Medicine

● 60 years old diabetic complaining of signs/symptoms of kidney failure, and

EKG showed t wave depression​. Management?
A. Ca gluconate
Answer is: ​This could be bad recall.
Kidney failure leads to hyperkalmia and a peaked T wave on EKG in which case we
start with IV calcium gluconate to stabalize the myocytes. However, according to this
recall the EKG shows T wave depression which would indicate hypokalemia (review
management for hypokalemia just in case).

● Patient on TPN complaining of ​weakness​, the most likely cause is

A. hypoMg
B. hypoK
C. hyperK
Answer is
N.B: Hypophosphatemia,more accurate if there is neurological sign, if ​no convulsion
choose hypoK.

● Pt with celiac disease suspect not compliance to gluten-free diet , how to

investigate?
A. Biopsy
 B. Food Diary
C. Antiendo…
D. anti-tissue transglutaminase antibodies
Answer is: D
N.B : Anti-tgg isn’t sensitive
The best is biopsy, but it’s invasive
So final answer still anti-ttg

● Most appropriate management of ​mild luminal stenosis​ (MRI finding)in

elderly 60 i believe?
A. Laminectomy
B. Biofeedback
C. Physiotherapy
D. Injection of steroid
Answer is C

● Patient with ​ascites​, ​paracentesis​ showed ​low SAAG​ what is the cause?
A. Liver cirrhosis
B. veno occlusive disease
C. TB peritonitis
D. constrictive pericarditis
Answer is: C

● 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
● Answer is: B
N.B: If asymptomatic aspiration needle.
If symptomatic chest tube.

● Patient with ​endometriosis​ treated with clindamycin and gentamicin, then

developed​ watery diarrhea, stool analysis shows bacterial toxins​, what is
the management?
A. Metro
B. Cipro
C. Ceftriaxone
Answer is: Vancomycin if not in choices A

● COPD patient on salmeterol and albuterol, still not controlled as he needs

to use albuterol more often now and he had multiple exacerbations in the
last 6 months, what to give him for maintenance?
A. Prednisolone
B. Tiotropium
Answer is: B

● 40yrs old guy, received a blood transfusion postoperative, after a few

minutes he developed pain at site ot transfusion, fever, and chest
tightness, dx?
A. Hemolytic
B. Febrile non-hemolytic
C. Allergic
D. Bacterial contamination
Answer is: A

● Pt with 2 weeks history of watery diarrhea, vitals were stable What is the
expected acid-base abnormality?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Compensated metabolic acidosis
D. Compensated metabolic alkalosis
Answer is A

● Female have SLE and seizure mx:

Answer is:
N.B: If active status epilepticus: anti-epileptic drug Otherwise IV cyclophosphamide

● The mosquito species Aedes (Stegomyia) aegypti - dengue fever which

time at day bite ?​ ​
A. early morning
B. early night
C. late nght
D. mid day
Answer is: A
 ● woman who is on DVT prophylaxis (enoxaparin) presents with sudden
onset SOB and dyspnea. Upon physical examination she has diminished
breath sounds bilaterally. Imaging shows a pulmonary embolus lodged in
the small bronchial tree. The best management is
A. continue same dose of enoxaparin
B. Switch to warfarin
Answer is: A

● Elderly Female with back pain, dexa scan shows: -1.9 lumbar spine, -2 hip,
CT shows compress fracture:..
A. Osteoporosis
B. Osteopenia
Answer is: A

● Patient on management for hyperprolactinemia .. when to indicate brain mri

A. Blurry vision
B. Doubled value of prolactin
C. Bilateral breast discharge
Answer is: B

● Indication of home therapy for copd pt:

Answer: 2 reading of PaO2 less than 7.3

● Patient with TTP scenario and labs. What’s the management ?

