‫‪Jointly Team‬‬

‫‪SMLE Group‬‬

‫‪ -‬اللهم نسألك التوفيق والسداد لجميع القائمين على هذا العمل‬

‫‪ -‬هذا العمل عمل تطوعي يمنع استخدامه استخدام تجاري‬
‫ال نحلل وال نبيح استخدامه بأي شكل من األشكال التجارية‬
‫( بنوك أسئلة ‪ ,‬كورسات مدفوعة وغيرها …‪).‬‬
1- Hypothyroidism clear Hx and labs with low Na (it was 129) normal 134 What to
do next ?
1. Levothyroxine
2. treat the hyponatremia with hyper Na fluid
NB:
Treatment of hypothyroidism and fluid restriction are usually adequate for the
management of mild hyponatremia in patients with hypothyroidism. Patients with
possible hyponatremic encephalopathy should be urgently treated according to current
guidelines.

2- Case of Hypothyroidism labs with Ab ( anti thyroglobulin Ab and other one + ),

ESR normal Dx ?
1. Hashimoto
2. Sub acute thyroiditis
3. Gravies
NB:
TPO ( thyroid peroxidase) Ab and TG ( thyroglobulin) Ab : Hishimoto
TSH receptor stimulating Ab ( TSAb)+ TSH receptor blocking Ab ( TRab) : Graves

3- Post partum 2weeks , asymptomatic , investigation showed that she had UTI (
ecoli sensitive to all drugs mentioned in the Answers ) next ?
1. No need to treat
2. Cipro
3. Trimeth
4. Other drug
NB:
The patient returns to your clinic for postpartum follow-up. According to the USPSTF,
should she be screened again for bacteriuria?
• A. Screening is not recommended for asymptomatic nonpregnant adults because the
potential harms of screening and treatment outweigh the benefits.

4- Pt with Rh - and her husband Rh+ , presented for follow up , stable no bleeding
, what to do ?
1. Repeat Ab
2. Assessment of fetus via US
NB:
Missing a lot of important things
Among these options 2 is more acceptable
5- t of stab wound 2 cm penetrating injury with omentum passing out , Pt is stable
, Ct report negative findings, Next step management
1- observation
2- close the wound
3- leave the wound open
4- laparotomy

6- A male patient has paraplegia as a result of MVA 1 yr ago. He came now with a
picture of PE + leg edema , On ultrasound: DVT in thigh. Patient was hypotensive:
1- IVC
2- ateplase
3- enxoparin
NB:
●For patients with a high clinical suspicion for PE who are hemodynamically unstable
(ie, systolic blood pressure <90 mmHg for >15 minutes, hypotension requiring
vasopressors, or clear evidence of shock), and in whom transfer to radiology for a
CTPA is considered unsafe, a portable perfusion scan can be done at some centers.
When portable perfusion scanning or CTPA is not available or is unsafe, we prefer
bedside echocardiography (transthoracic or transesophageal) to obtain a presumptive
diagnosis of PE (right ventricle enlargement/hypokinesis, regional wall motion
abnormalities that spare the right ventricular apex [McConnell's sign], or visualization of
clot) prior to the empiric administration of systemic thrombolytic therapy (ie, reperfusion
therapy). If bedside echocardiography is delayed or unavailable, the use of thrombolytic
therapy as a life-saving measure should be individualized; if not used, the patient should
receive empiric anticoagulation.

7- What is the tocolytic drugs that cause patent ductus arteriosus ?

1-Indomethacin
2-Nifedipine

8- 2 years old female complaining of sore throat and fever for 3 days, with bilateral
knee joint pain. (Case is complete)high Esr .Your diagnosis ?
A- JIA
B- Osgood
C- SLE
D- Acute RF
A vs D
9- Women 40 years old women asking abot colon cancer screening , there is no family
history or past medical history ..
1-you said for here not needed in her case
2- started crom 50 years
3- started (i think from now) then every 5 years

10- Most cancer screen in population :

1-Lung cancer
2-Colon cancer
3-Oral cancer

11- burn injury in the hand and foot with edema. What is the cause :
1-prostaglandin I2
2-Streptokinase
3-Serotonin
4-Bradikinin

12- Pregnant lady presented to ER at 7 weaks gestational age with abdominal pain,
Uterine mass 2*3 cm with BHCG level (18000 i think but it was more than 5000), whats
make the medical therapy fail ?
1- Mass size
2- Level of BHCG
3- Clinical symptoms
4- Gestational age
NB* WAFA * :
Relative Contraindications to Methotrexate MTX therapy (ACOG)
Embryonic cardiac activity detected by transvaginal ultrasonography
High initial hCG concentration >5000 milli-international units/mL.
Ectopic pregnancy greater than 4 cm in size as imaged by transvaginal ultrasonography
Refusal to accept blood transfusion

13-regnant at 8 week of GA had painful bleeding. Cervix was closed , US showed

crown rump length of 7 weeks ,Dx?
1- Threatened abortion
2- Incomplete abortion
3- Complete abortion
4- Invitable abortion
14- Women presented to ER with abdominal pain ,periumbilical protruding irreducible
mass , no pulsation with cough ?
1-Strangulated hernia
2-Obtorator hernia
<Most likely answer>

