1. A 3-year-old child presents with history of increasing eye puffiness for 1 week especially in the morning. He has had flu-like illness 2 week ago. On examination, he looks well, not m distress and no lower limb edema. Eye. chest and abdomen exams are normal (see lab results).
Blood pressure 110/70 mmHg
Heart rate 76 /min
Respiratory rate 18/min
Temperature 36.6 "C
Oxygen saturation 95 %
Test Result Normal Values
Color Clear clear or light yellow
Specific gravity 1010 1001-1030
Protein ++++ Absent Glucose

Absent Absent
Ketones Absent Absent
Nitrite Absent Absent
Hemoglobin Absent Absent
Leukocytes 0 0-3 per high power field
Erythrocytes 0 0-2 per high power field
Which of the following has highest diagnostic value?

2. A 70-year-old man presents with resistant hypertension despite treatment with 3 antihypertensive agents. Physical examination is unremarkable. Renal ultrasound demonstrates asymmetrical kidneys. What is the most likely diagnosis?

3. A patient complaining of severe uncontrolled HTN, “Venography” not sure”, showed Left renal artery stenosis, the next step is to?

4. 15-month-old baby boy has a colony of 100,000 of Klebsiella pneumoniae in mid-stream urine that’s it no symptoms mentioned in the questions) What to do next?

5. midstream urine culture show klebsiella pneumonia

6. A 4-years-old boy presented with fever and low abdominal pain. Mother complains that his urine has a foul smell. UA: gram -ve bacteria >100,000. Which of the following could be the cause?

7. Pediatric known of having febrile seizures , had fever and mother started giving him paracetamol every 4 hours because she was scared of him having seizures, on examination he was jaundiced and had hepatomegaly ?

8. Girls ingest 50 tab of paracetamol with 500 mg each tab Come in (6) hrs in ER What will you do:

9. Pregnant has DVT and given heparin then she developed postpartum hemorrhage. What is the most appropriate management?

10. A young man presented with history of agitation, visual hallucination and Hypertension what is the toxicity?

11. Women known with depression ingested 50 tablet of aspirin came after 8h with nausea, abdominal pain, tinnitus. What is the management?

12. Pt pediatric ingested large amounts pf baby aspirin What is the Acid base disturbance will be?

13. old male patient came with his brother, brother complaining of change in personality , mild forgetful , MRI show cortical atrophy ?

14. Case of Parkinson disease which one is the following factors presents in patients who are high risk of developing dementia?

15. Which of the following SSRI drugs with the highest serotonin toxicity effect?

16. A 23-year-old woman presented with breast tenderness, abdominal bloating, and food cravings. She has a 6-month history of tiredness, anxiety, emotional lability, difficulty 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 resolved within the first 3 days of menses. The patient felt totally incapacitated when symptomatic, and the symptoms adversely affect her personal and professional life.
Which of the following is the best-evidenced treatment?

17. 7-year-old child who is reported to be hyperactive, restless, talks rapidly, and has violent outbursts, the most appropriate intervention to help mitigate these issues is?

18. A 3-year-old girl is seen in the clinic. The mother gives history of yelling, hitting and saying 'no' with other oppositional behaviours Which of the following is the most likely diagnosis?

19. An old man, presented to the clinic, worry, insomnia and decrees concentration. What’s your diagnosis?

20. A 62-year-old woman receives a diagnosis of pre-diabetes based on routine lab work showing mildly elevated glycated hemoglobin (HbA1c).
She has had obesity for many years She eats a diet rich in processed foods She rarely exercises Physical exam reveals mildly elevated blood pressure along with trace acanthuses nigricans at the nape of the neck. Blood Pressure 145/87 mmHg BMI 30 km2 What advice should be given to reduce her risk of developing diabetes, in addition to increasing her physical activity to >150 minutes per week?

21. Target of HA1C in diabetic patient ?

22. Which of the following Is the treatment goal for diabetic patients with coronary artery disease?

23. 43 male patients with a history of GERD for 10 years presenting with dysphagia for solids for 4 months. His BMI = 15.4 kg. What's the next step?

