33-year-oid woman was referred to the Gynecology Clinic because of secondary infertility. Detailed clinical history revealed that she has history of severe dysmenorrhea.

Which of the following will typically be the cause of ber dysmenorrhea?

A 25-year-oifl woman complained of recurrent behavioral symptoms that started few days before her menstrual cycles and usually disappear around the second day of the cycle. These symptoms have led lo reduced work productivity, absenteeism from work, and increased visits to ambulatory healthcare.

Which of the following is the most reliable method to establish the diagnosis?

19-year-old girl complained of recurrent painful menstruation that stalls on day one of her menses and subsides between day 3 to 4. The pain is severe enough to affect her daily actvities and school attendance. All investigations were negative. She was started on non­steroid anti-inflammatory drugs, her pain severity became less and she was able to resume normal function during menses. The patient is still not satisfied and insisting to receive a stronger pain killer.

Which of the following is an appropriate management?

A 25-year-oJd woman G2 P1001 was admitted at 39 weeks' gestation In Labor Suite with labour pains. On AtxJofninal examination. 3 moderate contractions every 10 minutes. The cervix was 6

cm dilated. 80% effaced. Mouth, hps. nose and otbitai hollows were palpable.

Which of the following is the most appropnate next step in management?

A 40-year-old woman underwent a laparoscopic tubal ligation dunng the postpartum period following the delivery of her 4th child 4 years ago She presents to trie Maternal Health Clinic compialnmg of bright red vaginal spotting. Patient Iasi menstrual cycle was 6 weeks ago. A pelvic examination shows fullness over the right adnexa. There Is no pain or tenderness Her last pregnancy resulted in an emergency caesarean seciion with a mid-line incision. Which of the following is the best next step in management?

A 23-year-old G2 P1001 at 22 weeks' gestation presented with a complaint of her abdomen is larger than her previous pregnancy (see report).

Ultrasound: Showed dizygotic twin pregnancy.

Which of the following best described membranes and placenta of dizygotic twins?

A 38-year-oid woman admitted with pyelonephritis. 2 days after admission, she develops sudden severe shortness of txeath (see report).

Blood pressure B4/50 mmHg

Heart rate 124 /min

Oxygen saturation 84 %

CT-pulmonary angiogram:

A saddle embolus at the bifurcation of the pulmonary artery and multiple segmental pulmonary emboli bilaterally.

A 24-year-old woman is complaining of failure to conceive over the last 16 months despite regular intercourse. She has infrequent menstruation occurring once every 6 to 8 weeks along with increased facial hair and acne On ultrasound, her ovaries had multiple small follicles each is 2-5 mm d^ameler on the surface. She indicated that her main aim is getting pregnant. Body mass index 37 kg/m2

Which of the following is the initial step in management?

A 43-year-oJd-woman has fever, night sweats and weight toss. She has tost 12 Kg in the last 3 month (unintentional). She had no contact with a tuberculosis patient. On examination, she has bilateral cervical lymph nodes, largest 3 cm X 2 cm. There is also inguinal tymphadenopathy

and the spleen is palpable 3 fingers below the costal margin.

A 15-year-old unmarried girl presents with history of pain during menstruation. Her menarche was at age of 13 and menses are regular. Physical and pelvic examinations are normal for her age

Which of the following is the most appropriate management?

A 17-year.old woman comes at 39 weeks' gestation to the Emergency Department with no previous antenatal care. She delivered a healthy baby boy normally with no complications reported. Then she was given an injection of RhoGAM. What is the indication of RhoGAM?

25-year-oid woman complained of crampy, lower abdominal pain that occurs during the first day of her menses and usually improves by the third day Her periods is regular and all clinical assessment and pelvic ultrasound within normal

Which of the following most likely explains her clinical presentation?

A nulliparous woman is admitted to the hospital at 42 weeks' gestation fo< inducbon of labour with cervical prostaglandin gel. On admission, a pelvic examination shows the cervix is closed, thick and posterior faang. A non-stress test shows the fetal heart rate is 130-140 beats per minute with good variability. There are 3 accelerations and 2 fetal movements during the examination 1 hour after applying the prostaglandin gel, the fetal heart tones are 80 beats per minute and the contractions last for two minutes

Which of the following intervention is the most important?

A 14-year-oid healthy girt has painless vaginal bleeding occurring at interval of 3 weeks to 2 months. The bleeding usually lasts 2 to 4 days, not preceded by premenstrual symptoms and not associated with clots Review of systems Is nol significant. Physical exanmation shows a normal appearing pubertal girl along with normal development of secondary sex characteristics (see lab results)

Test Result Ncxmal Values

Hemoglobin 120112-165 g/L

RBC 6 4 6-4.8 x 1012/L

WBC 4.8 4.5-10.5 x 109/L

Platelets count 220 150-400 x 109/L

Pregnancy test Negative

Which of the following is the most appropriate management?

A 17-year-old man with no previous medical history, presented with 3-weeks history of bloody diarrhoea. He reported frequent urges to defecate, associated with mild lower abdominal cramps. He had experienced similar attacks in the past, but milder associated with bloating and loose stool, wtiich was mucus with few blood drops Abdominal examination was soft with mild tenderness at left lower quadrant but no guarding

Blood pressure 110/70 mmHg

Heart rate 76 'mln

Temperature 36.6 °C

Oxygen saturation 95 %

Which of the following is the most likely diagnosis?

A 78-year-old man was admitted to hospital with lethargy and back pain. He had a history of type 2 diabetes mellitus and rheumatoid arthritis (see lab results).

Test Result Normal Values

Calcium 2.72 2.15-2.62 mmol/L

Creatnine 196 44-115 pmol/L

Urinary protein: creatinine ratio 154 mg/mmol (<30)

Which of the following is most likely diagnosis?

A 25-year-old woman in her first trimester of pregnancy has come for a routine prenatal visit. She used to smoke one pack of cigarettes per day. and is now being advised to quit smoking.

Which of the following is the greatest risk to her untx)m child?

A 20-year-old pregnant woman presented with loss of fetal movements, followed by decreased urinary output and difficulty breathing (see lab results and report).

Test Result Normal Values

Hb 100 120-160 g/L

DLCO 70 75-140%

Platelets count 75 150-400 x 109/L

Creabnine 105 44-115 pmol/1.

Prothrombin time 24 10-13 sec

APTT 60 30-40 sec

Fibrinogen 1.6 2-4 g/L

Chest X-ray:

Diffuse ground glass opacities

Which of the following is the most appropriate diagnosis?

A 36-year-cMd woman presented with 2-year history of recurrent headaches. These headaches occur 3 to 4 times per month and last 12 to 24 hours. The headaches are usually located over the right or left frontal sinuses. This particular headache has lasted 2 days now. and she has some nausea associated with it. The patient has been using an over-the counter analgesic­decongestant combination without significant relief. Neurological examination is within normal limits. The optic fundi are normal.

Blood pressure 110/70 mmHg

Head rate 76 /min

Temperature 36.6 °C

What is the appropriate next step to determine the etiology of this headache?

A 23-year-old pnmigravida presented in labour. The mid wife advised mediolateral episiotomy during the 2nd stage of labour.

What is the advantage of a medioiaterai episiotomy?

A 49-year-oid smoker man has type 2 diabetes meilrtus. morbiQ obesity and a recent diagnosis of symptomatic peripheral arterial disease. He is started on atorvastatin (Lipitor), offered a supervised exercise program and discussed smoking cessabon and interventions.

Which of the following should be recommended to prevent cardiovascular events?

A primigravida at 37 weeks gestation known to have bicornuate uterus complains of subcostal discomfort and fetal kicking Is appreciated In the lower abdomen mainly. Leopold maneuver; shows global soft presenting part with sluggish ballottement by first and second pelvic gnps Fetal heart detected at the level of maternal umbIHcus.

What is the recommended method of delivery If this fetal presentation persisted?

A 25-year-oid nulliparous woman at 37 weeks' gestabon presents to the hospital with regular contractons and spontaneous rupture of membranes. A pelvic examination shows cervical dilation of 6 cm and 90% effacement. Fetal heart rate 130-140 bpm with good variability. Ultrasound examination shows the fetus in a tweecti position and the patient is admitted for a caesarean section.

