6 YO known case of congestive heart failure , present in ER with SOB after playing , HR : 200 other examination normal , ask about apportiate mangment : ⁃ iv fursamide ⁃ observation as symptom expected of ⁃ his diagnos .
60 YO male patient k/c of DM and HTN presented to ER with: neck pain and sweating for one hour. He has a previous history of recurrent chest pain which resolve spontaneously after resting. ECG done and showed non-specific ST segment and T wave changes. Troponin is normal. What is your next step? •A. Repeat troponin after 6 hours •B. Discharge the patient •C. Do stress ECG test •D. Give aspirin and nitroglycerin
a um alqura
Pediatric patient came with fever and sore throat, the tonsils were congested and he had papular lesion with erythematous base on his mouth and gingivitis: HSV EBV Coxsackie
pt from India with sign and symptoms of Meningitis , labs wbc : lymphocytes , high protein .. A- TB meningitis B-viral meningitis C-Bacterial meningitis
14 y female complain of vaginal bleeding in interval of 3 weeks to 2 months, she has normal development and normal secondary features, every thing normal What to do? A- Reassure B- OCP C- Order FSH and prolactin
Elderly man presented to the ER with rigid distended abdomen prepared for laparotomy with hypotension and fever (38) X ray showed free air under diaphragm What is the best initial resuscitation option ? A- intubation and ionotropes B-Broad spectrum Abx C-Colloid via central line D-Crystalloid fluid via peripheral line
28 year old female presented following radiation of neck with neck swelling. Ultrasound showed swelling in the left lobe of the thyroid of 3x4cm of papillary thyroid cancer. Which of the following is the best management? A) Left Lobectomy B) Left Lobectomy with Isthmusectomy C) Subtotal Thyroidectomy D) Total Thyroidectomy
about child present with projectile vomiting , on abdminal examination , olive like mass , what is the mx ? Pyleromytomy
vaccination at birth? Hep B, Dtap MMR, BCG MMR, Hep B BCG
Child with viarl infection not improving with 2 inhaled saba:- 1- cough suppressant 2- leukotrine 3-ICS 4- oral beta agonist
after using PPI when to do urea test? -2weeks -4weeks
4 weeks antibiotic
pic of spherocytosis
LOOKS LIKE A RED BALL NOT CONCAVE
What is the age in month of child talk 6-10 words, know 2 body parts, immature pencil grasp? A-17 B-19 C-12 D-24
(C) 1.5 yrs or 18 months . We expect 18 month’s milestones more from a 19 months old than 17 .
wart-like lesions on the genitals.
Why ACIs is Contraindicated during pregnancy : fetal anomaly Renal impairment of the fetus
Baby sit briefly, crawl , move object from hand to hand , but can't do pincer grasp , age ? A. 4 month B. 6 month C. 7 month D. 9 month
Co-morbid patient was admitted for some reason, was on salbutamol, spironolactone, aspirin, statin and metformin. K level: 2.5. What medication causes this lab finding: A- salbutamol. B- spironolactone. C- statin. D- Aspirin.
A Salbutamol reduces serum potassium levels by increasing the shift of extracellular potassium into the intracelluar space.
Case of pancreatic cyst for 5 Ws with collection was 18 cm x 24 cm how to manage? A- Percutaneous drainage B- Endoscopic drainage C- Surgical drainage
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 D. I don’t remember
Our case is Most likely TTP
1- supportive. ( Iv fluid if indicated, correct Acid base imbalance and
2- Pex ( Plasma exchange ) and steroid.
RBCs transfusion if Hb is less or equal to 7.
Platlets transfusion only for severe bleeding or going for invasive procedure.