15- lung nodule that grown 3mm since 9 m + then this month it was 10mm .. no any
symptoms , normal physical examination , no LN enlargment
- blind aspiration
- Refer to thoracic surgery
- nothing to do
-follow up after 6 mont

16- Pt had strok and admitted to the ICU, developed new weakness. On examination
there is papilledema, CT done showing *hemorhhagic transformation* . What is the
definitive treatment??
A/ decompressive craniotomy
B/ Mannitol
c/ iv dexa

17- Female patient came with history of sudden loss of vision in the left eye that
resolved spontaneously after 20 minutes. What is the most likely diagnosis?
A) multiple sclerosis
B) retinal detachment
c) TIA

18- 25 yo female, worraied about cervical cancer, she took her first dose of HPV
vaccine 3 months ago. What is the best thing to do at this visit today?
A. Schedule appointment after 3 months
B. No Need To Do Anything At This Visit
C. Give 2nd Dose At This Visit
D. Repeat 1st dose

19- Typical mi scenario they give you the ECG findings: ST elevation on lead I,L,V5-6:
what type of MI?
1- inferior MI
2- anterior
3- lateral
20- X-ray pic of RDS “ground glass appearance “asking about the management:
1- Intubation and ventilation (1st)
2- chest tube
3- Surfactant ( 2nd)

21-Neck penetrating injury on zone 1 with subcutaneous emphysema:

1 Neck exploration
2 CTA
3 Angio embolization

22- woman with spotting scanty blood after intercourse. She had a history of warts on
vulva with cryotherapy done 2 yrs back what is the site of the bleeding?
A. vulva
B. vagina
C. Uterine cervix
D. Uterine body
NB:
Postcoital bleeding suggestive of cervical issue

23- 18 years old female asking about pap testing what’s true
1. at 21 years
2. after being sexually active
3. she doesn’t need the test

24- 35 female with Green discharge from nipple, Mammo shows dilated pre aeroial
ducts briad2 :
1. biopsy
2. wide excision
3. follow up

25- 66 y o male patient diagnosed With inferior MI. treated at hospital then 2 days later
came complaining of sob,bilateral basal lung crepitation and pansystolic murmur
radiated to axilla .diagnosis ?
A. Rt sided heart ( no murmur + clear lung )
B. Papillary muscle rupture ( MR ) →
C. Ventricular septal defect ( heard best at LLSB with no
radiation )
D. Cardiac tamponade ( clear lung )
26- Patient with obstructive jaundice turned to septic cholangitis what are you
expecting to see?
1. high cardiac output
2. increase systemic vascular resistance
3. hypoglycemia
4. systemic vasoconstriction
NB:
# Increased intraductal pressures within the biliary tree → bacterial translocation from
bile into the systemic circulation → bacteremia → sepsis, septic shock, and MODS if
untreated.
# Effect on cardiac output :
Early: compensatory ↑ HR and contractility → ↑ CO (hyperdynamic state or “warm
shock”)
Late: ↓ preload and direct myocardial depression by cytokines → ↓ CO (hypodynamic
state or “cold shock”)

27- 54 yo female medically free come to the clinic for routine checkup ,Her cardiac
examination relieved grade 4 pansystolic murmur heard best at the apex and radiated
to the axilla,she is asymptomatic and the rest of her examination is normal,best next
step to confirm the diagnosis?
A. TTE
B. TEE
C. ASO TITER
D. CHEST X RAY
NB:
Transthoracic echocardiography (TTE)
A noninvasive ultrasonographic examination of the heart * Recommended for initial
evaluation of pathological murmurs*

28- 64 Y.O male pt known case of dm.htn,chf and old stroke, Present to the hospital
with palpitation for one week ,ecg showed atrial fibrillation ,what is the CHA2DS2-VAS
score ?
A. 1
B. 4
C. 5 →
29- 68 Y.o k/c of dm and htn , presented to the hospital with chest pain for past
week,this pain retrosternal and last for 15 min,increasing ,ecg show st segment
depression in lead V1-V4 , The patient received statin ,aspirin ,B blocker , heparin
,nitrate , captopril .what add ?
A. Candesartan
B. Clopidogrel ( any pt with ACS should receive dual antiplatelet )
C. Amlodipine
D. Atelaps ( STEMI, PE , Strock in 1st 4.5 hr , PAD )

30- 49 yo male k/c asthma and moderate MR presented to ER with sob,o/e he has
Grade lll pansystolic murmur and clear lung fields.best diagnostic test ?
A. TEE
B. TTE
C. SPIROMETRY
D. CHEST XRAY