When would be the optimal time to administer intravenous antibiotics?

A 34-week pregnant woman presents m labor with contractions occurring every 4 minutes, she also has vaginal bleeding which is heavier than normal menstrual flow The fetus is in a back­down position, transverse He. and the cervix is dilated 3 cm wilh bulging membranes. The fetal heart rate is 170 bpm. The sonography showed a posterior fundal placenta with a retroplacental sonolucent area.

Which of the following Is the most appropriate initial management?

A 29-year-o4d woman G7 P5015 is admitted at 30 weeks’ gestation in labor room with leaking liquor for observation

Which of the following most likely confirm the diagnosis?

A 77-year-oid man vzith poorly controlled hypertension presents with a 6-months history of fatigue and dyspnea on exertion. He denies edema, orthopnea, chest pain and palpitations. His only medication is hydrochlorothiazide (25 mg) once daily. On examination, he has a grade 2/6 midsystolic ejection murmur, which is loudest at the right upper sternal border. An S4 is heard at the apex, there is no S3. His lungs are clear and there is no peripheral edema

Which of the following is the most likely diagnosis?

A young couple has been trying to conceive a baby for 6 months with no success. The wife has regular cycles every 23 days and 4-day periods.

Which of the following is most appropriate investigation?

A 30-year-old woman P1 +0 presented to Obstetrics and Gynaecology Clinic complains of inability to conceive fo» the last 3 years. During that time, she was not on contraceptive and her menstrual periods every 45 days but no penod for the last 6 months (see lab results). Test Result Normal Values

Thyroid-Stimulating Hormone 9.2 pU/L 0.4 • 5.0 pU/L Follicular phase 5-20IU/L

Follicle-stimulating hormone 5.3 pU/L Luteal phase 5-15 IU/L

Postmenopausal women 50-100 IU/L

Men 5-20 IU/L

Men 3-15 U/L

Luteinizing hormone 7.2 jjU'L Follicular phase 5-22 U/L Luteal phase 5-22 U/L

Ovulatory phase 30-250 U/L

Postment^ausal Women > 30 U/L

Prolactin 140 ng/ml < 25 ng/ml

Which of the following is the most likely diagnosis?

A 55-year-oid man has congestive heart failure due to left ventricular systolic dysfunction He has no history of medications allergy or interadion.

Which of the following is the best first-line treatment option?

An 81-year-okl man with memory loss and difficulty recognizing his grandsons He has no

cardiovascular risk factors

Which of the following is the most common cause of his cognitive impairment?

A 24-year-old nulliparous woman presents to the Maternal Health CJinic in the evening at 34 weeks' gestation and complaining of decreased fetal movement. She says she had been at work all day and then came directly to the hospital when she noticed that the baby has not been moving as much as usual. There has been no leaking of amniotic fluid. There are no uterine contractions and also no vagmal bleeding.

Which of the following is the most appropriate next step In management?

A 35-year-old pregnant woman at 34 weeks of gestation presented with labour pains. On physical examination, the cervix was 4 cm dilated. Cardiotocography was performed (see image).

Blood pressure 135/88 mmHg

Heart rate 89 /min

Respiratory rate 18/min

Temperature 37.4” C

Which of the following is the most likely diagnosis?

A 35-year-oid woman delivered her fifth baby by vacuum extraction due to prolonged second stage of labor 3 months ago. The woman was complaining of leakage of urine when she coughed, sneezed or laughed The symptoms have started after delivery and persisted since then.

Which of the following is the most likely diagnosis?

A 30-year-oid woman presents to the Women’s Health Clinic after a spontaneous rupture of membranes occurred at home 1 hour before Patient medical records indicate a positive history of recurrent vaginal herpes simplex.

Which of the following is the next best step In management?

A 24-year-oid married nulliparous has an 18-month history of cyclic, debilitating pelvic pain related to menses which are regular and heavy requiring 10-15 thick pads on the days of heaviest flow. For the past year, the patient has been engaging in regular intercourse without contraception In an attempt to conceive. Pelvic examination showed normal-size, immobile, relroverted uterus with nodularity and tenderness on palpation of the uterosacral ligaments.

Which of the following is the most likely diagnosis?

A 24-year-old woman presents to the clinic with complaining of failure to conceive for more than 2 years of regular trials. Patient has history of irregular periods occurring once every 6 to 7 weeks and is usually scanty (see report).

Body mass index 35 kg/m2

Transvagmal ultrasound.

Revealed the presence of multiple small cysts; each is 3-5mm, lining the ovanan periphery,

representing pearl necklace appearance.

Which of the following is the most likely factor contributing to her infertility?

25-year-oid woman complained of recurrent behavioral symptoms that stalled few days before her menstrual cycles and usually disappeared around the second day of the cycle. These symptoms have led to reduced work productivity, increased work absenteeism, and increased visits to ambulatory healthcare.

What is the most common affective or behavioral symptom for her diagnosis?

A 60-year-oid man, with type 2 diabetes, presents with persistent diffuse neck pain for the past hour, diaphoresis, shortness of breath, a normal troponin I level, and an electrocardiogram that reveals only nonspecific ST-segment and T-wave changes

Which of the following is the most appropriate next step in management?

A 22-year-otd woman with chronic diarrhoea and malabsorption ：s suspected of having coeiiac disease, a jejunal biopsy taken.

Which of the following histological finding is expected?

A 20-year-old man with a history of high liver function test in the past presents, with tremors and dysarthria and dyskinesia. Slit-lamp examination reveals a greenish-brown ring at corneoscleral junction.

WhIch of the following is the most likely diagnosis?

A 30-year-old para 1 woman presents to the Maiernal Health Clinic at 20 days postpartum She has delivered a full-term girl vagmally by forceps-assisted delivery. The weight at birth is 3.54 kg. She presents with a yellow-white colored vaginal discharge. The discharge is odorless ana there is no itching or discomfort. An examination shows a pink cervix and absence of uterine tenderness. A microscopic analysis of the vaginal fluid is positive few leukocytes and epithelial cells.

Which of the following is the most appropriate management?

A 65-year-oid-woman has decreased concentration (see lab results).

Test Result Normal Values

Hb 89 130-170 g/L (Male)

120-160 (Female)

MCV 106 80-95 fl

Platelets count 129 150-400 x 109/L

Vrtamin B12 (Women) 0.46 0 12-0 66 nmol/L

Folic Add (Women) 0 03 <0.1 pmol/L

Which of the following would be found on further testing?

A 20-year-o!d woman presented to the Maternal Health Clinic with severe facial acne and irregular menstrual bleeding. Examination shows fine hair growth on the chin, upper back.

breasts and tower abdomen. A pregnancy test is returned negative. She retirns to the ciinic on the 5th day of her menstrual cycle and has a serum sample drawn for analysis (see lab results). Test Result Ncwmal Values

Follicle-stimulating hormone 10 5-20 IU/L

Luteinizing hormone 28 5-22 U/L

Prolactin 890 < 870 pmol/L

Testosterone 3 2 0.7-28 nmoVL

Which additional laboratory values should be obtained?

An 18-year-oJd-txjy is receiving chemotherapy for acute lymphoblastic leukemia On day 17 of chemotherapy, he has fever. He has no focus of infection (see lab results).

Heart rate 110/min

Temperalure 38.9 °C

Test Result Normal Values

Platelets count 25 150-400 x 109/L WBC 0.6 4.5-10.5 x 109/L

Neutrophils 60 40-60% Lymphocytes 20 20-40 %

Which of the following is the most approptiate management?

A 59-year-oia woman comes to the clinic with headaciie. dyspnea on exertion and occasional palpitations (see lab results).

Test Result Normal Values

Hb 95 130-170 g/L (Male)

120-160 g4. (Female)

MCV 68 80-95 fl

Platelets count 530 150-400 x 109/L

Total iron binding capacity 30 11.6-31.3 pmol/L (Male)

9-30.4 pmol/L (Female)

Ferritin 3 20-300 pg/L (Male)

20-120 pg/L (Female)

Which of the following is the most likely diagnosis?

A 45-year-oid woman presents to the Gynaecological Clinic with history of genital warts that were treated by electrocautery 2 years back The woman complained of recurrent occurrence of scanty fresh bleeOing after intercourse.