24. A 62-year man presents with a 3-month History of epigastric pain after eating and intermittent heartburn between meals. He has lost weight but does not have any nausea or vomiting. He has not noticed any change in bowel habit and has not passed any blood or melena stools. He has no past medical history. He quit smoking 2 years ago What is the most appropriate management strategy?

25. Q-Ulcerative colitis patient with y shape with very enlarged transverse colon and no haustrea ( Scenario of Toxic Megacolon )
Colon dilation on imaging 15 cm. Next appropriate Treatment ?
Q_ UC pt came with 4 days vomiting and bloody diarrhea and by X.ray found transverse colon is 15 cm what first manage you will
do ?

26. A young woman who is known to have pan ulcerative colitis is admitted for a severe relapse Since there was no response to medical treatment, surgery is decided The patient is very sceptical about surgery and requested more information.
What is the appropriate way to address her concerns?

27. 16 year old came to ER after vomiting once with blood , she had recurrent nausea and vomiting. before her period in the last time there was slight blood with vomiting , after 4-6 hours ,all labs and exams are normal what you should so?

28. Patient with history of peptic ulcer and +ve urea breath test. You started and finished the treatment course. When you can re-examine the urea breath test?

29. A 36-year-man has just completed a 2-week course of Helicobacter pylori therapy for dyspepsia He has stopped his eradication therapy today and he wants to repeat the test How soon can the test be re-performed to test for eradication?

30. -In 60s woman was recently treated for UTI , at first began to recover, 10 days following the completion of a course of oral penicillin. She develops a rash, fevers, hematuria and proteinuria, most likely diagnosis?

37. A pregnant woman at 32 weeks' gestation is brought to the Emergency Room with vaginal bleeding and abdominal pain. On examination: Fundal height equals 30 weeks, and the abdomen is tense. Cardiotocography revealed fetal tachycardia, reduced variability, and late decelerations. Which of the following is the most likely diagnosis?

38. A 22-year man presented with 6-month history of non-bloody diarrhoea, recurrent abdominal cramps and weight loss On examination, he looked pale with oral ulcers. Abdominal examination showed tender right lower quadrant
Blood pressure 110/70 mmHg Heart rate 100 ’min Temperature 38.1 °C
Which of the following is the most likely diagnosis?

39. Patient presented with infrequent anal bleeding did a colonoscopy that revealed one polyp size 1.5cm and a biopsy showed tubular adenoma 1.2 cm. Interval of screening?

40. A 54-year-old man presents for follow-up evaluation after diagnosed with type 2 diabetes mellitus 12 weeks ago He was managed with lifestyle modifications and he come back with blood glucose log for the past 2 weeks On physical examination, there is no evidence of diabetic retinopathy or peripheral neuropathy. Except for his blood glucose parameters, basic laboratory studies obtained at the time of her initial diagnosis were normal BM119 kg/m2 Initial test before lifestyle modifications: HbAIC 8.5% Blood glucose log for the past 2 weeks:
Test Result : preprandial blood glucose 150 to 160 mg/dL (8.3-8 9 mmol/L) 2-hour postprandial blood glucose 190 to 200 mg/dL (10 5-11.1mmol/L)
In addition to lifestyle modifications, which of the following is the most appropriate initial management?

42. In the management of preeclampsia, which drugs are given to prevent convulsions?

46. Blood pressure 164/92 mmHg. Heart rate 130 ‘minRespiratory rate 18/min Temperature 37 “C Which of the following Is the next best step in management

48. A woman after delivery developed uterine inversion and was returned. Which placental location increases the risk of this condition?

50. A pregnant woman develops pruritic symptoms but has no history of contact with infected people and no autoimmune disease. Diagnosis?

51. A 32-year-old diabetic woman who has taken contraceptive pills for 12 years develops right upper quadrant pain (see report). CT scan reveals a 5-cm hypo-dense lesion in the right lobe of the liver. What is the most appropriate next step in management?

52. A 30-year-old female smoker on OCPs for 6 years undergoes ovarian cystectomy and during the surgery develops hypotension, tachycardia, and hypoxia. What is the diagnosis?

