‫‪20/10/2021‬‬

‫‪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 …‪).‬‬
 20/10/2021

1- Boy presented with 2 weeks bloody diarrhea abdominal distension, bloating weight
loss and fatigue What’s the Dx?
-intestinal ascariasis
NB:
(In previous recall , there was amebiasis in the choices and it’s the correct answer ), so
In Ascariasis there is respiratory tract symptoms -->

2- How to Investigate for this Dx? (Confirmatory)

-Stool microscopy
NB:
If it’s amebiasis (stool antigen)

3- peds with projectile vomiting what electrolyte disturbance will he have?

A- HypoK
B- HypoCa
C- HypoPO4
NB:
Loss of Kcl from stomach

4- Electrolyte abnormality in TPN?

Hypophosphatemia and hypomagnesaemia + Hypokalaemia

5- Patient on parenteral feeding developed weakness and convulsions What cause these
symptoms?
A- Hypokalaemia (also happen in TPN but there are CVS abnormalities )
B- Hypomagnesemia (TPN + CNS abnormalities)
C- Hyperkalaemia
D- Hypermagnesemia

6- Child 9 or 10 years diagnosed as rheumatic fever. What’s the most common

organism?
A-GAS
B-GBS
C-Saph aureus
D-Staph epidermis

7- 43 yrs female heavy smoker, came for screening ,which screening test indicated :
A- Ct lung
B- Colposcopy
C- Mammography and ct lung(not sure)
D- Mammo+colposco+ct lung
NB:
B or c (not sure ), In my opinion ( after checking dynamed screening for lung cancer and breast
cancer ) , Weak recommendation for breast cancer screening in pt <50 ( see pic )
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8- Pregnant 8 weaks gestation diagnosed with missed abortion, what you will do next?
A-Misoprostol
B-Oxytocin
C- Hysterectomy
D- methotrexate
NB: Wafa notes→

9- Patient around 40s with intestinal ischemi sx. On xray there

was thumb print, Patient vitally stable, Next step?
A- Labratomy (if not stable)
B- Colonoscopy
NB:
Dx ischemic colitis →

10- Boy K/c of DM1 had ketacidosis but treated , what is your
advice or ur management regarding his insulin regimen?
A- Nph insulin twice a day
B-Just before male and cancel long acting
C- basal insulin with long acting glargine
D- basal insulin without long acting
NB:
Management of type 1 dm ( basal and long acting )

11- Patient with left inflamed red hemi scrotum, on examination there was red firm
irreducible painful swelling with high riding which is extended to to left inguinal region.
Left testis couldn't be palpated. What is the diagnosis?
A- Torsion appendix testis.
B- testicular torsion
C- epididymo orchitis.
D- incarcerated inguinal hernia (non palpable testes )
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12- Child known case of asthma present to ER have an asthma attack , his father is heavy
smoker, you told him many time to stop smoking but he is likely careless about his son,
what you will do?
A-Call child protection team
B-Consult the ethical committe
C-Explain to father importance of immunization
D-Ignore father refusal and focus to treat the child

13- Child has recurrent uti and undescended testis and aniridia , What else is expected to
be found ?
A- Nephroblastoma
NB:
wagr syndrome if they asked about the diagnosis) →

14- Bilateral hydronephrosis in baby what is the best diagnostic test ?

A- MCUG
B- DMSA ( used to detect renal scar )

15- Child with sandpaper like rash what organism?

A- Strept pyogens(GABs)
B- Staph aurues
NB:
Dx (scarlet fever )

16- Child has fatigue and splenomegaly , Hb low,RBC low ,MCV low ,Retic normal ,Iron
normal , What to replace in this case ?
A Iron (low mcv but serum low total iron not normal )
B. B12 (high mcv not low )
C. Folate (high mcv not low )
D. Erythrocytes
NB:
By exclusion (diagnosis is thalassemia ) →

17- Asthma with moderate presestant symptoms? On beta agonist what to add?
A- Ics
B- Ics and laba
NB:
this patient moderate persistent asthma , so ICS alone will not be enough ( dr m + dr baharith )
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18- Patient go for umrah and s&s of meningitis? Treatment :