Which of the following is the likely source of her bleeding?

A 30-year-oia woman G2P1001 at 32 weeks’ gestation Is admitted to labor and delivery complaining of lower abdominal and back pain She has a significant previous history of severe

preeclampsia (see lab results).

Blood pressure 140/90 mmHg

Test Result Noimal Values

Platelets count 80 150-400 x 109/L

Uric Acid 460 140-360 pmol/L

Which of the following findings would indicate severe preedampsia^?

A 33-year-oid woman presented to the Emergency Department with severe lower abdominal pain On examination, abdomen was diffuse tenderness, more ^n the lower quadrants Bimanual pelvic exam showed bilateral adnexal masses and palpable A diagnosis of bilateral tubo-

ovarian abscesses was entertained.

Blood pressure 130/70 mmHg

Heart rate 100/min

Respiratory rate 22 /mm

Temperature 39.9° C

Which of the following is the most appropriate next step in management?

A 43-year-cMd woman gravida 2 para 2 has had oligoovulation due to policystic ovary syndrome and used cyclic progesterone for withdrawal bleeding. Approximately 5 years ago. she discontinued taking progesterone

Which of the following risks is increased?

A 33-year-o»d woman presents with a history of amenorrhea for a year following dilatation and curettage because of abnormal uterine bleeding. She underwent to both progesterone and combined estrogen and progesterone withdrawal tests with no response Her serum FSH level was normal

Which of the following syndromes is the most likely diagnosis?

A 65-year-oid man wt)o is asymptomatic and has no known al:erg:es is seen for a general examination

What is the best approach for pneumococcus immumzatton?

A 61-year-old man complains of shortness of breath. He has a history of hypertension, type 2 diabetes and hyperlipidemia He was a smoker for more than 30 years but he quit 4 years ago On physical examination, he is not in respiratory distress, but he has diffuse wheezing bilaterally over lower lobes of his lungs His cardiac examination demonstrates an S4 and distended jugular veins.

WhIch of the following is the best treatment to relieve his symptoms?

A 21-year-old woman G2 P1001 presents to the Emergency Room with a severe lower abdominal pain for 1 day Pain is dull and intermittent that last for 10-15 minutes and associated with nausea and vomiting. Examination confirms tenderness and guarding in the lower abdomen, it is more on right side and slight fullness in the right iliac fossa (see report).

Blood pressure 90/60 mmHg

Heart rate 110'mln

Respiratory rate 13/min

Temperalure 37.6° C

Pregnancy Test:

Negative.

Which of the following is the most likely diagnosis?

26-year-old nulliparous patient presented to the clinic with vaginal itching and increased vaginal discharge. She had been diagnosed with a positive pregnancy test 3 months ago. A pelvic examination showed a yellow-white discharge at the vaginal introitus. The labia were inflamed and covered with scratch marks. The vaginal discharge was fishy smell pH 4.8. Which of the following is the most appropriate treatment?

A 38-year-old woman has fever and headache for 2 days. Peripheral smear done (see image and lab results).

Heart rate 110/min

Temperature 38.9 ^VC

Test Result Normal Values Hb 112 130-170 ga. (Male)

120-160 g4. (Female)

Reticulocyte 3.2 0.2-1.2%

Platelets count 123 150*400 x 109/L

Fibrinogen 1.1 2-4 g/L APTT 68 30-40 sec INR 1.8 0.8-1.2

Prothrombin time 24 10-13 sec

Direct bdirubin 24.5 1.5-6.5 pmol/L

Total Dilirubin 48.3 3.5-16.5 pmol/L

Lactate dehydrogenase 390 60-160 IU/L

A 28-year-old woman is diagnosed with an ectoptc pregnancy.

Which of the following is the most likely predisposing factor?

A woman presents at her 9th week of pregnancy with severe vaginal bleeding, lower abdominal pain and passage of the fetus through the vagina. On vaginal examination; cervix is open and tissue seen in the cervix.

Which of the following the most appropriate management?

A 47-yearo!d woman, poorly controlled diabetic, complains of polymenorrhagia every couple of weeks.

Body mass index 37 kg/m2

Which of the following Is most appropriate investigation to establish the diagnosis?

A 22-year-old married woman has had severe, recurrent depression associated with multiple suicide attempts. She has been stabilized tor the past 3 months on paroxetine and is now pregnant

Which of the following is the most appropriate management?

A 28-year-old gravida 3. para 2 presents to Obstetric Triage Unit at 37 weeks* gestation following spontaneous rupture of the amniotic membranes confirmed Dy physical examination. On adm-ssion to labour and delivery room she was complaining of abdommel pain. Digital examination shows a cervical dilation of 4 cm and 80% effacement with the presenting[Mrl at 0 station.

CTG Is reactive with baseline fetal heart of 170 bpm

Blood pressure 138/78 mmHg

Heart rate 111 /min

Respiratory rate 24 /min

Temperature 38.4º C oral

Which of the following Is the next step in management?

A 30-year-old woman presents to the Gynaecology Clinic with diffuse lower right-sided abdominal pain and low back pain that has been progressively worsening for the past month. The pain intensity wcxsens after sexual intercourse. Patient menstrual periods occur irregularly and with heavy bleedmg. Palpation reveals a tender mass in the lower right quadrant Ultrasound pelvis scan shows a 9X9 centimetre heterogeneous mass filled with a calcifications.

Which of the following Is most appropriate method of treatment?

A 38-year-old woman G3 P2002 at 34 weeks' gestation is admitted to labor and delivery complainmg of headache, epigastric pain and blurred vision. Non-stress test is reassuring

Blood pressure 170/120 mmHg

Which of the following is the most appropriate management?

A 75-year-oid man comes to the clinic with hypertension and gradual loss of cognitive function. He has predominant executive function impairment (see report) MRI:

Reveals diffuse penventricular white-matter hypenntensities.

Which of the following is most likely diagnosis?

Which of the following physical maneuvers Is most likely to assist the nsk of future falls for a healthy 68-year-old man?

A 28-year-oJd woman G 4 P2012 immigrant presented to the Maternal Health Clinic at 20 weeks' gestation with a cough and night chills for the past month. The cough is productive and produces thick sputum. She had been prescribed treatment by a general practitioner for the cxxjgh and il had not responded to treatment Patient nail beds and conjunctiva appeared pale and the cervical lymph nodes are palpable. Auscultation of the chest shows crepitation over the upper left lobe. She had received a BCG vaccine as a child. A Blood test is positive for mterferon-gamma release assays.

Blood pressure 110/70 mmHg

Heart rate 84 /min

Respiratory rate 18/min

Temperature 37.5° C oral

Which of the following is the next best step in obtaining a definitive diagnosis?

A 38-year-old G9 P8008 woman presented at 38 weeks gestation in labor and diagnosis of prolonged 2nd stage of labor was entertained and finally delivered 4.3 Kg baby by vacuum extraction. Anticipated management was taken because of risk of postpartun hemorrhage and hypovolemic shock

Which of the following is considered a best reliable indicator of above complications?

A 45-year-oid woman comes to the clinic complaining of loss of appetite, bloating and abdominal pain. Clinical assessment and investigations confirmed the presence of moderate ascites, pleural effusion and bilateral ovarian masses. Cancer antigen 125 (CA 125) was 100 unit/ml.

Which investigation is the most helpful in making a diagnosis?

53-year-oia woman has missed her period over the last 12 months. Which of the following hormones is likely to be altered as a result of the condition?

A 24-year-old woman presents at 7 weeks' gestation complaining of mild vaginal bleeding and lower abdominal pain colicky in nature. Upon examination; normal vital signs and speculum examination shows the cervix is closed and fresh bleed coming through the cervix.

Which of the following is the most likely cause of the bleeding?

A 35-year-o!d nulhparous woman presents to the Maternal Health Clinic at 24 weeks’ gestation. The significant medical history includes insulin-dependent diabetes class F with nephritis. Additionally, she has chronic hypertension which is controlled with medication. The pregnancy has Deen uncomplicated so far. The uterine fundus measured 25 cm above the symphysis and fetal heart tones show a baseline of 160 beats per minute.

Which of the following complicatons is most likely to occur?