64. A 50-year-old female diagnosed with stress incontinence, asking about definitive management?

67. 15-year-old girl with sparse pubic hair not reaching the mons pubis, breast budding with areolar enlargement, no clear distinction between breast and areola. Tanner stage?

68. Child in the clinic with pubic hair increasing towards adult, dark scrotum. Tanner stage?

69. 17-year-old female, no menstruation, high testosterone, normal breast development, coarse pubic hair. Diagnosis?

70. A 39-year-old woman presented with menorrhagia. Pelvic ultrasound confirms the presence of a uterine fibroid. What is the most likely location of this fibroid?

71. Which of the following is the most common degenerative changes of leiomyoma during pregnancy?

72. A patient with hyperthyroidism for 10 months treated with anti-hyperthyroidism drugs but with no improvement. Ultrasound shows multinodular goiter, and it is diagnosed as Graves' disease. What is the best next step?

74. patient with a high BMI wants to get pregnant. What is the recommended course of action?

75. Post-coital bleeding with scanty bleeding. What is the most appropriate next step?

76. A 48-year-old female presents with heavy vaginal bleeding. Ultrasound reveals clots in the uterus, the endometrium measuring 13mm with two 1mm lesions. Endometrial sampling was negative. What is the next step?

77. Which of the following is the physiological cause of iron loss?

78. A 28-year-old female with a history of recurrent pregnancy loss wants to improve her immunity before trying to conceive. What should you give her?

79. A woman had a C-section. What is the best way to prevent adhesions?

80. A 27-year-old woman presented to the Emergency Room with right lower abdominal pain for 1 day and vomiting. The Emergency Room physician requested a CT scan of the abdomen. Which of the following is the most important information to know?

81. 27-year-old woman presented to the Emergency Room with right lower abdominal pain for one day and vomiting. The Emergency Room physician requested a CT scan of the abdomen. Which of the following is the most important information to know?

82. A 40-year-old female, Para 4, with a history of tubal ligation four years ago after her last cesarean section delivery. Her last menstrual period was six weeks ago. She presented to the ER with

vaginal spotting and no abdominal pain. On examination, the OS is closed, and there is tenderness and fullness in her abdomen in the right lower quadrant. What is the best initial investigation?

83. Young patient with Pap smear showing high-grade squamous intraepithelial lesion, biopsy showing carcinoma in situ, wants to conserve fertility.

84. At 8 weeks GA, a woman is diagnosed with cervical incompetence. What should be done?

85. Pregnant with vaginal bleeding, suspect cervical lesion. How to confirm diagnosis?

86. At 8 weeks pregnant, a woman is diagnosed with cervical incompetence and has a history of previous fetal passage at 28 weeks. What is the most appropriate management?

97. A female is hypertensive and diabetic, on ACE inhibitors (ACEI), insulin, and Metformin. She has decided to get pregnant soon. Her labs show heavy proteinuria, and her HbA1c is 8. What's your most appropriate advice for her regarding diabetic control and fetal congenital malformations?

100. A 17-year-old female, complaining of primary dysmenorrhea with severe pain affecting her life and school attendance. She was on NSAIDs and the pain became less severe, allowing her to attend school and perform daily activities. What is the most appropriate next step?

101. Patient with severe abdominal pain coinciding with the menstrual cycle (dysmenorrhea), affecting her work. What can you prescribe?

104. In the case of an ectopic pregnancy with a size less than 3.5 cm and β-HCG at 2500, how will you manage it?

107. 22-year-oid woman who is 6 weeks of amenorrhoea presented with vaginal bleeding, severe lower abdominal pain and shoulder pain On examination, she had tachycardia with low blood pressure, and her abdomen was distended with guarding and rebound tenderness. Pelvic examination revealed cervical motion tenderness. Pregnancy test is positive and an ultrasound showed no intrauterine pregnancy. What is the most appropriate next step in management?

108. Female with mild to moderate dysmenorrhea and dyspareunia, three children, completed her family, diagnosed with endometriosis. What is the definitive treatment of endometriosis, after the failure of all treatments?