25 weeks pregnent ,sero-ve for rubella , when take vaccicine? A- now B- postpartum C- no need D- 3d trimester
4 months* old girl, during Pneumatic otoscope unilateral non-purulent effusion and decrease tympanic membrane motility , no fever pr other symptoms, and no hx of previous infectious diseases, breast feeding very well and no use of pacifier , What’s the best next step? - use amoxicillin tx - use of amoxicillin and clavulanate - Observe and F/U for 48hrs - Refer for ENT to evaluation for tympanostomy tube (للاسف الشديد هذا السؤال جاء نسخ لصق تكرر كثير بالاشهر الماضية وكنت اعتقد انه bad recall )
Lab technician give a result to nurse through the phone, said 2 then pause after that proceed 3 5 and the nurse wrote 2.35 but the correct one is 235, the patient had irreversible liver damage by this mistake, Cause of this condition ? A- Doctor did not check B- Lack of communication C- Technician didn’t check if the nurse got the number correctly D- Mishandling from the nurse
9 y/o pt his mom complaining about he is wetting his bed since one month. He used to be dry since 7 years. The urine is foul smelling His lab showing high wbs and turbid in colour and showed nitrate Diagnosis ? A- UTI B- normal for his age C- nocturnal enuresis
Female c/o urine leakage with cough, sneezing, exercise and with urgency. What type of incontinence does she have? A. Urge incontinence B. Stress incontinence C. Mixed incontinence D. Overflow incontinence
Patient presented with neck swelling, she is completely asymptomatic, neck US was done reveal a solid mass of 7 mm with regular margins, which of the following is the most appropriate next step? A. FNA cytology B. Thyroid scintigraphy C. Check TSH
A 4-month-old uncircumcised boy. He has low-grade fever. Many negative symptoms. He looks well and changed diaper multiple times. Temp: 39.1 Urine analysis: High WBC. Positive nitirte. Posiitve leukocyte. What is the most appropriate management? A. Oral cephalexin. B. Oral azithromycin. C. IV ceftriaxone. D. IV cefuroxime.
A, YOU CHECKED IT TWICE, ITS CORRECT
woman with dyspareunia and spotting fresh 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. valva b. vagina c. cervix uterus d. body of uterus
YOUR FOCUS TEAM SAYS C
Patient smokes 20 cigarettes and vital signs show BP 140/92 Which of the following is the most considerable risk factor for MI ? A) Hypertension B) Smoking C) Age
Pediatric patient presented with generalized seizure, hypoglycemia, ketones in the urine with characteristic odor. What is the dx? A. Galactosemia. B. Phenylketonuria. C. Maple syrup urine disease. D-Fatty acid oxidation defect
Typical case of intussusception asking about next initial step: A-NPO B-NGT decompression C-Iv hydration D-Surgery
couples with infertility ask about surrogate pregnancy which not allowed in ur hospital and u are not sure wither allowed in saudi or not? A. Warn them might not be allowed in ksa. B. appointment to check yourself and then tell them. C. Referral to colleague who can help to do it.
664-10 Yo female presented with RUO.pain for one week. Associated with jaundice, vomiting and diarrhea, she has a recent Mx of eating from outside, She has no Hx of drug. Which of the following test wil contirm her infectin ? A. HAV IgM B. HAV IgG C. HBSAg D. HCV RNA
Calculate the cerberal perfusion pressure of intercerinal of 15 and mean pressure of 65: -40 -50 -60 -70
Pregnant 20 weeks with with two previous histories of preterm labor. Her current pregnancy is uneventful and her cervix is closed, cervical length is 30 mm and Positive fibronectin.
What will you do?