A 28-year-oid woman G5 P3013 is seen in the Antenatal Clinic. Her previous pregnancies were term normal deliveries. Currently, she is 10 weeks’ gestation confirmed by a pregnancy test and

ultrasound examination.

Which of the following Is the most Important purpose of the first antenatal visit?

A 30-year-o)d woman G2 P2002 at 32 weeks' gestation presents to Emergency Department complaining of tower abdominal and back pain, which has increased in frequency and intensity over the last few hours. Abdominal examination shows fundal height equals to 32 cm, longitudinal lie fetus and cephalic presentation. Fetal heart was positive and cardiotocography is reactive with 2-3 uterine contractions per 10 minutes. Vaginal examination shows 1 cm dilated cervix, 70% effacement, -3 station and cephalic.

Which of the following is the most appropriate step in management?

A 26-year-old woman G2 P1001 admitted to the hospital in active labor and ruptured membranes at 38 weeks of gestation. Upon vaginal examination, the cervix was 6 cm dilated and 1 cm long. The otbital ridge and orbits, saddle of the nose, mouth, and chin were palpable.

What is the scientific term for this fetal presentation?

A 32-year-old primigravida at 34 weeks’ gestation presents for urgent care after falling down a flight of stairs. The patient complains of uterine tenderness and reduced fetal movement in the

45 minutes since the fall. There has Deen a small amount of dark red vaginal bleeding. The fetal heart monitoring revealed a heart rate of 150 bpm with inegular uterine contractions every 3 to 4 minutes. Her pregnancy has been uncomplicated. She has positive history of cigarettes smoking.

Which of the following is the most likely diagnosis?

A 28-year-old woman G3 P0020 at 5 weeks’ gestation presents with vaginal bleeding associated with some blood clots that has started 3 hours ago. She had Deei diagnosed with cervical incompetence in her 2 prior second-trimester abortions. A history of dilatation and curettage in her last abortion declared On examination; the cervical os is open and no on-going bleeding.

Which of the following is the most likely cause of her current diagnosis of vaginal bleeding?

A 48-year-old woman nulliparous presented to the Emergency Department v»ith heavy vaginal bleeding associated with sl»ght dizziness. No other significant past medical history except heavy menstruation in the past tew months. The examination was normal apart fron the presence of a large amount of blood in the vaginal vault (see lab results) Supine

Blood pressure 110/70 mmHg

Heart rate 90 /mln

Standing

Blood pressure 104/66 mmHg

Heart rate 100 /min

Temperature 36.6° C

Test Result Normal Values Hb 10 120-160 g/L

Pregnancy test -ve

Which of the following is the first step in management?

A paediatrician is called to attend a caesarean section delivery of 38 week's gestation baby. On delivery, the neonate does not cry immediately, appears cyanotic and floppy. After drying, suctioning and stimulating the baby under the radiant warmer, the following evidence is recorded at 5 minutes (see table).

Heart rate 120 beats per minute

Breathing Irregular, gasping

Reflex irrrtaDility Coughs, and cries with stimulation

Activity Arms and legs flexed, little movement

Appearance Rosy with blue extremities

What is the most accurate Apgar score?

A 23-year-oid woman G3 P02002 at 20 weeks' gestation with history of previous 2 preterm deliveries attends Antenatal Clinic. Current pregnancy is uneventful. An ultrasound shows size correspond to date, anterior placenta and cervical length is 30 mm

Which of the following is the most appropriate intervention?

A 35-year-oid healthy woman attended the Gynecological Clinic for her regular Pap smear screening. Upon speculum pelvic examination, the uterine cervix appeared raised irregular mass measuring 10 X 12 mm localized on the cervix left lateral aspect.

Which of the following is the most appropnate next step?

A 62-year-old woman has atrial fibrillation for which she has started on warfarin. Few weeks after, she fell down and developed a subdural hematoma that requires evacuation (see lab result).

Test Result Normal Values

INR 3 9 0.8-1.2

Which of the following is the most appropriate management?

45-year-oid woman has undergone a total abdominal hysterectomy and bilateral salpingo-

oophorectomy for a benign reason. Immediately post operation. she started to have acute vasomotor symptoms. Accordingly, she was counselled for hormone replacement therapy and

agreed.

Which of the following is the most appropoate honnone replacement therapy regimens?

A 16-year-old presented to the clinic for evaluation of primary amenorrhea. Examination showed normal adult-size breasts. But coarse pubic and axillary hair (see lab result). Test Result Normal Value

Testosterone 13.86 0.7-2.8 nmoVL

which of the following is the most likely diagnosis?

A prlmigravida at 37 weeks gestation known to have bicornuate uterus complains of subcostal discomfort and fetal kicking is appreciated in the lower abdomen mainly. Leopold maneuver; shows global soft presenting part with sluggish Dallottement by first and second pelvic gnps. Fetal heart detected at the level of maternal umbilicus.

Which of the following is the most likely fetal presentation?

A 40-year-oid woman has )ust delivered her 7th child at 38 weeks with 4 kg baby boy vaginaily 10 minutes ago The placenta is still in place and she starts to bleed profuse y The estimated amount of blood loss visually is around 800 ml.

Which of the following best describes this case?

28-year-oia woman at 24 weeks' gestation presented to the clinic for a routine examination. A pelvic examination showed a watery grey-colored discharge, fish-like smell. There were no signs of Inflammation of the vagina or cervix. She reported some itching and moderate discomfort. The vaginal pH 5.1. A sample of the vag nal discharge was collected for analysis.

Which of the following is the most likely finding?

A 25-year-old woman G5 P2022 presented to the clinic at 10 weeks' gestation with painless vaginal bleeding. Dunng her hospital admission, she developed heavy vaginal bleeding and lower abdominal pain. She has notced passage of Ussue. On examination, mild pain, vital signs normal. Pelvic examination showed trickling Blood through cervix and os is open.

Which of the following is most likely diagnosis?

A 39-year-old woman, who is a mother of 3 children and has completed her family, she is a known case of endometrioma in the right ovary that has Deen removeti 2 years ago. She came to the clinic complaining of mild to moderate dysmenorrhea and deep pain during intercourse along with her chronic lower abdomen pain.

Pelvic ultrasonography revealed the presence of left ovarian cyst measuring 6X7 cm that appeared to De an endometriotic cyst.

Which of the following is the most appropnate next step?

A 24-year-old woman is complaining of failure to conceive over the last 16 months despite regular inlercourse She has infrequent menstruation occurring once every 6 to 8 weeks, with increased facial hair and acne. On ultrasound, her ovaries had multiple small follicles each is 2-5 mm in diameter on the surface.

Body mass index 37 kg/m2

Which of the following is the most likely diagnosis?

A 30-year-old woman with a history of infertility for 6 years complains of severe dysmenorrhea unrelieved by naproxen.

Which of the following is the most likely diagnosis?

A 28-year-oid woman with mild intermittent asihma presents to the Health Clinic at 24 weeks' gestation and says that her symptoms have worsened as the pregnancy progresses Prior lo the pregnancy, she had an occasional exacerbation of asthma and used only an albuterol inhaler for treatment as needed. However, she now complains of daily symptoms and once per week symptoms at night time. A forced expiratory volume in 1 second test shows 70% of normal.

Which of the following medication regimen is now most appropriate?

A 53-year-o!d woman admitted to the hospital with pneumonia She has diabetes, hypertension and is on hemodialysis for end-stage renal disease (see lab results).

Test Result Normal Values

Hb 98 130-170 g/L (Male)

120-160 gfL (Female)

Platelets count 151 150-400 x 109/L

APTT 33 30-40 sec

INR 0.9 0.8-1.2

Prothrombin time 9.8 10-13 sec

Creatinine 460 44-115 pmol/L

Which of the following is the most appropriate venous thromboembolism prophylaxis for this patient?

A 23-year-oid woman presented with breast tenderness, abdominal bloating, and food cravings She has a 6-monih history of tiredness, anxiety, emotional lability, Oifficulty concentrating and insomnia There are no menstrual irregularities or prodromal life stressors The symptoms recurred on a regular basis during the week leading up to the menstrual period but completely resolve within the first 3 days of menses The patient felt totally incapacitated when symptomatic, and the symptoms adversely affect personal and professional life.

 Which of the following is the best-evidenced treatment?