A- Steroids ceftrixon azetheromicin
B- Ceftrixon azetheromycin
C- Ceftrixone + vancomycin + dexa

19- infant Hbg low Mcv low mch low retics normal dx?
A- Normal
B- Scd ( normal mcv )
C- Thalassemia trait -->
D- Lead poisoning
NB:
- C or d (not sure because in complete question but , if there is something in indicate lead
poisoning (risk factors)
- thalassemia major pt will have high retics but thalassemia trile will have normal retics

20- IBS pt advice ?

A. Increase honey intake
B. Increase fruit intake
C. Avoid lentis

21- 48 y.o very obese lady, BMI 41 had hx of pelvic organ prolapse had no surgery, but
she had + family history of prolapse repair what do you except she’s having now?
A.Enterocele
B. Rectocele
C. Uterine prolapse
D. Cystocele

22- 67 years old male complaining of painless hematuria , whx is the diagnostic test?
A- Cystoscopy
B- CT abdomen
C- Iv pyelogram
D- Us
NB:
Dx ( bladder cancer )
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23- Pregegnant lady with dm in active labor ctg show abnormal fetal heart pattern which
of the following is the most appropriate next step?
A- Change maternal position
B- put an o2 mask
C- stop oxytocin
D- give tocolytic
NB:
Wafa( in utero resuscitation)

24- Clozapine is used in pediatric age group to treat ?

A- schizophrenia
B- bipolar disorders
C- major depressive disorders

25- Q about screening for breast cancer in age group 50-74 ?

A-Yearly
B-Every 2 years
NB:
Based on CDC

26- Q about pediatric patient came in sever distress was given oxygen but saturation
remained low (80) asking what to do?
I choose (Intubation), NB: (Not sure )ICQ
27- A 35 year old car driver crashed into a concrete block without a safety belt on. Thirty
minutes after and on the way by ambulance to the hospital he begins to become
breathless. On administration of 100% oxygen there is not much improvement in this
condition. On arrival at the Emergency Department he has lost consciousness and
appears cyanosed with markedly distended jugular veins.
Blood pressure 80/40 ,Heart rate 120 /min ,Respiratory rate 34 /min,Temperature 36.6 c
,Oxygen saturation 60% on room air , What immediate action should be taken?
A. Intubation and 100% oxygen
B. Rapid infusion of crystalloid
C. Needle decompression
D. IV 0.2 mg adrenaline

28- 20s female, medically free presented with epigastric tenderness long duration , not
related to any thing, some time it associated with vomiting. Her mother have chronic non
specific abdominal pain , Patient had + blood and mucous in stool asking what to give
her ?
A- omeprazole
B- Tetracycline
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29- At what age baby talk 6-10 word and recognize two body part with no pincer grip ‫متاكد‬
A-17 month
B-19month
C-24 month
D-12month
NB:
(2 body parts )

30- Written Dx ( Aspergillosis ) ttt ?

-IV voriconazole

31- Zone 1 Neck injury ?

A- Endovascular repair
B- CTA

32- FTT (Failure to thrive )what’s the Dx ?

A- Celiac
B- Cystic fibrosis
NB:
Both Can cause FTT , based on previous Q + dr safder note (most common cause of FTT is
psycho social)

33- women diagnosed i think HF 9 month ago , now came c/o non productive cough she
is on ACE , statin and other drug . EF 40% what to do?
A- discontinue ACE
B- Change ACE to ARP(lorsatin)

34- 9 month what contraindications to vaccine ?

A- Penicillin allergy
B- Moderate to mild acute illness
C- Recent exposure infection

35- lactating mother 5 days fever rt breast red swelling tender?

A- Abx (mastitis)
B- I&D ( breast abscess)
NB: Not sure

36- 4th day post op stomach resection now came with picture of STEMI what to do ?
A- Ballon angioplasty
B- Thrombolytic
C- Warfarin
NB: Dr baharith
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37- Dysuria Dyspareunia Dribbling?

