of following statements is correct:
- ask the patient if there is a neck pain, if not remove the collar
- examine the for neurological deficit if not remove the collar
- order AP, lateral views with open mouth radiograph if clear remove the collar
- Do not remove the collar now wait for later
- Order MRI
65 year old lady with long standing hx of advanced knee osteoarthritis and associated
degenerative medial meniscal tear who is known to have well controlled DM and HTN,
presented with knee pain, limited ROM, tender joint line. What is the definitive treatment?
a. arthroscopic partial menisectomy
b. high tibial osteotomy
c. knee fusion
d. total knee replacement

40.20 years old male basketball player, had an injury to his shoulder while he was trying to stop
another player scoring, and you were in ER when patient arrives to hospital, what is the best
xray view to determine the direction of shoulder dislocation is:
A- Shoulder AP view
B- Shoulder Axillary view
C- Shoulder Scapular view
D- Shoulder CT scan
A patient with valgus knee was seen in orthopedic OPD, which knee ligament will be
stretched:
A- Medial collateral ligament
B- Medial meniscus
C- Lateral collateral ligament
D- Lateral meniscus
43.20 years old female playing football, she had direct injury to her knee from another player,
she couldn't continue playing, her knee was swollen, patient CAN NOT extent the knee fully,
you are suspecting either ACL injury or quadriceps. what is the main function of the
Quadriceps muscle:
A- Knee active flexion
B- Knee varus stabilizer
C- Knee active extension
D- Knee valgus stabilizer
52-year-old man known case of chronic gout and hypertension on thiazides 25 mg once
daily, comes to your clinic with one day history of pain in right big toe with associated swelling.
He denies any history of trauma or other joints involvement. His BP is 125/70 with normal rest
of his vital signs. He has swollen and tender big toe. His labs show normal CBC, ESR 40 CRP 9,
serum uric acid 10 mg/dL and creatinine 2.8 mg/dL.
Which of the following is the best modality for acute gout management in this patient:
A. Naproxen 500 mg twice daily
B. Colchicine 0.5 mg q8 hourly
C. Systemic or local steroid injection
D. High protein Diet restriction
E. Ice and rest
A 30-years old woman diagnosed with SLE 1 year ago, presents to rheumatology clinic for
follow up, She complains of a new onset joints pain and excessive hair loss. She states that she
is
taking her medications regularly.
on examination: her B.P is 150/90 mmHg (she was not hypertensive before), other vital signs
are
normal. she has a non-scarring alopecia and tenderness in wrist joints of both hands with
reduction of wrist extension.
Here are some of her labs results: WBC- 6, HGB= 11, Platelets= 110. Normal renal and liver
function test. Urinalysis= Protein 1, RBC casts ++.
Which of the following parameters are considered as indicators of lupus flare in this
patient?
A. Active urinary sediments and thrombocytopenia
B. Arthralgias and non- scarring alopecia
C. High titers of anti-ds DNA and normal complements levels
D. Low complements 3 and 4 level, high anti-ds DNA titers, active urinary sediments
E. Newly diagnosed hypertension
A 40-year-old woman is evaluated for a 6-month history of pain and swelling in her left
thumb, left fifth finger, and left foot. She has a 4-year history of lumbar and thoracic back pain
that is worse with bending and lifting and sometimes awaken her from sleep. She also has
morning stiffness lasting 2 to 3 hours. Naproxen is only mildly helpful for the pain.
On physical examination, vital signs are normal. Patches of erythema and scaling behind the
right ear and on the scalp at the occiput are noted. Fusiform swelling of the left thumb and left
fifth finger is present. There is mild lumbar tenderness, and full range of motion of the lumbar
spine and cervical spine is noted. No other joint swelling or tenderness is present.
Laboratory studies, including complete blood count with differential, comprehensive metabolic
panel, rheumatoid factor, and urinalysis, are normal; HLA-B27 testing is positive.
Which of the following is the most likely diagnosis?
A) Ankylosing spondylitis
B. Inflammatory bowel disease-associated arthritis
C. Psoriatic arthritis
D. Reactive arthritis
E. Adult-onset Still's disease
53. A 36-year-old woman presents with 2 months hx of small joints pain and swelling, These are
affecting her wrists and mainly MCPs bilaterally. Her right ankle and few of her MTP joints are
also painful with episodic swellings. She denies any fever or skin rash but very bothering mouth
mouth ulcers. However, she she used to have recurrent throat infections until recently, her
father
has psoriasis. She was pregnant 4 times with 2 grown up children and 2 abortions before the
age
of 10 weeks. She has definite polyarthritis on MSK exam.
Which one of the following laboratory test are you going to consider as initial step in
evaluating this patient?
A. Anticardiolipin antibodies. Lupus anticoagulant and Anti-B2-glycoprotien antibodiesse
B. Anti-ds DNA antibodies, Anti-Smith antibodies, Anti-RO and Anti-LA antibodies (not sure)
C. Antinuclear antibodies, Rheumatoid factor and Anti-citrullinated peptide antibodies
d. anti-neutrophilic cytoplasmic antibodies (c-ANCA and p-ANCA)
E. Viral serologie: parvovirus-B19 IgM, EBV-IgM, HBsAg, HbsAb, Anti-HCV-antibodies.
A 32-vear-old man known case of hypertension on calcium channel blocker presents to your
clinic complaining of 2 days duration of only right ankle pain and swelling. The pain started
suddenly and became severe within few hours with inability to walk and bear weight. He denies
history of preceding trauma, fall or recent infection. He had similar attack 2 years ago in the left
ankle that resolved gradually over 1 week. His physical exam showed swelling and redness of
the ankle joint with limited range of motion passively and actively. What is the most likely
diagnosis?
A. Systemic lupus erythematosus
B. Rheumatic Fever
C. psoriatic Arthritis
D. Rheumatoid Arthritis
E. Acute Gouty Attack
What’s true about DM NP. retinopathy.? ‫ﻣوﺟود ﻓﻲ اﻟﺗﺟﻣﯾﻌﺎت اﻟﻘدﯾﻣﮫ‬
cannot lead to blindness