Patient came with vaginal discharge she have done CS with episiotomy 10 days ago , the obstetrician diagnosed her with UTI and described Abx , but she did not improve then she went to another obstetrician and he found infected vaginal swab , What is the medical error done by the first obstetrician? A. let the midwife assist him and depend on her B. doctor failed to follow the surgical safety protocol in the OR C. No communication between the 1st and 2nd obstetrician D. Genuine different assessment or diagnosis of patient case
Female underwent gyne surgery, massive bleeding occurred intraop and the doctor and his colleague decided she needs emergency hysterectomy to save her life What to do? A. Get consent from husband B. Do it without consent C. Ethical committee consent
RTA, GCS 8, decrease rt side air entry, intubated cervical emphysema, penumomediastinum, pneumothorax What is the Diagnosis Open or tension pneumothorax Tracheobroncial injury
60 years old male patient k/c of hemorrhagic stroke 2 years ago presented to ER with crushing chest pain for 2 hours. ECG: ST elevation in lead Il, lead Ill, aVF. What is the most appropriate management? A. Aspirin B. PCI C. Unfractionated heparin D. thrombolytics
5 years old with stab wound in lower chest, has abdominal distension Fast shows free fluid in abdomen All vitals normal except O2 90 What is the most appropriate management: Thoracotomy Tube thoracostomy Expl lapratomy Angioembolization
c, badran says so shut up
4 days Post op pt of AAA with low BP despite 2L NS. BP still low. (-/40). HR normal. Periphery warm. Type of shock ? - no other parameters are given- A. Hemorrhagic B. Septic C. Anaphylactic D. Neurogenic
Patient was sympathetic + old she did Pap smear and it shows invasive lesion. Best diagnostic value? - colposcopy - biopsy
If Next step > A
Best diagnostic > B
patient female elderly with symptoms of Orthopnea SOB PND, JVP, Bilateral basal crackles. S3. what is the diagnosis A- Pulmonary edema B- MI C- Mitral regurgitation D- Right sided heart failure
C badran says so
CTG w/ prrolongrd decelation. Most appropriate to do? A) emergency CS B) hydration, reposition and assess in 20 mints
Patient presented to you with goiter and signs of hyperthyroidism and TFT was like this: TSH: LOW, T4,3: High, thyroid antibodies are negative, what is the most probable cause: Primary TSH secreting adenoma Graves disease Multinodular goiter
C because antibodies are negative
10 y old girl complain of abdominal pain since *14* days On examination you found bruises over the abdominal and asked her what is these she told you she fall from bicycle … A- ct abdomen B- us abdomen C- laparotomy D- laparoscopic
40 something year old female with menorrhagia What is you diagnosis? - endometrial polyp - submucosal fibroid
A a picture of homogynous US will come with this
36 Year old male patient diagnosed with WPW and he is on BB but still uncontrolled. What to do? A- Add CCB B- Increase the dose. C- Give amiodarone. D- Radiofrequency ablation
Case of 3 years old he has breathing hold, no inspiratory stridor and monophasic wheeze and barking cough ? A- bronchiolitis B- Tracheomalacia C- Laryngomalacia D- Bronchial asthma
47 year old lady known to have hypertension, came for clinic, what screening test to do? Pap smear Fasting blood glucose ✅ Colon cancer
she is not obese, i would go for pap smear
Pt with sjograns disease , ask what causes HYPERKALEMIA in this pt? A- RTA 1 B- RTA 2 C- RTA 3 D- RTA 4
sjogren causes RTA TYPE 1, hyperkalemia present i RTA type 4
A pregnant patient GA around 37 or 38 weeks came with labour , with contractions and cervix dilated and effaced. A picture of urinalysis showing positive ketones and Proteinuria and glucose. No vitals mentioned, the did not mention if she has gestational diabetes or not. What is the most appropriate management? A- Induction of labour B- Discharge and follow as outpatient
📝📌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 كلمه the most appropriate انه وش مفروض اسوي بعد ما اعالج ارتفاع السكر؟ هل اتركها ولا اولدها؟ والجواب توليد
والاصح طبعا اني اعالج السكر المرتفع!!
A Elderly patient with left lowr quadrant abdominal pain for few days associated with constipation and fever. What is the most appropriate next step? A- sigmoidoscopy B- colostomy with anastomoses C- explaratory laparotomy
If its diverticulitis case then CT
If volvulus then reduction by sigmoidoscopy
Ecg of hyperkalemia and the scenario mentioned the level of hyperkalemia asking about initial thing to give ? A- ca gluconate B- Insulin C- na bicarbonate
32 male patient, develop sever hypovolumic shock due to traumatic splenic injury, managed by splenectomy. In the operation he received 8 unit of blood, then transferred to the ICU. On the 3rd day he became febrile. Blood culture : positive for gram negative bacilli What is the most probable source of infection ? A- contaminated blood B- respiratory tract infection C- urinary tract infection D- from intestinal source
C Gram negative bacilli can be E.coli so UTI
Patient came with new onset of LBBB ( given dx ) what to the most appropriate next step ? ⁃ Give carvidolol ⁃ Give warfarin ⁃ Give thrombolytic ⁃ Wait for the cardiac biomarkers results
Child with Sx of tracheomalacia How to confirm the diagnosis? A) chest XR B) bronchoscopy C) Fluoroscopy
recurrent pregnancy loss in 1st. Trimester with Hx of theomebolism A- warfarin life long B- enoxaparin life long C- aspirin life long D- fandiprix life long
If pregnant or planning to get pregnant switch to enoxaprin
A doctor used the Foceps, place it in wrong position and injured the stylomastoid bone, what is the result? A.Baby cannot close his left eyes B.Loss of taste in anterior ⅔\
This Q was repeated a lot.