A. IVIG
B. Blood transfusion
C. Plasma transfusion
Answer is: C

● 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
Answer is: D
 ● 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
D. ABG
Answer is: B
N.B Cardiac tamponade

● years old come to ER complain of SOB . He cigarette 20/day but otherwise

well . Spirometry show restrictive picture . What Dx ?
A. pulmonary fibrosis
B. bronchiectasis
C. heart failure
D. Asthma
Answer is: A

● 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:
A. Tubercles Pleural Effusion
Answer: A

● Colon ca screening for low risk male :

A. 50y
Answer is: A

● ​In which stage prefer screening:

A. Pre disease stage
B. Clinical disease stage
C. Pre-clinical disease stage
D. Death stage
Answer is: C
N.B before it becomes clinically evident

● What pt develop after coming from Southeast Asia :

A. Dengue fever
B. Malaria
Answer is: A
 ● 32 y/o male with diarrhea 6-8 times per day .. what u expect ?
A. metabolic alkalosis
B. metabolic acidosis
C. compensate met alkalosis
D. compensated met acidosis
Answer: B

● population screening for cancer :

A. ovary
B. pancreas
C. colorectal
Answer is: C

● pt came with respiratory functions detotriation and LOC with sever

secretions in the throat mx?
A. cpap
B. mechanical ventilation
C. Oxygen mask
Answer is B

● Which of following is coming with criteria of SLE

A. hemolytic anemia
Answer is A

● Patient has high k 6.5 what to do start

A. Hemodialysis
B. IV ca gluconate
Answer is B

● 51 yrs old female complaining of ( classic case of meningitis ) what the

causative organism:
A. listeria
B. streptococcus pneumonia
Answer is B
Surgery
● Cipro and ofloxacin are safe in cases of a perforated tympanic membrane, I
got the question in my exam it was swimmer's ear otitis externa,
A. Neomycin
- no cipro ot ofloxa in choices,
Answer is

● Case of car accident..which of the following keep it low:

A. insulin
B. hypoglycemia
Answer is
N.B: Car accident so it’s a stressful event > all stress hormones will be elevated, insulin
will be low

● Post gastrectomy 3 days with LUQ pain. PE show LUQ mild tenderness on
palpation. Vitals 110\70 and HR 116. Why?
A. leak
B. dehydration
C. inadequate analgesia
Answer is A

Young man presented with multiple episodes of vomiting the last one was bloody
he is vitally stable ( BP 110/76 ) What is the most appropriate?
A. conservative management
B. Upper GI endoscopy
C. Sengstaken tube
Answer is A

● Post percutaneous transhepatic cholangiography developed upper gi

bleeding, invx?
A. Endoscopy
B. CT
C. US
Answer is:
N.B angiogram better if not in choices do CTA
PTC induced bleeding, go for angiogram diagnostic and therapeutic.
 ● Patient post abdominal surgery noticed 20 ml discharge from the wound
with no signs of infection, what to do?
A. Dressing
B. CT abdomen (or US)
C. open the wound(not sure)
Answer is A

● Complaint of loss appetite 1 month epigastric pain mass epigastric atrophy

muscle face +loss of wt diagnosis
A. Stromal carcinoma
B. Liver Metastasis
C. Adeno.
Answer is C
N.B as the most common gastric cancer, although it’s rare to cause Epigastric mass

● elderly presented with URQ pain jaundice investigation showed dilated cbd
- intrahepatic - palpable gall bladder
A. choices are syndromes mainly
B. liver tumor can’t recall
Answer is:
N.B palpable gallbladder indicates pancreatic cancer

● A 12 year old received a nonspecific blunt trauma on his abdomen and later
presented with generalized abdominal pain. Imaging of the spleen showed
a 7 mm hematoma and 4 cm tear(grade 3). Your management:
A. splenectomy
B. Spleen preserving surgery
C. Conservative
Answer is B

● Bradycardia (40 bpm) during laparoscopic procedure Is due to :

A. Cold gas insufflation
B. Rapid expansion of parietal peritoneum
C. Increase venous return
Answer is B
 ● Trauma patient with a wound on his thigh subcutaneous fat is lost
vasculature underneath is exposed what provides the best management
A. Debridement with primary closure

✅
B. Primary repair
C. Debridemnt with secondary closure
D. Debridement with vacuum assisted closure
Answer is C

● 60 years old patient come with sudden onset of upper abdominal pain after
a few bouts of vomiting. Examination confirme sick patient with tenderness
in epigastrium and supraclavicular subconscious emphysema . What’s Dx
?
A. esophagitis
B. acute gastritis
C. perforated peptic ulcer
D. boerhaav’s syndrome
Answer is D

● Adult case of intussusception, asking about management?