A 26-year-oid multiparous woman in labor is requesting pain relief. While in the lithotomy position, the obstetrician performs a puOendal nerve block, and injects a local anesthetic into the sacrotuberous ligament close to the ischial spine.

Which of the following structures will remain fully sensitive despite this pudendal nerve block?

A 25-year-old woman came to the clinic for an advice. She planning to get pregnant; she is a known case of distal ulcerative colitis diagnosed 3 years ago on 3 grams of mesalamine granules. Her last exacerbation was a year ago required a short course of steroid. Currently she has a 2-3 bowel motions a day. occasionally seen a streaks of blood once every 4-5 weeks. Her latest fecal calprotectin is 90 (normal 0-50)

Which one of the following is the most appropriate advice?

32-year-old woman presents with smelly vaginal discharge associated with intense itching. Her husband has history of slight urethral discharge. A pelvic examination confirmed strawbeny spots on the cervix.

Which one of the following is the most appropriate treatment?

A 79-year-oid man comes to the clinic for a follow-up He has a 1-year history of progressive memory Impairment and dlnical evidence of early Alzheimer dementia

Which of the following Is the most appropriate initial diagnostic tests?

A 77-year-old woman with stage 3 chronic kidney disease and pain from osteoarthritis of the first carpometacarpal Joint.

Which of the following is the best Initial treatment for her pain?

A 46-year-old man comes to the clinic with dyspnea on exertion and palpitations. On examination, he has patches of vitiligo (see lab results). Test Result No<mal Values

Hb 89 130-170 g/L (Male)

120-160 g4_ (Female)

MCV 103 80-95 fl

Platelets count 128 150-400 x 109/L

Ferritin 105 20-300 pg/L (Male)

20-120 pg'L (Female)

Vitamin B12 (Men) 122 160-900 ng/L

Folic Aod (Men) 8 <4 pg/L

Which of the following is the most appropriate test to be ordered next?

A 40-year-oid woman complains of Post-coital bleeding. Speculum examination reveals cervical mass.

Which of the following is the most appropnate next investigation?

A 23-year-old nulligravida patient complains of inability to become pregnant after 3 months of trying. Patient periods are regular and normal. She had no prior reproductive problems. She currently is not on any contraception. Examination is normal. Her husband is 25-year-old healthy and has one autistic cousin and one with tnsomy 21.

Which of the following is the best action?

A 55-year-oid woman comes to the Gynaecology Clmic complaining of a mass protruding through her vagina when standing for quite sometimes especially during cough and straining. She has 7 children that were delivered vaginally. The last delivery was complicated Dy prolonged second stage and ended up with vacuum extraction delivery of a 4.2 Kg baby.

Which of the following is the most appropriate next step?

A 24-year-oid married woman presented to the clinic with severe abdominal pain followed by vaginal bleeding, for the last 6 hours Patient's LMP was 8 weeks ago. On examination; she is drowsy and has a tense abdomen.

Blood pressure 90/60 mmHg

Heart rate 120 /mln

Respiratory rate 20 /min

Temperature 36.8 ⁰ C

Which of the following is the most likely diagnosis?

A 27-year-old nulliparous is concerned about not having conceived after a year of regular, unprotected intercourse. The patient denied any major medical illnesses and takes no medications. The patient’s spouse is reported to De healthy but has never fatiered a child.

What is the most appropriate initial step in evaluation after histexy and examination?

A 55-year-o(d man presents to the dinic with history of atrial fibrillation. What is the drug of choice to prevent complications of his condition?

A 76-year-oid woman with a history of hypertension and osteoporosis presents to the clinic for preoperative clearance for an upcoming eye surgery She complains of progressively worsening fatigue over the past 8 to 10 months. She states she often feels dizzy but denies syncope. Her

current medications include alendronate and hydroctilorothiazide.

Which of the following is the most appropriate action?

A 32-year-old woman G3 P2002 presented at 3B weeks’ gestation to Antenatal Clinic. She has had history of 2 previous normal deliveries of 3 Kg babies. Current pregnancy, fetus found to be breech In presentation The patient was counselled and consented for external cephalic version On the scheduled day. an estimated fetal weight is 2.6 Kg by ultrasound, flexed fetal head, and uterus is bicomuate with average liquor measured.

Which of the above findings is contraindicated external cephalic version?

A 31-year-old man complains of persistent watery diarrhoea and has noticed some weight loss. He returned 5 weeks ago from Egypt. He submits a stool sample that came back negative

Which of the following is the most likely diagnosis?

A 33-year-oid pregnant woman G4 P2012 al 38 weeks' gestation presented with a complaint of dizziness, light-headedness and fainting sensation especially m bed for 2 weeks duration (see lab results).

Blood pressure 110/70 mmHg

Heart rate 100 /min

Respiratory rate 24 /min

Temperature 36.6º C

Test Result Normal Values

Hb 95 120-160 g/L WBC 9 4.5-10.5 x 109/L Platelet count 200 150-400 x 109/L

Which of the following is the best management?

A 56-year-o；d man has a low-pitched diastolic rumble heard at the apex, a widened pulse pressure and a grade 3/6 diastolic decrescendo murmur at the left sternal border.

 Which of the following Is the most likely diagnosis?

A 32-year-o»d multiparous woman is admitted for indudon of labour at 41 weeks and 2 days' gestation. She had prior 2 uneventful vaginal deliveries. A pelvic examination shows the cervix is dilated at 2 cm and is 50% effaced with a medium consistency and mid-anterior position. The presenting part is at -2 station.

Which of the following methods would be most appropriate for labour induction?

A 26-year-oid woman had 2 episodes of syncope in the past 2 months during micturition and coughing. Physical examination and electrocardiogram are unremarkable.

Which of the following is the most appropriate management options?

A 77-year-dd man wilh a 7-years history of Parkinson d sease reports hallucinations, confusion and worsening motor function. On physical examination, he is akinetic and rigid with no tremor He has prominent gait disorder and postural instabilrty.

Which of the following symptoms is most strongly associated with an increased risk for demeniia?

A prirj^ravida woman at 32 weeks' gestation brought to the Emergency Room with vaginal Bleeding and abdominal pam. On examination: Fundal height equals to 30 weeks and atxlomen is tense. Cardiotocography revealed fetal tachycardia, reduced variability and late decelerations. Which of the following is the most likely diagnosis?

A 48-year-otd man presents wlih central and severe chest pain, which started around 1 hour ago There Is no radiation of the pain or associated shortness-of-breath. He has had some similar fleeting pains over the past 2 weeks txjt these settled spontaneously after a few seconds.

Which of the following is the most likely diagnosis?

A 59-year-dd man has diabetes, hypertension, dyslipidemia and chronic renal impairment. He was admitted 5 days ago to the Coronary Care Unit for a non-ST-elevation myocardial infarction (NSTEMI). He is receiving unfractionated heparin. His labs upon admission were normal. Day 5

of his admission, labs as shown (see lab results).

Test Result Normal Values

Hb 13.1 130-170 g/L (Male)

120-160 g.'L (Female)

Platelets count 65 150-400 x 10ft'L

WBC 10.3 4.5-10.5 x 109/L

Creatmine 88 44-115 pmol/L

APTT 36 30-40 sec

INR 1.1 0.8-12

Prothrombin time 11 10-13 sec

Which of the following is the most likely cause of his thrombocytopenia?

A young pnmigravida presents with significant edema of the lower extremities and hands. The patient was admitted for evaluation and management.

Blood pressure 150/95 mmHg

Hear! rate 76 'min

Respiratory rate 18/min

Temperature 36.6“ C

Which of the following would be the most appropnate management?

A 76-year-old man v/ith chronic obstructive pulmonary disease (COPD) comes to the dinic for a follow-up. He Is currently taking salmeterol, using albuterol rescue inhaler 2 to 3 times per day for the past 3 months. He has been hospitalized for COPD exacerbations twice in the past 6 months. Which of the following medications should be added to the maintenance regimen?

A 22-year-old woman with vasovagal syncope comes to the clinic. She has a normal physical examination and a normal electrocardiogram.

Which of the following management approaches is most appropriate’?

A 48-year-oid obese woman complains of nausea. Patient LMP was 2 months ago She is using barrier method (condoms) as a birth control method. Examination is normal except for a slight dusky discoloration of her cervix.