109. 39-year-old female, three children, completed her family, diagnosed with endometrioma, mild to moderate dysmenorrhea, and dyspareunia. Pelvic ultrasound shows a left ovary endometrioma cyst 6x7 in size. What is the most appropriate treatment?

110. 32-year-old woman with diffuse pelvic pain, vaginal bleeding, pain with defecation, dyspareunia, history of dysmenorrhea. Trying to conceive for years but failed. Pelvic examination shows blood in the posterior vaginal vault, a closed os, and no palpable masses or cervical motion tenderness. Most likely diagnosis?

113. Female presented with recurrent vaginal bleeding, history of cesarean section a week ago, temperature 38°C, other labs within normal. What is the suspected diagnosis?

115. woman presents to the Emergency Department 15 days after giving birth by cesarean section. She complains of persistent vaginal bleeding, blood pressure 110/70 mmHg, heart rate 85/min, temperature 38.1 °C. What is the most likely diagnosis?

117. 24-year-old patient with high FSH, LH, normal GTH, and amenorrhea for 9 months. Diagnosis?

29-year-old female with menarche at 15, high LH and FSH, LMP 9 months ago, negative pregnancy test. Diagnosis?

118. A pregnant woman came to the ER at 18 weeks, comes with bleeding, cervix is open, and some products passed out, now severe bleeding. What is the management

119. A pregnant woman at 15 weeks of gestation came with severe bleeding, and components seen in the cervix. What is the most appropriate next management

120. Pregnant at 37 weeks with intrauterine fetal demise, feeling guilty because she smokes 5 cigarettes/day, what to tell her

121. A patient at 8 weeks gestation, presenting to the ED with vaginal bleeding and abdominal pain, her cervical OS is open, and tissue can be seen within the cervical os. What is your diagnosis

122. A pregnant woman with a previous spontaneous abortion is asking about the percentage of abortion happening in the next pregnancy?

123. Pregnant at 5 weeks gestation with heavy bleeding and clots, she has a history of 5 previous abortions, all her previous abortions were at 2nd trimester, and she had multiple D&C. What causes her current bleeding

125. 19 year old lady with history of 3 of 1st trimester loss, PTT eleveated, Anticardiolipin elevated, what is the diagnosis?

126. Patient with symptoms and signs of Bacterial vaginosis. What will the sample analysis show?

127. A 26-year-old nulliparous patient presented with vaginal itching and increased discharge, diagnosed with a positive pregnancy test 3 months ago. Yellow-white discharge, inflamed labia with scratch marks, fishy smell, pH 4.8. Treatment?

128. Patients with symptoms of Bacterial Vaginitis. What's the test? Gram stain. What vaginal infection can cause cervical incompetency?

129. Diagnosis from an exam picture with fishy smell secretion?

130. A 32-year-old woman with smelly vaginal discharge and intense itching, husband with slight urethral discharge. Strawberry spots on the cervix observed. Appropriate treatment?

131. Diagnosis from a female patient with dysuria, vaginal discharge, strawberry cervix, and high Polymorphonuclear leukocytes under oil immersion analysis?

133. When should married women start to have Pap smear screening?

134. 27-year-old female for follow-up, asymptomatic, last Pap smear 3 years ago showed unconcerned squamous cells. What to do?

136. Female with cervical lesion measuring 11mmx12mm, irregular borders, Pap results pending. What to do?

137. Pap test showing high-grade squamous intraepithelial lesion. Next step?

138. A 24-year-oid man presented with 2-month of bloody diarrhoea He passes 3-4 loose motions /day associated with blood and mucus He gave history of left lower quadrant pain No fever or weight loss. He underwent sigmoidoscopy, which showed loss of normal vascular pattern with

erosions up to splenic flexure (see lab results)

Test Result Normal Values

4.7-6.1 x 1012/L (Male)

4.2-5.4x1012๕ (Female)

Hb 10.9 130-170 g/L (Male)

120-160 g/L (Female)

Platelets count 488 150-400 x 109/L

WBC 6 4.5-10.5 x 109/L

ESR 32 2-10 mnVh (Male)

3-15 mm/h (Female)

Consistency LIQUID (soft or tight)

Color YELLOW Brown

Mucus and blood *♦ absent

Leukocytes +++ solitary

Which of the following is the best treatment option?