A-Urge
B-Overflow
C-Stress
D-Urethral diverticulum -->

38- 9 y o with meningitis Blood culture gram +ve cocci . CSF will be ?
A- High protein low glucose high neutrophils

39- hydrosalpinx pic →

40- Sever cyclic pain and dyschezia?

A- adenomyosis
B- pid
C- endometriosis

41- Long case of copd pt has a diminished gag reflex asked about the most appropriate
management?
A-non invasive
B- abx
C- intubation and ventilation

42- Case of 17 or 19 year 30 week she was managed by corticosteroid i think for preterm
labor , Ask about the rationale behind corticosteroids administration?
A- hypoglycemia
B- RDS

43- Female known case of hepatitis C virus has multiple liver masses. What is your
further management?
A- liver biopsy
B- US
C- CT
+Same the case and take course of ttt what the investigation that follow up for liver?

44- 60 female Most common source of bleeding?

A- Uterus
B- Lower genitalia
C- Fallopian tube
D- Ovary
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45- How to Stop bleeding after delivery if you wish to preserve fertility .. which to ligate?
A-Internal iliac artery
B-External iliac artery
C-Internal iliac vein
D-Some uetro.. ligament

46- Female post CS 16 days ago present with fever and pain that is not improving with
antipyretics and ABX. She has history of 4 previous CS. CT showed fistula ,What is the
appropriate management?
A. NPO with pancreatic and gastric inhibitors
B. Resection and anastomosis
C. Stool softners

47- 62 years old F present to the ED with acute pain started 2 hours ago. The pain
progress with time and became more severe. US done showed Solitery with cystic
component complex left ovarian cyst measure 7x8 cm.(Scenario didn't mention any GI or
Genitourinary symptoms) , What is the appropriate management?
A. Laparotomy
B. Tumor markers
C. MRI
D. CT scan
NB:
A or b ( i will go with A unless there is constitutional symptoms ) →
Since ovarian cyst is risk factor for ovarian torsion

48- Patient post hartman procedure for diverticulitis has urine output of 50 ml over 8
hours. Central veinous pressure was 10 with lower limb edema. Other examinations
unremarkable. Vitals: Normal.(No labs provided). What to do?
A. Explore
B. US
C. CT abdomen
D. "Forgot it, sorry"
NB:
I am not sure if the vitals in the q was normal ?!!
Most likely dx is (abdominal compartment syndrome) -->

49- Female patient present with PE. Which of the following will indicate thrombophilia
work-up?
A. -ve family history
B. Use of oral contraceptivd pills
C. Age more that 50
D. Connective tissue disease
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50- Young Patient present with SOB with history MVA 2 weeks ago. No past medical or
surgical Hx. Respiratory examination suggest decrease air entery and breath sounds in
the right lung. CVS examination unremarkable. CXR (Photo provided) showed right
pleura effusion covering 1/2 of hemithorax.What is the appropriate management?

,
A. Refer for thoracic surgery.

51- patient smoke 20 cigarettes and vital signs show BP 140/92 Which of the following is
the most considerable risk factor for MI ?
A- HTN
B- Smoking
C- Age
NB:
People who smoke 20 or more cigarettes a day have a 2- to 3-fold increased risk of dying from
coronary heart disease compared with non-smokers or those who have quit for >10 years. Even
mild and passive smoking is associated with increased risk. ( BMJ ) Or A (dr baharith )

52- 80 years old bed ridden has pelvic organ prolapse appropriate management?
A- Pessary
B- Le forte colpcelesis
C- Others
NB:
can be offered to women with symptomatic POP who decline surgery, who are poor surgical
candidates because of medical co-morbidities, or who need temporary relief of pregnancy-
related prolapse or incontinence.BMJ