Which of the following is the next step m management?

A 78-year-old man presents with a 10-day history of intermittent colicky abdominal pain. The pain is low. central and seems to De worse after eating. He has no associated fever or vomiting but does feel nauseated when the pain is present. He says that prior to this episode he had hard stools once or twice a week that were difficult to pass. For the past several days, he has had only watery stools, several times a day. On examination, there is fullness in his left lower quadrant with nonspecific tenderness diffusely and no guarding or rebound. A urine dipslick is normal.

Which of the following is the most likely diagnosis?

Which of the following is the best exercise to improve lhe function ๙ a 68-year-old woman?

A 26-year-old woman presented to the clinic with secondary amenorrhea of 6 months duration. She gave history of breast tenderness. On examination: bilateral Breasl whitish discharge from

nippies. Her uiine pregnancy test was negative and elevated serum prolactin levels.

Which of the following radiological assessment Is most appropriate?

A 41-year-old patient presents to the Gynaecological Clinic with heavy bleeding. After a complete evaluation, the gynaecologist determines the patient has dysfunctional uterine bleeding.

Which of the following is the first step in management?

A 34-year-old woman with a history of prolonged QT syndrome presents with severe acute bacterial sinusitis.

Which of the following antibiotics should be avoided?

A 62-year-o4d woman presents with dysphagia Her symptoms were first noticed a few months ago and have steadily worsened. Initially she had difficulty swallowing solids but over recent weeks has also been having difficulty swallowing liquids. She lost 5 Kg over 5 weeKs. On examination, she looks thin and slightly pale.

Which of the following is the most likely diagnosis?

A 58-year-old man has chronic atrial fibrillation.

Which of the following Is this patient at increased risk for?

A 17-year-old man with no previous medical history, presented with 3-weeks history of bloody diarrhoea. He reported frequent urges to defecate, associated with mild lower abdominal cramps. He had experienced similar attacks in the past, but milder associated with bloating and loose stool, wtiich was mucus with few blood drops Abdominal examination was soft with mild tenderness at left lower quadrant but no guarding

Blood pressure 110/70 mmHg

Heart rate 76 'mln

Temperature 36.6 °C

Oxygen saturation 95 %

Which of the following is the most likely diagnosis?

An 81-year-old woman reports low back pain that began after a forceful coughing episode. Lumbar radiographs reveal features of a lumbar compression fracture

Which of the following is the most appropriate initial step in her care?

A 42-year-<Xd man presented with worsening pleuritic, positional chest pain. Examination revealed pericardial rub, a clear lung examination, and no evidence of lower-extremity edema ECG shows non-fliagnostic findings.

Which of the following is the most appropriate next step for diagnosis?

A 25-year-oid nulliparous presented with an 18-month history of cyclic and debilitating pelvic pain related to menses. Menses is regular and heavy, requiting 10-15 thick pads on the days of heaviest flow. The patient has been engaging in regular intercourse without contraception for 1 year in an attempt to conceive. Pelvic examination revealed a normal-sized, immobile, retroverted uterus with nodularity and tenderness on palpation of the uterosacral ligaments.

Which of the following would most likely help in the diagnosis?

A 38-year-old woman attended Outpatient Clinic complaining of fresh vaginal bleeding occumng after each intercourse. This problem has been disturbing her over the last 3 months. Upon examination, her speculum examination revealed normal cervix. The report of Pap smear is showing squamous cell carcinoma.

Which of the following is the most appropriate next immediate action?

25-year-old woman presented to the clinic with an unpleasant-smelling discharge. A speculum examination showed vaginal discharge, grey-green in color. The cervix was covered with papHlae with light-red color. A specimen of vaginal secretions was obtained for a wt-pcep microscopy which showed unicellular organisms with flagella.

Which of the following is the most appropriate management?

35-year-old woman G4 P2012 at 26 weeks’ gestation, uneventful pregnancy presented for a 50-gram oral glucose tolerance test. 1 hour later by finger stick sample glucose was 8.1 mmol/L.

Which vaginal infection is she at the highest risk of contracting?

A 75-year-old man has lung cancer comes to the clinic to manage his back pain. A month ago, his oncologist told him that the prognosis was poor and that he is unlikely to survive for more

than a year (see lab result).

Test Result Normal Values

Calcium ionised 3.2 1.1-1.3 mmoVL

Which of the following is the most appropiiate next step in management?

A 59-year-old man is admitted to the hospital with infero-lateral myocardial infarction.

Which of the following medications would improve his survival?

A 34-year-old woman piesented to the hospital 7 days before with nght-sided lower abdominal pain. In addition, she had slight bright red vaginal bleeding. A blood serum sample of B-human chorionic gonadotropin was 2900 lU/Liter. She was administered intramuscular methotrexate. A week later, she reported to the hospital with severe right-sided lower aDdominal pain. A blood serum sample of B-human chorionic gonadotropin was drawn and shown to be 6.000 lU/Liter.

Which of the following would be most appropriate?

A 28-year-oid pnmigravida 8 weeks gestation woman attended her first antenatal appointment During the history assessment, she reports that she never had chickenpox. A serum blood titer is drawn and is negative for antibodies

Which of the following is the next best step in management?

A multiparous woman presents to the Maternal Health Clinic at 37 weeks' gestation with regular contractons occurring every 2 minutes lasting for 45-60 seconds with moderate intensity. Last pregnancy ended up with low transverse incision caesarean section. She is now pregnant with twins. Twin A is breech and twin B is cephalic. There has been small amount of dear fluid leaking from the vagina for the past hour A nitrazme paper test turns blue-green in color Pelvic examination shows a cervical dilation of 4 cm and 80% effacemenl. The obstetrician informs her

that a caesarean section is necessary

Which of the following is the most likely reason for a caesarean section?

A 30-year-old woman G2 P2002 at 32 weeks’ gestation presents to Emergency Department complaining of tower abdominal and back pain which has increased in frequency and intensity over the last few hours. Abdominal examination shows funflal height equals to 32 cm, longitudinal lie fetus and cephalic preseniation Fetal heart was positive and cardiotocography is reactive with 2-3 uterine contractions/10 minutes. Vaginal examination shows 1 cm dilated cervix, 70% effacement, -3 station and cephalic.

Which of the following Is the next step to confirm the diagnosis?

A 24-year-oid primigravida is found during antenatal care at 22 weeks gestation to have a blood pressure of 140/95 mmHg in 2 different measurements documented 4 hours apart. Her urine test for protein was negative and she was asymptomatic.

Which of the following is the most likely diagnosis?

A 71-year-old man is referred to the Outpatent Clinic for advice on his antihypertensive treatment. He has a history of stroke and longstanding uncontrolled hypertension. 6 blood pressure recordings at home and at his surgery within the past 2 weeks were 188-216/103-112

mmHg. His therapy compnsed ramipnl, atenolol and amlodipine (see lab results).

Test Result Normal Values

Sodium 138 1 34-146 mmol/L

Potassium 2.9 3.5-5.1 mmol/L

Urea 8 2.75-7.4 mmol/L

Creabnine 88 44-115 pmol/L

Which of the following is most likely contributing to the treatment failure?

A 34-year-oid multiparous woman presents to the Maternal Health Clinic at 28 weeks' gestation with coughing and difficulty in breathing. She appeared restless and uncomfortable. Auscultation of the lung fields shows bilateral rhonchi The nafl beds and oral mucous membranes appear pale She is allergic to dust, pollen, mold and animal hair. There is no history of smoking She reports that the symptoms began 2 days prior and had started with coughing up clear-colored phlegm.

Blood pressure 124/72 mmHg

Heart rate 120 /mln

Respiratory rate 24 /mm

Temperature 37.5º C oral

Which of the following tests Is initially most approphate?

A patient is seen at 8 weeks* gestation in an Antenatal Clinic with a diagnosis of cervical incompetence.

Which of the following is the most appropoate management?

A 91-yearAd man with poor performance status, dementia, and multiple medical problems who has been diagnosed with an adenocarcinoma of an unknown primary site and has upper abdominal lymphadenopathy, liver lesions, and pulmonary nodules

Which of the following Is the most appropriate management?