31- 47 FEMALE CAME WITH FATIGUE FOR 2 MONTHS ASSOCIATED WITH WEIGHT
GAIN,SHE ALSO COMPLAINING OF AMENORRHEA FOR 6 MONTHS AND BILATERAL
MILKY BREAST DISCHARGE . WHAT IS THE MOST APPROPRIATE NEXT STEP?
A. TSH
B. SERUM PROLACTIN
C. MAMMOGRAM
D. PITUITARY MRI
NB:
Dx = hypothyroidism ( search for s&s )
Hypothyroidism → ↑ thyroid-releasing hormone → ↑ prolactin ( milk discharge) + ↑ TSH (
initial test to investigate)

32- 67 FEMALE K/C CASE POORLY CONTROLLED DM2 AND HYPERTENSION.SHE IS

ON ASPIRIN, ATENOLOL ,METFORMIN,INSULIN,MULTIVITAMINS. SHE COMPLAINING
OF DIZZINESS WHEN SHE STAND ,ON EXAMINATION THERE IS
DECREASE IN HER BP WHEN STAND BUT HR DOSE NOT
CHANGE. MOST LIKELY EXPLANATION ?
A. SIED EFFECT MED ( postural hypotension with tachycardia )
B. AUTOIMMUNE NEUROPATHY( postural hypotension
without tachycardia ) →
C. ADDISON Disease
D. DEHYDRATION
33- 33 YO FEMALE KNOWN CASE OF T1DM AND RA COME TO THE HOSPITAL FOR
REGULAR FOLLOW UP. SHE HAS BEEN USING NSAIDS TO RELIEVE SYMPTOMS OF
RA.SURGICAL HX IS SIGNIFICANT FOR CHOLECYSTECTOMY DONE 2 YEARS AGO. O/E
THER BP IS 162/95.HER PREVIOUS TOW READINGS WERE 156/89 AND 159/91……...
NA 138,K 3,CR0.94.COUSE HER HTN?
A. EssENTIAL HTN
B. PHEOCHROMOCYTOMA
C. NSAID INDUCED HTN
D. PRIMARY HYPERALDOSTERONISM →

34- Patient had strong of hx of tdm2 and had high fasting blood
glucose and hba1c of 6.3 , Best next ?
A. OGTT
B. Hba1c after 3month
C. Repeat fasting ( 2 READING REQUIRED TO MAKE THE DIAGNOSIS )
D. Repeat random blood glucose

35- Nurse in pulmonary clinic w they kept her xray she had like cavitation in upper
Right lung and she was suffering from fever,rigors and productive cough with no
improvement on 3 month antibiotic course .which bacteria is involved ?
A. Strep pneumo
B. Tb
C. Moraxella catarrhalis
D. H.influenza
NB:
Very clear scenario of progressive TB + working in health care setting is high risk.

36- Adult have trauma before 1 h of arriving the hospital, he was febrile and conscious
asking about water then he loss of consciousness , Bp 90/60 , HR 139 What type of
hemorrhagic shock ?
A- 1
B- 2
C-3
D-4
NB: →
37- burn + green discharge what is type of organisms?
A. E. Coli
B. Staph
C. Pseudomonas
NB:
Pseudomonas aeruginosa= Produces pyocyanin (blue-green pigment) → formation of
blue‑green pus in infection

38- Old patient came to the clinic what vaccine to give?

A- pneumoccoal
B- meningococcal
C- bcg
NB: →

39- Placenta attached???

A. - Placenta Increta
B. - Placenta Penceta
C. - Placenta Accreta
NB:
Abnormal Placental Implantation
Placenta Accrete: chorionic villi Attach to the myometrium
Placenta Increta: chorionic villi Invade into the myometrium
Placenta Percreta : chorionic villi Penetrate though the myometrium, penetrate the
serosa

40- Newly married young woman came for routine check up gyne, highest diagnostic
value?
A. General appearance
B. Vaginal inspection
C. Abdominal exam
D. Pelvic digital exam →

41- Pt of stab wound 2 cm penetrating injury with omentum

passing out ,Pt is stable Ct report negative findings، Next step
management
1. observation
2. close the wound
3. leave the wound open
4. laparotomy →
42- Pt came from sudan and diagnosed as malaria , Options
is drugs not sure about them ?
1- Artemisinin combination therapy
NB: →

43- Pt with hernia reducible came to er with pain and tenderness over the scrotum
1- Incarcerated
2- Obstructed
3- Strangulated
NB: →

44- Entamoeba histolytica(liver), Initial management:

-Metronidazole
- another drug
-Percutaneous drainage
-Percutaneous aspiration
NB: →

45- What indicates a doctors’ respect of a patents’ autonomy?

A- Patent information
B- Covering patient’s body parts
C- Treat all patient’s equally
D- Patient signing a consent
NB:
Autonomy is ;
- Provide sufficient information for the patient to be able to make their own
decisions regarding their care (i.e., informed consent).
- Honor the patient's choices to accept or decline care.

46- Indications for thoracostomy

- Suspected tension pneumothorax * it’s clinically diagnosed * : Emergency needle
thoracostomy, followed immediately by chest tube placement
- Bilateral pneumothorax OR any patients who either require mechanical
ventilation or do not meet pneumothorax stability criteria: Emergency chest tube
placement

47- ECG SVT →

 Pictures

Dx= TB

Dx= Slipped Capital Femoral Epiphysis