A. barium enema
B. surgical resection
C. surgical reduction
Answer is B

● Old male with htn and dm presented with claudication examination reveals
right femoral intact pulse and diminished popliteal and distal pulse and left
diminished pulse whats the most appropriate intervention:
A. ct angio
B. conventional angio
C. mra
D. venous US
Answer is A

Obs/Gyne:
 ● Young women G2p1 is smoker, no chronic disease and now she is
complaining of nothing, her first pregnancy is ok, what is the risk for her
current pregnancy?
A. IUGR
B. Forget others
Answer is A

● Couple came to the clinic regarding infertility. Female with regular cycle
every 26-30 days and monophasic basal body temperature. Semen analysis
normal. What would be the cause of infertility?
A. Male factor
B. Coital factor
C. Anovulatory
Answer is:
N.B Male factor practically excluded since semen analysis normal, could be anovulation
or coital, but anovulation more common.

● Female use paroxetine with history of suicidal attempts and depressions

pregnant what to do
A. Continue
B. Decrease dose
C. Discontinue
Answer is A
N.B having suicidal attempts or ideation This indicates severe depression
Take the risk of cardiac anomalies from paroxetin but you will avoid suicide which will
end up with mother and fetal death

● Turner syndrome came with primary amenorrhea. Most important

investigations?
A. TSH and T4
B. FSH and LH
Answer is
N.B think they mean typical turner case
The definitive diagnosis is karyotyping
The simplest helpful test is FSH/LH (specially FSH)

● Pregnant lady known case of crohn’s disease, she is on azathioprine and

another drug (I forgot the name). She delivered her baby. Regarding
vaccine?
A. The child should receive all vaccines
B. Delay live vaccine until 12 months
C. Delay all vaccines until 6 months
Answer is
N.B Other drug was biologic > delay 6m
If only azathioprine > give all

● Bilateral tubo ovarian abscess management?

A. Laparotomy
B. laparoscopic drainage
C. US guided drainage
D. IV abx
Answer is D
N.B if suspect sepsis surgical drainage

● 2 questions about pre-eclampsia, one 32wks pregnant the other 34wks has
hypertension and proteinuria, management?
A. Admit and observe
B. Immediate CS
C. IOL
Answer is A

● What of the following gives the highest yield in a patient coming for
prenatal visit?
A. General appearance
B. Pelvis rectal digital exam
C. Inspection of vagina
D. speculum exam
Answer is B
N.B Highest yield pelvic exam (in previous recalls)

● Couple came for infertility for 2 years female evaluated and was normal,
husband has cousin with Down syndrome and other autistic. What to do
next?
A. genetic test for husband
B. sperm count
C. wait and watch
Answer is B
 ● ​ emale on active delivery. Full effacement and 7 cm dilatation +3 station.
F
Doctor noticed cord protruded out of the vagina. Fetal HR 120. What to do?
A. CS
B. Follow after 2 hrs
C. Ventouse delivery
D. Continue vaginal delivery
Answer is A because it is (cord prolapse)

● Highest causing factor of endometrial cancer:

A. late menarche
B. early menopause
C. DM
D. progesterone tumor
Answer is Early menarche and late menopause are the risks, they are reversing it here
Progesterone is a protective factor for endometrial Ca, DM is a risk

● 60 y post menopause come with lump on the vulva and complain of itching
and after the itching bleeding on PE the mass was pea like , what is the Dx?
A. SCC
B. Bartholin cyst
C. Bartholin adenosis or adenoma
Answer is A It’s the most common vulvar carcinoma + the most common presentation is
itching, Bartholin usually asymptomatic or it will cause pain, tenderness presentation will
be like abscess, SCC usually present as small mass

● 12 years old female. obese with acne, she was iritated in the clinc. what
kind of problem?
A. Behaviour
B. Mood
C. Anxiety
Answer is: irritated > mood

● Post partum and cesarean section fever?