53- Women with previous history of miscarriage at 30 weeks. Now she is pregnant at 18
weeks and afraid of miscarriage again. What is most important to do?
A- Pelvic exam
B- Cervical lengths measure
NB: -->
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54- An object fell on this pt’s foot and the capillary refill was
delayed what are you going to do ?
A-Cta
B-Duplex
C-Compartment measurement
NB:
Trauma +decrease pulse
55- Patient post term, was delivered with meconium aspiration, after delivery was
intubated and suction was done, was put on inotropes . After 2 days now he becomes
hypoxic with increased oxygen neads. Pre ductal o2 is 92 and post ductal o2 is 81
What to give?
A. Mgso4
B. inhaled NO
C. surfactant lavage
D. urgent cardiac catheterization

56- Urine Dipstick pic with: +2 protein, very high glucose, +ve ketones in pregnant lady
39 weeks with effacement 90% and cervix dilation 2 cm, what is your most appropriate
action?
A. IOL 15%
B. CS 47%
C. Expectant management
NB: 📝📌Note to remember
When to deliver in case of Diabetes Mellitus? (ACOG)
- At 39+0 to 39+6 weeks if well-controlled glucose levels and no vascular disease;
- At 36+0 to 38+6 weeks if poorly controlled glucose levels or vascular disease (even earlier if
severity of complications warrants earlier delivery)
- Expectant management beyond 40+0 weeks is not recommended
Delivery before maternal stabilization should be avoided!!
For this patient the correct answer is to manage the DKA (by insulin and hydration) and stabilize
the mother!
-> Then induction of labor after correction of her status.!!
If IV insulin and hydration in the choices I would choose it. If not? IOL
‫ حليتها على أساس ان قصدهم من كلمه‬the most appropriate ‫انه وش مفروض اسوي بعد ما اعالج ارتفاع السكر؟ هل اتركها‬
‫وال اولدها؟ والجواب توليد‬
‫!!واالصح طبعا اني اعالج السكر المرتفع‬

57- 2 questions about tubular acidosis types

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58- Std’s and their management

59- Lots of questions about thyroid diseases and their mx

60- Active survillance vs health education

61- HTN nephropathy type

62- PE many questions

63- Meningitis tx
NB:
https://www.amboss.com/us/knowledge/Meningitis

64- Hyponatremia questions

65- Sacriilliac joint tender with hepatosplenomegaly in veteran?

A- Toxo
B- Syphilis
C- Brucellosis →
D-TB

66- 40s Female with previous DVT. What to do?

A- Aspirin
B- Warfarin
C- Heparin
D- Nothing
NB:
If pt pregnant pt in same as in other recall the answer will be (LMWH )
Dr alharbi
https://www.amboss.com/us/knowledge/Deep_vein_thrombosis
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67- T1dm uncontrolled, Mother concerned. What test modality to use in annual follow up
or screen “‫"نسيت الصيغة‬
A- Serum creatinine
B- Microalbuminurea
C- Urine analysis
D- HgbA1C
NB:
The National Institute for Health and Care Excellence (NICE) in the UK recommends a
glycosylated haemoglobin (HbA1c) target level of 48 mmol/mol (6.5%) or lower
Every 3 months in children and young people aged under 18 years [35]
Every 3 to 6 months in adults.BMJ

68- Patient in anaphylactic shock after CT what is the most appropriate immediate action
has wheezing and something else?
A- Epinephrine
B- Intubation
AMBOSS
Administer epinephrine IM 1:1,000 as soon as possible and repeat as needed.

70- 2 days of vomiting and diarrhea, Dehydration baby i think 10% , what will be the level
of sodium ?
A-normal
B-low
C-high
NB:
A or c ?

71- pt has hemorrhoid at 3 , 7 .. had injection sclerotherapy and resolved... what is the
type of hemorrhoid?
A-external
B-internal
C-thrombosed
NB:
Sclerotherapy, infrared photocoagulation, haemorrhoid arterial ligation, and stapled
haemorrhoidopexy can also be used for mild prolapsing internal haemorrhoids (grade 2).BMJ

72- 49 year old man heavy smoker , otherwise he’s healthy came for lung cancer screen
what do you do for him?
A-low dose CT
B-sputum cytology
C-chest x ray
D-maybe something biopsy
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73- Which of the following is the earliest plain radio finding of rheumatoid arthritis
A- Juxta-articular osteopenia
B- No abnormality
C- Soft tissue swelling
D- Subchondral erosions
E- Symmetric joint space loss
NB: the earliest sign of RA is a periarticular soft-tissue swelling with a fusiform appearance