Stylomastoid foramen is the place where the fibers of the facial nerve passes.
Responsible for ( Taste ) of the Ant 2/3 of the tounge.
Responsible of ms that closes the eye.
The recaller may have missed some important details in the Q.
If choice B says ( Sensation ) of the tounge not the taste it will be wrong. And the answer will be A.
If The injuried foramen is the left and choice A was Right eye it will be wrong because it’s ipsilateral and answer will be B.
Or: maybe it’s not a bad recall and both are correct.
A diabetic lady presenting to the clinic asking about travelers diarrhea prophylaxis. Mild Cr Elevation, BUN is high, urea is high. What prophylaxis to give? A.Fluoroquinolones B. No need ✅ C. Probiotics D. Bismuth
If renal impairment with severe dehydration the answer is A.
Mild renal impairment is not an indication for travelers prophylaxis.
Highest risk factor for ednodemtrial ca?
40 YO female has heavy menstrual bleeding, came to the clinic and she was diagnosed as a dysfunctional uterine bleeding. what is the treatment -OCP -D&C - Hysterectomy
A The answer is OCP .. She came to clinic not ER , D&C will be the last option
38 YO female presents to the clinic after finding of hilar lymphadenopathy on CXR. She has on and off cough, but denies any fever, headache, n/v, weight loss all negative. Labs insignificant except for X-ray shows confirmed bilateral hilar lymphadenopathy CT guided biopsy shows noncaseating granuloma What is the best next step in management (They wrote “all labs were normal” and didn’t mention hypercalcemia) A. Observe B. Start prednisolone C. Start azithromycin D. Start anti TB medication
Patient with thyroid mass measuring 2*3 on one lobe, patient is asymptomatic, TSH and T4 are normal, Bethesda 4, what’s next step in management? A. Hemithyroidectomy B. Nodule excision C. Total thyroidectomy
child came post URTI 2 days ago complaining of SOB Wheezing, RR 33, HR 100, O2 90%, other vitals normal (not sure). What’s most appropriate management? A. ABx and systemic steroid B. IV fluid and ventolin C. Ventolin and systemic steroid D. ABx with something (I don’t think it was Ventolin)
Female came to ER with sign and symptoms of appendicitis, appendectomy was done , surgeon discover the appendix was normal , what surgeon should be do ? A. Tellptwhathappenedandthatwasroutineandnocomplication B. Not tell the pt C. Write report about what happened and give it to hospital committee
Child with Supracondylar fracture, he has absent pulse, Next step? A, K-wire Fixation B, Explore
First step is Urgent reduction
If Hot and warm — K wire.
If Cold and pale — Exploration.
Here the answer is A.
Pt k/z DM present with perianal painful swelling and us fever, T 38 on DR exam you found posterior fullness with mimimal discharge, Dx ? A-Abcess B-Perianal fistula C. Thromposed pile
Man come to the ER for poly Trauma and he was intubated after resuscitation admitted to the ICU what is the best approach to exclude cervical spine injury and remove neck collar? A. MRI neck B.Ap and lateral x-ray neck C. Clinical judgment D. Ct neck
scenarios about a child 2 years old with SOB and Expiratory wheeze and other respiratory symptoms he had a viral illness 2 days ago A.Respiratory monitoring for hypoxia B. Inhaled epinephrine and steroids C. Intubation and antibiotics D. SABA
Diabetes millitus Risk ratio is 0.83 among patients who drink green tea (exposed) and patients who drink black tea (unexposed). A- green tea drinkers have lower risk of dm B- black tea drinker have higher risk of dm C- getting dm among both groups is unrelated/accidental D- no different between both are the same