A. Retained products of conception
B. Endometritis
Answer is B

● pregnant with 33 week gestation presented with headache protein urine +3,
Bp 150/100 , asking what to do ?
 A. Immediate C/S
B. delay for a week and give steroid
C. admitted for observation
Answer is B
N. B: Severe preeclampsia in preterm usually they admit her > Mgso4 and BP control +
steroids
Then they discuss delivery since she is preterm
Even if blood pressure 1000/500
1st avoid CS
2nd: If she is preterm > Mgso4, Steroids, BP control
Then discuss delivery
But if she is full term > Mgso4, BP control > infuse her with oxytocin for delivery +
Mgso4

● Mother with epigastric discomfort and baby kicks mostly felt in lower
abdomen , smooth regular .... balloting , fetal heart heard at umbilicus ,
presentation ?
A. Breech
B. Shoulder
C. Face
D. Brow
Answer is A

● Ectopic pregnancy bhcg 3500 hypotension tachypnea , management

A. Methotrexate
B. Laparoscopy
C. Laparotomy salpingectomy
Answer is C

● Presenting part, felt nose/mouth/brows

A. Face
Answer is A

● Best fetal presentation for vaginal delivery:

A. Cephalic cephalic
B. Cephalic transverse
C. Cephalic breech
D. Breech breech
Answer is A
 ● precious baby after 10 years infertility and the patient ​cervix open 4 cm
effacement 50% ​and the presenting part was soft globular at -2 station
A. Oxytocin
B. CS
C. Prostaglandin
Answer is;
N.B Firm and round signifies cephalic, soft and/or non-round suggests breech. If breech
presentation is suspected, the fetal head can be often be palpated in the upper uterus.

It is breech > CS
She's in labor no point of PG
Didn't mention contractions so no point of oxytocin
And too late to give tocolytics (plus it’s contraindicated >4cm dilated)

● Brown​ discharge, ​pregnant​ at 12 weeks.

A. Missed abortion
B. Threatened
C. Normal pregnancy
Answer is read about abortion. (Missed)
N.B Brown discharge means blood stays in uterus long time it’s seen in both
We need more information
 ● pic of ground glass appearance Uterus on U/S, asking what you should tell
the patient:
​ A. Infertility
Answer is A

● female 30 year old her pap smear result squamous cell ca , what to do next:
A. biopsy with colposcopy
B. Hysterectomy
C. Repeat pap smear
D. Neoadjuvant chemotherapy
Answer is A

● woman with dyspareunia and spotting fresh​ blood after intercourse​ . She
had history of warts on vulva with cryotherapy done 2 yrs back what is the
site of the bleeding?
A. Cervix
Answer is A

● Atypical hyperplasia in young ?

A. Progesterone
Answer is A

● Case of pregnant smokers:

A. Low birth weight
Answer is A

● Yellowish greenish vaginal discharge increase with intercourse, O/E

Strawberry cervix, whats the management?
A. Metronidazole
Answer is A

● Female pregnant with polyhydramnios, O/E uterus greater than gestation

age, US shows twin pregnancy, doctor said she will need C-S, what is the
most likely cause?
A. Breech-cephalic presentation
B. Cephalic- cephalic presentation
C. polyhydramnios
Answer is A

● Patient female has diabetic give high value of diabetic test

Which vaginal infection diagnosed:
A. Vilvopnea
B. Bacterial vaginosis
C. Candida
D. Trachominas
Answer is C

● ​detecting pregnant women is infected with HBV, what kind of prevention?