139. A 60-year-old man with chronic history of heart bum for several years, presented with occasional

hematemesis. Upper Gl endoscopy revealed intestinal-type metaplasia at the distal oesophagus.

Which of the following Is the most likely diagnosis?

140. What indicates a doctors’ respect of a patients’ autonomy

141. 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?

142. 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?

143. 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?

144. 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?

145. 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?

146. 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?

147. 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?

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

149. 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?

150. 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?

151. 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?

152. 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?

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

154. 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

155. 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.

156. 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?

157. 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?

158. 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?

159. 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?

160. 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?

161. 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?

162. 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?

163. 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?

164. 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?

165. 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?

166. 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?

167. 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?

168. 7 years old baby with sign of meningitis on CSF analysis you found gram positive diplococcai what is treatment? 

169. child 4 years old with sign of meningitis what is organisms

170. pediatric case of meningitis G penicilline was given to him. His parents are concerned about his brother because he was in contact with him. what to do to the brother? 

171. A 36-year-old man comes to the emergency department with weakness of both legs and acute painful loss of vision in the left eye. On examination, there is hyperreflexia, increase tone and reduced power in both lower limbs. This is consistent with upper motor neurone lesion He is vitally stable. Demyelination of nerves was found on Brain MRI best next step ?

172. a lady came with Sign and symptom of optic neuritis left leg weakness and left arm weakness, best modality to diagnose ?

173. A 20 years old Female, came with sudden visual impairment and unsteady gait, speech not affected, MRI showed demyelinating lesions peri-ventricular, diagnosis?

174. Mean Arterial Pressure is 55 , intracranial pressure 15. What's the cerebral perfusion pressure?

175. A 77-year-old man with a 7-year history of Parkinson's disease reports hallucinations, confusion, and worsening motor function. On physical examination, he is akinetic and rigid with no tremor. He has a prominent gait disorder and postural instability. Which of the following symptoms is most strongly associated with an increased risk for dementia?

176. patient diagnosed with parkinsonism, her only complain is right hand tremor that disturbs her manual activities. What Best medication to use ?

177. Married 3 years ago with irregular menses and milk expressed manually .. next step:

178.  -patient complain of Erection, Thyroid hormone normal

179. Female came with white breast discharge and high prolactin, what radiology you will do?

180. A 15 months old child is brought to the emergency department after having a generalized tonic-clonic seizure that lasted approximately 5 minutes. The parents say that the child had been previously well but developed cough and rhinorrhea earlier that day with a temperature of 39.2 C. Which of the following is the most appropriate management?

181. A 5-year-old boy is brought to the Emergency Department after episode of convulsion that involved all limbs 1 hour ago. It continued for 3 minutes and associated with drooling and loss of consciousness. He had runny nose, mild cough and fever for last 3 days. On physical examination, he was fully active with mild congested throat. Blood pressure 120/80 mmlg Heart rate 98 /min Respiratory rate 22 /min Temperature 37.9°C Which of the following is the most appropriate treatment?

182. child starting brief seizure (less than 30 seconds) , EEG (generalized 3-Hz spike-and-wave activity.) what is Treatment?