A 66 year old elderly male presents with heart disease and has sudden loss of vision in one
eye, fundus examination reveals a cherry red spot, the most important investigation to do is :
a. CT brain
b. Brain angio
C. Carotid doppler
d.Ocular ultrasound
---------------------------------------------------------------------------------------------------------------------------
Veniger eye ‫ﻣوﺟود ﻓﻲ اﻟﺗﺟﻣﯾﻌﺎت اﻟﻘدﯾﻣﺔ‬
irrigation and ER
Cataract common cause? ‫ﻣوﺟود ﻓﻲ اﻟﺗﺟﻣﯾﻌﺎت اﻟﻘدﯾﻣﺔ‬
HTN
DM ‫اﻟﻣﻔروض‬aging ‫ﻟﻛن اﻟﺧﯾﺎرات ﻛﺎﻧت ﻏﯾر‬
--------------------------------------------------------------------------------
55 years old male known case of open angle glaucoma, which of the following statement is
more appropriate in describing his condition
a. the angle is congenitally abnormal
b) ??? is an effective treatment
C. can be treated surgically
d. is treated with drops only
Where's the defect,
occipital lope
Ear pain and all examination normal most common referral
Tempomandibular referred pain( not sure)

Ear itching ?
Suction microscopy and eardrops fungal
A nine months old baby has put a plastic bead in his ear. On otoscopy, it is present in deeper
portion of meatus and totally occluding the meatus. The best way to remove this bead is:

1. Remove it with foreign body hook.

2. Remove it with crocodile forceps.
3. Remove it with suction.
4. Remove it with ear syringing.
5. Remove it under general anesthesia using microscope.

Quadriceps function,
extention of knee
30 y o. Unable to bend his back two days, test to comfirm? ‫اﻟﻜﯿﺲ ﻛﺎﻧﺖ ﺗﯿﺒﯿﻜﺎل‬AS
Straight leg rise
Modified chopper test
Compression test
After shoulder dislocation in 50 years old male, you are suspecting rotator cuff tear. which
muscle is responsible of shoulder internal rotation:
A- Deltoid Muscle
B- Supraspinatus Muscle
C- Subscapularis Muscle
D- Infraspinatus Muscle
years old female presenting with paralysis of 3rd
, 4th and 6th nerves with involvement of
ophthalmic division of 5th nerve, this localizes the lesion to:
a- Cavernous sinus thrombosis
b- Parietal lobe
C- Frontal lobe
d- Base of skull
Management of acute angle glocoma
Lazer irodotomy
Lasek
Immolsificatoon
Mineers disease , two attacks
_____________________________________________________________

55 years old patient present with neck mass (photo of bangali man)
FNA was preformed Sqaumous cell carcinoma
What is next step

CT Brain
CT Trachea
Panendoscopy
Incisional biopsy
Excisional biopsy
______________________________________________________________________________
this is an Xray of6 year old boy, presented with fever, throat pain then started to become
stridrous. This is his lateral soft tissue X ray.
what is the best therapeutic recommendation?
A. Reassurance
B. Observation
C. Antibiotic for two weeks.
D. Admission, humidified O2, steroids& IV Antibiotics
E. Admission & tracheostomy
_______________________________________________________________________