A 25-year-oid woman is 10 days postpartum and breastfeeding on demand For 48 hours before presentation to the clinic, she has had episodes of chills with feeling weak and tired. Physical examination revealed redness of the left breast and tenderness and excoriation of the areola. A left breast tender, mobile 3 cm dominant lump was found in the upper outer quadrant on palpation and left axillary lymphadenopathy was present (see lab results)

Blood pressure 110/70 mmHg

Heart rate 115 /min

Respiratory rate 20 /min

Temperature 39.0º C

Test Result Normal Values

 Hb 115 120-160 g/L

WBC 14 4.5-10.5 x 109/L

Neutrophils 80 40-60%

Band cells 7 3-5%

Basophils 1 0 5-1 %

Eosinophils 1 1-4%

Lymphocytes 50 20-40 %

 Monocytes 2 2-8 %

Which of the following is the most likely diagnosis?

A 50-year-old woman presented with amenorrhea for the last 6 months and has unwanted hot flushes disturbing her night sleep.

Which of the following serum levels would confirm the diagnosis?

A 37-year-oid woman G8 P7017 at 36 weeks' gestation has history of recurrent postpartum that required blood transfuston. She has no significant medical problem.

Which of the following is the most appropnate preventive measure at delivery?

A 30-year-oid woman with left-sided ulcerative colitis presented to Emergency Room with 7-8 bloody diarrhoea 'day associated with low-grade fever, abdominal pain and joint pam at her knees. On examination, she looks III and In pain. All stool cultures were negative Blood pressure 90/70 mmHg

Heart rate 120 'min

Respiratory rate 18/min

Temperature 37.3 °C

Oxygen saturation 95 %

Test Result Normal Values Hb 9 130-170 g/L (Male)

120-160 gl (Female) Platelets count 456 150-400 x 109/L WBC 10 4 5-10.5 x 109/L ESR 122 2-10 mnVh (Male)

3-15 mm/h (Female)

After fluid resusatation what is the best next step in management?

A 40-year-old sexually active patient presents for cervical cancer screening. Physical examination is unremarkable, menstruation is regular with a 28-day cycle and last menstrual period was 5 days ago.

Which of the following Is the best advice about Pap smear?

A 28-year-oid healthy woman presents to her gynecologist with history of inability to concerve after 2 years of trying. Menarche at 13-year-oW, regular cycles every 36-40 days and 5-day periods. Not on any medications. Semenanalysis of husband showed normospermia Cervical component examination is required. The basal body temperature showed a monophasic pattern

Which of the following is the most probable cause of the infertility?

A 28-year-oid man who was previously healthy, presented to the Emergency Department with 5- days history of right upper quadrant abdominal pain, wh ch was associated with nausea and 2 episodes of vomiting. 2 days later, his family noticed yellowsh discolouration of his eyes and skin. No history of alcohol or drug use. On examinaton, he was jaundiced. Abdominal exam showed tender right upper atxiomen (see lab results).

Test Result Normal Values

Alkaline phosphatase

109 39-117 IU/L

Alanine aminotransferase 990 5-40 IU/L

Aspartate aminotransferase 789 12-40 IU/L

Which of the following is the most appropriate next step in diagnosis?

A 37-year-old pnmigravida presented to the clinic with amenorrhea for 12 weeks, hyperemesis gravidarum, and raised human chorionic gonadotropin levels. Uterus size is equivalent to 16 weeks' gestation (see report).

Ultrasound:

Fetus is small for dates.

Which of the following is the most likely diagnosis?

A 75-year-old man with difficulty walking and left-sided leg weaknesses due to osteoarthritis of the hip.

In which hand should a cane be used by this patient?

A 39-year-old man presents with shortness of breath for 2 weeks. The symptoms associated with activity and relieved by rest He is otherwise healthy, takes no medications and denies chest pain or pressure.

Which of the following is the most likely diagnosis?

A 25-year-old woman has delivered a boy On inspection of the umbilical cord, a single artery was noticed.

Which of the following is associated with the above finding?

A 30-year-oid woman presents to the Maternal Health Clinic with the inability to conceive despite Irying for the past 18 months Patient menstrual cycles were regular until 2 years ago, and since then she has had irregular vaginal bleeding, there is hair covering the upper lip and chin. A pelvic examination confirms bilaterally enlarged ovaries. DHEA and 17-OH progesterone values are normal.

Body mass index 30 kg/m2

Which of the following laboratory values is most likely finding?

A 50-year-old man presents with 3-months history of jaundice, arlhralgia, Increase in skin pigmentation, and upper abdominal discomfort. He is on oral hypoglycemic medications for recently diagnosed diabetes mellitus. His viral hepatitis screening was negative. Examination revealed a bronze coloured skin, enlarged liver with span of 15 cm. no splenomegaly, and testicular atrophy. Cardiac examination revealed a 3rd heart sound (see lab results). Test Result Notmal Values

Direct bilirubin 24 1.5-6.5 pmol/L

Total bilirubin 31 3.5-16.5 pmol/L

Aspartate aminotransferase 79 12-40IU/L

Alanine aminotransferase 112 5-40IUZL

Alkaline phosphatase 109 39-117 IU/L

Random Glucose 7 3.9-5 5 mmol/L

Ferritin 400 20-300 pg/l (Male)

20-120 pg/L (Female)

Which of the following investigations is the most appropriate next step?

A 59-year-o!d man has unsteady gait. On examination, he has decreased proprioception in the lower limbs with positive planter reflexes (positive Bab<nski) and absent ankle and knee's reflexes He has anemia Peripheral smear done (see image)

Which of the following is the most likely diagnosis?

A 22-year-oid pnmigravida presented at 38 weeks' gestation m labor. Vaginal exammabon showed 7cm dilated cervix, full effacement and vertex. An hour later the obstetrician noticed a loop of the umbilical cord below the fetal head.

Foetal Heart Rate 120 beat/min

Which of the following is the most appropriate immediate management?

A 34-year-oid gravida 2 para 1 woman 10 weeks gestation known to have a hypertension taking labetalol 100 milligrams twice per day In her first pregnancy had no complications and resulted in a healthy infant

During this pregnancy which of the following risks is increased?

A 25-year-old woman was brought to the Emergency Department 7 weeks after her last mensUuation with positive pregnancy test. Abdominal and transvaginal ultrasound showed no intrauterine pregnancy sac. She has lower abdominal pain, mostly on the left side and mild vaginal bleeding.

Which of the following is the most probable diagnosis?

A 31-year-old patient came to Emergency Room with 1-day history of melena and dizziness He has no significant medical history and takes no medications apart from ibuprofen for dental pain for 5 days. Examination revealed cold extremities, and faint peripheral pulses. Per-rectal examination repealed maroon coloured stool (see lab results).

Blood pressure 90760 mmHg

Heart rate 120 'min

Respiratory rate 18/min

Temperature 36.6 °C

Oxygen saturation 95 %

Test Result Normal Values

RBC 4.3 4.7-6 1 X 10124. (Male) 42-5.4 X 1012/L (Female)

Hb8 7 130-170 g/L (Male)

120-160 g/L (Female)

Platelets count 343 150-400 x 109/L

WBC 8 4.5-10.5 x 109/L

Which of the following is the most appropriate next step in the management?

A 22-year-otd woman attends the Women's Health Clinic for a postnatal examination. She delivered a full-term baby boy 6 weeks earlier and the infant is exclusively breastfeeding and shows a good latch and wei^it gain. She would like to have more children, but not within the next 2 years. She does not sm<Ae cigarettes and not at risk for heart disease. She inquired about birth control methods.

Which of the following methoOs is most appropriate?

A 25-year-old woman complains of velvety, hyperpigmented plaques on her neck and axillae She fails to conceive over the last 2 years despite regular intercourse. Her menses are irregular and occurring once every 6 to 8 weeks. She starts recently to experience increased facial hairs.

What is the appropriate term of her skin hyperpigmentation?

A 14-year-old child presented to the clinic after being sexually abused 6 hours eartier. Genital examination confirmed anogenital erythema and mild bleeding vaginally, and labia majora was swollen and bruised.

Blood pressure 120/70 mmHg

Heart rate 90 /min

Respiratory rate 20 /min

Temperature 36.6“ C

What is the most likely site of hymeneal tear thai is suggestive of penile penetration?