183. A 69-year-old man presents to the clinic with increasing fatigue, drowsiness, and difficulty to arouse. He recently went on vacation two weeks ago and experienced multiple falls during this time. He denies any head injury.
Neurological examination shows no focal or lateralizing findings, and head and scalp examinations are negative for tenderness or deformity. Plain X-ray of the skull is normal. Here are the relevant lab results:
• RBC: 5.1 x 10^12/L (Male), 4.2-5.4 x 10^12/L (Female)
• Hb: 132 g/L (Male), 120-160 g/L (Female)
• HCT: 0.40 (Male), 0.37-0.48 (Female)
• MCH: 30 pg/cell (Normal Range: 28-33 pg/cell)
• MCHC: 322 g/L Normal Range: 320-360 g/L)
• MCV: 88 fl (Normal Range: 80-95 fl)
• Reticulocyte: 0.9% (Normal Range: 0.2-1.2%)
• Platelet count: 200 x 10^9/L. (Normal Range: 150-400 x 10^9/L)
• WBC: 5.5 x 10^9/L (Normal Range: 4.5-10.5 x 10^9/L)
• Neutrophils: 50% (Normal Range: 40-60%)
• Eosinophils: 2% (Normal Range: 1-4%)
• Basophils: 0.8%
• Lymphocytes: 32%
• Monocytes: 4.1%
• Calcium: 2.3 mmol/L
• Ionized calcium: 1.2 mmol/L
• Magnesium: 0.8 mmol/L
• Thyroid-Stimulating Hormone: 4.4 pU/mL
• Thyroxine (T4 free serum): 12 pmol/L
• Sodium: 136 mmol/L
• Potassium: 4.2 mmol/L
Based on this information, which of the following is the most likely diagnosis?

184. A 70-year-old man complains of a sudden severe headache while Bending down to pick up his keys this morning He describes it as the worst headache he has ever had; he says it was like being hit on the back of the neck Which of the following is the most likely diagnosis

185. A 31-year-old man was involved in road traffic accident; examination revealed he is fully oriented GCS15/15 before reaching the hospital paramedic reported interval unresponsiveness. The patient suddenly lost consciousness and dilatation of left pupil was noted (see report). X-ray of the skull: Left temporal fracture. Which is the following most likely diagnosis?

186. PT complaining of dizziness after waking up, hot warm and flushes Watery diarrhea , itching On examination Abdomen examination normal Respiratory exam reveal wheezing Cardiac exam (murmur maybe) I’m not sure but there is finding What you will order ?

187. girl has been brought to the Gastroenterology Clinic by her parents due to the observation of fine hand tremors. Further examination revealed jaundice and a palpable spleen. The following are her lab results:
• Copper: 0.8 (Normal Values: 1.72-3.54 mmol/L for males, 1.72-3.76 mmol/L for females)
• Direct bilirubin: 22.32 (Normal Values: 1.5-6.5 pmol/L)
• Total bilirubin: 38.2 (Normal Values: 3.5-16.5 pmol/L)
• Aspartate aminotransferase: 243 (Normal Values: 12-40 IU/L)
• Alanine aminotransferase: 165 (Normal Values: 5-40 IU/L)
• Albumin: 23 (Normal Values: 34-56 g/L)
• Total Proteins: 46 (Normal Values: 60-84 g/L)
• Serum ceruloplasmin: Low
• 24 hours urine copper: High
Given this clinical and laboratory profile, what is the most appropriate treatment option?

188. A 56-year-old woman was exposed to chemical burns to her trunk. on arrival to the Emergency Department, she was conscious and alert. Examination showed 5 cm x 11 cm wound at her back with burned clothes and powder of chemicals on her clothes and skin
Which of the following is most appropriate next step after removing her clothes?

189. child with pica, hepatosplenomegally and failure to thrive. Coming from a low socioeconomic economic status family. HGB low Lead - 2 high PT normal PTT normal INR normal Iron normal What’s the most appropriate treatment?

190. What is electrolytes testing present with Osmotic gap of stool vibrio cholera ?

191. Q -An 8 year old girl with persistent and continuous diarrhea, she drinks 3 [pints of goat milk per day and is a fussy eater. Which of the following conditions explain her presentation? Labs: Hb Low, MCV High and MCHC High
Q- Child with a long history of watery diarrhea ( foul-smelling stool) abdominal bloating and pain, what’s the Diagnosis ?

192. Pediatric patient with shigella toxin positive

193. 10 month old child with 3 days fever, vomiting, corpus watery diarrhea, on exam lethargic, cold and pale, tachycardia and mild tachypnea, which of the following will diagnose the case?

194. Q-Female patient complaining of back pain increase when she walking downstairs?
Q_ Another recall : 60 s male present to opd with Pain in the lower limbs that Started after walking 50 meters Pain aggravated when pt walk In down slop (opposite of incline) spine and neuro exam normal distal pulse patent diagnosis?