74- Patient came to the ER with signs and symptoms of myocardial infarction he was
going for PCI, when the cardiologist was assessing his condition he notice the patient
was depressed with low mood, the patient refused the PCI he demonstrate good
understanding of his problem to the . doctor what to do?
A. Treat the patient regardless of the consent
B. Refer the patient for psychiatric assessment then take the consent
C. Respect the patient choice after discussing the reasons of refusing
D. Take the consent from the patient relative
NB:
supportive therapy including assessment and psychotherapy, if no urgent need of doing PCI
now, and still in the window of 12 hrs

75-54 years old female presented to gynecology clinic complaining of dysuria and
urinary incontinence, she stated that the leak is not related to specific activities and
occasionally associated with coughUpon investigation urinalysis and cultures were
insignificant, However, urodynamic study showed: contracting bladder even with small
amount of dripping ,Which of the following is the most appropriate management
A. Kegel exercise
B. Anterior Colporrhaphy
C. Anticholinergic agent
D. Bladder Suspension

76-Cough & fever after antibiotics he became better but symptoms never gone What’s
the most likely diagnosis
A. PE
B. Parapneumonic effusion
C. HF
D. TB

77-Patient with HTN not responding for three anti hypertensive drugs on Ultrasound the
one kidney, is bigger what is diagnosis
A Adrenal hyperplasia
B Renal artery stenosis
C Pheochromocytoma
NB:
it should be "one kidney is smaller than the other", and the answer will be B
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78-SLE pt pregnant on treatment azathioprine and immunosuppressive drug newborn

vaccinations
a- Give all
b- Delay after 6 months
c- Delay after 12 months
d- All live vaccinations are contraindicated
NB: Answered by dr.‫→ صفدر‬
if started in the 2nd trimester, will delay the live vaccine for 6 months; if
started during the 3rd trimester, then delay all live vaccines for 12 months.

79-Patient with hx of pancreatitis months ago and now referred to surgery clinic for mild
abdominal pain and , what initial inves? I think it was psudocyst
A-U/S
B- CT
C- endoscopy
NB: Answered by dr.abeide
Imaging modality of choice is CT. Because this is how you decide your management.
Now, if they say “initial”, US can still be a good option to be done “initially”, followed by CT. It
just depends on how the question is put. But CT is certainly superior

80-Question about Menigitis, a 7-year-old patient infected with a gram-positive

diplococci. Treatment is:
A.Ceftriaxone →
B.Penicillin + gentamycin
C.Gentamycin
D.Gentamycin plus vancomycin

81-How to Stop bleeding after delivery if you wish to preserve fertility .. which to ligate
A- Internal iliac artery
B- External iliac artery
C- Internal iliac vein
D- Some uetro.. ligament
NB: Wafa notes

82- female Most common source of bleeding :

A- Uterus
B- Lower genitalia
C- Fallopian tube
D- Ovary
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84- Most common side effect of antipsychotic

A- Sezuires
B- Hyperthermia
C- MI
D- Akasthsia
NB:
Extrapyramidal Symptoms common side effects of antipsychotics; incidence related to
increased dose and potency. Acute (within 10 days, early-onset; reversible) vs. tardive (within
90 days, late-onset; often irreversible), treated Acute: lorazepam, propranolol, or
diphenhydramine; reduce dose or change antipsychotic to lower potency.