A. Tertiary
B. Secondary
C. Primary
D. Primordial
Answer is B

● Postmenopausal women come to take HRT. You said she didn't need it.
She insisted to take it. What to do?
A. Prescribe HRT to her
B. Don't give it
C. Consult Hospital authority
D. Refer to another Gynecologist
Answer is B

● weeks pregnant lady has features of abrupto placenta, severe bleeding,

hypotensive, tachycardic and anemia. What to do to safe live?
A. Multidisciplinary rapid response team
Answer is A

● Post partum haemorrhage due to atonic uterus, uterus message and

oxytocin failed, next management?
A. uterine artery ligation
B. hysterectomy
 C. b-Lynch suture
D. embolization
Answer is C

Pediatric:

● Kawasaki management?
A. Aspirin
B. Ibuprofen
C. Steroid
Answer is A

● Pedia 4 days with jaundice and his brother had the same thing Direct
bilirubin and total bilirubin was high what is the diagnosis:
High direct bilirubin in neonates:
A. Biliary atresia
B. Choledochal cysts
C. Neonatal hepatitis
And others
Answer is Choledochal cyst, Because they said his brother had similar,I will go with
Caroli's disease (previously called Choledochal cyst) it’s autosomal recessive

● Child presented with ulcers on mouth and gingiva erythematous based and
pale in the center. Dx?
A. Coxaci
B. EBV
C. Herpes
Answer is erythematous base and pale in center they are describing herpangina ulcer >
coxsackie

● 8 years old child girl ,complete pic of lower limb swelling ,abdominal pain
RBC cast ,HU , low C3 ,high creatinine and preceded with rash ?
This could be HUS or HSP
platelet count was given
N.B: If normal > HSP
if thrombocytopenia > HUS
 ● baby 3-7 days presented with bilious vomiting , decrease oral intake , this
happened after introducing milk formula He passed meconium after birth
and after that yellow stool :
A. Hirschsprung
B. milk allergy
C. Midgut volvulus
Answer is C
N.B: Bilious vomiting never reassuring in pedia, always search about surgical causes

● 2 months baby the mother complained about that he cried excessively

since 2 weeks they mentioned that the mother introduce 1 bottle feeding at
night recently.his growth on 50% What is the cause :
A. Infantile colic
B. Cow’s milk allergy
Answer is A

● 20 years old diagnosed with nephrotic syndrome (minimal change disease )

what is the best initial treatment to decrease proteinuria
A. prednisone
B. ACE inhibitor
C. Low protein diet
D. Diuretics
Answer is A
N.B: ACE decreases proteinuria, steroids causes remission of proteinuria.

● Girl came with history of fever and rash involving throat, gingiva tongue,
lips and body. Mom complaining that her daughter could not eat or drink
for two days because of painful throat. The girl looks dehydrated. What is
the management?
A. Acyclovir
B. IV fluid with acyclovir
C. topical antibiotics
D. IV fluid with topical antibiotic
Answer is B

● 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
Answer is B

● 8 years old male presented with 1 week history of headache ,fever ,pallor of
skin and mucous membrane, pitting edema around eye and ankle with
dark urine which of the following if present explain the symptoms ?
A. SCD
B. Recurrent UTI
C. Infection 1 week ago ( i forget the organism)
D. 1 week history of abdominal trauma
Answer is

● Ped URTI lethargy , confuse , Tem 39, RR 35, HR >100

A. Sepsis
B. Septic Shock
Answer is A, if hypotensive > B

● Child with a ​long history​ of ​watery diarrhea abdominal bloating and pain​,
what’s the Dx?
A. chronic giardiasis
B. chronic amebiasis
C. Carbohydrate intolerances
D. I think constipation
Answer is A Needs more hints but yeah

● 7​ ​year old with pubic hair, no axillary hair, no breast or mensis?