A 38-year-oid woman has fever and headache for 2 days. On examination, she has a scattered petichlae over her body. Peripheral smear done (see image and lab results).

Temperature 38.6 °C

Test Result Normal Values Hb 112 130-170 g/L (Male)

120-160 g'L (Female)

Reticulocyte 5.6 0.2-12 %

Platelets count 32 150-400 x 109/L

Indirect bdirubin 48 3.2-12 1 pmol/L

Total bilirubin 76 3.5-16 5 pmol/L

Lactate dehydrogenase 690 60-160

 lU'L APTT 33 30-40 sec INR 1.0 0.8-1.2

Prothrombin time 10 10-13 sec

Which of the following is the most appropriate treatment?

A 32-year-oid woman 16 weeks pregnant presents to the clinic with vaginal bleeding, abdominal enlargement and vomiting for the past 4 days. On examination, the uterine size is larger than expected for the gestational age (see lab result and report). Test Result Normal Value

Human chorionic gonadotropin 80.000 < 5 mIU/mL

Ultrasound

"Snowstorm-like’ appearance.

Which of the following is the most likely diagnosis?

A 59-year-otd woman comes to the clinic with headache, dyspnea on exertion and occasional palpitations (see lab reults).

Test Result Normal Values

Hb 95 130-170 g/L (Male)

120-160 g/L (Female)

MCV 68 80-95 fl

Platelets count 530 150-400 x 109/L

Total iron binding capacity 28 11.6-31.3 pmol/L (Male)

9-30.4 pmol/L (Female)

Ferritin 3 20-300 pg/L (Male)

20-120 pg'L (Female)

Apart from starting iron supplement

which of the following is the most appropriate next step in

management?

A 14-year-oia girl has a 6-month history of lower mid-abdominal pain colicky in nature, radiates to the back and upper thighs. It often begins with onset of menses which lasts for 2-4 days. She has missed several days of school during the last 2 months because the severity of pain. Physical examination is normal for abdomen and pelvis. Normal secondary sexual development is also noted

Which of the following is the first step in management?

A 63-year-oid man has diromc lymphocytic leukemia started on chemotherapy. His initial lynmphocyte count was 73.000. 2 days after chemotherapy, he presents with fatigue and dry mouth (see lab results).

Test Result Normal Values

WBC 5.7 4.5-10.5 x 109/L

Lymphocytes 60 20-40 %

Potassium 5.5 3.5-5.1 mmol/L

Phosphate, inorganic 1 48 082-1 51 mmol/L

Creatinine 139 44-115 pmol/L

Uric acid 620 200-410 pmol/L (Male)

140-360 pmol/L (Female)

Whih of the following electrolyte abnormality is associated with the above condition?

A 48-year-oid asymptomatic woman attended the Gynaecology Clinic for her Pap smear screening. During pelvic examination, pelvic mass was felt, further assessment by transvaginal ultrasonography indicated the presence of solitary uterine fibroid on the uterine fundus measuring 5x6 cm.

Which of the following is the most appropriate management?

A 22-year-old pnmigravlda at 7 weeks' gestation is brought to Emergency Department complaining of moderate vaginal bleeding with passage of tissue like material and lower abdominal colicky pain. Speculum examination; tissue is in the vagina, uterine cervix is opened and admitting one finger. Product of conception is protruding through cervical canal Bimanual examination reveals bulky uterus corresponding to seven-eght weeks gestation. Adnexa were free and there was no cervical excitation.

Which of the following is the most likely diagnosis?

An 82-year-old woman at long term nursing facility who wears hearing aids and is found to have bilateral cerumen impaction, a Weber test that lateralizes to the right and a bilaterally positive Rinne test.

Which of the following is the most likely explanation?

A 42-year-oid obese woman presented with a 5-year history of irregular vaginal bleeding. Thyroid studies are normal. She noticed thal her irregular m menstruation has started to put on

weight (see report).

Body mass index 35 kg/m2

Endometrial Biopsy:

Adenomatous hyperplasia

Which of the following is the most likely cause?

A 64-year-old man presents to the clinic after having first episode of right knee pain for 2 weeks duration. He asks for a medicine to relieve his pain. He does not have any other symptoms apart from epigastric burning. He has no history of injury to the knee Examination of knee is normal

Which is the most appropriate analgesic for this patient at this stage?

A 42-year-dd obese nulligravida patient with polycystic ovary syndrome has had irregular vaginal bleeding since menarche She has used no medication to control her periods (see lab results and report).

Test Result Normal Values

Cortsol 8 a m. 335 138-635 nmol/L

Estrogen 630 90-550 pmol/L

Follide-stimulating hormone 38 5-20 IU/L

Testosterone 3.1 0.7-2 8 nmoVL

Prolactin 590 < 870 pmol/L

T3 (Total serum} 1 2 0 9-2.8 nmol/L

Thyroxine (T4 Total serum) 82 64-155 nmoi/L

Thyroid-Stimulating Hormone 4.5 0.4 - 5.0 pU/L

Endometrial Biopsy:

Adenomatous hyperplasia.

Which of the following is the most likely cause of the adenomatous hyperplasia?

A son of 78-year-old patient brought a medical report of his father cognitive function status stating that he has” mild cognitive impairment”.

Which of the following is indicating mW cognitive impairment?

A hemodynamically stable woman has a tubal, ectopic pregnancy measuring 2.5x3 cm by ultrasound (see lab result).

Test Result Normal Value

Human chorionic gonadotropin N 5000 < 5 mIU.'mL

Which of the following is the most appropriate treatment?

A 31-year-oid woman P2 presented to the Women’s Health Clinic for a routine physical examination She has presented to routine health examinations annually foe the last 5 years Records indicate that in the previous year, she has negative tests for both the human papilloma virus and the papanicolaou cervical smear. This year both tests are with no abnormal findings.

 When should the tests be repeated?

In which conditions circumcision should be avoid?

A 48-year-old man develops right popliteal vein thrombosis post-sleeve surgery. He Is started on enoxaparin and warfarin.

What is the target therapeutic international normalization ratio range for this patient?

A 38-year-old man has episodic chest pain. He states that the pain feels like tightness, located right behind his sternum, lasts less than 3 minutes and is relieved with rest. He takes no medications. He has no family history of coronary disease and has never smoked. His ECG in the otfice is normal.

What is the most appropriate test to exclude cardiac ischemia?

A 45-year-old woman who has had last normal pregnancies 15 years ago presents with amenorrhea for 7 months duration Pregnancy test is negative. She expresses her desire to become pregnant again.

Which of the following is most appropnate investigation?

A 26-year-osd married woman presents to Endocnnology-Gynecdogy dinlc for a follow-up of her investigation resuhs. Accordingly, a polycystic ovarian syndrome is made. She is counseled about plan of management and metformin use in her condition.

What does metformin do in the above condition?

A gravida 2 para 0 woman presents to the Maternal Health Clinic reporting that she has not menstruated for the past 2 months The previous pregnancy had resulted In a stillbirth at 34 weeks' gestation. A human chorionic gonadotropin test is now positive She has been irying to

conceive for lhe past 6 months She is afraid of having another stillbirth and asks to be vaccinated against everything.

Which of the following vaccines is most appropriate to administer?

A 30-year-old woman G2 P1002 admitted at 40 weeks' gestation with onset of laDor and ruptured membranes. Her cervix was 5 cm dilated and 100% effaced with 0 station vertex for 3 hours. A fetal monitoring strip showed 2 contractions in 10 minutes with a reassured non-stress test.

Which of the following is the most appropriate management?

A 60-year-old man admitted to the Emergency Room with Kay history of hematemesis. He has multiple spider angiomata on his chest wrth bilateral gynecomastia. Abdominal examination showed splenomegaly (see lab results).

Blood pressure 100/60 mmHg

Heart rate 100 'min

Respiratory rate 18/min

Temperature 36.6 "C

Oxygen saturaton 95 %

Test Result Normal Values

Hb8.5 130-170 g/L (Male)

120-160 gfL (Female)

HCT 0.23 0.42-0.52 (Male)

0.37-0.48 (Female)

Which of the following l$ the most appropfiate next step In management after the initial fluid resuscitation?