195. doctor ask patient to face wall lean bend forward and let his arm unsupported, examining what?
Q- Another recall : Doctor asked a child to face the wall bend and hang loose the hands unsupported What is this screening for ?

196. Q—Hip pain in elderly, x ray showing osteophytes and narrowing
Q-Another recall : Old lady with hip pain, increases with walking

197. 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?

198. 66 yo Patient has a history of polyarthralgia with pain in distal and proximal interphalangeal , no hx of morning stiffness + medically free no active arthritis ?

199. Cause of psoriasis (pathophysiology)

200. Female with vaginal lesion And you suspected psoriasis. What is the most definitive way for diagnosis:

201. 47 was diagnosed as gout before and on allopurinol but didn't improve he still complaining of big toe pain attacks.. and ankle and bilateral knee pain. Then they repeated he suffering from big toe pain. In his history they mention he has psoriasis Labs uric acid was 450 Esr was high Asking about dx?

202. Female pt present with her family to routine clinic Pt looks to up all of the time and When dr asked her told this my mother and no body can see her except me..
her family said her mom was dead when she was a child Ask about What this abnormality?

203. Q-19 year old male attempts that the TV show presenter is trying to steel his thought, he stated to his mother that he believes in super power and they are controlling him, The likely diagnosis is:
Q-Man cover the tv bc he think it can see him and it is manipulated by other :

204. A 23-year-old woman complains of a 4-month history of abdominal discomfort with alternating bowel habits. She recently gave a history of bloating, passing mucus with stool, and noticed an increase in bowel motions (3-4 times a day). The abdominal pain is relieved by defecation, and there are no nocturnal symptoms. She has no weight loss or fever. She is concerned about a serious diagnosis because her uncle was diagnosed with colon cancer at the age of 60. The clinical examination is unremarkable (see lab results).
• RBC: 3.7 (Normal Range: 4.2-5.4 x 10^12/L Female) Hemoglobin (Hb): 11 (Normal Range: 120-160 g/dL Female)
• Platelet count: 332 (Normal Range: 150-400 x 10^9/L) WBC: 5 (Normal Range: 4.5-10.5 x 10^9/L)
• ESR: 10 (Normal Range: 3-15 mm/h Female)
• Alanine aminotransferase: 34 (Normal Range: 5-40 IU/L)
• Aspartate aminotransferase: 23 (Normal Range: 12-40 IU/L)
• Amylase: 122 (Normal Range: 24-151 IU/L)
Which of the following is the most likely diagnosis?

205. A 34-year woman presents with a 4-week history of retrosternal Heartburn The pain Is often worse following eating. Her past medical history includes depression and she is on escitalopram 10 mg OD. Clinical examination is unremarkable. Which of the following is the most likely diagnosis?

206. A 13-year boy Is complaining of recurrent abdominal pain foe the last year. The pain takes about 5 to 7 days to Improve and It is usually associated Increased frequency of stooling In these occasions, his stool is watery and explosive No history of vomiting, constipation or blood passage. Irritable bowel syndrome is suspected Which of the following is the most appropriate in management?

207. A 2S-year-woman with Irritable bowel syndrome comes to the clinic complaining that loperamide and antispasmodic medication have not eased her symptoms. She has no new symptoms suggestive of any serious condition. Which of the following is the most appropriate treatment?

208. Q- case of esophageal varices to prevent future recurrence/bleeding?
Q- What is a long term treatment for Esophageal varices ?

209. A 32 years-old alcoholic male patient is brought to the emergency department with the history of vomiting large amount of bright red blood. Physical examination revealed splenomegaly and ascites. Which of the following is the most likely source of bleeding?

210. healthy 35-year-old adult male presented to the emergency room with a complaint of several episodes of hematemesis for the first time. He takes no medication, has no family history of similar attacks, and had a normal abdominal examination with no guarding or tenderness. Endoscopy was performed and revealed dilated esophageal blood vessels with some adherent clots. His hemoglobin (Hgb) is 9, platelet count (Plt) is 250, and alkaline phosphatase (Alk) is slightly decreased. All other tests were normal. What is the diagnosis?"