85-Pediatric patient was just diagnosed with type 1 dm the doctor strongly advised for
screening of celiac disease
1-every two years at the diagnos of type 1 dm
2-every two years at puberty
NB:
ADA guidelines state that children with type 1 diabetes should be screened for the condition
"soon after" diagnosis. The International Society for Pediatric and Adolescent Diabetes (ISPAD)
recommends celiac screening "at diagnosis and then annually for 5 years
Madescape

86- Treatment of brucellosis with neurological symptoms

A. 3 weeks
B. weeks
C. 4 months
D. 6 months D

87- Female 47 years old she has iron def anemia w 3rd degree hemorroied what would u
do ?
A. Colonscopy
B. Hemorroidectomy
C. CT scan
NB: Answered by dr.abeidi

88- 20 years old female, medically free presented with epigastric tenderness long
duration , not related to any thing, some time it associatedwith vomiting Her mother have
chronic non specific abdominal pain Which of the followirg most appropriate for
diagnosis?
A- Endoscopy
B- Barium swallow
C- stool analysis
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89- What is the earliest manifestation in fructure (something like this)?

A)pain
b)cold
c)paresthesia
d)hotness or redness
NB:
Acute fractures usually cause severe pain.
In stress fractures pain may be mild and often has a gradual onset, becoming progressively
more severe over time.
Pain in the lower limb reproduced on weight-bearing exercise, such as hopping, jogging, or
even walking, can be due to a stress fracture.
Pathological and insufficiency fractures usually cause a sudden onset of pain . BMJ

90-Pt. With hx pulmonary embolism 3 years want contaceptive: which in is the best
choice:
A-Dermal patch
B-OCP
C-IUD
NB: -->

91- Patient with malar rash, rynoid phenomenon, joint pain of MCP joints, healed ulcer in
top of 2nd finger, proximal muscle weakness pt can't climb the stairs, what is diagnostic
AB ?
A. anti cep
B. anti smith
C. Anti ds dna
D. anti RNP →

92- Preeclampsia: what expected to be significantly decrease ?

1- Urea
2- Creatinine
3- Plasma volume
4- Platelets D
NB: 📌Let’s Exclude!!
- Uric acid -> Serum uric acid increases with preeclampsia
- Creatinine -> it may increase with preeclampsia not decrease
- Plasma volume?? -> it increases in pregnancy in general
- Thrombocytopenia -> may occur and may reach severe levels as part of HELLP

93- Pregnant with SOB... Tachycardic.. Bp normal...doppler normal... No DVT... Asking

about next inves..
A. D. Dimer
B. V/Q scan -->
C. CTPA
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94- Case of cystic fibrosis (giver), ask about the way of inheritance
A. Autosomal recessive
B. dominant
C. X-linked A
NB:
CF is a hereditary autosomal recessive disorder caused by defective CFTR ( AMBOSS)

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

96- Patient has sjogren syndrome which type of renal. tubular acidosis cause
hypokalemia
A- Type1
B- Type2
C- Type4
NB: The type already in above

98- World health organization (WHO) to determine the health of the population in KSA
What should KSA share to WHO:
A. Health determinant
B- Health indicator
C- Risk factors
D- Something variable
NB:
health indicator is a measure designed to summarize information about a given priority topic in
population health or health system performance.
Health indicators provide comparable and actionable information across different geographic,
organizational or administrative boundaries and/or can track progress over time.( Google)

99- Postpartum lady with difficulty to lactate her baby .fatigue .Cold intoleranc ..coarse
facial features.. low T3 What intial step
A. Requist TSH
B. To give thyroxin
C. To give estrogen
NB:
as initial you must check TSH according to UTD
 20/10/2021

Pictures

- SVT

- HSP

- inferior MI ecg

- Digoxin toxicity ECG (easy to dx >> yellow color in vision no need even to look at ECG)

- Prolonged deceleration asking about the cause (CTG)

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- Ask about managment ?

- Impetigo
General: wound cleansing with antibacterial washes (e.g., chlorhexidine)
Mild nonbullous impetigo (single lesions or small areas affected): topical antibiotics (mupirocin,
retapamulin)
Bullous impetigo, ecthyma, or severe nonbullous impetigo (widespread dispersion, numerous
lesions, and/or fever)
First-line treatment : first generation cephalosporins (e.g., cephalexin) or dicloxacillin [10]
Alternative: amoxicillin-clavulanate, macrolides [12]
If MRSA infection is confirmed or suspected : clindamycin, trimethoprim-sulfamethoxazole,
doxycycline
- A