A. Adrenarche
B. CAH
C. Precocious Puberty
Answer is C, and ​premature pubarche more accurate

● 4 years old boy presented to the ER complaining of ​hematuria​. No other

complaints. On exam; ​sore throat, mild fever,​ BP 150/100, HR 100.​ ​No UA.
A. Acute glomerulonephritis
B. IgA nephropathy
C. Kidney fever
D. Streptococcal infection
Answer is B

● Same scenario. But 2 weeks later (sore throat infection). Now complaint of
edema of face/limbs and urine cloudy + protein.
A. PSGN
Answer is A

● 7 years old came with redness, edema in face, upper limb, sole, hands,
mouth + heart murmur +2 weeks history of diarrhea
A. Kawasaki
B. VSD
C. ASD
D. cannot remember
Answer is A

● 5 years old boy suffering from severe chest infection and his father tell that
is the 3 times in the last 2 month and report that they lost another boy 2
years ago with severe chest infection and respiratory distress and they
have 2 good girls 7 years and 3 years
A. Deficient gamma globulin
B. Hemophilia
C. X linked immunodeficiency
Answer is C

● child can’t sleep at night , on ear examination perforated eardrum with pus
what is the diagnosis:
A. Acute otitis media
B. Serous otitis media
C. Chronic otitis media
D. Effusion otitis media
Answer: A

● 18 months c/o knee swelling + pain + redness .. most appropriate

investigation?
A. knee x-ray
B. joint fluid assessment
C. blood culture
D. can’t recall (but unrelated)
Answer is B

● child with sx of meningitis, on physical exam he has Papilledema , council

parents about what complication :
A. Hearing loss
B. Vision loss
C. Septic shock
Answer: A

● When to consider a nephrotic syndrome is a cortisone resistant:

A. 4 months of daily cortisone
B. 12 days of daily cortisone
C. 4 weeks of daily cortisone
Answer: C

● What is the vaccine CI in Pedia with Egg allergy and needs to be referred to
an immunologist before given?
A. Yellow fever
B. Influenza
Answer is A

● ​ scenario of a boy with recurrent infections. His brother died when he

A
was 3 years old. He has 2 sisters who are alive and well. Previous
investigations done at an outside clinic show low levels of all immune
markers except for T cells which are normal What does he have?
A. SCID

✅
B. Hyper immunoglobulinemia M
C. XLinkeda gammaglobulinemia
D. T cell deficiency
Answer is C

Ethics :

● Pregnant pregnant( i don't remember weeks ) after intercourse she had

vignal spoting diagnose as complete abortion ? They blame self which
action ?
 A. Identify their emotions and show empathy
B. Identify the emotion And empathy and prepare management plan
Answer is A

● Pregnant 34 weeks, diagnose with IUFD , she feels guilty because she
smokes, how will deal with her?
A. Tell her to wait for autopsy results
B. sympathize with he
Answer is A

● Pregnant 37 wks with IUFD, feeling guilty because she smoke 5 cigarettes /
day, what to tell her
A. Smoking not related to IUFD
B. Smoking increase rate of IUFD
C. Should stop smoking for future pregnancy
D. Cause not known and need more investigation
Answer is: D

● Female patients come to the doctor's office with signs of abuse. She told
you the abuse was from her husband and told you not to tell her husband.
What should you do?
A. Threatens the husband by police
B. Tell the police
C. Do what the patient said to you
D. Give the patient your number to tell if this happens again in future
Answer is

● couple, 10 years infertile due to male factor. Wife with incomplete abortion
and now will be admitted. (Not sure what the question is exactly)
A. Show sympathy (her answer)

● the rate of violence between couples increase at which period of the year ? ​
A. holidays
B. after family visit
C. Pregnancy
Answer is B
N.B answer is pregnancy
 ● question about what’s the appropriate thing to do after a child death for
parents ?
A. book them for a family medicine appointment
B. let the mother stay with the child to say goodbye
C. ignore
Answer is B

Topics and pics :

Ultrasound of fetal remnant at 6 weeks

4 qs about parathyroid gland complication management
4 qs about types of shock​
drugs that increase survival in CHF is: ACE